hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|CA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",general_contract_provisions,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Health Alliance Mary's Avenue Hospital,12/17/2024,2.1.0,"Health Alliance Mary's Avenue Hospital|Kingston, NY","105 Mary's Avenue, Kingston, NY 12401",5501000H,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,modifiers,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,standard_charge|discounted_cash|negotiated_percentage,standard_charge|discounted_cash|negotiated_algorithm,estimated_amount|discounted_cash,standard_charge|discounted_cash|methodology,additional_payer_notes|discounted_cash,standard_charge|Medicare_Advantage|negotiated_dollar,standard_charge|Medicare_Advantage|negotiated_percentage,standard_charge|Medicare_Advantage|negotiated_algorithm,estimated_amount|Medicare_Advantage,standard_charge|Medicare_Advantage|methodology,additional_payer_notes|Medicare_Advantage,standard_charge|Aetna|HMO_PPO|negotiated_dollar,standard_charge|Aetna|HMO_PPO|negotiated_percentage,standard_charge|Aetna|HMO_PPO|negotiated_algorithm,estimated_amount|Aetna|HMO_PPO,standard_charge|Aetna|HMO_PPO|methodology,additional_payer_notes|Aetna|HMO_PPO,standard_charge|Aetna|High_Performance_Network|negotiated_dollar,standard_charge|Aetna|High_Performance_Network|negotiated_percentage,standard_charge|Aetna|High_Performance_Network|negotiated_algorithm,estimated_amount|Aetna|High_Performance_Network,standard_charge|Aetna|High_Performance_Network|methodology,additional_payer_notes|Aetna|High_Performance_Network,standard_charge|Blue_Cross|HMO_PPO|negotiated_dollar,standard_charge|Blue_Cross|HMO_PPO|negotiated_percentage,standard_charge|Blue_Cross|HMO_PPO|negotiated_algorithm,estimated_amount|Blue_Cross|HMO_PPO,standard_charge|Blue_Cross|HMO_PPO|methodology,additional_payer_notes|Blue_Cross|HMO_PPO,standard_charge|Blue_Cross|Access|negotiated_dollar,standard_charge|Blue_Cross|Access|negotiated_percentage,standard_charge|Blue_Cross|Access|negotiated_algorithm,estimated_amount|Blue_Cross|Access,standard_charge|Blue_Cross|Access|methodology,additional_payer_notes|Blue_Cross|Access,standard_charge|Blue_Cross|Connection|negotiated_dollar,standard_charge|Blue_Cross|Connection|negotiated_percentage,standard_charge|Blue_Cross|Connection|negotiated_algorithm,estimated_amount|Blue_Cross|Connection,standard_charge|Blue_Cross|Connection|methodology,additional_payer_notes|Blue_Cross|Connection,standard_charge|CDPHP|HMO_Exchange|negotiated_dollar,standard_charge|CDPHP|HMO_Exchange|negotiated_percentage,standard_charge|CDPHP|HMO_Exchange|negotiated_algorithm,estimated_amount|CDPHP|HMO_Exchange,standard_charge|CDPHP|HMO_Exchange|methodology,additional_payer_notes|CDPHP|HMO_Exchange,standard_charge|Emblem|Exchange|negotiated_dollar,standard_charge|Emblem|Exchange|negotiated_percentage,standard_charge|Emblem|Exchange|negotiated_algorithm,estimated_amount|Emblem|Exchange,standard_charge|Emblem|Exchange|methodology,additional_payer_notes|Emblem|Exchange,standard_charge|Fidelis|Exchange|negotiated_dollar,standard_charge|Fidelis|Exchange|negotiated_percentage,standard_charge|Fidelis|Exchange|negotiated_algorithm,estimated_amount|Fidelis|Exchange,standard_charge|Fidelis|Exchange|methodology,additional_payer_notes|Fidelis|Exchange,standard_charge|Emblem_GHI|HMO|negotiated_dollar,standard_charge|Emblem_GHI|HMO|negotiated_percentage,standard_charge|Emblem_GHI|HMO|negotiated_algorithm,estimated_amount|Emblem_GHI|HMO,standard_charge|Emblem_GHI|HMO|methodology,additional_payer_notes|Emblem_GHI|HMO,standard_charge|Emblem_GHI|PPO_CBP|negotiated_dollar,standard_charge|Emblem_GHI|PPO_CBP|negotiated_percentage,standard_charge|Emblem_GHI|PPO_CBP|negotiated_algorithm,estimated_amount|Emblem_GHI|PPO_CBP,standard_charge|Emblem_GHI|PPO_CBP|methodology,additional_payer_notes|Emblem_GHI|PPO_CBP,standard_charge|Emblem_GHI|CBP|negotiated_dollar,standard_charge|Emblem_GHI|CBP|negotiated_percentage,standard_charge|Emblem_GHI|CBP|negotiated_algorithm,estimated_amount|Emblem_GHI|CBP,standard_charge|Emblem_GHI|CBP|methodology,additional_payer_notes|Emblem_GHI|CBP,standard_charge|Emblem_HIP|HMO|negotiated_dollar,standard_charge|Emblem_HIP|HMO|negotiated_percentage,standard_charge|Emblem_HIP|HMO|negotiated_algorithm,estimated_amount|Emblem_HIP|HMO,standard_charge|Emblem_HIP|HMO|methodology,additional_payer_notes|Emblem_HIP|HMO,standard_charge|Emblem_HIP|PPO|negotiated_dollar,standard_charge|Emblem_HIP|PPO|negotiated_percentage,standard_charge|Emblem_HIP|PPO|negotiated_algorithm,estimated_amount|Emblem_HIP|PPO,standard_charge|Emblem_HIP|PPO|methodology,additional_payer_notes|Emblem_HIP|PPO,standard_charge|Magnacare|Preferred|negotiated_dollar,standard_charge|Magnacare|Preferred|negotiated_percentage,standard_charge|Magnacare|Preferred|negotiated_algorithm,estimated_amount|Magnacare|Preferred,standard_charge|Magnacare|Preferred|methodology,additional_payer_notes|Magnacare|Preferred,standard_charge|Magnacare|Standard|negotiated_dollar,standard_charge|Magnacare|Standard|negotiated_percentage,standard_charge|Magnacare|Standard|negotiated_algorithm,estimated_amount|Magnacare|Standard,standard_charge|Magnacare|Standard|methodology,additional_payer_notes|Magnacare|Standard,standard_charge|MVP|HMO|negotiated_dollar,standard_charge|MVP|HMO|negotiated_percentage,standard_charge|MVP|HMO|negotiated_algorithm,estimated_amount|MVP|HMO,standard_charge|MVP|HMO|methodology,additional_payer_notes|MVP|HMO,standard_charge|MVP|Exchange|negotiated_dollar,standard_charge|MVP|Exchange|negotiated_percentage,standard_charge|MVP|Exchange|negotiated_algorithm,estimated_amount|MVP|Exchange,standard_charge|MVP|Exchange|methodology,additional_payer_notes|MVP|Exchange,standard_charge|Oxford|HMO_PPO|negotiated_dollar,standard_charge|Oxford|HMO_PPO|negotiated_percentage,standard_charge|Oxford|HMO_PPO|negotiated_algorithm,estimated_amount|Oxford|HMO_PPO,standard_charge|Oxford|HMO_PPO|methodology,additional_payer_notes|Oxford|HMO_PPO,standard_charge|Oxford|Metro|negotiated_dollar,standard_charge|Oxford|Metro|negotiated_percentage,standard_charge|Oxford|Metro|negotiated_algorithm,estimated_amount|Oxford|Metro,standard_charge|Oxford|Metro|methodology,additional_payer_notes|Oxford|Metro,standard_charge|United_Healthcare|HMO_PPO|negotiated_dollar,standard_charge|United_Healthcare|HMO_PPO|negotiated_percentage,standard_charge|United_Healthcare|HMO_PPO|negotiated_algorithm,estimated_amount|United_Healthcare|HMO_PPO,standard_charge|United_Healthcare|HMO_PPO|methodology,additional_payer_notes|United_Healthcare|HMO_PPO,standard_charge|United_Healthcare|Compass|negotiated_dollar,standard_charge|United_Healthcare|Compass|negotiated_percentage,standard_charge|United_Healthcare|Compass|negotiated_algorithm,estimated_amount|United_Healthcare|Compass,standard_charge|United_Healthcare|Compass|methodology,additional_payer_notes|United_Healthcare|Compass,standard_charge|Medicaid_Advantage|negotiated_dollar,standard_charge|Medicaid_Advantage|negotiated_percentage,standard_charge|Medicaid_Advantage|negotiated_algorithm,estimated_amount|Medicaid_Advantage,standard_charge|Medicaid_Advantage|methodology,additional_payer_notes|Medicaid_Advantage,standard_charge|Child_Health_PLus|negotiated_dollar,standard_charge|Child_Health_Plus|negotiated_percentage,standard_charge|Child_Health_Plus|negotiated_algorithm,estimated_amount|Child_Health_Plus,standard_charge|Child_Health_Plus|methodology,additional_payer_notes|Child_Health_Plus,standard_charge|Fidelis|Child_Health_PLus|negotiated_dollar,standard_charge|Fidelis|Child_Health_Plus|negotiated_percentage,standard_charge|Fidelis|Child_Health_Plus|negotiated_algorithm,estimated_amount|Fidelis|Child_Health_Plus,standard_charge|Fidelis|Child_Health_Plus|methodology,additional_payer_notes|Fidelis|Child_Health_Plus,standard_charge|United_Healthcare|Child_Health_PLus|negotiated_dollar,standard_charge|United_Healthcare|Child_Health_Plus|negotiated_percentage,standard_charge|United_Healthcare|Child_Health_Plus|negotiated_algorithm,estimated_amount|United_Healthcare|Child_Health_Plus,standard_charge|United_Healthcare|Child_Health_Plus|methodology,additional_payer_notes|United_Healthcare|Child_Health_Plus,standard_charge|Essential_3_&_4|negotiated_dollar,standard_charge|Essential_3_&_4|negotiated_percentage,standard_charge|Essential_3_&_4|negotiated_algorithm,estimated_amount|Essential_3_&_4,standard_charge|Essential_3_&_4|methodology,additional_payer_notes|Essential_3_&_4,standard_charge|CDPHP|Essential_1_&_2|negotiated_dollar,standard_charge|CDPHP|Essential_1_&_2|negotiated_percentage,standard_charge|CDPHP|Essential_1_&_2|negotiated_algorithm,estimated_amount|CDPHP|Essential_1_&_2,standard_charge|CDPHP|Essential_1_&_2|methodology,additional_payer_notes|CDPHP|Essential_1_&_2,standard_charge|Empire_HealthPlus|Essential_1_&_2|negotiated_dollar,standard_charge|Empire_HealthPlus|Essential_1_&_2|negotiated_percentage,standard_charge|Empire_HealthPlus|Essential_1_&_2|negotiated_algorithm,estimated_amount|Empire_HealthPlus|Essential_1_&_2,standard_charge|Empire_HealthPlus|Essential_1_&_2|methodology,additional_payer_notes|Empire_HealthPlus|Essential_1_&_2,standard_charge|Empire_HealthPlus|Exchange|negotiated_dollar,standard_charge|Empire_HealthPlus|Exchange|negotiated_percentage,standard_charge|Empire_HealthPlus|Exchange|negotiated_algorithm,estimated_amount|Empire_HealthPlus|Exchange,standard_charge|Empire_HealthPlus|Exchange|methodology,additional_payer_notes|Empire_HealthPlus|Exchange,standard_charge|Fidelis|Essential_1_&_2|negotiated_dollar,standard_charge|Fidelis|Essential_1_&_2|negotiated_percentage,standard_charge|Fidelis|Essential_1_&_2|negotiated_algorithm,estimated_amount|Fidelis|Essential_1_&_2,standard_charge|Fidelis|Essential_1_&_2|methodology,additional_payer_notes|Fidelis|Essential_1_&_2,standard_charge|HealthFirst|Essential_1_&_2|negotiated_dollar,standard_charge|HealthFirst|Essential_1_&_2|negotiated_percentage,standard_charge|HealthFirst|Essential_1_&_2|negotiated_algorithm,estimated_amount|HealthFirst|Essential_1_&_2,standard_charge|HealthFirst|Essential_1_&_2|methodology,additional_payer_notes|HealthFirst|Essential_1_&_2,standard_charge|HealthFirst|Exchange|negotiated_dollar,standard_charge|HealthFirst|Exchange|negotiated_percentage,standard_charge|HealthFirst|Exchange|negotiated_algorithm,estimated_amount|HealthFirst|Exchange,standard_charge|HealthFirst|Exchange|methodology,additional_payer_notes|HealthFirst|Exchange,standard_charge|MVP|Essential_1_&_2|negotiated_dollar,standard_charge|MVP|Essential_1_&_2|negotiated_percentage,standard_charge|MVP|Essential_1_&_2|negotiated_algorithm,estimated_amount|MVP|Essential_1_&_2,standard_charge|MVP|Essential_1_&_2|methodology,additional_payer_notes|MVP|Essential_1_&_2,standard_charge|MVP|Essential_3_&_4|negotiated_dollar,standard_charge|MVP|Essential_3_&_4|negotiated_percentage,standard_charge|MVP|Essential_3_&_4|negotiated_algorithm,estimated_amount|MVP|Essential_3_&_4,standard_charge|MVP|Essential_3_&_4|methodology,additional_payer_notes|MVP|Essential_3_&_4,standard_charge|United_Healthcare|Essential_1_to_4|negotiated_dollar,standard_charge|United_Healthcare|Essential_1_to_4|negotiated_percentage,standard_charge|United_Healthcare|Essential_1_to_4|negotiated_algorithm,estimated_amount|United_Healthcare|Essential_1_to_4,standard_charge|United_Healthcare|Essential_1_to_4|methodology,additional_payer_notes|United_Healthcare|Essential_1_to_4,standard_charge|min,standard_charge|max,additional_generic_notes
0.45% SODIUM CHLORIDE 500ML,,,,80000002,CDM,250,RC,264780210,NDC,both,24,ML,1.22,0.48,39.4668,,0.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.41,34,,0.41,percent of total billed charges,"Drugs, Inpatient Only",0.41,34,,0.41,percent of total billed charges,"Drugs, Inpatient Only",0.41,34,,0.41,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.85,70,,0.85,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.91,,,0.91,Other,225% of Medicaid,0.57,,,0.57,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.87,,,0.87,Other,215% Medicaid APG methodology,0.87,,,0.87,Other,215% Medicaid APG methodology,0.51,,,0.51,Other,125% Medicaid APG methodology,0.01,0.91,
ABACAVIR 300 MG TAB,,,,80000005,CDM,250,RC,31722055760,NDC,both,60,EA,0.84,0.33,39.4668,,0.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.59,70,,0.59,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.63,,,0.63,Other,225% of Medicaid,0.39,,,0.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.6,,,0.6,Other,215% Medicaid APG methodology,0.6,,,0.6,Other,215% Medicaid APG methodology,0.35,,,0.35,Other,125% Medicaid APG methodology,0.01,0.63,
ABSORBABLE GELATIN FILM,,,,80000007,CDM,250,RC,9029703,NDC,both,6,EA,689.58,272.16,39.4668,,272.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,234.46,34,,234.46,percent of total billed charges,"Drugs, Inpatient Only",234.46,34,,234.46,percent of total billed charges,"Drugs, Inpatient Only",234.46,34,,234.46,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,482.71,70,,482.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,229.86,,,229.86,Other,Drug Cost,229.86,,,229.86,Other,Drug Cost,229.86,,,229.86,Other,Drug Cost,229.86,,,229.86,Other,Drug Cost,229.86,,,229.86,Other,Drug Cost,229.86,,,229.86,Other,Drug Cost,517.19,,,517.19,Other,225% of Medicaid,321.8,,,321.8,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,494.2,,,494.2,Other,215% Medicaid APG methodology,494.2,,,494.2,Other,215% Medicaid APG methodology,287.33,,,287.33,Other,125% Medicaid APG methodology,0.01,517.19,
ACETAMINOPHEN 325 MG TAB,,,,80000016,CDM,250,RC,536132701,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ACETAMINOPHEN 325 MG SUPP,,,,80000017,CDM,250,RC,51672211602,NDC,both,6,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
ACETAMINOPHEN 650MG ORAL SUSP,,,,80000019,CDM,250,RC,121197100,NDC,both,20.3,ML,1.74,0.69,39.4668,,0.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.59,34,,0.59,percent of total billed charges,"Drugs, Inpatient Only",0.59,34,,0.59,percent of total billed charges,"Drugs, Inpatient Only",0.59,34,,0.59,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.22,70,,1.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.58,,,0.58,Other,Drug Cost,0.58,,,0.58,Other,Drug Cost,0.58,,,0.58,Other,Drug Cost,0.58,,,0.58,Other,Drug Cost,0.58,,,0.58,Other,Drug Cost,0.58,,,0.58,Other,Drug Cost,1.3,,,1.3,Other,225% of Medicaid,0.81,,,0.81,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.25,,,1.25,Other,215% Medicaid APG methodology,1.25,,,1.25,Other,215% Medicaid APG methodology,0.72,,,0.72,Other,125% Medicaid APG methodology,0.01,1.3,
ACETAZOLAMIDE 250 MG,,,,80000025,CDM,250,RC,23155028801,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.08,
ACETAZOLAMIDE 500 MG CAP ER,,,,80000026,CDM,250,RC,51285075402,NDC,both,100,EA,25.14,9.92,39.4668,,9.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.55,34,,8.55,percent of total billed charges,"Drugs, Inpatient Only",8.55,34,,8.55,percent of total billed charges,"Drugs, Inpatient Only",8.55,34,,8.55,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.6,70,,17.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.38,,,8.38,Other,Drug Cost,8.38,,,8.38,Other,Drug Cost,8.38,,,8.38,Other,Drug Cost,8.38,,,8.38,Other,Drug Cost,8.38,,,8.38,Other,Drug Cost,8.38,,,8.38,Other,Drug Cost,18.85,,,18.85,Other,225% of Medicaid,11.73,,,11.73,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,18.02,,,18.02,Other,215% Medicaid APG methodology,18.02,,,18.02,Other,215% Medicaid APG methodology,10.47,,,10.47,Other,125% Medicaid APG methodology,0.01,18.85,
ACETIC ACID 0.25% IRRIGATION S,,,,80000028,CDM,250,RC,264230400,NDC,both,1000,ML,5.26,2.08,39.4668,,2.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.79,34,,1.79,percent of total billed charges,"Drugs, Inpatient Only",1.79,34,,1.79,percent of total billed charges,"Drugs, Inpatient Only",1.79,34,,1.79,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.68,70,,3.68,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.75,,,1.75,Other,Drug Cost,1.75,,,1.75,Other,Drug Cost,1.75,,,1.75,Other,Drug Cost,1.75,,,1.75,Other,Drug Cost,1.75,,,1.75,Other,Drug Cost,1.75,,,1.75,Other,Drug Cost,3.94,,,3.94,Other,225% of Medicaid,2.45,,,2.45,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.77,,,3.77,Other,215% Medicaid APG methodology,3.77,,,3.77,Other,215% Medicaid APG methodology,2.19,,,2.19,Other,125% Medicaid APG methodology,0.01,3.94,
ACETONE 120ML,,,,80000032,CDM,250,RC,395001994,NDC,both,1,ML,26.13,10.31,39.4668,,10.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.88,34,,8.88,percent of total billed charges,"Drugs, Inpatient Only",8.88,34,,8.88,percent of total billed charges,"Drugs, Inpatient Only",8.88,34,,8.88,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.29,70,,18.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.71,,,8.71,Other,Drug Cost,8.71,,,8.71,Other,Drug Cost,8.71,,,8.71,Other,Drug Cost,8.71,,,8.71,Other,Drug Cost,8.71,,,8.71,Other,Drug Cost,8.71,,,8.71,Other,Drug Cost,19.6,,,19.6,Other,225% of Medicaid,12.19,,,12.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,18.73,,,18.73,Other,215% Medicaid APG methodology,18.73,,,18.73,Other,215% Medicaid APG methodology,10.89,,,10.89,Other,125% Medicaid APG methodology,0.01,19.6,
ACETYECYSTENE 20% 4 ML,,,,80000033,CDM,250,RC,63323069404,NDC,both,25,ML,10.06,3.97,39.4668,,3.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.42,34,,3.42,percent of total billed charges,"Drugs, Inpatient Only",3.42,34,,3.42,percent of total billed charges,"Drugs, Inpatient Only",3.42,34,,3.42,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.04,70,,7.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.35,,,3.35,Other,Drug Cost,3.35,,,3.35,Other,Drug Cost,3.35,,,3.35,Other,Drug Cost,3.35,,,3.35,Other,Drug Cost,3.35,,,3.35,Other,Drug Cost,3.35,,,3.35,Other,Drug Cost,7.54,,,7.54,Other,225% of Medicaid,4.69,,,4.69,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.21,,,7.21,Other,215% Medicaid APG methodology,7.21,,,7.21,Other,215% Medicaid APG methodology,4.19,,,4.19,Other,125% Medicaid APG methodology,0.01,7.54,
ACETYLCHOLINE 1% OPTH INJ,,,,80000035,CDM,250,RC,24208053920,NDC,both,1,EA,65.43,25.82,39.4668,,25.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.25,34,,22.25,percent of total billed charges,"Drugs, Inpatient Only",22.25,34,,22.25,percent of total billed charges,"Drugs, Inpatient Only",22.25,34,,22.25,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,45.8,70,,45.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.81,,,21.81,Other,Drug Cost,21.81,,,21.81,Other,Drug Cost,21.81,,,21.81,Other,Drug Cost,21.81,,,21.81,Other,Drug Cost,21.81,,,21.81,Other,Drug Cost,21.81,,,21.81,Other,Drug Cost,49.07,,,49.07,Other,225% of Medicaid,30.53,,,30.53,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,46.89,,,46.89,Other,215% Medicaid APG methodology,46.89,,,46.89,Other,215% Medicaid APG methodology,27.26,,,27.26,Other,125% Medicaid APG methodology,0.01,49.07,
ACETYLCYSTEINE 200 MG/ML 30 ML,,,,80000037,CDM,250,RC,409330803,NDC,both,3,ML,22.21,8.77,39.4668,,8.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.55,34,,7.55,percent of total billed charges,"Drugs, Inpatient Only",7.55,34,,7.55,percent of total billed charges,"Drugs, Inpatient Only",7.55,34,,7.55,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.55,70,,15.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.4,,,7.4,Other,Drug Cost,7.4,,,7.4,Other,Drug Cost,7.4,,,7.4,Other,Drug Cost,7.4,,,7.4,Other,Drug Cost,7.4,,,7.4,Other,Drug Cost,7.4,,,7.4,Other,Drug Cost,16.66,,,16.66,Other,225% of Medicaid,10.36,,,10.36,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,15.92,,,15.92,Other,215% Medicaid APG methodology,15.92,,,15.92,Other,215% Medicaid APG methodology,9.25,,,9.25,Other,125% Medicaid APG methodology,0.01,16.66,
ACIDOPH-PECTIN 1 CAPSULE,,,,80000040,CDM,250,RC,43292050022,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
ACTIVATED CHARCOAL 25 G/120 ML,,,,80000041,CDM,250,RC,574052174,NDC,both,1,ML,25.14,9.92,39.4668,,9.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.55,34,,8.55,percent of total billed charges,"Drugs, Inpatient Only",8.55,34,,8.55,percent of total billed charges,"Drugs, Inpatient Only",8.55,34,,8.55,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.6,70,,17.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.38,,,8.38,Other,Drug Cost,8.38,,,8.38,Other,Drug Cost,8.38,,,8.38,Other,Drug Cost,8.38,,,8.38,Other,Drug Cost,8.38,,,8.38,Other,Drug Cost,8.38,,,8.38,Other,Drug Cost,18.86,,,18.86,Other,225% of Medicaid,11.73,,,11.73,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,18.02,,,18.02,Other,215% Medicaid APG methodology,18.02,,,18.02,Other,215% Medicaid APG methodology,10.48,,,10.48,Other,125% Medicaid APG methodology,0.01,18.86,
ACTIVATED CHARCOAL 50 G/240 ML,,,,80000042,CDM,250,RC,66689020108,NDC,both,1,ML,6.51,2.57,39.4668,,2.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.21,34,,2.21,percent of total billed charges,"Drugs, Inpatient Only",2.21,34,,2.21,percent of total billed charges,"Drugs, Inpatient Only",2.21,34,,2.21,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.56,70,,4.56,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.17,,,2.17,Other,Drug Cost,2.17,,,2.17,Other,Drug Cost,2.17,,,2.17,Other,Drug Cost,2.17,,,2.17,Other,Drug Cost,2.17,,,2.17,Other,Drug Cost,2.17,,,2.17,Other,Drug Cost,4.88,,,4.88,Other,225% of Medicaid,3.04,,,3.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.67,,,4.67,Other,215% Medicaid APG methodology,4.67,,,4.67,Other,215% Medicaid APG methodology,2.71,,,2.71,Other,125% Medicaid APG methodology,0.01,4.88,
ACYCLOVIR 200 MG,,,,80000045,CDM,250,RC,904578961,NDC,both,10,EA,2.15,0.85,39.4668,,0.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.73,34,,0.73,percent of total billed charges,"Drugs, Inpatient Only",0.73,34,,0.73,percent of total billed charges,"Drugs, Inpatient Only",0.73,34,,0.73,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.51,70,,1.51,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.72,,,0.72,Other,Drug Cost,0.72,,,0.72,Other,Drug Cost,0.72,,,0.72,Other,Drug Cost,0.72,,,0.72,Other,Drug Cost,0.72,,,0.72,Other,Drug Cost,0.72,,,0.72,Other,Drug Cost,1.61,,,1.61,Other,225% of Medicaid,1,,,1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.54,,,1.54,Other,215% Medicaid APG methodology,1.54,,,1.54,Other,215% Medicaid APG methodology,0.9,,,0.9,Other,125% Medicaid APG methodology,0.01,1.61,
ACYCLOVIR 400 MG,,,,80000046,CDM,250,RC,31722077701,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
ALBUTEROL 2MG,,,,80000055,CDM,250,RC,53489017601,NDC,both,100,EA,0.55,0.22,39.4668,,0.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,34,,0.19,percent of total billed charges,"Drugs, Inpatient Only",0.19,34,,0.19,percent of total billed charges,"Drugs, Inpatient Only",0.19,34,,0.19,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.39,70,,0.39,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.41,,,0.41,Other,225% of Medicaid,0.26,,,0.26,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.39,,,0.39,Other,215% Medicaid APG methodology,0.39,,,0.39,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,125% Medicaid APG methodology,0.01,0.41,
ALBUTEROL 2.5MG/3ML,,,,80000057,CDM,250,RC,76204020030,NDC,both,30,ML,0.32,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,70,,0.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.24,,,0.24,Other,225% of Medicaid,0.15,,,0.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.23,,,0.23,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.24,
ALBUTEROL METERED DOSE INHALER,,,,80000060,CDM,250,RC,781729685,NDC,both,1,GM,10.38,4.1,39.4668,,4.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.53,34,,3.53,percent of total billed charges,"Drugs, Inpatient Only",3.53,34,,3.53,percent of total billed charges,"Drugs, Inpatient Only",3.53,34,,3.53,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.27,70,,7.27,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.46,,,3.46,Other,Drug Cost,3.46,,,3.46,Other,Drug Cost,3.46,,,3.46,Other,Drug Cost,3.46,,,3.46,Other,Drug Cost,3.46,,,3.46,Other,Drug Cost,3.46,,,3.46,Other,Drug Cost,7.79,,,7.79,Other,225% of Medicaid,4.84,,,4.84,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.44,,,7.44,Other,215% Medicaid APG methodology,7.44,,,7.44,Other,215% Medicaid APG methodology,4.33,,,4.33,Other,125% Medicaid APG methodology,0.01,7.79,
ALLOPURINOL 100MG,,,,80000065,CDM,250,RC,603211521,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
ALLOPURINOL 300 MG,,,,80000066,CDM,250,RC,603211621,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
ALPRAZOLAM 0.25 MG,,,,80000068,CDM,250,RC,65862067601,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ALPRAZOLAM 0.5 MG,,,,80000069,CDM,250,RC,228202910,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
AMANTADINE 100 MG,,,,80000075,CDM,250,RC,832101500,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
AMANTADINE 50MG/5ML,,,,80000076,CDM,250,RC,121064610,NDC,both,100,ML,0.27,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,70,,0.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.19,,,0.19,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.2,
AMINOCAP ACID 250MG/ML,,,,80000087,CDM,250,RC,409434673,NDC,both,25,ML,6.25,2.47,39.4668,,2.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.13,34,,2.13,percent of total billed charges,"Drugs, Inpatient Only",2.13,34,,2.13,percent of total billed charges,"Drugs, Inpatient Only",2.13,34,,2.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.38,70,,4.38,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.08,,,2.08,Other,Drug Cost,2.08,,,2.08,Other,Drug Cost,2.08,,,2.08,Other,Drug Cost,2.08,,,2.08,Other,Drug Cost,2.08,,,2.08,Other,Drug Cost,2.08,,,2.08,Other,Drug Cost,4.69,,,4.69,Other,225% of Medicaid,2.92,,,2.92,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.48,,,4.48,Other,215% Medicaid APG methodology,4.48,,,4.48,Other,215% Medicaid APG methodology,2.6,,,2.6,Other,125% Medicaid APG methodology,0.01,4.69,
AMINOCAPOROIC ACID (AMICAR) 500 MG,,,,80000088,CDM,250,RC,69238163703,NDC,both,30,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
AMIODARONE 150MG/100ML,,,,80000097,CDM,250,RC,43066015010,NDC,both,12,ML,55.14,21.76,39.4668,,21.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.75,34,,18.75,percent of total billed charges,"Drugs, Inpatient Only",18.75,34,,18.75,percent of total billed charges,"Drugs, Inpatient Only",18.75,34,,18.75,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.6,70,,38.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.38,,,18.38,Other,Drug Cost,18.38,,,18.38,Other,Drug Cost,18.38,,,18.38,Other,Drug Cost,18.38,,,18.38,Other,Drug Cost,18.38,,,18.38,Other,Drug Cost,18.38,,,18.38,Other,Drug Cost,41.36,,,41.36,Other,225% of Medicaid,25.73,,,25.73,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,39.52,,,39.52,Other,215% Medicaid APG methodology,39.52,,,39.52,Other,215% Medicaid APG methodology,22.98,,,22.98,Other,125% Medicaid APG methodology,0.01,41.36,
AMIODARONE 200 MG TAB,,,,80000098,CDM,250,RC,51672402504,NDC,both,60,EA,0.13,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.1,
AMITRIPTYLINE 10MG,,,,80000099,CDM,250,RC,16729017101,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
AMITRIPTYLINE 25 MG,,,,80000100,CDM,250,RC,16729017201,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
AMITRIPTYLINE 50MG TABLET,,,,80000102,CDM,250,RC,16729017301,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
AMLODIPINE 10MG TAB,,,,80000107,CDM,250,RC,67877019990,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
AMLODIPINE 2.5MG TAB,,,,80000108,CDM,250,RC,69152068,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
AMLODIPINE 5MG TAB,,,,80000109,CDM,250,RC,69097012705,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
AMMONIUM LACTATE (LAC-HYDRIN) 12% LOTN,,,,80000111,CDM,250,RC,904598426,NDC,both,1,GM,9.6,3.79,39.4668,,3.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.26,34,,3.26,percent of total billed charges,"Drugs, Inpatient Only",3.26,34,,3.26,percent of total billed charges,"Drugs, Inpatient Only",3.26,34,,3.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.72,70,,6.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,7.2,,,7.2,Other,225% of Medicaid,4.48,,,4.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.88,,,6.88,Other,215% Medicaid APG methodology,6.88,,,6.88,Other,215% Medicaid APG methodology,4,,,4,Other,125% Medicaid APG methodology,0.01,7.2,
AMMONIUM LACTATE 140GM,,,,80000112,CDM,250,RC,45802049383,NDC,both,2,GM,11.04,4.36,39.4668,,4.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.75,34,,3.75,percent of total billed charges,"Drugs, Inpatient Only",3.75,34,,3.75,percent of total billed charges,"Drugs, Inpatient Only",3.75,34,,3.75,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.73,70,,7.73,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.68,,,3.68,Other,Drug Cost,3.68,,,3.68,Other,Drug Cost,3.68,,,3.68,Other,Drug Cost,3.68,,,3.68,Other,Drug Cost,3.68,,,3.68,Other,Drug Cost,3.68,,,3.68,Other,Drug Cost,8.28,,,8.28,Other,225% of Medicaid,5.15,,,5.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.91,,,7.91,Other,215% Medicaid APG methodology,7.91,,,7.91,Other,215% Medicaid APG methodology,4.6,,,4.6,Other,125% Medicaid APG methodology,0.01,8.28,
AMOXICILLIN 250 MG,,,,80000118,CDM,250,RC,781202001,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.03,
AMOXICILLIN 500 MG,,,,80000122,CDM,250,RC,781261305,NDC,both,500,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
AMOXICILLIN-POT CLAV  250MG TABLET,,,,80000123,CDM,250,RC,781187431,NDC,both,30,EA,2.07,0.82,39.4668,,0.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.7,34,,0.7,percent of total billed charges,"Drugs, Inpatient Only",0.7,34,,0.7,percent of total billed charges,"Drugs, Inpatient Only",0.7,34,,0.7,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.45,70,,1.45,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,1.55,,,1.55,Other,225% of Medicaid,0.97,,,0.97,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.48,,,1.48,Other,215% Medicaid APG methodology,1.48,,,1.48,Other,215% Medicaid APG methodology,0.86,,,0.86,Other,125% Medicaid APG methodology,0.01,1.55,
AMOXICILLIN-POT CLAV 400MG/5ML 50 ML,,,,80000126,CDM,250,RC,143998250,NDC,both,1,ML,3.27,1.29,39.4668,,1.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.11,34,,1.11,percent of total billed charges,"Drugs, Inpatient Only",1.11,34,,1.11,percent of total billed charges,"Drugs, Inpatient Only",1.11,34,,1.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.29,70,,2.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,2.45,,,2.45,Other,225% of Medicaid,1.53,,,1.53,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.34,,,2.34,Other,215% Medicaid APG methodology,2.34,,,2.34,Other,215% Medicaid APG methodology,1.36,,,1.36,Other,125% Medicaid APG methodology,0.01,2.45,
AMOXICILLIN-POT CLAV 500 MG,,,,80000127,CDM,250,RC,65862050220,NDC,both,20,EA,0.32,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,70,,0.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.24,,,0.24,Other,225% of Medicaid,0.15,,,0.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.23,,,0.23,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.24,
AMOXICILLIN-POT CLAV 875 MG,,,,80000128,CDM,250,RC,65862050301,NDC,both,100,EA,0.35,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,70,,0.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.26,,,0.26,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.25,,,0.25,Other,215% Medicaid APG methodology,0.25,,,0.25,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,125% Medicaid APG methodology,0.01,0.26,
AMPHETINE SALT COMBO 10MG TAB,,,,80000132,CDM,250,RC,555097202,NDC,both,100,EA,0.19,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.14,,,0.14,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
ANALGESIC CREAM 30 GM (OINTMENT),,,,80000148,CDM,250,RC,41167008709,NDC,both,1,GM,17.76,7.01,39.4668,,7.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.04,34,,6.04,percent of total billed charges,"Drugs, Inpatient Only",6.04,34,,6.04,percent of total billed charges,"Drugs, Inpatient Only",6.04,34,,6.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.43,70,,12.43,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.92,,,5.92,Other,Drug Cost,5.92,,,5.92,Other,Drug Cost,5.92,,,5.92,Other,Drug Cost,5.92,,,5.92,Other,Drug Cost,5.92,,,5.92,Other,Drug Cost,5.92,,,5.92,Other,Drug Cost,13.32,,,13.32,Other,225% of Medicaid,8.29,,,8.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.73,,,12.73,Other,215% Medicaid APG methodology,12.73,,,12.73,Other,215% Medicaid APG methodology,7.4,,,7.4,Other,125% Medicaid APG methodology,0.01,13.32,
ANASTROZOLE 1MG,,,,80000149,CDM,250,RC,16729003510,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
APAP 120MG,,,,80000154,CDM,250,RC,45802073230,NDC,both,12,EA,0.38,0.15,39.4668,,0.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.27,70,,0.27,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.29,,,0.29,Other,225% of Medicaid,0.18,,,0.18,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.27,,,0.27,Other,215% Medicaid APG methodology,0.27,,,0.27,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,125% Medicaid APG methodology,0.01,0.29,
APAP 650MG SUPP,,,,80000155,CDM,250,RC,45802073030,NDC,both,12,EA,0.44,0.18,39.4668,,0.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.31,70,,0.31,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.33,,,0.33,Other,225% of Medicaid,0.21,,,0.21,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.32,,,0.32,Other,215% Medicaid APG methodology,0.32,,,0.32,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,125% Medicaid APG methodology,0.01,0.33,
ARIPIPRAZOLE (ABILIFY) 10MG,,,,80000164,CDM,250,RC,65162089803,NDC,both,30,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
ARIPIPRAZOLE (ABILIFY) 2MG TAB,,,,80000166,CDM,250,RC,65862066130,NDC,both,30,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.08,
ARIPIPRAZOLE (ABILIFY) 5MG,,,,80000167,CDM,250,RC,65162089703,NDC,both,30,EA,0.2,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.14,,,0.14,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.15,
ARIPIPRAZOLE 1 MG/ML SOLN,,,,80000170,CDM,250,RC,65162089374,NDC,both,1,ML,62.55,24.69,39.4668,,24.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.27,34,,21.27,percent of total billed charges,"Drugs, Inpatient Only",21.27,34,,21.27,percent of total billed charges,"Drugs, Inpatient Only",21.27,34,,21.27,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,43.79,70,,43.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,20.85,,,20.85,Other,Drug Cost,20.85,,,20.85,Other,Drug Cost,20.85,,,20.85,Other,Drug Cost,20.85,,,20.85,Other,Drug Cost,20.85,,,20.85,Other,Drug Cost,20.85,,,20.85,Other,Drug Cost,46.91,,,46.91,Other,225% of Medicaid,29.19,,,29.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,44.83,,,44.83,Other,215% Medicaid APG methodology,44.83,,,44.83,Other,215% Medicaid APG methodology,26.06,,,26.06,Other,125% Medicaid APG methodology,0.01,46.91,
ARMOUR THYROID 30MG,,,,80000172,CDM,250,RC,42192032901,NDC,both,100,EA,0.34,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,70,,0.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.25,,,0.25,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.24,,,0.24,Other,215% Medicaid APG methodology,0.24,,,0.24,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,0.25,
ARMOUR THYROID 60MG,,,,80000173,CDM,250,RC,456045901,NDC,both,100,EA,0.66,0.26,39.4668,,0.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.46,70,,0.46,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.5,,,0.5,Other,225% of Medicaid,0.31,,,0.31,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.47,,,0.47,Other,215% Medicaid APG methodology,0.47,,,0.47,Other,215% Medicaid APG methodology,0.28,,,0.28,Other,125% Medicaid APG methodology,0.01,0.5,
ASPIRIN 300 MG,,,,80000180,CDM,250,RC,574703412,NDC,both,12,EA,2.11,0.83,39.4668,,0.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.72,34,,0.72,percent of total billed charges,"Drugs, Inpatient Only",0.72,34,,0.72,percent of total billed charges,"Drugs, Inpatient Only",0.72,34,,0.72,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.47,70,,1.47,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,1.58,,,1.58,Other,225% of Medicaid,0.98,,,0.98,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.51,,,1.51,Other,215% Medicaid APG methodology,1.51,,,1.51,Other,215% Medicaid APG methodology,0.88,,,0.88,Other,125% Medicaid APG methodology,0.01,1.58,
ASPIRIN 325 MG,,,,80000181,CDM,250,RC,536105429,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ASPIRIN 81MG,,,,80000183,CDM,250,RC,904675180,NDC,both,1000,EA,0.02,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ASPIRIN EC 325 MG TAB,,,,80000184,CDM,250,RC,536123201,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.03,
ATENOLOL 25 MG,,,,80000185,CDM,250,RC,93078701,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ATOVAQUONE-PROGUANIL 250 MG-100 MG TAB,,,,80000190,CDM,250,RC,173067502,NDC,both,24,EA,4.31,1.7,39.4668,,1.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.47,34,,1.47,percent of total billed charges,"Drugs, Inpatient Only",1.47,34,,1.47,percent of total billed charges,"Drugs, Inpatient Only",1.47,34,,1.47,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.02,70,,3.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.44,,,1.44,Other,Drug Cost,1.44,,,1.44,Other,Drug Cost,1.44,,,1.44,Other,Drug Cost,1.44,,,1.44,Other,Drug Cost,1.44,,,1.44,Other,Drug Cost,1.44,,,1.44,Other,Drug Cost,3.23,,,3.23,Other,225% of Medicaid,2.01,,,2.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.09,,,3.09,Other,215% Medicaid APG methodology,3.09,,,3.09,Other,215% Medicaid APG methodology,1.8,,,1.8,Other,125% Medicaid APG methodology,0.01,3.23,
ATROVASTATIN (LIPITOR) 10MG TAB,,,,80000199,CDM,250,RC,378395077,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ATROVASTATIN (LIPITOR) 20MG TAB,,,,80000200,CDM,250,RC,378395177,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ATROVASTATIN (LIPITOR) 40MG TAB,,,,80000201,CDM,250,RC,378395277,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.03,
AZITHROMYCIN 200MG/5ML,,,,80000207,CDM,250,RC,59762312001,NDC,both,1,ML,0.42,0.17,39.4668,,0.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,70,,0.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.32,,,0.32,Other,225% of Medicaid,0.2,,,0.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.3,,,0.3,Other,215% Medicaid APG methodology,0.3,,,0.3,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,125% Medicaid APG methodology,0.01,0.32,
BACITRACIN PACKET,,,,80000215,CDM,250,RC,45802006070,NDC,both,144,GM,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
BACITRACIN-POLYMYXIN B 3.5 GM OPHTH OINT,,,,80000217,CDM,250,RC,24208055555,NDC,both,1,GM,13.83,5.46,39.4668,,5.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.7,34,,4.7,percent of total billed charges,"Drugs, Inpatient Only",4.7,34,,4.7,percent of total billed charges,"Drugs, Inpatient Only",4.7,34,,4.7,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.68,70,,9.68,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.61,,,4.61,Other,Drug Cost,4.61,,,4.61,Other,Drug Cost,4.61,,,4.61,Other,Drug Cost,4.61,,,4.61,Other,Drug Cost,4.61,,,4.61,Other,Drug Cost,4.61,,,4.61,Other,Drug Cost,10.37,,,10.37,Other,225% of Medicaid,6.45,,,6.45,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.91,,,9.91,Other,215% Medicaid APG methodology,9.91,,,9.91,Other,215% Medicaid APG methodology,5.76,,,5.76,Other,125% Medicaid APG methodology,0.01,10.37,
BACLOFEN 10 MG,,,,80000220,CDM,250,RC,172409660,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
BENZOCAINE 20% (ANBESOL),,,,80000232,CDM,250,RC,50024043201,NDC,both,1,ML,15.9,6.28,39.4668,,6.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.41,34,,5.41,percent of total billed charges,"Drugs, Inpatient Only",5.41,34,,5.41,percent of total billed charges,"Drugs, Inpatient Only",5.41,34,,5.41,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.13,70,,11.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.3,,,5.3,Other,Drug Cost,5.3,,,5.3,Other,Drug Cost,5.3,,,5.3,Other,Drug Cost,5.3,,,5.3,Other,Drug Cost,5.3,,,5.3,Other,Drug Cost,5.3,,,5.3,Other,Drug Cost,11.93,,,11.93,Other,225% of Medicaid,7.42,,,7.42,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.4,,,11.4,Other,215% Medicaid APG methodology,11.4,,,11.4,Other,215% Medicaid APG methodology,6.63,,,6.63,Other,125% Medicaid APG methodology,0.01,11.93,
BENZOCAINE/MENTHOL (DERMOPLAST) 56 ML,,,,80000234,CDM,250,RC,16864068003,NDC,both,1,GM,14.61,5.77,39.4668,,5.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.97,34,,4.97,percent of total billed charges,"Drugs, Inpatient Only",4.97,34,,4.97,percent of total billed charges,"Drugs, Inpatient Only",4.97,34,,4.97,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.23,70,,10.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.87,,,4.87,Other,Drug Cost,4.87,,,4.87,Other,Drug Cost,4.87,,,4.87,Other,Drug Cost,4.87,,,4.87,Other,Drug Cost,4.87,,,4.87,Other,Drug Cost,4.87,,,4.87,Other,Drug Cost,10.96,,,10.96,Other,225% of Medicaid,6.82,,,6.82,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.47,,,10.47,Other,215% Medicaid APG methodology,10.47,,,10.47,Other,215% Medicaid APG methodology,6.09,,,6.09,Other,125% Medicaid APG methodology,0.01,10.96,
BENZOCAINE/MENTHOL LOZENGE,,,,80000235,CDM,250,RC,904625549,NDC,both,18,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
BENZOIN COMPOUND 30ML,,,,80000236,CDM,250,RC,395024392,NDC,both,1,ML,21.6,8.52,39.4668,,8.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.34,34,,7.34,percent of total billed charges,"Drugs, Inpatient Only",7.34,34,,7.34,percent of total billed charges,"Drugs, Inpatient Only",7.34,34,,7.34,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.12,70,,15.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.2,,,7.2,Other,Drug Cost,7.2,,,7.2,Other,Drug Cost,7.2,,,7.2,Other,Drug Cost,7.2,,,7.2,Other,Drug Cost,7.2,,,7.2,Other,Drug Cost,7.2,,,7.2,Other,Drug Cost,16.2,,,16.2,Other,225% of Medicaid,10.08,,,10.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,15.48,,,15.48,Other,215% Medicaid APG methodology,15.48,,,15.48,Other,215% Medicaid APG methodology,9,,,9,Other,125% Medicaid APG methodology,0.01,16.2,
BENZONATATE 100MG,,,,80000237,CDM,250,RC,42806071405,NDC,both,500,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
BENZOYL PEROXINE GEL 10%,,,,80000239,CDM,250,RC,536105656,NDC,both,1,GM,6.69,2.64,39.4668,,2.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.27,34,,2.27,percent of total billed charges,"Drugs, Inpatient Only",2.27,34,,2.27,percent of total billed charges,"Drugs, Inpatient Only",2.27,34,,2.27,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.68,70,,4.68,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.23,,,2.23,Other,Drug Cost,2.23,,,2.23,Other,Drug Cost,2.23,,,2.23,Other,Drug Cost,2.23,,,2.23,Other,Drug Cost,2.23,,,2.23,Other,Drug Cost,2.23,,,2.23,Other,Drug Cost,5.02,,,5.02,Other,225% of Medicaid,3.12,,,3.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.79,,,4.79,Other,215% Medicaid APG methodology,4.79,,,4.79,Other,215% Medicaid APG methodology,2.79,,,2.79,Other,125% Medicaid APG methodology,0.01,5.02,
BENZTROPINE 0.5 MG,,,,80000240,CDM,250,RC,68084038101,NDC,both,10,EA,1.97,0.78,39.4668,,0.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.38,70,,1.38,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,1.48,,,1.48,Other,225% of Medicaid,0.92,,,0.92,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.41,,,1.41,Other,215% Medicaid APG methodology,1.41,,,1.41,Other,215% Medicaid APG methodology,0.82,,,0.82,Other,125% Medicaid APG methodology,0.01,1.48,
BENZTROPINE 1 MG TAB,,,,80000241,CDM,250,RC,69315013701,NDC,both,100,EA,0.09,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.06,
BERACTANT 100MG/4ML,,,,80000244,CDM,250,RC,74104004,NDC,both,1,ML,745.74,294.32,39.4668,,294.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,253.55,34,,253.55,percent of total billed charges,"Drugs, Inpatient Only",253.55,34,,253.55,percent of total billed charges,"Drugs, Inpatient Only",253.55,34,,253.55,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,522.02,70,,522.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,248.58,,,248.58,Other,Drug Cost,248.58,,,248.58,Other,Drug Cost,248.58,,,248.58,Other,Drug Cost,248.58,,,248.58,Other,Drug Cost,248.58,,,248.58,Other,Drug Cost,248.58,,,248.58,Other,Drug Cost,559.31,,,559.31,Other,225% of Medicaid,348.01,,,348.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,534.45,,,534.45,Other,215% Medicaid APG methodology,534.45,,,534.45,Other,215% Medicaid APG methodology,310.73,,,310.73,Other,125% Medicaid APG methodology,0.01,559.31,
BETAMETHASONE DIPROP 0.05 % CREAM,,,,80000250,CDM,250,RC,472038015,NDC,both,1,GM,5.52,2.18,39.4668,,2.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.88,34,,1.88,percent of total billed charges,"Drugs, Inpatient Only",1.88,34,,1.88,percent of total billed charges,"Drugs, Inpatient Only",1.88,34,,1.88,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.86,70,,3.86,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.84,,,1.84,Other,Drug Cost,1.84,,,1.84,Other,Drug Cost,1.84,,,1.84,Other,Drug Cost,1.84,,,1.84,Other,Drug Cost,1.84,,,1.84,Other,Drug Cost,1.84,,,1.84,Other,Drug Cost,4.14,,,4.14,Other,225% of Medicaid,2.58,,,2.58,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.96,,,3.96,Other,215% Medicaid APG methodology,3.96,,,3.96,Other,215% Medicaid APG methodology,2.3,,,2.3,Other,125% Medicaid APG methodology,0.01,4.14,
BETAMETHASONE VALERATE 15GM 0.1% CREAM,,,,80000253,CDM,250,RC,168004015,NDC,both,1,GM,4.14,1.63,39.4668,,1.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.41,34,,1.41,percent of total billed charges,"Drugs, Inpatient Only",1.41,34,,1.41,percent of total billed charges,"Drugs, Inpatient Only",1.41,34,,1.41,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.9,70,,2.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.38,,,1.38,Other,Drug Cost,1.38,,,1.38,Other,Drug Cost,1.38,,,1.38,Other,Drug Cost,1.38,,,1.38,Other,Drug Cost,1.38,,,1.38,Other,Drug Cost,1.38,,,1.38,Other,Drug Cost,3.11,,,3.11,Other,225% of Medicaid,1.93,,,1.93,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.97,,,2.97,Other,215% Medicaid APG methodology,2.97,,,2.97,Other,215% Medicaid APG methodology,1.73,,,1.73,Other,125% Medicaid APG methodology,0.01,3.11,
BETAXOLOL 0.5% 5ML OPHTH SOLN,,,,80000255,CDM,250,RC,61314024502,NDC,both,1,ML,104.43,41.22,39.4668,,41.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,35.51,34,,35.51,percent of total billed charges,"Drugs, Inpatient Only",35.51,34,,35.51,percent of total billed charges,"Drugs, Inpatient Only",35.51,34,,35.51,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,73.1,70,,73.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,34.81,,,34.81,Other,Drug Cost,34.81,,,34.81,Other,Drug Cost,34.81,,,34.81,Other,Drug Cost,34.81,,,34.81,Other,Drug Cost,34.81,,,34.81,Other,Drug Cost,34.81,,,34.81,Other,Drug Cost,78.32,,,78.32,Other,225% of Medicaid,48.73,,,48.73,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,74.84,,,74.84,Other,215% Medicaid APG methodology,74.84,,,74.84,Other,215% Medicaid APG methodology,43.51,,,43.51,Other,125% Medicaid APG methodology,0.01,78.32,
BETHANECHOL 5 MG TAB,,,,80000256,CDM,250,RC,832051000,NDC,both,100,EA,0.04,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.03,
BETHANECHOL CL 25MG,,,,80000258,CDM,250,RC,832051201,NDC,both,10,EA,2.18,0.86,39.4668,,0.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.74,34,,0.74,percent of total billed charges,"Drugs, Inpatient Only",0.74,34,,0.74,percent of total billed charges,"Drugs, Inpatient Only",0.74,34,,0.74,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.52,70,,1.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.73,,,0.73,Other,Drug Cost,0.73,,,0.73,Other,Drug Cost,0.73,,,0.73,Other,Drug Cost,0.73,,,0.73,Other,Drug Cost,0.73,,,0.73,Other,Drug Cost,0.73,,,0.73,Other,Drug Cost,1.63,,,1.63,Other,225% of Medicaid,1.02,,,1.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.56,,,1.56,Other,215% Medicaid APG methodology,1.56,,,1.56,Other,215% Medicaid APG methodology,0.91,,,0.91,Other,125% Medicaid APG methodology,0.01,1.63,
BICALUTAMIDE (CASODEX) 50MG,,,,80000259,CDM,250,RC,47335048583,NDC,both,30,EA,0.3,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,70,,0.21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.22,,,0.22,Other,225% of Medicaid,0.14,,,0.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.21,,,0.21,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.22,
BISACODYL 10MG SUPPOSITORY,,,,80000262,CDM,250,RC,574705012,NDC,both,12,EA,0.3,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,70,,0.21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.23,,,0.23,Other,225% of Medicaid,0.14,,,0.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.22,,,0.22,Other,215% Medicaid APG methodology,0.22,,,0.22,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.23,
BISACODYL 5 MG,,,,80000263,CDM,250,RC,904674860,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
BISOPROLOL 5MG,,,,80000265,CDM,250,RC,29300012613,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
BREVIBLOC 10MG/ML 10ML,,,,80000272,CDM,250,RC,55150019410,NDC,both,25,ML,4.44,1.75,39.4668,,1.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.51,34,,1.51,percent of total billed charges,"Drugs, Inpatient Only",1.51,34,,1.51,percent of total billed charges,"Drugs, Inpatient Only",1.51,34,,1.51,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.11,70,,3.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.48,,,1.48,Other,Drug Cost,1.48,,,1.48,Other,Drug Cost,1.48,,,1.48,Other,Drug Cost,1.48,,,1.48,Other,Drug Cost,1.48,,,1.48,Other,Drug Cost,1.48,,,1.48,Other,Drug Cost,3.33,,,3.33,Other,225% of Medicaid,2.07,,,2.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.19,,,3.19,Other,215% Medicaid APG methodology,3.19,,,3.19,Other,215% Medicaid APG methodology,1.85,,,1.85,Other,125% Medicaid APG methodology,0.01,3.33,
BRIMONIDINE 0.002,,,,80000274,CDM,250,RC,61314014305,NDC,both,1,ML,3.54,1.4,39.4668,,1.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.2,34,,1.2,percent of total billed charges,"Drugs, Inpatient Only",1.2,34,,1.2,percent of total billed charges,"Drugs, Inpatient Only",1.2,34,,1.2,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.48,70,,2.48,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,2.66,,,2.66,Other,225% of Medicaid,1.65,,,1.65,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.54,,,2.54,Other,215% Medicaid APG methodology,2.54,,,2.54,Other,215% Medicaid APG methodology,1.48,,,1.48,Other,125% Medicaid APG methodology,0.01,2.66,
BRIMONIDINE 0.15% OPHTHALMIC SOL,,,,80000275,CDM,250,RC,61314014405,NDC,both,1,ML,72.18,28.49,39.4668,,28.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.54,34,,24.54,percent of total billed charges,"Drugs, Inpatient Only",24.54,34,,24.54,percent of total billed charges,"Drugs, Inpatient Only",24.54,34,,24.54,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,50.53,70,,50.53,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.06,,,24.06,Other,Drug Cost,24.06,,,24.06,Other,Drug Cost,24.06,,,24.06,Other,Drug Cost,24.06,,,24.06,Other,Drug Cost,24.06,,,24.06,Other,Drug Cost,24.06,,,24.06,Other,Drug Cost,54.14,,,54.14,Other,225% of Medicaid,33.68,,,33.68,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,51.73,,,51.73,Other,215% Medicaid APG methodology,51.73,,,51.73,Other,215% Medicaid APG methodology,30.08,,,30.08,Other,125% Medicaid APG methodology,0.01,54.14,
BRIMONIDINE TATRATE (ALPHAGAN P) 0.1%,,,,80000276,CDM,250,RC,23932105,NDC,both,1,ML,528.42,208.55,39.4668,,208.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,179.66,34,,179.66,percent of total billed charges,"Drugs, Inpatient Only",179.66,34,,179.66,percent of total billed charges,"Drugs, Inpatient Only",179.66,34,,179.66,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,369.89,70,,369.89,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,176.14,,,176.14,Other,Drug Cost,176.14,,,176.14,Other,Drug Cost,176.14,,,176.14,Other,Drug Cost,176.14,,,176.14,Other,Drug Cost,176.14,,,176.14,Other,Drug Cost,176.14,,,176.14,Other,Drug Cost,396.32,,,396.32,Other,225% of Medicaid,246.6,,,246.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,378.7,,,378.7,Other,215% Medicaid APG methodology,378.7,,,378.7,Other,215% Medicaid APG methodology,220.18,,,220.18,Other,125% Medicaid APG methodology,0.01,396.32,
BROMOCRIPTINE 2.5MG,,,,80000280,CDM,250,RC,574010601,NDC,both,100,EA,1,0.39,39.4668,,0.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,34,,0.34,percent of total billed charges,"Drugs, Inpatient Only",0.34,34,,0.34,percent of total billed charges,"Drugs, Inpatient Only",0.34,34,,0.34,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.7,70,,0.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.33,,,0.33,Other,Drug Cost,0.33,,,0.33,Other,Drug Cost,0.33,,,0.33,Other,Drug Cost,0.33,,,0.33,Other,Drug Cost,0.33,,,0.33,Other,Drug Cost,0.33,,,0.33,Other,Drug Cost,0.75,,,0.75,Other,225% of Medicaid,0.46,,,0.46,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.71,,,0.71,Other,215% Medicaid APG methodology,0.71,,,0.71,Other,215% Medicaid APG methodology,0.41,,,0.41,Other,125% Medicaid APG methodology,0.01,0.75,
BUDESONIDE 0.25 MG/2 ML INH,,,,80000283,CDM,250,RC,93681573,NDC,both,30,ML,2.76,1.09,39.4668,,1.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.94,34,,0.94,percent of total billed charges,"Drugs, Inpatient Only",0.94,34,,0.94,percent of total billed charges,"Drugs, Inpatient Only",0.94,34,,0.94,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.93,70,,1.93,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,2.07,,,2.07,Other,225% of Medicaid,1.29,,,1.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.98,,,1.98,Other,215% Medicaid APG methodology,1.98,,,1.98,Other,215% Medicaid APG methodology,1.15,,,1.15,Other,125% Medicaid APG methodology,0.01,2.07,
BUDESONIDE 0.5 MG/2 ML INH,,,,80000284,CDM,250,RC,93681673,NDC,both,30,ML,1.07,0.42,39.4668,,0.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.36,34,,0.36,percent of total billed charges,"Drugs, Inpatient Only",0.36,34,,0.36,percent of total billed charges,"Drugs, Inpatient Only",0.36,34,,0.36,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.75,70,,0.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.8,,,0.8,Other,225% of Medicaid,0.5,,,0.5,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.77,,,0.77,Other,215% Medicaid APG methodology,0.77,,,0.77,Other,215% Medicaid APG methodology,0.45,,,0.45,Other,125% Medicaid APG methodology,0.01,0.8,
BUMETANIDE 1 MG,,,,80000287,CDM,250,RC,185012901,NDC,both,100,EA,0.16,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
BUPIVACAINE 0.25% 10ML,,,,80000289,CDM,250,RC,409115901,NDC,both,25,ML,1.58,0.62,39.4668,,0.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.54,34,,0.54,percent of total billed charges,"Drugs, Inpatient Only",0.54,34,,0.54,percent of total billed charges,"Drugs, Inpatient Only",0.54,34,,0.54,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.1,70,,1.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.53,,,0.53,Other,Drug Cost,0.53,,,0.53,Other,Drug Cost,0.53,,,0.53,Other,Drug Cost,0.53,,,0.53,Other,Drug Cost,0.53,,,0.53,Other,Drug Cost,0.53,,,0.53,Other,Drug Cost,1.18,,,1.18,Other,225% of Medicaid,0.74,,,0.74,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.13,,,1.13,Other,215% Medicaid APG methodology,1.13,,,1.13,Other,215% Medicaid APG methodology,0.66,,,0.66,Other,125% Medicaid APG methodology,0.01,1.18,
BUPIVACAINE 0.25% INJECTION,,,,80000290,CDM,250,RC,409158750,NDC,both,1,ML,12.78,5.04,39.4668,,5.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.35,34,,4.35,percent of total billed charges,"Drugs, Inpatient Only",4.35,34,,4.35,percent of total billed charges,"Drugs, Inpatient Only",4.35,34,,4.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.95,70,,8.95,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.26,,,4.26,Other,Drug Cost,4.26,,,4.26,Other,Drug Cost,4.26,,,4.26,Other,Drug Cost,4.26,,,4.26,Other,Drug Cost,4.26,,,4.26,Other,Drug Cost,4.26,,,4.26,Other,Drug Cost,9.59,,,9.59,Other,225% of Medicaid,5.96,,,5.96,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.16,,,9.16,Other,215% Medicaid APG methodology,9.16,,,9.16,Other,215% Medicaid APG methodology,5.33,,,5.33,Other,125% Medicaid APG methodology,0.01,9.59,
BUPIVACAINE 0.5% 30 ML,,,,80000291,CDM,250,RC,55150017030,NDC,both,25,ML,4.23,1.67,39.4668,,1.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.44,34,,1.44,percent of total billed charges,"Drugs, Inpatient Only",1.44,34,,1.44,percent of total billed charges,"Drugs, Inpatient Only",1.44,34,,1.44,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.96,70,,2.96,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,3.18,,,3.18,Other,225% of Medicaid,1.98,,,1.98,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.03,,,3.03,Other,215% Medicaid APG methodology,3.03,,,3.03,Other,215% Medicaid APG methodology,1.76,,,1.76,Other,125% Medicaid APG methodology,0.01,3.18,
BUPIVACAINE 0.5% 50 ML,,,,80000292,CDM,250,RC,409116301,NDC,both,25,ML,5.95,2.35,39.4668,,2.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.02,34,,2.02,percent of total billed charges,"Drugs, Inpatient Only",2.02,34,,2.02,percent of total billed charges,"Drugs, Inpatient Only",2.02,34,,2.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.16,70,,4.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.98,,,1.98,Other,Drug Cost,1.98,,,1.98,Other,Drug Cost,1.98,,,1.98,Other,Drug Cost,1.98,,,1.98,Other,Drug Cost,1.98,,,1.98,Other,Drug Cost,1.98,,,1.98,Other,Drug Cost,4.46,,,4.46,Other,225% of Medicaid,2.78,,,2.78,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.26,,,4.26,Other,215% Medicaid APG methodology,4.26,,,4.26,Other,215% Medicaid APG methodology,2.48,,,2.48,Other,125% Medicaid APG methodology,0.01,4.46,
BUPIVACAINE 0.5% INJECTION,,,,80000293,CDM,250,RC,409116201,NDC,both,25,ML,1.8,0.71,39.4668,,0.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.61,34,,0.61,percent of total billed charges,"Drugs, Inpatient Only",0.61,34,,0.61,percent of total billed charges,"Drugs, Inpatient Only",0.61,34,,0.61,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.26,70,,1.26,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,1.35,,,1.35,Other,225% of Medicaid,0.84,,,0.84,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.29,,,1.29,Other,215% Medicaid APG methodology,1.29,,,1.29,Other,215% Medicaid APG methodology,0.75,,,0.75,Other,125% Medicaid APG methodology,0.01,1.35,
BUPIVACAINE 0.75% INJECTION 10ML,,,,80000294,CDM,250,RC,63323047217,NDC,both,25,ML,1.96,0.77,39.4668,,0.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.37,70,,1.37,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,1.47,,,1.47,Other,225% of Medicaid,0.91,,,0.91,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.4,,,1.4,Other,215% Medicaid APG methodology,1.4,,,1.4,Other,215% Medicaid APG methodology,0.82,,,0.82,Other,125% Medicaid APG methodology,0.01,1.47,
BUPIVACAINE 0.75% INJECTION SPINAL 2ML,,,,80000295,CDM,250,RC,409361301,NDC,both,10,ML,5.49,2.17,39.4668,,2.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.87,34,,1.87,percent of total billed charges,"Drugs, Inpatient Only",1.87,34,,1.87,percent of total billed charges,"Drugs, Inpatient Only",1.87,34,,1.87,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.85,70,,3.85,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.83,,,1.83,Other,Drug Cost,1.83,,,1.83,Other,Drug Cost,1.83,,,1.83,Other,Drug Cost,1.83,,,1.83,Other,Drug Cost,1.83,,,1.83,Other,Drug Cost,1.83,,,1.83,Other,Drug Cost,4.12,,,4.12,Other,225% of Medicaid,2.56,,,2.56,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.94,,,3.94,Other,215% Medicaid APG methodology,3.94,,,3.94,Other,215% Medicaid APG methodology,2.29,,,2.29,Other,125% Medicaid APG methodology,0.01,4.12,
BUPIVACAINE PF 0.25%  30ML,,,,80000298,CDM,250,RC,55150016830,NDC,both,25,ML,4.6,1.82,39.4668,,1.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.56,34,,1.56,percent of total billed charges,"Drugs, Inpatient Only",1.56,34,,1.56,percent of total billed charges,"Drugs, Inpatient Only",1.56,34,,1.56,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.22,70,,3.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.53,,,1.53,Other,Drug Cost,1.53,,,1.53,Other,Drug Cost,1.53,,,1.53,Other,Drug Cost,1.53,,,1.53,Other,Drug Cost,1.53,,,1.53,Other,Drug Cost,1.53,,,1.53,Other,Drug Cost,3.45,,,3.45,Other,225% of Medicaid,2.15,,,2.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.3,,,3.3,Other,215% Medicaid APG methodology,3.3,,,3.3,Other,215% Medicaid APG methodology,1.92,,,1.92,Other,125% Medicaid APG methodology,0.01,3.45,
BUPIVACAINE/EPI 0.25% 10 ML,,,,80000299,CDM,250,RC,409904201,NDC,both,10,ML,1.47,0.58,39.4668,,0.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.5,34,,0.5,percent of total billed charges,"Drugs, Inpatient Only",0.5,34,,0.5,percent of total billed charges,"Drugs, Inpatient Only",0.5,34,,0.5,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.03,70,,1.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,1.1,,,1.1,Other,225% of Medicaid,0.69,,,0.69,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.05,,,1.05,Other,215% Medicaid APG methodology,1.05,,,1.05,Other,215% Medicaid APG methodology,0.61,,,0.61,Other,125% Medicaid APG methodology,0.01,1.1,
BUPIVACAINE/EPI 0.5%  10 ML,,,,80000301,CDM,250,RC,409904501,NDC,both,10,ML,1.54,0.61,39.4668,,0.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.52,34,,0.52,percent of total billed charges,"Drugs, Inpatient Only",0.52,34,,0.52,percent of total billed charges,"Drugs, Inpatient Only",0.52,34,,0.52,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.08,70,,1.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,1.15,,,1.15,Other,225% of Medicaid,0.72,,,0.72,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.1,,,1.1,Other,215% Medicaid APG methodology,1.1,,,1.1,Other,215% Medicaid APG methodology,0.64,,,0.64,Other,125% Medicaid APG methodology,0.01,1.15,
BUPRENORPHINE-NALOXONE 8 MG-2 MG TAB,,,,80000307,CDM,250,RC,54018913,NDC,both,30,EA,0.92,0.36,39.4668,,0.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.31,34,,0.31,percent of total billed charges,"Drugs, Inpatient Only",0.31,34,,0.31,percent of total billed charges,"Drugs, Inpatient Only",0.31,34,,0.31,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.64,70,,0.64,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.69,,,0.69,Other,225% of Medicaid,0.43,,,0.43,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.66,,,0.66,Other,215% Medicaid APG methodology,0.66,,,0.66,Other,215% Medicaid APG methodology,0.38,,,0.38,Other,125% Medicaid APG methodology,0.01,0.69,
BUPROPION 100 MG,,,,80000308,CDM,250,RC,60505015701,NDC,both,100,EA,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
BUPROPION 75 MG,,,,80000309,CDM,250,RC,60505015801,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
BUPROPION XL 150MG TAB,,,,80000310,CDM,250,RC,68180031909,NDC,both,90,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
BUSPIRONE 15MG,,,,80000312,CDM,250,RC,93100301,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
BUSPIRONE 5 MG,,,,80000313,CDM,250,RC,64380074106,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CACO3 ANTACID 500MG,,,,80000319,CDM,250,RC,904641292,NDC,both,150,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CACO3 SUSP 1250 MG/5 ML,,,,80000320,CDM,250,RC,121476605,NDC,both,40,ML,1.23,0.48,39.4668,,0.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.42,34,,0.42,percent of total billed charges,"Drugs, Inpatient Only",0.42,34,,0.42,percent of total billed charges,"Drugs, Inpatient Only",0.42,34,,0.42,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.86,70,,0.86,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.92,,,0.92,Other,225% of Medicaid,0.57,,,0.57,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.88,,,0.88,Other,215% Medicaid APG methodology,0.88,,,0.88,Other,215% Medicaid APG methodology,0.51,,,0.51,Other,125% Medicaid APG methodology,0.01,0.92,
CAFFEINE-SOD BENZ 250MG/ML,,,,80000321,CDM,250,RC,517250210,NDC,both,10,ML,8.75,3.45,39.4668,,3.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.97,34,,2.97,percent of total billed charges,"Drugs, Inpatient Only",2.97,34,,2.97,percent of total billed charges,"Drugs, Inpatient Only",2.97,34,,2.97,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.12,70,,6.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.92,,,2.92,Other,Drug Cost,2.92,,,2.92,Other,Drug Cost,2.92,,,2.92,Other,Drug Cost,2.92,,,2.92,Other,Drug Cost,2.92,,,2.92,Other,Drug Cost,2.92,,,2.92,Other,Drug Cost,6.56,,,6.56,Other,225% of Medicaid,4.08,,,4.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.27,,,6.27,Other,215% Medicaid APG methodology,6.27,,,6.27,Other,215% Medicaid APG methodology,3.64,,,3.64,Other,125% Medicaid APG methodology,0.01,6.56,
CALAMINE 120ML,,,,80000322,CDM,250,RC,904253321,NDC,both,1,ML,3.96,1.56,39.4668,,1.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.35,34,,1.35,percent of total billed charges,"Drugs, Inpatient Only",1.35,34,,1.35,percent of total billed charges,"Drugs, Inpatient Only",1.35,34,,1.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.77,70,,2.77,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.32,,,1.32,Other,Drug Cost,1.32,,,1.32,Other,Drug Cost,1.32,,,1.32,Other,Drug Cost,1.32,,,1.32,Other,Drug Cost,1.32,,,1.32,Other,Drug Cost,1.32,,,1.32,Other,Drug Cost,2.97,,,2.97,Other,225% of Medicaid,1.85,,,1.85,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.84,,,2.84,Other,215% Medicaid APG methodology,2.84,,,2.84,Other,215% Medicaid APG methodology,1.65,,,1.65,Other,125% Medicaid APG methodology,0.01,2.97,
CALCITRIOL 0.25 MCG,,,,80000326,CDM,250,RC,54000713,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CALCIUM ACETATE (PHOSLO) 667 MG CAP,,,,80000328,CDM,250,RC,781208102,NDC,both,200,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
CALCIUM CITRATE 950 MG TAB,,,,80000329,CDM,250,RC,80681014000,NDC,both,100,EA,0.06,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
CALCIUM CL SYRINGE 10ML,,,,80000330,CDM,250,RC,409163110,NDC,both,10,ML,1.24,0.49,39.4668,,0.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.42,34,,0.42,percent of total billed charges,"Drugs, Inpatient Only",0.42,34,,0.42,percent of total billed charges,"Drugs, Inpatient Only",0.42,34,,0.42,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.87,70,,0.87,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.93,,,0.93,Other,225% of Medicaid,0.58,,,0.58,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.89,,,0.89,Other,215% Medicaid APG methodology,0.89,,,0.89,Other,215% Medicaid APG methodology,0.52,,,0.52,Other,125% Medicaid APG methodology,0.01,0.93,
CALCIUM POLYCARBOPHIL (FIBERCON) 625 MG,,,,80000333,CDM,250,RC,536430608,NDC,both,60,EA,0.09,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.06,
CAPSAICIN 0.025% CREAM,,,,80000339,CDM,250,RC,536252525,NDC,both,1,GM,6.45,2.55,39.4668,,2.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.19,34,,2.19,percent of total billed charges,"Drugs, Inpatient Only",2.19,34,,2.19,percent of total billed charges,"Drugs, Inpatient Only",2.19,34,,2.19,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.52,70,,4.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.15,,,2.15,Other,Drug Cost,2.15,,,2.15,Other,Drug Cost,2.15,,,2.15,Other,Drug Cost,2.15,,,2.15,Other,Drug Cost,2.15,,,2.15,Other,Drug Cost,2.15,,,2.15,Other,Drug Cost,4.84,,,4.84,Other,225% of Medicaid,3.01,,,3.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.62,,,4.62,Other,215% Medicaid APG methodology,4.62,,,4.62,Other,215% Medicaid APG methodology,2.69,,,2.69,Other,125% Medicaid APG methodology,0.01,4.84,
CARBACHOL 0.01% OPTH SOLN,,,,80000343,CDM,250,RC,65002315,NDC,both,12,ML,1.85,0.73,39.4668,,0.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.29,70,,1.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,1.39,,,1.39,Other,225% of Medicaid,0.86,,,0.86,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.32,,,1.32,Other,215% Medicaid APG methodology,1.32,,,1.32,Other,215% Medicaid APG methodology,0.77,,,0.77,Other,125% Medicaid APG methodology,0.01,1.39,
CARBAMAZEPINE 100 MG,,,,80000345,CDM,250,RC,13668027101,NDC,both,100,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.08,
CARBAMAZEPINE 100 MG ER TABLET,,,,80000346,CDM,250,RC,78051005,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CARBAMAZEPINE 200 MG ER TABLET,,,,80000348,CDM,250,RC,51672412401,NDC,both,100,EA,0.02,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CARBAMAZEPINE 200 MG TAB,,,,80000349,CDM,250,RC,51672400501,NDC,both,100,EA,0.01,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CARBAMAZEPINE XR 400MG,,,,80000357,CDM,250,RC,78051205,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CARBAMIDE PEROXIDE EAR DROPS 15ML,,,,80000359,CDM,250,RC,904662735,NDC,both,1,ML,2.76,1.09,39.4668,,1.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.94,34,,0.94,percent of total billed charges,"Drugs, Inpatient Only",0.94,34,,0.94,percent of total billed charges,"Drugs, Inpatient Only",0.94,34,,0.94,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.93,70,,1.93,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,2.07,,,2.07,Other,225% of Medicaid,1.29,,,1.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.98,,,1.98,Other,215% Medicaid APG methodology,1.98,,,1.98,Other,215% Medicaid APG methodology,1.15,,,1.15,Other,125% Medicaid APG methodology,0.01,2.07,
CARBIDOPA/ LEVODOPA (CABIDOPA) 10/100,,,,80000361,CDM,250,RC,50228045701,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.08,
CARBIDOPA-LEVO 25-100MG,,,,80000364,CDM,250,RC,93970201,NDC,both,100,EA,0.13,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.1,
CARBIDOPA-LEVO 50-200MG,,,,80000366,CDM,250,RC,68084028201,NDC,both,10,EA,11.67,4.61,39.4668,,4.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.97,34,,3.97,percent of total billed charges,"Drugs, Inpatient Only",3.97,34,,3.97,percent of total billed charges,"Drugs, Inpatient Only",3.97,34,,3.97,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.17,70,,8.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,8.75,,,8.75,Other,225% of Medicaid,5.45,,,5.45,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.36,,,8.36,Other,215% Medicaid APG methodology,8.36,,,8.36,Other,215% Medicaid APG methodology,4.86,,,4.86,Other,125% Medicaid APG methodology,0.01,8.75,
CARBIDOPA-LEVO ER 25-100MG,,,,80000367,CDM,250,RC,62756046188,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
CARBOPROST 250 MCG/ML INJECTION,,,,80000372,CDM,250,RC,9085608,NDC,both,10,ML,50.65,19.99,39.4668,,19.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.22,34,,17.22,percent of total billed charges,"Drugs, Inpatient Only",17.22,34,,17.22,percent of total billed charges,"Drugs, Inpatient Only",17.22,34,,17.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,35.45,70,,35.45,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.88,,,16.88,Other,Drug Cost,16.88,,,16.88,Other,Drug Cost,16.88,,,16.88,Other,Drug Cost,16.88,,,16.88,Other,Drug Cost,16.88,,,16.88,Other,Drug Cost,16.88,,,16.88,Other,Drug Cost,37.99,,,37.99,Other,225% of Medicaid,23.64,,,23.64,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,36.3,,,36.3,Other,215% Medicaid APG methodology,36.3,,,36.3,Other,215% Medicaid APG methodology,21.1,,,21.1,Other,125% Medicaid APG methodology,0.01,37.99,
CARISOPRODOL 350 MG,,,,80000374,CDM,250,RC,16571078101,NDC,both,100,EA,0.09,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
CARVEDILOL (COREG) 12.5MG,,,,80000376,CDM,250,RC,68382009405,NDC,both,500,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CARVEDILOL (COREG) 25MG,,,,80000377,CDM,250,RC,68382009501,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
CARVEDILOL (COREG) 6.25MG,,,,80000379,CDM,250,RC,904630161,NDC,both,10,EA,0.36,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,70,,0.25,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.27,,,0.27,Other,225% of Medicaid,0.17,,,0.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.26,,,0.26,Other,215% Medicaid APG methodology,0.26,,,0.26,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,125% Medicaid APG methodology,0.01,0.27,
CEFUROXIME AXETIL 250 MG,,,,80000408,CDM,250,RC,67877021560,NDC,both,60,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CELECOXIB (CELEBREX) 200MG CAPS,,,,80000409,CDM,250,RC,69097042107,NDC,both,100,EA,0.09,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
CELECOXIB (CELEBREX) 100MG CAPS,,,,80000410,CDM,250,RC,25152031,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CEPHALEXIN 250 MG,,,,80000412,CDM,250,RC,93314501,NDC,both,100,EA,0.09,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.06,
CEPHALEXIN 250MG/5ML,,,,80000413,CDM,250,RC,93417773,NDC,both,1,ML,5.73,2.26,39.4668,,2.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.95,34,,1.95,percent of total billed charges,"Drugs, Inpatient Only",1.95,34,,1.95,percent of total billed charges,"Drugs, Inpatient Only",1.95,34,,1.95,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.01,70,,4.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.91,,,1.91,Other,Drug Cost,1.91,,,1.91,Other,Drug Cost,1.91,,,1.91,Other,Drug Cost,1.91,,,1.91,Other,Drug Cost,1.91,,,1.91,Other,Drug Cost,1.91,,,1.91,Other,Drug Cost,4.3,,,4.3,Other,225% of Medicaid,2.67,,,2.67,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.11,,,4.11,Other,215% Medicaid APG methodology,4.11,,,4.11,Other,215% Medicaid APG methodology,2.39,,,2.39,Other,125% Medicaid APG methodology,0.01,4.3,
CEPHALEXIN 500 MG,,,,80000414,CDM,250,RC,93314701,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
CHLORDIAZEPOXIDE 25 MG,,,,80000425,CDM,250,RC,555015902,NDC,both,100,EA,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
CHLORHEXIDINE GLUCONATE ORAL R,,,,80000427,CDM,250,RC,116200116,NDC,both,1,ML,7.62,3.01,39.4668,,3.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.59,34,,2.59,percent of total billed charges,"Drugs, Inpatient Only",2.59,34,,2.59,percent of total billed charges,"Drugs, Inpatient Only",2.59,34,,2.59,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.33,70,,5.33,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,5.72,,,5.72,Other,225% of Medicaid,3.56,,,3.56,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.46,,,5.46,Other,215% Medicaid APG methodology,5.46,,,5.46,Other,215% Medicaid APG methodology,3.18,,,3.18,Other,125% Medicaid APG methodology,0.01,5.72,
CHLOROPROCAINE HCL MPF 3%  20 ML,,,,80000428,CDM,250,RC,63323047827,NDC,both,25,ML,30.38,11.99,39.4668,,11.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.33,34,,10.33,percent of total billed charges,"Drugs, Inpatient Only",10.33,34,,10.33,percent of total billed charges,"Drugs, Inpatient Only",10.33,34,,10.33,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.27,70,,21.27,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.13,,,10.13,Other,Drug Cost,10.13,,,10.13,Other,Drug Cost,10.13,,,10.13,Other,Drug Cost,10.13,,,10.13,Other,Drug Cost,10.13,,,10.13,Other,Drug Cost,10.13,,,10.13,Other,Drug Cost,22.79,,,22.79,Other,225% of Medicaid,14.18,,,14.18,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,21.78,,,21.78,Other,215% Medicaid APG methodology,21.78,,,21.78,Other,215% Medicaid APG methodology,12.66,,,12.66,Other,125% Medicaid APG methodology,0.01,22.79,
CHLOROPROCAINE MPF 2% 20ML,,,,80000429,CDM,250,RC,63323047727,NDC,both,25,ML,24.3,9.59,39.4668,,9.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.26,34,,8.26,percent of total billed charges,"Drugs, Inpatient Only",8.26,34,,8.26,percent of total billed charges,"Drugs, Inpatient Only",8.26,34,,8.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.01,70,,17.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.1,,,8.1,Other,Drug Cost,8.1,,,8.1,Other,Drug Cost,8.1,,,8.1,Other,Drug Cost,8.1,,,8.1,Other,Drug Cost,8.1,,,8.1,Other,Drug Cost,8.1,,,8.1,Other,Drug Cost,18.22,,,18.22,Other,225% of Medicaid,11.34,,,11.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,17.41,,,17.41,Other,215% Medicaid APG methodology,17.41,,,17.41,Other,215% Medicaid APG methodology,10.12,,,10.12,Other,125% Medicaid APG methodology,0.01,18.22,
CHLORPROMAZINE HCL 25 MG,,,,80000439,CDM,250,RC,50268016315,NDC,both,5,EA,44.68,17.63,39.4668,,17.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.19,34,,15.19,percent of total billed charges,"Drugs, Inpatient Only",15.19,34,,15.19,percent of total billed charges,"Drugs, Inpatient Only",15.19,34,,15.19,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,31.27,70,,31.27,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.89,,,14.89,Other,Drug Cost,14.89,,,14.89,Other,Drug Cost,14.89,,,14.89,Other,Drug Cost,14.89,,,14.89,Other,Drug Cost,14.89,,,14.89,Other,Drug Cost,14.89,,,14.89,Other,Drug Cost,33.51,,,33.51,Other,225% of Medicaid,20.85,,,20.85,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,32.02,,,32.02,Other,215% Medicaid APG methodology,32.02,,,32.02,Other,215% Medicaid APG methodology,18.62,,,18.62,Other,125% Medicaid APG methodology,0.01,33.51,
CHLORTHALIDONE 25 MG,,,,80000443,CDM,250,RC,57664064888,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.08,
CHOLECALCIFEROL 400 INT. UNITS TAB,,,,80000444,CDM,250,RC,904582360,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CHOLESTYRAMINE 4GRAM PACKETS,,,,80000445,CDM,250,RC,68382052960,NDC,both,60,EA,1.02,0.4,39.4668,,0.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.71,70,,0.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.76,,,0.76,Other,225% of Medicaid,0.47,,,0.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.73,,,0.73,Other,215% Medicaid APG methodology,0.73,,,0.73,Other,215% Medicaid APG methodology,0.42,,,0.42,Other,125% Medicaid APG methodology,0.01,0.76,
CHROMIUM CHLORIDE 4 MCG/ML 10 ML INJ,,,,80000447,CDM,250,RC,409409301,NDC,both,25,ML,10.33,4.08,39.4668,,4.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.51,34,,3.51,percent of total billed charges,"Drugs, Inpatient Only",3.51,34,,3.51,percent of total billed charges,"Drugs, Inpatient Only",3.51,34,,3.51,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.23,70,,7.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.44,,,3.44,Other,Drug Cost,3.44,,,3.44,Other,Drug Cost,3.44,,,3.44,Other,Drug Cost,3.44,,,3.44,Other,Drug Cost,3.44,,,3.44,Other,Drug Cost,3.44,,,3.44,Other,Drug Cost,7.75,,,7.75,Other,225% of Medicaid,4.82,,,4.82,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.4,,,7.4,Other,215% Medicaid APG methodology,7.4,,,7.4,Other,215% Medicaid APG methodology,4.3,,,4.3,Other,125% Medicaid APG methodology,0.01,7.75,
CILOSTAZOL 50 MG,,,,80000451,CDM,250,RC,60505252101,NDC,both,60,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
CIPRODEX OTIC SOLN,,,,80000452,CDM,250,RC,781618667,NDC,both,1,ML,68.07,26.87,39.4668,,26.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,23.14,34,,23.14,percent of total billed charges,"Drugs, Inpatient Only",23.14,34,,23.14,percent of total billed charges,"Drugs, Inpatient Only",23.14,34,,23.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,47.65,70,,47.65,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.69,,,22.69,Other,Drug Cost,22.69,,,22.69,Other,Drug Cost,22.69,,,22.69,Other,Drug Cost,22.69,,,22.69,Other,Drug Cost,22.69,,,22.69,Other,Drug Cost,22.69,,,22.69,Other,Drug Cost,51.05,,,51.05,Other,225% of Medicaid,31.77,,,31.77,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,48.78,,,48.78,Other,215% Medicaid APG methodology,48.78,,,48.78,Other,215% Medicaid APG methodology,28.36,,,28.36,Other,125% Medicaid APG methodology,0.01,51.05,
CIPROFLOXACIN 0.3% (CILOXIN)2.5ML,,,,80000455,CDM,250,RC,61314065625,NDC,both,1,ML,1.86,0.73,39.4668,,0.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.3,70,,1.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,1.4,,,1.4,Other,225% of Medicaid,0.87,,,0.87,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.33,,,1.33,Other,215% Medicaid APG methodology,1.33,,,1.33,Other,215% Medicaid APG methodology,0.78,,,0.78,Other,125% Medicaid APG methodology,0.01,1.4,
CIPROFLOXACIN 250 MG TAB,,,,80000456,CDM,250,RC,143992701,NDC,both,100,EA,0.09,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
CIPROFLOXACIN 500MG TAB,,,,80000457,CDM,250,RC,143992801,NDC,both,100,EA,0.18,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,70,,0.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.13,
CISATRACURIUM 2 MG/ML INJECTION 5ML,,,,80000462,CDM,250,RC,74437805,NDC,both,10,ML,42.61,16.82,39.4668,,16.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.49,34,,14.49,percent of total billed charges,"Drugs, Inpatient Only",14.49,34,,14.49,percent of total billed charges,"Drugs, Inpatient Only",14.49,34,,14.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,29.83,70,,29.83,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.2,,,14.2,Other,Drug Cost,14.2,,,14.2,Other,Drug Cost,14.2,,,14.2,Other,Drug Cost,14.2,,,14.2,Other,Drug Cost,14.2,,,14.2,Other,Drug Cost,14.2,,,14.2,Other,Drug Cost,31.96,,,31.96,Other,225% of Medicaid,19.88,,,19.88,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,30.54,,,30.54,Other,215% Medicaid APG methodology,30.54,,,30.54,Other,215% Medicaid APG methodology,17.75,,,17.75,Other,125% Medicaid APG methodology,0.01,31.96,
CITALOPRAM (CELEXA) 10MG,,,,80000464,CDM,250,RC,378623101,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CITALOPRAM (CELEXA) 20MG,,,,80000465,CDM,250,RC,378623201,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CLARITHROMYCIN 500MG,,,,80000475,CDM,250,RC,65862022660,NDC,both,60,EA,0.43,0.17,39.4668,,0.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.3,70,,0.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.32,,,0.32,Other,225% of Medicaid,0.2,,,0.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.31,,,0.31,Other,215% Medicaid APG methodology,0.31,,,0.31,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,125% Medicaid APG methodology,0.01,0.32,
CLINDAMYCIN (CLEOCIN) 300MG/2ML VIAL,,,,80000477,CDM,250,RC,9087026,NDC,both,25,ML,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
CLINDAMYCIN HCL 150 MG CAPS,,,,80000480,CDM,250,RC,63304069201,NDC,both,100,EA,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
CLINDAMYCIN PHOS GEL 30 GM,,,,80000481,CDM,250,RC,59762374301,NDC,both,1,GM,8.22,3.24,39.4668,,3.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.79,34,,2.79,percent of total billed charges,"Drugs, Inpatient Only",2.79,34,,2.79,percent of total billed charges,"Drugs, Inpatient Only",2.79,34,,2.79,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.75,70,,5.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.74,,,2.74,Other,Drug Cost,2.74,,,2.74,Other,Drug Cost,2.74,,,2.74,Other,Drug Cost,2.74,,,2.74,Other,Drug Cost,2.74,,,2.74,Other,Drug Cost,2.74,,,2.74,Other,Drug Cost,6.17,,,6.17,Other,225% of Medicaid,3.84,,,3.84,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.89,,,5.89,Other,215% Medicaid APG methodology,5.89,,,5.89,Other,215% Medicaid APG methodology,3.43,,,3.43,Other,125% Medicaid APG methodology,0.01,6.17,
CLINIMIX 5/20 1000ML,,,,80000485,CDM,250,RC,338113803,NDC,both,6,ML,37.43,14.77,39.4668,,14.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.72,34,,12.72,percent of total billed charges,"Drugs, Inpatient Only",12.72,34,,12.72,percent of total billed charges,"Drugs, Inpatient Only",12.72,34,,12.72,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,26.2,70,,26.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.48,,,12.48,Other,Drug Cost,12.48,,,12.48,Other,Drug Cost,12.48,,,12.48,Other,Drug Cost,12.48,,,12.48,Other,Drug Cost,12.48,,,12.48,Other,Drug Cost,12.48,,,12.48,Other,Drug Cost,28.07,,,28.07,Other,225% of Medicaid,17.47,,,17.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,26.82,,,26.82,Other,215% Medicaid APG methodology,26.82,,,26.82,Other,215% Medicaid APG methodology,15.59,,,15.59,Other,125% Medicaid APG methodology,0.01,28.07,
CLINIMIX E AA/20% 1000ML,,,,80000488,CDM,250,RC,338114803,NDC,both,6,ML,40.14,15.84,39.4668,,15.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.65,34,,13.65,percent of total billed charges,"Drugs, Inpatient Only",13.65,34,,13.65,percent of total billed charges,"Drugs, Inpatient Only",13.65,34,,13.65,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,28.1,70,,28.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.38,,,13.38,Other,Drug Cost,13.38,,,13.38,Other,Drug Cost,13.38,,,13.38,Other,Drug Cost,13.38,,,13.38,Other,Drug Cost,13.38,,,13.38,Other,Drug Cost,13.38,,,13.38,Other,Drug Cost,30.11,,,30.11,Other,225% of Medicaid,18.73,,,18.73,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,28.77,,,28.77,Other,215% Medicaid APG methodology,28.77,,,28.77,Other,215% Medicaid APG methodology,16.73,,,16.73,Other,125% Medicaid APG methodology,0.01,30.11,
CLOBETASOL  0.05% CREAM 15 GM,,,,80000490,CDM,250,RC,51672125801,NDC,both,1,GM,0.69,0.27,39.4668,,0.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.48,70,,0.48,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.52,,,0.52,Other,225% of Medicaid,0.32,,,0.32,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.49,,,0.49,Other,215% Medicaid APG methodology,0.49,,,0.49,Other,215% Medicaid APG methodology,0.29,,,0.29,Other,125% Medicaid APG methodology,0.01,0.52,
CLOBETASOL  0.05% OINT 45 GM,,,,80000491,CDM,250,RC,51672125901,NDC,both,1,GM,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
CLOMIPRAMINE 25MG TAB,,,,80000494,CDM,250,RC,51672401106,NDC,both,30,EA,1.36,0.54,39.4668,,0.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.95,70,,0.95,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,1.02,,,1.02,Other,225% of Medicaid,0.63,,,0.63,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.97,,,0.97,Other,215% Medicaid APG methodology,0.97,,,0.97,Other,215% Medicaid APG methodology,0.57,,,0.57,Other,125% Medicaid APG methodology,0.01,1.02,
CLONAZEPAM 0.5 MG,,,,80000495,CDM,250,RC,93083201,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CLONIDINE (CATAPRES) 0.1 MG PATCH,,,,80000497,CDM,250,RC,378087199,NDC,both,4,EA,8.68,3.42,39.4668,,3.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.95,34,,2.95,percent of total billed charges,"Drugs, Inpatient Only",2.95,34,,2.95,percent of total billed charges,"Drugs, Inpatient Only",2.95,34,,2.95,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.07,70,,6.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,6.51,,,6.51,Other,225% of Medicaid,4.05,,,4.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.22,,,6.22,Other,215% Medicaid APG methodology,6.22,,,6.22,Other,215% Medicaid APG methodology,3.62,,,3.62,Other,125% Medicaid APG methodology,0.01,6.51,
CLONIDINE (CATAPRES) 0.2 MG PATCH,,,,80000498,CDM,250,RC,591350904,NDC,both,4,EA,11.17,4.41,39.4668,,4.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.8,34,,3.8,percent of total billed charges,"Drugs, Inpatient Only",3.8,34,,3.8,percent of total billed charges,"Drugs, Inpatient Only",3.8,34,,3.8,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.82,70,,7.82,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.72,,,3.72,Other,Drug Cost,3.72,,,3.72,Other,Drug Cost,3.72,,,3.72,Other,Drug Cost,3.72,,,3.72,Other,Drug Cost,3.72,,,3.72,Other,Drug Cost,3.72,,,3.72,Other,Drug Cost,8.38,,,8.38,Other,225% of Medicaid,5.21,,,5.21,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8,,,8,Other,215% Medicaid APG methodology,8,,,8,Other,215% Medicaid APG methodology,4.65,,,4.65,Other,125% Medicaid APG methodology,0.01,8.38,
CLONIDINE (CATAPRES) 0.3MG PATCH,,,,80000499,CDM,250,RC,378087399,NDC,both,4,EA,15.29,6.03,39.4668,,6.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.2,34,,5.2,percent of total billed charges,"Drugs, Inpatient Only",5.2,34,,5.2,percent of total billed charges,"Drugs, Inpatient Only",5.2,34,,5.2,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.7,70,,10.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.1,,,5.1,Other,Drug Cost,5.1,,,5.1,Other,Drug Cost,5.1,,,5.1,Other,Drug Cost,5.1,,,5.1,Other,Drug Cost,5.1,,,5.1,Other,Drug Cost,5.1,,,5.1,Other,Drug Cost,11.46,,,11.46,Other,225% of Medicaid,7.13,,,7.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.95,,,10.95,Other,215% Medicaid APG methodology,10.95,,,10.95,Other,215% Medicaid APG methodology,6.37,,,6.37,Other,125% Medicaid APG methodology,0.01,11.46,
CLONIDINE 0.1 MG,,,,80000500,CDM,250,RC,52817018010,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CLOTRIMAZOLE 1% 10 ML,,,,80000503,CDM,250,RC,51672126003,NDC,both,1,ML,23.82,9.4,39.4668,,9.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.1,34,,8.1,percent of total billed charges,"Drugs, Inpatient Only",8.1,34,,8.1,percent of total billed charges,"Drugs, Inpatient Only",8.1,34,,8.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.67,70,,16.67,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.94,,,7.94,Other,Drug Cost,7.94,,,7.94,Other,Drug Cost,7.94,,,7.94,Other,Drug Cost,7.94,,,7.94,Other,Drug Cost,7.94,,,7.94,Other,Drug Cost,7.94,,,7.94,Other,Drug Cost,17.87,,,17.87,Other,225% of Medicaid,11.12,,,11.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,17.07,,,17.07,Other,215% Medicaid APG methodology,17.07,,,17.07,Other,215% Medicaid APG methodology,9.93,,,9.93,Other,125% Medicaid APG methodology,0.01,17.87,
CLOTRIMAZOLE 10 MG,,,,80000506,CDM,250,RC,54414622,NDC,both,70,EA,0.42,0.17,39.4668,,0.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,70,,0.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.31,,,0.31,Other,225% of Medicaid,0.2,,,0.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.3,,,0.3,Other,215% Medicaid APG methodology,0.3,,,0.3,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,125% Medicaid APG methodology,0.01,0.31,
CLOTRIMAZOLE 15GM,,,,80000507,CDM,250,RC,45802043401,NDC,both,1,GM,2.1,0.83,39.4668,,0.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.71,34,,0.71,percent of total billed charges,"Drugs, Inpatient Only",0.71,34,,0.71,percent of total billed charges,"Drugs, Inpatient Only",0.71,34,,0.71,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.47,70,,1.47,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,1.58,,,1.58,Other,225% of Medicaid,0.98,,,0.98,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.51,,,1.51,Other,215% Medicaid APG methodology,1.51,,,1.51,Other,215% Medicaid APG methodology,0.88,,,0.88,Other,125% Medicaid APG methodology,0.01,1.58,
CLOTRIMAZOLE-BETAMETHASONE CRM,,,,80000509,CDM,250,RC,472037915,NDC,both,1,GM,2.94,1.16,39.4668,,1.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1,34,,1,percent of total billed charges,"Drugs, Inpatient Only",1,34,,1,percent of total billed charges,"Drugs, Inpatient Only",1,34,,1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.06,70,,2.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.98,,,0.98,Other,Drug Cost,0.98,,,0.98,Other,Drug Cost,0.98,,,0.98,Other,Drug Cost,0.98,,,0.98,Other,Drug Cost,0.98,,,0.98,Other,Drug Cost,0.98,,,0.98,Other,Drug Cost,2.21,,,2.21,Other,225% of Medicaid,1.37,,,1.37,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.11,,,2.11,Other,215% Medicaid APG methodology,2.11,,,2.11,Other,215% Medicaid APG methodology,1.23,,,1.23,Other,125% Medicaid APG methodology,0.01,2.21,
CLOZAPINE 100 MG,,,,80000510,CDM,250,RC,60687041501,NDC,both,10,EA,9.38,3.7,39.4668,,3.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.19,34,,3.19,percent of total billed charges,"Drugs, Inpatient Only",3.19,34,,3.19,percent of total billed charges,"Drugs, Inpatient Only",3.19,34,,3.19,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.57,70,,6.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.13,,,3.13,Other,Drug Cost,3.13,,,3.13,Other,Drug Cost,3.13,,,3.13,Other,Drug Cost,3.13,,,3.13,Other,Drug Cost,3.13,,,3.13,Other,Drug Cost,3.13,,,3.13,Other,Drug Cost,7.04,,,7.04,Other,225% of Medicaid,4.38,,,4.38,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.73,,,6.73,Other,215% Medicaid APG methodology,6.73,,,6.73,Other,215% Medicaid APG methodology,3.91,,,3.91,Other,125% Medicaid APG methodology,0.01,7.04,
CLOZAPINE 25 MG,,,,80000511,CDM,250,RC,904708961,NDC,both,10,EA,7.39,2.92,39.4668,,2.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.51,34,,2.51,percent of total billed charges,"Drugs, Inpatient Only",2.51,34,,2.51,percent of total billed charges,"Drugs, Inpatient Only",2.51,34,,2.51,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.17,70,,5.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.46,,,2.46,Other,Drug Cost,2.46,,,2.46,Other,Drug Cost,2.46,,,2.46,Other,Drug Cost,2.46,,,2.46,Other,Drug Cost,2.46,,,2.46,Other,Drug Cost,2.46,,,2.46,Other,Drug Cost,5.54,,,5.54,Other,225% of Medicaid,3.45,,,3.45,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.29,,,5.29,Other,215% Medicaid APG methodology,5.29,,,5.29,Other,215% Medicaid APG methodology,3.08,,,3.08,Other,125% Medicaid APG methodology,0.01,5.54,
CODEINE SULFATE 15 MG TABLET,,,,80000516,CDM,250,RC,54024324,NDC,both,10,EA,8.78,3.47,39.4668,,3.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.99,34,,2.99,percent of total billed charges,"Drugs, Inpatient Only",2.99,34,,2.99,percent of total billed charges,"Drugs, Inpatient Only",2.99,34,,2.99,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.15,70,,6.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,6.59,,,6.59,Other,225% of Medicaid,4.1,,,4.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.3,,,6.3,Other,215% Medicaid APG methodology,6.3,,,6.3,Other,215% Medicaid APG methodology,3.66,,,3.66,Other,125% Medicaid APG methodology,0.01,6.59,
COLCHICINE 0.6 MG,,,,80000521,CDM,250,RC,43598037201,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
COMPAZINE SUPP 25 MG,,,,80000527,CDM,250,RC,574722612,NDC,both,12,EA,4.49,1.77,39.4668,,1.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.14,70,,3.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,3.36,,,3.36,Other,225% of Medicaid,2.09,,,2.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.21,,,3.21,Other,215% Medicaid APG methodology,3.21,,,3.21,Other,215% Medicaid APG methodology,1.87,,,1.87,Other,125% Medicaid APG methodology,0.01,3.36,
CONJ ESTROGENS  42.5 GM CREAM,,,,80000529,CDM,250,RC,46087221,NDC,both,1,GM,0.81,0.32,39.4668,,0.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,70,,0.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.61,,,0.61,Other,225% of Medicaid,0.38,,,0.38,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.58,,,0.58,Other,215% Medicaid APG methodology,0.58,,,0.58,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,0.61,
CONJ ESTROGENS 0.625 MG TAB,,,,80000531,CDM,250,RC,46110291,NDC,both,1000,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CORTISPORIN 1% OTIC SOLUTION,,,,80000533,CDM,250,RC,24208063110,NDC,both,1,ML,32.22,12.72,39.4668,,12.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.95,34,,10.95,percent of total billed charges,"Drugs, Inpatient Only",10.95,34,,10.95,percent of total billed charges,"Drugs, Inpatient Only",10.95,34,,10.95,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.55,70,,22.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.74,,,10.74,Other,Drug Cost,10.74,,,10.74,Other,Drug Cost,10.74,,,10.74,Other,Drug Cost,10.74,,,10.74,Other,Drug Cost,10.74,,,10.74,Other,Drug Cost,10.74,,,10.74,Other,Drug Cost,24.17,,,24.17,Other,225% of Medicaid,15.04,,,15.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,23.09,,,23.09,Other,215% Medicaid APG methodology,23.09,,,23.09,Other,215% Medicaid APG methodology,13.43,,,13.43,Other,125% Medicaid APG methodology,0.01,24.17,
COSOPT OPTH SOLN 10 ML,,,,80000534,CDM,250,RC,61314003002,NDC,both,1,ML,18.57,7.33,39.4668,,7.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.31,34,,6.31,percent of total billed charges,"Drugs, Inpatient Only",6.31,34,,6.31,percent of total billed charges,"Drugs, Inpatient Only",6.31,34,,6.31,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13,70,,13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.19,,,6.19,Other,Drug Cost,6.19,,,6.19,Other,Drug Cost,6.19,,,6.19,Other,Drug Cost,6.19,,,6.19,Other,Drug Cost,6.19,,,6.19,Other,Drug Cost,6.19,,,6.19,Other,Drug Cost,13.93,,,13.93,Other,225% of Medicaid,8.67,,,8.67,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,13.31,,,13.31,Other,215% Medicaid APG methodology,13.31,,,13.31,Other,215% Medicaid APG methodology,7.74,,,7.74,Other,125% Medicaid APG methodology,0.01,13.93,
CROMOLYN 10 MG/ML SOL,,,,80000537,CDM,250,RC,172640649,NDC,both,60,ML,2.65,1.04,39.4668,,1.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.9,34,,0.9,percent of total billed charges,"Drugs, Inpatient Only",0.9,34,,0.9,percent of total billed charges,"Drugs, Inpatient Only",0.9,34,,0.9,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.85,70,,1.85,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,1.99,,,1.99,Other,225% of Medicaid,1.24,,,1.24,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.9,,,1.9,Other,215% Medicaid APG methodology,1.9,,,1.9,Other,215% Medicaid APG methodology,1.1,,,1.1,Other,125% Medicaid APG methodology,0.01,1.99,
CYANOCOBALAMIN 1000MCG TAB,,,,80000538,CDM,250,RC,20555000600,NDC,both,5,EA,4.01,1.58,39.4668,,1.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.36,34,,1.36,percent of total billed charges,"Drugs, Inpatient Only",1.36,34,,1.36,percent of total billed charges,"Drugs, Inpatient Only",1.36,34,,1.36,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.81,70,,2.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,3.01,,,3.01,Other,225% of Medicaid,1.87,,,1.87,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.88,,,2.88,Other,215% Medicaid APG methodology,2.88,,,2.88,Other,215% Medicaid APG methodology,1.67,,,1.67,Other,125% Medicaid APG methodology,0.01,3.01,
CYANOCOBALAMIN 100MCG TAB,,,,80000539,CDM,250,RC,50268085215,NDC,both,5,EA,4.22,1.66,39.4668,,1.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.43,34,,1.43,percent of total billed charges,"Drugs, Inpatient Only",1.43,34,,1.43,percent of total billed charges,"Drugs, Inpatient Only",1.43,34,,1.43,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.95,70,,2.95,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,3.16,,,3.16,Other,225% of Medicaid,1.97,,,1.97,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.02,,,3.02,Other,215% Medicaid APG methodology,3.02,,,3.02,Other,215% Medicaid APG methodology,1.76,,,1.76,Other,125% Medicaid APG methodology,0.01,3.16,
CYCLOBENZAPRINE 10 MG,,,,80000541,CDM,250,RC,69097084615,NDC,both,1000,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CYCLOBENZAPRINE 5 MG,,,,80000542,CDM,250,RC,72888001201,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CYCLOPENTOLATE (CYCLOGYL) 1% 2ML,,,,80000543,CDM,250,RC,61314039601,NDC,both,1,ML,3.33,1.31,39.4668,,1.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.13,34,,1.13,percent of total billed charges,"Drugs, Inpatient Only",1.13,34,,1.13,percent of total billed charges,"Drugs, Inpatient Only",1.13,34,,1.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.33,70,,2.33,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.11,,,1.11,Other,Drug Cost,1.11,,,1.11,Other,Drug Cost,1.11,,,1.11,Other,Drug Cost,1.11,,,1.11,Other,Drug Cost,1.11,,,1.11,Other,Drug Cost,1.11,,,1.11,Other,Drug Cost,2.5,,,2.5,Other,225% of Medicaid,1.55,,,1.55,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.39,,,2.39,Other,215% Medicaid APG methodology,2.39,,,2.39,Other,215% Medicaid APG methodology,1.39,,,1.39,Other,125% Medicaid APG methodology,0.01,2.5,
CYCLOPENTOLATE (CYCLOGYL) 2% 2ML,,,,80000544,CDM,250,RC,65039702,NDC,both,1,ML,46.44,18.33,39.4668,,18.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.79,34,,15.79,percent of total billed charges,"Drugs, Inpatient Only",15.79,34,,15.79,percent of total billed charges,"Drugs, Inpatient Only",15.79,34,,15.79,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,32.51,70,,32.51,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.48,,,15.48,Other,Drug Cost,15.48,,,15.48,Other,Drug Cost,15.48,,,15.48,Other,Drug Cost,15.48,,,15.48,Other,Drug Cost,15.48,,,15.48,Other,Drug Cost,15.48,,,15.48,Other,Drug Cost,34.83,,,34.83,Other,225% of Medicaid,21.67,,,21.67,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,33.28,,,33.28,Other,215% Medicaid APG methodology,33.28,,,33.28,Other,215% Medicaid APG methodology,19.35,,,19.35,Other,125% Medicaid APG methodology,0.01,34.83,
CYCLOSPORINE (NEORAL) 100MG/ML SOL,,,,80000550,CDM,250,RC,172731320,NDC,both,1,ML,185.82,73.34,39.4668,,73.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63.18,34,,63.18,percent of total billed charges,"Drugs, Inpatient Only",63.18,34,,63.18,percent of total billed charges,"Drugs, Inpatient Only",63.18,34,,63.18,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,130.07,70,,130.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,61.94,,,61.94,Other,Drug Cost,61.94,,,61.94,Other,Drug Cost,61.94,,,61.94,Other,Drug Cost,61.94,,,61.94,Other,Drug Cost,61.94,,,61.94,Other,Drug Cost,61.94,,,61.94,Other,Drug Cost,139.37,,,139.37,Other,225% of Medicaid,86.72,,,86.72,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,133.17,,,133.17,Other,215% Medicaid APG methodology,133.17,,,133.17,Other,215% Medicaid APG methodology,77.43,,,77.43,Other,125% Medicaid APG methodology,0.01,139.37,
CYCLOSPORINE (NEORAL) 25MG CAP,,,,80000551,CDM,250,RC,51862045847,NDC,both,30,EA,1.02,0.4,39.4668,,0.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.71,70,,0.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.76,,,0.76,Other,225% of Medicaid,0.47,,,0.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.73,,,0.73,Other,215% Medicaid APG methodology,0.73,,,0.73,Other,215% Medicaid APG methodology,0.42,,,0.42,Other,125% Medicaid APG methodology,0.01,0.76,
CYPROHEPTADINE 4MG TAB,,,,80000556,CDM,250,RC,115175701,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
D 5-1/2 NS + KCL 20 MEQ 1000ML,,,,80000563,CDM,250,RC,264763500,NDC,both,12,ML,3.59,1.42,39.4668,,1.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.22,34,,1.22,percent of total billed charges,"Drugs, Inpatient Only",1.22,34,,1.22,percent of total billed charges,"Drugs, Inpatient Only",1.22,34,,1.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.51,70,,2.51,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,2.69,,,2.69,Other,225% of Medicaid,1.68,,,1.68,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.57,,,2.57,Other,215% Medicaid APG methodology,2.57,,,2.57,Other,215% Medicaid APG methodology,1.5,,,1.5,Other,125% Medicaid APG methodology,0.01,2.69,
D5 - 1/2 NS + KCL 10 MEQ 1000 ML,,,,80000564,CDM,250,RC,264763400,NDC,both,1000,ML,2.88,1.14,39.4668,,1.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.98,34,,0.98,percent of total billed charges,"Drugs, Inpatient Only",0.98,34,,0.98,percent of total billed charges,"Drugs, Inpatient Only",0.98,34,,0.98,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.02,70,,2.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.96,,,0.96,Other,Drug Cost,0.96,,,0.96,Other,Drug Cost,0.96,,,0.96,Other,Drug Cost,0.96,,,0.96,Other,Drug Cost,0.96,,,0.96,Other,Drug Cost,0.96,,,0.96,Other,Drug Cost,2.16,,,2.16,Other,225% of Medicaid,1.35,,,1.35,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.07,,,2.07,Other,215% Medicaid APG methodology,2.07,,,2.07,Other,215% Medicaid APG methodology,1.2,,,1.2,Other,125% Medicaid APG methodology,0.01,2.16,
D5 - 1/2 NS + KCL 40 MEQ 1000 ML,,,,80000566,CDM,250,RC,264763800,NDC,both,12,ML,2.58,1.02,39.4668,,1.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.88,34,,0.88,percent of total billed charges,"Drugs, Inpatient Only",0.88,34,,0.88,percent of total billed charges,"Drugs, Inpatient Only",0.88,34,,0.88,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.81,70,,1.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.86,,,0.86,Other,Drug Cost,0.86,,,0.86,Other,Drug Cost,0.86,,,0.86,Other,Drug Cost,0.86,,,0.86,Other,Drug Cost,0.86,,,0.86,Other,Drug Cost,0.86,,,0.86,Other,Drug Cost,1.94,,,1.94,Other,225% of Medicaid,1.2,,,1.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.85,,,1.85,Other,215% Medicaid APG methodology,1.85,,,1.85,Other,215% Medicaid APG methodology,1.08,,,1.08,Other,125% Medicaid APG methodology,0.01,1.94,
D5-LR WITH 20MEQ KCL,,,,80000567,CDM,250,RC,338081104,NDC,both,1000,ML,9.61,3.79,39.4668,,3.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.27,34,,3.27,percent of total billed charges,"Drugs, Inpatient Only",3.27,34,,3.27,percent of total billed charges,"Drugs, Inpatient Only",3.27,34,,3.27,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.72,70,,6.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,7.2,,,7.2,Other,225% of Medicaid,4.48,,,4.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.88,,,6.88,Other,215% Medicaid APG methodology,6.88,,,6.88,Other,215% Medicaid APG methodology,4,,,4,Other,125% Medicaid APG methodology,0.01,7.2,
D5W 100 ML (500 ML = 1 UNIT),,,,80000569,CDM,250,RC,264151032,NDC,both,64,ML,3.78,1.49,39.4668,,1.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.29,34,,1.29,percent of total billed charges,"Drugs, Inpatient Only",1.29,34,,1.29,percent of total billed charges,"Drugs, Inpatient Only",1.29,34,,1.29,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.65,70,,2.65,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.26,,,1.26,Other,Drug Cost,1.26,,,1.26,Other,Drug Cost,1.26,,,1.26,Other,Drug Cost,1.26,,,1.26,Other,Drug Cost,1.26,,,1.26,Other,Drug Cost,1.26,,,1.26,Other,Drug Cost,2.84,,,2.84,Other,225% of Medicaid,1.76,,,1.76,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.71,,,2.71,Other,215% Medicaid APG methodology,2.71,,,2.71,Other,215% Medicaid APG methodology,1.58,,,1.58,Other,125% Medicaid APG methodology,0.01,2.84,
D5W WITH KCL 20MEQ 1000ML,,,,80000573,CDM,250,RC,990790509,NDC,both,12,ML,8.56,3.38,39.4668,,3.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.91,34,,2.91,percent of total billed charges,"Drugs, Inpatient Only",2.91,34,,2.91,percent of total billed charges,"Drugs, Inpatient Only",2.91,34,,2.91,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.99,70,,5.99,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.85,,,2.85,Other,Drug Cost,2.85,,,2.85,Other,Drug Cost,2.85,,,2.85,Other,Drug Cost,2.85,,,2.85,Other,Drug Cost,2.85,,,2.85,Other,Drug Cost,2.85,,,2.85,Other,Drug Cost,6.42,,,6.42,Other,225% of Medicaid,3.99,,,3.99,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.13,,,6.13,Other,215% Medicaid APG methodology,6.13,,,6.13,Other,215% Medicaid APG methodology,3.57,,,3.57,Other,125% Medicaid APG methodology,0.01,6.42,
D5W-NS WITH 20MEQ KCL 1000ML,,,,80000574,CDM,250,RC,264765200,NDC,both,12,ML,3.77,1.49,39.4668,,1.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.28,34,,1.28,percent of total billed charges,"Drugs, Inpatient Only",1.28,34,,1.28,percent of total billed charges,"Drugs, Inpatient Only",1.28,34,,1.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.64,70,,2.64,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.26,,,1.26,Other,Drug Cost,1.26,,,1.26,Other,Drug Cost,1.26,,,1.26,Other,Drug Cost,1.26,,,1.26,Other,Drug Cost,1.26,,,1.26,Other,Drug Cost,1.26,,,1.26,Other,Drug Cost,2.83,,,2.83,Other,225% of Medicaid,1.76,,,1.76,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.7,,,2.7,Other,215% Medicaid APG methodology,2.7,,,2.7,Other,215% Medicaid APG methodology,1.57,,,1.57,Other,125% Medicaid APG methodology,0.01,2.83,
D5W-NS WITH 40MEQ KCL 1000ML,,,,80000575,CDM,250,RC,338080704,NDC,both,1000,ML,10.24,4.04,39.4668,,4.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.48,34,,3.48,percent of total billed charges,"Drugs, Inpatient Only",3.48,34,,3.48,percent of total billed charges,"Drugs, Inpatient Only",3.48,34,,3.48,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.17,70,,7.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.41,,,3.41,Other,Drug Cost,3.41,,,3.41,Other,Drug Cost,3.41,,,3.41,Other,Drug Cost,3.41,,,3.41,Other,Drug Cost,3.41,,,3.41,Other,Drug Cost,3.41,,,3.41,Other,Drug Cost,7.68,,,7.68,Other,225% of Medicaid,4.78,,,4.78,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.34,,,7.34,Other,215% Medicaid APG methodology,7.34,,,7.34,Other,215% Medicaid APG methodology,4.27,,,4.27,Other,125% Medicaid APG methodology,0.01,7.68,
DABIGATRAN 150MG CAP,,,,80000576,CDM,250,RC,597036082,NDC,both,60,EA,2.25,0.89,39.4668,,0.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.76,34,,0.76,percent of total billed charges,"Drugs, Inpatient Only",0.76,34,,0.76,percent of total billed charges,"Drugs, Inpatient Only",0.76,34,,0.76,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.57,70,,1.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,1.68,,,1.68,Other,225% of Medicaid,1.05,,,1.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.61,,,1.61,Other,215% Medicaid APG methodology,1.61,,,1.61,Other,215% Medicaid APG methodology,0.94,,,0.94,Other,125% Medicaid APG methodology,0.01,1.68,
DABIGATRAN 75 MG CAP,,,,80000577,CDM,250,RC,597035556,NDC,both,10,EA,13.48,5.32,39.4668,,5.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.58,34,,4.58,percent of total billed charges,"Drugs, Inpatient Only",4.58,34,,4.58,percent of total billed charges,"Drugs, Inpatient Only",4.58,34,,4.58,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.44,70,,9.44,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.49,,,4.49,Other,Drug Cost,4.49,,,4.49,Other,Drug Cost,4.49,,,4.49,Other,Drug Cost,4.49,,,4.49,Other,Drug Cost,4.49,,,4.49,Other,Drug Cost,4.49,,,4.49,Other,Drug Cost,10.11,,,10.11,Other,225% of Medicaid,6.29,,,6.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.66,,,9.66,Other,215% Medicaid APG methodology,9.66,,,9.66,Other,215% Medicaid APG methodology,5.62,,,5.62,Other,125% Medicaid APG methodology,0.01,10.11,
DANAZOL,,,,80000579,CDM,250,RC,555063402,NDC,both,100,EA,2.54,1,39.4668,,1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.86,34,,0.86,percent of total billed charges,"Drugs, Inpatient Only",0.86,34,,0.86,percent of total billed charges,"Drugs, Inpatient Only",0.86,34,,0.86,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.78,70,,1.78,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,1.91,,,1.91,Other,225% of Medicaid,1.19,,,1.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.82,,,1.82,Other,215% Medicaid APG methodology,1.82,,,1.82,Other,215% Medicaid APG methodology,1.06,,,1.06,Other,125% Medicaid APG methodology,0.01,1.91,
DANTROLENE (DANTRIUM) 20MG INJ,,,,80000580,CDM,250,RC,42023012306,NDC,both,6,EA,132.63,52.34,39.4668,,52.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,45.09,34,,45.09,percent of total billed charges,"Drugs, Inpatient Only",45.09,34,,45.09,percent of total billed charges,"Drugs, Inpatient Only",45.09,34,,45.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,92.84,70,,92.84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,44.21,,,44.21,Other,Drug Cost,44.21,,,44.21,Other,Drug Cost,44.21,,,44.21,Other,Drug Cost,44.21,,,44.21,Other,Drug Cost,44.21,,,44.21,Other,Drug Cost,44.21,,,44.21,Other,Drug Cost,99.47,,,99.47,Other,225% of Medicaid,61.89,,,61.89,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,95.05,,,95.05,Other,215% Medicaid APG methodology,95.05,,,95.05,Other,215% Medicaid APG methodology,55.26,,,55.26,Other,125% Medicaid APG methodology,0.01,99.47,
DANTROLENE 25 MG CAPS,,,,80000581,CDM,250,RC,115441101,NDC,both,100,EA,0.35,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,70,,0.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.26,,,0.26,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.25,,,0.25,Other,215% Medicaid APG methodology,0.25,,,0.25,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,125% Medicaid APG methodology,0.01,0.26,
DAPSONE 100MG TAB,,,,80000582,CDM,250,RC,70954013610,NDC,both,30,EA,1.44,0.57,39.4668,,0.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.49,34,,0.49,percent of total billed charges,"Drugs, Inpatient Only",0.49,34,,0.49,percent of total billed charges,"Drugs, Inpatient Only",0.49,34,,0.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.01,70,,1.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,1.08,,,1.08,Other,225% of Medicaid,0.67,,,0.67,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.03,,,1.03,Other,215% Medicaid APG methodology,1.03,,,1.03,Other,215% Medicaid APG methodology,0.6,,,0.6,Other,125% Medicaid APG methodology,0.01,1.08,
DAPSONE 25 MG TAB,,,,80000583,CDM,250,RC,70954013510,NDC,both,30,EA,0.76,0.3,39.4668,,0.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.53,70,,0.53,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.57,,,0.57,Other,225% of Medicaid,0.35,,,0.35,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.54,,,0.54,Other,215% Medicaid APG methodology,0.54,,,0.54,Other,215% Medicaid APG methodology,0.32,,,0.32,Other,125% Medicaid APG methodology,0.01,0.57,
DESMOPRESSIN ACETATE (DDAVP) 0.1 MG TAB,,,,80000601,CDM,250,RC,69918010101,NDC,both,100,EA,0.31,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,70,,0.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.23,,,0.23,Other,225% of Medicaid,0.14,,,0.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.22,,,0.22,Other,215% Medicaid APG methodology,0.22,,,0.22,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.23,
DESMOPRESSIN ACETATE (DDAVP) SPRAY,,,,80000602,CDM,250,RC,60505081500,NDC,both,1,ML,34.11,13.46,39.4668,,13.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.6,34,,11.6,percent of total billed charges,"Drugs, Inpatient Only",11.6,34,,11.6,percent of total billed charges,"Drugs, Inpatient Only",11.6,34,,11.6,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,23.88,70,,23.88,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.37,,,11.37,Other,Drug Cost,11.37,,,11.37,Other,Drug Cost,11.37,,,11.37,Other,Drug Cost,11.37,,,11.37,Other,Drug Cost,11.37,,,11.37,Other,Drug Cost,11.37,,,11.37,Other,Drug Cost,25.58,,,25.58,Other,225% of Medicaid,15.92,,,15.92,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,24.45,,,24.45,Other,215% Medicaid APG methodology,24.45,,,24.45,Other,215% Medicaid APG methodology,14.21,,,14.21,Other,125% Medicaid APG methodology,0.01,25.58,
DESVENLAFAXINE 50 MG TABLET,,,,80000607,CDM,250,RC,68180059206,NDC,both,30,EA,0.41,0.16,39.4668,,0.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,70,,0.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.31,,,0.31,Other,225% of Medicaid,0.19,,,0.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.3,,,0.3,Other,215% Medicaid APG methodology,0.3,,,0.3,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,125% Medicaid APG methodology,0.01,0.31,
DEXTRAN (LOW M.W.) 10%-5% INJ,,,,80000616,CDM,250,RC,409741803,NDC,both,12,ML,37.17,14.67,39.4668,,14.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.64,34,,12.64,percent of total billed charges,"Drugs, Inpatient Only",12.64,34,,12.64,percent of total billed charges,"Drugs, Inpatient Only",12.64,34,,12.64,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,26.02,70,,26.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.39,,,12.39,Other,Drug Cost,12.39,,,12.39,Other,Drug Cost,12.39,,,12.39,Other,Drug Cost,12.39,,,12.39,Other,Drug Cost,12.39,,,12.39,Other,Drug Cost,12.39,,,12.39,Other,Drug Cost,27.88,,,27.88,Other,225% of Medicaid,17.35,,,17.35,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,26.64,,,26.64,Other,215% Medicaid APG methodology,26.64,,,26.64,Other,215% Medicaid APG methodology,15.49,,,15.49,Other,125% Medicaid APG methodology,0.01,27.88,
DEXTROSE (GLUTCOSE 15) 40% GEL,,,,80000622,CDM,250,RC,574006915,NDC,both,1,GM,9.45,3.73,39.4668,,3.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.21,34,,3.21,percent of total billed charges,"Drugs, Inpatient Only",3.21,34,,3.21,percent of total billed charges,"Drugs, Inpatient Only",3.21,34,,3.21,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.62,70,,6.62,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.15,,,3.15,Other,Drug Cost,3.15,,,3.15,Other,Drug Cost,3.15,,,3.15,Other,Drug Cost,3.15,,,3.15,Other,Drug Cost,3.15,,,3.15,Other,Drug Cost,3.15,,,3.15,Other,Drug Cost,7.09,,,7.09,Other,225% of Medicaid,4.41,,,4.41,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.77,,,6.77,Other,215% Medicaid APG methodology,6.77,,,6.77,Other,215% Medicaid APG methodology,3.94,,,3.94,Other,125% Medicaid APG methodology,0.01,7.09,
DEXTROSE 20% 500ML,,,,80000624,CDM,250,RC,990793519,NDC,both,12,ML,13.59,5.36,39.4668,,5.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.62,34,,4.62,percent of total billed charges,"Drugs, Inpatient Only",4.62,34,,4.62,percent of total billed charges,"Drugs, Inpatient Only",4.62,34,,4.62,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.51,70,,9.51,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.53,,,4.53,Other,Drug Cost,4.53,,,4.53,Other,Drug Cost,4.53,,,4.53,Other,Drug Cost,4.53,,,4.53,Other,Drug Cost,4.53,,,4.53,Other,Drug Cost,4.53,,,4.53,Other,Drug Cost,10.19,,,10.19,Other,225% of Medicaid,6.34,,,6.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.74,,,9.74,Other,215% Medicaid APG methodology,9.74,,,9.74,Other,215% Medicaid APG methodology,5.66,,,5.66,Other,125% Medicaid APG methodology,0.01,10.19,
DEXTROSE 25% 10ML ABBOJECT,,,,80000626,CDM,250,RC,409177510,NDC,both,10,ML,26.23,10.35,39.4668,,10.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.92,34,,8.92,percent of total billed charges,"Drugs, Inpatient Only",8.92,34,,8.92,percent of total billed charges,"Drugs, Inpatient Only",8.92,34,,8.92,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.36,70,,18.36,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.74,,,8.74,Other,Drug Cost,8.74,,,8.74,Other,Drug Cost,8.74,,,8.74,Other,Drug Cost,8.74,,,8.74,Other,Drug Cost,8.74,,,8.74,Other,Drug Cost,8.74,,,8.74,Other,Drug Cost,19.67,,,19.67,Other,225% of Medicaid,12.24,,,12.24,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,18.8,,,18.8,Other,215% Medicaid APG methodology,18.8,,,18.8,Other,215% Medicaid APG methodology,10.93,,,10.93,Other,125% Medicaid APG methodology,0.01,19.67,
DEXTROSE 5% LACTATED RINGERS 1000ML,,,,80000628,CDM,250,RC,264775100,NDC,both,12,ML,2.81,1.11,39.4668,,1.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.95,34,,0.95,percent of total billed charges,"Drugs, Inpatient Only",0.95,34,,0.95,percent of total billed charges,"Drugs, Inpatient Only",0.95,34,,0.95,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.96,70,,1.96,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.94,,,0.94,Other,Drug Cost,0.94,,,0.94,Other,Drug Cost,0.94,,,0.94,Other,Drug Cost,0.94,,,0.94,Other,Drug Cost,0.94,,,0.94,Other,Drug Cost,0.94,,,0.94,Other,Drug Cost,2.1,,,2.1,Other,225% of Medicaid,1.31,,,1.31,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.01,,,2.01,Other,215% Medicaid APG methodology,2.01,,,2.01,Other,215% Medicaid APG methodology,1.17,,,1.17,Other,125% Medicaid APG methodology,0.01,2.1,
DEXTROSE 5%-1/2 NS 1000ML,,,,80000629,CDM,250,RC,264761200,NDC,both,1000,ML,2.49,0.98,39.4668,,0.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.85,34,,0.85,percent of total billed charges,"Drugs, Inpatient Only",0.85,34,,0.85,percent of total billed charges,"Drugs, Inpatient Only",0.85,34,,0.85,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.74,70,,1.74,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,1.87,,,1.87,Other,225% of Medicaid,1.16,,,1.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.78,,,1.78,Other,215% Medicaid APG methodology,1.78,,,1.78,Other,215% Medicaid APG methodology,1.04,,,1.04,Other,125% Medicaid APG methodology,0.01,1.87,
DEXTROSE 5%-1/4 NS 1000ML,,,,80000630,CDM,250,RC,264761600,NDC,both,1000,ML,2.49,0.98,39.4668,,0.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.85,34,,0.85,percent of total billed charges,"Drugs, Inpatient Only",0.85,34,,0.85,percent of total billed charges,"Drugs, Inpatient Only",0.85,34,,0.85,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.74,70,,1.74,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,1.87,,,1.87,Other,225% of Medicaid,1.16,,,1.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.78,,,1.78,Other,215% Medicaid APG methodology,1.78,,,1.78,Other,215% Medicaid APG methodology,1.04,,,1.04,Other,125% Medicaid APG methodology,0.01,1.87,
DEXTROSE 50% 50ML ABBOJ,,,,80000632,CDM,250,RC,409490234,NDC,both,10,ML,18,7.1,39.4668,,7.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.12,34,,6.12,percent of total billed charges,"Drugs, Inpatient Only",6.12,34,,6.12,percent of total billed charges,"Drugs, Inpatient Only",6.12,34,,6.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.6,70,,12.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6,,,6,Other,Drug Cost,6,,,6,Other,Drug Cost,6,,,6,Other,Drug Cost,6,,,6,Other,Drug Cost,6,,,6,Other,Drug Cost,6,,,6,Other,Drug Cost,13.5,,,13.5,Other,225% of Medicaid,8.4,,,8.4,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.9,,,12.9,Other,215% Medicaid APG methodology,12.9,,,12.9,Other,215% Medicaid APG methodology,7.5,,,7.5,Other,125% Medicaid APG methodology,0.01,13.5,
DIAZEPAM 2 MG TAB,,,,80000636,CDM,250,RC,172392560,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
DIAZEPAM 5 MG TAB,,,,80000637,CDM,250,RC,172392660,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
DIAZOXIDE 50 MG/ML SUSP,,,,80000638,CDM,250,RC,575620030,NDC,both,1,ML,0.81,0.32,39.4668,,0.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,70,,0.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.61,,,0.61,Other,225% of Medicaid,0.38,,,0.38,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.58,,,0.58,Other,215% Medicaid APG methodology,0.58,,,0.58,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,0.61,
DICLOFENAC SOD 75 MG TAB,,,,80000642,CDM,250,RC,228255111,NDC,both,100,EA,0.18,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,70,,0.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.13,
DICLOFENAC SODIUM 25 MG EC TAB,,,,80000643,CDM,250,RC,16571020310,NDC,both,100,EA,1.42,0.56,39.4668,,0.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1,70,,1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,1.07,,,1.07,Other,225% of Medicaid,0.66,,,0.66,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.02,,,1.02,Other,215% Medicaid APG methodology,1.02,,,1.02,Other,215% Medicaid APG methodology,0.59,,,0.59,Other,125% Medicaid APG methodology,0.01,1.07,
DICLOXACILLIN SODIUM 250 MG CAPS,,,,80000644,CDM,250,RC,93312301,NDC,both,100,EA,0.32,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,70,,0.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.24,,,0.24,Other,225% of Medicaid,0.15,,,0.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.23,,,0.23,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.24,
DICYCLOMINE 20 MG TAB,,,,80000646,CDM,250,RC,591079501,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
DICYCOMINE 10 MG TAB,,,,80000647,CDM,250,RC,591079401,NDC,both,100,EA,0.13,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.1,
DIGOXIN (LANOXIN) 0. 25 MG TAB,,,,80000650,CDM,250,RC,904592261,NDC,both,10,EA,26.45,10.44,39.4668,,10.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.99,34,,8.99,percent of total billed charges,"Drugs, Inpatient Only",8.99,34,,8.99,percent of total billed charges,"Drugs, Inpatient Only",8.99,34,,8.99,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.51,70,,18.51,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.82,,,8.82,Other,Drug Cost,8.82,,,8.82,Other,Drug Cost,8.82,,,8.82,Other,Drug Cost,8.82,,,8.82,Other,Drug Cost,8.82,,,8.82,Other,Drug Cost,8.82,,,8.82,Other,Drug Cost,19.84,,,19.84,Other,225% of Medicaid,12.34,,,12.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,18.95,,,18.95,Other,215% Medicaid APG methodology,18.95,,,18.95,Other,215% Medicaid APG methodology,11.02,,,11.02,Other,125% Medicaid APG methodology,0.01,19.84,
DIGOXIN (LANOXIN) 0.125 MG TAB,,,,80000651,CDM,250,RC,57664043788,NDC,both,100,EA,0.02,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
DIGOXIN 250MCG/5ML SOLN,,,,80000652,CDM,250,RC,54005746,NDC,both,1,ML,24.66,9.73,39.4668,,9.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.38,34,,8.38,percent of total billed charges,"Drugs, Inpatient Only",8.38,34,,8.38,percent of total billed charges,"Drugs, Inpatient Only",8.38,34,,8.38,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.26,70,,17.26,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.22,,,8.22,Other,Drug Cost,8.22,,,8.22,Other,Drug Cost,8.22,,,8.22,Other,Drug Cost,8.22,,,8.22,Other,Drug Cost,8.22,,,8.22,Other,Drug Cost,8.22,,,8.22,Other,Drug Cost,18.5,,,18.5,Other,225% of Medicaid,11.51,,,11.51,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,17.67,,,17.67,Other,215% Medicaid APG methodology,17.67,,,17.67,Other,215% Medicaid APG methodology,10.28,,,10.28,Other,125% Medicaid APG methodology,0.01,18.5,
DILTIAZEM HCL 240MG ER CAPS,,,,80000659,CDM,250,RC,10370083111,NDC,both,30,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
DILTIAZEM HCL 300 MG SR CAPS,,,,80000660,CDM,250,RC,24979002907,NDC,both,90,EA,0.2,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.15,
DILTIAZEM HCL 30MG TAB,,,,80000661,CDM,250,RC,93031801,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
DILTIAZEM HCL 5MG/ML 5ML INJ,,,,80000662,CDM,250,RC,641601310,NDC,both,10,ML,2.55,1.01,39.4668,,1.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.87,34,,0.87,percent of total billed charges,"Drugs, Inpatient Only",0.87,34,,0.87,percent of total billed charges,"Drugs, Inpatient Only",0.87,34,,0.87,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.79,70,,1.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,1.91,,,1.91,Other,225% of Medicaid,1.19,,,1.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.83,,,1.83,Other,215% Medicaid APG methodology,1.83,,,1.83,Other,215% Medicaid APG methodology,1.06,,,1.06,Other,125% Medicaid APG methodology,0.01,1.91,
DILTIAZEM HCL CD 180MG CAPS,,,,80000663,CDM,250,RC,187079642,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
DILTIAZEM HCL ER 120MG CAPS,,,,80000664,CDM,250,RC,10370082909,NDC,both,90,EA,0.14,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.1,
DINOPROSTONE (CERVIDIL) 10 MG,,,,80000670,CDM,250,RC,55566280001,NDC,both,1,EA,427.8,168.84,39.4668,,168.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,145.45,34,,145.45,percent of total billed charges,"Drugs, Inpatient Only",145.45,34,,145.45,percent of total billed charges,"Drugs, Inpatient Only",145.45,34,,145.45,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,299.46,70,,299.46,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,142.6,,,142.6,Other,Drug Cost,142.6,,,142.6,Other,Drug Cost,142.6,,,142.6,Other,Drug Cost,142.6,,,142.6,Other,Drug Cost,142.6,,,142.6,Other,Drug Cost,142.6,,,142.6,Other,Drug Cost,320.85,,,320.85,Other,225% of Medicaid,199.64,,,199.64,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,306.59,,,306.59,Other,215% Medicaid APG methodology,306.59,,,306.59,Other,215% Medicaid APG methodology,178.25,,,178.25,Other,125% Medicaid APG methodology,0.01,320.85,
DIPHENHYDRAMINE 50MG CAPS,,,,80000674,CDM,250,RC,904530760,NDC,both,100,EA,0.04,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
DIPHENHYDRAMINE 12.5MG/5ML LIQ 5 ML,,,,80000676,CDM,250,RC,50580053404,NDC,both,1,ML,19.62,7.74,39.4668,,7.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.67,34,,6.67,percent of total billed charges,"Drugs, Inpatient Only",6.67,34,,6.67,percent of total billed charges,"Drugs, Inpatient Only",6.67,34,,6.67,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.73,70,,13.73,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.54,,,6.54,Other,Drug Cost,6.54,,,6.54,Other,Drug Cost,6.54,,,6.54,Other,Drug Cost,6.54,,,6.54,Other,Drug Cost,6.54,,,6.54,Other,Drug Cost,6.54,,,6.54,Other,Drug Cost,14.72,,,14.72,Other,225% of Medicaid,9.16,,,9.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,14.06,,,14.06,Other,215% Medicaid APG methodology,14.06,,,14.06,Other,215% Medicaid APG methodology,8.18,,,8.18,Other,125% Medicaid APG methodology,0.01,14.72,
DIPHENHYDRAMINE HCL 25MG CAPS,,,,80000677,CDM,250,RC,904723761,NDC,both,10,EA,0.36,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,70,,0.25,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.27,,,0.27,Other,225% of Medicaid,0.17,,,0.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.26,,,0.26,Other,215% Medicaid APG methodology,0.26,,,0.26,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,125% Medicaid APG methodology,0.01,0.27,
DIPHENHYDRAMINE(BENADRYL) ANTI-ITCH 28GM,,,,80000678,CDM,250,RC,45802035803,NDC,both,1,GM,2.31,0.91,39.4668,,0.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.79,34,,0.79,percent of total billed charges,"Drugs, Inpatient Only",0.79,34,,0.79,percent of total billed charges,"Drugs, Inpatient Only",0.79,34,,0.79,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.62,70,,1.62,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,1.73,,,1.73,Other,225% of Medicaid,1.08,,,1.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.66,,,1.66,Other,215% Medicaid APG methodology,1.66,,,1.66,Other,215% Medicaid APG methodology,0.96,,,0.96,Other,125% Medicaid APG methodology,0.01,1.73,
DIPYRIDAMOLE 25MG TAB,,,,80000681,CDM,250,RC,64980013301,NDC,both,100,EA,0.17,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,70,,0.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
DIPYRIDAMOLE/ASPIRIN (AGGRENOX 200-25 MG,,,,80000682,CDM,250,RC,43598033960,NDC,both,60,EA,0.77,0.3,39.4668,,0.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.54,70,,0.54,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.58,,,0.58,Other,225% of Medicaid,0.36,,,0.36,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.55,,,0.55,Other,215% Medicaid APG methodology,0.55,,,0.55,Other,215% Medicaid APG methodology,0.32,,,0.32,Other,125% Medicaid APG methodology,0.01,0.58,
DISULFIRAM 250 MG TAB,,,,80000686,CDM,250,RC,47781060730,NDC,both,30,EA,1.98,0.78,39.4668,,0.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.39,70,,1.39,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,1.48,,,1.48,Other,225% of Medicaid,0.92,,,0.92,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.42,,,1.42,Other,215% Medicaid APG methodology,1.42,,,1.42,Other,215% Medicaid APG methodology,0.82,,,0.82,Other,125% Medicaid APG methodology,0.01,1.48,
DIVALPROEX SODIUM (DEPAKOTE) 250MG TAB,,,,80000687,CDM,250,RC,62756079788,NDC,both,100,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
DIVALPROEX SODIUM (DEPAKOTE) 500MG TAB,,,,80000688,CDM,250,RC,62756079888,NDC,both,100,EA,0.16,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
DIVALPROEX SODIUM ER (DEPAKOTE ER) 250MG,,,,80000689,CDM,250,RC,904636361,NDC,both,10,EA,24.29,9.59,39.4668,,9.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.26,34,,8.26,percent of total billed charges,"Drugs, Inpatient Only",8.26,34,,8.26,percent of total billed charges,"Drugs, Inpatient Only",8.26,34,,8.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17,70,,17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.1,,,8.1,Other,Drug Cost,8.1,,,8.1,Other,Drug Cost,8.1,,,8.1,Other,Drug Cost,8.1,,,8.1,Other,Drug Cost,8.1,,,8.1,Other,Drug Cost,8.1,,,8.1,Other,Drug Cost,18.22,,,18.22,Other,225% of Medicaid,11.33,,,11.33,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,17.41,,,17.41,Other,215% Medicaid APG methodology,17.41,,,17.41,Other,215% Medicaid APG methodology,10.12,,,10.12,Other,125% Medicaid APG methodology,0.01,18.22,
DIVALPROEX SODIUM ER (DEPAKOTE ER) 500MG,,,,80000690,CDM,250,RC,55111053401,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.15,
DIVALPROEX SODIUM SPRIN (DEPAKOTE) 125MG,,,,80000691,CDM,250,RC,68382010601,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
DOCUSATE 100 MG CAP,,,,80000697,CDM,250,RC,57896040101,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
DOCUSATE SOD 50MG/5ML LIQ 10ML UD,,,,80000698,CDM,250,RC,121093540,NDC,both,40,ML,0.14,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.1,
DONEPEZIL (ARICEPT) 5 MG,,,,80000703,CDM,250,RC,43547027509,NDC,both,90,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
DONNATAL 16.2MG TAB,,,,80000704,CDM,250,RC,50742066701,NDC,both,100,EA,1.18,0.46,39.4668,,0.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.82,70,,0.82,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.88,,,0.88,Other,225% of Medicaid,0.55,,,0.55,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.84,,,0.84,Other,215% Medicaid APG methodology,0.84,,,0.84,Other,215% Medicaid APG methodology,0.49,,,0.49,Other,125% Medicaid APG methodology,0.01,0.88,
DORNASE ALFA 2.5 MG/2.5 ML INHALATION,,,,80000711,CDM,250,RC,50242010040,NDC,both,30,ML,352.97,139.31,39.4668,,139.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,120.01,34,,120.01,percent of total billed charges,"Drugs, Inpatient Only",120.01,34,,120.01,percent of total billed charges,"Drugs, Inpatient Only",120.01,34,,120.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,247.08,70,,247.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,117.66,,,117.66,Other,Drug Cost,117.66,,,117.66,Other,Drug Cost,117.66,,,117.66,Other,Drug Cost,117.66,,,117.66,Other,Drug Cost,117.66,,,117.66,Other,Drug Cost,117.66,,,117.66,Other,Drug Cost,264.73,,,264.73,Other,225% of Medicaid,164.72,,,164.72,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,252.96,,,252.96,Other,215% Medicaid APG methodology,252.96,,,252.96,Other,215% Medicaid APG methodology,147.07,,,147.07,Other,125% Medicaid APG methodology,0.01,264.73,
DORZOLAMIDE OPHTH 10ML,,,,80000712,CDM,250,RC,61314001910,NDC,both,1,ML,10.26,4.05,39.4668,,4.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.49,34,,3.49,percent of total billed charges,"Drugs, Inpatient Only",3.49,34,,3.49,percent of total billed charges,"Drugs, Inpatient Only",3.49,34,,3.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.18,70,,7.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.42,,,3.42,Other,Drug Cost,3.42,,,3.42,Other,Drug Cost,3.42,,,3.42,Other,Drug Cost,3.42,,,3.42,Other,Drug Cost,3.42,,,3.42,Other,Drug Cost,3.42,,,3.42,Other,Drug Cost,7.7,,,7.7,Other,225% of Medicaid,4.79,,,4.79,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.35,,,7.35,Other,215% Medicaid APG methodology,7.35,,,7.35,Other,215% Medicaid APG methodology,4.28,,,4.28,Other,125% Medicaid APG methodology,0.01,7.7,
DOXAZOSIN 1 MG TAB,,,,80000714,CDM,250,RC,93207001,NDC,both,100,EA,0.34,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,70,,0.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.25,,,0.25,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.24,,,0.24,Other,215% Medicaid APG methodology,0.24,,,0.24,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,0.25,
DOXAZOSIN 4MG TAB,,,,80000715,CDM,250,RC,60505009500,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
DOXEPIN 10 MG CAP,,,,80000717,CDM,250,RC,378104901,NDC,both,100,EA,0.43,0.17,39.4668,,0.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.3,70,,0.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.32,,,0.32,Other,225% of Medicaid,0.2,,,0.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.31,,,0.31,Other,215% Medicaid APG methodology,0.31,,,0.31,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,125% Medicaid APG methodology,0.01,0.32,
DOXEPIN 25 MG CAP,,,,80000718,CDM,250,RC,378312501,NDC,both,100,EA,0.64,0.25,39.4668,,0.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.45,70,,0.45,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.48,,,0.48,Other,225% of Medicaid,0.3,,,0.3,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.46,,,0.46,Other,215% Medicaid APG methodology,0.46,,,0.46,Other,215% Medicaid APG methodology,0.27,,,0.27,Other,125% Medicaid APG methodology,0.01,0.48,
DOXYCYCLINE 100 MG INJ,,,,80000726,CDM,250,RC,63323013011,NDC,both,10,EA,32.52,12.84,39.4668,,12.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.06,34,,11.06,percent of total billed charges,"Drugs, Inpatient Only",11.06,34,,11.06,percent of total billed charges,"Drugs, Inpatient Only",11.06,34,,11.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.77,70,,22.77,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.84,,,10.84,Other,Drug Cost,10.84,,,10.84,Other,Drug Cost,10.84,,,10.84,Other,Drug Cost,10.84,,,10.84,Other,Drug Cost,10.84,,,10.84,Other,Drug Cost,10.84,,,10.84,Other,Drug Cost,24.39,,,24.39,Other,225% of Medicaid,15.18,,,15.18,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,23.31,,,23.31,Other,215% Medicaid APG methodology,23.31,,,23.31,Other,215% Medicaid APG methodology,13.55,,,13.55,Other,125% Medicaid APG methodology,0.01,24.39,
DOXYCYCLINE 100MG TAB,,,,80000727,CDM,250,RC,53489012002,NDC,both,50,EA,0.01,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
DRONADERONE 400MG TAB,,,,80000730,CDM,250,RC,24414260,NDC,both,60,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
DULOXETINE (CYMBALTA) 20 MG,,,,80000732,CDM,250,RC,27241009706,NDC,both,60,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
DULOXETINE (CYMBALTA) 30 MG,,,,80000733,CDM,250,RC,57237001890,NDC,both,90,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.08,
DULOXETINE (CYMBALTA) 60 MG,,,,80000734,CDM,250,RC,57237001930,NDC,both,30,EA,0.19,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
DUTASTERIDE (AVODART) 0.5MG,,,,80000737,CDM,250,RC,31722013130,NDC,both,30,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.15,
EMTRICITABINE (EMTRIVA) 200 MG CAPS,,,,80000746,CDM,250,RC,61958060101,NDC,both,30,EA,28.16,11.11,39.4668,,11.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.57,34,,9.57,percent of total billed charges,"Drugs, Inpatient Only",9.57,34,,9.57,percent of total billed charges,"Drugs, Inpatient Only",9.57,34,,9.57,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.71,70,,19.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.39,,,9.39,Other,Drug Cost,9.39,,,9.39,Other,Drug Cost,9.39,,,9.39,Other,Drug Cost,9.39,,,9.39,Other,Drug Cost,9.39,,,9.39,Other,Drug Cost,9.39,,,9.39,Other,Drug Cost,21.12,,,21.12,Other,225% of Medicaid,13.14,,,13.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,20.18,,,20.18,Other,215% Medicaid APG methodology,20.18,,,20.18,Other,215% Medicaid APG methodology,11.73,,,11.73,Other,125% Medicaid APG methodology,0.01,21.12,
ENALAPRIL 1.25MG/ML 2ML INJECTION,,,,80000747,CDM,250,RC,143978610,NDC,both,10,ML,10.13,4,39.4668,,4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.44,34,,3.44,percent of total billed charges,"Drugs, Inpatient Only",3.44,34,,3.44,percent of total billed charges,"Drugs, Inpatient Only",3.44,34,,3.44,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.09,70,,7.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.38,,,3.38,Other,Drug Cost,3.38,,,3.38,Other,Drug Cost,3.38,,,3.38,Other,Drug Cost,3.38,,,3.38,Other,Drug Cost,3.38,,,3.38,Other,Drug Cost,3.38,,,3.38,Other,Drug Cost,7.6,,,7.6,Other,225% of Medicaid,4.73,,,4.73,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.26,,,7.26,Other,215% Medicaid APG methodology,7.26,,,7.26,Other,215% Medicaid APG methodology,4.22,,,4.22,Other,125% Medicaid APG methodology,0.01,7.6,
ENALAPRILAT 1.25MG/1ML INJ,,,,80000750,CDM,250,RC,143978710,NDC,both,10,ML,1.92,0.76,39.4668,,0.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.65,34,,0.65,percent of total billed charges,"Drugs, Inpatient Only",0.65,34,,0.65,percent of total billed charges,"Drugs, Inpatient Only",0.65,34,,0.65,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.34,70,,1.34,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,1.44,,,1.44,Other,225% of Medicaid,0.89,,,0.89,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.37,,,1.37,Other,215% Medicaid APG methodology,1.37,,,1.37,Other,215% Medicaid APG methodology,0.8,,,0.8,Other,125% Medicaid APG methodology,0.01,1.44,
ENTACAPONE (COMTAN) 200MG,,,,80000759,CDM,250,RC,65862065401,NDC,both,100,EA,0.37,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.26,70,,0.26,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.27,,,0.27,Other,225% of Medicaid,0.17,,,0.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.26,,,0.26,Other,215% Medicaid APG methodology,0.26,,,0.26,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,125% Medicaid APG methodology,0.01,0.27,
EPHEDRINE 50MG/ML,,,,80000760,CDM,250,RC,42023021625,NDC,both,25,ML,11.03,4.35,39.4668,,4.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.75,34,,3.75,percent of total billed charges,"Drugs, Inpatient Only",3.75,34,,3.75,percent of total billed charges,"Drugs, Inpatient Only",3.75,34,,3.75,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.72,70,,7.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.68,,,3.68,Other,Drug Cost,3.68,,,3.68,Other,Drug Cost,3.68,,,3.68,Other,Drug Cost,3.68,,,3.68,Other,Drug Cost,3.68,,,3.68,Other,Drug Cost,3.68,,,3.68,Other,Drug Cost,8.27,,,8.27,Other,225% of Medicaid,5.15,,,5.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.91,,,7.91,Other,215% Medicaid APG methodology,7.91,,,7.91,Other,215% Medicaid APG methodology,4.6,,,4.6,Other,125% Medicaid APG methodology,0.01,8.27,
EPINEPHRINE HCL (ADRENALIN) 0.1% NASAL,,,,80000762,CDM,250,RC,42023010301,NDC,both,1,ML,680.97,268.76,39.4668,,268.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,231.53,34,,231.53,percent of total billed charges,"Drugs, Inpatient Only",231.53,34,,231.53,percent of total billed charges,"Drugs, Inpatient Only",231.53,34,,231.53,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,476.68,70,,476.68,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,226.99,,,226.99,Other,Drug Cost,226.99,,,226.99,Other,Drug Cost,226.99,,,226.99,Other,Drug Cost,226.99,,,226.99,Other,Drug Cost,226.99,,,226.99,Other,Drug Cost,226.99,,,226.99,Other,Drug Cost,510.73,,,510.73,Other,225% of Medicaid,317.79,,,317.79,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,488.03,,,488.03,Other,215% Medicaid APG methodology,488.03,,,488.03,Other,215% Medicaid APG methodology,283.74,,,283.74,Other,125% Medicaid APG methodology,0.01,510.73,
ERGOCALCIFEROL 50000 INTL UNITS CAP,,,,80000774,CDM,250,RC,69452015120,NDC,both,100,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
ERYTHROMYCIN 1 GM OPHTH OINT,,,,80000781,CDM,250,RC,24208091019,NDC,both,50,GM,5.04,1.99,39.4668,,1.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.71,34,,1.71,percent of total billed charges,"Drugs, Inpatient Only",1.71,34,,1.71,percent of total billed charges,"Drugs, Inpatient Only",1.71,34,,1.71,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.53,70,,3.53,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.68,,,1.68,Other,Drug Cost,1.68,,,1.68,Other,Drug Cost,1.68,,,1.68,Other,Drug Cost,1.68,,,1.68,Other,Drug Cost,1.68,,,1.68,Other,Drug Cost,1.68,,,1.68,Other,Drug Cost,3.78,,,3.78,Other,225% of Medicaid,2.35,,,2.35,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.61,,,3.61,Other,215% Medicaid APG methodology,3.61,,,3.61,Other,215% Medicaid APG methodology,2.1,,,2.1,Other,125% Medicaid APG methodology,0.01,3.78,
ERYTHROMYCIN 2% TOPICAL SOLN 60 ML,,,,80000783,CDM,250,RC,45802003846,NDC,both,1,ML,26.49,10.45,39.4668,,10.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.01,34,,9.01,percent of total billed charges,"Drugs, Inpatient Only",9.01,34,,9.01,percent of total billed charges,"Drugs, Inpatient Only",9.01,34,,9.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.54,70,,18.54,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.83,,,8.83,Other,Drug Cost,8.83,,,8.83,Other,Drug Cost,8.83,,,8.83,Other,Drug Cost,8.83,,,8.83,Other,Drug Cost,8.83,,,8.83,Other,Drug Cost,8.83,,,8.83,Other,Drug Cost,19.87,,,19.87,Other,225% of Medicaid,12.36,,,12.36,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,18.98,,,18.98,Other,215% Medicaid APG methodology,18.98,,,18.98,Other,215% Medicaid APG methodology,11.04,,,11.04,Other,125% Medicaid APG methodology,0.01,19.87,
ERYTHROMYCIN 3.5 GM OPHTH OINT,,,,80000785,CDM,250,RC,24208091055,NDC,both,1,GM,12.84,5.07,39.4668,,5.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.37,34,,4.37,percent of total billed charges,"Drugs, Inpatient Only",4.37,34,,4.37,percent of total billed charges,"Drugs, Inpatient Only",4.37,34,,4.37,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.99,70,,8.99,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.28,,,4.28,Other,Drug Cost,4.28,,,4.28,Other,Drug Cost,4.28,,,4.28,Other,Drug Cost,4.28,,,4.28,Other,Drug Cost,4.28,,,4.28,Other,Drug Cost,4.28,,,4.28,Other,Drug Cost,9.63,,,9.63,Other,225% of Medicaid,5.99,,,5.99,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.2,,,9.2,Other,215% Medicaid APG methodology,9.2,,,9.2,Other,215% Medicaid APG methodology,5.35,,,5.35,Other,125% Medicaid APG methodology,0.01,9.63,
ERYTHROMYCIN ETHYLSUCCINAT 200 200MG/5ML,,,,80000786,CDM,250,RC,24338013402,NDC,both,1,ML,526.35,207.73,39.4668,,207.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,178.96,34,,178.96,percent of total billed charges,"Drugs, Inpatient Only",178.96,34,,178.96,percent of total billed charges,"Drugs, Inpatient Only",178.96,34,,178.96,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.45,70,,368.45,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,175.45,,,175.45,Other,Drug Cost,175.45,,,175.45,Other,Drug Cost,175.45,,,175.45,Other,Drug Cost,175.45,,,175.45,Other,Drug Cost,175.45,,,175.45,Other,Drug Cost,175.45,,,175.45,Other,Drug Cost,394.76,,,394.76,Other,225% of Medicaid,245.63,,,245.63,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,377.22,,,377.22,Other,215% Medicaid APG methodology,377.22,,,377.22,Other,215% Medicaid APG methodology,219.31,,,219.31,Other,125% Medicaid APG methodology,0.01,394.76,
ESCITALOPRAM (LEXAPRO) 10MG TAB,,,,80000788,CDM,250,RC,456201001,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ESTRADIOL 1MG TAB,,,,80000789,CDM,250,RC,555088602,NDC,both,100,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
ETOMIDATE (AMIDATE) 2MG/ML 10 ML,,,,80000800,CDM,250,RC,143950610,NDC,both,10,ML,3.84,1.52,39.4668,,1.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.31,34,,1.31,percent of total billed charges,"Drugs, Inpatient Only",1.31,34,,1.31,percent of total billed charges,"Drugs, Inpatient Only",1.31,34,,1.31,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.69,70,,2.69,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,2.88,,,2.88,Other,225% of Medicaid,1.79,,,1.79,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.75,,,2.75,Other,215% Medicaid APG methodology,2.75,,,2.75,Other,215% Medicaid APG methodology,1.6,,,1.6,Other,125% Medicaid APG methodology,0.01,2.88,
ETOMIDATE (AMIDATE) 2MG/ML 20 ML,,,,80000801,CDM,250,RC,409669502,NDC,both,10,ML,15.1,5.96,39.4668,,5.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.13,34,,5.13,percent of total billed charges,"Drugs, Inpatient Only",5.13,34,,5.13,percent of total billed charges,"Drugs, Inpatient Only",5.13,34,,5.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.57,70,,10.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.03,,,5.03,Other,Drug Cost,5.03,,,5.03,Other,Drug Cost,5.03,,,5.03,Other,Drug Cost,5.03,,,5.03,Other,Drug Cost,5.03,,,5.03,Other,Drug Cost,5.03,,,5.03,Other,Drug Cost,11.32,,,11.32,Other,225% of Medicaid,7.05,,,7.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.82,,,10.82,Other,215% Medicaid APG methodology,10.82,,,10.82,Other,215% Medicaid APG methodology,6.29,,,6.29,Other,125% Medicaid APG methodology,0.01,11.32,
ETRAVIRINE (INTELENCE) 100MG TAB,,,,80000803,CDM,250,RC,59676057001,NDC,both,120,EA,14.1,5.57,39.4668,,5.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.8,34,,4.8,percent of total billed charges,"Drugs, Inpatient Only",4.8,34,,4.8,percent of total billed charges,"Drugs, Inpatient Only",4.8,34,,4.8,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.87,70,,9.87,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.7,,,4.7,Other,Drug Cost,4.7,,,4.7,Other,Drug Cost,4.7,,,4.7,Other,Drug Cost,4.7,,,4.7,Other,Drug Cost,4.7,,,4.7,Other,Drug Cost,4.7,,,4.7,Other,Drug Cost,10.58,,,10.58,Other,225% of Medicaid,6.58,,,6.58,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.11,,,10.11,Other,215% Medicaid APG methodology,10.11,,,10.11,Other,215% Medicaid APG methodology,5.88,,,5.88,Other,125% Medicaid APG methodology,0.01,10.58,
EXEMESTANE 25 MG,,,,80000804,CDM,250,RC,59762285801,NDC,both,30,EA,0.62,0.24,39.4668,,0.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,34,,0.21,percent of total billed charges,"Drugs, Inpatient Only",0.21,34,,0.21,percent of total billed charges,"Drugs, Inpatient Only",0.21,34,,0.21,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.43,70,,0.43,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.46,,,0.46,Other,225% of Medicaid,0.29,,,0.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.44,,,0.44,Other,215% Medicaid APG methodology,0.44,,,0.44,Other,215% Medicaid APG methodology,0.26,,,0.26,Other,125% Medicaid APG methodology,0.01,0.46,
EYE WASH 120ML,,,,80000805,CDM,250,RC,10119000252,NDC,both,1,EA,11.13,4.39,39.4668,,4.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.78,34,,3.78,percent of total billed charges,"Drugs, Inpatient Only",3.78,34,,3.78,percent of total billed charges,"Drugs, Inpatient Only",3.78,34,,3.78,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.79,70,,7.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.71,,,3.71,Other,Drug Cost,3.71,,,3.71,Other,Drug Cost,3.71,,,3.71,Other,Drug Cost,3.71,,,3.71,Other,Drug Cost,3.71,,,3.71,Other,Drug Cost,3.71,,,3.71,Other,Drug Cost,8.35,,,8.35,Other,225% of Medicaid,5.19,,,5.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.98,,,7.98,Other,215% Medicaid APG methodology,7.98,,,7.98,Other,215% Medicaid APG methodology,4.64,,,4.64,Other,125% Medicaid APG methodology,0.01,8.35,
FAMOTIDINE 10 MG/ML 2ML INJ,,,,80000811,CDM,250,RC,63323073912,NDC,both,25,ML,1.03,0.41,39.4668,,0.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.72,70,,0.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.77,,,0.77,Other,225% of Medicaid,0.48,,,0.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.74,,,0.74,Other,215% Medicaid APG methodology,0.74,,,0.74,Other,215% Medicaid APG methodology,0.43,,,0.43,Other,125% Medicaid APG methodology,0.01,0.77,
FAMOTIDINE 10MG,,,,80000812,CDM,250,RC,904552987,NDC,both,30,EA,0.13,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.1,
FAMOTIDINE 20 MG TAB,,,,80000814,CDM,250,RC,172572870,NDC,both,500,EA,0.04,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.03,
FAMOTIDINE 20MG/50ML INJ,,,,80000815,CDM,250,RC,338519741,NDC,both,24,ML,11.52,4.55,39.4668,,4.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.92,34,,3.92,percent of total billed charges,"Drugs, Inpatient Only",3.92,34,,3.92,percent of total billed charges,"Drugs, Inpatient Only",3.92,34,,3.92,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.06,70,,8.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.84,,,3.84,Other,Drug Cost,3.84,,,3.84,Other,Drug Cost,3.84,,,3.84,Other,Drug Cost,3.84,,,3.84,Other,Drug Cost,3.84,,,3.84,Other,Drug Cost,3.84,,,3.84,Other,Drug Cost,8.64,,,8.64,Other,225% of Medicaid,5.37,,,5.37,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.25,,,8.25,Other,215% Medicaid APG methodology,8.25,,,8.25,Other,215% Medicaid APG methodology,4.8,,,4.8,Other,125% Medicaid APG methodology,0.01,8.64,
FENOFIBRATE 160MG TABLET,,,,80000821,CDM,250,RC,27241011703,NDC,both,90,EA,0.09,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
FENOFIBRATE 54MG TABLET,,,,80000823,CDM,250,RC,70756021490,NDC,both,90,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
FENTANYL (DURAGESIC) 12MCG/HR PATCH,,,,80000824,CDM,250,RC,378911998,NDC,both,5,EA,4.51,1.78,39.4668,,1.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.53,34,,1.53,percent of total billed charges,"Drugs, Inpatient Only",1.53,34,,1.53,percent of total billed charges,"Drugs, Inpatient Only",1.53,34,,1.53,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.16,70,,3.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,3.38,,,3.38,Other,225% of Medicaid,2.11,,,2.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.23,,,3.23,Other,215% Medicaid APG methodology,3.23,,,3.23,Other,215% Medicaid APG methodology,1.88,,,1.88,Other,125% Medicaid APG methodology,0.01,3.38,
FENTANYL 100MCG/HR PATCH,,,,80000826,CDM,250,RC,378912498,NDC,both,5,EA,26.4,10.42,39.4668,,10.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.98,34,,8.98,percent of total billed charges,"Drugs, Inpatient Only",8.98,34,,8.98,percent of total billed charges,"Drugs, Inpatient Only",8.98,34,,8.98,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.48,70,,18.48,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.8,,,8.8,Other,Drug Cost,8.8,,,8.8,Other,Drug Cost,8.8,,,8.8,Other,Drug Cost,8.8,,,8.8,Other,Drug Cost,8.8,,,8.8,Other,Drug Cost,8.8,,,8.8,Other,Drug Cost,19.8,,,19.8,Other,225% of Medicaid,12.32,,,12.32,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,18.92,,,18.92,Other,215% Medicaid APG methodology,18.92,,,18.92,Other,215% Medicaid APG methodology,11,,,11,Other,125% Medicaid APG methodology,0.01,19.8,
FERREX 150 FORTE 1EA,,,,80000838,CDM,250,RC,51991020311,NDC,both,100,EA,0.43,0.17,39.4668,,0.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.3,70,,0.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.32,,,0.32,Other,225% of Medicaid,0.2,,,0.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.31,,,0.31,Other,215% Medicaid APG methodology,0.31,,,0.31,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,125% Medicaid APG methodology,0.01,0.32,
FERROUS  SULFATE 325MG,,,,80000841,CDM,250,RC,904759160,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
FERROUS 300MG/5ML SOLN 5ML UD,,,,80000842,CDM,250,RC,121053005,NDC,both,100,ML,8.07,3.18,39.4668,,3.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.74,34,,2.74,percent of total billed charges,"Drugs, Inpatient Only",2.74,34,,2.74,percent of total billed charges,"Drugs, Inpatient Only",2.74,34,,2.74,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.65,70,,5.65,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.69,,,2.69,Other,Drug Cost,2.69,,,2.69,Other,Drug Cost,2.69,,,2.69,Other,Drug Cost,2.69,,,2.69,Other,Drug Cost,2.69,,,2.69,Other,Drug Cost,2.69,,,2.69,Other,Drug Cost,6.05,,,6.05,Other,225% of Medicaid,3.77,,,3.77,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.78,,,5.78,Other,215% Medicaid APG methodology,5.78,,,5.78,Other,215% Medicaid APG methodology,3.36,,,3.36,Other,125% Medicaid APG methodology,0.01,6.05,
FERROUS GLUC 324 MG TAB,,,,80000844,CDM,250,RC,574050801,NDC,both,100,EA,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
FIDAXOMICIN 200MG TAB,,,,80000846,CDM,250,RC,52015008001,NDC,both,20,EA,118.44,46.74,39.4668,,46.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,40.27,34,,40.27,percent of total billed charges,"Drugs, Inpatient Only",40.27,34,,40.27,percent of total billed charges,"Drugs, Inpatient Only",40.27,34,,40.27,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,82.91,70,,82.91,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,39.48,,,39.48,Other,Drug Cost,39.48,,,39.48,Other,Drug Cost,39.48,,,39.48,Other,Drug Cost,39.48,,,39.48,Other,Drug Cost,39.48,,,39.48,Other,Drug Cost,39.48,,,39.48,Other,Drug Cost,88.83,,,88.83,Other,225% of Medicaid,55.27,,,55.27,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,84.88,,,84.88,Other,215% Medicaid APG methodology,84.88,,,84.88,Other,215% Medicaid APG methodology,49.35,,,49.35,Other,125% Medicaid APG methodology,0.01,88.83,
FINASTERIDE 5MG TAB,,,,80000849,CDM,250,RC,43598030330,NDC,both,30,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
FLECAINIDE ACETATE 50MG TAB,,,,80000852,CDM,250,RC,53746064101,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
FLUCONAZOLE 100 MG TAB,,,,80000857,CDM,250,RC,68462010230,NDC,both,30,EA,0.33,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,70,,0.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.25,,,0.25,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.24,,,0.24,Other,215% Medicaid APG methodology,0.24,,,0.24,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,0.25,
FLUCONAZOLE 50 MG TAB,,,,80000858,CDM,250,RC,70710113703,NDC,both,30,EA,0.16,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
FLUDROCORTISONE 0.1 MG TAB,,,,80000863,CDM,250,RC,115703301,NDC,both,100,EA,0.34,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,70,,0.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.26,,,0.26,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.25,,,0.25,Other,215% Medicaid APG methodology,0.25,,,0.25,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,0.26,
FLUMAZENIL 0.1MG/ML 10ML INJ,,,,80000864,CDM,250,RC,143978310,NDC,both,10,ML,15.81,6.24,39.4668,,6.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.38,34,,5.38,percent of total billed charges,"Drugs, Inpatient Only",5.38,34,,5.38,percent of total billed charges,"Drugs, Inpatient Only",5.38,34,,5.38,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.07,70,,11.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.27,,,5.27,Other,Drug Cost,5.27,,,5.27,Other,Drug Cost,5.27,,,5.27,Other,Drug Cost,5.27,,,5.27,Other,Drug Cost,5.27,,,5.27,Other,Drug Cost,5.27,,,5.27,Other,Drug Cost,11.86,,,11.86,Other,225% of Medicaid,7.38,,,7.38,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.33,,,11.33,Other,215% Medicaid APG methodology,11.33,,,11.33,Other,215% Medicaid APG methodology,6.59,,,6.59,Other,125% Medicaid APG methodology,0.01,11.86,
FLUMAZENIL 0.1MG/ML 5ML INJ,,,,80000865,CDM,250,RC,143978410,NDC,both,10,ML,7.63,3.01,39.4668,,3.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.59,34,,2.59,percent of total billed charges,"Drugs, Inpatient Only",2.59,34,,2.59,percent of total billed charges,"Drugs, Inpatient Only",2.59,34,,2.59,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.34,70,,5.34,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,5.72,,,5.72,Other,225% of Medicaid,3.56,,,3.56,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.47,,,5.47,Other,215% Medicaid APG methodology,5.47,,,5.47,Other,215% Medicaid APG methodology,3.18,,,3.18,Other,125% Medicaid APG methodology,0.01,5.72,
FLUOCINONIDE 0.05% CRM 15 GM,,,,80000868,CDM,250,RC,93026215,NDC,both,1,GM,12,4.74,39.4668,,4.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.08,34,,4.08,percent of total billed charges,"Drugs, Inpatient Only",4.08,34,,4.08,percent of total billed charges,"Drugs, Inpatient Only",4.08,34,,4.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.4,70,,8.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4,,,4,Other,Drug Cost,4,,,4,Other,Drug Cost,4,,,4,Other,Drug Cost,4,,,4,Other,Drug Cost,4,,,4,Other,Drug Cost,4,,,4,Other,Drug Cost,9,,,9,Other,225% of Medicaid,5.6,,,5.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.6,,,8.6,Other,215% Medicaid APG methodology,8.6,,,8.6,Other,215% Medicaid APG methodology,5,,,5,Other,125% Medicaid APG methodology,0.01,9,
FLUOCINONIDE 0.05% OINT 60 GM,,,,80000871,CDM,250,RC,51672126403,NDC,both,1,GM,19.35,7.64,39.4668,,7.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.58,34,,6.58,percent of total billed charges,"Drugs, Inpatient Only",6.58,34,,6.58,percent of total billed charges,"Drugs, Inpatient Only",6.58,34,,6.58,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.55,70,,13.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.45,,,6.45,Other,Drug Cost,6.45,,,6.45,Other,Drug Cost,6.45,,,6.45,Other,Drug Cost,6.45,,,6.45,Other,Drug Cost,6.45,,,6.45,Other,Drug Cost,6.45,,,6.45,Other,Drug Cost,14.51,,,14.51,Other,225% of Medicaid,9.03,,,9.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,13.87,,,13.87,Other,215% Medicaid APG methodology,13.87,,,13.87,Other,215% Medicaid APG methodology,8.06,,,8.06,Other,125% Medicaid APG methodology,0.01,14.51,
FLUOCINONIDE 0.05% SOLN 60 ML,,,,80000872,CDM,250,RC,51672127302,NDC,both,1,ML,3.42,1.35,39.4668,,1.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.39,70,,2.39,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,2.57,,,2.57,Other,225% of Medicaid,1.6,,,1.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.45,,,2.45,Other,215% Medicaid APG methodology,2.45,,,2.45,Other,215% Medicaid APG methodology,1.43,,,1.43,Other,125% Medicaid APG methodology,0.01,2.57,
FLUORESCEIN 10% SOLN 5 ML,,,,80000873,CDM,250,RC,17478025310,NDC,both,12,ML,122.3,48.27,39.4668,,48.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,41.58,34,,41.58,percent of total billed charges,"Drugs, Inpatient Only",41.58,34,,41.58,percent of total billed charges,"Drugs, Inpatient Only",41.58,34,,41.58,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,85.61,70,,85.61,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,40.77,,,40.77,Other,Drug Cost,40.77,,,40.77,Other,Drug Cost,40.77,,,40.77,Other,Drug Cost,40.77,,,40.77,Other,Drug Cost,40.77,,,40.77,Other,Drug Cost,40.77,,,40.77,Other,Drug Cost,91.72,,,91.72,Other,225% of Medicaid,57.07,,,57.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,87.65,,,87.65,Other,215% Medicaid APG methodology,87.65,,,87.65,Other,215% Medicaid APG methodology,50.96,,,50.96,Other,125% Medicaid APG methodology,0.01,91.72,
FLUORESCEIN 1MG STRIP,,,,80000874,CDM,250,RC,17238090030,NDC,both,300,EA,0.32,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,70,,0.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.24,,,0.24,Other,225% of Medicaid,0.15,,,0.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.23,,,0.23,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.24,
FLUOROMETHOLONE 0.1% OPHTH DROP 5ML,,,,80000875,CDM,250,RC,60758088005,NDC,both,1,ML,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
FLUOXETINE 10MG CAPS,,,,80000879,CDM,250,RC,50111064701,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
FLUOXETINE 20MG,,,,80000880,CDM,250,RC,50111064801,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
FLUOXETINE 20MG/5ML SOLN,,,,80000881,CDM,250,RC,121072104,NDC,both,1,ML,8.91,3.52,39.4668,,3.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.03,34,,3.03,percent of total billed charges,"Drugs, Inpatient Only",3.03,34,,3.03,percent of total billed charges,"Drugs, Inpatient Only",3.03,34,,3.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.24,70,,6.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.97,,,2.97,Other,Drug Cost,2.97,,,2.97,Other,Drug Cost,2.97,,,2.97,Other,Drug Cost,2.97,,,2.97,Other,Drug Cost,2.97,,,2.97,Other,Drug Cost,2.97,,,2.97,Other,Drug Cost,6.68,,,6.68,Other,225% of Medicaid,4.16,,,4.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.39,,,6.39,Other,215% Medicaid APG methodology,6.39,,,6.39,Other,215% Medicaid APG methodology,3.71,,,3.71,Other,125% Medicaid APG methodology,0.01,6.68,
FLUPHENAZINE 2.5 MG/ML,,,,80000884,CDM,250,RC,63323028110,NDC,both,1,ML,280.77,110.81,39.4668,,110.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,95.46,34,,95.46,percent of total billed charges,"Drugs, Inpatient Only",95.46,34,,95.46,percent of total billed charges,"Drugs, Inpatient Only",95.46,34,,95.46,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,196.54,70,,196.54,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,93.59,,,93.59,Other,Drug Cost,93.59,,,93.59,Other,Drug Cost,93.59,,,93.59,Other,Drug Cost,93.59,,,93.59,Other,Drug Cost,93.59,,,93.59,Other,Drug Cost,93.59,,,93.59,Other,Drug Cost,210.58,,,210.58,Other,225% of Medicaid,131.03,,,131.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,201.22,,,201.22,Other,215% Medicaid APG methodology,201.22,,,201.22,Other,215% Medicaid APG methodology,116.99,,,116.99,Other,125% Medicaid APG methodology,0.01,210.58,
FLUPHENAZINE 5MG TAB,,,,80000885,CDM,250,RC,527179001,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.08,
FLUPHENAZINE HCL 2.5 MG/5 ML ELIXIR,,,,80000887,CDM,250,RC,121065402,NDC,both,1,ML,9.09,3.59,39.4668,,3.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.09,34,,3.09,percent of total billed charges,"Drugs, Inpatient Only",3.09,34,,3.09,percent of total billed charges,"Drugs, Inpatient Only",3.09,34,,3.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.36,70,,6.36,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.03,,,3.03,Other,Drug Cost,3.03,,,3.03,Other,Drug Cost,3.03,,,3.03,Other,Drug Cost,3.03,,,3.03,Other,Drug Cost,3.03,,,3.03,Other,Drug Cost,3.03,,,3.03,Other,Drug Cost,6.82,,,6.82,Other,225% of Medicaid,4.24,,,4.24,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.51,,,6.51,Other,215% Medicaid APG methodology,6.51,,,6.51,Other,215% Medicaid APG methodology,3.79,,,3.79,Other,125% Medicaid APG methodology,0.01,6.82,
FLUPHENAZINE HCL 5MG/ML ORAL CONC,,,,80000888,CDM,250,RC,121065304,NDC,both,1,ML,266.91,105.34,39.4668,,105.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,90.75,34,,90.75,percent of total billed charges,"Drugs, Inpatient Only",90.75,34,,90.75,percent of total billed charges,"Drugs, Inpatient Only",90.75,34,,90.75,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,186.84,70,,186.84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,88.97,,,88.97,Other,Drug Cost,88.97,,,88.97,Other,Drug Cost,88.97,,,88.97,Other,Drug Cost,88.97,,,88.97,Other,Drug Cost,88.97,,,88.97,Other,Drug Cost,88.97,,,88.97,Other,Drug Cost,200.18,,,200.18,Other,225% of Medicaid,124.56,,,124.56,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,191.29,,,191.29,Other,215% Medicaid APG methodology,191.29,,,191.29,Other,215% Medicaid APG methodology,111.21,,,111.21,Other,125% Medicaid APG methodology,0.01,200.18,
FLUTICASONE 50MCG/16GM NSL INHAL,,,,80000893,CDM,250,RC,54327099,NDC,both,1,GM,7.35,2.9,39.4668,,2.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.5,34,,2.5,percent of total billed charges,"Drugs, Inpatient Only",2.5,34,,2.5,percent of total billed charges,"Drugs, Inpatient Only",2.5,34,,2.5,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.15,70,,5.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.45,,,2.45,Other,Drug Cost,2.45,,,2.45,Other,Drug Cost,2.45,,,2.45,Other,Drug Cost,2.45,,,2.45,Other,Drug Cost,2.45,,,2.45,Other,Drug Cost,2.45,,,2.45,Other,Drug Cost,5.51,,,5.51,Other,225% of Medicaid,3.43,,,3.43,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.27,,,5.27,Other,215% Medicaid APG methodology,5.27,,,5.27,Other,215% Medicaid APG methodology,3.06,,,3.06,Other,125% Medicaid APG methodology,0.01,5.51,
FLUTICASONE PRO/SALMETEROL DISKUS 250-50,,,,80000895,CDM,250,RC,173069604,NDC,both,14,EA,0.91,0.36,39.4668,,0.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.31,34,,0.31,percent of total billed charges,"Drugs, Inpatient Only",0.31,34,,0.31,percent of total billed charges,"Drugs, Inpatient Only",0.31,34,,0.31,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.64,70,,0.64,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.3,,,0.3,Other,Drug Cost,0.3,,,0.3,Other,Drug Cost,0.3,,,0.3,Other,Drug Cost,0.3,,,0.3,Other,Drug Cost,0.3,,,0.3,Other,Drug Cost,0.3,,,0.3,Other,Drug Cost,0.68,,,0.68,Other,225% of Medicaid,0.43,,,0.43,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.65,,,0.65,Other,215% Medicaid APG methodology,0.65,,,0.65,Other,215% Medicaid APG methodology,0.38,,,0.38,Other,125% Medicaid APG methodology,0.01,0.68,
FLUVOXAMINE 50 MG TAB,,,,80000902,CDM,250,RC,62559015901,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
FOLIC ACID 1 MG TAB,,,,80000904,CDM,250,RC,69315012710,NDC,both,1000,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
FOLIC ACID 5 MG/ML 10ML INJ,,,,80000906,CDM,250,RC,63323018410,NDC,both,1,ML,44.49,17.56,39.4668,,17.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.13,34,,15.13,percent of total billed charges,"Drugs, Inpatient Only",15.13,34,,15.13,percent of total billed charges,"Drugs, Inpatient Only",15.13,34,,15.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,31.14,70,,31.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.83,,,14.83,Other,Drug Cost,14.83,,,14.83,Other,Drug Cost,14.83,,,14.83,Other,Drug Cost,14.83,,,14.83,Other,Drug Cost,14.83,,,14.83,Other,Drug Cost,14.83,,,14.83,Other,Drug Cost,33.37,,,33.37,Other,225% of Medicaid,20.76,,,20.76,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,31.88,,,31.88,Other,215% Medicaid APG methodology,31.88,,,31.88,Other,215% Medicaid APG methodology,18.54,,,18.54,Other,125% Medicaid APG methodology,0.01,33.37,
FUROSEMIDE 20 MG TAB,,,,80000920,CDM,250,RC,54429725,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
FUROSEMIDE 40 MG TAB,,,,80000921,CDM,250,RC,54429931,NDC,both,1000,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
FUROSEMIDE 40MG/5ML SOLN UD,,,,80000922,CDM,250,RC,68094086762,NDC,both,30,ML,4.21,1.66,39.4668,,1.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.43,34,,1.43,percent of total billed charges,"Drugs, Inpatient Only",1.43,34,,1.43,percent of total billed charges,"Drugs, Inpatient Only",1.43,34,,1.43,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.95,70,,2.95,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.4,,,1.4,Other,Drug Cost,1.4,,,1.4,Other,Drug Cost,1.4,,,1.4,Other,Drug Cost,1.4,,,1.4,Other,Drug Cost,1.4,,,1.4,Other,Drug Cost,1.4,,,1.4,Other,Drug Cost,3.16,,,3.16,Other,225% of Medicaid,1.97,,,1.97,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.02,,,3.02,Other,215% Medicaid APG methodology,3.02,,,3.02,Other,215% Medicaid APG methodology,1.76,,,1.76,Other,125% Medicaid APG methodology,0.01,3.16,
GABAPENTIN 100 MG CAPS,,,,80000923,CDM,250,RC,67877022201,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
GABAPENTIN 300 MG CAPS,,,,80000924,CDM,250,RC,67877022305,NDC,both,500,EA,0.06,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
GABAPENTIN 400 MG CAPS,,,,80000925,CDM,250,RC,65162010310,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
GELATIN SPONGE ABSORBABLE 12-7(GELFOAM),,,,80000932,CDM,250,RC,9031508,NDC,both,12,EA,16.29,6.43,39.4668,,6.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.54,34,,5.54,percent of total billed charges,"Drugs, Inpatient Only",5.54,34,,5.54,percent of total billed charges,"Drugs, Inpatient Only",5.54,34,,5.54,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.4,70,,11.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.43,,,5.43,Other,Drug Cost,5.43,,,5.43,Other,Drug Cost,5.43,,,5.43,Other,Drug Cost,5.43,,,5.43,Other,Drug Cost,5.43,,,5.43,Other,Drug Cost,5.43,,,5.43,Other,Drug Cost,12.22,,,12.22,Other,225% of Medicaid,7.6,,,7.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.67,,,11.67,Other,215% Medicaid APG methodology,11.67,,,11.67,Other,215% Medicaid APG methodology,6.79,,,6.79,Other,125% Medicaid APG methodology,0.01,12.22,
GELATIN SPONGE ABSORBABLE SIZE100,,,,80000933,CDM,250,RC,9034201,NDC,both,6,EA,59.09,23.32,39.4668,,23.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,20.09,34,,20.09,percent of total billed charges,"Drugs, Inpatient Only",20.09,34,,20.09,percent of total billed charges,"Drugs, Inpatient Only",20.09,34,,20.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,41.37,70,,41.37,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.7,,,19.7,Other,Drug Cost,19.7,,,19.7,Other,Drug Cost,19.7,,,19.7,Other,Drug Cost,19.7,,,19.7,Other,Drug Cost,19.7,,,19.7,Other,Drug Cost,19.7,,,19.7,Other,Drug Cost,44.32,,,44.32,Other,225% of Medicaid,27.58,,,27.58,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,42.35,,,42.35,Other,215% Medicaid APG methodology,42.35,,,42.35,Other,215% Medicaid APG methodology,24.62,,,24.62,Other,125% Medicaid APG methodology,0.01,44.32,
GENTAMICIN 0.1% OINT 15 GM,,,,80000939,CDM,250,RC,45802004635,NDC,both,1,GM,7.68,3.03,39.4668,,3.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.61,34,,2.61,percent of total billed charges,"Drugs, Inpatient Only",2.61,34,,2.61,percent of total billed charges,"Drugs, Inpatient Only",2.61,34,,2.61,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.38,70,,5.38,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.56,,,2.56,Other,Drug Cost,2.56,,,2.56,Other,Drug Cost,2.56,,,2.56,Other,Drug Cost,2.56,,,2.56,Other,Drug Cost,2.56,,,2.56,Other,Drug Cost,2.56,,,2.56,Other,Drug Cost,5.76,,,5.76,Other,225% of Medicaid,3.58,,,3.58,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.5,,,5.5,Other,215% Medicaid APG methodology,5.5,,,5.5,Other,215% Medicaid APG methodology,3.2,,,3.2,Other,125% Medicaid APG methodology,0.01,5.76,
GENTAMICIN 0.3% OPTH SOLN 5ML,,,,80000941,CDM,250,RC,61314063305,NDC,both,1,ML,3.27,1.29,39.4668,,1.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.11,34,,1.11,percent of total billed charges,"Drugs, Inpatient Only",1.11,34,,1.11,percent of total billed charges,"Drugs, Inpatient Only",1.11,34,,1.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.29,70,,2.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,2.45,,,2.45,Other,225% of Medicaid,1.53,,,1.53,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.34,,,2.34,Other,215% Medicaid APG methodology,2.34,,,2.34,Other,215% Medicaid APG methodology,1.36,,,1.36,Other,125% Medicaid APG methodology,0.01,2.45,
GENTIAN VIOLET,,,,80000944,CDM,250,RC,395100392,NDC,both,1,ML,18.06,7.13,39.4668,,7.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.14,34,,6.14,percent of total billed charges,"Drugs, Inpatient Only",6.14,34,,6.14,percent of total billed charges,"Drugs, Inpatient Only",6.14,34,,6.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.64,70,,12.64,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.02,,,6.02,Other,Drug Cost,6.02,,,6.02,Other,Drug Cost,6.02,,,6.02,Other,Drug Cost,6.02,,,6.02,Other,Drug Cost,6.02,,,6.02,Other,Drug Cost,6.02,,,6.02,Other,Drug Cost,13.55,,,13.55,Other,225% of Medicaid,8.43,,,8.43,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.94,,,12.94,Other,215% Medicaid APG methodology,12.94,,,12.94,Other,215% Medicaid APG methodology,7.53,,,7.53,Other,125% Medicaid APG methodology,0.01,13.55,
GLYCOPYRROLATE 0.2 MG/ML 1ML INJ,,,,80000960,CDM,250,RC,143968225,NDC,both,25,ML,1.45,0.57,39.4668,,0.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.49,34,,0.49,percent of total billed charges,"Drugs, Inpatient Only",0.49,34,,0.49,percent of total billed charges,"Drugs, Inpatient Only",0.49,34,,0.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.01,70,,1.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,1.09,,,1.09,Other,225% of Medicaid,0.68,,,0.68,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.04,,,1.04,Other,215% Medicaid APG methodology,1.04,,,1.04,Other,215% Medicaid APG methodology,0.6,,,0.6,Other,125% Medicaid APG methodology,0.01,1.09,
GOLYTELY 4000ML,,,,80000962,CDM,250,RC,52268010001,NDC,both,1,ML,20.76,8.19,39.4668,,8.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.06,34,,7.06,percent of total billed charges,"Drugs, Inpatient Only",7.06,34,,7.06,percent of total billed charges,"Drugs, Inpatient Only",7.06,34,,7.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.53,70,,14.53,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.92,,,6.92,Other,Drug Cost,6.92,,,6.92,Other,Drug Cost,6.92,,,6.92,Other,Drug Cost,6.92,,,6.92,Other,Drug Cost,6.92,,,6.92,Other,Drug Cost,6.92,,,6.92,Other,Drug Cost,15.57,,,15.57,Other,225% of Medicaid,9.69,,,9.69,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,14.88,,,14.88,Other,215% Medicaid APG methodology,14.88,,,14.88,Other,215% Medicaid APG methodology,8.65,,,8.65,Other,125% Medicaid APG methodology,0.01,15.57,
GUAIAFENESIN 600MG ER TAB,,,,80000968,CDM,250,RC,63824000850,NDC,both,500,EA,0.76,0.3,39.4668,,0.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.53,70,,0.53,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.57,,,0.57,Other,225% of Medicaid,0.35,,,0.35,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.54,,,0.54,Other,215% Medicaid APG methodology,0.54,,,0.54,Other,215% Medicaid APG methodology,0.31,,,0.31,Other,125% Medicaid APG methodology,0.01,0.57,
GUANFACINE 1MG TAB,,,,80000971,CDM,250,RC,53746071101,NDC,both,100,EA,0.23,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,70,,0.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.17,,,0.17,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.16,,,0.16,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.17,
HAEMOPH B POLYSAC CONJ-TET TOX (ACTHIB),,,,80000972,CDM,250,RC,49281054503,NDC,both,5,EA,35.32,13.94,39.4668,,13.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.01,34,,12.01,percent of total billed charges,"Drugs, Inpatient Only",12.01,34,,12.01,percent of total billed charges,"Drugs, Inpatient Only",12.01,34,,12.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.73,70,,24.73,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.77,,,11.77,Other,Drug Cost,11.77,,,11.77,Other,Drug Cost,11.77,,,11.77,Other,Drug Cost,11.77,,,11.77,Other,Drug Cost,11.77,,,11.77,Other,Drug Cost,11.77,,,11.77,Other,Drug Cost,26.49,,,26.49,Other,225% of Medicaid,16.48,,,16.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,25.31,,,25.31,Other,215% Medicaid APG methodology,25.31,,,25.31,Other,215% Medicaid APG methodology,14.72,,,14.72,Other,125% Medicaid APG methodology,0.01,26.49,
HALOPERIDOL 0.5 MG TAB,,,,80000975,CDM,250,RC,378035101,NDC,both,100,EA,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
HALOPERIDOL 1 MG TAB,,,,80000976,CDM,250,RC,378025710,NDC,both,1000,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
HALOPERIDOL 2 MG TAB,,,,80000977,CDM,250,RC,51079073520,NDC,both,10,EA,11.25,4.44,39.4668,,4.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.83,34,,3.83,percent of total billed charges,"Drugs, Inpatient Only",3.83,34,,3.83,percent of total billed charges,"Drugs, Inpatient Only",3.83,34,,3.83,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.88,70,,7.88,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.75,,,3.75,Other,Drug Cost,3.75,,,3.75,Other,Drug Cost,3.75,,,3.75,Other,Drug Cost,3.75,,,3.75,Other,Drug Cost,3.75,,,3.75,Other,Drug Cost,3.75,,,3.75,Other,Drug Cost,8.44,,,8.44,Other,225% of Medicaid,5.25,,,5.25,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.06,,,8.06,Other,215% Medicaid APG methodology,8.06,,,8.06,Other,215% Medicaid APG methodology,4.69,,,4.69,Other,125% Medicaid APG methodology,0.01,8.44,
HALOPERIDOL 5 MG TAB,,,,80000978,CDM,250,RC,378032701,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
HALOPERIDOL LACTATE 2MG/ML 5ML UD,,,,80000982,CDM,250,RC,121058105,NDC,both,100,ML,0.29,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,70,,0.21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.22,,,0.22,Other,225% of Medicaid,0.14,,,0.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.21,,,0.21,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.22,
HEPARIN SODIUM 10000 UNIT/ML INJ,,,,80000993,CDM,250,RC,25021040301,NDC,both,25,ML,3.05,1.2,39.4668,,1.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.04,34,,1.04,percent of total billed charges,"Drugs, Inpatient Only",1.04,34,,1.04,percent of total billed charges,"Drugs, Inpatient Only",1.04,34,,1.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.13,70,,2.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,2.28,,,2.28,Other,225% of Medicaid,1.42,,,1.42,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.18,,,2.18,Other,215% Medicaid APG methodology,2.18,,,2.18,Other,215% Medicaid APG methodology,1.27,,,1.27,Other,125% Medicaid APG methodology,0.01,2.28,
HEPARIN SODIUM 2000 UNIT/2ML INJ,,,,80000995,CDM,250,RC,63323027602,NDC,both,25,ML,14.35,5.66,39.4668,,5.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.88,34,,4.88,percent of total billed charges,"Drugs, Inpatient Only",4.88,34,,4.88,percent of total billed charges,"Drugs, Inpatient Only",4.88,34,,4.88,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.04,70,,10.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.78,,,4.78,Other,Drug Cost,4.78,,,4.78,Other,Drug Cost,4.78,,,4.78,Other,Drug Cost,4.78,,,4.78,Other,Drug Cost,4.78,,,4.78,Other,Drug Cost,4.78,,,4.78,Other,Drug Cost,10.76,,,10.76,Other,225% of Medicaid,6.7,,,6.7,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.28,,,10.28,Other,215% Medicaid APG methodology,10.28,,,10.28,Other,215% Medicaid APG methodology,5.98,,,5.98,Other,125% Medicaid APG methodology,0.01,10.76,
HYDRALAZINE 10 MG TAB,,,,80001006,CDM,250,RC,31722051901,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.03,
HYDRALAZINE 25MG TAB,,,,80001007,CDM,250,RC,50111032701,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
HYDROCHLOROTHIAZIDE 12.5 MG TAB,,,,80001009,CDM,250,RC,69315015501,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
HYDROCHLOROTHIAZIDE 25 MG TAB,,,,80001010,CDM,250,RC,172208380,NDC,both,1000,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
HYDROCOD/APAP 10-325MG TAB,,,,80001011,CDM,250,RC,53746011001,NDC,both,100,EA,0.17,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,70,,0.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.13,
HYDROCOD/APAP 5-325MG TAB,,,,80001012,CDM,250,RC,53746010901,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.06,
HYDROCOD/APAP 7.5-325MG TAB,,,,80001013,CDM,250,RC,406012401,NDC,both,100,EA,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
HYDROCORTISONE (ANUCORT-HC) 25MG,,,,80001021,CDM,250,RC,713050312,NDC,both,12,EA,1.91,0.75,39.4668,,0.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.65,34,,0.65,percent of total billed charges,"Drugs, Inpatient Only",0.65,34,,0.65,percent of total billed charges,"Drugs, Inpatient Only",0.65,34,,0.65,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.34,70,,1.34,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,1.43,,,1.43,Other,225% of Medicaid,0.89,,,0.89,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.37,,,1.37,Other,215% Medicaid APG methodology,1.37,,,1.37,Other,215% Medicaid APG methodology,0.8,,,0.8,Other,125% Medicaid APG methodology,0.01,1.43,
HYDROCORTISONE (CORTEF) 10MG,,,,80001022,CDM,250,RC,59762007401,NDC,both,100,EA,0.22,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.16,,,0.16,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
HYDROCORTISONE (CORTEF) 5MG,,,,80001023,CDM,250,RC,9001201,NDC,both,50,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
HYDROCORTISONE 1% CRM 28 GM,,,,80001026,CDM,250,RC,472032126,NDC,both,1,GM,1.77,0.7,39.4668,,0.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.6,34,,0.6,percent of total billed charges,"Drugs, Inpatient Only",0.6,34,,0.6,percent of total billed charges,"Drugs, Inpatient Only",0.6,34,,0.6,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.24,70,,1.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.59,,,0.59,Other,Drug Cost,0.59,,,0.59,Other,Drug Cost,0.59,,,0.59,Other,Drug Cost,0.59,,,0.59,Other,Drug Cost,0.59,,,0.59,Other,Drug Cost,0.59,,,0.59,Other,Drug Cost,1.33,,,1.33,Other,225% of Medicaid,0.83,,,0.83,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.27,,,1.27,Other,215% Medicaid APG methodology,1.27,,,1.27,Other,215% Medicaid APG methodology,0.74,,,0.74,Other,125% Medicaid APG methodology,0.01,1.33,
HYDROCORTISONE 1% OINT 30GM,,,,80001027,CDM,250,RC,45802027603,NDC,both,1,GM,2.52,0.99,39.4668,,0.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.86,34,,0.86,percent of total billed charges,"Drugs, Inpatient Only",0.86,34,,0.86,percent of total billed charges,"Drugs, Inpatient Only",0.86,34,,0.86,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.76,70,,1.76,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.84,,,0.84,Other,Drug Cost,0.84,,,0.84,Other,Drug Cost,0.84,,,0.84,Other,Drug Cost,0.84,,,0.84,Other,Drug Cost,0.84,,,0.84,Other,Drug Cost,0.84,,,0.84,Other,Drug Cost,1.89,,,1.89,Other,225% of Medicaid,1.18,,,1.18,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.81,,,1.81,Other,215% Medicaid APG methodology,1.81,,,1.81,Other,215% Medicaid APG methodology,1.05,,,1.05,Other,125% Medicaid APG methodology,0.01,1.89,
HYDROCORTISONE 2.5%  OINT 20GM,,,,80001028,CDM,250,RC,168014630,NDC,both,1,GM,2.55,1.01,39.4668,,1.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.87,34,,0.87,percent of total billed charges,"Drugs, Inpatient Only",0.87,34,,0.87,percent of total billed charges,"Drugs, Inpatient Only",0.87,34,,0.87,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.79,70,,1.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,1.91,,,1.91,Other,225% of Medicaid,1.19,,,1.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.83,,,1.83,Other,215% Medicaid APG methodology,1.83,,,1.83,Other,215% Medicaid APG methodology,1.06,,,1.06,Other,125% Medicaid APG methodology,0.01,1.91,
HYDROCORTISONE 2.5% CRM 30 GM,,,,80001029,CDM,250,RC,168008031,NDC,both,1,GM,2.4,0.95,39.4668,,0.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.82,34,,0.82,percent of total billed charges,"Drugs, Inpatient Only",0.82,34,,0.82,percent of total billed charges,"Drugs, Inpatient Only",0.82,34,,0.82,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.68,70,,1.68,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,1.8,,,1.8,Other,225% of Medicaid,1.12,,,1.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.72,,,1.72,Other,215% Medicaid APG methodology,1.72,,,1.72,Other,215% Medicaid APG methodology,1,,,1,Other,125% Medicaid APG methodology,0.01,1.8,
HYDROMORPHONE 2 MG TAB,,,,80001033,CDM,250,RC,406324301,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
HYDROMORPHONE 4 MG TAB,,,,80001034,CDM,250,RC,42858030225,NDC,both,4,EA,5.12,2.02,39.4668,,2.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.74,34,,1.74,percent of total billed charges,"Drugs, Inpatient Only",1.74,34,,1.74,percent of total billed charges,"Drugs, Inpatient Only",1.74,34,,1.74,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.59,70,,3.59,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.71,,,1.71,Other,Drug Cost,1.71,,,1.71,Other,Drug Cost,1.71,,,1.71,Other,Drug Cost,1.71,,,1.71,Other,Drug Cost,1.71,,,1.71,Other,Drug Cost,1.71,,,1.71,Other,Drug Cost,3.84,,,3.84,Other,225% of Medicaid,2.39,,,2.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.67,,,3.67,Other,215% Medicaid APG methodology,3.67,,,3.67,Other,215% Medicaid APG methodology,2.13,,,2.13,Other,125% Medicaid APG methodology,0.01,3.84,
HYDROPHILIC OINT,,,,80001038,CDM,250,RC,72140045231,NDC,both,1,EA,16.56,6.54,39.4668,,6.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.63,34,,5.63,percent of total billed charges,"Drugs, Inpatient Only",5.63,34,,5.63,percent of total billed charges,"Drugs, Inpatient Only",5.63,34,,5.63,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.59,70,,11.59,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.52,,,5.52,Other,Drug Cost,5.52,,,5.52,Other,Drug Cost,5.52,,,5.52,Other,Drug Cost,5.52,,,5.52,Other,Drug Cost,5.52,,,5.52,Other,Drug Cost,5.52,,,5.52,Other,Drug Cost,12.42,,,12.42,Other,225% of Medicaid,7.73,,,7.73,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.87,,,11.87,Other,215% Medicaid APG methodology,11.87,,,11.87,Other,215% Medicaid APG methodology,6.9,,,6.9,Other,125% Medicaid APG methodology,0.01,12.42,
HYDROPHOR 100GM OINT,,,,80001040,CDM,250,RC,536114397,NDC,both,1,GM,5.82,2.3,39.4668,,2.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.98,34,,1.98,percent of total billed charges,"Drugs, Inpatient Only",1.98,34,,1.98,percent of total billed charges,"Drugs, Inpatient Only",1.98,34,,1.98,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.07,70,,4.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.94,,,1.94,Other,Drug Cost,1.94,,,1.94,Other,Drug Cost,1.94,,,1.94,Other,Drug Cost,1.94,,,1.94,Other,Drug Cost,1.94,,,1.94,Other,Drug Cost,1.94,,,1.94,Other,Drug Cost,4.37,,,4.37,Other,225% of Medicaid,2.72,,,2.72,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.17,,,4.17,Other,215% Medicaid APG methodology,4.17,,,4.17,Other,215% Medicaid APG methodology,2.43,,,2.43,Other,125% Medicaid APG methodology,0.01,4.37,
HYDROXYCHLOROQ 200 MG TAB,,,,80001041,CDM,250,RC,43598072101,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.15,
HYDROXYUREA 500MG,,,,80001042,CDM,250,RC,49884072401,NDC,both,100,EA,0.27,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,70,,0.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.21,,,0.21,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.2,,,0.2,Other,215% Medicaid APG methodology,0.2,,,0.2,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.21,
HYDROXYZINE HCL 25 MG TAB,,,,80001044,CDM,250,RC,23155050101,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
HYDROXYZINE HCL 25MG/ML 1ML INJ,,,,80001045,CDM,250,RC,517420125,NDC,both,25,ML,1.7,0.67,39.4668,,0.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.58,34,,0.58,percent of total billed charges,"Drugs, Inpatient Only",0.58,34,,0.58,percent of total billed charges,"Drugs, Inpatient Only",0.58,34,,0.58,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.19,70,,1.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,1.27,,,1.27,Other,225% of Medicaid,0.79,,,0.79,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.22,,,1.22,Other,215% Medicaid APG methodology,1.22,,,1.22,Other,215% Medicaid APG methodology,0.71,,,0.71,Other,125% Medicaid APG methodology,0.01,1.27,
HYDROXYZINE PAMOATE 25 MG CAPS,,,,80001047,CDM,250,RC,185067401,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
HYDROXYZINE PAMOATE 50 MG CAPS,,,,80001048,CDM,250,RC,115180401,NDC,both,100,EA,0.09,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
HYOSCYAMINE 0.125MG SL TAB,,,,80001051,CDM,250,RC,68047025301,NDC,both,100,EA,0.35,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,70,,0.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.26,,,0.26,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.25,,,0.25,Other,215% Medicaid APG methodology,0.25,,,0.25,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,125% Medicaid APG methodology,0.01,0.26,
IBUPROFEN 100MG/5ML 5ML UD,,,,80001054,CDM,250,RC,68094049458,NDC,both,50,ML,1.64,0.65,39.4668,,0.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.56,34,,0.56,percent of total billed charges,"Drugs, Inpatient Only",0.56,34,,0.56,percent of total billed charges,"Drugs, Inpatient Only",0.56,34,,0.56,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.15,70,,1.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.55,,,0.55,Other,Drug Cost,0.55,,,0.55,Other,Drug Cost,0.55,,,0.55,Other,Drug Cost,0.55,,,0.55,Other,Drug Cost,0.55,,,0.55,Other,Drug Cost,0.55,,,0.55,Other,Drug Cost,1.23,,,1.23,Other,225% of Medicaid,0.77,,,0.77,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.18,,,1.18,Other,215% Medicaid APG methodology,1.18,,,1.18,Other,215% Medicaid APG methodology,0.68,,,0.68,Other,125% Medicaid APG methodology,0.01,1.23,
IBUPROFEN 200 MG TAB,,,,80001055,CDM,250,RC,904791259,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
IBUPROFEN 400MG TAB,,,,80001056,CDM,250,RC,67877031901,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
IBUPROFEN 600MG TAB,,,,80001057,CDM,250,RC,67877032005,NDC,both,500,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
IMIPRAMINE 10 MG TAB,,,,80001066,CDM,250,RC,64380016901,NDC,both,100,EA,0.09,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
IMIPRAMINE HCL 25 MG TAB,,,,80001068,CDM,250,RC,64380017001,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
IMIQUIMOD (ALDARA) 5%,,,,80001069,CDM,250,RC,45802036853,NDC,both,12,EA,4.1,1.62,39.4668,,1.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.39,34,,1.39,percent of total billed charges,"Drugs, Inpatient Only",1.39,34,,1.39,percent of total billed charges,"Drugs, Inpatient Only",1.39,34,,1.39,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.87,70,,2.87,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.37,,,1.37,Other,Drug Cost,1.37,,,1.37,Other,Drug Cost,1.37,,,1.37,Other,Drug Cost,1.37,,,1.37,Other,Drug Cost,1.37,,,1.37,Other,Drug Cost,1.37,,,1.37,Other,Drug Cost,3.07,,,3.07,Other,225% of Medicaid,1.91,,,1.91,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.93,,,2.93,Other,215% Medicaid APG methodology,2.93,,,2.93,Other,215% Medicaid APG methodology,1.71,,,1.71,Other,125% Medicaid APG methodology,0.01,3.07,
INDOMETHACIN 25 MG CAPS,,,,80001078,CDM,250,RC,68462040601,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
INSULIN GLARAGIN (LANTUS) 100 U/ML,,,,80001086,CDM,250,RC,88222033,NDC,both,1,ML,0.27,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,70,,0.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.19,,,0.19,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.2,
INTRALIPID 20% IV 250ML,,,,80001088,CDM,250,RC,338051909,NDC,both,10,ML,6.8,2.68,39.4668,,2.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.31,34,,2.31,percent of total billed charges,"Drugs, Inpatient Only",2.31,34,,2.31,percent of total billed charges,"Drugs, Inpatient Only",2.31,34,,2.31,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.76,70,,4.76,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,5.1,,,5.1,Other,225% of Medicaid,3.17,,,3.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.87,,,4.87,Other,215% Medicaid APG methodology,4.87,,,4.87,Other,215% Medicaid APG methodology,2.83,,,2.83,Other,125% Medicaid APG methodology,0.01,5.1,
IODINE TINCTURE 2% 30ML,,,,80001092,CDM,250,RC,869385110,NDC,both,1,ML,7.68,3.03,39.4668,,3.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.61,34,,2.61,percent of total billed charges,"Drugs, Inpatient Only",2.61,34,,2.61,percent of total billed charges,"Drugs, Inpatient Only",2.61,34,,2.61,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.38,70,,5.38,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.56,,,2.56,Other,Drug Cost,2.56,,,2.56,Other,Drug Cost,2.56,,,2.56,Other,Drug Cost,2.56,,,2.56,Other,Drug Cost,2.56,,,2.56,Other,Drug Cost,2.56,,,2.56,Other,Drug Cost,5.76,,,5.76,Other,225% of Medicaid,3.58,,,3.58,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.5,,,5.5,Other,215% Medicaid APG methodology,5.5,,,5.5,Other,215% Medicaid APG methodology,3.2,,,3.2,Other,125% Medicaid APG methodology,0.01,5.76,
IPRATROPIUM ALBUTERAL INHL SLN,,,,80001095,CDM,250,RC,69097084087,NDC,both,30,ML,0.26,0.1,39.4668,,0.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,70,,0.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.19,,,0.19,Other,225% of Medicaid,0.12,,,0.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.18,,,0.18,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.19,
IPRATROPIUM BROMIDE (ATROVENT) HFA 17MCG,,,,80001096,CDM,250,RC,597008717,NDC,both,1,GM,0.36,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,70,,0.25,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.27,,,0.27,Other,225% of Medicaid,0.17,,,0.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.26,,,0.26,Other,215% Medicaid APG methodology,0.26,,,0.26,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,125% Medicaid APG methodology,0.01,0.27,
IPRATROPIUM BROMIDE 0.02% SOLN,,,,80001097,CDM,250,RC,378797093,NDC,both,30,ML,0.25,0.1,39.4668,,0.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,70,,0.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.18,,,0.18,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.18,,,0.18,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.18,
IRON POLYSACCHARIDE COMPLEX  150MG CAPS,,,,80001101,CDM,250,RC,51991019811,NDC,both,100,EA,0.26,0.1,39.4668,,0.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,70,,0.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.12,,,0.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.19,,,0.19,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.2,
ISONIAZID 100 MG/ML INJ,,,,80001105,CDM,250,RC,781305670,NDC,both,1,ML,729.15,287.77,39.4668,,287.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,247.91,34,,247.91,percent of total billed charges,"Drugs, Inpatient Only",247.91,34,,247.91,percent of total billed charges,"Drugs, Inpatient Only",247.91,34,,247.91,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,510.41,70,,510.41,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,243.05,,,243.05,Other,Drug Cost,243.05,,,243.05,Other,Drug Cost,243.05,,,243.05,Other,Drug Cost,243.05,,,243.05,Other,Drug Cost,243.05,,,243.05,Other,Drug Cost,243.05,,,243.05,Other,Drug Cost,546.86,,,546.86,Other,225% of Medicaid,340.27,,,340.27,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,522.56,,,522.56,Other,215% Medicaid APG methodology,522.56,,,522.56,Other,215% Medicaid APG methodology,303.81,,,303.81,Other,125% Medicaid APG methodology,0.01,546.86,
ISONIAZID 300 MG,,,,80001106,CDM,250,RC,555007101,NDC,both,30,EA,0.19,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.14,,,0.14,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
ISOSORBIDE DINITRATE 10MG TAB,,,,80001110,CDM,250,RC,143177101,NDC,both,100,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.08,
ISOSORBIDE DINITRATE 20 MG TAB,,,,80001111,CDM,250,RC,781169501,NDC,both,100,EA,0.39,0.16,39.4668,,0.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,70,,0.28,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.29,,,0.29,Other,225% of Medicaid,0.18,,,0.18,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.28,,,0.28,Other,215% Medicaid APG methodology,0.28,,,0.28,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,125% Medicaid APG methodology,0.01,0.29,
ISOSORBIDE MONO 20MG TAB,,,,80001112,CDM,250,RC,228262011,NDC,both,100,EA,0.24,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,70,,0.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.18,,,0.18,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.17,,,0.17,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.18,
ISOSORBIDE MONO 30MG ER TAB,,,,80001113,CDM,250,RC,13668010401,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
ISOSORBIDE MONO 60MG ER TAB,,,,80001114,CDM,250,RC,23155017801,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
ITRACONAZOLE 100MG CAPSULE,,,,80001116,CDM,250,RC,10147170003,NDC,both,30,EA,1.18,0.46,39.4668,,0.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.82,70,,0.82,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.88,,,0.88,Other,225% of Medicaid,0.55,,,0.55,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.84,,,0.84,Other,215% Medicaid APG methodology,0.84,,,0.84,Other,215% Medicaid APG methodology,0.49,,,0.49,Other,125% Medicaid APG methodology,0.01,0.88,
IVERMECTIN 3MG TAB,,,,80001117,CDM,250,RC,6003220,NDC,both,20,EA,9.6,3.79,39.4668,,3.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.27,34,,3.27,percent of total billed charges,"Drugs, Inpatient Only",3.27,34,,3.27,percent of total billed charges,"Drugs, Inpatient Only",3.27,34,,3.27,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.72,70,,6.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,7.2,,,7.2,Other,225% of Medicaid,4.48,,,4.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.88,,,6.88,Other,215% Medicaid APG methodology,6.88,,,6.88,Other,215% Medicaid APG methodology,4,,,4,Other,125% Medicaid APG methodology,0.01,7.2,
KALETRA 200-50MG TAB,,,,80001119,CDM,250,RC,42385093412,NDC,both,120,EA,8.66,3.42,39.4668,,3.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.95,34,,2.95,percent of total billed charges,"Drugs, Inpatient Only",2.95,34,,2.95,percent of total billed charges,"Drugs, Inpatient Only",2.95,34,,2.95,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.07,70,,6.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,6.5,,,6.5,Other,225% of Medicaid,4.04,,,4.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.21,,,6.21,Other,215% Medicaid APG methodology,6.21,,,6.21,Other,215% Medicaid APG methodology,3.61,,,3.61,Other,125% Medicaid APG methodology,0.01,6.5,
KALETRA 400-100MG/5ML SOLN 160 ML,,,,80001120,CDM,250,RC,74395646,NDC,both,1,ML,1002.3,395.58,39.4668,,395.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,340.78,34,,340.78,percent of total billed charges,"Drugs, Inpatient Only",340.78,34,,340.78,percent of total billed charges,"Drugs, Inpatient Only",340.78,34,,340.78,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,701.61,70,,701.61,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,334.1,,,334.1,Other,Drug Cost,334.1,,,334.1,Other,Drug Cost,334.1,,,334.1,Other,Drug Cost,334.1,,,334.1,Other,Drug Cost,334.1,,,334.1,Other,Drug Cost,334.1,,,334.1,Other,Drug Cost,751.73,,,751.73,Other,225% of Medicaid,467.74,,,467.74,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,718.32,,,718.32,Other,215% Medicaid APG methodology,718.32,,,718.32,Other,215% Medicaid APG methodology,417.63,,,417.63,Other,125% Medicaid APG methodology,0.01,751.73,
KETAMINE (KETALAR) 50MG/ML 10ML INJ,,,,80001122,CDM,250,RC,409205310,NDC,both,10,ML,8.13,3.21,39.4668,,3.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.76,34,,2.76,percent of total billed charges,"Drugs, Inpatient Only",2.76,34,,2.76,percent of total billed charges,"Drugs, Inpatient Only",2.76,34,,2.76,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.69,70,,5.69,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.71,,,2.71,Other,Drug Cost,2.71,,,2.71,Other,Drug Cost,2.71,,,2.71,Other,Drug Cost,2.71,,,2.71,Other,Drug Cost,2.71,,,2.71,Other,Drug Cost,2.71,,,2.71,Other,Drug Cost,6.1,,,6.1,Other,225% of Medicaid,3.79,,,3.79,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.83,,,5.83,Other,215% Medicaid APG methodology,5.83,,,5.83,Other,215% Medicaid APG methodology,3.39,,,3.39,Other,125% Medicaid APG methodology,0.01,6.1,
KETOROLAC 10MG TAB,,,,80001126,CDM,250,RC,93031401,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.08,
KETOROLAC TROMETHAMINE (ACULAR) 10ML,,,,80001127,CDM,250,RC,61314012605,NDC,both,1,ML,12.21,4.82,39.4668,,4.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.15,34,,4.15,percent of total billed charges,"Drugs, Inpatient Only",4.15,34,,4.15,percent of total billed charges,"Drugs, Inpatient Only",4.15,34,,4.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.55,70,,8.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,9.16,,,9.16,Other,225% of Medicaid,5.7,,,5.7,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.75,,,8.75,Other,215% Medicaid APG methodology,8.75,,,8.75,Other,215% Medicaid APG methodology,5.09,,,5.09,Other,125% Medicaid APG methodology,0.01,9.16,
KETOROLAC TROMETHAMINE (ACULAR) 5ML,,,,80001129,CDM,250,RC,60505100301,NDC,both,1,ML,6.51,2.57,39.4668,,2.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.21,34,,2.21,percent of total billed charges,"Drugs, Inpatient Only",2.21,34,,2.21,percent of total billed charges,"Drugs, Inpatient Only",2.21,34,,2.21,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.56,70,,4.56,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.17,,,2.17,Other,Drug Cost,2.17,,,2.17,Other,Drug Cost,2.17,,,2.17,Other,Drug Cost,2.17,,,2.17,Other,Drug Cost,2.17,,,2.17,Other,Drug Cost,2.17,,,2.17,Other,Drug Cost,4.88,,,4.88,Other,225% of Medicaid,3.04,,,3.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.67,,,4.67,Other,215% Medicaid APG methodology,4.67,,,4.67,Other,215% Medicaid APG methodology,2.71,,,2.71,Other,125% Medicaid APG methodology,0.01,4.88,
LABETALOL 100 MG TAB,,,,80001131,CDM,250,RC,68382079801,NDC,both,100,EA,0.27,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,70,,0.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.19,,,0.19,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.2,
LABETALOL 200 MG TAB,,,,80001132,CDM,250,RC,591060601,NDC,both,100,EA,0.16,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
LABETALOL 5 MG/ML 20ML INJ,,,,80001133,CDM,250,RC,409226720,NDC,both,1,ML,3.81,1.5,39.4668,,1.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.3,34,,1.3,percent of total billed charges,"Drugs, Inpatient Only",1.3,34,,1.3,percent of total billed charges,"Drugs, Inpatient Only",1.3,34,,1.3,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.67,70,,2.67,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.27,,,1.27,Other,Drug Cost,1.27,,,1.27,Other,Drug Cost,1.27,,,1.27,Other,Drug Cost,1.27,,,1.27,Other,Drug Cost,1.27,,,1.27,Other,Drug Cost,1.27,,,1.27,Other,Drug Cost,2.86,,,2.86,Other,225% of Medicaid,1.78,,,1.78,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.73,,,2.73,Other,215% Medicaid APG methodology,2.73,,,2.73,Other,215% Medicaid APG methodology,1.59,,,1.59,Other,125% Medicaid APG methodology,0.01,2.86,
LACOSAMIDE 50 MG,,,,80001136,CDM,250,RC,62332017160,NDC,both,60,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.12,
LACTASE (LACTAID) 3MU CAPS,,,,80001138,CDM,250,RC,904522452,NDC,both,60,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
LACTULOSE (CONSTULOSE) 10G/15ML 946ML,,,,80001142,CDM,250,RC,45963043965,NDC,both,1,ML,25.71,10.15,39.4668,,10.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.74,34,,8.74,percent of total billed charges,"Drugs, Inpatient Only",8.74,34,,8.74,percent of total billed charges,"Drugs, Inpatient Only",8.74,34,,8.74,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18,70,,18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.57,,,8.57,Other,Drug Cost,8.57,,,8.57,Other,Drug Cost,8.57,,,8.57,Other,Drug Cost,8.57,,,8.57,Other,Drug Cost,8.57,,,8.57,Other,Drug Cost,8.57,,,8.57,Other,Drug Cost,19.28,,,19.28,Other,225% of Medicaid,12,,,12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,18.43,,,18.43,Other,215% Medicaid APG methodology,18.43,,,18.43,Other,215% Medicaid APG methodology,10.71,,,10.71,Other,125% Medicaid APG methodology,0.01,19.28,
LAMIVUDINE 150 MG TABLET,,,,80001144,CDM,250,RC,33342000109,NDC,both,60,EA,0.53,0.21,39.4668,,0.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,34,,0.18,percent of total billed charges,"Drugs, Inpatient Only",0.18,34,,0.18,percent of total billed charges,"Drugs, Inpatient Only",0.18,34,,0.18,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.37,70,,0.37,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.4,,,0.4,Other,225% of Medicaid,0.25,,,0.25,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.38,,,0.38,Other,215% Medicaid APG methodology,0.38,,,0.38,Other,215% Medicaid APG methodology,0.22,,,0.22,Other,125% Medicaid APG methodology,0.01,0.4,
LAMOTRIGINE (LAMICTAL) 100MG TAB,,,,80001145,CDM,250,RC,51672413101,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
LAMOTRIGINE (LAMICTAL) 25MG TAB,,,,80001146,CDM,250,RC,65862022701,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LANTHANUM CARBONATE (FOSRENOL) 500 MG,,,,80001147,CDM,250,RC,69097093498,NDC,both,2,EA,100.86,39.81,39.4668,,39.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,34.29,34,,34.29,percent of total billed charges,"Drugs, Inpatient Only",34.29,34,,34.29,percent of total billed charges,"Drugs, Inpatient Only",34.29,34,,34.29,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70.6,70,,70.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,33.62,,,33.62,Other,Drug Cost,33.62,,,33.62,Other,Drug Cost,33.62,,,33.62,Other,Drug Cost,33.62,,,33.62,Other,Drug Cost,33.62,,,33.62,Other,Drug Cost,33.62,,,33.62,Other,Drug Cost,75.65,,,75.65,Other,225% of Medicaid,47.07,,,47.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,72.28,,,72.28,Other,215% Medicaid APG methodology,72.28,,,72.28,Other,215% Medicaid APG methodology,42.03,,,42.03,Other,125% Medicaid APG methodology,0.01,75.65,
LATANOPROST OPHTH,,,,80001148,CDM,250,RC,13830304,NDC,both,1,ML,0.09,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
LEFLUNOMIDE (ARAVA) 10 MG,,,,80001149,CDM,250,RC,23155004303,NDC,both,30,EA,0.32,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,70,,0.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.24,,,0.24,Other,225% of Medicaid,0.15,,,0.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.23,,,0.23,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.24,
LETROZOLE (FEMARA) 2.5MG TAB,,,,80001151,CDM,250,RC,93762056,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.03,
LEUCOVORIN CALCIUM 5MG TAB,,,,80001155,CDM,250,RC,555048401,NDC,both,30,EA,0.5,0.2,39.4668,,0.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.35,70,,0.35,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.37,,,0.37,Other,225% of Medicaid,0.23,,,0.23,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.36,,,0.36,Other,215% Medicaid APG methodology,0.36,,,0.36,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,125% Medicaid APG methodology,0.01,0.37,
LEVETIRACETAM (KEPPRA) 250MG TAB,,,,80001161,CDM,250,RC,68180011216,NDC,both,120,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
LEVETIRACETAM (KEPPRA) 500MG TAB,,,,80001162,CDM,250,RC,68180011316,NDC,both,120,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LEVOBUNOLOL 0.5% OPTH SOLN  5ML,,,,80001166,CDM,250,RC,24208050505,NDC,both,1,ML,7.53,2.97,39.4668,,2.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.56,34,,2.56,percent of total billed charges,"Drugs, Inpatient Only",2.56,34,,2.56,percent of total billed charges,"Drugs, Inpatient Only",2.56,34,,2.56,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.27,70,,5.27,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.51,,,2.51,Other,Drug Cost,2.51,,,2.51,Other,Drug Cost,2.51,,,2.51,Other,Drug Cost,2.51,,,2.51,Other,Drug Cost,2.51,,,2.51,Other,Drug Cost,2.51,,,2.51,Other,Drug Cost,5.65,,,5.65,Other,225% of Medicaid,3.51,,,3.51,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.4,,,5.4,Other,215% Medicaid APG methodology,5.4,,,5.4,Other,215% Medicaid APG methodology,3.14,,,3.14,Other,125% Medicaid APG methodology,0.01,5.65,
LEVOCARNITINE (CARNITOR) 330MG,,,,80001167,CDM,250,RC,54482014407,NDC,both,90,EA,2.35,0.93,39.4668,,0.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.8,34,,0.8,percent of total billed charges,"Drugs, Inpatient Only",0.8,34,,0.8,percent of total billed charges,"Drugs, Inpatient Only",0.8,34,,0.8,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.65,70,,1.65,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.78,,,0.78,Other,Drug Cost,0.78,,,0.78,Other,Drug Cost,0.78,,,0.78,Other,Drug Cost,0.78,,,0.78,Other,Drug Cost,0.78,,,0.78,Other,Drug Cost,0.78,,,0.78,Other,Drug Cost,1.77,,,1.77,Other,225% of Medicaid,1.1,,,1.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.69,,,1.69,Other,215% Medicaid APG methodology,1.69,,,1.69,Other,215% Medicaid APG methodology,0.98,,,0.98,Other,125% Medicaid APG methodology,0.01,1.77,
LEVOFLOXACIN 250 MG TAB,,,,80001169,CDM,250,RC,55111027950,NDC,both,50,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
LEVOFLOXACIN 500 MG TAB,,,,80001172,CDM,250,RC,55111028050,NDC,both,50,EA,0.2,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.14,,,0.14,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.15,
LEVOFLOXACIN 750 MG TAB,,,,80001174,CDM,250,RC,55111028130,NDC,both,30,EA,0.49,0.19,39.4668,,0.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.35,70,,0.35,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.37,,,0.37,Other,225% of Medicaid,0.23,,,0.23,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.35,,,0.35,Other,215% Medicaid APG methodology,0.35,,,0.35,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,125% Medicaid APG methodology,0.01,0.37,
LEVOPHED 1MG/ML 4ML INJ,,,,80001177,CDM,250,RC,409337504,NDC,both,10,ML,5,1.97,39.4668,,1.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.7,34,,1.7,percent of total billed charges,"Drugs, Inpatient Only",1.7,34,,1.7,percent of total billed charges,"Drugs, Inpatient Only",1.7,34,,1.7,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.5,70,,3.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.67,,,1.67,Other,Drug Cost,1.67,,,1.67,Other,Drug Cost,1.67,,,1.67,Other,Drug Cost,1.67,,,1.67,Other,Drug Cost,1.67,,,1.67,Other,Drug Cost,1.67,,,1.67,Other,Drug Cost,3.75,,,3.75,Other,225% of Medicaid,2.33,,,2.33,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.58,,,3.58,Other,215% Medicaid APG methodology,3.58,,,3.58,Other,215% Medicaid APG methodology,2.08,,,2.08,Other,125% Medicaid APG methodology,0.01,3.75,
LEVOTHYROXINE 100MCG TAB,,,,80001178,CDM,250,RC,378180977,NDC,both,90,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
LEVOTHYROXINE 112MCG TAB,,,,80001179,CDM,250,RC,378181177,NDC,both,90,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
LEVOTHYROXINE 125MCG TAB,,,,80001180,CDM,250,RC,378181377,NDC,both,90,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
LEVOTHYROXINE 137 MCG TAB,,,,80001181,CDM,250,RC,68180097209,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LEVOTHYROXINE 150MCG TABLETS,,,,80001182,CDM,250,RC,378181577,NDC,both,90,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
LEVOTHYROXINE 175MCG TAB,,,,80001183,CDM,250,RC,378181777,NDC,both,90,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
LEVOTHYROXINE 25MCG TAB,,,,80001184,CDM,250,RC,68180096509,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LEVOTHYROXINE 50MCG TAB,,,,80001187,CDM,250,RC,378180377,NDC,both,90,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
LEVOTHYROXINE 75MCG TAB,,,,80001188,CDM,250,RC,378180577,NDC,both,90,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
LEVOTHYROXINE 88MCG TAB,,,,80001189,CDM,250,RC,378180777,NDC,both,90,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
LIDOCAINE 1% 20ML INJ,,,,80001190,CDM,250,RC,63323048527,NDC,both,25,ML,2.39,0.94,39.4668,,0.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.81,34,,0.81,percent of total billed charges,"Drugs, Inpatient Only",0.81,34,,0.81,percent of total billed charges,"Drugs, Inpatient Only",0.81,34,,0.81,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.67,70,,1.67,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,1.79,,,1.79,Other,225% of Medicaid,1.12,,,1.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.71,,,1.71,Other,215% Medicaid APG methodology,1.71,,,1.71,Other,215% Medicaid APG methodology,1,,,1,Other,125% Medicaid APG methodology,0.01,1.79,
LIDOCAINE 1% 30ML INJ,,,,80001191,CDM,250,RC,63323049227,NDC,both,25,ML,0.3,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,70,,0.21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.22,,,0.22,Other,225% of Medicaid,0.14,,,0.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.21,,,0.21,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.22,
LIDOCAINE 1% 50ML INJ,,,,80001192,CDM,250,RC,63323048557,NDC,both,25,ML,5.98,2.36,39.4668,,2.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.03,34,,2.03,percent of total billed charges,"Drugs, Inpatient Only",2.03,34,,2.03,percent of total billed charges,"Drugs, Inpatient Only",2.03,34,,2.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.18,70,,4.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.99,,,1.99,Other,Drug Cost,1.99,,,1.99,Other,Drug Cost,1.99,,,1.99,Other,Drug Cost,1.99,,,1.99,Other,Drug Cost,1.99,,,1.99,Other,Drug Cost,1.99,,,1.99,Other,Drug Cost,4.48,,,4.48,Other,225% of Medicaid,2.79,,,2.79,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.28,,,4.28,Other,215% Medicaid APG methodology,4.28,,,4.28,Other,215% Medicaid APG methodology,2.49,,,2.49,Other,125% Medicaid APG methodology,0.01,4.48,
LIDOCAINE 2% 20ML INJ,,,,80001194,CDM,250,RC,63323048617,NDC,both,25,ML,1.52,0.6,39.4668,,0.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.52,34,,0.52,percent of total billed charges,"Drugs, Inpatient Only",0.52,34,,0.52,percent of total billed charges,"Drugs, Inpatient Only",0.52,34,,0.52,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.07,70,,1.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,1.14,,,1.14,Other,225% of Medicaid,0.71,,,0.71,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.09,,,1.09,Other,215% Medicaid APG methodology,1.09,,,1.09,Other,215% Medicaid APG methodology,0.63,,,0.63,Other,125% Medicaid APG methodology,0.01,1.14,
LIDOCAINE 2% 5 ML MPF INJ,,,,80001195,CDM,250,RC,143959425,NDC,both,25,ML,1.67,0.66,39.4668,,0.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.17,70,,1.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,1.25,,,1.25,Other,225% of Medicaid,0.78,,,0.78,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.2,,,1.2,Other,215% Medicaid APG methodology,1.2,,,1.2,Other,215% Medicaid APG methodology,0.7,,,0.7,Other,125% Medicaid APG methodology,0.01,1.25,
LIDOCAINE 4% (LMX 4 PLUS) 5GM CRM,,,,80001198,CDM,250,RC,24357070106,NDC,both,5,GM,7.34,2.9,39.4668,,2.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.49,34,,2.49,percent of total billed charges,"Drugs, Inpatient Only",2.49,34,,2.49,percent of total billed charges,"Drugs, Inpatient Only",2.49,34,,2.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.14,70,,5.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.45,,,2.45,Other,Drug Cost,2.45,,,2.45,Other,Drug Cost,2.45,,,2.45,Other,Drug Cost,2.45,,,2.45,Other,Drug Cost,2.45,,,2.45,Other,Drug Cost,2.45,,,2.45,Other,Drug Cost,5.5,,,5.5,Other,225% of Medicaid,3.42,,,3.42,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.26,,,5.26,Other,215% Medicaid APG methodology,5.26,,,5.26,Other,215% Medicaid APG methodology,3.06,,,3.06,Other,125% Medicaid APG methodology,0.01,5.5,
LIDOCAINE 4% 5ML INJ,,,,80001199,CDM,250,RC,409428301,NDC,both,25,ML,7.05,2.78,39.4668,,2.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.4,34,,2.4,percent of total billed charges,"Drugs, Inpatient Only",2.4,34,,2.4,percent of total billed charges,"Drugs, Inpatient Only",2.4,34,,2.4,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.93,70,,4.93,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.35,,,2.35,Other,Drug Cost,2.35,,,2.35,Other,Drug Cost,2.35,,,2.35,Other,Drug Cost,2.35,,,2.35,Other,Drug Cost,2.35,,,2.35,Other,Drug Cost,2.35,,,2.35,Other,Drug Cost,5.28,,,5.28,Other,225% of Medicaid,3.29,,,3.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.05,,,5.05,Other,215% Medicaid APG methodology,5.05,,,5.05,Other,215% Medicaid APG methodology,2.94,,,2.94,Other,125% Medicaid APG methodology,0.01,5.28,
LIDOCAINE HCL 2% 5 ML UROJET,,,,80001201,CDM,250,RC,25021067376,NDC,both,10,ML,8.12,3.21,39.4668,,3.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.76,34,,2.76,percent of total billed charges,"Drugs, Inpatient Only",2.76,34,,2.76,percent of total billed charges,"Drugs, Inpatient Only",2.76,34,,2.76,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.68,70,,5.68,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.71,,,2.71,Other,Drug Cost,2.71,,,2.71,Other,Drug Cost,2.71,,,2.71,Other,Drug Cost,2.71,,,2.71,Other,Drug Cost,2.71,,,2.71,Other,Drug Cost,2.71,,,2.71,Other,Drug Cost,6.09,,,6.09,Other,225% of Medicaid,3.79,,,3.79,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.82,,,5.82,Other,215% Medicaid APG methodology,5.82,,,5.82,Other,215% Medicaid APG methodology,3.38,,,3.38,Other,125% Medicaid APG methodology,0.01,6.09,
LIDOCAINE HCL 4% 50 ML TOP,,,,80001203,CDM,250,RC,54350547,NDC,both,1,ML,2.61,1.03,39.4668,,1.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.89,34,,0.89,percent of total billed charges,"Drugs, Inpatient Only",0.89,34,,0.89,percent of total billed charges,"Drugs, Inpatient Only",0.89,34,,0.89,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.83,70,,1.83,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,1.96,,,1.96,Other,225% of Medicaid,1.22,,,1.22,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.87,,,1.87,Other,215% Medicaid APG methodology,1.87,,,1.87,Other,215% Medicaid APG methodology,1.09,,,1.09,Other,125% Medicaid APG methodology,0.01,1.96,
LIDOCAINE INJECTION 1% 10 ML VIAL,,,,80001205,CDM,250,RC,55150025110,NDC,both,25,ML,2.8,1.1,39.4668,,1.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.95,34,,0.95,percent of total billed charges,"Drugs, Inpatient Only",0.95,34,,0.95,percent of total billed charges,"Drugs, Inpatient Only",0.95,34,,0.95,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.96,70,,1.96,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.93,,,0.93,Other,Drug Cost,0.93,,,0.93,Other,Drug Cost,0.93,,,0.93,Other,Drug Cost,0.93,,,0.93,Other,Drug Cost,0.93,,,0.93,Other,Drug Cost,0.93,,,0.93,Other,Drug Cost,2.1,,,2.1,Other,225% of Medicaid,1.3,,,1.3,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2,,,2,Other,215% Medicaid APG methodology,2,,,2,Other,215% Medicaid APG methodology,1.17,,,1.17,Other,125% Medicaid APG methodology,0.01,2.1,
LIDOCAINE VISCOUS 2% 100 ML,,,,80001206,CDM,250,RC,54350049,NDC,both,1,ML,4.71,1.86,39.4668,,1.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.6,34,,1.6,percent of total billed charges,"Drugs, Inpatient Only",1.6,34,,1.6,percent of total billed charges,"Drugs, Inpatient Only",1.6,34,,1.6,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.3,70,,3.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.57,,,1.57,Other,Drug Cost,1.57,,,1.57,Other,Drug Cost,1.57,,,1.57,Other,Drug Cost,1.57,,,1.57,Other,Drug Cost,1.57,,,1.57,Other,Drug Cost,1.57,,,1.57,Other,Drug Cost,3.53,,,3.53,Other,225% of Medicaid,2.2,,,2.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.38,,,3.38,Other,215% Medicaid APG methodology,3.38,,,3.38,Other,215% Medicaid APG methodology,1.96,,,1.96,Other,125% Medicaid APG methodology,0.01,3.53,
LIDOCAINE-EPI 1% 20ML INJ,,,,80001208,CDM,250,RC,63323048217,NDC,both,25,ML,1.71,0.68,39.4668,,0.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.58,34,,0.58,percent of total billed charges,"Drugs, Inpatient Only",0.58,34,,0.58,percent of total billed charges,"Drugs, Inpatient Only",0.58,34,,0.58,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.2,70,,1.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,1.28,,,1.28,Other,225% of Medicaid,0.8,,,0.8,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.23,,,1.23,Other,215% Medicaid APG methodology,1.23,,,1.23,Other,215% Medicaid APG methodology,0.71,,,0.71,Other,125% Medicaid APG methodology,0.01,1.28,
LIDOCAINE-EPI 2% 20 ML INJ,,,,80001210,CDM,250,RC,63323048327,NDC,both,25,ML,1.47,0.58,39.4668,,0.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.5,34,,0.5,percent of total billed charges,"Drugs, Inpatient Only",0.5,34,,0.5,percent of total billed charges,"Drugs, Inpatient Only",0.5,34,,0.5,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.03,70,,1.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,1.1,,,1.1,Other,225% of Medicaid,0.68,,,0.68,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.05,,,1.05,Other,215% Medicaid APG methodology,1.05,,,1.05,Other,215% Medicaid APG methodology,0.61,,,0.61,Other,125% Medicaid APG methodology,0.01,1.1,
LIDOCAINE-PRILOC 30 GM CRM,,,,80001211,CDM,250,RC,168035755,NDC,both,5,GM,1.34,0.53,39.4668,,0.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.94,70,,0.94,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,1.01,,,1.01,Other,225% of Medicaid,0.63,,,0.63,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.96,,,0.96,Other,215% Medicaid APG methodology,0.96,,,0.96,Other,215% Medicaid APG methodology,0.56,,,0.56,Other,125% Medicaid APG methodology,0.01,1.01,
LIDODERM 5% 1 PATCH,,,,80001213,CDM,250,RC,603188016,NDC,both,30,EA,1.94,0.77,39.4668,,0.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.66,34,,0.66,percent of total billed charges,"Drugs, Inpatient Only",0.66,34,,0.66,percent of total billed charges,"Drugs, Inpatient Only",0.66,34,,0.66,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.36,70,,1.36,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,1.46,,,1.46,Other,225% of Medicaid,0.91,,,0.91,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.39,,,1.39,Other,215% Medicaid APG methodology,1.39,,,1.39,Other,215% Medicaid APG methodology,0.81,,,0.81,Other,125% Medicaid APG methodology,0.01,1.46,
LINEZOLID 600MG TAB,,,,80001216,CDM,250,RC,67877041920,NDC,both,20,EA,1.96,0.77,39.4668,,0.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.67,34,,0.67,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.37,70,,1.37,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,1.47,,,1.47,Other,225% of Medicaid,0.92,,,0.92,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.41,,,1.41,Other,215% Medicaid APG methodology,1.41,,,1.41,Other,215% Medicaid APG methodology,0.82,,,0.82,Other,125% Medicaid APG methodology,0.01,1.47,
LIOTHYRONINE SODIUM (CYTOMEL) 25 MCG TAB,,,,80001219,CDM,250,RC,62756059088,NDC,both,100,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
LIOTHYRONINE SODIUM (CYTOMEL) 5 MCG TABS,,,,80001220,CDM,250,RC,60793011501,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LISINOPRIL 10 MG TAB,,,,80001222,CDM,250,RC,68180098001,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LISINOPRIL 2.5 MG TAB,,,,80001223,CDM,250,RC,68180051201,NDC,both,100,EA,0.02,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LISINOPRIL 20 MG TAB,,,,80001224,CDM,250,RC,68180098101,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LITHIUM CARBONATE 150 MG CAPS,,,,80001227,CDM,250,RC,54252625,NDC,both,100,EA,0.09,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
LITHIUM CARBONATE 300 MG CAPS,,,,80001228,CDM,250,RC,68462022101,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
LITHIUM CARBONATE 300 MG SR TB,,,,80001229,CDM,250,RC,62559028001,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LITHIUM CARBONATE 450 MG ER TAB,,,,80001230,CDM,250,RC,54002025,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
LOMOTIL 2.5-0.025MG TAB,,,,80001232,CDM,250,RC,25006131,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LOPERAMIDE 2 MG CAPS,,,,80001237,CDM,250,RC,93031101,NDC,both,100,EA,0.2,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.14,,,0.14,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.15,
LOPRESSOR 25 MG TAB,,,,80001238,CDM,250,RC,378001801,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LOPRESSOR 50 MG TAB,,,,80001239,CDM,250,RC,378003210,NDC,both,1000,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LORAZEPAM 0.5 MG TAB,,,,80001242,CDM,250,RC,69315090405,NDC,both,500,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LORAZEPAM 1 MG TAB,,,,80001243,CDM,250,RC,13107008405,NDC,both,500,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LORAZEPAM INTENSOL 2 MG/ML 30ML CONC,,,,80001246,CDM,250,RC,54353244,NDC,both,1,ML,0.87,0.34,39.4668,,0.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.3,34,,0.3,percent of total billed charges,"Drugs, Inpatient Only",0.3,34,,0.3,percent of total billed charges,"Drugs, Inpatient Only",0.3,34,,0.3,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.61,70,,0.61,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,,,0.29,Other,Drug Cost,0.29,,,0.29,Other,Drug Cost,0.29,,,0.29,Other,Drug Cost,0.29,,,0.29,Other,Drug Cost,0.29,,,0.29,Other,Drug Cost,0.29,,,0.29,Other,Drug Cost,0.65,,,0.65,Other,225% of Medicaid,0.41,,,0.41,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.62,,,0.62,Other,215% Medicaid APG methodology,0.62,,,0.62,Other,215% Medicaid APG methodology,0.36,,,0.36,Other,125% Medicaid APG methodology,0.01,0.65,
LOSARTAN 50 MG TAB,,,,80001247,CDM,250,RC,65862020290,NDC,both,90,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
LOSARTAN POTASSIUM (COZAAR) 25 MG,,,,80001248,CDM,250,RC,65862020190,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
LOVASTATIN 20 MG TAB,,,,80001251,CDM,250,RC,61442014201,NDC,both,100,EA,0.23,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,70,,0.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.17,,,0.17,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.17,,,0.17,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.17,
LOXAPINE 25MG CAP,,,,80001252,CDM,250,RC,591037101,NDC,both,100,EA,0.58,0.23,39.4668,,0.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,34,,0.2,percent of total billed charges,"Drugs, Inpatient Only",0.2,34,,0.2,percent of total billed charges,"Drugs, Inpatient Only",0.2,34,,0.2,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.41,70,,0.41,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,,,0.19,Other,Drug Cost,0.19,,,0.19,Other,Drug Cost,0.19,,,0.19,Other,Drug Cost,0.19,,,0.19,Other,Drug Cost,0.19,,,0.19,Other,Drug Cost,0.19,,,0.19,Other,Drug Cost,0.43,,,0.43,Other,225% of Medicaid,0.27,,,0.27,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.42,,,0.42,Other,215% Medicaid APG methodology,0.42,,,0.42,Other,215% Medicaid APG methodology,0.24,,,0.24,Other,125% Medicaid APG methodology,0.01,0.43,
LOXAPINE SUCCINATE 10MG CAPS,,,,80001253,CDM,250,RC,591037001,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
MAG AL PLUS 1200MG/120MG/30ML UD,,,,80001256,CDM,250,RC,121176130,NDC,both,100,ML,1.47,0.58,39.4668,,0.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.5,34,,0.5,percent of total billed charges,"Drugs, Inpatient Only",0.5,34,,0.5,percent of total billed charges,"Drugs, Inpatient Only",0.5,34,,0.5,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.03,70,,1.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,1.1,,,1.1,Other,225% of Medicaid,0.69,,,0.69,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.05,,,1.05,Other,215% Medicaid APG methodology,1.05,,,1.05,Other,215% Medicaid APG methodology,0.61,,,0.61,Other,125% Medicaid APG methodology,0.01,1.1,
MAGIC MOUTHWASH,,,,80001257,CDM,250,RC,65628005001,NDC,both,1,ML,339.72,134.08,39.4668,,134.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,115.5,34,,115.5,percent of total billed charges,"Drugs, Inpatient Only",115.5,34,,115.5,percent of total billed charges,"Drugs, Inpatient Only",115.5,34,,115.5,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,237.8,70,,237.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,113.24,,,113.24,Other,Drug Cost,113.24,,,113.24,Other,Drug Cost,113.24,,,113.24,Other,Drug Cost,113.24,,,113.24,Other,Drug Cost,113.24,,,113.24,Other,Drug Cost,113.24,,,113.24,Other,Drug Cost,254.79,,,254.79,Other,225% of Medicaid,158.54,,,158.54,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,243.47,,,243.47,Other,215% Medicaid APG methodology,243.47,,,243.47,Other,215% Medicaid APG methodology,141.55,,,141.55,Other,125% Medicaid APG methodology,0.01,254.79,
MAGNESIUM 1GM/D5W 100 ML,,,,80001258,CDM,250,RC,338170940,NDC,both,40,ML,3.23,1.27,39.4668,,1.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.1,34,,1.1,percent of total billed charges,"Drugs, Inpatient Only",1.1,34,,1.1,percent of total billed charges,"Drugs, Inpatient Only",1.1,34,,1.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.26,70,,2.26,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.08,,,1.08,Other,Drug Cost,1.08,,,1.08,Other,Drug Cost,1.08,,,1.08,Other,Drug Cost,1.08,,,1.08,Other,Drug Cost,1.08,,,1.08,Other,Drug Cost,1.08,,,1.08,Other,Drug Cost,2.42,,,2.42,Other,225% of Medicaid,1.51,,,1.51,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.31,,,2.31,Other,215% Medicaid APG methodology,2.31,,,2.31,Other,215% Medicaid APG methodology,1.35,,,1.35,Other,125% Medicaid APG methodology,0.01,2.42,
MAGNESIUM OXIDE 400MG TAB,,,,80001261,CDM,250,RC,603020922,NDC,both,120,EA,0.06,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
MECLIZINE 25 MG TAB,,,,80001271,CDM,250,RC,50268052315,NDC,both,5,EA,12.32,4.86,39.4668,,4.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.19,34,,4.19,percent of total billed charges,"Drugs, Inpatient Only",4.19,34,,4.19,percent of total billed charges,"Drugs, Inpatient Only",4.19,34,,4.19,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.63,70,,8.63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.11,,,4.11,Other,Drug Cost,4.11,,,4.11,Other,Drug Cost,4.11,,,4.11,Other,Drug Cost,4.11,,,4.11,Other,Drug Cost,4.11,,,4.11,Other,Drug Cost,4.11,,,4.11,Other,Drug Cost,9.24,,,9.24,Other,225% of Medicaid,5.75,,,5.75,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.83,,,8.83,Other,215% Medicaid APG methodology,8.83,,,8.83,Other,215% Medicaid APG methodology,5.14,,,5.14,Other,125% Medicaid APG methodology,0.01,9.24,
MEDROXYPROGEST 2.5 MG TAB,,,,80001272,CDM,250,RC,555087202,NDC,both,100,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
MEDROXYPROGEST 5 MG TAB,,,,80001273,CDM,250,RC,555087302,NDC,both,100,EA,0.17,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,70,,0.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.13,
MEGESTROL 40 MG/ML SUSP 10ML UD,,,,80001274,CDM,250,RC,121094500,NDC,both,100,ML,1.51,0.6,39.4668,,0.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.51,34,,0.51,percent of total billed charges,"Drugs, Inpatient Only",0.51,34,,0.51,percent of total billed charges,"Drugs, Inpatient Only",0.51,34,,0.51,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.06,70,,1.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.5,,,0.5,Other,Drug Cost,0.5,,,0.5,Other,Drug Cost,0.5,,,0.5,Other,Drug Cost,0.5,,,0.5,Other,Drug Cost,0.5,,,0.5,Other,Drug Cost,0.5,,,0.5,Other,Drug Cost,1.14,,,1.14,Other,225% of Medicaid,0.71,,,0.71,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.08,,,1.08,Other,215% Medicaid APG methodology,1.08,,,1.08,Other,215% Medicaid APG methodology,0.63,,,0.63,Other,125% Medicaid APG methodology,0.01,1.14,
MEGESTROL 40MG TAB,,,,80001275,CDM,250,RC,64380015901,NDC,both,100,EA,0.27,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,70,,0.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.12,,,0.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.19,,,0.19,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.2,
MELOXICAM TABLETS 7.5MG,,,,80001278,CDM,250,RC,69097015807,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
MEMANTINE 10MG TAB,,,,80001280,CDM,250,RC,68180023007,NDC,both,60,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
MEMANTINE 5MG TAB,,,,80001281,CDM,250,RC,29300017116,NDC,both,60,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
MEPRON 750 MG/5ML,,,,80001299,CDM,250,RC,173054700,NDC,both,42,ML,90.11,35.56,39.4668,,35.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,30.64,34,,30.64,percent of total billed charges,"Drugs, Inpatient Only",30.64,34,,30.64,percent of total billed charges,"Drugs, Inpatient Only",30.64,34,,30.64,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63.07,70,,63.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,30.04,,,30.04,Other,Drug Cost,30.04,,,30.04,Other,Drug Cost,30.04,,,30.04,Other,Drug Cost,30.04,,,30.04,Other,Drug Cost,30.04,,,30.04,Other,Drug Cost,30.04,,,30.04,Other,Drug Cost,67.58,,,67.58,Other,225% of Medicaid,42.05,,,42.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,64.58,,,64.58,Other,215% Medicaid APG methodology,64.58,,,64.58,Other,215% Medicaid APG methodology,37.54,,,37.54,Other,125% Medicaid APG methodology,0.01,67.58,
MERCAPTOPURINE ORAL 50 MG,,,,80001300,CDM,250,RC,54458111,NDC,both,25,EA,1.13,0.45,39.4668,,0.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.39,34,,0.39,percent of total billed charges,"Drugs, Inpatient Only",0.39,34,,0.39,percent of total billed charges,"Drugs, Inpatient Only",0.39,34,,0.39,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.79,70,,0.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.85,,,0.85,Other,225% of Medicaid,0.53,,,0.53,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.81,,,0.81,Other,215% Medicaid APG methodology,0.81,,,0.81,Other,215% Medicaid APG methodology,0.47,,,0.47,Other,125% Medicaid APG methodology,0.01,0.85,
MESALAMINE 250 MG CAP,,,,80001304,CDM,250,RC,54092018981,NDC,both,240,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
MESALAMINE 4 GM/60 ML ENEMA,,,,80001307,CDM,250,RC,45802009851,NDC,both,7,ML,10.03,3.96,39.4668,,3.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.41,34,,3.41,percent of total billed charges,"Drugs, Inpatient Only",3.41,34,,3.41,percent of total billed charges,"Drugs, Inpatient Only",3.41,34,,3.41,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.02,70,,7.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.34,,,3.34,Other,Drug Cost,3.34,,,3.34,Other,Drug Cost,3.34,,,3.34,Other,Drug Cost,3.34,,,3.34,Other,Drug Cost,3.34,,,3.34,Other,Drug Cost,3.34,,,3.34,Other,Drug Cost,7.52,,,7.52,Other,225% of Medicaid,4.68,,,4.68,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.19,,,7.19,Other,215% Medicaid APG methodology,7.19,,,7.19,Other,215% Medicaid APG methodology,4.18,,,4.18,Other,125% Medicaid APG methodology,0.01,7.52,
METFORMIN 500 MG TAB,,,,80001311,CDM,250,RC,70010006301,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
METHADONE 10 MG TAB,,,,80001315,CDM,250,RC,406577162,NDC,both,10,EA,1.07,0.42,39.4668,,0.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.36,34,,0.36,percent of total billed charges,"Drugs, Inpatient Only",0.36,34,,0.36,percent of total billed charges,"Drugs, Inpatient Only",0.36,34,,0.36,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.75,70,,0.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.8,,,0.8,Other,225% of Medicaid,0.5,,,0.5,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.76,,,0.76,Other,215% Medicaid APG methodology,0.76,,,0.76,Other,215% Medicaid APG methodology,0.44,,,0.44,Other,125% Medicaid APG methodology,0.01,0.8,
METHADONE 40MG TAB,,,,80001318,CDM,250,RC,66689089840,NDC,both,100,EA,0.69,0.27,39.4668,,0.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.48,70,,0.48,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.52,,,0.52,Other,225% of Medicaid,0.32,,,0.32,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.5,,,0.5,Other,215% Medicaid APG methodology,0.5,,,0.5,Other,215% Medicaid APG methodology,0.29,,,0.29,Other,125% Medicaid APG methodology,0.01,0.52,
METHADONE 5 MG TAB,,,,80001319,CDM,250,RC,406575562,NDC,both,10,EA,0.85,0.33,39.4668,,0.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,34,,0.29,percent of total billed charges,"Drugs, Inpatient Only",0.29,34,,0.29,percent of total billed charges,"Drugs, Inpatient Only",0.29,34,,0.29,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.59,70,,0.59,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.63,,,0.63,Other,225% of Medicaid,0.39,,,0.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.61,,,0.61,Other,215% Medicaid APG methodology,0.61,,,0.61,Other,215% Medicaid APG methodology,0.35,,,0.35,Other,125% Medicaid APG methodology,0.01,0.63,
METHENAMINE 1G TAB,,,,80001321,CDM,250,RC,42799010601,NDC,both,100,EA,8.15,3.22,39.4668,,3.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.77,34,,2.77,percent of total billed charges,"Drugs, Inpatient Only",2.77,34,,2.77,percent of total billed charges,"Drugs, Inpatient Only",2.77,34,,2.77,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.71,70,,5.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,6.11,,,6.11,Other,225% of Medicaid,3.8,,,3.8,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.84,,,5.84,Other,215% Medicaid APG methodology,5.84,,,5.84,Other,215% Medicaid APG methodology,3.4,,,3.4,Other,125% Medicaid APG methodology,0.01,6.11,
METHENAMINE 500MG TAB,,,,80001322,CDM,250,RC,42799010501,NDC,both,100,EA,4.08,1.61,39.4668,,1.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.39,34,,1.39,percent of total billed charges,"Drugs, Inpatient Only",1.39,34,,1.39,percent of total billed charges,"Drugs, Inpatient Only",1.39,34,,1.39,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.85,70,,2.85,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.36,,,1.36,Other,Drug Cost,1.36,,,1.36,Other,Drug Cost,1.36,,,1.36,Other,Drug Cost,1.36,,,1.36,Other,Drug Cost,1.36,,,1.36,Other,Drug Cost,1.36,,,1.36,Other,Drug Cost,3.06,,,3.06,Other,225% of Medicaid,1.9,,,1.9,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.92,,,2.92,Other,215% Medicaid APG methodology,2.92,,,2.92,Other,215% Medicaid APG methodology,1.7,,,1.7,Other,125% Medicaid APG methodology,0.01,3.06,
METHERGINE 0.2 MG TAB,,,,80001324,CDM,250,RC,93365522,NDC,both,12,EA,8.62,3.4,39.4668,,3.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.93,34,,2.93,percent of total billed charges,"Drugs, Inpatient Only",2.93,34,,2.93,percent of total billed charges,"Drugs, Inpatient Only",2.93,34,,2.93,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.03,70,,6.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.87,,,2.87,Other,Drug Cost,2.87,,,2.87,Other,Drug Cost,2.87,,,2.87,Other,Drug Cost,2.87,,,2.87,Other,Drug Cost,2.87,,,2.87,Other,Drug Cost,2.87,,,2.87,Other,Drug Cost,6.46,,,6.46,Other,225% of Medicaid,4.02,,,4.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.18,,,6.18,Other,215% Medicaid APG methodology,6.18,,,6.18,Other,215% Medicaid APG methodology,3.59,,,3.59,Other,125% Medicaid APG methodology,0.01,6.46,
METHIMAZOLE 5MG TAB,,,,80001326,CDM,250,RC,23155007001,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
METHOCARBAMOL 500MG TAB,,,,80001327,CDM,250,RC,70010075401,NDC,both,100,EA,0.04,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
METHYLPHENIDATE 10MG TAB,,,,80001336,CDM,250,RC,16729047901,NDC,both,100,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
METHYLPHENIDATE 5MG TAB,,,,80001337,CDM,250,RC,10702010001,NDC,both,100,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
METOCLOPRAMIDE 10MG TAB,,,,80001344,CDM,250,RC,93220301,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
METOCLOPRAMIDE 5MG TAB,,,,80001345,CDM,250,RC,93220401,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
METOCLOPRAMIDE 5MG/5ML LIQ,,,,80001346,CDM,250,RC,121157610,NDC,both,100,ML,0.84,0.33,39.4668,,0.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,34,,0.29,percent of total billed charges,"Drugs, Inpatient Only",0.29,34,,0.29,percent of total billed charges,"Drugs, Inpatient Only",0.29,34,,0.29,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.59,70,,0.59,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.63,,,0.63,Other,225% of Medicaid,0.39,,,0.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.6,,,0.6,Other,215% Medicaid APG methodology,0.6,,,0.6,Other,215% Medicaid APG methodology,0.35,,,0.35,Other,125% Medicaid APG methodology,0.01,0.63,
METOLAZONE 2.5 MG TAB,,,,80001347,CDM,250,RC,378617201,NDC,both,100,EA,0.09,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
METOPROLOL 5MG/5ML INJ,,,,80001348,CDM,250,RC,143966010,NDC,both,10,ML,1.41,0.56,39.4668,,0.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.99,70,,0.99,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,1.06,,,1.06,Other,225% of Medicaid,0.66,,,0.66,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.01,,,1.01,Other,215% Medicaid APG methodology,1.01,,,1.01,Other,215% Medicaid APG methodology,0.59,,,0.59,Other,125% Medicaid APG methodology,0.01,1.06,
METOPROLOL SUCCINATE 25 MG TAB,,,,80001349,CDM,250,RC,45963070911,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
METOPROLOL SUCCINATE 50 MG TAB,,,,80001350,CDM,250,RC,45963067611,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
METRONIDAZOLE 250 MG TAB,,,,80001352,CDM,250,RC,29300022601,NDC,both,100,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
METRONIDAZOLE 500MG/100ML INJ,,,,80001353,CDM,250,RC,264553532,NDC,both,24,ML,2.6,1.03,39.4668,,1.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.88,34,,0.88,percent of total billed charges,"Drugs, Inpatient Only",0.88,34,,0.88,percent of total billed charges,"Drugs, Inpatient Only",0.88,34,,0.88,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.82,70,,1.82,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,1.95,,,1.95,Other,225% of Medicaid,1.21,,,1.21,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.86,,,1.86,Other,215% Medicaid APG methodology,1.86,,,1.86,Other,215% Medicaid APG methodology,1.08,,,1.08,Other,125% Medicaid APG methodology,0.01,1.95,
METRONIDAZOLE TOP GEL 0.75%,,,,80001354,CDM,250,RC,51672411606,NDC,both,1,GM,6.12,2.42,39.4668,,2.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.08,34,,2.08,percent of total billed charges,"Drugs, Inpatient Only",2.08,34,,2.08,percent of total billed charges,"Drugs, Inpatient Only",2.08,34,,2.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.28,70,,4.28,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.04,,,2.04,Other,Drug Cost,2.04,,,2.04,Other,Drug Cost,2.04,,,2.04,Other,Drug Cost,2.04,,,2.04,Other,Drug Cost,2.04,,,2.04,Other,Drug Cost,2.04,,,2.04,Other,Drug Cost,4.59,,,4.59,Other,225% of Medicaid,2.86,,,2.86,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.39,,,4.39,Other,215% Medicaid APG methodology,4.39,,,4.39,Other,215% Medicaid APG methodology,2.55,,,2.55,Other,125% Medicaid APG methodology,0.01,4.59,
METRONIDAZOLE VAG GEL 0.75%,,,,80001355,CDM,250,RC,45802013970,NDC,both,1,GM,8.16,3.22,39.4668,,3.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.77,34,,2.77,percent of total billed charges,"Drugs, Inpatient Only",2.77,34,,2.77,percent of total billed charges,"Drugs, Inpatient Only",2.77,34,,2.77,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.71,70,,5.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,6.12,,,6.12,Other,225% of Medicaid,3.81,,,3.81,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.85,,,5.85,Other,215% Medicaid APG methodology,5.85,,,5.85,Other,215% Medicaid APG methodology,3.4,,,3.4,Other,125% Medicaid APG methodology,0.01,6.12,
MEXILETINE 150 MG CAP,,,,80001356,CDM,250,RC,527410737,NDC,both,100,EA,0.36,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,70,,0.25,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.27,,,0.27,Other,225% of Medicaid,0.17,,,0.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.26,,,0.26,Other,215% Medicaid APG methodology,0.26,,,0.26,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,125% Medicaid APG methodology,0.01,0.27,
MEXILETINE 200 MG CAP,,,,80001357,CDM,250,RC,93874001,NDC,both,100,EA,0.28,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,70,,0.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.21,,,0.21,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.2,,,0.2,Other,215% Medicaid APG methodology,0.2,,,0.2,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.21,
MEXILETINE 250 MG CAP,,,,80001358,CDM,250,RC,93874101,NDC,both,100,EA,0.65,0.26,39.4668,,0.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.46,70,,0.46,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.49,,,0.49,Other,225% of Medicaid,0.3,,,0.3,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.47,,,0.47,Other,215% Medicaid APG methodology,0.47,,,0.47,Other,215% Medicaid APG methodology,0.27,,,0.27,Other,125% Medicaid APG methodology,0.01,0.49,
MIACALCIN 3.7 ML NASAL SPRAY,,,,80001359,CDM,250,RC,60505082306,NDC,both,1,ML,42.36,16.72,39.4668,,16.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.4,34,,14.4,percent of total billed charges,"Drugs, Inpatient Only",14.4,34,,14.4,percent of total billed charges,"Drugs, Inpatient Only",14.4,34,,14.4,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,29.65,70,,29.65,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.12,,,14.12,Other,Drug Cost,14.12,,,14.12,Other,Drug Cost,14.12,,,14.12,Other,Drug Cost,14.12,,,14.12,Other,Drug Cost,14.12,,,14.12,Other,Drug Cost,14.12,,,14.12,Other,Drug Cost,31.77,,,31.77,Other,225% of Medicaid,19.77,,,19.77,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,30.36,,,30.36,Other,215% Medicaid APG methodology,30.36,,,30.36,Other,215% Medicaid APG methodology,17.65,,,17.65,Other,125% Medicaid APG methodology,0.01,31.77,
MICONAZOLE 2% (LOTRIMIN AF) POWDER,,,,80001363,CDM,250,RC,11701003816,NDC,both,1,GM,20.94,8.26,39.4668,,8.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.12,34,,7.12,percent of total billed charges,"Drugs, Inpatient Only",7.12,34,,7.12,percent of total billed charges,"Drugs, Inpatient Only",7.12,34,,7.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.66,70,,14.66,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.98,,,6.98,Other,Drug Cost,6.98,,,6.98,Other,Drug Cost,6.98,,,6.98,Other,Drug Cost,6.98,,,6.98,Other,Drug Cost,6.98,,,6.98,Other,Drug Cost,6.98,,,6.98,Other,Drug Cost,15.71,,,15.71,Other,225% of Medicaid,9.77,,,9.77,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,15.01,,,15.01,Other,215% Medicaid APG methodology,15.01,,,15.01,Other,215% Medicaid APG methodology,8.73,,,8.73,Other,125% Medicaid APG methodology,0.01,15.71,
MICONAZOLE 3 200MG SUPP,,,,80001365,CDM,250,RC,472173803,NDC,both,3,EA,22.14,8.74,39.4668,,8.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.53,34,,7.53,percent of total billed charges,"Drugs, Inpatient Only",7.53,34,,7.53,percent of total billed charges,"Drugs, Inpatient Only",7.53,34,,7.53,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.5,70,,15.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.38,,,7.38,Other,Drug Cost,7.38,,,7.38,Other,Drug Cost,7.38,,,7.38,Other,Drug Cost,7.38,,,7.38,Other,Drug Cost,7.38,,,7.38,Other,Drug Cost,7.38,,,7.38,Other,Drug Cost,16.61,,,16.61,Other,225% of Medicaid,10.33,,,10.33,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,15.87,,,15.87,Other,215% Medicaid APG methodology,15.87,,,15.87,Other,215% Medicaid APG methodology,9.23,,,9.23,Other,125% Medicaid APG methodology,0.01,16.61,
MICONAZOLE 7% VAG CREAM,,,,80001366,CDM,250,RC,51672203506,NDC,both,1,GM,7.95,3.14,39.4668,,3.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.7,34,,2.7,percent of total billed charges,"Drugs, Inpatient Only",2.7,34,,2.7,percent of total billed charges,"Drugs, Inpatient Only",2.7,34,,2.7,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.57,70,,5.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.65,,,2.65,Other,Drug Cost,2.65,,,2.65,Other,Drug Cost,2.65,,,2.65,Other,Drug Cost,2.65,,,2.65,Other,Drug Cost,2.65,,,2.65,Other,Drug Cost,2.65,,,2.65,Other,Drug Cost,5.96,,,5.96,Other,225% of Medicaid,3.71,,,3.71,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.7,,,5.7,Other,215% Medicaid APG methodology,5.7,,,5.7,Other,215% Medicaid APG methodology,3.31,,,3.31,Other,125% Medicaid APG methodology,0.01,5.96,
MICROFIBRILLAR COLLAGEN HEMOSTAT,,,,80001368,CDM,250,RC,53276101002,NDC,both,6,GM,456.46,180.15,39.4668,,180.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,155.2,34,,155.2,percent of total billed charges,"Drugs, Inpatient Only",155.2,34,,155.2,percent of total billed charges,"Drugs, Inpatient Only",155.2,34,,155.2,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,319.52,70,,319.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,152.15,,,152.15,Other,Drug Cost,152.15,,,152.15,Other,Drug Cost,152.15,,,152.15,Other,Drug Cost,152.15,,,152.15,Other,Drug Cost,152.15,,,152.15,Other,Drug Cost,152.15,,,152.15,Other,Drug Cost,342.34,,,342.34,Other,225% of Medicaid,213.01,,,213.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,327.13,,,327.13,Other,215% Medicaid APG methodology,327.13,,,327.13,Other,215% Medicaid APG methodology,190.19,,,190.19,Other,125% Medicaid APG methodology,0.01,342.34,
MIDAZOLAM 2MG/ML SYRUP,,,,80001371,CDM,250,RC,54356699,NDC,both,1,ML,72.84,28.75,39.4668,,28.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.77,34,,24.77,percent of total billed charges,"Drugs, Inpatient Only",24.77,34,,24.77,percent of total billed charges,"Drugs, Inpatient Only",24.77,34,,24.77,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,50.99,70,,50.99,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.28,,,24.28,Other,Drug Cost,24.28,,,24.28,Other,Drug Cost,24.28,,,24.28,Other,Drug Cost,24.28,,,24.28,Other,Drug Cost,24.28,,,24.28,Other,Drug Cost,24.28,,,24.28,Other,Drug Cost,54.63,,,54.63,Other,225% of Medicaid,33.99,,,33.99,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,52.2,,,52.2,Other,215% Medicaid APG methodology,52.2,,,52.2,Other,215% Medicaid APG methodology,30.35,,,30.35,Other,125% Medicaid APG methodology,0.01,54.63,
MIDODRINE 2.5 MG TAB,,,,80001372,CDM,250,RC,245021111,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.08,
MIDODRINE 5 MG TAB,,,,80001373,CDM,250,RC,60505132101,NDC,both,100,EA,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
MILK OF MAGNESIA 400MG/5ML,,,,80001375,CDM,250,RC,121043130,NDC,both,100,ML,1.17,0.46,39.4668,,0.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.82,70,,0.82,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.88,,,0.88,Other,225% of Medicaid,0.55,,,0.55,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.84,,,0.84,Other,215% Medicaid APG methodology,0.84,,,0.84,Other,215% Medicaid APG methodology,0.49,,,0.49,Other,125% Medicaid APG methodology,0.01,0.88,
MINOXIDIL 10MG TAB,,,,80001381,CDM,250,RC,49884025701,NDC,both,100,EA,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
MINOXIDIL 2.5 MG TAB,,,,80001382,CDM,250,RC,53489038601,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
MIRAPEX 0.25MG,,,,80001384,CDM,250,RC,68462033190,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
MIRTAZAPINE 15 MG,,,,80001386,CDM,250,RC,13107003134,NDC,both,30,EA,0.09,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
MISOPROSTOL (CYTOTEC) 100MCG TAB,,,,80001387,CDM,250,RC,25145160,NDC,both,60,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
MISOPROSTOL 200 MCG TAB,,,,80001388,CDM,250,RC,59762500802,NDC,both,100,EA,0.58,0.23,39.4668,,0.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,34,,0.2,percent of total billed charges,"Drugs, Inpatient Only",0.2,34,,0.2,percent of total billed charges,"Drugs, Inpatient Only",0.2,34,,0.2,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.41,70,,0.41,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,,,0.19,Other,Drug Cost,0.19,,,0.19,Other,Drug Cost,0.19,,,0.19,Other,Drug Cost,0.19,,,0.19,Other,Drug Cost,0.19,,,0.19,Other,Drug Cost,0.19,,,0.19,Other,Drug Cost,0.43,,,0.43,Other,225% of Medicaid,0.27,,,0.27,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.42,,,0.42,Other,215% Medicaid APG methodology,0.42,,,0.42,Other,215% Medicaid APG methodology,0.24,,,0.24,Other,125% Medicaid APG methodology,0.01,0.43,
MODAFINIL 100MG TAB,,,,80001393,CDM,250,RC,62332038530,NDC,both,30,EA,0.17,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,70,,0.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.13,
MORPHINE (MS CONTIN)  100MG SR TAB,,,,80001397,CDM,250,RC,42858080401,NDC,both,100,EA,0.67,0.26,39.4668,,0.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.47,70,,0.47,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.5,,,0.5,Other,225% of Medicaid,0.31,,,0.31,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.48,,,0.48,Other,215% Medicaid APG methodology,0.48,,,0.48,Other,215% Medicaid APG methodology,0.28,,,0.28,Other,125% Medicaid APG methodology,0.01,0.5,
MORPHINE (MS CONTIN)  15MG SR TAB,,,,80001398,CDM,250,RC,42858080101,NDC,both,100,EA,0.28,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,70,,0.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.21,,,0.21,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.2,,,0.2,Other,215% Medicaid APG methodology,0.2,,,0.2,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.21,
MORPHINE (MS CONTIN)  30MG SR TAB,,,,80001399,CDM,250,RC,406833062,NDC,both,10,EA,6.02,2.38,39.4668,,2.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.05,34,,2.05,percent of total billed charges,"Drugs, Inpatient Only",2.05,34,,2.05,percent of total billed charges,"Drugs, Inpatient Only",2.05,34,,2.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.22,70,,4.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.01,,,2.01,Other,Drug Cost,2.01,,,2.01,Other,Drug Cost,2.01,,,2.01,Other,Drug Cost,2.01,,,2.01,Other,Drug Cost,2.01,,,2.01,Other,Drug Cost,2.01,,,2.01,Other,Drug Cost,4.52,,,4.52,Other,225% of Medicaid,2.81,,,2.81,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.32,,,4.32,Other,215% Medicaid APG methodology,4.32,,,4.32,Other,215% Medicaid APG methodology,2.51,,,2.51,Other,125% Medicaid APG methodology,0.01,4.52,
MORPHINE (MS IR) 15MG TAB,,,,80001401,CDM,250,RC,54023525,NDC,both,100,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
MORPHINE (MS IR) 30MG TAB,,,,80001402,CDM,250,RC,54023625,NDC,both,100,EA,0.19,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
MOXIFLOXACIN (AVELOX) 400 MG TAB,,,,80001414,CDM,250,RC,65862060330,NDC,both,30,EA,2.3,0.91,39.4668,,0.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.78,34,,0.78,percent of total billed charges,"Drugs, Inpatient Only",0.78,34,,0.78,percent of total billed charges,"Drugs, Inpatient Only",0.78,34,,0.78,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.61,70,,1.61,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,1.72,,,1.72,Other,225% of Medicaid,1.07,,,1.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.65,,,1.65,Other,215% Medicaid APG methodology,1.65,,,1.65,Other,215% Medicaid APG methodology,0.96,,,0.96,Other,125% Medicaid APG methodology,0.01,1.72,
MULTIVITAMIN (INFUVITE) INJ,,,,80001418,CDM,250,RC,54643564901,NDC,both,5,ML,0.27,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,70,,0.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.19,,,0.19,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.2,
MURO 128 2% OPHTH SOLN,,,,80001422,CDM,250,RC,24208027615,NDC,both,1,ML,37.56,14.82,39.4668,,14.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.77,34,,12.77,percent of total billed charges,"Drugs, Inpatient Only",12.77,34,,12.77,percent of total billed charges,"Drugs, Inpatient Only",12.77,34,,12.77,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,26.29,70,,26.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.52,,,12.52,Other,Drug Cost,12.52,,,12.52,Other,Drug Cost,12.52,,,12.52,Other,Drug Cost,12.52,,,12.52,Other,Drug Cost,12.52,,,12.52,Other,Drug Cost,12.52,,,12.52,Other,Drug Cost,28.17,,,28.17,Other,225% of Medicaid,17.53,,,17.53,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,26.92,,,26.92,Other,215% Medicaid APG methodology,26.92,,,26.92,Other,215% Medicaid APG methodology,15.65,,,15.65,Other,125% Medicaid APG methodology,0.01,28.17,
NADOLOL 20 MG TAB,,,,80001427,CDM,250,RC,68382073201,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.08,
NADOLOL 40 MG TAB,,,,80001428,CDM,250,RC,69238112409,NDC,both,90,EA,0.3,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,70,,0.21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.23,,,0.23,Other,225% of Medicaid,0.14,,,0.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.22,,,0.22,Other,215% Medicaid APG methodology,0.22,,,0.22,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.23,
NAFCILLIN 1GM INJ,,,,80001429,CDM,250,RC,63323032710,NDC,both,10,EA,18.92,7.47,39.4668,,7.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.43,34,,6.43,percent of total billed charges,"Drugs, Inpatient Only",6.43,34,,6.43,percent of total billed charges,"Drugs, Inpatient Only",6.43,34,,6.43,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.24,70,,13.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.31,,,6.31,Other,Drug Cost,6.31,,,6.31,Other,Drug Cost,6.31,,,6.31,Other,Drug Cost,6.31,,,6.31,Other,Drug Cost,6.31,,,6.31,Other,Drug Cost,6.31,,,6.31,Other,Drug Cost,14.19,,,14.19,Other,225% of Medicaid,8.83,,,8.83,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,13.56,,,13.56,Other,215% Medicaid APG methodology,13.56,,,13.56,Other,215% Medicaid APG methodology,7.88,,,7.88,Other,125% Medicaid APG methodology,0.01,14.19,
NAFCILLIN 2GM INJ,,,,80001430,CDM,250,RC,44567022210,NDC,both,10,EA,23.7,9.35,39.4668,,9.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.06,34,,8.06,percent of total billed charges,"Drugs, Inpatient Only",8.06,34,,8.06,percent of total billed charges,"Drugs, Inpatient Only",8.06,34,,8.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.59,70,,16.59,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.9,,,7.9,Other,Drug Cost,7.9,,,7.9,Other,Drug Cost,7.9,,,7.9,Other,Drug Cost,7.9,,,7.9,Other,Drug Cost,7.9,,,7.9,Other,Drug Cost,7.9,,,7.9,Other,Drug Cost,17.77,,,17.77,Other,225% of Medicaid,11.06,,,11.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,16.98,,,16.98,Other,215% Medicaid APG methodology,16.98,,,16.98,Other,215% Medicaid APG methodology,9.87,,,9.87,Other,125% Medicaid APG methodology,0.01,17.77,
NALTREXONE 50 MG TAB,,,,80001434,CDM,250,RC,47335032683,NDC,both,30,EA,0.83,0.33,39.4668,,0.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.58,70,,0.58,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.62,,,0.62,Other,225% of Medicaid,0.39,,,0.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.59,,,0.59,Other,215% Medicaid APG methodology,0.59,,,0.59,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,0.62,
NAPHAZOLINE-PHENIRAMINE OPTH SOLN,,,,80001435,CDM,250,RC,65008515,NDC,both,1,ML,15.9,6.28,39.4668,,6.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.41,34,,5.41,percent of total billed charges,"Drugs, Inpatient Only",5.41,34,,5.41,percent of total billed charges,"Drugs, Inpatient Only",5.41,34,,5.41,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.13,70,,11.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.3,,,5.3,Other,Drug Cost,5.3,,,5.3,Other,Drug Cost,5.3,,,5.3,Other,Drug Cost,5.3,,,5.3,Other,Drug Cost,5.3,,,5.3,Other,Drug Cost,5.3,,,5.3,Other,Drug Cost,11.93,,,11.93,Other,225% of Medicaid,7.42,,,7.42,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.4,,,11.4,Other,215% Medicaid APG methodology,11.4,,,11.4,Other,215% Medicaid APG methodology,6.63,,,6.63,Other,125% Medicaid APG methodology,0.01,11.93,
NAPROXEN 250MG TAB,,,,80001436,CDM,250,RC,68462018801,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
NAPROXEN 375MG TAB,,,,80001438,CDM,250,RC,68462018901,NDC,both,100,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
NASAL SALINE 0.65% 45 ML,,,,80001440,CDM,250,RC,904386575,NDC,both,1,ML,1.92,0.76,39.4668,,0.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.65,34,,0.65,percent of total billed charges,"Drugs, Inpatient Only",0.65,34,,0.65,percent of total billed charges,"Drugs, Inpatient Only",0.65,34,,0.65,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.34,70,,1.34,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,0.64,,,0.64,Other,Drug Cost,1.44,,,1.44,Other,225% of Medicaid,0.9,,,0.9,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.38,,,1.38,Other,215% Medicaid APG methodology,1.38,,,1.38,Other,215% Medicaid APG methodology,0.8,,,0.8,Other,125% Medicaid APG methodology,0.01,1.44,
NEO-BAC-POLY-HC 3.5GM OPHTH,,,,80001445,CDM,250,RC,24208078555,NDC,both,1,GM,28.02,11.06,39.4668,,11.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.53,34,,9.53,percent of total billed charges,"Drugs, Inpatient Only",9.53,34,,9.53,percent of total billed charges,"Drugs, Inpatient Only",9.53,34,,9.53,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.61,70,,19.61,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.34,,,9.34,Other,Drug Cost,9.34,,,9.34,Other,Drug Cost,9.34,,,9.34,Other,Drug Cost,9.34,,,9.34,Other,Drug Cost,9.34,,,9.34,Other,Drug Cost,9.34,,,9.34,Other,Drug Cost,21.02,,,21.02,Other,225% of Medicaid,13.08,,,13.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,20.08,,,20.08,Other,215% Medicaid APG methodology,20.08,,,20.08,Other,215% Medicaid APG methodology,11.68,,,11.68,Other,125% Medicaid APG methodology,0.01,21.02,
NEOMYCIN 500 MG TAB,,,,80001447,CDM,250,RC,93117701,NDC,both,100,EA,1.4,0.55,39.4668,,0.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.98,70,,0.98,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,1.05,,,1.05,Other,225% of Medicaid,0.65,,,0.65,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1,,,1,Other,215% Medicaid APG methodology,1,,,1,Other,215% Medicaid APG methodology,0.58,,,0.58,Other,125% Medicaid APG methodology,0.01,1.05,
NEO-POLY-BAC UD PACKET,,,,80001448,CDM,250,RC,904880567,NDC,both,144,GM,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
NEO-POLY-DEXAMETH 5ML OPHTH,,,,80001450,CDM,250,RC,24208083060,NDC,both,1,ML,9.33,3.68,39.4668,,3.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.17,34,,3.17,percent of total billed charges,"Drugs, Inpatient Only",3.17,34,,3.17,percent of total billed charges,"Drugs, Inpatient Only",3.17,34,,3.17,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.53,70,,6.53,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.11,,,3.11,Other,Drug Cost,3.11,,,3.11,Other,Drug Cost,3.11,,,3.11,Other,Drug Cost,3.11,,,3.11,Other,Drug Cost,3.11,,,3.11,Other,Drug Cost,3.11,,,3.11,Other,Drug Cost,7,,,7,Other,225% of Medicaid,4.35,,,4.35,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.69,,,6.69,Other,215% Medicaid APG methodology,6.69,,,6.69,Other,215% Medicaid APG methodology,3.89,,,3.89,Other,125% Medicaid APG methodology,0.01,7,
NEO-POLY-GRAMICIDIN 10ML OPHTH,,,,80001451,CDM,250,RC,24208079062,NDC,both,1,ML,31.98,12.62,39.4668,,12.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.87,34,,10.87,percent of total billed charges,"Drugs, Inpatient Only",10.87,34,,10.87,percent of total billed charges,"Drugs, Inpatient Only",10.87,34,,10.87,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.39,70,,22.39,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.66,,,10.66,Other,Drug Cost,10.66,,,10.66,Other,Drug Cost,10.66,,,10.66,Other,Drug Cost,10.66,,,10.66,Other,Drug Cost,10.66,,,10.66,Other,Drug Cost,10.66,,,10.66,Other,Drug Cost,23.99,,,23.99,Other,225% of Medicaid,14.92,,,14.92,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,22.92,,,22.92,Other,215% Medicaid APG methodology,22.92,,,22.92,Other,215% Medicaid APG methodology,13.33,,,13.33,Other,125% Medicaid APG methodology,0.01,23.99,
NICARDIPINE (CARDENE) 25MG/10ML INJ,,,,80001461,CDM,250,RC,143968910,NDC,both,10,ML,23.97,9.46,39.4668,,9.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.15,34,,8.15,percent of total billed charges,"Drugs, Inpatient Only",8.15,34,,8.15,percent of total billed charges,"Drugs, Inpatient Only",8.15,34,,8.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.78,70,,16.78,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.99,,,7.99,Other,Drug Cost,7.99,,,7.99,Other,Drug Cost,7.99,,,7.99,Other,Drug Cost,7.99,,,7.99,Other,Drug Cost,7.99,,,7.99,Other,Drug Cost,7.99,,,7.99,Other,Drug Cost,17.98,,,17.98,Other,225% of Medicaid,11.19,,,11.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,17.18,,,17.18,Other,215% Medicaid APG methodology,17.18,,,17.18,Other,215% Medicaid APG methodology,9.99,,,9.99,Other,125% Medicaid APG methodology,0.01,17.98,
NICARDIPINE 20 MG CAP,,,,80001462,CDM,250,RC,42806050109,NDC,both,90,EA,1.67,0.66,39.4668,,0.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.17,70,,1.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,1.25,,,1.25,Other,225% of Medicaid,0.78,,,0.78,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.2,,,1.2,Other,215% Medicaid APG methodology,1.2,,,1.2,Other,215% Medicaid APG methodology,0.7,,,0.7,Other,125% Medicaid APG methodology,0.01,1.25,
NICARDIPINE IN SALINE 20MG/200ML,,,,80001464,CDM,250,RC,43066000910,NDC,both,10,ML,49.52,19.54,39.4668,,19.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.84,34,,16.84,percent of total billed charges,"Drugs, Inpatient Only",16.84,34,,16.84,percent of total billed charges,"Drugs, Inpatient Only",16.84,34,,16.84,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,34.66,70,,34.66,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.51,,,16.51,Other,Drug Cost,16.51,,,16.51,Other,Drug Cost,16.51,,,16.51,Other,Drug Cost,16.51,,,16.51,Other,Drug Cost,16.51,,,16.51,Other,Drug Cost,16.51,,,16.51,Other,Drug Cost,37.14,,,37.14,Other,225% of Medicaid,23.11,,,23.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,35.49,,,35.49,Other,215% Medicaid APG methodology,35.49,,,35.49,Other,215% Medicaid APG methodology,20.63,,,20.63,Other,125% Medicaid APG methodology,0.01,37.14,
NICOTINE 14MG/ 24HR PATCH,,,,80001465,CDM,250,RC,43598044774,NDC,both,14,EA,1.82,0.72,39.4668,,0.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.28,70,,1.28,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,1.37,,,1.37,Other,225% of Medicaid,0.85,,,0.85,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.31,,,1.31,Other,215% Medicaid APG methodology,1.31,,,1.31,Other,215% Medicaid APG methodology,0.76,,,0.76,Other,125% Medicaid APG methodology,0.01,1.37,
NICOTINE 21MG/ 24HR PATCH,,,,80001466,CDM,250,RC,43598044870,NDC,both,7,EA,1.81,0.71,39.4668,,0.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.61,34,,0.61,percent of total billed charges,"Drugs, Inpatient Only",0.61,34,,0.61,percent of total billed charges,"Drugs, Inpatient Only",0.61,34,,0.61,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.27,70,,1.27,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,1.36,,,1.36,Other,225% of Medicaid,0.84,,,0.84,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.3,,,1.3,Other,215% Medicaid APG methodology,1.3,,,1.3,Other,215% Medicaid APG methodology,0.75,,,0.75,Other,125% Medicaid APG methodology,0.01,1.36,
NICOTINE 7MG/ 24HR PATCH,,,,80001467,CDM,250,RC,43598044674,NDC,both,14,EA,1.83,0.72,39.4668,,0.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.28,70,,1.28,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,1.38,,,1.38,Other,225% of Medicaid,0.86,,,0.86,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.31,,,1.31,Other,215% Medicaid APG methodology,1.31,,,1.31,Other,215% Medicaid APG methodology,0.76,,,0.76,Other,125% Medicaid APG methodology,0.01,1.38,
NICOTINE POLACRILEX 2 MG GUM,,,,80001468,CDM,250,RC,536311201,NDC,both,100,EA,0.41,0.16,39.4668,,0.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,70,,0.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.31,,,0.31,Other,225% of Medicaid,0.19,,,0.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.29,,,0.29,Other,215% Medicaid APG methodology,0.29,,,0.29,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,125% Medicaid APG methodology,0.01,0.31,
NICOTINE POLACRILEX 4 MG GUM,,,,80001469,CDM,250,RC,536303023,NDC,both,110,EA,0.32,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,70,,0.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.24,,,0.24,Other,225% of Medicaid,0.15,,,0.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.23,,,0.23,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.24,
NIFEDIPINE 10 MG CAP,,,,80001470,CDM,250,RC,23155019401,NDC,both,100,EA,0.25,0.1,39.4668,,0.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,70,,0.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.19,,,0.19,Other,225% of Medicaid,0.12,,,0.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.18,,,0.18,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.19,
NIFEDIPINE 30 MG ER TAB,,,,80001472,CDM,250,RC,50742062001,NDC,both,100,EA,0.13,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
NISOLDIPINE 20 MG ER TAB,,,,80001477,CDM,250,RC,378222201,NDC,both,100,EA,10.26,4.05,39.4668,,4.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.49,34,,3.49,percent of total billed charges,"Drugs, Inpatient Only",3.49,34,,3.49,percent of total billed charges,"Drugs, Inpatient Only",3.49,34,,3.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.18,70,,7.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.42,,,3.42,Other,Drug Cost,3.42,,,3.42,Other,Drug Cost,3.42,,,3.42,Other,Drug Cost,3.42,,,3.42,Other,Drug Cost,3.42,,,3.42,Other,Drug Cost,3.42,,,3.42,Other,Drug Cost,7.7,,,7.7,Other,225% of Medicaid,4.79,,,4.79,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.35,,,7.35,Other,215% Medicaid APG methodology,7.35,,,7.35,Other,215% Medicaid APG methodology,4.28,,,4.28,Other,125% Medicaid APG methodology,0.01,7.7,
NITROFURANTOIN 100MG CAP,,,,80001479,CDM,250,RC,47781030301,NDC,both,100,EA,0.36,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,70,,0.25,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.27,,,0.27,Other,225% of Medicaid,0.17,,,0.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.26,,,0.26,Other,215% Medicaid APG methodology,0.26,,,0.26,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,125% Medicaid APG methodology,0.01,0.27,
NITROGLYCERIN 0.1MG/HR,,,,80001482,CDM,250,RC,378910293,NDC,both,30,EA,0.69,0.27,39.4668,,0.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.49,70,,0.49,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.52,,,0.52,Other,225% of Medicaid,0.32,,,0.32,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.5,,,0.5,Other,215% Medicaid APG methodology,0.5,,,0.5,Other,215% Medicaid APG methodology,0.29,,,0.29,Other,125% Medicaid APG methodology,0.01,0.52,
NITROGLYCERIN 0.2MG/HR,,,,80001483,CDM,250,RC,378910493,NDC,both,30,EA,0.7,0.27,39.4668,,0.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.49,70,,0.49,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.52,,,0.52,Other,225% of Medicaid,0.32,,,0.32,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.5,,,0.5,Other,215% Medicaid APG methodology,0.5,,,0.5,Other,215% Medicaid APG methodology,0.29,,,0.29,Other,125% Medicaid APG methodology,0.01,0.52,
NITROGLYCERIN 0.4MG SL TAB,,,,80001488,CDM,250,RC,59762330403,NDC,both,4,EA,2.87,1.13,39.4668,,1.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.97,34,,0.97,percent of total billed charges,"Drugs, Inpatient Only",0.97,34,,0.97,percent of total billed charges,"Drugs, Inpatient Only",0.97,34,,0.97,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.01,70,,2.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.96,,,0.96,Other,Drug Cost,0.96,,,0.96,Other,Drug Cost,0.96,,,0.96,Other,Drug Cost,0.96,,,0.96,Other,Drug Cost,0.96,,,0.96,Other,Drug Cost,0.96,,,0.96,Other,Drug Cost,2.15,,,2.15,Other,225% of Medicaid,1.34,,,1.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.05,,,2.05,Other,215% Medicaid APG methodology,2.05,,,2.05,Other,215% Medicaid APG methodology,1.19,,,1.19,Other,125% Medicaid APG methodology,0.01,2.15,
NITROGLYCERIN 0.6 MG/HR,,,,80001489,CDM,250,RC,378911693,NDC,both,30,EA,1.08,0.43,39.4668,,0.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.37,34,,0.37,percent of total billed charges,"Drugs, Inpatient Only",0.37,34,,0.37,percent of total billed charges,"Drugs, Inpatient Only",0.37,34,,0.37,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.76,70,,0.76,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.81,,,0.81,Other,225% of Medicaid,0.5,,,0.5,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.77,,,0.77,Other,215% Medicaid APG methodology,0.77,,,0.77,Other,215% Medicaid APG methodology,0.45,,,0.45,Other,125% Medicaid APG methodology,0.01,0.81,
NITROGLYCERIN 2% 1GM OINT,,,,80001490,CDM,250,RC,281032608,NDC,both,48,GM,3.46,1.37,39.4668,,1.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.18,34,,1.18,percent of total billed charges,"Drugs, Inpatient Only",1.18,34,,1.18,percent of total billed charges,"Drugs, Inpatient Only",1.18,34,,1.18,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.42,70,,2.42,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.15,,,1.15,Other,Drug Cost,1.15,,,1.15,Other,Drug Cost,1.15,,,1.15,Other,Drug Cost,1.15,,,1.15,Other,Drug Cost,1.15,,,1.15,Other,Drug Cost,1.15,,,1.15,Other,Drug Cost,2.59,,,2.59,Other,225% of Medicaid,1.61,,,1.61,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.48,,,2.48,Other,215% Medicaid APG methodology,2.48,,,2.48,Other,215% Medicaid APG methodology,1.44,,,1.44,Other,125% Medicaid APG methodology,0.01,2.59,
NITROGLYCERIN 2% 30GM OINT,,,,80001491,CDM,250,RC,281032630,NDC,both,1,GM,92.55,36.53,39.4668,,36.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,31.47,34,,31.47,percent of total billed charges,"Drugs, Inpatient Only",31.47,34,,31.47,percent of total billed charges,"Drugs, Inpatient Only",31.47,34,,31.47,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,64.79,70,,64.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,30.85,,,30.85,Other,Drug Cost,30.85,,,30.85,Other,Drug Cost,30.85,,,30.85,Other,Drug Cost,30.85,,,30.85,Other,Drug Cost,30.85,,,30.85,Other,Drug Cost,30.85,,,30.85,Other,Drug Cost,69.41,,,69.41,Other,225% of Medicaid,43.19,,,43.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,66.33,,,66.33,Other,215% Medicaid APG methodology,66.33,,,66.33,Other,215% Medicaid APG methodology,38.56,,,38.56,Other,125% Medicaid APG methodology,0.01,69.41,
NITROGLYCERIN 200MCG/ML 250ML,,,,80001492,CDM,250,RC,338104902,NDC,both,12,ML,6.8,2.68,39.4668,,2.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.31,34,,2.31,percent of total billed charges,"Drugs, Inpatient Only",2.31,34,,2.31,percent of total billed charges,"Drugs, Inpatient Only",2.31,34,,2.31,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.76,70,,4.76,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,5.1,,,5.1,Other,225% of Medicaid,3.17,,,3.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.87,,,4.87,Other,215% Medicaid APG methodology,4.87,,,4.87,Other,215% Medicaid APG methodology,2.83,,,2.83,Other,125% Medicaid APG methodology,0.01,5.1,
NITROGLYCERIN 5 MG/ML 10ML INJ,,,,80001493,CDM,250,RC,517481025,NDC,both,25,ML,17.76,7.01,39.4668,,7.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.04,34,,6.04,percent of total billed charges,"Drugs, Inpatient Only",6.04,34,,6.04,percent of total billed charges,"Drugs, Inpatient Only",6.04,34,,6.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.43,70,,12.43,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.92,,,5.92,Other,Drug Cost,5.92,,,5.92,Other,Drug Cost,5.92,,,5.92,Other,Drug Cost,5.92,,,5.92,Other,Drug Cost,5.92,,,5.92,Other,Drug Cost,5.92,,,5.92,Other,Drug Cost,13.32,,,13.32,Other,225% of Medicaid,8.29,,,8.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.73,,,12.73,Other,215% Medicaid APG methodology,12.73,,,12.73,Other,215% Medicaid APG methodology,7.4,,,7.4,Other,125% Medicaid APG methodology,0.01,13.32,
NITROPRUSSIDE 50MG/2ML INJ,,,,80001496,CDM,250,RC,70436002880,NDC,both,1,ML,9.6,3.79,39.4668,,3.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.26,34,,3.26,percent of total billed charges,"Drugs, Inpatient Only",3.26,34,,3.26,percent of total billed charges,"Drugs, Inpatient Only",3.26,34,,3.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.72,70,,6.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,3.2,,,3.2,Other,Drug Cost,7.2,,,7.2,Other,225% of Medicaid,4.48,,,4.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.88,,,6.88,Other,215% Medicaid APG methodology,6.88,,,6.88,Other,215% Medicaid APG methodology,4,,,4,Other,125% Medicaid APG methodology,0.01,7.2,
NORETHINDNONE 5MG TAB,,,,80001506,CDM,250,RC,68462030450,NDC,both,50,EA,0.29,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,70,,0.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.22,,,0.22,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.21,,,0.21,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.22,
NORTRIPTYLINE 10 MG CAP,,,,80001508,CDM,250,RC,93081001,NDC,both,100,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
NORTRIPTYLINE 25 MG CAP,,,,80001509,CDM,250,RC,93081101,NDC,both,100,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
NORTRIPTYLINE 50 MG CAP,,,,80001510,CDM,250,RC,93081201,NDC,both,100,EA,0.13,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.1,
NYSTATIN 15 GM CREAM,,,,80001513,CDM,250,RC,51672128901,NDC,both,1,GM,1.02,0.4,39.4668,,0.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.71,70,,0.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.77,,,0.77,Other,225% of Medicaid,0.48,,,0.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.73,,,0.73,Other,215% Medicaid APG methodology,0.73,,,0.73,Other,215% Medicaid APG methodology,0.43,,,0.43,Other,125% Medicaid APG methodology,0.01,0.77,
NYSTATIN POWDER 15 GRAMS,,,,80001518,CDM,250,RC,832046515,NDC,both,1,GM,2.97,1.17,39.4668,,1.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.01,34,,1.01,percent of total billed charges,"Drugs, Inpatient Only",1.01,34,,1.01,percent of total billed charges,"Drugs, Inpatient Only",1.01,34,,1.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.08,70,,2.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.99,,,0.99,Other,Drug Cost,0.99,,,0.99,Other,Drug Cost,0.99,,,0.99,Other,Drug Cost,0.99,,,0.99,Other,Drug Cost,0.99,,,0.99,Other,Drug Cost,0.99,,,0.99,Other,Drug Cost,2.23,,,2.23,Other,225% of Medicaid,1.39,,,1.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.13,,,2.13,Other,215% Medicaid APG methodology,2.13,,,2.13,Other,215% Medicaid APG methodology,1.24,,,1.24,Other,125% Medicaid APG methodology,0.01,2.23,
NYSTATIN-TRIAMCIN 15GM CREAM,,,,80001520,CDM,250,RC,51672126301,NDC,both,1,GM,4.53,1.79,39.4668,,1.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.54,34,,1.54,percent of total billed charges,"Drugs, Inpatient Only",1.54,34,,1.54,percent of total billed charges,"Drugs, Inpatient Only",1.54,34,,1.54,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.17,70,,3.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,3.4,,,3.4,Other,225% of Medicaid,2.11,,,2.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.25,,,3.25,Other,215% Medicaid APG methodology,3.25,,,3.25,Other,215% Medicaid APG methodology,1.89,,,1.89,Other,125% Medicaid APG methodology,0.01,3.4,
NYSTATIN-TRIAMCIN 30GM OINT,,,,80001522,CDM,250,RC,62332058515,NDC,both,1,GM,4.95,1.95,39.4668,,1.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.68,34,,1.68,percent of total billed charges,"Drugs, Inpatient Only",1.68,34,,1.68,percent of total billed charges,"Drugs, Inpatient Only",1.68,34,,1.68,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.47,70,,3.47,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.65,,,1.65,Other,Drug Cost,1.65,,,1.65,Other,Drug Cost,1.65,,,1.65,Other,Drug Cost,1.65,,,1.65,Other,Drug Cost,1.65,,,1.65,Other,Drug Cost,1.65,,,1.65,Other,Drug Cost,3.71,,,3.71,Other,225% of Medicaid,2.31,,,2.31,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.55,,,3.55,Other,215% Medicaid APG methodology,3.55,,,3.55,Other,215% Medicaid APG methodology,2.06,,,2.06,Other,125% Medicaid APG methodology,0.01,3.71,
OFLOXACIN (FLOXIN) 0.3% 5ML OTIC SOLN,,,,80001527,CDM,250,RC,24208041005,NDC,both,1,ML,4.92,1.94,39.4668,,1.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.67,34,,1.67,percent of total billed charges,"Drugs, Inpatient Only",1.67,34,,1.67,percent of total billed charges,"Drugs, Inpatient Only",1.67,34,,1.67,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.44,70,,3.44,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.64,,,1.64,Other,Drug Cost,1.64,,,1.64,Other,Drug Cost,1.64,,,1.64,Other,Drug Cost,1.64,,,1.64,Other,Drug Cost,1.64,,,1.64,Other,Drug Cost,1.64,,,1.64,Other,Drug Cost,3.69,,,3.69,Other,225% of Medicaid,2.3,,,2.3,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.53,,,3.53,Other,215% Medicaid APG methodology,3.53,,,3.53,Other,215% Medicaid APG methodology,2.05,,,2.05,Other,125% Medicaid APG methodology,0.01,3.69,
OFLOXACIN 0.3% 5ML OPHTH,,,,80001528,CDM,250,RC,24208043405,NDC,both,1,ML,10.65,4.2,39.4668,,4.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.62,34,,3.62,percent of total billed charges,"Drugs, Inpatient Only",3.62,34,,3.62,percent of total billed charges,"Drugs, Inpatient Only",3.62,34,,3.62,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.46,70,,7.46,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.55,,,3.55,Other,Drug Cost,3.55,,,3.55,Other,Drug Cost,3.55,,,3.55,Other,Drug Cost,3.55,,,3.55,Other,Drug Cost,3.55,,,3.55,Other,Drug Cost,3.55,,,3.55,Other,Drug Cost,7.99,,,7.99,Other,225% of Medicaid,4.97,,,4.97,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.63,,,7.63,Other,215% Medicaid APG methodology,7.63,,,7.63,Other,215% Medicaid APG methodology,4.44,,,4.44,Other,125% Medicaid APG methodology,0.01,7.99,
OLANZAPINE  2.5 MG,,,,80001530,CDM,250,RC,55111016330,NDC,both,30,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
OLANZAPINE  5 MG,,,,80001531,CDM,250,RC,43598016430,NDC,both,30,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
OLANZAPINE LONG-ACTING 10MG INJ,,,,80001533,CDM,250,RC,2759701,NDC,both,1,EA,27.72,10.94,39.4668,,10.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.42,34,,9.42,percent of total billed charges,"Drugs, Inpatient Only",9.42,34,,9.42,percent of total billed charges,"Drugs, Inpatient Only",9.42,34,,9.42,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.4,70,,19.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.24,,,9.24,Other,Drug Cost,9.24,,,9.24,Other,Drug Cost,9.24,,,9.24,Other,Drug Cost,9.24,,,9.24,Other,Drug Cost,9.24,,,9.24,Other,Drug Cost,9.24,,,9.24,Other,Drug Cost,20.79,,,20.79,Other,225% of Medicaid,12.94,,,12.94,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,19.87,,,19.87,Other,215% Medicaid APG methodology,19.87,,,19.87,Other,215% Medicaid APG methodology,11.55,,,11.55,Other,125% Medicaid APG methodology,0.01,20.79,
OPIUM 10MG/ML TINCTURE,,,,80001541,CDM,250,RC,62559015304,NDC,both,1,ML,563.91,222.56,39.4668,,222.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,191.73,34,,191.73,percent of total billed charges,"Drugs, Inpatient Only",191.73,34,,191.73,percent of total billed charges,"Drugs, Inpatient Only",191.73,34,,191.73,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,394.74,70,,394.74,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,187.97,,,187.97,Other,Drug Cost,187.97,,,187.97,Other,Drug Cost,187.97,,,187.97,Other,Drug Cost,187.97,,,187.97,Other,Drug Cost,187.97,,,187.97,Other,Drug Cost,187.97,,,187.97,Other,Drug Cost,422.93,,,422.93,Other,225% of Medicaid,263.16,,,263.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,404.14,,,404.14,Other,215% Medicaid APG methodology,404.14,,,404.14,Other,215% Medicaid APG methodology,234.96,,,234.96,Other,125% Medicaid APG methodology,0.01,422.93,
ORAJEL 10%,,,,80001543,CDM,250,RC,50486055032,NDC,both,1,GM,18.03,7.12,39.4668,,7.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.13,34,,6.13,percent of total billed charges,"Drugs, Inpatient Only",6.13,34,,6.13,percent of total billed charges,"Drugs, Inpatient Only",6.13,34,,6.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.62,70,,12.62,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.01,,,6.01,Other,Drug Cost,6.01,,,6.01,Other,Drug Cost,6.01,,,6.01,Other,Drug Cost,6.01,,,6.01,Other,Drug Cost,6.01,,,6.01,Other,Drug Cost,6.01,,,6.01,Other,Drug Cost,13.52,,,13.52,Other,225% of Medicaid,8.41,,,8.41,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.92,,,12.92,Other,215% Medicaid APG methodology,12.92,,,12.92,Other,215% Medicaid APG methodology,7.51,,,7.51,Other,125% Medicaid APG methodology,0.01,13.52,
OSELTAMIVIR 75 MG CAP,,,,80001544,CDM,250,RC,64380079901,NDC,both,10,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
OXCARBAZEPINE 150MG TAB,,,,80001549,CDM,250,RC,78045605,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
OXCARBAZEPINE 300MG TAB,,,,80001550,CDM,250,RC,78033705,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
OXYBUTYNIN 5MG TAB,,,,80001552,CDM,250,RC,832003800,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
OXYCODONE (OXYCONTIN) 10MG SR TAB,,,,80001553,CDM,250,RC,59011041010,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
OXYCODONE (OXYCONTIN) 40MG SR TAB,,,,80001555,CDM,250,RC,59011044010,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
OXYCODONE 10MG IMMED REL TAB,,,,80001557,CDM,250,RC,42858000201,NDC,both,100,EA,0.17,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,70,,0.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.13,
OXYCODONE 5MG IMMED REL TAB,,,,80001558,CDM,250,RC,10702001801,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.08,
OXYCODONE/APAP 5/325MG TAB,,,,80001559,CDM,250,RC,47781019601,NDC,both,100,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.08,
OXYMETAZOLINE HCL (AFRIN) NASAL 15 ML,,,,80001560,CDM,250,RC,904700635,NDC,both,1,ML,3.6,1.42,39.4668,,1.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.22,34,,1.22,percent of total billed charges,"Drugs, Inpatient Only",1.22,34,,1.22,percent of total billed charges,"Drugs, Inpatient Only",1.22,34,,1.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.52,70,,2.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,2.7,,,2.7,Other,225% of Medicaid,1.68,,,1.68,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.58,,,2.58,Other,215% Medicaid APG methodology,2.58,,,2.58,Other,215% Medicaid APG methodology,1.5,,,1.5,Other,125% Medicaid APG methodology,0.01,2.7,
OXYBUTYNIN ER (DITROPAN XL) 5MG TAB,,,,80001561,CDM,250,RC,62175027037,NDC,both,100,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
OYSTER SHELL CALCIUM 500MG TAB,,,,80001565,CDM,250,RC,904188361,NDC,both,10,EA,0.34,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,70,,0.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.25,,,0.25,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.24,,,0.24,Other,215% Medicaid APG methodology,0.24,,,0.24,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,0.25,
OYSTER SHELL CALCIUM W/D 250MG TAB,,,,80001566,CDM,250,RC,904188260,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PAROXETINE HCL 10 MG TAB,,,,80001589,CDM,250,RC,68382009716,NDC,both,90,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
PAROXETINE HCL 20 MG TAB,,,,80001590,CDM,250,RC,60505008302,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.08,
PENICILLAMINE 250 MG CAP,,,,80001596,CDM,250,RC,25010070515,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PENICILLIN V 250 MG/5 ML 200ML SUSP,,,,80001598,CDM,250,RC,93412773,NDC,both,1,ML,4.23,1.67,39.4668,,1.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.44,34,,1.44,percent of total billed charges,"Drugs, Inpatient Only",1.44,34,,1.44,percent of total billed charges,"Drugs, Inpatient Only",1.44,34,,1.44,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.96,70,,2.96,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,3.17,,,3.17,Other,225% of Medicaid,1.97,,,1.97,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.03,,,3.03,Other,215% Medicaid APG methodology,3.03,,,3.03,Other,215% Medicaid APG methodology,1.76,,,1.76,Other,125% Medicaid APG methodology,0.01,3.17,
PENICILLIN VK 250 MG TAB,,,,80001599,CDM,250,RC,143983701,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
PENTAMIDINE 300MG INJ,,,,80001600,CDM,250,RC,63323011310,NDC,both,10,EA,113.19,44.67,39.4668,,44.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.49,34,,38.49,percent of total billed charges,"Drugs, Inpatient Only",38.49,34,,38.49,percent of total billed charges,"Drugs, Inpatient Only",38.49,34,,38.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,79.24,70,,79.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,37.73,,,37.73,Other,Drug Cost,37.73,,,37.73,Other,Drug Cost,37.73,,,37.73,Other,Drug Cost,37.73,,,37.73,Other,Drug Cost,37.73,,,37.73,Other,Drug Cost,37.73,,,37.73,Other,Drug Cost,84.89,,,84.89,Other,225% of Medicaid,52.82,,,52.82,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,81.12,,,81.12,Other,215% Medicaid APG methodology,81.12,,,81.12,Other,215% Medicaid APG methodology,47.16,,,47.16,Other,125% Medicaid APG methodology,0.01,84.89,
PENTOXIFYLLINE 400MG TAB,,,,80001603,CDM,250,RC,60505003306,NDC,both,100,EA,0.24,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,70,,0.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.18,,,0.18,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.17,,,0.17,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.18,
PEPPERMINT SPIRIT 30ML,,,,80001604,CDM,250,RC,395224391,NDC,both,1,EA,20.31,8.02,39.4668,,8.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.91,34,,6.91,percent of total billed charges,"Drugs, Inpatient Only",6.91,34,,6.91,percent of total billed charges,"Drugs, Inpatient Only",6.91,34,,6.91,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.22,70,,14.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.77,,,6.77,Other,Drug Cost,6.77,,,6.77,Other,Drug Cost,6.77,,,6.77,Other,Drug Cost,6.77,,,6.77,Other,Drug Cost,6.77,,,6.77,Other,Drug Cost,6.77,,,6.77,Other,Drug Cost,15.23,,,15.23,Other,225% of Medicaid,9.48,,,9.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,14.56,,,14.56,Other,215% Medicaid APG methodology,14.56,,,14.56,Other,215% Medicaid APG methodology,8.46,,,8.46,Other,125% Medicaid APG methodology,0.01,15.23,
PERMETHRIN 1% LOTION,,,,80001607,CDM,250,RC,63736012002,NDC,both,1,ML,30,11.84,39.4668,,11.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.2,34,,10.2,percent of total billed charges,"Drugs, Inpatient Only",10.2,34,,10.2,percent of total billed charges,"Drugs, Inpatient Only",10.2,34,,10.2,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21,70,,21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10,,,10,Other,Drug Cost,10,,,10,Other,Drug Cost,10,,,10,Other,Drug Cost,10,,,10,Other,Drug Cost,10,,,10,Other,Drug Cost,10,,,10,Other,Drug Cost,22.5,,,22.5,Other,225% of Medicaid,14,,,14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,21.5,,,21.5,Other,215% Medicaid APG methodology,21.5,,,21.5,Other,215% Medicaid APG methodology,12.5,,,12.5,Other,125% Medicaid APG methodology,0.01,22.5,
PERMETHRIN 60GM CREAM,,,,80001608,CDM,250,RC,21922002107,NDC,both,1,GM,16.14,6.37,39.4668,,6.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.49,34,,5.49,percent of total billed charges,"Drugs, Inpatient Only",5.49,34,,5.49,percent of total billed charges,"Drugs, Inpatient Only",5.49,34,,5.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.3,70,,11.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.38,,,5.38,Other,Drug Cost,5.38,,,5.38,Other,Drug Cost,5.38,,,5.38,Other,Drug Cost,5.38,,,5.38,Other,Drug Cost,5.38,,,5.38,Other,Drug Cost,5.38,,,5.38,Other,Drug Cost,12.11,,,12.11,Other,225% of Medicaid,7.53,,,7.53,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.57,,,11.57,Other,215% Medicaid APG methodology,11.57,,,11.57,Other,215% Medicaid APG methodology,6.73,,,6.73,Other,125% Medicaid APG methodology,0.01,12.11,
PERPHENAZINE 4MG TAB,,,,80001612,CDM,250,RC,52536016401,NDC,both,100,EA,0.27,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,70,,0.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.12,,,0.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.19,,,0.19,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.2,
PETROLATUM JELLY,,,,80001614,CDM,250,RC,904573182,NDC,both,1,GM,8.79,3.47,39.4668,,3.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.99,34,,2.99,percent of total billed charges,"Drugs, Inpatient Only",2.99,34,,2.99,percent of total billed charges,"Drugs, Inpatient Only",2.99,34,,2.99,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.15,70,,6.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,6.59,,,6.59,Other,225% of Medicaid,4.1,,,4.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.3,,,6.3,Other,215% Medicaid APG methodology,6.3,,,6.3,Other,215% Medicaid APG methodology,3.66,,,3.66,Other,125% Medicaid APG methodology,0.01,6.59,
PHENAZOPYRIDINE 100MG TAB,,,,80001616,CDM,250,RC,75826011410,NDC,both,100,EA,0.73,0.29,39.4668,,0.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,34,,0.25,percent of total billed charges,"Drugs, Inpatient Only",0.25,34,,0.25,percent of total billed charges,"Drugs, Inpatient Only",0.25,34,,0.25,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.51,70,,0.51,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,,,0.24,Other,Drug Cost,0.24,,,0.24,Other,Drug Cost,0.24,,,0.24,Other,Drug Cost,0.24,,,0.24,Other,Drug Cost,0.24,,,0.24,Other,Drug Cost,0.24,,,0.24,Other,Drug Cost,0.55,,,0.55,Other,225% of Medicaid,0.34,,,0.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.53,,,0.53,Other,215% Medicaid APG methodology,0.53,,,0.53,Other,215% Medicaid APG methodology,0.31,,,0.31,Other,125% Medicaid APG methodology,0.01,0.55,
PHENAZOPYRIDINE 200MG TAB,,,,80001617,CDM,250,RC,65162068210,NDC,both,100,EA,0.19,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
PHENOL TOPICAL 1.4% SPRAY,,,,80001624,CDM,250,RC,904630521,NDC,both,1,ML,4.77,1.88,39.4668,,1.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.62,34,,1.62,percent of total billed charges,"Drugs, Inpatient Only",1.62,34,,1.62,percent of total billed charges,"Drugs, Inpatient Only",1.62,34,,1.62,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.34,70,,3.34,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.59,,,1.59,Other,Drug Cost,1.59,,,1.59,Other,Drug Cost,1.59,,,1.59,Other,Drug Cost,1.59,,,1.59,Other,Drug Cost,1.59,,,1.59,Other,Drug Cost,1.59,,,1.59,Other,Drug Cost,3.58,,,3.58,Other,225% of Medicaid,2.23,,,2.23,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.42,,,3.42,Other,215% Medicaid APG methodology,3.42,,,3.42,Other,215% Medicaid APG methodology,1.99,,,1.99,Other,125% Medicaid APG methodology,0.01,3.58,
PHENYLEPHRINE (HEMORRHOIDAL) SUPP,,,,80001626,CDM,250,RC,536118612,NDC,both,12,EA,0.35,0.14,39.4668,,0.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,70,,0.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.12,,,0.12,Other,Drug Cost,0.26,,,0.26,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.25,,,0.25,Other,215% Medicaid APG methodology,0.25,,,0.25,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,0.26,
PHENYLEPHRINE 0.25% OPHTH,,,,80001627,CDM,250,RC,70756062925,NDC,both,1,ML,61.89,24.43,39.4668,,24.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.04,34,,21.04,percent of total billed charges,"Drugs, Inpatient Only",21.04,34,,21.04,percent of total billed charges,"Drugs, Inpatient Only",21.04,34,,21.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,43.32,70,,43.32,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,20.63,,,20.63,Other,Drug Cost,20.63,,,20.63,Other,Drug Cost,20.63,,,20.63,Other,Drug Cost,20.63,,,20.63,Other,Drug Cost,20.63,,,20.63,Other,Drug Cost,20.63,,,20.63,Other,Drug Cost,46.42,,,46.42,Other,225% of Medicaid,28.88,,,28.88,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,44.35,,,44.35,Other,215% Medicaid APG methodology,44.35,,,44.35,Other,215% Medicaid APG methodology,25.79,,,25.79,Other,125% Medicaid APG methodology,0.01,46.42,
PHENYTOIN (DILANTIN) 100 MG CAPS,,,,80001634,CDM,250,RC,71036924,NDC,both,100,EA,1.68,0.66,39.4668,,0.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.17,70,,1.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,1.26,,,1.26,Other,225% of Medicaid,0.78,,,0.78,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.2,,,1.2,Other,215% Medicaid APG methodology,1.2,,,1.2,Other,215% Medicaid APG methodology,0.7,,,0.7,Other,125% Medicaid APG methodology,0.01,1.26,
PHENYTOIN (DILANTIN) 30 MG CAPS,,,,80001635,CDM,250,RC,71374066,NDC,both,100,EA,1.44,0.57,39.4668,,0.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.49,34,,0.49,percent of total billed charges,"Drugs, Inpatient Only",0.49,34,,0.49,percent of total billed charges,"Drugs, Inpatient Only",0.49,34,,0.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.01,70,,1.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,1.08,,,1.08,Other,225% of Medicaid,0.67,,,0.67,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.03,,,1.03,Other,215% Medicaid APG methodology,1.03,,,1.03,Other,215% Medicaid APG methodology,0.6,,,0.6,Other,125% Medicaid APG methodology,0.01,1.08,
PHENYTOIN (DILANTIN) INFA 50MG TAB,,,,80001636,CDM,250,RC,51672414601,NDC,both,100,EA,0.16,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
PHOSPHORUS (K-PHOS NEUTRAL) 250MG TAB,,,,80001641,CDM,250,RC,64980010401,NDC,both,100,EA,0.22,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,70,,0.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.17,,,0.17,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.16,,,0.16,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.17,
PILOCARPINE 1% OPHTH,,,,80001642,CDM,250,RC,61314020315,NDC,both,1,ML,60.72,23.96,39.4668,,23.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,20.64,34,,20.64,percent of total billed charges,"Drugs, Inpatient Only",20.64,34,,20.64,percent of total billed charges,"Drugs, Inpatient Only",20.64,34,,20.64,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,42.5,70,,42.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,20.24,,,20.24,Other,Drug Cost,20.24,,,20.24,Other,Drug Cost,20.24,,,20.24,Other,Drug Cost,20.24,,,20.24,Other,Drug Cost,20.24,,,20.24,Other,Drug Cost,20.24,,,20.24,Other,Drug Cost,45.54,,,45.54,Other,225% of Medicaid,28.34,,,28.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,43.52,,,43.52,Other,215% Medicaid APG methodology,43.52,,,43.52,Other,215% Medicaid APG methodology,25.3,,,25.3,Other,125% Medicaid APG methodology,0.01,45.54,
PILOCARPINE 5 MG TAB,,,,80001644,CDM,250,RC,527131301,NDC,both,100,EA,0.19,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
PILOCARPINE HCL 2% OPHTH,,,,80001645,CDM,250,RC,61314020415,NDC,both,1,ML,17.13,6.76,39.4668,,6.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.82,34,,5.82,percent of total billed charges,"Drugs, Inpatient Only",5.82,34,,5.82,percent of total billed charges,"Drugs, Inpatient Only",5.82,34,,5.82,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.99,70,,11.99,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.71,,,5.71,Other,Drug Cost,5.71,,,5.71,Other,Drug Cost,5.71,,,5.71,Other,Drug Cost,5.71,,,5.71,Other,Drug Cost,5.71,,,5.71,Other,Drug Cost,5.71,,,5.71,Other,Drug Cost,12.85,,,12.85,Other,225% of Medicaid,7.99,,,7.99,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.28,,,12.28,Other,215% Medicaid APG methodology,12.28,,,12.28,Other,215% Medicaid APG methodology,7.14,,,7.14,Other,125% Medicaid APG methodology,0.01,12.85,
PILOCARPINE HCL 4% OPHTH,,,,80001646,CDM,250,RC,61314020615,NDC,both,1,ML,65.25,25.75,39.4668,,25.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.19,34,,22.19,percent of total billed charges,"Drugs, Inpatient Only",22.19,34,,22.19,percent of total billed charges,"Drugs, Inpatient Only",22.19,34,,22.19,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,45.68,70,,45.68,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.75,,,21.75,Other,Drug Cost,21.75,,,21.75,Other,Drug Cost,21.75,,,21.75,Other,Drug Cost,21.75,,,21.75,Other,Drug Cost,21.75,,,21.75,Other,Drug Cost,21.75,,,21.75,Other,Drug Cost,48.94,,,48.94,Other,225% of Medicaid,30.45,,,30.45,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,46.76,,,46.76,Other,215% Medicaid APG methodology,46.76,,,46.76,Other,215% Medicaid APG methodology,27.19,,,27.19,Other,125% Medicaid APG methodology,0.01,48.94,
PIMECROLIMUC (ELIDEL) CRM 30GM,,,,80001648,CDM,250,RC,187510001,NDC,both,1,GM,0.81,0.32,39.4668,,0.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,70,,0.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.61,,,0.61,Other,225% of Medicaid,0.38,,,0.38,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.58,,,0.58,Other,215% Medicaid APG methodology,0.58,,,0.58,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,0.61,
PLAVIX 300MG TAB,,,,80001659,CDM,250,RC,69367019430,NDC,both,30,EA,10.71,4.23,39.4668,,4.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.64,34,,3.64,percent of total billed charges,"Drugs, Inpatient Only",3.64,34,,3.64,percent of total billed charges,"Drugs, Inpatient Only",3.64,34,,3.64,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.5,70,,7.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.57,,,3.57,Other,Drug Cost,3.57,,,3.57,Other,Drug Cost,3.57,,,3.57,Other,Drug Cost,3.57,,,3.57,Other,Drug Cost,3.57,,,3.57,Other,Drug Cost,3.57,,,3.57,Other,Drug Cost,8.03,,,8.03,Other,225% of Medicaid,5,,,5,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.67,,,7.67,Other,215% Medicaid APG methodology,7.67,,,7.67,Other,215% Medicaid APG methodology,4.46,,,4.46,Other,125% Medicaid APG methodology,0.01,8.03,
PLAVIX 75MG,,,,80001660,CDM,250,RC,904629461,NDC,both,10,EA,1.84,0.73,39.4668,,0.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.29,70,,1.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,1.38,,,1.38,Other,225% of Medicaid,0.86,,,0.86,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.32,,,1.32,Other,215% Medicaid APG methodology,1.32,,,1.32,Other,215% Medicaid APG methodology,0.77,,,0.77,Other,125% Medicaid APG methodology,0.01,1.38,
POLYETHYLENE GLYCOL (MIRALAX)  255 GM,,,,80001662,CDM,250,RC,45802086802,NDC,both,1,GM,6.48,2.56,39.4668,,2.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.2,34,,2.2,percent of total billed charges,"Drugs, Inpatient Only",2.2,34,,2.2,percent of total billed charges,"Drugs, Inpatient Only",2.2,34,,2.2,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.54,70,,4.54,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.16,,,2.16,Other,Drug Cost,2.16,,,2.16,Other,Drug Cost,2.16,,,2.16,Other,Drug Cost,2.16,,,2.16,Other,Drug Cost,2.16,,,2.16,Other,Drug Cost,2.16,,,2.16,Other,Drug Cost,4.86,,,4.86,Other,225% of Medicaid,3.02,,,3.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.64,,,4.64,Other,215% Medicaid APG methodology,4.64,,,4.64,Other,215% Medicaid APG methodology,2.7,,,2.7,Other,125% Medicaid APG methodology,0.01,4.86,
POLYETHYLENE GLYCOL (MIRALAX) 17 GM,,,,80001663,CDM,250,RC,51079030630,NDC,both,30,EA,2.84,1.12,39.4668,,1.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.96,34,,0.96,percent of total billed charges,"Drugs, Inpatient Only",0.96,34,,0.96,percent of total billed charges,"Drugs, Inpatient Only",0.96,34,,0.96,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.99,70,,1.99,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.95,,,0.95,Other,Drug Cost,0.95,,,0.95,Other,Drug Cost,0.95,,,0.95,Other,Drug Cost,0.95,,,0.95,Other,Drug Cost,0.95,,,0.95,Other,Drug Cost,0.95,,,0.95,Other,Drug Cost,2.13,,,2.13,Other,225% of Medicaid,1.32,,,1.32,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.03,,,2.03,Other,215% Medicaid APG methodology,2.03,,,2.03,Other,215% Medicaid APG methodology,1.18,,,1.18,Other,125% Medicaid APG methodology,0.01,2.13,
POLYMYXIN B 500000 UNIT INJ,,,,80001664,CDM,250,RC,63323032110,NDC,both,10,EA,10.16,4.01,39.4668,,4.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.45,34,,3.45,percent of total billed charges,"Drugs, Inpatient Only",3.45,34,,3.45,percent of total billed charges,"Drugs, Inpatient Only",3.45,34,,3.45,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.11,70,,7.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.39,,,3.39,Other,Drug Cost,3.39,,,3.39,Other,Drug Cost,3.39,,,3.39,Other,Drug Cost,3.39,,,3.39,Other,Drug Cost,3.39,,,3.39,Other,Drug Cost,3.39,,,3.39,Other,Drug Cost,7.62,,,7.62,Other,225% of Medicaid,4.74,,,4.74,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.28,,,7.28,Other,215% Medicaid APG methodology,7.28,,,7.28,Other,215% Medicaid APG methodology,4.23,,,4.23,Other,125% Medicaid APG methodology,0.01,7.62,
POTASIUM CHLORIDE 10 MEQ TAB,,,,80001667,CDM,250,RC,832532411,NDC,both,100,EA,0.28,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,70,,0.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.21,,,0.21,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.2,,,0.2,Other,215% Medicaid APG methodology,0.2,,,0.2,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.21,
POTASSIUM CHLORIDE (K-LOR) 20 MEQ TAB,,,,80001671,CDM,250,RC,245531990,NDC,both,90,EA,0.33,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,70,,0.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.25,,,0.25,Other,225% of Medicaid,0.15,,,0.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.23,,,0.23,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,0.25,
POTASSIUM PHOS MONOBASIC 500MG TAB,,,,80001675,CDM,250,RC,486111101,NDC,both,100,EA,1.03,0.41,39.4668,,0.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.72,70,,0.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.77,,,0.77,Other,225% of Medicaid,0.48,,,0.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.74,,,0.74,Other,215% Medicaid APG methodology,0.74,,,0.74,Other,215% Medicaid APG methodology,0.43,,,0.43,Other,125% Medicaid APG methodology,0.01,0.77,
PRASUGREL (EFFIENT) 10MG TABLET,,,,80001679,CDM,250,RC,65862083030,NDC,both,30,EA,0.29,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,70,,0.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.22,,,0.22,Other,225% of Medicaid,0.14,,,0.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.21,,,0.21,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.22,
PRAVASTATIN 20MG TAB,,,,80001682,CDM,250,RC,60505016909,NDC,both,90,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
PRAZIQUANTEL (BILTRICIDE) 600 MG,,,,80001683,CDM,250,RC,50419074701,NDC,both,6,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PRAZOSIN 1 MG CAP,,,,80001684,CDM,250,RC,93406701,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
PREDNISOLONE 1% OPHTH 10ML,,,,80001687,CDM,250,RC,61314063705,NDC,both,1,ML,19.35,7.64,39.4668,,7.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.58,34,,6.58,percent of total billed charges,"Drugs, Inpatient Only",6.58,34,,6.58,percent of total billed charges,"Drugs, Inpatient Only",6.58,34,,6.58,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.55,70,,13.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.45,,,6.45,Other,Drug Cost,6.45,,,6.45,Other,Drug Cost,6.45,,,6.45,Other,Drug Cost,6.45,,,6.45,Other,Drug Cost,6.45,,,6.45,Other,Drug Cost,6.45,,,6.45,Other,Drug Cost,14.51,,,14.51,Other,225% of Medicaid,9.03,,,9.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,13.87,,,13.87,Other,215% Medicaid APG methodology,13.87,,,13.87,Other,215% Medicaid APG methodology,8.06,,,8.06,Other,125% Medicaid APG methodology,0.01,14.51,
PREDNISOLONE-SOD SULFACET OPHTH SOL,,,,80001691,CDM,250,RC,24208031705,NDC,both,1,ML,20.82,8.22,39.4668,,8.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.08,34,,7.08,percent of total billed charges,"Drugs, Inpatient Only",7.08,34,,7.08,percent of total billed charges,"Drugs, Inpatient Only",7.08,34,,7.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.57,70,,14.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.94,,,6.94,Other,Drug Cost,6.94,,,6.94,Other,Drug Cost,6.94,,,6.94,Other,Drug Cost,6.94,,,6.94,Other,Drug Cost,6.94,,,6.94,Other,Drug Cost,6.94,,,6.94,Other,Drug Cost,15.62,,,15.62,Other,225% of Medicaid,9.72,,,9.72,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,14.92,,,14.92,Other,215% Medicaid APG methodology,14.92,,,14.92,Other,215% Medicaid APG methodology,8.68,,,8.68,Other,125% Medicaid APG methodology,0.01,15.62,
PREGABALIN  (LYRICA) 25MG CAPS,,,,80001698,CDM,250,RC,71101268,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PREGABALIN  (LYRICA) 50MG CAPS,,,,80001699,CDM,250,RC,71101368,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PREGABALIN  (LYRICA) 75MG CAPS,,,,80001700,CDM,250,RC,71101468,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PREGABALIN (LYRICA) 100 MG CAPS,,,,80001701,CDM,250,RC,71101568,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PRENATAL PLUS 1 TAB,,,,80001702,CDM,250,RC,39328010610,NDC,both,100,EA,0.16,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
PREVACID 30 MG SOLU TAB,,,,80001704,CDM,250,RC,64764054411,NDC,both,10,EA,58.06,22.91,39.4668,,22.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.74,34,,19.74,percent of total billed charges,"Drugs, Inpatient Only",19.74,34,,19.74,percent of total billed charges,"Drugs, Inpatient Only",19.74,34,,19.74,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,40.64,70,,40.64,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.35,,,19.35,Other,Drug Cost,19.35,,,19.35,Other,Drug Cost,19.35,,,19.35,Other,Drug Cost,19.35,,,19.35,Other,Drug Cost,19.35,,,19.35,Other,Drug Cost,19.35,,,19.35,Other,Drug Cost,43.54,,,43.54,Other,225% of Medicaid,27.09,,,27.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,41.61,,,41.61,Other,215% Medicaid APG methodology,41.61,,,41.61,Other,215% Medicaid APG methodology,24.19,,,24.19,Other,125% Medicaid APG methodology,0.01,43.54,
PREVIDENT 5000 PLUS 51 GM,,,,80001707,CDM,250,RC,126028666,NDC,both,1,GM,51.96,20.51,39.4668,,20.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.67,34,,17.67,percent of total billed charges,"Drugs, Inpatient Only",17.67,34,,17.67,percent of total billed charges,"Drugs, Inpatient Only",17.67,34,,17.67,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,36.37,70,,36.37,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.32,,,17.32,Other,Drug Cost,17.32,,,17.32,Other,Drug Cost,17.32,,,17.32,Other,Drug Cost,17.32,,,17.32,Other,Drug Cost,17.32,,,17.32,Other,Drug Cost,17.32,,,17.32,Other,Drug Cost,38.97,,,38.97,Other,225% of Medicaid,24.25,,,24.25,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,37.24,,,37.24,Other,215% Medicaid APG methodology,37.24,,,37.24,Other,215% Medicaid APG methodology,21.65,,,21.65,Other,125% Medicaid APG methodology,0.01,38.97,
PREVIDENT 56 GM,,,,80001708,CDM,250,RC,126028802,NDC,both,1,GM,51.96,20.51,39.4668,,20.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.67,34,,17.67,percent of total billed charges,"Drugs, Inpatient Only",17.67,34,,17.67,percent of total billed charges,"Drugs, Inpatient Only",17.67,34,,17.67,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,36.37,70,,36.37,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.32,,,17.32,Other,Drug Cost,17.32,,,17.32,Other,Drug Cost,17.32,,,17.32,Other,Drug Cost,17.32,,,17.32,Other,Drug Cost,17.32,,,17.32,Other,Drug Cost,17.32,,,17.32,Other,Drug Cost,38.97,,,38.97,Other,225% of Medicaid,24.25,,,24.25,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,37.24,,,37.24,Other,215% Medicaid APG methodology,37.24,,,37.24,Other,215% Medicaid APG methodology,21.65,,,21.65,Other,125% Medicaid APG methodology,0.01,38.97,
PREZISTA TABLETS 600MG,,,,80001710,CDM,250,RC,59676056201,NDC,both,60,EA,31.24,12.33,39.4668,,12.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.62,34,,10.62,percent of total billed charges,"Drugs, Inpatient Only",10.62,34,,10.62,percent of total billed charges,"Drugs, Inpatient Only",10.62,34,,10.62,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.86,70,,21.86,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.41,,,10.41,Other,Drug Cost,10.41,,,10.41,Other,Drug Cost,10.41,,,10.41,Other,Drug Cost,10.41,,,10.41,Other,Drug Cost,10.41,,,10.41,Other,Drug Cost,10.41,,,10.41,Other,Drug Cost,23.43,,,23.43,Other,225% of Medicaid,14.58,,,14.58,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,22.39,,,22.39,Other,215% Medicaid APG methodology,22.39,,,22.39,Other,215% Medicaid APG methodology,13.01,,,13.01,Other,125% Medicaid APG methodology,0.01,23.43,
PRIMIDONE 250 MG,,,,80001712,CDM,250,RC,53746054501,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.15,
PROMETHAZINE 25MG SUPP,,,,80001714,CDM,250,RC,713052612,NDC,both,12,EA,2.76,1.09,39.4668,,1.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.94,34,,0.94,percent of total billed charges,"Drugs, Inpatient Only",0.94,34,,0.94,percent of total billed charges,"Drugs, Inpatient Only",0.94,34,,0.94,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.93,70,,1.93,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,2.07,,,2.07,Other,225% of Medicaid,1.29,,,1.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.98,,,1.98,Other,215% Medicaid APG methodology,1.98,,,1.98,Other,215% Medicaid APG methodology,1.15,,,1.15,Other,125% Medicaid APG methodology,0.01,2.07,
PROMETHAZINE 25MG TAB,,,,80001715,CDM,250,RC,68084015501,NDC,both,10,EA,1.95,0.77,39.4668,,0.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.66,34,,0.66,percent of total billed charges,"Drugs, Inpatient Only",0.66,34,,0.66,percent of total billed charges,"Drugs, Inpatient Only",0.66,34,,0.66,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.37,70,,1.37,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,1.46,,,1.46,Other,225% of Medicaid,0.91,,,0.91,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.4,,,1.4,Other,215% Medicaid APG methodology,1.4,,,1.4,Other,215% Medicaid APG methodology,0.81,,,0.81,Other,125% Medicaid APG methodology,0.01,1.46,
PROPAFENONE 150MG TAB,,,,80001717,CDM,250,RC,59651025601,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.08,
PROPRANOLOL 10MG,,,,80001722,CDM,250,RC,603548221,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PROPRANOLOL 20 MG TAB,,,,80001725,CDM,250,RC,603548321,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PROTONIX 40MG GRANULES,,,,80001733,CDM,250,RC,8084402,NDC,both,30,EA,2.6,1.03,39.4668,,1.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.88,34,,0.88,percent of total billed charges,"Drugs, Inpatient Only",0.88,34,,0.88,percent of total billed charges,"Drugs, Inpatient Only",0.88,34,,0.88,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.82,70,,1.82,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,1.95,,,1.95,Other,225% of Medicaid,1.21,,,1.21,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.86,,,1.86,Other,215% Medicaid APG methodology,1.86,,,1.86,Other,215% Medicaid APG methodology,1.08,,,1.08,Other,125% Medicaid APG methodology,0.01,1.95,
PROTONIX 40MG TAB,,,,80001734,CDM,250,RC,31722071390,NDC,both,90,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
PSEUDOEPHEDRINE 30 MG TAB,,,,80001735,CDM,250,RC,904505359,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.03,
PSYLLIUM 3.5 GM,,,,80001737,CDM,250,RC,38485080855,NDC,both,3.7,GM,0.76,0.3,39.4668,,0.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.53,70,,0.53,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.57,,,0.57,Other,225% of Medicaid,0.36,,,0.36,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.55,,,0.55,Other,215% Medicaid APG methodology,0.55,,,0.55,Other,215% Medicaid APG methodology,0.32,,,0.32,Other,125% Medicaid APG methodology,0.01,0.57,
PYRAZINAMIDE 500 MG TAB,,,,80001738,CDM,250,RC,70954048420,NDC,both,90,EA,3.15,1.24,39.4668,,1.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.07,34,,1.07,percent of total billed charges,"Drugs, Inpatient Only",1.07,34,,1.07,percent of total billed charges,"Drugs, Inpatient Only",1.07,34,,1.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.2,70,,2.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.05,,,1.05,Other,Drug Cost,1.05,,,1.05,Other,Drug Cost,1.05,,,1.05,Other,Drug Cost,1.05,,,1.05,Other,Drug Cost,1.05,,,1.05,Other,Drug Cost,1.05,,,1.05,Other,Drug Cost,2.36,,,2.36,Other,225% of Medicaid,1.47,,,1.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.25,,,2.25,Other,215% Medicaid APG methodology,2.25,,,2.25,Other,215% Medicaid APG methodology,1.31,,,1.31,Other,125% Medicaid APG methodology,0.01,2.36,
PYRIDOSTIGMINE 180 MG ER TAB,,,,80001739,CDM,250,RC,187301330,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PYRIDOSTIGMINE 60 MG TAB,,,,80001740,CDM,250,RC,187301030,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PYRIDOXINE 100 MG TAB,,,,80001741,CDM,250,RC,57896085401,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
PYRIDOXINE 50 MG TAB,,,,80001742,CDM,250,RC,77333094010,NDC,both,10,EA,3.37,1.33,39.4668,,1.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.15,34,,1.15,percent of total billed charges,"Drugs, Inpatient Only",1.15,34,,1.15,percent of total billed charges,"Drugs, Inpatient Only",1.15,34,,1.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.36,70,,2.36,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.12,,,1.12,Other,Drug Cost,1.12,,,1.12,Other,Drug Cost,1.12,,,1.12,Other,Drug Cost,1.12,,,1.12,Other,Drug Cost,1.12,,,1.12,Other,Drug Cost,1.12,,,1.12,Other,Drug Cost,2.53,,,2.53,Other,225% of Medicaid,1.57,,,1.57,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.42,,,2.42,Other,215% Medicaid APG methodology,2.42,,,2.42,Other,215% Medicaid APG methodology,1.41,,,1.41,Other,125% Medicaid APG methodology,0.01,2.53,
PYRITHIONE ZINC (DHS ZINC) 240 ML,,,,80001743,CDM,250,RC,96073508,NDC,both,1,ML,27.3,10.77,39.4668,,10.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.28,34,,9.28,percent of total billed charges,"Drugs, Inpatient Only",9.28,34,,9.28,percent of total billed charges,"Drugs, Inpatient Only",9.28,34,,9.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.11,70,,19.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,20.48,,,20.48,Other,225% of Medicaid,12.74,,,12.74,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,19.57,,,19.57,Other,215% Medicaid APG methodology,19.57,,,19.57,Other,215% Medicaid APG methodology,11.38,,,11.38,Other,125% Medicaid APG methodology,0.01,20.48,
QUETIAPINE 200MG TAB,,,,80001745,CDM,250,RC,904664161,NDC,both,10,EA,2.41,0.95,39.4668,,0.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.82,34,,0.82,percent of total billed charges,"Drugs, Inpatient Only",0.82,34,,0.82,percent of total billed charges,"Drugs, Inpatient Only",0.82,34,,0.82,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.69,70,,1.69,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,1.81,,,1.81,Other,225% of Medicaid,1.12,,,1.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.73,,,1.73,Other,215% Medicaid APG methodology,1.73,,,1.73,Other,215% Medicaid APG methodology,1,,,1,Other,125% Medicaid APG methodology,0.01,1.81,
QUETIAPINE 25MG TAB,,,,80001746,CDM,250,RC,67877024201,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
QUINIDINE GLUCONATE 324MG TAB,,,,80001753,CDM,250,RC,53489014101,NDC,both,100,EA,8.29,3.27,39.4668,,3.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.82,34,,2.82,percent of total billed charges,"Drugs, Inpatient Only",2.82,34,,2.82,percent of total billed charges,"Drugs, Inpatient Only",2.82,34,,2.82,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.8,70,,5.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.76,,,2.76,Other,Drug Cost,2.76,,,2.76,Other,Drug Cost,2.76,,,2.76,Other,Drug Cost,2.76,,,2.76,Other,Drug Cost,2.76,,,2.76,Other,Drug Cost,2.76,,,2.76,Other,Drug Cost,6.22,,,6.22,Other,225% of Medicaid,3.87,,,3.87,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.94,,,5.94,Other,215% Medicaid APG methodology,5.94,,,5.94,Other,215% Medicaid APG methodology,3.45,,,3.45,Other,125% Medicaid APG methodology,0.01,6.22,
QUININE SULFATE 324MG CAP,,,,80001754,CDM,250,RC,68180056006,NDC,both,30,EA,1.1,0.44,39.4668,,0.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.38,34,,0.38,percent of total billed charges,"Drugs, Inpatient Only",0.38,34,,0.38,percent of total billed charges,"Drugs, Inpatient Only",0.38,34,,0.38,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.77,70,,0.77,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.37,,,0.37,Other,Drug Cost,0.37,,,0.37,Other,Drug Cost,0.37,,,0.37,Other,Drug Cost,0.37,,,0.37,Other,Drug Cost,0.37,,,0.37,Other,Drug Cost,0.37,,,0.37,Other,Drug Cost,0.83,,,0.83,Other,225% of Medicaid,0.52,,,0.52,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.79,,,0.79,Other,215% Medicaid APG methodology,0.79,,,0.79,Other,215% Medicaid APG methodology,0.46,,,0.46,Other,125% Medicaid APG methodology,0.01,0.83,
RALOXIFENE HCL (EVISTA) 60 MG TAB,,,,80001758,CDM,250,RC,65162005703,NDC,both,30,EA,0.28,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,70,,0.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.21,,,0.21,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.2,,,0.2,Other,215% Medicaid APG methodology,0.2,,,0.2,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.21,
RALTERGRAVIR (ISENTRESS) 400MG TAB,,,,80001759,CDM,250,RC,6022761,NDC,both,60,EA,34.08,13.45,39.4668,,13.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.59,34,,11.59,percent of total billed charges,"Drugs, Inpatient Only",11.59,34,,11.59,percent of total billed charges,"Drugs, Inpatient Only",11.59,34,,11.59,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,23.85,70,,23.85,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.36,,,11.36,Other,Drug Cost,11.36,,,11.36,Other,Drug Cost,11.36,,,11.36,Other,Drug Cost,11.36,,,11.36,Other,Drug Cost,11.36,,,11.36,Other,Drug Cost,11.36,,,11.36,Other,Drug Cost,25.56,,,25.56,Other,225% of Medicaid,15.9,,,15.9,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,24.42,,,24.42,Other,215% Medicaid APG methodology,24.42,,,24.42,Other,215% Medicaid APG methodology,14.2,,,14.2,Other,125% Medicaid APG methodology,0.01,25.56,
RAMIPRIL 1.25MG CAP,,,,80001760,CDM,250,RC,65862047401,NDC,both,100,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
RAMIPRIL 10MG CAP,,,,80001761,CDM,250,RC,68180059101,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
RAMIPRIL 2.5MG CAP,,,,80001762,CDM,250,RC,68180058901,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
RAMIPRIL 5MG,,,,80001763,CDM,250,RC,68180059001,NDC,both,100,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
RANOLAZINE 500MG TAB,,,,80001765,CDM,250,RC,70756070360,NDC,both,60,EA,0.16,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
REGONOL 5 MG/ML INJ,,,,80001769,CDM,250,RC,781304095,NDC,both,10,ML,56.73,22.39,39.4668,,22.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.29,34,,19.29,percent of total billed charges,"Drugs, Inpatient Only",19.29,34,,19.29,percent of total billed charges,"Drugs, Inpatient Only",19.29,34,,19.29,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,39.71,70,,39.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.91,,,18.91,Other,Drug Cost,18.91,,,18.91,Other,Drug Cost,18.91,,,18.91,Other,Drug Cost,18.91,,,18.91,Other,Drug Cost,18.91,,,18.91,Other,Drug Cost,18.91,,,18.91,Other,Drug Cost,42.55,,,42.55,Other,225% of Medicaid,26.47,,,26.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,40.66,,,40.66,Other,215% Medicaid APG methodology,40.66,,,40.66,Other,215% Medicaid APG methodology,23.64,,,23.64,Other,125% Medicaid APG methodology,0.01,42.55,
RETROVIR 10 MG/ML,,,,80001777,CDM,250,RC,65862004824,NDC,both,1,ML,54.3,21.43,39.4668,,21.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.46,34,,18.46,percent of total billed charges,"Drugs, Inpatient Only",18.46,34,,18.46,percent of total billed charges,"Drugs, Inpatient Only",18.46,34,,18.46,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.01,70,,38.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.1,,,18.1,Other,Drug Cost,18.1,,,18.1,Other,Drug Cost,18.1,,,18.1,Other,Drug Cost,18.1,,,18.1,Other,Drug Cost,18.1,,,18.1,Other,Drug Cost,18.1,,,18.1,Other,Drug Cost,40.73,,,40.73,Other,225% of Medicaid,25.34,,,25.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,38.92,,,38.92,Other,215% Medicaid APG methodology,38.92,,,38.92,Other,215% Medicaid APG methodology,22.63,,,22.63,Other,125% Medicaid APG methodology,0.01,40.73,
RIBOFLAVIN 100 MG TAB,,,,80001779,CDM,250,RC,54629009501,NDC,both,100,EA,0.17,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,70,,0.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.13,
RIFAMIXIN 200MG TAB,,,,80001781,CDM,250,RC,65649030103,NDC,both,30,EA,6.34,2.5,39.4668,,2.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.15,34,,2.15,percent of total billed charges,"Drugs, Inpatient Only",2.15,34,,2.15,percent of total billed charges,"Drugs, Inpatient Only",2.15,34,,2.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.44,70,,4.44,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.11,,,2.11,Other,Drug Cost,2.11,,,2.11,Other,Drug Cost,2.11,,,2.11,Other,Drug Cost,2.11,,,2.11,Other,Drug Cost,2.11,,,2.11,Other,Drug Cost,2.11,,,2.11,Other,Drug Cost,4.75,,,4.75,Other,225% of Medicaid,2.96,,,2.96,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.54,,,4.54,Other,215% Medicaid APG methodology,4.54,,,4.54,Other,215% Medicaid APG methodology,2.64,,,2.64,Other,125% Medicaid APG methodology,0.01,4.75,
RIFAMPIN 600MG,,,,80001783,CDM,250,RC,68059701,NDC,both,1,EA,485.28,191.52,39.4668,,191.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165,34,,165,percent of total billed charges,"Drugs, Inpatient Only",165,34,,165,percent of total billed charges,"Drugs, Inpatient Only",165,34,,165,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339.7,70,,339.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,161.76,,,161.76,Other,Drug Cost,161.76,,,161.76,Other,Drug Cost,161.76,,,161.76,Other,Drug Cost,161.76,,,161.76,Other,Drug Cost,161.76,,,161.76,Other,Drug Cost,161.76,,,161.76,Other,Drug Cost,363.96,,,363.96,Other,225% of Medicaid,226.46,,,226.46,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,347.78,,,347.78,Other,215% Medicaid APG methodology,347.78,,,347.78,Other,215% Medicaid APG methodology,202.2,,,202.2,Other,125% Medicaid APG methodology,0.01,363.96,
RISPERIDONE 0.25MG TAB,,,,80001787,CDM,250,RC,68084027001,NDC,both,10,EA,4.02,1.59,39.4668,,1.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.37,34,,1.37,percent of total billed charges,"Drugs, Inpatient Only",1.37,34,,1.37,percent of total billed charges,"Drugs, Inpatient Only",1.37,34,,1.37,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.81,70,,2.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,3.01,,,3.01,Other,225% of Medicaid,1.87,,,1.87,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.88,,,2.88,Other,215% Medicaid APG methodology,2.88,,,2.88,Other,215% Medicaid APG methodology,1.67,,,1.67,Other,125% Medicaid APG methodology,0.01,3.01,
RISPERIDONE 0.5 MG,,,,80001788,CDM,250,RC,68382011314,NDC,both,60,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
RISPERIDONE 0.5 MG M-TAB,,,,80001789,CDM,250,RC,59746001032,NDC,both,3,EA,7.49,2.96,39.4668,,2.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.55,34,,2.55,percent of total billed charges,"Drugs, Inpatient Only",2.55,34,,2.55,percent of total billed charges,"Drugs, Inpatient Only",2.55,34,,2.55,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.24,70,,5.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.5,,,2.5,Other,Drug Cost,2.5,,,2.5,Other,Drug Cost,2.5,,,2.5,Other,Drug Cost,2.5,,,2.5,Other,Drug Cost,2.5,,,2.5,Other,Drug Cost,2.5,,,2.5,Other,Drug Cost,5.62,,,5.62,Other,225% of Medicaid,3.5,,,3.5,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.37,,,5.37,Other,215% Medicaid APG methodology,5.37,,,5.37,Other,215% Medicaid APG methodology,3.12,,,3.12,Other,125% Medicaid APG methodology,0.01,5.62,
RISPERIDONE 1 MG TAB,,,,80001790,CDM,250,RC,50458030001,NDC,both,10,EA,58.72,23.17,39.4668,,23.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.96,34,,19.96,percent of total billed charges,"Drugs, Inpatient Only",19.96,34,,19.96,percent of total billed charges,"Drugs, Inpatient Only",19.96,34,,19.96,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,41.1,70,,41.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.57,,,19.57,Other,Drug Cost,19.57,,,19.57,Other,Drug Cost,19.57,,,19.57,Other,Drug Cost,19.57,,,19.57,Other,Drug Cost,19.57,,,19.57,Other,Drug Cost,19.57,,,19.57,Other,Drug Cost,44.04,,,44.04,Other,225% of Medicaid,27.4,,,27.4,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,42.08,,,42.08,Other,215% Medicaid APG methodology,42.08,,,42.08,Other,215% Medicaid APG methodology,24.47,,,24.47,Other,125% Medicaid APG methodology,0.01,44.04,
RISPERIDONE 1MG M-TAB,,,,80001791,CDM,250,RC,49884031555,NDC,both,5,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
RISPERIDONE 1MG/ML,,,,80001792,CDM,250,RC,50458030503,NDC,both,1,ML,0.81,0.32,39.4668,,0.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,70,,0.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.61,,,0.61,Other,225% of Medicaid,0.38,,,0.38,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.58,,,0.58,Other,215% Medicaid APG methodology,0.58,,,0.58,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,0.61,
RISPERIDONE 2 MG TAB,,,,80001793,CDM,250,RC,50458032006,NDC,both,60,EA,9.75,3.85,39.4668,,3.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.32,34,,3.32,percent of total billed charges,"Drugs, Inpatient Only",3.32,34,,3.32,percent of total billed charges,"Drugs, Inpatient Only",3.32,34,,3.32,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.83,70,,6.83,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.25,,,3.25,Other,Drug Cost,3.25,,,3.25,Other,Drug Cost,3.25,,,3.25,Other,Drug Cost,3.25,,,3.25,Other,Drug Cost,3.25,,,3.25,Other,Drug Cost,3.25,,,3.25,Other,Drug Cost,7.32,,,7.32,Other,225% of Medicaid,4.55,,,4.55,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.99,,,6.99,Other,215% Medicaid APG methodology,6.99,,,6.99,Other,215% Medicaid APG methodology,4.06,,,4.06,Other,125% Medicaid APG methodology,0.01,7.32,
RIVAROXABAN 10MG TAB,,,,80001800,CDM,250,RC,50458058030,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ROPINIROLE 0.25MG,,,,80001806,CDM,250,RC,43547026810,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
ROPINIROLE 1 MG,,,,80001807,CDM,250,RC,68462025501,NDC,both,100,EA,0.04,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
ROSUVASTATIN CALCIUM (CRESTOR) 5 MG,,,,80001818,CDM,250,RC,67877043990,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ROSUVASTATIN CALCIUM (CRESTOR0 20 MG,,,,80001819,CDM,250,RC,65862029590,NDC,both,90,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
ROXICODONE 20MG/ML,,,,80001821,CDM,250,RC,406800330,NDC,both,1,ML,11.7,4.62,39.4668,,4.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.98,34,,3.98,percent of total billed charges,"Drugs, Inpatient Only",3.98,34,,3.98,percent of total billed charges,"Drugs, Inpatient Only",3.98,34,,3.98,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.19,70,,8.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.9,,,3.9,Other,Drug Cost,3.9,,,3.9,Other,Drug Cost,3.9,,,3.9,Other,Drug Cost,3.9,,,3.9,Other,Drug Cost,3.9,,,3.9,Other,Drug Cost,3.9,,,3.9,Other,Drug Cost,8.78,,,8.78,Other,225% of Medicaid,5.46,,,5.46,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.39,,,8.39,Other,215% Medicaid APG methodology,8.39,,,8.39,Other,215% Medicaid APG methodology,4.88,,,4.88,Other,125% Medicaid APG methodology,0.01,8.78,
SARNA LOTION,,,,80001827,CDM,250,RC,496074804,NDC,both,1,ML,55.17,21.77,39.4668,,21.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.76,34,,18.76,percent of total billed charges,"Drugs, Inpatient Only",18.76,34,,18.76,percent of total billed charges,"Drugs, Inpatient Only",18.76,34,,18.76,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.62,70,,38.62,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.39,,,18.39,Other,Drug Cost,18.39,,,18.39,Other,Drug Cost,18.39,,,18.39,Other,Drug Cost,18.39,,,18.39,Other,Drug Cost,18.39,,,18.39,Other,Drug Cost,18.39,,,18.39,Other,Drug Cost,41.38,,,41.38,Other,225% of Medicaid,25.75,,,25.75,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,39.54,,,39.54,Other,215% Medicaid APG methodology,39.54,,,39.54,Other,215% Medicaid APG methodology,22.99,,,22.99,Other,125% Medicaid APG methodology,0.01,41.38,
SELEGILINE HCL 5MG CAP,,,,80001829,CDM,250,RC,60505005501,NDC,both,60,EA,1,0.39,39.4668,,0.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,34,,0.34,percent of total billed charges,"Drugs, Inpatient Only",0.34,34,,0.34,percent of total billed charges,"Drugs, Inpatient Only",0.34,34,,0.34,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.7,70,,0.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.33,,,0.33,Other,Drug Cost,0.33,,,0.33,Other,Drug Cost,0.33,,,0.33,Other,Drug Cost,0.33,,,0.33,Other,Drug Cost,0.33,,,0.33,Other,Drug Cost,0.33,,,0.33,Other,Drug Cost,0.75,,,0.75,Other,225% of Medicaid,0.47,,,0.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.72,,,0.72,Other,215% Medicaid APG methodology,0.72,,,0.72,Other,215% Medicaid APG methodology,0.42,,,0.42,Other,125% Medicaid APG methodology,0.01,0.75,
SENNA 8.6 MG,,,,80001832,CDM,250,RC,49483008010,NDC,both,1000,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
SENNA-S 1 TAB,,,,80001833,CDM,250,RC,536124701,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
SERTRALINE 100MG TAB,,,,80001837,CDM,250,RC,68180035306,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
SERTRALINE 25MG TAB,,,,80001838,CDM,250,RC,69097083305,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
SERTRALINE 50MG TAB,,,,80001839,CDM,250,RC,68180035209,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
SEVELAMER  800MG,,,,80001841,CDM,250,RC,55111078927,NDC,both,270,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
SEVOFLURANE LIQ 250 ML,,,,80001842,CDM,250,RC,74445604,NDC,both,6,ML,97.87,38.62,39.4668,,38.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,33.27,34,,33.27,percent of total billed charges,"Drugs, Inpatient Only",33.27,34,,33.27,percent of total billed charges,"Drugs, Inpatient Only",33.27,34,,33.27,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,68.51,70,,68.51,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,32.62,,,32.62,Other,Drug Cost,32.62,,,32.62,Other,Drug Cost,32.62,,,32.62,Other,Drug Cost,32.62,,,32.62,Other,Drug Cost,32.62,,,32.62,Other,Drug Cost,32.62,,,32.62,Other,Drug Cost,73.4,,,73.4,Other,225% of Medicaid,45.67,,,45.67,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,70.14,,,70.14,Other,215% Medicaid APG methodology,70.14,,,70.14,Other,215% Medicaid APG methodology,40.78,,,40.78,Other,125% Medicaid APG methodology,0.01,73.4,
SILDENAFIL 20 MG TAB,,,,80001843,CDM,250,RC,69419068,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
SILVER NITRATE STICK,,,,80001847,CDM,250,RC,12870000101,NDC,both,100,EA,2.05,0.81,39.4668,,0.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.7,34,,0.7,percent of total billed charges,"Drugs, Inpatient Only",0.7,34,,0.7,percent of total billed charges,"Drugs, Inpatient Only",0.7,34,,0.7,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.43,70,,1.43,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.68,,,0.68,Other,Drug Cost,0.68,,,0.68,Other,Drug Cost,0.68,,,0.68,Other,Drug Cost,0.68,,,0.68,Other,Drug Cost,0.68,,,0.68,Other,Drug Cost,0.68,,,0.68,Other,Drug Cost,1.54,,,1.54,Other,225% of Medicaid,0.96,,,0.96,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.47,,,1.47,Other,215% Medicaid APG methodology,1.47,,,1.47,Other,215% Medicaid APG methodology,0.85,,,0.85,Other,125% Medicaid APG methodology,0.01,1.54,
SILVER NITRATE TOPICAL 0.5% SOLN,,,,80001848,CDM,250,RC,93961413,NDC,both,1,ML,53.94,21.29,39.4668,,21.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.34,34,,18.34,percent of total billed charges,"Drugs, Inpatient Only",18.34,34,,18.34,percent of total billed charges,"Drugs, Inpatient Only",18.34,34,,18.34,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,37.76,70,,37.76,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.98,,,17.98,Other,Drug Cost,17.98,,,17.98,Other,Drug Cost,17.98,,,17.98,Other,Drug Cost,17.98,,,17.98,Other,Drug Cost,17.98,,,17.98,Other,Drug Cost,17.98,,,17.98,Other,Drug Cost,40.46,,,40.46,Other,225% of Medicaid,25.17,,,25.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,38.66,,,38.66,Other,215% Medicaid APG methodology,38.66,,,38.66,Other,215% Medicaid APG methodology,22.48,,,22.48,Other,125% Medicaid APG methodology,0.01,40.46,
SILVER SULFADIAZINE 50 GM,,,,80001850,CDM,250,RC,67877012450,NDC,both,1,GM,4.56,1.8,39.4668,,1.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.55,34,,1.55,percent of total billed charges,"Drugs, Inpatient Only",1.55,34,,1.55,percent of total billed charges,"Drugs, Inpatient Only",1.55,34,,1.55,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.19,70,,3.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.52,,,1.52,Other,Drug Cost,1.52,,,1.52,Other,Drug Cost,1.52,,,1.52,Other,Drug Cost,1.52,,,1.52,Other,Drug Cost,1.52,,,1.52,Other,Drug Cost,1.52,,,1.52,Other,Drug Cost,3.42,,,3.42,Other,225% of Medicaid,2.13,,,2.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.27,,,3.27,Other,215% Medicaid APG methodology,3.27,,,3.27,Other,215% Medicaid APG methodology,1.9,,,1.9,Other,125% Medicaid APG methodology,0.01,3.42,
SIMETHICONE 30ML,,,,80001851,CDM,250,RC,70000005101,NDC,both,1,ML,10.29,4.06,39.4668,,4.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.5,34,,3.5,percent of total billed charges,"Drugs, Inpatient Only",3.5,34,,3.5,percent of total billed charges,"Drugs, Inpatient Only",3.5,34,,3.5,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.2,70,,7.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.43,,,3.43,Other,Drug Cost,3.43,,,3.43,Other,Drug Cost,3.43,,,3.43,Other,Drug Cost,3.43,,,3.43,Other,Drug Cost,3.43,,,3.43,Other,Drug Cost,3.43,,,3.43,Other,Drug Cost,7.72,,,7.72,Other,225% of Medicaid,4.8,,,4.8,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.37,,,7.37,Other,215% Medicaid APG methodology,7.37,,,7.37,Other,215% Medicaid APG methodology,4.29,,,4.29,Other,125% Medicaid APG methodology,0.01,7.72,
SIMETHICONE 80 MG,,,,80001852,CDM,250,RC,69618003301,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
SINGULAIR 10 MG,,,,80001855,CDM,250,RC,13668008105,NDC,both,500,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
SITAGLIPTIN PHOSPHATE  100 MG TAB,,,,80001859,CDM,250,RC,6027731,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
SITAGLIPTIN PHOSPHATE 25MG TAB,,,,80001860,CDM,250,RC,6022131,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
SOD BICARB 1MEQ/ML 50 ML,,,,80001862,CDM,250,RC,76329335201,NDC,both,10,ML,12.64,4.99,39.4668,,4.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.3,34,,4.3,percent of total billed charges,"Drugs, Inpatient Only",4.3,34,,4.3,percent of total billed charges,"Drugs, Inpatient Only",4.3,34,,4.3,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.85,70,,8.85,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.21,,,4.21,Other,Drug Cost,4.21,,,4.21,Other,Drug Cost,4.21,,,4.21,Other,Drug Cost,4.21,,,4.21,Other,Drug Cost,4.21,,,4.21,Other,Drug Cost,4.21,,,4.21,Other,Drug Cost,9.48,,,9.48,Other,225% of Medicaid,5.9,,,5.9,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.06,,,9.06,Other,215% Medicaid APG methodology,9.06,,,9.06,Other,215% Medicaid APG methodology,5.27,,,5.27,Other,125% Medicaid APG methodology,0.01,9.48,
SOD BICARB 650MG TAB,,,,80001863,CDM,250,RC,536104710,NDC,both,1000,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
SOD POLY SULF 15 G/60ML,,,,80001866,CDM,250,RC,46287000660,NDC,both,10,ML,8.96,3.54,39.4668,,3.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.05,34,,3.05,percent of total billed charges,"Drugs, Inpatient Only",3.05,34,,3.05,percent of total billed charges,"Drugs, Inpatient Only",3.05,34,,3.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.27,70,,6.27,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.99,,,2.99,Other,Drug Cost,2.99,,,2.99,Other,Drug Cost,2.99,,,2.99,Other,Drug Cost,2.99,,,2.99,Other,Drug Cost,2.99,,,2.99,Other,Drug Cost,2.99,,,2.99,Other,Drug Cost,6.72,,,6.72,Other,225% of Medicaid,4.18,,,4.18,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.42,,,6.42,Other,215% Medicaid APG methodology,6.42,,,6.42,Other,215% Medicaid APG methodology,3.74,,,3.74,Other,125% Medicaid APG methodology,0.01,6.72,
SOD POLY SULF 30G,,,,80001867,CDM,250,RC,46287000604,NDC,both,1,ML,17.94,7.08,39.4668,,7.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.1,34,,6.1,percent of total billed charges,"Drugs, Inpatient Only",6.1,34,,6.1,percent of total billed charges,"Drugs, Inpatient Only",6.1,34,,6.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.56,70,,12.56,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.98,,,5.98,Other,Drug Cost,5.98,,,5.98,Other,Drug Cost,5.98,,,5.98,Other,Drug Cost,5.98,,,5.98,Other,Drug Cost,5.98,,,5.98,Other,Drug Cost,5.98,,,5.98,Other,Drug Cost,13.46,,,13.46,Other,225% of Medicaid,8.37,,,8.37,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.86,,,12.86,Other,215% Medicaid APG methodology,12.86,,,12.86,Other,215% Medicaid APG methodology,7.48,,,7.48,Other,125% Medicaid APG methodology,0.01,13.46,
SOD THIOSULF 25% 50 ML,,,,80001869,CDM,250,RC,60267070550,NDC,both,1,ML,291,114.85,39.4668,,114.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,98.94,34,,98.94,percent of total billed charges,"Drugs, Inpatient Only",98.94,34,,98.94,percent of total billed charges,"Drugs, Inpatient Only",98.94,34,,98.94,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,203.7,70,,203.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,97,,,97,Other,Drug Cost,97,,,97,Other,Drug Cost,97,,,97,Other,Drug Cost,97,,,97,Other,Drug Cost,97,,,97,Other,Drug Cost,97,,,97,Other,Drug Cost,218.25,,,218.25,Other,225% of Medicaid,135.8,,,135.8,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,208.55,,,208.55,Other,215% Medicaid APG methodology,208.55,,,208.55,Other,215% Medicaid APG methodology,121.25,,,121.25,Other,125% Medicaid APG methodology,0.01,218.25,
SODIUM ACETATE 2MEQ/ML,,,,80001871,CDM,250,RC,409729973,NDC,both,25,ML,2.63,1.04,39.4668,,1.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.89,34,,0.89,percent of total billed charges,"Drugs, Inpatient Only",0.89,34,,0.89,percent of total billed charges,"Drugs, Inpatient Only",0.89,34,,0.89,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.84,70,,1.84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,1.97,,,1.97,Other,225% of Medicaid,1.23,,,1.23,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.88,,,1.88,Other,215% Medicaid APG methodology,1.88,,,1.88,Other,215% Medicaid APG methodology,1.09,,,1.09,Other,125% Medicaid APG methodology,0.01,1.97,
SODIUM BICARB 0.5 MEQ/ML 5 ML,,,,80001873,CDM,250,RC,63323008305,NDC,both,25,ML,25.41,10.03,39.4668,,10.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.64,34,,8.64,percent of total billed charges,"Drugs, Inpatient Only",8.64,34,,8.64,percent of total billed charges,"Drugs, Inpatient Only",8.64,34,,8.64,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.79,70,,17.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.47,,,8.47,Other,Drug Cost,8.47,,,8.47,Other,Drug Cost,8.47,,,8.47,Other,Drug Cost,8.47,,,8.47,Other,Drug Cost,8.47,,,8.47,Other,Drug Cost,8.47,,,8.47,Other,Drug Cost,19.06,,,19.06,Other,225% of Medicaid,11.86,,,11.86,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,18.21,,,18.21,Other,215% Medicaid APG methodology,18.21,,,18.21,Other,215% Medicaid APG methodology,10.59,,,10.59,Other,125% Medicaid APG methodology,0.01,19.06,
SODIUM BICARB 50 MEQ INJ,,,,80001874,CDM,250,RC,409662514,NDC,both,25,ML,17.42,6.88,39.4668,,6.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.92,34,,5.92,percent of total billed charges,"Drugs, Inpatient Only",5.92,34,,5.92,percent of total billed charges,"Drugs, Inpatient Only",5.92,34,,5.92,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.19,70,,12.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.81,,,5.81,Other,Drug Cost,5.81,,,5.81,Other,Drug Cost,5.81,,,5.81,Other,Drug Cost,5.81,,,5.81,Other,Drug Cost,5.81,,,5.81,Other,Drug Cost,5.81,,,5.81,Other,Drug Cost,13.07,,,13.07,Other,225% of Medicaid,8.13,,,8.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.48,,,12.48,Other,215% Medicaid APG methodology,12.48,,,12.48,Other,215% Medicaid APG methodology,7.26,,,7.26,Other,125% Medicaid APG methodology,0.01,13.07,
SODIUM CHLORIDE 0.45%/ KCL 20 MEQ,,,,80001875,CDM,250,RC,338070434,NDC,both,14,ML,8.37,3.3,39.4668,,3.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.85,34,,2.85,percent of total billed charges,"Drugs, Inpatient Only",2.85,34,,2.85,percent of total billed charges,"Drugs, Inpatient Only",2.85,34,,2.85,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.86,70,,5.86,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.79,,,2.79,Other,Drug Cost,2.79,,,2.79,Other,Drug Cost,2.79,,,2.79,Other,Drug Cost,2.79,,,2.79,Other,Drug Cost,2.79,,,2.79,Other,Drug Cost,2.79,,,2.79,Other,Drug Cost,6.28,,,6.28,Other,225% of Medicaid,3.9,,,3.9,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6,,,6,Other,215% Medicaid APG methodology,6,,,6,Other,215% Medicaid APG methodology,3.49,,,3.49,Other,125% Medicaid APG methodology,0.01,6.28,
SODIUM CHLORIDE 0.9% 500ML IRRIGATION,,,,80001880,CDM,250,RC,264220110,NDC,both,16,ML,1.42,0.56,39.4668,,0.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.48,34,,0.48,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.99,70,,0.99,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,0.47,,,0.47,Other,Drug Cost,1.06,,,1.06,Other,225% of Medicaid,0.66,,,0.66,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.02,,,1.02,Other,215% Medicaid APG methodology,1.02,,,1.02,Other,215% Medicaid APG methodology,0.59,,,0.59,Other,125% Medicaid APG methodology,0.01,1.06,
SODIUM CHLORIDE 1 GRAM TAB,,,,80001881,CDM,250,RC,223176002,NDC,both,1000,EA,0.25,0.1,39.4668,,0.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,70,,0.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.19,,,0.19,Other,225% of Medicaid,0.12,,,0.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.18,,,0.18,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.19,
SODIUM CHLORIDE 5% 3.5GM OINT,,,,80001884,CDM,250,RC,536125391,NDC,both,1,GM,17.46,6.89,39.4668,,6.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.94,34,,5.94,percent of total billed charges,"Drugs, Inpatient Only",5.94,34,,5.94,percent of total billed charges,"Drugs, Inpatient Only",5.94,34,,5.94,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.22,70,,12.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.82,,,5.82,Other,Drug Cost,5.82,,,5.82,Other,Drug Cost,5.82,,,5.82,Other,Drug Cost,5.82,,,5.82,Other,Drug Cost,5.82,,,5.82,Other,Drug Cost,5.82,,,5.82,Other,Drug Cost,13.1,,,13.1,Other,225% of Medicaid,8.15,,,8.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.51,,,12.51,Other,215% Medicaid APG methodology,12.51,,,12.51,Other,215% Medicaid APG methodology,7.28,,,7.28,Other,125% Medicaid APG methodology,0.01,13.1,
SODIUM CL 0.9% 10ML,,,,80001888,CDM,250,RC,63323018610,NDC,both,25,ML,0.54,0.21,39.4668,,0.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,34,,0.18,percent of total billed charges,"Drugs, Inpatient Only",0.18,34,,0.18,percent of total billed charges,"Drugs, Inpatient Only",0.18,34,,0.18,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.38,70,,0.38,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.41,,,0.41,Other,225% of Medicaid,0.25,,,0.25,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.39,,,0.39,Other,215% Medicaid APG methodology,0.39,,,0.39,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,125% Medicaid APG methodology,0.01,0.41,
SODIUM CL 0.9% 500ML,,,,80001890,CDM,250,RC,264780010,NDC,both,24,ML,1.53,0.6,39.4668,,0.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.52,34,,0.52,percent of total billed charges,"Drugs, Inpatient Only",0.52,34,,0.52,percent of total billed charges,"Drugs, Inpatient Only",0.52,34,,0.52,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.07,70,,1.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,1.15,,,1.15,Other,225% of Medicaid,0.71,,,0.71,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.1,,,1.1,Other,215% Medicaid APG methodology,1.1,,,1.1,Other,215% Medicaid APG methodology,0.64,,,0.64,Other,125% Medicaid APG methodology,0.01,1.15,
SODIUM CL 0.9% 50ML,,,,80001891,CDM,250,RC,338004931,NDC,both,96,ML,1.36,0.54,39.4668,,0.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.95,70,,0.95,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,1.02,,,1.02,Other,225% of Medicaid,0.63,,,0.63,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.97,,,0.97,Other,215% Medicaid APG methodology,0.97,,,0.97,Other,215% Medicaid APG methodology,0.57,,,0.57,Other,125% Medicaid APG methodology,0.01,1.02,
SODIUM CL 5% 15ML OPHTH,,,,80001893,CDM,250,RC,536125494,NDC,both,1,ML,6.99,2.76,39.4668,,2.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.38,34,,2.38,percent of total billed charges,"Drugs, Inpatient Only",2.38,34,,2.38,percent of total billed charges,"Drugs, Inpatient Only",2.38,34,,2.38,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.89,70,,4.89,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.33,,,2.33,Other,Drug Cost,2.33,,,2.33,Other,Drug Cost,2.33,,,2.33,Other,Drug Cost,2.33,,,2.33,Other,Drug Cost,2.33,,,2.33,Other,Drug Cost,2.33,,,2.33,Other,Drug Cost,5.24,,,5.24,Other,225% of Medicaid,3.26,,,3.26,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.01,,,5.01,Other,215% Medicaid APG methodology,5.01,,,5.01,Other,215% Medicaid APG methodology,2.91,,,2.91,Other,125% Medicaid APG methodology,0.01,5.24,
SODIUM HYPOCHLORITE (DAKINS) 1/2 STR,,,,80001894,CDM,250,RC,39328006325,NDC,both,1,ML,34.62,13.66,39.4668,,13.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.77,34,,11.77,percent of total billed charges,"Drugs, Inpatient Only",11.77,34,,11.77,percent of total billed charges,"Drugs, Inpatient Only",11.77,34,,11.77,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.23,70,,24.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,25.97,,,25.97,Other,225% of Medicaid,16.16,,,16.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,24.81,,,24.81,Other,215% Medicaid APG methodology,24.81,,,24.81,Other,215% Medicaid APG methodology,14.43,,,14.43,Other,125% Medicaid APG methodology,0.01,25.97,
SODIUM HYPOCHLORITE (DAKINS) 1/4 STR,,,,80001895,CDM,250,RC,39328006412,NDC,both,1,ML,34.62,13.66,39.4668,,13.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.77,34,,11.77,percent of total billed charges,"Drugs, Inpatient Only",11.77,34,,11.77,percent of total billed charges,"Drugs, Inpatient Only",11.77,34,,11.77,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.23,70,,24.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,25.97,,,25.97,Other,225% of Medicaid,16.16,,,16.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,24.81,,,24.81,Other,215% Medicaid APG methodology,24.81,,,24.81,Other,215% Medicaid APG methodology,14.43,,,14.43,Other,125% Medicaid APG methodology,0.01,25.97,
SODIUM HYPOCHLORITE (DAKINS) FULL STR,,,,80001896,CDM,250,RC,39328006250,NDC,both,1,ML,34.62,13.66,39.4668,,13.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.77,34,,11.77,percent of total billed charges,"Drugs, Inpatient Only",11.77,34,,11.77,percent of total billed charges,"Drugs, Inpatient Only",11.77,34,,11.77,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.23,70,,24.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,11.54,,,11.54,Other,Drug Cost,25.97,,,25.97,Other,225% of Medicaid,16.16,,,16.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,24.81,,,24.81,Other,215% Medicaid APG methodology,24.81,,,24.81,Other,215% Medicaid APG methodology,14.43,,,14.43,Other,125% Medicaid APG methodology,0.01,25.97,
SOLIFNACIN 5 MG TAB,,,,80001897,CDM,250,RC,51248015001,NDC,both,30,EA,3.76,1.48,39.4668,,1.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.28,34,,1.28,percent of total billed charges,"Drugs, Inpatient Only",1.28,34,,1.28,percent of total billed charges,"Drugs, Inpatient Only",1.28,34,,1.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.63,70,,2.63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.25,,,1.25,Other,Drug Cost,1.25,,,1.25,Other,Drug Cost,1.25,,,1.25,Other,Drug Cost,1.25,,,1.25,Other,Drug Cost,1.25,,,1.25,Other,Drug Cost,1.25,,,1.25,Other,Drug Cost,2.82,,,2.82,Other,225% of Medicaid,1.75,,,1.75,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.69,,,2.69,Other,215% Medicaid APG methodology,2.69,,,2.69,Other,215% Medicaid APG methodology,1.57,,,1.57,Other,125% Medicaid APG methodology,0.01,2.82,
SORBITOL SOLN 70 % W/W 30ML,,,,80001902,CDM,250,RC,46287050030,NDC,both,10,ML,9.37,3.7,39.4668,,3.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.19,34,,3.19,percent of total billed charges,"Drugs, Inpatient Only",3.19,34,,3.19,percent of total billed charges,"Drugs, Inpatient Only",3.19,34,,3.19,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.56,70,,6.56,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.12,,,3.12,Other,Drug Cost,3.12,,,3.12,Other,Drug Cost,3.12,,,3.12,Other,Drug Cost,3.12,,,3.12,Other,Drug Cost,3.12,,,3.12,Other,Drug Cost,3.12,,,3.12,Other,Drug Cost,7.03,,,7.03,Other,225% of Medicaid,4.37,,,4.37,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.71,,,6.71,Other,215% Medicaid APG methodology,6.71,,,6.71,Other,215% Medicaid APG methodology,3.9,,,3.9,Other,125% Medicaid APG methodology,0.01,7.03,
SOTALOL 120 MG TAB,,,,80001903,CDM,250,RC,60505015900,NDC,both,100,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.08,
SOTALOL 240 MG TAB,,,,80001905,CDM,250,RC,93106301,NDC,both,100,EA,0.67,0.27,39.4668,,0.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.47,70,,0.47,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.51,,,0.51,Other,225% of Medicaid,0.31,,,0.31,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.48,,,0.48,Other,215% Medicaid APG methodology,0.48,,,0.48,Other,215% Medicaid APG methodology,0.28,,,0.28,Other,125% Medicaid APG methodology,0.01,0.51,
SOTALOL 80 MG,,,,80001906,CDM,250,RC,60505008000,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
SPIRONOLACTONE 25MG,,,,80001908,CDM,250,RC,53746051101,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
STERILE WATER 10 ML,,,,80001912,CDM,250,RC,409488710,NDC,both,25,ML,1.37,0.54,39.4668,,0.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.96,70,,0.96,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.46,,,0.46,Other,Drug Cost,0.46,,,0.46,Other,Drug Cost,0.46,,,0.46,Other,Drug Cost,0.46,,,0.46,Other,Drug Cost,0.46,,,0.46,Other,Drug Cost,0.46,,,0.46,Other,Drug Cost,1.02,,,1.02,Other,225% of Medicaid,0.64,,,0.64,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.98,,,0.98,Other,215% Medicaid APG methodology,0.98,,,0.98,Other,215% Medicaid APG methodology,0.57,,,0.57,Other,125% Medicaid APG methodology,0.01,1.02,
SUBOXONE 2-0.5MG,,,,80001916,CDM,250,RC,54018813,NDC,both,30,EA,0.34,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.12,34,,0.12,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,70,,0.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.25,,,0.25,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.24,,,0.24,Other,215% Medicaid APG methodology,0.24,,,0.24,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,0.25,
SUCRALFATE 1 G,,,,80001919,CDM,250,RC,59762040101,NDC,both,100,EA,0.23,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,70,,0.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.17,,,0.17,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.16,,,0.16,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.17,
SULFACETAMIDE 10% OPHTH 15ML,,,,80001921,CDM,250,RC,24208067004,NDC,both,1,ML,48.03,18.96,39.4668,,18.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.33,34,,16.33,percent of total billed charges,"Drugs, Inpatient Only",16.33,34,,16.33,percent of total billed charges,"Drugs, Inpatient Only",16.33,34,,16.33,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,33.62,70,,33.62,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.01,,,16.01,Other,Drug Cost,16.01,,,16.01,Other,Drug Cost,16.01,,,16.01,Other,Drug Cost,16.01,,,16.01,Other,Drug Cost,16.01,,,16.01,Other,Drug Cost,16.01,,,16.01,Other,Drug Cost,36.02,,,36.02,Other,225% of Medicaid,22.41,,,22.41,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,34.42,,,34.42,Other,215% Medicaid APG methodology,34.42,,,34.42,Other,215% Medicaid APG methodology,20.01,,,20.01,Other,125% Medicaid APG methodology,0.01,36.02,
SULFATRIM 40-200 MG/ 5 ML SUSP,,,,80001923,CDM,250,RC,65862049647,NDC,both,1,ML,30.78,12.15,39.4668,,12.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.47,34,,10.47,percent of total billed charges,"Drugs, Inpatient Only",10.47,34,,10.47,percent of total billed charges,"Drugs, Inpatient Only",10.47,34,,10.47,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.55,70,,21.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.26,,,10.26,Other,Drug Cost,10.26,,,10.26,Other,Drug Cost,10.26,,,10.26,Other,Drug Cost,10.26,,,10.26,Other,Drug Cost,10.26,,,10.26,Other,Drug Cost,10.26,,,10.26,Other,Drug Cost,23.09,,,23.09,Other,225% of Medicaid,14.36,,,14.36,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,22.06,,,22.06,Other,215% Medicaid APG methodology,22.06,,,22.06,Other,215% Medicaid APG methodology,12.83,,,12.83,Other,125% Medicaid APG methodology,0.01,23.09,
SUMATRIPTAN SUCC (IMITREX) 100MG TAB,,,,80001925,CDM,250,RC,65862014836,NDC,both,9,EA,0.51,0.2,39.4668,,0.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.36,70,,0.36,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.38,,,0.38,Other,225% of Medicaid,0.24,,,0.24,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.37,,,0.37,Other,215% Medicaid APG methodology,0.37,,,0.37,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,125% Medicaid APG methodology,0.01,0.38,
SUMATRIPTAN SUCC (IMITREX) 25MG TAB,,,,80001926,CDM,250,RC,65862014636,NDC,both,9,EA,0.23,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,70,,0.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.17,,,0.17,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.16,,,0.16,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.17,
TAMOXIFEN 10 MG TAB,,,,80001933,CDM,250,RC,378014491,NDC,both,60,EA,0.42,0.17,39.4668,,0.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.3,70,,0.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.32,,,0.32,Other,225% of Medicaid,0.2,,,0.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.3,,,0.3,Other,215% Medicaid APG methodology,0.3,,,0.3,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,125% Medicaid APG methodology,0.01,0.32,
TAMSULOSIN (FLOMAX) 0.4 MG CAPS,,,,80001934,CDM,250,RC,65862059801,NDC,both,100,EA,0.06,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
TARSUM 120ML SHAMPOO,,,,80001937,CDM,250,RC,11086001101,NDC,both,1,ML,53.7,21.19,39.4668,,21.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.26,34,,18.26,percent of total billed charges,"Drugs, Inpatient Only",18.26,34,,18.26,percent of total billed charges,"Drugs, Inpatient Only",18.26,34,,18.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,37.59,70,,37.59,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.9,,,17.9,Other,Drug Cost,17.9,,,17.9,Other,Drug Cost,17.9,,,17.9,Other,Drug Cost,17.9,,,17.9,Other,Drug Cost,17.9,,,17.9,Other,Drug Cost,17.9,,,17.9,Other,Drug Cost,40.28,,,40.28,Other,225% of Medicaid,25.06,,,25.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,38.49,,,38.49,Other,215% Medicaid APG methodology,38.49,,,38.49,Other,215% Medicaid APG methodology,22.38,,,22.38,Other,125% Medicaid APG methodology,0.01,40.28,
TERBUTALINE 2.5 MG,,,,80001947,CDM,250,RC,115261101,NDC,both,100,EA,0.31,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,70,,0.21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.23,,,0.23,Other,225% of Medicaid,0.14,,,0.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.22,,,0.22,Other,215% Medicaid APG methodology,0.22,,,0.22,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.23,
TERBUTALINE 5 MG,,,,80001948,CDM,250,RC,115262201,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
THERAPEUTIC MVI 1EA,,,,80001963,CDM,250,RC,904053061,NDC,both,10,EA,0.5,0.2,39.4668,,0.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.35,70,,0.35,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.38,,,0.38,Other,225% of Medicaid,0.24,,,0.24,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.36,,,0.36,Other,215% Medicaid APG methodology,0.36,,,0.36,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,125% Medicaid APG methodology,0.01,0.38,
THIAMINE HCL 100 MG TAB,,,,80001966,CDM,250,RC,54629005701,NDC,both,100,EA,0.13,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.1,
THROMBIN-JMI 20000 UNIT KIT,,,,80001969,CDM,250,RC,60793021720,NDC,both,1,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
THROMBIN-JMI 5000 UNIT KIT,,,,80001970,CDM,250,RC,60793020505,NDC,both,1,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
TICAGRELOR 90 MG TABLET,,,,80001972,CDM,250,RC,186077739,NDC,both,100,EA,4.46,1.76,39.4668,,1.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.12,70,,3.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,3.34,,,3.34,Other,225% of Medicaid,2.08,,,2.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.2,,,3.2,Other,215% Medicaid APG methodology,3.2,,,3.2,Other,215% Medicaid APG methodology,1.86,,,1.86,Other,125% Medicaid APG methodology,0.01,3.34,
TIGABINE HCL (GABITRIL) 4MG TAB,,,,80001973,CDM,250,RC,62756022483,NDC,both,30,EA,4.53,1.79,39.4668,,1.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.54,34,,1.54,percent of total billed charges,"Drugs, Inpatient Only",1.54,34,,1.54,percent of total billed charges,"Drugs, Inpatient Only",1.54,34,,1.54,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.17,70,,3.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,3.39,,,3.39,Other,225% of Medicaid,2.11,,,2.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.24,,,3.24,Other,215% Medicaid APG methodology,3.24,,,3.24,Other,215% Medicaid APG methodology,1.89,,,1.89,Other,125% Medicaid APG methodology,0.01,3.39,
TIMOLOL 0.25% 5ML OPHTH,,,,80001977,CDM,250,RC,61314022605,NDC,both,1,ML,3.45,1.36,39.4668,,1.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.17,34,,1.17,percent of total billed charges,"Drugs, Inpatient Only",1.17,34,,1.17,percent of total billed charges,"Drugs, Inpatient Only",1.17,34,,1.17,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.42,70,,2.42,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.15,,,1.15,Other,Drug Cost,1.15,,,1.15,Other,Drug Cost,1.15,,,1.15,Other,Drug Cost,1.15,,,1.15,Other,Drug Cost,1.15,,,1.15,Other,Drug Cost,1.15,,,1.15,Other,Drug Cost,2.59,,,2.59,Other,225% of Medicaid,1.61,,,1.61,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.47,,,2.47,Other,215% Medicaid APG methodology,2.47,,,2.47,Other,215% Medicaid APG methodology,1.44,,,1.44,Other,125% Medicaid APG methodology,0.01,2.59,
TIMOLOL 0.5% 10ML OPHTH,,,,80001979,CDM,250,RC,61314022705,NDC,both,1,ML,3.9,1.54,39.4668,,1.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.33,34,,1.33,percent of total billed charges,"Drugs, Inpatient Only",1.33,34,,1.33,percent of total billed charges,"Drugs, Inpatient Only",1.33,34,,1.33,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.73,70,,2.73,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.3,,,1.3,Other,Drug Cost,1.3,,,1.3,Other,Drug Cost,1.3,,,1.3,Other,Drug Cost,1.3,,,1.3,Other,Drug Cost,1.3,,,1.3,Other,Drug Cost,1.3,,,1.3,Other,Drug Cost,2.93,,,2.93,Other,225% of Medicaid,1.82,,,1.82,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.8,,,2.8,Other,215% Medicaid APG methodology,2.8,,,2.8,Other,215% Medicaid APG methodology,1.63,,,1.63,Other,125% Medicaid APG methodology,0.01,2.93,
TIMOLOL 0.5% 5ML OPHTH,,,,80001980,CDM,250,RC,64980051405,NDC,both,1,ML,2.73,1.08,39.4668,,1.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.93,34,,0.93,percent of total billed charges,"Drugs, Inpatient Only",0.93,34,,0.93,percent of total billed charges,"Drugs, Inpatient Only",0.93,34,,0.93,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.91,70,,1.91,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.91,,,0.91,Other,Drug Cost,0.91,,,0.91,Other,Drug Cost,0.91,,,0.91,Other,Drug Cost,0.91,,,0.91,Other,Drug Cost,0.91,,,0.91,Other,Drug Cost,0.91,,,0.91,Other,Drug Cost,2.05,,,2.05,Other,225% of Medicaid,1.27,,,1.27,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.96,,,1.96,Other,215% Medicaid APG methodology,1.96,,,1.96,Other,215% Medicaid APG methodology,1.14,,,1.14,Other,125% Medicaid APG methodology,0.01,2.05,
TIMOLOL 0.5% 5ML OPTH,,,,80001981,CDM,250,RC,61314022505,NDC,both,1,ML,118.83,46.9,39.4668,,46.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,40.4,34,,40.4,percent of total billed charges,"Drugs, Inpatient Only",40.4,34,,40.4,percent of total billed charges,"Drugs, Inpatient Only",40.4,34,,40.4,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,83.18,70,,83.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,39.61,,,39.61,Other,Drug Cost,39.61,,,39.61,Other,Drug Cost,39.61,,,39.61,Other,Drug Cost,39.61,,,39.61,Other,Drug Cost,39.61,,,39.61,Other,Drug Cost,39.61,,,39.61,Other,Drug Cost,89.12,,,89.12,Other,225% of Medicaid,55.45,,,55.45,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,85.16,,,85.16,Other,215% Medicaid APG methodology,85.16,,,85.16,Other,215% Medicaid APG methodology,49.51,,,49.51,Other,125% Medicaid APG methodology,0.01,89.12,
TIPRANAVIR (APTIVUS) 250 MG,,,,80001987,CDM,250,RC,597000302,NDC,both,120,EA,21.54,8.5,39.4668,,8.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.32,34,,7.32,percent of total billed charges,"Drugs, Inpatient Only",7.32,34,,7.32,percent of total billed charges,"Drugs, Inpatient Only",7.32,34,,7.32,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.08,70,,15.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.18,,,7.18,Other,Drug Cost,7.18,,,7.18,Other,Drug Cost,7.18,,,7.18,Other,Drug Cost,7.18,,,7.18,Other,Drug Cost,7.18,,,7.18,Other,Drug Cost,7.18,,,7.18,Other,Drug Cost,16.16,,,16.16,Other,225% of Medicaid,10.05,,,10.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,15.44,,,15.44,Other,215% Medicaid APG methodology,15.44,,,15.44,Other,215% Medicaid APG methodology,8.98,,,8.98,Other,125% Medicaid APG methodology,0.01,16.16,
TIZANIDINE 4 MG TAB,,,,80001988,CDM,250,RC,55111018015,NDC,both,150,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.03,
TOBRAMYCIN 1.2 GM INJ,,,,80001991,CDM,250,RC,63323030351,NDC,both,6,EA,122.59,48.38,39.4668,,48.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,41.68,34,,41.68,percent of total billed charges,"Drugs, Inpatient Only",41.68,34,,41.68,percent of total billed charges,"Drugs, Inpatient Only",41.68,34,,41.68,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,85.81,70,,85.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,40.86,,,40.86,Other,Drug Cost,40.86,,,40.86,Other,Drug Cost,40.86,,,40.86,Other,Drug Cost,40.86,,,40.86,Other,Drug Cost,40.86,,,40.86,Other,Drug Cost,40.86,,,40.86,Other,Drug Cost,91.94,,,91.94,Other,225% of Medicaid,57.21,,,57.21,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,87.85,,,87.85,Other,215% Medicaid APG methodology,87.85,,,87.85,Other,215% Medicaid APG methodology,51.08,,,51.08,Other,125% Medicaid APG methodology,0.01,91.94,
TOBRAMYCIN 5ML OPHTH,,,,80001992,CDM,250,RC,70069013101,NDC,both,1,ML,5.34,2.11,39.4668,,2.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.82,34,,1.82,percent of total billed charges,"Drugs, Inpatient Only",1.82,34,,1.82,percent of total billed charges,"Drugs, Inpatient Only",1.82,34,,1.82,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.74,70,,3.74,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.78,,,1.78,Other,Drug Cost,1.78,,,1.78,Other,Drug Cost,1.78,,,1.78,Other,Drug Cost,1.78,,,1.78,Other,Drug Cost,1.78,,,1.78,Other,Drug Cost,1.78,,,1.78,Other,Drug Cost,4.01,,,4.01,Other,225% of Medicaid,2.49,,,2.49,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.83,,,3.83,Other,215% Medicaid APG methodology,3.83,,,3.83,Other,215% Medicaid APG methodology,2.23,,,2.23,Other,125% Medicaid APG methodology,0.01,4.01,
TOBREX 0.3% 3.5GM OPHTH OINT,,,,80001994,CDM,250,RC,78081301,NDC,both,1,GM,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
TOPAMAX 100MG TAB,,,,80001999,CDM,250,RC,68382014014,NDC,both,60,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
TOPAMAX 25MG TAB,,,,80002000,CDM,250,RC,47335070786,NDC,both,60,EA,0.01,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
TORSEMIDE 20MG,,,,80002006,CDM,250,RC,31722053101,NDC,both,100,EA,0.09,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
TRANSDERM-SCOP 1.5MG,,,,80002011,CDM,250,RC,10019055303,NDC,both,10,EA,4,1.58,39.4668,,1.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.36,34,,1.36,percent of total billed charges,"Drugs, Inpatient Only",1.36,34,,1.36,percent of total billed charges,"Drugs, Inpatient Only",1.36,34,,1.36,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.8,70,,2.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.33,,,1.33,Other,Drug Cost,1.33,,,1.33,Other,Drug Cost,1.33,,,1.33,Other,Drug Cost,1.33,,,1.33,Other,Drug Cost,1.33,,,1.33,Other,Drug Cost,1.33,,,1.33,Other,Drug Cost,3,,,3,Other,225% of Medicaid,1.86,,,1.86,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.86,,,2.86,Other,215% Medicaid APG methodology,2.86,,,2.86,Other,215% Medicaid APG methodology,1.67,,,1.67,Other,125% Medicaid APG methodology,0.01,3,
TRAZODONE 100 MG TAB,,,,80002015,CDM,250,RC,50111056101,NDC,both,100,EA,0.13,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.1,
TRAZODONE 50 MG TAB,,,,80002016,CDM,250,RC,50111056001,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
TRIAMCINOLONE 0.1% DENTAL PASTE,,,,80002017,CDM,250,RC,713065540,NDC,both,1,GM,16.53,6.52,39.4668,,6.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.62,34,,5.62,percent of total billed charges,"Drugs, Inpatient Only",5.62,34,,5.62,percent of total billed charges,"Drugs, Inpatient Only",5.62,34,,5.62,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.57,70,,11.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.51,,,5.51,Other,Drug Cost,5.51,,,5.51,Other,Drug Cost,5.51,,,5.51,Other,Drug Cost,5.51,,,5.51,Other,Drug Cost,5.51,,,5.51,Other,Drug Cost,5.51,,,5.51,Other,Drug Cost,12.4,,,12.4,Other,225% of Medicaid,7.71,,,7.71,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.85,,,11.85,Other,215% Medicaid APG methodology,11.85,,,11.85,Other,215% Medicaid APG methodology,6.89,,,6.89,Other,125% Medicaid APG methodology,0.01,12.4,
TRIAMCINOLONE ACET 454GM CREAM,,,,80002019,CDM,250,RC,67877025145,NDC,both,1,GM,28.47,11.24,39.4668,,11.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.68,34,,9.68,percent of total billed charges,"Drugs, Inpatient Only",9.68,34,,9.68,percent of total billed charges,"Drugs, Inpatient Only",9.68,34,,9.68,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.93,70,,19.93,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.49,,,9.49,Other,Drug Cost,9.49,,,9.49,Other,Drug Cost,9.49,,,9.49,Other,Drug Cost,9.49,,,9.49,Other,Drug Cost,9.49,,,9.49,Other,Drug Cost,9.49,,,9.49,Other,Drug Cost,21.35,,,21.35,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,20.4,,,20.4,Other,215% Medicaid APG methodology,20.4,,,20.4,Other,215% Medicaid APG methodology,11.86,,,11.86,Other,125% Medicaid APG methodology,0.01,21.35,
TRIAMCINOLONE ACET CREAM  15GM,,,,80002020,CDM,250,RC,168000315,NDC,both,1,GM,1.02,0.4,39.4668,,0.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.35,34,,0.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.71,70,,0.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.77,,,0.77,Other,225% of Medicaid,0.48,,,0.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.73,,,0.73,Other,215% Medicaid APG methodology,0.73,,,0.73,Other,215% Medicaid APG methodology,0.43,,,0.43,Other,125% Medicaid APG methodology,0.01,0.77,
TRIAMCINOLONE ACET CREAM 80GM,,,,80002021,CDM,250,RC,168000380,NDC,both,1,GM,5.46,2.15,39.4668,,2.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.86,34,,1.86,percent of total billed charges,"Drugs, Inpatient Only",1.86,34,,1.86,percent of total billed charges,"Drugs, Inpatient Only",1.86,34,,1.86,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.82,70,,3.82,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.82,,,1.82,Other,Drug Cost,1.82,,,1.82,Other,Drug Cost,1.82,,,1.82,Other,Drug Cost,1.82,,,1.82,Other,Drug Cost,1.82,,,1.82,Other,Drug Cost,1.82,,,1.82,Other,Drug Cost,4.1,,,4.1,Other,225% of Medicaid,2.55,,,2.55,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.91,,,3.91,Other,215% Medicaid APG methodology,3.91,,,3.91,Other,215% Medicaid APG methodology,2.28,,,2.28,Other,125% Medicaid APG methodology,0.01,4.1,
TRIAMCINOLONE ACET OINT 15GM,,,,80002024,CDM,250,RC,45802005535,NDC,both,1,GM,0.81,0.32,39.4668,,0.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,70,,0.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.61,,,0.61,Other,225% of Medicaid,0.38,,,0.38,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.58,,,0.58,Other,215% Medicaid APG methodology,0.58,,,0.58,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,0.61,
TRIAMCINOLONE ACET OINT 80GM,,,,80002025,CDM,250,RC,168000680,NDC,both,1,GM,9.24,3.65,39.4668,,3.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.14,34,,3.14,percent of total billed charges,"Drugs, Inpatient Only",3.14,34,,3.14,percent of total billed charges,"Drugs, Inpatient Only",3.14,34,,3.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.47,70,,6.47,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.08,,,3.08,Other,Drug Cost,3.08,,,3.08,Other,Drug Cost,3.08,,,3.08,Other,Drug Cost,3.08,,,3.08,Other,Drug Cost,3.08,,,3.08,Other,Drug Cost,3.08,,,3.08,Other,Drug Cost,6.93,,,6.93,Other,225% of Medicaid,4.31,,,4.31,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.62,,,6.62,Other,215% Medicaid APG methodology,6.62,,,6.62,Other,215% Medicaid APG methodology,3.85,,,3.85,Other,125% Medicaid APG methodology,0.01,6.93,
TRIAMCINOLONE ACETONIDE 0.1%,,,,80002026,CDM,250,RC,67877025115,NDC,both,1,GM,0.96,0.38,39.4668,,0.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.33,34,,0.33,percent of total billed charges,"Drugs, Inpatient Only",0.33,34,,0.33,percent of total billed charges,"Drugs, Inpatient Only",0.33,34,,0.33,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.67,70,,0.67,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.32,,,0.32,Other,Drug Cost,0.32,,,0.32,Other,Drug Cost,0.32,,,0.32,Other,Drug Cost,0.32,,,0.32,Other,Drug Cost,0.32,,,0.32,Other,Drug Cost,0.32,,,0.32,Other,Drug Cost,0.72,,,0.72,Other,225% of Medicaid,0.45,,,0.45,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.69,,,0.69,Other,215% Medicaid APG methodology,0.69,,,0.69,Other,215% Medicaid APG methodology,0.4,,,0.4,Other,125% Medicaid APG methodology,0.01,0.72,
TRIAMTERENE-HCTZ 37.5-25MG CAP,,,,80002030,CDM,250,RC,527163201,NDC,both,100,EA,0.09,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
TRIHEXYPHENIDYL 2MG TAB,,,,80002037,CDM,250,RC,69452024120,NDC,both,100,EA,0.04,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
TRIHEXYPHENIDYL 5MG TAB,,,,80002038,CDM,250,RC,591533701,NDC,both,100,EA,0.2,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.14,,,0.14,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.15,
TRIMETH-SULFAMETH 160-800MG TAB,,,,80002041,CDM,250,RC,65162027210,NDC,both,100,EA,0.09,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
TRIPLE ANTIBIOTIC 30GM,,,,80002042,CDM,250,RC,45802014303,NDC,both,1,GM,3.42,1.35,39.4668,,1.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.39,70,,2.39,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,2.57,,,2.57,Other,225% of Medicaid,1.6,,,1.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.45,,,2.45,Other,215% Medicaid APG methodology,2.45,,,2.45,Other,215% Medicaid APG methodology,1.43,,,1.43,Other,125% Medicaid APG methodology,0.01,2.57,
TROPICAMIDE 1% OPHTH,,,,80002047,CDM,250,RC,61314035501,NDC,both,1,ML,6.54,2.58,39.4668,,2.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.22,34,,2.22,percent of total billed charges,"Drugs, Inpatient Only",2.22,34,,2.22,percent of total billed charges,"Drugs, Inpatient Only",2.22,34,,2.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.58,70,,4.58,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,4.91,,,4.91,Other,225% of Medicaid,3.05,,,3.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.69,,,4.69,Other,215% Medicaid APG methodology,4.69,,,4.69,Other,215% Medicaid APG methodology,2.73,,,2.73,Other,125% Medicaid APG methodology,0.01,4.91,
TUBERCULIN PPD INJ,,,,80002048,CDM,250,RC,42023010401,NDC,both,1,ML,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
UREA 20% CREAM,,,,80002051,CDM,250,RC,58980061030,NDC,both,1,GM,23.52,9.28,39.4668,,9.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8,34,,8,percent of total billed charges,"Drugs, Inpatient Only",8,34,,8,percent of total billed charges,"Drugs, Inpatient Only",8,34,,8,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.46,70,,16.46,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.84,,,7.84,Other,Drug Cost,7.84,,,7.84,Other,Drug Cost,7.84,,,7.84,Other,Drug Cost,7.84,,,7.84,Other,Drug Cost,7.84,,,7.84,Other,Drug Cost,7.84,,,7.84,Other,Drug Cost,17.64,,,17.64,Other,225% of Medicaid,10.98,,,10.98,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,16.86,,,16.86,Other,215% Medicaid APG methodology,16.86,,,16.86,Other,215% Medicaid APG methodology,9.8,,,9.8,Other,125% Medicaid APG methodology,0.01,17.64,
UREA TOPICAL 40% CREAM,,,,80002052,CDM,250,RC,16477034003,NDC,both,1,GM,112.32,44.33,39.4668,,44.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.19,34,,38.19,percent of total billed charges,"Drugs, Inpatient Only",38.19,34,,38.19,percent of total billed charges,"Drugs, Inpatient Only",38.19,34,,38.19,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,78.62,70,,78.62,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,37.44,,,37.44,Other,Drug Cost,37.44,,,37.44,Other,Drug Cost,37.44,,,37.44,Other,Drug Cost,37.44,,,37.44,Other,Drug Cost,37.44,,,37.44,Other,Drug Cost,37.44,,,37.44,Other,Drug Cost,84.24,,,84.24,Other,225% of Medicaid,52.42,,,52.42,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,80.5,,,80.5,Other,215% Medicaid APG methodology,80.5,,,80.5,Other,215% Medicaid APG methodology,46.8,,,46.8,Other,125% Medicaid APG methodology,0.01,84.24,
UROCIT-K 10 1080MG,,,,80002053,CDM,250,RC,245007111,NDC,both,100,EA,0.28,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,70,,0.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.21,,,0.21,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.2,,,0.2,Other,215% Medicaid APG methodology,0.2,,,0.2,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.21,
URSODIOL 300 MG CAP,,,,80002056,CDM,250,RC,69238154001,NDC,both,100,EA,0.45,0.18,39.4668,,0.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.31,70,,0.31,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.34,,,0.34,Other,225% of Medicaid,0.21,,,0.21,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.32,,,0.32,Other,215% Medicaid APG methodology,0.32,,,0.32,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,125% Medicaid APG methodology,0.01,0.34,
VALACYCLOVIR 500 MG TAB,,,,80002057,CDM,250,RC,63304090430,NDC,both,30,EA,0.19,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
VALPROATE (DEPACON) 100MG/ML 5ML INJ,,,,80002058,CDM,250,RC,143978510,NDC,both,10,ML,6.68,2.63,39.4668,,2.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.27,34,,2.27,percent of total billed charges,"Drugs, Inpatient Only",2.27,34,,2.27,percent of total billed charges,"Drugs, Inpatient Only",2.27,34,,2.27,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.67,70,,4.67,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.23,,,2.23,Other,Drug Cost,2.23,,,2.23,Other,Drug Cost,2.23,,,2.23,Other,Drug Cost,2.23,,,2.23,Other,Drug Cost,2.23,,,2.23,Other,Drug Cost,2.23,,,2.23,Other,Drug Cost,5.01,,,5.01,Other,225% of Medicaid,3.12,,,3.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.78,,,4.78,Other,215% Medicaid APG methodology,4.78,,,4.78,Other,215% Medicaid APG methodology,2.78,,,2.78,Other,125% Medicaid APG methodology,0.01,5.01,
VALPROIC ACID 250MG/5ML SOL,,,,80002060,CDM,250,RC,121067585,NDC,both,1,ML,12.84,5.07,39.4668,,5.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.37,34,,4.37,percent of total billed charges,"Drugs, Inpatient Only",4.37,34,,4.37,percent of total billed charges,"Drugs, Inpatient Only",4.37,34,,4.37,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.99,70,,8.99,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.28,,,4.28,Other,Drug Cost,4.28,,,4.28,Other,Drug Cost,4.28,,,4.28,Other,Drug Cost,4.28,,,4.28,Other,Drug Cost,4.28,,,4.28,Other,Drug Cost,4.28,,,4.28,Other,Drug Cost,9.63,,,9.63,Other,225% of Medicaid,5.99,,,5.99,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.2,,,9.2,Other,215% Medicaid APG methodology,9.2,,,9.2,Other,215% Medicaid APG methodology,5.35,,,5.35,Other,125% Medicaid APG methodology,0.01,9.63,
VALSARTAN (DIOVAN) 40MG TAB,,,,80002062,CDM,250,RC,78042315,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
VALSARTAN (DIOVAN) 80MG TAB,,,,80002063,CDM,250,RC,78035834,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
VASOPRESSIN 20 U/ML,,,,80002073,CDM,250,RC,42023016425,NDC,both,25,ML,28.35,11.19,39.4668,,11.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.64,34,,9.64,percent of total billed charges,"Drugs, Inpatient Only",9.64,34,,9.64,percent of total billed charges,"Drugs, Inpatient Only",9.64,34,,9.64,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.85,70,,19.85,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.45,,,9.45,Other,Drug Cost,9.45,,,9.45,Other,Drug Cost,9.45,,,9.45,Other,Drug Cost,9.45,,,9.45,Other,Drug Cost,9.45,,,9.45,Other,Drug Cost,9.45,,,9.45,Other,Drug Cost,21.26,,,21.26,Other,225% of Medicaid,13.23,,,13.23,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,20.32,,,20.32,Other,215% Medicaid APG methodology,20.32,,,20.32,Other,215% Medicaid APG methodology,11.81,,,11.81,Other,125% Medicaid APG methodology,0.01,21.26,
VECURONIUM 10MG INJ,,,,80002074,CDM,250,RC,703291403,NDC,both,10,EA,17.12,6.76,39.4668,,6.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.82,34,,5.82,percent of total billed charges,"Drugs, Inpatient Only",5.82,34,,5.82,percent of total billed charges,"Drugs, Inpatient Only",5.82,34,,5.82,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.98,70,,11.98,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.71,,,5.71,Other,Drug Cost,5.71,,,5.71,Other,Drug Cost,5.71,,,5.71,Other,Drug Cost,5.71,,,5.71,Other,Drug Cost,5.71,,,5.71,Other,Drug Cost,5.71,,,5.71,Other,Drug Cost,12.84,,,12.84,Other,225% of Medicaid,7.99,,,7.99,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.27,,,12.27,Other,215% Medicaid APG methodology,12.27,,,12.27,Other,215% Medicaid APG methodology,7.13,,,7.13,Other,125% Medicaid APG methodology,0.01,12.84,
VENLAFAXINE HCL (EFFEXOR) 25 MG TAB,,,,80002075,CDM,250,RC,68382001801,NDC,both,100,EA,0.09,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
VENLAFAXINE HCL (EFFEXOR) 75MG TAB,,,,80002077,CDM,250,RC,68382002101,NDC,both,100,EA,0.09,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
VENLAFAXINE HCL ER (EFFEXOR XR) 37.5MG,,,,80002078,CDM,250,RC,65862052790,NDC,both,90,EA,0.09,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
VENLAFAXINE HCL ER (EFFEXOR XR) 75MG CAP,,,,80002079,CDM,250,RC,65862052899,NDC,both,1000,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.08,
VERAPAMIL 120 MG TAB,,,,80002080,CDM,250,RC,23155048601,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
VERAPAMIL 180 MG TAB,,,,80002081,CDM,250,RC,68462029301,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
VERAPAMIL 2.5MG/ML INJ,,,,80002082,CDM,250,RC,409114405,NDC,both,25,ML,13.31,5.25,39.4668,,5.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.53,34,,4.53,percent of total billed charges,"Drugs, Inpatient Only",4.53,34,,4.53,percent of total billed charges,"Drugs, Inpatient Only",4.53,34,,4.53,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.32,70,,9.32,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.44,,,4.44,Other,Drug Cost,4.44,,,4.44,Other,Drug Cost,4.44,,,4.44,Other,Drug Cost,4.44,,,4.44,Other,Drug Cost,4.44,,,4.44,Other,Drug Cost,4.44,,,4.44,Other,Drug Cost,9.98,,,9.98,Other,225% of Medicaid,6.21,,,6.21,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.54,,,9.54,Other,215% Medicaid APG methodology,9.54,,,9.54,Other,215% Medicaid APG methodology,5.55,,,5.55,Other,125% Medicaid APG methodology,0.01,9.98,
VERAPAMIL 240 MG TAB,,,,80002083,CDM,250,RC,68462026001,NDC,both,100,EA,0.2,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.14,,,0.14,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.15,
VERAPAMIL 40 MG TAB,,,,80002084,CDM,250,RC,23155005901,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
VIRACEPT,,,,80002091,CDM,250,RC,63010002770,NDC,both,120,EA,16.48,6.5,39.4668,,6.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.6,34,,5.6,percent of total billed charges,"Drugs, Inpatient Only",5.6,34,,5.6,percent of total billed charges,"Drugs, Inpatient Only",5.6,34,,5.6,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.53,70,,11.53,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.49,,,5.49,Other,Drug Cost,5.49,,,5.49,Other,Drug Cost,5.49,,,5.49,Other,Drug Cost,5.49,,,5.49,Other,Drug Cost,5.49,,,5.49,Other,Drug Cost,5.49,,,5.49,Other,Drug Cost,12.36,,,12.36,Other,225% of Medicaid,7.69,,,7.69,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.81,,,11.81,Other,215% Medicaid APG methodology,11.81,,,11.81,Other,215% Medicaid APG methodology,6.87,,,6.87,Other,125% Medicaid APG methodology,0.01,12.36,
VIRACEPT 250 MG,,,,80002092,CDM,250,RC,63010001030,NDC,both,300,EA,6.59,2.6,39.4668,,2.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.24,34,,2.24,percent of total billed charges,"Drugs, Inpatient Only",2.24,34,,2.24,percent of total billed charges,"Drugs, Inpatient Only",2.24,34,,2.24,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.61,70,,4.61,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.2,,,2.2,Other,Drug Cost,2.2,,,2.2,Other,Drug Cost,2.2,,,2.2,Other,Drug Cost,2.2,,,2.2,Other,Drug Cost,2.2,,,2.2,Other,Drug Cost,2.2,,,2.2,Other,Drug Cost,4.94,,,4.94,Other,225% of Medicaid,3.08,,,3.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.72,,,4.72,Other,215% Medicaid APG methodology,4.72,,,4.72,Other,215% Medicaid APG methodology,2.75,,,2.75,Other,125% Medicaid APG methodology,0.01,4.94,
VIRAMUNE 200 MG,,,,80002093,CDM,250,RC,31722050560,NDC,both,60,EA,0.22,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,70,,0.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.17,,,0.17,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.16,,,0.16,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.17,
VIREAD 300 MG,,,,80002094,CDM,250,RC,61958040101,NDC,both,30,EA,28.46,11.23,39.4668,,11.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.68,34,,9.68,percent of total billed charges,"Drugs, Inpatient Only",9.68,34,,9.68,percent of total billed charges,"Drugs, Inpatient Only",9.68,34,,9.68,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.92,70,,19.92,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.49,,,9.49,Other,Drug Cost,9.49,,,9.49,Other,Drug Cost,9.49,,,9.49,Other,Drug Cost,9.49,,,9.49,Other,Drug Cost,9.49,,,9.49,Other,Drug Cost,9.49,,,9.49,Other,Drug Cost,21.35,,,21.35,Other,225% of Medicaid,13.28,,,13.28,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,20.4,,,20.4,Other,215% Medicaid APG methodology,20.4,,,20.4,Other,215% Medicaid APG methodology,11.86,,,11.86,Other,125% Medicaid APG methodology,0.01,21.35,
VITAMIN A & D OINTMENT,,,,80002097,CDM,250,RC,16784011502,NDC,both,144,GM,0.16,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
VITAMIN B COMPLEX TAB,,,,80002098,CDM,250,RC,60258016001,NDC,both,100,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
VITAMIN C 500 MG TAB,,,,80002103,CDM,250,RC,904052360,NDC,both,100,EA,0.04,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
VITAMIN D 1000 UNIT CAP,,,,80002105,CDM,250,RC,96295012848,NDC,both,200,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
VITAMIN E 400 UNIT CAP,,,,80002107,CDM,250,RC,40985021245,NDC,both,110,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
VOLTAREN 2.5ML OPHTH,,,,80002109,CDM,250,RC,61314001425,NDC,both,1,ML,2.31,0.91,39.4668,,0.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.79,34,,0.79,percent of total billed charges,"Drugs, Inpatient Only",0.79,34,,0.79,percent of total billed charges,"Drugs, Inpatient Only",0.79,34,,0.79,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.62,70,,1.62,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,0.77,,,0.77,Other,Drug Cost,1.73,,,1.73,Other,225% of Medicaid,1.08,,,1.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.66,,,1.66,Other,215% Medicaid APG methodology,1.66,,,1.66,Other,215% Medicaid APG methodology,0.96,,,0.96,Other,125% Medicaid APG methodology,0.01,1.73,
VORICONZAZOLE 200 MG TAB,,,,80002110,CDM,250,RC,68462057330,NDC,both,30,EA,0.64,0.25,39.4668,,0.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.45,70,,0.45,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.48,,,0.48,Other,225% of Medicaid,0.3,,,0.3,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.46,,,0.46,Other,215% Medicaid APG methodology,0.46,,,0.46,Other,215% Medicaid APG methodology,0.27,,,0.27,Other,125% Medicaid APG methodology,0.01,0.48,
VORICONZAZOLE 50MG INJ,,,,80002111,CDM,250,RC,49317030,NDC,both,30,EA,3.11,1.23,39.4668,,1.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.06,34,,1.06,percent of total billed charges,"Drugs, Inpatient Only",1.06,34,,1.06,percent of total billed charges,"Drugs, Inpatient Only",1.06,34,,1.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.18,70,,2.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.04,,,1.04,Other,Drug Cost,1.04,,,1.04,Other,Drug Cost,1.04,,,1.04,Other,Drug Cost,1.04,,,1.04,Other,Drug Cost,1.04,,,1.04,Other,Drug Cost,1.04,,,1.04,Other,Drug Cost,2.33,,,2.33,Other,225% of Medicaid,1.45,,,1.45,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.23,,,2.23,Other,215% Medicaid APG methodology,2.23,,,2.23,Other,215% Medicaid APG methodology,1.3,,,1.3,Other,125% Medicaid APG methodology,0.01,2.33,
WARFARIN SODIUM (COUMADIN) 1MG,,,,80002112,CDM,250,RC,93171201,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
WARFARIN SODIUM (COUMADIN) 2.5MG,,,,80002113,CDM,250,RC,65162076310,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
WARFARIN SODIUM (COUMADIN) 2MG,,,,80002114,CDM,250,RC,832121201,NDC,both,10,EA,1.87,0.74,39.4668,,0.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.63,34,,0.63,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.31,70,,1.31,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,0.62,,,0.62,Other,Drug Cost,1.4,,,1.4,Other,225% of Medicaid,0.87,,,0.87,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.34,,,1.34,Other,215% Medicaid APG methodology,1.34,,,1.34,Other,215% Medicaid APG methodology,0.78,,,0.78,Other,125% Medicaid APG methodology,0.01,1.4,
WARFARIN SODIUM (COUMADIN) 3MG,,,,80002115,CDM,250,RC,832121401,NDC,both,10,EA,2.08,0.82,39.4668,,0.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.71,34,,0.71,percent of total billed charges,"Drugs, Inpatient Only",0.71,34,,0.71,percent of total billed charges,"Drugs, Inpatient Only",0.71,34,,0.71,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.46,70,,1.46,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,1.56,,,1.56,Other,225% of Medicaid,0.97,,,0.97,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.49,,,1.49,Other,215% Medicaid APG methodology,1.49,,,1.49,Other,215% Medicaid APG methodology,0.87,,,0.87,Other,125% Medicaid APG methodology,0.01,1.56,
WARFARIN SODIUM (COUMADIN) 5MG,,,,80002116,CDM,250,RC,832121600,NDC,both,100,EA,0.17,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,70,,0.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.13,
ZETIA 10 MG,,,,80002122,CDM,250,RC,67877049030,NDC,both,30,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
ZIDORUDINE 100 MG CAPSULE,,,,80002124,CDM,250,RC,65862010701,NDC,both,100,EA,1.61,0.64,39.4668,,0.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.55,34,,0.55,percent of total billed charges,"Drugs, Inpatient Only",0.55,34,,0.55,percent of total billed charges,"Drugs, Inpatient Only",0.55,34,,0.55,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.13,70,,1.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.54,,,0.54,Other,Drug Cost,0.54,,,0.54,Other,Drug Cost,0.54,,,0.54,Other,Drug Cost,0.54,,,0.54,Other,Drug Cost,0.54,,,0.54,Other,Drug Cost,0.54,,,0.54,Other,Drug Cost,1.21,,,1.21,Other,225% of Medicaid,0.75,,,0.75,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.15,,,1.15,Other,215% Medicaid APG methodology,1.15,,,1.15,Other,215% Medicaid APG methodology,0.67,,,0.67,Other,125% Medicaid APG methodology,0.01,1.21,
ZIDOVUDINE 300MG TAB,,,,80002127,CDM,250,RC,31722050960,NDC,both,60,EA,0.54,0.21,39.4668,,0.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,34,,0.18,percent of total billed charges,"Drugs, Inpatient Only",0.18,34,,0.18,percent of total billed charges,"Drugs, Inpatient Only",0.18,34,,0.18,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.38,70,,0.38,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.41,,,0.41,Other,225% of Medicaid,0.25,,,0.25,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.39,,,0.39,Other,215% Medicaid APG methodology,0.39,,,0.39,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,125% Medicaid APG methodology,0.01,0.41,
ZINC 220MG CAP,,,,80002128,CDM,250,RC,20555004000,NDC,both,10,EA,3.92,1.55,39.4668,,1.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.33,34,,1.33,percent of total billed charges,"Drugs, Inpatient Only",1.33,34,,1.33,percent of total billed charges,"Drugs, Inpatient Only",1.33,34,,1.33,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.75,70,,2.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.31,,,1.31,Other,Drug Cost,1.31,,,1.31,Other,Drug Cost,1.31,,,1.31,Other,Drug Cost,1.31,,,1.31,Other,Drug Cost,1.31,,,1.31,Other,Drug Cost,1.31,,,1.31,Other,Drug Cost,2.94,,,2.94,Other,225% of Medicaid,1.83,,,1.83,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.81,,,2.81,Other,215% Medicaid APG methodology,2.81,,,2.81,Other,215% Medicaid APG methodology,1.64,,,1.64,Other,125% Medicaid APG methodology,0.01,2.94,
ZINC GLUCONATE 50 MG TAB,,,,80002129,CDM,250,RC,30768000691,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
ZINC OXIDE (DESITIN) 113 GM,,,,80002130,CDM,250,RC,74300000300,NDC,both,1,GM,13.05,5.15,39.4668,,5.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.44,34,,4.44,percent of total billed charges,"Drugs, Inpatient Only",4.44,34,,4.44,percent of total billed charges,"Drugs, Inpatient Only",4.44,34,,4.44,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.14,70,,9.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.35,,,4.35,Other,Drug Cost,4.35,,,4.35,Other,Drug Cost,4.35,,,4.35,Other,Drug Cost,4.35,,,4.35,Other,Drug Cost,4.35,,,4.35,Other,Drug Cost,4.35,,,4.35,Other,Drug Cost,9.79,,,9.79,Other,225% of Medicaid,6.09,,,6.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.35,,,9.35,Other,215% Medicaid APG methodology,9.35,,,9.35,Other,215% Medicaid APG methodology,5.44,,,5.44,Other,125% Medicaid APG methodology,0.01,9.79,
ZINC OXIDE 30 GM OINT,,,,80002131,CDM,250,RC,75834017001,NDC,both,1,GM,2.73,1.08,39.4668,,1.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.93,34,,0.93,percent of total billed charges,"Drugs, Inpatient Only",0.93,34,,0.93,percent of total billed charges,"Drugs, Inpatient Only",0.93,34,,0.93,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.91,70,,1.91,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.91,,,0.91,Other,Drug Cost,0.91,,,0.91,Other,Drug Cost,0.91,,,0.91,Other,Drug Cost,0.91,,,0.91,Other,Drug Cost,0.91,,,0.91,Other,Drug Cost,0.91,,,0.91,Other,Drug Cost,2.05,,,2.05,Other,225% of Medicaid,1.27,,,1.27,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.96,,,1.96,Other,215% Medicaid APG methodology,1.96,,,1.96,Other,215% Medicaid APG methodology,1.14,,,1.14,Other,125% Medicaid APG methodology,0.01,2.05,
ZIPRASIDONE HCL (GEODON) 20MG CAPS,,,,80002134,CDM,250,RC,55111025660,NDC,both,60,EA,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
ZIPRASIDONE HCL (GEODON) 60MG CAPS,,,,80002135,CDM,250,RC,55111025860,NDC,both,60,EA,0.25,0.1,39.4668,,0.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,70,,0.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.19,,,0.19,Other,225% of Medicaid,0.12,,,0.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.18,,,0.18,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.19,
ZIPRASIDONE HCL (GEODON) 80MG CAPS,,,,80002136,CDM,250,RC,55111025960,NDC,both,60,EA,0.23,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,70,,0.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.18,,,0.18,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.17,,,0.17,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.18,
ZOCOR 10 MG,,,,80002138,CDM,250,RC,63739057110,NDC,both,10,EA,2.86,1.13,39.4668,,1.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.97,34,,0.97,percent of total billed charges,"Drugs, Inpatient Only",0.97,34,,0.97,percent of total billed charges,"Drugs, Inpatient Only",0.97,34,,0.97,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2,70,,2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.95,,,0.95,Other,Drug Cost,0.95,,,0.95,Other,Drug Cost,0.95,,,0.95,Other,Drug Cost,0.95,,,0.95,Other,Drug Cost,0.95,,,0.95,Other,Drug Cost,0.95,,,0.95,Other,Drug Cost,2.14,,,2.14,Other,225% of Medicaid,1.33,,,1.33,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.05,,,2.05,Other,215% Medicaid APG methodology,2.05,,,2.05,Other,215% Medicaid APG methodology,1.19,,,1.19,Other,125% Medicaid APG methodology,0.01,2.14,
ZOLPIDEM TATRATE (AMBIEN) 5MG,,,,80002143,CDM,250,RC,13668000701,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ZONISAMIDE 100 MG CAP,,,,80002144,CDM,250,RC,69097086107,NDC,both,100,EA,0.13,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
ZONISAMIDE 25MG CAP,,,,80002145,CDM,250,RC,59651037801,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
ZYRTEC 10MG,,,,80002147,CDM,250,RC,378363701,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
OXYBUTYNIN ER 10MG TAB,,,,80002149,CDM,250,RC,50268062815,NDC,both,5,EA,57.01,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.38,34,,19.38,percent of total billed charges,"Drugs, Inpatient Only",19.38,34,,19.38,percent of total billed charges,"Drugs, Inpatient Only",19.38,34,,19.38,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,39.9,70,,39.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19,,,19,Other,Drug Cost,19,,,19,Other,Drug Cost,19,,,19,Other,Drug Cost,19,,,19,Other,Drug Cost,19,,,19,Other,Drug Cost,19,,,19,Other,Drug Cost,42.75,,,42.75,Other,225% of Medicaid,26.6,,,26.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,40.85,,,40.85,Other,215% Medicaid APG methodology,40.85,,,40.85,Other,215% Medicaid APG methodology,23.75,,,23.75,Other,125% Medicaid APG methodology,0.01,42.75,
ASPIRIN 81MG CHEWABLE TABLET,,,,80002151,CDM,250,RC,904679480,NDC,both,1000,EA,0.02,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
BUMETANIDE 0.5MG TABLETS,,,,80002154,CDM,250,RC,185012801,NDC,both,100,EA,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.08,
CEFDINIR 300MG CAPS,,,,80002156,CDM,250,RC,57237009960,NDC,both,60,EA,0.65,0.26,39.4668,,0.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.22,34,,0.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.46,70,,0.46,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.22,,,0.22,Other,Drug Cost,0.49,,,0.49,Other,225% of Medicaid,0.3,,,0.3,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.47,,,0.47,Other,215% Medicaid APG methodology,0.47,,,0.47,Other,215% Medicaid APG methodology,0.27,,,0.27,Other,125% Medicaid APG methodology,0.01,0.49,
CEFDINIR 125MG/5ML 60ML,,,,80002163,CDM,250,RC,67877054798,NDC,both,1,ML,7.11,2.81,39.4668,,2.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.42,34,,2.42,percent of total billed charges,"Drugs, Inpatient Only",2.42,34,,2.42,percent of total billed charges,"Drugs, Inpatient Only",2.42,34,,2.42,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.98,70,,4.98,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.37,,,2.37,Other,Drug Cost,2.37,,,2.37,Other,Drug Cost,2.37,,,2.37,Other,Drug Cost,2.37,,,2.37,Other,Drug Cost,2.37,,,2.37,Other,Drug Cost,2.37,,,2.37,Other,Drug Cost,5.33,,,5.33,Other,225% of Medicaid,3.32,,,3.32,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.1,,,5.1,Other,215% Medicaid APG methodology,5.1,,,5.1,Other,215% Medicaid APG methodology,2.96,,,2.96,Other,125% Medicaid APG methodology,0.01,5.33,
BUSPIRONE 10MG TABLET,,,,80002166,CDM,250,RC,93005401,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
NEO/POLY B/HYDR OTIC SUSP,,,,80002179,CDM,250,RC,61314064511,NDC,both,1,ML,35.85,14.15,39.4668,,14.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.19,34,,12.19,percent of total billed charges,"Drugs, Inpatient Only",12.19,34,,12.19,percent of total billed charges,"Drugs, Inpatient Only",12.19,34,,12.19,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,25.1,70,,25.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.95,,,11.95,Other,Drug Cost,11.95,,,11.95,Other,Drug Cost,11.95,,,11.95,Other,Drug Cost,11.95,,,11.95,Other,Drug Cost,11.95,,,11.95,Other,Drug Cost,11.95,,,11.95,Other,Drug Cost,26.89,,,26.89,Other,225% of Medicaid,16.73,,,16.73,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,25.69,,,25.69,Other,215% Medicaid APG methodology,25.69,,,25.69,Other,215% Medicaid APG methodology,14.94,,,14.94,Other,125% Medicaid APG methodology,0.01,26.89,
PROCHLORPERAZINE 10MG TABLET,,,,80002183,CDM,250,RC,59746011506,NDC,both,100,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
PROCHLORPERAZINE 5MG TABLET,,,,80002184,CDM,250,RC,59746011306,NDC,both,100,EA,0.14,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.1,
OLANZAPINE 5MG ODT,,,,80002185,CDM,250,RC,60505327503,NDC,both,30,EA,0.19,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.14,,,0.14,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
VALPROIC ACID 250MG CAPS,,,,80002188,CDM,250,RC,69452015020,NDC,both,100,EA,0.24,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,70,,0.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.18,,,0.18,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.17,,,0.17,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.18,
FONDAPARINUX 10MG/0.8ML INJ,,,,80002191,CDM,250,RC,67457058508,NDC,both,10,ML,23.04,9.09,39.4668,,9.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.83,34,,7.83,percent of total billed charges,"Drugs, Inpatient Only",7.83,34,,7.83,percent of total billed charges,"Drugs, Inpatient Only",7.83,34,,7.83,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.13,70,,16.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.68,,,7.68,Other,Drug Cost,7.68,,,7.68,Other,Drug Cost,7.68,,,7.68,Other,Drug Cost,7.68,,,7.68,Other,Drug Cost,7.68,,,7.68,Other,Drug Cost,7.68,,,7.68,Other,Drug Cost,17.28,,,17.28,Other,225% of Medicaid,10.75,,,10.75,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,16.51,,,16.51,Other,215% Medicaid APG methodology,16.51,,,16.51,Other,215% Medicaid APG methodology,9.6,,,9.6,Other,125% Medicaid APG methodology,0.01,17.28,
FLUPHENAZINE DECANOATE 25MG/ML 5ML INJ,,,,80002192,CDM,250,RC,143952901,NDC,both,1,ML,101.22,39.95,39.4668,,39.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,34.41,34,,34.41,percent of total billed charges,"Drugs, Inpatient Only",34.41,34,,34.41,percent of total billed charges,"Drugs, Inpatient Only",34.41,34,,34.41,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70.85,70,,70.85,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,33.74,,,33.74,Other,Drug Cost,33.74,,,33.74,Other,Drug Cost,33.74,,,33.74,Other,Drug Cost,33.74,,,33.74,Other,Drug Cost,33.74,,,33.74,Other,Drug Cost,33.74,,,33.74,Other,Drug Cost,75.92,,,75.92,Other,225% of Medicaid,47.24,,,47.24,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,72.54,,,72.54,Other,215% Medicaid APG methodology,72.54,,,72.54,Other,215% Medicaid APG methodology,42.18,,,42.18,Other,125% Medicaid APG methodology,0.01,75.92,
DEXMEDETOMIDINE 200MCG/2ML INJ,,,,80002193,CDM,250,RC,409163802,NDC,both,25,ML,0.83,0.33,39.4668,,0.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.58,70,,0.58,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.62,,,0.62,Other,225% of Medicaid,0.39,,,0.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.59,,,0.59,Other,215% Medicaid APG methodology,0.59,,,0.59,Other,215% Medicaid APG methodology,0.35,,,0.35,Other,125% Medicaid APG methodology,0.01,0.62,
LIDOCAINE 2% W/EPI 30ML INJ,,,,80002197,CDM,250,RC,409318202,NDC,both,25,ML,8.4,3.31,39.4668,,3.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.86,34,,2.86,percent of total billed charges,"Drugs, Inpatient Only",2.86,34,,2.86,percent of total billed charges,"Drugs, Inpatient Only",2.86,34,,2.86,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.88,70,,5.88,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.8,,,2.8,Other,Drug Cost,2.8,,,2.8,Other,Drug Cost,2.8,,,2.8,Other,Drug Cost,2.8,,,2.8,Other,Drug Cost,2.8,,,2.8,Other,Drug Cost,2.8,,,2.8,Other,Drug Cost,6.3,,,6.3,Other,225% of Medicaid,3.92,,,3.92,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.02,,,6.02,Other,215% Medicaid APG methodology,6.02,,,6.02,Other,215% Medicaid APG methodology,3.5,,,3.5,Other,125% Medicaid APG methodology,0.01,6.3,
LIDOCAINE-MPF 2% W/EPI 10ML INJ,,,,80002198,CDM,250,RC,63323048917,NDC,both,25,ML,6.71,2.65,39.4668,,2.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.28,34,,2.28,percent of total billed charges,"Drugs, Inpatient Only",2.28,34,,2.28,percent of total billed charges,"Drugs, Inpatient Only",2.28,34,,2.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.7,70,,4.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.24,,,2.24,Other,Drug Cost,2.24,,,2.24,Other,Drug Cost,2.24,,,2.24,Other,Drug Cost,2.24,,,2.24,Other,Drug Cost,2.24,,,2.24,Other,Drug Cost,2.24,,,2.24,Other,Drug Cost,5.03,,,5.03,Other,225% of Medicaid,3.13,,,3.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.81,,,4.81,Other,215% Medicaid APG methodology,4.81,,,4.81,Other,215% Medicaid APG methodology,2.8,,,2.8,Other,125% Medicaid APG methodology,0.01,5.03,
DILTIAZEM 60MG TABLET,,,,80002202,CDM,250,RC,93031901,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.06,
LEVOTHYROXINE 100MCG/VIAL,,,,80002204,CDM,250,RC,42023020101,NDC,both,1,EA,86.49,34.13,39.4668,,34.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,29.41,34,,29.41,percent of total billed charges,"Drugs, Inpatient Only",29.41,34,,29.41,percent of total billed charges,"Drugs, Inpatient Only",29.41,34,,29.41,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,60.54,70,,60.54,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,28.83,,,28.83,Other,Drug Cost,28.83,,,28.83,Other,Drug Cost,28.83,,,28.83,Other,Drug Cost,28.83,,,28.83,Other,Drug Cost,28.83,,,28.83,Other,Drug Cost,28.83,,,28.83,Other,Drug Cost,64.87,,,64.87,Other,225% of Medicaid,40.36,,,40.36,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,61.98,,,61.98,Other,215% Medicaid APG methodology,61.98,,,61.98,Other,215% Medicaid APG methodology,36.04,,,36.04,Other,125% Medicaid APG methodology,0.01,64.87,
HEPARIN 1000 UNIT/ML 30 ML VIAL,,,,80002205,CDM,250,RC,71288040231,NDC,both,25,ML,8.89,3.51,39.4668,,3.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.02,34,,3.02,percent of total billed charges,"Drugs, Inpatient Only",3.02,34,,3.02,percent of total billed charges,"Drugs, Inpatient Only",3.02,34,,3.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.22,70,,6.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.96,,,2.96,Other,Drug Cost,2.96,,,2.96,Other,Drug Cost,2.96,,,2.96,Other,Drug Cost,2.96,,,2.96,Other,Drug Cost,2.96,,,2.96,Other,Drug Cost,2.96,,,2.96,Other,Drug Cost,6.67,,,6.67,Other,225% of Medicaid,4.15,,,4.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.37,,,6.37,Other,215% Medicaid APG methodology,6.37,,,6.37,Other,215% Medicaid APG methodology,3.7,,,3.7,Other,125% Medicaid APG methodology,0.01,6.67,
LIDOCAINE 2% 10ML W/ PRESERVATIVES,,,,80002210,CDM,250,RC,55150025410,NDC,both,25,ML,1.23,0.49,39.4668,,0.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.42,34,,0.42,percent of total billed charges,"Drugs, Inpatient Only",0.42,34,,0.42,percent of total billed charges,"Drugs, Inpatient Only",0.42,34,,0.42,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.86,70,,0.86,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.92,,,0.92,Other,225% of Medicaid,0.57,,,0.57,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.88,,,0.88,Other,215% Medicaid APG methodology,0.88,,,0.88,Other,215% Medicaid APG methodology,0.51,,,0.51,Other,125% Medicaid APG methodology,0.01,0.92,
METOPROLOL TARTRATE 100MG TABLET,,,,80002212,CDM,250,RC,378004701,NDC,both,100,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
METOPROLOL SUCCINATE 100MG TB24 (100MG),,,,80002214,CDM,250,RC,378459777,NDC,both,90,EA,0.29,0.12,39.4668,,0.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,70,,0.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.22,,,0.22,Other,225% of Medicaid,0.14,,,0.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.21,,,0.21,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.22,
PANTOPRAZOLE 20MG DR TABLET,,,,80002215,CDM,250,RC,378668877,NDC,both,90,EA,0.04,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
PENICILLIN 5MIL UNIT/100ML NS,,,,80002245,CDM,250,RC,49052083,NDC,both,10,EA,9.64,3.8,39.4668,,3.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.28,34,,3.28,percent of total billed charges,"Drugs, Inpatient Only",3.28,34,,3.28,percent of total billed charges,"Drugs, Inpatient Only",3.28,34,,3.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.75,70,,6.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.21,,,3.21,Other,Drug Cost,3.21,,,3.21,Other,Drug Cost,3.21,,,3.21,Other,Drug Cost,3.21,,,3.21,Other,Drug Cost,3.21,,,3.21,Other,Drug Cost,3.21,,,3.21,Other,Drug Cost,7.23,,,7.23,Other,225% of Medicaid,4.5,,,4.5,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.91,,,6.91,Other,215% Medicaid APG methodology,6.91,,,6.91,Other,215% Medicaid APG methodology,4.02,,,4.02,Other,125% Medicaid APG methodology,0.01,7.23,
TETRACAINE 0.5% OPHTH SOLN 4ML,,,,80002272,CDM,250,RC,65074114,NDC,both,12,ML,26.88,10.61,39.4668,,10.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.14,34,,9.14,percent of total billed charges,"Drugs, Inpatient Only",9.14,34,,9.14,percent of total billed charges,"Drugs, Inpatient Only",9.14,34,,9.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.81,70,,18.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.96,,,8.96,Other,Drug Cost,8.96,,,8.96,Other,Drug Cost,8.96,,,8.96,Other,Drug Cost,8.96,,,8.96,Other,Drug Cost,8.96,,,8.96,Other,Drug Cost,8.96,,,8.96,Other,Drug Cost,20.16,,,20.16,Other,225% of Medicaid,12.54,,,12.54,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,19.26,,,19.26,Other,215% Medicaid APG methodology,19.26,,,19.26,Other,215% Medicaid APG methodology,11.2,,,11.2,Other,125% Medicaid APG methodology,0.01,20.16,
ELECTROLYTE S 1000ML,,,,80002273,CDM,250,RC,338022104,NDC,both,14,ML,9.98,3.94,39.4668,,3.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.39,34,,3.39,percent of total billed charges,"Drugs, Inpatient Only",3.39,34,,3.39,percent of total billed charges,"Drugs, Inpatient Only",3.39,34,,3.39,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.98,70,,6.98,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.33,,,3.33,Other,Drug Cost,3.33,,,3.33,Other,Drug Cost,3.33,,,3.33,Other,Drug Cost,3.33,,,3.33,Other,Drug Cost,3.33,,,3.33,Other,Drug Cost,3.33,,,3.33,Other,Drug Cost,7.48,,,7.48,Other,225% of Medicaid,4.66,,,4.66,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.15,,,7.15,Other,215% Medicaid APG methodology,7.15,,,7.15,Other,215% Medicaid APG methodology,4.16,,,4.16,Other,125% Medicaid APG methodology,0.01,7.48,
"ZINC OXIDE BANDAGE 3"" (UNNA BOOT)",,,,80002276,CDM,250,RC,68455010763,NDC,both,1,EA,11.46,4.52,39.4668,,4.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.9,34,,3.9,percent of total billed charges,"Drugs, Inpatient Only",3.9,34,,3.9,percent of total billed charges,"Drugs, Inpatient Only",3.9,34,,3.9,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.02,70,,8.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.82,,,3.82,Other,Drug Cost,3.82,,,3.82,Other,Drug Cost,3.82,,,3.82,Other,Drug Cost,3.82,,,3.82,Other,Drug Cost,3.82,,,3.82,Other,Drug Cost,3.82,,,3.82,Other,Drug Cost,8.6,,,8.6,Other,225% of Medicaid,5.35,,,5.35,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.21,,,8.21,Other,215% Medicaid APG methodology,8.21,,,8.21,Other,215% Medicaid APG methodology,4.78,,,4.78,Other,125% Medicaid APG methodology,0.01,8.6,
NACL W/40MEQ KCL 1000ML,,,,80002277,CDM,250,RC,990711609,NDC,both,12,ML,9.7,3.83,39.4668,,3.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.3,34,,3.3,percent of total billed charges,"Drugs, Inpatient Only",3.3,34,,3.3,percent of total billed charges,"Drugs, Inpatient Only",3.3,34,,3.3,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.79,70,,6.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.23,,,3.23,Other,Drug Cost,3.23,,,3.23,Other,Drug Cost,3.23,,,3.23,Other,Drug Cost,3.23,,,3.23,Other,Drug Cost,3.23,,,3.23,Other,Drug Cost,3.23,,,3.23,Other,Drug Cost,7.28,,,7.28,Other,225% of Medicaid,4.53,,,4.53,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.95,,,6.95,Other,215% Medicaid APG methodology,6.95,,,6.95,Other,215% Medicaid APG methodology,4.04,,,4.04,Other,125% Medicaid APG methodology,0.01,7.28,
HUMULIN R INSULIN,,,,80002278,CDM,250,RC,2821501,NDC,both,1,ML,41.61,16.42,39.4668,,16.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.15,34,,14.15,percent of total billed charges,"Drugs, Inpatient Only",14.15,34,,14.15,percent of total billed charges,"Drugs, Inpatient Only",14.15,34,,14.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,29.13,70,,29.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.87,,,13.87,Other,Drug Cost,13.87,,,13.87,Other,Drug Cost,13.87,,,13.87,Other,Drug Cost,13.87,,,13.87,Other,Drug Cost,13.87,,,13.87,Other,Drug Cost,13.87,,,13.87,Other,Drug Cost,31.21,,,31.21,Other,225% of Medicaid,19.42,,,19.42,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,29.82,,,29.82,Other,215% Medicaid APG methodology,29.82,,,29.82,Other,215% Medicaid APG methodology,17.34,,,17.34,Other,125% Medicaid APG methodology,0.01,31.21,
AZITHROMYCIN 250MG TAB,,,,80002279,CDM,250,RC,50111078751,NDC,both,6,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
BENZOCAINE 20% SPRAY (UNIT DOSE),,,,80002288,CDM,250,RC,283061026,NDC,both,25,ML,28.17,11.12,39.4668,,11.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.58,34,,9.58,percent of total billed charges,"Drugs, Inpatient Only",9.58,34,,9.58,percent of total billed charges,"Drugs, Inpatient Only",9.58,34,,9.58,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.72,70,,19.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.39,,,9.39,Other,Drug Cost,9.39,,,9.39,Other,Drug Cost,9.39,,,9.39,Other,Drug Cost,9.39,,,9.39,Other,Drug Cost,9.39,,,9.39,Other,Drug Cost,9.39,,,9.39,Other,Drug Cost,21.13,,,21.13,Other,225% of Medicaid,13.15,,,13.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,20.19,,,20.19,Other,215% Medicaid APG methodology,20.19,,,20.19,Other,215% Medicaid APG methodology,11.74,,,11.74,Other,125% Medicaid APG methodology,0.01,21.13,
BUPROPION HCL 100MG TAB SR,,,,80002289,CDM,250,RC,173094755,NDC,both,60,EA,0.51,0.2,39.4668,,0.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.36,70,,0.36,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.38,,,0.38,Other,225% of Medicaid,0.24,,,0.24,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.37,,,0.37,Other,215% Medicaid APG methodology,0.37,,,0.37,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,125% Medicaid APG methodology,0.01,0.38,
BUPIVACAINE/EPI 0.25-.0005 30ML VIAL,,,,80002292,CDM,250,RC,63323046837,NDC,both,25,ML,18.56,7.33,39.4668,,7.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.31,34,,6.31,percent of total billed charges,"Drugs, Inpatient Only",6.31,34,,6.31,percent of total billed charges,"Drugs, Inpatient Only",6.31,34,,6.31,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.99,70,,12.99,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.19,,,6.19,Other,Drug Cost,6.19,,,6.19,Other,Drug Cost,6.19,,,6.19,Other,Drug Cost,6.19,,,6.19,Other,Drug Cost,6.19,,,6.19,Other,Drug Cost,6.19,,,6.19,Other,Drug Cost,13.92,,,13.92,Other,225% of Medicaid,8.66,,,8.66,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,13.3,,,13.3,Other,215% Medicaid APG methodology,13.3,,,13.3,Other,215% Medicaid APG methodology,7.73,,,7.73,Other,125% Medicaid APG methodology,0.01,13.92,
BUPIVACAINE/EPI 0.5-0.0005 30M VIAL,,,,80002293,CDM,250,RC,409174929,NDC,both,10,ML,9.86,3.89,39.4668,,3.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.35,34,,3.35,percent of total billed charges,"Drugs, Inpatient Only",3.35,34,,3.35,percent of total billed charges,"Drugs, Inpatient Only",3.35,34,,3.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.9,70,,6.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,7.39,,,7.39,Other,225% of Medicaid,4.6,,,4.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.06,,,7.06,Other,215% Medicaid APG methodology,7.06,,,7.06,Other,215% Medicaid APG methodology,4.11,,,4.11,Other,125% Medicaid APG methodology,0.01,7.39,
DEXAMETHASONE SOD PHOS (PF) 10MG/ML VIAL,,,,80002302,CDM,250,RC,63323050601,NDC,both,25,ML,3.48,1.37,39.4668,,1.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.18,34,,1.18,percent of total billed charges,"Drugs, Inpatient Only",1.18,34,,1.18,percent of total billed charges,"Drugs, Inpatient Only",1.18,34,,1.18,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.43,70,,2.43,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.16,,,1.16,Other,Drug Cost,1.16,,,1.16,Other,Drug Cost,1.16,,,1.16,Other,Drug Cost,1.16,,,1.16,Other,Drug Cost,1.16,,,1.16,Other,Drug Cost,1.16,,,1.16,Other,Drug Cost,2.61,,,2.61,Other,225% of Medicaid,1.62,,,1.62,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.49,,,2.49,Other,215% Medicaid APG methodology,2.49,,,2.49,Other,215% Medicaid APG methodology,1.45,,,1.45,Other,125% Medicaid APG methodology,0.01,2.61,
FLUPHENAZINE HCL 1MG TAB,,,,80002307,CDM,250,RC,527178801,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
HEPARIN SOD (PORCINE) 100UNIT/ML 5ML,,,,80002314,CDM,250,RC,63807060005,NDC,both,100,ML,1.16,0.46,39.4668,,0.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.4,34,,0.4,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.81,70,,0.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.39,,,0.39,Other,Drug Cost,0.87,,,0.87,Other,225% of Medicaid,0.54,,,0.54,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.83,,,0.83,Other,215% Medicaid APG methodology,0.83,,,0.83,Other,215% Medicaid APG methodology,0.48,,,0.48,Other,125% Medicaid APG methodology,0.01,0.87,
HYDROMORPHONE HCL 4MG/ML 1ML DISP SYRG,,,,80002316,CDM,250,RC,409130431,NDC,both,10,ML,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
INS HUMULIN 70/30 100 UNITS/ML 3ML VIAL,,,,80002318,CDM,250,RC,2871501,NDC,both,1,ML,48.51,19.15,39.4668,,19.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.49,34,,16.49,percent of total billed charges,"Drugs, Inpatient Only",16.49,34,,16.49,percent of total billed charges,"Drugs, Inpatient Only",16.49,34,,16.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,33.96,70,,33.96,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.17,,,16.17,Other,Drug Cost,16.17,,,16.17,Other,Drug Cost,16.17,,,16.17,Other,Drug Cost,16.17,,,16.17,Other,Drug Cost,16.17,,,16.17,Other,Drug Cost,16.17,,,16.17,Other,Drug Cost,36.38,,,36.38,Other,225% of Medicaid,22.64,,,22.64,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,34.77,,,34.77,Other,215% Medicaid APG methodology,34.77,,,34.77,Other,215% Medicaid APG methodology,20.21,,,20.21,Other,125% Medicaid APG methodology,0.01,36.38,
INSULIN HUMULIN N 100UNITS/ML 3ML VIAL,,,,80002319,CDM,250,RC,2831501,NDC,both,1,ML,41.61,16.42,39.4668,,16.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.15,34,,14.15,percent of total billed charges,"Drugs, Inpatient Only",14.15,34,,14.15,percent of total billed charges,"Drugs, Inpatient Only",14.15,34,,14.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,29.13,70,,29.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.87,,,13.87,Other,Drug Cost,13.87,,,13.87,Other,Drug Cost,13.87,,,13.87,Other,Drug Cost,13.87,,,13.87,Other,Drug Cost,13.87,,,13.87,Other,Drug Cost,13.87,,,13.87,Other,Drug Cost,31.21,,,31.21,Other,225% of Medicaid,19.42,,,19.42,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,29.82,,,29.82,Other,215% Medicaid APG methodology,29.82,,,29.82,Other,215% Medicaid APG methodology,17.34,,,17.34,Other,125% Medicaid APG methodology,0.01,31.21,
LANOLIN PURIFIED (LANSINOH) CREAM (GM),,,,80002320,CDM,250,RC,44677010202,NDC,both,1,GM,7.44,2.94,39.4668,,2.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.53,34,,2.53,percent of total billed charges,"Drugs, Inpatient Only",2.53,34,,2.53,percent of total billed charges,"Drugs, Inpatient Only",2.53,34,,2.53,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.21,70,,5.21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.48,,,2.48,Other,Drug Cost,2.48,,,2.48,Other,Drug Cost,2.48,,,2.48,Other,Drug Cost,2.48,,,2.48,Other,Drug Cost,2.48,,,2.48,Other,Drug Cost,2.48,,,2.48,Other,Drug Cost,5.58,,,5.58,Other,225% of Medicaid,3.47,,,3.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.33,,,5.33,Other,215% Medicaid APG methodology,5.33,,,5.33,Other,215% Medicaid APG methodology,3.1,,,3.1,Other,125% Medicaid APG methodology,0.01,5.58,
BUTALBITAL-ACETAMINOPHEN 50-325MG TAB,,,,80002322,CDM,250,RC,527169505,NDC,both,500,EA,0.2,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,70,,0.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.15,,,0.15,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.14,,,0.14,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.15,
LIDOCAINE HCL 2% 20MG/ML 2ML AMPULE,,,,80002327,CDM,250,RC,63323049527,NDC,both,25,ML,1.06,0.42,39.4668,,0.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.36,34,,0.36,percent of total billed charges,"Drugs, Inpatient Only",0.36,34,,0.36,percent of total billed charges,"Drugs, Inpatient Only",0.36,34,,0.36,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.74,70,,0.74,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.35,,,0.35,Other,Drug Cost,0.35,,,0.35,Other,Drug Cost,0.35,,,0.35,Other,Drug Cost,0.35,,,0.35,Other,Drug Cost,0.35,,,0.35,Other,Drug Cost,0.35,,,0.35,Other,Drug Cost,0.79,,,0.79,Other,225% of Medicaid,0.49,,,0.49,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.76,,,0.76,Other,215% Medicaid APG methodology,0.76,,,0.76,Other,215% Medicaid APG methodology,0.44,,,0.44,Other,125% Medicaid APG methodology,0.01,0.79,
LIDOCAINE-MPF 1% 5ML AMPULE,,,,80002331,CDM,250,RC,55150016205,NDC,both,10,ML,2.53,1,39.4668,,1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.86,34,,0.86,percent of total billed charges,"Drugs, Inpatient Only",0.86,34,,0.86,percent of total billed charges,"Drugs, Inpatient Only",0.86,34,,0.86,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.77,70,,1.77,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.84,,,0.84,Other,Drug Cost,0.84,,,0.84,Other,Drug Cost,0.84,,,0.84,Other,Drug Cost,0.84,,,0.84,Other,Drug Cost,0.84,,,0.84,Other,Drug Cost,0.84,,,0.84,Other,Drug Cost,1.89,,,1.89,Other,225% of Medicaid,1.18,,,1.18,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.81,,,1.81,Other,215% Medicaid APG methodology,1.81,,,1.81,Other,215% Medicaid APG methodology,1.05,,,1.05,Other,125% Medicaid APG methodology,0.01,1.89,
LURASIDONE 20MG TABLET,,,,80002333,CDM,250,RC,67877063830,NDC,both,30,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
MELATONIN 1MG TAB,,,,80002336,CDM,250,RC,74312002832,NDC,both,180,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
MELATONIN 3MG TAB,,,,80002337,CDM,250,RC,96295012827,NDC,both,100,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
METHOCARBAMOL 750MG TABLET,,,,80002341,CDM,250,RC,70010077001,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
HEPARIN SOD(PORCINE) 1000UNIT/ML 10ML VL,,,,80002342,CDM,250,RC,69005801,NDC,both,25,ML,0.27,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,70,,0.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.19,,,0.19,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.2,
MINERAL OIL (MURI-LUBE) 10ML OIL,,,,80002345,CDM,250,RC,63323025410,NDC,both,25,ML,54.3,21.43,39.4668,,21.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.46,34,,18.46,percent of total billed charges,"Drugs, Inpatient Only",18.46,34,,18.46,percent of total billed charges,"Drugs, Inpatient Only",18.46,34,,18.46,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.01,70,,38.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.1,,,18.1,Other,Drug Cost,18.1,,,18.1,Other,Drug Cost,18.1,,,18.1,Other,Drug Cost,18.1,,,18.1,Other,Drug Cost,18.1,,,18.1,Other,Drug Cost,18.1,,,18.1,Other,Drug Cost,40.73,,,40.73,Other,225% of Medicaid,25.34,,,25.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,38.92,,,38.92,Other,215% Medicaid APG methodology,38.92,,,38.92,Other,215% Medicaid APG methodology,22.63,,,22.63,Other,125% Medicaid APG methodology,0.01,40.73,
MINERAL OIL 30ML CUP,,,,80002346,CDM,250,RC,48433020230,NDC,both,40,ML,5.83,2.3,39.4668,,2.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.98,34,,1.98,percent of total billed charges,"Drugs, Inpatient Only",1.98,34,,1.98,percent of total billed charges,"Drugs, Inpatient Only",1.98,34,,1.98,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.08,70,,4.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.94,,,1.94,Other,Drug Cost,1.94,,,1.94,Other,Drug Cost,1.94,,,1.94,Other,Drug Cost,1.94,,,1.94,Other,Drug Cost,1.94,,,1.94,Other,Drug Cost,1.94,,,1.94,Other,Drug Cost,4.37,,,4.37,Other,225% of Medicaid,2.72,,,2.72,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.18,,,4.18,Other,215% Medicaid APG methodology,4.18,,,4.18,Other,215% Medicaid APG methodology,2.43,,,2.43,Other,125% Medicaid APG methodology,0.01,4.37,
MULTIVITAMIN W MINERALS TAB,,,,80002353,CDM,250,RC,40985022368,NDC,both,130,EA,0.14,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
MUPIROCIN 2% 15GM OINTMENT,,,,80002355,CDM,250,RC,51672131200,NDC,both,1,GM,4.02,1.59,39.4668,,1.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.37,34,,1.37,percent of total billed charges,"Drugs, Inpatient Only",1.37,34,,1.37,percent of total billed charges,"Drugs, Inpatient Only",1.37,34,,1.37,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.81,70,,2.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,3.02,,,3.02,Other,225% of Medicaid,1.88,,,1.88,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.88,,,2.88,Other,215% Medicaid APG methodology,2.88,,,2.88,Other,215% Medicaid APG methodology,1.68,,,1.68,Other,125% Medicaid APG methodology,0.01,3.02,
PENICILLIN G BENZATHINE 2.4 MILLION SYRG,,,,80002362,CDM,250,RC,60793070210,NDC,both,10,ML,0.11,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.08,
POTASSIUM CHLORIDE 20MEQ/15ML LIQUID,,,,80002367,CDM,250,RC,603154258,NDC,both,1,ML,18.33,7.23,39.4668,,7.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.23,34,,6.23,percent of total billed charges,"Drugs, Inpatient Only",6.23,34,,6.23,percent of total billed charges,"Drugs, Inpatient Only",6.23,34,,6.23,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.83,70,,12.83,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.11,,,6.11,Other,Drug Cost,6.11,,,6.11,Other,Drug Cost,6.11,,,6.11,Other,Drug Cost,6.11,,,6.11,Other,Drug Cost,6.11,,,6.11,Other,Drug Cost,6.11,,,6.11,Other,Drug Cost,13.75,,,13.75,Other,225% of Medicaid,8.55,,,8.55,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,13.14,,,13.14,Other,215% Medicaid APG methodology,13.14,,,13.14,Other,215% Medicaid APG methodology,7.64,,,7.64,Other,125% Medicaid APG methodology,0.01,13.75,
PRIMIDONE 50MG TAB,,,,80002371,CDM,250,RC,53746054401,NDC,both,100,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
TACROLIMUS 0.5MG CAPSULE,,,,80002378,CDM,250,RC,16729004101,NDC,both,100,EA,0.16,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
TOBRAMYCIN/DEXAMETH 0.3-0.1% 2.5ML SOLN,,,,80002381,CDM,250,RC,24208029525,NDC,both,1,ML,4.62,1.82,39.4668,,1.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.57,34,,1.57,percent of total billed charges,"Drugs, Inpatient Only",1.57,34,,1.57,percent of total billed charges,"Drugs, Inpatient Only",1.57,34,,1.57,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.23,70,,3.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,3.47,,,3.47,Other,225% of Medicaid,2.16,,,2.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.31,,,3.31,Other,215% Medicaid APG methodology,3.31,,,3.31,Other,215% Medicaid APG methodology,1.93,,,1.93,Other,125% Medicaid APG methodology,0.01,3.47,
TRIAMCINOLONE ACETONIDE 0.1% 80GM CREAM,,,,80002382,CDM,250,RC,45802006436,NDC,both,1,GM,3.9,1.54,39.4668,,1.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.33,34,,1.33,percent of total billed charges,"Drugs, Inpatient Only",1.33,34,,1.33,percent of total billed charges,"Drugs, Inpatient Only",1.33,34,,1.33,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.73,70,,2.73,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.3,,,1.3,Other,Drug Cost,1.3,,,1.3,Other,Drug Cost,1.3,,,1.3,Other,Drug Cost,1.3,,,1.3,Other,Drug Cost,1.3,,,1.3,Other,Drug Cost,1.3,,,1.3,Other,Drug Cost,2.93,,,2.93,Other,225% of Medicaid,1.82,,,1.82,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.8,,,2.8,Other,215% Medicaid APG methodology,2.8,,,2.8,Other,215% Medicaid APG methodology,1.63,,,1.63,Other,125% Medicaid APG methodology,0.01,2.93,
TRIAMCINOLONE ACETONIDE 40MG/ML 1ML VL,,,,80002383,CDM,250,RC,70121104902,NDC,both,1,ML,8.07,3.18,39.4668,,3.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.74,34,,2.74,percent of total billed charges,"Drugs, Inpatient Only",2.74,34,,2.74,percent of total billed charges,"Drugs, Inpatient Only",2.74,34,,2.74,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.65,70,,5.65,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.69,,,2.69,Other,Drug Cost,2.69,,,2.69,Other,Drug Cost,2.69,,,2.69,Other,Drug Cost,2.69,,,2.69,Other,Drug Cost,2.69,,,2.69,Other,Drug Cost,2.69,,,2.69,Other,Drug Cost,6.05,,,6.05,Other,225% of Medicaid,3.77,,,3.77,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.78,,,5.78,Other,215% Medicaid APG methodology,5.78,,,5.78,Other,215% Medicaid APG methodology,3.36,,,3.36,Other,125% Medicaid APG methodology,0.01,6.05,
TUCKS MEDICATED PADS,,,,80002384,CDM,250,RC,50289325001,NDC,both,40,EA,0.17,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.12,70,,0.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.12,,,0.12,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.12,,,0.12,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.12,
UNNA BOOT 4 INCH,,,,80002385,CDM,250,RC,68455010764,NDC,both,1,EA,13.05,5.15,39.4668,,5.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.44,34,,4.44,percent of total billed charges,"Drugs, Inpatient Only",4.44,34,,4.44,percent of total billed charges,"Drugs, Inpatient Only",4.44,34,,4.44,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.14,70,,9.14,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.35,,,4.35,Other,Drug Cost,4.35,,,4.35,Other,Drug Cost,4.35,,,4.35,Other,Drug Cost,4.35,,,4.35,Other,Drug Cost,4.35,,,4.35,Other,Drug Cost,4.35,,,4.35,Other,Drug Cost,9.79,,,9.79,Other,225% of Medicaid,6.09,,,6.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.35,,,9.35,Other,215% Medicaid APG methodology,9.35,,,9.35,Other,215% Medicaid APG methodology,5.44,,,5.44,Other,125% Medicaid APG methodology,0.01,9.79,
VENLAFAXINE HCL 50MG TAB,,,,80002388,CDM,250,RC,57237017401,NDC,both,100,EA,0.06,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
VERAPAMIL HCL 2.5MG/ML 2ML VIAL,,,,80002389,CDM,250,RC,51754020302,NDC,both,5,ML,8.15,3.22,39.4668,,3.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.77,34,,2.77,percent of total billed charges,"Drugs, Inpatient Only",2.77,34,,2.77,percent of total billed charges,"Drugs, Inpatient Only",2.77,34,,2.77,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.71,70,,5.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,2.72,,,2.72,Other,Drug Cost,6.12,,,6.12,Other,225% of Medicaid,3.81,,,3.81,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.84,,,5.84,Other,215% Medicaid APG methodology,5.84,,,5.84,Other,215% Medicaid APG methodology,3.4,,,3.4,Other,125% Medicaid APG methodology,0.01,6.12,
WARFARIN SODIUM 7.5MG TAB,,,,80002394,CDM,250,RC,832121801,NDC,both,10,EA,2.08,0.82,39.4668,,0.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.71,34,,0.71,percent of total billed charges,"Drugs, Inpatient Only",0.71,34,,0.71,percent of total billed charges,"Drugs, Inpatient Only",0.71,34,,0.71,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.45,70,,1.45,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,0.69,,,0.69,Other,Drug Cost,1.56,,,1.56,Other,225% of Medicaid,0.97,,,0.97,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.49,,,1.49,Other,215% Medicaid APG methodology,1.49,,,1.49,Other,215% Medicaid APG methodology,0.87,,,0.87,Other,125% Medicaid APG methodology,0.01,1.56,
ZONISAMIDE CAPSULES 50MG CAPSULE,,,,80002395,CDM,250,RC,62756025902,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
AMOXICILLIN 200MG/5ML SUSP 50ML,,,,80002397,CDM,250,RC,781615652,NDC,both,1,ML,1.35,0.53,39.4668,,0.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.46,34,,0.46,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.95,70,,0.95,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,1.01,,,1.01,Other,225% of Medicaid,0.63,,,0.63,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.97,,,0.97,Other,215% Medicaid APG methodology,0.97,,,0.97,Other,215% Medicaid APG methodology,0.56,,,0.56,Other,125% Medicaid APG methodology,0.01,1.01,
HYDROXYZINE HCL 10MG TAB,,,,80002400,CDM,250,RC,23155050001,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
BALANCED SALT (BSS) 15ML OPHTH,,,,80002407,CDM,250,RC,65079515,NDC,both,36,ML,1.01,0.4,39.4668,,0.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,34,,0.34,percent of total billed charges,"Drugs, Inpatient Only",0.34,34,,0.34,percent of total billed charges,"Drugs, Inpatient Only",0.34,34,,0.34,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.7,70,,0.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.75,,,0.75,Other,225% of Medicaid,0.47,,,0.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.72,,,0.72,Other,215% Medicaid APG methodology,0.72,,,0.72,Other,215% Medicaid APG methodology,0.42,,,0.42,Other,125% Medicaid APG methodology,0.01,0.75,
BALANCED SALT-PLUS 500ML OPHTH,,,,80002408,CDM,250,RC,65080050,NDC,both,6,ML,24.35,9.61,39.4668,,9.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.28,34,,8.28,percent of total billed charges,"Drugs, Inpatient Only",8.28,34,,8.28,percent of total billed charges,"Drugs, Inpatient Only",8.28,34,,8.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.05,70,,17.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.12,,,8.12,Other,Drug Cost,8.12,,,8.12,Other,Drug Cost,8.12,,,8.12,Other,Drug Cost,8.12,,,8.12,Other,Drug Cost,8.12,,,8.12,Other,Drug Cost,8.12,,,8.12,Other,Drug Cost,18.26,,,18.26,Other,225% of Medicaid,11.36,,,11.36,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,17.45,,,17.45,Other,215% Medicaid APG methodology,17.45,,,17.45,Other,215% Medicaid APG methodology,10.15,,,10.15,Other,125% Medicaid APG methodology,0.01,18.26,
CALCIUM 600MG W/VIT D3 TAB,,,,80002409,CDM,250,RC,80681002900,NDC,both,60,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.03,
HEPARIN 25000 UNITS/0.45% NS 500ML,,,,80002410,CDM,250,RC,63323051877,NDC,both,24,ML,13.59,5.36,39.4668,,5.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.62,34,,4.62,percent of total billed charges,"Drugs, Inpatient Only",4.62,34,,4.62,percent of total billed charges,"Drugs, Inpatient Only",4.62,34,,4.62,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.51,70,,9.51,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.53,,,4.53,Other,Drug Cost,4.53,,,4.53,Other,Drug Cost,4.53,,,4.53,Other,Drug Cost,4.53,,,4.53,Other,Drug Cost,4.53,,,4.53,Other,Drug Cost,4.53,,,4.53,Other,Drug Cost,10.19,,,10.19,Other,225% of Medicaid,6.34,,,6.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.74,,,9.74,Other,215% Medicaid APG methodology,9.74,,,9.74,Other,215% Medicaid APG methodology,5.66,,,5.66,Other,125% Medicaid APG methodology,0.01,10.19,
HEPARIN 2000 UNITS/NS 1000ML,,,,80002411,CDM,250,RC,409762059,NDC,both,12,ML,11.68,4.61,39.4668,,4.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.97,34,,3.97,percent of total billed charges,"Drugs, Inpatient Only",3.97,34,,3.97,percent of total billed charges,"Drugs, Inpatient Only",3.97,34,,3.97,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.18,70,,8.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,8.76,,,8.76,Other,225% of Medicaid,5.45,,,5.45,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.37,,,8.37,Other,215% Medicaid APG methodology,8.37,,,8.37,Other,215% Medicaid APG methodology,4.87,,,4.87,Other,125% Medicaid APG methodology,0.01,8.76,
NS 5ML FLUSH,,,,80002417,CDM,250,RC,8290306545,NDC,both,30,ML,0.78,0.31,39.4668,,0.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.26,34,,0.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.55,70,,0.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.58,,,0.58,Other,225% of Medicaid,0.36,,,0.36,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.56,,,0.56,Other,215% Medicaid APG methodology,0.56,,,0.56,Other,215% Medicaid APG methodology,0.32,,,0.32,Other,125% Medicaid APG methodology,0.01,0.58,
NS 10ML FLUSH,,,,80002418,CDM,250,RC,8290306546,NDC,both,30,ML,0.71,0.28,39.4668,,0.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.24,34,,0.24,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.5,70,,0.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.24,,,0.24,Other,Drug Cost,0.24,,,0.24,Other,Drug Cost,0.24,,,0.24,Other,Drug Cost,0.24,,,0.24,Other,Drug Cost,0.24,,,0.24,Other,Drug Cost,0.24,,,0.24,Other,Drug Cost,0.53,,,0.53,Other,225% of Medicaid,0.33,,,0.33,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.51,,,0.51,Other,215% Medicaid APG methodology,0.51,,,0.51,Other,215% Medicaid APG methodology,0.3,,,0.3,Other,125% Medicaid APG methodology,0.01,0.53,
SOD BIPHOSPHATE-SOD PHOS(PED) ENEMA,,,,80002450,CDM,250,RC,132020220,NDC,both,1,ML,4.62,1.82,39.4668,,1.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.57,34,,1.57,percent of total billed charges,"Drugs, Inpatient Only",1.57,34,,1.57,percent of total billed charges,"Drugs, Inpatient Only",1.57,34,,1.57,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.23,70,,3.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,3.47,,,3.47,Other,225% of Medicaid,2.16,,,2.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.31,,,3.31,Other,215% Medicaid APG methodology,3.31,,,3.31,Other,215% Medicaid APG methodology,1.93,,,1.93,Other,125% Medicaid APG methodology,0.01,3.47,
PHENYLEPHRINE 0.5% NASAL SPRAY,,,,80002451,CDM,250,RC,225080547,NDC,both,1,ML,11.7,4.62,39.4668,,4.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.98,34,,3.98,percent of total billed charges,"Drugs, Inpatient Only",3.98,34,,3.98,percent of total billed charges,"Drugs, Inpatient Only",3.98,34,,3.98,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.19,70,,8.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.9,,,3.9,Other,Drug Cost,3.9,,,3.9,Other,Drug Cost,3.9,,,3.9,Other,Drug Cost,3.9,,,3.9,Other,Drug Cost,3.9,,,3.9,Other,Drug Cost,3.9,,,3.9,Other,Drug Cost,8.78,,,8.78,Other,225% of Medicaid,5.46,,,5.46,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.39,,,8.39,Other,215% Medicaid APG methodology,8.39,,,8.39,Other,215% Medicaid APG methodology,4.88,,,4.88,Other,125% Medicaid APG methodology,0.01,8.78,
PREDNISOLONE 1% OPTH SOLN,,,,80002453,CDM,250,RC,11980018005,NDC,both,1,ML,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
NEFAZODONE 100MG TAB,,,,80002455,CDM,250,RC,93102406,NDC,both,60,EA,0.83,0.33,39.4668,,0.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.58,70,,0.58,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.62,,,0.62,Other,225% of Medicaid,0.39,,,0.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.59,,,0.59,Other,215% Medicaid APG methodology,0.59,,,0.59,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,0.62,
SODIUM CHLORIDE 0.45% 1000ML,,,,80002456,CDM,250,RC,264780200,NDC,both,1000,ML,2.44,0.96,39.4668,,0.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.83,34,,0.83,percent of total billed charges,"Drugs, Inpatient Only",0.83,34,,0.83,percent of total billed charges,"Drugs, Inpatient Only",0.83,34,,0.83,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.71,70,,1.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.81,,,0.81,Other,Drug Cost,0.81,,,0.81,Other,Drug Cost,0.81,,,0.81,Other,Drug Cost,0.81,,,0.81,Other,Drug Cost,0.81,,,0.81,Other,Drug Cost,0.81,,,0.81,Other,Drug Cost,1.83,,,1.83,Other,225% of Medicaid,1.14,,,1.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.75,,,1.75,Other,215% Medicaid APG methodology,1.75,,,1.75,Other,215% Medicaid APG methodology,1.02,,,1.02,Other,125% Medicaid APG methodology,0.01,1.83,
HEPATITIS B VACCINE (STATE),,,,80002463,CDM,250,RC,6498100,NDC,both,10,ML,76.06,30.02,39.4668,,30.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,25.86,34,,25.86,percent of total billed charges,"Drugs, Inpatient Only",25.86,34,,25.86,percent of total billed charges,"Drugs, Inpatient Only",25.86,34,,25.86,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,53.24,70,,53.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,25.35,,,25.35,Other,Drug Cost,25.35,,,25.35,Other,Drug Cost,25.35,,,25.35,Other,Drug Cost,25.35,,,25.35,Other,Drug Cost,25.35,,,25.35,Other,Drug Cost,25.35,,,25.35,Other,Drug Cost,57.04,,,57.04,Other,225% of Medicaid,35.49,,,35.49,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,54.51,,,54.51,Other,215% Medicaid APG methodology,54.51,,,54.51,Other,215% Medicaid APG methodology,31.69,,,31.69,Other,125% Medicaid APG methodology,0.01,57.04,
LANOLIN TOPICAL ONT,,,,80002466,CDM,250,RC,72140003868,NDC,both,1,EA,11.01,4.35,39.4668,,4.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.74,34,,3.74,percent of total billed charges,"Drugs, Inpatient Only",3.74,34,,3.74,percent of total billed charges,"Drugs, Inpatient Only",3.74,34,,3.74,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.71,70,,7.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.67,,,3.67,Other,Drug Cost,3.67,,,3.67,Other,Drug Cost,3.67,,,3.67,Other,Drug Cost,3.67,,,3.67,Other,Drug Cost,3.67,,,3.67,Other,Drug Cost,3.67,,,3.67,Other,Drug Cost,8.26,,,8.26,Other,225% of Medicaid,5.14,,,5.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.89,,,7.89,Other,215% Medicaid APG methodology,7.89,,,7.89,Other,215% Medicaid APG methodology,4.59,,,4.59,Other,125% Medicaid APG methodology,0.01,8.26,
POTASSIUM PHOSPHATE-SODIUM PHO PACK,,,,80002470,CDM,250,RC,80681017200,NDC,both,1.5,GM,0.84,0.33,39.4668,,0.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.59,70,,0.59,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.63,,,0.63,Other,225% of Medicaid,0.39,,,0.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.6,,,0.6,Other,215% Medicaid APG methodology,0.6,,,0.6,Other,215% Medicaid APG methodology,0.35,,,0.35,Other,125% Medicaid APG methodology,0.01,0.63,
OXYCODONE 30MG TAB,,,,80002472,CDM,250,RC,406853001,NDC,both,100,EA,0.33,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,70,,0.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.24,,,0.24,Other,225% of Medicaid,0.15,,,0.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.23,,,0.23,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,0.24,
OXYCODONE ER 20MG TAB,,,,80002473,CDM,250,RC,59011042010,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PENICILLIN 500MG TAB,,,,80002476,CDM,250,RC,93117401,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,70,,0.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
PREDNISONE 5MG/5ML SOLN,,,,80002479,CDM,250,RC,54372250,NDC,both,1,ML,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.38,34,,19.38,percent of total billed charges,"Drugs, Inpatient Only",19.38,34,,19.38,percent of total billed charges,"Drugs, Inpatient Only",19.38,34,,19.38,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,39.9,70,,39.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19,,,19,Other,Drug Cost,19,,,19,Other,Drug Cost,19,,,19,Other,Drug Cost,19,,,19,Other,Drug Cost,19,,,19,Other,Drug Cost,19,,,19,Other,Drug Cost,42.75,,,42.75,Other,225% of Medicaid,26.6,,,26.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,40.85,,,40.85,Other,215% Medicaid APG methodology,40.85,,,40.85,Other,215% Medicaid APG methodology,23.75,,,23.75,Other,125% Medicaid APG methodology,0.01,42.75,
SELENIUM SULFIDE TOPICAL,,,,80002481,CDM,250,RC,45802004064,NDC,both,1,ML,10.02,3.95,39.4668,,3.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.41,34,,3.41,percent of total billed charges,"Drugs, Inpatient Only",3.41,34,,3.41,percent of total billed charges,"Drugs, Inpatient Only",3.41,34,,3.41,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.01,70,,7.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.34,,,3.34,Other,Drug Cost,3.34,,,3.34,Other,Drug Cost,3.34,,,3.34,Other,Drug Cost,3.34,,,3.34,Other,Drug Cost,3.34,,,3.34,Other,Drug Cost,3.34,,,3.34,Other,Drug Cost,7.52,,,7.52,Other,225% of Medicaid,4.68,,,4.68,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.18,,,7.18,Other,215% Medicaid APG methodology,7.18,,,7.18,Other,215% Medicaid APG methodology,4.18,,,4.18,Other,125% Medicaid APG methodology,0.01,7.52,
CINACALCET 30MG TAB,,,,80002482,CDM,250,RC,69097041002,NDC,both,30,EA,0.48,0.19,39.4668,,0.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,34,,0.16,percent of total billed charges,"Drugs, Inpatient Only",0.16,34,,0.16,percent of total billed charges,"Drugs, Inpatient Only",0.16,34,,0.16,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,70,,0.34,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.36,,,0.36,Other,225% of Medicaid,0.22,,,0.22,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.35,,,0.35,Other,215% Medicaid APG methodology,0.35,,,0.35,Other,215% Medicaid APG methodology,0.2,,,0.2,Other,125% Medicaid APG methodology,0.01,0.36,
SULFAMETHOXAZOLE-TRIMETHOPRIM INJ,,,,80002483,CDM,250,RC,67457077805,NDC,both,10,ML,9.52,3.76,39.4668,,3.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.24,34,,3.24,percent of total billed charges,"Drugs, Inpatient Only",3.24,34,,3.24,percent of total billed charges,"Drugs, Inpatient Only",3.24,34,,3.24,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.66,70,,6.66,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.17,,,3.17,Other,Drug Cost,3.17,,,3.17,Other,Drug Cost,3.17,,,3.17,Other,Drug Cost,3.17,,,3.17,Other,Drug Cost,3.17,,,3.17,Other,Drug Cost,3.17,,,3.17,Other,Drug Cost,7.14,,,7.14,Other,225% of Medicaid,4.44,,,4.44,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.82,,,6.82,Other,215% Medicaid APG methodology,6.82,,,6.82,Other,215% Medicaid APG methodology,3.97,,,3.97,Other,125% Medicaid APG methodology,0.01,7.14,
SODIUM PHOSPHATE 15MMOL/5ML INJ,,,,80002484,CDM,250,RC,409739172,NDC,both,25,ML,6.83,2.7,39.4668,,2.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.32,34,,2.32,percent of total billed charges,"Drugs, Inpatient Only",2.32,34,,2.32,percent of total billed charges,"Drugs, Inpatient Only",2.32,34,,2.32,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.78,70,,4.78,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.28,,,2.28,Other,Drug Cost,2.28,,,2.28,Other,Drug Cost,2.28,,,2.28,Other,Drug Cost,2.28,,,2.28,Other,Drug Cost,2.28,,,2.28,Other,Drug Cost,2.28,,,2.28,Other,Drug Cost,5.12,,,5.12,Other,225% of Medicaid,3.19,,,3.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.9,,,4.9,Other,215% Medicaid APG methodology,4.9,,,4.9,Other,215% Medicaid APG methodology,2.85,,,2.85,Other,125% Medicaid APG methodology,0.01,5.12,
FLECAINIDE 100MG TAB,,,,80002487,CDM,250,RC,50268032115,NDC,both,5,EA,15.47,6.11,39.4668,,6.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.26,34,,5.26,percent of total billed charges,"Drugs, Inpatient Only",5.26,34,,5.26,percent of total billed charges,"Drugs, Inpatient Only",5.26,34,,5.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.83,70,,10.83,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.16,,,5.16,Other,Drug Cost,5.16,,,5.16,Other,Drug Cost,5.16,,,5.16,Other,Drug Cost,5.16,,,5.16,Other,Drug Cost,5.16,,,5.16,Other,Drug Cost,5.16,,,5.16,Other,Drug Cost,11.61,,,11.61,Other,225% of Medicaid,7.22,,,7.22,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.09,,,11.09,Other,215% Medicaid APG methodology,11.09,,,11.09,Other,215% Medicaid APG methodology,6.45,,,6.45,Other,125% Medicaid APG methodology,0.01,11.61,
TRIAMCINOLONE ACETONIDE 0.5% CREAM,,,,80002488,CDM,250,RC,45802006535,NDC,both,1,GM,2.34,0.92,39.4668,,0.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.8,34,,0.8,percent of total billed charges,"Drugs, Inpatient Only",0.8,34,,0.8,percent of total billed charges,"Drugs, Inpatient Only",0.8,34,,0.8,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.64,70,,1.64,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.78,,,0.78,Other,Drug Cost,0.78,,,0.78,Other,Drug Cost,0.78,,,0.78,Other,Drug Cost,0.78,,,0.78,Other,Drug Cost,0.78,,,0.78,Other,Drug Cost,0.78,,,0.78,Other,Drug Cost,1.76,,,1.76,Other,225% of Medicaid,1.09,,,1.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.68,,,1.68,Other,215% Medicaid APG methodology,1.68,,,1.68,Other,215% Medicaid APG methodology,0.98,,,0.98,Other,125% Medicaid APG methodology,0.01,1.76,
STERILE WATER 50ML VIAL,,,,80002492,CDM,250,RC,409488750,NDC,both,25,ML,5.63,2.22,39.4668,,2.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.91,34,,1.91,percent of total billed charges,"Drugs, Inpatient Only",1.91,34,,1.91,percent of total billed charges,"Drugs, Inpatient Only",1.91,34,,1.91,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.94,70,,3.94,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.88,,,1.88,Other,Drug Cost,1.88,,,1.88,Other,Drug Cost,1.88,,,1.88,Other,Drug Cost,1.88,,,1.88,Other,Drug Cost,1.88,,,1.88,Other,Drug Cost,1.88,,,1.88,Other,Drug Cost,4.22,,,4.22,Other,225% of Medicaid,2.63,,,2.63,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.03,,,4.03,Other,215% Medicaid APG methodology,4.03,,,4.03,Other,215% Medicaid APG methodology,2.35,,,2.35,Other,125% Medicaid APG methodology,0.01,4.22,
OSELTAMIVIR 30MG CAPS,,,,80002496,CDM,250,RC,68180067511,NDC,both,10,EA,0.74,0.29,39.4668,,0.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,34,,0.25,percent of total billed charges,"Drugs, Inpatient Only",0.25,34,,0.25,percent of total billed charges,"Drugs, Inpatient Only",0.25,34,,0.25,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.52,70,,0.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.56,,,0.56,Other,225% of Medicaid,0.35,,,0.35,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.53,,,0.53,Other,215% Medicaid APG methodology,0.53,,,0.53,Other,215% Medicaid APG methodology,0.31,,,0.31,Other,125% Medicaid APG methodology,0.01,0.56,
MORPHINE 10MG/5ML ORAL SOLN,,,,80002501,CDM,250,RC,54023749,NDC,both,1,ML,8.7,3.43,39.4668,,3.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.96,34,,2.96,percent of total billed charges,"Drugs, Inpatient Only",2.96,34,,2.96,percent of total billed charges,"Drugs, Inpatient Only",2.96,34,,2.96,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.09,70,,6.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.9,,,2.9,Other,Drug Cost,2.9,,,2.9,Other,Drug Cost,2.9,,,2.9,Other,Drug Cost,2.9,,,2.9,Other,Drug Cost,2.9,,,2.9,Other,Drug Cost,2.9,,,2.9,Other,Drug Cost,6.53,,,6.53,Other,225% of Medicaid,4.06,,,4.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.24,,,6.24,Other,215% Medicaid APG methodology,6.24,,,6.24,Other,215% Medicaid APG methodology,3.63,,,3.63,Other,125% Medicaid APG methodology,0.01,6.53,
FLUCONAZOLE 150MG TAB,,,,80002508,CDM,250,RC,57237000511,NDC,both,12,EA,0.49,0.19,39.4668,,0.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.17,34,,0.17,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.34,70,,0.34,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.16,,,0.16,Other,Drug Cost,0.37,,,0.37,Other,225% of Medicaid,0.23,,,0.23,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.35,,,0.35,Other,215% Medicaid APG methodology,0.35,,,0.35,Other,215% Medicaid APG methodology,0.2,,,0.2,Other,125% Medicaid APG methodology,0.01,0.37,
LUBRICANT EYE DROPS,,,,80002514,CDM,250,RC,23455430,NDC,both,30,ML,0.83,0.33,39.4668,,0.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.58,70,,0.58,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.62,,,0.62,Other,225% of Medicaid,0.39,,,0.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.59,,,0.59,Other,215% Medicaid APG methodology,0.59,,,0.59,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,0.62,
HYDROXOCOBALAMIN (CYANOKIT),,,,80002517,CDM,250,RC,50633031011,NDC,both,1,EA,2712.27,1070.45,39.4668,,1070.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,922.17,34,,922.17,percent of total billed charges,"Drugs, Inpatient Only",922.17,34,,922.17,percent of total billed charges,"Drugs, Inpatient Only",922.17,34,,922.17,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1898.59,70,,1898.59,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,904.09,,,904.09,Other,Drug Cost,904.09,,,904.09,Other,Drug Cost,904.09,,,904.09,Other,Drug Cost,904.09,,,904.09,Other,Drug Cost,904.09,,,904.09,Other,Drug Cost,904.09,,,904.09,Other,Drug Cost,2034.2,,,2034.2,Other,225% of Medicaid,1265.73,,,1265.73,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1943.79,,,1943.79,Other,215% Medicaid APG methodology,1943.79,,,1943.79,Other,215% Medicaid APG methodology,1130.11,,,1130.11,Other,125% Medicaid APG methodology,0.01,2034.2,
ASCORBIC ACID 500MG/ML 50ML,,,,80002520,CDM,250,RC,67157010150,NDC,both,1,ML,735.42,290.25,39.4668,,290.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,250.04,34,,250.04,percent of total billed charges,"Drugs, Inpatient Only",250.04,34,,250.04,percent of total billed charges,"Drugs, Inpatient Only",250.04,34,,250.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.79,70,,514.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,245.14,,,245.14,Other,Drug Cost,245.14,,,245.14,Other,Drug Cost,245.14,,,245.14,Other,Drug Cost,245.14,,,245.14,Other,Drug Cost,245.14,,,245.14,Other,Drug Cost,245.14,,,245.14,Other,Drug Cost,551.57,,,551.57,Other,225% of Medicaid,343.2,,,343.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,527.05,,,527.05,Other,215% Medicaid APG methodology,527.05,,,527.05,Other,215% Medicaid APG methodology,306.43,,,306.43,Other,125% Medicaid APG methodology,0.01,551.57,
APIXABAN 2.5MG TAB,,,,80002522,CDM,250,RC,3089321,NDC,both,60,EA,0.69,0.27,39.4668,,0.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.23,34,,0.23,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.48,70,,0.48,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.23,,,0.23,Other,Drug Cost,0.52,,,0.52,Other,225% of Medicaid,0.32,,,0.32,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.49,,,0.49,Other,215% Medicaid APG methodology,0.49,,,0.49,Other,215% Medicaid APG methodology,0.29,,,0.29,Other,125% Medicaid APG methodology,0.01,0.52,
APIXABAN 5MG TAB,,,,80002523,CDM,250,RC,3089421,NDC,both,60,EA,0.23,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.16,70,,0.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.17,,,0.17,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.17,,,0.17,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.17,
CLINIMIX 5/15 1000ML,,,,80002532,CDM,250,RC,338113703,NDC,both,6,ML,41.75,16.48,39.4668,,16.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.19,34,,14.19,percent of total billed charges,"Drugs, Inpatient Only",14.19,34,,14.19,percent of total billed charges,"Drugs, Inpatient Only",14.19,34,,14.19,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,29.22,70,,29.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.92,,,13.92,Other,Drug Cost,13.92,,,13.92,Other,Drug Cost,13.92,,,13.92,Other,Drug Cost,13.92,,,13.92,Other,Drug Cost,13.92,,,13.92,Other,Drug Cost,13.92,,,13.92,Other,Drug Cost,31.31,,,31.31,Other,225% of Medicaid,19.48,,,19.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,29.92,,,29.92,Other,215% Medicaid APG methodology,29.92,,,29.92,Other,215% Medicaid APG methodology,17.39,,,17.39,Other,125% Medicaid APG methodology,0.01,31.31,
COLLAGENASE OINT 5GM,,,,80002534,CDM,250,RC,50484001030,NDC,both,1,GM,616.29,243.23,39.4668,,243.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,209.54,34,,209.54,percent of total billed charges,"Drugs, Inpatient Only",209.54,34,,209.54,percent of total billed charges,"Drugs, Inpatient Only",209.54,34,,209.54,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.4,70,,431.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,205.43,,,205.43,Other,Drug Cost,205.43,,,205.43,Other,Drug Cost,205.43,,,205.43,Other,Drug Cost,205.43,,,205.43,Other,Drug Cost,205.43,,,205.43,Other,Drug Cost,205.43,,,205.43,Other,Drug Cost,462.22,,,462.22,Other,225% of Medicaid,287.6,,,287.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,441.67,,,441.67,Other,215% Medicaid APG methodology,441.67,,,441.67,Other,215% Medicaid APG methodology,256.79,,,256.79,Other,125% Medicaid APG methodology,0.01,462.22,
GENTAMICIN 0.1% OINT 5GM,,,,80002545,CDM,250,RC,45802004611,NDC,both,1,GM,15.42,6.09,39.4668,,6.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.24,34,,5.24,percent of total billed charges,"Drugs, Inpatient Only",5.24,34,,5.24,percent of total billed charges,"Drugs, Inpatient Only",5.24,34,,5.24,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.79,70,,10.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.14,,,5.14,Other,Drug Cost,5.14,,,5.14,Other,Drug Cost,5.14,,,5.14,Other,Drug Cost,5.14,,,5.14,Other,Drug Cost,5.14,,,5.14,Other,Drug Cost,5.14,,,5.14,Other,Drug Cost,11.57,,,11.57,Other,225% of Medicaid,7.2,,,7.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.05,,,11.05,Other,215% Medicaid APG methodology,11.05,,,11.05,Other,215% Medicaid APG methodology,6.43,,,6.43,Other,125% Medicaid APG methodology,0.01,11.57,
HEMORRHOIDAL OINT 57GM,,,,80002549,CDM,250,RC,45802018816,NDC,both,1,GM,3.18,1.26,39.4668,,1.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.08,34,,1.08,percent of total billed charges,"Drugs, Inpatient Only",1.08,34,,1.08,percent of total billed charges,"Drugs, Inpatient Only",1.08,34,,1.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.23,70,,2.23,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.06,,,1.06,Other,Drug Cost,1.06,,,1.06,Other,Drug Cost,1.06,,,1.06,Other,Drug Cost,1.06,,,1.06,Other,Drug Cost,1.06,,,1.06,Other,Drug Cost,1.06,,,1.06,Other,Drug Cost,2.39,,,2.39,Other,225% of Medicaid,1.48,,,1.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.28,,,2.28,Other,215% Medicaid APG methodology,2.28,,,2.28,Other,215% Medicaid APG methodology,1.33,,,1.33,Other,125% Medicaid APG methodology,0.01,2.39,
LIDOCAINE 4% LARYNGO-O-JET,,,,80002560,CDM,250,RC,76329630005,NDC,both,25,ML,5.11,2.02,39.4668,,2.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.74,34,,1.74,percent of total billed charges,"Drugs, Inpatient Only",1.74,34,,1.74,percent of total billed charges,"Drugs, Inpatient Only",1.74,34,,1.74,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.58,70,,3.58,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,3.83,,,3.83,Other,225% of Medicaid,2.38,,,2.38,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.66,,,3.66,Other,215% Medicaid APG methodology,3.66,,,3.66,Other,215% Medicaid APG methodology,2.13,,,2.13,Other,125% Medicaid APG methodology,0.01,3.83,
MANNITOL 20% 500ML,,,,80002561,CDM,250,RC,338035703,NDC,both,24,ML,14.4,5.68,39.4668,,5.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.9,34,,4.9,percent of total billed charges,"Drugs, Inpatient Only",4.9,34,,4.9,percent of total billed charges,"Drugs, Inpatient Only",4.9,34,,4.9,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.08,70,,10.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,10.8,,,10.8,Other,225% of Medicaid,6.72,,,6.72,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.32,,,10.32,Other,215% Medicaid APG methodology,10.32,,,10.32,Other,215% Medicaid APG methodology,6,,,6,Other,125% Medicaid APG methodology,0.01,10.8,
MELOXICAM 15MG TAB,,,,80002563,CDM,250,RC,29300012501,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.03,
MORPHINE PF 2MG/ML CARP,,,,80002569,CDM,250,RC,409189001,NDC,both,10,ML,2.39,0.94,39.4668,,0.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.81,34,,0.81,percent of total billed charges,"Drugs, Inpatient Only",0.81,34,,0.81,percent of total billed charges,"Drugs, Inpatient Only",0.81,34,,0.81,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.67,70,,1.67,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,1.79,,,1.79,Other,225% of Medicaid,1.12,,,1.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.71,,,1.71,Other,215% Medicaid APG methodology,1.71,,,1.71,Other,215% Medicaid APG methodology,1,,,1,Other,125% Medicaid APG methodology,0.01,1.79,
POTASSIUM PHOSPHATE 15MMOL/5ML INJ,,,,80002583,CDM,250,RC,65219005429,NDC,both,25,ML,22.75,8.98,39.4668,,8.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.73,34,,7.73,percent of total billed charges,"Drugs, Inpatient Only",7.73,34,,7.73,percent of total billed charges,"Drugs, Inpatient Only",7.73,34,,7.73,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.92,70,,15.92,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.58,,,7.58,Other,Drug Cost,7.58,,,7.58,Other,Drug Cost,7.58,,,7.58,Other,Drug Cost,7.58,,,7.58,Other,Drug Cost,7.58,,,7.58,Other,Drug Cost,7.58,,,7.58,Other,Drug Cost,17.06,,,17.06,Other,225% of Medicaid,10.62,,,10.62,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,16.3,,,16.3,Other,215% Medicaid APG methodology,16.3,,,16.3,Other,215% Medicaid APG methodology,9.48,,,9.48,Other,125% Medicaid APG methodology,0.01,17.06,
QUETIAPINE 50MG TAB,,,,80002584,CDM,250,RC,904663961,NDC,both,10,EA,0.82,0.32,39.4668,,0.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.28,34,,0.28,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.58,70,,0.58,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.62,,,0.62,Other,225% of Medicaid,0.38,,,0.38,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.59,,,0.59,Other,215% Medicaid APG methodology,0.59,,,0.59,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,0.62,
RITONAVIR 100MG TABLET,,,,80002590,CDM,250,RC,65862068730,NDC,both,30,EA,0.94,0.37,39.4668,,0.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.32,34,,0.32,percent of total billed charges,"Drugs, Inpatient Only",0.32,34,,0.32,percent of total billed charges,"Drugs, Inpatient Only",0.32,34,,0.32,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.66,70,,0.66,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.71,,,0.71,Other,225% of Medicaid,0.44,,,0.44,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.68,,,0.68,Other,215% Medicaid APG methodology,0.68,,,0.68,Other,215% Medicaid APG methodology,0.39,,,0.39,Other,125% Medicaid APG methodology,0.01,0.71,
VALSARTAN 160MG TAB,,,,80002603,CDM,250,RC,78035934,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
VERAPAMIL ER 120MG TAB,,,,80002604,CDM,250,RC,68462029201,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
TRANEXAMIC ACID 1000MG,,,,80002606,CDM,250,RC,55150018810,NDC,both,10,ML,5.97,2.36,39.4668,,2.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.03,34,,2.03,percent of total billed charges,"Drugs, Inpatient Only",2.03,34,,2.03,percent of total billed charges,"Drugs, Inpatient Only",2.03,34,,2.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.18,70,,4.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.99,,,1.99,Other,Drug Cost,1.99,,,1.99,Other,Drug Cost,1.99,,,1.99,Other,Drug Cost,1.99,,,1.99,Other,Drug Cost,1.99,,,1.99,Other,Drug Cost,1.99,,,1.99,Other,Drug Cost,4.48,,,4.48,Other,225% of Medicaid,2.79,,,2.79,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.28,,,4.28,Other,215% Medicaid APG methodology,4.28,,,4.28,Other,215% Medicaid APG methodology,2.49,,,2.49,Other,125% Medicaid APG methodology,0.01,4.48,
MARAVIROC 300MG TABLET,,,,80002607,CDM,250,RC,49702022418,NDC,both,60,EA,41.72,16.46,39.4668,,16.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.18,34,,14.18,percent of total billed charges,"Drugs, Inpatient Only",14.18,34,,14.18,percent of total billed charges,"Drugs, Inpatient Only",14.18,34,,14.18,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,29.2,70,,29.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.91,,,13.91,Other,Drug Cost,13.91,,,13.91,Other,Drug Cost,13.91,,,13.91,Other,Drug Cost,13.91,,,13.91,Other,Drug Cost,13.91,,,13.91,Other,Drug Cost,13.91,,,13.91,Other,Drug Cost,31.29,,,31.29,Other,225% of Medicaid,19.47,,,19.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,29.9,,,29.9,Other,215% Medicaid APG methodology,29.9,,,29.9,Other,215% Medicaid APG methodology,17.38,,,17.38,Other,125% Medicaid APG methodology,0.01,31.29,
METHENAMINE HIPPURATE 1GM TAB,,,,80002614,CDM,250,RC,65862078201,NDC,both,100,EA,0.4,0.16,39.4668,,0.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,70,,0.28,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.3,,,0.3,Other,225% of Medicaid,0.19,,,0.19,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.28,,,0.28,Other,215% Medicaid APG methodology,0.28,,,0.28,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,125% Medicaid APG methodology,0.01,0.3,
LEVOCARNITINE 200MG/ML 5ML INJ,,,,80002617,CDM,250,RC,54482014701,NDC,both,5,ML,64.06,25.28,39.4668,,25.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.78,34,,21.78,percent of total billed charges,"Drugs, Inpatient Only",21.78,34,,21.78,percent of total billed charges,"Drugs, Inpatient Only",21.78,34,,21.78,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,44.84,70,,44.84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.35,,,21.35,Other,Drug Cost,21.35,,,21.35,Other,Drug Cost,21.35,,,21.35,Other,Drug Cost,21.35,,,21.35,Other,Drug Cost,21.35,,,21.35,Other,Drug Cost,21.35,,,21.35,Other,Drug Cost,48.04,,,48.04,Other,225% of Medicaid,29.89,,,29.89,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,45.91,,,45.91,Other,215% Medicaid APG methodology,45.91,,,45.91,Other,215% Medicaid APG methodology,26.69,,,26.69,Other,125% Medicaid APG methodology,0.01,48.04,
INSULIN DRIP,,,,80002633,CDM,250,RC,338012612,NDC,both,12,ML,28.59,11.28,39.4668,,11.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.72,34,,9.72,percent of total billed charges,"Drugs, Inpatient Only",9.72,34,,9.72,percent of total billed charges,"Drugs, Inpatient Only",9.72,34,,9.72,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,20.01,70,,20.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.53,,,9.53,Other,Drug Cost,9.53,,,9.53,Other,Drug Cost,9.53,,,9.53,Other,Drug Cost,9.53,,,9.53,Other,Drug Cost,9.53,,,9.53,Other,Drug Cost,9.53,,,9.53,Other,Drug Cost,21.44,,,21.44,Other,225% of Medicaid,13.34,,,13.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,20.49,,,20.49,Other,215% Medicaid APG methodology,20.49,,,20.49,Other,215% Medicaid APG methodology,11.91,,,11.91,Other,125% Medicaid APG methodology,0.01,21.44,
RIVAROXABAN 15MG TABLET,,,,80002636,CDM,250,RC,50458057830,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
RIVAROXABAN 20MG TABLET,,,,80002637,CDM,250,RC,50458057930,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
DEXTROSE 50% 50ML VIAL,,,,80002644,CDM,250,RC,409664802,NDC,both,25,ML,7.54,2.98,39.4668,,2.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.56,34,,2.56,percent of total billed charges,"Drugs, Inpatient Only",2.56,34,,2.56,percent of total billed charges,"Drugs, Inpatient Only",2.56,34,,2.56,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.28,70,,5.28,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.51,,,2.51,Other,Drug Cost,2.51,,,2.51,Other,Drug Cost,2.51,,,2.51,Other,Drug Cost,2.51,,,2.51,Other,Drug Cost,2.51,,,2.51,Other,Drug Cost,2.51,,,2.51,Other,Drug Cost,5.66,,,5.66,Other,225% of Medicaid,3.52,,,3.52,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.41,,,5.41,Other,215% Medicaid APG methodology,5.41,,,5.41,Other,215% Medicaid APG methodology,3.14,,,3.14,Other,125% Medicaid APG methodology,0.01,5.66,
PHENOBARBITAL 32.4MG TABLET,,,,80002651,CDM,250,RC,13517011101,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
LINAGLIPTIN 5MG TAB,,,,80002655,CDM,250,RC,597014030,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
SILVER SULFADIAZINE CREAM 20 GRAM,,,,80002662,CDM,250,RC,67877012420,NDC,both,1,GM,1.83,0.72,39.4668,,0.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.28,70,,1.28,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,1.37,,,1.37,Other,225% of Medicaid,0.85,,,0.85,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.31,,,1.31,Other,215% Medicaid APG methodology,1.31,,,1.31,Other,215% Medicaid APG methodology,0.76,,,0.76,Other,125% Medicaid APG methodology,0.01,1.37,
PHENOBARBITAL 97.2MG TABLET,,,,80002666,CDM,250,RC,603516821,NDC,both,100,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
MINOCYCLINE 50MG CAP,,,,80002673,CDM,250,RC,591569460,NDC,both,60,EA,0.24,0.09,39.4668,,0.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.08,34,,0.08,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.17,70,,0.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.18,,,0.18,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.17,,,0.17,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.18,
ATOMOXETINE 40MG TABLET,,,,80002674,CDM,250,RC,68462026830,NDC,both,30,EA,0.86,0.34,39.4668,,0.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,34,,0.29,percent of total billed charges,"Drugs, Inpatient Only",0.29,34,,0.29,percent of total billed charges,"Drugs, Inpatient Only",0.29,34,,0.29,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.6,70,,0.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,,,0.29,Other,Drug Cost,0.29,,,0.29,Other,Drug Cost,0.29,,,0.29,Other,Drug Cost,0.29,,,0.29,Other,Drug Cost,0.29,,,0.29,Other,Drug Cost,0.29,,,0.29,Other,Drug Cost,0.64,,,0.64,Other,225% of Medicaid,0.4,,,0.4,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.61,,,0.61,Other,215% Medicaid APG methodology,0.61,,,0.61,Other,215% Medicaid APG methodology,0.36,,,0.36,Other,125% Medicaid APG methodology,0.01,0.64,
EPIVIR 10MG/ML,,,,80002677,CDM,250,RC,57237027424,NDC,both,1,ML,104.1,41.08,39.4668,,41.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,35.39,34,,35.39,percent of total billed charges,"Drugs, Inpatient Only",35.39,34,,35.39,percent of total billed charges,"Drugs, Inpatient Only",35.39,34,,35.39,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72.87,70,,72.87,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,34.7,,,34.7,Other,Drug Cost,34.7,,,34.7,Other,Drug Cost,34.7,,,34.7,Other,Drug Cost,34.7,,,34.7,Other,Drug Cost,34.7,,,34.7,Other,Drug Cost,34.7,,,34.7,Other,Drug Cost,78.08,,,78.08,Other,225% of Medicaid,48.58,,,48.58,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,74.61,,,74.61,Other,215% Medicaid APG methodology,74.61,,,74.61,Other,215% Medicaid APG methodology,43.38,,,43.38,Other,125% Medicaid APG methodology,0.01,78.08,
DARUNAVIR 800MG TABLET,,,,80002680,CDM,250,RC,59676056630,NDC,both,30,EA,62.76,24.77,39.4668,,24.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.34,34,,21.34,percent of total billed charges,"Drugs, Inpatient Only",21.34,34,,21.34,percent of total billed charges,"Drugs, Inpatient Only",21.34,34,,21.34,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,43.93,70,,43.93,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,20.92,,,20.92,Other,Drug Cost,20.92,,,20.92,Other,Drug Cost,20.92,,,20.92,Other,Drug Cost,20.92,,,20.92,Other,Drug Cost,20.92,,,20.92,Other,Drug Cost,20.92,,,20.92,Other,Drug Cost,47.07,,,47.07,Other,225% of Medicaid,29.29,,,29.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,44.98,,,44.98,Other,215% Medicaid APG methodology,44.98,,,44.98,Other,215% Medicaid APG methodology,26.15,,,26.15,Other,125% Medicaid APG methodology,0.01,47.07,
PHENOL EZ SWABS,,,,80002686,CDM,250,RC,884629730,NDC,both,30,EA,15.33,6.05,39.4668,,6.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.21,34,,5.21,percent of total billed charges,"Drugs, Inpatient Only",5.21,34,,5.21,percent of total billed charges,"Drugs, Inpatient Only",5.21,34,,5.21,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.73,70,,10.73,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.11,,,5.11,Other,Drug Cost,5.11,,,5.11,Other,Drug Cost,5.11,,,5.11,Other,Drug Cost,5.11,,,5.11,Other,Drug Cost,5.11,,,5.11,Other,Drug Cost,5.11,,,5.11,Other,Drug Cost,11.5,,,11.5,Other,225% of Medicaid,7.15,,,7.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.99,,,10.99,Other,215% Medicaid APG methodology,10.99,,,10.99,Other,215% Medicaid APG methodology,6.39,,,6.39,Other,125% Medicaid APG methodology,0.01,11.5,
TOLVAPTAN 15MG TABLET,,,,80002688,CDM,250,RC,67877063533,NDC,both,10,EA,58.13,22.94,39.4668,,22.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.76,34,,19.76,percent of total billed charges,"Drugs, Inpatient Only",19.76,34,,19.76,percent of total billed charges,"Drugs, Inpatient Only",19.76,34,,19.76,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,40.69,70,,40.69,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.38,,,19.38,Other,Drug Cost,19.38,,,19.38,Other,Drug Cost,19.38,,,19.38,Other,Drug Cost,19.38,,,19.38,Other,Drug Cost,19.38,,,19.38,Other,Drug Cost,19.38,,,19.38,Other,Drug Cost,43.59,,,43.59,Other,225% of Medicaid,27.13,,,27.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,41.66,,,41.66,Other,215% Medicaid APG methodology,41.66,,,41.66,Other,215% Medicaid APG methodology,24.22,,,24.22,Other,125% Medicaid APG methodology,0.01,43.59,
MESALAMINE DR 400 MG CAP,,,,80002689,CDM,250,RC,59762011701,NDC,both,180,EA,2,0.79,39.4668,,0.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.68,34,,0.68,percent of total billed charges,"Drugs, Inpatient Only",0.68,34,,0.68,percent of total billed charges,"Drugs, Inpatient Only",0.68,34,,0.68,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.4,70,,1.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.67,,,0.67,Other,Drug Cost,0.67,,,0.67,Other,Drug Cost,0.67,,,0.67,Other,Drug Cost,0.67,,,0.67,Other,Drug Cost,0.67,,,0.67,Other,Drug Cost,0.67,,,0.67,Other,Drug Cost,1.5,,,1.5,Other,225% of Medicaid,0.93,,,0.93,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.43,,,1.43,Other,215% Medicaid APG methodology,1.43,,,1.43,Other,215% Medicaid APG methodology,0.83,,,0.83,Other,125% Medicaid APG methodology,0.01,1.5,
OSELTAMIVIR 6MG/ML 60ML SOLN,,,,80002691,CDM,250,RC,4082205,NDC,both,1,ML,246.78,97.4,39.4668,,97.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,83.91,34,,83.91,percent of total billed charges,"Drugs, Inpatient Only",83.91,34,,83.91,percent of total billed charges,"Drugs, Inpatient Only",83.91,34,,83.91,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,172.75,70,,172.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,82.26,,,82.26,Other,Drug Cost,82.26,,,82.26,Other,Drug Cost,82.26,,,82.26,Other,Drug Cost,82.26,,,82.26,Other,Drug Cost,82.26,,,82.26,Other,Drug Cost,82.26,,,82.26,Other,Drug Cost,185.09,,,185.09,Other,225% of Medicaid,115.16,,,115.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,176.86,,,176.86,Other,215% Medicaid APG methodology,176.86,,,176.86,Other,215% Medicaid APG methodology,102.83,,,102.83,Other,125% Medicaid APG methodology,0.01,185.09,
NIMBEX 100MG/100ML,,,,80002692,CDM,250,RC,74438010,NDC,both,10,ML,74.75,29.5,39.4668,,29.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,25.41,34,,25.41,percent of total billed charges,"Drugs, Inpatient Only",25.41,34,,25.41,percent of total billed charges,"Drugs, Inpatient Only",25.41,34,,25.41,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,52.32,70,,52.32,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.92,,,24.92,Other,Drug Cost,24.92,,,24.92,Other,Drug Cost,24.92,,,24.92,Other,Drug Cost,24.92,,,24.92,Other,Drug Cost,24.92,,,24.92,Other,Drug Cost,24.92,,,24.92,Other,Drug Cost,56.06,,,56.06,Other,225% of Medicaid,34.88,,,34.88,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,53.57,,,53.57,Other,215% Medicaid APG methodology,53.57,,,53.57,Other,215% Medicaid APG methodology,31.15,,,31.15,Other,125% Medicaid APG methodology,0.01,56.06,
DEXMEDETOMIDINE HCL 200MCG/NS 50ML,,,,80002698,CDM,250,RC,409166050,NDC,both,20,ML,17.64,6.96,39.4668,,6.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6,34,,6,percent of total billed charges,"Drugs, Inpatient Only",6,34,,6,percent of total billed charges,"Drugs, Inpatient Only",6,34,,6,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.35,70,,12.35,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.88,,,5.88,Other,Drug Cost,5.88,,,5.88,Other,Drug Cost,5.88,,,5.88,Other,Drug Cost,5.88,,,5.88,Other,Drug Cost,5.88,,,5.88,Other,Drug Cost,5.88,,,5.88,Other,Drug Cost,13.23,,,13.23,Other,225% of Medicaid,8.23,,,8.23,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.65,,,12.65,Other,215% Medicaid APG methodology,12.65,,,12.65,Other,215% Medicaid APG methodology,7.35,,,7.35,Other,125% Medicaid APG methodology,0.01,13.23,
RALTEGRAVIR 100MG CHEW TAB,,,,80002701,CDM,250,RC,6047761,NDC,both,60,EA,9.87,3.9,39.4668,,3.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.36,34,,3.36,percent of total billed charges,"Drugs, Inpatient Only",3.36,34,,3.36,percent of total billed charges,"Drugs, Inpatient Only",3.36,34,,3.36,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.91,70,,6.91,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,7.41,,,7.41,Other,225% of Medicaid,4.61,,,4.61,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.08,,,7.08,Other,215% Medicaid APG methodology,7.08,,,7.08,Other,215% Medicaid APG methodology,4.11,,,4.11,Other,125% Medicaid APG methodology,0.01,7.41,
STRONG IODINE 5% 14ML,,,,80002713,CDM,250,RC,48433023015,NDC,both,1,ML,92.04,36.33,39.4668,,36.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,31.29,34,,31.29,percent of total billed charges,"Drugs, Inpatient Only",31.29,34,,31.29,percent of total billed charges,"Drugs, Inpatient Only",31.29,34,,31.29,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,64.43,70,,64.43,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,30.68,,,30.68,Other,Drug Cost,30.68,,,30.68,Other,Drug Cost,30.68,,,30.68,Other,Drug Cost,30.68,,,30.68,Other,Drug Cost,30.68,,,30.68,Other,Drug Cost,30.68,,,30.68,Other,Drug Cost,69.03,,,69.03,Other,225% of Medicaid,42.95,,,42.95,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,65.96,,,65.96,Other,215% Medicaid APG methodology,65.96,,,65.96,Other,215% Medicaid APG methodology,38.35,,,38.35,Other,125% Medicaid APG methodology,0.01,69.03,
FLUOCINONIDE 0.05% OINT 15GM,,,,80002715,CDM,250,RC,51672126401,NDC,both,1,GM,4.83,1.91,39.4668,,1.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.64,34,,1.64,percent of total billed charges,"Drugs, Inpatient Only",1.64,34,,1.64,percent of total billed charges,"Drugs, Inpatient Only",1.64,34,,1.64,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.38,70,,3.38,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.61,,,1.61,Other,Drug Cost,1.61,,,1.61,Other,Drug Cost,1.61,,,1.61,Other,Drug Cost,1.61,,,1.61,Other,Drug Cost,1.61,,,1.61,Other,Drug Cost,1.61,,,1.61,Other,Drug Cost,3.62,,,3.62,Other,225% of Medicaid,2.25,,,2.25,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.46,,,3.46,Other,215% Medicaid APG methodology,3.46,,,3.46,Other,215% Medicaid APG methodology,2.01,,,2.01,Other,125% Medicaid APG methodology,0.01,3.62,
CLOBETASOL 0.05% OINT 30GM,,,,80002719,CDM,250,RC,51672125902,NDC,both,1,GM,0.42,0.17,39.4668,,0.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,70,,0.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.32,,,0.32,Other,225% of Medicaid,0.2,,,0.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.3,,,0.3,Other,215% Medicaid APG methodology,0.3,,,0.3,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,125% Medicaid APG methodology,0.01,0.32,
ATAZANAVIR 200MG CAPSULE,,,,80002722,CDM,250,RC,3363112,NDC,both,60,EA,36.26,14.31,39.4668,,14.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.33,34,,12.33,percent of total billed charges,"Drugs, Inpatient Only",12.33,34,,12.33,percent of total billed charges,"Drugs, Inpatient Only",12.33,34,,12.33,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,25.38,70,,25.38,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.09,,,12.09,Other,Drug Cost,12.09,,,12.09,Other,Drug Cost,12.09,,,12.09,Other,Drug Cost,12.09,,,12.09,Other,Drug Cost,12.09,,,12.09,Other,Drug Cost,12.09,,,12.09,Other,Drug Cost,27.19,,,27.19,Other,225% of Medicaid,16.92,,,16.92,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,25.98,,,25.98,Other,215% Medicaid APG methodology,25.98,,,25.98,Other,215% Medicaid APG methodology,15.11,,,15.11,Other,125% Medicaid APG methodology,0.01,27.19,
LIDOCAINE 1% 2ML VIAL,,,,80002725,CDM,250,RC,55150016102,NDC,both,10,ML,2.9,1.15,39.4668,,1.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.99,34,,0.99,percent of total billed charges,"Drugs, Inpatient Only",0.99,34,,0.99,percent of total billed charges,"Drugs, Inpatient Only",0.99,34,,0.99,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.03,70,,2.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.97,,,0.97,Other,Drug Cost,0.97,,,0.97,Other,Drug Cost,0.97,,,0.97,Other,Drug Cost,0.97,,,0.97,Other,Drug Cost,0.97,,,0.97,Other,Drug Cost,0.97,,,0.97,Other,Drug Cost,2.18,,,2.18,Other,225% of Medicaid,1.36,,,1.36,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.08,,,2.08,Other,215% Medicaid APG methodology,2.08,,,2.08,Other,215% Medicaid APG methodology,1.21,,,1.21,Other,125% Medicaid APG methodology,0.01,2.18,
FLUTICASONE-VILANTEROL 100-25MCH INHALER,,,,80002736,CDM,250,RC,173085914,NDC,both,28,EA,3.42,1.35,39.4668,,1.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.39,70,,2.39,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,2.57,,,2.57,Other,225% of Medicaid,1.6,,,1.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.45,,,2.45,Other,215% Medicaid APG methodology,2.45,,,2.45,Other,215% Medicaid APG methodology,1.43,,,1.43,Other,125% Medicaid APG methodology,0.01,2.57,
RIFAXIMIN 550MG TABLET,,,,80002744,CDM,250,RC,65649030302,NDC,both,60,EA,31.79,12.55,39.4668,,12.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.81,34,,10.81,percent of total billed charges,"Drugs, Inpatient Only",10.81,34,,10.81,percent of total billed charges,"Drugs, Inpatient Only",10.81,34,,10.81,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.25,70,,22.25,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.6,,,10.6,Other,Drug Cost,10.6,,,10.6,Other,Drug Cost,10.6,,,10.6,Other,Drug Cost,10.6,,,10.6,Other,Drug Cost,10.6,,,10.6,Other,Drug Cost,10.6,,,10.6,Other,Drug Cost,23.84,,,23.84,Other,225% of Medicaid,14.84,,,14.84,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,22.78,,,22.78,Other,215% Medicaid APG methodology,22.78,,,22.78,Other,215% Medicaid APG methodology,13.25,,,13.25,Other,125% Medicaid APG methodology,0.01,23.84,
TRUVADA 200MG-300MG TABLET,,,,80002746,CDM,250,RC,42385095330,NDC,both,30,EA,0.63,0.25,39.4668,,0.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,34,,0.21,percent of total billed charges,"Drugs, Inpatient Only",0.21,34,,0.21,percent of total billed charges,"Drugs, Inpatient Only",0.21,34,,0.21,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.44,70,,0.44,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.21,,,0.21,Other,Drug Cost,0.47,,,0.47,Other,225% of Medicaid,0.29,,,0.29,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.45,,,0.45,Other,215% Medicaid APG methodology,0.45,,,0.45,Other,215% Medicaid APG methodology,0.26,,,0.26,Other,125% Medicaid APG methodology,0.01,0.47,
RILPIVIRINE 25MG TABLET,,,,80002751,CDM,250,RC,59676027801,NDC,both,30,EA,50.02,19.74,39.4668,,19.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.01,34,,17.01,percent of total billed charges,"Drugs, Inpatient Only",17.01,34,,17.01,percent of total billed charges,"Drugs, Inpatient Only",17.01,34,,17.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,35.01,70,,35.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.67,,,16.67,Other,Drug Cost,16.67,,,16.67,Other,Drug Cost,16.67,,,16.67,Other,Drug Cost,16.67,,,16.67,Other,Drug Cost,16.67,,,16.67,Other,Drug Cost,16.67,,,16.67,Other,Drug Cost,37.51,,,37.51,Other,225% of Medicaid,23.34,,,23.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,35.85,,,35.85,Other,215% Medicaid APG methodology,35.85,,,35.85,Other,215% Medicaid APG methodology,20.84,,,20.84,Other,125% Medicaid APG methodology,0.01,37.51,
TRANEXAMIC ACID 1000MG/100ML NS,,,,80002762,CDM,250,RC,51754010803,NDC,both,10,ML,20.17,7.96,39.4668,,7.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.86,34,,6.86,percent of total billed charges,"Drugs, Inpatient Only",6.86,34,,6.86,percent of total billed charges,"Drugs, Inpatient Only",6.86,34,,6.86,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.12,70,,14.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.72,,,6.72,Other,Drug Cost,6.72,,,6.72,Other,Drug Cost,6.72,,,6.72,Other,Drug Cost,6.72,,,6.72,Other,Drug Cost,6.72,,,6.72,Other,Drug Cost,6.72,,,6.72,Other,Drug Cost,15.12,,,15.12,Other,225% of Medicaid,9.41,,,9.41,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,14.45,,,14.45,Other,215% Medicaid APG methodology,14.45,,,14.45,Other,215% Medicaid APG methodology,8.4,,,8.4,Other,125% Medicaid APG methodology,0.01,15.12,
OLANZAPINE 10MG ODT,,,,80002774,CDM,250,RC,33342008407,NDC,both,30,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,70,,0.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
LEVONORGESTREL 1.5MG TABLET,,,,80002775,CDM,250,RC,68180085211,NDC,both,1,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
POSACONAZOLE 100MG TABLET,,,,80002790,CDM,250,RC,70748025807,NDC,both,60,EA,5.87,2.32,39.4668,,2.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2,34,,2,percent of total billed charges,"Drugs, Inpatient Only",2,34,,2,percent of total billed charges,"Drugs, Inpatient Only",2,34,,2,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.11,70,,4.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.96,,,1.96,Other,Drug Cost,1.96,,,1.96,Other,Drug Cost,1.96,,,1.96,Other,Drug Cost,1.96,,,1.96,Other,Drug Cost,1.96,,,1.96,Other,Drug Cost,1.96,,,1.96,Other,Drug Cost,4.4,,,4.4,Other,225% of Medicaid,2.74,,,2.74,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.21,,,4.21,Other,215% Medicaid APG methodology,4.21,,,4.21,Other,215% Medicaid APG methodology,2.45,,,2.45,Other,125% Medicaid APG methodology,0.01,4.4,
WOUND SEAL POWDER,,,,80002794,CDM,250,RC,34061000004,NDC,both,4,EA,6.53,2.58,39.4668,,2.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.22,34,,2.22,percent of total billed charges,"Drugs, Inpatient Only",2.22,34,,2.22,percent of total billed charges,"Drugs, Inpatient Only",2.22,34,,2.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.57,70,,4.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,4.9,,,4.9,Other,225% of Medicaid,3.05,,,3.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.68,,,4.68,Other,215% Medicaid APG methodology,4.68,,,4.68,Other,215% Medicaid APG methodology,2.72,,,2.72,Other,125% Medicaid APG methodology,0.01,4.9,
GLYCERIN 35% DRY MOUTH SPRAY,,,,80002796,CDM,250,RC,98669000201,NDC,both,1,ML,15.84,6.25,39.4668,,6.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.39,34,,5.39,percent of total billed charges,"Drugs, Inpatient Only",5.39,34,,5.39,percent of total billed charges,"Drugs, Inpatient Only",5.39,34,,5.39,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.09,70,,11.09,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.28,,,5.28,Other,Drug Cost,5.28,,,5.28,Other,Drug Cost,5.28,,,5.28,Other,Drug Cost,5.28,,,5.28,Other,Drug Cost,5.28,,,5.28,Other,Drug Cost,5.28,,,5.28,Other,Drug Cost,11.88,,,11.88,Other,225% of Medicaid,7.39,,,7.39,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.35,,,11.35,Other,215% Medicaid APG methodology,11.35,,,11.35,Other,215% Medicaid APG methodology,6.6,,,6.6,Other,125% Medicaid APG methodology,0.01,11.88,
LABETALOL HCL 20MG/4ML INJ,,,,80002799,CDM,250,RC,409233934,NDC,both,10,ML,8.46,3.34,39.4668,,3.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.88,34,,2.88,percent of total billed charges,"Drugs, Inpatient Only",2.88,34,,2.88,percent of total billed charges,"Drugs, Inpatient Only",2.88,34,,2.88,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.92,70,,5.92,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.82,,,2.82,Other,Drug Cost,2.82,,,2.82,Other,Drug Cost,2.82,,,2.82,Other,Drug Cost,2.82,,,2.82,Other,Drug Cost,2.82,,,2.82,Other,Drug Cost,2.82,,,2.82,Other,Drug Cost,6.34,,,6.34,Other,225% of Medicaid,3.95,,,3.95,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.06,,,6.06,Other,215% Medicaid APG methodology,6.06,,,6.06,Other,215% Medicaid APG methodology,3.52,,,3.52,Other,125% Medicaid APG methodology,0.01,6.34,
LIDOCAINE 5% ANORECTAL CREAM,,,,80002802,CDM,250,RC,496089230,NDC,both,1,GM,77.82,30.71,39.4668,,30.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,26.46,34,,26.46,percent of total billed charges,"Drugs, Inpatient Only",26.46,34,,26.46,percent of total billed charges,"Drugs, Inpatient Only",26.46,34,,26.46,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,54.47,70,,54.47,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,25.94,,,25.94,Other,Drug Cost,25.94,,,25.94,Other,Drug Cost,25.94,,,25.94,Other,Drug Cost,25.94,,,25.94,Other,Drug Cost,25.94,,,25.94,Other,Drug Cost,25.94,,,25.94,Other,Drug Cost,58.37,,,58.37,Other,225% of Medicaid,36.32,,,36.32,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,55.77,,,55.77,Other,215% Medicaid APG methodology,55.77,,,55.77,Other,215% Medicaid APG methodology,32.43,,,32.43,Other,125% Medicaid APG methodology,0.01,58.37,
MEROPENEM 500GM/NS 50ML,,,,80002803,CDM,250,RC,264318311,NDC,both,24,EA,24.57,9.7,39.4668,,9.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.35,34,,8.35,percent of total billed charges,"Drugs, Inpatient Only",8.35,34,,8.35,percent of total billed charges,"Drugs, Inpatient Only",8.35,34,,8.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.2,70,,17.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.19,,,8.19,Other,Drug Cost,8.19,,,8.19,Other,Drug Cost,8.19,,,8.19,Other,Drug Cost,8.19,,,8.19,Other,Drug Cost,8.19,,,8.19,Other,Drug Cost,8.19,,,8.19,Other,Drug Cost,18.43,,,18.43,Other,225% of Medicaid,11.47,,,11.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,17.61,,,17.61,Other,215% Medicaid APG methodology,17.61,,,17.61,Other,215% Medicaid APG methodology,10.24,,,10.24,Other,125% Medicaid APG methodology,0.01,18.43,
VALGANCICLOVIR 450MG TABLET,,,,80002805,CDM,250,RC,904679604,NDC,both,3,EA,160.8,63.46,39.4668,,63.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,54.67,34,,54.67,percent of total billed charges,"Drugs, Inpatient Only",54.67,34,,54.67,percent of total billed charges,"Drugs, Inpatient Only",54.67,34,,54.67,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,112.56,70,,112.56,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,53.6,,,53.6,Other,Drug Cost,53.6,,,53.6,Other,Drug Cost,53.6,,,53.6,Other,Drug Cost,53.6,,,53.6,Other,Drug Cost,53.6,,,53.6,Other,Drug Cost,53.6,,,53.6,Other,Drug Cost,120.6,,,120.6,Other,225% of Medicaid,75.04,,,75.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,115.24,,,115.24,Other,215% Medicaid APG methodology,115.24,,,115.24,Other,215% Medicaid APG methodology,67,,,67,Other,125% Medicaid APG methodology,0.01,120.6,
TRIAMCINOLONE 0.5% OINT 15GM,,,,80002807,CDM,250,RC,45802004935,NDC,both,1,GM,6.57,2.59,39.4668,,2.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.23,34,,2.23,percent of total billed charges,"Drugs, Inpatient Only",2.23,34,,2.23,percent of total billed charges,"Drugs, Inpatient Only",2.23,34,,2.23,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.6,70,,4.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.19,,,2.19,Other,Drug Cost,2.19,,,2.19,Other,Drug Cost,2.19,,,2.19,Other,Drug Cost,2.19,,,2.19,Other,Drug Cost,2.19,,,2.19,Other,Drug Cost,2.19,,,2.19,Other,Drug Cost,4.93,,,4.93,Other,225% of Medicaid,3.07,,,3.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.71,,,4.71,Other,215% Medicaid APG methodology,4.71,,,4.71,Other,215% Medicaid APG methodology,2.74,,,2.74,Other,125% Medicaid APG methodology,0.01,4.93,
BETAMETHASONE AUGMENTED 0.05% CREAM 15GM,,,,80002808,CDM,250,RC,51672131001,NDC,both,1,GM,3,1.18,39.4668,,1.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.02,34,,1.02,percent of total billed charges,"Drugs, Inpatient Only",1.02,34,,1.02,percent of total billed charges,"Drugs, Inpatient Only",1.02,34,,1.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.1,70,,2.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1,,,1,Other,Drug Cost,1,,,1,Other,Drug Cost,1,,,1,Other,Drug Cost,1,,,1,Other,Drug Cost,1,,,1,Other,Drug Cost,1,,,1,Other,Drug Cost,2.25,,,2.25,Other,225% of Medicaid,1.4,,,1.4,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.15,,,2.15,Other,215% Medicaid APG methodology,2.15,,,2.15,Other,215% Medicaid APG methodology,1.25,,,1.25,Other,125% Medicaid APG methodology,0.01,2.25,
BETAMETHASONE AUGMENTED 0.05% OINT 15GM,,,,80002809,CDM,250,RC,168026815,NDC,both,1,GM,8.91,3.52,39.4668,,3.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.03,34,,3.03,percent of total billed charges,"Drugs, Inpatient Only",3.03,34,,3.03,percent of total billed charges,"Drugs, Inpatient Only",3.03,34,,3.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.24,70,,6.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.97,,,2.97,Other,Drug Cost,2.97,,,2.97,Other,Drug Cost,2.97,,,2.97,Other,Drug Cost,2.97,,,2.97,Other,Drug Cost,2.97,,,2.97,Other,Drug Cost,2.97,,,2.97,Other,Drug Cost,6.68,,,6.68,Other,225% of Medicaid,4.16,,,4.16,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,6.39,,,6.39,Other,215% Medicaid APG methodology,6.39,,,6.39,Other,215% Medicaid APG methodology,3.71,,,3.71,Other,125% Medicaid APG methodology,0.01,6.68,
LANSOPRAZOLE 3MG/ML ORAL SUSP,,,,80002810,CDM,250,RC,65628008003,NDC,both,1,ML,475.59,187.7,39.4668,,187.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,161.7,34,,161.7,percent of total billed charges,"Drugs, Inpatient Only",161.7,34,,161.7,percent of total billed charges,"Drugs, Inpatient Only",161.7,34,,161.7,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,332.91,70,,332.91,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,158.53,,,158.53,Other,Drug Cost,158.53,,,158.53,Other,Drug Cost,158.53,,,158.53,Other,Drug Cost,158.53,,,158.53,Other,Drug Cost,158.53,,,158.53,Other,Drug Cost,158.53,,,158.53,Other,Drug Cost,356.69,,,356.69,Other,225% of Medicaid,221.94,,,221.94,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,340.84,,,340.84,Other,215% Medicaid APG methodology,340.84,,,340.84,Other,215% Medicaid APG methodology,198.16,,,198.16,Other,125% Medicaid APG methodology,0.01,356.69,
CLOMIPRAMINE 50MG CAPSULE,,,,80002813,CDM,250,RC,51672401206,NDC,both,30,EA,0.45,0.18,39.4668,,0.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.15,34,,0.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.31,70,,0.31,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.15,,,0.15,Other,Drug Cost,0.33,,,0.33,Other,225% of Medicaid,0.21,,,0.21,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.32,,,0.32,Other,215% Medicaid APG methodology,0.32,,,0.32,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,125% Medicaid APG methodology,0.01,0.33,
METHADONE ORAL CONCENTRATE 10MG/ML,,,,80002815,CDM,250,RC,66689069430,NDC,both,1,ML,1.29,0.51,39.4668,,0.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.44,34,,0.44,percent of total billed charges,"Drugs, Inpatient Only",0.44,34,,0.44,percent of total billed charges,"Drugs, Inpatient Only",0.44,34,,0.44,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.9,70,,0.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.43,,,0.43,Other,Drug Cost,0.43,,,0.43,Other,Drug Cost,0.43,,,0.43,Other,Drug Cost,0.43,,,0.43,Other,Drug Cost,0.43,,,0.43,Other,Drug Cost,0.43,,,0.43,Other,Drug Cost,0.97,,,0.97,Other,225% of Medicaid,0.6,,,0.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.92,,,0.92,Other,215% Medicaid APG methodology,0.92,,,0.92,Other,215% Medicaid APG methodology,0.54,,,0.54,Other,125% Medicaid APG methodology,0.01,0.97,
MELATONIN 5MG TABLET,,,,80002816,CDM,250,RC,7610015540,NDC,both,200,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
ENTRESTO 24MG/26MG TABLET,,,,80002817,CDM,250,RC,78065920,NDC,both,60,EA,14.15,5.58,39.4668,,5.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.81,34,,4.81,percent of total billed charges,"Drugs, Inpatient Only",4.81,34,,4.81,percent of total billed charges,"Drugs, Inpatient Only",4.81,34,,4.81,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.9,70,,9.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.72,,,4.72,Other,Drug Cost,4.72,,,4.72,Other,Drug Cost,4.72,,,4.72,Other,Drug Cost,4.72,,,4.72,Other,Drug Cost,4.72,,,4.72,Other,Drug Cost,4.72,,,4.72,Other,Drug Cost,10.61,,,10.61,Other,225% of Medicaid,6.6,,,6.6,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.14,,,10.14,Other,215% Medicaid APG methodology,10.14,,,10.14,Other,215% Medicaid APG methodology,5.89,,,5.89,Other,125% Medicaid APG methodology,0.01,10.61,
ENTRESTO 49MG/51MG TABLET,,,,80002818,CDM,250,RC,78077720,NDC,both,60,EA,14.07,5.55,39.4668,,5.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.78,34,,4.78,percent of total billed charges,"Drugs, Inpatient Only",4.78,34,,4.78,percent of total billed charges,"Drugs, Inpatient Only",4.78,34,,4.78,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.85,70,,9.85,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.69,,,4.69,Other,Drug Cost,4.69,,,4.69,Other,Drug Cost,4.69,,,4.69,Other,Drug Cost,4.69,,,4.69,Other,Drug Cost,4.69,,,4.69,Other,Drug Cost,4.69,,,4.69,Other,Drug Cost,10.55,,,10.55,Other,225% of Medicaid,6.56,,,6.56,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.08,,,10.08,Other,215% Medicaid APG methodology,10.08,,,10.08,Other,215% Medicaid APG methodology,5.86,,,5.86,Other,125% Medicaid APG methodology,0.01,10.55,
ENTRESTO 97MG/103MG TABLET,,,,80002819,CDM,250,RC,78069620,NDC,both,60,EA,14.58,5.75,39.4668,,5.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.96,34,,4.96,percent of total billed charges,"Drugs, Inpatient Only",4.96,34,,4.96,percent of total billed charges,"Drugs, Inpatient Only",4.96,34,,4.96,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.21,70,,10.21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.86,,,4.86,Other,Drug Cost,4.86,,,4.86,Other,Drug Cost,4.86,,,4.86,Other,Drug Cost,4.86,,,4.86,Other,Drug Cost,4.86,,,4.86,Other,Drug Cost,4.86,,,4.86,Other,Drug Cost,10.94,,,10.94,Other,225% of Medicaid,6.8,,,6.8,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.45,,,10.45,Other,215% Medicaid APG methodology,10.45,,,10.45,Other,215% Medicaid APG methodology,6.08,,,6.08,Other,125% Medicaid APG methodology,0.01,10.94,
GENVOYA 150MG/150MG/200MG/10MG TAB,,,,80002820,CDM,250,RC,61958190101,NDC,both,30,EA,229.59,90.61,39.4668,,90.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,78.06,34,,78.06,percent of total billed charges,"Drugs, Inpatient Only",78.06,34,,78.06,percent of total billed charges,"Drugs, Inpatient Only",78.06,34,,78.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,160.71,70,,160.71,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,76.53,,,76.53,Other,Drug Cost,76.53,,,76.53,Other,Drug Cost,76.53,,,76.53,Other,Drug Cost,76.53,,,76.53,Other,Drug Cost,76.53,,,76.53,Other,Drug Cost,76.53,,,76.53,Other,Drug Cost,172.19,,,172.19,Other,225% of Medicaid,107.14,,,107.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,164.54,,,164.54,Other,215% Medicaid APG methodology,164.54,,,164.54,Other,215% Medicaid APG methodology,95.66,,,95.66,Other,125% Medicaid APG methodology,0.01,172.19,
AMMONIUM LACTATE 12% LOTION 28GM,,,,80002823,CDM,250,RC,45802041926,NDC,both,1,GM,22.17,8.75,39.4668,,8.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.54,34,,7.54,percent of total billed charges,"Drugs, Inpatient Only",7.54,34,,7.54,percent of total billed charges,"Drugs, Inpatient Only",7.54,34,,7.54,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.52,70,,15.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.39,,,7.39,Other,Drug Cost,7.39,,,7.39,Other,Drug Cost,7.39,,,7.39,Other,Drug Cost,7.39,,,7.39,Other,Drug Cost,7.39,,,7.39,Other,Drug Cost,7.39,,,7.39,Other,Drug Cost,16.63,,,16.63,Other,225% of Medicaid,10.35,,,10.35,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,15.89,,,15.89,Other,215% Medicaid APG methodology,15.89,,,15.89,Other,215% Medicaid APG methodology,9.24,,,9.24,Other,125% Medicaid APG methodology,0.01,16.63,
BENZOYL PEROXIDE GEL 5%,,,,80002824,CDM,250,RC,536105556,NDC,both,1,GM,3.54,1.4,39.4668,,1.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.2,34,,1.2,percent of total billed charges,"Drugs, Inpatient Only",1.2,34,,1.2,percent of total billed charges,"Drugs, Inpatient Only",1.2,34,,1.2,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.48,70,,2.48,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,2.66,,,2.66,Other,225% of Medicaid,1.65,,,1.65,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.54,,,2.54,Other,215% Medicaid APG methodology,2.54,,,2.54,Other,215% Medicaid APG methodology,1.48,,,1.48,Other,125% Medicaid APG methodology,0.01,2.66,
DOLUTEGRAVIR 50MG TAB,,,,80002829,CDM,250,RC,49702022813,NDC,both,30,EA,97.09,38.32,39.4668,,38.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,33.01,34,,33.01,percent of total billed charges,"Drugs, Inpatient Only",33.01,34,,33.01,percent of total billed charges,"Drugs, Inpatient Only",33.01,34,,33.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,67.96,70,,67.96,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,32.36,,,32.36,Other,Drug Cost,32.36,,,32.36,Other,Drug Cost,32.36,,,32.36,Other,Drug Cost,32.36,,,32.36,Other,Drug Cost,32.36,,,32.36,Other,Drug Cost,32.36,,,32.36,Other,Drug Cost,72.82,,,72.82,Other,225% of Medicaid,45.31,,,45.31,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,69.58,,,69.58,Other,215% Medicaid APG methodology,69.58,,,69.58,Other,215% Medicaid APG methodology,40.45,,,40.45,Other,125% Medicaid APG methodology,0.01,72.82,
CLOBAZAM 10 MG TABLET,,,,80023637,CDM,250,RC,832058011,NDC,both,100,EA,0.29,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,70,,0.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.22,,,0.22,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.21,,,0.21,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.22,
RASAGILINE MESYLATE 0.5MG TABLET,,,,80023638,CDM,250,RC,93306056,NDC,both,30,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,70,,0.11,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
DESCOVY 200MG TABLET,,,,80023655,CDM,250,RC,61958200201,NDC,both,30,EA,91.48,36.1,39.4668,,36.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,31.1,34,,31.1,percent of total billed charges,"Drugs, Inpatient Only",31.1,34,,31.1,percent of total billed charges,"Drugs, Inpatient Only",31.1,34,,31.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,64.03,70,,64.03,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,30.49,,,30.49,Other,Drug Cost,30.49,,,30.49,Other,Drug Cost,30.49,,,30.49,Other,Drug Cost,30.49,,,30.49,Other,Drug Cost,30.49,,,30.49,Other,Drug Cost,30.49,,,30.49,Other,Drug Cost,68.61,,,68.61,Other,225% of Medicaid,42.69,,,42.69,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,65.56,,,65.56,Other,215% Medicaid APG methodology,65.56,,,65.56,Other,215% Medicaid APG methodology,38.12,,,38.12,Other,125% Medicaid APG methodology,0.01,68.61,
PREZCOBIX 800-150MG TABLET,,,,80023656,CDM,250,RC,59676057530,NDC,both,30,EA,123.91,48.9,39.4668,,48.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,42.13,34,,42.13,percent of total billed charges,"Drugs, Inpatient Only",42.13,34,,42.13,percent of total billed charges,"Drugs, Inpatient Only",42.13,34,,42.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,86.73,70,,86.73,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,41.3,,,41.3,Other,Drug Cost,41.3,,,41.3,Other,Drug Cost,41.3,,,41.3,Other,Drug Cost,41.3,,,41.3,Other,Drug Cost,41.3,,,41.3,Other,Drug Cost,41.3,,,41.3,Other,Drug Cost,92.93,,,92.93,Other,225% of Medicaid,57.82,,,57.82,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,88.8,,,88.8,Other,215% Medicaid APG methodology,88.8,,,88.8,Other,215% Medicaid APG methodology,51.63,,,51.63,Other,125% Medicaid APG methodology,0.01,92.93,
SUGAMMADEX 100MG/ML 2ML VIAL,,,,80023659,CDM,250,RC,6542312,NDC,both,10,ML,201.65,79.59,39.4668,,79.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,68.56,34,,68.56,percent of total billed charges,"Drugs, Inpatient Only",68.56,34,,68.56,percent of total billed charges,"Drugs, Inpatient Only",68.56,34,,68.56,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,141.16,70,,141.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,67.22,,,67.22,Other,Drug Cost,67.22,,,67.22,Other,Drug Cost,67.22,,,67.22,Other,Drug Cost,67.22,,,67.22,Other,Drug Cost,67.22,,,67.22,Other,Drug Cost,67.22,,,67.22,Other,Drug Cost,151.24,,,151.24,Other,225% of Medicaid,94.11,,,94.11,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,144.52,,,144.52,Other,215% Medicaid APG methodology,144.52,,,144.52,Other,215% Medicaid APG methodology,84.02,,,84.02,Other,125% Medicaid APG methodology,0.01,151.24,
MUPIROCIN 2% OINTMENT 1 GM,,,,80023660,CDM,250,RC,50268056815,NDC,both,50,GM,6.6,2.61,39.4668,,2.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.24,34,,2.24,percent of total billed charges,"Drugs, Inpatient Only",2.24,34,,2.24,percent of total billed charges,"Drugs, Inpatient Only",2.24,34,,2.24,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.62,70,,4.62,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.2,,,2.2,Other,Drug Cost,2.2,,,2.2,Other,Drug Cost,2.2,,,2.2,Other,Drug Cost,2.2,,,2.2,Other,Drug Cost,2.2,,,2.2,Other,Drug Cost,2.2,,,2.2,Other,Drug Cost,4.95,,,4.95,Other,225% of Medicaid,3.08,,,3.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.73,,,4.73,Other,215% Medicaid APG methodology,4.73,,,4.73,Other,215% Medicaid APG methodology,2.75,,,2.75,Other,125% Medicaid APG methodology,0.01,4.95,
CLOTRIMAZOLE 1% CREAM 1.9GM,,,,80023661,CDM,250,RC,51672127506,NDC,both,1,GM,10.71,4.23,39.4668,,4.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.64,34,,3.64,percent of total billed charges,"Drugs, Inpatient Only",3.64,34,,3.64,percent of total billed charges,"Drugs, Inpatient Only",3.64,34,,3.64,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.5,70,,7.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.57,,,3.57,Other,Drug Cost,3.57,,,3.57,Other,Drug Cost,3.57,,,3.57,Other,Drug Cost,3.57,,,3.57,Other,Drug Cost,3.57,,,3.57,Other,Drug Cost,3.57,,,3.57,Other,Drug Cost,8.03,,,8.03,Other,225% of Medicaid,5,,,5,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.68,,,7.68,Other,215% Medicaid APG methodology,7.68,,,7.68,Other,215% Medicaid APG methodology,4.46,,,4.46,Other,125% Medicaid APG methodology,0.01,8.03,
CLOTRIMAZOLE/BETAMETH CREAM 1.9GM,,,,80023662,CDM,250,RC,168025846,NDC,both,1,GM,16.2,6.39,39.4668,,6.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.51,34,,5.51,percent of total billed charges,"Drugs, Inpatient Only",5.51,34,,5.51,percent of total billed charges,"Drugs, Inpatient Only",5.51,34,,5.51,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.34,70,,11.34,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.4,,,5.4,Other,Drug Cost,5.4,,,5.4,Other,Drug Cost,5.4,,,5.4,Other,Drug Cost,5.4,,,5.4,Other,Drug Cost,5.4,,,5.4,Other,Drug Cost,5.4,,,5.4,Other,Drug Cost,12.15,,,12.15,Other,225% of Medicaid,7.56,,,7.56,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.61,,,11.61,Other,215% Medicaid APG methodology,11.61,,,11.61,Other,215% Medicaid APG methodology,6.75,,,6.75,Other,125% Medicaid APG methodology,0.01,12.15,
GELATIN ABSORBABLE POWDER 1GM,,,,80023678,CDM,250,RC,9043304,NDC,both,6,GM,148.04,58.43,39.4668,,58.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,50.33,34,,50.33,percent of total billed charges,"Drugs, Inpatient Only",50.33,34,,50.33,percent of total billed charges,"Drugs, Inpatient Only",50.33,34,,50.33,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,103.63,70,,103.63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,49.35,,,49.35,Other,Drug Cost,49.35,,,49.35,Other,Drug Cost,49.35,,,49.35,Other,Drug Cost,49.35,,,49.35,Other,Drug Cost,49.35,,,49.35,Other,Drug Cost,49.35,,,49.35,Other,Drug Cost,111.03,,,111.03,Other,225% of Medicaid,69.09,,,69.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,106.1,,,106.1,Other,215% Medicaid APG methodology,106.1,,,106.1,Other,215% Medicaid APG methodology,61.68,,,61.68,Other,125% Medicaid APG methodology,0.01,111.03,
FLUTICASONE FUROATE 100MCG INHALATION,,,,80023683,CDM,250,RC,173087414,NDC,both,14,EA,3.39,1.34,39.4668,,1.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.15,34,,1.15,percent of total billed charges,"Drugs, Inpatient Only",1.15,34,,1.15,percent of total billed charges,"Drugs, Inpatient Only",1.15,34,,1.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.37,70,,2.37,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.13,,,1.13,Other,Drug Cost,1.13,,,1.13,Other,Drug Cost,1.13,,,1.13,Other,Drug Cost,1.13,,,1.13,Other,Drug Cost,1.13,,,1.13,Other,Drug Cost,1.13,,,1.13,Other,Drug Cost,2.54,,,2.54,Other,225% of Medicaid,1.58,,,1.58,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.43,,,2.43,Other,215% Medicaid APG methodology,2.43,,,2.43,Other,215% Medicaid APG methodology,1.41,,,1.41,Other,125% Medicaid APG methodology,0.01,2.54,
FLUTICASONE FUROATE 200MCG INHALATION,,,,80023684,CDM,250,RC,173087614,NDC,both,14,EA,4.53,1.79,39.4668,,1.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.54,34,,1.54,percent of total billed charges,"Drugs, Inpatient Only",1.54,34,,1.54,percent of total billed charges,"Drugs, Inpatient Only",1.54,34,,1.54,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.17,70,,3.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,3.4,,,3.4,Other,225% of Medicaid,2.12,,,2.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.25,,,3.25,Other,215% Medicaid APG methodology,3.25,,,3.25,Other,215% Medicaid APG methodology,1.89,,,1.89,Other,125% Medicaid APG methodology,0.01,3.4,
UMECLIDINIUM 62.5MCG INHALATION,,,,80023685,CDM,250,RC,173087306,NDC,both,7,EA,6.53,2.58,39.4668,,2.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.22,34,,2.22,percent of total billed charges,"Drugs, Inpatient Only",2.22,34,,2.22,percent of total billed charges,"Drugs, Inpatient Only",2.22,34,,2.22,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.57,70,,4.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,4.9,,,4.9,Other,225% of Medicaid,3.05,,,3.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.68,,,4.68,Other,215% Medicaid APG methodology,4.68,,,4.68,Other,215% Medicaid APG methodology,2.72,,,2.72,Other,125% Medicaid APG methodology,0.01,4.9,
SODIUM CHORIDE 0.45% 250ML,,,,80023686,CDM,250,RC,990798502,NDC,both,24,ML,6.79,2.68,39.4668,,2.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.31,34,,2.31,percent of total billed charges,"Drugs, Inpatient Only",2.31,34,,2.31,percent of total billed charges,"Drugs, Inpatient Only",2.31,34,,2.31,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.76,70,,4.76,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.26,,,2.26,Other,Drug Cost,2.26,,,2.26,Other,Drug Cost,2.26,,,2.26,Other,Drug Cost,2.26,,,2.26,Other,Drug Cost,2.26,,,2.26,Other,Drug Cost,2.26,,,2.26,Other,Drug Cost,5.1,,,5.1,Other,225% of Medicaid,3.17,,,3.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.87,,,4.87,Other,215% Medicaid APG methodology,4.87,,,4.87,Other,215% Medicaid APG methodology,2.83,,,2.83,Other,125% Medicaid APG methodology,0.01,5.1,
FINASTERIDE SUSP 5MG/10ML,,,,80023688,CDM,250,RC,31722052510,NDC,both,1000,EA,0.1,0.04,39.4668,,0.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,70,,0.07,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.08,
FOSFOMYCIN TROMETHAMINE 3 GRAM SACHET,,,,80023690,CDM,250,RC,70700026894,NDC,both,1,EA,85.38,33.7,39.4668,,33.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,29.03,34,,29.03,percent of total billed charges,"Drugs, Inpatient Only",29.03,34,,29.03,percent of total billed charges,"Drugs, Inpatient Only",29.03,34,,29.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,59.77,70,,59.77,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,28.46,,,28.46,Other,Drug Cost,28.46,,,28.46,Other,Drug Cost,28.46,,,28.46,Other,Drug Cost,28.46,,,28.46,Other,Drug Cost,28.46,,,28.46,Other,Drug Cost,28.46,,,28.46,Other,Drug Cost,64.04,,,64.04,Other,225% of Medicaid,39.84,,,39.84,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,61.19,,,61.19,Other,215% Medicaid APG methodology,61.19,,,61.19,Other,215% Medicaid APG methodology,35.58,,,35.58,Other,125% Medicaid APG methodology,0.01,64.04,
CETIRIZINE 5 MG TAB,,,,80023704,CDM,250,RC,16571040110,NDC,both,100,EA,0.07,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
ESCITALOPRAM 5 MG TAB,,,,80023705,CDM,250,RC,456200501,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
ESTRADIOL 0.5 MG TAB,,,,80023706,CDM,250,RC,555089902,NDC,both,100,EA,0.05,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
MIRTAZAPINE 7.5 MG TAB,,,,80023709,CDM,250,RC,57237000730,NDC,both,30,EA,0.32,0.13,39.4668,,0.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.11,34,,0.11,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.22,70,,0.22,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.24,,,0.24,Other,225% of Medicaid,0.15,,,0.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.23,,,0.23,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,125% Medicaid APG methodology,0.01,0.24,
TIZANIDINE 2 MG TAB,,,,80023711,CDM,250,RC,57664050289,NDC,both,150,EA,0.02,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
AMIODARONE 100 MG TABLET,,,,80023714,CDM,250,RC,50268009715,NDC,both,5,EA,70.37,27.77,39.4668,,27.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,23.93,34,,23.93,percent of total billed charges,"Drugs, Inpatient Only",23.93,34,,23.93,percent of total billed charges,"Drugs, Inpatient Only",23.93,34,,23.93,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,49.26,70,,49.26,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,23.46,,,23.46,Other,Drug Cost,23.46,,,23.46,Other,Drug Cost,23.46,,,23.46,Other,Drug Cost,23.46,,,23.46,Other,Drug Cost,23.46,,,23.46,Other,Drug Cost,23.46,,,23.46,Other,Drug Cost,52.78,,,52.78,Other,225% of Medicaid,32.84,,,32.84,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,50.43,,,50.43,Other,215% Medicaid APG methodology,50.43,,,50.43,Other,215% Medicaid APG methodology,29.32,,,29.32,Other,125% Medicaid APG methodology,0.01,52.78,
ASCORBIC ACID 250 MG TABLET,,,,80023716,CDM,250,RC,50268086015,NDC,both,5,EA,4.67,1.84,39.4668,,1.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.59,34,,1.59,percent of total billed charges,"Drugs, Inpatient Only",1.59,34,,1.59,percent of total billed charges,"Drugs, Inpatient Only",1.59,34,,1.59,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.27,70,,3.27,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.56,,,1.56,Other,Drug Cost,1.56,,,1.56,Other,Drug Cost,1.56,,,1.56,Other,Drug Cost,1.56,,,1.56,Other,Drug Cost,1.56,,,1.56,Other,Drug Cost,1.56,,,1.56,Other,Drug Cost,3.5,,,3.5,Other,225% of Medicaid,2.18,,,2.18,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.35,,,3.35,Other,215% Medicaid APG methodology,3.35,,,3.35,Other,215% Medicaid APG methodology,1.95,,,1.95,Other,125% Medicaid APG methodology,0.01,3.5,
BACLOFEN 5 MG TABLET,,,,80023717,CDM,250,RC,52817031910,NDC,both,100,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
CYANOCOBALAMIN 250 MCG TABLET,,,,80023721,CDM,250,RC,50268085315,NDC,both,5,EA,4,1.58,39.4668,,1.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.36,34,,1.36,percent of total billed charges,"Drugs, Inpatient Only",1.36,34,,1.36,percent of total billed charges,"Drugs, Inpatient Only",1.36,34,,1.36,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.8,70,,2.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.33,,,1.33,Other,Drug Cost,1.33,,,1.33,Other,Drug Cost,1.33,,,1.33,Other,Drug Cost,1.33,,,1.33,Other,Drug Cost,1.33,,,1.33,Other,Drug Cost,1.33,,,1.33,Other,Drug Cost,3,,,3,Other,225% of Medicaid,1.86,,,1.86,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.86,,,2.86,Other,215% Medicaid APG methodology,2.86,,,2.86,Other,215% Medicaid APG methodology,1.67,,,1.67,Other,125% Medicaid APG methodology,0.01,3,
FLUVOXAMINE 25 MG TABLET,,,,80023722,CDM,250,RC,60505016401,NDC,both,100,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
NABUMETONE 750 MG TABLET,,,,80023724,CDM,250,RC,69097096607,NDC,both,100,EA,0.18,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
PREDNISONE 2.5 MG TABLET,,,,80023727,CDM,250,RC,603533621,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
PROPAFENONE 225 MG TABLET,,,,80023728,CDM,250,RC,59651025701,NDC,both,100,EA,0.15,0.06,39.4668,,0.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.05,34,,0.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,70,,0.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.11,
PHENOBARBITAL 16.2 MG TABLET,,,,80023745,CDM,250,RC,603516521,NDC,both,100,EA,0.11,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.08,,,0.08,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
CLONAZEPAM 0.25 MG ODT,,,,80023747,CDM,250,RC,49884030702,NDC,both,10,EA,3.23,1.27,39.4668,,1.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.1,34,,1.1,percent of total billed charges,"Drugs, Inpatient Only",1.1,34,,1.1,percent of total billed charges,"Drugs, Inpatient Only",1.1,34,,1.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.26,70,,2.26,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.08,,,1.08,Other,Drug Cost,1.08,,,1.08,Other,Drug Cost,1.08,,,1.08,Other,Drug Cost,1.08,,,1.08,Other,Drug Cost,1.08,,,1.08,Other,Drug Cost,1.08,,,1.08,Other,Drug Cost,2.42,,,2.42,Other,225% of Medicaid,1.51,,,1.51,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.31,,,2.31,Other,215% Medicaid APG methodology,2.31,,,2.31,Other,215% Medicaid APG methodology,1.34,,,1.34,Other,125% Medicaid APG methodology,0.01,2.42,
PRAMIPEXOLE 0.125 MG TABLET,,,,80023752,CDM,250,RC,13668009190,NDC,both,90,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
TORSEMIDE 5 MG TABLET,,,,80023753,CDM,250,RC,31722052901,NDC,both,100,EA,0.09,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
ANORO ELLIPTA 62.5MCG/25MCG INHALER,,,,80023777,CDM,250,RC,173086906,NDC,both,14,EA,1.95,0.77,39.4668,,0.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.66,34,,0.66,percent of total billed charges,"Drugs, Inpatient Only",0.66,34,,0.66,percent of total billed charges,"Drugs, Inpatient Only",0.66,34,,0.66,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.36,70,,1.36,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,1.46,,,1.46,Other,225% of Medicaid,0.91,,,0.91,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.39,,,1.39,Other,215% Medicaid APG methodology,1.39,,,1.39,Other,215% Medicaid APG methodology,0.81,,,0.81,Other,125% Medicaid APG methodology,0.01,1.46,
SODIUM CHLORIDE 0.9% 2000ML IRRIGATION,,,,80023781,CDM,250,RC,264220150,NDC,both,8,ML,14.34,5.66,39.4668,,5.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.88,34,,4.88,percent of total billed charges,"Drugs, Inpatient Only",4.88,34,,4.88,percent of total billed charges,"Drugs, Inpatient Only",4.88,34,,4.88,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.04,70,,10.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.78,,,4.78,Other,Drug Cost,4.78,,,4.78,Other,Drug Cost,4.78,,,4.78,Other,Drug Cost,4.78,,,4.78,Other,Drug Cost,4.78,,,4.78,Other,Drug Cost,4.78,,,4.78,Other,Drug Cost,10.76,,,10.76,Other,225% of Medicaid,6.69,,,6.69,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.28,,,10.28,Other,215% Medicaid APG methodology,10.28,,,10.28,Other,215% Medicaid APG methodology,5.98,,,5.98,Other,125% Medicaid APG methodology,0.01,10.76,
CEFAZOLIN 3 GM IN 100 ML,,,,80023792,CDM,250,RC,44567070810,NDC,both,10,EA,17.39,6.86,39.4668,,6.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.91,34,,5.91,percent of total billed charges,"Drugs, Inpatient Only",5.91,34,,5.91,percent of total billed charges,"Drugs, Inpatient Only",5.91,34,,5.91,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.17,70,,12.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.8,,,5.8,Other,Drug Cost,5.8,,,5.8,Other,Drug Cost,5.8,,,5.8,Other,Drug Cost,5.8,,,5.8,Other,Drug Cost,5.8,,,5.8,Other,Drug Cost,5.8,,,5.8,Other,Drug Cost,13.04,,,13.04,Other,225% of Medicaid,8.12,,,8.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,12.46,,,12.46,Other,215% Medicaid APG methodology,12.46,,,12.46,Other,215% Medicaid APG methodology,7.25,,,7.25,Other,125% Medicaid APG methodology,0.01,13.04,
BUSPIRONE 7.5 MG TABLET,,,,80023797,CDM,250,RC,64380078706,NDC,both,100,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,70,,0.06,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.06,,,0.06,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
ATOMOXETINE HCL 10MG CAPSULE,,,,80023801,CDM,250,RC,68462026530,NDC,both,30,EA,0.42,0.17,39.4668,,0.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.14,34,,0.14,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.29,70,,0.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.31,,,0.31,Other,225% of Medicaid,0.2,,,0.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.3,,,0.3,Other,215% Medicaid APG methodology,0.3,,,0.3,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,125% Medicaid APG methodology,0.01,0.31,
SEVELAMER CARBONATE 2.4GM PACKET,,,,80023816,CDM,250,RC,65862093190,NDC,both,90,EA,1.84,0.72,39.4668,,0.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.62,34,,0.62,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.29,70,,1.29,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,0.61,,,0.61,Other,Drug Cost,1.38,,,1.38,Other,225% of Medicaid,0.86,,,0.86,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.32,,,1.32,Other,215% Medicaid APG methodology,1.32,,,1.32,Other,215% Medicaid APG methodology,0.77,,,0.77,Other,125% Medicaid APG methodology,0.01,1.38,
LAMOTRIGINE 150MG TABLET,,,,80023819,CDM,250,RC,51672413204,NDC,both,60,EA,0.08,0.03,39.4668,,0.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.03,34,,0.03,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.05,70,,0.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.06,,,0.06,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.06,
LOSARTAN 100 MG TABLET,,,,80023824,CDM,250,RC,31722070290,NDC,both,90,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.05,
ANASTROZOLE 1 MG ORAL SUSP,,,,80023825,CDM,250,RC,51991062010,NDC,both,1000,EA,0.26,0.1,39.4668,,0.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.18,70,,0.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.19,,,0.19,Other,225% of Medicaid,0.12,,,0.12,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.18,,,0.18,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.19,
AMPHETAMINE-DEXTROAMPHETAMINE 5 MG TAB,,,,80023829,CDM,250,RC,47781017401,NDC,both,100,EA,0.18,0.07,39.4668,,0.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.06,34,,0.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
FLUTICASONE-VILANTEROL 200-25MCG INHALER,,,,80023842,CDM,250,RC,173088214,NDC,both,28,EA,3.41,1.35,39.4668,,1.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",1.16,34,,1.16,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.39,70,,2.39,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,1.14,,,1.14,Other,Drug Cost,2.56,,,2.56,Other,225% of Medicaid,1.59,,,1.59,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.44,,,2.44,Other,215% Medicaid APG methodology,2.44,,,2.44,Other,215% Medicaid APG methodology,1.42,,,1.42,Other,125% Medicaid APG methodology,0.01,2.56,
CARIPRAZINE HCL 3MG CAPSULE,,,,80023862,CDM,250,RC,61874013020,NDC,both,2,EA,731.15,288.56,39.4668,,288.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,248.59,34,,248.59,percent of total billed charges,"Drugs, Inpatient Only",248.59,34,,248.59,percent of total billed charges,"Drugs, Inpatient Only",248.59,34,,248.59,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,511.8,70,,511.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,243.72,,,243.72,Other,Drug Cost,243.72,,,243.72,Other,Drug Cost,243.72,,,243.72,Other,Drug Cost,243.72,,,243.72,Other,Drug Cost,243.72,,,243.72,Other,Drug Cost,243.72,,,243.72,Other,Drug Cost,548.36,,,548.36,Other,225% of Medicaid,341.2,,,341.2,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,523.99,,,523.99,Other,215% Medicaid APG methodology,523.99,,,523.99,Other,215% Medicaid APG methodology,304.64,,,304.64,Other,125% Medicaid APG methodology,0.01,548.36,
ISOSORBIDE 5 MG TABLET,,,,80023873,CDM,250,RC,50268044715,NDC,both,5,EA,15.98,6.31,39.4668,,6.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.43,34,,5.43,percent of total billed charges,"Drugs, Inpatient Only",5.43,34,,5.43,percent of total billed charges,"Drugs, Inpatient Only",5.43,34,,5.43,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.18,70,,11.18,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.33,,,5.33,Other,Drug Cost,5.33,,,5.33,Other,Drug Cost,5.33,,,5.33,Other,Drug Cost,5.33,,,5.33,Other,Drug Cost,5.33,,,5.33,Other,Drug Cost,5.33,,,5.33,Other,Drug Cost,11.98,,,11.98,Other,225% of Medicaid,7.46,,,7.46,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.45,,,11.45,Other,215% Medicaid APG methodology,11.45,,,11.45,Other,215% Medicaid APG methodology,6.66,,,6.66,Other,125% Medicaid APG methodology,0.01,11.98,
GLYCOPYRROLATE 1 MG TABLET,,,,80023878,CDM,250,RC,23155060601,NDC,both,100,EA,0.12,0.05,39.4668,,0.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.04,34,,0.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.08,70,,0.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.09,
ROFLUMILAST 250MCG TABLET,,,,80023880,CDM,250,RC,310008828,NDC,both,28,EA,11.67,4.6,39.4668,,4.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.97,34,,3.97,percent of total billed charges,"Drugs, Inpatient Only",3.97,34,,3.97,percent of total billed charges,"Drugs, Inpatient Only",3.97,34,,3.97,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.17,70,,8.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,3.89,,,3.89,Other,Drug Cost,8.75,,,8.75,Other,225% of Medicaid,5.44,,,5.44,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.36,,,8.36,Other,215% Medicaid APG methodology,8.36,,,8.36,Other,215% Medicaid APG methodology,4.86,,,4.86,Other,125% Medicaid APG methodology,0.01,8.75,
BIKTARVY 50MG-200MG-25MG TABLET,,,,80023891,CDM,250,RC,61958250101,NDC,both,30,EA,257.73,101.72,39.4668,,101.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,87.63,34,,87.63,percent of total billed charges,"Drugs, Inpatient Only",87.63,34,,87.63,percent of total billed charges,"Drugs, Inpatient Only",87.63,34,,87.63,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,180.41,70,,180.41,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,85.91,,,85.91,Other,Drug Cost,85.91,,,85.91,Other,Drug Cost,85.91,,,85.91,Other,Drug Cost,85.91,,,85.91,Other,Drug Cost,85.91,,,85.91,Other,Drug Cost,85.91,,,85.91,Other,Drug Cost,193.3,,,193.3,Other,225% of Medicaid,120.27,,,120.27,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,184.7,,,184.7,Other,215% Medicaid APG methodology,184.7,,,184.7,Other,215% Medicaid APG methodology,107.39,,,107.39,Other,125% Medicaid APG methodology,0.01,193.3,
AMOXICILLIN 400MG/5 ML SUSP 5ML,,,,80023898,CDM,250,RC,93416178,NDC,both,1,ML,3.72,1.47,39.4668,,1.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.26,34,,1.26,percent of total billed charges,"Drugs, Inpatient Only",1.26,34,,1.26,percent of total billed charges,"Drugs, Inpatient Only",1.26,34,,1.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.6,70,,2.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.24,,,1.24,Other,Drug Cost,1.24,,,1.24,Other,Drug Cost,1.24,,,1.24,Other,Drug Cost,1.24,,,1.24,Other,Drug Cost,1.24,,,1.24,Other,Drug Cost,1.24,,,1.24,Other,Drug Cost,2.79,,,2.79,Other,225% of Medicaid,1.74,,,1.74,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.67,,,2.67,Other,215% Medicaid APG methodology,2.67,,,2.67,Other,215% Medicaid APG methodology,1.55,,,1.55,Other,125% Medicaid APG methodology,0.01,2.79,
TICAGRELOR 60MG TABLET,,,,80023899,CDM,250,RC,186077660,NDC,both,60,EA,4.46,1.76,39.4668,,1.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.12,70,,3.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,3.34,,,3.34,Other,225% of Medicaid,2.08,,,2.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.2,,,3.2,Other,215% Medicaid APG methodology,3.2,,,3.2,Other,215% Medicaid APG methodology,1.86,,,1.86,Other,125% Medicaid APG methodology,0.01,3.34,
KETAMINE DRIP 500MG/500ML,,,,80023900,CDM,250,RC,42023011510,NDC,both,10,ML,4.46,1.76,39.4668,,1.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",1.52,34,,1.52,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.12,70,,3.12,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,3.35,,,3.35,Other,225% of Medicaid,2.08,,,2.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,3.2,,,3.2,Other,215% Medicaid APG methodology,3.2,,,3.2,Other,215% Medicaid APG methodology,1.86,,,1.86,Other,125% Medicaid APG methodology,0.01,3.35,
SODIUM ZIRCONIUM CYLOSILICATE 10GM PKT,,,,80023905,CDM,250,RC,310111030,NDC,both,30,EA,37.16,14.67,39.4668,,14.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.64,34,,12.64,percent of total billed charges,"Drugs, Inpatient Only",12.64,34,,12.64,percent of total billed charges,"Drugs, Inpatient Only",12.64,34,,12.64,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,26.02,70,,26.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12.39,,,12.39,Other,Drug Cost,12.39,,,12.39,Other,Drug Cost,12.39,,,12.39,Other,Drug Cost,12.39,,,12.39,Other,Drug Cost,12.39,,,12.39,Other,Drug Cost,12.39,,,12.39,Other,Drug Cost,27.87,,,27.87,Other,225% of Medicaid,17.34,,,17.34,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,26.63,,,26.63,Other,215% Medicaid APG methodology,26.63,,,26.63,Other,215% Medicaid APG methodology,15.49,,,15.49,Other,125% Medicaid APG methodology,0.01,27.87,
PORACTANT ALFA 80MG/ML 3ML,,,,80023912,CDM,250,RC,10122051003,NDC,both,1,ML,1466.79,578.9,39.4668,,578.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,498.71,34,,498.71,percent of total billed charges,"Drugs, Inpatient Only",498.71,34,,498.71,percent of total billed charges,"Drugs, Inpatient Only",498.71,34,,498.71,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1026.75,70,,1026.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,488.93,,,488.93,Other,Drug Cost,488.93,,,488.93,Other,Drug Cost,488.93,,,488.93,Other,Drug Cost,488.93,,,488.93,Other,Drug Cost,488.93,,,488.93,Other,Drug Cost,488.93,,,488.93,Other,Drug Cost,1100.09,,,1100.09,Other,225% of Medicaid,684.5,,,684.5,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1051.2,,,1051.2,Other,215% Medicaid APG methodology,1051.2,,,1051.2,Other,215% Medicaid APG methodology,611.16,,,611.16,Other,125% Medicaid APG methodology,0.01,1100.09,
VANCOMYCIN 1.25G IN 250 ML,,,,80023913,CDM,250,RC,67457082399,NDC,both,10,EA,34.65,13.68,39.4668,,13.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.78,34,,11.78,percent of total billed charges,"Drugs, Inpatient Only",11.78,34,,11.78,percent of total billed charges,"Drugs, Inpatient Only",11.78,34,,11.78,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.26,70,,24.26,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.55,,,11.55,Other,Drug Cost,11.55,,,11.55,Other,Drug Cost,11.55,,,11.55,Other,Drug Cost,11.55,,,11.55,Other,Drug Cost,11.55,,,11.55,Other,Drug Cost,11.55,,,11.55,Other,Drug Cost,25.99,,,25.99,Other,225% of Medicaid,16.17,,,16.17,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,24.83,,,24.83,Other,215% Medicaid APG methodology,24.83,,,24.83,Other,215% Medicaid APG methodology,14.44,,,14.44,Other,125% Medicaid APG methodology,0.01,25.99,
VANCOMYCIN 1.5G/250 ML,,,,80023914,CDM,250,RC,67457082499,NDC,both,10,EA,22.97,9.07,39.4668,,9.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.81,34,,7.81,percent of total billed charges,"Drugs, Inpatient Only",7.81,34,,7.81,percent of total billed charges,"Drugs, Inpatient Only",7.81,34,,7.81,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.08,70,,16.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.66,,,7.66,Other,Drug Cost,7.66,,,7.66,Other,Drug Cost,7.66,,,7.66,Other,Drug Cost,7.66,,,7.66,Other,Drug Cost,7.66,,,7.66,Other,Drug Cost,7.66,,,7.66,Other,Drug Cost,17.23,,,17.23,Other,225% of Medicaid,10.72,,,10.72,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,16.46,,,16.46,Other,215% Medicaid APG methodology,16.46,,,16.46,Other,215% Medicaid APG methodology,9.57,,,9.57,Other,125% Medicaid APG methodology,0.01,17.23,
LIDOCAINE 2% JELLY 20 ML UROJET,,,,80023915,CDM,250,RC,76329301505,NDC,both,25,ML,16.14,6.37,39.4668,,6.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.49,34,,5.49,percent of total billed charges,"Drugs, Inpatient Only",5.49,34,,5.49,percent of total billed charges,"Drugs, Inpatient Only",5.49,34,,5.49,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.3,70,,11.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.38,,,5.38,Other,Drug Cost,5.38,,,5.38,Other,Drug Cost,5.38,,,5.38,Other,Drug Cost,5.38,,,5.38,Other,Drug Cost,5.38,,,5.38,Other,Drug Cost,5.38,,,5.38,Other,Drug Cost,12.11,,,12.11,Other,225% of Medicaid,7.53,,,7.53,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.57,,,11.57,Other,215% Medicaid APG methodology,11.57,,,11.57,Other,215% Medicaid APG methodology,6.73,,,6.73,Other,125% Medicaid APG methodology,0.01,12.11,
NICARDIPINE IN SOD CHLORIDE 40MG/200ML,,,,80023923,CDM,250,RC,43066001610,NDC,both,10,ML,62.07,24.5,39.4668,,24.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21.1,34,,21.1,percent of total billed charges,"Drugs, Inpatient Only",21.1,34,,21.1,percent of total billed charges,"Drugs, Inpatient Only",21.1,34,,21.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,43.45,70,,43.45,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,20.69,,,20.69,Other,Drug Cost,20.69,,,20.69,Other,Drug Cost,20.69,,,20.69,Other,Drug Cost,20.69,,,20.69,Other,Drug Cost,20.69,,,20.69,Other,Drug Cost,20.69,,,20.69,Other,Drug Cost,46.55,,,46.55,Other,225% of Medicaid,28.97,,,28.97,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,44.49,,,44.49,Other,215% Medicaid APG methodology,44.49,,,44.49,Other,215% Medicaid APG methodology,25.86,,,25.86,Other,125% Medicaid APG methodology,0.01,46.55,
LEVETIRACETAM 1500MG/100ML IV,,,,80023925,CDM,250,RC,55150024847,NDC,both,10,ML,31.9,12.59,39.4668,,12.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.85,34,,10.85,percent of total billed charges,"Drugs, Inpatient Only",10.85,34,,10.85,percent of total billed charges,"Drugs, Inpatient Only",10.85,34,,10.85,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.33,70,,22.33,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.63,,,10.63,Other,Drug Cost,10.63,,,10.63,Other,Drug Cost,10.63,,,10.63,Other,Drug Cost,10.63,,,10.63,Other,Drug Cost,10.63,,,10.63,Other,Drug Cost,10.63,,,10.63,Other,Drug Cost,23.92,,,23.92,Other,225% of Medicaid,14.89,,,14.89,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,22.86,,,22.86,Other,215% Medicaid APG methodology,22.86,,,22.86,Other,215% Medicaid APG methodology,13.29,,,13.29,Other,125% Medicaid APG methodology,0.01,23.92,
THEOPHYLLINE 100MG ER CAPSULE,,,,80023930,CDM,250,RC,52244010010,NDC,both,100,EA,3.53,1.39,39.4668,,1.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.2,34,,1.2,percent of total billed charges,"Drugs, Inpatient Only",1.2,34,,1.2,percent of total billed charges,"Drugs, Inpatient Only",1.2,34,,1.2,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.47,70,,2.47,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,1.18,,,1.18,Other,Drug Cost,2.65,,,2.65,Other,225% of Medicaid,1.65,,,1.65,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.53,,,2.53,Other,215% Medicaid APG methodology,2.53,,,2.53,Other,215% Medicaid APG methodology,1.47,,,1.47,Other,125% Medicaid APG methodology,0.01,2.65,
Dexmedetomidine 400mcg/100mL,,,,80023937,CDM,250,RC,44567060324,NDC,both,24,ML,35.07,13.84,39.4668,,13.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.92,34,,11.92,percent of total billed charges,"Drugs, Inpatient Only",11.92,34,,11.92,percent of total billed charges,"Drugs, Inpatient Only",11.92,34,,11.92,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,24.55,70,,24.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.69,,,11.69,Other,Drug Cost,11.69,,,11.69,Other,Drug Cost,11.69,,,11.69,Other,Drug Cost,11.69,,,11.69,Other,Drug Cost,11.69,,,11.69,Other,Drug Cost,11.69,,,11.69,Other,Drug Cost,26.3,,,26.3,Other,225% of Medicaid,16.37,,,16.37,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,25.13,,,25.13,Other,215% Medicaid APG methodology,25.13,,,25.13,Other,215% Medicaid APG methodology,14.61,,,14.61,Other,125% Medicaid APG methodology,0.01,26.3,
SUCCIMER 100MG CAPSULES,,,,80023949,CDM,250,RC,55292020111,NDC,both,100,EA,66.1,26.09,39.4668,,26.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.48,34,,22.48,percent of total billed charges,"Drugs, Inpatient Only",22.48,34,,22.48,percent of total billed charges,"Drugs, Inpatient Only",22.48,34,,22.48,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,46.27,70,,46.27,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.03,,,22.03,Other,Drug Cost,22.03,,,22.03,Other,Drug Cost,22.03,,,22.03,Other,Drug Cost,22.03,,,22.03,Other,Drug Cost,22.03,,,22.03,Other,Drug Cost,22.03,,,22.03,Other,Drug Cost,49.58,,,49.58,Other,225% of Medicaid,30.85,,,30.85,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,47.37,,,47.37,Other,215% Medicaid APG methodology,47.37,,,47.37,Other,215% Medicaid APG methodology,27.54,,,27.54,Other,125% Medicaid APG methodology,0.01,49.58,
RALTEGRAVIR 25MG CHEWABLE TABLET,,,,80023953,CDM,250,RC,6047361,NDC,both,60,EA,2.46,0.97,39.4668,,0.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.84,34,,0.84,percent of total billed charges,"Drugs, Inpatient Only",0.84,34,,0.84,percent of total billed charges,"Drugs, Inpatient Only",0.84,34,,0.84,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.72,70,,1.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.82,,,0.82,Other,Drug Cost,0.82,,,0.82,Other,Drug Cost,0.82,,,0.82,Other,Drug Cost,0.82,,,0.82,Other,Drug Cost,0.82,,,0.82,Other,Drug Cost,0.82,,,0.82,Other,Drug Cost,1.85,,,1.85,Other,225% of Medicaid,1.15,,,1.15,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.77,,,1.77,Other,215% Medicaid APG methodology,1.77,,,1.77,Other,215% Medicaid APG methodology,1.03,,,1.03,Other,125% Medicaid APG methodology,0.01,1.85,
TENOFOVIR DISOPROXIS FUMARATE 40MG/SCOOP,,,,80023954,CDM,250,RC,61958040301,NDC,both,1,GM,461.43,182.11,39.4668,,182.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,156.89,34,,156.89,percent of total billed charges,"Drugs, Inpatient Only",156.89,34,,156.89,percent of total billed charges,"Drugs, Inpatient Only",156.89,34,,156.89,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,323,70,,323,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,153.81,,,153.81,Other,Drug Cost,153.81,,,153.81,Other,Drug Cost,153.81,,,153.81,Other,Drug Cost,153.81,,,153.81,Other,Drug Cost,153.81,,,153.81,Other,Drug Cost,153.81,,,153.81,Other,Drug Cost,346.07,,,346.07,Other,225% of Medicaid,215.33,,,215.33,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,330.69,,,330.69,Other,215% Medicaid APG methodology,330.69,,,330.69,Other,215% Medicaid APG methodology,192.26,,,192.26,Other,125% Medicaid APG methodology,0.01,346.07,
EMTRICITABINE 10MG/ML ORAL SOLN,,,,80023955,CDM,250,RC,61958060201,NDC,both,1,ML,199.5,78.74,39.4668,,78.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,67.83,34,,67.83,percent of total billed charges,"Drugs, Inpatient Only",67.83,34,,67.83,percent of total billed charges,"Drugs, Inpatient Only",67.83,34,,67.83,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,139.65,70,,139.65,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,66.5,,,66.5,Other,Drug Cost,66.5,,,66.5,Other,Drug Cost,66.5,,,66.5,Other,Drug Cost,66.5,,,66.5,Other,Drug Cost,66.5,,,66.5,Other,Drug Cost,66.5,,,66.5,Other,Drug Cost,149.63,,,149.63,Other,225% of Medicaid,93.1,,,93.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,142.98,,,142.98,Other,215% Medicaid APG methodology,142.98,,,142.98,Other,215% Medicaid APG methodology,83.13,,,83.13,Other,125% Medicaid APG methodology,0.01,149.63,
EPHEDRINE SUOLFATE 50MG/10ML,,,,80023958,CDM,250,RC,14789025010,NDC,both,10,ML,23.1,9.12,39.4668,,9.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.85,34,,7.85,percent of total billed charges,"Drugs, Inpatient Only",7.85,34,,7.85,percent of total billed charges,"Drugs, Inpatient Only",7.85,34,,7.85,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.17,70,,16.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.7,,,7.7,Other,Drug Cost,7.7,,,7.7,Other,Drug Cost,7.7,,,7.7,Other,Drug Cost,7.7,,,7.7,Other,Drug Cost,7.7,,,7.7,Other,Drug Cost,7.7,,,7.7,Other,Drug Cost,17.33,,,17.33,Other,225% of Medicaid,10.78,,,10.78,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,16.56,,,16.56,Other,215% Medicaid APG methodology,16.56,,,16.56,Other,215% Medicaid APG methodology,9.63,,,9.63,Other,125% Medicaid APG methodology,0.01,17.33,
AMOXICILLIN 875 MG TABLET,,,,80023960,CDM,250,RC,65862001501,NDC,both,100,EA,0.19,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,70,,0.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.14,,,0.14,Other,225% of Medicaid,0.09,,,0.09,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.14,,,0.14,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,215% Medicaid APG methodology,0.08,,,0.08,Other,125% Medicaid APG methodology,0.01,0.14,
VANCOMYCIN ORAL SOLN 125MG/2.5ML,,,,80023973,CDM,250,RC,62559083055,NDC,both,1,ML,487.08,192.23,39.4668,,192.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.61,34,,165.61,percent of total billed charges,"Drugs, Inpatient Only",165.61,34,,165.61,percent of total billed charges,"Drugs, Inpatient Only",165.61,34,,165.61,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,340.96,70,,340.96,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,162.36,,,162.36,Other,Drug Cost,162.36,,,162.36,Other,Drug Cost,162.36,,,162.36,Other,Drug Cost,162.36,,,162.36,Other,Drug Cost,162.36,,,162.36,Other,Drug Cost,162.36,,,162.36,Other,Drug Cost,365.31,,,365.31,Other,225% of Medicaid,227.3,,,227.3,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,349.07,,,349.07,Other,215% Medicaid APG methodology,349.07,,,349.07,Other,215% Medicaid APG methodology,202.95,,,202.95,Other,125% Medicaid APG methodology,0.01,365.31,
PRAZOSIN 5MG CAPS,,,,80023984,CDM,250,RC,70377006811,NDC,both,100,EA,0.4,0.16,39.4668,,0.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.28,70,,0.28,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.3,,,0.3,Other,225% of Medicaid,0.18,,,0.18,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.28,,,0.28,Other,215% Medicaid APG methodology,0.28,,,0.28,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,125% Medicaid APG methodology,0.01,0.3,
NOREPINEPHRINE 8MG/250ML,,,,80023990,CDM,250,RC,338010820,NDC,both,20,ML,26.02,10.27,39.4668,,10.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.85,34,,8.85,percent of total billed charges,"Drugs, Inpatient Only",8.85,34,,8.85,percent of total billed charges,"Drugs, Inpatient Only",8.85,34,,8.85,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.21,70,,18.21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.67,,,8.67,Other,Drug Cost,8.67,,,8.67,Other,Drug Cost,8.67,,,8.67,Other,Drug Cost,8.67,,,8.67,Other,Drug Cost,8.67,,,8.67,Other,Drug Cost,8.67,,,8.67,Other,Drug Cost,19.51,,,19.51,Other,225% of Medicaid,12.14,,,12.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,18.65,,,18.65,Other,215% Medicaid APG methodology,18.65,,,18.65,Other,215% Medicaid APG methodology,10.84,,,10.84,Other,125% Medicaid APG methodology,0.01,19.51,
BUPIVACAINE 0.75% (7.5MG/ML) 30ML,,,,80024007,CDM,250,RC,55150017230,NDC,both,25,ML,8.26,3.26,39.4668,,3.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.81,34,,2.81,percent of total billed charges,"Drugs, Inpatient Only",2.81,34,,2.81,percent of total billed charges,"Drugs, Inpatient Only",2.81,34,,2.81,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.78,70,,5.78,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.75,,,2.75,Other,Drug Cost,2.75,,,2.75,Other,Drug Cost,2.75,,,2.75,Other,Drug Cost,2.75,,,2.75,Other,Drug Cost,2.75,,,2.75,Other,Drug Cost,2.75,,,2.75,Other,Drug Cost,6.2,,,6.2,Other,225% of Medicaid,3.86,,,3.86,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.92,,,5.92,Other,215% Medicaid APG methodology,5.92,,,5.92,Other,215% Medicaid APG methodology,3.44,,,3.44,Other,125% Medicaid APG methodology,0.01,6.2,
DOFETILIDE 125 MCG CAPSULE,,,,80024012,CDM,250,RC,47335006186,NDC,both,60,EA,0.29,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.1,34,,0.1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.2,70,,0.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.1,,,0.1,Other,Drug Cost,0.22,,,0.22,Other,225% of Medicaid,0.14,,,0.14,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.21,,,0.21,Other,215% Medicaid APG methodology,0.21,,,0.21,Other,215% Medicaid APG methodology,0.12,,,0.12,Other,125% Medicaid APG methodology,0.01,0.22,
DOFETILIDE 500 MCG CAPSULE,,,,80024014,CDM,250,RC,72205004160,NDC,both,60,EA,0.38,0.15,39.4668,,0.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.13,34,,0.13,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.27,70,,0.27,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.29,,,0.29,Other,225% of Medicaid,0.18,,,0.18,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.28,,,0.28,Other,215% Medicaid APG methodology,0.28,,,0.28,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,125% Medicaid APG methodology,0.01,0.29,
EMPAGLIFLOZIN 10 MG TAB,,,,80024021,CDM,250,RC,597015230,NDC,both,30,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,34,,0.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,70,,0.02,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
DOXYCYLINE 25MG/5ML ORAL SUSP,,,,80024026,CDM,250,RC,68180065701,NDC,both,1,ML,10.29,4.06,39.4668,,4.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.5,34,,3.5,percent of total billed charges,"Drugs, Inpatient Only",3.5,34,,3.5,percent of total billed charges,"Drugs, Inpatient Only",3.5,34,,3.5,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.2,70,,7.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3.43,,,3.43,Other,Drug Cost,3.43,,,3.43,Other,Drug Cost,3.43,,,3.43,Other,Drug Cost,3.43,,,3.43,Other,Drug Cost,3.43,,,3.43,Other,Drug Cost,3.43,,,3.43,Other,Drug Cost,7.72,,,7.72,Other,225% of Medicaid,4.8,,,4.8,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,7.37,,,7.37,Other,215% Medicaid APG methodology,7.37,,,7.37,Other,215% Medicaid APG methodology,4.29,,,4.29,Other,125% Medicaid APG methodology,0.01,7.72,
NITROGLYCERIN 25MG / 250ML INJ,,,,80024040,CDM,250,RC,338104702,NDC,both,12,ML,6.96,2.75,39.4668,,2.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.37,34,,2.37,percent of total billed charges,"Drugs, Inpatient Only",2.37,34,,2.37,percent of total billed charges,"Drugs, Inpatient Only",2.37,34,,2.37,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.87,70,,4.87,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.32,,,2.32,Other,Drug Cost,2.32,,,2.32,Other,Drug Cost,2.32,,,2.32,Other,Drug Cost,2.32,,,2.32,Other,Drug Cost,2.32,,,2.32,Other,Drug Cost,2.32,,,2.32,Other,Drug Cost,5.22,,,5.22,Other,225% of Medicaid,3.25,,,3.25,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,4.99,,,4.99,Other,215% Medicaid APG methodology,4.99,,,4.99,Other,215% Medicaid APG methodology,2.9,,,2.9,Other,125% Medicaid APG methodology,0.01,5.22,
LACOSAMIDE 10 MG/ML 5 ML ORAL SOLN,,,,80024043,CDM,250,RC,67877073295,NDC,both,1,ML,14.73,5.81,39.4668,,5.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.01,34,,5.01,percent of total billed charges,"Drugs, Inpatient Only",5.01,34,,5.01,percent of total billed charges,"Drugs, Inpatient Only",5.01,34,,5.01,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,10.31,70,,10.31,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.91,,,4.91,Other,Drug Cost,4.91,,,4.91,Other,Drug Cost,4.91,,,4.91,Other,Drug Cost,4.91,,,4.91,Other,Drug Cost,4.91,,,4.91,Other,Drug Cost,4.91,,,4.91,Other,Drug Cost,11.05,,,11.05,Other,225% of Medicaid,6.87,,,6.87,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.56,,,10.56,Other,215% Medicaid APG methodology,10.56,,,10.56,Other,215% Medicaid APG methodology,6.14,,,6.14,Other,125% Medicaid APG methodology,0.01,11.05,
RISPERIDONE 0.25MG ODT,,,,80024059,CDM,250,RC,49884021255,NDC,both,5,EA,13.88,5.48,39.4668,,5.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.72,34,,4.72,percent of total billed charges,"Drugs, Inpatient Only",4.72,34,,4.72,percent of total billed charges,"Drugs, Inpatient Only",4.72,34,,4.72,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.72,70,,9.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.63,,,4.63,Other,Drug Cost,4.63,,,4.63,Other,Drug Cost,4.63,,,4.63,Other,Drug Cost,4.63,,,4.63,Other,Drug Cost,4.63,,,4.63,Other,Drug Cost,4.63,,,4.63,Other,Drug Cost,10.41,,,10.41,Other,225% of Medicaid,6.48,,,6.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,9.95,,,9.95,Other,215% Medicaid APG methodology,9.95,,,9.95,Other,215% Medicaid APG methodology,5.79,,,5.79,Other,125% Medicaid APG methodology,0.01,10.41,
TRACE ELEMENTS ZN-CU-MN-SE 1ML INJ,,,,80024062,CDM,250,RC,517930525,NDC,both,25,ML,41.35,16.32,39.4668,,16.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.06,34,,14.06,percent of total billed charges,"Drugs, Inpatient Only",14.06,34,,14.06,percent of total billed charges,"Drugs, Inpatient Only",14.06,34,,14.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,28.95,70,,28.95,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,13.78,,,13.78,Other,Drug Cost,13.78,,,13.78,Other,Drug Cost,13.78,,,13.78,Other,Drug Cost,13.78,,,13.78,Other,Drug Cost,13.78,,,13.78,Other,Drug Cost,13.78,,,13.78,Other,Drug Cost,31.01,,,31.01,Other,225% of Medicaid,19.3,,,19.3,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,29.64,,,29.64,Other,215% Medicaid APG methodology,29.64,,,29.64,Other,215% Medicaid APG methodology,17.23,,,17.23,Other,125% Medicaid APG methodology,0.01,31.01,
UREA 15G POWDER,,,,80024064,CDM,250,RC,62530000011,NDC,both,8,GM,12.22,4.82,39.4668,,4.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.15,34,,4.15,percent of total billed charges,"Drugs, Inpatient Only",4.15,34,,4.15,percent of total billed charges,"Drugs, Inpatient Only",4.15,34,,4.15,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.55,70,,8.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,9.16,,,9.16,Other,225% of Medicaid,5.7,,,5.7,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,8.76,,,8.76,Other,215% Medicaid APG methodology,8.76,,,8.76,Other,215% Medicaid APG methodology,5.09,,,5.09,Other,125% Medicaid APG methodology,0.01,9.16,
VASOPRESSIN 20 UNITS/100ML,,,,80024068,CDM,250,RC,42023023710,NDC,both,10,ML,141.32,55.77,39.4668,,55.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,48.05,34,,48.05,percent of total billed charges,"Drugs, Inpatient Only",48.05,34,,48.05,percent of total billed charges,"Drugs, Inpatient Only",48.05,34,,48.05,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,98.92,70,,98.92,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,47.11,,,47.11,Other,Drug Cost,47.11,,,47.11,Other,Drug Cost,47.11,,,47.11,Other,Drug Cost,47.11,,,47.11,Other,Drug Cost,47.11,,,47.11,Other,Drug Cost,47.11,,,47.11,Other,Drug Cost,105.99,,,105.99,Other,225% of Medicaid,65.95,,,65.95,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,101.28,,,101.28,Other,215% Medicaid APG methodology,101.28,,,101.28,Other,215% Medicaid APG methodology,58.88,,,58.88,Other,125% Medicaid APG methodology,0.01,105.99,
PROPRANOLOL 80 MG TABLET,,,,80024070,CDM,250,RC,603548621,NDC,both,100,EA,0.06,0.02,39.4668,,0.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.02,34,,0.02,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.04,70,,0.04,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.04,
FERRIC SUBSULFATE(MONSEL'S) 8ML,,,,80024072,CDM,250,RC,48783011208,NDC,both,12,ML,50.54,19.95,39.4668,,19.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.18,34,,17.18,percent of total billed charges,"Drugs, Inpatient Only",17.18,34,,17.18,percent of total billed charges,"Drugs, Inpatient Only",17.18,34,,17.18,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,35.38,70,,35.38,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.85,,,16.85,Other,Drug Cost,16.85,,,16.85,Other,Drug Cost,16.85,,,16.85,Other,Drug Cost,16.85,,,16.85,Other,Drug Cost,16.85,,,16.85,Other,Drug Cost,16.85,,,16.85,Other,Drug Cost,37.91,,,37.91,Other,225% of Medicaid,23.59,,,23.59,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,36.22,,,36.22,Other,215% Medicaid APG methodology,36.22,,,36.22,Other,215% Medicaid APG methodology,21.06,,,21.06,Other,125% Medicaid APG methodology,0.01,37.91,
NAPROXEN 125 MG/5 ML ORAL SUSP,,,,80024088,CDM,250,RC,69238173002,NDC,both,1,ML,110.82,43.74,39.4668,,43.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,37.68,34,,37.68,percent of total billed charges,"Drugs, Inpatient Only",37.68,34,,37.68,percent of total billed charges,"Drugs, Inpatient Only",37.68,34,,37.68,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,77.57,70,,77.57,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,36.94,,,36.94,Other,Drug Cost,36.94,,,36.94,Other,Drug Cost,36.94,,,36.94,Other,Drug Cost,36.94,,,36.94,Other,Drug Cost,36.94,,,36.94,Other,Drug Cost,36.94,,,36.94,Other,Drug Cost,83.12,,,83.12,Other,225% of Medicaid,51.72,,,51.72,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,79.42,,,79.42,Other,215% Medicaid APG methodology,79.42,,,79.42,Other,215% Medicaid APG methodology,46.18,,,46.18,Other,125% Medicaid APG methodology,0.01,83.12,
NEVIRAPINE 50MG/5ML SUSPENSION,,,,80024089,CDM,250,RC,65862005724,NDC,both,1,ML,264.63,104.44,39.4668,,104.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,89.97,34,,89.97,percent of total billed charges,"Drugs, Inpatient Only",89.97,34,,89.97,percent of total billed charges,"Drugs, Inpatient Only",89.97,34,,89.97,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,185.24,70,,185.24,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,88.21,,,88.21,Other,Drug Cost,88.21,,,88.21,Other,Drug Cost,88.21,,,88.21,Other,Drug Cost,88.21,,,88.21,Other,Drug Cost,88.21,,,88.21,Other,Drug Cost,88.21,,,88.21,Other,Drug Cost,198.47,,,198.47,Other,225% of Medicaid,123.49,,,123.49,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,189.65,,,189.65,Other,215% Medicaid APG methodology,189.65,,,189.65,Other,215% Medicaid APG methodology,110.26,,,110.26,Other,125% Medicaid APG methodology,0.01,198.47,
DOXEPIN 100MG CAPSULE,,,,80024091,CDM,250,RC,904705561,NDC,both,10,EA,42.48,16.77,39.4668,,16.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.44,34,,14.44,percent of total billed charges,"Drugs, Inpatient Only",14.44,34,,14.44,percent of total billed charges,"Drugs, Inpatient Only",14.44,34,,14.44,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,29.74,70,,29.74,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.16,,,14.16,Other,Drug Cost,14.16,,,14.16,Other,Drug Cost,14.16,,,14.16,Other,Drug Cost,14.16,,,14.16,Other,Drug Cost,14.16,,,14.16,Other,Drug Cost,14.16,,,14.16,Other,Drug Cost,31.86,,,31.86,Other,225% of Medicaid,19.83,,,19.83,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,30.45,,,30.45,Other,215% Medicaid APG methodology,30.45,,,30.45,Other,215% Medicaid APG methodology,17.7,,,17.7,Other,125% Medicaid APG methodology,0.01,31.86,
ZONISAMIDE 20 MG/ML SUSP,,,,80024093,CDM,250,RC,52652800101,NDC,both,1,ML,750.18,296.07,39.4668,,296.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,255.06,34,,255.06,percent of total billed charges,"Drugs, Inpatient Only",255.06,34,,255.06,percent of total billed charges,"Drugs, Inpatient Only",255.06,34,,255.06,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,525.13,70,,525.13,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,250.06,,,250.06,Other,Drug Cost,250.06,,,250.06,Other,Drug Cost,250.06,,,250.06,Other,Drug Cost,250.06,,,250.06,Other,Drug Cost,250.06,,,250.06,Other,Drug Cost,250.06,,,250.06,Other,Drug Cost,562.64,,,562.64,Other,225% of Medicaid,350.08,,,350.08,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,537.63,,,537.63,Other,215% Medicaid APG methodology,537.63,,,537.63,Other,215% Medicaid APG methodology,312.58,,,312.58,Other,125% Medicaid APG methodology,0.01,562.64,
ABIRATERONE ACETATE 250MG TABLET,,,,80024096,CDM,250,RC,60687045521,NDC,both,3,EA,68.69,27.11,39.4668,,27.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,23.35,34,,23.35,percent of total billed charges,"Drugs, Inpatient Only",23.35,34,,23.35,percent of total billed charges,"Drugs, Inpatient Only",23.35,34,,23.35,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,48.08,70,,48.08,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.9,,,22.9,Other,Drug Cost,22.9,,,22.9,Other,Drug Cost,22.9,,,22.9,Other,Drug Cost,22.9,,,22.9,Other,Drug Cost,22.9,,,22.9,Other,Drug Cost,22.9,,,22.9,Other,Drug Cost,51.52,,,51.52,Other,225% of Medicaid,32.06,,,32.06,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,49.23,,,49.23,Other,215% Medicaid APG methodology,49.23,,,49.23,Other,215% Medicaid APG methodology,28.62,,,28.62,Other,125% Medicaid APG methodology,0.01,51.52,
SODIUM CHLORIDE 3% INHALATION 4 ML,,,,80024104,CDM,250,RC,76204002260,NDC,both,60,ML,1.67,0.66,39.4668,,0.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.57,34,,0.57,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.17,70,,1.17,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,0.56,,,0.56,Other,Drug Cost,1.26,,,1.26,Other,225% of Medicaid,0.78,,,0.78,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.2,,,1.2,Other,215% Medicaid APG methodology,1.2,,,1.2,Other,215% Medicaid APG methodology,0.7,,,0.7,Other,125% Medicaid APG methodology,0.01,1.26,
CEFADROXIL 500MG CAPSULES,,,,80024108,CDM,250,RC,68180018008,NDC,both,50,EA,0.21,0.08,39.4668,,0.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.07,34,,0.07,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.15,70,,0.15,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,0.16,
CEFADROXIL 250MG/5ML SUSP,,,,80024109,CDM,250,RC,57237009701,NDC,both,1,ML,22.65,8.94,39.4668,,8.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.7,34,,7.7,percent of total billed charges,"Drugs, Inpatient Only",7.7,34,,7.7,percent of total billed charges,"Drugs, Inpatient Only",7.7,34,,7.7,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.86,70,,15.86,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7.55,,,7.55,Other,Drug Cost,7.55,,,7.55,Other,Drug Cost,7.55,,,7.55,Other,Drug Cost,7.55,,,7.55,Other,Drug Cost,7.55,,,7.55,Other,Drug Cost,7.55,,,7.55,Other,Drug Cost,16.99,,,16.99,Other,225% of Medicaid,10.57,,,10.57,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,16.23,,,16.23,Other,215% Medicaid APG methodology,16.23,,,16.23,Other,215% Medicaid APG methodology,9.44,,,9.44,Other,125% Medicaid APG methodology,0.01,16.99,
LEVOTHYROXINE 20MG/ML 5ML,,,,80024110,CDM,250,RC,63323088510,NDC,both,1,ML,85.41,33.71,39.4668,,33.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,29.04,34,,29.04,percent of total billed charges,"Drugs, Inpatient Only",29.04,34,,29.04,percent of total billed charges,"Drugs, Inpatient Only",29.04,34,,29.04,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,59.79,70,,59.79,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,28.47,,,28.47,Other,Drug Cost,28.47,,,28.47,Other,Drug Cost,28.47,,,28.47,Other,Drug Cost,28.47,,,28.47,Other,Drug Cost,28.47,,,28.47,Other,Drug Cost,28.47,,,28.47,Other,Drug Cost,64.06,,,64.06,Other,225% of Medicaid,39.86,,,39.86,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,61.21,,,61.21,Other,215% Medicaid APG methodology,61.21,,,61.21,Other,215% Medicaid APG methodology,35.59,,,35.59,Other,125% Medicaid APG methodology,0.01,64.06,
RIVAROXABAN 2.5 MG TABLET,,,,80024117,CDM,250,RC,50458057710,NDC,both,10,EA,0.27,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.09,34,,0.09,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.19,70,,0.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.2,,,0.2,Other,215% Medicaid APG methodology,0.2,,,0.2,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.2,
INDIGOTINDISULFONATE SODIUM 8MG/ML 5ML,,,,80024120,CDM,250,RC,81284031505,NDC,both,5,ML,759.6,299.79,39.4668,,299.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,258.26,34,,258.26,percent of total billed charges,"Drugs, Inpatient Only",258.26,34,,258.26,percent of total billed charges,"Drugs, Inpatient Only",258.26,34,,258.26,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,531.72,70,,531.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,253.2,,,253.2,Other,Drug Cost,253.2,,,253.2,Other,Drug Cost,253.2,,,253.2,Other,Drug Cost,253.2,,,253.2,Other,Drug Cost,253.2,,,253.2,Other,Drug Cost,253.2,,,253.2,Other,Drug Cost,569.7,,,569.7,Other,225% of Medicaid,354.48,,,354.48,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,544.38,,,544.38,Other,215% Medicaid APG methodology,544.38,,,544.38,Other,215% Medicaid APG methodology,316.5,,,316.5,Other,125% Medicaid APG methodology,0.01,569.7,
BUDESONIDE CR 3MG CAPSULE,,,,80024121,CDM,250,RC,65162077810,NDC,both,100,EA,0.93,0.37,39.4668,,0.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.32,34,,0.32,percent of total billed charges,"Drugs, Inpatient Only",0.32,34,,0.32,percent of total billed charges,"Drugs, Inpatient Only",0.32,34,,0.32,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.65,70,,0.65,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.31,,,0.31,Other,Drug Cost,0.7,,,0.7,Other,225% of Medicaid,0.43,,,0.43,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,0.67,,,0.67,Other,215% Medicaid APG methodology,0.67,,,0.67,Other,215% Medicaid APG methodology,0.39,,,0.39,Other,125% Medicaid APG methodology,0.01,0.7,
IVABRADINE 5 MG TABLET,,,,80024123,CDM,250,RC,55513080060,NDC,both,60,EA,14,5.52,39.4668,,5.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.76,34,,4.76,percent of total billed charges,"Drugs, Inpatient Only",4.76,34,,4.76,percent of total billed charges,"Drugs, Inpatient Only",4.76,34,,4.76,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.8,70,,9.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4.67,,,4.67,Other,Drug Cost,4.67,,,4.67,Other,Drug Cost,4.67,,,4.67,Other,Drug Cost,4.67,,,4.67,Other,Drug Cost,4.67,,,4.67,Other,Drug Cost,4.67,,,4.67,Other,Drug Cost,10.5,,,10.5,Other,225% of Medicaid,6.53,,,6.53,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,10.03,,,10.03,Other,215% Medicaid APG methodology,10.03,,,10.03,Other,215% Medicaid APG methodology,5.83,,,5.83,Other,125% Medicaid APG methodology,0.01,10.5,
VILAZODONE 40 MG TABLET,,,,80024124,CDM,250,RC,62332023430,NDC,both,30,EA,2.11,0.83,39.4668,,0.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.72,34,,0.72,percent of total billed charges,"Drugs, Inpatient Only",0.72,34,,0.72,percent of total billed charges,"Drugs, Inpatient Only",0.72,34,,0.72,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.47,70,,1.47,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,0.7,,,0.7,Other,Drug Cost,1.58,,,1.58,Other,225% of Medicaid,0.98,,,0.98,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,1.51,,,1.51,Other,215% Medicaid APG methodology,1.51,,,1.51,Other,215% Medicaid APG methodology,0.88,,,0.88,Other,125% Medicaid APG methodology,0.01,1.58,
SUMATRIPTAN 20 MG NASAL SPRAY,,,,80024128,CDM,250,RC,66993008269,NDC,both,6,EA,16.02,6.32,39.4668,,6.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.45,34,,5.45,percent of total billed charges,"Drugs, Inpatient Only",5.45,34,,5.45,percent of total billed charges,"Drugs, Inpatient Only",5.45,34,,5.45,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.21,70,,11.21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.34,,,5.34,Other,Drug Cost,5.34,,,5.34,Other,Drug Cost,5.34,,,5.34,Other,Drug Cost,5.34,,,5.34,Other,Drug Cost,5.34,,,5.34,Other,Drug Cost,5.34,,,5.34,Other,Drug Cost,12.01,,,12.01,Other,225% of Medicaid,7.47,,,7.47,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,11.48,,,11.48,Other,215% Medicaid APG methodology,11.48,,,11.48,Other,215% Medicaid APG methodology,6.67,,,6.67,Other,125% Medicaid APG methodology,0.01,12.01,
NS 20 ML FLUSH,,,,80001512,CDM,258,RC,409488820,NDC,both,25,ML,2.94,1.16,39.4668,,1.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1,34,,1,percent of total billed charges,"Drugs, Inpatient Only",1,34,,1,percent of total billed charges,"Drugs, Inpatient Only",1,34,,1,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.05,70,,2.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.98,,,0.98,Other,Drug Cost,0.98,,,0.98,Other,Drug Cost,0.98,,,0.98,Other,Drug Cost,0.98,,,0.98,Other,Drug Cost,0.98,,,0.98,Other,Drug Cost,0.98,,,0.98,Other,Drug Cost,2.2,,,2.2,Other,225% of Medicaid,1.37,,,1.37,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,2.1,,,2.1,Other,215% Medicaid APG methodology,2.1,,,2.1,Other,215% Medicaid APG methodology,1.22,,,1.22,Other,125% Medicaid APG methodology,0.01,2.2,
SODIUM CL 0.9% 100ML,,,,80001887,CDM,258,RC,338055318,NDC,both,80,ML,7.66,3.02,39.4668,,3.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.61,34,,2.61,percent of total billed charges,"Drugs, Inpatient Only",2.61,34,,2.61,percent of total billed charges,"Drugs, Inpatient Only",2.61,34,,2.61,percent of total billed charges,"Drugs, Inpatient Only",0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5.36,70,,5.36,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2.55,,,2.55,Other,Drug Cost,2.55,,,2.55,Other,Drug Cost,2.55,,,2.55,Other,Drug Cost,2.55,,,2.55,Other,Drug Cost,2.55,,,2.55,Other,Drug Cost,2.55,,,2.55,Other,Drug Cost,5.75,,,5.75,Other,225% of Medicaid,3.58,,,3.58,Other,140% of Medicaid,0.01,,,0.01,Other,Non-covered service,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,,,0.01,Other,Non-covered service,5.49,,,5.49,Other,215% Medicaid APG methodology,5.49,,,5.49,Other,215% Medicaid APG methodology,3.19,,,3.19,Other,125% Medicaid APG methodology,0.01,5.75,
HYDRATION IV INFUSION INIT 31-60 MINS,96360,CPT,,26096360,CDM,260,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,326.2,70,,326.2,percent of total billed charges,All Other,316.88,68,,316.88,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,386.78,83,,,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,All Other,165.64,,,165.64,Fee Schedule,,140.39,,,140.39,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,140.39,953,
HYDRATION INFUSION IV INIT,96360,CPT,,34096360,CDM,260,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,326.2,70,,326.2,percent of total billed charges,All Other,316.88,68,,316.88,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,386.78,83,,,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,All Other,165.64,,,165.64,Fee Schedule,,140.39,,,140.39,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,140.39,953,
HYDRATION IV INFUSION INIT,96360,CPT,,47096360,CDM,260,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,326.2,70,,326.2,percent of total billed charges,All Other,316.88,68,,316.88,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,386.78,83,,,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,All Other,165.64,,,165.64,Fee Schedule,,140.39,,,140.39,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,140.39,953,
HYDRATION IV INFUSION INIT,96360,CPT,,75096360,CDM,260,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,326.2,70,,326.2,percent of total billed charges,All Other,316.88,68,,316.88,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,386.78,83,,,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,All Other,165.64,,,165.64,Fee Schedule,,140.39,,,140.39,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,140.39,953,
HYDRATION INFUSION IV INIT,96360,CPT,,82096360,CDM,260,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,326.2,70,,326.2,percent of total billed charges,All Other,316.88,68,,316.88,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,386.78,83,,,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,All Other,165.64,,,165.64,Fee Schedule,,140.39,,,140.39,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,140.39,953,
IV HYDRATION EACH ADDL HOUR,96361,CPT,,26096361,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,62.32,,,62.32,Fee Schedule,,52.82,,,52.82,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,52.2,1936.53,
IV HYDRATION EACH ADDL HOUR,96361,CPT,,34096361,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,62.32,,,62.32,Fee Schedule,,52.82,,,52.82,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,52.2,1936.53,
IV HYDRATION EACH ADDL HO,96361,CPT,,47096361,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,62.32,,,62.32,Fee Schedule,,52.82,,,52.82,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,52.2,1936.53,
IV HYDRATION EACH ADDL HO,96361,CPT,,75096361,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,62.32,,,62.32,Fee Schedule,,52.82,,,52.82,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,52.2,1936.53,
IV HYDRATION EACH ADD ON,96361,CPT,,82096361,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,62.32,,,62.32,Fee Schedule,,52.82,,,52.82,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,52.2,1936.53,
THER/PROPH/DIAG IV INF INIT,96365,CPT,,26096365,CDM,260,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,463.45,65,,463.45,percent of total billed charges,All Other,420.67,59,,420.67,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,499.1,70,,499.1,percent of total billed charges,All Other,484.84,68,,484.84,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,591.79,83,,,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,499.1,70,,499.1,percent of total billed charges,All Other,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,228.51,953,
THER/PROPH/DIAG IV INF INIT,96365,CPT,,34096365,CDM,260,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,463.45,65,,463.45,percent of total billed charges,All Other,420.67,59,,420.67,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,499.1,70,,499.1,percent of total billed charges,All Other,484.84,68,,484.84,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,591.79,83,,,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,499.1,70,,499.1,percent of total billed charges,All Other,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,228.51,953,
THER/PROPH/DIAG IV INF INIT,96365,CPT,,44096365,CDM,260,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,463.45,65,,463.45,percent of total billed charges,All Other,420.67,59,,420.67,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,499.1,70,,499.1,percent of total billed charges,All Other,484.84,68,,484.84,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,591.79,83,,,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,499.1,70,,499.1,percent of total billed charges,All Other,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,228.51,953,
THER/PROPH/DIAG IV INF INIT,96365,CPT,,46096365,CDM,260,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,463.45,65,,463.45,percent of total billed charges,All Other,420.67,59,,420.67,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,499.1,70,,499.1,percent of total billed charges,All Other,484.84,68,,484.84,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,591.79,83,,,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,499.1,70,,499.1,percent of total billed charges,All Other,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,228.51,953,
THER/PROPH/DIAG IV INF INIT,96365,CPT,,47096365,CDM,260,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,463.45,65,,463.45,percent of total billed charges,All Other,420.67,59,,420.67,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,499.1,70,,499.1,percent of total billed charges,All Other,484.84,68,,484.84,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,591.79,83,,,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,499.1,70,,499.1,percent of total billed charges,All Other,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,228.51,953,
THER/PROPH/DIAG IV INF INIT,96365,CPT,,75096365,CDM,260,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,463.45,65,,463.45,percent of total billed charges,All Other,420.67,59,,420.67,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,499.1,70,,499.1,percent of total billed charges,All Other,484.84,68,,484.84,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,591.79,83,,,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,499.1,70,,499.1,percent of total billed charges,All Other,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,228.51,953,
INFUSION THERAPY 1 HOUR,96365,CPT,,82096365,CDM,260,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,463.45,65,,463.45,percent of total billed charges,All Other,420.67,59,,420.67,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,499.1,70,,499.1,percent of total billed charges,All Other,484.84,68,,484.84,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,591.79,83,,,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,591.79,83,,591.79,percent of total billed charges,All Other,570.4,80,,570.4,percent of total billed charges,All Other,499.1,70,,499.1,percent of total billed charges,All Other,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,228.51,953,
IV INFUSION EA ADDITIONAL,96366,CPT,,26096366,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,52.2,1936.53,
THER/PROPH/DIAG IV INF ADDON,96366,CPT,,34096366,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,52.2,1936.53,
IV INFUSION EA ADDITIONAL,96366,CPT,,75096366,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,52.2,1936.53,
THER/PROPH/DIAG IV INF ADDON,96366,CPT,,82096366,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,52.2,1936.53,
TX/PROPH/DG ADDL SEQ IV I,96367,CPT,,26096367,CDM,260,RC,,,both,,,458,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,297.7,65,,297.7,percent of total billed charges,All Other,270.22,59,,270.22,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,320.6,70,,320.6,percent of total billed charges,All Other,311.44,68,,311.44,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,366.4,80,,366.4,percent of total billed charges,All Other,380.14,83,,380.14,percent of total billed charges,All Other,380.14,83,,,percent of total billed charges,All Other,366.4,80,,366.4,percent of total billed charges,All Other,380.14,83,,380.14,percent of total billed charges,All Other,366.4,80,,366.4,percent of total billed charges,All Other,320.6,70,,320.6,percent of total billed charges,All Other,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,77.41,953,
TX/PROPH/DG ADDL SEQ IV INF,96367,CPT,,34096367,CDM,260,RC,,,both,,,458,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,297.7,65,,297.7,percent of total billed charges,All Other,270.22,59,,270.22,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,320.6,70,,320.6,percent of total billed charges,All Other,311.44,68,,311.44,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,366.4,80,,366.4,percent of total billed charges,All Other,380.14,83,,380.14,percent of total billed charges,All Other,380.14,83,,,percent of total billed charges,All Other,366.4,80,,366.4,percent of total billed charges,All Other,380.14,83,,380.14,percent of total billed charges,All Other,366.4,80,,366.4,percent of total billed charges,All Other,320.6,70,,320.6,percent of total billed charges,All Other,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,77.41,953,
TX/PROPH/DG ADDL SEQ IV I,96367,CPT,,75096367,CDM,260,RC,,,both,,,458,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,297.7,65,,297.7,percent of total billed charges,All Other,270.22,59,,270.22,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,320.6,70,,320.6,percent of total billed charges,All Other,311.44,68,,311.44,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,366.4,80,,366.4,percent of total billed charges,All Other,380.14,83,,380.14,percent of total billed charges,All Other,380.14,83,,,percent of total billed charges,All Other,366.4,80,,366.4,percent of total billed charges,All Other,380.14,83,,380.14,percent of total billed charges,All Other,366.4,80,,366.4,percent of total billed charges,All Other,320.6,70,,320.6,percent of total billed charges,All Other,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,77.41,953,
TX/PROPH/DG ADDL SEQ IV INF,96367,CPT,,82096367,CDM,260,RC,,,both,,,458,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,297.7,65,,297.7,percent of total billed charges,All Other,270.22,59,,270.22,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,320.6,70,,320.6,percent of total billed charges,All Other,311.44,68,,311.44,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,366.4,80,,366.4,percent of total billed charges,All Other,380.14,83,,380.14,percent of total billed charges,All Other,380.14,83,,,percent of total billed charges,All Other,366.4,80,,366.4,percent of total billed charges,All Other,380.14,83,,380.14,percent of total billed charges,All Other,366.4,80,,366.4,percent of total billed charges,All Other,320.6,70,,320.6,percent of total billed charges,All Other,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,77.41,953,
THER DIAG CONCURRENT INF,96368,CPT,,26096368,CDM,260,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,98.4,,,98.4,Fee Schedule,,83.4,,,83.4,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,953,
THER DIAG CONCURRENT INF,96368,CPT,,34096368,CDM,260,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,98.4,,,98.4,Fee Schedule,,83.4,,,83.4,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,953,
THER DIAG CONCURRENT INF,96368,CPT,,75096368,CDM,260,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,98.4,,,98.4,Fee Schedule,,83.4,,,83.4,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,953,
THER DIAG CONCURRENT INF,96368,CPT,,82096368,CDM,260,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,476,,,476,Case Rate,IV Therapy Per Visit,428,,,428,Case Rate,IV Therapy Per Visit,405,,,405,Case Rate,IV Therapy Per Visit,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,98.4,,,98.4,Fee Schedule,,83.4,,,83.4,Fee Schedule,,953,,,953,Case Rate,IV Therapy Per Visit,858,,,858,Case Rate,IV Therapy Per Visit,953,,,953,Case Rate,IV Therapy Per Visit,810,,,810,Case Rate,IV Therapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,953,
THER/PROPH/DIAG INJ SC/IM,96372,CPT,,26096372,CDM,260,RC,,,both,,,460,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
THER/PROPH/DIAG INJ SC/IM,96372,CPT,,34096372,CDM,260,RC,,,both,,,460,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
THER/PROPH/DIAG INJ SC/IM,96372,CPT,,36096372,CDM,260,RC,,,both,,,460,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
THER/PROPH/DIAG INJ SC/IM,96372,CPT,,50096372,CDM,260,RC,,,both,,,460,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
NON CHEMO IM/SC INJECTION,96372,CPT,,75096372,CDM,260,RC,,,both,,,460,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
THER/PROPH/DIAG INJ SC/IM,96372,CPT,,82096372,CDM,260,RC,,,both,,,460,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
THER/PROPH/DIAG INJ IV PUSH,96374,CPT,,26096374,CDM,260,RC,,,both,,,483,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,313.95,65,,313.95,percent of total billed charges,All Other,284.97,59,,284.97,percent of total billed charges,All Other,369.5,76.5,,369.5,percent of total billed charges,All Other,333.27,69,,333.27,percent of total billed charges,All Other,313.95,65,,313.95,percent of total billed charges,All Other,338.1,70,,338.1,percent of total billed charges,All Other,328.44,68,,328.44,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,386.4,80,,386.4,percent of total billed charges,All Other,400.89,83,,400.89,percent of total billed charges,All Other,400.89,83,,,percent of total billed charges,All Other,386.4,80,,386.4,percent of total billed charges,All Other,400.89,83,,400.89,percent of total billed charges,All Other,386.4,80,,386.4,percent of total billed charges,All Other,338.1,70,,338.1,percent of total billed charges,All Other,190.24,,,190.24,Fee Schedule,,161.24,,,161.24,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
THER/PROPH/DIAG INJ IV PUSH,96374,CPT,,34096374,CDM,260,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,356.49,76.5,,356.49,percent of total billed charges,All Other,321.54,69,,321.54,percent of total billed charges,All Other,302.9,65,,302.9,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,All Other,316.88,68,,316.88,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,386.78,83,,,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,All Other,190.24,,,190.24,Fee Schedule,,161.24,,,161.24,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
IV PUSH INITIAL,96374,CPT,,75096374,CDM,260,RC,,,both,,,483,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,313.95,65,,313.95,percent of total billed charges,All Other,284.97,59,,284.97,percent of total billed charges,All Other,369.5,76.5,,369.5,percent of total billed charges,All Other,333.27,69,,333.27,percent of total billed charges,All Other,313.95,65,,313.95,percent of total billed charges,All Other,338.1,70,,338.1,percent of total billed charges,All Other,328.44,68,,328.44,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,386.4,80,,386.4,percent of total billed charges,All Other,400.89,83,,400.89,percent of total billed charges,All Other,400.89,83,,,percent of total billed charges,All Other,386.4,80,,386.4,percent of total billed charges,All Other,400.89,83,,400.89,percent of total billed charges,All Other,386.4,80,,386.4,percent of total billed charges,All Other,338.1,70,,338.1,percent of total billed charges,All Other,190.24,,,190.24,Fee Schedule,,161.24,,,161.24,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
IV PUSH INITIAL,96374,CPT,,82096374,CDM,260,RC,,,both,,,483,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,313.95,65,,313.95,percent of total billed charges,All Other,284.97,59,,284.97,percent of total billed charges,All Other,369.5,76.5,,369.5,percent of total billed charges,All Other,333.27,69,,333.27,percent of total billed charges,All Other,313.95,65,,313.95,percent of total billed charges,All Other,338.1,70,,338.1,percent of total billed charges,All Other,328.44,68,,328.44,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,386.4,80,,386.4,percent of total billed charges,All Other,400.89,83,,400.89,percent of total billed charges,All Other,400.89,83,,,percent of total billed charges,All Other,386.4,80,,386.4,percent of total billed charges,All Other,400.89,83,,400.89,percent of total billed charges,All Other,386.4,80,,386.4,percent of total billed charges,All Other,338.1,70,,338.1,percent of total billed charges,All Other,190.24,,,190.24,Fee Schedule,,161.24,,,161.24,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
NON CHEMO IV PUSH EA ADDL,96375,CPT,,26096375,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,77.08,,,77.08,Fee Schedule,,65.33,,,65.33,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
TX/PRO/DX INJ NEW DRUG ADDON,96375,CPT,,34096375,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,77.08,,,77.08,Fee Schedule,,65.33,,,65.33,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
NON CHEMO IV PUSH EA ADDL,96375,CPT,,75096375,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,77.08,,,77.08,Fee Schedule,,65.33,,,65.33,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
TX/PRO/DX INJ NEW DRUG ADDON,96375,CPT,,82096375,CDM,260,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,77.08,,,77.08,Fee Schedule,,65.33,,,65.33,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,953,
TX/PRO/DX INJ SAME DRUG A,96376,CPT,,26096376,CDM,260,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,953,
TX/PRO/DX INJ SAME DRUG ADDON,96376,CPT,,34096376,CDM,260,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,953,
TX/PRO/DX INJ SAME DRUG A,96376,CPT,,75096376,CDM,260,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,953,
TX/PRO/DX INJ SAME DRUG ADDON,96376,CPT,,82096376,CDM,260,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,953,
APPLICATION ON-BODY INJECTOR,96377,CPT,,75096377,CDM,260,RC,,,both,,,212,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,137.8,65,,137.8,percent of total billed charges,All Other,125.08,59,,125.08,percent of total billed charges,All Other,17.4,,,17.4,Fee Schedule,,17.4,,,17.4,Fee Schedule,,17.4,,,17.4,Fee Schedule,,148.4,70,,148.4,percent of total billed charges,All Other,144.16,68,,144.16,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,169.6,80,,169.6,percent of total billed charges,All Other,175.96,83,,175.96,percent of total billed charges,All Other,175.96,83,,,percent of total billed charges,All Other,169.6,80,,169.6,percent of total billed charges,All Other,175.96,83,,175.96,percent of total billed charges,All Other,169.6,80,,169.6,percent of total billed charges,All Other,148.4,70,,148.4,percent of total billed charges,All Other,91.84,,,91.84,Fee Schedule,,77.84,,,77.84,Fee Schedule,,953,,,953,Case Rate,,858,,,858,Case Rate,,953,,,953,Case Rate,,810,,,810,Case Rate,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,17.4,953,
IRRIG DRUG DELIVERY DEVICE,96523,CPT,,34096523,CDM,260,RC,,,both,,,243,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,598,,,598,Fee Schedule,,538,,,538,Fee Schedule,,176.89,,,176.89,Fee Schedule,,159.14,,,159.14,Fee Schedule,,150.42,,,150.42,Fee Schedule,,170.1,70,,170.1,percent of total billed charges,All Other,165.24,68,,165.24,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,194.4,80,,194.4,percent of total billed charges,All Other,201.69,83,,201.69,percent of total billed charges,All Other,201.69,83,,,percent of total billed charges,All Other,194.4,80,,194.4,percent of total billed charges,All Other,201.69,83,,201.69,percent of total billed charges,All Other,107.2,,,107.2,Fee Schedule,,170.1,70,,170.1,percent of total billed charges,All Other,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,598,
ARTHREX ABS-4025 JUMPSTART WOUND DRESSIN,A6206,HCPCS,,79012298,CDM,270,RC,,,both,,,48,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,33.6,70,,33.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.6,
BOST SCI 27-136 8FR DRAINAGE CATH,C1729,HCPCS,,79002970,CDM,270,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
BOST SCI 27-137 10FR DRAINAGE CATH,C1729,HCPCS,,79002971,CDM,270,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
BOST SCI 27-138 12FR DRAINAGE CATH,C1729,HCPCS,,79002972,CDM,270,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
BOST SCI 27-139 14FR DRAINAGE CATH,C1729,HCPCS,,79002973,CDM,270,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
MEDTRONIC 043325M MARINR CATHETER,C1730,HCPCS,,79002641,CDM,270,RC,,,both,,,1650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1155,70,,1155,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1155,
ABBOTT 1009660J WIRE TIP,C1769,HCPCS,,79002630,CDM,270,RC,,,both,,,450,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,315,70,,315,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315,
ABBOTT 1009660 WIRE STRAIGHT,C1769,HCPCS,,79002631,CDM,270,RC,,,both,,,346,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,242.2,70,,242.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,242.2,
ABBOTT 12781-01 GRAND SLAM WIRE,C1769,HCPCS,,79002637,CDM,270,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
ABBOTT 1005357H GUIDEWIRE,C1769,HCPCS,,79002638,CDM,270,RC,,,both,,,346,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,242.2,70,,242.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,242.2,
TERUMO GA3501 .035X180 ADVANTG GLIDEWIRE,C1769,HCPCS,,79005241,CDM,270,RC,,,both,,,630,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,441,70,,441,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,441,
TERUMO GA3502 .035X260 ADVANTG GLIDEWIRE,C1769,HCPCS,,79005242,CDM,270,RC,,,both,,,690,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,483,70,,483,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,483,
MEDTRONIC 3037 PATIENT PROGRAMMER,C1787,HCPCS,,79002666,CDM,270,RC,,,both,,,3570,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2499,70,,2499,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2499,
PRESSURE PROD CSG/WORLEY-2-09 SHEATH,C1892,HCPCS,,79002643,CDM,270,RC,,,both,,,1350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,945,70,,945,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,945,
ST JUDE 410112 CPS CATHETER,C1893,HCPCS,,79002634,CDM,270,RC,,,both,,,1558,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1090.6,70,,1090.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1090.6,
J&J 402-604X SHEATH W/GW 4FRX11CM AVANTI,C1894,HCPCS,,79002710,CDM,270,RC,,,both,,,26,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.2,70,,18.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18.2,
J&J 402-605X SHEATH W/GW 5FRX11CM AVANTI,C1894,HCPCS,,79002711,CDM,270,RC,,,both,,,26,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.2,70,,18.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18.2,
J&J 402-607X SHEATH W/GW 7FRX11CM AVANTI,C1894,HCPCS,,79002712,CDM,270,RC,,,both,,,29,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,20.3,70,,20.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20.3,
SO CAP DESIGN W/O JNTS CF,L3671,HCPCS,,79006241,CDM,270,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
SO AIRPLANE W/WO JOINT CF,L3674,HCPCS,,79006242,CDM,270,RC,,,both,,,450,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,315,70,,315,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315,
EO W/O JOINTS CF,L3702,HCPCS,,79006243,CDM,270,RC,,,both,,,226,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,158.2,70,,158.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158.2,
FOREARM/ARM CUFFS EXT/FLEX A,L3730,HCPCS,,79006244,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
EWHO RIGID W/O JNTS CF,L3763,HCPCS,,79006245,CDM,270,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
EWHO W/JOINT(S) CF,L3764,HCPCS,,79006246,CDM,270,RC,,,both,,,450,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,315,70,,315,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315,
EWHFO RIGID W/O JNTS CF,L3765,HCPCS,,79006247,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
EWHFO W/JOINT(S) CF,L3766,HCPCS,,79006248,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
WHFO W/JOINT(S) CUSTOM FAB,L3806,HCPCS,,79006249,CDM,270,RC,,,both,,,226,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,158.2,70,,158.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158.2,
WHFO RIGID W/O JOINTS,L3808,HCPCS,,79006250,CDM,270,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,105,70,,105,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105,
WHO W/NONTORSION JNT(S) CF,L3905,HCPCS,,79006251,CDM,270,RC,,,both,,,450,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,315,70,,315,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315,
WHO W/O JOINTS CF,L3906,HCPCS,,79006252,CDM,270,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,105,70,,105,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105,
HFO W/O JOINTS CF,L3913,HCPCS,,79006253,CDM,270,RC,,,both,,,76,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,53.2,70,,53.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
HFO W/JOINT(S) CF,L3921,HCPCS,,79006255,CDM,270,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
HAND LAB HFO W/O JOINT PRECST METAGRIP 1,L3923,HCPCS,,79006269,CDM,270,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
PATTERSON MED HFO W/O JOINT PRECST,L3923,HCPCS,,79006275,CDM,270,RC,,,both,,,103,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72.1,70,,72.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72.1,
PATTERSON MED FO PIP DIP JNT/SPRNG LMB 1,L3925,HCPCS,,79006287,CDM,270,RC,,,both,,,85,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,59.5,70,,59.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,59.5,
PATTERSON MED FO PIPDIP JNT/SPRNG CAPNR1,L3925,HCPCS,,79006292,CDM,270,RC,,,both,,,121,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84.7,70,,84.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84.7,
PATTERSON MED FO PIPDIP NO JT SPR OVL8,L3927,HCPCS,,79006295,CDM,270,RC,,,both,,,82,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,57.4,70,,57.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,57.4,
FO W/O JOINTS CF,L3933,HCPCS,,79006256,CDM,270,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,70,,63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63,
FO NONTORSION JOINT CF,L3935,HCPCS,,79006257,CDM,270,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,70,,63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63,
SEWHO CAP DESIGN W/O JNTS CF,L3961,HCPCS,,79006258,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
SEWHO AIRPLANE W/O JNTS CF,L3967,HCPCS,,79006259,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
SEWHO CAP DESIGN W/JNT(S) CF,L3971,HCPCS,,79006260,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
SEWHO AIRPLANE W/JNT(S) CF,L3973,HCPCS,,79006261,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
SEWHFO CAP DESIGN W/O JNT CF,L3975,HCPCS,,79006262,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
SEWHFO AIRPLANE W/O JNTS CF,L3976,HCPCS,,79006263,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
SEWHFO CAP DESGN W/JNT(S) CF,L3977,HCPCS,,79006264,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
SEWHFO AIRPLANE W/JNT(S) CF,L3978,HCPCS,,79006265,CDM,270,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
UPP EXT FX ORTHOSIS HUMERAL,L3980,HCPCS,,79006266,CDM,270,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,105,70,,105,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105,
UPPER EXT FX ORTHOSIS RAD/UL,L3982,HCPCS,,79006267,CDM,270,RC,,,both,,,226,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,158.2,70,,158.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158.2,
UPPER EXT FX ORTHOSIS WRIST,L3984,HCPCS,,79006268,CDM,270,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,105,70,,105,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105,
HEARING AID CROS ITE,V5171,HCPCS,,66000138,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID MONAURAL ITC,V5172,HCPCS,,66000149,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID CROS BTE,V5181,HCPCS,,66000137,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID BICROS ITE,V5211,HCPCS,,66000142,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID BINAURAL ITE/ITC,V5212,HCPCS,,66000150,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID BINAURAL ITE/BTE,V5213,HCPCS,,66000151,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID BINAURAL ITC/ITC,V5214,HCPCS,,66000152,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID BINAURAL ITC/BTE,V5215,HCPCS,,66000153,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID BICROS BTE,V5221,HCPCS,,66000139,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID DIGIT MON ITE,V5256,HCPCS,,66000130,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID DIGIT MON BTE,V5257,HCPCS,,66000131,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID DIGIT BIN ITE,V5260,HCPCS,,66000132,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
HEARING AID DIGIT BIN BTE,V5261,HCPCS,,66000133,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
EAR MOLD/INSERT (ONE),V5264,HCPCS,,66000115,CDM,270,RC,,,both,,,142.79,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,99.95,70,,99.95,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,99.95,
BATTERY FOR HEARING DEVICE,V5266,HCPCS,,66000117,CDM,270,RC,,,both,,,13.08,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,9.16,70,,9.16,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9.16,
CUSTOM EARPLUGS,V5299,HCPCS,,66000136,CDM,270,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,70,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.01,
J&J 03.950-001S GRAFT DELIVERY SYSTEM,A4649,HCPCS,,79012224,CDM,272,RC,,,both,,,371,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,259.7,70,,259.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,259.7,
KCI M8278081/5.S SENSATRAC THIN DRESSING,A6550,HCPCS,,79013506,CDM,272,RC,,,both,,,168,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,117.6,70,,117.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
HALYARD 0250-18 G-J TUBE 18FRX45CM,B4087,HCPCS,,79008724,CDM,272,RC,,,both,,,671,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,469.7,70,,469.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,469.7,
ACUMED 80-1794 DRILL BIT 1.1MM,C1713,HCPCS,,79009755,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 TH-LS-M TURBOHAWK LS-M,C1714,HCPCS,,79000415,CDM,272,RC,,,both,,,8386,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5870.2,70,,5870.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5870.2,
EV3 THS-SS-CL TURBOHAWK SS-CL,C1714,HCPCS,,79000519,CDM,272,RC,,,both,,,10185,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7129.5,70,,7129.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7129.5,
EV3 THS-SX-C TURBOHAWK SX-C,C1714,HCPCS,,79000550,CDM,272,RC,,,both,,,10185,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7129.5,70,,7129.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7129.5,
EV3 TH-LX-M TURBOHAWK LX-M,C1714,HCPCS,,79000551,CDM,272,RC,,,both,,,8985,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6289.5,70,,6289.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6289.5,
EV3 THS-SS-C TURBOHAWK SS-C,C1714,HCPCS,,79003031,CDM,272,RC,,,both,,,10185,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7129.5,70,,7129.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7129.5,
EV3 THS-LX-C TURBOHAWK LX-C,C1714,HCPCS,,79003067,CDM,272,RC,,,both,,,8550,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5985,70,,5985,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5985,
EV3 THS-LS-C TURBOHAWK LS-C,C1714,HCPCS,,79003068,CDM,272,RC,,,both,,,8550,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5985,70,,5985,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5985,
BARD CRUS6A CROSSER CATHETER S6 154CM,C1714,HCPCS,,79007564,CDM,272,RC,,,both,,,6600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4620,70,,4620,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4620,
BARD CRUOS106 CROSSER CATH 14S 106CM,C1714,HCPCS,,79007567,CDM,272,RC,,,both,,,6600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4620,70,,4620,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4620,
BARD CRUOS14SA CROSSER CATH 14S 146CM,C1714,HCPCS,,79007568,CDM,272,RC,,,both,,,6600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4620,70,,4620,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4620,
BARD CRUS6106 CROSSER CATH S6 106CM,C1714,HCPCS,,79007569,CDM,272,RC,,,both,,,6600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4620,70,,4620,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4620,
MEDTRONIC H1-S HAWKONE S,C1714,HCPCS,,79013949,CDM,272,RC,,,both,,,10185,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7129.5,70,,7129.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7129.5,
MEDTRONIC H1-M HAWKONE M,C1714,HCPCS,,79013950,CDM,272,RC,,,both,,,10185,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7129.5,70,,7129.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7129.5,
CSI PRD-SC30-150 CSI ATHERECTOMY DEV 1.5,C1724,HCPCS,,79000326,CDM,272,RC,,,both,,,10186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7130.2,70,,7130.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7130.2,
CSI DBE-150 CSI ATHERECTOMY DEVICE 1.5,C1724,HCPCS,,79000327,CDM,272,RC,,,both,,,10186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7130.2,70,,7130.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7130.2,
CSI PRD-SC30-200 CSI ATHERECTOMY DEV 2MM,C1724,HCPCS,,79000328,CDM,272,RC,,,both,,,10186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7130.2,70,,7130.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7130.2,
PRD-SC30-125S CSI ATHERECTOMY DEV 1.25MM,C1724,HCPCS,,79003069,CDM,272,RC,,,both,,,10186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7130.2,70,,7130.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7130.2,
MEDTRONIC IAV07006008P 7X60X80CM IN.PACT,C1725,HCPCS,,78013435,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
BOST SCI 17-736 SDS BALLOON 10X4X75,C1725,HCPCS,,79000057,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI 39171-10047 MUSTANG BALLOON,C1725,HCPCS,,79000061,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BARD DR80104 10X4X80 DORADO BALLOON,C1725,HCPCS,,79000064,CDM,272,RC,,,both,,,616,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.2,70,,431.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.2,
BOST SCI 39171-12047 MUSTANG BALLOON,C1725,HCPCS,,79000073,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39147-25101 STERLING BALLOON,C1725,HCPCS,,79000084,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
EV3 AB14W025120150 NANOCROSS BALLOON,C1725,HCPCS,,79000085,CDM,272,RC,,,both,,,1041,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,728.7,70,,728.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,728.7,
BOST SCI 39185-25121 COYOTE BALLOON,C1725,HCPCS,,79000086,CDM,272,RC,,,both,,,1050,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,735,70,,735,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,735,
BOST SCI 39185-25221 COYOTE BALLOON,C1725,HCPCS,,79000087,CDM,272,RC,,,both,,,1216,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,851.2,70,,851.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,851.2,
BOST SCI 39185-25061 COYOTE BALLOON,C1725,HCPCS,,79000088,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
BOST SCI 39147-20101 STERLING MN BALLOON,C1725,HCPCS,,79000091,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39147-20801 STERLING SL BALLOON,C1725,HCPCS,,79000092,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39147-35801 STERLING SL BALLOON,C1725,HCPCS,,79000093,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39171-03034 MUSTANG BALLOON,C1725,HCPCS,,79000094,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39147-30101 STERLING SL BALLOON,C1725,HCPCS,,79000095,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39185-30101 COYOTE BALLOON,C1725,HCPCS,,79000096,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
EV3 AB14W030120150 NANOCROSS BALLOON,C1725,HCPCS,,79000097,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
BOST SCI 39185-30151 COYOTE BALLOON,C1725,HCPCS,,79000098,CDM,272,RC,,,both,,,1050,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,735,70,,735,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,735,
BOST SCI 39185-30061 COYOTE BALLOON,C1725,HCPCS,,79000099,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
BOST SCI 17-556 SDS BALLOONS ULTRATHIN,C1725,HCPCS,,79000109,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI 39032-40101 STERLING BALLOON,C1725,HCPCS,,79000110,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39147-40101 STERLING BALLOON,C1725,HCPCS,,79000111,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BARD DR135410 4X10X135 DORADO BALLOON,C1725,HCPCS,,79000112,CDM,272,RC,,,both,,,646,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,452.2,70,,452.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,452.2,
EV3 AB35W04120135 EVERCROSS BALLOON CATH,C1725,HCPCS,,79000113,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
BOST SCI 39185-40121 COYOTE BALLOON,C1725,HCPCS,,79000114,CDM,272,RC,,,both,,,1050,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,735,70,,735,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,735,
BOST SCI 39171-04024 MUSTANG BALLOON,C1725,HCPCS,,79000116,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39171-04034 MUSTANG BALLOON,C1725,HCPCS,,79000117,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39171-04041 MUSTANG BALLOON,C1725,HCPCS,,79000118,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BARD DR-4044 4X4X40CM DORADO BALLOON,C1725,HCPCS,,79000119,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39171-04047 MUSTANG BALLOON,C1725,HCPCS,,79000120,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39185-40061 COYOTE BALLOON,C1725,HCPCS,,79000121,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
BOST SCI 39031-40601 STERLING BALLOON,C1725,HCPCS,,79000122,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39147-40801 STERLING BALLOON,C1725,HCPCS,,79000123,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39171-04087 MUSTANG BALLOON,C1725,HCPCS,,79000124,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 17-586 SDS BALLOON ULTRATHIN,C1725,HCPCS,,79000148,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI 17-596 SDS BALLOON ULTRATHIN,C1725,HCPCS,,79000149,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI P510012001 POLAR CATH BALLOON,C1725,HCPCS,,79000150,CDM,272,RC,,,both,,,2160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1512,70,,1512,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1512,
BARD DR135510 5X100X135 DORADO BALLOON,C1725,HCPCS,,79000151,CDM,272,RC,,,both,,,646,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,452.2,70,,452.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,452.2,
BOST SCI 39032-50101 STERLING BALLOON,C1725,HCPCS,,79000152,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39171-05101 MUSTANG BALLOON,C1725,HCPCS,,79000153,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
EV3 AB35W05120135 EVERCROSS BALLOON,C1725,HCPCS,,79000154,CDM,272,RC,,,both,,,315,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,220.5,70,,220.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,220.5,
EV3 AB35W05150135 EVERCROSS BALLOON CATH,C1725,HCPCS,,79000155,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOST SCI 39171-05151 MUSTANG BALLOON,C1725,HCPCS,,79000156,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
BOST SCI 39171-05201 MUSTANG BALLOON,C1725,HCPCS,,79000158,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
BOST SCI PCB502090 CUTTING BALLOON,C1725,HCPCS,,79000159,CDM,272,RC,,,both,,,2598,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1818.6,70,,1818.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1818.6,
BOST SCI 39171-05047 MUSTANG BALLOON,C1725,HCPCS,,79000160,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BARD DR8054 5X4X80 DORADO BALLOON,C1725,HCPCS,,79000161,CDM,272,RC,,,both,,,616,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.2,70,,431.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.2,
BARD DR13558 5X8X135 DORADO BALLOON,C1725,HCPCS,,79000163,CDM,272,RC,,,both,,,646,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,452.2,70,,452.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,452.2,
BOST SCI 39171-05081 MUSTANG BALLOON,C1725,HCPCS,,79000164,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39171-05087 MUSTANG BALLOON,C1725,HCPCS,,79000165,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 17-616 SDS BALLOONS ULTRATHIN,C1725,HCPCS,,79000180,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI 17-626 SDS BALLOONS ULTRATHIN,C1725,HCPCS,,79000181,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI P610012001 6X100X120 POLAR CATH,C1725,HCPCS,,79000182,CDM,272,RC,,,both,,,2160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1512,70,,1512,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1512,
BOST SCI 39171-06101 MUSTANG BALLOON,C1725,HCPCS,,79000183,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39032-60101 STERLING BALLOON,C1725,HCPCS,,79000184,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
EV3 AB35W06120135 EVERCROSS BALLOON,C1725,HCPCS,,79000187,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W06150135 EVERCROSS BALLOON,C1725,HCPCS,,79000189,CDM,272,RC,,,both,,,675,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,472.5,70,,472.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,472.5,
BOST SCI 39171-06151 MUSTANG BALLOON,C1725,HCPCS,,79000190,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
BARD DR135620 6X200X135 DORADO BALLOON,C1725,HCPCS,,79000194,CDM,272,RC,,,both,,,826,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,578.2,70,,578.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,578.2,
BOST SCI 39171-06047 MUSTANG BALLOON,C1725,HCPCS,,79000199,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BARD DR13568 6X8X135 DORADO BALLOON,C1725,HCPCS,,79000203,CDM,272,RC,,,both,,,646,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,452.2,70,,452.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,452.2,
BARD DR-8068 6X8X80 DORADO BALLOON,C1725,HCPCS,,79000204,CDM,272,RC,,,both,,,616,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.2,70,,431.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.2,
BOST SCI 17-646 7X2X75 BALLOON ULTRATHIN,C1725,HCPCS,,79000213,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI 17-656 7X4X75 BALLOON ULTRATHIN,C1725,HCPCS,,79000214,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
EV3 AB35W07120135 EVERCROSS BALLOON,C1725,HCPCS,,79000215,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W07150135 EVERCROSS BALLOON,C1725,HCPCS,,79000217,CDM,272,RC,,,both,,,675,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,472.5,70,,472.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,472.5,
BOST SCI 39171-07151 MUSTANG BALLOON,C1725,HCPCS,,79000218,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
EV3 AB35W07200135 EVERCROSS BALLOON,C1725,HCPCS,,79000221,CDM,272,RC,,,both,,,675,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,472.5,70,,472.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,472.5,
BOST SCI 39171-07047 MUSTANG BALLOON,C1725,HCPCS,,79000224,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BARD CQ-5074 7X4X50 CONQUEST BALLOON,C1725,HCPCS,,79000225,CDM,272,RC,,,both,,,766,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,536.2,70,,536.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,536.2,
BARD CQ-5054 7X4X50 CONQUEST BALLOON,C1725,HCPCS,,79000226,CDM,272,RC,,,both,,,766,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,536.2,70,,536.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,536.2,
BOST SCI 17-676 SDS BALLOON ULTRATHIN,C1725,HCPCS,,79000239,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI 17-686 SDS BALLOON ULTRATHIN,C1725,HCPCS,,79000240,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI 39171-08047 MUSTANG BALLOON,C1725,HCPCS,,79000246,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BARD DR8084 8X4X75 DORADO BALLOON,C1725,HCPCS,,79000247,CDM,272,RC,,,both,,,616,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.2,70,,431.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.2,
BOST SCI 39171-08067 MUSTANG BALLOON,C1725,HCPCS,,79000248,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BARD CQ-7588 8X8X75 CONQUEST BALLOON,C1725,HCPCS,,79000250,CDM,272,RC,,,both,,,660,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,462,70,,462,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,462,
BOST SCI 17-711 SDS BALLOONS ULTRATHIN,C1725,HCPCS,,79000256,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI 39171-09047 MUSTANG BALLOON,C1725,HCPCS,,79000257,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BARD DR8094 9X4X80 DORADO BALLOON,C1725,HCPCS,,79000258,CDM,272,RC,,,both,,,616,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.2,70,,431.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.2,
BOST SCI PCB03015140F CUTTING BALLOON,C1725,HCPCS,,79000273,CDM,272,RC,,,both,,,2400,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1680,70,,1680,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
BOST SCI PCB04015140F CUTTING BALLOON,C1725,HCPCS,,79000274,CDM,272,RC,,,both,,,2400,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1680,70,,1680,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
BARD AT-75124 ATLAS BALLOON 12X4X75,C1725,HCPCS,,79000275,CDM,272,RC,,,both,,,916,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,641.2,70,,641.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,641.2,
BARD AT-75144 ATLAS BALLOON 14X4X75,C1725,HCPCS,,79000276,CDM,272,RC,,,both,,,916,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,641.2,70,,641.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,641.2,
BARD DR-8064 BALLOON DORADO 6X4X80,C1725,HCPCS,,79000278,CDM,272,RC,,,both,,,616,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.2,70,,431.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.2,
BARD DR8074 BALLOON DORADO 7X4X80,C1725,HCPCS,,79000279,CDM,272,RC,,,both,,,616,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.2,70,,431.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.2,
BOST SCI 39031-70401 BALLOON STERLING,C1725,HCPCS,,79000280,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-35201 STERLING BALLOON,C1725,HCPCS,,79000288,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI T30601500 CATH POLAR 3X60X150,C1725,HCPCS,,79000290,CDM,272,RC,,,both,,,2400,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1680,70,,1680,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
BOST SCI P48012001 CATH POLAR 4X80X120,C1725,HCPCS,,79000291,CDM,272,RC,,,both,,,2266,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1586.2,70,,1586.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1586.2,
J&J 4224020X PTA CATH BALLOON 4MMX2CM,C1725,HCPCS,,79000297,CDM,272,RC,,,both,,,953,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,667.1,70,,667.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667.1,
BOST SCI P66012001 POLAR CATH 6X6X120MM,C1725,HCPCS,,79000298,CDM,272,RC,,,both,,,1800,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1260,70,,1260,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
BOST SCI 17-603 CATH SDS BALLOON 5.3FRX5,C1725,HCPCS,,79000302,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BOST SCI 17-633 CATH SDS BALLOON 5.3FRX6,C1725,HCPCS,,79000303,CDM,272,RC,,,both,,,612,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428.4,70,,428.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.4,
BARD CQ-75104 CONQUEST BALLOON 10X4X75CM,C1725,HCPCS,,79000311,CDM,272,RC,,,both,,,764,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,534.8,70,,534.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,534.8,
BARD CQ-7564 CONQUEST BALLOON 6X4X75CM,C1725,HCPCS,,79000312,CDM,272,RC,,,both,,,660,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,462,70,,462,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,462,
BARD CQ-7574 CONQUEST 7X4X75CM BALLOON,C1725,HCPCS,,79000313,CDM,272,RC,,,both,,,660,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,462,70,,462,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,462,
BARD CQ-7584 CONQUEST 8X4X75CM BALLOON,C1725,HCPCS,,79000314,CDM,272,RC,,,both,,,660,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,462,70,,462,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,462,
BARD CQ-5062 CONQUEST BALLOON 6X2X50,C1725,HCPCS,,79000315,CDM,272,RC,,,both,,,810,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,567,70,,567,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,567,
BARD CQ-7568 CONQUEST BALLOON 6X8X75,C1725,HCPCS,,79000316,CDM,272,RC,,,both,,,988,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,691.6,70,,691.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,691.6,
BARD CQ-7578 CONQUEST BALLOON 7X8X75,C1725,HCPCS,,79000317,CDM,272,RC,,,both,,,930,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,651,70,,651,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,651,
BARD CQ-5072 CONQUEST BALLOON 7X2X50,C1725,HCPCS,,79000318,CDM,272,RC,,,both,,,660,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,462,70,,462,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,462,
BARD CQ-5084 CONQUEST BALLOON 8X4X50,C1725,HCPCS,,79000319,CDM,272,RC,,,both,,,810,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,567,70,,567,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,567,
BARD CQ-5064 CONQUEST PTA BALLOON 6X4,C1725,HCPCS,,79000320,CDM,272,RC,,,both,,,766,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,536.2,70,,536.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,536.2,
BARD CQ-5083 CONQUEST PTA BALLOON 8X3,C1725,HCPCS,,79000321,CDM,272,RC,,,both,,,810,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,567,70,,567,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,567,
BOST SCI PCB5020135 5X2X135 CTNG BALLOON,C1725,HCPCS,,79000329,CDM,272,RC,,,both,,,2400,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1680,70,,1680,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
BOST SCI PCB702090 7X2X90 CTNG BALLOON,C1725,HCPCS,,79000330,CDM,272,RC,,,both,,,2400,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1680,70,,1680,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
BOST SCI PCB802090 8X2X90 CTNG BALLOON,C1725,HCPCS,,79000332,CDM,272,RC,,,both,,,2400,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1680,70,,1680,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
BARD DR8044 DORADO BALLOON 4X4X80,C1725,HCPCS,,79000345,CDM,272,RC,,,both,,,616,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.2,70,,431.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.2,
BARD DR135515 DORADO BALLOON 5X15X135,C1725,HCPCS,,79000346,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BARD DR135610 DORADO BALLOON 6X10X135,C1725,HCPCS,,79000347,CDM,272,RC,,,both,,,646,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,452.2,70,,452.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,452.2,
BARD DR135615 DORADO BALLOON 6X15C135,C1725,HCPCS,,79000348,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
EV3 AB35W06200135 EVERCROSS BALLOON,C1725,HCPCS,,79000350,CDM,272,RC,,,both,,,675,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,472.5,70,,472.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,472.5,
J&J 417-2540S MAXI LD BALLOON CATH 25X4,C1725,HCPCS,,79000421,CDM,272,RC,,,both,,,1576,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1103.2,70,,1103.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1103.2,
BOST SCI H74939171050810 MUSTANG BALLOON,C1725,HCPCS,,79000425,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI H74939171080470 MUSTANG BALLOON,C1725,HCPCS,,79000426,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
EV3 AB14W035120150 NANOCROSS 3.5X120X150,C1725,HCPCS,,79000429,CDM,272,RC,,,both,,,1041,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,728.7,70,,728.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,728.7,
BOST SCI P58012001 POLAR CATH PERIPHERAL,C1725,HCPCS,,79000453,CDM,272,RC,,,both,,,2160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1512,70,,1512,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1512,
BOST SCI T3510013501 POLAR CATHETER,C1725,HCPCS,,79000454,CDM,272,RC,,,both,,,2776,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1943.2,70,,1943.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1943.2,
POLAR CATHETER 4X60X120,C1725,HCPCS,,79000455,CDM,272,RC,,,both,,,1860,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1302,70,,1302,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1302,
MEDTRONIC REL46 RELIANT BALLOON,C1725,HCPCS,,79000477,CDM,272,RC,,,both,,,1336,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,935.2,70,,935.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,935.2,
BOST SCI 39031-30601 STERLING BALLOON,C1725,HCPCS,,79000529,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-60401 STERLING BALLOON,C1725,HCPCS,,79000530,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-30201 STERLING BALLOON,C1725,HCPCS,,79000531,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39135-35401 STERLING BALLOON,C1725,HCPCS,,79000532,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-60201 STERLING BALLOON,C1725,HCPCS,,79000533,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-40201 STERLING BALLOON,C1725,HCPCS,,79000534,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-40401 STERLING BALLOON,C1725,HCPCS,,79000535,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-50201 STERLING BALLOON,C1725,HCPCS,,79000536,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-50401 STERLING BALLOON,C1725,HCPCS,,79000537,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-70201 STERLING BALLOON,C1725,HCPCS,,79000538,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39135-30401 STERLING BALLOON,C1725,HCPCS,,79000539,CDM,272,RC,,,both,,,1144,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,800.8,70,,800.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,800.8,
BOST SCI 39147-30801 STERLING BALLOON,C1725,HCPCS,,79000540,CDM,272,RC,,,both,,,1144,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,800.8,70,,800.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,800.8,
STERLING EX BALLOON 2.5X4X142,C1725,HCPCS,,79000542,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-50601 STERLING BALLOON,C1725,HCPCS,,79003070,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-60601 STERLING BALLOON,C1725,HCPCS,,79003071,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39171-03024 MUSTANG BALLOON,C1725,HCPCS,,79003072,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39171-03024 MUSTANG BALLOON,C1725,HCPCS,,79003073,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39171-05034 MUSTANG BALLOON,C1725,HCPCS,,79003074,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39171-05041 MUSTANG BALLOON,C1725,HCPCS,,79003075,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39171-06087 MUSTANG BALLOON,C1725,HCPCS,,79003076,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39171-06201 MUSTANG BALLOON,C1725,HCPCS,,79003077,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
BOST SCI 39171-07087 MUSTANG BALLOON,C1725,HCPCS,,79003078,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39171-07101 MUSTANG BALLOON,C1725,HCPCS,,79003079,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
BOST SCI 39171-07201 MUSTANG BALLOON,C1725,HCPCS,,79003080,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
BOST SCI 39171-08041 MUSTANG BALLOON,C1725,HCPCS,,79003081,CDM,272,RC,,,both,,,585,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,409.5,70,,409.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,409.5,
BOST SCI 39206-05101 CHARGER BALLOON,C1725,HCPCS,,79003082,CDM,272,RC,,,both,,,496,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,347.2,70,,347.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,347.2,
BOST SCI 39206-05201 CHARGER BALLOON,C1725,HCPCS,,79003083,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39206-06041 CHARGER BALLOON,C1725,HCPCS,,79003084,CDM,272,RC,,,both,,,495,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,346.5,70,,346.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,346.5,
BOST SCI 39206-06041 CHARGER BALLOON,C1725,HCPCS,,79003085,CDM,272,RC,,,both,,,496,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,347.2,70,,347.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,347.2,
BOST SCI 39206-07151 CHARGER BALLOON,C1725,HCPCS,,79003086,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39185-20061 COYOTE BALLOON,C1725,HCPCS,,79003087,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
BOST SCI 39185-20121 COYOTE BALLOON,C1725,HCPCS,,79003088,CDM,272,RC,,,both,,,1050,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,735,70,,735,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,735,
BOST SCI 39185-20221 COYOTE BALLOON,C1725,HCPCS,,79003089,CDM,272,RC,,,both,,,1216,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,851.2,70,,851.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,851.2,
BOST SCI 39135-25401 COYOTE ES BALLOON,C1725,HCPCS,,79003090,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39185-35061 COYOTE BALLOON,C1725,HCPCS,,79003091,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
J&J 426-1504X 4FR SLEEK CATH 1.5X40X150,C1725,HCPCS,,79003092,CDM,272,RC,,,both,,,1010,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,707,70,,707,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,707,
J&J 417-1860S MAXI LD BALLOON CATH 18X6,C1725,HCPCS,,79003093,CDM,272,RC,,,both,,,858,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,600.6,70,,600.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600.6,
BOST SCI 17-578 ULTRATHIN SDS BALLOON,C1725,HCPCS,,79003094,CDM,272,RC,,,both,,,480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,336,70,,336,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
BOST SCI 17-633 ULTRATHIN SDS BALLOON,C1725,HCPCS,,79003095,CDM,272,RC,,,both,,,480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,336,70,,336,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
BOST SCI 17-668 ULTRATHIN SDS BALLOON,C1725,HCPCS,,79003096,CDM,272,RC,,,both,,,480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,336,70,,336,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
BOST SCI 17-688 ULTRATHIN SDS BALLOON,C1725,HCPCS,,79003097,CDM,272,RC,,,both,,,480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,336,70,,336,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
EV3 AB35W03040080 EVERCROSS BALLOON,C1725,HCPCS,,79003098,CDM,272,RC,,,both,,,540,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378,70,,378,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378,
EV3 AB35W04020080 EVERCROSS BALLOON,C1725,HCPCS,,79003099,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W04040135 EVERCROSS BALLOON,C1725,HCPCS,,79003100,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W04080080 EVERCROSS BALLOON,C1725,HCPCS,,79003101,CDM,272,RC,,,both,,,540,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378,70,,378,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378,
EV3 AB35W04100135 EVERCROSS BALLOON,C1725,HCPCS,,79003102,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W05020080 EVERCROSS BALLOON,C1725,HCPCS,,79003103,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W05030040 EVERCROSS BALLOON,C1725,HCPCS,,79003104,CDM,272,RC,,,both,,,540,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378,70,,378,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378,
EV3 AB35W05040135 EVERCROSS BALLOON,C1725,HCPCS,,79003105,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W05200135 EVERCROSS BALLOON,C1725,HCPCS,,79003106,CDM,272,RC,,,both,,,675,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,472.5,70,,472.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,472.5,
EV3 AB35W06020040 EVERCROSS BALLOON,C1725,HCPCS,,79003107,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W06030080 EVERCROSS BALLOON,C1725,HCPCS,,79003108,CDM,272,RC,,,both,,,540,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378,70,,378,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378,
EV3 AB35W06040135 EVERCROSS BALLOON,C1725,HCPCS,,79003109,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W06060080 EVERCROSS BALLOON,C1725,HCPCS,,79003110,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W07020080 EVERCROSS BALLOON,C1725,HCPCS,,79003111,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W07040135 EVERCROSS BALLOON,C1725,HCPCS,,79003112,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W07060080 EVERCROSS BALLOON,C1725,HCPCS,,79003113,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W08040080 EVERCROSS BALLOON,C1725,HCPCS,,79003114,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W09040080 EVERCROSS BALLOON,C1725,HCPCS,,79003115,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W10040080 EVERCROSS BALLOON,C1725,HCPCS,,79003116,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
BOST SCI T304013501 3X40X135 POLAR CATH,C1725,HCPCS,,79003117,CDM,272,RC,,,both,,,2592,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1814.4,70,,1814.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1814.4,
BOST SCI P56012001 5X60X120 POLAR CATH,C1725,HCPCS,,79003118,CDM,272,RC,,,both,,,2592,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1814.4,70,,1814.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1814.4,
BOST SCI P64012001 6X40X120 POLAR CATH,C1725,HCPCS,,79003119,CDM,272,RC,,,both,,,2592,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1814.4,70,,1814.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1814.4,
BOST SCI PCB7020135 CUTTING BALLOON,C1725,HCPCS,,79003120,CDM,272,RC,,,both,,,2400,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1680,70,,1680,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
BOST SCI 22-138 8FRX26CM NEPHRRTRL STENT,C1725,HCPCS,,79003125,CDM,272,RC,,,both,,,317,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.9,70,,221.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.9,
BARD U4150322 ULTRAVERSE BALLOON 3X22,C1725,HCPCS,,79003262,CDM,272,RC,,,both,,,916,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,641.2,70,,641.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,641.2,
BARD U813034 ULTRAVERSE BALLOON 3X4,C1725,HCPCS,,79003263,CDM,272,RC,,,both,,,856,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,599.2,70,,599.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,599.2,
BARD U8130310 ULTRAVERSE BALLOON 3X10,C1725,HCPCS,,79003264,CDM,272,RC,,,both,,,856,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,599.2,70,,599.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,599.2,
BOST SCI 39206-06201 6X200X135CM BALLOON,C1725,HCPCS,,79004847,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39206-04087 4X80X75CM BALLOON,C1725,HCPCS,,79004848,CDM,272,RC,,,both,,,496,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,347.2,70,,347.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,347.2,
BOST SCI 39206-05087 5X80X75CM BALLOON,C1725,HCPCS,,79004849,CDM,272,RC,,,both,,,496,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,347.2,70,,347.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,347.2,
BOST SCI 39206-05151 5X150X135CM BALLOON,C1725,HCPCS,,79004850,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39206-06087 6X80X75CM BALLOON,C1725,HCPCS,,79004851,CDM,272,RC,,,both,,,496,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,347.2,70,,347.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,347.2,
BOST SCI 39206-07101 7X100X135CM BALLOON,C1725,HCPCS,,79004852,CDM,272,RC,,,both,,,496,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,347.2,70,,347.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,347.2,
BOST SCI 39206-07201 7X200X135CM BALLOON,C1725,HCPCS,,79004853,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39206-06151 6X150X135CM BALLOON,C1725,HCPCS,,79004855,CDM,272,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.2,70,,410.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.2,
BOST SCI 39147-35201 BALLOON 3.5X20X135,C1725,HCPCS,,79004978,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
EV3 A14BX020040170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005137,CDM,272,RC,,,both,,,1041,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,728.7,70,,728.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,728.7,
EV3 A14BX020210170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005138,CDM,272,RC,,,both,,,810,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,567,70,,567,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,567,
EV3 A14BX025210170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005139,CDM,272,RC,,,both,,,1290,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,903,70,,903,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,903,
EV3 A14BX025120170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005140,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX030080170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005141,CDM,272,RC,,,both,,,1062,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,743.4,70,,743.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,743.4,
EV3 A14BX030120170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005142,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX030210170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005143,CDM,272,RC,,,both,,,810,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,567,70,,567,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,567,
EV3 A14BX035210170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005144,CDM,272,RC,,,both,,,1290,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,903,70,,903,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,903,
EV3 A14BX040020170 4X20X170 BALLOON,C1725,HCPCS,,79005145,CDM,272,RC,,,both,,,1062,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,743.4,70,,743.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,743.4,
EV3 A14BX040080170 4X80X170 BALLOON,C1725,HCPCS,,79005146,CDM,272,RC,,,both,,,1062,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,743.4,70,,743.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,743.4,
EV3 A14BX040150170 4X150X170 BALLOON,C1725,HCPCS,,79005147,CDM,272,RC,,,both,,,1290,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,903,70,,903,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,903,
BOST SCI PCB602090 CUTTING BALLOON,C1725,HCPCS,,79005239,CDM,272,RC,,,both,,,2400,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1680,70,,1680,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
EV3 AB18W040150150 POWERCROSS BALLOON,C1725,HCPCS,,79005392,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
EV3 AB18W040200150 POWERCROSS BALLOON,C1725,HCPCS,,79005393,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
EV3 AB18W050120150 POWERCROSS BALLOON,C1725,HCPCS,,79005394,CDM,272,RC,,,both,,,526,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.2,70,,368.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,368.2,
EV3 AB18W050150150 POWERCROSS BALLOON,C1725,HCPCS,,79005395,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
EV3 AB18W050200150 POWERCROSS BALLOON,C1725,HCPCS,,79005396,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
EV3 AB18W060120150 POWERCROSS BALLOON,C1725,HCPCS,,79005397,CDM,272,RC,,,both,,,526,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.2,70,,368.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,368.2,
EV3 AB18W060150150 POWERCROSS BALLOON,C1725,HCPCS,,79005398,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
EV3 AB18W060200150 POWERCROSS BALLOON,C1725,HCPCS,,79005399,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
EV3 AB35W04080135 EVERCROSS BALLOON,C1725,HCPCS,,79005400,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W05060135 EVERCROSS BALLOON,C1725,HCPCS,,79005401,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W05150135 EVERCROSS BALLOON,C1725,HCPCS,,79005402,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
EV3 AB35W06040080 EVERCROSS BALLOON,C1725,HCPCS,,79005403,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W06060135 EVERCROSS BALLOON,C1725,HCPCS,,79005404,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W06080080 EVERCROSS BALLOON,C1725,HCPCS,,79005405,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W06080135 EVERCROSS BALLOON,C1725,HCPCS,,79005406,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W05080135 EVERCROSS BALLOON,C1725,HCPCS,,79005407,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W07060135 EVERCROSS BALLOON,C1725,HCPCS,,79005409,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W07080080 EVERCROSS BALLOON,C1725,HCPCS,,79005410,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W07080135 EVERCROSS BALLOON,C1725,HCPCS,,79005411,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W07100135 EVERCROSS BALLOON,C1725,HCPCS,,79005412,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W08060080 EVERCROSS BALLOON,C1725,HCPCS,,79005413,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W08080080 EVERCROSS BALLOON,C1725,HCPCS,,79005414,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W09060080 EVERCROSS BALLOON,C1725,HCPCS,,79005415,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB35W10060080 EVERCROSS BALLOON,C1725,HCPCS,,79005416,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
COOK G50233 4X10X135 PTA 4 COOK BALLOON,C1725,HCPCS,,79005442,CDM,272,RC,,,both,,,946,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,662.2,70,,662.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,662.2,
EV3 AB35W04060135 EVERCROSS BALLOON,C1725,HCPCS,,79005448,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
EV3 AB35W06100135 EVERCROSS BALLOON,C1725,HCPCS,,79005449,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
EV3 AB18W040020090 POWERCROSS BALLOON,C1725,HCPCS,,79005450,CDM,272,RC,,,both,,,526,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.2,70,,368.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,368.2,
EV3 AB18W050020090 POWERCROSS BALLOON,C1725,HCPCS,,79005451,CDM,272,RC,,,both,,,526,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.2,70,,368.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,368.2,
EV3 AB18W060020090 POWERCROSS BALLOON,C1725,HCPCS,,79005452,CDM,272,RC,,,both,,,526,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.2,70,,368.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,368.2,
EV3 AB18W050080150 POWERCROSS BALLOON,C1725,HCPCS,,79005453,CDM,272,RC,,,both,,,526,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.2,70,,368.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,368.2,
EV3 AB18W060100150 POWERCROSS BALLOON,C1725,HCPCS,,79005454,CDM,272,RC,,,both,,,526,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.2,70,,368.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,368.2,
EV3 A14BX020060170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005455,CDM,272,RC,,,both,,,1041,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,728.7,70,,728.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,728.7,
EV3 A14BX020120170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005456,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX025060170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005457,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX030060170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005458,CDM,272,RC,,,both,,,1062,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,743.4,70,,743.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,743.4,
EV3 A14BX035100170 RAPIDCROSS BALLOON,C1725,HCPCS,,79005459,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 AB18W060080150 POWERCROSS BALLOON,C1725,HCPCS,,79005851,CDM,272,RC,,,both,,,526,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.2,70,,368.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,368.2,
EV3 AB18W040120150 POWERCROSS 4X120X150,C1725,HCPCS,,79006184,CDM,272,RC,,,both,,,526,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.2,70,,368.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,368.2,
EV3 AB18W030200150 POWERCROSS 3X200X150,C1725,HCPCS,,79006188,CDM,272,RC,,,both,,,676,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.2,70,,473.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,473.2,
EV3 A14BX020020170 RAPIDCROSS 2X20X170,C1725,HCPCS,,79006189,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX020080170 RAPIDCROSS 2X80X170,C1725,HCPCS,,79006190,CDM,272,RC,,,both,,,1041,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,728.7,70,,728.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,728.7,
EV3 A14BX020150170 RAPIDCROSS 2X150X170,C1725,HCPCS,,79006191,CDM,272,RC,,,both,,,810,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,567,70,,567,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,567,
EV3 A14BX025020170 RAPIDCROSS 2.5X20X170,C1725,HCPCS,,79006192,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX025040170 RAPIDCROSS 2.5X40X170,C1725,HCPCS,,79006193,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX025080170 RAPIDCROSS 2.5X80X170,C1725,HCPCS,,79006194,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX025150170 RAPIDCRSS 2.5X150X170,C1725,HCPCS,,79006195,CDM,272,RC,,,both,,,810,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,567,70,,567,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,567,
EV3 A14BX030020170 RAPIDCROSS 3X20X170,C1725,HCPCS,,79006196,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX030040170 RAPIDCROSS 3X40X170,C1725,HCPCS,,79006197,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX030150170 RAPIDCROSS 3X150X170,C1725,HCPCS,,79006198,CDM,272,RC,,,both,,,1290,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,903,70,,903,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,903,
EV3 A14BX035020170 RAPIDCROSS 3.5X20X170,C1725,HCPCS,,79006199,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX035040170 RAPIDCROSS 3.5X40X170,C1725,HCPCS,,79006200,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX035060170 RAPIDCROSS 3.5X60X170,C1725,HCPCS,,79006201,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX035080170 RAPIDCROSS 3.5X80X170,C1725,HCPCS,,79006202,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX035120170 RAPIDCRSS 3.5X120X170,C1725,HCPCS,,79006203,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
EV3 A14BX035150170 RAPIDCRSS 3.5X150X170,C1725,HCPCS,,79006204,CDM,272,RC,,,both,,,810,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,567,70,,567,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,567,
EV3 A14BX040040170 RAPIDCROSS 4X40X170,C1725,HCPCS,,79006205,CDM,272,RC,,,both,,,1062,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,743.4,70,,743.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,743.4,
EV3 A14BX040060170 RAPIDCROSS 4X60X170,C1725,HCPCS,,79006206,CDM,272,RC,,,both,,,1062,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,743.4,70,,743.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,743.4,
EV3 A14BX040100170 RAPIDCROSS 4X100X170,C1725,HCPCS,,79006207,CDM,272,RC,,,both,,,1062,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,743.4,70,,743.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,743.4,
EV3 A14BX040120170 RAPIDCROSS 4X120X170,C1725,HCPCS,,79006208,CDM,272,RC,,,both,,,1062,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,743.4,70,,743.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,743.4,
EV3 A14BX040210170 RAPIDCROSS 4X210X170,C1725,HCPCS,,79006209,CDM,272,RC,,,both,,,1290,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,903,70,,903,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,903,
BOST SCI M001145520 BALLOON 16X40X75,C1725,HCPCS,,79006238,CDM,272,RC,,,both,,,780,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,546,70,,546,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,546,
BOST SCI M001145570 BALLOON 18X40X75,C1725,HCPCS,,79006239,CDM,272,RC,,,both,,,780,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,546,70,,546,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,546,
J&J 416-2040S MAXI LD BALLOON 20MMX4CM,C1725,HCPCS,,79006240,CDM,272,RC,,,both,,,858,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,600.6,70,,600.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600.6,
J&J 436-6015L SAVVY BALLOON 6X150X120,C1725,HCPCS,,79006408,CDM,272,RC,,,both,,,870,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,609,70,,609,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,609,
J&J 426-3022X SLEEK BALLOON 3X220X150,C1725,HCPCS,,79006409,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
BOST SCI 39032-50151 STERLING BALLOON,C1725,HCPCS,,79006456,CDM,272,RC,,,both,,,1186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,830.2,70,,830.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,830.2,
BOST SCI 39032-50211 STERLING BALLOON,C1725,HCPCS,,79006457,CDM,272,RC,,,both,,,1186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,830.2,70,,830.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,830.2,
BOST SCI 39032-60151 STERLING BALLOON,C1725,HCPCS,,79006458,CDM,272,RC,,,both,,,1186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,830.2,70,,830.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,830.2,
BOST SCI 39032-60211 STERLING BALLOON,C1725,HCPCS,,79006459,CDM,272,RC,,,both,,,1186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,830.2,70,,830.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,830.2,
BOST SCI 39032-70151 STERLING BALLOON,C1725,HCPCS,,79006460,CDM,272,RC,,,both,,,1186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,830.2,70,,830.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,830.2,
BOST SCI 39032-70211 STELRING BALLOON,C1725,HCPCS,,79006461,CDM,272,RC,,,both,,,1186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,830.2,70,,830.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,830.2,
COOK G52261 5MMX10CM ADVANCE 35 BALLOON,C1725,HCPCS,,79006466,CDM,272,RC,,,both,,,540,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378,70,,378,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378,
COOK G35536 6MMX20CM ADVANCE 35 BALLOON,C1725,HCPCS,,79006468,CDM,272,RC,,,both,,,540,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378,70,,378,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378,
J&J HEALTH 48006015X SABER 6X150 BALLOON,C1725,HCPCS,,79006771,CDM,272,RC,,,both,,,870,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,609,70,,609,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,609,
J&J HEALTH 48006020X SABER 6X200 BALLOON,C1725,HCPCS,,79006772,CDM,272,RC,,,both,,,870,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,609,70,,609,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,609,
BARD AT75164 ATLAS BALLOON 16MMX4CM,C1725,HCPCS,,79006883,CDM,272,RC,,,both,,,1020,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,714,70,,714,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,714,
BARD AT75184 ATLAS BALLOON 18MMX4CM,C1725,HCPCS,,79006884,CDM,272,RC,,,both,,,1020,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,714,70,,714,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,714,
MEDTRONIC CB1812050120OTW BALLOON 5X120,C1725,HCPCS,,79006924,CDM,272,RC,,,both,,,2520,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1764,70,,1764,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1764,
J&J 4400704S POWERFLEX BALLOON 7MMX4CM,C1725,HCPCS,,79006925,CDM,272,RC,,,both,,,402,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,281.4,70,,281.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,281.4,
J&J 4400804S POWERFLEX BALLOON 8MMX4CM,C1725,HCPCS,,79006926,CDM,272,RC,,,both,,,402,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,281.4,70,,281.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,281.4,
J&J 4400510X POWERFLEX BALLOON 5MMX10CM,C1725,HCPCS,,79006927,CDM,272,RC,,,both,,,402,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,281.4,70,,281.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,281.4,
J&J 4400515X POWERFLEX BALLOON 5MMX15CM,C1725,HCPCS,,79006928,CDM,272,RC,,,both,,,432,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,302.4,70,,302.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,302.4,
J&J 4400615X POWERFLEX BALLOON 6MMX15CM,C1725,HCPCS,,79006929,CDM,272,RC,,,both,,,432,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,302.4,70,,302.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,302.4,
J&J 4400622X POWERFLEX BALLOON 6MMX22CM,C1725,HCPCS,,79006930,CDM,272,RC,,,both,,,432,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,302.4,70,,302.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,302.4,
BARD AT75204 ATLAS BALLOON 20MMX4CM,C1725,HCPCS,,79006932,CDM,272,RC,,,both,,,1126,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,788.2,70,,788.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,788.2,
J&J 48003020S SABER 3MMX200MM BALLOON,C1725,HCPCS,,79006955,CDM,272,RC,,,both,,,870,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,609,70,,609,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,609,
MEDTRONIC CB1812050080OTW BALLOON 5X80,C1725,HCPCS,,79006997,CDM,272,RC,,,both,,,2700,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1890,70,,1890,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
J&J HLTH 48005015X SABER BALLOON 5X150,C1725,HCPCS,,79007058,CDM,272,RC,,,both,,,870,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,609,70,,609,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,609,
J&J HLTH 48007003X SABER 7X30MM BALLOON,C1725,HCPCS,,79007142,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
BOST SCI 39031-80201 STERLING BALLOON,C1725,HCPCS,,79007184,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
J&J 48003015X SABER 3X150MM BALLOON,C1725,HCPCS,,79007257,CDM,272,RC,,,both,,,870,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,609,70,,609,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,609,
MEDTRONIC CB1413540120OTW  BALLOON 4X120,C1725,HCPCS,,79007272,CDM,272,RC,,,both,,,2520,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1764,70,,1764,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1764,
COOK G30958 5X200MM ADVANCE 18LP BALLOON,C1725,HCPCS,,79007315,CDM,272,RC,,,both,,,946,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,662.2,70,,662.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,662.2,
STRYKER 39031-30201-R 3X20MM BALLOON,C1725,HCPCS,,79007316,CDM,272,RC,,,both,,,450,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,315,70,,315,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315,
STRYKER DR13558-R 5X80MM DORADO BALLOON,C1725,HCPCS,,79007317,CDM,272,RC,,,both,,,256,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,179.2,70,,179.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,179.2,
STRYKER DR8044-R 4X40MM DORADO BALLOON,C1725,HCPCS,,79007318,CDM,272,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,159.6,
STRYKER DR8054-R 5X40MM DORADO BALLOON,C1725,HCPCS,,79007319,CDM,272,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,159.6,
STRYKER DR8064-R 6X40MM DORADO BALLOON,C1725,HCPCS,,79007320,CDM,272,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,159.6,
STRYKER PCB5020135-R 5X2 CUTTING BALLOON,C1725,HCPCS,,79007321,CDM,272,RC,,,both,,,900,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,630,70,,630,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,630,
STRYKER PCB7020135-R 7X2 CUTTING BALLOON,C1725,HCPCS,,79007322,CDM,272,RC,,,both,,,900,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,630,70,,630,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,630,
BOST SCI 39147-20121 2X120X150 BALLOON,C1725,HCPCS,,79007385,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39147-20151 2X150X150 BALLOON,C1725,HCPCS,,79007386,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39031-20221 2X220X150 BALLOON,C1725,HCPCS,,79007387,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39147-25121 2.5X120X150 BALLOON,C1725,HCPCS,,79007388,CDM,272,RC,,,both,,,1259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,881.3,70,,881.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,881.3,
BOST SCI 39147-25151 2.5X150X150 BALLOON,C1725,HCPCS,,79007389,CDM,272,RC,,,both,,,1259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,881.3,70,,881.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,881.3,
BOST SCI 39031-25221 2.5X220X150 BALLOON,C1725,HCPCS,,79007390,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39147-30121 3X120X150 BALLOON,C1725,HCPCS,,79007391,CDM,272,RC,,,both,,,1259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,881.3,70,,881.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,881.3,
BOST SCI 39147-30151 3X150X150 BALLOON,C1725,HCPCS,,79007392,CDM,272,RC,,,both,,,1259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,881.3,70,,881.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,881.3,
BOST SCI 39031-30221 3X220X150 BALLOON,C1725,HCPCS,,79007393,CDM,272,RC,,,both,,,1186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,830.2,70,,830.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,830.2,
BOST SCI 39147-35151 3.5X150X150 BALLOON,C1725,HCPCS,,79007394,CDM,272,RC,,,both,,,1259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,881.3,70,,881.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,881.3,
BOST SCI 39031-35221 3.5X220X150 BALLOON,C1725,HCPCS,,79007395,CDM,272,RC,,,both,,,1110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777,70,,777,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,777,
BOST SCI 39147-40121 4X120X150 BALLOON,C1725,HCPCS,,79007396,CDM,272,RC,,,both,,,1259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,881.3,70,,881.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,881.3,
BOST SCI 39147-40151 4X150X150 BALLOON,C1725,HCPCS,,79007397,CDM,272,RC,,,both,,,1259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,881.3,70,,881.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,881.3,
BOST SCI 39135-15201 1.5X20X143 BALLOON,C1725,HCPCS,,79007398,CDM,272,RC,,,both,,,1144,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,800.8,70,,800.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,800.8,
BOST SCI 39185-20151 2X150X150 BALLOON,C1725,HCPCS,,79007399,CDM,272,RC,,,both,,,1050,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,735,70,,735,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,735,
BOST SCI 39185-30221 3X220X150 BALLOON,C1725,HCPCS,,79007400,CDM,272,RC,,,both,,,1216,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,851.2,70,,851.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,851.2,
BOST SCI 39185-35101 3.5X100X150 BALLOON,C1725,HCPCS,,79007401,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
BOST SCI 39185-35151 3.5X150X150 BALLOON,C1725,HCPCS,,79007402,CDM,272,RC,,,both,,,1050,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,735,70,,735,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,735,
BOST SCI 39185-35221 3.5X220X150 BALLOON,C1725,HCPCS,,79007403,CDM,272,RC,,,both,,,1216,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,851.2,70,,851.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,851.2,
J&J 48002515X SABER 2.5MMX15CM BALLOON,C1725,HCPCS,,79007427,CDM,272,RC,,,both,,,870,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,609,70,,609,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,609,
J&J 4263004X SLEEK 3MMX40X150CM BALLOON,C1725,HCPCS,,79007428,CDM,272,RC,,,both,,,900,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,630,70,,630,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,630,
COOK G50335 4X40X170CM ADVANCE BALLOON,C1725,HCPCS,,79007430,CDM,272,RC,,,both,,,1237,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,865.9,70,,865.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,865.9,
COOK G35532 5X200 ADVANCE 35LP BALLOON,C1725,HCPCS,,79007431,CDM,272,RC,,,both,,,540,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378,70,,378,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378,
J&J HEALTH 48005020X SABER 5X200 BALLOON,C1725,HCPCS,,79007463,CDM,272,RC,,,both,,,870,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,609,70,,609,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,609,
J&J 48006010X SABER 6MMX100MM BALLOON,C1725,HCPCS,,79007473,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
J&J 48004010X SABER 4MMX100MM BALLOON,C1725,HCPCS,,79007474,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
J&J 48003010S SABER 3X10CMX90CM BALLOON,C1725,HCPCS,,79007604,CDM,272,RC,,,both,,,720,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,504,70,,504,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
MEDTRONIC CB1413535080OTW 3.5X80 BALLOON,C1725,HCPCS,,79007605,CDM,272,RC,,,both,,,2700,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1890,70,,1890,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
J&J 426-2508X SLEEK 2.5X80MM BALLOON,C1725,HCPCS,,79007641,CDM,272,RC,,,both,,,900,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,630,70,,630,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,630,
MEDTRONIC CB1415030120OTW 3X120 BALLOON,C1725,HCPCS,,79007650,CDM,272,RC,,,both,,,3000,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2100,70,,2100,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2100,
CH CF1415030080OTW CHOCO 3X80 BALLOON,C1725,HCPCS,,79007857,CDM,272,RC,,,both,,,2370,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1659,70,,1659,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1659,
MEDTRONIC CB1413535040OTW 3.5X40 BALLOON,C1725,HCPCS,,79007858,CDM,272,RC,,,both,,,2430,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1701,70,,1701,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1701,
MEDTRONIC CB1413540040OTW 4X40 BALLOON,C1725,HCPCS,,79007859,CDM,272,RC,,,both,,,2700,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1890,70,,1890,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
MEDTRONIC CB1413540080OTW 4X80 BALLOON,C1725,HCPCS,,79007860,CDM,272,RC,,,both,,,2370,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1659,70,,1659,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1659,
MEDTRONIC CB1812050040OTW 5X40 BALLOON,C1725,HCPCS,,79007861,CDM,272,RC,,,both,,,2370,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1659,70,,1659,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1659,
MEDTRONIC CB1812060080OTW 6X80 BALLOON,C1725,HCPCS,,79007862,CDM,272,RC,,,both,,,2370,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1659,70,,1659,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1659,
MEDTRONIC CB1812060120OTW 6X120 BALLOON,C1725,HCPCS,,79007863,CDM,272,RC,,,both,,,2520,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1764,70,,1764,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1764,
CARDINAL 426-4004X SLEEK 4X40MM BALLOON,C1725,HCPCS,,79007939,CDM,272,RC,,,both,,,900,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,630,70,,630,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,630,
CARDINAL 426-2022X SLEEK 2X220MM BALLOON,C1725,HCPCS,,79007940,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
CARDINAL 426-2522X SLEEK 2.5X220 BALLOON,C1725,HCPCS,,79007959,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
BOST SCI 39185-20101 2X100X150 BALLOON,C1725,HCPCS,,79008019,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
Medtronic AB35W05040080 5X40X80 BALLOON,C1725,HCPCS,,79008039,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
Medtronic AB35W05100135 5100X135 BALLOON,C1725,HCPCS,,79008040,CDM,272,RC,,,both,,,515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,360.5,70,,360.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.5,
CARDINAL 426-5015X SLEEK 5X150MM BALLOON,C1725,HCPCS,,79008104,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
MEDTRONIC CB1413535120OTW 3.5X120 BALLON,C1725,HCPCS,,79008143,CDM,272,RC,,,both,,,2520,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1764,70,,1764,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1764,
MEDTRONIC CB14150300400TW 3X40MM BALLOON,C1725,HCPCS,,79008357,CDM,272,RC,,,both,,,2160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1512,70,,1512,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1512,
MEDTRONIC CB14150300800TW 3X80MM BALLOON,C1725,HCPCS,,79008358,CDM,272,RC,,,both,,,2700,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1890,70,,1890,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
MEDTRONIC CB18120600400TW  6X40 BALLOON,C1725,HCPCS,,79008359,CDM,272,RC,,,both,,,2160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1512,70,,1512,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1512,
CH 4400610X POWERFLEX BALLOON 6MMX10CM,C1725,HCPCS,,79008506,CDM,272,RC,,,both,,,402,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,281.4,70,,281.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,281.4,
BARD CQF7594 CONQUEST 40 BALLOON 9X4X75,C1725,HCPCS,,79009171,CDM,272,RC,,,both,,,1464,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1024.8,70,,1024.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1024.8,
MEDTRONIC A35HPV07080080 7X80X80 BALLOON,C1725,HCPCS,,79009602,CDM,272,RC,,,both,,,617,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.9,70,,431.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.9,
MEDTRONIC A35HPV08040080 8X40X80 BALLOON,C1725,HCPCS,,79009603,CDM,272,RC,,,both,,,617,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.9,70,,431.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.9,
MEDTRONIC A35HPV08080080 8X80X80 BALLOON,C1725,HCPCS,,79009604,CDM,272,RC,,,both,,,617,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.9,70,,431.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.9,
MEDTRONIC IAV12004008P 12X4X80CM BALLOON,C1725,HCPCS,,79011145,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC IAV10004008P 10X40X80 BALLOON,C1725,HCPCS,,79011156,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC IAV09008008P 9X80X80 BALLOON,C1725,HCPCS,,79011157,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC IAV08008008P 8X80X80 BALLOON,C1725,HCPCS,,79011159,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC IAV07004008P 7X40X80 BALLOON,C1725,HCPCS,,79011160,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC IAV06004008P 6X40X80 BALLOON,C1725,HCPCS,,79011161,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC EUP1506X BALLOON 1.5X6MM,C1725,HCPCS,,79011336,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP1510X BALLOON 1.5X10MM,C1725,HCPCS,,79011337,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP1512X BALLOON 1.5X12MM,C1725,HCPCS,,79011338,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP1515X BALLOON 1.5X15MM,C1725,HCPCS,,79011339,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP1520X BALLOON 1.5X20MM,C1725,HCPCS,,79011340,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP2006X BALLOON 2X6MM,C1725,HCPCS,,79011341,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP2010X BALLOON 2X10MM,C1725,HCPCS,,79011342,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP2012X BALLOON 2X12MM,C1725,HCPCS,,79011343,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP2015X BALLOON 2X15MM,C1725,HCPCS,,79011344,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP2020X BALLOON 2X20MM,C1725,HCPCS,,79011345,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP2506X BALLOON 2.5X6MM,C1725,HCPCS,,79011346,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP2510X BALLOON 2.5X10MM,C1725,HCPCS,,79011347,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP2512X BALLOON 2.5X12MM,C1725,HCPCS,,79011348,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP2515X BALLOON 2.5X15MM,C1725,HCPCS,,79011349,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP2520X BALLOON 2.5X20MM,C1725,HCPCS,,79011351,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP3006X BALLOON 3X6MM,C1725,HCPCS,,79011352,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP3010X BALLOON 3X10MM,C1725,HCPCS,,79011353,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP3012X BALLOON 3X12MM,C1725,HCPCS,,79011354,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP3015X BALLOON 3X15MM,C1725,HCPCS,,79011355,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP3506X BALLOON 3.5X6MM,C1725,HCPCS,,79011356,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP3510X BALLOON 3.5X10MM,C1725,HCPCS,,79011357,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP3512X BALLOON 3.5X12MM,C1725,HCPCS,,79011358,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP3515X BALLOON 3.5X15MM,C1725,HCPCS,,79011359,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP4006X BALLOON 4X6MM,C1725,HCPCS,,79011360,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP4010X BALLOON 4X10MM,C1725,HCPCS,,79011361,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP4012X BALLOON 4X12MM,C1725,HCPCS,,79011362,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC EUP4015X BALLOON 4X15MM,C1725,HCPCS,,79011363,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP2006X BALLOON 2X6MM,C1725,HCPCS,,79011364,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP2008X NC BALLOON 2X8MM,C1725,HCPCS,,79011365,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP2012X NC BALLOON 2X12MM,C1725,HCPCS,,79011366,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP2015X NC BALLOON 2X15MM,C1725,HCPCS,,79011367,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP2020X NC BALLOON 2X20MM,C1725,HCPCS,,79011368,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP22506X NC BALLOON 2.25X6,C1725,HCPCS,,79011369,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP22508X NC BALLOON 2.25X8,C1725,HCPCS,,79011370,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP22512X NC BALLOON 2.25X12,C1725,HCPCS,,79011371,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP22515X NC BALLOON 2.25X15,C1725,HCPCS,,79011372,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP22520X NC BALLOON 2.25X20,C1725,HCPCS,,79011373,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP2506X NC BALLOON 2.5X6MM,C1725,HCPCS,,79011374,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP2508X NC BALLOON 2.5X8MM,C1725,HCPCS,,79011375,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP2512X NC BALLOON 2.5X12MM,C1725,HCPCS,,79011376,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP2515X NC BALLOON 2.5X15MM,C1725,HCPCS,,79011377,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP2520X NC BALLOON 2.5X20MM,C1725,HCPCS,,79011378,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP27506X NC BALLOON 2.75X6,C1725,HCPCS,,79011379,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP27508X NC BALLOON 2.75X8,C1725,HCPCS,,79011380,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP27512X NC BALLOON 2.75X12,C1725,HCPCS,,79011381,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP27515X NC BALLOON 2.75X15,C1725,HCPCS,,79011382,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP27520X NC BALLOON 2.75X20,C1725,HCPCS,,79011383,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP3006X NC BALLOON 3X6MM,C1725,HCPCS,,79011384,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP3008X NC BALLOON 3X8MM,C1725,HCPCS,,79011385,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP3012X NC BALLOON 3X12MM,C1725,HCPCS,,79011386,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP3015X NC BALLOON 3X15MM,C1725,HCPCS,,79011387,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP3020X NC BALLOON 3X20MM,C1725,HCPCS,,79011388,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP32506X NC BALLOON 3.25X6,C1725,HCPCS,,79011389,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP32508X NC BALLOON 3.25X8,C1725,HCPCS,,79011390,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP32512X NC BALLOON 3.25X12,C1725,HCPCS,,79011391,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP32515X NC BALLOON 3.25X15,C1725,HCPCS,,79011392,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP32520X NC BALLOON 3.25X20,C1725,HCPCS,,79011393,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP3506X NC BALLOON 3.5X6MM,C1725,HCPCS,,79011394,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP3508X NC BALLOON 3.5X8MM,C1725,HCPCS,,79011395,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP3512X NC BALLOON 3.5X12MM,C1725,HCPCS,,79011396,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP3515X NC BALLOON 3.5X15MM,C1725,HCPCS,,79011397,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP3520X NC BALLOON 3.5X20MM,C1725,HCPCS,,79011398,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP37506X NC BALLOON 3.75X6,C1725,HCPCS,,79011399,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP37508X NC BALLOON 3.75X8,C1725,HCPCS,,79011400,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP37512X NC BALLOON 3.75X12,C1725,HCPCS,,79011401,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP37515X NC BALLOON 3.75X15,C1725,HCPCS,,79011402,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP37520X NC BALLOON 3.75X20,C1725,HCPCS,,79011403,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP4006X NC BALLOON 4X6MM,C1725,HCPCS,,79011404,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP4008X NC BALLOON 4X8MM,C1725,HCPCS,,79011405,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP4012X NC BALLOON 4X12MM,C1725,HCPCS,,79011406,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP4015X NC BALLOON 4X15MM,C1725,HCPCS,,79011407,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP4020X NC BALLOON 4X20MM,C1725,HCPCS,,79011408,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP4508X NC BALLOON 4.5X8MM,C1725,HCPCS,,79011409,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP4512X NC BALLOON 4.5X12MM,C1725,HCPCS,,79011410,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP4515X NC BALLOON 4.5X15MM,C1725,HCPCS,,79011411,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP5008X NC BALLOON 5X8MM,C1725,HCPCS,,79011412,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP5012X NC BALLOON 5X12MM,C1725,HCPCS,,79011413,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
MEDTRONIC NCEUP5015X NC BALLOON 5X15MM,C1725,HCPCS,,79011414,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
BOSTON SCI H7493918908150 BALLOON 1.5X8,C1725,HCPCS,,79011484,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918908200 BALLOON 2X8MM,C1725,HCPCS,,79011485,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918908220 BALLOON 2.25X8,C1725,HCPCS,,79011486,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918908250 BALLOON 2.5X8,C1725,HCPCS,,79011487,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918908270 BALLOON 2.75X8,C1725,HCPCS,,79011488,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918908300 BALLOON 3X8MM,C1725,HCPCS,,79011489,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918908350 BALLOON 3.5X8,C1725,HCPCS,,79011497,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918908400 BALLOON 4X8MM,C1725,HCPCS,,79011498,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918908120 BALLOON 1.2X8,C1725,HCPCS,,79011499,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918912150 BALLOON 1.5X12,C1725,HCPCS,,79011500,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918912200 BALLOON 2X12MM,C1725,HCPCS,,79011501,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493918912220 BALLOON 2.25X12,C1725,HCPCS,,79011502,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918912250 BALLOON 2.5X12,C1725,HCPCS,,79011503,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493918912270 BALLOON 2.75X12,C1725,HCPCS,,79011504,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918912300 BALLOON 3X12MM,C1725,HCPCS,,79011505,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918912350 BALLOON 3.5X12,C1725,HCPCS,,79011506,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918912120 BALLOON 1.2X12,C1725,HCPCS,,79011507,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918912400 BALLOON 4X12MM,C1725,HCPCS,,79011508,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918915200 BALLOON 2X15MM,C1725,HCPCS,,79011509,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493918915220 BALLOON 2.25X15,C1725,HCPCS,,79011510,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918915250 BALLOON 2.5X15,C1725,HCPCS,,79011511,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493918915270 BALLOON 2.75X15,C1725,HCPCS,,79011512,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918915300 BALLOON 3X15MM,C1725,HCPCS,,79011513,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918915350 BALLOON 3.5X15,C1725,HCPCS,,79011514,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918915400 BALLOON 4X15MM,C1725,HCPCS,,79011515,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918920200 BALLOON 2X20MM,C1725,HCPCS,,79011516,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493918920220 BALLOON 2.25X20,C1725,HCPCS,,79011517,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918920250 BALLOON 2.5X20,C1725,HCPCS,,79011518,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON H7493918920270 BALLOON 2.75X20MM,C1725,HCPCS,,79011519,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918920300 BALLOON 3X20MM,C1725,HCPCS,,79011520,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918920350 BALLOON 3.5X20,C1725,HCPCS,,79011521,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493918920400 BALOON 4X20MM,C1725,HCPCS,,79011522,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493919012150 BALLOON 1.5X12,C1725,HCPCS,,79011523,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493919012120 BALOON 1.2X12,C1725,HCPCS,,79011524,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926706200 BALLOON 2X6MM,C1725,HCPCS,,79011525,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926706220 BALLOON 2.25X6,C1725,HCPCS,,79011526,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926706250 BALLOON 2.5X6,C1725,HCPCS,,79011527,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926706270 BALLOON 2.75X6,C1725,HCPCS,,79011528,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926706300 BALLOON 3X6MM,C1725,HCPCS,,79011529,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926706320 BALLOON 3.25X6,C1725,HCPCS,,79011530,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926706350 BALLOON 3.5X6,C1725,HCPCS,,79011531,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926706370 BALLOON 3.75X6,C1725,HCPCS,,79011532,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926706400 BALLOON 4X6MM,C1725,HCPCS,,79011533,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926706450 BALLOON 4.5X6,C1725,HCPCS,,79011534,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708200 BALLOON 2X8MM,C1725,HCPCS,,79011535,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708220 BALLOON 2.25X8,C1725,HCPCS,,79011536,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708250 BALLOON 2.5X8,C1725,HCPCS,,79011537,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708270 BALLOON 2.75X8,C1725,HCPCS,,79011538,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708300 BALLOON 3X8MM,C1725,HCPCS,,79011539,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708320 BALLOON 3.25X8,C1725,HCPCS,,79011540,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708350 BALLOON 3.5X8,C1725,HCPCS,,79011541,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708370 BALLOON 3.75X8,C1725,HCPCS,,79011542,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708400 BALLOON 4X8MM,C1725,HCPCS,,79011543,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708450 BALLOON 4.5X8,C1725,HCPCS,,79011544,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708500 BALLOON 5X8MM,C1725,HCPCS,,79011545,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926708550 BALLOON 5.5X8,C1725,HCPCS,,79011546,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926712200 BALLOON 2X12MM,C1725,HCPCS,,79011547,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926712220 BALLOON 2.25X1,C1725,HCPCS,,79011548,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926712250 BALLOON 2.5X12,C1725,HCPCS,,79011549,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926712270 BALLOON 2.75X1,C1725,HCPCS,,79011550,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926712300 BALLOON 3X12MM,C1725,HCPCS,,79011551,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493926712320 BALLOON 3.25X12,C1725,HCPCS,,79011552,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926712350 BALLOON 3.5X12,C1725,HCPCS,,79011553,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493926712370 BALLOON 3.75X12,C1725,HCPCS,,79011554,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926712400 BALLOON 4X12MM,C1725,HCPCS,,79011555,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926712450 BALLOON 4.5X12,C1725,HCPCS,,79011556,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926712500 BALLOON 5X12MM,C1725,HCPCS,,79011557,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926712550 BALLOON 5.5X12,C1725,HCPCS,,79011558,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926715200 BALLOON 2X15MM,C1725,HCPCS,,79011559,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493926715220 BALLOON 2.25X15,C1725,HCPCS,,79011560,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926715250 BALLOON 2.5X15,C1725,HCPCS,,79011561,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926715300 BALLOON 3X15MM,C1725,HCPCS,,79011562,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493926715320 BALLOON 3.25X15,C1725,HCPCS,,79011563,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926715350 BALLOON 3.5X15,C1725,HCPCS,,79011564,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493926715370 BALLOON 3.75X15,C1725,HCPCS,,79011565,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926715400 BALLOON 4X15MM,C1725,HCPCS,,79011566,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926715450 BALLOON 4.5X15,C1725,HCPCS,,79011568,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926720200 BALLOON 2X20MM,C1725,HCPCS,,79011569,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493926720220 BALLOON 2.25X20,C1725,HCPCS,,79011570,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926720250 BALLOON 2.5X20,C1725,HCPCS,,79011571,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493926720270 BALLOON 2.75X20,C1725,HCPCS,,79011572,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926720300 BALLOON 3X20MM,C1725,HCPCS,,79011573,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493926720320 BALLOON 3.25X20,C1725,HCPCS,,79011574,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926720350 BALLOON 3.5X20,C1725,HCPCS,,79011575,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SC H7493926720370 BALLOON 3.75X20,C1725,HCPCS,,79011576,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926720400 BALLOON 4X20MM,C1725,HCPCS,,79011577,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H7493926720450 BALLOON 4.5X20,C1725,HCPCS,,79011578,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOSTON SCI H74939401062500 BALLOON 2.5X6,C1725,HCPCS,,79011579,CDM,272,RC,,,both,,,2850,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1995,70,,1995,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1995,
BOSTON SCI H74939401063000 BALLOON 3X6MM,C1725,HCPCS,,79011580,CDM,272,RC,,,both,,,2850,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1995,70,,1995,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1995,
BOSTON SCI H74939401063500 BALLOON 3.5X6,C1725,HCPCS,,79011581,CDM,272,RC,,,both,,,2850,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1995,70,,1995,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1995,
BOSTON SCI H74939401064000 BALLOON 4X6MM,C1725,HCPCS,,79011582,CDM,272,RC,,,both,,,2850,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1995,70,,1995,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1995,
BOSTON SC H74939401102500 BALLOON 2.5X10,C1725,HCPCS,,79011583,CDM,272,RC,,,both,,,2850,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1995,70,,1995,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1995,
BOSTON SCI H74939401103000 BALLOON 3X10,C1725,HCPCS,,79011584,CDM,272,RC,,,both,,,2850,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1995,70,,1995,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1995,
BOSTON SC H74939401103500 BALLOON 3.5X10,C1725,HCPCS,,79011585,CDM,272,RC,,,both,,,2850,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1995,70,,1995,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1995,
BOSTOB SCI H74939401104000 BALLOON 4X10,C1725,HCPCS,,79011586,CDM,272,RC,,,both,,,2850,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1995,70,,1995,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1995,
BOST 3917106067 6X60X75 MUSTANG BALLOON,C1725,HCPCS,,79011862,CDM,272,RC,,,both,,,401,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,280.7,70,,280.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280.7,
BOST 3917107067 7X60X75 MUSTANG BALLOON,C1725,HCPCS,,79011863,CDM,272,RC,,,both,,,401,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,280.7,70,,280.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280.7,
BOST 3917106041 6X40X135 MUSTANG BALLOON,C1725,HCPCS,,79011864,CDM,272,RC,,,both,,,401,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,280.7,70,,280.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280.7,
BOST 3917107041 7X40X135 MUSTANG BALLOON,C1725,HCPCS,,79011865,CDM,272,RC,,,both,,,401,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,280.7,70,,280.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280.7,
BOST 3913520401 2X40X150 COYOTE BALLOON,C1725,HCPCS,,79011866,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 3918520081 2X80X150 COYOTE BALLOON,C1725,HCPCS,,79011867,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 3918525101 2.5X100X150 COY BALLOON,C1725,HCPCS,,79011868,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 3913530401 3X40X150 COYOTE BALLOON,C1725,HCPCS,,79011869,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 3918530081 3X80X150 COYOTE BALLOON,C1725,HCPCS,,79011870,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST H74939171070870 7X80X75 MUS BALLOON,C1725,HCPCS,,79011902,CDM,272,RC,,,both,,,401,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,280.7,70,,280.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280.7,
BOST 39135-20201 COYOTE 2X20X143 BALLOON,C1725,HCPCS,,79012300,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39135-25201 COY 2.5X20X143 BALLOON,C1725,HCPCS,,79012301,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39185-25081 COY 2.5X80X150 BALLOON,C1725,HCPCS,,79012302,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39185-25151 COY 2.5X150X150 BALLOON,C1725,HCPCS,,79012304,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39135-30201 COYOTE 3X20X144 BALLOON,C1725,HCPCS,,79012305,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39185-30121 COY 3X120X150 BALLOON,C1725,HCPCS,,79012306,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39135-35201 COY 3.5X20X144 BALLOON,C1725,HCPCS,,79012307,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39185-35121 COY 3.5X120X150 BALLOON,C1725,HCPCS,,79012308,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39135-40201 COYOTE 4X20X144 BALLOON,C1725,HCPCS,,79012309,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39135-40401 COYOTE 4X40X146 BALLOON,C1725,HCPCS,,79012310,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39185-40081 COYOTE 4X80X150 BALLOON,C1725,HCPCS,,79012311,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39185-40151 COY 4X150X150 BALLOON,C1725,HCPCS,,79012312,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST 39185-40221 COY 4X220X150 BALLOON,C1725,HCPCS,,79012313,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST H74939347040470 ATHLETIS 4X40X75CM,C1725,HCPCS,,79012318,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347040670 ATHLETIS 4X60X75CM,C1725,HCPCS,,79012319,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347040870 ATHLETIS 4X80X75CM,C1725,HCPCS,,79012320,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347041070 ATHLETIS 4X100X75CM,C1725,HCPCS,,79012321,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347050470 ATHLETIS 5X40X75CM,C1725,HCPCS,,79012322,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347050670 ATHLETIS 5X60X75CM,C1725,HCPCS,,79012323,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347050870 ATHLETIS 5X80X75CM,C1725,HCPCS,,79012324,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939374051070 ATHLETIS 5X100X75CM,C1725,HCPCS,,79012325,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347060470 ATHLETIS 6X40X75CM,C1725,HCPCS,,79012326,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347060670 ATHLETIS 6X60X75CM,C1725,HCPCS,,79012327,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347060870 ATHLETIS 6X80X75CM,C1725,HCPCS,,79012328,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347061070 ATHLETIS 6X100X75CM,C1725,HCPCS,,79012329,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347070470 ATHLETIS 7X40X75CM,C1725,HCPCS,,79012330,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347070670 ATHLETIS 7X60X75CM,C1725,HCPCS,,79012331,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347070870 ATHLETIS 7X80X75CM,C1725,HCPCS,,79012332,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347071070 ATHLETIS 7X100X75CM,C1725,HCPCS,,79012333,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347080470 ATHLETIS 8X40X75CM,C1725,HCPCS,,79012334,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347080670 ATHLETIS 8X60X75CM,C1725,HCPCS,,79012335,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347080870 ATHLETIS 8X80X75CM,C1725,HCPCS,,79012336,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347081070 ATHLETIS 8X100X75CM,C1725,HCPCS,,79012337,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347090470 ATHLETIS 9X40X75CM,C1725,HCPCS,,79012338,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347090870 ATHLETIS 9X80X75CM,C1725,HCPCS,,79012339,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347100470 ATHLETIS 10X40X75CM,C1725,HCPCS,,79012340,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347100870 ATHLETIS 10X80X75CM,C1725,HCPCS,,79012341,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347120470 ATHLETIS 12X40X75CM,C1725,HCPCS,,79012342,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
BOST H74939347120670 ATHLETIS 12X60X75CM,C1725,HCPCS,,79012343,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
COOK G56552 CXI .018X150CM SUPPORT CATH,C1725,HCPCS,,79012398,CDM,272,RC,,,both,,,548,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,383.6,70,,383.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.6,
BOST 39147-35121 3.5X120X150 SL BALLOON,C1725,HCPCS,,79012671,CDM,272,RC,,,both,,,435,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,304.5,70,,304.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,304.5,
MEDTRONIC IAV08004008P 7X40X80CM BALLOON,C1725,HCPCS,,79013159,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
SHOCKWARE S4IVL2540 2.5MMX40MM S4,C1725,HCPCS,,79013301,CDM,272,RC,,,both,,,8250,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5775,70,,5775,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5775,
SHOCKWARE S4IVL3040 3MMX40MM S4,C1725,HCPCS,,79013302,CDM,272,RC,,,both,,,8250,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5775,70,,5775,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5775,
SHOCKWARE S4IVL3540 3.5MMX40MM S4,C1725,HCPCS,,79013303,CDM,272,RC,,,both,,,8250,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5775,70,,5775,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5775,
SHOCKWARE S4IVL4040 4X40 SHOCKWARE S4,C1725,HCPCS,,79013304,CDM,272,RC,,,both,,,8250,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5775,70,,5775,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5775,
SHOCKWARE M5PIVL3560 3.5MMX60MM M5+,C1725,HCPCS,,79013305,CDM,272,RC,,,both,,,10350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7245,70,,7245,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7245,
SHOCKWARE M5PIVL4060 4MMX60MM M5+,C1725,HCPCS,,79013306,CDM,272,RC,,,both,,,10350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7245,70,,7245,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7245,
SHOCKWARE M5PIVL4560 4.5MMX60MM M5+,C1725,HCPCS,,79013307,CDM,272,RC,,,both,,,10350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7245,70,,7245,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7245,
SHOCKWARE M5PIVL5060 5MMX60MM M5+,C1725,HCPCS,,79013308,CDM,272,RC,,,both,,,10350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7245,70,,7245,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7245,
SHOCKWARE M5PIVL5560 5.5MMX60MM M5+,C1725,HCPCS,,79013309,CDM,272,RC,,,both,,,10350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7245,70,,7245,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7245,
SHOCKWARE M5PIVL6060 6MMX60MM M5+,C1725,HCPCS,,79013310,CDM,272,RC,,,both,,,10350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7245,70,,7245,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7245,
SHOCKWARE M5PIVL6560 6.5MMX60MM M5+,C1725,HCPCS,,79013311,CDM,272,RC,,,both,,,10350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7245,70,,7245,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7245,
SHOCKWARE M5PIVL7060 7X60 SHOCKWARE M5+,C1725,HCPCS,,79013312,CDM,272,RC,,,both,,,10350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7245,70,,7245,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7245,
SHOCKWARE M5PIVL8060 8X60 SHOCKWARE M5+,C1725,HCPCS,,79013313,CDM,272,RC,,,both,,,10350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7245,70,,7245,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7245,
BECTON ATG80126 12X6X80CM PTA BALLOON,C1725,HCPCS,,79013652,CDM,272,RC,,,both,,,975,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,682.5,70,,682.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,682.5,
BECTON ATG80146 14X6X80 PTA BALLOON,C1725,HCPCS,,79013653,CDM,272,RC,,,both,,,975,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,682.5,70,,682.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,682.5,
BECTON ATG80166 16X6X80CM PTA BALLOON,C1725,HCPCS,,79013654,CDM,272,RC,,,both,,,975,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,682.5,70,,682.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,682.5,
SHOCKWAVE L6IVL090030 9MMX30MM L6,C1725,HCPCS,,79013678,CDM,272,RC,,,both,,,10350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7245,70,,7245,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7245,
BOST H74939185401210 4X120X150CM BALLOON,C1725,HCPCS,,79013973,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
BOST H74939185202210 2X220X150 BALLOON,C1725,HCPCS,,79013974,CDM,272,RC,,,both,,,567,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,396.9,70,,396.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.9,
LABORIE OPTBDL7003B BALLOON 24FRX5CM,C1726,HCPCS,,79012775,CDM,272,RC,,,both,,,6285,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4399.5,70,,4399.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4399.5,
BOST SCI 27-182 REG NEPHROSTOMY CATH,C1729,HCPCS,,79000078,CDM,272,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
BOST SCI 27-192 8FR APD KIT NON TEMPTIP,C1729,HCPCS,,79000234,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
BOST SCI 28-260 BILIARY CATH 8FR FLEXIMA,C1729,HCPCS,,79000284,CDM,272,RC,,,both,,,330,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,231,70,,231,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231,
BOST SCI 28-129 CATHETER DRAINAGE 8FR,C1729,HCPCS,,79000299,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
BOST SCI 27-165 CATH FLEXIMA BILIARY 8FR,C1729,HCPCS,,79000300,CDM,272,RC,,,both,,,534,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,373.8,70,,373.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,373.8,
BOST SCI 28-179 CATH NEPHRO 8FR FLEXIMA,C1729,HCPCS,,79000301,CDM,272,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.3,
BOST SCI 28-180 FLEXIMA 10FR,C1729,HCPCS,,79000361,CDM,272,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.3,
BOST SCI 27-180 10FRX25CM NEPHRO CATH,C1729,HCPCS,,79000362,CDM,272,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
BOST SCI 27-135 10FRX25CM FLEXIMA,C1729,HCPCS,,79000363,CDM,272,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
BOST SCI 27-134 8FRX25CM FLEXIMA,C1729,HCPCS,,79000364,CDM,272,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
BOST SCI 27-181 12FRX25CM NEPHRO CATH,C1729,HCPCS,,79000430,CDM,272,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
BOST SCI 27-179 NEPHROSTOMY CATH 8FR25CM,C1729,HCPCS,,79000562,CDM,272,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
BOST SCI 27-179 CATHETER NEPHROSTOMY 8FR,C1729,HCPCS,,79000823,CDM,272,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.2,70,,165.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
BOST SCI 27-127 8FR FLEXIMA CATHETER SET,C1729,HCPCS,,79003121,CDM,272,RC,,,both,,,292,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,204.4,70,,204.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204.4,
BOST SCI 27-260 8FRX35CM FLEXIMA CATH,C1729,HCPCS,,79003122,CDM,272,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.3,
BOST SCI 27-261 10FRX35CM FLEXIMA CATH,C1729,HCPCS,,79003123,CDM,272,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.3,
BOST SCI 22-137 8FRX24CM NEPHRRTRL STENT,C1729,HCPCS,,79003124,CDM,272,RC,,,both,,,310,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,217,70,,217,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,217,
CSI PAGH18M371 ASTATO 30 GUIDEWIRE,C1729,HCPCS,,79003126,CDM,272,RC,,,both,,,2550,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1785,70,,1785,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1785,
COOK G56888 DUAN PIGTAIL DRAINAGE CATH,C1729,HCPCS,,79008134,CDM,272,RC,,,both,,,166,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,116.2,70,,116.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,116.2,
MERIT OSC-5F-17PL 5FRX17CM CENTESIS CATH,C1729,HCPCS,,79008832,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MERIT PC101 6FR PERICARDIOCENTESIS CATH,C1729,HCPCS,,79012573,CDM,272,RC,,,both,,,285,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,199.5,70,,199.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.5,
MEDTRONIC 043325M MARINR EP CATHETER 6FR,C1730,HCPCS,,79002656,CDM,272,RC,,,both,,,1650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1155,70,,1155,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1155,
BOS SCI M0067913500 DISPOSAL URETERSCOPE,C1747,HCPCS,,79010548,CDM,272,RC,,,both,,,4500,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3150,70,,3150,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3150,
EDWARDS 777F8 8FR CCO SWAN-GANZ CATHETER,C1751,HCPCS,,79011737,CDM,272,RC,,,both,,,774,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,541.8,70,,541.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,541.8,
PHILIPS 85900PST EAGLE EYE CATHETER,C1753,HCPCS,,79011496,CDM,272,RC,,,both,,,2175,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1522.5,70,,1522.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1522.5,
PHILIPS IGT 89900 REFINITY ST IVUS CATH,C1753,HCPCS,,79013703,CDM,272,RC,,,both,,,2025,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1417.5,70,,1417.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1417.5,
EDWARDS 12TLW403F FOGARTY 3FR X 40CM,C1757,HCPCS,,79000370,CDM,272,RC,,,both,,,253,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,177.1,70,,177.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.1,
EDWARDS 12TLW803F FOGARTY 3FR X 80CM,C1757,HCPCS,,79000371,CDM,272,RC,,,both,,,253,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,177.1,70,,177.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.1,
EDWARDS 12TLW404F FOGARTY 4FR X 40CM,C1757,HCPCS,,79000372,CDM,272,RC,,,both,,,253,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,177.1,70,,177.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.1,
EDWARDS 12TLW405F35 FOGARTY 5.5FRX40CM,C1757,HCPCS,,79000373,CDM,272,RC,,,both,,,271,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.7,70,,189.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.7,
EDWARDS 12TLW805F35 FOGARTY 80CM BALLOON,C1757,HCPCS,,79000374,CDM,272,RC,,,both,,,260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182,70,,182,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182,
COVIDIEN BVT8-080-30 TRELLIS INF SYS,C1757,HCPCS,,79000549,CDM,272,RC,,,both,,,6286,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4400.2,70,,4400.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4400.2,
EDWARDS 120602F FOGARTY CATH EMBOL 2FR,C1757,HCPCS,,79000607,CDM,272,RC,,,both,,,230,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,161,70,,161,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,161,
EDWARDS 120803F FOGARTY CATH EMBOL 3FR,C1757,HCPCS,,79000608,CDM,272,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,105,70,,105,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105,
EDWARDS 120804F FOGARTY CATH EMBOL 4FR,C1757,HCPCS,,79000609,CDM,272,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,105,70,,105,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105,
EDWARDS 120805F FOGARTY CATH EMBOL 5FR,C1757,HCPCS,,79000610,CDM,272,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,105,70,,105,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105,
EDWARDS 120806F FOGARTY CATH EMBOL 6FR,C1757,HCPCS,,79000611,CDM,272,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,105,70,,105,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105,
EDWARDS 220804F FOG CATH EMBOL IRRIG 4FR,C1757,HCPCS,,79000612,CDM,272,RC,,,both,,,66,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,46.2,70,,46.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.2,
EDWARDS 220806F FOG CATH EMBOL IRRIG 6FR,C1757,HCPCS,,79000613,CDM,272,RC,,,both,,,67,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,46.9,70,,46.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.9,
EDWARDS 120804F CATHETER EMBOLECTOMY 4FR,C1757,HCPCS,,79000801,CDM,272,RC,,,both,,,154,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,107.8,70,,107.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.8,
EDWARDS 120805F CATHETER EMBOLECTOMY 5FR,C1757,HCPCS,,79000802,CDM,272,RC,,,both,,,154,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,107.8,70,,107.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.8,
EDWARDS 120802F CATHETER EMBOLECTOMY 2FR,C1757,HCPCS,,79000817,CDM,272,RC,,,both,,,234,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,163.8,70,,163.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.8,
EDWARDS 120803F CATHETER EMBOLECTOMY 3FR,C1757,HCPCS,,79000818,CDM,272,RC,,,both,,,154,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,107.8,70,,107.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.8,
EDWARDS 120806F CATHETER EMBOLECTOMY 6FR,C1757,HCPCS,,79000819,CDM,272,RC,,,both,,,154,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,107.8,70,,107.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.8,
EDWARDS 220804F-R FOGARTY CATHETER 4FR,C1757,HCPCS,,79000900,CDM,272,RC,,,both,,,67,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,46.9,70,,46.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.9,
EDWARDS 220806F-R FOGARTY CATHETER 6FR,C1757,HCPCS,,79000901,CDM,272,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,49,70,,49,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,49,
EDWARDS 220806FR FOGARTY CATHETER 6FR,C1757,HCPCS,,79000902,CDM,272,RC,,,both,,,71,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,49.7,70,,49.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,49.7,
EDWARDS 120602F FOGARTY CATH EMBOL 2FR,C1757,HCPCS,,79000903,CDM,272,RC,,,both,,,234,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,163.8,70,,163.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.8,
EDWARDS 2202310F FOGARTY IRRIG CATH 10FR,C1757,HCPCS,,79000905,CDM,272,RC,,,both,,,64,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,44.8,70,,44.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,44.8,
VASCULAR SLNS 4005 5.5 FR EXT CATHETER,C1757,HCPCS,,79003127,CDM,272,RC,,,both,,,886,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,620.2,70,,620.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,620.2,
ARGON MED 700009 THROMBECTOMY SYS 65CM,C1757,HCPCS,,79003128,CDM,272,RC,,,both,,,1786,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1250.2,70,,1250.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1250.2,
ARROW W01801 EMBOLECTOMY CATH 80CM,C1757,HCPCS,,79003129,CDM,272,RC,,,both,,,222,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,155.4,70,,155.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,155.4,
EXPORTAP MEDTRONIC 6FR ASPIR CATH 140CM,C1757,HCPCS,,79003130,CDM,272,RC,,,both,,,1710,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1197,70,,1197,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1197,
EV3 BVT6 080 30 TRELLIS INF SYS 6FR,C1757,HCPCS,,79005799,CDM,272,RC,,,both,,,6466,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4526.2,70,,4526.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4526.2,
EV3 BVT808015 TRELLIS INFSN 8FRX15X80CM,C1757,HCPCS,,79005821,CDM,272,RC,,,both,,,6286,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4400.2,70,,4400.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4400.2,
ARGON MED 700115 7FR X135CM CLEANER 15,C1757,HCPCS,,79007356,CDM,272,RC,,,both,,,2986,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2090.2,70,,2090.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2090.2,
MEDTRONIC SFR4-4-20 SOLITAIRE 4X20-10,C1757,HCPCS,,79013868,CDM,272,RC,,,both,,,17985,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12589.5,70,,12589.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12589.5,
MEDTRONIC SFR4-40-10 SOLITAIRE X 4X40,C1757,HCPCS,,79013869,CDM,272,RC,,,both,,,17985,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12589.5,70,,12589.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12589.5,
MEDTRONIC SFR4-6-40-10 SOLITAIRE X 6X40,C1757,HCPCS,,79013870,CDM,272,RC,,,both,,,17985,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12589.5,70,,12589.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12589.5,
MEDTRONIC SFR4-3-40-40 SOLITAIRE X 3X40,C1757,HCPCS,,79013871,CDM,272,RC,,,both,,,17985,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12589.5,70,,12589.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12589.5,
MEDTRONIC SFR4-3-20-10 SOLITAIRE X 3X20,C1757,HCPCS,,79013872,CDM,272,RC,,,both,,,17985,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12589.5,70,,12589.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12589.5,
J&J 6FR EXOSEAL CLOSURE DEVICE,C1760,HCPCS,,79000172,CDM,272,RC,,,both,,,570,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,399,70,,399,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,399,
ANGIO SEAL,C1760,HCPCS,,79000266,CDM,272,RC,,,both,,,825,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,577.5,70,,577.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,577.5,
ANGIOSEAL VIP 6FR,C1760,HCPCS,,79000267,CDM,272,RC,,,both,,,711,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,497.7,70,,497.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,497.7,
ACCESS MX5021 MYNX CLOSURE DEVICE 5FR,C1760,HCPCS,,79000427,CDM,272,RC,,,both,,,672,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,470.4,70,,470.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,470.4,
ACCESS MX6721 MYNX CLOSURE DEVICE 6FR,C1760,HCPCS,,79000428,CDM,272,RC,,,both,,,672,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,470.4,70,,470.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,470.4,
J&J MCL20 LIGACLIP MULTIPLE CLIP LARGE,C1760,HCPCS,,79001573,CDM,272,RC,,,both,,,189,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,132.3,70,,132.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.3,
J&J MCM20 LIGACLIP MULTIPLE CLIP MEDIUM,C1760,HCPCS,,79001574,CDM,272,RC,,,both,,,164,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,114.8,70,,114.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,114.8,
SUT EXP MCS20 LIGACLIP MULTIPLE CLIP SM,C1760,HCPCS,,79001575,CDM,272,RC,,,both,,,191,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,133.7,70,,133.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.7,
SUTURE EXPRESS EL21L LIGALOOP SURGITIE,C1760,HCPCS,,79001576,CDM,272,RC,,,both,,,123,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,86.1,70,,86.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.1,
SUT EXP LF4200 LIGASURE IMPACT 18CM,C1760,HCPCS,,79001577,CDM,272,RC,,,both,,,2260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1582,70,,1582,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1582,
SUTURE EXPRESS LS1500 LIGASURE 5MM,C1760,HCPCS,,79001578,CDM,272,RC,,,both,,,1575,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1102.5,70,,1102.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1102.5,
SUT EXP LS1037 LIGASURE ATLAS LAP,C1760,HCPCS,,79001579,CDM,272,RC,,,both,,,1500,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1050,70,,1050,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1050,
LIGASURE SHORT HANDLE 20CM SHORT,C1760,HCPCS,,79001580,CDM,272,RC,,,both,,,1457,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1019.9,70,,1019.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1019.9,
ST JUDE 610119 ANGIOSEAL 6FR CLOSURE DEV,C1760,HCPCS,,79002691,CDM,272,RC,,,both,,,870,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,609,70,,609,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,609,
J&J EX500 5FR EXOSEAL CLOSURE DEVICE,C1760,HCPCS,,79003131,CDM,272,RC,,,both,,,5700,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3990,70,,3990,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3990,
STRYKER LF4200 LIGASURE  IMPACT 18CM RR,C1760,HCPCS,,79005058,CDM,272,RC,,,both,,,1298,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,908.6,70,,908.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,908.6,
WEST COAST CTI-512N-W CLOSURE DEVICE,C1760,HCPCS,,79011002,CDM,272,RC,,,both,,,237,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.9,70,,165.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.9,
ABBOTT 12773-03 PERCLOSE PROSTYLE,C1760,HCPCS,,79011968,CDM,272,RC,,,both,,,750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,525,70,,525,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,525,
BIOTRONIK 398493 BIOMONITOR 2-AF,C1764,HCPCS,,79009859,CDM,272,RC,,,both,,,12600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8820,70,,8820,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8820,
BIOTRONIK 450218 BIOMONITOR IIIM,C1764,HCPCS,,79011057,CDM,272,RC,,,both,,,12600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8820,70,,8820,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8820,
COOK THSF-38-80-AES AMPLATZ COATD XSTIFF,C1769,HCPCS,,79000034,CDM,272,RC,,,both,,,62,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,43.4,70,,43.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.4,
LUNDERQUIST WIREGUIDE TSMG-35-145-7-LES2,C1769,HCPCS,,79000049,CDM,272,RC,,,both,,,214,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,149.8,70,,149.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,149.8,
TERUMO GR3508 .035X180CM ANGLD GLIDEWIRE,C1769,HCPCS,,79000054,CDM,272,RC,,,both,,,124,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,86.8,70,,86.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.8,
AMPLATZ SUPER STIFF 75CM,C1769,HCPCS,,79000262,CDM,272,RC,,,both,,,94,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,65.8,70,,65.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,65.8,
BOST SCI 46-524 .035X145CM AMPLATZ WIRE,C1769,HCPCS,,79000263,CDM,272,RC,,,both,,,499,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,349.3,70,,349.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,349.3,
COOK THSF35180AESBH AMPLATZ WIRE,C1769,HCPCS,,79000264,CDM,272,RC,,,both,,,101,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70.7,70,,70.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70.7,
BOST SCI 46-509 AMPLATZ X-CHANGE,C1769,HCPCS,,79000265,CDM,272,RC,,,both,,,773,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,541.1,70,,541.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,541.1,
COOK G01431 .035X180 COOK BENTSON WIRE,C1769,HCPCS,,79000281,CDM,272,RC,,,both,,,85,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,59.5,70,,59.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,59.5,
BOST SCI BENTSON WIRE .035X180CM,C1769,HCPCS,,79000282,CDM,272,RC,,,both,,,47,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,32.9,70,,32.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.9,
BOST SCI 46-848 CONTROL WIRE 110CM V18,C1769,HCPCS,,79000322,CDM,272,RC,,,both,,,251,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,175.7,70,,175.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,175.7,
TERUMO GS3508 .035X180CM ANGLED GLIDE,C1769,HCPCS,,79000380,CDM,272,RC,,,both,,,145,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,101.5,70,,101.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,101.5,
TERUMO GR3501 GLIDE WIRE STRAIGHT,C1769,HCPCS,,79000381,CDM,272,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,322,
GLIDEWIRE STIFF STRAIGHT .035X180,C1769,HCPCS,,79000385,CDM,272,RC,,,both,,,145,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,101.5,70,,101.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,101.5,
COOK G09508 GRAD WIRES,C1769,HCPCS,,79000388,CDM,272,RC,,,both,,,234,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,163.8,70,,163.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.8,
TERUMO GRJ509 GUIDE WIRE,C1769,HCPCS,,79000389,CDM,272,RC,,,both,,,154,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,107.8,70,,107.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.8,
COOK G03290 GUIDEWIRE AMPLATZ XTRA STIFF,C1769,HCPCS,,79000390,CDM,272,RC,,,both,,,108,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,75.6,70,,75.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,75.6,
COOK G04048 .035X80CM AMPLATZ WIRE COOK,C1769,HCPCS,,79000391,CDM,272,RC,,,both,,,62,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,43.4,70,,43.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.4,
COOK G09956 GUIDEWIRE AMPLATZ STIFF,C1769,HCPCS,,79000392,CDM,272,RC,,,both,,,112,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,78.4,70,,78.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78.4,
COOK G03562 .035X260CM AMPLATZ XTRA STFF,C1769,HCPCS,,79000393,CDM,272,RC,,,both,,,77,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,53.9,70,,53.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.9,
BOST SCI 46-852 GUIDEWIRE V-18 .018X200,C1769,HCPCS,,79000394,CDM,272,RC,,,both,,,264,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.8,70,,184.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,184.8,
GUIDEWIRE VASC .018X260 LG TAPER 8CMTIP,C1769,HCPCS,,79000395,CDM,272,RC,,,both,,,275,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,192.5,70,,192.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192.5,
GUIDEWIRE XS .014 X 180CM,C1769,HCPCS,,79000396,CDM,272,RC,,,both,,,538,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,376.6,70,,376.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,376.6,
H20 WIRES .018 X 260CM,C1769,HCPCS,,79000397,CDM,272,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,105,70,,105,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105,
BOST SCI 39-128 JOURNEY WIRE .014X300CM,C1769,HCPCS,,79000404,CDM,272,RC,,,both,,,614,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,429.8,70,,429.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.8,
COOK G11953 LUNDERQUIST WIRE GUIDE,C1769,HCPCS,,79000416,CDM,272,RC,,,both,,,214,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,149.8,70,,149.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,149.8,
COOK G31453 LUNDERQUIST X-STIFF .035X260,C1769,HCPCS,,79000417,CDM,272,RC,,,both,,,309,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,216.3,70,,216.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.3,
COOK G46729 LUNDERQUIST X-STIFF .035X180,C1769,HCPCS,,79000418,CDM,272,RC,,,both,,,204,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,142.8,70,,142.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142.8,
BOST SCI 46-592 MAGIC TORQUE 3.5X260CM,C1769,HCPCS,,79000419,CDM,272,RC,,,both,,,522,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.4,70,,365.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.4,
COOK G05183 MANDRIL WIRE,C1769,HCPCS,,79000420,CDM,272,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,49,70,,49,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,49,
ACCESS N181804 NITREX WIRE .018X180CM,C1769,HCPCS,,79000434,CDM,272,RC,,,both,,,229,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,160.3,70,,160.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,160.3,
NITREX WIRE .018X80CM,C1769,HCPCS,,79000435,CDM,272,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.5,70,,367.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,367.5,
PLATINUM PLUS .014 300CM,C1769,HCPCS,,79000448,CDM,272,RC,,,both,,,320,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,224,70,,224,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224,
PLATINUM PLUS .018x180CM,C1769,HCPCS,,79000449,CDM,272,RC,,,both,,,233,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,163.1,70,,163.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.1,
PLATINUM PLUS GUIDE WIRE .014X180CM,C1769,HCPCS,,79000450,CDM,272,RC,,,both,,,310,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,217,70,,217,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,217,
COOK G01428 ROSEN WIRE .035X180CM,C1769,HCPCS,,79000480,CDM,272,RC,,,both,,,40,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,28,70,,28,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28,
ABBOTT 1005202 SPARTA-CORE WIRE .014X180,C1769,HCPCS,,79000517,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
ABBOTT 1005203 SPARTA-CORE WIRE .014X300,C1769,HCPCS,,79000518,CDM,272,RC,,,both,,,360,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,252,70,,252,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 527-914 STABILIZER GUIDEWIRE,C1769,HCPCS,,79000520,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
STABILIZER WIRE .014 300CM,C1769,HCPCS,,79000521,CDM,272,RC,,,both,,,2626,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1838.2,70,,1838.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1838.2,
BOST SCI 49-297 THRUWAY WIRE .014 300CM,C1769,HCPCS,,79000543,CDM,272,RC,,,both,,,362,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,253.4,70,,253.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.4,
"CSI VPR-GW-14 VIPER WIRES W/0.014"" TIP",C1769,HCPCS,,79000555,CDM,272,RC,,,both,,,2550,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1785,70,,1785,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1785,
TERUMO GR1806 ANGLD GLIDEWIRE .018X180CM,C1769,HCPCS,,79000563,CDM,272,RC,,,both,,,167,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,116.9,70,,116.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,116.9,
TERUMO GR1802 STR GLIDEWIRE .018X130CM,C1769,HCPCS,,79000564,CDM,272,RC,,,both,,,167,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,116.9,70,,116.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,116.9,
BOST SCI 46-125B ANGLED GLIDEWIRE,C1769,HCPCS,,79000565,CDM,272,RC,,,both,,,130,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,91,70,,91,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,91,
TERUMO GR3509 ANGLED GLIDEWIRE .035X260,C1769,HCPCS,,79000566,CDM,272,RC,,,both,,,138,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,96.6,70,,96.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96.6,
TERUMO GS3509 ANGLD GLIDE STIFF .035X260,C1769,HCPCS,,79000567,CDM,272,RC,,,both,,,155,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,108.5,70,,108.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108.5,
STRYKER GR3504 STR GLIDEWIRE .035X260CM,C1769,HCPCS,,79000568,CDM,272,RC,,,both,,,190,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,133,70,,133,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133,
BOST SCI 46-523 AMPLATZ GUIDE .035X145CM,C1769,HCPCS,,79000569,CDM,272,RC,,,both,,,79,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,55.3,70,,55.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.3,
COOK THSCF351803AES AMPLATZ STIFF G03565,C1769,HCPCS,,79000570,CDM,272,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70,70,,70,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
COOK G08427 WIRE GUIDE COPE MONDIAL 60CM,C1769,HCPCS,,79000571,CDM,272,RC,,,both,,,101,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70.7,70,,70.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70.7,
BOST SCI 46-604 WIRE PLATINUM PLUS,C1769,HCPCS,,79000572,CDM,272,RC,,,both,,,233,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,163.1,70,,163.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.1,
STRYKER G07937 WIRE ROADRUNNER .035X180,C1769,HCPCS,,79000573,CDM,272,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,67.2,70,,67.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,67.2,
BOST SCI 46-854 WIRE V18 CONT .018X300CM,C1769,HCPCS,,79000574,CDM,272,RC,,,both,,,276,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,193.2,70,,193.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,193.2,
COOK G03330 AMPLATZ XTRA STIFF .035X180,C1769,HCPCS,,79000575,CDM,272,RC,,,both,,,62,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,43.4,70,,43.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.4,
ANGIODYNAMICS 5500501 NEWTON WIRE 150CM,C1769,HCPCS,,79000576,CDM,272,RC,,,both,,,36,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,25.2,70,,25.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,25.2,
ZIP WIRE .035 180CM ANGLED,C1769,HCPCS,,79000577,CDM,272,RC,,,both,,,125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,87.5,70,,87.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,87.5,
BOST SCI 46-517 AMPLATZ SUPER STIFF WIRE,C1769,HCPCS,,79000734,CDM,272,RC,,,both,,,79,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,55.3,70,,55.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.3,
BOST SCI 46-519 AMPLATZ SUPER STIFF WIRE,C1769,HCPCS,,79000735,CDM,272,RC,,,both,,,121,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84.7,70,,84.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84.7,
COOK G03330 AMPLATZ WIRE .035X180CM,C1769,HCPCS,,79000736,CDM,272,RC,,,both,,,62,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,43.4,70,,43.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.4,
BOST SCI 46-151 GLIDE WIRE ANGLE,C1769,HCPCS,,79000908,CDM,272,RC,,,both,,,114,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,79.8,70,,79.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,79.8,
GLIDE WIRES STR TIP 038 X 50CM,C1769,HCPCS,,79000909,CDM,272,RC,,,both,,,164,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,114.8,70,,114.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,114.8,
BOST SCI 630-201B ZIPWIRE STRAIGHT .025,C1769,HCPCS,,79000910,CDM,272,RC,,,both,,,113,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,79.1,70,,79.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,79.1,
BOST SCI 630-205B ZIPWIRE STRAIGHT .035,C1769,HCPCS,,79000911,CDM,272,RC,,,both,,,110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,77,70,,77,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,77,
BOST SCI 630-208B ZIPWIRE STRAIGHT .038,C1769,HCPCS,,79000912,CDM,272,RC,,,both,,,128,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,89.6,70,,89.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,89.6,
COOK GR1806RR GLIDEWIRE ANG .018X130CM,C1769,HCPCS,,79000913,CDM,272,RC,,,both,,,64,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,44.8,70,,44.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,44.8,
GUIDE WIRE 1.2MM,C1769,HCPCS,,79000915,CDM,272,RC,,,both,,,106,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,74.2,70,,74.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.2,
STRYKER 702459 GUIDE WIRE 1.4X150MM,C1769,HCPCS,,79000916,CDM,272,RC,,,both,,,372,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,260.4,70,,260.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,260.4,
GUIDE WIRE THREADED 1.1 X 150MM,C1769,HCPCS,,79000918,CDM,272,RC,,,both,,,106,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,74.2,70,,74.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.2,
BOST SCI 630-103 GUIDEWIRE ANGLED,C1769,HCPCS,,79000921,CDM,272,RC,,,both,,,113,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,79.1,70,,79.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,79.1,
BOST SCI 630-093 GLIDEWIRE ANGLD TIP 3CM,C1769,HCPCS,,79000923,CDM,272,RC,,,both,,,113,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,79.1,70,,79.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,79.1,
ZIMMER 47-2237-38 GUIDE WIRE,C1769,HCPCS,,79002059,CDM,272,RC,,,both,,,510,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,357,70,,357,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357,
ARTHREX AR-8941K GUIDE WIRE,C1769,HCPCS,,79002443,CDM,272,RC,,,both,,,49,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,34.3,70,,34.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34.3,
ACUMED WS1406ST GUIDE WIRE,C1769,HCPCS,,79002621,CDM,272,RC,,,both,,,46,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,32.2,70,,32.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.2,
ACUMED WS-2009-ST GUIDE WIRE,C1769,HCPCS,,79002622,CDM,272,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,49,70,,49,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,49,
GWR419388 HYBRID WIRE,C1769,HCPCS,,79002658,CDM,272,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
GWR419688 GUIDE WIRE 108CM GLOBAL CE,C1769,HCPCS,,79002659,CDM,272,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
STRYKER 1806-0093S GUIDE WIRE 2.2X800MM,C1769,HCPCS,,79002892,CDM,272,RC,,,both,,,355,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,248.5,70,,248.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,248.5,
STRYKER 1806-0085S GUIDE WIRE 3X100MM,C1769,HCPCS,,79003022,CDM,272,RC,,,both,,,392,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,274.4,70,,274.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.4,
BOST SCI 46-152B ANGLED ZIPWIRE .035X180,C1769,HCPCS,,79003132,CDM,272,RC,,,both,,,125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,87.5,70,,87.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,87.5,
BOST SCI 39216-73001 V-14 CONTROL WIRE,C1769,HCPCS,,79003133,CDM,272,RC,,,both,,,628,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,439.6,70,,439.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,439.6,
BOST SCI 49-148 BENTSON WIRE .035X260CM,C1769,HCPCS,,79003134,CDM,272,RC,,,both,,,305,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,213.5,70,,213.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,213.5,
BOST SCI 50-810 FATHOM-14 .014X200CM,C1769,HCPCS,,79003135,CDM,272,RC,,,both,,,1020,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,714,70,,714,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,714,
BOST SCI 50-910 FATHOM-16 .016X180CM,C1769,HCPCS,,79003136,CDM,272,RC,,,both,,,316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,221.2,70,,221.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
BOST SCI 46-740 PLATINUM PLUS .014X180CM,C1769,HCPCS,,79003137,CDM,272,RC,,,both,,,310,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,217,70,,217,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,217,
BOST SCI 46-712 PLATINUM PLUS .014X300CM,C1769,HCPCS,,79003138,CDM,272,RC,,,both,,,320,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,224,70,,224,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224,
BOST SCI 46-601 PLATINUM PLUS .018X180CM,C1769,HCPCS,,79003139,CDM,272,RC,,,both,,,233,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,163.1,70,,163.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.1,
BOST SCI 46-602 PLATINUM PLUS .018X260CM,C1769,HCPCS,,79003140,CDM,272,RC,,,both,,,275,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,192.5,70,,192.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192.5,
BOST SCI PAGH18M370 TREASURE-12 WIRE,C1769,HCPCS,,79003141,CDM,272,RC,,,both,,,510,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,357,70,,357,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357,
J&J 527-914J STABILIZER WIRE .014 180CM,C1769,HCPCS,,79003142,CDM,272,RC,,,both,,,538,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,376.6,70,,376.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,376.6,
COOK G09957 AMPLATZ ULTRA STIFF WIRE 145,C1769,HCPCS,,79003143,CDM,272,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,70,,63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63,
COOK G06979 ROADRUNNER PC GUIDE WIRE 145,C1769,HCPCS,,79003144,CDM,272,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,67.2,70,,67.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,67.2,
COOK G36278 ANGLED HIWIRE .018 X 260CM,C1769,HCPCS,,79003145,CDM,272,RC,,,both,,,162,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,113.4,70,,113.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,113.4,
COOK G47733 APPROACH PRO LT .014 X 190CM,C1769,HCPCS,,79003146,CDM,272,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,159.6,
COOK G47734 APPROACH PRO LT .014 X 300CM,C1769,HCPCS,,79003147,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
COOK G01253 ROSEN CURVED GUIDEWIRE 260CM,C1769,HCPCS,,79003148,CDM,272,RC,,,both,,,49,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,34.3,70,,34.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34.3,
COOK G52938 APPROACH HYDRO ST .014X190CM,C1769,HCPCS,,79003149,CDM,272,RC,,,both,,,516,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,361.2,70,,361.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,361.2,
COOK CMW-14-190 WIRE GUIDE .014 X 190CM,C1769,HCPCS,,79003150,CDM,272,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,159.6,
COOK CMW-14-300 WIRE GUIDE .014 X 300CM,C1769,HCPCS,,79003151,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
ARTHREX AR-8737-01 GUIDE WIRE 1.35MM,C1769,HCPCS,,79003313,CDM,272,RC,,,both,,,49,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,34.3,70,,34.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34.3,
ZIMMER 74-2237-37 ZMS GUIDE WIRE 3.0,C1769,HCPCS,,79003417,CDM,272,RC,,,both,,,354,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,247.8,70,,247.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,247.8,
ARTHREX AR-8737-05 GUIDE WIRE 1.1MM,C1769,HCPCS,,79003615,CDM,272,RC,,,both,,,60,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,42,70,,42,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42,
GWR419478 GUIDEWIRE 98CM GLOBAL ICE,C1769,HCPCS,,79003626,CDM,272,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
STRYKER 1806-0080S GUIDE WIRE 3X800MM,C1769,HCPCS,,79003726,CDM,272,RC,,,both,,,373,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,261.1,70,,261.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,261.1,
ARTHREX AR-8737-21 GUIDE WIRE .86MM,C1769,HCPCS,,79003766,CDM,272,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,45.5,70,,45.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.5,
ZIMMER 47-2255-008-01 GUIDE WIRE 3X100CM,C1769,HCPCS,,79003774,CDM,272,RC,,,both,,,430,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,301,70,,301,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,301,
DEPUY 2810-01-100 GUIDE WIRE 3MMX100CM,C1769,HCPCS,,79003913,CDM,272,RC,,,both,,,389,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,272.3,70,,272.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.3,
SYNTHES 900.726 GUIDE WIRE 2.8X450MM,C1769,HCPCS,,79004206,CDM,272,RC,,,both,,,184,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,128.8,70,,128.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.8,
ZIMMER 2228-14 GUIDE WIRE 2.4MM,C1769,HCPCS,,79004820,CDM,272,RC,,,both,,,362,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,253.4,70,,253.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.4,
ZIMMER 47-2255-008-01 GUIDE WIRE 3MM,C1769,HCPCS,,79004842,CDM,272,RC,,,both,,,367,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,256.9,70,,256.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,256.9,
EV3 ENW-SF-014-300 ENTER GUIDEWIRE STIFF,C1769,HCPCS,,79004846,CDM,272,RC,,,both,,,1080,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,756,70,,756,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,756,
SYNTHES 900.722 GUIDE WIRE 1.25X150MM,C1769,HCPCS,,79004908,CDM,272,RC,,,both,,,59,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,41.3,70,,41.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,41.3,
SYNTHES 292.68 GUIDE WIRE 2.8X300MM,C1769,HCPCS,,79005117,CDM,272,RC,,,both,,,106,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,74.2,70,,74.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.2,
ZIMMER 2255-25 GUIDE WIRE 2.4MM,C1769,HCPCS,,79005696,CDM,272,RC,,,both,,,160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,112,70,,112,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112,
ACUMED WS1106ST GUIDE WIRE .045 ACUMED,C1769,HCPCS,,79005714,CDM,272,RC,,,both,,,46,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,32.2,70,,32.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.2,
BIOMET 2810-17-006 GUIDE WIRE 2MMX70CM,C1769,HCPCS,,79005755,CDM,272,RC,,,both,,,1080,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,756,70,,756,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,756,
SYNTHES 03.211.410 COMP GUIDE WIRE 1.6MM,C1769,HCPCS,,79005858,CDM,272,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,76.3,70,,76.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.3,
ZIMMER 47-2255-008-00 GUIDE WIRE 2.4MM,C1769,HCPCS,,79005894,CDM,272,RC,,,both,,,367,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,256.9,70,,256.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,256.9,
ARTHREX AR-8967K GUIDE WIRE .092X8,C1769,HCPCS,,79005993,CDM,272,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,45.5,70,,45.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.5,
SYNTHES 292.623 GUIDE WIRE 1.1X150MM,C1769,HCPCS,,79006088,CDM,272,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,76.3,70,,76.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.3,
MEDTRONIC GWR419678 ATTAIN GUIDE WIRE,C1769,HCPCS,,79006095,CDM,272,RC,,,both,,,600,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
ARTHREX AR-8956K-01 GUIDE WIRE 2X200MM,C1769,HCPCS,,79006345,CDM,272,RC,,,both,,,76,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,53.2,70,,53.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
ABBOTT 10001782 GUIDE WIRE .014X300CM,C1769,HCPCS,,79006414,CDM,272,RC,,,both,,,276,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,193.2,70,,193.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,193.2,
STRYKER 702460 GUIDE WIRE 2X150MM,C1769,HCPCS,,79006440,CDM,272,RC,,,both,,,156,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.2,70,,109.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.2,
BOST SCI 46-300B .035X80CM ZIP WIRE,C1769,HCPCS,,79006469,CDM,272,RC,,,both,,,141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,98.7,70,,98.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,98.7,
STRYKER 1806-0090S GUIDE WIRE 3X800MM,C1769,HCPCS,,79006582,CDM,272,RC,,,both,,,311,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,217.7,70,,217.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,217.7,
DEPUY 357.399 3.2MM GUIDE WIRE,C1769,HCPCS,,79006663,CDM,272,RC,,,both,,,146,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,102.2,70,,102.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.2,
ACUMED 80-1524 TROCAR GUIDE WIRE .035X6,C1769,HCPCS,,79006736,CDM,272,RC,,,both,,,52,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,36.4,70,,36.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,36.4,
BOST SCI 7081 MAILMAN .014X182 GUIDEWIRE,C1769,HCPCS,,79006800,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
BOST SCI 12130-01 LUGE .014X182 GUIDEWRE,C1769,HCPCS,,79006801,CDM,272,RC,,,both,,,247,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,172.9,70,,172.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.9,
SYNTHES 900.601 GUIDE WIRE 1.6X150MM,C1769,HCPCS,,79006802,CDM,272,RC,,,both,,,98,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,68.6,70,,68.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,68.6,
"ARTHREX AR-8941-6 GUIDE WIRE 1.6MM 6""",C1769,HCPCS,,79007026,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
"ARTHREX AR-8941-7 GUIDE WIRE 1.6MM 7""",C1769,HCPCS,,79007027,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
BOST SCI 46-525 180CM AMPLATZ WIRE,C1769,HCPCS,,79007294,CDM,272,RC,,,both,,,125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,87.5,70,,87.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,87.5,
DEPUY 900.721 1.25X150MM GUIDE WIRE,C1769,HCPCS,,79007334,CDM,272,RC,,,both,,,55,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.5,70,,38.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.5,
BOST SCI 46-564 .038X75CM AMPLATZ WIRE,C1769,HCPCS,,79007338,CDM,272,RC,,,both,,,79,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,55.3,70,,55.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.3,
ARTHREX AR-8967KT-12 GUIDE WIRE 2.4X12,C1769,HCPCS,,79007444,CDM,272,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,70,,63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63,
ARTHREX AR-8005K GUIDE WIRE 1.2MM,C1769,HCPCS,,79007445,CDM,272,RC,,,both,,,66,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,46.2,70,,46.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.2,
DEPUY 292.656 GUIDE WIRE 2X230MM,C1769,HCPCS,,79007458,CDM,272,RC,,,both,,,75,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,52.5,70,,52.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.5,
ARTHREX AR-8737-40 GUIDE WIRE .86MM,C1769,HCPCS,,79007477,CDM,272,RC,,,both,,,78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,54.6,70,,54.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.6,
ARTHREX AR-8967K-12 GUIDE WIRE 2.4MM,C1769,HCPCS,,79007536,CDM,272,RC,,,both,,,66,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,46.2,70,,46.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.2,
ACUMED 80-1525 DOUBLE TROCAR GUIDE WIRE,C1769,HCPCS,,79007657,CDM,272,RC,,,both,,,52,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,36.4,70,,36.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,36.4,
DEPUY 03.010.025 2.0X240MM GUIDE WIRE,C1769,HCPCS,,79007810,CDM,272,RC,,,both,,,63,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,44.1,70,,44.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,44.1,
STRYKER 702463 3.2X300MM GUIDE WIRE,C1769,HCPCS,,79009324,CDM,272,RC,,,both,,,237,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,165.9,70,,165.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.9,
ABBOTT 1005357H WHISPER MS GUIDEWIRE 190,C1769,HCPCS,,79011415,CDM,272,RC,,,both,,,375,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,262.5,70,,262.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,262.5,
ABBOTT 1001309 IRON MAN GUIDEWIRE 190CM,C1769,HCPCS,,79011416,CDM,272,RC,,,both,,,375,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,262.5,70,,262.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,262.5,
ABBOTT 1001780 BMW GUIDEWIRE 190CM,C1769,HCPCS,,79011417,CDM,272,RC,,,both,,,375,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,262.5,70,,262.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,262.5,
ABBOTT 1001780-HC HYDROCOAT GUIDEWIRE,C1769,HCPCS,,79011418,CDM,272,RC,,,both,,,375,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,262.5,70,,262.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,262.5,
ABBOTT 1009660 BMW UNIV GUIDEWIRE 190CM,C1769,HCPCS,,79011419,CDM,272,RC,,,both,,,375,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,262.5,70,,262.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,262.5,
ABBOTT 1009664 BMW UNIV II GUIDEWIRE 190,C1769,HCPCS,,79011420,CDM,272,RC,,,both,,,375,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,262.5,70,,262.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,262.5,
ASAHI AGH146000 PROWATER PTCA GW 180CM,C1769,HCPCS,,79011421,CDM,272,RC,,,both,,,285,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,199.5,70,,199.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.5,
ASAHI AGP140002 FIELDER XT PTCA GW 190CM,C1769,HCPCS,,79011422,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
ASAHI AGP140001 FIELDER FC PTCA GW 180CM,C1769,HCPCS,,79011423,CDM,272,RC,,,both,,,285,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,199.5,70,,199.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.5,
ASAHI AG141000 ASAHI SOFT 180CM,C1769,HCPCS,,79011424,CDM,272,RC,,,both,,,285,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,199.5,70,,199.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.5,
TERUMO 25-1011 NS EXTRA FLOPPY 180CM,C1769,HCPCS,,79011425,CDM,272,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
TERUMO 25-3011 NS HYPERCOAT 180CM,C1769,HCPCS,,79011426,CDM,272,RC,,,both,,,390,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,273,70,,273,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273,
PHILIPS 89185 PRESSURE WIRE OMNI 185CM,C1769,HCPCS,,79011495,CDM,272,RC,,,both,,,2100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1470,70,,1470,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470,
BOSTON SCI H74938931032 GUIDEWIRE 185CM,C1769,HCPCS,,79011595,CDM,272,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,174.3,70,,174.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.3,
BOSTON SCI H74912161012 GUIDEWIRE 182CM,C1769,HCPCS,,79011596,CDM,272,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,174.3,70,,174.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.3,
BOSTON SCI H74912160012 GUIDEWIRE 182CM,C1769,HCPCS,,79011597,CDM,272,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,174.3,70,,174.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.3,
BOSTON SCI H74912136012 GUIDEWIRE 182CM,C1769,HCPCS,,79011598,CDM,272,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,174.3,70,,174.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.3,
BOSTON SCI H74912120012 GUIDEWIRE 300CM,C1769,HCPCS,,79011599,CDM,272,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,174.3,70,,174.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.3,
BOSTON SCI H7491213001M2 GUIDEWIRE 182CM,C1769,HCPCS,,79011600,CDM,272,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,174.3,70,,174.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.3,
BOSTON SCI H74912155012 GUIDEWIRE 300CM,C1769,HCPCS,,79011601,CDM,272,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,174.3,70,,174.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.3,
ABBOTT 10005359H GUIDEWIRE 300CM,C1769,HCPCS,,79011602,CDM,272,RC,,,both,,,375,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,262.5,70,,262.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,262.5,
ABBOTT 1011834H GUIDEWIRE 190CM,C1769,HCPCS,,79011603,CDM,272,RC,,,both,,,375,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,262.5,70,,262.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,262.5,
PHILIPS 10185P PRESSURE WIRE 185CM,C1769,HCPCS,,79011609,CDM,272,RC,,,both,,,2025,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1417.5,70,,1417.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1417.5,
MEDLINE 60110152 RS-LEFT HEART CASE,C1769,HCPCS,,79011702,CDM,272,RC,,,both,,,116,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,81.2,70,,81.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,81.2,
ABBOTT 22260 DOC GUIDEWIRE EXTENSION,C1769,HCPCS,,79011808,CDM,272,RC,,,both,,,375,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,262.5,70,,262.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,262.5,
ASAHI-INTECC AG141300 ASAHI SOFT 300CM,C1769,HCPCS,,79011809,CDM,272,RC,,,both,,,285,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,199.5,70,,199.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.5,
CARDINAL 502-521 GUIDEWIRE 0.35X150,C1769,HCPCS,,79011816,CDM,272,RC,,,both,,,28,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.6,70,,19.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,19.6,
CARDINAL 502-455 GUIDEWIRE 0.35X260,C1769,HCPCS,,79011817,CDM,272,RC,,,both,,,30,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,21,70,,21,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21,
BOST SCI 46-591 MAGIC TORQUE .035X180CM,C1769,HCPCS,,79011840,CDM,272,RC,,,both,,,155,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,108.5,70,,108.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108.5,
GETINGE 0684-00-0254-09 .025X145 GUIDEWI,C1769,HCPCS,,79011922,CDM,272,RC,,,both,,,69,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,48.3,70,,48.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.3,
ASAHI-INTECC AG141002 PTCA GW 180CM,C1769,HCPCS,,79011965,CDM,272,RC,,,both,,,405,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,283.5,70,,283.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,283.5,
J&J 03.120.026 DRILL TIP GUIDE WIRE 2.5,C1769,HCPCS,,79012063,CDM,272,RC,,,both,,,141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,98.7,70,,98.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,98.7,
J&J 03.010.115 GUIDE WIRE 3.2X290MM,C1769,HCPCS,,79012100,CDM,272,RC,,,both,,,146,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,102.2,70,,102.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.2,
J&J 292.72 THREADED GUIDE WIRE 1.6X150MM,C1769,HCPCS,,79012104,CDM,272,RC,,,both,,,67,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,46.9,70,,46.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.9,
ASAHI AHW14R104S BLUE PCI GUIDEWIRE 190,C1769,HCPCS,,79012140,CDM,272,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294,70,,294,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
ASAHI AG141302 GRAND SLAM 300 CM,C1769,HCPCS,,79012287,CDM,272,RC,,,both,,,405,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,283.5,70,,283.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,283.5,
ABBOTT 1012068-06 .035X260CM GUIDEWIRE,C1769,HCPCS,,79012366,CDM,272,RC,,,both,,,285,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,199.5,70,,199.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.5,
CARDINAL 503-456X STORQ STANDARD,C1769,HCPCS,,79012367,CDM,272,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,146.3,70,,146.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,146.3,
ABBOTT 1012068-04 .035X175CM GUIDEWIRE,C1769,HCPCS,,79012368,CDM,272,RC,,,both,,,255,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,178.5,70,,178.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.5,
ABBOTT 1002703-01 SUPRA CORE 35 0.35X190,C1769,HCPCS,,79012369,CDM,272,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,168,70,,168,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
MEDLINE DNYJGWIRE20 GUIDEWIRE .035X260CM,C1769,HCPCS,,79012528,CDM,272,RC,,,both,,,27,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,18.9,70,,18.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18.9,
MERIT IQ35F260J3 GUIDEWIRE .035X260CM,C1769,HCPCS,,79012529,CDM,272,RC,,,both,,,28,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.6,70,,19.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,19.6,
BOST H74914902012 MODEL-GRAPHIX INT,C1769,HCPCS,,79012734,CDM,272,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,174.3,70,,174.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.3,
J&J 03.333.001 GUIDEWIRE 1.1MM,C1769,HCPCS,,79012813,CDM,272,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,127.4,70,,127.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,127.4,
COOK G01793 .021X180 CORE WIRE GUIDE,C1769,HCPCS,,79012867,CDM,272,RC,,,both,,,39,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,27.3,70,,27.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27.3,
"MERIT 6682 GUIDEWIRE INQWIRE .025"" 150CM",C1769,HCPCS,,79012876,CDM,272,RC,,,both,,,22,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.4,70,,15.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,15.4,
MEDLINE MSG14150 GUIDEWIRE 1.4X150MM,C1769,HCPCS,,79012999,CDM,272,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,70,,63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63,
BOST H74908641022 JR4 CATHETER FR4 EXPO,C1769,HCPCS,,79013007,CDM,272,RC,,,both,,,29,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,20.3,70,,20.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20.3,
WRIGHT CSI-GP09 FUTURA GUIDE PIN 2X229MM,C1769,HCPCS,,79013078,CDM,272,RC,,,both,,,149,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,104.3,70,,104.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,104.3,
J&J 09.037.010 GUIDEWIRE 3.2X475MM,C1769,HCPCS,,79013160,CDM,272,RC,,,both,,,283,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,198.1,70,,198.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.1,
J&J 03.333.000 GUIDEWIRE 0.8MM,C1769,HCPCS,,79013375,CDM,272,RC,,,both,,,164,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,114.8,70,,114.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,114.8,
J&J 03.333.002 GUIDEWIRE WIRE 1.4X150MM,C1769,HCPCS,,79013493,CDM,272,RC,,,both,,,210,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,147,70,,147,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,147,
MERIT IQ35F150J3,C1769,HCPCS,,79013545,CDM,272,RC,,,both,,,21,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,14.7,70,,14.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14.7,
TERUMO 25-5211 RUNTHRU AZANAI .014X180CM,C1769,HCPCS,,79013551,CDM,272,RC,,,both,,,334,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,233.8,70,,233.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.8,
MERIT EZ-REG/A RADIAL COMP DEVICE 32CM,C1769,HCPCS,,79013577,CDM,272,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,73.5,70,,73.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,73.5,
MERIT EZ-SML/A RADIAL COMP DEVICE 26CM,C1769,HCPCS,,79013578,CDM,272,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,73.5,70,,73.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,73.5,
TERUMO 25-9092 RUNTHROUGH NS EXT WIRE,C1769,HCPCS,,79013624,CDM,272,RC,,,both,,,318,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,222.6,70,,222.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,222.6,
ARTHREX AR-8956K GUIDEWIRE 2.0MM,C1769,HCPCS,,79013779,CDM,272,RC,,,both,,,82,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,57.4,70,,57.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,57.4,
ARTHREX AR-8750K GUIDEWIRE 1.6MM,C1769,HCPCS,,79013785,CDM,272,RC,,,both,,,49,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,34.3,70,,34.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34.3,
MERIT BASIXTOUCH IN8802/C INFLATION DEV,C1769,HCPCS,,79013959,CDM,272,RC,,,both,,,172,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,120.4,70,,120.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120.4,
MEDTRONIC GN2501 65CMX25MM SNARE,C1773,HCPCS,,79000166,CDM,272,RC,,,both,,,897,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,627.9,70,,627.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,627.9,
COOK G13287 FILTER RETRIEVAL SET,C1773,HCPCS,,79000359,CDM,272,RC,,,both,,,750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,525,70,,525,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,525,
GOOSE NECK SNAR 15MM LOOP 120CM,C1773,HCPCS,,79000386,CDM,272,RC,,,both,,,810,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,567,70,,567,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,567,
GOOSENECK SNARE 25MM LOOP 120CM,C1773,HCPCS,,79000387,CDM,272,RC,,,both,,,960,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,672,70,,672,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
ANGIOTECH 392006020 6FR SNARE SYS12-20MM,C1773,HCPCS,,79003152,CDM,272,RC,,,both,,,1036,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,725.2,70,,725.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,725.2,
ANGIOTECH 392006010 6FR SNARE SYS 6-10MM,C1773,HCPCS,,79003153,CDM,272,RC,,,both,,,1155,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,808.5,70,,808.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,808.5,
COOK G07187 VASC RETVL FORCEPS 3FRX120CM,C1773,HCPCS,,79003154,CDM,272,RC,,,both,,,1836,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1285.2,70,,1285.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1285.2,
GTRS-200-RB COOK VC FILTER RETRIEVAL SET,C1773,HCPCS,,79003155,CDM,272,RC,,,both,,,750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,525,70,,525,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,525,
MERIT MED EN2006020 EN SNARE MULTI 20MM,C1773,HCPCS,,79007178,CDM,272,RC,,,both,,,1080,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,756,70,,756,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,756,
EV3 SPD2-US-050-320 5MM SPIDER FX,C1884,HCPCS,,79005186,CDM,272,RC,,,both,,,3886,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2720.2,70,,2720.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2720.2,
EV3 SPD2-US-060-320 6MM SPIDER FX,C1884,HCPCS,,79005187,CDM,272,RC,,,both,,,3886,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2720.2,70,,2720.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2720.2,
EV3 SPD2-US-040-320 SPIDER FX 4X320/190,C1884,HCPCS,,79005432,CDM,272,RC,,,both,,,3886,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2720.2,70,,2720.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2720.2,
EV3 SPD2-US-070-320 SPIDER FX 7X320/190,C1884,HCPCS,,79005433,CDM,272,RC,,,both,,,3886,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2720.2,70,,2720.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2720.2,
BOSTON SCI H749201001900 FILTERWIRE 190,C1884,HCPCS,,79011604,CDM,272,RC,,,both,,,4485,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3139.5,70,,3139.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3139.5,
BOSTON SCI H749201003000 FILTERWIRE 300,C1884,HCPCS,,79011605,CDM,272,RC,,,both,,,4485,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3139.5,70,,3139.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3139.5,
BOSTON SCI H749390711900 FILTERWIRE 190,C1884,HCPCS,,79011606,CDM,272,RC,,,both,,,4485,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3139.5,70,,3139.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3139.5,
BOSTON SCI H749390713000 FILTERWIRE 300,C1884,HCPCS,,79011607,CDM,272,RC,,,both,,,4485,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3139.5,70,,3139.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3139.5,
COOK G06416 INFUSION CATHETER 5FRX65CM,C1887,HCPCS,,79000144,CDM,272,RC,,,both,,,380,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,266,70,,266,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266,
COOK G06422 INFUSION CATHETER 5FRX100CM,C1887,HCPCS,,79000146,CDM,272,RC,,,both,,,380,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,266,70,,266,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266,
CORDIS 6FR VISTA BRITE RDC GUIDE CATH,C1887,HCPCS,,79000177,CDM,272,RC,,,both,,,340,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,238,70,,238,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,238,
J&J 403-7553R 7FR GUIDING CATH,C1887,HCPCS,,79000210,CDM,272,RC,,,both,,,338,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,236.6,70,,236.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,236.6,
BOST SCI 19-826 8FR GUIDE CATH MP 90CM,C1887,HCPCS,,79000235,CDM,272,RC,,,both,,,318,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,222.6,70,,222.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,222.6,
CATHETER 6FR IM VISTA BRITE GUIDE,C1887,HCPCS,,79000294,CDM,272,RC,,,both,,,366,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,256.2,70,,256.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,256.2,
J&J G780IMD 7FRX55CM IM GUIDE CATH,C1887,HCPCS,,79000295,CDM,272,RC,,,both,,,539,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,377.3,70,,377.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,377.3,
J&J 403-7553H 7FRX55CM GUIDE CATHETER,C1887,HCPCS,,79000305,CDM,272,RC,,,both,,,335,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,234.5,70,,234.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.5,
J&J 403-7553A 7FRX55CM IM GUIDE CATHETER,C1887,HCPCS,,79000306,CDM,272,RC,,,both,,,335,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,234.5,70,,234.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.5,
J&J MGC3990 FRONTRUNNER CATHETER 90CM,C1887,HCPCS,,79000375,CDM,272,RC,,,both,,,750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,525,70,,525,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,525,
J&J FBS3990 FRONTRUNNER XP CTO CATH 90CM,C1887,HCPCS,,79000376,CDM,272,RC,,,both,,,3136,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2195.2,70,,2195.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2195.2,
BOST SCI 19-762 LIMA MACH1 GUIDECATH 7FR,C1887,HCPCS,,79000414,CDM,272,RC,,,both,,,318,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,222.6,70,,222.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,222.6,
TERUMO RSC07 MPA GUIDE CATH DEST 6FR,C1887,HCPCS,,79000424,CDM,272,RC,,,both,,,383,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,268.1,70,,268.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.1,
J&J OTB42120 OUTBACK RE-ENTRY CATH 120CM,C1887,HCPCS,,79000441,CDM,272,RC,,,both,,,6894,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4825.8,70,,4825.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4825.8,
TERUMO RSP02 PINNACLE GUIDE SHEATH 7FX65,C1887,HCPCS,,79000447,CDM,272,RC,,,both,,,348,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,243.6,70,,243.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,243.6,
BOST SCI 18-133 RENEGRADE ANG MICROCATH,C1887,HCPCS,,79003200,CDM,272,RC,,,both,,,1446,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1012.2,70,,1012.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1012.2,
BOST SCI 18-137 RENEGRADE STR MICROCATH,C1887,HCPCS,,79003201,CDM,272,RC,,,both,,,1446,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1012.2,70,,1012.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1012.2,
BOST SCI 39239-01813 RUBICON .018X135CM,C1887,HCPCS,,79003202,CDM,272,RC,,,both,,,406,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,284.2,70,,284.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,284.2,
BOST SCI 39240-03509 RUBICON .035X90CM,C1887,HCPCS,,79003203,CDM,272,RC,,,both,,,406,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,284.2,70,,284.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,284.2,
J&J 670-190-55 GUIDING CATH IM 6FRX55CM,C1887,HCPCS,,79003204,CDM,272,RC,,,both,,,174,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,121.8,70,,121.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.8,
J&J 670-210-55 GUIDING CATH RDC 6FRX55CM,C1887,HCPCS,,79003205,CDM,272,RC,,,both,,,340,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,238,70,,238,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,238,
J&J 670-278-90 GUIDE CATH H-STICK 6FRX90,C1887,HCPCS,,79003206,CDM,272,RC,,,both,,,330,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,231,70,,231,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231,
J&J 670-190-90 GUIDING CATH IM 6FRX90CM,C1887,HCPCS,,79003207,CDM,272,RC,,,both,,,336,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,235.2,70,,235.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,235.2,
J&J 670-270-90 GUIDING CATH MPA 6FRX90CM,C1887,HCPCS,,79003208,CDM,272,RC,,,both,,,174,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,121.8,70,,121.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.8,
COOK G52546 4FR CXI SUPPORT CATH 90CM,C1887,HCPCS,,79003209,CDM,272,RC,,,both,,,450,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,315,70,,315,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315,
EV3 41035-01 INFUSION CATH 4FR X 65CM,C1887,HCPCS,,79003210,CDM,272,RC,,,both,,,346,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,242.2,70,,242.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,242.2,
EV3 41042-01 INFUSION CATH 4FR X 135CM,C1887,HCPCS,,79003211,CDM,272,RC,,,both,,,346,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,242.2,70,,242.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,242.2,
EV3 SC-035-135 TRAILBLAZER CATH 5FRX135,C1887,HCPCS,,79003212,CDM,272,RC,,,both,,,2626,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1838.2,70,,1838.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1838.2,
BARD SK15035 .035X150 SEEKER CROSS CATH,C1887,HCPCS,,79003213,CDM,272,RC,,,both,,,480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,336,70,,336,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
MEDTRONIC 6250EH02 CATHETER ATTAIN,C1887,HCPCS,,79003627,CDM,272,RC,,,both,,,648,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,453.6,70,,453.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,453.6,
MEDTRONIC 6248V-90P ATTAIN CATHETER,C1887,HCPCS,,79006629,CDM,272,RC,,,both,,,910,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,637,70,,637,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,637,
EV3 BVT808030 TRELLIS DEVICE 8FRX80X30CM,C1887,HCPCS,,79006931,CDM,272,RC,,,both,,,6285,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4399.5,70,,4399.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4399.5,
BARD USH130AT USHER CATH 130CM ANGLED,C1887,HCPCS,,79007565,CDM,272,RC,,,both,,,946,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,662.2,70,,662.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,662.2,
BARD USH83AT USHER SUPPORT CATH 83CM,C1887,HCPCS,,79007570,CDM,272,RC,,,both,,,946,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,662.2,70,,662.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,662.2,
BARD SD70T SIDEKICK CATH 70CM ANGLED,C1887,HCPCS,,79007571,CDM,272,RC,,,both,,,946,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,662.2,70,,662.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,662.2,
BARD SD70AT SIDEKICK CATH 70CM ANG/TAP,C1887,HCPCS,,79007572,CDM,272,RC,,,both,,,946,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,662.2,70,,662.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,662.2,
BARD SD110T SIDEKICK CATH 110CM TAPER,C1887,HCPCS,,79007573,CDM,272,RC,,,both,,,946,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,662.2,70,,662.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,662.2,
BARD SD110AT SIDEKICK CATH 110CM ANG/TAP,C1887,HCPCS,,79007574,CDM,272,RC,,,both,,,946,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,662.2,70,,662.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,662.2,
MEDTRONIC LA6AL10SH GUIDECATH 6FR AL1 SH,C1887,HCPCS,,79011427,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AL15 GUIDECATH 6FR AL1.5,C1887,HCPCS,,79011428,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AL15SH GUIDECATH 6FR AL1.5,C1887,HCPCS,,79011429,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AL20SH GUIDECATH 6FR AL2 SH,C1887,HCPCS,,79011430,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AR10SH GUIDECATH 6FR AR1 SH,C1887,HCPCS,,79011431,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AR20SH GUIDECATH 6FR AR2 SH,C1887,HCPCS,,79011432,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6EBU375 GUIDECATH 6FR 3.75,C1887,HCPCS,,79011433,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6HSISHD GUIDECATH 6FR HS SH,C1887,HCPCS,,79011434,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6IMASHD GUIDECATH 6FR IM SH,C1887,HCPCS,,79011435,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JCL35 GUIDECATH 6FR JCL 3.5,C1887,HCPCS,,79011436,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JCL40 GUIDECATH 6FR JCL 4,C1887,HCPCS,,79011437,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6MB1SH GUIDECATH 6FR SH 100,C1887,HCPCS,,79011438,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6MB1SHD GUIDECATH 6FR SH 90,C1887,HCPCS,,79011439,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6MB1 GUIDECATH 6FR MB1,C1887,HCPCS,,79011440,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AL10 GUIDECATH 6FR AL1,C1887,HCPCS,,79011441,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AL75 GUIDECATH 6FR AL7.5,C1887,HCPCS,,79011442,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AR10 GUIDECATH 6FR AR1,C1887,HCPCS,,79011443,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AR20 GUIDECATH 6FR AR2,C1887,HCPCS,,79011444,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6EBU30 GUIDECATH 6FR EBU 3.0,C1887,HCPCS,,79011445,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6EBU35SH GUIDECATH 6FR 3.5SH,C1887,HCPCS,,79011446,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6EBU50 GUIDECATH 6FR EBU 5.0,C1887,HCPCS,,79011447,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6HSI GUIDECATH 6FR HSI,C1887,HCPCS,,79011448,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6HSISH GUIDECATH 6FR HSI SH,C1887,HCPCS,,79011449,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6IMAD GUIDECATH 6FR IM,C1887,HCPCS,,79011450,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JL35 GUIDECATH 6FR JL 3.5,C1887,HCPCS,,79011451,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JL35SH GUIDECATH JL 3.5 SH,C1887,HCPCS,,79011452,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JL40SH GUIDECATH JL 4.0 SH,C1887,HCPCS,,79011453,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JL50 GUIDECATH 6FR JL 5.0,C1887,HCPCS,,79011454,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JR35 GUIDECATH 6FR JR 3.5,C1887,HCPCS,,79011455,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JR40SH GUIDECATH JR 4.0 SH,C1887,HCPCS,,79011456,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AL20 GUIDECATH 6FR AL2,C1887,HCPCS,,79011457,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AL75SH GUIDECATH AL7.5 SH,C1887,HCPCS,,79011458,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA63DRC GUIDECATH 6FR 3DRC,C1887,HCPCS,,79011459,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6EBU35 GUIDECATH EBU 3.5,C1887,HCPCS,,79011460,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6EBU40 GUIDECATH 6FR EBU 4.0,C1887,HCPCS,,79011464,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JL40 GUIDECATH 6FR JL 4,C1887,HCPCS,,79011465,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JR40 GUIDECATH 6FR JR 4,C1887,HCPCS,,79011466,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
CARDINAL 67200200 GUIDECATH 6FR JL 3.5,C1887,HCPCS,,79011467,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67200400 GUIDECATH 6FR JL 4,C1887,HCPCS,,79011468,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67200800 GUIDECATH 6FR JL 5,C1887,HCPCS,,79011469,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67208200 GUIDECATH 6FR JR 4,C1887,HCPCS,,79011470,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67208300 GUIDECATH 6FR JR 4 SH,C1887,HCPCS,,79011471,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67205200 GUIDECATH 6FR XB 3,C1887,HCPCS,,79011472,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67205400 GUIDECATH 6FR XB 3.5,C1887,HCPCS,,79011473,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67205600 GUIDECATH 6FR XB 4,C1887,HCPCS,,79011474,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67203400 GUIDECATH 6FR AL 0.75,C1887,HCPCS,,79011475,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67203600 GUIDECATH 6FR AL1,C1887,HCPCS,,79011476,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67211000 GUIDECATH 6FR AR1,C1887,HCPCS,,79011477,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67227800 GUIDECATH 6FR H-STICK,C1887,HCPCS,,79011478,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67227000 GUIDECATH 6FR MPA,C1887,HCPCS,,79011479,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 534524T 5FR JL 6 100CM CATHETER,C1887,HCPCS,,79011490,CDM,272,RC,,,both,,,23,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.1,70,,16.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,16.1,
CARDINAL 534-617T 6FR JL 4.5 100CM CATH,C1887,HCPCS,,79011491,CDM,272,RC,,,both,,,23,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.1,70,,16.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,16.1,
CARDINAL 533-640 6FR MPA1 100CM CATHETER,C1887,HCPCS,,79011492,CDM,272,RC,,,both,,,23,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.1,70,,16.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,16.1,
TERUMO 35-1430 MICRO GUIDE 130CM,C1887,HCPCS,,79011493,CDM,272,RC,,,both,,,1500,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1050,70,,1050,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1050,
TERUMO 35-1450 MICRO GUIDE 150CM,C1887,HCPCS,,79011494,CDM,272,RC,,,both,,,1500,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1050,70,,1050,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1050,
TELEFLEX 5571 6FR GUIDELINER 150CM,C1887,HCPCS,,79011587,CDM,272,RC,,,both,,,1275,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,892.5,70,,892.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,892.5,
TELEFLEX 5572 7FR GUIDELINER 150CM,C1887,HCPCS,,79011588,CDM,272,RC,,,both,,,1275,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,892.5,70,,892.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,892.5,
TELEFLEX 5540 6FR CATHETER 145CM,C1887,HCPCS,,79011610,CDM,272,RC,,,both,,,2328,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1629.6,70,,1629.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1629.6,
MEDTRONIC LA7AL10 GUIDECATH 7FR AL1,C1887,HCPCS,,79011617,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA7AR10 GUIDECATH 7FR AR1,C1887,HCPCS,,79011618,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA7EBU30 GUIDECATH 7FR EBU 3.0,C1887,HCPCS,,79011619,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA7IMAD GUIDECATH 7FR IM,C1887,HCPCS,,79011620,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA7JL40SH GUIDECATH 7FR JL 4.0,C1887,HCPCS,,79011621,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA7EBU35 GUIDECATH 7FR EBU 3.5,C1887,HCPCS,,79011622,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA7EBU40 GUIDECATH 7FR EBU 4.0,C1887,HCPCS,,79011623,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA7JR40 GUIDECATH 7FR JR 4.0,C1887,HCPCS,,79011624,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6MP1 GUIDECATH 6FR MP1,C1887,HCPCS,,79011625,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6HSII GUIDECATH 6FR HS2,C1887,HCPCS,,79011626,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JL45SH GUIDECATH 6FR JL 4.5,C1887,HCPCS,,79011627,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JL45 GUIDECATH 6FR JL 4.5 S,C1887,HCPCS,,79011628,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JR45 GUIDECATH 6FR JR 4.5,C1887,HCPCS,,79011629,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LAJR50 GUIDECATH 6FR JR 5,C1887,HCPCS,,79011630,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JR50SH GUIDECATH 6FR JR 5 S,C1887,HCPCS,,79011631,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6EBU45 GUIDECATH 6FR EBU 4.5,C1887,HCPCS,,79011632,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AL30 LAUNCHER GUIDECATH 6FR,C1887,HCPCS,,79011834,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA5JL35 GUIDECATH 5FR JL 3.5,C1887,HCPCS,,79011915,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA5JL40 GUIDECATH 5FR JL 4.0,C1887,HCPCS,,79011916,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA5JR40 GUIDECATH 5FR JR 4.0,C1887,HCPCS,,79011917,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA5EBU30 GUIDECATH 5FR EBU 3.0,C1887,HCPCS,,79011918,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA5EBU35 GUIDECATH 5FR EBU 3.5,C1887,HCPCS,,79011919,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA5EBY375 GUIDECATH 5FR 3.75,C1887,HCPCS,,79011920,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA5IMA GUIDECATH 5FR IMA,C1887,HCPCS,,79011921,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
CARDINAL 55800200 GUIDECATH 5FR JL 3.5,C1887,HCPCS,,79011925,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 55800400 GUIDECATH 5FR JL 4.0,C1887,HCPCS,,79011926,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 55808200 GUIDECATH 5FR JR 4.0,C1887,HCPCS,,79011927,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 55819000 GUIDECATH 5FR IM,C1887,HCPCS,,79011928,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67206600 GUIDECATH 6FR XB LAD 3,C1887,HCPCS,,79011929,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67206000 GUIDECATH 6FR XB 3.5,C1887,HCPCS,,79011930,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67206200 GUIDECATH 6FR XB LAD 4,C1887,HCPCS,,79011931,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67206400 GUIDECATH 6FR XB 4.5,C1887,HCPCS,,79011932,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL SRD6994 5FR JL 3 100CM CATHETER,C1887,HCPCS,,79011978,CDM,272,RC,,,both,,,23,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16.1,70,,16.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,16.1,
CARDINAL 67212600 GUIDECATH 6FR XB RCA,C1887,HCPCS,,79012005,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67212700 GUIDECATH 6FR XB W/SH,C1887,HCPCS,,79012006,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
MEDTRONIC TELE6F 6FR TELESCOPE 150CM,C1887,HCPCS,,79012539,CDM,272,RC,,,both,,,1200,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,840,70,,840,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
MEDTRONIC TELE7F 7FR TELESCOPE 150CM,C1887,HCPCS,,79012540,CDM,272,RC,,,both,,,1200,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,840,70,,840,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
MEDTRONIC LA6AL10A CATH LA 6F 110CM AL10,C1887,HCPCS,,79012847,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6EBU375A CATH 6F 110CM EB375,C1887,HCPCS,,79012848,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JL35A CATH 6F 110CM JL35,C1887,HCPCS,,79012849,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JL40A CATH 6F 110CM JL40,C1887,HCPCS,,79012850,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6JR40A CATH 6F 110CM JR40,C1887,HCPCS,,79012851,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
CARDINAL 67005400 3.5 GUIDE CATH VISTABR,C1887,HCPCS,,79012877,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67027000 MP1 GUIDE CATH VISTABR,C1887,HCPCS,,79012878,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67027800 GUIDE CATH VISTABRI,C1887,HCPCS,,79012879,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
CARDINAL 67019000 IM GUIDE CATH VISTABR,C1887,HCPCS,,79012880,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
MEDTRONIC LA6EBU35A CATH LA 6F 110 EB35,C1887,HCPCS,,79012881,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AL20A CATH LA 6F 110CM AL20,C1887,HCPCS,,79012882,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MEDTRONIC LA6AL30A CATH LA 6F 110CM AL30,C1887,HCPCS,,79012883,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
CARDINAL 67006600 XBLAD 3 GUIDE CATH,C1887,HCPCS,,79012899,CDM,272,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126,70,,126,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
TERUMO M3-1430 FINECROSS MICROGUIDE 130,C1887,HCPCS,,79013552,CDM,272,RC,,,both,,,2175,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1522.5,70,,1522.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1522.5,
MEDTRONIC LA7JL40 GUIDECATH 7FR JL 4.0,C1887,HCPCS,,79013655,CDM,272,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
PENUMBRA CAT7DKIT INDIGO CATH 7DX50 KIT,C1887,HCPCS,,79013721,CDM,272,RC,,,both,,,8070,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5649,70,,5649,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5649,
PENUMBRA CATRXKIT INDIGO CATH RXX140 KIT,C1887,HCPCS,,79013722,CDM,272,RC,,,both,,,5400,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3780,70,,3780,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3780,
PENUMBRA LITNGBT7TQ130 BOLT 7 CATH X130,C1887,HCPCS,,79013723,CDM,272,RC,,,both,,,24060,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,16842,70,,16842,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,16842,
MEDTRONIC REACT-71 CATH .071 ID,C1887,HCPCS,,79013866,CDM,272,RC,,,both,,,6285,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4399.5,70,,4399.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4399.5,
MEDTRONIC REACT-68 REACT CATH .068 ID,C1887,HCPCS,,79013867,CDM,272,RC,,,both,,,6285,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4399.5,70,,4399.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4399.5,
MEDTRONIC FG13160-0615-1S MICRO CATHETER,C1887,HCPCS,,79013873,CDM,272,RC,,,both,,,3015,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2110.5,70,,2110.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2110.5,
PENUMBRA RED72KIT RED 72 CATH/TUBING,C1887,HCPCS,,79013875,CDM,272,RC,,,both,,,8250,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5775,70,,5775,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5775,
PENUMBRA RED62SKIT RED 62 CATH/TUBING,C1887,HCPCS,,79013876,CDM,272,RC,,,both,,,8250,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5775,70,,5775,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5775,
PENUMBRA RED43160 RED 43 REPERFUS CATH,C1887,HCPCS,,79013877,CDM,272,RC,,,both,,,7170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5019,70,,5019,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5019,
PENUMBRA RED43138 RED 43 REPERFUS CATH,C1887,HCPCS,,79013878,CDM,272,RC,,,both,,,7170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5019,70,,5019,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5019,
PENUMBRA BMX9690BER125 BMX96 90CM 6F,C1887,HCPCS,,79013881,CDM,272,RC,,,both,,,2685,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1879.5,70,,1879.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1879.5,
PENUMBRA BMX9690SIM125 BMX96 90CM 6F,C1887,HCPCS,,79013882,CDM,272,RC,,,both,,,2685,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1879.5,70,,1879.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1879.5,
PENUMBRA BMX9680BER105 BMX96 80CM 6F,C1887,HCPCS,,79013883,CDM,272,RC,,,both,,,2685,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1879.5,70,,1879.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1879.5,
GETINGE 0684-00-0403-05 7.5FR SHEATH SET,C1893,HCPCS,,79011923,CDM,272,RC,,,both,,,115,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,80.5,70,,80.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,80.5,
GETINGE 0684-00-0403-10 8FR SHEATH SET,C1893,HCPCS,,79011924,CDM,272,RC,,,both,,,111,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,77.7,70,,77.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,77.7,
TERUMO 80-1065 6FR GLIDESHEATH W/NEEDLE,C1893,HCPCS,,79011933,CDM,272,RC,,,both,,,319,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,223.3,70,,223.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.3,
VASCULAR 7262V 4FR STIFF MICROPUNT VASC,C1893,HCPCS,,79011934,CDM,272,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,90.3,70,,90.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90.3,
COOK G03224 INTRODCR PLVW-7.0.38-30-VADS,C1894,HCPCS,,79000046,CDM,272,RC,,,both,,,204,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,142.8,70,,142.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142.8,
COOK G02994 INTRODUCER SET PEEL-AWAY 8FR,C1894,HCPCS,,79000047,CDM,272,RC,,,both,,,204,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,142.8,70,,142.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142.8,
COOK G08956 12FR INTRODUCER SHEATH X30CM,C1894,HCPCS,,79000070,CDM,272,RC,,,both,,,214,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,149.8,70,,149.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,149.8,
COOK G06492 12FR PEEL-AWAY SHEATH,C1894,HCPCS,,79000071,CDM,272,RC,,,both,,,124,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,86.8,70,,86.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.8,
COOK G06496 14FR PEEL-AWAY SHEATH,C1894,HCPCS,,79000079,CDM,272,RC,,,both,,,124,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,86.8,70,,86.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.8,
COOK G08957 14FRX30CM INTRODUCER SHEATH,C1894,HCPCS,,79000080,CDM,272,RC,,,both,,,183,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,128.1,70,,128.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.1,
COOK G09691 16FR INTRODUCER SHEATH 30CM,C1894,HCPCS,,79000082,CDM,272,RC,,,both,,,358,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,250.6,70,,250.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,250.6,
COOK G11672 18FR INTRODUCER SHEATH 30CM,C1894,HCPCS,,79000083,CDM,272,RC,,,both,,,358,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,250.6,70,,250.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,250.6,
COOK G28999 20FRX25CM INTRODUCER SHEATH,C1894,HCPCS,,79000089,CDM,272,RC,,,both,,,1242,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,869.4,70,,869.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,869.4,
ANGIODYNAMICS 6508402 MICRO INTRODUCER,C1894,HCPCS,,79000104,CDM,272,RC,,,both,,,593,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,415.1,70,,415.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,415.1,
ANGIODYNAMICS H965457501 4FRX10CM MINSTK,C1894,HCPCS,,79000105,CDM,272,RC,,,both,,,98,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,68.6,70,,68.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,68.6,
ANGIODYNAMICS 45-900 4FR MINSTK KIT,C1894,HCPCS,,79000106,CDM,272,RC,,,both,,,58,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,40.6,70,,40.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40.6,
NAVILYST 45-994 5FR MICROPUNCTURE SET,C1894,HCPCS,,79000132,CDM,272,RC,,,both,,,97,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,67.9,70,,67.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,67.9,
TERUMO RSB503 5FR PINNACLE SHEATH 25CM,C1894,HCPCS,,79000136,CDM,272,RC,,,both,,,101,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70.7,70,,70.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70.7,
TERUMO 5FR R02 SHEATH 10CM,C1894,HCPCS,,79000137,CDM,272,RC,,,both,,,78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,54.6,70,,54.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.6,
TERUMO RSB501 5FR PINNACLE SHEATH 6CM,C1894,HCPCS,,79000138,CDM,272,RC,,,both,,,73,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,51.1,70,,51.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,51.1,
BOST SCI 15-721B 5FR SUPER SHEATH 11CM,C1894,HCPCS,,79000140,CDM,272,RC,,,both,,,66,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,46.2,70,,46.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.2,
NAVILYST 45-990 5FR VAXCEL MIN-STICK KIT,C1894,HCPCS,,79000141,CDM,272,RC,,,both,,,136,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,95.2,70,,95.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,95.2,
TERUMO RSB512 5FRX10CM SHEATH INTRODUCER,C1894,HCPCS,,79000142,CDM,272,RC,,,both,,,9,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6.3,70,,6.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6.3,
TERUMO RSR14 6FR DESTINATION LIMA,C1894,HCPCS,,79000168,CDM,272,RC,,,both,,,313,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,219.1,70,,219.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,219.1,
TERUMO RSR13 6FR DESTINATION RDC,C1894,HCPCS,,79000169,CDM,272,RC,,,both,,,319,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,223.3,70,,223.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.3,
TERUMO RSP01 6FR DESTINATION SHEATH 65CM,C1894,HCPCS,,79000170,CDM,272,RC,,,both,,,348,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,243.6,70,,243.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,243.6,
TERUMO RSC05 6FR DESTINATION SHEATH 90CM,C1894,HCPCS,,79000171,CDM,272,RC,,,both,,,383,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,268.1,70,,268.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.1,
TERUMO RSB603 6FRX25CM TERUMO SHEATH R/O,C1894,HCPCS,,79000173,CDM,272,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70,70,,70,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
COOK G11638 6FR RAABE SHEATH 55CM,C1894,HCPCS,,79000174,CDM,272,RC,,,both,,,132,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,92.4,70,,92.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,92.4,
TERUMO RSB601 6FRX6CM TERUMO SHEATH R/O,C1894,HCPCS,,79000175,CDM,272,RC,,,both,,,73,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,51.1,70,,51.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,51.1,
TERUMO RSB612 6FRX10CM SHEATH,C1894,HCPCS,,79000178,CDM,272,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,70,,63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63,
TERUMO RSR01 6FRX45CM DESTINATION SHEATH,C1894,HCPCS,,79000179,CDM,272,RC,,,both,,,313,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,219.1,70,,219.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,219.1,
TERUMO RSB702 7FRX10CM BRITE TIP SHEATH,C1894,HCPCS,,79000206,CDM,272,RC,,,both,,,78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,54.6,70,,54.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.6,
TERUMO RSC06 7FR DESTINATION SHEATH 90CM,C1894,HCPCS,,79000207,CDM,272,RC,,,both,,,383,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,268.1,70,,268.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.1,
TERUMO RSB703 7FRX25CM PINNACLE SHEATH,C1894,HCPCS,,79000208,CDM,272,RC,,,both,,,101,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70.7,70,,70.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70.7,
COOK G11633 7FR RAABE SHEATH 55CM,C1894,HCPCS,,79000209,CDM,272,RC,,,both,,,132,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,92.4,70,,92.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,92.4,
TERUMO RSB701 7FR SHORT BRITE SHEATH,C1894,HCPCS,,79000211,CDM,272,RC,,,both,,,73,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,51.1,70,,51.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,51.1,
TERUMO RSR04 7FRX45CM DESTINATION SHEATH,C1894,HCPCS,,79000212,CDM,272,RC,,,both,,,313,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,219.1,70,,219.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,219.1,
TERUMO 8FR PINNACLE BRITETIP SHEATH 25CM,C1894,HCPCS,,79000236,CDM,272,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70,70,,70,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
TERUMO 8FR 10CM SHEATH,C1894,HCPCS,,79000237,CDM,272,RC,,,both,,,78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,54.6,70,,54.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.6,
CARDIO MED CME9 9FR INTRODUCER,C1894,HCPCS,,79000253,CDM,272,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,67.2,70,,67.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,67.2,
TERUMO 9FR R02 PINNACLE SHEATH 6CM,C1894,HCPCS,,79000254,CDM,272,RC,,,both,,,73,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,51.1,70,,51.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,51.1,
TERUMO 9FR SHEATH 10CM,C1894,HCPCS,,79000255,CDM,272,RC,,,both,,,78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,54.6,70,,54.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.6,
COOK G44154 FLEXOR CHECK-FLO CATH 6FRX45,C1894,HCPCS,,79000365,CDM,272,RC,,,both,,,151,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,105.7,70,,105.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105.7,
STRYKER G11636 FLEXOR SHEATH 70CMX6FR,C1894,HCPCS,,79000366,CDM,272,RC,,,both,,,167,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,116.9,70,,116.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,116.9,
COOK G02947 INTRODUCER PEEL-AWAY,C1894,HCPCS,,79000400,CDM,272,RC,,,both,,,188,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,131.6,70,,131.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,131.6,
INTRODUCER SET PEEL-AWAY 8FR,C1894,HCPCS,,79000401,CDM,272,RC,,,both,,,204,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,142.8,70,,142.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142.8,
NAVILYST 45-989 PEELABLE 4FR MINI-STICK,C1894,HCPCS,,79000443,CDM,272,RC,,,both,,,166,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,116.2,70,,116.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,116.2,
J&J 401-855M SHEATH BRITE-TIP 8FR,C1894,HCPCS,,79000493,CDM,272,RC,,,both,,,112,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,78.4,70,,78.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78.4,
J&J 401-890M SHEATH BRITE-TIP 8FR,C1894,HCPCS,,79000494,CDM,272,RC,,,both,,,318,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,222.6,70,,222.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,222.6,
INTRODUCER PER-Q-CATH 3FR,C1894,HCPCS,,79000596,CDM,272,RC,,,both,,,102,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,71.4,70,,71.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.4,
ANGIODYNAMICS HMP-009-08 8FR INTRODUCER,C1894,HCPCS,,79000679,CDM,272,RC,,,both,,,184,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,128.8,70,,128.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.8,
ANGIODYNAMICS HMP-009-09 9FR INTRODUCER,C1894,HCPCS,,79000680,CDM,272,RC,,,both,,,170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,119,70,,119,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,119,
ANGIODYNAMICS HMP-009-10 10FR INTRODUCER,C1894,HCPCS,,79000681,CDM,272,RC,,,both,,,184,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,128.8,70,,128.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.8,
ANGIODYNAMICS HMP-009-12 12FR INTRODUCER,C1894,HCPCS,,79000682,CDM,272,RC,,,both,,,179,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,125.3,70,,125.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,125.3,
CARDIO MEDICAL CME6 INTRODUCER 6FR,C1894,HCPCS,,79000957,CDM,272,RC,,,both,,,145,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,101.5,70,,101.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,101.5,
CARDIO MEDICAL CME7 INTRODUCER 7FR,C1894,HCPCS,,79000958,CDM,272,RC,,,both,,,145,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,101.5,70,,101.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,101.5,
CARDIO MEDICAL IS-08AS INTRODUCER 8FR,C1894,HCPCS,,79000959,CDM,272,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70,70,,70,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
BOST SCI 20-703 ACCUSTICK STR WIRE 21X15,C1894,HCPCS,,79003214,CDM,272,RC,,,both,,,260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182,70,,182,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182,
BOST SCI 20-710 ACCUSTICK JTIP WIRE21X15,C1894,HCPCS,,79003215,CDM,272,RC,,,both,,,233,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,163.1,70,,163.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.1,
J&J 401-755M BRITE TIP SHEATHS 7FRX55CM,C1894,HCPCS,,79003216,CDM,272,RC,,,both,,,112,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,78.4,70,,78.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78.4,
J&J 401-823M BRITE TIP SHEATHS 8FRX23CM,C1894,HCPCS,,79003217,CDM,272,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,70,70,,70,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
COOK G32233 10FR CHECK-FLO INTRODUCERSET,C1894,HCPCS,,79003218,CDM,272,RC,,,both,,,306,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,214.2,70,,214.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.2,
COOK G29986 7FR CHECK-FLO INTRODUCER SET,C1894,HCPCS,,79003219,CDM,272,RC,,,both,,,245,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,171.5,70,,171.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,171.5,
COOK G56233 8FR CHECK-FLO INTRODUCER,C1894,HCPCS,,79003220,CDM,272,RC,,,both,,,192,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,134.4,70,,134.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
COOK G56222 7FR CHECK-FLO INTRODUCER,C1894,HCPCS,,79003221,CDM,272,RC,,,both,,,222,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,155.4,70,,155.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,155.4,
COOK G56221 6FR CHECK-FLO INTRODUCER,C1894,HCPCS,,79003222,CDM,272,RC,,,both,,,222,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,155.4,70,,155.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,155.4,
COOK G12831 22FR CHECK-FLO INTRODUCER,C1894,HCPCS,,79003223,CDM,272,RC,,,both,,,1018,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,712.6,70,,712.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,712.6,
COOK G47944 4FR MICROPUNCT INTRODUCER ST,C1894,HCPCS,,79003224,CDM,272,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,76.3,70,,76.3,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.3,
COOK G48002 4FR STIFF MICROPUNCT INTROD,C1894,HCPCS,,79003225,CDM,272,RC,,,both,,,116,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,81.2,70,,81.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,81.2,
COOK G02972 4FR MICROPUNCT PEDAL ACC SET,C1894,HCPCS,,79003226,CDM,272,RC,,,both,,,178,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,124.6,70,,124.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.6,
COOK G03563 5FR NEEDLE SET 15CM,C1894,HCPCS,,79003227,CDM,272,RC,,,both,,,134,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,93.8,70,,93.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.8,
COOK G03388 5FR NEEDLE SET 25CM,C1894,HCPCS,,79003228,CDM,272,RC,,,both,,,134,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,93.8,70,,93.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.8,
TERUMO RSC08 7FR DEST GUIDE SHEATH 90CM,C1894,HCPCS,,79003229,CDM,272,RC,,,both,,,383,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,268.1,70,,268.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.1,
GORE DSL1828 DRYSEAL SHEATH,C1894,HCPCS,,79003643,CDM,272,RC,,,both,,,1014,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,709.8,70,,709.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,709.8,
J&J 401-655MRR 6FR 55CM BRITE TIP SHEATH,C1894,HCPCS,,79005073,CDM,272,RC,,,both,,,34,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,23.8,70,,23.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.8,
J&J 401-755MRR 7FR 55CM BRITE TIP SHEATH,C1894,HCPCS,,79005074,CDM,272,RC,,,both,,,34,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,23.8,70,,23.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.8,
COOK G11672RR 18FR 30CM CHECK-FLO SHEATH,C1894,HCPCS,,79005075,CDM,272,RC,,,both,,,156,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.2,70,,109.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.2,
TERUMO 54-89001 DESTINATION SHEATH 8X90,C1894,HCPCS,,79007350,CDM,272,RC,,,both,,,383,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,268.1,70,,268.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.1,
TERUMO RSB412 4FRX10 SHEATH W/GUIDEWIRE,C1894,HCPCS,,79007374,CDM,272,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,70,,63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63,
TERUMO RSB712 7FRX10 SHEATH W/GUIDEWIRE,C1894,HCPCS,,79007375,CDM,272,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,70,,63,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63,
COOK G35550 4FR STIFF MICROPUNCTURE,C1894,HCPCS,,79009771,CDM,272,RC,,,both,,,60,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,42,70,,42,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42,
COOK G35551 5FR STIFFENED MICROPUNCTURE,C1894,HCPCS,,79011132,CDM,272,RC,,,both,,,68,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,47.6,70,,47.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,47.6,
BOSTON H749501001500 FILTERWIRE SHEATH,C1894,HCPCS,,79011608,CDM,272,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,168,70,,168,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
BOST SCI 4712 ELECTRODE DELIVERY SYSTEM,C1894,HCPCS,,79012162,CDM,272,RC,,,both,,,2913,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2039.1,70,,2039.1,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2039.1,
TERUMO RSB801 8FRX6CM TERUMO SHEATH R/O,C1894,HCPCS,,79012371,CDM,272,RC,,,both,,,164,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,114.8,70,,114.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,114.8,
COOK G56279 12FRX45CM SHEATH INTRODUCER,C1894,HCPCS,,79013646,CDM,272,RC,,,both,,,191,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,133.7,70,,133.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.7,
COOK G56278 10FRX45CM SHEATH INTRODUCER,C1894,HCPCS,,79013647,CDM,272,RC,,,both,,,191,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,133.7,70,,133.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.7,
TERUMO RSB912 9FR 1OCM SHEATH W/WIRE,C1894,HCPCS,,79013702,CDM,272,RC,,,both,,,181,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126.7,70,,126.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.7,
MEDTRONIC ADM04004013P 4X60 ADMIRAL DCB,C2623,HCPCS,,79007827,CDM,272,RC,,,both,,,3990,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2793,70,,2793,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2793,
MEDTRONIC ADM05006013P 5X60 ADMIRAL DCB,C2623,HCPCS,,79007828,CDM,272,RC,,,both,,,3990,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2793,70,,2793,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2793,
MEDTRONIC ADM05008013P 5X80 ADMIRAL DCB,C2623,HCPCS,,79007829,CDM,272,RC,,,both,,,3990,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2793,70,,2793,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2793,
MEDTRONIC ADM06004013P 6X40 ADMIRAL DCB,C2623,HCPCS,,79007830,CDM,272,RC,,,both,,,3990,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2793,70,,2793,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2793,
MEDTRONIC ADM06006013P 6X60 ADMIRAL DCB,C2623,HCPCS,,79007831,CDM,272,RC,,,both,,,3990,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2793,70,,2793,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2793,
MEDTRONIC ADM06008013P 6X80 ADMIRAL DCB,C2623,HCPCS,,79007832,CDM,272,RC,,,both,,,4470,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3129,70,,3129,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3129,
MEDTRONIC ADM06012013P 6X120 ADMIRAL DCB,C2623,HCPCS,,79007833,CDM,272,RC,,,both,,,4920,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3444,70,,3444,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3444,
MEDTRONIC ADM07004013P 7X40 ADMIRAL DCB,C2623,HCPCS,,79007834,CDM,272,RC,,,both,,,3990,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2793,70,,2793,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2793,
MEDTRONIC ADM07008013P 7X80 ADMIRAL DCB,C2623,HCPCS,,79007835,CDM,272,RC,,,both,,,3990,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2793,70,,2793,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2793,
MEDTRONIC ADM05012013P ADMIRAL DCB 5X120,C2623,HCPCS,,79008065,CDM,272,RC,,,both,,,4440,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3108,70,,3108,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3108,
MEDTRONIC IAV09004008P 9X40X80 BALLOON,C2623,HCPCS,,79011158,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC ADM06020013P 6X200MM BALLOON,C2623,HCPCS,,79011611,CDM,272,RC,,,both,,,5835,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4084.5,70,,4084.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4084.5,
MEDTRONIC ADM05015013P 5X150 DC BALLOON,C2623,HCPCS,,79012735,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC ADM05025013P 5X250 DC BALLOON,C2623,HCPCS,,79012736,CDM,272,RC,,,both,,,6420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4494,70,,4494,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4494,
MEDTRONIC ADM06025013P 6X250 DC BALLOON,C2623,HCPCS,,79012737,CDM,272,RC,,,both,,,6420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4494,70,,4494,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4494,
MEDTRONIC IAV06006008P 6X60X80CM BALLOON,C2623,HCPCS,,79013507,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC ADM05020013P 5X200 BALLOON,C2623,HCPCS,,79013526,CDM,272,RC,,,both,,,5835,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4084.5,70,,4084.5,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4084.5,
MEDTRONIC IPU04006013P 4X60X130 .018 DCB,C2623,HCPCS,,79013731,CDM,272,RC,,,both,,,3750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2625,70,,2625,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2625,
MEDTRONIC IPU04008013P 4X80X130 .018 DCB,C2623,HCPCS,,79013732,CDM,272,RC,,,both,,,3750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2625,70,,2625,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2625,
MEDTRONIC IPU04010013P 4X100X130 .018DCB,C2623,HCPCS,,79013733,CDM,272,RC,,,both,,,4200,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2940,70,,2940,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
MEDTRONIC IPU04012013P 4X120X130 .018DCB,C2623,HCPCS,,79013734,CDM,272,RC,,,both,,,4200,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2940,70,,2940,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
MEDTRONIC IPU0401013P 4X150X130 .018DCB,C2623,HCPCS,,79013735,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC IPU05004013P 5X40X130 .018DCB,C2623,HCPCS,,79013736,CDM,272,RC,,,both,,,3750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2625,70,,2625,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2625,
MEDTRONIC IPU05006013P 5X60X130 .018 DCB,C2623,HCPCS,,79013737,CDM,272,RC,,,both,,,3750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2625,70,,2625,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2625,
MEDTRONIC IPU05008013P 5X80X130 .018DCB,C2623,HCPCS,,79013738,CDM,272,RC,,,both,,,3750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2625,70,,2625,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2625,
MEDTRONIC IPU05010013P 5X100X130 .018DCB,C2623,HCPCS,,79013739,CDM,272,RC,,,both,,,4200,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2940,70,,2940,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
MEDTRONIC IPU05012013P 5X120X130 .018DCB,C2623,HCPCS,,79013740,CDM,272,RC,,,both,,,4200,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2940,70,,2940,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
MEDTRONIC IPU05012013P 5X150X130 .018DCB,C2623,HCPCS,,79013741,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
MEDTRONIC IPU06004013P 6X40X130 .018 DCB,C2623,HCPCS,,79013742,CDM,272,RC,,,both,,,3750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2625,70,,2625,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2625,
MEDTRONIC IPU06006013P 6X60X130 .018 DCB,C2623,HCPCS,,79013743,CDM,272,RC,,,both,,,3750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2625,70,,2625,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2625,
MEDTRONIC IPU06008013P 6X80X130 .018 DCB,C2623,HCPCS,,79013744,CDM,272,RC,,,both,,,3750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2625,70,,2625,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2625,
MEDTRONIC IPU06010013P 6X100X130 .018DCB,C2623,HCPCS,,79013745,CDM,272,RC,,,both,,,4200,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2940,70,,2940,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
MEDTRONIC IPU06012013P 6X120X130 .018DCB,C2623,HCPCS,,79013746,CDM,272,RC,,,both,,,4200,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2940,70,,2940,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
MEDTRONIC IPU07006013P 7X60X130 .018 DCB,C2623,HCPCS,,79013747,CDM,272,RC,,,both,,,3750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2625,70,,2625,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2625,
MEDTRONIC IPU07008013P 7X80X130 .018 DCB,C2623,HCPCS,,79013748,CDM,272,RC,,,both,,,3750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2625,70,,2625,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2625,
MEDTRONIC IPU06015013P .018 INPACT DCB,C2623,HCPCS,,79013836,CDM,272,RC,,,both,,,4650,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3255,70,,3255,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3255,
COOK G24237 BALLOON UTERINE 24FR 54CM,C2628,HCPCS,,79012105,CDM,272,RC,,,both,,,807,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,564.9,70,,564.9,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,564.9,
TLSO BRACE,L1200,HCPCS,,79000578,CDM,274,RC,,,both,,,2853,1125.99,39.4668,,1125.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,970.02,34,,970.02,percent of total billed charges,Implant Device,970.02,34,,970.02,percent of total billed charges,Implant Device,970.02,34,,970.02,percent of total billed charges,Implant Device,970.02,34,,970.02,percent of total billed charges,Implant Device,970.02,34,,970.02,percent of total billed charges,Implant Device,970.02,34,,970.02,percent of total billed charges,Implant Device,998.55,35,,998.55,percent of total billed charges,Implant Device,970.02,34,"Charges > $500, x 34%",970.02,percent of total billed charges,Implant Device,998.55,35,,998.55,percent of total billed charges,Implant Devices,998.55,35,,998.55,percent of total billed charges,Implant Devices,998.55,35,,,percent of total billed charges,Implant Devices,998.55,35,,998.55,percent of total billed charges,Implant Devices,998.55,35,,998.55,percent of total billed charges,Implant Devices,1141.2,40,,1141.2,percent of total billed charges,Implant Devices,1997.1,70,,1997.1,percent of total billed charges,Implant Devices,970.02,34,,970.02,percent of total billed charges,Implant Devices,970.02,34,,970.02,percent of total billed charges,Implant Devices,998.55,35,,998.55,percent of total billed charges,Implant Devices,998.55,35,,998.55,percent of total billed charges,Implant Devices,998.55,35,,998.55,percent of total billed charges,Implant Devices,998.55,35,,998.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,970.02,34,"If Charge > 2,000, then 34 percent",970.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1997.1,
MEDLINE ORT16300L IMMOBILIZ W/ABDUCT LG,L3650,HCPCS,,79013441,CDM,274,RC,,,both,,,51,20.13,39.4668,,20.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.85,35,,17.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,20.4,40,,20.4,percent of total billed charges,Implant Devices,17.85,70,,17.85,percent of total billed charges,Implant Devices,17.34,34,,17.34,percent of total billed charges,Implant Devices,17.34,34,,17.34,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20.4,
MEDLINE ORT16300M IMMOBILIZ W/ABDUCT MED,L3670,HCPCS,,79013440,CDM,274,RC,,,both,,,51,20.13,39.4668,,20.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.85,35,,17.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,20.4,40,,20.4,percent of total billed charges,Implant Devices,17.85,70,,17.85,percent of total billed charges,Implant Devices,17.34,34,,17.34,percent of total billed charges,Implant Devices,17.34,34,,17.34,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20.4,
MEDLINE ORT16300XL IMMOBILIZ W/ABDUC XL,L3670,HCPCS,,79013442,CDM,274,RC,,,both,,,51,20.13,39.4668,,20.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.34,34,,17.34,percent of total billed charges,Implant Device,17.85,35,,17.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,20.4,40,,20.4,percent of total billed charges,Implant Devices,17.85,70,,17.85,percent of total billed charges,Implant Devices,17.34,34,,17.34,percent of total billed charges,Implant Devices,17.34,34,,17.34,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,17.85,35,,17.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20.4,
BOST SC-6412-3 PRECISION CHARGE SYS KIT,L8689,HCPCS,,79012703,CDM,274,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
MEDTRONIC D314DRG PROTECTA XT,C1721,HCPCS,,79002650,CDM,275,RC,,,both,,,69354,27371.8,39.4668,,27371.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23580.36,34,,23580.36,percent of total billed charges,Implant Device,23580.36,34,,23580.36,percent of total billed charges,Implant Device,23580.36,34,,23580.36,percent of total billed charges,Implant Device,23580.36,34,,23580.36,percent of total billed charges,Implant Device,23580.36,34,,23580.36,percent of total billed charges,Implant Device,23580.36,34,,23580.36,percent of total billed charges,Implant Device,24273.9,35,,24273.9,percent of total billed charges,Implant Device,23580.36,34,"Charges > $500, x 34%",23580.36,percent of total billed charges,Implant Device,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,27741.6,40,,27741.6,percent of total billed charges,Implant Devices,24273.9,70,,24273.9,percent of total billed charges,Implant Devices,23580.36,34,,23580.36,percent of total billed charges,Implant Devices,23580.36,34,,23580.36,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,23580.36,34,"If Charge > 2,000, then 34 percent",23580.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27741.6,
MEDTRONIC D314DRM PROTECTA XT DR,C1721,HCPCS,,79002651,CDM,275,RC,,,both,,,69354,27371.8,39.4668,,27371.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23580.36,34,,23580.36,percent of total billed charges,Implant Device,23580.36,34,,23580.36,percent of total billed charges,Implant Device,23580.36,34,,23580.36,percent of total billed charges,Implant Device,23580.36,34,,23580.36,percent of total billed charges,Implant Device,23580.36,34,,23580.36,percent of total billed charges,Implant Device,23580.36,34,,23580.36,percent of total billed charges,Implant Device,24273.9,35,,24273.9,percent of total billed charges,Implant Device,23580.36,34,"Charges > $500, x 34%",23580.36,percent of total billed charges,Implant Device,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,27741.6,40,,27741.6,percent of total billed charges,Implant Devices,24273.9,70,,24273.9,percent of total billed charges,Implant Devices,23580.36,34,,23580.36,percent of total billed charges,Implant Devices,23580.36,34,,23580.36,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,24273.9,35,,24273.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,23580.36,34,"If Charge > 2,000, then 34 percent",23580.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27741.6,
MEDTRONIC D334DRG ICD PROTECTA,C1721,HCPCS,,79002652,CDM,275,RC,,,both,,,65430,25823.13,39.4668,,25823.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,22246.2,34,,22246.2,percent of total billed charges,Implant Device,22246.2,34,,22246.2,percent of total billed charges,Implant Device,22246.2,34,,22246.2,percent of total billed charges,Implant Device,22246.2,34,,22246.2,percent of total billed charges,Implant Device,22246.2,34,,22246.2,percent of total billed charges,Implant Device,22246.2,34,,22246.2,percent of total billed charges,Implant Device,22900.5,35,,22900.5,percent of total billed charges,Implant Device,22246.2,34,"Charges > $500, x 34%",22246.2,percent of total billed charges,Implant Device,22900.5,35,,22900.5,percent of total billed charges,Implant Devices,22900.5,35,,22900.5,percent of total billed charges,Implant Devices,22900.5,35,,,percent of total billed charges,Implant Devices,22900.5,35,,22900.5,percent of total billed charges,Implant Devices,22900.5,35,,22900.5,percent of total billed charges,Implant Devices,26172,40,,26172,percent of total billed charges,Implant Devices,22900.5,70,,22900.5,percent of total billed charges,Implant Devices,22246.2,34,,22246.2,percent of total billed charges,Implant Devices,22246.2,34,,22246.2,percent of total billed charges,Implant Devices,22900.5,35,,22900.5,percent of total billed charges,Implant Devices,22900.5,35,,22900.5,percent of total billed charges,Implant Devices,22900.5,35,,22900.5,percent of total billed charges,Implant Devices,22900.5,35,,22900.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,22246.2,34,"If Charge > 2,000, then 34 percent",22246.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,26172,
ST JUDE CD2231-40 PULSE GENERATOR,C1721,HCPCS,,79002685,CDM,275,RC,,,both,,,52096,20560.62,39.4668,,20560.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17712.64,34,,17712.64,percent of total billed charges,Implant Device,17712.64,34,,17712.64,percent of total billed charges,Implant Device,17712.64,34,,17712.64,percent of total billed charges,Implant Device,17712.64,34,,17712.64,percent of total billed charges,Implant Device,17712.64,34,,17712.64,percent of total billed charges,Implant Device,17712.64,34,,17712.64,percent of total billed charges,Implant Device,18233.6,35,,18233.6,percent of total billed charges,Implant Device,17712.64,34,"Charges > $500, x 34%",17712.64,percent of total billed charges,Implant Device,18233.6,35,,18233.6,percent of total billed charges,Implant Devices,18233.6,35,,18233.6,percent of total billed charges,Implant Devices,18233.6,35,,,percent of total billed charges,Implant Devices,18233.6,35,,18233.6,percent of total billed charges,Implant Devices,18233.6,35,,18233.6,percent of total billed charges,Implant Devices,20838.4,40,,20838.4,percent of total billed charges,Implant Devices,18233.6,70,,18233.6,percent of total billed charges,Implant Devices,17712.64,34,,17712.64,percent of total billed charges,Implant Devices,17712.64,34,,17712.64,percent of total billed charges,Implant Devices,18233.6,35,,18233.6,percent of total billed charges,Implant Devices,18233.6,35,,18233.6,percent of total billed charges,Implant Devices,18233.6,35,,18233.6,percent of total billed charges,Implant Devices,18233.6,35,,18233.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,17712.64,34,"If Charge > 2,000, then 34 percent",17712.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20838.4,
ST JUDE CD2357-40C FORTIFY ASSURA DR,C1721,HCPCS,,79002686,CDM,275,RC,,,both,,,44307,17486.56,39.4668,,17486.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15064.38,34,,15064.38,percent of total billed charges,Implant Device,15064.38,34,,15064.38,percent of total billed charges,Implant Device,15064.38,34,,15064.38,percent of total billed charges,Implant Device,15064.38,34,,15064.38,percent of total billed charges,Implant Device,15064.38,34,,15064.38,percent of total billed charges,Implant Device,15064.38,34,,15064.38,percent of total billed charges,Implant Device,15507.45,35,,15507.45,percent of total billed charges,Implant Device,15064.38,34,"Charges > $500, x 34%",15064.38,percent of total billed charges,Implant Device,15507.45,35,,15507.45,percent of total billed charges,Implant Devices,15507.45,35,,15507.45,percent of total billed charges,Implant Devices,15507.45,35,,,percent of total billed charges,Implant Devices,15507.45,35,,15507.45,percent of total billed charges,Implant Devices,15507.45,35,,15507.45,percent of total billed charges,Implant Devices,17722.8,40,,17722.8,percent of total billed charges,Implant Devices,15507.45,70,,15507.45,percent of total billed charges,Implant Devices,15064.38,34,,15064.38,percent of total billed charges,Implant Devices,15064.38,34,,15064.38,percent of total billed charges,Implant Devices,15507.45,35,,15507.45,percent of total billed charges,Implant Devices,15507.45,35,,15507.45,percent of total billed charges,Implant Devices,15507.45,35,,15507.45,percent of total billed charges,Implant Devices,15507.45,35,,15507.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,15064.38,34,"If Charge > 2,000, then 34 percent",15064.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,17722.8,
ST JUDE CD2257-40Q FORTIFY ASSURA DR,C1721,HCPCS,,79002687,CDM,275,RC,,,both,,,54586,21543.35,39.4668,,21543.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18559.24,34,,18559.24,percent of total billed charges,Implant Device,18559.24,34,,18559.24,percent of total billed charges,Implant Device,18559.24,34,,18559.24,percent of total billed charges,Implant Device,18559.24,34,,18559.24,percent of total billed charges,Implant Device,18559.24,34,,18559.24,percent of total billed charges,Implant Device,18559.24,34,,18559.24,percent of total billed charges,Implant Device,19105.1,35,,19105.1,percent of total billed charges,Implant Device,18559.24,34,"Charges > $500, x 34%",18559.24,percent of total billed charges,Implant Device,19105.1,35,,19105.1,percent of total billed charges,Implant Devices,19105.1,35,,19105.1,percent of total billed charges,Implant Devices,19105.1,35,,,percent of total billed charges,Implant Devices,19105.1,35,,19105.1,percent of total billed charges,Implant Devices,19105.1,35,,19105.1,percent of total billed charges,Implant Devices,21834.4,40,,21834.4,percent of total billed charges,Implant Devices,19105.1,70,,19105.1,percent of total billed charges,Implant Devices,18559.24,34,,18559.24,percent of total billed charges,Implant Devices,18559.24,34,,18559.24,percent of total billed charges,Implant Devices,19105.1,35,,19105.1,percent of total billed charges,Implant Devices,19105.1,35,,19105.1,percent of total billed charges,Implant Devices,19105.1,35,,19105.1,percent of total billed charges,Implant Devices,19105.1,35,,19105.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,18559.24,34,"If Charge > 2,000, then 34 percent",18559.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21834.4,
ST JUDE CD2311-36 ELLIPSE DR ICD,C1721,HCPCS,,79005188,CDM,275,RC,,,both,,,52095,20560.23,39.4668,,20560.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17712.3,34,,17712.3,percent of total billed charges,Implant Device,17712.3,34,,17712.3,percent of total billed charges,Implant Device,17712.3,34,,17712.3,percent of total billed charges,Implant Device,17712.3,34,,17712.3,percent of total billed charges,Implant Device,17712.3,34,,17712.3,percent of total billed charges,Implant Device,17712.3,34,,17712.3,percent of total billed charges,Implant Device,18233.25,35,,18233.25,percent of total billed charges,Implant Device,17712.3,34,"Charges > $500, x 34%",17712.3,percent of total billed charges,Implant Device,18233.25,35,,18233.25,percent of total billed charges,Implant Devices,18233.25,35,,18233.25,percent of total billed charges,Implant Devices,18233.25,35,,,percent of total billed charges,Implant Devices,18233.25,35,,18233.25,percent of total billed charges,Implant Devices,18233.25,35,,18233.25,percent of total billed charges,Implant Devices,20838,40,,20838,percent of total billed charges,Implant Devices,18233.25,70,,18233.25,percent of total billed charges,Implant Devices,17712.3,34,,17712.3,percent of total billed charges,Implant Devices,17712.3,34,,17712.3,percent of total billed charges,Implant Devices,18233.25,35,,18233.25,percent of total billed charges,Implant Devices,18233.25,35,,18233.25,percent of total billed charges,Implant Devices,18233.25,35,,18233.25,percent of total billed charges,Implant Devices,18233.25,35,,18233.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,17712.3,34,"If Charge > 2,000, then 34 percent",17712.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20838,
MEDTRONIC DDBB1D1 EVERA XT DR PACEMAKER,C1721,HCPCS,,79005567,CDM,275,RC,,,both,,,69465,27415.61,39.4668,,27415.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23618.1,34,,23618.1,percent of total billed charges,Implant Device,23618.1,34,,23618.1,percent of total billed charges,Implant Device,23618.1,34,,23618.1,percent of total billed charges,Implant Device,23618.1,34,,23618.1,percent of total billed charges,Implant Device,23618.1,34,,23618.1,percent of total billed charges,Implant Device,23618.1,34,,23618.1,percent of total billed charges,Implant Device,24312.75,35,,24312.75,percent of total billed charges,Implant Device,23618.1,34,"Charges > $500, x 34%",23618.1,percent of total billed charges,Implant Device,24312.75,35,,24312.75,percent of total billed charges,Implant Devices,24312.75,35,,24312.75,percent of total billed charges,Implant Devices,24312.75,35,,,percent of total billed charges,Implant Devices,24312.75,35,,24312.75,percent of total billed charges,Implant Devices,24312.75,35,,24312.75,percent of total billed charges,Implant Devices,27786,40,,27786,percent of total billed charges,Implant Devices,24312.75,70,,24312.75,percent of total billed charges,Implant Devices,23618.1,34,,23618.1,percent of total billed charges,Implant Devices,23618.1,34,,23618.1,percent of total billed charges,Implant Devices,24312.75,35,,24312.75,percent of total billed charges,Implant Devices,24312.75,35,,24312.75,percent of total billed charges,Implant Devices,24312.75,35,,24312.75,percent of total billed charges,Implant Devices,24312.75,35,,24312.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,23618.1,34,"If Charge > 2,000, then 34 percent",23618.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27786,
ST JUDE CD2357-40C FORTIFY ASSURA DR 40,C1721,HCPCS,,79007701,CDM,275,RC,,,both,,,46444,18329.96,39.4668,,18329.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15790.96,34,,15790.96,percent of total billed charges,Implant Device,15790.96,34,,15790.96,percent of total billed charges,Implant Device,15790.96,34,,15790.96,percent of total billed charges,Implant Device,15790.96,34,,15790.96,percent of total billed charges,Implant Device,15790.96,34,,15790.96,percent of total billed charges,Implant Device,15790.96,34,,15790.96,percent of total billed charges,Implant Device,16255.4,35,,16255.4,percent of total billed charges,Implant Device,15790.96,34,"Charges > $500, x 34%",15790.96,percent of total billed charges,Implant Device,16255.4,35,,16255.4,percent of total billed charges,Implant Devices,16255.4,35,,16255.4,percent of total billed charges,Implant Devices,16255.4,35,,,percent of total billed charges,Implant Devices,16255.4,35,,16255.4,percent of total billed charges,Implant Devices,16255.4,35,,16255.4,percent of total billed charges,Implant Devices,18577.6,40,,18577.6,percent of total billed charges,Implant Devices,16255.4,70,,16255.4,percent of total billed charges,Implant Devices,15790.96,34,,15790.96,percent of total billed charges,Implant Devices,15790.96,34,,15790.96,percent of total billed charges,Implant Devices,16255.4,35,,16255.4,percent of total billed charges,Implant Devices,16255.4,35,,16255.4,percent of total billed charges,Implant Devices,16255.4,35,,16255.4,percent of total billed charges,Implant Devices,16255.4,35,,16255.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,15790.96,34,"If Charge > 2,000, then 34 percent",15790.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18577.6,
ST JUDE CD2411-36C ELLIPSE DR ICD,C1721,HCPCS,,79008215,CDM,275,RC,,,both,,,45372,17906.88,39.4668,,17906.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15426.48,34,,15426.48,percent of total billed charges,Implant Device,15426.48,34,,15426.48,percent of total billed charges,Implant Device,15426.48,34,,15426.48,percent of total billed charges,Implant Device,15426.48,34,,15426.48,percent of total billed charges,Implant Device,15426.48,34,,15426.48,percent of total billed charges,Implant Device,15426.48,34,,15426.48,percent of total billed charges,Implant Device,15880.2,35,,15880.2,percent of total billed charges,Implant Device,15426.48,34,"Charges > $500, x 34%",15426.48,percent of total billed charges,Implant Device,15880.2,35,,15880.2,percent of total billed charges,Implant Devices,15880.2,35,,15880.2,percent of total billed charges,Implant Devices,15880.2,35,,,percent of total billed charges,Implant Devices,15880.2,35,,15880.2,percent of total billed charges,Implant Devices,15880.2,35,,15880.2,percent of total billed charges,Implant Devices,18148.8,40,,18148.8,percent of total billed charges,Implant Devices,15880.2,70,,15880.2,percent of total billed charges,Implant Devices,15426.48,34,,15426.48,percent of total billed charges,Implant Devices,15426.48,34,,15426.48,percent of total billed charges,Implant Devices,15880.2,35,,15880.2,percent of total billed charges,Implant Devices,15880.2,35,,15880.2,percent of total billed charges,Implant Devices,15880.2,35,,15880.2,percent of total billed charges,Implant Devices,15880.2,35,,15880.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,15426.48,34,"If Charge > 2,000, then 34 percent",15426.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18148.8,
BOST SCI M365SC12320 PULSE GENERATOR KIT,C1721,HCPCS,,79011850,CDM,275,RC,,,both,,,51000,20128.07,39.4668,,20128.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17340,34,,17340,percent of total billed charges,Implant Device,17340,34,,17340,percent of total billed charges,Implant Device,17340,34,,17340,percent of total billed charges,Implant Device,17340,34,,17340,percent of total billed charges,Implant Device,17340,34,,17340,percent of total billed charges,Implant Device,17340,34,,17340,percent of total billed charges,Implant Device,17850,35,,17850,percent of total billed charges,Implant Device,17340,34,"Charges > $500, x 34%",17340,percent of total billed charges,Implant Device,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,20400,40,,20400,percent of total billed charges,Implant Devices,17850,70,,17850,percent of total billed charges,Implant Devices,17340,34,,17340,percent of total billed charges,Implant Devices,17340,34,,17340,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,17340,34,"If Charge > 2,000, then 34 percent",17340,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20400,
ABBOTT CDDRA500Q GALLANT DR,C1721,HCPCS,,79012263,CDM,275,RC,,,both,,,54654,21570.18,39.4668,,21570.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18582.36,34,,18582.36,percent of total billed charges,Implant Device,18582.36,34,,18582.36,percent of total billed charges,Implant Device,18582.36,34,,18582.36,percent of total billed charges,Implant Device,18582.36,34,,18582.36,percent of total billed charges,Implant Device,18582.36,34,,18582.36,percent of total billed charges,Implant Device,18582.36,34,,18582.36,percent of total billed charges,Implant Device,19128.9,35,,19128.9,percent of total billed charges,Implant Device,18582.36,34,"Charges > $500, x 34%",18582.36,percent of total billed charges,Implant Device,19128.9,35,,19128.9,percent of total billed charges,Implant Devices,19128.9,35,,19128.9,percent of total billed charges,Implant Devices,19128.9,35,,,percent of total billed charges,Implant Devices,19128.9,35,,19128.9,percent of total billed charges,Implant Devices,19128.9,35,,19128.9,percent of total billed charges,Implant Devices,21861.6,40,,21861.6,percent of total billed charges,Implant Devices,19128.9,70,,19128.9,percent of total billed charges,Implant Devices,18582.36,34,,18582.36,percent of total billed charges,Implant Devices,18582.36,34,,18582.36,percent of total billed charges,Implant Devices,19128.9,35,,19128.9,percent of total billed charges,Implant Devices,19128.9,35,,19128.9,percent of total billed charges,Implant Devices,19128.9,35,,19128.9,percent of total billed charges,Implant Devices,19128.9,35,,19128.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,18582.36,34,"If Charge > 2,000, then 34 percent",18582.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21861.6,
BIOTRONIK 429534 RIVACOR 7 DR-T AICD,C1721,HCPCS,,79012416,CDM,275,RC,,,both,,,50028,19744.45,39.4668,,19744.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17009.52,34,,17009.52,percent of total billed charges,Implant Device,17009.52,34,,17009.52,percent of total billed charges,Implant Device,17009.52,34,,17009.52,percent of total billed charges,Implant Device,17009.52,34,,17009.52,percent of total billed charges,Implant Device,17009.52,34,,17009.52,percent of total billed charges,Implant Device,17009.52,34,,17009.52,percent of total billed charges,Implant Device,17509.8,35,,17509.8,percent of total billed charges,Implant Device,17009.52,34,"Charges > $500, x 34%",17009.52,percent of total billed charges,Implant Device,17509.8,35,,17509.8,percent of total billed charges,Implant Devices,17509.8,35,,17509.8,percent of total billed charges,Implant Devices,17509.8,35,,,percent of total billed charges,Implant Devices,17509.8,35,,17509.8,percent of total billed charges,Implant Devices,17509.8,35,,17509.8,percent of total billed charges,Implant Devices,20011.2,40,,20011.2,percent of total billed charges,Implant Devices,17509.8,70,,17509.8,percent of total billed charges,Implant Devices,17009.52,34,,17009.52,percent of total billed charges,Implant Devices,17009.52,34,,17009.52,percent of total billed charges,Implant Devices,17509.8,35,,17509.8,percent of total billed charges,Implant Devices,17509.8,35,,17509.8,percent of total billed charges,Implant Devices,17509.8,35,,17509.8,percent of total billed charges,Implant Devices,17509.8,35,,17509.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,17009.52,34,"If Charge > 2,000, then 34 percent",17009.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20011.2,
ABBOTT CDHFA500Q GALLANT HF,C1721,HCPCS,,79012498,CDM,275,RC,,,both,,,80478,31762.09,39.4668,,31762.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27362.52,34,,27362.52,percent of total billed charges,Implant Device,27362.52,34,,27362.52,percent of total billed charges,Implant Device,27362.52,34,,27362.52,percent of total billed charges,Implant Device,27362.52,34,,27362.52,percent of total billed charges,Implant Device,27362.52,34,,27362.52,percent of total billed charges,Implant Device,27362.52,34,,27362.52,percent of total billed charges,Implant Device,28167.3,35,,28167.3,percent of total billed charges,Implant Device,27362.52,34,"Charges > $500, x 34%",27362.52,percent of total billed charges,Implant Device,28167.3,35,,28167.3,percent of total billed charges,Implant Devices,28167.3,35,,28167.3,percent of total billed charges,Implant Devices,28167.3,35,,,percent of total billed charges,Implant Devices,28167.3,35,,28167.3,percent of total billed charges,Implant Devices,28167.3,35,,28167.3,percent of total billed charges,Implant Devices,32191.2,40,,32191.2,percent of total billed charges,Implant Devices,28167.3,70,,28167.3,percent of total billed charges,Implant Devices,27362.52,34,,27362.52,percent of total billed charges,Implant Devices,27362.52,34,,27362.52,percent of total billed charges,Implant Devices,28167.3,35,,28167.3,percent of total billed charges,Implant Devices,28167.3,35,,28167.3,percent of total billed charges,Implant Devices,28167.3,35,,28167.3,percent of total billed charges,Implant Devices,28167.3,35,,28167.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,27362.52,34,"If Charge > 2,000, then 34 percent",27362.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32191.2,
MEDTRONIC D314VRG PROTECTA XT VR,C1722,HCPCS,,79002653,CDM,275,RC,,,both,,,54012,21316.81,39.4668,,21316.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18364.08,34,,18364.08,percent of total billed charges,Implant Device,18364.08,34,,18364.08,percent of total billed charges,Implant Device,18364.08,34,,18364.08,percent of total billed charges,Implant Device,18364.08,34,,18364.08,percent of total billed charges,Implant Device,18364.08,34,,18364.08,percent of total billed charges,Implant Device,18364.08,34,,18364.08,percent of total billed charges,Implant Device,18904.2,35,,18904.2,percent of total billed charges,Implant Device,18364.08,34,"Charges > $500, x 34%",18364.08,percent of total billed charges,Implant Device,18904.2,35,,18904.2,percent of total billed charges,Implant Devices,18904.2,35,,18904.2,percent of total billed charges,Implant Devices,18904.2,35,,,percent of total billed charges,Implant Devices,18904.2,35,,18904.2,percent of total billed charges,Implant Devices,18904.2,35,,18904.2,percent of total billed charges,Implant Devices,21604.8,40,,21604.8,percent of total billed charges,Implant Devices,18904.2,70,,18904.2,percent of total billed charges,Implant Devices,18364.08,34,,18364.08,percent of total billed charges,Implant Devices,18364.08,34,,18364.08,percent of total billed charges,Implant Devices,18904.2,35,,18904.2,percent of total billed charges,Implant Devices,18904.2,35,,18904.2,percent of total billed charges,Implant Devices,18904.2,35,,18904.2,percent of total billed charges,Implant Devices,18904.2,35,,18904.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,18364.08,34,"If Charge > 2,000, then 34 percent",18364.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21604.8,
MEDTRONIC D314VRM PROTECTA XT VR DR4,C1722,HCPCS,,79002654,CDM,275,RC,,,both,,,56830,22428.98,39.4668,,22428.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19322.2,34,,19322.2,percent of total billed charges,Implant Device,19322.2,34,,19322.2,percent of total billed charges,Implant Device,19322.2,34,,19322.2,percent of total billed charges,Implant Device,19322.2,34,,19322.2,percent of total billed charges,Implant Device,19322.2,34,,19322.2,percent of total billed charges,Implant Device,19322.2,34,,19322.2,percent of total billed charges,Implant Device,19890.5,35,,19890.5,percent of total billed charges,Implant Device,19322.2,34,"Charges > $500, x 34%",19322.2,percent of total billed charges,Implant Device,19890.5,35,,19890.5,percent of total billed charges,Implant Devices,19890.5,35,,19890.5,percent of total billed charges,Implant Devices,19890.5,35,,,percent of total billed charges,Implant Devices,19890.5,35,,19890.5,percent of total billed charges,Implant Devices,19890.5,35,,19890.5,percent of total billed charges,Implant Devices,22732,40,,22732,percent of total billed charges,Implant Devices,19890.5,70,,19890.5,percent of total billed charges,Implant Devices,19322.2,34,,19322.2,percent of total billed charges,Implant Devices,19322.2,34,,19322.2,percent of total billed charges,Implant Devices,19890.5,35,,19890.5,percent of total billed charges,Implant Devices,19890.5,35,,19890.5,percent of total billed charges,Implant Devices,19890.5,35,,19890.5,percent of total billed charges,Implant Devices,19890.5,35,,19890.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,19322.2,34,"If Charge > 2,000, then 34 percent",19322.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22732,
MEDTRONIC D334VRG ICD PROTECTA,C1722,HCPCS,,79002655,CDM,275,RC,,,both,,,50956,20110.7,39.4668,,20110.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17325.04,34,,17325.04,percent of total billed charges,Implant Device,17325.04,34,,17325.04,percent of total billed charges,Implant Device,17325.04,34,,17325.04,percent of total billed charges,Implant Device,17325.04,34,,17325.04,percent of total billed charges,Implant Device,17325.04,34,,17325.04,percent of total billed charges,Implant Device,17325.04,34,,17325.04,percent of total billed charges,Implant Device,17834.6,35,,17834.6,percent of total billed charges,Implant Device,17325.04,34,"Charges > $500, x 34%",17325.04,percent of total billed charges,Implant Device,17834.6,35,,17834.6,percent of total billed charges,Implant Devices,17834.6,35,,17834.6,percent of total billed charges,Implant Devices,17834.6,35,,,percent of total billed charges,Implant Devices,17834.6,35,,17834.6,percent of total billed charges,Implant Devices,17834.6,35,,17834.6,percent of total billed charges,Implant Devices,20382.4,40,,20382.4,percent of total billed charges,Implant Devices,17834.6,70,,17834.6,percent of total billed charges,Implant Devices,17325.04,34,,17325.04,percent of total billed charges,Implant Devices,17325.04,34,,17325.04,percent of total billed charges,Implant Devices,17834.6,35,,17834.6,percent of total billed charges,Implant Devices,17834.6,35,,17834.6,percent of total billed charges,Implant Devices,17834.6,35,,17834.6,percent of total billed charges,Implant Devices,17834.6,35,,17834.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,17325.04,34,"If Charge > 2,000, then 34 percent",17325.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20382.4,
ST JUDE CD1231-40Q FORTIFY VR PACEMAKER,C1722,HCPCS,,79002688,CDM,275,RC,,,both,,,51270,20234.63,39.4668,,20234.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17944.5,35,,17944.5,percent of total billed charges,Implant Device,17431.8,34,"Charges > $500, x 34%",17431.8,percent of total billed charges,Implant Device,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,20508,40,,20508,percent of total billed charges,Implant Devices,17944.5,70,,17944.5,percent of total billed charges,Implant Devices,17431.8,34,,17431.8,percent of total billed charges,Implant Devices,17431.8,34,,17431.8,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,17431.8,34,"If Charge > 2,000, then 34 percent",17431.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20508,
ST JUDE CD1257-40 FORTIFYASSURA,C1722,HCPCS,,79002689,CDM,275,RC,,,both,,,44040,17381.18,39.4668,,17381.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14973.6,34,,14973.6,percent of total billed charges,Implant Device,14973.6,34,,14973.6,percent of total billed charges,Implant Device,14973.6,34,,14973.6,percent of total billed charges,Implant Device,14973.6,34,,14973.6,percent of total billed charges,Implant Device,14973.6,34,,14973.6,percent of total billed charges,Implant Device,14973.6,34,,14973.6,percent of total billed charges,Implant Device,15414,35,,15414,percent of total billed charges,Implant Device,14973.6,34,"Charges > $500, x 34%",14973.6,percent of total billed charges,Implant Device,15414,35,,15414,percent of total billed charges,Implant Devices,15414,35,,15414,percent of total billed charges,Implant Devices,15414,35,,,percent of total billed charges,Implant Devices,15414,35,,15414,percent of total billed charges,Implant Devices,15414,35,,15414,percent of total billed charges,Implant Devices,17616,40,,17616,percent of total billed charges,Implant Devices,15414,70,,15414,percent of total billed charges,Implant Devices,14973.6,34,,14973.6,percent of total billed charges,Implant Devices,14973.6,34,,14973.6,percent of total billed charges,Implant Devices,15414,35,,15414,percent of total billed charges,Implant Devices,15414,35,,15414,percent of total billed charges,Implant Devices,15414,35,,15414,percent of total billed charges,Implant Devices,15414,35,,15414,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,14973.6,34,"If Charge > 2,000, then 34 percent",14973.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,17616,
ST JUDE CD1357-40Q FORTIFY ASSURA,C1722,HCPCS,,79002690,CDM,275,RC,,,both,,,51270,20234.63,39.4668,,20234.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17431.8,34,,17431.8,percent of total billed charges,Implant Device,17944.5,35,,17944.5,percent of total billed charges,Implant Device,17431.8,34,"Charges > $500, x 34%",17431.8,percent of total billed charges,Implant Device,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,20508,40,,20508,percent of total billed charges,Implant Devices,17944.5,70,,17944.5,percent of total billed charges,Implant Devices,17431.8,34,,17431.8,percent of total billed charges,Implant Devices,17431.8,34,,17431.8,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,17944.5,35,,17944.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,17431.8,34,"If Charge > 2,000, then 34 percent",17431.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20508,
BIOTRONIK 372419 LUMAX 740 ICD,C1722,HCPCS,,79003041,CDM,275,RC,,,both,,,49590,19571.59,39.4668,,19571.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,16860.6,34,,16860.6,percent of total billed charges,Implant Device,16860.6,34,,16860.6,percent of total billed charges,Implant Device,16860.6,34,,16860.6,percent of total billed charges,Implant Device,16860.6,34,,16860.6,percent of total billed charges,Implant Device,16860.6,34,,16860.6,percent of total billed charges,Implant Device,16860.6,34,,16860.6,percent of total billed charges,Implant Device,17356.5,35,,17356.5,percent of total billed charges,Implant Device,16860.6,34,"Charges > $500, x 34%",16860.6,percent of total billed charges,Implant Device,17356.5,35,,17356.5,percent of total billed charges,Implant Devices,17356.5,35,,17356.5,percent of total billed charges,Implant Devices,17356.5,35,,,percent of total billed charges,Implant Devices,17356.5,35,,17356.5,percent of total billed charges,Implant Devices,17356.5,35,,17356.5,percent of total billed charges,Implant Devices,19836,40,,19836,percent of total billed charges,Implant Devices,17356.5,70,,17356.5,percent of total billed charges,Implant Devices,16860.6,34,,16860.6,percent of total billed charges,Implant Devices,16860.6,34,,16860.6,percent of total billed charges,Implant Devices,17356.5,35,,17356.5,percent of total billed charges,Implant Devices,17356.5,35,,17356.5,percent of total billed charges,Implant Devices,17356.5,35,,17356.5,percent of total billed charges,Implant Devices,17356.5,35,,17356.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,16860.6,34,"If Charge > 2,000, then 34 percent",16860.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,19836,
BIOTRONIK 397193 LUMAX 740 ICD,C1722,HCPCS,,79003042,CDM,275,RC,,,both,,,53266,21022.39,39.4668,,21022.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18110.44,34,,18110.44,percent of total billed charges,Implant Device,18110.44,34,,18110.44,percent of total billed charges,Implant Device,18110.44,34,,18110.44,percent of total billed charges,Implant Device,18110.44,34,,18110.44,percent of total billed charges,Implant Device,18110.44,34,,18110.44,percent of total billed charges,Implant Device,18110.44,34,,18110.44,percent of total billed charges,Implant Device,18643.1,35,,18643.1,percent of total billed charges,Implant Device,18110.44,34,"Charges > $500, x 34%",18110.44,percent of total billed charges,Implant Device,18643.1,35,,18643.1,percent of total billed charges,Implant Devices,18643.1,35,,18643.1,percent of total billed charges,Implant Devices,18643.1,35,,,percent of total billed charges,Implant Devices,18643.1,35,,18643.1,percent of total billed charges,Implant Devices,18643.1,35,,18643.1,percent of total billed charges,Implant Devices,21306.4,40,,21306.4,percent of total billed charges,Implant Devices,18643.1,70,,18643.1,percent of total billed charges,Implant Devices,18110.44,34,,18110.44,percent of total billed charges,Implant Devices,18110.44,34,,18110.44,percent of total billed charges,Implant Devices,18643.1,35,,18643.1,percent of total billed charges,Implant Devices,18643.1,35,,18643.1,percent of total billed charges,Implant Devices,18643.1,35,,18643.1,percent of total billed charges,Implant Devices,18643.1,35,,18643.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,18110.44,34,"If Charge > 2,000, then 34 percent",18110.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21306.4,
MEDTRONIC DVBB1D1 EVERA XT US ICD,C1722,HCPCS,,79005794,CDM,275,RC,,,both,,,59230,23376.19,39.4668,,23376.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20138.2,34,,20138.2,percent of total billed charges,Implant Device,20138.2,34,,20138.2,percent of total billed charges,Implant Device,20138.2,34,,20138.2,percent of total billed charges,Implant Device,20138.2,34,,20138.2,percent of total billed charges,Implant Device,20138.2,34,,20138.2,percent of total billed charges,Implant Device,20138.2,34,,20138.2,percent of total billed charges,Implant Device,20730.5,35,,20730.5,percent of total billed charges,Implant Device,20138.2,34,"Charges > $500, x 34%",20138.2,percent of total billed charges,Implant Device,20730.5,35,,20730.5,percent of total billed charges,Implant Devices,20730.5,35,,20730.5,percent of total billed charges,Implant Devices,20730.5,35,,,percent of total billed charges,Implant Devices,20730.5,35,,20730.5,percent of total billed charges,Implant Devices,20730.5,35,,20730.5,percent of total billed charges,Implant Devices,23692,40,,23692,percent of total billed charges,Implant Devices,20730.5,70,,20730.5,percent of total billed charges,Implant Devices,20138.2,34,,20138.2,percent of total billed charges,Implant Devices,20138.2,34,,20138.2,percent of total billed charges,Implant Devices,20730.5,35,,20730.5,percent of total billed charges,Implant Devices,20730.5,35,,20730.5,percent of total billed charges,Implant Devices,20730.5,35,,20730.5,percent of total billed charges,Implant Devices,20730.5,35,,20730.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,20138.2,34,"If Charge > 2,000, then 34 percent",20138.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23692,
MEDTRONIC DVBB1D4 EVERA XT ICD-VR,C1722,HCPCS,,79006096,CDM,275,RC,,,both,,,59229,23375.79,39.4668,,23375.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20137.86,34,,20137.86,percent of total billed charges,Implant Device,20137.86,34,,20137.86,percent of total billed charges,Implant Device,20137.86,34,,20137.86,percent of total billed charges,Implant Device,20137.86,34,,20137.86,percent of total billed charges,Implant Device,20137.86,34,,20137.86,percent of total billed charges,Implant Device,20137.86,34,,20137.86,percent of total billed charges,Implant Device,20730.15,35,,20730.15,percent of total billed charges,Implant Device,20137.86,34,"Charges > $500, x 34%",20137.86,percent of total billed charges,Implant Device,20730.15,35,,20730.15,percent of total billed charges,Implant Devices,20730.15,35,,20730.15,percent of total billed charges,Implant Devices,20730.15,35,,,percent of total billed charges,Implant Devices,20730.15,35,,20730.15,percent of total billed charges,Implant Devices,20730.15,35,,20730.15,percent of total billed charges,Implant Devices,23691.6,40,,23691.6,percent of total billed charges,Implant Devices,20730.15,70,,20730.15,percent of total billed charges,Implant Devices,20137.86,34,,20137.86,percent of total billed charges,Implant Devices,20137.86,34,,20137.86,percent of total billed charges,Implant Devices,20730.15,35,,20730.15,percent of total billed charges,Implant Devices,20730.15,35,,20730.15,percent of total billed charges,Implant Devices,20730.15,35,,20730.15,percent of total billed charges,Implant Devices,20730.15,35,,20730.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,20137.86,34,"If Charge > 2,000, then 34 percent",20137.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23691.6,
ST JUDE CD1357-40C FORTIFY ASSURA,C1722,HCPCS,,79007118,CDM,275,RC,,,both,,,48936,19313.47,39.4668,,19313.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,16638.24,34,,16638.24,percent of total billed charges,Implant Device,16638.24,34,,16638.24,percent of total billed charges,Implant Device,16638.24,34,,16638.24,percent of total billed charges,Implant Device,16638.24,34,,16638.24,percent of total billed charges,Implant Device,16638.24,34,,16638.24,percent of total billed charges,Implant Device,16638.24,34,,16638.24,percent of total billed charges,Implant Device,17127.6,35,,17127.6,percent of total billed charges,Implant Device,16638.24,34,"Charges > $500, x 34%",16638.24,percent of total billed charges,Implant Device,17127.6,35,,17127.6,percent of total billed charges,Implant Devices,17127.6,35,,17127.6,percent of total billed charges,Implant Devices,17127.6,35,,,percent of total billed charges,Implant Devices,17127.6,35,,17127.6,percent of total billed charges,Implant Devices,17127.6,35,,17127.6,percent of total billed charges,Implant Devices,19574.4,40,,19574.4,percent of total billed charges,Implant Devices,17127.6,70,,17127.6,percent of total billed charges,Implant Devices,16638.24,34,,16638.24,percent of total billed charges,Implant Devices,16638.24,34,,16638.24,percent of total billed charges,Implant Devices,17127.6,35,,17127.6,percent of total billed charges,Implant Devices,17127.6,35,,17127.6,percent of total billed charges,Implant Devices,17127.6,35,,17127.6,percent of total billed charges,Implant Devices,17127.6,35,,17127.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,16638.24,34,"If Charge > 2,000, then 34 percent",16638.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,19574.4,
ST JUDE CD1411-36Q ELLIPSE VR SINGL ICD,C1722,HCPCS,,79007504,CDM,275,RC,,,both,,,44228,17455.38,39.4668,,17455.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15037.52,34,,15037.52,percent of total billed charges,Implant Device,15037.52,34,,15037.52,percent of total billed charges,Implant Device,15037.52,34,,15037.52,percent of total billed charges,Implant Device,15037.52,34,,15037.52,percent of total billed charges,Implant Device,15037.52,34,,15037.52,percent of total billed charges,Implant Device,15037.52,34,,15037.52,percent of total billed charges,Implant Device,15479.8,35,,15479.8,percent of total billed charges,Implant Device,15037.52,34,"Charges > $500, x 34%",15037.52,percent of total billed charges,Implant Device,15479.8,35,,15479.8,percent of total billed charges,Implant Devices,15479.8,35,,15479.8,percent of total billed charges,Implant Devices,15479.8,35,,,percent of total billed charges,Implant Devices,15479.8,35,,15479.8,percent of total billed charges,Implant Devices,15479.8,35,,15479.8,percent of total billed charges,Implant Devices,17691.2,40,,17691.2,percent of total billed charges,Implant Devices,15479.8,70,,15479.8,percent of total billed charges,Implant Devices,15037.52,34,,15037.52,percent of total billed charges,Implant Devices,15037.52,34,,15037.52,percent of total billed charges,Implant Devices,15479.8,35,,15479.8,percent of total billed charges,Implant Devices,15479.8,35,,15479.8,percent of total billed charges,Implant Devices,15479.8,35,,15479.8,percent of total billed charges,Implant Devices,15479.8,35,,15479.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,15037.52,34,"If Charge > 2,000, then 34 percent",15037.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,17691.2,
BIOTRONIK 399436 INVENTRA 7  VR-T  DX,C1722,HCPCS,,79008214,CDM,275,RC,,,both,,,60342,23815.06,39.4668,,23815.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20516.28,34,,20516.28,percent of total billed charges,Implant Device,20516.28,34,,20516.28,percent of total billed charges,Implant Device,20516.28,34,,20516.28,percent of total billed charges,Implant Device,20516.28,34,,20516.28,percent of total billed charges,Implant Device,20516.28,34,,20516.28,percent of total billed charges,Implant Device,20516.28,34,,20516.28,percent of total billed charges,Implant Device,21119.7,35,,21119.7,percent of total billed charges,Implant Device,20516.28,34,"Charges > $500, x 34%",20516.28,percent of total billed charges,Implant Device,21119.7,35,,21119.7,percent of total billed charges,Implant Devices,21119.7,35,,21119.7,percent of total billed charges,Implant Devices,21119.7,35,,,percent of total billed charges,Implant Devices,21119.7,35,,21119.7,percent of total billed charges,Implant Devices,21119.7,35,,21119.7,percent of total billed charges,Implant Devices,24136.8,40,,24136.8,percent of total billed charges,Implant Devices,21119.7,70,,21119.7,percent of total billed charges,Implant Devices,20516.28,34,,20516.28,percent of total billed charges,Implant Devices,20516.28,34,,20516.28,percent of total billed charges,Implant Devices,21119.7,35,,21119.7,percent of total billed charges,Implant Devices,21119.7,35,,21119.7,percent of total billed charges,Implant Devices,21119.7,35,,21119.7,percent of total billed charges,Implant Devices,21119.7,35,,21119.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,20516.28,34,"If Charge > 2,000, then 34 percent",20516.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24136.8,
BIOTRONIK 393032 IPERIA  VR-T DX DF-1,C1722,HCPCS,,79008220,CDM,275,RC,,,both,,,58945,23263.71,39.4668,,23263.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20041.3,34,,20041.3,percent of total billed charges,Implant Device,20041.3,34,,20041.3,percent of total billed charges,Implant Device,20041.3,34,,20041.3,percent of total billed charges,Implant Device,20041.3,34,,20041.3,percent of total billed charges,Implant Device,20041.3,34,,20041.3,percent of total billed charges,Implant Device,20041.3,34,,20041.3,percent of total billed charges,Implant Device,20630.75,35,,20630.75,percent of total billed charges,Implant Device,20041.3,34,"Charges > $500, x 34%",20041.3,percent of total billed charges,Implant Device,20630.75,35,,20630.75,percent of total billed charges,Implant Devices,20630.75,35,,20630.75,percent of total billed charges,Implant Devices,20630.75,35,,,percent of total billed charges,Implant Devices,20630.75,35,,20630.75,percent of total billed charges,Implant Devices,20630.75,35,,20630.75,percent of total billed charges,Implant Devices,23578,40,,23578,percent of total billed charges,Implant Devices,20630.75,70,,20630.75,percent of total billed charges,Implant Devices,20041.3,34,,20041.3,percent of total billed charges,Implant Devices,20041.3,34,,20041.3,percent of total billed charges,Implant Devices,20630.75,35,,20630.75,percent of total billed charges,Implant Devices,20630.75,35,,20630.75,percent of total billed charges,Implant Devices,20630.75,35,,20630.75,percent of total billed charges,Implant Devices,20630.75,35,,20630.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,20041.3,34,"If Charge > 2,000, then 34 percent",20041.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23578,
MEDTRONIC DVFB1D1 VISIA AF MRI SURESCAN,C1722,HCPCS,,79012139,CDM,275,RC,,,both,,,33000,13024.04,39.4668,,13024.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11550,35,,11550,percent of total billed charges,Implant Device,11220,34,"Charges > $500, x 34%",11220,percent of total billed charges,Implant Device,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,13200,40,,13200,percent of total billed charges,Implant Devices,11550,70,,11550,percent of total billed charges,Implant Devices,11220,34,,11220,percent of total billed charges,Implant Devices,11220,34,,11220,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11220,34,"If Charge > 2,000, then 34 percent",11220,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13200,
BOST SCI A219 EMBLEM MRI S-ICD,C1722,HCPCS,,79012160,CDM,275,RC,,,both,,,99000,39072.13,39.4668,,39072.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33660,34,,33660,percent of total billed charges,Implant Device,33660,34,,33660,percent of total billed charges,Implant Device,33660,34,,33660,percent of total billed charges,Implant Device,33660,34,,33660,percent of total billed charges,Implant Device,33660,34,,33660,percent of total billed charges,Implant Device,33660,34,,33660,percent of total billed charges,Implant Device,34650,35,,34650,percent of total billed charges,Implant Device,33660,34,"Charges > $500, x 34%",33660,percent of total billed charges,Implant Device,34650,35,,34650,percent of total billed charges,Implant Devices,34650,35,,34650,percent of total billed charges,Implant Devices,34650,35,,,percent of total billed charges,Implant Devices,34650,35,,34650,percent of total billed charges,Implant Devices,34650,35,,34650,percent of total billed charges,Implant Devices,39600,40,,39600,percent of total billed charges,Implant Devices,34650,70,,34650,percent of total billed charges,Implant Devices,33660,34,,33660,percent of total billed charges,Implant Devices,33660,34,,33660,percent of total billed charges,Implant Devices,34650,35,,34650,percent of total billed charges,Implant Devices,34650,35,,34650,percent of total billed charges,Implant Devices,34650,35,,34650,percent of total billed charges,Implant Devices,34650,35,,34650,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,33660,34,"If Charge > 2,000, then 34 percent",33660,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39600,
BIOTRONIK 429525 ACTICOR 7 VR-T AICD MRI,C1722,HCPCS,,79012235,CDM,275,RC,,,both,,,48177,19013.92,39.4668,,19013.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,16380.18,34,,16380.18,percent of total billed charges,Implant Device,16380.18,34,,16380.18,percent of total billed charges,Implant Device,16380.18,34,,16380.18,percent of total billed charges,Implant Device,16380.18,34,,16380.18,percent of total billed charges,Implant Device,16380.18,34,,16380.18,percent of total billed charges,Implant Device,16380.18,34,,16380.18,percent of total billed charges,Implant Device,16861.95,35,,16861.95,percent of total billed charges,Implant Device,16380.18,34,"Charges > $500, x 34%",16380.18,percent of total billed charges,Implant Device,16861.95,35,,16861.95,percent of total billed charges,Implant Devices,16861.95,35,,16861.95,percent of total billed charges,Implant Devices,16861.95,35,,,percent of total billed charges,Implant Devices,16861.95,35,,16861.95,percent of total billed charges,Implant Devices,16861.95,35,,16861.95,percent of total billed charges,Implant Devices,19270.8,40,,19270.8,percent of total billed charges,Implant Devices,16861.95,70,,16861.95,percent of total billed charges,Implant Devices,16380.18,34,,16380.18,percent of total billed charges,Implant Devices,16380.18,34,,16380.18,percent of total billed charges,Implant Devices,16861.95,35,,16861.95,percent of total billed charges,Implant Devices,16861.95,35,,16861.95,percent of total billed charges,Implant Devices,16861.95,35,,16861.95,percent of total billed charges,Implant Devices,16861.95,35,,16861.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,16380.18,34,"If Charge > 2,000, then 34 percent",16380.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,19270.8,
"MEDTRONIC DTMA1D1 CLARIA ,RI CRTD US DF1",C1722,HCPCS,,79012365,CDM,275,RC,,,both,,,57003,22497.26,39.4668,,22497.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19381.02,34,,19381.02,percent of total billed charges,Implant Device,19381.02,34,,19381.02,percent of total billed charges,Implant Device,19381.02,34,,19381.02,percent of total billed charges,Implant Device,19381.02,34,,19381.02,percent of total billed charges,Implant Device,19381.02,34,,19381.02,percent of total billed charges,Implant Device,19381.02,34,,19381.02,percent of total billed charges,Implant Device,19951.05,35,,19951.05,percent of total billed charges,Implant Device,19381.02,34,"Charges > $500, x 34%",19381.02,percent of total billed charges,Implant Device,19951.05,35,,19951.05,percent of total billed charges,Implant Devices,19951.05,35,,19951.05,percent of total billed charges,Implant Devices,19951.05,35,,,percent of total billed charges,Implant Devices,19951.05,35,,19951.05,percent of total billed charges,Implant Devices,19951.05,35,,19951.05,percent of total billed charges,Implant Devices,22801.2,40,,22801.2,percent of total billed charges,Implant Devices,19951.05,70,,19951.05,percent of total billed charges,Implant Devices,19381.02,34,,19381.02,percent of total billed charges,Implant Devices,19381.02,34,,19381.02,percent of total billed charges,Implant Devices,19951.05,35,,19951.05,percent of total billed charges,Implant Devices,19951.05,35,,19951.05,percent of total billed charges,Implant Devices,19951.05,35,,19951.05,percent of total billed charges,Implant Devices,19951.05,35,,19951.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,19381.02,34,"If Charge > 2,000, then 34 percent",19381.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22801.2,
MEDTRONIC DVPA2D4 XT VR MRI SURESCAN,C1722,HCPCS,,79013837,CDM,275,RC,,,both,,,52332,20653.77,39.4668,,20653.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17792.88,34,,17792.88,percent of total billed charges,Implant Device,17792.88,34,,17792.88,percent of total billed charges,Implant Device,17792.88,34,,17792.88,percent of total billed charges,Implant Device,17792.88,34,,17792.88,percent of total billed charges,Implant Device,17792.88,34,,17792.88,percent of total billed charges,Implant Device,17792.88,34,,17792.88,percent of total billed charges,Implant Device,18316.2,35,,18316.2,percent of total billed charges,Implant Device,17792.88,34,"Charges > $500, x 34%",17792.88,percent of total billed charges,Implant Device,18316.2,35,,18316.2,percent of total billed charges,Implant Devices,18316.2,35,,18316.2,percent of total billed charges,Implant Devices,18316.2,35,,,percent of total billed charges,Implant Devices,18316.2,35,,18316.2,percent of total billed charges,Implant Devices,18316.2,35,,18316.2,percent of total billed charges,Implant Devices,20932.8,40,,20932.8,percent of total billed charges,Implant Devices,18316.2,70,,18316.2,percent of total billed charges,Implant Devices,17792.88,34,,17792.88,percent of total billed charges,Implant Devices,17792.88,34,,17792.88,percent of total billed charges,Implant Devices,18316.2,35,,18316.2,percent of total billed charges,Implant Devices,18316.2,35,,18316.2,percent of total billed charges,Implant Devices,18316.2,35,,18316.2,percent of total billed charges,Implant Devices,18316.2,35,,18316.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,17792.88,34,"If Charge > 2,000, then 34 percent",17792.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20932.8,
BIOTRONIK 436909 PLEXA PROMRI S DX 65/15,C1777,HCPCS,,79012236,CDM,275,RC,,,both,,,10800,4262.41,39.4668,,4262.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3672,34,,3672,percent of total billed charges,Implant Device,3672,34,,3672,percent of total billed charges,Implant Device,3672,34,,3672,percent of total billed charges,Implant Device,3672,34,,3672,percent of total billed charges,Implant Device,3672,34,,3672,percent of total billed charges,Implant Device,3672,34,,3672,percent of total billed charges,Implant Device,3780,35,,3780,percent of total billed charges,Implant Device,3672,34,"Charges > $500, x 34%",3672,percent of total billed charges,Implant Device,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,4320,40,,4320,percent of total billed charges,Implant Devices,3780,70,,3780,percent of total billed charges,Implant Devices,3672,34,,3672,percent of total billed charges,Implant Devices,3672,34,,3672,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3672,34,"If Charge > 2,000, then 34 percent",3672,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4320,
BIOTRONIK 402266 PLEXA PROMRI S 65,C1777,HCPCS,,79012419,CDM,275,RC,,,both,,,10800,4262.41,39.4668,,4262.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3672,34,,3672,percent of total billed charges,Implant Device,3672,34,,3672,percent of total billed charges,Implant Device,3672,34,,3672,percent of total billed charges,Implant Device,3672,34,,3672,percent of total billed charges,Implant Device,3672,34,,3672,percent of total billed charges,Implant Device,3672,34,,3672,percent of total billed charges,Implant Device,3780,35,,3780,percent of total billed charges,Implant Device,3672,34,"Charges > $500, x 34%",3672,percent of total billed charges,Implant Device,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,4320,40,,4320,percent of total billed charges,Implant Devices,3780,70,,3780,percent of total billed charges,Implant Devices,3672,34,,3672,percent of total billed charges,Implant Devices,3672,34,,3672,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,3780,35,,3780,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3672,34,"If Charge > 2,000, then 34 percent",3672,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4320,
MEDTRONIC RNA015062G AZURE XT SR MRI,C1777,HCPCS,,79012805,CDM,275,RC,,,both,,,11007,4344.11,39.4668,,4344.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3742.38,34,,3742.38,percent of total billed charges,Implant Device,3742.38,34,,3742.38,percent of total billed charges,Implant Device,3742.38,34,,3742.38,percent of total billed charges,Implant Device,3742.38,34,,3742.38,percent of total billed charges,Implant Device,3742.38,34,,3742.38,percent of total billed charges,Implant Device,3742.38,34,,3742.38,percent of total billed charges,Implant Device,3852.45,35,,3852.45,percent of total billed charges,Implant Device,3742.38,34,"Charges > $500, x 34%",3742.38,percent of total billed charges,Implant Device,3852.45,35,,3852.45,percent of total billed charges,Implant Devices,3852.45,35,,3852.45,percent of total billed charges,Implant Devices,3852.45,35,,,percent of total billed charges,Implant Devices,3852.45,35,,3852.45,percent of total billed charges,Implant Devices,3852.45,35,,3852.45,percent of total billed charges,Implant Devices,4402.8,40,,4402.8,percent of total billed charges,Implant Devices,3852.45,70,,3852.45,percent of total billed charges,Implant Devices,3742.38,34,,3742.38,percent of total billed charges,Implant Devices,3742.38,34,,3742.38,percent of total billed charges,Implant Devices,3852.45,35,,3852.45,percent of total billed charges,Implant Devices,3852.45,35,,3852.45,percent of total billed charges,Implant Devices,3852.45,35,,3852.45,percent of total billed charges,Implant Devices,3852.45,35,,3852.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3742.38,34,"If Charge > 2,000, then 34 percent",3742.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4402.8,
MEDTRONIC RVDR01 PACEMAKER,C1785,HCPCS,,79002604,CDM,275,RC,,,both,,,17214,6793.81,39.4668,,6793.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5852.76,34,,5852.76,percent of total billed charges,Implant Device,5852.76,34,,5852.76,percent of total billed charges,Implant Device,5852.76,34,,5852.76,percent of total billed charges,Implant Device,5852.76,34,,5852.76,percent of total billed charges,Implant Device,5852.76,34,,5852.76,percent of total billed charges,Implant Device,5852.76,34,,5852.76,percent of total billed charges,Implant Device,6024.9,35,,6024.9,percent of total billed charges,Implant Device,5852.76,34,"Charges > $500, x 34%",5852.76,percent of total billed charges,Implant Device,6024.9,35,,6024.9,percent of total billed charges,Implant Devices,6024.9,35,,6024.9,percent of total billed charges,Implant Devices,6024.9,35,,,percent of total billed charges,Implant Devices,6024.9,35,,6024.9,percent of total billed charges,Implant Devices,6024.9,35,,6024.9,percent of total billed charges,Implant Devices,6885.6,40,,6885.6,percent of total billed charges,Implant Devices,6024.9,70,,6024.9,percent of total billed charges,Implant Devices,5852.76,34,,5852.76,percent of total billed charges,Implant Devices,5852.76,34,,5852.76,percent of total billed charges,Implant Devices,6024.9,35,,6024.9,percent of total billed charges,Implant Devices,6024.9,35,,6024.9,percent of total billed charges,Implant Devices,6024.9,35,,6024.9,percent of total billed charges,Implant Devices,6024.9,35,,6024.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5852.76,34,"If Charge > 2,000, then 34 percent",5852.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6885.6,
RVDR01 REVO MRI DEVICE,C1785,HCPCS,,79002663,CDM,275,RC,,,both,,,16354,6454.4,39.4668,,6454.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5560.36,34,,5560.36,percent of total billed charges,Implant Device,5560.36,34,,5560.36,percent of total billed charges,Implant Device,5560.36,34,,5560.36,percent of total billed charges,Implant Device,5560.36,34,,5560.36,percent of total billed charges,Implant Device,5560.36,34,,5560.36,percent of total billed charges,Implant Device,5560.36,34,,5560.36,percent of total billed charges,Implant Device,5723.9,35,,5723.9,percent of total billed charges,Implant Device,5560.36,34,"Charges > $500, x 34%",5560.36,percent of total billed charges,Implant Device,5723.9,35,,5723.9,percent of total billed charges,Implant Devices,5723.9,35,,5723.9,percent of total billed charges,Implant Devices,5723.9,35,,,percent of total billed charges,Implant Devices,5723.9,35,,5723.9,percent of total billed charges,Implant Devices,5723.9,35,,5723.9,percent of total billed charges,Implant Devices,6541.6,40,,6541.6,percent of total billed charges,Implant Devices,5723.9,70,,5723.9,percent of total billed charges,Implant Devices,5560.36,34,,5560.36,percent of total billed charges,Implant Devices,5560.36,34,,5560.36,percent of total billed charges,Implant Devices,5723.9,35,,5723.9,percent of total billed charges,Implant Devices,5723.9,35,,5723.9,percent of total billed charges,Implant Devices,5723.9,35,,5723.9,percent of total billed charges,Implant Devices,5723.9,35,,5723.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5560.36,34,"If Charge > 2,000, then 34 percent",5560.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6541.6,
SEDR01 SENSIA DUAL CHAMBER,C1785,HCPCS,,79002664,CDM,275,RC,,,both,,,13572,5356.43,39.4668,,5356.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4614.48,34,,4614.48,percent of total billed charges,Implant Device,4614.48,34,,4614.48,percent of total billed charges,Implant Device,4614.48,34,,4614.48,percent of total billed charges,Implant Device,4614.48,34,,4614.48,percent of total billed charges,Implant Device,4614.48,34,,4614.48,percent of total billed charges,Implant Device,4614.48,34,,4614.48,percent of total billed charges,Implant Device,4750.2,35,,4750.2,percent of total billed charges,Implant Device,4614.48,34,"Charges > $500, x 34%",4614.48,percent of total billed charges,Implant Device,4750.2,35,,4750.2,percent of total billed charges,Implant Devices,4750.2,35,,4750.2,percent of total billed charges,Implant Devices,4750.2,35,,,percent of total billed charges,Implant Devices,4750.2,35,,4750.2,percent of total billed charges,Implant Devices,4750.2,35,,4750.2,percent of total billed charges,Implant Devices,5428.8,40,,5428.8,percent of total billed charges,Implant Devices,4750.2,70,,4750.2,percent of total billed charges,Implant Devices,4614.48,34,,4614.48,percent of total billed charges,Implant Devices,4614.48,34,,4614.48,percent of total billed charges,Implant Devices,4750.2,35,,4750.2,percent of total billed charges,Implant Devices,4750.2,35,,4750.2,percent of total billed charges,Implant Devices,4750.2,35,,4750.2,percent of total billed charges,Implant Devices,4750.2,35,,4750.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4614.48,34,"If Charge > 2,000, then 34 percent",4614.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5428.8,
ST JUDE PM2110 ACCENT DR PACEMAKER,C1785,HCPCS,,79002692,CDM,275,RC,,,both,,,15694,6193.92,39.4668,,6193.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5492.9,35,,5492.9,percent of total billed charges,Implant Device,5335.96,34,"Charges > $500, x 34%",5335.96,percent of total billed charges,Implant Device,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,6277.6,40,,6277.6,percent of total billed charges,Implant Devices,5492.9,70,,5492.9,percent of total billed charges,Implant Devices,5335.96,34,,5335.96,percent of total billed charges,Implant Devices,5335.96,34,,5335.96,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5335.96,34,"If Charge > 2,000, then 34 percent",5335.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6277.6,
ST JUDE PM2210 ACCENT DR RF PACEMAKER,C1785,HCPCS,,79002693,CDM,275,RC,,,both,,,15694,6193.92,39.4668,,6193.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5335.96,34,,5335.96,percent of total billed charges,Implant Device,5492.9,35,,5492.9,percent of total billed charges,Implant Device,5335.96,34,"Charges > $500, x 34%",5335.96,percent of total billed charges,Implant Device,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,6277.6,40,,6277.6,percent of total billed charges,Implant Devices,5492.9,70,,5492.9,percent of total billed charges,Implant Devices,5335.96,34,,5335.96,percent of total billed charges,Implant Devices,5335.96,34,,5335.96,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,5492.9,35,,5492.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5335.96,34,"If Charge > 2,000, then 34 percent",5335.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6277.6,
ST JUDE 5820 ZEPHYR DR PACEMAKER,C1785,HCPCS,,79002930,CDM,275,RC,,,both,,,12542,4949.93,39.4668,,4949.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4264.28,34,,4264.28,percent of total billed charges,Implant Device,4264.28,34,,4264.28,percent of total billed charges,Implant Device,4264.28,34,,4264.28,percent of total billed charges,Implant Device,4264.28,34,,4264.28,percent of total billed charges,Implant Device,4264.28,34,,4264.28,percent of total billed charges,Implant Device,4264.28,34,,4264.28,percent of total billed charges,Implant Device,4389.7,35,,4389.7,percent of total billed charges,Implant Device,4264.28,34,"Charges > $500, x 34%",4264.28,percent of total billed charges,Implant Device,4389.7,35,,4389.7,percent of total billed charges,Implant Devices,4389.7,35,,4389.7,percent of total billed charges,Implant Devices,4389.7,35,,,percent of total billed charges,Implant Devices,4389.7,35,,4389.7,percent of total billed charges,Implant Devices,4389.7,35,,4389.7,percent of total billed charges,Implant Devices,5016.8,40,,5016.8,percent of total billed charges,Implant Devices,4389.7,70,,4389.7,percent of total billed charges,Implant Devices,4264.28,34,,4264.28,percent of total billed charges,Implant Devices,4264.28,34,,4264.28,percent of total billed charges,Implant Devices,4389.7,35,,4389.7,percent of total billed charges,Implant Devices,4389.7,35,,4389.7,percent of total billed charges,Implant Devices,4389.7,35,,4389.7,percent of total billed charges,Implant Devices,4389.7,35,,4389.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4264.28,34,"If Charge > 2,000, then 34 percent",4264.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5016.8,
MEDTRONIC A2DR01 ADVIS DR MRI SURESCAN,C1785,HCPCS,,79005062,CDM,275,RC,,,both,,,17814,7030.62,39.4668,,7030.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6056.76,34,,6056.76,percent of total billed charges,Implant Device,6056.76,34,,6056.76,percent of total billed charges,Implant Device,6056.76,34,,6056.76,percent of total billed charges,Implant Device,6056.76,34,,6056.76,percent of total billed charges,Implant Device,6056.76,34,,6056.76,percent of total billed charges,Implant Device,6056.76,34,,6056.76,percent of total billed charges,Implant Device,6234.9,35,,6234.9,percent of total billed charges,Implant Device,6056.76,34,"Charges > $500, x 34%",6056.76,percent of total billed charges,Implant Device,6234.9,35,,6234.9,percent of total billed charges,Implant Devices,6234.9,35,,6234.9,percent of total billed charges,Implant Devices,6234.9,35,,,percent of total billed charges,Implant Devices,6234.9,35,,6234.9,percent of total billed charges,Implant Devices,6234.9,35,,6234.9,percent of total billed charges,Implant Devices,7125.6,40,,7125.6,percent of total billed charges,Implant Devices,6234.9,70,,6234.9,percent of total billed charges,Implant Devices,6056.76,34,,6056.76,percent of total billed charges,Implant Devices,6056.76,34,,6056.76,percent of total billed charges,Implant Devices,6234.9,35,,6234.9,percent of total billed charges,Implant Devices,6234.9,35,,6234.9,percent of total billed charges,Implant Devices,6234.9,35,,6234.9,percent of total billed charges,Implant Devices,6234.9,35,,6234.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6056.76,34,"If Charge > 2,000, then 34 percent",6056.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7125.6,
MEDTRONIC ADDR01 ADAPTA DR,C1785,HCPCS,,79005568,CDM,275,RC,,,both,,,15768,6223.13,39.4668,,6223.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5361.12,34,,5361.12,percent of total billed charges,Implant Device,5361.12,34,,5361.12,percent of total billed charges,Implant Device,5361.12,34,,5361.12,percent of total billed charges,Implant Device,5361.12,34,,5361.12,percent of total billed charges,Implant Device,5361.12,34,,5361.12,percent of total billed charges,Implant Device,5361.12,34,,5361.12,percent of total billed charges,Implant Device,5518.8,35,,5518.8,percent of total billed charges,Implant Device,5361.12,34,"Charges > $500, x 34%",5361.12,percent of total billed charges,Implant Device,5518.8,35,,5518.8,percent of total billed charges,Implant Devices,5518.8,35,,5518.8,percent of total billed charges,Implant Devices,5518.8,35,,,percent of total billed charges,Implant Devices,5518.8,35,,5518.8,percent of total billed charges,Implant Devices,5518.8,35,,5518.8,percent of total billed charges,Implant Devices,6307.2,40,,6307.2,percent of total billed charges,Implant Devices,5518.8,70,,5518.8,percent of total billed charges,Implant Devices,5361.12,34,,5361.12,percent of total billed charges,Implant Devices,5361.12,34,,5361.12,percent of total billed charges,Implant Devices,5518.8,35,,5518.8,percent of total billed charges,Implant Devices,5518.8,35,,5518.8,percent of total billed charges,Implant Devices,5518.8,35,,5518.8,percent of total billed charges,Implant Devices,5518.8,35,,5518.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5361.12,34,"If Charge > 2,000, then 34 percent",5361.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6307.2,
ST JUDE PM2240 ASSURITY PACEMAKER,C1785,HCPCS,,79006723,CDM,275,RC,,,both,,,12300,4854.42,39.4668,,4854.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Device,4182,34,"Charges > $500, x 34%",4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4920,40,,4920,percent of total billed charges,Implant Devices,4305,70,,4305,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4182,34,"If Charge > 2,000, then 34 percent",4182,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4920,
BIOTRONIK 394969 ELUNA 8 DR-T PACEMAKER,C1785,HCPCS,,79007544,CDM,275,RC,,,both,,,18450,7281.62,39.4668,,7281.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6273,34,,6273,percent of total billed charges,Implant Device,6273,34,,6273,percent of total billed charges,Implant Device,6273,34,,6273,percent of total billed charges,Implant Device,6273,34,,6273,percent of total billed charges,Implant Device,6273,34,,6273,percent of total billed charges,Implant Device,6273,34,,6273,percent of total billed charges,Implant Device,6457.5,35,,6457.5,percent of total billed charges,Implant Device,6273,34,"Charges > $500, x 34%",6273,percent of total billed charges,Implant Device,6457.5,35,,6457.5,percent of total billed charges,Implant Devices,6457.5,35,,6457.5,percent of total billed charges,Implant Devices,6457.5,35,,,percent of total billed charges,Implant Devices,6457.5,35,,6457.5,percent of total billed charges,Implant Devices,6457.5,35,,6457.5,percent of total billed charges,Implant Devices,7380,40,,7380,percent of total billed charges,Implant Devices,6457.5,70,,6457.5,percent of total billed charges,Implant Devices,6273,34,,6273,percent of total billed charges,Implant Devices,6273,34,,6273,percent of total billed charges,Implant Devices,6457.5,35,,6457.5,percent of total billed charges,Implant Devices,6457.5,35,,6457.5,percent of total billed charges,Implant Devices,6457.5,35,,6457.5,percent of total billed charges,Implant Devices,6457.5,35,,6457.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6273,34,"If Charge > 2,000, then 34 percent",6273,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7380,
MEDTRONIC VEDR01 VERSA PACEMAKER,C1785,HCPCS,,79008986,CDM,275,RC,,,both,,,10545,4161.77,39.4668,,4161.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3585.3,34,,3585.3,percent of total billed charges,Implant Device,3585.3,34,,3585.3,percent of total billed charges,Implant Device,3585.3,34,,3585.3,percent of total billed charges,Implant Device,3585.3,34,,3585.3,percent of total billed charges,Implant Device,3585.3,34,,3585.3,percent of total billed charges,Implant Device,3585.3,34,,3585.3,percent of total billed charges,Implant Device,3690.75,35,,3690.75,percent of total billed charges,Implant Device,3585.3,34,"Charges > $500, x 34%",3585.3,percent of total billed charges,Implant Device,3690.75,35,,3690.75,percent of total billed charges,Implant Devices,3690.75,35,,3690.75,percent of total billed charges,Implant Devices,3690.75,35,,,percent of total billed charges,Implant Devices,3690.75,35,,3690.75,percent of total billed charges,Implant Devices,3690.75,35,,3690.75,percent of total billed charges,Implant Devices,4218,40,,4218,percent of total billed charges,Implant Devices,3690.75,70,,3690.75,percent of total billed charges,Implant Devices,3585.3,34,,3585.3,percent of total billed charges,Implant Devices,3585.3,34,,3585.3,percent of total billed charges,Implant Devices,3690.75,35,,3690.75,percent of total billed charges,Implant Devices,3690.75,35,,3690.75,percent of total billed charges,Implant Devices,3690.75,35,,3690.75,percent of total billed charges,Implant Devices,3690.75,35,,3690.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3585.3,34,"If Charge > 2,000, then 34 percent",3585.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4218,
BIOTRONIK 407157 EDORA 8 SR-T PACEMAKER,C1785,HCPCS,,79009647,CDM,275,RC,,,both,,,20456,8073.33,39.4668,,8073.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6955.04,34,,6955.04,percent of total billed charges,Implant Device,6955.04,34,,6955.04,percent of total billed charges,Implant Device,6955.04,34,,6955.04,percent of total billed charges,Implant Device,6955.04,34,,6955.04,percent of total billed charges,Implant Device,6955.04,34,,6955.04,percent of total billed charges,Implant Device,6955.04,34,,6955.04,percent of total billed charges,Implant Device,7159.6,35,,7159.6,percent of total billed charges,Implant Device,6955.04,34,"Charges > $500, x 34%",6955.04,percent of total billed charges,Implant Device,7159.6,35,,7159.6,percent of total billed charges,Implant Devices,7159.6,35,,7159.6,percent of total billed charges,Implant Devices,7159.6,35,,,percent of total billed charges,Implant Devices,7159.6,35,,7159.6,percent of total billed charges,Implant Devices,7159.6,35,,7159.6,percent of total billed charges,Implant Devices,8182.4,40,,8182.4,percent of total billed charges,Implant Devices,7159.6,70,,7159.6,percent of total billed charges,Implant Devices,6955.04,34,,6955.04,percent of total billed charges,Implant Devices,6955.04,34,,6955.04,percent of total billed charges,Implant Devices,7159.6,35,,7159.6,percent of total billed charges,Implant Devices,7159.6,35,,7159.6,percent of total billed charges,Implant Devices,7159.6,35,,7159.6,percent of total billed charges,Implant Devices,7159.6,35,,7159.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6955.04,34,"If Charge > 2,000, then 34 percent",6955.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8182.4,
BIOTRONIK 407145 EDORA 8 DR-T PACEMAKER,C1785,HCPCS,,79009648,CDM,275,RC,,,both,,,15300,6038.42,39.4668,,6038.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5202,34,,5202,percent of total billed charges,Implant Device,5202,34,,5202,percent of total billed charges,Implant Device,5202,34,,5202,percent of total billed charges,Implant Device,5202,34,,5202,percent of total billed charges,Implant Device,5202,34,,5202,percent of total billed charges,Implant Device,5202,34,,5202,percent of total billed charges,Implant Device,5355,35,,5355,percent of total billed charges,Implant Device,5202,34,"Charges > $500, x 34%",5202,percent of total billed charges,Implant Device,5355,35,,5355,percent of total billed charges,Implant Devices,5355,35,,5355,percent of total billed charges,Implant Devices,5355,35,,,percent of total billed charges,Implant Devices,5355,35,,5355,percent of total billed charges,Implant Devices,5355,35,,5355,percent of total billed charges,Implant Devices,6120,40,,6120,percent of total billed charges,Implant Devices,5355,70,,5355,percent of total billed charges,Implant Devices,5202,34,,5202,percent of total billed charges,Implant Devices,5202,34,,5202,percent of total billed charges,Implant Devices,5355,35,,5355,percent of total billed charges,Implant Devices,5355,35,,5355,percent of total billed charges,Implant Devices,5355,35,,5355,percent of total billed charges,Implant Devices,5355,35,,5355,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5202,34,"If Charge > 2,000, then 34 percent",5202,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6120,
MEDTRONIC W1DR01 DR MRI SURESCAN,C1785,HCPCS,,79010746,CDM,275,RC,,,both,,,19614,7741.02,39.4668,,7741.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6668.76,34,,6668.76,percent of total billed charges,Implant Device,6668.76,34,,6668.76,percent of total billed charges,Implant Device,6668.76,34,,6668.76,percent of total billed charges,Implant Device,6668.76,34,,6668.76,percent of total billed charges,Implant Device,6668.76,34,,6668.76,percent of total billed charges,Implant Device,6668.76,34,,6668.76,percent of total billed charges,Implant Device,6864.9,35,,6864.9,percent of total billed charges,Implant Device,6668.76,34,"Charges > $500, x 34%",6668.76,percent of total billed charges,Implant Device,6864.9,35,,6864.9,percent of total billed charges,Implant Devices,6864.9,35,,6864.9,percent of total billed charges,Implant Devices,6864.9,35,,,percent of total billed charges,Implant Devices,6864.9,35,,6864.9,percent of total billed charges,Implant Devices,6864.9,35,,6864.9,percent of total billed charges,Implant Devices,7845.6,40,,7845.6,percent of total billed charges,Implant Devices,6864.9,70,,6864.9,percent of total billed charges,Implant Devices,6668.76,34,,6668.76,percent of total billed charges,Implant Devices,6668.76,34,,6668.76,percent of total billed charges,Implant Devices,6864.9,35,,6864.9,percent of total billed charges,Implant Devices,6864.9,35,,6864.9,percent of total billed charges,Implant Devices,6864.9,35,,6864.9,percent of total billed charges,Implant Devices,6864.9,35,,6864.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6668.76,34,"If Charge > 2,000, then 34 percent",6668.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7845.6,
SESR01 SENSIA SR SINGLE CHAMBER,C1786,HCPCS,,79002665,CDM,275,RC,,,both,,,11226,4430.54,39.4668,,4430.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3816.84,34,,3816.84,percent of total billed charges,Implant Device,3816.84,34,,3816.84,percent of total billed charges,Implant Device,3816.84,34,,3816.84,percent of total billed charges,Implant Device,3816.84,34,,3816.84,percent of total billed charges,Implant Device,3816.84,34,,3816.84,percent of total billed charges,Implant Device,3816.84,34,,3816.84,percent of total billed charges,Implant Device,3929.1,35,,3929.1,percent of total billed charges,Implant Device,3816.84,34,"Charges > $500, x 34%",3816.84,percent of total billed charges,Implant Device,3929.1,35,,3929.1,percent of total billed charges,Implant Devices,3929.1,35,,3929.1,percent of total billed charges,Implant Devices,3929.1,35,,,percent of total billed charges,Implant Devices,3929.1,35,,3929.1,percent of total billed charges,Implant Devices,3929.1,35,,3929.1,percent of total billed charges,Implant Devices,4490.4,40,,4490.4,percent of total billed charges,Implant Devices,3929.1,70,,3929.1,percent of total billed charges,Implant Devices,3816.84,34,,3816.84,percent of total billed charges,Implant Devices,3816.84,34,,3816.84,percent of total billed charges,Implant Devices,3929.1,35,,3929.1,percent of total billed charges,Implant Devices,3929.1,35,,3929.1,percent of total billed charges,Implant Devices,3929.1,35,,3929.1,percent of total billed charges,Implant Devices,3929.1,35,,3929.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3816.84,34,"If Charge > 2,000, then 34 percent",3816.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4490.4,
ST JUDE PM1210 ACCENT SR RF PACEMAKER,C1786,HCPCS,,79002694,CDM,275,RC,,,both,,,12816,5058.07,39.4668,,5058.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4485.6,35,,4485.6,percent of total billed charges,Implant Device,4357.44,34,"Charges > $500, x 34%",4357.44,percent of total billed charges,Implant Device,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,5126.4,40,,5126.4,percent of total billed charges,Implant Devices,4485.6,70,,4485.6,percent of total billed charges,Implant Devices,4357.44,34,,4357.44,percent of total billed charges,Implant Devices,4357.44,34,,4357.44,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4357.44,34,"If Charge > 2,000, then 34 percent",4357.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5126.4,
ST JUDE MEDICAL 5620 ZEPHYR SR PACEMAKER,C1786,HCPCS,,79003435,CDM,275,RC,,,both,,,10317,4071.79,39.4668,,4071.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3507.78,34,,3507.78,percent of total billed charges,Implant Device,3507.78,34,,3507.78,percent of total billed charges,Implant Device,3507.78,34,,3507.78,percent of total billed charges,Implant Device,3507.78,34,,3507.78,percent of total billed charges,Implant Device,3507.78,34,,3507.78,percent of total billed charges,Implant Device,3507.78,34,,3507.78,percent of total billed charges,Implant Device,3610.95,35,,3610.95,percent of total billed charges,Implant Device,3507.78,34,"Charges > $500, x 34%",3507.78,percent of total billed charges,Implant Device,3610.95,35,,3610.95,percent of total billed charges,Implant Devices,3610.95,35,,3610.95,percent of total billed charges,Implant Devices,3610.95,35,,,percent of total billed charges,Implant Devices,3610.95,35,,3610.95,percent of total billed charges,Implant Devices,3610.95,35,,3610.95,percent of total billed charges,Implant Devices,4126.8,40,,4126.8,percent of total billed charges,Implant Devices,3610.95,70,,3610.95,percent of total billed charges,Implant Devices,3507.78,34,,3507.78,percent of total billed charges,Implant Devices,3507.78,34,,3507.78,percent of total billed charges,Implant Devices,3610.95,35,,3610.95,percent of total billed charges,Implant Devices,3610.95,35,,3610.95,percent of total billed charges,Implant Devices,3610.95,35,,3610.95,percent of total billed charges,Implant Devices,3610.95,35,,3610.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3507.78,34,"If Charge > 2,000, then 34 percent",3507.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4126.8,
ST JUDE PM1110 ACCENT SR PACEMAKER,C1786,HCPCS,,79003479,CDM,275,RC,,,both,,,12816,5058.07,39.4668,,5058.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4357.44,34,,4357.44,percent of total billed charges,Implant Device,4485.6,35,,4485.6,percent of total billed charges,Implant Device,4357.44,34,"Charges > $500, x 34%",4357.44,percent of total billed charges,Implant Device,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,5126.4,40,,5126.4,percent of total billed charges,Implant Devices,4485.6,70,,4485.6,percent of total billed charges,Implant Devices,4357.44,34,,4357.44,percent of total billed charges,Implant Devices,4357.44,34,,4357.44,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,4485.6,35,,4485.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4357.44,34,"If Charge > 2,000, then 34 percent",4357.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5126.4,
ST JUDE 5626 ZEPHYR SR PACEMAKER,C1786,HCPCS,,79005368,CDM,275,RC,,,both,,,12204,4816.53,39.4668,,4816.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4149.36,34,,4149.36,percent of total billed charges,Implant Device,4149.36,34,,4149.36,percent of total billed charges,Implant Device,4149.36,34,,4149.36,percent of total billed charges,Implant Device,4149.36,34,,4149.36,percent of total billed charges,Implant Device,4149.36,34,,4149.36,percent of total billed charges,Implant Device,4149.36,34,,4149.36,percent of total billed charges,Implant Device,4271.4,35,,4271.4,percent of total billed charges,Implant Device,4149.36,34,"Charges > $500, x 34%",4149.36,percent of total billed charges,Implant Device,4271.4,35,,4271.4,percent of total billed charges,Implant Devices,4271.4,35,,4271.4,percent of total billed charges,Implant Devices,4271.4,35,,,percent of total billed charges,Implant Devices,4271.4,35,,4271.4,percent of total billed charges,Implant Devices,4271.4,35,,4271.4,percent of total billed charges,Implant Devices,4881.6,40,,4881.6,percent of total billed charges,Implant Devices,4271.4,70,,4271.4,percent of total billed charges,Implant Devices,4149.36,34,,4149.36,percent of total billed charges,Implant Devices,4149.36,34,,4149.36,percent of total billed charges,Implant Devices,4271.4,35,,4271.4,percent of total billed charges,Implant Devices,4271.4,35,,4271.4,percent of total billed charges,Implant Devices,4271.4,35,,4271.4,percent of total billed charges,Implant Devices,4271.4,35,,4271.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4149.36,34,"If Charge > 2,000, then 34 percent",4149.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4881.6,
ST JUDE PM1240 ASSURITY PACEMAKER,C1786,HCPCS,,79006724,CDM,275,RC,,,both,,,12962,5115.69,39.4668,,5115.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4407.08,34,,4407.08,percent of total billed charges,Implant Device,4407.08,34,,4407.08,percent of total billed charges,Implant Device,4407.08,34,,4407.08,percent of total billed charges,Implant Device,4407.08,34,,4407.08,percent of total billed charges,Implant Device,4407.08,34,,4407.08,percent of total billed charges,Implant Device,4407.08,34,,4407.08,percent of total billed charges,Implant Device,4536.7,35,,4536.7,percent of total billed charges,Implant Device,4407.08,34,"Charges > $500, x 34%",4407.08,percent of total billed charges,Implant Device,4536.7,35,,4536.7,percent of total billed charges,Implant Devices,4536.7,35,,4536.7,percent of total billed charges,Implant Devices,4536.7,35,,,percent of total billed charges,Implant Devices,4536.7,35,,4536.7,percent of total billed charges,Implant Devices,4536.7,35,,4536.7,percent of total billed charges,Implant Devices,5184.8,40,,5184.8,percent of total billed charges,Implant Devices,4536.7,70,,4536.7,percent of total billed charges,Implant Devices,4407.08,34,,4407.08,percent of total billed charges,Implant Devices,4407.08,34,,4407.08,percent of total billed charges,Implant Devices,4536.7,35,,4536.7,percent of total billed charges,Implant Devices,4536.7,35,,4536.7,percent of total billed charges,Implant Devices,4536.7,35,,4536.7,percent of total billed charges,Implant Devices,4536.7,35,,4536.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4407.08,34,"If Charge > 2,000, then 34 percent",4407.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5184.8,
MEDTRONIC A3SR01 ADVISA SR MRI,C1786,HCPCS,,79008296,CDM,275,RC,,,both,,,13827,5457.07,39.4668,,5457.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4701.18,34,,4701.18,percent of total billed charges,Implant Device,4701.18,34,,4701.18,percent of total billed charges,Implant Device,4701.18,34,,4701.18,percent of total billed charges,Implant Device,4701.18,34,,4701.18,percent of total billed charges,Implant Device,4701.18,34,,4701.18,percent of total billed charges,Implant Device,4701.18,34,,4701.18,percent of total billed charges,Implant Device,4839.45,35,,4839.45,percent of total billed charges,Implant Device,4701.18,34,"Charges > $500, x 34%",4701.18,percent of total billed charges,Implant Device,4839.45,35,,4839.45,percent of total billed charges,Implant Devices,4839.45,35,,4839.45,percent of total billed charges,Implant Devices,4839.45,35,,,percent of total billed charges,Implant Devices,4839.45,35,,4839.45,percent of total billed charges,Implant Devices,4839.45,35,,4839.45,percent of total billed charges,Implant Devices,5530.8,40,,5530.8,percent of total billed charges,Implant Devices,4839.45,70,,4839.45,percent of total billed charges,Implant Devices,4701.18,34,,4701.18,percent of total billed charges,Implant Devices,4701.18,34,,4701.18,percent of total billed charges,Implant Devices,4839.45,35,,4839.45,percent of total billed charges,Implant Devices,4839.45,35,,4839.45,percent of total billed charges,Implant Devices,4839.45,35,,4839.45,percent of total billed charges,Implant Devices,4839.45,35,,4839.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4701.18,34,"If Charge > 2,000, then 34 percent",4701.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5530.8,
ST JUDE PM1272 ASSURITY MRI PACEMAKER,C1786,HCPCS,,79009206,CDM,275,RC,,,both,,,14462,5707.69,39.4668,,5707.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4917.08,34,,4917.08,percent of total billed charges,Implant Device,4917.08,34,,4917.08,percent of total billed charges,Implant Device,4917.08,34,,4917.08,percent of total billed charges,Implant Device,4917.08,34,,4917.08,percent of total billed charges,Implant Device,4917.08,34,,4917.08,percent of total billed charges,Implant Device,4917.08,34,,4917.08,percent of total billed charges,Implant Device,5061.7,35,,5061.7,percent of total billed charges,Implant Device,4917.08,34,"Charges > $500, x 34%",4917.08,percent of total billed charges,Implant Device,5061.7,35,,5061.7,percent of total billed charges,Implant Devices,5061.7,35,,5061.7,percent of total billed charges,Implant Devices,5061.7,35,,,percent of total billed charges,Implant Devices,5061.7,35,,5061.7,percent of total billed charges,Implant Devices,5061.7,35,,5061.7,percent of total billed charges,Implant Devices,5784.8,40,,5784.8,percent of total billed charges,Implant Devices,5061.7,70,,5061.7,percent of total billed charges,Implant Devices,4917.08,34,,4917.08,percent of total billed charges,Implant Devices,4917.08,34,,4917.08,percent of total billed charges,Implant Devices,5061.7,35,,5061.7,percent of total billed charges,Implant Devices,5061.7,35,,5061.7,percent of total billed charges,Implant Devices,5061.7,35,,5061.7,percent of total billed charges,Implant Devices,5061.7,35,,5061.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4917.08,34,"If Charge > 2,000, then 34 percent",4917.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5784.8,
ST JUDE PM2272 ASSURITY MRI PACEMAKER,C1786,HCPCS,,79009455,CDM,275,RC,,,both,,,16800,6630.42,39.4668,,6630.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5712,34,,5712,percent of total billed charges,Implant Device,5712,34,,5712,percent of total billed charges,Implant Device,5712,34,,5712,percent of total billed charges,Implant Device,5712,34,,5712,percent of total billed charges,Implant Device,5712,34,,5712,percent of total billed charges,Implant Device,5712,34,,5712,percent of total billed charges,Implant Device,5880,35,,5880,percent of total billed charges,Implant Device,5712,34,"Charges > $500, x 34%",5712,percent of total billed charges,Implant Device,5880,35,,5880,percent of total billed charges,Implant Devices,5880,35,,5880,percent of total billed charges,Implant Devices,5880,35,,,percent of total billed charges,Implant Devices,5880,35,,5880,percent of total billed charges,Implant Devices,5880,35,,5880,percent of total billed charges,Implant Devices,6720,40,,6720,percent of total billed charges,Implant Devices,5880,70,,5880,percent of total billed charges,Implant Devices,5712,34,,5712,percent of total billed charges,Implant Devices,5712,34,,5712,percent of total billed charges,Implant Devices,5880,35,,5880,percent of total billed charges,Implant Devices,5880,35,,5880,percent of total billed charges,Implant Devices,5880,35,,5880,percent of total billed charges,Implant Devices,5880,35,,5880,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5712,34,"If Charge > 2,000, then 34 percent",5712,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6720,
MEDTRONIC D314TRG PROTECTA XT CRT,C1882,HCPCS,,79002667,CDM,275,RC,,,both,,,78718,31067.48,39.4668,,31067.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26764.12,34,,26764.12,percent of total billed charges,Implant Device,26764.12,34,,26764.12,percent of total billed charges,Implant Device,26764.12,34,,26764.12,percent of total billed charges,Implant Device,26764.12,34,,26764.12,percent of total billed charges,Implant Device,26764.12,34,,26764.12,percent of total billed charges,Implant Device,26764.12,34,,26764.12,percent of total billed charges,Implant Device,27551.3,35,,27551.3,percent of total billed charges,Implant Device,26764.12,34,"Charges > $500, x 34%",26764.12,percent of total billed charges,Implant Device,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,31487.2,40,,31487.2,percent of total billed charges,Implant Devices,27551.3,70,,27551.3,percent of total billed charges,Implant Devices,26764.12,34,,26764.12,percent of total billed charges,Implant Devices,26764.12,34,,26764.12,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,26764.12,34,"If Charge > 2,000, then 34 percent",26764.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31487.2,
MEDTRONIC D334TRG ICD PROTECTA CRT-D,C1882,HCPCS,,79002668,CDM,275,RC,,,both,,,65794,25966.79,39.4668,,25966.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,22369.96,34,,22369.96,percent of total billed charges,Implant Device,22369.96,34,,22369.96,percent of total billed charges,Implant Device,22369.96,34,,22369.96,percent of total billed charges,Implant Device,22369.96,34,,22369.96,percent of total billed charges,Implant Device,22369.96,34,,22369.96,percent of total billed charges,Implant Device,22369.96,34,,22369.96,percent of total billed charges,Implant Device,23027.9,35,,23027.9,percent of total billed charges,Implant Device,22369.96,34,"Charges > $500, x 34%",22369.96,percent of total billed charges,Implant Device,23027.9,35,,23027.9,percent of total billed charges,Implant Devices,23027.9,35,,23027.9,percent of total billed charges,Implant Devices,23027.9,35,,,percent of total billed charges,Implant Devices,23027.9,35,,23027.9,percent of total billed charges,Implant Devices,23027.9,35,,23027.9,percent of total billed charges,Implant Devices,26317.6,40,,26317.6,percent of total billed charges,Implant Devices,23027.9,70,,23027.9,percent of total billed charges,Implant Devices,22369.96,34,,22369.96,percent of total billed charges,Implant Devices,22369.96,34,,22369.96,percent of total billed charges,Implant Devices,23027.9,35,,23027.9,percent of total billed charges,Implant Devices,23027.9,35,,23027.9,percent of total billed charges,Implant Devices,23027.9,35,,23027.9,percent of total billed charges,Implant Devices,23027.9,35,,23027.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,22369.96,34,"If Charge > 2,000, then 34 percent",22369.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,26317.6,
ST JUDE CD3231-40Q UNIFY PACEMAKER,C1882,HCPCS,,79002695,CDM,275,RC,,,both,,,68962,27217.09,39.4668,,27217.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23447.08,34,,23447.08,percent of total billed charges,Implant Device,23447.08,34,,23447.08,percent of total billed charges,Implant Device,23447.08,34,,23447.08,percent of total billed charges,Implant Device,23447.08,34,,23447.08,percent of total billed charges,Implant Device,23447.08,34,,23447.08,percent of total billed charges,Implant Device,23447.08,34,,23447.08,percent of total billed charges,Implant Device,24136.7,35,,24136.7,percent of total billed charges,Implant Device,23447.08,34,"Charges > $500, x 34%",23447.08,percent of total billed charges,Implant Device,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,27584.8,40,,27584.8,percent of total billed charges,Implant Devices,24136.7,70,,24136.7,percent of total billed charges,Implant Devices,23447.08,34,,23447.08,percent of total billed charges,Implant Devices,23447.08,34,,23447.08,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,23447.08,34,"If Charge > 2,000, then 34 percent",23447.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27584.8,
ST JUDE CD3249-40Q UNIFY QUADRA ICD PACE,C1882,HCPCS,,79002696,CDM,275,RC,,,both,,,78228,30874.09,39.4668,,30874.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26597.52,34,,26597.52,percent of total billed charges,Implant Device,26597.52,34,,26597.52,percent of total billed charges,Implant Device,26597.52,34,,26597.52,percent of total billed charges,Implant Device,26597.52,34,,26597.52,percent of total billed charges,Implant Device,26597.52,34,,26597.52,percent of total billed charges,Implant Device,26597.52,34,,26597.52,percent of total billed charges,Implant Device,27379.8,35,,27379.8,percent of total billed charges,Implant Device,26597.52,34,"Charges > $500, x 34%",26597.52,percent of total billed charges,Implant Device,27379.8,35,,27379.8,percent of total billed charges,Implant Devices,27379.8,35,,27379.8,percent of total billed charges,Implant Devices,27379.8,35,,,percent of total billed charges,Implant Devices,27379.8,35,,27379.8,percent of total billed charges,Implant Devices,27379.8,35,,27379.8,percent of total billed charges,Implant Devices,31291.2,40,,31291.2,percent of total billed charges,Implant Devices,27379.8,70,,27379.8,percent of total billed charges,Implant Devices,26597.52,34,,26597.52,percent of total billed charges,Implant Devices,26597.52,34,,26597.52,percent of total billed charges,Implant Devices,27379.8,35,,27379.8,percent of total billed charges,Implant Devices,27379.8,35,,27379.8,percent of total billed charges,Implant Devices,27379.8,35,,27379.8,percent of total billed charges,Implant Devices,27379.8,35,,27379.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,26597.52,34,"If Charge > 2,000, then 34 percent",26597.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31291.2,
ST JUDE CD3257-40 HV GEN UNIFY ASSURA,C1882,HCPCS,,79002697,CDM,275,RC,,,both,,,68962,27217.09,39.4668,,27217.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23447.08,34,,23447.08,percent of total billed charges,Implant Device,23447.08,34,,23447.08,percent of total billed charges,Implant Device,23447.08,34,,23447.08,percent of total billed charges,Implant Device,23447.08,34,,23447.08,percent of total billed charges,Implant Device,23447.08,34,,23447.08,percent of total billed charges,Implant Device,23447.08,34,,23447.08,percent of total billed charges,Implant Device,24136.7,35,,24136.7,percent of total billed charges,Implant Device,23447.08,34,"Charges > $500, x 34%",23447.08,percent of total billed charges,Implant Device,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,27584.8,40,,27584.8,percent of total billed charges,Implant Devices,24136.7,70,,24136.7,percent of total billed charges,Implant Devices,23447.08,34,,23447.08,percent of total billed charges,Implant Devices,23447.08,34,,23447.08,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,24136.7,35,,24136.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,23447.08,34,"If Charge > 2,000, then 34 percent",23447.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27584.8,
MEDTRONIC DTBA1D1 VIVA XT CRTD,C1882,HCPCS,,79005955,CDM,275,RC,,,both,,,79716,31461.35,39.4668,,31461.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27900.6,35,,27900.6,percent of total billed charges,Implant Device,27103.44,34,"Charges > $500, x 34%",27103.44,percent of total billed charges,Implant Device,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,31886.4,40,,31886.4,percent of total billed charges,Implant Devices,27900.6,70,,27900.6,percent of total billed charges,Implant Devices,27103.44,34,,27103.44,percent of total billed charges,Implant Devices,27103.44,34,,27103.44,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,27103.44,34,"If Charge > 2,000, then 34 percent",27103.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31886.4,
MEDTRONIC DTBA1D4 VIVA XT CRTD (4),C1882,HCPCS,,79006628,CDM,275,RC,,,both,,,79716,31461.35,39.4668,,31461.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27900.6,35,,27900.6,percent of total billed charges,Implant Device,27103.44,34,"Charges > $500, x 34%",27103.44,percent of total billed charges,Implant Device,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,31886.4,40,,31886.4,percent of total billed charges,Implant Devices,27900.6,70,,27900.6,percent of total billed charges,Implant Devices,27103.44,34,,27103.44,percent of total billed charges,Implant Devices,27103.44,34,,27103.44,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,27103.44,34,"If Charge > 2,000, then 34 percent",27103.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31886.4,
MEDTRONIC DTBA1QQ VIVA QUAD XT CRT-D,C1882,HCPCS,,79007181,CDM,275,RC,,,both,,,79716,31461.35,39.4668,,31461.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27103.44,34,,27103.44,percent of total billed charges,Implant Device,27900.6,35,,27900.6,percent of total billed charges,Implant Device,27103.44,34,"Charges > $500, x 34%",27103.44,percent of total billed charges,Implant Device,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,31886.4,40,,31886.4,percent of total billed charges,Implant Devices,27900.6,70,,27900.6,percent of total billed charges,Implant Devices,27103.44,34,,27103.44,percent of total billed charges,Implant Devices,27103.44,34,,27103.44,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,27900.6,35,,27900.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,27103.44,34,"If Charge > 2,000, then 34 percent",27103.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31886.4,
MEDTRONIC DTBB1Q1 VIVA QUAD S CRT-D,C1882,HCPCS,,79007182,CDM,275,RC,,,both,,,77916,30750.95,39.4668,,30750.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26491.44,34,,26491.44,percent of total billed charges,Implant Device,26491.44,34,,26491.44,percent of total billed charges,Implant Device,26491.44,34,,26491.44,percent of total billed charges,Implant Device,26491.44,34,,26491.44,percent of total billed charges,Implant Device,26491.44,34,,26491.44,percent of total billed charges,Implant Device,26491.44,34,,26491.44,percent of total billed charges,Implant Device,27270.6,35,,27270.6,percent of total billed charges,Implant Device,26491.44,34,"Charges > $500, x 34%",26491.44,percent of total billed charges,Implant Device,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,31166.4,40,,31166.4,percent of total billed charges,Implant Devices,27270.6,70,,27270.6,percent of total billed charges,Implant Devices,26491.44,34,,26491.44,percent of total billed charges,Implant Devices,26491.44,34,,26491.44,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,26491.44,34,"If Charge > 2,000, then 34 percent",26491.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31166.4,
MEDTRONIC DTBB1QQ VIVA QUAD S CRT-D,C1882,HCPCS,,79007183,CDM,275,RC,,,both,,,77916,30750.95,39.4668,,30750.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26491.44,34,,26491.44,percent of total billed charges,Implant Device,26491.44,34,,26491.44,percent of total billed charges,Implant Device,26491.44,34,,26491.44,percent of total billed charges,Implant Device,26491.44,34,,26491.44,percent of total billed charges,Implant Device,26491.44,34,,26491.44,percent of total billed charges,Implant Device,26491.44,34,,26491.44,percent of total billed charges,Implant Device,27270.6,35,,27270.6,percent of total billed charges,Implant Device,26491.44,34,"Charges > $500, x 34%",26491.44,percent of total billed charges,Implant Device,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,31166.4,40,,31166.4,percent of total billed charges,Implant Devices,27270.6,70,,27270.6,percent of total billed charges,Implant Devices,26491.44,34,,26491.44,percent of total billed charges,Implant Devices,26491.44,34,,26491.44,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,27270.6,35,,27270.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,26491.44,34,"If Charge > 2,000, then 34 percent",26491.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31166.4,
ST JUDE CD3357-40C UNIFY ASSURA ICD,C1882,HCPCS,,79007328,CDM,275,RC,,,both,,,57867,22838.25,39.4668,,22838.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19674.78,34,,19674.78,percent of total billed charges,Implant Device,19674.78,34,,19674.78,percent of total billed charges,Implant Device,19674.78,34,,19674.78,percent of total billed charges,Implant Device,19674.78,34,,19674.78,percent of total billed charges,Implant Device,19674.78,34,,19674.78,percent of total billed charges,Implant Device,19674.78,34,,19674.78,percent of total billed charges,Implant Device,20253.45,35,,20253.45,percent of total billed charges,Implant Device,19674.78,34,"Charges > $500, x 34%",19674.78,percent of total billed charges,Implant Device,20253.45,35,,20253.45,percent of total billed charges,Implant Devices,20253.45,35,,20253.45,percent of total billed charges,Implant Devices,20253.45,35,,,percent of total billed charges,Implant Devices,20253.45,35,,20253.45,percent of total billed charges,Implant Devices,20253.45,35,,20253.45,percent of total billed charges,Implant Devices,23146.8,40,,23146.8,percent of total billed charges,Implant Devices,20253.45,70,,20253.45,percent of total billed charges,Implant Devices,19674.78,34,,19674.78,percent of total billed charges,Implant Devices,19674.78,34,,19674.78,percent of total billed charges,Implant Devices,20253.45,35,,20253.45,percent of total billed charges,Implant Devices,20253.45,35,,20253.45,percent of total billed charges,Implant Devices,20253.45,35,,20253.45,percent of total billed charges,Implant Devices,20253.45,35,,20253.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,19674.78,34,"If Charge > 2,000, then 34 percent",19674.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23146.8,
ST JUDE CD3357-40Q UNIFY ASSURA,C1882,HCPCS,,79007941,CDM,275,RC,,,both,,,60634,23930.3,39.4668,,23930.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20615.56,34,,20615.56,percent of total billed charges,Implant Device,20615.56,34,,20615.56,percent of total billed charges,Implant Device,20615.56,34,,20615.56,percent of total billed charges,Implant Device,20615.56,34,,20615.56,percent of total billed charges,Implant Device,20615.56,34,,20615.56,percent of total billed charges,Implant Device,20615.56,34,,20615.56,percent of total billed charges,Implant Device,21221.9,35,,21221.9,percent of total billed charges,Implant Device,20615.56,34,"Charges > $500, x 34%",20615.56,percent of total billed charges,Implant Device,21221.9,35,,21221.9,percent of total billed charges,Implant Devices,21221.9,35,,21221.9,percent of total billed charges,Implant Devices,21221.9,35,,,percent of total billed charges,Implant Devices,21221.9,35,,21221.9,percent of total billed charges,Implant Devices,21221.9,35,,21221.9,percent of total billed charges,Implant Devices,24253.6,40,,24253.6,percent of total billed charges,Implant Devices,21221.9,70,,21221.9,percent of total billed charges,Implant Devices,20615.56,34,,20615.56,percent of total billed charges,Implant Devices,20615.56,34,,20615.56,percent of total billed charges,Implant Devices,21221.9,35,,21221.9,percent of total billed charges,Implant Devices,21221.9,35,,21221.9,percent of total billed charges,Implant Devices,21221.9,35,,21221.9,percent of total billed charges,Implant Devices,21221.9,35,,21221.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,20615.56,34,"If Charge > 2,000, then 34 percent",20615.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24253.6,
ABBOTT CD3369-40Q QUADRA ASSURA,C1882,HCPCS,,79012648,CDM,275,RC,,,both,,,69378,27381.28,39.4668,,27381.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23588.52,34,,23588.52,percent of total billed charges,Implant Device,23588.52,34,,23588.52,percent of total billed charges,Implant Device,23588.52,34,,23588.52,percent of total billed charges,Implant Device,23588.52,34,,23588.52,percent of total billed charges,Implant Device,23588.52,34,,23588.52,percent of total billed charges,Implant Device,23588.52,34,,23588.52,percent of total billed charges,Implant Device,24282.3,35,,24282.3,percent of total billed charges,Implant Device,23588.52,34,"Charges > $500, x 34%",23588.52,percent of total billed charges,Implant Device,24282.3,35,,24282.3,percent of total billed charges,Implant Devices,24282.3,35,,24282.3,percent of total billed charges,Implant Devices,24282.3,35,,,percent of total billed charges,Implant Devices,24282.3,35,,24282.3,percent of total billed charges,Implant Devices,24282.3,35,,24282.3,percent of total billed charges,Implant Devices,27751.2,40,,27751.2,percent of total billed charges,Implant Devices,24282.3,70,,24282.3,percent of total billed charges,Implant Devices,23588.52,34,,23588.52,percent of total billed charges,Implant Devices,23588.52,34,,23588.52,percent of total billed charges,Implant Devices,24282.3,35,,24282.3,percent of total billed charges,Implant Devices,24282.3,35,,24282.3,percent of total billed charges,Implant Devices,24282.3,35,,24282.3,percent of total billed charges,Implant Devices,24282.3,35,,24282.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,23588.52,34,"If Charge > 2,000, then 34 percent",23588.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27751.2,
BOST SCI 3501 EMBLEM S-ICD ELECTRODE 45,C1896,HCPCS,,79012161,CDM,275,RC,,,both,,,18000,7104.02,39.4668,,7104.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6120,34,,6120,percent of total billed charges,Implant Device,6120,34,,6120,percent of total billed charges,Implant Device,6120,34,,6120,percent of total billed charges,Implant Device,6120,34,,6120,percent of total billed charges,Implant Device,6120,34,,6120,percent of total billed charges,Implant Device,6120,34,,6120,percent of total billed charges,Implant Device,6300,35,,6300,percent of total billed charges,Implant Device,6120,34,"Charges > $500, x 34%",6120,percent of total billed charges,Implant Device,6300,35,,6300,percent of total billed charges,Implant Devices,6300,35,,6300,percent of total billed charges,Implant Devices,6300,35,,,percent of total billed charges,Implant Devices,6300,35,,6300,percent of total billed charges,Implant Devices,6300,35,,6300,percent of total billed charges,Implant Devices,7200,40,,7200,percent of total billed charges,Implant Devices,6300,70,,6300,percent of total billed charges,Implant Devices,6120,34,,6120,percent of total billed charges,Implant Devices,6120,34,,6120,percent of total billed charges,Implant Devices,6300,35,,6300,percent of total billed charges,Implant Devices,6300,35,,6300,percent of total billed charges,Implant Devices,6300,35,,6300,percent of total billed charges,Implant Devices,6300,35,,6300,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6120,34,"If Charge > 2,000, then 34 percent",6120,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7200,
BIOTRONIK 377177 SOLIA S 53 PACING LEAD,C1898,HCPCS,,79009646,CDM,275,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
BIOTRONIK 377179 SOLIA S 60 LEAD,C1898,HCPCS,,79010765,CDM,275,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
MEDTRONIC C4TR01 CRT PACEMAKER CONSULTA,C2621,HCPCS,,79007333,CDM,275,RC,,,both,,,26544,10476.07,39.4668,,10476.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,9024.96,34,,9024.96,percent of total billed charges,Implant Device,9024.96,34,,9024.96,percent of total billed charges,Implant Device,9024.96,34,,9024.96,percent of total billed charges,Implant Device,9024.96,34,,9024.96,percent of total billed charges,Implant Device,9024.96,34,,9024.96,percent of total billed charges,Implant Device,9024.96,34,,9024.96,percent of total billed charges,Implant Device,9290.4,35,,9290.4,percent of total billed charges,Implant Device,9024.96,34,"Charges > $500, x 34%",9024.96,percent of total billed charges,Implant Device,9290.4,35,,9290.4,percent of total billed charges,Implant Devices,9290.4,35,,9290.4,percent of total billed charges,Implant Devices,9290.4,35,,,percent of total billed charges,Implant Devices,9290.4,35,,9290.4,percent of total billed charges,Implant Devices,9290.4,35,,9290.4,percent of total billed charges,Implant Devices,10617.6,40,,10617.6,percent of total billed charges,Implant Devices,9290.4,70,,9290.4,percent of total billed charges,Implant Devices,9024.96,34,,9024.96,percent of total billed charges,Implant Devices,9024.96,34,,9024.96,percent of total billed charges,Implant Devices,9290.4,35,,9290.4,percent of total billed charges,Implant Devices,9290.4,35,,9290.4,percent of total billed charges,Implant Devices,9290.4,35,,9290.4,percent of total billed charges,Implant Devices,9290.4,35,,9290.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,9024.96,34,"If Charge > 2,000, then 34 percent",9024.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10617.6,
THERACOM ESS305 ESSURE BIRTH CNTRL IMPL,A4264,HCPCS,,79006278,CDM,278,RC,,,both,,,5550,2190.41,39.4668,,2190.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Device,1887,34,"Charges > $500, x 34%",1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,2220,40,,2220,percent of total billed charges,Implant Devices,1942.5,70,,1942.5,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1887,34,"If Charge > 2,000, then 34 percent",1887,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2220,
BREAST MARKER MAMMOMARK 11G,A4648,HCPCS,,79000016,CDM,278,RC,,,both,,,206,81.3,39.4668,,81.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,72.1,35,,72.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,82.4,40,,82.4,percent of total billed charges,Implant Devices,72.1,70,,72.1,percent of total billed charges,Implant Devices,70.04,34,,70.04,percent of total billed charges,Implant Devices,70.04,34,,70.04,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,82.4,
DEVICOR8G MAMMOMARK BREAST MARKER,A4648,HCPCS,,79000019,CDM,278,RC,,,both,,,206,81.3,39.4668,,81.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,72.1,35,,72.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,82.4,40,,82.4,percent of total billed charges,Implant Devices,72.1,70,,72.1,percent of total billed charges,Implant Devices,70.04,34,,70.04,percent of total billed charges,Implant Devices,70.04,34,,70.04,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,82.4,
DEVICOR MAM3002 MAMMO MARK 2ND SITE,A4648,HCPCS,,79000021,CDM,278,RC,,,both,,,206,81.3,39.4668,,81.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,70.04,34,,70.04,percent of total billed charges,Implant Device,72.1,35,,72.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,82.4,40,,82.4,percent of total billed charges,Implant Devices,72.1,70,,72.1,percent of total billed charges,Implant Devices,70.04,34,,70.04,percent of total billed charges,Implant Devices,70.04,34,,70.04,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,72.1,35,,72.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,82.4,
BREAST MARKER MAMMOMARK 11G,A4648,HCPCS,,79000027,CDM,278,RC,,,both,,,227,89.59,39.4668,,89.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.18,34,,77.18,percent of total billed charges,Implant Device,77.18,34,,77.18,percent of total billed charges,Implant Device,77.18,34,,77.18,percent of total billed charges,Implant Device,77.18,34,,77.18,percent of total billed charges,Implant Device,77.18,34,,77.18,percent of total billed charges,Implant Device,77.18,34,,77.18,percent of total billed charges,Implant Device,79.45,35,,79.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.45,35,,79.45,percent of total billed charges,Implant Devices,79.45,35,,79.45,percent of total billed charges,Implant Devices,79.45,35,,,percent of total billed charges,Implant Devices,79.45,35,,79.45,percent of total billed charges,Implant Devices,79.45,35,,79.45,percent of total billed charges,Implant Devices,90.8,40,,90.8,percent of total billed charges,Implant Devices,79.45,70,,79.45,percent of total billed charges,Implant Devices,77.18,34,,77.18,percent of total billed charges,Implant Devices,77.18,34,,77.18,percent of total billed charges,Implant Devices,79.45,35,,79.45,percent of total billed charges,Implant Devices,79.45,35,,79.45,percent of total billed charges,Implant Devices,79.45,35,,79.45,percent of total billed charges,Implant Devices,79.45,35,,79.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90.8,
DEVICOR 8G MAMMOMARK BREAST MARKER,A4648,HCPCS,,79000029,CDM,278,RC,,,both,,,230,90.77,39.4668,,90.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78.2,34,,78.2,percent of total billed charges,Implant Device,78.2,34,,78.2,percent of total billed charges,Implant Device,78.2,34,,78.2,percent of total billed charges,Implant Device,78.2,34,,78.2,percent of total billed charges,Implant Device,78.2,34,,78.2,percent of total billed charges,Implant Device,78.2,34,,78.2,percent of total billed charges,Implant Device,80.5,35,,80.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,92,40,,92,percent of total billed charges,Implant Devices,80.5,70,,80.5,percent of total billed charges,Implant Devices,78.2,34,,78.2,percent of total billed charges,Implant Devices,78.2,34,,78.2,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,92,
MAMMO MARK 2ND SITE,A4648,HCPCS,,79000030,CDM,278,RC,,,both,,,2263,893.13,39.4668,,893.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,769.42,34,,769.42,percent of total billed charges,Implant Device,769.42,34,,769.42,percent of total billed charges,Implant Device,769.42,34,,769.42,percent of total billed charges,Implant Device,769.42,34,,769.42,percent of total billed charges,Implant Device,769.42,34,,769.42,percent of total billed charges,Implant Device,769.42,34,,769.42,percent of total billed charges,Implant Device,792.05,35,,792.05,percent of total billed charges,Implant Device,769.42,34,"Charges > $500, x 34%",769.42,percent of total billed charges,Implant Device,792.05,35,,792.05,percent of total billed charges,Implant Devices,792.05,35,,792.05,percent of total billed charges,Implant Devices,792.05,35,,,percent of total billed charges,Implant Devices,792.05,35,,792.05,percent of total billed charges,Implant Devices,792.05,35,,792.05,percent of total billed charges,Implant Devices,905.2,40,,905.2,percent of total billed charges,Implant Devices,792.05,70,,792.05,percent of total billed charges,Implant Devices,769.42,34,,769.42,percent of total billed charges,Implant Devices,769.42,34,,769.42,percent of total billed charges,Implant Devices,792.05,35,,792.05,percent of total billed charges,Implant Devices,792.05,35,,792.05,percent of total billed charges,Implant Devices,792.05,35,,792.05,percent of total billed charges,Implant Devices,792.05,35,,792.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,769.42,34,"If Charge > 2,000, then 34 percent",769.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,905.2,
SYWEST 231030G MAMMOLOCK NEEDLE 20GAX3CM,A4648,HCPCS,,79002709,CDM,278,RC,,,both,,,99,39.07,39.4668,,39.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,39.6,40,,39.6,percent of total billed charges,Implant Devices,34.65,70,,34.65,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39.6,
DEVICOR MMK0801 8G MAMMOMARK BOWTIE,A4648,HCPCS,,79005556,CDM,278,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,91.2,40,,91.2,percent of total billed charges,Implant Devices,79.8,70,,79.8,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,91.2,
DEVICOR MMK0802 8G MAMMOMARK V SHAPE,A4648,HCPCS,,79005557,CDM,278,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,91.2,40,,91.2,percent of total billed charges,Implant Devices,79.8,70,,79.8,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,91.2,
DEVICOR MMK1001 10G MAMMOMARK BOWTIE,A4648,HCPCS,,79005618,CDM,278,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,91.2,40,,91.2,percent of total billed charges,Implant Devices,79.8,70,,79.8,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,91.2,
DEVICOR MMK1002 10G MAMMOMARK V SHAPE,A4648,HCPCS,,79005619,CDM,278,RC,,,both,,,213,84.06,39.4668,,84.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,72.42,34,,72.42,percent of total billed charges,Implant Device,72.42,34,,72.42,percent of total billed charges,Implant Device,72.42,34,,72.42,percent of total billed charges,Implant Device,72.42,34,,72.42,percent of total billed charges,Implant Device,72.42,34,,72.42,percent of total billed charges,Implant Device,72.42,34,,72.42,percent of total billed charges,Implant Device,74.55,35,,74.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,74.55,35,,74.55,percent of total billed charges,Implant Devices,74.55,35,,74.55,percent of total billed charges,Implant Devices,74.55,35,,,percent of total billed charges,Implant Devices,74.55,35,,74.55,percent of total billed charges,Implant Devices,74.55,35,,74.55,percent of total billed charges,Implant Devices,85.2,40,,85.2,percent of total billed charges,Implant Devices,74.55,70,,74.55,percent of total billed charges,Implant Devices,72.42,34,,72.42,percent of total billed charges,Implant Devices,72.42,34,,72.42,percent of total billed charges,Implant Devices,74.55,35,,74.55,percent of total billed charges,Implant Devices,74.55,35,,74.55,percent of total billed charges,Implant Devices,74.55,35,,74.55,percent of total billed charges,Implant Devices,74.55,35,,74.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,85.2,
BARD GMUTC005SS GELMARK ULTRACOR 14G RBN,A4648,HCPCS,,79006236,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
BARD GMUTC005T GELMARK ULTRACOR US 14G S,A4648,HCPCS,,79006237,CDM,278,RC,,,both,,,357,140.9,39.4668,,140.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,124.95,35,,124.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,142.8,40,,142.8,percent of total billed charges,Implant Devices,124.95,70,,124.95,percent of total billed charges,Implant Devices,121.38,34,,121.38,percent of total billed charges,Implant Devices,121.38,34,,121.38,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142.8,
DEVICOR MRM4008 BREAST BX MARKERS,A4648,HCPCS,,79007224,CDM,278,RC,,,both,,,280,110.51,39.4668,,110.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.2,34,,95.2,percent of total billed charges,Implant Device,95.2,34,,95.2,percent of total billed charges,Implant Device,95.2,34,,95.2,percent of total billed charges,Implant Device,95.2,34,,95.2,percent of total billed charges,Implant Device,95.2,34,,95.2,percent of total billed charges,Implant Device,95.2,34,,95.2,percent of total billed charges,Implant Device,98,35,,98,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98,35,,98,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,98,35,,,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,112,40,,112,percent of total billed charges,Implant Devices,98,70,,98,percent of total billed charges,Implant Devices,95.2,34,,95.2,percent of total billed charges,Implant Devices,95.2,34,,95.2,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112,
DEVICOR JMRM4002 10G MR BREAST MARKER,A4648,HCPCS,,79008333,CDM,278,RC,,,both,,,280,110.51,39.4668,,110.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.2,34,,95.2,percent of total billed charges,Implant Device,95.2,34,,95.2,percent of total billed charges,Implant Device,95.2,34,,95.2,percent of total billed charges,Implant Device,95.2,34,,95.2,percent of total billed charges,Implant Device,95.2,34,,95.2,percent of total billed charges,Implant Device,95.2,34,,95.2,percent of total billed charges,Implant Device,98,35,,98,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98,35,,98,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,98,35,,,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,112,40,,112,percent of total billed charges,Implant Devices,98,70,,98,percent of total billed charges,Implant Devices,95.2,34,,95.2,percent of total billed charges,Implant Devices,95.2,34,,95.2,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,98,35,,98,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112,
ARGON 231050G HOMER BLN 20GX5CM,A4648,HCPCS,,79013372,CDM,278,RC,,,both,,,99,39.07,39.4668,,39.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,39.6,40,,39.6,percent of total billed charges,Implant Devices,34.65,70,,34.65,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39.6,
ARGON 231075G HOMER BLN 20GX7.5CM,A4648,HCPCS,,79013373,CDM,278,RC,,,both,,,99,39.07,39.4668,,39.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,39.6,40,,39.6,percent of total billed charges,Implant Devices,34.65,70,,34.65,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39.6,
ARGON 231100G HOMER BLN 20GX10CM,A4648,HCPCS,,79013374,CDM,278,RC,,,both,,,99,39.07,39.4668,,39.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,39.6,40,,39.6,percent of total billed charges,Implant Devices,34.65,70,,34.65,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39.6,
MEDTRONIC C01B CEMENT WITH MIXER,C1713,HCPCS,,79000307,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ARTHREX AR-1530BC SCREW BIOCOMP 3X8MM,C1713,HCPCS,,79000894,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
MICRO AIRE 1600-1945 K WIRE .045,C1713,HCPCS,,79000962,CDM,278,RC,,,both,,,19,7.5,39.4668,,7.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.65,35,,6.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,7.6,40,,7.6,percent of total billed charges,Implant Devices,6.65,70,,6.65,percent of total billed charges,Implant Devices,6.46,34,,6.46,percent of total billed charges,Implant Devices,6.46,34,,6.46,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7.6,
ZIMMER 186-03-69 K WIRE .062,C1713,HCPCS,,79000975,CDM,278,RC,,,both,,,18,7.1,39.4668,,7.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6.12,34,,6.12,percent of total billed charges,Implant Device,6.12,34,,6.12,percent of total billed charges,Implant Device,6.12,34,,6.12,percent of total billed charges,Implant Device,6.12,34,,6.12,percent of total billed charges,Implant Device,6.12,34,,6.12,percent of total billed charges,Implant Device,6.12,34,,6.12,percent of total billed charges,Implant Device,6.3,35,,6.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,6.3,35,,6.3,percent of total billed charges,Implant Devices,6.3,35,,6.3,percent of total billed charges,Implant Devices,6.3,35,,,percent of total billed charges,Implant Devices,6.3,35,,6.3,percent of total billed charges,Implant Devices,6.3,35,,6.3,percent of total billed charges,Implant Devices,7.2,40,,7.2,percent of total billed charges,Implant Devices,6.3,70,,6.3,percent of total billed charges,Implant Devices,6.12,34,,6.12,percent of total billed charges,Implant Devices,6.12,34,,6.12,percent of total billed charges,Implant Devices,6.3,35,,6.3,percent of total billed charges,Implant Devices,6.3,35,,6.3,percent of total billed charges,Implant Devices,6.3,35,,6.3,percent of total billed charges,Implant Devices,6.3,35,,6.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7.2,
MICRO AIRE 1600-628 K-WIRE 028,C1713,HCPCS,,79000980,CDM,278,RC,,,both,,,19,7.5,39.4668,,7.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.65,35,,6.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,7.6,40,,7.6,percent of total billed charges,Implant Devices,6.65,70,,6.65,percent of total billed charges,Implant Devices,6.46,34,,6.46,percent of total billed charges,Implant Devices,6.46,34,,6.46,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7.6,
MICRO AIRE 1600-635 K-WIRE 035,C1713,HCPCS,,79000981,CDM,278,RC,,,both,,,19,7.5,39.4668,,7.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.65,35,,6.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,7.6,40,,7.6,percent of total billed charges,Implant Devices,6.65,70,,6.65,percent of total billed charges,Implant Devices,6.46,34,,6.46,percent of total billed charges,Implant Devices,6.46,34,,6.46,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7.6,
BIOMET 91-5611 2.0X11MM SD IMF SCREW,C1713,HCPCS,,79001186,CDM,278,RC,,,both,,,454,179.18,39.4668,,179.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,181.6,40,,181.6,percent of total billed charges,Implant Devices,158.9,70,,158.9,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.6,
J&J 254506 ABSOLUTE INTER SCREW 9 X 30,C1713,HCPCS,,79001187,CDM,278,RC,,,both,,,436,172.08,39.4668,,172.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.24,34,,148.24,percent of total billed charges,Implant Device,148.24,34,,148.24,percent of total billed charges,Implant Device,148.24,34,,148.24,percent of total billed charges,Implant Device,148.24,34,,148.24,percent of total billed charges,Implant Device,148.24,34,,148.24,percent of total billed charges,Implant Device,148.24,34,,148.24,percent of total billed charges,Implant Device,152.6,35,,152.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,152.6,35,,152.6,percent of total billed charges,Implant Devices,152.6,35,,152.6,percent of total billed charges,Implant Devices,152.6,35,,,percent of total billed charges,Implant Devices,152.6,35,,152.6,percent of total billed charges,Implant Devices,152.6,35,,152.6,percent of total billed charges,Implant Devices,174.4,40,,174.4,percent of total billed charges,Implant Devices,152.6,70,,152.6,percent of total billed charges,Implant Devices,148.24,34,,148.24,percent of total billed charges,Implant Devices,148.24,34,,148.24,percent of total billed charges,Implant Devices,152.6,35,,152.6,percent of total billed charges,Implant Devices,152.6,35,,152.6,percent of total billed charges,Implant Devices,152.6,35,,152.6,percent of total billed charges,Implant Devices,152.6,35,,152.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.4,
ARTHREX AR-1588T ACL TIGHTROPE,C1713,HCPCS,,79001188,CDM,278,RC,,,both,,,1180,465.71,39.4668,,465.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,401.2,34,,401.2,percent of total billed charges,Implant Device,401.2,34,,401.2,percent of total billed charges,Implant Device,401.2,34,,401.2,percent of total billed charges,Implant Device,401.2,34,,401.2,percent of total billed charges,Implant Device,401.2,34,,401.2,percent of total billed charges,Implant Device,401.2,34,,401.2,percent of total billed charges,Implant Device,413,35,,413,percent of total billed charges,Implant Device,401.2,34,"Charges > $500, x 34%",401.2,percent of total billed charges,Implant Device,413,35,,413,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,413,35,,,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,472,40,,472,percent of total billed charges,Implant Devices,413,70,,413,percent of total billed charges,Implant Devices,401.2,34,,401.2,percent of total billed charges,Implant Devices,401.2,34,,401.2,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,472,
ARTHREX AR-1588RT ACL TIGHTROPE KIT,C1713,HCPCS,,79001189,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
STRYKER 54-25384 VOLAR PLATE 56MM RIGHT,C1713,HCPCS,,79001193,CDM,278,RC,,,both,,,3873,1528.55,39.4668,,1528.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1316.82,34,,1316.82,percent of total billed charges,Implant Device,1316.82,34,,1316.82,percent of total billed charges,Implant Device,1316.82,34,,1316.82,percent of total billed charges,Implant Device,1316.82,34,,1316.82,percent of total billed charges,Implant Device,1316.82,34,,1316.82,percent of total billed charges,Implant Device,1316.82,34,,1316.82,percent of total billed charges,Implant Device,1355.55,35,,1355.55,percent of total billed charges,Implant Device,1316.82,34,"Charges > $500, x 34%",1316.82,percent of total billed charges,Implant Device,1355.55,35,,1355.55,percent of total billed charges,Implant Devices,1355.55,35,,1355.55,percent of total billed charges,Implant Devices,1355.55,35,,,percent of total billed charges,Implant Devices,1355.55,35,,1355.55,percent of total billed charges,Implant Devices,1355.55,35,,1355.55,percent of total billed charges,Implant Devices,1549.2,40,,1549.2,percent of total billed charges,Implant Devices,1355.55,70,,1355.55,percent of total billed charges,Implant Devices,1316.82,34,,1316.82,percent of total billed charges,Implant Devices,1316.82,34,,1316.82,percent of total billed charges,Implant Devices,1355.55,35,,1355.55,percent of total billed charges,Implant Devices,1355.55,35,,1355.55,percent of total billed charges,Implant Devices,1355.55,35,,1355.55,percent of total billed charges,Implant Devices,1355.55,35,,1355.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1316.82,34,"If Charge > 2,000, then 34 percent",1316.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1549.2,
STRYKER 40-20110E CANN SCREW 2X10/4MM,C1713,HCPCS,,79001197,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER 40-20111E CANN SCREW 2X11/5MM,C1713,HCPCS,,79001198,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER 40-30112E CANN SCREW 2X12/4MM,C1713,HCPCS,,79001199,CDM,278,RC,,,both,,,859,339.02,39.4668,,339.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,300.65,35,,300.65,percent of total billed charges,Implant Device,292.06,34,"Charges > $500, x 34%",292.06,percent of total billed charges,Implant Device,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,343.6,40,,343.6,percent of total billed charges,Implant Devices,300.65,70,,300.65,percent of total billed charges,Implant Devices,292.06,34,,292.06,percent of total billed charges,Implant Devices,292.06,34,,292.06,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.6,
STRYKER 40-20112E CANN SCREW 2X12/5MM,C1713,HCPCS,,79001200,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER 40-20113E CANN SCREW 2X13/6MM,C1713,HCPCS,,79001201,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 40-30114E CANN SCREW 2X14/4MM,C1713,HCPCS,,79001202,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER 40-20114E CANN SCREW 2X14/6MM,C1713,HCPCS,,79001203,CDM,278,RC,,,both,,,455,179.57,39.4668,,179.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,159.25,35,,159.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,182,40,,182,percent of total billed charges,Implant Devices,159.25,70,,159.25,percent of total billed charges,Implant Devices,154.7,34,,154.7,percent of total billed charges,Implant Devices,154.7,34,,154.7,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182,
STRYKER 40-20115E CANN SCREW 2X15/6MM,C1713,HCPCS,,79001204,CDM,278,RC,,,both,,,910,359.15,39.4668,,359.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,318.5,35,,318.5,percent of total billed charges,Implant Device,309.4,34,"Charges > $500, x 34%",309.4,percent of total billed charges,Implant Device,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,364,40,,364,percent of total billed charges,Implant Devices,318.5,70,,318.5,percent of total billed charges,Implant Devices,309.4,34,,309.4,percent of total billed charges,Implant Devices,309.4,34,,309.4,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,364,
STRYKER 40-20116S CANN SCREW 2X16/7MM,C1713,HCPCS,,79001205,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER 40-20117E CANN SCREW 2X17/5MM,C1713,HCPCS,,79001206,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 40-20118E CANN SCREW 2X18/5MM,C1713,HCPCS,,79001207,CDM,278,RC,,,both,,,910,359.15,39.4668,,359.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,318.5,35,,318.5,percent of total billed charges,Implant Device,309.4,34,"Charges > $500, x 34%",309.4,percent of total billed charges,Implant Device,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,364,40,,364,percent of total billed charges,Implant Devices,318.5,70,,318.5,percent of total billed charges,Implant Devices,309.4,34,,309.4,percent of total billed charges,Implant Devices,309.4,34,,309.4,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,364,
STRYKER 40-30118E CANN SCREW 2X18/5MM,C1713,HCPCS,,79001208,CDM,278,RC,,,both,,,646,254.96,39.4668,,254.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Device,219.64,34,"Charges > $500, x 34%",219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,258.4,40,,258.4,percent of total billed charges,Implant Devices,226.1,70,,226.1,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258.4,
STRYKER ASNIS MICRO CANN SCREW 2X20/5MM,C1713,HCPCS,,79001209,CDM,278,RC,,,both,,,707,279.03,39.4668,,279.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,247.45,35,,247.45,percent of total billed charges,Implant Device,240.38,34,"Charges > $500, x 34%",240.38,percent of total billed charges,Implant Device,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,282.8,40,,282.8,percent of total billed charges,Implant Devices,247.45,70,,247.45,percent of total billed charges,Implant Devices,240.38,34,,240.38,percent of total billed charges,Implant Devices,240.38,34,,240.38,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.8,
STRYKER 40-30120E CANN SCREW 2X20/5MM,C1713,HCPCS,,79001210,CDM,278,RC,,,both,,,910,359.15,39.4668,,359.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,318.5,35,,318.5,percent of total billed charges,Implant Device,309.4,34,"Charges > $500, x 34%",309.4,percent of total billed charges,Implant Device,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,364,40,,364,percent of total billed charges,Implant Devices,318.5,70,,318.5,percent of total billed charges,Implant Devices,309.4,34,,309.4,percent of total billed charges,Implant Devices,309.4,34,,309.4,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,364,
STRYKER 40-20220S CANN SCREW 2X20/9MM,C1713,HCPCS,,79001211,CDM,278,RC,,,both,,,707,279.03,39.4668,,279.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,247.45,35,,247.45,percent of total billed charges,Implant Device,240.38,34,"Charges > $500, x 34%",240.38,percent of total billed charges,Implant Device,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,282.8,40,,282.8,percent of total billed charges,Implant Devices,247.45,70,,247.45,percent of total billed charges,Implant Devices,240.38,34,,240.38,percent of total billed charges,Implant Devices,240.38,34,,240.38,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.8,
STRYKER 40-20122E CANN SCREW 2X22/5MM,C1713,HCPCS,,79001212,CDM,278,RC,,,both,,,910,359.15,39.4668,,359.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,318.5,35,,318.5,percent of total billed charges,Implant Device,309.4,34,"Charges > $500, x 34%",309.4,percent of total billed charges,Implant Device,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,364,40,,364,percent of total billed charges,Implant Devices,318.5,70,,318.5,percent of total billed charges,Implant Devices,309.4,34,,309.4,percent of total billed charges,Implant Devices,309.4,34,,309.4,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,364,
STRYKER 40-30122E CANN SCREW 2X22/5MM,C1713,HCPCS,,79001213,CDM,278,RC,,,both,,,646,254.96,39.4668,,254.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Device,219.64,34,"Charges > $500, x 34%",219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,258.4,40,,258.4,percent of total billed charges,Implant Devices,226.1,70,,226.1,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258.4,
STRYKER 40-30124E CANN SCREW 2X24/6MM,C1713,HCPCS,,79001214,CDM,278,RC,,,both,,,646,254.96,39.4668,,254.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Device,219.64,34,"Charges > $500, x 34%",219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,258.4,40,,258.4,percent of total billed charges,Implant Devices,226.1,70,,226.1,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258.4,
STRYKER 40-30125E CANN SCREW 2 X 25MM,C1713,HCPCS,,79001215,CDM,278,RC,,,both,,,581,229.3,39.4668,,229.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Device,197.54,34,"Charges > $500, x 34%",197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,232.4,40,,232.4,percent of total billed charges,Implant Devices,203.35,70,,203.35,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.4,
STRYKER 40-30126E CANN SCREW 2X26/6MM,C1713,HCPCS,,79001216,CDM,278,RC,,,both,,,581,229.3,39.4668,,229.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Device,197.54,34,"Charges > $500, x 34%",197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,232.4,40,,232.4,percent of total billed charges,Implant Devices,203.35,70,,203.35,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.4,
STRYKER 40-30128E CANN SCREW 2X28/6MM,C1713,HCPCS,,79001217,CDM,278,RC,,,both,,,596,235.22,39.4668,,235.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,202.64,34,,202.64,percent of total billed charges,Implant Device,202.64,34,,202.64,percent of total billed charges,Implant Device,202.64,34,,202.64,percent of total billed charges,Implant Device,202.64,34,,202.64,percent of total billed charges,Implant Device,202.64,34,,202.64,percent of total billed charges,Implant Device,202.64,34,,202.64,percent of total billed charges,Implant Device,208.6,35,,208.6,percent of total billed charges,Implant Device,202.64,34,"Charges > $500, x 34%",202.64,percent of total billed charges,Implant Device,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,238.4,40,,238.4,percent of total billed charges,Implant Devices,208.6,70,,208.6,percent of total billed charges,Implant Devices,202.64,34,,202.64,percent of total billed charges,Implant Devices,202.64,34,,202.64,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,238.4,
STRYKER 40-30132E CANN SCREW 2X32/6MM,C1713,HCPCS,,79001218,CDM,278,RC,,,both,,,581,229.3,39.4668,,229.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Device,197.54,34,"Charges > $500, x 34%",197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,232.4,40,,232.4,percent of total billed charges,Implant Devices,203.35,70,,203.35,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.4,
STRYKER 40-30134 CANN SCREW 2X34/7MM,C1713,HCPCS,,79001219,CDM,278,RC,,,both,,,596,235.22,39.4668,,235.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,202.64,34,,202.64,percent of total billed charges,Implant Device,202.64,34,,202.64,percent of total billed charges,Implant Device,202.64,34,,202.64,percent of total billed charges,Implant Device,202.64,34,,202.64,percent of total billed charges,Implant Device,202.64,34,,202.64,percent of total billed charges,Implant Device,202.64,34,,202.64,percent of total billed charges,Implant Device,208.6,35,,208.6,percent of total billed charges,Implant Device,202.64,34,"Charges > $500, x 34%",202.64,percent of total billed charges,Implant Device,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,238.4,40,,238.4,percent of total billed charges,Implant Devices,208.6,70,,208.6,percent of total billed charges,Implant Devices,202.64,34,,202.64,percent of total billed charges,Implant Devices,202.64,34,,202.64,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,208.6,35,,208.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,238.4,
STRYKER 40-30136S CANN SCREW 2X36/7MM,C1713,HCPCS,,79001220,CDM,278,RC,,,both,,,704,277.85,39.4668,,277.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.36,34,,239.36,percent of total billed charges,Implant Device,239.36,34,,239.36,percent of total billed charges,Implant Device,239.36,34,,239.36,percent of total billed charges,Implant Device,239.36,34,,239.36,percent of total billed charges,Implant Device,239.36,34,,239.36,percent of total billed charges,Implant Device,239.36,34,,239.36,percent of total billed charges,Implant Device,246.4,35,,246.4,percent of total billed charges,Implant Device,239.36,34,"Charges > $500, x 34%",239.36,percent of total billed charges,Implant Device,246.4,35,,246.4,percent of total billed charges,Implant Devices,246.4,35,,246.4,percent of total billed charges,Implant Devices,246.4,35,,,percent of total billed charges,Implant Devices,246.4,35,,246.4,percent of total billed charges,Implant Devices,246.4,35,,246.4,percent of total billed charges,Implant Devices,281.6,40,,281.6,percent of total billed charges,Implant Devices,246.4,70,,246.4,percent of total billed charges,Implant Devices,239.36,34,,239.36,percent of total billed charges,Implant Devices,239.36,34,,239.36,percent of total billed charges,Implant Devices,246.4,35,,246.4,percent of total billed charges,Implant Devices,246.4,35,,246.4,percent of total billed charges,Implant Devices,246.4,35,,246.4,percent of total billed charges,Implant Devices,246.4,35,,246.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,281.6,
STRYKER 40-30138E CANN SCREW 2X38/8MM,C1713,HCPCS,,79001221,CDM,278,RC,,,both,,,581,229.3,39.4668,,229.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Device,197.54,34,"Charges > $500, x 34%",197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,232.4,40,,232.4,percent of total billed charges,Implant Devices,203.35,70,,203.35,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.4,
STRYKER 40-20009E CANN SCREW 2 X 9/4MM,C1713,HCPCS,,79001222,CDM,278,RC,,,both,,,574,226.54,39.4668,,226.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Device,195.16,34,"Charges > $500, x 34%",195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,229.6,40,,229.6,percent of total billed charges,Implant Devices,200.9,70,,200.9,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,229.6,
ARTHREX AR-1923BC BIO COMPOSITE PUSHLOCK,C1713,HCPCS,,79001224,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
ARTHREX AR-1927BCFT SUT ANCHOR 5.5MM,C1713,HCPCS,,79001225,CDM,278,RC,,,both,,,1036,408.88,39.4668,,408.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Device,352.24,34,"Charges > $500, x 34%",352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,414.4,40,,414.4,percent of total billed charges,Implant Devices,362.6,70,,362.6,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,414.4,
ARTHREX AR-1680B BIOTENOD SCREW 8X12,C1713,HCPCS,,79001228,CDM,278,RC,,,both,,,1110,438.08,39.4668,,438.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Device,377.4,34,"Charges > $500, x 34%",377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,444,40,,444,percent of total billed charges,Implant Devices,388.5,70,,388.5,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,444,
ARTHREX AR-1934BCFT SUTURE TACKS 3.0,C1713,HCPCS,,79001229,CDM,278,RC,,,both,,,975,384.8,39.4668,,384.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,341.25,35,,341.25,percent of total billed charges,Implant Device,331.5,34,"Charges > $500, x 34%",331.5,percent of total billed charges,Implant Device,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,390,40,,390,percent of total billed charges,Implant Devices,341.25,70,,341.25,percent of total billed charges,Implant Devices,331.5,34,,331.5,percent of total billed charges,Implant Devices,331.5,34,,331.5,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,390,
ARTHREX AR-1934BCF-24 BIOCOMPOSITE 2.4MM,C1713,HCPCS,,79001230,CDM,278,RC,,,both,,,915,361.12,39.4668,,361.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,320.25,35,,320.25,percent of total billed charges,Implant Device,311.1,34,"Charges > $500, x 34%",311.1,percent of total billed charges,Implant Device,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,366,40,,366,percent of total billed charges,Implant Devices,320.25,70,,320.25,percent of total billed charges,Implant Devices,311.1,34,,311.1,percent of total billed charges,Implant Devices,311.1,34,,311.1,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,366,
ARTHREX AR-1920BNF SUT ANCHOR 5X17.9,C1713,HCPCS,,79001231,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
ARTHREX AR-1920BF-37 SUT ANCHOR 3.7X17.9,C1713,HCPCS,,79001232,CDM,278,RC,,,both,,,780,307.84,39.4668,,307.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Device,265.2,34,"Charges > $500, x 34%",265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,312,40,,312,percent of total billed charges,Implant Devices,273,70,,273,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,312,
ARTHREX AR-1925BNF SUT ANCHOR 5X17.9,C1713,HCPCS,,79001233,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
ARTHREX AR-1920BFT SUTURE ANCHOR 5X17.9,C1713,HCPCS,,79001234,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
ARTHREX AR-1927BF-65 SUTURE ANCHOR 6.5,C1713,HCPCS,,79001235,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
J&J 212739 BIOKNOTLSS RC ANCHOR PANACRYL,C1713,HCPCS,,79001236,CDM,278,RC,,,both,,,868,342.57,39.4668,,342.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,303.8,35,,303.8,percent of total billed charges,Implant Device,295.12,34,"Charges > $500, x 34%",295.12,percent of total billed charges,Implant Device,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,347.2,40,,347.2,percent of total billed charges,Implant Devices,303.8,70,,303.8,percent of total billed charges,Implant Devices,295.12,34,,295.12,percent of total billed charges,Implant Devices,295.12,34,,295.12,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,347.2,
ARTHREX AR-1934BF BIOSUTURE TACK 3 X 14,C1713,HCPCS,,79001238,CDM,278,RC,,,both,,,148,58.41,39.4668,,58.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,51.8,35,,51.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,59.2,40,,59.2,percent of total billed charges,Implant Devices,51.8,70,,51.8,percent of total billed charges,Implant Devices,50.32,34,,50.32,percent of total billed charges,Implant Devices,50.32,34,,50.32,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,59.2,
ARTHREX AR-1530B BIOTENDODESIS SCREW,C1713,HCPCS,,79001239,CDM,278,RC,,,both,,,1006,397.04,39.4668,,397.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,342.04,34,,342.04,percent of total billed charges,Implant Device,342.04,34,,342.04,percent of total billed charges,Implant Device,342.04,34,,342.04,percent of total billed charges,Implant Device,342.04,34,,342.04,percent of total billed charges,Implant Device,342.04,34,,342.04,percent of total billed charges,Implant Device,342.04,34,,342.04,percent of total billed charges,Implant Device,352.1,35,,352.1,percent of total billed charges,Implant Device,342.04,34,"Charges > $500, x 34%",342.04,percent of total billed charges,Implant Device,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,402.4,40,,402.4,percent of total billed charges,Implant Devices,352.1,70,,352.1,percent of total billed charges,Implant Devices,342.04,34,,342.04,percent of total billed charges,Implant Devices,342.04,34,,342.04,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,402.4,
ARTHREX AR-1570BC BIOTENODESIS 7 X 23,C1713,HCPCS,,79001240,CDM,278,RC,,,both,,,1035,408.48,39.4668,,408.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,362.25,35,,362.25,percent of total billed charges,Implant Device,351.9,34,"Charges > $500, x 34%",351.9,percent of total billed charges,Implant Device,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,414,40,,414,percent of total billed charges,Implant Devices,362.25,70,,362.25,percent of total billed charges,Implant Devices,351.9,34,,351.9,percent of total billed charges,Implant Devices,351.9,34,,351.9,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,414,
ARTHREX AR-1580BC BIOTENODESIS 8 X 23,C1713,HCPCS,,79001241,CDM,278,RC,,,both,,,1036,408.88,39.4668,,408.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Device,352.24,34,"Charges > $500, x 34%",352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,414.4,40,,414.4,percent of total billed charges,Implant Devices,362.6,70,,362.6,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,414.4,
ARTHREX AR-1547B BIOTENOD SCREW 4.75X15,C1713,HCPCS,,79001243,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ARTHREX AR-1555B BIOTENOD SCREW 5.5X15,C1713,HCPCS,,79001244,CDM,278,RC,,,both,,,1224,483.07,39.4668,,483.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,428.4,35,,428.4,percent of total billed charges,Implant Device,416.16,34,"Charges > $500, x 34%",416.16,percent of total billed charges,Implant Device,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,489.6,40,,489.6,percent of total billed charges,Implant Devices,428.4,70,,428.4,percent of total billed charges,Implant Devices,416.16,34,,416.16,percent of total billed charges,Implant Devices,416.16,34,,416.16,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,489.6,
ARTHREX AR-1570B BIOTENOD SCREW 7X23,C1713,HCPCS,,79001245,CDM,278,RC,,,both,,,1110,438.08,39.4668,,438.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Device,377.4,34,"Charges > $500, x 34%",377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,444,40,,444,percent of total billed charges,Implant Devices,388.5,70,,388.5,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,444,
ARTHREX AR-1580B BIOTENOD SCREW 8X23,C1713,HCPCS,,79001246,CDM,278,RC,,,both,,,1110,438.08,39.4668,,438.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Device,377.4,34,"Charges > $500, x 34%",377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,444,40,,444,percent of total billed charges,Implant Devices,388.5,70,,388.5,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,444,
DEPUY 5450-35-500 BONE CEMENT,C1713,HCPCS,,79001247,CDM,278,RC,,,both,,,864,340.99,39.4668,,340.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,302.4,35,,302.4,percent of total billed charges,Implant Device,293.76,34,"Charges > $500, x 34%",293.76,percent of total billed charges,Implant Device,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,345.6,40,,345.6,percent of total billed charges,Implant Devices,302.4,70,,302.4,percent of total billed charges,Implant Devices,293.76,34,,293.76,percent of total billed charges,Implant Devices,293.76,34,,293.76,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,345.6,
STRYKER 6191-1-001 BONE CEMENT B,C1713,HCPCS,,79001248,CDM,278,RC,,,both,,,346,136.56,39.4668,,136.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,138.4,40,,138.4,percent of total billed charges,Implant Devices,121.1,70,,121.1,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138.4,
STRYKER 52-23012E BONE SCREW ST 2.3X12MM,C1713,HCPCS,,79001249,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER 52-27126E BONE SCREW PT 2.7X26MM,C1713,HCPCS,,79001250,CDM,278,RC,,,both,,,322,127.08,39.4668,,127.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,128.8,40,,128.8,percent of total billed charges,Implant Devices,112.7,70,,112.7,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.8,
STRYKER 52-27026E BONE SCREW ST 2.7X26MM,C1713,HCPCS,,79001251,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER 52-27222E BONE SCREW PT 2.7X22MM,C1713,HCPCS,,79001252,CDM,278,RC,,,both,,,319,125.9,39.4668,,125.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,127.6,40,,127.6,percent of total billed charges,Implant Devices,111.65,70,,111.65,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,127.6,
STRYKER 53-27126E BONE SCREW PT 2.7X26MM,C1713,HCPCS,,79001253,CDM,278,RC,,,both,,,385,151.95,39.4668,,151.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,134.75,35,,134.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,154,40,,154,percent of total billed charges,Implant Devices,134.75,70,,134.75,percent of total billed charges,Implant Devices,130.9,34,,130.9,percent of total billed charges,Implant Devices,130.9,34,,130.9,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,154,
STRYKER 52-27012E BONE SCREW ST 2.7X12MM,C1713,HCPCS,,79001254,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
STRYKER 58-17010E BONE SCREW ST 1.7X10MM,C1713,HCPCS,,79001255,CDM,278,RC,,,both,,,199,78.54,39.4668,,78.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,67.66,34,,67.66,percent of total billed charges,Implant Device,67.66,34,,67.66,percent of total billed charges,Implant Device,67.66,34,,67.66,percent of total billed charges,Implant Device,67.66,34,,67.66,percent of total billed charges,Implant Device,67.66,34,,67.66,percent of total billed charges,Implant Device,67.66,34,,67.66,percent of total billed charges,Implant Device,69.65,35,,69.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,79.6,40,,79.6,percent of total billed charges,Implant Devices,69.65,70,,69.65,percent of total billed charges,Implant Devices,67.66,34,,67.66,percent of total billed charges,Implant Devices,67.66,34,,67.66,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,79.6,
STRYKER 58-17011E BONE SCREW ST 1.7X11MM,C1713,HCPCS,,79001256,CDM,278,RC,,,both,,,367,144.84,39.4668,,144.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,128.45,35,,128.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,146.8,40,,146.8,percent of total billed charges,Implant Devices,128.45,70,,128.45,percent of total billed charges,Implant Devices,124.78,34,,124.78,percent of total billed charges,Implant Devices,124.78,34,,124.78,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,146.8,
STRYKER 58-17012E BONE SCREW ST 1.7X12MM,C1713,HCPCS,,79001257,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
STRYKER 58-17014E BONE SCREW ST 1.7X12MM,C1713,HCPCS,,79001258,CDM,278,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,70,40,,70,percent of total billed charges,Implant Devices,61.25,70,,61.25,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
STRYKER 58-17016E BONE SCREW ST 1.7X16MM,C1713,HCPCS,,79001259,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
STRYKER 58-17018E BONE SCREW ST 1.7X18MM,C1713,HCPCS,,79001260,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
STRYKER 58-17005E BONE SCREW ST 1.7X5MM,C1713,HCPCS,,79001261,CDM,278,RC,,,both,,,367,144.84,39.4668,,144.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,128.45,35,,128.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,146.8,40,,146.8,percent of total billed charges,Implant Devices,128.45,70,,128.45,percent of total billed charges,Implant Devices,124.78,34,,124.78,percent of total billed charges,Implant Devices,124.78,34,,124.78,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,146.8,
STRYKER 58-17006E BONE SCREW ST 1.7X6MM,C1713,HCPCS,,79001262,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
STRYKER 58-17008E BONE SCREW ST 1.7X8MM,C1713,HCPCS,,79001263,CDM,278,RC,,,both,,,281,110.9,39.4668,,110.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,98.35,35,,98.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,112.4,40,,112.4,percent of total billed charges,Implant Devices,98.35,70,,98.35,percent of total billed charges,Implant Devices,95.54,34,,95.54,percent of total billed charges,Implant Devices,95.54,34,,95.54,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.4,
STRYKER 58-17009E BONE SCREW ST 1.7X9MM,C1713,HCPCS,,79001264,CDM,278,RC,,,both,,,199,78.54,39.4668,,78.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,67.66,34,,67.66,percent of total billed charges,Implant Device,67.66,34,,67.66,percent of total billed charges,Implant Device,67.66,34,,67.66,percent of total billed charges,Implant Device,67.66,34,,67.66,percent of total billed charges,Implant Device,67.66,34,,67.66,percent of total billed charges,Implant Device,67.66,34,,67.66,percent of total billed charges,Implant Device,69.65,35,,69.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,79.6,40,,79.6,percent of total billed charges,Implant Devices,69.65,70,,69.65,percent of total billed charges,Implant Devices,67.66,34,,67.66,percent of total billed charges,Implant Devices,67.66,34,,67.66,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,69.65,35,,69.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,79.6,
STRYKER 58-23010E BONE SCREW ST 2.3X10MM,C1713,HCPCS,,79001265,CDM,278,RC,,,both,,,283,111.69,39.4668,,111.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,99.05,35,,99.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,113.2,40,,113.2,percent of total billed charges,Implant Devices,99.05,70,,99.05,percent of total billed charges,Implant Devices,96.22,34,,96.22,percent of total billed charges,Implant Devices,96.22,34,,96.22,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,113.2,
STRYKER 58-23011E BONE SCREW ST 2.3X11MM,C1713,HCPCS,,79001266,CDM,278,RC,,,both,,,283,111.69,39.4668,,111.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,99.05,35,,99.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,113.2,40,,113.2,percent of total billed charges,Implant Devices,99.05,70,,99.05,percent of total billed charges,Implant Devices,96.22,34,,96.22,percent of total billed charges,Implant Devices,96.22,34,,96.22,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,113.2,
STRYKER 58-23012E BONE SCREW ST 2.3X12MM,C1713,HCPCS,,79001267,CDM,278,RC,,,both,,,283,111.69,39.4668,,111.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,99.05,35,,99.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,113.2,40,,113.2,percent of total billed charges,Implant Devices,99.05,70,,99.05,percent of total billed charges,Implant Devices,96.22,34,,96.22,percent of total billed charges,Implant Devices,96.22,34,,96.22,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,113.2,
STRYKER 58-23013E BONE SCREW ST 2.3X13MM,C1713,HCPCS,,79001268,CDM,278,RC,,,both,,,170,67.09,39.4668,,67.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,57.8,34,,57.8,percent of total billed charges,Implant Device,57.8,34,,57.8,percent of total billed charges,Implant Device,57.8,34,,57.8,percent of total billed charges,Implant Device,57.8,34,,57.8,percent of total billed charges,Implant Device,57.8,34,,57.8,percent of total billed charges,Implant Device,57.8,34,,57.8,percent of total billed charges,Implant Device,59.5,35,,59.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,68,40,,68,percent of total billed charges,Implant Devices,59.5,70,,59.5,percent of total billed charges,Implant Devices,57.8,34,,57.8,percent of total billed charges,Implant Devices,57.8,34,,57.8,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,68,
STRYKER 58-23014E BONE SCREW ST 2.3X14MM,C1713,HCPCS,,79001269,CDM,278,RC,,,both,,,331,130.64,39.4668,,130.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,132.4,40,,132.4,percent of total billed charges,Implant Devices,115.85,70,,115.85,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.4,
STRYKER 58-23015E BONE SCREW ST 2.3X15MM,C1713,HCPCS,,79001270,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
STRYKER 58-23016E BONE SCREW ST 2.3X16MM,C1713,HCPCS,,79001271,CDM,278,RC,,,both,,,265,104.59,39.4668,,104.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,90.1,34,,90.1,percent of total billed charges,Implant Device,90.1,34,,90.1,percent of total billed charges,Implant Device,90.1,34,,90.1,percent of total billed charges,Implant Device,90.1,34,,90.1,percent of total billed charges,Implant Device,90.1,34,,90.1,percent of total billed charges,Implant Device,90.1,34,,90.1,percent of total billed charges,Implant Device,92.75,35,,92.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,106,40,,106,percent of total billed charges,Implant Devices,92.75,70,,92.75,percent of total billed charges,Implant Devices,90.1,34,,90.1,percent of total billed charges,Implant Devices,90.1,34,,90.1,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,106,
STRYKER 58-23018E BONE SCREW ST 2.3X18MM,C1713,HCPCS,,79001272,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
STRYKER 53-23210E BONE SCREW T7 2.3X10MM,C1713,HCPCS,,79001273,CDM,278,RC,,,both,,,319,125.9,39.4668,,125.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,127.6,40,,127.6,percent of total billed charges,Implant Devices,111.65,70,,111.65,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,127.6,
STRYKER 53-23216E BONE SCREW T7 2.3X16MM,C1713,HCPCS,,79001274,CDM,278,RC,,,both,,,385,151.95,39.4668,,151.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,134.75,35,,134.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,154,40,,154,percent of total billed charges,Implant Devices,134.75,70,,134.75,percent of total billed charges,Implant Devices,130.9,34,,130.9,percent of total billed charges,Implant Devices,130.9,34,,130.9,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,154,
STRYKER 53-23218E BONE SCREW T7 2.3X20MM,C1713,HCPCS,,79001275,CDM,278,RC,,,both,,,319,125.9,39.4668,,125.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,127.6,40,,127.6,percent of total billed charges,Implant Devices,111.65,70,,111.65,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,127.6,
STRYKER 53-23220E BONE SCREW T7 2.3X20MM,C1713,HCPCS,,79001276,CDM,278,RC,,,both,,,319,125.9,39.4668,,125.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,127.6,40,,127.6,percent of total billed charges,Implant Devices,111.65,70,,111.65,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,127.6,
STRYKER 53-23222E BONE SCREW T7 2.3X22MM,C1713,HCPCS,,79001277,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 53-23224E BONE SCREW T7 2.3X24MM,C1713,HCPCS,,79001278,CDM,278,RC,,,both,,,319,125.9,39.4668,,125.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,127.6,40,,127.6,percent of total billed charges,Implant Devices,111.65,70,,111.65,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,127.6,
STRYKER 53-23226E BONE SCREW T7 2.3X26MM,C1713,HCPCS,,79001279,CDM,278,RC,,,both,,,319,125.9,39.4668,,125.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,127.6,40,,127.6,percent of total billed charges,Implant Devices,111.65,70,,111.65,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,127.6,
STRYKER 53-27210E BONE SCREW T7 2.7X10MM,C1713,HCPCS,,79001280,CDM,278,RC,,,both,,,331,130.64,39.4668,,130.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,132.4,40,,132.4,percent of total billed charges,Implant Devices,115.85,70,,115.85,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.4,
STRYKER 53-27214E BONE SCREW T7 2.7X14MM,C1713,HCPCS,,79001282,CDM,278,RC,,,both,,,190,74.99,39.4668,,74.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,64.6,34,,64.6,percent of total billed charges,Implant Device,64.6,34,,64.6,percent of total billed charges,Implant Device,64.6,34,,64.6,percent of total billed charges,Implant Device,64.6,34,,64.6,percent of total billed charges,Implant Device,64.6,34,,64.6,percent of total billed charges,Implant Device,64.6,34,,64.6,percent of total billed charges,Implant Device,66.5,35,,66.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,76,40,,76,percent of total billed charges,Implant Devices,66.5,70,,66.5,percent of total billed charges,Implant Devices,64.6,34,,64.6,percent of total billed charges,Implant Devices,64.6,34,,64.6,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76,
STRYKER 53-27216E BONE SCREW T7 2.7X16MM,C1713,HCPCS,,79001283,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
STRYKER 53-27220E BONE SCREW T7 2.7X20MM,C1713,HCPCS,,79001284,CDM,278,RC,,,both,,,344,135.77,39.4668,,135.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,120.4,35,,120.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,137.6,40,,137.6,percent of total billed charges,Implant Devices,120.4,70,,120.4,percent of total billed charges,Implant Devices,116.96,34,,116.96,percent of total billed charges,Implant Devices,116.96,34,,116.96,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.6,
STRYKER 53-27224E BONE SCREW T7 2.7X24MM,C1713,HCPCS,,79001285,CDM,278,RC,,,both,,,319,125.9,39.4668,,125.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,127.6,40,,127.6,percent of total billed charges,Implant Devices,111.65,70,,111.65,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,127.6,
STRYKER 53-27226E BONE SCREW T7 2.7X26MM,C1713,HCPCS,,79001286,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
BIOMET 1974503 BURR HOLE PLATE 13MM,C1713,HCPCS,,79001308,CDM,278,RC,,,both,,,574,226.54,39.4668,,226.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Device,195.16,34,"Charges > $500, x 34%",195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,229.6,40,,229.6,percent of total billed charges,Implant Devices,200.9,70,,200.9,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,229.6,
BIOMET 1975233 BURR HOLE PLATE 18.5MM,C1713,HCPCS,,79001309,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
BIOMET 45-1405 CANCELLOUS CHIPS 30CC,C1713,HCPCS,,79001310,CDM,278,RC,,,both,,,1278,504.39,39.4668,,504.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,434.52,34,,434.52,percent of total billed charges,Implant Device,434.52,34,,434.52,percent of total billed charges,Implant Device,434.52,34,,434.52,percent of total billed charges,Implant Device,434.52,34,,434.52,percent of total billed charges,Implant Device,434.52,34,,434.52,percent of total billed charges,Implant Device,434.52,34,,434.52,percent of total billed charges,Implant Device,447.3,35,,447.3,percent of total billed charges,Implant Device,434.52,34,"Charges > $500, x 34%",434.52,percent of total billed charges,Implant Device,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,511.2,40,,511.2,percent of total billed charges,Implant Devices,447.3,70,,447.3,percent of total billed charges,Implant Devices,434.52,34,,434.52,percent of total billed charges,Implant Devices,434.52,34,,434.52,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,511.2,
BIOMET SPINE 1595 CANCELLOUS CHIPS 60CC,C1713,HCPCS,,79001311,CDM,278,RC,,,both,,,2196,866.69,39.4668,,866.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,746.64,34,,746.64,percent of total billed charges,Implant Device,746.64,34,,746.64,percent of total billed charges,Implant Device,746.64,34,,746.64,percent of total billed charges,Implant Device,746.64,34,,746.64,percent of total billed charges,Implant Device,746.64,34,,746.64,percent of total billed charges,Implant Device,746.64,34,,746.64,percent of total billed charges,Implant Device,768.6,35,,768.6,percent of total billed charges,Implant Device,746.64,34,"Charges > $500, x 34%",746.64,percent of total billed charges,Implant Device,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,878.4,40,,878.4,percent of total billed charges,Implant Devices,768.6,70,,768.6,percent of total billed charges,Implant Devices,746.64,34,,746.64,percent of total billed charges,Implant Devices,746.64,34,,746.64,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,746.64,34,"If Charge > 2,000, then 34 percent",746.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,878.4,
BIOMET 45-1597 CANCELLOUS CHIPS 90CC,C1713,HCPCS,,79001312,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
BIOMET 8161-40-010 CANC SCREW 4.0X10MM,C1713,HCPCS,,79001313,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-012 CANC SCREW 4.0X12MM,C1713,HCPCS,,79001314,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-014 CANC SCREW 4.0X14MM,C1713,HCPCS,,79001315,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-016 CANC SCREW 4.0X16MM,C1713,HCPCS,,79001316,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-018 CANC SCREW 4.0X18MM,C1713,HCPCS,,79001317,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-020 CANC SCREW 4.0X20MM,C1713,HCPCS,,79001318,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-030 CANC SCREW 4.0X30MM,C1713,HCPCS,,79001319,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-034 CANC SCREW 4.0X34MM,C1713,HCPCS,,79001320,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-036 CANC SCREW 4.0X36MM,C1713,HCPCS,,79001321,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-042 CANC SCREW 4.0X42MM,C1713,HCPCS,,79001322,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-044 CANC SCREW 4.0X44MM,C1713,HCPCS,,79001323,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-046 CANC SCREW 4.0X46MM,C1713,HCPCS,,79001324,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-048 CANC SCREW 4.0X48MM,C1713,HCPCS,,79001325,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
SYNTHES 207.05 CANCELLOUS SCREW 4.0X50MM,C1713,HCPCS,,79001326,CDM,278,RC,,,both,,,61,24.07,39.4668,,24.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.74,34,,20.74,percent of total billed charges,Implant Device,20.74,34,,20.74,percent of total billed charges,Implant Device,20.74,34,,20.74,percent of total billed charges,Implant Device,20.74,34,,20.74,percent of total billed charges,Implant Device,20.74,34,,20.74,percent of total billed charges,Implant Device,20.74,34,,20.74,percent of total billed charges,Implant Device,21.35,35,,21.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,21.35,35,,21.35,percent of total billed charges,Implant Devices,21.35,35,,21.35,percent of total billed charges,Implant Devices,21.35,35,,,percent of total billed charges,Implant Devices,21.35,35,,21.35,percent of total billed charges,Implant Devices,21.35,35,,21.35,percent of total billed charges,Implant Devices,24.4,40,,24.4,percent of total billed charges,Implant Devices,21.35,70,,21.35,percent of total billed charges,Implant Devices,20.74,34,,20.74,percent of total billed charges,Implant Devices,20.74,34,,20.74,percent of total billed charges,Implant Devices,21.35,35,,21.35,percent of total billed charges,Implant Devices,21.35,35,,21.35,percent of total billed charges,Implant Devices,21.35,35,,21.35,percent of total billed charges,Implant Devices,21.35,35,,21.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24.4,
BIOMET 8161-40-050 CANC SCREW 4.0X50MM,C1713,HCPCS,,79001327,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-055 CANC SCREW 4.0X55MM,C1713,HCPCS,,79001328,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-060 CANC SCREW 4.0X60MM,C1713,HCPCS,,79001329,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-075 CANC SCREW 4.0X75MM,C1713,HCPCS,,79001330,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-080 CANC SCREW 4.0X80MM,C1713,HCPCS,,79001331,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-40-085 CANC SCREW 4.0X85MM,C1713,HCPCS,,79001332,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8153-41-038 CANC SCREW 4.0X38MM,C1713,HCPCS,,79001333,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8153-41-065 CANC SCREW 4.0X65MM,C1713,HCPCS,,79001334,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8153-41-070 CANC SCREW 4.0X70MM,C1713,HCPCS,,79001335,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8153-41-010 CANC SCREW 4.1X10MM,C1713,HCPCS,,79001336,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8153-41-012 CANC SCREW 4.1X12MM,C1713,HCPCS,,79001337,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
BIOMET 8153-41-014 CANC SCREW 4.1X14MM,C1713,HCPCS,,79001338,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8153-41-016 CANC SCREW 4.1X16MM,C1713,HCPCS,,79001339,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8153-41-018 CANC SCREW 4.1X18MM,C1713,HCPCS,,79001340,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8153-41-020 CANC SCREW 4.1X20MM,C1713,HCPCS,,79001341,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8153-41-022 CANC SCREW 4.1X38MM,C1713,HCPCS,,79001342,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8155-40-014 CANC SCREW 4.0X14MM,C1713,HCPCS,,79001343,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8155-40-030 CANC SCREW 4.0X30MM,C1713,HCPCS,,79001344,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8155-40-040 CANC SCREW 4.0X40MM,C1713,HCPCS,,79001345,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8155-40-045 CANC SCREW 4.0X45MM,C1713,HCPCS,,79001346,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8155-40-050 CANC SCREW 4.0X50MM,C1713,HCPCS,,79001347,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 14196-80 CANN SCREW  6.5X80MM,C1713,HCPCS,,79001349,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
BIOMET 14376-16 CANN SCREW 4.0X16MM,C1713,HCPCS,,79001350,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
BIOMET 14376-26 CANN SCREW 4.0X26MM,C1713,HCPCS,,79001351,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
BIOMET 14376-32 CANN SCREW 4.0X32MM,C1713,HCPCS,,79001352,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
BIOMET 14376-36 CANN SCREW 4.0X36MM,C1713,HCPCS,,79001353,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
BIOMET 14376-40 CANN SCREW 4.0X40MM,C1713,HCPCS,,79001354,CDM,278,RC,,,both,,,514,202.86,39.4668,,202.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Device,174.76,34,"Charges > $500, x 34%",174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,205.6,40,,205.6,percent of total billed charges,Implant Devices,179.9,70,,179.9,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.6,
BIOMET 14376-42 CANN SCREW 4.0X42MM,C1713,HCPCS,,79001355,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
BIOMET 14376-44 CANN SCREW 4.0X44MM,C1713,HCPCS,,79001356,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
BIOMET 14376-46 CANN SCREW 4.0X46MM,C1713,HCPCS,,79001357,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
BIOMET 14376-48 CANN SCREW 4.0X48MM,C1713,HCPCS,,79001358,CDM,278,RC,,,both,,,514,202.86,39.4668,,202.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Device,174.76,34,"Charges > $500, x 34%",174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,205.6,40,,205.6,percent of total billed charges,Implant Devices,179.9,70,,179.9,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.6,
BIOMET 14376-50 CANN SCREW 4.0X50MM,C1713,HCPCS,,79001359,CDM,278,RC,,,both,,,514,202.86,39.4668,,202.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Device,174.76,34,"Charges > $500, x 34%",174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,205.6,40,,205.6,percent of total billed charges,Implant Devices,179.9,70,,179.9,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.6,
BIOMET 14376-55 CANN SCREW 4.0X55MM,C1713,HCPCS,,79001360,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
BIOMET 14376-60 CANN SCREW 4.0X60MM,C1713,HCPCS,,79001361,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
BIOMET 14376-65 CANN SCREW 4.0X65MM,C1713,HCPCS,,79001362,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
BIOMET 14376-70 CANN SCREW 4.0X70MM,C1713,HCPCS,,79001363,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
BIOMET 14196-70 CANN SCREW 6.5X70MM,C1713,HCPCS,,79001364,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
STRYKER 355028S CANNULATED SCREW 28MM,C1713,HCPCS,,79001365,CDM,278,RC,,,both,,,562,221.8,39.4668,,221.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Device,191.08,34,"Charges > $500, x 34%",191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,224.8,40,,224.8,percent of total billed charges,Implant Devices,196.7,70,,196.7,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224.8,
STRYKER 325014 CANNULATED SCREW 4.0 X 14,C1713,HCPCS,,79001368,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 325024 CANNULATED SCREW 4.0 X 24,C1713,HCPCS,,79001369,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 325026 CANNULATED SCREW 4.0 X 26,C1713,HCPCS,,79001370,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 325030 CANNULATED SCREW 4.0 X 30,C1713,HCPCS,,79001371,CDM,278,RC,,,both,,,824,325.21,39.4668,,325.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Device,280.16,34,"Charges > $500, x 34%",280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,329.6,40,,329.6,percent of total billed charges,Implant Devices,288.4,70,,288.4,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,329.6,
SYNTHES 207.63 CANNULATED SCREW 4.0X30MM,C1713,HCPCS,,79001372,CDM,278,RC,,,both,,,856,337.84,39.4668,,337.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,299.6,35,,299.6,percent of total billed charges,Implant Device,291.04,34,"Charges > $500, x 34%",291.04,percent of total billed charges,Implant Device,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,342.4,40,,342.4,percent of total billed charges,Implant Devices,299.6,70,,299.6,percent of total billed charges,Implant Devices,291.04,34,,291.04,percent of total billed charges,Implant Devices,291.04,34,,291.04,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,342.4,
STRYKER 325032 CANNULATED SCREW 4.0 X 32,C1713,HCPCS,,79001373,CDM,278,RC,,,both,,,562,221.8,39.4668,,221.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Device,191.08,34,"Charges > $500, x 34%",191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,224.8,40,,224.8,percent of total billed charges,Implant Devices,196.7,70,,196.7,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224.8,
SYNTHES 207.632 CANNULATED SCREW 4X32MM,C1713,HCPCS,,79001374,CDM,278,RC,,,both,,,798,314.95,39.4668,,314.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,271.32,34,,271.32,percent of total billed charges,Implant Device,271.32,34,,271.32,percent of total billed charges,Implant Device,271.32,34,,271.32,percent of total billed charges,Implant Device,271.32,34,,271.32,percent of total billed charges,Implant Device,271.32,34,,271.32,percent of total billed charges,Implant Device,271.32,34,,271.32,percent of total billed charges,Implant Device,279.3,35,,279.3,percent of total billed charges,Implant Device,271.32,34,"Charges > $500, x 34%",271.32,percent of total billed charges,Implant Device,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,319.2,40,,319.2,percent of total billed charges,Implant Devices,279.3,70,,279.3,percent of total billed charges,Implant Devices,271.32,34,,271.32,percent of total billed charges,Implant Devices,271.32,34,,271.32,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,319.2,
STRYKER 325034 CANNULATED SCREW 4.0 X 34,C1713,HCPCS,,79001375,CDM,278,RC,,,both,,,824,325.21,39.4668,,325.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Device,280.16,34,"Charges > $500, x 34%",280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,329.6,40,,329.6,percent of total billed charges,Implant Devices,288.4,70,,288.4,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,329.6,
STRYKER 325036 CANNULATED SCREW 4.0 X 36,C1713,HCPCS,,79001376,CDM,278,RC,,,both,,,824,325.21,39.4668,,325.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Device,280.16,34,"Charges > $500, x 34%",280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,329.6,40,,329.6,percent of total billed charges,Implant Devices,288.4,70,,288.4,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,329.6,
SYNTHES 207.64 CANNULATED SCREW 4.0X40MM,C1713,HCPCS,,79001377,CDM,278,RC,,,both,,,815,321.65,39.4668,,321.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,277.1,34,,277.1,percent of total billed charges,Implant Device,277.1,34,,277.1,percent of total billed charges,Implant Device,277.1,34,,277.1,percent of total billed charges,Implant Device,277.1,34,,277.1,percent of total billed charges,Implant Device,277.1,34,,277.1,percent of total billed charges,Implant Device,277.1,34,,277.1,percent of total billed charges,Implant Device,285.25,35,,285.25,percent of total billed charges,Implant Device,277.1,34,"Charges > $500, x 34%",277.1,percent of total billed charges,Implant Device,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,326,40,,326,percent of total billed charges,Implant Devices,285.25,70,,285.25,percent of total billed charges,Implant Devices,277.1,34,,277.1,percent of total billed charges,Implant Devices,277.1,34,,277.1,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,326,
STRYKER 325242 CANNULATED SCREW 4.0 X 42,C1713,HCPCS,,79001378,CDM,278,RC,,,both,,,535,211.15,39.4668,,211.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,187.25,35,,187.25,percent of total billed charges,Implant Device,181.9,34,"Charges > $500, x 34%",181.9,percent of total billed charges,Implant Device,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,214,40,,214,percent of total billed charges,Implant Devices,187.25,70,,187.25,percent of total billed charges,Implant Devices,181.9,34,,181.9,percent of total billed charges,Implant Devices,181.9,34,,181.9,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214,
STRYKER 325244 CANNULATED SCREW 4.0 X 44,C1713,HCPCS,,79001379,CDM,278,RC,,,both,,,571,225.36,39.4668,,225.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,194.14,34,,194.14,percent of total billed charges,Implant Device,194.14,34,,194.14,percent of total billed charges,Implant Device,194.14,34,,194.14,percent of total billed charges,Implant Device,194.14,34,,194.14,percent of total billed charges,Implant Device,194.14,34,,194.14,percent of total billed charges,Implant Device,194.14,34,,194.14,percent of total billed charges,Implant Device,199.85,35,,199.85,percent of total billed charges,Implant Device,194.14,34,"Charges > $500, x 34%",194.14,percent of total billed charges,Implant Device,199.85,35,,199.85,percent of total billed charges,Implant Devices,199.85,35,,199.85,percent of total billed charges,Implant Devices,199.85,35,,,percent of total billed charges,Implant Devices,199.85,35,,199.85,percent of total billed charges,Implant Devices,199.85,35,,199.85,percent of total billed charges,Implant Devices,228.4,40,,228.4,percent of total billed charges,Implant Devices,199.85,70,,199.85,percent of total billed charges,Implant Devices,194.14,34,,194.14,percent of total billed charges,Implant Devices,194.14,34,,194.14,percent of total billed charges,Implant Devices,199.85,35,,199.85,percent of total billed charges,Implant Devices,199.85,35,,199.85,percent of total billed charges,Implant Devices,199.85,35,,199.85,percent of total billed charges,Implant Devices,199.85,35,,199.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228.4,
SYNTHES 207.65 CANNULATED SCREW 4.0X50MM,C1713,HCPCS,,79001380,CDM,278,RC,,,both,,,685,270.35,39.4668,,270.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Device,232.9,34,"Charges > $500, x 34%",232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,274,40,,274,percent of total billed charges,Implant Devices,239.75,70,,239.75,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274,
STRYKER 355040S CANNULATED SCREW 40MM,C1713,HCPCS,,79001384,CDM,278,RC,,,both,,,575,226.93,39.4668,,226.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,201.25,35,,201.25,percent of total billed charges,Implant Device,195.5,34,"Charges > $500, x 34%",195.5,percent of total billed charges,Implant Device,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,230,40,,230,percent of total billed charges,Implant Devices,201.25,70,,201.25,percent of total billed charges,Implant Devices,195.5,34,,195.5,percent of total billed charges,Implant Devices,195.5,34,,195.5,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230,
STRYKER 355042S CANNULATED SCREW 42MM,C1713,HCPCS,,79001385,CDM,278,RC,,,both,,,575,226.93,39.4668,,226.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,201.25,35,,201.25,percent of total billed charges,Implant Device,195.5,34,"Charges > $500, x 34%",195.5,percent of total billed charges,Implant Device,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,230,40,,230,percent of total billed charges,Implant Devices,201.25,70,,201.25,percent of total billed charges,Implant Devices,195.5,34,,195.5,percent of total billed charges,Implant Devices,195.5,34,,195.5,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230,
SYNTHES 208.85 CANNULATED SCREW 7.3X50MM,C1713,HCPCS,,79001386,CDM,278,RC,,,both,,,1042,411.24,39.4668,,411.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,354.28,34,,354.28,percent of total billed charges,Implant Device,354.28,34,,354.28,percent of total billed charges,Implant Device,354.28,34,,354.28,percent of total billed charges,Implant Device,354.28,34,,354.28,percent of total billed charges,Implant Device,354.28,34,,354.28,percent of total billed charges,Implant Device,354.28,34,,354.28,percent of total billed charges,Implant Device,364.7,35,,364.7,percent of total billed charges,Implant Device,354.28,34,"Charges > $500, x 34%",354.28,percent of total billed charges,Implant Device,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,416.8,40,,416.8,percent of total billed charges,Implant Devices,364.7,70,,364.7,percent of total billed charges,Implant Devices,354.28,34,,354.28,percent of total billed charges,Implant Devices,354.28,34,,354.28,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,416.8,
ARTHREX AR-1925SF SUTURE ANCHOR 6.5X15.5,C1713,HCPCS,,79001393,CDM,278,RC,,,both,,,586,231.28,39.4668,,231.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Device,199.24,34,"Charges > $500, x 34%",199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,234.4,40,,234.4,percent of total billed charges,Implant Devices,205.1,70,,205.1,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.4,
SYNTHES 202.012 CORTEX SCREW 2.7 X 12MM,C1713,HCPCS,,79001394,CDM,278,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,161,35,,161,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,184,40,,184,percent of total billed charges,Implant Devices,161,70,,161,percent of total billed charges,Implant Devices,156.4,34,,156.4,percent of total billed charges,Implant Devices,156.4,34,,156.4,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,184,
SYNTHES 202.014 CORTEX SCREW 2.7 X 14MM,C1713,HCPCS,,79001395,CDM,278,RC,,,both,,,134,52.89,39.4668,,52.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.56,34,,45.56,percent of total billed charges,Implant Device,45.56,34,,45.56,percent of total billed charges,Implant Device,45.56,34,,45.56,percent of total billed charges,Implant Device,45.56,34,,45.56,percent of total billed charges,Implant Device,45.56,34,,45.56,percent of total billed charges,Implant Device,45.56,34,,45.56,percent of total billed charges,Implant Device,46.9,35,,46.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.9,35,,46.9,percent of total billed charges,Implant Devices,46.9,35,,46.9,percent of total billed charges,Implant Devices,46.9,35,,,percent of total billed charges,Implant Devices,46.9,35,,46.9,percent of total billed charges,Implant Devices,46.9,35,,46.9,percent of total billed charges,Implant Devices,53.6,40,,53.6,percent of total billed charges,Implant Devices,46.9,70,,46.9,percent of total billed charges,Implant Devices,45.56,34,,45.56,percent of total billed charges,Implant Devices,45.56,34,,45.56,percent of total billed charges,Implant Devices,46.9,35,,46.9,percent of total billed charges,Implant Devices,46.9,35,,46.9,percent of total billed charges,Implant Devices,46.9,35,,46.9,percent of total billed charges,Implant Devices,46.9,35,,46.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.6,
SYNTHES 202.016 CORTEX SCREW 2.7 X 16MM,C1713,HCPCS,,79001396,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
SYNTHES 202.018 CORTEX SCREW 2.7 X 18MM,C1713,HCPCS,,79001397,CDM,278,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,161,35,,161,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,184,40,,184,percent of total billed charges,Implant Devices,161,70,,161,percent of total billed charges,Implant Devices,156.4,34,,156.4,percent of total billed charges,Implant Devices,156.4,34,,156.4,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,184,
SYNTHES 202.02 CORTEX SCREW 2.7 X 20MM,C1713,HCPCS,,79001398,CDM,278,RC,,,both,,,34,13.42,39.4668,,13.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11.56,34,,11.56,percent of total billed charges,Implant Device,11.56,34,,11.56,percent of total billed charges,Implant Device,11.56,34,,11.56,percent of total billed charges,Implant Device,11.56,34,,11.56,percent of total billed charges,Implant Device,11.56,34,,11.56,percent of total billed charges,Implant Device,11.56,34,,11.56,percent of total billed charges,Implant Device,11.9,35,,11.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,11.9,35,,11.9,percent of total billed charges,Implant Devices,11.9,35,,11.9,percent of total billed charges,Implant Devices,11.9,35,,,percent of total billed charges,Implant Devices,11.9,35,,11.9,percent of total billed charges,Implant Devices,11.9,35,,11.9,percent of total billed charges,Implant Devices,13.6,40,,13.6,percent of total billed charges,Implant Devices,11.9,70,,11.9,percent of total billed charges,Implant Devices,11.56,34,,11.56,percent of total billed charges,Implant Devices,11.56,34,,11.56,percent of total billed charges,Implant Devices,11.9,35,,11.9,percent of total billed charges,Implant Devices,11.9,35,,11.9,percent of total billed charges,Implant Devices,11.9,35,,11.9,percent of total billed charges,Implant Devices,11.9,35,,11.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13.6,
SYNTHES 200.012 CORTEX SCREW 1.5 X 12MM,C1713,HCPCS,,79001399,CDM,278,RC,,,both,,,104,41.05,39.4668,,41.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,41.6,40,,41.6,percent of total billed charges,Implant Devices,36.4,70,,36.4,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,41.6,
SYNTHES 200.007 CORTEX SCREW 1.5 X 7MM,C1713,HCPCS,,79001400,CDM,278,RC,,,both,,,35,13.81,39.4668,,13.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11.9,34,,11.9,percent of total billed charges,Implant Device,11.9,34,,11.9,percent of total billed charges,Implant Device,11.9,34,,11.9,percent of total billed charges,Implant Device,11.9,34,,11.9,percent of total billed charges,Implant Device,11.9,34,,11.9,percent of total billed charges,Implant Device,11.9,34,,11.9,percent of total billed charges,Implant Device,12.25,35,,12.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,14,40,,14,percent of total billed charges,Implant Devices,12.25,70,,12.25,percent of total billed charges,Implant Devices,11.9,34,,11.9,percent of total billed charges,Implant Devices,11.9,34,,11.9,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14,
SYNTHES 200.008 CORTEX SCREW 1.5 X 8MM,C1713,HCPCS,,79001401,CDM,278,RC,,,both,,,44,17.37,39.4668,,17.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14.96,34,,14.96,percent of total billed charges,Implant Device,14.96,34,,14.96,percent of total billed charges,Implant Device,14.96,34,,14.96,percent of total billed charges,Implant Device,14.96,34,,14.96,percent of total billed charges,Implant Device,14.96,34,,14.96,percent of total billed charges,Implant Device,14.96,34,,14.96,percent of total billed charges,Implant Device,15.4,35,,15.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,17.6,40,,17.6,percent of total billed charges,Implant Devices,15.4,70,,15.4,percent of total billed charges,Implant Devices,14.96,34,,14.96,percent of total billed charges,Implant Devices,14.96,34,,14.96,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,17.6,
SYNTHES 200.009 CORTEX SCREW 1.5 X 9MM,C1713,HCPCS,,79001402,CDM,278,RC,,,both,,,35,13.81,39.4668,,13.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11.9,34,,11.9,percent of total billed charges,Implant Device,11.9,34,,11.9,percent of total billed charges,Implant Device,11.9,34,,11.9,percent of total billed charges,Implant Device,11.9,34,,11.9,percent of total billed charges,Implant Device,11.9,34,,11.9,percent of total billed charges,Implant Device,11.9,34,,11.9,percent of total billed charges,Implant Device,12.25,35,,12.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,14,40,,14,percent of total billed charges,Implant Devices,12.25,70,,12.25,percent of total billed charges,Implant Devices,11.9,34,,11.9,percent of total billed charges,Implant Devices,11.9,34,,11.9,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,12.25,35,,12.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14,
SYNTHES 201.01 CORTEX SCREW 2.0 X 10MM,C1713,HCPCS,,79001403,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
SYNTHES 201.012 CORTEX SCREW 2.0 X 12MM,C1713,HCPCS,,79001404,CDM,278,RC,,,both,,,118,46.57,39.4668,,46.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,47.2,40,,47.2,percent of total billed charges,Implant Devices,41.3,70,,41.3,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,47.2,
SYNTHES 201.014 CORTEX SCREW 2.0 X 14MM,C1713,HCPCS,,79001405,CDM,278,RC,,,both,,,118,46.57,39.4668,,46.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,47.2,40,,47.2,percent of total billed charges,Implant Devices,41.3,70,,41.3,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,47.2,
SYNTHES 201.814 CORTEX SCREW 2X14MM ST,C1713,HCPCS,,79001406,CDM,278,RC,,,both,,,126,49.73,39.4668,,49.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,50.4,40,,50.4,percent of total billed charges,Implant Devices,44.1,70,,44.1,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50.4,
SYNTHES 201.016 CORTEX SCREW 2.0 X 16MM,C1713,HCPCS,,79001407,CDM,278,RC,,,both,,,126,49.73,39.4668,,49.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,50.4,40,,50.4,percent of total billed charges,Implant Devices,44.1,70,,44.1,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50.4,
SYNTHES 201.018 CORTEX SCREW 2.0 X 18MM,C1713,HCPCS,,79001408,CDM,278,RC,,,both,,,104,41.05,39.4668,,41.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,41.6,40,,41.6,percent of total billed charges,Implant Devices,36.4,70,,36.4,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,41.6,
SYNTHES 201.006 CORTEX SCREW 2.0 X 6MM,C1713,HCPCS,,79001409,CDM,278,RC,,,both,,,104,41.05,39.4668,,41.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,41.6,40,,41.6,percent of total billed charges,Implant Devices,36.4,70,,36.4,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,41.6,
SYNTHES 201.008 CORTEX SCREW 2.0 X 8MM,C1713,HCPCS,,79001410,CDM,278,RC,,,both,,,104,41.05,39.4668,,41.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,41.6,40,,41.6,percent of total billed charges,Implant Devices,36.4,70,,36.4,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,41.6,
SYNTHES 202.814 CORTEX SCREW 2.7 X 14MM,C1713,HCPCS,,79001411,CDM,278,RC,,,both,,,141,55.65,39.4668,,55.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.94,34,,47.94,percent of total billed charges,Implant Device,47.94,34,,47.94,percent of total billed charges,Implant Device,47.94,34,,47.94,percent of total billed charges,Implant Device,47.94,34,,47.94,percent of total billed charges,Implant Device,47.94,34,,47.94,percent of total billed charges,Implant Device,47.94,34,,47.94,percent of total billed charges,Implant Device,49.35,35,,49.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,56.4,40,,56.4,percent of total billed charges,Implant Devices,49.35,70,,49.35,percent of total billed charges,Implant Devices,47.94,34,,47.94,percent of total billed charges,Implant Devices,47.94,34,,47.94,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,56.4,
SYNTHES 202.617 CORTEX SCREW 3.0 X 17MM,C1713,HCPCS,,79001412,CDM,278,RC,,,both,,,712,281,39.4668,,281,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,249.2,35,,249.2,percent of total billed charges,Implant Device,242.08,34,"Charges > $500, x 34%",242.08,percent of total billed charges,Implant Device,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,284.8,40,,284.8,percent of total billed charges,Implant Devices,249.2,70,,249.2,percent of total billed charges,Implant Devices,242.08,34,,242.08,percent of total billed charges,Implant Devices,242.08,34,,242.08,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,284.8,
SYNTHES 202.624 CORTEX SCREW 3.0 X 24MM,C1713,HCPCS,,79001413,CDM,278,RC,,,both,,,712,281,39.4668,,281,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,249.2,35,,249.2,percent of total billed charges,Implant Device,242.08,34,"Charges > $500, x 34%",242.08,percent of total billed charges,Implant Device,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,284.8,40,,284.8,percent of total billed charges,Implant Devices,249.2,70,,249.2,percent of total billed charges,Implant Devices,242.08,34,,242.08,percent of total billed charges,Implant Devices,242.08,34,,242.08,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,284.8,
SYNTHES 202.625 CORTEX SCREW 3.0 X 25MM,C1713,HCPCS,,79001414,CDM,278,RC,,,both,,,712,281,39.4668,,281,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,242.08,34,,242.08,percent of total billed charges,Implant Device,249.2,35,,249.2,percent of total billed charges,Implant Device,242.08,34,"Charges > $500, x 34%",242.08,percent of total billed charges,Implant Device,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,284.8,40,,284.8,percent of total billed charges,Implant Devices,249.2,70,,249.2,percent of total billed charges,Implant Devices,242.08,34,,242.08,percent of total billed charges,Implant Devices,242.08,34,,242.08,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,249.2,35,,249.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,284.8,
SYNTHES 204.812 CORTEX SCREW 3.5 X 12MM,C1713,HCPCS,,79001415,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
SYNTHES 204.816 CORTEX SCREW 3.5X16MM,C1713,HCPCS,,79001416,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
SYNTHES 204.855 CORTEX SCREW 3.5 X 55MM,C1713,HCPCS,,79001417,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
ORTHOFIX M316 CORTICAL BONE SCREW,C1713,HCPCS,,79001418,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
BIOMET 8140-27-018 CORT SCREW 2.7X18MM,C1713,HCPCS,,79001419,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 1312-18-012 CORT SCREW 3.5X12MM,C1713,HCPCS,,79001420,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 1312-18-020 CORT SCREW 3.5X20MM,C1713,HCPCS,,79001421,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 1312-18-022 CORT SCREW 3.5X22MM,C1713,HCPCS,,79001422,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 1312-18-032 CORT SCREW 3.5X32MM,C1713,HCPCS,,79001423,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 1312-18-060 CORT SCREW 3.5X60MM,C1713,HCPCS,,79001424,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 8161-35-010 CORT SCREW 35X10MM,C1713,HCPCS,,79001425,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-012 CORT SCREW 35X12MM,C1713,HCPCS,,79001426,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-014 CORT SCREW 35X14MM,C1713,HCPCS,,79001427,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-018 CORT SCREW 35X18MM,C1713,HCPCS,,79001428,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-020 CORT SCREW 3.5X20MM,C1713,HCPCS,,79001429,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-052 CORT SCREW 35X52MM,C1713,HCPCS,,79001430,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-060 CORT SCREW 35X60MM,C1713,HCPCS,,79001431,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-065 CORT SCREW 35X65MM,C1713,HCPCS,,79001432,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-070 CORT SCREW 35X70MM,C1713,HCPCS,,79001433,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8140-27-010 CORT SCREW 2.7X10MM,C1713,HCPCS,,79001434,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8140-27-014 CORT SCREW 2.7X14MM,C1713,HCPCS,,79001435,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8140-27-016 CORT SCREW 2.7X16MM,C1713,HCPCS,,79001436,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-010 CORT SCREW 3.5X10MM,C1713,HCPCS,,79001437,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-012 CORT SCREW 3.5X12MM,C1713,HCPCS,,79001438,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
BIOMET 8150-37-014 CORT SCREW 3.5X14MM,C1713,HCPCS,,79001439,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
BIOMET 8150-37-016 CORT SCREW 3.5X16MM,C1713,HCPCS,,79001440,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
BIOMET 8150-37-018 CORT SCREW 3.5X18MM,C1713,HCPCS,,79001441,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-020 CORT SCREW 3.5X20MM,C1713,HCPCS,,79001442,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-022 CORT SCREW 3.5X22MM,C1713,HCPCS,,79001443,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-024 CORT SCREW 3.5X24MM,C1713,HCPCS,,79001444,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-026 CORT SCREW 3.5X26MM,C1713,HCPCS,,79001445,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-028 CORT SCREW 3.5X28MM,C1713,HCPCS,,79001446,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-030 CORT SCREW 3.5X30MM,C1713,HCPCS,,79001447,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-032 CORT SCREW 3.5X32MM,C1713,HCPCS,,79001448,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-034 CORT SCREW 3.5X34MM,C1713,HCPCS,,79001449,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-036 CORT SCREW 3.5X36MM,C1713,HCPCS,,79001450,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-040 CORT SCREW 3.5X40MM,C1713,HCPCS,,79001451,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-042 CORT SCREW 3.5X42MM,C1713,HCPCS,,79001452,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-046 CORT SCREW 3.5X46MM,C1713,HCPCS,,79001453,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-048 CORT SCREW 3.5X48MM,C1713,HCPCS,,79001454,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-065 CORT SCREW 3.5X65MM,C1713,HCPCS,,79001455,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-070 CORT SCREW 3.5X70MM,C1713,HCPCS,,79001456,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET CS10000 CORTICAL SCREW 3.5X10MM,C1713,HCPCS,,79001457,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
BIOMET CS12000 CORTICAL SCREW 3.5X12MM,C1713,HCPCS,,79001458,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
BIOMET CS13000 CORTICAL SCREW 3.5X13MM,C1713,HCPCS,,79001459,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
BIOMET CS14000 CORTICAL SCREW 3.5X14MM,C1713,HCPCS,,79001460,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
BIOMET CS16000 CORTICAL SCREW 3.5X16MM,C1713,HCPCS,,79001461,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
BIOMET CS18000 CORTICAL SCREW 3.5X18MM,C1713,HCPCS,,79001462,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
BIOMET SPINE DBM001 DBM PUTTY 1CC,C1713,HCPCS,,79001479,CDM,278,RC,,,both,,,627,247.46,39.4668,,247.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,219.45,35,,219.45,percent of total billed charges,Implant Device,213.18,34,"Charges > $500, x 34%",213.18,percent of total billed charges,Implant Device,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,250.8,40,,250.8,percent of total billed charges,Implant Devices,219.45,70,,219.45,percent of total billed charges,Implant Devices,213.18,34,,213.18,percent of total billed charges,Implant Devices,213.18,34,,213.18,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,250.8,
BIOMET SPINE DBM010 DBM PUTTY 10CC,C1713,HCPCS,,79001480,CDM,278,RC,,,both,,,4035,1592.49,39.4668,,1592.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1371.9,34,,1371.9,percent of total billed charges,Implant Device,1371.9,34,,1371.9,percent of total billed charges,Implant Device,1371.9,34,,1371.9,percent of total billed charges,Implant Device,1371.9,34,,1371.9,percent of total billed charges,Implant Device,1371.9,34,,1371.9,percent of total billed charges,Implant Device,1371.9,34,,1371.9,percent of total billed charges,Implant Device,1412.25,35,,1412.25,percent of total billed charges,Implant Device,1371.9,34,"Charges > $500, x 34%",1371.9,percent of total billed charges,Implant Device,1412.25,35,,1412.25,percent of total billed charges,Implant Devices,1412.25,35,,1412.25,percent of total billed charges,Implant Devices,1412.25,35,,,percent of total billed charges,Implant Devices,1412.25,35,,1412.25,percent of total billed charges,Implant Devices,1412.25,35,,1412.25,percent of total billed charges,Implant Devices,1614,40,,1614,percent of total billed charges,Implant Devices,1412.25,70,,1412.25,percent of total billed charges,Implant Devices,1371.9,34,,1371.9,percent of total billed charges,Implant Devices,1371.9,34,,1371.9,percent of total billed charges,Implant Devices,1412.25,35,,1412.25,percent of total billed charges,Implant Devices,1412.25,35,,1412.25,percent of total billed charges,Implant Devices,1412.25,35,,1412.25,percent of total billed charges,Implant Devices,1412.25,35,,1412.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1371.9,34,"If Charge > 2,000, then 34 percent",1371.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1614,
BIOMET SPINE DBM002 DBM PUTTY 2CC,C1713,HCPCS,,79001481,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
BIOMET SPINE DBM005 DBM PUTTY 5CC,C1713,HCPCS,,79001482,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
BIOMET SPINE DBMW05 DBM PUTTY PLUS 5CC,C1713,HCPCS,,79001483,CDM,278,RC,,,both,,,3039,1199.4,39.4668,,1199.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1033.26,34,,1033.26,percent of total billed charges,Implant Device,1033.26,34,,1033.26,percent of total billed charges,Implant Device,1033.26,34,,1033.26,percent of total billed charges,Implant Device,1033.26,34,,1033.26,percent of total billed charges,Implant Device,1033.26,34,,1033.26,percent of total billed charges,Implant Device,1033.26,34,,1033.26,percent of total billed charges,Implant Device,1063.65,35,,1063.65,percent of total billed charges,Implant Device,1033.26,34,"Charges > $500, x 34%",1033.26,percent of total billed charges,Implant Device,1063.65,35,,1063.65,percent of total billed charges,Implant Devices,1063.65,35,,1063.65,percent of total billed charges,Implant Devices,1063.65,35,,,percent of total billed charges,Implant Devices,1063.65,35,,1063.65,percent of total billed charges,Implant Devices,1063.65,35,,1063.65,percent of total billed charges,Implant Devices,1215.6,40,,1215.6,percent of total billed charges,Implant Devices,1063.65,70,,1063.65,percent of total billed charges,Implant Devices,1033.26,34,,1033.26,percent of total billed charges,Implant Devices,1033.26,34,,1033.26,percent of total billed charges,Implant Devices,1063.65,35,,1063.65,percent of total billed charges,Implant Devices,1063.65,35,,1063.65,percent of total billed charges,Implant Devices,1063.65,35,,1063.65,percent of total billed charges,Implant Devices,1063.65,35,,1063.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1033.26,34,"If Charge > 2,000, then 34 percent",1033.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1215.6,
BIOMET SPINE DBMW10 DBM PUTTY PLUS 10CC,C1713,HCPCS,,79001484,CDM,278,RC,,,both,,,4678,1846.26,39.4668,,1846.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1590.52,34,,1590.52,percent of total billed charges,Implant Device,1590.52,34,,1590.52,percent of total billed charges,Implant Device,1590.52,34,,1590.52,percent of total billed charges,Implant Device,1590.52,34,,1590.52,percent of total billed charges,Implant Device,1590.52,34,,1590.52,percent of total billed charges,Implant Device,1590.52,34,,1590.52,percent of total billed charges,Implant Device,1637.3,35,,1637.3,percent of total billed charges,Implant Device,1590.52,34,"Charges > $500, x 34%",1590.52,percent of total billed charges,Implant Device,1637.3,35,,1637.3,percent of total billed charges,Implant Devices,1637.3,35,,1637.3,percent of total billed charges,Implant Devices,1637.3,35,,,percent of total billed charges,Implant Devices,1637.3,35,,1637.3,percent of total billed charges,Implant Devices,1637.3,35,,1637.3,percent of total billed charges,Implant Devices,1871.2,40,,1871.2,percent of total billed charges,Implant Devices,1637.3,70,,1637.3,percent of total billed charges,Implant Devices,1590.52,34,,1590.52,percent of total billed charges,Implant Devices,1590.52,34,,1590.52,percent of total billed charges,Implant Devices,1637.3,35,,1637.3,percent of total billed charges,Implant Devices,1637.3,35,,1637.3,percent of total billed charges,Implant Devices,1637.3,35,,1637.3,percent of total billed charges,Implant Devices,1637.3,35,,1637.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1590.52,34,"If Charge > 2,000, then 34 percent",1590.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1871.2,
BIOMET SPINE DBMW20 DBM PUTTY PLUS 20CC,C1713,HCPCS,,79001485,CDM,278,RC,,,both,,,8062,3181.81,39.4668,,3181.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2741.08,34,,2741.08,percent of total billed charges,Implant Device,2741.08,34,,2741.08,percent of total billed charges,Implant Device,2741.08,34,,2741.08,percent of total billed charges,Implant Device,2741.08,34,,2741.08,percent of total billed charges,Implant Device,2741.08,34,,2741.08,percent of total billed charges,Implant Device,2741.08,34,,2741.08,percent of total billed charges,Implant Device,2821.7,35,,2821.7,percent of total billed charges,Implant Device,2741.08,34,"Charges > $500, x 34%",2741.08,percent of total billed charges,Implant Device,2821.7,35,,2821.7,percent of total billed charges,Implant Devices,2821.7,35,,2821.7,percent of total billed charges,Implant Devices,2821.7,35,,,percent of total billed charges,Implant Devices,2821.7,35,,2821.7,percent of total billed charges,Implant Devices,2821.7,35,,2821.7,percent of total billed charges,Implant Devices,3224.8,40,,3224.8,percent of total billed charges,Implant Devices,2821.7,70,,2821.7,percent of total billed charges,Implant Devices,2741.08,34,,2741.08,percent of total billed charges,Implant Devices,2741.08,34,,2741.08,percent of total billed charges,Implant Devices,2821.7,35,,2821.7,percent of total billed charges,Implant Devices,2821.7,35,,2821.7,percent of total billed charges,Implant Devices,2821.7,35,,2821.7,percent of total billed charges,Implant Devices,2821.7,35,,2821.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2741.08,34,"If Charge > 2,000, then 34 percent",2741.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3224.8,
ZIMMER DVRAX-R DVR PLATE EXT RIGHT,C1713,HCPCS,,79001489,CDM,278,RC,,,both,,,3690,1456.32,39.4668,,1456.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Device,1254.6,34,"Charges > $500, x 34%",1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1476,40,,1476,percent of total billed charges,Implant Devices,1291.5,70,,1291.5,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1254.6,34,"If Charge > 2,000, then 34 percent",1254.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1476,
BIOMET DVRANSL PLATE NARROW SHORT LEFT,C1713,HCPCS,,79001490,CDM,278,RC,,,both,,,3690,1456.32,39.4668,,1456.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Device,1254.6,34,"Charges > $500, x 34%",1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1476,40,,1476,percent of total billed charges,Implant Devices,1291.5,70,,1291.5,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1254.6,34,"If Charge > 2,000, then 34 percent",1254.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1476,
BIOMET DVRASL PLATE SHORT LEFT,C1713,HCPCS,,79001491,CDM,278,RC,,,both,,,2394,944.84,39.4668,,944.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,837.9,35,,837.9,percent of total billed charges,Implant Device,813.96,34,"Charges > $500, x 34%",813.96,percent of total billed charges,Implant Device,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,957.6,40,,957.6,percent of total billed charges,Implant Devices,837.9,70,,837.9,percent of total billed charges,Implant Devices,813.96,34,,813.96,percent of total billed charges,Implant Devices,813.96,34,,813.96,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,813.96,34,"If Charge > 2,000, then 34 percent",813.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,957.6,
BIOMET DVRANS-R PLATE SHORT RIGHT,C1713,HCPCS,,79001492,CDM,278,RC,,,both,,,3690,1456.32,39.4668,,1456.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Device,1254.6,34,"Charges > $500, x 34%",1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1476,40,,1476,percent of total billed charges,Implant Devices,1291.5,70,,1291.5,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1254.6,34,"If Charge > 2,000, then 34 percent",1254.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1476,
BIOMET DVRASR PLATE SHORT RIGHT,C1713,HCPCS,,79001493,CDM,278,RC,,,both,,,3690,1456.32,39.4668,,1456.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Device,1254.6,34,"Charges > $500, x 34%",1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1476,40,,1476,percent of total billed charges,Implant Devices,1291.5,70,,1291.5,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1254.6,34,"If Charge > 2,000, then 34 percent",1254.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1476,
BIOMET DVRAXL PLATE SHORT RIGHT,C1713,HCPCS,,79001494,CDM,278,RC,,,both,,,3690,1456.32,39.4668,,1456.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Device,1254.6,34,"Charges > $500, x 34%",1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1476,40,,1476,percent of total billed charges,Implant Devices,1291.5,70,,1291.5,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1254.6,34,"If Charge > 2,000, then 34 percent",1254.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1476,
BIOMET DVRAL PLATE STD LEFT,C1713,HCPCS,,79001495,CDM,278,RC,,,both,,,3690,1456.32,39.4668,,1456.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Device,1254.6,34,"Charges > $500, x 34%",1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1476,40,,1476,percent of total billed charges,Implant Devices,1291.5,70,,1291.5,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1254.6,34,"If Charge > 2,000, then 34 percent",1254.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1476,
BIOMET DVRAR PLATE STD RIGHT,C1713,HCPCS,,79001496,CDM,278,RC,,,both,,,3690,1456.32,39.4668,,1456.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1254.6,34,,1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Device,1254.6,34,"Charges > $500, x 34%",1254.6,percent of total billed charges,Implant Device,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1476,40,,1476,percent of total billed charges,Implant Devices,1291.5,70,,1291.5,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1254.6,34,,1254.6,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,1291.5,35,,1291.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1254.6,34,"If Charge > 2,000, then 34 percent",1254.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1476,
STRYKER 58-25012E EMERG SCREW 2.5X12MM,C1713,HCPCS,,79001500,CDM,278,RC,,,both,,,423,166.94,39.4668,,166.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,148.05,35,,148.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,169.2,40,,169.2,percent of total billed charges,Implant Devices,148.05,70,,148.05,percent of total billed charges,Implant Devices,143.82,34,,143.82,percent of total billed charges,Implant Devices,143.82,34,,143.82,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,169.2,
STRYKER 58-19012E EMERG SCREWS 1.9X12MM,C1713,HCPCS,,79001501,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
BIOMET 1991670 GAP PLATE MEDIUM,C1713,HCPCS,,79001504,CDM,278,RC,,,both,,,570,224.96,39.4668,,224.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Device,193.8,34,"Charges > $500, x 34%",193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,228,40,,228,percent of total billed charges,Implant Devices,199.5,70,,199.5,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228,
BIOMET 1990939 GAP PLATE SMALL,C1713,HCPCS,,79001505,CDM,278,RC,,,both,,,456,179.97,39.4668,,179.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,182.4,40,,182.4,percent of total billed charges,Implant Devices,159.6,70,,159.6,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182.4,
BIOMET 95-6103 HTXDRIVE SCREW SD 1.5X3.5,C1713,HCPCS,,79001542,CDM,278,RC,,,both,,,174,68.67,39.4668,,68.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,69.6,40,,69.6,percent of total billed charges,Implant Devices,60.9,70,,60.9,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,69.6,
BIOMET 91-6104 HTXDRIVE SCREW SD 1.5X4MM,C1713,HCPCS,,79001543,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
BIOMET 95-6104 HTXDRIVE SCREW SD 1.5X4MM,C1713,HCPCS,,79001544,CDM,278,RC,,,both,,,174,68.67,39.4668,,68.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,69.6,40,,69.6,percent of total billed charges,Implant Devices,60.9,70,,60.9,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,69.6,
BIOMET 91-6105 HTXDRIVE SCREW SD 1.5X5MM,C1713,HCPCS,,79001545,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
BIOMET 95-6105 HTXDRIVE SCREW SD 1.5X5MM,C1713,HCPCS,,79001546,CDM,278,RC,,,both,,,174,68.67,39.4668,,68.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,69.6,40,,69.6,percent of total billed charges,Implant Devices,60.9,70,,60.9,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,69.6,
BIOMET 91-6106 HTXDRIVE SCREW SD 1.5X6MM,C1713,HCPCS,,79001547,CDM,278,RC,,,both,,,37,14.6,39.4668,,14.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12.58,34,,12.58,percent of total billed charges,Implant Device,12.58,34,,12.58,percent of total billed charges,Implant Device,12.58,34,,12.58,percent of total billed charges,Implant Device,12.58,34,,12.58,percent of total billed charges,Implant Device,12.58,34,,12.58,percent of total billed charges,Implant Device,12.58,34,,12.58,percent of total billed charges,Implant Device,12.95,35,,12.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,14.8,40,,14.8,percent of total billed charges,Implant Devices,12.95,70,,12.95,percent of total billed charges,Implant Devices,12.58,34,,12.58,percent of total billed charges,Implant Devices,12.58,34,,12.58,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14.8,
BIOMET 91-6107 HTXDRIVE SCREW SD 1.5X7MM,C1713,HCPCS,,79001548,CDM,278,RC,,,both,,,37,14.6,39.4668,,14.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12.58,34,,12.58,percent of total billed charges,Implant Device,12.58,34,,12.58,percent of total billed charges,Implant Device,12.58,34,,12.58,percent of total billed charges,Implant Device,12.58,34,,12.58,percent of total billed charges,Implant Device,12.58,34,,12.58,percent of total billed charges,Implant Device,12.58,34,,12.58,percent of total billed charges,Implant Device,12.95,35,,12.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,14.8,40,,14.8,percent of total billed charges,Implant Devices,12.95,70,,12.95,percent of total billed charges,Implant Devices,12.58,34,,12.58,percent of total billed charges,Implant Devices,12.58,34,,12.58,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,12.95,35,,12.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14.8,
BIOMET 91-1511 HTXDRIVE SCREW 1.5X11MM,C1713,HCPCS,,79001549,CDM,278,RC,,,both,,,36,14.21,39.4668,,14.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12.24,34,,12.24,percent of total billed charges,Implant Device,12.24,34,,12.24,percent of total billed charges,Implant Device,12.24,34,,12.24,percent of total billed charges,Implant Device,12.24,34,,12.24,percent of total billed charges,Implant Device,12.24,34,,12.24,percent of total billed charges,Implant Device,12.24,34,,12.24,percent of total billed charges,Implant Device,12.6,35,,12.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,14.4,40,,14.4,percent of total billed charges,Implant Devices,12.6,70,,12.6,percent of total billed charges,Implant Devices,12.24,34,,12.24,percent of total billed charges,Implant Devices,12.24,34,,12.24,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14.4,
BIOMET 91-1507 HTXDRIVE SCREW 1.5X7MM,C1713,HCPCS,,79001550,CDM,278,RC,,,both,,,31,12.23,39.4668,,12.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10.54,34,,10.54,percent of total billed charges,Implant Device,10.54,34,,10.54,percent of total billed charges,Implant Device,10.54,34,,10.54,percent of total billed charges,Implant Device,10.54,34,,10.54,percent of total billed charges,Implant Device,10.54,34,,10.54,percent of total billed charges,Implant Device,10.54,34,,10.54,percent of total billed charges,Implant Device,10.85,35,,10.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,10.85,35,,10.85,percent of total billed charges,Implant Devices,10.85,35,,10.85,percent of total billed charges,Implant Devices,10.85,35,,,percent of total billed charges,Implant Devices,10.85,35,,10.85,percent of total billed charges,Implant Devices,10.85,35,,10.85,percent of total billed charges,Implant Devices,12.4,40,,12.4,percent of total billed charges,Implant Devices,10.85,70,,10.85,percent of total billed charges,Implant Devices,10.54,34,,10.54,percent of total billed charges,Implant Devices,10.54,34,,10.54,percent of total billed charges,Implant Devices,10.85,35,,10.85,percent of total billed charges,Implant Devices,10.85,35,,10.85,percent of total billed charges,Implant Devices,10.85,35,,10.85,percent of total billed charges,Implant Devices,10.85,35,,10.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12.4,
BIOMET 91-1509 HTXDRIVE SCREW 1.5X9MM,C1713,HCPCS,,79001551,CDM,278,RC,,,both,,,36,14.21,39.4668,,14.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12.24,34,,12.24,percent of total billed charges,Implant Device,12.24,34,,12.24,percent of total billed charges,Implant Device,12.24,34,,12.24,percent of total billed charges,Implant Device,12.24,34,,12.24,percent of total billed charges,Implant Device,12.24,34,,12.24,percent of total billed charges,Implant Device,12.24,34,,12.24,percent of total billed charges,Implant Device,12.6,35,,12.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,14.4,40,,14.4,percent of total billed charges,Implant Devices,12.6,70,,12.6,percent of total billed charges,Implant Devices,12.24,34,,12.24,percent of total billed charges,Implant Devices,12.24,34,,12.24,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,12.6,35,,12.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14.4,
BIOMET 91-1805 HTXDRIVE SCREW 1.8X5MM,C1713,HCPCS,,79001552,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
BIOMET 91-1807 HTXDRIVE SCREW 1.8X7MM,C1713,HCPCS,,79001553,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
BIOMET 95-1803 HT XDRIVE SCREW 1.8X3.5MM,C1713,HCPCS,,79001554,CDM,278,RC,,,both,,,176,69.46,39.4668,,69.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.84,34,,59.84,percent of total billed charges,Implant Device,59.84,34,,59.84,percent of total billed charges,Implant Device,59.84,34,,59.84,percent of total billed charges,Implant Device,59.84,34,,59.84,percent of total billed charges,Implant Device,59.84,34,,59.84,percent of total billed charges,Implant Device,59.84,34,,59.84,percent of total billed charges,Implant Device,61.6,35,,61.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,70.4,40,,70.4,percent of total billed charges,Implant Devices,61.6,70,,61.6,percent of total billed charges,Implant Devices,59.84,34,,59.84,percent of total billed charges,Implant Devices,59.84,34,,59.84,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70.4,
BIOMET 95-1805 HT XDRIVE SCREW 1.8X5MM,C1713,HCPCS,,79001555,CDM,278,RC,,,both,,,176,69.46,39.4668,,69.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.84,34,,59.84,percent of total billed charges,Implant Device,59.84,34,,59.84,percent of total billed charges,Implant Device,59.84,34,,59.84,percent of total billed charges,Implant Device,59.84,34,,59.84,percent of total billed charges,Implant Device,59.84,34,,59.84,percent of total billed charges,Implant Device,59.84,34,,59.84,percent of total billed charges,Implant Device,61.6,35,,61.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,70.4,40,,70.4,percent of total billed charges,Implant Devices,61.6,70,,61.6,percent of total billed charges,Implant Devices,59.84,34,,59.84,percent of total billed charges,Implant Devices,59.84,34,,59.84,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,61.6,35,,61.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70.4,
STRYKER 79-43905 HYDROSET - 5CC,C1713,HCPCS,,79001556,CDM,278,RC,,,both,,,4336,1711.28,39.4668,,1711.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1517.6,35,,1517.6,percent of total billed charges,Implant Device,1474.24,34,"Charges > $500, x 34%",1474.24,percent of total billed charges,Implant Device,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1734.4,40,,1734.4,percent of total billed charges,Implant Devices,1517.6,70,,1517.6,percent of total billed charges,Implant Devices,1474.24,34,,1474.24,percent of total billed charges,Implant Devices,1474.24,34,,1474.24,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1474.24,34,"If Charge > 2,000, then 34 percent",1474.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1734.4,
STRYKER 397010 HYDROSET 10CC,C1713,HCPCS,,79001557,CDM,278,RC,,,both,,,10546,4162.17,39.4668,,4162.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3691.1,35,,3691.1,percent of total billed charges,Implant Device,3585.64,34,"Charges > $500, x 34%",3585.64,percent of total billed charges,Implant Device,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,4218.4,40,,4218.4,percent of total billed charges,Implant Devices,3691.1,70,,3691.1,percent of total billed charges,Implant Devices,3585.64,34,,3585.64,percent of total billed charges,Implant Devices,3585.64,34,,3585.64,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3585.64,34,"If Charge > 2,000, then 34 percent",3585.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4218.4,
STRYKER 397003 HYDROSET 3CC,C1713,HCPCS,,79001558,CDM,278,RC,,,both,,,3772,1488.69,39.4668,,1488.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1320.2,35,,1320.2,percent of total billed charges,Implant Device,1282.48,34,"Charges > $500, x 34%",1282.48,percent of total billed charges,Implant Device,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1508.8,40,,1508.8,percent of total billed charges,Implant Devices,1320.2,70,,1320.2,percent of total billed charges,Implant Devices,1282.48,34,,1282.48,percent of total billed charges,Implant Devices,1282.48,34,,1282.48,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1282.48,34,"If Charge > 2,000, then 34 percent",1282.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1508.8,
STRYKER 397005 HYDROSET 5CC,C1713,HCPCS,,79001559,CDM,278,RC,,,both,,,6049,2387.35,39.4668,,2387.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2117.15,35,,2117.15,percent of total billed charges,Implant Device,2056.66,34,"Charges > $500, x 34%",2056.66,percent of total billed charges,Implant Device,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2419.6,40,,2419.6,percent of total billed charges,Implant Devices,2117.15,70,,2117.15,percent of total billed charges,Implant Devices,2056.66,34,,2056.66,percent of total billed charges,Implant Devices,2056.66,34,,2056.66,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2056.66,34,"If Charge > 2,000, then 34 percent",2056.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2419.6,
ARTHREX AR-1370E INTERFERENCE SCREW 7X20,C1713,HCPCS,,79001562,CDM,278,RC,,,both,,,496,195.76,39.4668,,195.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,198.4,40,,198.4,percent of total billed charges,Implant Devices,173.6,70,,173.6,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.4,
S&N 71064701 JET-X MINI DISTAL RADIUS,C1713,HCPCS,,79001564,CDM,278,RC,,,both,,,9002,3552.8,39.4668,,3552.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060.68,34,,3060.68,percent of total billed charges,Implant Device,3060.68,34,,3060.68,percent of total billed charges,Implant Device,3060.68,34,,3060.68,percent of total billed charges,Implant Device,3060.68,34,,3060.68,percent of total billed charges,Implant Device,3060.68,34,,3060.68,percent of total billed charges,Implant Device,3060.68,34,,3060.68,percent of total billed charges,Implant Device,3150.7,35,,3150.7,percent of total billed charges,Implant Device,3060.68,34,"Charges > $500, x 34%",3060.68,percent of total billed charges,Implant Device,3150.7,35,,3150.7,percent of total billed charges,Implant Devices,3150.7,35,,3150.7,percent of total billed charges,Implant Devices,3150.7,35,,,percent of total billed charges,Implant Devices,3150.7,35,,3150.7,percent of total billed charges,Implant Devices,3150.7,35,,3150.7,percent of total billed charges,Implant Devices,3600.8,40,,3600.8,percent of total billed charges,Implant Devices,3150.7,70,,3150.7,percent of total billed charges,Implant Devices,3060.68,34,,3060.68,percent of total billed charges,Implant Devices,3060.68,34,,3060.68,percent of total billed charges,Implant Devices,3150.7,35,,3150.7,percent of total billed charges,Implant Devices,3150.7,35,,3150.7,percent of total billed charges,Implant Devices,3150.7,35,,3150.7,percent of total billed charges,Implant Devices,3150.7,35,,3150.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060.68,34,"If Charge > 2,000, then 34 percent",3060.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600.8,
BIOMET 8162-04-007 LOCKING PLATE 7 HOLE,C1713,HCPCS,,79001581,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
BIOMET 8162-06-003 LOCKING PLATE 95MM,C1713,HCPCS,,79001582,CDM,278,RC,,,both,,,3390,1337.92,39.4668,,1337.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1186.5,35,,1186.5,percent of total billed charges,Implant Device,1152.6,34,"Charges > $500, x 34%",1152.6,percent of total billed charges,Implant Device,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1356,40,,1356,percent of total billed charges,Implant Devices,1186.5,70,,1186.5,percent of total billed charges,Implant Devices,1152.6,34,,1152.6,percent of total billed charges,Implant Devices,1152.6,34,,1152.6,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1152.6,34,"If Charge > 2,000, then 34 percent",1152.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1356,
BIOMET 8162-10-006 LOCK PLATE TIB 6HOLE,C1713,HCPCS,,79001583,CDM,278,RC,,,both,,,7020,2770.57,39.4668,,2770.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2457,35,,2457,percent of total billed charges,Implant Device,2386.8,34,"Charges > $500, x 34%",2386.8,percent of total billed charges,Implant Device,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2808,40,,2808,percent of total billed charges,Implant Devices,2457,70,,2457,percent of total billed charges,Implant Devices,2386.8,34,,2386.8,percent of total billed charges,Implant Devices,2386.8,34,,2386.8,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2386.8,34,"If Charge > 2,000, then 34 percent",2386.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2808,
STRYKER 53-23011E LOCKING SCREW 2.3X11MM,C1713,HCPCS,,79001584,CDM,278,RC,,,both,,,296,116.82,39.4668,,116.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,103.6,35,,103.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,118.4,40,,118.4,percent of total billed charges,Implant Devices,103.6,70,,103.6,percent of total billed charges,Implant Devices,100.64,34,,100.64,percent of total billed charges,Implant Devices,100.64,34,,100.64,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,118.4,
STRYKER 53-23012E LOCKING SCREW 2.3X12MM,C1713,HCPCS,,79001585,CDM,278,RC,,,both,,,515,203.25,39.4668,,203.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,180.25,35,,180.25,percent of total billed charges,Implant Device,175.1,34,"Charges > $500, x 34%",175.1,percent of total billed charges,Implant Device,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,206,40,,206,percent of total billed charges,Implant Devices,180.25,70,,180.25,percent of total billed charges,Implant Devices,175.1,34,,175.1,percent of total billed charges,Implant Devices,175.1,34,,175.1,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,206,
STRYKER 53-23015E LOCKING SCREW 2.3X15MM,C1713,HCPCS,,79001586,CDM,278,RC,,,both,,,296,116.82,39.4668,,116.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,103.6,35,,103.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,118.4,40,,118.4,percent of total billed charges,Implant Devices,103.6,70,,103.6,percent of total billed charges,Implant Devices,100.64,34,,100.64,percent of total billed charges,Implant Devices,100.64,34,,100.64,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,118.4,
STRYKER 53-23016E LOCKING SCREW 2.3X16MM,C1713,HCPCS,,79001587,CDM,278,RC,,,both,,,296,116.82,39.4668,,116.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,100.64,34,,100.64,percent of total billed charges,Implant Device,103.6,35,,103.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,118.4,40,,118.4,percent of total billed charges,Implant Devices,103.6,70,,103.6,percent of total billed charges,Implant Devices,100.64,34,,100.64,percent of total billed charges,Implant Devices,100.64,34,,100.64,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,103.6,35,,103.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,118.4,
SYNTHES 212.106 LOCKING SCREW 3.5 X 20MM,C1713,HCPCS,,79001588,CDM,278,RC,,,both,,,402,158.66,39.4668,,158.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,160.8,40,,160.8,percent of total billed charges,Implant Devices,140.7,70,,140.7,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,160.8,
SYNTHES 212.11 LOCKING SCREW 3.5 X 28MM,C1713,HCPCS,,79001589,CDM,278,RC,,,both,,,520,205.23,39.4668,,205.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,176.8,34,,176.8,percent of total billed charges,Implant Device,176.8,34,,176.8,percent of total billed charges,Implant Device,176.8,34,,176.8,percent of total billed charges,Implant Device,176.8,34,,176.8,percent of total billed charges,Implant Device,176.8,34,,176.8,percent of total billed charges,Implant Device,176.8,34,,176.8,percent of total billed charges,Implant Device,182,35,,182,percent of total billed charges,Implant Device,176.8,34,"Charges > $500, x 34%",176.8,percent of total billed charges,Implant Device,182,35,,182,percent of total billed charges,Implant Devices,182,35,,182,percent of total billed charges,Implant Devices,182,35,,,percent of total billed charges,Implant Devices,182,35,,182,percent of total billed charges,Implant Devices,182,35,,182,percent of total billed charges,Implant Devices,208,40,,208,percent of total billed charges,Implant Devices,182,70,,182,percent of total billed charges,Implant Devices,176.8,34,,176.8,percent of total billed charges,Implant Devices,176.8,34,,176.8,percent of total billed charges,Implant Devices,182,35,,182,percent of total billed charges,Implant Devices,182,35,,182,percent of total billed charges,Implant Devices,182,35,,182,percent of total billed charges,Implant Devices,182,35,,182,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,208,
SYNTHES 212.113 LOCKING SCREW 3.5 X 34MM,C1713,HCPCS,,79001593,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
SYNTHES 222.588 LOCKING SCREW 4.0 X 42MM,C1713,HCPCS,,79001596,CDM,278,RC,,,both,,,496,195.76,39.4668,,195.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,198.4,40,,198.4,percent of total billed charges,Implant Devices,173.6,70,,173.6,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.4,
SYNTHES 222.59 LOCKING SCREW 4.0 X 50MM,C1713,HCPCS,,79001597,CDM,278,RC,,,both,,,512,202.07,39.4668,,202.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.08,34,,174.08,percent of total billed charges,Implant Device,174.08,34,,174.08,percent of total billed charges,Implant Device,174.08,34,,174.08,percent of total billed charges,Implant Device,174.08,34,,174.08,percent of total billed charges,Implant Device,174.08,34,,174.08,percent of total billed charges,Implant Device,174.08,34,,174.08,percent of total billed charges,Implant Device,179.2,35,,179.2,percent of total billed charges,Implant Device,174.08,34,"Charges > $500, x 34%",174.08,percent of total billed charges,Implant Device,179.2,35,,179.2,percent of total billed charges,Implant Devices,179.2,35,,179.2,percent of total billed charges,Implant Devices,179.2,35,,,percent of total billed charges,Implant Devices,179.2,35,,179.2,percent of total billed charges,Implant Devices,179.2,35,,179.2,percent of total billed charges,Implant Devices,204.8,40,,204.8,percent of total billed charges,Implant Devices,179.2,70,,179.2,percent of total billed charges,Implant Devices,174.08,34,,174.08,percent of total billed charges,Implant Devices,174.08,34,,174.08,percent of total billed charges,Implant Devices,179.2,35,,179.2,percent of total billed charges,Implant Devices,179.2,35,,179.2,percent of total billed charges,Implant Devices,179.2,35,,179.2,percent of total billed charges,Implant Devices,179.2,35,,179.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204.8,
SYNTHES 222.591 LOCKING SCREW 4.0 X 54MM,C1713,HCPCS,,79001598,CDM,278,RC,,,both,,,496,195.76,39.4668,,195.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,198.4,40,,198.4,percent of total billed charges,Implant Devices,173.6,70,,173.6,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.4,
STRYKER 53-23610E LOCK SCREW T7 2.3X10MM,C1713,HCPCS,,79001599,CDM,278,RC,,,both,,,385,151.95,39.4668,,151.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,134.75,35,,134.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,154,40,,154,percent of total billed charges,Implant Devices,134.75,70,,134.75,percent of total billed charges,Implant Devices,130.9,34,,130.9,percent of total billed charges,Implant Devices,130.9,34,,130.9,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,154,
STRYKER 53-23612E LOCK SCREW T7 2.3X12MM,C1713,HCPCS,,79001600,CDM,278,RC,,,both,,,398,157.08,39.4668,,157.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,135.32,34,,135.32,percent of total billed charges,Implant Device,135.32,34,,135.32,percent of total billed charges,Implant Device,135.32,34,,135.32,percent of total billed charges,Implant Device,135.32,34,,135.32,percent of total billed charges,Implant Device,135.32,34,,135.32,percent of total billed charges,Implant Device,135.32,34,,135.32,percent of total billed charges,Implant Device,139.3,35,,139.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,159.2,40,,159.2,percent of total billed charges,Implant Devices,139.3,70,,139.3,percent of total billed charges,Implant Devices,135.32,34,,135.32,percent of total billed charges,Implant Devices,135.32,34,,135.32,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,159.2,
STRYKER 53-23620E LOCK SCREW T7 2.3X20MM,C1713,HCPCS,,79001601,CDM,278,RC,,,both,,,492,194.18,39.4668,,194.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,196.8,40,,196.8,percent of total billed charges,Implant Devices,172.2,70,,172.2,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196.8,
STRYKER 53-23626E LOCK SCREW T7 2.3X26MM,C1713,HCPCS,,79001602,CDM,278,RC,,,both,,,469,185.1,39.4668,,185.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,164.15,35,,164.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,187.6,40,,187.6,percent of total billed charges,Implant Devices,164.15,70,,164.15,percent of total billed charges,Implant Devices,159.46,34,,159.46,percent of total billed charges,Implant Devices,159.46,34,,159.46,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.6,
STRYKER 53-23628E LOCK SCREW T7 2.3X28MM,C1713,HCPCS,,79001603,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
STRYKER 53-27610E LOCK SCREW T7 2.7X10MM,C1713,HCPCS,,79001604,CDM,278,RC,,,both,,,385,151.95,39.4668,,151.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,134.75,35,,134.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,154,40,,154,percent of total billed charges,Implant Devices,134.75,70,,134.75,percent of total billed charges,Implant Devices,130.9,34,,130.9,percent of total billed charges,Implant Devices,130.9,34,,130.9,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,154,
STRYKER 53-27620E LOCK SCREW T7 2.7X20MM,C1713,HCPCS,,79001605,CDM,278,RC,,,both,,,304,119.98,39.4668,,119.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,106.4,35,,106.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,121.6,40,,121.6,percent of total billed charges,Implant Devices,106.4,70,,106.4,percent of total billed charges,Implant Devices,103.36,34,,103.36,percent of total billed charges,Implant Devices,103.36,34,,103.36,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.6,
LOCKING SCREW T7 2.7MM 22MM,C1713,HCPCS,,79001606,CDM,278,RC,,,both,,,385,151.95,39.4668,,151.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,130.9,34,,130.9,percent of total billed charges,Implant Device,134.75,35,,134.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,154,40,,154,percent of total billed charges,Implant Devices,134.75,70,,134.75,percent of total billed charges,Implant Devices,130.9,34,,130.9,percent of total billed charges,Implant Devices,130.9,34,,130.9,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,134.75,35,,134.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,154,
STRYKER 53-27624E LOCK SCREW T7 2.7X24MM,C1713,HCPCS,,79001607,CDM,278,RC,,,both,,,492,194.18,39.4668,,194.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,196.8,40,,196.8,percent of total billed charges,Implant Devices,172.2,70,,172.2,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196.8,
STRYKER 53-27626E LOCK SCREW T7 2.7X26MM,C1713,HCPCS,,79001608,CDM,278,RC,,,both,,,469,185.1,39.4668,,185.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,164.15,35,,164.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,187.6,40,,187.6,percent of total billed charges,Implant Devices,164.15,70,,164.15,percent of total billed charges,Implant Devices,159.46,34,,159.46,percent of total billed charges,Implant Devices,159.46,34,,159.46,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.6,
STRYKER 52-27618E LOCK SCREW T7 2.7X18MM,C1713,HCPCS,,79001609,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
STRYKER 52-27622E LOCK SCREW T7 2.7X22MM,C1713,HCPCS,,79001610,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
LOCKING SCREW T7 2.7MM X 26MM,C1713,HCPCS,,79001611,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
STRYKER 53-17010E LOCKING SCREW 1.7X10MM,C1713,HCPCS,,79001612,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
STRYKER 53-17012E LOCKING SCREW 1.7X12MM,C1713,HCPCS,,79001613,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
J&J 212867 MICRO ANCHOR W/CUTTING,C1713,HCPCS,,79001620,CDM,278,RC,,,both,,,970,382.83,39.4668,,382.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,329.8,34,,329.8,percent of total billed charges,Implant Device,329.8,34,,329.8,percent of total billed charges,Implant Device,329.8,34,,329.8,percent of total billed charges,Implant Device,329.8,34,,329.8,percent of total billed charges,Implant Device,329.8,34,,329.8,percent of total billed charges,Implant Device,329.8,34,,329.8,percent of total billed charges,Implant Device,339.5,35,,339.5,percent of total billed charges,Implant Device,329.8,34,"Charges > $500, x 34%",329.8,percent of total billed charges,Implant Device,339.5,35,,339.5,percent of total billed charges,Implant Devices,339.5,35,,339.5,percent of total billed charges,Implant Devices,339.5,35,,,percent of total billed charges,Implant Devices,339.5,35,,339.5,percent of total billed charges,Implant Devices,339.5,35,,339.5,percent of total billed charges,Implant Devices,388,40,,388,percent of total billed charges,Implant Devices,339.5,70,,339.5,percent of total billed charges,Implant Devices,329.8,34,,329.8,percent of total billed charges,Implant Devices,329.8,34,,329.8,percent of total billed charges,Implant Devices,339.5,35,,339.5,percent of total billed charges,Implant Devices,339.5,35,,339.5,percent of total billed charges,Implant Devices,339.5,35,,339.5,percent of total billed charges,Implant Devices,339.5,35,,339.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,388,
J&J 212033 MINI QUICK ANCHOR,C1713,HCPCS,,79001621,CDM,278,RC,,,both,,,1068,421.51,39.4668,,421.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,363.12,34,,363.12,percent of total billed charges,Implant Device,363.12,34,,363.12,percent of total billed charges,Implant Device,363.12,34,,363.12,percent of total billed charges,Implant Device,363.12,34,,363.12,percent of total billed charges,Implant Device,363.12,34,,363.12,percent of total billed charges,Implant Device,363.12,34,,363.12,percent of total billed charges,Implant Device,373.8,35,,373.8,percent of total billed charges,Implant Device,363.12,34,"Charges > $500, x 34%",363.12,percent of total billed charges,Implant Device,373.8,35,,373.8,percent of total billed charges,Implant Devices,373.8,35,,373.8,percent of total billed charges,Implant Devices,373.8,35,,,percent of total billed charges,Implant Devices,373.8,35,,373.8,percent of total billed charges,Implant Devices,373.8,35,,373.8,percent of total billed charges,Implant Devices,427.2,40,,427.2,percent of total billed charges,Implant Devices,373.8,70,,373.8,percent of total billed charges,Implant Devices,363.12,34,,363.12,percent of total billed charges,Implant Devices,363.12,34,,363.12,percent of total billed charges,Implant Devices,373.8,35,,373.8,percent of total billed charges,Implant Devices,373.8,35,,373.8,percent of total billed charges,Implant Devices,373.8,35,,373.8,percent of total billed charges,Implant Devices,373.8,35,,373.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,427.2,
BIOMET 1312-18-600 OLECRANON PLATE SMALL,C1713,HCPCS,,79001632,CDM,278,RC,,,both,,,4620,1823.37,39.4668,,1823.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1570.8,34,,1570.8,percent of total billed charges,Implant Device,1570.8,34,,1570.8,percent of total billed charges,Implant Device,1570.8,34,,1570.8,percent of total billed charges,Implant Device,1570.8,34,,1570.8,percent of total billed charges,Implant Device,1570.8,34,,1570.8,percent of total billed charges,Implant Device,1570.8,34,,1570.8,percent of total billed charges,Implant Device,1617,35,,1617,percent of total billed charges,Implant Device,1570.8,34,"Charges > $500, x 34%",1570.8,percent of total billed charges,Implant Device,1617,35,,1617,percent of total billed charges,Implant Devices,1617,35,,1617,percent of total billed charges,Implant Devices,1617,35,,,percent of total billed charges,Implant Devices,1617,35,,1617,percent of total billed charges,Implant Devices,1617,35,,1617,percent of total billed charges,Implant Devices,1848,40,,1848,percent of total billed charges,Implant Devices,1617,70,,1617,percent of total billed charges,Implant Devices,1570.8,34,,1570.8,percent of total billed charges,Implant Devices,1570.8,34,,1570.8,percent of total billed charges,Implant Devices,1617,35,,1617,percent of total billed charges,Implant Devices,1617,35,,1617,percent of total billed charges,Implant Devices,1617,35,,1617,percent of total billed charges,Implant Devices,1617,35,,1617,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1570.8,34,"If Charge > 2,000, then 34 percent",1570.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1848,
DEPUY 84-1052 ORTHOSORB,C1713,HCPCS,,79001633,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
DEPUY 84-1070 ORTHOSORB W/KNIFE,C1713,HCPCS,,79001634,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ZIMMER 00-1112-140-01 PALACOS R,C1713,HCPCS,,79001636,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
ZIMMER 00-1113-140-01 PALACOS R PLUS,C1713,HCPCS,,79001637,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
J&J 210725 PANALOK 3.5 ABSORBABLE ANCHOR,C1713,HCPCS,,79001638,CDM,278,RC,,,both,,,1122,442.82,39.4668,,442.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,381.48,34,,381.48,percent of total billed charges,Implant Device,381.48,34,,381.48,percent of total billed charges,Implant Device,381.48,34,,381.48,percent of total billed charges,Implant Device,381.48,34,,381.48,percent of total billed charges,Implant Device,381.48,34,,381.48,percent of total billed charges,Implant Device,381.48,34,,381.48,percent of total billed charges,Implant Device,392.7,35,,392.7,percent of total billed charges,Implant Device,381.48,34,"Charges > $500, x 34%",381.48,percent of total billed charges,Implant Device,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,448.8,40,,448.8,percent of total billed charges,Implant Devices,392.7,70,,392.7,percent of total billed charges,Implant Devices,381.48,34,,381.48,percent of total billed charges,Implant Devices,381.48,34,,381.48,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,448.8,
J&J 212730 PANALOK RC QUICK,C1713,HCPCS,,79001639,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
ARTHREX AR-1927PSF-45 PEEK 4.5 FTS,C1713,HCPCS,,79001640,CDM,278,RC,,,both,,,856,337.84,39.4668,,337.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,299.6,35,,299.6,percent of total billed charges,Implant Device,291.04,34,"Charges > $500, x 34%",291.04,percent of total billed charges,Implant Device,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,342.4,40,,342.4,percent of total billed charges,Implant Devices,299.6,70,,299.6,percent of total billed charges,Implant Devices,291.04,34,,291.04,percent of total billed charges,Implant Devices,291.04,34,,291.04,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,342.4,
BIOMET SP12000 PEG SCREW 2.5X12MM,C1713,HCPCS,,79001641,CDM,278,RC,,,both,,,510,201.28,39.4668,,201.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Device,173.4,34,"Charges > $500, x 34%",173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,204,40,,204,percent of total billed charges,Implant Devices,178.5,70,,178.5,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204,
BIOMET SP14000 PEG SCREW 2.5X14MM,C1713,HCPCS,,79001642,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
BIOMET SP24000 PEG SCREW 2.5X24MM,C1713,HCPCS,,79001643,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
BIOMET SP28000 PEG SCREW 2.5X28MM,C1713,HCPCS,,79001644,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
BIOMET 14355-7 PLATE  3.5MM 7 HOLE,C1713,HCPCS,,79001649,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
BIOMET 14355-2 PLATE 3.5MM 2 HOLE,C1713,HCPCS,,79001650,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
BIOMET 14355-3 PLATE 3.5MM 3 HOLE,C1713,HCPCS,,79001651,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
BIOMET 14355-5 PLATE 3.5MM 5 HOLE,C1713,HCPCS,,79001652,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
BIOMET 14355-6 PLATE 3.5MM 6 HOLE,C1713,HCPCS,,79001653,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
STRYKER 57-05292 PLATE 1.7X4 2 HOLE,C1713,HCPCS,,79001654,CDM,278,RC,,,both,,,1480,584.11,39.4668,,584.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,503.2,34,,503.2,percent of total billed charges,Implant Device,503.2,34,,503.2,percent of total billed charges,Implant Device,503.2,34,,503.2,percent of total billed charges,Implant Device,503.2,34,,503.2,percent of total billed charges,Implant Device,503.2,34,,503.2,percent of total billed charges,Implant Device,503.2,34,,503.2,percent of total billed charges,Implant Device,518,35,,518,percent of total billed charges,Implant Device,503.2,34,"Charges > $500, x 34%",503.2,percent of total billed charges,Implant Device,518,35,,518,percent of total billed charges,Implant Devices,518,35,,518,percent of total billed charges,Implant Devices,518,35,,,percent of total billed charges,Implant Devices,518,35,,518,percent of total billed charges,Implant Devices,518,35,,518,percent of total billed charges,Implant Devices,592,40,,592,percent of total billed charges,Implant Devices,518,70,,518,percent of total billed charges,Implant Devices,503.2,34,,503.2,percent of total billed charges,Implant Devices,503.2,34,,503.2,percent of total billed charges,Implant Devices,518,35,,518,percent of total billed charges,Implant Devices,518,35,,518,percent of total billed charges,Implant Devices,518,35,,518,percent of total billed charges,Implant Devices,518,35,,518,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,592,
STRYKER 57-05270 PLATE 1.7MM 7 HOLE,C1713,HCPCS,,79001655,CDM,278,RC,,,both,,,786,310.21,39.4668,,310.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,267.24,34,,267.24,percent of total billed charges,Implant Device,267.24,34,,267.24,percent of total billed charges,Implant Device,267.24,34,,267.24,percent of total billed charges,Implant Device,267.24,34,,267.24,percent of total billed charges,Implant Device,267.24,34,,267.24,percent of total billed charges,Implant Device,267.24,34,,267.24,percent of total billed charges,Implant Device,275.1,35,,275.1,percent of total billed charges,Implant Device,267.24,34,"Charges > $500, x 34%",267.24,percent of total billed charges,Implant Device,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,314.4,40,,314.4,percent of total billed charges,Implant Devices,275.1,70,,275.1,percent of total billed charges,Implant Devices,267.24,34,,267.24,percent of total billed charges,Implant Devices,267.24,34,,267.24,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,314.4,
BIOMET 1989478 PLATE 2 HOLE STRAIGHT LG,C1713,HCPCS,,79001656,CDM,278,RC,,,both,,,142,56.04,39.4668,,56.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,49.7,35,,49.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,56.8,40,,56.8,percent of total billed charges,Implant Devices,49.7,70,,49.7,percent of total billed charges,Implant Devices,48.28,34,,48.28,percent of total billed charges,Implant Devices,48.28,34,,48.28,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,56.8,
BIOMET 1988748 PLATE 2 HOLE STRAIGHT MED,C1713,HCPCS,,79001657,CDM,278,RC,,,both,,,142,56.04,39.4668,,56.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,49.7,35,,49.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,56.8,40,,56.8,percent of total billed charges,Implant Devices,49.7,70,,49.7,percent of total billed charges,Implant Devices,48.28,34,,48.28,percent of total billed charges,Implant Devices,48.28,34,,48.28,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,56.8,
BIOMET 1912411 PLATE 2X3 MATRIX RECTANGL,C1713,HCPCS,,79001658,CDM,278,RC,,,both,,,574,226.54,39.4668,,226.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Device,195.16,34,"Charges > $500, x 34%",195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,229.6,40,,229.6,percent of total billed charges,Implant Devices,200.9,70,,200.9,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,229.6,
STRYKER 57-10192 PLATE 2.3X4 2 HOLE,C1713,HCPCS,,79001659,CDM,278,RC,,,both,,,1385,546.62,39.4668,,546.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,470.9,34,,470.9,percent of total billed charges,Implant Device,470.9,34,,470.9,percent of total billed charges,Implant Device,470.9,34,,470.9,percent of total billed charges,Implant Device,470.9,34,,470.9,percent of total billed charges,Implant Device,470.9,34,,470.9,percent of total billed charges,Implant Device,470.9,34,,470.9,percent of total billed charges,Implant Device,484.75,35,,484.75,percent of total billed charges,Implant Device,470.9,34,"Charges > $500, x 34%",470.9,percent of total billed charges,Implant Device,484.75,35,,484.75,percent of total billed charges,Implant Devices,484.75,35,,484.75,percent of total billed charges,Implant Devices,484.75,35,,,percent of total billed charges,Implant Devices,484.75,35,,484.75,percent of total billed charges,Implant Devices,484.75,35,,484.75,percent of total billed charges,Implant Devices,554,40,,554,percent of total billed charges,Implant Devices,484.75,70,,484.75,percent of total billed charges,Implant Devices,470.9,34,,470.9,percent of total billed charges,Implant Devices,470.9,34,,470.9,percent of total billed charges,Implant Devices,484.75,35,,484.75,percent of total billed charges,Implant Devices,484.75,35,,484.75,percent of total billed charges,Implant Devices,484.75,35,,484.75,percent of total billed charges,Implant Devices,484.75,35,,484.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,554,
STRYKER 57-10185 PLATE 2.3MM 5 HOLES,C1713,HCPCS,,79001660,CDM,278,RC,,,both,,,1612,636.2,39.4668,,636.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,548.08,34,,548.08,percent of total billed charges,Implant Device,548.08,34,,548.08,percent of total billed charges,Implant Device,548.08,34,,548.08,percent of total billed charges,Implant Device,548.08,34,,548.08,percent of total billed charges,Implant Device,548.08,34,,548.08,percent of total billed charges,Implant Device,548.08,34,,548.08,percent of total billed charges,Implant Device,564.2,35,,564.2,percent of total billed charges,Implant Device,548.08,34,"Charges > $500, x 34%",548.08,percent of total billed charges,Implant Device,564.2,35,,564.2,percent of total billed charges,Implant Devices,564.2,35,,564.2,percent of total billed charges,Implant Devices,564.2,35,,,percent of total billed charges,Implant Devices,564.2,35,,564.2,percent of total billed charges,Implant Devices,564.2,35,,564.2,percent of total billed charges,Implant Devices,644.8,40,,644.8,percent of total billed charges,Implant Devices,564.2,70,,564.2,percent of total billed charges,Implant Devices,548.08,34,,548.08,percent of total billed charges,Implant Devices,548.08,34,,548.08,percent of total billed charges,Implant Devices,564.2,35,,564.2,percent of total billed charges,Implant Devices,564.2,35,,564.2,percent of total billed charges,Implant Devices,564.2,35,,564.2,percent of total billed charges,Implant Devices,564.2,35,,564.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,644.8,
STRYKER 57-10121 PLATE 2.3MM LEFT 6 HOLE,C1713,HCPCS,,79001661,CDM,278,RC,,,both,,,775,305.87,39.4668,,305.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,263.5,34,,263.5,percent of total billed charges,Implant Device,263.5,34,,263.5,percent of total billed charges,Implant Device,263.5,34,,263.5,percent of total billed charges,Implant Device,263.5,34,,263.5,percent of total billed charges,Implant Device,263.5,34,,263.5,percent of total billed charges,Implant Device,263.5,34,,263.5,percent of total billed charges,Implant Device,271.25,35,,271.25,percent of total billed charges,Implant Device,263.5,34,"Charges > $500, x 34%",263.5,percent of total billed charges,Implant Device,271.25,35,,271.25,percent of total billed charges,Implant Devices,271.25,35,,271.25,percent of total billed charges,Implant Devices,271.25,35,,,percent of total billed charges,Implant Devices,271.25,35,,271.25,percent of total billed charges,Implant Devices,271.25,35,,271.25,percent of total billed charges,Implant Devices,310,40,,310,percent of total billed charges,Implant Devices,271.25,70,,271.25,percent of total billed charges,Implant Devices,263.5,34,,263.5,percent of total billed charges,Implant Devices,263.5,34,,263.5,percent of total billed charges,Implant Devices,271.25,35,,271.25,percent of total billed charges,Implant Devices,271.25,35,,271.25,percent of total billed charges,Implant Devices,271.25,35,,271.25,percent of total billed charges,Implant Devices,271.25,35,,271.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,310,
STRYKER 57-10179 PLATE 2.3MM 13 HOLE,C1713,HCPCS,,79001662,CDM,278,RC,,,both,,,913,360.33,39.4668,,360.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,310.42,34,,310.42,percent of total billed charges,Implant Device,310.42,34,,310.42,percent of total billed charges,Implant Device,310.42,34,,310.42,percent of total billed charges,Implant Device,310.42,34,,310.42,percent of total billed charges,Implant Device,310.42,34,,310.42,percent of total billed charges,Implant Device,310.42,34,,310.42,percent of total billed charges,Implant Device,319.55,35,,319.55,percent of total billed charges,Implant Device,310.42,34,"Charges > $500, x 34%",310.42,percent of total billed charges,Implant Device,319.55,35,,319.55,percent of total billed charges,Implant Devices,319.55,35,,319.55,percent of total billed charges,Implant Devices,319.55,35,,,percent of total billed charges,Implant Devices,319.55,35,,319.55,percent of total billed charges,Implant Devices,319.55,35,,319.55,percent of total billed charges,Implant Devices,365.2,40,,365.2,percent of total billed charges,Implant Devices,319.55,70,,319.55,percent of total billed charges,Implant Devices,310.42,34,,310.42,percent of total billed charges,Implant Devices,310.42,34,,310.42,percent of total billed charges,Implant Devices,319.55,35,,319.55,percent of total billed charges,Implant Devices,319.55,35,,319.55,percent of total billed charges,Implant Devices,319.55,35,,319.55,percent of total billed charges,Implant Devices,319.55,35,,319.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
BIOMET 8162-07-003 PLATE 3 HOLE,C1713,HCPCS,,79001663,CDM,278,RC,,,both,,,1798,709.61,39.4668,,709.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,611.32,34,,611.32,percent of total billed charges,Implant Device,611.32,34,,611.32,percent of total billed charges,Implant Device,611.32,34,,611.32,percent of total billed charges,Implant Device,611.32,34,,611.32,percent of total billed charges,Implant Device,611.32,34,,611.32,percent of total billed charges,Implant Device,611.32,34,,611.32,percent of total billed charges,Implant Device,629.3,35,,629.3,percent of total billed charges,Implant Device,611.32,34,"Charges > $500, x 34%",611.32,percent of total billed charges,Implant Device,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,719.2,40,,719.2,percent of total billed charges,Implant Devices,629.3,70,,629.3,percent of total billed charges,Implant Devices,611.32,34,,611.32,percent of total billed charges,Implant Devices,611.32,34,,611.32,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,719.2,
BIOMET 1874426 PLATE 3 X 3 L SHAPED LEFT,C1713,HCPCS,,79001664,CDM,278,RC,,,both,,,534,210.75,39.4668,,210.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,186.9,35,,186.9,percent of total billed charges,Implant Device,181.56,34,"Charges > $500, x 34%",181.56,percent of total billed charges,Implant Device,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,213.6,40,,213.6,percent of total billed charges,Implant Devices,186.9,70,,186.9,percent of total billed charges,Implant Devices,181.56,34,,181.56,percent of total billed charges,Implant Devices,181.56,34,,181.56,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,213.6,
BIOMET 1895611 PLATE 3X3 T SHAPED REG,C1713,HCPCS,,79001665,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
BIOMET 1877348 PLATE 4 HOLE STRAIGHT,C1713,HCPCS,,79001666,CDM,278,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,85.68,34,,85.68,percent of total billed charges,Implant Device,85.68,34,,85.68,percent of total billed charges,Implant Device,85.68,34,,85.68,percent of total billed charges,Implant Device,85.68,34,,85.68,percent of total billed charges,Implant Device,85.68,34,,85.68,percent of total billed charges,Implant Device,85.68,34,,85.68,percent of total billed charges,Implant Device,88.2,35,,88.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,100.8,40,,100.8,percent of total billed charges,Implant Devices,88.2,70,,88.2,percent of total billed charges,Implant Devices,85.68,34,,85.68,percent of total billed charges,Implant Devices,85.68,34,,85.68,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,100.8,
BIOMET 1899993 PLATE 5 HOLE Y LONG,C1713,HCPCS,,79001667,CDM,278,RC,,,both,,,496,195.76,39.4668,,195.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,198.4,40,,198.4,percent of total billed charges,Implant Devices,173.6,70,,173.6,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.4,
SYNTHES 242.16 PLATE 6 HOLE,C1713,HCPCS,,79001668,CDM,278,RC,,,both,,,372,146.82,39.4668,,146.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,126.48,34,,126.48,percent of total billed charges,Implant Device,126.48,34,,126.48,percent of total billed charges,Implant Device,126.48,34,,126.48,percent of total billed charges,Implant Device,126.48,34,,126.48,percent of total billed charges,Implant Device,126.48,34,,126.48,percent of total billed charges,Implant Device,126.48,34,,126.48,percent of total billed charges,Implant Device,130.2,35,,130.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,130.2,35,,130.2,percent of total billed charges,Implant Devices,130.2,35,,130.2,percent of total billed charges,Implant Devices,130.2,35,,,percent of total billed charges,Implant Devices,130.2,35,,130.2,percent of total billed charges,Implant Devices,130.2,35,,130.2,percent of total billed charges,Implant Devices,148.8,40,,148.8,percent of total billed charges,Implant Devices,130.2,70,,130.2,percent of total billed charges,Implant Devices,126.48,34,,126.48,percent of total billed charges,Implant Devices,126.48,34,,126.48,percent of total billed charges,Implant Devices,130.2,35,,130.2,percent of total billed charges,Implant Devices,130.2,35,,130.2,percent of total billed charges,Implant Devices,130.2,35,,130.2,percent of total billed charges,Implant Devices,130.2,35,,130.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,148.8,
BIOMET 1903645 PLATE 6 HOLE YY LONG,C1713,HCPCS,,79001669,CDM,278,RC,,,both,,,588,232.06,39.4668,,232.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.92,34,,199.92,percent of total billed charges,Implant Device,199.92,34,,199.92,percent of total billed charges,Implant Device,199.92,34,,199.92,percent of total billed charges,Implant Device,199.92,34,,199.92,percent of total billed charges,Implant Device,199.92,34,,199.92,percent of total billed charges,Implant Device,199.92,34,,199.92,percent of total billed charges,Implant Device,205.8,35,,205.8,percent of total billed charges,Implant Device,199.92,34,"Charges > $500, x 34%",199.92,percent of total billed charges,Implant Device,205.8,35,,205.8,percent of total billed charges,Implant Devices,205.8,35,,205.8,percent of total billed charges,Implant Devices,205.8,35,,,percent of total billed charges,Implant Devices,205.8,35,,205.8,percent of total billed charges,Implant Devices,205.8,35,,205.8,percent of total billed charges,Implant Devices,235.2,40,,235.2,percent of total billed charges,Implant Devices,205.8,70,,205.8,percent of total billed charges,Implant Devices,199.92,34,,199.92,percent of total billed charges,Implant Devices,199.92,34,,199.92,percent of total billed charges,Implant Devices,205.8,35,,205.8,percent of total billed charges,Implant Devices,205.8,35,,205.8,percent of total billed charges,Implant Devices,205.8,35,,205.8,percent of total billed charges,Implant Devices,205.8,35,,205.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,235.2,
SYNTHES 241.361 PLATE 6 HOLE 69MM,C1713,HCPCS,,79001670,CDM,278,RC,,,both,,,702,277.06,39.4668,,277.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,245.7,35,,245.7,percent of total billed charges,Implant Device,238.68,34,"Charges > $500, x 34%",238.68,percent of total billed charges,Implant Device,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,280.8,40,,280.8,percent of total billed charges,Implant Devices,245.7,70,,245.7,percent of total billed charges,Implant Devices,238.68,34,,238.68,percent of total billed charges,Implant Devices,238.68,34,,238.68,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280.8,
BIOMET 1902915 PLATE 6 HOLE DOUBLE Y REG,C1713,HCPCS,,79001671,CDM,278,RC,,,both,,,570,224.96,39.4668,,224.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Device,193.8,34,"Charges > $500, x 34%",193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,228,40,,228,percent of total billed charges,Implant Devices,199.5,70,,199.5,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228,
BIOMET 1904376 PLATE 6 HOLE YY X LONG,C1713,HCPCS,,79001672,CDM,278,RC,,,both,,,606,239.17,39.4668,,239.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,206.04,34,,206.04,percent of total billed charges,Implant Device,206.04,34,,206.04,percent of total billed charges,Implant Device,206.04,34,,206.04,percent of total billed charges,Implant Device,206.04,34,,206.04,percent of total billed charges,Implant Device,206.04,34,,206.04,percent of total billed charges,Implant Device,206.04,34,,206.04,percent of total billed charges,Implant Device,212.1,35,,212.1,percent of total billed charges,Implant Device,206.04,34,"Charges > $500, x 34%",206.04,percent of total billed charges,Implant Device,212.1,35,,212.1,percent of total billed charges,Implant Devices,212.1,35,,212.1,percent of total billed charges,Implant Devices,212.1,35,,,percent of total billed charges,Implant Devices,212.1,35,,212.1,percent of total billed charges,Implant Devices,212.1,35,,212.1,percent of total billed charges,Implant Devices,242.4,40,,242.4,percent of total billed charges,Implant Devices,212.1,70,,212.1,percent of total billed charges,Implant Devices,206.04,34,,206.04,percent of total billed charges,Implant Devices,206.04,34,,206.04,percent of total billed charges,Implant Devices,212.1,35,,212.1,percent of total billed charges,Implant Devices,212.1,35,,212.1,percent of total billed charges,Implant Devices,212.1,35,,212.1,percent of total billed charges,Implant Devices,212.1,35,,212.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,242.4,
BIOMET 1881001 PLATE 6 HOLE STRAIGHT,C1713,HCPCS,,79001673,CDM,278,RC,,,both,,,537,211.94,39.4668,,211.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,187.95,35,,187.95,percent of total billed charges,Implant Device,182.58,34,"Charges > $500, x 34%",182.58,percent of total billed charges,Implant Device,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,214.8,40,,214.8,percent of total billed charges,Implant Devices,187.95,70,,187.95,percent of total billed charges,Implant Devices,182.58,34,,182.58,percent of total billed charges,Implant Devices,182.58,34,,182.58,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.8,
SYNTHES 242.18 PLATE 8 HOLE,C1713,HCPCS,,79001674,CDM,278,RC,,,both,,,382,150.76,39.4668,,150.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,133.7,35,,133.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,152.8,40,,152.8,percent of total billed charges,Implant Devices,133.7,70,,133.7,percent of total billed charges,Implant Devices,129.88,34,,129.88,percent of total billed charges,Implant Devices,129.88,34,,129.88,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,152.8,
STRYKER 53-05612 PLATE GAP SMALL,C1713,HCPCS,,79001675,CDM,278,RC,,,both,,,851,335.86,39.4668,,335.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,289.34,34,,289.34,percent of total billed charges,Implant Device,289.34,34,,289.34,percent of total billed charges,Implant Device,289.34,34,,289.34,percent of total billed charges,Implant Device,289.34,34,,289.34,percent of total billed charges,Implant Device,289.34,34,,289.34,percent of total billed charges,Implant Device,289.34,34,,289.34,percent of total billed charges,Implant Device,297.85,35,,297.85,percent of total billed charges,Implant Device,289.34,34,"Charges > $500, x 34%",289.34,percent of total billed charges,Implant Device,297.85,35,,297.85,percent of total billed charges,Implant Devices,297.85,35,,297.85,percent of total billed charges,Implant Devices,297.85,35,,,percent of total billed charges,Implant Devices,297.85,35,,297.85,percent of total billed charges,Implant Devices,297.85,35,,297.85,percent of total billed charges,Implant Devices,340.4,40,,340.4,percent of total billed charges,Implant Devices,297.85,70,,297.85,percent of total billed charges,Implant Devices,289.34,34,,289.34,percent of total billed charges,Implant Devices,289.34,34,,289.34,percent of total billed charges,Implant Devices,297.85,35,,297.85,percent of total billed charges,Implant Devices,297.85,35,,297.85,percent of total billed charges,Implant Devices,297.85,35,,297.85,percent of total billed charges,Implant Devices,297.85,35,,297.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,340.4,
BIOMET 8162-35-009 PLATE LOCK ACP 9 HOLE,C1713,HCPCS,,79001677,CDM,278,RC,,,both,,,1140,449.92,39.4668,,449.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,387.6,34,,387.6,percent of total billed charges,Implant Device,387.6,34,,387.6,percent of total billed charges,Implant Device,387.6,34,,387.6,percent of total billed charges,Implant Device,387.6,34,,387.6,percent of total billed charges,Implant Device,387.6,34,,387.6,percent of total billed charges,Implant Device,387.6,34,,387.6,percent of total billed charges,Implant Device,399,35,,399,percent of total billed charges,Implant Device,387.6,34,"Charges > $500, x 34%",387.6,percent of total billed charges,Implant Device,399,35,,399,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,399,35,,,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,456,40,,456,percent of total billed charges,Implant Devices,399,70,,399,percent of total billed charges,Implant Devices,387.6,34,,387.6,percent of total billed charges,Implant Devices,387.6,34,,387.6,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,456,
BIOMET 8162-07-004 PLATE RIGHT4 HOLE,C1713,HCPCS,,79001678,CDM,278,RC,,,both,,,3480,1373.44,39.4668,,1373.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1218,35,,1218,percent of total billed charges,Implant Device,1183.2,34,"Charges > $500, x 34%",1183.2,percent of total billed charges,Implant Device,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1392,40,,1392,percent of total billed charges,Implant Devices,1218,70,,1218,percent of total billed charges,Implant Devices,1183.2,34,,1183.2,percent of total billed charges,Implant Devices,1183.2,34,,1183.2,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1183.2,34,"If Charge > 2,000, then 34 percent",1183.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1392,
BIOMET 1910585 PLATE SQUARE,C1713,HCPCS,,79001679,CDM,278,RC,,,both,,,636,251.01,39.4668,,251.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Device,216.24,34,"Charges > $500, x 34%",216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,254.4,40,,254.4,percent of total billed charges,Implant Devices,222.6,70,,222.6,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,254.4,
BIOMET 8162-35-703 PLATE TIB LOCK 3 HOLE,C1713,HCPCS,,79001680,CDM,278,RC,,,both,,,6180,2439.05,39.4668,,2439.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2101.2,34,,2101.2,percent of total billed charges,Implant Device,2101.2,34,,2101.2,percent of total billed charges,Implant Device,2101.2,34,,2101.2,percent of total billed charges,Implant Device,2101.2,34,,2101.2,percent of total billed charges,Implant Device,2101.2,34,,2101.2,percent of total billed charges,Implant Device,2101.2,34,,2101.2,percent of total billed charges,Implant Device,2163,35,,2163,percent of total billed charges,Implant Device,2101.2,34,"Charges > $500, x 34%",2101.2,percent of total billed charges,Implant Device,2163,35,,2163,percent of total billed charges,Implant Devices,2163,35,,2163,percent of total billed charges,Implant Devices,2163,35,,,percent of total billed charges,Implant Devices,2163,35,,2163,percent of total billed charges,Implant Devices,2163,35,,2163,percent of total billed charges,Implant Devices,2472,40,,2472,percent of total billed charges,Implant Devices,2163,70,,2163,percent of total billed charges,Implant Devices,2101.2,34,,2101.2,percent of total billed charges,Implant Devices,2101.2,34,,2101.2,percent of total billed charges,Implant Devices,2163,35,,2163,percent of total billed charges,Implant Devices,2163,35,,2163,percent of total billed charges,Implant Devices,2163,35,,2163,percent of total billed charges,Implant Devices,2163,35,,2163,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2101.2,34,"If Charge > 2,000, then 34 percent",2101.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2472,
STRYKER 53-05608 PLATE-DOUBLE Y 6 HOLE,C1713,HCPCS,,79001681,CDM,278,RC,,,both,,,714,281.79,39.4668,,281.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,249.9,35,,249.9,percent of total billed charges,Implant Device,242.76,34,"Charges > $500, x 34%",242.76,percent of total billed charges,Implant Device,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,285.6,40,,285.6,percent of total billed charges,Implant Devices,249.9,70,,249.9,percent of total billed charges,Implant Devices,242.76,34,,242.76,percent of total billed charges,Implant Devices,242.76,34,,242.76,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,285.6,
MTF 38100 PUTTY DBX 10CC,C1713,HCPCS,,79001694,CDM,278,RC,,,both,,,3982,1571.57,39.4668,,1571.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1353.88,34,,1353.88,percent of total billed charges,Implant Device,1353.88,34,,1353.88,percent of total billed charges,Implant Device,1353.88,34,,1353.88,percent of total billed charges,Implant Device,1353.88,34,,1353.88,percent of total billed charges,Implant Device,1353.88,34,,1353.88,percent of total billed charges,Implant Device,1353.88,34,,1353.88,percent of total billed charges,Implant Device,1393.7,35,,1393.7,percent of total billed charges,Implant Device,1353.88,34,"Charges > $500, x 34%",1353.88,percent of total billed charges,Implant Device,1393.7,35,,1393.7,percent of total billed charges,Implant Devices,1393.7,35,,1393.7,percent of total billed charges,Implant Devices,1393.7,35,,,percent of total billed charges,Implant Devices,1393.7,35,,1393.7,percent of total billed charges,Implant Devices,1393.7,35,,1393.7,percent of total billed charges,Implant Devices,1592.8,40,,1592.8,percent of total billed charges,Implant Devices,1393.7,70,,1393.7,percent of total billed charges,Implant Devices,1353.88,34,,1353.88,percent of total billed charges,Implant Devices,1353.88,34,,1353.88,percent of total billed charges,Implant Devices,1393.7,35,,1393.7,percent of total billed charges,Implant Devices,1393.7,35,,1393.7,percent of total billed charges,Implant Devices,1393.7,35,,1393.7,percent of total billed charges,Implant Devices,1393.7,35,,1393.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1353.88,34,"If Charge > 2,000, then 34 percent",1353.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1592.8,
PUTTY DBX 2.5CC,C1713,HCPCS,,79001695,CDM,278,RC,,,both,,,2770,1093.23,39.4668,,1093.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,941.8,34,,941.8,percent of total billed charges,Implant Device,941.8,34,,941.8,percent of total billed charges,Implant Device,941.8,34,,941.8,percent of total billed charges,Implant Device,941.8,34,,941.8,percent of total billed charges,Implant Device,941.8,34,,941.8,percent of total billed charges,Implant Device,941.8,34,,941.8,percent of total billed charges,Implant Device,969.5,35,,969.5,percent of total billed charges,Implant Device,941.8,34,"Charges > $500, x 34%",941.8,percent of total billed charges,Implant Device,969.5,35,,969.5,percent of total billed charges,Implant Devices,969.5,35,,969.5,percent of total billed charges,Implant Devices,969.5,35,,,percent of total billed charges,Implant Devices,969.5,35,,969.5,percent of total billed charges,Implant Devices,969.5,35,,969.5,percent of total billed charges,Implant Devices,1108,40,,1108,percent of total billed charges,Implant Devices,969.5,70,,969.5,percent of total billed charges,Implant Devices,941.8,34,,941.8,percent of total billed charges,Implant Devices,941.8,34,,941.8,percent of total billed charges,Implant Devices,969.5,35,,969.5,percent of total billed charges,Implant Devices,969.5,35,,969.5,percent of total billed charges,Implant Devices,969.5,35,,969.5,percent of total billed charges,Implant Devices,969.5,35,,969.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,941.8,34,"If Charge > 2,000, then 34 percent",941.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1108,
MTF 38025 PUTTY DBX 2CC,C1713,HCPCS,,79001696,CDM,278,RC,,,both,,,1504,593.58,39.4668,,593.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,511.36,34,,511.36,percent of total billed charges,Implant Device,511.36,34,,511.36,percent of total billed charges,Implant Device,511.36,34,,511.36,percent of total billed charges,Implant Device,511.36,34,,511.36,percent of total billed charges,Implant Device,511.36,34,,511.36,percent of total billed charges,Implant Device,511.36,34,,511.36,percent of total billed charges,Implant Device,526.4,35,,526.4,percent of total billed charges,Implant Device,511.36,34,"Charges > $500, x 34%",511.36,percent of total billed charges,Implant Device,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,601.6,40,,601.6,percent of total billed charges,Implant Devices,526.4,70,,526.4,percent of total billed charges,Implant Devices,511.36,34,,511.36,percent of total billed charges,Implant Devices,511.36,34,,511.36,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,601.6,
MTF 58025 PUTTY DBX MIX 2.5CC,C1713,HCPCS,,79001697,CDM,278,RC,,,both,,,1770,698.56,39.4668,,698.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,601.8,34,,601.8,percent of total billed charges,Implant Device,601.8,34,,601.8,percent of total billed charges,Implant Device,601.8,34,,601.8,percent of total billed charges,Implant Device,601.8,34,,601.8,percent of total billed charges,Implant Device,601.8,34,,601.8,percent of total billed charges,Implant Device,601.8,34,,601.8,percent of total billed charges,Implant Device,619.5,35,,619.5,percent of total billed charges,Implant Device,601.8,34,"Charges > $500, x 34%",601.8,percent of total billed charges,Implant Device,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,708,40,,708,percent of total billed charges,Implant Devices,619.5,70,,619.5,percent of total billed charges,Implant Devices,601.8,34,,601.8,percent of total billed charges,Implant Devices,601.8,34,,601.8,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,708,
PUTTY DBX MIX 2.5CC,C1713,HCPCS,,79001698,CDM,278,RC,,,both,,,3434,1355.29,39.4668,,1355.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1201.9,35,,1201.9,percent of total billed charges,Implant Device,1167.56,34,"Charges > $500, x 34%",1167.56,percent of total billed charges,Implant Device,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1373.6,40,,1373.6,percent of total billed charges,Implant Devices,1201.9,70,,1201.9,percent of total billed charges,Implant Devices,1167.56,34,,1167.56,percent of total billed charges,Implant Devices,1167.56,34,,1167.56,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1167.56,34,"If Charge > 2,000, then 34 percent",1167.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1373.6,
ZIMMER 00-1105-005-01 PUTTY W/CHIPS .5CC,C1713,HCPCS,,79001699,CDM,278,RC,,,both,,,346,136.56,39.4668,,136.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,138.4,40,,138.4,percent of total billed charges,Implant Devices,121.1,70,,121.1,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138.4,
ZIMMER 00-1105-010-02 PUTTY W/CHIPS 1CC,C1713,HCPCS,,79001700,CDM,278,RC,,,both,,,1140,449.92,39.4668,,449.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,387.6,34,,387.6,percent of total billed charges,Implant Device,387.6,34,,387.6,percent of total billed charges,Implant Device,387.6,34,,387.6,percent of total billed charges,Implant Device,387.6,34,,387.6,percent of total billed charges,Implant Device,387.6,34,,387.6,percent of total billed charges,Implant Device,387.6,34,,387.6,percent of total billed charges,Implant Device,399,35,,399,percent of total billed charges,Implant Device,387.6,34,"Charges > $500, x 34%",387.6,percent of total billed charges,Implant Device,399,35,,399,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,399,35,,,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,456,40,,456,percent of total billed charges,Implant Devices,399,70,,399,percent of total billed charges,Implant Devices,387.6,34,,387.6,percent of total billed charges,Implant Devices,387.6,34,,387.6,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,399,35,,399,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,456,
ZIMMER 00-1105-020-02 PUTTY W/CHIPS 2CC,C1713,HCPCS,,79001701,CDM,278,RC,,,both,,,1192,470.44,39.4668,,470.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,405.28,34,,405.28,percent of total billed charges,Implant Device,405.28,34,,405.28,percent of total billed charges,Implant Device,405.28,34,,405.28,percent of total billed charges,Implant Device,405.28,34,,405.28,percent of total billed charges,Implant Device,405.28,34,,405.28,percent of total billed charges,Implant Device,405.28,34,,405.28,percent of total billed charges,Implant Device,417.2,35,,417.2,percent of total billed charges,Implant Device,405.28,34,"Charges > $500, x 34%",405.28,percent of total billed charges,Implant Device,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,476.8,40,,476.8,percent of total billed charges,Implant Devices,417.2,70,,417.2,percent of total billed charges,Implant Devices,405.28,34,,405.28,percent of total billed charges,Implant Devices,405.28,34,,405.28,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,476.8,
J&J 222983 QUICKANCHOR,C1713,HCPCS,,79001702,CDM,278,RC,,,both,,,1176,464.13,39.4668,,464.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,399.84,34,,399.84,percent of total billed charges,Implant Device,399.84,34,,399.84,percent of total billed charges,Implant Device,399.84,34,,399.84,percent of total billed charges,Implant Device,399.84,34,,399.84,percent of total billed charges,Implant Device,399.84,34,,399.84,percent of total billed charges,Implant Device,399.84,34,,399.84,percent of total billed charges,Implant Device,411.6,35,,411.6,percent of total billed charges,Implant Device,399.84,34,"Charges > $500, x 34%",399.84,percent of total billed charges,Implant Device,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,470.4,40,,470.4,percent of total billed charges,Implant Devices,411.6,70,,411.6,percent of total billed charges,Implant Devices,399.84,34,,399.84,percent of total billed charges,Implant Devices,399.84,34,,399.84,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,470.4,
BIOMET 21-2109 SCREW 2.0,C1713,HCPCS,,79001704,CDM,278,RC,,,both,,,67,26.44,39.4668,,26.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,23.45,35,,23.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,26.8,40,,26.8,percent of total billed charges,Implant Devices,23.45,70,,23.45,percent of total billed charges,Implant Devices,22.78,34,,22.78,percent of total billed charges,Implant Devices,22.78,34,,22.78,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,26.8,
BIOMET 20-2107 SCREW 2.0,C1713,HCPCS,,79001705,CDM,278,RC,,,both,,,67,26.44,39.4668,,26.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,23.45,35,,23.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,26.8,40,,26.8,percent of total billed charges,Implant Devices,23.45,70,,23.45,percent of total billed charges,Implant Devices,22.78,34,,22.78,percent of total billed charges,Implant Devices,22.78,34,,22.78,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,26.8,
BIOMET 20-2111 SCREW 2.0,C1713,HCPCS,,79001706,CDM,278,RC,,,both,,,67,26.44,39.4668,,26.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,22.78,34,,22.78,percent of total billed charges,Implant Device,23.45,35,,23.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,26.8,40,,26.8,percent of total billed charges,Implant Devices,23.45,70,,23.45,percent of total billed charges,Implant Devices,22.78,34,,22.78,percent of total billed charges,Implant Devices,22.78,34,,22.78,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,23.45,35,,23.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,26.8,
BIOMET 20-2307 SCREW 2.3,C1713,HCPCS,,79001707,CDM,278,RC,,,both,,,144,56.83,39.4668,,56.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,50.4,35,,50.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,57.6,40,,57.6,percent of total billed charges,Implant Devices,50.4,70,,50.4,percent of total billed charges,Implant Devices,48.96,34,,48.96,percent of total billed charges,Implant Devices,48.96,34,,48.96,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,57.6,
BIOMET 81-2410 SCREW 2.4,C1713,HCPCS,,79001708,CDM,278,RC,,,both,,,52,20.52,39.4668,,20.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17.68,34,,17.68,percent of total billed charges,Implant Device,17.68,34,,17.68,percent of total billed charges,Implant Device,17.68,34,,17.68,percent of total billed charges,Implant Device,17.68,34,,17.68,percent of total billed charges,Implant Device,17.68,34,,17.68,percent of total billed charges,Implant Device,17.68,34,,17.68,percent of total billed charges,Implant Device,18.2,35,,18.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.2,35,,18.2,percent of total billed charges,Implant Devices,18.2,35,,18.2,percent of total billed charges,Implant Devices,18.2,35,,,percent of total billed charges,Implant Devices,18.2,35,,18.2,percent of total billed charges,Implant Devices,18.2,35,,18.2,percent of total billed charges,Implant Devices,20.8,40,,20.8,percent of total billed charges,Implant Devices,18.2,70,,18.2,percent of total billed charges,Implant Devices,17.68,34,,17.68,percent of total billed charges,Implant Devices,17.68,34,,17.68,percent of total billed charges,Implant Devices,18.2,35,,18.2,percent of total billed charges,Implant Devices,18.2,35,,18.2,percent of total billed charges,Implant Devices,18.2,35,,18.2,percent of total billed charges,Implant Devices,18.2,35,,18.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20.8,
BIOMET 81-2716 SCREW 2.7,C1713,HCPCS,,79001709,CDM,278,RC,,,both,,,55,21.71,39.4668,,21.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.7,34,,18.7,percent of total billed charges,Implant Device,18.7,34,,18.7,percent of total billed charges,Implant Device,18.7,34,,18.7,percent of total billed charges,Implant Device,18.7,34,,18.7,percent of total billed charges,Implant Device,18.7,34,,18.7,percent of total billed charges,Implant Device,18.7,34,,18.7,percent of total billed charges,Implant Device,19.25,35,,19.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.25,35,,19.25,percent of total billed charges,Implant Devices,19.25,35,,19.25,percent of total billed charges,Implant Devices,19.25,35,,,percent of total billed charges,Implant Devices,19.25,35,,19.25,percent of total billed charges,Implant Devices,19.25,35,,19.25,percent of total billed charges,Implant Devices,22,40,,22,percent of total billed charges,Implant Devices,19.25,70,,19.25,percent of total billed charges,Implant Devices,18.7,34,,18.7,percent of total billed charges,Implant Devices,18.7,34,,18.7,percent of total billed charges,Implant Devices,19.25,35,,19.25,percent of total billed charges,Implant Devices,19.25,35,,19.25,percent of total billed charges,Implant Devices,19.25,35,,19.25,percent of total billed charges,Implant Devices,19.25,35,,19.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22,
ARTHREX AR-1390E SCREW 9 X 20,C1713,HCPCS,,79001710,CDM,278,RC,,,both,,,346,136.56,39.4668,,136.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,138.4,40,,138.4,percent of total billed charges,Implant Devices,121.1,70,,121.1,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138.4,
BIOMET 63028 SCREW SELF DRILLING 4X14MM,C1713,HCPCS,,79001711,CDM,278,RC,,,both,,,1180,465.71,39.4668,,465.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,401.2,34,,401.2,percent of total billed charges,Implant Device,401.2,34,,401.2,percent of total billed charges,Implant Device,401.2,34,,401.2,percent of total billed charges,Implant Device,401.2,34,,401.2,percent of total billed charges,Implant Device,401.2,34,,401.2,percent of total billed charges,Implant Device,401.2,34,,401.2,percent of total billed charges,Implant Device,413,35,,413,percent of total billed charges,Implant Device,401.2,34,"Charges > $500, x 34%",401.2,percent of total billed charges,Implant Device,413,35,,413,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,413,35,,,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,472,40,,472,percent of total billed charges,Implant Devices,413,70,,413,percent of total billed charges,Implant Devices,401.2,34,,401.2,percent of total billed charges,Implant Devices,401.2,34,,401.2,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,413,35,,413,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,472,
BIOMET 63030 SCREW SELF DRILLING 4X16MM,C1713,HCPCS,,79001712,CDM,278,RC,,,both,,,1122,442.82,39.4668,,442.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,381.48,34,,381.48,percent of total billed charges,Implant Device,381.48,34,,381.48,percent of total billed charges,Implant Device,381.48,34,,381.48,percent of total billed charges,Implant Device,381.48,34,,381.48,percent of total billed charges,Implant Device,381.48,34,,381.48,percent of total billed charges,Implant Device,381.48,34,,381.48,percent of total billed charges,Implant Device,392.7,35,,392.7,percent of total billed charges,Implant Device,381.48,34,"Charges > $500, x 34%",381.48,percent of total billed charges,Implant Device,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,448.8,40,,448.8,percent of total billed charges,Implant Devices,392.7,70,,392.7,percent of total billed charges,Implant Devices,381.48,34,,381.48,percent of total billed charges,Implant Devices,381.48,34,,381.48,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,392.7,35,,392.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,448.8,
INTEGRA DHRSL5 SCREW HEAD RING LARGE,C1713,HCPCS,,79001713,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
INTEGRA DHRSS5 SCREWS HEAD RING SMALL,C1713,HCPCS,,79001714,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
BIOMET 91-6105X SCREW SD 1.65X5MM,C1713,HCPCS,,79001715,CDM,278,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,85.68,34,,85.68,percent of total billed charges,Implant Device,85.68,34,,85.68,percent of total billed charges,Implant Device,85.68,34,,85.68,percent of total billed charges,Implant Device,85.68,34,,85.68,percent of total billed charges,Implant Device,85.68,34,,85.68,percent of total billed charges,Implant Device,85.68,34,,85.68,percent of total billed charges,Implant Device,88.2,35,,88.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,100.8,40,,100.8,percent of total billed charges,Implant Devices,88.2,70,,88.2,percent of total billed charges,Implant Devices,85.68,34,,85.68,percent of total billed charges,Implant Devices,85.68,34,,85.68,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,88.2,35,,88.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,100.8,
BIOMET SPINE 45-5538 SPACER CERVICAL 8MM,C1713,HCPCS,,79001716,CDM,278,RC,,,both,,,3724,1469.74,39.4668,,1469.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1303.4,35,,1303.4,percent of total billed charges,Implant Device,1266.16,34,"Charges > $500, x 34%",1266.16,percent of total billed charges,Implant Device,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1489.6,40,,1489.6,percent of total billed charges,Implant Devices,1303.4,70,,1303.4,percent of total billed charges,Implant Devices,1266.16,34,,1266.16,percent of total billed charges,Implant Devices,1266.16,34,,1266.16,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1266.16,34,"If Charge > 2,000, then 34 percent",1266.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1489.6,
BIOMET SPINE 45-5539 SPACER CERVICAL 9MM,C1713,HCPCS,,79001717,CDM,278,RC,,,both,,,4170,1645.77,39.4668,,1645.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1417.8,34,,1417.8,percent of total billed charges,Implant Device,1417.8,34,,1417.8,percent of total billed charges,Implant Device,1417.8,34,,1417.8,percent of total billed charges,Implant Device,1417.8,34,,1417.8,percent of total billed charges,Implant Device,1417.8,34,,1417.8,percent of total billed charges,Implant Device,1417.8,34,,1417.8,percent of total billed charges,Implant Device,1459.5,35,,1459.5,percent of total billed charges,Implant Device,1417.8,34,"Charges > $500, x 34%",1417.8,percent of total billed charges,Implant Device,1459.5,35,,1459.5,percent of total billed charges,Implant Devices,1459.5,35,,1459.5,percent of total billed charges,Implant Devices,1459.5,35,,,percent of total billed charges,Implant Devices,1459.5,35,,1459.5,percent of total billed charges,Implant Devices,1459.5,35,,1459.5,percent of total billed charges,Implant Devices,1668,40,,1668,percent of total billed charges,Implant Devices,1459.5,70,,1459.5,percent of total billed charges,Implant Devices,1417.8,34,,1417.8,percent of total billed charges,Implant Devices,1417.8,34,,1417.8,percent of total billed charges,Implant Devices,1459.5,35,,1459.5,percent of total billed charges,Implant Devices,1459.5,35,,1459.5,percent of total billed charges,Implant Devices,1459.5,35,,1459.5,percent of total billed charges,Implant Devices,1459.5,35,,1459.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1417.8,34,"If Charge > 2,000, then 34 percent",1417.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1668,
JNT RST FDN 80038005 STIMUPLAST PUTTY5CC,C1713,HCPCS,,79001731,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
ARTHREX AR-1927BCF-45 SUT ANCHOR 4.5MM,C1713,HCPCS,,79001735,CDM,278,RC,,,both,,,975,384.8,39.4668,,384.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,341.25,35,,341.25,percent of total billed charges,Implant Device,331.5,34,"Charges > $500, x 34%",331.5,percent of total billed charges,Implant Device,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,390,40,,390,percent of total billed charges,Implant Devices,341.25,70,,341.25,percent of total billed charges,Implant Devices,331.5,34,,331.5,percent of total billed charges,Implant Devices,331.5,34,,331.5,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,390,
ARTHREX AR-1927BCFT-65 SUT ANCHOR 4.75,C1713,HCPCS,,79001736,CDM,278,RC,,,both,,,1005,396.64,39.4668,,396.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,351.75,35,,351.75,percent of total billed charges,Implant Device,341.7,34,"Charges > $500, x 34%",341.7,percent of total billed charges,Implant Device,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,402,40,,402,percent of total billed charges,Implant Devices,351.75,70,,351.75,percent of total billed charges,Implant Devices,341.7,34,,341.7,percent of total billed charges,Implant Devices,341.7,34,,341.7,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,402,
ARTHREX AR-1927BNF SUTURE ANCHOR 5.5X15,C1713,HCPCS,,79001737,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
SUTURE ANCHOR SWIVELOCK  4.75 X 19.1,C1713,HCPCS,,79001738,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
ARTHREX AR-2323BCC SUT ANCHOR 5.5X19.1,C1713,HCPCS,,79001739,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
SOLANA TSF-2718A ALLOGRAFT 2.7X18 ANGLED,C1713,HCPCS,,79001740,CDM,278,RC,,,both,,,3496,1379.76,39.4668,,1379.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1223.6,35,,1223.6,percent of total billed charges,Implant Device,1188.64,34,"Charges > $500, x 34%",1188.64,percent of total billed charges,Implant Device,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1398.4,40,,1398.4,percent of total billed charges,Implant Devices,1223.6,70,,1223.6,percent of total billed charges,Implant Devices,1188.64,34,,1188.64,percent of total billed charges,Implant Devices,1188.64,34,,1188.64,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1188.64,34,"If Charge > 2,000, then 34 percent",1188.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1398.4,
ARTHREX AR-8921DS TIGHTROPE CANNULATED,C1713,HCPCS,,79001741,CDM,278,RC,,,both,,,1440,568.32,39.4668,,568.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,489.6,34,,489.6,percent of total billed charges,Implant Device,489.6,34,,489.6,percent of total billed charges,Implant Device,489.6,34,,489.6,percent of total billed charges,Implant Device,489.6,34,,489.6,percent of total billed charges,Implant Device,489.6,34,,489.6,percent of total billed charges,Implant Device,489.6,34,,489.6,percent of total billed charges,Implant Device,504,35,,504,percent of total billed charges,Implant Device,489.6,34,"Charges > $500, x 34%",489.6,percent of total billed charges,Implant Device,504,35,,504,percent of total billed charges,Implant Devices,504,35,,504,percent of total billed charges,Implant Devices,504,35,,,percent of total billed charges,Implant Devices,504,35,,504,percent of total billed charges,Implant Devices,504,35,,504,percent of total billed charges,Implant Devices,576,40,,576,percent of total billed charges,Implant Devices,504,70,,504,percent of total billed charges,Implant Devices,489.6,34,,489.6,percent of total billed charges,Implant Devices,489.6,34,,489.6,percent of total billed charges,Implant Devices,504,35,,504,percent of total billed charges,Implant Devices,504,35,,504,percent of total billed charges,Implant Devices,504,35,,504,percent of total billed charges,Implant Devices,504,35,,504,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,576,
ARTHREX AR-8920DS TIGHTROPE REPAIR KIT,C1713,HCPCS,,79001742,CDM,278,RC,,,both,,,2640,1041.92,39.4668,,1041.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,924,35,,924,percent of total billed charges,Implant Device,897.6,34,"Charges > $500, x 34%",897.6,percent of total billed charges,Implant Device,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,1056,40,,1056,percent of total billed charges,Implant Devices,924,70,,924,percent of total billed charges,Implant Devices,897.6,34,,897.6,percent of total billed charges,Implant Devices,897.6,34,,897.6,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,897.6,34,"If Charge > 2,000, then 34 percent",897.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1056,
ARTHREX AR-8920CDS TIGHTROPE CANN,C1713,HCPCS,,79001743,CDM,278,RC,,,both,,,1576,622,39.4668,,622,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,535.84,34,,535.84,percent of total billed charges,Implant Device,535.84,34,,535.84,percent of total billed charges,Implant Device,535.84,34,,535.84,percent of total billed charges,Implant Device,535.84,34,,535.84,percent of total billed charges,Implant Device,535.84,34,,535.84,percent of total billed charges,Implant Device,535.84,34,,535.84,percent of total billed charges,Implant Device,551.6,35,,551.6,percent of total billed charges,Implant Device,535.84,34,"Charges > $500, x 34%",535.84,percent of total billed charges,Implant Device,551.6,35,,551.6,percent of total billed charges,Implant Devices,551.6,35,,551.6,percent of total billed charges,Implant Devices,551.6,35,,,percent of total billed charges,Implant Devices,551.6,35,,551.6,percent of total billed charges,Implant Devices,551.6,35,,551.6,percent of total billed charges,Implant Devices,630.4,40,,630.4,percent of total billed charges,Implant Devices,551.6,70,,551.6,percent of total billed charges,Implant Devices,535.84,34,,535.84,percent of total billed charges,Implant Devices,535.84,34,,535.84,percent of total billed charges,Implant Devices,551.6,35,,551.6,percent of total billed charges,Implant Devices,551.6,35,,551.6,percent of total billed charges,Implant Devices,551.6,35,,551.6,percent of total billed charges,Implant Devices,551.6,35,,551.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,630.4,
STRYKER 54-25394 VOLOR PLATE 53MM NARROW,C1713,HCPCS,,79001751,CDM,278,RC,,,both,,,2973,1173.35,39.4668,,1173.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1040.55,35,,1040.55,percent of total billed charges,Implant Device,1010.82,34,"Charges > $500, x 34%",1010.82,percent of total billed charges,Implant Device,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1189.2,40,,1189.2,percent of total billed charges,Implant Devices,1040.55,70,,1040.55,percent of total billed charges,Implant Devices,1010.82,34,,1010.82,percent of total billed charges,Implant Devices,1010.82,34,,1010.82,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1010.82,34,"If Charge > 2,000, then 34 percent",1010.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1189.2,
STRYKER 54-25398 VOLOR PLATE 73MM WIDE,C1713,HCPCS,,79001752,CDM,278,RC,,,both,,,2269,895.5,39.4668,,895.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,771.46,34,,771.46,percent of total billed charges,Implant Device,771.46,34,,771.46,percent of total billed charges,Implant Device,771.46,34,,771.46,percent of total billed charges,Implant Device,771.46,34,,771.46,percent of total billed charges,Implant Device,771.46,34,,771.46,percent of total billed charges,Implant Device,771.46,34,,771.46,percent of total billed charges,Implant Device,794.15,35,,794.15,percent of total billed charges,Implant Device,771.46,34,"Charges > $500, x 34%",771.46,percent of total billed charges,Implant Device,794.15,35,,794.15,percent of total billed charges,Implant Devices,794.15,35,,794.15,percent of total billed charges,Implant Devices,794.15,35,,,percent of total billed charges,Implant Devices,794.15,35,,794.15,percent of total billed charges,Implant Devices,794.15,35,,794.15,percent of total billed charges,Implant Devices,907.6,40,,907.6,percent of total billed charges,Implant Devices,794.15,70,,794.15,percent of total billed charges,Implant Devices,771.46,34,,771.46,percent of total billed charges,Implant Devices,771.46,34,,771.46,percent of total billed charges,Implant Devices,794.15,35,,794.15,percent of total billed charges,Implant Devices,794.15,35,,794.15,percent of total billed charges,Implant Devices,794.15,35,,794.15,percent of total billed charges,Implant Devices,794.15,35,,794.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,771.46,34,"If Charge > 2,000, then 34 percent",771.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,907.6,
STRYKER 59-17049E WASHER,C1713,HCPCS,,79001762,CDM,278,RC,,,both,,,102,40.26,39.4668,,40.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,35.7,35,,35.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,40.8,40,,40.8,percent of total billed charges,Implant Devices,35.7,70,,35.7,percent of total billed charges,Implant Devices,34.68,34,,34.68,percent of total billed charges,Implant Devices,34.68,34,,34.68,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40.8,
BIOMET 1312-18-000 WASHER 3.5 HEADLESS,C1713,HCPCS,,79001763,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
SYNTHES 219.98 WASHERS 7.0M,C1713,HCPCS,,79001764,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
BIOMET 1.7347 2 HOLE STR PLATE 1.5X16MM,C1713,HCPCS,,79001769,CDM,278,RC,,,both,,,142,56.04,39.4668,,56.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,49.7,35,,49.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,56.8,40,,56.8,percent of total billed charges,Implant Devices,49.7,70,,49.7,percent of total billed charges,Implant Devices,48.28,34,,48.28,percent of total billed charges,Implant Devices,48.28,34,,48.28,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,56.8,
BIOMET 54 ILIAC CREST WEDGE 19X21,C1713,HCPCS,,79001770,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
SYNTHES 208.407 SCREW,C1713,HCPCS,,79001771,CDM,278,RC,,,both,,,636,251.01,39.4668,,251.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Device,216.24,34,"Charges > $500, x 34%",216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,254.4,40,,254.4,percent of total billed charges,Implant Devices,222.6,70,,222.6,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,254.4,
SYNTHES 208.415 SCREW,C1713,HCPCS,,79001772,CDM,278,RC,,,both,,,625,246.67,39.4668,,246.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,212.5,34,,212.5,percent of total billed charges,Implant Device,212.5,34,,212.5,percent of total billed charges,Implant Device,212.5,34,,212.5,percent of total billed charges,Implant Device,212.5,34,,212.5,percent of total billed charges,Implant Device,212.5,34,,212.5,percent of total billed charges,Implant Device,212.5,34,,212.5,percent of total billed charges,Implant Device,218.75,35,,218.75,percent of total billed charges,Implant Device,212.5,34,"Charges > $500, x 34%",212.5,percent of total billed charges,Implant Device,218.75,35,,218.75,percent of total billed charges,Implant Devices,218.75,35,,218.75,percent of total billed charges,Implant Devices,218.75,35,,,percent of total billed charges,Implant Devices,218.75,35,,218.75,percent of total billed charges,Implant Devices,218.75,35,,218.75,percent of total billed charges,Implant Devices,250,40,,250,percent of total billed charges,Implant Devices,218.75,70,,218.75,percent of total billed charges,Implant Devices,212.5,34,,212.5,percent of total billed charges,Implant Devices,212.5,34,,212.5,percent of total billed charges,Implant Devices,218.75,35,,218.75,percent of total billed charges,Implant Devices,218.75,35,,218.75,percent of total billed charges,Implant Devices,218.75,35,,218.75,percent of total billed charges,Implant Devices,218.75,35,,218.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,250,
SYNTHES 208.435 SCREW,C1713,HCPCS,,79001773,CDM,278,RC,,,both,,,636,251.01,39.4668,,251.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Device,216.24,34,"Charges > $500, x 34%",216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,254.4,40,,254.4,percent of total billed charges,Implant Devices,222.6,70,,222.6,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,254.4,
SYNTHES 208.442 SCREW CANN 6.5X100MM,C1713,HCPCS,,79001774,CDM,278,RC,,,both,,,908,358.36,39.4668,,358.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Device,308.72,34,"Charges > $500, x 34%",308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,363.2,40,,363.2,percent of total billed charges,Implant Devices,317.8,70,,317.8,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,363.2,
SYNTHES 208.443 SCREW 6.5X105MM,C1713,HCPCS,,79001775,CDM,278,RC,,,both,,,908,358.36,39.4668,,358.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Device,308.72,34,"Charges > $500, x 34%",308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,363.2,40,,363.2,percent of total billed charges,Implant Devices,317.8,70,,317.8,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,363.2,
BIOMET 1405 CANCELLOUS CRUSHED - 30CC,C1713,HCPCS,,79001778,CDM,278,RC,,,both,,,1521,600.29,39.4668,,600.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,517.14,34,,517.14,percent of total billed charges,Implant Device,517.14,34,,517.14,percent of total billed charges,Implant Device,517.14,34,,517.14,percent of total billed charges,Implant Device,517.14,34,,517.14,percent of total billed charges,Implant Device,517.14,34,,517.14,percent of total billed charges,Implant Device,517.14,34,,517.14,percent of total billed charges,Implant Device,532.35,35,,532.35,percent of total billed charges,Implant Device,517.14,34,"Charges > $500, x 34%",517.14,percent of total billed charges,Implant Device,532.35,35,,532.35,percent of total billed charges,Implant Devices,532.35,35,,532.35,percent of total billed charges,Implant Devices,532.35,35,,,percent of total billed charges,Implant Devices,532.35,35,,532.35,percent of total billed charges,Implant Devices,532.35,35,,532.35,percent of total billed charges,Implant Devices,608.4,40,,608.4,percent of total billed charges,Implant Devices,532.35,70,,532.35,percent of total billed charges,Implant Devices,517.14,34,,517.14,percent of total billed charges,Implant Devices,517.14,34,,517.14,percent of total billed charges,Implant Devices,532.35,35,,532.35,percent of total billed charges,Implant Devices,532.35,35,,532.35,percent of total billed charges,Implant Devices,532.35,35,,532.35,percent of total billed charges,Implant Devices,532.35,35,,532.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,608.4,
UMTB 1482 CANCELLOUS CRUSHED IRRAD 60CC,C1713,HCPCS,,79001779,CDM,278,RC,,,both,,,2196,866.69,39.4668,,866.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,746.64,34,,746.64,percent of total billed charges,Implant Device,746.64,34,,746.64,percent of total billed charges,Implant Device,746.64,34,,746.64,percent of total billed charges,Implant Device,746.64,34,,746.64,percent of total billed charges,Implant Device,746.64,34,,746.64,percent of total billed charges,Implant Device,746.64,34,,746.64,percent of total billed charges,Implant Device,768.6,35,,768.6,percent of total billed charges,Implant Device,746.64,34,"Charges > $500, x 34%",746.64,percent of total billed charges,Implant Device,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,878.4,40,,878.4,percent of total billed charges,Implant Devices,768.6,70,,768.6,percent of total billed charges,Implant Devices,746.64,34,,746.64,percent of total billed charges,Implant Devices,746.64,34,,746.64,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,768.6,35,,768.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,746.64,34,"If Charge > 2,000, then 34 percent",746.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,878.4,
BIOMET 29237 LAG SCREW ASSY 90MM,C1713,HCPCS,,79001784,CDM,278,RC,,,both,,,3330,1314.24,39.4668,,1314.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Device,1132.2,34,"Charges > $500, x 34%",1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1332,40,,1332,percent of total billed charges,Implant Devices,1165.5,70,,1165.5,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1132.2,34,"If Charge > 2,000, then 34 percent",1132.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1332,
BIOMET 29241 LAG SCREW ASSY KEYED,C1713,HCPCS,,79001785,CDM,278,RC,,,both,,,2406,949.57,39.4668,,949.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,818.04,34,,818.04,percent of total billed charges,Implant Device,818.04,34,,818.04,percent of total billed charges,Implant Device,818.04,34,,818.04,percent of total billed charges,Implant Device,818.04,34,,818.04,percent of total billed charges,Implant Device,818.04,34,,818.04,percent of total billed charges,Implant Device,818.04,34,,818.04,percent of total billed charges,Implant Device,842.1,35,,842.1,percent of total billed charges,Implant Device,818.04,34,"Charges > $500, x 34%",818.04,percent of total billed charges,Implant Device,842.1,35,,842.1,percent of total billed charges,Implant Devices,842.1,35,,842.1,percent of total billed charges,Implant Devices,842.1,35,,,percent of total billed charges,Implant Devices,842.1,35,,842.1,percent of total billed charges,Implant Devices,842.1,35,,842.1,percent of total billed charges,Implant Devices,962.4,40,,962.4,percent of total billed charges,Implant Devices,842.1,70,,842.1,percent of total billed charges,Implant Devices,818.04,34,,818.04,percent of total billed charges,Implant Devices,818.04,34,,818.04,percent of total billed charges,Implant Devices,842.1,35,,842.1,percent of total billed charges,Implant Devices,842.1,35,,842.1,percent of total billed charges,Implant Devices,842.1,35,,842.1,percent of total billed charges,Implant Devices,842.1,35,,842.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,818.04,34,"If Charge > 2,000, then 34 percent",818.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,962.4,
BIOMET 29243 LAG SCREW ASSY KEYED 120MM,C1713,HCPCS,,79001786,CDM,278,RC,,,both,,,3330,1314.24,39.4668,,1314.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Device,1132.2,34,"Charges > $500, x 34%",1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1332,40,,1332,percent of total billed charges,Implant Devices,1165.5,70,,1165.5,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1132.2,34,"If Charge > 2,000, then 34 percent",1132.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1332,
BIOMET 29278 LAG SCREW,C1713,HCPCS,,79001787,CDM,278,RC,,,both,,,1738,685.93,39.4668,,685.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,590.92,34,,590.92,percent of total billed charges,Implant Device,590.92,34,,590.92,percent of total billed charges,Implant Device,590.92,34,,590.92,percent of total billed charges,Implant Device,590.92,34,,590.92,percent of total billed charges,Implant Device,590.92,34,,590.92,percent of total billed charges,Implant Device,590.92,34,,590.92,percent of total billed charges,Implant Device,608.3,35,,608.3,percent of total billed charges,Implant Device,590.92,34,"Charges > $500, x 34%",590.92,percent of total billed charges,Implant Device,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,695.2,40,,695.2,percent of total billed charges,Implant Devices,608.3,70,,608.3,percent of total billed charges,Implant Devices,590.92,34,,590.92,percent of total billed charges,Implant Devices,590.92,34,,590.92,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,695.2,
BIOMET 63029 SCREW,C1713,HCPCS,,79001790,CDM,278,RC,,,both,,,1044,412.03,39.4668,,412.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,354.96,34,,354.96,percent of total billed charges,Implant Device,354.96,34,,354.96,percent of total billed charges,Implant Device,354.96,34,,354.96,percent of total billed charges,Implant Device,354.96,34,,354.96,percent of total billed charges,Implant Device,354.96,34,,354.96,percent of total billed charges,Implant Device,354.96,34,,354.96,percent of total billed charges,Implant Device,365.4,35,,365.4,percent of total billed charges,Implant Device,354.96,34,"Charges > $500, x 34%",354.96,percent of total billed charges,Implant Device,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,417.6,40,,417.6,percent of total billed charges,Implant Devices,365.4,70,,365.4,percent of total billed charges,Implant Devices,354.96,34,,354.96,percent of total billed charges,Implant Devices,354.96,34,,354.96,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,417.6,
BIOMET 115340 PLATE,C1713,HCPCS,,79001796,CDM,278,RC,,,both,,,9510,3753.29,39.4668,,3753.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3328.5,35,,3328.5,percent of total billed charges,Implant Device,3233.4,34,"Charges > $500, x 34%",3233.4,percent of total billed charges,Implant Device,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3804,40,,3804,percent of total billed charges,Implant Devices,3328.5,70,,3328.5,percent of total billed charges,Implant Devices,3233.4,34,,3233.4,percent of total billed charges,Implant Devices,3233.4,34,,3233.4,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3233.4,34,"If Charge > 2,000, then 34 percent",3233.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3804,
STRYKER 325040 SCREW,C1713,HCPCS,,79001805,CDM,278,RC,,,both,,,694,273.9,39.4668,,273.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Device,235.96,34,"Charges > $500, x 34%",235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,277.6,40,,277.6,percent of total billed charges,Implant Devices,242.9,70,,242.9,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.6,
STRYKER 325044 CANN SCREW 4X44MM,C1713,HCPCS,,79001806,CDM,278,RC,,,both,,,770,303.89,39.4668,,303.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Device,261.8,34,"Charges > $500, x 34%",261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,308,40,,308,percent of total billed charges,Implant Devices,269.5,70,,269.5,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,308,
STRYKER 370332 SCREW,C1713,HCPCS,,79001807,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
MTF 400047 CANCELLOUS CHIPS 90CC,C1713,HCPCS,,79001808,CDM,278,RC,,,both,,,3912,1543.94,39.4668,,1543.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1330.08,34,,1330.08,percent of total billed charges,Implant Device,1330.08,34,,1330.08,percent of total billed charges,Implant Device,1330.08,34,,1330.08,percent of total billed charges,Implant Device,1330.08,34,,1330.08,percent of total billed charges,Implant Device,1330.08,34,,1330.08,percent of total billed charges,Implant Device,1330.08,34,,1330.08,percent of total billed charges,Implant Device,1369.2,35,,1369.2,percent of total billed charges,Implant Device,1330.08,34,"Charges > $500, x 34%",1330.08,percent of total billed charges,Implant Device,1369.2,35,,1369.2,percent of total billed charges,Implant Devices,1369.2,35,,1369.2,percent of total billed charges,Implant Devices,1369.2,35,,,percent of total billed charges,Implant Devices,1369.2,35,,1369.2,percent of total billed charges,Implant Devices,1369.2,35,,1369.2,percent of total billed charges,Implant Devices,1564.8,40,,1564.8,percent of total billed charges,Implant Devices,1369.2,70,,1369.2,percent of total billed charges,Implant Devices,1330.08,34,,1330.08,percent of total billed charges,Implant Devices,1330.08,34,,1330.08,percent of total billed charges,Implant Devices,1369.2,35,,1369.2,percent of total billed charges,Implant Devices,1369.2,35,,1369.2,percent of total billed charges,Implant Devices,1369.2,35,,1369.2,percent of total billed charges,Implant Devices,1369.2,35,,1369.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1330.08,34,"If Charge > 2,000, then 34 percent",1330.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1564.8,
BIOMET 402438 BONE CEMENT,C1713,HCPCS,,79001810,CDM,278,RC,,,both,,,766,302.32,39.4668,,302.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.44,34,,260.44,percent of total billed charges,Implant Device,260.44,34,,260.44,percent of total billed charges,Implant Device,260.44,34,,260.44,percent of total billed charges,Implant Device,260.44,34,,260.44,percent of total billed charges,Implant Device,260.44,34,,260.44,percent of total billed charges,Implant Device,260.44,34,,260.44,percent of total billed charges,Implant Device,268.1,35,,268.1,percent of total billed charges,Implant Device,260.44,34,"Charges > $500, x 34%",260.44,percent of total billed charges,Implant Device,268.1,35,,268.1,percent of total billed charges,Implant Devices,268.1,35,,268.1,percent of total billed charges,Implant Devices,268.1,35,,,percent of total billed charges,Implant Devices,268.1,35,,268.1,percent of total billed charges,Implant Devices,268.1,35,,268.1,percent of total billed charges,Implant Devices,306.4,40,,306.4,percent of total billed charges,Implant Devices,268.1,70,,268.1,percent of total billed charges,Implant Devices,260.44,34,,260.44,percent of total billed charges,Implant Devices,260.44,34,,260.44,percent of total billed charges,Implant Devices,268.1,35,,268.1,percent of total billed charges,Implant Devices,268.1,35,,268.1,percent of total billed charges,Implant Devices,268.1,35,,268.1,percent of total billed charges,Implant Devices,268.1,35,,268.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306.4,
BIOMET 402439 BONE CEMENT,C1713,HCPCS,,79001811,CDM,278,RC,,,both,,,1098,433.35,39.4668,,433.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,384.3,35,,384.3,percent of total billed charges,Implant Device,373.32,34,"Charges > $500, x 34%",373.32,percent of total billed charges,Implant Device,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,439.2,40,,439.2,percent of total billed charges,Implant Devices,384.3,70,,384.3,percent of total billed charges,Implant Devices,373.32,34,,373.32,percent of total billed charges,Implant Devices,373.32,34,,373.32,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,439.2,
BIOMET 405800 STEINMAN PIN,C1713,HCPCS,,79001812,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
MTF 410101 ALLOGRAFT 1CC,C1713,HCPCS,,79001814,CDM,278,RC,,,both,,,1740,686.72,39.4668,,686.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,591.6,34,,591.6,percent of total billed charges,Implant Device,591.6,34,,591.6,percent of total billed charges,Implant Device,591.6,34,,591.6,percent of total billed charges,Implant Device,591.6,34,,591.6,percent of total billed charges,Implant Device,591.6,34,,591.6,percent of total billed charges,Implant Device,591.6,34,,591.6,percent of total billed charges,Implant Device,609,35,,609,percent of total billed charges,Implant Device,591.6,34,"Charges > $500, x 34%",591.6,percent of total billed charges,Implant Device,609,35,,609,percent of total billed charges,Implant Devices,609,35,,609,percent of total billed charges,Implant Devices,609,35,,,percent of total billed charges,Implant Devices,609,35,,609,percent of total billed charges,Implant Devices,609,35,,609,percent of total billed charges,Implant Devices,696,40,,696,percent of total billed charges,Implant Devices,609,70,,609,percent of total billed charges,Implant Devices,591.6,34,,591.6,percent of total billed charges,Implant Devices,591.6,34,,591.6,percent of total billed charges,Implant Devices,609,35,,609,percent of total billed charges,Implant Devices,609,35,,609,percent of total billed charges,Implant Devices,609,35,,609,percent of total billed charges,Implant Devices,609,35,,609,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,696,
MTF 410110 ALLOGRAFT 10CC,C1713,HCPCS,,79001815,CDM,278,RC,,,both,,,13096,5168.57,39.4668,,5168.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4452.64,34,,4452.64,percent of total billed charges,Implant Device,4452.64,34,,4452.64,percent of total billed charges,Implant Device,4452.64,34,,4452.64,percent of total billed charges,Implant Device,4452.64,34,,4452.64,percent of total billed charges,Implant Device,4452.64,34,,4452.64,percent of total billed charges,Implant Device,4452.64,34,,4452.64,percent of total billed charges,Implant Device,4583.6,35,,4583.6,percent of total billed charges,Implant Device,4452.64,34,"Charges > $500, x 34%",4452.64,percent of total billed charges,Implant Device,4583.6,35,,4583.6,percent of total billed charges,Implant Devices,4583.6,35,,4583.6,percent of total billed charges,Implant Devices,4583.6,35,,,percent of total billed charges,Implant Devices,4583.6,35,,4583.6,percent of total billed charges,Implant Devices,4583.6,35,,4583.6,percent of total billed charges,Implant Devices,5238.4,40,,5238.4,percent of total billed charges,Implant Devices,4583.6,70,,4583.6,percent of total billed charges,Implant Devices,4452.64,34,,4452.64,percent of total billed charges,Implant Devices,4452.64,34,,4452.64,percent of total billed charges,Implant Devices,4583.6,35,,4583.6,percent of total billed charges,Implant Devices,4583.6,35,,4583.6,percent of total billed charges,Implant Devices,4583.6,35,,4583.6,percent of total billed charges,Implant Devices,4583.6,35,,4583.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4452.64,34,"If Charge > 2,000, then 34 percent",4452.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5238.4,
STRYKER 602670 SCREW,C1713,HCPCS,,79001821,CDM,278,RC,,,both,,,696,274.69,39.4668,,274.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Device,236.64,34,"Charges > $500, x 34%",236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,278.4,40,,278.4,percent of total billed charges,Implant Devices,243.6,70,,243.6,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,278.4,
STRYKER 602675 SCREW,C1713,HCPCS,,79001822,CDM,278,RC,,,both,,,753,297.19,39.4668,,297.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,263.55,35,,263.55,percent of total billed charges,Implant Device,256.02,34,"Charges > $500, x 34%",256.02,percent of total billed charges,Implant Device,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,301.2,40,,301.2,percent of total billed charges,Implant Devices,263.55,70,,263.55,percent of total billed charges,Implant Devices,256.02,34,,256.02,percent of total billed charges,Implant Devices,256.02,34,,256.02,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,301.2,
STRYKER 602680 SCREW,C1713,HCPCS,,79001823,CDM,278,RC,,,both,,,753,297.19,39.4668,,297.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,263.55,35,,263.55,percent of total billed charges,Implant Device,256.02,34,"Charges > $500, x 34%",256.02,percent of total billed charges,Implant Device,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,301.2,40,,301.2,percent of total billed charges,Implant Devices,263.55,70,,263.55,percent of total billed charges,Implant Devices,256.02,34,,256.02,percent of total billed charges,Implant Devices,256.02,34,,256.02,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,301.2,
STRYKER 604642 SCREW,C1713,HCPCS,,79001824,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 604646 SCREW,C1713,HCPCS,,79001825,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
STRYKER 614620 SCREW 3.5X18MM,C1713,HCPCS,,79001826,CDM,278,RC,,,both,,,755,297.97,39.4668,,297.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,264.25,35,,264.25,percent of total billed charges,Implant Device,256.7,34,"Charges > $500, x 34%",256.7,percent of total billed charges,Implant Device,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,302,40,,302,percent of total billed charges,Implant Devices,264.25,70,,264.25,percent of total billed charges,Implant Devices,256.7,34,,256.7,percent of total billed charges,Implant Devices,256.7,34,,256.7,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,302,
STRYKER 614820 SCREW,C1713,HCPCS,,79001827,CDM,278,RC,,,both,,,331,130.64,39.4668,,130.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,132.4,40,,132.4,percent of total billed charges,Implant Devices,115.85,70,,115.85,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.4,
STRYKER 628223 PLATE,C1713,HCPCS,,79001828,CDM,278,RC,,,both,,,3342,1318.98,39.4668,,1318.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1169.7,35,,1169.7,percent of total billed charges,Implant Device,1136.28,34,"Charges > $500, x 34%",1136.28,percent of total billed charges,Implant Device,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1336.8,40,,1336.8,percent of total billed charges,Implant Devices,1169.7,70,,1169.7,percent of total billed charges,Implant Devices,1136.28,34,,1136.28,percent of total billed charges,Implant Devices,1136.28,34,,1136.28,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1136.28,34,"If Charge > 2,000, then 34 percent",1136.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1336.8,
BIOMET 909853 ZIPTIGHT ANKLE,C1713,HCPCS,,79001832,CDM,278,RC,,,both,,,3579,1412.52,39.4668,,1412.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1252.65,35,,1252.65,percent of total billed charges,Implant Device,1216.86,34,"Charges > $500, x 34%",1216.86,percent of total billed charges,Implant Device,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1431.6,40,,1431.6,percent of total billed charges,Implant Devices,1252.65,70,,1252.65,percent of total billed charges,Implant Devices,1216.86,34,,1216.86,percent of total billed charges,Implant Devices,1216.86,34,,1216.86,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1216.86,34,"If Charge > 2,000, then 34 percent",1216.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1431.6,
BIOMET 01-7106 PLATE,C1713,HCPCS,,79001835,CDM,278,RC,,,both,,,2472,975.62,39.4668,,975.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,840.48,34,,840.48,percent of total billed charges,Implant Device,840.48,34,,840.48,percent of total billed charges,Implant Device,840.48,34,,840.48,percent of total billed charges,Implant Device,840.48,34,,840.48,percent of total billed charges,Implant Device,840.48,34,,840.48,percent of total billed charges,Implant Device,840.48,34,,840.48,percent of total billed charges,Implant Device,865.2,35,,865.2,percent of total billed charges,Implant Device,840.48,34,"Charges > $500, x 34%",840.48,percent of total billed charges,Implant Device,865.2,35,,865.2,percent of total billed charges,Implant Devices,865.2,35,,865.2,percent of total billed charges,Implant Devices,865.2,35,,,percent of total billed charges,Implant Devices,865.2,35,,865.2,percent of total billed charges,Implant Devices,865.2,35,,865.2,percent of total billed charges,Implant Devices,988.8,40,,988.8,percent of total billed charges,Implant Devices,865.2,70,,865.2,percent of total billed charges,Implant Devices,840.48,34,,840.48,percent of total billed charges,Implant Devices,840.48,34,,840.48,percent of total billed charges,Implant Devices,865.2,35,,865.2,percent of total billed charges,Implant Devices,865.2,35,,865.2,percent of total billed charges,Implant Devices,865.2,35,,865.2,percent of total billed charges,Implant Devices,865.2,35,,865.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,840.48,34,"If Charge > 2,000, then 34 percent",840.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,988.8,
BIOMET 01-7305 PLATE,C1713,HCPCS,,79001836,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
BIOMET 01-7309 PLATE,C1713,HCPCS,,79001837,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
MEDTRONIC 7510200 BONE GRAFT,C1713,HCPCS,,79001838,CDM,278,RC,,,both,,,10354,4086.39,39.4668,,4086.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3520.36,34,,3520.36,percent of total billed charges,Implant Device,3520.36,34,,3520.36,percent of total billed charges,Implant Device,3520.36,34,,3520.36,percent of total billed charges,Implant Device,3520.36,34,,3520.36,percent of total billed charges,Implant Device,3520.36,34,,3520.36,percent of total billed charges,Implant Device,3520.36,34,,3520.36,percent of total billed charges,Implant Device,3623.9,35,,3623.9,percent of total billed charges,Implant Device,3520.36,34,"Charges > $500, x 34%",3520.36,percent of total billed charges,Implant Device,3623.9,35,,3623.9,percent of total billed charges,Implant Devices,3623.9,35,,3623.9,percent of total billed charges,Implant Devices,3623.9,35,,,percent of total billed charges,Implant Devices,3623.9,35,,3623.9,percent of total billed charges,Implant Devices,3623.9,35,,3623.9,percent of total billed charges,Implant Devices,4141.6,40,,4141.6,percent of total billed charges,Implant Devices,3623.9,70,,3623.9,percent of total billed charges,Implant Devices,3520.36,34,,3520.36,percent of total billed charges,Implant Devices,3520.36,34,,3520.36,percent of total billed charges,Implant Devices,3623.9,35,,3623.9,percent of total billed charges,Implant Devices,3623.9,35,,3623.9,percent of total billed charges,Implant Devices,3623.9,35,,3623.9,percent of total billed charges,Implant Devices,3623.9,35,,3623.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3520.36,34,"If Charge > 2,000, then 34 percent",3520.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4141.6,
MEDTRONIC 7510400 BONE GRAFT,C1713,HCPCS,,79001839,CDM,278,RC,,,both,,,14680,5793.73,39.4668,,5793.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4991.2,34,,4991.2,percent of total billed charges,Implant Device,4991.2,34,,4991.2,percent of total billed charges,Implant Device,4991.2,34,,4991.2,percent of total billed charges,Implant Device,4991.2,34,,4991.2,percent of total billed charges,Implant Device,4991.2,34,,4991.2,percent of total billed charges,Implant Device,4991.2,34,,4991.2,percent of total billed charges,Implant Device,5138,35,,5138,percent of total billed charges,Implant Device,4991.2,34,"Charges > $500, x 34%",4991.2,percent of total billed charges,Implant Device,5138,35,,5138,percent of total billed charges,Implant Devices,5138,35,,5138,percent of total billed charges,Implant Devices,5138,35,,,percent of total billed charges,Implant Devices,5138,35,,5138,percent of total billed charges,Implant Devices,5138,35,,5138,percent of total billed charges,Implant Devices,5872,40,,5872,percent of total billed charges,Implant Devices,5138,70,,5138,percent of total billed charges,Implant Devices,4991.2,34,,4991.2,percent of total billed charges,Implant Devices,4991.2,34,,4991.2,percent of total billed charges,Implant Devices,5138,35,,5138,percent of total billed charges,Implant Devices,5138,35,,5138,percent of total billed charges,Implant Devices,5138,35,,5138,percent of total billed charges,Implant Devices,5138,35,,5138,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4991.2,34,"If Charge > 2,000, then 34 percent",4991.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5872,
WRIGHT MEDICAL 40130120 PLATE,C1713,HCPCS,,79001840,CDM,278,RC,,,both,,,5370,2119.37,39.4668,,2119.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1879.5,35,,1879.5,percent of total billed charges,Implant Device,1825.8,34,"Charges > $500, x 34%",1825.8,percent of total billed charges,Implant Device,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,2148,40,,2148,percent of total billed charges,Implant Devices,1879.5,70,,1879.5,percent of total billed charges,Implant Devices,1825.8,34,,1825.8,percent of total billed charges,Implant Devices,1825.8,34,,1825.8,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1825.8,34,"If Charge > 2,000, then 34 percent",1825.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2148,
WRIGHT MEDICAL 40130125 PLATE,C1713,HCPCS,,79001841,CDM,278,RC,,,both,,,5530,2182.51,39.4668,,2182.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1880.2,34,,1880.2,percent of total billed charges,Implant Device,1880.2,34,,1880.2,percent of total billed charges,Implant Device,1880.2,34,,1880.2,percent of total billed charges,Implant Device,1880.2,34,,1880.2,percent of total billed charges,Implant Device,1880.2,34,,1880.2,percent of total billed charges,Implant Device,1880.2,34,,1880.2,percent of total billed charges,Implant Device,1935.5,35,,1935.5,percent of total billed charges,Implant Device,1880.2,34,"Charges > $500, x 34%",1880.2,percent of total billed charges,Implant Device,1935.5,35,,1935.5,percent of total billed charges,Implant Devices,1935.5,35,,1935.5,percent of total billed charges,Implant Devices,1935.5,35,,,percent of total billed charges,Implant Devices,1935.5,35,,1935.5,percent of total billed charges,Implant Devices,1935.5,35,,1935.5,percent of total billed charges,Implant Devices,2212,40,,2212,percent of total billed charges,Implant Devices,1935.5,70,,1935.5,percent of total billed charges,Implant Devices,1880.2,34,,1880.2,percent of total billed charges,Implant Devices,1880.2,34,,1880.2,percent of total billed charges,Implant Devices,1935.5,35,,1935.5,percent of total billed charges,Implant Devices,1935.5,35,,1935.5,percent of total billed charges,Implant Devices,1935.5,35,,1935.5,percent of total billed charges,Implant Devices,1935.5,35,,1935.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1880.2,34,"If Charge > 2,000, then 34 percent",1880.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2212,
WRIGHT MEDICAL 40133518 SCREW,C1713,HCPCS,,79001842,CDM,278,RC,,,both,,,822,324.42,39.4668,,324.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,279.48,34,,279.48,percent of total billed charges,Implant Device,279.48,34,,279.48,percent of total billed charges,Implant Device,279.48,34,,279.48,percent of total billed charges,Implant Device,279.48,34,,279.48,percent of total billed charges,Implant Device,279.48,34,,279.48,percent of total billed charges,Implant Device,279.48,34,,279.48,percent of total billed charges,Implant Device,287.7,35,,287.7,percent of total billed charges,Implant Device,279.48,34,"Charges > $500, x 34%",279.48,percent of total billed charges,Implant Device,287.7,35,,287.7,percent of total billed charges,Implant Devices,287.7,35,,287.7,percent of total billed charges,Implant Devices,287.7,35,,,percent of total billed charges,Implant Devices,287.7,35,,287.7,percent of total billed charges,Implant Devices,287.7,35,,287.7,percent of total billed charges,Implant Devices,328.8,40,,328.8,percent of total billed charges,Implant Devices,287.7,70,,287.7,percent of total billed charges,Implant Devices,279.48,34,,279.48,percent of total billed charges,Implant Devices,279.48,34,,279.48,percent of total billed charges,Implant Devices,287.7,35,,287.7,percent of total billed charges,Implant Devices,287.7,35,,287.7,percent of total billed charges,Implant Devices,287.7,35,,287.7,percent of total billed charges,Implant Devices,287.7,35,,287.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,328.8,
WRIGHT MEDICAL 40133524 SCREW,C1713,HCPCS,,79001843,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ZIMMER 00-4835-020-01-REV SCREW,C1713,HCPCS,,79001848,CDM,278,RC,,,both,,,62,24.47,39.4668,,24.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,24.8,40,,24.8,percent of total billed charges,Implant Devices,21.7,70,,21.7,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24.8,
ZIMMER 00-4835-022-01-REV SCREW,C1713,HCPCS,,79001849,CDM,278,RC,,,both,,,62,24.47,39.4668,,24.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,24.8,40,,24.8,percent of total billed charges,Implant Devices,21.7,70,,21.7,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24.8,
ZIMMER 00-4835-028-01-REV SCREW,C1713,HCPCS,,79001850,CDM,278,RC,,,both,,,62,24.47,39.4668,,24.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,24.8,40,,24.8,percent of total billed charges,Implant Devices,21.7,70,,21.7,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24.8,
ZIMMER 00-4835-030-01-REV SCREW,C1713,HCPCS,,79001851,CDM,278,RC,,,both,,,62,24.47,39.4668,,24.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,24.8,40,,24.8,percent of total billed charges,Implant Devices,21.7,70,,21.7,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24.8,
ZIMMER 00-4835-040-01-REV SCREW,C1713,HCPCS,,79001852,CDM,278,RC,,,both,,,62,24.47,39.4668,,24.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,24.8,40,,24.8,percent of total billed charges,Implant Devices,21.7,70,,21.7,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24.8,
ZIMMER 00-4835-045-01-REV SCREW,C1713,HCPCS,,79001853,CDM,278,RC,,,both,,,62,24.47,39.4668,,24.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,24.8,40,,24.8,percent of total billed charges,Implant Devices,21.7,70,,21.7,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24.8,
ZIMMER 00-4835-055-01-REV SCREW,C1713,HCPCS,,79001854,CDM,278,RC,,,both,,,62,24.47,39.4668,,24.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,24.8,40,,24.8,percent of total billed charges,Implant Devices,21.7,70,,21.7,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24.8,
ZIMMER 00-5606-000-10 TISSUE GRAFT,C1713,HCPCS,,79001858,CDM,278,RC,,,both,,,13200,5209.62,39.4668,,5209.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Device,4488,34,"Charges > $500, x 34%",4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,5280,40,,5280,percent of total billed charges,Implant Devices,4620,70,,4620,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4488,34,"If Charge > 2,000, then 34 percent",4488,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5280,
ZIMMER 00-5606-000-11 TISSUE GRAFT,C1713,HCPCS,,79001859,CDM,278,RC,,,both,,,13986,5519.83,39.4668,,5519.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4755.24,34,,4755.24,percent of total billed charges,Implant Device,4755.24,34,,4755.24,percent of total billed charges,Implant Device,4755.24,34,,4755.24,percent of total billed charges,Implant Device,4755.24,34,,4755.24,percent of total billed charges,Implant Device,4755.24,34,,4755.24,percent of total billed charges,Implant Device,4755.24,34,,4755.24,percent of total billed charges,Implant Device,4895.1,35,,4895.1,percent of total billed charges,Implant Device,4755.24,34,"Charges > $500, x 34%",4755.24,percent of total billed charges,Implant Device,4895.1,35,,4895.1,percent of total billed charges,Implant Devices,4895.1,35,,4895.1,percent of total billed charges,Implant Devices,4895.1,35,,,percent of total billed charges,Implant Devices,4895.1,35,,4895.1,percent of total billed charges,Implant Devices,4895.1,35,,4895.1,percent of total billed charges,Implant Devices,5594.4,40,,5594.4,percent of total billed charges,Implant Devices,4895.1,70,,4895.1,percent of total billed charges,Implant Devices,4755.24,34,,4755.24,percent of total billed charges,Implant Devices,4755.24,34,,4755.24,percent of total billed charges,Implant Devices,4895.1,35,,4895.1,percent of total billed charges,Implant Devices,4895.1,35,,4895.1,percent of total billed charges,Implant Devices,4895.1,35,,4895.1,percent of total billed charges,Implant Devices,4895.1,35,,4895.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4755.24,34,"If Charge > 2,000, then 34 percent",4755.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5594.4,
ZIMMER 00-5901-020-00-REV DRILL PIN,C1713,HCPCS,,79001860,CDM,278,RC,,,both,,,1798,709.61,39.4668,,709.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,611.32,34,,611.32,percent of total billed charges,Implant Device,611.32,34,,611.32,percent of total billed charges,Implant Device,611.32,34,,611.32,percent of total billed charges,Implant Device,611.32,34,,611.32,percent of total billed charges,Implant Device,611.32,34,,611.32,percent of total billed charges,Implant Device,611.32,34,,611.32,percent of total billed charges,Implant Device,629.3,35,,629.3,percent of total billed charges,Implant Device,611.32,34,"Charges > $500, x 34%",611.32,percent of total billed charges,Implant Device,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,719.2,40,,719.2,percent of total billed charges,Implant Devices,629.3,70,,629.3,percent of total billed charges,Implant Devices,611.32,34,,611.32,percent of total billed charges,Implant Devices,611.32,34,,611.32,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,629.3,35,,629.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,719.2,
SYNTHES 02.110.152 PLATE,C1713,HCPCS,,79001894,CDM,278,RC,,,both,,,5689,2245.27,39.4668,,2245.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1934.26,34,,1934.26,percent of total billed charges,Implant Device,1934.26,34,,1934.26,percent of total billed charges,Implant Device,1934.26,34,,1934.26,percent of total billed charges,Implant Device,1934.26,34,,1934.26,percent of total billed charges,Implant Device,1934.26,34,,1934.26,percent of total billed charges,Implant Device,1934.26,34,,1934.26,percent of total billed charges,Implant Device,1991.15,35,,1991.15,percent of total billed charges,Implant Device,1934.26,34,"Charges > $500, x 34%",1934.26,percent of total billed charges,Implant Device,1991.15,35,,1991.15,percent of total billed charges,Implant Devices,1991.15,35,,1991.15,percent of total billed charges,Implant Devices,1991.15,35,,,percent of total billed charges,Implant Devices,1991.15,35,,1991.15,percent of total billed charges,Implant Devices,1991.15,35,,1991.15,percent of total billed charges,Implant Devices,2275.6,40,,2275.6,percent of total billed charges,Implant Devices,1991.15,70,,1991.15,percent of total billed charges,Implant Devices,1934.26,34,,1934.26,percent of total billed charges,Implant Devices,1934.26,34,,1934.26,percent of total billed charges,Implant Devices,1991.15,35,,1991.15,percent of total billed charges,Implant Devices,1991.15,35,,1991.15,percent of total billed charges,Implant Devices,1991.15,35,,1991.15,percent of total billed charges,Implant Devices,1991.15,35,,1991.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1934.26,34,"If Charge > 2,000, then 34 percent",1934.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2275.6,
ZIMMER 02-03150-040 SCREW,C1713,HCPCS,,79001897,CDM,278,RC,,,both,,,523,206.41,39.4668,,206.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Device,177.82,34,"Charges > $500, x 34%",177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,209.2,40,,209.2,percent of total billed charges,Implant Devices,183.05,70,,183.05,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.2,
ZIMMER 02-03150-048 SCREW,C1713,HCPCS,,79001898,CDM,278,RC,,,both,,,636,251.01,39.4668,,251.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Device,216.24,34,"Charges > $500, x 34%",216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,254.4,40,,254.4,percent of total billed charges,Implant Devices,222.6,70,,222.6,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,254.4,
ZIMMER 02-03150-300 SCREW CAP,C1713,HCPCS,,79001899,CDM,278,RC,,,both,,,462,182.34,39.4668,,182.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,157.08,34,,157.08,percent of total billed charges,Implant Device,157.08,34,,157.08,percent of total billed charges,Implant Device,157.08,34,,157.08,percent of total billed charges,Implant Device,157.08,34,,157.08,percent of total billed charges,Implant Device,157.08,34,,157.08,percent of total billed charges,Implant Device,157.08,34,,157.08,percent of total billed charges,Implant Device,161.7,35,,161.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,161.7,35,,161.7,percent of total billed charges,Implant Devices,161.7,35,,161.7,percent of total billed charges,Implant Devices,161.7,35,,,percent of total billed charges,Implant Devices,161.7,35,,161.7,percent of total billed charges,Implant Devices,161.7,35,,161.7,percent of total billed charges,Implant Devices,184.8,40,,184.8,percent of total billed charges,Implant Devices,161.7,70,,161.7,percent of total billed charges,Implant Devices,157.08,34,,157.08,percent of total billed charges,Implant Devices,157.08,34,,157.08,percent of total billed charges,Implant Devices,161.7,35,,161.7,percent of total billed charges,Implant Devices,161.7,35,,161.7,percent of total billed charges,Implant Devices,161.7,35,,161.7,percent of total billed charges,Implant Devices,161.7,35,,161.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,184.8,
ZIMMER 02-03150-310 BLIND CAP,C1713,HCPCS,,79001900,CDM,278,RC,,,both,,,148,58.41,39.4668,,58.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,51.8,35,,51.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,59.2,40,,59.2,percent of total billed charges,Implant Devices,51.8,70,,51.8,percent of total billed charges,Implant Devices,50.32,34,,50.32,percent of total billed charges,Implant Devices,50.32,34,,50.32,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,59.2,
ZIMMER 02-03155-036 SCREW,C1713,HCPCS,,79001901,CDM,278,RC,,,both,,,402,158.66,39.4668,,158.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,160.8,40,,160.8,percent of total billed charges,Implant Devices,140.7,70,,140.7,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,160.8,
ZIMMER 02-03155-038 SCREW,C1713,HCPCS,,79001902,CDM,278,RC,,,both,,,402,158.66,39.4668,,158.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,160.8,40,,160.8,percent of total billed charges,Implant Devices,140.7,70,,140.7,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,160.8,
ZIMMER 1179-05-10-REV PLATE,C1713,HCPCS,,79001915,CDM,278,RC,,,both,,,1224,483.07,39.4668,,483.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,428.4,35,,428.4,percent of total billed charges,Implant Device,416.16,34,"Charges > $500, x 34%",416.16,percent of total billed charges,Implant Device,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,489.6,40,,489.6,percent of total billed charges,Implant Devices,428.4,70,,428.4,percent of total billed charges,Implant Devices,416.16,34,,416.16,percent of total billed charges,Implant Devices,416.16,34,,416.16,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,489.6,
DEPUY 14196-105 SCREW,C1713,HCPCS,,79001944,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
DEPUY 14196-35 SCREW,C1713,HCPCS,,79001945,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
DEPUY 14250-38 SCREW,C1713,HCPCS,,79001946,CDM,278,RC,,,both,,,522,206.02,39.4668,,206.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,182.7,35,,182.7,percent of total billed charges,Implant Device,177.48,34,"Charges > $500, x 34%",177.48,percent of total billed charges,Implant Device,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,208.8,40,,208.8,percent of total billed charges,Implant Devices,182.7,70,,182.7,percent of total billed charges,Implant Devices,177.48,34,,177.48,percent of total billed charges,Implant Devices,177.48,34,,177.48,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,208.8,
DEPUY 14250-42 SCREW,C1713,HCPCS,,79001947,CDM,278,RC,,,both,,,522,206.02,39.4668,,206.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,182.7,35,,182.7,percent of total billed charges,Implant Device,177.48,34,"Charges > $500, x 34%",177.48,percent of total billed charges,Implant Device,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,208.8,40,,208.8,percent of total billed charges,Implant Devices,182.7,70,,182.7,percent of total billed charges,Implant Devices,177.48,34,,177.48,percent of total billed charges,Implant Devices,177.48,34,,177.48,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,208.8,
DEPUY 14250-46 SCREW,C1713,HCPCS,,79001948,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
BIOMET 14-405026 SCREW,C1713,HCPCS,,79001949,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
BIOMET 14-405030 SCREW,C1713,HCPCS,,79001950,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
BIOMET 14-405032 SCREW 5X32MM,C1713,HCPCS,,79001951,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
BIOMET 14-405034 SCREW 5X34MM,C1713,HCPCS,,79001952,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
BIOMET 14-405036 SCREW 5X36MM,C1713,HCPCS,,79001953,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
BIOMET 14-405038 SCREW 5X38MM,C1713,HCPCS,,79001954,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
STRYKER 1822-1037S NAIL,C1713,HCPCS,,79001959,CDM,278,RC,,,both,,,4886,1928.35,39.4668,,1928.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1710.1,35,,1710.1,percent of total billed charges,Implant Device,1661.24,34,"Charges > $500, x 34%",1661.24,percent of total billed charges,Implant Device,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1954.4,40,,1954.4,percent of total billed charges,Implant Devices,1710.1,70,,1710.1,percent of total billed charges,Implant Devices,1661.24,34,,1661.24,percent of total billed charges,Implant Devices,1661.24,34,,1661.24,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1661.24,34,"If Charge > 2,000, then 34 percent",1661.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1954.4,
STRYKER 1822-1133S NAIL,C1713,HCPCS,,79001960,CDM,278,RC,,,both,,,6416,2532.19,39.4668,,2532.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2245.6,35,,2245.6,percent of total billed charges,Implant Device,2181.44,34,"Charges > $500, x 34%",2181.44,percent of total billed charges,Implant Device,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2566.4,40,,2566.4,percent of total billed charges,Implant Devices,2245.6,70,,2245.6,percent of total billed charges,Implant Devices,2181.44,34,,2181.44,percent of total billed charges,Implant Devices,2181.44,34,,2181.44,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2181.44,34,"If Charge > 2,000, then 34 percent",2181.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2566.4,
STRYKER 1822-1137S NAIL,C1713,HCPCS,,79001961,CDM,278,RC,,,both,,,5131,2025.04,39.4668,,2025.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1795.85,35,,1795.85,percent of total billed charges,Implant Device,1744.54,34,"Charges > $500, x 34%",1744.54,percent of total billed charges,Implant Device,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,2052.4,40,,2052.4,percent of total billed charges,Implant Devices,1795.85,70,,1795.85,percent of total billed charges,Implant Devices,1744.54,34,,1744.54,percent of total billed charges,Implant Devices,1744.54,34,,1744.54,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1744.54,34,"If Charge > 2,000, then 34 percent",1744.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2052.4,
STRYKER 1822-1140S NAIL,C1713,HCPCS,,79001962,CDM,278,RC,,,both,,,5131,2025.04,39.4668,,2025.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1795.85,35,,1795.85,percent of total billed charges,Implant Device,1744.54,34,"Charges > $500, x 34%",1744.54,percent of total billed charges,Implant Device,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,2052.4,40,,2052.4,percent of total billed charges,Implant Devices,1795.85,70,,1795.85,percent of total billed charges,Implant Devices,1744.54,34,,1744.54,percent of total billed charges,Implant Devices,1744.54,34,,1744.54,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1744.54,34,"If Charge > 2,000, then 34 percent",1744.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2052.4,
STRYKER 2030-6525-1-REV SCREW,C1713,HCPCS,,79001966,CDM,278,RC,,,both,,,451,178,39.4668,,178,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,157.85,35,,157.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,180.4,40,,180.4,percent of total billed charges,Implant Devices,157.85,70,,157.85,percent of total billed charges,Implant Devices,153.34,34,,153.34,percent of total billed charges,Implant Devices,153.34,34,,153.34,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180.4,
STRYKER 2030-6535-1-REV SCREW,C1713,HCPCS,,79001967,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
STRYKER 2102-2102 BONE GRAFT,C1713,HCPCS,,79001970,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
ZIMMER 2102-2105 BONE GRAFT,C1713,HCPCS,,79001971,CDM,278,RC,,,both,,,7722,3047.63,39.4668,,3047.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2702.7,35,,2702.7,percent of total billed charges,Implant Device,2625.48,34,"Charges > $500, x 34%",2625.48,percent of total billed charges,Implant Device,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,3088.8,40,,3088.8,percent of total billed charges,Implant Devices,2702.7,70,,2702.7,percent of total billed charges,Implant Devices,2625.48,34,,2625.48,percent of total billed charges,Implant Devices,2625.48,34,,2625.48,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2625.48,34,"If Charge > 2,000, then 34 percent",2625.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3088.8,
PAC 3 21-11-3114 SPINAL PLATE,C1713,HCPCS,,79001973,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
PAC 3 21-LT-3112 MODULAR NECK,C1713,HCPCS,,79001974,CDM,278,RC,,,both,,,15000,5920.02,39.4668,,5920.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5100,34,,5100,percent of total billed charges,Implant Device,5100,34,,5100,percent of total billed charges,Implant Device,5100,34,,5100,percent of total billed charges,Implant Device,5100,34,,5100,percent of total billed charges,Implant Device,5100,34,,5100,percent of total billed charges,Implant Device,5100,34,,5100,percent of total billed charges,Implant Device,5250,35,,5250,percent of total billed charges,Implant Device,5100,34,"Charges > $500, x 34%",5100,percent of total billed charges,Implant Device,5250,35,,5250,percent of total billed charges,Implant Devices,5250,35,,5250,percent of total billed charges,Implant Devices,5250,35,,,percent of total billed charges,Implant Devices,5250,35,,5250,percent of total billed charges,Implant Devices,5250,35,,5250,percent of total billed charges,Implant Devices,6000,40,,6000,percent of total billed charges,Implant Devices,5250,70,,5250,percent of total billed charges,Implant Devices,5100,34,,5100,percent of total billed charges,Implant Devices,5100,34,,5100,percent of total billed charges,Implant Devices,5250,35,,5250,percent of total billed charges,Implant Devices,5250,35,,5250,percent of total billed charges,Implant Devices,5250,35,,5250,percent of total billed charges,Implant Devices,5250,35,,5250,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5100,34,"If Charge > 2,000, then 34 percent",5100,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6000,
ZIMMER 2232-02-05-REV GTR PLATE,C1713,HCPCS,,79001975,CDM,278,RC,,,both,,,7720,3046.84,39.4668,,3046.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2624.8,34,,2624.8,percent of total billed charges,Implant Device,2624.8,34,,2624.8,percent of total billed charges,Implant Device,2624.8,34,,2624.8,percent of total billed charges,Implant Device,2624.8,34,,2624.8,percent of total billed charges,Implant Device,2624.8,34,,2624.8,percent of total billed charges,Implant Device,2624.8,34,,2624.8,percent of total billed charges,Implant Device,2702,35,,2702,percent of total billed charges,Implant Device,2624.8,34,"Charges > $500, x 34%",2624.8,percent of total billed charges,Implant Device,2702,35,,2702,percent of total billed charges,Implant Devices,2702,35,,2702,percent of total billed charges,Implant Devices,2702,35,,,percent of total billed charges,Implant Devices,2702,35,,2702,percent of total billed charges,Implant Devices,2702,35,,2702,percent of total billed charges,Implant Devices,3088,40,,3088,percent of total billed charges,Implant Devices,2702,70,,2702,percent of total billed charges,Implant Devices,2624.8,34,,2624.8,percent of total billed charges,Implant Devices,2624.8,34,,2624.8,percent of total billed charges,Implant Devices,2702,35,,2702,percent of total billed charges,Implant Devices,2702,35,,2702,percent of total billed charges,Implant Devices,2702,35,,2702,percent of total billed charges,Implant Devices,2702,35,,2702,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2624.8,34,"If Charge > 2,000, then 34 percent",2624.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3088,
ZIMMER 2232-02-06-REV GTR PLATE,C1713,HCPCS,,79001976,CDM,278,RC,,,both,,,10568,4170.85,39.4668,,4170.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3593.12,34,,3593.12,percent of total billed charges,Implant Device,3593.12,34,,3593.12,percent of total billed charges,Implant Device,3593.12,34,,3593.12,percent of total billed charges,Implant Device,3593.12,34,,3593.12,percent of total billed charges,Implant Device,3593.12,34,,3593.12,percent of total billed charges,Implant Device,3593.12,34,,3593.12,percent of total billed charges,Implant Device,3698.8,35,,3698.8,percent of total billed charges,Implant Device,3593.12,34,"Charges > $500, x 34%",3593.12,percent of total billed charges,Implant Device,3698.8,35,,3698.8,percent of total billed charges,Implant Devices,3698.8,35,,3698.8,percent of total billed charges,Implant Devices,3698.8,35,,,percent of total billed charges,Implant Devices,3698.8,35,,3698.8,percent of total billed charges,Implant Devices,3698.8,35,,3698.8,percent of total billed charges,Implant Devices,4227.2,40,,4227.2,percent of total billed charges,Implant Devices,3698.8,70,,3698.8,percent of total billed charges,Implant Devices,3593.12,34,,3593.12,percent of total billed charges,Implant Devices,3593.12,34,,3593.12,percent of total billed charges,Implant Devices,3698.8,35,,3698.8,percent of total billed charges,Implant Devices,3698.8,35,,3698.8,percent of total billed charges,Implant Devices,3698.8,35,,3698.8,percent of total billed charges,Implant Devices,3698.8,35,,3698.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3593.12,34,"If Charge > 2,000, then 34 percent",3593.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4227.2,
ZIMMER 2347-17-04 PLATE,C1713,HCPCS,,79001980,CDM,278,RC,,,both,,,1260,497.28,39.4668,,497.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,428.4,34,,428.4,percent of total billed charges,Implant Device,428.4,34,,428.4,percent of total billed charges,Implant Device,428.4,34,,428.4,percent of total billed charges,Implant Device,428.4,34,,428.4,percent of total billed charges,Implant Device,428.4,34,,428.4,percent of total billed charges,Implant Device,428.4,34,,428.4,percent of total billed charges,Implant Device,441,35,,441,percent of total billed charges,Implant Device,428.4,34,"Charges > $500, x 34%",428.4,percent of total billed charges,Implant Device,441,35,,441,percent of total billed charges,Implant Devices,441,35,,441,percent of total billed charges,Implant Devices,441,35,,,percent of total billed charges,Implant Devices,441,35,,441,percent of total billed charges,Implant Devices,441,35,,441,percent of total billed charges,Implant Devices,504,40,,504,percent of total billed charges,Implant Devices,441,70,,441,percent of total billed charges,Implant Devices,428.4,34,,428.4,percent of total billed charges,Implant Devices,428.4,34,,428.4,percent of total billed charges,Implant Devices,441,35,,441,percent of total billed charges,Implant Devices,441,35,,441,percent of total billed charges,Implant Devices,441,35,,441,percent of total billed charges,Implant Devices,441,35,,441,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,504,
ZIMMER 2357-101-14 PLATE,C1713,HCPCS,,79001981,CDM,278,RC,,,both,,,4872,1922.82,39.4668,,1922.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1705.2,35,,1705.2,percent of total billed charges,Implant Device,1656.48,34,"Charges > $500, x 34%",1656.48,percent of total billed charges,Implant Device,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1948.8,40,,1948.8,percent of total billed charges,Implant Devices,1705.2,70,,1705.2,percent of total billed charges,Implant Devices,1656.48,34,,1656.48,percent of total billed charges,Implant Devices,1656.48,34,,1656.48,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1656.48,34,"If Charge > 2,000, then 34 percent",1656.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1948.8,
EXACTECH 300-10-15 PLATE,C1713,HCPCS,,79001993,CDM,278,RC,,,both,,,1890,745.92,39.4668,,745.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,661.5,35,,661.5,percent of total billed charges,Implant Device,642.6,34,"Charges > $500, x 34%",642.6,percent of total billed charges,Implant Device,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,756,40,,756,percent of total billed charges,Implant Devices,661.5,70,,661.5,percent of total billed charges,Implant Devices,642.6,34,,642.6,percent of total billed charges,Implant Devices,642.6,34,,642.6,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,756,
ACUMED 30-0236 SCREW,C1713,HCPCS,,79001995,CDM,278,RC,,,both,,,507,200.1,39.4668,,200.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,172.38,34,,172.38,percent of total billed charges,Implant Device,172.38,34,,172.38,percent of total billed charges,Implant Device,172.38,34,,172.38,percent of total billed charges,Implant Device,172.38,34,,172.38,percent of total billed charges,Implant Device,172.38,34,,172.38,percent of total billed charges,Implant Device,172.38,34,,172.38,percent of total billed charges,Implant Device,177.45,35,,177.45,percent of total billed charges,Implant Device,172.38,34,"Charges > $500, x 34%",172.38,percent of total billed charges,Implant Device,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,202.8,40,,202.8,percent of total billed charges,Implant Devices,177.45,70,,177.45,percent of total billed charges,Implant Devices,172.38,34,,172.38,percent of total billed charges,Implant Devices,172.38,34,,172.38,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,202.8,
ACUMED 30-0238 SCREW,C1713,HCPCS,,79001996,CDM,278,RC,,,both,,,424,167.34,39.4668,,167.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,148.4,35,,148.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,169.6,40,,169.6,percent of total billed charges,Implant Devices,148.4,70,,148.4,percent of total billed charges,Implant Devices,144.16,34,,144.16,percent of total billed charges,Implant Devices,144.16,34,,144.16,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,169.6,
ACUMED 30-0248 SCREW 3.5X40,C1713,HCPCS,,79001997,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
ACUMED 30-0249 SCREW,C1713,HCPCS,,79001998,CDM,278,RC,,,both,,,424,167.34,39.4668,,167.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,148.4,35,,148.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,169.6,40,,169.6,percent of total billed charges,Implant Devices,148.4,70,,148.4,percent of total billed charges,Implant Devices,144.16,34,,144.16,percent of total billed charges,Implant Devices,144.16,34,,144.16,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,169.6,
ACUMED 30-0259 SCREW,C1713,HCPCS,,79001999,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
ACUMED 30-0260 SCREW,C1713,HCPCS,,79002000,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
ACUMED 30-0265 SCREW,C1713,HCPCS,,79002001,CDM,278,RC,,,both,,,274,108.14,39.4668,,108.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,95.9,35,,95.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,109.6,40,,109.6,percent of total billed charges,Implant Devices,95.9,70,,95.9,percent of total billed charges,Implant Devices,93.16,34,,93.16,percent of total billed charges,Implant Devices,93.16,34,,93.16,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.6,
ACUMED 30-0326 SCREW,C1713,HCPCS,,79002002,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
ACUMED 30-0327 SCREW,C1713,HCPCS,,79002003,CDM,278,RC,,,both,,,424,167.34,39.4668,,167.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,148.4,35,,148.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,169.6,40,,169.6,percent of total billed charges,Implant Devices,148.4,70,,148.4,percent of total billed charges,Implant Devices,144.16,34,,144.16,percent of total billed charges,Implant Devices,144.16,34,,144.16,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,169.6,
ACUMED 30-0328 SCREW,C1713,HCPCS,,79002004,CDM,278,RC,,,both,,,510,201.28,39.4668,,201.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Device,173.4,34,"Charges > $500, x 34%",173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,204,40,,204,percent of total billed charges,Implant Devices,178.5,70,,178.5,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204,
ACUMED 30-0348 SCREW 2.7X18,C1713,HCPCS,,79002005,CDM,278,RC,,,both,,,262,103.4,39.4668,,103.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,91.7,35,,91.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,104.8,40,,104.8,percent of total billed charges,Implant Devices,91.7,70,,91.7,percent of total billed charges,Implant Devices,89.08,34,,89.08,percent of total billed charges,Implant Devices,89.08,34,,89.08,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,104.8,
EXACTECH 304-22-09 HUMERAL STEM,C1713,HCPCS,,79002007,CDM,278,RC,,,both,,,6225,2456.81,39.4668,,2456.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Device,2116.5,34,"Charges > $500, x 34%",2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2490,40,,2490,percent of total billed charges,Implant Devices,2178.75,70,,2178.75,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2116.5,34,"If Charge > 2,000, then 34 percent",2116.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2490,
STRYKER 3125-0170S NAIL KIT,C1713,HCPCS,,79002012,CDM,278,RC,,,both,,,2928,1155.59,39.4668,,1155.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,1024.8,35,,1024.8,percent of total billed charges,Implant Device,995.52,34,"Charges > $500, x 34%",995.52,percent of total billed charges,Implant Device,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1171.2,40,,1171.2,percent of total billed charges,Implant Devices,1024.8,70,,1024.8,percent of total billed charges,Implant Devices,995.52,34,,995.52,percent of total billed charges,Implant Devices,995.52,34,,995.52,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,995.52,34,"If Charge > 2,000, then 34 percent",995.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1171.2,
ZIMMER 3704-0-510-REV CABLE SLEEVE,C1713,HCPCS,,79002028,CDM,278,RC,,,both,,,1536,606.21,39.4668,,606.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Device,522.24,34,"Charges > $500, x 34%",522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,614.4,40,,614.4,percent of total billed charges,Implant Devices,537.6,70,,537.6,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,614.4,
STRYKER 40-20116E SCREW,C1713,HCPCS,,79002034,CDM,278,RC,,,both,,,859,339.02,39.4668,,339.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,300.65,35,,300.65,percent of total billed charges,Implant Device,292.06,34,"Charges > $500, x 34%",292.06,percent of total billed charges,Implant Device,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,343.6,40,,343.6,percent of total billed charges,Implant Devices,300.65,70,,300.65,percent of total billed charges,Implant Devices,292.06,34,,292.06,percent of total billed charges,Implant Devices,292.06,34,,292.06,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.6,
STRYKER 40-30114 MICRO CANN SCREW 3X14MM,C1713,HCPCS,,79002036,CDM,278,RC,,,both,,,859,339.02,39.4668,,339.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,300.65,35,,300.65,percent of total billed charges,Implant Device,292.06,34,"Charges > $500, x 34%",292.06,percent of total billed charges,Implant Device,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,343.6,40,,343.6,percent of total billed charges,Implant Devices,300.65,70,,300.65,percent of total billed charges,Implant Devices,292.06,34,,292.06,percent of total billed charges,Implant Devices,292.06,34,,292.06,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.6,
STRYKER 40-30120 SCREW,C1713,HCPCS,,79002038,CDM,278,RC,,,both,,,964,380.46,39.4668,,380.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Device,327.76,34,"Charges > $500, x 34%",327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,385.6,40,,385.6,percent of total billed charges,Implant Devices,337.4,70,,337.4,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,385.6,
STRYKER 40-30130 SCREW,C1713,HCPCS,,79002039,CDM,278,RC,,,both,,,859,339.02,39.4668,,339.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,300.65,35,,300.65,percent of total billed charges,Implant Device,292.06,34,"Charges > $500, x 34%",292.06,percent of total billed charges,Implant Device,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,343.6,40,,343.6,percent of total billed charges,Implant Devices,300.65,70,,300.65,percent of total billed charges,Implant Devices,292.06,34,,292.06,percent of total billed charges,Implant Devices,292.06,34,,292.06,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.6,
STRYKER 40-30134E SCREW,C1713,HCPCS,,79002040,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER 40-30136 SCREW 3X36X7MM,C1713,HCPCS,,79002041,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
STRYKER 40-30215 SCREW,C1713,HCPCS,,79002042,CDM,278,RC,,,both,,,566,223.38,39.4668,,223.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,198.1,35,,198.1,percent of total billed charges,Implant Device,192.44,34,"Charges > $500, x 34%",192.44,percent of total billed charges,Implant Device,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,226.4,40,,226.4,percent of total billed charges,Implant Devices,198.1,70,,198.1,percent of total billed charges,Implant Devices,192.44,34,,192.44,percent of total billed charges,Implant Devices,192.44,34,,192.44,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,226.4,
STRYKER 40-35024 SCREW 3.5X24MM,C1713,HCPCS,,79002043,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
STRYKER 40-35028 SCREW,C1713,HCPCS,,79002044,CDM,278,RC,,,both,,,163,64.33,39.4668,,64.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,57.05,35,,57.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,65.2,40,,65.2,percent of total billed charges,Implant Devices,57.05,70,,57.05,percent of total billed charges,Implant Devices,55.42,34,,55.42,percent of total billed charges,Implant Devices,55.42,34,,55.42,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,65.2,
STRYKER 40-35618 SCREW,C1713,HCPCS,,79002045,CDM,278,RC,,,both,,,379,149.58,39.4668,,149.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,132.65,35,,132.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,151.6,40,,151.6,percent of total billed charges,Implant Devices,132.65,70,,132.65,percent of total billed charges,Implant Devices,128.86,34,,128.86,percent of total billed charges,Implant Devices,128.86,34,,128.86,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,151.6,
STRYKER 40-35624 SCREW,C1713,HCPCS,,79002046,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 40-35628 SCREW,C1713,HCPCS,,79002047,CDM,278,RC,,,both,,,809,319.29,39.4668,,319.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.06,34,,275.06,percent of total billed charges,Implant Device,275.06,34,,275.06,percent of total billed charges,Implant Device,275.06,34,,275.06,percent of total billed charges,Implant Device,275.06,34,,275.06,percent of total billed charges,Implant Device,275.06,34,,275.06,percent of total billed charges,Implant Device,275.06,34,,275.06,percent of total billed charges,Implant Device,283.15,35,,283.15,percent of total billed charges,Implant Device,275.06,34,"Charges > $500, x 34%",275.06,percent of total billed charges,Implant Device,283.15,35,,283.15,percent of total billed charges,Implant Devices,283.15,35,,283.15,percent of total billed charges,Implant Devices,283.15,35,,,percent of total billed charges,Implant Devices,283.15,35,,283.15,percent of total billed charges,Implant Devices,283.15,35,,283.15,percent of total billed charges,Implant Devices,323.6,40,,323.6,percent of total billed charges,Implant Devices,283.15,70,,283.15,percent of total billed charges,Implant Devices,275.06,34,,275.06,percent of total billed charges,Implant Devices,275.06,34,,275.06,percent of total billed charges,Implant Devices,283.15,35,,283.15,percent of total billed charges,Implant Devices,283.15,35,,283.15,percent of total billed charges,Implant Devices,283.15,35,,283.15,percent of total billed charges,Implant Devices,283.15,35,,283.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,323.6,
STRYKER 40-35630 SCREW,C1713,HCPCS,,79002048,CDM,278,RC,,,both,,,732,288.9,39.4668,,288.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Device,248.88,34,"Charges > $500, x 34%",248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,292.8,40,,292.8,percent of total billed charges,Implant Devices,256.2,70,,256.2,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,292.8,
WRIGHT MEDICAL 426-0020 TOE IMPLANT,C1713,HCPCS,,79002050,CDM,278,RC,,,both,,,3510,1385.28,39.4668,,1385.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1193.4,34,,1193.4,percent of total billed charges,Implant Device,1193.4,34,,1193.4,percent of total billed charges,Implant Device,1193.4,34,,1193.4,percent of total billed charges,Implant Device,1193.4,34,,1193.4,percent of total billed charges,Implant Device,1193.4,34,,1193.4,percent of total billed charges,Implant Device,1193.4,34,,1193.4,percent of total billed charges,Implant Device,1228.5,35,,1228.5,percent of total billed charges,Implant Device,1193.4,34,"Charges > $500, x 34%",1193.4,percent of total billed charges,Implant Device,1228.5,35,,1228.5,percent of total billed charges,Implant Devices,1228.5,35,,1228.5,percent of total billed charges,Implant Devices,1228.5,35,,,percent of total billed charges,Implant Devices,1228.5,35,,1228.5,percent of total billed charges,Implant Devices,1228.5,35,,1228.5,percent of total billed charges,Implant Devices,1404,40,,1404,percent of total billed charges,Implant Devices,1228.5,70,,1228.5,percent of total billed charges,Implant Devices,1193.4,34,,1193.4,percent of total billed charges,Implant Devices,1193.4,34,,1193.4,percent of total billed charges,Implant Devices,1228.5,35,,1228.5,percent of total billed charges,Implant Devices,1228.5,35,,1228.5,percent of total billed charges,Implant Devices,1228.5,35,,1228.5,percent of total billed charges,Implant Devices,1228.5,35,,1228.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1193.4,34,"If Charge > 2,000, then 34 percent",1193.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1404,
BIOMET 45-3009 BONE GRAFT,C1713,HCPCS,,79002054,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
BIOMET 45-5556 ALLOGRAFT,C1713,HCPCS,,79002055,CDM,278,RC,,,both,,,4594,1813.1,39.4668,,1813.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1607.9,35,,1607.9,percent of total billed charges,Implant Device,1561.96,34,"Charges > $500, x 34%",1561.96,percent of total billed charges,Implant Device,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1837.6,40,,1837.6,percent of total billed charges,Implant Devices,1607.9,70,,1607.9,percent of total billed charges,Implant Devices,1561.96,34,,1561.96,percent of total billed charges,Implant Devices,1561.96,34,,1561.96,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1561.96,34,"If Charge > 2,000, then 34 percent",1561.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1837.6,
BIOMET 45-5557 ALLOGRAFT,C1713,HCPCS,,79002056,CDM,278,RC,,,both,,,4594,1813.1,39.4668,,1813.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1607.9,35,,1607.9,percent of total billed charges,Implant Device,1561.96,34,"Charges > $500, x 34%",1561.96,percent of total billed charges,Implant Device,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1837.6,40,,1837.6,percent of total billed charges,Implant Devices,1607.9,70,,1607.9,percent of total billed charges,Implant Devices,1561.96,34,,1561.96,percent of total billed charges,Implant Devices,1561.96,34,,1561.96,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1561.96,34,"If Charge > 2,000, then 34 percent",1561.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1837.6,
BIOMET 45-5558 ALLOGRAFT,C1713,HCPCS,,79002057,CDM,278,RC,,,both,,,4594,1813.1,39.4668,,1813.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1561.96,34,,1561.96,percent of total billed charges,Implant Device,1607.9,35,,1607.9,percent of total billed charges,Implant Device,1561.96,34,"Charges > $500, x 34%",1561.96,percent of total billed charges,Implant Device,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1837.6,40,,1837.6,percent of total billed charges,Implant Devices,1607.9,70,,1607.9,percent of total billed charges,Implant Devices,1561.96,34,,1561.96,percent of total billed charges,Implant Devices,1561.96,34,,1561.96,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,1607.9,35,,1607.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1561.96,34,"If Charge > 2,000, then 34 percent",1561.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1837.6,
ZIMMER 47-2484-027-50 SCREW,C1713,HCPCS,,79002060,CDM,278,RC,,,both,,,667,263.24,39.4668,,263.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Device,226.78,34,"Charges > $500, x 34%",226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,266.8,40,,266.8,percent of total billed charges,Implant Devices,233.45,70,,233.45,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.8,
ZIMMER 47-2484-032-50 SCREW,C1713,HCPCS,,79002061,CDM,278,RC,,,both,,,665,262.45,39.4668,,262.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,232.75,35,,232.75,percent of total billed charges,Implant Device,226.1,34,"Charges > $500, x 34%",226.1,percent of total billed charges,Implant Device,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,266,40,,266,percent of total billed charges,Implant Devices,232.75,70,,232.75,percent of total billed charges,Implant Devices,226.1,34,,226.1,percent of total billed charges,Implant Devices,226.1,34,,226.1,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266,
ZIMMER 47-2484-042-50 SCREW,C1713,HCPCS,,79002062,CDM,278,RC,,,both,,,665,262.45,39.4668,,262.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,232.75,35,,232.75,percent of total billed charges,Implant Device,226.1,34,"Charges > $500, x 34%",226.1,percent of total billed charges,Implant Device,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,266,40,,266,percent of total billed charges,Implant Devices,232.75,70,,232.75,percent of total billed charges,Implant Devices,226.1,34,,226.1,percent of total billed charges,Implant Devices,226.1,34,,226.1,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266,
ZIMMER 47-2485-080-10 SCREW,C1713,HCPCS,,79002063,CDM,278,RC,,,both,,,1990,785.39,39.4668,,785.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,676.6,34,,676.6,percent of total billed charges,Implant Device,676.6,34,,676.6,percent of total billed charges,Implant Device,676.6,34,,676.6,percent of total billed charges,Implant Device,676.6,34,,676.6,percent of total billed charges,Implant Device,676.6,34,,676.6,percent of total billed charges,Implant Device,676.6,34,,676.6,percent of total billed charges,Implant Device,696.5,35,,696.5,percent of total billed charges,Implant Device,676.6,34,"Charges > $500, x 34%",676.6,percent of total billed charges,Implant Device,696.5,35,,696.5,percent of total billed charges,Implant Devices,696.5,35,,696.5,percent of total billed charges,Implant Devices,696.5,35,,,percent of total billed charges,Implant Devices,696.5,35,,696.5,percent of total billed charges,Implant Devices,696.5,35,,696.5,percent of total billed charges,Implant Devices,796,40,,796,percent of total billed charges,Implant Devices,696.5,70,,696.5,percent of total billed charges,Implant Devices,676.6,34,,676.6,percent of total billed charges,Implant Devices,676.6,34,,676.6,percent of total billed charges,Implant Devices,696.5,35,,696.5,percent of total billed charges,Implant Devices,696.5,35,,696.5,percent of total billed charges,Implant Devices,696.5,35,,696.5,percent of total billed charges,Implant Devices,696.5,35,,696.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,796,
ZIMMER 47-2485-095-10 SCREW 10.5X95MM,C1713,HCPCS,,79002064,CDM,278,RC,,,both,,,1685,665.02,39.4668,,665.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,572.9,34,,572.9,percent of total billed charges,Implant Device,572.9,34,,572.9,percent of total billed charges,Implant Device,572.9,34,,572.9,percent of total billed charges,Implant Device,572.9,34,,572.9,percent of total billed charges,Implant Device,572.9,34,,572.9,percent of total billed charges,Implant Device,572.9,34,,572.9,percent of total billed charges,Implant Device,589.75,35,,589.75,percent of total billed charges,Implant Device,572.9,34,"Charges > $500, x 34%",572.9,percent of total billed charges,Implant Device,589.75,35,,589.75,percent of total billed charges,Implant Devices,589.75,35,,589.75,percent of total billed charges,Implant Devices,589.75,35,,,percent of total billed charges,Implant Devices,589.75,35,,589.75,percent of total billed charges,Implant Devices,589.75,35,,589.75,percent of total billed charges,Implant Devices,674,40,,674,percent of total billed charges,Implant Devices,589.75,70,,589.75,percent of total billed charges,Implant Devices,572.9,34,,572.9,percent of total billed charges,Implant Devices,572.9,34,,572.9,percent of total billed charges,Implant Devices,589.75,35,,589.75,percent of total billed charges,Implant Devices,589.75,35,,589.75,percent of total billed charges,Implant Devices,589.75,35,,589.75,percent of total billed charges,Implant Devices,589.75,35,,589.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,674,
ZIMMER 47-2485-100-10 SCREW,C1713,HCPCS,,79002065,CDM,278,RC,,,both,,,1872,738.82,39.4668,,738.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,636.48,34,,636.48,percent of total billed charges,Implant Device,636.48,34,,636.48,percent of total billed charges,Implant Device,636.48,34,,636.48,percent of total billed charges,Implant Device,636.48,34,,636.48,percent of total billed charges,Implant Device,636.48,34,,636.48,percent of total billed charges,Implant Device,636.48,34,,636.48,percent of total billed charges,Implant Device,655.2,35,,655.2,percent of total billed charges,Implant Device,636.48,34,"Charges > $500, x 34%",636.48,percent of total billed charges,Implant Device,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,748.8,40,,748.8,percent of total billed charges,Implant Devices,655.2,70,,655.2,percent of total billed charges,Implant Devices,636.48,34,,636.48,percent of total billed charges,Implant Devices,636.48,34,,636.48,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,748.8,
ZIMMER 47-2485-105-10 SCREW,C1713,HCPCS,,79002066,CDM,278,RC,,,both,,,1872,738.82,39.4668,,738.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,636.48,34,,636.48,percent of total billed charges,Implant Device,636.48,34,,636.48,percent of total billed charges,Implant Device,636.48,34,,636.48,percent of total billed charges,Implant Device,636.48,34,,636.48,percent of total billed charges,Implant Device,636.48,34,,636.48,percent of total billed charges,Implant Device,636.48,34,,636.48,percent of total billed charges,Implant Device,655.2,35,,655.2,percent of total billed charges,Implant Device,636.48,34,"Charges > $500, x 34%",636.48,percent of total billed charges,Implant Device,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,748.8,40,,748.8,percent of total billed charges,Implant Devices,655.2,70,,655.2,percent of total billed charges,Implant Devices,636.48,34,,636.48,percent of total billed charges,Implant Devices,636.48,34,,636.48,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,655.2,35,,655.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,748.8,
ZIMMER 47-2485-110-10 NAIL SYSTEM,C1713,HCPCS,,79002067,CDM,278,RC,,,both,,,1873,739.21,39.4668,,739.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,655.55,35,,655.55,percent of total billed charges,Implant Device,636.82,34,"Charges > $500, x 34%",636.82,percent of total billed charges,Implant Device,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,749.2,40,,749.2,percent of total billed charges,Implant Devices,655.55,70,,655.55,percent of total billed charges,Implant Devices,636.82,34,,636.82,percent of total billed charges,Implant Devices,636.82,34,,636.82,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,749.2,
ZIMMER 47-2493-000-00 NAIL SYSTEM,C1713,HCPCS,,79002068,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
ZIMMER 47-2493-210-10 NAIL SYSTEM,C1713,HCPCS,,79002069,CDM,278,RC,,,both,,,5160,2036.49,39.4668,,2036.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1806,35,,1806,percent of total billed charges,Implant Device,1754.4,34,"Charges > $500, x 34%",1754.4,percent of total billed charges,Implant Device,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,2064,40,,2064,percent of total billed charges,Implant Devices,1806,70,,1806,percent of total billed charges,Implant Devices,1754.4,34,,1754.4,percent of total billed charges,Implant Devices,1754.4,34,,1754.4,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1754.4,34,"If Charge > 2,000, then 34 percent",1754.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2064,
ZIMMER 47-2493-210-11 NAIL SYSTEM,C1713,HCPCS,,79002070,CDM,278,RC,,,both,,,4644,1832.84,39.4668,,1832.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1625.4,35,,1625.4,percent of total billed charges,Implant Device,1578.96,34,"Charges > $500, x 34%",1578.96,percent of total billed charges,Implant Device,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1857.6,40,,1857.6,percent of total billed charges,Implant Devices,1625.4,70,,1625.4,percent of total billed charges,Implant Devices,1578.96,34,,1578.96,percent of total billed charges,Implant Devices,1578.96,34,,1578.96,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1578.96,34,"If Charge > 2,000, then 34 percent",1578.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1857.6,
ZIMMER 47-2493-211-13 NAIL CPM 13X21.5,C1713,HCPCS,,79002071,CDM,278,RC,,,both,,,5170,2040.43,39.4668,,2040.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1809.5,35,,1809.5,percent of total billed charges,Implant Device,1757.8,34,"Charges > $500, x 34%",1757.8,percent of total billed charges,Implant Device,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,2068,40,,2068,percent of total billed charges,Implant Devices,1809.5,70,,1809.5,percent of total billed charges,Implant Devices,1757.8,34,,1757.8,percent of total billed charges,Implant Devices,1757.8,34,,1757.8,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1757.8,34,"If Charge > 2,000, then 34 percent",1757.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2068,
ZIMMER 47-2493-212-11 NAIL CPM,C1713,HCPCS,,79002072,CDM,278,RC,,,both,,,5106,2015.17,39.4668,,2015.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1736.04,34,,1736.04,percent of total billed charges,Implant Device,1736.04,34,,1736.04,percent of total billed charges,Implant Device,1736.04,34,,1736.04,percent of total billed charges,Implant Device,1736.04,34,,1736.04,percent of total billed charges,Implant Device,1736.04,34,,1736.04,percent of total billed charges,Implant Device,1736.04,34,,1736.04,percent of total billed charges,Implant Device,1787.1,35,,1787.1,percent of total billed charges,Implant Device,1736.04,34,"Charges > $500, x 34%",1736.04,percent of total billed charges,Implant Device,1787.1,35,,1787.1,percent of total billed charges,Implant Devices,1787.1,35,,1787.1,percent of total billed charges,Implant Devices,1787.1,35,,,percent of total billed charges,Implant Devices,1787.1,35,,1787.1,percent of total billed charges,Implant Devices,1787.1,35,,1787.1,percent of total billed charges,Implant Devices,2042.4,40,,2042.4,percent of total billed charges,Implant Devices,1787.1,70,,1787.1,percent of total billed charges,Implant Devices,1736.04,34,,1736.04,percent of total billed charges,Implant Devices,1736.04,34,,1736.04,percent of total billed charges,Implant Devices,1787.1,35,,1787.1,percent of total billed charges,Implant Devices,1787.1,35,,1787.1,percent of total billed charges,Implant Devices,1787.1,35,,1787.1,percent of total billed charges,Implant Devices,1787.1,35,,1787.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1736.04,34,"If Charge > 2,000, then 34 percent",1736.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2042.4,
ZIMMER 47-2493-213-11 NAIL CPM,C1713,HCPCS,,79002073,CDM,278,RC,,,both,,,5170,2040.43,39.4668,,2040.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1809.5,35,,1809.5,percent of total billed charges,Implant Device,1757.8,34,"Charges > $500, x 34%",1757.8,percent of total billed charges,Implant Device,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,2068,40,,2068,percent of total billed charges,Implant Devices,1809.5,70,,1809.5,percent of total billed charges,Implant Devices,1757.8,34,,1757.8,percent of total billed charges,Implant Devices,1757.8,34,,1757.8,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1757.8,34,"If Charge > 2,000, then 34 percent",1757.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2068,
ZIMMER 4811-110-40 SCREW,C1713,HCPCS,,79002079,CDM,278,RC,,,both,,,378,149.18,39.4668,,149.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,132.3,35,,132.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,151.2,40,,151.2,percent of total billed charges,Implant Devices,132.3,70,,132.3,percent of total billed charges,Implant Devices,128.52,34,,128.52,percent of total billed charges,Implant Devices,128.52,34,,128.52,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,151.2,
ZIMMER 4828-012-02 SCREW,C1713,HCPCS,,79002080,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ZIMMER 4828-014-02 SCREW,C1713,HCPCS,,79002081,CDM,278,RC,,,both,,,335,132.21,39.4668,,132.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,134,40,,134,percent of total billed charges,Implant Devices,117.25,70,,117.25,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134,
ZIMMER 4828-016-02 SCREW,C1713,HCPCS,,79002082,CDM,278,RC,,,both,,,335,132.21,39.4668,,132.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,134,40,,134,percent of total billed charges,Implant Devices,117.25,70,,117.25,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134,
ZIMMER 4828-018-02 SCREW,C1713,HCPCS,,79002083,CDM,278,RC,,,both,,,335,132.21,39.4668,,132.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,134,40,,134,percent of total billed charges,Implant Devices,117.25,70,,117.25,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134,
ZIMMER 4828-020-02 SCREW,C1713,HCPCS,,79002084,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ZIMMER 4835-014-01 SCREW,C1713,HCPCS,,79002085,CDM,278,RC,,,both,,,601,237.2,39.4668,,237.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,210.35,35,,210.35,percent of total billed charges,Implant Device,204.34,34,"Charges > $500, x 34%",204.34,percent of total billed charges,Implant Device,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,240.4,40,,240.4,percent of total billed charges,Implant Devices,210.35,70,,210.35,percent of total billed charges,Implant Devices,204.34,34,,204.34,percent of total billed charges,Implant Devices,204.34,34,,204.34,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240.4,
ZIMMER 4840-022-00 SCREW,C1713,HCPCS,,79002086,CDM,278,RC,,,both,,,84,33.15,39.4668,,33.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,33.6,40,,33.6,percent of total billed charges,Implant Devices,29.4,70,,29.4,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.6,
ZIMMER 4840-030-01 SCREW,C1713,HCPCS,,79002087,CDM,278,RC,,,both,,,84,33.15,39.4668,,33.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,33.6,40,,33.6,percent of total billed charges,Implant Devices,29.4,70,,29.4,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.6,
ZIMMER 4840-045-00 SCREW,C1713,HCPCS,,79002088,CDM,278,RC,,,both,,,84,33.15,39.4668,,33.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,33.6,40,,33.6,percent of total billed charges,Implant Devices,29.4,70,,29.4,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.6,
ZIMMER 4936-006-03 PLATE,C1713,HCPCS,,79002090,CDM,278,RC,,,both,,,466,183.92,39.4668,,183.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,163.1,35,,163.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,186.4,40,,186.4,percent of total billed charges,Implant Devices,163.1,70,,163.1,percent of total billed charges,Implant Devices,158.44,34,,158.44,percent of total billed charges,Implant Devices,158.44,34,,158.44,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,186.4,
STRYKER 53-17008E SCREW,C1713,HCPCS,,79002099,CDM,278,RC,,,both,,,241,95.11,39.4668,,95.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,84.35,35,,84.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,96.4,40,,96.4,percent of total billed charges,Implant Devices,84.35,70,,84.35,percent of total billed charges,Implant Devices,81.94,34,,81.94,percent of total billed charges,Implant Devices,81.94,34,,81.94,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96.4,
STRYKER 53-17011E SCREW,C1713,HCPCS,,79002100,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
STRYKER 53-17013E SCREW,C1713,HCPCS,,79002101,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
STRYKER 53-23614E SCREW 2.3X14MM,C1713,HCPCS,,79002102,CDM,278,RC,,,both,,,492,194.18,39.4668,,194.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,196.8,40,,196.8,percent of total billed charges,Implant Devices,172.2,70,,172.2,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196.8,
STRYKER 53-23618E SCREW,C1713,HCPCS,,79002103,CDM,278,RC,,,both,,,398,157.08,39.4668,,157.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,135.32,34,,135.32,percent of total billed charges,Implant Device,135.32,34,,135.32,percent of total billed charges,Implant Device,135.32,34,,135.32,percent of total billed charges,Implant Device,135.32,34,,135.32,percent of total billed charges,Implant Device,135.32,34,,135.32,percent of total billed charges,Implant Device,135.32,34,,135.32,percent of total billed charges,Implant Device,139.3,35,,139.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,159.2,40,,159.2,percent of total billed charges,Implant Devices,139.3,70,,139.3,percent of total billed charges,Implant Devices,135.32,34,,135.32,percent of total billed charges,Implant Devices,135.32,34,,135.32,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,139.3,35,,139.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,159.2,
STRYKER 53-27612E SCREW,C1713,HCPCS,,79002104,CDM,278,RC,,,both,,,492,194.18,39.4668,,194.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,196.8,40,,196.8,percent of total billed charges,Implant Devices,172.2,70,,172.2,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196.8,
ZIMMER 5791-41-UNI SCREW,C1713,HCPCS,,79002106,CDM,278,RC,,,both,,,244,96.3,39.4668,,96.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,85.4,35,,85.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,97.6,40,,97.6,percent of total billed charges,Implant Devices,85.4,70,,85.4,percent of total billed charges,Implant Devices,82.96,34,,82.96,percent of total billed charges,Implant Devices,82.96,34,,82.96,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,97.6,
ZIMMER 5791-44-UNI SCREW,C1713,HCPCS,,79002107,CDM,278,RC,,,both,,,274,108.14,39.4668,,108.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,95.9,35,,95.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,109.6,40,,109.6,percent of total billed charges,Implant Devices,95.9,70,,95.9,percent of total billed charges,Implant Devices,93.16,34,,93.16,percent of total billed charges,Implant Devices,93.16,34,,93.16,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.6,
STRYKER FOOT & ANKLE 58-17007E SCREW,C1713,HCPCS,,79002108,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
STRYKER 58-17013E SCREW,C1713,HCPCS,,79002109,CDM,278,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,70,40,,70,percent of total billed charges,Implant Devices,61.25,70,,61.25,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
STRYKER FOOT & ANKLE 604628S SCREW,C1713,HCPCS,,79002170,CDM,278,RC,,,both,,,882,348.1,39.4668,,348.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299.88,34,,299.88,percent of total billed charges,Implant Device,299.88,34,,299.88,percent of total billed charges,Implant Device,299.88,34,,299.88,percent of total billed charges,Implant Device,299.88,34,,299.88,percent of total billed charges,Implant Device,299.88,34,,299.88,percent of total billed charges,Implant Device,299.88,34,,299.88,percent of total billed charges,Implant Device,308.7,35,,308.7,percent of total billed charges,Implant Device,299.88,34,"Charges > $500, x 34%",299.88,percent of total billed charges,Implant Device,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,352.8,40,,352.8,percent of total billed charges,Implant Devices,308.7,70,,308.7,percent of total billed charges,Implant Devices,299.88,34,,299.88,percent of total billed charges,Implant Devices,299.88,34,,299.88,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,352.8,
STRYKER 604632S SCREW,C1713,HCPCS,,79002171,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
ZIMMER 604634S SCREW,C1713,HCPCS,,79002172,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
STRYKER 604636S SCREW,C1713,HCPCS,,79002173,CDM,278,RC,,,both,,,882,348.1,39.4668,,348.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299.88,34,,299.88,percent of total billed charges,Implant Device,299.88,34,,299.88,percent of total billed charges,Implant Device,299.88,34,,299.88,percent of total billed charges,Implant Device,299.88,34,,299.88,percent of total billed charges,Implant Device,299.88,34,,299.88,percent of total billed charges,Implant Device,299.88,34,,299.88,percent of total billed charges,Implant Device,308.7,35,,308.7,percent of total billed charges,Implant Device,299.88,34,"Charges > $500, x 34%",299.88,percent of total billed charges,Implant Device,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,352.8,40,,352.8,percent of total billed charges,Implant Devices,308.7,70,,308.7,percent of total billed charges,Implant Devices,299.88,34,,299.88,percent of total billed charges,Implant Devices,299.88,34,,299.88,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,308.7,35,,308.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,352.8,
STRYKER 604640S SCREW,C1713,HCPCS,,79002174,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
EXACTECH 616-01-05 ALLOGRAFT PASTE,C1713,HCPCS,,79002182,CDM,278,RC,,,both,,,1618,638.57,39.4668,,638.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,550.12,34,,550.12,percent of total billed charges,Implant Device,550.12,34,,550.12,percent of total billed charges,Implant Device,550.12,34,,550.12,percent of total billed charges,Implant Device,550.12,34,,550.12,percent of total billed charges,Implant Device,550.12,34,,550.12,percent of total billed charges,Implant Device,550.12,34,,550.12,percent of total billed charges,Implant Device,566.3,35,,566.3,percent of total billed charges,Implant Device,550.12,34,"Charges > $500, x 34%",550.12,percent of total billed charges,Implant Device,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,647.2,40,,647.2,percent of total billed charges,Implant Devices,566.3,70,,566.3,percent of total billed charges,Implant Devices,550.12,34,,550.12,percent of total billed charges,Implant Devices,550.12,34,,550.12,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,647.2,
PAC 3 62055-40 SCREW,C1713,HCPCS,,79002187,CDM,278,RC,,,both,,,2694,1063.24,39.4668,,1063.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,915.96,34,,915.96,percent of total billed charges,Implant Device,915.96,34,,915.96,percent of total billed charges,Implant Device,915.96,34,,915.96,percent of total billed charges,Implant Device,915.96,34,,915.96,percent of total billed charges,Implant Device,915.96,34,,915.96,percent of total billed charges,Implant Device,915.96,34,,915.96,percent of total billed charges,Implant Device,942.9,35,,942.9,percent of total billed charges,Implant Device,915.96,34,"Charges > $500, x 34%",915.96,percent of total billed charges,Implant Device,942.9,35,,942.9,percent of total billed charges,Implant Devices,942.9,35,,942.9,percent of total billed charges,Implant Devices,942.9,35,,,percent of total billed charges,Implant Devices,942.9,35,,942.9,percent of total billed charges,Implant Devices,942.9,35,,942.9,percent of total billed charges,Implant Devices,1077.6,40,,1077.6,percent of total billed charges,Implant Devices,942.9,70,,942.9,percent of total billed charges,Implant Devices,915.96,34,,915.96,percent of total billed charges,Implant Devices,915.96,34,,915.96,percent of total billed charges,Implant Devices,942.9,35,,942.9,percent of total billed charges,Implant Devices,942.9,35,,942.9,percent of total billed charges,Implant Devices,942.9,35,,942.9,percent of total billed charges,Implant Devices,942.9,35,,942.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,915.96,34,"If Charge > 2,000, then 34 percent",915.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1077.6,
PAC 3 62055-45 SCREW,C1713,HCPCS,,79002188,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
PAC 3 62055-50 SCREW,C1713,HCPCS,,79002189,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
PAC 3 62065-35 SCREW,C1713,HCPCS,,79002190,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
PAC 3 62065-45 SCREW,C1713,HCPCS,,79002191,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
PAC 3 62065-50 SCREW,C1713,HCPCS,,79002192,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
PAC 3 62065-55 SCREW,C1713,HCPCS,,79002193,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
PAC 3 62075-35 SCREW,C1713,HCPCS,,79002194,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
PAC 3 62075-40 SCREW,C1713,HCPCS,,79002195,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
ZIMMER 6250-65-20-REV SCREW,C1713,HCPCS,,79002202,CDM,278,RC,,,both,,,427,168.52,39.4668,,168.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,170.8,40,,170.8,percent of total billed charges,Implant Devices,149.45,70,,149.45,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.8,
ZIMMER 6250-65-25-REV SCREW,C1713,HCPCS,,79002203,CDM,278,RC,,,both,,,96,37.89,39.4668,,37.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,33.6,35,,33.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,38.4,40,,38.4,percent of total billed charges,Implant Devices,33.6,70,,33.6,percent of total billed charges,Implant Devices,32.64,34,,32.64,percent of total billed charges,Implant Devices,32.64,34,,32.64,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.4,
ZIMMER 6250-65-30-REV SCREW,C1713,HCPCS,,79002204,CDM,278,RC,,,both,,,243,95.9,39.4668,,95.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,82.62,34,,82.62,percent of total billed charges,Implant Device,82.62,34,,82.62,percent of total billed charges,Implant Device,82.62,34,,82.62,percent of total billed charges,Implant Device,82.62,34,,82.62,percent of total billed charges,Implant Device,82.62,34,,82.62,percent of total billed charges,Implant Device,82.62,34,,82.62,percent of total billed charges,Implant Device,85.05,35,,85.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,97.2,40,,97.2,percent of total billed charges,Implant Devices,85.05,70,,85.05,percent of total billed charges,Implant Devices,82.62,34,,82.62,percent of total billed charges,Implant Devices,82.62,34,,82.62,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,97.2,
ZIMMER 6250-65-35-REV SCREW,C1713,HCPCS,,79002205,CDM,278,RC,,,both,,,96,37.89,39.4668,,37.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,33.6,35,,33.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,38.4,40,,38.4,percent of total billed charges,Implant Devices,33.6,70,,33.6,percent of total billed charges,Implant Devices,32.64,34,,32.64,percent of total billed charges,Implant Devices,32.64,34,,32.64,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.4,
ZIMMER 6250-65-40-REV SCREW,C1713,HCPCS,,79002206,CDM,278,RC,,,both,,,243,95.9,39.4668,,95.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,82.62,34,,82.62,percent of total billed charges,Implant Device,82.62,34,,82.62,percent of total billed charges,Implant Device,82.62,34,,82.62,percent of total billed charges,Implant Device,82.62,34,,82.62,percent of total billed charges,Implant Device,82.62,34,,82.62,percent of total billed charges,Implant Device,82.62,34,,82.62,percent of total billed charges,Implant Device,85.05,35,,85.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,97.2,40,,97.2,percent of total billed charges,Implant Devices,85.05,70,,85.05,percent of total billed charges,Implant Devices,82.62,34,,82.62,percent of total billed charges,Implant Devices,82.62,34,,82.62,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,85.05,35,,85.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,97.2,
ZIMMER 6250-65-50-REV SCREW,C1713,HCPCS,,79002207,CDM,278,RC,,,both,,,427,168.52,39.4668,,168.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,170.8,40,,170.8,percent of total billed charges,Implant Devices,149.45,70,,149.45,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.8,
ZIMMER 6624-65-25-REV SCREW,C1713,HCPCS,,79002243,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
ZIMMER 6624-65-35-REV SCREW,C1713,HCPCS,,79002244,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
ZIMMER 6624-65-40-REV SCREW,C1713,HCPCS,,79002245,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
STRYKER 6704-0-510 CABLE & SLEEVE 2MM,C1713,HCPCS,,79002246,CDM,278,RC,,,both,,,1588,626.73,39.4668,,626.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,539.92,34,,539.92,percent of total billed charges,Implant Device,539.92,34,,539.92,percent of total billed charges,Implant Device,539.92,34,,539.92,percent of total billed charges,Implant Device,539.92,34,,539.92,percent of total billed charges,Implant Device,539.92,34,,539.92,percent of total billed charges,Implant Device,539.92,34,,539.92,percent of total billed charges,Implant Device,555.8,35,,555.8,percent of total billed charges,Implant Device,539.92,34,"Charges > $500, x 34%",539.92,percent of total billed charges,Implant Device,555.8,35,,555.8,percent of total billed charges,Implant Devices,555.8,35,,555.8,percent of total billed charges,Implant Devices,555.8,35,,,percent of total billed charges,Implant Devices,555.8,35,,555.8,percent of total billed charges,Implant Devices,555.8,35,,555.8,percent of total billed charges,Implant Devices,635.2,40,,635.2,percent of total billed charges,Implant Devices,555.8,70,,555.8,percent of total billed charges,Implant Devices,539.92,34,,539.92,percent of total billed charges,Implant Devices,539.92,34,,539.92,percent of total billed charges,Implant Devices,555.8,35,,555.8,percent of total billed charges,Implant Devices,555.8,35,,555.8,percent of total billed charges,Implant Devices,555.8,35,,555.8,percent of total billed charges,Implant Devices,555.8,35,,555.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,635.2,
STRYKER 6704-0-520 CABLE & SLEEVE,C1713,HCPCS,,79002247,CDM,278,RC,,,both,,,1536,606.21,39.4668,,606.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Device,522.24,34,"Charges > $500, x 34%",522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,614.4,40,,614.4,percent of total billed charges,Implant Devices,537.6,70,,537.6,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,614.4,
STRYKER 6704-0-520-REV CABLE & SLEEVE,C1713,HCPCS,,79002248,CDM,278,RC,,,both,,,963,380.07,39.4668,,380.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,327.42,34,,327.42,percent of total billed charges,Implant Device,327.42,34,,327.42,percent of total billed charges,Implant Device,327.42,34,,327.42,percent of total billed charges,Implant Device,327.42,34,,327.42,percent of total billed charges,Implant Device,327.42,34,,327.42,percent of total billed charges,Implant Device,327.42,34,,327.42,percent of total billed charges,Implant Device,337.05,35,,337.05,percent of total billed charges,Implant Device,327.42,34,"Charges > $500, x 34%",327.42,percent of total billed charges,Implant Device,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,385.2,40,,385.2,percent of total billed charges,Implant Devices,337.05,70,,337.05,percent of total billed charges,Implant Devices,327.42,34,,327.42,percent of total billed charges,Implant Devices,327.42,34,,327.42,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,385.2,
STRYKER 6704-3-082-REV PLATE,C1713,HCPCS,,79002249,CDM,278,RC,,,both,,,4320,1704.97,39.4668,,1704.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1512,35,,1512,percent of total billed charges,Implant Device,1468.8,34,"Charges > $500, x 34%",1468.8,percent of total billed charges,Implant Device,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1728,40,,1728,percent of total billed charges,Implant Devices,1512,70,,1512,percent of total billed charges,Implant Devices,1468.8,34,,1468.8,percent of total billed charges,Implant Devices,1468.8,34,,1468.8,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1468.8,34,"If Charge > 2,000, then 34 percent",1468.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1728,
ZIMMER 6704-3-083-REV PLATE,C1713,HCPCS,,79002250,CDM,278,RC,,,both,,,8688,3428.88,39.4668,,3428.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2953.92,34,,2953.92,percent of total billed charges,Implant Device,2953.92,34,,2953.92,percent of total billed charges,Implant Device,2953.92,34,,2953.92,percent of total billed charges,Implant Device,2953.92,34,,2953.92,percent of total billed charges,Implant Device,2953.92,34,,2953.92,percent of total billed charges,Implant Device,2953.92,34,,2953.92,percent of total billed charges,Implant Device,3040.8,35,,3040.8,percent of total billed charges,Implant Device,2953.92,34,"Charges > $500, x 34%",2953.92,percent of total billed charges,Implant Device,3040.8,35,,3040.8,percent of total billed charges,Implant Devices,3040.8,35,,3040.8,percent of total billed charges,Implant Devices,3040.8,35,,,percent of total billed charges,Implant Devices,3040.8,35,,3040.8,percent of total billed charges,Implant Devices,3040.8,35,,3040.8,percent of total billed charges,Implant Devices,3475.2,40,,3475.2,percent of total billed charges,Implant Devices,3040.8,70,,3040.8,percent of total billed charges,Implant Devices,2953.92,34,,2953.92,percent of total billed charges,Implant Devices,2953.92,34,,2953.92,percent of total billed charges,Implant Devices,3040.8,35,,3040.8,percent of total billed charges,Implant Devices,3040.8,35,,3040.8,percent of total billed charges,Implant Devices,3040.8,35,,3040.8,percent of total billed charges,Implant Devices,3040.8,35,,3040.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2953.92,34,"If Charge > 2,000, then 34 percent",2953.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3475.2,
ACUMED 70-0060 PLATE,C1713,HCPCS,,79002251,CDM,278,RC,,,both,,,2446,965.36,39.4668,,965.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,831.64,34,,831.64,percent of total billed charges,Implant Device,831.64,34,,831.64,percent of total billed charges,Implant Device,831.64,34,,831.64,percent of total billed charges,Implant Device,831.64,34,,831.64,percent of total billed charges,Implant Device,831.64,34,,831.64,percent of total billed charges,Implant Device,831.64,34,,831.64,percent of total billed charges,Implant Device,856.1,35,,856.1,percent of total billed charges,Implant Device,831.64,34,"Charges > $500, x 34%",831.64,percent of total billed charges,Implant Device,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,978.4,40,,978.4,percent of total billed charges,Implant Devices,856.1,70,,856.1,percent of total billed charges,Implant Devices,831.64,34,,831.64,percent of total billed charges,Implant Devices,831.64,34,,831.64,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,831.64,34,"If Charge > 2,000, then 34 percent",831.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,978.4,
ACUMED 70-0067 PLATE,C1713,HCPCS,,79002252,CDM,278,RC,,,both,,,2734,1079.02,39.4668,,1079.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,956.9,35,,956.9,percent of total billed charges,Implant Device,929.56,34,"Charges > $500, x 34%",929.56,percent of total billed charges,Implant Device,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,1093.6,40,,1093.6,percent of total billed charges,Implant Devices,956.9,70,,956.9,percent of total billed charges,Implant Devices,929.56,34,,929.56,percent of total billed charges,Implant Devices,929.56,34,,929.56,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,929.56,34,"If Charge > 2,000, then 34 percent",929.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1093.6,
ACUMED 70-0070 PLATE,C1713,HCPCS,,79002253,CDM,278,RC,,,both,,,2734,1079.02,39.4668,,1079.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,956.9,35,,956.9,percent of total billed charges,Implant Device,929.56,34,"Charges > $500, x 34%",929.56,percent of total billed charges,Implant Device,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,1093.6,40,,1093.6,percent of total billed charges,Implant Devices,956.9,70,,956.9,percent of total billed charges,Implant Devices,929.56,34,,929.56,percent of total billed charges,Implant Devices,929.56,34,,929.56,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,929.56,34,"If Charge > 2,000, then 34 percent",929.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1093.6,
ACUMED 70-0071 PLATE,C1713,HCPCS,,79002254,CDM,278,RC,,,both,,,2446,965.36,39.4668,,965.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,831.64,34,,831.64,percent of total billed charges,Implant Device,831.64,34,,831.64,percent of total billed charges,Implant Device,831.64,34,,831.64,percent of total billed charges,Implant Device,831.64,34,,831.64,percent of total billed charges,Implant Device,831.64,34,,831.64,percent of total billed charges,Implant Device,831.64,34,,831.64,percent of total billed charges,Implant Device,856.1,35,,856.1,percent of total billed charges,Implant Device,831.64,34,"Charges > $500, x 34%",831.64,percent of total billed charges,Implant Device,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,978.4,40,,978.4,percent of total billed charges,Implant Devices,856.1,70,,856.1,percent of total billed charges,Implant Devices,831.64,34,,831.64,percent of total billed charges,Implant Devices,831.64,34,,831.64,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,856.1,35,,856.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,831.64,34,"If Charge > 2,000, then 34 percent",831.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,978.4,
ACUMED 70-0112 PLATE,C1713,HCPCS,,79002255,CDM,278,RC,,,both,,,3366,1328.45,39.4668,,1328.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1178.1,35,,1178.1,percent of total billed charges,Implant Device,1144.44,34,"Charges > $500, x 34%",1144.44,percent of total billed charges,Implant Device,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1346.4,40,,1346.4,percent of total billed charges,Implant Devices,1178.1,70,,1178.1,percent of total billed charges,Implant Devices,1144.44,34,,1144.44,percent of total billed charges,Implant Devices,1144.44,34,,1144.44,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1144.44,34,"If Charge > 2,000, then 34 percent",1144.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1346.4,
ACUMED 70-0295 PLATE,C1713,HCPCS,,79002256,CDM,278,RC,,,both,,,4467,1762.98,39.4668,,1762.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1518.78,34,,1518.78,percent of total billed charges,Implant Device,1518.78,34,,1518.78,percent of total billed charges,Implant Device,1518.78,34,,1518.78,percent of total billed charges,Implant Device,1518.78,34,,1518.78,percent of total billed charges,Implant Device,1518.78,34,,1518.78,percent of total billed charges,Implant Device,1518.78,34,,1518.78,percent of total billed charges,Implant Device,1563.45,35,,1563.45,percent of total billed charges,Implant Device,1518.78,34,"Charges > $500, x 34%",1518.78,percent of total billed charges,Implant Device,1563.45,35,,1563.45,percent of total billed charges,Implant Devices,1563.45,35,,1563.45,percent of total billed charges,Implant Devices,1563.45,35,,,percent of total billed charges,Implant Devices,1563.45,35,,1563.45,percent of total billed charges,Implant Devices,1563.45,35,,1563.45,percent of total billed charges,Implant Devices,1786.8,40,,1786.8,percent of total billed charges,Implant Devices,1563.45,70,,1563.45,percent of total billed charges,Implant Devices,1518.78,34,,1518.78,percent of total billed charges,Implant Devices,1518.78,34,,1518.78,percent of total billed charges,Implant Devices,1563.45,35,,1563.45,percent of total billed charges,Implant Devices,1563.45,35,,1563.45,percent of total billed charges,Implant Devices,1563.45,35,,1563.45,percent of total billed charges,Implant Devices,1563.45,35,,1563.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1518.78,34,"If Charge > 2,000, then 34 percent",1518.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1786.8,
ACUMED 70-0297 PLATE,C1713,HCPCS,,79002257,CDM,278,RC,,,both,,,3498,1380.55,39.4668,,1380.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1224.3,35,,1224.3,percent of total billed charges,Implant Device,1189.32,34,"Charges > $500, x 34%",1189.32,percent of total billed charges,Implant Device,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1399.2,40,,1399.2,percent of total billed charges,Implant Devices,1224.3,70,,1224.3,percent of total billed charges,Implant Devices,1189.32,34,,1189.32,percent of total billed charges,Implant Devices,1189.32,34,,1189.32,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1189.32,34,"If Charge > 2,000, then 34 percent",1189.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1399.2,
ACUMED 70-0298 PLATE,C1713,HCPCS,,79002258,CDM,278,RC,,,both,,,3498,1380.55,39.4668,,1380.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1224.3,35,,1224.3,percent of total billed charges,Implant Device,1189.32,34,"Charges > $500, x 34%",1189.32,percent of total billed charges,Implant Device,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1399.2,40,,1399.2,percent of total billed charges,Implant Devices,1224.3,70,,1224.3,percent of total billed charges,Implant Devices,1189.32,34,,1189.32,percent of total billed charges,Implant Devices,1189.32,34,,1189.32,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1189.32,34,"If Charge > 2,000, then 34 percent",1189.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1399.2,
ACUMED 70-0299 PLATE,C1713,HCPCS,,79002259,CDM,278,RC,,,both,,,3498,1380.55,39.4668,,1380.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1224.3,35,,1224.3,percent of total billed charges,Implant Device,1189.32,34,"Charges > $500, x 34%",1189.32,percent of total billed charges,Implant Device,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1399.2,40,,1399.2,percent of total billed charges,Implant Devices,1224.3,70,,1224.3,percent of total billed charges,Implant Devices,1189.32,34,,1189.32,percent of total billed charges,Implant Devices,1189.32,34,,1189.32,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1189.32,34,"If Charge > 2,000, then 34 percent",1189.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1399.2,
ACUMED 70-0301 PLATE,C1713,HCPCS,,79002260,CDM,278,RC,,,both,,,3498,1380.55,39.4668,,1380.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1224.3,35,,1224.3,percent of total billed charges,Implant Device,1189.32,34,"Charges > $500, x 34%",1189.32,percent of total billed charges,Implant Device,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1399.2,40,,1399.2,percent of total billed charges,Implant Devices,1224.3,70,,1224.3,percent of total billed charges,Implant Devices,1189.32,34,,1189.32,percent of total billed charges,Implant Devices,1189.32,34,,1189.32,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1189.32,34,"If Charge > 2,000, then 34 percent",1189.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1399.2,
ACUMED 70-0304 PLATE,C1713,HCPCS,,79002261,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
ACUMED 70-0357-PLATE,C1713,HCPCS,,79002262,CDM,278,RC,,,both,,,3801,1500.13,39.4668,,1500.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1330.35,35,,1330.35,percent of total billed charges,Implant Device,1292.34,34,"Charges > $500, x 34%",1292.34,percent of total billed charges,Implant Device,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1520.4,40,,1520.4,percent of total billed charges,Implant Devices,1330.35,70,,1330.35,percent of total billed charges,Implant Devices,1292.34,34,,1292.34,percent of total billed charges,Implant Devices,1292.34,34,,1292.34,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1292.34,34,"If Charge > 2,000, then 34 percent",1292.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1520.4,
BIOMET 8155-40-022 SCREW,C1713,HCPCS,,79002305,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8155-40-028 SCREW,C1713,HCPCS,,79002306,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
DEPUY 8157-45-022 SCREW,C1713,HCPCS,,79002308,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
DEPUY 8157-45-024 SCREW,C1713,HCPCS,,79002309,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
BIOMET 8161-35-034 SCREW,C1713,HCPCS,,79002310,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
BIOMET 8161-35-036 SCREW,C1713,HCPCS,,79002311,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
DEPUY 8161-35-080 SCREW,C1713,HCPCS,,79002312,CDM,278,RC,,,both,,,364,143.66,39.4668,,143.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,145.6,40,,145.6,percent of total billed charges,Implant Devices,127.4,70,,127.4,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,145.6,
DEPUY 8161-35-085 SCREW,C1713,HCPCS,,79002313,CDM,278,RC,,,both,,,364,143.66,39.4668,,143.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,145.6,40,,145.6,percent of total billed charges,Implant Devices,127.4,70,,127.4,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,145.6,
DEPUY 8161-35-095 SCREW,C1713,HCPCS,,79002314,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
DEPUY 8161-40-038 SCREW,C1713,HCPCS,,79002315,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
DEPUY 8162-07-006 PLATE,C1713,HCPCS,,79002316,CDM,278,RC,,,both,,,4020,1586.57,39.4668,,1586.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1407,35,,1407,percent of total billed charges,Implant Device,1366.8,34,"Charges > $500, x 34%",1366.8,percent of total billed charges,Implant Device,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1608,40,,1608,percent of total billed charges,Implant Devices,1407,70,,1407,percent of total billed charges,Implant Devices,1366.8,34,,1366.8,percent of total billed charges,Implant Devices,1366.8,34,,1366.8,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1366.8,34,"If Charge > 2,000, then 34 percent",1366.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1608,
BIOMET 8162-35-005 PLATE,C1713,HCPCS,,79002317,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
DEPUY 8162-45-007 PLATE,C1713,HCPCS,,79002318,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
ARTHREX AR-1008 LIGAMENT STAPLE,C1713,HCPCS,,79002363,CDM,278,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,115.6,34,,115.6,percent of total billed charges,Implant Device,115.6,34,,115.6,percent of total billed charges,Implant Device,115.6,34,,115.6,percent of total billed charges,Implant Device,115.6,34,,115.6,percent of total billed charges,Implant Device,115.6,34,,115.6,percent of total billed charges,Implant Device,115.6,34,,115.6,percent of total billed charges,Implant Device,119,35,,119,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,119,35,,119,percent of total billed charges,Implant Devices,119,35,,119,percent of total billed charges,Implant Devices,119,35,,,percent of total billed charges,Implant Devices,119,35,,119,percent of total billed charges,Implant Devices,119,35,,119,percent of total billed charges,Implant Devices,136,40,,136,percent of total billed charges,Implant Devices,119,70,,119,percent of total billed charges,Implant Devices,115.6,34,,115.6,percent of total billed charges,Implant Devices,115.6,34,,115.6,percent of total billed charges,Implant Devices,119,35,,119,percent of total billed charges,Implant Devices,119,35,,119,percent of total billed charges,Implant Devices,119,35,,119,percent of total billed charges,Implant Devices,119,35,,119,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,136,
ARTHREX AR-1320BNF SUTURE TAK,C1713,HCPCS,,79002369,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
ARTHREX AR-13226T THREADED BBTAK,C1713,HCPCS,,79002372,CDM,278,RC,,,both,,,277,109.32,39.4668,,109.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,94.18,34,,94.18,percent of total billed charges,Implant Device,94.18,34,,94.18,percent of total billed charges,Implant Device,94.18,34,,94.18,percent of total billed charges,Implant Device,94.18,34,,94.18,percent of total billed charges,Implant Device,94.18,34,,94.18,percent of total billed charges,Implant Device,94.18,34,,94.18,percent of total billed charges,Implant Device,96.95,35,,96.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,96.95,35,,96.95,percent of total billed charges,Implant Devices,96.95,35,,96.95,percent of total billed charges,Implant Devices,96.95,35,,,percent of total billed charges,Implant Devices,96.95,35,,96.95,percent of total billed charges,Implant Devices,96.95,35,,96.95,percent of total billed charges,Implant Devices,110.8,40,,110.8,percent of total billed charges,Implant Devices,96.95,70,,96.95,percent of total billed charges,Implant Devices,94.18,34,,94.18,percent of total billed charges,Implant Devices,94.18,34,,94.18,percent of total billed charges,Implant Devices,96.95,35,,96.95,percent of total billed charges,Implant Devices,96.95,35,,96.95,percent of total billed charges,Implant Devices,96.95,35,,96.95,percent of total billed charges,Implant Devices,96.95,35,,96.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.8,
ARTHREX AR-13280-40 SCREW,C1713,HCPCS,,79002373,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
ARTHREX AR-13280-70 SCREW,C1713,HCPCS,,79002374,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
ARTHREX AR-13370-1 BONE WEDGE,C1713,HCPCS,,79002375,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
ARTHREX AR-13370-2 BONE WEDGE,C1713,HCPCS,,79002376,CDM,278,RC,,,both,,,2124,838.27,39.4668,,838.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,743.4,35,,743.4,percent of total billed charges,Implant Device,722.16,34,"Charges > $500, x 34%",722.16,percent of total billed charges,Implant Device,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,849.6,40,,849.6,percent of total billed charges,Implant Devices,743.4,70,,743.4,percent of total billed charges,Implant Devices,722.16,34,,722.16,percent of total billed charges,Implant Devices,722.16,34,,722.16,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,722.16,34,"If Charge > 2,000, then 34 percent",722.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,849.6,
ARTHREX AR-13372-2 BONE VOID FILLER,C1713,HCPCS,,79002377,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-13380-34 SCREW,C1713,HCPCS,,79002378,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
ARTHREX AR-13380-38 SCREW,C1713,HCPCS,,79002379,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
ARTHREX AR-13401-28 ANCHOR,C1713,HCPCS,,79002380,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-13401-30 ANCHOR,C1713,HCPCS,,79002381,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-13402-36 ANCHOR,C1713,HCPCS,,79002382,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-13402-48 ANCHOR,C1713,HCPCS,,79002383,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-1349L SPIKED WASHER,C1713,HCPCS,,79002384,CDM,278,RC,,,both,,,430,169.71,39.4668,,169.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,150.5,35,,150.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,172,40,,172,percent of total billed charges,Implant Devices,150.5,70,,150.5,percent of total billed charges,Implant Devices,146.2,34,,146.2,percent of total billed charges,Implant Devices,146.2,34,,146.2,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172,
ARTHREX AR-14003 PLATE,C1713,HCPCS,,79002385,CDM,278,RC,,,both,,,6408,2529.03,39.4668,,2529.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2242.8,35,,2242.8,percent of total billed charges,Implant Device,2178.72,34,"Charges > $500, x 34%",2178.72,percent of total billed charges,Implant Device,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2563.2,40,,2563.2,percent of total billed charges,Implant Devices,2242.8,70,,2242.8,percent of total billed charges,Implant Devices,2178.72,34,,2178.72,percent of total billed charges,Implant Devices,2178.72,34,,2178.72,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2178.72,34,"If Charge > 2,000, then 34 percent",2178.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2563.2,
ARTHREX AR-1403TC SCREW,C1713,HCPCS,,79002386,CDM,278,RC,,,both,,,966,381.25,39.4668,,381.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Device,328.44,34,"Charges > $500, x 34%",328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,386.4,40,,386.4,percent of total billed charges,Implant Devices,338.1,70,,338.1,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,386.4,
ARTHREX AR-14120 SCREW,C1713,HCPCS,,79002388,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
ARTHREX AR-14122 SCREW,C1713,HCPCS,,79002389,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
ARTHREX AR-14122NL SCREW,C1713,HCPCS,,79002390,CDM,278,RC,,,both,,,136,53.67,39.4668,,53.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,54.4,40,,54.4,percent of total billed charges,Implant Devices,47.6,70,,47.6,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.4,
ARTHREX AR-14224 SCREW,C1713,HCPCS,,79002391,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
ARTHREX AR-14238 SCREW,C1713,HCPCS,,79002392,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
ARTHREX AR-14240 SCREW,C1713,HCPCS,,79002393,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
ARTHREX AR-14242 SCREW,C1713,HCPCS,,79002394,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
ARTHREX AR-1540BC SCREW,C1713,HCPCS,,79002395,CDM,278,RC,,,both,,,1036,408.88,39.4668,,408.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Device,352.24,34,"Charges > $500, x 34%",352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,414.4,40,,414.4,percent of total billed charges,Implant Devices,362.6,70,,362.6,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,414.4,
ARTHREX AR-1586RB-08 SCREW,C1713,HCPCS,,79002396,CDM,278,RC,,,both,,,834,329.15,39.4668,,329.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,291.9,35,,291.9,percent of total billed charges,Implant Device,283.56,34,"Charges > $500, x 34%",283.56,percent of total billed charges,Implant Device,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,333.6,40,,333.6,percent of total billed charges,Implant Devices,291.9,70,,291.9,percent of total billed charges,Implant Devices,283.56,34,,283.56,percent of total billed charges,Implant Devices,283.56,34,,283.56,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,333.6,
ARTHREX AR-1923BCH SUTURE ANCHOR,C1713,HCPCS,,79002398,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
ARTHREX AR-1927BCF-65 SUTURE ANCHOR,C1713,HCPCS,,79002399,CDM,278,RC,,,both,,,1006,397.04,39.4668,,397.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,342.04,34,,342.04,percent of total billed charges,Implant Device,342.04,34,,342.04,percent of total billed charges,Implant Device,342.04,34,,342.04,percent of total billed charges,Implant Device,342.04,34,,342.04,percent of total billed charges,Implant Device,342.04,34,,342.04,percent of total billed charges,Implant Device,342.04,34,,342.04,percent of total billed charges,Implant Device,352.1,35,,352.1,percent of total billed charges,Implant Device,342.04,34,"Charges > $500, x 34%",342.04,percent of total billed charges,Implant Device,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,402.4,40,,402.4,percent of total billed charges,Implant Devices,352.1,70,,352.1,percent of total billed charges,Implant Devices,342.04,34,,342.04,percent of total billed charges,Implant Devices,342.04,34,,342.04,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,352.1,35,,352.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,402.4,
ARTHREX AR-1934BCF-24 SUTURE ANCHOR,C1713,HCPCS,,79002400,CDM,278,RC,,,both,,,916,361.52,39.4668,,361.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,311.44,34,,311.44,percent of total billed charges,Implant Device,311.44,34,,311.44,percent of total billed charges,Implant Device,311.44,34,,311.44,percent of total billed charges,Implant Device,311.44,34,,311.44,percent of total billed charges,Implant Device,311.44,34,,311.44,percent of total billed charges,Implant Device,311.44,34,,311.44,percent of total billed charges,Implant Device,320.6,35,,320.6,percent of total billed charges,Implant Device,311.44,34,"Charges > $500, x 34%",311.44,percent of total billed charges,Implant Device,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,366.4,40,,366.4,percent of total billed charges,Implant Devices,320.6,70,,320.6,percent of total billed charges,Implant Devices,311.44,34,,311.44,percent of total billed charges,Implant Devices,311.44,34,,311.44,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,366.4,
ARTHREX AR-2258 AC GRAFTROPE,C1713,HCPCS,,79002401,CDM,278,RC,,,both,,,2086,823.28,39.4668,,823.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,730.1,35,,730.1,percent of total billed charges,Implant Device,709.24,34,"Charges > $500, x 34%",709.24,percent of total billed charges,Implant Device,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,834.4,40,,834.4,percent of total billed charges,Implant Devices,730.1,70,,730.1,percent of total billed charges,Implant Devices,709.24,34,,709.24,percent of total billed charges,Implant Devices,709.24,34,,709.24,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,709.24,34,"If Charge > 2,000, then 34 percent",709.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834.4,
ARTHREX AR-5025B-22 SCREW,C1713,HCPCS,,79002404,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
ARTHREX AR-5026B-16 SCREW,C1713,HCPCS,,79002407,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ARTHREX AR-5026B-18 SCREW,C1713,HCPCS,,79002408,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ARTHREX AR-5028C-09 SCREW,C1713,HCPCS,,79002409,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ARTHREX AR-5028C-10 SCREW,C1713,HCPCS,,79002410,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ARTHREX AR-5035TC-10 SCREW,C1713,HCPCS,,79002411,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ARTHREX AR-5080AB SCREW,C1713,HCPCS,,79002412,CDM,278,RC,,,both,,,610,240.75,39.4668,,240.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,207.4,34,,207.4,percent of total billed charges,Implant Device,207.4,34,,207.4,percent of total billed charges,Implant Device,207.4,34,,207.4,percent of total billed charges,Implant Device,207.4,34,,207.4,percent of total billed charges,Implant Device,207.4,34,,207.4,percent of total billed charges,Implant Device,207.4,34,,207.4,percent of total billed charges,Implant Device,213.5,35,,213.5,percent of total billed charges,Implant Device,207.4,34,"Charges > $500, x 34%",207.4,percent of total billed charges,Implant Device,213.5,35,,213.5,percent of total billed charges,Implant Devices,213.5,35,,213.5,percent of total billed charges,Implant Devices,213.5,35,,,percent of total billed charges,Implant Devices,213.5,35,,213.5,percent of total billed charges,Implant Devices,213.5,35,,213.5,percent of total billed charges,Implant Devices,244,40,,244,percent of total billed charges,Implant Devices,213.5,70,,213.5,percent of total billed charges,Implant Devices,207.4,34,,207.4,percent of total billed charges,Implant Devices,207.4,34,,207.4,percent of total billed charges,Implant Devices,213.5,35,,213.5,percent of total billed charges,Implant Devices,213.5,35,,213.5,percent of total billed charges,Implant Devices,213.5,35,,213.5,percent of total billed charges,Implant Devices,213.5,35,,213.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244,
ARTHREX AR-5100-09 GRAFTBOLT,C1713,HCPCS,,79002413,CDM,278,RC,,,both,,,1696,669.36,39.4668,,669.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,593.6,35,,593.6,percent of total billed charges,Implant Device,576.64,34,"Charges > $500, x 34%",576.64,percent of total billed charges,Implant Device,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,678.4,40,,678.4,percent of total billed charges,Implant Devices,593.6,70,,593.6,percent of total billed charges,Implant Devices,576.64,34,,576.64,percent of total billed charges,Implant Devices,576.64,34,,576.64,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,678.4,
ARTHREX AR-8720-12PT SCREW,C1713,HCPCS,,79002415,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ARTHREX AR-8835-12 SCREW,C1713,HCPCS,,79002416,CDM,278,RC,,,both,,,105,41.44,39.4668,,41.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,42,40,,42,percent of total billed charges,Implant Devices,36.75,70,,36.75,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42,
ARTHREX AR-8835-14 SCREW,C1713,HCPCS,,79002417,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ARTHREX AR-8835-18 SCREW,C1713,HCPCS,,79002418,CDM,278,RC,,,both,,,105,41.44,39.4668,,41.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,42,40,,42,percent of total billed charges,Implant Devices,36.75,70,,36.75,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42,
ARTHREX AR-8835-24 SCREW,C1713,HCPCS,,79002419,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ARTHREX AR-8840C-42 SCREW,C1713,HCPCS,,79002420,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ARTHREX AR-8840C-46 SCREW,C1713,HCPCS,,79002421,CDM,278,RC,,,both,,,496,195.76,39.4668,,195.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,198.4,40,,198.4,percent of total billed charges,Implant Devices,173.6,70,,173.6,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.4,
ARTHREX AR-8928BC-CP ACH SPEEDBRIDGE,C1713,HCPCS,,79002422,CDM,278,RC,,,both,,,7116,2808.46,39.4668,,2808.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2419.44,34,,2419.44,percent of total billed charges,Implant Device,2419.44,34,,2419.44,percent of total billed charges,Implant Device,2419.44,34,,2419.44,percent of total billed charges,Implant Device,2419.44,34,,2419.44,percent of total billed charges,Implant Device,2419.44,34,,2419.44,percent of total billed charges,Implant Device,2419.44,34,,2419.44,percent of total billed charges,Implant Device,2490.6,35,,2490.6,percent of total billed charges,Implant Device,2419.44,34,"Charges > $500, x 34%",2419.44,percent of total billed charges,Implant Device,2490.6,35,,2490.6,percent of total billed charges,Implant Devices,2490.6,35,,2490.6,percent of total billed charges,Implant Devices,2490.6,35,,,percent of total billed charges,Implant Devices,2490.6,35,,2490.6,percent of total billed charges,Implant Devices,2490.6,35,,2490.6,percent of total billed charges,Implant Devices,2846.4,40,,2846.4,percent of total billed charges,Implant Devices,2490.6,70,,2490.6,percent of total billed charges,Implant Devices,2419.44,34,,2419.44,percent of total billed charges,Implant Devices,2419.44,34,,2419.44,percent of total billed charges,Implant Devices,2490.6,35,,2490.6,percent of total billed charges,Implant Devices,2490.6,35,,2490.6,percent of total billed charges,Implant Devices,2490.6,35,,2490.6,percent of total billed charges,Implant Devices,2490.6,35,,2490.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2419.44,34,"If Charge > 2,000, then 34 percent",2419.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2846.4,
ARTHREX AR-8933-10 SCREW,C1713,HCPCS,,79002423,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8933-12 SCREEW,C1713,HCPCS,,79002424,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8933-14 SCREW,C1713,HCPCS,,79002425,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ARTHREX AR-8933-16 SCREW,C1713,HCPCS,,79002426,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8933-18 SCREW,C1713,HCPCS,,79002427,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ARTHREX AR-8933-20 SCREW,C1713,HCPCS,,79002428,CDM,278,RC,,,both,,,359,141.69,39.4668,,141.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.06,34,,122.06,percent of total billed charges,Implant Device,122.06,34,,122.06,percent of total billed charges,Implant Device,122.06,34,,122.06,percent of total billed charges,Implant Device,122.06,34,,122.06,percent of total billed charges,Implant Device,122.06,34,,122.06,percent of total billed charges,Implant Device,122.06,34,,122.06,percent of total billed charges,Implant Device,125.65,35,,125.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,125.65,35,,125.65,percent of total billed charges,Implant Devices,125.65,35,,125.65,percent of total billed charges,Implant Devices,125.65,35,,,percent of total billed charges,Implant Devices,125.65,35,,125.65,percent of total billed charges,Implant Devices,125.65,35,,125.65,percent of total billed charges,Implant Devices,143.6,40,,143.6,percent of total billed charges,Implant Devices,125.65,70,,125.65,percent of total billed charges,Implant Devices,122.06,34,,122.06,percent of total billed charges,Implant Devices,122.06,34,,122.06,percent of total billed charges,Implant Devices,125.65,35,,125.65,percent of total billed charges,Implant Devices,125.65,35,,125.65,percent of total billed charges,Implant Devices,125.65,35,,125.65,percent of total billed charges,Implant Devices,125.65,35,,125.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,143.6,
ARTHREX AR-8933-22PT SCREW,C1713,HCPCS,,79002429,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ARTHREX AR-8933-26PT SCREW,C1713,HCPCS,,79002430,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
ARTHREX AR-8933-28PT SCREW,C1713,HCPCS,,79002431,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
ARTHREX AR-8933L-10 SCREW,C1713,HCPCS,,79002433,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8933L-12 SCREW,C1713,HCPCS,,79002434,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8933L-14 SCREW,C1713,HCPCS,,79002435,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ARTHREX AR-8933L-16 SCREW,C1713,HCPCS,,79002436,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8933L-18 SCREW,C1713,HCPCS,,79002437,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8935L-20 SCREW,C1713,HCPCS,,79002440,CDM,278,RC,,,both,,,645,254.56,39.4668,,254.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Device,219.3,34,"Charges > $500, x 34%",219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,258,40,,258,percent of total billed charges,Implant Devices,225.75,70,,225.75,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258,
ARTHREX AR-8935L-24 SCREW,C1713,HCPCS,,79002441,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
ARTHREX AR-8941 PLATE,C1713,HCPCS,,79002442,CDM,278,RC,,,both,,,2574,1015.88,39.4668,,1015.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,900.9,35,,900.9,percent of total billed charges,Implant Device,875.16,34,"Charges > $500, x 34%",875.16,percent of total billed charges,Implant Device,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,1029.6,40,,1029.6,percent of total billed charges,Implant Devices,900.9,70,,900.9,percent of total billed charges,Implant Devices,875.16,34,,875.16,percent of total billed charges,Implant Devices,875.16,34,,875.16,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,875.16,34,"If Charge > 2,000, then 34 percent",875.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1029.6,
ARTHREX AR-8942L-M PLATE,C1713,HCPCS,,79002444,CDM,278,RC,,,both,,,2574,1015.88,39.4668,,1015.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,900.9,35,,900.9,percent of total billed charges,Implant Device,875.16,34,"Charges > $500, x 34%",875.16,percent of total billed charges,Implant Device,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,1029.6,40,,1029.6,percent of total billed charges,Implant Devices,900.9,70,,900.9,percent of total billed charges,Implant Devices,875.16,34,,875.16,percent of total billed charges,Implant Devices,875.16,34,,875.16,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,875.16,34,"If Charge > 2,000, then 34 percent",875.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1029.6,
ARTHREX AR-8944CL-P PLATE,C1713,HCPCS,,79002447,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
ARTHREX AR-8944CR-5 PLATE,C1713,HCPCS,,79002448,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
ARTHREX AR-8944CR-L PLATE,C1713,HCPCS,,79002449,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
ARTHREX AR-8944CR-P PLATE,C1713,HCPCS,,79002450,CDM,278,RC,,,both,,,3430,1353.71,39.4668,,1353.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1200.5,35,,1200.5,percent of total billed charges,Implant Device,1166.2,34,"Charges > $500, x 34%",1166.2,percent of total billed charges,Implant Device,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1372,40,,1372,percent of total billed charges,Implant Devices,1200.5,70,,1200.5,percent of total billed charges,Implant Devices,1166.2,34,,1166.2,percent of total billed charges,Implant Devices,1166.2,34,,1166.2,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1166.2,34,"If Charge > 2,000, then 34 percent",1166.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1372,
ARTHREX AR-8944CR-S PLATE,C1713,HCPCS,,79002451,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
ARTHREX AR-8945-40FT SCREW,C1713,HCPCS,,79002461,CDM,278,RC,,,both,,,646,254.96,39.4668,,254.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Device,219.64,34,"Charges > $500, x 34%",219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,258.4,40,,258.4,percent of total billed charges,Implant Devices,226.1,70,,226.1,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258.4,
ARTHREX AR-8945-50FT SCREW,C1713,HCPCS,,79002462,CDM,278,RC,,,both,,,646,254.96,39.4668,,254.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Device,219.64,34,"Charges > $500, x 34%",219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,258.4,40,,258.4,percent of total billed charges,Implant Devices,226.1,70,,226.1,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258.4,
ARTHREX AR-8967-2885 SCREW,C1713,HCPCS,,79002464,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ACUMED AT2-M22 SCREW,C1713,HCPCS,,79002467,CDM,278,RC,,,both,,,1570,619.63,39.4668,,619.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Device,533.8,34,"Charges > $500, x 34%",533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,628,40,,628,percent of total billed charges,Implant Devices,549.5,70,,549.5,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,628,
ACUMED AT2-M24 SCREW,C1713,HCPCS,,79002468,CDM,278,RC,,,both,,,1570,619.63,39.4668,,619.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Device,533.8,34,"Charges > $500, x 34%",533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,628,40,,628,percent of total billed charges,Implant Devices,549.5,70,,549.5,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,628,
ACUMED AT2-M26 SCREW,C1713,HCPCS,,79002469,CDM,278,RC,,,both,,,1584,625.15,39.4668,,625.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Device,538.56,34,"Charges > $500, x 34%",538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,633.6,40,,633.6,percent of total billed charges,Implant Devices,554.4,70,,554.4,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,633.6,
ACUMED AT2-S22 SCREW,C1713,HCPCS,,79002471,CDM,278,RC,,,both,,,1570,619.63,39.4668,,619.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Device,533.8,34,"Charges > $500, x 34%",533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,628,40,,628,percent of total billed charges,Implant Devices,549.5,70,,549.5,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,628,
ACUMED CO-2716 SCREW,C1713,HCPCS,,79002477,CDM,278,RC,,,both,,,226,89.19,39.4668,,89.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,79.1,35,,79.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,90.4,40,,90.4,percent of total billed charges,Implant Devices,79.1,70,,79.1,percent of total billed charges,Implant Devices,76.84,34,,76.84,percent of total billed charges,Implant Devices,76.84,34,,76.84,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90.4,
ACUMED CO-2718 SCREW,C1713,HCPCS,,79002478,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
ACUMED CO-2720 SCREW,C1713,HCPCS,,79002479,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
ACUMED CO-2724 SCREW,C1713,HCPCS,,79002480,CDM,278,RC,,,both,,,226,89.19,39.4668,,89.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,79.1,35,,79.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,90.4,40,,90.4,percent of total billed charges,Implant Devices,79.1,70,,79.1,percent of total billed charges,Implant Devices,76.84,34,,76.84,percent of total billed charges,Implant Devices,76.84,34,,76.84,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90.4,
ACUMED CO-3080 SCREW,C1713,HCPCS,,79002481,CDM,278,RC,,,both,,,226,89.19,39.4668,,89.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,76.84,34,,76.84,percent of total billed charges,Implant Device,79.1,35,,79.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,90.4,40,,90.4,percent of total billed charges,Implant Devices,79.1,70,,79.1,percent of total billed charges,Implant Devices,76.84,34,,76.84,percent of total billed charges,Implant Devices,76.84,34,,76.84,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,79.1,35,,79.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90.4,
ACUMED CO-3100 SCREW,C1713,HCPCS,,79002482,CDM,278,RC,,,both,,,232,91.56,39.4668,,91.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,81.2,35,,81.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,92.8,40,,92.8,percent of total billed charges,Implant Devices,81.2,70,,81.2,percent of total billed charges,Implant Devices,78.88,34,,78.88,percent of total billed charges,Implant Devices,78.88,34,,78.88,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,92.8,
ACUMED CO-3140 SCREW,C1713,HCPCS,,79002483,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
ACUMED CO-3160 SCREW,C1713,HCPCS,,79002484,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
ACUMED CO-3200 SCREW,C1713,HCPCS,,79002485,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
ACUMED CO-3220 SCREW,C1713,HCPCS,,79002486,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
ACUMED CO-3260 SCREW,C1713,HCPCS,,79002487,CDM,278,RC,,,both,,,232,91.56,39.4668,,91.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,81.2,35,,81.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,92.8,40,,92.8,percent of total billed charges,Implant Devices,81.2,70,,81.2,percent of total billed charges,Implant Devices,78.88,34,,78.88,percent of total billed charges,Implant Devices,78.88,34,,78.88,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,92.8,
ACUMED COL-3140 SCREW,C1713,HCPCS,,79002488,CDM,278,RC,,,both,,,382,150.76,39.4668,,150.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,133.7,35,,133.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,152.8,40,,152.8,percent of total billed charges,Implant Devices,133.7,70,,133.7,percent of total billed charges,Implant Devices,129.88,34,,129.88,percent of total billed charges,Implant Devices,129.88,34,,129.88,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,152.8,
ACUMED COL-3160 SCREW,C1713,HCPCS,,79002489,CDM,278,RC,,,both,,,382,150.76,39.4668,,150.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,133.7,35,,133.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,152.8,40,,152.8,percent of total billed charges,Implant Devices,133.7,70,,133.7,percent of total billed charges,Implant Devices,129.88,34,,129.88,percent of total billed charges,Implant Devices,129.88,34,,129.88,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,152.8,
BIOMET DBMW02 DBM PUTTY,C1713,HCPCS,,79002490,CDM,278,RC,,,both,,,1746,689.09,39.4668,,689.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Device,593.64,34,"Charges > $500, x 34%",593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,698.4,40,,698.4,percent of total billed charges,Implant Devices,611.1,70,,611.1,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,698.4,
WRIGHT MEDICAL DC2820016 SCREW,C1713,HCPCS,,79002491,CDM,278,RC,,,both,,,654,258.11,39.4668,,258.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Device,222.36,34,"Charges > $500, x 34%",222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,261.6,40,,261.6,percent of total billed charges,Implant Devices,228.9,70,,228.9,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,261.6,
WRIGHT MEDICAL DC2820018 SCREW,C1713,HCPCS,,79002492,CDM,278,RC,,,both,,,322,127.08,39.4668,,127.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,128.8,40,,128.8,percent of total billed charges,Implant Devices,112.7,70,,112.7,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.8,
WRIGHT MEDICAL DC2820022 SCREW,C1713,HCPCS,,79002493,CDM,278,RC,,,both,,,322,127.08,39.4668,,127.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,128.8,40,,128.8,percent of total billed charges,Implant Devices,112.7,70,,112.7,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.8,
WRIGHT MEDICAL DC2820030 SCREW,C1713,HCPCS,,79002494,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
WRIGHT MEDICAL DC2820118 SCREW,C1713,HCPCS,,79002495,CDM,278,RC,,,both,,,322,127.08,39.4668,,127.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,128.8,40,,128.8,percent of total billed charges,Implant Devices,112.7,70,,112.7,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.8,
WRIGHT MEDICAL DC2820122 SCREW,C1713,HCPCS,,79002496,CDM,278,RC,,,both,,,654,258.11,39.4668,,258.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Device,222.36,34,"Charges > $500, x 34%",222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,261.6,40,,261.6,percent of total billed charges,Implant Devices,228.9,70,,228.9,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,261.6,
WRIGHT MEDICAL DC2820126 SCREW,C1713,HCPCS,,79002497,CDM,278,RC,,,both,,,322,127.08,39.4668,,127.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,128.8,40,,128.8,percent of total billed charges,Implant Devices,112.7,70,,112.7,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.8,
BIOMET DVRANR PLATE,C1713,HCPCS,,79002501,CDM,278,RC,,,both,,,2394,944.84,39.4668,,944.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,837.9,35,,837.9,percent of total billed charges,Implant Device,813.96,34,"Charges > $500, x 34%",813.96,percent of total billed charges,Implant Device,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,957.6,40,,957.6,percent of total billed charges,Implant Devices,837.9,70,,837.9,percent of total billed charges,Implant Devices,813.96,34,,813.96,percent of total billed charges,Implant Devices,813.96,34,,813.96,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,813.96,34,"If Charge > 2,000, then 34 percent",813.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,957.6,
ORTHOFIX M315 SCREW,C1713,HCPCS,,79002525,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
ORTHOHELIX MFT-002-PMLKG PLATE,C1713,HCPCS,,79002530,CDM,278,RC,,,both,,,3624,1430.28,39.4668,,1430.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1268.4,35,,1268.4,percent of total billed charges,Implant Device,1232.16,34,"Charges > $500, x 34%",1232.16,percent of total billed charges,Implant Device,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1449.6,40,,1449.6,percent of total billed charges,Implant Devices,1268.4,70,,1268.4,percent of total billed charges,Implant Devices,1232.16,34,,1232.16,percent of total billed charges,Implant Devices,1232.16,34,,1232.16,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1232.16,34,"If Charge > 2,000, then 34 percent",1232.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1449.6,
ORTHOHELIX MFT-002-PMX PLATE,C1713,HCPCS,,79002531,CDM,278,RC,,,both,,,3624,1430.28,39.4668,,1430.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1232.16,34,,1232.16,percent of total billed charges,Implant Device,1268.4,35,,1268.4,percent of total billed charges,Implant Device,1232.16,34,"Charges > $500, x 34%",1232.16,percent of total billed charges,Implant Device,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1449.6,40,,1449.6,percent of total billed charges,Implant Devices,1268.4,70,,1268.4,percent of total billed charges,Implant Devices,1232.16,34,,1232.16,percent of total billed charges,Implant Devices,1232.16,34,,1232.16,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,1268.4,35,,1268.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1232.16,34,"If Charge > 2,000, then 34 percent",1232.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1449.6,
ORTHOHELIX MFT-011-40-30 SCREW,C1713,HCPCS,,79002532,CDM,278,RC,,,both,,,546,215.49,39.4668,,215.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Device,185.64,34,"Charges > $500, x 34%",185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,218.4,40,,218.4,percent of total billed charges,Implant Devices,191.1,70,,191.1,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
ORTHOHELIX MFT-021-35-14 SCREEW,C1713,HCPCS,,79002533,CDM,278,RC,,,both,,,546,215.49,39.4668,,215.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Device,185.64,34,"Charges > $500, x 34%",185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,218.4,40,,218.4,percent of total billed charges,Implant Devices,191.1,70,,191.1,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
ORTHOHELIX MFT-021-35-18 SCREW,C1713,HCPCS,,79002534,CDM,278,RC,,,both,,,546,215.49,39.4668,,215.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Device,185.64,34,"Charges > $500, x 34%",185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,218.4,40,,218.4,percent of total billed charges,Implant Devices,191.1,70,,191.1,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
ORTHOHELIX MFT-021-35-30 SCREW,C1713,HCPCS,,79002535,CDM,278,RC,,,both,,,546,215.49,39.4668,,215.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Device,185.64,34,"Charges > $500, x 34%",185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,218.4,40,,218.4,percent of total billed charges,Implant Devices,191.1,70,,191.1,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
ORTHOHELIX MFT-021-35-325 SCREW,C1713,HCPCS,,79002536,CDM,278,RC,,,both,,,546,215.49,39.4668,,215.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Device,185.64,34,"Charges > $500, x 34%",185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,218.4,40,,218.4,percent of total billed charges,Implant Devices,191.1,70,,191.1,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
ORTHOHELIX MDS-010-40-285 SCREW,C1713,HCPCS,,79002544,CDM,278,RC,,,both,,,646,254.96,39.4668,,254.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Device,219.64,34,"Charges > $500, x 34%",219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,258.4,40,,258.4,percent of total billed charges,Implant Devices,226.1,70,,226.1,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258.4,
ORTHOHELIX MSD-010-40-3255 SCREW,C1713,HCPCS,,79002545,CDM,278,RC,,,both,,,646,254.96,39.4668,,254.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Device,219.64,34,"Charges > $500, x 34%",219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,258.4,40,,258.4,percent of total billed charges,Implant Devices,226.1,70,,226.1,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258.4,
ORTHOHELIX MXM-011-24-08 SCREW,C1713,HCPCS,,79002550,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ORTHOHELIX MXM-011-24-14 SCREW,C1713,HCPCS,,79002551,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ORTHOHELIX MXM-011-24-16 SCREW,C1713,HCPCS,,79002552,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ORTHOHELIX MXM-011-27-12 SCREW,C1713,HCPCS,,79002553,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ORTHOHELIX MXM-021-24-08 SCREW,C1713,HCPCS,,79002554,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ORTHOHELIX MXM-021-24-10 SCREW,C1713,HCPCS,,79002555,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ORTHOHELIX MXM-021-24-14 SCREW,C1713,HCPCS,,79002556,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ORTHOHELIX MXM-021-27-14 SCREW,C1713,HCPCS,,79002557,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
PAC 3 N60000101 X-SPINE PLATE,C1713,HCPCS,,79002561,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
PAC 3 N60000103 X-SPINE PLATE,C1713,HCPCS,,79002562,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
PAC 3 N60000109 X-SPINE PLATE,C1713,HCPCS,,79002563,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
PAC 3 N60000110 X-SPINE PLATE,C1713,HCPCS,,79002564,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
PAC 3 N60000111 X-SPINE PLATE,C1713,HCPCS,,79002565,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
PAC 3 N60000115 X-SPINE PLATE,C1713,HCPCS,,79002566,CDM,278,RC,,,both,,,3136,1237.68,39.4668,,1237.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Device,1066.24,34,"Charges > $500, x 34%",1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1254.4,40,,1254.4,percent of total billed charges,Implant Devices,1097.6,70,,1097.6,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1066.24,34,"If Charge > 2,000, then 34 percent",1066.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254.4,
PAC 3 N60000116 X-SPINE PLATE,C1713,HCPCS,,79002567,CDM,278,RC,,,both,,,3136,1237.68,39.4668,,1237.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Device,1066.24,34,"Charges > $500, x 34%",1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1254.4,40,,1254.4,percent of total billed charges,Implant Devices,1097.6,70,,1097.6,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1066.24,34,"If Charge > 2,000, then 34 percent",1066.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254.4,
N60000117,C1713,HCPCS,,79002568,CDM,278,RC,,,both,,,3136,1237.68,39.4668,,1237.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Device,1066.24,34,"Charges > $500, x 34%",1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1254.4,40,,1254.4,percent of total billed charges,Implant Devices,1097.6,70,,1097.6,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1066.24,34,"If Charge > 2,000, then 34 percent",1066.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254.4,
PAC 3 N60000118 X-SPINE PLATE,C1713,HCPCS,,79002569,CDM,278,RC,,,both,,,3136,1237.68,39.4668,,1237.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Device,1066.24,34,"Charges > $500, x 34%",1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1254.4,40,,1254.4,percent of total billed charges,Implant Devices,1097.6,70,,1097.6,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1066.24,34,"If Charge > 2,000, then 34 percent",1066.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254.4,
PAC 3 N60000119 X-SPINE PLATE,C1713,HCPCS,,79002570,CDM,278,RC,,,both,,,3136,1237.68,39.4668,,1237.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Device,1066.24,34,"Charges > $500, x 34%",1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1254.4,40,,1254.4,percent of total billed charges,Implant Devices,1097.6,70,,1097.6,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1066.24,34,"If Charge > 2,000, then 34 percent",1066.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254.4,
PAC 3 N60000135 X-SPINE SCREW,C1713,HCPCS,,79002571,CDM,278,RC,,,both,,,706,278.64,39.4668,,278.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Device,240.04,34,"Charges > $500, x 34%",240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,282.4,40,,282.4,percent of total billed charges,Implant Devices,247.1,70,,247.1,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.4,
PAC 3 N60000136 X-SPINE SCREW,C1713,HCPCS,,79002572,CDM,278,RC,,,both,,,706,278.64,39.4668,,278.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Device,240.04,34,"Charges > $500, x 34%",240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,282.4,40,,282.4,percent of total billed charges,Implant Devices,247.1,70,,247.1,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.4,
PAC 3 N60000141 X-SPINE SCREW,C1713,HCPCS,,79002573,CDM,278,RC,,,both,,,706,278.64,39.4668,,278.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Device,240.04,34,"Charges > $500, x 34%",240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,282.4,40,,282.4,percent of total billed charges,Implant Devices,247.1,70,,247.1,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.4,
SOLANA SURGICAL NBAT1134078 ALLOGRAFT,C1713,HCPCS,,79002574,CDM,278,RC,,,both,,,3886,1533.68,39.4668,,1533.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1321.24,34,,1321.24,percent of total billed charges,Implant Device,1321.24,34,,1321.24,percent of total billed charges,Implant Device,1321.24,34,,1321.24,percent of total billed charges,Implant Device,1321.24,34,,1321.24,percent of total billed charges,Implant Device,1321.24,34,,1321.24,percent of total billed charges,Implant Device,1321.24,34,,1321.24,percent of total billed charges,Implant Device,1360.1,35,,1360.1,percent of total billed charges,Implant Device,1321.24,34,"Charges > $500, x 34%",1321.24,percent of total billed charges,Implant Device,1360.1,35,,1360.1,percent of total billed charges,Implant Devices,1360.1,35,,1360.1,percent of total billed charges,Implant Devices,1360.1,35,,,percent of total billed charges,Implant Devices,1360.1,35,,1360.1,percent of total billed charges,Implant Devices,1360.1,35,,1360.1,percent of total billed charges,Implant Devices,1554.4,40,,1554.4,percent of total billed charges,Implant Devices,1360.1,70,,1360.1,percent of total billed charges,Implant Devices,1321.24,34,,1321.24,percent of total billed charges,Implant Devices,1321.24,34,,1321.24,percent of total billed charges,Implant Devices,1360.1,35,,1360.1,percent of total billed charges,Implant Devices,1360.1,35,,1360.1,percent of total billed charges,Implant Devices,1360.1,35,,1360.1,percent of total billed charges,Implant Devices,1360.1,35,,1360.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1321.24,34,"If Charge > 2,000, then 34 percent",1321.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1554.4,
SOLANA PHG-02C ALLOGRAFT CRUSH,C1713,HCPCS,,79002577,CDM,278,RC,,,both,,,3348,1321.35,39.4668,,1321.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1138.32,34,,1138.32,percent of total billed charges,Implant Device,1138.32,34,,1138.32,percent of total billed charges,Implant Device,1138.32,34,,1138.32,percent of total billed charges,Implant Device,1138.32,34,,1138.32,percent of total billed charges,Implant Device,1138.32,34,,1138.32,percent of total billed charges,Implant Device,1138.32,34,,1138.32,percent of total billed charges,Implant Device,1171.8,35,,1171.8,percent of total billed charges,Implant Device,1138.32,34,"Charges > $500, x 34%",1138.32,percent of total billed charges,Implant Device,1171.8,35,,1171.8,percent of total billed charges,Implant Devices,1171.8,35,,1171.8,percent of total billed charges,Implant Devices,1171.8,35,,,percent of total billed charges,Implant Devices,1171.8,35,,1171.8,percent of total billed charges,Implant Devices,1171.8,35,,1171.8,percent of total billed charges,Implant Devices,1339.2,40,,1339.2,percent of total billed charges,Implant Devices,1171.8,70,,1171.8,percent of total billed charges,Implant Devices,1138.32,34,,1138.32,percent of total billed charges,Implant Devices,1138.32,34,,1138.32,percent of total billed charges,Implant Devices,1171.8,35,,1171.8,percent of total billed charges,Implant Devices,1171.8,35,,1171.8,percent of total billed charges,Implant Devices,1171.8,35,,1171.8,percent of total billed charges,Implant Devices,1171.8,35,,1171.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1138.32,34,"If Charge > 2,000, then 34 percent",1138.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1339.2,
SOLANA PHG-02P ALLOGRAFT PUTTY,C1713,HCPCS,,79002578,CDM,278,RC,,,both,,,2497,985.49,39.4668,,985.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.98,34,,848.98,percent of total billed charges,Implant Device,848.98,34,,848.98,percent of total billed charges,Implant Device,848.98,34,,848.98,percent of total billed charges,Implant Device,848.98,34,,848.98,percent of total billed charges,Implant Device,848.98,34,,848.98,percent of total billed charges,Implant Device,848.98,34,,848.98,percent of total billed charges,Implant Device,873.95,35,,873.95,percent of total billed charges,Implant Device,848.98,34,"Charges > $500, x 34%",848.98,percent of total billed charges,Implant Device,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,998.8,40,,998.8,percent of total billed charges,Implant Devices,873.95,70,,873.95,percent of total billed charges,Implant Devices,848.98,34,,848.98,percent of total billed charges,Implant Devices,848.98,34,,848.98,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.98,34,"If Charge > 2,000, then 34 percent",848.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.8,
SOLANA PHG-10C ALLOGRAFT CRUSH,C1713,HCPCS,,79002579,CDM,278,RC,,,both,,,8506,3357.05,39.4668,,3357.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2892.04,34,,2892.04,percent of total billed charges,Implant Device,2892.04,34,,2892.04,percent of total billed charges,Implant Device,2892.04,34,,2892.04,percent of total billed charges,Implant Device,2892.04,34,,2892.04,percent of total billed charges,Implant Device,2892.04,34,,2892.04,percent of total billed charges,Implant Device,2892.04,34,,2892.04,percent of total billed charges,Implant Device,2977.1,35,,2977.1,percent of total billed charges,Implant Device,2892.04,34,"Charges > $500, x 34%",2892.04,percent of total billed charges,Implant Device,2977.1,35,,2977.1,percent of total billed charges,Implant Devices,2977.1,35,,2977.1,percent of total billed charges,Implant Devices,2977.1,35,,,percent of total billed charges,Implant Devices,2977.1,35,,2977.1,percent of total billed charges,Implant Devices,2977.1,35,,2977.1,percent of total billed charges,Implant Devices,3402.4,40,,3402.4,percent of total billed charges,Implant Devices,2977.1,70,,2977.1,percent of total billed charges,Implant Devices,2892.04,34,,2892.04,percent of total billed charges,Implant Devices,2892.04,34,,2892.04,percent of total billed charges,Implant Devices,2977.1,35,,2977.1,percent of total billed charges,Implant Devices,2977.1,35,,2977.1,percent of total billed charges,Implant Devices,2977.1,35,,2977.1,percent of total billed charges,Implant Devices,2977.1,35,,2977.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2892.04,34,"If Charge > 2,000, then 34 percent",2892.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3402.4,
WRIGHT MEDICAL SCN403232 SCREW,C1713,HCPCS,,79002605,CDM,278,RC,,,both,,,952,375.72,39.4668,,375.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,323.68,34,,323.68,percent of total billed charges,Implant Device,323.68,34,,323.68,percent of total billed charges,Implant Device,323.68,34,,323.68,percent of total billed charges,Implant Device,323.68,34,,323.68,percent of total billed charges,Implant Device,323.68,34,,323.68,percent of total billed charges,Implant Device,323.68,34,,323.68,percent of total billed charges,Implant Device,333.2,35,,333.2,percent of total billed charges,Implant Device,323.68,34,"Charges > $500, x 34%",323.68,percent of total billed charges,Implant Device,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,380.8,40,,380.8,percent of total billed charges,Implant Devices,333.2,70,,333.2,percent of total billed charges,Implant Devices,323.68,34,,323.68,percent of total billed charges,Implant Devices,323.68,34,,323.68,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,380.8,
BIOMET 63027 SCREW,C1713,HCPCS,,79002608,CDM,278,RC,,,both,,,1044,412.03,39.4668,,412.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,354.96,34,,354.96,percent of total billed charges,Implant Device,354.96,34,,354.96,percent of total billed charges,Implant Device,354.96,34,,354.96,percent of total billed charges,Implant Device,354.96,34,,354.96,percent of total billed charges,Implant Device,354.96,34,,354.96,percent of total billed charges,Implant Device,354.96,34,,354.96,percent of total billed charges,Implant Device,365.4,35,,365.4,percent of total billed charges,Implant Device,354.96,34,"Charges > $500, x 34%",354.96,percent of total billed charges,Implant Device,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,417.6,40,,417.6,percent of total billed charges,Implant Devices,365.4,70,,365.4,percent of total billed charges,Implant Devices,354.96,34,,354.96,percent of total billed charges,Implant Devices,354.96,34,,354.96,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,365.4,35,,365.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,417.6,
SOLANO SFT-2011 SCREW,C1713,HCPCS,,79002611,CDM,278,RC,,,both,,,1380,544.64,39.4668,,544.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Device,469.2,34,"Charges > $500, x 34%",469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,552,40,,552,percent of total billed charges,Implant Devices,483,70,,483,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552,
ARTHREX TFF-2718 ALLOGRAFT,C1713,HCPCS,,79002614,CDM,278,RC,,,both,,,3557,1403.83,39.4668,,1403.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1244.95,35,,1244.95,percent of total billed charges,Implant Device,1209.38,34,"Charges > $500, x 34%",1209.38,percent of total billed charges,Implant Device,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1422.8,40,,1422.8,percent of total billed charges,Implant Devices,1244.95,70,,1244.95,percent of total billed charges,Implant Devices,1209.38,34,,1209.38,percent of total billed charges,Implant Devices,1209.38,34,,1209.38,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1209.38,34,"If Charge > 2,000, then 34 percent",1209.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1422.8,
ARTHREX TFF-2718A ALLOGRAFT,C1713,HCPCS,,79002615,CDM,278,RC,,,both,,,3556,1403.44,39.4668,,1403.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1209.04,34,,1209.04,percent of total billed charges,Implant Device,1209.04,34,,1209.04,percent of total billed charges,Implant Device,1209.04,34,,1209.04,percent of total billed charges,Implant Device,1209.04,34,,1209.04,percent of total billed charges,Implant Device,1209.04,34,,1209.04,percent of total billed charges,Implant Device,1209.04,34,,1209.04,percent of total billed charges,Implant Device,1244.6,35,,1244.6,percent of total billed charges,Implant Device,1209.04,34,"Charges > $500, x 34%",1209.04,percent of total billed charges,Implant Device,1244.6,35,,1244.6,percent of total billed charges,Implant Devices,1244.6,35,,1244.6,percent of total billed charges,Implant Devices,1244.6,35,,,percent of total billed charges,Implant Devices,1244.6,35,,1244.6,percent of total billed charges,Implant Devices,1244.6,35,,1244.6,percent of total billed charges,Implant Devices,1422.4,40,,1422.4,percent of total billed charges,Implant Devices,1244.6,70,,1244.6,percent of total billed charges,Implant Devices,1209.04,34,,1209.04,percent of total billed charges,Implant Devices,1209.04,34,,1209.04,percent of total billed charges,Implant Devices,1244.6,35,,1244.6,percent of total billed charges,Implant Devices,1244.6,35,,1244.6,percent of total billed charges,Implant Devices,1244.6,35,,1244.6,percent of total billed charges,Implant Devices,1244.6,35,,1244.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1209.04,34,"If Charge > 2,000, then 34 percent",1209.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1422.4,
SOLANA TSS-05CC SPONGE FILLER,C1713,HCPCS,,79002617,CDM,278,RC,,,both,,,3847,1518.29,39.4668,,1518.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1346.45,35,,1346.45,percent of total billed charges,Implant Device,1307.98,34,"Charges > $500, x 34%",1307.98,percent of total billed charges,Implant Device,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1538.8,40,,1538.8,percent of total billed charges,Implant Devices,1346.45,70,,1346.45,percent of total billed charges,Implant Devices,1307.98,34,,1307.98,percent of total billed charges,Implant Devices,1307.98,34,,1307.98,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1307.98,34,"If Charge > 2,000, then 34 percent",1307.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1538.8,
STRYKER ORTHO 3125-1180S NAIL 11X180MM,C1713,HCPCS,,79002804,CDM,278,RC,,,both,,,5274,2081.48,39.4668,,2081.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1793.16,34,,1793.16,percent of total billed charges,Implant Device,1793.16,34,,1793.16,percent of total billed charges,Implant Device,1793.16,34,,1793.16,percent of total billed charges,Implant Device,1793.16,34,,1793.16,percent of total billed charges,Implant Device,1793.16,34,,1793.16,percent of total billed charges,Implant Device,1793.16,34,,1793.16,percent of total billed charges,Implant Device,1845.9,35,,1845.9,percent of total billed charges,Implant Device,1793.16,34,"Charges > $500, x 34%",1793.16,percent of total billed charges,Implant Device,1845.9,35,,1845.9,percent of total billed charges,Implant Devices,1845.9,35,,1845.9,percent of total billed charges,Implant Devices,1845.9,35,,,percent of total billed charges,Implant Devices,1845.9,35,,1845.9,percent of total billed charges,Implant Devices,1845.9,35,,1845.9,percent of total billed charges,Implant Devices,2109.6,40,,2109.6,percent of total billed charges,Implant Devices,1845.9,70,,1845.9,percent of total billed charges,Implant Devices,1793.16,34,,1793.16,percent of total billed charges,Implant Devices,1793.16,34,,1793.16,percent of total billed charges,Implant Devices,1845.9,35,,1845.9,percent of total billed charges,Implant Devices,1845.9,35,,1845.9,percent of total billed charges,Implant Devices,1845.9,35,,1845.9,percent of total billed charges,Implant Devices,1845.9,35,,1845.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1793.16,34,"If Charge > 2,000, then 34 percent",1793.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2109.6,
STRYKER ORTHO 3060-0100S SCREW 10.5X100M,C1713,HCPCS,,79002807,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
STRYKER ORTHO 1896-5032S SCREW 5X32/5MM,C1713,HCPCS,,79002808,CDM,278,RC,,,both,,,355,140.11,39.4668,,140.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,142,40,,142,percent of total billed charges,Implant Devices,124.25,70,,124.25,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142,
ZIMMER 00-5980-037-01-REV PLATE SZ3,C1713,HCPCS,,79002813,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 00-5901-020-00-REV DRILL PIN,C1713,HCPCS,,79002819,CDM,278,RC,,,both,,,257,101.43,39.4668,,101.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.38,34,,87.38,percent of total billed charges,Implant Device,87.38,34,,87.38,percent of total billed charges,Implant Device,87.38,34,,87.38,percent of total billed charges,Implant Device,87.38,34,,87.38,percent of total billed charges,Implant Device,87.38,34,,87.38,percent of total billed charges,Implant Device,87.38,34,,87.38,percent of total billed charges,Implant Device,89.95,35,,89.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,102.8,40,,102.8,percent of total billed charges,Implant Devices,89.95,70,,89.95,percent of total billed charges,Implant Devices,87.38,34,,87.38,percent of total billed charges,Implant Devices,87.38,34,,87.38,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.8,
ARTHREX AR-1360C BIOCOMP SCREW 6X23MM,C1713,HCPCS,,79002820,CDM,278,RC,,,both,,,966,381.25,39.4668,,381.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Device,328.44,34,"Charges > $500, x 34%",328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,386.4,40,,386.4,percent of total billed charges,Implant Devices,338.1,70,,338.1,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,386.4,
SOLANA SURGICAL TFF-2718A TENFUSE 2.7X18,C1713,HCPCS,,79002825,CDM,278,RC,,,both,,,3557,1403.83,39.4668,,1403.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1244.95,35,,1244.95,percent of total billed charges,Implant Device,1209.38,34,"Charges > $500, x 34%",1209.38,percent of total billed charges,Implant Device,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1422.8,40,,1422.8,percent of total billed charges,Implant Devices,1244.95,70,,1244.95,percent of total billed charges,Implant Devices,1209.38,34,,1209.38,percent of total billed charges,Implant Devices,1209.38,34,,1209.38,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1209.38,34,"If Charge > 2,000, then 34 percent",1209.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1422.8,
SOLANA SURGICAL SFT-2012 SCREW 12MM,C1713,HCPCS,,79002826,CDM,278,RC,,,both,,,1161,458.21,39.4668,,458.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,394.74,34,,394.74,percent of total billed charges,Implant Device,394.74,34,,394.74,percent of total billed charges,Implant Device,394.74,34,,394.74,percent of total billed charges,Implant Device,394.74,34,,394.74,percent of total billed charges,Implant Device,394.74,34,,394.74,percent of total billed charges,Implant Device,394.74,34,,394.74,percent of total billed charges,Implant Device,406.35,35,,406.35,percent of total billed charges,Implant Device,394.74,34,"Charges > $500, x 34%",394.74,percent of total billed charges,Implant Device,406.35,35,,406.35,percent of total billed charges,Implant Devices,406.35,35,,406.35,percent of total billed charges,Implant Devices,406.35,35,,,percent of total billed charges,Implant Devices,406.35,35,,406.35,percent of total billed charges,Implant Devices,406.35,35,,406.35,percent of total billed charges,Implant Devices,464.4,40,,464.4,percent of total billed charges,Implant Devices,406.35,70,,406.35,percent of total billed charges,Implant Devices,394.74,34,,394.74,percent of total billed charges,Implant Devices,394.74,34,,394.74,percent of total billed charges,Implant Devices,406.35,35,,406.35,percent of total billed charges,Implant Devices,406.35,35,,406.35,percent of total billed charges,Implant Devices,406.35,35,,406.35,percent of total billed charges,Implant Devices,406.35,35,,406.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,464.4,
SOLANA SURGICAL SFT-1003 PIN 1.1X100MM,C1713,HCPCS,,79002827,CDM,278,RC,,,both,,,203,80.12,39.4668,,80.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,71.05,35,,71.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,81.2,40,,81.2,percent of total billed charges,Implant Devices,71.05,70,,71.05,percent of total billed charges,Implant Devices,69.02,34,,69.02,percent of total billed charges,Implant Devices,69.02,34,,69.02,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,81.2,
LIFE NET VG2C-T46P CERVICAL BONE GRAFT,C1713,HCPCS,,79002828,CDM,278,RC,,,both,,,3516,1387.65,39.4668,,1387.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1230.6,35,,1230.6,percent of total billed charges,Implant Device,1195.44,34,"Charges > $500, x 34%",1195.44,percent of total billed charges,Implant Device,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1406.4,40,,1406.4,percent of total billed charges,Implant Devices,1230.6,70,,1230.6,percent of total billed charges,Implant Devices,1195.44,34,,1195.44,percent of total billed charges,Implant Devices,1195.44,34,,1195.44,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1195.44,34,"If Charge > 2,000, then 34 percent",1195.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1406.4,
ARTHREX AR-1547BC TENOD SCREW 4.75X15MM,C1713,HCPCS,,79002829,CDM,278,RC,,,both,,,1036,408.88,39.4668,,408.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Device,352.24,34,"Charges > $500, x 34%",352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,414.4,40,,414.4,percent of total billed charges,Implant Devices,362.6,70,,362.6,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,414.4,
ZIMMER 00-5938-040-48 HEADED SCREW,C1713,HCPCS,,79002830,CDM,278,RC,,,both,,,348,137.34,39.4668,,137.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.32,34,,118.32,percent of total billed charges,Implant Device,118.32,34,,118.32,percent of total billed charges,Implant Device,118.32,34,,118.32,percent of total billed charges,Implant Device,118.32,34,,118.32,percent of total billed charges,Implant Device,118.32,34,,118.32,percent of total billed charges,Implant Device,118.32,34,,118.32,percent of total billed charges,Implant Device,121.8,35,,121.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,139.2,40,,139.2,percent of total billed charges,Implant Devices,121.8,70,,121.8,percent of total billed charges,Implant Devices,118.32,34,,118.32,percent of total billed charges,Implant Devices,118.32,34,,118.32,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.2,
ARTHREX AR-8944CL-S STD LT MTP PLATE,C1713,HCPCS,,79002831,CDM,278,RC,,,both,,,2909,1148.09,39.4668,,1148.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,989.06,34,,989.06,percent of total billed charges,Implant Device,989.06,34,,989.06,percent of total billed charges,Implant Device,989.06,34,,989.06,percent of total billed charges,Implant Device,989.06,34,,989.06,percent of total billed charges,Implant Device,989.06,34,,989.06,percent of total billed charges,Implant Device,989.06,34,,989.06,percent of total billed charges,Implant Device,1018.15,35,,1018.15,percent of total billed charges,Implant Device,989.06,34,"Charges > $500, x 34%",989.06,percent of total billed charges,Implant Device,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1163.6,40,,1163.6,percent of total billed charges,Implant Devices,1018.15,70,,1018.15,percent of total billed charges,Implant Devices,989.06,34,,989.06,percent of total billed charges,Implant Devices,989.06,34,,989.06,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,989.06,34,"If Charge > 2,000, then 34 percent",989.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1163.6,
ARTHREX AR-8933-32PT CANN SCREW 3.0X32MM,C1713,HCPCS,,79002832,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
ARTHREX AR-8933-34PT CANN SCREW 3.0X34MM,C1713,HCPCS,,79002833,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
ARTHREX AR-8933-36PT CANN SCREW 3.0X36MM,C1713,HCPCS,,79002834,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
ARTHREX AR-8933-16 SCREW 3.0X16MM,C1713,HCPCS,,79002835,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
BIOMET 14285 BONE SCREW 5MM,C1713,HCPCS,,79002836,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
BIOMET SD50-15050 BONE SCREW 5MM,C1713,HCPCS,,79002837,CDM,278,RC,,,both,,,720,284.16,39.4668,,284.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Device,244.8,34,"Charges > $500, x 34%",244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,288,40,,288,percent of total billed charges,Implant Devices,252,70,,252,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,288,
BIOMET 14180 CARBON RODS 350 MM,C1713,HCPCS,,79002838,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
BIOMET 14600 CLAMP BAR TO BAR,C1713,HCPCS,,79002840,CDM,278,RC,,,both,,,3120,1231.36,39.4668,,1231.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1060.8,34,,1060.8,percent of total billed charges,Implant Device,1060.8,34,,1060.8,percent of total billed charges,Implant Device,1060.8,34,,1060.8,percent of total billed charges,Implant Device,1060.8,34,,1060.8,percent of total billed charges,Implant Device,1060.8,34,,1060.8,percent of total billed charges,Implant Device,1060.8,34,,1060.8,percent of total billed charges,Implant Device,1092,35,,1092,percent of total billed charges,Implant Device,1060.8,34,"Charges > $500, x 34%",1060.8,percent of total billed charges,Implant Device,1092,35,,1092,percent of total billed charges,Implant Devices,1092,35,,1092,percent of total billed charges,Implant Devices,1092,35,,,percent of total billed charges,Implant Devices,1092,35,,1092,percent of total billed charges,Implant Devices,1092,35,,1092,percent of total billed charges,Implant Devices,1248,40,,1248,percent of total billed charges,Implant Devices,1092,70,,1092,percent of total billed charges,Implant Devices,1060.8,34,,1060.8,percent of total billed charges,Implant Devices,1060.8,34,,1060.8,percent of total billed charges,Implant Devices,1092,35,,1092,percent of total billed charges,Implant Devices,1092,35,,1092,percent of total billed charges,Implant Devices,1092,35,,1092,percent of total billed charges,Implant Devices,1092,35,,1092,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1060.8,34,"If Charge > 2,000, then 34 percent",1060.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1248,
BIOMET 14060 CLAMP 3 HOLE,C1713,HCPCS,,79002841,CDM,278,RC,,,both,,,2730,1077.44,39.4668,,1077.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,928.2,34,,928.2,percent of total billed charges,Implant Device,928.2,34,,928.2,percent of total billed charges,Implant Device,928.2,34,,928.2,percent of total billed charges,Implant Device,928.2,34,,928.2,percent of total billed charges,Implant Device,928.2,34,,928.2,percent of total billed charges,Implant Device,928.2,34,,928.2,percent of total billed charges,Implant Device,955.5,35,,955.5,percent of total billed charges,Implant Device,928.2,34,"Charges > $500, x 34%",928.2,percent of total billed charges,Implant Device,955.5,35,,955.5,percent of total billed charges,Implant Devices,955.5,35,,955.5,percent of total billed charges,Implant Devices,955.5,35,,,percent of total billed charges,Implant Devices,955.5,35,,955.5,percent of total billed charges,Implant Devices,955.5,35,,955.5,percent of total billed charges,Implant Devices,1092,40,,1092,percent of total billed charges,Implant Devices,955.5,70,,955.5,percent of total billed charges,Implant Devices,928.2,34,,928.2,percent of total billed charges,Implant Devices,928.2,34,,928.2,percent of total billed charges,Implant Devices,955.5,35,,955.5,percent of total billed charges,Implant Devices,955.5,35,,955.5,percent of total billed charges,Implant Devices,955.5,35,,955.5,percent of total billed charges,Implant Devices,955.5,35,,955.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,928.2,34,"If Charge > 2,000, then 34 percent",928.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1092,
BIOMET 14-400065 POST 3/5,C1713,HCPCS,,79002842,CDM,278,RC,,,both,,,1110,438.08,39.4668,,438.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Device,377.4,34,"Charges > $500, x 34%",377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,444,40,,444,percent of total billed charges,Implant Devices,388.5,70,,388.5,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,444,
ARTHREX AR-1934-BCF-24-2 SUTURE TAK,C1713,HCPCS,,79002847,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
ZIMMER 00-5983-040-48-REV HEADED SCREW,C1713,HCPCS,,79002850,CDM,278,RC,,,both,,,237,93.54,39.4668,,93.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,80.58,34,,80.58,percent of total billed charges,Implant Device,80.58,34,,80.58,percent of total billed charges,Implant Device,80.58,34,,80.58,percent of total billed charges,Implant Device,80.58,34,,80.58,percent of total billed charges,Implant Device,80.58,34,,80.58,percent of total billed charges,Implant Device,80.58,34,,80.58,percent of total billed charges,Implant Device,82.95,35,,82.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,94.8,40,,94.8,percent of total billed charges,Implant Devices,82.95,70,,82.95,percent of total billed charges,Implant Devices,80.58,34,,80.58,percent of total billed charges,Implant Devices,80.58,34,,80.58,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,94.8,
BIOMET 45-5537 LORDOTIC CERVICAL SPACER,C1713,HCPCS,,79002851,CDM,278,RC,,,both,,,3724,1469.74,39.4668,,1469.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1266.16,34,,1266.16,percent of total billed charges,Implant Device,1303.4,35,,1303.4,percent of total billed charges,Implant Device,1266.16,34,"Charges > $500, x 34%",1266.16,percent of total billed charges,Implant Device,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1489.6,40,,1489.6,percent of total billed charges,Implant Devices,1303.4,70,,1303.4,percent of total billed charges,Implant Devices,1266.16,34,,1266.16,percent of total billed charges,Implant Devices,1266.16,34,,1266.16,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,1303.4,35,,1303.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1266.16,34,"If Charge > 2,000, then 34 percent",1266.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1489.6,
BIOMET 14-522234 SLEEVE PLATE 34MM,C1713,HCPCS,,79002852,CDM,278,RC,,,both,,,6761,2668.35,39.4668,,2668.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2298.74,34,,2298.74,percent of total billed charges,Implant Device,2298.74,34,,2298.74,percent of total billed charges,Implant Device,2298.74,34,,2298.74,percent of total billed charges,Implant Device,2298.74,34,,2298.74,percent of total billed charges,Implant Device,2298.74,34,,2298.74,percent of total billed charges,Implant Device,2298.74,34,,2298.74,percent of total billed charges,Implant Device,2366.35,35,,2366.35,percent of total billed charges,Implant Device,2298.74,34,"Charges > $500, x 34%",2298.74,percent of total billed charges,Implant Device,2366.35,35,,2366.35,percent of total billed charges,Implant Devices,2366.35,35,,2366.35,percent of total billed charges,Implant Devices,2366.35,35,,,percent of total billed charges,Implant Devices,2366.35,35,,2366.35,percent of total billed charges,Implant Devices,2366.35,35,,2366.35,percent of total billed charges,Implant Devices,2704.4,40,,2704.4,percent of total billed charges,Implant Devices,2366.35,70,,2366.35,percent of total billed charges,Implant Devices,2298.74,34,,2298.74,percent of total billed charges,Implant Devices,2298.74,34,,2298.74,percent of total billed charges,Implant Devices,2366.35,35,,2366.35,percent of total billed charges,Implant Devices,2366.35,35,,2366.35,percent of total billed charges,Implant Devices,2366.35,35,,2366.35,percent of total billed charges,Implant Devices,2366.35,35,,2366.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2298.74,34,"If Charge > 2,000, then 34 percent",2298.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2704.4,
BIOMET 14-521614 VARIABLE SCREW,C1713,HCPCS,,79002853,CDM,278,RC,,,both,,,1369,540.3,39.4668,,540.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,465.46,34,,465.46,percent of total billed charges,Implant Device,465.46,34,,465.46,percent of total billed charges,Implant Device,465.46,34,,465.46,percent of total billed charges,Implant Device,465.46,34,,465.46,percent of total billed charges,Implant Device,465.46,34,,465.46,percent of total billed charges,Implant Device,465.46,34,,465.46,percent of total billed charges,Implant Device,479.15,35,,479.15,percent of total billed charges,Implant Device,465.46,34,"Charges > $500, x 34%",465.46,percent of total billed charges,Implant Device,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,547.6,40,,547.6,percent of total billed charges,Implant Devices,479.15,70,,479.15,percent of total billed charges,Implant Devices,465.46,34,,465.46,percent of total billed charges,Implant Devices,465.46,34,,465.46,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,547.6,
BIOMET 14-521612 VARIABLE SCREW 4X12MM,C1713,HCPCS,,79002854,CDM,278,RC,,,both,,,1369,540.3,39.4668,,540.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,465.46,34,,465.46,percent of total billed charges,Implant Device,465.46,34,,465.46,percent of total billed charges,Implant Device,465.46,34,,465.46,percent of total billed charges,Implant Device,465.46,34,,465.46,percent of total billed charges,Implant Device,465.46,34,,465.46,percent of total billed charges,Implant Device,465.46,34,,465.46,percent of total billed charges,Implant Device,479.15,35,,479.15,percent of total billed charges,Implant Device,465.46,34,"Charges > $500, x 34%",465.46,percent of total billed charges,Implant Device,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,547.6,40,,547.6,percent of total billed charges,Implant Devices,479.15,70,,479.15,percent of total billed charges,Implant Devices,465.46,34,,465.46,percent of total billed charges,Implant Devices,465.46,34,,465.46,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,479.15,35,,479.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,547.6,
STRYKER 1830-0001S COMP SCREW 6X13.5MM,C1713,HCPCS,,79002883,CDM,278,RC,,,both,,,668,263.64,39.4668,,263.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,233.8,35,,233.8,percent of total billed charges,Implant Device,227.12,34,"Charges > $500, x 34%",227.12,percent of total billed charges,Implant Device,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,267.2,40,,267.2,percent of total billed charges,Implant Devices,233.8,70,,233.8,percent of total billed charges,Implant Devices,227.12,34,,227.12,percent of total billed charges,Implant Devices,227.12,34,,227.12,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,267.2,
STRYKER 1896-4026S LOCKING SCREW 4X26MM,C1713,HCPCS,,79002884,CDM,278,RC,,,both,,,447,176.42,39.4668,,176.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,156.45,35,,156.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,178.8,40,,178.8,percent of total billed charges,Implant Devices,156.45,70,,156.45,percent of total billed charges,Implant Devices,151.98,34,,151.98,percent of total billed charges,Implant Devices,151.98,34,,151.98,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.8,
STRYKER 1891-4032S LOCKING SCREW 4X32MM,C1713,HCPCS,,79002885,CDM,278,RC,,,both,,,668,263.64,39.4668,,263.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,233.8,35,,233.8,percent of total billed charges,Implant Device,227.12,34,"Charges > $500, x 34%",227.12,percent of total billed charges,Implant Device,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,267.2,40,,267.2,percent of total billed charges,Implant Devices,233.8,70,,233.8,percent of total billed charges,Implant Devices,227.12,34,,227.12,percent of total billed charges,Implant Devices,227.12,34,,227.12,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,267.2,
ARTHREX AR-8926T TITANIUM TIGHTROPE,C1713,HCPCS,,79002915,CDM,278,RC,,,both,,,2640,1041.92,39.4668,,1041.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,924,35,,924,percent of total billed charges,Implant Device,897.6,34,"Charges > $500, x 34%",897.6,percent of total billed charges,Implant Device,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,1056,40,,1056,percent of total billed charges,Implant Devices,924,70,,924,percent of total billed charges,Implant Devices,897.6,34,,897.6,percent of total billed charges,Implant Devices,897.6,34,,897.6,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,897.6,34,"If Charge > 2,000, then 34 percent",897.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1056,
SOLANA SFT-2013 SOLAFIX SCREW 2.0X13MM,C1713,HCPCS,,79002916,CDM,278,RC,,,both,,,3496,1379.76,39.4668,,1379.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1223.6,35,,1223.6,percent of total billed charges,Implant Device,1188.64,34,"Charges > $500, x 34%",1188.64,percent of total billed charges,Implant Device,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1398.4,40,,1398.4,percent of total billed charges,Implant Devices,1223.6,70,,1223.6,percent of total billed charges,Implant Devices,1188.64,34,,1188.64,percent of total billed charges,Implant Devices,1188.64,34,,1188.64,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1188.64,34,"If Charge > 2,000, then 34 percent",1188.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1398.4,
ARTHREX AR-1580BC SCREW 8X23MM,C1713,HCPCS,,79002917,CDM,278,RC,,,both,,,1035,408.48,39.4668,,408.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,362.25,35,,362.25,percent of total billed charges,Implant Device,351.9,34,"Charges > $500, x 34%",351.9,percent of total billed charges,Implant Device,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,414,40,,414,percent of total billed charges,Implant Devices,362.25,70,,362.25,percent of total billed charges,Implant Devices,351.9,34,,351.9,percent of total billed charges,Implant Devices,351.9,34,,351.9,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,414,
ALAMO TISSUE AT292FF BONE TENDON BONE,C1713,HCPCS,,79002918,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
ARTHREX AR-8952MS-05 PLATE STRT 5 HOLE,C1713,HCPCS,,79002919,CDM,278,RC,,,both,,,2086,823.28,39.4668,,823.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,730.1,35,,730.1,percent of total billed charges,Implant Device,709.24,34,"Charges > $500, x 34%",709.24,percent of total billed charges,Implant Device,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,834.4,40,,834.4,percent of total billed charges,Implant Devices,730.1,70,,730.1,percent of total billed charges,Implant Devices,709.24,34,,709.24,percent of total billed charges,Implant Devices,709.24,34,,709.24,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,709.24,34,"If Charge > 2,000, then 34 percent",709.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834.4,
ARTHREX AR-8724-18 SCREW 2.4X18MM,C1713,HCPCS,,79002920,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8724-20 SCREW 2.4X20MM,C1713,HCPCS,,79002921,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8924-22 SCREW 2.4X22MM,C1713,HCPCS,,79002922,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ARTHREX AR-1380BC BIOCOMP SCREW 8X23MM,C1713,HCPCS,,79002935,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
STRYKER 6197-9-010 CEMENT W/TOBRAMYCIN,C1713,HCPCS,,79002944,CDM,278,RC,,,both,,,786,310.21,39.4668,,310.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,267.24,34,,267.24,percent of total billed charges,Implant Device,267.24,34,,267.24,percent of total billed charges,Implant Device,267.24,34,,267.24,percent of total billed charges,Implant Device,267.24,34,,267.24,percent of total billed charges,Implant Device,267.24,34,,267.24,percent of total billed charges,Implant Device,267.24,34,,267.24,percent of total billed charges,Implant Device,275.1,35,,275.1,percent of total billed charges,Implant Device,267.24,34,"Charges > $500, x 34%",267.24,percent of total billed charges,Implant Device,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,314.4,40,,314.4,percent of total billed charges,Implant Devices,275.1,70,,275.1,percent of total billed charges,Implant Devices,267.24,34,,267.24,percent of total billed charges,Implant Devices,267.24,34,,267.24,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,275.1,35,,275.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,314.4,
SYNTHES 201.810 2.0 CORTEX SCREW 10MM,C1713,HCPCS,,79002958,CDM,278,RC,,,both,,,83,32.76,39.4668,,32.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,33.2,40,,33.2,percent of total billed charges,Implant Devices,29.05,70,,29.05,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.2,
SYNTHES 201.812 2.0 CORTEX SCREW 12MM,C1713,HCPCS,,79002959,CDM,278,RC,,,both,,,83,32.76,39.4668,,32.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,33.2,40,,33.2,percent of total billed charges,Implant Devices,29.05,70,,29.05,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.2,
SYNTHES 201.814 2.0 CORTEX SCREW 14MM,C1713,HCPCS,,79002960,CDM,278,RC,,,both,,,83,32.76,39.4668,,32.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,33.2,40,,33.2,percent of total billed charges,Implant Devices,29.05,70,,29.05,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.2,
ARTHREX AR-1555BC TENODESIS SCREW 5.5X15,C1713,HCPCS,,79002976,CDM,278,RC,,,both,,,1036,408.88,39.4668,,408.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Device,352.24,34,"Charges > $500, x 34%",352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,414.4,40,,414.4,percent of total billed charges,Implant Devices,362.6,70,,362.6,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,414.4,
ARTHREX AR-2656DL CLAVICLE LOCKING PLATE,C1713,HCPCS,,79002978,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ARTHREX AR-8827L-18 LOCKING SCREW 2.7X18,C1713,HCPCS,,79002979,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ARTHREX AR-8827L-20 LOCKING SCREW 2.7X20,C1713,HCPCS,,79002980,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ARTHREX AR-8835L-14 LOCKING SCREW 3.5X14,C1713,HCPCS,,79002981,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ARTHREX AR-8835-12 SCREW 2.5X12MM,C1713,HCPCS,,79002982,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ARTHREX AR-8835-14 SCREW 3.5X14MM,C1713,HCPCS,,79002983,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
ARTHREX AR-8830-18 SCREW 3X18MM,C1713,HCPCS,,79002984,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
STRYKER 1830-0001S COM SCREW 6X13.5MM,C1713,HCPCS,,79002994,CDM,278,RC,,,both,,,668,263.64,39.4668,,263.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,233.8,35,,233.8,percent of total billed charges,Implant Device,227.12,34,"Charges > $500, x 34%",227.12,percent of total billed charges,Implant Device,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,267.2,40,,267.2,percent of total billed charges,Implant Devices,233.8,70,,233.8,percent of total billed charges,Implant Devices,227.12,34,,227.12,percent of total billed charges,Implant Devices,227.12,34,,227.12,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,267.2,
STRYKER 1830-0925S HUMERAL NAIL 9X250MM,C1713,HCPCS,,79002995,CDM,278,RC,,,both,,,3489,1377,39.4668,,1377,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1221.15,35,,1221.15,percent of total billed charges,Implant Device,1186.26,34,"Charges > $500, x 34%",1186.26,percent of total billed charges,Implant Device,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1395.6,40,,1395.6,percent of total billed charges,Implant Devices,1221.15,70,,1221.15,percent of total billed charges,Implant Devices,1186.26,34,,1186.26,percent of total billed charges,Implant Devices,1186.26,34,,1186.26,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1186.26,34,"If Charge > 2,000, then 34 percent",1186.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1395.6,
ATLAS SPINE 1106-09-0000 LOCKING COLLAR,C1713,HCPCS,,79003000,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
ATLAS SPINE 1106-05-0000 REDUCTION HEAD,C1713,HCPCS,,79003001,CDM,278,RC,,,both,,,2468,974.04,39.4668,,974.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,839.12,34,,839.12,percent of total billed charges,Implant Device,839.12,34,,839.12,percent of total billed charges,Implant Device,839.12,34,,839.12,percent of total billed charges,Implant Device,839.12,34,,839.12,percent of total billed charges,Implant Device,839.12,34,,839.12,percent of total billed charges,Implant Device,839.12,34,,839.12,percent of total billed charges,Implant Device,863.8,35,,863.8,percent of total billed charges,Implant Device,839.12,34,"Charges > $500, x 34%",839.12,percent of total billed charges,Implant Device,863.8,35,,863.8,percent of total billed charges,Implant Devices,863.8,35,,863.8,percent of total billed charges,Implant Devices,863.8,35,,,percent of total billed charges,Implant Devices,863.8,35,,863.8,percent of total billed charges,Implant Devices,863.8,35,,863.8,percent of total billed charges,Implant Devices,987.2,40,,987.2,percent of total billed charges,Implant Devices,863.8,70,,863.8,percent of total billed charges,Implant Devices,839.12,34,,839.12,percent of total billed charges,Implant Devices,839.12,34,,839.12,percent of total billed charges,Implant Devices,863.8,35,,863.8,percent of total billed charges,Implant Devices,863.8,35,,863.8,percent of total billed charges,Implant Devices,863.8,35,,863.8,percent of total billed charges,Implant Devices,863.8,35,,863.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,839.12,34,"If Charge > 2,000, then 34 percent",839.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,987.2,
ATLAS SPINE 1106-01-6550 SCREW 6.5X50MM,C1713,HCPCS,,79003002,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ATLAS SPINE 1106-01-6555 SCREW 6.5X55MM,C1713,HCPCS,,79003003,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ATLAS SPINE 1100-03-0085 CONTOURED ROD,C1713,HCPCS,,79003004,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
ATLAS SPINE 1106-01-7540 SCREW 7.5X40MM,C1713,HCPCS,,79003005,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
ATLAS SPINE 1100-05-6066 CROSS CONNECTOR,C1713,HCPCS,,79003006,CDM,278,RC,,,both,,,3570,1408.96,39.4668,,1408.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1249.5,35,,1249.5,percent of total billed charges,Implant Device,1213.8,34,"Charges > $500, x 34%",1213.8,percent of total billed charges,Implant Device,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1428,40,,1428,percent of total billed charges,Implant Devices,1249.5,70,,1249.5,percent of total billed charges,Implant Devices,1213.8,34,,1213.8,percent of total billed charges,Implant Devices,1213.8,34,,1213.8,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1213.8,34,"If Charge > 2,000, then 34 percent",1213.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1428,
ATLAS SPINE 1100-03-0070 CONTOURED ROD,C1713,HCPCS,,79003007,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
ATLAS SPINE 1100-05-6672 CROSS CONNECTOR,C1713,HCPCS,,79003008,CDM,278,RC,,,both,,,3570,1408.96,39.4668,,1408.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1249.5,35,,1249.5,percent of total billed charges,Implant Device,1213.8,34,"Charges > $500, x 34%",1213.8,percent of total billed charges,Implant Device,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1428,40,,1428,percent of total billed charges,Implant Devices,1249.5,70,,1249.5,percent of total billed charges,Implant Devices,1213.8,34,,1213.8,percent of total billed charges,Implant Devices,1213.8,34,,1213.8,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1213.8,34,"If Charge > 2,000, then 34 percent",1213.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1428,
ATLAS SPINE 1100-05-5460 CROSS CONNECTOR,C1713,HCPCS,,79003009,CDM,278,RC,,,both,,,3570,1408.96,39.4668,,1408.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1249.5,35,,1249.5,percent of total billed charges,Implant Device,1213.8,34,"Charges > $500, x 34%",1213.8,percent of total billed charges,Implant Device,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1428,40,,1428,percent of total billed charges,Implant Devices,1249.5,70,,1249.5,percent of total billed charges,Implant Devices,1213.8,34,,1213.8,percent of total billed charges,Implant Devices,1213.8,34,,1213.8,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1213.8,34,"If Charge > 2,000, then 34 percent",1213.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1428,
STRYKER 1830-0924S T2 HUMERUS SYSTEM,C1713,HCPCS,,79003013,CDM,278,RC,,,both,,,7061,2786.75,39.4668,,2786.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2400.74,34,,2400.74,percent of total billed charges,Implant Device,2400.74,34,,2400.74,percent of total billed charges,Implant Device,2400.74,34,,2400.74,percent of total billed charges,Implant Device,2400.74,34,,2400.74,percent of total billed charges,Implant Device,2400.74,34,,2400.74,percent of total billed charges,Implant Device,2400.74,34,,2400.74,percent of total billed charges,Implant Device,2471.35,35,,2471.35,percent of total billed charges,Implant Device,2400.74,34,"Charges > $500, x 34%",2400.74,percent of total billed charges,Implant Device,2471.35,35,,2471.35,percent of total billed charges,Implant Devices,2471.35,35,,2471.35,percent of total billed charges,Implant Devices,2471.35,35,,,percent of total billed charges,Implant Devices,2471.35,35,,2471.35,percent of total billed charges,Implant Devices,2471.35,35,,2471.35,percent of total billed charges,Implant Devices,2824.4,40,,2824.4,percent of total billed charges,Implant Devices,2471.35,70,,2471.35,percent of total billed charges,Implant Devices,2400.74,34,,2400.74,percent of total billed charges,Implant Devices,2400.74,34,,2400.74,percent of total billed charges,Implant Devices,2471.35,35,,2471.35,percent of total billed charges,Implant Devices,2471.35,35,,2471.35,percent of total billed charges,Implant Devices,2471.35,35,,2471.35,percent of total billed charges,Implant Devices,2471.35,35,,2471.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2400.74,34,"If Charge > 2,000, then 34 percent",2400.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2824.4,
STRYKER 1896-4040S LOCKING SCREW 4X40MM,C1713,HCPCS,,79003014,CDM,278,RC,,,both,,,836,329.94,39.4668,,329.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,292.6,35,,292.6,percent of total billed charges,Implant Device,284.24,34,"Charges > $500, x 34%",284.24,percent of total billed charges,Implant Device,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,334.4,40,,334.4,percent of total billed charges,Implant Devices,292.6,70,,292.6,percent of total billed charges,Implant Devices,284.24,34,,284.24,percent of total billed charges,Implant Devices,284.24,34,,284.24,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.4,
STRYKER 1896-5035S SCREW LOCKING FT 5X35,C1713,HCPCS,,79003023,CDM,278,RC,,,both,,,355,140.11,39.4668,,140.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,142,40,,142,percent of total billed charges,Implant Devices,124.25,70,,124.25,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142,
STRYKER 3060-0110S SCREW LAG TI 10.5X110,C1713,HCPCS,,79003024,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
STRYKER 3125-1180S NAIL KIT 11X180X125,C1713,HCPCS,,79003025,CDM,278,RC,,,both,,,2928,1155.59,39.4668,,1155.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,1024.8,35,,1024.8,percent of total billed charges,Implant Device,995.52,34,"Charges > $500, x 34%",995.52,percent of total billed charges,Implant Device,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1171.2,40,,1171.2,percent of total billed charges,Implant Devices,1024.8,70,,1024.8,percent of total billed charges,Implant Devices,995.52,34,,995.52,percent of total billed charges,Implant Devices,995.52,34,,995.52,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,995.52,34,"If Charge > 2,000, then 34 percent",995.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1171.2,
ARTHREX ALFEX101 ARTHROFLEX 4X7CM,C1713,HCPCS,,79003026,CDM,278,RC,,,both,,,7517,2966.72,39.4668,,2966.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2630.95,35,,2630.95,percent of total billed charges,Implant Device,2555.78,34,"Charges > $500, x 34%",2555.78,percent of total billed charges,Implant Device,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,3006.8,40,,3006.8,percent of total billed charges,Implant Devices,2630.95,70,,2630.95,percent of total billed charges,Implant Devices,2555.78,34,,2555.78,percent of total billed charges,Implant Devices,2555.78,34,,2555.78,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2555.78,34,"If Charge > 2,000, then 34 percent",2555.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3006.8,
ZIMMER 6624-65-360-REV BONE SCREW,C1713,HCPCS,,79003034,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
EXACTECH 320-20-334 COMPRESSION SCREW 34,C1713,HCPCS,,79003048,CDM,278,RC,,,both,,,406,160.24,39.4668,,160.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,142.1,35,,142.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,162.4,40,,162.4,percent of total billed charges,Implant Devices,142.1,70,,142.1,percent of total billed charges,Implant Devices,138.04,34,,138.04,percent of total billed charges,Implant Devices,138.04,34,,138.04,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,162.4,
EXACTECH 320-20-30 COMPRESSION SCREW 30,C1713,HCPCS,,79003049,CDM,278,RC,,,both,,,406,160.24,39.4668,,160.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,142.1,35,,142.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,162.4,40,,162.4,percent of total billed charges,Implant Devices,142.1,70,,142.1,percent of total billed charges,Implant Devices,138.04,34,,138.04,percent of total billed charges,Implant Devices,138.04,34,,138.04,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,162.4,
EXACTECH 320-20-18 COMPRESSION SCREW 18,C1713,HCPCS,,79003050,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
EXACTECH 320-20-26 COMPRESSION SCREW 26,C1713,HCPCS,,79003051,CDM,278,RC,,,both,,,406,160.24,39.4668,,160.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,142.1,35,,142.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,162.4,40,,162.4,percent of total billed charges,Implant Devices,142.1,70,,142.1,percent of total billed charges,Implant Devices,138.04,34,,138.04,percent of total billed charges,Implant Devices,138.04,34,,138.04,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,162.4,
EXACTECH 320-15-05 GLENOSPHERE LOCK SCRW,C1713,HCPCS,,79003052,CDM,278,RC,,,both,,,406,160.24,39.4668,,160.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,142.1,35,,142.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,162.4,40,,162.4,percent of total billed charges,Implant Devices,142.1,70,,142.1,percent of total billed charges,Implant Devices,138.04,34,,138.04,percent of total billed charges,Implant Devices,138.04,34,,138.04,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,162.4,
EXACTECH 320-20-00 REV TORQUE SCREW KIT,C1713,HCPCS,,79003055,CDM,278,RC,,,both,,,1404,554.11,39.4668,,554.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,477.36,34,,477.36,percent of total billed charges,Implant Device,477.36,34,,477.36,percent of total billed charges,Implant Device,477.36,34,,477.36,percent of total billed charges,Implant Device,477.36,34,,477.36,percent of total billed charges,Implant Device,477.36,34,,477.36,percent of total billed charges,Implant Device,477.36,34,,477.36,percent of total billed charges,Implant Device,491.4,35,,491.4,percent of total billed charges,Implant Device,477.36,34,"Charges > $500, x 34%",477.36,percent of total billed charges,Implant Device,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,561.6,40,,561.6,percent of total billed charges,Implant Devices,491.4,70,,491.4,percent of total billed charges,Implant Devices,477.36,34,,477.36,percent of total billed charges,Implant Devices,477.36,34,,477.36,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,561.6,
ARTHREX AR-2324BCM SWIVELOCK 4.75X24.5,C1713,HCPCS,,79003058,CDM,278,RC,,,both,,,1716,677.25,39.4668,,677.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,583.44,34,,583.44,percent of total billed charges,Implant Device,583.44,34,,583.44,percent of total billed charges,Implant Device,583.44,34,,583.44,percent of total billed charges,Implant Device,583.44,34,,583.44,percent of total billed charges,Implant Device,583.44,34,,583.44,percent of total billed charges,Implant Device,583.44,34,,583.44,percent of total billed charges,Implant Device,600.6,35,,600.6,percent of total billed charges,Implant Device,583.44,34,"Charges > $500, x 34%",583.44,percent of total billed charges,Implant Device,600.6,35,,600.6,percent of total billed charges,Implant Devices,600.6,35,,600.6,percent of total billed charges,Implant Devices,600.6,35,,,percent of total billed charges,Implant Devices,600.6,35,,600.6,percent of total billed charges,Implant Devices,600.6,35,,600.6,percent of total billed charges,Implant Devices,686.4,40,,686.4,percent of total billed charges,Implant Devices,600.6,70,,600.6,percent of total billed charges,Implant Devices,583.44,34,,583.44,percent of total billed charges,Implant Devices,583.44,34,,583.44,percent of total billed charges,Implant Devices,600.6,35,,600.6,percent of total billed charges,Implant Devices,600.6,35,,600.6,percent of total billed charges,Implant Devices,600.6,35,,600.6,percent of total billed charges,Implant Devices,600.6,35,,600.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,686.4,
ARTHREX AR-7000-28 CANN SCREW 3.75X28MM,C1713,HCPCS,,79003059,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ARTHREX AR-7000-32 CANN SCREW 3.75X32MM,C1713,HCPCS,,79003060,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ARTHREX AR-7000-34 CANN SCREW 3.75X34MM,C1713,HCPCS,,79003061,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ALAMO TISSUE AR652FF TIBIALIS TENDON,C1713,HCPCS,,79003065,CDM,278,RC,,,both,,,5700,2249.61,39.4668,,2249.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1938,34,,1938,percent of total billed charges,Implant Device,1938,34,,1938,percent of total billed charges,Implant Device,1938,34,,1938,percent of total billed charges,Implant Device,1938,34,,1938,percent of total billed charges,Implant Device,1938,34,,1938,percent of total billed charges,Implant Device,1938,34,,1938,percent of total billed charges,Implant Device,1995,35,,1995,percent of total billed charges,Implant Device,1938,34,"Charges > $500, x 34%",1938,percent of total billed charges,Implant Device,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,2280,40,,2280,percent of total billed charges,Implant Devices,1995,70,,1995,percent of total billed charges,Implant Devices,1938,34,,1938,percent of total billed charges,Implant Devices,1938,34,,1938,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1938,34,"If Charge > 2,000, then 34 percent",1938,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2280,
STRYKER 6495-9-001 TISSUE MEND 5X6,C1713,HCPCS,,79003066,CDM,278,RC,,,both,,,9137,3606.08,39.4668,,3606.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3106.58,34,,3106.58,percent of total billed charges,Implant Device,3106.58,34,,3106.58,percent of total billed charges,Implant Device,3106.58,34,,3106.58,percent of total billed charges,Implant Device,3106.58,34,,3106.58,percent of total billed charges,Implant Device,3106.58,34,,3106.58,percent of total billed charges,Implant Device,3106.58,34,,3106.58,percent of total billed charges,Implant Device,3197.95,35,,3197.95,percent of total billed charges,Implant Device,3106.58,34,"Charges > $500, x 34%",3106.58,percent of total billed charges,Implant Device,3197.95,35,,3197.95,percent of total billed charges,Implant Devices,3197.95,35,,3197.95,percent of total billed charges,Implant Devices,3197.95,35,,,percent of total billed charges,Implant Devices,3197.95,35,,3197.95,percent of total billed charges,Implant Devices,3197.95,35,,3197.95,percent of total billed charges,Implant Devices,3654.8,40,,3654.8,percent of total billed charges,Implant Devices,3197.95,70,,3197.95,percent of total billed charges,Implant Devices,3106.58,34,,3106.58,percent of total billed charges,Implant Devices,3106.58,34,,3106.58,percent of total billed charges,Implant Devices,3197.95,35,,3197.95,percent of total billed charges,Implant Devices,3197.95,35,,3197.95,percent of total billed charges,Implant Devices,3197.95,35,,3197.95,percent of total billed charges,Implant Devices,3197.95,35,,3197.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3106.58,34,"If Charge > 2,000, then 34 percent",3106.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3654.8,
STRYKER 53-23214E BONE SCREW T7 2.3X14MM,C1713,HCPCS,,79003265,CDM,278,RC,,,both,,,344,135.77,39.4668,,135.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,120.4,35,,120.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,137.6,40,,137.6,percent of total billed charges,Implant Devices,120.4,70,,120.4,percent of total billed charges,Implant Devices,116.96,34,,116.96,percent of total billed charges,Implant Devices,116.96,34,,116.96,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.6,
ARTHREX AR-8730-30PT CANN SCREW 3.0X30MM,C1713,HCPCS,,79003270,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ARTHREX AR-8724-26PT CANN SCREW 2.4X26MM,C1713,HCPCS,,79003271,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ARTHREX AR-13226 BB TAK,C1713,HCPCS,,79003272,CDM,278,RC,,,both,,,163,64.33,39.4668,,64.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,57.05,35,,57.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,65.2,40,,65.2,percent of total billed charges,Implant Devices,57.05,70,,57.05,percent of total billed charges,Implant Devices,55.42,34,,55.42,percent of total billed charges,Implant Devices,55.42,34,,55.42,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,65.2,
ARTHREX AR-8941 LAPIDUS PLATE,C1713,HCPCS,,79003273,CDM,278,RC,,,both,,,1800,710.4,39.4668,,710.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Device,612,34,"Charges > $500, x 34%",612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,720,40,,720,percent of total billed charges,Implant Devices,630,70,,630,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,720,
STRYKER 40-35020 BONE SCREW 3.5X20MM,C1713,HCPCS,,79003283,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
STRYKER 40-35018 BONE SCREW 3.5X18MM,C1713,HCPCS,,79003284,CDM,278,RC,,,both,,,232,91.56,39.4668,,91.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,81.2,35,,81.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,92.8,40,,92.8,percent of total billed charges,Implant Devices,81.2,70,,81.2,percent of total billed charges,Implant Devices,78.88,34,,78.88,percent of total billed charges,Implant Devices,78.88,34,,78.88,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,92.8,
STRYKER 40-35012 BONE SCREW 3.5X12MM,C1713,HCPCS,,79003285,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
STRYKER 40-35014 LOCKING SCREW 3.5X14MM,C1713,HCPCS,,79003286,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
STRYKER 40-35612 LOCKING SCREW 3.5X12MM,C1713,HCPCS,,79003287,CDM,278,RC,,,both,,,379,149.58,39.4668,,149.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,132.65,35,,132.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,151.6,40,,151.6,percent of total billed charges,Implant Devices,132.65,70,,132.65,percent of total billed charges,Implant Devices,128.86,34,,128.86,percent of total billed charges,Implant Devices,128.86,34,,128.86,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,151.6,
STRYKER 604650 CANNULATED SCREW 4X50,C1713,HCPCS,,79003289,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 40-20906 FIBULA PLATE 6 HOLE,C1713,HCPCS,,79003290,CDM,278,RC,,,both,,,1781,702.9,39.4668,,702.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,605.54,34,,605.54,percent of total billed charges,Implant Device,605.54,34,,605.54,percent of total billed charges,Implant Device,605.54,34,,605.54,percent of total billed charges,Implant Device,605.54,34,,605.54,percent of total billed charges,Implant Device,605.54,34,,605.54,percent of total billed charges,Implant Device,605.54,34,,605.54,percent of total billed charges,Implant Device,623.35,35,,623.35,percent of total billed charges,Implant Device,605.54,34,"Charges > $500, x 34%",605.54,percent of total billed charges,Implant Device,623.35,35,,623.35,percent of total billed charges,Implant Devices,623.35,35,,623.35,percent of total billed charges,Implant Devices,623.35,35,,,percent of total billed charges,Implant Devices,623.35,35,,623.35,percent of total billed charges,Implant Devices,623.35,35,,623.35,percent of total billed charges,Implant Devices,712.4,40,,712.4,percent of total billed charges,Implant Devices,623.35,70,,623.35,percent of total billed charges,Implant Devices,605.54,34,,605.54,percent of total billed charges,Implant Devices,605.54,34,,605.54,percent of total billed charges,Implant Devices,623.35,35,,623.35,percent of total billed charges,Implant Devices,623.35,35,,623.35,percent of total billed charges,Implant Devices,623.35,35,,623.35,percent of total billed charges,Implant Devices,623.35,35,,623.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,712.4,
STRYKER 40-20905 FIBULA PLATE 5 HOLE,C1713,HCPCS,,79003291,CDM,278,RC,,,both,,,1867,736.85,39.4668,,736.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,653.45,35,,653.45,percent of total billed charges,Implant Device,634.78,34,"Charges > $500, x 34%",634.78,percent of total billed charges,Implant Device,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,746.8,40,,746.8,percent of total billed charges,Implant Devices,653.45,70,,653.45,percent of total billed charges,Implant Devices,634.78,34,,634.78,percent of total billed charges,Implant Devices,634.78,34,,634.78,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,746.8,
STRYKER 40-35022 BONE SCREW,C1713,HCPCS,,79003292,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
STRYKER 619905 WASHER 4.0,C1713,HCPCS,,79003293,CDM,278,RC,,,both,,,80,31.57,39.4668,,31.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,28,35,,28,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,32,40,,32,percent of total billed charges,Implant Devices,28,70,,28,percent of total billed charges,Implant Devices,27.2,34,,27.2,percent of total billed charges,Implant Devices,27.2,34,,27.2,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32,
STRYKER 40-35612 LOCKING SCREW 3.5X12MM,C1713,HCPCS,,79003294,CDM,278,RC,,,both,,,523,206.41,39.4668,,206.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Device,177.82,34,"Charges > $500, x 34%",177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,209.2,40,,209.2,percent of total billed charges,Implant Devices,183.05,70,,183.05,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.2,
STRYKER 40-35614 LOCKING SCREW 3.5X14MM,C1713,HCPCS,,79003295,CDM,278,RC,,,both,,,379,149.58,39.4668,,149.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,132.65,35,,132.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,151.6,40,,151.6,percent of total billed charges,Implant Devices,132.65,70,,132.65,percent of total billed charges,Implant Devices,128.86,34,,128.86,percent of total billed charges,Implant Devices,128.86,34,,128.86,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,151.6,
STRYKER 40-35616 LOCKING SCREW 3.5X16MM,C1713,HCPCS,,79003296,CDM,278,RC,,,both,,,379,149.58,39.4668,,149.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,132.65,35,,132.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,151.6,40,,151.6,percent of total billed charges,Implant Devices,132.65,70,,132.65,percent of total billed charges,Implant Devices,128.86,34,,128.86,percent of total billed charges,Implant Devices,128.86,34,,128.86,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,151.6,
ZIMMER 00-5791-041-UNI HEADED SCREW 48MM,C1713,HCPCS,,79003297,CDM,278,RC,,,both,,,244,96.3,39.4668,,96.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,85.4,35,,85.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,97.6,40,,97.6,percent of total billed charges,Implant Devices,85.4,70,,85.4,percent of total billed charges,Implant Devices,82.96,34,,82.96,percent of total billed charges,Implant Devices,82.96,34,,82.96,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,97.6,
ZIMMER 00-5791-044-UNI HEADED SCREW 33MM,C1713,HCPCS,,79003298,CDM,278,RC,,,both,,,274,108.14,39.4668,,108.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,95.9,35,,95.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,109.6,40,,109.6,percent of total billed charges,Implant Devices,95.9,70,,95.9,percent of total billed charges,Implant Devices,93.16,34,,93.16,percent of total billed charges,Implant Devices,93.16,34,,93.16,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.6,
BIOMET 14-520510 LORDOTIC SPACR 10X14X12,C1713,HCPCS,,79003303,CDM,278,RC,,,both,,,15120,5967.38,39.4668,,5967.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5292,35,,5292,percent of total billed charges,Implant Device,5140.8,34,"Charges > $500, x 34%",5140.8,percent of total billed charges,Implant Device,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,6048,40,,6048,percent of total billed charges,Implant Devices,5292,70,,5292,percent of total billed charges,Implant Devices,5140.8,34,,5140.8,percent of total billed charges,Implant Devices,5140.8,34,,5140.8,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5140.8,34,"If Charge > 2,000, then 34 percent",5140.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6048,
BIOMET 14-531712 SCREW 3.5X12MM,C1713,HCPCS,,79003304,CDM,278,RC,,,both,,,1080,426.24,39.4668,,426.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,378,35,,378,percent of total billed charges,Implant Device,367.2,34,"Charges > $500, x 34%",367.2,percent of total billed charges,Implant Device,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,432,40,,432,percent of total billed charges,Implant Devices,378,70,,378,percent of total billed charges,Implant Devices,367.2,34,,367.2,percent of total billed charges,Implant Devices,367.2,34,,367.2,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,432,
ARTHREX AR-8935L-14 LOCKING SCREW 3.5X14,C1713,HCPCS,,79003310,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
ARTHREX AR-8935-18 SCREW 3.5X18MM,C1713,HCPCS,,79003311,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-8740-36PTS CANN SCREW 4.0X36,C1713,HCPCS,,79003312,CDM,278,RC,,,both,,,536,211.54,39.4668,,211.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,187.6,35,,187.6,percent of total billed charges,Implant Device,182.24,34,"Charges > $500, x 34%",182.24,percent of total billed charges,Implant Device,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,214.4,40,,214.4,percent of total billed charges,Implant Devices,187.6,70,,187.6,percent of total billed charges,Implant Devices,182.24,34,,182.24,percent of total billed charges,Implant Devices,182.24,34,,182.24,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.4,
STRYKER 0194-2250S FLEX NAIL 2.25X300MM,C1713,HCPCS,,79003314,CDM,278,RC,,,both,,,1124,443.61,39.4668,,443.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.16,34,,382.16,percent of total billed charges,Implant Device,382.16,34,,382.16,percent of total billed charges,Implant Device,382.16,34,,382.16,percent of total billed charges,Implant Device,382.16,34,,382.16,percent of total billed charges,Implant Device,382.16,34,,382.16,percent of total billed charges,Implant Device,382.16,34,,382.16,percent of total billed charges,Implant Device,393.4,35,,393.4,percent of total billed charges,Implant Device,382.16,34,"Charges > $500, x 34%",382.16,percent of total billed charges,Implant Device,393.4,35,,393.4,percent of total billed charges,Implant Devices,393.4,35,,393.4,percent of total billed charges,Implant Devices,393.4,35,,,percent of total billed charges,Implant Devices,393.4,35,,393.4,percent of total billed charges,Implant Devices,393.4,35,,393.4,percent of total billed charges,Implant Devices,449.6,40,,449.6,percent of total billed charges,Implant Devices,393.4,70,,393.4,percent of total billed charges,Implant Devices,382.16,34,,382.16,percent of total billed charges,Implant Devices,382.16,34,,382.16,percent of total billed charges,Implant Devices,393.4,35,,393.4,percent of total billed charges,Implant Devices,393.4,35,,393.4,percent of total billed charges,Implant Devices,393.4,35,,393.4,percent of total billed charges,Implant Devices,393.4,35,,393.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,449.6,
STRYKER 0194-2500S FLEX NAIL 2.5X450MM,C1713,HCPCS,,79003315,CDM,278,RC,,,both,,,966,381.25,39.4668,,381.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Device,328.44,34,"Charges > $500, x 34%",328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,386.4,40,,386.4,percent of total billed charges,Implant Devices,338.1,70,,338.1,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,386.4,
STRYKER 3325-0360S NAIL KIT R2.0 TI LT,C1713,HCPCS,,79003316,CDM,278,RC,,,both,,,5021,1981.63,39.4668,,1981.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1757.35,35,,1757.35,percent of total billed charges,Implant Device,1707.14,34,"Charges > $500, x 34%",1707.14,percent of total billed charges,Implant Device,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,2008.4,40,,2008.4,percent of total billed charges,Implant Devices,1757.35,70,,1757.35,percent of total billed charges,Implant Devices,1707.14,34,,1707.14,percent of total billed charges,Implant Devices,1707.14,34,,1707.14,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1707.14,34,"If Charge > 2,000, then 34 percent",1707.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2008.4,
STRYKER 3060-0090S LAG SCREW 5X90MM,C1713,HCPCS,,79003317,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
STRYKER 1896-5040S LOCK SCREW 5X40MM FT,C1713,HCPCS,,79003318,CDM,278,RC,,,both,,,355,140.11,39.4668,,140.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,142,40,,142,percent of total billed charges,Implant Devices,124.25,70,,124.25,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142,
STRYKER 437324 TIBIA PLATE 4 HOLE RIGHT,C1713,HCPCS,,79003323,CDM,278,RC,,,both,,,5111,2017.15,39.4668,,2017.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1737.74,34,,1737.74,percent of total billed charges,Implant Device,1737.74,34,,1737.74,percent of total billed charges,Implant Device,1737.74,34,,1737.74,percent of total billed charges,Implant Device,1737.74,34,,1737.74,percent of total billed charges,Implant Device,1737.74,34,,1737.74,percent of total billed charges,Implant Device,1737.74,34,,1737.74,percent of total billed charges,Implant Device,1788.85,35,,1788.85,percent of total billed charges,Implant Device,1737.74,34,"Charges > $500, x 34%",1737.74,percent of total billed charges,Implant Device,1788.85,35,,1788.85,percent of total billed charges,Implant Devices,1788.85,35,,1788.85,percent of total billed charges,Implant Devices,1788.85,35,,,percent of total billed charges,Implant Devices,1788.85,35,,1788.85,percent of total billed charges,Implant Devices,1788.85,35,,1788.85,percent of total billed charges,Implant Devices,2044.4,40,,2044.4,percent of total billed charges,Implant Devices,1788.85,70,,1788.85,percent of total billed charges,Implant Devices,1737.74,34,,1737.74,percent of total billed charges,Implant Devices,1737.74,34,,1737.74,percent of total billed charges,Implant Devices,1788.85,35,,1788.85,percent of total billed charges,Implant Devices,1788.85,35,,1788.85,percent of total billed charges,Implant Devices,1788.85,35,,1788.85,percent of total billed charges,Implant Devices,1788.85,35,,1788.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1737.74,34,"If Charge > 2,000, then 34 percent",1737.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2044.4,
STRYKER 427036S RECON LOCK PLATE 6 HOLE,C1713,HCPCS,,79003324,CDM,278,RC,,,both,,,1721,679.22,39.4668,,679.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,585.14,34,,585.14,percent of total billed charges,Implant Device,585.14,34,,585.14,percent of total billed charges,Implant Device,585.14,34,,585.14,percent of total billed charges,Implant Device,585.14,34,,585.14,percent of total billed charges,Implant Device,585.14,34,,585.14,percent of total billed charges,Implant Device,585.14,34,,585.14,percent of total billed charges,Implant Device,602.35,35,,602.35,percent of total billed charges,Implant Device,585.14,34,"Charges > $500, x 34%",585.14,percent of total billed charges,Implant Device,602.35,35,,602.35,percent of total billed charges,Implant Devices,602.35,35,,602.35,percent of total billed charges,Implant Devices,602.35,35,,,percent of total billed charges,Implant Devices,602.35,35,,602.35,percent of total billed charges,Implant Devices,602.35,35,,602.35,percent of total billed charges,Implant Devices,688.4,40,,688.4,percent of total billed charges,Implant Devices,602.35,70,,602.35,percent of total billed charges,Implant Devices,585.14,34,,585.14,percent of total billed charges,Implant Devices,585.14,34,,585.14,percent of total billed charges,Implant Devices,602.35,35,,602.35,percent of total billed charges,Implant Devices,602.35,35,,602.35,percent of total billed charges,Implant Devices,602.35,35,,602.35,percent of total billed charges,Implant Devices,602.35,35,,602.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,688.4,
STRYKER 371534 LOCKING SCREW 4.0X34MM,C1713,HCPCS,,79003325,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 371540 LOCKING SCREW 4.0X40MM,C1713,HCPCS,,79003326,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 371560 LOCKING SCREW 4.0X60MM,C1713,HCPCS,,79003327,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 338650 CORTICAL SCREW 3.5X50MM,C1713,HCPCS,,79003331,CDM,278,RC,,,both,,,69,27.23,39.4668,,27.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23.46,34,,23.46,percent of total billed charges,Implant Device,23.46,34,,23.46,percent of total billed charges,Implant Device,23.46,34,,23.46,percent of total billed charges,Implant Device,23.46,34,,23.46,percent of total billed charges,Implant Device,23.46,34,,23.46,percent of total billed charges,Implant Device,23.46,34,,23.46,percent of total billed charges,Implant Device,24.15,35,,24.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,24.15,35,,24.15,percent of total billed charges,Implant Devices,24.15,35,,24.15,percent of total billed charges,Implant Devices,24.15,35,,,percent of total billed charges,Implant Devices,24.15,35,,24.15,percent of total billed charges,Implant Devices,24.15,35,,24.15,percent of total billed charges,Implant Devices,27.6,40,,27.6,percent of total billed charges,Implant Devices,24.15,70,,24.15,percent of total billed charges,Implant Devices,23.46,34,,23.46,percent of total billed charges,Implant Devices,23.46,34,,23.46,percent of total billed charges,Implant Devices,24.15,35,,24.15,percent of total billed charges,Implant Devices,24.15,35,,24.15,percent of total billed charges,Implant Devices,24.15,35,,24.15,percent of total billed charges,Implant Devices,24.15,35,,24.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27.6,
STRYKER 345450 CANC SCREW FT 4.0X50MM,C1713,HCPCS,,79003332,CDM,278,RC,,,both,,,89,35.13,39.4668,,35.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,31.15,35,,31.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,35.6,40,,35.6,percent of total billed charges,Implant Devices,31.15,70,,31.15,percent of total billed charges,Implant Devices,30.26,34,,30.26,percent of total billed charges,Implant Devices,30.26,34,,30.26,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.6,
STRYKER 345460 CANC SCREW FT 4.0X60MM,C1713,HCPCS,,79003333,CDM,278,RC,,,both,,,89,35.13,39.4668,,35.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,31.15,35,,31.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,35.6,40,,35.6,percent of total billed charges,Implant Devices,31.15,70,,31.15,percent of total billed charges,Implant Devices,30.26,34,,30.26,percent of total billed charges,Implant Devices,30.26,34,,30.26,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.6,
STRYKER 370002 LOCKING INSERT 4.0,C1713,HCPCS,,79003334,CDM,278,RC,,,both,,,209,82.49,39.4668,,82.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.06,34,,71.06,percent of total billed charges,Implant Device,71.06,34,,71.06,percent of total billed charges,Implant Device,71.06,34,,71.06,percent of total billed charges,Implant Device,71.06,34,,71.06,percent of total billed charges,Implant Device,71.06,34,,71.06,percent of total billed charges,Implant Device,71.06,34,,71.06,percent of total billed charges,Implant Device,73.15,35,,73.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.15,35,,73.15,percent of total billed charges,Implant Devices,73.15,35,,73.15,percent of total billed charges,Implant Devices,73.15,35,,,percent of total billed charges,Implant Devices,73.15,35,,73.15,percent of total billed charges,Implant Devices,73.15,35,,73.15,percent of total billed charges,Implant Devices,83.6,40,,83.6,percent of total billed charges,Implant Devices,73.15,70,,73.15,percent of total billed charges,Implant Devices,71.06,34,,71.06,percent of total billed charges,Implant Devices,71.06,34,,71.06,percent of total billed charges,Implant Devices,73.15,35,,73.15,percent of total billed charges,Implant Devices,73.15,35,,73.15,percent of total billed charges,Implant Devices,73.15,35,,73.15,percent of total billed charges,Implant Devices,73.15,35,,73.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,83.6,
PIONEER SURGI 83-00-08 BACFUSE STD 8MM,C1713,HCPCS,,79003340,CDM,278,RC,,,both,,,24900,9827.23,39.4668,,9827.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8466,34,,8466,percent of total billed charges,Implant Device,8466,34,,8466,percent of total billed charges,Implant Device,8466,34,,8466,percent of total billed charges,Implant Device,8466,34,,8466,percent of total billed charges,Implant Device,8466,34,,8466,percent of total billed charges,Implant Device,8466,34,,8466,percent of total billed charges,Implant Device,8715,35,,8715,percent of total billed charges,Implant Device,8466,34,"Charges > $500, x 34%",8466,percent of total billed charges,Implant Device,8715,35,,8715,percent of total billed charges,Implant Devices,8715,35,,8715,percent of total billed charges,Implant Devices,8715,35,,,percent of total billed charges,Implant Devices,8715,35,,8715,percent of total billed charges,Implant Devices,8715,35,,8715,percent of total billed charges,Implant Devices,9960,40,,9960,percent of total billed charges,Implant Devices,8715,70,,8715,percent of total billed charges,Implant Devices,8466,34,,8466,percent of total billed charges,Implant Devices,8466,34,,8466,percent of total billed charges,Implant Devices,8715,35,,8715,percent of total billed charges,Implant Devices,8715,35,,8715,percent of total billed charges,Implant Devices,8715,35,,8715,percent of total billed charges,Implant Devices,8715,35,,8715,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8466,34,"If Charge > 2,000, then 34 percent",8466,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9960,
STRYKER 371528 LOCKING SCREW 4.0X28MM,C1713,HCPCS,,79003341,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 3715505 LOCKING SCREW 4.0X55MM,C1713,HCPCS,,79003342,CDM,278,RC,,,both,,,492,194.18,39.4668,,194.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,196.8,40,,196.8,percent of total billed charges,Implant Devices,172.2,70,,172.2,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196.8,
STRYKER 371530 LOCKING SCREW 4.0X30MM,C1713,HCPCS,,79003343,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 371532 LOCKING SCREW 4.0X32MM,C1713,HCPCS,,79003344,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 371536 LOCKING SCREW 4.0X36MM,C1713,HCPCS,,79003345,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 371542 LOCKING SCREW 4.0X42MM,C1713,HCPCS,,79003346,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
EXACTECH 320-20-34 COMPRESSION SCRW 34MM,C1713,HCPCS,,79003360,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
EXACTECH 320-20-22 COMPRESSION SCRW 22MM,C1713,HCPCS,,79003361,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
EXACTECH 340-02-01 EQUINOX FX PLATE 80MM,C1713,HCPCS,,79003363,CDM,278,RC,,,both,,,4644,1832.84,39.4668,,1832.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1625.4,35,,1625.4,percent of total billed charges,Implant Device,1578.96,34,"Charges > $500, x 34%",1578.96,percent of total billed charges,Implant Device,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1857.6,40,,1857.6,percent of total billed charges,Implant Devices,1625.4,70,,1625.4,percent of total billed charges,Implant Devices,1578.96,34,,1578.96,percent of total billed charges,Implant Devices,1578.96,34,,1578.96,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1578.96,34,"If Charge > 2,000, then 34 percent",1578.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1857.6,
EXACTECH 340-65-35 CANC LCK SCREW 6.5X35,C1713,HCPCS,,79003364,CDM,278,RC,,,both,,,581,229.3,39.4668,,229.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Device,197.54,34,"Charges > $500, x 34%",197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,232.4,40,,232.4,percent of total billed charges,Implant Devices,203.35,70,,203.35,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.4,
EXACTECH 340-38-20 CANC LCK SCREW 3.8X20,C1713,HCPCS,,79003365,CDM,278,RC,,,both,,,406,160.24,39.4668,,160.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,138.04,34,,138.04,percent of total billed charges,Implant Device,142.1,35,,142.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,162.4,40,,162.4,percent of total billed charges,Implant Devices,142.1,70,,142.1,percent of total billed charges,Implant Devices,138.04,34,,138.04,percent of total billed charges,Implant Devices,138.04,34,,138.04,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,142.1,35,,142.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,162.4,
EXACTECH 340-38-23 CANC LCK SCREW 3.8X23,C1713,HCPCS,,79003366,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
EXACTECH 340-38-26 CANC LCK SCREW 3.8X26,C1713,HCPCS,,79003367,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
EXACTECH 340-38-32 CANC LCK SCREW 3.8X32,C1713,HCPCS,,79003368,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
EXACTECH 340-38-35 CANC LCK SCREW 3.8X35,C1713,HCPCS,,79003369,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
EXACTECH 340-38-38 CANC LCK SCREW 3.8X38,C1713,HCPCS,,79003370,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
EXACTECH 340-40-23 CORT LCK SCREW 3.8X23,C1713,HCPCS,,79003371,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
EXACTECH 340-40-26 CORT LCK SCREW 3.8X26,C1713,HCPCS,,79003372,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
EXACTECH 340-41-23 CORT CMP SCREW 3.8X23,C1713,HCPCS,,79003373,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
EXACTECH 340-41-26 CORT CMP SCREW 3.8X26,C1713,HCPCS,,79003374,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
STABL BIOLGCS ATAM1236-008-005 ALLOGRAFT,C1713,HCPCS,,79003404,CDM,278,RC,,,both,,,5310,2095.69,39.4668,,2095.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1805.4,34,,1805.4,percent of total billed charges,Implant Device,1805.4,34,,1805.4,percent of total billed charges,Implant Device,1805.4,34,,1805.4,percent of total billed charges,Implant Device,1805.4,34,,1805.4,percent of total billed charges,Implant Device,1805.4,34,,1805.4,percent of total billed charges,Implant Device,1805.4,34,,1805.4,percent of total billed charges,Implant Device,1858.5,35,,1858.5,percent of total billed charges,Implant Device,1805.4,34,"Charges > $500, x 34%",1805.4,percent of total billed charges,Implant Device,1858.5,35,,1858.5,percent of total billed charges,Implant Devices,1858.5,35,,1858.5,percent of total billed charges,Implant Devices,1858.5,35,,,percent of total billed charges,Implant Devices,1858.5,35,,1858.5,percent of total billed charges,Implant Devices,1858.5,35,,1858.5,percent of total billed charges,Implant Devices,2124,40,,2124,percent of total billed charges,Implant Devices,1858.5,70,,1858.5,percent of total billed charges,Implant Devices,1805.4,34,,1805.4,percent of total billed charges,Implant Devices,1805.4,34,,1805.4,percent of total billed charges,Implant Devices,1858.5,35,,1858.5,percent of total billed charges,Implant Devices,1858.5,35,,1858.5,percent of total billed charges,Implant Devices,1858.5,35,,1858.5,percent of total billed charges,Implant Devices,1858.5,35,,1858.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1805.4,34,"If Charge > 2,000, then 34 percent",1805.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2124,
ARTHREX AR-8827L-14 LOCK SCREW 2.7X14MM,C1713,HCPCS,,79003405,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ARTHREX AR-8827L-12 LOCK SCREW 2.7X12MM,C1713,HCPCS,,79003406,CDM,278,RC,,,both,,,346,136.56,39.4668,,136.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,138.4,40,,138.4,percent of total billed charges,Implant Devices,121.1,70,,121.1,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138.4,
ARTHREX AR-8835-16 NON LOCK SCREW 3.5X16,C1713,HCPCS,,79003407,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ARTHREX AR-8830-16 CANCNONLOCK SCRW 3X16,C1713,HCPCS,,79003408,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
STRYKER 3060-0085S LAG SCREW 10.5X85MM,C1713,HCPCS,,79003415,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
STRYKER 437103 PLATE 3 HOLE,C1713,HCPCS,,79003419,CDM,278,RC,,,both,,,5483,2163.96,39.4668,,2163.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Device,1864.22,34,"Charges > $500, x 34%",1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,2193.2,40,,2193.2,percent of total billed charges,Implant Devices,1919.05,70,,1919.05,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1864.22,34,"If Charge > 2,000, then 34 percent",1864.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2193.2,
STRYKER 345434 CANCELLOUS SCREW 4.0X34MM,C1713,HCPCS,,79003421,CDM,278,RC,,,both,,,89,35.13,39.4668,,35.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,31.15,35,,31.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,35.6,40,,35.6,percent of total billed charges,Implant Devices,31.15,70,,31.15,percent of total billed charges,Implant Devices,30.26,34,,30.26,percent of total billed charges,Implant Devices,30.26,34,,30.26,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.6,
STRYKER 371550 LOCKING SCREW 4.0X50MM,C1713,HCPCS,,79003422,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 338634 CORTICAL SCREW 3.5X34MM,C1713,HCPCS,,79003423,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 338638 CORTICAL SCREW 3.5X38MM,C1713,HCPCS,,79003424,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 1830-0928S HUMERAL NAIL 9X280MM,C1713,HCPCS,,79003427,CDM,278,RC,,,both,,,5483,2163.96,39.4668,,2163.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Device,1864.22,34,"Charges > $500, x 34%",1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,2193.2,40,,2193.2,percent of total billed charges,Implant Devices,1919.05,70,,1919.05,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1864.22,34,"If Charge > 2,000, then 34 percent",1864.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2193.2,
STRYKER 1896-4055S LOCKING SCREW FT 4X55,C1713,HCPCS,,79003428,CDM,278,RC,,,both,,,836,329.94,39.4668,,329.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,292.6,35,,292.6,percent of total billed charges,Implant Device,284.24,34,"Charges > $500, x 34%",284.24,percent of total billed charges,Implant Device,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,334.4,40,,334.4,percent of total billed charges,Implant Devices,292.6,70,,292.6,percent of total billed charges,Implant Devices,284.24,34,,284.24,percent of total billed charges,Implant Devices,284.24,34,,284.24,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.4,
STRYKER 1896-4028S LOCKING SCREW FT 4X28,C1713,HCPCS,,79003429,CDM,278,RC,,,both,,,447,176.42,39.4668,,176.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,156.45,35,,156.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,178.8,40,,178.8,percent of total billed charges,Implant Devices,156.45,70,,156.45,percent of total billed charges,Implant Devices,151.98,34,,151.98,percent of total billed charges,Implant Devices,151.98,34,,151.98,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.8,
RTI BIOLOGICS 606-01-05 ALLOGRAFT PASTE,C1713,HCPCS,,79003434,CDM,278,RC,,,both,,,4494,1773.64,39.4668,,1773.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1527.96,34,,1527.96,percent of total billed charges,Implant Device,1527.96,34,,1527.96,percent of total billed charges,Implant Device,1527.96,34,,1527.96,percent of total billed charges,Implant Device,1527.96,34,,1527.96,percent of total billed charges,Implant Device,1527.96,34,,1527.96,percent of total billed charges,Implant Device,1527.96,34,,1527.96,percent of total billed charges,Implant Device,1572.9,35,,1572.9,percent of total billed charges,Implant Device,1527.96,34,"Charges > $500, x 34%",1527.96,percent of total billed charges,Implant Device,1572.9,35,,1572.9,percent of total billed charges,Implant Devices,1572.9,35,,1572.9,percent of total billed charges,Implant Devices,1572.9,35,,,percent of total billed charges,Implant Devices,1572.9,35,,1572.9,percent of total billed charges,Implant Devices,1572.9,35,,1572.9,percent of total billed charges,Implant Devices,1797.6,40,,1797.6,percent of total billed charges,Implant Devices,1572.9,70,,1572.9,percent of total billed charges,Implant Devices,1527.96,34,,1527.96,percent of total billed charges,Implant Devices,1527.96,34,,1527.96,percent of total billed charges,Implant Devices,1572.9,35,,1572.9,percent of total billed charges,Implant Devices,1572.9,35,,1572.9,percent of total billed charges,Implant Devices,1572.9,35,,1572.9,percent of total billed charges,Implant Devices,1572.9,35,,1572.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1527.96,34,"If Charge > 2,000, then 34 percent",1527.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1797.6,
ZIMMER 47-2493-211-10 FEM NAIL 10.5X100,C1713,HCPCS,,79003437,CDM,278,RC,,,both,,,5170,2040.43,39.4668,,2040.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1809.5,35,,1809.5,percent of total billed charges,Implant Device,1757.8,34,"Charges > $500, x 34%",1757.8,percent of total billed charges,Implant Device,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,2068,40,,2068,percent of total billed charges,Implant Devices,1809.5,70,,1809.5,percent of total billed charges,Implant Devices,1757.8,34,,1757.8,percent of total billed charges,Implant Devices,1757.8,34,,1757.8,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1757.8,34,"If Charge > 2,000, then 34 percent",1757.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2068,
ZIMMER 1147-85-75 7.5MM CANN SCREW 16X85,C1713,HCPCS,,79003439,CDM,278,RC,,,both,,,738,291.26,39.4668,,291.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,258.3,35,,258.3,percent of total billed charges,Implant Device,250.92,34,"Charges > $500, x 34%",250.92,percent of total billed charges,Implant Device,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,295.2,40,,295.2,percent of total billed charges,Implant Devices,258.3,70,,258.3,percent of total billed charges,Implant Devices,250.92,34,,250.92,percent of total billed charges,Implant Devices,250.92,34,,250.92,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,295.2,
ZIMMER 1147-90-75 7.5MM CANN SCREW 16X90,C1713,HCPCS,,79003440,CDM,278,RC,,,both,,,738,291.26,39.4668,,291.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,258.3,35,,258.3,percent of total billed charges,Implant Device,250.92,34,"Charges > $500, x 34%",250.92,percent of total billed charges,Implant Device,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,295.2,40,,295.2,percent of total billed charges,Implant Devices,258.3,70,,258.3,percent of total billed charges,Implant Devices,250.92,34,,250.92,percent of total billed charges,Implant Devices,250.92,34,,250.92,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,295.2,
ZIMMER 1147-90-76 7.5MM CANN SCREW 32X90,C1713,HCPCS,,79003441,CDM,278,RC,,,both,,,738,291.26,39.4668,,291.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,250.92,34,,250.92,percent of total billed charges,Implant Device,258.3,35,,258.3,percent of total billed charges,Implant Device,250.92,34,"Charges > $500, x 34%",250.92,percent of total billed charges,Implant Device,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,295.2,40,,295.2,percent of total billed charges,Implant Devices,258.3,70,,258.3,percent of total billed charges,Implant Devices,250.92,34,,250.92,percent of total billed charges,Implant Devices,250.92,34,,250.92,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,258.3,35,,258.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,295.2,
STRYKER 53-23616E LOCKING SCREW 2.3X16MM,C1713,HCPCS,,79003445,CDM,278,RC,,,both,,,492,194.18,39.4668,,194.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,196.8,40,,196.8,percent of total billed charges,Implant Devices,172.2,70,,172.2,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196.8,
STRYKER 53-27614E LOCKING SCREW 2.7X14MM,C1713,HCPCS,,79003446,CDM,278,RC,,,both,,,253,99.85,39.4668,,99.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.02,34,,86.02,percent of total billed charges,Implant Device,86.02,34,,86.02,percent of total billed charges,Implant Device,86.02,34,,86.02,percent of total billed charges,Implant Device,86.02,34,,86.02,percent of total billed charges,Implant Device,86.02,34,,86.02,percent of total billed charges,Implant Device,86.02,34,,86.02,percent of total billed charges,Implant Device,88.55,35,,88.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,101.2,40,,101.2,percent of total billed charges,Implant Devices,88.55,70,,88.55,percent of total billed charges,Implant Devices,86.02,34,,86.02,percent of total billed charges,Implant Devices,86.02,34,,86.02,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,101.2,
ZIMMER 00-4936-007-07 PLATE 7 HOLE,C1713,HCPCS,,79003449,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
ARTHREX AR-8943BR-06 FIB LCK PLATE 6 HOL,C1713,HCPCS,,79003453,CDM,278,RC,,,both,,,2176,858.8,39.4668,,858.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,739.84,34,,739.84,percent of total billed charges,Implant Device,739.84,34,,739.84,percent of total billed charges,Implant Device,739.84,34,,739.84,percent of total billed charges,Implant Device,739.84,34,,739.84,percent of total billed charges,Implant Device,739.84,34,,739.84,percent of total billed charges,Implant Device,739.84,34,,739.84,percent of total billed charges,Implant Device,761.6,35,,761.6,percent of total billed charges,Implant Device,739.84,34,"Charges > $500, x 34%",739.84,percent of total billed charges,Implant Device,761.6,35,,761.6,percent of total billed charges,Implant Devices,761.6,35,,761.6,percent of total billed charges,Implant Devices,761.6,35,,,percent of total billed charges,Implant Devices,761.6,35,,761.6,percent of total billed charges,Implant Devices,761.6,35,,761.6,percent of total billed charges,Implant Devices,870.4,40,,870.4,percent of total billed charges,Implant Devices,761.6,70,,761.6,percent of total billed charges,Implant Devices,739.84,34,,739.84,percent of total billed charges,Implant Devices,739.84,34,,739.84,percent of total billed charges,Implant Devices,761.6,35,,761.6,percent of total billed charges,Implant Devices,761.6,35,,761.6,percent of total billed charges,Implant Devices,761.6,35,,761.6,percent of total billed charges,Implant Devices,761.6,35,,761.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,739.84,34,"If Charge > 2,000, then 34 percent",739.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,870.4,
ARTHREX AR-8835-22 SCREW 3.5X22MM,C1713,HCPCS,,79003454,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
ARTHREX AR-8835-26 SCREW 3.5X26MM,C1713,HCPCS,,79003455,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ZIMMER 00-2490-047-32 3.2MM PIN 508MM,C1713,HCPCS,,79003458,CDM,278,RC,,,both,,,389,153.53,39.4668,,153.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,136.15,35,,136.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,155.6,40,,155.6,percent of total billed charges,Implant Devices,136.15,70,,136.15,percent of total billed charges,Implant Devices,132.26,34,,132.26,percent of total billed charges,Implant Devices,132.26,34,,132.26,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,155.6,
ARTHREX AR-8935L-16 LOCK SCREW 3.5X16MM,C1713,HCPCS,,79003463,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
STRYKER 40-35026 NON-LOCK SCREW 3.5X26MM,C1713,HCPCS,,79003464,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
EXACTECH 340-01-01 FRACTURE PLATE 80MM,C1713,HCPCS,,79003466,CDM,278,RC,,,both,,,4644,1832.84,39.4668,,1832.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1625.4,35,,1625.4,percent of total billed charges,Implant Device,1578.96,34,"Charges > $500, x 34%",1578.96,percent of total billed charges,Implant Device,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1857.6,40,,1857.6,percent of total billed charges,Implant Devices,1625.4,70,,1625.4,percent of total billed charges,Implant Devices,1578.96,34,,1578.96,percent of total billed charges,Implant Devices,1578.96,34,,1578.96,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1578.96,34,"If Charge > 2,000, then 34 percent",1578.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1857.6,
EXACTECH 340-65-41 CANC SCREW 6.5X41MM,C1713,HCPCS,,79003467,CDM,278,RC,,,both,,,581,229.3,39.4668,,229.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Device,197.54,34,"Charges > $500, x 34%",197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,232.4,40,,232.4,percent of total billed charges,Implant Devices,203.35,70,,203.35,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.4,
EXACTECH 340-38-29 CANC SCREW 3.8X29MM,C1713,HCPCS,,79003468,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
EXACTECH 340-40-20 CORTICAL SCREW 3.8X20,C1713,HCPCS,,79003469,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
ARTHREX AR-1670BC BIOCOMP SCREW 7X10MM,C1713,HCPCS,,79003470,CDM,278,RC,,,both,,,1350,532.8,39.4668,,532.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Device,459,34,"Charges > $500, x 34%",459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,540,40,,540,percent of total billed charges,Implant Devices,472.5,70,,472.5,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,540,
ARTHREX AR-1680BC BIOCOMP SCREW 8X12MM,C1713,HCPCS,,79003471,CDM,278,RC,,,both,,,1350,532.8,39.4668,,532.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Device,459,34,"Charges > $500, x 34%",459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,540,40,,540,percent of total billed charges,Implant Devices,472.5,70,,472.5,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,540,
INTL BIOLOGICS 905 TENOD GRAFT 9.5X170MM,C1713,HCPCS,,79003472,CDM,278,RC,,,both,,,5325,2101.61,39.4668,,2101.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1863.75,35,,1863.75,percent of total billed charges,Implant Device,1810.5,34,"Charges > $500, x 34%",1810.5,percent of total billed charges,Implant Device,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,2130,40,,2130,percent of total billed charges,Implant Devices,1863.75,70,,1863.75,percent of total billed charges,Implant Devices,1810.5,34,,1810.5,percent of total billed charges,Implant Devices,1810.5,34,,1810.5,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1810.5,34,"If Charge > 2,000, then 34 percent",1810.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2130,
SYNTHES 223.551 PLATE 3.5MM LCP 5H 72MM,C1713,HCPCS,,79003477,CDM,278,RC,,,both,,,1049,414.01,39.4668,,414.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,356.66,34,,356.66,percent of total billed charges,Implant Device,356.66,34,,356.66,percent of total billed charges,Implant Device,356.66,34,,356.66,percent of total billed charges,Implant Device,356.66,34,,356.66,percent of total billed charges,Implant Device,356.66,34,,356.66,percent of total billed charges,Implant Device,356.66,34,,356.66,percent of total billed charges,Implant Device,367.15,35,,367.15,percent of total billed charges,Implant Device,356.66,34,"Charges > $500, x 34%",356.66,percent of total billed charges,Implant Device,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,419.6,40,,419.6,percent of total billed charges,Implant Devices,367.15,70,,367.15,percent of total billed charges,Implant Devices,356.66,34,,356.66,percent of total billed charges,Implant Devices,356.66,34,,356.66,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,419.6,
SYNTHES 204.814 SCREW 3.5MM CORTEX 14MM,C1713,HCPCS,,79003478,CDM,278,RC,,,both,,,59,23.29,39.4668,,23.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,23.6,40,,23.6,percent of total billed charges,Implant Devices,20.65,70,,20.65,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.6,
EXACTECH 320-20-26 COMPRESSN SCREW 26MM,C1713,HCPCS,,79003488,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
EXACTECH 320-20-30 COMPRESSN SCREW 30MM,C1713,HCPCS,,79003489,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
EXACTECH 320-15-05 GLENOSPHRE LOCK SCREW,C1713,HCPCS,,79003491,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
EXACTECH 320-20-00 REV TORQUE SCREW KIT,C1713,HCPCS,,79003492,CDM,278,RC,,,both,,,675,266.4,39.4668,,266.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Device,229.5,34,"Charges > $500, x 34%",229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,270,40,,270,percent of total billed charges,Implant Devices,236.25,70,,236.25,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270,
ARTHREX AR-8967-2875 CANN SCREW 6.7X75MM,C1713,HCPCS,,79003494,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
ARTHREX AR-8945-55PT CANN SCREW 4.5X55MM,C1713,HCPCS,,79003495,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ARTHREX AR-8952XM X-PLATE MEDIUM,C1713,HCPCS,,79003496,CDM,278,RC,,,both,,,3429,1353.32,39.4668,,1353.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1200.15,35,,1200.15,percent of total billed charges,Implant Device,1165.86,34,"Charges > $500, x 34%",1165.86,percent of total billed charges,Implant Device,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1371.6,40,,1371.6,percent of total billed charges,Implant Devices,1200.15,70,,1200.15,percent of total billed charges,Implant Devices,1165.86,34,,1165.86,percent of total billed charges,Implant Devices,1165.86,34,,1165.86,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1165.86,34,"If Charge > 2,000, then 34 percent",1165.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1371.6,
ARTHREX AR-8740-38PTS CANN SCREW 4X38M,C1713,HCPCS,,79003497,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
SOLANA TSS-2020S ALLOGRAFT TENSIX 2X2X.5,C1713,HCPCS,,79003499,CDM,278,RC,,,both,,,6467,2552.32,39.4668,,2552.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2198.78,34,,2198.78,percent of total billed charges,Implant Device,2198.78,34,,2198.78,percent of total billed charges,Implant Device,2198.78,34,,2198.78,percent of total billed charges,Implant Device,2198.78,34,,2198.78,percent of total billed charges,Implant Device,2198.78,34,,2198.78,percent of total billed charges,Implant Device,2198.78,34,,2198.78,percent of total billed charges,Implant Device,2263.45,35,,2263.45,percent of total billed charges,Implant Device,2198.78,34,"Charges > $500, x 34%",2198.78,percent of total billed charges,Implant Device,2263.45,35,,2263.45,percent of total billed charges,Implant Devices,2263.45,35,,2263.45,percent of total billed charges,Implant Devices,2263.45,35,,,percent of total billed charges,Implant Devices,2263.45,35,,2263.45,percent of total billed charges,Implant Devices,2263.45,35,,2263.45,percent of total billed charges,Implant Devices,2586.8,40,,2586.8,percent of total billed charges,Implant Devices,2263.45,70,,2263.45,percent of total billed charges,Implant Devices,2198.78,34,,2198.78,percent of total billed charges,Implant Devices,2198.78,34,,2198.78,percent of total billed charges,Implant Devices,2263.45,35,,2263.45,percent of total billed charges,Implant Devices,2263.45,35,,2263.45,percent of total billed charges,Implant Devices,2263.45,35,,2263.45,percent of total billed charges,Implant Devices,2263.45,35,,2263.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2198.78,34,"If Charge > 2,000, then 34 percent",2198.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2586.8,
SOLANA TSS-1515 ALLOGRAFT 1.5X1.5X1.5,C1713,HCPCS,,79003500,CDM,278,RC,,,both,,,5467,2157.65,39.4668,,2157.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1913.45,35,,1913.45,percent of total billed charges,Implant Device,1858.78,34,"Charges > $500, x 34%",1858.78,percent of total billed charges,Implant Device,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,2186.8,40,,2186.8,percent of total billed charges,Implant Devices,1913.45,70,,1913.45,percent of total billed charges,Implant Devices,1858.78,34,,1858.78,percent of total billed charges,Implant Devices,1858.78,34,,1858.78,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1858.78,34,"If Charge > 2,000, then 34 percent",1858.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2186.8,
PARAGON 28 P28-05-001 CALCANEUS PLATE,C1713,HCPCS,,79003501,CDM,278,RC,,,both,,,4590,1811.53,39.4668,,1811.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1606.5,35,,1606.5,percent of total billed charges,Implant Device,1560.6,34,"Charges > $500, x 34%",1560.6,percent of total billed charges,Implant Device,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1836,40,,1836,percent of total billed charges,Implant Devices,1606.5,70,,1606.5,percent of total billed charges,Implant Devices,1560.6,34,,1560.6,percent of total billed charges,Implant Devices,1560.6,34,,1560.6,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1560.6,34,"If Charge > 2,000, then 34 percent",1560.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1836,
PARAGON 28 P28-20-028 SCREW 3.5X28MM,C1713,HCPCS,,79003502,CDM,278,RC,,,both,,,532,209.96,39.4668,,209.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,186.2,35,,186.2,percent of total billed charges,Implant Device,180.88,34,"Charges > $500, x 34%",180.88,percent of total billed charges,Implant Device,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,212.8,40,,212.8,percent of total billed charges,Implant Devices,186.2,70,,186.2,percent of total billed charges,Implant Devices,180.88,34,,180.88,percent of total billed charges,Implant Devices,180.88,34,,180.88,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,212.8,
PARAGON 28 P28-20-030 SCREW 3.5X30MM,C1713,HCPCS,,79003503,CDM,278,RC,,,both,,,586,231.28,39.4668,,231.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Device,199.24,34,"Charges > $500, x 34%",199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,234.4,40,,234.4,percent of total billed charges,Implant Devices,205.1,70,,205.1,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.4,
PARAGON 28 P28-20-035 SCREW 3.5X35MM,C1713,HCPCS,,79003504,CDM,278,RC,,,both,,,532,209.96,39.4668,,209.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,186.2,35,,186.2,percent of total billed charges,Implant Device,180.88,34,"Charges > $500, x 34%",180.88,percent of total billed charges,Implant Device,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,212.8,40,,212.8,percent of total billed charges,Implant Devices,186.2,70,,186.2,percent of total billed charges,Implant Devices,180.88,34,,180.88,percent of total billed charges,Implant Devices,180.88,34,,180.88,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,212.8,
PARAGON 28 P28-20-128 SCREW STD 3.5X28MM,C1713,HCPCS,,79003505,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
SYNTHES 223.551 LCP PLATE 3.5X72MM,C1713,HCPCS,,79003508,CDM,278,RC,,,both,,,1049,414.01,39.4668,,414.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,356.66,34,,356.66,percent of total billed charges,Implant Device,356.66,34,,356.66,percent of total billed charges,Implant Device,356.66,34,,356.66,percent of total billed charges,Implant Device,356.66,34,,356.66,percent of total billed charges,Implant Device,356.66,34,,356.66,percent of total billed charges,Implant Device,356.66,34,,356.66,percent of total billed charges,Implant Device,367.15,35,,367.15,percent of total billed charges,Implant Device,356.66,34,"Charges > $500, x 34%",356.66,percent of total billed charges,Implant Device,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,419.6,40,,419.6,percent of total billed charges,Implant Devices,367.15,70,,367.15,percent of total billed charges,Implant Devices,356.66,34,,356.66,percent of total billed charges,Implant Devices,356.66,34,,356.66,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,367.15,35,,367.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,419.6,
SYNTHES 202.816 CORTEX ST SCREW 2.7X16MM,C1713,HCPCS,,79003509,CDM,278,RC,,,both,,,85,33.55,39.4668,,33.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,34,40,,34,percent of total billed charges,Implant Devices,29.75,70,,29.75,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34,
SYNTHES 202.818 CORTEX ST SCREW 2.7X18MM,C1713,HCPCS,,79003510,CDM,278,RC,,,both,,,85,33.55,39.4668,,33.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,34,40,,34,percent of total billed charges,Implant Devices,29.75,70,,29.75,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34,
BIOMET 180500 LOCKING SCREW 4.75X15MM,C1713,HCPCS,,79003513,CDM,278,RC,,,both,,,570,224.96,39.4668,,224.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Device,193.8,34,"Charges > $500, x 34%",193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,228,40,,228,percent of total billed charges,Implant Devices,199.5,70,,199.5,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228,
SYNTHES 404.014 3.5 TITANIUM SCREW 14MM,C1713,HCPCS,,79003516,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 404.016 3.5 TITANIUM SCREW 16MM,C1713,HCPCS,,79003517,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 404.018 3.5 TITANIUM SCREW 18MM,C1713,HCPCS,,79003518,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 404.020 3.5 TITANIUM SCREW 20MM,C1713,HCPCS,,79003519,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 423.57 LC-DCP PLATE 3.5MM 7 HOLE,C1713,HCPCS,,79003520,CDM,278,RC,,,both,,,550,217.07,39.4668,,217.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,187,34,,187,percent of total billed charges,Implant Device,187,34,,187,percent of total billed charges,Implant Device,187,34,,187,percent of total billed charges,Implant Device,187,34,,187,percent of total billed charges,Implant Device,187,34,,187,percent of total billed charges,Implant Device,187,34,,187,percent of total billed charges,Implant Device,192.5,35,,192.5,percent of total billed charges,Implant Device,187,34,"Charges > $500, x 34%",187,percent of total billed charges,Implant Device,192.5,35,,192.5,percent of total billed charges,Implant Devices,192.5,35,,192.5,percent of total billed charges,Implant Devices,192.5,35,,,percent of total billed charges,Implant Devices,192.5,35,,192.5,percent of total billed charges,Implant Devices,192.5,35,,192.5,percent of total billed charges,Implant Devices,220,40,,220,percent of total billed charges,Implant Devices,192.5,70,,192.5,percent of total billed charges,Implant Devices,187,34,,187,percent of total billed charges,Implant Devices,187,34,,187,percent of total billed charges,Implant Devices,192.5,35,,192.5,percent of total billed charges,Implant Devices,192.5,35,,192.5,percent of total billed charges,Implant Devices,192.5,35,,192.5,percent of total billed charges,Implant Devices,192.5,35,,192.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,220,
SYNTHES 441.36 6 HOLE PLATE COLLAR,C1713,HCPCS,,79003521,CDM,278,RC,,,both,,,244,96.3,39.4668,,96.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,85.4,35,,85.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,97.6,40,,97.6,percent of total billed charges,Implant Devices,85.4,70,,85.4,percent of total billed charges,Implant Devices,82.96,34,,82.96,percent of total billed charges,Implant Devices,82.96,34,,82.96,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,97.6,
SYNTHES 204.814 SCREW 3.5X14MM,C1713,HCPCS,,79003523,CDM,278,RC,,,both,,,59,23.29,39.4668,,23.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,23.6,40,,23.6,percent of total billed charges,Implant Devices,20.65,70,,20.65,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.6,
SYNTHES 208.845 SCREW 2.7X50MM,C1713,HCPCS,,79003524,CDM,278,RC,,,both,,,1080,426.24,39.4668,,426.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,378,35,,378,percent of total billed charges,Implant Device,367.2,34,"Charges > $500, x 34%",367.2,percent of total billed charges,Implant Device,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,432,40,,432,percent of total billed charges,Implant Devices,378,70,,378,percent of total billed charges,Implant Devices,367.2,34,,367.2,percent of total billed charges,Implant Devices,367.2,34,,367.2,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,432,
STRYKER 629284 DISTAL MEDIAL HUM PLATE,C1713,HCPCS,,79003527,CDM,278,RC,,,both,,,3697,1459.09,39.4668,,1459.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1293.95,35,,1293.95,percent of total billed charges,Implant Device,1256.98,34,"Charges > $500, x 34%",1256.98,percent of total billed charges,Implant Device,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1478.8,40,,1478.8,percent of total billed charges,Implant Devices,1293.95,70,,1293.95,percent of total billed charges,Implant Devices,1256.98,34,,1256.98,percent of total billed charges,Implant Devices,1256.98,34,,1256.98,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1256.98,34,"If Charge > 2,000, then 34 percent",1256.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1478.8,
STRYKER 629264 DISTAL POST LAT PLATE R,C1713,HCPCS,,79003528,CDM,278,RC,,,both,,,3697,1459.09,39.4668,,1459.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1293.95,35,,1293.95,percent of total billed charges,Implant Device,1256.98,34,"Charges > $500, x 34%",1256.98,percent of total billed charges,Implant Device,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1478.8,40,,1478.8,percent of total billed charges,Implant Devices,1293.95,70,,1293.95,percent of total billed charges,Implant Devices,1256.98,34,,1256.98,percent of total billed charges,Implant Devices,1256.98,34,,1256.98,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1256.98,34,"If Charge > 2,000, then 34 percent",1256.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1478.8,
STRYKER 629364 4 HOLE R PLATE OLECRANON,C1713,HCPCS,,79003529,CDM,278,RC,,,both,,,2804,1106.65,39.4668,,1106.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,981.4,35,,981.4,percent of total billed charges,Implant Device,953.36,34,"Charges > $500, x 34%",953.36,percent of total billed charges,Implant Device,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,1121.6,40,,1121.6,percent of total billed charges,Implant Devices,981.4,70,,981.4,percent of total billed charges,Implant Devices,953.36,34,,953.36,percent of total billed charges,Implant Devices,953.36,34,,953.36,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,953.36,34,"If Charge > 2,000, then 34 percent",953.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1121.6,
STRYKER 614608 LOCKING SCREW 3.5X8MM,C1713,HCPCS,,79003530,CDM,278,RC,,,both,,,574,226.54,39.4668,,226.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Device,195.16,34,"Charges > $500, x 34%",195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,229.6,40,,229.6,percent of total billed charges,Implant Devices,200.9,70,,200.9,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,229.6,
STRYKER 614610 LOCKING SCREW 3.5X10MM,C1713,HCPCS,,79003531,CDM,278,RC,,,both,,,1451,572.66,39.4668,,572.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,493.34,34,,493.34,percent of total billed charges,Implant Device,493.34,34,,493.34,percent of total billed charges,Implant Device,493.34,34,,493.34,percent of total billed charges,Implant Device,493.34,34,,493.34,percent of total billed charges,Implant Device,493.34,34,,493.34,percent of total billed charges,Implant Device,493.34,34,,493.34,percent of total billed charges,Implant Device,507.85,35,,507.85,percent of total billed charges,Implant Device,493.34,34,"Charges > $500, x 34%",493.34,percent of total billed charges,Implant Device,507.85,35,,507.85,percent of total billed charges,Implant Devices,507.85,35,,507.85,percent of total billed charges,Implant Devices,507.85,35,,,percent of total billed charges,Implant Devices,507.85,35,,507.85,percent of total billed charges,Implant Devices,507.85,35,,507.85,percent of total billed charges,Implant Devices,580.4,40,,580.4,percent of total billed charges,Implant Devices,507.85,70,,507.85,percent of total billed charges,Implant Devices,493.34,34,,493.34,percent of total billed charges,Implant Devices,493.34,34,,493.34,percent of total billed charges,Implant Devices,507.85,35,,507.85,percent of total billed charges,Implant Devices,507.85,35,,507.85,percent of total billed charges,Implant Devices,507.85,35,,507.85,percent of total billed charges,Implant Devices,507.85,35,,507.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,580.4,
STRYKER 614612 LOCKING SCREW 3.5X12MM,C1713,HCPCS,,79003532,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
STRYKER 614616 LOCKING SCREW 3.5X16MM,C1713,HCPCS,,79003533,CDM,278,RC,,,both,,,755,297.97,39.4668,,297.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,264.25,35,,264.25,percent of total billed charges,Implant Device,256.7,34,"Charges > $500, x 34%",256.7,percent of total billed charges,Implant Device,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,302,40,,302,percent of total billed charges,Implant Devices,264.25,70,,264.25,percent of total billed charges,Implant Devices,256.7,34,,256.7,percent of total billed charges,Implant Devices,256.7,34,,256.7,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,302,
STRYKER 614618 LOCKING SCREW 3.5X18MM,C1713,HCPCS,,79003534,CDM,278,RC,,,both,,,755,297.97,39.4668,,297.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,256.7,34,,256.7,percent of total billed charges,Implant Device,264.25,35,,264.25,percent of total billed charges,Implant Device,256.7,34,"Charges > $500, x 34%",256.7,percent of total billed charges,Implant Device,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,302,40,,302,percent of total billed charges,Implant Devices,264.25,70,,264.25,percent of total billed charges,Implant Devices,256.7,34,,256.7,percent of total billed charges,Implant Devices,256.7,34,,256.7,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,264.25,35,,264.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,302,
STRYKER 614622 LOCKING SCREW 3.5X22MM,C1713,HCPCS,,79003535,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
STRYKER 614624 LOCKING SCREW 3.5X24MM,C1713,HCPCS,,79003536,CDM,278,RC,,,both,,,666,262.85,39.4668,,262.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,233.1,35,,233.1,percent of total billed charges,Implant Device,226.44,34,"Charges > $500, x 34%",226.44,percent of total billed charges,Implant Device,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,266.4,40,,266.4,percent of total billed charges,Implant Devices,233.1,70,,233.1,percent of total billed charges,Implant Devices,226.44,34,,226.44,percent of total billed charges,Implant Devices,226.44,34,,226.44,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.4,
STRYKER 614640 LOCKING SCREW 3.5X40MM,C1713,HCPCS,,79003537,CDM,278,RC,,,both,,,293,115.64,39.4668,,115.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,102.55,35,,102.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,117.2,40,,117.2,percent of total billed charges,Implant Devices,102.55,70,,102.55,percent of total billed charges,Implant Devices,99.62,34,,99.62,percent of total billed charges,Implant Devices,99.62,34,,99.62,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.2,
STRYKER 614670 LOCKING SCREW 3.5X70MM,C1713,HCPCS,,79003538,CDM,278,RC,,,both,,,653,257.72,39.4668,,257.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,222.02,34,,222.02,percent of total billed charges,Implant Device,222.02,34,,222.02,percent of total billed charges,Implant Device,222.02,34,,222.02,percent of total billed charges,Implant Device,222.02,34,,222.02,percent of total billed charges,Implant Device,222.02,34,,222.02,percent of total billed charges,Implant Device,222.02,34,,222.02,percent of total billed charges,Implant Device,228.55,35,,228.55,percent of total billed charges,Implant Device,222.02,34,"Charges > $500, x 34%",222.02,percent of total billed charges,Implant Device,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,261.2,40,,261.2,percent of total billed charges,Implant Devices,228.55,70,,228.55,percent of total billed charges,Implant Devices,222.02,34,,222.02,percent of total billed charges,Implant Devices,222.02,34,,222.02,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,261.2,
STRYKER 614812 NON LOCK SCREW 3.5X17MM,C1713,HCPCS,,79003539,CDM,278,RC,,,both,,,374,147.61,39.4668,,147.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,130.9,35,,130.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,149.6,40,,149.6,percent of total billed charges,Implant Devices,130.9,70,,130.9,percent of total billed charges,Implant Devices,127.16,34,,127.16,percent of total billed charges,Implant Devices,127.16,34,,127.16,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,149.6,
STRYKER 614818 NON LOCK SCREW 3.5X18MM,C1713,HCPCS,,79003540,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
STRYKER 614822 NON LOCK SCREW 3.5X22MM,C1713,HCPCS,,79003541,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 614828 NON LOCK SCREW 3.5X28MM,C1713,HCPCS,,79003542,CDM,278,RC,,,both,,,293,115.64,39.4668,,115.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,102.55,35,,102.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,117.2,40,,117.2,percent of total billed charges,Implant Devices,102.55,70,,102.55,percent of total billed charges,Implant Devices,99.62,34,,99.62,percent of total billed charges,Implant Devices,99.62,34,,99.62,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.2,
STRYKER 614850 NON LOCK SCREW 3.5X50MM,C1713,HCPCS,,79003543,CDM,278,RC,,,both,,,319,125.9,39.4668,,125.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,127.6,40,,127.6,percent of total billed charges,Implant Devices,111.65,70,,111.65,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,127.6,
STRYKER 2102-2202 VITOSS BB TRAUMA 2.5CC,C1713,HCPCS,,79003544,CDM,278,RC,,,both,,,4977,1964.26,39.4668,,1964.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1692.18,34,,1692.18,percent of total billed charges,Implant Device,1692.18,34,,1692.18,percent of total billed charges,Implant Device,1692.18,34,,1692.18,percent of total billed charges,Implant Device,1692.18,34,,1692.18,percent of total billed charges,Implant Device,1692.18,34,,1692.18,percent of total billed charges,Implant Device,1692.18,34,,1692.18,percent of total billed charges,Implant Device,1741.95,35,,1741.95,percent of total billed charges,Implant Device,1692.18,34,"Charges > $500, x 34%",1692.18,percent of total billed charges,Implant Device,1741.95,35,,1741.95,percent of total billed charges,Implant Devices,1741.95,35,,1741.95,percent of total billed charges,Implant Devices,1741.95,35,,,percent of total billed charges,Implant Devices,1741.95,35,,1741.95,percent of total billed charges,Implant Devices,1741.95,35,,1741.95,percent of total billed charges,Implant Devices,1990.8,40,,1990.8,percent of total billed charges,Implant Devices,1741.95,70,,1741.95,percent of total billed charges,Implant Devices,1692.18,34,,1692.18,percent of total billed charges,Implant Devices,1692.18,34,,1692.18,percent of total billed charges,Implant Devices,1741.95,35,,1741.95,percent of total billed charges,Implant Devices,1741.95,35,,1741.95,percent of total billed charges,Implant Devices,1741.95,35,,1741.95,percent of total billed charges,Implant Devices,1741.95,35,,1741.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1692.18,34,"If Charge > 2,000, then 34 percent",1692.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1990.8,
ZIMMER 2232-04-18-REV CBL RDY COCR ASSY,C1713,HCPCS,,79003554,CDM,278,RC,,,both,,,2222,876.95,39.4668,,876.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,755.48,34,,755.48,percent of total billed charges,Implant Device,755.48,34,,755.48,percent of total billed charges,Implant Device,755.48,34,,755.48,percent of total billed charges,Implant Device,755.48,34,,755.48,percent of total billed charges,Implant Device,755.48,34,,755.48,percent of total billed charges,Implant Device,755.48,34,,755.48,percent of total billed charges,Implant Device,777.7,35,,777.7,percent of total billed charges,Implant Device,755.48,34,"Charges > $500, x 34%",755.48,percent of total billed charges,Implant Device,777.7,35,,777.7,percent of total billed charges,Implant Devices,777.7,35,,777.7,percent of total billed charges,Implant Devices,777.7,35,,,percent of total billed charges,Implant Devices,777.7,35,,777.7,percent of total billed charges,Implant Devices,777.7,35,,777.7,percent of total billed charges,Implant Devices,888.8,40,,888.8,percent of total billed charges,Implant Devices,777.7,70,,777.7,percent of total billed charges,Implant Devices,755.48,34,,755.48,percent of total billed charges,Implant Devices,755.48,34,,755.48,percent of total billed charges,Implant Devices,777.7,35,,777.7,percent of total billed charges,Implant Devices,777.7,35,,777.7,percent of total billed charges,Implant Devices,777.7,35,,777.7,percent of total billed charges,Implant Devices,777.7,35,,777.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,755.48,34,"If Charge > 2,000, then 34 percent",755.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,888.8,
BIOMET 180502 FIXED LOCK SCREW 4.75X25MM,C1713,HCPCS,,79003556,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
ARTHREX AR-1934BCF-24-2 SUTURETAK 2.4,C1713,HCPCS,,79003557,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
PARAGON 28 P28-20-130 SCREW STD 3.5X30,C1713,HCPCS,,79003558,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
INTL BIOLOGICS 907 ANT TIB TENDON 7X290,C1713,HCPCS,,79003560,CDM,278,RC,,,both,,,5325,2101.61,39.4668,,2101.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1863.75,35,,1863.75,percent of total billed charges,Implant Device,1810.5,34,"Charges > $500, x 34%",1810.5,percent of total billed charges,Implant Device,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,2130,40,,2130,percent of total billed charges,Implant Devices,1863.75,70,,1863.75,percent of total billed charges,Implant Devices,1810.5,34,,1810.5,percent of total billed charges,Implant Devices,1810.5,34,,1810.5,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1810.5,34,"If Charge > 2,000, then 34 percent",1810.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2130,
STRYKER 5023-5-120 APEX PINS 4X120MM,C1713,HCPCS,,79003563,CDM,278,RC,,,both,,,503,198.52,39.4668,,198.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,176.05,35,,176.05,percent of total billed charges,Implant Device,171.02,34,"Charges > $500, x 34%",171.02,percent of total billed charges,Implant Device,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,201.2,40,,201.2,percent of total billed charges,Implant Devices,176.05,70,,176.05,percent of total billed charges,Implant Devices,171.02,34,,171.02,percent of total billed charges,Implant Devices,171.02,34,,171.02,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.2,
BIOMET 402283 BONE CEMENT W/GENTAMICIN,C1713,HCPCS,,79003571,CDM,278,RC,,,both,,,1098,433.35,39.4668,,433.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,384.3,35,,384.3,percent of total billed charges,Implant Device,373.32,34,"Charges > $500, x 34%",373.32,percent of total billed charges,Implant Device,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,439.2,40,,439.2,percent of total billed charges,Implant Devices,384.3,70,,384.3,percent of total billed charges,Implant Devices,373.32,34,,373.32,percent of total billed charges,Implant Devices,373.32,34,,373.32,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,439.2,
ACUMED 70-0383 OLECRANON PLATE 3 HOLE,C1713,HCPCS,,79003572,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
ACUMED 30-0262 NON LOCK SCREW 3.5X22MM,C1713,HCPCS,,79003575,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
ACUMED 30-0330 LOCKING SCREW 2.7X20MM,C1713,HCPCS,,79003576,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ACUMED 30-0331 LOCKING SCREW 2.7X22MM,C1713,HCPCS,,79003577,CDM,278,RC,,,both,,,424,167.34,39.4668,,167.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,148.4,35,,148.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,169.6,40,,169.6,percent of total billed charges,Implant Devices,148.4,70,,148.4,percent of total billed charges,Implant Devices,144.16,34,,144.16,percent of total billed charges,Implant Devices,144.16,34,,144.16,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,169.6,
ACUMED 30-0241 LOCKING SCREW 3.5X26MM,C1713,HCPCS,,79003578,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ACUMED 30-0239 LOCKING SC REW 3.5X22MM,C1713,HCPCS,,79003579,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
ACUMED 70-0296 CLAVICLE PLATE 6 HOLE,C1713,HCPCS,,79003580,CDM,278,RC,,,both,,,3366,1328.45,39.4668,,1328.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1178.1,35,,1178.1,percent of total billed charges,Implant Device,1144.44,34,"Charges > $500, x 34%",1144.44,percent of total billed charges,Implant Device,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1346.4,40,,1346.4,percent of total billed charges,Implant Devices,1178.1,70,,1178.1,percent of total billed charges,Implant Devices,1144.44,34,,1144.44,percent of total billed charges,Implant Devices,1144.44,34,,1144.44,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1144.44,34,"If Charge > 2,000, then 34 percent",1144.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1346.4,
ACUMED CO-3180 NON LOCK SCREW 3.5X18MM,C1713,HCPCS,,79003581,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
ACUMED CO-3120 NON LOCK SCREW 3.5X12MM,C1713,HCPCS,,79003582,CDM,278,RC,,,both,,,232,91.56,39.4668,,91.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,78.88,34,,78.88,percent of total billed charges,Implant Device,81.2,35,,81.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,92.8,40,,92.8,percent of total billed charges,Implant Devices,81.2,70,,81.2,percent of total billed charges,Implant Devices,78.88,34,,78.88,percent of total billed charges,Implant Devices,78.88,34,,78.88,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,81.2,35,,81.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,92.8,
ACUMED COL-3100 LOCKING SCREW 3.5X10MM,C1713,HCPCS,,79003584,CDM,278,RC,,,both,,,382,150.76,39.4668,,150.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,133.7,35,,133.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,152.8,40,,152.8,percent of total billed charges,Implant Devices,133.7,70,,133.7,percent of total billed charges,Implant Devices,129.88,34,,129.88,percent of total billed charges,Implant Devices,129.88,34,,129.88,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,152.8,
ARTHREX AR-893-40PT PART THRD SCREW 3X40,C1713,HCPCS,,79003586,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
STABL BIOLOGICS 908 POST TIB ALLOGRAFT,C1713,HCPCS,,79003587,CDM,278,RC,,,both,,,5326,2102,39.4668,,2102,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1864.1,35,,1864.1,percent of total billed charges,Implant Device,1810.84,34,"Charges > $500, x 34%",1810.84,percent of total billed charges,Implant Device,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,2130.4,40,,2130.4,percent of total billed charges,Implant Devices,1864.1,70,,1864.1,percent of total billed charges,Implant Devices,1810.84,34,,1810.84,percent of total billed charges,Implant Devices,1810.84,34,,1810.84,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1810.84,34,"If Charge > 2,000, then 34 percent",1810.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2130.4,
EXACTECH 300-10-45 REPLICATOR PLATE 4.5,C1713,HCPCS,,79003589,CDM,278,RC,,,both,,,1890,745.92,39.4668,,745.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,661.5,35,,661.5,percent of total billed charges,Implant Device,642.6,34,"Charges > $500, x 34%",642.6,percent of total billed charges,Implant Device,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,756,40,,756,percent of total billed charges,Implant Devices,661.5,70,,661.5,percent of total billed charges,Implant Devices,642.6,34,,642.6,percent of total billed charges,Implant Devices,642.6,34,,642.6,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,756,
EXACTECH 300-20-02 TORQUE SCREW KIT,C1713,HCPCS,,79003590,CDM,278,RC,,,both,,,675,266.4,39.4668,,266.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Device,229.5,34,"Charges > $500, x 34%",229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,270,40,,270,percent of total billed charges,Implant Devices,236.25,70,,236.25,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270,
ACUMED 70-0306 OLECRANON PLATE 7 HOLE LT,C1713,HCPCS,,79003592,CDM,278,RC,,,both,,,3744,1477.64,39.4668,,1477.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1272.96,34,,1272.96,percent of total billed charges,Implant Device,1272.96,34,,1272.96,percent of total billed charges,Implant Device,1272.96,34,,1272.96,percent of total billed charges,Implant Device,1272.96,34,,1272.96,percent of total billed charges,Implant Device,1272.96,34,,1272.96,percent of total billed charges,Implant Device,1272.96,34,,1272.96,percent of total billed charges,Implant Device,1310.4,35,,1310.4,percent of total billed charges,Implant Device,1272.96,34,"Charges > $500, x 34%",1272.96,percent of total billed charges,Implant Device,1310.4,35,,1310.4,percent of total billed charges,Implant Devices,1310.4,35,,1310.4,percent of total billed charges,Implant Devices,1310.4,35,,,percent of total billed charges,Implant Devices,1310.4,35,,1310.4,percent of total billed charges,Implant Devices,1310.4,35,,1310.4,percent of total billed charges,Implant Devices,1497.6,40,,1497.6,percent of total billed charges,Implant Devices,1310.4,70,,1310.4,percent of total billed charges,Implant Devices,1272.96,34,,1272.96,percent of total billed charges,Implant Devices,1272.96,34,,1272.96,percent of total billed charges,Implant Devices,1310.4,35,,1310.4,percent of total billed charges,Implant Devices,1310.4,35,,1310.4,percent of total billed charges,Implant Devices,1310.4,35,,1310.4,percent of total billed charges,Implant Devices,1310.4,35,,1310.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1272.96,34,"If Charge > 2,000, then 34 percent",1272.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1497.6,
ACUMED CON2326 NON LOCK SCREW 3.5X14MM,C1713,HCPCS,,79003593,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
ACUMED 30-0258 LOCKING SCREW 2.7X18MM,C1713,HCPCS,,79003594,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
ACUMED 30-0329 LOCKING SCREW 2.7X18MM,C1713,HCPCS,,79003595,CDM,278,RC,,,both,,,510,201.28,39.4668,,201.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Device,173.4,34,"Charges > $500, x 34%",173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,204,40,,204,percent of total billed charges,Implant Devices,178.5,70,,178.5,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204,
ACUMED 30-0262 NON LOCK SCREW 3.5X22MM,C1713,HCPCS,,79003596,CDM,278,RC,,,both,,,274,108.14,39.4668,,108.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,95.9,35,,95.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,109.6,40,,109.6,percent of total billed charges,Implant Devices,95.9,70,,95.9,percent of total billed charges,Implant Devices,93.16,34,,93.16,percent of total billed charges,Implant Devices,93.16,34,,93.16,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.6,
ACUMED 30-0257 NON LOCK SCREW 3.5X12MM,C1713,HCPCS,,79003597,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
ACUMED 30-0243 LOCKING SCREW 3.5 X 30MM,C1713,HCPCS,,79003598,CDM,278,RC,,,both,,,424,167.34,39.4668,,167.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,144.16,34,,144.16,percent of total billed charges,Implant Device,148.4,35,,148.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,169.6,40,,169.6,percent of total billed charges,Implant Devices,148.4,70,,148.4,percent of total billed charges,Implant Devices,144.16,34,,144.16,percent of total billed charges,Implant Devices,144.16,34,,144.16,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,148.4,35,,148.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,169.6,
ACUMED AT2-C18-S MICRO SCREW 18MM,C1713,HCPCS,,79003601,CDM,278,RC,,,both,,,1570,619.63,39.4668,,619.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Device,533.8,34,"Charges > $500, x 34%",533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,628,40,,628,percent of total billed charges,Implant Devices,549.5,70,,549.5,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,628,
ACUMED AT2-C16-S MICRO SCREW 16MM,C1713,HCPCS,,79003602,CDM,278,RC,,,both,,,1584,625.15,39.4668,,625.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Device,538.56,34,"Charges > $500, x 34%",538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,633.6,40,,633.6,percent of total billed charges,Implant Devices,554.4,70,,554.4,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,633.6,
STRYKER 5038-5-060 APEX PIN 3X60MM,C1713,HCPCS,,79003610,CDM,278,RC,,,both,,,148,58.41,39.4668,,58.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,51.8,35,,51.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,59.2,40,,59.2,percent of total billed charges,Implant Devices,51.8,70,,51.8,percent of total billed charges,Implant Devices,50.32,34,,50.32,percent of total billed charges,Implant Devices,50.32,34,,50.32,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,59.2,
STRYKER 5038-5-080 APEX PIN 3X80MM,C1713,HCPCS,,79003611,CDM,278,RC,,,both,,,148,58.41,39.4668,,58.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,51.8,35,,51.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,59.2,40,,59.2,percent of total billed charges,Implant Devices,51.8,70,,51.8,percent of total billed charges,Implant Devices,50.32,34,,50.32,percent of total billed charges,Implant Devices,50.32,34,,50.32,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,59.2,
ARTRHEX AR-8740-34PTS CANN SCREW 4X34MM,C1713,HCPCS,,79003612,CDM,278,RC,,,both,,,708,279.42,39.4668,,279.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Device,240.72,34,"Charges > $500, x 34%",240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,283.2,40,,283.2,percent of total billed charges,Implant Devices,247.8,70,,247.8,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,283.2,
ARTHREX AR-8740-44PTS CANN SCREW 4X44MM,C1713,HCPCS,,79003613,CDM,278,RC,,,both,,,536,211.54,39.4668,,211.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,187.6,35,,187.6,percent of total billed charges,Implant Device,182.24,34,"Charges > $500, x 34%",182.24,percent of total billed charges,Implant Device,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,214.4,40,,214.4,percent of total billed charges,Implant Devices,187.6,70,,187.6,percent of total billed charges,Implant Devices,182.24,34,,182.24,percent of total billed charges,Implant Devices,182.24,34,,182.24,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.4,
ARTRHEX AR-8730-14PT CANN SCREW 3X14MM,C1713,HCPCS,,79003614,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
ARTHREX AR-8933-40PT PT SCREW 3.0X40MM,C1713,HCPCS,,79003617,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
BIOMET 14-520508 SOLI-C SPACER 8X14X12,C1713,HCPCS,,79003618,CDM,278,RC,,,both,,,15120,5967.38,39.4668,,5967.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5140.8,34,,5140.8,percent of total billed charges,Implant Device,5292,35,,5292,percent of total billed charges,Implant Device,5140.8,34,"Charges > $500, x 34%",5140.8,percent of total billed charges,Implant Device,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,6048,40,,6048,percent of total billed charges,Implant Devices,5292,70,,5292,percent of total billed charges,Implant Devices,5140.8,34,,5140.8,percent of total billed charges,Implant Devices,5140.8,34,,5140.8,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,5292,35,,5292,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5140.8,34,"If Charge > 2,000, then 34 percent",5140.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6048,
STRYKER 3060-0080S LAG SCREW 10.5X80MM,C1713,HCPCS,,79003623,CDM,278,RC,,,both,,,2012,794.07,39.4668,,794.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,684.08,34,,684.08,percent of total billed charges,Implant Device,684.08,34,,684.08,percent of total billed charges,Implant Device,684.08,34,,684.08,percent of total billed charges,Implant Device,684.08,34,,684.08,percent of total billed charges,Implant Device,684.08,34,,684.08,percent of total billed charges,Implant Device,684.08,34,,684.08,percent of total billed charges,Implant Device,704.2,35,,704.2,percent of total billed charges,Implant Device,684.08,34,"Charges > $500, x 34%",684.08,percent of total billed charges,Implant Device,704.2,35,,704.2,percent of total billed charges,Implant Devices,704.2,35,,704.2,percent of total billed charges,Implant Devices,704.2,35,,,percent of total billed charges,Implant Devices,704.2,35,,704.2,percent of total billed charges,Implant Devices,704.2,35,,704.2,percent of total billed charges,Implant Devices,804.8,40,,804.8,percent of total billed charges,Implant Devices,704.2,70,,704.2,percent of total billed charges,Implant Devices,684.08,34,,684.08,percent of total billed charges,Implant Devices,684.08,34,,684.08,percent of total billed charges,Implant Devices,704.2,35,,704.2,percent of total billed charges,Implant Devices,704.2,35,,704.2,percent of total billed charges,Implant Devices,704.2,35,,704.2,percent of total billed charges,Implant Devices,704.2,35,,704.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,684.08,34,"If Charge > 2,000, then 34 percent",684.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804.8,
STRYKER 628006 CLAVICLE PLATE 6 HOLE,C1713,HCPCS,,79003631,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
STRYKER 614614 LOCKING SCREW 3.5X14MM,C1713,HCPCS,,79003632,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
STRYKER 614814 NON LOCKING SCREW 3.5X14,C1713,HCPCS,,79003633,CDM,278,RC,,,both,,,374,147.61,39.4668,,147.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,130.9,35,,130.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,149.6,40,,149.6,percent of total billed charges,Implant Devices,130.9,70,,130.9,percent of total billed charges,Implant Devices,127.16,34,,127.16,percent of total billed charges,Implant Devices,127.16,34,,127.16,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,149.6,
STRYKER 40-30110 3.0X10MM ASNIS SCREW,C1713,HCPCS,,79003634,CDM,278,RC,,,both,,,707,279.03,39.4668,,279.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,240.38,34,,240.38,percent of total billed charges,Implant Device,247.45,35,,247.45,percent of total billed charges,Implant Device,240.38,34,"Charges > $500, x 34%",240.38,percent of total billed charges,Implant Device,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,282.8,40,,282.8,percent of total billed charges,Implant Devices,247.45,70,,247.45,percent of total billed charges,Implant Devices,240.38,34,,240.38,percent of total billed charges,Implant Devices,240.38,34,,240.38,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,247.45,35,,247.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.8,
SYNTHES 208.870 CANNULATED SCREW 7.3X10,C1713,HCPCS,,79003639,CDM,278,RC,,,both,,,1080,426.24,39.4668,,426.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,378,35,,378,percent of total billed charges,Implant Device,367.2,34,"Charges > $500, x 34%",367.2,percent of total billed charges,Implant Device,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,432,40,,432,percent of total billed charges,Implant Devices,378,70,,378,percent of total billed charges,Implant Devices,367.2,34,,367.2,percent of total billed charges,Implant Devices,367.2,34,,367.2,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,432,
SOLANA PHG-05C TENSIX ALLOFRAFT 5CC,C1713,HCPCS,,79003645,CDM,278,RC,,,both,,,4788,1889.67,39.4668,,1889.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1627.92,34,,1627.92,percent of total billed charges,Implant Device,1627.92,34,,1627.92,percent of total billed charges,Implant Device,1627.92,34,,1627.92,percent of total billed charges,Implant Device,1627.92,34,,1627.92,percent of total billed charges,Implant Device,1627.92,34,,1627.92,percent of total billed charges,Implant Device,1627.92,34,,1627.92,percent of total billed charges,Implant Device,1675.8,35,,1675.8,percent of total billed charges,Implant Device,1627.92,34,"Charges > $500, x 34%",1627.92,percent of total billed charges,Implant Device,1675.8,35,,1675.8,percent of total billed charges,Implant Devices,1675.8,35,,1675.8,percent of total billed charges,Implant Devices,1675.8,35,,,percent of total billed charges,Implant Devices,1675.8,35,,1675.8,percent of total billed charges,Implant Devices,1675.8,35,,1675.8,percent of total billed charges,Implant Devices,1915.2,40,,1915.2,percent of total billed charges,Implant Devices,1675.8,70,,1675.8,percent of total billed charges,Implant Devices,1627.92,34,,1627.92,percent of total billed charges,Implant Devices,1627.92,34,,1627.92,percent of total billed charges,Implant Devices,1675.8,35,,1675.8,percent of total billed charges,Implant Devices,1675.8,35,,1675.8,percent of total billed charges,Implant Devices,1675.8,35,,1675.8,percent of total billed charges,Implant Devices,1675.8,35,,1675.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1627.92,34,"If Charge > 2,000, then 34 percent",1627.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1915.2,
SYNTHES 208.875 CANN SCREW 7.3X75MM,C1713,HCPCS,,79003649,CDM,278,RC,,,both,,,742,292.84,39.4668,,292.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,252.28,34,,252.28,percent of total billed charges,Implant Device,252.28,34,,252.28,percent of total billed charges,Implant Device,252.28,34,,252.28,percent of total billed charges,Implant Device,252.28,34,,252.28,percent of total billed charges,Implant Device,252.28,34,,252.28,percent of total billed charges,Implant Device,252.28,34,,252.28,percent of total billed charges,Implant Device,259.7,35,,259.7,percent of total billed charges,Implant Device,252.28,34,"Charges > $500, x 34%",252.28,percent of total billed charges,Implant Device,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,296.8,40,,296.8,percent of total billed charges,Implant Devices,259.7,70,,259.7,percent of total billed charges,Implant Devices,252.28,34,,252.28,percent of total billed charges,Implant Devices,252.28,34,,252.28,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,296.8,
ARTHREX AR-8720-14PT CANN SCREW 2X14MM,C1713,HCPCS,,79003653,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ARTHREX AR-8724-18PT CANN SCREW 2.4X18MM,C1713,HCPCS,,79003654,CDM,278,RC,,,both,,,376,148.4,39.4668,,148.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.84,34,,127.84,percent of total billed charges,Implant Device,127.84,34,,127.84,percent of total billed charges,Implant Device,127.84,34,,127.84,percent of total billed charges,Implant Device,127.84,34,,127.84,percent of total billed charges,Implant Device,127.84,34,,127.84,percent of total billed charges,Implant Device,127.84,34,,127.84,percent of total billed charges,Implant Device,131.6,35,,131.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,150.4,40,,150.4,percent of total billed charges,Implant Devices,131.6,70,,131.6,percent of total billed charges,Implant Devices,127.84,34,,127.84,percent of total billed charges,Implant Devices,127.84,34,,127.84,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150.4,
BIOMET 28821 TROCHANTERIC NAIL 11X17CM,C1713,HCPCS,,79003658,CDM,278,RC,,,both,,,7950,3137.61,39.4668,,3137.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2782.5,35,,2782.5,percent of total billed charges,Implant Device,2703,34,"Charges > $500, x 34%",2703,percent of total billed charges,Implant Device,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,3180,40,,3180,percent of total billed charges,Implant Devices,2782.5,70,,2782.5,percent of total billed charges,Implant Devices,2703,34,,2703,percent of total billed charges,Implant Devices,2703,34,,2703,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2703,34,"If Charge > 2,000, then 34 percent",2703,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3180,
ZIMMER 6250-65-60 BONE SCREW 6.5X60MM,C1713,HCPCS,,79003663,CDM,278,RC,,,both,,,96,37.89,39.4668,,37.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,33.6,35,,33.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,38.4,40,,38.4,percent of total billed charges,Implant Devices,33.6,70,,33.6,percent of total billed charges,Implant Devices,32.64,34,,32.64,percent of total billed charges,Implant Devices,32.64,34,,32.64,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.4,
STRYKER 40-30118 MICRO SCREW 3X18/5MM,C1713,HCPCS,,79003668,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
SYNTHES 208.440 CANNULATD SCREW 3.2X90MM,C1713,HCPCS,,79003686,CDM,278,RC,,,both,,,908,358.36,39.4668,,358.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Device,308.72,34,"Charges > $500, x 34%",308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,363.2,40,,363.2,percent of total billed charges,Implant Devices,317.8,70,,317.8,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,363.2,
SYNTHES 208.441 CANNULATD SCREW 3.2X95MM,C1713,HCPCS,,79003687,CDM,278,RC,,,both,,,908,358.36,39.4668,,358.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Device,308.72,34,"Charges > $500, x 34%",308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,363.2,40,,363.2,percent of total billed charges,Implant Devices,317.8,70,,317.8,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,363.2,
ARTHREX AR-5035TC-12 BIOCOMP SCREW 12X35,C1713,HCPCS,,79003691,CDM,278,RC,,,both,,,966,381.25,39.4668,,381.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Device,328.44,34,"Charges > $500, x 34%",328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,386.4,40,,386.4,percent of total billed charges,Implant Devices,338.1,70,,338.1,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,386.4,
SYNTHES XM106.1625S TISSUE MATRX 16X25CM,C1713,HCPCS,,79003692,CDM,278,RC,,,both,,,36810,14527.73,39.4668,,14527.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12515.4,34,,12515.4,percent of total billed charges,Implant Device,12515.4,34,,12515.4,percent of total billed charges,Implant Device,12515.4,34,,12515.4,percent of total billed charges,Implant Device,12515.4,34,,12515.4,percent of total billed charges,Implant Device,12515.4,34,,12515.4,percent of total billed charges,Implant Device,12515.4,34,,12515.4,percent of total billed charges,Implant Device,12883.5,35,,12883.5,percent of total billed charges,Implant Device,12515.4,34,"Charges > $500, x 34%",12515.4,percent of total billed charges,Implant Device,12883.5,35,,12883.5,percent of total billed charges,Implant Devices,12883.5,35,,12883.5,percent of total billed charges,Implant Devices,12883.5,35,,,percent of total billed charges,Implant Devices,12883.5,35,,12883.5,percent of total billed charges,Implant Devices,12883.5,35,,12883.5,percent of total billed charges,Implant Devices,14724,40,,14724,percent of total billed charges,Implant Devices,12883.5,70,,12883.5,percent of total billed charges,Implant Devices,12515.4,34,,12515.4,percent of total billed charges,Implant Devices,12515.4,34,,12515.4,percent of total billed charges,Implant Devices,12883.5,35,,12883.5,percent of total billed charges,Implant Devices,12883.5,35,,12883.5,percent of total billed charges,Implant Devices,12883.5,35,,12883.5,percent of total billed charges,Implant Devices,12883.5,35,,12883.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,12515.4,34,"If Charge > 2,000, then 34 percent",12515.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14724,
ZIMMER 00-2359-014-35 SCREW 3.5X14MM,C1713,HCPCS,,79003696,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
ZIMMER 00-2359-016-35 SCREW 3.5X16MM,C1713,HCPCS,,79003697,CDM,278,RC,,,both,,,310,122.35,39.4668,,122.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,108.5,35,,108.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,124,40,,124,percent of total billed charges,Implant Devices,108.5,70,,108.5,percent of total billed charges,Implant Devices,105.4,34,,105.4,percent of total billed charges,Implant Devices,105.4,34,,105.4,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124,
ZIMMER 00-4835-014-01 CORT SCREW 3.4X14,C1713,HCPCS,,79003701,CDM,278,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,28.8,40,,28.8,percent of total billed charges,Implant Devices,25.2,70,,25.2,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28.8,
ZIMMER 00-4835-016-01 CORT SCREW 3.5X16,C1713,HCPCS,,79003702,CDM,278,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,28.8,40,,28.8,percent of total billed charges,Implant Devices,25.2,70,,25.2,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28.8,
ZIMMER 00-4835-018-01 CORT SCREW 3.5X18,C1713,HCPCS,,79003703,CDM,278,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,28.8,40,,28.8,percent of total billed charges,Implant Devices,25.2,70,,25.2,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28.8,
STRYKER 6191-1-010 SIMPLEX BONE CEMENT,C1713,HCPCS,,79003711,CDM,278,RC,,,both,,,314,123.93,39.4668,,123.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.76,34,,106.76,percent of total billed charges,Implant Device,106.76,34,,106.76,percent of total billed charges,Implant Device,106.76,34,,106.76,percent of total billed charges,Implant Device,106.76,34,,106.76,percent of total billed charges,Implant Device,106.76,34,,106.76,percent of total billed charges,Implant Device,106.76,34,,106.76,percent of total billed charges,Implant Device,109.9,35,,109.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,125.6,40,,125.6,percent of total billed charges,Implant Devices,109.9,70,,109.9,percent of total billed charges,Implant Devices,106.76,34,,106.76,percent of total billed charges,Implant Devices,106.76,34,,106.76,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,125.6,
STRYKER 6704-3-090 TROCH GRIP CABLES LG,C1713,HCPCS,,79003725,CDM,278,RC,,,both,,,5203,2053.46,39.4668,,2053.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1769.02,34,,1769.02,percent of total billed charges,Implant Device,1769.02,34,,1769.02,percent of total billed charges,Implant Device,1769.02,34,,1769.02,percent of total billed charges,Implant Device,1769.02,34,,1769.02,percent of total billed charges,Implant Device,1769.02,34,,1769.02,percent of total billed charges,Implant Device,1769.02,34,,1769.02,percent of total billed charges,Implant Device,1821.05,35,,1821.05,percent of total billed charges,Implant Device,1769.02,34,"Charges > $500, x 34%",1769.02,percent of total billed charges,Implant Device,1821.05,35,,1821.05,percent of total billed charges,Implant Devices,1821.05,35,,1821.05,percent of total billed charges,Implant Devices,1821.05,35,,,percent of total billed charges,Implant Devices,1821.05,35,,1821.05,percent of total billed charges,Implant Devices,1821.05,35,,1821.05,percent of total billed charges,Implant Devices,2081.2,40,,2081.2,percent of total billed charges,Implant Devices,1821.05,70,,1821.05,percent of total billed charges,Implant Devices,1769.02,34,,1769.02,percent of total billed charges,Implant Devices,1769.02,34,,1769.02,percent of total billed charges,Implant Devices,1821.05,35,,1821.05,percent of total billed charges,Implant Devices,1821.05,35,,1821.05,percent of total billed charges,Implant Devices,1821.05,35,,1821.05,percent of total billed charges,Implant Devices,1821.05,35,,1821.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1769.02,34,"If Charge > 2,000, then 34 percent",1769.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2081.2,
ARTHREX AR-1400C BIOCOMP SCREW 6X23MM,C1713,HCPCS,,79003727,CDM,278,RC,,,both,,,966,381.25,39.4668,,381.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Device,328.44,34,"Charges > $500, x 34%",328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,386.4,40,,386.4,percent of total billed charges,Implant Devices,338.1,70,,338.1,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,386.4,
ACUMED 70-0294 CLAVICLE PLATE 4 HOLE,C1713,HCPCS,,79003731,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
ACUMED CO-2326 THRED LOCK SCREW 2.3X26MM,C1713,HCPCS,,79003732,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
ACUMED AT2-M165 ACUTAK 2 SCREW 16MM,C1713,HCPCS,,79003733,CDM,278,RC,,,both,,,1374,542.27,39.4668,,542.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,480.9,35,,480.9,percent of total billed charges,Implant Device,467.16,34,"Charges > $500, x 34%",467.16,percent of total billed charges,Implant Device,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,549.6,40,,549.6,percent of total billed charges,Implant Devices,480.9,70,,480.9,percent of total billed charges,Implant Devices,467.16,34,,467.16,percent of total billed charges,Implant Devices,467.16,34,,467.16,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,549.6,
ACUMED COL-2712 2.7X12MM LOCKING SCREW,C1713,HCPCS,,79003735,CDM,278,RC,,,both,,,328,129.45,39.4668,,129.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,114.8,35,,114.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,131.2,40,,131.2,percent of total billed charges,Implant Devices,114.8,70,,114.8,percent of total billed charges,Implant Devices,111.52,34,,111.52,percent of total billed charges,Implant Devices,111.52,34,,111.52,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,131.2,
ACUMED COL-3030 3.5X8MM LOCKING SCREW,C1713,HCPCS,,79003736,CDM,278,RC,,,both,,,328,129.45,39.4668,,129.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,114.8,35,,114.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,131.2,40,,131.2,percent of total billed charges,Implant Devices,114.8,70,,114.8,percent of total billed charges,Implant Devices,111.52,34,,111.52,percent of total billed charges,Implant Devices,111.52,34,,111.52,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,131.2,
ACUMED AT2-M22-S ACUTRAK II BONE SCREW,C1713,HCPCS,,79003738,CDM,278,RC,,,both,,,1374,542.27,39.4668,,542.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,480.9,35,,480.9,percent of total billed charges,Implant Device,467.16,34,"Charges > $500, x 34%",467.16,percent of total billed charges,Implant Device,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,549.6,40,,549.6,percent of total billed charges,Implant Devices,480.9,70,,480.9,percent of total billed charges,Implant Devices,467.16,34,,467.16,percent of total billed charges,Implant Devices,467.16,34,,467.16,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,549.6,
ACUMED AT2-M30-S ACUTAK 2 SCREW 30MM,C1713,HCPCS,,79003739,CDM,278,RC,,,both,,,1374,542.27,39.4668,,542.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,480.9,35,,480.9,percent of total billed charges,Implant Device,467.16,34,"Charges > $500, x 34%",467.16,percent of total billed charges,Implant Device,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,549.6,40,,549.6,percent of total billed charges,Implant Devices,480.9,70,,480.9,percent of total billed charges,Implant Devices,467.16,34,,467.16,percent of total billed charges,Implant Devices,467.16,34,,467.16,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,549.6,
ACUMED AT2-M30 ACUTRAK MINI SCREW 30MM,C1713,HCPCS,,79003740,CDM,278,RC,,,both,,,1570,619.63,39.4668,,619.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Device,533.8,34,"Charges > $500, x 34%",533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,628,40,,628,percent of total billed charges,Implant Devices,549.5,70,,549.5,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,628,
ACUMED 70-0305 7 HOLE OLECRANON PATE R,C1713,HCPCS,,79003741,CDM,278,RC,,,both,,,3430,1353.71,39.4668,,1353.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1200.5,35,,1200.5,percent of total billed charges,Implant Device,1166.2,34,"Charges > $500, x 34%",1166.2,percent of total billed charges,Implant Device,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1372,40,,1372,percent of total billed charges,Implant Devices,1200.5,70,,1200.5,percent of total billed charges,Implant Devices,1166.2,34,,1166.2,percent of total billed charges,Implant Devices,1166.2,34,,1166.2,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1166.2,34,"If Charge > 2,000, then 34 percent",1166.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1372,
ACUMED CO-2714 CORTICAL SCREW 2.7X14,C1713,HCPCS,,79003742,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
ACUMED CO-T2322 LOCKING SCREW 2.3X22MM,C1713,HCPCS,,79003743,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ACUMED AT2-M18-S BONE SCREW 18.0MM,C1713,HCPCS,,79003744,CDM,278,RC,,,both,,,1374,542.27,39.4668,,542.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,467.16,34,,467.16,percent of total billed charges,Implant Device,480.9,35,,480.9,percent of total billed charges,Implant Device,467.16,34,"Charges > $500, x 34%",467.16,percent of total billed charges,Implant Device,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,549.6,40,,549.6,percent of total billed charges,Implant Devices,480.9,70,,480.9,percent of total billed charges,Implant Devices,467.16,34,,467.16,percent of total billed charges,Implant Devices,467.16,34,,467.16,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,480.9,35,,480.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,549.6,
ARTHREX AR-8949CL-S MTP PLATE STD LT,C1713,HCPCS,,79003752,CDM,278,RC,,,both,,,3430,1353.71,39.4668,,1353.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1200.5,35,,1200.5,percent of total billed charges,Implant Device,1166.2,34,"Charges > $500, x 34%",1166.2,percent of total billed charges,Implant Device,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1372,40,,1372,percent of total billed charges,Implant Devices,1200.5,70,,1200.5,percent of total billed charges,Implant Devices,1166.2,34,,1166.2,percent of total billed charges,Implant Devices,1166.2,34,,1166.2,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1166.2,34,"If Charge > 2,000, then 34 percent",1166.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1372,
ARTHREX AR-1655PS TENODESIS SCREW 5.5X8,C1713,HCPCS,,79003753,CDM,278,RC,,,both,,,1224,483.07,39.4668,,483.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,428.4,35,,428.4,percent of total billed charges,Implant Device,416.16,34,"Charges > $500, x 34%",416.16,percent of total billed charges,Implant Device,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,489.6,40,,489.6,percent of total billed charges,Implant Devices,428.4,70,,428.4,percent of total billed charges,Implant Devices,416.16,34,,416.16,percent of total billed charges,Implant Devices,416.16,34,,416.16,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,489.6,
ARTHREX AR-8935L-18 LOCKING SCREW 3.5X18,C1713,HCPCS,,79003756,CDM,278,RC,,,both,,,645,254.56,39.4668,,254.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Device,219.3,34,"Charges > $500, x 34%",219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,258,40,,258,percent of total billed charges,Implant Devices,225.75,70,,225.75,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258,
ARTHREX AR-8943T-08 PLATE 8 HOLE,C1713,HCPCS,,79003757,CDM,278,RC,,,both,,,1138,449.13,39.4668,,449.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,386.92,34,,386.92,percent of total billed charges,Implant Device,386.92,34,,386.92,percent of total billed charges,Implant Device,386.92,34,,386.92,percent of total billed charges,Implant Device,386.92,34,,386.92,percent of total billed charges,Implant Device,386.92,34,,386.92,percent of total billed charges,Implant Device,386.92,34,,386.92,percent of total billed charges,Implant Device,398.3,35,,398.3,percent of total billed charges,Implant Device,386.92,34,"Charges > $500, x 34%",386.92,percent of total billed charges,Implant Device,398.3,35,,398.3,percent of total billed charges,Implant Devices,398.3,35,,398.3,percent of total billed charges,Implant Devices,398.3,35,,,percent of total billed charges,Implant Devices,398.3,35,,398.3,percent of total billed charges,Implant Devices,398.3,35,,398.3,percent of total billed charges,Implant Devices,455.2,40,,455.2,percent of total billed charges,Implant Devices,398.3,70,,398.3,percent of total billed charges,Implant Devices,386.92,34,,386.92,percent of total billed charges,Implant Devices,386.92,34,,386.92,percent of total billed charges,Implant Devices,398.3,35,,398.3,percent of total billed charges,Implant Devices,398.3,35,,398.3,percent of total billed charges,Implant Devices,398.3,35,,398.3,percent of total billed charges,Implant Devices,398.3,35,,398.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,455.2,
ARTHREX AR-8928BC-CP ACHILLES SPEEDBRIDG,C1713,HCPCS,,79003765,CDM,278,RC,,,both,,,5220,2060.17,39.4668,,2060.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1827,35,,1827,percent of total billed charges,Implant Device,1774.8,34,"Charges > $500, x 34%",1774.8,percent of total billed charges,Implant Device,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,2088,40,,2088,percent of total billed charges,Implant Devices,1827,70,,1827,percent of total billed charges,Implant Devices,1774.8,34,,1774.8,percent of total billed charges,Implant Devices,1774.8,34,,1774.8,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1774.8,34,"If Charge > 2,000, then 34 percent",1774.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2088,
ARTHREX 8945-40FT SCREW 4.5X40FT,C1713,HCPCS,,79003768,CDM,278,RC,,,both,,,646,254.96,39.4668,,254.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Device,219.64,34,"Charges > $500, x 34%",219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,258.4,40,,258.4,percent of total billed charges,Implant Devices,226.1,70,,226.1,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258.4,
ARTHREX AR-8945-45PT CANN SCREW 4-5X45MM,C1713,HCPCS,,79003769,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ARTHREX AR-8935-20 CORT SCREW 3.5X20MM,C1713,HCPCS,,79003770,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-13380-28 CORT SCREW 4.5X28MM,C1713,HCPCS,,79003772,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
ARTHREX AR-1380C BIOCOMP SCREW 8X23MM,C1713,HCPCS,,79003773,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ARTHREX 8945-50FT ARTHREX 4.5X50FT SCREW,C1713,HCPCS,,79003775,CDM,278,RC,,,both,,,646,254.96,39.4668,,254.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Device,219.64,34,"Charges > $500, x 34%",219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,258.4,40,,258.4,percent of total billed charges,Implant Devices,226.1,70,,226.1,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258.4,
ARTHREX AR-5028C-08 BIOCOMP SCREW 8X28,C1713,HCPCS,,79003776,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ARTHREX AR-5035P-10 DELTA PK INTER SCREW,C1713,HCPCS,,79003778,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-2521 2.8 THREADED PIN,C1713,HCPCS,,79003779,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-8935-22 CORT SCREW 3.5X22MM,C1713,HCPCS,,79003781,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
BIOMED 430-9109 BME BOSS 9X7X7 1.2MM,C1713,HCPCS,,79003787,CDM,278,RC,,,both,,,2386,941.68,39.4668,,941.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,835.1,35,,835.1,percent of total billed charges,Implant Device,811.24,34,"Charges > $500, x 34%",811.24,percent of total billed charges,Implant Device,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,954.4,40,,954.4,percent of total billed charges,Implant Devices,835.1,70,,835.1,percent of total billed charges,Implant Devices,811.24,34,,811.24,percent of total billed charges,Implant Devices,811.24,34,,811.24,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,811.24,34,"If Charge > 2,000, then 34 percent",811.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,954.4,
BIOMET 162656 DISTAL CENTRALIZER 9MM,C1713,HCPCS,,79003788,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
BIOMET 26885 NON LOCK SCREW 4.5X85MM,C1713,HCPCS,,79003790,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
BIIOMET 26860 NON LOCK SCREW 4.5X60MM,C1713,HCPCS,,79003791,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
BIOMET 180-503 FIXED LOCK SCREW 4.75X30,C1713,HCPCS,,79003792,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
BIOMET 948213 REWRITE PIN 2.4X40MM,C1713,HCPCS,,79003793,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
BIOMET 26880 NON LOCK SCREW 4.5X80MM,C1713,HCPCS,,79003794,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
BIOMET 29277 LAG SCREW 90MM,C1713,HCPCS,,79003797,CDM,278,RC,,,both,,,2670,1053.76,39.4668,,1053.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,934.5,35,,934.5,percent of total billed charges,Implant Device,907.8,34,"Charges > $500, x 34%",907.8,percent of total billed charges,Implant Device,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,1068,40,,1068,percent of total billed charges,Implant Devices,934.5,70,,934.5,percent of total billed charges,Implant Devices,907.8,34,,907.8,percent of total billed charges,Implant Devices,907.8,34,,907.8,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,907.8,34,"If Charge > 2,000, then 34 percent",907.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1068,
BIOMET 406669 STEINMANN PIN 1/2X2/5,C1713,HCPCS,,79003798,CDM,278,RC,,,both,,,1110,438.08,39.4668,,438.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Device,377.4,34,"Charges > $500, x 34%",377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,444,40,,444,percent of total billed charges,Implant Devices,388.5,70,,388.5,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,444,
BIOMET 26875 NON LOCK SCREW 4.5X75MM,C1713,HCPCS,,79003802,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
BIOMET 2000-1005 LUMBAR PLUG,C1713,HCPCS,,79003804,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
BIOMET 1200 FF SEMI TENODESIS-IRR,C1713,HCPCS,,79003806,CDM,278,RC,,,both,,,5170,2040.43,39.4668,,2040.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1757.8,34,,1757.8,percent of total billed charges,Implant Device,1809.5,35,,1809.5,percent of total billed charges,Implant Device,1757.8,34,"Charges > $500, x 34%",1757.8,percent of total billed charges,Implant Device,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,2068,40,,2068,percent of total billed charges,Implant Devices,1809.5,70,,1809.5,percent of total billed charges,Implant Devices,1757.8,34,,1757.8,percent of total billed charges,Implant Devices,1757.8,34,,1757.8,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,1809.5,35,,1809.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1757.8,34,"If Charge > 2,000, then 34 percent",1757.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2068,
BIOMET 115383 CENTRAL SCREW 6.5X35MM,C1713,HCPCS,,79003809,CDM,278,RC,,,both,,,780,307.84,39.4668,,307.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Device,265.2,34,"Charges > $500, x 34%",265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,312,40,,312,percent of total billed charges,Implant Devices,273,70,,273,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,312,
BIOMET 91-61035 HT X-DRIVE SCREW 1.5X3.5,C1713,HCPCS,,79003810,CDM,278,RC,,,both,,,174,68.67,39.4668,,68.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,69.6,40,,69.6,percent of total billed charges,Implant Devices,60.9,70,,60.9,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,69.6,
BIOMET 26480 CANNULATED SCREW 5.5X80MM,C1713,HCPCS,,79003816,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
BIOMET 28811 TROCHANT NAIL SHORT 11X22CM,C1713,HCPCS,,79003818,CDM,278,RC,,,both,,,7950,3137.61,39.4668,,3137.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2782.5,35,,2782.5,percent of total billed charges,Implant Device,2703,34,"Charges > $500, x 34%",2703,percent of total billed charges,Implant Device,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,3180,40,,3180,percent of total billed charges,Implant Devices,2782.5,70,,2782.5,percent of total billed charges,Implant Devices,2703,34,,2703,percent of total billed charges,Implant Devices,2703,34,,2703,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2703,34,"If Charge > 2,000, then 34 percent",2703,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3180,
BIOMET 26852 NON LOCK SCREW 4.5X52MM,C1713,HCPCS,,79003819,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
BIOMET 8135-0032-W HEMICAP 13.5MM TAPER,C1713,HCPCS,,79003820,CDM,278,RC,,,both,,,1956,771.97,39.4668,,771.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,665.04,34,,665.04,percent of total billed charges,Implant Device,665.04,34,,665.04,percent of total billed charges,Implant Device,665.04,34,,665.04,percent of total billed charges,Implant Device,665.04,34,,665.04,percent of total billed charges,Implant Device,665.04,34,,665.04,percent of total billed charges,Implant Device,665.04,34,,665.04,percent of total billed charges,Implant Device,684.6,35,,684.6,percent of total billed charges,Implant Device,665.04,34,"Charges > $500, x 34%",665.04,percent of total billed charges,Implant Device,684.6,35,,684.6,percent of total billed charges,Implant Devices,684.6,35,,684.6,percent of total billed charges,Implant Devices,684.6,35,,,percent of total billed charges,Implant Devices,684.6,35,,684.6,percent of total billed charges,Implant Devices,684.6,35,,684.6,percent of total billed charges,Implant Devices,782.4,40,,782.4,percent of total billed charges,Implant Devices,684.6,70,,684.6,percent of total billed charges,Implant Devices,665.04,34,,665.04,percent of total billed charges,Implant Devices,665.04,34,,665.04,percent of total billed charges,Implant Devices,684.6,35,,684.6,percent of total billed charges,Implant Devices,684.6,35,,684.6,percent of total billed charges,Implant Devices,684.6,35,,684.6,percent of total billed charges,Implant Devices,684.6,35,,684.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,782.4,
BIOMET 28-334 TROCH NAIL RT 11MM/34CM,C1713,HCPCS,,79003821,CDM,278,RC,,,both,,,11040,4357.13,39.4668,,4357.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Device,3753.6,34,"Charges > $500, x 34%",3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,4416,40,,4416,percent of total billed charges,Implant Devices,3864,70,,3864,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3753.6,34,"If Charge > 2,000, then 34 percent",3753.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4416,
BIOMET 2000-2450 MULTIAXIAL SCREW 6.5X50,C1713,HCPCS,,79003822,CDM,278,RC,,,both,,,2820,1112.96,39.4668,,1112.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,958.8,34,,958.8,percent of total billed charges,Implant Device,958.8,34,,958.8,percent of total billed charges,Implant Device,958.8,34,,958.8,percent of total billed charges,Implant Device,958.8,34,,958.8,percent of total billed charges,Implant Device,958.8,34,,958.8,percent of total billed charges,Implant Device,958.8,34,,958.8,percent of total billed charges,Implant Device,987,35,,987,percent of total billed charges,Implant Device,958.8,34,"Charges > $500, x 34%",958.8,percent of total billed charges,Implant Device,987,35,,987,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,987,35,,,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,1128,40,,1128,percent of total billed charges,Implant Devices,987,70,,987,percent of total billed charges,Implant Devices,958.8,34,,958.8,percent of total billed charges,Implant Devices,958.8,34,,958.8,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,958.8,34,"If Charge > 2,000, then 34 percent",958.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1128,
BIOMET 1198 FF ANTERIOR TIBIALIS TENDON,C1713,HCPCS,,79003823,CDM,278,RC,,,both,,,6606,2607.18,39.4668,,2607.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2312.1,35,,2312.1,percent of total billed charges,Implant Device,2246.04,34,"Charges > $500, x 34%",2246.04,percent of total billed charges,Implant Device,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2642.4,40,,2642.4,percent of total billed charges,Implant Devices,2312.1,70,,2312.1,percent of total billed charges,Implant Devices,2246.04,34,,2246.04,percent of total billed charges,Implant Devices,2246.04,34,,2246.04,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2246.04,34,"If Charge > 2,000, then 34 percent",2246.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2642.4,
BIOMET 28232 TROCH NAIL LONG 11MM/32CM,C1713,HCPCS,,79003824,CDM,278,RC,,,both,,,11040,4357.13,39.4668,,4357.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Device,3753.6,34,"Charges > $500, x 34%",3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,4416,40,,4416,percent of total billed charges,Implant Devices,3864,70,,3864,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3753.6,34,"If Charge > 2,000, then 34 percent",3753.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4416,
BIOMET 29238 LAG SCREW ASSY 95MM,C1713,HCPCS,,79003828,CDM,278,RC,,,both,,,3330,1314.24,39.4668,,1314.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Device,1132.2,34,"Charges > $500, x 34%",1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1332,40,,1332,percent of total billed charges,Implant Devices,1165.5,70,,1165.5,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1132.2,34,"If Charge > 2,000, then 34 percent",1132.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1332,
BIOMET 1199 POST TIBIALIS TENDON GRAFT,C1713,HCPCS,,79003831,CDM,278,RC,,,both,,,6606,2607.18,39.4668,,2607.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2246.04,34,,2246.04,percent of total billed charges,Implant Device,2312.1,35,,2312.1,percent of total billed charges,Implant Device,2246.04,34,"Charges > $500, x 34%",2246.04,percent of total billed charges,Implant Device,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2642.4,40,,2642.4,percent of total billed charges,Implant Devices,2312.1,70,,2312.1,percent of total billed charges,Implant Devices,2246.04,34,,2246.04,percent of total billed charges,Implant Devices,2246.04,34,,2246.04,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,2312.1,35,,2312.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2246.04,34,"If Charge > 2,000, then 34 percent",2246.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2642.4,
ARTHREX AR-1530PS TENODESIS SCREW 3.8MM,C1713,HCPCS,,79003838,CDM,278,RC,,,both,,,1566,618.05,39.4668,,618.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,532.44,34,,532.44,percent of total billed charges,Implant Device,532.44,34,,532.44,percent of total billed charges,Implant Device,532.44,34,,532.44,percent of total billed charges,Implant Device,532.44,34,,532.44,percent of total billed charges,Implant Device,532.44,34,,532.44,percent of total billed charges,Implant Device,532.44,34,,532.44,percent of total billed charges,Implant Device,548.1,35,,548.1,percent of total billed charges,Implant Device,532.44,34,"Charges > $500, x 34%",532.44,percent of total billed charges,Implant Device,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,626.4,40,,626.4,percent of total billed charges,Implant Devices,548.1,70,,548.1,percent of total billed charges,Implant Devices,532.44,34,,532.44,percent of total billed charges,Implant Devices,532.44,34,,532.44,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,626.4,
SYNTHES 207.636 CANN SCREW ST SS,C1713,HCPCS,,79003840,CDM,278,RC,,,both,,,685,270.35,39.4668,,270.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Device,232.9,34,"Charges > $500, x 34%",232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,274,40,,274,percent of total billed charges,Implant Devices,239.75,70,,239.75,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274,
SYNTHES 207.634 CANN SCREW ST SS,C1713,HCPCS,,79003841,CDM,278,RC,,,both,,,761,300.34,39.4668,,300.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,258.74,34,,258.74,percent of total billed charges,Implant Device,258.74,34,,258.74,percent of total billed charges,Implant Device,258.74,34,,258.74,percent of total billed charges,Implant Device,258.74,34,,258.74,percent of total billed charges,Implant Device,258.74,34,,258.74,percent of total billed charges,Implant Device,258.74,34,,258.74,percent of total billed charges,Implant Device,266.35,35,,266.35,percent of total billed charges,Implant Device,258.74,34,"Charges > $500, x 34%",258.74,percent of total billed charges,Implant Device,266.35,35,,266.35,percent of total billed charges,Implant Devices,266.35,35,,266.35,percent of total billed charges,Implant Devices,266.35,35,,,percent of total billed charges,Implant Devices,266.35,35,,266.35,percent of total billed charges,Implant Devices,266.35,35,,266.35,percent of total billed charges,Implant Devices,304.4,40,,304.4,percent of total billed charges,Implant Devices,266.35,70,,266.35,percent of total billed charges,Implant Devices,258.74,34,,258.74,percent of total billed charges,Implant Devices,258.74,34,,258.74,percent of total billed charges,Implant Devices,266.35,35,,266.35,percent of total billed charges,Implant Devices,266.35,35,,266.35,percent of total billed charges,Implant Devices,266.35,35,,266.35,percent of total billed charges,Implant Devices,266.35,35,,266.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,304.4,
SYNTHES 208.441 CANN SCREW 6.5X32MM,C1713,HCPCS,,79003843,CDM,278,RC,,,both,,,908,358.36,39.4668,,358.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Device,308.72,34,"Charges > $500, x 34%",308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,363.2,40,,363.2,percent of total billed charges,Implant Devices,317.8,70,,317.8,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,363.2,
STRYKER 1830-0823S HUMERAL NAIL 8X230MM,C1713,HCPCS,,79003852,CDM,278,RC,,,both,,,5483,2163.96,39.4668,,2163.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Device,1864.22,34,"Charges > $500, x 34%",1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,2193.2,40,,2193.2,percent of total billed charges,Implant Devices,1919.05,70,,1919.05,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1864.22,34,"If Charge > 2,000, then 34 percent",1864.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2193.2,
STRYKER 1896-4036S LOCKING SCREW 4X36MM,C1713,HCPCS,,79003853,CDM,278,RC,,,both,,,905,357.17,39.4668,,357.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,307.7,34,,307.7,percent of total billed charges,Implant Device,307.7,34,,307.7,percent of total billed charges,Implant Device,307.7,34,,307.7,percent of total billed charges,Implant Device,307.7,34,,307.7,percent of total billed charges,Implant Device,307.7,34,,307.7,percent of total billed charges,Implant Device,307.7,34,,307.7,percent of total billed charges,Implant Device,316.75,35,,316.75,percent of total billed charges,Implant Device,307.7,34,"Charges > $500, x 34%",307.7,percent of total billed charges,Implant Device,316.75,35,,316.75,percent of total billed charges,Implant Devices,316.75,35,,316.75,percent of total billed charges,Implant Devices,316.75,35,,,percent of total billed charges,Implant Devices,316.75,35,,316.75,percent of total billed charges,Implant Devices,316.75,35,,316.75,percent of total billed charges,Implant Devices,362,40,,362,percent of total billed charges,Implant Devices,316.75,70,,316.75,percent of total billed charges,Implant Devices,307.7,34,,307.7,percent of total billed charges,Implant Devices,307.7,34,,307.7,percent of total billed charges,Implant Devices,316.75,35,,316.75,percent of total billed charges,Implant Devices,316.75,35,,316.75,percent of total billed charges,Implant Devices,316.75,35,,316.75,percent of total billed charges,Implant Devices,316.75,35,,316.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,362,
STRYKER 1896-4024S LOCKING SCREW 4X24MM,C1713,HCPCS,,79003854,CDM,278,RC,,,both,,,701,276.66,39.4668,,276.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,238.34,34,,238.34,percent of total billed charges,Implant Device,238.34,34,,238.34,percent of total billed charges,Implant Device,238.34,34,,238.34,percent of total billed charges,Implant Device,238.34,34,,238.34,percent of total billed charges,Implant Device,238.34,34,,238.34,percent of total billed charges,Implant Device,238.34,34,,238.34,percent of total billed charges,Implant Device,245.35,35,,245.35,percent of total billed charges,Implant Device,238.34,34,"Charges > $500, x 34%",238.34,percent of total billed charges,Implant Device,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,280.4,40,,280.4,percent of total billed charges,Implant Devices,245.35,70,,245.35,percent of total billed charges,Implant Devices,238.34,34,,238.34,percent of total billed charges,Implant Devices,238.34,34,,238.34,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280.4,
ARTHREX AR-1322BCNF SUTURE TAK 2.4X8.5,C1713,HCPCS,,79003858,CDM,278,RC,,,both,,,1308,516.23,39.4668,,516.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,444.72,34,,444.72,percent of total billed charges,Implant Device,444.72,34,,444.72,percent of total billed charges,Implant Device,444.72,34,,444.72,percent of total billed charges,Implant Device,444.72,34,,444.72,percent of total billed charges,Implant Device,444.72,34,,444.72,percent of total billed charges,Implant Device,444.72,34,,444.72,percent of total billed charges,Implant Device,457.8,35,,457.8,percent of total billed charges,Implant Device,444.72,34,"Charges > $500, x 34%",444.72,percent of total billed charges,Implant Device,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,523.2,40,,523.2,percent of total billed charges,Implant Devices,457.8,70,,457.8,percent of total billed charges,Implant Devices,444.72,34,,444.72,percent of total billed charges,Implant Devices,444.72,34,,444.72,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,523.2,
ARTHREX AR-8825B MINI PUSHLOCK 2.5X8MM,C1713,HCPCS,,79003859,CDM,278,RC,,,both,,,1545,609.76,39.4668,,609.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,540.75,35,,540.75,percent of total billed charges,Implant Device,525.3,34,"Charges > $500, x 34%",525.3,percent of total billed charges,Implant Device,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,618,40,,618,percent of total billed charges,Implant Devices,540.75,70,,540.75,percent of total billed charges,Implant Devices,525.3,34,,525.3,percent of total billed charges,Implant Devices,525.3,34,,525.3,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,618,
ARTHREX AR-5028C-11 INTER SCREW 11X28MM,C1713,HCPCS,,79003862,CDM,278,RC,,,both,,,1008,397.83,39.4668,,397.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,352.8,35,,352.8,percent of total billed charges,Implant Device,342.72,34,"Charges > $500, x 34%",342.72,percent of total billed charges,Implant Device,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,403.2,40,,403.2,percent of total billed charges,Implant Devices,352.8,70,,352.8,percent of total billed charges,Implant Devices,342.72,34,,342.72,percent of total billed charges,Implant Devices,342.72,34,,342.72,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,403.2,
BIOMET 2000-2535 MULTIAXIAL SCREW 7.5X35,C1713,HCPCS,,79003864,CDM,278,RC,,,both,,,2820,1112.96,39.4668,,1112.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,958.8,34,,958.8,percent of total billed charges,Implant Device,958.8,34,,958.8,percent of total billed charges,Implant Device,958.8,34,,958.8,percent of total billed charges,Implant Device,958.8,34,,958.8,percent of total billed charges,Implant Device,958.8,34,,958.8,percent of total billed charges,Implant Device,958.8,34,,958.8,percent of total billed charges,Implant Device,987,35,,987,percent of total billed charges,Implant Device,958.8,34,"Charges > $500, x 34%",958.8,percent of total billed charges,Implant Device,987,35,,987,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,987,35,,,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,1128,40,,1128,percent of total billed charges,Implant Devices,987,70,,987,percent of total billed charges,Implant Devices,958.8,34,,958.8,percent of total billed charges,Implant Devices,958.8,34,,958.8,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,987,35,,987,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,958.8,34,"If Charge > 2,000, then 34 percent",958.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1128,
BIOMET 29279 LAG SCREW 100MM,C1713,HCPCS,,79003866,CDM,278,RC,,,both,,,2670,1053.76,39.4668,,1053.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,934.5,35,,934.5,percent of total billed charges,Implant Device,907.8,34,"Charges > $500, x 34%",907.8,percent of total billed charges,Implant Device,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,1068,40,,1068,percent of total billed charges,Implant Devices,934.5,70,,934.5,percent of total billed charges,Implant Devices,907.8,34,,907.8,percent of total billed charges,Implant Devices,907.8,34,,907.8,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,907.8,34,"If Charge > 2,000, then 34 percent",907.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1068,
BIOMET O1-7306 BURR HOLE PLATE 13MM,C1713,HCPCS,,79003868,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
BIOMET 29-278 LAG SCREW 95MM,C1713,HCPCS,,79003870,CDM,278,RC,,,both,,,1738,685.93,39.4668,,685.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,590.92,34,,590.92,percent of total billed charges,Implant Device,590.92,34,,590.92,percent of total billed charges,Implant Device,590.92,34,,590.92,percent of total billed charges,Implant Device,590.92,34,,590.92,percent of total billed charges,Implant Device,590.92,34,,590.92,percent of total billed charges,Implant Device,590.92,34,,590.92,percent of total billed charges,Implant Device,608.3,35,,608.3,percent of total billed charges,Implant Device,590.92,34,"Charges > $500, x 34%",590.92,percent of total billed charges,Implant Device,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,695.2,40,,695.2,percent of total billed charges,Implant Devices,608.3,70,,608.3,percent of total billed charges,Implant Devices,590.92,34,,590.92,percent of total billed charges,Implant Devices,590.92,34,,590.92,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,608.3,35,,608.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,695.2,
BIOMET 948208 REUNITE PIN 2X40MM,C1713,HCPCS,,79003872,CDM,278,RC,,,both,,,834,329.15,39.4668,,329.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,291.9,35,,291.9,percent of total billed charges,Implant Device,283.56,34,"Charges > $500, x 34%",283.56,percent of total billed charges,Implant Device,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,333.6,40,,333.6,percent of total billed charges,Implant Devices,291.9,70,,291.9,percent of total billed charges,Implant Devices,283.56,34,,283.56,percent of total billed charges,Implant Devices,283.56,34,,283.56,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,333.6,
DEPUY 8153-04-080 POLY LOCK SCREW 4X80MM,C1713,HCPCS,,79003883,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
DEPUY 8153-04-065 POLY SCREW 4X65MM,C1713,HCPCS,,79003886,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
DEPUY 14196-40 CANN SCREW 6.5X40M,C1713,HCPCS,,79003887,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
DEPUY 8150-45-530 CORT LOCK SCREW 4X30MM,C1713,HCPCS,,79003888,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
DEPUY 8153-55-050 POLY LOCK SCREW 55X50,C1713,HCPCS,,79003889,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
DEPUY NL28 90 DEG LOCK SCREW 3.8X28MM,C1713,HCPCS,,79003891,CDM,278,RC,,,both,,,378,149.18,39.4668,,149.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,132.3,35,,132.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,151.2,40,,151.2,percent of total billed charges,Implant Devices,132.3,70,,132.3,percent of total billed charges,Implant Devices,128.52,34,,128.52,percent of total billed charges,Implant Devices,128.52,34,,128.52,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,151.2,
DEPUY 8157-45-028 CORT BONE SCREW 4.5X28,C1713,HCPCS,,79003892,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
DEPUY STPT35 PEG THREADED 4X34MM,C1713,HCPCS,,79003894,CDM,278,RC,,,both,,,378,149.18,39.4668,,149.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,128.52,34,,128.52,percent of total billed charges,Implant Device,132.3,35,,132.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,151.2,40,,151.2,percent of total billed charges,Implant Devices,132.3,70,,132.3,percent of total billed charges,Implant Devices,128.52,34,,128.52,percent of total billed charges,Implant Devices,128.52,34,,128.52,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,132.3,35,,132.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,151.2,
DEPUY 8153-04-060 LOCKING SCREW 4X60MM,C1713,HCPCS,,79003895,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
DEPUY 8157-45-040 LOCKING SCREW 4.5X40MM,C1713,HCPCS,,79003896,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
DEPUY 222233 ORTHOCORD 5.5MM,C1713,HCPCS,,79003902,CDM,278,RC,,,both,,,1218,480.71,39.4668,,480.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,414.12,34,,414.12,percent of total billed charges,Implant Device,414.12,34,,414.12,percent of total billed charges,Implant Device,414.12,34,,414.12,percent of total billed charges,Implant Device,414.12,34,,414.12,percent of total billed charges,Implant Device,414.12,34,,414.12,percent of total billed charges,Implant Device,414.12,34,,414.12,percent of total billed charges,Implant Device,426.3,35,,426.3,percent of total billed charges,Implant Device,414.12,34,"Charges > $500, x 34%",414.12,percent of total billed charges,Implant Device,426.3,35,,426.3,percent of total billed charges,Implant Devices,426.3,35,,426.3,percent of total billed charges,Implant Devices,426.3,35,,,percent of total billed charges,Implant Devices,426.3,35,,426.3,percent of total billed charges,Implant Devices,426.3,35,,426.3,percent of total billed charges,Implant Devices,487.2,40,,487.2,percent of total billed charges,Implant Devices,426.3,70,,426.3,percent of total billed charges,Implant Devices,414.12,34,,414.12,percent of total billed charges,Implant Devices,414.12,34,,414.12,percent of total billed charges,Implant Devices,426.3,35,,426.3,percent of total billed charges,Implant Devices,426.3,35,,426.3,percent of total billed charges,Implant Devices,426.3,35,,426.3,percent of total billed charges,Implant Devices,426.3,35,,426.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,487.2,
DEPUY 8141-23-009 PLATE 9 HOLE L 122MM,C1713,HCPCS,,79003903,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
DEPUY SBFS062 SMALL BONE FIXATION 1.6MM,C1713,HCPCS,,79003907,CDM,278,RC,,,both,,,1148,453.08,39.4668,,453.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,390.32,34,,390.32,percent of total billed charges,Implant Device,390.32,34,,390.32,percent of total billed charges,Implant Device,390.32,34,,390.32,percent of total billed charges,Implant Device,390.32,34,,390.32,percent of total billed charges,Implant Device,390.32,34,,390.32,percent of total billed charges,Implant Device,390.32,34,,390.32,percent of total billed charges,Implant Device,401.8,35,,401.8,percent of total billed charges,Implant Device,390.32,34,"Charges > $500, x 34%",390.32,percent of total billed charges,Implant Device,401.8,35,,401.8,percent of total billed charges,Implant Devices,401.8,35,,401.8,percent of total billed charges,Implant Devices,401.8,35,,,percent of total billed charges,Implant Devices,401.8,35,,401.8,percent of total billed charges,Implant Devices,401.8,35,,401.8,percent of total billed charges,Implant Devices,459.2,40,,459.2,percent of total billed charges,Implant Devices,401.8,70,,401.8,percent of total billed charges,Implant Devices,390.32,34,,390.32,percent of total billed charges,Implant Devices,390.32,34,,390.32,percent of total billed charges,Implant Devices,401.8,35,,401.8,percent of total billed charges,Implant Devices,401.8,35,,401.8,percent of total billed charges,Implant Devices,401.8,35,,401.8,percent of total billed charges,Implant Devices,401.8,35,,401.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,459.2,
DEPUY 8153-41-030 CAN SCREW 4X30MM,C1713,HCPCS,,79003908,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
DEPUY 8155-40-065 CANC LAG SCREW 4X65MM,C1713,HCPCS,,79003910,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
DEPUY 222207 SUTURE ANCHOR W/ORTHOCORD,C1713,HCPCS,,79003911,CDM,278,RC,,,both,,,2334,921.16,39.4668,,921.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,793.56,34,,793.56,percent of total billed charges,Implant Device,793.56,34,,793.56,percent of total billed charges,Implant Device,793.56,34,,793.56,percent of total billed charges,Implant Device,793.56,34,,793.56,percent of total billed charges,Implant Device,793.56,34,,793.56,percent of total billed charges,Implant Device,793.56,34,,793.56,percent of total billed charges,Implant Device,816.9,35,,816.9,percent of total billed charges,Implant Device,793.56,34,"Charges > $500, x 34%",793.56,percent of total billed charges,Implant Device,816.9,35,,816.9,percent of total billed charges,Implant Devices,816.9,35,,816.9,percent of total billed charges,Implant Devices,816.9,35,,,percent of total billed charges,Implant Devices,816.9,35,,816.9,percent of total billed charges,Implant Devices,816.9,35,,816.9,percent of total billed charges,Implant Devices,933.6,40,,933.6,percent of total billed charges,Implant Devices,816.9,70,,816.9,percent of total billed charges,Implant Devices,793.56,34,,793.56,percent of total billed charges,Implant Devices,793.56,34,,793.56,percent of total billed charges,Implant Devices,816.9,35,,816.9,percent of total billed charges,Implant Devices,816.9,35,,816.9,percent of total billed charges,Implant Devices,816.9,35,,816.9,percent of total billed charges,Implant Devices,816.9,35,,816.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,793.56,34,"If Charge > 2,000, then 34 percent",793.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,933.6,
DEPUY 8141-32-011 TIBIAL PLATE 11 HOLE,C1713,HCPCS,,79003915,CDM,278,RC,,,both,,,7320,2888.97,39.4668,,2888.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Device,2488.8,34,"Charges > $500, x 34%",2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2928,40,,2928,percent of total billed charges,Implant Devices,2562,70,,2562,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2488.8,34,"If Charge > 2,000, then 34 percent",2488.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2928,
DEPUY 8162-35-006 LOCK PLATE 6HOLE 3.5MM,C1713,HCPCS,,79003917,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
DEPUY 8157.45-038 LOCKING SCREW 4.5X38MM,C1713,HCPCS,,79003918,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
DEPUY SBFN062 BONE FIXATION NAIL 1.6MM,C1713,HCPCS,,79003920,CDM,278,RC,,,both,,,776,306.26,39.4668,,306.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,263.84,34,,263.84,percent of total billed charges,Implant Device,263.84,34,,263.84,percent of total billed charges,Implant Device,263.84,34,,263.84,percent of total billed charges,Implant Device,263.84,34,,263.84,percent of total billed charges,Implant Device,263.84,34,,263.84,percent of total billed charges,Implant Device,263.84,34,,263.84,percent of total billed charges,Implant Device,271.6,35,,271.6,percent of total billed charges,Implant Device,263.84,34,"Charges > $500, x 34%",263.84,percent of total billed charges,Implant Device,271.6,35,,271.6,percent of total billed charges,Implant Devices,271.6,35,,271.6,percent of total billed charges,Implant Devices,271.6,35,,,percent of total billed charges,Implant Devices,271.6,35,,271.6,percent of total billed charges,Implant Devices,271.6,35,,271.6,percent of total billed charges,Implant Devices,310.4,40,,310.4,percent of total billed charges,Implant Devices,271.6,70,,271.6,percent of total billed charges,Implant Devices,263.84,34,,263.84,percent of total billed charges,Implant Devices,263.84,34,,263.84,percent of total billed charges,Implant Devices,271.6,35,,271.6,percent of total billed charges,Implant Devices,271.6,35,,271.6,percent of total billed charges,Implant Devices,271.6,35,,271.6,percent of total billed charges,Implant Devices,271.6,35,,271.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,310.4,
DEPUY 8161-40-065 CANC LOCK SCREW 4X65MM,C1713,HCPCS,,79003921,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
DEPUY 8141-16-003 META PLATE LG 3HOLE,C1713,HCPCS,,79003925,CDM,278,RC,,,both,,,1590,627.52,39.4668,,627.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Device,540.6,34,"Charges > $500, x 34%",540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,636,40,,636,percent of total billed charges,Implant Devices,556.5,70,,556.5,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,636,
DEPUY 8145-10-090 LAG SCREW 10.5X90MM,C1713,HCPCS,,79003926,CDM,278,RC,,,both,,,1786,704.88,39.4668,,704.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,625.1,35,,625.1,percent of total billed charges,Implant Device,607.24,34,"Charges > $500, x 34%",607.24,percent of total billed charges,Implant Device,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,714.4,40,,714.4,percent of total billed charges,Implant Devices,625.1,70,,625.1,percent of total billed charges,Implant Devices,607.24,34,,607.24,percent of total billed charges,Implant Devices,607.24,34,,607.24,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,714.4,
DEPUY 8150-45-526 LOCK SCREW 4.5X26MM,C1713,HCPCS,,79003927,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
DEPUY 8153-55-060 LOCKING SCREW 5.5X60MM,C1713,HCPCS,,79003928,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
DEPUY 14196-55 CANN SCREW 6.5X55MM,C1713,HCPCS,,79003929,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
DEPUY 8143-13-180 HIP FX NAIL 13X180MM,C1713,HCPCS,,79003930,CDM,278,RC,,,both,,,4464,1761.8,39.4668,,1761.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1562.4,35,,1562.4,percent of total billed charges,Implant Device,1517.76,34,"Charges > $500, x 34%",1517.76,percent of total billed charges,Implant Device,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1785.6,40,,1785.6,percent of total billed charges,Implant Devices,1562.4,70,,1562.4,percent of total billed charges,Implant Devices,1517.76,34,,1517.76,percent of total billed charges,Implant Devices,1517.76,34,,1517.76,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1517.76,34,"If Charge > 2,000, then 34 percent",1517.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1785.6,
DEPUY 8145-13-180 HIP FX NAIL 13X180MM,C1713,HCPCS,,79003931,CDM,278,RC,,,both,,,8040,3173.13,39.4668,,3173.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2733.6,34,,2733.6,percent of total billed charges,Implant Device,2733.6,34,,2733.6,percent of total billed charges,Implant Device,2733.6,34,,2733.6,percent of total billed charges,Implant Device,2733.6,34,,2733.6,percent of total billed charges,Implant Device,2733.6,34,,2733.6,percent of total billed charges,Implant Device,2733.6,34,,2733.6,percent of total billed charges,Implant Device,2814,35,,2814,percent of total billed charges,Implant Device,2733.6,34,"Charges > $500, x 34%",2733.6,percent of total billed charges,Implant Device,2814,35,,2814,percent of total billed charges,Implant Devices,2814,35,,2814,percent of total billed charges,Implant Devices,2814,35,,,percent of total billed charges,Implant Devices,2814,35,,2814,percent of total billed charges,Implant Devices,2814,35,,2814,percent of total billed charges,Implant Devices,3216,40,,3216,percent of total billed charges,Implant Devices,2814,70,,2814,percent of total billed charges,Implant Devices,2733.6,34,,2733.6,percent of total billed charges,Implant Devices,2733.6,34,,2733.6,percent of total billed charges,Implant Devices,2814,35,,2814,percent of total billed charges,Implant Devices,2814,35,,2814,percent of total billed charges,Implant Devices,2814,35,,2814,percent of total billed charges,Implant Devices,2814,35,,2814,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2733.6,34,"If Charge > 2,000, then 34 percent",2733.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3216,
DEPUY 8153-04-085 PLOY LOCK SCREW 4X85MM,C1713,HCPCS,,79003932,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
DEPUY SP20000 PEG SCREW 2.5X20MM,C1713,HCPCS,,79003933,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
DEPUY 1987-07-125 SEGMENTED COMP 125MM,C1713,HCPCS,,79003934,CDM,278,RC,,,both,,,5497,2169.49,39.4668,,2169.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1868.98,34,,1868.98,percent of total billed charges,Implant Device,1868.98,34,,1868.98,percent of total billed charges,Implant Device,1868.98,34,,1868.98,percent of total billed charges,Implant Device,1868.98,34,,1868.98,percent of total billed charges,Implant Device,1868.98,34,,1868.98,percent of total billed charges,Implant Device,1868.98,34,,1868.98,percent of total billed charges,Implant Device,1923.95,35,,1923.95,percent of total billed charges,Implant Device,1868.98,34,"Charges > $500, x 34%",1868.98,percent of total billed charges,Implant Device,1923.95,35,,1923.95,percent of total billed charges,Implant Devices,1923.95,35,,1923.95,percent of total billed charges,Implant Devices,1923.95,35,,,percent of total billed charges,Implant Devices,1923.95,35,,1923.95,percent of total billed charges,Implant Devices,1923.95,35,,1923.95,percent of total billed charges,Implant Devices,2198.8,40,,2198.8,percent of total billed charges,Implant Devices,1923.95,70,,1923.95,percent of total billed charges,Implant Devices,1868.98,34,,1868.98,percent of total billed charges,Implant Devices,1868.98,34,,1868.98,percent of total billed charges,Implant Devices,1923.95,35,,1923.95,percent of total billed charges,Implant Devices,1923.95,35,,1923.95,percent of total billed charges,Implant Devices,1923.95,35,,1923.95,percent of total billed charges,Implant Devices,1923.95,35,,1923.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1868.98,34,"If Charge > 2,000, then 34 percent",1868.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2198.8,
DEPUY 8153-41-050 CANN SCREW FT 4MM,C1713,HCPCS,,79003935,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
DEPUY 8161-40-070 CANC LOCK SCREW 4X70MM,C1713,HCPCS,,79003936,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
DEPUY 8154-55-090 NONLOCK SCREW 5.5X90MM,C1713,HCPCS,,79003938,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
DEPUY 8157-45-032 CORT SCREW FT 4.5X32MM,C1713,HCPCS,,79003943,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
DEPUY 8154-55-070 NON LOCK SCREW 5.5X70,C1713,HCPCS,,79003944,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
DEPUY 8145-50-036 CORT BONE SCREW 5X36MM,C1713,HCPCS,,79003945,CDM,278,RC,,,both,,,533,210.36,39.4668,,210.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,186.55,35,,186.55,percent of total billed charges,Implant Device,181.22,34,"Charges > $500, x 34%",181.22,percent of total billed charges,Implant Device,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,213.2,40,,213.2,percent of total billed charges,Implant Devices,186.55,70,,186.55,percent of total billed charges,Implant Devices,181.22,34,,181.22,percent of total billed charges,Implant Devices,181.22,34,,181.22,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,213.2,
DEPUY 8153-41-028 CANC SCREW 4X28MM,C1713,HCPCS,,79003948,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
DEPUY 8162-06-006 LOCK PLATE L 6H 139MM,C1713,HCPCS,,79003949,CDM,278,RC,,,both,,,4020,1586.57,39.4668,,1586.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1366.8,34,,1366.8,percent of total billed charges,Implant Device,1407,35,,1407,percent of total billed charges,Implant Device,1366.8,34,"Charges > $500, x 34%",1366.8,percent of total billed charges,Implant Device,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1608,40,,1608,percent of total billed charges,Implant Devices,1407,70,,1407,percent of total billed charges,Implant Devices,1366.8,34,,1366.8,percent of total billed charges,Implant Devices,1366.8,34,,1366.8,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,1407,35,,1407,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1366.8,34,"If Charge > 2,000, then 34 percent",1366.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1608,
DEPUY 1987-27-012 TIB INS HINGE XXS 12MM,C1713,HCPCS,,79003952,CDM,278,RC,,,both,,,11227,4430.94,39.4668,,4430.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3929.45,35,,3929.45,percent of total billed charges,Implant Device,3817.18,34,"Charges > $500, x 34%",3817.18,percent of total billed charges,Implant Device,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,4490.8,40,,4490.8,percent of total billed charges,Implant Devices,3929.45,70,,3929.45,percent of total billed charges,Implant Devices,3817.18,34,,3817.18,percent of total billed charges,Implant Devices,3817.18,34,,3817.18,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3817.18,34,"If Charge > 2,000, then 34 percent",3817.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4490.8,
DEPUY 1987-27-118 TIB INS HINGE 18MM,C1713,HCPCS,,79003953,CDM,278,RC,,,both,,,10692,4219.79,39.4668,,4219.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3742.2,35,,3742.2,percent of total billed charges,Implant Device,3635.28,34,"Charges > $500, x 34%",3635.28,percent of total billed charges,Implant Device,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,4276.8,40,,4276.8,percent of total billed charges,Implant Devices,3742.2,70,,3742.2,percent of total billed charges,Implant Devices,3635.28,34,,3635.28,percent of total billed charges,Implant Devices,3635.28,34,,3635.28,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3635.28,34,"If Charge > 2,000, then 34 percent",3635.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4276.8,
DEPUY 8141-33-011 POLY TIB PLATE 11 HOLE,C1713,HCPCS,,79003955,CDM,278,RC,,,both,,,7320,2888.97,39.4668,,2888.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Device,2488.8,34,"Charges > $500, x 34%",2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2928,40,,2928,percent of total billed charges,Implant Devices,2562,70,,2562,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2488.8,34,"If Charge > 2,000, then 34 percent",2488.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2928,
DEPUY NLSS 90 DEG LOCK SCREW SET,C1713,HCPCS,,79003956,CDM,278,RC,,,both,,,241,95.11,39.4668,,95.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,84.35,35,,84.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,96.4,40,,96.4,percent of total billed charges,Implant Devices,84.35,70,,84.35,percent of total billed charges,Implant Devices,81.94,34,,81.94,percent of total billed charges,Implant Devices,81.94,34,,81.94,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96.4,
DEPUY MD28 MULTI DIR SCREW 3.8X28MM,C1713,HCPCS,,79003957,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
DEPUY 1312-18036 CORT SCREW 3.5X36MM,C1713,HCPCS,,79003958,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
DEPUY MD26 MULTI DIR SCREW 3.8X26MM,C1713,HCPCS,,79003960,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
DEPUY 9215905 SCREW 1.5X5MM NEW HEAD,C1713,HCPCS,,79003964,CDM,278,RC,,,both,,,215,84.85,39.4668,,84.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.1,34,,73.1,percent of total billed charges,Implant Device,73.1,34,,73.1,percent of total billed charges,Implant Device,73.1,34,,73.1,percent of total billed charges,Implant Device,73.1,34,,73.1,percent of total billed charges,Implant Device,73.1,34,,73.1,percent of total billed charges,Implant Device,73.1,34,,73.1,percent of total billed charges,Implant Device,75.25,35,,75.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.25,35,,75.25,percent of total billed charges,Implant Devices,75.25,35,,75.25,percent of total billed charges,Implant Devices,75.25,35,,,percent of total billed charges,Implant Devices,75.25,35,,75.25,percent of total billed charges,Implant Devices,75.25,35,,75.25,percent of total billed charges,Implant Devices,86,40,,86,percent of total billed charges,Implant Devices,75.25,70,,75.25,percent of total billed charges,Implant Devices,73.1,34,,73.1,percent of total billed charges,Implant Devices,73.1,34,,73.1,percent of total billed charges,Implant Devices,75.25,35,,75.25,percent of total billed charges,Implant Devices,75.25,35,,75.25,percent of total billed charges,Implant Devices,75.25,35,,75.25,percent of total billed charges,Implant Devices,75.25,35,,75.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86,
STRYKER 629366 PLATE OLECRANON 6 HOLE RT,C1713,HCPCS,,79003967,CDM,278,RC,,,both,,,3697,1459.09,39.4668,,1459.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1256.98,34,,1256.98,percent of total billed charges,Implant Device,1293.95,35,,1293.95,percent of total billed charges,Implant Device,1256.98,34,"Charges > $500, x 34%",1256.98,percent of total billed charges,Implant Device,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1478.8,40,,1478.8,percent of total billed charges,Implant Devices,1293.95,70,,1293.95,percent of total billed charges,Implant Devices,1256.98,34,,1256.98,percent of total billed charges,Implant Devices,1256.98,34,,1256.98,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,1293.95,35,,1293.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1256.98,34,"If Charge > 2,000, then 34 percent",1256.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1478.8,
STRYKER 614824 NON LOCK SCREW 3.5X24MM,C1713,HCPCS,,79003968,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 614816 NON LOCK SCREW 3.5X16MM,C1713,HCPCS,,79003969,CDM,278,RC,,,both,,,374,147.61,39.4668,,147.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,130.9,35,,130.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,149.6,40,,149.6,percent of total billed charges,Implant Devices,130.9,70,,130.9,percent of total billed charges,Implant Devices,127.16,34,,127.16,percent of total billed charges,Implant Devices,127.16,34,,127.16,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,149.6,
STRYKER 614626 LOCKING SCREW 3.5X26MM,C1713,HCPCS,,79003970,CDM,278,RC,,,both,,,574,226.54,39.4668,,226.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Device,195.16,34,"Charges > $500, x 34%",195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,229.6,40,,229.6,percent of total billed charges,Implant Devices,200.9,70,,200.9,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,229.6,
STRYKER 614560 LOCKING SCREW 2.7X60MM,C1713,HCPCS,,79003971,CDM,278,RC,,,both,,,653,257.72,39.4668,,257.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,222.02,34,,222.02,percent of total billed charges,Implant Device,222.02,34,,222.02,percent of total billed charges,Implant Device,222.02,34,,222.02,percent of total billed charges,Implant Device,222.02,34,,222.02,percent of total billed charges,Implant Device,222.02,34,,222.02,percent of total billed charges,Implant Device,222.02,34,,222.02,percent of total billed charges,Implant Device,228.55,35,,228.55,percent of total billed charges,Implant Device,222.02,34,"Charges > $500, x 34%",222.02,percent of total billed charges,Implant Device,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,261.2,40,,261.2,percent of total billed charges,Implant Devices,228.55,70,,228.55,percent of total billed charges,Implant Devices,222.02,34,,222.02,percent of total billed charges,Implant Devices,222.02,34,,222.02,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,228.55,35,,228.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,261.2,
DEPUY 8145-10-105 LAG SCREW 10.5X105MM,C1713,HCPCS,,79003974,CDM,278,RC,,,both,,,2052,809.86,39.4668,,809.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,718.2,35,,718.2,percent of total billed charges,Implant Device,697.68,34,"Charges > $500, x 34%",697.68,percent of total billed charges,Implant Device,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,820.8,40,,820.8,percent of total billed charges,Implant Devices,718.2,70,,718.2,percent of total billed charges,Implant Devices,697.68,34,,697.68,percent of total billed charges,Implant Devices,697.68,34,,697.68,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,697.68,34,"If Charge > 2,000, then 34 percent",697.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,820.8,
DEPUY 1312-18-065 CORT SCREW 3.5X65MM,C1713,HCPCS,,79003976,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
DEPUY 8153-55-070 POLY LCK SCREW 55X70MM,C1713,HCPCS,,79003978,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
DEPUY 1312-17-003 SM FRAG LOCKING PLATE,C1713,HCPCS,,79003979,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
DEPUY 8145-50-0470 BONE SCREW 5X40MM,C1713,HCPCS,,79003980,CDM,278,RC,,,both,,,646,254.96,39.4668,,254.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,219.64,34,,219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Device,219.64,34,"Charges > $500, x 34%",219.64,percent of total billed charges,Implant Device,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,258.4,40,,258.4,percent of total billed charges,Implant Devices,226.1,70,,226.1,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,219.64,34,,219.64,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,226.1,35,,226.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258.4,
EV3 EHG-02P H-GENIN PUTTY 2.5CC,C1713,HCPCS,,79003981,CDM,278,RC,,,both,,,1036,408.88,39.4668,,408.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Device,352.24,34,"Charges > $500, x 34%",352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,414.4,40,,414.4,percent of total billed charges,Implant Devices,362.6,70,,362.6,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,414.4,
EXACTECH SPS00 SHLDR KIT GENTA #1400/AG,C1713,HCPCS,,79003982,CDM,278,RC,,,both,,,10546,4162.17,39.4668,,4162.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3585.64,34,,3585.64,percent of total billed charges,Implant Device,3691.1,35,,3691.1,percent of total billed charges,Implant Device,3585.64,34,"Charges > $500, x 34%",3585.64,percent of total billed charges,Implant Device,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,4218.4,40,,4218.4,percent of total billed charges,Implant Devices,3691.1,70,,3691.1,percent of total billed charges,Implant Devices,3585.64,34,,3585.64,percent of total billed charges,Implant Devices,3585.64,34,,3585.64,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,3691.1,35,,3691.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3585.64,34,"If Charge > 2,000, then 34 percent",3585.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4218.4,
INTEGRA 330-217-SND 2 HOLE PLATE,C1713,HCPCS,,79003983,CDM,278,RC,,,both,,,5052,1993.86,39.4668,,1993.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1717.68,34,,1717.68,percent of total billed charges,Implant Device,1717.68,34,,1717.68,percent of total billed charges,Implant Device,1717.68,34,,1717.68,percent of total billed charges,Implant Device,1717.68,34,,1717.68,percent of total billed charges,Implant Device,1717.68,34,,1717.68,percent of total billed charges,Implant Device,1717.68,34,,1717.68,percent of total billed charges,Implant Device,1768.2,35,,1768.2,percent of total billed charges,Implant Device,1717.68,34,"Charges > $500, x 34%",1717.68,percent of total billed charges,Implant Device,1768.2,35,,1768.2,percent of total billed charges,Implant Devices,1768.2,35,,1768.2,percent of total billed charges,Implant Devices,1768.2,35,,,percent of total billed charges,Implant Devices,1768.2,35,,1768.2,percent of total billed charges,Implant Devices,1768.2,35,,1768.2,percent of total billed charges,Implant Devices,2020.8,40,,2020.8,percent of total billed charges,Implant Devices,1768.2,70,,1768.2,percent of total billed charges,Implant Devices,1717.68,34,,1717.68,percent of total billed charges,Implant Devices,1717.68,34,,1717.68,percent of total billed charges,Implant Devices,1768.2,35,,1768.2,percent of total billed charges,Implant Devices,1768.2,35,,1768.2,percent of total billed charges,Implant Devices,1768.2,35,,1768.2,percent of total billed charges,Implant Devices,1768.2,35,,1768.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1717.68,34,"If Charge > 2,000, then 34 percent",1717.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2020.8,
INTEGRA 440-234 PART THRD SCREW 4X34MM,C1713,HCPCS,,79003984,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
INTEGRA 186-300-SND LOCK SCREW 3.5MM,C1713,HCPCS,,79003988,CDM,278,RC,,,both,,,472,186.28,39.4668,,186.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,160.48,34,,160.48,percent of total billed charges,Implant Device,160.48,34,,160.48,percent of total billed charges,Implant Device,160.48,34,,160.48,percent of total billed charges,Implant Device,160.48,34,,160.48,percent of total billed charges,Implant Device,160.48,34,,160.48,percent of total billed charges,Implant Device,160.48,34,,160.48,percent of total billed charges,Implant Device,165.2,35,,165.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.2,35,,165.2,percent of total billed charges,Implant Devices,165.2,35,,165.2,percent of total billed charges,Implant Devices,165.2,35,,,percent of total billed charges,Implant Devices,165.2,35,,165.2,percent of total billed charges,Implant Devices,165.2,35,,165.2,percent of total billed charges,Implant Devices,188.8,40,,188.8,percent of total billed charges,Implant Devices,165.2,70,,165.2,percent of total billed charges,Implant Devices,160.48,34,,160.48,percent of total billed charges,Implant Devices,160.48,34,,160.48,percent of total billed charges,Implant Devices,165.2,35,,165.2,percent of total billed charges,Implant Devices,165.2,35,,165.2,percent of total billed charges,Implant Devices,165.2,35,,165.2,percent of total billed charges,Implant Devices,165.2,35,,165.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,188.8,
INTEGRA 286-318-SND SCREW 3.5X18MM,C1713,HCPCS,,79003989,CDM,278,RC,,,both,,,1054,415.98,39.4668,,415.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,358.36,34,,358.36,percent of total billed charges,Implant Device,358.36,34,,358.36,percent of total billed charges,Implant Device,358.36,34,,358.36,percent of total billed charges,Implant Device,358.36,34,,358.36,percent of total billed charges,Implant Device,358.36,34,,358.36,percent of total billed charges,Implant Device,358.36,34,,358.36,percent of total billed charges,Implant Device,368.9,35,,368.9,percent of total billed charges,Implant Device,358.36,34,"Charges > $500, x 34%",358.36,percent of total billed charges,Implant Device,368.9,35,,368.9,percent of total billed charges,Implant Devices,368.9,35,,368.9,percent of total billed charges,Implant Devices,368.9,35,,,percent of total billed charges,Implant Devices,368.9,35,,368.9,percent of total billed charges,Implant Devices,368.9,35,,368.9,percent of total billed charges,Implant Devices,421.6,40,,421.6,percent of total billed charges,Implant Devices,368.9,70,,368.9,percent of total billed charges,Implant Devices,358.36,34,,358.36,percent of total billed charges,Implant Devices,358.36,34,,358.36,percent of total billed charges,Implant Devices,368.9,35,,368.9,percent of total billed charges,Implant Devices,368.9,35,,368.9,percent of total billed charges,Implant Devices,368.9,35,,368.9,percent of total billed charges,Implant Devices,368.9,35,,368.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,421.6,
JRF 1033-12 TRI- CORTCL BLCK 1.5X2.5CM,C1713,HCPCS,,79003993,CDM,278,RC,,,both,,,2086,823.28,39.4668,,823.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,709.24,34,,709.24,percent of total billed charges,Implant Device,730.1,35,,730.1,percent of total billed charges,Implant Device,709.24,34,"Charges > $500, x 34%",709.24,percent of total billed charges,Implant Device,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,834.4,40,,834.4,percent of total billed charges,Implant Devices,730.1,70,,730.1,percent of total billed charges,Implant Devices,709.24,34,,709.24,percent of total billed charges,Implant Devices,709.24,34,,709.24,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,730.1,35,,730.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,709.24,34,"If Charge > 2,000, then 34 percent",709.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834.4,
JRF 1021-14 TIBIALIS POST 0.85X26CM,C1713,HCPCS,,79003994,CDM,278,RC,,,both,,,6600,2604.81,39.4668,,2604.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2310,35,,2310,percent of total billed charges,Implant Device,2244,34,"Charges > $500, x 34%",2244,percent of total billed charges,Implant Device,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2640,40,,2640,percent of total billed charges,Implant Devices,2310,70,,2310,percent of total billed charges,Implant Devices,2244,34,,2244,percent of total billed charges,Implant Devices,2244,34,,2244,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2244,34,"If Charge > 2,000, then 34 percent",2244,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2640,
LIFE CELL 892 HEMI PATELLA TENDON,C1713,HCPCS,,79003996,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
MTF 430200 ACHILLES TENDON W/CALC 19.5CM,C1713,HCPCS,,79004016,CDM,278,RC,,,both,,,5056,1995.44,39.4668,,1995.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1769.6,35,,1769.6,percent of total billed charges,Implant Device,1719.04,34,"Charges > $500, x 34%",1719.04,percent of total billed charges,Implant Device,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,2022.4,40,,2022.4,percent of total billed charges,Implant Devices,1769.6,70,,1769.6,percent of total billed charges,Implant Devices,1719.04,34,,1719.04,percent of total billed charges,Implant Devices,1719.04,34,,1719.04,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1719.04,34,"If Charge > 2,000, then 34 percent",1719.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2022.4,
ORTHOHELIX CSS-011-70-855 SCREW 7.0MM,C1713,HCPCS,,79004020,CDM,278,RC,,,both,,,978,385.99,39.4668,,385.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,332.52,34,,332.52,percent of total billed charges,Implant Device,332.52,34,,332.52,percent of total billed charges,Implant Device,332.52,34,,332.52,percent of total billed charges,Implant Device,332.52,34,,332.52,percent of total billed charges,Implant Device,332.52,34,,332.52,percent of total billed charges,Implant Device,332.52,34,,332.52,percent of total billed charges,Implant Device,342.3,35,,342.3,percent of total billed charges,Implant Device,332.52,34,"Charges > $500, x 34%",332.52,percent of total billed charges,Implant Device,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,391.2,40,,391.2,percent of total billed charges,Implant Devices,342.3,70,,342.3,percent of total billed charges,Implant Devices,332.52,34,,332.52,percent of total billed charges,Implant Devices,332.52,34,,332.52,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,391.2,
ORTHOHELIX CSS-011-55-0405 SCREW 5.5X40,C1713,HCPCS,,79004021,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
ORTHOHELIX TMT-022-23-ML PLATE LT STD,C1713,HCPCS,,79004022,CDM,278,RC,,,both,,,3940,1554.99,39.4668,,1554.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1339.6,34,,1339.6,percent of total billed charges,Implant Device,1339.6,34,,1339.6,percent of total billed charges,Implant Device,1339.6,34,,1339.6,percent of total billed charges,Implant Device,1339.6,34,,1339.6,percent of total billed charges,Implant Device,1339.6,34,,1339.6,percent of total billed charges,Implant Device,1339.6,34,,1339.6,percent of total billed charges,Implant Device,1379,35,,1379,percent of total billed charges,Implant Device,1339.6,34,"Charges > $500, x 34%",1339.6,percent of total billed charges,Implant Device,1379,35,,1379,percent of total billed charges,Implant Devices,1379,35,,1379,percent of total billed charges,Implant Devices,1379,35,,,percent of total billed charges,Implant Devices,1379,35,,1379,percent of total billed charges,Implant Devices,1379,35,,1379,percent of total billed charges,Implant Devices,1576,40,,1576,percent of total billed charges,Implant Devices,1379,70,,1379,percent of total billed charges,Implant Devices,1339.6,34,,1339.6,percent of total billed charges,Implant Devices,1339.6,34,,1339.6,percent of total billed charges,Implant Devices,1379,35,,1379,percent of total billed charges,Implant Devices,1379,35,,1379,percent of total billed charges,Implant Devices,1379,35,,1379,percent of total billed charges,Implant Devices,1379,35,,1379,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1339.6,34,"If Charge > 2,000, then 34 percent",1339.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1576,
ORTHOHELIX MXM-022-MTP-R STD MTP PLATE,C1713,HCPCS,,79004023,CDM,278,RC,,,both,,,5236,2066.48,39.4668,,2066.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1780.24,34,,1780.24,percent of total billed charges,Implant Device,1780.24,34,,1780.24,percent of total billed charges,Implant Device,1780.24,34,,1780.24,percent of total billed charges,Implant Device,1780.24,34,,1780.24,percent of total billed charges,Implant Device,1780.24,34,,1780.24,percent of total billed charges,Implant Device,1780.24,34,,1780.24,percent of total billed charges,Implant Device,1832.6,35,,1832.6,percent of total billed charges,Implant Device,1780.24,34,"Charges > $500, x 34%",1780.24,percent of total billed charges,Implant Device,1832.6,35,,1832.6,percent of total billed charges,Implant Devices,1832.6,35,,1832.6,percent of total billed charges,Implant Devices,1832.6,35,,,percent of total billed charges,Implant Devices,1832.6,35,,1832.6,percent of total billed charges,Implant Devices,1832.6,35,,1832.6,percent of total billed charges,Implant Devices,2094.4,40,,2094.4,percent of total billed charges,Implant Devices,1832.6,70,,1832.6,percent of total billed charges,Implant Devices,1780.24,34,,1780.24,percent of total billed charges,Implant Devices,1780.24,34,,1780.24,percent of total billed charges,Implant Devices,1832.6,35,,1832.6,percent of total billed charges,Implant Devices,1832.6,35,,1832.6,percent of total billed charges,Implant Devices,1832.6,35,,1832.6,percent of total billed charges,Implant Devices,1832.6,35,,1832.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1780.24,34,"If Charge > 2,000, then 34 percent",1780.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2094.4,
ORTHOHELIX MXM-011-24-10 SCREW 2.4X10MM,C1713,HCPCS,,79004024,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ORTHOHELIX MTF-021-35-35 SCREW 3.5X35MM,C1713,HCPCS,,79004026,CDM,278,RC,,,both,,,546,215.49,39.4668,,215.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Device,185.64,34,"Charges > $500, x 34%",185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,218.4,40,,218.4,percent of total billed charges,Implant Devices,191.1,70,,191.1,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
PAC 3 N600102 PLATE-26MM 1 LEVEL X SPINE,C1713,HCPCS,,79004027,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
PAC 3 N600136 X SPINE SCREW 4X14MM,C1713,HCPCS,,79004028,CDM,278,RC,,,both,,,706,278.64,39.4668,,278.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Device,240.04,34,"Charges > $500, x 34%",240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,282.4,40,,282.4,percent of total billed charges,Implant Devices,247.1,70,,247.1,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.4,
PAC 3 N6000019 X SPINE PLATE 42MM 2LEVEL,C1713,HCPCS,,79004029,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
PAC 3 N60000108 XSPINE 2LEVEL PLATE 39MM,C1713,HCPCS,,79004030,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
SMITH & NEPHEW 121828 SCREW CANN 4X28MM,C1713,HCPCS,,79004033,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
SOLANA 5740106 LORDOTC ALLOGRAFT 6X11X14,C1713,HCPCS,,79004039,CDM,278,RC,,,both,,,4486,1770.48,39.4668,,1770.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1570.1,35,,1570.1,percent of total billed charges,Implant Device,1525.24,34,"Charges > $500, x 34%",1525.24,percent of total billed charges,Implant Device,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1794.4,40,,1794.4,percent of total billed charges,Implant Devices,1570.1,70,,1570.1,percent of total billed charges,Implant Devices,1525.24,34,,1525.24,percent of total billed charges,Implant Devices,1525.24,34,,1525.24,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1525.24,34,"If Charge > 2,000, then 34 percent",1525.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794.4,
SOLANA 5740107 LORDOTC ALLOGRAFT 7X11X14,C1713,HCPCS,,79004040,CDM,278,RC,,,both,,,4486,1770.48,39.4668,,1770.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1525.24,34,,1525.24,percent of total billed charges,Implant Device,1570.1,35,,1570.1,percent of total billed charges,Implant Device,1525.24,34,"Charges > $500, x 34%",1525.24,percent of total billed charges,Implant Device,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1794.4,40,,1794.4,percent of total billed charges,Implant Devices,1570.1,70,,1570.1,percent of total billed charges,Implant Devices,1525.24,34,,1525.24,percent of total billed charges,Implant Devices,1525.24,34,,1525.24,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,1570.1,35,,1570.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1525.24,34,"If Charge > 2,000, then 34 percent",1525.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794.4,
STRYKER 1822-0939S NAIL TIBIAL STD 9X390,C1713,HCPCS,,79004045,CDM,278,RC,,,both,,,5131,2025.04,39.4668,,2025.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1744.54,34,,1744.54,percent of total billed charges,Implant Device,1795.85,35,,1795.85,percent of total billed charges,Implant Device,1744.54,34,"Charges > $500, x 34%",1744.54,percent of total billed charges,Implant Device,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,2052.4,40,,2052.4,percent of total billed charges,Implant Devices,1795.85,70,,1795.85,percent of total billed charges,Implant Devices,1744.54,34,,1744.54,percent of total billed charges,Implant Devices,1744.54,34,,1744.54,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,1795.85,35,,1795.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1744.54,34,"If Charge > 2,000, then 34 percent",1744.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2052.4,
STRYKER 58-23212E BONE SCREW 2.3X12MM,C1713,HCPCS,,79004046,CDM,278,RC,,,both,,,265,104.59,39.4668,,104.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,90.1,34,,90.1,percent of total billed charges,Implant Device,90.1,34,,90.1,percent of total billed charges,Implant Device,90.1,34,,90.1,percent of total billed charges,Implant Device,90.1,34,,90.1,percent of total billed charges,Implant Device,90.1,34,,90.1,percent of total billed charges,Implant Device,90.1,34,,90.1,percent of total billed charges,Implant Device,92.75,35,,92.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,106,40,,106,percent of total billed charges,Implant Devices,92.75,70,,92.75,percent of total billed charges,Implant Devices,90.1,34,,90.1,percent of total billed charges,Implant Devices,90.1,34,,90.1,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,92.75,35,,92.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,106,
STRYKER 602700 SCREW 6.5X100,C1713,HCPCS,,79004048,CDM,278,RC,,,both,,,753,297.19,39.4668,,297.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,263.55,35,,263.55,percent of total billed charges,Implant Device,256.02,34,"Charges > $500, x 34%",256.02,percent of total billed charges,Implant Device,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,301.2,40,,301.2,percent of total billed charges,Implant Devices,263.55,70,,263.55,percent of total billed charges,Implant Devices,256.02,34,,256.02,percent of total billed charges,Implant Devices,256.02,34,,256.02,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,301.2,
STRYKER 59-23015 BONE SCREW 2.3X15,C1713,HCPCS,,79004052,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
STRYKER 430208 8 HOLE 1/3 TUBULAR PLATE,C1713,HCPCS,,79004053,CDM,278,RC,,,both,,,202,79.72,39.4668,,79.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.68,34,,68.68,percent of total billed charges,Implant Device,68.68,34,,68.68,percent of total billed charges,Implant Device,68.68,34,,68.68,percent of total billed charges,Implant Device,68.68,34,,68.68,percent of total billed charges,Implant Device,68.68,34,,68.68,percent of total billed charges,Implant Device,68.68,34,,68.68,percent of total billed charges,Implant Device,70.7,35,,70.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,80.8,40,,80.8,percent of total billed charges,Implant Devices,70.7,70,,70.7,percent of total billed charges,Implant Devices,68.68,34,,68.68,percent of total billed charges,Implant Devices,68.68,34,,68.68,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,80.8,
STRYKER 338655 CORTICAL SCREW 3.5X55MM,C1713,HCPCS,,79004054,CDM,278,RC,,,both,,,70,27.63,39.4668,,27.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23.8,34,,23.8,percent of total billed charges,Implant Device,23.8,34,,23.8,percent of total billed charges,Implant Device,23.8,34,,23.8,percent of total billed charges,Implant Device,23.8,34,,23.8,percent of total billed charges,Implant Device,23.8,34,,23.8,percent of total billed charges,Implant Device,23.8,34,,23.8,percent of total billed charges,Implant Device,24.5,35,,24.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,28,40,,28,percent of total billed charges,Implant Devices,24.5,70,,24.5,percent of total billed charges,Implant Devices,23.8,34,,23.8,percent of total billed charges,Implant Devices,23.8,34,,23.8,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28,
STRYKER 1828-1234S FEMORAL NAIL 12X340MM,C1713,HCPCS,,79004055,CDM,278,RC,,,both,,,7031,2774.91,39.4668,,2774.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2390.54,34,,2390.54,percent of total billed charges,Implant Device,2390.54,34,,2390.54,percent of total billed charges,Implant Device,2390.54,34,,2390.54,percent of total billed charges,Implant Device,2390.54,34,,2390.54,percent of total billed charges,Implant Device,2390.54,34,,2390.54,percent of total billed charges,Implant Device,2390.54,34,,2390.54,percent of total billed charges,Implant Device,2460.85,35,,2460.85,percent of total billed charges,Implant Device,2390.54,34,"Charges > $500, x 34%",2390.54,percent of total billed charges,Implant Device,2460.85,35,,2460.85,percent of total billed charges,Implant Devices,2460.85,35,,2460.85,percent of total billed charges,Implant Devices,2460.85,35,,,percent of total billed charges,Implant Devices,2460.85,35,,2460.85,percent of total billed charges,Implant Devices,2460.85,35,,2460.85,percent of total billed charges,Implant Devices,2812.4,40,,2812.4,percent of total billed charges,Implant Devices,2460.85,70,,2460.85,percent of total billed charges,Implant Devices,2390.54,34,,2390.54,percent of total billed charges,Implant Devices,2390.54,34,,2390.54,percent of total billed charges,Implant Devices,2460.85,35,,2460.85,percent of total billed charges,Implant Devices,2460.85,35,,2460.85,percent of total billed charges,Implant Devices,2460.85,35,,2460.85,percent of total billed charges,Implant Devices,2460.85,35,,2460.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2390.54,34,"If Charge > 2,000, then 34 percent",2390.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2812.4,
STRYKER 59-17010 BONE SCREW 1.7X10MM,C1713,HCPCS,,79004057,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
STRYKER 3713-46 LOCKING SCREW 5X46,C1713,HCPCS,,79004060,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 57-13405 COMPRESSION PLATE,C1713,HCPCS,,79004061,CDM,278,RC,,,both,,,857,338.23,39.4668,,338.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.38,34,,291.38,percent of total billed charges,Implant Device,291.38,34,,291.38,percent of total billed charges,Implant Device,291.38,34,,291.38,percent of total billed charges,Implant Device,291.38,34,,291.38,percent of total billed charges,Implant Device,291.38,34,,291.38,percent of total billed charges,Implant Device,291.38,34,,291.38,percent of total billed charges,Implant Device,299.95,35,,299.95,percent of total billed charges,Implant Device,291.38,34,"Charges > $500, x 34%",291.38,percent of total billed charges,Implant Device,299.95,35,,299.95,percent of total billed charges,Implant Devices,299.95,35,,299.95,percent of total billed charges,Implant Devices,299.95,35,,,percent of total billed charges,Implant Devices,299.95,35,,299.95,percent of total billed charges,Implant Devices,299.95,35,,299.95,percent of total billed charges,Implant Devices,342.8,40,,342.8,percent of total billed charges,Implant Devices,299.95,70,,299.95,percent of total billed charges,Implant Devices,291.38,34,,291.38,percent of total billed charges,Implant Devices,291.38,34,,291.38,percent of total billed charges,Implant Devices,299.95,35,,299.95,percent of total billed charges,Implant Devices,299.95,35,,299.95,percent of total billed charges,Implant Devices,299.95,35,,299.95,percent of total billed charges,Implant Devices,299.95,35,,299.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,342.8,
STRYKER 437530 10 HOLE PLATE DIS FEMUR,C1713,HCPCS,,79004062,CDM,278,RC,,,both,,,4954,1955.19,39.4668,,1955.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1684.36,34,,1684.36,percent of total billed charges,Implant Device,1684.36,34,,1684.36,percent of total billed charges,Implant Device,1684.36,34,,1684.36,percent of total billed charges,Implant Device,1684.36,34,,1684.36,percent of total billed charges,Implant Device,1684.36,34,,1684.36,percent of total billed charges,Implant Device,1684.36,34,,1684.36,percent of total billed charges,Implant Device,1733.9,35,,1733.9,percent of total billed charges,Implant Device,1684.36,34,"Charges > $500, x 34%",1684.36,percent of total billed charges,Implant Device,1733.9,35,,1733.9,percent of total billed charges,Implant Devices,1733.9,35,,1733.9,percent of total billed charges,Implant Devices,1733.9,35,,,percent of total billed charges,Implant Devices,1733.9,35,,1733.9,percent of total billed charges,Implant Devices,1733.9,35,,1733.9,percent of total billed charges,Implant Devices,1981.6,40,,1981.6,percent of total billed charges,Implant Devices,1733.9,70,,1733.9,percent of total billed charges,Implant Devices,1684.36,34,,1684.36,percent of total billed charges,Implant Devices,1684.36,34,,1684.36,percent of total billed charges,Implant Devices,1733.9,35,,1733.9,percent of total billed charges,Implant Devices,1733.9,35,,1733.9,percent of total billed charges,Implant Devices,1733.9,35,,1733.9,percent of total billed charges,Implant Devices,1733.9,35,,1733.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1684.36,34,"If Charge > 2,000, then 34 percent",1684.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1981.6,
STRYKER 5317016E LOCK SCREW 1.7X16MM,C1713,HCPCS,,79004063,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
STRYKER 345560 CANCELLOUS SCREW 4.0X60MM,C1713,HCPCS,,79004064,CDM,278,RC,,,both,,,68,26.84,39.4668,,26.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.8,35,,23.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,27.2,40,,27.2,percent of total billed charges,Implant Devices,23.8,70,,23.8,percent of total billed charges,Implant Devices,23.12,34,,23.12,percent of total billed charges,Implant Devices,23.12,34,,23.12,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27.2,
STRYKER 5030-4-250 APEX PINS 35MM,C1713,HCPCS,,79004066,CDM,278,RC,,,both,,,620,244.69,39.4668,,244.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,210.8,34,,210.8,percent of total billed charges,Implant Device,210.8,34,,210.8,percent of total billed charges,Implant Device,210.8,34,,210.8,percent of total billed charges,Implant Device,210.8,34,,210.8,percent of total billed charges,Implant Device,210.8,34,,210.8,percent of total billed charges,Implant Device,210.8,34,,210.8,percent of total billed charges,Implant Device,217,35,,217,percent of total billed charges,Implant Device,210.8,34,"Charges > $500, x 34%",210.8,percent of total billed charges,Implant Device,217,35,,217,percent of total billed charges,Implant Devices,217,35,,217,percent of total billed charges,Implant Devices,217,35,,,percent of total billed charges,Implant Devices,217,35,,217,percent of total billed charges,Implant Devices,217,35,,217,percent of total billed charges,Implant Devices,248,40,,248,percent of total billed charges,Implant Devices,217,70,,217,percent of total billed charges,Implant Devices,210.8,34,,210.8,percent of total billed charges,Implant Devices,210.8,34,,210.8,percent of total billed charges,Implant Devices,217,35,,217,percent of total billed charges,Implant Devices,217,35,,217,percent of total billed charges,Implant Devices,217,35,,217,percent of total billed charges,Implant Devices,217,35,,217,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,248,
STRYKER 371544 LOCK SCREW SS 4.0X44MM,C1713,HCPCS,,79004067,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 437208 DIST MED TIB PLATE 8HOLE,C1713,HCPCS,,79004069,CDM,278,RC,,,both,,,5643,2227.11,39.4668,,2227.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1975.05,35,,1975.05,percent of total billed charges,Implant Device,1918.62,34,"Charges > $500, x 34%",1918.62,percent of total billed charges,Implant Device,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,2257.2,40,,2257.2,percent of total billed charges,Implant Devices,1975.05,70,,1975.05,percent of total billed charges,Implant Devices,1918.62,34,,1918.62,percent of total billed charges,Implant Devices,1918.62,34,,1918.62,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1918.62,34,"If Charge > 2,000, then 34 percent",1918.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2257.2,
STRYKER 53-17015E LOCK SCREW 1.7X15MM,C1713,HCPCS,,79004070,CDM,278,RC,,,both,,,423,166.94,39.4668,,166.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,148.05,35,,148.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,169.2,40,,169.2,percent of total billed charges,Implant Devices,148.05,70,,148.05,percent of total billed charges,Implant Devices,143.82,34,,143.82,percent of total billed charges,Implant Devices,143.82,34,,143.82,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,169.2,
STRYKER 3225-0420S NAIL KIT R2.0 TI,C1713,HCPCS,,79004071,CDM,278,RC,,,both,,,6268,2473.78,39.4668,,2473.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2193.8,35,,2193.8,percent of total billed charges,Implant Device,2131.12,34,"Charges > $500, x 34%",2131.12,percent of total billed charges,Implant Device,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2507.2,40,,2507.2,percent of total billed charges,Implant Devices,2193.8,70,,2193.8,percent of total billed charges,Implant Devices,2131.12,34,,2131.12,percent of total billed charges,Implant Devices,2131.12,34,,2131.12,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2131.12,34,"If Charge > 2,000, then 34 percent",2131.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2507.2,
STRYKER 1832-2824S PROX HUM NAIL 8X24MM,C1713,HCPCS,,79004073,CDM,278,RC,,,both,,,5933,2341.57,39.4668,,2341.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2017.22,34,,2017.22,percent of total billed charges,Implant Device,2017.22,34,,2017.22,percent of total billed charges,Implant Device,2017.22,34,,2017.22,percent of total billed charges,Implant Device,2017.22,34,,2017.22,percent of total billed charges,Implant Device,2017.22,34,,2017.22,percent of total billed charges,Implant Device,2017.22,34,,2017.22,percent of total billed charges,Implant Device,2076.55,35,,2076.55,percent of total billed charges,Implant Device,2017.22,34,"Charges > $500, x 34%",2017.22,percent of total billed charges,Implant Device,2076.55,35,,2076.55,percent of total billed charges,Implant Devices,2076.55,35,,2076.55,percent of total billed charges,Implant Devices,2076.55,35,,,percent of total billed charges,Implant Devices,2076.55,35,,2076.55,percent of total billed charges,Implant Devices,2076.55,35,,2076.55,percent of total billed charges,Implant Devices,2373.2,40,,2373.2,percent of total billed charges,Implant Devices,2076.55,70,,2076.55,percent of total billed charges,Implant Devices,2017.22,34,,2017.22,percent of total billed charges,Implant Devices,2017.22,34,,2017.22,percent of total billed charges,Implant Devices,2076.55,35,,2076.55,percent of total billed charges,Implant Devices,2076.55,35,,2076.55,percent of total billed charges,Implant Devices,2076.55,35,,2076.55,percent of total billed charges,Implant Devices,2076.55,35,,2076.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2017.22,34,"If Charge > 2,000, then 34 percent",2017.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2373.2,
STRYKER 326085S CANN SCREW 6.5CMX85MM,C1713,HCPCS,,79004074,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
STRYKER 340632 NONLOCK SCREW 4.5X32MM,C1713,HCPCS,,79004075,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
STRYKER 57-10379 2 HOLE LOCK PLATE 1.7MM,C1713,HCPCS,,79004079,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
STRYKER 1830-0009S WASHER SQUARE 18X10MM,C1713,HCPCS,,79004080,CDM,278,RC,,,both,,,592,233.64,39.4668,,233.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.28,34,,201.28,percent of total billed charges,Implant Device,201.28,34,,201.28,percent of total billed charges,Implant Device,201.28,34,,201.28,percent of total billed charges,Implant Device,201.28,34,,201.28,percent of total billed charges,Implant Device,201.28,34,,201.28,percent of total billed charges,Implant Device,201.28,34,,201.28,percent of total billed charges,Implant Device,207.2,35,,207.2,percent of total billed charges,Implant Device,201.28,34,"Charges > $500, x 34%",201.28,percent of total billed charges,Implant Device,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,236.8,40,,236.8,percent of total billed charges,Implant Devices,207.2,70,,207.2,percent of total billed charges,Implant Devices,201.28,34,,201.28,percent of total billed charges,Implant Devices,201.28,34,,201.28,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,236.8,
STRYKER 1830-0725S HUMERAL NAIL 7X250MM,C1713,HCPCS,,79004081,CDM,278,RC,,,both,,,4876,1924.4,39.4668,,1924.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1657.84,34,,1657.84,percent of total billed charges,Implant Device,1657.84,34,,1657.84,percent of total billed charges,Implant Device,1657.84,34,,1657.84,percent of total billed charges,Implant Device,1657.84,34,,1657.84,percent of total billed charges,Implant Device,1657.84,34,,1657.84,percent of total billed charges,Implant Device,1657.84,34,,1657.84,percent of total billed charges,Implant Device,1706.6,35,,1706.6,percent of total billed charges,Implant Device,1657.84,34,"Charges > $500, x 34%",1657.84,percent of total billed charges,Implant Device,1706.6,35,,1706.6,percent of total billed charges,Implant Devices,1706.6,35,,1706.6,percent of total billed charges,Implant Devices,1706.6,35,,,percent of total billed charges,Implant Devices,1706.6,35,,1706.6,percent of total billed charges,Implant Devices,1706.6,35,,1706.6,percent of total billed charges,Implant Devices,1950.4,40,,1950.4,percent of total billed charges,Implant Devices,1706.6,70,,1706.6,percent of total billed charges,Implant Devices,1657.84,34,,1657.84,percent of total billed charges,Implant Devices,1657.84,34,,1657.84,percent of total billed charges,Implant Devices,1706.6,35,,1706.6,percent of total billed charges,Implant Devices,1706.6,35,,1706.6,percent of total billed charges,Implant Devices,1706.6,35,,1706.6,percent of total billed charges,Implant Devices,1706.6,35,,1706.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1657.84,34,"If Charge > 2,000, then 34 percent",1657.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1950.4,
STRYKER 370350 LOCKING SCREW 5X50MM,C1713,HCPCS,,79004082,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
STRYKER 6495-9-114 PREMATRIX GRAFT 4X4,C1713,HCPCS,,79004084,CDM,278,RC,,,both,,,2844,1122.44,39.4668,,1122.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,966.96,34,,966.96,percent of total billed charges,Implant Device,966.96,34,,966.96,percent of total billed charges,Implant Device,966.96,34,,966.96,percent of total billed charges,Implant Device,966.96,34,,966.96,percent of total billed charges,Implant Device,966.96,34,,966.96,percent of total billed charges,Implant Device,966.96,34,,966.96,percent of total billed charges,Implant Device,995.4,35,,995.4,percent of total billed charges,Implant Device,966.96,34,"Charges > $500, x 34%",966.96,percent of total billed charges,Implant Device,995.4,35,,995.4,percent of total billed charges,Implant Devices,995.4,35,,995.4,percent of total billed charges,Implant Devices,995.4,35,,,percent of total billed charges,Implant Devices,995.4,35,,995.4,percent of total billed charges,Implant Devices,995.4,35,,995.4,percent of total billed charges,Implant Devices,1137.6,40,,1137.6,percent of total billed charges,Implant Devices,995.4,70,,995.4,percent of total billed charges,Implant Devices,966.96,34,,966.96,percent of total billed charges,Implant Devices,966.96,34,,966.96,percent of total billed charges,Implant Devices,995.4,35,,995.4,percent of total billed charges,Implant Devices,995.4,35,,995.4,percent of total billed charges,Implant Devices,995.4,35,,995.4,percent of total billed charges,Implant Devices,995.4,35,,995.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,966.96,34,"If Charge > 2,000, then 34 percent",966.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1137.6,
STRYKER 5015-5-150 APEX PIN CANC 50MM,C1713,HCPCS,,79004085,CDM,278,RC,,,both,,,468,184.7,39.4668,,184.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,187.2,40,,187.2,percent of total billed charges,Implant Devices,163.8,70,,163.8,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.2,
STRYKER 602705 SCREW 6.5X105MM,C1713,HCPCS,,79004086,CDM,278,RC,,,both,,,1285,507.15,39.4668,,507.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,436.9,34,,436.9,percent of total billed charges,Implant Device,436.9,34,,436.9,percent of total billed charges,Implant Device,436.9,34,,436.9,percent of total billed charges,Implant Device,436.9,34,,436.9,percent of total billed charges,Implant Device,436.9,34,,436.9,percent of total billed charges,Implant Device,436.9,34,,436.9,percent of total billed charges,Implant Device,449.75,35,,449.75,percent of total billed charges,Implant Device,436.9,34,"Charges > $500, x 34%",436.9,percent of total billed charges,Implant Device,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,514,40,,514,percent of total billed charges,Implant Devices,449.75,70,,449.75,percent of total billed charges,Implant Devices,436.9,34,,436.9,percent of total billed charges,Implant Devices,436.9,34,,436.9,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,514,
STRYKER 345438 SCREW CANCELLOUS 4X38MM,C1713,HCPCS,,79004087,CDM,278,RC,,,both,,,74,29.21,39.4668,,29.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,29.6,40,,29.6,percent of total billed charges,Implant Devices,25.9,70,,25.9,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,29.6,
STRYKER 371546 LOCK SCREW 4MMX46CM,C1713,HCPCS,,79004088,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 5317006E LOCK SCREW 1.7X6MM,C1713,HCPCS,,79004089,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
STRYKER 4365-08 DIST LAT FEM PLATE 8HOLE,C1713,HCPCS,,79004092,CDM,278,RC,,,both,,,3715,1466.19,39.4668,,1466.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1263.1,34,,1263.1,percent of total billed charges,Implant Device,1263.1,34,,1263.1,percent of total billed charges,Implant Device,1263.1,34,,1263.1,percent of total billed charges,Implant Device,1263.1,34,,1263.1,percent of total billed charges,Implant Device,1263.1,34,,1263.1,percent of total billed charges,Implant Device,1263.1,34,,1263.1,percent of total billed charges,Implant Device,1300.25,35,,1300.25,percent of total billed charges,Implant Device,1263.1,34,"Charges > $500, x 34%",1263.1,percent of total billed charges,Implant Device,1300.25,35,,1300.25,percent of total billed charges,Implant Devices,1300.25,35,,1300.25,percent of total billed charges,Implant Devices,1300.25,35,,,percent of total billed charges,Implant Devices,1300.25,35,,1300.25,percent of total billed charges,Implant Devices,1300.25,35,,1300.25,percent of total billed charges,Implant Devices,1486,40,,1486,percent of total billed charges,Implant Devices,1300.25,70,,1300.25,percent of total billed charges,Implant Devices,1263.1,34,,1263.1,percent of total billed charges,Implant Devices,1263.1,34,,1263.1,percent of total billed charges,Implant Devices,1300.25,35,,1300.25,percent of total billed charges,Implant Devices,1300.25,35,,1300.25,percent of total billed charges,Implant Devices,1300.25,35,,1300.25,percent of total billed charges,Implant Devices,1300.25,35,,1300.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1263.1,34,"If Charge > 2,000, then 34 percent",1263.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1486,
STRYKER 57-10197 STD PLATES 2.3X2X2+2,C1713,HCPCS,,79004093,CDM,278,RC,,,both,,,1276,503.6,39.4668,,503.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,446.6,35,,446.6,percent of total billed charges,Implant Device,433.84,34,"Charges > $500, x 34%",433.84,percent of total billed charges,Implant Device,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,510.4,40,,510.4,percent of total billed charges,Implant Devices,446.6,70,,446.6,percent of total billed charges,Implant Devices,433.84,34,,433.84,percent of total billed charges,Implant Devices,433.84,34,,433.84,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510.4,
STRYKER 340646 NON LOCK SCREW 4.5X46MM,C1713,HCPCS,,79004094,CDM,278,RC,,,both,,,84,33.15,39.4668,,33.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,33.6,40,,33.6,percent of total billed charges,Implant Devices,29.4,70,,29.4,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.6,
STRYKER 3325-0440S NAIL KIT LT 11X440MM,C1713,HCPCS,,79004095,CDM,278,RC,,,both,,,8879,3504.26,39.4668,,3504.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3107.65,35,,3107.65,percent of total billed charges,Implant Device,3018.86,34,"Charges > $500, x 34%",3018.86,percent of total billed charges,Implant Device,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3551.6,40,,3551.6,percent of total billed charges,Implant Devices,3107.65,70,,3107.65,percent of total billed charges,Implant Devices,3018.86,34,,3018.86,percent of total billed charges,Implant Devices,3018.86,34,,3018.86,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3018.86,34,"If Charge > 2,000, then 34 percent",3018.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3551.6,
STRYKER 3406-34 CORTICAL SCREW 4.5X34,C1713,HCPCS,,79004096,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
STRYKER 5118-1-340 WIRES 2.0,C1713,HCPCS,,79004098,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 437105 PROX LAT HUM PLATE 5HOLE,C1713,HCPCS,,79004099,CDM,278,RC,,,both,,,5483,2163.96,39.4668,,2163.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Device,1864.22,34,"Charges > $500, x 34%",1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,2193.2,40,,2193.2,percent of total billed charges,Implant Devices,1919.05,70,,1919.05,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1864.22,34,"If Charge > 2,000, then 34 percent",1864.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2193.2,
STRYKER 51-15904 SCREW 4.MM,C1713,HCPCS,,79004100,CDM,278,RC,,,both,,,173,68.28,39.4668,,68.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,58.82,34,,58.82,percent of total billed charges,Implant Device,58.82,34,,58.82,percent of total billed charges,Implant Device,58.82,34,,58.82,percent of total billed charges,Implant Device,58.82,34,,58.82,percent of total billed charges,Implant Device,58.82,34,,58.82,percent of total billed charges,Implant Device,58.82,34,,58.82,percent of total billed charges,Implant Device,60.55,35,,60.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,69.2,40,,69.2,percent of total billed charges,Implant Devices,60.55,70,,60.55,percent of total billed charges,Implant Devices,58.82,34,,58.82,percent of total billed charges,Implant Devices,58.82,34,,58.82,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,69.2,
STRYKER 1067-0008 DIST CEMENT SPACER 8MM,C1713,HCPCS,,79004104,CDM,278,RC,,,both,,,341,134.58,39.4668,,134.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,119.35,35,,119.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,136.4,40,,136.4,percent of total billed charges,Implant Devices,119.35,70,,119.35,percent of total billed charges,Implant Devices,115.94,34,,115.94,percent of total billed charges,Implant Devices,115.94,34,,115.94,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,136.4,
STRYKER 1826-1438S SUPRCNDLR NAIL 14X380,C1713,HCPCS,,79004105,CDM,278,RC,,,both,,,6598,2604.02,39.4668,,2604.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2243.32,34,,2243.32,percent of total billed charges,Implant Device,2243.32,34,,2243.32,percent of total billed charges,Implant Device,2243.32,34,,2243.32,percent of total billed charges,Implant Device,2243.32,34,,2243.32,percent of total billed charges,Implant Device,2243.32,34,,2243.32,percent of total billed charges,Implant Device,2243.32,34,,2243.32,percent of total billed charges,Implant Device,2309.3,35,,2309.3,percent of total billed charges,Implant Device,2243.32,34,"Charges > $500, x 34%",2243.32,percent of total billed charges,Implant Device,2309.3,35,,2309.3,percent of total billed charges,Implant Devices,2309.3,35,,2309.3,percent of total billed charges,Implant Devices,2309.3,35,,,percent of total billed charges,Implant Devices,2309.3,35,,2309.3,percent of total billed charges,Implant Devices,2309.3,35,,2309.3,percent of total billed charges,Implant Devices,2639.2,40,,2639.2,percent of total billed charges,Implant Devices,2309.3,70,,2309.3,percent of total billed charges,Implant Devices,2243.32,34,,2243.32,percent of total billed charges,Implant Devices,2243.32,34,,2243.32,percent of total billed charges,Implant Devices,2309.3,35,,2309.3,percent of total billed charges,Implant Devices,2309.3,35,,2309.3,percent of total billed charges,Implant Devices,2309.3,35,,2309.3,percent of total billed charges,Implant Devices,2309.3,35,,2309.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2243.32,34,"If Charge > 2,000, then 34 percent",2243.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2639.2,
STRYKER 1828-1436S FEMORAL NAIL 14X360MM,C1713,HCPCS,,79004106,CDM,278,RC,,,both,,,3682,1453.17,39.4668,,1453.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1251.88,34,,1251.88,percent of total billed charges,Implant Device,1251.88,34,,1251.88,percent of total billed charges,Implant Device,1251.88,34,,1251.88,percent of total billed charges,Implant Device,1251.88,34,,1251.88,percent of total billed charges,Implant Device,1251.88,34,,1251.88,percent of total billed charges,Implant Device,1251.88,34,,1251.88,percent of total billed charges,Implant Device,1288.7,35,,1288.7,percent of total billed charges,Implant Device,1251.88,34,"Charges > $500, x 34%",1251.88,percent of total billed charges,Implant Device,1288.7,35,,1288.7,percent of total billed charges,Implant Devices,1288.7,35,,1288.7,percent of total billed charges,Implant Devices,1288.7,35,,,percent of total billed charges,Implant Devices,1288.7,35,,1288.7,percent of total billed charges,Implant Devices,1288.7,35,,1288.7,percent of total billed charges,Implant Devices,1472.8,40,,1472.8,percent of total billed charges,Implant Devices,1288.7,70,,1288.7,percent of total billed charges,Implant Devices,1251.88,34,,1251.88,percent of total billed charges,Implant Devices,1251.88,34,,1251.88,percent of total billed charges,Implant Devices,1288.7,35,,1288.7,percent of total billed charges,Implant Devices,1288.7,35,,1288.7,percent of total billed charges,Implant Devices,1288.7,35,,1288.7,percent of total billed charges,Implant Devices,1288.7,35,,1288.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1251.88,34,"If Charge > 2,000, then 34 percent",1251.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1472.8,
STRYKER 2080-0040 PLATE SCREW 6.5X40MM,C1713,HCPCS,,79004107,CDM,278,RC,,,both,,,516,203.65,39.4668,,203.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,175.44,34,,175.44,percent of total billed charges,Implant Device,175.44,34,,175.44,percent of total billed charges,Implant Device,175.44,34,,175.44,percent of total billed charges,Implant Device,175.44,34,,175.44,percent of total billed charges,Implant Device,175.44,34,,175.44,percent of total billed charges,Implant Device,175.44,34,,175.44,percent of total billed charges,Implant Device,180.6,35,,180.6,percent of total billed charges,Implant Device,175.44,34,"Charges > $500, x 34%",175.44,percent of total billed charges,Implant Device,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,206.4,40,,206.4,percent of total billed charges,Implant Devices,180.6,70,,180.6,percent of total billed charges,Implant Devices,175.44,34,,175.44,percent of total billed charges,Implant Devices,175.44,34,,175.44,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,206.4,
STRYKER 1896-4020S LOCK SCREW 4X20MM,C1713,HCPCS,,79004108,CDM,278,RC,,,both,,,592,233.64,39.4668,,233.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.28,34,,201.28,percent of total billed charges,Implant Device,201.28,34,,201.28,percent of total billed charges,Implant Device,201.28,34,,201.28,percent of total billed charges,Implant Device,201.28,34,,201.28,percent of total billed charges,Implant Device,201.28,34,,201.28,percent of total billed charges,Implant Device,201.28,34,,201.28,percent of total billed charges,Implant Device,207.2,35,,207.2,percent of total billed charges,Implant Device,201.28,34,"Charges > $500, x 34%",201.28,percent of total billed charges,Implant Device,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,236.8,40,,236.8,percent of total billed charges,Implant Devices,207.2,70,,207.2,percent of total billed charges,Implant Devices,201.28,34,,201.28,percent of total billed charges,Implant Devices,201.28,34,,201.28,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,207.2,35,,207.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,236.8,
STRYKER 3060-0130S LAG SCREW 10.5X130MM,C1713,HCPCS,,79004109,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
STRYKER 370385 LOCKING SCREW 5X85MM,C1713,HCPCS,,79004110,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
STRYKER 2030-6535-1 CANC SCREW 6.5X35MM,C1713,HCPCS,,79004111,CDM,278,RC,,,both,,,451,178,39.4668,,178,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,157.85,35,,157.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,180.4,40,,180.4,percent of total billed charges,Implant Devices,157.85,70,,157.85,percent of total billed charges,Implant Devices,153.34,34,,153.34,percent of total billed charges,Implant Devices,153.34,34,,153.34,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180.4,
STRYKER 371350 LOCKING SCREW 5X50MM,C1713,HCPCS,,79004113,CDM,278,RC,,,both,,,523,206.41,39.4668,,206.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Device,177.82,34,"Charges > $500, x 34%",177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,209.2,40,,209.2,percent of total billed charges,Implant Devices,183.05,70,,183.05,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.2,
STRYKER 32285-3380S LONG NAIL 13X380MM,C1713,HCPCS,,79004114,CDM,278,RC,,,both,,,7140,2817.93,39.4668,,2817.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2499,35,,2499,percent of total billed charges,Implant Device,2427.6,34,"Charges > $500, x 34%",2427.6,percent of total billed charges,Implant Device,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2856,40,,2856,percent of total billed charges,Implant Devices,2499,70,,2499,percent of total billed charges,Implant Devices,2427.6,34,,2427.6,percent of total billed charges,Implant Devices,2427.6,34,,2427.6,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2427.6,34,"If Charge > 2,000, then 34 percent",2427.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2856,
STRYKER 3430-80 CANCELLOUS SCREW 6.5X80,C1713,HCPCS,,79004116,CDM,278,RC,,,both,,,84,33.15,39.4668,,33.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,33.6,40,,33.6,percent of total billed charges,Implant Devices,29.4,70,,29.4,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.6,
STRYKER 343085 CANCELLOUS SCREW 6.5X85,C1713,HCPCS,,79004118,CDM,278,RC,,,both,,,113,44.6,39.4668,,44.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,45.2,40,,45.2,percent of total billed charges,Implant Devices,39.55,70,,39.55,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.2,
STRYKER 343095 FT CAN SCREW 6.5X95MM,C1713,HCPCS,,79004119,CDM,278,RC,,,both,,,127,50.12,39.4668,,50.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,43.18,34,,43.18,percent of total billed charges,Implant Device,43.18,34,,43.18,percent of total billed charges,Implant Device,43.18,34,,43.18,percent of total billed charges,Implant Device,43.18,34,,43.18,percent of total billed charges,Implant Device,43.18,34,,43.18,percent of total billed charges,Implant Device,43.18,34,,43.18,percent of total billed charges,Implant Device,44.45,35,,44.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,50.8,40,,50.8,percent of total billed charges,Implant Devices,44.45,70,,44.45,percent of total billed charges,Implant Devices,43.18,34,,43.18,percent of total billed charges,Implant Devices,43.18,34,,43.18,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50.8,
STRYKER 345516 CAN PART SCREW 4X16MM,C1713,HCPCS,,79004120,CDM,278,RC,,,both,,,74,29.21,39.4668,,29.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,29.6,40,,29.6,percent of total billed charges,Implant Devices,25.9,70,,25.9,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,29.6,
STRYKER 502-03-50D HEMI HOLE SHELL 50MM,C1713,HCPCS,,79004121,CDM,278,RC,,,both,,,9197,3629.76,39.4668,,3629.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3126.98,34,,3126.98,percent of total billed charges,Implant Device,3126.98,34,,3126.98,percent of total billed charges,Implant Device,3126.98,34,,3126.98,percent of total billed charges,Implant Device,3126.98,34,,3126.98,percent of total billed charges,Implant Device,3126.98,34,,3126.98,percent of total billed charges,Implant Device,3126.98,34,,3126.98,percent of total billed charges,Implant Device,3218.95,35,,3218.95,percent of total billed charges,Implant Device,3126.98,34,"Charges > $500, x 34%",3126.98,percent of total billed charges,Implant Device,3218.95,35,,3218.95,percent of total billed charges,Implant Devices,3218.95,35,,3218.95,percent of total billed charges,Implant Devices,3218.95,35,,,percent of total billed charges,Implant Devices,3218.95,35,,3218.95,percent of total billed charges,Implant Devices,3218.95,35,,3218.95,percent of total billed charges,Implant Devices,3678.8,40,,3678.8,percent of total billed charges,Implant Devices,3218.95,70,,3218.95,percent of total billed charges,Implant Devices,3126.98,34,,3126.98,percent of total billed charges,Implant Devices,3126.98,34,,3126.98,percent of total billed charges,Implant Devices,3218.95,35,,3218.95,percent of total billed charges,Implant Devices,3218.95,35,,3218.95,percent of total billed charges,Implant Devices,3218.95,35,,3218.95,percent of total billed charges,Implant Devices,3218.95,35,,3218.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3126.98,34,"If Charge > 2,000, then 34 percent",3126.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3678.8,
STRYKER 1828-1432S FEMORAL NAIL 14X320MM,C1713,HCPCS,,79004122,CDM,278,RC,,,both,,,6258,2469.83,39.4668,,2469.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2127.72,34,,2127.72,percent of total billed charges,Implant Device,2127.72,34,,2127.72,percent of total billed charges,Implant Device,2127.72,34,,2127.72,percent of total billed charges,Implant Device,2127.72,34,,2127.72,percent of total billed charges,Implant Device,2127.72,34,,2127.72,percent of total billed charges,Implant Device,2127.72,34,,2127.72,percent of total billed charges,Implant Device,2190.3,35,,2190.3,percent of total billed charges,Implant Device,2127.72,34,"Charges > $500, x 34%",2127.72,percent of total billed charges,Implant Device,2190.3,35,,2190.3,percent of total billed charges,Implant Devices,2190.3,35,,2190.3,percent of total billed charges,Implant Devices,2190.3,35,,,percent of total billed charges,Implant Devices,2190.3,35,,2190.3,percent of total billed charges,Implant Devices,2190.3,35,,2190.3,percent of total billed charges,Implant Devices,2503.2,40,,2503.2,percent of total billed charges,Implant Devices,2190.3,70,,2190.3,percent of total billed charges,Implant Devices,2127.72,34,,2127.72,percent of total billed charges,Implant Devices,2127.72,34,,2127.72,percent of total billed charges,Implant Devices,2190.3,35,,2190.3,percent of total billed charges,Implant Devices,2190.3,35,,2190.3,percent of total billed charges,Implant Devices,2190.3,35,,2190.3,percent of total billed charges,Implant Devices,2190.3,35,,2190.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2127.72,34,"If Charge > 2,000, then 34 percent",2127.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2503.2,
STRYKER 604665S ASNIS CANN SCREW 4X65MM,C1713,HCPCS,,79004123,CDM,278,RC,,,both,,,770,303.89,39.4668,,303.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Device,261.8,34,"Charges > $500, x 34%",261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,308,40,,308,percent of total billed charges,Implant Devices,269.5,70,,269.5,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,308,
STRYKER 53-17014E LOCK SCREW 1.7X14MM,C1713,HCPCS,,79004124,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
STRYKER 40-20108 ASNIS MICRO SCREW 2X8,C1713,HCPCS,,79004125,CDM,278,RC,,,both,,,455,179.57,39.4668,,179.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,159.25,35,,159.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,182,40,,182,percent of total billed charges,Implant Devices,159.25,70,,159.25,percent of total billed charges,Implant Devices,154.7,34,,154.7,percent of total billed charges,Implant Devices,154.7,34,,154.7,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182,
STRYKER 5018-8-180 APEX PINS 5X180MM,C1713,HCPCS,,79004126,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 3713-70 LOCKING SCREW 5X70,C1713,HCPCS,,79004128,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 3225-0400S NAIL 11X400MMX125DEG,C1713,HCPCS,,79004129,CDM,278,RC,,,both,,,5021,1981.63,39.4668,,1981.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1707.14,34,,1707.14,percent of total billed charges,Implant Device,1757.35,35,,1757.35,percent of total billed charges,Implant Device,1707.14,34,"Charges > $500, x 34%",1707.14,percent of total billed charges,Implant Device,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,2008.4,40,,2008.4,percent of total billed charges,Implant Devices,1757.35,70,,1757.35,percent of total billed charges,Implant Devices,1707.14,34,,1707.14,percent of total billed charges,Implant Devices,1707.14,34,,1707.14,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,1757.35,35,,1757.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1707.14,34,"If Charge > 2,000, then 34 percent",1707.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2008.4,
STRYKER 437123 PROX LAT HUM PLATE 4MM,C1713,HCPCS,,79004134,CDM,278,RC,,,both,,,5222,2060.96,39.4668,,2060.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1827.7,35,,1827.7,percent of total billed charges,Implant Device,1775.48,34,"Charges > $500, x 34%",1775.48,percent of total billed charges,Implant Device,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,2088.8,40,,2088.8,percent of total billed charges,Implant Devices,1827.7,70,,1827.7,percent of total billed charges,Implant Devices,1775.48,34,,1775.48,percent of total billed charges,Implant Devices,1775.48,34,,1775.48,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1775.48,34,"If Charge > 2,000, then 34 percent",1775.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2088.8,
STRYKER 1896-5057S LOCK SCREW 5X57MM,C1713,HCPCS,,79004135,CDM,278,RC,,,both,,,441,174.05,39.4668,,174.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,176.4,40,,176.4,percent of total billed charges,Implant Devices,154.35,70,,154.35,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,176.4,
STRYKER 5015-4-150 APEX PIN CANC 40MM,C1713,HCPCS,,79004136,CDM,278,RC,,,both,,,467,184.31,39.4668,,184.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,158.78,34,,158.78,percent of total billed charges,Implant Device,158.78,34,,158.78,percent of total billed charges,Implant Device,158.78,34,,158.78,percent of total billed charges,Implant Device,158.78,34,,158.78,percent of total billed charges,Implant Device,158.78,34,,158.78,percent of total billed charges,Implant Device,158.78,34,,158.78,percent of total billed charges,Implant Device,163.45,35,,163.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.45,35,,163.45,percent of total billed charges,Implant Devices,163.45,35,,163.45,percent of total billed charges,Implant Devices,163.45,35,,,percent of total billed charges,Implant Devices,163.45,35,,163.45,percent of total billed charges,Implant Devices,163.45,35,,163.45,percent of total billed charges,Implant Devices,186.8,40,,186.8,percent of total billed charges,Implant Devices,163.45,70,,163.45,percent of total billed charges,Implant Devices,158.78,34,,158.78,percent of total billed charges,Implant Devices,158.78,34,,158.78,percent of total billed charges,Implant Devices,163.45,35,,163.45,percent of total billed charges,Implant Devices,163.45,35,,163.45,percent of total billed charges,Implant Devices,163.45,35,,163.45,percent of total billed charges,Implant Devices,163.45,35,,163.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,186.8,
STRYKER 59-23010 NONLOCK SCREW 2.3X10MM,C1713,HCPCS,,79004137,CDM,278,RC,,,both,,,247,97.48,39.4668,,97.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,83.98,34,,83.98,percent of total billed charges,Implant Device,83.98,34,,83.98,percent of total billed charges,Implant Device,83.98,34,,83.98,percent of total billed charges,Implant Device,83.98,34,,83.98,percent of total billed charges,Implant Device,83.98,34,,83.98,percent of total billed charges,Implant Device,83.98,34,,83.98,percent of total billed charges,Implant Device,86.45,35,,86.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,86.45,35,,86.45,percent of total billed charges,Implant Devices,86.45,35,,86.45,percent of total billed charges,Implant Devices,86.45,35,,,percent of total billed charges,Implant Devices,86.45,35,,86.45,percent of total billed charges,Implant Devices,86.45,35,,86.45,percent of total billed charges,Implant Devices,98.8,40,,98.8,percent of total billed charges,Implant Devices,86.45,70,,86.45,percent of total billed charges,Implant Devices,83.98,34,,83.98,percent of total billed charges,Implant Devices,83.98,34,,83.98,percent of total billed charges,Implant Devices,86.45,35,,86.45,percent of total billed charges,Implant Devices,86.45,35,,86.45,percent of total billed charges,Implant Devices,86.45,35,,86.45,percent of total billed charges,Implant Devices,86.45,35,,86.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,98.8,
STRYKER 54-25290 DORSAL PLATE STD 60MM,C1713,HCPCS,,79004139,CDM,278,RC,,,both,,,2484,980.36,39.4668,,980.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,869.4,35,,869.4,percent of total billed charges,Implant Device,844.56,34,"Charges > $500, x 34%",844.56,percent of total billed charges,Implant Device,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,993.6,40,,993.6,percent of total billed charges,Implant Devices,869.4,70,,869.4,percent of total billed charges,Implant Devices,844.56,34,,844.56,percent of total billed charges,Implant Devices,844.56,34,,844.56,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,844.56,34,"If Charge > 2,000, then 34 percent",844.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,993.6,
STRYKER 57-10368 LOCKING PLATE 10 HOLE,C1713,HCPCS,,79004140,CDM,278,RC,,,both,,,1423,561.61,39.4668,,561.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,483.82,34,,483.82,percent of total billed charges,Implant Device,483.82,34,,483.82,percent of total billed charges,Implant Device,483.82,34,,483.82,percent of total billed charges,Implant Device,483.82,34,,483.82,percent of total billed charges,Implant Device,483.82,34,,483.82,percent of total billed charges,Implant Device,483.82,34,,483.82,percent of total billed charges,Implant Device,498.05,35,,498.05,percent of total billed charges,Implant Device,483.82,34,"Charges > $500, x 34%",483.82,percent of total billed charges,Implant Device,498.05,35,,498.05,percent of total billed charges,Implant Devices,498.05,35,,498.05,percent of total billed charges,Implant Devices,498.05,35,,,percent of total billed charges,Implant Devices,498.05,35,,498.05,percent of total billed charges,Implant Devices,498.05,35,,498.05,percent of total billed charges,Implant Devices,569.2,40,,569.2,percent of total billed charges,Implant Devices,498.05,70,,498.05,percent of total billed charges,Implant Devices,483.82,34,,483.82,percent of total billed charges,Implant Devices,483.82,34,,483.82,percent of total billed charges,Implant Devices,498.05,35,,498.05,percent of total billed charges,Implant Devices,498.05,35,,498.05,percent of total billed charges,Implant Devices,498.05,35,,498.05,percent of total billed charges,Implant Devices,498.05,35,,498.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,569.2,
STRYKER 371348 LOCKING SCREW 5X48MM,C1713,HCPCS,,79004141,CDM,278,RC,,,both,,,523,206.41,39.4668,,206.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Device,177.82,34,"Charges > $500, x 34%",177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,209.2,40,,209.2,percent of total billed charges,Implant Devices,183.05,70,,183.05,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.2,
STRYKER 2030-6525-1 BONE SCREW 65X25MM,C1713,HCPCS,,79004142,CDM,278,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,154,35,,154,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,176,40,,176,percent of total billed charges,Implant Devices,154,70,,154,percent of total billed charges,Implant Devices,149.6,34,,149.6,percent of total billed charges,Implant Devices,149.6,34,,149.6,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,176,
STRYKER 1851-1340S FEMORAL NAIL 13X400MM,C1713,HCPCS,,79004143,CDM,278,RC,,,both,,,6768,2671.11,39.4668,,2671.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2301.12,34,,2301.12,percent of total billed charges,Implant Device,2301.12,34,,2301.12,percent of total billed charges,Implant Device,2301.12,34,,2301.12,percent of total billed charges,Implant Device,2301.12,34,,2301.12,percent of total billed charges,Implant Device,2301.12,34,,2301.12,percent of total billed charges,Implant Device,2301.12,34,,2301.12,percent of total billed charges,Implant Device,2368.8,35,,2368.8,percent of total billed charges,Implant Device,2301.12,34,"Charges > $500, x 34%",2301.12,percent of total billed charges,Implant Device,2368.8,35,,2368.8,percent of total billed charges,Implant Devices,2368.8,35,,2368.8,percent of total billed charges,Implant Devices,2368.8,35,,,percent of total billed charges,Implant Devices,2368.8,35,,2368.8,percent of total billed charges,Implant Devices,2368.8,35,,2368.8,percent of total billed charges,Implant Devices,2707.2,40,,2707.2,percent of total billed charges,Implant Devices,2368.8,70,,2368.8,percent of total billed charges,Implant Devices,2301.12,34,,2301.12,percent of total billed charges,Implant Devices,2301.12,34,,2301.12,percent of total billed charges,Implant Devices,2368.8,35,,2368.8,percent of total billed charges,Implant Devices,2368.8,35,,2368.8,percent of total billed charges,Implant Devices,2368.8,35,,2368.8,percent of total billed charges,Implant Devices,2368.8,35,,2368.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2301.12,34,"If Charge > 2,000, then 34 percent",2301.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2707.2,
STRYKER 1832-3826S HUMERL NAIL 8CMX260MM,C1713,HCPCS,,79004144,CDM,278,RC,,,both,,,5934,2341.96,39.4668,,2341.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2017.56,34,,2017.56,percent of total billed charges,Implant Device,2017.56,34,,2017.56,percent of total billed charges,Implant Device,2017.56,34,,2017.56,percent of total billed charges,Implant Device,2017.56,34,,2017.56,percent of total billed charges,Implant Device,2017.56,34,,2017.56,percent of total billed charges,Implant Device,2017.56,34,,2017.56,percent of total billed charges,Implant Device,2076.9,35,,2076.9,percent of total billed charges,Implant Device,2017.56,34,"Charges > $500, x 34%",2017.56,percent of total billed charges,Implant Device,2076.9,35,,2076.9,percent of total billed charges,Implant Devices,2076.9,35,,2076.9,percent of total billed charges,Implant Devices,2076.9,35,,,percent of total billed charges,Implant Devices,2076.9,35,,2076.9,percent of total billed charges,Implant Devices,2076.9,35,,2076.9,percent of total billed charges,Implant Devices,2373.6,40,,2373.6,percent of total billed charges,Implant Devices,2076.9,70,,2076.9,percent of total billed charges,Implant Devices,2017.56,34,,2017.56,percent of total billed charges,Implant Devices,2017.56,34,,2017.56,percent of total billed charges,Implant Devices,2076.9,35,,2076.9,percent of total billed charges,Implant Devices,2076.9,35,,2076.9,percent of total billed charges,Implant Devices,2076.9,35,,2076.9,percent of total billed charges,Implant Devices,2076.9,35,,2076.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2017.56,34,"If Charge > 2,000, then 34 percent",2017.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2373.6,
STRYKER 342095 CANCELLOUS SCREW 6.5X95MM,C1713,HCPCS,,79004147,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 57-05297 STD PLATES 2X2+2 1.7MM,C1713,HCPCS,,79004148,CDM,278,RC,,,both,,,1129,445.58,39.4668,,445.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,383.86,34,,383.86,percent of total billed charges,Implant Device,383.86,34,,383.86,percent of total billed charges,Implant Device,383.86,34,,383.86,percent of total billed charges,Implant Device,383.86,34,,383.86,percent of total billed charges,Implant Device,383.86,34,,383.86,percent of total billed charges,Implant Device,383.86,34,,383.86,percent of total billed charges,Implant Device,395.15,35,,395.15,percent of total billed charges,Implant Device,383.86,34,"Charges > $500, x 34%",383.86,percent of total billed charges,Implant Device,395.15,35,,395.15,percent of total billed charges,Implant Devices,395.15,35,,395.15,percent of total billed charges,Implant Devices,395.15,35,,,percent of total billed charges,Implant Devices,395.15,35,,395.15,percent of total billed charges,Implant Devices,395.15,35,,395.15,percent of total billed charges,Implant Devices,451.6,40,,451.6,percent of total billed charges,Implant Devices,395.15,70,,395.15,percent of total billed charges,Implant Devices,383.86,34,,383.86,percent of total billed charges,Implant Devices,383.86,34,,383.86,percent of total billed charges,Implant Devices,395.15,35,,395.15,percent of total billed charges,Implant Devices,395.15,35,,395.15,percent of total billed charges,Implant Devices,395.15,35,,395.15,percent of total billed charges,Implant Devices,395.15,35,,395.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,451.6,
STRYKER 3325-0380S LONG NAIL KIT TI LEFT,C1713,HCPCS,,79004149,CDM,278,RC,,,both,,,6268,2473.78,39.4668,,2473.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2131.12,34,,2131.12,percent of total billed charges,Implant Device,2193.8,35,,2193.8,percent of total billed charges,Implant Device,2131.12,34,"Charges > $500, x 34%",2131.12,percent of total billed charges,Implant Device,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2507.2,40,,2507.2,percent of total billed charges,Implant Devices,2193.8,70,,2193.8,percent of total billed charges,Implant Devices,2131.12,34,,2131.12,percent of total billed charges,Implant Devices,2131.12,34,,2131.12,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,2193.8,35,,2193.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2131.12,34,"If Charge > 2,000, then 34 percent",2131.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2507.2,
STRYKER 53-23013E LOCKING SCREW 2.3X13MM,C1713,HCPCS,,79004150,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
STRYKER 59-17009 NONLOCK SCREW 1.7X9MM,C1713,HCPCS,,79004151,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
STRYKER 371390 LOCKING SCREW 5X90MM,C1713,HCPCS,,79004152,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 430204 TUBULAR PLATE 1/3 4 HOLE,C1713,HCPCS,,79004153,CDM,278,RC,,,both,,,181,71.43,39.4668,,71.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.54,34,,61.54,percent of total billed charges,Implant Device,61.54,34,,61.54,percent of total billed charges,Implant Device,61.54,34,,61.54,percent of total billed charges,Implant Device,61.54,34,,61.54,percent of total billed charges,Implant Device,61.54,34,,61.54,percent of total billed charges,Implant Device,61.54,34,,61.54,percent of total billed charges,Implant Device,63.35,35,,63.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63.35,35,,63.35,percent of total billed charges,Implant Devices,63.35,35,,63.35,percent of total billed charges,Implant Devices,63.35,35,,,percent of total billed charges,Implant Devices,63.35,35,,63.35,percent of total billed charges,Implant Devices,63.35,35,,63.35,percent of total billed charges,Implant Devices,72.4,40,,72.4,percent of total billed charges,Implant Devices,63.35,70,,63.35,percent of total billed charges,Implant Devices,61.54,34,,61.54,percent of total billed charges,Implant Devices,61.54,34,,61.54,percent of total billed charges,Implant Devices,63.35,35,,63.35,percent of total billed charges,Implant Devices,63.35,35,,63.35,percent of total billed charges,Implant Devices,63.35,35,,63.35,percent of total billed charges,Implant Devices,63.35,35,,63.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72.4,
STRYKER 6942-7-065 C-TAPER NECK SLEEVE,C1713,HCPCS,,79004154,CDM,278,RC,,,both,,,667,263.24,39.4668,,263.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Device,226.78,34,"Charges > $500, x 34%",226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,266.8,40,,266.8,percent of total billed charges,Implant Devices,233.45,70,,233.45,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.8,
STRYKER 1822-0937S TIBIAL NAIL 9X375MM,C1713,HCPCS,,79004155,CDM,278,RC,,,both,,,3193,1260.17,39.4668,,1260.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1085.62,34,,1085.62,percent of total billed charges,Implant Device,1085.62,34,,1085.62,percent of total billed charges,Implant Device,1085.62,34,,1085.62,percent of total billed charges,Implant Device,1085.62,34,,1085.62,percent of total billed charges,Implant Device,1085.62,34,,1085.62,percent of total billed charges,Implant Device,1085.62,34,,1085.62,percent of total billed charges,Implant Device,1117.55,35,,1117.55,percent of total billed charges,Implant Device,1085.62,34,"Charges > $500, x 34%",1085.62,percent of total billed charges,Implant Device,1117.55,35,,1117.55,percent of total billed charges,Implant Devices,1117.55,35,,1117.55,percent of total billed charges,Implant Devices,1117.55,35,,,percent of total billed charges,Implant Devices,1117.55,35,,1117.55,percent of total billed charges,Implant Devices,1117.55,35,,1117.55,percent of total billed charges,Implant Devices,1277.2,40,,1277.2,percent of total billed charges,Implant Devices,1117.55,70,,1117.55,percent of total billed charges,Implant Devices,1085.62,34,,1085.62,percent of total billed charges,Implant Devices,1085.62,34,,1085.62,percent of total billed charges,Implant Devices,1117.55,35,,1117.55,percent of total billed charges,Implant Devices,1117.55,35,,1117.55,percent of total billed charges,Implant Devices,1117.55,35,,1117.55,percent of total billed charges,Implant Devices,1117.55,35,,1117.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1085.62,34,"If Charge > 2,000, then 34 percent",1085.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1277.2,
STRYKER 3225-3380S LONG NAIL 13X380X125,C1713,HCPCS,,79004156,CDM,278,RC,,,both,,,7140,2817.93,39.4668,,2817.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2499,35,,2499,percent of total billed charges,Implant Device,2427.6,34,"Charges > $500, x 34%",2427.6,percent of total billed charges,Implant Device,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2856,40,,2856,percent of total billed charges,Implant Devices,2499,70,,2499,percent of total billed charges,Implant Devices,2427.6,34,,2427.6,percent of total billed charges,Implant Devices,2427.6,34,,2427.6,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2427.6,34,"If Charge > 2,000, then 34 percent",2427.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2856,
STRYKER 5317009E LOCKING SCREW 1.7X9MM,C1713,HCPCS,,79004157,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
STRYKER 5023-2-090 APEX PIN 4X90MM,C1713,HCPCS,,79004158,CDM,278,RC,,,both,,,392,154.71,39.4668,,154.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,156.8,40,,156.8,percent of total billed charges,Implant Devices,137.2,70,,137.2,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156.8,
STRYKER 3406-38 CORTICAL SCREW 4.5X38,C1713,HCPCS,,79004159,CDM,278,RC,,,both,,,84,33.15,39.4668,,33.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,33.6,40,,33.6,percent of total billed charges,Implant Devices,29.4,70,,29.4,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.6,
STRYKER 1236-2-848 X3 INSERTER SZ28/SZ42,C1713,HCPCS,,79004160,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 1067-00009 UNI DISTAL SPACER 9MM,C1713,HCPCS,,79004161,CDM,278,RC,,,both,,,341,134.58,39.4668,,134.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,119.35,35,,119.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,136.4,40,,136.4,percent of total billed charges,Implant Devices,119.35,70,,119.35,percent of total billed charges,Implant Devices,115.94,34,,115.94,percent of total billed charges,Implant Devices,115.94,34,,115.94,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,136.4,
STRYKER 1828-1132S FEMORAL NAIL 11X320,C1713,HCPCS,,79004162,CDM,278,RC,,,both,,,5959,2351.83,39.4668,,2351.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2026.06,34,,2026.06,percent of total billed charges,Implant Device,2026.06,34,,2026.06,percent of total billed charges,Implant Device,2026.06,34,,2026.06,percent of total billed charges,Implant Device,2026.06,34,,2026.06,percent of total billed charges,Implant Device,2026.06,34,,2026.06,percent of total billed charges,Implant Device,2026.06,34,,2026.06,percent of total billed charges,Implant Device,2085.65,35,,2085.65,percent of total billed charges,Implant Device,2026.06,34,"Charges > $500, x 34%",2026.06,percent of total billed charges,Implant Device,2085.65,35,,2085.65,percent of total billed charges,Implant Devices,2085.65,35,,2085.65,percent of total billed charges,Implant Devices,2085.65,35,,,percent of total billed charges,Implant Devices,2085.65,35,,2085.65,percent of total billed charges,Implant Devices,2085.65,35,,2085.65,percent of total billed charges,Implant Devices,2383.6,40,,2383.6,percent of total billed charges,Implant Devices,2085.65,70,,2085.65,percent of total billed charges,Implant Devices,2026.06,34,,2026.06,percent of total billed charges,Implant Devices,2026.06,34,,2026.06,percent of total billed charges,Implant Devices,2085.65,35,,2085.65,percent of total billed charges,Implant Devices,2085.65,35,,2085.65,percent of total billed charges,Implant Devices,2085.65,35,,2085.65,percent of total billed charges,Implant Devices,2085.65,35,,2085.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2026.06,34,"If Charge > 2,000, then 34 percent",2026.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2383.6,
STRYKER 1896-40-245 LOCKING SCREW 4X24MM,C1713,HCPCS,,79004163,CDM,278,RC,,,both,,,623,245.88,39.4668,,245.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,211.82,34,,211.82,percent of total billed charges,Implant Device,211.82,34,,211.82,percent of total billed charges,Implant Device,211.82,34,,211.82,percent of total billed charges,Implant Device,211.82,34,,211.82,percent of total billed charges,Implant Device,211.82,34,,211.82,percent of total billed charges,Implant Device,211.82,34,,211.82,percent of total billed charges,Implant Device,218.05,35,,218.05,percent of total billed charges,Implant Device,211.82,34,"Charges > $500, x 34%",211.82,percent of total billed charges,Implant Device,218.05,35,,218.05,percent of total billed charges,Implant Devices,218.05,35,,218.05,percent of total billed charges,Implant Devices,218.05,35,,,percent of total billed charges,Implant Devices,218.05,35,,218.05,percent of total billed charges,Implant Devices,218.05,35,,218.05,percent of total billed charges,Implant Devices,249.2,40,,249.2,percent of total billed charges,Implant Devices,218.05,70,,218.05,percent of total billed charges,Implant Devices,211.82,34,,211.82,percent of total billed charges,Implant Devices,211.82,34,,211.82,percent of total billed charges,Implant Devices,218.05,35,,218.05,percent of total billed charges,Implant Devices,218.05,35,,218.05,percent of total billed charges,Implant Devices,218.05,35,,218.05,percent of total billed charges,Implant Devices,218.05,35,,218.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,249.2,
STRYKER 1896-4045S LOCK SCREW 4X45MM,C1713,HCPCS,,79004164,CDM,278,RC,,,both,,,447,176.42,39.4668,,176.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,156.45,35,,156.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,178.8,40,,178.8,percent of total billed charges,Implant Devices,156.45,70,,156.45,percent of total billed charges,Implant Devices,151.98,34,,151.98,percent of total billed charges,Implant Devices,151.98,34,,151.98,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.8,
STRYKER 1896-4050S LOCK SCREW 4X50MM,C1713,HCPCS,,79004165,CDM,278,RC,,,both,,,405,159.84,39.4668,,159.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,141.75,35,,141.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,162,40,,162,percent of total billed charges,Implant Devices,141.75,70,,141.75,percent of total billed charges,Implant Devices,137.7,34,,137.7,percent of total billed charges,Implant Devices,137.7,34,,137.7,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,162,
STRYKER 1830-0927S HUMERAL NAIL 9X270MM,C1713,HCPCS,,79004166,CDM,278,RC,,,both,,,3157,1245.97,39.4668,,1245.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1073.38,34,,1073.38,percent of total billed charges,Implant Device,1073.38,34,,1073.38,percent of total billed charges,Implant Device,1073.38,34,,1073.38,percent of total billed charges,Implant Device,1073.38,34,,1073.38,percent of total billed charges,Implant Device,1073.38,34,,1073.38,percent of total billed charges,Implant Device,1073.38,34,,1073.38,percent of total billed charges,Implant Device,1104.95,35,,1104.95,percent of total billed charges,Implant Device,1073.38,34,"Charges > $500, x 34%",1073.38,percent of total billed charges,Implant Device,1104.95,35,,1104.95,percent of total billed charges,Implant Devices,1104.95,35,,1104.95,percent of total billed charges,Implant Devices,1104.95,35,,,percent of total billed charges,Implant Devices,1104.95,35,,1104.95,percent of total billed charges,Implant Devices,1104.95,35,,1104.95,percent of total billed charges,Implant Devices,1262.8,40,,1262.8,percent of total billed charges,Implant Devices,1104.95,70,,1104.95,percent of total billed charges,Implant Devices,1073.38,34,,1073.38,percent of total billed charges,Implant Devices,1073.38,34,,1073.38,percent of total billed charges,Implant Devices,1104.95,35,,1104.95,percent of total billed charges,Implant Devices,1104.95,35,,1104.95,percent of total billed charges,Implant Devices,1104.95,35,,1104.95,percent of total billed charges,Implant Devices,1104.95,35,,1104.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1073.38,34,"If Charge > 2,000, then 34 percent",1073.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1262.8,
STRYKER 3060-0125S LAG SCREW 10.5X125MM,C1713,HCPCS,,79004168,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
STRYKER 40-35620 LOCK SCREW 3.5X20MM,C1713,HCPCS,,79004169,CDM,278,RC,,,both,,,696,274.69,39.4668,,274.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Device,236.64,34,"Charges > $500, x 34%",236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,278.4,40,,278.4,percent of total billed charges,Implant Devices,243.6,70,,243.6,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,278.4,
STRYKER 370334 LOCKING SCREW 5X34MM,C1713,HCPCS,,79004170,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
STRYKER 3713-42 LOCKING SCREW 5X42,C1713,HCPCS,,79004172,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 3713-14 CORTICAL SCREW 5X14,C1713,HCPCS,,79004173,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 345412 CANN FT SCREW 4X12MM,C1713,HCPCS,,79004174,CDM,278,RC,,,both,,,74,29.21,39.4668,,29.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,29.6,40,,29.6,percent of total billed charges,Implant Devices,25.9,70,,25.9,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,29.6,
STRYKER 3425-0380S LONG NAIL R1 5 TI R,C1713,HCPCS,,79004175,CDM,278,RC,,,both,,,8249,3255.62,39.4668,,3255.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2804.66,34,,2804.66,percent of total billed charges,Implant Device,2804.66,34,,2804.66,percent of total billed charges,Implant Device,2804.66,34,,2804.66,percent of total billed charges,Implant Device,2804.66,34,,2804.66,percent of total billed charges,Implant Device,2804.66,34,,2804.66,percent of total billed charges,Implant Device,2804.66,34,,2804.66,percent of total billed charges,Implant Device,2887.15,35,,2887.15,percent of total billed charges,Implant Device,2804.66,34,"Charges > $500, x 34%",2804.66,percent of total billed charges,Implant Device,2887.15,35,,2887.15,percent of total billed charges,Implant Devices,2887.15,35,,2887.15,percent of total billed charges,Implant Devices,2887.15,35,,,percent of total billed charges,Implant Devices,2887.15,35,,2887.15,percent of total billed charges,Implant Devices,2887.15,35,,2887.15,percent of total billed charges,Implant Devices,3299.6,40,,3299.6,percent of total billed charges,Implant Devices,2887.15,70,,2887.15,percent of total billed charges,Implant Devices,2804.66,34,,2804.66,percent of total billed charges,Implant Devices,2804.66,34,,2804.66,percent of total billed charges,Implant Devices,2887.15,35,,2887.15,percent of total billed charges,Implant Devices,2887.15,35,,2887.15,percent of total billed charges,Implant Devices,2887.15,35,,2887.15,percent of total billed charges,Implant Devices,2887.15,35,,2887.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2804.66,34,"If Charge > 2,000, then 34 percent",2804.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3299.6,
STRYKER 604660S ASNIS CANN SCREW 4X60MM,C1713,HCPCS,,79004178,CDM,278,RC,,,both,,,734,289.69,39.4668,,289.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,256.9,35,,256.9,percent of total billed charges,Implant Device,249.56,34,"Charges > $500, x 34%",249.56,percent of total billed charges,Implant Device,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,293.6,40,,293.6,percent of total billed charges,Implant Devices,256.9,70,,256.9,percent of total billed charges,Implant Devices,249.56,34,,249.56,percent of total billed charges,Implant Devices,249.56,34,,249.56,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,293.6,
STRYKER 371340 LOCKING SCREW 5X40MM,C1713,HCPCS,,79004180,CDM,278,RC,,,both,,,451,178,39.4668,,178,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,157.85,35,,157.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,180.4,40,,180.4,percent of total billed charges,Implant Devices,157.85,70,,157.85,percent of total billed charges,Implant Devices,153.34,34,,153.34,percent of total billed charges,Implant Devices,153.34,34,,153.34,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180.4,
STRYKER 371520 LOCKING SCREW 4X20MM,C1713,HCPCS,,79004181,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 371360 LOCKING SCREW 5X60MM,C1713,HCPCS,,79004185,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 371555 CANN SCREW 4X38MM,C1713,HCPCS,,79004186,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 40-35634 LOCKING SCREW 3.5X34,C1713,HCPCS,,79004187,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER CNCF2525 NEUROFLEX  2.5X2.5MM,C1713,HCPCS,,79004188,CDM,278,RC,,,both,,,4394,1734.17,39.4668,,1734.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1537.9,35,,1537.9,percent of total billed charges,Implant Device,1493.96,34,"Charges > $500, x 34%",1493.96,percent of total billed charges,Implant Device,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1757.6,40,,1757.6,percent of total billed charges,Implant Devices,1537.9,70,,1537.9,percent of total billed charges,Implant Devices,1493.96,34,,1493.96,percent of total billed charges,Implant Devices,1493.96,34,,1493.96,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1493.96,34,"If Charge > 2,000, then 34 percent",1493.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1757.6,
STRYKER 371336 LOCKING SCREW 5X36,C1713,HCPCS,,79004189,CDM,278,RC,,,both,,,451,178,39.4668,,178,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,153.34,34,,153.34,percent of total billed charges,Implant Device,157.85,35,,157.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,180.4,40,,180.4,percent of total billed charges,Implant Devices,157.85,70,,157.85,percent of total billed charges,Implant Devices,153.34,34,,153.34,percent of total billed charges,Implant Devices,153.34,34,,153.34,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,157.85,35,,157.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180.4,
STRYKER 343090 CANC SCREW 6.5X90,C1713,HCPCS,,79004190,CDM,278,RC,,,both,,,113,44.6,39.4668,,44.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,45.2,40,,45.2,percent of total billed charges,Implant Devices,39.55,70,,39.55,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.2,
STRYKER 342090 PT CAN SCREW 6.5X90MM,C1713,HCPCS,,79004192,CDM,278,RC,,,both,,,127,50.12,39.4668,,50.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,43.18,34,,43.18,percent of total billed charges,Implant Device,43.18,34,,43.18,percent of total billed charges,Implant Device,43.18,34,,43.18,percent of total billed charges,Implant Device,43.18,34,,43.18,percent of total billed charges,Implant Device,43.18,34,,43.18,percent of total billed charges,Implant Device,43.18,34,,43.18,percent of total billed charges,Implant Device,44.45,35,,44.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,50.8,40,,50.8,percent of total billed charges,Implant Devices,44.45,70,,44.45,percent of total billed charges,Implant Devices,43.18,34,,43.18,percent of total billed charges,Implant Devices,43.18,34,,43.18,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,44.45,35,,44.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50.8,
STRYKER 342085 CANCELLOUS SCREW 6.5X85MM,C1713,HCPCS,,79004193,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 371385 LOCKING SCREW 5X85MM,C1713,HCPCS,,79004194,CDM,278,RC,,,both,,,576,227.33,39.4668,,227.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Device,195.84,34,"Charges > $500, x 34%",195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,230.4,40,,230.4,percent of total billed charges,Implant Devices,201.6,70,,201.6,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.4,
STRYKER 345536 CANN SCREW 4.0MM,C1713,HCPCS,,79004195,CDM,278,RC,,,both,,,74,29.21,39.4668,,29.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,29.6,40,,29.6,percent of total billed charges,Implant Devices,25.9,70,,25.9,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,29.6,
STRYKER 3225-5460S LONG NAIL 15X460MM,C1713,HCPCS,,79004196,CDM,278,RC,,,both,,,6671,2632.83,39.4668,,2632.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2268.14,34,,2268.14,percent of total billed charges,Implant Device,2268.14,34,,2268.14,percent of total billed charges,Implant Device,2268.14,34,,2268.14,percent of total billed charges,Implant Device,2268.14,34,,2268.14,percent of total billed charges,Implant Device,2268.14,34,,2268.14,percent of total billed charges,Implant Device,2268.14,34,,2268.14,percent of total billed charges,Implant Device,2334.85,35,,2334.85,percent of total billed charges,Implant Device,2268.14,34,"Charges > $500, x 34%",2268.14,percent of total billed charges,Implant Device,2334.85,35,,2334.85,percent of total billed charges,Implant Devices,2334.85,35,,2334.85,percent of total billed charges,Implant Devices,2334.85,35,,,percent of total billed charges,Implant Devices,2334.85,35,,2334.85,percent of total billed charges,Implant Devices,2334.85,35,,2334.85,percent of total billed charges,Implant Devices,2668.4,40,,2668.4,percent of total billed charges,Implant Devices,2334.85,70,,2334.85,percent of total billed charges,Implant Devices,2268.14,34,,2268.14,percent of total billed charges,Implant Devices,2268.14,34,,2268.14,percent of total billed charges,Implant Devices,2334.85,35,,2334.85,percent of total billed charges,Implant Devices,2334.85,35,,2334.85,percent of total billed charges,Implant Devices,2334.85,35,,2334.85,percent of total billed charges,Implant Devices,2334.85,35,,2334.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2268.14,34,"If Charge > 2,000, then 34 percent",2268.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2668.4,
STRYKER 371380 LOCKING SCREW 5X80MM,C1713,HCPCS,,79004197,CDM,278,RC,,,both,,,576,227.33,39.4668,,227.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Device,195.84,34,"Charges > $500, x 34%",195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,230.4,40,,230.4,percent of total billed charges,Implant Devices,201.6,70,,201.6,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.4,
STRYKER 40-35636 LOCKING SCREW 3.5X36,C1713,HCPCS,,79004198,CDM,278,RC,,,both,,,732,288.9,39.4668,,288.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Device,248.88,34,"Charges > $500, x 34%",248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,292.8,40,,292.8,percent of total billed charges,Implant Devices,256.2,70,,256.2,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,292.8,
STRYKER 57-15379 Z PLATE 13 HOLE,C1713,HCPCS,,79004201,CDM,278,RC,,,both,,,2290,903.79,39.4668,,903.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,778.6,34,,778.6,percent of total billed charges,Implant Device,778.6,34,,778.6,percent of total billed charges,Implant Device,778.6,34,,778.6,percent of total billed charges,Implant Device,778.6,34,,778.6,percent of total billed charges,Implant Device,778.6,34,,778.6,percent of total billed charges,Implant Device,778.6,34,,778.6,percent of total billed charges,Implant Device,801.5,35,,801.5,percent of total billed charges,Implant Device,778.6,34,"Charges > $500, x 34%",778.6,percent of total billed charges,Implant Device,801.5,35,,801.5,percent of total billed charges,Implant Devices,801.5,35,,801.5,percent of total billed charges,Implant Devices,801.5,35,,,percent of total billed charges,Implant Devices,801.5,35,,801.5,percent of total billed charges,Implant Devices,801.5,35,,801.5,percent of total billed charges,Implant Devices,916,40,,916,percent of total billed charges,Implant Devices,801.5,70,,801.5,percent of total billed charges,Implant Devices,778.6,34,,778.6,percent of total billed charges,Implant Devices,778.6,34,,778.6,percent of total billed charges,Implant Devices,801.5,35,,801.5,percent of total billed charges,Implant Devices,801.5,35,,801.5,percent of total billed charges,Implant Devices,801.5,35,,801.5,percent of total billed charges,Implant Devices,801.5,35,,801.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,778.6,34,"If Charge > 2,000, then 34 percent",778.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,916,
STRYKER 57-15316 PLATE 2.3 16 HOLE,C1713,HCPCS,,79004203,CDM,278,RC,,,both,,,2045,807.1,39.4668,,807.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,695.3,34,,695.3,percent of total billed charges,Implant Device,695.3,34,,695.3,percent of total billed charges,Implant Device,695.3,34,,695.3,percent of total billed charges,Implant Device,695.3,34,,695.3,percent of total billed charges,Implant Device,695.3,34,,695.3,percent of total billed charges,Implant Device,695.3,34,,695.3,percent of total billed charges,Implant Device,715.75,35,,715.75,percent of total billed charges,Implant Device,695.3,34,"Charges > $500, x 34%",695.3,percent of total billed charges,Implant Device,715.75,35,,715.75,percent of total billed charges,Implant Devices,715.75,35,,715.75,percent of total billed charges,Implant Devices,715.75,35,,,percent of total billed charges,Implant Devices,715.75,35,,715.75,percent of total billed charges,Implant Devices,715.75,35,,715.75,percent of total billed charges,Implant Devices,818,40,,818,percent of total billed charges,Implant Devices,715.75,70,,715.75,percent of total billed charges,Implant Devices,695.3,34,,695.3,percent of total billed charges,Implant Devices,695.3,34,,695.3,percent of total billed charges,Implant Devices,715.75,35,,715.75,percent of total billed charges,Implant Devices,715.75,35,,715.75,percent of total billed charges,Implant Devices,715.75,35,,715.75,percent of total billed charges,Implant Devices,715.75,35,,715.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,695.3,34,"If Charge > 2,000, then 34 percent",695.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,818,
SYNTHES 207.734 34 LONG CANNULATED SCREW,C1713,HCPCS,,79004205,CDM,278,RC,,,both,,,685,270.35,39.4668,,270.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Device,232.9,34,"Charges > $500, x 34%",232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,274,40,,274,percent of total billed charges,Implant Devices,239.75,70,,239.75,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274,
SYNTHES 239.985S PROXIMAL MED PLATE 4.5,C1713,HCPCS,,79004207,CDM,278,RC,,,both,,,4669,1842.7,39.4668,,1842.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1587.46,34,,1587.46,percent of total billed charges,Implant Device,1587.46,34,,1587.46,percent of total billed charges,Implant Device,1587.46,34,,1587.46,percent of total billed charges,Implant Device,1587.46,34,,1587.46,percent of total billed charges,Implant Device,1587.46,34,,1587.46,percent of total billed charges,Implant Device,1587.46,34,,1587.46,percent of total billed charges,Implant Device,1634.15,35,,1634.15,percent of total billed charges,Implant Device,1587.46,34,"Charges > $500, x 34%",1587.46,percent of total billed charges,Implant Device,1634.15,35,,1634.15,percent of total billed charges,Implant Devices,1634.15,35,,1634.15,percent of total billed charges,Implant Devices,1634.15,35,,,percent of total billed charges,Implant Devices,1634.15,35,,1634.15,percent of total billed charges,Implant Devices,1634.15,35,,1634.15,percent of total billed charges,Implant Devices,1867.6,40,,1867.6,percent of total billed charges,Implant Devices,1634.15,70,,1634.15,percent of total billed charges,Implant Devices,1587.46,34,,1587.46,percent of total billed charges,Implant Devices,1587.46,34,,1587.46,percent of total billed charges,Implant Devices,1634.15,35,,1634.15,percent of total billed charges,Implant Devices,1634.15,35,,1634.15,percent of total billed charges,Implant Devices,1634.15,35,,1634.15,percent of total billed charges,Implant Devices,1634.15,35,,1634.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1587.46,34,"If Charge > 2,000, then 34 percent",1587.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1867.6,
WRIGHT 24920018 CORTICAL SCREW 2.7X18MM,C1713,HCPCS,,79004217,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
WRIGHT 49110424 CANCELLOUS SCREW 2X24MM,C1713,HCPCS,,79004218,CDM,278,RC,,,both,,,658,259.69,39.4668,,259.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,223.72,34,,223.72,percent of total billed charges,Implant Device,223.72,34,,223.72,percent of total billed charges,Implant Device,223.72,34,,223.72,percent of total billed charges,Implant Device,223.72,34,,223.72,percent of total billed charges,Implant Device,223.72,34,,223.72,percent of total billed charges,Implant Device,223.72,34,,223.72,percent of total billed charges,Implant Device,230.3,35,,230.3,percent of total billed charges,Implant Device,223.72,34,"Charges > $500, x 34%",223.72,percent of total billed charges,Implant Device,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,263.2,40,,263.2,percent of total billed charges,Implant Devices,230.3,70,,230.3,percent of total billed charges,Implant Devices,223.72,34,,223.72,percent of total billed charges,Implant Devices,223.72,34,,223.72,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,263.2,
WRIGHT 44110040 COMP SCREW 4.3X50MM,C1713,HCPCS,,79004219,CDM,278,RC,,,both,,,1192,470.44,39.4668,,470.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,405.28,34,,405.28,percent of total billed charges,Implant Device,405.28,34,,405.28,percent of total billed charges,Implant Device,405.28,34,,405.28,percent of total billed charges,Implant Device,405.28,34,,405.28,percent of total billed charges,Implant Device,405.28,34,,405.28,percent of total billed charges,Implant Device,405.28,34,,405.28,percent of total billed charges,Implant Device,417.2,35,,417.2,percent of total billed charges,Implant Device,405.28,34,"Charges > $500, x 34%",405.28,percent of total billed charges,Implant Device,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,476.8,40,,476.8,percent of total billed charges,Implant Devices,417.2,70,,417.2,percent of total billed charges,Implant Devices,405.28,34,,405.28,percent of total billed charges,Implant Devices,405.28,34,,405.28,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,417.2,35,,417.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,476.8,
WRIGHT DC2820124 SCREW 3.5X24MM,C1713,HCPCS,,79004220,CDM,278,RC,,,both,,,654,258.11,39.4668,,258.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Device,222.36,34,"Charges > $500, x 34%",222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,261.6,40,,261.6,percent of total billed charges,Implant Devices,228.9,70,,228.9,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,261.6,
WRIGHT 441770116 HEADLESS SCREW 7.0X70MM,C1713,HCPCS,,79004221,CDM,278,RC,,,both,,,3202,1263.73,39.4668,,1263.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1088.68,34,,1088.68,percent of total billed charges,Implant Device,1088.68,34,,1088.68,percent of total billed charges,Implant Device,1088.68,34,,1088.68,percent of total billed charges,Implant Device,1088.68,34,,1088.68,percent of total billed charges,Implant Device,1088.68,34,,1088.68,percent of total billed charges,Implant Device,1088.68,34,,1088.68,percent of total billed charges,Implant Device,1120.7,35,,1120.7,percent of total billed charges,Implant Device,1088.68,34,"Charges > $500, x 34%",1088.68,percent of total billed charges,Implant Device,1120.7,35,,1120.7,percent of total billed charges,Implant Devices,1120.7,35,,1120.7,percent of total billed charges,Implant Devices,1120.7,35,,,percent of total billed charges,Implant Devices,1120.7,35,,1120.7,percent of total billed charges,Implant Devices,1120.7,35,,1120.7,percent of total billed charges,Implant Devices,1280.8,40,,1280.8,percent of total billed charges,Implant Devices,1120.7,70,,1120.7,percent of total billed charges,Implant Devices,1088.68,34,,1088.68,percent of total billed charges,Implant Devices,1088.68,34,,1088.68,percent of total billed charges,Implant Devices,1120.7,35,,1120.7,percent of total billed charges,Implant Devices,1120.7,35,,1120.7,percent of total billed charges,Implant Devices,1120.7,35,,1120.7,percent of total billed charges,Implant Devices,1120.7,35,,1120.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1088.68,34,"If Charge > 2,000, then 34 percent",1088.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1280.8,
WRIGHT 86620006 ALLOPURE 6MM ALLOGRAFT,C1713,HCPCS,,79004222,CDM,278,RC,,,both,,,6150,2427.21,39.4668,,2427.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2091,34,,2091,percent of total billed charges,Implant Device,2091,34,,2091,percent of total billed charges,Implant Device,2091,34,,2091,percent of total billed charges,Implant Device,2091,34,,2091,percent of total billed charges,Implant Device,2091,34,,2091,percent of total billed charges,Implant Device,2091,34,,2091,percent of total billed charges,Implant Device,2152.5,35,,2152.5,percent of total billed charges,Implant Device,2091,34,"Charges > $500, x 34%",2091,percent of total billed charges,Implant Device,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2460,40,,2460,percent of total billed charges,Implant Devices,2152.5,70,,2152.5,percent of total billed charges,Implant Devices,2091,34,,2091,percent of total billed charges,Implant Devices,2091,34,,2091,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2091,34,"If Charge > 2,000, then 34 percent",2091,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2460,
WRIGHT 44110032 HEADLESS SCREW 4.3X50MM,C1713,HCPCS,,79004223,CDM,278,RC,,,both,,,1156,456.24,39.4668,,456.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,393.04,34,,393.04,percent of total billed charges,Implant Device,393.04,34,,393.04,percent of total billed charges,Implant Device,393.04,34,,393.04,percent of total billed charges,Implant Device,393.04,34,,393.04,percent of total billed charges,Implant Device,393.04,34,,393.04,percent of total billed charges,Implant Device,393.04,34,,393.04,percent of total billed charges,Implant Device,404.6,35,,404.6,percent of total billed charges,Implant Device,393.04,34,"Charges > $500, x 34%",393.04,percent of total billed charges,Implant Device,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,462.4,40,,462.4,percent of total billed charges,Implant Devices,404.6,70,,404.6,percent of total billed charges,Implant Devices,393.04,34,,393.04,percent of total billed charges,Implant Devices,393.04,34,,393.04,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,462.4,
WRIGHT 49105002 EVOLVE PLATE SIZE 2,C1713,HCPCS,,79004224,CDM,278,RC,,,both,,,4918,1940.98,39.4668,,1940.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1672.12,34,,1672.12,percent of total billed charges,Implant Device,1672.12,34,,1672.12,percent of total billed charges,Implant Device,1672.12,34,,1672.12,percent of total billed charges,Implant Device,1672.12,34,,1672.12,percent of total billed charges,Implant Device,1672.12,34,,1672.12,percent of total billed charges,Implant Device,1672.12,34,,1672.12,percent of total billed charges,Implant Device,1721.3,35,,1721.3,percent of total billed charges,Implant Device,1672.12,34,"Charges > $500, x 34%",1672.12,percent of total billed charges,Implant Device,1721.3,35,,1721.3,percent of total billed charges,Implant Devices,1721.3,35,,1721.3,percent of total billed charges,Implant Devices,1721.3,35,,,percent of total billed charges,Implant Devices,1721.3,35,,1721.3,percent of total billed charges,Implant Devices,1721.3,35,,1721.3,percent of total billed charges,Implant Devices,1967.2,40,,1967.2,percent of total billed charges,Implant Devices,1721.3,70,,1721.3,percent of total billed charges,Implant Devices,1672.12,34,,1672.12,percent of total billed charges,Implant Devices,1672.12,34,,1672.12,percent of total billed charges,Implant Devices,1721.3,35,,1721.3,percent of total billed charges,Implant Devices,1721.3,35,,1721.3,percent of total billed charges,Implant Devices,1721.3,35,,1721.3,percent of total billed charges,Implant Devices,1721.3,35,,1721.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1672.12,34,"If Charge > 2,000, then 34 percent",1672.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1967.2,
WRIGHT 40130025 CLAW 4H .25MM 35 PLATE,C1713,HCPCS,,79004225,CDM,278,RC,,,both,,,6588,2600.07,39.4668,,2600.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2305.8,35,,2305.8,percent of total billed charges,Implant Device,2239.92,34,"Charges > $500, x 34%",2239.92,percent of total billed charges,Implant Device,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2635.2,40,,2635.2,percent of total billed charges,Implant Devices,2305.8,70,,2305.8,percent of total billed charges,Implant Devices,2239.92,34,,2239.92,percent of total billed charges,Implant Devices,2239.92,34,,2239.92,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2239.92,34,"If Charge > 2,000, then 34 percent",2239.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2635.2,
WRIGHT DIN200145 DARTFIRE SCREW 2.0X14MM,C1713,HCPCS,,79004226,CDM,278,RC,,,both,,,634,250.22,39.4668,,250.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Device,215.56,34,"Charges > $500, x 34%",215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,253.6,40,,253.6,percent of total billed charges,Implant Devices,221.9,70,,221.9,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.6,
WRIGHT 49110426 CANC SCREW 2.0X26MM,C1713,HCPCS,,79004228,CDM,278,RC,,,both,,,658,259.69,39.4668,,259.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,223.72,34,,223.72,percent of total billed charges,Implant Device,223.72,34,,223.72,percent of total billed charges,Implant Device,223.72,34,,223.72,percent of total billed charges,Implant Device,223.72,34,,223.72,percent of total billed charges,Implant Device,223.72,34,,223.72,percent of total billed charges,Implant Device,223.72,34,,223.72,percent of total billed charges,Implant Device,230.3,35,,230.3,percent of total billed charges,Implant Device,223.72,34,"Charges > $500, x 34%",223.72,percent of total billed charges,Implant Device,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,263.2,40,,263.2,percent of total billed charges,Implant Devices,230.3,70,,230.3,percent of total billed charges,Implant Devices,223.72,34,,223.72,percent of total billed charges,Implant Devices,223.72,34,,223.72,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,230.3,35,,230.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,263.2,
WRIGHT 40133520 CLAW HEX SCREW 3.5X20MM,C1713,HCPCS,,79004229,CDM,278,RC,,,both,,,816,322.05,39.4668,,322.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,285.6,35,,285.6,percent of total billed charges,Implant Device,277.44,34,"Charges > $500, x 34%",277.44,percent of total billed charges,Implant Device,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,326.4,40,,326.4,percent of total billed charges,Implant Devices,285.6,70,,285.6,percent of total billed charges,Implant Devices,277.44,34,,277.44,percent of total billed charges,Implant Devices,277.44,34,,277.44,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,326.4,
WRIGHT 86660012 EVANS ALLOGRAFT 12X38MM,C1713,HCPCS,,79004231,CDM,278,RC,,,both,,,6556,2587.44,39.4668,,2587.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2229.04,34,,2229.04,percent of total billed charges,Implant Device,2229.04,34,,2229.04,percent of total billed charges,Implant Device,2229.04,34,,2229.04,percent of total billed charges,Implant Device,2229.04,34,,2229.04,percent of total billed charges,Implant Device,2229.04,34,,2229.04,percent of total billed charges,Implant Device,2229.04,34,,2229.04,percent of total billed charges,Implant Device,2294.6,35,,2294.6,percent of total billed charges,Implant Device,2229.04,34,"Charges > $500, x 34%",2229.04,percent of total billed charges,Implant Device,2294.6,35,,2294.6,percent of total billed charges,Implant Devices,2294.6,35,,2294.6,percent of total billed charges,Implant Devices,2294.6,35,,,percent of total billed charges,Implant Devices,2294.6,35,,2294.6,percent of total billed charges,Implant Devices,2294.6,35,,2294.6,percent of total billed charges,Implant Devices,2622.4,40,,2622.4,percent of total billed charges,Implant Devices,2294.6,70,,2294.6,percent of total billed charges,Implant Devices,2229.04,34,,2229.04,percent of total billed charges,Implant Devices,2229.04,34,,2229.04,percent of total billed charges,Implant Devices,2294.6,35,,2294.6,percent of total billed charges,Implant Devices,2294.6,35,,2294.6,percent of total billed charges,Implant Devices,2294.6,35,,2294.6,percent of total billed charges,Implant Devices,2294.6,35,,2294.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2229.04,34,"If Charge > 2,000, then 34 percent",2229.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2622.4,
WRIGHT 40133526 CLAW HEX SCREW 3.5X26MM,C1713,HCPCS,,79004233,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ZIMMER 00-2232-004-18 CBL RDY ASSY,C1713,HCPCS,,79004236,CDM,278,RC,,,both,,,1038,409.67,39.4668,,409.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,352.92,34,,352.92,percent of total billed charges,Implant Device,352.92,34,,352.92,percent of total billed charges,Implant Device,352.92,34,,352.92,percent of total billed charges,Implant Device,352.92,34,,352.92,percent of total billed charges,Implant Device,352.92,34,,352.92,percent of total billed charges,Implant Device,352.92,34,,352.92,percent of total billed charges,Implant Device,363.3,35,,363.3,percent of total billed charges,Implant Device,352.92,34,"Charges > $500, x 34%",352.92,percent of total billed charges,Implant Device,363.3,35,,363.3,percent of total billed charges,Implant Devices,363.3,35,,363.3,percent of total billed charges,Implant Devices,363.3,35,,,percent of total billed charges,Implant Devices,363.3,35,,363.3,percent of total billed charges,Implant Devices,363.3,35,,363.3,percent of total billed charges,Implant Devices,415.2,40,,415.2,percent of total billed charges,Implant Devices,363.3,70,,363.3,percent of total billed charges,Implant Devices,352.92,34,,352.92,percent of total billed charges,Implant Devices,352.92,34,,352.92,percent of total billed charges,Implant Devices,363.3,35,,363.3,percent of total billed charges,Implant Devices,363.3,35,,363.3,percent of total billed charges,Implant Devices,363.3,35,,363.3,percent of total billed charges,Implant Devices,363.3,35,,363.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,415.2,
ZIMMER 2253-040-55 INTRLOCK SCREW 5.5X40,C1713,HCPCS,,79004238,CDM,278,RC,,,both,,,654,258.11,39.4668,,258.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Device,222.36,34,"Charges > $500, x 34%",222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,261.6,40,,261.6,percent of total billed charges,Implant Devices,228.9,70,,228.9,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,261.6,
ZIMMER 6043636S ASNIS SCREW 4.0X36MM,C1713,HCPCS,,79004239,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
ZIMMER 00-2359-050-45 LCK SCREW 4.5X50MM,C1713,HCPCS,,79004240,CDM,278,RC,,,both,,,445,175.63,39.4668,,175.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,178,40,,178,percent of total billed charges,Implant Devices,155.75,70,,155.75,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178,
ZIMMER 00-2359-075-55 CANN SCREW 5.5X75,C1713,HCPCS,,79004241,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 1147-65-40 CANN SCREW 4.0X65MM,C1713,HCPCS,,79004242,CDM,278,RC,,,both,,,558,220.22,39.4668,,220.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Device,189.72,34,"Charges > $500, x 34%",189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,223.2,40,,223.2,percent of total billed charges,Implant Devices,195.3,70,,195.3,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.2,
ZIMMER 00-1147-095-45 CANN SCREW 4.5MM,C1713,HCPCS,,79004243,CDM,278,RC,,,both,,,589,232.46,39.4668,,232.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,200.26,34,,200.26,percent of total billed charges,Implant Device,200.26,34,,200.26,percent of total billed charges,Implant Device,200.26,34,,200.26,percent of total billed charges,Implant Device,200.26,34,,200.26,percent of total billed charges,Implant Device,200.26,34,,200.26,percent of total billed charges,Implant Device,200.26,34,,200.26,percent of total billed charges,Implant Device,206.15,35,,206.15,percent of total billed charges,Implant Device,200.26,34,"Charges > $500, x 34%",200.26,percent of total billed charges,Implant Device,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,235.6,40,,235.6,percent of total billed charges,Implant Devices,206.15,70,,206.15,percent of total billed charges,Implant Devices,200.26,34,,200.26,percent of total billed charges,Implant Devices,200.26,34,,200.26,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,235.6,
ZIMMER 00-2357-004-06 TIBIAL PLATE 3.5,C1713,HCPCS,,79004246,CDM,278,RC,,,both,,,4080,1610.25,39.4668,,1610.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1428,35,,1428,percent of total billed charges,Implant Device,1387.2,34,"Charges > $500, x 34%",1387.2,percent of total billed charges,Implant Device,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1632,40,,1632,percent of total billed charges,Implant Devices,1428,70,,1428,percent of total billed charges,Implant Devices,1387.2,34,,1387.2,percent of total billed charges,Implant Devices,1387.2,34,,1387.2,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1387.2,34,"If Charge > 2,000, then 34 percent",1387.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1632,
ZIMMER 2480-16-41 CANCELLOUS SCREW 4X16,C1713,HCPCS,,79004248,CDM,278,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,70,40,,70,percent of total billed charges,Implant Devices,61.25,70,,61.25,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
ZIMMER 4835-026-01 CORTICAL SCREW 26MM,C1713,HCPCS,,79004250,CDM,278,RC,,,both,,,144,56.83,39.4668,,56.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,50.4,35,,50.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,57.6,40,,57.6,percent of total billed charges,Implant Devices,50.4,70,,50.4,percent of total billed charges,Implant Devices,48.96,34,,48.96,percent of total billed charges,Implant Devices,48.96,34,,48.96,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,57.6,
ZIMMER 02.03155.028 CORT SCREW 4.0X28MM,C1713,HCPCS,,79004251,CDM,278,RC,,,both,,,443,174.84,39.4668,,174.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,177.2,40,,177.2,percent of total billed charges,Implant Devices,155.05,70,,155.05,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.2,
ZIMMER 02-03152-090 CANC SCREW 5.0X90MM,C1713,HCPCS,,79004252,CDM,278,RC,,,both,,,546,215.49,39.4668,,215.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Device,185.64,34,"Charges > $500, x 34%",185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,218.4,40,,218.4,percent of total billed charges,Implant Devices,191.1,70,,191.1,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
ZIMMER 00-2359-042-45 LCK SCREW 4.5X42MM,C1713,HCPCS,,79004254,CDM,278,RC,,,both,,,445,175.63,39.4668,,175.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,178,40,,178,percent of total billed charges,Implant Devices,155.75,70,,155.75,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178,
ZIMMER 02-03150-060 CORT SCREW 5.0X60MM,C1713,HCPCS,,79004255,CDM,278,RC,,,both,,,636,251.01,39.4668,,251.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Device,216.24,34,"Charges > $500, x 34%",216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,254.4,40,,254.4,percent of total billed charges,Implant Devices,222.6,70,,222.6,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,254.4,
ZIMMER 00-4828-018-02 LOCK SCREW 18MM,C1713,HCPCS,,79004256,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ZIMMER 7711-12-20 M/L FEM STEM 12/14,C1713,HCPCS,,79004257,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 00-7711-012-00 M/L FEM STEM 12.5,C1713,HCPCS,,79004258,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 00-4840-010-00 CANC SCREW 4X10MM,C1713,HCPCS,,79004259,CDM,278,RC,,,both,,,54,21.31,39.4668,,21.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.36,34,,18.36,percent of total billed charges,Implant Device,18.36,34,,18.36,percent of total billed charges,Implant Device,18.36,34,,18.36,percent of total billed charges,Implant Device,18.36,34,,18.36,percent of total billed charges,Implant Device,18.36,34,,18.36,percent of total billed charges,Implant Device,18.36,34,,18.36,percent of total billed charges,Implant Device,18.9,35,,18.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,21.6,40,,21.6,percent of total billed charges,Implant Devices,18.9,70,,18.9,percent of total billed charges,Implant Devices,18.36,34,,18.36,percent of total billed charges,Implant Devices,18.36,34,,18.36,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.6,
ZIMMER 2347-20-28 CORTSCREW 3.5X28MM,C1713,HCPCS,,79004260,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
ZIMMER 00-4824-014-01 CORT SCREW 14MM ST,C1713,HCPCS,,79004261,CDM,278,RC,,,both,,,65,25.65,39.4668,,25.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.75,35,,22.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,26,40,,26,percent of total billed charges,Implant Devices,22.75,70,,22.75,percent of total billed charges,Implant Devices,22.1,34,,22.1,percent of total billed charges,Implant Devices,22.1,34,,22.1,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,26,
ZIMMER 2480-34-40 CANC SCREW 4X34MM,C1713,HCPCS,,79004262,CDM,278,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,70,40,,70,percent of total billed charges,Implant Devices,61.25,70,,61.25,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
ZIMMER 00-2480-22-40 CANC SCREW 4X22MM,C1713,HCPCS,,79004263,CDM,278,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,70,40,,70,percent of total billed charges,Implant Devices,61.25,70,,61.25,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
ZIMMER 00-2357-018-06 DIST FIB PLATE 6H,C1713,HCPCS,,79004266,CDM,278,RC,,,both,,,2225,878.14,39.4668,,878.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,778.75,35,,778.75,percent of total billed charges,Implant Device,756.5,34,"Charges > $500, x 34%",756.5,percent of total billed charges,Implant Device,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,890,40,,890,percent of total billed charges,Implant Devices,778.75,70,,778.75,percent of total billed charges,Implant Devices,756.5,34,,756.5,percent of total billed charges,Implant Devices,756.5,34,,756.5,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,756.5,34,"If Charge > 2,000, then 34 percent",756.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,890,
ZIMMER 2359-55-56 CANN SCREW 5.5X55MM,C1713,HCPCS,,79004268,CDM,278,RC,,,both,,,560,221.01,39.4668,,221.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,196,35,,196,percent of total billed charges,Implant Device,190.4,34,"Charges > $500, x 34%",190.4,percent of total billed charges,Implant Device,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,224,40,,224,percent of total billed charges,Implant Devices,196,70,,196,percent of total billed charges,Implant Devices,190.4,34,,190.4,percent of total billed charges,Implant Devices,190.4,34,,190.4,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224,
ZIMMER 2359-36-45 LOCK SCREW 4.5X36MM,C1713,HCPCS,,79004270,CDM,278,RC,,,both,,,430,169.71,39.4668,,169.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,150.5,35,,150.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,172,40,,172,percent of total billed charges,Implant Devices,150.5,70,,150.5,percent of total billed charges,Implant Devices,146.2,34,,146.2,percent of total billed charges,Implant Devices,146.2,34,,146.2,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172,
ZIMMER 2348-014-35 ST SCREW 23.5X14MM,C1713,HCPCS,,79004271,CDM,278,RC,,,both,,,113,44.6,39.4668,,44.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,45.2,40,,45.2,percent of total billed charges,Implant Devices,39.55,70,,39.55,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.2,
ZIMMER 00-1147-096-00 WASHER CANN SCREWS,C1713,HCPCS,,79004272,CDM,278,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.72,34,,36.72,percent of total billed charges,Implant Device,36.72,34,,36.72,percent of total billed charges,Implant Device,36.72,34,,36.72,percent of total billed charges,Implant Device,36.72,34,,36.72,percent of total billed charges,Implant Device,36.72,34,,36.72,percent of total billed charges,Implant Device,36.72,34,,36.72,percent of total billed charges,Implant Device,37.8,35,,37.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,43.2,40,,43.2,percent of total billed charges,Implant Devices,37.8,70,,37.8,percent of total billed charges,Implant Devices,36.72,34,,36.72,percent of total billed charges,Implant Devices,36.72,34,,36.72,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.2,
ZIMMER 4936-007-03 7 HOLE PLATE 1/3 TUB,C1713,HCPCS,,79004273,CDM,278,RC,,,both,,,470,185.49,39.4668,,185.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.8,34,,159.8,percent of total billed charges,Implant Device,159.8,34,,159.8,percent of total billed charges,Implant Device,159.8,34,,159.8,percent of total billed charges,Implant Device,159.8,34,,159.8,percent of total billed charges,Implant Device,159.8,34,,159.8,percent of total billed charges,Implant Device,159.8,34,,159.8,percent of total billed charges,Implant Device,164.5,35,,164.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,164.5,35,,164.5,percent of total billed charges,Implant Devices,164.5,35,,164.5,percent of total billed charges,Implant Devices,164.5,35,,,percent of total billed charges,Implant Devices,164.5,35,,164.5,percent of total billed charges,Implant Devices,164.5,35,,164.5,percent of total billed charges,Implant Devices,188,40,,188,percent of total billed charges,Implant Devices,164.5,70,,164.5,percent of total billed charges,Implant Devices,159.8,34,,159.8,percent of total billed charges,Implant Devices,159.8,34,,159.8,percent of total billed charges,Implant Devices,164.5,35,,164.5,percent of total billed charges,Implant Devices,164.5,35,,164.5,percent of total billed charges,Implant Devices,164.5,35,,164.5,percent of total billed charges,Implant Devices,164.5,35,,164.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,188,
ZIMMER 6250-65-50 ST BONE SCREW 6.5X50MM,C1713,HCPCS,,79004274,CDM,278,RC,,,both,,,105,41.44,39.4668,,41.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,42,40,,42,percent of total billed charges,Implant Devices,36.75,70,,36.75,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42,
ZIMMER 00-2359-016-35 SCREW 3.5X16MM,C1713,HCPCS,,79004275,CDM,278,RC,,,both,,,310,122.35,39.4668,,122.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,108.5,35,,108.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,124,40,,124,percent of total billed charges,Implant Devices,108.5,70,,108.5,percent of total billed charges,Implant Devices,105.4,34,,105.4,percent of total billed charges,Implant Devices,105.4,34,,105.4,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124,
ZIMMER 00-1147-20-41 CANN SCREW 4.0 20MM,C1713,HCPCS,,79004276,CDM,278,RC,,,both,,,558,220.22,39.4668,,220.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Device,189.72,34,"Charges > $500, x 34%",189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,223.2,40,,223.2,percent of total billed charges,Implant Devices,195.3,70,,195.3,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.2,
ZIMMER 00-1147-018-40 CANN SCREW 4X18MM,C1713,HCPCS,,79004277,CDM,278,RC,,,both,,,560,221.01,39.4668,,221.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,196,35,,196,percent of total billed charges,Implant Device,190.4,34,"Charges > $500, x 34%",190.4,percent of total billed charges,Implant Device,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,224,40,,224,percent of total billed charges,Implant Devices,196,70,,196,percent of total billed charges,Implant Devices,190.4,34,,190.4,percent of total billed charges,Implant Devices,190.4,34,,190.4,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224,
ZIMMER 4840-022 CANC SCREW SM HEX 4X22MM,C1713,HCPCS,,79004279,CDM,278,RC,,,both,,,84,33.15,39.4668,,33.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,33.6,40,,33.6,percent of total billed charges,Implant Devices,29.4,70,,29.4,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.6,
ZIMMER 2359-34-45 LOCK SCREW 4.5X34MM,C1713,HCPCS,,79004280,CDM,278,RC,,,both,,,430,169.71,39.4668,,169.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,146.2,34,,146.2,percent of total billed charges,Implant Device,150.5,35,,150.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,172,40,,172,percent of total billed charges,Implant Devices,150.5,70,,150.5,percent of total billed charges,Implant Devices,146.2,34,,146.2,percent of total billed charges,Implant Devices,146.2,34,,146.2,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,150.5,35,,150.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172,
ZIMMER 02-03150-055 CORT SCREW 5.0X55MM,C1713,HCPCS,,79004281,CDM,278,RC,,,both,,,498,196.54,39.4668,,196.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,199.2,40,,199.2,percent of total billed charges,Implant Devices,174.3,70,,174.3,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.2,
ZIMMER 00-2359-055-45 LCK SCREW 4.5X55MM,C1713,HCPCS,,79004283,CDM,278,RC,,,both,,,386,152.34,39.4668,,152.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,131.24,34,,131.24,percent of total billed charges,Implant Device,131.24,34,,131.24,percent of total billed charges,Implant Device,131.24,34,,131.24,percent of total billed charges,Implant Device,131.24,34,,131.24,percent of total billed charges,Implant Device,131.24,34,,131.24,percent of total billed charges,Implant Device,131.24,34,,131.24,percent of total billed charges,Implant Device,135.1,35,,135.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,135.1,35,,135.1,percent of total billed charges,Implant Devices,135.1,35,,135.1,percent of total billed charges,Implant Devices,135.1,35,,,percent of total billed charges,Implant Devices,135.1,35,,135.1,percent of total billed charges,Implant Devices,135.1,35,,135.1,percent of total billed charges,Implant Devices,154.4,40,,154.4,percent of total billed charges,Implant Devices,135.1,70,,135.1,percent of total billed charges,Implant Devices,131.24,34,,131.24,percent of total billed charges,Implant Devices,131.24,34,,131.24,percent of total billed charges,Implant Devices,135.1,35,,135.1,percent of total billed charges,Implant Devices,135.1,35,,135.1,percent of total billed charges,Implant Devices,135.1,35,,135.1,percent of total billed charges,Implant Devices,135.1,35,,135.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,154.4,
ZIMMER 02-03150-075 CORT SCREW 5X75MM,C1713,HCPCS,,79004284,CDM,278,RC,,,both,,,498,196.54,39.4668,,196.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,199.2,40,,199.2,percent of total billed charges,Implant Devices,174.3,70,,174.3,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.2,
ZIMMER 2347-20-30 CORT SCREW 3.5X30MM,C1713,HCPCS,,79004285,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
ZIMMER 02-03510-034 CORT SCREW 5.0 X 34M,C1713,HCPCS,,79004286,CDM,278,RC,,,both,,,498,196.54,39.4668,,196.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,199.2,40,,199.2,percent of total billed charges,Implant Devices,174.3,70,,174.3,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.2,
ZIMMER 2480-26-40 CANC SCREW 4.0X26,C1713,HCPCS,,79004290,CDM,278,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,70,40,,70,percent of total billed charges,Implant Devices,61.25,70,,61.25,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
ZIMMER 00-4928-007-03 TUBE PLATE 7H 82MM,C1713,HCPCS,,79004292,CDM,278,RC,,,both,,,454,179.18,39.4668,,179.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,181.6,40,,181.6,percent of total billed charges,Implant Devices,158.9,70,,158.9,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.6,
ZIMMER 2347-23-26 4.5X26MM PERIART SCREW,C1713,HCPCS,,79004294,CDM,278,RC,,,both,,,97,38.28,39.4668,,38.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,38.8,40,,38.8,percent of total billed charges,Implant Devices,33.95,70,,33.95,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.8,
ZIMMER 00-4936-006-07 CMP PLT 6H 3.5X79,C1713,HCPCS,,79004296,CDM,278,RC,,,both,,,1182,466.5,39.4668,,466.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,401.88,34,,401.88,percent of total billed charges,Implant Device,401.88,34,,401.88,percent of total billed charges,Implant Device,401.88,34,,401.88,percent of total billed charges,Implant Device,401.88,34,,401.88,percent of total billed charges,Implant Device,401.88,34,,401.88,percent of total billed charges,Implant Device,401.88,34,,401.88,percent of total billed charges,Implant Device,413.7,35,,413.7,percent of total billed charges,Implant Device,401.88,34,"Charges > $500, x 34%",401.88,percent of total billed charges,Implant Device,413.7,35,,413.7,percent of total billed charges,Implant Devices,413.7,35,,413.7,percent of total billed charges,Implant Devices,413.7,35,,,percent of total billed charges,Implant Devices,413.7,35,,413.7,percent of total billed charges,Implant Devices,413.7,35,,413.7,percent of total billed charges,Implant Devices,472.8,40,,472.8,percent of total billed charges,Implant Devices,413.7,70,,413.7,percent of total billed charges,Implant Devices,401.88,34,,401.88,percent of total billed charges,Implant Devices,401.88,34,,401.88,percent of total billed charges,Implant Devices,413.7,35,,413.7,percent of total billed charges,Implant Devices,413.7,35,,413.7,percent of total billed charges,Implant Devices,413.7,35,,413.7,percent of total billed charges,Implant Devices,413.7,35,,413.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,472.8,
ZIMMER 00-4835-045-01 CORT SCREW 3.5X45,C1713,HCPCS,,79004299,CDM,278,RC,,,both,,,68,26.84,39.4668,,26.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.8,35,,23.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,27.2,40,,27.2,percent of total billed charges,Implant Devices,23.8,70,,23.8,percent of total billed charges,Implant Devices,23.12,34,,23.12,percent of total billed charges,Implant Devices,23.12,34,,23.12,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27.2,
ZIMMER 00-2348-016-35 SCREW 3.5MM X 16MM,C1713,HCPCS,,79004303,CDM,278,RC,,,both,,,116,45.78,39.4668,,45.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,40.6,35,,40.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,46.4,40,,46.4,percent of total billed charges,Implant Devices,40.6,70,,40.6,percent of total billed charges,Implant Devices,39.44,34,,39.44,percent of total billed charges,Implant Devices,39.44,34,,39.44,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.4,
ZIMMER 00-4828-014-02 SCREW 2.7X14MM,C1713,HCPCS,,79004304,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ZIMMER 604734S ASNIS CANN SCREW 34MM,C1713,HCPCS,,79004305,CDM,278,RC,,,both,,,535,211.15,39.4668,,211.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,187.25,35,,187.25,percent of total billed charges,Implant Device,181.9,34,"Charges > $500, x 34%",181.9,percent of total billed charges,Implant Device,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,214,40,,214,percent of total billed charges,Implant Devices,187.25,70,,187.25,percent of total billed charges,Implant Devices,181.9,34,,181.9,percent of total billed charges,Implant Devices,181.9,34,,181.9,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214,
ZIMMER 121339 CBL RDY CBL FOR PL 1.8X610,C1713,HCPCS,,79004306,CDM,278,RC,,,both,,,1026,404.93,39.4668,,404.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,348.84,34,,348.84,percent of total billed charges,Implant Device,348.84,34,,348.84,percent of total billed charges,Implant Device,348.84,34,,348.84,percent of total billed charges,Implant Device,348.84,34,,348.84,percent of total billed charges,Implant Device,348.84,34,,348.84,percent of total billed charges,Implant Device,348.84,34,,348.84,percent of total billed charges,Implant Device,359.1,35,,359.1,percent of total billed charges,Implant Device,348.84,34,"Charges > $500, x 34%",348.84,percent of total billed charges,Implant Device,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,410.4,40,,410.4,percent of total billed charges,Implant Devices,359.1,70,,359.1,percent of total billed charges,Implant Devices,348.84,34,,348.84,percent of total billed charges,Implant Devices,348.84,34,,348.84,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.4,
ZIMMER 2359-014-38 LOCK SCREW 3.5X2.7X14,C1713,HCPCS,,79004307,CDM,278,RC,,,both,,,313,123.53,39.4668,,123.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,109.55,35,,109.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,125.2,40,,125.2,percent of total billed charges,Implant Devices,109.55,70,,109.55,percent of total billed charges,Implant Devices,106.42,34,,106.42,percent of total billed charges,Implant Devices,106.42,34,,106.42,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,125.2,
ZIMMER 00-4828-020-02 LOCK SCREW 20MM,C1713,HCPCS,,79004309,CDM,278,RC,,,both,,,302,119.19,39.4668,,119.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102.68,34,,102.68,percent of total billed charges,Implant Device,102.68,34,,102.68,percent of total billed charges,Implant Device,102.68,34,,102.68,percent of total billed charges,Implant Device,102.68,34,,102.68,percent of total billed charges,Implant Device,102.68,34,,102.68,percent of total billed charges,Implant Device,102.68,34,,102.68,percent of total billed charges,Implant Device,105.7,35,,105.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,120.8,40,,120.8,percent of total billed charges,Implant Devices,105.7,70,,105.7,percent of total billed charges,Implant Devices,102.68,34,,102.68,percent of total billed charges,Implant Devices,102.68,34,,102.68,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120.8,
ZIMMER 00-4835-018-01 CORT SCREW 18MM,C1713,HCPCS,,79004310,CDM,278,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,28.8,40,,28.8,percent of total billed charges,Implant Devices,25.2,70,,25.2,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28.8,
ZIMMER 00-4835-010-01 CORT SCREW 10MM,C1713,HCPCS,,79004311,CDM,278,RC,,,both,,,71,28.02,39.4668,,28.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.85,35,,24.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,28.4,40,,28.4,percent of total billed charges,Implant Devices,24.85,70,,24.85,percent of total billed charges,Implant Devices,24.14,34,,24.14,percent of total billed charges,Implant Devices,24.14,34,,24.14,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28.4,
ZIMMER 00-2357-101-10 DIS LATERAL PL 10H,C1713,HCPCS,,79004312,CDM,278,RC,,,both,,,6030,2379.85,39.4668,,2379.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2050.2,34,,2050.2,percent of total billed charges,Implant Device,2050.2,34,,2050.2,percent of total billed charges,Implant Device,2050.2,34,,2050.2,percent of total billed charges,Implant Device,2050.2,34,,2050.2,percent of total billed charges,Implant Device,2050.2,34,,2050.2,percent of total billed charges,Implant Device,2050.2,34,,2050.2,percent of total billed charges,Implant Device,2110.5,35,,2110.5,percent of total billed charges,Implant Device,2050.2,34,"Charges > $500, x 34%",2050.2,percent of total billed charges,Implant Device,2110.5,35,,2110.5,percent of total billed charges,Implant Devices,2110.5,35,,2110.5,percent of total billed charges,Implant Devices,2110.5,35,,,percent of total billed charges,Implant Devices,2110.5,35,,2110.5,percent of total billed charges,Implant Devices,2110.5,35,,2110.5,percent of total billed charges,Implant Devices,2412,40,,2412,percent of total billed charges,Implant Devices,2110.5,70,,2110.5,percent of total billed charges,Implant Devices,2050.2,34,,2050.2,percent of total billed charges,Implant Devices,2050.2,34,,2050.2,percent of total billed charges,Implant Devices,2110.5,35,,2110.5,percent of total billed charges,Implant Devices,2110.5,35,,2110.5,percent of total billed charges,Implant Devices,2110.5,35,,2110.5,percent of total billed charges,Implant Devices,2110.5,35,,2110.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2050.2,34,"If Charge > 2,000, then 34 percent",2050.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2412,
ZIMMER 1147-46-40 SCREW 46MM,C1713,HCPCS,,79004313,CDM,278,RC,,,both,,,1121,442.42,39.4668,,442.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,381.14,34,,381.14,percent of total billed charges,Implant Device,381.14,34,,381.14,percent of total billed charges,Implant Device,381.14,34,,381.14,percent of total billed charges,Implant Device,381.14,34,,381.14,percent of total billed charges,Implant Device,381.14,34,,381.14,percent of total billed charges,Implant Device,381.14,34,,381.14,percent of total billed charges,Implant Device,392.35,35,,392.35,percent of total billed charges,Implant Device,381.14,34,"Charges > $500, x 34%",381.14,percent of total billed charges,Implant Device,392.35,35,,392.35,percent of total billed charges,Implant Devices,392.35,35,,392.35,percent of total billed charges,Implant Devices,392.35,35,,,percent of total billed charges,Implant Devices,392.35,35,,392.35,percent of total billed charges,Implant Devices,392.35,35,,392.35,percent of total billed charges,Implant Devices,448.4,40,,448.4,percent of total billed charges,Implant Devices,392.35,70,,392.35,percent of total billed charges,Implant Devices,381.14,34,,381.14,percent of total billed charges,Implant Devices,381.14,34,,381.14,percent of total billed charges,Implant Devices,392.35,35,,392.35,percent of total billed charges,Implant Devices,392.35,35,,392.35,percent of total billed charges,Implant Devices,392.35,35,,392.35,percent of total billed charges,Implant Devices,392.35,35,,392.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,448.4,
ZIMMER 00-2480-016-40 CANC SCREW 4 X16MM,C1713,HCPCS,,79004314,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ZIMMER 00-2359-014-35 SCREW 3.5X14MM,C1713,HCPCS,,79004315,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 00-2359-035-36 CANN SCREW 3.5X35,C1713,HCPCS,,79004316,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ZIMMER 00-2359-046-45 LCK SCREW 4.5X46MM,C1713,HCPCS,,79004318,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
ZIMMER 00-1147-040-41 CANN SCREW 40MM,C1713,HCPCS,,79004320,CDM,278,RC,,,both,,,574,226.54,39.4668,,226.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Device,195.16,34,"Charges > $500, x 34%",195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,229.6,40,,229.6,percent of total billed charges,Implant Devices,200.9,70,,200.9,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,229.6,
ZIMMER 223203-01 CBL READY BONE PLATE 6H,C1713,HCPCS,,79004322,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
ZIMMER 02-03152-085 CANC SCREW 5.0X85MM,C1713,HCPCS,,79004323,CDM,278,RC,,,both,,,546,215.49,39.4668,,215.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Device,185.64,34,"Charges > $500, x 34%",185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,218.4,40,,218.4,percent of total billed charges,Implant Devices,191.1,70,,191.1,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
ZIMMER 00-2348-018-35 SCREW 3.5X18MM,C1713,HCPCS,,79004324,CDM,278,RC,,,both,,,113,44.6,39.4668,,44.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,45.2,40,,45.2,percent of total billed charges,Implant Devices,39.55,70,,39.55,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.2,
ZIMMER 00-2348-014-35 SCREW 2.5X14MM,C1713,HCPCS,,79004325,CDM,278,RC,,,both,,,116,45.78,39.4668,,45.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,40.6,35,,40.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,46.4,40,,46.4,percent of total billed charges,Implant Devices,40.6,70,,40.6,percent of total billed charges,Implant Devices,39.44,34,,39.44,percent of total billed charges,Implant Devices,39.44,34,,39.44,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.4,
ZIMMER 2253-055-55 IM SCREW 5.5X55MM,C1713,HCPCS,,79004326,CDM,278,RC,,,both,,,654,258.11,39.4668,,258.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Device,222.36,34,"Charges > $500, x 34%",222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,261.6,40,,261.6,percent of total billed charges,Implant Devices,228.9,70,,228.9,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,261.6,
ZIMMER 1147-44-41 4X44MM CANN SCREW,C1713,HCPCS,,79004327,CDM,278,RC,,,both,,,5580,2202.25,39.4668,,2202.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1897.2,34,,1897.2,percent of total billed charges,Implant Device,1897.2,34,,1897.2,percent of total billed charges,Implant Device,1897.2,34,,1897.2,percent of total billed charges,Implant Device,1897.2,34,,1897.2,percent of total billed charges,Implant Device,1897.2,34,,1897.2,percent of total billed charges,Implant Device,1897.2,34,,1897.2,percent of total billed charges,Implant Device,1953,35,,1953,percent of total billed charges,Implant Device,1897.2,34,"Charges > $500, x 34%",1897.2,percent of total billed charges,Implant Device,1953,35,,1953,percent of total billed charges,Implant Devices,1953,35,,1953,percent of total billed charges,Implant Devices,1953,35,,,percent of total billed charges,Implant Devices,1953,35,,1953,percent of total billed charges,Implant Devices,1953,35,,1953,percent of total billed charges,Implant Devices,2232,40,,2232,percent of total billed charges,Implant Devices,1953,70,,1953,percent of total billed charges,Implant Devices,1897.2,34,,1897.2,percent of total billed charges,Implant Devices,1897.2,34,,1897.2,percent of total billed charges,Implant Devices,1953,35,,1953,percent of total billed charges,Implant Devices,1953,35,,1953,percent of total billed charges,Implant Devices,1953,35,,1953,percent of total billed charges,Implant Devices,1953,35,,1953,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1897.2,34,"If Charge > 2,000, then 34 percent",1897.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2232,
ZIMMER 1147-065-40 SCREW 4.0X65MM,C1713,HCPCS,,79004329,CDM,278,RC,,,both,,,532,209.96,39.4668,,209.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,186.2,35,,186.2,percent of total billed charges,Implant Device,180.88,34,"Charges > $500, x 34%",180.88,percent of total billed charges,Implant Device,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,212.8,40,,212.8,percent of total billed charges,Implant Devices,186.2,70,,186.2,percent of total billed charges,Implant Devices,180.88,34,,180.88,percent of total billed charges,Implant Devices,180.88,34,,180.88,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,212.8,
ZIMMER 2359-50-56 CANN SCREW 5.5X50MM,C1713,HCPCS,,79004330,CDM,278,RC,,,both,,,560,221.01,39.4668,,221.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,196,35,,196,percent of total billed charges,Implant Device,190.4,34,"Charges > $500, x 34%",190.4,percent of total billed charges,Implant Device,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,224,40,,224,percent of total billed charges,Implant Devices,196,70,,196,percent of total billed charges,Implant Devices,190.4,34,,190.4,percent of total billed charges,Implant Devices,190.4,34,,190.4,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224,
ZIMMER 00-2359-080-56 CANN SCREW 5.5X80,C1713,HCPCS,,79004331,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
ZIMMER 00-2359-085-56 CANN SCREW 5.5X85,C1713,HCPCS,,79004332,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
ZIMMER 00-1147-065-41 CANN SCREW 4X65MM,C1713,HCPCS,,79004334,CDM,278,RC,,,both,,,558,220.22,39.4668,,220.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Device,189.72,34,"Charges > $500, x 34%",189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,223.2,40,,223.2,percent of total billed charges,Implant Devices,195.3,70,,195.3,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.2,
ZIMMER 1147-066-45 CANN SCREW 4.5X66MM,C1713,HCPCS,,79004335,CDM,278,RC,,,both,,,601,237.2,39.4668,,237.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,210.35,35,,210.35,percent of total billed charges,Implant Device,204.34,34,"Charges > $500, x 34%",204.34,percent of total billed charges,Implant Device,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,240.4,40,,240.4,percent of total billed charges,Implant Devices,210.35,70,,210.35,percent of total billed charges,Implant Devices,204.34,34,,204.34,percent of total billed charges,Implant Devices,204.34,34,,204.34,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240.4,
ZIMMER 6043638S ASNIS SCREW 4X38MM,C1713,HCPCS,,79004336,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
ZIMMER 2102-1505 BONEGRAFT SUB 25X50X4MM,C1713,HCPCS,,79004338,CDM,278,RC,,,both,,,6450,2545.61,39.4668,,2545.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2193,34,,2193,percent of total billed charges,Implant Device,2193,34,,2193,percent of total billed charges,Implant Device,2193,34,,2193,percent of total billed charges,Implant Device,2193,34,,2193,percent of total billed charges,Implant Device,2193,34,,2193,percent of total billed charges,Implant Device,2193,34,,2193,percent of total billed charges,Implant Device,2257.5,35,,2257.5,percent of total billed charges,Implant Device,2193,34,"Charges > $500, x 34%",2193,percent of total billed charges,Implant Device,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2580,40,,2580,percent of total billed charges,Implant Devices,2257.5,70,,2257.5,percent of total billed charges,Implant Devices,2193,34,,2193,percent of total billed charges,Implant Devices,2193,34,,2193,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2193,34,"If Charge > 2,000, then 34 percent",2193,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2580,
ZIMMER 2347-23-30 PERI SCREW 4.5X30MM,C1713,HCPCS,,79004339,CDM,278,RC,,,both,,,97,38.28,39.4668,,38.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,38.8,40,,38.8,percent of total billed charges,Implant Devices,33.95,70,,33.95,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.8,
ZIMMER 00-4835-030-01 CORT SCREW 3.5X30,C1713,HCPCS,,79004340,CDM,278,RC,,,both,,,73,28.81,39.4668,,28.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,25.55,35,,25.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,29.2,40,,29.2,percent of total billed charges,Implant Devices,25.55,70,,25.55,percent of total billed charges,Implant Devices,24.82,34,,24.82,percent of total billed charges,Implant Devices,24.82,34,,24.82,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,29.2,
ZIMMER 00-2358-001-08 LATRL HUM PLATE 8H,C1713,HCPCS,,79004341,CDM,278,RC,,,both,,,6150,2427.21,39.4668,,2427.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2091,34,,2091,percent of total billed charges,Implant Device,2091,34,,2091,percent of total billed charges,Implant Device,2091,34,,2091,percent of total billed charges,Implant Device,2091,34,,2091,percent of total billed charges,Implant Device,2091,34,,2091,percent of total billed charges,Implant Device,2091,34,,2091,percent of total billed charges,Implant Device,2152.5,35,,2152.5,percent of total billed charges,Implant Device,2091,34,"Charges > $500, x 34%",2091,percent of total billed charges,Implant Device,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2460,40,,2460,percent of total billed charges,Implant Devices,2152.5,70,,2152.5,percent of total billed charges,Implant Devices,2091,34,,2091,percent of total billed charges,Implant Devices,2091,34,,2091,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,2152.5,35,,2152.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2091,34,"If Charge > 2,000, then 34 percent",2091,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2460,
ZIMMER 2347-23-28 4.5X28MM PERIART SCREW,C1713,HCPCS,,79004342,CDM,278,RC,,,both,,,97,38.28,39.4668,,38.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,38.8,40,,38.8,percent of total billed charges,Implant Devices,33.95,70,,33.95,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.8,
ZIMMER 00-4936-006-03 TUB PLATE 6H 1/3,C1713,HCPCS,,79004346,CDM,278,RC,,,both,,,455,179.57,39.4668,,179.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,159.25,35,,159.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,182,40,,182,percent of total billed charges,Implant Devices,159.25,70,,159.25,percent of total billed charges,Implant Devices,154.7,34,,154.7,percent of total billed charges,Implant Devices,154.7,34,,154.7,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182,
ZIMMER 00-2359-018-35 LCK SCREW 3.5MX18,C1713,HCPCS,,79004647,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
ZIMMER 00-1147-41-55 CANN SCREW 4X55M,C1713,HCPCS,,79004648,CDM,278,RC,,,both,,,558,220.22,39.4668,,220.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Device,189.72,34,"Charges > $500, x 34%",189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,223.2,40,,223.2,percent of total billed charges,Implant Devices,195.3,70,,195.3,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.2,
ZIMMER 00-1147-044-40 CANN SCREW 4X44MM,C1713,HCPCS,,79004650,CDM,278,RC,,,both,,,1713,676.07,39.4668,,676.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,582.42,34,,582.42,percent of total billed charges,Implant Device,582.42,34,,582.42,percent of total billed charges,Implant Device,582.42,34,,582.42,percent of total billed charges,Implant Device,582.42,34,,582.42,percent of total billed charges,Implant Device,582.42,34,,582.42,percent of total billed charges,Implant Device,582.42,34,,582.42,percent of total billed charges,Implant Device,599.55,35,,599.55,percent of total billed charges,Implant Device,582.42,34,"Charges > $500, x 34%",582.42,percent of total billed charges,Implant Device,599.55,35,,599.55,percent of total billed charges,Implant Devices,599.55,35,,599.55,percent of total billed charges,Implant Devices,599.55,35,,,percent of total billed charges,Implant Devices,599.55,35,,599.55,percent of total billed charges,Implant Devices,599.55,35,,599.55,percent of total billed charges,Implant Devices,685.2,40,,685.2,percent of total billed charges,Implant Devices,599.55,70,,599.55,percent of total billed charges,Implant Devices,582.42,34,,582.42,percent of total billed charges,Implant Devices,582.42,34,,582.42,percent of total billed charges,Implant Devices,599.55,35,,599.55,percent of total billed charges,Implant Devices,599.55,35,,599.55,percent of total billed charges,Implant Devices,599.55,35,,599.55,percent of total billed charges,Implant Devices,599.55,35,,599.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,685.2,
ZIMMER 00-4827-010-01 CORT SCREW 2.7X10,C1713,HCPCS,,79004651,CDM,278,RC,,,both,,,62,24.47,39.4668,,24.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.08,34,,21.08,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,24.8,40,,24.8,percent of total billed charges,Implant Devices,21.7,70,,21.7,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.08,34,,21.08,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,21.7,35,,21.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24.8,
ZIMMER 00-2359-060-36 CANN SCREW 3.5X60,C1713,HCPCS,,79004653,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
ZIMMER 00-1103-020-05 BONE VOID FILL 5MM,C1713,HCPCS,,79004654,CDM,278,RC,,,both,,,2148,847.75,39.4668,,847.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,730.32,34,,730.32,percent of total billed charges,Implant Device,730.32,34,,730.32,percent of total billed charges,Implant Device,730.32,34,,730.32,percent of total billed charges,Implant Device,730.32,34,,730.32,percent of total billed charges,Implant Device,730.32,34,,730.32,percent of total billed charges,Implant Device,730.32,34,,730.32,percent of total billed charges,Implant Device,751.8,35,,751.8,percent of total billed charges,Implant Device,730.32,34,"Charges > $500, x 34%",730.32,percent of total billed charges,Implant Device,751.8,35,,751.8,percent of total billed charges,Implant Devices,751.8,35,,751.8,percent of total billed charges,Implant Devices,751.8,35,,,percent of total billed charges,Implant Devices,751.8,35,,751.8,percent of total billed charges,Implant Devices,751.8,35,,751.8,percent of total billed charges,Implant Devices,859.2,40,,859.2,percent of total billed charges,Implant Devices,751.8,70,,751.8,percent of total billed charges,Implant Devices,730.32,34,,730.32,percent of total billed charges,Implant Devices,730.32,34,,730.32,percent of total billed charges,Implant Devices,751.8,35,,751.8,percent of total billed charges,Implant Devices,751.8,35,,751.8,percent of total billed charges,Implant Devices,751.8,35,,751.8,percent of total billed charges,Implant Devices,751.8,35,,751.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,730.32,34,"If Charge > 2,000, then 34 percent",730.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,859.2,
ZIMMER 02-03150-080 CORT SCREW 5X80MM,C1713,HCPCS,,79004662,CDM,278,RC,,,both,,,498,196.54,39.4668,,196.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,199.2,40,,199.2,percent of total billed charges,Implant Devices,174.3,70,,174.3,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.2,
ZIMMER 00-5970-000-01 CR FLEX PIN GUIDES,C1713,HCPCS,,79004663,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
ZIMMER 2359-40-55 CANN LCK SCREW 5.5X40,C1713,HCPCS,,79004664,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 02-03264-118 DIST FEM PLATE 355MM,C1713,HCPCS,,79004666,CDM,278,RC,,,both,,,4752,1875.46,39.4668,,1875.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1615.68,34,,1615.68,percent of total billed charges,Implant Device,1615.68,34,,1615.68,percent of total billed charges,Implant Device,1615.68,34,,1615.68,percent of total billed charges,Implant Device,1615.68,34,,1615.68,percent of total billed charges,Implant Device,1615.68,34,,1615.68,percent of total billed charges,Implant Device,1615.68,34,,1615.68,percent of total billed charges,Implant Device,1663.2,35,,1663.2,percent of total billed charges,Implant Device,1615.68,34,"Charges > $500, x 34%",1615.68,percent of total billed charges,Implant Device,1663.2,35,,1663.2,percent of total billed charges,Implant Devices,1663.2,35,,1663.2,percent of total billed charges,Implant Devices,1663.2,35,,,percent of total billed charges,Implant Devices,1663.2,35,,1663.2,percent of total billed charges,Implant Devices,1663.2,35,,1663.2,percent of total billed charges,Implant Devices,1900.8,40,,1900.8,percent of total billed charges,Implant Devices,1663.2,70,,1663.2,percent of total billed charges,Implant Devices,1615.68,34,,1615.68,percent of total billed charges,Implant Devices,1615.68,34,,1615.68,percent of total billed charges,Implant Devices,1663.2,35,,1663.2,percent of total billed charges,Implant Devices,1663.2,35,,1663.2,percent of total billed charges,Implant Devices,1663.2,35,,1663.2,percent of total billed charges,Implant Devices,1663.2,35,,1663.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1615.68,34,"If Charge > 2,000, then 34 percent",1615.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1900.8,
ZIMMER 2348-22-35 CORT  SCREW 3.5X22MM,C1713,HCPCS,,79004667,CDM,278,RC,,,both,,,103,40.65,39.4668,,40.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,36.05,35,,36.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,41.2,40,,41.2,percent of total billed charges,Implant Devices,36.05,70,,36.05,percent of total billed charges,Implant Devices,35.02,34,,35.02,percent of total billed charges,Implant Devices,35.02,34,,35.02,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,41.2,
ZIMMER 1147-96 WASHER,C1713,HCPCS,,79004669,CDM,278,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.72,34,,36.72,percent of total billed charges,Implant Device,36.72,34,,36.72,percent of total billed charges,Implant Device,36.72,34,,36.72,percent of total billed charges,Implant Device,36.72,34,,36.72,percent of total billed charges,Implant Device,36.72,34,,36.72,percent of total billed charges,Implant Device,36.72,34,,36.72,percent of total billed charges,Implant Device,37.8,35,,37.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,43.2,40,,43.2,percent of total billed charges,Implant Devices,37.8,70,,37.8,percent of total billed charges,Implant Devices,36.72,34,,36.72,percent of total billed charges,Implant Devices,36.72,34,,36.72,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,37.8,35,,37.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.2,
ZIMMER 2253-035-55 INTERLCK SCREW5.5X35,C1713,HCPCS,,79004670,CDM,278,RC,,,both,,,654,258.11,39.4668,,258.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,222.36,34,,222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Device,222.36,34,"Charges > $500, x 34%",222.36,percent of total billed charges,Implant Device,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,261.6,40,,261.6,percent of total billed charges,Implant Devices,228.9,70,,228.9,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,222.36,34,,222.36,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,228.9,35,,228.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,261.6,
ZIMMER 00-2359-070-36 LOCK SCREW 3.5X70,C1713,HCPCS,,79004672,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
ZIMMER 00-2359-034-45 LOCK SCREW 4.5X34,C1713,HCPCS,,79004673,CDM,278,RC,,,both,,,445,175.63,39.4668,,175.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,178,40,,178,percent of total billed charges,Implant Devices,155.75,70,,155.75,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178,
ZIMMER 00-4835-016-01 CORT SCREW 3.5X16`,C1713,HCPCS,,79004674,CDM,278,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,28.8,40,,28.8,percent of total billed charges,Implant Devices,25.2,70,,25.2,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28.8,
ZIMMER 00-2359-030-55LOCK SCREW 5.5XMM,C1713,HCPCS,,79004675,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 00-2359-080-55 LOCK SCREW 5.5X80,C1713,HCPCS,,79004676,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 02-03150-070 CORT SCREW 5X70MM,C1713,HCPCS,,79004677,CDM,278,RC,,,both,,,498,196.54,39.4668,,196.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,199.2,40,,199.2,percent of total billed charges,Implant Devices,174.3,70,,174.3,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.2,
ZIMMER 00-4835-014-01 CORT SCREW 3.5X14,C1713,HCPCS,,79004678,CDM,278,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,24.48,34,,24.48,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,28.8,40,,28.8,percent of total billed charges,Implant Devices,25.2,70,,25.2,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,24.48,34,,24.48,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,25.2,35,,25.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28.8,
ZIMMER 00-1147-042-40 CANN SCREW 4X42MM,C1713,HCPCS,,79004679,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
ZIMMER 002359-012-38 LOCK SCREW 3.5X12MM,C1713,HCPCS,,79004680,CDM,278,RC,,,both,,,313,123.53,39.4668,,123.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,109.55,35,,109.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,125.2,40,,125.2,percent of total billed charges,Implant Devices,109.55,70,,109.55,percent of total billed charges,Implant Devices,106.42,34,,106.42,percent of total billed charges,Implant Devices,106.42,34,,106.42,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,125.2,
ZIMMER 4865-70-02 CANC SCREW 6.5X70MM,C1713,HCPCS,,79004681,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ZIMMER 02.03151.020 UNICORT SCR 5X20MM,C1713,HCPCS,,79004682,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
ZIMMER 00-2480-014-40 CANC SCREW 4X14MM,C1713,HCPCS,,79004685,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ZIMMER 02.03151.010 UNICORT SCR 5X10MM,C1713,HCPCS,,79004686,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
ZIMMER 00-4936-005-03 ULS 1/3 PLT 3.5X68,C1713,HCPCS,,79004690,CDM,278,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,154,35,,154,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,176,40,,176,percent of total billed charges,Implant Devices,154,70,,154,percent of total billed charges,Implant Devices,149.6,34,,149.6,percent of total billed charges,Implant Devices,149.6,34,,149.6,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,176,
ZIMMER 00-2347-020-40 PERI SCREW 35X40MM,C1713,HCPCS,,79004693,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
ZIMMER 00-2348-054-35 SCREW 3.5X54X2.7,C1713,HCPCS,,79004695,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ZIMMER 00-4835-012-01 CORT SCREW 3.5X12,C1713,HCPCS,,79004696,CDM,278,RC,,,both,,,71,28.02,39.4668,,28.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.85,35,,24.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,28.4,40,,28.4,percent of total billed charges,Implant Devices,24.85,70,,24.85,percent of total billed charges,Implant Devices,24.14,34,,24.14,percent of total billed charges,Implant Devices,24.14,34,,24.14,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28.4,
ZIMMER 00-4828-022-02 LOCK SCREW 2.7X22,C1713,HCPCS,,79004697,CDM,278,RC,,,both,,,302,119.19,39.4668,,119.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102.68,34,,102.68,percent of total billed charges,Implant Device,102.68,34,,102.68,percent of total billed charges,Implant Device,102.68,34,,102.68,percent of total billed charges,Implant Device,102.68,34,,102.68,percent of total billed charges,Implant Device,102.68,34,,102.68,percent of total billed charges,Implant Device,102.68,34,,102.68,percent of total billed charges,Implant Device,105.7,35,,105.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,120.8,40,,120.8,percent of total billed charges,Implant Devices,105.7,70,,105.7,percent of total billed charges,Implant Devices,102.68,34,,102.68,percent of total billed charges,Implant Devices,102.68,34,,102.68,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,105.7,35,,105.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120.8,
ZIMMER 00-2347-023-34 PER SCREW 4.5X34MM,C1713,HCPCS,,79004698,CDM,278,RC,,,both,,,141,55.65,39.4668,,55.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.94,34,,47.94,percent of total billed charges,Implant Device,47.94,34,,47.94,percent of total billed charges,Implant Device,47.94,34,,47.94,percent of total billed charges,Implant Device,47.94,34,,47.94,percent of total billed charges,Implant Device,47.94,34,,47.94,percent of total billed charges,Implant Device,47.94,34,,47.94,percent of total billed charges,Implant Device,49.35,35,,49.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,56.4,40,,56.4,percent of total billed charges,Implant Devices,49.35,70,,49.35,percent of total billed charges,Implant Devices,47.94,34,,47.94,percent of total billed charges,Implant Devices,47.94,34,,47.94,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,49.35,35,,49.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,56.4,
ZIMMER 00-2358-009-03 ULNAR LK PLATE 3H,C1713,HCPCS,,79004700,CDM,278,RC,,,both,,,2892,1141.38,39.4668,,1141.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,983.28,34,,983.28,percent of total billed charges,Implant Device,983.28,34,,983.28,percent of total billed charges,Implant Device,983.28,34,,983.28,percent of total billed charges,Implant Device,983.28,34,,983.28,percent of total billed charges,Implant Device,983.28,34,,983.28,percent of total billed charges,Implant Device,983.28,34,,983.28,percent of total billed charges,Implant Device,1012.2,35,,1012.2,percent of total billed charges,Implant Device,983.28,34,"Charges > $500, x 34%",983.28,percent of total billed charges,Implant Device,1012.2,35,,1012.2,percent of total billed charges,Implant Devices,1012.2,35,,1012.2,percent of total billed charges,Implant Devices,1012.2,35,,,percent of total billed charges,Implant Devices,1012.2,35,,1012.2,percent of total billed charges,Implant Devices,1012.2,35,,1012.2,percent of total billed charges,Implant Devices,1156.8,40,,1156.8,percent of total billed charges,Implant Devices,1012.2,70,,1012.2,percent of total billed charges,Implant Devices,983.28,34,,983.28,percent of total billed charges,Implant Devices,983.28,34,,983.28,percent of total billed charges,Implant Devices,1012.2,35,,1012.2,percent of total billed charges,Implant Devices,1012.2,35,,1012.2,percent of total billed charges,Implant Devices,1012.2,35,,1012.2,percent of total billed charges,Implant Devices,1012.2,35,,1012.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,983.28,34,"If Charge > 2,000, then 34 percent",983.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1156.8,
ZIMMER 02.03155.034 CORT SCREW 4X34MM,C1713,HCPCS,,79004701,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 02-03150-065 CORT SCREW 5X65MM,C1713,HCPCS,,79004703,CDM,278,RC,,,both,,,498,196.54,39.4668,,196.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,199.2,40,,199.2,percent of total billed charges,Implant Devices,174.3,70,,174.3,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.2,
ZIMMER 1147-40-40 CANN SCREW 4X40MM,C1713,HCPCS,,79004704,CDM,278,RC,,,both,,,605,238.77,39.4668,,238.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,211.75,35,,211.75,percent of total billed charges,Implant Device,205.7,34,"Charges > $500, x 34%",205.7,percent of total billed charges,Implant Device,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,242,40,,242,percent of total billed charges,Implant Devices,211.75,70,,211.75,percent of total billed charges,Implant Devices,205.7,34,,205.7,percent of total billed charges,Implant Devices,205.7,34,,205.7,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,242,
ZIMMER 00-1147-050-41 CANN SCREW 4X50MM,C1713,HCPCS,,79004705,CDM,278,RC,,,both,,,558,220.22,39.4668,,220.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Device,189.72,34,"Charges > $500, x 34%",189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,223.2,40,,223.2,percent of total billed charges,Implant Devices,195.3,70,,195.3,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.2,
ZIMMER 2348-010-35 CORT SCREW 3.5X10MM,C1713,HCPCS,,79004706,CDM,278,RC,,,both,,,103,40.65,39.4668,,40.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,36.05,35,,36.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,41.2,40,,41.2,percent of total billed charges,Implant Devices,36.05,70,,36.05,percent of total billed charges,Implant Devices,35.02,34,,35.02,percent of total billed charges,Implant Devices,35.02,34,,35.02,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,41.2,
ZIMMER 02.03152.075 NCB CANC SCREW 5X75,C1713,HCPCS,,79004707,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
ZIMMER 2359-65-55 LOCK SCREW 5.5X65MM,C1713,HCPCS,,79004709,CDM,278,RC,,,both,,,575,226.93,39.4668,,226.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,195.5,34,,195.5,percent of total billed charges,Implant Device,201.25,35,,201.25,percent of total billed charges,Implant Device,195.5,34,"Charges > $500, x 34%",195.5,percent of total billed charges,Implant Device,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,230,40,,230,percent of total billed charges,Implant Devices,201.25,70,,201.25,percent of total billed charges,Implant Devices,195.5,34,,195.5,percent of total billed charges,Implant Devices,195.5,34,,195.5,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,201.25,35,,201.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230,
ZIMMER 02-03155-026 NCB CORT SCREW 4X26,C1713,HCPCS,,79004710,CDM,278,RC,,,both,,,402,158.66,39.4668,,158.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,160.8,40,,160.8,percent of total billed charges,Implant Devices,140.7,70,,140.7,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,160.8,
ZIMMER 00-2348-026-35 SCREW 3.5X26X2.7,C1713,HCPCS,,79004711,CDM,278,RC,,,both,,,276,108.93,39.4668,,108.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,96.6,35,,96.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,110.4,40,,110.4,percent of total billed charges,Implant Devices,96.6,70,,96.6,percent of total billed charges,Implant Devices,93.84,34,,93.84,percent of total billed charges,Implant Devices,93.84,34,,93.84,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.4,
ZIMMER 02.03150.050 NCB CORT SCREW 5X50,C1713,HCPCS,,79004716,CDM,278,RC,,,both,,,514,202.86,39.4668,,202.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Device,174.76,34,"Charges > $500, x 34%",174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,205.6,40,,205.6,percent of total billed charges,Implant Devices,179.9,70,,179.9,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.6,
ZIMMER 02-03264-115 DISTAL FEMUR 15H PLT,C1713,HCPCS,,79004717,CDM,278,RC,,,both,,,4672,1843.89,39.4668,,1843.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1588.48,34,,1588.48,percent of total billed charges,Implant Device,1588.48,34,,1588.48,percent of total billed charges,Implant Device,1588.48,34,,1588.48,percent of total billed charges,Implant Device,1588.48,34,,1588.48,percent of total billed charges,Implant Device,1588.48,34,,1588.48,percent of total billed charges,Implant Device,1588.48,34,,1588.48,percent of total billed charges,Implant Device,1635.2,35,,1635.2,percent of total billed charges,Implant Device,1588.48,34,"Charges > $500, x 34%",1588.48,percent of total billed charges,Implant Device,1635.2,35,,1635.2,percent of total billed charges,Implant Devices,1635.2,35,,1635.2,percent of total billed charges,Implant Devices,1635.2,35,,,percent of total billed charges,Implant Devices,1635.2,35,,1635.2,percent of total billed charges,Implant Devices,1635.2,35,,1635.2,percent of total billed charges,Implant Devices,1868.8,40,,1868.8,percent of total billed charges,Implant Devices,1635.2,70,,1635.2,percent of total billed charges,Implant Devices,1588.48,34,,1588.48,percent of total billed charges,Implant Devices,1588.48,34,,1588.48,percent of total billed charges,Implant Devices,1635.2,35,,1635.2,percent of total billed charges,Implant Devices,1635.2,35,,1635.2,percent of total billed charges,Implant Devices,1635.2,35,,1635.2,percent of total billed charges,Implant Devices,1635.2,35,,1635.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1588.48,34,"If Charge > 2,000, then 34 percent",1588.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1868.8,
ZIMMER 1147-46-41 CANN SCREW 4X46MM,C1713,HCPCS,,79004719,CDM,278,RC,,,both,,,560,221.01,39.4668,,221.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,196,35,,196,percent of total billed charges,Implant Device,190.4,34,"Charges > $500, x 34%",190.4,percent of total billed charges,Implant Device,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,224,40,,224,percent of total billed charges,Implant Devices,196,70,,196,percent of total billed charges,Implant Devices,190.4,34,,190.4,percent of total billed charges,Implant Devices,190.4,34,,190.4,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224,
ZIMMER 1147-065-41 CANC SCREW 4X65MM,C1713,HCPCS,,79004720,CDM,278,RC,,,both,,,558,220.22,39.4668,,220.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Device,189.72,34,"Charges > $500, x 34%",189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,223.2,40,,223.2,percent of total billed charges,Implant Devices,195.3,70,,195.3,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.2,
ZIMMER 1147-095-45 CANN. SCREW 4.5X95MM,C1713,HCPCS,,79004721,CDM,278,RC,,,both,,,601,237.2,39.4668,,237.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,204.34,34,,204.34,percent of total billed charges,Implant Device,210.35,35,,210.35,percent of total billed charges,Implant Device,204.34,34,"Charges > $500, x 34%",204.34,percent of total billed charges,Implant Device,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,240.4,40,,240.4,percent of total billed charges,Implant Devices,210.35,70,,210.35,percent of total billed charges,Implant Devices,204.34,34,,204.34,percent of total billed charges,Implant Devices,204.34,34,,204.34,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,210.35,35,,210.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240.4,
ZIMMER 2357-018-06 DISTAL FIB LCK PL 6H,C1713,HCPCS,,79004722,CDM,278,RC,,,both,,,2160,852.48,39.4668,,852.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,756,35,,756,percent of total billed charges,Implant Device,734.4,34,"Charges > $500, x 34%",734.4,percent of total billed charges,Implant Device,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,864,40,,864,percent of total billed charges,Implant Devices,756,70,,756,percent of total billed charges,Implant Devices,734.4,34,,734.4,percent of total billed charges,Implant Devices,734.4,34,,734.4,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,734.4,34,"If Charge > 2,000, then 34 percent",734.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,864,
ZIMMER 00-2359-022-35 LOCK SCREW 3.5X22,C1713,HCPCS,,79004723,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
ZIMMER 02-03150-038 CORT SCREW 5X38MM,C1713,HCPCS,,79004730,CDM,278,RC,,,both,,,498,196.54,39.4668,,196.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,169.32,34,,169.32,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,199.2,40,,199.2,percent of total billed charges,Implant Devices,174.3,70,,174.3,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,169.32,34,,169.32,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,174.3,35,,174.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.2,
STRYKER 604736S ASNIS CANN SCREW 36MM,C1713,HCPCS,,79004731,CDM,278,RC,,,both,,,1058,417.56,39.4668,,417.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,359.72,34,,359.72,percent of total billed charges,Implant Device,359.72,34,,359.72,percent of total billed charges,Implant Device,359.72,34,,359.72,percent of total billed charges,Implant Device,359.72,34,,359.72,percent of total billed charges,Implant Device,359.72,34,,359.72,percent of total billed charges,Implant Device,359.72,34,,359.72,percent of total billed charges,Implant Device,370.3,35,,370.3,percent of total billed charges,Implant Device,359.72,34,"Charges > $500, x 34%",359.72,percent of total billed charges,Implant Device,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,423.2,40,,423.2,percent of total billed charges,Implant Devices,370.3,70,,370.3,percent of total billed charges,Implant Devices,359.72,34,,359.72,percent of total billed charges,Implant Devices,359.72,34,,359.72,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,423.2,
ZIMMER 1147-44-40 CANN SCREW 4X44MM,C1713,HCPCS,,79004733,CDM,278,RC,,,both,,,605,238.77,39.4668,,238.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,211.75,35,,211.75,percent of total billed charges,Implant Device,205.7,34,"Charges > $500, x 34%",205.7,percent of total billed charges,Implant Device,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,242,40,,242,percent of total billed charges,Implant Devices,211.75,70,,211.75,percent of total billed charges,Implant Devices,205.7,34,,205.7,percent of total billed charges,Implant Devices,205.7,34,,205.7,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,242,
ZIMMER 002359-016-38 LOCK SCREW 3.5X16MM,C1713,HCPCS,,79004734,CDM,278,RC,,,both,,,281,110.9,39.4668,,110.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,98.35,35,,98.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,112.4,40,,112.4,percent of total billed charges,Implant Devices,98.35,70,,98.35,percent of total billed charges,Implant Devices,95.54,34,,95.54,percent of total billed charges,Implant Devices,95.54,34,,95.54,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.4,
ZIMMER 1147-050-41 CANNULATED SCREW 50MM,C1713,HCPCS,,79004735,CDM,278,RC,,,both,,,558,220.22,39.4668,,220.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Device,189.72,34,"Charges > $500, x 34%",189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,223.2,40,,223.2,percent of total billed charges,Implant Devices,195.3,70,,195.3,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.2,
ZIMMER 00-2359-012-35 SCREW 3.5X12MM,C1713,HCPCS,,79004736,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 00-2359-040-45 LOCK SCREW 4.5X40,C1713,HCPCS,,79004737,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
ZIMMER 00-2359-040-36 LOCK SCREW 3.5X40,C1713,HCPCS,,79004738,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ZIMMER 00-2359-020-35 LOCK SCREW 3.5X20,C1713,HCPCS,,79004739,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
ZIMMER 00-2359-085-55 LOCK SCREW 5.5X85,C1713,HCPCS,,79004740,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 00-2359-075-36 CANN SCREW 3.5X75,C1713,HCPCS,,79004741,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
ZIMMER 00-2359-045-36 CANN SCREW 3.5X45,C1713,HCPCS,,79004742,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ZIMMER 00-2360-041-55 LOCK SCREW STD 5.5,C1713,HCPCS,,79004743,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ZIMMER 00-4827-012-01 CORT SCREW 2.7X12,C1713,HCPCS,,79004746,CDM,278,RC,,,both,,,71,28.02,39.4668,,28.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.85,35,,24.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,28.4,40,,28.4,percent of total billed charges,Implant Devices,24.85,70,,24.85,percent of total billed charges,Implant Devices,24.14,34,,24.14,percent of total billed charges,Implant Devices,24.14,34,,24.14,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28.4,
ZIMMER 00-2480-032-40 CANC SCREW 4X32MM,C1713,HCPCS,,79004747,CDM,278,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,59.5,34,,59.5,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,70,40,,70,percent of total billed charges,Implant Devices,61.25,70,,61.25,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,59.5,34,,59.5,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,61.25,35,,61.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70,
ZIMMER 00-2480-030-40 CANC SCREW 4X30MM,C1713,HCPCS,,79004748,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ZIMMER 00-4840-016-00 CANC SCREW 4X16MM,C1713,HCPCS,,79004749,CDM,278,RC,,,both,,,58,22.89,39.4668,,22.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.72,34,,19.72,percent of total billed charges,Implant Device,19.72,34,,19.72,percent of total billed charges,Implant Device,19.72,34,,19.72,percent of total billed charges,Implant Device,19.72,34,,19.72,percent of total billed charges,Implant Device,19.72,34,,19.72,percent of total billed charges,Implant Device,19.72,34,,19.72,percent of total billed charges,Implant Device,20.3,35,,20.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.3,35,,20.3,percent of total billed charges,Implant Devices,20.3,35,,20.3,percent of total billed charges,Implant Devices,20.3,35,,,percent of total billed charges,Implant Devices,20.3,35,,20.3,percent of total billed charges,Implant Devices,20.3,35,,20.3,percent of total billed charges,Implant Devices,23.2,40,,23.2,percent of total billed charges,Implant Devices,20.3,70,,20.3,percent of total billed charges,Implant Devices,19.72,34,,19.72,percent of total billed charges,Implant Devices,19.72,34,,19.72,percent of total billed charges,Implant Devices,20.3,35,,20.3,percent of total billed charges,Implant Devices,20.3,35,,20.3,percent of total billed charges,Implant Devices,20.3,35,,20.3,percent of total billed charges,Implant Devices,20.3,35,,20.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.2,
ZIMMER 00-4840-012-00 CANC SCREW 4X12MM,C1713,HCPCS,,79004750,CDM,278,RC,,,both,,,54,21.31,39.4668,,21.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.36,34,,18.36,percent of total billed charges,Implant Device,18.36,34,,18.36,percent of total billed charges,Implant Device,18.36,34,,18.36,percent of total billed charges,Implant Device,18.36,34,,18.36,percent of total billed charges,Implant Device,18.36,34,,18.36,percent of total billed charges,Implant Device,18.36,34,,18.36,percent of total billed charges,Implant Device,18.9,35,,18.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,21.6,40,,21.6,percent of total billed charges,Implant Devices,18.9,70,,18.9,percent of total billed charges,Implant Devices,18.36,34,,18.36,percent of total billed charges,Implant Devices,18.36,34,,18.36,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,18.9,35,,18.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.6,
ZIMMER 00-1146-064-45 CANN SCREW 4.564MM,C1713,HCPCS,,79004751,CDM,278,RC,,,both,,,589,232.46,39.4668,,232.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,200.26,34,,200.26,percent of total billed charges,Implant Device,200.26,34,,200.26,percent of total billed charges,Implant Device,200.26,34,,200.26,percent of total billed charges,Implant Device,200.26,34,,200.26,percent of total billed charges,Implant Device,200.26,34,,200.26,percent of total billed charges,Implant Device,200.26,34,,200.26,percent of total billed charges,Implant Device,206.15,35,,206.15,percent of total billed charges,Implant Device,200.26,34,"Charges > $500, x 34%",200.26,percent of total billed charges,Implant Device,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,235.6,40,,235.6,percent of total billed charges,Implant Devices,206.15,70,,206.15,percent of total billed charges,Implant Devices,200.26,34,,200.26,percent of total billed charges,Implant Devices,200.26,34,,200.26,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,206.15,35,,206.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,235.6,
ZIMMER 00-4936-007-03 ULS PLT 7H 3.5X94,C1713,HCPCS,,79004752,CDM,278,RC,,,both,,,482,190.23,39.4668,,190.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,168.7,35,,168.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,192.8,40,,192.8,percent of total billed charges,Implant Devices,168.7,70,,168.7,percent of total billed charges,Implant Devices,163.88,34,,163.88,percent of total billed charges,Implant Devices,163.88,34,,163.88,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192.8,
ZIMMER 2240-012-30 M/DN IM NAIL 12X30CM,C1713,HCPCS,,79004754,CDM,278,RC,,,both,,,5370,2119.37,39.4668,,2119.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1879.5,35,,1879.5,percent of total billed charges,Implant Device,1825.8,34,"Charges > $500, x 34%",1825.8,percent of total billed charges,Implant Device,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,2148,40,,2148,percent of total billed charges,Implant Devices,1879.5,70,,1879.5,percent of total billed charges,Implant Devices,1825.8,34,,1825.8,percent of total billed charges,Implant Devices,1825.8,34,,1825.8,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1825.8,34,"If Charge > 2,000, then 34 percent",1825.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2148,
ZIMMER 00-1147-038-40 CANN SCREW 4X38MM,C1713,HCPCS,,79004755,CDM,278,RC,,,both,,,560,221.01,39.4668,,221.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,190.4,34,,190.4,percent of total billed charges,Implant Device,196,35,,196,percent of total billed charges,Implant Device,190.4,34,"Charges > $500, x 34%",190.4,percent of total billed charges,Implant Device,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,224,40,,224,percent of total billed charges,Implant Devices,196,70,,196,percent of total billed charges,Implant Devices,190.4,34,,190.4,percent of total billed charges,Implant Devices,190.4,34,,190.4,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,196,35,,196,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224,
ZIMMER 00-1147-046-31 CANN SCREW 3.0MM,C1713,HCPCS,,79004758,CDM,278,RC,,,both,,,1139,449.53,39.4668,,449.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,387.26,34,,387.26,percent of total billed charges,Implant Device,387.26,34,,387.26,percent of total billed charges,Implant Device,387.26,34,,387.26,percent of total billed charges,Implant Device,387.26,34,,387.26,percent of total billed charges,Implant Device,387.26,34,,387.26,percent of total billed charges,Implant Device,387.26,34,,387.26,percent of total billed charges,Implant Device,398.65,35,,398.65,percent of total billed charges,Implant Device,387.26,34,"Charges > $500, x 34%",387.26,percent of total billed charges,Implant Device,398.65,35,,398.65,percent of total billed charges,Implant Devices,398.65,35,,398.65,percent of total billed charges,Implant Devices,398.65,35,,,percent of total billed charges,Implant Devices,398.65,35,,398.65,percent of total billed charges,Implant Devices,398.65,35,,398.65,percent of total billed charges,Implant Devices,455.6,40,,455.6,percent of total billed charges,Implant Devices,398.65,70,,398.65,percent of total billed charges,Implant Devices,387.26,34,,387.26,percent of total billed charges,Implant Devices,387.26,34,,387.26,percent of total billed charges,Implant Devices,398.65,35,,398.65,percent of total billed charges,Implant Devices,398.65,35,,398.65,percent of total billed charges,Implant Devices,398.65,35,,398.65,percent of total billed charges,Implant Devices,398.65,35,,398.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,455.6,
ZIMMER 00-2348-028-35 SCREW 3.5X28X2.7MM,C1713,HCPCS,,79004762,CDM,278,RC,,,both,,,276,108.93,39.4668,,108.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,96.6,35,,96.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,110.4,40,,110.4,percent of total billed charges,Implant Devices,96.6,70,,96.6,percent of total billed charges,Implant Devices,93.84,34,,93.84,percent of total billed charges,Implant Devices,93.84,34,,93.84,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.4,
ZIMMER 5791-43 HEADED SCREW 27MM,C1713,HCPCS,,79004763,CDM,278,RC,,,both,,,244,96.3,39.4668,,96.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,82.96,34,,82.96,percent of total billed charges,Implant Device,85.4,35,,85.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,97.6,40,,97.6,percent of total billed charges,Implant Devices,85.4,70,,85.4,percent of total billed charges,Implant Devices,82.96,34,,82.96,percent of total billed charges,Implant Devices,82.96,34,,82.96,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,85.4,35,,85.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,97.6,
ZIMMER 00-2359-065-36 CANN SCREW 3.5X65,C1713,HCPCS,,79004764,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
ZIMMER 2357-018-04 FIB LCK PLATE 4H 80MM,C1713,HCPCS,,79004765,CDM,278,RC,,,both,,,1938,764.87,39.4668,,764.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,658.92,34,,658.92,percent of total billed charges,Implant Device,658.92,34,,658.92,percent of total billed charges,Implant Device,658.92,34,,658.92,percent of total billed charges,Implant Device,658.92,34,,658.92,percent of total billed charges,Implant Device,658.92,34,,658.92,percent of total billed charges,Implant Device,658.92,34,,658.92,percent of total billed charges,Implant Device,678.3,35,,678.3,percent of total billed charges,Implant Device,658.92,34,"Charges > $500, x 34%",658.92,percent of total billed charges,Implant Device,678.3,35,,678.3,percent of total billed charges,Implant Devices,678.3,35,,678.3,percent of total billed charges,Implant Devices,678.3,35,,,percent of total billed charges,Implant Devices,678.3,35,,678.3,percent of total billed charges,Implant Devices,678.3,35,,678.3,percent of total billed charges,Implant Devices,775.2,40,,775.2,percent of total billed charges,Implant Devices,678.3,70,,678.3,percent of total billed charges,Implant Devices,658.92,34,,658.92,percent of total billed charges,Implant Devices,658.92,34,,658.92,percent of total billed charges,Implant Devices,678.3,35,,678.3,percent of total billed charges,Implant Devices,678.3,35,,678.3,percent of total billed charges,Implant Devices,678.3,35,,678.3,percent of total billed charges,Implant Devices,678.3,35,,678.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,775.2,
ZIMMER 00-2348-020-35 PER SCREW 3.5X20MM,C1713,HCPCS,,79004766,CDM,278,RC,,,both,,,116,45.78,39.4668,,45.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,40.6,35,,40.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,46.4,40,,46.4,percent of total billed charges,Implant Devices,40.6,70,,40.6,percent of total billed charges,Implant Devices,39.44,34,,39.44,percent of total billed charges,Implant Devices,39.44,34,,39.44,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.4,
ZIMMER 02.03155.065 NCB CORT SCREW 4X65,C1713,HCPCS,,79004768,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 4865-65-02 CANC SCREW 6.5X65MM,C1713,HCPCS,,79004769,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ZIMMER 4936-010-07 10 HOLE 1/3 TUB PLATE,C1713,HCPCS,,79004771,CDM,278,RC,,,both,,,1426,562.8,39.4668,,562.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,499.1,35,,499.1,percent of total billed charges,Implant Device,484.84,34,"Charges > $500, x 34%",484.84,percent of total billed charges,Implant Device,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,570.4,40,,570.4,percent of total billed charges,Implant Devices,499.1,70,,499.1,percent of total billed charges,Implant Devices,484.84,34,,484.84,percent of total billed charges,Implant Devices,484.84,34,,484.84,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,570.4,
ZIMMER 00-1147-070-40 CANN SCREW 4X70MM,C1713,HCPCS,,79004772,CDM,278,RC,,,both,,,574,226.54,39.4668,,226.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Device,195.16,34,"Charges > $500, x 34%",195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,229.6,40,,229.6,percent of total billed charges,Implant Devices,200.9,70,,200.9,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,229.6,
ZIMMER 2359-30-55 CANN LOCK SCREW 5.5X30,C1713,HCPCS,,79004773,CDM,278,RC,,,both,,,562,221.8,39.4668,,221.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Device,191.08,34,"Charges > $500, x 34%",191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,224.8,40,,224.8,percent of total billed charges,Implant Devices,196.7,70,,196.7,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224.8,
ZIMMER 00-1147-50-40 CANN SCREW 4X50MM,C1713,HCPCS,,79004774,CDM,278,RC,,,both,,,558,220.22,39.4668,,220.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Device,189.72,34,"Charges > $500, x 34%",189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,223.2,40,,223.2,percent of total billed charges,Implant Devices,195.3,70,,195.3,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.2,
ZIMMER 00-1147-20-35 CAN SCREW 3.5X20MM,C1713,HCPCS,,79004776,CDM,278,RC,,,both,,,532,209.96,39.4668,,209.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,180.88,34,,180.88,percent of total billed charges,Implant Device,186.2,35,,186.2,percent of total billed charges,Implant Device,180.88,34,"Charges > $500, x 34%",180.88,percent of total billed charges,Implant Device,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,212.8,40,,212.8,percent of total billed charges,Implant Devices,186.2,70,,186.2,percent of total billed charges,Implant Devices,180.88,34,,180.88,percent of total billed charges,Implant Devices,180.88,34,,180.88,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,186.2,35,,186.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,212.8,
ZIMMER 1147-056-45 SCREW 4.5X56MM,C1713,HCPCS,,79004781,CDM,278,RC,,,both,,,546,215.49,39.4668,,215.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Device,185.64,34,"Charges > $500, x 34%",185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,218.4,40,,218.4,percent of total billed charges,Implant Devices,191.1,70,,191.1,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
ZIMMER 2359-75-55 CAN LOCK SCREW 5.5X75,C1713,HCPCS,,79004783,CDM,278,RC,,,both,,,562,221.8,39.4668,,221.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Device,191.08,34,"Charges > $500, x 34%",191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,224.8,40,,224.8,percent of total billed charges,Implant Devices,196.7,70,,196.7,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224.8,
ZIMMER 2359-80-55 CANN SCREW 5.5X80MM,C1713,HCPCS,,79004785,CDM,278,RC,,,both,,,562,221.8,39.4668,,221.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Device,191.08,34,"Charges > $500, x 34%",191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,224.8,40,,224.8,percent of total billed charges,Implant Devices,196.7,70,,196.7,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224.8,
ZIMMER 00-2348-012-35 CORT SCREW 3.5X2.7,C1713,HCPCS,,79004786,CDM,278,RC,,,both,,,113,44.6,39.4668,,44.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,45.2,40,,45.2,percent of total billed charges,Implant Devices,39.55,70,,39.55,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.2,
ZIMMER 002359-014-38 LOCK SCREW 3.5X14MM,C1713,HCPCS,,79004787,CDM,278,RC,,,both,,,281,110.9,39.4668,,110.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,98.35,35,,98.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,112.4,40,,112.4,percent of total billed charges,Implant Devices,98.35,70,,98.35,percent of total billed charges,Implant Devices,95.54,34,,95.54,percent of total billed charges,Implant Devices,95.54,34,,95.54,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.4,
ZIMMER 00-2480-040-40 CANC SCREW 4X40MM,C1713,HCPCS,,79004789,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ZIMMER 00-1147-044-41 CANN CREW 4X44MM,C1713,HCPCS,,79004790,CDM,278,RC,,,both,,,558,220.22,39.4668,,220.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Device,189.72,34,"Charges > $500, x 34%",189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,223.2,40,,223.2,percent of total billed charges,Implant Devices,195.3,70,,195.3,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.2,
ZIMMER 00-2357-017-06 FIB LCK PLT 6H 106,C1713,HCPCS,,79004791,CDM,278,RC,,,both,,,2160,852.48,39.4668,,852.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,756,35,,756,percent of total billed charges,Implant Device,734.4,34,"Charges > $500, x 34%",734.4,percent of total billed charges,Implant Device,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,864,40,,864,percent of total billed charges,Implant Devices,756,70,,756,percent of total billed charges,Implant Devices,734.4,34,,734.4,percent of total billed charges,Implant Devices,734.4,34,,734.4,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,734.4,34,"If Charge > 2,000, then 34 percent",734.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,864,
ZIMMER 00-4840-020-00 CANC SCREW 4X20MM,C1713,HCPCS,,79004793,CDM,278,RC,,,both,,,56,22.1,39.4668,,22.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.6,35,,19.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,22.4,40,,22.4,percent of total billed charges,Implant Devices,19.6,70,,19.6,percent of total billed charges,Implant Devices,19.04,34,,19.04,percent of total billed charges,Implant Devices,19.04,34,,19.04,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.4,
ZIMMER 4836-005-03 5H PLATE 1/3 TUBULAR,C1713,HCPCS,,79004794,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
ZIMMER 00-2348-022-35 SCREW 3.5X22MM,C1713,HCPCS,,79004795,CDM,278,RC,,,both,,,276,108.93,39.4668,,108.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,96.6,35,,96.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,110.4,40,,110.4,percent of total billed charges,Implant Devices,96.6,70,,96.6,percent of total billed charges,Implant Devices,93.84,34,,93.84,percent of total billed charges,Implant Devices,93.84,34,,93.84,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.4,
ZIMMER 02-03150-032 CORT SCREW 5X32MM,C1713,HCPCS,,79004796,CDM,278,RC,,,both,,,523,206.41,39.4668,,206.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Device,177.82,34,"Charges > $500, x 34%",177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,209.2,40,,209.2,percent of total billed charges,Implant Devices,183.05,70,,183.05,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.2,
ZIMMER 2347-20-26 CORT SCREW 3.5X26MM,C1713,HCPCS,,79004799,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
ZIMMER 00-2357-017-04 FIB LCK PLT 4H 80M,C1713,HCPCS,,79004801,CDM,278,RC,,,both,,,2080,820.91,39.4668,,820.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,707.2,34,,707.2,percent of total billed charges,Implant Device,707.2,34,,707.2,percent of total billed charges,Implant Device,707.2,34,,707.2,percent of total billed charges,Implant Device,707.2,34,,707.2,percent of total billed charges,Implant Device,707.2,34,,707.2,percent of total billed charges,Implant Device,707.2,34,,707.2,percent of total billed charges,Implant Device,728,35,,728,percent of total billed charges,Implant Device,707.2,34,"Charges > $500, x 34%",707.2,percent of total billed charges,Implant Device,728,35,,728,percent of total billed charges,Implant Devices,728,35,,728,percent of total billed charges,Implant Devices,728,35,,,percent of total billed charges,Implant Devices,728,35,,728,percent of total billed charges,Implant Devices,728,35,,728,percent of total billed charges,Implant Devices,832,40,,832,percent of total billed charges,Implant Devices,728,70,,728,percent of total billed charges,Implant Devices,707.2,34,,707.2,percent of total billed charges,Implant Devices,707.2,34,,707.2,percent of total billed charges,Implant Devices,728,35,,728,percent of total billed charges,Implant Devices,728,35,,728,percent of total billed charges,Implant Devices,728,35,,728,percent of total billed charges,Implant Devices,728,35,,728,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,707.2,34,"If Charge > 2,000, then 34 percent",707.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,832,
ZIMMER 4936-008-13 8 HOLE RECON PLATE,C1713,HCPCS,,79004802,CDM,278,RC,,,both,,,1493,589.24,39.4668,,589.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,507.62,34,,507.62,percent of total billed charges,Implant Device,507.62,34,,507.62,percent of total billed charges,Implant Device,507.62,34,,507.62,percent of total billed charges,Implant Device,507.62,34,,507.62,percent of total billed charges,Implant Device,507.62,34,,507.62,percent of total billed charges,Implant Device,507.62,34,,507.62,percent of total billed charges,Implant Device,522.55,35,,522.55,percent of total billed charges,Implant Device,507.62,34,"Charges > $500, x 34%",507.62,percent of total billed charges,Implant Device,522.55,35,,522.55,percent of total billed charges,Implant Devices,522.55,35,,522.55,percent of total billed charges,Implant Devices,522.55,35,,,percent of total billed charges,Implant Devices,522.55,35,,522.55,percent of total billed charges,Implant Devices,522.55,35,,522.55,percent of total billed charges,Implant Devices,597.2,40,,597.2,percent of total billed charges,Implant Devices,522.55,70,,522.55,percent of total billed charges,Implant Devices,507.62,34,,507.62,percent of total billed charges,Implant Devices,507.62,34,,507.62,percent of total billed charges,Implant Devices,522.55,35,,522.55,percent of total billed charges,Implant Devices,522.55,35,,522.55,percent of total billed charges,Implant Devices,522.55,35,,522.55,percent of total billed charges,Implant Devices,522.55,35,,522.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,597.2,
ZIMMER 1147-050-40 CANN SCREW 1X3 4X50MM,C1713,HCPCS,,79004803,CDM,278,RC,,,both,,,558,220.22,39.4668,,220.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,189.72,34,,189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Device,189.72,34,"Charges > $500, x 34%",189.72,percent of total billed charges,Implant Device,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,223.2,40,,223.2,percent of total billed charges,Implant Devices,195.3,70,,195.3,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,189.72,34,,189.72,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,195.3,35,,195.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,223.2,
ZIMMER 4836-006-03 LEFT PLATE,C1713,HCPCS,,79004804,CDM,278,RC,,,both,,,433,170.89,39.4668,,170.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,147.22,34,,147.22,percent of total billed charges,Implant Device,147.22,34,,147.22,percent of total billed charges,Implant Device,147.22,34,,147.22,percent of total billed charges,Implant Device,147.22,34,,147.22,percent of total billed charges,Implant Device,147.22,34,,147.22,percent of total billed charges,Implant Device,147.22,34,,147.22,percent of total billed charges,Implant Device,151.55,35,,151.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.55,35,,151.55,percent of total billed charges,Implant Devices,151.55,35,,151.55,percent of total billed charges,Implant Devices,151.55,35,,,percent of total billed charges,Implant Devices,151.55,35,,151.55,percent of total billed charges,Implant Devices,151.55,35,,151.55,percent of total billed charges,Implant Devices,173.2,40,,173.2,percent of total billed charges,Implant Devices,151.55,70,,151.55,percent of total billed charges,Implant Devices,147.22,34,,147.22,percent of total billed charges,Implant Devices,147.22,34,,147.22,percent of total billed charges,Implant Devices,151.55,35,,151.55,percent of total billed charges,Implant Devices,151.55,35,,151.55,percent of total billed charges,Implant Devices,151.55,35,,151.55,percent of total billed charges,Implant Devices,151.55,35,,151.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,173.2,
ZIMMER 00-4828-016-02 LOCK SCREW 2.7X16,C1713,HCPCS,,79004805,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ZIMMER 2357-018-08 DISTAL FIBULA PLATE,C1713,HCPCS,,79004806,CDM,278,RC,,,both,,,2224,877.74,39.4668,,877.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,756.16,34,,756.16,percent of total billed charges,Implant Device,756.16,34,,756.16,percent of total billed charges,Implant Device,756.16,34,,756.16,percent of total billed charges,Implant Device,756.16,34,,756.16,percent of total billed charges,Implant Device,756.16,34,,756.16,percent of total billed charges,Implant Device,756.16,34,,756.16,percent of total billed charges,Implant Device,778.4,35,,778.4,percent of total billed charges,Implant Device,756.16,34,"Charges > $500, x 34%",756.16,percent of total billed charges,Implant Device,778.4,35,,778.4,percent of total billed charges,Implant Devices,778.4,35,,778.4,percent of total billed charges,Implant Devices,778.4,35,,,percent of total billed charges,Implant Devices,778.4,35,,778.4,percent of total billed charges,Implant Devices,778.4,35,,778.4,percent of total billed charges,Implant Devices,889.6,40,,889.6,percent of total billed charges,Implant Devices,778.4,70,,778.4,percent of total billed charges,Implant Devices,756.16,34,,756.16,percent of total billed charges,Implant Devices,756.16,34,,756.16,percent of total billed charges,Implant Devices,778.4,35,,778.4,percent of total billed charges,Implant Devices,778.4,35,,778.4,percent of total billed charges,Implant Devices,778.4,35,,778.4,percent of total billed charges,Implant Devices,778.4,35,,778.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,756.16,34,"If Charge > 2,000, then 34 percent",756.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,889.6,
ZIMMER 00-2359-012-27 LOCK SCREW 2.7X12,C1713,HCPCS,,79004807,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
ZIMMER 02-03155-030 NCB CORT SCREW 4X30M,C1713,HCPCS,,79004809,CDM,278,RC,,,both,,,402,158.66,39.4668,,158.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,160.8,40,,160.8,percent of total billed charges,Implant Devices,140.7,70,,140.7,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,160.8,
ZIMMER 4835-024-01 CORT SCREW 3.5X24MM,C1713,HCPCS,,79004813,CDM,278,RC,,,both,,,144,56.83,39.4668,,56.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,50.4,35,,50.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,57.6,40,,57.6,percent of total billed charges,Implant Devices,50.4,70,,50.4,percent of total billed charges,Implant Devices,48.96,34,,48.96,percent of total billed charges,Implant Devices,48.96,34,,48.96,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,57.6,
ZIMMER 2347-20-10 CORT SCREW 3.5X10MM,C1713,HCPCS,,79004814,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
ZIMMER 00-4936-008-03 8H PLATE 3.5X107MM,C1713,HCPCS,,79004815,CDM,278,RC,,,both,,,490,193.39,39.4668,,193.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,171.5,35,,171.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,196,40,,196,percent of total billed charges,Implant Devices,171.5,70,,171.5,percent of total billed charges,Implant Devices,166.6,34,,166.6,percent of total billed charges,Implant Devices,166.6,34,,166.6,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196,
ARTHREX AR-2654CR PLATE CENTRAL THIRD,C1713,HCPCS,,79004816,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ARTHREX AR-8835L-12 LOCK SCREW 3.5X12MM,C1713,HCPCS,,79004817,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
STRYKER 58-23022E BONE SCREW 2.3MM,C1713,HCPCS,,79004819,CDM,278,RC,,,both,,,283,111.69,39.4668,,111.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,96.22,34,,96.22,percent of total billed charges,Implant Device,99.05,35,,99.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,113.2,40,,113.2,percent of total billed charges,Implant Devices,99.05,70,,99.05,percent of total billed charges,Implant Devices,96.22,34,,96.22,percent of total billed charges,Implant Devices,96.22,34,,96.22,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,99.05,35,,99.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,113.2,
STRYKER 3225-0380S LONG NAIL R2.0 11X380,C1713,HCPCS,,79004825,CDM,278,RC,,,both,,,10162,4010.62,39.4668,,4010.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3556.7,35,,3556.7,percent of total billed charges,Implant Device,3455.08,34,"Charges > $500, x 34%",3455.08,percent of total billed charges,Implant Device,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,4064.8,40,,4064.8,percent of total billed charges,Implant Devices,3556.7,70,,3556.7,percent of total billed charges,Implant Devices,3455.08,34,,3455.08,percent of total billed charges,Implant Devices,3455.08,34,,3455.08,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3455.08,34,"If Charge > 2,000, then 34 percent",3455.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4064.8,
STRYKER 3060-105S LAG SCREW 10.5X105MM,C1713,HCPCS,,79004826,CDM,278,RC,,,both,,,2153,849.72,39.4668,,849.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,732.02,34,,732.02,percent of total billed charges,Implant Device,732.02,34,,732.02,percent of total billed charges,Implant Device,732.02,34,,732.02,percent of total billed charges,Implant Device,732.02,34,,732.02,percent of total billed charges,Implant Device,732.02,34,,732.02,percent of total billed charges,Implant Device,732.02,34,,732.02,percent of total billed charges,Implant Device,753.55,35,,753.55,percent of total billed charges,Implant Device,732.02,34,"Charges > $500, x 34%",732.02,percent of total billed charges,Implant Device,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,861.2,40,,861.2,percent of total billed charges,Implant Devices,753.55,70,,753.55,percent of total billed charges,Implant Devices,732.02,34,,732.02,percent of total billed charges,Implant Devices,732.02,34,,732.02,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,732.02,34,"If Charge > 2,000, then 34 percent",732.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,861.2,
STRYKER 1896-5050S LOCKING SCREW FT 5X50,C1713,HCPCS,,79004828,CDM,278,RC,,,both,,,355,140.11,39.4668,,140.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,142,40,,142,percent of total billed charges,Implant Devices,124.25,70,,124.25,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142,
STRYKER 54-25295 DORSAL PLATE STD 81MM,C1713,HCPCS,,79004829,CDM,278,RC,,,both,,,3570,1408.96,39.4668,,1408.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1213.8,34,,1213.8,percent of total billed charges,Implant Device,1249.5,35,,1249.5,percent of total billed charges,Implant Device,1213.8,34,"Charges > $500, x 34%",1213.8,percent of total billed charges,Implant Device,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1428,40,,1428,percent of total billed charges,Implant Devices,1249.5,70,,1249.5,percent of total billed charges,Implant Devices,1213.8,34,,1213.8,percent of total billed charges,Implant Devices,1213.8,34,,1213.8,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,1249.5,35,,1249.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1213.8,34,"If Charge > 2,000, then 34 percent",1213.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1428,
STRYKER 53-23622E T7 LOCK SCREW 2.3X22MM,C1713,HCPCS,,79004830,CDM,278,RC,,,both,,,518,204.44,39.4668,,204.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,181.3,35,,181.3,percent of total billed charges,Implant Device,176.12,34,"Charges > $500, x 34%",176.12,percent of total billed charges,Implant Device,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,207.2,40,,207.2,percent of total billed charges,Implant Devices,181.3,70,,181.3,percent of total billed charges,Implant Devices,176.12,34,,176.12,percent of total billed charges,Implant Devices,176.12,34,,176.12,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,207.2,
STRYKER 53-23624E T7 LOCK SCREW 2.3X24MM,C1713,HCPCS,,79004831,CDM,278,RC,,,both,,,518,204.44,39.4668,,204.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,181.3,35,,181.3,percent of total billed charges,Implant Device,176.12,34,"Charges > $500, x 34%",176.12,percent of total billed charges,Implant Device,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,207.2,40,,207.2,percent of total billed charges,Implant Devices,181.3,70,,181.3,percent of total billed charges,Implant Devices,176.12,34,,176.12,percent of total billed charges,Implant Devices,176.12,34,,176.12,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,207.2,
STRYKER 53-27218E T7 BONE SCREW 2.7X18MM,C1713,HCPCS,,79004833,CDM,278,RC,,,both,,,388,153.13,39.4668,,153.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,131.92,34,,131.92,percent of total billed charges,Implant Device,131.92,34,,131.92,percent of total billed charges,Implant Device,131.92,34,,131.92,percent of total billed charges,Implant Device,131.92,34,,131.92,percent of total billed charges,Implant Device,131.92,34,,131.92,percent of total billed charges,Implant Device,131.92,34,,131.92,percent of total billed charges,Implant Device,135.8,35,,135.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,135.8,35,,135.8,percent of total billed charges,Implant Devices,135.8,35,,135.8,percent of total billed charges,Implant Devices,135.8,35,,,percent of total billed charges,Implant Devices,135.8,35,,135.8,percent of total billed charges,Implant Devices,135.8,35,,135.8,percent of total billed charges,Implant Devices,155.2,40,,155.2,percent of total billed charges,Implant Devices,135.8,70,,135.8,percent of total billed charges,Implant Devices,131.92,34,,131.92,percent of total billed charges,Implant Devices,131.92,34,,131.92,percent of total billed charges,Implant Devices,135.8,35,,135.8,percent of total billed charges,Implant Devices,135.8,35,,135.8,percent of total billed charges,Implant Devices,135.8,35,,135.8,percent of total billed charges,Implant Devices,135.8,35,,135.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,155.2,
STRYKER 427038 8 HOLE RECON PLATE 4.0MM,C1713,HCPCS,,79004834,CDM,278,RC,,,both,,,1913,755,39.4668,,755,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,650.42,34,,650.42,percent of total billed charges,Implant Device,650.42,34,,650.42,percent of total billed charges,Implant Device,650.42,34,,650.42,percent of total billed charges,Implant Device,650.42,34,,650.42,percent of total billed charges,Implant Device,650.42,34,,650.42,percent of total billed charges,Implant Device,650.42,34,,650.42,percent of total billed charges,Implant Device,669.55,35,,669.55,percent of total billed charges,Implant Device,650.42,34,"Charges > $500, x 34%",650.42,percent of total billed charges,Implant Device,669.55,35,,669.55,percent of total billed charges,Implant Devices,669.55,35,,669.55,percent of total billed charges,Implant Devices,669.55,35,,,percent of total billed charges,Implant Devices,669.55,35,,669.55,percent of total billed charges,Implant Devices,669.55,35,,669.55,percent of total billed charges,Implant Devices,765.2,40,,765.2,percent of total billed charges,Implant Devices,669.55,70,,669.55,percent of total billed charges,Implant Devices,650.42,34,,650.42,percent of total billed charges,Implant Devices,650.42,34,,650.42,percent of total billed charges,Implant Devices,669.55,35,,669.55,percent of total billed charges,Implant Devices,669.55,35,,669.55,percent of total billed charges,Implant Devices,669.55,35,,669.55,percent of total billed charges,Implant Devices,669.55,35,,669.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,765.2,
STRYKER 338616 STD SCREW 3.5X16MM,C1713,HCPCS,,79004835,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 338618 STD SCREW 3.5X18MM,C1713,HCPCS,,79004836,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 338640 STD SCREW 3.5X40MM,C1713,HCPCS,,79004837,CDM,278,RC,,,both,,,102,40.26,39.4668,,40.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,35.7,35,,35.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,40.8,40,,40.8,percent of total billed charges,Implant Devices,35.7,70,,35.7,percent of total billed charges,Implant Devices,34.68,34,,34.68,percent of total billed charges,Implant Devices,34.68,34,,34.68,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40.8,
STRYKER 338646 STD SCREW 3.5X46MM,C1713,HCPCS,,79004838,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 338648 STD SCREW 3.5X48MM,C1713,HCPCS,,79004839,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 338612 STD SCREW 3.5X12MM,C1713,HCPCS,,79004840,CDM,278,RC,,,both,,,102,40.26,39.4668,,40.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,35.7,35,,35.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,40.8,40,,40.8,percent of total billed charges,Implant Devices,35.7,70,,35.7,percent of total billed charges,Implant Devices,34.68,34,,34.68,percent of total billed charges,Implant Devices,34.68,34,,34.68,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40.8,
STRYKER 345520 CANCLLOUS SCREW PT 4X20MM,C1713,HCPCS,,79004841,CDM,278,RC,,,both,,,89,35.13,39.4668,,35.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,31.15,35,,31.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,35.6,40,,35.6,percent of total billed charges,Implant Devices,31.15,70,,31.15,percent of total billed charges,Implant Devices,30.26,34,,30.26,percent of total billed charges,Implant Devices,30.26,34,,30.26,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.6,
STRYKER 53-27222E T7 BONE SCREW 2.7X22MM,C1713,HCPCS,,79004854,CDM,278,RC,,,both,,,374,147.61,39.4668,,147.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,130.9,35,,130.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,149.6,40,,149.6,percent of total billed charges,Implant Devices,130.9,70,,130.9,percent of total billed charges,Implant Devices,127.16,34,,127.16,percent of total billed charges,Implant Devices,127.16,34,,127.16,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,149.6,
STRYKER 3060-0095S LAG SCREW 10.5X95MM,C1713,HCPCS,,79004857,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
STRYKER 1896-5037S LOCK SCREW 5X37 5 MM,C1713,HCPCS,,79004858,CDM,278,RC,,,both,,,355,140.11,39.4668,,140.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,142,40,,142,percent of total billed charges,Implant Devices,124.25,70,,124.25,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142,
STRYKER 1822-1139S TIBIAL NAIL 11X390MM,C1713,HCPCS,,79004859,CDM,278,RC,,,both,,,5440,2146.99,39.4668,,2146.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1849.6,34,,1849.6,percent of total billed charges,Implant Device,1849.6,34,,1849.6,percent of total billed charges,Implant Device,1849.6,34,,1849.6,percent of total billed charges,Implant Device,1849.6,34,,1849.6,percent of total billed charges,Implant Device,1849.6,34,,1849.6,percent of total billed charges,Implant Device,1849.6,34,,1849.6,percent of total billed charges,Implant Device,1904,35,,1904,percent of total billed charges,Implant Device,1849.6,34,"Charges > $500, x 34%",1849.6,percent of total billed charges,Implant Device,1904,35,,1904,percent of total billed charges,Implant Devices,1904,35,,1904,percent of total billed charges,Implant Devices,1904,35,,,percent of total billed charges,Implant Devices,1904,35,,1904,percent of total billed charges,Implant Devices,1904,35,,1904,percent of total billed charges,Implant Devices,2176,40,,2176,percent of total billed charges,Implant Devices,1904,70,,1904,percent of total billed charges,Implant Devices,1849.6,34,,1849.6,percent of total billed charges,Implant Devices,1849.6,34,,1849.6,percent of total billed charges,Implant Devices,1904,35,,1904,percent of total billed charges,Implant Devices,1904,35,,1904,percent of total billed charges,Implant Devices,1904,35,,1904,percent of total billed charges,Implant Devices,1904,35,,1904,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1849.6,34,"If Charge > 2,000, then 34 percent",1849.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2176,
STRYKER 1896-5055S LOCK SCREW FT 5X55MM,C1713,HCPCS,,79004860,CDM,278,RC,,,both,,,441,174.05,39.4668,,174.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,176.4,40,,176.4,percent of total billed charges,Implant Devices,154.35,70,,154.35,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,176.4,
STRYKER 1896-5052S LOCK SCREW FT 5X52MM,C1713,HCPCS,,79004861,CDM,278,RC,,,both,,,355,140.11,39.4668,,140.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,142,40,,142,percent of total billed charges,Implant Devices,124.25,70,,124.25,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142,
STRYKER 370520 LOCKING SCREW 4X20MM,C1713,HCPCS,,79004862,CDM,278,RC,,,both,,,464,183.13,39.4668,,183.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,162.4,35,,162.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,185.6,40,,185.6,percent of total billed charges,Implant Devices,162.4,70,,162.4,percent of total billed charges,Implant Devices,157.76,34,,157.76,percent of total billed charges,Implant Devices,157.76,34,,157.76,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,185.6,
STRYKER 370522 LOCKING SCREW 4X22MM,C1713,HCPCS,,79004863,CDM,278,RC,,,both,,,464,183.13,39.4668,,183.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,162.4,35,,162.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,185.6,40,,185.6,percent of total billed charges,Implant Devices,162.4,70,,162.4,percent of total billed charges,Implant Devices,157.76,34,,157.76,percent of total billed charges,Implant Devices,157.76,34,,157.76,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,185.6,
STRYKER 338614 CORTICAL SCREW 3.5X14MM,C1713,HCPCS,,79004864,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 345532 PT SCREW 4.0X32MM,C1713,HCPCS,,79004865,CDM,278,RC,,,both,,,89,35.13,39.4668,,35.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,30.26,34,,30.26,percent of total billed charges,Implant Device,31.15,35,,31.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,35.6,40,,35.6,percent of total billed charges,Implant Devices,31.15,70,,31.15,percent of total billed charges,Implant Devices,30.26,34,,30.26,percent of total billed charges,Implant Devices,30.26,34,,30.26,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,31.15,35,,31.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.6,
ZIMMER 00-6250-065-15 BONESCREW 6.5X15MM,C1713,HCPCS,,79004867,CDM,278,RC,,,both,,,428,168.92,39.4668,,168.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,171.2,40,,171.2,percent of total billed charges,Implant Devices,149.8,70,,149.8,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,171.2,
STRYKER 53-23618E LOCK SCREW T7 2.3X18MM,C1713,HCPCS,,79004870,CDM,278,RC,,,both,,,518,204.44,39.4668,,204.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,176.12,34,,176.12,percent of total billed charges,Implant Device,181.3,35,,181.3,percent of total billed charges,Implant Device,176.12,34,"Charges > $500, x 34%",176.12,percent of total billed charges,Implant Device,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,207.2,40,,207.2,percent of total billed charges,Implant Devices,181.3,70,,181.3,percent of total billed charges,Implant Devices,176.12,34,,176.12,percent of total billed charges,Implant Devices,176.12,34,,176.12,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,181.3,35,,181.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,207.2,
STRYKER 53-27618E LOCK SCREW T7 2.7X18MM,C1713,HCPCS,,79004871,CDM,278,RC,,,both,,,304,119.98,39.4668,,119.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,106.4,35,,106.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,121.6,40,,121.6,percent of total billed charges,Implant Devices,106.4,70,,106.4,percent of total billed charges,Implant Devices,103.36,34,,103.36,percent of total billed charges,Implant Devices,103.36,34,,103.36,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.6,
STRYKER 53-27212E BONE SCREW T2 2.7X12MM,C1713,HCPCS,,79004872,CDM,278,RC,,,both,,,190,74.99,39.4668,,74.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,64.6,34,,64.6,percent of total billed charges,Implant Device,64.6,34,,64.6,percent of total billed charges,Implant Device,64.6,34,,64.6,percent of total billed charges,Implant Device,64.6,34,,64.6,percent of total billed charges,Implant Device,64.6,34,,64.6,percent of total billed charges,Implant Device,64.6,34,,64.6,percent of total billed charges,Implant Device,66.5,35,,66.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,76,40,,76,percent of total billed charges,Implant Devices,66.5,70,,66.5,percent of total billed charges,Implant Devices,64.6,34,,64.6,percent of total billed charges,Implant Devices,64.6,34,,64.6,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,66.5,35,,66.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76,
STRYKER 40-20904 FIB LOCK PLATE 4 HOLE,C1713,HCPCS,,79004880,CDM,278,RC,,,both,,,1867,736.85,39.4668,,736.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,653.45,35,,653.45,percent of total billed charges,Implant Device,634.78,34,"Charges > $500, x 34%",634.78,percent of total billed charges,Implant Device,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,746.8,40,,746.8,percent of total billed charges,Implant Devices,653.45,70,,653.45,percent of total billed charges,Implant Devices,634.78,34,,634.78,percent of total billed charges,Implant Devices,634.78,34,,634.78,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,746.8,
STRYKER 40-35016 NON LOCK SCREW 3.5X16MM,C1713,HCPCS,,79004881,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
ACUMED 70-0361 PLATE ACULOC WIDE 2 HOLE,C1713,HCPCS,,79004886,CDM,278,RC,,,both,,,3552,1401.86,39.4668,,1401.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1207.68,34,,1207.68,percent of total billed charges,Implant Device,1207.68,34,,1207.68,percent of total billed charges,Implant Device,1207.68,34,,1207.68,percent of total billed charges,Implant Device,1207.68,34,,1207.68,percent of total billed charges,Implant Device,1207.68,34,,1207.68,percent of total billed charges,Implant Device,1207.68,34,,1207.68,percent of total billed charges,Implant Device,1243.2,35,,1243.2,percent of total billed charges,Implant Device,1207.68,34,"Charges > $500, x 34%",1207.68,percent of total billed charges,Implant Device,1243.2,35,,1243.2,percent of total billed charges,Implant Devices,1243.2,35,,1243.2,percent of total billed charges,Implant Devices,1243.2,35,,,percent of total billed charges,Implant Devices,1243.2,35,,1243.2,percent of total billed charges,Implant Devices,1243.2,35,,1243.2,percent of total billed charges,Implant Devices,1420.8,40,,1420.8,percent of total billed charges,Implant Devices,1243.2,70,,1243.2,percent of total billed charges,Implant Devices,1207.68,34,,1207.68,percent of total billed charges,Implant Devices,1207.68,34,,1207.68,percent of total billed charges,Implant Devices,1243.2,35,,1243.2,percent of total billed charges,Implant Devices,1243.2,35,,1243.2,percent of total billed charges,Implant Devices,1243.2,35,,1243.2,percent of total billed charges,Implant Devices,1243.2,35,,1243.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1207.68,34,"If Charge > 2,000, then 34 percent",1207.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1420.8,
ACUMED COT2320 LOCKING SCREW 2.3X20MM,C1713,HCPCS,,79004887,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
ACUMED COT2322 LOCKING SCREW 2.3X22MM,C1713,HCPCS,,79004888,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
ACUMED COT2326 LOCKING SCREW 2.3X26MM,C1713,HCPCS,,79004889,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
ACUMED COT2328 LOCKING SCREW 2.3X28MM,C1713,HCPCS,,79004890,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
ACUMED COT2330 LOCKING SCREW 2.3X30MM,C1713,HCPCS,,79004891,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
STRYKER 40-30115 ASNIS CANN SCREW,C1713,HCPCS,,79004894,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
ATLAS 1106-01-5545 APELO SCREW 5.5X45MM,C1713,HCPCS,,79004895,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ATLAS 1106-09-0000 LOCKING COLLAR,C1713,HCPCS,,79004896,CDM,278,RC,,,both,,,662,261.27,39.4668,,261.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,225.08,34,,225.08,percent of total billed charges,Implant Device,225.08,34,,225.08,percent of total billed charges,Implant Device,225.08,34,,225.08,percent of total billed charges,Implant Device,225.08,34,,225.08,percent of total billed charges,Implant Device,225.08,34,,225.08,percent of total billed charges,Implant Device,225.08,34,,225.08,percent of total billed charges,Implant Device,231.7,35,,231.7,percent of total billed charges,Implant Device,225.08,34,"Charges > $500, x 34%",225.08,percent of total billed charges,Implant Device,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,264.8,40,,264.8,percent of total billed charges,Implant Devices,231.7,70,,231.7,percent of total billed charges,Implant Devices,225.08,34,,225.08,percent of total billed charges,Implant Devices,225.08,34,,225.08,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264.8,
ATLAS 1100-03-0045 CONTOURED ROD 45MM,C1713,HCPCS,,79004897,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
STRYKER 40-35010 BONE SCREW 3.5X10MM,C1713,HCPCS,,79004902,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
STRYKER 604644 CANNULATED SCREW 4X44MM,C1713,HCPCS,,79004904,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
BIOMET TP20000 THREADED PEG 2.5X20MM,C1713,HCPCS,,79004905,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
SOLANA FFS-1212 FUSEFORCE IMP KIT 12X12,C1713,HCPCS,,79004907,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
INTEGRA 303102 SHORT BEND PLATE,C1713,HCPCS,,79004916,CDM,278,RC,,,both,,,3376,1332.4,39.4668,,1332.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1181.6,35,,1181.6,percent of total billed charges,Implant Device,1147.84,34,"Charges > $500, x 34%",1147.84,percent of total billed charges,Implant Device,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1350.4,40,,1350.4,percent of total billed charges,Implant Devices,1181.6,70,,1181.6,percent of total billed charges,Implant Devices,1147.84,34,,1147.84,percent of total billed charges,Implant Devices,1147.84,34,,1147.84,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1147.84,34,"If Charge > 2,000, then 34 percent",1147.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1350.4,
INTEGRA 303214 CORTICAL SCREW 2.7X14MM,C1713,HCPCS,,79004917,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
INTEGRA 303216 CORTICAL SCREW 2.7X16MM,C1713,HCPCS,,79004918,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
INTEGRA 303312 CORTICAL SCREW 3.5X 12MM,C1713,HCPCS,,79004919,CDM,278,RC,,,both,,,346,136.56,39.4668,,136.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,138.4,40,,138.4,percent of total billed charges,Implant Devices,121.1,70,,121.1,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138.4,
INTEGRA 303322 CORTICAL SCREW 3.5X22MM,C1713,HCPCS,,79004920,CDM,278,RC,,,both,,,346,136.56,39.4668,,136.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,138.4,40,,138.4,percent of total billed charges,Implant Devices,121.1,70,,121.1,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138.4,
INTEGRA 286214ND SURFIX SCREW 2.7X14MM,C1713,HCPCS,,79004921,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
INTEGRA 286222ND SURFIX SCREW 2.7X22MM,C1713,HCPCS,,79004922,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
INTEGRA 186200ND SURFIX LOCK SCREW 2.7MM,C1713,HCPCS,,79004923,CDM,278,RC,,,both,,,466,183.92,39.4668,,183.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,163.1,35,,163.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,186.4,40,,186.4,percent of total billed charges,Implant Devices,163.1,70,,163.1,percent of total billed charges,Implant Devices,158.44,34,,158.44,percent of total billed charges,Implant Devices,158.44,34,,158.44,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,186.4,
INTEGRA 286312ND SURFIX SCREW 3.5X12MM,C1713,HCPCS,,79004924,CDM,278,RC,,,both,,,1110,438.08,39.4668,,438.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Device,377.4,34,"Charges > $500, x 34%",377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,444,40,,444,percent of total billed charges,Implant Devices,388.5,70,,388.5,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,444,
INTEGRA 286328ND SURFIX SCREW 3.5X28MM,C1713,HCPCS,,79004925,CDM,278,RC,,,both,,,1110,438.08,39.4668,,438.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Device,377.4,34,"Charges > $500, x 34%",377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,444,40,,444,percent of total billed charges,Implant Devices,388.5,70,,388.5,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,444,
BIOMET 01-7123 PLATE 4 HOLE,C1713,HCPCS,,79004941,CDM,278,RC,,,both,,,1119,441.63,39.4668,,441.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Device,380.46,34,"Charges > $500, x 34%",380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,447.6,40,,447.6,percent of total billed charges,Implant Devices,391.65,70,,391.65,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,447.6,
BIOMET 01-7104 PLATE 5 HOLE X LARGE,C1713,HCPCS,,79004942,CDM,278,RC,,,both,,,742,292.84,39.4668,,292.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,252.28,34,,252.28,percent of total billed charges,Implant Device,252.28,34,,252.28,percent of total billed charges,Implant Device,252.28,34,,252.28,percent of total billed charges,Implant Device,252.28,34,,252.28,percent of total billed charges,Implant Device,252.28,34,,252.28,percent of total billed charges,Implant Device,252.28,34,,252.28,percent of total billed charges,Implant Device,259.7,35,,259.7,percent of total billed charges,Implant Device,252.28,34,"Charges > $500, x 34%",252.28,percent of total billed charges,Implant Device,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,296.8,40,,296.8,percent of total billed charges,Implant Devices,259.7,70,,259.7,percent of total billed charges,Implant Devices,252.28,34,,252.28,percent of total billed charges,Implant Devices,252.28,34,,252.28,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,259.7,35,,259.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,296.8,
BIOMET 43-1005 PLATE 4 HOLE,C1713,HCPCS,,79004943,CDM,278,RC,,,both,,,2316,914.05,39.4668,,914.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,810.6,35,,810.6,percent of total billed charges,Implant Device,787.44,34,"Charges > $500, x 34%",787.44,percent of total billed charges,Implant Device,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,926.4,40,,926.4,percent of total billed charges,Implant Devices,810.6,70,,810.6,percent of total billed charges,Implant Devices,787.44,34,,787.44,percent of total billed charges,Implant Devices,787.44,34,,787.44,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,787.44,34,"If Charge > 2,000, then 34 percent",787.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,926.4,
BIOMET 43-1004 PLATE 4 HOLE LARGE,C1713,HCPCS,,79004944,CDM,278,RC,,,both,,,2316,914.05,39.4668,,914.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,810.6,35,,810.6,percent of total billed charges,Implant Device,787.44,34,"Charges > $500, x 34%",787.44,percent of total billed charges,Implant Device,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,926.4,40,,926.4,percent of total billed charges,Implant Devices,810.6,70,,810.6,percent of total billed charges,Implant Devices,787.44,34,,787.44,percent of total billed charges,Implant Devices,787.44,34,,787.44,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,787.44,34,"If Charge > 2,000, then 34 percent",787.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,926.4,
BIOMET 41-2314 NON LOCK SCREW 2.3X14MM,C1713,HCPCS,,79004945,CDM,278,RC,,,both,,,354,139.71,39.4668,,139.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,141.6,40,,141.6,percent of total billed charges,Implant Devices,123.9,70,,123.9,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,141.6,
BIOMET 41-2310 NON LOCK SCREW 2.3X10MM,C1713,HCPCS,,79004946,CDM,278,RC,,,both,,,354,139.71,39.4668,,139.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,141.6,40,,141.6,percent of total billed charges,Implant Devices,123.9,70,,123.9,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,141.6,
BIOMET 41-2308 NON LOCK SCREW 2.3X8MM,C1713,HCPCS,,79004947,CDM,278,RC,,,both,,,354,139.71,39.4668,,139.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,141.6,40,,141.6,percent of total billed charges,Implant Devices,123.9,70,,123.9,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,141.6,
BIOMET 41-2306 NON LOCK SCREW 2.3X6MM,C1713,HCPCS,,79004948,CDM,278,RC,,,both,,,354,139.71,39.4668,,139.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,141.6,40,,141.6,percent of total billed charges,Implant Devices,123.9,70,,123.9,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,141.6,
BIOMET 41-2318 NON LOCK SCREW 2.3X18MM,C1713,HCPCS,,79004949,CDM,278,RC,,,both,,,354,139.71,39.4668,,139.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,141.6,40,,141.6,percent of total billed charges,Implant Devices,123.9,70,,123.9,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,141.6,
BIOMET 41-2714 NON LOCK SCREW 2.7X14MM,C1713,HCPCS,,79004950,CDM,278,RC,,,both,,,354,139.71,39.4668,,139.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,141.6,40,,141.6,percent of total billed charges,Implant Devices,123.9,70,,123.9,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,141.6,
PAC 3 62004-07 CURVED ROD 7CM,C1713,HCPCS,,79004953,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
PAC 3 62005 SET SCREW,C1713,HCPCS,,79004954,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
PAC 3 11-2075 LARGE X-CONNECTOR,C1713,HCPCS,,79004955,CDM,278,RC,,,both,,,3750,1480.01,39.4668,,1480.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Device,1275,34,"Charges > $500, x 34%",1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1500,40,,1500,percent of total billed charges,Implant Devices,1312.5,70,,1312.5,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1275,34,"If Charge > 2,000, then 34 percent",1275,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
ARTHREX AR-8840P-50 CANN SCREW 4X50MM,C1713,HCPCS,,79004960,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
ARTHREX AR-8926SS KNOTLESS TIGHTROPE,C1713,HCPCS,,79004961,CDM,278,RC,,,both,,,2640,1041.92,39.4668,,1041.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,897.6,34,,897.6,percent of total billed charges,Implant Device,924,35,,924,percent of total billed charges,Implant Device,897.6,34,"Charges > $500, x 34%",897.6,percent of total billed charges,Implant Device,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,1056,40,,1056,percent of total billed charges,Implant Devices,924,70,,924,percent of total billed charges,Implant Devices,897.6,34,,897.6,percent of total billed charges,Implant Devices,897.6,34,,897.6,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,924,35,,924,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,897.6,34,"If Charge > 2,000, then 34 percent",897.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1056,
STRYKER 57-10140 PLATE 2.3MM,C1713,HCPCS,,79004974,CDM,278,RC,,,both,,,1107,436.9,39.4668,,436.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,376.38,34,,376.38,percent of total billed charges,Implant Device,376.38,34,,376.38,percent of total billed charges,Implant Device,376.38,34,,376.38,percent of total billed charges,Implant Device,376.38,34,,376.38,percent of total billed charges,Implant Device,376.38,34,,376.38,percent of total billed charges,Implant Device,376.38,34,,376.38,percent of total billed charges,Implant Device,387.45,35,,387.45,percent of total billed charges,Implant Device,376.38,34,"Charges > $500, x 34%",376.38,percent of total billed charges,Implant Device,387.45,35,,387.45,percent of total billed charges,Implant Devices,387.45,35,,387.45,percent of total billed charges,Implant Devices,387.45,35,,,percent of total billed charges,Implant Devices,387.45,35,,387.45,percent of total billed charges,Implant Devices,387.45,35,,387.45,percent of total billed charges,Implant Devices,442.8,40,,442.8,percent of total billed charges,Implant Devices,387.45,70,,387.45,percent of total billed charges,Implant Devices,376.38,34,,376.38,percent of total billed charges,Implant Devices,376.38,34,,376.38,percent of total billed charges,Implant Devices,387.45,35,,387.45,percent of total billed charges,Implant Devices,387.45,35,,387.45,percent of total billed charges,Implant Devices,387.45,35,,387.45,percent of total billed charges,Implant Devices,387.45,35,,387.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442.8,
STRYKER 57-05282 PLATE,C1713,HCPCS,,79004975,CDM,278,RC,,,both,,,1276,503.6,39.4668,,503.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,446.6,35,,446.6,percent of total billed charges,Implant Device,433.84,34,"Charges > $500, x 34%",433.84,percent of total billed charges,Implant Device,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,510.4,40,,510.4,percent of total billed charges,Implant Devices,446.6,70,,446.6,percent of total billed charges,Implant Devices,433.84,34,,433.84,percent of total billed charges,Implant Devices,433.84,34,,433.84,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510.4,
STRYKER 53-23010E LOCKING SCREW 2.3MM,C1713,HCPCS,,79004976,CDM,278,RC,,,both,,,515,203.25,39.4668,,203.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,180.25,35,,180.25,percent of total billed charges,Implant Device,175.1,34,"Charges > $500, x 34%",175.1,percent of total billed charges,Implant Device,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,206,40,,206,percent of total billed charges,Implant Devices,180.25,70,,180.25,percent of total billed charges,Implant Devices,175.1,34,,175.1,percent of total billed charges,Implant Devices,175.1,34,,175.1,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,206,
ATLAS 1106-01-6560 MODULAR SCREW 6.5X60,C1713,HCPCS,,79004982,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ATLAS 1100-01-0070 STRAIGHT ROD 5.5X70MM,C1713,HCPCS,,79004983,CDM,278,RC,,,both,,,736,290.48,39.4668,,290.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,250.24,34,,250.24,percent of total billed charges,Implant Device,250.24,34,,250.24,percent of total billed charges,Implant Device,250.24,34,,250.24,percent of total billed charges,Implant Device,250.24,34,,250.24,percent of total billed charges,Implant Device,250.24,34,,250.24,percent of total billed charges,Implant Device,250.24,34,,250.24,percent of total billed charges,Implant Device,257.6,35,,257.6,percent of total billed charges,Implant Device,250.24,34,"Charges > $500, x 34%",250.24,percent of total billed charges,Implant Device,257.6,35,,257.6,percent of total billed charges,Implant Devices,257.6,35,,257.6,percent of total billed charges,Implant Devices,257.6,35,,,percent of total billed charges,Implant Devices,257.6,35,,257.6,percent of total billed charges,Implant Devices,257.6,35,,257.6,percent of total billed charges,Implant Devices,294.4,40,,294.4,percent of total billed charges,Implant Devices,257.6,70,,257.6,percent of total billed charges,Implant Devices,250.24,34,,250.24,percent of total billed charges,Implant Devices,250.24,34,,250.24,percent of total billed charges,Implant Devices,257.6,35,,257.6,percent of total billed charges,Implant Devices,257.6,35,,257.6,percent of total billed charges,Implant Devices,257.6,35,,257.6,percent of total billed charges,Implant Devices,257.6,35,,257.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294.4,
BIOMET 28234 TROCH NAIL LONG 11MM 34CM,C1713,HCPCS,,79004984,CDM,278,RC,,,both,,,11040,4357.13,39.4668,,4357.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Device,3753.6,34,"Charges > $500, x 34%",3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,4416,40,,4416,percent of total billed charges,Implant Devices,3864,70,,3864,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3753.6,34,"If Charge > 2,000, then 34 percent",3753.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4416,
BIOMET 29278 LAG SCREW SOLID SLIDNG 95MM,C1713,HCPCS,,79004985,CDM,278,RC,,,both,,,2670,1053.76,39.4668,,1053.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,934.5,35,,934.5,percent of total billed charges,Implant Device,907.8,34,"Charges > $500, x 34%",907.8,percent of total billed charges,Implant Device,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,1068,40,,1068,percent of total billed charges,Implant Devices,934.5,70,,934.5,percent of total billed charges,Implant Devices,907.8,34,,907.8,percent of total billed charges,Implant Devices,907.8,34,,907.8,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,907.8,34,"If Charge > 2,000, then 34 percent",907.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1068,
STRYKER 3704-0-050 BEAD CABLE SLEEVE 2MM,C1713,HCPCS,,79004994,CDM,278,RC,,,both,,,1536,606.21,39.4668,,606.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Device,522.24,34,"Charges > $500, x 34%",522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,614.4,40,,614.4,percent of total billed charges,Implant Devices,537.6,70,,537.6,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,614.4,
ARTHREX AR-13200-075 WEDGE PLATE 7.5MM,C1713,HCPCS,,79004995,CDM,278,RC,,,both,,,2230,880.11,39.4668,,880.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,758.2,34,,758.2,percent of total billed charges,Implant Device,758.2,34,,758.2,percent of total billed charges,Implant Device,758.2,34,,758.2,percent of total billed charges,Implant Device,758.2,34,,758.2,percent of total billed charges,Implant Device,758.2,34,,758.2,percent of total billed charges,Implant Device,758.2,34,,758.2,percent of total billed charges,Implant Device,780.5,35,,780.5,percent of total billed charges,Implant Device,758.2,34,"Charges > $500, x 34%",758.2,percent of total billed charges,Implant Device,780.5,35,,780.5,percent of total billed charges,Implant Devices,780.5,35,,780.5,percent of total billed charges,Implant Devices,780.5,35,,,percent of total billed charges,Implant Devices,780.5,35,,780.5,percent of total billed charges,Implant Devices,780.5,35,,780.5,percent of total billed charges,Implant Devices,892,40,,892,percent of total billed charges,Implant Devices,780.5,70,,780.5,percent of total billed charges,Implant Devices,758.2,34,,758.2,percent of total billed charges,Implant Devices,758.2,34,,758.2,percent of total billed charges,Implant Devices,780.5,35,,780.5,percent of total billed charges,Implant Devices,780.5,35,,780.5,percent of total billed charges,Implant Devices,780.5,35,,780.5,percent of total billed charges,Implant Devices,780.5,35,,780.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,758.2,34,"If Charge > 2,000, then 34 percent",758.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,892,
BIOMET 8161-35-016 LOCK SCREW 3.5X16MM,C1713,HCPCS,,79004998,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 1312-18-014 CORT SCREW 3.5X14MM,C1713,HCPCS,,79004999,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 1312-18-016 CORT SCREW 3.5X16MM,C1713,HCPCS,,79005000,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 8162-06-004 FIBULA LOCK LT 4 HOLE,C1713,HCPCS,,79005001,CDM,278,RC,,,both,,,3480,1373.44,39.4668,,1373.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1218,35,,1218,percent of total billed charges,Implant Device,1183.2,34,"Charges > $500, x 34%",1183.2,percent of total billed charges,Implant Device,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1392,40,,1392,percent of total billed charges,Implant Devices,1218,70,,1218,percent of total billed charges,Implant Devices,1183.2,34,,1183.2,percent of total billed charges,Implant Devices,1183.2,34,,1183.2,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1183.2,34,"If Charge > 2,000, then 34 percent",1183.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1392,
ZIMMER 2347-23-36 PERIART SCREW 4.5X36MM,C1713,HCPCS,,79005004,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
ZIMMER 2347-23-40 PERIART SCREW 4.5X40MM,C1713,HCPCS,,79005005,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
ZIMMER 2347-23-42 PERIART SCREW 4.5X42MM,C1713,HCPCS,,79005006,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
ZIMMER 2347-23-44 PERIART SCREW 4.5X44MM,C1713,HCPCS,,79005007,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
ZIMMER 2347-23-50 PERIART SCREW 4.5X50MM,C1713,HCPCS,,79005008,CDM,278,RC,,,both,,,91,35.91,39.4668,,35.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.94,34,,30.94,percent of total billed charges,Implant Device,30.94,34,,30.94,percent of total billed charges,Implant Device,30.94,34,,30.94,percent of total billed charges,Implant Device,30.94,34,,30.94,percent of total billed charges,Implant Device,30.94,34,,30.94,percent of total billed charges,Implant Device,30.94,34,,30.94,percent of total billed charges,Implant Device,31.85,35,,31.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,31.85,35,,31.85,percent of total billed charges,Implant Devices,31.85,35,,31.85,percent of total billed charges,Implant Devices,31.85,35,,,percent of total billed charges,Implant Devices,31.85,35,,31.85,percent of total billed charges,Implant Devices,31.85,35,,31.85,percent of total billed charges,Implant Devices,36.4,40,,36.4,percent of total billed charges,Implant Devices,31.85,70,,31.85,percent of total billed charges,Implant Devices,30.94,34,,30.94,percent of total billed charges,Implant Devices,30.94,34,,30.94,percent of total billed charges,Implant Devices,31.85,35,,31.85,percent of total billed charges,Implant Devices,31.85,35,,31.85,percent of total billed charges,Implant Devices,31.85,35,,31.85,percent of total billed charges,Implant Devices,31.85,35,,31.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,36.4,
ZIMMER 2347-26-40 PERIART SCREW 6.5X40MM,C1713,HCPCS,,79005009,CDM,278,RC,,,both,,,101,39.86,39.4668,,39.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,35.35,35,,35.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,40.4,40,,40.4,percent of total billed charges,Implant Devices,35.35,70,,35.35,percent of total billed charges,Implant Devices,34.34,34,,34.34,percent of total billed charges,Implant Devices,34.34,34,,34.34,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40.4,
ZIMMER 2347-26-45 PERIART SCREW 6.5X45MM,C1713,HCPCS,,79005010,CDM,278,RC,,,both,,,101,39.86,39.4668,,39.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,35.35,35,,35.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,40.4,40,,40.4,percent of total billed charges,Implant Devices,35.35,70,,35.35,percent of total billed charges,Implant Devices,34.34,34,,34.34,percent of total billed charges,Implant Devices,34.34,34,,34.34,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40.4,
ZIMMER 2347-26-50 PERIART SCREW 6.5X50MM,C1713,HCPCS,,79005011,CDM,278,RC,,,both,,,101,39.86,39.4668,,39.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,35.35,35,,35.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,40.4,40,,40.4,percent of total billed charges,Implant Devices,35.35,70,,35.35,percent of total billed charges,Implant Devices,34.34,34,,34.34,percent of total billed charges,Implant Devices,34.34,34,,34.34,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40.4,
BIOMET 8162-35-707 TIB LOCK PLATE 7 HOLE,C1713,HCPCS,,79005012,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
BIOMET 1312-18-040 CORT SCREW 3.5X40MM,C1713,HCPCS,,79005013,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
BIOMET 1312-18-044 CORT SCREW 3.5X44MM,C1713,HCPCS,,79005014,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 8163-35-070 LOCK SCREW 3.5X70MM,C1713,HCPCS,,79005015,CDM,278,RC,,,both,,,930,367.04,39.4668,,367.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Device,316.2,34,"Charges > $500, x 34%",316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,372,40,,372,percent of total billed charges,Implant Devices,325.5,70,,325.5,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,372,
BIOMET 8161-35-050 CORT SCREW 3.5X50MM,C1713,HCPCS,,79005016,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-075 CORT SCREW 3.5X75MM,C1713,HCPCS,,79005017,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-080 CORT SCREW 3.5X80MM,C1713,HCPCS,,79005018,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 8161-35-085 CORT SCREW 3.5X85MM,C1713,HCPCS,,79005019,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
ARTHREX AR-8730-28PT CANN SCREW 3X28MM,C1713,HCPCS,,79005020,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
ARTHREX AR-8967-1880 CANN SCREW 6.7X80MM,C1713,HCPCS,,79005024,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-8967-1885 CANN SCREW 6.7X85MM,C1713,HCPCS,,79005025,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ALPHATEC SPINE 71001-034 2LEV PLATE 34MM,C1713,HCPCS,,79005026,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
ALPHATEC SPINE 71240-14 VAR SCREW 4X14MM,C1713,HCPCS,,79005027,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ACUMED COT2324 LOCKING SCREW 2.3X24MM,C1713,HCPCS,,79005034,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
ACUMED COT2322 LOCKING SCREW 2.3X22MM,C1713,HCPCS,,79005035,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
ACUMED COT2314 LOCKING SCREW 2.3X14MM,C1713,HCPCS,,79005036,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
ACUMED COT2316 LOCKING SCREW 2.3X16MM,C1713,HCPCS,,79005037,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
ACUMED COT2318 LOCKING SCREW 2.3X18MM,C1713,HCPCS,,79005039,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
LIFENET VG2C-T57P VG2 CERVICL BONE GRAFT,C1713,HCPCS,,79005040,CDM,278,RC,,,both,,,3516,1387.65,39.4668,,1387.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1230.6,35,,1230.6,percent of total billed charges,Implant Device,1195.44,34,"Charges > $500, x 34%",1195.44,percent of total billed charges,Implant Device,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1406.4,40,,1406.4,percent of total billed charges,Implant Devices,1230.6,70,,1230.6,percent of total billed charges,Implant Devices,1195.44,34,,1195.44,percent of total billed charges,Implant Devices,1195.44,34,,1195.44,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1195.44,34,"If Charge > 2,000, then 34 percent",1195.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1406.4,
LIFENET VG2C-T68P VG2 CERVICL BONE GRAFT,C1713,HCPCS,,79005041,CDM,278,RC,,,both,,,3518,1388.44,39.4668,,1388.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1196.12,34,,1196.12,percent of total billed charges,Implant Device,1196.12,34,,1196.12,percent of total billed charges,Implant Device,1196.12,34,,1196.12,percent of total billed charges,Implant Device,1196.12,34,,1196.12,percent of total billed charges,Implant Device,1196.12,34,,1196.12,percent of total billed charges,Implant Device,1196.12,34,,1196.12,percent of total billed charges,Implant Device,1231.3,35,,1231.3,percent of total billed charges,Implant Device,1196.12,34,"Charges > $500, x 34%",1196.12,percent of total billed charges,Implant Device,1231.3,35,,1231.3,percent of total billed charges,Implant Devices,1231.3,35,,1231.3,percent of total billed charges,Implant Devices,1231.3,35,,,percent of total billed charges,Implant Devices,1231.3,35,,1231.3,percent of total billed charges,Implant Devices,1231.3,35,,1231.3,percent of total billed charges,Implant Devices,1407.2,40,,1407.2,percent of total billed charges,Implant Devices,1231.3,70,,1231.3,percent of total billed charges,Implant Devices,1196.12,34,,1196.12,percent of total billed charges,Implant Devices,1196.12,34,,1196.12,percent of total billed charges,Implant Devices,1231.3,35,,1231.3,percent of total billed charges,Implant Devices,1231.3,35,,1231.3,percent of total billed charges,Implant Devices,1231.3,35,,1231.3,percent of total billed charges,Implant Devices,1231.3,35,,1231.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1196.12,34,"If Charge > 2,000, then 34 percent",1196.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1407.2,
LIFENET VG2C-T79P VG2 CERVICL BONE GRAFT,C1713,HCPCS,,79005042,CDM,278,RC,,,both,,,3516,1387.65,39.4668,,1387.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1230.6,35,,1230.6,percent of total billed charges,Implant Device,1195.44,34,"Charges > $500, x 34%",1195.44,percent of total billed charges,Implant Device,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1406.4,40,,1406.4,percent of total billed charges,Implant Devices,1230.6,70,,1230.6,percent of total billed charges,Implant Devices,1195.44,34,,1195.44,percent of total billed charges,Implant Devices,1195.44,34,,1195.44,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1195.44,34,"If Charge > 2,000, then 34 percent",1195.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1406.4,
LIFENET VG2C-T810P VG2 CERVCL BONE GRAFT,C1713,HCPCS,,79005043,CDM,278,RC,,,both,,,3516,1387.65,39.4668,,1387.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1230.6,35,,1230.6,percent of total billed charges,Implant Device,1195.44,34,"Charges > $500, x 34%",1195.44,percent of total billed charges,Implant Device,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1406.4,40,,1406.4,percent of total billed charges,Implant Devices,1230.6,70,,1230.6,percent of total billed charges,Implant Devices,1195.44,34,,1195.44,percent of total billed charges,Implant Devices,1195.44,34,,1195.44,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1195.44,34,"If Charge > 2,000, then 34 percent",1195.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1406.4,
BIOMET 8157-61-045 CANN SCREW 45X6.5MM,C1713,HCPCS,,79005048,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
ARTHREX AR-2655CR CLAVICLE PLATE RT,C1713,HCPCS,,79005053,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ARTHREX AR-8835L-14 LOCK SCREW 3.5X14MM,C1713,HCPCS,,79005054,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
STRYKER 3130-1180S TROCH NAIL 11X180MM,C1713,HCPCS,,79005059,CDM,278,RC,,,both,,,2928,1155.59,39.4668,,1155.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,1024.8,35,,1024.8,percent of total billed charges,Implant Device,995.52,34,"Charges > $500, x 34%",995.52,percent of total billed charges,Implant Device,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1171.2,40,,1171.2,percent of total billed charges,Implant Devices,1024.8,70,,1024.8,percent of total billed charges,Implant Devices,995.52,34,,995.52,percent of total billed charges,Implant Devices,995.52,34,,995.52,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,995.52,34,"If Charge > 2,000, then 34 percent",995.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1171.2,
ARTHREX AR-1926BC PUSHLOCK 3.5,C1713,HCPCS,,79005060,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
ARTHREX AR-1926DS PUSHLOCK 3.5,C1713,HCPCS,,79005063,CDM,278,RC,,,both,,,525,207.2,39.4668,,207.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Device,178.5,34,"Charges > $500, x 34%",178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,210,40,,210,percent of total billed charges,Implant Devices,183.75,70,,183.75,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
ARTHREX AR-4151DS DRILL PIN 1.5X100MM,C1713,HCPCS,,79005066,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ACUMED COL-3120 LOCKING SCREW 3.5X12MM,C1713,HCPCS,,79005067,CDM,278,RC,,,both,,,382,150.76,39.4668,,150.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,129.88,34,,129.88,percent of total billed charges,Implant Device,133.7,35,,133.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,152.8,40,,152.8,percent of total billed charges,Implant Devices,133.7,70,,133.7,percent of total billed charges,Implant Devices,129.88,34,,129.88,percent of total billed charges,Implant Devices,129.88,34,,129.88,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,133.7,35,,133.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,152.8,
SMITH & NEPHEW 121860 CANN SCREW 4X60MM,C1713,HCPCS,,79005069,CDM,278,RC,,,both,,,587,231.67,39.4668,,231.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.58,34,,199.58,percent of total billed charges,Implant Device,199.58,34,,199.58,percent of total billed charges,Implant Device,199.58,34,,199.58,percent of total billed charges,Implant Device,199.58,34,,199.58,percent of total billed charges,Implant Device,199.58,34,,199.58,percent of total billed charges,Implant Device,199.58,34,,199.58,percent of total billed charges,Implant Device,205.45,35,,205.45,percent of total billed charges,Implant Device,199.58,34,"Charges > $500, x 34%",199.58,percent of total billed charges,Implant Device,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,234.8,40,,234.8,percent of total billed charges,Implant Devices,205.45,70,,205.45,percent of total billed charges,Implant Devices,199.58,34,,199.58,percent of total billed charges,Implant Devices,199.58,34,,199.58,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.8,
DEPUY 86-6401 MODULAR STEM 13X30MM,C1713,HCPCS,,79005070,CDM,278,RC,,,both,,,3862,1524.21,39.4668,,1524.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1313.08,34,,1313.08,percent of total billed charges,Implant Device,1313.08,34,,1313.08,percent of total billed charges,Implant Device,1313.08,34,,1313.08,percent of total billed charges,Implant Device,1313.08,34,,1313.08,percent of total billed charges,Implant Device,1313.08,34,,1313.08,percent of total billed charges,Implant Device,1313.08,34,,1313.08,percent of total billed charges,Implant Device,1351.7,35,,1351.7,percent of total billed charges,Implant Device,1313.08,34,"Charges > $500, x 34%",1313.08,percent of total billed charges,Implant Device,1351.7,35,,1351.7,percent of total billed charges,Implant Devices,1351.7,35,,1351.7,percent of total billed charges,Implant Devices,1351.7,35,,,percent of total billed charges,Implant Devices,1351.7,35,,1351.7,percent of total billed charges,Implant Devices,1351.7,35,,1351.7,percent of total billed charges,Implant Devices,1544.8,40,,1544.8,percent of total billed charges,Implant Devices,1351.7,70,,1351.7,percent of total billed charges,Implant Devices,1313.08,34,,1313.08,percent of total billed charges,Implant Devices,1313.08,34,,1313.08,percent of total billed charges,Implant Devices,1351.7,35,,1351.7,percent of total billed charges,Implant Devices,1351.7,35,,1351.7,percent of total billed charges,Implant Devices,1351.7,35,,1351.7,percent of total billed charges,Implant Devices,1351.7,35,,1351.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1313.08,34,"If Charge > 2,000, then 34 percent",1313.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1544.8,
DEPUY 96-2042 TIBIAL INSERT CURVD 12.5MM,C1713,HCPCS,,79005071,CDM,278,RC,,,both,,,3696,1458.69,39.4668,,1458.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1293.6,35,,1293.6,percent of total billed charges,Implant Device,1256.64,34,"Charges > $500, x 34%",1256.64,percent of total billed charges,Implant Device,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1478.4,40,,1478.4,percent of total billed charges,Implant Devices,1293.6,70,,1293.6,percent of total billed charges,Implant Devices,1256.64,34,,1256.64,percent of total billed charges,Implant Devices,1256.64,34,,1256.64,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1256.64,34,"If Charge > 2,000, then 34 percent",1256.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1478.4,
ARTHREX AR-8730-32PT CANN SCREW 3X32MM,C1713,HCPCS,,79005077,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
ARTHREX AR-8953-00 FLAT WEDGE PLATE,C1713,HCPCS,,79005078,CDM,278,RC,,,both,,,2909,1148.09,39.4668,,1148.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,989.06,34,,989.06,percent of total billed charges,Implant Device,989.06,34,,989.06,percent of total billed charges,Implant Device,989.06,34,,989.06,percent of total billed charges,Implant Device,989.06,34,,989.06,percent of total billed charges,Implant Device,989.06,34,,989.06,percent of total billed charges,Implant Device,989.06,34,,989.06,percent of total billed charges,Implant Device,1018.15,35,,1018.15,percent of total billed charges,Implant Device,989.06,34,"Charges > $500, x 34%",989.06,percent of total billed charges,Implant Device,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1163.6,40,,1163.6,percent of total billed charges,Implant Devices,1018.15,70,,1018.15,percent of total billed charges,Implant Devices,989.06,34,,989.06,percent of total billed charges,Implant Devices,989.06,34,,989.06,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,1018.15,35,,1018.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,989.06,34,"If Charge > 2,000, then 34 percent",989.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1163.6,
SOLANA SURGICAL FFS-1010 FUSEFORCE 10X10,C1713,HCPCS,,79005079,CDM,278,RC,,,both,,,4068,1605.51,39.4668,,1605.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1383.12,34,,1383.12,percent of total billed charges,Implant Device,1383.12,34,,1383.12,percent of total billed charges,Implant Device,1383.12,34,,1383.12,percent of total billed charges,Implant Device,1383.12,34,,1383.12,percent of total billed charges,Implant Device,1383.12,34,,1383.12,percent of total billed charges,Implant Device,1383.12,34,,1383.12,percent of total billed charges,Implant Device,1423.8,35,,1423.8,percent of total billed charges,Implant Device,1383.12,34,"Charges > $500, x 34%",1383.12,percent of total billed charges,Implant Device,1423.8,35,,1423.8,percent of total billed charges,Implant Devices,1423.8,35,,1423.8,percent of total billed charges,Implant Devices,1423.8,35,,,percent of total billed charges,Implant Devices,1423.8,35,,1423.8,percent of total billed charges,Implant Devices,1423.8,35,,1423.8,percent of total billed charges,Implant Devices,1627.2,40,,1627.2,percent of total billed charges,Implant Devices,1423.8,70,,1423.8,percent of total billed charges,Implant Devices,1383.12,34,,1383.12,percent of total billed charges,Implant Devices,1383.12,34,,1383.12,percent of total billed charges,Implant Devices,1423.8,35,,1423.8,percent of total billed charges,Implant Devices,1423.8,35,,1423.8,percent of total billed charges,Implant Devices,1423.8,35,,1423.8,percent of total billed charges,Implant Devices,1423.8,35,,1423.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1383.12,34,"If Charge > 2,000, then 34 percent",1383.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1627.2,
SOLANA SURGICAL FFS-0808 FUSEFORCE 8X8MM,C1713,HCPCS,,79005080,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
STRYKER 6495-9-004 TISSUEMEND 6CMX10CM,C1713,HCPCS,,79005084,CDM,278,RC,,,both,,,10014,3952.21,39.4668,,3952.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3504.9,35,,3504.9,percent of total billed charges,Implant Device,3404.76,34,"Charges > $500, x 34%",3404.76,percent of total billed charges,Implant Device,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,4005.6,40,,4005.6,percent of total billed charges,Implant Devices,3504.9,70,,3504.9,percent of total billed charges,Implant Devices,3404.76,34,,3404.76,percent of total billed charges,Implant Devices,3404.76,34,,3404.76,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3404.76,34,"If Charge > 2,000, then 34 percent",3404.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4005.6,
STRYKER 1822-0934S T2 TIBIA NAIL 9X345MM,C1713,HCPCS,,79005088,CDM,278,RC,,,both,,,7143,2819.11,39.4668,,2819.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2500.05,35,,2500.05,percent of total billed charges,Implant Device,2428.62,34,"Charges > $500, x 34%",2428.62,percent of total billed charges,Implant Device,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2857.2,40,,2857.2,percent of total billed charges,Implant Devices,2500.05,70,,2500.05,percent of total billed charges,Implant Devices,2428.62,34,,2428.62,percent of total billed charges,Implant Devices,2428.62,34,,2428.62,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2428.62,34,"If Charge > 2,000, then 34 percent",2428.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2857.2,
STRYKER 1896-5042S LOCKING SCREW 5X42MM,C1713,HCPCS,,79005089,CDM,278,RC,,,both,,,355,140.11,39.4668,,140.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,142,40,,142,percent of total billed charges,Implant Devices,124.25,70,,124.25,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142,
STRYKER 437302 TIBIA LOCK PLATE 2 HOLE,C1713,HCPCS,,79005100,CDM,278,RC,,,both,,,5315,2097.66,39.4668,,2097.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1860.25,35,,1860.25,percent of total billed charges,Implant Device,1807.1,34,"Charges > $500, x 34%",1807.1,percent of total billed charges,Implant Device,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,2126,40,,2126,percent of total billed charges,Implant Devices,1860.25,70,,1860.25,percent of total billed charges,Implant Devices,1807.1,34,,1807.1,percent of total billed charges,Implant Devices,1807.1,34,,1807.1,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1807.1,34,"If Charge > 2,000, then 34 percent",1807.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2126,
STRYKER 427036S LOCK PLATE 6 HOLE 4MM,C1713,HCPCS,,79005101,CDM,278,RC,,,both,,,1826,720.66,39.4668,,720.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,620.84,34,,620.84,percent of total billed charges,Implant Device,620.84,34,,620.84,percent of total billed charges,Implant Device,620.84,34,,620.84,percent of total billed charges,Implant Device,620.84,34,,620.84,percent of total billed charges,Implant Device,620.84,34,,620.84,percent of total billed charges,Implant Device,620.84,34,,620.84,percent of total billed charges,Implant Device,639.1,35,,639.1,percent of total billed charges,Implant Device,620.84,34,"Charges > $500, x 34%",620.84,percent of total billed charges,Implant Device,639.1,35,,639.1,percent of total billed charges,Implant Devices,639.1,35,,639.1,percent of total billed charges,Implant Devices,639.1,35,,,percent of total billed charges,Implant Devices,639.1,35,,639.1,percent of total billed charges,Implant Devices,639.1,35,,639.1,percent of total billed charges,Implant Devices,730.4,40,,730.4,percent of total billed charges,Implant Devices,639.1,70,,639.1,percent of total billed charges,Implant Devices,620.84,34,,620.84,percent of total billed charges,Implant Devices,620.84,34,,620.84,percent of total billed charges,Implant Devices,639.1,35,,639.1,percent of total billed charges,Implant Devices,639.1,35,,639.1,percent of total billed charges,Implant Devices,639.1,35,,639.1,percent of total billed charges,Implant Devices,639.1,35,,639.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,730.4,
STRYKER 371565 LOCKING SCREW 4X65MM,C1713,HCPCS,,79005102,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 371580 LOCKING SCREW 4X80MM,C1713,HCPCS,,79005103,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 371585 LOCKING SCREW 4X85MM,C1713,HCPCS,,79005104,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 371590 LOCKING SCREW 4X90MM,C1713,HCPCS,,79005105,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 338644 CORTICAL SCREW 3.5X44MM,C1713,HCPCS,,79005106,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 338695 CORTICAL SCREW 3.5X95MM,C1713,HCPCS,,79005107,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 7650-2038A HEADLESS PIN 3.2X89MM,C1713,HCPCS,,79005110,CDM,278,RC,,,both,,,1353,533.99,39.4668,,533.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,460.02,34,,460.02,percent of total billed charges,Implant Device,460.02,34,,460.02,percent of total billed charges,Implant Device,460.02,34,,460.02,percent of total billed charges,Implant Device,460.02,34,,460.02,percent of total billed charges,Implant Device,460.02,34,,460.02,percent of total billed charges,Implant Device,460.02,34,,460.02,percent of total billed charges,Implant Device,473.55,35,,473.55,percent of total billed charges,Implant Device,460.02,34,"Charges > $500, x 34%",460.02,percent of total billed charges,Implant Device,473.55,35,,473.55,percent of total billed charges,Implant Devices,473.55,35,,473.55,percent of total billed charges,Implant Devices,473.55,35,,,percent of total billed charges,Implant Devices,473.55,35,,473.55,percent of total billed charges,Implant Devices,473.55,35,,473.55,percent of total billed charges,Implant Devices,541.2,40,,541.2,percent of total billed charges,Implant Devices,473.55,70,,473.55,percent of total billed charges,Implant Devices,460.02,34,,460.02,percent of total billed charges,Implant Devices,460.02,34,,460.02,percent of total billed charges,Implant Devices,473.55,35,,473.55,percent of total billed charges,Implant Devices,473.55,35,,473.55,percent of total billed charges,Implant Devices,473.55,35,,473.55,percent of total billed charges,Implant Devices,473.55,35,,473.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,541.2,
ALPHATEC SPINE 22015 ALPHATEC SET SCREW,C1713,HCPCS,,79005116,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
STRYKER 628068 RT CLAVICLE PLATE 8 HOLE,C1713,HCPCS,,79005118,CDM,278,RC,,,both,,,3374,1331.61,39.4668,,1331.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1147.16,34,,1147.16,percent of total billed charges,Implant Device,1147.16,34,,1147.16,percent of total billed charges,Implant Device,1147.16,34,,1147.16,percent of total billed charges,Implant Device,1147.16,34,,1147.16,percent of total billed charges,Implant Device,1147.16,34,,1147.16,percent of total billed charges,Implant Device,1147.16,34,,1147.16,percent of total billed charges,Implant Device,1180.9,35,,1180.9,percent of total billed charges,Implant Device,1147.16,34,"Charges > $500, x 34%",1147.16,percent of total billed charges,Implant Device,1180.9,35,,1180.9,percent of total billed charges,Implant Devices,1180.9,35,,1180.9,percent of total billed charges,Implant Devices,1180.9,35,,,percent of total billed charges,Implant Devices,1180.9,35,,1180.9,percent of total billed charges,Implant Devices,1180.9,35,,1180.9,percent of total billed charges,Implant Devices,1349.6,40,,1349.6,percent of total billed charges,Implant Devices,1180.9,70,,1180.9,percent of total billed charges,Implant Devices,1147.16,34,,1147.16,percent of total billed charges,Implant Devices,1147.16,34,,1147.16,percent of total billed charges,Implant Devices,1180.9,35,,1180.9,percent of total billed charges,Implant Devices,1180.9,35,,1180.9,percent of total billed charges,Implant Devices,1180.9,35,,1180.9,percent of total billed charges,Implant Devices,1180.9,35,,1180.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1147.16,34,"If Charge > 2,000, then 34 percent",1147.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1349.6,
BIOMET 8157-61-075 CANC SCREW 6.5X75MM,C1713,HCPCS,,79005120,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
BIOMET 8157-61-080 CANC SCREW 6.5X80MM,C1713,HCPCS,,79005121,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
BIOMET 8157-61-085 CANC SCREW 6.5X85MM,C1713,HCPCS,,79005122,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
BIOMET 8157-62-040 CANC SCREW 6.5X40MM,C1713,HCPCS,,79005123,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
STRYKER 3325-0340S LONG NAIL LT 11X340,C1713,HCPCS,,79005124,CDM,278,RC,,,both,,,9323,3679.49,39.4668,,3679.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3263.05,35,,3263.05,percent of total billed charges,Implant Device,3169.82,34,"Charges > $500, x 34%",3169.82,percent of total billed charges,Implant Device,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3729.2,40,,3729.2,percent of total billed charges,Implant Devices,3263.05,70,,3263.05,percent of total billed charges,Implant Devices,3169.82,34,,3169.82,percent of total billed charges,Implant Devices,3169.82,34,,3169.82,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3169.82,34,"If Charge > 2,000, then 34 percent",3169.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3729.2,
STRYKER 3060-0080S LAG SCREW 10.5X80MM,C1713,HCPCS,,79005125,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
STRYKER 338626 3.5 CORTICAL SCREW 26MM,C1713,HCPCS,,79005148,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 371524 LOCKING SCREW 4X24MM,C1713,HCPCS,,79005149,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 338624 CORTICAL SCREW 3.5X24MM,C1713,HCPCS,,79005150,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
ARTHREX AR-8943BR-05 LOCKING PLATE 5HOLE,C1713,HCPCS,,79005151,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
ARTHREX AR-8835-32 CORTICAL SCREW 3.5X32,C1713,HCPCS,,79005152,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ARTHREX AR-8835-38 CORTICAL SCREW 3.5X38,C1713,HCPCS,,79005153,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ARTHREX AR-8835-20 CORTICAL SCREW 3.5X20,C1713,HCPCS,,79005154,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ARTHREX AR-8827L-16 LOCKING SCREW 2.7X16,C1713,HCPCS,,79005155,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ARTHREX AR-13120T-14 SCREW 2.3X14MM,C1713,HCPCS,,79005157,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
EXACTECH 314-02-33 POST AUGMENT GLENOID,C1713,HCPCS,,79005159,CDM,278,RC,,,both,,,7992,3154.19,39.4668,,3154.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2797.2,35,,2797.2,percent of total billed charges,Implant Device,2717.28,34,"Charges > $500, x 34%",2717.28,percent of total billed charges,Implant Device,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,3196.8,40,,3196.8,percent of total billed charges,Implant Devices,2797.2,70,,2797.2,percent of total billed charges,Implant Devices,2717.28,34,,2717.28,percent of total billed charges,Implant Devices,2717.28,34,,2717.28,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2717.28,34,"If Charge > 2,000, then 34 percent",2717.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3196.8,
BIOMET M30-070020T CORTICAL SCEW 3X2.5MM,C1713,HCPCS,,79005160,CDM,278,RC,,,both,,,448,176.81,39.4668,,176.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,152.32,34,,152.32,percent of total billed charges,Implant Device,152.32,34,,152.32,percent of total billed charges,Implant Device,152.32,34,,152.32,percent of total billed charges,Implant Device,152.32,34,,152.32,percent of total billed charges,Implant Device,152.32,34,,152.32,percent of total billed charges,Implant Device,152.32,34,,152.32,percent of total billed charges,Implant Device,156.8,35,,156.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.8,35,,156.8,percent of total billed charges,Implant Devices,156.8,35,,156.8,percent of total billed charges,Implant Devices,156.8,35,,,percent of total billed charges,Implant Devices,156.8,35,,156.8,percent of total billed charges,Implant Devices,156.8,35,,156.8,percent of total billed charges,Implant Devices,179.2,40,,179.2,percent of total billed charges,Implant Devices,156.8,70,,156.8,percent of total billed charges,Implant Devices,152.32,34,,152.32,percent of total billed charges,Implant Devices,152.32,34,,152.32,percent of total billed charges,Implant Devices,156.8,35,,156.8,percent of total billed charges,Implant Devices,156.8,35,,156.8,percent of total billed charges,Implant Devices,156.8,35,,156.8,percent of total billed charges,Implant Devices,156.8,35,,156.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,179.2,
BIOMET 1802-49-048 TIMAX CANN SCREW 4X48,C1713,HCPCS,,79005161,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
BIOMET 1802-49-060 TIMAX CANN SCREW 4X60,C1713,HCPCS,,79005162,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
BIOMET 1802-49-040 TIMAX CANN SCREW 4X40,C1713,HCPCS,,79005163,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
BIOMET 1802-49-042 TIMAX CANN SCREW 4X42,C1713,HCPCS,,79005164,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
BIOMET 1802-49-046 TIMAX CANN SCREW 4X46,C1713,HCPCS,,79005165,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
BIOMET 1802-48-038 TIMAX CANN SCREW 4X38,C1713,HCPCS,,79005166,CDM,278,RC,,,both,,,780,307.84,39.4668,,307.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Device,265.2,34,"Charges > $500, x 34%",265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,312,40,,312,percent of total billed charges,Implant Devices,273,70,,273,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,312,
BIOMET 07020 LONG MINI FIXATOR,C1713,HCPCS,,79005167,CDM,278,RC,,,both,,,6196,2445.36,39.4668,,2445.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2106.64,34,,2106.64,percent of total billed charges,Implant Device,2106.64,34,,2106.64,percent of total billed charges,Implant Device,2106.64,34,,2106.64,percent of total billed charges,Implant Device,2106.64,34,,2106.64,percent of total billed charges,Implant Device,2106.64,34,,2106.64,percent of total billed charges,Implant Device,2106.64,34,,2106.64,percent of total billed charges,Implant Device,2168.6,35,,2168.6,percent of total billed charges,Implant Device,2106.64,34,"Charges > $500, x 34%",2106.64,percent of total billed charges,Implant Device,2168.6,35,,2168.6,percent of total billed charges,Implant Devices,2168.6,35,,2168.6,percent of total billed charges,Implant Devices,2168.6,35,,,percent of total billed charges,Implant Devices,2168.6,35,,2168.6,percent of total billed charges,Implant Devices,2168.6,35,,2168.6,percent of total billed charges,Implant Devices,2478.4,40,,2478.4,percent of total billed charges,Implant Devices,2168.6,70,,2168.6,percent of total billed charges,Implant Devices,2106.64,34,,2106.64,percent of total billed charges,Implant Devices,2106.64,34,,2106.64,percent of total billed charges,Implant Devices,2168.6,35,,2168.6,percent of total billed charges,Implant Devices,2168.6,35,,2168.6,percent of total billed charges,Implant Devices,2168.6,35,,2168.6,percent of total billed charges,Implant Devices,2168.6,35,,2168.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2106.64,34,"If Charge > 2,000, then 34 percent",2106.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2478.4,
ALPHATEC 71001-045 PLATE 3 LEVEL 45MM,C1713,HCPCS,,79005172,CDM,278,RC,,,both,,,3136,1237.68,39.4668,,1237.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Device,1066.24,34,"Charges > $500, x 34%",1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1254.4,40,,1254.4,percent of total billed charges,Implant Devices,1097.6,70,,1097.6,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1066.24,34,"If Charge > 2,000, then 34 percent",1066.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254.4,
ALPHATEC 71240-12 SD SCREW 4X12MM,C1713,HCPCS,,79005173,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
STRYKER 54-25292 WRIST PLATE RT DORSAL,C1713,HCPCS,,79005174,CDM,278,RC,,,both,,,3316,1308.72,39.4668,,1308.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1160.6,35,,1160.6,percent of total billed charges,Implant Device,1127.44,34,"Charges > $500, x 34%",1127.44,percent of total billed charges,Implant Device,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1326.4,40,,1326.4,percent of total billed charges,Implant Devices,1160.6,70,,1160.6,percent of total billed charges,Implant Devices,1127.44,34,,1127.44,percent of total billed charges,Implant Devices,1127.44,34,,1127.44,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1127.44,34,"If Charge > 2,000, then 34 percent",1127.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1326.4,
STRYKER 53-23630E LOCKING SCREW 2.3X30MM,C1713,HCPCS,,79005175,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
ALAMO TISS AT392FF SEMI-TENOD ALLGRAFT,C1713,HCPCS,,79005176,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
EXACTECH 304-21-09 HUMERAL STEM LT 8.5MM,C1713,HCPCS,,79005177,CDM,278,RC,,,both,,,6225,2456.81,39.4668,,2456.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Device,2116.5,34,"Charges > $500, x 34%",2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2490,40,,2490,percent of total billed charges,Implant Devices,2178.75,70,,2178.75,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2116.5,34,"If Charge > 2,000, then 34 percent",2116.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2490,
ALPHATEC 71240-10 SD SCREW 4X10MM,C1713,HCPCS,,79005178,CDM,278,RC,,,both,,,706,278.64,39.4668,,278.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Device,240.04,34,"Charges > $500, x 34%",240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,282.4,40,,282.4,percent of total billed charges,Implant Devices,247.1,70,,247.1,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.4,
STRYKER 58-23008E BONE SCREW 2.3X8MM,C1713,HCPCS,,79005189,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
STRYKER 58-23009E BONE SCREW 2.3X9MM,C1713,HCPCS,,79005190,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
BIOMET PT-113950 HYBRID GLENOID POST,C1713,HCPCS,,79005191,CDM,278,RC,,,both,,,2310,911.68,39.4668,,911.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,785.4,34,,785.4,percent of total billed charges,Implant Device,785.4,34,,785.4,percent of total billed charges,Implant Device,785.4,34,,785.4,percent of total billed charges,Implant Device,785.4,34,,785.4,percent of total billed charges,Implant Device,785.4,34,,785.4,percent of total billed charges,Implant Device,785.4,34,,785.4,percent of total billed charges,Implant Device,808.5,35,,808.5,percent of total billed charges,Implant Device,785.4,34,"Charges > $500, x 34%",785.4,percent of total billed charges,Implant Device,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,924,40,,924,percent of total billed charges,Implant Devices,808.5,70,,808.5,percent of total billed charges,Implant Devices,785.4,34,,785.4,percent of total billed charges,Implant Devices,785.4,34,,785.4,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,785.4,34,"If Charge > 2,000, then 34 percent",785.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,924,
BIOMET 118001 COMPREHENSIVE STD ADAPTOR,C1713,HCPCS,,79005192,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
ARTHREX AR-1360C-CP MPFL BIOCMP IMPL SYS,C1713,HCPCS,,79005193,CDM,278,RC,,,both,,,4462,1761.01,39.4668,,1761.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1517.08,34,,1517.08,percent of total billed charges,Implant Device,1517.08,34,,1517.08,percent of total billed charges,Implant Device,1517.08,34,,1517.08,percent of total billed charges,Implant Device,1517.08,34,,1517.08,percent of total billed charges,Implant Device,1517.08,34,,1517.08,percent of total billed charges,Implant Device,1517.08,34,,1517.08,percent of total billed charges,Implant Device,1561.7,35,,1561.7,percent of total billed charges,Implant Device,1517.08,34,"Charges > $500, x 34%",1517.08,percent of total billed charges,Implant Device,1561.7,35,,1561.7,percent of total billed charges,Implant Devices,1561.7,35,,1561.7,percent of total billed charges,Implant Devices,1561.7,35,,,percent of total billed charges,Implant Devices,1561.7,35,,1561.7,percent of total billed charges,Implant Devices,1561.7,35,,1561.7,percent of total billed charges,Implant Devices,1784.8,40,,1784.8,percent of total billed charges,Implant Devices,1561.7,70,,1561.7,percent of total billed charges,Implant Devices,1517.08,34,,1517.08,percent of total billed charges,Implant Devices,1517.08,34,,1517.08,percent of total billed charges,Implant Devices,1561.7,35,,1561.7,percent of total billed charges,Implant Devices,1561.7,35,,1561.7,percent of total billed charges,Implant Devices,1561.7,35,,1561.7,percent of total billed charges,Implant Devices,1561.7,35,,1561.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1517.08,34,"If Charge > 2,000, then 34 percent",1517.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1784.8,
BIOMET 110003484 ACCSS THRD STEINMAN PIN,C1713,HCPCS,,79005196,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
STRYKER 54-25396 VOLAR PLATE,C1713,HCPCS,,79005197,CDM,278,RC,,,both,,,3057,1206.5,39.4668,,1206.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1039.38,34,,1039.38,percent of total billed charges,Implant Device,1039.38,34,,1039.38,percent of total billed charges,Implant Device,1039.38,34,,1039.38,percent of total billed charges,Implant Device,1039.38,34,,1039.38,percent of total billed charges,Implant Device,1039.38,34,,1039.38,percent of total billed charges,Implant Device,1039.38,34,,1039.38,percent of total billed charges,Implant Device,1069.95,35,,1069.95,percent of total billed charges,Implant Device,1039.38,34,"Charges > $500, x 34%",1039.38,percent of total billed charges,Implant Device,1069.95,35,,1069.95,percent of total billed charges,Implant Devices,1069.95,35,,1069.95,percent of total billed charges,Implant Devices,1069.95,35,,,percent of total billed charges,Implant Devices,1069.95,35,,1069.95,percent of total billed charges,Implant Devices,1069.95,35,,1069.95,percent of total billed charges,Implant Devices,1222.8,40,,1222.8,percent of total billed charges,Implant Devices,1069.95,70,,1069.95,percent of total billed charges,Implant Devices,1039.38,34,,1039.38,percent of total billed charges,Implant Devices,1039.38,34,,1039.38,percent of total billed charges,Implant Devices,1069.95,35,,1069.95,percent of total billed charges,Implant Devices,1069.95,35,,1069.95,percent of total billed charges,Implant Devices,1069.95,35,,1069.95,percent of total billed charges,Implant Devices,1069.95,35,,1069.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1039.38,34,"If Charge > 2,000, then 34 percent",1039.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1222.8,
STRYKER 53-27622E LOCKING SCREW 2.7X22MM,C1713,HCPCS,,79005198,CDM,278,RC,,,both,,,304,119.98,39.4668,,119.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,103.36,34,,103.36,percent of total billed charges,Implant Device,106.4,35,,106.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,121.6,40,,121.6,percent of total billed charges,Implant Devices,106.4,70,,106.4,percent of total billed charges,Implant Devices,103.36,34,,103.36,percent of total billed charges,Implant Devices,103.36,34,,103.36,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,106.4,35,,106.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.6,
STRYKER 53-27214E CORT SCREW 2.7X14MM,C1713,HCPCS,,79005199,CDM,278,RC,,,both,,,344,135.77,39.4668,,135.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,116.96,34,,116.96,percent of total billed charges,Implant Device,120.4,35,,120.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,137.6,40,,137.6,percent of total billed charges,Implant Devices,120.4,70,,120.4,percent of total billed charges,Implant Devices,116.96,34,,116.96,percent of total billed charges,Implant Devices,116.96,34,,116.96,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,120.4,35,,120.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.6,
SYNTHES XM106.2020S TISSUE MATRX 20X20CM,C1713,HCPCS,,79005202,CDM,278,RC,,,both,,,37707,14881.75,39.4668,,14881.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12820.38,34,,12820.38,percent of total billed charges,Implant Device,12820.38,34,,12820.38,percent of total billed charges,Implant Device,12820.38,34,,12820.38,percent of total billed charges,Implant Device,12820.38,34,,12820.38,percent of total billed charges,Implant Device,12820.38,34,,12820.38,percent of total billed charges,Implant Device,12820.38,34,,12820.38,percent of total billed charges,Implant Device,13197.45,35,,13197.45,percent of total billed charges,Implant Device,12820.38,34,"Charges > $500, x 34%",12820.38,percent of total billed charges,Implant Device,13197.45,35,,13197.45,percent of total billed charges,Implant Devices,13197.45,35,,13197.45,percent of total billed charges,Implant Devices,13197.45,35,,,percent of total billed charges,Implant Devices,13197.45,35,,13197.45,percent of total billed charges,Implant Devices,13197.45,35,,13197.45,percent of total billed charges,Implant Devices,15082.8,40,,15082.8,percent of total billed charges,Implant Devices,13197.45,70,,13197.45,percent of total billed charges,Implant Devices,12820.38,34,,12820.38,percent of total billed charges,Implant Devices,12820.38,34,,12820.38,percent of total billed charges,Implant Devices,13197.45,35,,13197.45,percent of total billed charges,Implant Devices,13197.45,35,,13197.45,percent of total billed charges,Implant Devices,13197.45,35,,13197.45,percent of total billed charges,Implant Devices,13197.45,35,,13197.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,12820.38,34,"If Charge > 2,000, then 34 percent",12820.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,15082.8,
ARTHREX AR-2656DR DISTAL CLAV PLATE SHRT,C1713,HCPCS,,79005207,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
STRYKER 2030-6530-1 CANC SCREW 6.5X30MM,C1713,HCPCS,,79005208,CDM,278,RC,,,both,,,533,210.36,39.4668,,210.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,186.55,35,,186.55,percent of total billed charges,Implant Device,181.22,34,"Charges > $500, x 34%",181.22,percent of total billed charges,Implant Device,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,213.2,40,,213.2,percent of total billed charges,Implant Devices,186.55,70,,186.55,percent of total billed charges,Implant Devices,181.22,34,,181.22,percent of total billed charges,Implant Devices,181.22,34,,181.22,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,213.2,
STRYKER 2030-6520-1 CANC SCREW 6.5X20MM,C1713,HCPCS,,79005210,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
ARTHREX AR-8948-08 COTTON PLATE 8MM,C1713,HCPCS,,79005218,CDM,278,RC,,,both,,,2386,941.68,39.4668,,941.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,835.1,35,,835.1,percent of total billed charges,Implant Device,811.24,34,"Charges > $500, x 34%",811.24,percent of total billed charges,Implant Device,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,954.4,40,,954.4,percent of total billed charges,Implant Devices,835.1,70,,835.1,percent of total billed charges,Implant Devices,811.24,34,,811.24,percent of total billed charges,Implant Devices,811.24,34,,811.24,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,811.24,34,"If Charge > 2,000, then 34 percent",811.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,954.4,
ARTHREX AR-13120T-16 SCREW 2.3X16MM,C1713,HCPCS,,79005219,CDM,278,RC,,,both,,,196,77.35,39.4668,,77.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,68.6,35,,68.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,78.4,40,,78.4,percent of total billed charges,Implant Devices,68.6,70,,68.6,percent of total billed charges,Implant Devices,66.64,34,,66.64,percent of total billed charges,Implant Devices,66.64,34,,66.64,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78.4,
ARTHREX AR-13120T-20 SCREW 2.3X20MM,C1713,HCPCS,,79005220,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
ARTHREX AR-13120T-24 SCREW 2.3X24MM,C1713,HCPCS,,79005221,CDM,278,RC,,,both,,,196,77.35,39.4668,,77.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,68.6,35,,68.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,78.4,40,,78.4,percent of total billed charges,Implant Devices,68.6,70,,68.6,percent of total billed charges,Implant Devices,66.64,34,,66.64,percent of total billed charges,Implant Devices,66.64,34,,66.64,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78.4,
ARTRHEX AR-13120T-26 SCREW 2.3X26MM,C1713,HCPCS,,79005222,CDM,278,RC,,,both,,,196,77.35,39.4668,,77.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,66.64,34,,66.64,percent of total billed charges,Implant Device,68.6,35,,68.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,78.4,40,,78.4,percent of total billed charges,Implant Devices,68.6,70,,68.6,percent of total billed charges,Implant Devices,66.64,34,,66.64,percent of total billed charges,Implant Devices,66.64,34,,66.64,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,68.6,35,,68.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78.4,
ARTHREX AR-8967-1855 CANN SCREW 6.7X55MM,C1713,HCPCS,,79005223,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-8967-1850 CANN SCREW 6.7X50MM,C1713,HCPCS,,79005224,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-8933-30PT SCREW 3.0X30MM,C1713,HCPCS,,79005227,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
ARTHREX AR-8931-13 QUICK FIX SCRW 3X13MM,C1713,HCPCS,,79005228,CDM,278,RC,,,both,,,720,284.16,39.4668,,284.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Device,244.8,34,"Charges > $500, x 34%",244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,288,40,,288,percent of total billed charges,Implant Devices,252,70,,252,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,288,
BIOMET 41-2014 NON LOCKING SCREW 2X14MM,C1713,HCPCS,,79005243,CDM,278,RC,,,both,,,268,105.77,39.4668,,105.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,93.8,35,,93.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,107.2,40,,107.2,percent of total billed charges,Implant Devices,93.8,70,,93.8,percent of total billed charges,Implant Devices,91.12,34,,91.12,percent of total billed charges,Implant Devices,91.12,34,,91.12,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.2,
BIOMET 91-5607 SCREW SD IMF 2X7MM,C1713,HCPCS,,79005244,CDM,278,RC,,,both,,,454,179.18,39.4668,,179.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,181.6,40,,181.6,percent of total billed charges,Implant Devices,158.9,70,,158.9,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.6,
BIOMET 42-1004 4 HOLE PLATE 1.5,C1713,HCPCS,,79005246,CDM,278,RC,,,both,,,2316,914.05,39.4668,,914.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,787.44,34,,787.44,percent of total billed charges,Implant Device,810.6,35,,810.6,percent of total billed charges,Implant Device,787.44,34,"Charges > $500, x 34%",787.44,percent of total billed charges,Implant Device,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,926.4,40,,926.4,percent of total billed charges,Implant Devices,810.6,70,,810.6,percent of total billed charges,Implant Devices,787.44,34,,787.44,percent of total billed charges,Implant Devices,787.44,34,,787.44,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,810.6,35,,810.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,787.44,34,"If Charge > 2,000, then 34 percent",787.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,926.4,
ARTHREX AR-7000-30 SCREW 3.75X30MM,C1713,HCPCS,,79005254,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
ARTHREX AR-14226 LOCKING SCREW 4.0X26MM,C1713,HCPCS,,79005257,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
ARTHREX AR-14230 LOCKING SCREW 4.0X30MM,C1713,HCPCS,,79005258,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
ARTHREX AR-14236 LOCKING SCREW 4.0X36MM,C1713,HCPCS,,79005259,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
ARTRHEX AR-14120NL SCREW 3.5X22MM,C1713,HCPCS,,79005260,CDM,278,RC,,,both,,,136,53.67,39.4668,,53.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,54.4,40,,54.4,percent of total billed charges,Implant Devices,47.6,70,,47.6,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.4,
ARTHREX AR-14124NL SCREW 3.5X24MM,C1713,HCPCS,,79005261,CDM,278,RC,,,both,,,136,53.67,39.4668,,53.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,54.4,40,,54.4,percent of total billed charges,Implant Devices,47.6,70,,47.6,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.4,
BIOMET 8161-45-226 CORT SCREW 4.5X26MM,C1713,HCPCS,,79005264,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
BIOMET 8161-45-230 CORT SCREW 4.5X30MM,C1713,HCPCS,,79005265,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
BIOMET 8161-45-232 CORT SCREW 4.5X32MM,C1713,HCPCS,,79005266,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
BIOMET 8161-45-234 CORT SCREW 4.5X34MM,C1713,HCPCS,,79005267,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
BIOMET 8157-45-034 NON LOCK SCREW 4.5X34,C1713,HCPCS,,79005268,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
BIOMET 8157-45-046 NON LOCK SCREW 4.5X46,C1713,HCPCS,,79005269,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
BIOMET 8157-45-048 NON LOCK SCREW 4.5X48,C1713,HCPCS,,79005270,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
BIOMET 8157-45-050 NON LOCK SCREW 4.5X50,C1713,HCPCS,,79005271,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
SYNTHES 241.351 PLATE 5 HOLE 57MM,C1713,HCPCS,,79005273,CDM,278,RC,,,both,,,696,274.69,39.4668,,274.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Device,236.64,34,"Charges > $500, x 34%",236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,278.4,40,,278.4,percent of total billed charges,Implant Devices,243.6,70,,243.6,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,278.4,
SYNTHES 241.381 PLATE 8 HOLE 93MM,C1713,HCPCS,,79005274,CDM,278,RC,,,both,,,804,317.31,39.4668,,317.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Device,273.36,34,"Charges > $500, x 34%",273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,321.6,40,,321.6,percent of total billed charges,Implant Devices,281.4,70,,281.4,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,321.6,
SYNTHES 241.401 PLATE 10 HOLE 117MM,C1713,HCPCS,,79005275,CDM,278,RC,,,both,,,700,276.27,39.4668,,276.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,238,34,,238,percent of total billed charges,Implant Device,238,34,,238,percent of total billed charges,Implant Device,238,34,,238,percent of total billed charges,Implant Device,238,34,,238,percent of total billed charges,Implant Device,238,34,,238,percent of total billed charges,Implant Device,238,34,,238,percent of total billed charges,Implant Device,245,35,,245,percent of total billed charges,Implant Device,238,34,"Charges > $500, x 34%",238,percent of total billed charges,Implant Device,245,35,,245,percent of total billed charges,Implant Devices,245,35,,245,percent of total billed charges,Implant Devices,245,35,,,percent of total billed charges,Implant Devices,245,35,,245,percent of total billed charges,Implant Devices,245,35,,245,percent of total billed charges,Implant Devices,280,40,,280,percent of total billed charges,Implant Devices,245,70,,245,percent of total billed charges,Implant Devices,238,34,,238,percent of total billed charges,Implant Devices,238,34,,238,percent of total billed charges,Implant Devices,245,35,,245,percent of total billed charges,Implant Devices,245,35,,245,percent of total billed charges,Implant Devices,245,35,,245,percent of total billed charges,Implant Devices,245,35,,245,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280,
SYNTHES 223.641 PLATE 14 HOLE 189MM,C1713,HCPCS,,79005276,CDM,278,RC,,,both,,,2338,922.73,39.4668,,922.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,794.92,34,,794.92,percent of total billed charges,Implant Device,794.92,34,,794.92,percent of total billed charges,Implant Device,794.92,34,,794.92,percent of total billed charges,Implant Device,794.92,34,,794.92,percent of total billed charges,Implant Device,794.92,34,,794.92,percent of total billed charges,Implant Device,794.92,34,,794.92,percent of total billed charges,Implant Device,818.3,35,,818.3,percent of total billed charges,Implant Device,794.92,34,"Charges > $500, x 34%",794.92,percent of total billed charges,Implant Device,818.3,35,,818.3,percent of total billed charges,Implant Devices,818.3,35,,818.3,percent of total billed charges,Implant Devices,818.3,35,,,percent of total billed charges,Implant Devices,818.3,35,,818.3,percent of total billed charges,Implant Devices,818.3,35,,818.3,percent of total billed charges,Implant Devices,935.2,40,,935.2,percent of total billed charges,Implant Devices,818.3,70,,818.3,percent of total billed charges,Implant Devices,794.92,34,,794.92,percent of total billed charges,Implant Devices,794.92,34,,794.92,percent of total billed charges,Implant Devices,818.3,35,,818.3,percent of total billed charges,Implant Devices,818.3,35,,818.3,percent of total billed charges,Implant Devices,818.3,35,,818.3,percent of total billed charges,Implant Devices,818.3,35,,818.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,794.92,34,"If Charge > 2,000, then 34 percent",794.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,935.2,
SYNTHES 223.621 PLATE 12 HOLE 163MM,C1713,HCPCS,,79005277,CDM,278,RC,,,both,,,1558,614.89,39.4668,,614.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,529.72,34,,529.72,percent of total billed charges,Implant Device,529.72,34,,529.72,percent of total billed charges,Implant Device,529.72,34,,529.72,percent of total billed charges,Implant Device,529.72,34,,529.72,percent of total billed charges,Implant Device,529.72,34,,529.72,percent of total billed charges,Implant Device,529.72,34,,529.72,percent of total billed charges,Implant Device,545.3,35,,545.3,percent of total billed charges,Implant Device,529.72,34,"Charges > $500, x 34%",529.72,percent of total billed charges,Implant Device,545.3,35,,545.3,percent of total billed charges,Implant Devices,545.3,35,,545.3,percent of total billed charges,Implant Devices,545.3,35,,,percent of total billed charges,Implant Devices,545.3,35,,545.3,percent of total billed charges,Implant Devices,545.3,35,,545.3,percent of total billed charges,Implant Devices,623.2,40,,623.2,percent of total billed charges,Implant Devices,545.3,70,,545.3,percent of total billed charges,Implant Devices,529.72,34,,529.72,percent of total billed charges,Implant Devices,529.72,34,,529.72,percent of total billed charges,Implant Devices,545.3,35,,545.3,percent of total billed charges,Implant Devices,545.3,35,,545.3,percent of total billed charges,Implant Devices,545.3,35,,545.3,percent of total billed charges,Implant Devices,545.3,35,,545.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,623.2,
SYNTHES 223.591 PLATE 9 HOLE 124MM,C1713,HCPCS,,79005278,CDM,278,RC,,,both,,,1372,541.48,39.4668,,541.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,466.48,34,,466.48,percent of total billed charges,Implant Device,466.48,34,,466.48,percent of total billed charges,Implant Device,466.48,34,,466.48,percent of total billed charges,Implant Device,466.48,34,,466.48,percent of total billed charges,Implant Device,466.48,34,,466.48,percent of total billed charges,Implant Device,466.48,34,,466.48,percent of total billed charges,Implant Device,480.2,35,,480.2,percent of total billed charges,Implant Device,466.48,34,"Charges > $500, x 34%",466.48,percent of total billed charges,Implant Device,480.2,35,,480.2,percent of total billed charges,Implant Devices,480.2,35,,480.2,percent of total billed charges,Implant Devices,480.2,35,,,percent of total billed charges,Implant Devices,480.2,35,,480.2,percent of total billed charges,Implant Devices,480.2,35,,480.2,percent of total billed charges,Implant Devices,548.8,40,,548.8,percent of total billed charges,Implant Devices,480.2,70,,480.2,percent of total billed charges,Implant Devices,466.48,34,,466.48,percent of total billed charges,Implant Devices,466.48,34,,466.48,percent of total billed charges,Implant Devices,480.2,35,,480.2,percent of total billed charges,Implant Devices,480.2,35,,480.2,percent of total billed charges,Implant Devices,480.2,35,,480.2,percent of total billed charges,Implant Devices,480.2,35,,480.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,548.8,
SYNTHES 315.28 DRILL BIT 2.7X125MM,C1713,HCPCS,,79005279,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
STRYKER 5036-1-580 BLUNT PIN 3X80X15MM,C1713,HCPCS,,79005281,CDM,278,RC,,,both,,,322,127.08,39.4668,,127.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,128.8,40,,128.8,percent of total billed charges,Implant Devices,112.7,70,,112.7,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.8,
STRYKER 5036-1-110 BLUNT PIN 3X110X25MM,C1713,HCPCS,,79005282,CDM,278,RC,,,both,,,322,127.08,39.4668,,127.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,109.48,34,,109.48,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,128.8,40,,128.8,percent of total billed charges,Implant Devices,112.7,70,,112.7,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,109.48,34,,109.48,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,112.7,35,,112.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,128.8,
STRYKER 5048-5-100 CARBON ROD 5X100MM,C1713,HCPCS,,79005283,CDM,278,RC,,,both,,,285,112.48,39.4668,,112.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,99.75,35,,99.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,114,40,,114,percent of total billed charges,Implant Devices,99.75,70,,99.75,percent of total billed charges,Implant Devices,96.9,34,,96.9,percent of total billed charges,Implant Devices,96.9,34,,96.9,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,114,
ARTHREX AR-8943C-08 LOCKING PLATE 8 HOLE,C1713,HCPCS,,79005287,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ARTHREX AR-8944CL-L MTP FUSION PLATE LG,C1713,HCPCS,,79005291,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
ARTHREX AR-8933-22 SCREW 3X22MM,C1713,HCPCS,,79005292,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ARTHREX AR-8933L-20 LOCKING SCREW 3X20MM,C1713,HCPCS,,79005293,CDM,278,RC,,,both,,,256,101.04,39.4668,,101.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,87.04,34,,87.04,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,102.4,40,,102.4,percent of total billed charges,Implant Devices,89.6,70,,89.6,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,87.04,34,,87.04,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,89.6,35,,89.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.4,
EXACTECH 320-20-00 REVERSE TORQUE SCREW,C1713,HCPCS,,79005296,CDM,278,RC,,,both,,,1404,554.11,39.4668,,554.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,477.36,34,,477.36,percent of total billed charges,Implant Device,477.36,34,,477.36,percent of total billed charges,Implant Device,477.36,34,,477.36,percent of total billed charges,Implant Device,477.36,34,,477.36,percent of total billed charges,Implant Device,477.36,34,,477.36,percent of total billed charges,Implant Device,477.36,34,,477.36,percent of total billed charges,Implant Device,491.4,35,,491.4,percent of total billed charges,Implant Device,477.36,34,"Charges > $500, x 34%",477.36,percent of total billed charges,Implant Device,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,561.6,40,,561.6,percent of total billed charges,Implant Devices,491.4,70,,491.4,percent of total billed charges,Implant Devices,477.36,34,,477.36,percent of total billed charges,Implant Devices,477.36,34,,477.36,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,491.4,35,,491.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,561.6,
ARTHREX AR-8720-10PT CANN SCREW 2X10MM,C1713,HCPCS,,79005302,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
SYNTHES 222.658 8 HOLE PLATE 4.5MM,C1713,HCPCS,,79005304,CDM,278,RC,,,both,,,6064,2393.27,39.4668,,2393.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2122.4,35,,2122.4,percent of total billed charges,Implant Device,2061.76,34,"Charges > $500, x 34%",2061.76,percent of total billed charges,Implant Device,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2425.6,40,,2425.6,percent of total billed charges,Implant Devices,2122.4,70,,2122.4,percent of total billed charges,Implant Devices,2061.76,34,,2061.76,percent of total billed charges,Implant Devices,2061.76,34,,2061.76,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2061.76,34,"If Charge > 2,000, then 34 percent",2061.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2425.6,
SYNTHES 02.207.070 CANN LCK SCREW 7.3X70,C1713,HCPCS,,79005305,CDM,278,RC,,,both,,,1126,444.4,39.4668,,444.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Device,382.84,34,"Charges > $500, x 34%",382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,450.4,40,,450.4,percent of total billed charges,Implant Devices,394.1,70,,394.1,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450.4,
SYNTHES 02.205.030 CANN LOCK SCREW 5X30,C1713,HCPCS,,79005306,CDM,278,RC,,,both,,,760,299.95,39.4668,,299.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,266,35,,266,percent of total billed charges,Implant Device,258.4,34,"Charges > $500, x 34%",258.4,percent of total billed charges,Implant Device,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,304,40,,304,percent of total billed charges,Implant Devices,266,70,,266,percent of total billed charges,Implant Devices,258.4,34,,258.4,percent of total billed charges,Implant Devices,258.4,34,,258.4,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,304,
SYNTHES 02.205.035 CANN LOCK SCREW 5X35,C1713,HCPCS,,79005307,CDM,278,RC,,,both,,,760,299.95,39.4668,,299.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,266,35,,266,percent of total billed charges,Implant Device,258.4,34,"Charges > $500, x 34%",258.4,percent of total billed charges,Implant Device,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,304,40,,304,percent of total billed charges,Implant Devices,266,70,,266,percent of total billed charges,Implant Devices,258.4,34,,258.4,percent of total billed charges,Implant Devices,258.4,34,,258.4,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,304,
SYNTHES 02.205.045 CANN LOCK SCREW 5X45,C1713,HCPCS,,79005308,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
SYNTHES 02.205.055 CANN LOCK SCREW 5X55,C1713,HCPCS,,79005309,CDM,278,RC,,,both,,,760,299.95,39.4668,,299.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,258.4,34,,258.4,percent of total billed charges,Implant Device,266,35,,266,percent of total billed charges,Implant Device,258.4,34,"Charges > $500, x 34%",258.4,percent of total billed charges,Implant Device,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,304,40,,304,percent of total billed charges,Implant Devices,266,70,,266,percent of total billed charges,Implant Devices,258.4,34,,258.4,percent of total billed charges,Implant Devices,258.4,34,,258.4,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,266,35,,266,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,304,
SYNTHES 02.205.060 CANN LOCK SCREW 5X60,C1713,HCPCS,,79005310,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
SYNTHES 02.205.065 CANN LOCK SCREW 5X65,C1713,HCPCS,,79005311,CDM,278,RC,,,both,,,868,342.57,39.4668,,342.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,303.8,35,,303.8,percent of total billed charges,Implant Device,295.12,34,"Charges > $500, x 34%",295.12,percent of total billed charges,Implant Device,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,347.2,40,,347.2,percent of total billed charges,Implant Devices,303.8,70,,303.8,percent of total billed charges,Implant Devices,295.12,34,,295.12,percent of total billed charges,Implant Devices,295.12,34,,295.12,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,347.2,
SYNTHES XM106.2030S TISSUE MATRIX 20X30,C1713,HCPCS,,79005312,CDM,278,RC,,,both,,,56560,22322.42,39.4668,,22322.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19230.4,34,,19230.4,percent of total billed charges,Implant Device,19230.4,34,,19230.4,percent of total billed charges,Implant Device,19230.4,34,,19230.4,percent of total billed charges,Implant Device,19230.4,34,,19230.4,percent of total billed charges,Implant Device,19230.4,34,,19230.4,percent of total billed charges,Implant Device,19230.4,34,,19230.4,percent of total billed charges,Implant Device,19796,35,,19796,percent of total billed charges,Implant Device,19230.4,34,"Charges > $500, x 34%",19230.4,percent of total billed charges,Implant Device,19796,35,,19796,percent of total billed charges,Implant Devices,19796,35,,19796,percent of total billed charges,Implant Devices,19796,35,,,percent of total billed charges,Implant Devices,19796,35,,19796,percent of total billed charges,Implant Devices,19796,35,,19796,percent of total billed charges,Implant Devices,22624,40,,22624,percent of total billed charges,Implant Devices,19796,70,,19796,percent of total billed charges,Implant Devices,19230.4,34,,19230.4,percent of total billed charges,Implant Devices,19230.4,34,,19230.4,percent of total billed charges,Implant Devices,19796,35,,19796,percent of total billed charges,Implant Devices,19796,35,,19796,percent of total billed charges,Implant Devices,19796,35,,19796,percent of total billed charges,Implant Devices,19796,35,,19796,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,19230.4,34,"If Charge > 2,000, then 34 percent",19230.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22624,
SYNTHES 222.571 CANN SCREW 7.3X70MM,C1713,HCPCS,,79005313,CDM,278,RC,,,both,,,582,229.7,39.4668,,229.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,203.7,35,,203.7,percent of total billed charges,Implant Device,197.88,34,"Charges > $500, x 34%",197.88,percent of total billed charges,Implant Device,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,232.8,40,,232.8,percent of total billed charges,Implant Devices,203.7,70,,203.7,percent of total billed charges,Implant Devices,197.88,34,,197.88,percent of total billed charges,Implant Devices,197.88,34,,197.88,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.8,
SYNTHES 222.536 CANN SCREW 5.0X30MM,C1713,HCPCS,,79005314,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
SYTNHES 222.537 CANN SCREW 5.0X35MM,C1713,HCPCS,,79005315,CDM,278,RC,,,both,,,496,195.76,39.4668,,195.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,198.4,40,,198.4,percent of total billed charges,Implant Devices,173.6,70,,173.6,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.4,
SYNTHES 222.539 CANN SCREW 5.0X45MM,C1713,HCPCS,,79005316,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
SYNTHES 222.541 CANN SCREW 5.0X55MM,C1713,HCPCS,,79005317,CDM,278,RC,,,both,,,496,195.76,39.4668,,195.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,198.4,40,,198.4,percent of total billed charges,Implant Devices,173.6,70,,173.6,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.4,
SYNTHES 222.542 CANN SCREW 5.0X60MM,C1713,HCPCS,,79005318,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
SYNTHES 222.543 CANN SCREW 5.0X65MM,C1713,HCPCS,,79005319,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
STRYKER 338630 CORTICAL SCREW 3.5X30MM,C1713,HCPCS,,79005322,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 371526 LOCKING SCREW 4X26MM,C1713,HCPCS,,79005323,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 371538 LOCKING SCREW 4X38MM,C1713,HCPCS,,79005324,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
STRYKER 54-25291 DORSAL DR PLATE LEFT,C1713,HCPCS,,79005325,CDM,278,RC,,,both,,,2484,980.36,39.4668,,980.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,869.4,35,,869.4,percent of total billed charges,Implant Device,844.56,34,"Charges > $500, x 34%",844.56,percent of total billed charges,Implant Device,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,993.6,40,,993.6,percent of total billed charges,Implant Devices,869.4,70,,869.4,percent of total billed charges,Implant Devices,844.56,34,,844.56,percent of total billed charges,Implant Devices,844.56,34,,844.56,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,844.56,34,"If Charge > 2,000, then 34 percent",844.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,993.6,
STRYKER 53-23612E LOCKING SCREW 2.3X12MM,C1713,HCPCS,,79005326,CDM,278,RC,,,both,,,469,185.1,39.4668,,185.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,159.46,34,,159.46,percent of total billed charges,Implant Device,164.15,35,,164.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,187.6,40,,187.6,percent of total billed charges,Implant Devices,164.15,70,,164.15,percent of total billed charges,Implant Devices,159.46,34,,159.46,percent of total billed charges,Implant Devices,159.46,34,,159.46,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,164.15,35,,164.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.6,
STRYKER 53-23618E LOCKING SCREW 2.3X18MM,C1713,HCPCS,,79005327,CDM,278,RC,,,both,,,492,194.18,39.4668,,194.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,196.8,40,,196.8,percent of total billed charges,Implant Devices,172.2,70,,172.2,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196.8,
SYNTHES 206.014 CANCELLOUS SCREW 4X14MM,C1713,HCPCS,,79005330,CDM,278,RC,,,both,,,80,31.57,39.4668,,31.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,28,35,,28,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,32,40,,32,percent of total billed charges,Implant Devices,28,70,,28,percent of total billed charges,Implant Devices,27.2,34,,27.2,percent of total billed charges,Implant Devices,27.2,34,,27.2,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32,
ARTHERX AR-8943BR-08 FIBULA PLATE 8 HOLE,C1713,HCPCS,,79005331,CDM,278,RC,,,both,,,3408,1345.03,39.4668,,1345.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1192.8,35,,1192.8,percent of total billed charges,Implant Device,1158.72,34,"Charges > $500, x 34%",1158.72,percent of total billed charges,Implant Device,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1363.2,40,,1363.2,percent of total billed charges,Implant Devices,1192.8,70,,1192.8,percent of total billed charges,Implant Devices,1158.72,34,,1158.72,percent of total billed charges,Implant Devices,1158.72,34,,1158.72,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1158.72,34,"If Charge > 2,000, then 34 percent",1158.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1363.2,
ARTHREX AR-8827L-10 LOCK SCREW 2.7X10MM,C1713,HCPCS,,79005332,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
ARTHREX AR-8830-20 SCREW 3X20MM,C1713,HCPCS,,79005333,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ARTHERX AR-8835-10 SCREW 3.5X10MM,C1713,HCPCS,,79005334,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
BME SE-1818 SPEED IMPLANT 18X18X18MM,C1713,HCPCS,,79005339,CDM,278,RC,,,both,,,4710,1858.89,39.4668,,1858.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1648.5,35,,1648.5,percent of total billed charges,Implant Device,1601.4,34,"Charges > $500, x 34%",1601.4,percent of total billed charges,Implant Device,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1884,40,,1884,percent of total billed charges,Implant Devices,1648.5,70,,1648.5,percent of total billed charges,Implant Devices,1601.4,34,,1601.4,percent of total billed charges,Implant Devices,1601.4,34,,1601.4,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1601.4,34,"If Charge > 2,000, then 34 percent",1601.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1884,
ARTHREX AR-8724-12 SCREW 2.4X12MM,C1713,HCPCS,,79005340,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8724-14 SCREW 2.4X14MM,C1713,HCPCS,,79005341,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
OLYMPUS 005280-901 FALOPE RING APP W/TRO,C1713,HCPCS,,79005343,CDM,278,RC,,,both,,,1402,553.32,39.4668,,553.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,476.68,34,,476.68,percent of total billed charges,Implant Device,476.68,34,,476.68,percent of total billed charges,Implant Device,476.68,34,,476.68,percent of total billed charges,Implant Device,476.68,34,,476.68,percent of total billed charges,Implant Device,476.68,34,,476.68,percent of total billed charges,Implant Device,476.68,34,,476.68,percent of total billed charges,Implant Device,490.7,35,,490.7,percent of total billed charges,Implant Device,476.68,34,"Charges > $500, x 34%",476.68,percent of total billed charges,Implant Device,490.7,35,,490.7,percent of total billed charges,Implant Devices,490.7,35,,490.7,percent of total billed charges,Implant Devices,490.7,35,,,percent of total billed charges,Implant Devices,490.7,35,,490.7,percent of total billed charges,Implant Devices,490.7,35,,490.7,percent of total billed charges,Implant Devices,560.8,40,,560.8,percent of total billed charges,Implant Devices,490.7,70,,490.7,percent of total billed charges,Implant Devices,476.68,34,,476.68,percent of total billed charges,Implant Devices,476.68,34,,476.68,percent of total billed charges,Implant Devices,490.7,35,,490.7,percent of total billed charges,Implant Devices,490.7,35,,490.7,percent of total billed charges,Implant Devices,490.7,35,,490.7,percent of total billed charges,Implant Devices,490.7,35,,490.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,560.8,
ACUMED 70-0303 OLECRANON PLATE RT 3 HOLE,C1713,HCPCS,,79005345,CDM,278,RC,,,both,,,3639,1436.2,39.4668,,1436.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1237.26,34,,1237.26,percent of total billed charges,Implant Device,1237.26,34,,1237.26,percent of total billed charges,Implant Device,1237.26,34,,1237.26,percent of total billed charges,Implant Device,1237.26,34,,1237.26,percent of total billed charges,Implant Device,1237.26,34,,1237.26,percent of total billed charges,Implant Device,1237.26,34,,1237.26,percent of total billed charges,Implant Device,1273.65,35,,1273.65,percent of total billed charges,Implant Device,1237.26,34,"Charges > $500, x 34%",1237.26,percent of total billed charges,Implant Device,1273.65,35,,1273.65,percent of total billed charges,Implant Devices,1273.65,35,,1273.65,percent of total billed charges,Implant Devices,1273.65,35,,,percent of total billed charges,Implant Devices,1273.65,35,,1273.65,percent of total billed charges,Implant Devices,1273.65,35,,1273.65,percent of total billed charges,Implant Devices,1455.6,40,,1455.6,percent of total billed charges,Implant Devices,1273.65,70,,1273.65,percent of total billed charges,Implant Devices,1237.26,34,,1237.26,percent of total billed charges,Implant Devices,1237.26,34,,1237.26,percent of total billed charges,Implant Devices,1273.65,35,,1273.65,percent of total billed charges,Implant Devices,1273.65,35,,1273.65,percent of total billed charges,Implant Devices,1273.65,35,,1273.65,percent of total billed charges,Implant Devices,1273.65,35,,1273.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1237.26,34,"If Charge > 2,000, then 34 percent",1237.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1455.6,
ACUMED 30-0264 NON LOCK SCREW 3.5X26MM,C1713,HCPCS,,79005346,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
ACUMED 30-0261 NON LOCK SCREW 3.5X20MM,C1713,HCPCS,,79005347,CDM,278,RC,,,both,,,262,103.4,39.4668,,103.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,91.7,35,,91.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,104.8,40,,104.8,percent of total billed charges,Implant Devices,91.7,70,,91.7,percent of total billed charges,Implant Devices,89.08,34,,89.08,percent of total billed charges,Implant Devices,89.08,34,,89.08,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,104.8,
ACUMED 30-0271 NON LOCK SCREW 3.5X40MM,C1713,HCPCS,,79005348,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
ALPHATEC 71001-060 4 LEVEL PLATE 60CM,C1713,HCPCS,,79005349,CDM,278,RC,,,both,,,3750,1480.01,39.4668,,1480.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Device,1275,34,"Charges > $500, x 34%",1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1500,40,,1500,percent of total billed charges,Implant Devices,1312.5,70,,1312.5,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1275,34,"If Charge > 2,000, then 34 percent",1275,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
ALPHATEC 71001-012 ONE LEVE PLATE 12MM,C1713,HCPCS,,79005350,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
S&N 410236 GUIDE PIN 230X2.4MM,C1713,HCPCS,,79005356,CDM,278,RC,,,both,,,124,48.94,39.4668,,48.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.16,34,,42.16,percent of total billed charges,Implant Device,42.16,34,,42.16,percent of total billed charges,Implant Device,42.16,34,,42.16,percent of total billed charges,Implant Device,42.16,34,,42.16,percent of total billed charges,Implant Device,42.16,34,,42.16,percent of total billed charges,Implant Device,42.16,34,,42.16,percent of total billed charges,Implant Device,43.4,35,,43.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.4,35,,43.4,percent of total billed charges,Implant Devices,43.4,35,,43.4,percent of total billed charges,Implant Devices,43.4,35,,,percent of total billed charges,Implant Devices,43.4,35,,43.4,percent of total billed charges,Implant Devices,43.4,35,,43.4,percent of total billed charges,Implant Devices,49.6,40,,49.6,percent of total billed charges,Implant Devices,43.4,70,,43.4,percent of total billed charges,Implant Devices,42.16,34,,42.16,percent of total billed charges,Implant Devices,42.16,34,,42.16,percent of total billed charges,Implant Devices,43.4,35,,43.4,percent of total billed charges,Implant Devices,43.4,35,,43.4,percent of total billed charges,Implant Devices,43.4,35,,43.4,percent of total billed charges,Implant Devices,43.4,35,,43.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,49.6,
S&N 202.824 CORTEX SCREW SELF TAP 2.7X24,C1713,HCPCS,,79005357,CDM,278,RC,,,both,,,85,33.55,39.4668,,33.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,34,40,,34,percent of total billed charges,Implant Devices,29.75,70,,29.75,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34,
S&N 242.05 PLATE W/COLLAR 5 HOLE 39MM,C1713,HCPCS,,79005358,CDM,278,RC,,,both,,,263,103.8,39.4668,,103.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,89.42,34,,89.42,percent of total billed charges,Implant Device,89.42,34,,89.42,percent of total billed charges,Implant Device,89.42,34,,89.42,percent of total billed charges,Implant Device,89.42,34,,89.42,percent of total billed charges,Implant Device,89.42,34,,89.42,percent of total billed charges,Implant Device,89.42,34,,89.42,percent of total billed charges,Implant Device,92.05,35,,92.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,92.05,35,,92.05,percent of total billed charges,Implant Devices,92.05,35,,92.05,percent of total billed charges,Implant Devices,92.05,35,,,percent of total billed charges,Implant Devices,92.05,35,,92.05,percent of total billed charges,Implant Devices,92.05,35,,92.05,percent of total billed charges,Implant Devices,105.2,40,,105.2,percent of total billed charges,Implant Devices,92.05,70,,92.05,percent of total billed charges,Implant Devices,89.42,34,,89.42,percent of total billed charges,Implant Devices,89.42,34,,89.42,percent of total billed charges,Implant Devices,92.05,35,,92.05,percent of total billed charges,Implant Devices,92.05,35,,92.05,percent of total billed charges,Implant Devices,92.05,35,,92.05,percent of total billed charges,Implant Devices,92.05,35,,92.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105.2,
MICRO AIRE 1600-1962 K WIRE .062,C1713,HCPCS,,79005360,CDM,278,RC,,,both,,,19,7.5,39.4668,,7.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.46,34,,6.46,percent of total billed charges,Implant Device,6.65,35,,6.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,7.6,40,,7.6,percent of total billed charges,Implant Devices,6.65,70,,6.65,percent of total billed charges,Implant Devices,6.46,34,,6.46,percent of total billed charges,Implant Devices,6.46,34,,6.46,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,6.65,35,,6.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7.6,
SYNTHES 202.812 CORTEX SCREW 2.7X12MM,C1713,HCPCS,,79005362,CDM,278,RC,,,both,,,128,50.52,39.4668,,50.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,44.8,35,,44.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,51.2,40,,51.2,percent of total billed charges,Implant Devices,44.8,70,,44.8,percent of total billed charges,Implant Devices,43.52,34,,43.52,percent of total billed charges,Implant Devices,43.52,34,,43.52,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,51.2,
SYNTHES 202.810 CORTEX SCREW 2.7X10MM,C1713,HCPCS,,79005363,CDM,278,RC,,,both,,,128,50.52,39.4668,,50.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,44.8,35,,44.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,51.2,40,,51.2,percent of total billed charges,Implant Devices,44.8,70,,44.8,percent of total billed charges,Implant Devices,43.52,34,,43.52,percent of total billed charges,Implant Devices,43.52,34,,43.52,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,51.2,
ZIMMER 00-1105-200-002 PUROS DBM 20CC,C1713,HCPCS,,79005376,CDM,278,RC,,,both,,,8764,3458.87,39.4668,,3458.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2979.76,34,,2979.76,percent of total billed charges,Implant Device,2979.76,34,,2979.76,percent of total billed charges,Implant Device,2979.76,34,,2979.76,percent of total billed charges,Implant Device,2979.76,34,,2979.76,percent of total billed charges,Implant Device,2979.76,34,,2979.76,percent of total billed charges,Implant Device,2979.76,34,,2979.76,percent of total billed charges,Implant Device,3067.4,35,,3067.4,percent of total billed charges,Implant Device,2979.76,34,"Charges > $500, x 34%",2979.76,percent of total billed charges,Implant Device,3067.4,35,,3067.4,percent of total billed charges,Implant Devices,3067.4,35,,3067.4,percent of total billed charges,Implant Devices,3067.4,35,,,percent of total billed charges,Implant Devices,3067.4,35,,3067.4,percent of total billed charges,Implant Devices,3067.4,35,,3067.4,percent of total billed charges,Implant Devices,3505.6,40,,3505.6,percent of total billed charges,Implant Devices,3067.4,70,,3067.4,percent of total billed charges,Implant Devices,2979.76,34,,2979.76,percent of total billed charges,Implant Devices,2979.76,34,,2979.76,percent of total billed charges,Implant Devices,3067.4,35,,3067.4,percent of total billed charges,Implant Devices,3067.4,35,,3067.4,percent of total billed charges,Implant Devices,3067.4,35,,3067.4,percent of total billed charges,Implant Devices,3067.4,35,,3067.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2979.76,34,"If Charge > 2,000, then 34 percent",2979.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3505.6,
SOLANA FFS-1515 FUSEFORCE IMPLNT 15X15MM,C1713,HCPCS,,79005377,CDM,278,RC,,,both,,,5508,2173.83,39.4668,,2173.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1872.72,34,,1872.72,percent of total billed charges,Implant Device,1872.72,34,,1872.72,percent of total billed charges,Implant Device,1872.72,34,,1872.72,percent of total billed charges,Implant Device,1872.72,34,,1872.72,percent of total billed charges,Implant Device,1872.72,34,,1872.72,percent of total billed charges,Implant Device,1872.72,34,,1872.72,percent of total billed charges,Implant Device,1927.8,35,,1927.8,percent of total billed charges,Implant Device,1872.72,34,"Charges > $500, x 34%",1872.72,percent of total billed charges,Implant Device,1927.8,35,,1927.8,percent of total billed charges,Implant Devices,1927.8,35,,1927.8,percent of total billed charges,Implant Devices,1927.8,35,,,percent of total billed charges,Implant Devices,1927.8,35,,1927.8,percent of total billed charges,Implant Devices,1927.8,35,,1927.8,percent of total billed charges,Implant Devices,2203.2,40,,2203.2,percent of total billed charges,Implant Devices,1927.8,70,,1927.8,percent of total billed charges,Implant Devices,1872.72,34,,1872.72,percent of total billed charges,Implant Devices,1872.72,34,,1872.72,percent of total billed charges,Implant Devices,1927.8,35,,1927.8,percent of total billed charges,Implant Devices,1927.8,35,,1927.8,percent of total billed charges,Implant Devices,1927.8,35,,1927.8,percent of total billed charges,Implant Devices,1927.8,35,,1927.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1872.72,34,"If Charge > 2,000, then 34 percent",1872.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2203.2,
BIOMET 14-522357 MAKAM PLATE 57MM,C1713,HCPCS,,79005378,CDM,278,RC,,,both,,,7447,2939.09,39.4668,,2939.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2531.98,34,,2531.98,percent of total billed charges,Implant Device,2531.98,34,,2531.98,percent of total billed charges,Implant Device,2531.98,34,,2531.98,percent of total billed charges,Implant Device,2531.98,34,,2531.98,percent of total billed charges,Implant Device,2531.98,34,,2531.98,percent of total billed charges,Implant Device,2531.98,34,,2531.98,percent of total billed charges,Implant Device,2606.45,35,,2606.45,percent of total billed charges,Implant Device,2531.98,34,"Charges > $500, x 34%",2531.98,percent of total billed charges,Implant Device,2606.45,35,,2606.45,percent of total billed charges,Implant Devices,2606.45,35,,2606.45,percent of total billed charges,Implant Devices,2606.45,35,,,percent of total billed charges,Implant Devices,2606.45,35,,2606.45,percent of total billed charges,Implant Devices,2606.45,35,,2606.45,percent of total billed charges,Implant Devices,2978.8,40,,2978.8,percent of total billed charges,Implant Devices,2606.45,70,,2606.45,percent of total billed charges,Implant Devices,2531.98,34,,2531.98,percent of total billed charges,Implant Devices,2531.98,34,,2531.98,percent of total billed charges,Implant Devices,2606.45,35,,2606.45,percent of total billed charges,Implant Devices,2606.45,35,,2606.45,percent of total billed charges,Implant Devices,2606.45,35,,2606.45,percent of total billed charges,Implant Devices,2606.45,35,,2606.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2531.98,34,"If Charge > 2,000, then 34 percent",2531.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2978.8,
ARTHREX AR-8967-1855 CANN SCREW 6.7X55MM,C1713,HCPCS,,79005380,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
ARTHREX AR-8952TS-04 PLATE STR 4 HOLE,C1713,HCPCS,,79005381,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
ARTHREX AR-8730-16PT SCREW 3.0X16MM,C1713,HCPCS,,79005382,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
STRYKER 40-30116 ASNIS CANN SCREW 3X16MM,C1713,HCPCS,,79005386,CDM,278,RC,,,both,,,818,322.84,39.4668,,322.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,278.12,34,,278.12,percent of total billed charges,Implant Device,278.12,34,,278.12,percent of total billed charges,Implant Device,278.12,34,,278.12,percent of total billed charges,Implant Device,278.12,34,,278.12,percent of total billed charges,Implant Device,278.12,34,,278.12,percent of total billed charges,Implant Device,278.12,34,,278.12,percent of total billed charges,Implant Device,286.3,35,,286.3,percent of total billed charges,Implant Device,278.12,34,"Charges > $500, x 34%",278.12,percent of total billed charges,Implant Device,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,327.2,40,,327.2,percent of total billed charges,Implant Devices,286.3,70,,286.3,percent of total billed charges,Implant Devices,278.12,34,,278.12,percent of total billed charges,Implant Devices,278.12,34,,278.12,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,327.2,
ZIMMER 47-2484-030-50 NAIL 5X30 CORT SCR,C1713,HCPCS,,79005389,CDM,278,RC,,,both,,,665,262.45,39.4668,,262.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,226.1,34,,226.1,percent of total billed charges,Implant Device,232.75,35,,232.75,percent of total billed charges,Implant Device,226.1,34,"Charges > $500, x 34%",226.1,percent of total billed charges,Implant Device,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,266,40,,266,percent of total billed charges,Implant Devices,232.75,70,,232.75,percent of total billed charges,Implant Devices,226.1,34,,226.1,percent of total billed charges,Implant Devices,226.1,34,,226.1,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,232.75,35,,232.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266,
ZIMMER  00-5791-054-00 UNI HOLDING PIN,C1713,HCPCS,,79005437,CDM,278,RC,,,both,,,529,208.78,39.4668,,208.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Device,179.86,34,"Charges > $500, x 34%",179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,211.6,40,,211.6,percent of total billed charges,Implant Devices,185.15,70,,185.15,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,211.6,
ZIMMER  00-2357-018-04 PLATE 4 HOLE 80MM,C1713,HCPCS,,79005439,CDM,278,RC,,,both,,,2020,797.23,39.4668,,797.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,686.8,34,,686.8,percent of total billed charges,Implant Device,686.8,34,,686.8,percent of total billed charges,Implant Device,686.8,34,,686.8,percent of total billed charges,Implant Device,686.8,34,,686.8,percent of total billed charges,Implant Device,686.8,34,,686.8,percent of total billed charges,Implant Device,686.8,34,,686.8,percent of total billed charges,Implant Device,707,35,,707,percent of total billed charges,Implant Device,686.8,34,"Charges > $500, x 34%",686.8,percent of total billed charges,Implant Device,707,35,,707,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,707,35,,,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,808,40,,808,percent of total billed charges,Implant Devices,707,70,,707,percent of total billed charges,Implant Devices,686.8,34,,686.8,percent of total billed charges,Implant Devices,686.8,34,,686.8,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,686.8,34,"If Charge > 2,000, then 34 percent",686.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,808,
JRF 32147002 LEFT LAT HEMI CONDYLE GRAFT,C1713,HCPCS,,79005460,CDM,278,RC,,,both,,,32850,12964.84,39.4668,,12964.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11169,34,,11169,percent of total billed charges,Implant Device,11169,34,,11169,percent of total billed charges,Implant Device,11169,34,,11169,percent of total billed charges,Implant Device,11169,34,,11169,percent of total billed charges,Implant Device,11169,34,,11169,percent of total billed charges,Implant Device,11169,34,,11169,percent of total billed charges,Implant Device,11497.5,35,,11497.5,percent of total billed charges,Implant Device,11169,34,"Charges > $500, x 34%",11169,percent of total billed charges,Implant Device,11497.5,35,,11497.5,percent of total billed charges,Implant Devices,11497.5,35,,11497.5,percent of total billed charges,Implant Devices,11497.5,35,,,percent of total billed charges,Implant Devices,11497.5,35,,11497.5,percent of total billed charges,Implant Devices,11497.5,35,,11497.5,percent of total billed charges,Implant Devices,13140,40,,13140,percent of total billed charges,Implant Devices,11497.5,70,,11497.5,percent of total billed charges,Implant Devices,11169,34,,11169,percent of total billed charges,Implant Devices,11169,34,,11169,percent of total billed charges,Implant Devices,11497.5,35,,11497.5,percent of total billed charges,Implant Devices,11497.5,35,,11497.5,percent of total billed charges,Implant Devices,11497.5,35,,11497.5,percent of total billed charges,Implant Devices,11497.5,35,,11497.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11169,34,"If Charge > 2,000, then 34 percent",11169,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13140,
STRYKER 1896-5045S LOCK SCREW 5X45MM FT,C1713,HCPCS,,79005466,CDM,278,RC,,,both,,,355,140.11,39.4668,,140.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,142,40,,142,percent of total billed charges,Implant Devices,124.25,70,,124.25,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142,
STRYKER 1822-1233S TIBIAL NAIL 12X30MM,C1713,HCPCS,,79005467,CDM,278,RC,,,both,,,5819,2296.57,39.4668,,2296.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,2036.65,35,,2036.65,percent of total billed charges,Implant Device,1978.46,34,"Charges > $500, x 34%",1978.46,percent of total billed charges,Implant Device,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2327.6,40,,2327.6,percent of total billed charges,Implant Devices,2036.65,70,,2036.65,percent of total billed charges,Implant Devices,1978.46,34,,1978.46,percent of total billed charges,Implant Devices,1978.46,34,,1978.46,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1978.46,34,"If Charge > 2,000, then 34 percent",1978.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2327.6,
EXACTECH 320-20-38 COMPRESSN SCREW SZ 38,C1713,HCPCS,,79005474,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
STRYKER 606670 CANNULATED SCREW 4X70,C1713,HCPCS,,79005477,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
STABILITY BIOLOGICS 904 GRACILIS TENDON,C1713,HCPCS,,79005478,CDM,278,RC,,,both,,,5326,2102,39.4668,,2102,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1864.1,35,,1864.1,percent of total billed charges,Implant Device,1810.84,34,"Charges > $500, x 34%",1810.84,percent of total billed charges,Implant Device,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,2130.4,40,,2130.4,percent of total billed charges,Implant Devices,1864.1,70,,1864.1,percent of total billed charges,Implant Devices,1810.84,34,,1810.84,percent of total billed charges,Implant Devices,1810.84,34,,1810.84,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1810.84,34,"If Charge > 2,000, then 34 percent",1810.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2130.4,
STRYKER 4921-2-120 STRAIGHT POST,C1713,HCPCS,,79005479,CDM,278,RC,,,both,,,581,229.3,39.4668,,229.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Device,197.54,34,"Charges > $500, x 34%",197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,232.4,40,,232.4,percent of total billed charges,Implant Devices,203.35,70,,203.35,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.4,
STRYKER 5028-7-030 SEMI-CIRCLE ROD,C1713,HCPCS,,79005480,CDM,278,RC,,,both,,,768,303.11,39.4668,,303.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,268.8,35,,268.8,percent of total billed charges,Implant Device,261.12,34,"Charges > $500, x 34%",261.12,percent of total billed charges,Implant Device,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,307.2,40,,307.2,percent of total billed charges,Implant Devices,268.8,70,,268.8,percent of total billed charges,Implant Devices,261.12,34,,261.12,percent of total billed charges,Implant Devices,261.12,34,,261.12,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,307.2,
STRYKER 427067 3.0 LOCKING SCREW,C1713,HCPCS,,79005481,CDM,278,RC,,,both,,,587,231.67,39.4668,,231.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.58,34,,199.58,percent of total billed charges,Implant Device,199.58,34,,199.58,percent of total billed charges,Implant Device,199.58,34,,199.58,percent of total billed charges,Implant Device,199.58,34,,199.58,percent of total billed charges,Implant Device,199.58,34,,199.58,percent of total billed charges,Implant Device,199.58,34,,199.58,percent of total billed charges,Implant Device,205.45,35,,205.45,percent of total billed charges,Implant Device,199.58,34,"Charges > $500, x 34%",199.58,percent of total billed charges,Implant Device,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,234.8,40,,234.8,percent of total billed charges,Implant Devices,205.45,70,,205.45,percent of total billed charges,Implant Devices,199.58,34,,199.58,percent of total billed charges,Implant Devices,199.58,34,,199.58,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,205.45,35,,205.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.8,
STRYKER 388622 LOCKING SCREW 3.5X22MM,C1713,HCPCS,,79005482,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 388620 LOCKING SCREW 3.0X20MM,C1713,HCPCS,,79005483,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 325042 CANNULATED SCREW 4.0,C1713,HCPCS,,79005484,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
ZIMMER 5990-35-23 NEXGEN FEM AUG SZ E,C1713,HCPCS,,79005488,CDM,278,RC,,,both,,,3617,1427.51,39.4668,,1427.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1265.95,35,,1265.95,percent of total billed charges,Implant Device,1229.78,34,"Charges > $500, x 34%",1229.78,percent of total billed charges,Implant Device,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1446.8,40,,1446.8,percent of total billed charges,Implant Devices,1265.95,70,,1265.95,percent of total billed charges,Implant Devices,1229.78,34,,1229.78,percent of total billed charges,Implant Devices,1229.78,34,,1229.78,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1229.78,34,"If Charge > 2,000, then 34 percent",1229.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1446.8,
ARTHREX AR-2651CR CLAVICLE PLATE,C1713,HCPCS,,79005489,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ARTHREX AR-8724-22 SCREW 2.4X22MM,C1713,HCPCS,,79005493,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8724-24 SCREW 2.4X24MM,C1713,HCPCS,,79005494,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8724-28 SCREW 2.4X28MM,C1713,HCPCS,,79005495,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
ARTHREX AR-8740-50PTS CANN SCREW 4.0X50,C1713,HCPCS,,79005496,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ARTHREX AR-8740-32PTS CANN SCREW 4.0X32,C1713,HCPCS,,79005497,CDM,278,RC,,,both,,,708,279.42,39.4668,,279.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Device,240.72,34,"Charges > $500, x 34%",240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,283.2,40,,283.2,percent of total billed charges,Implant Devices,247.8,70,,247.8,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,283.2,
ACUMED 70-0125 DISTAL CLAVICLE PLATE 2.3,C1713,HCPCS,,79005498,CDM,278,RC,,,both,,,3603,1421.99,39.4668,,1421.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1225.02,34,,1225.02,percent of total billed charges,Implant Device,1225.02,34,,1225.02,percent of total billed charges,Implant Device,1225.02,34,,1225.02,percent of total billed charges,Implant Device,1225.02,34,,1225.02,percent of total billed charges,Implant Device,1225.02,34,,1225.02,percent of total billed charges,Implant Device,1225.02,34,,1225.02,percent of total billed charges,Implant Device,1261.05,35,,1261.05,percent of total billed charges,Implant Device,1225.02,34,"Charges > $500, x 34%",1225.02,percent of total billed charges,Implant Device,1261.05,35,,1261.05,percent of total billed charges,Implant Devices,1261.05,35,,1261.05,percent of total billed charges,Implant Devices,1261.05,35,,,percent of total billed charges,Implant Devices,1261.05,35,,1261.05,percent of total billed charges,Implant Devices,1261.05,35,,1261.05,percent of total billed charges,Implant Devices,1441.2,40,,1441.2,percent of total billed charges,Implant Devices,1261.05,70,,1261.05,percent of total billed charges,Implant Devices,1225.02,34,,1225.02,percent of total billed charges,Implant Devices,1225.02,34,,1225.02,percent of total billed charges,Implant Devices,1261.05,35,,1261.05,percent of total billed charges,Implant Devices,1261.05,35,,1261.05,percent of total billed charges,Implant Devices,1261.05,35,,1261.05,percent of total billed charges,Implant Devices,1261.05,35,,1261.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1225.02,34,"If Charge > 2,000, then 34 percent",1225.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1441.2,
STRYKER 3060-0100S LAG SCREW 10.5X100MM,C1713,HCPCS,,79005501,CDM,278,RC,,,both,,,2153,849.72,39.4668,,849.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,732.02,34,,732.02,percent of total billed charges,Implant Device,732.02,34,,732.02,percent of total billed charges,Implant Device,732.02,34,,732.02,percent of total billed charges,Implant Device,732.02,34,,732.02,percent of total billed charges,Implant Device,732.02,34,,732.02,percent of total billed charges,Implant Device,732.02,34,,732.02,percent of total billed charges,Implant Device,753.55,35,,753.55,percent of total billed charges,Implant Device,732.02,34,"Charges > $500, x 34%",732.02,percent of total billed charges,Implant Device,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,861.2,40,,861.2,percent of total billed charges,Implant Devices,753.55,70,,753.55,percent of total billed charges,Implant Devices,732.02,34,,732.02,percent of total billed charges,Implant Devices,732.02,34,,732.02,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,753.55,35,,753.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,732.02,34,"If Charge > 2,000, then 34 percent",732.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,861.2,
STRYKER 604630 ASNIS 4X30MM SCREW,C1713,HCPCS,,79005550,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 3120-1180S TROCH NAIL 11X180X120,C1713,HCPCS,,79005553,CDM,278,RC,,,both,,,3287,1297.27,39.4668,,1297.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1117.58,34,,1117.58,percent of total billed charges,Implant Device,1117.58,34,,1117.58,percent of total billed charges,Implant Device,1117.58,34,,1117.58,percent of total billed charges,Implant Device,1117.58,34,,1117.58,percent of total billed charges,Implant Device,1117.58,34,,1117.58,percent of total billed charges,Implant Device,1117.58,34,,1117.58,percent of total billed charges,Implant Device,1150.45,35,,1150.45,percent of total billed charges,Implant Device,1117.58,34,"Charges > $500, x 34%",1117.58,percent of total billed charges,Implant Device,1150.45,35,,1150.45,percent of total billed charges,Implant Devices,1150.45,35,,1150.45,percent of total billed charges,Implant Devices,1150.45,35,,,percent of total billed charges,Implant Devices,1150.45,35,,1150.45,percent of total billed charges,Implant Devices,1150.45,35,,1150.45,percent of total billed charges,Implant Devices,1314.8,40,,1314.8,percent of total billed charges,Implant Devices,1150.45,70,,1150.45,percent of total billed charges,Implant Devices,1117.58,34,,1117.58,percent of total billed charges,Implant Devices,1117.58,34,,1117.58,percent of total billed charges,Implant Devices,1150.45,35,,1150.45,percent of total billed charges,Implant Devices,1150.45,35,,1150.45,percent of total billed charges,Implant Devices,1150.45,35,,1150.45,percent of total billed charges,Implant Devices,1150.45,35,,1150.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1117.58,34,"If Charge > 2,000, then 34 percent",1117.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1314.8,
ALPHATEC 62055-55 SCREW 5.5X55MM,C1713,HCPCS,,79005564,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
ALPHATEC 71002-032 PLATE 2 LEVEL 32MM,C1713,HCPCS,,79005565,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
STRYKER 371570 LOCKING SCREW 4.0X70MM,C1713,HCPCS,,79005570,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 371575 LOCKING SCREW 4.0X75MM,C1713,HCPCS,,79005571,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 371528 LOCKING SCREW 4.0X28MM,C1713,HCPCS,,79005574,CDM,278,RC,,,both,,,1081,426.64,39.4668,,426.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,367.54,34,,367.54,percent of total billed charges,Implant Device,367.54,34,,367.54,percent of total billed charges,Implant Device,367.54,34,,367.54,percent of total billed charges,Implant Device,367.54,34,,367.54,percent of total billed charges,Implant Device,367.54,34,,367.54,percent of total billed charges,Implant Device,367.54,34,,367.54,percent of total billed charges,Implant Device,378.35,35,,378.35,percent of total billed charges,Implant Device,367.54,34,"Charges > $500, x 34%",367.54,percent of total billed charges,Implant Device,378.35,35,,378.35,percent of total billed charges,Implant Devices,378.35,35,,378.35,percent of total billed charges,Implant Devices,378.35,35,,,percent of total billed charges,Implant Devices,378.35,35,,378.35,percent of total billed charges,Implant Devices,378.35,35,,378.35,percent of total billed charges,Implant Devices,432.4,40,,432.4,percent of total billed charges,Implant Devices,378.35,70,,378.35,percent of total billed charges,Implant Devices,367.54,34,,367.54,percent of total billed charges,Implant Devices,367.54,34,,367.54,percent of total billed charges,Implant Devices,378.35,35,,378.35,percent of total billed charges,Implant Devices,378.35,35,,378.35,percent of total billed charges,Implant Devices,378.35,35,,378.35,percent of total billed charges,Implant Devices,378.35,35,,378.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,432.4,
STRYKER 371555 LOCKING SCREW 4.0X55MM,C1713,HCPCS,,79005575,CDM,278,RC,,,both,,,541,213.52,39.4668,,213.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,183.94,34,,183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Device,183.94,34,"Charges > $500, x 34%",183.94,percent of total billed charges,Implant Device,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,216.4,40,,216.4,percent of total billed charges,Implant Devices,189.35,70,,189.35,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,183.94,34,,183.94,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,189.35,35,,189.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.4,
STRYKER 338628 CORTICAL SCREW 3.5X28MM,C1713,HCPCS,,79005576,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 345540 CANC SCREW PT 4.0X40MM,C1713,HCPCS,,79005577,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
STRYKER 345570 CANC SCREW PT 4.0X70MM,C1713,HCPCS,,79005578,CDM,278,RC,,,both,,,118,46.57,39.4668,,46.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,47.2,40,,47.2,percent of total billed charges,Implant Devices,41.3,70,,41.3,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,47.2,
STRYKER 2102-2205 VITOSS BB TRAUMA,C1713,HCPCS,,79005579,CDM,278,RC,,,both,,,5334,2105.16,39.4668,,2105.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1813.56,34,,1813.56,percent of total billed charges,Implant Device,1813.56,34,,1813.56,percent of total billed charges,Implant Device,1813.56,34,,1813.56,percent of total billed charges,Implant Device,1813.56,34,,1813.56,percent of total billed charges,Implant Device,1813.56,34,,1813.56,percent of total billed charges,Implant Device,1813.56,34,,1813.56,percent of total billed charges,Implant Device,1866.9,35,,1866.9,percent of total billed charges,Implant Device,1813.56,34,"Charges > $500, x 34%",1813.56,percent of total billed charges,Implant Device,1866.9,35,,1866.9,percent of total billed charges,Implant Devices,1866.9,35,,1866.9,percent of total billed charges,Implant Devices,1866.9,35,,,percent of total billed charges,Implant Devices,1866.9,35,,1866.9,percent of total billed charges,Implant Devices,1866.9,35,,1866.9,percent of total billed charges,Implant Devices,2133.6,40,,2133.6,percent of total billed charges,Implant Devices,1866.9,70,,1866.9,percent of total billed charges,Implant Devices,1813.56,34,,1813.56,percent of total billed charges,Implant Devices,1813.56,34,,1813.56,percent of total billed charges,Implant Devices,1866.9,35,,1866.9,percent of total billed charges,Implant Devices,1866.9,35,,1866.9,percent of total billed charges,Implant Devices,1866.9,35,,1866.9,percent of total billed charges,Implant Devices,1866.9,35,,1866.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1813.56,34,"If Charge > 2,000, then 34 percent",1813.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2133.6,
STRYKER 604655S PT SCREW TITANIUM 4X55MM,C1713,HCPCS,,79005580,CDM,278,RC,,,both,,,824,325.21,39.4668,,325.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Device,280.16,34,"Charges > $500, x 34%",280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,329.6,40,,329.6,percent of total billed charges,Implant Devices,288.4,70,,288.4,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,329.6,
STRYKER 604638 ASNIS SCREW 4.0 X 38MM,C1713,HCPCS,,79005581,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
EXACTECH 340-38-44 CANC SCREW 3.9X44MM,C1713,HCPCS,,79005585,CDM,278,RC,,,both,,,499,196.94,39.4668,,196.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,169.66,34,,169.66,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,199.6,40,,199.6,percent of total billed charges,Implant Devices,174.65,70,,174.65,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,169.66,34,,169.66,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,174.65,35,,174.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,199.6,
ZIMMER 47-2484-035-50 Z NAIL 5X35MM,C1713,HCPCS,,79005593,CDM,278,RC,,,both,,,605,238.77,39.4668,,238.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,211.75,35,,211.75,percent of total billed charges,Implant Device,205.7,34,"Charges > $500, x 34%",205.7,percent of total billed charges,Implant Device,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,242,40,,242,percent of total billed charges,Implant Devices,211.75,70,,211.75,percent of total billed charges,Implant Devices,205.7,34,,205.7,percent of total billed charges,Implant Devices,205.7,34,,205.7,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,242,
ZIMMER 47-4936-007-03 PLATE 7HOLE 3.5X94,C1713,HCPCS,,79005595,CDM,278,RC,,,both,,,529,208.78,39.4668,,208.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Device,179.86,34,"Charges > $500, x 34%",179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,211.6,40,,211.6,percent of total billed charges,Implant Devices,185.15,70,,185.15,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,211.6,
ALAMO TISSUE SVC AT290FF ACHILLES TENDON,C1713,HCPCS,,79005596,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
STRYKER 397015 HYDROSET 15CC,C1713,HCPCS,,79005602,CDM,278,RC,,,both,,,13861,5470.49,39.4668,,5470.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4712.74,34,,4712.74,percent of total billed charges,Implant Device,4712.74,34,,4712.74,percent of total billed charges,Implant Device,4712.74,34,,4712.74,percent of total billed charges,Implant Device,4712.74,34,,4712.74,percent of total billed charges,Implant Device,4712.74,34,,4712.74,percent of total billed charges,Implant Device,4712.74,34,,4712.74,percent of total billed charges,Implant Device,4851.35,35,,4851.35,percent of total billed charges,Implant Device,4712.74,34,"Charges > $500, x 34%",4712.74,percent of total billed charges,Implant Device,4851.35,35,,4851.35,percent of total billed charges,Implant Devices,4851.35,35,,4851.35,percent of total billed charges,Implant Devices,4851.35,35,,,percent of total billed charges,Implant Devices,4851.35,35,,4851.35,percent of total billed charges,Implant Devices,4851.35,35,,4851.35,percent of total billed charges,Implant Devices,5544.4,40,,5544.4,percent of total billed charges,Implant Devices,4851.35,70,,4851.35,percent of total billed charges,Implant Devices,4712.74,34,,4712.74,percent of total billed charges,Implant Devices,4712.74,34,,4712.74,percent of total billed charges,Implant Devices,4851.35,35,,4851.35,percent of total billed charges,Implant Devices,4851.35,35,,4851.35,percent of total billed charges,Implant Devices,4851.35,35,,4851.35,percent of total billed charges,Implant Devices,4851.35,35,,4851.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4712.74,34,"If Charge > 2,000, then 34 percent",4712.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5544.4,
DEPUY 1975-20-085 RECLAIM LCK BOLT 20X85,C1713,HCPCS,,79005605,CDM,278,RC,,,both,,,16910,6673.84,39.4668,,6673.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5749.4,34,,5749.4,percent of total billed charges,Implant Device,5749.4,34,,5749.4,percent of total billed charges,Implant Device,5749.4,34,,5749.4,percent of total billed charges,Implant Device,5749.4,34,,5749.4,percent of total billed charges,Implant Device,5749.4,34,,5749.4,percent of total billed charges,Implant Device,5749.4,34,,5749.4,percent of total billed charges,Implant Device,5918.5,35,,5918.5,percent of total billed charges,Implant Device,5749.4,34,"Charges > $500, x 34%",5749.4,percent of total billed charges,Implant Device,5918.5,35,,5918.5,percent of total billed charges,Implant Devices,5918.5,35,,5918.5,percent of total billed charges,Implant Devices,5918.5,35,,,percent of total billed charges,Implant Devices,5918.5,35,,5918.5,percent of total billed charges,Implant Devices,5918.5,35,,5918.5,percent of total billed charges,Implant Devices,6764,40,,6764,percent of total billed charges,Implant Devices,5918.5,70,,5918.5,percent of total billed charges,Implant Devices,5749.4,34,,5749.4,percent of total billed charges,Implant Devices,5749.4,34,,5749.4,percent of total billed charges,Implant Devices,5918.5,35,,5918.5,percent of total billed charges,Implant Devices,5918.5,35,,5918.5,percent of total billed charges,Implant Devices,5918.5,35,,5918.5,percent of total billed charges,Implant Devices,5918.5,35,,5918.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5749.4,34,"If Charge > 2,000, then 34 percent",5749.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6764,
STRYKER 3225-0420S LONG NAIL KIT 11X420,C1713,HCPCS,,79005610,CDM,278,RC,,,both,,,8221,3244.57,39.4668,,3244.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2877.35,35,,2877.35,percent of total billed charges,Implant Device,2795.14,34,"Charges > $500, x 34%",2795.14,percent of total billed charges,Implant Device,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,3288.4,40,,3288.4,percent of total billed charges,Implant Devices,2877.35,70,,2877.35,percent of total billed charges,Implant Devices,2795.14,34,,2795.14,percent of total billed charges,Implant Devices,2795.14,34,,2795.14,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2795.14,34,"If Charge > 2,000, then 34 percent",2795.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3288.4,
STRYKER 3060-0115S LAG SCREW 10.5X115MM,C1713,HCPCS,,79005611,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
STRYKER 1896-5047S LOCKING SCREW FT 5X47,C1713,HCPCS,,79005612,CDM,278,RC,,,both,,,355,140.11,39.4668,,140.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,120.7,34,,120.7,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,142,40,,142,percent of total billed charges,Implant Devices,124.25,70,,124.25,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,120.7,34,,120.7,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,124.25,35,,124.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142,
BIOMET 8153-41-055 CANC SCREW 4.0X55MM,C1713,HCPCS,,79005615,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8153-41-024 CANC SCREW 4.0X24MM,C1713,HCPCS,,79005616,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
STRYKER 5018-6-180 APEX PIN 6 X 180MM,C1713,HCPCS,,79005641,CDM,278,RC,,,both,,,297,117.22,39.4668,,117.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,103.95,35,,103.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,118.8,40,,118.8,percent of total billed charges,Implant Devices,103.95,70,,103.95,percent of total billed charges,Implant Devices,100.98,34,,100.98,percent of total billed charges,Implant Devices,100.98,34,,100.98,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,118.8,
STRYKER 4936-2-010 RING CLAMP,C1713,HCPCS,,79005642,CDM,278,RC,,,both,,,1700,670.94,39.4668,,670.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,578,34,,578,percent of total billed charges,Implant Device,578,34,,578,percent of total billed charges,Implant Device,578,34,,578,percent of total billed charges,Implant Device,578,34,,578,percent of total billed charges,Implant Device,578,34,,578,percent of total billed charges,Implant Device,578,34,,578,percent of total billed charges,Implant Device,595,35,,595,percent of total billed charges,Implant Device,578,34,"Charges > $500, x 34%",578,percent of total billed charges,Implant Device,595,35,,595,percent of total billed charges,Implant Devices,595,35,,595,percent of total billed charges,Implant Devices,595,35,,,percent of total billed charges,Implant Devices,595,35,,595,percent of total billed charges,Implant Devices,595,35,,595,percent of total billed charges,Implant Devices,680,40,,680,percent of total billed charges,Implant Devices,595,70,,595,percent of total billed charges,Implant Devices,578,34,,578,percent of total billed charges,Implant Devices,578,34,,578,percent of total billed charges,Implant Devices,595,35,,595,percent of total billed charges,Implant Devices,595,35,,595,percent of total billed charges,Implant Devices,595,35,,595,percent of total billed charges,Implant Devices,595,35,,595,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,680,
STRYKER 4936-2-040 WIRE POST,C1713,HCPCS,,79005643,CDM,278,RC,,,both,,,1229,485.05,39.4668,,485.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,417.86,34,,417.86,percent of total billed charges,Implant Device,417.86,34,,417.86,percent of total billed charges,Implant Device,417.86,34,,417.86,percent of total billed charges,Implant Device,417.86,34,,417.86,percent of total billed charges,Implant Device,417.86,34,,417.86,percent of total billed charges,Implant Device,417.86,34,,417.86,percent of total billed charges,Implant Device,430.15,35,,430.15,percent of total billed charges,Implant Device,417.86,34,"Charges > $500, x 34%",417.86,percent of total billed charges,Implant Device,430.15,35,,430.15,percent of total billed charges,Implant Devices,430.15,35,,430.15,percent of total billed charges,Implant Devices,430.15,35,,,percent of total billed charges,Implant Devices,430.15,35,,430.15,percent of total billed charges,Implant Devices,430.15,35,,430.15,percent of total billed charges,Implant Devices,491.6,40,,491.6,percent of total billed charges,Implant Devices,430.15,70,,430.15,percent of total billed charges,Implant Devices,417.86,34,,417.86,percent of total billed charges,Implant Devices,417.86,34,,417.86,percent of total billed charges,Implant Devices,430.15,35,,430.15,percent of total billed charges,Implant Devices,430.15,35,,430.15,percent of total billed charges,Implant Devices,430.15,35,,430.15,percent of total billed charges,Implant Devices,430.15,35,,430.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,491.6,
STRYKER 4936-0-015 150MM OPEN RING,C1713,HCPCS,,79005645,CDM,278,RC,,,both,,,2099,828.41,39.4668,,828.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,713.66,34,,713.66,percent of total billed charges,Implant Device,713.66,34,,713.66,percent of total billed charges,Implant Device,713.66,34,,713.66,percent of total billed charges,Implant Device,713.66,34,,713.66,percent of total billed charges,Implant Device,713.66,34,,713.66,percent of total billed charges,Implant Device,713.66,34,,713.66,percent of total billed charges,Implant Device,734.65,35,,734.65,percent of total billed charges,Implant Device,713.66,34,"Charges > $500, x 34%",713.66,percent of total billed charges,Implant Device,734.65,35,,734.65,percent of total billed charges,Implant Devices,734.65,35,,734.65,percent of total billed charges,Implant Devices,734.65,35,,,percent of total billed charges,Implant Devices,734.65,35,,734.65,percent of total billed charges,Implant Devices,734.65,35,,734.65,percent of total billed charges,Implant Devices,839.6,40,,839.6,percent of total billed charges,Implant Devices,734.65,70,,734.65,percent of total billed charges,Implant Devices,713.66,34,,713.66,percent of total billed charges,Implant Devices,713.66,34,,713.66,percent of total billed charges,Implant Devices,734.65,35,,734.65,percent of total billed charges,Implant Devices,734.65,35,,734.65,percent of total billed charges,Implant Devices,734.65,35,,734.65,percent of total billed charges,Implant Devices,734.65,35,,734.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,713.66,34,"If Charge > 2,000, then 34 percent",713.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,839.6,
STRYKER 40-20805 PLATE FIBULA STR 5 HOLE,C1713,HCPCS,,79005689,CDM,278,RC,,,both,,,2340,923.52,39.4668,,923.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,795.6,34,,795.6,percent of total billed charges,Implant Device,795.6,34,,795.6,percent of total billed charges,Implant Device,795.6,34,,795.6,percent of total billed charges,Implant Device,795.6,34,,795.6,percent of total billed charges,Implant Device,795.6,34,,795.6,percent of total billed charges,Implant Device,795.6,34,,795.6,percent of total billed charges,Implant Device,819,35,,819,percent of total billed charges,Implant Device,795.6,34,"Charges > $500, x 34%",795.6,percent of total billed charges,Implant Device,819,35,,819,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,819,35,,,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,936,40,,936,percent of total billed charges,Implant Devices,819,70,,819,percent of total billed charges,Implant Devices,795.6,34,,795.6,percent of total billed charges,Implant Devices,795.6,34,,795.6,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,795.6,34,"If Charge > 2,000, then 34 percent",795.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,936,
STRYKER 604626 CANN SCREW 26X4.0MM,C1713,HCPCS,,79005690,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
ALPHATEC 71002-030 PLATE 2 LEVEL 30MM,C1713,HCPCS,,79005692,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
ZIMMER 5880-60-14 ART SURFACE SZ F 14MM,C1713,HCPCS,,79005693,CDM,278,RC,,,both,,,5765,2275.26,39.4668,,2275.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,2017.75,35,,2017.75,percent of total billed charges,Implant Device,1960.1,34,"Charges > $500, x 34%",1960.1,percent of total billed charges,Implant Device,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2306,40,,2306,percent of total billed charges,Implant Devices,2017.75,70,,2017.75,percent of total billed charges,Implant Devices,1960.1,34,,1960.1,percent of total billed charges,Implant Devices,1960.1,34,,1960.1,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1960.1,34,"If Charge > 2,000, then 34 percent",1960.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2306,
ARTHREX AR-1555PS TENOD SCREW 5.5X15MM,C1713,HCPCS,,79005697,CDM,278,RC,,,both,,,946,373.36,39.4668,,373.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Device,321.64,34,"Charges > $500, x 34%",321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,378.4,40,,378.4,percent of total billed charges,Implant Devices,331.1,70,,331.1,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.4,
STRYKER 40-35622 LOCKING SCREW 3.5X22MM,C1713,HCPCS,,79005702,CDM,278,RC,,,both,,,696,274.69,39.4668,,274.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Device,236.64,34,"Charges > $500, x 34%",236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,278.4,40,,278.4,percent of total billed charges,Implant Devices,243.6,70,,243.6,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,278.4,
STRYKER 1822-0928S TIBIAL NAIL 9X285MM,C1713,HCPCS,,79005709,CDM,278,RC,,,both,,,6110,2411.42,39.4668,,2411.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2138.5,35,,2138.5,percent of total billed charges,Implant Device,2077.4,34,"Charges > $500, x 34%",2077.4,percent of total billed charges,Implant Device,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2444,40,,2444,percent of total billed charges,Implant Devices,2138.5,70,,2138.5,percent of total billed charges,Implant Devices,2077.4,34,,2077.4,percent of total billed charges,Implant Devices,2077.4,34,,2077.4,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2077.4,34,"If Charge > 2,000, then 34 percent",2077.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2444,
STRYKER 1826-5027S LOCK SCREW FT 5X27MM,C1713,HCPCS,,79005710,CDM,278,RC,,,both,,,714,281.79,39.4668,,281.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,249.9,35,,249.9,percent of total billed charges,Implant Device,242.76,34,"Charges > $500, x 34%",242.76,percent of total billed charges,Implant Device,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,285.6,40,,285.6,percent of total billed charges,Implant Devices,249.9,70,,249.9,percent of total billed charges,Implant Devices,242.76,34,,242.76,percent of total billed charges,Implant Devices,242.76,34,,242.76,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,285.6,
ACUMED AT2-M16S ACUTRAK BONE SCREW 16MM,C1713,HCPCS,,79005712,CDM,278,RC,,,both,,,1570,619.63,39.4668,,619.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,533.8,34,,533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Device,533.8,34,"Charges > $500, x 34%",533.8,percent of total billed charges,Implant Device,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,628,40,,628,percent of total billed charges,Implant Devices,549.5,70,,549.5,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,533.8,34,,533.8,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,549.5,35,,549.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,628,
MTF 40004 CORT CANCELLOUS CHIPS 30CC,C1713,HCPCS,,79005719,CDM,278,RC,,,both,,,1566,618.05,39.4668,,618.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,532.44,34,,532.44,percent of total billed charges,Implant Device,532.44,34,,532.44,percent of total billed charges,Implant Device,532.44,34,,532.44,percent of total billed charges,Implant Device,532.44,34,,532.44,percent of total billed charges,Implant Device,532.44,34,,532.44,percent of total billed charges,Implant Device,532.44,34,,532.44,percent of total billed charges,Implant Device,548.1,35,,548.1,percent of total billed charges,Implant Device,532.44,34,"Charges > $500, x 34%",532.44,percent of total billed charges,Implant Device,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,626.4,40,,626.4,percent of total billed charges,Implant Devices,548.1,70,,548.1,percent of total billed charges,Implant Devices,532.44,34,,532.44,percent of total billed charges,Implant Devices,532.44,34,,532.44,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,548.1,35,,548.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,626.4,
SYNTHES 201.361.97 CORTEX SCREW 2.0X11MM,C1713,HCPCS,,79005732,CDM,278,RC,,,both,,,142,56.04,39.4668,,56.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,48.28,34,,48.28,percent of total billed charges,Implant Device,49.7,35,,49.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,56.8,40,,56.8,percent of total billed charges,Implant Devices,49.7,70,,49.7,percent of total billed charges,Implant Devices,48.28,34,,48.28,percent of total billed charges,Implant Devices,48.28,34,,48.28,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,49.7,35,,49.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,56.8,
SYNTHES 243.15 PLATE STRAIGHT 5 HOLE 2MM,C1713,HCPCS,,79005734,CDM,278,RC,,,both,,,174,68.67,39.4668,,68.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,69.6,40,,69.6,percent of total billed charges,Implant Devices,60.9,70,,60.9,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,69.6,
STRYKER 3325-0380S LONG NAIL 11X380MM,C1713,HCPCS,,79005736,CDM,278,RC,,,both,,,10162,4010.62,39.4668,,4010.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3455.08,34,,3455.08,percent of total billed charges,Implant Device,3556.7,35,,3556.7,percent of total billed charges,Implant Device,3455.08,34,"Charges > $500, x 34%",3455.08,percent of total billed charges,Implant Device,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,4064.8,40,,4064.8,percent of total billed charges,Implant Devices,3556.7,70,,3556.7,percent of total billed charges,Implant Devices,3455.08,34,,3455.08,percent of total billed charges,Implant Devices,3455.08,34,,3455.08,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,3556.7,35,,3556.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3455.08,34,"If Charge > 2,000, then 34 percent",3455.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4064.8,
STRYKER 3060-0120S LAG SCREW 10.5X120MM,C1713,HCPCS,,79005737,CDM,278,RC,,,both,,,2616,1032.45,39.4668,,1032.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,889.44,34,,889.44,percent of total billed charges,Implant Device,889.44,34,,889.44,percent of total billed charges,Implant Device,889.44,34,,889.44,percent of total billed charges,Implant Device,889.44,34,,889.44,percent of total billed charges,Implant Device,889.44,34,,889.44,percent of total billed charges,Implant Device,889.44,34,,889.44,percent of total billed charges,Implant Device,915.6,35,,915.6,percent of total billed charges,Implant Device,889.44,34,"Charges > $500, x 34%",889.44,percent of total billed charges,Implant Device,915.6,35,,915.6,percent of total billed charges,Implant Devices,915.6,35,,915.6,percent of total billed charges,Implant Devices,915.6,35,,,percent of total billed charges,Implant Devices,915.6,35,,915.6,percent of total billed charges,Implant Devices,915.6,35,,915.6,percent of total billed charges,Implant Devices,1046.4,40,,1046.4,percent of total billed charges,Implant Devices,915.6,70,,915.6,percent of total billed charges,Implant Devices,889.44,34,,889.44,percent of total billed charges,Implant Devices,889.44,34,,889.44,percent of total billed charges,Implant Devices,915.6,35,,915.6,percent of total billed charges,Implant Devices,915.6,35,,915.6,percent of total billed charges,Implant Devices,915.6,35,,915.6,percent of total billed charges,Implant Devices,915.6,35,,915.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,889.44,34,"If Charge > 2,000, then 34 percent",889.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1046.4,
STRYKER 604646S CANNULATED SCREW 4X46MM,C1713,HCPCS,,79005738,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
SYNTHES 207.646 CANNULATED SCREW 4X46MM,C1713,HCPCS,,79005743,CDM,278,RC,,,both,,,915,361.12,39.4668,,361.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,320.25,35,,320.25,percent of total billed charges,Implant Device,311.1,34,"Charges > $500, x 34%",311.1,percent of total billed charges,Implant Device,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,366,40,,366,percent of total billed charges,Implant Devices,320.25,70,,320.25,percent of total billed charges,Implant Devices,311.1,34,,311.1,percent of total billed charges,Implant Devices,311.1,34,,311.1,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,366,
STRYKER 5028-8-400 CARBON ROD 8X400MM,C1713,HCPCS,,79005744,CDM,278,RC,,,both,,,1533,605.03,39.4668,,605.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,521.22,34,,521.22,percent of total billed charges,Implant Device,521.22,34,,521.22,percent of total billed charges,Implant Device,521.22,34,,521.22,percent of total billed charges,Implant Device,521.22,34,,521.22,percent of total billed charges,Implant Device,521.22,34,,521.22,percent of total billed charges,Implant Device,521.22,34,,521.22,percent of total billed charges,Implant Device,536.55,35,,536.55,percent of total billed charges,Implant Device,521.22,34,"Charges > $500, x 34%",521.22,percent of total billed charges,Implant Device,536.55,35,,536.55,percent of total billed charges,Implant Devices,536.55,35,,536.55,percent of total billed charges,Implant Devices,536.55,35,,,percent of total billed charges,Implant Devices,536.55,35,,536.55,percent of total billed charges,Implant Devices,536.55,35,,536.55,percent of total billed charges,Implant Devices,613.2,40,,613.2,percent of total billed charges,Implant Devices,536.55,70,,536.55,percent of total billed charges,Implant Devices,521.22,34,,521.22,percent of total billed charges,Implant Devices,521.22,34,,521.22,percent of total billed charges,Implant Devices,536.55,35,,536.55,percent of total billed charges,Implant Devices,536.55,35,,536.55,percent of total billed charges,Implant Devices,536.55,35,,536.55,percent of total billed charges,Implant Devices,536.55,35,,536.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,613.2,
STRYKER 1822-1130S TIBIAL NAIL 11X300MM,C1713,HCPCS,,79005745,CDM,278,RC,,,both,,,5819,2296.57,39.4668,,2296.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,2036.65,35,,2036.65,percent of total billed charges,Implant Device,1978.46,34,"Charges > $500, x 34%",1978.46,percent of total billed charges,Implant Device,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2327.6,40,,2327.6,percent of total billed charges,Implant Devices,2036.65,70,,2036.65,percent of total billed charges,Implant Devices,1978.46,34,,1978.46,percent of total billed charges,Implant Devices,1978.46,34,,1978.46,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1978.46,34,"If Charge > 2,000, then 34 percent",1978.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2327.6,
STRYKER 1822-1033S TIBIAL NAIL 11X330MM,C1713,HCPCS,,79005747,CDM,278,RC,,,both,,,3529,1392.78,39.4668,,1392.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Device,1199.86,34,"Charges > $500, x 34%",1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1411.6,40,,1411.6,percent of total billed charges,Implant Devices,1235.15,70,,1235.15,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1199.86,34,"If Charge > 2,000, then 34 percent",1199.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1411.6,
STRYKER 1896-5065S LOCKING SCREW 5X65MM,C1713,HCPCS,,79005748,CDM,278,RC,,,both,,,893,352.44,39.4668,,352.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,312.55,35,,312.55,percent of total billed charges,Implant Device,303.62,34,"Charges > $500, x 34%",303.62,percent of total billed charges,Implant Device,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,357.2,40,,357.2,percent of total billed charges,Implant Devices,312.55,70,,312.55,percent of total billed charges,Implant Devices,303.62,34,,303.62,percent of total billed charges,Implant Devices,303.62,34,,303.62,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357.2,
ARTHREX AR-1390C BCMP INTER SCREW 9X23MM,C1713,HCPCS,,79005749,CDM,278,RC,,,both,,,966,381.25,39.4668,,381.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,328.44,34,,328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Device,328.44,34,"Charges > $500, x 34%",328.44,percent of total billed charges,Implant Device,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,386.4,40,,386.4,percent of total billed charges,Implant Devices,338.1,70,,338.1,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,328.44,34,,328.44,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,338.1,35,,338.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,386.4,
BIOMET 1817-09-281 HUMERAL NAIL 9X280MM,C1713,HCPCS,,79005753,CDM,278,RC,,,both,,,7560,2983.69,39.4668,,2983.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2646,35,,2646,percent of total billed charges,Implant Device,2570.4,34,"Charges > $500, x 34%",2570.4,percent of total billed charges,Implant Device,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,3024,40,,3024,percent of total billed charges,Implant Devices,2646,70,,2646,percent of total billed charges,Implant Devices,2570.4,34,,2570.4,percent of total billed charges,Implant Devices,2570.4,34,,2570.4,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2570.4,34,"If Charge > 2,000, then 34 percent",2570.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3024,
BIOMET 1819-48-040 CANCELLOUS SCREW 40MM,C1713,HCPCS,,79005757,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 1819-48-042 CANCELLOUS SCREW 42MM,C1713,HCPCS,,79005758,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 1819-48-044 CANCELLOUS SCREW 44MM,C1713,HCPCS,,79005759,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 1819-48-052 CANCELLOUS SCREW 52MM,C1713,HCPCS,,79005760,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 1402230 CORTICAL SCREW 30MM,C1713,HCPCS,,79005761,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
ARTHREX AR-1934BCF SUTURE ANCHOR 3X14.5M,C1713,HCPCS,,79005770,CDM,278,RC,,,both,,,915,361.12,39.4668,,361.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,320.25,35,,320.25,percent of total billed charges,Implant Device,311.1,34,"Charges > $500, x 34%",311.1,percent of total billed charges,Implant Device,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,366,40,,366,percent of total billed charges,Implant Devices,320.25,70,,320.25,percent of total billed charges,Implant Devices,311.1,34,,311.1,percent of total billed charges,Implant Devices,311.1,34,,311.1,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,366,
STRYKER 58-17015E BONE SCREW 1.7X15MM,C1713,HCPCS,,79005771,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
SYNTHES 214.036 4.5MM CORTEX SCREW 36MM,C1713,HCPCS,,79005772,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 214.028 4.5MM CORTEX SCREW 28MM,C1713,HCPCS,,79005773,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 214.026 4.5MM CORTEX SCREW 26MM,C1713,HCPCS,,79005774,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 214.032 4.5MM CORTEX SCREW 32MM,C1713,HCPCS,,79005775,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 214.024 4.5MM CORTEX SCREW 24MM,C1713,HCPCS,,79005776,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 214.034 4.5MM CORTEX SCREW 34MM,C1713,HCPCS,,79005777,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 224.57 PLATE 7 HOLE 4.5X124MM,C1713,HCPCS,,79005778,CDM,278,RC,,,both,,,557,219.83,39.4668,,219.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,189.38,34,,189.38,percent of total billed charges,Implant Device,189.38,34,,189.38,percent of total billed charges,Implant Device,189.38,34,,189.38,percent of total billed charges,Implant Device,189.38,34,,189.38,percent of total billed charges,Implant Device,189.38,34,,189.38,percent of total billed charges,Implant Device,189.38,34,,189.38,percent of total billed charges,Implant Device,194.95,35,,194.95,percent of total billed charges,Implant Device,189.38,34,"Charges > $500, x 34%",189.38,percent of total billed charges,Implant Device,194.95,35,,194.95,percent of total billed charges,Implant Devices,194.95,35,,194.95,percent of total billed charges,Implant Devices,194.95,35,,,percent of total billed charges,Implant Devices,194.95,35,,194.95,percent of total billed charges,Implant Devices,194.95,35,,194.95,percent of total billed charges,Implant Devices,222.8,40,,222.8,percent of total billed charges,Implant Devices,194.95,70,,194.95,percent of total billed charges,Implant Devices,189.38,34,,189.38,percent of total billed charges,Implant Devices,189.38,34,,189.38,percent of total billed charges,Implant Devices,194.95,35,,194.95,percent of total billed charges,Implant Devices,194.95,35,,194.95,percent of total billed charges,Implant Devices,194.95,35,,194.95,percent of total billed charges,Implant Devices,194.95,35,,194.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,222.8,
ZIMMER 2347-23-45 CORTICAL SCRW 4.5X45MM,C1713,HCPCS,,79005779,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
ZIMMER 2357-102-06 PLATE LEFT,C1713,HCPCS,,79005780,CDM,278,RC,,,both,,,4255,1679.31,39.4668,,1679.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1446.7,34,,1446.7,percent of total billed charges,Implant Device,1446.7,34,,1446.7,percent of total billed charges,Implant Device,1446.7,34,,1446.7,percent of total billed charges,Implant Device,1446.7,34,,1446.7,percent of total billed charges,Implant Device,1446.7,34,,1446.7,percent of total billed charges,Implant Device,1446.7,34,,1446.7,percent of total billed charges,Implant Device,1489.25,35,,1489.25,percent of total billed charges,Implant Device,1446.7,34,"Charges > $500, x 34%",1446.7,percent of total billed charges,Implant Device,1489.25,35,,1489.25,percent of total billed charges,Implant Devices,1489.25,35,,1489.25,percent of total billed charges,Implant Devices,1489.25,35,,,percent of total billed charges,Implant Devices,1489.25,35,,1489.25,percent of total billed charges,Implant Devices,1489.25,35,,1489.25,percent of total billed charges,Implant Devices,1702,40,,1702,percent of total billed charges,Implant Devices,1489.25,70,,1489.25,percent of total billed charges,Implant Devices,1446.7,34,,1446.7,percent of total billed charges,Implant Devices,1446.7,34,,1446.7,percent of total billed charges,Implant Devices,1489.25,35,,1489.25,percent of total billed charges,Implant Devices,1489.25,35,,1489.25,percent of total billed charges,Implant Devices,1489.25,35,,1489.25,percent of total billed charges,Implant Devices,1489.25,35,,1489.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1446.7,34,"If Charge > 2,000, then 34 percent",1446.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1702,
ZIMMER 2359-70-55  5.5MM CANN LOCK SCREW,C1713,HCPCS,,79005781,CDM,278,RC,,,both,,,562,221.8,39.4668,,221.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Device,191.08,34,"Charges > $500, x 34%",191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,224.8,40,,224.8,percent of total billed charges,Implant Devices,196.7,70,,196.7,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224.8,
SOLANA CCP-UTN3 UTILITY COMP LOCK PLATE,C1713,HCPCS,,79005782,CDM,278,RC,,,both,,,6586,2599.28,39.4668,,2599.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2239.24,34,,2239.24,percent of total billed charges,Implant Device,2239.24,34,,2239.24,percent of total billed charges,Implant Device,2239.24,34,,2239.24,percent of total billed charges,Implant Device,2239.24,34,,2239.24,percent of total billed charges,Implant Device,2239.24,34,,2239.24,percent of total billed charges,Implant Device,2239.24,34,,2239.24,percent of total billed charges,Implant Device,2305.1,35,,2305.1,percent of total billed charges,Implant Device,2239.24,34,"Charges > $500, x 34%",2239.24,percent of total billed charges,Implant Device,2305.1,35,,2305.1,percent of total billed charges,Implant Devices,2305.1,35,,2305.1,percent of total billed charges,Implant Devices,2305.1,35,,,percent of total billed charges,Implant Devices,2305.1,35,,2305.1,percent of total billed charges,Implant Devices,2305.1,35,,2305.1,percent of total billed charges,Implant Devices,2634.4,40,,2634.4,percent of total billed charges,Implant Devices,2305.1,70,,2305.1,percent of total billed charges,Implant Devices,2239.24,34,,2239.24,percent of total billed charges,Implant Devices,2239.24,34,,2239.24,percent of total billed charges,Implant Devices,2305.1,35,,2305.1,percent of total billed charges,Implant Devices,2305.1,35,,2305.1,percent of total billed charges,Implant Devices,2305.1,35,,2305.1,percent of total billed charges,Implant Devices,2305.1,35,,2305.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2239.24,34,"If Charge > 2,000, then 34 percent",2239.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2634.4,
SOLANA L3020 LOCKING SCREW 3.0X20MM,C1713,HCPCS,,79005783,CDM,278,RC,,,both,,,1126,444.4,39.4668,,444.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Device,382.84,34,"Charges > $500, x 34%",382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,450.4,40,,450.4,percent of total billed charges,Implant Devices,394.1,70,,394.1,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450.4,
SOLANA L3022 LOCKING SCREW 3.0X22MM,C1713,HCPCS,,79005784,CDM,278,RC,,,both,,,1126,444.4,39.4668,,444.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Device,382.84,34,"Charges > $500, x 34%",382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,450.4,40,,450.4,percent of total billed charges,Implant Devices,394.1,70,,394.1,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450.4,
SOLANA N3020 NONLOCK SCREW 3.0X20MM,C1713,HCPCS,,79005785,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
BIOMET 14196-75 CANN SCREW 6.5X75MM,C1713,HCPCS,,79005789,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
BIOMET 1802-53-055 CANN SCREW 5.0X55MM,C1713,HCPCS,,79005790,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
STRYKER 338610 CORTICAL SCREW 3.5X10MM,C1713,HCPCS,,79005795,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 430205 5 HOLE 1/3 TUBULAR PLATE,C1713,HCPCS,,79005796,CDM,278,RC,,,both,,,235,92.75,39.4668,,92.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.9,34,,79.9,percent of total billed charges,Implant Device,79.9,34,,79.9,percent of total billed charges,Implant Device,79.9,34,,79.9,percent of total billed charges,Implant Device,79.9,34,,79.9,percent of total billed charges,Implant Device,79.9,34,,79.9,percent of total billed charges,Implant Device,79.9,34,,79.9,percent of total billed charges,Implant Device,82.25,35,,82.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,82.25,35,,82.25,percent of total billed charges,Implant Devices,82.25,35,,82.25,percent of total billed charges,Implant Devices,82.25,35,,,percent of total billed charges,Implant Devices,82.25,35,,82.25,percent of total billed charges,Implant Devices,82.25,35,,82.25,percent of total billed charges,Implant Devices,94,40,,94,percent of total billed charges,Implant Devices,82.25,70,,82.25,percent of total billed charges,Implant Devices,79.9,34,,79.9,percent of total billed charges,Implant Devices,79.9,34,,79.9,percent of total billed charges,Implant Devices,82.25,35,,82.25,percent of total billed charges,Implant Devices,82.25,35,,82.25,percent of total billed charges,Implant Devices,82.25,35,,82.25,percent of total billed charges,Implant Devices,82.25,35,,82.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,94,
STRYKER 390018 WASHER,C1713,HCPCS,,79005797,CDM,278,RC,,,both,,,76,29.99,39.4668,,29.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.84,34,,25.84,percent of total billed charges,Implant Device,25.84,34,,25.84,percent of total billed charges,Implant Device,25.84,34,,25.84,percent of total billed charges,Implant Device,25.84,34,,25.84,percent of total billed charges,Implant Device,25.84,34,,25.84,percent of total billed charges,Implant Device,25.84,34,,25.84,percent of total billed charges,Implant Device,26.6,35,,26.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,26.6,35,,26.6,percent of total billed charges,Implant Devices,26.6,35,,26.6,percent of total billed charges,Implant Devices,26.6,35,,,percent of total billed charges,Implant Devices,26.6,35,,26.6,percent of total billed charges,Implant Devices,26.6,35,,26.6,percent of total billed charges,Implant Devices,30.4,40,,30.4,percent of total billed charges,Implant Devices,26.6,70,,26.6,percent of total billed charges,Implant Devices,25.84,34,,25.84,percent of total billed charges,Implant Devices,25.84,34,,25.84,percent of total billed charges,Implant Devices,26.6,35,,26.6,percent of total billed charges,Implant Devices,26.6,35,,26.6,percent of total billed charges,Implant Devices,26.6,35,,26.6,percent of total billed charges,Implant Devices,26.6,35,,26.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,30.4,
STRYKER 40-65044 BONE SCREW 3.5X44MM,C1713,HCPCS,,79005798,CDM,278,RC,,,both,,,268,105.77,39.4668,,105.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,93.8,35,,93.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,107.2,40,,107.2,percent of total billed charges,Implant Devices,93.8,70,,93.8,percent of total billed charges,Implant Devices,91.12,34,,91.12,percent of total billed charges,Implant Devices,91.12,34,,91.12,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.2,
STRYKER 40-35016 NON-LOCK SCREW 16X12MM,C1713,HCPCS,,79005801,CDM,278,RC,,,both,,,268,105.77,39.4668,,105.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,93.8,35,,93.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,107.2,40,,107.2,percent of total billed charges,Implant Devices,93.8,70,,93.8,percent of total billed charges,Implant Devices,91.12,34,,91.12,percent of total billed charges,Implant Devices,91.12,34,,91.12,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.2,
STRYKER 40-35018 NON-LOCK SCREW 16X12MM,C1713,HCPCS,,79005802,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
STRYKER 40-20812 VARIAX STR PLATE 10HOLE,C1713,HCPCS,,79005803,CDM,278,RC,,,both,,,1864,735.66,39.4668,,735.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,652.4,35,,652.4,percent of total billed charges,Implant Device,633.76,34,"Charges > $500, x 34%",633.76,percent of total billed charges,Implant Device,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,745.6,40,,745.6,percent of total billed charges,Implant Devices,652.4,70,,652.4,percent of total billed charges,Implant Devices,633.76,34,,633.76,percent of total billed charges,Implant Devices,633.76,34,,633.76,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,745.6,
STRYKER 57-10407 ST PLATE 2.3MM 6 HOLE,C1713,HCPCS,,79005804,CDM,278,RC,,,both,,,1147,452.68,39.4668,,452.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,389.98,34,,389.98,percent of total billed charges,Implant Device,389.98,34,,389.98,percent of total billed charges,Implant Device,389.98,34,,389.98,percent of total billed charges,Implant Device,389.98,34,,389.98,percent of total billed charges,Implant Device,389.98,34,,389.98,percent of total billed charges,Implant Device,389.98,34,,389.98,percent of total billed charges,Implant Device,401.45,35,,401.45,percent of total billed charges,Implant Device,389.98,34,"Charges > $500, x 34%",389.98,percent of total billed charges,Implant Device,401.45,35,,401.45,percent of total billed charges,Implant Devices,401.45,35,,401.45,percent of total billed charges,Implant Devices,401.45,35,,,percent of total billed charges,Implant Devices,401.45,35,,401.45,percent of total billed charges,Implant Devices,401.45,35,,401.45,percent of total billed charges,Implant Devices,458.8,40,,458.8,percent of total billed charges,Implant Devices,401.45,70,,401.45,percent of total billed charges,Implant Devices,389.98,34,,389.98,percent of total billed charges,Implant Devices,389.98,34,,389.98,percent of total billed charges,Implant Devices,401.45,35,,401.45,percent of total billed charges,Implant Devices,401.45,35,,401.45,percent of total billed charges,Implant Devices,401.45,35,,401.45,percent of total billed charges,Implant Devices,401.45,35,,401.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,458.8,
STRYKER 58-23010E NONLOCK SCREW 2.3X10MM,C1713,HCPCS,,79005805,CDM,278,RC,,,both,,,439,173.26,39.4668,,173.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.26,34,,149.26,percent of total billed charges,Implant Device,149.26,34,,149.26,percent of total billed charges,Implant Device,149.26,34,,149.26,percent of total billed charges,Implant Device,149.26,34,,149.26,percent of total billed charges,Implant Device,149.26,34,,149.26,percent of total billed charges,Implant Device,149.26,34,,149.26,percent of total billed charges,Implant Device,153.65,35,,153.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,175.6,40,,175.6,percent of total billed charges,Implant Devices,153.65,70,,153.65,percent of total billed charges,Implant Devices,149.26,34,,149.26,percent of total billed charges,Implant Devices,149.26,34,,149.26,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,175.6,
STRYKER 58-23011E NONLOCK SCREW 2.3X11MM,C1713,HCPCS,,79005806,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
STRYKER 58-23012E NONLOCK SCREW 2.3X12MM,C1713,HCPCS,,79005807,CDM,278,RC,,,both,,,202,79.72,39.4668,,79.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.68,34,,68.68,percent of total billed charges,Implant Device,68.68,34,,68.68,percent of total billed charges,Implant Device,68.68,34,,68.68,percent of total billed charges,Implant Device,68.68,34,,68.68,percent of total billed charges,Implant Device,68.68,34,,68.68,percent of total billed charges,Implant Device,68.68,34,,68.68,percent of total billed charges,Implant Device,70.7,35,,70.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,80.8,40,,80.8,percent of total billed charges,Implant Devices,70.7,70,,70.7,percent of total billed charges,Implant Devices,68.68,34,,68.68,percent of total billed charges,Implant Devices,68.68,34,,68.68,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,70.7,35,,70.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,80.8,
STRYKER 58-23014E NONLOCK SCREW 2.3X14MM,C1713,HCPCS,,79005808,CDM,278,RC,,,both,,,170,67.09,39.4668,,67.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,57.8,34,,57.8,percent of total billed charges,Implant Device,57.8,34,,57.8,percent of total billed charges,Implant Device,57.8,34,,57.8,percent of total billed charges,Implant Device,57.8,34,,57.8,percent of total billed charges,Implant Device,57.8,34,,57.8,percent of total billed charges,Implant Device,57.8,34,,57.8,percent of total billed charges,Implant Device,59.5,35,,59.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,68,40,,68,percent of total billed charges,Implant Devices,59.5,70,,59.5,percent of total billed charges,Implant Devices,57.8,34,,57.8,percent of total billed charges,Implant Devices,57.8,34,,57.8,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,59.5,35,,59.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,68,
STRYKER 58-23016E NONLOCK SCREW 2.3X16MM,C1713,HCPCS,,79005809,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
STRYKER 58-17012E NONLOCK SCREW 1.7X12MM,C1713,HCPCS,,79005810,CDM,278,RC,,,both,,,169,66.7,39.4668,,66.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,57.46,34,,57.46,percent of total billed charges,Implant Device,57.46,34,,57.46,percent of total billed charges,Implant Device,57.46,34,,57.46,percent of total billed charges,Implant Device,57.46,34,,57.46,percent of total billed charges,Implant Device,57.46,34,,57.46,percent of total billed charges,Implant Device,57.46,34,,57.46,percent of total billed charges,Implant Device,59.15,35,,59.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,59.15,35,,59.15,percent of total billed charges,Implant Devices,59.15,35,,59.15,percent of total billed charges,Implant Devices,59.15,35,,,percent of total billed charges,Implant Devices,59.15,35,,59.15,percent of total billed charges,Implant Devices,59.15,35,,59.15,percent of total billed charges,Implant Devices,67.6,40,,67.6,percent of total billed charges,Implant Devices,59.15,70,,59.15,percent of total billed charges,Implant Devices,57.46,34,,57.46,percent of total billed charges,Implant Devices,57.46,34,,57.46,percent of total billed charges,Implant Devices,59.15,35,,59.15,percent of total billed charges,Implant Devices,59.15,35,,59.15,percent of total billed charges,Implant Devices,59.15,35,,59.15,percent of total billed charges,Implant Devices,59.15,35,,59.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,67.6,
STRYKER 57-15320 L SHAPED PLATE,C1713,HCPCS,,79005812,CDM,278,RC,,,both,,,1276,503.6,39.4668,,503.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,446.6,35,,446.6,percent of total billed charges,Implant Device,433.84,34,"Charges > $500, x 34%",433.84,percent of total billed charges,Implant Device,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,510.4,40,,510.4,percent of total billed charges,Implant Devices,446.6,70,,446.6,percent of total billed charges,Implant Devices,433.84,34,,433.84,percent of total billed charges,Implant Devices,433.84,34,,433.84,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510.4,
STRYKER 57-15302 4 HOLE PLATE,C1713,HCPCS,,79005813,CDM,278,RC,,,both,,,1390,548.59,39.4668,,548.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.6,34,,472.6,percent of total billed charges,Implant Device,472.6,34,,472.6,percent of total billed charges,Implant Device,472.6,34,,472.6,percent of total billed charges,Implant Device,472.6,34,,472.6,percent of total billed charges,Implant Device,472.6,34,,472.6,percent of total billed charges,Implant Device,472.6,34,,472.6,percent of total billed charges,Implant Device,486.5,35,,486.5,percent of total billed charges,Implant Device,472.6,34,"Charges > $500, x 34%",472.6,percent of total billed charges,Implant Device,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,556,40,,556,percent of total billed charges,Implant Devices,486.5,70,,486.5,percent of total billed charges,Implant Devices,472.6,34,,472.6,percent of total billed charges,Implant Devices,472.6,34,,472.6,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556,
ALPHATEC SPINE 62004-09 ROD 90MM,C1713,HCPCS,,79005815,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
MIMEDX AL-5020 AMNIOFIX 2ML,C1713,HCPCS,,79005817,CDM,278,RC,,,both,,,1186,468.08,39.4668,,468.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,403.24,34,,403.24,percent of total billed charges,Implant Device,403.24,34,,403.24,percent of total billed charges,Implant Device,403.24,34,,403.24,percent of total billed charges,Implant Device,403.24,34,,403.24,percent of total billed charges,Implant Device,403.24,34,,403.24,percent of total billed charges,Implant Device,403.24,34,,403.24,percent of total billed charges,Implant Device,415.1,35,,415.1,percent of total billed charges,Implant Device,403.24,34,"Charges > $500, x 34%",403.24,percent of total billed charges,Implant Device,415.1,35,,415.1,percent of total billed charges,Implant Devices,415.1,35,,415.1,percent of total billed charges,Implant Devices,415.1,35,,,percent of total billed charges,Implant Devices,415.1,35,,415.1,percent of total billed charges,Implant Devices,415.1,35,,415.1,percent of total billed charges,Implant Devices,474.4,40,,474.4,percent of total billed charges,Implant Devices,415.1,70,,415.1,percent of total billed charges,Implant Devices,403.24,34,,403.24,percent of total billed charges,Implant Devices,403.24,34,,403.24,percent of total billed charges,Implant Devices,415.1,35,,415.1,percent of total billed charges,Implant Devices,415.1,35,,415.1,percent of total billed charges,Implant Devices,415.1,35,,415.1,percent of total billed charges,Implant Devices,415.1,35,,415.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,474.4,
ARTHREX AR-1360B-CP MPFL IMPLANT SYSTEM,C1713,HCPCS,,79005823,CDM,278,RC,,,both,,,5910,2332.49,39.4668,,2332.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2009.4,34,,2009.4,percent of total billed charges,Implant Device,2009.4,34,,2009.4,percent of total billed charges,Implant Device,2009.4,34,,2009.4,percent of total billed charges,Implant Device,2009.4,34,,2009.4,percent of total billed charges,Implant Device,2009.4,34,,2009.4,percent of total billed charges,Implant Device,2009.4,34,,2009.4,percent of total billed charges,Implant Device,2068.5,35,,2068.5,percent of total billed charges,Implant Device,2009.4,34,"Charges > $500, x 34%",2009.4,percent of total billed charges,Implant Device,2068.5,35,,2068.5,percent of total billed charges,Implant Devices,2068.5,35,,2068.5,percent of total billed charges,Implant Devices,2068.5,35,,,percent of total billed charges,Implant Devices,2068.5,35,,2068.5,percent of total billed charges,Implant Devices,2068.5,35,,2068.5,percent of total billed charges,Implant Devices,2364,40,,2364,percent of total billed charges,Implant Devices,2068.5,70,,2068.5,percent of total billed charges,Implant Devices,2009.4,34,,2009.4,percent of total billed charges,Implant Devices,2009.4,34,,2009.4,percent of total billed charges,Implant Devices,2068.5,35,,2068.5,percent of total billed charges,Implant Devices,2068.5,35,,2068.5,percent of total billed charges,Implant Devices,2068.5,35,,2068.5,percent of total billed charges,Implant Devices,2068.5,35,,2068.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2009.4,34,"If Charge > 2,000, then 34 percent",2009.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2364,
SOLANA CCP-MPX1L CROSSCHECK MTP PLATE LT,C1713,HCPCS,,79005824,CDM,278,RC,,,both,,,7245,2859.37,39.4668,,2859.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2535.75,35,,2535.75,percent of total billed charges,Implant Device,2463.3,34,"Charges > $500, x 34%",2463.3,percent of total billed charges,Implant Device,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2898,40,,2898,percent of total billed charges,Implant Devices,2535.75,70,,2535.75,percent of total billed charges,Implant Devices,2463.3,34,,2463.3,percent of total billed charges,Implant Devices,2463.3,34,,2463.3,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2463.3,34,"If Charge > 2,000, then 34 percent",2463.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2898,
SOLANA CCP-L3008 XCHECK LOCK SCREW 3X8MM,C1713,HCPCS,,79005825,CDM,278,RC,,,both,,,1126,444.4,39.4668,,444.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Device,382.84,34,"Charges > $500, x 34%",382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,450.4,40,,450.4,percent of total billed charges,Implant Devices,394.1,70,,394.1,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450.4,
SOLANA CCP-L3010 XCHECK LOCK SCREW 3X10,C1713,HCPCS,,79005826,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
SOLANA CCP-L3012 XCHECK LOCK SCREW 3X12,C1713,HCPCS,,79005827,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
SOLANA CCP-L3014 XCHECK LOCK SCREW 3X14,C1713,HCPCS,,79005828,CDM,278,RC,,,both,,,1126,444.4,39.4668,,444.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Device,382.84,34,"Charges > $500, x 34%",382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,450.4,40,,450.4,percent of total billed charges,Implant Devices,394.1,70,,394.1,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450.4,
SOLANA CCP-X3520 XCHECK LAG SCREW 3.5X20,C1713,HCPCS,,79005829,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
BIOMET 8155-40-016 NON LOCK SCREW 4X16MM,C1713,HCPCS,,79005832,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
STRYKER 57-15340 LOCK PLATE 6 HOLE 2.3MM,C1713,HCPCS,,79005836,CDM,278,RC,,,both,,,1276,503.6,39.4668,,503.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,446.6,35,,446.6,percent of total billed charges,Implant Device,433.84,34,"Charges > $500, x 34%",433.84,percent of total billed charges,Implant Device,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,510.4,40,,510.4,percent of total billed charges,Implant Devices,446.6,70,,446.6,percent of total billed charges,Implant Devices,433.84,34,,433.84,percent of total billed charges,Implant Devices,433.84,34,,433.84,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510.4,
STRYKER 53-23008E LOCKING SCREW 2.3X8MM,C1713,HCPCS,,79005837,CDM,278,RC,,,both,,,515,203.25,39.4668,,203.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,180.25,35,,180.25,percent of total billed charges,Implant Device,175.1,34,"Charges > $500, x 34%",175.1,percent of total billed charges,Implant Device,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,206,40,,206,percent of total billed charges,Implant Devices,180.25,70,,180.25,percent of total billed charges,Implant Devices,175.1,34,,175.1,percent of total billed charges,Implant Devices,175.1,34,,175.1,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,206,
STRYKER 53-23006E LOCKING SCREW 2.3X6MM,C1713,HCPCS,,79005838,CDM,278,RC,,,both,,,515,203.25,39.4668,,203.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,180.25,35,,180.25,percent of total billed charges,Implant Device,175.1,34,"Charges > $500, x 34%",175.1,percent of total billed charges,Implant Device,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,206,40,,206,percent of total billed charges,Implant Devices,180.25,70,,180.25,percent of total billed charges,Implant Devices,175.1,34,,175.1,percent of total billed charges,Implant Devices,175.1,34,,175.1,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,206,
SYNTHES 212.117 LOCKING SCREW 3.5MM,C1713,HCPCS,,79005839,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
SYNTHES 212-121 LOCKING SCREW 3.5MM,C1713,HCPCS,,79005840,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
SYNTHES 02.200.032 CORTEX SCEW 3.5MM,C1713,HCPCS,,79005841,CDM,278,RC,,,both,,,101,39.86,39.4668,,39.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,35.35,35,,35.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,40.4,40,,40.4,percent of total billed charges,Implant Devices,35.35,70,,35.35,percent of total billed charges,Implant Devices,34.34,34,,34.34,percent of total billed charges,Implant Devices,34.34,34,,34.34,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40.4,
SYNTHES 02.120.702S LCP PLATE 2 HOLE 3.5,C1713,HCPCS,,79005843,CDM,278,RC,,,both,,,2444,964.57,39.4668,,964.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,830.96,34,,830.96,percent of total billed charges,Implant Device,830.96,34,,830.96,percent of total billed charges,Implant Device,830.96,34,,830.96,percent of total billed charges,Implant Device,830.96,34,,830.96,percent of total billed charges,Implant Device,830.96,34,,830.96,percent of total billed charges,Implant Device,830.96,34,,830.96,percent of total billed charges,Implant Device,855.4,35,,855.4,percent of total billed charges,Implant Device,830.96,34,"Charges > $500, x 34%",830.96,percent of total billed charges,Implant Device,855.4,35,,855.4,percent of total billed charges,Implant Devices,855.4,35,,855.4,percent of total billed charges,Implant Devices,855.4,35,,,percent of total billed charges,Implant Devices,855.4,35,,855.4,percent of total billed charges,Implant Devices,855.4,35,,855.4,percent of total billed charges,Implant Devices,977.6,40,,977.6,percent of total billed charges,Implant Devices,855.4,70,,855.4,percent of total billed charges,Implant Devices,830.96,34,,830.96,percent of total billed charges,Implant Devices,830.96,34,,830.96,percent of total billed charges,Implant Devices,855.4,35,,855.4,percent of total billed charges,Implant Devices,855.4,35,,855.4,percent of total billed charges,Implant Devices,855.4,35,,855.4,percent of total billed charges,Implant Devices,855.4,35,,855.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,830.96,34,"If Charge > 2,000, then 34 percent",830.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,977.6,
SYNTHES 02.127.211 VA-LCP PLATE 4HOLE3.5,C1713,HCPCS,,79005844,CDM,278,RC,,,both,,,6130,2419.31,39.4668,,2419.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2084.2,34,,2084.2,percent of total billed charges,Implant Device,2084.2,34,,2084.2,percent of total billed charges,Implant Device,2084.2,34,,2084.2,percent of total billed charges,Implant Device,2084.2,34,,2084.2,percent of total billed charges,Implant Device,2084.2,34,,2084.2,percent of total billed charges,Implant Device,2084.2,34,,2084.2,percent of total billed charges,Implant Device,2145.5,35,,2145.5,percent of total billed charges,Implant Device,2084.2,34,"Charges > $500, x 34%",2084.2,percent of total billed charges,Implant Device,2145.5,35,,2145.5,percent of total billed charges,Implant Devices,2145.5,35,,2145.5,percent of total billed charges,Implant Devices,2145.5,35,,,percent of total billed charges,Implant Devices,2145.5,35,,2145.5,percent of total billed charges,Implant Devices,2145.5,35,,2145.5,percent of total billed charges,Implant Devices,2452,40,,2452,percent of total billed charges,Implant Devices,2145.5,70,,2145.5,percent of total billed charges,Implant Devices,2084.2,34,,2084.2,percent of total billed charges,Implant Devices,2084.2,34,,2084.2,percent of total billed charges,Implant Devices,2145.5,35,,2145.5,percent of total billed charges,Implant Devices,2145.5,35,,2145.5,percent of total billed charges,Implant Devices,2145.5,35,,2145.5,percent of total billed charges,Implant Devices,2145.5,35,,2145.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2084.2,34,"If Charge > 2,000, then 34 percent",2084.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2452,
SYNTHES 02.127.154 LOCK SCREW 3.5X54MM,C1713,HCPCS,,79005846,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
SYNTHES 02.127.165 LOCK SCREW 3.5X65MM,C1713,HCPCS,,79005847,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
SYNTHES 02.127.170 LOCK SCREW 3.5X70MM,C1713,HCPCS,,79005848,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
SYNTHES 07-704-010S DRILLABL CEMENT 10CC,C1713,HCPCS,,79005850,CDM,278,RC,,,both,,,3531,1393.57,39.4668,,1393.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1235.85,35,,1235.85,percent of total billed charges,Implant Device,1200.54,34,"Charges > $500, x 34%",1200.54,percent of total billed charges,Implant Device,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1412.4,40,,1412.4,percent of total billed charges,Implant Devices,1235.85,70,,1235.85,percent of total billed charges,Implant Devices,1200.54,34,,1200.54,percent of total billed charges,Implant Devices,1200.54,34,,1200.54,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1200.54,34,"If Charge > 2,000, then 34 percent",1200.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1412.4,
SYNTHES 204.818 CORTEX SCREW 3.5X18MM,C1713,HCPCS,,79005852,CDM,278,RC,,,both,,,82,32.36,39.4668,,32.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,28.7,35,,28.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,32.8,40,,32.8,percent of total billed charges,Implant Devices,28.7,70,,28.7,percent of total billed charges,Implant Devices,27.88,34,,27.88,percent of total billed charges,Implant Devices,27.88,34,,27.88,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.8,
SYNTHES 204.820 CORTEX SCREW 3.5X20MM,C1713,HCPCS,,79005853,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
SYNTHES 206.016 CANCELLOUS SCREW 4X16MM,C1713,HCPCS,,79005854,CDM,278,RC,,,both,,,73,28.81,39.4668,,28.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,25.55,35,,25.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,29.2,40,,29.2,percent of total billed charges,Implant Devices,25.55,70,,25.55,percent of total billed charges,Implant Devices,24.82,34,,24.82,percent of total billed charges,Implant Devices,24.82,34,,24.82,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,29.2,
SYNTHES 206.018 CANCELLOUS SCREW 4X18MM,C1713,HCPCS,,79005855,CDM,278,RC,,,both,,,68,26.84,39.4668,,26.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.8,35,,23.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,27.2,40,,27.2,percent of total billed charges,Implant Devices,23.8,70,,23.8,percent of total billed charges,Implant Devices,23.12,34,,23.12,percent of total billed charges,Implant Devices,23.12,34,,23.12,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27.2,
SYNTHES 206.020 CANCELLOUS SCREW 4X20MM,C1713,HCPCS,,79005856,CDM,278,RC,,,both,,,59,23.29,39.4668,,23.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,23.6,40,,23.6,percent of total billed charges,Implant Devices,20.65,70,,20.65,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.6,
SYNTHES 04.211.220 NAVCLR PLATE 2.4/2.7,C1713,HCPCS,,79005857,CDM,278,RC,,,both,,,4630,1827.31,39.4668,,1827.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1574.2,34,,1574.2,percent of total billed charges,Implant Device,1574.2,34,,1574.2,percent of total billed charges,Implant Device,1574.2,34,,1574.2,percent of total billed charges,Implant Device,1574.2,34,,1574.2,percent of total billed charges,Implant Device,1574.2,34,,1574.2,percent of total billed charges,Implant Device,1574.2,34,,1574.2,percent of total billed charges,Implant Device,1620.5,35,,1620.5,percent of total billed charges,Implant Device,1574.2,34,"Charges > $500, x 34%",1574.2,percent of total billed charges,Implant Device,1620.5,35,,1620.5,percent of total billed charges,Implant Devices,1620.5,35,,1620.5,percent of total billed charges,Implant Devices,1620.5,35,,,percent of total billed charges,Implant Devices,1620.5,35,,1620.5,percent of total billed charges,Implant Devices,1620.5,35,,1620.5,percent of total billed charges,Implant Devices,1852,40,,1852,percent of total billed charges,Implant Devices,1620.5,70,,1620.5,percent of total billed charges,Implant Devices,1574.2,34,,1574.2,percent of total billed charges,Implant Devices,1574.2,34,,1574.2,percent of total billed charges,Implant Devices,1620.5,35,,1620.5,percent of total billed charges,Implant Devices,1620.5,35,,1620.5,percent of total billed charges,Implant Devices,1620.5,35,,1620.5,percent of total billed charges,Implant Devices,1620.5,35,,1620.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1574.2,34,"If Charge > 2,000, then 34 percent",1574.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1852,
SYNTHES 04.210-118 LOCK VA SCREW 2.4X18,C1713,HCPCS,,79005859,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
SYNTHES 04.210.120 LOCK VA SCREW 2.4X20,C1713,HCPCS,,79005861,CDM,278,RC,,,both,,,534,210.75,39.4668,,210.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,186.9,35,,186.9,percent of total billed charges,Implant Device,181.56,34,"Charges > $500, x 34%",181.56,percent of total billed charges,Implant Device,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,213.6,40,,213.6,percent of total billed charges,Implant Devices,186.9,70,,186.9,percent of total billed charges,Implant Devices,181.56,34,,181.56,percent of total billed charges,Implant Devices,181.56,34,,181.56,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,213.6,
SYNTHES 04.210-112 LOCK VA SCREW 2.4X14,C1713,HCPCS,,79005862,CDM,278,RC,,,both,,,534,210.75,39.4668,,210.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,186.9,35,,186.9,percent of total billed charges,Implant Device,181.56,34,"Charges > $500, x 34%",181.56,percent of total billed charges,Implant Device,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,213.6,40,,213.6,percent of total billed charges,Implant Devices,186.9,70,,186.9,percent of total billed charges,Implant Devices,181.56,34,,181.56,percent of total billed charges,Implant Devices,181.56,34,,181.56,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,213.6,
SYNTHES 04.210.114 LOCK VA SCREW 2.4X14,C1713,HCPCS,,79005863,CDM,278,RC,,,both,,,534,210.75,39.4668,,210.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,181.56,34,,181.56,percent of total billed charges,Implant Device,186.9,35,,186.9,percent of total billed charges,Implant Device,181.56,34,"Charges > $500, x 34%",181.56,percent of total billed charges,Implant Device,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,213.6,40,,213.6,percent of total billed charges,Implant Devices,186.9,70,,186.9,percent of total billed charges,Implant Devices,181.56,34,,181.56,percent of total billed charges,Implant Devices,181.56,34,,181.56,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,186.9,35,,186.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,213.6,
SYNTHES 207.638 CANNULATED SCREW 4X38MM,C1713,HCPCS,,79005864,CDM,278,RC,,,both,,,855,337.44,39.4668,,337.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,290.7,34,,290.7,percent of total billed charges,Implant Device,290.7,34,,290.7,percent of total billed charges,Implant Device,290.7,34,,290.7,percent of total billed charges,Implant Device,290.7,34,,290.7,percent of total billed charges,Implant Device,290.7,34,,290.7,percent of total billed charges,Implant Device,290.7,34,,290.7,percent of total billed charges,Implant Device,299.25,35,,299.25,percent of total billed charges,Implant Device,290.7,34,"Charges > $500, x 34%",290.7,percent of total billed charges,Implant Device,299.25,35,,299.25,percent of total billed charges,Implant Devices,299.25,35,,299.25,percent of total billed charges,Implant Devices,299.25,35,,,percent of total billed charges,Implant Devices,299.25,35,,299.25,percent of total billed charges,Implant Devices,299.25,35,,299.25,percent of total billed charges,Implant Devices,342,40,,342,percent of total billed charges,Implant Devices,299.25,70,,299.25,percent of total billed charges,Implant Devices,290.7,34,,290.7,percent of total billed charges,Implant Devices,290.7,34,,290.7,percent of total billed charges,Implant Devices,299.25,35,,299.25,percent of total billed charges,Implant Devices,299.25,35,,299.25,percent of total billed charges,Implant Devices,299.25,35,,299.25,percent of total billed charges,Implant Devices,299.25,35,,299.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,342,
SYNTHES 207.644 CANNULATED SCREW 4X44MM,C1713,HCPCS,,79005865,CDM,278,RC,,,both,,,519,204.83,39.4668,,204.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,176.46,34,,176.46,percent of total billed charges,Implant Device,176.46,34,,176.46,percent of total billed charges,Implant Device,176.46,34,,176.46,percent of total billed charges,Implant Device,176.46,34,,176.46,percent of total billed charges,Implant Device,176.46,34,,176.46,percent of total billed charges,Implant Device,176.46,34,,176.46,percent of total billed charges,Implant Device,181.65,35,,181.65,percent of total billed charges,Implant Device,176.46,34,"Charges > $500, x 34%",176.46,percent of total billed charges,Implant Device,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,207.6,40,,207.6,percent of total billed charges,Implant Devices,181.65,70,,181.65,percent of total billed charges,Implant Devices,176.46,34,,176.46,percent of total billed charges,Implant Devices,176.46,34,,176.46,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,207.6,
SYNTHES 219.98 WASHER 7.0MM,C1713,HCPCS,,79005868,CDM,278,RC,,,both,,,66,26.05,39.4668,,26.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,22.44,34,,22.44,percent of total billed charges,Implant Device,22.44,34,,22.44,percent of total billed charges,Implant Device,22.44,34,,22.44,percent of total billed charges,Implant Device,22.44,34,,22.44,percent of total billed charges,Implant Device,22.44,34,,22.44,percent of total billed charges,Implant Device,22.44,34,,22.44,percent of total billed charges,Implant Device,23.1,35,,23.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,23.1,35,,23.1,percent of total billed charges,Implant Devices,23.1,35,,23.1,percent of total billed charges,Implant Devices,23.1,35,,,percent of total billed charges,Implant Devices,23.1,35,,23.1,percent of total billed charges,Implant Devices,23.1,35,,23.1,percent of total billed charges,Implant Devices,26.4,40,,26.4,percent of total billed charges,Implant Devices,23.1,70,,23.1,percent of total billed charges,Implant Devices,22.44,34,,22.44,percent of total billed charges,Implant Devices,22.44,34,,22.44,percent of total billed charges,Implant Devices,23.1,35,,23.1,percent of total billed charges,Implant Devices,23.1,35,,23.1,percent of total billed charges,Implant Devices,23.1,35,,23.1,percent of total billed charges,Implant Devices,23.1,35,,23.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,26.4,
STRYKER 59-23014 BONE SCREW 2.3X14MM,C1713,HCPCS,,79005869,CDM,278,RC,,,both,,,459,181.15,39.4668,,181.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,156.06,34,,156.06,percent of total billed charges,Implant Device,156.06,34,,156.06,percent of total billed charges,Implant Device,156.06,34,,156.06,percent of total billed charges,Implant Device,156.06,34,,156.06,percent of total billed charges,Implant Device,156.06,34,,156.06,percent of total billed charges,Implant Device,156.06,34,,156.06,percent of total billed charges,Implant Device,160.65,35,,160.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,183.6,40,,183.6,percent of total billed charges,Implant Devices,160.65,70,,160.65,percent of total billed charges,Implant Devices,156.06,34,,156.06,percent of total billed charges,Implant Devices,156.06,34,,156.06,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,183.6,
STRYKER 59-23018 BONE SCREW 2.3X18MM,C1713,HCPCS,,79005870,CDM,278,RC,,,both,,,331,130.64,39.4668,,130.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,132.4,40,,132.4,percent of total billed charges,Implant Devices,115.85,70,,115.85,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.4,
STRYKER 59-23020 BONE SCREW 2.3X20MM,C1713,HCPCS,,79005871,CDM,278,RC,,,both,,,331,130.64,39.4668,,130.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,132.4,40,,132.4,percent of total billed charges,Implant Devices,115.85,70,,115.85,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.4,
STRYKER 59-23022 BONE SCREW 2.3X22MM,C1713,HCPCS,,79005872,CDM,278,RC,,,both,,,331,130.64,39.4668,,130.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,132.4,40,,132.4,percent of total billed charges,Implant Devices,115.85,70,,115.85,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.4,
STRYKER 59-17012 BONE SCREW 1.7X12MM,C1713,HCPCS,,79005873,CDM,278,RC,,,both,,,331,130.64,39.4668,,130.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,132.4,40,,132.4,percent of total billed charges,Implant Devices,115.85,70,,115.85,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.4,
STRYKER 5038-2-110 PIN 3 X 110MM,C1713,HCPCS,,79005874,CDM,278,RC,,,both,,,174,68.67,39.4668,,68.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,59.16,34,,59.16,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,69.6,40,,69.6,percent of total billed charges,Implant Devices,60.9,70,,60.9,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,59.16,34,,59.16,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,60.9,35,,60.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,69.6,
STRYKER 57-13402 COMPRESSION PLATE,C1713,HCPCS,,79005877,CDM,278,RC,,,both,,,803,316.92,39.4668,,316.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,273.02,34,,273.02,percent of total billed charges,Implant Device,273.02,34,,273.02,percent of total billed charges,Implant Device,273.02,34,,273.02,percent of total billed charges,Implant Device,273.02,34,,273.02,percent of total billed charges,Implant Device,273.02,34,,273.02,percent of total billed charges,Implant Device,273.02,34,,273.02,percent of total billed charges,Implant Device,281.05,35,,281.05,percent of total billed charges,Implant Device,273.02,34,"Charges > $500, x 34%",273.02,percent of total billed charges,Implant Device,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,321.2,40,,321.2,percent of total billed charges,Implant Devices,281.05,70,,281.05,percent of total billed charges,Implant Devices,273.02,34,,273.02,percent of total billed charges,Implant Devices,273.02,34,,273.02,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,321.2,
STRYKER PLP21342 LAPIDUS PLATE STEP 1 RT,C1713,HCPCS,,79005878,CDM,278,RC,,,both,,,5836,2303.28,39.4668,,2303.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1984.24,34,,1984.24,percent of total billed charges,Implant Device,1984.24,34,,1984.24,percent of total billed charges,Implant Device,1984.24,34,,1984.24,percent of total billed charges,Implant Device,1984.24,34,,1984.24,percent of total billed charges,Implant Device,1984.24,34,,1984.24,percent of total billed charges,Implant Device,1984.24,34,,1984.24,percent of total billed charges,Implant Device,2042.6,35,,2042.6,percent of total billed charges,Implant Device,1984.24,34,"Charges > $500, x 34%",1984.24,percent of total billed charges,Implant Device,2042.6,35,,2042.6,percent of total billed charges,Implant Devices,2042.6,35,,2042.6,percent of total billed charges,Implant Devices,2042.6,35,,,percent of total billed charges,Implant Devices,2042.6,35,,2042.6,percent of total billed charges,Implant Devices,2042.6,35,,2042.6,percent of total billed charges,Implant Devices,2334.4,40,,2334.4,percent of total billed charges,Implant Devices,2042.6,70,,2042.6,percent of total billed charges,Implant Devices,1984.24,34,,1984.24,percent of total billed charges,Implant Devices,1984.24,34,,1984.24,percent of total billed charges,Implant Devices,2042.6,35,,2042.6,percent of total billed charges,Implant Devices,2042.6,35,,2042.6,percent of total billed charges,Implant Devices,2042.6,35,,2042.6,percent of total billed charges,Implant Devices,2042.6,35,,2042.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1984.24,34,"If Charge > 2,000, then 34 percent",1984.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2334.4,
STRYKER PLSL3014 LOCKING SCREW T8 3X14MM,C1713,HCPCS,,79005879,CDM,278,RC,,,both,,,1119,441.63,39.4668,,441.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Device,380.46,34,"Charges > $500, x 34%",380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,447.6,40,,447.6,percent of total billed charges,Implant Devices,391.65,70,,391.65,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,447.6,
STRYKER PLSS3026 NONLOCK SCREW T8 3X26MM,C1713,HCPCS,,79005880,CDM,278,RC,,,both,,,570,224.96,39.4668,,224.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Device,193.8,34,"Charges > $500, x 34%",193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,228,40,,228,percent of total billed charges,Implant Devices,199.5,70,,199.5,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228,
STRYKER PLSS3022 NONLOCK SCREW T8 3X22MM,C1713,HCPCS,,79005881,CDM,278,RC,,,both,,,570,224.96,39.4668,,224.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Device,193.8,34,"Charges > $500, x 34%",193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,228,40,,228,percent of total billed charges,Implant Devices,199.5,70,,199.5,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228,
STRYKER 59-23049 WASHER,C1713,HCPCS,,79005884,CDM,278,RC,,,both,,,194,76.57,39.4668,,76.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.96,34,,65.96,percent of total billed charges,Implant Device,65.96,34,,65.96,percent of total billed charges,Implant Device,65.96,34,,65.96,percent of total billed charges,Implant Device,65.96,34,,65.96,percent of total billed charges,Implant Device,65.96,34,,65.96,percent of total billed charges,Implant Device,65.96,34,,65.96,percent of total billed charges,Implant Device,67.9,35,,67.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,77.6,40,,77.6,percent of total billed charges,Implant Devices,67.9,70,,67.9,percent of total billed charges,Implant Devices,65.96,34,,65.96,percent of total billed charges,Implant Devices,65.96,34,,65.96,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,77.6,
STRYKER 1851-1244S FEMORAL NAIL 12X440MM,C1713,HCPCS,,79005891,CDM,278,RC,,,both,,,7640,3015.26,39.4668,,3015.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2674,35,,2674,percent of total billed charges,Implant Device,2597.6,34,"Charges > $500, x 34%",2597.6,percent of total billed charges,Implant Device,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,3056,40,,3056,percent of total billed charges,Implant Devices,2674,70,,2674,percent of total billed charges,Implant Devices,2597.6,34,,2597.6,percent of total billed charges,Implant Devices,2597.6,34,,2597.6,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2597.6,34,"If Charge > 2,000, then 34 percent",2597.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3056,
STRYKER 1896-5060S LOCKING SCREW FT 5X55,C1713,HCPCS,,79005892,CDM,278,RC,,,both,,,441,174.05,39.4668,,174.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,176.4,40,,176.4,percent of total billed charges,Implant Devices,154.35,70,,154.35,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,176.4,
SYNTHES 207.724 CANNULATED SCREW 4X24MM,C1713,HCPCS,,79005893,CDM,278,RC,,,both,,,685,270.35,39.4668,,270.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Device,232.9,34,"Charges > $500, x 34%",232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,274,40,,274,percent of total billed charges,Implant Devices,239.75,70,,239.75,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274,
STRYKER 1822-0930S TIBIAL NAIL 9X300MM,C1713,HCPCS,,79005895,CDM,278,RC,,,both,,,7143,2819.11,39.4668,,2819.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2500.05,35,,2500.05,percent of total billed charges,Implant Device,2428.62,34,"Charges > $500, x 34%",2428.62,percent of total billed charges,Implant Device,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2857.2,40,,2857.2,percent of total billed charges,Implant Devices,2500.05,70,,2500.05,percent of total billed charges,Implant Devices,2428.62,34,,2428.62,percent of total billed charges,Implant Devices,2428.62,34,,2428.62,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2428.62,34,"If Charge > 2,000, then 34 percent",2428.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2857.2,
STRYKER 40-20807 7 HOLE VARIAX STR PLATE,C1713,HCPCS,,79005896,CDM,278,RC,,,both,,,1170,461.76,39.4668,,461.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,409.5,35,,409.5,percent of total billed charges,Implant Device,397.8,34,"Charges > $500, x 34%",397.8,percent of total billed charges,Implant Device,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,468,40,,468,percent of total billed charges,Implant Devices,409.5,70,,409.5,percent of total billed charges,Implant Devices,397.8,34,,397.8,percent of total billed charges,Implant Devices,397.8,34,,397.8,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,468,
SOLANA LPX2R LAPIDUS CX PLATE 2MM RIGHT,C1713,HCPCS,,79005902,CDM,278,RC,,,both,,,6708,2647.43,39.4668,,2647.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Device,2280.72,34,"Charges > $500, x 34%",2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2683.2,40,,2683.2,percent of total billed charges,Implant Devices,2347.8,70,,2347.8,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2280.72,34,"If Charge > 2,000, then 34 percent",2280.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2683.2,
SOLANA XGP2545 OLIVE STABILIZER .045X2.5,C1713,HCPCS,,79005904,CDM,278,RC,,,both,,,585,230.88,39.4668,,230.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,204.75,35,,204.75,percent of total billed charges,Implant Device,198.9,34,"Charges > $500, x 34%",198.9,percent of total billed charges,Implant Device,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,234,40,,234,percent of total billed charges,Implant Devices,204.75,70,,204.75,percent of total billed charges,Implant Devices,198.9,34,,198.9,percent of total billed charges,Implant Devices,198.9,34,,198.9,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234,
SOLANA CCP-X3530 LAG SCREW 3.5X30MM,C1713,HCPCS,,79005905,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
SOLANA CCP-L3014 LOCKING SCREW 3.0X14MM,C1713,HCPCS,,79005906,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
SOLANA CCP-L3016 LOCKING SCREW 3.0X16MM,C1713,HCPCS,,79005907,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
SOLANA CCP-LPX2R PLATE LAPIDUS CX 2MM,C1713,HCPCS,,79005908,CDM,278,RC,,,both,,,6708,2647.43,39.4668,,2647.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Device,2280.72,34,"Charges > $500, x 34%",2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2683.2,40,,2683.2,percent of total billed charges,Implant Devices,2347.8,70,,2347.8,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2280.72,34,"If Charge > 2,000, then 34 percent",2280.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2683.2,
BIOMET 1802-49-050 CANN CANC SCREW 4X50,C1713,HCPCS,,79005909,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
BIOMET 1802-49-036 CANN CANC SCREW 4X36,C1713,HCPCS,,79005910,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ACUMED AT2-S18-S BONE SCREW ACUTRAK 22MM,C1713,HCPCS,,79005911,CDM,278,RC,,,both,,,1584,625.15,39.4668,,625.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Device,538.56,34,"Charges > $500, x 34%",538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,633.6,40,,633.6,percent of total billed charges,Implant Devices,554.4,70,,554.4,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,633.6,
ACUMED AT2-S22-S BONE SCREW ACUTRAK 18MM,C1713,HCPCS,,79005912,CDM,278,RC,,,both,,,1584,625.15,39.4668,,625.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Device,538.56,34,"Charges > $500, x 34%",538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,633.6,40,,633.6,percent of total billed charges,Implant Devices,554.4,70,,554.4,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,633.6,
ACUMED AT2-M18-S BONE SCREW ACUTRAK 18MM,C1713,HCPCS,,79005915,CDM,278,RC,,,both,,,1584,625.15,39.4668,,625.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Device,538.56,34,"Charges > $500, x 34%",538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,633.6,40,,633.6,percent of total billed charges,Implant Devices,554.4,70,,554.4,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,633.6,
SOLANA CCP-LP2XL LAPIDUS PLATE 2MMM LEFT,C1713,HCPCS,,79005934,CDM,278,RC,,,both,,,6708,2647.43,39.4668,,2647.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Device,2280.72,34,"Charges > $500, x 34%",2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2683.2,40,,2683.2,percent of total billed charges,Implant Devices,2347.8,70,,2347.8,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2280.72,34,"If Charge > 2,000, then 34 percent",2280.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2683.2,
SOLANA CCP-L3018 LOCKING SCREW 3X18MM,C1713,HCPCS,,79005935,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
SOLANA CCP-X3532 LAG SCREW 3.5X32MM,C1713,HCPCS,,79005936,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
BIOMET 14-405042 CORT SCREW TI 5X42MM,C1713,HCPCS,,79005937,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
BIOMET 29242 LAG SCREW ASSY 115MM,C1713,HCPCS,,79005938,CDM,278,RC,,,both,,,3330,1314.24,39.4668,,1314.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Device,1132.2,34,"Charges > $500, x 34%",1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1332,40,,1332,percent of total billed charges,Implant Devices,1165.5,70,,1165.5,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1132.2,34,"If Charge > 2,000, then 34 percent",1132.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1332,
STRYKER 349616 2.7X16MM CORTICAL SCREW,C1713,HCPCS,,79005939,CDM,278,RC,,,both,,,138,54.46,39.4668,,54.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,55.2,40,,55.2,percent of total billed charges,Implant Devices,48.3,70,,48.3,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.2,
STRYKER 371012 3.0X12MM LOCKING SCREW,C1713,HCPCS,,79005940,CDM,278,RC,,,both,,,352,138.92,39.4668,,138.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,123.2,35,,123.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,140.8,40,,140.8,percent of total billed charges,Implant Devices,123.2,70,,123.2,percent of total billed charges,Implant Devices,119.68,34,,119.68,percent of total billed charges,Implant Devices,119.68,34,,119.68,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,140.8,
STRYKER 371014 3.0X14MM LOCKING SCREW,C1713,HCPCS,,79005941,CDM,278,RC,,,both,,,352,138.92,39.4668,,138.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,123.2,35,,123.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,140.8,40,,140.8,percent of total billed charges,Implant Devices,123.2,70,,123.2,percent of total billed charges,Implant Devices,119.68,34,,119.68,percent of total billed charges,Implant Devices,119.68,34,,119.68,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,140.8,
STRYKER 371016 3.0X16MM LOCKING SCREW,C1713,HCPCS,,79005942,CDM,278,RC,,,both,,,352,138.92,39.4668,,138.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,123.2,35,,123.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,140.8,40,,140.8,percent of total billed charges,Implant Devices,123.2,70,,123.2,percent of total billed charges,Implant Devices,119.68,34,,119.68,percent of total billed charges,Implant Devices,119.68,34,,119.68,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,140.8,
STRYKER 371018 3.0X18MM LOCKING SCREW,C1713,HCPCS,,79005943,CDM,278,RC,,,both,,,319,125.9,39.4668,,125.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,108.46,34,,108.46,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,127.6,40,,127.6,percent of total billed charges,Implant Devices,111.65,70,,111.65,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,108.46,34,,108.46,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,111.65,35,,111.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,127.6,
STRYKER 427066S 6 HOLE TUBLAR PLATES 1/3,C1713,HCPCS,,79005944,CDM,278,RC,,,both,,,602,237.59,39.4668,,237.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204.68,34,,204.68,percent of total billed charges,Implant Device,204.68,34,,204.68,percent of total billed charges,Implant Device,204.68,34,,204.68,percent of total billed charges,Implant Device,204.68,34,,204.68,percent of total billed charges,Implant Device,204.68,34,,204.68,percent of total billed charges,Implant Device,204.68,34,,204.68,percent of total billed charges,Implant Device,210.7,35,,210.7,percent of total billed charges,Implant Device,204.68,34,"Charges > $500, x 34%",204.68,percent of total billed charges,Implant Device,210.7,35,,210.7,percent of total billed charges,Implant Devices,210.7,35,,210.7,percent of total billed charges,Implant Devices,210.7,35,,,percent of total billed charges,Implant Devices,210.7,35,,210.7,percent of total billed charges,Implant Devices,210.7,35,,210.7,percent of total billed charges,Implant Devices,240.8,40,,240.8,percent of total billed charges,Implant Devices,210.7,70,,210.7,percent of total billed charges,Implant Devices,204.68,34,,204.68,percent of total billed charges,Implant Devices,204.68,34,,204.68,percent of total billed charges,Implant Devices,210.7,35,,210.7,percent of total billed charges,Implant Devices,210.7,35,,210.7,percent of total billed charges,Implant Devices,210.7,35,,210.7,percent of total billed charges,Implant Devices,210.7,35,,210.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240.8,
STRYKER 54-25376 DISTAL RADIUS PLATE STD,C1713,HCPCS,,79005947,CDM,278,RC,,,both,,,3316,1308.72,39.4668,,1308.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1127.44,34,,1127.44,percent of total billed charges,Implant Device,1160.6,35,,1160.6,percent of total billed charges,Implant Device,1127.44,34,"Charges > $500, x 34%",1127.44,percent of total billed charges,Implant Device,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1326.4,40,,1326.4,percent of total billed charges,Implant Devices,1160.6,70,,1160.6,percent of total billed charges,Implant Devices,1127.44,34,,1127.44,percent of total billed charges,Implant Devices,1127.44,34,,1127.44,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,1160.6,35,,1160.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1127.44,34,"If Charge > 2,000, then 34 percent",1127.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1326.4,
STRYKER 40-35030 3.5X30MM LOCKING SCREW,C1713,HCPCS,,79005948,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
STRYKER 1822-1013S TIBIAL NAIL 10X315MM,C1713,HCPCS,,79005949,CDM,278,RC,,,both,,,5819,2296.57,39.4668,,2296.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,1978.46,34,,1978.46,percent of total billed charges,Implant Device,2036.65,35,,2036.65,percent of total billed charges,Implant Device,1978.46,34,"Charges > $500, x 34%",1978.46,percent of total billed charges,Implant Device,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2327.6,40,,2327.6,percent of total billed charges,Implant Devices,2036.65,70,,2036.65,percent of total billed charges,Implant Devices,1978.46,34,,1978.46,percent of total billed charges,Implant Devices,1978.46,34,,1978.46,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,2036.65,35,,2036.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1978.46,34,"If Charge > 2,000, then 34 percent",1978.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2327.6,
STRYKER 325050 CANNULATED SCREW 4X50MM,C1713,HCPCS,,79005950,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
STRYKER 3120-0170S TROCHANT NAIL 170X120,C1713,HCPCS,,79005951,CDM,278,RC,,,both,,,6689,2639.93,39.4668,,2639.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2274.26,34,,2274.26,percent of total billed charges,Implant Device,2274.26,34,,2274.26,percent of total billed charges,Implant Device,2274.26,34,,2274.26,percent of total billed charges,Implant Device,2274.26,34,,2274.26,percent of total billed charges,Implant Device,2274.26,34,,2274.26,percent of total billed charges,Implant Device,2274.26,34,,2274.26,percent of total billed charges,Implant Device,2341.15,35,,2341.15,percent of total billed charges,Implant Device,2274.26,34,"Charges > $500, x 34%",2274.26,percent of total billed charges,Implant Device,2341.15,35,,2341.15,percent of total billed charges,Implant Devices,2341.15,35,,2341.15,percent of total billed charges,Implant Devices,2341.15,35,,,percent of total billed charges,Implant Devices,2341.15,35,,2341.15,percent of total billed charges,Implant Devices,2341.15,35,,2341.15,percent of total billed charges,Implant Devices,2675.6,40,,2675.6,percent of total billed charges,Implant Devices,2341.15,70,,2341.15,percent of total billed charges,Implant Devices,2274.26,34,,2274.26,percent of total billed charges,Implant Devices,2274.26,34,,2274.26,percent of total billed charges,Implant Devices,2341.15,35,,2341.15,percent of total billed charges,Implant Devices,2341.15,35,,2341.15,percent of total billed charges,Implant Devices,2341.15,35,,2341.15,percent of total billed charges,Implant Devices,2341.15,35,,2341.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2274.26,34,"If Charge > 2,000, then 34 percent",2274.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2675.6,
STRYKER 3060-0075S LAG SCREW 10.5X75MM,C1713,HCPCS,,79005952,CDM,278,RC,,,both,,,2371,935.76,39.4668,,935.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,806.14,34,,806.14,percent of total billed charges,Implant Device,806.14,34,,806.14,percent of total billed charges,Implant Device,806.14,34,,806.14,percent of total billed charges,Implant Device,806.14,34,,806.14,percent of total billed charges,Implant Device,806.14,34,,806.14,percent of total billed charges,Implant Device,806.14,34,,806.14,percent of total billed charges,Implant Device,829.85,35,,829.85,percent of total billed charges,Implant Device,806.14,34,"Charges > $500, x 34%",806.14,percent of total billed charges,Implant Device,829.85,35,,829.85,percent of total billed charges,Implant Devices,829.85,35,,829.85,percent of total billed charges,Implant Devices,829.85,35,,,percent of total billed charges,Implant Devices,829.85,35,,829.85,percent of total billed charges,Implant Devices,829.85,35,,829.85,percent of total billed charges,Implant Devices,948.4,40,,948.4,percent of total billed charges,Implant Devices,829.85,70,,829.85,percent of total billed charges,Implant Devices,806.14,34,,806.14,percent of total billed charges,Implant Devices,806.14,34,,806.14,percent of total billed charges,Implant Devices,829.85,35,,829.85,percent of total billed charges,Implant Devices,829.85,35,,829.85,percent of total billed charges,Implant Devices,829.85,35,,829.85,percent of total billed charges,Implant Devices,829.85,35,,829.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,806.14,34,"If Charge > 2,000, then 34 percent",806.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,948.4,
ARTHREX AR-2257 AC TIGHTROPE REPAIR KIT,C1713,HCPCS,,79005957,CDM,278,RC,,,both,,,1350,532.8,39.4668,,532.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Device,459,34,"Charges > $500, x 34%",459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,540,40,,540,percent of total billed charges,Implant Devices,472.5,70,,472.5,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,540,
ARTHREX AR-8724-22PT CANN SCREW 2.4X22MM,C1713,HCPCS,,79005958,CDM,278,RC,,,both,,,376,148.4,39.4668,,148.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.84,34,,127.84,percent of total billed charges,Implant Device,127.84,34,,127.84,percent of total billed charges,Implant Device,127.84,34,,127.84,percent of total billed charges,Implant Device,127.84,34,,127.84,percent of total billed charges,Implant Device,127.84,34,,127.84,percent of total billed charges,Implant Device,127.84,34,,127.84,percent of total billed charges,Implant Device,131.6,35,,131.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,150.4,40,,150.4,percent of total billed charges,Implant Devices,131.6,70,,131.6,percent of total billed charges,Implant Devices,127.84,34,,127.84,percent of total billed charges,Implant Devices,127.84,34,,127.84,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,131.6,35,,131.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150.4,
SYNTHES 223.581 PLATE 8 HOLE 3.5X111MM,C1713,HCPCS,,79005963,CDM,278,RC,,,both,,,1506,594.37,39.4668,,594.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,512.04,34,,512.04,percent of total billed charges,Implant Device,512.04,34,,512.04,percent of total billed charges,Implant Device,512.04,34,,512.04,percent of total billed charges,Implant Device,512.04,34,,512.04,percent of total billed charges,Implant Device,512.04,34,,512.04,percent of total billed charges,Implant Device,512.04,34,,512.04,percent of total billed charges,Implant Device,527.1,35,,527.1,percent of total billed charges,Implant Device,512.04,34,"Charges > $500, x 34%",512.04,percent of total billed charges,Implant Device,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,602.4,40,,602.4,percent of total billed charges,Implant Devices,527.1,70,,527.1,percent of total billed charges,Implant Devices,512.04,34,,512.04,percent of total billed charges,Implant Devices,512.04,34,,512.04,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,602.4,
SYNTHES 212.104 LOCKING SCREW 3.5X16MM,C1713,HCPCS,,79005964,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
SYNTHES 212.105 LOCKING SCREW 3.5X18MM,C1713,HCPCS,,79005965,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
SYNTHES 212.103 LOCKING SCREW 3.5X14MM,C1713,HCPCS,,79005966,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
STRYKER 59-17014 BONE SCREW 1.7X14MM,C1713,HCPCS,,79005968,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
STABILITY BIO 447-13808 ANT TIB ALLOGRFT,C1713,HCPCS,,79005969,CDM,278,RC,,,both,,,5326,2102,39.4668,,2102,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1810.84,34,,1810.84,percent of total billed charges,Implant Device,1864.1,35,,1864.1,percent of total billed charges,Implant Device,1810.84,34,"Charges > $500, x 34%",1810.84,percent of total billed charges,Implant Device,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,2130.4,40,,2130.4,percent of total billed charges,Implant Devices,1864.1,70,,1864.1,percent of total billed charges,Implant Devices,1810.84,34,,1810.84,percent of total billed charges,Implant Devices,1810.84,34,,1810.84,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,1864.1,35,,1864.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1810.84,34,"If Charge > 2,000, then 34 percent",1810.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2130.4,
STRYKER 6194-1-001 SIMPLEX HV CEMENT,C1713,HCPCS,,79005972,CDM,278,RC,,,both,,,314,123.93,39.4668,,123.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.76,34,,106.76,percent of total billed charges,Implant Device,106.76,34,,106.76,percent of total billed charges,Implant Device,106.76,34,,106.76,percent of total billed charges,Implant Device,106.76,34,,106.76,percent of total billed charges,Implant Device,106.76,34,,106.76,percent of total billed charges,Implant Device,106.76,34,,106.76,percent of total billed charges,Implant Device,109.9,35,,109.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,125.6,40,,125.6,percent of total billed charges,Implant Devices,109.9,70,,109.9,percent of total billed charges,Implant Devices,106.76,34,,106.76,percent of total billed charges,Implant Devices,106.76,34,,106.76,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,109.9,35,,109.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,125.6,
ARTHREX AR-14120 LOCKING SCREW 3.5X28MM,C1713,HCPCS,,79005973,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
ARTHREX AR-14244 LOCKING SCREW 4.0X44MM,C1713,HCPCS,,79005974,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
SYNTHES 214.056 CORTEX SCREW 4.5X56MM,C1713,HCPCS,,79005975,CDM,278,RC,,,both,,,53,20.92,39.4668,,20.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.02,34,,18.02,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,21.2,40,,21.2,percent of total billed charges,Implant Devices,18.55,70,,18.55,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.02,34,,18.02,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,18.55,35,,18.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,21.2,
SYNTHES 214.050 CORTEX SCREW 4.5X50MM,C1713,HCPCS,,79005976,CDM,278,RC,,,both,,,56,22.1,39.4668,,22.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.6,35,,19.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,22.4,40,,22.4,percent of total billed charges,Implant Devices,19.6,70,,19.6,percent of total billed charges,Implant Devices,19.04,34,,19.04,percent of total billed charges,Implant Devices,19.04,34,,19.04,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.4,
STRYKER 629286 PLATE EXT MEDIAL 6 HOLE,C1713,HCPCS,,79005977,CDM,278,RC,,,both,,,3883,1532.5,39.4668,,1532.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1320.22,34,,1320.22,percent of total billed charges,Implant Device,1320.22,34,,1320.22,percent of total billed charges,Implant Device,1320.22,34,,1320.22,percent of total billed charges,Implant Device,1320.22,34,,1320.22,percent of total billed charges,Implant Device,1320.22,34,,1320.22,percent of total billed charges,Implant Device,1320.22,34,,1320.22,percent of total billed charges,Implant Device,1359.05,35,,1359.05,percent of total billed charges,Implant Device,1320.22,34,"Charges > $500, x 34%",1320.22,percent of total billed charges,Implant Device,1359.05,35,,1359.05,percent of total billed charges,Implant Devices,1359.05,35,,1359.05,percent of total billed charges,Implant Devices,1359.05,35,,,percent of total billed charges,Implant Devices,1359.05,35,,1359.05,percent of total billed charges,Implant Devices,1359.05,35,,1359.05,percent of total billed charges,Implant Devices,1553.2,40,,1553.2,percent of total billed charges,Implant Devices,1359.05,70,,1359.05,percent of total billed charges,Implant Devices,1320.22,34,,1320.22,percent of total billed charges,Implant Devices,1320.22,34,,1320.22,percent of total billed charges,Implant Devices,1359.05,35,,1359.05,percent of total billed charges,Implant Devices,1359.05,35,,1359.05,percent of total billed charges,Implant Devices,1359.05,35,,1359.05,percent of total billed charges,Implant Devices,1359.05,35,,1359.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1320.22,34,"If Charge > 2,000, then 34 percent",1320.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1553.2,
STRYKER 614865 CORTICAL SCREW 3.5X65MM,C1713,HCPCS,,79005978,CDM,278,RC,,,both,,,331,130.64,39.4668,,130.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,132.4,40,,132.4,percent of total billed charges,Implant Devices,115.85,70,,115.85,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.4,
STRYKER 614660 LOCKING SCREW 3.5X60MM,C1713,HCPCS,,79005979,CDM,278,RC,,,both,,,666,262.85,39.4668,,262.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,233.1,35,,233.1,percent of total billed charges,Implant Device,226.44,34,"Charges > $500, x 34%",226.44,percent of total billed charges,Implant Device,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,266.4,40,,266.4,percent of total billed charges,Implant Devices,233.1,70,,233.1,percent of total billed charges,Implant Devices,226.44,34,,226.44,percent of total billed charges,Implant Devices,226.44,34,,226.44,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.4,
STRYKER 614630 LOCKING SCREW 3.5X30MM,C1713,HCPCS,,79005980,CDM,278,RC,,,both,,,666,262.85,39.4668,,262.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,233.1,35,,233.1,percent of total billed charges,Implant Device,226.44,34,"Charges > $500, x 34%",226.44,percent of total billed charges,Implant Device,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,266.4,40,,266.4,percent of total billed charges,Implant Devices,233.1,70,,233.1,percent of total billed charges,Implant Devices,226.44,34,,226.44,percent of total billed charges,Implant Devices,226.44,34,,226.44,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.4,
STRYKER 629244 PLATE POSTERIOR LATERAL,C1713,HCPCS,,79005981,CDM,278,RC,,,both,,,3051,1204.13,39.4668,,1204.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1067.85,35,,1067.85,percent of total billed charges,Implant Device,1037.34,34,"Charges > $500, x 34%",1037.34,percent of total billed charges,Implant Device,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1220.4,40,,1220.4,percent of total billed charges,Implant Devices,1067.85,70,,1067.85,percent of total billed charges,Implant Devices,1037.34,34,,1037.34,percent of total billed charges,Implant Devices,1037.34,34,,1037.34,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1037.34,34,"If Charge > 2,000, then 34 percent",1037.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1220.4,
STRYKER 614812 CORTICAL SCREW 3.5X12MM,C1713,HCPCS,,79005982,CDM,278,RC,,,both,,,331,130.64,39.4668,,130.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,132.4,40,,132.4,percent of total billed charges,Implant Devices,115.85,70,,115.85,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.4,
ARTHREX AR-14128 LOCKING SCREW 3.5X28MM,C1713,HCPCS,,79005984,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
MIMEDX AI-5050 AMNIOFIX MEMBRANE 0.5ML,C1713,HCPCS,,79005985,CDM,278,RC,,,both,,,2242,884.85,39.4668,,884.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,762.28,34,,762.28,percent of total billed charges,Implant Device,762.28,34,,762.28,percent of total billed charges,Implant Device,762.28,34,,762.28,percent of total billed charges,Implant Device,762.28,34,,762.28,percent of total billed charges,Implant Device,762.28,34,,762.28,percent of total billed charges,Implant Device,762.28,34,,762.28,percent of total billed charges,Implant Device,784.7,35,,784.7,percent of total billed charges,Implant Device,762.28,34,"Charges > $500, x 34%",762.28,percent of total billed charges,Implant Device,784.7,35,,784.7,percent of total billed charges,Implant Devices,784.7,35,,784.7,percent of total billed charges,Implant Devices,784.7,35,,,percent of total billed charges,Implant Devices,784.7,35,,784.7,percent of total billed charges,Implant Devices,784.7,35,,784.7,percent of total billed charges,Implant Devices,896.8,40,,896.8,percent of total billed charges,Implant Devices,784.7,70,,784.7,percent of total billed charges,Implant Devices,762.28,34,,762.28,percent of total billed charges,Implant Devices,762.28,34,,762.28,percent of total billed charges,Implant Devices,784.7,35,,784.7,percent of total billed charges,Implant Devices,784.7,35,,784.7,percent of total billed charges,Implant Devices,784.7,35,,784.7,percent of total billed charges,Implant Devices,784.7,35,,784.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,762.28,34,"If Charge > 2,000, then 34 percent",762.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,896.8,
MIMEDX TN-5240 AMNIOFIX MEMBRANE 2X4CM,C1713,HCPCS,,79005986,CDM,278,RC,,,both,,,3885,1533.29,39.4668,,1533.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1359.75,35,,1359.75,percent of total billed charges,Implant Device,1320.9,34,"Charges > $500, x 34%",1320.9,percent of total billed charges,Implant Device,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1554,40,,1554,percent of total billed charges,Implant Devices,1359.75,70,,1359.75,percent of total billed charges,Implant Devices,1320.9,34,,1320.9,percent of total billed charges,Implant Devices,1320.9,34,,1320.9,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1320.9,34,"If Charge > 2,000, then 34 percent",1320.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1554,
STRYKER 40-35610 LOCKING SCREW 3.5X10MM,C1713,HCPCS,,79005988,CDM,278,RC,,,both,,,379,149.58,39.4668,,149.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,128.86,34,,128.86,percent of total billed charges,Implant Device,132.65,35,,132.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,151.6,40,,151.6,percent of total billed charges,Implant Devices,132.65,70,,132.65,percent of total billed charges,Implant Devices,128.86,34,,128.86,percent of total billed charges,Implant Devices,128.86,34,,128.86,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,132.65,35,,132.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,151.6,
STRYKER 325240S CANNULATED SCREW 4X40MM,C1713,HCPCS,,79005989,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
EXACTECH 652-00-02 OPTECURE DBM 2CC,C1713,HCPCS,,79005990,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
BIOMET/EBI 8162-35-010 PLATE 10 HOLE,C1713,HCPCS,,79005991,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
ARTHREX AR-8967-1860 CANN SCREW 6.7X60MM,C1713,HCPCS,,79005992,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-1680PS TENODESIS SCREW 8X12MM,C1713,HCPCS,,79005994,CDM,278,RC,,,both,,,946,373.36,39.4668,,373.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Device,321.64,34,"Charges > $500, x 34%",321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,378.4,40,,378.4,percent of total billed charges,Implant Devices,331.1,70,,331.1,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.4,
ARTHREX AR-2657DL CLAVICLE PLATE 8 HOLE,C1713,HCPCS,,79005995,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ARTHREX AR-8830-12 CANC SCREW 3X12MM,C1713,HCPCS,,79005996,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ZIMMER 2347-23-28 PERIART SCREW 4.5X28MM,C1713,HCPCS,,79005997,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ZIMMER 2347-23-30 PERIART SCREW 4.5X30MM,C1713,HCPCS,,79005998,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ZIMMER 2357-102-10 LOCKING PLATE 10 HOLE,C1713,HCPCS,,79005999,CDM,278,RC,,,both,,,4536,1790.21,39.4668,,1790.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1587.6,35,,1587.6,percent of total billed charges,Implant Device,1542.24,34,"Charges > $500, x 34%",1542.24,percent of total billed charges,Implant Device,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1814.4,40,,1814.4,percent of total billed charges,Implant Devices,1587.6,70,,1587.6,percent of total billed charges,Implant Devices,1542.24,34,,1542.24,percent of total billed charges,Implant Devices,1542.24,34,,1542.24,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1542.24,34,"If Charge > 2,000, then 34 percent",1542.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1814.4,
ZIMMER 2359-30-45 LOCKING SCREW 4.5X30MM,C1713,HCPCS,,79006000,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
ZIMMER 2359-35-55 LOCKING SCREW 5.5X35MM,C1713,HCPCS,,79006001,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 2359-50-55 LOCKING SCREW 5.5X50MM,C1713,HCPCS,,79006002,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 2359-55-55 LOCKING SCREW 5.5X55MM,C1713,HCPCS,,79006003,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 2359-60-55 LOCKING SCREW 5.5X60MM,C1713,HCPCS,,79006004,CDM,278,RC,,,both,,,562,221.8,39.4668,,221.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Device,191.08,34,"Charges > $500, x 34%",191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,224.8,40,,224.8,percent of total billed charges,Implant Devices,196.7,70,,196.7,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224.8,
STRYKER 627302 PROX LAT TIB PLATE 2 HOLE,C1713,HCPCS,,79006006,CDM,278,RC,,,both,,,5922,2337.22,39.4668,,2337.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2072.7,35,,2072.7,percent of total billed charges,Implant Device,2013.48,34,"Charges > $500, x 34%",2013.48,percent of total billed charges,Implant Device,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2368.8,40,,2368.8,percent of total billed charges,Implant Devices,2072.7,70,,2072.7,percent of total billed charges,Implant Devices,2013.48,34,,2013.48,percent of total billed charges,Implant Devices,2013.48,34,,2013.48,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2013.48,34,"If Charge > 2,000, then 34 percent",2013.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2368.8,
STRYKER 661036 LOCKING SCREW 4.0X36MM,C1713,HCPCS,,79006007,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 661070 LOCKING SCREW 4.0X70MM,C1713,HCPCS,,79006008,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 661075 LOCKING SCERW 4.0X75MM,C1713,HCPCS,,79006009,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 661065 LOCKING SCREW 4.0X665MM,C1713,HCPCS,,79006010,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 601438 CORTICAL SCREW 3.5X38MM,C1713,HCPCS,,79006011,CDM,278,RC,,,both,,,118,46.57,39.4668,,46.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,47.2,40,,47.2,percent of total billed charges,Implant Devices,41.3,70,,41.3,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,47.2,
STRYKER 1851-1038S FEMORAL NAIL 10X380MM,C1713,HCPCS,,79006012,CDM,278,RC,,,both,,,7640,3015.26,39.4668,,3015.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2597.6,34,,2597.6,percent of total billed charges,Implant Device,2674,35,,2674,percent of total billed charges,Implant Device,2597.6,34,"Charges > $500, x 34%",2597.6,percent of total billed charges,Implant Device,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,3056,40,,3056,percent of total billed charges,Implant Devices,2674,70,,2674,percent of total billed charges,Implant Devices,2597.6,34,,2597.6,percent of total billed charges,Implant Devices,2597.6,34,,2597.6,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,2674,35,,2674,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2597.6,34,"If Charge > 2,000, then 34 percent",2597.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3056,
STRYKER 1896-5030S LOCK SCREW FT 5X30MM,C1713,HCPCS,,79006026,CDM,278,RC,,,both,,,441,174.05,39.4668,,174.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,176.4,40,,176.4,percent of total billed charges,Implant Devices,154.35,70,,154.35,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,176.4,
STRYKER 5010-4-200S HALF PIN 6X200X4MM,C1713,HCPCS,,79006027,CDM,278,RC,,,both,,,684,269.95,39.4668,,269.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,239.4,35,,239.4,percent of total billed charges,Implant Device,232.56,34,"Charges > $500, x 34%",232.56,percent of total billed charges,Implant Device,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,273.6,40,,273.6,percent of total billed charges,Implant Devices,239.4,70,,239.4,percent of total billed charges,Implant Devices,232.56,34,,232.56,percent of total billed charges,Implant Devices,232.56,34,,232.56,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.6,
STRYKER 5010-8-200S HALF PIN 6X200X25MM,C1713,HCPCS,,79006028,CDM,278,RC,,,both,,,684,269.95,39.4668,,269.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,239.4,35,,239.4,percent of total billed charges,Implant Device,232.56,34,"Charges > $500, x 34%",232.56,percent of total billed charges,Implant Device,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,273.6,40,,273.6,percent of total billed charges,Implant Devices,239.4,70,,239.4,percent of total billed charges,Implant Devices,232.56,34,,232.56,percent of total billed charges,Implant Devices,232.56,34,,232.56,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.6,
STRYKER 5010-3-200S HALF PIN 6X200X30MM,C1713,HCPCS,,79006029,CDM,278,RC,,,both,,,684,269.95,39.4668,,269.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,239.4,35,,239.4,percent of total billed charges,Implant Device,232.56,34,"Charges > $500, x 34%",232.56,percent of total billed charges,Implant Device,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,273.6,40,,273.6,percent of total billed charges,Implant Devices,239.4,70,,239.4,percent of total billed charges,Implant Devices,232.56,34,,232.56,percent of total billed charges,Implant Devices,232.56,34,,232.56,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.6,
STRYKER ORTHO 4933-1-001 WIRE BOLT SHORT,C1713,HCPCS,,79006031,CDM,278,RC,,,both,,,290,114.45,39.4668,,114.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,101.5,35,,101.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,116,40,,116,percent of total billed charges,Implant Devices,101.5,70,,101.5,percent of total billed charges,Implant Devices,98.6,34,,98.6,percent of total billed charges,Implant Devices,98.6,34,,98.6,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,116,
STRYKER 4933-1-002 WIRE BOLT MEDIUM,C1713,HCPCS,,79006032,CDM,278,RC,,,both,,,405,159.84,39.4668,,159.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,141.75,35,,141.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,162,40,,162,percent of total billed charges,Implant Devices,141.75,70,,141.75,percent of total billed charges,Implant Devices,137.7,34,,137.7,percent of total billed charges,Implant Devices,137.7,34,,137.7,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,162,
STRYKER 4933-1-005 WIRE BOLT ADAPT LONG,C1713,HCPCS,,79006033,CDM,278,RC,,,both,,,1245,491.36,39.4668,,491.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,423.3,34,,423.3,percent of total billed charges,Implant Device,423.3,34,,423.3,percent of total billed charges,Implant Device,423.3,34,,423.3,percent of total billed charges,Implant Device,423.3,34,,423.3,percent of total billed charges,Implant Device,423.3,34,,423.3,percent of total billed charges,Implant Device,423.3,34,,423.3,percent of total billed charges,Implant Device,435.75,35,,435.75,percent of total billed charges,Implant Device,423.3,34,"Charges > $500, x 34%",423.3,percent of total billed charges,Implant Device,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,498,40,,498,percent of total billed charges,Implant Devices,435.75,70,,435.75,percent of total billed charges,Implant Devices,423.3,34,,423.3,percent of total billed charges,Implant Devices,423.3,34,,423.3,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,498,
ARTHREX AR-8840-14 CANC SCREW 4.0X14MM,C1713,HCPCS,,79006043,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ZIMMER 2357-017-06 DIST LAT PLATE 6 HOLE,C1713,HCPCS,,79006047,CDM,278,RC,,,both,,,2160,852.48,39.4668,,852.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,734.4,34,,734.4,percent of total billed charges,Implant Device,756,35,,756,percent of total billed charges,Implant Device,734.4,34,"Charges > $500, x 34%",734.4,percent of total billed charges,Implant Device,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,864,40,,864,percent of total billed charges,Implant Devices,756,70,,756,percent of total billed charges,Implant Devices,734.4,34,,734.4,percent of total billed charges,Implant Devices,734.4,34,,734.4,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,756,35,,756,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,734.4,34,"If Charge > 2,000, then 34 percent",734.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,864,
ZIMMER 2348-012-35 PERIART SCREW 3.5X12,C1713,HCPCS,,79006048,CDM,278,RC,,,both,,,116,45.78,39.4668,,45.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,39.44,34,,39.44,percent of total billed charges,Implant Device,40.6,35,,40.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,46.4,40,,46.4,percent of total billed charges,Implant Devices,40.6,70,,40.6,percent of total billed charges,Implant Devices,39.44,34,,39.44,percent of total billed charges,Implant Devices,39.44,34,,39.44,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,40.6,35,,40.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.4,
ZIMMER 2357-017-08 DIST LAT PLATE 8 HOLE,C1713,HCPCS,,79006049,CDM,278,RC,,,both,,,2333,920.76,39.4668,,920.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,793.22,34,,793.22,percent of total billed charges,Implant Device,793.22,34,,793.22,percent of total billed charges,Implant Device,793.22,34,,793.22,percent of total billed charges,Implant Device,793.22,34,,793.22,percent of total billed charges,Implant Device,793.22,34,,793.22,percent of total billed charges,Implant Device,793.22,34,,793.22,percent of total billed charges,Implant Device,816.55,35,,816.55,percent of total billed charges,Implant Device,793.22,34,"Charges > $500, x 34%",793.22,percent of total billed charges,Implant Device,816.55,35,,816.55,percent of total billed charges,Implant Devices,816.55,35,,816.55,percent of total billed charges,Implant Devices,816.55,35,,,percent of total billed charges,Implant Devices,816.55,35,,816.55,percent of total billed charges,Implant Devices,816.55,35,,816.55,percent of total billed charges,Implant Devices,933.2,40,,933.2,percent of total billed charges,Implant Devices,816.55,70,,816.55,percent of total billed charges,Implant Devices,793.22,34,,793.22,percent of total billed charges,Implant Devices,793.22,34,,793.22,percent of total billed charges,Implant Devices,816.55,35,,816.55,percent of total billed charges,Implant Devices,816.55,35,,816.55,percent of total billed charges,Implant Devices,816.55,35,,816.55,percent of total billed charges,Implant Devices,816.55,35,,816.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,793.22,34,"If Charge > 2,000, then 34 percent",793.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,933.2,
ZIMMER 4828-010-02 LOCK SCREW 2.7X10MM,C1713,HCPCS,,79006050,CDM,278,RC,,,both,,,335,132.21,39.4668,,132.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,134,40,,134,percent of total billed charges,Implant Devices,117.25,70,,117.25,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134,
SOLANA CCP-LPX1L LAPIDUS 1MM LEFT PLATE,C1713,HCPCS,,79006053,CDM,278,RC,,,both,,,8386,3309.69,39.4668,,3309.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2851.24,34,,2851.24,percent of total billed charges,Implant Device,2851.24,34,,2851.24,percent of total billed charges,Implant Device,2851.24,34,,2851.24,percent of total billed charges,Implant Device,2851.24,34,,2851.24,percent of total billed charges,Implant Device,2851.24,34,,2851.24,percent of total billed charges,Implant Device,2851.24,34,,2851.24,percent of total billed charges,Implant Device,2935.1,35,,2935.1,percent of total billed charges,Implant Device,2851.24,34,"Charges > $500, x 34%",2851.24,percent of total billed charges,Implant Device,2935.1,35,,2935.1,percent of total billed charges,Implant Devices,2935.1,35,,2935.1,percent of total billed charges,Implant Devices,2935.1,35,,,percent of total billed charges,Implant Devices,2935.1,35,,2935.1,percent of total billed charges,Implant Devices,2935.1,35,,2935.1,percent of total billed charges,Implant Devices,3354.4,40,,3354.4,percent of total billed charges,Implant Devices,2935.1,70,,2935.1,percent of total billed charges,Implant Devices,2851.24,34,,2851.24,percent of total billed charges,Implant Devices,2851.24,34,,2851.24,percent of total billed charges,Implant Devices,2935.1,35,,2935.1,percent of total billed charges,Implant Devices,2935.1,35,,2935.1,percent of total billed charges,Implant Devices,2935.1,35,,2935.1,percent of total billed charges,Implant Devices,2935.1,35,,2935.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2851.24,34,"If Charge > 2,000, then 34 percent",2851.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3354.4,
SOLANA CCP-X3526 LAG SCREW 3.5X26MM,C1713,HCPCS,,79006054,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
SOLANA CCP-X3020 NON LOCK SCREW 3.5X20MM,C1713,HCPCS,,79006055,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
SOLANA CCP-N3526 NON LOCK SCREW 3.5X26MM,C1713,HCPCS,,79006056,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
STRYKER 59-23016 BONE SCREW 2.3X16MM,C1713,HCPCS,,79006059,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
MTF 410105 MTF TRINITY EVOLUTION 5CC,C1713,HCPCS,,79006062,CDM,278,RC,,,both,,,7555,2981.72,39.4668,,2981.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2568.7,34,,2568.7,percent of total billed charges,Implant Device,2568.7,34,,2568.7,percent of total billed charges,Implant Device,2568.7,34,,2568.7,percent of total billed charges,Implant Device,2568.7,34,,2568.7,percent of total billed charges,Implant Device,2568.7,34,,2568.7,percent of total billed charges,Implant Device,2568.7,34,,2568.7,percent of total billed charges,Implant Device,2644.25,35,,2644.25,percent of total billed charges,Implant Device,2568.7,34,"Charges > $500, x 34%",2568.7,percent of total billed charges,Implant Device,2644.25,35,,2644.25,percent of total billed charges,Implant Devices,2644.25,35,,2644.25,percent of total billed charges,Implant Devices,2644.25,35,,,percent of total billed charges,Implant Devices,2644.25,35,,2644.25,percent of total billed charges,Implant Devices,2644.25,35,,2644.25,percent of total billed charges,Implant Devices,3022,40,,3022,percent of total billed charges,Implant Devices,2644.25,70,,2644.25,percent of total billed charges,Implant Devices,2568.7,34,,2568.7,percent of total billed charges,Implant Devices,2568.7,34,,2568.7,percent of total billed charges,Implant Devices,2644.25,35,,2644.25,percent of total billed charges,Implant Devices,2644.25,35,,2644.25,percent of total billed charges,Implant Devices,2644.25,35,,2644.25,percent of total billed charges,Implant Devices,2644.25,35,,2644.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2568.7,34,"If Charge > 2,000, then 34 percent",2568.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3022,
STRYKER 40-20806 DISTAL FIB PLATE 6 HOLE,C1713,HCPCS,,79006063,CDM,278,RC,,,both,,,1170,461.76,39.4668,,461.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,409.5,35,,409.5,percent of total billed charges,Implant Device,397.8,34,"Charges > $500, x 34%",397.8,percent of total billed charges,Implant Device,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,468,40,,468,percent of total billed charges,Implant Devices,409.5,70,,409.5,percent of total billed charges,Implant Devices,397.8,34,,397.8,percent of total billed charges,Implant Devices,397.8,34,,397.8,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,468,
STRYKER 604670 CANNULATED SCREW 4X70MM,C1713,HCPCS,,79006064,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
MTF 410002 TRINITY ELITE MEDIUM,C1713,HCPCS,,79006069,CDM,278,RC,,,both,,,9108,3594.64,39.4668,,3594.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3096.72,34,,3096.72,percent of total billed charges,Implant Device,3096.72,34,,3096.72,percent of total billed charges,Implant Device,3096.72,34,,3096.72,percent of total billed charges,Implant Device,3096.72,34,,3096.72,percent of total billed charges,Implant Device,3096.72,34,,3096.72,percent of total billed charges,Implant Device,3096.72,34,,3096.72,percent of total billed charges,Implant Device,3187.8,35,,3187.8,percent of total billed charges,Implant Device,3096.72,34,"Charges > $500, x 34%",3096.72,percent of total billed charges,Implant Device,3187.8,35,,3187.8,percent of total billed charges,Implant Devices,3187.8,35,,3187.8,percent of total billed charges,Implant Devices,3187.8,35,,,percent of total billed charges,Implant Devices,3187.8,35,,3187.8,percent of total billed charges,Implant Devices,3187.8,35,,3187.8,percent of total billed charges,Implant Devices,3643.2,40,,3643.2,percent of total billed charges,Implant Devices,3187.8,70,,3187.8,percent of total billed charges,Implant Devices,3096.72,34,,3096.72,percent of total billed charges,Implant Devices,3096.72,34,,3096.72,percent of total billed charges,Implant Devices,3187.8,35,,3187.8,percent of total billed charges,Implant Devices,3187.8,35,,3187.8,percent of total billed charges,Implant Devices,3187.8,35,,3187.8,percent of total billed charges,Implant Devices,3187.8,35,,3187.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3096.72,34,"If Charge > 2,000, then 34 percent",3096.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3643.2,
STRYKER 427109 9 HOLE 5M COMPRSSN PLATE,C1713,HCPCS,,79006076,CDM,278,RC,,,both,,,732,288.9,39.4668,,288.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Device,248.88,34,"Charges > $500, x 34%",248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,292.8,40,,292.8,percent of total billed charges,Implant Devices,256.2,70,,256.2,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,292.8,
STRYKER 340636 CORTICAL SCREW 4.5X36MM,C1713,HCPCS,,79006077,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
STRYKER 340630 CORTICAL SCREW 4.5X30MM,C1713,HCPCS,,79006078,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
STRYKER 340626 CORTICAL SCREW 4.5X26MM,C1713,HCPCS,,79006079,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
STRYKER 340640 CORTICAL SCREW 4.5X40MM,C1713,HCPCS,,79006080,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
STRYKER 340628 CORTICAL SCREW 4.5X28MM,C1713,HCPCS,,79006081,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
STRYKER 371326 LOCKING SCREW 5.0X26MM,C1713,HCPCS,,79006082,CDM,278,RC,,,both,,,576,227.33,39.4668,,227.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Device,195.84,34,"Charges > $500, x 34%",195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,230.4,40,,230.4,percent of total billed charges,Implant Devices,201.6,70,,201.6,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.4,
STRYKER 371328 LOCKING SCREW 5.0X28MM,C1713,HCPCS,,79006083,CDM,278,RC,,,both,,,576,227.33,39.4668,,227.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Device,195.84,34,"Charges > $500, x 34%",195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,230.4,40,,230.4,percent of total billed charges,Implant Devices,201.6,70,,201.6,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.4,
STRYKER 370003 LOCKING WASHER 5.0,C1713,HCPCS,,79006084,CDM,278,RC,,,both,,,268,105.77,39.4668,,105.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,93.8,35,,93.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,107.2,40,,107.2,percent of total billed charges,Implant Devices,93.8,70,,93.8,percent of total billed charges,Implant Devices,91.12,34,,91.12,percent of total billed charges,Implant Devices,91.12,34,,91.12,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.2,
SYNTHES 207.648 CANNULATED SCREW 4X48MM,C1713,HCPCS,,79006087,CDM,278,RC,,,both,,,828,326.79,39.4668,,326.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,281.52,34,,281.52,percent of total billed charges,Implant Device,281.52,34,,281.52,percent of total billed charges,Implant Device,281.52,34,,281.52,percent of total billed charges,Implant Device,281.52,34,,281.52,percent of total billed charges,Implant Device,281.52,34,,281.52,percent of total billed charges,Implant Device,281.52,34,,281.52,percent of total billed charges,Implant Device,289.8,35,,289.8,percent of total billed charges,Implant Device,281.52,34,"Charges > $500, x 34%",281.52,percent of total billed charges,Implant Device,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,331.2,40,,331.2,percent of total billed charges,Implant Devices,289.8,70,,289.8,percent of total billed charges,Implant Devices,281.52,34,,281.52,percent of total billed charges,Implant Devices,281.52,34,,281.52,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,331.2,
ACUMED 70-0290 CLAVICLE PLATE 8 HOLE,C1713,HCPCS,,79006089,CDM,278,RC,,,both,,,3498,1380.55,39.4668,,1380.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1189.32,34,,1189.32,percent of total billed charges,Implant Device,1224.3,35,,1224.3,percent of total billed charges,Implant Device,1189.32,34,"Charges > $500, x 34%",1189.32,percent of total billed charges,Implant Device,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1399.2,40,,1399.2,percent of total billed charges,Implant Devices,1224.3,70,,1224.3,percent of total billed charges,Implant Devices,1189.32,34,,1189.32,percent of total billed charges,Implant Devices,1189.32,34,,1189.32,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,1224.3,35,,1224.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1189.32,34,"If Charge > 2,000, then 34 percent",1189.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1399.2,
ACUMED CO-T2320 LOCKING SCREW 2.3X10MM,C1713,HCPCS,,79006091,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
BIOMET 14196-85 6.5X80MM CANN SCREW,C1713,HCPCS,,79006103,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
BIOMET 14196-90 6.5X90MM CANN SCREW,C1713,HCPCS,,79006104,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
BIOMET 14196-95 6.5X95MM CANN SCREW,C1713,HCPCS,,79006105,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
STRYKER 437532 DIST FEM PLATE RT 12 HOLE,C1713,HCPCS,,79006108,CDM,278,RC,,,both,,,6492,2562.18,39.4668,,2562.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2272.2,35,,2272.2,percent of total billed charges,Implant Device,2207.28,34,"Charges > $500, x 34%",2207.28,percent of total billed charges,Implant Device,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2596.8,40,,2596.8,percent of total billed charges,Implant Devices,2272.2,70,,2272.2,percent of total billed charges,Implant Devices,2207.28,34,,2207.28,percent of total billed charges,Implant Devices,2207.28,34,,2207.28,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2207.28,34,"If Charge > 2,000, then 34 percent",2207.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2596.8,
STRYKER 370112 LOCKING SCREW 5.0X2MM,C1713,HCPCS,,79006109,CDM,278,RC,,,both,,,737,290.87,39.4668,,290.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,250.58,34,,250.58,percent of total billed charges,Implant Device,250.58,34,,250.58,percent of total billed charges,Implant Device,250.58,34,,250.58,percent of total billed charges,Implant Device,250.58,34,,250.58,percent of total billed charges,Implant Device,250.58,34,,250.58,percent of total billed charges,Implant Device,250.58,34,,250.58,percent of total billed charges,Implant Device,257.95,35,,257.95,percent of total billed charges,Implant Device,250.58,34,"Charges > $500, x 34%",250.58,percent of total billed charges,Implant Device,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,294.8,40,,294.8,percent of total billed charges,Implant Devices,257.95,70,,257.95,percent of total billed charges,Implant Devices,250.58,34,,250.58,percent of total billed charges,Implant Devices,250.58,34,,250.58,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294.8,
STRYKER 371338 LOCKING SCREW 5.0X38MM,C1713,HCPCS,,79006110,CDM,278,RC,,,both,,,576,227.33,39.4668,,227.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Device,195.84,34,"Charges > $500, x 34%",195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,230.4,40,,230.4,percent of total billed charges,Implant Devices,201.6,70,,201.6,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.4,
STRYKER 371370 LOCKING SCREW 5.0X70MM,C1713,HCPCS,,79006111,CDM,278,RC,,,both,,,576,227.33,39.4668,,227.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Device,195.84,34,"Charges > $500, x 34%",195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,230.4,40,,230.4,percent of total billed charges,Implant Devices,201.6,70,,201.6,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.4,
STRYKER 340655 CORTICAL SCREW 4.5X55MM,C1713,HCPCS,,79006112,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
STRYKER 340648 CORTICAL SCREW 4.5X48MM,C1713,HCPCS,,79006113,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
BME SE-0910 SPEED IMPLANT 9X10X10MM,C1713,HCPCS,,79006120,CDM,278,RC,,,both,,,3630,1432.64,39.4668,,1432.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1234.2,34,,1234.2,percent of total billed charges,Implant Device,1234.2,34,,1234.2,percent of total billed charges,Implant Device,1234.2,34,,1234.2,percent of total billed charges,Implant Device,1234.2,34,,1234.2,percent of total billed charges,Implant Device,1234.2,34,,1234.2,percent of total billed charges,Implant Device,1234.2,34,,1234.2,percent of total billed charges,Implant Device,1270.5,35,,1270.5,percent of total billed charges,Implant Device,1234.2,34,"Charges > $500, x 34%",1234.2,percent of total billed charges,Implant Device,1270.5,35,,1270.5,percent of total billed charges,Implant Devices,1270.5,35,,1270.5,percent of total billed charges,Implant Devices,1270.5,35,,,percent of total billed charges,Implant Devices,1270.5,35,,1270.5,percent of total billed charges,Implant Devices,1270.5,35,,1270.5,percent of total billed charges,Implant Devices,1452,40,,1452,percent of total billed charges,Implant Devices,1270.5,70,,1270.5,percent of total billed charges,Implant Devices,1234.2,34,,1234.2,percent of total billed charges,Implant Devices,1234.2,34,,1234.2,percent of total billed charges,Implant Devices,1270.5,35,,1270.5,percent of total billed charges,Implant Devices,1270.5,35,,1270.5,percent of total billed charges,Implant Devices,1270.5,35,,1270.5,percent of total billed charges,Implant Devices,1270.5,35,,1270.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1234.2,34,"If Charge > 2,000, then 34 percent",1234.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1452,
PARAGON28 P20-055-WF00 FLAT WASHER 5.5MM,C1713,HCPCS,,79006122,CDM,278,RC,,,both,,,542,213.91,39.4668,,213.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,184.28,34,,184.28,percent of total billed charges,Implant Device,184.28,34,,184.28,percent of total billed charges,Implant Device,184.28,34,,184.28,percent of total billed charges,Implant Device,184.28,34,,184.28,percent of total billed charges,Implant Device,184.28,34,,184.28,percent of total billed charges,Implant Device,184.28,34,,184.28,percent of total billed charges,Implant Device,189.7,35,,189.7,percent of total billed charges,Implant Device,184.28,34,"Charges > $500, x 34%",184.28,percent of total billed charges,Implant Device,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,216.8,40,,216.8,percent of total billed charges,Implant Devices,189.7,70,,189.7,percent of total billed charges,Implant Devices,184.28,34,,184.28,percent of total billed charges,Implant Devices,184.28,34,,184.28,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.8,
PARAGON28 P20-155-056S CANN SCREW 5.5X56,C1713,HCPCS,,79006123,CDM,278,RC,,,both,,,1324,522.54,39.4668,,522.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,450.16,34,,450.16,percent of total billed charges,Implant Device,450.16,34,,450.16,percent of total billed charges,Implant Device,450.16,34,,450.16,percent of total billed charges,Implant Device,450.16,34,,450.16,percent of total billed charges,Implant Device,450.16,34,,450.16,percent of total billed charges,Implant Device,450.16,34,,450.16,percent of total billed charges,Implant Device,463.4,35,,463.4,percent of total billed charges,Implant Device,450.16,34,"Charges > $500, x 34%",450.16,percent of total billed charges,Implant Device,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,529.6,40,,529.6,percent of total billed charges,Implant Devices,463.4,70,,463.4,percent of total billed charges,Implant Devices,450.16,34,,450.16,percent of total billed charges,Implant Devices,450.16,34,,450.16,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,529.6,
PARAGON28 P20-155-060S CANN SCREW 5.5X60,C1713,HCPCS,,79006124,CDM,278,RC,,,both,,,1236,487.81,39.4668,,487.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,420.24,34,,420.24,percent of total billed charges,Implant Device,420.24,34,,420.24,percent of total billed charges,Implant Device,420.24,34,,420.24,percent of total billed charges,Implant Device,420.24,34,,420.24,percent of total billed charges,Implant Device,420.24,34,,420.24,percent of total billed charges,Implant Device,420.24,34,,420.24,percent of total billed charges,Implant Device,432.6,35,,432.6,percent of total billed charges,Implant Device,420.24,34,"Charges > $500, x 34%",420.24,percent of total billed charges,Implant Device,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,494.4,40,,494.4,percent of total billed charges,Implant Devices,432.6,70,,432.6,percent of total billed charges,Implant Devices,420.24,34,,420.24,percent of total billed charges,Implant Devices,420.24,34,,420.24,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,494.4,
PARAGON28 P20-170-090M CANN SCREW 7X90,C1713,HCPCS,,79006125,CDM,278,RC,,,both,,,1860,734.08,39.4668,,734.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,632.4,34,,632.4,percent of total billed charges,Implant Device,632.4,34,,632.4,percent of total billed charges,Implant Device,632.4,34,,632.4,percent of total billed charges,Implant Device,632.4,34,,632.4,percent of total billed charges,Implant Device,632.4,34,,632.4,percent of total billed charges,Implant Device,632.4,34,,632.4,percent of total billed charges,Implant Device,651,35,,651,percent of total billed charges,Implant Device,632.4,34,"Charges > $500, x 34%",632.4,percent of total billed charges,Implant Device,651,35,,651,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,651,35,,,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,744,40,,744,percent of total billed charges,Implant Devices,651,70,,651,percent of total billed charges,Implant Devices,632.4,34,,632.4,percent of total billed charges,Implant Devices,632.4,34,,632.4,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,744,
BME SE-2020 SPEED IMPLANT 20X20X20MM,C1713,HCPCS,,79006131,CDM,278,RC,,,both,,,5016,1979.65,39.4668,,1979.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1705.44,34,,1705.44,percent of total billed charges,Implant Device,1705.44,34,,1705.44,percent of total billed charges,Implant Device,1705.44,34,,1705.44,percent of total billed charges,Implant Device,1705.44,34,,1705.44,percent of total billed charges,Implant Device,1705.44,34,,1705.44,percent of total billed charges,Implant Device,1705.44,34,,1705.44,percent of total billed charges,Implant Device,1755.6,35,,1755.6,percent of total billed charges,Implant Device,1705.44,34,"Charges > $500, x 34%",1705.44,percent of total billed charges,Implant Device,1755.6,35,,1755.6,percent of total billed charges,Implant Devices,1755.6,35,,1755.6,percent of total billed charges,Implant Devices,1755.6,35,,,percent of total billed charges,Implant Devices,1755.6,35,,1755.6,percent of total billed charges,Implant Devices,1755.6,35,,1755.6,percent of total billed charges,Implant Devices,2006.4,40,,2006.4,percent of total billed charges,Implant Devices,1755.6,70,,1755.6,percent of total billed charges,Implant Devices,1705.44,34,,1705.44,percent of total billed charges,Implant Devices,1705.44,34,,1705.44,percent of total billed charges,Implant Devices,1755.6,35,,1755.6,percent of total billed charges,Implant Devices,1755.6,35,,1755.6,percent of total billed charges,Implant Devices,1755.6,35,,1755.6,percent of total billed charges,Implant Devices,1755.6,35,,1755.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1705.44,34,"If Charge > 2,000, then 34 percent",1705.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2006.4,
BME SE-1818 SPEED IMPLANT 18X18X18MM,C1713,HCPCS,,79006132,CDM,278,RC,,,both,,,3960,1562.89,39.4668,,1562.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1346.4,34,,1346.4,percent of total billed charges,Implant Device,1346.4,34,,1346.4,percent of total billed charges,Implant Device,1346.4,34,,1346.4,percent of total billed charges,Implant Device,1346.4,34,,1346.4,percent of total billed charges,Implant Device,1346.4,34,,1346.4,percent of total billed charges,Implant Device,1346.4,34,,1346.4,percent of total billed charges,Implant Device,1386,35,,1386,percent of total billed charges,Implant Device,1346.4,34,"Charges > $500, x 34%",1346.4,percent of total billed charges,Implant Device,1386,35,,1386,percent of total billed charges,Implant Devices,1386,35,,1386,percent of total billed charges,Implant Devices,1386,35,,,percent of total billed charges,Implant Devices,1386,35,,1386,percent of total billed charges,Implant Devices,1386,35,,1386,percent of total billed charges,Implant Devices,1584,40,,1584,percent of total billed charges,Implant Devices,1386,70,,1386,percent of total billed charges,Implant Devices,1346.4,34,,1346.4,percent of total billed charges,Implant Devices,1346.4,34,,1346.4,percent of total billed charges,Implant Devices,1386,35,,1386,percent of total billed charges,Implant Devices,1386,35,,1386,percent of total billed charges,Implant Devices,1386,35,,1386,percent of total billed charges,Implant Devices,1386,35,,1386,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1346.4,34,"If Charge > 2,000, then 34 percent",1346.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1584,
ARTHREX AR-8740-42PTS SCREW 4X42MM,C1713,HCPCS,,79006133,CDM,278,RC,,,both,,,496,195.76,39.4668,,195.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,198.4,40,,198.4,percent of total billed charges,Implant Devices,173.6,70,,173.6,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.4,
SYNTHES 201.766 CORTEX SCREW 2.4X16MM,C1713,HCPCS,,79006134,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
METASURG DF-2010S DIGIFUSE SCREW 2.0,C1713,HCPCS,,79006136,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
STRYKER 1830-0722S HUMERAL NAIL 7X220MM,C1713,HCPCS,,79006138,CDM,278,RC,,,both,,,5868,2315.91,39.4668,,2315.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1995.12,34,,1995.12,percent of total billed charges,Implant Device,1995.12,34,,1995.12,percent of total billed charges,Implant Device,1995.12,34,,1995.12,percent of total billed charges,Implant Device,1995.12,34,,1995.12,percent of total billed charges,Implant Device,1995.12,34,,1995.12,percent of total billed charges,Implant Device,1995.12,34,,1995.12,percent of total billed charges,Implant Device,2053.8,35,,2053.8,percent of total billed charges,Implant Device,1995.12,34,"Charges > $500, x 34%",1995.12,percent of total billed charges,Implant Device,2053.8,35,,2053.8,percent of total billed charges,Implant Devices,2053.8,35,,2053.8,percent of total billed charges,Implant Devices,2053.8,35,,,percent of total billed charges,Implant Devices,2053.8,35,,2053.8,percent of total billed charges,Implant Devices,2053.8,35,,2053.8,percent of total billed charges,Implant Devices,2347.2,40,,2347.2,percent of total billed charges,Implant Devices,2053.8,70,,2053.8,percent of total billed charges,Implant Devices,1995.12,34,,1995.12,percent of total billed charges,Implant Devices,1995.12,34,,1995.12,percent of total billed charges,Implant Devices,2053.8,35,,2053.8,percent of total billed charges,Implant Devices,2053.8,35,,2053.8,percent of total billed charges,Implant Devices,2053.8,35,,2053.8,percent of total billed charges,Implant Devices,2053.8,35,,2053.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1995.12,34,"If Charge > 2,000, then 34 percent",1995.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2347.2,
STRYKER 1896-4032S LOCKING SCREW 4X32MM,C1713,HCPCS,,79006139,CDM,278,RC,,,both,,,447,176.42,39.4668,,176.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,151.98,34,,151.98,percent of total billed charges,Implant Device,156.45,35,,156.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,178.8,40,,178.8,percent of total billed charges,Implant Devices,156.45,70,,156.45,percent of total billed charges,Implant Devices,151.98,34,,151.98,percent of total billed charges,Implant Devices,151.98,34,,151.98,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,156.45,35,,156.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.8,
SOLANA CCP-MPX1R CROSSCHECK PLATE RT SZ1,C1713,HCPCS,,79006145,CDM,278,RC,,,both,,,7246,2859.76,39.4668,,2859.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2463.64,34,,2463.64,percent of total billed charges,Implant Device,2463.64,34,,2463.64,percent of total billed charges,Implant Device,2463.64,34,,2463.64,percent of total billed charges,Implant Device,2463.64,34,,2463.64,percent of total billed charges,Implant Device,2463.64,34,,2463.64,percent of total billed charges,Implant Device,2463.64,34,,2463.64,percent of total billed charges,Implant Device,2536.1,35,,2536.1,percent of total billed charges,Implant Device,2463.64,34,"Charges > $500, x 34%",2463.64,percent of total billed charges,Implant Device,2536.1,35,,2536.1,percent of total billed charges,Implant Devices,2536.1,35,,2536.1,percent of total billed charges,Implant Devices,2536.1,35,,,percent of total billed charges,Implant Devices,2536.1,35,,2536.1,percent of total billed charges,Implant Devices,2536.1,35,,2536.1,percent of total billed charges,Implant Devices,2898.4,40,,2898.4,percent of total billed charges,Implant Devices,2536.1,70,,2536.1,percent of total billed charges,Implant Devices,2463.64,34,,2463.64,percent of total billed charges,Implant Devices,2463.64,34,,2463.64,percent of total billed charges,Implant Devices,2536.1,35,,2536.1,percent of total billed charges,Implant Devices,2536.1,35,,2536.1,percent of total billed charges,Implant Devices,2536.1,35,,2536.1,percent of total billed charges,Implant Devices,2536.1,35,,2536.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2463.64,34,"If Charge > 2,000, then 34 percent",2463.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2898.4,
SOLANA CCP-L3514 LOCKING SCREW 3.5X14MM,C1713,HCPCS,,79006146,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
SOLANA CCP-N3016 NONLOCK SCREW 3X16MM,C1713,HCPCS,,79006149,CDM,278,RC,,,both,,,1126,444.4,39.4668,,444.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Device,382.84,34,"Charges > $500, x 34%",382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,450.4,40,,450.4,percent of total billed charges,Implant Devices,394.1,70,,394.1,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450.4,
ARTHREX AR-8967-1875 CANN SCREW 6.7X75MM,C1713,HCPCS,,79006150,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
INTEGRA 050108 SUBTALAR MBA IMPLANT 8MM,C1713,HCPCS,,79006151,CDM,278,RC,,,both,,,3749,1479.61,39.4668,,1479.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1274.66,34,,1274.66,percent of total billed charges,Implant Device,1274.66,34,,1274.66,percent of total billed charges,Implant Device,1274.66,34,,1274.66,percent of total billed charges,Implant Device,1274.66,34,,1274.66,percent of total billed charges,Implant Device,1274.66,34,,1274.66,percent of total billed charges,Implant Device,1274.66,34,,1274.66,percent of total billed charges,Implant Device,1312.15,35,,1312.15,percent of total billed charges,Implant Device,1274.66,34,"Charges > $500, x 34%",1274.66,percent of total billed charges,Implant Device,1312.15,35,,1312.15,percent of total billed charges,Implant Devices,1312.15,35,,1312.15,percent of total billed charges,Implant Devices,1312.15,35,,,percent of total billed charges,Implant Devices,1312.15,35,,1312.15,percent of total billed charges,Implant Devices,1312.15,35,,1312.15,percent of total billed charges,Implant Devices,1499.6,40,,1499.6,percent of total billed charges,Implant Devices,1312.15,70,,1312.15,percent of total billed charges,Implant Devices,1274.66,34,,1274.66,percent of total billed charges,Implant Devices,1274.66,34,,1274.66,percent of total billed charges,Implant Devices,1312.15,35,,1312.15,percent of total billed charges,Implant Devices,1312.15,35,,1312.15,percent of total billed charges,Implant Devices,1312.15,35,,1312.15,percent of total billed charges,Implant Devices,1312.15,35,,1312.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1274.66,34,"If Charge > 2,000, then 34 percent",1274.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1499.6,
SYNTHES 201.366.97 CORTEX SCREW 2.0X16MM,C1713,HCPCS,,79006155,CDM,278,RC,,,both,,,93,36.7,39.4668,,36.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,32.55,35,,32.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,37.2,40,,37.2,percent of total billed charges,Implant Devices,32.55,70,,32.55,percent of total billed charges,Implant Devices,31.62,34,,31.62,percent of total billed charges,Implant Devices,31.62,34,,31.62,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,37.2,
SYNTHES 201.764 CORTEX SCREW 2.4X14MM,C1713,HCPCS,,79006158,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
ARTRHEX AR-1390TC INTERFRNCE SCREW 9X28,C1713,HCPCS,,79006159,CDM,278,RC,,,both,,,1008,397.83,39.4668,,397.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,352.8,35,,352.8,percent of total billed charges,Implant Device,342.72,34,"Charges > $500, x 34%",342.72,percent of total billed charges,Implant Device,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,403.2,40,,403.2,percent of total billed charges,Implant Devices,352.8,70,,352.8,percent of total billed charges,Implant Devices,342.72,34,,342.72,percent of total billed charges,Implant Devices,342.72,34,,342.72,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,403.2,
SOLANA CCP-X3522 LAG SCREW 3.5X22M,C1713,HCPCS,,79006161,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
SOLANA CCP-L3516 LOCKING SCREW 3.5X16MM,C1713,HCPCS,,79006162,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
ARTHREX AR-8840CL-44 CANN SCREW 4X44MM,C1713,HCPCS,,79006165,CDM,278,RC,,,both,,,708,279.42,39.4668,,279.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Device,240.72,34,"Charges > $500, x 34%",240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,283.2,40,,283.2,percent of total billed charges,Implant Devices,247.8,70,,247.8,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,283.2,
SOLANA CCP-X3524 LAG SCREW 3.5X24MM,C1713,HCPCS,,79006169,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
STRYKER 59-17013 BONE SCREW 1.7X13MM,C1713,HCPCS,,79006170,CDM,278,RC,,,both,,,331,130.64,39.4668,,130.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,112.54,34,,112.54,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,132.4,40,,132.4,percent of total billed charges,Implant Devices,115.85,70,,115.85,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,112.54,34,,112.54,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,115.85,35,,115.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.4,
SOLANA TFF-2015A TENFUSE ALLOGRAFT 2X15,C1713,HCPCS,,79006173,CDM,278,RC,,,both,,,3497,1380.15,39.4668,,1380.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1188.98,34,,1188.98,percent of total billed charges,Implant Device,1188.98,34,,1188.98,percent of total billed charges,Implant Device,1188.98,34,,1188.98,percent of total billed charges,Implant Device,1188.98,34,,1188.98,percent of total billed charges,Implant Device,1188.98,34,,1188.98,percent of total billed charges,Implant Device,1188.98,34,,1188.98,percent of total billed charges,Implant Device,1223.95,35,,1223.95,percent of total billed charges,Implant Device,1188.98,34,"Charges > $500, x 34%",1188.98,percent of total billed charges,Implant Device,1223.95,35,,1223.95,percent of total billed charges,Implant Devices,1223.95,35,,1223.95,percent of total billed charges,Implant Devices,1223.95,35,,,percent of total billed charges,Implant Devices,1223.95,35,,1223.95,percent of total billed charges,Implant Devices,1223.95,35,,1223.95,percent of total billed charges,Implant Devices,1398.8,40,,1398.8,percent of total billed charges,Implant Devices,1223.95,70,,1223.95,percent of total billed charges,Implant Devices,1188.98,34,,1188.98,percent of total billed charges,Implant Devices,1188.98,34,,1188.98,percent of total billed charges,Implant Devices,1223.95,35,,1223.95,percent of total billed charges,Implant Devices,1223.95,35,,1223.95,percent of total billed charges,Implant Devices,1223.95,35,,1223.95,percent of total billed charges,Implant Devices,1223.95,35,,1223.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1188.98,34,"If Charge > 2,000, then 34 percent",1188.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1398.8,
MTF 410001 TRINITY ELITE 1CC,C1713,HCPCS,,79006176,CDM,278,RC,,,both,,,2081,821.3,39.4668,,821.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,707.54,34,,707.54,percent of total billed charges,Implant Device,707.54,34,,707.54,percent of total billed charges,Implant Device,707.54,34,,707.54,percent of total billed charges,Implant Device,707.54,34,,707.54,percent of total billed charges,Implant Device,707.54,34,,707.54,percent of total billed charges,Implant Device,707.54,34,,707.54,percent of total billed charges,Implant Device,728.35,35,,728.35,percent of total billed charges,Implant Device,707.54,34,"Charges > $500, x 34%",707.54,percent of total billed charges,Implant Device,728.35,35,,728.35,percent of total billed charges,Implant Devices,728.35,35,,728.35,percent of total billed charges,Implant Devices,728.35,35,,,percent of total billed charges,Implant Devices,728.35,35,,728.35,percent of total billed charges,Implant Devices,728.35,35,,728.35,percent of total billed charges,Implant Devices,832.4,40,,832.4,percent of total billed charges,Implant Devices,728.35,70,,728.35,percent of total billed charges,Implant Devices,707.54,34,,707.54,percent of total billed charges,Implant Devices,707.54,34,,707.54,percent of total billed charges,Implant Devices,728.35,35,,728.35,percent of total billed charges,Implant Devices,728.35,35,,728.35,percent of total billed charges,Implant Devices,728.35,35,,728.35,percent of total billed charges,Implant Devices,728.35,35,,728.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,707.54,34,"If Charge > 2,000, then 34 percent",707.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,832.4,
BIOMET/EBI 29241 LAG SCREW ASSY 110MM,C1713,HCPCS,,79006210,CDM,278,RC,,,both,,,3330,1314.24,39.4668,,1314.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Device,1132.2,34,"Charges > $500, x 34%",1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1332,40,,1332,percent of total billed charges,Implant Devices,1165.5,70,,1165.5,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1132.2,34,"If Charge > 2,000, then 34 percent",1132.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1332,
ACUMED AT2-S34-S STD BONE SCREW 34MM,C1713,HCPCS,,79006212,CDM,278,RC,,,both,,,1584,625.15,39.4668,,625.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Device,538.56,34,"Charges > $500, x 34%",538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,633.6,40,,633.6,percent of total billed charges,Implant Devices,554.4,70,,554.4,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,633.6,
BIOMET/EBI 29240 LAG SCREW ASSY 105MM,C1713,HCPCS,,79006213,CDM,278,RC,,,both,,,3330,1314.24,39.4668,,1314.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Device,1132.2,34,"Charges > $500, x 34%",1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1332,40,,1332,percent of total billed charges,Implant Devices,1165.5,70,,1165.5,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1132.2,34,"If Charge > 2,000, then 34 percent",1132.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1332,
ZIMMER 2348-12-35 PERI SCREW 3.5X12MM,C1713,HCPCS,,79006214,CDM,278,RC,,,both,,,113,44.6,39.4668,,44.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,45.2,40,,45.2,percent of total billed charges,Implant Devices,39.55,70,,39.55,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.2,
ZIMMER 2348-14-35 PERI SCREW 3.5X14MM,C1713,HCPCS,,79006215,CDM,278,RC,,,both,,,113,44.6,39.4668,,44.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,45.2,40,,45.2,percent of total billed charges,Implant Devices,39.55,70,,39.55,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.2,
ZIMMER 2348-16-35 PERI SCREW 3.5X16MM,C1713,HCPCS,,79006216,CDM,278,RC,,,both,,,113,44.6,39.4668,,44.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,45.2,40,,45.2,percent of total billed charges,Implant Devices,39.55,70,,39.55,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.2,
ZIMMER 2357-17-04 LAT LOCK PLATE 4H 80MM,C1713,HCPCS,,79006217,CDM,278,RC,,,both,,,2020,797.23,39.4668,,797.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,686.8,34,,686.8,percent of total billed charges,Implant Device,686.8,34,,686.8,percent of total billed charges,Implant Device,686.8,34,,686.8,percent of total billed charges,Implant Device,686.8,34,,686.8,percent of total billed charges,Implant Device,686.8,34,,686.8,percent of total billed charges,Implant Device,686.8,34,,686.8,percent of total billed charges,Implant Device,707,35,,707,percent of total billed charges,Implant Device,686.8,34,"Charges > $500, x 34%",686.8,percent of total billed charges,Implant Device,707,35,,707,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,707,35,,,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,808,40,,808,percent of total billed charges,Implant Devices,707,70,,707,percent of total billed charges,Implant Devices,686.8,34,,686.8,percent of total billed charges,Implant Devices,686.8,34,,686.8,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,707,35,,707,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,686.8,34,"If Charge > 2,000, then 34 percent",686.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,808,
ZIMMER 2359-12-38 LOCK SCREW 3.5X12MM,C1713,HCPCS,,79006218,CDM,278,RC,,,both,,,313,123.53,39.4668,,123.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,106.42,34,,106.42,percent of total billed charges,Implant Device,109.55,35,,109.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,125.2,40,,125.2,percent of total billed charges,Implant Devices,109.55,70,,109.55,percent of total billed charges,Implant Devices,106.42,34,,106.42,percent of total billed charges,Implant Devices,106.42,34,,106.42,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,109.55,35,,109.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,125.2,
ZIMMER 2360-153-35 3.5MM LOCKING SCREW,C1713,HCPCS,,79006219,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
ZIMMER 4828-12-02 LOCK SCREW 2.7X12MM,C1713,HCPCS,,79006222,CDM,278,RC,,,both,,,335,132.21,39.4668,,132.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,134,40,,134,percent of total billed charges,Implant Devices,117.25,70,,117.25,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134,
ZIMMER 4828-16-02 LOCK SCREW 2.7X16MM,C1713,HCPCS,,79006223,CDM,278,RC,,,both,,,335,132.21,39.4668,,132.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,113.9,34,,113.9,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,134,40,,134,percent of total billed charges,Implant Devices,117.25,70,,117.25,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,113.9,34,,113.9,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,117.25,35,,117.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134,
ACUMED 70-0356 LEFT STD VDR PLATE,C1713,HCPCS,,79006226,CDM,278,RC,,,both,,,3801,1500.13,39.4668,,1500.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1330.35,35,,1330.35,percent of total billed charges,Implant Device,1292.34,34,"Charges > $500, x 34%",1292.34,percent of total billed charges,Implant Device,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1520.4,40,,1520.4,percent of total billed charges,Implant Devices,1330.35,70,,1330.35,percent of total billed charges,Implant Devices,1292.34,34,,1292.34,percent of total billed charges,Implant Devices,1292.34,34,,1292.34,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1292.34,34,"If Charge > 2,000, then 34 percent",1292.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1520.4,
ACUMED CO-T2318 LOCKING SCREW 2.3X18MM,C1713,HCPCS,,79006227,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ACUMED CO-T2316 LOCKING SCREW 2.3X16MM,C1713,HCPCS,,79006228,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ACUMED CO-T2314 LOCKING SCREW 2.3X14MM,C1713,HCPCS,,79006229,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ACUMED 70-0300 CLAVICLE PLATE 8 HOLE,C1713,HCPCS,,79006233,CDM,278,RC,,,both,,,6567,2591.78,39.4668,,2591.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2232.78,34,,2232.78,percent of total billed charges,Implant Device,2232.78,34,,2232.78,percent of total billed charges,Implant Device,2232.78,34,,2232.78,percent of total billed charges,Implant Device,2232.78,34,,2232.78,percent of total billed charges,Implant Device,2232.78,34,,2232.78,percent of total billed charges,Implant Device,2232.78,34,,2232.78,percent of total billed charges,Implant Device,2298.45,35,,2298.45,percent of total billed charges,Implant Device,2232.78,34,"Charges > $500, x 34%",2232.78,percent of total billed charges,Implant Device,2298.45,35,,2298.45,percent of total billed charges,Implant Devices,2298.45,35,,2298.45,percent of total billed charges,Implant Devices,2298.45,35,,,percent of total billed charges,Implant Devices,2298.45,35,,2298.45,percent of total billed charges,Implant Devices,2298.45,35,,2298.45,percent of total billed charges,Implant Devices,2626.8,40,,2626.8,percent of total billed charges,Implant Devices,2298.45,70,,2298.45,percent of total billed charges,Implant Devices,2232.78,34,,2232.78,percent of total billed charges,Implant Devices,2232.78,34,,2232.78,percent of total billed charges,Implant Devices,2298.45,35,,2298.45,percent of total billed charges,Implant Devices,2298.45,35,,2298.45,percent of total billed charges,Implant Devices,2298.45,35,,2298.45,percent of total billed charges,Implant Devices,2298.45,35,,2298.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2232.78,34,"If Charge > 2,000, then 34 percent",2232.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2626.8,
STRYKER 3060-0105S LAG SCREW 10.5X105MM,C1713,HCPCS,,79006270,CDM,278,RC,,,both,,,1230,485.44,39.4668,,485.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,418.2,34,,418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Device,418.2,34,"Charges > $500, x 34%",418.2,percent of total billed charges,Implant Device,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,492,40,,492,percent of total billed charges,Implant Devices,430.5,70,,430.5,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,418.2,34,,418.2,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,430.5,35,,430.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,492,
STRYKER 40-35055 NON LOCK SCREW 3.5X55MM,C1713,HCPCS,,79006290,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
STRYKER 53-27616E LOCKING SCREW 2.7X16MM,C1713,HCPCS,,79006293,CDM,278,RC,,,both,,,253,99.85,39.4668,,99.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.02,34,,86.02,percent of total billed charges,Implant Device,86.02,34,,86.02,percent of total billed charges,Implant Device,86.02,34,,86.02,percent of total billed charges,Implant Device,86.02,34,,86.02,percent of total billed charges,Implant Device,86.02,34,,86.02,percent of total billed charges,Implant Device,86.02,34,,86.02,percent of total billed charges,Implant Device,88.55,35,,88.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,101.2,40,,101.2,percent of total billed charges,Implant Devices,88.55,70,,88.55,percent of total billed charges,Implant Devices,86.02,34,,86.02,percent of total billed charges,Implant Devices,86.02,34,,86.02,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,88.55,35,,88.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,101.2,
BIOMET 41-2205 SCREW 2.0X5MM,C1713,HCPCS,,79006294,CDM,278,RC,,,both,,,328,129.45,39.4668,,129.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,111.52,34,,111.52,percent of total billed charges,Implant Device,114.8,35,,114.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,131.2,40,,131.2,percent of total billed charges,Implant Devices,114.8,70,,114.8,percent of total billed charges,Implant Devices,111.52,34,,111.52,percent of total billed charges,Implant Devices,111.52,34,,111.52,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,114.8,35,,114.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,131.2,
BIOMET 41-2106 SCREW 2.0X6MM,C1713,HCPCS,,79006296,CDM,278,RC,,,both,,,468,184.7,39.4668,,184.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,187.2,40,,187.2,percent of total billed charges,Implant Devices,163.8,70,,163.8,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.2,
NOVABONE NB0602 NOVABONE PUTTY 2.5CC,C1713,HCPCS,,79006298,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
"LIFESPINE  20-1613-708 PROLINK 8MM 7""",C1713,HCPCS,,79006299,CDM,278,RC,,,both,,,17940,7080.34,39.4668,,7080.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6099.6,34,,6099.6,percent of total billed charges,Implant Device,6099.6,34,,6099.6,percent of total billed charges,Implant Device,6099.6,34,,6099.6,percent of total billed charges,Implant Device,6099.6,34,,6099.6,percent of total billed charges,Implant Device,6099.6,34,,6099.6,percent of total billed charges,Implant Device,6099.6,34,,6099.6,percent of total billed charges,Implant Device,6279,35,,6279,percent of total billed charges,Implant Device,6099.6,34,"Charges > $500, x 34%",6099.6,percent of total billed charges,Implant Device,6279,35,,6279,percent of total billed charges,Implant Devices,6279,35,,6279,percent of total billed charges,Implant Devices,6279,35,,,percent of total billed charges,Implant Devices,6279,35,,6279,percent of total billed charges,Implant Devices,6279,35,,6279,percent of total billed charges,Implant Devices,7176,40,,7176,percent of total billed charges,Implant Devices,6279,70,,6279,percent of total billed charges,Implant Devices,6099.6,34,,6099.6,percent of total billed charges,Implant Devices,6099.6,34,,6099.6,percent of total billed charges,Implant Devices,6279,35,,6279,percent of total billed charges,Implant Devices,6279,35,,6279,percent of total billed charges,Implant Devices,6279,35,,6279,percent of total billed charges,Implant Devices,6279,35,,6279,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6099.6,34,"If Charge > 2,000, then 34 percent",6099.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7176,
LIFESPINE  129-010 ANGLE SCREW 3X10MM,C1713,HCPCS,,79006300,CDM,278,RC,,,both,,,1980,781.44,39.4668,,781.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,693,35,,693,percent of total billed charges,Implant Device,673.2,34,"Charges > $500, x 34%",673.2,percent of total billed charges,Implant Device,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,792,40,,792,percent of total billed charges,Implant Devices,693,70,,693,percent of total billed charges,Implant Devices,673.2,34,,673.2,percent of total billed charges,Implant Devices,673.2,34,,673.2,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,792,
LIFESPINE  129-012 ANGLE SCREW 3X10MM,C1713,HCPCS,,79006301,CDM,278,RC,,,both,,,1980,781.44,39.4668,,781.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,693,35,,693,percent of total billed charges,Implant Device,673.2,34,"Charges > $500, x 34%",673.2,percent of total billed charges,Implant Device,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,792,40,,792,percent of total billed charges,Implant Devices,693,70,,693,percent of total billed charges,Implant Devices,673.2,34,,673.2,percent of total billed charges,Implant Devices,673.2,34,,673.2,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,792,
LIFESPINE  129-002 LOCK PLATE,C1713,HCPCS,,79006302,CDM,278,RC,,,both,,,1992,786.18,39.4668,,786.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,677.28,34,,677.28,percent of total billed charges,Implant Device,677.28,34,,677.28,percent of total billed charges,Implant Device,677.28,34,,677.28,percent of total billed charges,Implant Device,677.28,34,,677.28,percent of total billed charges,Implant Device,677.28,34,,677.28,percent of total billed charges,Implant Device,677.28,34,,677.28,percent of total billed charges,Implant Device,697.2,35,,697.2,percent of total billed charges,Implant Device,677.28,34,"Charges > $500, x 34%",677.28,percent of total billed charges,Implant Device,697.2,35,,697.2,percent of total billed charges,Implant Devices,697.2,35,,697.2,percent of total billed charges,Implant Devices,697.2,35,,,percent of total billed charges,Implant Devices,697.2,35,,697.2,percent of total billed charges,Implant Devices,697.2,35,,697.2,percent of total billed charges,Implant Devices,796.8,40,,796.8,percent of total billed charges,Implant Devices,697.2,70,,697.2,percent of total billed charges,Implant Devices,677.28,34,,677.28,percent of total billed charges,Implant Devices,677.28,34,,677.28,percent of total billed charges,Implant Devices,697.2,35,,697.2,percent of total billed charges,Implant Devices,697.2,35,,697.2,percent of total billed charges,Implant Devices,697.2,35,,697.2,percent of total billed charges,Implant Devices,697.2,35,,697.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,796.8,
BIOMET 115380 6.5MM CENTRAL SCREW 20MM,C1713,HCPCS,,79006305,CDM,278,RC,,,both,,,780,307.84,39.4668,,307.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Device,265.2,34,"Charges > $500, x 34%",265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,312,40,,312,percent of total billed charges,Implant Devices,273,70,,273,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,312,
BIOMET 180550 LOCK SCREW 3.5HEX 4.76X15,C1713,HCPCS,,79006306,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
BIOMET 180552 LOCK SCREW 3.5HEX 4.75X25,C1713,HCPCS,,79006308,CDM,278,RC,,,both,,,211,83.27,39.4668,,83.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,73.85,35,,73.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,84.4,40,,84.4,percent of total billed charges,Implant Devices,73.85,70,,73.85,percent of total billed charges,Implant Devices,71.74,34,,71.74,percent of total billed charges,Implant Devices,71.74,34,,71.74,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84.4,
BIOMET 180551 LOCK SCREW 3.5HEX 4.75X20,C1713,HCPCS,,79006310,CDM,278,RC,,,both,,,211,83.27,39.4668,,83.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,73.85,35,,73.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,84.4,40,,84.4,percent of total billed charges,Implant Devices,73.85,70,,73.85,percent of total billed charges,Implant Devices,71.74,34,,71.74,percent of total billed charges,Implant Devices,71.74,34,,71.74,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84.4,
ACUMED 70-0302 OLECRANON PLATE 3 HOLE LT,C1713,HCPCS,,79006311,CDM,278,RC,,,both,,,4575,1805.61,39.4668,,1805.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1555.5,34,,1555.5,percent of total billed charges,Implant Device,1555.5,34,,1555.5,percent of total billed charges,Implant Device,1555.5,34,,1555.5,percent of total billed charges,Implant Device,1555.5,34,,1555.5,percent of total billed charges,Implant Device,1555.5,34,,1555.5,percent of total billed charges,Implant Device,1555.5,34,,1555.5,percent of total billed charges,Implant Device,1601.25,35,,1601.25,percent of total billed charges,Implant Device,1555.5,34,"Charges > $500, x 34%",1555.5,percent of total billed charges,Implant Device,1601.25,35,,1601.25,percent of total billed charges,Implant Devices,1601.25,35,,1601.25,percent of total billed charges,Implant Devices,1601.25,35,,,percent of total billed charges,Implant Devices,1601.25,35,,1601.25,percent of total billed charges,Implant Devices,1601.25,35,,1601.25,percent of total billed charges,Implant Devices,1830,40,,1830,percent of total billed charges,Implant Devices,1601.25,70,,1601.25,percent of total billed charges,Implant Devices,1555.5,34,,1555.5,percent of total billed charges,Implant Devices,1555.5,34,,1555.5,percent of total billed charges,Implant Devices,1601.25,35,,1601.25,percent of total billed charges,Implant Devices,1601.25,35,,1601.25,percent of total billed charges,Implant Devices,1601.25,35,,1601.25,percent of total billed charges,Implant Devices,1601.25,35,,1601.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1555.5,34,"If Charge > 2,000, then 34 percent",1555.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1830,
SYNTHES 201.818 CORTEX SCREW 2X18MM,C1713,HCPCS,,79006313,CDM,278,RC,,,both,,,78,30.78,39.4668,,30.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,27.3,35,,27.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,31.2,40,,31.2,percent of total billed charges,Implant Devices,27.3,70,,27.3,percent of total billed charges,Implant Devices,26.52,34,,26.52,percent of total billed charges,Implant Devices,26.52,34,,26.52,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.2,
STRYKER 4933-1.003 LONG WIRE BOLT,C1713,HCPCS,,79006321,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
STRYKER 611065 8x65 CANNULATED SCREW,C1713,HCPCS,,79006331,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
STRYKER 611060 8X60 CANNULATED SCREW,C1713,HCPCS,,79006332,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
STRYKER EZ18-14-14 EASYCLIP EZ18-14-14,C1713,HCPCS,,79006333,CDM,278,RC,,,both,,,2567,1013.11,39.4668,,1013.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.78,34,,872.78,percent of total billed charges,Implant Device,872.78,34,,872.78,percent of total billed charges,Implant Device,872.78,34,,872.78,percent of total billed charges,Implant Device,872.78,34,,872.78,percent of total billed charges,Implant Device,872.78,34,,872.78,percent of total billed charges,Implant Device,872.78,34,,872.78,percent of total billed charges,Implant Device,898.45,35,,898.45,percent of total billed charges,Implant Device,872.78,34,"Charges > $500, x 34%",872.78,percent of total billed charges,Implant Device,898.45,35,,898.45,percent of total billed charges,Implant Devices,898.45,35,,898.45,percent of total billed charges,Implant Devices,898.45,35,,,percent of total billed charges,Implant Devices,898.45,35,,898.45,percent of total billed charges,Implant Devices,898.45,35,,898.45,percent of total billed charges,Implant Devices,1026.8,40,,1026.8,percent of total billed charges,Implant Devices,898.45,70,,898.45,percent of total billed charges,Implant Devices,872.78,34,,872.78,percent of total billed charges,Implant Devices,872.78,34,,872.78,percent of total billed charges,Implant Devices,898.45,35,,898.45,percent of total billed charges,Implant Devices,898.45,35,,898.45,percent of total billed charges,Implant Devices,898.45,35,,898.45,percent of total billed charges,Implant Devices,898.45,35,,898.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.78,34,"If Charge > 2,000, then 34 percent",872.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026.8,
S&N 121639 CANNULATED SCREW  6.5X95MM,C1713,HCPCS,,79006334,CDM,278,RC,,,both,,,974,384.41,39.4668,,384.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,331.16,34,,331.16,percent of total billed charges,Implant Device,331.16,34,,331.16,percent of total billed charges,Implant Device,331.16,34,,331.16,percent of total billed charges,Implant Device,331.16,34,,331.16,percent of total billed charges,Implant Device,331.16,34,,331.16,percent of total billed charges,Implant Device,331.16,34,,331.16,percent of total billed charges,Implant Device,340.9,35,,340.9,percent of total billed charges,Implant Device,331.16,34,"Charges > $500, x 34%",331.16,percent of total billed charges,Implant Device,340.9,35,,340.9,percent of total billed charges,Implant Devices,340.9,35,,340.9,percent of total billed charges,Implant Devices,340.9,35,,,percent of total billed charges,Implant Devices,340.9,35,,340.9,percent of total billed charges,Implant Devices,340.9,35,,340.9,percent of total billed charges,Implant Devices,389.6,40,,389.6,percent of total billed charges,Implant Devices,340.9,70,,340.9,percent of total billed charges,Implant Devices,331.16,34,,331.16,percent of total billed charges,Implant Devices,331.16,34,,331.16,percent of total billed charges,Implant Devices,340.9,35,,340.9,percent of total billed charges,Implant Devices,340.9,35,,340.9,percent of total billed charges,Implant Devices,340.9,35,,340.9,percent of total billed charges,Implant Devices,340.9,35,,340.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,389.6,
BIOMET 41-2108 LOCKING SCREW 2.0X8MM,C1713,HCPCS,,79006335,CDM,278,RC,,,both,,,468,184.7,39.4668,,184.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,187.2,40,,187.2,percent of total billed charges,Implant Devices,163.8,70,,163.8,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.2,
BIOMET 41-2110 LOCKING SCREW 2.0X10MM,C1713,HCPCS,,79006336,CDM,278,RC,,,both,,,468,184.7,39.4668,,184.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,187.2,40,,187.2,percent of total billed charges,Implant Devices,163.8,70,,163.8,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.2,
BIOMET 41-2112 LOCKING SCREW 2.0X12MM,C1713,HCPCS,,79006337,CDM,278,RC,,,both,,,468,184.7,39.4668,,184.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,187.2,40,,187.2,percent of total billed charges,Implant Devices,163.8,70,,163.8,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.2,
ALPHATEC SPINE 62004-70 ROD 70MM,C1713,HCPCS,,79006339,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
SOLANA SFT-2015 SNAP OFF SCREW 2X15MM,C1713,HCPCS,,79006342,CDM,278,RC,,,both,,,1380,544.64,39.4668,,544.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Device,469.2,34,"Charges > $500, x 34%",469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,552,40,,552,percent of total billed charges,Implant Devices,483,70,,483,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552,
ALPHATEC 71003-54 PLATE 3 LEVEL 54MM,C1713,HCPCS,,79006343,CDM,278,RC,,,both,,,3136,1237.68,39.4668,,1237.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Device,1066.24,34,"Charges > $500, x 34%",1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1254.4,40,,1254.4,percent of total billed charges,Implant Devices,1097.6,70,,1097.6,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1066.24,34,"If Charge > 2,000, then 34 percent",1066.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254.4,
ARTHREX AR-9045-40PT SCREW 4.5X40MM,C1713,HCPCS,,79006344,CDM,278,RC,,,both,,,2386,941.68,39.4668,,941.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,835.1,35,,835.1,percent of total billed charges,Implant Device,811.24,34,"Charges > $500, x 34%",811.24,percent of total billed charges,Implant Device,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,954.4,40,,954.4,percent of total billed charges,Implant Devices,835.1,70,,835.1,percent of total billed charges,Implant Devices,811.24,34,,811.24,percent of total billed charges,Implant Devices,811.24,34,,811.24,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,811.24,34,"If Charge > 2,000, then 34 percent",811.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,954.4,
BIOMET 1312-18-018 CORT SCREW 3.5X18MM,C1713,HCPCS,,79006352,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 1312-18-024 CORT SCREW 3.5X24MM,C1713,HCPCS,,79006353,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 1312-18-010 CORT SCREW 3.5X10MM,C1713,HCPCS,,79006354,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
BIOMET 1425-6 1.6MM WIRE,C1713,HCPCS,,79006355,CDM,278,RC,,,both,,,132,52.1,39.4668,,52.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,52.8,40,,52.8,percent of total billed charges,Implant Devices,46.2,70,,46.2,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.8,
BIOMET 8140-27-048 CANNULATED NL 4X48MM,C1713,HCPCS,,79006356,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8140-27-050 CANN SCREW 4X50MM,C1713,HCPCS,,79006357,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8150-37-044 CANN SCREW 3.5X44MM,C1713,HCPCS,,79006358,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
BIOMET 8140-27-040 CANN SCREW 4X40MM,C1713,HCPCS,,79006359,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
METASURG TC2514 CANN SCREW 2.5X14MM,C1713,HCPCS,,79006360,CDM,278,RC,,,both,,,586,231.28,39.4668,,231.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Device,199.24,34,"Charges > $500, x 34%",199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,234.4,40,,234.4,percent of total billed charges,Implant Devices,205.1,70,,205.1,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.4,
METASURG TC2516 CANN SCREW 2.5X16MM,C1713,HCPCS,,79006361,CDM,278,RC,,,both,,,586,231.28,39.4668,,231.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Device,199.24,34,"Charges > $500, x 34%",199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,234.4,40,,234.4,percent of total billed charges,Implant Devices,205.1,70,,205.1,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.4,
METASURG TH2514 HEADLESS SCREW 2.5X14MM,C1713,HCPCS,,79006363,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
BME SE-1110 SPEED IMPLANT 11X10X10MM,C1713,HCPCS,,79006365,CDM,278,RC,,,both,,,3085,1217.55,39.4668,,1217.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1048.9,34,,1048.9,percent of total billed charges,Implant Device,1048.9,34,,1048.9,percent of total billed charges,Implant Device,1048.9,34,,1048.9,percent of total billed charges,Implant Device,1048.9,34,,1048.9,percent of total billed charges,Implant Device,1048.9,34,,1048.9,percent of total billed charges,Implant Device,1048.9,34,,1048.9,percent of total billed charges,Implant Device,1079.75,35,,1079.75,percent of total billed charges,Implant Device,1048.9,34,"Charges > $500, x 34%",1048.9,percent of total billed charges,Implant Device,1079.75,35,,1079.75,percent of total billed charges,Implant Devices,1079.75,35,,1079.75,percent of total billed charges,Implant Devices,1079.75,35,,,percent of total billed charges,Implant Devices,1079.75,35,,1079.75,percent of total billed charges,Implant Devices,1079.75,35,,1079.75,percent of total billed charges,Implant Devices,1234,40,,1234,percent of total billed charges,Implant Devices,1079.75,70,,1079.75,percent of total billed charges,Implant Devices,1048.9,34,,1048.9,percent of total billed charges,Implant Devices,1048.9,34,,1048.9,percent of total billed charges,Implant Devices,1079.75,35,,1079.75,percent of total billed charges,Implant Devices,1079.75,35,,1079.75,percent of total billed charges,Implant Devices,1079.75,35,,1079.75,percent of total billed charges,Implant Devices,1079.75,35,,1079.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1048.9,34,"If Charge > 2,000, then 34 percent",1048.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1234,
BIOMET 8161-35-022 LOCKNG SCREW 3.5X22MM,C1713,HCPCS,,79006366,CDM,278,RC,,,both,,,780,307.84,39.4668,,307.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Device,265.2,34,"Charges > $500, x 34%",265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,312,40,,312,percent of total billed charges,Implant Devices,273,70,,273,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,312,
ACUMED 70-0304 5 HOLE PLATE LEFT,C1713,HCPCS,,79006367,CDM,278,RC,,,both,,,3430,1353.71,39.4668,,1353.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1200.5,35,,1200.5,percent of total billed charges,Implant Device,1166.2,34,"Charges > $500, x 34%",1166.2,percent of total billed charges,Implant Device,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1372,40,,1372,percent of total billed charges,Implant Devices,1200.5,70,,1200.5,percent of total billed charges,Implant Devices,1166.2,34,,1166.2,percent of total billed charges,Implant Devices,1166.2,34,,1166.2,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1166.2,34,"If Charge > 2,000, then 34 percent",1166.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1372,
ACUMED 30-0331 LOCKING SCREW 2.7X22MM,C1713,HCPCS,,79006368,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ACUMED 30-0328 LOCKING SCREW 2.7X16MM,C1713,HCPCS,,79006369,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
ACUMED 30-0349 LOCKING SCREW 2.7X120MM,C1713,HCPCS,,79006370,CDM,278,RC,,,both,,,262,103.4,39.4668,,103.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,91.7,35,,91.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,104.8,40,,104.8,percent of total billed charges,Implant Devices,91.7,70,,91.7,percent of total billed charges,Implant Devices,89.08,34,,89.08,percent of total billed charges,Implant Devices,89.08,34,,89.08,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,104.8,
ACUMED 30-0332 NONLOCKING SCREW 2.7X24MM,C1713,HCPCS,,79006372,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ACUMED 30-0235 LOCKING SCREW 3.5X14MM,C1713,HCPCS,,79006373,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
SYNTHES 02.127.180 LOCKNG SCREW 3.5X80MM,C1713,HCPCS,,79006375,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
SYNTHES 02.127.185 LOCKNG SCREW 3.5X85MM,C1713,HCPCS,,79006376,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
SYNTHES 02.127.190 LOCKNG SCREW 3.5X90MM,C1713,HCPCS,,79006377,CDM,278,RC,,,both,,,604,238.38,39.4668,,238.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,205.36,34,,205.36,percent of total billed charges,Implant Device,205.36,34,,205.36,percent of total billed charges,Implant Device,205.36,34,,205.36,percent of total billed charges,Implant Device,205.36,34,,205.36,percent of total billed charges,Implant Device,205.36,34,,205.36,percent of total billed charges,Implant Device,205.36,34,,205.36,percent of total billed charges,Implant Device,211.4,35,,211.4,percent of total billed charges,Implant Device,205.36,34,"Charges > $500, x 34%",205.36,percent of total billed charges,Implant Device,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,241.6,40,,241.6,percent of total billed charges,Implant Devices,211.4,70,,211.4,percent of total billed charges,Implant Devices,205.36,34,,205.36,percent of total billed charges,Implant Devices,205.36,34,,205.36,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,241.6,
SYNTHES 07.704-005S BONE VOID FILLER 5CC,C1713,HCPCS,,79006379,CDM,278,RC,,,both,,,3531,1393.57,39.4668,,1393.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1200.54,34,,1200.54,percent of total billed charges,Implant Device,1235.85,35,,1235.85,percent of total billed charges,Implant Device,1200.54,34,"Charges > $500, x 34%",1200.54,percent of total billed charges,Implant Device,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1412.4,40,,1412.4,percent of total billed charges,Implant Devices,1235.85,70,,1235.85,percent of total billed charges,Implant Devices,1200.54,34,,1200.54,percent of total billed charges,Implant Devices,1200.54,34,,1200.54,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,1235.85,35,,1235.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1200.54,34,"If Charge > 2,000, then 34 percent",1200.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1412.4,
DEPUY 207.738 CANNULATED SCREW 4X38MM,C1713,HCPCS,,79006388,CDM,278,RC,,,both,,,686,270.74,39.4668,,270.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,240.1,35,,240.1,percent of total billed charges,Implant Device,233.24,34,"Charges > $500, x 34%",233.24,percent of total billed charges,Implant Device,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,274.4,40,,274.4,percent of total billed charges,Implant Devices,240.1,70,,240.1,percent of total billed charges,Implant Devices,233.24,34,,233.24,percent of total billed charges,Implant Devices,233.24,34,,233.24,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.4,
DEPUY 207.750 CANNULATED SCREW 4X50MM,C1713,HCPCS,,79006389,CDM,278,RC,,,both,,,686,270.74,39.4668,,270.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,240.1,35,,240.1,percent of total billed charges,Implant Device,233.24,34,"Charges > $500, x 34%",233.24,percent of total billed charges,Implant Device,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,274.4,40,,274.4,percent of total billed charges,Implant Devices,240.1,70,,240.1,percent of total billed charges,Implant Devices,233.24,34,,233.24,percent of total billed charges,Implant Devices,233.24,34,,233.24,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.4,
BIOMET 8140-27-038 CANNULATED SCREW 4X38,C1713,HCPCS,,79006390,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
SYNTHES 204.840 LOCKING SCREW 3.5X40MM,C1713,HCPCS,,79006391,CDM,278,RC,,,both,,,98,38.68,39.4668,,38.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33.32,34,,33.32,percent of total billed charges,Implant Device,33.32,34,,33.32,percent of total billed charges,Implant Device,33.32,34,,33.32,percent of total billed charges,Implant Device,33.32,34,,33.32,percent of total billed charges,Implant Device,33.32,34,,33.32,percent of total billed charges,Implant Device,33.32,34,,33.32,percent of total billed charges,Implant Device,34.3,35,,34.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,39.2,40,,39.2,percent of total billed charges,Implant Devices,34.3,70,,34.3,percent of total billed charges,Implant Devices,33.32,34,,33.32,percent of total billed charges,Implant Devices,33.32,34,,33.32,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39.2,
SYNTHES 204.845 LOCKING SCREW 3.5X45MM,C1713,HCPCS,,79006392,CDM,278,RC,,,both,,,82,32.36,39.4668,,32.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,28.7,35,,28.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,32.8,40,,32.8,percent of total billed charges,Implant Devices,28.7,70,,28.7,percent of total billed charges,Implant Devices,27.88,34,,27.88,percent of total billed charges,Implant Devices,27.88,34,,27.88,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.8,
PARAGON 28 P20-070-WD00 DOME WASHER 7MM,C1713,HCPCS,,79006394,CDM,278,RC,,,both,,,730,288.11,39.4668,,288.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,255.5,35,,255.5,percent of total billed charges,Implant Device,248.2,34,"Charges > $500, x 34%",248.2,percent of total billed charges,Implant Device,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,292,40,,292,percent of total billed charges,Implant Devices,255.5,70,,255.5,percent of total billed charges,Implant Devices,248.2,34,,248.2,percent of total billed charges,Implant Devices,248.2,34,,248.2,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,292,
PARAGON 28 P20-170-078M CANN SCREW 7X7.8,C1713,HCPCS,,79006395,CDM,278,RC,,,both,,,1771,698.96,39.4668,,698.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,602.14,34,,602.14,percent of total billed charges,Implant Device,602.14,34,,602.14,percent of total billed charges,Implant Device,602.14,34,,602.14,percent of total billed charges,Implant Device,602.14,34,,602.14,percent of total billed charges,Implant Device,602.14,34,,602.14,percent of total billed charges,Implant Device,602.14,34,,602.14,percent of total billed charges,Implant Device,619.85,35,,619.85,percent of total billed charges,Implant Device,602.14,34,"Charges > $500, x 34%",602.14,percent of total billed charges,Implant Device,619.85,35,,619.85,percent of total billed charges,Implant Devices,619.85,35,,619.85,percent of total billed charges,Implant Devices,619.85,35,,,percent of total billed charges,Implant Devices,619.85,35,,619.85,percent of total billed charges,Implant Devices,619.85,35,,619.85,percent of total billed charges,Implant Devices,708.4,40,,708.4,percent of total billed charges,Implant Devices,619.85,70,,619.85,percent of total billed charges,Implant Devices,602.14,34,,602.14,percent of total billed charges,Implant Devices,602.14,34,,602.14,percent of total billed charges,Implant Devices,619.85,35,,619.85,percent of total billed charges,Implant Devices,619.85,35,,619.85,percent of total billed charges,Implant Devices,619.85,35,,619.85,percent of total billed charges,Implant Devices,619.85,35,,619.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,708.4,
PARAGON 28 P20-170-082M CANN SCREW 7X82,C1713,HCPCS,,79006396,CDM,278,RC,,,both,,,1860,734.08,39.4668,,734.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,632.4,34,,632.4,percent of total billed charges,Implant Device,632.4,34,,632.4,percent of total billed charges,Implant Device,632.4,34,,632.4,percent of total billed charges,Implant Device,632.4,34,,632.4,percent of total billed charges,Implant Device,632.4,34,,632.4,percent of total billed charges,Implant Device,632.4,34,,632.4,percent of total billed charges,Implant Device,651,35,,651,percent of total billed charges,Implant Device,632.4,34,"Charges > $500, x 34%",632.4,percent of total billed charges,Implant Device,651,35,,651,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,651,35,,,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,744,40,,744,percent of total billed charges,Implant Devices,651,70,,651,percent of total billed charges,Implant Devices,632.4,34,,632.4,percent of total billed charges,Implant Devices,632.4,34,,632.4,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,651,35,,651,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,744,
STRYKER 340634 CORTICAL SCREW 4.5X34MM,C1713,HCPCS,,79006398,CDM,278,RC,,,both,,,158,62.36,39.4668,,62.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,53.72,34,,53.72,percent of total billed charges,Implant Device,53.72,34,,53.72,percent of total billed charges,Implant Device,53.72,34,,53.72,percent of total billed charges,Implant Device,53.72,34,,53.72,percent of total billed charges,Implant Device,53.72,34,,53.72,percent of total billed charges,Implant Device,53.72,34,,53.72,percent of total billed charges,Implant Device,55.3,35,,55.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,63.2,40,,63.2,percent of total billed charges,Implant Devices,55.3,70,,55.3,percent of total billed charges,Implant Devices,53.72,34,,53.72,percent of total billed charges,Implant Devices,53.72,34,,53.72,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63.2,
STRYKER 340638 CORTICAL SCREW 4.5X38MM,C1713,HCPCS,,79006399,CDM,278,RC,,,both,,,158,62.36,39.4668,,62.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,53.72,34,,53.72,percent of total billed charges,Implant Device,53.72,34,,53.72,percent of total billed charges,Implant Device,53.72,34,,53.72,percent of total billed charges,Implant Device,53.72,34,,53.72,percent of total billed charges,Implant Device,53.72,34,,53.72,percent of total billed charges,Implant Device,53.72,34,,53.72,percent of total billed charges,Implant Device,55.3,35,,55.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,63.2,40,,63.2,percent of total billed charges,Implant Devices,55.3,70,,55.3,percent of total billed charges,Implant Devices,53.72,34,,53.72,percent of total billed charges,Implant Devices,53.72,34,,53.72,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,55.3,35,,55.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63.2,
STRYKER 371375 LOCKING SCREW 5.0X75MM,C1713,HCPCS,,79006400,CDM,278,RC,,,both,,,576,227.33,39.4668,,227.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Device,195.84,34,"Charges > $500, x 34%",195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,230.4,40,,230.4,percent of total billed charges,Implant Devices,201.6,70,,201.6,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.4,
STRYKER 371365 LOCKING SCREW 5.0X65MM,C1713,HCPCS,,79006401,CDM,278,RC,,,both,,,576,227.33,39.4668,,227.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Device,195.84,34,"Charges > $500, x 34%",195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,230.4,40,,230.4,percent of total billed charges,Implant Devices,201.6,70,,201.6,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.4,
STRYKER 370116 LOCKING SCREW 5.0X16MM,C1713,HCPCS,,79006402,CDM,278,RC,,,both,,,737,290.87,39.4668,,290.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,250.58,34,,250.58,percent of total billed charges,Implant Device,250.58,34,,250.58,percent of total billed charges,Implant Device,250.58,34,,250.58,percent of total billed charges,Implant Device,250.58,34,,250.58,percent of total billed charges,Implant Device,250.58,34,,250.58,percent of total billed charges,Implant Device,250.58,34,,250.58,percent of total billed charges,Implant Device,257.95,35,,257.95,percent of total billed charges,Implant Device,250.58,34,"Charges > $500, x 34%",250.58,percent of total billed charges,Implant Device,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,294.8,40,,294.8,percent of total billed charges,Implant Devices,257.95,70,,257.95,percent of total billed charges,Implant Devices,250.58,34,,250.58,percent of total billed charges,Implant Devices,250.58,34,,250.58,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,257.95,35,,257.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294.8,
STRYKER 342065 CANCELLOUS SCREW 6.5X65MM,C1713,HCPCS,,79006403,CDM,278,RC,,,both,,,140,55.25,39.4668,,55.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,49,35,,49,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,56,40,,56,percent of total billed charges,Implant Devices,49,70,,49,percent of total billed charges,Implant Devices,47.6,34,,47.6,percent of total billed charges,Implant Devices,47.6,34,,47.6,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,56,
STRYKER 371324 LOCKING SCREW 5.0X24MM,C1713,HCPCS,,79006404,CDM,278,RC,,,both,,,576,227.33,39.4668,,227.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Device,195.84,34,"Charges > $500, x 34%",195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,230.4,40,,230.4,percent of total billed charges,Implant Devices,201.6,70,,201.6,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.4,
STRYKER 437526 PLATE 6 HOLE RIGHT,C1713,HCPCS,,79006405,CDM,278,RC,,,both,,,6492,2562.18,39.4668,,2562.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2207.28,34,,2207.28,percent of total billed charges,Implant Device,2272.2,35,,2272.2,percent of total billed charges,Implant Device,2207.28,34,"Charges > $500, x 34%",2207.28,percent of total billed charges,Implant Device,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2596.8,40,,2596.8,percent of total billed charges,Implant Devices,2272.2,70,,2272.2,percent of total billed charges,Implant Devices,2207.28,34,,2207.28,percent of total billed charges,Implant Devices,2207.28,34,,2207.28,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,2272.2,35,,2272.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2207.28,34,"If Charge > 2,000, then 34 percent",2207.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2596.8,
ACUMED CO-N2316 NON LOCK SCREW 2.3X16MM,C1713,HCPCS,,79006412,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
ALAMO AT4F7FF FEM HEAD ALLOGRAFT FORZ,C1713,HCPCS,,79006415,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
BIOMET 28240 TROCH NAIL LONG 11MM LEFT,C1713,HCPCS,,79006416,CDM,278,RC,,,both,,,11040,4357.13,39.4668,,4357.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Device,3753.6,34,"Charges > $500, x 34%",3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,4416,40,,4416,percent of total billed charges,Implant Devices,3864,70,,3864,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3753.6,34,"If Charge > 2,000, then 34 percent",3753.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4416,
BIOMET 29283 LAG SCREW 120MM,C1713,HCPCS,,79006417,CDM,278,RC,,,both,,,2670,1053.76,39.4668,,1053.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,934.5,35,,934.5,percent of total billed charges,Implant Device,907.8,34,"Charges > $500, x 34%",907.8,percent of total billed charges,Implant Device,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,1068,40,,1068,percent of total billed charges,Implant Devices,934.5,70,,934.5,percent of total billed charges,Implant Devices,907.8,34,,907.8,percent of total billed charges,Implant Devices,907.8,34,,907.8,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,907.8,34,"If Charge > 2,000, then 34 percent",907.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1068,
BIOMET 14-405060 CORTICAL SCREW 5X60MM,C1713,HCPCS,,79006418,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
STRYKER 1806-1417S FIXATION K-WIRE 3X285,C1713,HCPCS,,79006419,CDM,278,RC,,,both,,,245,96.69,39.4668,,96.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,83.3,34,,83.3,percent of total billed charges,Implant Device,83.3,34,,83.3,percent of total billed charges,Implant Device,83.3,34,,83.3,percent of total billed charges,Implant Device,83.3,34,,83.3,percent of total billed charges,Implant Device,83.3,34,,83.3,percent of total billed charges,Implant Device,83.3,34,,83.3,percent of total billed charges,Implant Device,85.75,35,,85.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,85.75,35,,85.75,percent of total billed charges,Implant Devices,85.75,35,,85.75,percent of total billed charges,Implant Devices,85.75,35,,,percent of total billed charges,Implant Devices,85.75,35,,85.75,percent of total billed charges,Implant Devices,85.75,35,,85.75,percent of total billed charges,Implant Devices,98,40,,98,percent of total billed charges,Implant Devices,85.75,70,,85.75,percent of total billed charges,Implant Devices,83.3,34,,83.3,percent of total billed charges,Implant Devices,83.3,34,,83.3,percent of total billed charges,Implant Devices,85.75,35,,85.75,percent of total billed charges,Implant Devices,85.75,35,,85.75,percent of total billed charges,Implant Devices,85.75,35,,85.75,percent of total billed charges,Implant Devices,85.75,35,,85.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,98,
STRYKER 1806-1407S NAIL INSERT SLEEVE T2,C1713,HCPCS,,79006420,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 430210 10 HOLE 1/3 TUBULAR PLATE,C1713,HCPCS,,79006424,CDM,278,RC,,,both,,,290,114.45,39.4668,,114.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,101.5,35,,101.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,116,40,,116,percent of total billed charges,Implant Devices,101.5,70,,101.5,percent of total billed charges,Implant Devices,98.6,34,,98.6,percent of total billed charges,Implant Devices,98.6,34,,98.6,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,116,
STRYKER 345418 4X18MM CANCELLLOUS SCREW,C1713,HCPCS,,79006425,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
STRYKER 345545 4X45MM CANCELLLOUS SCREW,C1713,HCPCS,,79006426,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
BIOMET 28244 TROCH NAIL LONG 11MM LEFT,C1713,HCPCS,,79006437,CDM,278,RC,,,both,,,11040,4357.13,39.4668,,4357.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Device,3753.6,34,"Charges > $500, x 34%",3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,4416,40,,4416,percent of total billed charges,Implant Devices,3864,70,,3864,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3753.6,34,"If Charge > 2,000, then 34 percent",3753.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4416,
STRYKER 611080S CANN CANC SCREW 8X80MM,C1713,HCPCS,,79006438,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
STRYKER 601660S CANNULATED SCREW 5X6MM,C1713,HCPCS,,79006439,CDM,278,RC,,,both,,,725,286.13,39.4668,,286.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,246.5,34,,246.5,percent of total billed charges,Implant Device,246.5,34,,246.5,percent of total billed charges,Implant Device,246.5,34,,246.5,percent of total billed charges,Implant Device,246.5,34,,246.5,percent of total billed charges,Implant Device,246.5,34,,246.5,percent of total billed charges,Implant Device,246.5,34,,246.5,percent of total billed charges,Implant Device,253.75,35,,253.75,percent of total billed charges,Implant Device,246.5,34,"Charges > $500, x 34%",246.5,percent of total billed charges,Implant Device,253.75,35,,253.75,percent of total billed charges,Implant Devices,253.75,35,,253.75,percent of total billed charges,Implant Devices,253.75,35,,,percent of total billed charges,Implant Devices,253.75,35,,253.75,percent of total billed charges,Implant Devices,253.75,35,,253.75,percent of total billed charges,Implant Devices,290,40,,290,percent of total billed charges,Implant Devices,253.75,70,,253.75,percent of total billed charges,Implant Devices,246.5,34,,246.5,percent of total billed charges,Implant Devices,246.5,34,,246.5,percent of total billed charges,Implant Devices,253.75,35,,253.75,percent of total billed charges,Implant Devices,253.75,35,,253.75,percent of total billed charges,Implant Devices,253.75,35,,253.75,percent of total billed charges,Implant Devices,253.75,35,,253.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290,
STRYKER 5030-5-200 04/5 TRANSFIXION PIN,C1713,HCPCS,,79006443,CDM,278,RC,,,both,,,510,201.28,39.4668,,201.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Device,173.4,34,"Charges > $500, x 34%",173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,204,40,,204,percent of total billed charges,Implant Devices,178.5,70,,178.5,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204,
STRYKER EZ20-20-20 EASYCLIP,C1713,HCPCS,,79006444,CDM,278,RC,,,both,,,3646,1438.96,39.4668,,1438.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1239.64,34,,1239.64,percent of total billed charges,Implant Device,1239.64,34,,1239.64,percent of total billed charges,Implant Device,1239.64,34,,1239.64,percent of total billed charges,Implant Device,1239.64,34,,1239.64,percent of total billed charges,Implant Device,1239.64,34,,1239.64,percent of total billed charges,Implant Device,1239.64,34,,1239.64,percent of total billed charges,Implant Device,1276.1,35,,1276.1,percent of total billed charges,Implant Device,1239.64,34,"Charges > $500, x 34%",1239.64,percent of total billed charges,Implant Device,1276.1,35,,1276.1,percent of total billed charges,Implant Devices,1276.1,35,,1276.1,percent of total billed charges,Implant Devices,1276.1,35,,,percent of total billed charges,Implant Devices,1276.1,35,,1276.1,percent of total billed charges,Implant Devices,1276.1,35,,1276.1,percent of total billed charges,Implant Devices,1458.4,40,,1458.4,percent of total billed charges,Implant Devices,1276.1,70,,1276.1,percent of total billed charges,Implant Devices,1239.64,34,,1239.64,percent of total billed charges,Implant Devices,1239.64,34,,1239.64,percent of total billed charges,Implant Devices,1276.1,35,,1276.1,percent of total billed charges,Implant Devices,1276.1,35,,1276.1,percent of total billed charges,Implant Devices,1276.1,35,,1276.1,percent of total billed charges,Implant Devices,1276.1,35,,1276.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1239.64,34,"If Charge > 2,000, then 34 percent",1239.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1458.4,
STRYKER EZ25-22-22 EASYCLIP,C1713,HCPCS,,79006445,CDM,278,RC,,,both,,,6246,2465.1,39.4668,,2465.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2123.64,34,,2123.64,percent of total billed charges,Implant Device,2123.64,34,,2123.64,percent of total billed charges,Implant Device,2123.64,34,,2123.64,percent of total billed charges,Implant Device,2123.64,34,,2123.64,percent of total billed charges,Implant Device,2123.64,34,,2123.64,percent of total billed charges,Implant Device,2123.64,34,,2123.64,percent of total billed charges,Implant Device,2186.1,35,,2186.1,percent of total billed charges,Implant Device,2123.64,34,"Charges > $500, x 34%",2123.64,percent of total billed charges,Implant Device,2186.1,35,,2186.1,percent of total billed charges,Implant Devices,2186.1,35,,2186.1,percent of total billed charges,Implant Devices,2186.1,35,,,percent of total billed charges,Implant Devices,2186.1,35,,2186.1,percent of total billed charges,Implant Devices,2186.1,35,,2186.1,percent of total billed charges,Implant Devices,2498.4,40,,2498.4,percent of total billed charges,Implant Devices,2186.1,70,,2186.1,percent of total billed charges,Implant Devices,2123.64,34,,2123.64,percent of total billed charges,Implant Devices,2123.64,34,,2123.64,percent of total billed charges,Implant Devices,2186.1,35,,2186.1,percent of total billed charges,Implant Devices,2186.1,35,,2186.1,percent of total billed charges,Implant Devices,2186.1,35,,2186.1,percent of total billed charges,Implant Devices,2186.1,35,,2186.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2123.64,34,"If Charge > 2,000, then 34 percent",2123.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2498.4,
STRYKER 629344 OLECRANON PLATE 4 HOLE LT,C1713,HCPCS,,79006446,CDM,278,RC,,,both,,,3051,1204.13,39.4668,,1204.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1037.34,34,,1037.34,percent of total billed charges,Implant Device,1067.85,35,,1067.85,percent of total billed charges,Implant Device,1037.34,34,"Charges > $500, x 34%",1037.34,percent of total billed charges,Implant Device,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1220.4,40,,1220.4,percent of total billed charges,Implant Devices,1067.85,70,,1067.85,percent of total billed charges,Implant Devices,1037.34,34,,1037.34,percent of total billed charges,Implant Devices,1037.34,34,,1037.34,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,1067.85,35,,1067.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1037.34,34,"If Charge > 2,000, then 34 percent",1037.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1220.4,
ALPHATEC SPINE 71002-34 PLATE 2 LEV 34MM,C1713,HCPCS,,79006448,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
STRYKER 6495-9-006 TISSUE MEND 3X3CM,C1713,HCPCS,,79006449,CDM,278,RC,,,both,,,3936,1553.41,39.4668,,1553.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1338.24,34,,1338.24,percent of total billed charges,Implant Device,1338.24,34,,1338.24,percent of total billed charges,Implant Device,1338.24,34,,1338.24,percent of total billed charges,Implant Device,1338.24,34,,1338.24,percent of total billed charges,Implant Device,1338.24,34,,1338.24,percent of total billed charges,Implant Device,1338.24,34,,1338.24,percent of total billed charges,Implant Device,1377.6,35,,1377.6,percent of total billed charges,Implant Device,1338.24,34,"Charges > $500, x 34%",1338.24,percent of total billed charges,Implant Device,1377.6,35,,1377.6,percent of total billed charges,Implant Devices,1377.6,35,,1377.6,percent of total billed charges,Implant Devices,1377.6,35,,,percent of total billed charges,Implant Devices,1377.6,35,,1377.6,percent of total billed charges,Implant Devices,1377.6,35,,1377.6,percent of total billed charges,Implant Devices,1574.4,40,,1574.4,percent of total billed charges,Implant Devices,1377.6,70,,1377.6,percent of total billed charges,Implant Devices,1338.24,34,,1338.24,percent of total billed charges,Implant Devices,1338.24,34,,1338.24,percent of total billed charges,Implant Devices,1377.6,35,,1377.6,percent of total billed charges,Implant Devices,1377.6,35,,1377.6,percent of total billed charges,Implant Devices,1377.6,35,,1377.6,percent of total billed charges,Implant Devices,1377.6,35,,1377.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1338.24,34,"If Charge > 2,000, then 34 percent",1338.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1574.4,
ALPHATEC 62075-45 POLYAX SCREW 7.5X45MM,C1713,HCPCS,,79006450,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
ALPHATEC SPINE 11-2053 CROSSLINK MEDIUM,C1713,HCPCS,,79006451,CDM,278,RC,,,both,,,3750,1480.01,39.4668,,1480.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Device,1275,34,"Charges > $500, x 34%",1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1500,40,,1500,percent of total billed charges,Implant Devices,1312.5,70,,1312.5,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1275,34,"If Charge > 2,000, then 34 percent",1275,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
ALPHATEC SPINE 62004-90 ROD 90MM,C1713,HCPCS,,79006452,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
ALPHATEC SPINE 71001-20 PLATE 1 LEV 20MM,C1713,HCPCS,,79006453,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
ALPHATEC SPINE 71345-14 RSCUE SCREW 14MM,C1713,HCPCS,,79006454,CDM,278,RC,,,both,,,706,278.64,39.4668,,278.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,240.04,34,,240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Device,240.04,34,"Charges > $500, x 34%",240.04,percent of total billed charges,Implant Device,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,282.4,40,,282.4,percent of total billed charges,Implant Devices,247.1,70,,247.1,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,240.04,34,,240.04,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,247.1,35,,247.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.4,
BIOMET 28336 TROCH NAIL LONG 11MM RT,C1713,HCPCS,,79006462,CDM,278,RC,,,both,,,11040,4357.13,39.4668,,4357.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3753.6,34,,3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Device,3753.6,34,"Charges > $500, x 34%",3753.6,percent of total billed charges,Implant Device,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,4416,40,,4416,percent of total billed charges,Implant Devices,3864,70,,3864,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3753.6,34,,3753.6,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,3864,35,,3864,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3753.6,34,"If Charge > 2,000, then 34 percent",3753.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4416,
BIOMET 29239 LAG SCREW ASSY 100MM,C1713,HCPCS,,79006463,CDM,278,RC,,,both,,,3330,1314.24,39.4668,,1314.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1132.2,34,,1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Device,1132.2,34,"Charges > $500, x 34%",1132.2,percent of total billed charges,Implant Device,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1332,40,,1332,percent of total billed charges,Implant Devices,1165.5,70,,1165.5,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1132.2,34,,1132.2,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,1165.5,35,,1165.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1132.2,34,"If Charge > 2,000, then 34 percent",1132.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1332,
BIOMET 14-405040 CORT SCREW 5X40MM,C1713,HCPCS,,79006464,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
ZIMMER 00-5994-032-12 ART SURFACE 12MM,C1713,HCPCS,,79006465,CDM,278,RC,,,both,,,6257,2469.44,39.4668,,2469.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Device,2127.38,34,"Charges > $500, x 34%",2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2502.8,40,,2502.8,percent of total billed charges,Implant Devices,2189.95,70,,2189.95,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2127.38,34,"If Charge > 2,000, then 34 percent",2127.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2502.8,
ZIMMER 00-5842-023-09 ART SURFCE SZ3 9MM,C1713,HCPCS,,79006467,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
SYNTHES 207.746 SCREW CANNULATED 4X46MM,C1713,HCPCS,,79006470,CDM,278,RC,,,both,,,686,270.74,39.4668,,270.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,240.1,35,,240.1,percent of total billed charges,Implant Device,233.24,34,"Charges > $500, x 34%",233.24,percent of total billed charges,Implant Device,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,274.4,40,,274.4,percent of total billed charges,Implant Devices,240.1,70,,240.1,percent of total billed charges,Implant Devices,233.24,34,,233.24,percent of total billed charges,Implant Devices,233.24,34,,233.24,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.4,
SYNTHES 207.742 SCREW CANNULATED 4X42MM,C1713,HCPCS,,79006471,CDM,278,RC,,,both,,,685,270.35,39.4668,,270.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Device,232.9,34,"Charges > $500, x 34%",232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,274,40,,274,percent of total billed charges,Implant Devices,239.75,70,,239.75,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274,
STRYKER 57-15370 2.3MM 7 HOLE Y PLATE,C1713,HCPCS,,79006473,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
SYNTHES 241.331 LCP PLATE 3 HOLE 33MM,C1713,HCPCS,,79006474,CDM,278,RC,,,both,,,604,238.38,39.4668,,238.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,205.36,34,,205.36,percent of total billed charges,Implant Device,205.36,34,,205.36,percent of total billed charges,Implant Device,205.36,34,,205.36,percent of total billed charges,Implant Device,205.36,34,,205.36,percent of total billed charges,Implant Device,205.36,34,,205.36,percent of total billed charges,Implant Device,205.36,34,,205.36,percent of total billed charges,Implant Device,211.4,35,,211.4,percent of total billed charges,Implant Device,205.36,34,"Charges > $500, x 34%",205.36,percent of total billed charges,Implant Device,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,241.6,40,,241.6,percent of total billed charges,Implant Devices,211.4,70,,211.4,percent of total billed charges,Implant Devices,205.36,34,,205.36,percent of total billed charges,Implant Devices,205.36,34,,205.36,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,211.4,35,,211.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,241.6,
BIOMET 8162-45-209 PLATE 9 HOLE 4.5MM,C1713,HCPCS,,79006482,CDM,278,RC,,,both,,,1980,781.44,39.4668,,781.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,673.2,34,,673.2,percent of total billed charges,Implant Device,693,35,,693,percent of total billed charges,Implant Device,673.2,34,"Charges > $500, x 34%",673.2,percent of total billed charges,Implant Device,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,792,40,,792,percent of total billed charges,Implant Devices,693,70,,693,percent of total billed charges,Implant Devices,673.2,34,,673.2,percent of total billed charges,Implant Devices,673.2,34,,673.2,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,693,35,,693,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,792,
BIOMET 8157-45-026 CORTICAL SCREW 4.5X26,C1713,HCPCS,,79006483,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
BIOMET 8157-45-030 CORTICAL SCREW 4.5X30,C1713,HCPCS,,79006484,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
ARTHREX AR-1934BCF SUTURE ANHOR 14.5X3,C1713,HCPCS,,79006495,CDM,278,RC,,,both,,,915,361.12,39.4668,,361.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,311.1,34,,311.1,percent of total billed charges,Implant Device,320.25,35,,320.25,percent of total billed charges,Implant Device,311.1,34,"Charges > $500, x 34%",311.1,percent of total billed charges,Implant Device,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,366,40,,366,percent of total billed charges,Implant Devices,320.25,70,,320.25,percent of total billed charges,Implant Devices,311.1,34,,311.1,percent of total billed charges,Implant Devices,311.1,34,,311.1,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,320.25,35,,320.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,366,
TRISTATE BIOLOGICS AI-5125 ALLOGRAFT,C1713,HCPCS,,79006499,CDM,278,RC,,,both,,,5502,2171.46,39.4668,,2171.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1870.68,34,,1870.68,percent of total billed charges,Implant Device,1870.68,34,,1870.68,percent of total billed charges,Implant Device,1870.68,34,,1870.68,percent of total billed charges,Implant Device,1870.68,34,,1870.68,percent of total billed charges,Implant Device,1870.68,34,,1870.68,percent of total billed charges,Implant Device,1870.68,34,,1870.68,percent of total billed charges,Implant Device,1925.7,35,,1925.7,percent of total billed charges,Implant Device,1870.68,34,"Charges > $500, x 34%",1870.68,percent of total billed charges,Implant Device,1925.7,35,,1925.7,percent of total billed charges,Implant Devices,1925.7,35,,1925.7,percent of total billed charges,Implant Devices,1925.7,35,,,percent of total billed charges,Implant Devices,1925.7,35,,1925.7,percent of total billed charges,Implant Devices,1925.7,35,,1925.7,percent of total billed charges,Implant Devices,2200.8,40,,2200.8,percent of total billed charges,Implant Devices,1925.7,70,,1925.7,percent of total billed charges,Implant Devices,1870.68,34,,1870.68,percent of total billed charges,Implant Devices,1870.68,34,,1870.68,percent of total billed charges,Implant Devices,1925.7,35,,1925.7,percent of total billed charges,Implant Devices,1925.7,35,,1925.7,percent of total billed charges,Implant Devices,1925.7,35,,1925.7,percent of total billed charges,Implant Devices,1925.7,35,,1925.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1870.68,34,"If Charge > 2,000, then 34 percent",1870.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2200.8,
METASURG BF46200 BIOFIX ALLOGRAFT,C1713,HCPCS,,79006500,CDM,278,RC,,,both,,,12623,4981.89,39.4668,,4981.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4291.82,34,,4291.82,percent of total billed charges,Implant Device,4291.82,34,,4291.82,percent of total billed charges,Implant Device,4291.82,34,,4291.82,percent of total billed charges,Implant Device,4291.82,34,,4291.82,percent of total billed charges,Implant Device,4291.82,34,,4291.82,percent of total billed charges,Implant Device,4291.82,34,,4291.82,percent of total billed charges,Implant Device,4418.05,35,,4418.05,percent of total billed charges,Implant Device,4291.82,34,"Charges > $500, x 34%",4291.82,percent of total billed charges,Implant Device,4418.05,35,,4418.05,percent of total billed charges,Implant Devices,4418.05,35,,4418.05,percent of total billed charges,Implant Devices,4418.05,35,,,percent of total billed charges,Implant Devices,4418.05,35,,4418.05,percent of total billed charges,Implant Devices,4418.05,35,,4418.05,percent of total billed charges,Implant Devices,5049.2,40,,5049.2,percent of total billed charges,Implant Devices,4418.05,70,,4418.05,percent of total billed charges,Implant Devices,4291.82,34,,4291.82,percent of total billed charges,Implant Devices,4291.82,34,,4291.82,percent of total billed charges,Implant Devices,4418.05,35,,4418.05,percent of total billed charges,Implant Devices,4418.05,35,,4418.05,percent of total billed charges,Implant Devices,4418.05,35,,4418.05,percent of total billed charges,Implant Devices,4418.05,35,,4418.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4291.82,34,"If Charge > 2,000, then 34 percent",4291.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5049.2,
WRIGHT MEDICAL CCP-LPNIR LAPIDUS PLATE,C1713,HCPCS,,79006501,CDM,278,RC,,,both,,,6708,2647.43,39.4668,,2647.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Device,2280.72,34,"Charges > $500, x 34%",2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2683.2,40,,2683.2,percent of total billed charges,Implant Devices,2347.8,70,,2347.8,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2280.72,34,"If Charge > 2,000, then 34 percent",2280.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2683.2,
WRIGHT MEDICAL CCP-L3022 LOCK SCREW 3X22,C1713,HCPCS,,79006502,CDM,278,RC,,,both,,,1126,444.4,39.4668,,444.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Device,382.84,34,"Charges > $500, x 34%",382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,450.4,40,,450.4,percent of total billed charges,Implant Devices,394.1,70,,394.1,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450.4,
BIOCOMPOSITES 620-010 RAPIDCURE 10CC,C1713,HCPCS,,79006512,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
DEPUY 1246-03-000 HOLE ELIMINATOR,C1713,HCPCS,,79006513,CDM,278,RC,,,both,,,524,206.81,39.4668,,206.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,178.16,34,,178.16,percent of total billed charges,Implant Device,178.16,34,,178.16,percent of total billed charges,Implant Device,178.16,34,,178.16,percent of total billed charges,Implant Device,178.16,34,,178.16,percent of total billed charges,Implant Device,178.16,34,,178.16,percent of total billed charges,Implant Device,178.16,34,,178.16,percent of total billed charges,Implant Device,183.4,35,,183.4,percent of total billed charges,Implant Device,178.16,34,"Charges > $500, x 34%",178.16,percent of total billed charges,Implant Device,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,209.6,40,,209.6,percent of total billed charges,Implant Devices,183.4,70,,183.4,percent of total billed charges,Implant Devices,178.16,34,,178.16,percent of total billed charges,Implant Devices,178.16,34,,178.16,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.6,
WRIGHT MEDICAL CCP-LPNOL LAPIDUS PLATE,C1713,HCPCS,,79006518,CDM,278,RC,,,both,,,6708,2647.43,39.4668,,2647.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Device,2280.72,34,"Charges > $500, x 34%",2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2683.2,40,,2683.2,percent of total billed charges,Implant Devices,2347.8,70,,2347.8,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2280.72,34,"If Charge > 2,000, then 34 percent",2280.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2683.2,
WRIGHT MEDICAL CCP-L3022 LOCK SCREW 3X22,C1713,HCPCS,,79006519,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
STRYKER 5050-4-300 TRANSFIXING PIN,C1713,HCPCS,,79006522,CDM,278,RC,,,both,,,275,108.53,39.4668,,108.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.5,34,,93.5,percent of total billed charges,Implant Device,93.5,34,,93.5,percent of total billed charges,Implant Device,93.5,34,,93.5,percent of total billed charges,Implant Device,93.5,34,,93.5,percent of total billed charges,Implant Device,93.5,34,,93.5,percent of total billed charges,Implant Device,93.5,34,,93.5,percent of total billed charges,Implant Device,96.25,35,,96.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,110,40,,110,percent of total billed charges,Implant Devices,96.25,70,,96.25,percent of total billed charges,Implant Devices,93.5,34,,93.5,percent of total billed charges,Implant Devices,93.5,34,,93.5,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110,
SYNTHES 208.860 7.3MM CANNULATED SCREW,C1713,HCPCS,,79006523,CDM,278,RC,,,both,,,906,357.57,39.4668,,357.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,317.1,35,,317.1,percent of total billed charges,Implant Device,308.04,34,"Charges > $500, x 34%",308.04,percent of total billed charges,Implant Device,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,362.4,40,,362.4,percent of total billed charges,Implant Devices,317.1,70,,317.1,percent of total billed charges,Implant Devices,308.04,34,,308.04,percent of total billed charges,Implant Devices,308.04,34,,308.04,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,362.4,
SYNTHES 208.865 7.3MM CANNULATED SCREW,C1713,HCPCS,,79006524,CDM,278,RC,,,both,,,906,357.57,39.4668,,357.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,317.1,35,,317.1,percent of total billed charges,Implant Device,308.04,34,"Charges > $500, x 34%",308.04,percent of total billed charges,Implant Device,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,362.4,40,,362.4,percent of total billed charges,Implant Devices,317.1,70,,317.1,percent of total billed charges,Implant Devices,308.04,34,,308.04,percent of total billed charges,Implant Devices,308.04,34,,308.04,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,362.4,
SYNTHES 208.870 7.3MM CANNULATED SCREW,C1713,HCPCS,,79006525,CDM,278,RC,,,both,,,906,357.57,39.4668,,357.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,308.04,34,,308.04,percent of total billed charges,Implant Device,317.1,35,,317.1,percent of total billed charges,Implant Device,308.04,34,"Charges > $500, x 34%",308.04,percent of total billed charges,Implant Device,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,362.4,40,,362.4,percent of total billed charges,Implant Devices,317.1,70,,317.1,percent of total billed charges,Implant Devices,308.04,34,,308.04,percent of total billed charges,Implant Devices,308.04,34,,308.04,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,317.1,35,,317.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,362.4,
STRYKER 3225-0360S LONG NAIL KIT 11X125,C1713,HCPCS,,79006529,CDM,278,RC,,,both,,,9323,3679.49,39.4668,,3679.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3263.05,35,,3263.05,percent of total billed charges,Implant Device,3169.82,34,"Charges > $500, x 34%",3169.82,percent of total billed charges,Implant Device,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3729.2,40,,3729.2,percent of total billed charges,Implant Devices,3263.05,70,,3263.05,percent of total billed charges,Implant Devices,3169.82,34,,3169.82,percent of total billed charges,Implant Devices,3169.82,34,,3169.82,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3169.82,34,"If Charge > 2,000, then 34 percent",3169.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3729.2,
ACUMED 30-0350 NONLOCKING SCREW 2.7X22MM,C1713,HCPCS,,79006534,CDM,278,RC,,,both,,,262,103.4,39.4668,,103.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,89.08,34,,89.08,percent of total billed charges,Implant Device,91.7,35,,91.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,104.8,40,,104.8,percent of total billed charges,Implant Devices,91.7,70,,91.7,percent of total billed charges,Implant Devices,89.08,34,,89.08,percent of total billed charges,Implant Devices,89.08,34,,89.08,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,91.7,35,,91.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,104.8,
ACUMED 30-0274 NONLOCKING SCREW 3.5X55MM,C1713,HCPCS,,79006535,CDM,278,RC,,,both,,,405,159.84,39.4668,,159.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,141.75,35,,141.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,162,40,,162,percent of total billed charges,Implant Devices,141.75,70,,141.75,percent of total billed charges,Implant Devices,137.7,34,,137.7,percent of total billed charges,Implant Devices,137.7,34,,137.7,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,162,
ACUMED 30-0263 NONLOCKING SCREW 3.5X24MM,C1713,HCPCS,,79006536,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
ACUMED 30-0237 LOCKING SCREW 3.5X18MM,C1713,HCPCS,,79006537,CDM,278,RC,,,both,,,507,200.1,39.4668,,200.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,172.38,34,,172.38,percent of total billed charges,Implant Device,172.38,34,,172.38,percent of total billed charges,Implant Device,172.38,34,,172.38,percent of total billed charges,Implant Device,172.38,34,,172.38,percent of total billed charges,Implant Device,172.38,34,,172.38,percent of total billed charges,Implant Device,172.38,34,,172.38,percent of total billed charges,Implant Device,177.45,35,,177.45,percent of total billed charges,Implant Device,172.38,34,"Charges > $500, x 34%",172.38,percent of total billed charges,Implant Device,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,202.8,40,,202.8,percent of total billed charges,Implant Devices,177.45,70,,177.45,percent of total billed charges,Implant Devices,172.38,34,,172.38,percent of total billed charges,Implant Devices,172.38,34,,172.38,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,177.45,35,,177.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,202.8,
ACUMED 30-0251 LOCKING SCREW 3.5X55MM,C1713,HCPCS,,79006538,CDM,278,RC,,,both,,,546,215.49,39.4668,,215.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,185.64,34,,185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Device,185.64,34,"Charges > $500, x 34%",185.64,percent of total billed charges,Implant Device,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,218.4,40,,218.4,percent of total billed charges,Implant Devices,191.1,70,,191.1,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,185.64,34,,185.64,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,191.1,35,,191.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
ACUMED CO-N2318 NONLOCK SCREW 2.3X18MM,C1713,HCPCS,,79006539,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
S&N 121832 SCREW CANNULATED 4X32MM,C1713,HCPCS,,79006549,CDM,278,RC,,,both,,,721,284.56,39.4668,,284.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,245.14,34,,245.14,percent of total billed charges,Implant Device,245.14,34,,245.14,percent of total billed charges,Implant Device,245.14,34,,245.14,percent of total billed charges,Implant Device,245.14,34,,245.14,percent of total billed charges,Implant Device,245.14,34,,245.14,percent of total billed charges,Implant Device,245.14,34,,245.14,percent of total billed charges,Implant Device,252.35,35,,252.35,percent of total billed charges,Implant Device,245.14,34,"Charges > $500, x 34%",245.14,percent of total billed charges,Implant Device,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,288.4,40,,288.4,percent of total billed charges,Implant Devices,252.35,70,,252.35,percent of total billed charges,Implant Devices,245.14,34,,245.14,percent of total billed charges,Implant Devices,245.14,34,,245.14,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,288.4,
EXACTECH 340-01-03 FRACTURE PLATE 150MM,C1713,HCPCS,,79006550,CDM,278,RC,,,both,,,4644,1832.84,39.4668,,1832.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1578.96,34,,1578.96,percent of total billed charges,Implant Device,1625.4,35,,1625.4,percent of total billed charges,Implant Device,1578.96,34,"Charges > $500, x 34%",1578.96,percent of total billed charges,Implant Device,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1857.6,40,,1857.6,percent of total billed charges,Implant Devices,1625.4,70,,1625.4,percent of total billed charges,Implant Devices,1578.96,34,,1578.96,percent of total billed charges,Implant Devices,1578.96,34,,1578.96,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,1625.4,35,,1625.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1578.96,34,"If Charge > 2,000, then 34 percent",1578.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1857.6,
ARTHREX AR-8927BNF-CP ACHLLES SUT BRIDGE,C1713,HCPCS,,79006552,CDM,278,RC,,,both,,,3720,1468.16,39.4668,,1468.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1264.8,34,,1264.8,percent of total billed charges,Implant Device,1264.8,34,,1264.8,percent of total billed charges,Implant Device,1264.8,34,,1264.8,percent of total billed charges,Implant Device,1264.8,34,,1264.8,percent of total billed charges,Implant Device,1264.8,34,,1264.8,percent of total billed charges,Implant Device,1264.8,34,,1264.8,percent of total billed charges,Implant Device,1302,35,,1302,percent of total billed charges,Implant Device,1264.8,34,"Charges > $500, x 34%",1264.8,percent of total billed charges,Implant Device,1302,35,,1302,percent of total billed charges,Implant Devices,1302,35,,1302,percent of total billed charges,Implant Devices,1302,35,,,percent of total billed charges,Implant Devices,1302,35,,1302,percent of total billed charges,Implant Devices,1302,35,,1302,percent of total billed charges,Implant Devices,1488,40,,1488,percent of total billed charges,Implant Devices,1302,70,,1302,percent of total billed charges,Implant Devices,1264.8,34,,1264.8,percent of total billed charges,Implant Devices,1264.8,34,,1264.8,percent of total billed charges,Implant Devices,1302,35,,1302,percent of total billed charges,Implant Devices,1302,35,,1302,percent of total billed charges,Implant Devices,1302,35,,1302,percent of total billed charges,Implant Devices,1302,35,,1302,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1264.8,34,"If Charge > 2,000, then 34 percent",1264.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1488,
STRYKER 1896-5070S LOCKING SCREW 5X70MM,C1713,HCPCS,,79006555,CDM,278,RC,,,both,,,714,281.79,39.4668,,281.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,249.9,35,,249.9,percent of total billed charges,Implant Device,242.76,34,"Charges > $500, x 34%",242.76,percent of total billed charges,Implant Device,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,285.6,40,,285.6,percent of total billed charges,Implant Devices,249.9,70,,249.9,percent of total billed charges,Implant Devices,242.76,34,,242.76,percent of total billed charges,Implant Devices,242.76,34,,242.76,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,285.6,
DEPUY 202.876 CORTEX ST SCRW T8 2.7X16MM,C1713,HCPCS,,79006571,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
DEPUY 202.878 CORTEX ST SCRW T8 2.7X18MM,C1713,HCPCS,,79006572,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
DEPUY 02.211.016 VA LOCK SCREW 2.7X16MM,C1713,HCPCS,,79006573,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 02.211.018 VA LOCK SCREW 2.7X18MM,C1713,HCPCS,,79006574,CDM,278,RC,,,both,,,536,211.54,39.4668,,211.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,187.6,35,,187.6,percent of total billed charges,Implant Device,182.24,34,"Charges > $500, x 34%",182.24,percent of total billed charges,Implant Device,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,214.4,40,,214.4,percent of total billed charges,Implant Devices,187.6,70,,187.6,percent of total billed charges,Implant Devices,182.24,34,,182.24,percent of total billed charges,Implant Devices,182.24,34,,182.24,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.4,
DEPUY 02.118.407 DIST FIB PLATE 6 HOLE,C1713,HCPCS,,79006575,CDM,278,RC,,,both,,,3266,1288.99,39.4668,,1288.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1143.1,35,,1143.1,percent of total billed charges,Implant Device,1110.44,34,"Charges > $500, x 34%",1110.44,percent of total billed charges,Implant Device,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1306.4,40,,1306.4,percent of total billed charges,Implant Devices,1143.1,70,,1143.1,percent of total billed charges,Implant Devices,1110.44,34,,1110.44,percent of total billed charges,Implant Devices,1110.44,34,,1110.44,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1110.44,34,"If Charge > 2,000, then 34 percent",1110.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1306.4,
DEPUY 207.045 4X45MM CANC SCREW PT,C1713,HCPCS,,79006577,CDM,278,RC,,,both,,,56,22.1,39.4668,,22.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.04,34,,19.04,percent of total billed charges,Implant Device,19.6,35,,19.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,22.4,40,,22.4,percent of total billed charges,Implant Devices,19.6,70,,19.6,percent of total billed charges,Implant Devices,19.04,34,,19.04,percent of total billed charges,Implant Devices,19.04,34,,19.04,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,19.6,35,,19.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.4,
DEPUY 207.045 4X45MM CANC SCREW PT,C1713,HCPCS,,79006579,CDM,278,RC,,,both,,,78,30.78,39.4668,,30.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,27.3,35,,27.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,31.2,40,,31.2,percent of total billed charges,Implant Devices,27.3,70,,27.3,percent of total billed charges,Implant Devices,26.52,34,,26.52,percent of total billed charges,Implant Devices,26.52,34,,26.52,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.2,
ACUMED AT2-S20-S ACUTRAK BONE SCREW 20MM,C1713,HCPCS,,79006580,CDM,278,RC,,,both,,,1584,625.15,39.4668,,625.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Device,538.56,34,"Charges > $500, x 34%",538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,633.6,40,,633.6,percent of total billed charges,Implant Devices,554.4,70,,554.4,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,633.6,
STRYKER 1822-1036S TIBIAL NAIL 10X360MM,C1713,HCPCS,,79006583,CDM,278,RC,,,both,,,3529,1392.78,39.4668,,1392.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Device,1199.86,34,"Charges > $500, x 34%",1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1411.6,40,,1411.6,percent of total billed charges,Implant Devices,1235.15,70,,1235.15,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1199.86,34,"If Charge > 2,000, then 34 percent",1199.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1411.6,
ARTHREX 1850 BIOCARTILAGE 1CC,C1713,HCPCS,,79006584,CDM,278,RC,,,both,,,2310,911.68,39.4668,,911.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,785.4,34,,785.4,percent of total billed charges,Implant Device,785.4,34,,785.4,percent of total billed charges,Implant Device,785.4,34,,785.4,percent of total billed charges,Implant Device,785.4,34,,785.4,percent of total billed charges,Implant Device,785.4,34,,785.4,percent of total billed charges,Implant Device,785.4,34,,785.4,percent of total billed charges,Implant Device,808.5,35,,808.5,percent of total billed charges,Implant Device,785.4,34,"Charges > $500, x 34%",785.4,percent of total billed charges,Implant Device,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,924,40,,924,percent of total billed charges,Implant Devices,808.5,70,,808.5,percent of total billed charges,Implant Devices,785.4,34,,785.4,percent of total billed charges,Implant Devices,785.4,34,,785.4,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,808.5,35,,808.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,785.4,34,"If Charge > 2,000, then 34 percent",785.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,924,
ARTHREX AR-8943TH-03 PLATE HOOK 3 HOLE,C1713,HCPCS,,79006590,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
ARTHREX AR-8835-36 CORTCL SCREW 3.5X36MM,C1713,HCPCS,,79006591,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ARTHREX AR-8835-40 CORTCL SCREW 3.5X40MM,C1713,HCPCS,,79006592,CDM,278,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,36.04,34,,36.04,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,42.4,40,,42.4,percent of total billed charges,Implant Devices,37.1,70,,37.1,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,36.04,34,,36.04,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,37.1,35,,37.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42.4,
ARTHREX AR-13400L-06 HTO IMP I BAL LG/XL,C1713,HCPCS,,79006595,CDM,278,RC,,,both,,,8146,3214.97,39.4668,,3214.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2769.64,34,,2769.64,percent of total billed charges,Implant Device,2769.64,34,,2769.64,percent of total billed charges,Implant Device,2769.64,34,,2769.64,percent of total billed charges,Implant Device,2769.64,34,,2769.64,percent of total billed charges,Implant Device,2769.64,34,,2769.64,percent of total billed charges,Implant Device,2769.64,34,,2769.64,percent of total billed charges,Implant Device,2851.1,35,,2851.1,percent of total billed charges,Implant Device,2769.64,34,"Charges > $500, x 34%",2769.64,percent of total billed charges,Implant Device,2851.1,35,,2851.1,percent of total billed charges,Implant Devices,2851.1,35,,2851.1,percent of total billed charges,Implant Devices,2851.1,35,,,percent of total billed charges,Implant Devices,2851.1,35,,2851.1,percent of total billed charges,Implant Devices,2851.1,35,,2851.1,percent of total billed charges,Implant Devices,3258.4,40,,3258.4,percent of total billed charges,Implant Devices,2851.1,70,,2851.1,percent of total billed charges,Implant Devices,2769.64,34,,2769.64,percent of total billed charges,Implant Devices,2769.64,34,,2769.64,percent of total billed charges,Implant Devices,2851.1,35,,2851.1,percent of total billed charges,Implant Devices,2851.1,35,,2851.1,percent of total billed charges,Implant Devices,2851.1,35,,2851.1,percent of total billed charges,Implant Devices,2851.1,35,,2851.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2769.64,34,"If Charge > 2,000, then 34 percent",2769.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3258.4,
ARTHREX AR-13370-1 BONE VOID FILLER 12MM,C1713,HCPCS,,79006596,CDM,278,RC,,,both,,,2124,838.27,39.4668,,838.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,743.4,35,,743.4,percent of total billed charges,Implant Device,722.16,34,"Charges > $500, x 34%",722.16,percent of total billed charges,Implant Device,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,849.6,40,,849.6,percent of total billed charges,Implant Devices,743.4,70,,743.4,percent of total billed charges,Implant Devices,722.16,34,,722.16,percent of total billed charges,Implant Devices,722.16,34,,722.16,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,722.16,34,"If Charge > 2,000, then 34 percent",722.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,849.6,
ARTHREX AR-13402-38 HTO ANCHOR 4.5X38MM,C1713,HCPCS,,79006597,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-13401-26 HTO ANCHOR 6.5X26MM,C1713,HCPCS,,79006598,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-13401-30 HTO ANCHOR 6.5X30MM,C1713,HCPCS,,79006599,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ZIMMER 00-5604-020-07 CHONDROFIX ALLGRFT,C1713,HCPCS,,79006601,CDM,278,RC,,,both,,,8142,3213.39,39.4668,,3213.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2849.7,35,,2849.7,percent of total billed charges,Implant Device,2768.28,34,"Charges > $500, x 34%",2768.28,percent of total billed charges,Implant Device,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,3256.8,40,,3256.8,percent of total billed charges,Implant Devices,2849.7,70,,2849.7,percent of total billed charges,Implant Devices,2768.28,34,,2768.28,percent of total billed charges,Implant Devices,2768.28,34,,2768.28,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2768.28,34,"If Charge > 2,000, then 34 percent",2768.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3256.8,
ZIMMER 00-5990-034-23 NEXGEN AUG BLCK 15,C1713,HCPCS,,79006604,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 00-5990-034-24 NEXGEN AUG BLCK 20,C1713,HCPCS,,79006605,CDM,278,RC,,,both,,,3488,1376.6,39.4668,,1376.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1220.8,35,,1220.8,percent of total billed charges,Implant Device,1185.92,34,"Charges > $500, x 34%",1185.92,percent of total billed charges,Implant Device,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1395.2,40,,1395.2,percent of total billed charges,Implant Devices,1220.8,70,,1220.8,percent of total billed charges,Implant Devices,1185.92,34,,1185.92,percent of total billed charges,Implant Devices,1185.92,34,,1185.92,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1185.92,34,"If Charge > 2,000, then 34 percent",1185.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1395.2,
S&N 74023266 ARTICULAR INSRT SZ 5-6 18MM,C1713,HCPCS,,79006606,CDM,278,RC,,,both,,,8610,3398.09,39.4668,,3398.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2927.4,34,,2927.4,percent of total billed charges,Implant Device,2927.4,34,,2927.4,percent of total billed charges,Implant Device,2927.4,34,,2927.4,percent of total billed charges,Implant Device,2927.4,34,,2927.4,percent of total billed charges,Implant Device,2927.4,34,,2927.4,percent of total billed charges,Implant Device,2927.4,34,,2927.4,percent of total billed charges,Implant Device,3013.5,35,,3013.5,percent of total billed charges,Implant Device,2927.4,34,"Charges > $500, x 34%",2927.4,percent of total billed charges,Implant Device,3013.5,35,,3013.5,percent of total billed charges,Implant Devices,3013.5,35,,3013.5,percent of total billed charges,Implant Devices,3013.5,35,,,percent of total billed charges,Implant Devices,3013.5,35,,3013.5,percent of total billed charges,Implant Devices,3013.5,35,,3013.5,percent of total billed charges,Implant Devices,3444,40,,3444,percent of total billed charges,Implant Devices,3013.5,70,,3013.5,percent of total billed charges,Implant Devices,2927.4,34,,2927.4,percent of total billed charges,Implant Devices,2927.4,34,,2927.4,percent of total billed charges,Implant Devices,3013.5,35,,3013.5,percent of total billed charges,Implant Devices,3013.5,35,,3013.5,percent of total billed charges,Implant Devices,3013.5,35,,3013.5,percent of total billed charges,Implant Devices,3013.5,35,,3013.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2927.4,34,"If Charge > 2,000, then 34 percent",2927.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3444,
ZIMMER 187-06-69 STEINMN PIN SMOOTH 5/32,C1713,HCPCS,,79006607,CDM,278,RC,,,both,,,26,10.26,39.4668,,10.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8.84,34,,8.84,percent of total billed charges,Implant Device,8.84,34,,8.84,percent of total billed charges,Implant Device,8.84,34,,8.84,percent of total billed charges,Implant Device,8.84,34,,8.84,percent of total billed charges,Implant Device,8.84,34,,8.84,percent of total billed charges,Implant Device,8.84,34,,8.84,percent of total billed charges,Implant Device,9.1,35,,9.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,9.1,35,,9.1,percent of total billed charges,Implant Devices,9.1,35,,9.1,percent of total billed charges,Implant Devices,9.1,35,,,percent of total billed charges,Implant Devices,9.1,35,,9.1,percent of total billed charges,Implant Devices,9.1,35,,9.1,percent of total billed charges,Implant Devices,10.4,40,,10.4,percent of total billed charges,Implant Devices,9.1,70,,9.1,percent of total billed charges,Implant Devices,8.84,34,,8.84,percent of total billed charges,Implant Devices,8.84,34,,8.84,percent of total billed charges,Implant Devices,9.1,35,,9.1,percent of total billed charges,Implant Devices,9.1,35,,9.1,percent of total billed charges,Implant Devices,9.1,35,,9.1,percent of total billed charges,Implant Devices,9.1,35,,9.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10.4,
DEPUY 9505-02-303 PIN THREADED HEADED,C1713,HCPCS,,79006608,CDM,278,RC,,,both,,,1552,612.52,39.4668,,612.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,527.68,34,,527.68,percent of total billed charges,Implant Device,527.68,34,,527.68,percent of total billed charges,Implant Device,527.68,34,,527.68,percent of total billed charges,Implant Device,527.68,34,,527.68,percent of total billed charges,Implant Device,527.68,34,,527.68,percent of total billed charges,Implant Device,527.68,34,,527.68,percent of total billed charges,Implant Device,543.2,35,,543.2,percent of total billed charges,Implant Device,527.68,34,"Charges > $500, x 34%",527.68,percent of total billed charges,Implant Device,543.2,35,,543.2,percent of total billed charges,Implant Devices,543.2,35,,543.2,percent of total billed charges,Implant Devices,543.2,35,,,percent of total billed charges,Implant Devices,543.2,35,,543.2,percent of total billed charges,Implant Devices,543.2,35,,543.2,percent of total billed charges,Implant Devices,620.8,40,,620.8,percent of total billed charges,Implant Devices,543.2,70,,543.2,percent of total billed charges,Implant Devices,527.68,34,,527.68,percent of total billed charges,Implant Devices,527.68,34,,527.68,percent of total billed charges,Implant Devices,543.2,35,,543.2,percent of total billed charges,Implant Devices,543.2,35,,543.2,percent of total billed charges,Implant Devices,543.2,35,,543.2,percent of total billed charges,Implant Devices,543.2,35,,543.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,620.8,
ARTHREX AR-1927PSF-3 SUTURE ANCHOR 5.5,C1713,HCPCS,,79006612,CDM,278,RC,,,both,,,1288,508.33,39.4668,,508.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,437.92,34,,437.92,percent of total billed charges,Implant Device,437.92,34,,437.92,percent of total billed charges,Implant Device,437.92,34,,437.92,percent of total billed charges,Implant Device,437.92,34,,437.92,percent of total billed charges,Implant Device,437.92,34,,437.92,percent of total billed charges,Implant Device,437.92,34,,437.92,percent of total billed charges,Implant Device,450.8,35,,450.8,percent of total billed charges,Implant Device,437.92,34,"Charges > $500, x 34%",437.92,percent of total billed charges,Implant Device,450.8,35,,450.8,percent of total billed charges,Implant Devices,450.8,35,,450.8,percent of total billed charges,Implant Devices,450.8,35,,,percent of total billed charges,Implant Devices,450.8,35,,450.8,percent of total billed charges,Implant Devices,450.8,35,,450.8,percent of total billed charges,Implant Devices,515.2,40,,515.2,percent of total billed charges,Implant Devices,450.8,70,,450.8,percent of total billed charges,Implant Devices,437.92,34,,437.92,percent of total billed charges,Implant Devices,437.92,34,,437.92,percent of total billed charges,Implant Devices,450.8,35,,450.8,percent of total billed charges,Implant Devices,450.8,35,,450.8,percent of total billed charges,Implant Devices,450.8,35,,450.8,percent of total billed charges,Implant Devices,450.8,35,,450.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,515.2,
SYNTHES 202.626 CANNULATED SCREW 3X26MM,C1713,HCPCS,,79006613,CDM,278,RC,,,both,,,852,336.26,39.4668,,336.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,298.2,35,,298.2,percent of total billed charges,Implant Device,289.68,34,"Charges > $500, x 34%",289.68,percent of total billed charges,Implant Device,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,340.8,40,,340.8,percent of total billed charges,Implant Devices,298.2,70,,298.2,percent of total billed charges,Implant Devices,289.68,34,,289.68,percent of total billed charges,Implant Devices,289.68,34,,289.68,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,340.8,
SYNTHES 202.630 CANNULATED SCREW 3X30MM,C1713,HCPCS,,79006614,CDM,278,RC,,,both,,,852,336.26,39.4668,,336.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,298.2,35,,298.2,percent of total billed charges,Implant Device,289.68,34,"Charges > $500, x 34%",289.68,percent of total billed charges,Implant Device,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,340.8,40,,340.8,percent of total billed charges,Implant Devices,298.2,70,,298.2,percent of total billed charges,Implant Devices,289.68,34,,289.68,percent of total billed charges,Implant Devices,289.68,34,,289.68,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,340.8,
SYNTHES 202.638 CANNULATED SCREW 3X38MM,C1713,HCPCS,,79006615,CDM,278,RC,,,both,,,852,336.26,39.4668,,336.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,289.68,34,,289.68,percent of total billed charges,Implant Device,298.2,35,,298.2,percent of total billed charges,Implant Device,289.68,34,"Charges > $500, x 34%",289.68,percent of total billed charges,Implant Device,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,340.8,40,,340.8,percent of total billed charges,Implant Devices,298.2,70,,298.2,percent of total billed charges,Implant Devices,289.68,34,,289.68,percent of total billed charges,Implant Devices,289.68,34,,289.68,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,298.2,35,,298.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,340.8,
STRYKER 54-25683 DISTAL PLATE RT X-SHORT,C1713,HCPCS,,79006616,CDM,278,RC,,,both,,,2834,1118.49,39.4668,,1118.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,991.9,35,,991.9,percent of total billed charges,Implant Device,963.56,34,"Charges > $500, x 34%",963.56,percent of total billed charges,Implant Device,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,1133.6,40,,1133.6,percent of total billed charges,Implant Devices,991.9,70,,991.9,percent of total billed charges,Implant Devices,963.56,34,,963.56,percent of total billed charges,Implant Devices,963.56,34,,963.56,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,963.56,34,"If Charge > 2,000, then 34 percent",963.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1133.6,
ZIMMER 00-5842-023-10 ART SURF SZ 3 10MM,C1713,HCPCS,,79006622,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
SYNTHES 219.972 WASHER 6.5MM,C1713,HCPCS,,79006623,CDM,278,RC,,,both,,,119,46.97,39.4668,,46.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.46,34,,40.46,percent of total billed charges,Implant Device,40.46,34,,40.46,percent of total billed charges,Implant Device,40.46,34,,40.46,percent of total billed charges,Implant Device,40.46,34,,40.46,percent of total billed charges,Implant Device,40.46,34,,40.46,percent of total billed charges,Implant Device,40.46,34,,40.46,percent of total billed charges,Implant Device,41.65,35,,41.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,41.65,35,,41.65,percent of total billed charges,Implant Devices,41.65,35,,41.65,percent of total billed charges,Implant Devices,41.65,35,,,percent of total billed charges,Implant Devices,41.65,35,,41.65,percent of total billed charges,Implant Devices,41.65,35,,41.65,percent of total billed charges,Implant Devices,47.6,40,,47.6,percent of total billed charges,Implant Devices,41.65,70,,41.65,percent of total billed charges,Implant Devices,40.46,34,,40.46,percent of total billed charges,Implant Devices,40.46,34,,40.46,percent of total billed charges,Implant Devices,41.65,35,,41.65,percent of total billed charges,Implant Devices,41.65,35,,41.65,percent of total billed charges,Implant Devices,41.65,35,,41.65,percent of total billed charges,Implant Devices,41.65,35,,41.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,47.6,
SYNTHES 207.620 CANNULATED SCREW 4X20MM,C1713,HCPCS,,79006624,CDM,278,RC,,,both,,,828,326.79,39.4668,,326.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,281.52,34,,281.52,percent of total billed charges,Implant Device,281.52,34,,281.52,percent of total billed charges,Implant Device,281.52,34,,281.52,percent of total billed charges,Implant Device,281.52,34,,281.52,percent of total billed charges,Implant Device,281.52,34,,281.52,percent of total billed charges,Implant Device,281.52,34,,281.52,percent of total billed charges,Implant Device,289.8,35,,289.8,percent of total billed charges,Implant Device,281.52,34,"Charges > $500, x 34%",281.52,percent of total billed charges,Implant Device,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,331.2,40,,331.2,percent of total billed charges,Implant Devices,289.8,70,,289.8,percent of total billed charges,Implant Devices,281.52,34,,281.52,percent of total billed charges,Implant Devices,281.52,34,,281.52,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,289.8,35,,289.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,331.2,
PGON28 P20-155-036S CANN SCREW 5.5X36,C1713,HCPCS,,79006645,CDM,278,RC,,,both,,,1324,522.54,39.4668,,522.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,450.16,34,,450.16,percent of total billed charges,Implant Device,450.16,34,,450.16,percent of total billed charges,Implant Device,450.16,34,,450.16,percent of total billed charges,Implant Device,450.16,34,,450.16,percent of total billed charges,Implant Device,450.16,34,,450.16,percent of total billed charges,Implant Device,450.16,34,,450.16,percent of total billed charges,Implant Device,463.4,35,,463.4,percent of total billed charges,Implant Device,450.16,34,"Charges > $500, x 34%",450.16,percent of total billed charges,Implant Device,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,529.6,40,,529.6,percent of total billed charges,Implant Devices,463.4,70,,463.4,percent of total billed charges,Implant Devices,450.16,34,,450.16,percent of total billed charges,Implant Devices,450.16,34,,450.16,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,463.4,35,,463.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,529.6,
PGON28 P28-08-207 ARROW PLATE XL LEFT,C1713,HCPCS,,79006646,CDM,278,RC,,,both,,,7426,2930.8,39.4668,,2930.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2524.84,34,,2524.84,percent of total billed charges,Implant Device,2524.84,34,,2524.84,percent of total billed charges,Implant Device,2524.84,34,,2524.84,percent of total billed charges,Implant Device,2524.84,34,,2524.84,percent of total billed charges,Implant Device,2524.84,34,,2524.84,percent of total billed charges,Implant Device,2524.84,34,,2524.84,percent of total billed charges,Implant Device,2599.1,35,,2599.1,percent of total billed charges,Implant Device,2524.84,34,"Charges > $500, x 34%",2524.84,percent of total billed charges,Implant Device,2599.1,35,,2599.1,percent of total billed charges,Implant Devices,2599.1,35,,2599.1,percent of total billed charges,Implant Devices,2599.1,35,,,percent of total billed charges,Implant Devices,2599.1,35,,2599.1,percent of total billed charges,Implant Devices,2599.1,35,,2599.1,percent of total billed charges,Implant Devices,2970.4,40,,2970.4,percent of total billed charges,Implant Devices,2599.1,70,,2599.1,percent of total billed charges,Implant Devices,2524.84,34,,2524.84,percent of total billed charges,Implant Devices,2524.84,34,,2524.84,percent of total billed charges,Implant Devices,2599.1,35,,2599.1,percent of total billed charges,Implant Devices,2599.1,35,,2599.1,percent of total billed charges,Implant Devices,2599.1,35,,2599.1,percent of total billed charges,Implant Devices,2599.1,35,,2599.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2524.84,34,"If Charge > 2,000, then 34 percent",2524.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2970.4,
PGON28 P28-20-020 LOCKPLATE SCREW 3.5X20,C1713,HCPCS,,79006647,CDM,278,RC,,,both,,,586,231.28,39.4668,,231.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Device,199.24,34,"Charges > $500, x 34%",199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,234.4,40,,234.4,percent of total billed charges,Implant Devices,205.1,70,,205.1,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.4,
PGON28 P28-20-022 LOCKPLATE SCREW 3.5X22,C1713,HCPCS,,79006648,CDM,278,RC,,,both,,,586,231.28,39.4668,,231.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Device,199.24,34,"Charges > $500, x 34%",199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,234.4,40,,234.4,percent of total billed charges,Implant Devices,205.1,70,,205.1,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.4,
PGON28 P28-20-024 LOCKPLATE SCREW 3.5X24,C1713,HCPCS,,79006649,CDM,278,RC,,,both,,,586,231.28,39.4668,,231.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Device,199.24,34,"Charges > $500, x 34%",199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,234.4,40,,234.4,percent of total billed charges,Implant Devices,205.1,70,,205.1,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.4,
PGON28 P28-20-026 LOCKPLATE SCREW 3.5X26,C1713,HCPCS,,79006650,CDM,278,RC,,,both,,,586,231.28,39.4668,,231.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,199.24,34,,199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Device,199.24,34,"Charges > $500, x 34%",199.24,percent of total billed charges,Implant Device,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,234.4,40,,234.4,percent of total billed charges,Implant Devices,205.1,70,,205.1,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,199.24,34,,199.24,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,205.1,35,,205.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234.4,
PGON28 P50-053-3520 PLATE SCREW 3.5X20,C1713,HCPCS,,79006651,CDM,278,RC,,,both,,,619,244.3,39.4668,,244.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,210.46,34,,210.46,percent of total billed charges,Implant Device,210.46,34,,210.46,percent of total billed charges,Implant Device,210.46,34,,210.46,percent of total billed charges,Implant Device,210.46,34,,210.46,percent of total billed charges,Implant Device,210.46,34,,210.46,percent of total billed charges,Implant Device,210.46,34,,210.46,percent of total billed charges,Implant Device,216.65,35,,216.65,percent of total billed charges,Implant Device,210.46,34,"Charges > $500, x 34%",210.46,percent of total billed charges,Implant Device,216.65,35,,216.65,percent of total billed charges,Implant Devices,216.65,35,,216.65,percent of total billed charges,Implant Devices,216.65,35,,,percent of total billed charges,Implant Devices,216.65,35,,216.65,percent of total billed charges,Implant Devices,216.65,35,,216.65,percent of total billed charges,Implant Devices,247.6,40,,247.6,percent of total billed charges,Implant Devices,216.65,70,,216.65,percent of total billed charges,Implant Devices,210.46,34,,210.46,percent of total billed charges,Implant Devices,210.46,34,,210.46,percent of total billed charges,Implant Devices,216.65,35,,216.65,percent of total billed charges,Implant Devices,216.65,35,,216.65,percent of total billed charges,Implant Devices,216.65,35,,216.65,percent of total billed charges,Implant Devices,216.65,35,,216.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,247.6,
PGON28 P50-053-3530 PLATE SCREW 3.5X30,C1713,HCPCS,,79006652,CDM,278,RC,,,both,,,694,273.9,39.4668,,273.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Device,235.96,34,"Charges > $500, x 34%",235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,277.6,40,,277.6,percent of total billed charges,Implant Devices,242.9,70,,242.9,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.6,
PGON28 P53-154-0003 TEDDYBEAR PLATE LG,C1713,HCPCS,,79006653,CDM,278,RC,,,both,,,5117,2019.52,39.4668,,2019.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1739.78,34,,1739.78,percent of total billed charges,Implant Device,1739.78,34,,1739.78,percent of total billed charges,Implant Device,1739.78,34,,1739.78,percent of total billed charges,Implant Device,1739.78,34,,1739.78,percent of total billed charges,Implant Device,1739.78,34,,1739.78,percent of total billed charges,Implant Device,1739.78,34,,1739.78,percent of total billed charges,Implant Device,1790.95,35,,1790.95,percent of total billed charges,Implant Device,1739.78,34,"Charges > $500, x 34%",1739.78,percent of total billed charges,Implant Device,1790.95,35,,1790.95,percent of total billed charges,Implant Devices,1790.95,35,,1790.95,percent of total billed charges,Implant Devices,1790.95,35,,,percent of total billed charges,Implant Devices,1790.95,35,,1790.95,percent of total billed charges,Implant Devices,1790.95,35,,1790.95,percent of total billed charges,Implant Devices,2046.8,40,,2046.8,percent of total billed charges,Implant Devices,1790.95,70,,1790.95,percent of total billed charges,Implant Devices,1739.78,34,,1739.78,percent of total billed charges,Implant Devices,1739.78,34,,1739.78,percent of total billed charges,Implant Devices,1790.95,35,,1790.95,percent of total billed charges,Implant Devices,1790.95,35,,1790.95,percent of total billed charges,Implant Devices,1790.95,35,,1790.95,percent of total billed charges,Implant Devices,1790.95,35,,1790.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1739.78,34,"If Charge > 2,000, then 34 percent",1739.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2046.8,
STRYKER 370518 LOCKING SCREW 4.0 X 18MM,C1713,HCPCS,,79006656,CDM,278,RC,,,both,,,482,190.23,39.4668,,190.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,168.7,35,,168.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,192.8,40,,192.8,percent of total billed charges,Implant Devices,168.7,70,,168.7,percent of total billed charges,Implant Devices,163.88,34,,163.88,percent of total billed charges,Implant Devices,163.88,34,,163.88,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192.8,
STRYKER 370516 LOCKING SCREW 4.0 X 16MM,C1713,HCPCS,,79006657,CDM,278,RC,,,both,,,482,190.23,39.4668,,190.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,168.7,35,,168.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,192.8,40,,192.8,percent of total billed charges,Implant Devices,168.7,70,,168.7,percent of total billed charges,Implant Devices,163.88,34,,163.88,percent of total billed charges,Implant Devices,163.88,34,,163.88,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192.8,
STRYKER 370514 LOCKING SCREW 4.0 X 14MM,C1713,HCPCS,,79006658,CDM,278,RC,,,both,,,482,190.23,39.4668,,190.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,163.88,34,,163.88,percent of total billed charges,Implant Device,168.7,35,,168.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,192.8,40,,192.8,percent of total billed charges,Implant Devices,168.7,70,,168.7,percent of total billed charges,Implant Devices,163.88,34,,163.88,percent of total billed charges,Implant Devices,163.88,34,,163.88,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,168.7,35,,168.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192.8,
STRYKER 345416 NON LOCKING SCREW 4.0MM,C1713,HCPCS,,79006659,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
DEPUY 458.938S 5.0 C 38MM TI LOCK SCREW,C1713,HCPCS,,79006665,CDM,278,RC,,,both,,,888,350.47,39.4668,,350.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,310.8,35,,310.8,percent of total billed charges,Implant Device,301.92,34,"Charges > $500, x 34%",301.92,percent of total billed charges,Implant Device,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,355.2,40,,355.2,percent of total billed charges,Implant Devices,310.8,70,,310.8,percent of total billed charges,Implant Devices,301.92,34,,301.92,percent of total billed charges,Implant Devices,301.92,34,,301.92,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,355.2,
DEPUY 456.328S TI CANN FIX NAIL 235MM,C1713,HCPCS,,79006666,CDM,278,RC,,,both,,,2738,1080.6,39.4668,,1080.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Device,930.92,34,"Charges > $500, x 34%",930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,1095.2,40,,1095.2,percent of total billed charges,Implant Devices,958.3,70,,958.3,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,930.92,34,"If Charge > 2,000, then 34 percent",930.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1095.2,
DEPUY 456.306S 11X105MM HELICAL BLADE,C1713,HCPCS,,79006667,CDM,278,RC,,,both,,,2226,878.53,39.4668,,878.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,756.84,34,,756.84,percent of total billed charges,Implant Device,756.84,34,,756.84,percent of total billed charges,Implant Device,756.84,34,,756.84,percent of total billed charges,Implant Device,756.84,34,,756.84,percent of total billed charges,Implant Device,756.84,34,,756.84,percent of total billed charges,Implant Device,756.84,34,,756.84,percent of total billed charges,Implant Device,779.1,35,,779.1,percent of total billed charges,Implant Device,756.84,34,"Charges > $500, x 34%",756.84,percent of total billed charges,Implant Device,779.1,35,,779.1,percent of total billed charges,Implant Devices,779.1,35,,779.1,percent of total billed charges,Implant Devices,779.1,35,,,percent of total billed charges,Implant Devices,779.1,35,,779.1,percent of total billed charges,Implant Devices,779.1,35,,779.1,percent of total billed charges,Implant Devices,890.4,40,,890.4,percent of total billed charges,Implant Devices,779.1,70,,779.1,percent of total billed charges,Implant Devices,756.84,34,,756.84,percent of total billed charges,Implant Devices,756.84,34,,756.84,percent of total billed charges,Implant Devices,779.1,35,,779.1,percent of total billed charges,Implant Devices,779.1,35,,779.1,percent of total billed charges,Implant Devices,779.1,35,,779.1,percent of total billed charges,Implant Devices,779.1,35,,779.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,756.84,34,"If Charge > 2,000, then 34 percent",756.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,890.4,
STRYKER 1822-1031S TIBIAL NAIL 10X315MM,C1713,HCPCS,,79006669,CDM,278,RC,,,both,,,6416,2532.19,39.4668,,2532.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2245.6,35,,2245.6,percent of total billed charges,Implant Device,2181.44,34,"Charges > $500, x 34%",2181.44,percent of total billed charges,Implant Device,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2566.4,40,,2566.4,percent of total billed charges,Implant Devices,2245.6,70,,2245.6,percent of total billed charges,Implant Devices,2181.44,34,,2181.44,percent of total billed charges,Implant Devices,2181.44,34,,2181.44,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2181.44,34,"If Charge > 2,000, then 34 percent",2181.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2566.4,
ZIMMER 00-5990-037-01 FEM AUG BLOCK 5MM,C1713,HCPCS,,79006678,CDM,278,RC,,,both,,,3061,1208.08,39.4668,,1208.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1071.35,35,,1071.35,percent of total billed charges,Implant Device,1040.74,34,"Charges > $500, x 34%",1040.74,percent of total billed charges,Implant Device,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1224.4,40,,1224.4,percent of total billed charges,Implant Devices,1071.35,70,,1071.35,percent of total billed charges,Implant Devices,1040.74,34,,1040.74,percent of total billed charges,Implant Devices,1040.74,34,,1040.74,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1040.74,34,"If Charge > 2,000, then 34 percent",1040.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1224.4,
ZIMMER 00-5990-037-20 FEM AUG BLOCK 10MM,C1713,HCPCS,,79006679,CDM,278,RC,,,both,,,3061,1208.08,39.4668,,1208.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1071.35,35,,1071.35,percent of total billed charges,Implant Device,1040.74,34,"Charges > $500, x 34%",1040.74,percent of total billed charges,Implant Device,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1224.4,40,,1224.4,percent of total billed charges,Implant Devices,1071.35,70,,1071.35,percent of total billed charges,Implant Devices,1040.74,34,,1040.74,percent of total billed charges,Implant Devices,1040.74,34,,1040.74,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1040.74,34,"If Charge > 2,000, then 34 percent",1040.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1224.4,
ZIMMER 00-5994-017-91 FEM COMP SZ G LT,C1713,HCPCS,,79006680,CDM,278,RC,,,both,,,18586,7335.3,39.4668,,7335.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6505.1,35,,6505.1,percent of total billed charges,Implant Device,6319.24,34,"Charges > $500, x 34%",6319.24,percent of total billed charges,Implant Device,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,7434.4,40,,7434.4,percent of total billed charges,Implant Devices,6505.1,70,,6505.1,percent of total billed charges,Implant Devices,6319.24,34,,6319.24,percent of total billed charges,Implant Devices,6319.24,34,,6319.24,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6319.24,34,"If Charge > 2,000, then 34 percent",6319.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7434.4,
ZIMMER 00-5994-042-10 ART SURF 10MM,C1713,HCPCS,,79006681,CDM,278,RC,,,both,,,6465,2551.53,39.4668,,2551.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Device,2198.1,34,"Charges > $500, x 34%",2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2586,40,,2586,percent of total billed charges,Implant Devices,2262.75,70,,2262.75,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2198.1,34,"If Charge > 2,000, then 34 percent",2198.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2586,
DEPUY 96-2044 TIB INS ROTTNG PLAT 17.5MM,C1713,HCPCS,,79006682,CDM,278,RC,,,both,,,3696,1458.69,39.4668,,1458.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1256.64,34,,1256.64,percent of total billed charges,Implant Device,1293.6,35,,1293.6,percent of total billed charges,Implant Device,1256.64,34,"Charges > $500, x 34%",1256.64,percent of total billed charges,Implant Device,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1478.4,40,,1478.4,percent of total billed charges,Implant Devices,1293.6,70,,1293.6,percent of total billed charges,Implant Devices,1256.64,34,,1256.64,percent of total billed charges,Implant Devices,1256.64,34,,1256.64,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,1293.6,35,,1293.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1256.64,34,"If Charge > 2,000, then 34 percent",1256.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1478.4,
ARTHREX AR-8954-01 SHANZ PINS,C1713,HCPCS,,79006685,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
ARTHREX AR-8954PR-M PLATE MED RT PERIM,C1713,HCPCS,,79006686,CDM,278,RC,,,both,,,3286,1296.88,39.4668,,1296.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1117.24,34,,1117.24,percent of total billed charges,Implant Device,1117.24,34,,1117.24,percent of total billed charges,Implant Device,1117.24,34,,1117.24,percent of total billed charges,Implant Device,1117.24,34,,1117.24,percent of total billed charges,Implant Device,1117.24,34,,1117.24,percent of total billed charges,Implant Device,1117.24,34,,1117.24,percent of total billed charges,Implant Device,1150.1,35,,1150.1,percent of total billed charges,Implant Device,1117.24,34,"Charges > $500, x 34%",1117.24,percent of total billed charges,Implant Device,1150.1,35,,1150.1,percent of total billed charges,Implant Devices,1150.1,35,,1150.1,percent of total billed charges,Implant Devices,1150.1,35,,,percent of total billed charges,Implant Devices,1150.1,35,,1150.1,percent of total billed charges,Implant Devices,1150.1,35,,1150.1,percent of total billed charges,Implant Devices,1314.4,40,,1314.4,percent of total billed charges,Implant Devices,1150.1,70,,1150.1,percent of total billed charges,Implant Devices,1117.24,34,,1117.24,percent of total billed charges,Implant Devices,1117.24,34,,1117.24,percent of total billed charges,Implant Devices,1150.1,35,,1150.1,percent of total billed charges,Implant Devices,1150.1,35,,1150.1,percent of total billed charges,Implant Devices,1150.1,35,,1150.1,percent of total billed charges,Implant Devices,1150.1,35,,1150.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1117.24,34,"If Charge > 2,000, then 34 percent",1117.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1314.4,
ARTHREX AR-8935-32 CORTICAL SCREW 3.5X32,C1713,HCPCS,,79006687,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ARTHREX AR-8935-36 CORTICAL SCREW 3.5X36,C1713,HCPCS,,79006688,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ARTHREX AR-8935-34 CORTICAL SCREW 3.5X34,C1713,HCPCS,,79006689,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-8935L-28 LOCKING SCREW 3.5X28,C1713,HCPCS,,79006690,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ARTHREX AR-8935L-30 LOCKING SCREW 3.5X30,C1713,HCPCS,,79006691,CDM,278,RC,,,both,,,645,254.56,39.4668,,254.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Device,219.3,34,"Charges > $500, x 34%",219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,258,40,,258,percent of total billed charges,Implant Devices,225.75,70,,225.75,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258,
ARTHREX AR-8935L-32 LOCKING SCREW 3.5X32,C1713,HCPCS,,79006692,CDM,278,RC,,,both,,,645,254.56,39.4668,,254.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Device,219.3,34,"Charges > $500, x 34%",219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,258,40,,258,percent of total billed charges,Implant Devices,225.75,70,,225.75,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258,
STRYKER 338636 NONLOCK SCREW 3.5X36MM,C1713,HCPCS,,79006694,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
ARTHREX AR-1322BCNF MINI SUTURTAK ANCHOR,C1713,HCPCS,,79006695,CDM,278,RC,,,both,,,975,384.8,39.4668,,384.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,331.5,34,,331.5,percent of total billed charges,Implant Device,341.25,35,,341.25,percent of total billed charges,Implant Device,331.5,34,"Charges > $500, x 34%",331.5,percent of total billed charges,Implant Device,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,390,40,,390,percent of total billed charges,Implant Devices,341.25,70,,341.25,percent of total billed charges,Implant Devices,331.5,34,,331.5,percent of total billed charges,Implant Devices,331.5,34,,331.5,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,341.25,35,,341.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,390,
SYNTHES XM106.1020A TISSUEMATRIX 10X20CM,C1713,HCPCS,,79006701,CDM,278,RC,,,both,,,19632,7748.12,39.4668,,7748.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6674.88,34,,6674.88,percent of total billed charges,Implant Device,6674.88,34,,6674.88,percent of total billed charges,Implant Device,6674.88,34,,6674.88,percent of total billed charges,Implant Device,6674.88,34,,6674.88,percent of total billed charges,Implant Device,6674.88,34,,6674.88,percent of total billed charges,Implant Device,6674.88,34,,6674.88,percent of total billed charges,Implant Device,6871.2,35,,6871.2,percent of total billed charges,Implant Device,6674.88,34,"Charges > $500, x 34%",6674.88,percent of total billed charges,Implant Device,6871.2,35,,6871.2,percent of total billed charges,Implant Devices,6871.2,35,,6871.2,percent of total billed charges,Implant Devices,6871.2,35,,,percent of total billed charges,Implant Devices,6871.2,35,,6871.2,percent of total billed charges,Implant Devices,6871.2,35,,6871.2,percent of total billed charges,Implant Devices,7852.8,40,,7852.8,percent of total billed charges,Implant Devices,6871.2,70,,6871.2,percent of total billed charges,Implant Devices,6674.88,34,,6674.88,percent of total billed charges,Implant Devices,6674.88,34,,6674.88,percent of total billed charges,Implant Devices,6871.2,35,,6871.2,percent of total billed charges,Implant Devices,6871.2,35,,6871.2,percent of total billed charges,Implant Devices,6871.2,35,,6871.2,percent of total billed charges,Implant Devices,6871.2,35,,6871.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6674.88,34,"If Charge > 2,000, then 34 percent",6674.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7852.8,
ZIMMER 00-5842-022-11 ART SURF SZ2 11MM,C1713,HCPCS,,79006716,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
STRYKER 59-23012 2.3X12MM BONE SCREW,C1713,HCPCS,,79006725,CDM,278,RC,,,both,,,380,149.97,39.4668,,149.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,129.2,34,,129.2,percent of total billed charges,Implant Device,129.2,34,,129.2,percent of total billed charges,Implant Device,129.2,34,,129.2,percent of total billed charges,Implant Device,129.2,34,,129.2,percent of total billed charges,Implant Device,129.2,34,,129.2,percent of total billed charges,Implant Device,129.2,34,,129.2,percent of total billed charges,Implant Device,133,35,,133,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,133,35,,133,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,133,35,,,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,152,40,,152,percent of total billed charges,Implant Devices,133,70,,133,percent of total billed charges,Implant Devices,129.2,34,,129.2,percent of total billed charges,Implant Devices,129.2,34,,129.2,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,152,
STRYKER 59-23013 2.3X13MM BONE SCREW,C1713,HCPCS,,79006726,CDM,278,RC,,,both,,,459,181.15,39.4668,,181.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,156.06,34,,156.06,percent of total billed charges,Implant Device,156.06,34,,156.06,percent of total billed charges,Implant Device,156.06,34,,156.06,percent of total billed charges,Implant Device,156.06,34,,156.06,percent of total billed charges,Implant Device,156.06,34,,156.06,percent of total billed charges,Implant Device,156.06,34,,156.06,percent of total billed charges,Implant Device,160.65,35,,160.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,183.6,40,,183.6,percent of total billed charges,Implant Devices,160.65,70,,160.65,percent of total billed charges,Implant Devices,156.06,34,,156.06,percent of total billed charges,Implant Devices,156.06,34,,156.06,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,160.65,35,,160.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,183.6,
STRYKER 59-25012 2.5X12MM EMERGNCY SCREW,C1713,HCPCS,,79006727,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
STRYKER 40-30113 ASNIS CANN SCREW 3X13MM,C1713,HCPCS,,79006729,CDM,278,RC,,,both,,,773,305.08,39.4668,,305.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,270.55,35,,270.55,percent of total billed charges,Implant Device,262.82,34,"Charges > $500, x 34%",262.82,percent of total billed charges,Implant Device,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,309.2,40,,309.2,percent of total billed charges,Implant Devices,270.55,70,,270.55,percent of total billed charges,Implant Devices,262.82,34,,262.82,percent of total billed charges,Implant Devices,262.82,34,,262.82,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,309.2,
DAVOL 1180816M ALLOMAX SURG GRAFT 8X16CM,C1713,HCPCS,,79006730,CDM,278,RC,,,both,,,11250,4440.02,39.4668,,4440.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3825,34,,3825,percent of total billed charges,Implant Device,3825,34,,3825,percent of total billed charges,Implant Device,3825,34,,3825,percent of total billed charges,Implant Device,3825,34,,3825,percent of total billed charges,Implant Device,3825,34,,3825,percent of total billed charges,Implant Device,3825,34,,3825,percent of total billed charges,Implant Device,3937.5,35,,3937.5,percent of total billed charges,Implant Device,3825,34,"Charges > $500, x 34%",3825,percent of total billed charges,Implant Device,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,4500,40,,4500,percent of total billed charges,Implant Devices,3937.5,70,,3937.5,percent of total billed charges,Implant Devices,3825,34,,3825,percent of total billed charges,Implant Devices,3825,34,,3825,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3825,34,"If Charge > 2,000, then 34 percent",3825,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4500,
ATLAS 1100-03-0065 ROD CONTOURED 65MM,C1713,HCPCS,,79006731,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
STRYKER 5620-B-402 TIBIAL BASEPLATE SZ 4,C1713,HCPCS,,79006733,CDM,278,RC,,,both,,,4937,1948.48,39.4668,,1948.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Device,1678.58,34,"Charges > $500, x 34%",1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1974.8,40,,1974.8,percent of total billed charges,Implant Devices,1727.95,70,,1727.95,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.58,34,"If Charge > 2,000, then 34 percent",1678.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.8,
ALPHATEC SPINE 71003-57 PLATE 57MM,C1713,HCPCS,,79006735,CDM,278,RC,,,both,,,3136,1237.68,39.4668,,1237.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Device,1066.24,34,"Charges > $500, x 34%",1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1254.4,40,,1254.4,percent of total billed charges,Implant Devices,1097.6,70,,1097.6,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1066.24,34,"If Charge > 2,000, then 34 percent",1066.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254.4,
ARTHREX AR-8931-15 QUICKFIX SCREW 3X15MM,C1713,HCPCS,,79006738,CDM,278,RC,,,both,,,720,284.16,39.4668,,284.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Device,244.8,34,"Charges > $500, x 34%",244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,288,40,,288,percent of total billed charges,Implant Devices,252,70,,252,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,288,
ARTHERX AR-8730-34PT CANN SCREW 3X34MM,C1713,HCPCS,,79006739,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
EXACTECH 320-15-03 GLENOID PLATE 8 DEG,C1713,HCPCS,,79006740,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
ARTHREX AR-8930-12 QUICKFIX SCREW 2X12MM,C1713,HCPCS,,79006742,CDM,278,RC,,,both,,,720,284.16,39.4668,,284.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Device,244.8,34,"Charges > $500, x 34%",244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,288,40,,288,percent of total billed charges,Implant Devices,252,70,,252,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,288,
ZIMMER 0107Z BIOMEND MEMBRANE 30X40MM,C1713,HCPCS,,79006743,CDM,278,RC,,,both,,,726,286.53,39.4668,,286.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,246.84,34,,246.84,percent of total billed charges,Implant Device,246.84,34,,246.84,percent of total billed charges,Implant Device,246.84,34,,246.84,percent of total billed charges,Implant Device,246.84,34,,246.84,percent of total billed charges,Implant Device,246.84,34,,246.84,percent of total billed charges,Implant Device,246.84,34,,246.84,percent of total billed charges,Implant Device,254.1,35,,254.1,percent of total billed charges,Implant Device,246.84,34,"Charges > $500, x 34%",246.84,percent of total billed charges,Implant Device,254.1,35,,254.1,percent of total billed charges,Implant Devices,254.1,35,,254.1,percent of total billed charges,Implant Devices,254.1,35,,,percent of total billed charges,Implant Devices,254.1,35,,254.1,percent of total billed charges,Implant Devices,254.1,35,,254.1,percent of total billed charges,Implant Devices,290.4,40,,290.4,percent of total billed charges,Implant Devices,254.1,70,,254.1,percent of total billed charges,Implant Devices,246.84,34,,246.84,percent of total billed charges,Implant Devices,246.84,34,,246.84,percent of total billed charges,Implant Devices,254.1,35,,254.1,percent of total billed charges,Implant Devices,254.1,35,,254.1,percent of total billed charges,Implant Devices,254.1,35,,254.1,percent of total billed charges,Implant Devices,254.1,35,,254.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.4,
ZIMMER 187-01-69 PIN SMOOTH K WIRE 5/64,C1713,HCPCS,,79006749,CDM,278,RC,,,both,,,24,9.47,39.4668,,9.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8.16,34,,8.16,percent of total billed charges,Implant Device,8.16,34,,8.16,percent of total billed charges,Implant Device,8.16,34,,8.16,percent of total billed charges,Implant Device,8.16,34,,8.16,percent of total billed charges,Implant Device,8.16,34,,8.16,percent of total billed charges,Implant Device,8.16,34,,8.16,percent of total billed charges,Implant Device,8.4,35,,8.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,9.6,40,,9.6,percent of total billed charges,Implant Devices,8.4,70,,8.4,percent of total billed charges,Implant Devices,8.16,34,,8.16,percent of total billed charges,Implant Devices,8.16,34,,8.16,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9.6,
ARTHREX AR-8935-26 CORTICAL SCREW 3.5X26,C1713,HCPCS,,79006750,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-8935L-26 LOCKING SCREW 3.5X26,C1713,HCPCS,,79006751,CDM,278,RC,,,both,,,645,254.56,39.4668,,254.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Device,219.3,34,"Charges > $500, x 34%",219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,258,40,,258,percent of total billed charges,Implant Devices,225.75,70,,225.75,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258,
ZIMMER 187-02-69 PIN SMOOTH K WIRE 3/32,C1713,HCPCS,,79006755,CDM,278,RC,,,both,,,20,7.89,39.4668,,7.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6.8,34,,6.8,percent of total billed charges,Implant Device,6.8,34,,6.8,percent of total billed charges,Implant Device,6.8,34,,6.8,percent of total billed charges,Implant Device,6.8,34,,6.8,percent of total billed charges,Implant Device,6.8,34,,6.8,percent of total billed charges,Implant Device,6.8,34,,6.8,percent of total billed charges,Implant Device,7,35,,7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,7,35,,7,percent of total billed charges,Implant Devices,7,35,,7,percent of total billed charges,Implant Devices,7,35,,,percent of total billed charges,Implant Devices,7,35,,7,percent of total billed charges,Implant Devices,7,35,,7,percent of total billed charges,Implant Devices,8,40,,8,percent of total billed charges,Implant Devices,7,70,,7,percent of total billed charges,Implant Devices,6.8,34,,6.8,percent of total billed charges,Implant Devices,6.8,34,,6.8,percent of total billed charges,Implant Devices,7,35,,7,percent of total billed charges,Implant Devices,7,35,,7,percent of total billed charges,Implant Devices,7,35,,7,percent of total billed charges,Implant Devices,7,35,,7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8,
ARTHREX AR-8942R-L PLATE LARGE H RIGHT,C1713,HCPCS,,79006756,CDM,278,RC,,,both,,,1800,710.4,39.4668,,710.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Device,612,34,"Charges > $500, x 34%",612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,720,40,,720,percent of total billed charges,Implant Devices,630,70,,630,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,720,
LIFESPINE 132-308-1 ALLERON SM CORE GEN3,C1713,HCPCS,,79006762,CDM,278,RC,,,both,,,20640,8145.95,39.4668,,8145.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7224,35,,7224,percent of total billed charges,Implant Device,7017.6,34,"Charges > $500, x 34%",7017.6,percent of total billed charges,Implant Device,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,8256,40,,8256,percent of total billed charges,Implant Devices,7224,70,,7224,percent of total billed charges,Implant Devices,7017.6,34,,7017.6,percent of total billed charges,Implant Devices,7017.6,34,,7017.6,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7017.6,34,"If Charge > 2,000, then 34 percent",7017.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8256,
LIFESPINE 132-308-2 ALLERON SM PLTE GEN3,C1713,HCPCS,,79006763,CDM,278,RC,,,both,,,13680,5399.06,39.4668,,5399.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4788,35,,4788,percent of total billed charges,Implant Device,4651.2,34,"Charges > $500, x 34%",4651.2,percent of total billed charges,Implant Device,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,5472,40,,5472,percent of total billed charges,Implant Devices,4788,70,,4788,percent of total billed charges,Implant Devices,4651.2,34,,4651.2,percent of total billed charges,Implant Devices,4651.2,34,,4651.2,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4651.2,34,"If Charge > 2,000, then 34 percent",4651.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5472,
S&N 128694 STAPLE FIXATION LONG LEG MED,C1713,HCPCS,,79006773,CDM,278,RC,,,both,,,410,161.81,39.4668,,161.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,143.5,35,,143.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,164,40,,164,percent of total billed charges,Implant Devices,143.5,70,,143.5,percent of total billed charges,Implant Devices,139.4,34,,139.4,percent of total billed charges,Implant Devices,139.4,34,,139.4,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164,
ARTHREX AR-1370C BIOCOMP INTR SCREW 7X23,C1713,HCPCS,,79006774,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ARTHREX AR-8943T-10 PLATE TUBULAR 10HOLE,C1713,HCPCS,,79006778,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
ZIMMER 02-03150-034 CORTCAL SCREW 5X34MM,C1713,HCPCS,,79006779,CDM,278,RC,,,both,,,508,200.49,39.4668,,200.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,177.8,35,,177.8,percent of total billed charges,Implant Device,172.72,34,"Charges > $500, x 34%",172.72,percent of total billed charges,Implant Device,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,203.2,40,,203.2,percent of total billed charges,Implant Devices,177.8,70,,177.8,percent of total billed charges,Implant Devices,172.72,34,,172.72,percent of total billed charges,Implant Devices,172.72,34,,172.72,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,203.2,
ZIMMER 02-03150-036 CORTCAL SCREW 5X36MM,C1713,HCPCS,,79006780,CDM,278,RC,,,both,,,508,200.49,39.4668,,200.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,177.8,35,,177.8,percent of total billed charges,Implant Device,172.72,34,"Charges > $500, x 34%",172.72,percent of total billed charges,Implant Device,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,203.2,40,,203.2,percent of total billed charges,Implant Devices,177.8,70,,177.8,percent of total billed charges,Implant Devices,172.72,34,,172.72,percent of total billed charges,Implant Devices,172.72,34,,172.72,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,203.2,
ZIMMER 02-03150-042 CORTCAL SCREW 5X42MM,C1713,HCPCS,,79006781,CDM,278,RC,,,both,,,508,200.49,39.4668,,200.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,172.72,34,,172.72,percent of total billed charges,Implant Device,177.8,35,,177.8,percent of total billed charges,Implant Device,172.72,34,"Charges > $500, x 34%",172.72,percent of total billed charges,Implant Device,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,203.2,40,,203.2,percent of total billed charges,Implant Devices,177.8,70,,177.8,percent of total billed charges,Implant Devices,172.72,34,,172.72,percent of total billed charges,Implant Devices,172.72,34,,172.72,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,177.8,35,,177.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,203.2,
ZIMMER 02-03151-012 UNICORT SCREW 5X12MM,C1713,HCPCS,,79006782,CDM,278,RC,,,both,,,478,188.65,39.4668,,188.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,167.3,35,,167.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,191.2,40,,191.2,percent of total billed charges,Implant Devices,167.3,70,,167.3,percent of total billed charges,Implant Devices,162.52,34,,162.52,percent of total billed charges,Implant Devices,162.52,34,,162.52,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,191.2,
ZIMMER 02-03151-014 UNICORT SCREW 5X14MM,C1713,HCPCS,,79006783,CDM,278,RC,,,both,,,478,188.65,39.4668,,188.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,167.3,35,,167.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,191.2,40,,191.2,percent of total billed charges,Implant Devices,167.3,70,,167.3,percent of total billed charges,Implant Devices,162.52,34,,162.52,percent of total billed charges,Implant Devices,162.52,34,,162.52,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,191.2,
ZIMMER 02-03152-055 CANC SCREW 5X55MM,C1713,HCPCS,,79006784,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
ZIMMER 02-03152-060 CANC SCREW 5X60MM,C1713,HCPCS,,79006785,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
ZIMMER 02-03152-065 CANC SCREW 5X65MM,C1713,HCPCS,,79006786,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
ARTHREX AR-2600SBS-4 SPEEDBRIDGE IMPLANT,C1713,HCPCS,,79006791,CDM,278,RC,,,both,,,5220,2060.17,39.4668,,2060.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1774.8,34,,1774.8,percent of total billed charges,Implant Device,1827,35,,1827,percent of total billed charges,Implant Device,1774.8,34,"Charges > $500, x 34%",1774.8,percent of total billed charges,Implant Device,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,2088,40,,2088,percent of total billed charges,Implant Devices,1827,70,,1827,percent of total billed charges,Implant Devices,1774.8,34,,1774.8,percent of total billed charges,Implant Devices,1774.8,34,,1774.8,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,1827,35,,1827,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1774.8,34,"If Charge > 2,000, then 34 percent",1774.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2088,
BIOMET 41-2008 NONLOCK SCREW X DRIVE 2X8,C1713,HCPCS,,79006792,CDM,278,RC,,,both,,,268,105.77,39.4668,,105.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,91.12,34,,91.12,percent of total billed charges,Implant Device,93.8,35,,93.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,107.2,40,,107.2,percent of total billed charges,Implant Devices,93.8,70,,93.8,percent of total billed charges,Implant Devices,91.12,34,,91.12,percent of total billed charges,Implant Devices,91.12,34,,91.12,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,93.8,35,,93.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.2,
BIOMET 45-0557 CRUSHED CANCELLOUS 15CC,C1713,HCPCS,,79006793,CDM,278,RC,,,both,,,846,333.89,39.4668,,333.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Device,287.64,34,"Charges > $500, x 34%",287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,338.4,40,,338.4,percent of total billed charges,Implant Devices,296.1,70,,296.1,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,338.4,
SYNTHES 02.240.046 CAN LOCK SCREW 3.7X46,C1713,HCPCS,,79006803,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
SYNTHES 02.240.050 CAN LOCK SCREW 3.7X50,C1713,HCPCS,,79006804,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
SYNTHES 02.240.038 CAN LOCK SCREW 3.7X38,C1713,HCPCS,,79006805,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
SYNTHES 02.240.032 CAN LOCK SCREW 3.7X32,C1713,HCPCS,,79006806,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
SYNTHES 02.240.042 CAN LOCK SCREW 3.7X42,C1713,HCPCS,,79006807,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
SYNTHES 02.123.023 HUMERUS PLATE 3.5X127,C1713,HCPCS,,79006808,CDM,278,RC,,,both,,,4155,1639.85,39.4668,,1639.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1412.7,34,,1412.7,percent of total billed charges,Implant Device,1412.7,34,,1412.7,percent of total billed charges,Implant Device,1412.7,34,,1412.7,percent of total billed charges,Implant Device,1412.7,34,,1412.7,percent of total billed charges,Implant Device,1412.7,34,,1412.7,percent of total billed charges,Implant Device,1412.7,34,,1412.7,percent of total billed charges,Implant Device,1454.25,35,,1454.25,percent of total billed charges,Implant Device,1412.7,34,"Charges > $500, x 34%",1412.7,percent of total billed charges,Implant Device,1454.25,35,,1454.25,percent of total billed charges,Implant Devices,1454.25,35,,1454.25,percent of total billed charges,Implant Devices,1454.25,35,,,percent of total billed charges,Implant Devices,1454.25,35,,1454.25,percent of total billed charges,Implant Devices,1454.25,35,,1454.25,percent of total billed charges,Implant Devices,1662,40,,1662,percent of total billed charges,Implant Devices,1454.25,70,,1454.25,percent of total billed charges,Implant Devices,1412.7,34,,1412.7,percent of total billed charges,Implant Devices,1412.7,34,,1412.7,percent of total billed charges,Implant Devices,1454.25,35,,1454.25,percent of total billed charges,Implant Devices,1454.25,35,,1454.25,percent of total billed charges,Implant Devices,1454.25,35,,1454.25,percent of total billed charges,Implant Devices,1454.25,35,,1454.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1412.7,34,"If Charge > 2,000, then 34 percent",1412.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1662,
SYNTHES 02.240.052 CAN LOCK SCREW 3.7X52,C1713,HCPCS,,79006809,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
SYNTHES 204.850 CORTEX SCREW 3.5X50MM,C1713,HCPCS,,79006811,CDM,278,RC,,,both,,,82,32.36,39.4668,,32.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,28.7,35,,28.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,32.8,40,,32.8,percent of total billed charges,Implant Devices,28.7,70,,28.7,percent of total billed charges,Implant Devices,27.88,34,,27.88,percent of total billed charges,Implant Devices,27.88,34,,27.88,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.8,
SYNTHES 204.834 CORTEX SCREW 3.5X34MM,C1713,HCPCS,,79006812,CDM,278,RC,,,both,,,59,23.29,39.4668,,23.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,23.6,40,,23.6,percent of total billed charges,Implant Devices,20.65,70,,20.65,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.6,
SYNTHES 204.836 CORTEX SCREW 3.5X36MM,C1713,HCPCS,,79006813,CDM,278,RC,,,both,,,59,23.29,39.4668,,23.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,23.6,40,,23.6,percent of total billed charges,Implant Devices,20.65,70,,20.65,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.6,
ARTHREX AR-1688-CP LIGAMENT AUGMENTATION,C1713,HCPCS,,79006814,CDM,278,RC,,,both,,,3225,1272.8,39.4668,,1272.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Device,1096.5,34,"Charges > $500, x 34%",1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1290,40,,1290,percent of total billed charges,Implant Devices,1128.75,70,,1128.75,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1096.5,34,"If Charge > 2,000, then 34 percent",1096.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1290,
ARTHREX AR-8943BL-05 FIB LOCK PLATE 5H,C1713,HCPCS,,79006818,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
ARTHREX AR-8840C-44 CANN SCREW 4.0X44MM,C1713,HCPCS,,79006819,CDM,278,RC,,,both,,,496,195.76,39.4668,,195.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,198.4,40,,198.4,percent of total billed charges,Implant Devices,173.6,70,,173.6,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.4,
LIFE SPINE 9035-14 POLY SCREW 3.5X14MM,C1713,HCPCS,,79006820,CDM,278,RC,,,both,,,4320,1704.97,39.4668,,1704.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1512,35,,1512,percent of total billed charges,Implant Device,1468.8,34,"Charges > $500, x 34%",1468.8,percent of total billed charges,Implant Device,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1728,40,,1728,percent of total billed charges,Implant Devices,1512,70,,1512,percent of total billed charges,Implant Devices,1468.8,34,,1468.8,percent of total billed charges,Implant Devices,1468.8,34,,1468.8,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1468.8,34,"If Charge > 2,000, then 34 percent",1468.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1728,
LIFE SPINE 4350-080 ROD 3.5X80MM,C1713,HCPCS,,79006821,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
LIFE SPINE 3350-120 STRGHT ROD 3.5X120MM,C1713,HCPCS,,79006822,CDM,278,RC,,,both,,,804,317.31,39.4668,,317.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Device,273.36,34,"Charges > $500, x 34%",273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,321.6,40,,321.6,percent of total billed charges,Implant Devices,281.4,70,,281.4,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,321.6,
LIFE SPINE 900-003 LOCKING CAP ASSEMBLY,C1713,HCPCS,,79006823,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
STRYKER 3425-0400S LONG NAIL KIT R1 5 RT,C1713,HCPCS,,79006825,CDM,278,RC,,,both,,,9415,3715.8,39.4668,,3715.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3201.1,34,,3201.1,percent of total billed charges,Implant Device,3201.1,34,,3201.1,percent of total billed charges,Implant Device,3201.1,34,,3201.1,percent of total billed charges,Implant Device,3201.1,34,,3201.1,percent of total billed charges,Implant Device,3201.1,34,,3201.1,percent of total billed charges,Implant Device,3201.1,34,,3201.1,percent of total billed charges,Implant Device,3295.25,35,,3295.25,percent of total billed charges,Implant Device,3201.1,34,"Charges > $500, x 34%",3201.1,percent of total billed charges,Implant Device,3295.25,35,,3295.25,percent of total billed charges,Implant Devices,3295.25,35,,3295.25,percent of total billed charges,Implant Devices,3295.25,35,,,percent of total billed charges,Implant Devices,3295.25,35,,3295.25,percent of total billed charges,Implant Devices,3295.25,35,,3295.25,percent of total billed charges,Implant Devices,3766,40,,3766,percent of total billed charges,Implant Devices,3295.25,70,,3295.25,percent of total billed charges,Implant Devices,3201.1,34,,3201.1,percent of total billed charges,Implant Devices,3201.1,34,,3201.1,percent of total billed charges,Implant Devices,3295.25,35,,3295.25,percent of total billed charges,Implant Devices,3295.25,35,,3295.25,percent of total billed charges,Implant Devices,3295.25,35,,3295.25,percent of total billed charges,Implant Devices,3295.25,35,,3295.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3201.1,34,"If Charge > 2,000, then 34 percent",3201.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3766,
ARTHREX AR-9055-55PT SCREW 5.5X55MM,C1713,HCPCS,,79006831,CDM,278,RC,,,both,,,3408,1345.03,39.4668,,1345.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1192.8,35,,1192.8,percent of total billed charges,Implant Device,1158.72,34,"Charges > $500, x 34%",1158.72,percent of total billed charges,Implant Device,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1363.2,40,,1363.2,percent of total billed charges,Implant Devices,1192.8,70,,1192.8,percent of total billed charges,Implant Devices,1158.72,34,,1158.72,percent of total billed charges,Implant Devices,1158.72,34,,1158.72,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1158.72,34,"If Charge > 2,000, then 34 percent",1158.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1363.2,
STRYKER 58-19008E NON LOCK SCREW 1.9X8M,C1713,HCPCS,,79006832,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
STRYKER 57-13408 PLATE STRAIGHT 6 HOLE,C1713,HCPCS,,79006833,CDM,278,RC,,,both,,,1206,475.97,39.4668,,475.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,410.04,34,,410.04,percent of total billed charges,Implant Device,410.04,34,,410.04,percent of total billed charges,Implant Device,410.04,34,,410.04,percent of total billed charges,Implant Device,410.04,34,,410.04,percent of total billed charges,Implant Device,410.04,34,,410.04,percent of total billed charges,Implant Device,410.04,34,,410.04,percent of total billed charges,Implant Device,422.1,35,,422.1,percent of total billed charges,Implant Device,410.04,34,"Charges > $500, x 34%",410.04,percent of total billed charges,Implant Device,422.1,35,,422.1,percent of total billed charges,Implant Devices,422.1,35,,422.1,percent of total billed charges,Implant Devices,422.1,35,,,percent of total billed charges,Implant Devices,422.1,35,,422.1,percent of total billed charges,Implant Devices,422.1,35,,422.1,percent of total billed charges,Implant Devices,482.4,40,,482.4,percent of total billed charges,Implant Devices,422.1,70,,422.1,percent of total billed charges,Implant Devices,410.04,34,,410.04,percent of total billed charges,Implant Devices,410.04,34,,410.04,percent of total billed charges,Implant Devices,422.1,35,,422.1,percent of total billed charges,Implant Devices,422.1,35,,422.1,percent of total billed charges,Implant Devices,422.1,35,,422.1,percent of total billed charges,Implant Devices,422.1,35,,422.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,482.4,
BIOCOMPOSITES 620-020 STIMULAN 20CC,C1713,HCPCS,,79006841,CDM,278,RC,,,both,,,9570,3776.97,39.4668,,3776.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3253.8,34,,3253.8,percent of total billed charges,Implant Device,3253.8,34,,3253.8,percent of total billed charges,Implant Device,3253.8,34,,3253.8,percent of total billed charges,Implant Device,3253.8,34,,3253.8,percent of total billed charges,Implant Device,3253.8,34,,3253.8,percent of total billed charges,Implant Device,3253.8,34,,3253.8,percent of total billed charges,Implant Device,3349.5,35,,3349.5,percent of total billed charges,Implant Device,3253.8,34,"Charges > $500, x 34%",3253.8,percent of total billed charges,Implant Device,3349.5,35,,3349.5,percent of total billed charges,Implant Devices,3349.5,35,,3349.5,percent of total billed charges,Implant Devices,3349.5,35,,,percent of total billed charges,Implant Devices,3349.5,35,,3349.5,percent of total billed charges,Implant Devices,3349.5,35,,3349.5,percent of total billed charges,Implant Devices,3828,40,,3828,percent of total billed charges,Implant Devices,3349.5,70,,3349.5,percent of total billed charges,Implant Devices,3253.8,34,,3253.8,percent of total billed charges,Implant Devices,3253.8,34,,3253.8,percent of total billed charges,Implant Devices,3349.5,35,,3349.5,percent of total billed charges,Implant Devices,3349.5,35,,3349.5,percent of total billed charges,Implant Devices,3349.5,35,,3349.5,percent of total billed charges,Implant Devices,3349.5,35,,3349.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3253.8,34,"If Charge > 2,000, then 34 percent",3253.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3828,
DEPUY 02.200.018 3.5X18MM CORTEX SCREW,C1713,HCPCS,,79006846,CDM,278,RC,,,both,,,95,37.49,39.4668,,37.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.3,34,,32.3,percent of total billed charges,Implant Device,32.3,34,,32.3,percent of total billed charges,Implant Device,32.3,34,,32.3,percent of total billed charges,Implant Device,32.3,34,,32.3,percent of total billed charges,Implant Device,32.3,34,,32.3,percent of total billed charges,Implant Device,32.3,34,,32.3,percent of total billed charges,Implant Device,33.25,35,,33.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.25,35,,33.25,percent of total billed charges,Implant Devices,33.25,35,,33.25,percent of total billed charges,Implant Devices,33.25,35,,,percent of total billed charges,Implant Devices,33.25,35,,33.25,percent of total billed charges,Implant Devices,33.25,35,,33.25,percent of total billed charges,Implant Devices,38,40,,38,percent of total billed charges,Implant Devices,33.25,70,,33.25,percent of total billed charges,Implant Devices,32.3,34,,32.3,percent of total billed charges,Implant Devices,32.3,34,,32.3,percent of total billed charges,Implant Devices,33.25,35,,33.25,percent of total billed charges,Implant Devices,33.25,35,,33.25,percent of total billed charges,Implant Devices,33.25,35,,33.25,percent of total billed charges,Implant Devices,33.25,35,,33.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38,
DEPUY 02.200.016 3.5X16MM CORTEX SCREW,C1713,HCPCS,,79006847,CDM,278,RC,,,both,,,99,39.07,39.4668,,39.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,39.6,40,,39.6,percent of total billed charges,Implant Devices,34.65,70,,34.65,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39.6,
ARTHREX AR-8740-20PTS 4X20MM SCREW,C1713,HCPCS,,79006852,CDM,278,RC,,,both,,,496,195.76,39.4668,,195.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,168.64,34,,168.64,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,198.4,40,,198.4,percent of total billed charges,Implant Devices,173.6,70,,173.6,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,168.64,34,,168.64,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,173.6,35,,173.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.4,
ARTHREX AR-8740-30PTS 4X30MM SCREW,C1713,HCPCS,,79006853,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ARTHREX AR-8740-28H 4X28MM THREAD SCREW,C1713,HCPCS,,79006854,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
ARTHREX AR-8737-42 1.1 K WIRE,C1713,HCPCS,,79006855,CDM,278,RC,,,both,,,78,30.78,39.4668,,30.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,27.3,35,,27.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,31.2,40,,31.2,percent of total billed charges,Implant Devices,27.3,70,,27.3,percent of total billed charges,Implant Devices,26.52,34,,26.52,percent of total billed charges,Implant Devices,26.52,34,,26.52,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.2,
ARTHREX AR-8737-22 .86 THREAD TIP K-WIRE,C1713,HCPCS,,79006856,CDM,278,RC,,,both,,,60,23.68,39.4668,,23.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.4,34,,20.4,percent of total billed charges,Implant Device,20.4,34,,20.4,percent of total billed charges,Implant Device,20.4,34,,20.4,percent of total billed charges,Implant Device,20.4,34,,20.4,percent of total billed charges,Implant Device,20.4,34,,20.4,percent of total billed charges,Implant Device,20.4,34,,20.4,percent of total billed charges,Implant Device,21,35,,21,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,21,35,,21,percent of total billed charges,Implant Devices,21,35,,21,percent of total billed charges,Implant Devices,21,35,,,percent of total billed charges,Implant Devices,21,35,,21,percent of total billed charges,Implant Devices,21,35,,21,percent of total billed charges,Implant Devices,24,40,,24,percent of total billed charges,Implant Devices,21,70,,21,percent of total billed charges,Implant Devices,20.4,34,,20.4,percent of total billed charges,Implant Devices,20.4,34,,20.4,percent of total billed charges,Implant Devices,21,35,,21,percent of total billed charges,Implant Devices,21,35,,21,percent of total billed charges,Implant Devices,21,35,,21,percent of total billed charges,Implant Devices,21,35,,21,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24,
ARTHREX AR-8956-01 5TH MERAT HOOK PLATE,C1713,HCPCS,,79006857,CDM,278,RC,,,both,,,2775,1095.2,39.4668,,1095.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,943.5,34,,943.5,percent of total billed charges,Implant Device,943.5,34,,943.5,percent of total billed charges,Implant Device,943.5,34,,943.5,percent of total billed charges,Implant Device,943.5,34,,943.5,percent of total billed charges,Implant Device,943.5,34,,943.5,percent of total billed charges,Implant Device,943.5,34,,943.5,percent of total billed charges,Implant Device,971.25,35,,971.25,percent of total billed charges,Implant Device,943.5,34,"Charges > $500, x 34%",943.5,percent of total billed charges,Implant Device,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,1110,40,,1110,percent of total billed charges,Implant Devices,971.25,70,,971.25,percent of total billed charges,Implant Devices,943.5,34,,943.5,percent of total billed charges,Implant Devices,943.5,34,,943.5,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,943.5,34,"If Charge > 2,000, then 34 percent",943.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1110,
ARTHREX AR-8724V-08 2.4X8MM LOCK SCREW,C1713,HCPCS,,79006858,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ARTHREX AR-8724-10 2.4X10MM NON-LCK SCRW,C1713,HCPCS,,79006859,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
STRYKER ORTHO 437123 3 HOLE RT PROX PLTE,C1713,HCPCS,,79006860,CDM,278,RC,,,both,,,5483,2163.96,39.4668,,2163.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Device,1864.22,34,"Charges > $500, x 34%",1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,2193.2,40,,2193.2,percent of total billed charges,Implant Devices,1919.05,70,,1919.05,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1864.22,34,"If Charge > 2,000, then 34 percent",1864.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2193.2,
STRYKER ORTHO 338620 3.5X20MM CORT SCREW,C1713,HCPCS,,79006861,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER ORTHO 345430 4X30MM CANCEL SCREW,C1713,HCPCS,,79006862,CDM,278,RC,,,both,,,104,41.05,39.4668,,41.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,41.6,40,,41.6,percent of total billed charges,Implant Devices,36.4,70,,36.4,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,41.6,
SYNTHES 204.826 CORTEX SCREW 3.5X26MM,C1713,HCPCS,,79006868,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
SYNTHES 02.211.020 LOCK SCREW 2.7X20MM,C1713,HCPCS,,79006869,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
SYNTHES 02.118.532 SELF TAP SCREW 2.7X32,C1713,HCPCS,,79006870,CDM,278,RC,,,both,,,184,72.62,39.4668,,72.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,62.56,34,,62.56,percent of total billed charges,Implant Device,62.56,34,,62.56,percent of total billed charges,Implant Device,62.56,34,,62.56,percent of total billed charges,Implant Device,62.56,34,,62.56,percent of total billed charges,Implant Device,62.56,34,,62.56,percent of total billed charges,Implant Device,62.56,34,,62.56,percent of total billed charges,Implant Device,64.4,35,,64.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,73.6,40,,73.6,percent of total billed charges,Implant Devices,64.4,70,,64.4,percent of total billed charges,Implant Devices,62.56,34,,62.56,percent of total billed charges,Implant Devices,62.56,34,,62.56,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,73.6,
SYNTHES 02.211.030 LOCK SCREW 2.7X30MM,C1713,HCPCS,,79006871,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
SYNTHES 02.211.056 LOCK SCREW 2.7X56MM,C1713,HCPCS,,79006872,CDM,278,RC,,,both,,,553,218.25,39.4668,,218.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,193.55,35,,193.55,percent of total billed charges,Implant Device,188.02,34,"Charges > $500, x 34%",188.02,percent of total billed charges,Implant Device,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,221.2,40,,221.2,percent of total billed charges,Implant Devices,193.55,70,,193.55,percent of total billed charges,Implant Devices,188.02,34,,188.02,percent of total billed charges,Implant Devices,188.02,34,,188.02,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
SYNTHES 02.211.016 LOCK SCREW 2.7X16MM,C1713,HCPCS,,79006873,CDM,278,RC,,,both,,,570,224.96,39.4668,,224.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,193.8,34,,193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Device,193.8,34,"Charges > $500, x 34%",193.8,percent of total billed charges,Implant Device,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,228,40,,228,percent of total billed charges,Implant Devices,199.5,70,,199.5,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,193.8,34,,193.8,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,199.5,35,,199.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228,
SYNTHES 02.107.302 OLECRN PLATE 2.7X3.5,C1713,HCPCS,,79006874,CDM,278,RC,,,both,,,2826,1115.33,39.4668,,1115.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,989.1,35,,989.1,percent of total billed charges,Implant Device,960.84,34,"Charges > $500, x 34%",960.84,percent of total billed charges,Implant Device,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,1130.4,40,,1130.4,percent of total billed charges,Implant Devices,989.1,70,,989.1,percent of total billed charges,Implant Devices,960.84,34,,960.84,percent of total billed charges,Implant Devices,960.84,34,,960.84,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,960.84,34,"If Charge > 2,000, then 34 percent",960.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1130.4,
SYNTHES 02.211.040 LOCK SCREW 2.7X40MM,C1713,HCPCS,,79006875,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
ARTHREX AR-8724V-12 LOCKING SCREW 2.4X12,C1713,HCPCS,,79006877,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
SYNTHES 02.123.041 HUMERUS PLATE 3.5MM,C1713,HCPCS,,79006888,CDM,278,RC,,,both,,,3987,1573.54,39.4668,,1573.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1395.45,35,,1395.45,percent of total billed charges,Implant Device,1355.58,34,"Charges > $500, x 34%",1355.58,percent of total billed charges,Implant Device,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1594.8,40,,1594.8,percent of total billed charges,Implant Devices,1395.45,70,,1395.45,percent of total billed charges,Implant Devices,1355.58,34,,1355.58,percent of total billed charges,Implant Devices,1355.58,34,,1355.58,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1355.58,34,"If Charge > 2,000, then 34 percent",1355.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1594.8,
SYNTHES 02.240.034 CANN LCK SCREW 3.7X34,C1713,HCPCS,,79006889,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
SYNTHES 02.240.036 CANN LCK SCREW 3.7X36,C1713,HCPCS,,79006890,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
SYNTHES 02.240.048 CANN LCK SCREW 3.7X48,C1713,HCPCS,,79006891,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
SYNTHES 02.240.054 CANN LCK SCREW 3.7X54,C1713,HCPCS,,79006892,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
SYNTHES 204.830 CORTEX SCREW 3.5X30MM,C1713,HCPCS,,79006893,CDM,278,RC,,,both,,,59,23.29,39.4668,,23.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,23.6,40,,23.6,percent of total billed charges,Implant Devices,20.65,70,,20.65,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.6,
SYNTHES 204.828 CORTEX SCREW 3.5X28MM,C1713,HCPCS,,79006894,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
SYNTHES 212.109 LOCKING SCREW 3.5X26MM,C1713,HCPCS,,79006895,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
VILEX TH-25-20T-1100 HAMMERFUZE 2.5X2,C1713,HCPCS,,79006900,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
ARTHREX AR-8916VNR-03 VOLAR PLATE 3HOLE,C1713,HCPCS,,79006908,CDM,278,RC,,,both,,,2386,941.68,39.4668,,941.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,811.24,34,,811.24,percent of total billed charges,Implant Device,835.1,35,,835.1,percent of total billed charges,Implant Device,811.24,34,"Charges > $500, x 34%",811.24,percent of total billed charges,Implant Device,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,954.4,40,,954.4,percent of total billed charges,Implant Devices,835.1,70,,835.1,percent of total billed charges,Implant Devices,811.24,34,,811.24,percent of total billed charges,Implant Devices,811.24,34,,811.24,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,835.1,35,,835.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,811.24,34,"If Charge > 2,000, then 34 percent",811.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,954.4,
ARTHREX AR-8935-14 CORT SCREW 3.5X14MM,C1713,HCPCS,,79006909,CDM,278,RC,,,both,,,195,76.96,39.4668,,76.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,78,40,,78,percent of total billed charges,Implant Devices,68.25,70,,68.25,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78,
ARTHREX AR-8935-16 CORT SCREW 3.5X16MM,C1713,HCPCS,,79006910,CDM,278,RC,,,both,,,195,76.96,39.4668,,76.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,78,40,,78,percent of total billed charges,Implant Devices,68.25,70,,68.25,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78,
ARTHREX AR-8924V-16 LOCK SCREW 2.4X16MM,C1713,HCPCS,,79006911,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ARTHREX AR-8724V-18 LOCK SCREW 2.4X18MM,C1713,HCPCS,,79006912,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ARTHREX AR-8924V-22 LOCK SCREW 2.4X22MM,C1713,HCPCS,,79006913,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ARTHREX AR-8720V-20 LOCK SCREW 2.4X20MM,C1713,HCPCS,,79006914,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ALPHATEC SPINE 71001-14 PLATE 14MM,C1713,HCPCS,,79006922,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
ALPHATEC SPINE 71002-37 PLATE 2 LEV 37MM,C1713,HCPCS,,79006923,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
SYNTHES 208.406 CANN SCREW 6.5X55MM,C1713,HCPCS,,79006938,CDM,278,RC,,,both,,,1120,442.03,39.4668,,442.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,380.8,34,,380.8,percent of total billed charges,Implant Device,380.8,34,,380.8,percent of total billed charges,Implant Device,380.8,34,,380.8,percent of total billed charges,Implant Device,380.8,34,,380.8,percent of total billed charges,Implant Device,380.8,34,,380.8,percent of total billed charges,Implant Device,380.8,34,,380.8,percent of total billed charges,Implant Device,392,35,,392,percent of total billed charges,Implant Device,380.8,34,"Charges > $500, x 34%",380.8,percent of total billed charges,Implant Device,392,35,,392,percent of total billed charges,Implant Devices,392,35,,392,percent of total billed charges,Implant Devices,392,35,,,percent of total billed charges,Implant Devices,392,35,,392,percent of total billed charges,Implant Devices,392,35,,392,percent of total billed charges,Implant Devices,448,40,,448,percent of total billed charges,Implant Devices,392,70,,392,percent of total billed charges,Implant Devices,380.8,34,,380.8,percent of total billed charges,Implant Devices,380.8,34,,380.8,percent of total billed charges,Implant Devices,392,35,,392,percent of total billed charges,Implant Devices,392,35,,392,percent of total billed charges,Implant Devices,392,35,,392,percent of total billed charges,Implant Devices,392,35,,392,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,448,
SYNTHES 214.064 CORTEX SCREW 4.5X64MM,C1713,HCPCS,,79006939,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
ZIMMER 00-5980-047-02 TIBIAL PLATE SZ 6,C1713,HCPCS,,79006941,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
DEPUY 02.118.402 2.7 MM 4 HOLE PLATE,C1713,HCPCS,,79006944,CDM,278,RC,,,both,,,3169,1250.7,39.4668,,1250.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1077.46,34,,1077.46,percent of total billed charges,Implant Device,1077.46,34,,1077.46,percent of total billed charges,Implant Device,1077.46,34,,1077.46,percent of total billed charges,Implant Device,1077.46,34,,1077.46,percent of total billed charges,Implant Device,1077.46,34,,1077.46,percent of total billed charges,Implant Device,1077.46,34,,1077.46,percent of total billed charges,Implant Device,1109.15,35,,1109.15,percent of total billed charges,Implant Device,1077.46,34,"Charges > $500, x 34%",1077.46,percent of total billed charges,Implant Device,1109.15,35,,1109.15,percent of total billed charges,Implant Devices,1109.15,35,,1109.15,percent of total billed charges,Implant Devices,1109.15,35,,,percent of total billed charges,Implant Devices,1109.15,35,,1109.15,percent of total billed charges,Implant Devices,1109.15,35,,1109.15,percent of total billed charges,Implant Devices,1267.6,40,,1267.6,percent of total billed charges,Implant Devices,1109.15,70,,1109.15,percent of total billed charges,Implant Devices,1077.46,34,,1077.46,percent of total billed charges,Implant Devices,1077.46,34,,1077.46,percent of total billed charges,Implant Devices,1109.15,35,,1109.15,percent of total billed charges,Implant Devices,1109.15,35,,1109.15,percent of total billed charges,Implant Devices,1109.15,35,,1109.15,percent of total billed charges,Implant Devices,1109.15,35,,1109.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1077.46,34,"If Charge > 2,000, then 34 percent",1077.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1267.6,
DEPUY 202.884 2.7 X 24MM CORTEX SCREW,C1713,HCPCS,,79006945,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
DEPUY 02.206.216 3.5X16MM CORTEX SCREW,C1713,HCPCS,,79006946,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
DEPUY 02.118.516 2.7 C 16MM META SCREW,C1713,HCPCS,,79006947,CDM,278,RC,,,both,,,178,70.25,39.4668,,70.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,62.3,35,,62.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,71.2,40,,71.2,percent of total billed charges,Implant Devices,62.3,70,,62.3,percent of total billed charges,Implant Devices,60.52,34,,60.52,percent of total billed charges,Implant Devices,60.52,34,,60.52,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.2,
DEPUY 02.211.018 2.7X18MM VA LCKNG SCREW,C1713,HCPCS,,79006948,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 02.118.400 2.7MM 3 HOLE PLATE,C1713,HCPCS,,79006949,CDM,278,RC,,,both,,,3125,1233.34,39.4668,,1233.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1093.75,35,,1093.75,percent of total billed charges,Implant Device,1062.5,34,"Charges > $500, x 34%",1062.5,percent of total billed charges,Implant Device,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1250,40,,1250,percent of total billed charges,Implant Devices,1093.75,70,,1093.75,percent of total billed charges,Implant Devices,1062.5,34,,1062.5,percent of total billed charges,Implant Devices,1062.5,34,,1062.5,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1062.5,34,"If Charge > 2,000, then 34 percent",1062.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1250,
DEPUY 02.118.518 2.7 C 18MM META SCREW,C1713,HCPCS,,79006950,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
DEPUY 02.211.012 2.7 X 12MM LCKNG SCREW,C1713,HCPCS,,79006951,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 202.874 2.7 X 14MM CORTEX SCREW,C1713,HCPCS,,79006952,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
DEPUY 02.206.214 3.5X14MM CORTEX SCREW,C1713,HCPCS,,79006953,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
DEPUY 207.744 4X44MM CANNUALTED SCREW,C1713,HCPCS,,79006954,CDM,278,RC,,,both,,,685,270.35,39.4668,,270.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,232.9,34,,232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Device,232.9,34,"Charges > $500, x 34%",232.9,percent of total billed charges,Implant Device,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,274,40,,274,percent of total billed charges,Implant Devices,239.75,70,,239.75,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,232.9,34,,232.9,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,239.75,35,,239.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274,
STRYKER 54-25374 VOLAR PLATE LEFT,C1713,HCPCS,,79006958,CDM,278,RC,,,both,,,2438,962.2,39.4668,,962.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,828.92,34,,828.92,percent of total billed charges,Implant Device,828.92,34,,828.92,percent of total billed charges,Implant Device,828.92,34,,828.92,percent of total billed charges,Implant Device,828.92,34,,828.92,percent of total billed charges,Implant Device,828.92,34,,828.92,percent of total billed charges,Implant Device,828.92,34,,828.92,percent of total billed charges,Implant Device,853.3,35,,853.3,percent of total billed charges,Implant Device,828.92,34,"Charges > $500, x 34%",828.92,percent of total billed charges,Implant Device,853.3,35,,853.3,percent of total billed charges,Implant Devices,853.3,35,,853.3,percent of total billed charges,Implant Devices,853.3,35,,,percent of total billed charges,Implant Devices,853.3,35,,853.3,percent of total billed charges,Implant Devices,853.3,35,,853.3,percent of total billed charges,Implant Devices,975.2,40,,975.2,percent of total billed charges,Implant Devices,853.3,70,,853.3,percent of total billed charges,Implant Devices,828.92,34,,828.92,percent of total billed charges,Implant Devices,828.92,34,,828.92,percent of total billed charges,Implant Devices,853.3,35,,853.3,percent of total billed charges,Implant Devices,853.3,35,,853.3,percent of total billed charges,Implant Devices,853.3,35,,853.3,percent of total billed charges,Implant Devices,853.3,35,,853.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,828.92,34,"If Charge > 2,000, then 34 percent",828.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,975.2,
ARTHREX AR-8835L-20 3.5X20MM LOCK SCREW,C1713,HCPCS,,79006959,CDM,278,RC,,,both,,,346,136.56,39.4668,,136.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,138.4,40,,138.4,percent of total billed charges,Implant Devices,121.1,70,,121.1,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138.4,
SYNTHES 212.111 LOCKING SCREW 3.5X30MM,C1713,HCPCS,,79006960,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
DEPUY 02.240.030 CANN LOCK SCREW 3.7X30,C1713,HCPCS,,79006966,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
DEPUY 02.240.044 CANN LOCK SCREW 3.7X44,C1713,HCPCS,,79006967,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
DEPUY 02.123.021 HUMERUS PLATE 2HOLE 3.5,C1713,HCPCS,,79006977,CDM,278,RC,,,both,,,3929,1550.65,39.4668,,1550.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1375.15,35,,1375.15,percent of total billed charges,Implant Device,1335.86,34,"Charges > $500, x 34%",1335.86,percent of total billed charges,Implant Device,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1571.6,40,,1571.6,percent of total billed charges,Implant Devices,1375.15,70,,1375.15,percent of total billed charges,Implant Devices,1335.86,34,,1335.86,percent of total billed charges,Implant Devices,1335.86,34,,1335.86,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1335.86,34,"If Charge > 2,000, then 34 percent",1335.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1571.6,
DEPUY 204.824 CORTEX SCREW 3.5X24MM,C1713,HCPCS,,79006978,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
STRYKER 349614 2.7X14MM CORTEX SCREW SS,C1713,HCPCS,,79006979,CDM,278,RC,,,both,,,138,54.46,39.4668,,54.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,55.2,40,,55.2,percent of total billed charges,Implant Devices,48.3,70,,48.3,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.2,
STRYKER 371008 3X8MM LOCKING SCREW SS,C1713,HCPCS,,79006980,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
STRYKER 371020 3X20MM LOCKING SCREW SS,C1713,HCPCS,,79006981,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
STRYKER 371022 3X22MM LOCKING SCREW SS,C1713,HCPCS,,79006982,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
ARTHREX AR-8692DS IMPLANT SYS CPR VIPER,C1713,HCPCS,,79006983,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
DEPUY 456.317S 11X125MM TROCH NAIL 170MM,C1713,HCPCS,,79006984,CDM,278,RC,,,both,,,2738,1080.6,39.4668,,1080.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Device,930.92,34,"Charges > $500, x 34%",930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,1095.2,40,,1095.2,percent of total billed charges,Implant Devices,958.3,70,,958.3,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,930.92,34,"If Charge > 2,000, then 34 percent",930.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1095.2,
DEPUY 458.936S 5X36MM LOCK SCREW,C1713,HCPCS,,79006985,CDM,278,RC,,,both,,,456,179.97,39.4668,,179.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,182.4,40,,182.4,percent of total billed charges,Implant Devices,159.6,70,,159.6,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182.4,
DEPUY 04.02.095S 11X95MM TROCH SCREW,C1713,HCPCS,,79006986,CDM,278,RC,,,both,,,1900,749.87,39.4668,,749.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,646,34,,646,percent of total billed charges,Implant Device,646,34,,646,percent of total billed charges,Implant Device,646,34,,646,percent of total billed charges,Implant Device,646,34,,646,percent of total billed charges,Implant Device,646,34,,646,percent of total billed charges,Implant Device,646,34,,646,percent of total billed charges,Implant Device,665,35,,665,percent of total billed charges,Implant Device,646,34,"Charges > $500, x 34%",646,percent of total billed charges,Implant Device,665,35,,665,percent of total billed charges,Implant Devices,665,35,,665,percent of total billed charges,Implant Devices,665,35,,,percent of total billed charges,Implant Devices,665,35,,665,percent of total billed charges,Implant Devices,665,35,,665,percent of total billed charges,Implant Devices,760,40,,760,percent of total billed charges,Implant Devices,665,70,,665,percent of total billed charges,Implant Devices,646,34,,646,percent of total billed charges,Implant Devices,646,34,,646,percent of total billed charges,Implant Devices,665,35,,665,percent of total billed charges,Implant Devices,665,35,,665,percent of total billed charges,Implant Devices,665,35,,665,percent of total billed charges,Implant Devices,665,35,,665,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,760,
EXACTECH 320-20-46 COMPRESSN SCREW 46MM,C1713,HCPCS,,79006990,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
ARTHREX AR-8945-36PT CANN SCREW 4.5X36MM,C1713,HCPCS,,79006998,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ARTHREX AR-8930-11 SNAP OFF SCREW 2X11MM,C1713,HCPCS,,79006999,CDM,278,RC,,,both,,,1029,406.11,39.4668,,406.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,360.15,35,,360.15,percent of total billed charges,Implant Device,349.86,34,"Charges > $500, x 34%",349.86,percent of total billed charges,Implant Device,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,411.6,40,,411.6,percent of total billed charges,Implant Devices,360.15,70,,360.15,percent of total billed charges,Implant Devices,349.86,34,,349.86,percent of total billed charges,Implant Devices,349.86,34,,349.86,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,411.6,
ZIMMER 402.202 SUBCHONDROPLASTY KNEE KIT,C1713,HCPCS,,79007001,CDM,278,RC,,,both,,,9885,3901.29,39.4668,,3901.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3360.9,34,,3360.9,percent of total billed charges,Implant Device,3360.9,34,,3360.9,percent of total billed charges,Implant Device,3360.9,34,,3360.9,percent of total billed charges,Implant Device,3360.9,34,,3360.9,percent of total billed charges,Implant Device,3360.9,34,,3360.9,percent of total billed charges,Implant Device,3360.9,34,,3360.9,percent of total billed charges,Implant Device,3459.75,35,,3459.75,percent of total billed charges,Implant Device,3360.9,34,"Charges > $500, x 34%",3360.9,percent of total billed charges,Implant Device,3459.75,35,,3459.75,percent of total billed charges,Implant Devices,3459.75,35,,3459.75,percent of total billed charges,Implant Devices,3459.75,35,,,percent of total billed charges,Implant Devices,3459.75,35,,3459.75,percent of total billed charges,Implant Devices,3459.75,35,,3459.75,percent of total billed charges,Implant Devices,3954,40,,3954,percent of total billed charges,Implant Devices,3459.75,70,,3459.75,percent of total billed charges,Implant Devices,3360.9,34,,3360.9,percent of total billed charges,Implant Devices,3360.9,34,,3360.9,percent of total billed charges,Implant Devices,3459.75,35,,3459.75,percent of total billed charges,Implant Devices,3459.75,35,,3459.75,percent of total billed charges,Implant Devices,3459.75,35,,3459.75,percent of total billed charges,Implant Devices,3459.75,35,,3459.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3360.9,34,"If Charge > 2,000, then 34 percent",3360.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3954,
WRIGHT CCP-RPNOL LAPIDUS NEUTAL PLATE,C1713,HCPCS,,79007006,CDM,278,RC,,,both,,,6708,2647.43,39.4668,,2647.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Device,2280.72,34,"Charges > $500, x 34%",2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2683.2,40,,2683.2,percent of total billed charges,Implant Devices,2347.8,70,,2347.8,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2280.72,34,"If Charge > 2,000, then 34 percent",2280.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2683.2,
WRIGHT CCP-L3020 LOCKING SCREW 2X20MM,C1713,HCPCS,,79007007,CDM,278,RC,,,both,,,1126,444.4,39.4668,,444.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Device,382.84,34,"Charges > $500, x 34%",382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,450.4,40,,450.4,percent of total billed charges,Implant Devices,394.1,70,,394.1,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450.4,
WRIGHT CCP-N3018 NONLOCKING SCREW 3X18MM,C1713,HCPCS,,79007008,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
P28 P20-135-022S CANN SCREW 3.5X22MM,C1713,HCPCS,,79007011,CDM,278,RC,,,both,,,686,270.74,39.4668,,270.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,240.1,35,,240.1,percent of total billed charges,Implant Device,233.24,34,"Charges > $500, x 34%",233.24,percent of total billed charges,Implant Device,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,274.4,40,,274.4,percent of total billed charges,Implant Devices,240.1,70,,240.1,percent of total billed charges,Implant Devices,233.24,34,,233.24,percent of total billed charges,Implant Devices,233.24,34,,233.24,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.4,
P28 P50-053-2714 LOCK PLATE SCREW 2.7X14,C1713,HCPCS,,79007012,CDM,278,RC,,,both,,,667,263.24,39.4668,,263.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Device,226.78,34,"Charges > $500, x 34%",226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,266.8,40,,266.8,percent of total billed charges,Implant Devices,233.45,70,,233.45,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.8,
P28 P50-053-2715 LOCK PLATE SCREW 2.7X15,C1713,HCPCS,,79007013,CDM,278,RC,,,both,,,667,263.24,39.4668,,263.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Device,226.78,34,"Charges > $500, x 34%",226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,266.8,40,,266.8,percent of total billed charges,Implant Devices,233.45,70,,233.45,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.8,
P28 P50-053-3516 LOCK PLATE SCREW 3.5X16,C1713,HCPCS,,79007014,CDM,278,RC,,,both,,,880,347.31,39.4668,,347.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Device,299.2,34,"Charges > $500, x 34%",299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,352,40,,352,percent of total billed charges,Implant Devices,308,70,,308,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,352,
P28 P50-153-3516 NON LOCK SCREW 3.5X16,C1713,HCPCS,,79007015,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
P28 P53-103-L052 PLATE MED LT 5 DEG MTP,C1713,HCPCS,,79007016,CDM,278,RC,,,both,,,4837,1909.01,39.4668,,1909.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1644.58,34,,1644.58,percent of total billed charges,Implant Device,1644.58,34,,1644.58,percent of total billed charges,Implant Device,1644.58,34,,1644.58,percent of total billed charges,Implant Device,1644.58,34,,1644.58,percent of total billed charges,Implant Device,1644.58,34,,1644.58,percent of total billed charges,Implant Device,1644.58,34,,1644.58,percent of total billed charges,Implant Device,1692.95,35,,1692.95,percent of total billed charges,Implant Device,1644.58,34,"Charges > $500, x 34%",1644.58,percent of total billed charges,Implant Device,1692.95,35,,1692.95,percent of total billed charges,Implant Devices,1692.95,35,,1692.95,percent of total billed charges,Implant Devices,1692.95,35,,,percent of total billed charges,Implant Devices,1692.95,35,,1692.95,percent of total billed charges,Implant Devices,1692.95,35,,1692.95,percent of total billed charges,Implant Devices,1934.8,40,,1934.8,percent of total billed charges,Implant Devices,1692.95,70,,1692.95,percent of total billed charges,Implant Devices,1644.58,34,,1644.58,percent of total billed charges,Implant Devices,1644.58,34,,1644.58,percent of total billed charges,Implant Devices,1692.95,35,,1692.95,percent of total billed charges,Implant Devices,1692.95,35,,1692.95,percent of total billed charges,Implant Devices,1692.95,35,,1692.95,percent of total billed charges,Implant Devices,1692.95,35,,1692.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1644.58,34,"If Charge > 2,000, then 34 percent",1644.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1934.8,
ARTHREX AR-8952TS-02 COMP PLATE 2 HOLE,C1713,HCPCS,,79007020,CDM,278,RC,,,both,,,3429,1353.32,39.4668,,1353.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1200.15,35,,1200.15,percent of total billed charges,Implant Device,1165.86,34,"Charges > $500, x 34%",1165.86,percent of total billed charges,Implant Device,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1371.6,40,,1371.6,percent of total billed charges,Implant Devices,1200.15,70,,1200.15,percent of total billed charges,Implant Devices,1165.86,34,,1165.86,percent of total billed charges,Implant Devices,1165.86,34,,1165.86,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1165.86,34,"If Charge > 2,000, then 34 percent",1165.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1371.6,
STRYKER ORTHO 54-25674 VDR PLATE SHORT L,C1713,HCPCS,,79007021,CDM,278,RC,,,both,,,2604,1027.72,39.4668,,1027.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,911.4,35,,911.4,percent of total billed charges,Implant Device,885.36,34,"Charges > $500, x 34%",885.36,percent of total billed charges,Implant Device,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,1041.6,40,,1041.6,percent of total billed charges,Implant Devices,911.4,70,,911.4,percent of total billed charges,Implant Devices,885.36,34,,885.36,percent of total billed charges,Implant Devices,885.36,34,,885.36,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,885.36,34,"If Charge > 2,000, then 34 percent",885.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1041.6,
ARTHREX AR-7000-18T SUTURE WASHER TITAN,C1713,HCPCS,,79007024,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
ARTHREX AR-7000-36 PT SCREW 3.75X36MM,C1713,HCPCS,,79007025,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ARTHREX AR-8692DS IMPLANT SYS CPR VIPER,C1713,HCPCS,,79007033,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ARTHREX AR-8690DS IMPLANT SYS CPR SCORPN,C1713,HCPCS,,79007034,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
INTEGRA 50112 SUBTALAR MBA IMPLANT 12MM,C1713,HCPCS,,79007038,CDM,278,RC,,,both,,,5398,2130.42,39.4668,,2130.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1835.32,34,,1835.32,percent of total billed charges,Implant Device,1835.32,34,,1835.32,percent of total billed charges,Implant Device,1835.32,34,,1835.32,percent of total billed charges,Implant Device,1835.32,34,,1835.32,percent of total billed charges,Implant Device,1835.32,34,,1835.32,percent of total billed charges,Implant Device,1835.32,34,,1835.32,percent of total billed charges,Implant Device,1889.3,35,,1889.3,percent of total billed charges,Implant Device,1835.32,34,"Charges > $500, x 34%",1835.32,percent of total billed charges,Implant Device,1889.3,35,,1889.3,percent of total billed charges,Implant Devices,1889.3,35,,1889.3,percent of total billed charges,Implant Devices,1889.3,35,,,percent of total billed charges,Implant Devices,1889.3,35,,1889.3,percent of total billed charges,Implant Devices,1889.3,35,,1889.3,percent of total billed charges,Implant Devices,2159.2,40,,2159.2,percent of total billed charges,Implant Devices,1889.3,70,,1889.3,percent of total billed charges,Implant Devices,1835.32,34,,1835.32,percent of total billed charges,Implant Devices,1835.32,34,,1835.32,percent of total billed charges,Implant Devices,1889.3,35,,1889.3,percent of total billed charges,Implant Devices,1889.3,35,,1889.3,percent of total billed charges,Implant Devices,1889.3,35,,1889.3,percent of total billed charges,Implant Devices,1889.3,35,,1889.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1835.32,34,"If Charge > 2,000, then 34 percent",1835.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2159.2,
MTF 450-636 FIBULA ALLOGRAFT 18CM,C1713,HCPCS,,79007040,CDM,278,RC,,,both,,,3053,1204.92,39.4668,,1204.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1038.02,34,,1038.02,percent of total billed charges,Implant Device,1038.02,34,,1038.02,percent of total billed charges,Implant Device,1038.02,34,,1038.02,percent of total billed charges,Implant Device,1038.02,34,,1038.02,percent of total billed charges,Implant Device,1038.02,34,,1038.02,percent of total billed charges,Implant Device,1038.02,34,,1038.02,percent of total billed charges,Implant Device,1068.55,35,,1068.55,percent of total billed charges,Implant Device,1038.02,34,"Charges > $500, x 34%",1038.02,percent of total billed charges,Implant Device,1068.55,35,,1068.55,percent of total billed charges,Implant Devices,1068.55,35,,1068.55,percent of total billed charges,Implant Devices,1068.55,35,,,percent of total billed charges,Implant Devices,1068.55,35,,1068.55,percent of total billed charges,Implant Devices,1068.55,35,,1068.55,percent of total billed charges,Implant Devices,1221.2,40,,1221.2,percent of total billed charges,Implant Devices,1068.55,70,,1068.55,percent of total billed charges,Implant Devices,1038.02,34,,1038.02,percent of total billed charges,Implant Devices,1038.02,34,,1038.02,percent of total billed charges,Implant Devices,1068.55,35,,1068.55,percent of total billed charges,Implant Devices,1068.55,35,,1068.55,percent of total billed charges,Implant Devices,1068.55,35,,1068.55,percent of total billed charges,Implant Devices,1068.55,35,,1068.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1038.02,34,"If Charge > 2,000, then 34 percent",1038.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1221.2,
STRYKER 602690SS 6.5X90MM CANN SCREW,C1713,HCPCS,,79007042,CDM,278,RC,,,both,,,702,277.06,39.4668,,277.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,245.7,35,,245.7,percent of total billed charges,Implant Device,238.68,34,"Charges > $500, x 34%",238.68,percent of total billed charges,Implant Device,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,280.8,40,,280.8,percent of total billed charges,Implant Devices,245.7,70,,245.7,percent of total billed charges,Implant Devices,238.68,34,,238.68,percent of total billed charges,Implant Devices,238.68,34,,238.68,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280.8,
STRYKER 602695S 6.4X95MM CANN SCREW,C1713,HCPCS,,79007043,CDM,278,RC,,,both,,,753,297.19,39.4668,,297.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,263.55,35,,263.55,percent of total billed charges,Implant Device,256.02,34,"Charges > $500, x 34%",256.02,percent of total billed charges,Implant Device,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,301.2,40,,301.2,percent of total billed charges,Implant Devices,263.55,70,,263.55,percent of total billed charges,Implant Devices,256.02,34,,256.02,percent of total billed charges,Implant Devices,256.02,34,,256.02,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,301.2,
TELEFLEX KM-71-742 STEINMAN PIN 9/64 3.5,C1713,HCPCS,,79007044,CDM,278,RC,,,both,,,41,16.18,39.4668,,16.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,13.94,34,,13.94,percent of total billed charges,Implant Device,13.94,34,,13.94,percent of total billed charges,Implant Device,13.94,34,,13.94,percent of total billed charges,Implant Device,13.94,34,,13.94,percent of total billed charges,Implant Device,13.94,34,,13.94,percent of total billed charges,Implant Device,13.94,34,,13.94,percent of total billed charges,Implant Device,14.35,35,,14.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,16.4,40,,16.4,percent of total billed charges,Implant Devices,14.35,70,,14.35,percent of total billed charges,Implant Devices,13.94,34,,13.94,percent of total billed charges,Implant Devices,13.94,34,,13.94,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,16.4,
TELEFLEX KM-71-745 STEINMAN PIN 5/32 4MM,C1713,HCPCS,,79007045,CDM,278,RC,,,both,,,44,17.37,39.4668,,17.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14.96,34,,14.96,percent of total billed charges,Implant Device,14.96,34,,14.96,percent of total billed charges,Implant Device,14.96,34,,14.96,percent of total billed charges,Implant Device,14.96,34,,14.96,percent of total billed charges,Implant Device,14.96,34,,14.96,percent of total billed charges,Implant Device,14.96,34,,14.96,percent of total billed charges,Implant Device,15.4,35,,15.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,17.6,40,,17.6,percent of total billed charges,Implant Devices,15.4,70,,15.4,percent of total billed charges,Implant Devices,14.96,34,,14.96,percent of total billed charges,Implant Devices,14.96,34,,14.96,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,15.4,35,,15.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,17.6,
DEPUY 02.123.020 PERIART HUMERS PLATE 2H,C1713,HCPCS,,79007046,CDM,278,RC,,,both,,,3929,1550.65,39.4668,,1550.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1375.15,35,,1375.15,percent of total billed charges,Implant Device,1335.86,34,"Charges > $500, x 34%",1335.86,percent of total billed charges,Implant Device,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1571.6,40,,1571.6,percent of total billed charges,Implant Devices,1375.15,70,,1375.15,percent of total billed charges,Implant Devices,1335.86,34,,1335.86,percent of total billed charges,Implant Devices,1335.86,34,,1335.86,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1335.86,34,"If Charge > 2,000, then 34 percent",1335.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1571.6,
DEPUY 02.240.040 CANN LOCK SCREW 3.7X40M,C1713,HCPCS,,79007047,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
DEPUY 456.304S TI NAIL HELCL BLADE 11X95,C1713,HCPCS,,79007056,CDM,278,RC,,,both,,,1301,513.46,39.4668,,513.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,455.35,35,,455.35,percent of total billed charges,Implant Device,442.34,34,"Charges > $500, x 34%",442.34,percent of total billed charges,Implant Device,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,520.4,40,,520.4,percent of total billed charges,Implant Devices,455.35,70,,455.35,percent of total billed charges,Implant Devices,442.34,34,,442.34,percent of total billed charges,Implant Devices,442.34,34,,442.34,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,520.4,
ZIMMER 5001-046-00 BIPOLAR SHELL 46MM OD,C1713,HCPCS,,79007057,CDM,278,RC,,,both,,,2273,897.08,39.4668,,897.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Device,772.82,34,"Charges > $500, x 34%",772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,909.2,40,,909.2,percent of total billed charges,Implant Devices,795.55,70,,795.55,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,772.82,34,"If Charge > 2,000, then 34 percent",772.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,909.2,
STRYKER 3003-0822S SET SCREW TI 8X17MM,C1713,HCPCS,,79007062,CDM,278,RC,,,both,,,464,183.13,39.4668,,183.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,162.4,35,,162.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,185.6,40,,185.6,percent of total billed charges,Implant Devices,162.4,70,,162.4,percent of total billed charges,Implant Devices,157.76,34,,157.76,percent of total billed charges,Implant Devices,157.76,34,,157.76,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,185.6,
DEPUY 298.801.01S CABLE W CRIMP 1.7X750,C1713,HCPCS,,79007065,CDM,278,RC,,,both,,,1211,477.94,39.4668,,477.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,411.74,34,,411.74,percent of total billed charges,Implant Device,411.74,34,,411.74,percent of total billed charges,Implant Device,411.74,34,,411.74,percent of total billed charges,Implant Device,411.74,34,,411.74,percent of total billed charges,Implant Device,411.74,34,,411.74,percent of total billed charges,Implant Device,411.74,34,,411.74,percent of total billed charges,Implant Device,423.85,35,,423.85,percent of total billed charges,Implant Device,411.74,34,"Charges > $500, x 34%",411.74,percent of total billed charges,Implant Device,423.85,35,,423.85,percent of total billed charges,Implant Devices,423.85,35,,423.85,percent of total billed charges,Implant Devices,423.85,35,,,percent of total billed charges,Implant Devices,423.85,35,,423.85,percent of total billed charges,Implant Devices,423.85,35,,423.85,percent of total billed charges,Implant Devices,484.4,40,,484.4,percent of total billed charges,Implant Devices,423.85,70,,423.85,percent of total billed charges,Implant Devices,411.74,34,,411.74,percent of total billed charges,Implant Devices,411.74,34,,411.74,percent of total billed charges,Implant Devices,423.85,35,,423.85,percent of total billed charges,Implant Devices,423.85,35,,423.85,percent of total billed charges,Implant Devices,423.85,35,,423.85,percent of total billed charges,Implant Devices,423.85,35,,423.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,484.4,
LIFE SPINE 165-45-5 PEDICLE SCREW 6.5X45,C1713,HCPCS,,79007066,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
LIFE SPINE 175-40-5 PEDICLE SCREW 7.5X40,C1713,HCPCS,,79007067,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
LIFE SPINE 500-029 LOCK SCREW CONQUEST,C1713,HCPCS,,79007068,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
LIFE SPINE 4550-070 ROD 5.5X70MM,C1713,HCPCS,,79007069,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
LIFE SPINE 32-1024-09 PLATE STR 10X24X9,C1713,HCPCS,,79007070,CDM,278,RC,,,both,,,14400,5683.22,39.4668,,5683.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Device,4896,34,"Charges > $500, x 34%",4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5760,40,,5760,percent of total billed charges,Implant Devices,5040,70,,5040,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4896,34,"If Charge > 2,000, then 34 percent",4896,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5760,
ARTHREX AR-5035TC-11 INTER SCREW 11X35MM,C1713,HCPCS,,79007071,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
INTEGRA 206520 DURASEAL SEALANT,C1713,HCPCS,,79007074,CDM,278,RC,,,both,,,3770,1487.9,39.4668,,1487.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1281.8,34,,1281.8,percent of total billed charges,Implant Device,1281.8,34,,1281.8,percent of total billed charges,Implant Device,1281.8,34,,1281.8,percent of total billed charges,Implant Device,1281.8,34,,1281.8,percent of total billed charges,Implant Device,1281.8,34,,1281.8,percent of total billed charges,Implant Device,1281.8,34,,1281.8,percent of total billed charges,Implant Device,1319.5,35,,1319.5,percent of total billed charges,Implant Device,1281.8,34,"Charges > $500, x 34%",1281.8,percent of total billed charges,Implant Device,1319.5,35,,1319.5,percent of total billed charges,Implant Devices,1319.5,35,,1319.5,percent of total billed charges,Implant Devices,1319.5,35,,,percent of total billed charges,Implant Devices,1319.5,35,,1319.5,percent of total billed charges,Implant Devices,1319.5,35,,1319.5,percent of total billed charges,Implant Devices,1508,40,,1508,percent of total billed charges,Implant Devices,1319.5,70,,1319.5,percent of total billed charges,Implant Devices,1281.8,34,,1281.8,percent of total billed charges,Implant Devices,1281.8,34,,1281.8,percent of total billed charges,Implant Devices,1319.5,35,,1319.5,percent of total billed charges,Implant Devices,1319.5,35,,1319.5,percent of total billed charges,Implant Devices,1319.5,35,,1319.5,percent of total billed charges,Implant Devices,1319.5,35,,1319.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1281.8,34,"If Charge > 2,000, then 34 percent",1281.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1508,
DEPUY 456.318S CANN FIX NAIL 11X170MM,C1713,HCPCS,,79007083,CDM,278,RC,,,both,,,2738,1080.6,39.4668,,1080.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Device,930.92,34,"Charges > $500, x 34%",930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,1095.2,40,,1095.2,percent of total billed charges,Implant Devices,958.3,70,,958.3,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,930.92,34,"If Charge > 2,000, then 34 percent",930.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1095.2,
DEPUY 458.932S LOCKING SCREW 5X32MM,C1713,HCPCS,,79007084,CDM,278,RC,,,both,,,888,350.47,39.4668,,350.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,310.8,35,,310.8,percent of total billed charges,Implant Device,301.92,34,"Charges > $500, x 34%",301.92,percent of total billed charges,Implant Device,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,355.2,40,,355.2,percent of total billed charges,Implant Devices,310.8,70,,310.8,percent of total billed charges,Implant Devices,301.92,34,,301.92,percent of total billed charges,Implant Devices,301.92,34,,301.92,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,355.2,
DEPUY 459.934S LOCKING SCREW 5X34MM,C1713,HCPCS,,79007085,CDM,278,RC,,,both,,,767,302.71,39.4668,,302.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.78,34,,260.78,percent of total billed charges,Implant Device,260.78,34,,260.78,percent of total billed charges,Implant Device,260.78,34,,260.78,percent of total billed charges,Implant Device,260.78,34,,260.78,percent of total billed charges,Implant Device,260.78,34,,260.78,percent of total billed charges,Implant Device,260.78,34,,260.78,percent of total billed charges,Implant Device,268.45,35,,268.45,percent of total billed charges,Implant Device,260.78,34,"Charges > $500, x 34%",260.78,percent of total billed charges,Implant Device,268.45,35,,268.45,percent of total billed charges,Implant Devices,268.45,35,,268.45,percent of total billed charges,Implant Devices,268.45,35,,,percent of total billed charges,Implant Devices,268.45,35,,268.45,percent of total billed charges,Implant Devices,268.45,35,,268.45,percent of total billed charges,Implant Devices,306.8,40,,306.8,percent of total billed charges,Implant Devices,268.45,70,,268.45,percent of total billed charges,Implant Devices,260.78,34,,260.78,percent of total billed charges,Implant Devices,260.78,34,,260.78,percent of total billed charges,Implant Devices,268.45,35,,268.45,percent of total billed charges,Implant Devices,268.45,35,,268.45,percent of total billed charges,Implant Devices,268.45,35,,268.45,percent of total billed charges,Implant Devices,268.45,35,,268.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306.8,
TELEFLEX KM-71612 STEIN PIN 9/64 3.5MM,C1713,HCPCS,,79007087,CDM,278,RC,,,both,,,23,9.08,39.4668,,9.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7.82,34,,7.82,percent of total billed charges,Implant Device,7.82,34,,7.82,percent of total billed charges,Implant Device,7.82,34,,7.82,percent of total billed charges,Implant Device,7.82,34,,7.82,percent of total billed charges,Implant Device,7.82,34,,7.82,percent of total billed charges,Implant Device,7.82,34,,7.82,percent of total billed charges,Implant Device,8.05,35,,8.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,8.05,35,,8.05,percent of total billed charges,Implant Devices,8.05,35,,8.05,percent of total billed charges,Implant Devices,8.05,35,,,percent of total billed charges,Implant Devices,8.05,35,,8.05,percent of total billed charges,Implant Devices,8.05,35,,8.05,percent of total billed charges,Implant Devices,9.2,40,,9.2,percent of total billed charges,Implant Devices,8.05,70,,8.05,percent of total billed charges,Implant Devices,7.82,34,,7.82,percent of total billed charges,Implant Devices,7.82,34,,7.82,percent of total billed charges,Implant Devices,8.05,35,,8.05,percent of total billed charges,Implant Devices,8.05,35,,8.05,percent of total billed charges,Implant Devices,8.05,35,,8.05,percent of total billed charges,Implant Devices,8.05,35,,8.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9.2,
TELEFLEX KM-71615 STEIN PIN 5/32 4.0MM,C1713,HCPCS,,79007088,CDM,278,RC,,,both,,,24,9.47,39.4668,,9.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8.16,34,,8.16,percent of total billed charges,Implant Device,8.16,34,,8.16,percent of total billed charges,Implant Device,8.16,34,,8.16,percent of total billed charges,Implant Device,8.16,34,,8.16,percent of total billed charges,Implant Device,8.16,34,,8.16,percent of total billed charges,Implant Device,8.16,34,,8.16,percent of total billed charges,Implant Device,8.4,35,,8.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,9.6,40,,9.6,percent of total billed charges,Implant Devices,8.4,70,,8.4,percent of total billed charges,Implant Devices,8.16,34,,8.16,percent of total billed charges,Implant Devices,8.16,34,,8.16,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,8.4,35,,8.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9.6,
DEPUY 456.477S 130DEG CAN NAIL 12X360MM,C1713,HCPCS,,79007090,CDM,278,RC,,,both,,,6225,2456.81,39.4668,,2456.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Device,2116.5,34,"Charges > $500, x 34%",2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2490,40,,2490,percent of total billed charges,Implant Devices,2178.75,70,,2178.75,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2116.5,34,"If Charge > 2,000, then 34 percent",2116.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2490,
DEPUY 04.032.100S TI NAIL SCREW 11X100MM,C1713,HCPCS,,79007091,CDM,278,RC,,,both,,,2197,867.09,39.4668,,867.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,768.95,35,,768.95,percent of total billed charges,Implant Device,746.98,34,"Charges > $500, x 34%",746.98,percent of total billed charges,Implant Device,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,878.8,40,,878.8,percent of total billed charges,Implant Devices,768.95,70,,768.95,percent of total billed charges,Implant Devices,746.98,34,,746.98,percent of total billed charges,Implant Devices,746.98,34,,746.98,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,746.98,34,"If Charge > 2,000, then 34 percent",746.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,878.8,
DEPUY 458.944S LOCKING SCREW 5X44MM,C1713,HCPCS,,79007092,CDM,278,RC,,,both,,,888,350.47,39.4668,,350.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,310.8,35,,310.8,percent of total billed charges,Implant Device,301.92,34,"Charges > $500, x 34%",301.92,percent of total billed charges,Implant Device,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,355.2,40,,355.2,percent of total billed charges,Implant Devices,310.8,70,,310.8,percent of total billed charges,Implant Devices,301.92,34,,301.92,percent of total billed charges,Implant Devices,301.92,34,,301.92,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,355.2,
DEPUY 458.940S LOCKING SCREW 5X40MM,C1713,HCPCS,,79007093,CDM,278,RC,,,both,,,959,378.49,39.4668,,378.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Device,326.06,34,"Charges > $500, x 34%",326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,383.6,40,,383.6,percent of total billed charges,Implant Devices,335.65,70,,335.65,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.6,
ZIMMER 00-1147-046-40 CANN SCREW 4X46MM,C1713,HCPCS,,79007095,CDM,278,RC,,,both,,,605,238.77,39.4668,,238.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,211.75,35,,211.75,percent of total billed charges,Implant Device,205.7,34,"Charges > $500, x 34%",205.7,percent of total billed charges,Implant Device,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,242,40,,242,percent of total billed charges,Implant Devices,211.75,70,,211.75,percent of total billed charges,Implant Devices,205.7,34,,205.7,percent of total billed charges,Implant Devices,205.7,34,,205.7,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,242,
DEPUY 04.032.095S 11X95MM TI NAIL SCREW,C1713,HCPCS,,79007097,CDM,278,RC,,,both,,,2197,867.09,39.4668,,867.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,768.95,35,,768.95,percent of total billed charges,Implant Device,746.98,34,"Charges > $500, x 34%",746.98,percent of total billed charges,Implant Device,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,878.8,40,,878.8,percent of total billed charges,Implant Devices,768.95,70,,768.95,percent of total billed charges,Implant Devices,746.98,34,,746.98,percent of total billed charges,Implant Devices,746.98,34,,746.98,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,746.98,34,"If Charge > 2,000, then 34 percent",746.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,878.8,
DEPUY 456.325S CAN FIX NAIL 10X235MM,C1713,HCPCS,,79007098,CDM,278,RC,,,both,,,5795,2287.1,39.4668,,2287.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1970.3,34,,1970.3,percent of total billed charges,Implant Device,1970.3,34,,1970.3,percent of total billed charges,Implant Device,1970.3,34,,1970.3,percent of total billed charges,Implant Device,1970.3,34,,1970.3,percent of total billed charges,Implant Device,1970.3,34,,1970.3,percent of total billed charges,Implant Device,1970.3,34,,1970.3,percent of total billed charges,Implant Device,2028.25,35,,2028.25,percent of total billed charges,Implant Device,1970.3,34,"Charges > $500, x 34%",1970.3,percent of total billed charges,Implant Device,2028.25,35,,2028.25,percent of total billed charges,Implant Devices,2028.25,35,,2028.25,percent of total billed charges,Implant Devices,2028.25,35,,,percent of total billed charges,Implant Devices,2028.25,35,,2028.25,percent of total billed charges,Implant Devices,2028.25,35,,2028.25,percent of total billed charges,Implant Devices,2318,40,,2318,percent of total billed charges,Implant Devices,2028.25,70,,2028.25,percent of total billed charges,Implant Devices,1970.3,34,,1970.3,percent of total billed charges,Implant Devices,1970.3,34,,1970.3,percent of total billed charges,Implant Devices,2028.25,35,,2028.25,percent of total billed charges,Implant Devices,2028.25,35,,2028.25,percent of total billed charges,Implant Devices,2028.25,35,,2028.25,percent of total billed charges,Implant Devices,2028.25,35,,2028.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1970.3,34,"If Charge > 2,000, then 34 percent",1970.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2318,
WRIGHT CCP-MPNIL CROSSCHECK PLATE,C1713,HCPCS,,79007100,CDM,278,RC,,,both,,,6708,2647.43,39.4668,,2647.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2280.72,34,,2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Device,2280.72,34,"Charges > $500, x 34%",2280.72,percent of total billed charges,Implant Device,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2683.2,40,,2683.2,percent of total billed charges,Implant Devices,2347.8,70,,2347.8,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2280.72,34,,2280.72,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,2347.8,35,,2347.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2280.72,34,"If Charge > 2,000, then 34 percent",2280.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2683.2,
WRIGHT CCP-X3518 LAG SCREW 3.5X18MM,C1713,HCPCS,,79007101,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
STRYKER 3325-0300S LONG NAIL 11X300MM,C1713,HCPCS,,79007102,CDM,278,RC,,,both,,,8221,3244.57,39.4668,,3244.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2795.14,34,,2795.14,percent of total billed charges,Implant Device,2877.35,35,,2877.35,percent of total billed charges,Implant Device,2795.14,34,"Charges > $500, x 34%",2795.14,percent of total billed charges,Implant Device,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,3288.4,40,,3288.4,percent of total billed charges,Implant Devices,2877.35,70,,2877.35,percent of total billed charges,Implant Devices,2795.14,34,,2795.14,percent of total billed charges,Implant Devices,2795.14,34,,2795.14,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,2877.35,35,,2877.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2795.14,34,"If Charge > 2,000, then 34 percent",2795.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3288.4,
ARTHREX AR-8916VSR-03 STD PLATE RT 3HOLE,C1713,HCPCS,,79007103,CDM,278,RC,,,both,,,3408,1345.03,39.4668,,1345.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1192.8,35,,1192.8,percent of total billed charges,Implant Device,1158.72,34,"Charges > $500, x 34%",1158.72,percent of total billed charges,Implant Device,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1363.2,40,,1363.2,percent of total billed charges,Implant Devices,1192.8,70,,1192.8,percent of total billed charges,Implant Devices,1158.72,34,,1158.72,percent of total billed charges,Implant Devices,1158.72,34,,1158.72,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1158.72,34,"If Charge > 2,000, then 34 percent",1158.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1363.2,
ARTHREX AR-8724V-20 LOCK SCREW 2.4X20MM,C1713,HCPCS,,79007104,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ARTHREX AR-8724V-22 LOCK SCREW 2.4X22MM,C1713,HCPCS,,79007105,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
STRYKER 54-25673 VOLAR PLATE SHORT LEFT,C1713,HCPCS,,79007106,CDM,278,RC,,,both,,,2834,1118.49,39.4668,,1118.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,991.9,35,,991.9,percent of total billed charges,Implant Device,963.56,34,"Charges > $500, x 34%",963.56,percent of total billed charges,Implant Device,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,1133.6,40,,1133.6,percent of total billed charges,Implant Devices,991.9,70,,991.9,percent of total billed charges,Implant Devices,963.56,34,,963.56,percent of total billed charges,Implant Devices,963.56,34,,963.56,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,963.56,34,"If Charge > 2,000, then 34 percent",963.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1133.6,
STRYKER 656414 NON LOCK SCREW 2.7X14MM,C1713,HCPCS,,79007107,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656018 LOCKING SCREW 2.4X18MM,C1713,HCPCS,,79007108,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 656022 LOCKING SCREW 2.4X22MM,C1713,HCPCS,,79007109,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 656024 LOCKING SCREW 2.4X24MM,C1713,HCPCS,,79007110,CDM,278,RC,,,both,,,443,174.84,39.4668,,174.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,177.2,40,,177.2,percent of total billed charges,Implant Devices,155.05,70,,155.05,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.2,
LIFE SPINE 132-314-1 AILERON CORE MEDIUM,C1713,HCPCS,,79007111,CDM,278,RC,,,both,,,20640,8145.95,39.4668,,8145.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7224,35,,7224,percent of total billed charges,Implant Device,7017.6,34,"Charges > $500, x 34%",7017.6,percent of total billed charges,Implant Device,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,8256,40,,8256,percent of total billed charges,Implant Devices,7224,70,,7224,percent of total billed charges,Implant Devices,7017.6,34,,7017.6,percent of total billed charges,Implant Devices,7017.6,34,,7017.6,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7017.6,34,"If Charge > 2,000, then 34 percent",7017.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8256,
LIFE SPINE 132-314-2 AILERON PLATE MED,C1713,HCPCS,,79007112,CDM,278,RC,,,both,,,13680,5399.06,39.4668,,5399.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4788,35,,4788,percent of total billed charges,Implant Device,4651.2,34,"Charges > $500, x 34%",4651.2,percent of total billed charges,Implant Device,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,5472,40,,5472,percent of total billed charges,Implant Devices,4788,70,,4788,percent of total billed charges,Implant Devices,4651.2,34,,4651.2,percent of total billed charges,Implant Devices,4651.2,34,,4651.2,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4651.2,34,"If Charge > 2,000, then 34 percent",4651.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5472,
STRYKER 338642 CORTEX SCREW 3.5X42MM,C1713,HCPCS,,79007113,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 338622 CORTEX SCREW 3.5X22MM,C1713,HCPCS,,79007114,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 436208 DISTAL MED 8 HOLE PLATE,C1713,HCPCS,,79007115,CDM,278,RC,,,both,,,5643,2227.11,39.4668,,2227.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1918.62,34,,1918.62,percent of total billed charges,Implant Device,1975.05,35,,1975.05,percent of total billed charges,Implant Device,1918.62,34,"Charges > $500, x 34%",1918.62,percent of total billed charges,Implant Device,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,2257.2,40,,2257.2,percent of total billed charges,Implant Devices,1975.05,70,,1975.05,percent of total billed charges,Implant Devices,1918.62,34,,1918.62,percent of total billed charges,Implant Devices,1918.62,34,,1918.62,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,1975.05,35,,1975.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1918.62,34,"If Charge > 2,000, then 34 percent",1918.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2257.2,
DEPUY 208.411 CANNULATED SCREW 6.5X16MM,C1713,HCPCS,,79007116,CDM,278,RC,,,both,,,908,358.36,39.4668,,358.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,308.72,34,,308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Device,308.72,34,"Charges > $500, x 34%",308.72,percent of total billed charges,Implant Device,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,363.2,40,,363.2,percent of total billed charges,Implant Devices,317.8,70,,317.8,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,308.72,34,,308.72,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,317.8,35,,317.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,363.2,
ARTHREX AR-8949-075 CALAC PLATE 7.5MM,C1713,HCPCS,,79007119,CDM,278,RC,,,both,,,3558,1404.23,39.4668,,1404.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1209.72,34,,1209.72,percent of total billed charges,Implant Device,1209.72,34,,1209.72,percent of total billed charges,Implant Device,1209.72,34,,1209.72,percent of total billed charges,Implant Device,1209.72,34,,1209.72,percent of total billed charges,Implant Device,1209.72,34,,1209.72,percent of total billed charges,Implant Device,1209.72,34,,1209.72,percent of total billed charges,Implant Device,1245.3,35,,1245.3,percent of total billed charges,Implant Device,1209.72,34,"Charges > $500, x 34%",1209.72,percent of total billed charges,Implant Device,1245.3,35,,1245.3,percent of total billed charges,Implant Devices,1245.3,35,,1245.3,percent of total billed charges,Implant Devices,1245.3,35,,,percent of total billed charges,Implant Devices,1245.3,35,,1245.3,percent of total billed charges,Implant Devices,1245.3,35,,1245.3,percent of total billed charges,Implant Devices,1423.2,40,,1423.2,percent of total billed charges,Implant Devices,1245.3,70,,1245.3,percent of total billed charges,Implant Devices,1209.72,34,,1209.72,percent of total billed charges,Implant Devices,1209.72,34,,1209.72,percent of total billed charges,Implant Devices,1245.3,35,,1245.3,percent of total billed charges,Implant Devices,1245.3,35,,1245.3,percent of total billed charges,Implant Devices,1245.3,35,,1245.3,percent of total billed charges,Implant Devices,1245.3,35,,1245.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1209.72,34,"If Charge > 2,000, then 34 percent",1209.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1423.2,
ARTHREX AR-8940-32 CANCLLS SCREW 4X32MM,C1713,HCPCS,,79007120,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ARTHREX AR-8940-24 CANCLLS SCREW 4X24MM,C1713,HCPCS,,79007121,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ARTHREX AR-8935L-34 LOCK SCREW 3.5X34MM,C1713,HCPCS,,79007122,CDM,278,RC,,,both,,,366,144.45,39.4668,,144.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,124.44,34,,124.44,percent of total billed charges,Implant Device,124.44,34,,124.44,percent of total billed charges,Implant Device,124.44,34,,124.44,percent of total billed charges,Implant Device,124.44,34,,124.44,percent of total billed charges,Implant Device,124.44,34,,124.44,percent of total billed charges,Implant Device,124.44,34,,124.44,percent of total billed charges,Implant Device,128.1,35,,128.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,146.4,40,,146.4,percent of total billed charges,Implant Devices,128.1,70,,128.1,percent of total billed charges,Implant Devices,124.44,34,,124.44,percent of total billed charges,Implant Devices,124.44,34,,124.44,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,146.4,
DEPUY 02.107.304 OLEC PLATE 4HOLE 116MM,C1713,HCPCS,,79007125,CDM,278,RC,,,both,,,2826,1115.33,39.4668,,1115.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,989.1,35,,989.1,percent of total billed charges,Implant Device,960.84,34,"Charges > $500, x 34%",960.84,percent of total billed charges,Implant Device,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,1130.4,40,,1130.4,percent of total billed charges,Implant Devices,989.1,70,,989.1,percent of total billed charges,Implant Devices,960.84,34,,960.84,percent of total billed charges,Implant Devices,960.84,34,,960.84,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,960.84,34,"If Charge > 2,000, then 34 percent",960.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1130.4,
DEPUY 02.211.022 LOCKING SCREW 2.7X22MM,C1713,HCPCS,,79007126,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 02.211.038 LOCKING SCREW 2.7X38MM,C1713,HCPCS,,79007127,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 02.211.024 LOCKING SCREW 2.7X34MM,C1713,HCPCS,,79007128,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 02.211.026 LOCKING SCREW 2.7X26MM,C1713,HCPCS,,79007129,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
ARTHREX AR-5035TC-09 ACL SCREW 9X35MM,C1713,HCPCS,,79007130,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
EXACTECH 314-13-02 CAGE GLENOID SM ALPHA,C1713,HCPCS,,79007131,CDM,278,RC,,,both,,,8559,3377.96,39.4668,,3377.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2910.06,34,,2910.06,percent of total billed charges,Implant Device,2910.06,34,,2910.06,percent of total billed charges,Implant Device,2910.06,34,,2910.06,percent of total billed charges,Implant Device,2910.06,34,,2910.06,percent of total billed charges,Implant Device,2910.06,34,,2910.06,percent of total billed charges,Implant Device,2910.06,34,,2910.06,percent of total billed charges,Implant Device,2995.65,35,,2995.65,percent of total billed charges,Implant Device,2910.06,34,"Charges > $500, x 34%",2910.06,percent of total billed charges,Implant Device,2995.65,35,,2995.65,percent of total billed charges,Implant Devices,2995.65,35,,2995.65,percent of total billed charges,Implant Devices,2995.65,35,,,percent of total billed charges,Implant Devices,2995.65,35,,2995.65,percent of total billed charges,Implant Devices,2995.65,35,,2995.65,percent of total billed charges,Implant Devices,3423.6,40,,3423.6,percent of total billed charges,Implant Devices,2995.65,70,,2995.65,percent of total billed charges,Implant Devices,2910.06,34,,2910.06,percent of total billed charges,Implant Devices,2910.06,34,,2910.06,percent of total billed charges,Implant Devices,2995.65,35,,2995.65,percent of total billed charges,Implant Devices,2995.65,35,,2995.65,percent of total billed charges,Implant Devices,2995.65,35,,2995.65,percent of total billed charges,Implant Devices,2995.65,35,,2995.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2910.06,34,"If Charge > 2,000, then 34 percent",2910.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3423.6,
STRYKER 54-25386 ANATOMIC VOLAR PLATE,C1713,HCPCS,,79007132,CDM,278,RC,,,both,,,2274,897.48,39.4668,,897.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,773.16,34,,773.16,percent of total billed charges,Implant Device,773.16,34,,773.16,percent of total billed charges,Implant Device,773.16,34,,773.16,percent of total billed charges,Implant Device,773.16,34,,773.16,percent of total billed charges,Implant Device,773.16,34,,773.16,percent of total billed charges,Implant Device,773.16,34,,773.16,percent of total billed charges,Implant Device,795.9,35,,795.9,percent of total billed charges,Implant Device,773.16,34,"Charges > $500, x 34%",773.16,percent of total billed charges,Implant Device,795.9,35,,795.9,percent of total billed charges,Implant Devices,795.9,35,,795.9,percent of total billed charges,Implant Devices,795.9,35,,,percent of total billed charges,Implant Devices,795.9,35,,795.9,percent of total billed charges,Implant Devices,795.9,35,,795.9,percent of total billed charges,Implant Devices,909.6,40,,909.6,percent of total billed charges,Implant Devices,795.9,70,,795.9,percent of total billed charges,Implant Devices,773.16,34,,773.16,percent of total billed charges,Implant Devices,773.16,34,,773.16,percent of total billed charges,Implant Devices,795.9,35,,795.9,percent of total billed charges,Implant Devices,795.9,35,,795.9,percent of total billed charges,Implant Devices,795.9,35,,795.9,percent of total billed charges,Implant Devices,795.9,35,,795.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,773.16,34,"If Charge > 2,000, then 34 percent",773.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,909.6,
STRYKER 1822-0933S TIBIAL NAIL STD 9X330,C1713,HCPCS,,79007135,CDM,278,RC,,,both,,,6110,2411.42,39.4668,,2411.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2138.5,35,,2138.5,percent of total billed charges,Implant Device,2077.4,34,"Charges > $500, x 34%",2077.4,percent of total billed charges,Implant Device,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2444,40,,2444,percent of total billed charges,Implant Devices,2138.5,70,,2138.5,percent of total billed charges,Implant Devices,2077.4,34,,2077.4,percent of total billed charges,Implant Devices,2077.4,34,,2077.4,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2077.4,34,"If Charge > 2,000, then 34 percent",2077.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2444,
DEPUY 458.934S TI LOCKING SCREW 5X34MM,C1713,HCPCS,,79007137,CDM,278,RC,,,both,,,456,179.97,39.4668,,179.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,182.4,40,,182.4,percent of total billed charges,Implant Devices,159.6,70,,159.6,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182.4,
DEPUY 07.704.010S BONE VOID FILLER 10CC,C1713,HCPCS,,79007138,CDM,278,RC,,,both,,,11232,4432.91,39.4668,,4432.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3818.88,34,,3818.88,percent of total billed charges,Implant Device,3818.88,34,,3818.88,percent of total billed charges,Implant Device,3818.88,34,,3818.88,percent of total billed charges,Implant Device,3818.88,34,,3818.88,percent of total billed charges,Implant Device,3818.88,34,,3818.88,percent of total billed charges,Implant Device,3818.88,34,,3818.88,percent of total billed charges,Implant Device,3931.2,35,,3931.2,percent of total billed charges,Implant Device,3818.88,34,"Charges > $500, x 34%",3818.88,percent of total billed charges,Implant Device,3931.2,35,,3931.2,percent of total billed charges,Implant Devices,3931.2,35,,3931.2,percent of total billed charges,Implant Devices,3931.2,35,,,percent of total billed charges,Implant Devices,3931.2,35,,3931.2,percent of total billed charges,Implant Devices,3931.2,35,,3931.2,percent of total billed charges,Implant Devices,4492.8,40,,4492.8,percent of total billed charges,Implant Devices,3931.2,70,,3931.2,percent of total billed charges,Implant Devices,3818.88,34,,3818.88,percent of total billed charges,Implant Devices,3818.88,34,,3818.88,percent of total billed charges,Implant Devices,3931.2,35,,3931.2,percent of total billed charges,Implant Devices,3931.2,35,,3931.2,percent of total billed charges,Implant Devices,3931.2,35,,3931.2,percent of total billed charges,Implant Devices,3931.2,35,,3931.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3818.88,34,"If Charge > 2,000, then 34 percent",3818.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4492.8,
DEPUY 02.240.060 CANNLOCK SCREW 3.7X60MM,C1713,HCPCS,,79007139,CDM,278,RC,,,both,,,789,311.39,39.4668,,311.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Device,268.26,34,"Charges > $500, x 34%",268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,315.6,40,,315.6,percent of total billed charges,Implant Devices,276.15,70,,276.15,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.6,
DEPUY 02.240.058 CANNLOCK SCREW 3.7X58MM,C1713,HCPCS,,79007140,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
DEPUY 204.832 CORTEX SCREW 3.5X32MM,C1713,HCPCS,,79007141,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
STRYKER 427064 4 HOLE LOCKING PLATE,C1713,HCPCS,,79007147,CDM,278,RC,,,both,,,574,226.54,39.4668,,226.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,195.16,34,,195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Device,195.16,34,"Charges > $500, x 34%",195.16,percent of total billed charges,Implant Device,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,229.6,40,,229.6,percent of total billed charges,Implant Devices,200.9,70,,200.9,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,195.16,34,,195.16,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,200.9,35,,200.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,229.6,
STRYKER 371010 LOCKING SCREW 3X10MM,C1713,HCPCS,,79007148,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
DEPUY 208.438 CANNULATED SCREW 6.5X32MM,C1713,HCPCS,,79007149,CDM,278,RC,,,both,,,683,269.56,39.4668,,269.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Device,232.22,34,"Charges > $500, x 34%",232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,273.2,40,,273.2,percent of total billed charges,Implant Devices,239.05,70,,239.05,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.2,
DEPUY 208.408 CANNULATED SCREW 6.5X16MM,C1713,HCPCS,,79007150,CDM,278,RC,,,both,,,1021,402.96,39.4668,,402.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,347.14,34,,347.14,percent of total billed charges,Implant Device,347.14,34,,347.14,percent of total billed charges,Implant Device,347.14,34,,347.14,percent of total billed charges,Implant Device,347.14,34,,347.14,percent of total billed charges,Implant Device,347.14,34,,347.14,percent of total billed charges,Implant Device,347.14,34,,347.14,percent of total billed charges,Implant Device,357.35,35,,357.35,percent of total billed charges,Implant Device,347.14,34,"Charges > $500, x 34%",347.14,percent of total billed charges,Implant Device,357.35,35,,357.35,percent of total billed charges,Implant Devices,357.35,35,,357.35,percent of total billed charges,Implant Devices,357.35,35,,,percent of total billed charges,Implant Devices,357.35,35,,357.35,percent of total billed charges,Implant Devices,357.35,35,,357.35,percent of total billed charges,Implant Devices,408.4,40,,408.4,percent of total billed charges,Implant Devices,357.35,70,,357.35,percent of total billed charges,Implant Devices,347.14,34,,347.14,percent of total billed charges,Implant Devices,347.14,34,,347.14,percent of total billed charges,Implant Devices,357.35,35,,357.35,percent of total billed charges,Implant Devices,357.35,35,,357.35,percent of total billed charges,Implant Devices,357.35,35,,357.35,percent of total billed charges,Implant Devices,357.35,35,,357.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408.4,
LIFE SPINE 465-45-5 POLY SCREW 6.5X45MM,C1713,HCPCS,,79007151,CDM,278,RC,,,both,,,6720,2652.17,39.4668,,2652.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2352,35,,2352,percent of total billed charges,Implant Device,2284.8,34,"Charges > $500, x 34%",2284.8,percent of total billed charges,Implant Device,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2688,40,,2688,percent of total billed charges,Implant Devices,2352,70,,2352,percent of total billed charges,Implant Devices,2284.8,34,,2284.8,percent of total billed charges,Implant Devices,2284.8,34,,2284.8,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2284.8,34,"If Charge > 2,000, then 34 percent",2284.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2688,
LIFE SPINE 465-50-5 POLY SCREW 6.5X50MM,C1713,HCPCS,,79007152,CDM,278,RC,,,both,,,6720,2652.17,39.4668,,2652.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2352,35,,2352,percent of total billed charges,Implant Device,2284.8,34,"Charges > $500, x 34%",2284.8,percent of total billed charges,Implant Device,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2688,40,,2688,percent of total billed charges,Implant Devices,2352,70,,2352,percent of total billed charges,Implant Devices,2284.8,34,,2284.8,percent of total billed charges,Implant Devices,2284.8,34,,2284.8,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2284.8,34,"If Charge > 2,000, then 34 percent",2284.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2688,
LIFE SPINE 475-40-5 POLY SCREW 7.5X40MM,C1713,HCPCS,,79007153,CDM,278,RC,,,both,,,6720,2652.17,39.4668,,2652.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2352,35,,2352,percent of total billed charges,Implant Device,2284.8,34,"Charges > $500, x 34%",2284.8,percent of total billed charges,Implant Device,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2688,40,,2688,percent of total billed charges,Implant Devices,2352,70,,2352,percent of total billed charges,Implant Devices,2284.8,34,,2284.8,percent of total billed charges,Implant Devices,2284.8,34,,2284.8,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2284.8,34,"If Charge > 2,000, then 34 percent",2284.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2688,
LIFE SPINE 4550-075 PREBENT ROD 5.5X75MM,C1713,HCPCS,,79007154,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
LIFE SPINE 148-003 LOCKING CAP,C1713,HCPCS,,79007155,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
LIFE SPINE 800-316-55 XCONNECT LYNX 55MM,C1713,HCPCS,,79007156,CDM,278,RC,,,both,,,9480,3741.45,39.4668,,3741.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3223.2,34,,3223.2,percent of total billed charges,Implant Device,3223.2,34,,3223.2,percent of total billed charges,Implant Device,3223.2,34,,3223.2,percent of total billed charges,Implant Device,3223.2,34,,3223.2,percent of total billed charges,Implant Device,3223.2,34,,3223.2,percent of total billed charges,Implant Device,3223.2,34,,3223.2,percent of total billed charges,Implant Device,3318,35,,3318,percent of total billed charges,Implant Device,3223.2,34,"Charges > $500, x 34%",3223.2,percent of total billed charges,Implant Device,3318,35,,3318,percent of total billed charges,Implant Devices,3318,35,,3318,percent of total billed charges,Implant Devices,3318,35,,,percent of total billed charges,Implant Devices,3318,35,,3318,percent of total billed charges,Implant Devices,3318,35,,3318,percent of total billed charges,Implant Devices,3792,40,,3792,percent of total billed charges,Implant Devices,3318,70,,3318,percent of total billed charges,Implant Devices,3223.2,34,,3223.2,percent of total billed charges,Implant Devices,3223.2,34,,3223.2,percent of total billed charges,Implant Devices,3318,35,,3318,percent of total billed charges,Implant Devices,3318,35,,3318,percent of total billed charges,Implant Devices,3318,35,,3318,percent of total billed charges,Implant Devices,3318,35,,3318,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3223.2,34,"If Charge > 2,000, then 34 percent",3223.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3792,
STRYKER 4922-8-400 11X400MM CARBON ROD,C1713,HCPCS,,79007161,CDM,278,RC,,,both,,,2121,837.09,39.4668,,837.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,721.14,34,,721.14,percent of total billed charges,Implant Device,721.14,34,,721.14,percent of total billed charges,Implant Device,721.14,34,,721.14,percent of total billed charges,Implant Device,721.14,34,,721.14,percent of total billed charges,Implant Device,721.14,34,,721.14,percent of total billed charges,Implant Device,721.14,34,,721.14,percent of total billed charges,Implant Device,742.35,35,,742.35,percent of total billed charges,Implant Device,721.14,34,"Charges > $500, x 34%",721.14,percent of total billed charges,Implant Device,742.35,35,,742.35,percent of total billed charges,Implant Devices,742.35,35,,742.35,percent of total billed charges,Implant Devices,742.35,35,,,percent of total billed charges,Implant Devices,742.35,35,,742.35,percent of total billed charges,Implant Devices,742.35,35,,742.35,percent of total billed charges,Implant Devices,848.4,40,,848.4,percent of total billed charges,Implant Devices,742.35,70,,742.35,percent of total billed charges,Implant Devices,721.14,34,,721.14,percent of total billed charges,Implant Devices,721.14,34,,721.14,percent of total billed charges,Implant Devices,742.35,35,,742.35,percent of total billed charges,Implant Devices,742.35,35,,742.35,percent of total billed charges,Implant Devices,742.35,35,,742.35,percent of total billed charges,Implant Devices,742.35,35,,742.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,721.14,34,"If Charge > 2,000, then 34 percent",721.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,848.4,
STRYKER 4922-2-020 5 PIN CLAMP,C1713,HCPCS,,79007163,CDM,278,RC,,,both,,,1646,649.62,39.4668,,649.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,559.64,34,,559.64,percent of total billed charges,Implant Device,559.64,34,,559.64,percent of total billed charges,Implant Device,559.64,34,,559.64,percent of total billed charges,Implant Device,559.64,34,,559.64,percent of total billed charges,Implant Device,559.64,34,,559.64,percent of total billed charges,Implant Device,559.64,34,,559.64,percent of total billed charges,Implant Device,576.1,35,,576.1,percent of total billed charges,Implant Device,559.64,34,"Charges > $500, x 34%",559.64,percent of total billed charges,Implant Device,576.1,35,,576.1,percent of total billed charges,Implant Devices,576.1,35,,576.1,percent of total billed charges,Implant Devices,576.1,35,,,percent of total billed charges,Implant Devices,576.1,35,,576.1,percent of total billed charges,Implant Devices,576.1,35,,576.1,percent of total billed charges,Implant Devices,658.4,40,,658.4,percent of total billed charges,Implant Devices,576.1,70,,576.1,percent of total billed charges,Implant Devices,559.64,34,,559.64,percent of total billed charges,Implant Devices,559.64,34,,559.64,percent of total billed charges,Implant Devices,576.1,35,,576.1,percent of total billed charges,Implant Devices,576.1,35,,576.1,percent of total billed charges,Implant Devices,576.1,35,,576.1,percent of total billed charges,Implant Devices,576.1,35,,576.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,658.4,
STRYKER 4922-2-140 11X30DEG ANGELED POST,C1713,HCPCS,,79007164,CDM,278,RC,,,both,,,289,114.06,39.4668,,114.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,98.26,34,,98.26,percent of total billed charges,Implant Device,98.26,34,,98.26,percent of total billed charges,Implant Device,98.26,34,,98.26,percent of total billed charges,Implant Device,98.26,34,,98.26,percent of total billed charges,Implant Device,98.26,34,,98.26,percent of total billed charges,Implant Device,98.26,34,,98.26,percent of total billed charges,Implant Device,101.15,35,,101.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,101.15,35,,101.15,percent of total billed charges,Implant Devices,101.15,35,,101.15,percent of total billed charges,Implant Devices,101.15,35,,,percent of total billed charges,Implant Devices,101.15,35,,101.15,percent of total billed charges,Implant Devices,101.15,35,,101.15,percent of total billed charges,Implant Devices,115.6,40,,115.6,percent of total billed charges,Implant Devices,101.15,70,,101.15,percent of total billed charges,Implant Devices,98.26,34,,98.26,percent of total billed charges,Implant Devices,98.26,34,,98.26,percent of total billed charges,Implant Devices,101.15,35,,101.15,percent of total billed charges,Implant Devices,101.15,35,,101.15,percent of total billed charges,Implant Devices,101.15,35,,101.15,percent of total billed charges,Implant Devices,101.15,35,,101.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.6,
STRYKER 604648S 4X48MM PT SCREW,C1713,HCPCS,,79007169,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
ARTHREX AR-2324BCC-2 SWIVELOCK 4.75MM,C1713,HCPCS,,79007171,CDM,278,RC,,,both,,,1251,493.73,39.4668,,493.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,425.34,34,,425.34,percent of total billed charges,Implant Device,425.34,34,,425.34,percent of total billed charges,Implant Device,425.34,34,,425.34,percent of total billed charges,Implant Device,425.34,34,,425.34,percent of total billed charges,Implant Device,425.34,34,,425.34,percent of total billed charges,Implant Device,425.34,34,,425.34,percent of total billed charges,Implant Device,437.85,35,,437.85,percent of total billed charges,Implant Device,425.34,34,"Charges > $500, x 34%",425.34,percent of total billed charges,Implant Device,437.85,35,,437.85,percent of total billed charges,Implant Devices,437.85,35,,437.85,percent of total billed charges,Implant Devices,437.85,35,,,percent of total billed charges,Implant Devices,437.85,35,,437.85,percent of total billed charges,Implant Devices,437.85,35,,437.85,percent of total billed charges,Implant Devices,500.4,40,,500.4,percent of total billed charges,Implant Devices,437.85,70,,437.85,percent of total billed charges,Implant Devices,425.34,34,,425.34,percent of total billed charges,Implant Devices,425.34,34,,425.34,percent of total billed charges,Implant Devices,437.85,35,,437.85,percent of total billed charges,Implant Devices,437.85,35,,437.85,percent of total billed charges,Implant Devices,437.85,35,,437.85,percent of total billed charges,Implant Devices,437.85,35,,437.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,500.4,
ALPHATEC 62085-50 SCREW 8.5X50MM,C1713,HCPCS,,79007172,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
ALPHATEC 62004-12 ROD 120MM,C1713,HCPCS,,79007173,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
ALPHATEC 22085 SET SCREW FOR 8.5 SCREW,C1713,HCPCS,,79007174,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
ALPHATEC 71003-51 PLATE 3 LEVEL 51MM,C1713,HCPCS,,79007175,CDM,278,RC,,,both,,,3135,1237.28,39.4668,,1237.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1097.25,35,,1097.25,percent of total billed charges,Implant Device,1065.9,34,"Charges > $500, x 34%",1065.9,percent of total billed charges,Implant Device,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1254,40,,1254,percent of total billed charges,Implant Devices,1097.25,70,,1097.25,percent of total billed charges,Implant Devices,1065.9,34,,1065.9,percent of total billed charges,Implant Devices,1065.9,34,,1065.9,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1065.9,34,"If Charge > 2,000, then 34 percent",1065.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254,
ZIMMER 00-2357-003-06 LOCK PLATE 6H 3.5,C1713,HCPCS,,79007187,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
ZIMMER 00-2359-036-35 LOCK SCREW 3.5X36,C1713,HCPCS,,79007188,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 00-2359-070-35 LOCK SCREW 3.5X70,C1713,HCPCS,,79007189,CDM,278,RC,,,both,,,367,144.84,39.4668,,144.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,128.45,35,,128.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,146.8,40,,146.8,percent of total billed charges,Implant Devices,128.45,70,,128.45,percent of total billed charges,Implant Devices,124.78,34,,124.78,percent of total billed charges,Implant Devices,124.78,34,,124.78,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,146.8,
ZIMMER 00-2359-080-36 CANN SCREW 3.5X80,C1713,HCPCS,,79007190,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
ZIMMER 00-2359-085-36 CANN SCREW 3.5X85,C1713,HCPCS,,79007191,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 00-2347-020-36 PERI SCREW 3.5X36,C1713,HCPCS,,79007192,CDM,278,RC,,,both,,,97,38.28,39.4668,,38.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,38.8,40,,38.8,percent of total billed charges,Implant Devices,33.95,70,,33.95,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.8,
ZIMMER 00-2347-020-42 PERI SCREW 3.5X42,C1713,HCPCS,,79007193,CDM,278,RC,,,both,,,97,38.28,39.4668,,38.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,38.8,40,,38.8,percent of total billed charges,Implant Devices,33.95,70,,33.95,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.8,
ZIMMER 00-2347-020-48 PERI SCREW 3.5X48,C1713,HCPCS,,79007194,CDM,278,RC,,,both,,,97,38.28,39.4668,,38.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,38.8,40,,38.8,percent of total billed charges,Implant Devices,33.95,70,,33.95,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.8,
ZIMMER 00-2347-020-50 PERI SCREW 3.5X50,C1713,HCPCS,,79007195,CDM,278,RC,,,both,,,97,38.28,39.4668,,38.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,38.8,40,,38.8,percent of total billed charges,Implant Devices,33.95,70,,33.95,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.8,
ZIMMER 00-2347-020-95 PERI SCREW 3.5X95,C1713,HCPCS,,79007196,CDM,278,RC,,,both,,,97,38.28,39.4668,,38.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,38.8,40,,38.8,percent of total billed charges,Implant Devices,33.95,70,,33.95,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.8,
ZIMMER 00-2347-020-90 PERI SCREW 3.5X90,C1713,HCPCS,,79007197,CDM,278,RC,,,both,,,97,38.28,39.4668,,38.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,38.8,40,,38.8,percent of total billed charges,Implant Devices,33.95,70,,33.95,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.8,
ZIMMER 00-2347-020-85 PERI SCREW 3.5X85,C1713,HCPCS,,79007198,CDM,278,RC,,,both,,,97,38.28,39.4668,,38.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,32.98,34,,32.98,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,38.8,40,,38.8,percent of total billed charges,Implant Devices,33.95,70,,33.95,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,32.98,34,,32.98,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,33.95,35,,33.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.8,
DEPUY 207.628 CANNULATED SCREW 4X28MM,C1713,HCPCS,,79007203,CDM,278,RC,,,both,,,491,193.78,39.4668,,193.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,166.94,34,,166.94,percent of total billed charges,Implant Device,166.94,34,,166.94,percent of total billed charges,Implant Device,166.94,34,,166.94,percent of total billed charges,Implant Device,166.94,34,,166.94,percent of total billed charges,Implant Device,166.94,34,,166.94,percent of total billed charges,Implant Device,166.94,34,,166.94,percent of total billed charges,Implant Device,171.85,35,,171.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,196.4,40,,196.4,percent of total billed charges,Implant Devices,171.85,70,,171.85,percent of total billed charges,Implant Devices,166.94,34,,166.94,percent of total billed charges,Implant Devices,166.94,34,,166.94,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196.4,
MEDLINE MDS9091212 DISTRACTION PIN 12MM,C1713,HCPCS,,79007204,CDM,278,RC,,,both,,,81,31.97,39.4668,,31.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.54,34,,27.54,percent of total billed charges,Implant Device,27.54,34,,27.54,percent of total billed charges,Implant Device,27.54,34,,27.54,percent of total billed charges,Implant Device,27.54,34,,27.54,percent of total billed charges,Implant Device,27.54,34,,27.54,percent of total billed charges,Implant Device,27.54,34,,27.54,percent of total billed charges,Implant Device,28.35,35,,28.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,28.35,35,,28.35,percent of total billed charges,Implant Devices,28.35,35,,28.35,percent of total billed charges,Implant Devices,28.35,35,,,percent of total billed charges,Implant Devices,28.35,35,,28.35,percent of total billed charges,Implant Devices,28.35,35,,28.35,percent of total billed charges,Implant Devices,32.4,40,,32.4,percent of total billed charges,Implant Devices,28.35,70,,28.35,percent of total billed charges,Implant Devices,27.54,34,,27.54,percent of total billed charges,Implant Devices,27.54,34,,27.54,percent of total billed charges,Implant Devices,28.35,35,,28.35,percent of total billed charges,Implant Devices,28.35,35,,28.35,percent of total billed charges,Implant Devices,28.35,35,,28.35,percent of total billed charges,Implant Devices,28.35,35,,28.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.4,
MEDLINE MDS9091414 DISTRACTION PIN 14MM,C1713,HCPCS,,79007205,CDM,278,RC,,,both,,,74,29.21,39.4668,,29.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,29.6,40,,29.6,percent of total billed charges,Implant Devices,25.9,70,,25.9,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,29.6,
MEDLINE MDS9091616 DISTRACTION PIN 16MM,C1713,HCPCS,,79007206,CDM,278,RC,,,both,,,74,29.21,39.4668,,29.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.16,34,,25.16,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,29.6,40,,29.6,percent of total billed charges,Implant Devices,25.9,70,,25.9,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.16,34,,25.16,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,25.9,35,,25.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,29.6,
DEPUY SYNTHES 226.581 PLATE 8 HOLE 4.5MM,C1713,HCPCS,,79007208,CDM,278,RC,,,both,,,2241,884.45,39.4668,,884.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,761.94,34,,761.94,percent of total billed charges,Implant Device,761.94,34,,761.94,percent of total billed charges,Implant Device,761.94,34,,761.94,percent of total billed charges,Implant Device,761.94,34,,761.94,percent of total billed charges,Implant Device,761.94,34,,761.94,percent of total billed charges,Implant Device,761.94,34,,761.94,percent of total billed charges,Implant Device,784.35,35,,784.35,percent of total billed charges,Implant Device,761.94,34,"Charges > $500, x 34%",761.94,percent of total billed charges,Implant Device,784.35,35,,784.35,percent of total billed charges,Implant Devices,784.35,35,,784.35,percent of total billed charges,Implant Devices,784.35,35,,,percent of total billed charges,Implant Devices,784.35,35,,784.35,percent of total billed charges,Implant Devices,784.35,35,,784.35,percent of total billed charges,Implant Devices,896.4,40,,896.4,percent of total billed charges,Implant Devices,784.35,70,,784.35,percent of total billed charges,Implant Devices,761.94,34,,761.94,percent of total billed charges,Implant Devices,761.94,34,,761.94,percent of total billed charges,Implant Devices,784.35,35,,784.35,percent of total billed charges,Implant Devices,784.35,35,,784.35,percent of total billed charges,Implant Devices,784.35,35,,784.35,percent of total billed charges,Implant Devices,784.35,35,,784.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,761.94,34,"If Charge > 2,000, then 34 percent",761.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,896.4,
DEPUY 214.832 CORTEX SCREW 4.5X32MM,C1713,HCPCS,,79007210,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
DEPUY 214.830 CORTEX SCREW 4.5X30MM,C1713,HCPCS,,79007211,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
DEPUY 214.834 CORTEX SCREW 4.5X34MM,C1713,HCPCS,,79007212,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
DEPUY 214.842 CORTEX SCREW 4.5X42MM,C1713,HCPCS,,79007213,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
DEPUY 214.838 CORTEX SCREW 4.5X38MM,C1713,HCPCS,,79007214,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
DEPUY 214.828 CORTEX SCREW 4.5X28MM,C1713,HCPCS,,79007215,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
WRIGHT CCP-MPN1R MTP PLATE RIGHT,C1713,HCPCS,,79007218,CDM,278,RC,,,both,,,7245,2859.37,39.4668,,2859.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2535.75,35,,2535.75,percent of total billed charges,Implant Device,2463.3,34,"Charges > $500, x 34%",2463.3,percent of total billed charges,Implant Device,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2898,40,,2898,percent of total billed charges,Implant Devices,2535.75,70,,2535.75,percent of total billed charges,Implant Devices,2463.3,34,,2463.3,percent of total billed charges,Implant Devices,2463.3,34,,2463.3,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2463.3,34,"If Charge > 2,000, then 34 percent",2463.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2898,
WRIGHT CCP-N3010 NON LOCK SCREW 3X10MM,C1713,HCPCS,,79007219,CDM,278,RC,,,both,,,958,378.09,39.4668,,378.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,335.3,35,,335.3,percent of total billed charges,Implant Device,325.72,34,"Charges > $500, x 34%",325.72,percent of total billed charges,Implant Device,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,383.2,40,,383.2,percent of total billed charges,Implant Devices,335.3,70,,335.3,percent of total billed charges,Implant Devices,325.72,34,,325.72,percent of total billed charges,Implant Devices,325.72,34,,325.72,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.2,
TRILLIANT SURG 210-40-006 K WIRE .045,C1713,HCPCS,,79007223,CDM,278,RC,,,both,,,30,11.84,39.4668,,11.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10.2,34,,10.2,percent of total billed charges,Implant Device,10.2,34,,10.2,percent of total billed charges,Implant Device,10.2,34,,10.2,percent of total billed charges,Implant Device,10.2,34,,10.2,percent of total billed charges,Implant Device,10.2,34,,10.2,percent of total billed charges,Implant Device,10.2,34,,10.2,percent of total billed charges,Implant Device,10.5,35,,10.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,10.5,35,,10.5,percent of total billed charges,Implant Devices,10.5,35,,10.5,percent of total billed charges,Implant Devices,10.5,35,,,percent of total billed charges,Implant Devices,10.5,35,,10.5,percent of total billed charges,Implant Devices,10.5,35,,10.5,percent of total billed charges,Implant Devices,12,40,,12,percent of total billed charges,Implant Devices,10.5,70,,10.5,percent of total billed charges,Implant Devices,10.2,34,,10.2,percent of total billed charges,Implant Devices,10.2,34,,10.2,percent of total billed charges,Implant Devices,10.5,35,,10.5,percent of total billed charges,Implant Devices,10.5,35,,10.5,percent of total billed charges,Implant Devices,10.5,35,,10.5,percent of total billed charges,Implant Devices,10.5,35,,10.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12,
ACUMED 65-0110-S BONE VOID FILLER 10CC,C1713,HCPCS,,79007230,CDM,278,RC,,,both,,,9828,3878.8,39.4668,,3878.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3439.8,35,,3439.8,percent of total billed charges,Implant Device,3341.52,34,"Charges > $500, x 34%",3341.52,percent of total billed charges,Implant Device,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3931.2,40,,3931.2,percent of total billed charges,Implant Devices,3439.8,70,,3439.8,percent of total billed charges,Implant Devices,3341.52,34,,3341.52,percent of total billed charges,Implant Devices,3341.52,34,,3341.52,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3341.52,34,"If Charge > 2,000, then 34 percent",3341.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3931.2,
ACUMED 65-0105-S BONE VOID FILLER 5CC,C1713,HCPCS,,79007231,CDM,278,RC,,,both,,,4950,1953.61,39.4668,,1953.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Device,1683,34,"Charges > $500, x 34%",1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1980,40,,1980,percent of total billed charges,Implant Devices,1732.5,70,,1732.5,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1683,34,"If Charge > 2,000, then 34 percent",1683,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1980,
DEPUY 458.946S TI LOCKING SCREW 5X46MM,C1713,HCPCS,,79007233,CDM,278,RC,,,both,,,456,179.97,39.4668,,179.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,182.4,40,,182.4,percent of total billed charges,Implant Devices,159.6,70,,159.6,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182.4,
DEPUY 04.032.090S TI NAIL SCREW 11X90MM,C1713,HCPCS,,79007234,CDM,278,RC,,,both,,,2197,867.09,39.4668,,867.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,768.95,35,,768.95,percent of total billed charges,Implant Device,746.98,34,"Charges > $500, x 34%",746.98,percent of total billed charges,Implant Device,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,878.8,40,,878.8,percent of total billed charges,Implant Devices,768.95,70,,768.95,percent of total billed charges,Implant Devices,746.98,34,,746.98,percent of total billed charges,Implant Devices,746.98,34,,746.98,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,746.98,34,"If Charge > 2,000, then 34 percent",746.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,878.8,
DEPUY 456.411S TI CANN NAIL LT 11X300MM,C1713,HCPCS,,79007235,CDM,278,RC,,,both,,,6692,2641.12,39.4668,,2641.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2275.28,34,,2275.28,percent of total billed charges,Implant Device,2275.28,34,,2275.28,percent of total billed charges,Implant Device,2275.28,34,,2275.28,percent of total billed charges,Implant Device,2275.28,34,,2275.28,percent of total billed charges,Implant Device,2275.28,34,,2275.28,percent of total billed charges,Implant Device,2275.28,34,,2275.28,percent of total billed charges,Implant Device,2342.2,35,,2342.2,percent of total billed charges,Implant Device,2275.28,34,"Charges > $500, x 34%",2275.28,percent of total billed charges,Implant Device,2342.2,35,,2342.2,percent of total billed charges,Implant Devices,2342.2,35,,2342.2,percent of total billed charges,Implant Devices,2342.2,35,,,percent of total billed charges,Implant Devices,2342.2,35,,2342.2,percent of total billed charges,Implant Devices,2342.2,35,,2342.2,percent of total billed charges,Implant Devices,2676.8,40,,2676.8,percent of total billed charges,Implant Devices,2342.2,70,,2342.2,percent of total billed charges,Implant Devices,2275.28,34,,2275.28,percent of total billed charges,Implant Devices,2275.28,34,,2275.28,percent of total billed charges,Implant Devices,2342.2,35,,2342.2,percent of total billed charges,Implant Devices,2342.2,35,,2342.2,percent of total billed charges,Implant Devices,2342.2,35,,2342.2,percent of total billed charges,Implant Devices,2342.2,35,,2342.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2275.28,34,"If Charge > 2,000, then 34 percent",2275.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2676.8,
DEPUY 02.210.118 LOCKING SCREW 2.4X18MM,C1713,HCPCS,,79007242,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
DEPUY 02.210.120 LOCKING SCREW 2.4X20MM,C1713,HCPCS,,79007243,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
DEPUY 02.111.531 RADIUS PLATE 6HOLE2.4MM,C1713,HCPCS,,79007244,CDM,278,RC,,,both,,,2323,916.81,39.4668,,916.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,813.05,35,,813.05,percent of total billed charges,Implant Device,789.82,34,"Charges > $500, x 34%",789.82,percent of total billed charges,Implant Device,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,929.2,40,,929.2,percent of total billed charges,Implant Devices,813.05,70,,813.05,percent of total billed charges,Implant Devices,789.82,34,,789.82,percent of total billed charges,Implant Devices,789.82,34,,789.82,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,789.82,34,"If Charge > 2,000, then 34 percent",789.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,929.2,
DEPUY 04.004-452S CANN TIB NAIL 10X360MM,C1713,HCPCS,,79007248,CDM,278,RC,,,both,,,5640,2225.93,39.4668,,2225.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1974,35,,1974,percent of total billed charges,Implant Device,1917.6,34,"Charges > $500, x 34%",1917.6,percent of total billed charges,Implant Device,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,2256,40,,2256,percent of total billed charges,Implant Devices,1974,70,,1974,percent of total billed charges,Implant Devices,1917.6,34,,1917.6,percent of total billed charges,Implant Devices,1917.6,34,,1917.6,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1917.6,34,"If Charge > 2,000, then 34 percent",1917.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2256,
DEPUY 04.005.530S LOCKING SCREW 5X40MM,C1713,HCPCS,,79007249,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 04.005.534S LOCKING SCREW 5X44MM,C1713,HCPCS,,79007250,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 204.844 CORTEX SCREW 3.5X44MM,C1713,HCPCS,,79007252,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
DEPUY 02.127.175 LOCK SCREW 3.5X75MM,C1713,HCPCS,,79007254,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
DEPUY 04.005.538S LOCK SCREW 5.0X48MM,C1713,HCPCS,,79007255,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
BIOMET EBI 1802-49-055 CANN SCREW 4X55MM,C1713,HCPCS,,79007256,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ARTHREX AR-7000-38 PT SCREW 3.75X38MM,C1713,HCPCS,,79007258,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
STRYKER 345445 CANC FT SCREW 4X45MM,C1713,HCPCS,,79007259,CDM,278,RC,,,both,,,105,41.44,39.4668,,41.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,42,40,,42,percent of total billed charges,Implant Devices,36.75,70,,36.75,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42,
ZIMMER 02.03263.015 PROX FEM PLATE 324MM,C1713,HCPCS,,79007260,CDM,278,RC,,,both,,,4536,1790.21,39.4668,,1790.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1542.24,34,,1542.24,percent of total billed charges,Implant Device,1587.6,35,,1587.6,percent of total billed charges,Implant Device,1542.24,34,"Charges > $500, x 34%",1542.24,percent of total billed charges,Implant Device,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1814.4,40,,1814.4,percent of total billed charges,Implant Devices,1587.6,70,,1587.6,percent of total billed charges,Implant Devices,1542.24,34,,1542.24,percent of total billed charges,Implant Devices,1542.24,34,,1542.24,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,1587.6,35,,1587.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1542.24,34,"If Charge > 2,000, then 34 percent",1542.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1814.4,
ZIMMER 02.03150.300 LOCKING SCREW CAP,C1713,HCPCS,,79007261,CDM,278,RC,,,both,,,478,188.65,39.4668,,188.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,167.3,35,,167.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,191.2,40,,191.2,percent of total billed charges,Implant Devices,167.3,70,,167.3,percent of total billed charges,Implant Devices,162.52,34,,162.52,percent of total billed charges,Implant Devices,162.52,34,,162.52,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,191.2,
ZIMMER 02.03155.030 CORT SCREW 4X30MM,C1713,HCPCS,,79007262,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 02.03155.036 CORT SCREW 4X36MM,C1713,HCPCS,,79007263,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 02.03155.038 CORT SCREW 4X38MM,C1713,HCPCS,,79007264,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 02.03155.042 CORT SCREW 4X42MM,C1713,HCPCS,,79007265,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 02.03155.044 CORT SCREW 4X44MM,C1713,HCPCS,,79007266,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 02.03155.050 CORT SCREW 4X50MM,C1713,HCPCS,,79007267,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ARTHREX AR-8933V-18 LOCKING SCREW 3X18MM,C1713,HCPCS,,79007275,CDM,278,RC,,,both,,,756,298.37,39.4668,,298.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,257.04,34,,257.04,percent of total billed charges,Implant Device,257.04,34,,257.04,percent of total billed charges,Implant Device,257.04,34,,257.04,percent of total billed charges,Implant Device,257.04,34,,257.04,percent of total billed charges,Implant Device,257.04,34,,257.04,percent of total billed charges,Implant Device,257.04,34,,257.04,percent of total billed charges,Implant Device,264.6,35,,264.6,percent of total billed charges,Implant Device,257.04,34,"Charges > $500, x 34%",257.04,percent of total billed charges,Implant Device,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,302.4,40,,302.4,percent of total billed charges,Implant Devices,264.6,70,,264.6,percent of total billed charges,Implant Devices,257.04,34,,257.04,percent of total billed charges,Implant Devices,257.04,34,,257.04,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,302.4,
STABILITY BIOLOGICS 901 ACHILLES TENDON,C1713,HCPCS,,79007277,CDM,278,RC,,,both,,,5025,1983.21,39.4668,,1983.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1708.5,34,,1708.5,percent of total billed charges,Implant Device,1708.5,34,,1708.5,percent of total billed charges,Implant Device,1708.5,34,,1708.5,percent of total billed charges,Implant Device,1708.5,34,,1708.5,percent of total billed charges,Implant Device,1708.5,34,,1708.5,percent of total billed charges,Implant Device,1708.5,34,,1708.5,percent of total billed charges,Implant Device,1758.75,35,,1758.75,percent of total billed charges,Implant Device,1708.5,34,"Charges > $500, x 34%",1708.5,percent of total billed charges,Implant Device,1758.75,35,,1758.75,percent of total billed charges,Implant Devices,1758.75,35,,1758.75,percent of total billed charges,Implant Devices,1758.75,35,,,percent of total billed charges,Implant Devices,1758.75,35,,1758.75,percent of total billed charges,Implant Devices,1758.75,35,,1758.75,percent of total billed charges,Implant Devices,2010,40,,2010,percent of total billed charges,Implant Devices,1758.75,70,,1758.75,percent of total billed charges,Implant Devices,1708.5,34,,1708.5,percent of total billed charges,Implant Devices,1708.5,34,,1708.5,percent of total billed charges,Implant Devices,1758.75,35,,1758.75,percent of total billed charges,Implant Devices,1758.75,35,,1758.75,percent of total billed charges,Implant Devices,1758.75,35,,1758.75,percent of total billed charges,Implant Devices,1758.75,35,,1758.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1708.5,34,"If Charge > 2,000, then 34 percent",1708.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2010,
ATLAS 1100-03-0060 ROD CONTOURED 60MM,C1713,HCPCS,,79007280,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
P 28 P20-135-026S CANN SCREW 3.5X26MM,C1713,HCPCS,,79007284,CDM,278,RC,,,both,,,768,303.11,39.4668,,303.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,268.8,35,,268.8,percent of total billed charges,Implant Device,261.12,34,"Charges > $500, x 34%",261.12,percent of total billed charges,Implant Device,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,307.2,40,,307.2,percent of total billed charges,Implant Devices,268.8,70,,268.8,percent of total billed charges,Implant Devices,261.12,34,,261.12,percent of total billed charges,Implant Devices,261.12,34,,261.12,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,307.2,
P 28 SE-1310 SPEED IMPLANT 13X10X10MM,C1713,HCPCS,,79007288,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
P 28 HL2M HAMMERLOCK 2 IMPLANT 15X5MM,C1713,HCPCS,,79007289,CDM,278,RC,,,both,,,3480,1373.44,39.4668,,1373.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1183.2,34,,1183.2,percent of total billed charges,Implant Device,1218,35,,1218,percent of total billed charges,Implant Device,1183.2,34,"Charges > $500, x 34%",1183.2,percent of total billed charges,Implant Device,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1392,40,,1392,percent of total billed charges,Implant Devices,1218,70,,1218,percent of total billed charges,Implant Devices,1183.2,34,,1183.2,percent of total billed charges,Implant Devices,1183.2,34,,1183.2,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,1218,35,,1218,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1183.2,34,"If Charge > 2,000, then 34 percent",1183.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1392,
ALPHATEC 62075-50 POLYAX SCREW 7.5X50MM,C1713,HCPCS,,79007290,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
ATLAS 1208-01-2712 INTERBDY SPACER 27X12,C1713,HCPCS,,79007291,CDM,278,RC,,,both,,,9555,3771.05,39.4668,,3771.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3344.25,35,,3344.25,percent of total billed charges,Implant Device,3248.7,34,"Charges > $500, x 34%",3248.7,percent of total billed charges,Implant Device,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3822,40,,3822,percent of total billed charges,Implant Devices,3344.25,70,,3344.25,percent of total billed charges,Implant Devices,3248.7,34,,3248.7,percent of total billed charges,Implant Devices,3248.7,34,,3248.7,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3248.7,34,"If Charge > 2,000, then 34 percent",3248.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3822,
DEPUY 226.591 LCP PLATE 9 HOLE 4.5X170MM,C1713,HCPCS,,79007295,CDM,278,RC,,,both,,,1554,613.31,39.4668,,613.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,528.36,34,,528.36,percent of total billed charges,Implant Device,528.36,34,,528.36,percent of total billed charges,Implant Device,528.36,34,,528.36,percent of total billed charges,Implant Device,528.36,34,,528.36,percent of total billed charges,Implant Device,528.36,34,,528.36,percent of total billed charges,Implant Device,528.36,34,,528.36,percent of total billed charges,Implant Device,543.9,35,,543.9,percent of total billed charges,Implant Device,528.36,34,"Charges > $500, x 34%",528.36,percent of total billed charges,Implant Device,543.9,35,,543.9,percent of total billed charges,Implant Devices,543.9,35,,543.9,percent of total billed charges,Implant Devices,543.9,35,,,percent of total billed charges,Implant Devices,543.9,35,,543.9,percent of total billed charges,Implant Devices,543.9,35,,543.9,percent of total billed charges,Implant Devices,621.6,40,,621.6,percent of total billed charges,Implant Devices,543.9,70,,543.9,percent of total billed charges,Implant Devices,528.36,34,,528.36,percent of total billed charges,Implant Devices,528.36,34,,528.36,percent of total billed charges,Implant Devices,543.9,35,,543.9,percent of total billed charges,Implant Devices,543.9,35,,543.9,percent of total billed charges,Implant Devices,543.9,35,,543.9,percent of total billed charges,Implant Devices,543.9,35,,543.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,621.6,
DEPUY 214.826 CORTEX SCREW 4.5X26MM,C1713,HCPCS,,79007296,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
DEPUY 02.221.510 LOCKING SCREW 5X10MM,C1713,HCPCS,,79007298,CDM,278,RC,,,both,,,564,222.59,39.4668,,222.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.76,34,,191.76,percent of total billed charges,Implant Device,191.76,34,,191.76,percent of total billed charges,Implant Device,191.76,34,,191.76,percent of total billed charges,Implant Device,191.76,34,,191.76,percent of total billed charges,Implant Device,191.76,34,,191.76,percent of total billed charges,Implant Device,191.76,34,,191.76,percent of total billed charges,Implant Device,197.4,35,,197.4,percent of total billed charges,Implant Device,191.76,34,"Charges > $500, x 34%",191.76,percent of total billed charges,Implant Device,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,225.6,40,,225.6,percent of total billed charges,Implant Devices,197.4,70,,197.4,percent of total billed charges,Implant Devices,191.76,34,,191.76,percent of total billed charges,Implant Devices,191.76,34,,191.76,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,225.6,
DEPUY 212.209 LOCKING SCREW 5X30MM,C1713,HCPCS,,79007299,CDM,278,RC,,,both,,,567,223.78,39.4668,,223.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,198.45,35,,198.45,percent of total billed charges,Implant Device,192.78,34,"Charges > $500, x 34%",192.78,percent of total billed charges,Implant Device,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,226.8,40,,226.8,percent of total billed charges,Implant Devices,198.45,70,,198.45,percent of total billed charges,Implant Devices,192.78,34,,192.78,percent of total billed charges,Implant Devices,192.78,34,,192.78,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,226.8,
DEPUY 298.803S THREAD CERCLAGE PIN 4.5MM,C1713,HCPCS,,79007300,CDM,278,RC,,,both,,,711,280.61,39.4668,,280.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,248.85,35,,248.85,percent of total billed charges,Implant Device,241.74,34,"Charges > $500, x 34%",241.74,percent of total billed charges,Implant Device,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,284.4,40,,284.4,percent of total billed charges,Implant Devices,248.85,70,,248.85,percent of total billed charges,Implant Devices,241.74,34,,241.74,percent of total billed charges,Implant Devices,241.74,34,,241.74,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,284.4,
STRYKER 3910-500-512 ICONIX 1.4MM ANCHOR,C1713,HCPCS,,79007301,CDM,278,RC,,,both,,,1126,444.4,39.4668,,444.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Device,382.84,34,"Charges > $500, x 34%",382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,450.4,40,,450.4,percent of total billed charges,Implant Devices,394.1,70,,394.1,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450.4,
STRYKER 629223 DISTAL HUM PLATE 3HOLE,C1713,HCPCS,,79007303,CDM,278,RC,,,both,,,3884,1532.89,39.4668,,1532.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1320.56,34,,1320.56,percent of total billed charges,Implant Device,1320.56,34,,1320.56,percent of total billed charges,Implant Device,1320.56,34,,1320.56,percent of total billed charges,Implant Device,1320.56,34,,1320.56,percent of total billed charges,Implant Device,1320.56,34,,1320.56,percent of total billed charges,Implant Device,1320.56,34,,1320.56,percent of total billed charges,Implant Device,1359.4,35,,1359.4,percent of total billed charges,Implant Device,1320.56,34,"Charges > $500, x 34%",1320.56,percent of total billed charges,Implant Device,1359.4,35,,1359.4,percent of total billed charges,Implant Devices,1359.4,35,,1359.4,percent of total billed charges,Implant Devices,1359.4,35,,,percent of total billed charges,Implant Devices,1359.4,35,,1359.4,percent of total billed charges,Implant Devices,1359.4,35,,1359.4,percent of total billed charges,Implant Devices,1553.6,40,,1553.6,percent of total billed charges,Implant Devices,1359.4,70,,1359.4,percent of total billed charges,Implant Devices,1320.56,34,,1320.56,percent of total billed charges,Implant Devices,1320.56,34,,1320.56,percent of total billed charges,Implant Devices,1359.4,35,,1359.4,percent of total billed charges,Implant Devices,1359.4,35,,1359.4,percent of total billed charges,Implant Devices,1359.4,35,,1359.4,percent of total billed charges,Implant Devices,1359.4,35,,1359.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1320.56,34,"If Charge > 2,000, then 34 percent",1320.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1553.6,
STRYKER 614742 NONLOCKING SCREW 2.7X42MM,C1713,HCPCS,,79007304,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
STRYKER 614724 NONLOCKING SCREW 2.7X24MM,C1713,HCPCS,,79007305,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
STRYKER 614732 NONLOCKING SCREW 2.7X32MM,C1713,HCPCS,,79007306,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 614528 LOCKING SCREW 2.7X28MM,C1713,HCPCS,,79007307,CDM,278,RC,,,both,,,671,264.82,39.4668,,264.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,228.14,34,,228.14,percent of total billed charges,Implant Device,228.14,34,,228.14,percent of total billed charges,Implant Device,228.14,34,,228.14,percent of total billed charges,Implant Device,228.14,34,,228.14,percent of total billed charges,Implant Device,228.14,34,,228.14,percent of total billed charges,Implant Device,228.14,34,,228.14,percent of total billed charges,Implant Device,234.85,35,,234.85,percent of total billed charges,Implant Device,228.14,34,"Charges > $500, x 34%",228.14,percent of total billed charges,Implant Device,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,268.4,40,,268.4,percent of total billed charges,Implant Devices,234.85,70,,234.85,percent of total billed charges,Implant Devices,228.14,34,,228.14,percent of total billed charges,Implant Devices,228.14,34,,228.14,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.4,
STRYKER 40-20222S 2X22MM CANN SCREW,C1713,HCPCS,,79007329,CDM,278,RC,,,both,,,773,305.08,39.4668,,305.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,270.55,35,,270.55,percent of total billed charges,Implant Device,262.82,34,"Charges > $500, x 34%",262.82,percent of total billed charges,Implant Device,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,309.2,40,,309.2,percent of total billed charges,Implant Devices,270.55,70,,270.55,percent of total billed charges,Implant Devices,262.82,34,,262.82,percent of total billed charges,Implant Devices,262.82,34,,262.82,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,309.2,
DEPUY 207.010 CANCELLOUS SCREW 4X10MM,C1713,HCPCS,,79007337,CDM,278,RC,,,both,,,85,33.55,39.4668,,33.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,34,40,,34,percent of total billed charges,Implant Devices,29.75,70,,29.75,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34,
DEPUY 02.110.151 LCP WRIST FUSION PLATE,C1713,HCPCS,,79007339,CDM,278,RC,,,both,,,6503,2566.53,39.4668,,2566.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2211.02,34,,2211.02,percent of total billed charges,Implant Device,2211.02,34,,2211.02,percent of total billed charges,Implant Device,2211.02,34,,2211.02,percent of total billed charges,Implant Device,2211.02,34,,2211.02,percent of total billed charges,Implant Device,2211.02,34,,2211.02,percent of total billed charges,Implant Device,2211.02,34,,2211.02,percent of total billed charges,Implant Device,2276.05,35,,2276.05,percent of total billed charges,Implant Device,2211.02,34,"Charges > $500, x 34%",2211.02,percent of total billed charges,Implant Device,2276.05,35,,2276.05,percent of total billed charges,Implant Devices,2276.05,35,,2276.05,percent of total billed charges,Implant Devices,2276.05,35,,,percent of total billed charges,Implant Devices,2276.05,35,,2276.05,percent of total billed charges,Implant Devices,2276.05,35,,2276.05,percent of total billed charges,Implant Devices,2601.2,40,,2601.2,percent of total billed charges,Implant Devices,2276.05,70,,2276.05,percent of total billed charges,Implant Devices,2211.02,34,,2211.02,percent of total billed charges,Implant Devices,2211.02,34,,2211.02,percent of total billed charges,Implant Devices,2276.05,35,,2276.05,percent of total billed charges,Implant Devices,2276.05,35,,2276.05,percent of total billed charges,Implant Devices,2276.05,35,,2276.05,percent of total billed charges,Implant Devices,2276.05,35,,2276.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2211.02,34,"If Charge > 2,000, then 34 percent",2211.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2601.2,
DEPUY 202.220 LOCK SCREW SELF TAP 2.7X20,C1713,HCPCS,,79007340,CDM,278,RC,,,both,,,311,122.74,39.4668,,122.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,105.74,34,,105.74,percent of total billed charges,Implant Device,105.74,34,,105.74,percent of total billed charges,Implant Device,105.74,34,,105.74,percent of total billed charges,Implant Device,105.74,34,,105.74,percent of total billed charges,Implant Device,105.74,34,,105.74,percent of total billed charges,Implant Device,105.74,34,,105.74,percent of total billed charges,Implant Device,108.85,35,,108.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,108.85,35,,108.85,percent of total billed charges,Implant Devices,108.85,35,,108.85,percent of total billed charges,Implant Devices,108.85,35,,,percent of total billed charges,Implant Devices,108.85,35,,108.85,percent of total billed charges,Implant Devices,108.85,35,,108.85,percent of total billed charges,Implant Devices,124.4,40,,124.4,percent of total billed charges,Implant Devices,108.85,70,,108.85,percent of total billed charges,Implant Devices,105.74,34,,105.74,percent of total billed charges,Implant Devices,105.74,34,,105.74,percent of total billed charges,Implant Devices,108.85,35,,108.85,percent of total billed charges,Implant Devices,108.85,35,,108.85,percent of total billed charges,Implant Devices,108.85,35,,108.85,percent of total billed charges,Implant Devices,108.85,35,,108.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.4,
DEPUY 202.210 LOCK SCREW SELF TAP 2.7X10,C1713,HCPCS,,79007341,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
STRYKER 1828-1334S FEMORAL NAIL 13X340MM,C1713,HCPCS,,79007342,CDM,278,RC,,,both,,,7030,2774.52,39.4668,,2774.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2460.5,35,,2460.5,percent of total billed charges,Implant Device,2390.2,34,"Charges > $500, x 34%",2390.2,percent of total billed charges,Implant Device,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2812,40,,2812,percent of total billed charges,Implant Devices,2460.5,70,,2460.5,percent of total billed charges,Implant Devices,2390.2,34,,2390.2,percent of total billed charges,Implant Devices,2390.2,34,,2390.2,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2390.2,34,"If Charge > 2,000, then 34 percent",2390.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2812,
DEPUY 212.108 LOCK SCREW SELF TAP 3.5X24,C1713,HCPCS,,79007343,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
STRYKER 1896-5075S LOCKING SCREW 5X75,C1713,HCPCS,,79007344,CDM,278,RC,,,both,,,788,311,39.4668,,311,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,275.8,35,,275.8,percent of total billed charges,Implant Device,267.92,34,"Charges > $500, x 34%",267.92,percent of total billed charges,Implant Device,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,315.2,40,,315.2,percent of total billed charges,Implant Devices,275.8,70,,275.8,percent of total billed charges,Implant Devices,267.92,34,,267.92,percent of total billed charges,Implant Devices,267.92,34,,267.92,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.2,
STRYKER 6704-0-420 CABLE/SLEEVE SET 1.6,C1713,HCPCS,,79007345,CDM,278,RC,,,both,,,963,380.07,39.4668,,380.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,327.42,34,,327.42,percent of total billed charges,Implant Device,327.42,34,,327.42,percent of total billed charges,Implant Device,327.42,34,,327.42,percent of total billed charges,Implant Device,327.42,34,,327.42,percent of total billed charges,Implant Device,327.42,34,,327.42,percent of total billed charges,Implant Device,327.42,34,,327.42,percent of total billed charges,Implant Device,337.05,35,,337.05,percent of total billed charges,Implant Device,327.42,34,"Charges > $500, x 34%",327.42,percent of total billed charges,Implant Device,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,385.2,40,,385.2,percent of total billed charges,Implant Devices,337.05,70,,337.05,percent of total billed charges,Implant Devices,327.42,34,,327.42,percent of total billed charges,Implant Devices,327.42,34,,327.42,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,337.05,35,,337.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,385.2,
PHOENIX 400-651 SPINAL CABLE SYS 4-CRIMP,C1713,HCPCS,,79007347,CDM,278,RC,,,both,,,5550,2190.41,39.4668,,2190.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Device,1887,34,"Charges > $500, x 34%",1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,2220,40,,2220,percent of total billed charges,Implant Devices,1942.5,70,,1942.5,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1887,34,"If Charge > 2,000, then 34 percent",1887,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2220,
PHOENIX 90-300-25508 BONE VOID FILL 10CC,C1713,HCPCS,,79007348,CDM,278,RC,,,both,,,8625,3404.01,39.4668,,3404.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,3018.75,35,,3018.75,percent of total billed charges,Implant Device,2932.5,34,"Charges > $500, x 34%",2932.5,percent of total billed charges,Implant Device,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3450,40,,3450,percent of total billed charges,Implant Devices,3018.75,70,,3018.75,percent of total billed charges,Implant Devices,2932.5,34,,2932.5,percent of total billed charges,Implant Devices,2932.5,34,,2932.5,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2932.5,34,"If Charge > 2,000, then 34 percent",2932.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3450,
PHOENIX 90-200-10 BONE VOID FILLER 10CC,C1713,HCPCS,,79007349,CDM,278,RC,,,both,,,8625,3404.01,39.4668,,3404.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,3018.75,35,,3018.75,percent of total billed charges,Implant Device,2932.5,34,"Charges > $500, x 34%",2932.5,percent of total billed charges,Implant Device,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3450,40,,3450,percent of total billed charges,Implant Devices,3018.75,70,,3018.75,percent of total billed charges,Implant Devices,2932.5,34,,2932.5,percent of total billed charges,Implant Devices,2932.5,34,,2932.5,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2932.5,34,"If Charge > 2,000, then 34 percent",2932.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3450,
ZIMMER 00-5852-050-11 STEM EXT 11X130MM,C1713,HCPCS,,79007352,CDM,278,RC,,,both,,,11453,4520.13,39.4668,,4520.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,4008.55,35,,4008.55,percent of total billed charges,Implant Device,3894.02,34,"Charges > $500, x 34%",3894.02,percent of total billed charges,Implant Device,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4581.2,40,,4581.2,percent of total billed charges,Implant Devices,4008.55,70,,4008.55,percent of total billed charges,Implant Devices,3894.02,34,,3894.02,percent of total billed charges,Implant Devices,3894.02,34,,3894.02,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3894.02,34,"If Charge > 2,000, then 34 percent",3894.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4581.2,
ZIMMER 00-5850-046-03 SEGMENT 30MM,C1713,HCPCS,,79007353,CDM,278,RC,,,both,,,11302,4460.54,39.4668,,4460.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3842.68,34,,3842.68,percent of total billed charges,Implant Device,3842.68,34,,3842.68,percent of total billed charges,Implant Device,3842.68,34,,3842.68,percent of total billed charges,Implant Device,3842.68,34,,3842.68,percent of total billed charges,Implant Device,3842.68,34,,3842.68,percent of total billed charges,Implant Device,3842.68,34,,3842.68,percent of total billed charges,Implant Device,3955.7,35,,3955.7,percent of total billed charges,Implant Device,3842.68,34,"Charges > $500, x 34%",3842.68,percent of total billed charges,Implant Device,3955.7,35,,3955.7,percent of total billed charges,Implant Devices,3955.7,35,,3955.7,percent of total billed charges,Implant Devices,3955.7,35,,,percent of total billed charges,Implant Devices,3955.7,35,,3955.7,percent of total billed charges,Implant Devices,3955.7,35,,3955.7,percent of total billed charges,Implant Devices,4520.8,40,,4520.8,percent of total billed charges,Implant Devices,3955.7,70,,3955.7,percent of total billed charges,Implant Devices,3842.68,34,,3842.68,percent of total billed charges,Implant Devices,3842.68,34,,3842.68,percent of total billed charges,Implant Devices,3955.7,35,,3955.7,percent of total billed charges,Implant Devices,3955.7,35,,3955.7,percent of total billed charges,Implant Devices,3955.7,35,,3955.7,percent of total billed charges,Implant Devices,3955.7,35,,3955.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3842.68,34,"If Charge > 2,000, then 34 percent",3842.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4520.8,
ZIMMER 00-5852-040-25 STEM COLLAR 25MM,C1713,HCPCS,,79007354,CDM,278,RC,,,both,,,7178,2832.93,39.4668,,2832.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2440.52,34,,2440.52,percent of total billed charges,Implant Device,2440.52,34,,2440.52,percent of total billed charges,Implant Device,2440.52,34,,2440.52,percent of total billed charges,Implant Device,2440.52,34,,2440.52,percent of total billed charges,Implant Device,2440.52,34,,2440.52,percent of total billed charges,Implant Device,2440.52,34,,2440.52,percent of total billed charges,Implant Device,2512.3,35,,2512.3,percent of total billed charges,Implant Device,2440.52,34,"Charges > $500, x 34%",2440.52,percent of total billed charges,Implant Device,2512.3,35,,2512.3,percent of total billed charges,Implant Devices,2512.3,35,,2512.3,percent of total billed charges,Implant Devices,2512.3,35,,,percent of total billed charges,Implant Devices,2512.3,35,,2512.3,percent of total billed charges,Implant Devices,2512.3,35,,2512.3,percent of total billed charges,Implant Devices,2871.2,40,,2871.2,percent of total billed charges,Implant Devices,2512.3,70,,2512.3,percent of total billed charges,Implant Devices,2440.52,34,,2440.52,percent of total billed charges,Implant Devices,2440.52,34,,2440.52,percent of total billed charges,Implant Devices,2512.3,35,,2512.3,percent of total billed charges,Implant Devices,2512.3,35,,2512.3,percent of total billed charges,Implant Devices,2512.3,35,,2512.3,percent of total billed charges,Implant Devices,2512.3,35,,2512.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2440.52,34,"If Charge > 2,000, then 34 percent",2440.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2871.2,
IN2BONES S22 ST010 SCREW 2.2X10MM,C1713,HCPCS,,79007360,CDM,278,RC,,,both,,,675,266.4,39.4668,,266.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Device,229.5,34,"Charges > $500, x 34%",229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,270,40,,270,percent of total billed charges,Implant Devices,236.25,70,,236.25,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270,
STRYKER 627438 8 HOLE PLATE RT DIST MED,C1713,HCPCS,,79007362,CDM,278,RC,,,both,,,7635,3013.29,39.4668,,3013.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2595.9,34,,2595.9,percent of total billed charges,Implant Device,2595.9,34,,2595.9,percent of total billed charges,Implant Device,2595.9,34,,2595.9,percent of total billed charges,Implant Device,2595.9,34,,2595.9,percent of total billed charges,Implant Device,2595.9,34,,2595.9,percent of total billed charges,Implant Device,2595.9,34,,2595.9,percent of total billed charges,Implant Device,2672.25,35,,2672.25,percent of total billed charges,Implant Device,2595.9,34,"Charges > $500, x 34%",2595.9,percent of total billed charges,Implant Device,2672.25,35,,2672.25,percent of total billed charges,Implant Devices,2672.25,35,,2672.25,percent of total billed charges,Implant Devices,2672.25,35,,,percent of total billed charges,Implant Devices,2672.25,35,,2672.25,percent of total billed charges,Implant Devices,2672.25,35,,2672.25,percent of total billed charges,Implant Devices,3054,40,,3054,percent of total billed charges,Implant Devices,2672.25,70,,2672.25,percent of total billed charges,Implant Devices,2595.9,34,,2595.9,percent of total billed charges,Implant Devices,2595.9,34,,2595.9,percent of total billed charges,Implant Devices,2672.25,35,,2672.25,percent of total billed charges,Implant Devices,2672.25,35,,2672.25,percent of total billed charges,Implant Devices,2672.25,35,,2672.25,percent of total billed charges,Implant Devices,2672.25,35,,2672.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2595.9,34,"If Charge > 2,000, then 34 percent",2595.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3054,
STRYKER 661050 4.5X50MM LOCKING SCREW,C1713,HCPCS,,79007363,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 661046 4.5X46MM LOCKING SCREW,C1713,HCPCS,,79007364,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 661018 4.5X18MM LOCKING SCREW,C1713,HCPCS,,79007365,CDM,278,RC,,,both,,,753,297.19,39.4668,,297.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,256.02,34,,256.02,percent of total billed charges,Implant Device,263.55,35,,263.55,percent of total billed charges,Implant Device,256.02,34,"Charges > $500, x 34%",256.02,percent of total billed charges,Implant Device,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,301.2,40,,301.2,percent of total billed charges,Implant Devices,263.55,70,,263.55,percent of total billed charges,Implant Devices,256.02,34,,256.02,percent of total billed charges,Implant Devices,256.02,34,,256.02,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,263.55,35,,263.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,301.2,
STRYKER 661024 4.5X24MM LOCKING SCREW,C1713,HCPCS,,79007366,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 661026 4.5X26MM LOCKING SCREW,C1713,HCPCS,,79007367,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 661450 3.5X50MM CORTICAL SCREW,C1713,HCPCS,,79007368,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 661440 3.5X40MM CORTICAL SCREW,C1713,HCPCS,,79007369,CDM,278,RC,,,both,,,132,52.1,39.4668,,52.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,52.8,40,,52.8,percent of total billed charges,Implant Devices,46.2,70,,46.2,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.8,
STRYKER 661430 3.5X30MM CORTICAL SCREW,C1713,HCPCS,,79007370,CDM,278,RC,,,both,,,132,52.1,39.4668,,52.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,52.8,40,,52.8,percent of total billed charges,Implant Devices,46.2,70,,46.2,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.8,
STRYKER 661428 3.5X28MM CORTICAL SCREW,C1713,HCPCS,,79007371,CDM,278,RC,,,both,,,132,52.1,39.4668,,52.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,52.8,40,,52.8,percent of total billed charges,Implant Devices,46.2,70,,46.2,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.8,
STRYKER 5030-4-300 TRANSFIX PIN 4/5X300,C1713,HCPCS,,79007404,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
DEPUY 456.322S FIXATION NAIL 12X170MM,C1713,HCPCS,,79007409,CDM,278,RC,,,both,,,5240,2068.06,39.4668,,2068.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1834,35,,1834,percent of total billed charges,Implant Device,1781.6,34,"Charges > $500, x 34%",1781.6,percent of total billed charges,Implant Device,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,2096,40,,2096,percent of total billed charges,Implant Devices,1834,70,,1834,percent of total billed charges,Implant Devices,1781.6,34,,1781.6,percent of total billed charges,Implant Devices,1781.6,34,,1781.6,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1781.6,34,"If Charge > 2,000, then 34 percent",1781.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2096,
DEPUY 212.119 LOCKING SCREW 3.5X45MM,C1713,HCPCS,,79007410,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
DEPUY 239.916S TIBIAL PLATE 3.5X220,C1713,HCPCS,,79007411,CDM,278,RC,,,both,,,6657,2627.3,39.4668,,2627.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2263.38,34,,2263.38,percent of total billed charges,Implant Device,2263.38,34,,2263.38,percent of total billed charges,Implant Device,2263.38,34,,2263.38,percent of total billed charges,Implant Device,2263.38,34,,2263.38,percent of total billed charges,Implant Device,2263.38,34,,2263.38,percent of total billed charges,Implant Device,2263.38,34,,2263.38,percent of total billed charges,Implant Device,2329.95,35,,2329.95,percent of total billed charges,Implant Device,2263.38,34,"Charges > $500, x 34%",2263.38,percent of total billed charges,Implant Device,2329.95,35,,2329.95,percent of total billed charges,Implant Devices,2329.95,35,,2329.95,percent of total billed charges,Implant Devices,2329.95,35,,,percent of total billed charges,Implant Devices,2329.95,35,,2329.95,percent of total billed charges,Implant Devices,2329.95,35,,2329.95,percent of total billed charges,Implant Devices,2662.8,40,,2662.8,percent of total billed charges,Implant Devices,2329.95,70,,2329.95,percent of total billed charges,Implant Devices,2263.38,34,,2263.38,percent of total billed charges,Implant Devices,2263.38,34,,2263.38,percent of total billed charges,Implant Devices,2329.95,35,,2329.95,percent of total billed charges,Implant Devices,2329.95,35,,2329.95,percent of total billed charges,Implant Devices,2329.95,35,,2329.95,percent of total billed charges,Implant Devices,2329.95,35,,2329.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2263.38,34,"If Charge > 2,000, then 34 percent",2263.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2662.8,
STRYKER 1828-1244S FEMORAL NAIL 12X440MM,C1713,HCPCS,,79007412,CDM,278,RC,,,both,,,7030,2774.52,39.4668,,2774.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2460.5,35,,2460.5,percent of total billed charges,Implant Device,2390.2,34,"Charges > $500, x 34%",2390.2,percent of total billed charges,Implant Device,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2812,40,,2812,percent of total billed charges,Implant Devices,2460.5,70,,2460.5,percent of total billed charges,Implant Devices,2390.2,34,,2390.2,percent of total billed charges,Implant Devices,2390.2,34,,2390.2,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2390.2,34,"If Charge > 2,000, then 34 percent",2390.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2812,
STRYKER 1896-5080S LOCKING SCREW 5X80MM,C1713,HCPCS,,79007413,CDM,278,RC,,,both,,,441,174.05,39.4668,,174.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,176.4,40,,176.4,percent of total billed charges,Implant Devices,154.35,70,,154.35,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,176.4,
DEPUY 204.838 CORTEX SCREW 3.5X38MM,C1713,HCPCS,,79007414,CDM,278,RC,,,both,,,82,32.36,39.4668,,32.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,28.7,35,,28.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,32.8,40,,32.8,percent of total billed charges,Implant Devices,28.7,70,,28.7,percent of total billed charges,Implant Devices,27.88,34,,27.88,percent of total billed charges,Implant Devices,27.88,34,,27.88,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.8,
P28 P50-053-2713 TUFFNEK SCREW 2.7X13MM,C1713,HCPCS,,79007416,CDM,278,RC,,,both,,,667,263.24,39.4668,,263.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Device,226.78,34,"Charges > $500, x 34%",226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,266.8,40,,266.8,percent of total billed charges,Implant Devices,233.45,70,,233.45,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.8,
P28 P53-101-2011 PLATE 2 HOLE 1.1X15MM,C1713,HCPCS,,79007417,CDM,278,RC,,,both,,,3590,1416.86,39.4668,,1416.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1256.5,35,,1256.5,percent of total billed charges,Implant Device,1220.6,34,"Charges > $500, x 34%",1220.6,percent of total billed charges,Implant Device,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1436,40,,1436,percent of total billed charges,Implant Devices,1256.5,70,,1256.5,percent of total billed charges,Implant Devices,1220.6,34,,1220.6,percent of total billed charges,Implant Devices,1220.6,34,,1220.6,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1220.6,34,"If Charge > 2,000, then 34 percent",1220.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1436,
P28 P53-105-R003 HEVANS PLATE LG RT 24MM,C1713,HCPCS,,79007418,CDM,278,RC,,,both,,,4851,1914.53,39.4668,,1914.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1697.85,35,,1697.85,percent of total billed charges,Implant Device,1649.34,34,"Charges > $500, x 34%",1649.34,percent of total billed charges,Implant Device,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1940.4,40,,1940.4,percent of total billed charges,Implant Devices,1697.85,70,,1697.85,percent of total billed charges,Implant Devices,1649.34,34,,1649.34,percent of total billed charges,Implant Devices,1649.34,34,,1649.34,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1649.34,34,"If Charge > 2,000, then 34 percent",1649.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1940.4,
P28 PCOT-181406 COTTON WEDGE 6MM,C1713,HCPCS,,79007420,CDM,278,RC,,,both,,,5198,2051.48,39.4668,,2051.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1819.3,35,,1819.3,percent of total billed charges,Implant Device,1767.32,34,"Charges > $500, x 34%",1767.32,percent of total billed charges,Implant Device,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,2079.2,40,,2079.2,percent of total billed charges,Implant Devices,1819.3,70,,1819.3,percent of total billed charges,Implant Devices,1767.32,34,,1767.32,percent of total billed charges,Implant Devices,1767.32,34,,1767.32,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1767.32,34,"If Charge > 2,000, then 34 percent",1767.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2079.2,
P28 PLCL-25010 EVANS WEDGE 10MM,C1713,HCPCS,,79007421,CDM,278,RC,,,both,,,5985,2362.09,39.4668,,2362.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2094.75,35,,2094.75,percent of total billed charges,Implant Device,2034.9,34,"Charges > $500, x 34%",2034.9,percent of total billed charges,Implant Device,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2394,40,,2394,percent of total billed charges,Implant Devices,2094.75,70,,2094.75,percent of total billed charges,Implant Devices,2034.9,34,,2034.9,percent of total billed charges,Implant Devices,2034.9,34,,2034.9,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2034.9,34,"If Charge > 2,000, then 34 percent",2034.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2394,
RTI SURGICAL DL0407 ELEMAX SPACER 7MM,C1713,HCPCS,,79007423,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
RTI SURGICAL DL0406 ELEMAX SPACER 6MM,C1713,HCPCS,,79007424,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ALPHATEC 71003-048 TRESTLE LUXE PLATE 48,C1713,HCPCS,,79007425,CDM,278,RC,,,both,,,3135,1237.28,39.4668,,1237.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1097.25,35,,1097.25,percent of total billed charges,Implant Device,1065.9,34,"Charges > $500, x 34%",1065.9,percent of total billed charges,Implant Device,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1254,40,,1254,percent of total billed charges,Implant Devices,1097.25,70,,1097.25,percent of total billed charges,Implant Devices,1065.9,34,,1065.9,percent of total billed charges,Implant Devices,1065.9,34,,1065.9,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1065.9,34,"If Charge > 2,000, then 34 percent",1065.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254,
ARTHREX AR-8967-1870 CANN SCREW 6.7X70MM,C1713,HCPCS,,79007440,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-8967-1865 CANN SCREW 6.7X65MM,C1713,HCPCS,,79007441,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-8967W WASHER 6.7MM,C1713,HCPCS,,79007442,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
ARTHREX AR-8005-20 COMP STAPLE 20X20MM,C1713,HCPCS,,79007443,CDM,278,RC,,,both,,,1824,719.87,39.4668,,719.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,638.4,35,,638.4,percent of total billed charges,Implant Device,620.16,34,"Charges > $500, x 34%",620.16,percent of total billed charges,Implant Device,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,729.6,40,,729.6,percent of total billed charges,Implant Devices,638.4,70,,638.4,percent of total billed charges,Implant Devices,620.16,34,,620.16,percent of total billed charges,Implant Devices,620.16,34,,620.16,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,729.6,
ZIMMER 00-5850-032-17 TISSUE ATTACH 7MM,C1713,HCPCS,,79007452,CDM,278,RC,,,both,,,6633,2617.83,39.4668,,2617.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2255.22,34,,2255.22,percent of total billed charges,Implant Device,2255.22,34,,2255.22,percent of total billed charges,Implant Device,2255.22,34,,2255.22,percent of total billed charges,Implant Device,2255.22,34,,2255.22,percent of total billed charges,Implant Device,2255.22,34,,2255.22,percent of total billed charges,Implant Device,2255.22,34,,2255.22,percent of total billed charges,Implant Device,2321.55,35,,2321.55,percent of total billed charges,Implant Device,2255.22,34,"Charges > $500, x 34%",2255.22,percent of total billed charges,Implant Device,2321.55,35,,2321.55,percent of total billed charges,Implant Devices,2321.55,35,,2321.55,percent of total billed charges,Implant Devices,2321.55,35,,,percent of total billed charges,Implant Devices,2321.55,35,,2321.55,percent of total billed charges,Implant Devices,2321.55,35,,2321.55,percent of total billed charges,Implant Devices,2653.2,40,,2653.2,percent of total billed charges,Implant Devices,2321.55,70,,2321.55,percent of total billed charges,Implant Devices,2255.22,34,,2255.22,percent of total billed charges,Implant Devices,2255.22,34,,2255.22,percent of total billed charges,Implant Devices,2321.55,35,,2321.55,percent of total billed charges,Implant Devices,2321.55,35,,2321.55,percent of total billed charges,Implant Devices,2321.55,35,,2321.55,percent of total billed charges,Implant Devices,2321.55,35,,2321.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2255.22,34,"If Charge > 2,000, then 34 percent",2255.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2653.2,
DEPUY 239.987 MED PROX TIB PLATE 6HOLE,C1713,HCPCS,,79007457,CDM,278,RC,,,both,,,5931,2340.78,39.4668,,2340.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2016.54,34,,2016.54,percent of total billed charges,Implant Device,2016.54,34,,2016.54,percent of total billed charges,Implant Device,2016.54,34,,2016.54,percent of total billed charges,Implant Device,2016.54,34,,2016.54,percent of total billed charges,Implant Device,2016.54,34,,2016.54,percent of total billed charges,Implant Device,2016.54,34,,2016.54,percent of total billed charges,Implant Device,2075.85,35,,2075.85,percent of total billed charges,Implant Device,2016.54,34,"Charges > $500, x 34%",2016.54,percent of total billed charges,Implant Device,2075.85,35,,2075.85,percent of total billed charges,Implant Devices,2075.85,35,,2075.85,percent of total billed charges,Implant Devices,2075.85,35,,,percent of total billed charges,Implant Devices,2075.85,35,,2075.85,percent of total billed charges,Implant Devices,2075.85,35,,2075.85,percent of total billed charges,Implant Devices,2372.4,40,,2372.4,percent of total billed charges,Implant Devices,2075.85,70,,2075.85,percent of total billed charges,Implant Devices,2016.54,34,,2016.54,percent of total billed charges,Implant Devices,2016.54,34,,2016.54,percent of total billed charges,Implant Devices,2075.85,35,,2075.85,percent of total billed charges,Implant Devices,2075.85,35,,2075.85,percent of total billed charges,Implant Devices,2075.85,35,,2075.85,percent of total billed charges,Implant Devices,2075.85,35,,2075.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2016.54,34,"If Charge > 2,000, then 34 percent",2016.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2372.4,
DEPUY 02.205.050 CANN LOCK SCREW 5X50MM,C1713,HCPCS,,79007459,CDM,278,RC,,,both,,,868,342.57,39.4668,,342.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,295.12,34,,295.12,percent of total billed charges,Implant Device,303.8,35,,303.8,percent of total billed charges,Implant Device,295.12,34,"Charges > $500, x 34%",295.12,percent of total billed charges,Implant Device,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,347.2,40,,347.2,percent of total billed charges,Implant Devices,303.8,70,,303.8,percent of total billed charges,Implant Devices,295.12,34,,295.12,percent of total billed charges,Implant Devices,295.12,34,,295.12,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,303.8,35,,303.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,347.2,
DEPUY 02.205.040 CANN LOCK SCREW 5X40MM,C1713,HCPCS,,79007460,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
DEPUY 214.866 CORTEX SCREW 4.5X66MM,C1713,HCPCS,,79007462,CDM,278,RC,,,both,,,99,39.07,39.4668,,39.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,39.6,40,,39.6,percent of total billed charges,Implant Devices,34.65,70,,34.65,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39.6,
DEPUY 02.118.514 MATAPHYSEAL SCRW 2.7X14,C1713,HCPCS,,79007465,CDM,278,RC,,,both,,,178,70.25,39.4668,,70.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,62.3,35,,62.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,71.2,40,,71.2,percent of total billed charges,Implant Devices,62.3,70,,62.3,percent of total billed charges,Implant Devices,60.52,34,,60.52,percent of total billed charges,Implant Devices,60.52,34,,60.52,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.2,
DEPUY 02.211.014 LOCKING SCREW 2.7X14MM,C1713,HCPCS,,79007466,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 02.211.010 LOCKING SCREW 2.7X10MM,C1713,HCPCS,,79007467,CDM,278,RC,,,both,,,357,140.9,39.4668,,140.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,124.95,35,,124.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,142.8,40,,142.8,percent of total billed charges,Implant Devices,124.95,70,,124.95,percent of total billed charges,Implant Devices,121.38,34,,121.38,percent of total billed charges,Implant Devices,121.38,34,,121.38,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142.8,
STRYKER 6704-3-080 TROCHANTERIC GRIP 2/2,C1713,HCPCS,,79007468,CDM,278,RC,,,both,,,3315,1308.32,39.4668,,1308.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1160.25,35,,1160.25,percent of total billed charges,Implant Device,1127.1,34,"Charges > $500, x 34%",1127.1,percent of total billed charges,Implant Device,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1326,40,,1326,percent of total billed charges,Implant Devices,1160.25,70,,1160.25,percent of total billed charges,Implant Devices,1127.1,34,,1127.1,percent of total billed charges,Implant Devices,1127.1,34,,1127.1,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1127.1,34,"If Charge > 2,000, then 34 percent",1127.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1326,
ARTHREX AR-1319FT ANCHOR BONE K-WIRE,C1713,HCPCS,,79007469,CDM,278,RC,,,both,,,171,67.49,39.4668,,67.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,59.85,35,,59.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,68.4,40,,68.4,percent of total billed charges,Implant Devices,59.85,70,,59.85,percent of total billed charges,Implant Devices,58.14,34,,58.14,percent of total billed charges,Implant Devices,58.14,34,,58.14,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,68.4,
STRYKER 40-35900 WASHER FOR 3.5MM SCREW,C1713,HCPCS,,79007470,CDM,278,RC,,,both,,,362,142.87,39.4668,,142.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,123.08,34,,123.08,percent of total billed charges,Implant Device,123.08,34,,123.08,percent of total billed charges,Implant Device,123.08,34,,123.08,percent of total billed charges,Implant Device,123.08,34,,123.08,percent of total billed charges,Implant Device,123.08,34,,123.08,percent of total billed charges,Implant Device,123.08,34,,123.08,percent of total billed charges,Implant Device,126.7,35,,126.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,144.8,40,,144.8,percent of total billed charges,Implant Devices,126.7,70,,126.7,percent of total billed charges,Implant Devices,123.08,34,,123.08,percent of total billed charges,Implant Devices,123.08,34,,123.08,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144.8,
STRYKER 40-20810 VARIAX LOCK PLATE 10 HL,C1713,HCPCS,,79007472,CDM,278,RC,,,both,,,2205,870.24,39.4668,,870.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,749.7,34,,749.7,percent of total billed charges,Implant Device,749.7,34,,749.7,percent of total billed charges,Implant Device,749.7,34,,749.7,percent of total billed charges,Implant Device,749.7,34,,749.7,percent of total billed charges,Implant Device,749.7,34,,749.7,percent of total billed charges,Implant Device,749.7,34,,749.7,percent of total billed charges,Implant Device,771.75,35,,771.75,percent of total billed charges,Implant Device,749.7,34,"Charges > $500, x 34%",749.7,percent of total billed charges,Implant Device,771.75,35,,771.75,percent of total billed charges,Implant Devices,771.75,35,,771.75,percent of total billed charges,Implant Devices,771.75,35,,,percent of total billed charges,Implant Devices,771.75,35,,771.75,percent of total billed charges,Implant Devices,771.75,35,,771.75,percent of total billed charges,Implant Devices,882,40,,882,percent of total billed charges,Implant Devices,771.75,70,,771.75,percent of total billed charges,Implant Devices,749.7,34,,749.7,percent of total billed charges,Implant Devices,749.7,34,,749.7,percent of total billed charges,Implant Devices,771.75,35,,771.75,percent of total billed charges,Implant Devices,771.75,35,,771.75,percent of total billed charges,Implant Devices,771.75,35,,771.75,percent of total billed charges,Implant Devices,771.75,35,,771.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,749.7,34,"If Charge > 2,000, then 34 percent",749.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,882,
ARTHREX AR-8725-14H CANN SCREW 2.5X14MM,C1713,HCPCS,,79007475,CDM,278,RC,,,both,,,1266,499.65,39.4668,,499.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,443.1,35,,443.1,percent of total billed charges,Implant Device,430.44,34,"Charges > $500, x 34%",430.44,percent of total billed charges,Implant Device,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,506.4,40,,506.4,percent of total billed charges,Implant Devices,443.1,70,,443.1,percent of total billed charges,Implant Devices,430.44,34,,430.44,percent of total billed charges,Implant Devices,430.44,34,,430.44,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,506.4,
ARTHREX AR-8725-16H CANN SCREW 2.5X16MM,C1713,HCPCS,,79007476,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
STRYKER 629508 8 HOLE NARROW COMP PLATE,C1713,HCPCS,,79007479,CDM,278,RC,,,both,,,1873,739.21,39.4668,,739.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,655.55,35,,655.55,percent of total billed charges,Implant Device,636.82,34,"Charges > $500, x 34%",636.82,percent of total billed charges,Implant Device,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,749.2,40,,749.2,percent of total billed charges,Implant Devices,655.55,70,,655.55,percent of total billed charges,Implant Devices,636.82,34,,636.82,percent of total billed charges,Implant Devices,636.82,34,,636.82,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,749.2,
STRYKER 657412 3.5X12MM NONLOCK SCREW,C1713,HCPCS,,79007480,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657414 3.5X14MM NONLOCK SCREW,C1713,HCPCS,,79007481,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657416 3.5X16MM NONLOCK SCREW,C1713,HCPCS,,79007482,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
IN2BONES S22 ST012 SNPOFF SCREW 2.2X12MM,C1713,HCPCS,,79007484,CDM,278,RC,,,both,,,1275,503.2,39.4668,,503.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Device,433.5,34,"Charges > $500, x 34%",433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,510,40,,510,percent of total billed charges,Implant Devices,446.25,70,,446.25,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510,
STRYKER 53-23212E BONE SCREW T7 2.3X12,C1713,HCPCS,,79007489,CDM,278,RC,,,both,,,362,142.87,39.4668,,142.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,123.08,34,,123.08,percent of total billed charges,Implant Device,123.08,34,,123.08,percent of total billed charges,Implant Device,123.08,34,,123.08,percent of total billed charges,Implant Device,123.08,34,,123.08,percent of total billed charges,Implant Device,123.08,34,,123.08,percent of total billed charges,Implant Device,123.08,34,,123.08,percent of total billed charges,Implant Device,126.7,35,,126.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,144.8,40,,144.8,percent of total billed charges,Implant Devices,126.7,70,,126.7,percent of total billed charges,Implant Devices,123.08,34,,123.08,percent of total billed charges,Implant Devices,123.08,34,,123.08,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,126.7,35,,126.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144.8,
DEPUY 02.123.040 3.5MM PROX HUM PLATE 3H,C1713,HCPCS,,79007490,CDM,278,RC,,,both,,,3987,1573.54,39.4668,,1573.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1355.58,34,,1355.58,percent of total billed charges,Implant Device,1395.45,35,,1395.45,percent of total billed charges,Implant Device,1355.58,34,"Charges > $500, x 34%",1355.58,percent of total billed charges,Implant Device,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1594.8,40,,1594.8,percent of total billed charges,Implant Devices,1395.45,70,,1395.45,percent of total billed charges,Implant Devices,1355.58,34,,1355.58,percent of total billed charges,Implant Devices,1355.58,34,,1355.58,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,1395.45,35,,1395.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1355.58,34,"If Charge > 2,000, then 34 percent",1355.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1594.8,
ATLAS SPINE 1106-01-6540 SCREW 6.5X40MM,C1713,HCPCS,,79007492,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ATLAS SPINE 1106-01-6545 SCREW 6/5X45MM,C1713,HCPCS,,79007493,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ATLAS SPINE 1100-03-0095 ROD 60MM,C1713,HCPCS,,79007494,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
ATLAS SPINE 1106-01-6540 SCREW 6.5X40MM,C1713,HCPCS,,79007495,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
DEPUY 206.012 CANCELLOUS SCREW 4X12MM,C1713,HCPCS,,79007497,CDM,278,RC,,,both,,,86,33.94,39.4668,,33.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.24,34,,29.24,percent of total billed charges,Implant Device,29.24,34,,29.24,percent of total billed charges,Implant Device,29.24,34,,29.24,percent of total billed charges,Implant Device,29.24,34,,29.24,percent of total billed charges,Implant Device,29.24,34,,29.24,percent of total billed charges,Implant Device,29.24,34,,29.24,percent of total billed charges,Implant Device,30.1,35,,30.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.1,35,,30.1,percent of total billed charges,Implant Devices,30.1,35,,30.1,percent of total billed charges,Implant Devices,30.1,35,,,percent of total billed charges,Implant Devices,30.1,35,,30.1,percent of total billed charges,Implant Devices,30.1,35,,30.1,percent of total billed charges,Implant Devices,34.4,40,,34.4,percent of total billed charges,Implant Devices,30.1,70,,30.1,percent of total billed charges,Implant Devices,29.24,34,,29.24,percent of total billed charges,Implant Devices,29.24,34,,29.24,percent of total billed charges,Implant Devices,30.1,35,,30.1,percent of total billed charges,Implant Devices,30.1,35,,30.1,percent of total billed charges,Implant Devices,30.1,35,,30.1,percent of total billed charges,Implant Devices,30.1,35,,30.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34.4,
DEPUY 04.037.155S NAIL 11X340MM 130DG LT,C1713,HCPCS,,79007499,CDM,278,RC,,,both,,,9372,3698.83,39.4668,,3698.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3186.48,34,,3186.48,percent of total billed charges,Implant Device,3186.48,34,,3186.48,percent of total billed charges,Implant Device,3186.48,34,,3186.48,percent of total billed charges,Implant Device,3186.48,34,,3186.48,percent of total billed charges,Implant Device,3186.48,34,,3186.48,percent of total billed charges,Implant Device,3186.48,34,,3186.48,percent of total billed charges,Implant Device,3280.2,35,,3280.2,percent of total billed charges,Implant Device,3186.48,34,"Charges > $500, x 34%",3186.48,percent of total billed charges,Implant Device,3280.2,35,,3280.2,percent of total billed charges,Implant Devices,3280.2,35,,3280.2,percent of total billed charges,Implant Devices,3280.2,35,,,percent of total billed charges,Implant Devices,3280.2,35,,3280.2,percent of total billed charges,Implant Devices,3280.2,35,,3280.2,percent of total billed charges,Implant Devices,3748.8,40,,3748.8,percent of total billed charges,Implant Devices,3280.2,70,,3280.2,percent of total billed charges,Implant Devices,3186.48,34,,3186.48,percent of total billed charges,Implant Devices,3186.48,34,,3186.48,percent of total billed charges,Implant Devices,3280.2,35,,3280.2,percent of total billed charges,Implant Devices,3280.2,35,,3280.2,percent of total billed charges,Implant Devices,3280.2,35,,3280.2,percent of total billed charges,Implant Devices,3280.2,35,,3280.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3186.48,34,"If Charge > 2,000, then 34 percent",3186.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3748.8,
DEPUY 04.038.295S TFN HELICAL BLADE 95MM,C1713,HCPCS,,79007500,CDM,278,RC,,,both,,,3195,1260.96,39.4668,,1260.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1086.3,34,,1086.3,percent of total billed charges,Implant Device,1086.3,34,,1086.3,percent of total billed charges,Implant Device,1086.3,34,,1086.3,percent of total billed charges,Implant Device,1086.3,34,,1086.3,percent of total billed charges,Implant Device,1086.3,34,,1086.3,percent of total billed charges,Implant Device,1086.3,34,,1086.3,percent of total billed charges,Implant Device,1118.25,35,,1118.25,percent of total billed charges,Implant Device,1086.3,34,"Charges > $500, x 34%",1086.3,percent of total billed charges,Implant Device,1118.25,35,,1118.25,percent of total billed charges,Implant Devices,1118.25,35,,1118.25,percent of total billed charges,Implant Devices,1118.25,35,,,percent of total billed charges,Implant Devices,1118.25,35,,1118.25,percent of total billed charges,Implant Devices,1118.25,35,,1118.25,percent of total billed charges,Implant Devices,1278,40,,1278,percent of total billed charges,Implant Devices,1118.25,70,,1118.25,percent of total billed charges,Implant Devices,1086.3,34,,1086.3,percent of total billed charges,Implant Devices,1086.3,34,,1086.3,percent of total billed charges,Implant Devices,1118.25,35,,1118.25,percent of total billed charges,Implant Devices,1118.25,35,,1118.25,percent of total billed charges,Implant Devices,1118.25,35,,1118.25,percent of total billed charges,Implant Devices,1118.25,35,,1118.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1086.3,34,"If Charge > 2,000, then 34 percent",1086.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1278,
P28 P20-140-032S CANN SHORT SCREW 4X32MM,C1713,HCPCS,,79007501,CDM,278,RC,,,both,,,794,313.37,39.4668,,313.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,269.96,34,,269.96,percent of total billed charges,Implant Device,269.96,34,,269.96,percent of total billed charges,Implant Device,269.96,34,,269.96,percent of total billed charges,Implant Device,269.96,34,,269.96,percent of total billed charges,Implant Device,269.96,34,,269.96,percent of total billed charges,Implant Device,269.96,34,,269.96,percent of total billed charges,Implant Device,277.9,35,,277.9,percent of total billed charges,Implant Device,269.96,34,"Charges > $500, x 34%",269.96,percent of total billed charges,Implant Device,277.9,35,,277.9,percent of total billed charges,Implant Devices,277.9,35,,277.9,percent of total billed charges,Implant Devices,277.9,35,,,percent of total billed charges,Implant Devices,277.9,35,,277.9,percent of total billed charges,Implant Devices,277.9,35,,277.9,percent of total billed charges,Implant Devices,317.6,40,,317.6,percent of total billed charges,Implant Devices,277.9,70,,277.9,percent of total billed charges,Implant Devices,269.96,34,,269.96,percent of total billed charges,Implant Devices,269.96,34,,269.96,percent of total billed charges,Implant Devices,277.9,35,,277.9,percent of total billed charges,Implant Devices,277.9,35,,277.9,percent of total billed charges,Implant Devices,277.9,35,,277.9,percent of total billed charges,Implant Devices,277.9,35,,277.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,317.6,
P28 P53-101-2021 PLATE 15X1.5MM  2 HOLE,C1713,HCPCS,,79007505,CDM,278,RC,,,both,,,3590,1416.86,39.4668,,1416.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1256.5,35,,1256.5,percent of total billed charges,Implant Device,1220.6,34,"Charges > $500, x 34%",1220.6,percent of total billed charges,Implant Device,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1436,40,,1436,percent of total billed charges,Implant Devices,1256.5,70,,1256.5,percent of total billed charges,Implant Devices,1220.6,34,,1220.6,percent of total billed charges,Implant Devices,1220.6,34,,1220.6,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1220.6,34,"If Charge > 2,000, then 34 percent",1220.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1436,
STRYKER 627332 PROX TIBIAL PLATE 2 HOLE,C1713,HCPCS,,79007506,CDM,278,RC,,,both,,,5922,2337.22,39.4668,,2337.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2013.48,34,,2013.48,percent of total billed charges,Implant Device,2072.7,35,,2072.7,percent of total billed charges,Implant Device,2013.48,34,"Charges > $500, x 34%",2013.48,percent of total billed charges,Implant Device,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2368.8,40,,2368.8,percent of total billed charges,Implant Devices,2072.7,70,,2072.7,percent of total billed charges,Implant Devices,2013.48,34,,2013.48,percent of total billed charges,Implant Devices,2013.48,34,,2013.48,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,2072.7,35,,2072.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2013.48,34,"If Charge > 2,000, then 34 percent",2013.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2368.8,
STRYKER 607365 4.0X65MM CANCELLOUS CREW,C1713,HCPCS,,79007507,CDM,278,RC,,,both,,,133,52.49,39.4668,,52.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,53.2,40,,53.2,percent of total billed charges,Implant Devices,46.55,70,,46.55,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
STRYKER 661438 3.5X38MM CORTICAL SCREW,C1713,HCPCS,,79007508,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
STRYKER 661085 4.0X85MM LOCKING SCREW,C1713,HCPCS,,79007509,CDM,278,RC,,,both,,,816,322.05,39.4668,,322.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,285.6,35,,285.6,percent of total billed charges,Implant Device,277.44,34,"Charges > $500, x 34%",277.44,percent of total billed charges,Implant Device,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,326.4,40,,326.4,percent of total billed charges,Implant Devices,285.6,70,,285.6,percent of total billed charges,Implant Devices,277.44,34,,277.44,percent of total billed charges,Implant Devices,277.44,34,,277.44,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,326.4,
STRYKER 661032 4.0 X 32MM LOCKING SCREW,C1713,HCPCS,,79007511,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ARTHREX AR-8954PL-M CALCANEAL PLATE MED,C1713,HCPCS,,79007524,CDM,278,RC,,,both,,,4695,1852.97,39.4668,,1852.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1643.25,35,,1643.25,percent of total billed charges,Implant Device,1596.3,34,"Charges > $500, x 34%",1596.3,percent of total billed charges,Implant Device,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1878,40,,1878,percent of total billed charges,Implant Devices,1643.25,70,,1643.25,percent of total billed charges,Implant Devices,1596.3,34,,1596.3,percent of total billed charges,Implant Devices,1596.3,34,,1596.3,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1596.3,34,"If Charge > 2,000, then 34 percent",1596.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1878,
ARTHREX AR-8935L-38 LOCKING SCREW 3.5X38,C1713,HCPCS,,79007525,CDM,278,RC,,,both,,,366,144.45,39.4668,,144.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,124.44,34,,124.44,percent of total billed charges,Implant Device,124.44,34,,124.44,percent of total billed charges,Implant Device,124.44,34,,124.44,percent of total billed charges,Implant Device,124.44,34,,124.44,percent of total billed charges,Implant Device,124.44,34,,124.44,percent of total billed charges,Implant Device,124.44,34,,124.44,percent of total billed charges,Implant Device,128.1,35,,128.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,146.4,40,,146.4,percent of total billed charges,Implant Devices,128.1,70,,128.1,percent of total billed charges,Implant Devices,124.44,34,,124.44,percent of total billed charges,Implant Devices,124.44,34,,124.44,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,128.1,35,,128.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,146.4,
ARTHREX AR-8933-24 CORT SCREW 3.0X24MM,C1713,HCPCS,,79007526,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8933L-24 LOCKING SCREW 3X24MM,C1713,HCPCS,,79007527,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8970TT TIB TALAR ANKLE PLATE,C1713,HCPCS,,79007528,CDM,278,RC,,,both,,,8895,3510.57,39.4668,,3510.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3113.25,35,,3113.25,percent of total billed charges,Implant Device,3024.3,34,"Charges > $500, x 34%",3024.3,percent of total billed charges,Implant Device,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3558,40,,3558,percent of total billed charges,Implant Devices,3113.25,70,,3113.25,percent of total billed charges,Implant Devices,3024.3,34,,3024.3,percent of total billed charges,Implant Devices,3024.3,34,,3024.3,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3024.3,34,"If Charge > 2,000, then 34 percent",3024.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3558,
ARTHREX AR-8545L-32 LOCKING SCREW 4.5X32,C1713,HCPCS,,79007529,CDM,278,RC,,,both,,,837,330.34,39.4668,,330.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Device,284.58,34,"Charges > $500, x 34%",284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,334.8,40,,334.8,percent of total billed charges,Implant Devices,292.95,70,,292.95,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.8,
ARTHREX AR-8545L-34 LOCKING SCREW 4.5X34,C1713,HCPCS,,79007530,CDM,278,RC,,,both,,,837,330.34,39.4668,,330.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Device,284.58,34,"Charges > $500, x 34%",284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,334.8,40,,334.8,percent of total billed charges,Implant Devices,292.95,70,,292.95,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.8,
ARTHREX AR-8545L-36 LOCKING SCREW 4.5X36,C1713,HCPCS,,79007531,CDM,278,RC,,,both,,,585,230.88,39.4668,,230.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,204.75,35,,204.75,percent of total billed charges,Implant Device,198.9,34,"Charges > $500, x 34%",198.9,percent of total billed charges,Implant Device,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,234,40,,234,percent of total billed charges,Implant Devices,204.75,70,,204.75,percent of total billed charges,Implant Devices,198.9,34,,198.9,percent of total billed charges,Implant Devices,198.9,34,,198.9,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234,
ARTHREX AR-8545L-38 LOCKING SCREW 4.5X28,C1713,HCPCS,,79007532,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
ARTHREX AR-8545-36 CORTICAL SCREW 4.5X36,C1713,HCPCS,,79007533,CDM,278,RC,,,both,,,225,88.8,39.4668,,88.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,90,40,,90,percent of total billed charges,Implant Devices,78.75,70,,78.75,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90,
ARTHREX AR-8967-28100 CANN SCREW 6.7X100,C1713,HCPCS,,79007534,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ARTHREX AR-8967-1895 CANN SCREW 6.7X95,C1713,HCPCS,,79007535,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-8970-09T BB-TAK LG THREADED,C1713,HCPCS,,79007537,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
DEPUY 02.240.244 CANN SCREW 3.7X44MM,C1713,HCPCS,,79007540,CDM,278,RC,,,both,,,690,272.32,39.4668,,272.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,241.5,35,,241.5,percent of total billed charges,Implant Device,234.6,34,"Charges > $500, x 34%",234.6,percent of total billed charges,Implant Device,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,276,40,,276,percent of total billed charges,Implant Devices,241.5,70,,241.5,percent of total billed charges,Implant Devices,234.6,34,,234.6,percent of total billed charges,Implant Devices,234.6,34,,234.6,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,276,
ARTHREX ABS-3008 QUICKSET KIT CA PO,C1713,HCPCS,,79007541,CDM,278,RC,,,both,,,5985,2362.09,39.4668,,2362.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2094.75,35,,2094.75,percent of total billed charges,Implant Device,2034.9,34,"Charges > $500, x 34%",2034.9,percent of total billed charges,Implant Device,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2394,40,,2394,percent of total billed charges,Implant Devices,2094.75,70,,2094.75,percent of total billed charges,Implant Devices,2034.9,34,,2034.9,percent of total billed charges,Implant Devices,2034.9,34,,2034.9,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2034.9,34,"If Charge > 2,000, then 34 percent",2034.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2394,
MICROAIRE 1620-509 PIN 2.0X5X64 SMOOTH,C1713,HCPCS,,79007545,CDM,278,RC,,,both,,,10,3.95,39.4668,,3.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3.4,34,,3.4,percent of total billed charges,Implant Device,3.4,34,,3.4,percent of total billed charges,Implant Device,3.4,34,,3.4,percent of total billed charges,Implant Device,3.4,34,,3.4,percent of total billed charges,Implant Device,3.4,34,,3.4,percent of total billed charges,Implant Device,3.4,34,,3.4,percent of total billed charges,Implant Device,3.5,35,,3.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,3.5,35,,3.5,percent of total billed charges,Implant Devices,3.5,35,,3.5,percent of total billed charges,Implant Devices,3.5,35,,,percent of total billed charges,Implant Devices,3.5,35,,3.5,percent of total billed charges,Implant Devices,3.5,35,,3.5,percent of total billed charges,Implant Devices,4,40,,4,percent of total billed charges,Implant Devices,3.5,70,,3.5,percent of total billed charges,Implant Devices,3.4,34,,3.4,percent of total billed charges,Implant Devices,3.4,34,,3.4,percent of total billed charges,Implant Devices,3.5,35,,3.5,percent of total billed charges,Implant Devices,3.5,35,,3.5,percent of total billed charges,Implant Devices,3.5,35,,3.5,percent of total billed charges,Implant Devices,3.5,35,,3.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4,
MICROAIRE 1620-509T PIN 2.0X5X64 THREAD,C1713,HCPCS,,79007546,CDM,278,RC,,,both,,,25,9.87,39.4668,,9.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,10,40,,10,percent of total billed charges,Implant Devices,8.75,70,,8.75,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10,
MICROAIRE 1624-509 PIN 2.4X3X32 SMOOTH,C1713,HCPCS,,79007547,CDM,278,RC,,,both,,,12,4.74,39.4668,,4.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.2,35,,4.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.8,40,,4.8,percent of total billed charges,Implant Devices,4.2,70,,4.2,percent of total billed charges,Implant Devices,4.08,34,,4.08,percent of total billed charges,Implant Devices,4.08,34,,4.08,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4.8,
MICORAIRE 1624-509T PIN 2.4X3X32 THREAD,C1713,HCPCS,,79007548,CDM,278,RC,,,both,,,25,9.87,39.4668,,9.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,10,40,,10,percent of total billed charges,Implant Devices,8.75,70,,8.75,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10,
MICROAIRE 1628-509 PIN 2.8X7X64 SMOOTH,C1713,HCPCS,,79007549,CDM,278,RC,,,both,,,12,4.74,39.4668,,4.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.2,35,,4.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.8,40,,4.8,percent of total billed charges,Implant Devices,4.2,70,,4.2,percent of total billed charges,Implant Devices,4.08,34,,4.08,percent of total billed charges,Implant Devices,4.08,34,,4.08,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4.8,
MICROAIRE 1628-509T PIN 2.8X7X64 THREAD,C1713,HCPCS,,79007550,CDM,278,RC,,,both,,,25,9.87,39.4668,,9.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,10,40,,10,percent of total billed charges,Implant Devices,8.75,70,,8.75,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10,
MICROAIRE 1632-509 PIN 3.2X1X8 SMOOTH,C1713,HCPCS,,79007551,CDM,278,RC,,,both,,,12,4.74,39.4668,,4.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.2,35,,4.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.8,40,,4.8,percent of total billed charges,Implant Devices,4.2,70,,4.2,percent of total billed charges,Implant Devices,4.08,34,,4.08,percent of total billed charges,Implant Devices,4.08,34,,4.08,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4.8,
MICROAIRE 1632-509T PIN 3.2X1X8 THREAD,C1713,HCPCS,,79007552,CDM,278,RC,,,both,,,25,9.87,39.4668,,9.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,10,40,,10,percent of total billed charges,Implant Devices,8.75,70,,8.75,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10,
MICROAIRE 1636-509 PIN 3.6X9X64 SMOOTH,C1713,HCPCS,,79007553,CDM,278,RC,,,both,,,12,4.74,39.4668,,4.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.08,34,,4.08,percent of total billed charges,Implant Device,4.2,35,,4.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.8,40,,4.8,percent of total billed charges,Implant Devices,4.2,70,,4.2,percent of total billed charges,Implant Devices,4.08,34,,4.08,percent of total billed charges,Implant Devices,4.08,34,,4.08,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,4.2,35,,4.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4.8,
MICROAIRE 1636-509T PIN 3.6X9X64 THREAD,C1713,HCPCS,,79007554,CDM,278,RC,,,both,,,25,9.87,39.4668,,9.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,10,40,,10,percent of total billed charges,Implant Devices,8.75,70,,8.75,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10,
MICROAIRE 1640-509 PIN 4.0X5X32 SMOOTH,C1713,HCPCS,,79007555,CDM,278,RC,,,both,,,41,16.18,39.4668,,16.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,13.94,34,,13.94,percent of total billed charges,Implant Device,13.94,34,,13.94,percent of total billed charges,Implant Device,13.94,34,,13.94,percent of total billed charges,Implant Device,13.94,34,,13.94,percent of total billed charges,Implant Device,13.94,34,,13.94,percent of total billed charges,Implant Device,13.94,34,,13.94,percent of total billed charges,Implant Device,14.35,35,,14.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,16.4,40,,16.4,percent of total billed charges,Implant Devices,14.35,70,,14.35,percent of total billed charges,Implant Devices,13.94,34,,13.94,percent of total billed charges,Implant Devices,13.94,34,,13.94,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,14.35,35,,14.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,16.4,
MICROAIRE 1640-509T PIN 4.0X5X32 THREAD,C1713,HCPCS,,79007556,CDM,278,RC,,,both,,,25,9.87,39.4668,,9.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.5,34,,8.5,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,10,40,,10,percent of total billed charges,Implant Devices,8.75,70,,8.75,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.5,34,,8.5,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,8.75,35,,8.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10,
MICORAIRE 1648-509 PIN 4.8X3X16 SMOOTH,C1713,HCPCS,,79007557,CDM,278,RC,,,both,,,13,5.13,39.4668,,5.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4.42,34,,4.42,percent of total billed charges,Implant Device,4.42,34,,4.42,percent of total billed charges,Implant Device,4.42,34,,4.42,percent of total billed charges,Implant Device,4.42,34,,4.42,percent of total billed charges,Implant Device,4.42,34,,4.42,percent of total billed charges,Implant Device,4.42,34,,4.42,percent of total billed charges,Implant Device,4.55,35,,4.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,4.55,35,,4.55,percent of total billed charges,Implant Devices,4.55,35,,4.55,percent of total billed charges,Implant Devices,4.55,35,,,percent of total billed charges,Implant Devices,4.55,35,,4.55,percent of total billed charges,Implant Devices,4.55,35,,4.55,percent of total billed charges,Implant Devices,5.2,40,,5.2,percent of total billed charges,Implant Devices,4.55,70,,4.55,percent of total billed charges,Implant Devices,4.42,34,,4.42,percent of total billed charges,Implant Devices,4.42,34,,4.42,percent of total billed charges,Implant Devices,4.55,35,,4.55,percent of total billed charges,Implant Devices,4.55,35,,4.55,percent of total billed charges,Implant Devices,4.55,35,,4.55,percent of total billed charges,Implant Devices,4.55,35,,4.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5.2,
MICROAIRE 1648-509T PIN 4.8X3X16 THREAD,C1713,HCPCS,,79007558,CDM,278,RC,,,both,,,70,27.63,39.4668,,27.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23.8,34,,23.8,percent of total billed charges,Implant Device,23.8,34,,23.8,percent of total billed charges,Implant Device,23.8,34,,23.8,percent of total billed charges,Implant Device,23.8,34,,23.8,percent of total billed charges,Implant Device,23.8,34,,23.8,percent of total billed charges,Implant Device,23.8,34,,23.8,percent of total billed charges,Implant Device,24.5,35,,24.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,28,40,,28,percent of total billed charges,Implant Devices,24.5,70,,24.5,percent of total billed charges,Implant Devices,23.8,34,,23.8,percent of total billed charges,Implant Devices,23.8,34,,23.8,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,24.5,35,,24.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28,
STRYKER 54-25573 PLATE LEFT NARROW,C1713,HCPCS,,79007560,CDM,278,RC,,,both,,,5208,2055.43,39.4668,,2055.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1770.72,34,,1770.72,percent of total billed charges,Implant Device,1770.72,34,,1770.72,percent of total billed charges,Implant Device,1770.72,34,,1770.72,percent of total billed charges,Implant Device,1770.72,34,,1770.72,percent of total billed charges,Implant Device,1770.72,34,,1770.72,percent of total billed charges,Implant Device,1770.72,34,,1770.72,percent of total billed charges,Implant Device,1822.8,35,,1822.8,percent of total billed charges,Implant Device,1770.72,34,"Charges > $500, x 34%",1770.72,percent of total billed charges,Implant Device,1822.8,35,,1822.8,percent of total billed charges,Implant Devices,1822.8,35,,1822.8,percent of total billed charges,Implant Devices,1822.8,35,,,percent of total billed charges,Implant Devices,1822.8,35,,1822.8,percent of total billed charges,Implant Devices,1822.8,35,,1822.8,percent of total billed charges,Implant Devices,2083.2,40,,2083.2,percent of total billed charges,Implant Devices,1822.8,70,,1822.8,percent of total billed charges,Implant Devices,1770.72,34,,1770.72,percent of total billed charges,Implant Devices,1770.72,34,,1770.72,percent of total billed charges,Implant Devices,1822.8,35,,1822.8,percent of total billed charges,Implant Devices,1822.8,35,,1822.8,percent of total billed charges,Implant Devices,1822.8,35,,1822.8,percent of total billed charges,Implant Devices,1822.8,35,,1822.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1770.72,34,"If Charge > 2,000, then 34 percent",1770.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2083.2,
STRYKER 57-15385 5 HOLE PLATE 2.3 ROTATN,C1713,HCPCS,,79007566,CDM,278,RC,,,both,,,1877,740.79,39.4668,,740.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,656.95,35,,656.95,percent of total billed charges,Implant Device,638.18,34,"Charges > $500, x 34%",638.18,percent of total billed charges,Implant Device,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,750.8,40,,750.8,percent of total billed charges,Implant Devices,656.95,70,,656.95,percent of total billed charges,Implant Devices,638.18,34,,638.18,percent of total billed charges,Implant Devices,638.18,34,,638.18,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,750.8,
ALPHATEC SPINE 71001-16 PLATE 16MM,C1713,HCPCS,,79007575,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
ARTHREX AR-8740-28PTS CANN SCREW 4X28MM,C1713,HCPCS,,79007576,CDM,278,RC,,,both,,,708,279.42,39.4668,,279.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Device,240.72,34,"Charges > $500, x 34%",240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,283.2,40,,283.2,percent of total billed charges,Implant Devices,247.8,70,,247.8,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,283.2,
ARTHREX AR-8004-15 COMP STAPLE 15X15MM,C1713,HCPCS,,79007577,CDM,278,RC,,,both,,,1824,719.87,39.4668,,719.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,638.4,35,,638.4,percent of total billed charges,Implant Device,620.16,34,"Charges > $500, x 34%",620.16,percent of total billed charges,Implant Device,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,729.6,40,,729.6,percent of total billed charges,Implant Devices,638.4,70,,638.4,percent of total billed charges,Implant Devices,620.16,34,,620.16,percent of total billed charges,Implant Devices,620.16,34,,620.16,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,729.6,
DEPUY 02.112.081 CLAVICLE PLATE 3.5X85MM,C1713,HCPCS,,79007579,CDM,278,RC,,,both,,,2397,946.02,39.4668,,946.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,838.95,35,,838.95,percent of total billed charges,Implant Device,814.98,34,"Charges > $500, x 34%",814.98,percent of total billed charges,Implant Device,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,958.8,40,,958.8,percent of total billed charges,Implant Devices,838.95,70,,838.95,percent of total billed charges,Implant Devices,814.98,34,,814.98,percent of total billed charges,Implant Devices,814.98,34,,814.98,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,814.98,34,"If Charge > 2,000, then 34 percent",814.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,958.8,
DEPUY 202.820 CORTEX SCREW 2.7X20MM,C1713,HCPCS,,79007580,CDM,278,RC,,,both,,,85,33.55,39.4668,,33.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,34,40,,34,percent of total billed charges,Implant Devices,29.75,70,,29.75,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34,
DEPUY 02.240.240 CANN SCREW 3.7X25MM,C1713,HCPCS,,79007581,CDM,278,RC,,,both,,,690,272.32,39.4668,,272.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,241.5,35,,241.5,percent of total billed charges,Implant Device,234.6,34,"Charges > $500, x 34%",234.6,percent of total billed charges,Implant Device,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,276,40,,276,percent of total billed charges,Implant Devices,241.5,70,,241.5,percent of total billed charges,Implant Devices,234.6,34,,234.6,percent of total billed charges,Implant Devices,234.6,34,,234.6,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,276,
S&N 71453252 ARTICULAR INSERT SZ 5 9MM,C1713,HCPCS,,79007591,CDM,278,RC,,,both,,,5528,2181.72,39.4668,,2181.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1934.8,35,,1934.8,percent of total billed charges,Implant Device,1879.52,34,"Charges > $500, x 34%",1879.52,percent of total billed charges,Implant Device,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,2211.2,40,,2211.2,percent of total billed charges,Implant Devices,1934.8,70,,1934.8,percent of total billed charges,Implant Devices,1879.52,34,,1879.52,percent of total billed charges,Implant Devices,1879.52,34,,1879.52,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1879.52,34,"If Charge > 2,000, then 34 percent",1879.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2211.2,
DEPUY 1294-35-140 TIBIAL TRAY PLTFRM SZ4,C1713,HCPCS,,79007592,CDM,278,RC,,,both,,,19157,7560.65,39.4668,,7560.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6704.95,35,,6704.95,percent of total billed charges,Implant Device,6513.38,34,"Charges > $500, x 34%",6513.38,percent of total billed charges,Implant Device,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,7662.8,40,,7662.8,percent of total billed charges,Implant Devices,6704.95,70,,6704.95,percent of total billed charges,Implant Devices,6513.38,34,,6513.38,percent of total billed charges,Implant Devices,6513.38,34,,6513.38,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6513.38,34,"If Charge > 2,000, then 34 percent",6513.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7662.8,
DEPUY 1987-07-030 LPS SEG COMPONENT 30MM,C1713,HCPCS,,79007593,CDM,278,RC,,,both,,,5969,2355.77,39.4668,,2355.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2089.15,35,,2089.15,percent of total billed charges,Implant Device,2029.46,34,"Charges > $500, x 34%",2029.46,percent of total billed charges,Implant Device,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2387.6,40,,2387.6,percent of total billed charges,Implant Devices,2089.15,70,,2089.15,percent of total billed charges,Implant Devices,2029.46,34,,2029.46,percent of total billed charges,Implant Devices,2029.46,34,,2029.46,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2029.46,34,"If Charge > 2,000, then 34 percent",2029.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2387.6,
DEPUY 1987-15-214 FEMORAL STEM 14X150MM,C1713,HCPCS,,79007594,CDM,278,RC,,,both,,,14302,5644.54,39.4668,,5644.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4862.68,34,,4862.68,percent of total billed charges,Implant Device,4862.68,34,,4862.68,percent of total billed charges,Implant Device,4862.68,34,,4862.68,percent of total billed charges,Implant Device,4862.68,34,,4862.68,percent of total billed charges,Implant Device,4862.68,34,,4862.68,percent of total billed charges,Implant Device,4862.68,34,,4862.68,percent of total billed charges,Implant Device,5005.7,35,,5005.7,percent of total billed charges,Implant Device,4862.68,34,"Charges > $500, x 34%",4862.68,percent of total billed charges,Implant Device,5005.7,35,,5005.7,percent of total billed charges,Implant Devices,5005.7,35,,5005.7,percent of total billed charges,Implant Devices,5005.7,35,,,percent of total billed charges,Implant Devices,5005.7,35,,5005.7,percent of total billed charges,Implant Devices,5005.7,35,,5005.7,percent of total billed charges,Implant Devices,5720.8,40,,5720.8,percent of total billed charges,Implant Devices,5005.7,70,,5005.7,percent of total billed charges,Implant Devices,4862.68,34,,4862.68,percent of total billed charges,Implant Devices,4862.68,34,,4862.68,percent of total billed charges,Implant Devices,5005.7,35,,5005.7,percent of total billed charges,Implant Devices,5005.7,35,,5005.7,percent of total billed charges,Implant Devices,5005.7,35,,5005.7,percent of total billed charges,Implant Devices,5005.7,35,,5005.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4862.68,34,"If Charge > 2,000, then 34 percent",4862.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5720.8,
STRYKER 1828-0934S T2 FEM NAIL 9X430MM,C1713,HCPCS,,79007595,CDM,278,RC,,,both,,,7030,2774.52,39.4668,,2774.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2460.5,35,,2460.5,percent of total billed charges,Implant Device,2390.2,34,"Charges > $500, x 34%",2390.2,percent of total billed charges,Implant Device,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2812,40,,2812,percent of total billed charges,Implant Devices,2460.5,70,,2460.5,percent of total billed charges,Implant Devices,2390.2,34,,2390.2,percent of total billed charges,Implant Devices,2390.2,34,,2390.2,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2390.2,34,"If Charge > 2,000, then 34 percent",2390.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2812,
IN2BONES A06 SP003 DUAFIT PIP SZ3 IMPLNT,C1713,HCPCS,,79007598,CDM,278,RC,,,both,,,3525,1391.2,39.4668,,1391.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Device,1198.5,34,"Charges > $500, x 34%",1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1410,40,,1410,percent of total billed charges,Implant Devices,1233.75,70,,1233.75,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1198.5,34,"If Charge > 2,000, then 34 percent",1198.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1410,
LIFENET AFLEX 301 DECELL DERMIS 40X70X3,C1713,HCPCS,,79007599,CDM,278,RC,,,both,,,11317,4466.46,39.4668,,4466.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3847.78,34,,3847.78,percent of total billed charges,Implant Device,3847.78,34,,3847.78,percent of total billed charges,Implant Device,3847.78,34,,3847.78,percent of total billed charges,Implant Device,3847.78,34,,3847.78,percent of total billed charges,Implant Device,3847.78,34,,3847.78,percent of total billed charges,Implant Device,3847.78,34,,3847.78,percent of total billed charges,Implant Device,3960.95,35,,3960.95,percent of total billed charges,Implant Device,3847.78,34,"Charges > $500, x 34%",3847.78,percent of total billed charges,Implant Device,3960.95,35,,3960.95,percent of total billed charges,Implant Devices,3960.95,35,,3960.95,percent of total billed charges,Implant Devices,3960.95,35,,,percent of total billed charges,Implant Devices,3960.95,35,,3960.95,percent of total billed charges,Implant Devices,3960.95,35,,3960.95,percent of total billed charges,Implant Devices,4526.8,40,,4526.8,percent of total billed charges,Implant Devices,3960.95,70,,3960.95,percent of total billed charges,Implant Devices,3847.78,34,,3847.78,percent of total billed charges,Implant Devices,3847.78,34,,3847.78,percent of total billed charges,Implant Devices,3960.95,35,,3960.95,percent of total billed charges,Implant Devices,3960.95,35,,3960.95,percent of total billed charges,Implant Devices,3960.95,35,,3960.95,percent of total billed charges,Implant Devices,3960.95,35,,3960.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3847.78,34,"If Charge > 2,000, then 34 percent",3847.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4526.8,
STRYKER 1822-0931S TIBIAL NAIL STD 9X315,C1713,HCPCS,,79007600,CDM,278,RC,,,both,,,3529,1392.78,39.4668,,1392.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Device,1199.86,34,"Charges > $500, x 34%",1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1411.6,40,,1411.6,percent of total billed charges,Implant Devices,1235.15,70,,1235.15,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1199.86,34,"If Charge > 2,000, then 34 percent",1199.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1411.6,
ARTHREX ABS-1007-BC BIOCARTLIDGE .75CC,C1713,HCPCS,,79007608,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
ARTRHEX ABS-1010-BC BIOCARTLIDGE 1CC,C1713,HCPCS,,79007609,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
ZIMMER 5962-050-12 ART SURFCE 7 10 12MM,C1713,HCPCS,,79007611,CDM,278,RC,,,both,,,5130,2024.65,39.4668,,2024.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1795.5,35,,1795.5,percent of total billed charges,Implant Device,1744.2,34,"Charges > $500, x 34%",1744.2,percent of total billed charges,Implant Device,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,2052,40,,2052,percent of total billed charges,Implant Devices,1795.5,70,,1795.5,percent of total billed charges,Implant Devices,1744.2,34,,1744.2,percent of total billed charges,Implant Devices,1744.2,34,,1744.2,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1744.2,34,"If Charge > 2,000, then 34 percent",1744.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2052,
STRYKER 5038-2-080 APEX PIN 3X80MM,C1713,HCPCS,,79007612,CDM,278,RC,,,both,,,337,133,39.4668,,133,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.58,34,,114.58,percent of total billed charges,Implant Device,114.58,34,,114.58,percent of total billed charges,Implant Device,114.58,34,,114.58,percent of total billed charges,Implant Device,114.58,34,,114.58,percent of total billed charges,Implant Device,114.58,34,,114.58,percent of total billed charges,Implant Device,114.58,34,,114.58,percent of total billed charges,Implant Device,117.95,35,,117.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.95,35,,117.95,percent of total billed charges,Implant Devices,117.95,35,,117.95,percent of total billed charges,Implant Devices,117.95,35,,,percent of total billed charges,Implant Devices,117.95,35,,117.95,percent of total billed charges,Implant Devices,117.95,35,,117.95,percent of total billed charges,Implant Devices,134.8,40,,134.8,percent of total billed charges,Implant Devices,117.95,70,,117.95,percent of total billed charges,Implant Devices,114.58,34,,114.58,percent of total billed charges,Implant Devices,114.58,34,,114.58,percent of total billed charges,Implant Devices,117.95,35,,117.95,percent of total billed charges,Implant Devices,117.95,35,,117.95,percent of total billed charges,Implant Devices,117.95,35,,117.95,percent of total billed charges,Implant Devices,117.95,35,,117.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.8,
STRYKER 5023-2-090 APEX PIN 4X90MM,C1713,HCPCS,,79007613,CDM,278,RC,,,both,,,464,183.13,39.4668,,183.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,157.76,34,,157.76,percent of total billed charges,Implant Device,162.4,35,,162.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,185.6,40,,185.6,percent of total billed charges,Implant Devices,162.4,70,,162.4,percent of total billed charges,Implant Devices,157.76,34,,157.76,percent of total billed charges,Implant Devices,157.76,34,,157.76,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,162.4,35,,162.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,185.6,
STRYKER 1822-1030S TIB NAIL STD 10X300M,C1713,HCPCS,,79007623,CDM,278,RC,,,both,,,6110,2411.42,39.4668,,2411.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2077.4,34,,2077.4,percent of total billed charges,Implant Device,2138.5,35,,2138.5,percent of total billed charges,Implant Device,2077.4,34,"Charges > $500, x 34%",2077.4,percent of total billed charges,Implant Device,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2444,40,,2444,percent of total billed charges,Implant Devices,2138.5,70,,2138.5,percent of total billed charges,Implant Devices,2077.4,34,,2077.4,percent of total billed charges,Implant Devices,2077.4,34,,2077.4,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,2138.5,35,,2138.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2077.4,34,"If Charge > 2,000, then 34 percent",2077.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2444,
STRYKER 661426 NON LOCK SCREW 3.5X26MM,C1713,HCPCS,,79007624,CDM,278,RC,,,both,,,132,52.1,39.4668,,52.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,52.8,40,,52.8,percent of total billed charges,Implant Devices,46.2,70,,46.2,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.8,
STRYKER 661022 LOCK SCREW 4X22MM,C1713,HCPCS,,79007625,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
DEPUY 214.040 4.5MM CORTEX SCREW 40MM,C1713,HCPCS,,79007627,CDM,278,RC,,,both,,,80,31.57,39.4668,,31.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,28,35,,28,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,32,40,,32,percent of total billed charges,Implant Devices,28,70,,28,percent of total billed charges,Implant Devices,27.2,34,,27.2,percent of total billed charges,Implant Devices,27.2,34,,27.2,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32,
DEPUY 214.048 4.5MM CORTEX SCREW 48MM,C1713,HCPCS,,79007628,CDM,278,RC,,,both,,,80,31.57,39.4668,,31.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,27.2,34,,27.2,percent of total billed charges,Implant Device,28,35,,28,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,32,40,,32,percent of total billed charges,Implant Devices,28,70,,28,percent of total billed charges,Implant Devices,27.2,34,,27.2,percent of total billed charges,Implant Devices,27.2,34,,27.2,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,28,35,,28,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32,
DEPUY 02.112.093 CLAVICLE PLATE 3.5X120,C1713,HCPCS,,79007629,CDM,278,RC,,,both,,,2459,970.49,39.4668,,970.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,860.65,35,,860.65,percent of total billed charges,Implant Device,836.06,34,"Charges > $500, x 34%",836.06,percent of total billed charges,Implant Device,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,983.6,40,,983.6,percent of total billed charges,Implant Devices,860.65,70,,860.65,percent of total billed charges,Implant Devices,836.06,34,,836.06,percent of total billed charges,Implant Devices,836.06,34,,836.06,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,836.06,34,"If Charge > 2,000, then 34 percent",836.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,983.6,
DEPUY 202.214 LOCKING SCREW 2.7X14MM,C1713,HCPCS,,79007631,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
DEPUY 201.768 CORTEX SCREW 2.4X18MM,C1713,HCPCS,,79007632,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
STRYKER 1832-2828S HUMERAL NAIL 8X280,C1713,HCPCS,,79007635,CDM,278,RC,,,both,,,7492,2956.85,39.4668,,2956.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2547.28,34,,2547.28,percent of total billed charges,Implant Device,2547.28,34,,2547.28,percent of total billed charges,Implant Device,2547.28,34,,2547.28,percent of total billed charges,Implant Device,2547.28,34,,2547.28,percent of total billed charges,Implant Device,2547.28,34,,2547.28,percent of total billed charges,Implant Device,2547.28,34,,2547.28,percent of total billed charges,Implant Device,2622.2,35,,2622.2,percent of total billed charges,Implant Device,2547.28,34,"Charges > $500, x 34%",2547.28,percent of total billed charges,Implant Device,2622.2,35,,2622.2,percent of total billed charges,Implant Devices,2622.2,35,,2622.2,percent of total billed charges,Implant Devices,2622.2,35,,,percent of total billed charges,Implant Devices,2622.2,35,,2622.2,percent of total billed charges,Implant Devices,2622.2,35,,2622.2,percent of total billed charges,Implant Devices,2996.8,40,,2996.8,percent of total billed charges,Implant Devices,2622.2,70,,2622.2,percent of total billed charges,Implant Devices,2547.28,34,,2547.28,percent of total billed charges,Implant Devices,2547.28,34,,2547.28,percent of total billed charges,Implant Devices,2622.2,35,,2622.2,percent of total billed charges,Implant Devices,2622.2,35,,2622.2,percent of total billed charges,Implant Devices,2622.2,35,,2622.2,percent of total billed charges,Implant Devices,2622.2,35,,2622.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2547.28,34,"If Charge > 2,000, then 34 percent",2547.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2996.8,
DEPUY 02.107.002 PLATE 2 HOLE 2.7/3.5X73,C1713,HCPCS,,79007637,CDM,278,RC,,,both,,,2513,991.8,39.4668,,991.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,854.42,34,,854.42,percent of total billed charges,Implant Device,854.42,34,,854.42,percent of total billed charges,Implant Device,854.42,34,,854.42,percent of total billed charges,Implant Device,854.42,34,,854.42,percent of total billed charges,Implant Device,854.42,34,,854.42,percent of total billed charges,Implant Device,854.42,34,,854.42,percent of total billed charges,Implant Device,879.55,35,,879.55,percent of total billed charges,Implant Device,854.42,34,"Charges > $500, x 34%",854.42,percent of total billed charges,Implant Device,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,1005.2,40,,1005.2,percent of total billed charges,Implant Devices,879.55,70,,879.55,percent of total billed charges,Implant Devices,854.42,34,,854.42,percent of total billed charges,Implant Devices,854.42,34,,854.42,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,854.42,34,"If Charge > 2,000, then 34 percent",854.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1005.2,
DEPUY 02.211.050 LOCK SCREW 2.7X50,C1713,HCPCS,,79007638,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
P28 P20-135-024F CANN SCREW 3.5X24MM,C1713,HCPCS,,79007642,CDM,278,RC,,,both,,,768,303.11,39.4668,,303.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,261.12,34,,261.12,percent of total billed charges,Implant Device,268.8,35,,268.8,percent of total billed charges,Implant Device,261.12,34,"Charges > $500, x 34%",261.12,percent of total billed charges,Implant Device,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,307.2,40,,307.2,percent of total billed charges,Implant Devices,268.8,70,,268.8,percent of total billed charges,Implant Devices,261.12,34,,261.12,percent of total billed charges,Implant Devices,261.12,34,,261.12,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,268.8,35,,268.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,307.2,
P28 P50-053-2708 LOCKING SCREW 2.7X08MM,C1713,HCPCS,,79007644,CDM,278,RC,,,both,,,667,263.24,39.4668,,263.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Device,226.78,34,"Charges > $500, x 34%",226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,266.8,40,,266.8,percent of total billed charges,Implant Devices,233.45,70,,233.45,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.8,
P28 P50-053-2712 LOCKING SCREW 2.7X12MM,C1713,HCPCS,,79007645,CDM,278,RC,,,both,,,667,263.24,39.4668,,263.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Device,226.78,34,"Charges > $500, x 34%",226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,266.8,40,,266.8,percent of total billed charges,Implant Devices,233.45,70,,233.45,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.8,
P28 P50-053-3512 LOCKING SCREW 3.5X12MM,C1713,HCPCS,,79007646,CDM,278,RC,,,both,,,694,273.9,39.4668,,273.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Device,235.96,34,"Charges > $500, x 34%",235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,277.6,40,,277.6,percent of total billed charges,Implant Devices,242.9,70,,242.9,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.6,
P28 P50-053-3514 LOCKING SCREW 3.5X14MM,C1713,HCPCS,,79007647,CDM,278,RC,,,both,,,880,347.31,39.4668,,347.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Device,299.2,34,"Charges > $500, x 34%",299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,352,40,,352,percent of total billed charges,Implant Devices,308,70,,308,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,352,
P28 P53-103-L053 MTP PLATE 5HOLE LONG LT,C1713,HCPCS,,79007648,CDM,278,RC,,,both,,,5688,2244.87,39.4668,,2244.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1933.92,34,,1933.92,percent of total billed charges,Implant Device,1933.92,34,,1933.92,percent of total billed charges,Implant Device,1933.92,34,,1933.92,percent of total billed charges,Implant Device,1933.92,34,,1933.92,percent of total billed charges,Implant Device,1933.92,34,,1933.92,percent of total billed charges,Implant Device,1933.92,34,,1933.92,percent of total billed charges,Implant Device,1990.8,35,,1990.8,percent of total billed charges,Implant Device,1933.92,34,"Charges > $500, x 34%",1933.92,percent of total billed charges,Implant Device,1990.8,35,,1990.8,percent of total billed charges,Implant Devices,1990.8,35,,1990.8,percent of total billed charges,Implant Devices,1990.8,35,,,percent of total billed charges,Implant Devices,1990.8,35,,1990.8,percent of total billed charges,Implant Devices,1990.8,35,,1990.8,percent of total billed charges,Implant Devices,2275.2,40,,2275.2,percent of total billed charges,Implant Devices,1990.8,70,,1990.8,percent of total billed charges,Implant Devices,1933.92,34,,1933.92,percent of total billed charges,Implant Devices,1933.92,34,,1933.92,percent of total billed charges,Implant Devices,1990.8,35,,1990.8,percent of total billed charges,Implant Devices,1990.8,35,,1990.8,percent of total billed charges,Implant Devices,1990.8,35,,1990.8,percent of total billed charges,Implant Devices,1990.8,35,,1990.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1933.92,34,"If Charge > 2,000, then 34 percent",1933.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2275.2,
DEPUY 207.040 CANCELLOUS BONE SCREW 4X40,C1713,HCPCS,,79007655,CDM,278,RC,,,both,,,78,30.78,39.4668,,30.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,26.52,34,,26.52,percent of total billed charges,Implant Device,27.3,35,,27.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,31.2,40,,31.2,percent of total billed charges,Implant Devices,27.3,70,,27.3,percent of total billed charges,Implant Devices,26.52,34,,26.52,percent of total billed charges,Implant Devices,26.52,34,,26.52,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,27.3,35,,27.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.2,
STRYKER 1828-1326S FEMORAL NAIL 13X260MM,C1713,HCPCS,,79007658,CDM,278,RC,,,both,,,7030,2774.52,39.4668,,2774.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2390.2,34,,2390.2,percent of total billed charges,Implant Device,2460.5,35,,2460.5,percent of total billed charges,Implant Device,2390.2,34,"Charges > $500, x 34%",2390.2,percent of total billed charges,Implant Device,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2812,40,,2812,percent of total billed charges,Implant Devices,2460.5,70,,2460.5,percent of total billed charges,Implant Devices,2390.2,34,,2390.2,percent of total billed charges,Implant Devices,2390.2,34,,2390.2,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,2460.5,35,,2460.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2390.2,34,"If Charge > 2,000, then 34 percent",2390.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2812,
ARTHREX AR-5028P-08 DELTA SCREW 8X28MM,C1713,HCPCS,,79007660,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-1380P PEEK INTER SCREW 8X23MM,C1713,HCPCS,,79007661,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-8935-24 CORTICAL SCREW 3.5X24,C1713,HCPCS,,79007662,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ACUMED CO-N2314 NON LOCKING SCREW 2.3X14,C1713,HCPCS,,79007663,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
ACUMED CO-N2312 NON LOCKING SCREW 2.3X12,C1713,HCPCS,,79007664,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
STRYKER 1830-0930S HUMERAL NAIL 09X300MM,C1713,HCPCS,,79007666,CDM,278,RC,,,both,,,6161,2431.55,39.4668,,2431.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2094.74,34,,2094.74,percent of total billed charges,Implant Device,2094.74,34,,2094.74,percent of total billed charges,Implant Device,2094.74,34,,2094.74,percent of total billed charges,Implant Device,2094.74,34,,2094.74,percent of total billed charges,Implant Device,2094.74,34,,2094.74,percent of total billed charges,Implant Device,2094.74,34,,2094.74,percent of total billed charges,Implant Device,2156.35,35,,2156.35,percent of total billed charges,Implant Device,2094.74,34,"Charges > $500, x 34%",2094.74,percent of total billed charges,Implant Device,2156.35,35,,2156.35,percent of total billed charges,Implant Devices,2156.35,35,,2156.35,percent of total billed charges,Implant Devices,2156.35,35,,,percent of total billed charges,Implant Devices,2156.35,35,,2156.35,percent of total billed charges,Implant Devices,2156.35,35,,2156.35,percent of total billed charges,Implant Devices,2464.4,40,,2464.4,percent of total billed charges,Implant Devices,2156.35,70,,2156.35,percent of total billed charges,Implant Devices,2094.74,34,,2094.74,percent of total billed charges,Implant Devices,2094.74,34,,2094.74,percent of total billed charges,Implant Devices,2156.35,35,,2156.35,percent of total billed charges,Implant Devices,2156.35,35,,2156.35,percent of total billed charges,Implant Devices,2156.35,35,,2156.35,percent of total billed charges,Implant Devices,2156.35,35,,2156.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2094.74,34,"If Charge > 2,000, then 34 percent",2094.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2464.4,
DEPUY 202.872 CORTEX SCREW 2.7X12MM,C1713,HCPCS,,79007667,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
DEPUY 02.111.640 DIST RADIUS PLATE 2.4MM,C1713,HCPCS,,79007668,CDM,278,RC,,,both,,,2410,951.15,39.4668,,951.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,819.4,34,,819.4,percent of total billed charges,Implant Device,819.4,34,,819.4,percent of total billed charges,Implant Device,819.4,34,,819.4,percent of total billed charges,Implant Device,819.4,34,,819.4,percent of total billed charges,Implant Device,819.4,34,,819.4,percent of total billed charges,Implant Device,819.4,34,,819.4,percent of total billed charges,Implant Device,843.5,35,,843.5,percent of total billed charges,Implant Device,819.4,34,"Charges > $500, x 34%",819.4,percent of total billed charges,Implant Device,843.5,35,,843.5,percent of total billed charges,Implant Devices,843.5,35,,843.5,percent of total billed charges,Implant Devices,843.5,35,,,percent of total billed charges,Implant Devices,843.5,35,,843.5,percent of total billed charges,Implant Devices,843.5,35,,843.5,percent of total billed charges,Implant Devices,964,40,,964,percent of total billed charges,Implant Devices,843.5,70,,843.5,percent of total billed charges,Implant Devices,819.4,34,,819.4,percent of total billed charges,Implant Devices,819.4,34,,819.4,percent of total billed charges,Implant Devices,843.5,35,,843.5,percent of total billed charges,Implant Devices,843.5,35,,843.5,percent of total billed charges,Implant Devices,843.5,35,,843.5,percent of total billed charges,Implant Devices,843.5,35,,843.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,819.4,34,"If Charge > 2,000, then 34 percent",819.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,964,
DEPUY 201.772 CORTEX SCREW 2.4X22MM,C1713,HCPCS,,79007669,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
DEPUY 201.774 CORTEX SCREW 2.4X24MM,C1713,HCPCS,,79007670,CDM,278,RC,,,both,,,233,91.96,39.4668,,91.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.22,34,,79.22,percent of total billed charges,Implant Device,79.22,34,,79.22,percent of total billed charges,Implant Device,79.22,34,,79.22,percent of total billed charges,Implant Device,79.22,34,,79.22,percent of total billed charges,Implant Device,79.22,34,,79.22,percent of total billed charges,Implant Device,79.22,34,,79.22,percent of total billed charges,Implant Device,81.55,35,,81.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.55,35,,81.55,percent of total billed charges,Implant Devices,81.55,35,,81.55,percent of total billed charges,Implant Devices,81.55,35,,,percent of total billed charges,Implant Devices,81.55,35,,81.55,percent of total billed charges,Implant Devices,81.55,35,,81.55,percent of total billed charges,Implant Devices,93.2,40,,93.2,percent of total billed charges,Implant Devices,81.55,70,,81.55,percent of total billed charges,Implant Devices,79.22,34,,79.22,percent of total billed charges,Implant Devices,79.22,34,,79.22,percent of total billed charges,Implant Devices,81.55,35,,81.55,percent of total billed charges,Implant Devices,81.55,35,,81.55,percent of total billed charges,Implant Devices,81.55,35,,81.55,percent of total billed charges,Implant Devices,81.55,35,,81.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.2,
DEPUY 02.210.112 LOCKING SCREW 2.4X12MM,C1713,HCPCS,,79007671,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
DEPUY 02.210.122 LOCKING SCREW 2.4X22MM,C1713,HCPCS,,79007672,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
DEPUY 02.210.116 LOCKING SCREW 2.4X16MM,C1713,HCPCS,,79007673,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
DEPUY 02.210.126 LOCKING SCREW 2.4X26MM,C1713,HCPCS,,79007674,CDM,278,RC,,,both,,,562,221.8,39.4668,,221.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,191.08,34,,191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Device,191.08,34,"Charges > $500, x 34%",191.08,percent of total billed charges,Implant Device,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,224.8,40,,224.8,percent of total billed charges,Implant Devices,196.7,70,,196.7,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,191.08,34,,191.08,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,196.7,35,,196.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,224.8,
DEPUY 1035-53-000 BI-POLAR HEAD 23X53MM,C1713,HCPCS,,79007675,CDM,278,RC,,,both,,,4030,1590.51,39.4668,,1590.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Device,1370.2,34,"Charges > $500, x 34%",1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1612,40,,1612,percent of total billed charges,Implant Devices,1410.5,70,,1410.5,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1370.2,34,"If Charge > 2,000, then 34 percent",1370.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1612,
DEPUY 02.111.621 DISTAL RAD PLATE 2.4MM,C1713,HCPCS,,79007677,CDM,278,RC,,,both,,,3963,1564.07,39.4668,,1564.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1347.42,34,,1347.42,percent of total billed charges,Implant Device,1347.42,34,,1347.42,percent of total billed charges,Implant Device,1347.42,34,,1347.42,percent of total billed charges,Implant Device,1347.42,34,,1347.42,percent of total billed charges,Implant Device,1347.42,34,,1347.42,percent of total billed charges,Implant Device,1347.42,34,,1347.42,percent of total billed charges,Implant Device,1387.05,35,,1387.05,percent of total billed charges,Implant Device,1347.42,34,"Charges > $500, x 34%",1347.42,percent of total billed charges,Implant Device,1387.05,35,,1387.05,percent of total billed charges,Implant Devices,1387.05,35,,1387.05,percent of total billed charges,Implant Devices,1387.05,35,,,percent of total billed charges,Implant Devices,1387.05,35,,1387.05,percent of total billed charges,Implant Devices,1387.05,35,,1387.05,percent of total billed charges,Implant Devices,1585.2,40,,1585.2,percent of total billed charges,Implant Devices,1387.05,70,,1387.05,percent of total billed charges,Implant Devices,1347.42,34,,1347.42,percent of total billed charges,Implant Devices,1347.42,34,,1347.42,percent of total billed charges,Implant Devices,1387.05,35,,1387.05,percent of total billed charges,Implant Devices,1387.05,35,,1387.05,percent of total billed charges,Implant Devices,1387.05,35,,1387.05,percent of total billed charges,Implant Devices,1387.05,35,,1387.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1347.42,34,"If Charge > 2,000, then 34 percent",1347.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1585.2,
DEPUY 02.210.114 LOCKING SCEW 2.4X14MM,C1713,HCPCS,,79007678,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
DEPUY 202.006 2.7X16MM CORTEX  SCREW,C1713,HCPCS,,79007682,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
STRYKER 608085 6.5X85MM CANCELLOUS SCREW,C1713,HCPCS,,79007683,CDM,278,RC,,,both,,,155,61.17,39.4668,,61.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,54.25,35,,54.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,62,40,,62,percent of total billed charges,Implant Devices,54.25,70,,54.25,percent of total billed charges,Implant Devices,52.7,34,,52.7,percent of total billed charges,Implant Devices,52.7,34,,52.7,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,62,
STRYKER 661744 4.5X44MM CORTICAL SCREW,C1713,HCPCS,,79007684,CDM,278,RC,,,both,,,138,54.46,39.4668,,54.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,55.2,40,,55.2,percent of total billed charges,Implant Devices,48.3,70,,48.3,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.2,
STRYKER 608075 6.5X75MM CANCELLOUS SCREW,C1713,HCPCS,,79007685,CDM,278,RC,,,both,,,155,61.17,39.4668,,61.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,54.25,35,,54.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,62,40,,62,percent of total billed charges,Implant Devices,54.25,70,,54.25,percent of total billed charges,Implant Devices,52.7,34,,52.7,percent of total billed charges,Implant Devices,52.7,34,,52.7,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,62,
STRYKER 627604 DIST FEM PLATE 4HOL 130MM,C1713,HCPCS,,79007686,CDM,278,RC,,,both,,,9654,3810.12,39.4668,,3810.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3282.36,34,,3282.36,percent of total billed charges,Implant Device,3282.36,34,,3282.36,percent of total billed charges,Implant Device,3282.36,34,,3282.36,percent of total billed charges,Implant Device,3282.36,34,,3282.36,percent of total billed charges,Implant Device,3282.36,34,,3282.36,percent of total billed charges,Implant Device,3282.36,34,,3282.36,percent of total billed charges,Implant Device,3378.9,35,,3378.9,percent of total billed charges,Implant Device,3282.36,34,"Charges > $500, x 34%",3282.36,percent of total billed charges,Implant Device,3378.9,35,,3378.9,percent of total billed charges,Implant Devices,3378.9,35,,3378.9,percent of total billed charges,Implant Devices,3378.9,35,,,percent of total billed charges,Implant Devices,3378.9,35,,3378.9,percent of total billed charges,Implant Devices,3378.9,35,,3378.9,percent of total billed charges,Implant Devices,3861.6,40,,3861.6,percent of total billed charges,Implant Devices,3378.9,70,,3378.9,percent of total billed charges,Implant Devices,3282.36,34,,3282.36,percent of total billed charges,Implant Devices,3282.36,34,,3282.36,percent of total billed charges,Implant Devices,3378.9,35,,3378.9,percent of total billed charges,Implant Devices,3378.9,35,,3378.9,percent of total billed charges,Implant Devices,3378.9,35,,3378.9,percent of total billed charges,Implant Devices,3378.9,35,,3378.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3282.36,34,"If Charge > 2,000, then 34 percent",3282.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3861.6,
STRYKER 661175 5X75MM LOCKING SCREW,C1713,HCPCS,,79007687,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 661140 5X40MM LOCKING SCREW,C1713,HCPCS,,79007688,CDM,278,RC,,,both,,,801,316.13,39.4668,,316.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,272.34,34,,272.34,percent of total billed charges,Implant Device,272.34,34,,272.34,percent of total billed charges,Implant Device,272.34,34,,272.34,percent of total billed charges,Implant Device,272.34,34,,272.34,percent of total billed charges,Implant Device,272.34,34,,272.34,percent of total billed charges,Implant Device,272.34,34,,272.34,percent of total billed charges,Implant Device,280.35,35,,280.35,percent of total billed charges,Implant Device,272.34,34,"Charges > $500, x 34%",272.34,percent of total billed charges,Implant Device,280.35,35,,280.35,percent of total billed charges,Implant Devices,280.35,35,,280.35,percent of total billed charges,Implant Devices,280.35,35,,,percent of total billed charges,Implant Devices,280.35,35,,280.35,percent of total billed charges,Implant Devices,280.35,35,,280.35,percent of total billed charges,Implant Devices,320.4,40,,320.4,percent of total billed charges,Implant Devices,280.35,70,,280.35,percent of total billed charges,Implant Devices,272.34,34,,272.34,percent of total billed charges,Implant Devices,272.34,34,,272.34,percent of total billed charges,Implant Devices,280.35,35,,280.35,percent of total billed charges,Implant Devices,280.35,35,,280.35,percent of total billed charges,Implant Devices,280.35,35,,280.35,percent of total billed charges,Implant Devices,280.35,35,,280.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,320.4,
J&J 212035 MINI QUICKANCHOR 2/0 SUTURE,C1713,HCPCS,,79007693,CDM,278,RC,,,both,,,1401,552.93,39.4668,,552.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,476.34,34,,476.34,percent of total billed charges,Implant Device,476.34,34,,476.34,percent of total billed charges,Implant Device,476.34,34,,476.34,percent of total billed charges,Implant Device,476.34,34,,476.34,percent of total billed charges,Implant Device,476.34,34,,476.34,percent of total billed charges,Implant Device,476.34,34,,476.34,percent of total billed charges,Implant Device,490.35,35,,490.35,percent of total billed charges,Implant Device,476.34,34,"Charges > $500, x 34%",476.34,percent of total billed charges,Implant Device,490.35,35,,490.35,percent of total billed charges,Implant Devices,490.35,35,,490.35,percent of total billed charges,Implant Devices,490.35,35,,,percent of total billed charges,Implant Devices,490.35,35,,490.35,percent of total billed charges,Implant Devices,490.35,35,,490.35,percent of total billed charges,Implant Devices,560.4,40,,560.4,percent of total billed charges,Implant Devices,490.35,70,,490.35,percent of total billed charges,Implant Devices,476.34,34,,476.34,percent of total billed charges,Implant Devices,476.34,34,,476.34,percent of total billed charges,Implant Devices,490.35,35,,490.35,percent of total billed charges,Implant Devices,490.35,35,,490.35,percent of total billed charges,Implant Devices,490.35,35,,490.35,percent of total billed charges,Implant Devices,490.35,35,,490.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,560.4,
J&J 212843 MINI QUICKANCHOR 3/0 SUTURE,C1713,HCPCS,,79007694,CDM,278,RC,,,both,,,1362,537.54,39.4668,,537.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,463.08,34,,463.08,percent of total billed charges,Implant Device,463.08,34,,463.08,percent of total billed charges,Implant Device,463.08,34,,463.08,percent of total billed charges,Implant Device,463.08,34,,463.08,percent of total billed charges,Implant Device,463.08,34,,463.08,percent of total billed charges,Implant Device,463.08,34,,463.08,percent of total billed charges,Implant Device,476.7,35,,476.7,percent of total billed charges,Implant Device,463.08,34,"Charges > $500, x 34%",463.08,percent of total billed charges,Implant Device,476.7,35,,476.7,percent of total billed charges,Implant Devices,476.7,35,,476.7,percent of total billed charges,Implant Devices,476.7,35,,,percent of total billed charges,Implant Devices,476.7,35,,476.7,percent of total billed charges,Implant Devices,476.7,35,,476.7,percent of total billed charges,Implant Devices,544.8,40,,544.8,percent of total billed charges,Implant Devices,476.7,70,,476.7,percent of total billed charges,Implant Devices,463.08,34,,463.08,percent of total billed charges,Implant Devices,463.08,34,,463.08,percent of total billed charges,Implant Devices,476.7,35,,476.7,percent of total billed charges,Implant Devices,476.7,35,,476.7,percent of total billed charges,Implant Devices,476.7,35,,476.7,percent of total billed charges,Implant Devices,476.7,35,,476.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,544.8,
STRYKER 628224 PLATE 4 HOLE SUPR LATERAL,C1713,HCPCS,,79007698,CDM,278,RC,,,both,,,5010,1977.29,39.4668,,1977.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1703.4,34,,1703.4,percent of total billed charges,Implant Device,1703.4,34,,1703.4,percent of total billed charges,Implant Device,1703.4,34,,1703.4,percent of total billed charges,Implant Device,1703.4,34,,1703.4,percent of total billed charges,Implant Device,1703.4,34,,1703.4,percent of total billed charges,Implant Device,1703.4,34,,1703.4,percent of total billed charges,Implant Device,1753.5,35,,1753.5,percent of total billed charges,Implant Device,1703.4,34,"Charges > $500, x 34%",1703.4,percent of total billed charges,Implant Device,1753.5,35,,1753.5,percent of total billed charges,Implant Devices,1753.5,35,,1753.5,percent of total billed charges,Implant Devices,1753.5,35,,,percent of total billed charges,Implant Devices,1753.5,35,,1753.5,percent of total billed charges,Implant Devices,1753.5,35,,1753.5,percent of total billed charges,Implant Devices,2004,40,,2004,percent of total billed charges,Implant Devices,1753.5,70,,1753.5,percent of total billed charges,Implant Devices,1703.4,34,,1703.4,percent of total billed charges,Implant Devices,1703.4,34,,1703.4,percent of total billed charges,Implant Devices,1753.5,35,,1753.5,percent of total billed charges,Implant Devices,1753.5,35,,1753.5,percent of total billed charges,Implant Devices,1753.5,35,,1753.5,percent of total billed charges,Implant Devices,1753.5,35,,1753.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1703.4,34,"If Charge > 2,000, then 34 percent",1703.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2004,
STRYKER 614720 NON LOCK SCREW 2.7X20MM,C1713,HCPCS,,79007699,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
ARTHREX AR-8945-40PT SCREW 4.5X40MM,C1713,HCPCS,,79007703,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
STRYKER 54-25783 PLATE RT STD X SHORT,C1713,HCPCS,,79007706,CDM,278,RC,,,both,,,2604,1027.72,39.4668,,1027.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,911.4,35,,911.4,percent of total billed charges,Implant Device,885.36,34,"Charges > $500, x 34%",885.36,percent of total billed charges,Implant Device,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,1041.6,40,,1041.6,percent of total billed charges,Implant Devices,911.4,70,,911.4,percent of total billed charges,Implant Devices,885.36,34,,885.36,percent of total billed charges,Implant Devices,885.36,34,,885.36,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,885.36,34,"If Charge > 2,000, then 34 percent",885.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1041.6,
STRYKER 656416 NON LOCK SCREW 2.7X16MM,C1713,HCPCS,,79007707,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656418 NON LOCK SCREW 2.7X18MM,C1713,HCPCS,,79007708,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER 656420 NON LOCK SCREW 2.7X20MM,C1713,HCPCS,,79007709,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER 656026 LOCKING SCREW 2.4X26MM,C1713,HCPCS,,79007710,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 656020 LOCKING SCREW 2.4X20MM,C1713,HCPCS,,79007711,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 628027 CLAVICLE PLATE 7 HOLE RT,C1713,HCPCS,,79007713,CDM,278,RC,,,both,,,2762,1090.07,39.4668,,1090.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,939.08,34,,939.08,percent of total billed charges,Implant Device,939.08,34,,939.08,percent of total billed charges,Implant Device,939.08,34,,939.08,percent of total billed charges,Implant Device,939.08,34,,939.08,percent of total billed charges,Implant Device,939.08,34,,939.08,percent of total billed charges,Implant Device,939.08,34,,939.08,percent of total billed charges,Implant Device,966.7,35,,966.7,percent of total billed charges,Implant Device,939.08,34,"Charges > $500, x 34%",939.08,percent of total billed charges,Implant Device,966.7,35,,966.7,percent of total billed charges,Implant Devices,966.7,35,,966.7,percent of total billed charges,Implant Devices,966.7,35,,,percent of total billed charges,Implant Devices,966.7,35,,966.7,percent of total billed charges,Implant Devices,966.7,35,,966.7,percent of total billed charges,Implant Devices,1104.8,40,,1104.8,percent of total billed charges,Implant Devices,966.7,70,,966.7,percent of total billed charges,Implant Devices,939.08,34,,939.08,percent of total billed charges,Implant Devices,939.08,34,,939.08,percent of total billed charges,Implant Devices,966.7,35,,966.7,percent of total billed charges,Implant Devices,966.7,35,,966.7,percent of total billed charges,Implant Devices,966.7,35,,966.7,percent of total billed charges,Implant Devices,966.7,35,,966.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,939.08,34,"If Charge > 2,000, then 34 percent",939.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1104.8,
STRYKER 614710 NON LOCK SCREW 2.7X10MM,C1713,HCPCS,,79007714,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
STRYKER 614712 NON LOCK SCREW 2.7X12MM,C1713,HCPCS,,79007715,CDM,278,RC,,,both,,,349,137.74,39.4668,,137.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,118.66,34,,118.66,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,139.6,40,,139.6,percent of total billed charges,Implant Devices,122.15,70,,122.15,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,118.66,34,,118.66,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,122.15,35,,122.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.6,
STRYKER 614714 NON LOCK SCREW 2.7X14MM,C1713,HCPCS,,79007716,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 614508 LOCKING SCREW 2.7X8MM,C1713,HCPCS,,79007717,CDM,278,RC,,,both,,,671,264.82,39.4668,,264.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,228.14,34,,228.14,percent of total billed charges,Implant Device,228.14,34,,228.14,percent of total billed charges,Implant Device,228.14,34,,228.14,percent of total billed charges,Implant Device,228.14,34,,228.14,percent of total billed charges,Implant Device,228.14,34,,228.14,percent of total billed charges,Implant Device,228.14,34,,228.14,percent of total billed charges,Implant Device,234.85,35,,234.85,percent of total billed charges,Implant Device,228.14,34,"Charges > $500, x 34%",228.14,percent of total billed charges,Implant Device,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,268.4,40,,268.4,percent of total billed charges,Implant Devices,234.85,70,,234.85,percent of total billed charges,Implant Devices,228.14,34,,228.14,percent of total billed charges,Implant Devices,228.14,34,,228.14,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,234.85,35,,234.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.4,
STRYKER 614510 LOCKING SCREW 2.7X10MM,C1713,HCPCS,,79007718,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
ARTHREX AR-8930-13 SNAP OFF SCREW 2X13MM,C1713,HCPCS,,79007720,CDM,278,RC,,,both,,,720,284.16,39.4668,,284.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Device,244.8,34,"Charges > $500, x 34%",244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,288,40,,288,percent of total billed charges,Implant Devices,252,70,,252,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,288,
STRYKER 40-35046 NONLOCK SCREW 3.5X46MM,C1713,HCPCS,,79007721,CDM,278,RC,,,both,,,352,138.92,39.4668,,138.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,123.2,35,,123.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,140.8,40,,140.8,percent of total billed charges,Implant Devices,123.2,70,,123.2,percent of total billed charges,Implant Devices,119.68,34,,119.68,percent of total billed charges,Implant Devices,119.68,34,,119.68,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,140.8,
DEPUY 04.005.536S 46X5.0MM TI LOCK SCREW,C1713,HCPCS,,79007724,CDM,278,RC,,,both,,,939,370.59,39.4668,,370.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,319.26,34,,319.26,percent of total billed charges,Implant Device,319.26,34,,319.26,percent of total billed charges,Implant Device,319.26,34,,319.26,percent of total billed charges,Implant Device,319.26,34,,319.26,percent of total billed charges,Implant Device,319.26,34,,319.26,percent of total billed charges,Implant Device,319.26,34,,319.26,percent of total billed charges,Implant Device,328.65,35,,328.65,percent of total billed charges,Implant Device,319.26,34,"Charges > $500, x 34%",319.26,percent of total billed charges,Implant Device,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,375.6,40,,375.6,percent of total billed charges,Implant Devices,328.65,70,,328.65,percent of total billed charges,Implant Devices,319.26,34,,319.26,percent of total billed charges,Implant Devices,319.26,34,,319.26,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,375.6,
DEPUY 04.005.528S 28X5.0MM TI LOCK SCREW,C1713,HCPCS,,79007725,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 04.005.532S 32X5.0MM TI LOCK SCREW,C1713,HCPCS,,79007726,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 04.004.455S 10X375 CANNULATED NAIL,C1713,HCPCS,,79007727,CDM,278,RC,,,both,,,6035,2381.82,39.4668,,2381.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2112.25,35,,2112.25,percent of total billed charges,Implant Device,2051.9,34,"Charges > $500, x 34%",2051.9,percent of total billed charges,Implant Device,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2414,40,,2414,percent of total billed charges,Implant Devices,2112.25,70,,2112.25,percent of total billed charges,Implant Devices,2051.9,34,,2051.9,percent of total billed charges,Implant Devices,2051.9,34,,2051.9,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2051.9,34,"If Charge > 2,000, then 34 percent",2051.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2414,
WRIGHT TFF-2015 TENFUSE PIP ALLOGRAFT,C1713,HCPCS,,79007728,CDM,278,RC,,,both,,,3557,1403.83,39.4668,,1403.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1244.95,35,,1244.95,percent of total billed charges,Implant Device,1209.38,34,"Charges > $500, x 34%",1209.38,percent of total billed charges,Implant Device,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1422.8,40,,1422.8,percent of total billed charges,Implant Devices,1244.95,70,,1244.95,percent of total billed charges,Implant Devices,1209.38,34,,1209.38,percent of total billed charges,Implant Devices,1209.38,34,,1209.38,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1209.38,34,"If Charge > 2,000, then 34 percent",1209.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1422.8,
STRYKER 40-20905 DISTAL FIB PLATE 5 HOLE,C1713,HCPCS,,79007729,CDM,278,RC,,,both,,,2644,1043.5,39.4668,,1043.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,898.96,34,,898.96,percent of total billed charges,Implant Device,898.96,34,,898.96,percent of total billed charges,Implant Device,898.96,34,,898.96,percent of total billed charges,Implant Device,898.96,34,,898.96,percent of total billed charges,Implant Device,898.96,34,,898.96,percent of total billed charges,Implant Device,898.96,34,,898.96,percent of total billed charges,Implant Device,925.4,35,,925.4,percent of total billed charges,Implant Device,898.96,34,"Charges > $500, x 34%",898.96,percent of total billed charges,Implant Device,925.4,35,,925.4,percent of total billed charges,Implant Devices,925.4,35,,925.4,percent of total billed charges,Implant Devices,925.4,35,,,percent of total billed charges,Implant Devices,925.4,35,,925.4,percent of total billed charges,Implant Devices,925.4,35,,925.4,percent of total billed charges,Implant Devices,1057.6,40,,1057.6,percent of total billed charges,Implant Devices,925.4,70,,925.4,percent of total billed charges,Implant Devices,898.96,34,,898.96,percent of total billed charges,Implant Devices,898.96,34,,898.96,percent of total billed charges,Implant Devices,925.4,35,,925.4,percent of total billed charges,Implant Devices,925.4,35,,925.4,percent of total billed charges,Implant Devices,925.4,35,,925.4,percent of total billed charges,Implant Devices,925.4,35,,925.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,898.96,34,"If Charge > 2,000, then 34 percent",898.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1057.6,
STRYKER 40-35042 NONLCK BONE SCRW 3.5X42,C1713,HCPCS,,79007730,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
ARTHREX AR-8967-1840 CANN SCREW 6.7X40MM,C1713,HCPCS,,79007731,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ZIMMER 201.050 KNEE CREATIONS BONE SUBST,C1713,HCPCS,,79007734,CDM,278,RC,,,both,,,8850,3492.81,39.4668,,3492.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3097.5,35,,3097.5,percent of total billed charges,Implant Device,3009,34,"Charges > $500, x 34%",3009,percent of total billed charges,Implant Device,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3540,40,,3540,percent of total billed charges,Implant Devices,3097.5,70,,3097.5,percent of total billed charges,Implant Devices,3009,34,,3009,percent of total billed charges,Implant Devices,3009,34,,3009,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3009,34,"If Charge > 2,000, then 34 percent",3009,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3540,
STRYKER 58-19005 EMERGENCY SCREW 1.9X5MM,C1713,HCPCS,,79007737,CDM,278,RC,,,both,,,367,144.84,39.4668,,144.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,124.78,34,,124.78,percent of total billed charges,Implant Device,128.45,35,,128.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,146.8,40,,146.8,percent of total billed charges,Implant Devices,128.45,70,,128.45,percent of total billed charges,Implant Devices,124.78,34,,124.78,percent of total billed charges,Implant Devices,124.78,34,,124.78,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,128.45,35,,128.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,146.8,
WRIGHT DIN40040S CANNULATED SCREW 4X40MM,C1713,HCPCS,,79007738,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
WRIGHT DIN40036S CANNULATED SCREW 4X36MM,C1713,HCPCS,,79007739,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
WRIGHT DIN20020S CANNULATED SCREW 2X20MM,C1713,HCPCS,,79007740,CDM,278,RC,,,both,,,856,337.84,39.4668,,337.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,291.04,34,,291.04,percent of total billed charges,Implant Device,299.6,35,,299.6,percent of total billed charges,Implant Device,291.04,34,"Charges > $500, x 34%",291.04,percent of total billed charges,Implant Device,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,342.4,40,,342.4,percent of total billed charges,Implant Devices,299.6,70,,299.6,percent of total billed charges,Implant Devices,291.04,34,,291.04,percent of total billed charges,Implant Devices,291.04,34,,291.04,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,299.6,35,,299.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,342.4,
ZIMMER 00-2347-023-32 4.5X32MM SCREW,C1713,HCPCS,,79007775,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
ZIMMER 00-2357-102-14 FEM LOCK PLATE 14H,C1713,HCPCS,,79007776,CDM,278,RC,,,both,,,4872,1922.82,39.4668,,1922.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1656.48,34,,1656.48,percent of total billed charges,Implant Device,1705.2,35,,1705.2,percent of total billed charges,Implant Device,1656.48,34,"Charges > $500, x 34%",1656.48,percent of total billed charges,Implant Device,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1948.8,40,,1948.8,percent of total billed charges,Implant Devices,1705.2,70,,1705.2,percent of total billed charges,Implant Devices,1656.48,34,,1656.48,percent of total billed charges,Implant Devices,1656.48,34,,1656.48,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,1705.2,35,,1705.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1656.48,34,"If Charge > 2,000, then 34 percent",1656.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1948.8,
ZIMMER 00-2359-060-55 5.5X60MM SCREW,C1713,HCPCS,,79007777,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 00-2359-065-55 5.5X65MM SCREW,C1713,HCPCS,,79007778,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 00-2359-070-55 5.5X70MM SCREW,C1713,HCPCS,,79007779,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
DEPUY 212.101 LOCKING SCREW 3.5X10MM,C1713,HCPCS,,79007781,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
P28 P50-053-3524 LOCK PLATE SCREW 3.5X24,C1713,HCPCS,,79007783,CDM,278,RC,,,both,,,694,273.9,39.4668,,273.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Device,235.96,34,"Charges > $500, x 34%",235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,277.6,40,,277.6,percent of total billed charges,Implant Devices,242.9,70,,242.9,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.6,
P28 P50-053-3526 LOCK PLATE SCREW 3.5X26,C1713,HCPCS,,79007784,CDM,278,RC,,,both,,,829,327.18,39.4668,,327.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,290.15,35,,290.15,percent of total billed charges,Implant Device,281.86,34,"Charges > $500, x 34%",281.86,percent of total billed charges,Implant Device,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,331.6,40,,331.6,percent of total billed charges,Implant Devices,290.15,70,,290.15,percent of total billed charges,Implant Devices,281.86,34,,281.86,percent of total billed charges,Implant Devices,281.86,34,,281.86,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,331.6,
P28 P50-053-3528 LOCK PLATE SCREW 3.5X28,C1713,HCPCS,,79007785,CDM,278,RC,,,both,,,880,347.31,39.4668,,347.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Device,299.2,34,"Charges > $500, x 34%",299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,352,40,,352,percent of total billed charges,Implant Devices,308,70,,308,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,352,
P28 P50-053-3538 LOCK PLATE SCREW 3.5X38,C1713,HCPCS,,79007786,CDM,278,RC,,,both,,,694,273.9,39.4668,,273.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Device,235.96,34,"Charges > $500, x 34%",235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,277.6,40,,277.6,percent of total billed charges,Implant Devices,242.9,70,,242.9,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.6,
P28 P50-053-3542 LOCK PLATE SCREW 3.5X42,C1713,HCPCS,,79007787,CDM,278,RC,,,both,,,694,273.9,39.4668,,273.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Device,235.96,34,"Charges > $500, x 34%",235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,277.6,40,,277.6,percent of total billed charges,Implant Devices,242.9,70,,242.9,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.6,
P28 P53-107-2015 BEAVER PLATE MED SLIDE,C1713,HCPCS,,79007788,CDM,278,RC,,,both,,,6872,2712.16,39.4668,,2712.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2336.48,34,,2336.48,percent of total billed charges,Implant Device,2336.48,34,,2336.48,percent of total billed charges,Implant Device,2336.48,34,,2336.48,percent of total billed charges,Implant Device,2336.48,34,,2336.48,percent of total billed charges,Implant Device,2336.48,34,,2336.48,percent of total billed charges,Implant Device,2336.48,34,,2336.48,percent of total billed charges,Implant Device,2405.2,35,,2405.2,percent of total billed charges,Implant Device,2336.48,34,"Charges > $500, x 34%",2336.48,percent of total billed charges,Implant Device,2405.2,35,,2405.2,percent of total billed charges,Implant Devices,2405.2,35,,2405.2,percent of total billed charges,Implant Devices,2405.2,35,,,percent of total billed charges,Implant Devices,2405.2,35,,2405.2,percent of total billed charges,Implant Devices,2405.2,35,,2405.2,percent of total billed charges,Implant Devices,2748.8,40,,2748.8,percent of total billed charges,Implant Devices,2405.2,70,,2405.2,percent of total billed charges,Implant Devices,2336.48,34,,2336.48,percent of total billed charges,Implant Devices,2336.48,34,,2336.48,percent of total billed charges,Implant Devices,2405.2,35,,2405.2,percent of total billed charges,Implant Devices,2405.2,35,,2405.2,percent of total billed charges,Implant Devices,2405.2,35,,2405.2,percent of total billed charges,Implant Devices,2405.2,35,,2405.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2336.48,34,"If Charge > 2,000, then 34 percent",2336.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2748.8,
P28 P50-053-4228 LOCK PLATE SCREW 4.2X28,C1713,HCPCS,,79007790,CDM,278,RC,,,both,,,718,283.37,39.4668,,283.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,244.12,34,,244.12,percent of total billed charges,Implant Device,244.12,34,,244.12,percent of total billed charges,Implant Device,244.12,34,,244.12,percent of total billed charges,Implant Device,244.12,34,,244.12,percent of total billed charges,Implant Device,244.12,34,,244.12,percent of total billed charges,Implant Device,244.12,34,,244.12,percent of total billed charges,Implant Device,251.3,35,,251.3,percent of total billed charges,Implant Device,244.12,34,"Charges > $500, x 34%",244.12,percent of total billed charges,Implant Device,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,287.2,40,,287.2,percent of total billed charges,Implant Devices,251.3,70,,251.3,percent of total billed charges,Implant Devices,244.12,34,,244.12,percent of total billed charges,Implant Devices,244.12,34,,244.12,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,287.2,
STRYKER 3325-0400S NAIL KIT LT 11X400MM,C1713,HCPCS,,79007793,CDM,278,RC,,,both,,,8879,3504.26,39.4668,,3504.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3107.65,35,,3107.65,percent of total billed charges,Implant Device,3018.86,34,"Charges > $500, x 34%",3018.86,percent of total billed charges,Implant Device,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3551.6,40,,3551.6,percent of total billed charges,Implant Devices,3107.65,70,,3107.65,percent of total billed charges,Implant Devices,3018.86,34,,3018.86,percent of total billed charges,Implant Devices,3018.86,34,,3018.86,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3018.86,34,"If Charge > 2,000, then 34 percent",3018.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3551.6,
IN2BONES A60 SP103 DUAFIT PIP 10DEG SZ 3,C1713,HCPCS,,79007794,CDM,278,RC,,,both,,,3525,1391.2,39.4668,,1391.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Device,1198.5,34,"Charges > $500, x 34%",1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1410,40,,1410,percent of total billed charges,Implant Devices,1233.75,70,,1233.75,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1198.5,34,"If Charge > 2,000, then 34 percent",1198.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1410,
STRYKER 656412 NON LOCK SCREW 2.7X12MM,C1713,HCPCS,,79007795,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656016 LOCK SCREW 2.4X16MM,C1713,HCPCS,,79007796,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
TRILLIANT 200-24-014 14X2.4MM CORT SCREW,C1713,HCPCS,,79007797,CDM,278,RC,,,both,,,525,207.2,39.4668,,207.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Device,178.5,34,"Charges > $500, x 34%",178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,210,40,,210,percent of total billed charges,Implant Devices,183.75,70,,183.75,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
TRILLIANT 200-24-016 16X2.4MM CORT SCREW,C1713,HCPCS,,79007798,CDM,278,RC,,,both,,,525,207.2,39.4668,,207.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Device,178.5,34,"Charges > $500, x 34%",178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,210,40,,210,percent of total billed charges,Implant Devices,183.75,70,,183.75,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
ARTHREX AR-1562BC TENOD SCREW 6.25X15MM,C1713,HCPCS,,79007802,CDM,278,RC,,,both,,,1036,408.88,39.4668,,408.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,352.24,34,,352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Device,352.24,34,"Charges > $500, x 34%",352.24,percent of total billed charges,Implant Device,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,414.4,40,,414.4,percent of total billed charges,Implant Devices,362.6,70,,362.6,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,352.24,34,,352.24,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,362.6,35,,362.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,414.4,
STABILITY BIO 447-10201 ACHILLES TENDON,C1713,HCPCS,,79007803,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
DEPUY 462.642 TI SPIRAL BLADE SCREW 42MM,C1713,HCPCS,,79007812,CDM,278,RC,,,both,,,1189,469.26,39.4668,,469.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,404.26,34,,404.26,percent of total billed charges,Implant Device,404.26,34,,404.26,percent of total billed charges,Implant Device,404.26,34,,404.26,percent of total billed charges,Implant Device,404.26,34,,404.26,percent of total billed charges,Implant Device,404.26,34,,404.26,percent of total billed charges,Implant Device,404.26,34,,404.26,percent of total billed charges,Implant Device,416.15,35,,416.15,percent of total billed charges,Implant Device,404.26,34,"Charges > $500, x 34%",404.26,percent of total billed charges,Implant Device,416.15,35,,416.15,percent of total billed charges,Implant Devices,416.15,35,,416.15,percent of total billed charges,Implant Devices,416.15,35,,,percent of total billed charges,Implant Devices,416.15,35,,416.15,percent of total billed charges,Implant Devices,416.15,35,,416.15,percent of total billed charges,Implant Devices,475.6,40,,475.6,percent of total billed charges,Implant Devices,416.15,70,,416.15,percent of total billed charges,Implant Devices,404.26,34,,404.26,percent of total billed charges,Implant Devices,404.26,34,,404.26,percent of total billed charges,Implant Devices,416.15,35,,416.15,percent of total billed charges,Implant Devices,416.15,35,,416.15,percent of total billed charges,Implant Devices,416.15,35,,416.15,percent of total billed charges,Implant Devices,416.15,35,,416.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,475.6,
DEPUY 04.005.416 4.0X26MM LOCKING SCREW,C1713,HCPCS,,79007813,CDM,278,RC,,,both,,,364,143.66,39.4668,,143.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,145.6,40,,145.6,percent of total billed charges,Implant Devices,127.4,70,,127.4,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,145.6,
DEPUY 04.005.418 4.0X28MM LOCKING SCREW,C1713,HCPCS,,79007814,CDM,278,RC,,,both,,,449,177.21,39.4668,,177.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,152.66,34,,152.66,percent of total billed charges,Implant Device,152.66,34,,152.66,percent of total billed charges,Implant Device,152.66,34,,152.66,percent of total billed charges,Implant Device,152.66,34,,152.66,percent of total billed charges,Implant Device,152.66,34,,152.66,percent of total billed charges,Implant Device,152.66,34,,152.66,percent of total billed charges,Implant Device,157.15,35,,157.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,179.6,40,,179.6,percent of total billed charges,Implant Devices,157.15,70,,157.15,percent of total billed charges,Implant Devices,152.66,34,,152.66,percent of total billed charges,Implant Devices,152.66,34,,152.66,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,179.6,
DEPUY 04.001.000S END CAP HUMERAL NAIL,C1713,HCPCS,,79007815,CDM,278,RC,,,both,,,396,156.29,39.4668,,156.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.64,34,,134.64,percent of total billed charges,Implant Device,134.64,34,,134.64,percent of total billed charges,Implant Device,134.64,34,,134.64,percent of total billed charges,Implant Device,134.64,34,,134.64,percent of total billed charges,Implant Device,134.64,34,,134.64,percent of total billed charges,Implant Device,134.64,34,,134.64,percent of total billed charges,Implant Device,138.6,35,,138.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.6,35,,138.6,percent of total billed charges,Implant Devices,138.6,35,,138.6,percent of total billed charges,Implant Devices,138.6,35,,,percent of total billed charges,Implant Devices,138.6,35,,138.6,percent of total billed charges,Implant Devices,138.6,35,,138.6,percent of total billed charges,Implant Devices,158.4,40,,158.4,percent of total billed charges,Implant Devices,138.6,70,,138.6,percent of total billed charges,Implant Devices,134.64,34,,134.64,percent of total billed charges,Implant Devices,134.64,34,,134.64,percent of total billed charges,Implant Devices,138.6,35,,138.6,percent of total billed charges,Implant Devices,138.6,35,,138.6,percent of total billed charges,Implant Devices,138.6,35,,138.6,percent of total billed charges,Implant Devices,138.6,35,,138.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158.4,
DEPUY 04.001.210S 7X150 CANN HUMRL NAIL,C1713,HCPCS,,79007816,CDM,278,RC,,,both,,,6940,2739,39.4668,,2739,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2359.6,34,,2359.6,percent of total billed charges,Implant Device,2359.6,34,,2359.6,percent of total billed charges,Implant Device,2359.6,34,,2359.6,percent of total billed charges,Implant Device,2359.6,34,,2359.6,percent of total billed charges,Implant Device,2359.6,34,,2359.6,percent of total billed charges,Implant Device,2359.6,34,,2359.6,percent of total billed charges,Implant Device,2429,35,,2429,percent of total billed charges,Implant Device,2359.6,34,"Charges > $500, x 34%",2359.6,percent of total billed charges,Implant Device,2429,35,,2429,percent of total billed charges,Implant Devices,2429,35,,2429,percent of total billed charges,Implant Devices,2429,35,,,percent of total billed charges,Implant Devices,2429,35,,2429,percent of total billed charges,Implant Devices,2429,35,,2429,percent of total billed charges,Implant Devices,2776,40,,2776,percent of total billed charges,Implant Devices,2429,70,,2429,percent of total billed charges,Implant Devices,2359.6,34,,2359.6,percent of total billed charges,Implant Devices,2359.6,34,,2359.6,percent of total billed charges,Implant Devices,2429,35,,2429,percent of total billed charges,Implant Devices,2429,35,,2429,percent of total billed charges,Implant Devices,2429,35,,2429,percent of total billed charges,Implant Devices,2429,35,,2429,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2359.6,34,"If Charge > 2,000, then 34 percent",2359.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2776,
DEPUY 456.327S 11X235MM TI CANN FEM NAIL,C1713,HCPCS,,79007817,CDM,278,RC,,,both,,,2738,1080.6,39.4668,,1080.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Device,930.92,34,"Charges > $500, x 34%",930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,1095.2,40,,1095.2,percent of total billed charges,Implant Devices,958.3,70,,958.3,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,930.92,34,"If Charge > 2,000, then 34 percent",930.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1095.2,
DEPUY 456.303S 11X90MM TI HELOCAL BLADE,C1713,HCPCS,,79007818,CDM,278,RC,,,both,,,1301,513.46,39.4668,,513.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,455.35,35,,455.35,percent of total billed charges,Implant Device,442.34,34,"Charges > $500, x 34%",442.34,percent of total billed charges,Implant Device,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,520.4,40,,520.4,percent of total billed charges,Implant Devices,455.35,70,,455.35,percent of total billed charges,Implant Devices,442.34,34,,442.34,percent of total billed charges,Implant Devices,442.34,34,,442.34,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,520.4,
MEDLINE PCO15X PARIETEX MESH 15CM ROUND,C1713,HCPCS,,79007820,CDM,278,RC,,,both,,,2309,911.29,39.4668,,911.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,785.06,34,,785.06,percent of total billed charges,Implant Device,785.06,34,,785.06,percent of total billed charges,Implant Device,785.06,34,,785.06,percent of total billed charges,Implant Device,785.06,34,,785.06,percent of total billed charges,Implant Device,785.06,34,,785.06,percent of total billed charges,Implant Device,785.06,34,,785.06,percent of total billed charges,Implant Device,808.15,35,,808.15,percent of total billed charges,Implant Device,785.06,34,"Charges > $500, x 34%",785.06,percent of total billed charges,Implant Device,808.15,35,,808.15,percent of total billed charges,Implant Devices,808.15,35,,808.15,percent of total billed charges,Implant Devices,808.15,35,,,percent of total billed charges,Implant Devices,808.15,35,,808.15,percent of total billed charges,Implant Devices,808.15,35,,808.15,percent of total billed charges,Implant Devices,923.6,40,,923.6,percent of total billed charges,Implant Devices,808.15,70,,808.15,percent of total billed charges,Implant Devices,785.06,34,,785.06,percent of total billed charges,Implant Devices,785.06,34,,785.06,percent of total billed charges,Implant Devices,808.15,35,,808.15,percent of total billed charges,Implant Devices,808.15,35,,808.15,percent of total billed charges,Implant Devices,808.15,35,,808.15,percent of total billed charges,Implant Devices,808.15,35,,808.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,785.06,34,"If Charge > 2,000, then 34 percent",785.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,923.6,
STRYKER 628048 PLATE 8 HOLE LEFT,C1713,HCPCS,,79007822,CDM,278,RC,,,both,,,6747,2662.82,39.4668,,2662.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2293.98,34,,2293.98,percent of total billed charges,Implant Device,2293.98,34,,2293.98,percent of total billed charges,Implant Device,2293.98,34,,2293.98,percent of total billed charges,Implant Device,2293.98,34,,2293.98,percent of total billed charges,Implant Device,2293.98,34,,2293.98,percent of total billed charges,Implant Device,2293.98,34,,2293.98,percent of total billed charges,Implant Device,2361.45,35,,2361.45,percent of total billed charges,Implant Device,2293.98,34,"Charges > $500, x 34%",2293.98,percent of total billed charges,Implant Device,2361.45,35,,2361.45,percent of total billed charges,Implant Devices,2361.45,35,,2361.45,percent of total billed charges,Implant Devices,2361.45,35,,,percent of total billed charges,Implant Devices,2361.45,35,,2361.45,percent of total billed charges,Implant Devices,2361.45,35,,2361.45,percent of total billed charges,Implant Devices,2698.8,40,,2698.8,percent of total billed charges,Implant Devices,2361.45,70,,2361.45,percent of total billed charges,Implant Devices,2293.98,34,,2293.98,percent of total billed charges,Implant Devices,2293.98,34,,2293.98,percent of total billed charges,Implant Devices,2361.45,35,,2361.45,percent of total billed charges,Implant Devices,2361.45,35,,2361.45,percent of total billed charges,Implant Devices,2361.45,35,,2361.45,percent of total billed charges,Implant Devices,2361.45,35,,2361.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2293.98,34,"If Charge > 2,000, then 34 percent",2293.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2698.8,
STRYKER 614718 NON LOCK SCREW 2.7X18MM,C1713,HCPCS,,79007823,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 614716 NON LOCK SCREW 2.7X16MM,C1713,HCPCS,,79007824,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 614810 NON LOCK SCREW 3.5X10MM,C1713,HCPCS,,79007825,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
DEPUY 202.640 CANNULATED SCREW 3.0X40MM,C1713,HCPCS,,79007826,CDM,278,RC,,,both,,,770,303.89,39.4668,,303.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Device,261.8,34,"Charges > $500, x 34%",261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,308,40,,308,percent of total billed charges,Implant Devices,269.5,70,,269.5,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,308,
ATLAS 1208-01-3010 INTERBODY SPACR 30X10,C1713,HCPCS,,79007846,CDM,278,RC,,,both,,,9555,3771.05,39.4668,,3771.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3344.25,35,,3344.25,percent of total billed charges,Implant Device,3248.7,34,"Charges > $500, x 34%",3248.7,percent of total billed charges,Implant Device,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3822,40,,3822,percent of total billed charges,Implant Devices,3344.25,70,,3344.25,percent of total billed charges,Implant Devices,3248.7,34,,3248.7,percent of total billed charges,Implant Devices,3248.7,34,,3248.7,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3248.7,34,"If Charge > 2,000, then 34 percent",3248.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3822,
STABILITY BIO SB 692 FEM HEAD ALLOGRAFT,C1713,HCPCS,,79007855,CDM,278,RC,,,both,,,4186,1652.08,39.4668,,1652.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1423.24,34,,1423.24,percent of total billed charges,Implant Device,1423.24,34,,1423.24,percent of total billed charges,Implant Device,1423.24,34,,1423.24,percent of total billed charges,Implant Device,1423.24,34,,1423.24,percent of total billed charges,Implant Device,1423.24,34,,1423.24,percent of total billed charges,Implant Device,1423.24,34,,1423.24,percent of total billed charges,Implant Device,1465.1,35,,1465.1,percent of total billed charges,Implant Device,1423.24,34,"Charges > $500, x 34%",1423.24,percent of total billed charges,Implant Device,1465.1,35,,1465.1,percent of total billed charges,Implant Devices,1465.1,35,,1465.1,percent of total billed charges,Implant Devices,1465.1,35,,,percent of total billed charges,Implant Devices,1465.1,35,,1465.1,percent of total billed charges,Implant Devices,1465.1,35,,1465.1,percent of total billed charges,Implant Devices,1674.4,40,,1674.4,percent of total billed charges,Implant Devices,1465.1,70,,1465.1,percent of total billed charges,Implant Devices,1423.24,34,,1423.24,percent of total billed charges,Implant Devices,1423.24,34,,1423.24,percent of total billed charges,Implant Devices,1465.1,35,,1465.1,percent of total billed charges,Implant Devices,1465.1,35,,1465.1,percent of total billed charges,Implant Devices,1465.1,35,,1465.1,percent of total billed charges,Implant Devices,1465.1,35,,1465.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1423.24,34,"If Charge > 2,000, then 34 percent",1423.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1674.4,
STRYKER 180-0824S HUMERAL NAIL 8X240MM,C1713,HCPCS,,79007864,CDM,278,RC,,,both,,,6344,2503.77,39.4668,,2503.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2156.96,34,,2156.96,percent of total billed charges,Implant Device,2156.96,34,,2156.96,percent of total billed charges,Implant Device,2156.96,34,,2156.96,percent of total billed charges,Implant Device,2156.96,34,,2156.96,percent of total billed charges,Implant Device,2156.96,34,,2156.96,percent of total billed charges,Implant Device,2156.96,34,,2156.96,percent of total billed charges,Implant Device,2220.4,35,,2220.4,percent of total billed charges,Implant Device,2156.96,34,"Charges > $500, x 34%",2156.96,percent of total billed charges,Implant Device,2220.4,35,,2220.4,percent of total billed charges,Implant Devices,2220.4,35,,2220.4,percent of total billed charges,Implant Devices,2220.4,35,,,percent of total billed charges,Implant Devices,2220.4,35,,2220.4,percent of total billed charges,Implant Devices,2220.4,35,,2220.4,percent of total billed charges,Implant Devices,2537.6,40,,2537.6,percent of total billed charges,Implant Devices,2220.4,70,,2220.4,percent of total billed charges,Implant Devices,2156.96,34,,2156.96,percent of total billed charges,Implant Devices,2156.96,34,,2156.96,percent of total billed charges,Implant Devices,2220.4,35,,2220.4,percent of total billed charges,Implant Devices,2220.4,35,,2220.4,percent of total billed charges,Implant Devices,2220.4,35,,2220.4,percent of total billed charges,Implant Devices,2220.4,35,,2220.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2156.96,34,"If Charge > 2,000, then 34 percent",2156.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2537.6,
WRIGHT CCP-N3012 LOCKING SCREW 3X12MM,C1713,HCPCS,,79007865,CDM,278,RC,,,both,,,957,377.7,39.4668,,377.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,325.38,34,,325.38,percent of total billed charges,Implant Device,325.38,34,,325.38,percent of total billed charges,Implant Device,325.38,34,,325.38,percent of total billed charges,Implant Device,325.38,34,,325.38,percent of total billed charges,Implant Device,325.38,34,,325.38,percent of total billed charges,Implant Device,325.38,34,,325.38,percent of total billed charges,Implant Device,334.95,35,,334.95,percent of total billed charges,Implant Device,325.38,34,"Charges > $500, x 34%",325.38,percent of total billed charges,Implant Device,334.95,35,,334.95,percent of total billed charges,Implant Devices,334.95,35,,334.95,percent of total billed charges,Implant Devices,334.95,35,,,percent of total billed charges,Implant Devices,334.95,35,,334.95,percent of total billed charges,Implant Devices,334.95,35,,334.95,percent of total billed charges,Implant Devices,382.8,40,,382.8,percent of total billed charges,Implant Devices,334.95,70,,334.95,percent of total billed charges,Implant Devices,325.38,34,,325.38,percent of total billed charges,Implant Devices,325.38,34,,325.38,percent of total billed charges,Implant Devices,334.95,35,,334.95,percent of total billed charges,Implant Devices,334.95,35,,334.95,percent of total billed charges,Implant Devices,334.95,35,,334.95,percent of total billed charges,Implant Devices,334.95,35,,334.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,382.8,
STRYKER 6704-0-110 BEADED CABLE 1.6MM,C1713,HCPCS,,79007866,CDM,278,RC,,,both,,,2858,1127.96,39.4668,,1127.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,971.72,34,,971.72,percent of total billed charges,Implant Device,971.72,34,,971.72,percent of total billed charges,Implant Device,971.72,34,,971.72,percent of total billed charges,Implant Device,971.72,34,,971.72,percent of total billed charges,Implant Device,971.72,34,,971.72,percent of total billed charges,Implant Device,971.72,34,,971.72,percent of total billed charges,Implant Device,1000.3,35,,1000.3,percent of total billed charges,Implant Device,971.72,34,"Charges > $500, x 34%",971.72,percent of total billed charges,Implant Device,1000.3,35,,1000.3,percent of total billed charges,Implant Devices,1000.3,35,,1000.3,percent of total billed charges,Implant Devices,1000.3,35,,,percent of total billed charges,Implant Devices,1000.3,35,,1000.3,percent of total billed charges,Implant Devices,1000.3,35,,1000.3,percent of total billed charges,Implant Devices,1143.2,40,,1143.2,percent of total billed charges,Implant Devices,1000.3,70,,1000.3,percent of total billed charges,Implant Devices,971.72,34,,971.72,percent of total billed charges,Implant Devices,971.72,34,,971.72,percent of total billed charges,Implant Devices,1000.3,35,,1000.3,percent of total billed charges,Implant Devices,1000.3,35,,1000.3,percent of total billed charges,Implant Devices,1000.3,35,,1000.3,percent of total billed charges,Implant Devices,1000.3,35,,1000.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,971.72,34,"If Charge > 2,000, then 34 percent",971.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1143.2,
STABILITY BIOLOGICS 1005-14 FEMORAL HEAD,C1713,HCPCS,,79007867,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
WRIGHT CCP-3528 LAG SCREW 3.5X26MM,C1713,HCPCS,,79007868,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
SYNTHES 201.816 2.0 CORTEX SCREW 10MM,C1713,HCPCS,,79007869,CDM,278,RC,,,both,,,83,32.76,39.4668,,32.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,33.2,40,,33.2,percent of total billed charges,Implant Devices,29.05,70,,29.05,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.2,
DEPUY 02.111.631 DIST RAD PLATE 2.4MM 6H,C1713,HCPCS,,79007873,CDM,278,RC,,,both,,,2323,916.81,39.4668,,916.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,813.05,35,,813.05,percent of total billed charges,Implant Device,789.82,34,"Charges > $500, x 34%",789.82,percent of total billed charges,Implant Device,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,929.2,40,,929.2,percent of total billed charges,Implant Devices,813.05,70,,813.05,percent of total billed charges,Implant Devices,789.82,34,,789.82,percent of total billed charges,Implant Devices,789.82,34,,789.82,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,789.82,34,"If Charge > 2,000, then 34 percent",789.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,929.2,
PARAGON 28 P20-155-065S SCREW 5.5X65MM,C1713,HCPCS,,79007874,CDM,278,RC,,,both,,,1236,487.81,39.4668,,487.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,420.24,34,,420.24,percent of total billed charges,Implant Device,420.24,34,,420.24,percent of total billed charges,Implant Device,420.24,34,,420.24,percent of total billed charges,Implant Device,420.24,34,,420.24,percent of total billed charges,Implant Device,420.24,34,,420.24,percent of total billed charges,Implant Device,420.24,34,,420.24,percent of total billed charges,Implant Device,432.6,35,,432.6,percent of total billed charges,Implant Device,420.24,34,"Charges > $500, x 34%",420.24,percent of total billed charges,Implant Device,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,494.4,40,,494.4,percent of total billed charges,Implant Devices,432.6,70,,432.6,percent of total billed charges,Implant Devices,420.24,34,,420.24,percent of total billed charges,Implant Devices,420.24,34,,420.24,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,432.6,35,,432.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,494.4,
PARAGON 28 P20-170-076F SCREW 7.0X76MM,C1713,HCPCS,,79007875,CDM,278,RC,,,both,,,1697,669.75,39.4668,,669.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,576.98,34,,576.98,percent of total billed charges,Implant Device,576.98,34,,576.98,percent of total billed charges,Implant Device,576.98,34,,576.98,percent of total billed charges,Implant Device,576.98,34,,576.98,percent of total billed charges,Implant Device,576.98,34,,576.98,percent of total billed charges,Implant Device,576.98,34,,576.98,percent of total billed charges,Implant Device,593.95,35,,593.95,percent of total billed charges,Implant Device,576.98,34,"Charges > $500, x 34%",576.98,percent of total billed charges,Implant Device,593.95,35,,593.95,percent of total billed charges,Implant Devices,593.95,35,,593.95,percent of total billed charges,Implant Devices,593.95,35,,,percent of total billed charges,Implant Devices,593.95,35,,593.95,percent of total billed charges,Implant Devices,593.95,35,,593.95,percent of total billed charges,Implant Devices,678.8,40,,678.8,percent of total billed charges,Implant Devices,593.95,70,,593.95,percent of total billed charges,Implant Devices,576.98,34,,576.98,percent of total billed charges,Implant Devices,576.98,34,,576.98,percent of total billed charges,Implant Devices,593.95,35,,593.95,percent of total billed charges,Implant Devices,593.95,35,,593.95,percent of total billed charges,Implant Devices,593.95,35,,593.95,percent of total billed charges,Implant Devices,593.95,35,,593.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,678.8,
PARAGON 28 PSBT-1608 ARTHROD WEDGE 16MM,C1713,HCPCS,,79007876,CDM,278,RC,,,both,,,8520,3362.57,39.4668,,3362.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2896.8,34,,2896.8,percent of total billed charges,Implant Device,2896.8,34,,2896.8,percent of total billed charges,Implant Device,2896.8,34,,2896.8,percent of total billed charges,Implant Device,2896.8,34,,2896.8,percent of total billed charges,Implant Device,2896.8,34,,2896.8,percent of total billed charges,Implant Device,2896.8,34,,2896.8,percent of total billed charges,Implant Device,2982,35,,2982,percent of total billed charges,Implant Device,2896.8,34,"Charges > $500, x 34%",2896.8,percent of total billed charges,Implant Device,2982,35,,2982,percent of total billed charges,Implant Devices,2982,35,,2982,percent of total billed charges,Implant Devices,2982,35,,,percent of total billed charges,Implant Devices,2982,35,,2982,percent of total billed charges,Implant Devices,2982,35,,2982,percent of total billed charges,Implant Devices,3408,40,,3408,percent of total billed charges,Implant Devices,2982,70,,2982,percent of total billed charges,Implant Devices,2896.8,34,,2896.8,percent of total billed charges,Implant Devices,2896.8,34,,2896.8,percent of total billed charges,Implant Devices,2982,35,,2982,percent of total billed charges,Implant Devices,2982,35,,2982,percent of total billed charges,Implant Devices,2982,35,,2982,percent of total billed charges,Implant Devices,2982,35,,2982,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2896.8,34,"If Charge > 2,000, then 34 percent",2896.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3408,
ARTHREX AR-8724-16 SCREW 2.4X16MM,C1713,HCPCS,,79007877,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 614730 2.7X30MM BONE SCREW,C1713,HCPCS,,79007881,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 614750 2.7X50MM BONE SCREW,C1713,HCPCS,,79007882,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 629224 4 HOLE LATERAL PLATE,C1713,HCPCS,,79007883,CDM,278,RC,,,both,,,4281,1689.57,39.4668,,1689.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1455.54,34,,1455.54,percent of total billed charges,Implant Device,1455.54,34,,1455.54,percent of total billed charges,Implant Device,1455.54,34,,1455.54,percent of total billed charges,Implant Device,1455.54,34,,1455.54,percent of total billed charges,Implant Device,1455.54,34,,1455.54,percent of total billed charges,Implant Device,1455.54,34,,1455.54,percent of total billed charges,Implant Device,1498.35,35,,1498.35,percent of total billed charges,Implant Device,1455.54,34,"Charges > $500, x 34%",1455.54,percent of total billed charges,Implant Device,1498.35,35,,1498.35,percent of total billed charges,Implant Devices,1498.35,35,,1498.35,percent of total billed charges,Implant Devices,1498.35,35,,,percent of total billed charges,Implant Devices,1498.35,35,,1498.35,percent of total billed charges,Implant Devices,1498.35,35,,1498.35,percent of total billed charges,Implant Devices,1712.4,40,,1712.4,percent of total billed charges,Implant Devices,1498.35,70,,1498.35,percent of total billed charges,Implant Devices,1455.54,34,,1455.54,percent of total billed charges,Implant Devices,1455.54,34,,1455.54,percent of total billed charges,Implant Devices,1498.35,35,,1498.35,percent of total billed charges,Implant Devices,1498.35,35,,1498.35,percent of total billed charges,Implant Devices,1498.35,35,,1498.35,percent of total billed charges,Implant Devices,1498.35,35,,1498.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1455.54,34,"If Charge > 2,000, then 34 percent",1455.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1712.4,
STRYKER 614738 2.7X38MM BONE SCREW,C1713,HCPCS,,79007884,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 629384 4 HOLE MEDIVAL PLATE,C1713,HCPCS,,79007885,CDM,278,RC,,,both,,,2804,1106.65,39.4668,,1106.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,981.4,35,,981.4,percent of total billed charges,Implant Device,953.36,34,"Charges > $500, x 34%",953.36,percent of total billed charges,Implant Device,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,1121.6,40,,1121.6,percent of total billed charges,Implant Devices,981.4,70,,981.4,percent of total billed charges,Implant Devices,953.36,34,,953.36,percent of total billed charges,Implant Devices,953.36,34,,953.36,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,953.36,34,"If Charge > 2,000, then 34 percent",953.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1121.6,
STRYKER 614522 2.7X22MM LOCK SCREW,C1713,HCPCS,,79007886,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
STRYKER 614830 3.5X30MM BONE SCREW,C1713,HCPCS,,79007887,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 614760 2.7X60MM BONE SCREW,C1713,HCPCS,,79007888,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 614832 3.5X32MM BONE SCREW,C1713,HCPCS,,79007889,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
STRYKER 0194-2000S FLEXIBLE NAIL 2.0MM,C1713,HCPCS,,79007893,CDM,278,RC,,,both,,,1089,429.79,39.4668,,429.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,370.26,34,,370.26,percent of total billed charges,Implant Device,370.26,34,,370.26,percent of total billed charges,Implant Device,370.26,34,,370.26,percent of total billed charges,Implant Device,370.26,34,,370.26,percent of total billed charges,Implant Device,370.26,34,,370.26,percent of total billed charges,Implant Device,370.26,34,,370.26,percent of total billed charges,Implant Device,381.15,35,,381.15,percent of total billed charges,Implant Device,370.26,34,"Charges > $500, x 34%",370.26,percent of total billed charges,Implant Device,381.15,35,,381.15,percent of total billed charges,Implant Devices,381.15,35,,381.15,percent of total billed charges,Implant Devices,381.15,35,,,percent of total billed charges,Implant Devices,381.15,35,,381.15,percent of total billed charges,Implant Devices,381.15,35,,381.15,percent of total billed charges,Implant Devices,435.6,40,,435.6,percent of total billed charges,Implant Devices,381.15,70,,381.15,percent of total billed charges,Implant Devices,370.26,34,,370.26,percent of total billed charges,Implant Devices,370.26,34,,370.26,percent of total billed charges,Implant Devices,381.15,35,,381.15,percent of total billed charges,Implant Devices,381.15,35,,381.15,percent of total billed charges,Implant Devices,381.15,35,,381.15,percent of total billed charges,Implant Devices,381.15,35,,381.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,435.6,
STRYKER 53-05216 DOG BONE PLATE,C1713,HCPCS,,79007894,CDM,278,RC,,,both,,,409,161.42,39.4668,,161.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,139.06,34,,139.06,percent of total billed charges,Implant Device,139.06,34,,139.06,percent of total billed charges,Implant Device,139.06,34,,139.06,percent of total billed charges,Implant Device,139.06,34,,139.06,percent of total billed charges,Implant Device,139.06,34,,139.06,percent of total billed charges,Implant Device,139.06,34,,139.06,percent of total billed charges,Implant Device,143.15,35,,143.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,163.6,40,,163.6,percent of total billed charges,Implant Devices,143.15,70,,143.15,percent of total billed charges,Implant Devices,139.06,34,,139.06,percent of total billed charges,Implant Devices,139.06,34,,139.06,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.6,
STRYKER 53-05228 SQUARE PLATE 4 HOLE,C1713,HCPCS,,79007895,CDM,278,RC,,,both,,,511,201.68,39.4668,,201.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.74,34,,173.74,percent of total billed charges,Implant Device,173.74,34,,173.74,percent of total billed charges,Implant Device,173.74,34,,173.74,percent of total billed charges,Implant Device,173.74,34,,173.74,percent of total billed charges,Implant Device,173.74,34,,173.74,percent of total billed charges,Implant Device,173.74,34,,173.74,percent of total billed charges,Implant Device,178.85,35,,178.85,percent of total billed charges,Implant Device,173.74,34,"Charges > $500, x 34%",173.74,percent of total billed charges,Implant Device,178.85,35,,178.85,percent of total billed charges,Implant Devices,178.85,35,,178.85,percent of total billed charges,Implant Devices,178.85,35,,,percent of total billed charges,Implant Devices,178.85,35,,178.85,percent of total billed charges,Implant Devices,178.85,35,,178.85,percent of total billed charges,Implant Devices,204.4,40,,204.4,percent of total billed charges,Implant Devices,178.85,70,,178.85,percent of total billed charges,Implant Devices,173.74,34,,173.74,percent of total billed charges,Implant Devices,173.74,34,,173.74,percent of total billed charges,Implant Devices,178.85,35,,178.85,percent of total billed charges,Implant Devices,178.85,35,,178.85,percent of total billed charges,Implant Devices,178.85,35,,178.85,percent of total billed charges,Implant Devices,178.85,35,,178.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204.4,
P28 P50-053-2710 LOCK PLATE SCREW 27X10,C1713,HCPCS,,79007907,CDM,278,RC,,,both,,,667,263.24,39.4668,,263.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,226.78,34,,226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Device,226.78,34,"Charges > $500, x 34%",226.78,percent of total billed charges,Implant Device,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,266.8,40,,266.8,percent of total billed charges,Implant Devices,233.45,70,,233.45,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,226.78,34,,226.78,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,233.45,35,,233.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.8,
P28 P50-153-2710 NONLOCK SCREW 2.7X10,C1713,HCPCS,,79007908,CDM,278,RC,,,both,,,542,213.91,39.4668,,213.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,184.28,34,,184.28,percent of total billed charges,Implant Device,184.28,34,,184.28,percent of total billed charges,Implant Device,184.28,34,,184.28,percent of total billed charges,Implant Device,184.28,34,,184.28,percent of total billed charges,Implant Device,184.28,34,,184.28,percent of total billed charges,Implant Device,184.28,34,,184.28,percent of total billed charges,Implant Device,189.7,35,,189.7,percent of total billed charges,Implant Device,184.28,34,"Charges > $500, x 34%",184.28,percent of total billed charges,Implant Device,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,216.8,40,,216.8,percent of total billed charges,Implant Devices,189.7,70,,189.7,percent of total billed charges,Implant Devices,184.28,34,,184.28,percent of total billed charges,Implant Devices,184.28,34,,184.28,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,189.7,35,,189.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216.8,
P28 P50-153-3514 NONLOCK SCREW 3.5X14,C1713,HCPCS,,79007909,CDM,278,RC,,,both,,,566,223.38,39.4668,,223.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,198.1,35,,198.1,percent of total billed charges,Implant Device,192.44,34,"Charges > $500, x 34%",192.44,percent of total billed charges,Implant Device,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,226.4,40,,226.4,percent of total billed charges,Implant Devices,198.1,70,,198.1,percent of total billed charges,Implant Devices,192.44,34,,192.44,percent of total billed charges,Implant Devices,192.44,34,,192.44,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,226.4,
P28 P53-103-L002 MTP PLATE O MD LT,C1713,HCPCS,,79007910,CDM,278,RC,,,both,,,5155,2034.51,39.4668,,2034.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1752.7,34,,1752.7,percent of total billed charges,Implant Device,1752.7,34,,1752.7,percent of total billed charges,Implant Device,1752.7,34,,1752.7,percent of total billed charges,Implant Device,1752.7,34,,1752.7,percent of total billed charges,Implant Device,1752.7,34,,1752.7,percent of total billed charges,Implant Device,1752.7,34,,1752.7,percent of total billed charges,Implant Device,1804.25,35,,1804.25,percent of total billed charges,Implant Device,1752.7,34,"Charges > $500, x 34%",1752.7,percent of total billed charges,Implant Device,1804.25,35,,1804.25,percent of total billed charges,Implant Devices,1804.25,35,,1804.25,percent of total billed charges,Implant Devices,1804.25,35,,,percent of total billed charges,Implant Devices,1804.25,35,,1804.25,percent of total billed charges,Implant Devices,1804.25,35,,1804.25,percent of total billed charges,Implant Devices,2062,40,,2062,percent of total billed charges,Implant Devices,1804.25,70,,1804.25,percent of total billed charges,Implant Devices,1752.7,34,,1752.7,percent of total billed charges,Implant Devices,1752.7,34,,1752.7,percent of total billed charges,Implant Devices,1804.25,35,,1804.25,percent of total billed charges,Implant Devices,1804.25,35,,1804.25,percent of total billed charges,Implant Devices,1804.25,35,,1804.25,percent of total billed charges,Implant Devices,1804.25,35,,1804.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1752.7,34,"If Charge > 2,000, then 34 percent",1752.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2062,
DEPUY 206.024 CANCELLOUS SCREW 4X24MM,C1713,HCPCS,,79007911,CDM,278,RC,,,both,,,92,36.31,39.4668,,36.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,31.28,34,,31.28,percent of total billed charges,Implant Device,31.28,34,,31.28,percent of total billed charges,Implant Device,31.28,34,,31.28,percent of total billed charges,Implant Device,31.28,34,,31.28,percent of total billed charges,Implant Device,31.28,34,,31.28,percent of total billed charges,Implant Device,31.28,34,,31.28,percent of total billed charges,Implant Device,32.2,35,,32.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,36.8,40,,36.8,percent of total billed charges,Implant Devices,32.2,70,,32.2,percent of total billed charges,Implant Devices,31.28,34,,31.28,percent of total billed charges,Implant Devices,31.28,34,,31.28,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,36.8,
S&N 71424029 STEM STRAIGHT 16X120MM,C1713,HCPCS,,79007914,CDM,278,RC,,,both,,,4608,1818.63,39.4668,,1818.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1612.8,35,,1612.8,percent of total billed charges,Implant Device,1566.72,34,"Charges > $500, x 34%",1566.72,percent of total billed charges,Implant Device,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1843.2,40,,1843.2,percent of total billed charges,Implant Devices,1612.8,70,,1612.8,percent of total billed charges,Implant Devices,1566.72,34,,1566.72,percent of total billed charges,Implant Devices,1566.72,34,,1566.72,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1566.72,34,"If Charge > 2,000, then 34 percent",1566.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1843.2,
S&N 71421514 ARTICULAR INSERT 25MM,C1713,HCPCS,,79007915,CDM,278,RC,,,both,,,3292,1299.25,39.4668,,1299.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1119.28,34,,1119.28,percent of total billed charges,Implant Device,1119.28,34,,1119.28,percent of total billed charges,Implant Device,1119.28,34,,1119.28,percent of total billed charges,Implant Device,1119.28,34,,1119.28,percent of total billed charges,Implant Device,1119.28,34,,1119.28,percent of total billed charges,Implant Device,1119.28,34,,1119.28,percent of total billed charges,Implant Device,1152.2,35,,1152.2,percent of total billed charges,Implant Device,1119.28,34,"Charges > $500, x 34%",1119.28,percent of total billed charges,Implant Device,1152.2,35,,1152.2,percent of total billed charges,Implant Devices,1152.2,35,,1152.2,percent of total billed charges,Implant Devices,1152.2,35,,,percent of total billed charges,Implant Devices,1152.2,35,,1152.2,percent of total billed charges,Implant Devices,1152.2,35,,1152.2,percent of total billed charges,Implant Devices,1316.8,40,,1316.8,percent of total billed charges,Implant Devices,1152.2,70,,1152.2,percent of total billed charges,Implant Devices,1119.28,34,,1119.28,percent of total billed charges,Implant Devices,1119.28,34,,1119.28,percent of total billed charges,Implant Devices,1152.2,35,,1152.2,percent of total billed charges,Implant Devices,1152.2,35,,1152.2,percent of total billed charges,Implant Devices,1152.2,35,,1152.2,percent of total billed charges,Implant Devices,1152.2,35,,1152.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1119.28,34,"If Charge > 2,000, then 34 percent",1119.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1316.8,
IN2BONES S25 ST014 COMP SCREW 2.5X14MM,C1713,HCPCS,,79007917,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
WRIGHT CCP-L3512 LOCKING SCREW 3.5X12MM,C1713,HCPCS,,79007919,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
BME SE-2015 SPEED IMPLANT 20X15X15MM,C1713,HCPCS,,79007920,CDM,278,RC,,,both,,,5160,2036.49,39.4668,,2036.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1806,35,,1806,percent of total billed charges,Implant Device,1754.4,34,"Charges > $500, x 34%",1754.4,percent of total billed charges,Implant Device,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,2064,40,,2064,percent of total billed charges,Implant Devices,1806,70,,1806,percent of total billed charges,Implant Devices,1754.4,34,,1754.4,percent of total billed charges,Implant Devices,1754.4,34,,1754.4,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1754.4,34,"If Charge > 2,000, then 34 percent",1754.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2064,
ZIMMER 14376-38 CANNULATED SCREW 4X38MM,C1713,HCPCS,,79007921,CDM,278,RC,,,both,,,514,202.86,39.4668,,202.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Device,174.76,34,"Charges > $500, x 34%",174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,205.6,40,,205.6,percent of total billed charges,Implant Devices,179.9,70,,179.9,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.6,
DEPUY 204.822 CORTEX SCREW ST 3.5X22MM,C1713,HCPCS,,79007922,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
DEPUY 206.022 CANCELLOUS SCREW 4X22MM,C1713,HCPCS,,79007923,CDM,278,RC,,,both,,,59,23.29,39.4668,,23.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,23.6,40,,23.6,percent of total billed charges,Implant Devices,20.65,70,,20.65,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.6,
SUT EXP PC012X PARIETEX COMP MESH 12CM,C1713,HCPCS,,79007924,CDM,278,RC,,,both,,,1857,732.9,39.4668,,732.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,631.38,34,,631.38,percent of total billed charges,Implant Device,631.38,34,,631.38,percent of total billed charges,Implant Device,631.38,34,,631.38,percent of total billed charges,Implant Device,631.38,34,,631.38,percent of total billed charges,Implant Device,631.38,34,,631.38,percent of total billed charges,Implant Device,631.38,34,,631.38,percent of total billed charges,Implant Device,649.95,35,,649.95,percent of total billed charges,Implant Device,631.38,34,"Charges > $500, x 34%",631.38,percent of total billed charges,Implant Device,649.95,35,,649.95,percent of total billed charges,Implant Devices,649.95,35,,649.95,percent of total billed charges,Implant Devices,649.95,35,,,percent of total billed charges,Implant Devices,649.95,35,,649.95,percent of total billed charges,Implant Devices,649.95,35,,649.95,percent of total billed charges,Implant Devices,742.8,40,,742.8,percent of total billed charges,Implant Devices,649.95,70,,649.95,percent of total billed charges,Implant Devices,631.38,34,,631.38,percent of total billed charges,Implant Devices,631.38,34,,631.38,percent of total billed charges,Implant Devices,649.95,35,,649.95,percent of total billed charges,Implant Devices,649.95,35,,649.95,percent of total billed charges,Implant Devices,649.95,35,,649.95,percent of total billed charges,Implant Devices,649.95,35,,649.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,742.8,
P28 P50-053-2730 LOCK PLATE SCREW 2.7X30,C1713,HCPCS,,79007925,CDM,278,RC,,,both,,,880,347.31,39.4668,,347.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Device,299.2,34,"Charges > $500, x 34%",299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,352,40,,352,percent of total billed charges,Implant Devices,308,70,,308,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,352,
P28 P50-053-3534 LOCK PLATE SCREW 3.5X24,C1713,HCPCS,,79007926,CDM,278,RC,,,both,,,694,273.9,39.4668,,273.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Device,235.96,34,"Charges > $500, x 34%",235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,277.6,40,,277.6,percent of total billed charges,Implant Devices,242.9,70,,242.9,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.6,
P28 P50-053-4232 LOCK PLATE SCREW 4.2X32,C1713,HCPCS,,79007927,CDM,278,RC,,,both,,,854,337.05,39.4668,,337.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,298.9,35,,298.9,percent of total billed charges,Implant Device,290.36,34,"Charges > $500, x 34%",290.36,percent of total billed charges,Implant Device,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,341.6,40,,341.6,percent of total billed charges,Implant Devices,298.9,70,,298.9,percent of total billed charges,Implant Devices,290.36,34,,290.36,percent of total billed charges,Implant Devices,290.36,34,,290.36,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,341.6,
P28 P53-105-L003 PLATE LONG LEFT 24MM,C1713,HCPCS,,79007928,CDM,278,RC,,,both,,,4851,1914.53,39.4668,,1914.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1697.85,35,,1697.85,percent of total billed charges,Implant Device,1649.34,34,"Charges > $500, x 34%",1649.34,percent of total billed charges,Implant Device,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1940.4,40,,1940.4,percent of total billed charges,Implant Devices,1697.85,70,,1697.85,percent of total billed charges,Implant Devices,1649.34,34,,1649.34,percent of total billed charges,Implant Devices,1649.34,34,,1649.34,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1649.34,34,"If Charge > 2,000, then 34 percent",1649.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1940.4,
S&N 71335552 SHELL 3 HOLE 52MM,C1713,HCPCS,,79007931,CDM,278,RC,,,both,,,3801,1500.13,39.4668,,1500.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1292.34,34,,1292.34,percent of total billed charges,Implant Device,1330.35,35,,1330.35,percent of total billed charges,Implant Device,1292.34,34,"Charges > $500, x 34%",1292.34,percent of total billed charges,Implant Device,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1520.4,40,,1520.4,percent of total billed charges,Implant Devices,1330.35,70,,1330.35,percent of total billed charges,Implant Devices,1292.34,34,,1292.34,percent of total billed charges,Implant Devices,1292.34,34,,1292.34,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,1330.35,35,,1330.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1292.34,34,"If Charge > 2,000, then 34 percent",1292.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1520.4,
S&N 71306612 FEMORAL COMPONENT SIZE 12,C1713,HCPCS,,79007932,CDM,278,RC,,,both,,,9135,3605.29,39.4668,,3605.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3105.9,34,,3105.9,percent of total billed charges,Implant Device,3105.9,34,,3105.9,percent of total billed charges,Implant Device,3105.9,34,,3105.9,percent of total billed charges,Implant Device,3105.9,34,,3105.9,percent of total billed charges,Implant Device,3105.9,34,,3105.9,percent of total billed charges,Implant Device,3105.9,34,,3105.9,percent of total billed charges,Implant Device,3197.25,35,,3197.25,percent of total billed charges,Implant Device,3105.9,34,"Charges > $500, x 34%",3105.9,percent of total billed charges,Implant Device,3197.25,35,,3197.25,percent of total billed charges,Implant Devices,3197.25,35,,3197.25,percent of total billed charges,Implant Devices,3197.25,35,,,percent of total billed charges,Implant Devices,3197.25,35,,3197.25,percent of total billed charges,Implant Devices,3197.25,35,,3197.25,percent of total billed charges,Implant Devices,3654,40,,3654,percent of total billed charges,Implant Devices,3197.25,70,,3197.25,percent of total billed charges,Implant Devices,3105.9,34,,3105.9,percent of total billed charges,Implant Devices,3105.9,34,,3105.9,percent of total billed charges,Implant Devices,3197.25,35,,3197.25,percent of total billed charges,Implant Devices,3197.25,35,,3197.25,percent of total billed charges,Implant Devices,3197.25,35,,3197.25,percent of total billed charges,Implant Devices,3197.25,35,,3197.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3105.9,34,"If Charge > 2,000, then 34 percent",3105.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3654,
S&N 71332520 CANC HEAD SCREW 6.5X20MM,C1713,HCPCS,,79007933,CDM,278,RC,,,both,,,273,107.74,39.4668,,107.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,92.82,34,,92.82,percent of total billed charges,Implant Device,92.82,34,,92.82,percent of total billed charges,Implant Device,92.82,34,,92.82,percent of total billed charges,Implant Device,92.82,34,,92.82,percent of total billed charges,Implant Device,92.82,34,,92.82,percent of total billed charges,Implant Device,92.82,34,,92.82,percent of total billed charges,Implant Device,95.55,35,,95.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,109.2,40,,109.2,percent of total billed charges,Implant Devices,95.55,70,,95.55,percent of total billed charges,Implant Devices,92.82,34,,92.82,percent of total billed charges,Implant Devices,92.82,34,,92.82,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.2,
S&N 71343603 FEM HEAD 12/14 TAPER 36MM,C1713,HCPCS,,79007934,CDM,278,RC,,,both,,,3969,1566.44,39.4668,,1566.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1349.46,34,,1349.46,percent of total billed charges,Implant Device,1349.46,34,,1349.46,percent of total billed charges,Implant Device,1349.46,34,,1349.46,percent of total billed charges,Implant Device,1349.46,34,,1349.46,percent of total billed charges,Implant Device,1349.46,34,,1349.46,percent of total billed charges,Implant Device,1349.46,34,,1349.46,percent of total billed charges,Implant Device,1389.15,35,,1389.15,percent of total billed charges,Implant Device,1349.46,34,"Charges > $500, x 34%",1349.46,percent of total billed charges,Implant Device,1389.15,35,,1389.15,percent of total billed charges,Implant Devices,1389.15,35,,1389.15,percent of total billed charges,Implant Devices,1389.15,35,,,percent of total billed charges,Implant Devices,1389.15,35,,1389.15,percent of total billed charges,Implant Devices,1389.15,35,,1389.15,percent of total billed charges,Implant Devices,1587.6,40,,1587.6,percent of total billed charges,Implant Devices,1389.15,70,,1389.15,percent of total billed charges,Implant Devices,1349.46,34,,1349.46,percent of total billed charges,Implant Devices,1349.46,34,,1349.46,percent of total billed charges,Implant Devices,1389.15,35,,1389.15,percent of total billed charges,Implant Devices,1389.15,35,,1389.15,percent of total billed charges,Implant Devices,1389.15,35,,1389.15,percent of total billed charges,Implant Devices,1389.15,35,,1389.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1349.46,34,"If Charge > 2,000, then 34 percent",1349.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1587.6,
S&N 71335752 ACETABULAR LINER 36X52MM,C1713,HCPCS,,79007935,CDM,278,RC,,,both,,,3003,1185.19,39.4668,,1185.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1021.02,34,,1021.02,percent of total billed charges,Implant Device,1021.02,34,,1021.02,percent of total billed charges,Implant Device,1021.02,34,,1021.02,percent of total billed charges,Implant Device,1021.02,34,,1021.02,percent of total billed charges,Implant Device,1021.02,34,,1021.02,percent of total billed charges,Implant Device,1021.02,34,,1021.02,percent of total billed charges,Implant Device,1051.05,35,,1051.05,percent of total billed charges,Implant Device,1021.02,34,"Charges > $500, x 34%",1021.02,percent of total billed charges,Implant Device,1051.05,35,,1051.05,percent of total billed charges,Implant Devices,1051.05,35,,1051.05,percent of total billed charges,Implant Devices,1051.05,35,,,percent of total billed charges,Implant Devices,1051.05,35,,1051.05,percent of total billed charges,Implant Devices,1051.05,35,,1051.05,percent of total billed charges,Implant Devices,1201.2,40,,1201.2,percent of total billed charges,Implant Devices,1051.05,70,,1051.05,percent of total billed charges,Implant Devices,1021.02,34,,1021.02,percent of total billed charges,Implant Devices,1021.02,34,,1021.02,percent of total billed charges,Implant Devices,1051.05,35,,1051.05,percent of total billed charges,Implant Devices,1051.05,35,,1051.05,percent of total billed charges,Implant Devices,1051.05,35,,1051.05,percent of total billed charges,Implant Devices,1051.05,35,,1051.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1021.02,34,"If Charge > 2,000, then 34 percent",1021.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1201.2,
S&N 71332525 CANC HEAD SCREW 6.5X25MM,C1713,HCPCS,,79007936,CDM,278,RC,,,both,,,273,107.74,39.4668,,107.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,92.82,34,,92.82,percent of total billed charges,Implant Device,92.82,34,,92.82,percent of total billed charges,Implant Device,92.82,34,,92.82,percent of total billed charges,Implant Device,92.82,34,,92.82,percent of total billed charges,Implant Device,92.82,34,,92.82,percent of total billed charges,Implant Device,92.82,34,,92.82,percent of total billed charges,Implant Device,95.55,35,,95.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,109.2,40,,109.2,percent of total billed charges,Implant Devices,95.55,70,,95.55,percent of total billed charges,Implant Devices,92.82,34,,92.82,percent of total billed charges,Implant Devices,92.82,34,,92.82,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,95.55,35,,95.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.2,
S&N 71336500 CENTRAL HOLE COVER,C1713,HCPCS,,79007937,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
STRYKER 3425-1420S 11X120MM LONG NAIL,C1713,HCPCS,,79007938,CDM,278,RC,,,both,,,11742,4634.19,39.4668,,4634.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3992.28,34,,3992.28,percent of total billed charges,Implant Device,3992.28,34,,3992.28,percent of total billed charges,Implant Device,3992.28,34,,3992.28,percent of total billed charges,Implant Device,3992.28,34,,3992.28,percent of total billed charges,Implant Device,3992.28,34,,3992.28,percent of total billed charges,Implant Device,3992.28,34,,3992.28,percent of total billed charges,Implant Device,4109.7,35,,4109.7,percent of total billed charges,Implant Device,3992.28,34,"Charges > $500, x 34%",3992.28,percent of total billed charges,Implant Device,4109.7,35,,4109.7,percent of total billed charges,Implant Devices,4109.7,35,,4109.7,percent of total billed charges,Implant Devices,4109.7,35,,,percent of total billed charges,Implant Devices,4109.7,35,,4109.7,percent of total billed charges,Implant Devices,4109.7,35,,4109.7,percent of total billed charges,Implant Devices,4696.8,40,,4696.8,percent of total billed charges,Implant Devices,4109.7,70,,4109.7,percent of total billed charges,Implant Devices,3992.28,34,,3992.28,percent of total billed charges,Implant Devices,3992.28,34,,3992.28,percent of total billed charges,Implant Devices,4109.7,35,,4109.7,percent of total billed charges,Implant Devices,4109.7,35,,4109.7,percent of total billed charges,Implant Devices,4109.7,35,,4109.7,percent of total billed charges,Implant Devices,4109.7,35,,4109.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3992.28,34,"If Charge > 2,000, then 34 percent",3992.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4696.8,
ARTHREX AR-1588TP PCL TIGHTROPE,C1713,HCPCS,,79007942,CDM,278,RC,,,both,,,1497,590.82,39.4668,,590.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,508.98,34,,508.98,percent of total billed charges,Implant Device,508.98,34,,508.98,percent of total billed charges,Implant Device,508.98,34,,508.98,percent of total billed charges,Implant Device,508.98,34,,508.98,percent of total billed charges,Implant Device,508.98,34,,508.98,percent of total billed charges,Implant Device,508.98,34,,508.98,percent of total billed charges,Implant Device,523.95,35,,523.95,percent of total billed charges,Implant Device,508.98,34,"Charges > $500, x 34%",508.98,percent of total billed charges,Implant Device,523.95,35,,523.95,percent of total billed charges,Implant Devices,523.95,35,,523.95,percent of total billed charges,Implant Devices,523.95,35,,,percent of total billed charges,Implant Devices,523.95,35,,523.95,percent of total billed charges,Implant Devices,523.95,35,,523.95,percent of total billed charges,Implant Devices,598.8,40,,598.8,percent of total billed charges,Implant Devices,523.95,70,,523.95,percent of total billed charges,Implant Devices,508.98,34,,508.98,percent of total billed charges,Implant Devices,508.98,34,,508.98,percent of total billed charges,Implant Devices,523.95,35,,523.95,percent of total billed charges,Implant Devices,523.95,35,,523.95,percent of total billed charges,Implant Devices,523.95,35,,523.95,percent of total billed charges,Implant Devices,523.95,35,,523.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,598.8,
IN2BONES S30-ST134 IBS 3X34MM COMP SCRW,C1713,HCPCS,,79007945,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
DEPUY 02.0206.222 CORTEX SCREW 3.5X22MM,C1713,HCPCS,,79007946,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
DEPUY 02.0206.226 CORTEX SCREW 3.5X26MM,C1713,HCPCS,,79007947,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
DEPUY 02.206.222 CORTEX SCREW 3.5X22MM,C1713,HCPCS,,79007957,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
STRYKER 40-20808 PLATE 8 HOLE STRAIGHT,C1713,HCPCS,,79007962,CDM,278,RC,,,both,,,2229,879.71,39.4668,,879.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,757.86,34,,757.86,percent of total billed charges,Implant Device,757.86,34,,757.86,percent of total billed charges,Implant Device,757.86,34,,757.86,percent of total billed charges,Implant Device,757.86,34,,757.86,percent of total billed charges,Implant Device,757.86,34,,757.86,percent of total billed charges,Implant Device,757.86,34,,757.86,percent of total billed charges,Implant Device,780.15,35,,780.15,percent of total billed charges,Implant Device,757.86,34,"Charges > $500, x 34%",757.86,percent of total billed charges,Implant Device,780.15,35,,780.15,percent of total billed charges,Implant Devices,780.15,35,,780.15,percent of total billed charges,Implant Devices,780.15,35,,,percent of total billed charges,Implant Devices,780.15,35,,780.15,percent of total billed charges,Implant Devices,780.15,35,,780.15,percent of total billed charges,Implant Devices,891.6,40,,891.6,percent of total billed charges,Implant Devices,780.15,70,,780.15,percent of total billed charges,Implant Devices,757.86,34,,757.86,percent of total billed charges,Implant Devices,757.86,34,,757.86,percent of total billed charges,Implant Devices,780.15,35,,780.15,percent of total billed charges,Implant Devices,780.15,35,,780.15,percent of total billed charges,Implant Devices,780.15,35,,780.15,percent of total billed charges,Implant Devices,780.15,35,,780.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,757.86,34,"If Charge > 2,000, then 34 percent",757.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,891.6,
IN2BONES S25 ST012 COMP SCREW 2.5X12MM,C1713,HCPCS,,79007972,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
J&J 212029 KNOTLESS SUTURE ANCHOR,C1713,HCPCS,,79007983,CDM,278,RC,,,both,,,1080,426.24,39.4668,,426.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,378,35,,378,percent of total billed charges,Implant Device,367.2,34,"Charges > $500, x 34%",367.2,percent of total billed charges,Implant Device,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,432,40,,432,percent of total billed charges,Implant Devices,378,70,,378,percent of total billed charges,Implant Devices,367.2,34,,367.2,percent of total billed charges,Implant Devices,367.2,34,,367.2,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,432,
J&J 212032 GII SUPER QUICK ANCHOR,C1713,HCPCS,,79007984,CDM,278,RC,,,both,,,1042,411.24,39.4668,,411.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,354.28,34,,354.28,percent of total billed charges,Implant Device,354.28,34,,354.28,percent of total billed charges,Implant Device,354.28,34,,354.28,percent of total billed charges,Implant Device,354.28,34,,354.28,percent of total billed charges,Implant Device,354.28,34,,354.28,percent of total billed charges,Implant Device,354.28,34,,354.28,percent of total billed charges,Implant Device,364.7,35,,364.7,percent of total billed charges,Implant Device,354.28,34,"Charges > $500, x 34%",354.28,percent of total billed charges,Implant Device,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,416.8,40,,416.8,percent of total billed charges,Implant Devices,364.7,70,,364.7,percent of total billed charges,Implant Devices,354.28,34,,354.28,percent of total billed charges,Implant Devices,354.28,34,,354.28,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,364.7,35,,364.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,416.8,
J&J 212134 GII QUICK ANCHOR PLUS PANNERY,C1713,HCPCS,,79007985,CDM,278,RC,,,both,,,664,262.06,39.4668,,262.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,225.76,34,,225.76,percent of total billed charges,Implant Device,225.76,34,,225.76,percent of total billed charges,Implant Device,225.76,34,,225.76,percent of total billed charges,Implant Device,225.76,34,,225.76,percent of total billed charges,Implant Device,225.76,34,,225.76,percent of total billed charges,Implant Device,225.76,34,,225.76,percent of total billed charges,Implant Device,232.4,35,,232.4,percent of total billed charges,Implant Device,225.76,34,"Charges > $500, x 34%",225.76,percent of total billed charges,Implant Device,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,265.6,40,,265.6,percent of total billed charges,Implant Devices,232.4,70,,232.4,percent of total billed charges,Implant Devices,225.76,34,,225.76,percent of total billed charges,Implant Devices,225.76,34,,225.76,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,265.6,
J&J 212450 GII EASY ARTHROSCOPE,C1713,HCPCS,,79007986,CDM,278,RC,,,both,,,1024,404.14,39.4668,,404.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,348.16,34,,348.16,percent of total billed charges,Implant Device,348.16,34,,348.16,percent of total billed charges,Implant Device,348.16,34,,348.16,percent of total billed charges,Implant Device,348.16,34,,348.16,percent of total billed charges,Implant Device,348.16,34,,348.16,percent of total billed charges,Implant Device,348.16,34,,348.16,percent of total billed charges,Implant Device,358.4,35,,358.4,percent of total billed charges,Implant Device,348.16,34,"Charges > $500, x 34%",348.16,percent of total billed charges,Implant Device,358.4,35,,358.4,percent of total billed charges,Implant Devices,358.4,35,,358.4,percent of total billed charges,Implant Devices,358.4,35,,,percent of total billed charges,Implant Devices,358.4,35,,358.4,percent of total billed charges,Implant Devices,358.4,35,,358.4,percent of total billed charges,Implant Devices,409.6,40,,409.6,percent of total billed charges,Implant Devices,358.4,70,,358.4,percent of total billed charges,Implant Devices,348.16,34,,348.16,percent of total billed charges,Implant Devices,348.16,34,,348.16,percent of total billed charges,Implant Devices,358.4,35,,358.4,percent of total billed charges,Implant Devices,358.4,35,,358.4,percent of total billed charges,Implant Devices,358.4,35,,358.4,percent of total billed charges,Implant Devices,358.4,35,,358.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,409.6,
J&J 212725 KNOTLESS ANCHOR,C1713,HCPCS,,79007987,CDM,278,RC,,,both,,,1126,444.4,39.4668,,444.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,382.84,34,,382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Device,382.84,34,"Charges > $500, x 34%",382.84,percent of total billed charges,Implant Device,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,450.4,40,,450.4,percent of total billed charges,Implant Devices,394.1,70,,394.1,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,382.84,34,,382.84,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,394.1,35,,394.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450.4,
DEPUY 208.434 CANN SCREW 6.5X32X60MM,C1713,HCPCS,,79008021,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
DEPUY 208.436 CANN SCREW 6.5X32X70MM,C1713,HCPCS,,79008022,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
ATLAS SPINE 1106-01-7545 SHAFT 7.5X45MM,C1713,HCPCS,,79008023,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ATLAS SPINE 1100-03-0040 ROD 40MM,C1713,HCPCS,,79008024,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
ATLAS 1208-01-2709 TRUE POS CAGE 27X9MM,C1713,HCPCS,,79008025,CDM,278,RC,,,both,,,9555,3771.05,39.4668,,3771.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3248.7,34,,3248.7,percent of total billed charges,Implant Device,3344.25,35,,3344.25,percent of total billed charges,Implant Device,3248.7,34,"Charges > $500, x 34%",3248.7,percent of total billed charges,Implant Device,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3822,40,,3822,percent of total billed charges,Implant Devices,3344.25,70,,3344.25,percent of total billed charges,Implant Devices,3248.7,34,,3248.7,percent of total billed charges,Implant Devices,3248.7,34,,3248.7,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,3344.25,35,,3344.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3248.7,34,"If Charge > 2,000, then 34 percent",3248.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3822,
P28 P50-053-3522 LOCKING SCREW 3.5X22MM,C1713,HCPCS,,79008027,CDM,278,RC,,,both,,,694,273.9,39.4668,,273.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,235.96,34,,235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Device,235.96,34,"Charges > $500, x 34%",235.96,percent of total billed charges,Implant Device,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,277.6,40,,277.6,percent of total billed charges,Implant Devices,242.9,70,,242.9,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,235.96,34,,235.96,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,242.9,35,,242.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.6,
P28 P50-053-4226 LOCKING SCREW 4.2X26MM,C1713,HCPCS,,79008028,CDM,278,RC,,,both,,,718,283.37,39.4668,,283.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,244.12,34,,244.12,percent of total billed charges,Implant Device,244.12,34,,244.12,percent of total billed charges,Implant Device,244.12,34,,244.12,percent of total billed charges,Implant Device,244.12,34,,244.12,percent of total billed charges,Implant Device,244.12,34,,244.12,percent of total billed charges,Implant Device,244.12,34,,244.12,percent of total billed charges,Implant Device,251.3,35,,251.3,percent of total billed charges,Implant Device,244.12,34,"Charges > $500, x 34%",244.12,percent of total billed charges,Implant Device,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,287.2,40,,287.2,percent of total billed charges,Implant Devices,251.3,70,,251.3,percent of total billed charges,Implant Devices,244.12,34,,244.12,percent of total billed charges,Implant Devices,244.12,34,,244.12,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,251.3,35,,251.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,287.2,
P28 P53-104-0210 EVANS WEDGE PLATE 10MM,C1713,HCPCS,,79008029,CDM,278,RC,,,both,,,5784,2282.76,39.4668,,2282.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1966.56,34,,1966.56,percent of total billed charges,Implant Device,1966.56,34,,1966.56,percent of total billed charges,Implant Device,1966.56,34,,1966.56,percent of total billed charges,Implant Device,1966.56,34,,1966.56,percent of total billed charges,Implant Device,1966.56,34,,1966.56,percent of total billed charges,Implant Device,1966.56,34,,1966.56,percent of total billed charges,Implant Device,2024.4,35,,2024.4,percent of total billed charges,Implant Device,1966.56,34,"Charges > $500, x 34%",1966.56,percent of total billed charges,Implant Device,2024.4,35,,2024.4,percent of total billed charges,Implant Devices,2024.4,35,,2024.4,percent of total billed charges,Implant Devices,2024.4,35,,,percent of total billed charges,Implant Devices,2024.4,35,,2024.4,percent of total billed charges,Implant Devices,2024.4,35,,2024.4,percent of total billed charges,Implant Devices,2313.6,40,,2313.6,percent of total billed charges,Implant Devices,2024.4,70,,2024.4,percent of total billed charges,Implant Devices,1966.56,34,,1966.56,percent of total billed charges,Implant Devices,1966.56,34,,1966.56,percent of total billed charges,Implant Devices,2024.4,35,,2024.4,percent of total billed charges,Implant Devices,2024.4,35,,2024.4,percent of total billed charges,Implant Devices,2024.4,35,,2024.4,percent of total billed charges,Implant Devices,2024.4,35,,2024.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1966.56,34,"If Charge > 2,000, then 34 percent",1966.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2313.6,
P28 PLCL-30012 EVANS WEDGE 12MM,C1713,HCPCS,,79008030,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
BME SE-1818TI SPEED TITAN IMPL 18X18X18,C1713,HCPCS,,79008031,CDM,278,RC,,,both,,,3612,1425.54,39.4668,,1425.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1264.2,35,,1264.2,percent of total billed charges,Implant Device,1228.08,34,"Charges > $500, x 34%",1228.08,percent of total billed charges,Implant Device,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1444.8,40,,1444.8,percent of total billed charges,Implant Devices,1264.2,70,,1264.2,percent of total billed charges,Implant Devices,1228.08,34,,1228.08,percent of total billed charges,Implant Devices,1228.08,34,,1228.08,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1228.08,34,"If Charge > 2,000, then 34 percent",1228.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1444.8,
DEPUY 456.321S 12X125 CANN FIXATION NAIL,C1713,HCPCS,,79008032,CDM,278,RC,,,both,,,2738,1080.6,39.4668,,1080.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Device,930.92,34,"Charges > $500, x 34%",930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,1095.2,40,,1095.2,percent of total billed charges,Implant Devices,958.3,70,,958.3,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,930.92,34,"If Charge > 2,000, then 34 percent",930.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1095.2,
ATLAS SPINE 1106-04-0000 STD LOCK COLLAR,C1713,HCPCS,,79008034,CDM,278,RC,,,both,,,662,261.27,39.4668,,261.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,225.08,34,,225.08,percent of total billed charges,Implant Device,225.08,34,,225.08,percent of total billed charges,Implant Device,225.08,34,,225.08,percent of total billed charges,Implant Device,225.08,34,,225.08,percent of total billed charges,Implant Device,225.08,34,,225.08,percent of total billed charges,Implant Device,225.08,34,,225.08,percent of total billed charges,Implant Device,231.7,35,,231.7,percent of total billed charges,Implant Device,225.08,34,"Charges > $500, x 34%",225.08,percent of total billed charges,Implant Device,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,264.8,40,,264.8,percent of total billed charges,Implant Devices,231.7,70,,231.7,percent of total billed charges,Implant Devices,225.08,34,,225.08,percent of total billed charges,Implant Devices,225.08,34,,225.08,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,231.7,35,,231.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264.8,
EXACTECH 314-13-23 GLENOID CAGE LT MED,C1713,HCPCS,,79008035,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
STRYKER 59-23011 BONE SCREW 2.3X11MM,C1713,HCPCS,,79008037,CDM,278,RC,,,both,,,380,149.97,39.4668,,149.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,129.2,34,,129.2,percent of total billed charges,Implant Device,129.2,34,,129.2,percent of total billed charges,Implant Device,129.2,34,,129.2,percent of total billed charges,Implant Device,129.2,34,,129.2,percent of total billed charges,Implant Device,129.2,34,,129.2,percent of total billed charges,Implant Device,129.2,34,,129.2,percent of total billed charges,Implant Device,133,35,,133,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,133,35,,133,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,133,35,,,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,152,40,,152,percent of total billed charges,Implant Devices,133,70,,133,percent of total billed charges,Implant Devices,129.2,34,,129.2,percent of total billed charges,Implant Devices,129.2,34,,129.2,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,133,35,,133,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,152,
STRYKER 57-10101 PLATE STRT 4 HOLE 2.3MM,C1713,HCPCS,,79008038,CDM,278,RC,,,both,,,959,378.49,39.4668,,378.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Device,326.06,34,"Charges > $500, x 34%",326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,383.6,40,,383.6,percent of total billed charges,Implant Devices,335.65,70,,335.65,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.6,
STRYKER 602875 3.5X75MM CANNULATED SCREW,C1713,HCPCS,,79008043,CDM,278,RC,,,both,,,1145,451.89,39.4668,,451.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Device,389.3,34,"Charges > $500, x 34%",389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,458,40,,458,percent of total billed charges,Implant Devices,400.75,70,,400.75,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,458,
STRYKER 602885 3.5X80MM CANNULATED SCREW,C1713,HCPCS,,79008044,CDM,278,RC,,,both,,,696,274.69,39.4668,,274.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Device,236.64,34,"Charges > $500, x 34%",236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,278.4,40,,278.4,percent of total billed charges,Implant Devices,243.6,70,,243.6,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,278.4,
STRYKER 326090 ASNIS CANN SCREW 6.5X90MM,C1713,HCPCS,,79008045,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
LIFENET FGL GRAFTLINK ALLOGRAFT PREMADE,C1713,HCPCS,,79008046,CDM,278,RC,,,both,,,6886,2717.68,39.4668,,2717.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2410.1,35,,2410.1,percent of total billed charges,Implant Device,2341.24,34,"Charges > $500, x 34%",2341.24,percent of total billed charges,Implant Device,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2754.4,40,,2754.4,percent of total billed charges,Implant Devices,2410.1,70,,2410.1,percent of total billed charges,Implant Devices,2341.24,34,,2341.24,percent of total billed charges,Implant Devices,2341.24,34,,2341.24,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2341.24,34,"If Charge > 2,000, then 34 percent",2341.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2754.4,
ARTHREX AR-1588TN-1 OPEN TBS TIGHTROPE,C1713,HCPCS,,79008047,CDM,278,RC,,,both,,,582,229.7,39.4668,,229.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,203.7,35,,203.7,percent of total billed charges,Implant Device,197.88,34,"Charges > $500, x 34%",197.88,percent of total billed charges,Implant Device,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,232.8,40,,232.8,percent of total billed charges,Implant Devices,203.7,70,,203.7,percent of total billed charges,Implant Devices,197.88,34,,197.88,percent of total billed charges,Implant Devices,197.88,34,,197.88,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.8,
ARTHREX AR-1588TB BUTTON 8/X12,C1713,HCPCS,,79008048,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 3225-0440S LONG NAIL TI 11X440MM,C1713,HCPCS,,79008050,CDM,278,RC,,,both,,,8879,3504.26,39.4668,,3504.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3018.86,34,,3018.86,percent of total billed charges,Implant Device,3107.65,35,,3107.65,percent of total billed charges,Implant Device,3018.86,34,"Charges > $500, x 34%",3018.86,percent of total billed charges,Implant Device,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3551.6,40,,3551.6,percent of total billed charges,Implant Devices,3107.65,70,,3107.65,percent of total billed charges,Implant Devices,3018.86,34,,3018.86,percent of total billed charges,Implant Devices,3018.86,34,,3018.86,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,3107.65,35,,3107.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3018.86,34,"If Charge > 2,000, then 34 percent",3018.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3551.6,
DEPUY 240.039 PROXTIB PLATE 6H 4.5X118MM,C1713,HCPCS,,79008051,CDM,278,RC,,,both,,,6351,2506.54,39.4668,,2506.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2159.34,34,,2159.34,percent of total billed charges,Implant Device,2159.34,34,,2159.34,percent of total billed charges,Implant Device,2159.34,34,,2159.34,percent of total billed charges,Implant Device,2159.34,34,,2159.34,percent of total billed charges,Implant Device,2159.34,34,,2159.34,percent of total billed charges,Implant Device,2159.34,34,,2159.34,percent of total billed charges,Implant Device,2222.85,35,,2222.85,percent of total billed charges,Implant Device,2159.34,34,"Charges > $500, x 34%",2159.34,percent of total billed charges,Implant Device,2222.85,35,,2222.85,percent of total billed charges,Implant Devices,2222.85,35,,2222.85,percent of total billed charges,Implant Devices,2222.85,35,,,percent of total billed charges,Implant Devices,2222.85,35,,2222.85,percent of total billed charges,Implant Devices,2222.85,35,,2222.85,percent of total billed charges,Implant Devices,2540.4,40,,2540.4,percent of total billed charges,Implant Devices,2222.85,70,,2222.85,percent of total billed charges,Implant Devices,2159.34,34,,2159.34,percent of total billed charges,Implant Devices,2159.34,34,,2159.34,percent of total billed charges,Implant Devices,2222.85,35,,2222.85,percent of total billed charges,Implant Devices,2222.85,35,,2222.85,percent of total billed charges,Implant Devices,2222.85,35,,2222.85,percent of total billed charges,Implant Devices,2222.85,35,,2222.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2159.34,34,"If Charge > 2,000, then 34 percent",2159.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2540.4,
DEPUY 214.846 CORTEX SCREW 4.5X46MM,C1713,HCPCS,,79008052,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
DEPUY 214.836 CORTEX SCREW 4.5X36MM,C1713,HCPCS,,79008053,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
DEPUY 02.205.070 CANN LOCK SCREW 5X70MM,C1713,HCPCS,,79008054,CDM,278,RC,,,both,,,867,342.18,39.4668,,342.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,294.78,34,,294.78,percent of total billed charges,Implant Device,294.78,34,,294.78,percent of total billed charges,Implant Device,294.78,34,,294.78,percent of total billed charges,Implant Device,294.78,34,,294.78,percent of total billed charges,Implant Device,294.78,34,,294.78,percent of total billed charges,Implant Device,294.78,34,,294.78,percent of total billed charges,Implant Device,303.45,35,,303.45,percent of total billed charges,Implant Device,294.78,34,"Charges > $500, x 34%",294.78,percent of total billed charges,Implant Device,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,346.8,40,,346.8,percent of total billed charges,Implant Devices,303.45,70,,303.45,percent of total billed charges,Implant Devices,294.78,34,,294.78,percent of total billed charges,Implant Devices,294.78,34,,294.78,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,346.8,
DEPUY 02.205.075 CANN LOCK SCREW 5X75MM,C1713,HCPCS,,79008055,CDM,278,RC,,,both,,,867,342.18,39.4668,,342.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,294.78,34,,294.78,percent of total billed charges,Implant Device,294.78,34,,294.78,percent of total billed charges,Implant Device,294.78,34,,294.78,percent of total billed charges,Implant Device,294.78,34,,294.78,percent of total billed charges,Implant Device,294.78,34,,294.78,percent of total billed charges,Implant Device,294.78,34,,294.78,percent of total billed charges,Implant Device,303.45,35,,303.45,percent of total billed charges,Implant Device,294.78,34,"Charges > $500, x 34%",294.78,percent of total billed charges,Implant Device,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,346.8,40,,346.8,percent of total billed charges,Implant Devices,303.45,70,,303.45,percent of total billed charges,Implant Devices,294.78,34,,294.78,percent of total billed charges,Implant Devices,294.78,34,,294.78,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,303.45,35,,303.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,346.8,
DEPUY 214.870 CORTEX SCREW 4.5X70MM,C1713,HCPCS,,79008056,CDM,278,RC,,,both,,,83,32.76,39.4668,,32.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,33.2,40,,33.2,percent of total billed charges,Implant Devices,29.05,70,,29.05,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.2,
DEPUY 02.240.234 CANN CONCL SCREW 3.7X25,C1713,HCPCS,,79008058,CDM,278,RC,,,both,,,741,292.45,39.4668,,292.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,251.94,34,,251.94,percent of total billed charges,Implant Device,251.94,34,,251.94,percent of total billed charges,Implant Device,251.94,34,,251.94,percent of total billed charges,Implant Device,251.94,34,,251.94,percent of total billed charges,Implant Device,251.94,34,,251.94,percent of total billed charges,Implant Device,251.94,34,,251.94,percent of total billed charges,Implant Device,259.35,35,,259.35,percent of total billed charges,Implant Device,251.94,34,"Charges > $500, x 34%",251.94,percent of total billed charges,Implant Device,259.35,35,,259.35,percent of total billed charges,Implant Devices,259.35,35,,259.35,percent of total billed charges,Implant Devices,259.35,35,,,percent of total billed charges,Implant Devices,259.35,35,,259.35,percent of total billed charges,Implant Devices,259.35,35,,259.35,percent of total billed charges,Implant Devices,296.4,40,,296.4,percent of total billed charges,Implant Devices,259.35,70,,259.35,percent of total billed charges,Implant Devices,251.94,34,,251.94,percent of total billed charges,Implant Devices,251.94,34,,251.94,percent of total billed charges,Implant Devices,259.35,35,,259.35,percent of total billed charges,Implant Devices,259.35,35,,259.35,percent of total billed charges,Implant Devices,259.35,35,,259.35,percent of total billed charges,Implant Devices,259.35,35,,259.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,296.4,
DEPUY SYNTHES 217.075 CANC SCREW 6.5X75,C1713,HCPCS,,79008059,CDM,278,RC,,,both,,,173,68.28,39.4668,,68.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,58.82,34,,58.82,percent of total billed charges,Implant Device,58.82,34,,58.82,percent of total billed charges,Implant Device,58.82,34,,58.82,percent of total billed charges,Implant Device,58.82,34,,58.82,percent of total billed charges,Implant Device,58.82,34,,58.82,percent of total billed charges,Implant Device,58.82,34,,58.82,percent of total billed charges,Implant Device,60.55,35,,60.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,69.2,40,,69.2,percent of total billed charges,Implant Devices,60.55,70,,60.55,percent of total billed charges,Implant Devices,58.82,34,,58.82,percent of total billed charges,Implant Devices,58.82,34,,58.82,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,60.55,35,,60.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,69.2,
DEPUY SYNTHES 245.081 PLATE 8 HOLE,C1713,HCPCS,,79008060,CDM,278,RC,,,both,,,2412,951.94,39.4668,,951.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,820.08,34,,820.08,percent of total billed charges,Implant Device,820.08,34,,820.08,percent of total billed charges,Implant Device,820.08,34,,820.08,percent of total billed charges,Implant Device,820.08,34,,820.08,percent of total billed charges,Implant Device,820.08,34,,820.08,percent of total billed charges,Implant Device,820.08,34,,820.08,percent of total billed charges,Implant Device,844.2,35,,844.2,percent of total billed charges,Implant Device,820.08,34,"Charges > $500, x 34%",820.08,percent of total billed charges,Implant Device,844.2,35,,844.2,percent of total billed charges,Implant Devices,844.2,35,,844.2,percent of total billed charges,Implant Devices,844.2,35,,,percent of total billed charges,Implant Devices,844.2,35,,844.2,percent of total billed charges,Implant Devices,844.2,35,,844.2,percent of total billed charges,Implant Devices,964.8,40,,964.8,percent of total billed charges,Implant Devices,844.2,70,,844.2,percent of total billed charges,Implant Devices,820.08,34,,820.08,percent of total billed charges,Implant Devices,820.08,34,,820.08,percent of total billed charges,Implant Devices,844.2,35,,844.2,percent of total billed charges,Implant Devices,844.2,35,,844.2,percent of total billed charges,Implant Devices,844.2,35,,844.2,percent of total billed charges,Implant Devices,844.2,35,,844.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,820.08,34,"If Charge > 2,000, then 34 percent",820.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,964.8,
STRYKER 53-23014E 2.3X12MM LOCK SCREW,C1713,HCPCS,,79008061,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
WRIGHT K20003010 AUGMENT BONE GRAFT 3CC,C1713,HCPCS,,79008066,CDM,278,RC,,,both,,,10485,4138.09,39.4668,,4138.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3669.75,35,,3669.75,percent of total billed charges,Implant Device,3564.9,34,"Charges > $500, x 34%",3564.9,percent of total billed charges,Implant Device,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,4194,40,,4194,percent of total billed charges,Implant Devices,3669.75,70,,3669.75,percent of total billed charges,Implant Devices,3564.9,34,,3564.9,percent of total billed charges,Implant Devices,3564.9,34,,3564.9,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3564.9,34,"If Charge > 2,000, then 34 percent",3564.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194,
ZIMMER 00-2359-014-45 LOCK SCREW 4.5X14,C1713,HCPCS,,79008068,CDM,278,RC,,,both,,,445,175.63,39.4668,,175.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,178,40,,178,percent of total billed charges,Implant Devices,155.75,70,,155.75,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178,
ZIMMER 00-2359-044-45 LOCK SCREW 4.5X44,C1713,HCPCS,,79008069,CDM,278,RC,,,both,,,445,175.63,39.4668,,175.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,178,40,,178,percent of total billed charges,Implant Devices,155.75,70,,155.75,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178,
ZIMMER 00-2359-090-55 CANN SCREW 5.5X90,C1713,HCPCS,,79008070,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 00-2359-095-55 CANN SCREW 5.5X95,C1713,HCPCS,,79008071,CDM,278,RC,,,both,,,578,228.12,39.4668,,228.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,196.52,34,,196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Device,196.52,34,"Charges > $500, x 34%",196.52,percent of total billed charges,Implant Device,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,231.2,40,,231.2,percent of total billed charges,Implant Devices,202.3,70,,202.3,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,196.52,34,,196.52,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,202.3,35,,202.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,231.2,
ZIMMER 00-2347-023-38 PERI SCREW 4.5X38,C1713,HCPCS,,79008072,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
ACUMED 30-0246 LOCKING SCREW 3.5X36MM,C1713,HCPCS,,79008076,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ACUMED 70-0314 OLECRANON PLATE LT 9 HOLE,C1713,HCPCS,,79008077,CDM,278,RC,,,both,,,4128,1629.19,39.4668,,1629.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1444.8,35,,1444.8,percent of total billed charges,Implant Device,1403.52,34,"Charges > $500, x 34%",1403.52,percent of total billed charges,Implant Device,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1651.2,40,,1651.2,percent of total billed charges,Implant Devices,1444.8,70,,1444.8,percent of total billed charges,Implant Devices,1403.52,34,,1403.52,percent of total billed charges,Implant Devices,1403.52,34,,1403.52,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1403.52,34,"If Charge > 2,000, then 34 percent",1403.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1651.2,
ACUMED 30-0306 NON LOCKING SCREW 3X18MM,C1713,HCPCS,,79008078,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
STRYKER 53-23228E NONLOCK SCREW 2.3X28MM,C1713,HCPCS,,79008081,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
IN2BONES S25 ST016 COMP SCREW 2.5X14MM,C1713,HCPCS,,79008094,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
EXACTECH 300-10-00 HUMERAL ADAPT TRAY +0,C1713,HCPCS,,79008095,CDM,278,RC,,,both,,,6480,2557.45,39.4668,,2557.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2268,35,,2268,percent of total billed charges,Implant Device,2203.2,34,"Charges > $500, x 34%",2203.2,percent of total billed charges,Implant Device,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2592,40,,2592,percent of total billed charges,Implant Devices,2268,70,,2268,percent of total billed charges,Implant Devices,2203.2,34,,2203.2,percent of total billed charges,Implant Devices,2203.2,34,,2203.2,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2203.2,34,"If Charge > 2,000, then 34 percent",2203.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2592,
STRYKER EZ20-16-16 EASYCLIP,C1713,HCPCS,,79008096,CDM,278,RC,,,both,,,7503,2961.19,39.4668,,2961.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2551.02,34,,2551.02,percent of total billed charges,Implant Device,2551.02,34,,2551.02,percent of total billed charges,Implant Device,2551.02,34,,2551.02,percent of total billed charges,Implant Device,2551.02,34,,2551.02,percent of total billed charges,Implant Device,2551.02,34,,2551.02,percent of total billed charges,Implant Device,2551.02,34,,2551.02,percent of total billed charges,Implant Device,2626.05,35,,2626.05,percent of total billed charges,Implant Device,2551.02,34,"Charges > $500, x 34%",2551.02,percent of total billed charges,Implant Device,2626.05,35,,2626.05,percent of total billed charges,Implant Devices,2626.05,35,,2626.05,percent of total billed charges,Implant Devices,2626.05,35,,,percent of total billed charges,Implant Devices,2626.05,35,,2626.05,percent of total billed charges,Implant Devices,2626.05,35,,2626.05,percent of total billed charges,Implant Devices,3001.2,40,,3001.2,percent of total billed charges,Implant Devices,2626.05,70,,2626.05,percent of total billed charges,Implant Devices,2551.02,34,,2551.02,percent of total billed charges,Implant Devices,2551.02,34,,2551.02,percent of total billed charges,Implant Devices,2626.05,35,,2626.05,percent of total billed charges,Implant Devices,2626.05,35,,2626.05,percent of total billed charges,Implant Devices,2626.05,35,,2626.05,percent of total billed charges,Implant Devices,2626.05,35,,2626.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2551.02,34,"If Charge > 2,000, then 34 percent",2551.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3001.2,
DEPUY 02.118.403 PLATE 2.7 4 HOLE LEFT,C1713,HCPCS,,79008099,CDM,278,RC,,,both,,,3266,1288.99,39.4668,,1288.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1110.44,34,,1110.44,percent of total billed charges,Implant Device,1143.1,35,,1143.1,percent of total billed charges,Implant Device,1110.44,34,"Charges > $500, x 34%",1110.44,percent of total billed charges,Implant Device,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1306.4,40,,1306.4,percent of total billed charges,Implant Devices,1143.1,70,,1143.1,percent of total billed charges,Implant Devices,1110.44,34,,1110.44,percent of total billed charges,Implant Devices,1110.44,34,,1110.44,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,1143.1,35,,1143.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1110.44,34,"If Charge > 2,000, then 34 percent",1110.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1306.4,
DEPUY 02.118.512 SELF TAP SCREW 2.7X12MM,C1713,HCPCS,,79008100,CDM,278,RC,,,both,,,203,80.12,39.4668,,80.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,71.05,35,,71.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,81.2,40,,81.2,percent of total billed charges,Implant Devices,71.05,70,,71.05,percent of total billed charges,Implant Devices,69.02,34,,69.02,percent of total billed charges,Implant Devices,69.02,34,,69.02,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,81.2,
STRYKER 5028-6-150 5X150MM APEX PIN,C1713,HCPCS,,79008101,CDM,278,RC,,,both,,,622,245.48,39.4668,,245.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,211.48,34,,211.48,percent of total billed charges,Implant Device,211.48,34,,211.48,percent of total billed charges,Implant Device,211.48,34,,211.48,percent of total billed charges,Implant Device,211.48,34,,211.48,percent of total billed charges,Implant Device,211.48,34,,211.48,percent of total billed charges,Implant Device,211.48,34,,211.48,percent of total billed charges,Implant Device,217.7,35,,217.7,percent of total billed charges,Implant Device,211.48,34,"Charges > $500, x 34%",211.48,percent of total billed charges,Implant Device,217.7,35,,217.7,percent of total billed charges,Implant Devices,217.7,35,,217.7,percent of total billed charges,Implant Devices,217.7,35,,,percent of total billed charges,Implant Devices,217.7,35,,217.7,percent of total billed charges,Implant Devices,217.7,35,,217.7,percent of total billed charges,Implant Devices,248.8,40,,248.8,percent of total billed charges,Implant Devices,217.7,70,,217.7,percent of total billed charges,Implant Devices,211.48,34,,211.48,percent of total billed charges,Implant Devices,211.48,34,,211.48,percent of total billed charges,Implant Devices,217.7,35,,217.7,percent of total billed charges,Implant Devices,217.7,35,,217.7,percent of total billed charges,Implant Devices,217.7,35,,217.7,percent of total billed charges,Implant Devices,217.7,35,,217.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,248.8,
ARTHREX AR-8952MT-04 METATARSAL PLATE 4H,C1713,HCPCS,,79008105,CDM,278,RC,,,both,,,2979,1175.72,39.4668,,1175.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1012.86,34,,1012.86,percent of total billed charges,Implant Device,1012.86,34,,1012.86,percent of total billed charges,Implant Device,1012.86,34,,1012.86,percent of total billed charges,Implant Device,1012.86,34,,1012.86,percent of total billed charges,Implant Device,1012.86,34,,1012.86,percent of total billed charges,Implant Device,1012.86,34,,1012.86,percent of total billed charges,Implant Device,1042.65,35,,1042.65,percent of total billed charges,Implant Device,1012.86,34,"Charges > $500, x 34%",1012.86,percent of total billed charges,Implant Device,1042.65,35,,1042.65,percent of total billed charges,Implant Devices,1042.65,35,,1042.65,percent of total billed charges,Implant Devices,1042.65,35,,,percent of total billed charges,Implant Devices,1042.65,35,,1042.65,percent of total billed charges,Implant Devices,1042.65,35,,1042.65,percent of total billed charges,Implant Devices,1191.6,40,,1191.6,percent of total billed charges,Implant Devices,1042.65,70,,1042.65,percent of total billed charges,Implant Devices,1012.86,34,,1012.86,percent of total billed charges,Implant Devices,1012.86,34,,1012.86,percent of total billed charges,Implant Devices,1042.65,35,,1042.65,percent of total billed charges,Implant Devices,1042.65,35,,1042.65,percent of total billed charges,Implant Devices,1042.65,35,,1042.65,percent of total billed charges,Implant Devices,1042.65,35,,1042.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1012.86,34,"If Charge > 2,000, then 34 percent",1012.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1191.6,
ARTHREX AR-8724V-14 LOCK SCREW 2.4X14MM,C1713,HCPCS,,79008106,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
EXACTECH 314-13-33 CAGE GLENOID POST AUG,C1713,HCPCS,,79008107,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
ARTHREX AR-8724V-16 LOCK SCREW 2.4X16MM,C1713,HCPCS,,79008111,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
DEPUY 02.200.026 3.5X26MM CORTEX SCREW,C1713,HCPCS,,79008112,CDM,278,RC,,,both,,,99,39.07,39.4668,,39.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,39.6,40,,39.6,percent of total billed charges,Implant Devices,34.65,70,,34.65,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39.6,
DEPUY 02.200.022 3.5X22MM CORTEX SCREW,C1713,HCPCS,,79008113,CDM,278,RC,,,both,,,99,39.07,39.4668,,39.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,33.66,34,,33.66,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,39.6,40,,39.6,percent of total billed charges,Implant Devices,34.65,70,,34.65,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,33.66,34,,33.66,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,34.65,35,,34.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39.6,
DEPUY 212.102 3.5X12MM LOCKING SCREW,C1713,HCPCS,,79008114,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
STRYKER 4933-8-040 2.0 OLIVE WIRE,C1713,HCPCS,,79008115,CDM,278,RC,,,both,,,441,174.05,39.4668,,174.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,176.4,40,,176.4,percent of total billed charges,Implant Devices,154.35,70,,154.35,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,176.4,
STRYKER 5014-4-200S APEX PIN 6X200X40MM,C1713,HCPCS,,79008118,CDM,278,RC,,,both,,,701,276.66,39.4668,,276.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,238.34,34,,238.34,percent of total billed charges,Implant Device,238.34,34,,238.34,percent of total billed charges,Implant Device,238.34,34,,238.34,percent of total billed charges,Implant Device,238.34,34,,238.34,percent of total billed charges,Implant Device,238.34,34,,238.34,percent of total billed charges,Implant Device,238.34,34,,238.34,percent of total billed charges,Implant Device,245.35,35,,245.35,percent of total billed charges,Implant Device,238.34,34,"Charges > $500, x 34%",238.34,percent of total billed charges,Implant Device,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,280.4,40,,280.4,percent of total billed charges,Implant Devices,245.35,70,,245.35,percent of total billed charges,Implant Devices,238.34,34,,238.34,percent of total billed charges,Implant Devices,238.34,34,,238.34,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,245.35,35,,245.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280.4,
X-SPINE X090-0015-PT5CC DBM PUTTY 5CC,C1713,HCPCS,,79008122,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
X-SPINE 109640 OSTEOSPONGE STRIP 40X15X5,C1713,HCPCS,,79008123,CDM,278,RC,,,both,,,4590,1811.53,39.4668,,1811.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1606.5,35,,1606.5,percent of total billed charges,Implant Device,1560.6,34,"Charges > $500, x 34%",1560.6,percent of total billed charges,Implant Device,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1836,40,,1836,percent of total billed charges,Implant Devices,1606.5,70,,1606.5,percent of total billed charges,Implant Devices,1560.6,34,,1560.6,percent of total billed charges,Implant Devices,1560.6,34,,1560.6,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1560.6,34,"If Charge > 2,000, then 34 percent",1560.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1836,
PROVIDENCE DX-22-100 DTRAX SPINAL SYSTEM,C1713,HCPCS,,79008124,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
PROVIDENCE PD-31-100 CERVICAL CAGE-T,C1713,HCPCS,,79008125,CDM,278,RC,,,both,,,9600,3788.81,39.4668,,3788.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3264,34,,3264,percent of total billed charges,Implant Device,3264,34,,3264,percent of total billed charges,Implant Device,3264,34,,3264,percent of total billed charges,Implant Device,3264,34,,3264,percent of total billed charges,Implant Device,3264,34,,3264,percent of total billed charges,Implant Device,3264,34,,3264,percent of total billed charges,Implant Device,3360,35,,3360,percent of total billed charges,Implant Device,3264,34,"Charges > $500, x 34%",3264,percent of total billed charges,Implant Device,3360,35,,3360,percent of total billed charges,Implant Devices,3360,35,,3360,percent of total billed charges,Implant Devices,3360,35,,,percent of total billed charges,Implant Devices,3360,35,,3360,percent of total billed charges,Implant Devices,3360,35,,3360,percent of total billed charges,Implant Devices,3840,40,,3840,percent of total billed charges,Implant Devices,3360,70,,3360,percent of total billed charges,Implant Devices,3264,34,,3264,percent of total billed charges,Implant Devices,3264,34,,3264,percent of total billed charges,Implant Devices,3360,35,,3360,percent of total billed charges,Implant Devices,3360,35,,3360,percent of total billed charges,Implant Devices,3360,35,,3360,percent of total billed charges,Implant Devices,3360,35,,3360,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3264,34,"If Charge > 2,000, then 34 percent",3264,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3840,
BIOMET 8143-11-180 HIP NAIL 125DG 11X180,C1713,HCPCS,,79008137,CDM,278,RC,,,both,,,4464,1761.8,39.4668,,1761.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1562.4,35,,1562.4,percent of total billed charges,Implant Device,1517.76,34,"Charges > $500, x 34%",1517.76,percent of total billed charges,Implant Device,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1785.6,40,,1785.6,percent of total billed charges,Implant Devices,1562.4,70,,1562.4,percent of total billed charges,Implant Devices,1517.76,34,,1517.76,percent of total billed charges,Implant Devices,1517.76,34,,1517.76,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1517.76,34,"If Charge > 2,000, then 34 percent",1517.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1785.6,
BIOMET 8145-10-100 HIP SCREW 10.5X100,C1713,HCPCS,,79008138,CDM,278,RC,,,both,,,1786,704.88,39.4668,,704.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,625.1,35,,625.1,percent of total billed charges,Implant Device,607.24,34,"Charges > $500, x 34%",607.24,percent of total billed charges,Implant Device,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,714.4,40,,714.4,percent of total billed charges,Implant Devices,625.1,70,,625.1,percent of total billed charges,Implant Devices,607.24,34,,607.24,percent of total billed charges,Implant Devices,607.24,34,,607.24,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,714.4,
STRYKER 40-35038 3.5X38MM NONLOCK SCREW,C1713,HCPCS,,79008141,CDM,278,RC,,,both,,,352,138.92,39.4668,,138.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,119.68,34,,119.68,percent of total billed charges,Implant Device,123.2,35,,123.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,140.8,40,,140.8,percent of total billed charges,Implant Devices,123.2,70,,123.2,percent of total billed charges,Implant Devices,119.68,34,,119.68,percent of total billed charges,Implant Devices,119.68,34,,119.68,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,123.2,35,,123.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,140.8,
STRYKER 40-35032 3.5X32MM NONLOCK SCREW,C1713,HCPCS,,79008142,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
ALPHATEC SPINE 62004-80 ROD 80MM,C1713,HCPCS,,79008145,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
STRYKER 1822-0925S 9X255MM TIBIAL NAIL,C1713,HCPCS,,79008147,CDM,278,RC,,,both,,,6416,2532.19,39.4668,,2532.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2181.44,34,,2181.44,percent of total billed charges,Implant Device,2245.6,35,,2245.6,percent of total billed charges,Implant Device,2181.44,34,"Charges > $500, x 34%",2181.44,percent of total billed charges,Implant Device,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2566.4,40,,2566.4,percent of total billed charges,Implant Devices,2245.6,70,,2245.6,percent of total billed charges,Implant Devices,2181.44,34,,2181.44,percent of total billed charges,Implant Devices,2181.44,34,,2181.44,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,2245.6,35,,2245.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2181.44,34,"If Charge > 2,000, then 34 percent",2181.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2566.4,
STRYKER 1896-5027S 5X27 5MM LOCK SCREW,C1713,HCPCS,,79008148,CDM,278,RC,,,both,,,826,326,39.4668,,326,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.84,34,,280.84,percent of total billed charges,Implant Device,280.84,34,,280.84,percent of total billed charges,Implant Device,280.84,34,,280.84,percent of total billed charges,Implant Device,280.84,34,,280.84,percent of total billed charges,Implant Device,280.84,34,,280.84,percent of total billed charges,Implant Device,280.84,34,,280.84,percent of total billed charges,Implant Device,289.1,35,,289.1,percent of total billed charges,Implant Device,280.84,34,"Charges > $500, x 34%",280.84,percent of total billed charges,Implant Device,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,330.4,40,,330.4,percent of total billed charges,Implant Devices,289.1,70,,289.1,percent of total billed charges,Implant Devices,280.84,34,,280.84,percent of total billed charges,Implant Devices,280.84,34,,280.84,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330.4,
BME SE-1515TI SPEED TITAN IMP 15X15X15,C1713,HCPCS,,79008150,CDM,278,RC,,,both,,,3612,1425.54,39.4668,,1425.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1228.08,34,,1228.08,percent of total billed charges,Implant Device,1264.2,35,,1264.2,percent of total billed charges,Implant Device,1228.08,34,"Charges > $500, x 34%",1228.08,percent of total billed charges,Implant Device,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1444.8,40,,1444.8,percent of total billed charges,Implant Devices,1264.2,70,,1264.2,percent of total billed charges,Implant Devices,1228.08,34,,1228.08,percent of total billed charges,Implant Devices,1228.08,34,,1228.08,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,1264.2,35,,1264.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1228.08,34,"If Charge > 2,000, then 34 percent",1228.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1444.8,
DEPUY 02.206.212 CORTEX SCREW 3.5X12MM,C1713,HCPCS,,79008152,CDM,278,RC,,,both,,,140,55.25,39.4668,,55.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,49,35,,49,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,56,40,,56,percent of total billed charges,Implant Devices,49,70,,49,percent of total billed charges,Implant Devices,47.6,34,,47.6,percent of total billed charges,Implant Devices,47.6,34,,47.6,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,56,
DEPUY 02.206.228 CORTEX SCREW 3.5X28MM,C1713,HCPCS,,79008153,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
DEPUY 02.206.226 CORTEX SCREW 3.5X26MM,C1713,HCPCS,,79008154,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
STRYKER 1832-1045S HUMERAL NAIL 8X150MM,C1713,HCPCS,,79008155,CDM,278,RC,,,both,,,4760,1878.62,39.4668,,1878.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1618.4,34,,1618.4,percent of total billed charges,Implant Device,1618.4,34,,1618.4,percent of total billed charges,Implant Device,1618.4,34,,1618.4,percent of total billed charges,Implant Device,1618.4,34,,1618.4,percent of total billed charges,Implant Device,1618.4,34,,1618.4,percent of total billed charges,Implant Device,1618.4,34,,1618.4,percent of total billed charges,Implant Device,1666,35,,1666,percent of total billed charges,Implant Device,1618.4,34,"Charges > $500, x 34%",1618.4,percent of total billed charges,Implant Device,1666,35,,1666,percent of total billed charges,Implant Devices,1666,35,,1666,percent of total billed charges,Implant Devices,1666,35,,,percent of total billed charges,Implant Devices,1666,35,,1666,percent of total billed charges,Implant Devices,1666,35,,1666,percent of total billed charges,Implant Devices,1904,40,,1904,percent of total billed charges,Implant Devices,1666,70,,1666,percent of total billed charges,Implant Devices,1618.4,34,,1618.4,percent of total billed charges,Implant Devices,1618.4,34,,1618.4,percent of total billed charges,Implant Devices,1666,35,,1666,percent of total billed charges,Implant Devices,1666,35,,1666,percent of total billed charges,Implant Devices,1666,35,,1666,percent of total billed charges,Implant Devices,1666,35,,1666,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1618.4,34,"If Charge > 2,000, then 34 percent",1618.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1904,
STRYKER 1896-4034S LOCKING SCREW 4X34MM,C1713,HCPCS,,79008156,CDM,278,RC,,,both,,,773,305.08,39.4668,,305.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,270.55,35,,270.55,percent of total billed charges,Implant Device,262.82,34,"Charges > $500, x 34%",262.82,percent of total billed charges,Implant Device,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,309.2,40,,309.2,percent of total billed charges,Implant Devices,270.55,70,,270.55,percent of total billed charges,Implant Devices,262.82,34,,262.82,percent of total billed charges,Implant Devices,262.82,34,,262.82,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,309.2,
DEPUY 241.371 TUBULAR PLATE 7 HOLE,C1713,HCPCS,,79008157,CDM,278,RC,,,both,,,668,263.64,39.4668,,263.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,227.12,34,,227.12,percent of total billed charges,Implant Device,233.8,35,,233.8,percent of total billed charges,Implant Device,227.12,34,"Charges > $500, x 34%",227.12,percent of total billed charges,Implant Device,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,267.2,40,,267.2,percent of total billed charges,Implant Devices,233.8,70,,233.8,percent of total billed charges,Implant Devices,227.12,34,,227.12,percent of total billed charges,Implant Devices,227.12,34,,227.12,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,233.8,35,,233.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,267.2,
DEPUY 02.206.218 CORTEX SCREW 3.5X18MM,C1713,HCPCS,,79008158,CDM,278,RC,,,both,,,140,55.25,39.4668,,55.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,47.6,34,,47.6,percent of total billed charges,Implant Device,49,35,,49,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,56,40,,56,percent of total billed charges,Implant Devices,49,70,,49,percent of total billed charges,Implant Devices,47.6,34,,47.6,percent of total billed charges,Implant Devices,47.6,34,,47.6,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,49,35,,49,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,56,
ARTHREX AR-8740-44H 4X44MM FT COMP SCREW,C1713,HCPCS,,79008160,CDM,278,RC,,,both,,,1266,499.65,39.4668,,499.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,443.1,35,,443.1,percent of total billed charges,Implant Device,430.44,34,"Charges > $500, x 34%",430.44,percent of total billed charges,Implant Device,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,506.4,40,,506.4,percent of total billed charges,Implant Devices,443.1,70,,443.1,percent of total billed charges,Implant Devices,430.44,34,,430.44,percent of total billed charges,Implant Devices,430.44,34,,430.44,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,506.4,
ARTHREX AR-8740-30H 4X30MM FT COMP SCREW,C1713,HCPCS,,79008161,CDM,278,RC,,,both,,,1266,499.65,39.4668,,499.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,443.1,35,,443.1,percent of total billed charges,Implant Device,430.44,34,"Charges > $500, x 34%",430.44,percent of total billed charges,Implant Device,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,506.4,40,,506.4,percent of total billed charges,Implant Devices,443.1,70,,443.1,percent of total billed charges,Implant Devices,430.44,34,,430.44,percent of total billed charges,Implant Devices,430.44,34,,430.44,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,506.4,
P28 P50-053-2720 LOCK PLATE SCREW 2.7X20,C1713,HCPCS,,79008164,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
P28 P53-105-L002 PLATE MEDIUM LEFT 20MM,C1713,HCPCS,,79008165,CDM,278,RC,,,both,,,5610,2214.09,39.4668,,2214.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1963.5,35,,1963.5,percent of total billed charges,Implant Device,1907.4,34,"Charges > $500, x 34%",1907.4,percent of total billed charges,Implant Device,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,2244,40,,2244,percent of total billed charges,Implant Devices,1963.5,70,,1963.5,percent of total billed charges,Implant Devices,1907.4,34,,1907.4,percent of total billed charges,Implant Devices,1907.4,34,,1907.4,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1907.4,34,"If Charge > 2,000, then 34 percent",1907.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2244,
P28 PCOT-181405 COTTON WEDGE 5MM,C1713,HCPCS,,79008166,CDM,278,RC,,,both,,,5993,2365.25,39.4668,,2365.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2097.55,35,,2097.55,percent of total billed charges,Implant Device,2037.62,34,"Charges > $500, x 34%",2037.62,percent of total billed charges,Implant Device,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2397.2,40,,2397.2,percent of total billed charges,Implant Devices,2097.55,70,,2097.55,percent of total billed charges,Implant Devices,2037.62,34,,2037.62,percent of total billed charges,Implant Devices,2037.62,34,,2037.62,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2037.62,34,"If Charge > 2,000, then 34 percent",2037.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2397.2,
P28 PLCL-20008 EVANS WWEDGE 8MM,C1713,HCPCS,,79008167,CDM,278,RC,,,both,,,5610,2214.09,39.4668,,2214.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1963.5,35,,1963.5,percent of total billed charges,Implant Device,1907.4,34,"Charges > $500, x 34%",1907.4,percent of total billed charges,Implant Device,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,2244,40,,2244,percent of total billed charges,Implant Devices,1963.5,70,,1963.5,percent of total billed charges,Implant Devices,1907.4,34,,1907.4,percent of total billed charges,Implant Devices,1907.4,34,,1907.4,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1907.4,34,"If Charge > 2,000, then 34 percent",1907.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2244,
ARTHREX AR-4154P-3010 PIP DART 30 BEND,C1713,HCPCS,,79008168,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
DEPUY 202.216 LOCKING SCREW 2.7X16MM,C1713,HCPCS,,79008169,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
STRYKER MV32A 4X32MM FIXOS,C1713,HCPCS,,79008170,CDM,278,RC,,,both,,,1413,557.67,39.4668,,557.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,480.42,34,,480.42,percent of total billed charges,Implant Device,480.42,34,,480.42,percent of total billed charges,Implant Device,480.42,34,,480.42,percent of total billed charges,Implant Device,480.42,34,,480.42,percent of total billed charges,Implant Device,480.42,34,,480.42,percent of total billed charges,Implant Device,480.42,34,,480.42,percent of total billed charges,Implant Device,494.55,35,,494.55,percent of total billed charges,Implant Device,480.42,34,"Charges > $500, x 34%",480.42,percent of total billed charges,Implant Device,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,565.2,40,,565.2,percent of total billed charges,Implant Devices,494.55,70,,494.55,percent of total billed charges,Implant Devices,480.42,34,,480.42,percent of total billed charges,Implant Devices,480.42,34,,480.42,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,565.2,
STRYKER MV28A 4X28MM FIXOS,C1713,HCPCS,,79008171,CDM,278,RC,,,both,,,1413,557.67,39.4668,,557.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,480.42,34,,480.42,percent of total billed charges,Implant Device,480.42,34,,480.42,percent of total billed charges,Implant Device,480.42,34,,480.42,percent of total billed charges,Implant Device,480.42,34,,480.42,percent of total billed charges,Implant Device,480.42,34,,480.42,percent of total billed charges,Implant Device,480.42,34,,480.42,percent of total billed charges,Implant Device,494.55,35,,494.55,percent of total billed charges,Implant Device,480.42,34,"Charges > $500, x 34%",480.42,percent of total billed charges,Implant Device,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,565.2,40,,565.2,percent of total billed charges,Implant Devices,494.55,70,,494.55,percent of total billed charges,Implant Devices,480.42,34,,480.42,percent of total billed charges,Implant Devices,480.42,34,,480.42,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,494.55,35,,494.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,565.2,
BIOMET TP16000 PEG PARTIAL THREAD 2.5X16,C1713,HCPCS,,79008174,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
BIOMET TP22000 PEG PARTIAL THREAD 2.5X22,C1713,HCPCS,,79008175,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
STABILITY BIO SB 1152-14 HUMERUS SHAFT,C1713,HCPCS,,79008176,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
ZIMMER 00-2359-020-38 LOCK SCREW 3.5X30,C1713,HCPCS,,79008178,CDM,278,RC,,,both,,,323,127.48,39.4668,,127.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,109.82,34,,109.82,percent of total billed charges,Implant Device,109.82,34,,109.82,percent of total billed charges,Implant Device,109.82,34,,109.82,percent of total billed charges,Implant Device,109.82,34,,109.82,percent of total billed charges,Implant Device,109.82,34,,109.82,percent of total billed charges,Implant Device,109.82,34,,109.82,percent of total billed charges,Implant Device,113.05,35,,113.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.05,35,,113.05,percent of total billed charges,Implant Devices,113.05,35,,113.05,percent of total billed charges,Implant Devices,113.05,35,,,percent of total billed charges,Implant Devices,113.05,35,,113.05,percent of total billed charges,Implant Devices,113.05,35,,113.05,percent of total billed charges,Implant Devices,129.2,40,,129.2,percent of total billed charges,Implant Devices,113.05,70,,113.05,percent of total billed charges,Implant Devices,109.82,34,,109.82,percent of total billed charges,Implant Devices,109.82,34,,109.82,percent of total billed charges,Implant Devices,113.05,35,,113.05,percent of total billed charges,Implant Devices,113.05,35,,113.05,percent of total billed charges,Implant Devices,113.05,35,,113.05,percent of total billed charges,Implant Devices,113.05,35,,113.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.2,
DEPUY 02.113.103S LCP HOOK PLATE 3H 3.5,C1713,HCPCS,,79008180,CDM,278,RC,,,both,,,2295,905.76,39.4668,,905.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,780.3,34,,780.3,percent of total billed charges,Implant Device,780.3,34,,780.3,percent of total billed charges,Implant Device,780.3,34,,780.3,percent of total billed charges,Implant Device,780.3,34,,780.3,percent of total billed charges,Implant Device,780.3,34,,780.3,percent of total billed charges,Implant Device,780.3,34,,780.3,percent of total billed charges,Implant Device,803.25,35,,803.25,percent of total billed charges,Implant Device,780.3,34,"Charges > $500, x 34%",780.3,percent of total billed charges,Implant Device,803.25,35,,803.25,percent of total billed charges,Implant Devices,803.25,35,,803.25,percent of total billed charges,Implant Devices,803.25,35,,,percent of total billed charges,Implant Devices,803.25,35,,803.25,percent of total billed charges,Implant Devices,803.25,35,,803.25,percent of total billed charges,Implant Devices,918,40,,918,percent of total billed charges,Implant Devices,803.25,70,,803.25,percent of total billed charges,Implant Devices,780.3,34,,780.3,percent of total billed charges,Implant Devices,780.3,34,,780.3,percent of total billed charges,Implant Devices,803.25,35,,803.25,percent of total billed charges,Implant Devices,803.25,35,,803.25,percent of total billed charges,Implant Devices,803.25,35,,803.25,percent of total billed charges,Implant Devices,803.25,35,,803.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,780.3,34,"If Charge > 2,000, then 34 percent",780.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,918,
WRIGHT CCP-LPXOR LAPIDUS PLATE RIGHT,C1713,HCPCS,,79008181,CDM,278,RC,,,both,,,7245,2859.37,39.4668,,2859.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2535.75,35,,2535.75,percent of total billed charges,Implant Device,2463.3,34,"Charges > $500, x 34%",2463.3,percent of total billed charges,Implant Device,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2898,40,,2898,percent of total billed charges,Implant Devices,2535.75,70,,2535.75,percent of total billed charges,Implant Devices,2463.3,34,,2463.3,percent of total billed charges,Implant Devices,2463.3,34,,2463.3,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2463.3,34,"If Charge > 2,000, then 34 percent",2463.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2898,
WRIGHT CCP-X3534 LAG SCREW 3.5X34MM,C1713,HCPCS,,79008182,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
WRIGHT CCP-L3528 LOCKING SCREW 3.5X28MM,C1713,HCPCS,,79008183,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
WRIGHT CCP-L3526 LOCKING SCREW 3.5X26MM,C1713,HCPCS,,79008184,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
BME EL-1818S2 ELITE STR BRIDGE 18X18X18,C1713,HCPCS,,79008187,CDM,278,RC,,,both,,,5160,2036.49,39.4668,,2036.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1806,35,,1806,percent of total billed charges,Implant Device,1754.4,34,"Charges > $500, x 34%",1754.4,percent of total billed charges,Implant Device,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,2064,40,,2064,percent of total billed charges,Implant Devices,1806,70,,1806,percent of total billed charges,Implant Devices,1754.4,34,,1754.4,percent of total billed charges,Implant Devices,1754.4,34,,1754.4,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1754.4,34,"If Charge > 2,000, then 34 percent",1754.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2064,
BME EL-2020S2 ELITE STR BRIDGE 20X20X20,C1713,HCPCS,,79008188,CDM,278,RC,,,both,,,5160,2036.49,39.4668,,2036.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1754.4,34,,1754.4,percent of total billed charges,Implant Device,1806,35,,1806,percent of total billed charges,Implant Device,1754.4,34,"Charges > $500, x 34%",1754.4,percent of total billed charges,Implant Device,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,2064,40,,2064,percent of total billed charges,Implant Devices,1806,70,,1806,percent of total billed charges,Implant Devices,1754.4,34,,1754.4,percent of total billed charges,Implant Devices,1754.4,34,,1754.4,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,1806,35,,1806,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1754.4,34,"If Charge > 2,000, then 34 percent",1754.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2064,
BME SE-2520T1 SPEED TITAN IMPL 25X20X20,C1713,HCPCS,,79008189,CDM,278,RC,,,both,,,5640,2225.93,39.4668,,2225.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1917.6,34,,1917.6,percent of total billed charges,Implant Device,1974,35,,1974,percent of total billed charges,Implant Device,1917.6,34,"Charges > $500, x 34%",1917.6,percent of total billed charges,Implant Device,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,2256,40,,2256,percent of total billed charges,Implant Devices,1974,70,,1974,percent of total billed charges,Implant Devices,1917.6,34,,1917.6,percent of total billed charges,Implant Devices,1917.6,34,,1917.6,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,1974,35,,1974,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1917.6,34,"If Charge > 2,000, then 34 percent",1917.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2256,
P 28 PCCC-0804 CALCANEAL JOINT WEDGE 8MM,C1713,HCPCS,,79008192,CDM,278,RC,,,both,,,5993,2365.25,39.4668,,2365.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2037.62,34,,2037.62,percent of total billed charges,Implant Device,2097.55,35,,2097.55,percent of total billed charges,Implant Device,2037.62,34,"Charges > $500, x 34%",2037.62,percent of total billed charges,Implant Device,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2397.2,40,,2397.2,percent of total billed charges,Implant Devices,2097.55,70,,2097.55,percent of total billed charges,Implant Devices,2037.62,34,,2037.62,percent of total billed charges,Implant Devices,2037.62,34,,2037.62,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,2097.55,35,,2097.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2037.62,34,"If Charge > 2,000, then 34 percent",2037.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2397.2,
P 28 PLP-3008 LAPIDUS WEDGE 8MM,C1713,HCPCS,,79008193,CDM,278,RC,,,both,,,6064,2393.27,39.4668,,2393.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2122.4,35,,2122.4,percent of total billed charges,Implant Device,2061.76,34,"Charges > $500, x 34%",2061.76,percent of total billed charges,Implant Device,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2425.6,40,,2425.6,percent of total billed charges,Implant Devices,2122.4,70,,2122.4,percent of total billed charges,Implant Devices,2061.76,34,,2061.76,percent of total billed charges,Implant Devices,2061.76,34,,2061.76,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2061.76,34,"If Charge > 2,000, then 34 percent",2061.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2425.6,
P 28 PLP-3012 LAPIDUS WEDGE 12MM,C1713,HCPCS,,79008194,CDM,278,RC,,,both,,,6064,2393.27,39.4668,,2393.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2061.76,34,,2061.76,percent of total billed charges,Implant Device,2122.4,35,,2122.4,percent of total billed charges,Implant Device,2061.76,34,"Charges > $500, x 34%",2061.76,percent of total billed charges,Implant Device,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2425.6,40,,2425.6,percent of total billed charges,Implant Devices,2122.4,70,,2122.4,percent of total billed charges,Implant Devices,2061.76,34,,2061.76,percent of total billed charges,Implant Devices,2061.76,34,,2061.76,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,2122.4,35,,2122.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2061.76,34,"If Charge > 2,000, then 34 percent",2061.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2425.6,
DEPUY 224.581 LCP PLATE 8 HOLE 4.5X152MM,C1713,HCPCS,,79008196,CDM,278,RC,,,both,,,1222,482.28,39.4668,,482.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,415.48,34,,415.48,percent of total billed charges,Implant Device,415.48,34,,415.48,percent of total billed charges,Implant Device,415.48,34,,415.48,percent of total billed charges,Implant Device,415.48,34,,415.48,percent of total billed charges,Implant Device,415.48,34,,415.48,percent of total billed charges,Implant Device,415.48,34,,415.48,percent of total billed charges,Implant Device,427.7,35,,427.7,percent of total billed charges,Implant Device,415.48,34,"Charges > $500, x 34%",415.48,percent of total billed charges,Implant Device,427.7,35,,427.7,percent of total billed charges,Implant Devices,427.7,35,,427.7,percent of total billed charges,Implant Devices,427.7,35,,,percent of total billed charges,Implant Devices,427.7,35,,427.7,percent of total billed charges,Implant Devices,427.7,35,,427.7,percent of total billed charges,Implant Devices,488.8,40,,488.8,percent of total billed charges,Implant Devices,427.7,70,,427.7,percent of total billed charges,Implant Devices,415.48,34,,415.48,percent of total billed charges,Implant Devices,415.48,34,,415.48,percent of total billed charges,Implant Devices,427.7,35,,427.7,percent of total billed charges,Implant Devices,427.7,35,,427.7,percent of total billed charges,Implant Devices,427.7,35,,427.7,percent of total billed charges,Implant Devices,427.7,35,,427.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,488.8,
DEPUY 214.824 CORTEX SCREW 4.5X24MM,C1713,HCPCS,,79008197,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
BIOMET 110007658 CANN SCREW 5X55MM,C1713,HCPCS,,79008198,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
BIOMET 110007747 CANN SCREW 6.5X16MM,C1713,HCPCS,,79008199,CDM,278,RC,,,both,,,1320,520.96,39.4668,,520.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,462,35,,462,percent of total billed charges,Implant Device,448.8,34,"Charges > $500, x 34%",448.8,percent of total billed charges,Implant Device,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,528,40,,528,percent of total billed charges,Implant Devices,462,70,,462,percent of total billed charges,Implant Devices,448.8,34,,448.8,percent of total billed charges,Implant Devices,448.8,34,,448.8,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,528,
BIOMET 8240-77-022 FUSION PLATE LARGE,C1713,HCPCS,,79008204,CDM,278,RC,,,both,,,4710,1858.89,39.4668,,1858.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1601.4,34,,1601.4,percent of total billed charges,Implant Device,1648.5,35,,1648.5,percent of total billed charges,Implant Device,1601.4,34,"Charges > $500, x 34%",1601.4,percent of total billed charges,Implant Device,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1884,40,,1884,percent of total billed charges,Implant Devices,1648.5,70,,1648.5,percent of total billed charges,Implant Devices,1601.4,34,,1601.4,percent of total billed charges,Implant Devices,1601.4,34,,1601.4,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,1648.5,35,,1648.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1601.4,34,"If Charge > 2,000, then 34 percent",1601.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1884,
BIOMET 8163-35-028 MULTI SCREW 3.5X28MM,C1713,HCPCS,,79008205,CDM,278,RC,,,both,,,930,367.04,39.4668,,367.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Device,316.2,34,"Charges > $500, x 34%",316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,372,40,,372,percent of total billed charges,Implant Devices,325.5,70,,325.5,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,372,
BIOMET 8163-35-030 MULTI SCREW 3.5X30MM,C1713,HCPCS,,79008206,CDM,278,RC,,,both,,,930,367.04,39.4668,,367.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Device,316.2,34,"Charges > $500, x 34%",316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,372,40,,372,percent of total billed charges,Implant Devices,325.5,70,,325.5,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,372,
BIOMET 8161-35-028 CORT SCREW 3.5X28MM,C1713,HCPCS,,79008207,CDM,278,RC,,,both,,,660,260.48,39.4668,,260.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,224.4,34,,224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Device,224.4,34,"Charges > $500, x 34%",224.4,percent of total billed charges,Implant Device,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,264,40,,264,percent of total billed charges,Implant Devices,231,70,,231,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,224.4,34,,224.4,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,231,35,,231,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,264,
BIOMET 110007745 CANN SCREW 6.5X60X16MM,C1713,HCPCS,,79008208,CDM,278,RC,,,both,,,1320,520.96,39.4668,,520.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,462,35,,462,percent of total billed charges,Implant Device,448.8,34,"Charges > $500, x 34%",448.8,percent of total billed charges,Implant Device,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,528,40,,528,percent of total billed charges,Implant Devices,462,70,,462,percent of total billed charges,Implant Devices,448.8,34,,448.8,percent of total billed charges,Implant Devices,448.8,34,,448.8,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,528,
STRYKER 6195-1-001 SIMPLEX CEMENT W/GENT,C1713,HCPCS,,79008210,CDM,278,RC,,,both,,,833,328.76,39.4668,,328.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,291.55,35,,291.55,percent of total billed charges,Implant Device,283.22,34,"Charges > $500, x 34%",283.22,percent of total billed charges,Implant Device,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,333.2,40,,333.2,percent of total billed charges,Implant Devices,291.55,70,,291.55,percent of total billed charges,Implant Devices,283.22,34,,283.22,percent of total billed charges,Implant Devices,283.22,34,,283.22,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,333.2,
ARTHREX AR-1588RT-J ACL TIGHTROPE KIT,C1713,HCPCS,,79008213,CDM,278,RC,,,both,,,1110,438.08,39.4668,,438.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Device,377.4,34,"Charges > $500, x 34%",377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,444,40,,444,percent of total billed charges,Implant Devices,388.5,70,,388.5,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,444,
ARTHREX AR-8970AR ANKLE FUSION PLATE RT,C1713,HCPCS,,79008222,CDM,278,RC,,,both,,,8896,3510.97,39.4668,,3510.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3024.64,34,,3024.64,percent of total billed charges,Implant Device,3024.64,34,,3024.64,percent of total billed charges,Implant Device,3024.64,34,,3024.64,percent of total billed charges,Implant Device,3024.64,34,,3024.64,percent of total billed charges,Implant Device,3024.64,34,,3024.64,percent of total billed charges,Implant Device,3024.64,34,,3024.64,percent of total billed charges,Implant Device,3113.6,35,,3113.6,percent of total billed charges,Implant Device,3024.64,34,"Charges > $500, x 34%",3024.64,percent of total billed charges,Implant Device,3113.6,35,,3113.6,percent of total billed charges,Implant Devices,3113.6,35,,3113.6,percent of total billed charges,Implant Devices,3113.6,35,,,percent of total billed charges,Implant Devices,3113.6,35,,3113.6,percent of total billed charges,Implant Devices,3113.6,35,,3113.6,percent of total billed charges,Implant Devices,3558.4,40,,3558.4,percent of total billed charges,Implant Devices,3113.6,70,,3113.6,percent of total billed charges,Implant Devices,3024.64,34,,3024.64,percent of total billed charges,Implant Devices,3024.64,34,,3024.64,percent of total billed charges,Implant Devices,3113.6,35,,3113.6,percent of total billed charges,Implant Devices,3113.6,35,,3113.6,percent of total billed charges,Implant Devices,3113.6,35,,3113.6,percent of total billed charges,Implant Devices,3113.6,35,,3113.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3024.64,34,"If Charge > 2,000, then 34 percent",3024.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3558.4,
ARTHREX AR-8545L-24 LOCK SCREW 4.5X24MM,C1713,HCPCS,,79008223,CDM,278,RC,,,both,,,837,330.34,39.4668,,330.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Device,284.58,34,"Charges > $500, x 34%",284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,334.8,40,,334.8,percent of total billed charges,Implant Devices,292.95,70,,292.95,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.8,
ARTHREX AR-8545L-28 LOCK SCREW 4.5X28MM,C1713,HCPCS,,79008224,CDM,278,RC,,,both,,,837,330.34,39.4668,,330.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Device,284.58,34,"Charges > $500, x 34%",284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,334.8,40,,334.8,percent of total billed charges,Implant Devices,292.95,70,,292.95,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.8,
ARTHREX AR-8545L-30 LOCK SCREW 4.5X30MM,C1713,HCPCS,,79008225,CDM,278,RC,,,both,,,837,330.34,39.4668,,330.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Device,284.58,34,"Charges > $500, x 34%",284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,334.8,40,,334.8,percent of total billed charges,Implant Devices,292.95,70,,292.95,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.8,
ARTHREX AR-8545L-40 LOCK SCREW 4.5X40MM,C1713,HCPCS,,79008226,CDM,278,RC,,,both,,,837,330.34,39.4668,,330.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Device,284.58,34,"Charges > $500, x 34%",284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,334.8,40,,334.8,percent of total billed charges,Implant Devices,292.95,70,,292.95,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.8,
ARTHREX AR-8545-30 CORT SCREW 4.5X30MM,C1713,HCPCS,,79008227,CDM,278,RC,,,both,,,225,88.8,39.4668,,88.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,90,40,,90,percent of total billed charges,Implant Devices,78.75,70,,78.75,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90,
ARTHREX AR-8967-2860 CANN SCREW 6.7X60MM,C1713,HCPCS,,79008228,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ARTHREX AR-8555-55 CANC SCREW 5.5X55MM,C1713,HCPCS,,79008230,CDM,278,RC,,,both,,,225,88.8,39.4668,,88.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,90,40,,90,percent of total billed charges,Implant Devices,78.75,70,,78.75,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90,
ARTHREX AR-8930-14 2X14MM SNAP OFF SCREW,C1713,HCPCS,,79008232,CDM,278,RC,,,both,,,720,284.16,39.4668,,284.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Device,244.8,34,"Charges > $500, x 34%",244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,288,40,,288,percent of total billed charges,Implant Devices,252,70,,252,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,288,
ARTHREX AR-4154P-3000 PIP DART 2.5X30MM,C1713,HCPCS,,79008234,CDM,278,RC,,,both,,,1785,704.48,39.4668,,704.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,606.9,34,,606.9,percent of total billed charges,Implant Device,606.9,34,,606.9,percent of total billed charges,Implant Device,606.9,34,,606.9,percent of total billed charges,Implant Device,606.9,34,,606.9,percent of total billed charges,Implant Device,606.9,34,,606.9,percent of total billed charges,Implant Device,606.9,34,,606.9,percent of total billed charges,Implant Device,624.75,35,,624.75,percent of total billed charges,Implant Device,606.9,34,"Charges > $500, x 34%",606.9,percent of total billed charges,Implant Device,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,714,40,,714,percent of total billed charges,Implant Devices,624.75,70,,624.75,percent of total billed charges,Implant Devices,606.9,34,,606.9,percent of total billed charges,Implant Devices,606.9,34,,606.9,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,714,
ZIMMER 00-4827-014-01 CORT SCREW 2.7X14,C1713,HCPCS,,79008235,CDM,278,RC,,,both,,,71,28.02,39.4668,,28.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.14,34,,24.14,percent of total billed charges,Implant Device,24.85,35,,24.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,28.4,40,,28.4,percent of total billed charges,Implant Devices,24.85,70,,24.85,percent of total billed charges,Implant Devices,24.14,34,,24.14,percent of total billed charges,Implant Devices,24.14,34,,24.14,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,24.85,35,,24.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28.4,
STRYKER 627735 PROX MED PLATE RT 5 HOLE,C1713,HCPCS,,79008236,CDM,278,RC,,,both,,,7191,2838.06,39.4668,,2838.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2444.94,34,,2444.94,percent of total billed charges,Implant Device,2444.94,34,,2444.94,percent of total billed charges,Implant Device,2444.94,34,,2444.94,percent of total billed charges,Implant Device,2444.94,34,,2444.94,percent of total billed charges,Implant Device,2444.94,34,,2444.94,percent of total billed charges,Implant Device,2444.94,34,,2444.94,percent of total billed charges,Implant Device,2516.85,35,,2516.85,percent of total billed charges,Implant Device,2444.94,34,"Charges > $500, x 34%",2444.94,percent of total billed charges,Implant Device,2516.85,35,,2516.85,percent of total billed charges,Implant Devices,2516.85,35,,2516.85,percent of total billed charges,Implant Devices,2516.85,35,,,percent of total billed charges,Implant Devices,2516.85,35,,2516.85,percent of total billed charges,Implant Devices,2516.85,35,,2516.85,percent of total billed charges,Implant Devices,2876.4,40,,2876.4,percent of total billed charges,Implant Devices,2516.85,70,,2516.85,percent of total billed charges,Implant Devices,2444.94,34,,2444.94,percent of total billed charges,Implant Devices,2444.94,34,,2444.94,percent of total billed charges,Implant Devices,2516.85,35,,2516.85,percent of total billed charges,Implant Devices,2516.85,35,,2516.85,percent of total billed charges,Implant Devices,2516.85,35,,2516.85,percent of total billed charges,Implant Devices,2516.85,35,,2516.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2444.94,34,"If Charge > 2,000, then 34 percent",2444.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2876.4,
STRYKER 627336 PROX LAT PLATE RT 6 HOLE,C1713,HCPCS,,79008237,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
STRYKER 661448 NON LOCK SCREW 3.5X48MM,C1713,HCPCS,,79008238,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
STRYKER 661432 NON LOCK SCREW 3.5X32MM,C1713,HCPCS,,79008239,CDM,278,RC,,,both,,,132,52.1,39.4668,,52.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,52.8,40,,52.8,percent of total billed charges,Implant Devices,46.2,70,,46.2,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.8,
STRYKER 661020 LOCKING SCREW 4.0X20MM,C1713,HCPCS,,79008240,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 661034 LOCKING SCREW 4.0X34MM,C1713,HCPCS,,79008241,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 661028 LOCKING SCREW 4.0X28MM,C1713,HCPCS,,79008242,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
P28 P50-053-2718 LOCK PLATE SCREW 2.7X18,C1713,HCPCS,,79008244,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
P28 P50-053-2726 LOCK PLATE SCREW 2.7X26,C1713,HCPCS,,79008245,CDM,278,RC,,,both,,,829,327.18,39.4668,,327.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,290.15,35,,290.15,percent of total billed charges,Implant Device,281.86,34,"Charges > $500, x 34%",281.86,percent of total billed charges,Implant Device,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,331.6,40,,331.6,percent of total billed charges,Implant Devices,290.15,70,,290.15,percent of total billed charges,Implant Devices,281.86,34,,281.86,percent of total billed charges,Implant Devices,281.86,34,,281.86,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,331.6,
ARTHREX AR-9045-50PT SCREW 4.5X50,C1713,HCPCS,,79008250,CDM,278,RC,,,both,,,2385,941.28,39.4668,,941.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,834.75,35,,834.75,percent of total billed charges,Implant Device,810.9,34,"Charges > $500, x 34%",810.9,percent of total billed charges,Implant Device,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,954,40,,954,percent of total billed charges,Implant Devices,834.75,70,,834.75,percent of total billed charges,Implant Devices,810.9,34,,810.9,percent of total billed charges,Implant Devices,810.9,34,,810.9,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,810.9,34,"If Charge > 2,000, then 34 percent",810.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,954,
STRYKER 57-10304 1.7MM 4 HOLE LOCK PLATE,C1713,HCPCS,,79008266,CDM,278,RC,,,both,,,1506,594.37,39.4668,,594.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,512.04,34,,512.04,percent of total billed charges,Implant Device,512.04,34,,512.04,percent of total billed charges,Implant Device,512.04,34,,512.04,percent of total billed charges,Implant Device,512.04,34,,512.04,percent of total billed charges,Implant Device,512.04,34,,512.04,percent of total billed charges,Implant Device,512.04,34,,512.04,percent of total billed charges,Implant Device,527.1,35,,527.1,percent of total billed charges,Implant Device,512.04,34,"Charges > $500, x 34%",512.04,percent of total billed charges,Implant Device,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,602.4,40,,602.4,percent of total billed charges,Implant Devices,527.1,70,,527.1,percent of total billed charges,Implant Devices,512.04,34,,512.04,percent of total billed charges,Implant Devices,512.04,34,,512.04,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,527.1,35,,527.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,602.4,
STRYKER 53-17005E 1.7X5MM LOCKING SCREWS,C1713,HCPCS,,79008267,CDM,278,RC,,,both,,,423,166.94,39.4668,,166.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,148.05,35,,148.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,169.2,40,,169.2,percent of total billed charges,Implant Devices,148.05,70,,148.05,percent of total billed charges,Implant Devices,143.82,34,,143.82,percent of total billed charges,Implant Devices,143.82,34,,143.82,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,169.2,
STRYKER 53-17007E 1.7X7MM LOCKING SCREWS,C1713,HCPCS,,79008268,CDM,278,RC,,,both,,,241,95.11,39.4668,,95.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,84.35,35,,84.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,96.4,40,,96.4,percent of total billed charges,Implant Devices,84.35,70,,84.35,percent of total billed charges,Implant Devices,81.94,34,,81.94,percent of total billed charges,Implant Devices,81.94,34,,81.94,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96.4,
STRYKER 54-25684 VDR PLATE RIGHT SHORT,C1713,HCPCS,,79008269,CDM,278,RC,,,both,,,2604,1027.72,39.4668,,1027.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,911.4,35,,911.4,percent of total billed charges,Implant Device,885.36,34,"Charges > $500, x 34%",885.36,percent of total billed charges,Implant Device,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,1041.6,40,,1041.6,percent of total billed charges,Implant Devices,911.4,70,,911.4,percent of total billed charges,Implant Devices,885.36,34,,885.36,percent of total billed charges,Implant Devices,885.36,34,,885.36,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,885.36,34,"If Charge > 2,000, then 34 percent",885.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1041.6,
STRYKER 656114 NONLOCKING SCREW 2.4X14MM,C1713,HCPCS,,79008270,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
EXACTECH 308-15-50 HUM LOCK SCREW SZ 50,C1713,HCPCS,,79008278,CDM,278,RC,,,both,,,1701,671.33,39.4668,,671.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,578.34,34,,578.34,percent of total billed charges,Implant Device,578.34,34,,578.34,percent of total billed charges,Implant Device,578.34,34,,578.34,percent of total billed charges,Implant Device,578.34,34,,578.34,percent of total billed charges,Implant Device,578.34,34,,578.34,percent of total billed charges,Implant Device,578.34,34,,578.34,percent of total billed charges,Implant Device,595.35,35,,595.35,percent of total billed charges,Implant Device,578.34,34,"Charges > $500, x 34%",578.34,percent of total billed charges,Implant Device,595.35,35,,595.35,percent of total billed charges,Implant Devices,595.35,35,,595.35,percent of total billed charges,Implant Devices,595.35,35,,,percent of total billed charges,Implant Devices,595.35,35,,595.35,percent of total billed charges,Implant Devices,595.35,35,,595.35,percent of total billed charges,Implant Devices,680.4,40,,680.4,percent of total billed charges,Implant Devices,595.35,70,,595.35,percent of total billed charges,Implant Devices,578.34,34,,578.34,percent of total billed charges,Implant Devices,578.34,34,,578.34,percent of total billed charges,Implant Devices,595.35,35,,595.35,percent of total billed charges,Implant Devices,595.35,35,,595.35,percent of total billed charges,Implant Devices,595.35,35,,595.35,percent of total billed charges,Implant Devices,595.35,35,,595.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,680.4,
STRYKER 40-35048 3.5X48MM CORTICAL SCREW,C1713,HCPCS,,79008285,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
STRYKER 40-35048 3.5X48MM CORTICAL SCREW,C1713,HCPCS,,79008286,CDM,278,RC,,,both,,,354,139.71,39.4668,,139.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,141.6,40,,141.6,percent of total billed charges,Implant Devices,123.9,70,,123.9,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,141.6,
BIOMET 01-7100 PLATE 5 HOLE Y REGULAR,C1713,HCPCS,,79008287,CDM,278,RC,,,both,,,912,359.94,39.4668,,359.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,310.08,34,,310.08,percent of total billed charges,Implant Device,310.08,34,,310.08,percent of total billed charges,Implant Device,310.08,34,,310.08,percent of total billed charges,Implant Device,310.08,34,,310.08,percent of total billed charges,Implant Device,310.08,34,,310.08,percent of total billed charges,Implant Device,310.08,34,,310.08,percent of total billed charges,Implant Device,319.2,35,,319.2,percent of total billed charges,Implant Device,310.08,34,"Charges > $500, x 34%",310.08,percent of total billed charges,Implant Device,319.2,35,,319.2,percent of total billed charges,Implant Devices,319.2,35,,319.2,percent of total billed charges,Implant Devices,319.2,35,,,percent of total billed charges,Implant Devices,319.2,35,,319.2,percent of total billed charges,Implant Devices,319.2,35,,319.2,percent of total billed charges,Implant Devices,364.8,40,,364.8,percent of total billed charges,Implant Devices,319.2,70,,319.2,percent of total billed charges,Implant Devices,310.08,34,,310.08,percent of total billed charges,Implant Devices,310.08,34,,310.08,percent of total billed charges,Implant Devices,319.2,35,,319.2,percent of total billed charges,Implant Devices,319.2,35,,319.2,percent of total billed charges,Implant Devices,319.2,35,,319.2,percent of total billed charges,Implant Devices,319.2,35,,319.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,364.8,
BIOMET 91-1506 SCREW 1.5X6MM,C1713,HCPCS,,79008288,CDM,278,RC,,,both,,,285,112.48,39.4668,,112.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,99.75,35,,99.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,114,40,,114,percent of total billed charges,Implant Devices,99.75,70,,99.75,percent of total billed charges,Implant Devices,96.9,34,,96.9,percent of total billed charges,Implant Devices,96.9,34,,96.9,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,114,
BIOMET 91-1504 SCREW 1.5X4MM,C1713,HCPCS,,79008289,CDM,278,RC,,,both,,,285,112.48,39.4668,,112.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,99.75,35,,99.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,114,40,,114,percent of total billed charges,Implant Devices,99.75,70,,99.75,percent of total billed charges,Implant Devices,96.9,34,,96.9,percent of total billed charges,Implant Devices,96.9,34,,96.9,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,114,
DEPUY 02.111.530 PLATE 2.4MM 6 HOLE RT,C1713,HCPCS,,79008293,CDM,278,RC,,,both,,,2323,916.81,39.4668,,916.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,813.05,35,,813.05,percent of total billed charges,Implant Device,789.82,34,"Charges > $500, x 34%",789.82,percent of total billed charges,Implant Device,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,929.2,40,,929.2,percent of total billed charges,Implant Devices,813.05,70,,813.05,percent of total billed charges,Implant Devices,789.82,34,,789.82,percent of total billed charges,Implant Devices,789.82,34,,789.82,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,789.82,34,"If Charge > 2,000, then 34 percent",789.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,929.2,
BIOMET 8145-10-110 LAG SCREW 10.5X110MM,C1713,HCPCS,,79008304,CDM,278,RC,,,both,,,2052,809.86,39.4668,,809.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,718.2,35,,718.2,percent of total billed charges,Implant Device,697.68,34,"Charges > $500, x 34%",697.68,percent of total billed charges,Implant Device,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,820.8,40,,820.8,percent of total billed charges,Implant Devices,718.2,70,,718.2,percent of total billed charges,Implant Devices,697.68,34,,697.68,percent of total billed charges,Implant Devices,697.68,34,,697.68,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,697.68,34,"If Charge > 2,000, then 34 percent",697.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,820.8,
BOIMET 8145-50-038 CORT BONE SCREW 5X38,C1713,HCPCS,,79008305,CDM,278,RC,,,both,,,594,234.43,39.4668,,234.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Device,201.96,34,"Charges > $500, x 34%",201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,237.6,40,,237.6,percent of total billed charges,Implant Devices,207.9,70,,207.9,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,237.6,
DEPUY 02.240.026 CANNLOCK SCREW 3.7X26MM,C1713,HCPCS,,79008306,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
DEPUY 02.240.028 CANNLOCK SCREW 3.7X28MM,C1713,HCPCS,,79008307,CDM,278,RC,,,both,,,476,187.86,39.4668,,187.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,161.84,34,,161.84,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,190.4,40,,190.4,percent of total billed charges,Implant Devices,166.6,70,,166.6,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,161.84,34,,161.84,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,166.6,35,,166.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190.4,
STRYKER EZM12-10-10 EASYCLIP COMP SCREW,C1713,HCPCS,,79008308,CDM,278,RC,,,both,,,2132,841.43,39.4668,,841.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,724.88,34,,724.88,percent of total billed charges,Implant Device,724.88,34,,724.88,percent of total billed charges,Implant Device,724.88,34,,724.88,percent of total billed charges,Implant Device,724.88,34,,724.88,percent of total billed charges,Implant Device,724.88,34,,724.88,percent of total billed charges,Implant Device,724.88,34,,724.88,percent of total billed charges,Implant Device,746.2,35,,746.2,percent of total billed charges,Implant Device,724.88,34,"Charges > $500, x 34%",724.88,percent of total billed charges,Implant Device,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,852.8,40,,852.8,percent of total billed charges,Implant Devices,746.2,70,,746.2,percent of total billed charges,Implant Devices,724.88,34,,724.88,percent of total billed charges,Implant Devices,724.88,34,,724.88,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,724.88,34,"If Charge > 2,000, then 34 percent",724.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,852.8,
ARTHREX AR-1370P INTERFEREN SCREW 7X23MM,C1713,HCPCS,,79008316,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
P 28 P20-535-032S 3.5X32MM CANN ST SCREW,C1713,HCPCS,,79008317,CDM,278,RC,,,both,,,1058,417.56,39.4668,,417.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,359.72,34,,359.72,percent of total billed charges,Implant Device,359.72,34,,359.72,percent of total billed charges,Implant Device,359.72,34,,359.72,percent of total billed charges,Implant Device,359.72,34,,359.72,percent of total billed charges,Implant Device,359.72,34,,359.72,percent of total billed charges,Implant Device,359.72,34,,359.72,percent of total billed charges,Implant Device,370.3,35,,370.3,percent of total billed charges,Implant Device,359.72,34,"Charges > $500, x 34%",359.72,percent of total billed charges,Implant Device,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,423.2,40,,423.2,percent of total billed charges,Implant Devices,370.3,70,,370.3,percent of total billed charges,Implant Devices,359.72,34,,359.72,percent of total billed charges,Implant Devices,359.72,34,,359.72,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,370.3,35,,370.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,423.2,
P 28 P50-053-2722 2.7X22MM LOCK SCREW,C1713,HCPCS,,79008318,CDM,278,RC,,,both,,,829,327.18,39.4668,,327.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,290.15,35,,290.15,percent of total billed charges,Implant Device,281.86,34,"Charges > $500, x 34%",281.86,percent of total billed charges,Implant Device,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,331.6,40,,331.6,percent of total billed charges,Implant Devices,290.15,70,,290.15,percent of total billed charges,Implant Devices,281.86,34,,281.86,percent of total billed charges,Implant Devices,281.86,34,,281.86,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,331.6,
P 28 P50-053-2724 2.7X24MM LOCK SCREW,C1713,HCPCS,,79008319,CDM,278,RC,,,both,,,829,327.18,39.4668,,327.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,290.15,35,,290.15,percent of total billed charges,Implant Device,281.86,34,"Charges > $500, x 34%",281.86,percent of total billed charges,Implant Device,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,331.6,40,,331.6,percent of total billed charges,Implant Devices,290.15,70,,290.15,percent of total billed charges,Implant Devices,281.86,34,,281.86,percent of total billed charges,Implant Devices,281.86,34,,281.86,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,331.6,
P 28 P50-153-2720 2.7X20MM NONLOCK SCREW,C1713,HCPCS,,79008320,CDM,278,RC,,,both,,,428,168.92,39.4668,,168.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,171.2,40,,171.2,percent of total billed charges,Implant Devices,149.8,70,,149.8,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,171.2,
P 28 P50-153-2724 2.7X24MM NONLOCK SCREW,C1713,HCPCS,,79008321,CDM,278,RC,,,both,,,428,168.92,39.4668,,168.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,171.2,40,,171.2,percent of total billed charges,Implant Devices,149.8,70,,149.8,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,171.2,
P 28 P53-101-2012 28 PLATE 2 H 20X1.1MM,C1713,HCPCS,,79008322,CDM,278,RC,,,both,,,4055,1600.38,39.4668,,1600.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1378.7,34,,1378.7,percent of total billed charges,Implant Device,1378.7,34,,1378.7,percent of total billed charges,Implant Device,1378.7,34,,1378.7,percent of total billed charges,Implant Device,1378.7,34,,1378.7,percent of total billed charges,Implant Device,1378.7,34,,1378.7,percent of total billed charges,Implant Device,1378.7,34,,1378.7,percent of total billed charges,Implant Device,1419.25,35,,1419.25,percent of total billed charges,Implant Device,1378.7,34,"Charges > $500, x 34%",1378.7,percent of total billed charges,Implant Device,1419.25,35,,1419.25,percent of total billed charges,Implant Devices,1419.25,35,,1419.25,percent of total billed charges,Implant Devices,1419.25,35,,,percent of total billed charges,Implant Devices,1419.25,35,,1419.25,percent of total billed charges,Implant Devices,1419.25,35,,1419.25,percent of total billed charges,Implant Devices,1622,40,,1622,percent of total billed charges,Implant Devices,1419.25,70,,1419.25,percent of total billed charges,Implant Devices,1378.7,34,,1378.7,percent of total billed charges,Implant Devices,1378.7,34,,1378.7,percent of total billed charges,Implant Devices,1419.25,35,,1419.25,percent of total billed charges,Implant Devices,1419.25,35,,1419.25,percent of total billed charges,Implant Devices,1419.25,35,,1419.25,percent of total billed charges,Implant Devices,1419.25,35,,1419.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1378.7,34,"If Charge > 2,000, then 34 percent",1378.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1622,
ALPHATEC 71002-28 PLATE 28MM 2 LEVEL,C1713,HCPCS,,79008324,CDM,278,RC,,,both,,,2700,1065.6,39.4668,,1065.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,918,34,,918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Device,918,34,"Charges > $500, x 34%",918,percent of total billed charges,Implant Device,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,1080,40,,1080,percent of total billed charges,Implant Devices,945,70,,945,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,918,34,,918,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,945,35,,945,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,918,34,"If Charge > 2,000, then 34 percent",918,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1080,
STRYKER 602685 6.5X85MM CANN SCREW,C1713,HCPCS,,79008325,CDM,278,RC,,,both,,,759,299.55,39.4668,,299.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,265.65,35,,265.65,percent of total billed charges,Implant Device,258.06,34,"Charges > $500, x 34%",258.06,percent of total billed charges,Implant Device,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,303.6,40,,303.6,percent of total billed charges,Implant Devices,265.65,70,,265.65,percent of total billed charges,Implant Devices,258.06,34,,258.06,percent of total billed charges,Implant Devices,258.06,34,,258.06,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,303.6,
DEPUY 201.644 CORTEX SCREW 2.4X14MM,C1713,HCPCS,,79008328,CDM,278,RC,,,both,,,186,73.41,39.4668,,73.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,65.1,35,,65.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,74.4,40,,74.4,percent of total billed charges,Implant Devices,65.1,70,,65.1,percent of total billed charges,Implant Devices,63.24,34,,63.24,percent of total billed charges,Implant Devices,63.24,34,,63.24,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.4,
P 28 P50-053-3532 LOCKING SCREW 3.5X32MM,C1713,HCPCS,,79008329,CDM,278,RC,,,both,,,829,327.18,39.4668,,327.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,281.86,34,,281.86,percent of total billed charges,Implant Device,290.15,35,,290.15,percent of total billed charges,Implant Device,281.86,34,"Charges > $500, x 34%",281.86,percent of total billed charges,Implant Device,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,331.6,40,,331.6,percent of total billed charges,Implant Devices,290.15,70,,290.15,percent of total billed charges,Implant Devices,281.86,34,,281.86,percent of total billed charges,Implant Devices,281.86,34,,281.86,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,290.15,35,,290.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,331.6,
P 28 P50-053-4234 LOCKING SCREW 4.2X34MM,C1713,HCPCS,,79008330,CDM,278,RC,,,both,,,854,337.05,39.4668,,337.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,298.9,35,,298.9,percent of total billed charges,Implant Device,290.36,34,"Charges > $500, x 34%",290.36,percent of total billed charges,Implant Device,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,341.6,40,,341.6,percent of total billed charges,Implant Devices,298.9,70,,298.9,percent of total billed charges,Implant Devices,290.36,34,,290.36,percent of total billed charges,Implant Devices,290.36,34,,290.36,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,341.6,
P 28 P50-053-4238 LOCKING SCREW 4.2X36MM,C1713,HCPCS,,79008331,CDM,278,RC,,,both,,,854,337.05,39.4668,,337.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,290.36,34,,290.36,percent of total billed charges,Implant Device,298.9,35,,298.9,percent of total billed charges,Implant Device,290.36,34,"Charges > $500, x 34%",290.36,percent of total billed charges,Implant Device,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,341.6,40,,341.6,percent of total billed charges,Implant Devices,298.9,70,,298.9,percent of total billed charges,Implant Devices,290.36,34,,290.36,percent of total billed charges,Implant Devices,290.36,34,,290.36,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,298.9,35,,298.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,341.6,
PARAGON 28 PLCL-18006 EVANS WEDGE 6MM,C1713,HCPCS,,79008332,CDM,278,RC,,,both,,,5158,2035.7,39.4668,,2035.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1753.72,34,,1753.72,percent of total billed charges,Implant Device,1753.72,34,,1753.72,percent of total billed charges,Implant Device,1753.72,34,,1753.72,percent of total billed charges,Implant Device,1753.72,34,,1753.72,percent of total billed charges,Implant Device,1753.72,34,,1753.72,percent of total billed charges,Implant Device,1753.72,34,,1753.72,percent of total billed charges,Implant Device,1805.3,35,,1805.3,percent of total billed charges,Implant Device,1753.72,34,"Charges > $500, x 34%",1753.72,percent of total billed charges,Implant Device,1805.3,35,,1805.3,percent of total billed charges,Implant Devices,1805.3,35,,1805.3,percent of total billed charges,Implant Devices,1805.3,35,,,percent of total billed charges,Implant Devices,1805.3,35,,1805.3,percent of total billed charges,Implant Devices,1805.3,35,,1805.3,percent of total billed charges,Implant Devices,2063.2,40,,2063.2,percent of total billed charges,Implant Devices,1805.3,70,,1805.3,percent of total billed charges,Implant Devices,1753.72,34,,1753.72,percent of total billed charges,Implant Devices,1753.72,34,,1753.72,percent of total billed charges,Implant Devices,1805.3,35,,1805.3,percent of total billed charges,Implant Devices,1805.3,35,,1805.3,percent of total billed charges,Implant Devices,1805.3,35,,1805.3,percent of total billed charges,Implant Devices,1805.3,35,,1805.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1753.72,34,"If Charge > 2,000, then 34 percent",1753.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2063.2,
STRYKER 3525-1440S LONG NAIL R1 5 TI LT,C1713,HCPCS,,79008334,CDM,278,RC,,,both,,,4969,1961.11,39.4668,,1961.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Device,1689.46,34,"Charges > $500, x 34%",1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1987.6,40,,1987.6,percent of total billed charges,Implant Devices,1739.15,70,,1739.15,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.46,34,"If Charge > 2,000, then 34 percent",1689.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.6,
STRYKER 3425-1440S LONG NAIL R1 R TI RT,C1713,HCPCS,,79008335,CDM,278,RC,,,both,,,5438,2146.2,39.4668,,2146.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Device,1848.92,34,"Charges > $500, x 34%",1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,2175.2,40,,2175.2,percent of total billed charges,Implant Devices,1903.3,70,,1903.3,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1848.92,34,"If Charge > 2,000, then 34 percent",1848.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2175.2,
WRIGHT CCP-LPX1R LAPIDUS PLATE RT 1MM,C1713,HCPCS,,79008340,CDM,278,RC,,,both,,,7245,2859.37,39.4668,,2859.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2463.3,34,,2463.3,percent of total billed charges,Implant Device,2535.75,35,,2535.75,percent of total billed charges,Implant Device,2463.3,34,"Charges > $500, x 34%",2463.3,percent of total billed charges,Implant Device,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2898,40,,2898,percent of total billed charges,Implant Devices,2535.75,70,,2535.75,percent of total billed charges,Implant Devices,2463.3,34,,2463.3,percent of total billed charges,Implant Devices,2463.3,34,,2463.3,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,2535.75,35,,2535.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2463.3,34,"If Charge > 2,000, then 34 percent",2463.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2898,
DEPUY 294.777 DRILLING SCREW 4.0X40MM,C1713,HCPCS,,79008347,CDM,278,RC,,,both,,,272,107.35,39.4668,,107.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,92.48,34,,92.48,percent of total billed charges,Implant Device,92.48,34,,92.48,percent of total billed charges,Implant Device,92.48,34,,92.48,percent of total billed charges,Implant Device,92.48,34,,92.48,percent of total billed charges,Implant Device,92.48,34,,92.48,percent of total billed charges,Implant Device,92.48,34,,92.48,percent of total billed charges,Implant Device,95.2,35,,95.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,108.8,40,,108.8,percent of total billed charges,Implant Devices,95.2,70,,95.2,percent of total billed charges,Implant Devices,92.48,34,,92.48,percent of total billed charges,Implant Devices,92.48,34,,92.48,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108.8,
BIOMET 1802-53-042 CANN SCREW 5.0X42MM,C1713,HCPCS,,79008360,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
BIOMET 1802-53-044 CANN SCREW 5.0X44MM,C1713,HCPCS,,79008361,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
BIOMET 110030166 CARTRDGE THREAD ADAPTOR,C1713,HCPCS,,79008362,CDM,278,RC,,,both,,,90,35.52,39.4668,,35.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,31.5,35,,31.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,36,40,,36,percent of total billed charges,Implant Devices,31.5,70,,31.5,percent of total billed charges,Implant Devices,30.6,34,,30.6,percent of total billed charges,Implant Devices,30.6,34,,30.6,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,36,
STRYKER 3525-0420S LONG NAIL 010X420X125,C1713,HCPCS,,79008364,CDM,278,RC,,,both,,,9981,3939.18,39.4668,,3939.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3393.54,34,,3393.54,percent of total billed charges,Implant Device,3393.54,34,,3393.54,percent of total billed charges,Implant Device,3393.54,34,,3393.54,percent of total billed charges,Implant Device,3393.54,34,,3393.54,percent of total billed charges,Implant Device,3393.54,34,,3393.54,percent of total billed charges,Implant Device,3393.54,34,,3393.54,percent of total billed charges,Implant Device,3493.35,35,,3493.35,percent of total billed charges,Implant Device,3393.54,34,"Charges > $500, x 34%",3393.54,percent of total billed charges,Implant Device,3493.35,35,,3493.35,percent of total billed charges,Implant Devices,3493.35,35,,3493.35,percent of total billed charges,Implant Devices,3493.35,35,,,percent of total billed charges,Implant Devices,3493.35,35,,3493.35,percent of total billed charges,Implant Devices,3493.35,35,,3493.35,percent of total billed charges,Implant Devices,3992.4,40,,3992.4,percent of total billed charges,Implant Devices,3493.35,70,,3493.35,percent of total billed charges,Implant Devices,3393.54,34,,3393.54,percent of total billed charges,Implant Devices,3393.54,34,,3393.54,percent of total billed charges,Implant Devices,3493.35,35,,3493.35,percent of total billed charges,Implant Devices,3493.35,35,,3493.35,percent of total billed charges,Implant Devices,3493.35,35,,3493.35,percent of total billed charges,Implant Devices,3493.35,35,,3493.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3393.54,34,"If Charge > 2,000, then 34 percent",3393.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3992.4,
STRYKER WS12 SNAP OFF SCREW 2 LG 12,C1713,HCPCS,,79008369,CDM,278,RC,,,both,,,1250,493.34,39.4668,,493.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,425,34,,425,percent of total billed charges,Implant Device,425,34,,425,percent of total billed charges,Implant Device,425,34,,425,percent of total billed charges,Implant Device,425,34,,425,percent of total billed charges,Implant Device,425,34,,425,percent of total billed charges,Implant Device,425,34,,425,percent of total billed charges,Implant Device,437.5,35,,437.5,percent of total billed charges,Implant Device,425,34,"Charges > $500, x 34%",425,percent of total billed charges,Implant Device,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,500,40,,500,percent of total billed charges,Implant Devices,437.5,70,,437.5,percent of total billed charges,Implant Devices,425,34,,425,percent of total billed charges,Implant Devices,425,34,,425,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,500,
ARTHREX AR-8943H-03 MEDICAL HOOK PLATE 3,C1713,HCPCS,,79008375,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
ARTHREX AR-8827-44 2.7X44MM CORT SCREW,C1713,HCPCS,,79008376,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
ARTHREX AR-8827-48 2.7X48MM CORT SCREW,C1713,HCPCS,,79008377,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
ARTHREX AR-8835L-34 3.5X34MM LOCK SCREW,C1713,HCPCS,,79008378,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ARTHREX AR-8835L-36 3.5X36MM LOCK SCREW,C1713,HCPCS,,79008379,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
STRYKER 627408 8H LT DIS MEDIAL PLATE,C1713,HCPCS,,79008382,CDM,278,RC,,,both,,,8085,3190.89,39.4668,,3190.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2748.9,34,,2748.9,percent of total billed charges,Implant Device,2748.9,34,,2748.9,percent of total billed charges,Implant Device,2748.9,34,,2748.9,percent of total billed charges,Implant Device,2748.9,34,,2748.9,percent of total billed charges,Implant Device,2748.9,34,,2748.9,percent of total billed charges,Implant Device,2748.9,34,,2748.9,percent of total billed charges,Implant Device,2829.75,35,,2829.75,percent of total billed charges,Implant Device,2748.9,34,"Charges > $500, x 34%",2748.9,percent of total billed charges,Implant Device,2829.75,35,,2829.75,percent of total billed charges,Implant Devices,2829.75,35,,2829.75,percent of total billed charges,Implant Devices,2829.75,35,,,percent of total billed charges,Implant Devices,2829.75,35,,2829.75,percent of total billed charges,Implant Devices,2829.75,35,,2829.75,percent of total billed charges,Implant Devices,3234,40,,3234,percent of total billed charges,Implant Devices,2829.75,70,,2829.75,percent of total billed charges,Implant Devices,2748.9,34,,2748.9,percent of total billed charges,Implant Devices,2748.9,34,,2748.9,percent of total billed charges,Implant Devices,2829.75,35,,2829.75,percent of total billed charges,Implant Devices,2829.75,35,,2829.75,percent of total billed charges,Implant Devices,2829.75,35,,2829.75,percent of total billed charges,Implant Devices,2829.75,35,,2829.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2748.9,34,"If Charge > 2,000, then 34 percent",2748.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3234,
STRYKER 661422 3.5X22MM NONLOCK SCREW,C1713,HCPCS,,79008383,CDM,278,RC,,,both,,,132,52.1,39.4668,,52.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,52.8,40,,52.8,percent of total billed charges,Implant Devices,46.2,70,,46.2,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.8,
STRYKER 661424 3.5X24MM NONLOCK SCREW,C1713,HCPCS,,79008384,CDM,278,RC,,,both,,,132,52.1,39.4668,,52.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,52.8,40,,52.8,percent of total billed charges,Implant Devices,46.2,70,,46.2,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.8,
STRYKER 661434 3.5X34MM NONLOCK SCREW,C1713,HCPCS,,79008385,CDM,278,RC,,,both,,,132,52.1,39.4668,,52.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,52.8,40,,52.8,percent of total billed charges,Implant Devices,46.2,70,,46.2,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.8,
STRYKER 661436 3.5X36MM NONLOCK SCREW,C1713,HCPCS,,79008386,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
STRYKER 661026 4.0X26MM LOCKING SCREW,C1713,HCPCS,,79008387,CDM,278,RC,,,both,,,792,312.58,39.4668,,312.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,269.28,34,,269.28,percent of total billed charges,Implant Device,269.28,34,,269.28,percent of total billed charges,Implant Device,269.28,34,,269.28,percent of total billed charges,Implant Device,269.28,34,,269.28,percent of total billed charges,Implant Device,269.28,34,,269.28,percent of total billed charges,Implant Device,269.28,34,,269.28,percent of total billed charges,Implant Device,277.2,35,,277.2,percent of total billed charges,Implant Device,269.28,34,"Charges > $500, x 34%",269.28,percent of total billed charges,Implant Device,277.2,35,,277.2,percent of total billed charges,Implant Devices,277.2,35,,277.2,percent of total billed charges,Implant Devices,277.2,35,,,percent of total billed charges,Implant Devices,277.2,35,,277.2,percent of total billed charges,Implant Devices,277.2,35,,277.2,percent of total billed charges,Implant Devices,316.8,40,,316.8,percent of total billed charges,Implant Devices,277.2,70,,277.2,percent of total billed charges,Implant Devices,269.28,34,,269.28,percent of total billed charges,Implant Devices,269.28,34,,269.28,percent of total billed charges,Implant Devices,277.2,35,,277.2,percent of total billed charges,Implant Devices,277.2,35,,277.2,percent of total billed charges,Implant Devices,277.2,35,,277.2,percent of total billed charges,Implant Devices,277.2,35,,277.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,316.8,
STRYKER 661038 4.0X38MM LOCKING SCREW,C1713,HCPCS,,79008388,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 661044 4.0X44MM LOCKING SCREW,C1713,HCPCS,,79008389,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 661042 4.0X42MM LOCKING SCREW,C1713,HCPCS,,79008390,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 607336 4.0X36MM CANCELLOUSSCREW,C1713,HCPCS,,79008391,CDM,278,RC,,,both,,,186,73.41,39.4668,,73.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,65.1,35,,65.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,74.4,40,,74.4,percent of total billed charges,Implant Devices,65.1,70,,65.1,percent of total billed charges,Implant Devices,63.24,34,,63.24,percent of total billed charges,Implant Devices,63.24,34,,63.24,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.4,
ZIMMER 00-5980-057-02 TIBIAL PLATE SZ 8,C1713,HCPCS,,79008393,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
STRYKER ORTHO 628203 PLATE LATERAL 3H,C1713,HCPCS,,79008398,CDM,278,RC,,,both,,,3069,1211.24,39.4668,,1211.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1074.15,35,,1074.15,percent of total billed charges,Implant Device,1043.46,34,"Charges > $500, x 34%",1043.46,percent of total billed charges,Implant Device,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1227.6,40,,1227.6,percent of total billed charges,Implant Devices,1074.15,70,,1074.15,percent of total billed charges,Implant Devices,1043.46,34,,1043.46,percent of total billed charges,Implant Devices,1043.46,34,,1043.46,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1043.46,34,"If Charge > 2,000, then 34 percent",1043.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1227.6,
STRYKER 614512 LOCKING SCREW 2.7X12MM,C1713,HCPCS,,79008399,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
STRYKER 614516 LOCKING PLATE 2.7X16MM,C1713,HCPCS,,79008400,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
STRYKER 614514 LOCKING PLATE 2.7X14MM,C1713,HCPCS,,79008401,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
STRYKER 54-25428S PLATE XXL VOLAR 2.7MM,C1713,HCPCS,,79008402,CDM,278,RC,,,both,,,6072,2396.42,39.4668,,2396.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2064.48,34,,2064.48,percent of total billed charges,Implant Device,2064.48,34,,2064.48,percent of total billed charges,Implant Device,2064.48,34,,2064.48,percent of total billed charges,Implant Device,2064.48,34,,2064.48,percent of total billed charges,Implant Device,2064.48,34,,2064.48,percent of total billed charges,Implant Device,2064.48,34,,2064.48,percent of total billed charges,Implant Device,2125.2,35,,2125.2,percent of total billed charges,Implant Device,2064.48,34,"Charges > $500, x 34%",2064.48,percent of total billed charges,Implant Device,2125.2,35,,2125.2,percent of total billed charges,Implant Devices,2125.2,35,,2125.2,percent of total billed charges,Implant Devices,2125.2,35,,,percent of total billed charges,Implant Devices,2125.2,35,,2125.2,percent of total billed charges,Implant Devices,2125.2,35,,2125.2,percent of total billed charges,Implant Devices,2428.8,40,,2428.8,percent of total billed charges,Implant Devices,2125.2,70,,2125.2,percent of total billed charges,Implant Devices,2064.48,34,,2064.48,percent of total billed charges,Implant Devices,2064.48,34,,2064.48,percent of total billed charges,Implant Devices,2125.2,35,,2125.2,percent of total billed charges,Implant Devices,2125.2,35,,2125.2,percent of total billed charges,Implant Devices,2125.2,35,,2125.2,percent of total billed charges,Implant Devices,2125.2,35,,2125.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2064.48,34,"If Charge > 2,000, then 34 percent",2064.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2428.8,
STRYKER 656426 NON LOCKNG SCREW 2.7X26MM,C1713,HCPCS,,79008403,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER 656318 LOCKING SCREW 2.7X18MM,C1713,HCPCS,,79008404,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 656322 LOCKING SCREW 2.7X22MM,C1713,HCPCS,,79008405,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
ARTHREX AR-7000-32PT PT SCREW 3.75X32MM,C1713,HCPCS,,79008407,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ARTHREX AR-7000-28PT PT SCREW 3.75X28MM,C1713,HCPCS,,79008408,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
STRYKER 661444 3.5X44MM CORTICAL SCREW,C1713,HCPCS,,79008416,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
STRYKER 661442 3.5X42MM CORTICAL SCREW,C1713,HCPCS,,79008418,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
ACUMED AT2-M18 ACCUTRAK2 MINI SCREW 18MM,C1713,HCPCS,,79008419,CDM,278,RC,,,both,,,1584,625.15,39.4668,,625.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,538.56,34,,538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Device,538.56,34,"Charges > $500, x 34%",538.56,percent of total billed charges,Implant Device,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,633.6,40,,633.6,percent of total billed charges,Implant Devices,554.4,70,,554.4,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,538.56,34,,538.56,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,554.4,35,,554.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,633.6,
DEPUY 02.112.084 CLAV PLATE 3.5X115MM 8H,C1713,HCPCS,,79008420,CDM,278,RC,,,both,,,3691,1456.72,39.4668,,1456.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1254.94,34,,1254.94,percent of total billed charges,Implant Device,1254.94,34,,1254.94,percent of total billed charges,Implant Device,1254.94,34,,1254.94,percent of total billed charges,Implant Device,1254.94,34,,1254.94,percent of total billed charges,Implant Device,1254.94,34,,1254.94,percent of total billed charges,Implant Device,1254.94,34,,1254.94,percent of total billed charges,Implant Device,1291.85,35,,1291.85,percent of total billed charges,Implant Device,1254.94,34,"Charges > $500, x 34%",1254.94,percent of total billed charges,Implant Device,1291.85,35,,1291.85,percent of total billed charges,Implant Devices,1291.85,35,,1291.85,percent of total billed charges,Implant Devices,1291.85,35,,,percent of total billed charges,Implant Devices,1291.85,35,,1291.85,percent of total billed charges,Implant Devices,1291.85,35,,1291.85,percent of total billed charges,Implant Devices,1476.4,40,,1476.4,percent of total billed charges,Implant Devices,1291.85,70,,1291.85,percent of total billed charges,Implant Devices,1254.94,34,,1254.94,percent of total billed charges,Implant Devices,1254.94,34,,1254.94,percent of total billed charges,Implant Devices,1291.85,35,,1291.85,percent of total billed charges,Implant Devices,1291.85,35,,1291.85,percent of total billed charges,Implant Devices,1291.85,35,,1291.85,percent of total billed charges,Implant Devices,1291.85,35,,1291.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1254.94,34,"If Charge > 2,000, then 34 percent",1254.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1476.4,
STRYKER 661480 LOCKING SCREW 3.5X80MM,C1713,HCPCS,,79008421,CDM,278,RC,,,both,,,171,67.49,39.4668,,67.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,59.85,35,,59.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,68.4,40,,68.4,percent of total billed charges,Implant Devices,59.85,70,,59.85,percent of total billed charges,Implant Devices,58.14,34,,58.14,percent of total billed charges,Implant Devices,58.14,34,,58.14,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,68.4,
STRYKER 607360 CANCELLOUS SCREW 4.0X60MM,C1713,HCPCS,,79008422,CDM,278,RC,,,both,,,186,73.41,39.4668,,73.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,65.1,35,,65.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,74.4,40,,74.4,percent of total billed charges,Implant Devices,65.1,70,,65.1,percent of total billed charges,Implant Devices,63.24,34,,63.24,percent of total billed charges,Implant Devices,63.24,34,,63.24,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.4,
STRYKER 102-2210 VITOSS BONE GRAFT 10CC,C1713,HCPCS,,79008423,CDM,278,RC,,,both,,,9955,3928.92,39.4668,,3928.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3384.7,34,,3384.7,percent of total billed charges,Implant Device,3384.7,34,,3384.7,percent of total billed charges,Implant Device,3384.7,34,,3384.7,percent of total billed charges,Implant Device,3384.7,34,,3384.7,percent of total billed charges,Implant Device,3384.7,34,,3384.7,percent of total billed charges,Implant Device,3384.7,34,,3384.7,percent of total billed charges,Implant Device,3484.25,35,,3484.25,percent of total billed charges,Implant Device,3384.7,34,"Charges > $500, x 34%",3384.7,percent of total billed charges,Implant Device,3484.25,35,,3484.25,percent of total billed charges,Implant Devices,3484.25,35,,3484.25,percent of total billed charges,Implant Devices,3484.25,35,,,percent of total billed charges,Implant Devices,3484.25,35,,3484.25,percent of total billed charges,Implant Devices,3484.25,35,,3484.25,percent of total billed charges,Implant Devices,3982,40,,3982,percent of total billed charges,Implant Devices,3484.25,70,,3484.25,percent of total billed charges,Implant Devices,3384.7,34,,3384.7,percent of total billed charges,Implant Devices,3384.7,34,,3384.7,percent of total billed charges,Implant Devices,3484.25,35,,3484.25,percent of total billed charges,Implant Devices,3484.25,35,,3484.25,percent of total billed charges,Implant Devices,3484.25,35,,3484.25,percent of total billed charges,Implant Devices,3484.25,35,,3484.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3384.7,34,"If Charge > 2,000, then 34 percent",3384.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3982,
BIOMET 91-1505 SELF TAPPNG SCREW 1.5X5MM,C1713,HCPCS,,79008424,CDM,278,RC,,,both,,,285,112.48,39.4668,,112.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,96.9,34,,96.9,percent of total billed charges,Implant Device,99.75,35,,99.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,114,40,,114,percent of total billed charges,Implant Devices,99.75,70,,99.75,percent of total billed charges,Implant Devices,96.9,34,,96.9,percent of total billed charges,Implant Devices,96.9,34,,96.9,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,99.75,35,,99.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,114,
STRYKER F&A 626892 MTP LOCKING PLATE RT,C1713,HCPCS,,79008425,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
STRYKER F&A 626924 LAG SCREW 3.6X24MM,C1713,HCPCS,,79008426,CDM,278,RC,,,both,,,879,346.91,39.4668,,346.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,307.65,35,,307.65,percent of total billed charges,Implant Device,298.86,34,"Charges > $500, x 34%",298.86,percent of total billed charges,Implant Device,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,351.6,40,,351.6,percent of total billed charges,Implant Devices,307.65,70,,307.65,percent of total billed charges,Implant Devices,298.86,34,,298.86,percent of total billed charges,Implant Devices,298.86,34,,298.86,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,351.6,
STRYKER F&A 656314 LOCKNG SCREW 2.7X14MM,C1713,HCPCS,,79008427,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER F&A 656316 LOCKNG SCREW 2.7X16MM,C1713,HCPCS,,79008428,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER F&A 656312 LOCKNG SCREW 2.7X12MM,C1713,HCPCS,,79008429,CDM,278,RC,,,both,,,443,174.84,39.4668,,174.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,177.2,40,,177.2,percent of total billed charges,Implant Devices,155.05,70,,155.05,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.2,
ZIMMER 8145-50-34 5X34MM CORT BONE SCREW,C1713,HCPCS,,79008433,CDM,278,RC,,,both,,,930,367.04,39.4668,,367.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Device,316.2,34,"Charges > $500, x 34%",316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,372,40,,372,percent of total billed charges,Implant Devices,325.5,70,,325.5,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,372,
IN2BONES S22 ST011 SNAP OFF SCREW 2.2X11,C1713,HCPCS,,79008434,CDM,278,RC,,,both,,,675,266.4,39.4668,,266.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Device,229.5,34,"Charges > $500, x 34%",229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,270,40,,270,percent of total billed charges,Implant Devices,236.25,70,,236.25,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270,
STRYKER 626891 LOCK MTP CROSS PLATE LEFT,C1713,HCPCS,,79008435,CDM,278,RC,,,both,,,8961,3536.62,39.4668,,3536.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3046.74,34,,3046.74,percent of total billed charges,Implant Device,3046.74,34,,3046.74,percent of total billed charges,Implant Device,3046.74,34,,3046.74,percent of total billed charges,Implant Device,3046.74,34,,3046.74,percent of total billed charges,Implant Device,3046.74,34,,3046.74,percent of total billed charges,Implant Device,3046.74,34,,3046.74,percent of total billed charges,Implant Device,3136.35,35,,3136.35,percent of total billed charges,Implant Device,3046.74,34,"Charges > $500, x 34%",3046.74,percent of total billed charges,Implant Device,3136.35,35,,3136.35,percent of total billed charges,Implant Devices,3136.35,35,,3136.35,percent of total billed charges,Implant Devices,3136.35,35,,,percent of total billed charges,Implant Devices,3136.35,35,,3136.35,percent of total billed charges,Implant Devices,3136.35,35,,3136.35,percent of total billed charges,Implant Devices,3584.4,40,,3584.4,percent of total billed charges,Implant Devices,3136.35,70,,3136.35,percent of total billed charges,Implant Devices,3046.74,34,,3046.74,percent of total billed charges,Implant Devices,3046.74,34,,3046.74,percent of total billed charges,Implant Devices,3136.35,35,,3136.35,percent of total billed charges,Implant Devices,3136.35,35,,3136.35,percent of total billed charges,Implant Devices,3136.35,35,,3136.35,percent of total billed charges,Implant Devices,3136.35,35,,3136.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3046.74,34,"If Charge > 2,000, then 34 percent",3046.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3584.4,
ZIMMER 00-2347-023-60 SCREW 4.5X38MM,C1713,HCPCS,,79008443,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
STABILITY SB1152-12 HUMERUS SHAFT,C1713,HCPCS,,79008451,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
ALAMO AT444FD FEMORAL SHAFT,C1713,HCPCS,,79008452,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
STRYKER 58-23006 BONE SCREW 2.3X6MM,C1713,HCPCS,,79008453,CDM,278,RC,,,both,,,370,146.03,39.4668,,146.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,129.5,35,,129.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,148,40,,148,percent of total billed charges,Implant Devices,129.5,70,,129.5,percent of total billed charges,Implant Devices,125.8,34,,125.8,percent of total billed charges,Implant Devices,125.8,34,,125.8,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,148,
STRYKER 1828-1036S T2 FEMUR NAIL R1500,C1713,HCPCS,,79008457,CDM,278,RC,,,both,,,7382,2913.44,39.4668,,2913.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2509.88,34,,2509.88,percent of total billed charges,Implant Device,2509.88,34,,2509.88,percent of total billed charges,Implant Device,2509.88,34,,2509.88,percent of total billed charges,Implant Device,2509.88,34,,2509.88,percent of total billed charges,Implant Device,2509.88,34,,2509.88,percent of total billed charges,Implant Device,2509.88,34,,2509.88,percent of total billed charges,Implant Device,2583.7,35,,2583.7,percent of total billed charges,Implant Device,2509.88,34,"Charges > $500, x 34%",2509.88,percent of total billed charges,Implant Device,2583.7,35,,2583.7,percent of total billed charges,Implant Devices,2583.7,35,,2583.7,percent of total billed charges,Implant Devices,2583.7,35,,,percent of total billed charges,Implant Devices,2583.7,35,,2583.7,percent of total billed charges,Implant Devices,2583.7,35,,2583.7,percent of total billed charges,Implant Devices,2952.8,40,,2952.8,percent of total billed charges,Implant Devices,2583.7,70,,2583.7,percent of total billed charges,Implant Devices,2509.88,34,,2509.88,percent of total billed charges,Implant Devices,2509.88,34,,2509.88,percent of total billed charges,Implant Devices,2583.7,35,,2583.7,percent of total billed charges,Implant Devices,2583.7,35,,2583.7,percent of total billed charges,Implant Devices,2583.7,35,,2583.7,percent of total billed charges,Implant Devices,2583.7,35,,2583.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2509.88,34,"If Charge > 2,000, then 34 percent",2509.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2952.8,
STRYKER 1896-5085S LOCK SCREW FT 5X85MM,C1713,HCPCS,,79008458,CDM,278,RC,,,both,,,788,311,39.4668,,311,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,275.8,35,,275.8,percent of total billed charges,Implant Device,267.92,34,"Charges > $500, x 34%",267.92,percent of total billed charges,Implant Device,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,315.2,40,,315.2,percent of total billed charges,Implant Devices,275.8,70,,275.8,percent of total billed charges,Implant Devices,267.92,34,,267.92,percent of total billed charges,Implant Devices,267.92,34,,267.92,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.2,
WRIGHT 777404022 DARCO SCREW 4.0 X 40L,C1713,HCPCS,,79008459,CDM,278,RC,,,both,,,1254,494.91,39.4668,,494.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,438.9,35,,438.9,percent of total billed charges,Implant Device,426.36,34,"Charges > $500, x 34%",426.36,percent of total billed charges,Implant Device,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,501.6,40,,501.6,percent of total billed charges,Implant Devices,438.9,70,,438.9,percent of total billed charges,Implant Devices,426.36,34,,426.36,percent of total billed charges,Implant Devices,426.36,34,,426.36,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,501.6,
WRIGHT 777404032 DARCO SCREW 4.0 X 40S,C1713,HCPCS,,79008460,CDM,278,RC,,,both,,,1254,494.91,39.4668,,494.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,438.9,35,,438.9,percent of total billed charges,Implant Device,426.36,34,"Charges > $500, x 34%",426.36,percent of total billed charges,Implant Device,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,501.6,40,,501.6,percent of total billed charges,Implant Devices,438.9,70,,438.9,percent of total billed charges,Implant Devices,426.36,34,,426.36,percent of total billed charges,Implant Devices,426.36,34,,426.36,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,501.6,
WRIGHT 777404432 DARCO SCREW 4.0 X 44S,C1713,HCPCS,,79008461,CDM,278,RC,,,both,,,1254,494.91,39.4668,,494.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,438.9,35,,438.9,percent of total billed charges,Implant Device,426.36,34,"Charges > $500, x 34%",426.36,percent of total billed charges,Implant Device,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,501.6,40,,501.6,percent of total billed charges,Implant Devices,438.9,70,,438.9,percent of total billed charges,Implant Devices,426.36,34,,426.36,percent of total billed charges,Implant Devices,426.36,34,,426.36,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,501.6,
STRYKER 3102-2102 BIO4 BONE MATRIX-2.5CC,C1713,HCPCS,,79008462,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
STRYKER 3102-2105 BOI4 BONE MATRIX-5CC,C1713,HCPCS,,79008463,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
STRYKER 3102-2110 BIO4 BONE MATRIX-10CC,C1713,HCPCS,,79008464,CDM,278,RC,,,both,,,15360,6062.1,39.4668,,6062.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5222.4,34,,5222.4,percent of total billed charges,Implant Device,5222.4,34,,5222.4,percent of total billed charges,Implant Device,5222.4,34,,5222.4,percent of total billed charges,Implant Device,5222.4,34,,5222.4,percent of total billed charges,Implant Device,5222.4,34,,5222.4,percent of total billed charges,Implant Device,5222.4,34,,5222.4,percent of total billed charges,Implant Device,5376,35,,5376,percent of total billed charges,Implant Device,5222.4,34,"Charges > $500, x 34%",5222.4,percent of total billed charges,Implant Device,5376,35,,5376,percent of total billed charges,Implant Devices,5376,35,,5376,percent of total billed charges,Implant Devices,5376,35,,,percent of total billed charges,Implant Devices,5376,35,,5376,percent of total billed charges,Implant Devices,5376,35,,5376,percent of total billed charges,Implant Devices,6144,40,,6144,percent of total billed charges,Implant Devices,5376,70,,5376,percent of total billed charges,Implant Devices,5222.4,34,,5222.4,percent of total billed charges,Implant Devices,5222.4,34,,5222.4,percent of total billed charges,Implant Devices,5376,35,,5376,percent of total billed charges,Implant Devices,5376,35,,5376,percent of total billed charges,Implant Devices,5376,35,,5376,percent of total billed charges,Implant Devices,5376,35,,5376,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5222.4,34,"If Charge > 2,000, then 34 percent",5222.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6144,
STRYKER 40-20908 VARIAX FIB PLATE 8 HOLE,C1713,HCPCS,,79008465,CDM,278,RC,,,both,,,1932,762.5,39.4668,,762.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,656.88,34,,656.88,percent of total billed charges,Implant Device,656.88,34,,656.88,percent of total billed charges,Implant Device,656.88,34,,656.88,percent of total billed charges,Implant Device,656.88,34,,656.88,percent of total billed charges,Implant Device,656.88,34,,656.88,percent of total billed charges,Implant Device,656.88,34,,656.88,percent of total billed charges,Implant Device,676.2,35,,676.2,percent of total billed charges,Implant Device,656.88,34,"Charges > $500, x 34%",656.88,percent of total billed charges,Implant Device,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,772.8,40,,772.8,percent of total billed charges,Implant Devices,676.2,70,,676.2,percent of total billed charges,Implant Devices,656.88,34,,656.88,percent of total billed charges,Implant Devices,656.88,34,,656.88,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,772.8,
STRYKER 629507 COMP PLATE NARROW 7 HOLE,C1713,HCPCS,,79008470,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
STRYKER 657418 NON LOCK SCREW 3.5X18MM,C1713,HCPCS,,79008471,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657314 LOCKING SCREW 3.5X14MM,C1713,HCPCS,,79008472,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 657318 LOCKING SCREW 3.5X18MM,C1713,HCPCS,,79008473,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 626920 LAG SCREW 3.6X20MM,C1713,HCPCS,,79008474,CDM,278,RC,,,both,,,879,346.91,39.4668,,346.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,307.65,35,,307.65,percent of total billed charges,Implant Device,298.86,34,"Charges > $500, x 34%",298.86,percent of total billed charges,Implant Device,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,351.6,40,,351.6,percent of total billed charges,Implant Devices,307.65,70,,307.65,percent of total billed charges,Implant Devices,298.86,34,,298.86,percent of total billed charges,Implant Devices,298.86,34,,298.86,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,351.6,
STRYKER 626922 LAG SCREW 3.6X22MM,C1713,HCPCS,,79008475,CDM,278,RC,,,both,,,879,346.91,39.4668,,346.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,307.65,35,,307.65,percent of total billed charges,Implant Device,298.86,34,"Charges > $500, x 34%",298.86,percent of total billed charges,Implant Device,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,351.6,40,,351.6,percent of total billed charges,Implant Devices,307.65,70,,307.65,percent of total billed charges,Implant Devices,298.86,34,,298.86,percent of total billed charges,Implant Devices,298.86,34,,298.86,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,351.6,
STRYKER 656310 LOCKING SCREW 2.7X1.10MM,C1713,HCPCS,,79008476,CDM,278,RC,,,both,,,636,251.01,39.4668,,251.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,216.24,34,,216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Device,216.24,34,"Charges > $500, x 34%",216.24,percent of total billed charges,Implant Device,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,254.4,40,,254.4,percent of total billed charges,Implant Devices,222.6,70,,222.6,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,216.24,34,,216.24,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,222.6,35,,222.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,254.4,
DEPUY 458.950S 5.0X50MM TI LOCKNG SCREW,C1713,HCPCS,,79008479,CDM,278,RC,,,both,,,456,179.97,39.4668,,179.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,182.4,40,,182.4,percent of total billed charges,Implant Devices,159.6,70,,159.6,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182.4,
DEPUY 456.416S 11MM/130DEG NAIL 360MM/R,C1713,HCPCS,,79008480,CDM,278,RC,,,both,,,6895,2721.24,39.4668,,2721.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2413.25,35,,2413.25,percent of total billed charges,Implant Device,2344.3,34,"Charges > $500, x 34%",2344.3,percent of total billed charges,Implant Device,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2758,40,,2758,percent of total billed charges,Implant Devices,2413.25,70,,2413.25,percent of total billed charges,Implant Devices,2344.3,34,,2344.3,percent of total billed charges,Implant Devices,2344.3,34,,2344.3,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2344.3,34,"If Charge > 2,000, then 34 percent",2344.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2758,
DEPUY 237.24 CONDYLAR PLATE 70X204MM,C1713,HCPCS,,79008485,CDM,278,RC,,,both,,,2507,989.43,39.4668,,989.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,852.38,34,,852.38,percent of total billed charges,Implant Device,852.38,34,,852.38,percent of total billed charges,Implant Device,852.38,34,,852.38,percent of total billed charges,Implant Device,852.38,34,,852.38,percent of total billed charges,Implant Device,852.38,34,,852.38,percent of total billed charges,Implant Device,852.38,34,,852.38,percent of total billed charges,Implant Device,877.45,35,,877.45,percent of total billed charges,Implant Device,852.38,34,"Charges > $500, x 34%",852.38,percent of total billed charges,Implant Device,877.45,35,,877.45,percent of total billed charges,Implant Devices,877.45,35,,877.45,percent of total billed charges,Implant Devices,877.45,35,,,percent of total billed charges,Implant Devices,877.45,35,,877.45,percent of total billed charges,Implant Devices,877.45,35,,877.45,percent of total billed charges,Implant Devices,1002.8,40,,1002.8,percent of total billed charges,Implant Devices,877.45,70,,877.45,percent of total billed charges,Implant Devices,852.38,34,,852.38,percent of total billed charges,Implant Devices,852.38,34,,852.38,percent of total billed charges,Implant Devices,877.45,35,,877.45,percent of total billed charges,Implant Devices,877.45,35,,877.45,percent of total billed charges,Implant Devices,877.45,35,,877.45,percent of total billed charges,Implant Devices,877.45,35,,877.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,852.38,34,"If Charge > 2,000, then 34 percent",852.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1002.8,
DEPUY 214.856 CORTEX SCREW 4.5X56MM,C1713,HCPCS,,79008486,CDM,278,RC,,,both,,,83,32.76,39.4668,,32.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,28.22,34,,28.22,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,33.2,40,,33.2,percent of total billed charges,Implant Devices,29.05,70,,29.05,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,28.22,34,,28.22,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,29.05,35,,29.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.2,
DEPUY 214.840 CORTEX SCREW 4.5X40MM,C1713,HCPCS,,79008487,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
STRYKER 5572-4528 PERPHRL SCREW 4.5X28MM,C1713,HCPCS,,79008493,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
STRYKER 5572-4520 PERPHRL SCREW 4.5X20MM,C1713,HCPCS,,79008496,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
STRYKER 5573-6524 CTR SCREW 6.5X24MM,C1713,HCPCS,,79008497,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
STRYKER 40-35050 3.5X50MM NON LOCK SCREW,C1713,HCPCS,,79008501,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
DEPUY 02.118.401 DIS FIB PLATE 3 HOLES,C1713,HCPCS,,79008502,CDM,278,RC,,,both,,,3125,1233.34,39.4668,,1233.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1062.5,34,,1062.5,percent of total billed charges,Implant Device,1093.75,35,,1093.75,percent of total billed charges,Implant Device,1062.5,34,"Charges > $500, x 34%",1062.5,percent of total billed charges,Implant Device,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1250,40,,1250,percent of total billed charges,Implant Devices,1093.75,70,,1093.75,percent of total billed charges,Implant Devices,1062.5,34,,1062.5,percent of total billed charges,Implant Devices,1062.5,34,,1062.5,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,1093.75,35,,1093.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1062.5,34,"If Charge > 2,000, then 34 percent",1062.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1250,
ZIMMER 32-8105-038-00 PLUG W/NOZ 16X25MM,C1713,HCPCS,,79008503,CDM,278,RC,,,both,,,581,229.3,39.4668,,229.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,197.54,34,,197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Device,197.54,34,"Charges > $500, x 34%",197.54,percent of total billed charges,Implant Device,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,232.4,40,,232.4,percent of total billed charges,Implant Devices,203.35,70,,203.35,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,197.54,34,,197.54,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,203.35,35,,203.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.4,
"ZIMMER 32-8105-035-08 HUMERAL ASSY 8""",C1713,HCPCS,,79008504,CDM,278,RC,,,both,,,16500,6512.02,39.4668,,6512.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5610,34,,5610,percent of total billed charges,Implant Device,5610,34,,5610,percent of total billed charges,Implant Device,5610,34,,5610,percent of total billed charges,Implant Device,5610,34,,5610,percent of total billed charges,Implant Device,5610,34,,5610,percent of total billed charges,Implant Device,5610,34,,5610,percent of total billed charges,Implant Device,5775,35,,5775,percent of total billed charges,Implant Device,5610,34,"Charges > $500, x 34%",5610,percent of total billed charges,Implant Device,5775,35,,5775,percent of total billed charges,Implant Devices,5775,35,,5775,percent of total billed charges,Implant Devices,5775,35,,,percent of total billed charges,Implant Devices,5775,35,,5775,percent of total billed charges,Implant Devices,5775,35,,5775,percent of total billed charges,Implant Devices,6600,40,,6600,percent of total billed charges,Implant Devices,5775,70,,5775,percent of total billed charges,Implant Devices,5610,34,,5610,percent of total billed charges,Implant Devices,5610,34,,5610,percent of total billed charges,Implant Devices,5775,35,,5775,percent of total billed charges,Implant Devices,5775,35,,5775,percent of total billed charges,Implant Devices,5775,35,,5775,percent of total billed charges,Implant Devices,5775,35,,5775,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5610,34,"If Charge > 2,000, then 34 percent",5610,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6600,
STRYKER 629368 OLECRANON PLATE R 8 HOLE,C1713,HCPCS,,79008507,CDM,278,RC,,,both,,,5462,2155.68,39.4668,,2155.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1857.08,34,,1857.08,percent of total billed charges,Implant Device,1857.08,34,,1857.08,percent of total billed charges,Implant Device,1857.08,34,,1857.08,percent of total billed charges,Implant Device,1857.08,34,,1857.08,percent of total billed charges,Implant Device,1857.08,34,,1857.08,percent of total billed charges,Implant Device,1857.08,34,,1857.08,percent of total billed charges,Implant Device,1911.7,35,,1911.7,percent of total billed charges,Implant Device,1857.08,34,"Charges > $500, x 34%",1857.08,percent of total billed charges,Implant Device,1911.7,35,,1911.7,percent of total billed charges,Implant Devices,1911.7,35,,1911.7,percent of total billed charges,Implant Devices,1911.7,35,,,percent of total billed charges,Implant Devices,1911.7,35,,1911.7,percent of total billed charges,Implant Devices,1911.7,35,,1911.7,percent of total billed charges,Implant Devices,2184.8,40,,2184.8,percent of total billed charges,Implant Devices,1911.7,70,,1911.7,percent of total billed charges,Implant Devices,1857.08,34,,1857.08,percent of total billed charges,Implant Devices,1857.08,34,,1857.08,percent of total billed charges,Implant Devices,1911.7,35,,1911.7,percent of total billed charges,Implant Devices,1911.7,35,,1911.7,percent of total billed charges,Implant Devices,1911.7,35,,1911.7,percent of total billed charges,Implant Devices,1911.7,35,,1911.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1857.08,34,"If Charge > 2,000, then 34 percent",1857.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2184.8,
STRYKER 614638 3.5 X 38MM LOCKING SCREW,C1713,HCPCS,,79008508,CDM,278,RC,,,both,,,727,286.92,39.4668,,286.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,247.18,34,,247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Device,247.18,34,"Charges > $500, x 34%",247.18,percent of total billed charges,Implant Device,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,290.8,40,,290.8,percent of total billed charges,Implant Devices,254.45,70,,254.45,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,247.18,34,,247.18,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,254.45,35,,254.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,290.8,
ACUMED PL-SA06L LT 6-H ANROMIOIN PLATE,C1713,HCPCS,,79008512,CDM,278,RC,,,both,,,5082,2005.7,39.4668,,2005.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1727.88,34,,1727.88,percent of total billed charges,Implant Device,1727.88,34,,1727.88,percent of total billed charges,Implant Device,1727.88,34,,1727.88,percent of total billed charges,Implant Device,1727.88,34,,1727.88,percent of total billed charges,Implant Device,1727.88,34,,1727.88,percent of total billed charges,Implant Device,1727.88,34,,1727.88,percent of total billed charges,Implant Device,1778.7,35,,1778.7,percent of total billed charges,Implant Device,1727.88,34,"Charges > $500, x 34%",1727.88,percent of total billed charges,Implant Device,1778.7,35,,1778.7,percent of total billed charges,Implant Devices,1778.7,35,,1778.7,percent of total billed charges,Implant Devices,1778.7,35,,,percent of total billed charges,Implant Devices,1778.7,35,,1778.7,percent of total billed charges,Implant Devices,1778.7,35,,1778.7,percent of total billed charges,Implant Devices,2032.8,40,,2032.8,percent of total billed charges,Implant Devices,1778.7,70,,1778.7,percent of total billed charges,Implant Devices,1727.88,34,,1727.88,percent of total billed charges,Implant Devices,1727.88,34,,1727.88,percent of total billed charges,Implant Devices,1778.7,35,,1778.7,percent of total billed charges,Implant Devices,1778.7,35,,1778.7,percent of total billed charges,Implant Devices,1778.7,35,,1778.7,percent of total billed charges,Implant Devices,1778.7,35,,1778.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1727.88,34,"If Charge > 2,000, then 34 percent",1727.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2032.8,
ACUMED CA-4260 40 X 26MM CAN SCREW,C1713,HCPCS,,79008513,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
ACUMED 30-0256 3.5 X 10MM NON-LOCK SCREW,C1713,HCPCS,,79008514,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
ACUMED 30-0232 3.5 X 8MM LOCK SCREW,C1713,HCPCS,,79008515,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
DEPUY 200.011 CORTEX SCREW 1.5X11MM,C1713,HCPCS,,79008525,CDM,278,RC,,,both,,,113,44.6,39.4668,,44.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,45.2,40,,45.2,percent of total billed charges,Implant Devices,39.55,70,,39.55,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.2,
STRYKER 1822-1034S TIBIAL NAIL 10X345MM,C1713,HCPCS,,79008526,CDM,278,RC,,,both,,,3529,1392.78,39.4668,,1392.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Device,1199.86,34,"Charges > $500, x 34%",1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1411.6,40,,1411.6,percent of total billed charges,Implant Devices,1235.15,70,,1235.15,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1199.86,34,"If Charge > 2,000, then 34 percent",1199.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1411.6,
"LIFE SPINE 132-2308-1 AILERON CORE,SMALL",C1713,HCPCS,,79008528,CDM,278,RC,,,both,,,20520,8098.59,39.4668,,8098.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6976.8,34,,6976.8,percent of total billed charges,Implant Device,6976.8,34,,6976.8,percent of total billed charges,Implant Device,6976.8,34,,6976.8,percent of total billed charges,Implant Device,6976.8,34,,6976.8,percent of total billed charges,Implant Device,6976.8,34,,6976.8,percent of total billed charges,Implant Device,6976.8,34,,6976.8,percent of total billed charges,Implant Device,7182,35,,7182,percent of total billed charges,Implant Device,6976.8,34,"Charges > $500, x 34%",6976.8,percent of total billed charges,Implant Device,7182,35,,7182,percent of total billed charges,Implant Devices,7182,35,,7182,percent of total billed charges,Implant Devices,7182,35,,,percent of total billed charges,Implant Devices,7182,35,,7182,percent of total billed charges,Implant Devices,7182,35,,7182,percent of total billed charges,Implant Devices,8208,40,,8208,percent of total billed charges,Implant Devices,7182,70,,7182,percent of total billed charges,Implant Devices,6976.8,34,,6976.8,percent of total billed charges,Implant Devices,6976.8,34,,6976.8,percent of total billed charges,Implant Devices,7182,35,,7182,percent of total billed charges,Implant Devices,7182,35,,7182,percent of total billed charges,Implant Devices,7182,35,,7182,percent of total billed charges,Implant Devices,7182,35,,7182,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6976.8,34,"If Charge > 2,000, then 34 percent",6976.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8208,
"LIFE SPINE 132-2308-2 AILERON PLT, SMALL",C1713,HCPCS,,79008529,CDM,278,RC,,,both,,,13680,5399.06,39.4668,,5399.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4788,35,,4788,percent of total billed charges,Implant Device,4651.2,34,"Charges > $500, x 34%",4651.2,percent of total billed charges,Implant Device,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,5472,40,,5472,percent of total billed charges,Implant Devices,4788,70,,4788,percent of total billed charges,Implant Devices,4651.2,34,,4651.2,percent of total billed charges,Implant Devices,4651.2,34,,4651.2,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4651.2,34,"If Charge > 2,000, then 34 percent",4651.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5472,
STRYKER 3102-2101 BIO4 BONE MATRIX 1CC,C1713,HCPCS,,79008530,CDM,278,RC,,,both,,,2340,923.52,39.4668,,923.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,795.6,34,,795.6,percent of total billed charges,Implant Device,795.6,34,,795.6,percent of total billed charges,Implant Device,795.6,34,,795.6,percent of total billed charges,Implant Device,795.6,34,,795.6,percent of total billed charges,Implant Device,795.6,34,,795.6,percent of total billed charges,Implant Device,795.6,34,,795.6,percent of total billed charges,Implant Device,819,35,,819,percent of total billed charges,Implant Device,795.6,34,"Charges > $500, x 34%",795.6,percent of total billed charges,Implant Device,819,35,,819,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,819,35,,,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,936,40,,936,percent of total billed charges,Implant Devices,819,70,,819,percent of total billed charges,Implant Devices,795.6,34,,795.6,percent of total billed charges,Implant Devices,795.6,34,,795.6,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,819,35,,819,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,795.6,34,"If Charge > 2,000, then 34 percent",795.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,936,
ARTHREX AR-13200M-07L PLATE WEDGE 7MM,C1713,HCPCS,,79008531,CDM,278,RC,,,both,,,2385,941.28,39.4668,,941.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,834.75,35,,834.75,percent of total billed charges,Implant Device,810.9,34,"Charges > $500, x 34%",810.9,percent of total billed charges,Implant Device,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,954,40,,954,percent of total billed charges,Implant Devices,834.75,70,,834.75,percent of total billed charges,Implant Devices,810.9,34,,810.9,percent of total billed charges,Implant Devices,810.9,34,,810.9,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,810.9,34,"If Charge > 2,000, then 34 percent",810.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,954,
IN2BONES 100-0044 VITRIUM EVANS WEDGE,C1713,HCPCS,,79008532,CDM,278,RC,,,both,,,9450,3729.61,39.4668,,3729.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Device,3213,34,"Charges > $500, x 34%",3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3780,40,,3780,percent of total billed charges,Implant Devices,3307.5,70,,3307.5,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3213,34,"If Charge > 2,000, then 34 percent",3213,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3780,
IN2BONES USA S35 ST128 SCREW 3.5X28MM,C1713,HCPCS,,79008533,CDM,278,RC,,,both,,,1350,532.8,39.4668,,532.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Device,459,34,"Charges > $500, x 34%",459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,540,40,,540,percent of total billed charges,Implant Devices,472.5,70,,472.5,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,540,
ARTHREX AR-5026B-24 COMP SCREW 3.5X24MM,C1713,HCPCS,,79008539,CDM,278,RC,,,both,,,1695,668.96,39.4668,,668.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,593.25,35,,593.25,percent of total billed charges,Implant Device,576.3,34,"Charges > $500, x 34%",576.3,percent of total billed charges,Implant Device,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,678,40,,678,percent of total billed charges,Implant Devices,593.25,70,,593.25,percent of total billed charges,Implant Devices,576.3,34,,576.3,percent of total billed charges,Implant Devices,576.3,34,,576.3,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,678,
ARTHREX AR-5026B-26 COMP SCREW 3.5X26MM,C1713,HCPCS,,79008540,CDM,278,RC,,,both,,,1695,668.96,39.4668,,668.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,593.25,35,,593.25,percent of total billed charges,Implant Device,576.3,34,"Charges > $500, x 34%",576.3,percent of total billed charges,Implant Device,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,678,40,,678,percent of total billed charges,Implant Devices,593.25,70,,593.25,percent of total billed charges,Implant Devices,576.3,34,,576.3,percent of total billed charges,Implant Devices,576.3,34,,576.3,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,678,
ARTHREX AR-5026B-28 COMP SCREW 3.5X28MM,C1713,HCPCS,,79008541,CDM,278,RC,,,both,,,1695,668.96,39.4668,,668.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,593.25,35,,593.25,percent of total billed charges,Implant Device,576.3,34,"Charges > $500, x 34%",576.3,percent of total billed charges,Implant Device,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,678,40,,678,percent of total billed charges,Implant Devices,593.25,70,,593.25,percent of total billed charges,Implant Devices,576.3,34,,576.3,percent of total billed charges,Implant Devices,576.3,34,,576.3,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,678,
STRYKER F&A 626895 POLY LOCK PLATE (T8),C1713,HCPCS,,79008543,CDM,278,RC,,,both,,,8652,3414.67,39.4668,,3414.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2941.68,34,,2941.68,percent of total billed charges,Implant Device,2941.68,34,,2941.68,percent of total billed charges,Implant Device,2941.68,34,,2941.68,percent of total billed charges,Implant Device,2941.68,34,,2941.68,percent of total billed charges,Implant Device,2941.68,34,,2941.68,percent of total billed charges,Implant Device,2941.68,34,,2941.68,percent of total billed charges,Implant Device,3028.2,35,,3028.2,percent of total billed charges,Implant Device,2941.68,34,"Charges > $500, x 34%",2941.68,percent of total billed charges,Implant Device,3028.2,35,,3028.2,percent of total billed charges,Implant Devices,3028.2,35,,3028.2,percent of total billed charges,Implant Devices,3028.2,35,,,percent of total billed charges,Implant Devices,3028.2,35,,3028.2,percent of total billed charges,Implant Devices,3028.2,35,,3028.2,percent of total billed charges,Implant Devices,3460.8,40,,3460.8,percent of total billed charges,Implant Devices,3028.2,70,,3028.2,percent of total billed charges,Implant Devices,2941.68,34,,2941.68,percent of total billed charges,Implant Devices,2941.68,34,,2941.68,percent of total billed charges,Implant Devices,3028.2,35,,3028.2,percent of total billed charges,Implant Devices,3028.2,35,,3028.2,percent of total billed charges,Implant Devices,3028.2,35,,3028.2,percent of total billed charges,Implant Devices,3028.2,35,,3028.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2941.68,34,"If Charge > 2,000, then 34 percent",2941.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3460.8,
STRYKER 661490 NON LOCKNG SCREW 3.5X90MM,C1713,HCPCS,,79008544,CDM,278,RC,,,both,,,171,67.49,39.4668,,67.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,58.14,34,,58.14,percent of total billed charges,Implant Device,59.85,35,,59.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,68.4,40,,68.4,percent of total billed charges,Implant Devices,59.85,70,,59.85,percent of total billed charges,Implant Devices,58.14,34,,58.14,percent of total billed charges,Implant Devices,58.14,34,,58.14,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,59.85,35,,59.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,68.4,
STRYKER SV14 S-FIX SCREW 2.5LG 14MM,C1713,HCPCS,,79008545,CDM,278,RC,,,both,,,1486,586.48,39.4668,,586.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,505.24,34,,505.24,percent of total billed charges,Implant Device,505.24,34,,505.24,percent of total billed charges,Implant Device,505.24,34,,505.24,percent of total billed charges,Implant Device,505.24,34,,505.24,percent of total billed charges,Implant Device,505.24,34,,505.24,percent of total billed charges,Implant Device,505.24,34,,505.24,percent of total billed charges,Implant Device,520.1,35,,520.1,percent of total billed charges,Implant Device,505.24,34,"Charges > $500, x 34%",505.24,percent of total billed charges,Implant Device,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,594.4,40,,594.4,percent of total billed charges,Implant Devices,520.1,70,,520.1,percent of total billed charges,Implant Devices,505.24,34,,505.24,percent of total billed charges,Implant Devices,505.24,34,,505.24,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,594.4,
STRYKER 3525-0380S NAIL KIT 010X380X125,C1713,HCPCS,,79008549,CDM,278,RC,,,both,,,4920,1941.77,39.4668,,1941.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1722,35,,1722,percent of total billed charges,Implant Device,1672.8,34,"Charges > $500, x 34%",1672.8,percent of total billed charges,Implant Device,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1968,40,,1968,percent of total billed charges,Implant Devices,1722,70,,1722,percent of total billed charges,Implant Devices,1672.8,34,,1672.8,percent of total billed charges,Implant Devices,1672.8,34,,1672.8,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1672.8,34,"If Charge > 2,000, then 34 percent",1672.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1968,
DEPUY 02.221.512S LOCKING SCREW 5.0X12MM,C1713,HCPCS,,79008552,CDM,278,RC,,,both,,,564,222.59,39.4668,,222.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.76,34,,191.76,percent of total billed charges,Implant Device,191.76,34,,191.76,percent of total billed charges,Implant Device,191.76,34,,191.76,percent of total billed charges,Implant Device,191.76,34,,191.76,percent of total billed charges,Implant Device,191.76,34,,191.76,percent of total billed charges,Implant Device,191.76,34,,191.76,percent of total billed charges,Implant Device,197.4,35,,197.4,percent of total billed charges,Implant Device,191.76,34,"Charges > $500, x 34%",191.76,percent of total billed charges,Implant Device,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,225.6,40,,225.6,percent of total billed charges,Implant Devices,197.4,70,,197.4,percent of total billed charges,Implant Devices,191.76,34,,191.76,percent of total billed charges,Implant Devices,191.76,34,,191.76,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,197.4,35,,197.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,225.6,
STRYKER 5572-4516 PERI SCREW 4.5X16MM,C1713,HCPCS,,79008554,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
STRYKER 5573-6528 CTR SCREW 6.5X28MM,C1713,HCPCS,,79008556,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
DEPUY 204.810 CORTEX SCREW 3.5X10MM,C1713,HCPCS,,79008557,CDM,278,RC,,,both,,,82,32.36,39.4668,,32.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,27.88,34,,27.88,percent of total billed charges,Implant Device,28.7,35,,28.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,32.8,40,,32.8,percent of total billed charges,Implant Devices,28.7,70,,28.7,percent of total billed charges,Implant Devices,27.88,34,,27.88,percent of total billed charges,Implant Devices,27.88,34,,27.88,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,28.7,35,,28.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.8,
ARTHREX AR-1588BTB-J TIGHTROPE W/SUTURE,C1713,HCPCS,,79008563,CDM,278,RC,,,both,,,1335,526.88,39.4668,,526.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,453.9,34,,453.9,percent of total billed charges,Implant Device,453.9,34,,453.9,percent of total billed charges,Implant Device,453.9,34,,453.9,percent of total billed charges,Implant Device,453.9,34,,453.9,percent of total billed charges,Implant Device,453.9,34,,453.9,percent of total billed charges,Implant Device,453.9,34,,453.9,percent of total billed charges,Implant Device,467.25,35,,467.25,percent of total billed charges,Implant Device,453.9,34,"Charges > $500, x 34%",453.9,percent of total billed charges,Implant Device,467.25,35,,467.25,percent of total billed charges,Implant Devices,467.25,35,,467.25,percent of total billed charges,Implant Devices,467.25,35,,,percent of total billed charges,Implant Devices,467.25,35,,467.25,percent of total billed charges,Implant Devices,467.25,35,,467.25,percent of total billed charges,Implant Devices,534,40,,534,percent of total billed charges,Implant Devices,467.25,70,,467.25,percent of total billed charges,Implant Devices,453.9,34,,453.9,percent of total billed charges,Implant Devices,453.9,34,,453.9,percent of total billed charges,Implant Devices,467.25,35,,467.25,percent of total billed charges,Implant Devices,467.25,35,,467.25,percent of total billed charges,Implant Devices,467.25,35,,467.25,percent of total billed charges,Implant Devices,467.25,35,,467.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,534,
ARTHREX AR-1588TB-4 TIGHTROPE BUTTON 14,C1713,HCPCS,,79008564,CDM,278,RC,,,both,,,672,265.22,39.4668,,265.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,235.2,35,,235.2,percent of total billed charges,Implant Device,228.48,34,"Charges > $500, x 34%",228.48,percent of total billed charges,Implant Device,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,268.8,40,,268.8,percent of total billed charges,Implant Devices,235.2,70,,235.2,percent of total billed charges,Implant Devices,228.48,34,,228.48,percent of total billed charges,Implant Devices,228.48,34,,228.48,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.8,
ARTHREX AR-1588TB-5 TIGHTROPE IMP 8X12,C1713,HCPCS,,79008565,CDM,278,RC,,,both,,,672,265.22,39.4668,,265.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,235.2,35,,235.2,percent of total billed charges,Implant Device,228.48,34,"Charges > $500, x 34%",228.48,percent of total billed charges,Implant Device,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,268.8,40,,268.8,percent of total billed charges,Implant Devices,235.2,70,,235.2,percent of total billed charges,Implant Devices,228.48,34,,228.48,percent of total billed charges,Implant Devices,228.48,34,,228.48,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.8,
EXACTECH 05-090-01-1407 FUSION 12X14.7MM,C1713,HCPCS,,79008566,CDM,278,RC,,,both,,,11745,4635.38,39.4668,,4635.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3993.3,34,,3993.3,percent of total billed charges,Implant Device,3993.3,34,,3993.3,percent of total billed charges,Implant Device,3993.3,34,,3993.3,percent of total billed charges,Implant Device,3993.3,34,,3993.3,percent of total billed charges,Implant Device,3993.3,34,,3993.3,percent of total billed charges,Implant Device,3993.3,34,,3993.3,percent of total billed charges,Implant Device,4110.75,35,,4110.75,percent of total billed charges,Implant Device,3993.3,34,"Charges > $500, x 34%",3993.3,percent of total billed charges,Implant Device,4110.75,35,,4110.75,percent of total billed charges,Implant Devices,4110.75,35,,4110.75,percent of total billed charges,Implant Devices,4110.75,35,,,percent of total billed charges,Implant Devices,4110.75,35,,4110.75,percent of total billed charges,Implant Devices,4110.75,35,,4110.75,percent of total billed charges,Implant Devices,4698,40,,4698,percent of total billed charges,Implant Devices,4110.75,70,,4110.75,percent of total billed charges,Implant Devices,3993.3,34,,3993.3,percent of total billed charges,Implant Devices,3993.3,34,,3993.3,percent of total billed charges,Implant Devices,4110.75,35,,4110.75,percent of total billed charges,Implant Devices,4110.75,35,,4110.75,percent of total billed charges,Implant Devices,4110.75,35,,4110.75,percent of total billed charges,Implant Devices,4110.75,35,,4110.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3993.3,34,"If Charge > 2,000, then 34 percent",3993.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4698,
DEPUY 243.33 2.0MML PLATES OBLIQUE LEFT,C1713,HCPCS,,79008572,CDM,278,RC,,,both,,,214,84.46,39.4668,,84.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,72.76,34,,72.76,percent of total billed charges,Implant Device,72.76,34,,72.76,percent of total billed charges,Implant Device,72.76,34,,72.76,percent of total billed charges,Implant Device,72.76,34,,72.76,percent of total billed charges,Implant Device,72.76,34,,72.76,percent of total billed charges,Implant Device,72.76,34,,72.76,percent of total billed charges,Implant Device,74.9,35,,74.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,74.9,35,,74.9,percent of total billed charges,Implant Devices,74.9,35,,74.9,percent of total billed charges,Implant Devices,74.9,35,,,percent of total billed charges,Implant Devices,74.9,35,,74.9,percent of total billed charges,Implant Devices,74.9,35,,74.9,percent of total billed charges,Implant Devices,85.6,40,,85.6,percent of total billed charges,Implant Devices,74.9,70,,74.9,percent of total billed charges,Implant Devices,72.76,34,,72.76,percent of total billed charges,Implant Devices,72.76,34,,72.76,percent of total billed charges,Implant Devices,74.9,35,,74.9,percent of total billed charges,Implant Devices,74.9,35,,74.9,percent of total billed charges,Implant Devices,74.9,35,,74.9,percent of total billed charges,Implant Devices,74.9,35,,74.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,85.6,
LOCKING SCREW 3.5X34MM,C1713,HCPCS,,79008574,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
LOCKING SCREW 3.5X28MM,C1713,HCPCS,,79008575,CDM,278,RC,,,both,,,458,180.76,39.4668,,180.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.72,34,,155.72,percent of total billed charges,Implant Device,155.72,34,,155.72,percent of total billed charges,Implant Device,155.72,34,,155.72,percent of total billed charges,Implant Device,155.72,34,,155.72,percent of total billed charges,Implant Device,155.72,34,,155.72,percent of total billed charges,Implant Device,155.72,34,,155.72,percent of total billed charges,Implant Device,160.3,35,,160.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,183.2,40,,183.2,percent of total billed charges,Implant Devices,160.3,70,,160.3,percent of total billed charges,Implant Devices,155.72,34,,155.72,percent of total billed charges,Implant Devices,155.72,34,,155.72,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,183.2,
LOCKING SCREW 3.5X30MM,C1713,HCPCS,,79008576,CDM,278,RC,,,both,,,458,180.76,39.4668,,180.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.72,34,,155.72,percent of total billed charges,Implant Device,155.72,34,,155.72,percent of total billed charges,Implant Device,155.72,34,,155.72,percent of total billed charges,Implant Device,155.72,34,,155.72,percent of total billed charges,Implant Device,155.72,34,,155.72,percent of total billed charges,Implant Device,155.72,34,,155.72,percent of total billed charges,Implant Device,160.3,35,,160.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,183.2,40,,183.2,percent of total billed charges,Implant Devices,160.3,70,,160.3,percent of total billed charges,Implant Devices,155.72,34,,155.72,percent of total billed charges,Implant Devices,155.72,34,,155.72,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,160.3,35,,160.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,183.2,
LOCKING SCREW 3.5X32MM,C1713,HCPCS,,79008577,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
LOCKING SCREW 3.5X34MM,C1713,HCPCS,,79008578,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
STRYKER F&A 955-3002 BREAK AWAY SCREW TI,C1713,HCPCS,,79008579,CDM,278,RC,,,both,,,711,280.61,39.4668,,280.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,248.85,35,,248.85,percent of total billed charges,Implant Device,241.74,34,"Charges > $500, x 34%",241.74,percent of total billed charges,Implant Device,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,284.4,40,,284.4,percent of total billed charges,Implant Devices,248.85,70,,248.85,percent of total billed charges,Implant Devices,241.74,34,,241.74,percent of total billed charges,Implant Devices,241.74,34,,241.74,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,284.4,
ZIMMER 00-2357-102-18 DIST LAT PLATE 18H,C1713,HCPCS,,79008580,CDM,278,RC,,,both,,,5095,2010.83,39.4668,,2010.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1732.3,34,,1732.3,percent of total billed charges,Implant Device,1732.3,34,,1732.3,percent of total billed charges,Implant Device,1732.3,34,,1732.3,percent of total billed charges,Implant Device,1732.3,34,,1732.3,percent of total billed charges,Implant Device,1732.3,34,,1732.3,percent of total billed charges,Implant Device,1732.3,34,,1732.3,percent of total billed charges,Implant Device,1783.25,35,,1783.25,percent of total billed charges,Implant Device,1732.3,34,"Charges > $500, x 34%",1732.3,percent of total billed charges,Implant Device,1783.25,35,,1783.25,percent of total billed charges,Implant Devices,1783.25,35,,1783.25,percent of total billed charges,Implant Devices,1783.25,35,,,percent of total billed charges,Implant Devices,1783.25,35,,1783.25,percent of total billed charges,Implant Devices,1783.25,35,,1783.25,percent of total billed charges,Implant Devices,2038,40,,2038,percent of total billed charges,Implant Devices,1783.25,70,,1783.25,percent of total billed charges,Implant Devices,1732.3,34,,1732.3,percent of total billed charges,Implant Devices,1732.3,34,,1732.3,percent of total billed charges,Implant Devices,1783.25,35,,1783.25,percent of total billed charges,Implant Devices,1783.25,35,,1783.25,percent of total billed charges,Implant Devices,1783.25,35,,1783.25,percent of total billed charges,Implant Devices,1783.25,35,,1783.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1732.3,34,"If Charge > 2,000, then 34 percent",1732.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2038,
ZIMMER 00-2347-023-46 PERI SCREW 4.5X46,C1713,HCPCS,,79008581,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
ZIMMER 00-2359-024-45 LOCK SCREW 4.5X24,C1713,HCPCS,,79008582,CDM,278,RC,,,both,,,445,175.63,39.4668,,175.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,178,40,,178,percent of total billed charges,Implant Devices,155.75,70,,155.75,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178,
ZIMMER 00-2359-012-45 LOCK SCREW 4.5X12,C1713,HCPCS,,79008583,CDM,278,RC,,,both,,,445,175.63,39.4668,,175.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,178,40,,178,percent of total billed charges,Implant Devices,155.75,70,,155.75,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178,
ZIMMER 00-2347-023-55 PERI SCREW 4.5X55,C1713,HCPCS,,79008584,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
MEDTRONIC 7510800 INFUSE BONE GRAFT 8ML,C1713,HCPCS,,79008585,CDM,278,RC,,,both,,,17205,6790.26,39.4668,,6790.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5849.7,34,,5849.7,percent of total billed charges,Implant Device,5849.7,34,,5849.7,percent of total billed charges,Implant Device,5849.7,34,,5849.7,percent of total billed charges,Implant Device,5849.7,34,,5849.7,percent of total billed charges,Implant Device,5849.7,34,,5849.7,percent of total billed charges,Implant Device,5849.7,34,,5849.7,percent of total billed charges,Implant Device,6021.75,35,,6021.75,percent of total billed charges,Implant Device,5849.7,34,"Charges > $500, x 34%",5849.7,percent of total billed charges,Implant Device,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6882,40,,6882,percent of total billed charges,Implant Devices,6021.75,70,,6021.75,percent of total billed charges,Implant Devices,5849.7,34,,5849.7,percent of total billed charges,Implant Devices,5849.7,34,,5849.7,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5849.7,34,"If Charge > 2,000, then 34 percent",5849.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6882,
DEPUY 456.324S FIXATION NAIL 10MM/125DEG,C1713,HCPCS,,79008597,CDM,278,RC,,,both,,,2738,1080.6,39.4668,,1080.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,930.92,34,,930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Device,930.92,34,"Charges > $500, x 34%",930.92,percent of total billed charges,Implant Device,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,1095.2,40,,1095.2,percent of total billed charges,Implant Devices,958.3,70,,958.3,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,930.92,34,,930.92,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,958.3,35,,958.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,930.92,34,"If Charge > 2,000, then 34 percent",930.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1095.2,
STRYKER 663050 CANN COMP SCREW 4.0/L50MM,C1713,HCPCS,,79008606,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
STRYKER 663150 CANN COMP SCREW 5.0/L50MM,C1713,HCPCS,,79008607,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
STRYKER SK2710-38 CORTICAL SCREW 2.7X38,C1713,HCPCS,,79008616,CDM,278,RC,,,both,,,255,100.64,39.4668,,100.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,89.25,35,,89.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,102,40,,102,percent of total billed charges,Implant Devices,89.25,70,,89.25,percent of total billed charges,Implant Devices,86.7,34,,86.7,percent of total billed charges,Implant Devices,86.7,34,,86.7,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102,
STRYKER SK2710-22 CORTICAL SCREW 2.7X22,C1713,HCPCS,,79008617,CDM,278,RC,,,both,,,255,100.64,39.4668,,100.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,89.25,35,,89.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,102,40,,102,percent of total billed charges,Implant Devices,89.25,70,,89.25,percent of total billed charges,Implant Devices,86.7,34,,86.7,percent of total billed charges,Implant Devices,86.7,34,,86.7,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102,
STRYKER 325028 CANNULATED SCREW 4.0X28MM,C1713,HCPCS,,79008618,CDM,278,RC,,,both,,,770,303.89,39.4668,,303.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Device,261.8,34,"Charges > $500, x 34%",261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,308,40,,308,percent of total billed charges,Implant Devices,269.5,70,,269.5,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,308,
STRYKER 325038 CANNULATED SCREW 4.0X38MM,C1713,HCPCS,,79008619,CDM,278,RC,,,both,,,770,303.89,39.4668,,303.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Device,261.8,34,"Charges > $500, x 34%",261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,308,40,,308,percent of total billed charges,Implant Devices,269.5,70,,269.5,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,308,
STRYKER 629343 OLECRANON PLATE 3 HOLE LT,C1713,HCPCS,,79008620,CDM,278,RC,,,both,,,2543,1003.64,39.4668,,1003.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Device,864.62,34,"Charges > $500, x 34%",864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,1017.2,40,,1017.2,percent of total billed charges,Implant Devices,890.05,70,,890.05,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,864.62,34,"If Charge > 2,000, then 34 percent",864.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1017.2,
STRYKER 614770 NON LOCKING SCREW 2.7X70,C1713,HCPCS,,79008621,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
STRYKER 614836 NON LOCKING SCREW 3.5X36,C1713,HCPCS,,79008622,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
STRYKER 614826 NON LOCKING SCREW 3.5X26,C1713,HCPCS,,79008623,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
DEPUY 223.561 LCP PLATE 3.5MM 6 HOLE,C1713,HCPCS,,79008624,CDM,278,RC,,,both,,,1210,477.55,39.4668,,477.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,411.4,34,,411.4,percent of total billed charges,Implant Device,411.4,34,,411.4,percent of total billed charges,Implant Device,411.4,34,,411.4,percent of total billed charges,Implant Device,411.4,34,,411.4,percent of total billed charges,Implant Device,411.4,34,,411.4,percent of total billed charges,Implant Device,411.4,34,,411.4,percent of total billed charges,Implant Device,423.5,35,,423.5,percent of total billed charges,Implant Device,411.4,34,"Charges > $500, x 34%",411.4,percent of total billed charges,Implant Device,423.5,35,,423.5,percent of total billed charges,Implant Devices,423.5,35,,423.5,percent of total billed charges,Implant Devices,423.5,35,,,percent of total billed charges,Implant Devices,423.5,35,,423.5,percent of total billed charges,Implant Devices,423.5,35,,423.5,percent of total billed charges,Implant Devices,484,40,,484,percent of total billed charges,Implant Devices,423.5,70,,423.5,percent of total billed charges,Implant Devices,411.4,34,,411.4,percent of total billed charges,Implant Devices,411.4,34,,411.4,percent of total billed charges,Implant Devices,423.5,35,,423.5,percent of total billed charges,Implant Devices,423.5,35,,423.5,percent of total billed charges,Implant Devices,423.5,35,,423.5,percent of total billed charges,Implant Devices,423.5,35,,423.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,484,
DEPUY SYNTHES 202.808 2.7 X 8MM SCREW,C1713,HCPCS,,79008626,CDM,278,RC,,,both,,,128,50.52,39.4668,,50.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,43.52,34,,43.52,percent of total billed charges,Implant Device,44.8,35,,44.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,51.2,40,,51.2,percent of total billed charges,Implant Devices,44.8,70,,44.8,percent of total billed charges,Implant Devices,43.52,34,,43.52,percent of total billed charges,Implant Devices,43.52,34,,43.52,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,44.8,35,,44.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,51.2,
DEPUY SYNTHES 201.808 2.0 X 8MM SCREW,C1713,HCPCS,,79008627,CDM,278,RC,,,both,,,126,49.73,39.4668,,49.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,50.4,40,,50.4,percent of total billed charges,Implant Devices,44.1,70,,44.1,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50.4,
STRYKER 661040 4.0X40MM LOCKING SCREW,C1713,HCPCS,,79008630,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 661048 4.0X48MM LOCKING SCREW,C1713,HCPCS,,79008631,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 661055 4.0X55MM LOCKING SCREW,C1713,HCPCS,,79008632,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 607355 4.0X55M CORTICAL SCREW,C1713,HCPCS,,79008633,CDM,278,RC,,,both,,,133,52.49,39.4668,,52.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,53.2,40,,53.2,percent of total billed charges,Implant Devices,46.55,70,,46.55,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
WRIGHT CCP-L3518 LOCKING SCREW 3.5X18MM,C1713,HCPCS,,79008636,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
DEPUY 1739-28-000 CABLE&SLEEVE 1.8MMX24,C1713,HCPCS,,79008639,CDM,278,RC,,,both,,,1877,740.79,39.4668,,740.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,656.95,35,,656.95,percent of total billed charges,Implant Device,638.18,34,"Charges > $500, x 34%",638.18,percent of total billed charges,Implant Device,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,750.8,40,,750.8,percent of total billed charges,Implant Devices,656.95,70,,656.95,percent of total billed charges,Implant Devices,638.18,34,,638.18,percent of total billed charges,Implant Devices,638.18,34,,638.18,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,750.8,
DEPUY 207.736 4.0X36MM CANN LONG SCREW,C1713,HCPCS,,79008640,CDM,278,RC,,,both,,,686,270.74,39.4668,,270.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,233.24,34,,233.24,percent of total billed charges,Implant Device,240.1,35,,240.1,percent of total billed charges,Implant Device,233.24,34,"Charges > $500, x 34%",233.24,percent of total billed charges,Implant Device,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,274.4,40,,274.4,percent of total billed charges,Implant Devices,240.1,70,,240.1,percent of total billed charges,Implant Devices,233.24,34,,233.24,percent of total billed charges,Implant Devices,233.24,34,,233.24,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,240.1,35,,240.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.4,
STRYKER PLSS3018 ANCHORAGE SCREW 3X18MM,C1713,HCPCS,,79008641,CDM,278,RC,,,both,,,675,266.4,39.4668,,266.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Device,229.5,34,"Charges > $500, x 34%",229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,270,40,,270,percent of total billed charges,Implant Devices,236.25,70,,236.25,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270,
STRYKER PLSS3020 ANCHORAGE SCREW 3X20MM,C1713,HCPCS,,79008642,CDM,278,RC,,,both,,,759,299.55,39.4668,,299.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,265.65,35,,265.65,percent of total billed charges,Implant Device,258.06,34,"Charges > $500, x 34%",258.06,percent of total billed charges,Implant Device,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,303.6,40,,303.6,percent of total billed charges,Implant Devices,265.65,70,,265.65,percent of total billed charges,Implant Devices,258.06,34,,258.06,percent of total billed charges,Implant Devices,258.06,34,,258.06,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,303.6,
STRYKER 2102-2110 VITOSS FOAM STRIP,C1713,HCPCS,,79008643,CDM,278,RC,,,both,,,14412,5687.96,39.4668,,5687.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4900.08,34,,4900.08,percent of total billed charges,Implant Device,4900.08,34,,4900.08,percent of total billed charges,Implant Device,4900.08,34,,4900.08,percent of total billed charges,Implant Device,4900.08,34,,4900.08,percent of total billed charges,Implant Device,4900.08,34,,4900.08,percent of total billed charges,Implant Device,4900.08,34,,4900.08,percent of total billed charges,Implant Device,5044.2,35,,5044.2,percent of total billed charges,Implant Device,4900.08,34,"Charges > $500, x 34%",4900.08,percent of total billed charges,Implant Device,5044.2,35,,5044.2,percent of total billed charges,Implant Devices,5044.2,35,,5044.2,percent of total billed charges,Implant Devices,5044.2,35,,,percent of total billed charges,Implant Devices,5044.2,35,,5044.2,percent of total billed charges,Implant Devices,5044.2,35,,5044.2,percent of total billed charges,Implant Devices,5764.8,40,,5764.8,percent of total billed charges,Implant Devices,5044.2,70,,5044.2,percent of total billed charges,Implant Devices,4900.08,34,,4900.08,percent of total billed charges,Implant Devices,4900.08,34,,4900.08,percent of total billed charges,Implant Devices,5044.2,35,,5044.2,percent of total billed charges,Implant Devices,5044.2,35,,5044.2,percent of total billed charges,Implant Devices,5044.2,35,,5044.2,percent of total billed charges,Implant Devices,5044.2,35,,5044.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4900.08,34,"If Charge > 2,000, then 34 percent",4900.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5764.8,
STRYKER 601665 CANNULATED SCREW 5X65MM,C1713,HCPCS,,79008644,CDM,278,RC,,,both,,,847,334.28,39.4668,,334.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,296.45,35,,296.45,percent of total billed charges,Implant Device,287.98,34,"Charges > $500, x 34%",287.98,percent of total billed charges,Implant Device,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,338.8,40,,338.8,percent of total billed charges,Implant Devices,296.45,70,,296.45,percent of total billed charges,Implant Devices,287.98,34,,287.98,percent of total billed charges,Implant Devices,287.98,34,,287.98,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,338.8,
STRYKER 5017-2-150S HALF PIN 5MM 150X20,C1713,HCPCS,,79008647,CDM,278,RC,,,both,,,752,296.79,39.4668,,296.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255.68,34,,255.68,percent of total billed charges,Implant Device,255.68,34,,255.68,percent of total billed charges,Implant Device,255.68,34,,255.68,percent of total billed charges,Implant Device,255.68,34,,255.68,percent of total billed charges,Implant Device,255.68,34,,255.68,percent of total billed charges,Implant Device,255.68,34,,255.68,percent of total billed charges,Implant Device,263.2,35,,263.2,percent of total billed charges,Implant Device,255.68,34,"Charges > $500, x 34%",255.68,percent of total billed charges,Implant Device,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,300.8,40,,300.8,percent of total billed charges,Implant Devices,263.2,70,,263.2,percent of total billed charges,Implant Devices,255.68,34,,255.68,percent of total billed charges,Implant Devices,255.68,34,,255.68,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300.8,
ARTHREX AR-8970TTC LATERAL CALCANEAL PLT,C1713,HCPCS,,79008652,CDM,278,RC,,,both,,,9324,3679.88,39.4668,,3679.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3170.16,34,,3170.16,percent of total billed charges,Implant Device,3170.16,34,,3170.16,percent of total billed charges,Implant Device,3170.16,34,,3170.16,percent of total billed charges,Implant Device,3170.16,34,,3170.16,percent of total billed charges,Implant Device,3170.16,34,,3170.16,percent of total billed charges,Implant Device,3170.16,34,,3170.16,percent of total billed charges,Implant Device,3263.4,35,,3263.4,percent of total billed charges,Implant Device,3170.16,34,"Charges > $500, x 34%",3170.16,percent of total billed charges,Implant Device,3263.4,35,,3263.4,percent of total billed charges,Implant Devices,3263.4,35,,3263.4,percent of total billed charges,Implant Devices,3263.4,35,,,percent of total billed charges,Implant Devices,3263.4,35,,3263.4,percent of total billed charges,Implant Devices,3263.4,35,,3263.4,percent of total billed charges,Implant Devices,3729.6,40,,3729.6,percent of total billed charges,Implant Devices,3263.4,70,,3263.4,percent of total billed charges,Implant Devices,3170.16,34,,3170.16,percent of total billed charges,Implant Devices,3170.16,34,,3170.16,percent of total billed charges,Implant Devices,3263.4,35,,3263.4,percent of total billed charges,Implant Devices,3263.4,35,,3263.4,percent of total billed charges,Implant Devices,3263.4,35,,3263.4,percent of total billed charges,Implant Devices,3263.4,35,,3263.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3170.16,34,"If Charge > 2,000, then 34 percent",3170.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3729.6,
ARTHREX AR-8545-40 CORT SCREW 4.5X40MM,C1713,HCPCS,,79008653,CDM,278,RC,,,both,,,225,88.8,39.4668,,88.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,90,40,,90,percent of total billed charges,Implant Devices,78.75,70,,78.75,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90,
ARTHREX AR-8545-45 CORT SCREW 4.5X45MM,C1713,HCPCS,,79008654,CDM,278,RC,,,both,,,225,88.8,39.4668,,88.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,90,40,,90,percent of total billed charges,Implant Devices,78.75,70,,78.75,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90,
ARTHREX AR-8545-50 CORT SCREW 4.5X50MM,C1713,HCPCS,,79008655,CDM,278,RC,,,both,,,225,88.8,39.4668,,88.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,90,40,,90,percent of total billed charges,Implant Devices,78.75,70,,78.75,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90,
ARTHREX AR-8545L-45 LOCK SCREW 4.5X45MM,C1713,HCPCS,,79008656,CDM,278,RC,,,both,,,837,330.34,39.4668,,330.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Device,284.58,34,"Charges > $500, x 34%",284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,334.8,40,,334.8,percent of total billed charges,Implant Devices,292.95,70,,292.95,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.8,
ARTHREX AR-8555-45 CANC SCREW 5.5X45MM,C1713,HCPCS,,79008657,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ARTHREX AR-8555-50 CANC SCREW 5.5X50MM,C1713,HCPCS,,79008658,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ARTHREX AR-8555-65 CANC SCREW 5.5X65MM,C1713,HCPCS,,79008659,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER 657420 NON LOCK SCREW 3.5X20MM,C1713,HCPCS,,79008663,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657316 LOCKING SCREW 3.5X16MM,C1713,HCPCS,,79008664,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 627203 PROX HUMERAL PLATE 3 HOLE,C1713,HCPCS,,79008672,CDM,278,RC,,,both,,,6634,2618.23,39.4668,,2618.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2321.9,35,,2321.9,percent of total billed charges,Implant Device,2255.56,34,"Charges > $500, x 34%",2255.56,percent of total billed charges,Implant Device,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2653.6,40,,2653.6,percent of total billed charges,Implant Devices,2321.9,70,,2321.9,percent of total billed charges,Implant Devices,2255.56,34,,2255.56,percent of total billed charges,Implant Devices,2255.56,34,,2255.56,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2255.56,34,"If Charge > 2,000, then 34 percent",2255.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2653.6,
STRYKER 626773 LOCKING PLATE LEFT LONG,C1713,HCPCS,,79008682,CDM,278,RC,,,both,,,7368,2907.91,39.4668,,2907.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2578.8,35,,2578.8,percent of total billed charges,Implant Device,2505.12,34,"Charges > $500, x 34%",2505.12,percent of total billed charges,Implant Device,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2947.2,40,,2947.2,percent of total billed charges,Implant Devices,2578.8,70,,2578.8,percent of total billed charges,Implant Devices,2505.12,34,,2505.12,percent of total billed charges,Implant Devices,2505.12,34,,2505.12,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2505.12,34,"If Charge > 2,000, then 34 percent",2505.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2947.2,
STRYKER 657324 LOCKING SCREW 3.5XL24MM,C1713,HCPCS,,79008683,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 657322 LOCKING SCREW 3.5XL22MM,C1713,HCPCS,,79008684,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 657428 BONE SCREW 3.5XL28MM,C1713,HCPCS,,79008685,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657320 LOCKING SCREW 3.5XL20MM,C1713,HCPCS,,79008686,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 657432 BONE SCREW 3.5XL32MM,C1713,HCPCS,,79008687,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657436 BONE SCREW 3.5XL36MM,C1713,HCPCS,,79008688,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
RTI D00101 BIOREADY DBM PUTTY 1CC,C1713,HCPCS,,79008689,CDM,278,RC,,,both,,,489,192.99,39.4668,,192.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,166.26,34,,166.26,percent of total billed charges,Implant Device,166.26,34,,166.26,percent of total billed charges,Implant Device,166.26,34,,166.26,percent of total billed charges,Implant Device,166.26,34,,166.26,percent of total billed charges,Implant Device,166.26,34,,166.26,percent of total billed charges,Implant Device,166.26,34,,166.26,percent of total billed charges,Implant Device,171.15,35,,171.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,171.15,35,,171.15,percent of total billed charges,Implant Devices,171.15,35,,171.15,percent of total billed charges,Implant Devices,171.15,35,,,percent of total billed charges,Implant Devices,171.15,35,,171.15,percent of total billed charges,Implant Devices,171.15,35,,171.15,percent of total billed charges,Implant Devices,195.6,40,,195.6,percent of total billed charges,Implant Devices,171.15,70,,171.15,percent of total billed charges,Implant Devices,166.26,34,,166.26,percent of total billed charges,Implant Devices,166.26,34,,166.26,percent of total billed charges,Implant Devices,171.15,35,,171.15,percent of total billed charges,Implant Devices,171.15,35,,171.15,percent of total billed charges,Implant Devices,171.15,35,,171.15,percent of total billed charges,Implant Devices,171.15,35,,171.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.6,
RTI D00102 BIOREADY DBM PUTTY 2CC,C1713,HCPCS,,79008690,CDM,278,RC,,,both,,,846,333.89,39.4668,,333.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Device,287.64,34,"Charges > $500, x 34%",287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,338.4,40,,338.4,percent of total billed charges,Implant Devices,296.1,70,,296.1,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,338.4,
RTI D00105 BIOREADY DBM PUTTY 5CC,C1713,HCPCS,,79008691,CDM,278,RC,,,both,,,1761,695.01,39.4668,,695.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,616.35,35,,616.35,percent of total billed charges,Implant Device,598.74,34,"Charges > $500, x 34%",598.74,percent of total billed charges,Implant Device,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,704.4,40,,704.4,percent of total billed charges,Implant Devices,616.35,70,,616.35,percent of total billed charges,Implant Devices,598.74,34,,598.74,percent of total billed charges,Implant Devices,598.74,34,,598.74,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,704.4,
RTI D00302 BIOREADY DBM PUTTY W/CHIPS,C1713,HCPCS,,79008692,CDM,278,RC,,,both,,,846,333.89,39.4668,,333.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Device,287.64,34,"Charges > $500, x 34%",287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,338.4,40,,338.4,percent of total billed charges,Implant Devices,296.1,70,,296.1,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,338.4,
RTI D00305 BIOREADY DBM PUTTY W/CHIPS,C1713,HCPCS,,79008693,CDM,278,RC,,,both,,,1761,695.01,39.4668,,695.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,616.35,35,,616.35,percent of total billed charges,Implant Device,598.74,34,"Charges > $500, x 34%",598.74,percent of total billed charges,Implant Device,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,704.4,40,,704.4,percent of total billed charges,Implant Devices,616.35,70,,616.35,percent of total billed charges,Implant Devices,598.74,34,,598.74,percent of total billed charges,Implant Devices,598.74,34,,598.74,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,704.4,
RTI 100415 CANCELLOUS CHIPS 15CC,C1713,HCPCS,,79008694,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
RTI 100430 CANCELLOUS CHIPS 30CC,C1713,HCPCS,,79008695,CDM,278,RC,,,both,,,1395,550.56,39.4668,,550.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,488.25,35,,488.25,percent of total billed charges,Implant Device,474.3,34,"Charges > $500, x 34%",474.3,percent of total billed charges,Implant Device,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,558,40,,558,percent of total billed charges,Implant Devices,488.25,70,,488.25,percent of total billed charges,Implant Devices,474.3,34,,474.3,percent of total billed charges,Implant Devices,474.3,34,,474.3,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,558,
RTI 100460 CANCELLOUS CHIPS 60CC,C1713,HCPCS,,79008696,CDM,278,RC,,,both,,,2655,1047.84,39.4668,,1047.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,902.7,34,,902.7,percent of total billed charges,Implant Device,902.7,34,,902.7,percent of total billed charges,Implant Device,902.7,34,,902.7,percent of total billed charges,Implant Device,902.7,34,,902.7,percent of total billed charges,Implant Device,902.7,34,,902.7,percent of total billed charges,Implant Device,902.7,34,,902.7,percent of total billed charges,Implant Device,929.25,35,,929.25,percent of total billed charges,Implant Device,902.7,34,"Charges > $500, x 34%",902.7,percent of total billed charges,Implant Device,929.25,35,,929.25,percent of total billed charges,Implant Devices,929.25,35,,929.25,percent of total billed charges,Implant Devices,929.25,35,,,percent of total billed charges,Implant Devices,929.25,35,,929.25,percent of total billed charges,Implant Devices,929.25,35,,929.25,percent of total billed charges,Implant Devices,1062,40,,1062,percent of total billed charges,Implant Devices,929.25,70,,929.25,percent of total billed charges,Implant Devices,902.7,34,,902.7,percent of total billed charges,Implant Devices,902.7,34,,902.7,percent of total billed charges,Implant Devices,929.25,35,,929.25,percent of total billed charges,Implant Devices,929.25,35,,929.25,percent of total billed charges,Implant Devices,929.25,35,,929.25,percent of total billed charges,Implant Devices,929.25,35,,929.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,902.7,34,"If Charge > 2,000, then 34 percent",902.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1062,
RTI D00110 BIOREADY DBM PUTTY 10CC,C1713,HCPCS,,79008697,CDM,278,RC,,,both,,,3225,1272.8,39.4668,,1272.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Device,1096.5,34,"Charges > $500, x 34%",1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1290,40,,1290,percent of total billed charges,Implant Devices,1128.75,70,,1128.75,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1096.5,34,"If Charge > 2,000, then 34 percent",1096.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1290,
RTI D03125 ILLIUM TRICORT BLOCK 25X30X14,C1713,HCPCS,,79008698,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
ARTHREX AR-13200M-07R WEDGE PLATE 7MM,C1713,HCPCS,,79008707,CDM,278,RC,,,both,,,3408,1345.03,39.4668,,1345.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1192.8,35,,1192.8,percent of total billed charges,Implant Device,1158.72,34,"Charges > $500, x 34%",1158.72,percent of total billed charges,Implant Device,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1363.2,40,,1363.2,percent of total billed charges,Implant Devices,1192.8,70,,1192.8,percent of total billed charges,Implant Devices,1158.72,34,,1158.72,percent of total billed charges,Implant Devices,1158.72,34,,1158.72,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1158.72,34,"If Charge > 2,000, then 34 percent",1158.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1363.2,
ARTHREX AR-8935-30 CORT SCREW 3.5X30MM,C1713,HCPCS,,79008708,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-8940-34 CAN SCREW 4.0X34MM,C1713,HCPCS,,79008709,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER 1822-1136S TIBIAL NAIL 11X360MM,C1713,HCPCS,,79008711,CDM,278,RC,,,both,,,3529,1392.78,39.4668,,1392.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Device,1199.86,34,"Charges > $500, x 34%",1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1411.6,40,,1411.6,percent of total billed charges,Implant Devices,1235.15,70,,1235.15,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1199.86,34,"If Charge > 2,000, then 34 percent",1199.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1411.6,
STRYKER F&A SV12 LAG SCREW 2.5X12MM,C1713,HCPCS,,79008712,CDM,278,RC,,,both,,,1761,695.01,39.4668,,695.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,616.35,35,,616.35,percent of total billed charges,Implant Device,598.74,34,"Charges > $500, x 34%",598.74,percent of total billed charges,Implant Device,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,704.4,40,,704.4,percent of total billed charges,Implant Devices,616.35,70,,616.35,percent of total billed charges,Implant Devices,598.74,34,,598.74,percent of total billed charges,Implant Devices,598.74,34,,598.74,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,704.4,
PARAGON P50-053-2728 LOCK SCREW 2.7X28MM,C1713,HCPCS,,79008713,CDM,278,RC,,,both,,,880,347.31,39.4668,,347.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Device,299.2,34,"Charges > $500, x 34%",299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,352,40,,352,percent of total billed charges,Implant Devices,308,70,,308,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,352,
PARAGON P50-053-4230 LOCK SCREW 4.2X30MM,C1713,HCPCS,,79008714,CDM,278,RC,,,both,,,893,352.44,39.4668,,352.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,312.55,35,,312.55,percent of total billed charges,Implant Device,303.62,34,"Charges > $500, x 34%",303.62,percent of total billed charges,Implant Device,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,357.2,40,,357.2,percent of total billed charges,Implant Devices,312.55,70,,312.55,percent of total billed charges,Implant Devices,303.62,34,,303.62,percent of total billed charges,Implant Devices,303.62,34,,303.62,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357.2,
STRYKER 597030S HIP PLATE 135DEG 10 HOLE,C1713,HCPCS,,79008717,CDM,278,RC,,,both,,,2780,1097.18,39.4668,,1097.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.2,34,,945.2,percent of total billed charges,Implant Device,945.2,34,,945.2,percent of total billed charges,Implant Device,945.2,34,,945.2,percent of total billed charges,Implant Device,945.2,34,,945.2,percent of total billed charges,Implant Device,945.2,34,,945.2,percent of total billed charges,Implant Device,945.2,34,,945.2,percent of total billed charges,Implant Device,973,35,,973,percent of total billed charges,Implant Device,945.2,34,"Charges > $500, x 34%",945.2,percent of total billed charges,Implant Device,973,35,,973,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,973,35,,,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,1112,40,,1112,percent of total billed charges,Implant Devices,973,70,,973,percent of total billed charges,Implant Devices,945.2,34,,945.2,percent of total billed charges,Implant Devices,945.2,34,,945.2,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.2,34,"If Charge > 2,000, then 34 percent",945.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112,
STRYKER 597010S HIP PLATE 130DEG 10 HOLE,C1713,HCPCS,,79008718,CDM,278,RC,,,both,,,2780,1097.18,39.4668,,1097.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.2,34,,945.2,percent of total billed charges,Implant Device,945.2,34,,945.2,percent of total billed charges,Implant Device,945.2,34,,945.2,percent of total billed charges,Implant Device,945.2,34,,945.2,percent of total billed charges,Implant Device,945.2,34,,945.2,percent of total billed charges,Implant Device,945.2,34,,945.2,percent of total billed charges,Implant Device,973,35,,973,percent of total billed charges,Implant Device,945.2,34,"Charges > $500, x 34%",945.2,percent of total billed charges,Implant Device,973,35,,973,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,973,35,,,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,1112,40,,1112,percent of total billed charges,Implant Devices,973,70,,973,percent of total billed charges,Implant Devices,945.2,34,,945.2,percent of total billed charges,Implant Devices,945.2,34,,945.2,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,973,35,,973,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.2,34,"If Charge > 2,000, then 34 percent",945.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112,
STRYKER 3362-5-105 STD LAG SCREW 105MM,C1713,HCPCS,,79008719,CDM,278,RC,,,both,,,1415,558.46,39.4668,,558.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,481.1,34,,481.1,percent of total billed charges,Implant Device,481.1,34,,481.1,percent of total billed charges,Implant Device,481.1,34,,481.1,percent of total billed charges,Implant Device,481.1,34,,481.1,percent of total billed charges,Implant Device,481.1,34,,481.1,percent of total billed charges,Implant Device,481.1,34,,481.1,percent of total billed charges,Implant Device,495.25,35,,495.25,percent of total billed charges,Implant Device,481.1,34,"Charges > $500, x 34%",481.1,percent of total billed charges,Implant Device,495.25,35,,495.25,percent of total billed charges,Implant Devices,495.25,35,,495.25,percent of total billed charges,Implant Devices,495.25,35,,,percent of total billed charges,Implant Devices,495.25,35,,495.25,percent of total billed charges,Implant Devices,495.25,35,,495.25,percent of total billed charges,Implant Devices,566,40,,566,percent of total billed charges,Implant Devices,495.25,70,,495.25,percent of total billed charges,Implant Devices,481.1,34,,481.1,percent of total billed charges,Implant Devices,481.1,34,,481.1,percent of total billed charges,Implant Devices,495.25,35,,495.25,percent of total billed charges,Implant Devices,495.25,35,,495.25,percent of total billed charges,Implant Devices,495.25,35,,495.25,percent of total billed charges,Implant Devices,495.25,35,,495.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,566,
STRYKER 596001S COMPRESSION SCREW 32.3MM,C1713,HCPCS,,79008720,CDM,278,RC,,,both,,,354,139.71,39.4668,,139.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,120.36,34,,120.36,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,141.6,40,,141.6,percent of total billed charges,Implant Devices,123.9,70,,123.9,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,120.36,34,,120.36,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,123.9,35,,123.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,141.6,
STRYKER PLP40220 PLATE STRAIGHT 3 HOLE,C1713,HCPCS,,79008726,CDM,278,RC,,,both,,,5733,2262.63,39.4668,,2262.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1949.22,34,,1949.22,percent of total billed charges,Implant Device,1949.22,34,,1949.22,percent of total billed charges,Implant Device,1949.22,34,,1949.22,percent of total billed charges,Implant Device,1949.22,34,,1949.22,percent of total billed charges,Implant Device,1949.22,34,,1949.22,percent of total billed charges,Implant Device,1949.22,34,,1949.22,percent of total billed charges,Implant Device,2006.55,35,,2006.55,percent of total billed charges,Implant Device,1949.22,34,"Charges > $500, x 34%",1949.22,percent of total billed charges,Implant Device,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2293.2,40,,2293.2,percent of total billed charges,Implant Devices,2006.55,70,,2006.55,percent of total billed charges,Implant Devices,1949.22,34,,1949.22,percent of total billed charges,Implant Devices,1949.22,34,,1949.22,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1949.22,34,"If Charge > 2,000, then 34 percent",1949.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2293.2,
STRYKER PLSL3018 LOCKING SCREW 3X18MM,C1713,HCPCS,,79008727,CDM,278,RC,,,both,,,1119,441.63,39.4668,,441.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Device,380.46,34,"Charges > $500, x 34%",380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,447.6,40,,447.6,percent of total billed charges,Implant Devices,391.65,70,,391.65,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,447.6,
STRYKER EZM08-08-08 COMP STAPLE 8X8X8MM,C1713,HCPCS,,79008728,CDM,278,RC,,,both,,,4386,1731.01,39.4668,,1731.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1491.24,34,,1491.24,percent of total billed charges,Implant Device,1491.24,34,,1491.24,percent of total billed charges,Implant Device,1491.24,34,,1491.24,percent of total billed charges,Implant Device,1491.24,34,,1491.24,percent of total billed charges,Implant Device,1491.24,34,,1491.24,percent of total billed charges,Implant Device,1491.24,34,,1491.24,percent of total billed charges,Implant Device,1535.1,35,,1535.1,percent of total billed charges,Implant Device,1491.24,34,"Charges > $500, x 34%",1491.24,percent of total billed charges,Implant Device,1535.1,35,,1535.1,percent of total billed charges,Implant Devices,1535.1,35,,1535.1,percent of total billed charges,Implant Devices,1535.1,35,,,percent of total billed charges,Implant Devices,1535.1,35,,1535.1,percent of total billed charges,Implant Devices,1535.1,35,,1535.1,percent of total billed charges,Implant Devices,1754.4,40,,1754.4,percent of total billed charges,Implant Devices,1535.1,70,,1535.1,percent of total billed charges,Implant Devices,1491.24,34,,1491.24,percent of total billed charges,Implant Devices,1491.24,34,,1491.24,percent of total billed charges,Implant Devices,1535.1,35,,1535.1,percent of total billed charges,Implant Devices,1535.1,35,,1535.1,percent of total billed charges,Implant Devices,1535.1,35,,1535.1,percent of total billed charges,Implant Devices,1535.1,35,,1535.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1491.24,34,"If Charge > 2,000, then 34 percent",1491.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1754.4,
STRYKER EZM10-10-10 COMP STAPLE 10X10X10,C1713,HCPCS,,79008729,CDM,278,RC,,,both,,,2132,841.43,39.4668,,841.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,724.88,34,,724.88,percent of total billed charges,Implant Device,724.88,34,,724.88,percent of total billed charges,Implant Device,724.88,34,,724.88,percent of total billed charges,Implant Device,724.88,34,,724.88,percent of total billed charges,Implant Device,724.88,34,,724.88,percent of total billed charges,Implant Device,724.88,34,,724.88,percent of total billed charges,Implant Device,746.2,35,,746.2,percent of total billed charges,Implant Device,724.88,34,"Charges > $500, x 34%",724.88,percent of total billed charges,Implant Device,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,852.8,40,,852.8,percent of total billed charges,Implant Devices,746.2,70,,746.2,percent of total billed charges,Implant Devices,724.88,34,,724.88,percent of total billed charges,Implant Devices,724.88,34,,724.88,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,746.2,35,,746.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,724.88,34,"If Charge > 2,000, then 34 percent",724.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,852.8,
STRYKER HT-0001 SMALL HAMMERTOE IMPLANT,C1713,HCPCS,,79008730,CDM,278,RC,,,both,,,5970,2356.17,39.4668,,2356.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2029.8,34,,2029.8,percent of total billed charges,Implant Device,2029.8,34,,2029.8,percent of total billed charges,Implant Device,2029.8,34,,2029.8,percent of total billed charges,Implant Device,2029.8,34,,2029.8,percent of total billed charges,Implant Device,2029.8,34,,2029.8,percent of total billed charges,Implant Device,2029.8,34,,2029.8,percent of total billed charges,Implant Device,2089.5,35,,2089.5,percent of total billed charges,Implant Device,2029.8,34,"Charges > $500, x 34%",2029.8,percent of total billed charges,Implant Device,2089.5,35,,2089.5,percent of total billed charges,Implant Devices,2089.5,35,,2089.5,percent of total billed charges,Implant Devices,2089.5,35,,,percent of total billed charges,Implant Devices,2089.5,35,,2089.5,percent of total billed charges,Implant Devices,2089.5,35,,2089.5,percent of total billed charges,Implant Devices,2388,40,,2388,percent of total billed charges,Implant Devices,2089.5,70,,2089.5,percent of total billed charges,Implant Devices,2029.8,34,,2029.8,percent of total billed charges,Implant Devices,2029.8,34,,2029.8,percent of total billed charges,Implant Devices,2089.5,35,,2089.5,percent of total billed charges,Implant Devices,2089.5,35,,2089.5,percent of total billed charges,Implant Devices,2089.5,35,,2089.5,percent of total billed charges,Implant Devices,2089.5,35,,2089.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2029.8,34,"If Charge > 2,000, then 34 percent",2029.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2388,
STRYKER PLSL3016 LOCKING SCREW 3X16MM,C1713,HCPCS,,79008731,CDM,278,RC,,,both,,,978,385.99,39.4668,,385.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,332.52,34,,332.52,percent of total billed charges,Implant Device,332.52,34,,332.52,percent of total billed charges,Implant Device,332.52,34,,332.52,percent of total billed charges,Implant Device,332.52,34,,332.52,percent of total billed charges,Implant Device,332.52,34,,332.52,percent of total billed charges,Implant Device,332.52,34,,332.52,percent of total billed charges,Implant Device,342.3,35,,342.3,percent of total billed charges,Implant Device,332.52,34,"Charges > $500, x 34%",332.52,percent of total billed charges,Implant Device,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,391.2,40,,391.2,percent of total billed charges,Implant Devices,342.3,70,,342.3,percent of total billed charges,Implant Devices,332.52,34,,332.52,percent of total billed charges,Implant Devices,332.52,34,,332.52,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,342.3,35,,342.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,391.2,
STRYKER SV16 S-FIX SCREW 2.5LG 16MM,C1713,HCPCS,,79008732,CDM,278,RC,,,both,,,1761,695.01,39.4668,,695.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,598.74,34,,598.74,percent of total billed charges,Implant Device,616.35,35,,616.35,percent of total billed charges,Implant Device,598.74,34,"Charges > $500, x 34%",598.74,percent of total billed charges,Implant Device,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,704.4,40,,704.4,percent of total billed charges,Implant Devices,616.35,70,,616.35,percent of total billed charges,Implant Devices,598.74,34,,598.74,percent of total billed charges,Implant Devices,598.74,34,,598.74,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,616.35,35,,616.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,704.4,
STRYKER 626926 LAG SCREW 3.6X6MM,C1713,HCPCS,,79008737,CDM,278,RC,,,both,,,879,346.91,39.4668,,346.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,298.86,34,,298.86,percent of total billed charges,Implant Device,307.65,35,,307.65,percent of total billed charges,Implant Device,298.86,34,"Charges > $500, x 34%",298.86,percent of total billed charges,Implant Device,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,351.6,40,,351.6,percent of total billed charges,Implant Devices,307.65,70,,307.65,percent of total billed charges,Implant Devices,298.86,34,,298.86,percent of total billed charges,Implant Devices,298.86,34,,298.86,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,307.65,35,,307.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,351.6,
STRYKER 627644 14 HOLE DIS RT FEMUR PLT,C1713,HCPCS,,79008739,CDM,278,RC,,,both,,,11103,4382,39.4668,,4382,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3775.02,34,,3775.02,percent of total billed charges,Implant Device,3775.02,34,,3775.02,percent of total billed charges,Implant Device,3775.02,34,,3775.02,percent of total billed charges,Implant Device,3775.02,34,,3775.02,percent of total billed charges,Implant Device,3775.02,34,,3775.02,percent of total billed charges,Implant Device,3775.02,34,,3775.02,percent of total billed charges,Implant Device,3886.05,35,,3886.05,percent of total billed charges,Implant Device,3775.02,34,"Charges > $500, x 34%",3775.02,percent of total billed charges,Implant Device,3886.05,35,,3886.05,percent of total billed charges,Implant Devices,3886.05,35,,3886.05,percent of total billed charges,Implant Devices,3886.05,35,,,percent of total billed charges,Implant Devices,3886.05,35,,3886.05,percent of total billed charges,Implant Devices,3886.05,35,,3886.05,percent of total billed charges,Implant Devices,4441.2,40,,4441.2,percent of total billed charges,Implant Devices,3886.05,70,,3886.05,percent of total billed charges,Implant Devices,3775.02,34,,3775.02,percent of total billed charges,Implant Devices,3775.02,34,,3775.02,percent of total billed charges,Implant Devices,3886.05,35,,3886.05,percent of total billed charges,Implant Devices,3886.05,35,,3886.05,percent of total billed charges,Implant Devices,3886.05,35,,3886.05,percent of total billed charges,Implant Devices,3886.05,35,,3886.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3775.02,34,"If Charge > 2,000, then 34 percent",3775.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4441.2,
STRYKER 661734 4.5X34MM NON LOCK SCREW,C1713,HCPCS,,79008740,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
STRYKER 661732 4.5X32MM NON LOCK SCREW,C1713,HCPCS,,79008741,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
STRYKER 661730 4.5X30MM NON LOCK SCREW,C1713,HCPCS,,79008742,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
STRYKER 661738 4.5X38MM NON LOCK SCREW,C1713,HCPCS,,79008743,CDM,278,RC,,,both,,,195,76.96,39.4668,,76.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,78,40,,78,percent of total billed charges,Implant Devices,68.25,70,,68.25,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78,
STRYKER 661728 4.5X28MM NON LOCK SCREW,C1713,HCPCS,,79008744,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
STRYKER 661170 5.0X70MM LOCKING SCREW,C1713,HCPCS,,79008745,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 661165 5.0X65MM LOCKING SCREW,C1713,HCPCS,,79008746,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 661160 5.0X60MM LOCKING SCREW,C1713,HCPCS,,79008747,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 661136 5.0X36MM LOCKING SCREW,C1713,HCPCS,,79008748,CDM,278,RC,,,both,,,864,340.99,39.4668,,340.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,302.4,35,,302.4,percent of total billed charges,Implant Device,293.76,34,"Charges > $500, x 34%",293.76,percent of total billed charges,Implant Device,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,345.6,40,,345.6,percent of total billed charges,Implant Devices,302.4,70,,302.4,percent of total billed charges,Implant Devices,293.76,34,,293.76,percent of total billed charges,Implant Devices,293.76,34,,293.76,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,345.6,
STRYKER 661130 5.0X30MM LOCKING SCREW,C1713,HCPCS,,79008749,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 608040 6.5X40MM CANCELLOUS SCREW,C1713,HCPCS,,79008750,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
STRYKER 661310 5.0X10MM LOCKING SCREW,C1713,HCPCS,,79008751,CDM,278,RC,,,both,,,996,393.09,39.4668,,393.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,338.64,34,,338.64,percent of total billed charges,Implant Device,338.64,34,,338.64,percent of total billed charges,Implant Device,338.64,34,,338.64,percent of total billed charges,Implant Device,338.64,34,,338.64,percent of total billed charges,Implant Device,338.64,34,,338.64,percent of total billed charges,Implant Device,338.64,34,,338.64,percent of total billed charges,Implant Device,348.6,35,,348.6,percent of total billed charges,Implant Device,338.64,34,"Charges > $500, x 34%",338.64,percent of total billed charges,Implant Device,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,398.4,40,,398.4,percent of total billed charges,Implant Devices,348.6,70,,348.6,percent of total billed charges,Implant Devices,338.64,34,,338.64,percent of total billed charges,Implant Devices,338.64,34,,338.64,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,398.4,
STRYKER 661308 5.0X8MM LOCKING SCREW,C1713,HCPCS,,79008752,CDM,278,RC,,,both,,,996,393.09,39.4668,,393.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,338.64,34,,338.64,percent of total billed charges,Implant Device,338.64,34,,338.64,percent of total billed charges,Implant Device,338.64,34,,338.64,percent of total billed charges,Implant Device,338.64,34,,338.64,percent of total billed charges,Implant Device,338.64,34,,338.64,percent of total billed charges,Implant Device,338.64,34,,338.64,percent of total billed charges,Implant Device,348.6,35,,348.6,percent of total billed charges,Implant Device,338.64,34,"Charges > $500, x 34%",338.64,percent of total billed charges,Implant Device,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,398.4,40,,398.4,percent of total billed charges,Implant Devices,348.6,70,,348.6,percent of total billed charges,Implant Devices,338.64,34,,338.64,percent of total billed charges,Implant Devices,338.64,34,,338.64,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,348.6,35,,348.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,398.4,
DEPUY VS501.024 CORTEX SCREW 5.5X24MM,C1713,HCPCS,,79008757,CDM,278,RC,,,both,,,65,25.65,39.4668,,25.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.75,35,,22.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,26,40,,26,percent of total billed charges,Implant Devices,22.75,70,,22.75,percent of total billed charges,Implant Devices,22.1,34,,22.1,percent of total billed charges,Implant Devices,22.1,34,,22.1,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,26,
DEPUY VS501.026 CORTEX SCREW 5.5X26MM,C1713,HCPCS,,79008758,CDM,278,RC,,,both,,,65,25.65,39.4668,,25.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.1,34,,22.1,percent of total billed charges,Implant Device,22.75,35,,22.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,26,40,,26,percent of total billed charges,Implant Devices,22.75,70,,22.75,percent of total billed charges,Implant Devices,22.1,34,,22.1,percent of total billed charges,Implant Devices,22.1,34,,22.1,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,22.75,35,,22.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,26,
BIOMET 8145-50-040 CORT BONE SCRW 5X40MM,C1713,HCPCS,,79008759,CDM,278,RC,,,both,,,990,390.72,39.4668,,390.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,336.6,34,,336.6,percent of total billed charges,Implant Device,336.6,34,,336.6,percent of total billed charges,Implant Device,336.6,34,,336.6,percent of total billed charges,Implant Device,336.6,34,,336.6,percent of total billed charges,Implant Device,336.6,34,,336.6,percent of total billed charges,Implant Device,336.6,34,,336.6,percent of total billed charges,Implant Device,346.5,35,,346.5,percent of total billed charges,Implant Device,336.6,34,"Charges > $500, x 34%",336.6,percent of total billed charges,Implant Device,346.5,35,,346.5,percent of total billed charges,Implant Devices,346.5,35,,346.5,percent of total billed charges,Implant Devices,346.5,35,,,percent of total billed charges,Implant Devices,346.5,35,,346.5,percent of total billed charges,Implant Devices,346.5,35,,346.5,percent of total billed charges,Implant Devices,396,40,,396,percent of total billed charges,Implant Devices,346.5,70,,346.5,percent of total billed charges,Implant Devices,336.6,34,,336.6,percent of total billed charges,Implant Devices,336.6,34,,336.6,percent of total billed charges,Implant Devices,346.5,35,,346.5,percent of total billed charges,Implant Devices,346.5,35,,346.5,percent of total billed charges,Implant Devices,346.5,35,,346.5,percent of total billed charges,Implant Devices,346.5,35,,346.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396,
STRYKER 661060 4.0X60MM LOCKING SCREW,C1713,HCPCS,,79008760,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 54-25773 VDR PLATE STANDARD LEFT,C1713,HCPCS,,79008761,CDM,278,RC,,,both,,,4866,1920.45,39.4668,,1920.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1654.44,34,,1654.44,percent of total billed charges,Implant Device,1654.44,34,,1654.44,percent of total billed charges,Implant Device,1654.44,34,,1654.44,percent of total billed charges,Implant Device,1654.44,34,,1654.44,percent of total billed charges,Implant Device,1654.44,34,,1654.44,percent of total billed charges,Implant Device,1654.44,34,,1654.44,percent of total billed charges,Implant Device,1703.1,35,,1703.1,percent of total billed charges,Implant Device,1654.44,34,"Charges > $500, x 34%",1654.44,percent of total billed charges,Implant Device,1703.1,35,,1703.1,percent of total billed charges,Implant Devices,1703.1,35,,1703.1,percent of total billed charges,Implant Devices,1703.1,35,,,percent of total billed charges,Implant Devices,1703.1,35,,1703.1,percent of total billed charges,Implant Devices,1703.1,35,,1703.1,percent of total billed charges,Implant Devices,1946.4,40,,1946.4,percent of total billed charges,Implant Devices,1703.1,70,,1703.1,percent of total billed charges,Implant Devices,1654.44,34,,1654.44,percent of total billed charges,Implant Devices,1654.44,34,,1654.44,percent of total billed charges,Implant Devices,1703.1,35,,1703.1,percent of total billed charges,Implant Devices,1703.1,35,,1703.1,percent of total billed charges,Implant Devices,1703.1,35,,1703.1,percent of total billed charges,Implant Devices,1703.1,35,,1703.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1654.44,34,"If Charge > 2,000, then 34 percent",1654.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1946.4,
DEPUY 201.770 CORTEX SCREW 2.4X20MM,C1713,HCPCS,,79008763,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
ARTHREX AR-8935-28 NON LOCK SCREW 3.5X28,C1713,HCPCS,,79008773,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-8940-30 CAN SCREW 4.0X30MM,C1713,HCPCS,,79008774,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-13200M-06R WEDGE PLATE RT 6MM,C1713,HCPCS,,79008775,CDM,278,RC,,,both,,,3408,1345.03,39.4668,,1345.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1158.72,34,,1158.72,percent of total billed charges,Implant Device,1192.8,35,,1192.8,percent of total billed charges,Implant Device,1158.72,34,"Charges > $500, x 34%",1158.72,percent of total billed charges,Implant Device,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1363.2,40,,1363.2,percent of total billed charges,Implant Devices,1192.8,70,,1192.8,percent of total billed charges,Implant Devices,1158.72,34,,1158.72,percent of total billed charges,Implant Devices,1158.72,34,,1158.72,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,1192.8,35,,1192.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1158.72,34,"If Charge > 2,000, then 34 percent",1158.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1363.2,
IN2BONES S65 ST180 SCREW 6.5X80MM,C1713,HCPCS,,79008776,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
IN2BONES S45 ST150 SCREW 4.5X50MM,C1713,HCPCS,,79008777,CDM,278,RC,,,both,,,1545,609.76,39.4668,,609.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,540.75,35,,540.75,percent of total billed charges,Implant Device,525.3,34,"Charges > $500, x 34%",525.3,percent of total billed charges,Implant Device,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,618,40,,618,percent of total billed charges,Implant Devices,540.75,70,,540.75,percent of total billed charges,Implant Devices,525.3,34,,525.3,percent of total billed charges,Implant Devices,525.3,34,,525.3,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,618,
IN2BONES T50 SN025 COMP STAPLE 25X22X22,C1713,HCPCS,,79008778,CDM,278,RC,,,both,,,4860,1918.09,39.4668,,1918.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1701,35,,1701,percent of total billed charges,Implant Device,1652.4,34,"Charges > $500, x 34%",1652.4,percent of total billed charges,Implant Device,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1944,40,,1944,percent of total billed charges,Implant Devices,1701,70,,1701,percent of total billed charges,Implant Devices,1652.4,34,,1652.4,percent of total billed charges,Implant Devices,1652.4,34,,1652.4,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1652.4,34,"If Charge > 2,000, then 34 percent",1652.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1944,
IN2BONES 100-0050 VITRIUM WEDGE 22X8MM,C1713,HCPCS,,79008782,CDM,278,RC,,,both,,,9450,3729.61,39.4668,,3729.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Device,3213,34,"Charges > $500, x 34%",3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3780,40,,3780,percent of total billed charges,Implant Devices,3307.5,70,,3307.5,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3213,34,"If Charge > 2,000, then 34 percent",3213,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3780,
IN2BONES T50 SN115 COMP STAPLE 15X15X15,C1713,HCPCS,,79008783,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
IN2BONES T50 SN020 COMP STAPLE 20X20X20,C1713,HCPCS,,79008784,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
IN2BONES S45 ST132 SCREW 4.5X32MM,C1713,HCPCS,,79008785,CDM,278,RC,,,both,,,1545,609.76,39.4668,,609.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,540.75,35,,540.75,percent of total billed charges,Implant Device,525.3,34,"Charges > $500, x 34%",525.3,percent of total billed charges,Implant Device,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,618,40,,618,percent of total billed charges,Implant Devices,540.75,70,,540.75,percent of total billed charges,Implant Devices,525.3,34,,525.3,percent of total billed charges,Implant Devices,525.3,34,,525.3,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,618,
STRYKER 3325-0420S LONG NAIL KIT 11X420,C1713,HCPCS,,79008786,CDM,278,RC,,,both,,,9323,3679.49,39.4668,,3679.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3169.82,34,,3169.82,percent of total billed charges,Implant Device,3263.05,35,,3263.05,percent of total billed charges,Implant Device,3169.82,34,"Charges > $500, x 34%",3169.82,percent of total billed charges,Implant Device,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3729.2,40,,3729.2,percent of total billed charges,Implant Devices,3263.05,70,,3263.05,percent of total billed charges,Implant Devices,3169.82,34,,3169.82,percent of total billed charges,Implant Devices,3169.82,34,,3169.82,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,3263.05,35,,3263.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3169.82,34,"If Charge > 2,000, then 34 percent",3169.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3729.2,
IN2BONES S65 ST145 SCREW 6.5X45MM,C1713,HCPCS,,79008789,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
IN2BONES 100-0042 VITRIUM WEDGE 20X6MM,C1713,HCPCS,,79008790,CDM,278,RC,,,both,,,9450,3729.61,39.4668,,3729.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Device,3213,34,"Charges > $500, x 34%",3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3780,40,,3780,percent of total billed charges,Implant Devices,3307.5,70,,3307.5,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3213,34,"If Charge > 2,000, then 34 percent",3213,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3780,
IN2BONES PAA-050 DBM PUTTY 5CC,C1713,HCPCS,,79008791,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
STRYKER 40-30116 ASNIS SCREW 3.0X16MM,C1713,HCPCS,,79008801,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STABILITY SB 905 TENODESIS ALLOGRAFT,C1713,HCPCS,,79008802,CDM,278,RC,,,both,,,5325,2101.61,39.4668,,2101.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1863.75,35,,1863.75,percent of total billed charges,Implant Device,1810.5,34,"Charges > $500, x 34%",1810.5,percent of total billed charges,Implant Device,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,2130,40,,2130,percent of total billed charges,Implant Devices,1863.75,70,,1863.75,percent of total billed charges,Implant Devices,1810.5,34,,1810.5,percent of total billed charges,Implant Devices,1810.5,34,,1810.5,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1810.5,34,"If Charge > 2,000, then 34 percent",1810.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2130,
IN2BONES APA-001 PIP ALLOGRAFT 2.5X16MM,C1713,HCPCS,,79008806,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 604750 ASNIS CANN SCREW 4.0X50MM,C1713,HCPCS,,79008808,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 601670 ASNIS CANN SCREW 5.0X70MM,C1713,HCPCS,,79008809,CDM,278,RC,,,both,,,847,334.28,39.4668,,334.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,296.45,35,,296.45,percent of total billed charges,Implant Device,287.98,34,"Charges > $500, x 34%",287.98,percent of total billed charges,Implant Device,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,338.8,40,,338.8,percent of total billed charges,Implant Devices,296.45,70,,296.45,percent of total billed charges,Implant Devices,287.98,34,,287.98,percent of total billed charges,Implant Devices,287.98,34,,287.98,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,338.8,
STRYKER 5023-3-120 APEX HALF PIN 4X12MM,C1713,HCPCS,,79008810,CDM,278,RC,,,both,,,203,80.12,39.4668,,80.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,69.02,34,,69.02,percent of total billed charges,Implant Device,71.05,35,,71.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,81.2,40,,81.2,percent of total billed charges,Implant Devices,71.05,70,,71.05,percent of total billed charges,Implant Devices,69.02,34,,69.02,percent of total billed charges,Implant Devices,69.02,34,,69.02,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,71.05,35,,71.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,81.2,
STRYKER 604744 ASNIS CANN SCREW 4.0X44MM,C1713,HCPCS,,79008811,CDM,278,RC,,,both,,,770,303.89,39.4668,,303.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,261.8,34,,261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Device,261.8,34,"Charges > $500, x 34%",261.8,percent of total billed charges,Implant Device,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,308,40,,308,percent of total billed charges,Implant Devices,269.5,70,,269.5,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,261.8,34,,261.8,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,269.5,35,,269.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,308,
STRYKER FOOT & ANKLE SK988 9X8X8 STAPLE,C1713,HCPCS,,79008813,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
DEPUY 206.030 4.0X30MM CANCELLOUS SCREW,C1713,HCPCS,,79008816,CDM,278,RC,,,both,,,47,18.55,39.4668,,18.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,16.45,35,,16.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,18.8,40,,18.8,percent of total billed charges,Implant Devices,16.45,70,,16.45,percent of total billed charges,Implant Devices,15.98,34,,15.98,percent of total billed charges,Implant Devices,15.98,34,,15.98,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18.8,
DEPUY 202.218 2.7X18MM LOCKING SCREW,C1713,HCPCS,,79008817,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
DEPUY 02.112.143 6 HOLE DIS FIB PLATE,C1713,HCPCS,,79008818,CDM,278,RC,,,both,,,1743,687.91,39.4668,,687.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,592.62,34,,592.62,percent of total billed charges,Implant Device,592.62,34,,592.62,percent of total billed charges,Implant Device,592.62,34,,592.62,percent of total billed charges,Implant Device,592.62,34,,592.62,percent of total billed charges,Implant Device,592.62,34,,592.62,percent of total billed charges,Implant Device,592.62,34,,592.62,percent of total billed charges,Implant Device,610.05,35,,610.05,percent of total billed charges,Implant Device,592.62,34,"Charges > $500, x 34%",592.62,percent of total billed charges,Implant Device,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,697.2,40,,697.2,percent of total billed charges,Implant Devices,610.05,70,,610.05,percent of total billed charges,Implant Devices,592.62,34,,592.62,percent of total billed charges,Implant Devices,592.62,34,,592.62,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,697.2,
STRYKER 661090 4.0X90MM LOCKING SCREW,C1713,HCPCS,,79008824,CDM,278,RC,,,both,,,816,322.05,39.4668,,322.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,285.6,35,,285.6,percent of total billed charges,Implant Device,277.44,34,"Charges > $500, x 34%",277.44,percent of total billed charges,Implant Device,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,326.4,40,,326.4,percent of total billed charges,Implant Devices,285.6,70,,285.6,percent of total billed charges,Implant Devices,277.44,34,,277.44,percent of total billed charges,Implant Devices,277.44,34,,277.44,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,326.4,
STRYKER 661080 4.0X80MM LOCKING SCREW,C1713,HCPCS,,79008825,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
MTF PK1612 FLEX HD PLIABLE ACELL DERMIS,C1713,HCPCS,,79008829,CDM,278,RC,,,both,,,9786,3862.22,39.4668,,3862.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3327.24,34,,3327.24,percent of total billed charges,Implant Device,3327.24,34,,3327.24,percent of total billed charges,Implant Device,3327.24,34,,3327.24,percent of total billed charges,Implant Device,3327.24,34,,3327.24,percent of total billed charges,Implant Device,3327.24,34,,3327.24,percent of total billed charges,Implant Device,3327.24,34,,3327.24,percent of total billed charges,Implant Device,3425.1,35,,3425.1,percent of total billed charges,Implant Device,3327.24,34,"Charges > $500, x 34%",3327.24,percent of total billed charges,Implant Device,3425.1,35,,3425.1,percent of total billed charges,Implant Devices,3425.1,35,,3425.1,percent of total billed charges,Implant Devices,3425.1,35,,,percent of total billed charges,Implant Devices,3425.1,35,,3425.1,percent of total billed charges,Implant Devices,3425.1,35,,3425.1,percent of total billed charges,Implant Devices,3914.4,40,,3914.4,percent of total billed charges,Implant Devices,3425.1,70,,3425.1,percent of total billed charges,Implant Devices,3327.24,34,,3327.24,percent of total billed charges,Implant Devices,3327.24,34,,3327.24,percent of total billed charges,Implant Devices,3425.1,35,,3425.1,percent of total billed charges,Implant Devices,3425.1,35,,3425.1,percent of total billed charges,Implant Devices,3425.1,35,,3425.1,percent of total billed charges,Implant Devices,3425.1,35,,3425.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3327.24,34,"If Charge > 2,000, then 34 percent",3327.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3914.4,
MTF PK1616 FLEX HD PLIABLE ACELL DERMIS,C1713,HCPCS,,79008830,CDM,278,RC,,,both,,,15091,5955.93,39.4668,,5955.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5130.94,34,,5130.94,percent of total billed charges,Implant Device,5130.94,34,,5130.94,percent of total billed charges,Implant Device,5130.94,34,,5130.94,percent of total billed charges,Implant Device,5130.94,34,,5130.94,percent of total billed charges,Implant Device,5130.94,34,,5130.94,percent of total billed charges,Implant Device,5130.94,34,,5130.94,percent of total billed charges,Implant Device,5281.85,35,,5281.85,percent of total billed charges,Implant Device,5130.94,34,"Charges > $500, x 34%",5130.94,percent of total billed charges,Implant Device,5281.85,35,,5281.85,percent of total billed charges,Implant Devices,5281.85,35,,5281.85,percent of total billed charges,Implant Devices,5281.85,35,,,percent of total billed charges,Implant Devices,5281.85,35,,5281.85,percent of total billed charges,Implant Devices,5281.85,35,,5281.85,percent of total billed charges,Implant Devices,6036.4,40,,6036.4,percent of total billed charges,Implant Devices,5281.85,70,,5281.85,percent of total billed charges,Implant Devices,5130.94,34,,5130.94,percent of total billed charges,Implant Devices,5130.94,34,,5130.94,percent of total billed charges,Implant Devices,5281.85,35,,5281.85,percent of total billed charges,Implant Devices,5281.85,35,,5281.85,percent of total billed charges,Implant Devices,5281.85,35,,5281.85,percent of total billed charges,Implant Devices,5281.85,35,,5281.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5130.94,34,"If Charge > 2,000, then 34 percent",5130.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6036.4,
PARAGON P20-130-026S CANN SCREW 3.0X26MM,C1713,HCPCS,,79008838,CDM,278,RC,,,both,,,893,352.44,39.4668,,352.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,303.62,34,,303.62,percent of total billed charges,Implant Device,312.55,35,,312.55,percent of total billed charges,Implant Device,303.62,34,"Charges > $500, x 34%",303.62,percent of total billed charges,Implant Device,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,357.2,40,,357.2,percent of total billed charges,Implant Devices,312.55,70,,312.55,percent of total billed charges,Implant Devices,303.62,34,,303.62,percent of total billed charges,Implant Devices,303.62,34,,303.62,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,312.55,35,,312.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357.2,
PARAGON P53-103-R003 MTP PLATE O LONG RT,C1713,HCPCS,,79008839,CDM,278,RC,,,both,,,6031,2380.24,39.4668,,2380.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2050.54,34,,2050.54,percent of total billed charges,Implant Device,2050.54,34,,2050.54,percent of total billed charges,Implant Device,2050.54,34,,2050.54,percent of total billed charges,Implant Device,2050.54,34,,2050.54,percent of total billed charges,Implant Device,2050.54,34,,2050.54,percent of total billed charges,Implant Device,2050.54,34,,2050.54,percent of total billed charges,Implant Device,2110.85,35,,2110.85,percent of total billed charges,Implant Device,2050.54,34,"Charges > $500, x 34%",2050.54,percent of total billed charges,Implant Device,2110.85,35,,2110.85,percent of total billed charges,Implant Devices,2110.85,35,,2110.85,percent of total billed charges,Implant Devices,2110.85,35,,,percent of total billed charges,Implant Devices,2110.85,35,,2110.85,percent of total billed charges,Implant Devices,2110.85,35,,2110.85,percent of total billed charges,Implant Devices,2412.4,40,,2412.4,percent of total billed charges,Implant Devices,2110.85,70,,2110.85,percent of total billed charges,Implant Devices,2050.54,34,,2050.54,percent of total billed charges,Implant Devices,2050.54,34,,2050.54,percent of total billed charges,Implant Devices,2110.85,35,,2110.85,percent of total billed charges,Implant Devices,2110.85,35,,2110.85,percent of total billed charges,Implant Devices,2110.85,35,,2110.85,percent of total billed charges,Implant Devices,2110.85,35,,2110.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2050.54,34,"If Charge > 2,000, then 34 percent",2050.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2412.4,
STRYKER 1910-1272S SONICANCHOR 2.5X10MM,C1713,HCPCS,,79008847,CDM,278,RC,,,both,,,1734,684.35,39.4668,,684.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,589.56,34,,589.56,percent of total billed charges,Implant Device,589.56,34,,589.56,percent of total billed charges,Implant Device,589.56,34,,589.56,percent of total billed charges,Implant Device,589.56,34,,589.56,percent of total billed charges,Implant Device,589.56,34,,589.56,percent of total billed charges,Implant Device,589.56,34,,589.56,percent of total billed charges,Implant Device,606.9,35,,606.9,percent of total billed charges,Implant Device,589.56,34,"Charges > $500, x 34%",589.56,percent of total billed charges,Implant Device,606.9,35,,606.9,percent of total billed charges,Implant Devices,606.9,35,,606.9,percent of total billed charges,Implant Devices,606.9,35,,,percent of total billed charges,Implant Devices,606.9,35,,606.9,percent of total billed charges,Implant Devices,606.9,35,,606.9,percent of total billed charges,Implant Devices,693.6,40,,693.6,percent of total billed charges,Implant Devices,606.9,70,,606.9,percent of total billed charges,Implant Devices,589.56,34,,589.56,percent of total billed charges,Implant Devices,589.56,34,,589.56,percent of total billed charges,Implant Devices,606.9,35,,606.9,percent of total billed charges,Implant Devices,606.9,35,,606.9,percent of total billed charges,Implant Devices,606.9,35,,606.9,percent of total billed charges,Implant Devices,606.9,35,,606.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,693.6,
PARAGON P50-053-3510 LOCK SCREW 3.5X10MM,C1713,HCPCS,,79008850,CDM,278,RC,,,both,,,880,347.31,39.4668,,347.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,299.2,34,,299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Device,299.2,34,"Charges > $500, x 34%",299.2,percent of total billed charges,Implant Device,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,352,40,,352,percent of total billed charges,Implant Devices,308,70,,308,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,299.2,34,,299.2,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,308,35,,308,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,352,
STRYKER 657014 LOCK SCREW T10 2.7X14MM,C1713,HCPCS,,79008851,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 657010 LOCK SCREW T10 2.7X10MM,C1713,HCPCS,,79008852,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
MTF HP1612 FLEX HD PLIABLE TISSUE-THICK,C1713,HCPCS,,79008854,CDM,278,RC,,,both,,,8343,3292.72,39.4668,,3292.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2836.62,34,,2836.62,percent of total billed charges,Implant Device,2836.62,34,,2836.62,percent of total billed charges,Implant Device,2836.62,34,,2836.62,percent of total billed charges,Implant Device,2836.62,34,,2836.62,percent of total billed charges,Implant Device,2836.62,34,,2836.62,percent of total billed charges,Implant Device,2836.62,34,,2836.62,percent of total billed charges,Implant Device,2920.05,35,,2920.05,percent of total billed charges,Implant Device,2836.62,34,"Charges > $500, x 34%",2836.62,percent of total billed charges,Implant Device,2920.05,35,,2920.05,percent of total billed charges,Implant Devices,2920.05,35,,2920.05,percent of total billed charges,Implant Devices,2920.05,35,,,percent of total billed charges,Implant Devices,2920.05,35,,2920.05,percent of total billed charges,Implant Devices,2920.05,35,,2920.05,percent of total billed charges,Implant Devices,3337.2,40,,3337.2,percent of total billed charges,Implant Devices,2920.05,70,,2920.05,percent of total billed charges,Implant Devices,2836.62,34,,2836.62,percent of total billed charges,Implant Devices,2836.62,34,,2836.62,percent of total billed charges,Implant Devices,2920.05,35,,2920.05,percent of total billed charges,Implant Devices,2920.05,35,,2920.05,percent of total billed charges,Implant Devices,2920.05,35,,2920.05,percent of total billed charges,Implant Devices,2920.05,35,,2920.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2836.62,34,"If Charge > 2,000, then 34 percent",2836.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3337.2,
STRYKER 657312 LOCKING SCREW 3.5X12MM,C1713,HCPCS,,79008855,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 657116 NON LOCK SCREW 2.7X16MM,C1713,HCPCS,,79008856,CDM,278,RC,,,both,,,293,115.64,39.4668,,115.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,102.55,35,,102.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,117.2,40,,117.2,percent of total billed charges,Implant Devices,102.55,70,,102.55,percent of total billed charges,Implant Devices,99.62,34,,99.62,percent of total billed charges,Implant Devices,99.62,34,,99.62,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.2,
STRYKER 657118 NON LOCK SCREW 2.7X18MM,C1713,HCPCS,,79008857,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
BIOMET 800-4001 BONE VOID FILLER 10CC,C1713,HCPCS,,79008861,CDM,278,RC,,,both,,,13620,5375.38,39.4668,,5375.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4767,35,,4767,percent of total billed charges,Implant Device,4630.8,34,"Charges > $500, x 34%",4630.8,percent of total billed charges,Implant Device,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,5448,40,,5448,percent of total billed charges,Implant Devices,4767,70,,4767,percent of total billed charges,Implant Devices,4630.8,34,,4630.8,percent of total billed charges,Implant Devices,4630.8,34,,4630.8,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4630.8,34,"If Charge > 2,000, then 34 percent",4630.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5448,
BIOMET 800-4000 BONE VOID FILLER 5CC,C1713,HCPCS,,79008862,CDM,278,RC,,,both,,,6810,2687.69,39.4668,,2687.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2315.4,34,,2315.4,percent of total billed charges,Implant Device,2315.4,34,,2315.4,percent of total billed charges,Implant Device,2315.4,34,,2315.4,percent of total billed charges,Implant Device,2315.4,34,,2315.4,percent of total billed charges,Implant Device,2315.4,34,,2315.4,percent of total billed charges,Implant Device,2315.4,34,,2315.4,percent of total billed charges,Implant Device,2383.5,35,,2383.5,percent of total billed charges,Implant Device,2315.4,34,"Charges > $500, x 34%",2315.4,percent of total billed charges,Implant Device,2383.5,35,,2383.5,percent of total billed charges,Implant Devices,2383.5,35,,2383.5,percent of total billed charges,Implant Devices,2383.5,35,,,percent of total billed charges,Implant Devices,2383.5,35,,2383.5,percent of total billed charges,Implant Devices,2383.5,35,,2383.5,percent of total billed charges,Implant Devices,2724,40,,2724,percent of total billed charges,Implant Devices,2383.5,70,,2383.5,percent of total billed charges,Implant Devices,2315.4,34,,2315.4,percent of total billed charges,Implant Devices,2315.4,34,,2315.4,percent of total billed charges,Implant Devices,2383.5,35,,2383.5,percent of total billed charges,Implant Devices,2383.5,35,,2383.5,percent of total billed charges,Implant Devices,2383.5,35,,2383.5,percent of total billed charges,Implant Devices,2383.5,35,,2383.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2315.4,34,"If Charge > 2,000, then 34 percent",2315.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2724,
BIOMET 348012 CALCIGEN-S BONE GRAFT 10GM,C1713,HCPCS,,79008865,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
WRIGHT 5820MPXIR CROSSCHECK RT,C1713,HCPCS,,79008870,CDM,278,RC,,,both,,,9330,3682.25,39.4668,,3682.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3172.2,34,,3172.2,percent of total billed charges,Implant Device,3172.2,34,,3172.2,percent of total billed charges,Implant Device,3172.2,34,,3172.2,percent of total billed charges,Implant Device,3172.2,34,,3172.2,percent of total billed charges,Implant Device,3172.2,34,,3172.2,percent of total billed charges,Implant Device,3172.2,34,,3172.2,percent of total billed charges,Implant Device,3265.5,35,,3265.5,percent of total billed charges,Implant Device,3172.2,34,"Charges > $500, x 34%",3172.2,percent of total billed charges,Implant Device,3265.5,35,,3265.5,percent of total billed charges,Implant Devices,3265.5,35,,3265.5,percent of total billed charges,Implant Devices,3265.5,35,,,percent of total billed charges,Implant Devices,3265.5,35,,3265.5,percent of total billed charges,Implant Devices,3265.5,35,,3265.5,percent of total billed charges,Implant Devices,3732,40,,3732,percent of total billed charges,Implant Devices,3265.5,70,,3265.5,percent of total billed charges,Implant Devices,3172.2,34,,3172.2,percent of total billed charges,Implant Devices,3172.2,34,,3172.2,percent of total billed charges,Implant Devices,3265.5,35,,3265.5,percent of total billed charges,Implant Devices,3265.5,35,,3265.5,percent of total billed charges,Implant Devices,3265.5,35,,3265.5,percent of total billed charges,Implant Devices,3265.5,35,,3265.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3172.2,34,"If Charge > 2,000, then 34 percent",3172.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3732,
WRIGHT 588003518 SCREW 2.5LX18MM,C1713,HCPCS,,79008871,CDM,278,RC,,,both,,,1317,519.78,39.4668,,519.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,460.95,35,,460.95,percent of total billed charges,Implant Device,447.78,34,"Charges > $500, x 34%",447.78,percent of total billed charges,Implant Device,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,526.8,40,,526.8,percent of total billed charges,Implant Devices,460.95,70,,460.95,percent of total billed charges,Implant Devices,447.78,34,,447.78,percent of total billed charges,Implant Devices,447.78,34,,447.78,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,526.8,
WRIGHT 5820X3526 SCREW 3.5X26MM,C1713,HCPCS,,79008872,CDM,278,RC,,,both,,,1254,494.91,39.4668,,494.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,426.36,34,,426.36,percent of total billed charges,Implant Device,438.9,35,,438.9,percent of total billed charges,Implant Device,426.36,34,"Charges > $500, x 34%",426.36,percent of total billed charges,Implant Device,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,501.6,40,,501.6,percent of total billed charges,Implant Devices,438.9,70,,438.9,percent of total billed charges,Implant Devices,426.36,34,,426.36,percent of total billed charges,Implant Devices,426.36,34,,426.36,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,438.9,35,,438.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,501.6,
STRYKER 604742 4.0X42MM ASNIS CANN SCREW,C1713,HCPCS,,79008876,CDM,278,RC,,,both,,,824,325.21,39.4668,,325.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Device,280.16,34,"Charges > $500, x 34%",280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,329.6,40,,329.6,percent of total billed charges,Implant Devices,288.4,70,,288.4,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,329.6,
STRYKER 604746 4.0X46MM ASNIS CANN SCREW,C1713,HCPCS,,79008877,CDM,278,RC,,,both,,,824,325.21,39.4668,,325.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Device,280.16,34,"Charges > $500, x 34%",280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,329.6,40,,329.6,percent of total billed charges,Implant Devices,288.4,70,,288.4,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,329.6,
MEDTRONIC 6950315 SET SCREW,C1713,HCPCS,,79008879,CDM,278,RC,,,both,,,230,90.77,39.4668,,90.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78.2,34,,78.2,percent of total billed charges,Implant Device,78.2,34,,78.2,percent of total billed charges,Implant Device,78.2,34,,78.2,percent of total billed charges,Implant Device,78.2,34,,78.2,percent of total billed charges,Implant Device,78.2,34,,78.2,percent of total billed charges,Implant Device,78.2,34,,78.2,percent of total billed charges,Implant Device,80.5,35,,80.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,92,40,,92,percent of total billed charges,Implant Devices,80.5,70,,80.5,percent of total billed charges,Implant Devices,78.2,34,,78.2,percent of total billed charges,Implant Devices,78.2,34,,78.2,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,80.5,35,,80.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,92,
MEDTRONIC 7753770 70MM VENTEX ROD,C1713,HCPCS,,79008880,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
MEDTRONIC 6958714 3.5X14MM SCREWS,C1713,HCPCS,,79008881,CDM,278,RC,,,both,,,1823,719.48,39.4668,,719.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,619.82,34,,619.82,percent of total billed charges,Implant Device,619.82,34,,619.82,percent of total billed charges,Implant Device,619.82,34,,619.82,percent of total billed charges,Implant Device,619.82,34,,619.82,percent of total billed charges,Implant Device,619.82,34,,619.82,percent of total billed charges,Implant Device,619.82,34,,619.82,percent of total billed charges,Implant Device,638.05,35,,638.05,percent of total billed charges,Implant Device,619.82,34,"Charges > $500, x 34%",619.82,percent of total billed charges,Implant Device,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,729.2,40,,729.2,percent of total billed charges,Implant Devices,638.05,70,,638.05,percent of total billed charges,Implant Devices,619.82,34,,619.82,percent of total billed charges,Implant Devices,619.82,34,,619.82,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,729.2,
MEDTRONIC 7753780 80MM VENTEX ROD,C1713,HCPCS,,79008883,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
MEDTRONIC 6958712 3.5X12MM SCREW,C1713,HCPCS,,79008884,CDM,278,RC,,,both,,,1823,719.48,39.4668,,719.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,619.82,34,,619.82,percent of total billed charges,Implant Device,619.82,34,,619.82,percent of total billed charges,Implant Device,619.82,34,,619.82,percent of total billed charges,Implant Device,619.82,34,,619.82,percent of total billed charges,Implant Device,619.82,34,,619.82,percent of total billed charges,Implant Device,619.82,34,,619.82,percent of total billed charges,Implant Device,638.05,35,,638.05,percent of total billed charges,Implant Device,619.82,34,"Charges > $500, x 34%",619.82,percent of total billed charges,Implant Device,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,729.2,40,,729.2,percent of total billed charges,Implant Devices,638.05,70,,638.05,percent of total billed charges,Implant Devices,619.82,34,,619.82,percent of total billed charges,Implant Devices,619.82,34,,619.82,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,638.05,35,,638.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,729.2,
MEDTRONIC 7752536 MD CROSSLINK,C1713,HCPCS,,79008885,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
STRYKER 40-27614 LOCKING SCREW 2.7X14MM,C1713,HCPCS,,79008886,CDM,278,RC,,,both,,,732,288.9,39.4668,,288.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Device,248.88,34,"Charges > $500, x 34%",248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,292.8,40,,292.8,percent of total billed charges,Implant Devices,256.2,70,,256.2,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,292.8,
STRYKER 40-27610 LOCKING SCREW 2.7X10MM,C1713,HCPCS,,79008887,CDM,278,RC,,,both,,,732,288.9,39.4668,,288.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Device,248.88,34,"Charges > $500, x 34%",248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,292.8,40,,292.8,percent of total billed charges,Implant Devices,256.2,70,,256.2,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,292.8,
STRYKER 657112 BONE SCREW 2.7X12MM,C1713,HCPCS,,79008890,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657114 BONE SCREW 2.7X14MM,C1713,HCPCS,,79008891,CDM,278,RC,,,both,,,293,115.64,39.4668,,115.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,99.62,34,,99.62,percent of total billed charges,Implant Device,102.55,35,,102.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,117.2,40,,117.2,percent of total billed charges,Implant Devices,102.55,70,,102.55,percent of total billed charges,Implant Devices,99.62,34,,99.62,percent of total billed charges,Implant Devices,99.62,34,,99.62,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,102.55,35,,102.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.2,
STRYKER 40-20909 DISTAL FIBULA PLATE 9H,C1713,HCPCS,,79008892,CDM,278,RC,,,both,,,2102,829.59,39.4668,,829.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714.68,34,,714.68,percent of total billed charges,Implant Device,714.68,34,,714.68,percent of total billed charges,Implant Device,714.68,34,,714.68,percent of total billed charges,Implant Device,714.68,34,,714.68,percent of total billed charges,Implant Device,714.68,34,,714.68,percent of total billed charges,Implant Device,714.68,34,,714.68,percent of total billed charges,Implant Device,735.7,35,,735.7,percent of total billed charges,Implant Device,714.68,34,"Charges > $500, x 34%",714.68,percent of total billed charges,Implant Device,735.7,35,,735.7,percent of total billed charges,Implant Devices,735.7,35,,735.7,percent of total billed charges,Implant Devices,735.7,35,,,percent of total billed charges,Implant Devices,735.7,35,,735.7,percent of total billed charges,Implant Devices,735.7,35,,735.7,percent of total billed charges,Implant Devices,840.8,40,,840.8,percent of total billed charges,Implant Devices,735.7,70,,735.7,percent of total billed charges,Implant Devices,714.68,34,,714.68,percent of total billed charges,Implant Devices,714.68,34,,714.68,percent of total billed charges,Implant Devices,735.7,35,,735.7,percent of total billed charges,Implant Devices,735.7,35,,735.7,percent of total billed charges,Implant Devices,735.7,35,,735.7,percent of total billed charges,Implant Devices,735.7,35,,735.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714.68,34,"If Charge > 2,000, then 34 percent",714.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840.8,
STRYKER 657012 LOCKING SCREW 2.7X12MM,C1713,HCPCS,,79008893,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 40-30140 CANN SCREW 3.0X40/8MM,C1713,HCPCS,,79008895,CDM,278,RC,,,both,,,859,339.02,39.4668,,339.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,292.06,34,,292.06,percent of total billed charges,Implant Device,300.65,35,,300.65,percent of total billed charges,Implant Device,292.06,34,"Charges > $500, x 34%",292.06,percent of total billed charges,Implant Device,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,343.6,40,,343.6,percent of total billed charges,Implant Devices,300.65,70,,300.65,percent of total billed charges,Implant Devices,292.06,34,,292.06,percent of total billed charges,Implant Devices,292.06,34,,292.06,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,300.65,35,,300.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.6,
ARTHREX AR-13120T-18 CORT SCREW 2.3X18MM,C1713,HCPCS,,79008896,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
ARTHREX AR-13120T-12 CORT SCREW 2.3X12MM,C1713,HCPCS,,79008898,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
IN2BONES 100-0061 COTTON WEDGE 6X23MM,C1713,HCPCS,,79008899,CDM,278,RC,,,both,,,8985,3546.09,39.4668,,3546.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3144.75,35,,3144.75,percent of total billed charges,Implant Device,3054.9,34,"Charges > $500, x 34%",3054.9,percent of total billed charges,Implant Device,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3594,40,,3594,percent of total billed charges,Implant Devices,3144.75,70,,3144.75,percent of total billed charges,Implant Devices,3054.9,34,,3054.9,percent of total billed charges,Implant Devices,3054.9,34,,3054.9,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3054.9,34,"If Charge > 2,000, then 34 percent",3054.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3594,
STRYKER 658036 COMP SCREW 4.0X38MM,C1713,HCPCS,,79008901,CDM,278,RC,,,both,,,1767,697.38,39.4668,,697.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,618.45,35,,618.45,percent of total billed charges,Implant Device,600.78,34,"Charges > $500, x 34%",600.78,percent of total billed charges,Implant Device,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,706.8,40,,706.8,percent of total billed charges,Implant Devices,618.45,70,,618.45,percent of total billed charges,Implant Devices,600.78,34,,600.78,percent of total billed charges,Implant Devices,600.78,34,,600.78,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,706.8,
STRYKER PLP40280 ANCHORAGE PLT STR 4 H,C1713,HCPCS,,79008902,CDM,278,RC,,,both,,,5733,2262.63,39.4668,,2262.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1949.22,34,,1949.22,percent of total billed charges,Implant Device,1949.22,34,,1949.22,percent of total billed charges,Implant Device,1949.22,34,,1949.22,percent of total billed charges,Implant Device,1949.22,34,,1949.22,percent of total billed charges,Implant Device,1949.22,34,,1949.22,percent of total billed charges,Implant Device,1949.22,34,,1949.22,percent of total billed charges,Implant Device,2006.55,35,,2006.55,percent of total billed charges,Implant Device,1949.22,34,"Charges > $500, x 34%",1949.22,percent of total billed charges,Implant Device,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2293.2,40,,2293.2,percent of total billed charges,Implant Devices,2006.55,70,,2006.55,percent of total billed charges,Implant Devices,1949.22,34,,1949.22,percent of total billed charges,Implant Devices,1949.22,34,,1949.22,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,2006.55,35,,2006.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1949.22,34,"If Charge > 2,000, then 34 percent",1949.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2293.2,
STRYKER PLSS3016 ANCHORAGE SCREW 3X16MM,C1713,HCPCS,,79008903,CDM,278,RC,,,both,,,1767,697.38,39.4668,,697.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,618.45,35,,618.45,percent of total billed charges,Implant Device,600.78,34,"Charges > $500, x 34%",600.78,percent of total billed charges,Implant Device,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,706.8,40,,706.8,percent of total billed charges,Implant Devices,618.45,70,,618.45,percent of total billed charges,Implant Devices,600.78,34,,600.78,percent of total billed charges,Implant Devices,600.78,34,,600.78,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,706.8,
BIOMET 01-7126 FACIAL PLATE 8-HOLE,C1713,HCPCS,,79008910,CDM,278,RC,,,both,,,1029,406.11,39.4668,,406.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,360.15,35,,360.15,percent of total billed charges,Implant Device,349.86,34,"Charges > $500, x 34%",349.86,percent of total billed charges,Implant Device,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,411.6,40,,411.6,percent of total billed charges,Implant Devices,360.15,70,,360.15,percent of total billed charges,Implant Devices,349.86,34,,349.86,percent of total billed charges,Implant Devices,349.86,34,,349.86,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,411.6,
STRYKER 661446 NON LOCK SCREW 3.5X46MM,C1713,HCPCS,,79008914,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
STRYKER 607348 NON LOCK CAN SCREW 4X48MM,C1713,HCPCS,,79008915,CDM,278,RC,,,both,,,133,52.49,39.4668,,52.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,53.2,40,,53.2,percent of total billed charges,Implant Devices,46.55,70,,46.55,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
IN2BONES APA-003 PIP ALLOGRAFT 2.9X19MM,C1713,HCPCS,,79008916,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 627706 PROX TIBIAL PLATE 6 H,C1713,HCPCS,,79008918,CDM,278,RC,,,both,,,5561,2194.75,39.4668,,2194.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1890.74,34,,1890.74,percent of total billed charges,Implant Device,1890.74,34,,1890.74,percent of total billed charges,Implant Device,1890.74,34,,1890.74,percent of total billed charges,Implant Device,1890.74,34,,1890.74,percent of total billed charges,Implant Device,1890.74,34,,1890.74,percent of total billed charges,Implant Device,1890.74,34,,1890.74,percent of total billed charges,Implant Device,1946.35,35,,1946.35,percent of total billed charges,Implant Device,1890.74,34,"Charges > $500, x 34%",1890.74,percent of total billed charges,Implant Device,1946.35,35,,1946.35,percent of total billed charges,Implant Devices,1946.35,35,,1946.35,percent of total billed charges,Implant Devices,1946.35,35,,,percent of total billed charges,Implant Devices,1946.35,35,,1946.35,percent of total billed charges,Implant Devices,1946.35,35,,1946.35,percent of total billed charges,Implant Devices,2224.4,40,,2224.4,percent of total billed charges,Implant Devices,1946.35,70,,1946.35,percent of total billed charges,Implant Devices,1890.74,34,,1890.74,percent of total billed charges,Implant Devices,1890.74,34,,1890.74,percent of total billed charges,Implant Devices,1946.35,35,,1946.35,percent of total billed charges,Implant Devices,1946.35,35,,1946.35,percent of total billed charges,Implant Devices,1946.35,35,,1946.35,percent of total billed charges,Implant Devices,1946.35,35,,1946.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1890.74,34,"If Charge > 2,000, then 34 percent",1890.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2224.4,
STRYKER 40-27022 BONE SCREW 2.7X22MM,C1713,HCPCS,,79008919,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
IN2BONES P40 ST235 MTP PLATE 6 HOLE LEFT,C1713,HCPCS,,79008926,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES V30 ST314 LOCKING SCREW 3X14MM,C1713,HCPCS,,79008927,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V30 ST424 TRANSVERSE SCREW 3X24,C1713,HCPCS,,79008928,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V30 ST312 LOCKING SCREW 3X12MM,C1713,HCPCS,,79008929,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V30 ST316 LOCKING SCREW 3X16MM,C1713,HCPCS,,79008930,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
DEPUY 294.786 SCHANZ SCREW 5.0X200MM,C1713,HCPCS,,79008932,CDM,278,RC,,,both,,,305,120.37,39.4668,,120.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,106.75,35,,106.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,122,40,,122,percent of total billed charges,Implant Devices,106.75,70,,106.75,percent of total billed charges,Implant Devices,103.7,34,,103.7,percent of total billed charges,Implant Devices,103.7,34,,103.7,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122,
STRYKER 658044 HDLESS COMP SCREW 4X44MM,C1713,HCPCS,,79008938,CDM,278,RC,,,both,,,1767,697.38,39.4668,,697.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,618.45,35,,618.45,percent of total billed charges,Implant Device,600.78,34,"Charges > $500, x 34%",600.78,percent of total billed charges,Implant Device,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,706.8,40,,706.8,percent of total billed charges,Implant Devices,618.45,70,,618.45,percent of total billed charges,Implant Devices,600.78,34,,600.78,percent of total billed charges,Implant Devices,600.78,34,,600.78,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,706.8,
STRYKER 656112 2.4X12MM BONE SCREW,C1713,HCPCS,,79008942,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656116 2.4X16MM BONE SCREW,C1713,HCPCS,,79008943,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
MIMEDX AI-5020 AMNIOFIX INJECTABLE 20MG,C1713,HCPCS,,79008946,CDM,278,RC,,,both,,,992,391.51,39.4668,,391.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,337.28,34,,337.28,percent of total billed charges,Implant Device,337.28,34,,337.28,percent of total billed charges,Implant Device,337.28,34,,337.28,percent of total billed charges,Implant Device,337.28,34,,337.28,percent of total billed charges,Implant Device,337.28,34,,337.28,percent of total billed charges,Implant Device,337.28,34,,337.28,percent of total billed charges,Implant Device,347.2,35,,347.2,percent of total billed charges,Implant Device,337.28,34,"Charges > $500, x 34%",337.28,percent of total billed charges,Implant Device,347.2,35,,347.2,percent of total billed charges,Implant Devices,347.2,35,,347.2,percent of total billed charges,Implant Devices,347.2,35,,,percent of total billed charges,Implant Devices,347.2,35,,347.2,percent of total billed charges,Implant Devices,347.2,35,,347.2,percent of total billed charges,Implant Devices,396.8,40,,396.8,percent of total billed charges,Implant Devices,347.2,70,,347.2,percent of total billed charges,Implant Devices,337.28,34,,337.28,percent of total billed charges,Implant Devices,337.28,34,,337.28,percent of total billed charges,Implant Devices,347.2,35,,347.2,percent of total billed charges,Implant Devices,347.2,35,,347.2,percent of total billed charges,Implant Devices,347.2,35,,347.2,percent of total billed charges,Implant Devices,347.2,35,,347.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,396.8,
S&N 71343612 FEM HEAD 12/14 TAPER 36MM,C1713,HCPCS,,79008950,CDM,278,RC,,,both,,,4851,1914.53,39.4668,,1914.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1697.85,35,,1697.85,percent of total billed charges,Implant Device,1649.34,34,"Charges > $500, x 34%",1649.34,percent of total billed charges,Implant Device,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1940.4,40,,1940.4,percent of total billed charges,Implant Devices,1697.85,70,,1697.85,percent of total billed charges,Implant Devices,1649.34,34,,1649.34,percent of total billed charges,Implant Devices,1649.34,34,,1649.34,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1649.34,34,"If Charge > 2,000, then 34 percent",1649.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1940.4,
STRYKER 604636 4.0X36MM ASNIS SCREW,C1713,HCPCS,,79008952,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 1830-0929S 9X290MM HUMERAL NAIL,C1713,HCPCS,,79008953,CDM,278,RC,,,both,,,6661,2628.88,39.4668,,2628.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2331.35,35,,2331.35,percent of total billed charges,Implant Device,2264.74,34,"Charges > $500, x 34%",2264.74,percent of total billed charges,Implant Device,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2664.4,40,,2664.4,percent of total billed charges,Implant Devices,2331.35,70,,2331.35,percent of total billed charges,Implant Devices,2264.74,34,,2264.74,percent of total billed charges,Implant Devices,2264.74,34,,2264.74,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2264.74,34,"If Charge > 2,000, then 34 percent",2264.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2664.4,
STRYKER 1896-4060S 4X60MM LOCKING SCREW,C1713,HCPCS,,79008954,CDM,278,RC,,,both,,,836,329.94,39.4668,,329.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,284.24,34,,284.24,percent of total billed charges,Implant Device,292.6,35,,292.6,percent of total billed charges,Implant Device,284.24,34,"Charges > $500, x 34%",284.24,percent of total billed charges,Implant Device,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,334.4,40,,334.4,percent of total billed charges,Implant Devices,292.6,70,,292.6,percent of total billed charges,Implant Devices,284.24,34,,284.24,percent of total billed charges,Implant Devices,284.24,34,,284.24,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,292.6,35,,292.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.4,
STRYKER 1832-3822S 8X220MM HUMERAL NAIL,C1713,HCPCS,,79008955,CDM,278,RC,,,both,,,4326,1707.33,39.4668,,1707.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1470.84,34,,1470.84,percent of total billed charges,Implant Device,1470.84,34,,1470.84,percent of total billed charges,Implant Device,1470.84,34,,1470.84,percent of total billed charges,Implant Device,1470.84,34,,1470.84,percent of total billed charges,Implant Device,1470.84,34,,1470.84,percent of total billed charges,Implant Device,1470.84,34,,1470.84,percent of total billed charges,Implant Device,1514.1,35,,1514.1,percent of total billed charges,Implant Device,1470.84,34,"Charges > $500, x 34%",1470.84,percent of total billed charges,Implant Device,1514.1,35,,1514.1,percent of total billed charges,Implant Devices,1514.1,35,,1514.1,percent of total billed charges,Implant Devices,1514.1,35,,,percent of total billed charges,Implant Devices,1514.1,35,,1514.1,percent of total billed charges,Implant Devices,1514.1,35,,1514.1,percent of total billed charges,Implant Devices,1730.4,40,,1730.4,percent of total billed charges,Implant Devices,1514.1,70,,1514.1,percent of total billed charges,Implant Devices,1470.84,34,,1470.84,percent of total billed charges,Implant Devices,1470.84,34,,1470.84,percent of total billed charges,Implant Devices,1514.1,35,,1514.1,percent of total billed charges,Implant Devices,1514.1,35,,1514.1,percent of total billed charges,Implant Devices,1514.1,35,,1514.1,percent of total billed charges,Implant Devices,1514.1,35,,1514.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1470.84,34,"If Charge > 2,000, then 34 percent",1470.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1730.4,
IN2BONES P40 ST245 LAPIDUS PLATE STD LT,C1713,HCPCS,,79008961,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES V30 ST310 PLATE SCREW 3.0X10MM,C1713,HCPCS,,79008962,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V30 ST430 TRANSVERSE SCREW 3X30,C1713,HCPCS,,79008963,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V30 ST426 TRANSVERSE SCREW 3X26,C1713,HCPCS,,79008964,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P40 ST145 LAPIDUS PLATE STD RT,C1713,HCPCS,,79008965,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES V30 ST318 PLATE SCREW 3.0X18MM,C1713,HCPCS,,79008966,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V30 ST320 PLATE SCREW 3.0X20MM,C1713,HCPCS,,79008967,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
STRYKER 5030-3-2501 5/4X250 TRANSFIX PIN,C1713,HCPCS,,79008972,CDM,278,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,79.56,34,,79.56,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,93.6,40,,93.6,percent of total billed charges,Implant Devices,81.9,70,,81.9,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,79.56,34,,79.56,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,81.9,35,,81.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,93.6,
ARTHREX AR-8950-12 2X12MM QUICK FIX SCRW,C1713,HCPCS,,79008975,CDM,278,RC,,,both,,,1029,406.11,39.4668,,406.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,360.15,35,,360.15,percent of total billed charges,Implant Device,349.86,34,"Charges > $500, x 34%",349.86,percent of total billed charges,Implant Device,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,411.6,40,,411.6,percent of total billed charges,Implant Devices,360.15,70,,360.15,percent of total billed charges,Implant Devices,349.86,34,,349.86,percent of total billed charges,Implant Devices,349.86,34,,349.86,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,411.6,
BIOMET 8145-10-130 10.5X130MM LAG SCREW,C1713,HCPCS,,79008977,CDM,278,RC,,,both,,,3180,1255.04,39.4668,,1255.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1081.2,34,,1081.2,percent of total billed charges,Implant Device,1081.2,34,,1081.2,percent of total billed charges,Implant Device,1081.2,34,,1081.2,percent of total billed charges,Implant Device,1081.2,34,,1081.2,percent of total billed charges,Implant Device,1081.2,34,,1081.2,percent of total billed charges,Implant Device,1081.2,34,,1081.2,percent of total billed charges,Implant Device,1113,35,,1113,percent of total billed charges,Implant Device,1081.2,34,"Charges > $500, x 34%",1081.2,percent of total billed charges,Implant Device,1113,35,,1113,percent of total billed charges,Implant Devices,1113,35,,1113,percent of total billed charges,Implant Devices,1113,35,,,percent of total billed charges,Implant Devices,1113,35,,1113,percent of total billed charges,Implant Devices,1113,35,,1113,percent of total billed charges,Implant Devices,1272,40,,1272,percent of total billed charges,Implant Devices,1113,70,,1113,percent of total billed charges,Implant Devices,1081.2,34,,1081.2,percent of total billed charges,Implant Devices,1081.2,34,,1081.2,percent of total billed charges,Implant Devices,1113,35,,1113,percent of total billed charges,Implant Devices,1113,35,,1113,percent of total billed charges,Implant Devices,1113,35,,1113,percent of total billed charges,Implant Devices,1113,35,,1113,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1081.2,34,"If Charge > 2,000, then 34 percent",1081.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1272,
NUVASIVE 5016001 BONE MATRIX-SM-1CC,C1713,HCPCS,,79008979,CDM,278,RC,,,both,,,1800,710.4,39.4668,,710.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Device,612,34,"Charges > $500, x 34%",612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,720,40,,720,percent of total billed charges,Implant Devices,630,70,,630,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,720,
NUVASIVE 5016005 BONE MATRIX-MED-5CC,C1713,HCPCS,,79008980,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
NUVASIVE 5016010 BONE MATRIX-LRG-10CC,C1713,HCPCS,,79008981,CDM,278,RC,,,both,,,13500,5328.02,39.4668,,5328.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Device,4590,34,"Charges > $500, x 34%",4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,5400,40,,5400,percent of total billed charges,Implant Devices,4725,70,,4725,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4590,34,"If Charge > 2,000, then 34 percent",4590,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5400,
STRYKER 40-35060 3.5X60MM NON LOCK SCREW,C1713,HCPCS,,79008982,CDM,278,RC,,,both,,,370,146.03,39.4668,,146.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,129.5,35,,129.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,148,40,,148,percent of total billed charges,Implant Devices,129.5,70,,129.5,percent of total billed charges,Implant Devices,125.8,34,,125.8,percent of total billed charges,Implant Devices,125.8,34,,125.8,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,148,
STRYKER 602710 6.5X110MM CANCELLOUS SCRW,C1713,HCPCS,,79008983,CDM,278,RC,,,both,,,1224,483.07,39.4668,,483.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,428.4,35,,428.4,percent of total billed charges,Implant Device,416.16,34,"Charges > $500, x 34%",416.16,percent of total billed charges,Implant Device,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,489.6,40,,489.6,percent of total billed charges,Implant Devices,428.4,70,,428.4,percent of total billed charges,Implant Devices,416.16,34,,416.16,percent of total billed charges,Implant Devices,416.16,34,,416.16,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,489.6,
DEPUY 202.212 LOCKING SCREW 2.7X12MM,C1713,HCPCS,,79008987,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
DEPUY 02.112.137 DIS FIB PLATE 3.5X73MM,C1713,HCPCS,,79008988,CDM,278,RC,,,both,,,1618,638.57,39.4668,,638.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,550.12,34,,550.12,percent of total billed charges,Implant Device,550.12,34,,550.12,percent of total billed charges,Implant Device,550.12,34,,550.12,percent of total billed charges,Implant Device,550.12,34,,550.12,percent of total billed charges,Implant Device,550.12,34,,550.12,percent of total billed charges,Implant Device,550.12,34,,550.12,percent of total billed charges,Implant Device,566.3,35,,566.3,percent of total billed charges,Implant Device,550.12,34,"Charges > $500, x 34%",550.12,percent of total billed charges,Implant Device,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,647.2,40,,647.2,percent of total billed charges,Implant Devices,566.3,70,,566.3,percent of total billed charges,Implant Devices,550.12,34,,550.12,percent of total billed charges,Implant Devices,550.12,34,,550.12,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,566.3,35,,566.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,647.2,
IN2BONES V30 ST432 TRANSVERSE SCREW 3X32,C1713,HCPCS,,79008989,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES S35 ST132 SCREW 3.5X32MM,C1713,HCPCS,,79008990,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
STRYKER 44317000 ANT TIBIALIS ALLOGRAFT,C1713,HCPCS,,79008992,CDM,278,RC,,,both,,,6420,2533.77,39.4668,,2533.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2182.8,34,,2182.8,percent of total billed charges,Implant Device,2182.8,34,,2182.8,percent of total billed charges,Implant Device,2182.8,34,,2182.8,percent of total billed charges,Implant Device,2182.8,34,,2182.8,percent of total billed charges,Implant Device,2182.8,34,,2182.8,percent of total billed charges,Implant Device,2182.8,34,,2182.8,percent of total billed charges,Implant Device,2247,35,,2247,percent of total billed charges,Implant Device,2182.8,34,"Charges > $500, x 34%",2182.8,percent of total billed charges,Implant Device,2247,35,,2247,percent of total billed charges,Implant Devices,2247,35,,2247,percent of total billed charges,Implant Devices,2247,35,,,percent of total billed charges,Implant Devices,2247,35,,2247,percent of total billed charges,Implant Devices,2247,35,,2247,percent of total billed charges,Implant Devices,2568,40,,2568,percent of total billed charges,Implant Devices,2247,70,,2247,percent of total billed charges,Implant Devices,2182.8,34,,2182.8,percent of total billed charges,Implant Devices,2182.8,34,,2182.8,percent of total billed charges,Implant Devices,2247,35,,2247,percent of total billed charges,Implant Devices,2247,35,,2247,percent of total billed charges,Implant Devices,2247,35,,2247,percent of total billed charges,Implant Devices,2247,35,,2247,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2182.8,34,"If Charge > 2,000, then 34 percent",2182.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2568,
STRYKER 44317001 POST TIBIALIS ALLOGRAFT,C1713,HCPCS,,79008993,CDM,278,RC,,,both,,,3894,1536.84,39.4668,,1536.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1323.96,34,,1323.96,percent of total billed charges,Implant Device,1323.96,34,,1323.96,percent of total billed charges,Implant Device,1323.96,34,,1323.96,percent of total billed charges,Implant Device,1323.96,34,,1323.96,percent of total billed charges,Implant Device,1323.96,34,,1323.96,percent of total billed charges,Implant Device,1323.96,34,,1323.96,percent of total billed charges,Implant Device,1362.9,35,,1362.9,percent of total billed charges,Implant Device,1323.96,34,"Charges > $500, x 34%",1323.96,percent of total billed charges,Implant Device,1362.9,35,,1362.9,percent of total billed charges,Implant Devices,1362.9,35,,1362.9,percent of total billed charges,Implant Devices,1362.9,35,,,percent of total billed charges,Implant Devices,1362.9,35,,1362.9,percent of total billed charges,Implant Devices,1362.9,35,,1362.9,percent of total billed charges,Implant Devices,1557.6,40,,1557.6,percent of total billed charges,Implant Devices,1362.9,70,,1362.9,percent of total billed charges,Implant Devices,1323.96,34,,1323.96,percent of total billed charges,Implant Devices,1323.96,34,,1323.96,percent of total billed charges,Implant Devices,1362.9,35,,1362.9,percent of total billed charges,Implant Devices,1362.9,35,,1362.9,percent of total billed charges,Implant Devices,1362.9,35,,1362.9,percent of total billed charges,Implant Devices,1362.9,35,,1362.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1323.96,34,"If Charge > 2,000, then 34 percent",1323.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1557.6,
STRYKER 44317003 SEMI TENODSIS ALLOGRAFT,C1713,HCPCS,,79008994,CDM,278,RC,,,both,,,3654,1442.12,39.4668,,1442.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1242.36,34,,1242.36,percent of total billed charges,Implant Device,1242.36,34,,1242.36,percent of total billed charges,Implant Device,1242.36,34,,1242.36,percent of total billed charges,Implant Device,1242.36,34,,1242.36,percent of total billed charges,Implant Device,1242.36,34,,1242.36,percent of total billed charges,Implant Device,1242.36,34,,1242.36,percent of total billed charges,Implant Device,1278.9,35,,1278.9,percent of total billed charges,Implant Device,1242.36,34,"Charges > $500, x 34%",1242.36,percent of total billed charges,Implant Device,1278.9,35,,1278.9,percent of total billed charges,Implant Devices,1278.9,35,,1278.9,percent of total billed charges,Implant Devices,1278.9,35,,,percent of total billed charges,Implant Devices,1278.9,35,,1278.9,percent of total billed charges,Implant Devices,1278.9,35,,1278.9,percent of total billed charges,Implant Devices,1461.6,40,,1461.6,percent of total billed charges,Implant Devices,1278.9,70,,1278.9,percent of total billed charges,Implant Devices,1242.36,34,,1242.36,percent of total billed charges,Implant Devices,1242.36,34,,1242.36,percent of total billed charges,Implant Devices,1278.9,35,,1278.9,percent of total billed charges,Implant Devices,1278.9,35,,1278.9,percent of total billed charges,Implant Devices,1278.9,35,,1278.9,percent of total billed charges,Implant Devices,1278.9,35,,1278.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1242.36,34,"If Charge > 2,000, then 34 percent",1242.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1461.6,
ALPHATEC SPINE 62065-50 6.5 X 50MM SCREW,C1713,HCPCS,,79008995,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
ZIMMER 00-2359-055-36 CANN SCREW 3.5X55,C1713,HCPCS,,79008996,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
ZIMMER 00-2347-020-38 PERI SCREW 3.5X38,C1713,HCPCS,,79008997,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
STRYKER 627704 PROX MEDIAL PLATE LT 4H,C1713,HCPCS,,79008998,CDM,278,RC,,,both,,,5222,2060.96,39.4668,,2060.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1827.7,35,,1827.7,percent of total billed charges,Implant Device,1775.48,34,"Charges > $500, x 34%",1775.48,percent of total billed charges,Implant Device,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,2088.8,40,,2088.8,percent of total billed charges,Implant Devices,1827.7,70,,1827.7,percent of total billed charges,Implant Devices,1775.48,34,,1775.48,percent of total billed charges,Implant Devices,1775.48,34,,1775.48,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1775.48,34,"If Charge > 2,000, then 34 percent",1775.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2088.8,
STRYKER 661030 LOCKING SCREW 4.0X30MM,C1713,HCPCS,,79008999,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 607428 CANCELLOUS SCREW 4X28MM,C1713,HCPCS,,79009000,CDM,278,RC,,,both,,,186,73.41,39.4668,,73.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,65.1,35,,65.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,74.4,40,,74.4,percent of total billed charges,Implant Devices,65.1,70,,65.1,percent of total billed charges,Implant Devices,63.24,34,,63.24,percent of total billed charges,Implant Devices,63.24,34,,63.24,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.4,
STRYKER 607334 CANCELLOUS SCREW 4X34MM,C1713,HCPCS,,79009001,CDM,278,RC,,,both,,,186,73.41,39.4668,,73.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,63.24,34,,63.24,percent of total billed charges,Implant Device,65.1,35,,65.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,74.4,40,,74.4,percent of total billed charges,Implant Devices,65.1,70,,65.1,percent of total billed charges,Implant Devices,63.24,34,,63.24,percent of total billed charges,Implant Devices,63.24,34,,63.24,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,65.1,35,,65.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.4,
STRYKER 661475 CORTICAL SCREW 3.5X75MM,C1713,HCPCS,,79009002,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
STRYKER 657020 LOCKING SCREW 2.7X20MM,C1713,HCPCS,,79009003,CDM,278,RC,,,both,,,939,370.59,39.4668,,370.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,319.26,34,,319.26,percent of total billed charges,Implant Device,319.26,34,,319.26,percent of total billed charges,Implant Device,319.26,34,,319.26,percent of total billed charges,Implant Device,319.26,34,,319.26,percent of total billed charges,Implant Device,319.26,34,,319.26,percent of total billed charges,Implant Device,319.26,34,,319.26,percent of total billed charges,Implant Device,328.65,35,,328.65,percent of total billed charges,Implant Device,319.26,34,"Charges > $500, x 34%",319.26,percent of total billed charges,Implant Device,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,375.6,40,,375.6,percent of total billed charges,Implant Devices,328.65,70,,328.65,percent of total billed charges,Implant Devices,319.26,34,,319.26,percent of total billed charges,Implant Devices,319.26,34,,319.26,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,328.65,35,,328.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,375.6,
ZIMMER 8144-11-400 NAIL 125 DEG 11X400MM,C1713,HCPCS,,79009005,CDM,278,RC,,,both,,,11430,4511.06,39.4668,,4511.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3886.2,34,,3886.2,percent of total billed charges,Implant Device,3886.2,34,,3886.2,percent of total billed charges,Implant Device,3886.2,34,,3886.2,percent of total billed charges,Implant Device,3886.2,34,,3886.2,percent of total billed charges,Implant Device,3886.2,34,,3886.2,percent of total billed charges,Implant Device,3886.2,34,,3886.2,percent of total billed charges,Implant Device,4000.5,35,,4000.5,percent of total billed charges,Implant Device,3886.2,34,"Charges > $500, x 34%",3886.2,percent of total billed charges,Implant Device,4000.5,35,,4000.5,percent of total billed charges,Implant Devices,4000.5,35,,4000.5,percent of total billed charges,Implant Devices,4000.5,35,,,percent of total billed charges,Implant Devices,4000.5,35,,4000.5,percent of total billed charges,Implant Devices,4000.5,35,,4000.5,percent of total billed charges,Implant Devices,4572,40,,4572,percent of total billed charges,Implant Devices,4000.5,70,,4000.5,percent of total billed charges,Implant Devices,3886.2,34,,3886.2,percent of total billed charges,Implant Devices,3886.2,34,,3886.2,percent of total billed charges,Implant Devices,4000.5,35,,4000.5,percent of total billed charges,Implant Devices,4000.5,35,,4000.5,percent of total billed charges,Implant Devices,4000.5,35,,4000.5,percent of total billed charges,Implant Devices,4000.5,35,,4000.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3886.2,34,"If Charge > 2,000, then 34 percent",3886.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4572,
DEPUY 04.032.080S 11X80MM TROCH SCREW,C1713,HCPCS,,79009007,CDM,278,RC,,,both,,,2197,867.09,39.4668,,867.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,768.95,35,,768.95,percent of total billed charges,Implant Device,746.98,34,"Charges > $500, x 34%",746.98,percent of total billed charges,Implant Device,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,878.8,40,,878.8,percent of total billed charges,Implant Devices,768.95,70,,768.95,percent of total billed charges,Implant Devices,746.98,34,,746.98,percent of total billed charges,Implant Devices,746.98,34,,746.98,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,746.98,34,"If Charge > 2,000, then 34 percent",746.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,878.8,
STRYKER 601675 ASNIS CANN SCREW 5X75MM,C1713,HCPCS,,79009008,CDM,278,RC,,,both,,,847,334.28,39.4668,,334.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,287.98,34,,287.98,percent of total billed charges,Implant Device,296.45,35,,296.45,percent of total billed charges,Implant Device,287.98,34,"Charges > $500, x 34%",287.98,percent of total billed charges,Implant Device,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,338.8,40,,338.8,percent of total billed charges,Implant Devices,296.45,70,,296.45,percent of total billed charges,Implant Devices,287.98,34,,287.98,percent of total billed charges,Implant Devices,287.98,34,,287.98,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,296.45,35,,296.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,338.8,
DEPUY 04.005.540S 5X50MM TI LOCK SCREW,C1713,HCPCS,,79009012,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 04.005.544S 5X54MM TI LOCK SCREW,C1713,HCPCS,,79009013,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 5038-1-110 3X110MM APEX HALF PIN,C1713,HCPCS,,79009014,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
BIOMET 8145-10-095 10.5X95 HIP LAG SCREW,C1713,HCPCS,,79009015,CDM,278,RC,,,both,,,1786,704.88,39.4668,,704.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,625.1,35,,625.1,percent of total billed charges,Implant Device,607.24,34,"Charges > $500, x 34%",607.24,percent of total billed charges,Implant Device,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,714.4,40,,714.4,percent of total billed charges,Implant Devices,625.1,70,,625.1,percent of total billed charges,Implant Devices,607.24,34,,607.24,percent of total billed charges,Implant Devices,607.24,34,,607.24,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,714.4,
DEPUY 04.032.085S 11X85MM TI NAIL SCREW,C1713,HCPCS,,79009017,CDM,278,RC,,,both,,,2197,867.09,39.4668,,867.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,746.98,34,,746.98,percent of total billed charges,Implant Device,768.95,35,,768.95,percent of total billed charges,Implant Device,746.98,34,"Charges > $500, x 34%",746.98,percent of total billed charges,Implant Device,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,878.8,40,,878.8,percent of total billed charges,Implant Devices,768.95,70,,768.95,percent of total billed charges,Implant Devices,746.98,34,,746.98,percent of total billed charges,Implant Devices,746.98,34,,746.98,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,768.95,35,,768.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,746.98,34,"If Charge > 2,000, then 34 percent",746.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,878.8,
DEPUY 456.397S TI CANN NAIL 3609MM,C1713,HCPCS,,79009018,CDM,278,RC,,,both,,,6895,2721.24,39.4668,,2721.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2344.3,34,,2344.3,percent of total billed charges,Implant Device,2413.25,35,,2413.25,percent of total billed charges,Implant Device,2344.3,34,"Charges > $500, x 34%",2344.3,percent of total billed charges,Implant Device,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2758,40,,2758,percent of total billed charges,Implant Devices,2413.25,70,,2413.25,percent of total billed charges,Implant Devices,2344.3,34,,2344.3,percent of total billed charges,Implant Devices,2344.3,34,,2344.3,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,2413.25,35,,2413.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2344.3,34,"If Charge > 2,000, then 34 percent",2344.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2758,
IN2BONES P40 ST135 MTP PLATE 6 HOLE LT,C1713,HCPCS,,79009019,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
BIOMET 8143-09-180 HIP FRCTRE NAIL 9X180,C1713,HCPCS,,79009020,CDM,278,RC,,,both,,,4464,1761.8,39.4668,,1761.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1562.4,35,,1562.4,percent of total billed charges,Implant Device,1517.76,34,"Charges > $500, x 34%",1517.76,percent of total billed charges,Implant Device,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1785.6,40,,1785.6,percent of total billed charges,Implant Devices,1562.4,70,,1562.4,percent of total billed charges,Implant Devices,1517.76,34,,1517.76,percent of total billed charges,Implant Devices,1517.76,34,,1517.76,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1517.76,34,"If Charge > 2,000, then 34 percent",1517.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1785.6,
BIOMET 8145-50-032 CORT BONE SCREW 5X32,C1713,HCPCS,,79009021,CDM,278,RC,,,both,,,533,210.36,39.4668,,210.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,186.55,35,,186.55,percent of total billed charges,Implant Device,181.22,34,"Charges > $500, x 34%",181.22,percent of total billed charges,Implant Device,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,213.2,40,,213.2,percent of total billed charges,Implant Devices,186.55,70,,186.55,percent of total billed charges,Implant Devices,181.22,34,,181.22,percent of total billed charges,Implant Devices,181.22,34,,181.22,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,213.2,
STRYKER 626808S LOCKING PLATE T10 8MM,C1713,HCPCS,,79009022,CDM,278,RC,,,both,,,6498,2564.55,39.4668,,2564.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2209.32,34,,2209.32,percent of total billed charges,Implant Device,2209.32,34,,2209.32,percent of total billed charges,Implant Device,2209.32,34,,2209.32,percent of total billed charges,Implant Device,2209.32,34,,2209.32,percent of total billed charges,Implant Device,2209.32,34,,2209.32,percent of total billed charges,Implant Device,2209.32,34,,2209.32,percent of total billed charges,Implant Device,2274.3,35,,2274.3,percent of total billed charges,Implant Device,2209.32,34,"Charges > $500, x 34%",2209.32,percent of total billed charges,Implant Device,2274.3,35,,2274.3,percent of total billed charges,Implant Devices,2274.3,35,,2274.3,percent of total billed charges,Implant Devices,2274.3,35,,,percent of total billed charges,Implant Devices,2274.3,35,,2274.3,percent of total billed charges,Implant Devices,2274.3,35,,2274.3,percent of total billed charges,Implant Devices,2599.2,40,,2599.2,percent of total billed charges,Implant Devices,2274.3,70,,2274.3,percent of total billed charges,Implant Devices,2209.32,34,,2209.32,percent of total billed charges,Implant Devices,2209.32,34,,2209.32,percent of total billed charges,Implant Devices,2274.3,35,,2274.3,percent of total billed charges,Implant Devices,2274.3,35,,2274.3,percent of total billed charges,Implant Devices,2274.3,35,,2274.3,percent of total billed charges,Implant Devices,2274.3,35,,2274.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2209.32,34,"If Charge > 2,000, then 34 percent",2209.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2599.2,
STRYKER 3102-1908 ALLOGRAFT 8X22X20MM,C1713,HCPCS,,79009023,CDM,278,RC,,,both,,,7929,3129.32,39.4668,,3129.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2695.86,34,,2695.86,percent of total billed charges,Implant Device,2695.86,34,,2695.86,percent of total billed charges,Implant Device,2695.86,34,,2695.86,percent of total billed charges,Implant Device,2695.86,34,,2695.86,percent of total billed charges,Implant Device,2695.86,34,,2695.86,percent of total billed charges,Implant Device,2695.86,34,,2695.86,percent of total billed charges,Implant Device,2775.15,35,,2775.15,percent of total billed charges,Implant Device,2695.86,34,"Charges > $500, x 34%",2695.86,percent of total billed charges,Implant Device,2775.15,35,,2775.15,percent of total billed charges,Implant Devices,2775.15,35,,2775.15,percent of total billed charges,Implant Devices,2775.15,35,,,percent of total billed charges,Implant Devices,2775.15,35,,2775.15,percent of total billed charges,Implant Devices,2775.15,35,,2775.15,percent of total billed charges,Implant Devices,3171.6,40,,3171.6,percent of total billed charges,Implant Devices,2775.15,70,,2775.15,percent of total billed charges,Implant Devices,2695.86,34,,2695.86,percent of total billed charges,Implant Devices,2695.86,34,,2695.86,percent of total billed charges,Implant Devices,2775.15,35,,2775.15,percent of total billed charges,Implant Devices,2775.15,35,,2775.15,percent of total billed charges,Implant Devices,2775.15,35,,2775.15,percent of total billed charges,Implant Devices,2775.15,35,,2775.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2695.86,34,"If Charge > 2,000, then 34 percent",2695.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3171.6,
STRYKER 3102-1900 ALLOGRAFT 6X24X14MM,C1713,HCPCS,,79009024,CDM,278,RC,,,both,,,8151,3216.94,39.4668,,3216.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2852.85,35,,2852.85,percent of total billed charges,Implant Device,2771.34,34,"Charges > $500, x 34%",2771.34,percent of total billed charges,Implant Device,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,3260.4,40,,3260.4,percent of total billed charges,Implant Devices,2852.85,70,,2852.85,percent of total billed charges,Implant Devices,2771.34,34,,2771.34,percent of total billed charges,Implant Devices,2771.34,34,,2771.34,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2771.34,34,"If Charge > 2,000, then 34 percent",2771.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3260.4,
STRYKER 40-35036 BONE SCREW T10 3.5X36MM,C1713,HCPCS,,79009025,CDM,278,RC,,,both,,,408,161.02,39.4668,,161.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,138.72,34,,138.72,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,163.2,40,,163.2,percent of total billed charges,Implant Devices,142.8,70,,142.8,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,138.72,34,,138.72,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,142.8,35,,142.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.2,
STRYKER 626771 LOCKING PLATE LEFT SHORT,C1713,HCPCS,,79009026,CDM,278,RC,,,both,,,7368,2907.91,39.4668,,2907.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2505.12,34,,2505.12,percent of total billed charges,Implant Device,2578.8,35,,2578.8,percent of total billed charges,Implant Device,2505.12,34,"Charges > $500, x 34%",2505.12,percent of total billed charges,Implant Device,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2947.2,40,,2947.2,percent of total billed charges,Implant Devices,2578.8,70,,2578.8,percent of total billed charges,Implant Devices,2505.12,34,,2505.12,percent of total billed charges,Implant Devices,2505.12,34,,2505.12,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,2578.8,35,,2578.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2505.12,34,"If Charge > 2,000, then 34 percent",2505.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2947.2,
IN2BONES 100-0040 VITRIUM WEDGE 18X10,C1713,HCPCS,,79009028,CDM,278,RC,,,both,,,9450,3729.61,39.4668,,3729.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Device,3213,34,"Charges > $500, x 34%",3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3780,40,,3780,percent of total billed charges,Implant Devices,3307.5,70,,3307.5,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3213,34,"If Charge > 2,000, then 34 percent",3213,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3780,
STRYKER 658610 COMP SCREW 7/L110MM,C1713,HCPCS,,79009034,CDM,278,RC,,,both,,,2955,1166.24,39.4668,,1166.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1004.7,34,,1004.7,percent of total billed charges,Implant Device,1004.7,34,,1004.7,percent of total billed charges,Implant Device,1004.7,34,,1004.7,percent of total billed charges,Implant Device,1004.7,34,,1004.7,percent of total billed charges,Implant Device,1004.7,34,,1004.7,percent of total billed charges,Implant Device,1004.7,34,,1004.7,percent of total billed charges,Implant Device,1034.25,35,,1034.25,percent of total billed charges,Implant Device,1004.7,34,"Charges > $500, x 34%",1004.7,percent of total billed charges,Implant Device,1034.25,35,,1034.25,percent of total billed charges,Implant Devices,1034.25,35,,1034.25,percent of total billed charges,Implant Devices,1034.25,35,,,percent of total billed charges,Implant Devices,1034.25,35,,1034.25,percent of total billed charges,Implant Devices,1034.25,35,,1034.25,percent of total billed charges,Implant Devices,1182,40,,1182,percent of total billed charges,Implant Devices,1034.25,70,,1034.25,percent of total billed charges,Implant Devices,1004.7,34,,1004.7,percent of total billed charges,Implant Devices,1004.7,34,,1004.7,percent of total billed charges,Implant Devices,1034.25,35,,1034.25,percent of total billed charges,Implant Devices,1034.25,35,,1034.25,percent of total billed charges,Implant Devices,1034.25,35,,1034.25,percent of total billed charges,Implant Devices,1034.25,35,,1034.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1004.7,34,"If Charge > 2,000, then 34 percent",1004.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1182,
STRYKER 602660 CANNULATED SCREW 6.5X60MM,C1713,HCPCS,,79009036,CDM,278,RC,,,both,,,1224,483.07,39.4668,,483.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,416.16,34,,416.16,percent of total billed charges,Implant Device,428.4,35,,428.4,percent of total billed charges,Implant Device,416.16,34,"Charges > $500, x 34%",416.16,percent of total billed charges,Implant Device,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,489.6,40,,489.6,percent of total billed charges,Implant Devices,428.4,70,,428.4,percent of total billed charges,Implant Devices,416.16,34,,416.16,percent of total billed charges,Implant Devices,416.16,34,,416.16,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,428.4,35,,428.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,489.6,
STRYKER 5017-8-150S HALF PIN 5X15X25MM,C1713,HCPCS,,79009039,CDM,278,RC,,,both,,,752,296.79,39.4668,,296.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255.68,34,,255.68,percent of total billed charges,Implant Device,255.68,34,,255.68,percent of total billed charges,Implant Device,255.68,34,,255.68,percent of total billed charges,Implant Device,255.68,34,,255.68,percent of total billed charges,Implant Device,255.68,34,,255.68,percent of total billed charges,Implant Device,255.68,34,,255.68,percent of total billed charges,Implant Device,263.2,35,,263.2,percent of total billed charges,Implant Device,255.68,34,"Charges > $500, x 34%",255.68,percent of total billed charges,Implant Device,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,300.8,40,,300.8,percent of total billed charges,Implant Devices,263.2,70,,263.2,percent of total billed charges,Implant Devices,255.68,34,,255.68,percent of total billed charges,Implant Devices,255.68,34,,255.68,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,263.2,35,,263.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300.8,
STRYKER 897010 HYDROSET XT 10C,C1713,HCPCS,,79009046,CDM,278,RC,,,both,,,8512,3359.41,39.4668,,3359.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2894.08,34,,2894.08,percent of total billed charges,Implant Device,2894.08,34,,2894.08,percent of total billed charges,Implant Device,2894.08,34,,2894.08,percent of total billed charges,Implant Device,2894.08,34,,2894.08,percent of total billed charges,Implant Device,2894.08,34,,2894.08,percent of total billed charges,Implant Device,2894.08,34,,2894.08,percent of total billed charges,Implant Device,2979.2,35,,2979.2,percent of total billed charges,Implant Device,2894.08,34,"Charges > $500, x 34%",2894.08,percent of total billed charges,Implant Device,2979.2,35,,2979.2,percent of total billed charges,Implant Devices,2979.2,35,,2979.2,percent of total billed charges,Implant Devices,2979.2,35,,,percent of total billed charges,Implant Devices,2979.2,35,,2979.2,percent of total billed charges,Implant Devices,2979.2,35,,2979.2,percent of total billed charges,Implant Devices,3404.8,40,,3404.8,percent of total billed charges,Implant Devices,2979.2,70,,2979.2,percent of total billed charges,Implant Devices,2894.08,34,,2894.08,percent of total billed charges,Implant Devices,2894.08,34,,2894.08,percent of total billed charges,Implant Devices,2979.2,35,,2979.2,percent of total billed charges,Implant Devices,2979.2,35,,2979.2,percent of total billed charges,Implant Devices,2979.2,35,,2979.2,percent of total billed charges,Implant Devices,2979.2,35,,2979.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2894.08,34,"If Charge > 2,000, then 34 percent",2894.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3404.8,
STRYKER 40-10114 CALCANEUS STD PLATE MED,C1713,HCPCS,,79009047,CDM,278,RC,,,both,,,3695,1458.3,39.4668,,1458.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1256.3,34,,1256.3,percent of total billed charges,Implant Device,1256.3,34,,1256.3,percent of total billed charges,Implant Device,1256.3,34,,1256.3,percent of total billed charges,Implant Device,1256.3,34,,1256.3,percent of total billed charges,Implant Device,1256.3,34,,1256.3,percent of total billed charges,Implant Device,1256.3,34,,1256.3,percent of total billed charges,Implant Device,1293.25,35,,1293.25,percent of total billed charges,Implant Device,1256.3,34,"Charges > $500, x 34%",1256.3,percent of total billed charges,Implant Device,1293.25,35,,1293.25,percent of total billed charges,Implant Devices,1293.25,35,,1293.25,percent of total billed charges,Implant Devices,1293.25,35,,,percent of total billed charges,Implant Devices,1293.25,35,,1293.25,percent of total billed charges,Implant Devices,1293.25,35,,1293.25,percent of total billed charges,Implant Devices,1478,40,,1478,percent of total billed charges,Implant Devices,1293.25,70,,1293.25,percent of total billed charges,Implant Devices,1256.3,34,,1256.3,percent of total billed charges,Implant Devices,1256.3,34,,1256.3,percent of total billed charges,Implant Devices,1293.25,35,,1293.25,percent of total billed charges,Implant Devices,1293.25,35,,1293.25,percent of total billed charges,Implant Devices,1293.25,35,,1293.25,percent of total billed charges,Implant Devices,1293.25,35,,1293.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1256.3,34,"If Charge > 2,000, then 34 percent",1256.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1478,
STRYKER 40-10104 CALCANEUS MESH PLATE,C1713,HCPCS,,79009048,CDM,278,RC,,,both,,,2174,858.01,39.4668,,858.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,739.16,34,,739.16,percent of total billed charges,Implant Device,739.16,34,,739.16,percent of total billed charges,Implant Device,739.16,34,,739.16,percent of total billed charges,Implant Device,739.16,34,,739.16,percent of total billed charges,Implant Device,739.16,34,,739.16,percent of total billed charges,Implant Device,739.16,34,,739.16,percent of total billed charges,Implant Device,760.9,35,,760.9,percent of total billed charges,Implant Device,739.16,34,"Charges > $500, x 34%",739.16,percent of total billed charges,Implant Device,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,869.6,40,,869.6,percent of total billed charges,Implant Devices,760.9,70,,760.9,percent of total billed charges,Implant Devices,739.16,34,,739.16,percent of total billed charges,Implant Devices,739.16,34,,739.16,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,739.16,34,"If Charge > 2,000, then 34 percent",739.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,869.6,
STRYKER 40-35640 LOCK SCREW T10 3.5X40MM,C1713,HCPCS,,79009049,CDM,278,RC,,,both,,,732,288.9,39.4668,,288.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Device,248.88,34,"Charges > $500, x 34%",248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,292.8,40,,292.8,percent of total billed charges,Implant Devices,256.2,70,,256.2,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,292.8,
STRYKER 40-35638 LOCK SCREW T10 3.5X38MM,C1713,HCPCS,,79009050,CDM,278,RC,,,both,,,732,288.9,39.4668,,288.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,248.88,34,,248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Device,248.88,34,"Charges > $500, x 34%",248.88,percent of total billed charges,Implant Device,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,292.8,40,,292.8,percent of total billed charges,Implant Devices,256.2,70,,256.2,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,248.88,34,,248.88,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,256.2,35,,256.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,292.8,
STRYKER 627540 COMPRESSION PLATE 10H 5MM,C1713,HCPCS,,79009053,CDM,278,RC,,,both,,,8235,3250.09,39.4668,,3250.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2882.25,35,,2882.25,percent of total billed charges,Implant Device,2799.9,34,"Charges > $500, x 34%",2799.9,percent of total billed charges,Implant Device,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,3294,40,,3294,percent of total billed charges,Implant Devices,2882.25,70,,2882.25,percent of total billed charges,Implant Devices,2799.9,34,,2799.9,percent of total billed charges,Implant Devices,2799.9,34,,2799.9,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2799.9,34,"If Charge > 2,000, then 34 percent",2799.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3294,
STRYKER 661724 CORTICAL SCREW 4.5X24MM,C1713,HCPCS,,79009054,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
STRYKER 661722 CORTICAL SCREW 4.5X22MM,C1713,HCPCS,,79009055,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
STRYKER 661122 LOCKING SCREW 5.0X22MM,C1713,HCPCS,,79009056,CDM,278,RC,,,both,,,864,340.99,39.4668,,340.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,293.76,34,,293.76,percent of total billed charges,Implant Device,302.4,35,,302.4,percent of total billed charges,Implant Device,293.76,34,"Charges > $500, x 34%",293.76,percent of total billed charges,Implant Device,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,345.6,40,,345.6,percent of total billed charges,Implant Devices,302.4,70,,302.4,percent of total billed charges,Implant Devices,293.76,34,,293.76,percent of total billed charges,Implant Devices,293.76,34,,293.76,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,302.4,35,,302.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,345.6,
STRYKER 608025 CANCELLOUS SCREW 6.0X25MM,C1713,HCPCS,,79009057,CDM,278,RC,,,both,,,155,61.17,39.4668,,61.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,54.25,35,,54.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,62,40,,62,percent of total billed charges,Implant Devices,54.25,70,,54.25,percent of total billed charges,Implant Devices,52.7,34,,52.7,percent of total billed charges,Implant Devices,52.7,34,,52.7,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,62,
STRYKER 603018 CORTICAL SCREW 3.5X18MM,C1713,HCPCS,,79009058,CDM,278,RC,,,both,,,118,46.57,39.4668,,46.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,47.2,40,,47.2,percent of total billed charges,Implant Devices,41.3,70,,41.3,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,47.2,
STRYKER 604018 CANCELLOUS SCREW 4.0X18MM,C1713,HCPCS,,79009059,CDM,278,RC,,,both,,,118,46.57,39.4668,,46.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,47.2,40,,47.2,percent of total billed charges,Implant Devices,41.3,70,,41.3,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,47.2,
STRYKER 604020 CANCELLOUS SCREW 4.0X20MM,C1713,HCPCS,,79009060,CDM,278,RC,,,both,,,115,45.39,39.4668,,45.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,39.1,34,,39.1,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,46,40,,46,percent of total billed charges,Implant Devices,40.25,70,,40.25,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,39.1,34,,39.1,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,40.25,35,,40.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46,
STRYKER 627234 PROX HUMERUS PLATE RT 4H,C1713,HCPCS,,79009061,CDM,278,RC,,,both,,,6151,2427.6,39.4668,,2427.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2152.85,35,,2152.85,percent of total billed charges,Implant Device,2091.34,34,"Charges > $500, x 34%",2091.34,percent of total billed charges,Implant Device,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2460.4,40,,2460.4,percent of total billed charges,Implant Devices,2152.85,70,,2152.85,percent of total billed charges,Implant Devices,2091.34,34,,2091.34,percent of total billed charges,Implant Devices,2091.34,34,,2091.34,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2091.34,34,"If Charge > 2,000, then 34 percent",2091.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2460.4,
STRYKER 657016 LOCK SCREW F10 2.7XL16MM,C1713,HCPCS,,79009063,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 657310 LOCK SCREW F10 3.5XL10MM,C1713,HCPCS,,79009064,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 5018-6-150 APEX PIN 5X150MM,C1713,HCPCS,,79009065,CDM,278,RC,,,both,,,297,117.22,39.4668,,117.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,103.95,35,,103.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,118.8,40,,118.8,percent of total billed charges,Implant Devices,103.95,70,,103.95,percent of total billed charges,Implant Devices,100.98,34,,100.98,percent of total billed charges,Implant Devices,100.98,34,,100.98,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,118.8,
STRYKER 619906 4.0MM WASHER,C1713,HCPCS,,79009067,CDM,278,RC,,,both,,,153,60.38,39.4668,,60.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,61.2,40,,61.2,percent of total billed charges,Implant Devices,53.55,70,,53.55,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,61.2,
DEPUY 02-112-082 CLAV PLTE 3.5X100 7 HLE,C1713,HCPCS,,79009069,CDM,278,RC,,,both,,,2459,970.49,39.4668,,970.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,860.65,35,,860.65,percent of total billed charges,Implant Device,836.06,34,"Charges > $500, x 34%",836.06,percent of total billed charges,Implant Device,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,983.6,40,,983.6,percent of total billed charges,Implant Devices,860.65,70,,860.65,percent of total billed charges,Implant Devices,836.06,34,,836.06,percent of total billed charges,Implant Devices,836.06,34,,836.06,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,836.06,34,"If Charge > 2,000, then 34 percent",836.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,983.6,
LIFE SPINE INC 4045-35-41 4.5X35MM SCREW,C1713,HCPCS,,79009070,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
LIFE SPNE INC 4045-25-41 4.5X25MM SCREW,C1713,HCPCS,,79009071,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
LIFE SPINE INC 6475-045 45MM RODS,C1713,HCPCS,,79009072,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
LIFE SPINE INC 148-037 45MM SET CAPS,C1713,HCPCS,,79009073,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
LIFE SPINE 290-35-5010 50X10X7 CANC STRI,C1713,HCPCS,,79009075,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
IN2BONES V30 ST216 NON LOCK SCREW 3X16MM,C1713,HCPCS,,79009078,CDM,278,RC,,,both,,,735,290.08,39.4668,,290.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Device,249.9,34,"Charges > $500, x 34%",249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,294,40,,294,percent of total billed charges,Implant Devices,257.25,70,,257.25,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
IN2BONES APA-002 PIP ALLOGRAFT 2.5X16MM,C1713,HCPCS,,79009079,CDM,278,RC,,,both,,,4308,1700.23,39.4668,,1700.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1507.8,35,,1507.8,percent of total billed charges,Implant Device,1464.72,34,"Charges > $500, x 34%",1464.72,percent of total billed charges,Implant Device,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1723.2,40,,1723.2,percent of total billed charges,Implant Devices,1507.8,70,,1507.8,percent of total billed charges,Implant Devices,1464.72,34,,1464.72,percent of total billed charges,Implant Devices,1464.72,34,,1464.72,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1464.72,34,"If Charge > 2,000, then 34 percent",1464.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1723.2,
DEPUY 02.112.007 CLAVICLE PLATE 3.5X69MM,C1713,HCPCS,,79009080,CDM,278,RC,,,both,,,2292,904.58,39.4668,,904.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,802.2,35,,802.2,percent of total billed charges,Implant Device,779.28,34,"Charges > $500, x 34%",779.28,percent of total billed charges,Implant Device,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,916.8,40,,916.8,percent of total billed charges,Implant Devices,802.2,70,,802.2,percent of total billed charges,Implant Devices,779.28,34,,779.28,percent of total billed charges,Implant Devices,779.28,34,,779.28,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,779.28,34,"If Charge > 2,000, then 34 percent",779.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,916.8,
ARTHREX AR-7000-26 THREAD SCRW 3.75X26MM,C1713,HCPCS,,79009082,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
STRYKER 657326 LOCK SCREW T10 3.5X26MM,C1713,HCPCS,,79009086,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 657328 LOCK SCREW T10 3.5X28MM,C1713,HCPCS,,79009087,CDM,278,RC,,,both,,,494,194.97,39.4668,,194.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,197.6,40,,197.6,percent of total billed charges,Implant Devices,172.9,70,,172.9,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.6,
STRYKER 657334 LOCK SCREW T10 3.5X34MM,C1713,HCPCS,,79009088,CDM,278,RC,,,both,,,1035,408.48,39.4668,,408.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,351.9,34,,351.9,percent of total billed charges,Implant Device,362.25,35,,362.25,percent of total billed charges,Implant Device,351.9,34,"Charges > $500, x 34%",351.9,percent of total billed charges,Implant Device,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,414,40,,414,percent of total billed charges,Implant Devices,362.25,70,,362.25,percent of total billed charges,Implant Devices,351.9,34,,351.9,percent of total billed charges,Implant Devices,351.9,34,,351.9,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,362.25,35,,362.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,414,
STRYKER 657434 BONE SCREW T10 3.5X34MM,C1713,HCPCS,,79009089,CDM,278,RC,,,both,,,269,106.17,39.4668,,106.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,107.6,40,,107.6,percent of total billed charges,Implant Devices,94.15,70,,94.15,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.6,
BIOMET 14196-110 CANN SCREW 6.5X110MM,C1713,HCPCS,,79009091,CDM,278,RC,,,both,,,1290,509.12,39.4668,,509.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,438.6,34,,438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Device,438.6,34,"Charges > $500, x 34%",438.6,percent of total billed charges,Implant Device,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,516,40,,516,percent of total billed charges,Implant Devices,451.5,70,,451.5,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,438.6,34,,438.6,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,451.5,35,,451.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,516,
IN2BONES P60 ST445 FX SCREW 4.5X45MM,C1713,HCPCS,,79009096,CDM,278,RC,,,both,,,3108,1226.63,39.4668,,1226.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1087.8,35,,1087.8,percent of total billed charges,Implant Device,1056.72,34,"Charges > $500, x 34%",1056.72,percent of total billed charges,Implant Device,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1243.2,40,,1243.2,percent of total billed charges,Implant Devices,1087.8,70,,1087.8,percent of total billed charges,Implant Devices,1056.72,34,,1056.72,percent of total billed charges,Implant Devices,1056.72,34,,1056.72,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1056.72,34,"If Charge > 2,000, then 34 percent",1056.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1243.2,
DEPUY 200.806 CORTEX SCREW 1.5X6MM,C1713,HCPCS,,79009099,CDM,278,RC,,,both,,,126,49.73,39.4668,,49.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,50.4,40,,50.4,percent of total billed charges,Implant Devices,44.1,70,,44.1,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50.4,
DEPUY 200.807 CORTEX SCREW 1.5X7MM,C1713,HCPCS,,79009100,CDM,278,RC,,,both,,,126,49.73,39.4668,,49.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,50.4,40,,50.4,percent of total billed charges,Implant Devices,44.1,70,,44.1,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50.4,
DEPUY 200.814 CORTEX SCREW 1.5X14MM,C1713,HCPCS,,79009101,CDM,278,RC,,,both,,,126,49.73,39.4668,,49.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,42.84,34,,42.84,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,50.4,40,,50.4,percent of total billed charges,Implant Devices,44.1,70,,44.1,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,42.84,34,,42.84,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,44.1,35,,44.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50.4,
DEPUY 214.550 CANNULATED SCREW 4.5X50MM,C1713,HCPCS,,79009102,CDM,278,RC,,,both,,,781,308.24,39.4668,,308.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,265.54,34,,265.54,percent of total billed charges,Implant Device,265.54,34,,265.54,percent of total billed charges,Implant Device,265.54,34,,265.54,percent of total billed charges,Implant Device,265.54,34,,265.54,percent of total billed charges,Implant Device,265.54,34,,265.54,percent of total billed charges,Implant Device,265.54,34,,265.54,percent of total billed charges,Implant Device,273.35,35,,273.35,percent of total billed charges,Implant Device,265.54,34,"Charges > $500, x 34%",265.54,percent of total billed charges,Implant Device,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,312.4,40,,312.4,percent of total billed charges,Implant Devices,273.35,70,,273.35,percent of total billed charges,Implant Devices,265.54,34,,265.54,percent of total billed charges,Implant Devices,265.54,34,,265.54,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,312.4,
DEPUY 214.544 CANNULATED SCREW 4.5X44MM,C1713,HCPCS,,79009103,CDM,278,RC,,,both,,,781,308.24,39.4668,,308.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,265.54,34,,265.54,percent of total billed charges,Implant Device,265.54,34,,265.54,percent of total billed charges,Implant Device,265.54,34,,265.54,percent of total billed charges,Implant Device,265.54,34,,265.54,percent of total billed charges,Implant Device,265.54,34,,265.54,percent of total billed charges,Implant Device,265.54,34,,265.54,percent of total billed charges,Implant Device,273.35,35,,273.35,percent of total billed charges,Implant Device,265.54,34,"Charges > $500, x 34%",265.54,percent of total billed charges,Implant Device,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,312.4,40,,312.4,percent of total billed charges,Implant Devices,273.35,70,,273.35,percent of total billed charges,Implant Devices,265.54,34,,265.54,percent of total billed charges,Implant Devices,265.54,34,,265.54,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,273.35,35,,273.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,312.4,
DEPUY 219.92 WASHER 10MM,C1713,HCPCS,,79009104,CDM,278,RC,,,both,,,104,41.05,39.4668,,41.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,35.36,34,,35.36,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,41.6,40,,41.6,percent of total billed charges,Implant Devices,36.4,70,,36.4,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,35.36,34,,35.36,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,36.4,35,,36.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,41.6,
ORTHOFIX 99-611540 X-CALIBER SCRW 150/40,C1713,HCPCS,,79009112,CDM,278,RC,,,both,,,455,179.57,39.4668,,179.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,159.25,35,,159.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,182,40,,182,percent of total billed charges,Implant Devices,159.25,70,,159.25,percent of total billed charges,Implant Devices,154.7,34,,154.7,percent of total billed charges,Implant Devices,154.7,34,,154.7,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182,
ORTHOFIX 99-611530 X-CALIBER SCRW 150/30,C1713,HCPCS,,79009113,CDM,278,RC,,,both,,,455,179.57,39.4668,,179.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,154.7,34,,154.7,percent of total billed charges,Implant Device,159.25,35,,159.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,182,40,,182,percent of total billed charges,Implant Devices,159.25,70,,159.25,percent of total billed charges,Implant Devices,154.7,34,,154.7,percent of total billed charges,Implant Devices,154.7,34,,154.7,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,159.25,35,,159.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182,
BIOMET 11-300922 DIS STEM W/SCREW 22X190,C1713,HCPCS,,79009114,CDM,278,RC,,,both,,,18660,7364.5,39.4668,,7364.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6531,35,,6531,percent of total billed charges,Implant Device,6344.4,34,"Charges > $500, x 34%",6344.4,percent of total billed charges,Implant Device,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,7464,40,,7464,percent of total billed charges,Implant Devices,6531,70,,6531,percent of total billed charges,Implant Devices,6344.4,34,,6344.4,percent of total billed charges,Implant Devices,6344.4,34,,6344.4,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6344.4,34,"If Charge > 2,000, then 34 percent",6344.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7464,
STRYKER 5573-6532 CORTEX SCREW 6.5X32MM,C1713,HCPCS,,79009115,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
STRYKER 5572-4536 PERIPH SCREW 4.5X36MM,C1713,HCPCS,,79009116,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
STRYKER 5572-4524 PERIPH SCREW 4.5X24MM,C1713,HCPCS,,79009117,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
ARTHREX AR-8933-26 3.0X26MM CORT SCREW,C1713,HCPCS,,79009118,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8933-28 3.0X28MM CORT SCREW,C1713,HCPCS,,79009119,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
ARTHREX AR-8933V-12 3.0X12MM LOCK SCREW,C1713,HCPCS,,79009120,CDM,278,RC,,,both,,,525,207.2,39.4668,,207.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Device,178.5,34,"Charges > $500, x 34%",178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,210,40,,210,percent of total billed charges,Implant Devices,183.75,70,,183.75,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
ARTHREX AR-8933V-24 3.0X24MM LOCK SCREW,C1713,HCPCS,,79009121,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
ARTHREX AR-8942W-2008 20X20X8 EVAN WEDGE,C1713,HCPCS,,79009122,CDM,278,RC,,,both,,,9408,3713.04,39.4668,,3713.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3198.72,34,,3198.72,percent of total billed charges,Implant Device,3198.72,34,,3198.72,percent of total billed charges,Implant Device,3198.72,34,,3198.72,percent of total billed charges,Implant Device,3198.72,34,,3198.72,percent of total billed charges,Implant Device,3198.72,34,,3198.72,percent of total billed charges,Implant Device,3198.72,34,,3198.72,percent of total billed charges,Implant Device,3292.8,35,,3292.8,percent of total billed charges,Implant Device,3198.72,34,"Charges > $500, x 34%",3198.72,percent of total billed charges,Implant Device,3292.8,35,,3292.8,percent of total billed charges,Implant Devices,3292.8,35,,3292.8,percent of total billed charges,Implant Devices,3292.8,35,,,percent of total billed charges,Implant Devices,3292.8,35,,3292.8,percent of total billed charges,Implant Devices,3292.8,35,,3292.8,percent of total billed charges,Implant Devices,3763.2,40,,3763.2,percent of total billed charges,Implant Devices,3292.8,70,,3292.8,percent of total billed charges,Implant Devices,3198.72,34,,3198.72,percent of total billed charges,Implant Devices,3198.72,34,,3198.72,percent of total billed charges,Implant Devices,3292.8,35,,3292.8,percent of total billed charges,Implant Devices,3292.8,35,,3292.8,percent of total billed charges,Implant Devices,3292.8,35,,3292.8,percent of total billed charges,Implant Devices,3292.8,35,,3292.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3198.72,34,"If Charge > 2,000, then 34 percent",3198.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3763.2,
ARTHREX AR-8948W-1655 16X15.5 COTT WEDGE,C1713,HCPCS,,79009123,CDM,278,RC,,,both,,,8550,3374.41,39.4668,,3374.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2992.5,35,,2992.5,percent of total billed charges,Implant Device,2907,34,"Charges > $500, x 34%",2907,percent of total billed charges,Implant Device,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,3420,40,,3420,percent of total billed charges,Implant Devices,2992.5,70,,2992.5,percent of total billed charges,Implant Devices,2907,34,,2907,percent of total billed charges,Implant Devices,2907,34,,2907,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2907,34,"If Charge > 2,000, then 34 percent",2907,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3420,
IN2BONES APA-004 PIP ALLOGRAFT 2.9X19MM,C1713,HCPCS,,79009135,CDM,278,RC,,,both,,,4308,1700.23,39.4668,,1700.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1464.72,34,,1464.72,percent of total billed charges,Implant Device,1507.8,35,,1507.8,percent of total billed charges,Implant Device,1464.72,34,"Charges > $500, x 34%",1464.72,percent of total billed charges,Implant Device,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1723.2,40,,1723.2,percent of total billed charges,Implant Devices,1507.8,70,,1507.8,percent of total billed charges,Implant Devices,1464.72,34,,1464.72,percent of total billed charges,Implant Devices,1464.72,34,,1464.72,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,1507.8,35,,1507.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1464.72,34,"If Charge > 2,000, then 34 percent",1464.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1723.2,
DEPUY 02.111.630 DIST RAD PLT 2.4MM 3H,C1713,HCPCS,,79009138,CDM,278,RC,,,both,,,2323,916.81,39.4668,,916.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,813.05,35,,813.05,percent of total billed charges,Implant Device,789.82,34,"Charges > $500, x 34%",789.82,percent of total billed charges,Implant Device,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,929.2,40,,929.2,percent of total billed charges,Implant Devices,813.05,70,,813.05,percent of total billed charges,Implant Devices,789.82,34,,789.82,percent of total billed charges,Implant Devices,789.82,34,,789.82,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,789.82,34,"If Charge > 2,000, then 34 percent",789.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,929.2,
IN2BONES V30 ST322 LOCKING SCREW 3X22MM,C1713,HCPCS,,79009139,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V30 ST436 LOCKING SCREW 3X36MM,C1713,HCPCS,,79009140,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES S35 ST134 COMP SCREW 3.5X34MM,C1713,HCPCS,,79009141,CDM,278,RC,,,both,,,1350,532.8,39.4668,,532.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Device,459,34,"Charges > $500, x 34%",459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,540,40,,540,percent of total billed charges,Implant Devices,472.5,70,,472.5,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,540,
STRYKER SV10 S-FIX SCREW 2.5LG 10MM,C1713,HCPCS,,79009142,CDM,278,RC,,,both,,,1866,736.45,39.4668,,736.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,634.44,34,,634.44,percent of total billed charges,Implant Device,634.44,34,,634.44,percent of total billed charges,Implant Device,634.44,34,,634.44,percent of total billed charges,Implant Device,634.44,34,,634.44,percent of total billed charges,Implant Device,634.44,34,,634.44,percent of total billed charges,Implant Device,634.44,34,,634.44,percent of total billed charges,Implant Device,653.1,35,,653.1,percent of total billed charges,Implant Device,634.44,34,"Charges > $500, x 34%",634.44,percent of total billed charges,Implant Device,653.1,35,,653.1,percent of total billed charges,Implant Devices,653.1,35,,653.1,percent of total billed charges,Implant Devices,653.1,35,,,percent of total billed charges,Implant Devices,653.1,35,,653.1,percent of total billed charges,Implant Devices,653.1,35,,653.1,percent of total billed charges,Implant Devices,746.4,40,,746.4,percent of total billed charges,Implant Devices,653.1,70,,653.1,percent of total billed charges,Implant Devices,634.44,34,,634.44,percent of total billed charges,Implant Devices,634.44,34,,634.44,percent of total billed charges,Implant Devices,653.1,35,,653.1,percent of total billed charges,Implant Devices,653.1,35,,653.1,percent of total billed charges,Implant Devices,653.1,35,,653.1,percent of total billed charges,Implant Devices,653.1,35,,653.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,746.4,
TRYKER 54-25400 PLATE SHORT LATERAL,C1713,HCPCS,,79009143,CDM,278,RC,,,both,,,3086,1217.95,39.4668,,1217.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1049.24,34,,1049.24,percent of total billed charges,Implant Device,1049.24,34,,1049.24,percent of total billed charges,Implant Device,1049.24,34,,1049.24,percent of total billed charges,Implant Device,1049.24,34,,1049.24,percent of total billed charges,Implant Device,1049.24,34,,1049.24,percent of total billed charges,Implant Device,1049.24,34,,1049.24,percent of total billed charges,Implant Device,1080.1,35,,1080.1,percent of total billed charges,Implant Device,1049.24,34,"Charges > $500, x 34%",1049.24,percent of total billed charges,Implant Device,1080.1,35,,1080.1,percent of total billed charges,Implant Devices,1080.1,35,,1080.1,percent of total billed charges,Implant Devices,1080.1,35,,,percent of total billed charges,Implant Devices,1080.1,35,,1080.1,percent of total billed charges,Implant Devices,1080.1,35,,1080.1,percent of total billed charges,Implant Devices,1234.4,40,,1234.4,percent of total billed charges,Implant Devices,1080.1,70,,1080.1,percent of total billed charges,Implant Devices,1049.24,34,,1049.24,percent of total billed charges,Implant Devices,1049.24,34,,1049.24,percent of total billed charges,Implant Devices,1080.1,35,,1080.1,percent of total billed charges,Implant Devices,1080.1,35,,1080.1,percent of total billed charges,Implant Devices,1080.1,35,,1080.1,percent of total billed charges,Implant Devices,1080.1,35,,1080.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1049.24,34,"If Charge > 2,000, then 34 percent",1049.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1234.4,
STRYKER 656028 LOCKING SCREW 2.4X28MM,C1713,HCPCS,,79009144,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
STRYKER EZS-08 STEP STAPLE 8MM,C1713,HCPCS,,79009145,CDM,278,RC,,,both,,,7875,3108.01,39.4668,,3108.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2756.25,35,,2756.25,percent of total billed charges,Implant Device,2677.5,34,"Charges > $500, x 34%",2677.5,percent of total billed charges,Implant Device,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,3150,40,,3150,percent of total billed charges,Implant Devices,2756.25,70,,2756.25,percent of total billed charges,Implant Devices,2677.5,34,,2677.5,percent of total billed charges,Implant Devices,2677.5,34,,2677.5,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2677.5,34,"If Charge > 2,000, then 34 percent",2677.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3150,
STRYKER 5029-7-030 8MM SEMICIRCULAR ROD,C1713,HCPCS,,79009158,CDM,278,RC,,,both,,,1005,396.64,39.4668,,396.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,351.75,35,,351.75,percent of total billed charges,Implant Device,341.7,34,"Charges > $500, x 34%",341.7,percent of total billed charges,Implant Device,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,402,40,,402,percent of total billed charges,Implant Devices,351.75,70,,351.75,percent of total billed charges,Implant Devices,341.7,34,,341.7,percent of total billed charges,Implant Devices,341.7,34,,341.7,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,402,
ZIMMER 8144-11-380 HFN NAIL 11X380MM,C1713,HCPCS,,79009160,CDM,278,RC,,,both,,,7290,2877.13,39.4668,,2877.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2551.5,35,,2551.5,percent of total billed charges,Implant Device,2478.6,34,"Charges > $500, x 34%",2478.6,percent of total billed charges,Implant Device,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2916,40,,2916,percent of total billed charges,Implant Devices,2551.5,70,,2551.5,percent of total billed charges,Implant Devices,2478.6,34,,2478.6,percent of total billed charges,Implant Devices,2478.6,34,,2478.6,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2478.6,34,"If Charge > 2,000, then 34 percent",2478.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2916,
ZIMMER 8145-50-042 CORTICAL SCREW 5X42MM,C1713,HCPCS,,79009161,CDM,278,RC,,,both,,,594,234.43,39.4668,,234.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Device,201.96,34,"Charges > $500, x 34%",201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,237.6,40,,237.6,percent of total billed charges,Implant Devices,207.9,70,,207.9,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,237.6,
ARTHREX AR-4502 SPEEDCINCH CURVED NEEDLE,C1713,HCPCS,,79009162,CDM,278,RC,,,both,,,1185,467.68,39.4668,,467.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,402.9,34,,402.9,percent of total billed charges,Implant Device,402.9,34,,402.9,percent of total billed charges,Implant Device,402.9,34,,402.9,percent of total billed charges,Implant Device,402.9,34,,402.9,percent of total billed charges,Implant Device,402.9,34,,402.9,percent of total billed charges,Implant Device,402.9,34,,402.9,percent of total billed charges,Implant Device,414.75,35,,414.75,percent of total billed charges,Implant Device,402.9,34,"Charges > $500, x 34%",402.9,percent of total billed charges,Implant Device,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,474,40,,474,percent of total billed charges,Implant Devices,414.75,70,,414.75,percent of total billed charges,Implant Devices,402.9,34,,402.9,percent of total billed charges,Implant Devices,402.9,34,,402.9,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,474,
STRYKER 1822-1234S TIBIAL NAIL 12X345MM,C1713,HCPCS,,79009165,CDM,278,RC,,,both,,,3529,1392.78,39.4668,,1392.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Device,1199.86,34,"Charges > $500, x 34%",1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1411.6,40,,1411.6,percent of total billed charges,Implant Devices,1235.15,70,,1235.15,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1199.86,34,"If Charge > 2,000, then 34 percent",1199.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1411.6,
STRYKER 627204 PROX HUMERUS PLATE 4 HOLE,C1713,HCPCS,,79009166,CDM,278,RC,,,both,,,9045,3569.77,39.4668,,3569.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3075.3,34,,3075.3,percent of total billed charges,Implant Device,3075.3,34,,3075.3,percent of total billed charges,Implant Device,3075.3,34,,3075.3,percent of total billed charges,Implant Device,3075.3,34,,3075.3,percent of total billed charges,Implant Device,3075.3,34,,3075.3,percent of total billed charges,Implant Device,3075.3,34,,3075.3,percent of total billed charges,Implant Device,3165.75,35,,3165.75,percent of total billed charges,Implant Device,3075.3,34,"Charges > $500, x 34%",3075.3,percent of total billed charges,Implant Device,3165.75,35,,3165.75,percent of total billed charges,Implant Devices,3165.75,35,,3165.75,percent of total billed charges,Implant Devices,3165.75,35,,,percent of total billed charges,Implant Devices,3165.75,35,,3165.75,percent of total billed charges,Implant Devices,3165.75,35,,3165.75,percent of total billed charges,Implant Devices,3618,40,,3618,percent of total billed charges,Implant Devices,3165.75,70,,3165.75,percent of total billed charges,Implant Devices,3075.3,34,,3075.3,percent of total billed charges,Implant Devices,3075.3,34,,3075.3,percent of total billed charges,Implant Devices,3165.75,35,,3165.75,percent of total billed charges,Implant Devices,3165.75,35,,3165.75,percent of total billed charges,Implant Devices,3165.75,35,,3165.75,percent of total billed charges,Implant Devices,3165.75,35,,3165.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3075.3,34,"If Charge > 2,000, then 34 percent",3075.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3618,
STRYKER 5023-5-150 APEX PIN 4X150MM,C1713,HCPCS,,79009167,CDM,278,RC,,,both,,,576,227.33,39.4668,,227.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,195.84,34,,195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Device,195.84,34,"Charges > $500, x 34%",195.84,percent of total billed charges,Implant Device,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,230.4,40,,230.4,percent of total billed charges,Implant Devices,201.6,70,,201.6,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,195.84,34,,195.84,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,201.6,35,,201.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.4,
IN2BONES S22 ST013 SNAP OFF SCREW 2.2X13,C1713,HCPCS,,79009172,CDM,278,RC,,,both,,,1275,503.2,39.4668,,503.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Device,433.5,34,"Charges > $500, x 34%",433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,510,40,,510,percent of total billed charges,Implant Devices,446.25,70,,446.25,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510,
STRYKER 627334 PROX LAT TIBIAL PLATE 4 H,C1713,HCPCS,,79009179,CDM,278,RC,,,both,,,8895,3510.57,39.4668,,3510.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3113.25,35,,3113.25,percent of total billed charges,Implant Device,3024.3,34,"Charges > $500, x 34%",3024.3,percent of total billed charges,Implant Device,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3558,40,,3558,percent of total billed charges,Implant Devices,3113.25,70,,3113.25,percent of total billed charges,Implant Devices,3024.3,34,,3024.3,percent of total billed charges,Implant Devices,3024.3,34,,3024.3,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3024.3,34,"If Charge > 2,000, then 34 percent",3024.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3558,
STRYKER 661460 NON LOCK SCREW 3.5X60MM,C1713,HCPCS,,79009180,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
STRYKER 661420 NON LOCK SCREW 3.5X20MM,C1713,HCPCS,,79009181,CDM,278,RC,,,both,,,132,52.1,39.4668,,52.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,44.88,34,,44.88,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,52.8,40,,52.8,percent of total billed charges,Implant Devices,46.2,70,,46.2,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,44.88,34,,44.88,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,46.2,35,,46.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52.8,
STRYKER 661418 NON LOCK SCREW 3.5X18MM,C1713,HCPCS,,79009182,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
STRYKER 607370 CANCELLOUS SCREW 4.0X70MM,C1713,HCPCS,,79009183,CDM,278,RC,,,both,,,133,52.49,39.4668,,52.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,53.2,40,,53.2,percent of total billed charges,Implant Devices,46.55,70,,46.55,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
STRYKER 607320 CANCELLOUS SCREW 4.0X20MM,C1713,HCPCS,,79009184,CDM,278,RC,,,both,,,195,76.96,39.4668,,76.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,78,40,,78,percent of total billed charges,Implant Devices,68.25,70,,68.25,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78,
STRYKER 627736 PROX MEDIAL TIB PLATE 6 H,C1713,HCPCS,,79009191,CDM,278,RC,,,both,,,8178,3227.59,39.4668,,3227.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2780.52,34,,2780.52,percent of total billed charges,Implant Device,2780.52,34,,2780.52,percent of total billed charges,Implant Device,2780.52,34,,2780.52,percent of total billed charges,Implant Device,2780.52,34,,2780.52,percent of total billed charges,Implant Device,2780.52,34,,2780.52,percent of total billed charges,Implant Device,2780.52,34,,2780.52,percent of total billed charges,Implant Device,2862.3,35,,2862.3,percent of total billed charges,Implant Device,2780.52,34,"Charges > $500, x 34%",2780.52,percent of total billed charges,Implant Device,2862.3,35,,2862.3,percent of total billed charges,Implant Devices,2862.3,35,,2862.3,percent of total billed charges,Implant Devices,2862.3,35,,,percent of total billed charges,Implant Devices,2862.3,35,,2862.3,percent of total billed charges,Implant Devices,2862.3,35,,2862.3,percent of total billed charges,Implant Devices,3271.2,40,,3271.2,percent of total billed charges,Implant Devices,2862.3,70,,2862.3,percent of total billed charges,Implant Devices,2780.52,34,,2780.52,percent of total billed charges,Implant Devices,2780.52,34,,2780.52,percent of total billed charges,Implant Devices,2862.3,35,,2862.3,percent of total billed charges,Implant Devices,2862.3,35,,2862.3,percent of total billed charges,Implant Devices,2862.3,35,,2862.3,percent of total billed charges,Implant Devices,2862.3,35,,2862.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2780.52,34,"If Charge > 2,000, then 34 percent",2780.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3271.2,
IN2BONES V30 ST422 TRANSVERSE SCREW 3X22,C1713,HCPCS,,79009192,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
STRYKER 5018-3-120 5X120 APEX HALF PIN,C1713,HCPCS,,79009200,CDM,278,RC,,,both,,,711,280.61,39.4668,,280.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,248.85,35,,248.85,percent of total billed charges,Implant Device,241.74,34,"Charges > $500, x 34%",241.74,percent of total billed charges,Implant Device,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,284.4,40,,284.4,percent of total billed charges,Implant Devices,248.85,70,,248.85,percent of total billed charges,Implant Devices,241.74,34,,241.74,percent of total billed charges,Implant Devices,241.74,34,,241.74,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,284.4,
STRYKER 897015 HYDROSET XT 15CC,C1713,HCPCS,,79009201,CDM,278,RC,,,both,,,21354,8427.74,39.4668,,8427.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7260.36,34,,7260.36,percent of total billed charges,Implant Device,7260.36,34,,7260.36,percent of total billed charges,Implant Device,7260.36,34,,7260.36,percent of total billed charges,Implant Device,7260.36,34,,7260.36,percent of total billed charges,Implant Device,7260.36,34,,7260.36,percent of total billed charges,Implant Device,7260.36,34,,7260.36,percent of total billed charges,Implant Device,7473.9,35,,7473.9,percent of total billed charges,Implant Device,7260.36,34,"Charges > $500, x 34%",7260.36,percent of total billed charges,Implant Device,7473.9,35,,7473.9,percent of total billed charges,Implant Devices,7473.9,35,,7473.9,percent of total billed charges,Implant Devices,7473.9,35,,,percent of total billed charges,Implant Devices,7473.9,35,,7473.9,percent of total billed charges,Implant Devices,7473.9,35,,7473.9,percent of total billed charges,Implant Devices,8541.6,40,,8541.6,percent of total billed charges,Implant Devices,7473.9,70,,7473.9,percent of total billed charges,Implant Devices,7260.36,34,,7260.36,percent of total billed charges,Implant Devices,7260.36,34,,7260.36,percent of total billed charges,Implant Devices,7473.9,35,,7473.9,percent of total billed charges,Implant Devices,7473.9,35,,7473.9,percent of total billed charges,Implant Devices,7473.9,35,,7473.9,percent of total billed charges,Implant Devices,7473.9,35,,7473.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7260.36,34,"If Charge > 2,000, then 34 percent",7260.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8541.6,
STRYKER 40-35626 LOCK SCREW T10 3.5X26MM,C1713,HCPCS,,79009202,CDM,278,RC,,,both,,,806,318.1,39.4668,,318.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,274.04,34,,274.04,percent of total billed charges,Implant Device,274.04,34,,274.04,percent of total billed charges,Implant Device,274.04,34,,274.04,percent of total billed charges,Implant Device,274.04,34,,274.04,percent of total billed charges,Implant Device,274.04,34,,274.04,percent of total billed charges,Implant Device,274.04,34,,274.04,percent of total billed charges,Implant Device,282.1,35,,282.1,percent of total billed charges,Implant Device,274.04,34,"Charges > $500, x 34%",274.04,percent of total billed charges,Implant Device,282.1,35,,282.1,percent of total billed charges,Implant Devices,282.1,35,,282.1,percent of total billed charges,Implant Devices,282.1,35,,,percent of total billed charges,Implant Devices,282.1,35,,282.1,percent of total billed charges,Implant Devices,282.1,35,,282.1,percent of total billed charges,Implant Devices,322.4,40,,322.4,percent of total billed charges,Implant Devices,282.1,70,,282.1,percent of total billed charges,Implant Devices,274.04,34,,274.04,percent of total billed charges,Implant Devices,274.04,34,,274.04,percent of total billed charges,Implant Devices,282.1,35,,282.1,percent of total billed charges,Implant Devices,282.1,35,,282.1,percent of total billed charges,Implant Devices,282.1,35,,282.1,percent of total billed charges,Implant Devices,282.1,35,,282.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,322.4,
STRYKER 54-25583 VDR PLATE RIGHT NARROW,C1713,HCPCS,,79009207,CDM,278,RC,,,both,,,2604,1027.72,39.4668,,1027.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,885.36,34,,885.36,percent of total billed charges,Implant Device,911.4,35,,911.4,percent of total billed charges,Implant Device,885.36,34,"Charges > $500, x 34%",885.36,percent of total billed charges,Implant Device,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,1041.6,40,,1041.6,percent of total billed charges,Implant Devices,911.4,70,,911.4,percent of total billed charges,Implant Devices,885.36,34,,885.36,percent of total billed charges,Implant Devices,885.36,34,,885.36,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,911.4,35,,911.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,885.36,34,"If Charge > 2,000, then 34 percent",885.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1041.6,
STRYKER 657422 NON LOCK SCREW 3.5X22MM,C1713,HCPCS,,79009208,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657424 NON LOCK SCREW 3.5X24MM,C1713,HCPCS,,79009209,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
ZIMMER 514.315 KNEE CREATIONS KIT 15X3CC,C1713,HCPCS,,79009211,CDM,278,RC,,,both,,,10020,3954.57,39.4668,,3954.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3507,35,,3507,percent of total billed charges,Implant Device,3406.8,34,"Charges > $500, x 34%",3406.8,percent of total billed charges,Implant Device,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,4008,40,,4008,percent of total billed charges,Implant Devices,3507,70,,3507,percent of total billed charges,Implant Devices,3406.8,34,,3406.8,percent of total billed charges,Implant Devices,3406.8,34,,3406.8,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3406.8,34,"If Charge > 2,000, then 34 percent",3406.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4008,
DEPUY 456.309S 11.0M HELICAL BLADE 120MM,C1713,HCPCS,,79009218,CDM,278,RC,,,both,,,2502,987.46,39.4668,,987.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,850.68,34,,850.68,percent of total billed charges,Implant Device,850.68,34,,850.68,percent of total billed charges,Implant Device,850.68,34,,850.68,percent of total billed charges,Implant Device,850.68,34,,850.68,percent of total billed charges,Implant Device,850.68,34,,850.68,percent of total billed charges,Implant Device,850.68,34,,850.68,percent of total billed charges,Implant Device,875.7,35,,875.7,percent of total billed charges,Implant Device,850.68,34,"Charges > $500, x 34%",850.68,percent of total billed charges,Implant Device,875.7,35,,875.7,percent of total billed charges,Implant Devices,875.7,35,,875.7,percent of total billed charges,Implant Devices,875.7,35,,,percent of total billed charges,Implant Devices,875.7,35,,875.7,percent of total billed charges,Implant Devices,875.7,35,,875.7,percent of total billed charges,Implant Devices,1000.8,40,,1000.8,percent of total billed charges,Implant Devices,875.7,70,,875.7,percent of total billed charges,Implant Devices,850.68,34,,850.68,percent of total billed charges,Implant Devices,850.68,34,,850.68,percent of total billed charges,Implant Devices,875.7,35,,875.7,percent of total billed charges,Implant Devices,875.7,35,,875.7,percent of total billed charges,Implant Devices,875.7,35,,875.7,percent of total billed charges,Implant Devices,875.7,35,,875.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,850.68,34,"If Charge > 2,000, then 34 percent",850.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1000.8,
ORTHOFIX M317 CORT SCREW 100/30 3/2.5MM,C1713,HCPCS,,79009220,CDM,278,RC,,,both,,,276,108.93,39.4668,,108.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,96.6,35,,96.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,110.4,40,,110.4,percent of total billed charges,Implant Devices,96.6,70,,96.6,percent of total billed charges,Implant Devices,93.84,34,,93.84,percent of total billed charges,Implant Devices,93.84,34,,93.84,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.4,
IN2BONES P60 ST011 PLANTAR PLATE 5 HOLE,C1713,HCPCS,,79009224,CDM,278,RC,,,both,,,5748,2268.55,39.4668,,2268.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,2011.8,35,,2011.8,percent of total billed charges,Implant Device,1954.32,34,"Charges > $500, x 34%",1954.32,percent of total billed charges,Implant Device,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2299.2,40,,2299.2,percent of total billed charges,Implant Devices,2011.8,70,,2011.8,percent of total billed charges,Implant Devices,1954.32,34,,1954.32,percent of total billed charges,Implant Devices,1954.32,34,,1954.32,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1954.32,34,"If Charge > 2,000, then 34 percent",1954.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2299.2,
IN2BONES P64 ST418 LOCK SCREW 2.4X18MM,C1713,HCPCS,,79009225,CDM,278,RC,,,both,,,804,317.31,39.4668,,317.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Device,273.36,34,"Charges > $500, x 34%",273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,321.6,40,,321.6,percent of total billed charges,Implant Devices,281.4,70,,281.4,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,321.6,
IN2BONES P64 ST414 LOCK SCREW 2.4X14MM,C1713,HCPCS,,79009226,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P64 ST710 LOCK SCREW 2.7X10MM,C1713,HCPCS,,79009227,CDM,278,RC,,,both,,,804,317.31,39.4668,,317.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Device,273.36,34,"Charges > $500, x 34%",273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,321.6,40,,321.6,percent of total billed charges,Implant Devices,281.4,70,,281.4,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,321.6,
IN2BONES P62 ST711 NON LOCK SCREW 2.7X11,C1713,HCPCS,,79009228,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
IN2BONES P62 ST714 NON LOCK SCREW 2.7X14,C1713,HCPCS,,79009229,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
DEPUY 02.118.548 SELF TAP SCREW 2.7X48MM,C1713,HCPCS,,79009231,CDM,278,RC,,,both,,,178,70.25,39.4668,,70.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,62.3,35,,62.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,71.2,40,,71.2,percent of total billed charges,Implant Devices,62.3,70,,62.3,percent of total billed charges,Implant Devices,60.52,34,,60.52,percent of total billed charges,Implant Devices,60.52,34,,60.52,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.2,
DEPUY 02.211.060 LOCKING SCREW 2.7X60MM,C1713,HCPCS,,79009232,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 02.117.501 DIS HUM PLATE 2.7X3.5MM,C1713,HCPCS,,79009233,CDM,278,RC,,,both,,,4419,1744.04,39.4668,,1744.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1502.46,34,,1502.46,percent of total billed charges,Implant Device,1502.46,34,,1502.46,percent of total billed charges,Implant Device,1502.46,34,,1502.46,percent of total billed charges,Implant Device,1502.46,34,,1502.46,percent of total billed charges,Implant Device,1502.46,34,,1502.46,percent of total billed charges,Implant Device,1502.46,34,,1502.46,percent of total billed charges,Implant Device,1546.65,35,,1546.65,percent of total billed charges,Implant Device,1502.46,34,"Charges > $500, x 34%",1502.46,percent of total billed charges,Implant Device,1546.65,35,,1546.65,percent of total billed charges,Implant Devices,1546.65,35,,1546.65,percent of total billed charges,Implant Devices,1546.65,35,,,percent of total billed charges,Implant Devices,1546.65,35,,1546.65,percent of total billed charges,Implant Devices,1546.65,35,,1546.65,percent of total billed charges,Implant Devices,1767.6,40,,1767.6,percent of total billed charges,Implant Devices,1546.65,70,,1546.65,percent of total billed charges,Implant Devices,1502.46,34,,1502.46,percent of total billed charges,Implant Devices,1502.46,34,,1502.46,percent of total billed charges,Implant Devices,1546.65,35,,1546.65,percent of total billed charges,Implant Devices,1546.65,35,,1546.65,percent of total billed charges,Implant Devices,1546.65,35,,1546.65,percent of total billed charges,Implant Devices,1546.65,35,,1546.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1502.46,34,"If Charge > 2,000, then 34 percent",1502.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1767.6,
DEPUY 02.118.520 SELF TAP SCREW 2.7X20MM,C1713,HCPCS,,79009234,CDM,278,RC,,,both,,,178,70.25,39.4668,,70.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,62.3,35,,62.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,71.2,40,,71.2,percent of total billed charges,Implant Devices,62.3,70,,62.3,percent of total billed charges,Implant Devices,60.52,34,,60.52,percent of total billed charges,Implant Devices,60.52,34,,60.52,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.2,
DEPUY 241.263 DIS HUM PLATE 3.5MM 3 HOLE,C1713,HCPCS,,79009235,CDM,278,RC,,,both,,,3579,1412.52,39.4668,,1412.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1216.86,34,,1216.86,percent of total billed charges,Implant Device,1252.65,35,,1252.65,percent of total billed charges,Implant Device,1216.86,34,"Charges > $500, x 34%",1216.86,percent of total billed charges,Implant Device,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1431.6,40,,1431.6,percent of total billed charges,Implant Devices,1252.65,70,,1252.65,percent of total billed charges,Implant Devices,1216.86,34,,1216.86,percent of total billed charges,Implant Devices,1216.86,34,,1216.86,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,1252.65,35,,1252.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1216.86,34,"If Charge > 2,000, then 34 percent",1216.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1431.6,
DEPUY 02.118.522 SELF TAP SCREW 2.7X22MM,C1713,HCPCS,,79009236,CDM,278,RC,,,both,,,178,70.25,39.4668,,70.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,60.52,34,,60.52,percent of total billed charges,Implant Device,62.3,35,,62.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,71.2,40,,71.2,percent of total billed charges,Implant Devices,62.3,70,,62.3,percent of total billed charges,Implant Devices,60.52,34,,60.52,percent of total billed charges,Implant Devices,60.52,34,,60.52,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,62.3,35,,62.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.2,
DEPUY 02.118.524 SELF TAP SCREW 2.7X24MM,C1713,HCPCS,,79009237,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
DEPUY 02.211.046 LOCKING SCREW 2.7X46MM,C1713,HCPCS,,79009238,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 02.211.032 LOCKING SCREW 2.7X32MM,C1713,HCPCS,,79009239,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 02.211.034 LOCKING SCREW 2.7X34MM,C1713,HCPCS,,79009240,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
DEPUY 02.107.102 OLEC PLATE 2.7X3.5MM 2H,C1713,HCPCS,,79009241,CDM,278,RC,,,both,,,2513,991.8,39.4668,,991.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,854.42,34,,854.42,percent of total billed charges,Implant Device,854.42,34,,854.42,percent of total billed charges,Implant Device,854.42,34,,854.42,percent of total billed charges,Implant Device,854.42,34,,854.42,percent of total billed charges,Implant Device,854.42,34,,854.42,percent of total billed charges,Implant Device,854.42,34,,854.42,percent of total billed charges,Implant Device,879.55,35,,879.55,percent of total billed charges,Implant Device,854.42,34,"Charges > $500, x 34%",854.42,percent of total billed charges,Implant Device,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,1005.2,40,,1005.2,percent of total billed charges,Implant Devices,879.55,70,,879.55,percent of total billed charges,Implant Devices,854.42,34,,854.42,percent of total billed charges,Implant Devices,854.42,34,,854.42,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,879.55,35,,879.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,854.42,34,"If Charge > 2,000, then 34 percent",854.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1005.2,
DEPUY 204.016 CORTEX SCREW 3.5X16MM,C1713,HCPCS,,79009242,CDM,278,RC,,,both,,,59,23.29,39.4668,,23.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,23.6,40,,23.6,percent of total billed charges,Implant Devices,20.65,70,,20.65,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.6,
DEPUY 456.302S 11X85MM TI HELICAL BLADE,C1713,HCPCS,,79009243,CDM,278,RC,,,both,,,2687,1060.47,39.4668,,1060.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,913.58,34,,913.58,percent of total billed charges,Implant Device,913.58,34,,913.58,percent of total billed charges,Implant Device,913.58,34,,913.58,percent of total billed charges,Implant Device,913.58,34,,913.58,percent of total billed charges,Implant Device,913.58,34,,913.58,percent of total billed charges,Implant Device,913.58,34,,913.58,percent of total billed charges,Implant Device,940.45,35,,940.45,percent of total billed charges,Implant Device,913.58,34,"Charges > $500, x 34%",913.58,percent of total billed charges,Implant Device,940.45,35,,940.45,percent of total billed charges,Implant Devices,940.45,35,,940.45,percent of total billed charges,Implant Devices,940.45,35,,,percent of total billed charges,Implant Devices,940.45,35,,940.45,percent of total billed charges,Implant Devices,940.45,35,,940.45,percent of total billed charges,Implant Devices,1074.8,40,,1074.8,percent of total billed charges,Implant Devices,940.45,70,,940.45,percent of total billed charges,Implant Devices,913.58,34,,913.58,percent of total billed charges,Implant Devices,913.58,34,,913.58,percent of total billed charges,Implant Devices,940.45,35,,940.45,percent of total billed charges,Implant Devices,940.45,35,,940.45,percent of total billed charges,Implant Devices,940.45,35,,940.45,percent of total billed charges,Implant Devices,940.45,35,,940.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,913.58,34,"If Charge > 2,000, then 34 percent",913.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1074.8,
IN2BONES BGP001-05 BIO DBM PUTTY 5CC,C1713,HCPCS,,79009263,CDM,278,RC,,,both,,,5505,2172.65,39.4668,,2172.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1926.75,35,,1926.75,percent of total billed charges,Implant Device,1871.7,34,"Charges > $500, x 34%",1871.7,percent of total billed charges,Implant Device,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,2202,40,,2202,percent of total billed charges,Implant Devices,1926.75,70,,1926.75,percent of total billed charges,Implant Devices,1871.7,34,,1871.7,percent of total billed charges,Implant Devices,1871.7,34,,1871.7,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1871.7,34,"If Charge > 2,000, then 34 percent",1871.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2202,
ARTHREX AR-89443T-06 PLATE 1/3 6 HOLE,C1713,HCPCS,,79009266,CDM,278,RC,,,both,,,720,284.16,39.4668,,284.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Device,244.8,34,"Charges > $500, x 34%",244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,288,40,,288,percent of total billed charges,Implant Devices,252,70,,252,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,288,
ACUMED 30-0234 LOCKING SCREW 3.5X12MM,C1713,HCPCS,,79009279,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ACUMED CO-S2314 LOCK CORT PEG 2.3X14MM,C1713,HCPCS,,79009280,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ACUMED CO-S2316 LOCK CORT PEG 2.3X16MM,C1713,HCPCS,,79009281,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ACUMED CO-S2318 LOCK CORT PEG 2.3X18MM,C1713,HCPCS,,79009282,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ACUMED CO-S2320 LOCK CORT PEG 2.3X20MM,C1713,HCPCS,,79009283,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER HT-00002  TOE TAC HAMMERTOE MED,C1713,HCPCS,,79009284,CDM,278,RC,,,both,,,6270,2474.57,39.4668,,2474.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2194.5,35,,2194.5,percent of total billed charges,Implant Device,2131.8,34,"Charges > $500, x 34%",2131.8,percent of total billed charges,Implant Device,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2508,40,,2508,percent of total billed charges,Implant Devices,2194.5,70,,2194.5,percent of total billed charges,Implant Devices,2131.8,34,,2131.8,percent of total billed charges,Implant Devices,2131.8,34,,2131.8,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2131.8,34,"If Charge > 2,000, then 34 percent",2131.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2508,
DEPUY 02.226.212 2.4X12MM HEADLESS SCREW,C1713,HCPCS,,79009285,CDM,278,RC,,,both,,,1325,522.94,39.4668,,522.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,463.75,35,,463.75,percent of total billed charges,Implant Device,450.5,34,"Charges > $500, x 34%",450.5,percent of total billed charges,Implant Device,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,530,40,,530,percent of total billed charges,Implant Devices,463.75,70,,463.75,percent of total billed charges,Implant Devices,450.5,34,,450.5,percent of total billed charges,Implant Devices,450.5,34,,450.5,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,530,
DEPUY 02.226.216 2.4X16MM HEADLESS SCREW,C1713,HCPCS,,79009286,CDM,278,RC,,,both,,,1325,522.94,39.4668,,522.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,463.75,35,,463.75,percent of total billed charges,Implant Device,450.5,34,"Charges > $500, x 34%",450.5,percent of total billed charges,Implant Device,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,530,40,,530,percent of total billed charges,Implant Devices,463.75,70,,463.75,percent of total billed charges,Implant Devices,450.5,34,,450.5,percent of total billed charges,Implant Devices,450.5,34,,450.5,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,530,
DEPUY 02.226.116 3.0X16MM HEADLESS SCREW,C1713,HCPCS,,79009287,CDM,278,RC,,,both,,,1325,522.94,39.4668,,522.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,450.5,34,,450.5,percent of total billed charges,Implant Device,463.75,35,,463.75,percent of total billed charges,Implant Device,450.5,34,"Charges > $500, x 34%",450.5,percent of total billed charges,Implant Device,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,530,40,,530,percent of total billed charges,Implant Devices,463.75,70,,463.75,percent of total billed charges,Implant Devices,450.5,34,,450.5,percent of total billed charges,Implant Devices,450.5,34,,450.5,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,463.75,35,,463.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,530,
STRYKER 40-30117 3.0X17MM ASNIS SCREW,C1713,HCPCS,,79009288,CDM,278,RC,,,both,,,910,359.15,39.4668,,359.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,309.4,34,,309.4,percent of total billed charges,Implant Device,318.5,35,,318.5,percent of total billed charges,Implant Device,309.4,34,"Charges > $500, x 34%",309.4,percent of total billed charges,Implant Device,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,364,40,,364,percent of total billed charges,Implant Devices,318.5,70,,318.5,percent of total billed charges,Implant Devices,309.4,34,,309.4,percent of total billed charges,Implant Devices,309.4,34,,309.4,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,318.5,35,,318.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,364,
STRYKER 657450 BONE SCREW 3.5X50MM,C1713,HCPCS,,79009290,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
DEPUY 04.005.526S 5X36MM TI LOCK SCREW,C1713,HCPCS,,79009291,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 04.004.549S 11X345MM CAN TIB NAIL,C1713,HCPCS,,79009292,CDM,278,RC,,,both,,,6035,2381.82,39.4668,,2381.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2051.9,34,,2051.9,percent of total billed charges,Implant Device,2112.25,35,,2112.25,percent of total billed charges,Implant Device,2051.9,34,"Charges > $500, x 34%",2051.9,percent of total billed charges,Implant Device,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2414,40,,2414,percent of total billed charges,Implant Devices,2112.25,70,,2112.25,percent of total billed charges,Implant Devices,2051.9,34,,2051.9,percent of total billed charges,Implant Devices,2051.9,34,,2051.9,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,2112.25,35,,2112.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2051.9,34,"If Charge > 2,000, then 34 percent",2051.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2414,
DEPUY SE-181508TRR SPEED IMPLANT 18X15X8,C1713,HCPCS,,79009295,CDM,278,RC,,,both,,,4935,1947.69,39.4668,,1947.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1727.25,35,,1727.25,percent of total billed charges,Implant Device,1677.9,34,"Charges > $500, x 34%",1677.9,percent of total billed charges,Implant Device,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1974,40,,1974,percent of total billed charges,Implant Devices,1727.25,70,,1727.25,percent of total billed charges,Implant Devices,1677.9,34,,1677.9,percent of total billed charges,Implant Devices,1677.9,34,,1677.9,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1677.9,34,"If Charge > 2,000, then 34 percent",1677.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974,
STRYKER 656122 2.4X2MM LOCKING SCREW,C1713,HCPCS,,79009298,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656118 2.4X18MM NON LOCK SCREW,C1713,HCPCS,,79009299,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 3425-1340S NAIL KIT 11X340MMX125,C1713,HCPCS,,79009302,CDM,278,RC,,,both,,,4969,1961.11,39.4668,,1961.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Device,1689.46,34,"Charges > $500, x 34%",1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1987.6,40,,1987.6,percent of total billed charges,Implant Devices,1739.15,70,,1739.15,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.46,34,"If Charge > 2,000, then 34 percent",1689.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.6,
STRYKER 657444 NON-LOCK SCREW 3.5X44MM,C1713,HCPCS,,79009303,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 626680 TUBLAR 10 LOCKING PLATE,C1713,HCPCS,,79009305,CDM,278,RC,,,both,,,1097,432.95,39.4668,,432.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,372.98,34,,372.98,percent of total billed charges,Implant Device,372.98,34,,372.98,percent of total billed charges,Implant Device,372.98,34,,372.98,percent of total billed charges,Implant Device,372.98,34,,372.98,percent of total billed charges,Implant Device,372.98,34,,372.98,percent of total billed charges,Implant Device,372.98,34,,372.98,percent of total billed charges,Implant Device,383.95,35,,383.95,percent of total billed charges,Implant Device,372.98,34,"Charges > $500, x 34%",372.98,percent of total billed charges,Implant Device,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,438.8,40,,438.8,percent of total billed charges,Implant Devices,383.95,70,,383.95,percent of total billed charges,Implant Devices,372.98,34,,372.98,percent of total billed charges,Implant Devices,372.98,34,,372.98,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,438.8,
STRYKER 58-25010 EMERG SCREW 2.5X10MM,C1713,HCPCS,,79009306,CDM,278,RC,,,both,,,423,166.94,39.4668,,166.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,143.82,34,,143.82,percent of total billed charges,Implant Device,148.05,35,,148.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,169.2,40,,169.2,percent of total billed charges,Implant Devices,148.05,70,,148.05,percent of total billed charges,Implant Devices,143.82,34,,143.82,percent of total billed charges,Implant Devices,143.82,34,,143.82,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,148.05,35,,148.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,169.2,
DEPUY 04.001.410S PROX HUM NAIL 9X150MM,C1713,HCPCS,,79009308,CDM,278,RC,,,both,,,3772,1488.69,39.4668,,1488.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1320.2,35,,1320.2,percent of total billed charges,Implant Device,1282.48,34,"Charges > $500, x 34%",1282.48,percent of total billed charges,Implant Device,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1508.8,40,,1508.8,percent of total billed charges,Implant Devices,1320.2,70,,1320.2,percent of total billed charges,Implant Devices,1282.48,34,,1282.48,percent of total billed charges,Implant Devices,1282.48,34,,1282.48,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1282.48,34,"If Charge > 2,000, then 34 percent",1282.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1508.8,
DEPUY 04.005.414 TI LOCK SCREW 4X24MM,C1713,HCPCS,,79009309,CDM,278,RC,,,both,,,730,288.11,39.4668,,288.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,255.5,35,,255.5,percent of total billed charges,Implant Device,248.2,34,"Charges > $500, x 34%",248.2,percent of total billed charges,Implant Device,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,292,40,,292,percent of total billed charges,Implant Devices,255.5,70,,255.5,percent of total billed charges,Implant Devices,248.2,34,,248.2,percent of total billed charges,Implant Devices,248.2,34,,248.2,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,292,
DEPUY 462.638 TI SPIRAL BLADE 38MM,C1713,HCPCS,,79009310,CDM,278,RC,,,both,,,2414,952.73,39.4668,,952.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,820.76,34,,820.76,percent of total billed charges,Implant Device,820.76,34,,820.76,percent of total billed charges,Implant Device,820.76,34,,820.76,percent of total billed charges,Implant Device,820.76,34,,820.76,percent of total billed charges,Implant Device,820.76,34,,820.76,percent of total billed charges,Implant Device,820.76,34,,820.76,percent of total billed charges,Implant Device,844.9,35,,844.9,percent of total billed charges,Implant Device,820.76,34,"Charges > $500, x 34%",820.76,percent of total billed charges,Implant Device,844.9,35,,844.9,percent of total billed charges,Implant Devices,844.9,35,,844.9,percent of total billed charges,Implant Devices,844.9,35,,,percent of total billed charges,Implant Devices,844.9,35,,844.9,percent of total billed charges,Implant Devices,844.9,35,,844.9,percent of total billed charges,Implant Devices,965.6,40,,965.6,percent of total billed charges,Implant Devices,844.9,70,,844.9,percent of total billed charges,Implant Devices,820.76,34,,820.76,percent of total billed charges,Implant Devices,820.76,34,,820.76,percent of total billed charges,Implant Devices,844.9,35,,844.9,percent of total billed charges,Implant Devices,844.9,35,,844.9,percent of total billed charges,Implant Devices,844.9,35,,844.9,percent of total billed charges,Implant Devices,844.9,35,,844.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,820.76,34,"If Charge > 2,000, then 34 percent",820.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,965.6,
DEPUY 1035-59-000 FEM HEAD 28MM 12/14,C1713,HCPCS,,79009311,CDM,278,RC,,,both,,,4030,1590.51,39.4668,,1590.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Device,1370.2,34,"Charges > $500, x 34%",1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1612,40,,1612,percent of total billed charges,Implant Devices,1410.5,70,,1410.5,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1370.2,34,"If Charge > 2,000, then 34 percent",1370.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1612,
IN2BONES P60 ST034 LATERALNECK PLATE 6H,C1713,HCPCS,,79009314,CDM,278,RC,,,both,,,5748,2268.55,39.4668,,2268.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,2011.8,35,,2011.8,percent of total billed charges,Implant Device,1954.32,34,"Charges > $500, x 34%",1954.32,percent of total billed charges,Implant Device,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2299.2,40,,2299.2,percent of total billed charges,Implant Devices,2011.8,70,,2011.8,percent of total billed charges,Implant Devices,1954.32,34,,1954.32,percent of total billed charges,Implant Devices,1954.32,34,,1954.32,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1954.32,34,"If Charge > 2,000, then 34 percent",1954.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2299.2,
IN2BONES P64 ST412 LOCK SCREW 2.4X12MM,C1713,HCPCS,,79009315,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P64 ST411 LOCK SCREW 2.4X11MM,C1713,HCPCS,,79009316,CDM,278,RC,,,both,,,804,317.31,39.4668,,317.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Device,273.36,34,"Charges > $500, x 34%",273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,321.6,40,,321.6,percent of total billed charges,Implant Devices,281.4,70,,281.4,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,321.6,
IN2BONES P62 ST412 NON LOCK SCREW 2.4X12,C1713,HCPCS,,79009317,CDM,278,RC,,,both,,,735,290.08,39.4668,,290.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Device,249.9,34,"Charges > $500, x 34%",249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,294,40,,294,percent of total billed charges,Implant Devices,257.25,70,,257.25,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
IN2BONES P64 ST408 LOCKING SCREW 2.4X8MM,C1713,HCPCS,,79009318,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P64 ST409 LOCKING SCREW 2.4X9MM,C1713,HCPCS,,79009319,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
STRYKER 626964 PLATE 4 HOLE,C1713,HCPCS,,79009320,CDM,278,RC,,,both,,,4173,1646.95,39.4668,,1646.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1418.82,34,,1418.82,percent of total billed charges,Implant Device,1418.82,34,,1418.82,percent of total billed charges,Implant Device,1418.82,34,,1418.82,percent of total billed charges,Implant Device,1418.82,34,,1418.82,percent of total billed charges,Implant Device,1418.82,34,,1418.82,percent of total billed charges,Implant Device,1418.82,34,,1418.82,percent of total billed charges,Implant Device,1460.55,35,,1460.55,percent of total billed charges,Implant Device,1418.82,34,"Charges > $500, x 34%",1418.82,percent of total billed charges,Implant Device,1460.55,35,,1460.55,percent of total billed charges,Implant Devices,1460.55,35,,1460.55,percent of total billed charges,Implant Devices,1460.55,35,,,percent of total billed charges,Implant Devices,1460.55,35,,1460.55,percent of total billed charges,Implant Devices,1460.55,35,,1460.55,percent of total billed charges,Implant Devices,1669.2,40,,1669.2,percent of total billed charges,Implant Devices,1460.55,70,,1460.55,percent of total billed charges,Implant Devices,1418.82,34,,1418.82,percent of total billed charges,Implant Devices,1418.82,34,,1418.82,percent of total billed charges,Implant Devices,1460.55,35,,1460.55,percent of total billed charges,Implant Devices,1460.55,35,,1460.55,percent of total billed charges,Implant Devices,1460.55,35,,1460.55,percent of total billed charges,Implant Devices,1460.55,35,,1460.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1418.82,34,"If Charge > 2,000, then 34 percent",1418.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1669.2,
STRYKER 656320 LOCKING SCREW 2.7X20MM,C1713,HCPCS,,79009321,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 656324 LOCKING SCREW 2.7X24MM,C1713,HCPCS,,79009322,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 1822-1237S TIBIAL NAIL 12X375MM,C1713,HCPCS,,79009323,CDM,278,RC,,,both,,,7143,2819.11,39.4668,,2819.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2500.05,35,,2500.05,percent of total billed charges,Implant Device,2428.62,34,"Charges > $500, x 34%",2428.62,percent of total billed charges,Implant Device,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2857.2,40,,2857.2,percent of total billed charges,Implant Devices,2500.05,70,,2500.05,percent of total billed charges,Implant Devices,2428.62,34,,2428.62,percent of total billed charges,Implant Devices,2428.62,34,,2428.62,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2428.62,34,"If Charge > 2,000, then 34 percent",2428.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2857.2,
IN2BONES V30 ST428 TRANS SCREW 3.0X28MM,C1713,HCPCS,,79009328,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V35 ST316 LOCK SCREW 3.5X16MM,C1713,HCPCS,,79009329,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ZIMMER 00-2357-003-08 TIB LOCK PLT 2.5MM,C1713,HCPCS,,79009332,CDM,278,RC,,,both,,,4183,1650.9,39.4668,,1650.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1422.22,34,,1422.22,percent of total billed charges,Implant Device,1422.22,34,,1422.22,percent of total billed charges,Implant Device,1422.22,34,,1422.22,percent of total billed charges,Implant Device,1422.22,34,,1422.22,percent of total billed charges,Implant Device,1422.22,34,,1422.22,percent of total billed charges,Implant Device,1422.22,34,,1422.22,percent of total billed charges,Implant Device,1464.05,35,,1464.05,percent of total billed charges,Implant Device,1422.22,34,"Charges > $500, x 34%",1422.22,percent of total billed charges,Implant Device,1464.05,35,,1464.05,percent of total billed charges,Implant Devices,1464.05,35,,1464.05,percent of total billed charges,Implant Devices,1464.05,35,,,percent of total billed charges,Implant Devices,1464.05,35,,1464.05,percent of total billed charges,Implant Devices,1464.05,35,,1464.05,percent of total billed charges,Implant Devices,1673.2,40,,1673.2,percent of total billed charges,Implant Devices,1464.05,70,,1464.05,percent of total billed charges,Implant Devices,1422.22,34,,1422.22,percent of total billed charges,Implant Devices,1422.22,34,,1422.22,percent of total billed charges,Implant Devices,1464.05,35,,1464.05,percent of total billed charges,Implant Devices,1464.05,35,,1464.05,percent of total billed charges,Implant Devices,1464.05,35,,1464.05,percent of total billed charges,Implant Devices,1464.05,35,,1464.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1422.22,34,"If Charge > 2,000, then 34 percent",1422.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1673.2,
ZIMMER 00-2347-020-44 PERI SCREW 3.5X44,C1713,HCPCS,,79009333,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
ZIMMER 00-2347-020-34 PERI SCREW 3.5X34,C1713,HCPCS,,79009334,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
STRYKER 3525-1320S NAIL KIT 011X320X125',C1713,HCPCS,,79009336,CDM,278,RC,,,both,,,12948,5110.16,39.4668,,5110.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4402.32,34,,4402.32,percent of total billed charges,Implant Device,4402.32,34,,4402.32,percent of total billed charges,Implant Device,4402.32,34,,4402.32,percent of total billed charges,Implant Device,4402.32,34,,4402.32,percent of total billed charges,Implant Device,4402.32,34,,4402.32,percent of total billed charges,Implant Device,4402.32,34,,4402.32,percent of total billed charges,Implant Device,4531.8,35,,4531.8,percent of total billed charges,Implant Device,4402.32,34,"Charges > $500, x 34%",4402.32,percent of total billed charges,Implant Device,4531.8,35,,4531.8,percent of total billed charges,Implant Devices,4531.8,35,,4531.8,percent of total billed charges,Implant Devices,4531.8,35,,,percent of total billed charges,Implant Devices,4531.8,35,,4531.8,percent of total billed charges,Implant Devices,4531.8,35,,4531.8,percent of total billed charges,Implant Devices,5179.2,40,,5179.2,percent of total billed charges,Implant Devices,4531.8,70,,4531.8,percent of total billed charges,Implant Devices,4402.32,34,,4402.32,percent of total billed charges,Implant Devices,4402.32,34,,4402.32,percent of total billed charges,Implant Devices,4531.8,35,,4531.8,percent of total billed charges,Implant Devices,4531.8,35,,4531.8,percent of total billed charges,Implant Devices,4531.8,35,,4531.8,percent of total billed charges,Implant Devices,4531.8,35,,4531.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4402.32,34,"If Charge > 2,000, then 34 percent",4402.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5179.2,
ZIMMER 8145-50-034 CORT BONE SCREW 5X34,C1713,HCPCS,,79009338,CDM,278,RC,,,both,,,353,139.32,39.4668,,139.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.02,34,,120.02,percent of total billed charges,Implant Device,120.02,34,,120.02,percent of total billed charges,Implant Device,120.02,34,,120.02,percent of total billed charges,Implant Device,120.02,34,,120.02,percent of total billed charges,Implant Device,120.02,34,,120.02,percent of total billed charges,Implant Device,120.02,34,,120.02,percent of total billed charges,Implant Device,123.55,35,,123.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,123.55,35,,123.55,percent of total billed charges,Implant Devices,123.55,35,,123.55,percent of total billed charges,Implant Devices,123.55,35,,,percent of total billed charges,Implant Devices,123.55,35,,123.55,percent of total billed charges,Implant Devices,123.55,35,,123.55,percent of total billed charges,Implant Devices,141.2,40,,141.2,percent of total billed charges,Implant Devices,123.55,70,,123.55,percent of total billed charges,Implant Devices,120.02,34,,120.02,percent of total billed charges,Implant Devices,120.02,34,,120.02,percent of total billed charges,Implant Devices,123.55,35,,123.55,percent of total billed charges,Implant Devices,123.55,35,,123.55,percent of total billed charges,Implant Devices,123.55,35,,123.55,percent of total billed charges,Implant Devices,123.55,35,,123.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,141.2,
STRYKER 627233 PROX HUMERUS PLATE 3H RT,C1713,HCPCS,,79009339,CDM,278,RC,,,both,,,6634,2618.23,39.4668,,2618.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2255.56,34,,2255.56,percent of total billed charges,Implant Device,2321.9,35,,2321.9,percent of total billed charges,Implant Device,2255.56,34,"Charges > $500, x 34%",2255.56,percent of total billed charges,Implant Device,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2653.6,40,,2653.6,percent of total billed charges,Implant Devices,2321.9,70,,2321.9,percent of total billed charges,Implant Devices,2255.56,34,,2255.56,percent of total billed charges,Implant Devices,2255.56,34,,2255.56,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,2321.9,35,,2321.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2255.56,34,"If Charge > 2,000, then 34 percent",2255.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2653.6,
EXACTECH 320-20-42 COMPR SCREW 4.5X42MM,C1713,HCPCS,,79009342,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
ARTHREX AR-2324BCT-2 SWIVELOCK 4.75X22MM,C1713,HCPCS,,79009343,CDM,278,RC,,,both,,,1275,503.2,39.4668,,503.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Device,433.5,34,"Charges > $500, x 34%",433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,510,40,,510,percent of total billed charges,Implant Devices,446.25,70,,446.25,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510,
STRYKER 626996 Y PLATE,C1713,HCPCS,,79009349,CDM,278,RC,,,both,,,3489,1377,39.4668,,1377,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1186.26,34,,1186.26,percent of total billed charges,Implant Device,1221.15,35,,1221.15,percent of total billed charges,Implant Device,1186.26,34,"Charges > $500, x 34%",1186.26,percent of total billed charges,Implant Device,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1395.6,40,,1395.6,percent of total billed charges,Implant Devices,1221.15,70,,1221.15,percent of total billed charges,Implant Devices,1186.26,34,,1186.26,percent of total billed charges,Implant Devices,1186.26,34,,1186.26,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,1221.15,35,,1221.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1186.26,34,"If Charge > 2,000, then 34 percent",1186.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1395.6,
STRYKER 897005 HYDROSET XT,C1713,HCPCS,,79009352,CDM,278,RC,,,both,,,4293,1694.31,39.4668,,1694.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1459.62,34,,1459.62,percent of total billed charges,Implant Device,1459.62,34,,1459.62,percent of total billed charges,Implant Device,1459.62,34,,1459.62,percent of total billed charges,Implant Device,1459.62,34,,1459.62,percent of total billed charges,Implant Device,1459.62,34,,1459.62,percent of total billed charges,Implant Device,1459.62,34,,1459.62,percent of total billed charges,Implant Device,1502.55,35,,1502.55,percent of total billed charges,Implant Device,1459.62,34,"Charges > $500, x 34%",1459.62,percent of total billed charges,Implant Device,1502.55,35,,1502.55,percent of total billed charges,Implant Devices,1502.55,35,,1502.55,percent of total billed charges,Implant Devices,1502.55,35,,,percent of total billed charges,Implant Devices,1502.55,35,,1502.55,percent of total billed charges,Implant Devices,1502.55,35,,1502.55,percent of total billed charges,Implant Devices,1717.2,40,,1717.2,percent of total billed charges,Implant Devices,1502.55,70,,1502.55,percent of total billed charges,Implant Devices,1459.62,34,,1459.62,percent of total billed charges,Implant Devices,1459.62,34,,1459.62,percent of total billed charges,Implant Devices,1502.55,35,,1502.55,percent of total billed charges,Implant Devices,1502.55,35,,1502.55,percent of total billed charges,Implant Devices,1502.55,35,,1502.55,percent of total billed charges,Implant Devices,1502.55,35,,1502.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1459.62,34,"If Charge > 2,000, then 34 percent",1459.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1717.2,
STRYKER 4922-8-450 11X450 ROD,C1713,HCPCS,,79009359,CDM,278,RC,,,both,,,1004,396.25,39.4668,,396.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,341.36,34,,341.36,percent of total billed charges,Implant Device,341.36,34,,341.36,percent of total billed charges,Implant Device,341.36,34,,341.36,percent of total billed charges,Implant Device,341.36,34,,341.36,percent of total billed charges,Implant Device,341.36,34,,341.36,percent of total billed charges,Implant Device,341.36,34,,341.36,percent of total billed charges,Implant Device,351.4,35,,351.4,percent of total billed charges,Implant Device,341.36,34,"Charges > $500, x 34%",341.36,percent of total billed charges,Implant Device,351.4,35,,351.4,percent of total billed charges,Implant Devices,351.4,35,,351.4,percent of total billed charges,Implant Devices,351.4,35,,,percent of total billed charges,Implant Devices,351.4,35,,351.4,percent of total billed charges,Implant Devices,351.4,35,,351.4,percent of total billed charges,Implant Devices,401.6,40,,401.6,percent of total billed charges,Implant Devices,351.4,70,,351.4,percent of total billed charges,Implant Devices,341.36,34,,341.36,percent of total billed charges,Implant Devices,341.36,34,,341.36,percent of total billed charges,Implant Devices,351.4,35,,351.4,percent of total billed charges,Implant Devices,351.4,35,,351.4,percent of total billed charges,Implant Devices,351.4,35,,351.4,percent of total billed charges,Implant Devices,351.4,35,,351.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,401.6,
STRYKER 657442 3.5X42MM BONE SCREW,C1713,HCPCS,,79009361,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657338 3.5X38MM LOCKING SCREW,C1713,HCPCS,,79009362,CDM,278,RC,,,both,,,987,389.54,39.4668,,389.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,335.58,34,,335.58,percent of total billed charges,Implant Device,335.58,34,,335.58,percent of total billed charges,Implant Device,335.58,34,,335.58,percent of total billed charges,Implant Device,335.58,34,,335.58,percent of total billed charges,Implant Device,335.58,34,,335.58,percent of total billed charges,Implant Device,335.58,34,,335.58,percent of total billed charges,Implant Device,345.45,35,,345.45,percent of total billed charges,Implant Device,335.58,34,"Charges > $500, x 34%",335.58,percent of total billed charges,Implant Device,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,394.8,40,,394.8,percent of total billed charges,Implant Devices,345.45,70,,345.45,percent of total billed charges,Implant Devices,335.58,34,,335.58,percent of total billed charges,Implant Devices,335.58,34,,335.58,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,394.8,
STRYKER 657330 3.5X30MM LOCKING SCREW,C1713,HCPCS,,79009363,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 657332 3.5X32MM LOCKING SCREW,C1713,HCPCS,,79009364,CDM,278,RC,,,both,,,987,389.54,39.4668,,389.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,335.58,34,,335.58,percent of total billed charges,Implant Device,335.58,34,,335.58,percent of total billed charges,Implant Device,335.58,34,,335.58,percent of total billed charges,Implant Device,335.58,34,,335.58,percent of total billed charges,Implant Device,335.58,34,,335.58,percent of total billed charges,Implant Device,335.58,34,,335.58,percent of total billed charges,Implant Device,345.45,35,,345.45,percent of total billed charges,Implant Device,335.58,34,"Charges > $500, x 34%",335.58,percent of total billed charges,Implant Device,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,394.8,40,,394.8,percent of total billed charges,Implant Devices,345.45,70,,345.45,percent of total billed charges,Implant Devices,335.58,34,,335.58,percent of total billed charges,Implant Devices,335.58,34,,335.58,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,345.45,35,,345.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,394.8,
STRYKER 657446 3.5X46MM BONE SCREW,C1713,HCPCS,,79009365,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
ARTHREX AR-8943BL-04 DISTAL FIB PLATE LT,C1713,HCPCS,,79009366,CDM,278,RC,,,both,,,2358,930.63,39.4668,,930.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,801.72,34,,801.72,percent of total billed charges,Implant Device,801.72,34,,801.72,percent of total billed charges,Implant Device,801.72,34,,801.72,percent of total billed charges,Implant Device,801.72,34,,801.72,percent of total billed charges,Implant Device,801.72,34,,801.72,percent of total billed charges,Implant Device,801.72,34,,801.72,percent of total billed charges,Implant Device,825.3,35,,825.3,percent of total billed charges,Implant Device,801.72,34,"Charges > $500, x 34%",801.72,percent of total billed charges,Implant Device,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,943.2,40,,943.2,percent of total billed charges,Implant Devices,825.3,70,,825.3,percent of total billed charges,Implant Devices,801.72,34,,801.72,percent of total billed charges,Implant Devices,801.72,34,,801.72,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,801.72,34,"If Charge > 2,000, then 34 percent",801.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,943.2,
ARTHREX AR-8835-30 CORT SCREW 3.5X30MM,C1713,HCPCS,,79009367,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
ARTHREX AR-8827-18 CORT SCREW 2.7X18MM,C1713,HCPCS,,79009368,CDM,278,RC,,,both,,,194,76.57,39.4668,,76.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.96,34,,65.96,percent of total billed charges,Implant Device,65.96,34,,65.96,percent of total billed charges,Implant Device,65.96,34,,65.96,percent of total billed charges,Implant Device,65.96,34,,65.96,percent of total billed charges,Implant Device,65.96,34,,65.96,percent of total billed charges,Implant Device,65.96,34,,65.96,percent of total billed charges,Implant Device,67.9,35,,67.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,77.6,40,,77.6,percent of total billed charges,Implant Devices,67.9,70,,67.9,percent of total billed charges,Implant Devices,65.96,34,,65.96,percent of total billed charges,Implant Devices,65.96,34,,65.96,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,67.9,35,,67.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,77.6,
ARTHREX AR-8827-24 CORT SCREW 2.7X24MM,C1713,HCPCS,,79009369,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
ARTHREX AR-8840C-30 CANN SCREW 4X30MM,C1713,HCPCS,,79009370,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
IN2BONES V30 ST308 LOCK SCREW 3X8MM,C1713,HCPCS,,79009372,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V35 ST314 LOCK SCREW 3.5X14MM,C1713,HCPCS,,79009373,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
DEPUY 04.005.524S LOCKING SCREW 5.0X34MM,C1713,HCPCS,,79009377,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 207.645 4.0X4MM CANNULATED SCREW,C1713,HCPCS,,79009378,CDM,278,RC,,,both,,,815,321.65,39.4668,,321.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,277.1,34,,277.1,percent of total billed charges,Implant Device,277.1,34,,277.1,percent of total billed charges,Implant Device,277.1,34,,277.1,percent of total billed charges,Implant Device,277.1,34,,277.1,percent of total billed charges,Implant Device,277.1,34,,277.1,percent of total billed charges,Implant Device,277.1,34,,277.1,percent of total billed charges,Implant Device,285.25,35,,285.25,percent of total billed charges,Implant Device,277.1,34,"Charges > $500, x 34%",277.1,percent of total billed charges,Implant Device,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,326,40,,326,percent of total billed charges,Implant Devices,285.25,70,,285.25,percent of total billed charges,Implant Devices,277.1,34,,277.1,percent of total billed charges,Implant Devices,277.1,34,,277.1,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,285.25,35,,285.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,326,
DEPUY 214.381 8 HOLE TIBIAL PLATE,C1713,HCPCS,,79009379,CDM,278,RC,,,both,,,756,298.37,39.4668,,298.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,257.04,34,,257.04,percent of total billed charges,Implant Device,257.04,34,,257.04,percent of total billed charges,Implant Device,257.04,34,,257.04,percent of total billed charges,Implant Device,257.04,34,,257.04,percent of total billed charges,Implant Device,257.04,34,,257.04,percent of total billed charges,Implant Device,257.04,34,,257.04,percent of total billed charges,Implant Device,264.6,35,,264.6,percent of total billed charges,Implant Device,257.04,34,"Charges > $500, x 34%",257.04,percent of total billed charges,Implant Device,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,302.4,40,,302.4,percent of total billed charges,Implant Devices,264.6,70,,264.6,percent of total billed charges,Implant Devices,257.04,34,,257.04,percent of total billed charges,Implant Devices,257.04,34,,257.04,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,264.6,35,,264.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,302.4,
ZIMMER 00-6250-65-40 BONE SCREW 6.5X40MM,C1713,HCPCS,,79009384,CDM,278,RC,,,both,,,428,168.92,39.4668,,168.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,171.2,40,,171.2,percent of total billed charges,Implant Devices,149.8,70,,149.8,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,171.2,
STRYKER ORTHO 897003 HYDROSET XT,C1713,HCPCS,,79009385,CDM,278,RC,,,both,,,2814,1110.6,39.4668,,1110.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,956.76,34,,956.76,percent of total billed charges,Implant Device,956.76,34,,956.76,percent of total billed charges,Implant Device,956.76,34,,956.76,percent of total billed charges,Implant Device,956.76,34,,956.76,percent of total billed charges,Implant Device,956.76,34,,956.76,percent of total billed charges,Implant Device,956.76,34,,956.76,percent of total billed charges,Implant Device,984.9,35,,984.9,percent of total billed charges,Implant Device,956.76,34,"Charges > $500, x 34%",956.76,percent of total billed charges,Implant Device,984.9,35,,984.9,percent of total billed charges,Implant Devices,984.9,35,,984.9,percent of total billed charges,Implant Devices,984.9,35,,,percent of total billed charges,Implant Devices,984.9,35,,984.9,percent of total billed charges,Implant Devices,984.9,35,,984.9,percent of total billed charges,Implant Devices,1125.6,40,,1125.6,percent of total billed charges,Implant Devices,984.9,70,,984.9,percent of total billed charges,Implant Devices,956.76,34,,956.76,percent of total billed charges,Implant Devices,956.76,34,,956.76,percent of total billed charges,Implant Devices,984.9,35,,984.9,percent of total billed charges,Implant Devices,984.9,35,,984.9,percent of total billed charges,Implant Devices,984.9,35,,984.9,percent of total billed charges,Implant Devices,984.9,35,,984.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,956.76,34,"If Charge > 2,000, then 34 percent",956.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1125.6,
ARTHREX AR-8929BC-CP ACHILLES SPEEDBRDGE,C1713,HCPCS,,79009386,CDM,278,RC,,,both,,,2925,1154.4,39.4668,,1154.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,1023.75,35,,1023.75,percent of total billed charges,Implant Device,994.5,34,"Charges > $500, x 34%",994.5,percent of total billed charges,Implant Device,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1170,40,,1170,percent of total billed charges,Implant Devices,1023.75,70,,1023.75,percent of total billed charges,Implant Devices,994.5,34,,994.5,percent of total billed charges,Implant Devices,994.5,34,,994.5,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,994.5,34,"If Charge > 2,000, then 34 percent",994.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1170,
DEPUY 462.644 TI SPIRAL BLADE 44MM,C1713,HCPCS,,79009387,CDM,278,RC,,,both,,,1278,504.39,39.4668,,504.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,434.52,34,,434.52,percent of total billed charges,Implant Device,434.52,34,,434.52,percent of total billed charges,Implant Device,434.52,34,,434.52,percent of total billed charges,Implant Device,434.52,34,,434.52,percent of total billed charges,Implant Device,434.52,34,,434.52,percent of total billed charges,Implant Device,434.52,34,,434.52,percent of total billed charges,Implant Device,447.3,35,,447.3,percent of total billed charges,Implant Device,434.52,34,"Charges > $500, x 34%",434.52,percent of total billed charges,Implant Device,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,511.2,40,,511.2,percent of total billed charges,Implant Devices,447.3,70,,447.3,percent of total billed charges,Implant Devices,434.52,34,,434.52,percent of total billed charges,Implant Devices,434.52,34,,434.52,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,447.3,35,,447.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,511.2,
DEPUY 04.005.442 LOCKING SCREW 4.0X52MM,C1713,HCPCS,,79009388,CDM,278,RC,,,both,,,730,288.11,39.4668,,288.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,248.2,34,,248.2,percent of total billed charges,Implant Device,255.5,35,,255.5,percent of total billed charges,Implant Device,248.2,34,"Charges > $500, x 34%",248.2,percent of total billed charges,Implant Device,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,292,40,,292,percent of total billed charges,Implant Devices,255.5,70,,255.5,percent of total billed charges,Implant Devices,248.2,34,,248.2,percent of total billed charges,Implant Devices,248.2,34,,248.2,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,255.5,35,,255.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,292,
IN2BONES S80 ST185 IBS SCREW 8.0X85MM,C1713,HCPCS,,79009389,CDM,278,RC,,,both,,,3585,1414.88,39.4668,,1414.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1254.75,35,,1254.75,percent of total billed charges,Implant Device,1218.9,34,"Charges > $500, x 34%",1218.9,percent of total billed charges,Implant Device,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1434,40,,1434,percent of total billed charges,Implant Devices,1254.75,70,,1254.75,percent of total billed charges,Implant Devices,1218.9,34,,1218.9,percent of total billed charges,Implant Devices,1218.9,34,,1218.9,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1218.9,34,"If Charge > 2,000, then 34 percent",1218.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1434,
IN2BONES BGP001-02 BIOV W/PUTTY 2CC,C1713,HCPCS,,79009390,CDM,278,RC,,,both,,,5505,2172.65,39.4668,,2172.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1871.7,34,,1871.7,percent of total billed charges,Implant Device,1926.75,35,,1926.75,percent of total billed charges,Implant Device,1871.7,34,"Charges > $500, x 34%",1871.7,percent of total billed charges,Implant Device,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,2202,40,,2202,percent of total billed charges,Implant Devices,1926.75,70,,1926.75,percent of total billed charges,Implant Devices,1871.7,34,,1871.7,percent of total billed charges,Implant Devices,1871.7,34,,1871.7,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,1926.75,35,,1926.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1871.7,34,"If Charge > 2,000, then 34 percent",1871.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2202,
IN2BONES P65 ST685 COLAG SCREW 6.7X85MM,C1713,HCPCS,,79009393,CDM,278,RC,,,both,,,3225,1272.8,39.4668,,1272.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Device,1096.5,34,"Charges > $500, x 34%",1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1290,40,,1290,percent of total billed charges,Implant Devices,1128.75,70,,1128.75,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1096.5,34,"If Charge > 2,000, then 34 percent",1096.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1290,
STRYKER 141-2522 HEADLESS SCREW 2.5X22MM,C1713,HCPCS,,79009396,CDM,278,RC,,,both,,,1557,614.5,39.4668,,614.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,544.95,35,,544.95,percent of total billed charges,Implant Device,529.38,34,"Charges > $500, x 34%",529.38,percent of total billed charges,Implant Device,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,622.8,40,,622.8,percent of total billed charges,Implant Devices,544.95,70,,544.95,percent of total billed charges,Implant Devices,529.38,34,,529.38,percent of total billed charges,Implant Devices,529.38,34,,529.38,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,622.8,
RTI M3C005 ALLOGENEIC BONE GRAFT - 5CC,C1713,HCPCS,,79009398,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
STABILITY SB 895 TENODESIS ALLOGRAFT,C1713,HCPCS,,79009402,CDM,278,RC,,,both,,,5325,2101.61,39.4668,,2101.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1810.5,34,,1810.5,percent of total billed charges,Implant Device,1863.75,35,,1863.75,percent of total billed charges,Implant Device,1810.5,34,"Charges > $500, x 34%",1810.5,percent of total billed charges,Implant Device,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,2130,40,,2130,percent of total billed charges,Implant Devices,1863.75,70,,1863.75,percent of total billed charges,Implant Devices,1810.5,34,,1810.5,percent of total billed charges,Implant Devices,1810.5,34,,1810.5,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,1863.75,35,,1863.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1810.5,34,"If Charge > 2,000, then 34 percent",1810.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2130,
STRYKER 629548 8 HOLE NARROW COMP PLATE,C1713,HCPCS,,79009403,CDM,278,RC,,,both,,,1873,739.21,39.4668,,739.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,636.82,34,,636.82,percent of total billed charges,Implant Device,655.55,35,,655.55,percent of total billed charges,Implant Device,636.82,34,"Charges > $500, x 34%",636.82,percent of total billed charges,Implant Device,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,749.2,40,,749.2,percent of total billed charges,Implant Devices,655.55,70,,655.55,percent of total billed charges,Implant Devices,636.82,34,,636.82,percent of total billed charges,Implant Devices,636.82,34,,636.82,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,655.55,35,,655.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,749.2,
STRYKER 657410 3.5X10MM NON-LOCK SCREW,C1713,HCPCS,,79009404,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
ARTHREX AR-8970AL ANTERIOP FUSION PLT LT,C1713,HCPCS,,79009406,CDM,278,RC,,,both,,,8895,3510.57,39.4668,,3510.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3113.25,35,,3113.25,percent of total billed charges,Implant Device,3024.3,34,"Charges > $500, x 34%",3024.3,percent of total billed charges,Implant Device,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3558,40,,3558,percent of total billed charges,Implant Devices,3113.25,70,,3113.25,percent of total billed charges,Implant Devices,3024.3,34,,3024.3,percent of total billed charges,Implant Devices,3024.3,34,,3024.3,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3024.3,34,"If Charge > 2,000, then 34 percent",3024.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3558,
ARTHREX AR-8545-32 CORTICAL SCREW 4.5X32,C1713,HCPCS,,79009407,CDM,278,RC,,,both,,,225,88.8,39.4668,,88.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,90,40,,90,percent of total billed charges,Implant Devices,78.75,70,,78.75,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90,
ARTHREX AR-8545-34 CORTICAL SCREW 4.5X34,C1713,HCPCS,,79009408,CDM,278,RC,,,both,,,225,88.8,39.4668,,88.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,90,40,,90,percent of total billed charges,Implant Devices,78.75,70,,78.75,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90,
ARTHREX AR-8967-2865 CANN SCREW 6.7X65MM,C1713,HCPCS,,79009410,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
DEPUY 02.123.026 PERIART PROX HUM PLT 8H,C1713,HCPCS,,79009411,CDM,278,RC,,,both,,,4431,1748.77,39.4668,,1748.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1550.85,35,,1550.85,percent of total billed charges,Implant Device,1506.54,34,"Charges > $500, x 34%",1506.54,percent of total billed charges,Implant Device,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1772.4,40,,1772.4,percent of total billed charges,Implant Devices,1550.85,70,,1550.85,percent of total billed charges,Implant Devices,1506.54,34,,1506.54,percent of total billed charges,Implant Devices,1506.54,34,,1506.54,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1506.54,34,"If Charge > 2,000, then 34 percent",1506.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1772.4,
ARTHREX AR-2324BCCS IMPLANT SYSTEM,C1713,HCPCS,,79009415,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
ARTHREX AR-1927BCT-475 CORKSCREW 4.75,C1713,HCPCS,,79009416,CDM,278,RC,,,both,,,1065,420.32,39.4668,,420.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,372.75,35,,372.75,percent of total billed charges,Implant Device,362.1,34,"Charges > $500, x 34%",362.1,percent of total billed charges,Implant Device,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,426,40,,426,percent of total billed charges,Implant Devices,372.75,70,,372.75,percent of total billed charges,Implant Devices,362.1,34,,362.1,percent of total billed charges,Implant Devices,362.1,34,,362.1,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,426,
STRYKER 5572-4532 PERIPH SCREW 4.5X32MM,C1713,HCPCS,,79009435,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
STRYKER 1822-0936S TIBIAL NAIL 9X360MM,C1713,HCPCS,,79009440,CDM,278,RC,,,both,,,7143,2819.11,39.4668,,2819.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2428.62,34,,2428.62,percent of total billed charges,Implant Device,2500.05,35,,2500.05,percent of total billed charges,Implant Device,2428.62,34,"Charges > $500, x 34%",2428.62,percent of total billed charges,Implant Device,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2857.2,40,,2857.2,percent of total billed charges,Implant Devices,2500.05,70,,2500.05,percent of total billed charges,Implant Devices,2428.62,34,,2428.62,percent of total billed charges,Implant Devices,2428.62,34,,2428.62,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,2500.05,35,,2500.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2428.62,34,"If Charge > 2,000, then 34 percent",2428.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2857.2,
ARTHREX AR-8925SS TIGHTROPE XP,C1713,HCPCS,,79009443,CDM,278,RC,,,both,,,6408,2529.03,39.4668,,2529.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2178.72,34,,2178.72,percent of total billed charges,Implant Device,2242.8,35,,2242.8,percent of total billed charges,Implant Device,2178.72,34,"Charges > $500, x 34%",2178.72,percent of total billed charges,Implant Device,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2563.2,40,,2563.2,percent of total billed charges,Implant Devices,2242.8,70,,2242.8,percent of total billed charges,Implant Devices,2178.72,34,,2178.72,percent of total billed charges,Implant Devices,2178.72,34,,2178.72,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,2242.8,35,,2242.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2178.72,34,"If Charge > 2,000, then 34 percent",2178.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2563.2,
STRYKER 629527 COMP PLATE 7 HOLE NARROW,C1713,HCPCS,,79009444,CDM,278,RC,,,both,,,1276,503.6,39.4668,,503.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,433.84,34,,433.84,percent of total billed charges,Implant Device,446.6,35,,446.6,percent of total billed charges,Implant Device,433.84,34,"Charges > $500, x 34%",433.84,percent of total billed charges,Implant Device,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,510.4,40,,510.4,percent of total billed charges,Implant Devices,446.6,70,,446.6,percent of total billed charges,Implant Devices,433.84,34,,433.84,percent of total billed charges,Implant Devices,433.84,34,,433.84,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,446.6,35,,446.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510.4,
IN2BONES S80 ST195 IBS SCREW 8.0X95MM,C1713,HCPCS,,79009445,CDM,278,RC,,,both,,,3585,1414.88,39.4668,,1414.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1218.9,34,,1218.9,percent of total billed charges,Implant Device,1254.75,35,,1254.75,percent of total billed charges,Implant Device,1218.9,34,"Charges > $500, x 34%",1218.9,percent of total billed charges,Implant Device,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1434,40,,1434,percent of total billed charges,Implant Devices,1254.75,70,,1254.75,percent of total billed charges,Implant Devices,1218.9,34,,1218.9,percent of total billed charges,Implant Devices,1218.9,34,,1218.9,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,1254.75,35,,1254.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1218.9,34,"If Charge > 2,000, then 34 percent",1218.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1434,
IN2BONES S45 ST145 IBS SCREW 4.5X45MM,C1713,HCPCS,,79009446,CDM,278,RC,,,both,,,1545,609.76,39.4668,,609.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,540.75,35,,540.75,percent of total billed charges,Implant Device,525.3,34,"Charges > $500, x 34%",525.3,percent of total billed charges,Implant Device,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,618,40,,618,percent of total billed charges,Implant Devices,540.75,70,,540.75,percent of total billed charges,Implant Devices,525.3,34,,525.3,percent of total billed charges,Implant Devices,525.3,34,,525.3,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,618,
IN2BONES S65 ST150 IBS SCREW 6.5X50MM,C1713,HCPCS,,79009447,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
IN2BONES T50 SN018 COMP STAPLE 18X16X16,C1713,HCPCS,,79009448,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
STRYKER 141-2528 HEADLESS SCREW 2.5X28MM,C1713,HCPCS,,79009457,CDM,278,RC,,,both,,,1557,614.5,39.4668,,614.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,544.95,35,,544.95,percent of total billed charges,Implant Device,529.38,34,"Charges > $500, x 34%",529.38,percent of total billed charges,Implant Device,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,622.8,40,,622.8,percent of total billed charges,Implant Devices,544.95,70,,544.95,percent of total billed charges,Implant Devices,529.38,34,,529.38,percent of total billed charges,Implant Devices,529.38,34,,529.38,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,622.8,
STRYKER 141-2524 HEADLESS SCREW 2.5X24MM,C1713,HCPCS,,79009458,CDM,278,RC,,,both,,,1557,614.5,39.4668,,614.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,544.95,35,,544.95,percent of total billed charges,Implant Device,529.38,34,"Charges > $500, x 34%",529.38,percent of total billed charges,Implant Device,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,622.8,40,,622.8,percent of total billed charges,Implant Devices,544.95,70,,544.95,percent of total billed charges,Implant Devices,529.38,34,,529.38,percent of total billed charges,Implant Devices,529.38,34,,529.38,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,622.8,
STRYKER 141-2523 HEADLESS SCREW 2.5X23MM,C1713,HCPCS,,79009459,CDM,278,RC,,,both,,,1557,614.5,39.4668,,614.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,529.38,34,,529.38,percent of total billed charges,Implant Device,544.95,35,,544.95,percent of total billed charges,Implant Device,529.38,34,"Charges > $500, x 34%",529.38,percent of total billed charges,Implant Device,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,622.8,40,,622.8,percent of total billed charges,Implant Devices,544.95,70,,544.95,percent of total billed charges,Implant Devices,529.38,34,,529.38,percent of total billed charges,Implant Devices,529.38,34,,529.38,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,544.95,35,,544.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,622.8,
STRYKER 657128 CORTICAL SCREW 2.7X28MM,C1713,HCPCS,,79009460,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 325046 CANNULATED SCREW 4.0X46MM,C1713,HCPCS,,79009461,CDM,278,RC,,,both,,,824,325.21,39.4668,,325.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,280.16,34,,280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Device,280.16,34,"Charges > $500, x 34%",280.16,percent of total billed charges,Implant Device,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,329.6,40,,329.6,percent of total billed charges,Implant Devices,288.4,70,,288.4,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,280.16,34,,280.16,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,288.4,35,,288.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,329.6,
ZIMMER 08A022LL CANCELLOUS CHIPS 15CC,C1713,HCPCS,,79009465,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ZIMMER 08A020LL CANCELLOUS CHIPS 30CC,C1713,HCPCS,,79009466,CDM,278,RC,,,both,,,993,391.91,39.4668,,391.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,337.62,34,,337.62,percent of total billed charges,Implant Device,337.62,34,,337.62,percent of total billed charges,Implant Device,337.62,34,,337.62,percent of total billed charges,Implant Device,337.62,34,,337.62,percent of total billed charges,Implant Device,337.62,34,,337.62,percent of total billed charges,Implant Device,337.62,34,,337.62,percent of total billed charges,Implant Device,347.55,35,,347.55,percent of total billed charges,Implant Device,337.62,34,"Charges > $500, x 34%",337.62,percent of total billed charges,Implant Device,347.55,35,,347.55,percent of total billed charges,Implant Devices,347.55,35,,347.55,percent of total billed charges,Implant Devices,347.55,35,,,percent of total billed charges,Implant Devices,347.55,35,,347.55,percent of total billed charges,Implant Devices,347.55,35,,347.55,percent of total billed charges,Implant Devices,397.2,40,,397.2,percent of total billed charges,Implant Devices,347.55,70,,347.55,percent of total billed charges,Implant Devices,337.62,34,,337.62,percent of total billed charges,Implant Devices,337.62,34,,337.62,percent of total billed charges,Implant Devices,347.55,35,,347.55,percent of total billed charges,Implant Devices,347.55,35,,347.55,percent of total billed charges,Implant Devices,347.55,35,,347.55,percent of total billed charges,Implant Devices,347.55,35,,347.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,397.2,
ZIMMER 08A021LL CANCELLOUS CHIPS 60CC,C1713,HCPCS,,79009467,CDM,278,RC,,,both,,,1626,641.73,39.4668,,641.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,552.84,34,,552.84,percent of total billed charges,Implant Device,552.84,34,,552.84,percent of total billed charges,Implant Device,552.84,34,,552.84,percent of total billed charges,Implant Device,552.84,34,,552.84,percent of total billed charges,Implant Device,552.84,34,,552.84,percent of total billed charges,Implant Device,552.84,34,,552.84,percent of total billed charges,Implant Device,569.1,35,,569.1,percent of total billed charges,Implant Device,552.84,34,"Charges > $500, x 34%",552.84,percent of total billed charges,Implant Device,569.1,35,,569.1,percent of total billed charges,Implant Devices,569.1,35,,569.1,percent of total billed charges,Implant Devices,569.1,35,,,percent of total billed charges,Implant Devices,569.1,35,,569.1,percent of total billed charges,Implant Devices,569.1,35,,569.1,percent of total billed charges,Implant Devices,650.4,40,,650.4,percent of total billed charges,Implant Devices,569.1,70,,569.1,percent of total billed charges,Implant Devices,552.84,34,,552.84,percent of total billed charges,Implant Devices,552.84,34,,552.84,percent of total billed charges,Implant Devices,569.1,35,,569.1,percent of total billed charges,Implant Devices,569.1,35,,569.1,percent of total billed charges,Implant Devices,569.1,35,,569.1,percent of total billed charges,Implant Devices,569.1,35,,569.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,650.4,
IN2BONES M40 SE020 RTS MTP IMPLANT SZ 2,C1713,HCPCS,,79009470,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
STRYKER 1822-1236S TIBIAL NAIL 12X360MM,C1713,HCPCS,,79009471,CDM,278,RC,,,both,,,3529,1392.78,39.4668,,1392.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Device,1199.86,34,"Charges > $500, x 34%",1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1411.6,40,,1411.6,percent of total billed charges,Implant Devices,1235.15,70,,1235.15,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1199.86,34,"If Charge > 2,000, then 34 percent",1199.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1411.6,
DEPUY 04.005.436S LOCKING SCREW 4.0X46MM,C1713,HCPCS,,79009478,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 462.642S SPIRAL BLADE SCREW 42MM,C1713,HCPCS,,79009479,CDM,278,RC,,,both,,,2623,1035.21,39.4668,,1035.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,891.82,34,,891.82,percent of total billed charges,Implant Device,891.82,34,,891.82,percent of total billed charges,Implant Device,891.82,34,,891.82,percent of total billed charges,Implant Device,891.82,34,,891.82,percent of total billed charges,Implant Device,891.82,34,,891.82,percent of total billed charges,Implant Device,891.82,34,,891.82,percent of total billed charges,Implant Device,918.05,35,,918.05,percent of total billed charges,Implant Device,891.82,34,"Charges > $500, x 34%",891.82,percent of total billed charges,Implant Device,918.05,35,,918.05,percent of total billed charges,Implant Devices,918.05,35,,918.05,percent of total billed charges,Implant Devices,918.05,35,,,percent of total billed charges,Implant Devices,918.05,35,,918.05,percent of total billed charges,Implant Devices,918.05,35,,918.05,percent of total billed charges,Implant Devices,1049.2,40,,1049.2,percent of total billed charges,Implant Devices,918.05,70,,918.05,percent of total billed charges,Implant Devices,891.82,34,,891.82,percent of total billed charges,Implant Devices,891.82,34,,891.82,percent of total billed charges,Implant Devices,918.05,35,,918.05,percent of total billed charges,Implant Devices,918.05,35,,918.05,percent of total billed charges,Implant Devices,918.05,35,,918.05,percent of total billed charges,Implant Devices,918.05,35,,918.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,891.82,34,"If Charge > 2,000, then 34 percent",891.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1049.2,
DEPUY 04.005.416S LOCKING SCREW 4.0X26MM,C1713,HCPCS,,79009480,CDM,278,RC,,,both,,,454,179.18,39.4668,,179.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,181.6,40,,181.6,percent of total billed charges,Implant Devices,158.9,70,,158.9,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.6,
DEPUY 04.001.230S CANN HUM NAIL 7X250MM,C1713,HCPCS,,79009481,CDM,278,RC,,,both,,,7882,3110.77,39.4668,,3110.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2679.88,34,,2679.88,percent of total billed charges,Implant Device,2679.88,34,,2679.88,percent of total billed charges,Implant Device,2679.88,34,,2679.88,percent of total billed charges,Implant Device,2679.88,34,,2679.88,percent of total billed charges,Implant Device,2679.88,34,,2679.88,percent of total billed charges,Implant Device,2679.88,34,,2679.88,percent of total billed charges,Implant Device,2758.7,35,,2758.7,percent of total billed charges,Implant Device,2679.88,34,"Charges > $500, x 34%",2679.88,percent of total billed charges,Implant Device,2758.7,35,,2758.7,percent of total billed charges,Implant Devices,2758.7,35,,2758.7,percent of total billed charges,Implant Devices,2758.7,35,,,percent of total billed charges,Implant Devices,2758.7,35,,2758.7,percent of total billed charges,Implant Devices,2758.7,35,,2758.7,percent of total billed charges,Implant Devices,3152.8,40,,3152.8,percent of total billed charges,Implant Devices,2758.7,70,,2758.7,percent of total billed charges,Implant Devices,2679.88,34,,2679.88,percent of total billed charges,Implant Devices,2679.88,34,,2679.88,percent of total billed charges,Implant Devices,2758.7,35,,2758.7,percent of total billed charges,Implant Devices,2758.7,35,,2758.7,percent of total billed charges,Implant Devices,2758.7,35,,2758.7,percent of total billed charges,Implant Devices,2758.7,35,,2758.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2679.88,34,"If Charge > 2,000, then 34 percent",2679.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3152.8,
ARTHREX AR-8943C-10 LOCKING PLATE 10M,C1713,HCPCS,,79009484,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
ARTHREX AR-8835L-18 3.5X18MM LOCK SCREW,C1713,HCPCS,,79009485,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ARTHREX AR-8835L-16 3.5X16MM LOCK SCREW,C1713,HCPCS,,79009486,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ACUMED ATF-240-S ACUTRAK FUSION SCREW 24,C1713,HCPCS,,79009487,CDM,278,RC,,,both,,,1008,397.83,39.4668,,397.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,352.8,35,,352.8,percent of total billed charges,Implant Device,342.72,34,"Charges > $500, x 34%",342.72,percent of total billed charges,Implant Device,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,403.2,40,,403.2,percent of total billed charges,Implant Devices,352.8,70,,352.8,percent of total billed charges,Implant Devices,342.72,34,,342.72,percent of total billed charges,Implant Devices,342.72,34,,342.72,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,403.2,
ARTHREX AR-8840-26 4X26 CANCELLOUS SCREW,C1713,HCPCS,,79009498,CDM,278,RC,,,both,,,105,41.44,39.4668,,41.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,42,40,,42,percent of total billed charges,Implant Devices,36.75,70,,36.75,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42,
ACUMED 30-0322 NON LOCK SCREW 3X65MM,C1713,HCPCS,,79009503,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
ACUMED 30-0268 NON LOCK SCREW 3.5X34MM,C1713,HCPCS,,79009504,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
ACUMED 30-0269 NON LOCK SCREW 3.5X36MM,C1713,HCPCS,,79009505,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
STRYKER 658048 COMPRESSION SCREW 4X48MM,C1713,HCPCS,,79009508,CDM,278,RC,,,both,,,1854,731.71,39.4668,,731.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,630.36,34,,630.36,percent of total billed charges,Implant Device,630.36,34,,630.36,percent of total billed charges,Implant Device,630.36,34,,630.36,percent of total billed charges,Implant Device,630.36,34,,630.36,percent of total billed charges,Implant Device,630.36,34,,630.36,percent of total billed charges,Implant Device,630.36,34,,630.36,percent of total billed charges,Implant Device,648.9,35,,648.9,percent of total billed charges,Implant Device,630.36,34,"Charges > $500, x 34%",630.36,percent of total billed charges,Implant Device,648.9,35,,648.9,percent of total billed charges,Implant Devices,648.9,35,,648.9,percent of total billed charges,Implant Devices,648.9,35,,,percent of total billed charges,Implant Devices,648.9,35,,648.9,percent of total billed charges,Implant Devices,648.9,35,,648.9,percent of total billed charges,Implant Devices,741.6,40,,741.6,percent of total billed charges,Implant Devices,648.9,70,,648.9,percent of total billed charges,Implant Devices,630.36,34,,630.36,percent of total billed charges,Implant Devices,630.36,34,,630.36,percent of total billed charges,Implant Devices,648.9,35,,648.9,percent of total billed charges,Implant Devices,648.9,35,,648.9,percent of total billed charges,Implant Devices,648.9,35,,648.9,percent of total billed charges,Implant Devices,648.9,35,,648.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,741.6,
DEPUY 209.875 CANNULATED SCREW 7.3X75MM,C1713,HCPCS,,79009510,CDM,278,RC,,,both,,,1072,423.08,39.4668,,423.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,375.2,35,,375.2,percent of total billed charges,Implant Device,364.48,34,"Charges > $500, x 34%",364.48,percent of total billed charges,Implant Device,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,428.8,40,,428.8,percent of total billed charges,Implant Devices,375.2,70,,375.2,percent of total billed charges,Implant Devices,364.48,34,,364.48,percent of total billed charges,Implant Devices,364.48,34,,364.48,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.8,
DEPUY 208.895 CANNULATED SCREW 7.3X95MM,C1713,HCPCS,,79009511,CDM,278,RC,,,both,,,1072,423.08,39.4668,,423.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,375.2,35,,375.2,percent of total billed charges,Implant Device,364.48,34,"Charges > $500, x 34%",364.48,percent of total billed charges,Implant Device,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,428.8,40,,428.8,percent of total billed charges,Implant Devices,375.2,70,,375.2,percent of total billed charges,Implant Devices,364.48,34,,364.48,percent of total billed charges,Implant Devices,364.48,34,,364.48,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.8,
ARTHREX AR-4005B-18 CHONDRAL DART 18MM,C1713,HCPCS,,79009515,CDM,278,RC,,,both,,,363,143.26,39.4668,,143.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,123.42,34,,123.42,percent of total billed charges,Implant Device,123.42,34,,123.42,percent of total billed charges,Implant Device,123.42,34,,123.42,percent of total billed charges,Implant Device,123.42,34,,123.42,percent of total billed charges,Implant Device,123.42,34,,123.42,percent of total billed charges,Implant Device,123.42,34,,123.42,percent of total billed charges,Implant Device,127.05,35,,127.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,127.05,35,,127.05,percent of total billed charges,Implant Devices,127.05,35,,127.05,percent of total billed charges,Implant Devices,127.05,35,,,percent of total billed charges,Implant Devices,127.05,35,,127.05,percent of total billed charges,Implant Devices,127.05,35,,127.05,percent of total billed charges,Implant Devices,145.2,40,,145.2,percent of total billed charges,Implant Devices,127.05,70,,127.05,percent of total billed charges,Implant Devices,123.42,34,,123.42,percent of total billed charges,Implant Devices,123.42,34,,123.42,percent of total billed charges,Implant Devices,127.05,35,,127.05,percent of total billed charges,Implant Devices,127.05,35,,127.05,percent of total billed charges,Implant Devices,127.05,35,,127.05,percent of total billed charges,Implant Devices,127.05,35,,127.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,145.2,
STRYKER 629547 COMP PLATE NARROW 7 HOLE,C1713,HCPCS,,79009517,CDM,278,RC,,,both,,,2343,924.71,39.4668,,924.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,796.62,34,,796.62,percent of total billed charges,Implant Device,796.62,34,,796.62,percent of total billed charges,Implant Device,796.62,34,,796.62,percent of total billed charges,Implant Device,796.62,34,,796.62,percent of total billed charges,Implant Device,796.62,34,,796.62,percent of total billed charges,Implant Device,796.62,34,,796.62,percent of total billed charges,Implant Device,820.05,35,,820.05,percent of total billed charges,Implant Device,796.62,34,"Charges > $500, x 34%",796.62,percent of total billed charges,Implant Device,820.05,35,,820.05,percent of total billed charges,Implant Devices,820.05,35,,820.05,percent of total billed charges,Implant Devices,820.05,35,,,percent of total billed charges,Implant Devices,820.05,35,,820.05,percent of total billed charges,Implant Devices,820.05,35,,820.05,percent of total billed charges,Implant Devices,937.2,40,,937.2,percent of total billed charges,Implant Devices,820.05,70,,820.05,percent of total billed charges,Implant Devices,796.62,34,,796.62,percent of total billed charges,Implant Devices,796.62,34,,796.62,percent of total billed charges,Implant Devices,820.05,35,,820.05,percent of total billed charges,Implant Devices,820.05,35,,820.05,percent of total billed charges,Implant Devices,820.05,35,,820.05,percent of total billed charges,Implant Devices,820.05,35,,820.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,796.62,34,"If Charge > 2,000, then 34 percent",796.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,937.2,
STRYKER 58-23010E BONE SCREW 2.3X20MM,C1713,HCPCS,,79009522,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
STRYKER 5573-6536 CTR SCREW 6.5X36MM,C1713,HCPCS,,79009526,CDM,278,RC,,,both,,,837,330.34,39.4668,,330.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,284.58,34,,284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Device,284.58,34,"Charges > $500, x 34%",284.58,percent of total billed charges,Implant Device,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,334.8,40,,334.8,percent of total billed charges,Implant Devices,292.95,70,,292.95,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,284.58,34,,284.58,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,292.95,35,,292.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,334.8,
STRYKER 604730 CANN SCREW 4.0X30MM,C1713,HCPCS,,79009529,CDM,278,RC,,,both,,,535,211.15,39.4668,,211.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,187.25,35,,187.25,percent of total billed charges,Implant Device,181.9,34,"Charges > $500, x 34%",181.9,percent of total billed charges,Implant Device,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,214,40,,214,percent of total billed charges,Implant Devices,187.25,70,,187.25,percent of total billed charges,Implant Devices,181.9,34,,181.9,percent of total billed charges,Implant Devices,181.9,34,,181.9,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214,
DEPUY 208.412 CANN SCREW 6.5X85MM,C1713,HCPCS,,79009531,CDM,278,RC,,,both,,,683,269.56,39.4668,,269.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Device,232.22,34,"Charges > $500, x 34%",232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,273.2,40,,273.2,percent of total billed charges,Implant Devices,239.05,70,,239.05,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.2,
DEPUY 208.413 CANN SCREW 6.5X90MM,C1713,HCPCS,,79009532,CDM,278,RC,,,both,,,683,269.56,39.4668,,269.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Device,232.22,34,"Charges > $500, x 34%",232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,273.2,40,,273.2,percent of total billed charges,Implant Devices,239.05,70,,239.05,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.2,
DEPUY 208.414 CANN SCREW 6.5X95MM,C1713,HCPCS,,79009533,CDM,278,RC,,,both,,,1077,425.06,39.4668,,425.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,366.18,34,,366.18,percent of total billed charges,Implant Device,366.18,34,,366.18,percent of total billed charges,Implant Device,366.18,34,,366.18,percent of total billed charges,Implant Device,366.18,34,,366.18,percent of total billed charges,Implant Device,366.18,34,,366.18,percent of total billed charges,Implant Device,366.18,34,,366.18,percent of total billed charges,Implant Device,376.95,35,,376.95,percent of total billed charges,Implant Device,366.18,34,"Charges > $500, x 34%",366.18,percent of total billed charges,Implant Device,376.95,35,,376.95,percent of total billed charges,Implant Devices,376.95,35,,376.95,percent of total billed charges,Implant Devices,376.95,35,,,percent of total billed charges,Implant Devices,376.95,35,,376.95,percent of total billed charges,Implant Devices,376.95,35,,376.95,percent of total billed charges,Implant Devices,430.8,40,,430.8,percent of total billed charges,Implant Devices,376.95,70,,376.95,percent of total billed charges,Implant Devices,366.18,34,,366.18,percent of total billed charges,Implant Devices,366.18,34,,366.18,percent of total billed charges,Implant Devices,376.95,35,,376.95,percent of total billed charges,Implant Devices,376.95,35,,376.95,percent of total billed charges,Implant Devices,376.95,35,,376.95,percent of total billed charges,Implant Devices,376.95,35,,376.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,430.8,
ARTHREX AR-8930-10 SNAP OFF SCREW 2X10MM,C1713,HCPCS,,79009536,CDM,278,RC,,,both,,,1029,406.11,39.4668,,406.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,349.86,34,,349.86,percent of total billed charges,Implant Device,360.15,35,,360.15,percent of total billed charges,Implant Device,349.86,34,"Charges > $500, x 34%",349.86,percent of total billed charges,Implant Device,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,411.6,40,,411.6,percent of total billed charges,Implant Devices,360.15,70,,360.15,percent of total billed charges,Implant Devices,349.86,34,,349.86,percent of total billed charges,Implant Devices,349.86,34,,349.86,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,360.15,35,,360.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,411.6,
LIFE SPIN 132-2318-1 AILERON LAREG CORE,C1713,HCPCS,,79009537,CDM,278,RC,,,both,,,20640,8145.95,39.4668,,8145.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7017.6,34,,7017.6,percent of total billed charges,Implant Device,7224,35,,7224,percent of total billed charges,Implant Device,7017.6,34,"Charges > $500, x 34%",7017.6,percent of total billed charges,Implant Device,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,8256,40,,8256,percent of total billed charges,Implant Devices,7224,70,,7224,percent of total billed charges,Implant Devices,7017.6,34,,7017.6,percent of total billed charges,Implant Devices,7017.6,34,,7017.6,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,7224,35,,7224,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7017.6,34,"If Charge > 2,000, then 34 percent",7017.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8256,
LIFE SPIN 132-2318-2 AILERON LAREG PLATE,C1713,HCPCS,,79009538,CDM,278,RC,,,both,,,13680,5399.06,39.4668,,5399.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4651.2,34,,4651.2,percent of total billed charges,Implant Device,4788,35,,4788,percent of total billed charges,Implant Device,4651.2,34,"Charges > $500, x 34%",4651.2,percent of total billed charges,Implant Device,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,5472,40,,5472,percent of total billed charges,Implant Devices,4788,70,,4788,percent of total billed charges,Implant Devices,4651.2,34,,4651.2,percent of total billed charges,Implant Devices,4651.2,34,,4651.2,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,4788,35,,4788,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4651.2,34,"If Charge > 2,000, then 34 percent",4651.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5472,
IN2BONES V35 ST320 LOCK SCREW 3.5X20MM,C1713,HCPCS,,79009539,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
DEPUY 208.880 CANNULATED SCREW 7.3X80MM,C1713,HCPCS,,79009540,CDM,278,RC,,,both,,,1072,423.08,39.4668,,423.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,375.2,35,,375.2,percent of total billed charges,Implant Device,364.48,34,"Charges > $500, x 34%",364.48,percent of total billed charges,Implant Device,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,428.8,40,,428.8,percent of total billed charges,Implant Devices,375.2,70,,375.2,percent of total billed charges,Implant Devices,364.48,34,,364.48,percent of total billed charges,Implant Devices,364.48,34,,364.48,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.8,
DEPUY 208.885 CANNULATED SCREW 7.3X85MM,C1713,HCPCS,,79009541,CDM,278,RC,,,both,,,1072,423.08,39.4668,,423.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,375.2,35,,375.2,percent of total billed charges,Implant Device,364.48,34,"Charges > $500, x 34%",364.48,percent of total billed charges,Implant Device,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,428.8,40,,428.8,percent of total billed charges,Implant Devices,375.2,70,,375.2,percent of total billed charges,Implant Devices,364.48,34,,364.48,percent of total billed charges,Implant Devices,364.48,34,,364.48,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.8,
DEPUY 208.890 CANNULATED SCREW 7.3X90MM,C1713,HCPCS,,79009542,CDM,278,RC,,,both,,,1072,423.08,39.4668,,423.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,364.48,34,,364.48,percent of total billed charges,Implant Device,375.2,35,,375.2,percent of total billed charges,Implant Device,364.48,34,"Charges > $500, x 34%",364.48,percent of total billed charges,Implant Device,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,428.8,40,,428.8,percent of total billed charges,Implant Devices,375.2,70,,375.2,percent of total billed charges,Implant Devices,364.48,34,,364.48,percent of total billed charges,Implant Devices,364.48,34,,364.48,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,375.2,35,,375.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,428.8,
ARTHREX SC2714-S 2.7X14MM SCREW,C1713,HCPCS,,79009544,CDM,278,RC,,,both,,,537,211.94,39.4668,,211.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,187.95,35,,187.95,percent of total billed charges,Implant Device,182.58,34,"Charges > $500, x 34%",182.58,percent of total billed charges,Implant Device,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,214.8,40,,214.8,percent of total billed charges,Implant Devices,187.95,70,,187.95,percent of total billed charges,Implant Devices,182.58,34,,182.58,percent of total billed charges,Implant Devices,182.58,34,,182.58,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.8,
ARTHREX FIB30130L FIBULOCK NAIL LT 3X130,C1713,HCPCS,,79009545,CDM,278,RC,,,both,,,12837,5066.35,39.4668,,5066.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4364.58,34,,4364.58,percent of total billed charges,Implant Device,4364.58,34,,4364.58,percent of total billed charges,Implant Device,4364.58,34,,4364.58,percent of total billed charges,Implant Device,4364.58,34,,4364.58,percent of total billed charges,Implant Device,4364.58,34,,4364.58,percent of total billed charges,Implant Device,4364.58,34,,4364.58,percent of total billed charges,Implant Device,4492.95,35,,4492.95,percent of total billed charges,Implant Device,4364.58,34,"Charges > $500, x 34%",4364.58,percent of total billed charges,Implant Device,4492.95,35,,4492.95,percent of total billed charges,Implant Devices,4492.95,35,,4492.95,percent of total billed charges,Implant Devices,4492.95,35,,,percent of total billed charges,Implant Devices,4492.95,35,,4492.95,percent of total billed charges,Implant Devices,4492.95,35,,4492.95,percent of total billed charges,Implant Devices,5134.8,40,,5134.8,percent of total billed charges,Implant Devices,4492.95,70,,4492.95,percent of total billed charges,Implant Devices,4364.58,34,,4364.58,percent of total billed charges,Implant Devices,4364.58,34,,4364.58,percent of total billed charges,Implant Devices,4492.95,35,,4492.95,percent of total billed charges,Implant Devices,4492.95,35,,4492.95,percent of total billed charges,Implant Devices,4492.95,35,,4492.95,percent of total billed charges,Implant Devices,4492.95,35,,4492.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4364.58,34,"If Charge > 2,000, then 34 percent",4364.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5134.8,
ARTHREX FIB6000 FIBULOK END CAP,C1713,HCPCS,,79009546,CDM,278,RC,,,both,,,516,203.65,39.4668,,203.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,175.44,34,,175.44,percent of total billed charges,Implant Device,175.44,34,,175.44,percent of total billed charges,Implant Device,175.44,34,,175.44,percent of total billed charges,Implant Device,175.44,34,,175.44,percent of total billed charges,Implant Device,175.44,34,,175.44,percent of total billed charges,Implant Device,175.44,34,,175.44,percent of total billed charges,Implant Device,180.6,35,,180.6,percent of total billed charges,Implant Device,175.44,34,"Charges > $500, x 34%",175.44,percent of total billed charges,Implant Device,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,206.4,40,,206.4,percent of total billed charges,Implant Devices,180.6,70,,180.6,percent of total billed charges,Implant Devices,175.44,34,,175.44,percent of total billed charges,Implant Devices,175.44,34,,175.44,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,180.6,35,,180.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,206.4,
STRYKER 607326 CANCELLOUS SCREW 4.0X26MM,C1713,HCPCS,,79009547,CDM,278,RC,,,both,,,133,52.49,39.4668,,52.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,53.2,40,,53.2,percent of total billed charges,Implant Devices,46.55,70,,46.55,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
IN2BONES V35 ST322 LOCK SCREW 3.5X22MM,C1713,HCPCS,,79009548,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
STRYKER 602720 CANN SCREW 6.5X120MM,C1713,HCPCS,,79009580,CDM,278,RC,,,both,,,1285,507.15,39.4668,,507.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,436.9,34,,436.9,percent of total billed charges,Implant Device,436.9,34,,436.9,percent of total billed charges,Implant Device,436.9,34,,436.9,percent of total billed charges,Implant Device,436.9,34,,436.9,percent of total billed charges,Implant Device,436.9,34,,436.9,percent of total billed charges,Implant Device,436.9,34,,436.9,percent of total billed charges,Implant Device,449.75,35,,449.75,percent of total billed charges,Implant Device,436.9,34,"Charges > $500, x 34%",436.9,percent of total billed charges,Implant Device,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,514,40,,514,percent of total billed charges,Implant Devices,449.75,70,,449.75,percent of total billed charges,Implant Devices,436.9,34,,436.9,percent of total billed charges,Implant Devices,436.9,34,,436.9,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,449.75,35,,449.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,514,
ARTHREX ABS-30001S DX MATRIX THICK 5X5CM,C1713,HCPCS,,79009583,CDM,278,RC,,,both,,,4950,1953.61,39.4668,,1953.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Device,1683,34,"Charges > $500, x 34%",1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1980,40,,1980,percent of total billed charges,Implant Devices,1732.5,70,,1732.5,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1683,34,"If Charge > 2,000, then 34 percent",1683,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1980,
STRYKER 58-23020 BONE SCREW 2.3X20MM,C1713,HCPCS,,79009584,CDM,278,RC,,,both,,,426,168.13,39.4668,,168.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,144.84,34,,144.84,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,170.4,40,,170.4,percent of total billed charges,Implant Devices,149.1,70,,149.1,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,144.84,34,,144.84,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,149.1,35,,149.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.4,
STRYKER 657448 NON LOCK SCREW 3.5X48MM,C1713,HCPCS,,79009587,CDM,278,RC,,,both,,,269,106.17,39.4668,,106.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,107.6,40,,107.6,percent of total billed charges,Implant Devices,94.15,70,,94.15,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.6,
STRYKER 657455 NON LOCK SCREW 3.5X55MM,C1713,HCPCS,,79009588,CDM,278,RC,,,both,,,269,106.17,39.4668,,106.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,107.6,40,,107.6,percent of total billed charges,Implant Devices,94.15,70,,94.15,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.6,
PARAGON PDMW-4X4 DERMA COLLAGEN MATRIX,C1713,HCPCS,,79009589,CDM,278,RC,,,both,,,4581,1807.97,39.4668,,1807.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1557.54,34,,1557.54,percent of total billed charges,Implant Device,1557.54,34,,1557.54,percent of total billed charges,Implant Device,1557.54,34,,1557.54,percent of total billed charges,Implant Device,1557.54,34,,1557.54,percent of total billed charges,Implant Device,1557.54,34,,1557.54,percent of total billed charges,Implant Device,1557.54,34,,1557.54,percent of total billed charges,Implant Device,1603.35,35,,1603.35,percent of total billed charges,Implant Device,1557.54,34,"Charges > $500, x 34%",1557.54,percent of total billed charges,Implant Device,1603.35,35,,1603.35,percent of total billed charges,Implant Devices,1603.35,35,,1603.35,percent of total billed charges,Implant Devices,1603.35,35,,,percent of total billed charges,Implant Devices,1603.35,35,,1603.35,percent of total billed charges,Implant Devices,1603.35,35,,1603.35,percent of total billed charges,Implant Devices,1832.4,40,,1832.4,percent of total billed charges,Implant Devices,1603.35,70,,1603.35,percent of total billed charges,Implant Devices,1557.54,34,,1557.54,percent of total billed charges,Implant Devices,1557.54,34,,1557.54,percent of total billed charges,Implant Devices,1603.35,35,,1603.35,percent of total billed charges,Implant Devices,1603.35,35,,1603.35,percent of total billed charges,Implant Devices,1603.35,35,,1603.35,percent of total billed charges,Implant Devices,1603.35,35,,1603.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1557.54,34,"If Charge > 2,000, then 34 percent",1557.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1832.4,
ZIMMER 14355-12-100 DEG TUBULAR 1/2 PLT,C1713,HCPCS,,79009597,CDM,278,RC,,,both,,,510,201.28,39.4668,,201.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Device,173.4,34,"Charges > $500, x 34%",173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,204,40,,204,percent of total billed charges,Implant Devices,178.5,70,,178.5,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204,
ZIMMER 8153-41-044 4.0MM CANC SCREW 44MM,C1713,HCPCS,,79009598,CDM,278,RC,,,both,,,270,106.56,39.4668,,106.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,91.8,34,,91.8,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,108,40,,108,percent of total billed charges,Implant Devices,94.5,70,,94.5,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,91.8,34,,91.8,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,94.5,35,,94.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108,
ZIMMER 8146-11-380 HFN LSG SCREW 11X380,C1713,HCPCS,,79009599,CDM,278,RC,,,both,,,11790,4653.14,39.4668,,4653.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4008.6,34,,4008.6,percent of total billed charges,Implant Device,4008.6,34,,4008.6,percent of total billed charges,Implant Device,4008.6,34,,4008.6,percent of total billed charges,Implant Device,4008.6,34,,4008.6,percent of total billed charges,Implant Device,4008.6,34,,4008.6,percent of total billed charges,Implant Device,4008.6,34,,4008.6,percent of total billed charges,Implant Device,4126.5,35,,4126.5,percent of total billed charges,Implant Device,4008.6,34,"Charges > $500, x 34%",4008.6,percent of total billed charges,Implant Device,4126.5,35,,4126.5,percent of total billed charges,Implant Devices,4126.5,35,,4126.5,percent of total billed charges,Implant Devices,4126.5,35,,,percent of total billed charges,Implant Devices,4126.5,35,,4126.5,percent of total billed charges,Implant Devices,4126.5,35,,4126.5,percent of total billed charges,Implant Devices,4716,40,,4716,percent of total billed charges,Implant Devices,4126.5,70,,4126.5,percent of total billed charges,Implant Devices,4008.6,34,,4008.6,percent of total billed charges,Implant Devices,4008.6,34,,4008.6,percent of total billed charges,Implant Devices,4126.5,35,,4126.5,percent of total billed charges,Implant Devices,4126.5,35,,4126.5,percent of total billed charges,Implant Devices,4126.5,35,,4126.5,percent of total billed charges,Implant Devices,4126.5,35,,4126.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4008.6,34,"If Charge > 2,000, then 34 percent",4008.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4716,
ZIMMER 8145-50-044 CORT BONE SCREW 5X44,C1713,HCPCS,,79009600,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
STRYKER 6704-3-081 TROCHANTERIC GRIP PLT,C1713,HCPCS,,79009601,CDM,278,RC,,,both,,,5851,2309.2,39.4668,,2309.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1989.34,34,,1989.34,percent of total billed charges,Implant Device,1989.34,34,,1989.34,percent of total billed charges,Implant Device,1989.34,34,,1989.34,percent of total billed charges,Implant Device,1989.34,34,,1989.34,percent of total billed charges,Implant Device,1989.34,34,,1989.34,percent of total billed charges,Implant Device,1989.34,34,,1989.34,percent of total billed charges,Implant Device,2047.85,35,,2047.85,percent of total billed charges,Implant Device,1989.34,34,"Charges > $500, x 34%",1989.34,percent of total billed charges,Implant Device,2047.85,35,,2047.85,percent of total billed charges,Implant Devices,2047.85,35,,2047.85,percent of total billed charges,Implant Devices,2047.85,35,,,percent of total billed charges,Implant Devices,2047.85,35,,2047.85,percent of total billed charges,Implant Devices,2047.85,35,,2047.85,percent of total billed charges,Implant Devices,2340.4,40,,2340.4,percent of total billed charges,Implant Devices,2047.85,70,,2047.85,percent of total billed charges,Implant Devices,1989.34,34,,1989.34,percent of total billed charges,Implant Devices,1989.34,34,,1989.34,percent of total billed charges,Implant Devices,2047.85,35,,2047.85,percent of total billed charges,Implant Devices,2047.85,35,,2047.85,percent of total billed charges,Implant Devices,2047.85,35,,2047.85,percent of total billed charges,Implant Devices,2047.85,35,,2047.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1989.34,34,"If Charge > 2,000, then 34 percent",1989.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2340.4,
STRYKER 626987 PLATE-Y 7 HOLE,C1713,HCPCS,,79009605,CDM,278,RC,,,both,,,4572,1804.42,39.4668,,1804.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1600.2,35,,1600.2,percent of total billed charges,Implant Device,1554.48,34,"Charges > $500, x 34%",1554.48,percent of total billed charges,Implant Device,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1828.8,40,,1828.8,percent of total billed charges,Implant Devices,1600.2,70,,1600.2,percent of total billed charges,Implant Devices,1554.48,34,,1554.48,percent of total billed charges,Implant Devices,1554.48,34,,1554.48,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1554.48,34,"If Charge > 2,000, then 34 percent",1554.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1828.8,
STRYKER 656010 LOCKING SCREW 2.4X10MM,C1713,HCPCS,,79009606,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 656012 LOCKING SCREW 2.4X12MM,C1713,HCPCS,,79009607,CDM,278,RC,,,both,,,443,174.84,39.4668,,174.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,177.2,40,,177.2,percent of total billed charges,Implant Devices,155.05,70,,155.05,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.2,
STRYKER 656014 LOCKING SCREW 2.4X14MM,C1713,HCPCS,,79009608,CDM,278,RC,,,both,,,443,174.84,39.4668,,174.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,177.2,40,,177.2,percent of total billed charges,Implant Devices,155.05,70,,155.05,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.2,
ARTHREX AR-8919DS CMC TIGHROPE IMPLANT,C1713,HCPCS,,79009609,CDM,278,RC,,,both,,,2685,1059.68,39.4668,,1059.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,912.9,34,,912.9,percent of total billed charges,Implant Device,912.9,34,,912.9,percent of total billed charges,Implant Device,912.9,34,,912.9,percent of total billed charges,Implant Device,912.9,34,,912.9,percent of total billed charges,Implant Device,912.9,34,,912.9,percent of total billed charges,Implant Device,912.9,34,,912.9,percent of total billed charges,Implant Device,939.75,35,,939.75,percent of total billed charges,Implant Device,912.9,34,"Charges > $500, x 34%",912.9,percent of total billed charges,Implant Device,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,1074,40,,1074,percent of total billed charges,Implant Devices,939.75,70,,939.75,percent of total billed charges,Implant Devices,912.9,34,,912.9,percent of total billed charges,Implant Devices,912.9,34,,912.9,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,912.9,34,"If Charge > 2,000, then 34 percent",912.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1074,
STRYKER 629263 HUMERUS PLATE DISTAL 80MM,C1713,HCPCS,,79009610,CDM,278,RC,,,both,,,4582,1808.37,39.4668,,1808.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1557.88,34,,1557.88,percent of total billed charges,Implant Device,1557.88,34,,1557.88,percent of total billed charges,Implant Device,1557.88,34,,1557.88,percent of total billed charges,Implant Device,1557.88,34,,1557.88,percent of total billed charges,Implant Device,1557.88,34,,1557.88,percent of total billed charges,Implant Device,1557.88,34,,1557.88,percent of total billed charges,Implant Device,1603.7,35,,1603.7,percent of total billed charges,Implant Device,1557.88,34,"Charges > $500, x 34%",1557.88,percent of total billed charges,Implant Device,1603.7,35,,1603.7,percent of total billed charges,Implant Devices,1603.7,35,,1603.7,percent of total billed charges,Implant Devices,1603.7,35,,,percent of total billed charges,Implant Devices,1603.7,35,,1603.7,percent of total billed charges,Implant Devices,1603.7,35,,1603.7,percent of total billed charges,Implant Devices,1832.8,40,,1832.8,percent of total billed charges,Implant Devices,1603.7,70,,1603.7,percent of total billed charges,Implant Devices,1557.88,34,,1557.88,percent of total billed charges,Implant Devices,1557.88,34,,1557.88,percent of total billed charges,Implant Devices,1603.7,35,,1603.7,percent of total billed charges,Implant Devices,1603.7,35,,1603.7,percent of total billed charges,Implant Devices,1603.7,35,,1603.7,percent of total billed charges,Implant Devices,1603.7,35,,1603.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1557.88,34,"If Charge > 2,000, then 34 percent",1557.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1832.8,
STRYKER 629283 HUMERUS PLATE DISTAL 69MM,C1713,HCPCS,,79009611,CDM,278,RC,,,both,,,2766,1091.65,39.4668,,1091.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,940.44,34,,940.44,percent of total billed charges,Implant Device,940.44,34,,940.44,percent of total billed charges,Implant Device,940.44,34,,940.44,percent of total billed charges,Implant Device,940.44,34,,940.44,percent of total billed charges,Implant Device,940.44,34,,940.44,percent of total billed charges,Implant Device,940.44,34,,940.44,percent of total billed charges,Implant Device,968.1,35,,968.1,percent of total billed charges,Implant Device,940.44,34,"Charges > $500, x 34%",940.44,percent of total billed charges,Implant Device,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,1106.4,40,,1106.4,percent of total billed charges,Implant Devices,968.1,70,,968.1,percent of total billed charges,Implant Devices,940.44,34,,940.44,percent of total billed charges,Implant Devices,940.44,34,,940.44,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,940.44,34,"If Charge > 2,000, then 34 percent",940.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1106.4,
STRYKER 657430 BONE SCREW 3.5X30MM,C1713,HCPCS,,79009612,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657438 BONE SCREW 3.5X38MM,C1713,HCPCS,,79009613,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657465 BONE SCREW 3.5X65MM,C1713,HCPCS,,79009614,CDM,278,RC,,,both,,,269,106.17,39.4668,,106.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,107.6,40,,107.6,percent of total billed charges,Implant Devices,94.15,70,,94.15,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.6,
DEPUY 241.421 TUBLAR PLATE 12 HOLE,C1713,HCPCS,,79009615,CDM,278,RC,,,both,,,510,201.28,39.4668,,201.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Device,173.4,34,"Charges > $500, x 34%",173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,204,40,,204,percent of total billed charges,Implant Devices,178.5,70,,178.5,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204,
DEPUY 204.860 CORTEX SCREW 3.5X16MM,C1713,HCPCS,,79009616,CDM,278,RC,,,both,,,59,23.29,39.4668,,23.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,23.6,40,,23.6,percent of total billed charges,Implant Devices,20.65,70,,20.65,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.6,
DEPUY 206.010 CANCELLOUS SCREW 4.0X10MM,C1713,HCPCS,,79009617,CDM,278,RC,,,both,,,73,28.81,39.4668,,28.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,24.82,34,,24.82,percent of total billed charges,Implant Device,25.55,35,,25.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,29.2,40,,29.2,percent of total billed charges,Implant Devices,25.55,70,,25.55,percent of total billed charges,Implant Devices,24.82,34,,24.82,percent of total billed charges,Implant Devices,24.82,34,,24.82,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,25.55,35,,25.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,29.2,
IN2BONES P65 ST432 COLAG SCREW 4.0X32MM,C1713,HCPCS,,79009624,CDM,278,RC,,,both,,,1668,658.31,39.4668,,658.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,583.8,35,,583.8,percent of total billed charges,Implant Device,567.12,34,"Charges > $500, x 34%",567.12,percent of total billed charges,Implant Device,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,667.2,40,,667.2,percent of total billed charges,Implant Devices,583.8,70,,583.8,percent of total billed charges,Implant Devices,567.12,34,,567.12,percent of total billed charges,Implant Devices,567.12,34,,567.12,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667.2,
IN2BONES P40 ST014 PLATE UNIV 4 HOLE,C1713,HCPCS,,79009625,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES V35 ST214 NON LOCK SCREW 3.5X14,C1713,HCPCS,,79009626,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ARTHREX AR-4020C-06 BIOCOMP SCREW 6X20MM,C1713,HCPCS,,79009630,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-4020C-07 BIOCOMP SCREW 7X20MM,C1713,HCPCS,,79009631,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-4020C-08 BIOCOMP SCREW 8X20MM,C1713,HCPCS,,79009632,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-4020C-09 BIOCOMP SCREW 9X20MM,C1713,HCPCS,,79009633,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-4020C-10 BIOCOMP SCREW 10X20,C1713,HCPCS,,79009634,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-4030C-07 BIOCOMP SCREW 7X30MM,C1713,HCPCS,,79009635,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-4030C-08 BIOCOMP SCREW 8X30MM,C1713,HCPCS,,79009636,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-4030C-09 BIOCOMP SCREW 9X30MM,C1713,HCPCS,,79009637,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-4030C-10 BIOCOMP SCREW 10X30,C1713,HCPCS,,79009638,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-4030C-11 BIOCOMP SCREW 11X30,C1713,HCPCS,,79009639,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-4030C-12 BIOCOMP SCREW 12X30,C1713,HCPCS,,79009640,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
STRYKER 626992 BROAD Y-PLT 2 SHAFT HOLES,C1713,HCPCS,,79009641,CDM,278,RC,,,both,,,5904,2330.12,39.4668,,2330.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2007.36,34,,2007.36,percent of total billed charges,Implant Device,2007.36,34,,2007.36,percent of total billed charges,Implant Device,2007.36,34,,2007.36,percent of total billed charges,Implant Device,2007.36,34,,2007.36,percent of total billed charges,Implant Device,2007.36,34,,2007.36,percent of total billed charges,Implant Device,2007.36,34,,2007.36,percent of total billed charges,Implant Device,2066.4,35,,2066.4,percent of total billed charges,Implant Device,2007.36,34,"Charges > $500, x 34%",2007.36,percent of total billed charges,Implant Device,2066.4,35,,2066.4,percent of total billed charges,Implant Devices,2066.4,35,,2066.4,percent of total billed charges,Implant Devices,2066.4,35,,,percent of total billed charges,Implant Devices,2066.4,35,,2066.4,percent of total billed charges,Implant Devices,2066.4,35,,2066.4,percent of total billed charges,Implant Devices,2361.6,40,,2361.6,percent of total billed charges,Implant Devices,2066.4,70,,2066.4,percent of total billed charges,Implant Devices,2007.36,34,,2007.36,percent of total billed charges,Implant Devices,2007.36,34,,2007.36,percent of total billed charges,Implant Devices,2066.4,35,,2066.4,percent of total billed charges,Implant Devices,2066.4,35,,2066.4,percent of total billed charges,Implant Devices,2066.4,35,,2066.4,percent of total billed charges,Implant Devices,2066.4,35,,2066.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2007.36,34,"If Charge > 2,000, then 34 percent",2007.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2361.6,
STRYKER PLP30141 ANCHORAGE LISFRANC PLT,C1713,HCPCS,,79009642,CDM,278,RC,,,both,,,7878,3109.19,39.4668,,3109.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2757.3,35,,2757.3,percent of total billed charges,Implant Device,2678.52,34,"Charges > $500, x 34%",2678.52,percent of total billed charges,Implant Device,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,3151.2,40,,3151.2,percent of total billed charges,Implant Devices,2757.3,70,,2757.3,percent of total billed charges,Implant Devices,2678.52,34,,2678.52,percent of total billed charges,Implant Devices,2678.52,34,,2678.52,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2678.52,34,"If Charge > 2,000, then 34 percent",2678.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3151.2,
STRYKER PLSL3012 LOCKING SCREW 3X12MM,C1713,HCPCS,,79009643,CDM,278,RC,,,both,,,1119,441.63,39.4668,,441.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Device,380.46,34,"Charges > $500, x 34%",380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,447.6,40,,447.6,percent of total billed charges,Implant Devices,391.65,70,,391.65,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,447.6,
STRYKER PLSL3020 LOCKING SCREW 3X20MM,C1713,HCPCS,,79009644,CDM,278,RC,,,both,,,1119,441.63,39.4668,,441.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Device,380.46,34,"Charges > $500, x 34%",380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,447.6,40,,447.6,percent of total billed charges,Implant Devices,391.65,70,,391.65,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,447.6,
STRYKER PLSL3022 LOCKING SCREW 3X22MM,C1713,HCPCS,,79009645,CDM,278,RC,,,both,,,1098,433.35,39.4668,,433.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,373.32,34,,373.32,percent of total billed charges,Implant Device,384.3,35,,384.3,percent of total billed charges,Implant Device,373.32,34,"Charges > $500, x 34%",373.32,percent of total billed charges,Implant Device,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,439.2,40,,439.2,percent of total billed charges,Implant Devices,384.3,70,,384.3,percent of total billed charges,Implant Devices,373.32,34,,373.32,percent of total billed charges,Implant Devices,373.32,34,,373.32,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,384.3,35,,384.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,439.2,
STRYKER PLP30172 LISFRANC PLATING MEDIUM,C1713,HCPCS,,79009651,CDM,278,RC,,,both,,,7878,3109.19,39.4668,,3109.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2678.52,34,,2678.52,percent of total billed charges,Implant Device,2757.3,35,,2757.3,percent of total billed charges,Implant Device,2678.52,34,"Charges > $500, x 34%",2678.52,percent of total billed charges,Implant Device,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,3151.2,40,,3151.2,percent of total billed charges,Implant Devices,2757.3,70,,2757.3,percent of total billed charges,Implant Devices,2678.52,34,,2678.52,percent of total billed charges,Implant Devices,2678.52,34,,2678.52,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,2757.3,35,,2757.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2678.52,34,"If Charge > 2,000, then 34 percent",2678.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3151.2,
STRYKER PLSL3516 LOCKING SCREW 3.5X16MM,C1713,HCPCS,,79009652,CDM,278,RC,,,both,,,1119,441.63,39.4668,,441.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Device,380.46,34,"Charges > $500, x 34%",380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,447.6,40,,447.6,percent of total billed charges,Implant Devices,391.65,70,,391.65,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,447.6,
STRYKER PLSL3518 LOCKING SCREW 3.5X18MM,C1713,HCPCS,,79009653,CDM,278,RC,,,both,,,1119,441.63,39.4668,,441.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,380.46,34,,380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Device,380.46,34,"Charges > $500, x 34%",380.46,percent of total billed charges,Implant Device,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,447.6,40,,447.6,percent of total billed charges,Implant Devices,391.65,70,,391.65,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,380.46,34,,380.46,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,391.65,35,,391.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,447.6,
STRYKER PLSS3518 STANDARD SCREW 3.5X18MM,C1713,HCPCS,,79009654,CDM,278,RC,,,both,,,759,299.55,39.4668,,299.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,265.65,35,,265.65,percent of total billed charges,Implant Device,258.06,34,"Charges > $500, x 34%",258.06,percent of total billed charges,Implant Device,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,303.6,40,,303.6,percent of total billed charges,Implant Devices,265.65,70,,265.65,percent of total billed charges,Implant Devices,258.06,34,,258.06,percent of total billed charges,Implant Devices,258.06,34,,258.06,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,303.6,
IN2BONES V35 ST318 LOCK SCREW 3.5X18MM,C1713,HCPCS,,79009658,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ARTHREX AR-8724-32 CORTEX SCREW 2.4X32MM,C1713,HCPCS,,79009659,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 53-23009E LOCKING SCREW 2.3X9MM,C1713,HCPCS,,79009669,CDM,278,RC,,,both,,,515,203.25,39.4668,,203.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,175.1,34,,175.1,percent of total billed charges,Implant Device,180.25,35,,180.25,percent of total billed charges,Implant Device,175.1,34,"Charges > $500, x 34%",175.1,percent of total billed charges,Implant Device,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,206,40,,206,percent of total billed charges,Implant Devices,180.25,70,,180.25,percent of total billed charges,Implant Devices,175.1,34,,175.1,percent of total billed charges,Implant Devices,175.1,34,,175.1,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,180.25,35,,180.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,206,
ACUMED CO-S2322 SMOOTH PEG 2.3X22MM,C1713,HCPCS,,79009670,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ARTHREX AR-8967-2850 CANN SCREW 6.7X50MM,C1713,HCPCS,,79009671,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX AR-8967-2870 CANN SCREW 6.7X70MM,C1713,HCPCS,,79009672,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ARTHREX ABS-2008-03 CORTICAL FIBER 5CC,C1713,HCPCS,,79009674,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
DEPUY 04.005.430 LOCKING SCREW 4.0X40MM,C1713,HCPCS,,79009677,CDM,278,RC,,,both,,,364,143.66,39.4668,,143.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,145.6,40,,145.6,percent of total billed charges,Implant Devices,127.4,70,,127.4,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,145.6,
DEPUY 04.001.426S CANN HUM NAIL 9X230MM,C1713,HCPCS,,79009679,CDM,278,RC,,,both,,,3810,1503.69,39.4668,,1503.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1333.5,35,,1333.5,percent of total billed charges,Implant Device,1295.4,34,"Charges > $500, x 34%",1295.4,percent of total billed charges,Implant Device,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1524,40,,1524,percent of total billed charges,Implant Devices,1333.5,70,,1333.5,percent of total billed charges,Implant Devices,1295.4,34,,1295.4,percent of total billed charges,Implant Devices,1295.4,34,,1295.4,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1295.4,34,"If Charge > 2,000, then 34 percent",1295.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1524,
ZIMMER 14250-30 CANN SCREW 4.5X30MM,C1713,HCPCS,,79009680,CDM,278,RC,,,both,,,468,184.7,39.4668,,184.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,187.2,40,,187.2,percent of total billed charges,Implant Devices,163.8,70,,163.8,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.2,
ZIMMER 14200-20 CANN SCREW 4.5X20MM,C1713,HCPCS,,79009681,CDM,278,RC,,,both,,,468,184.7,39.4668,,184.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,187.2,40,,187.2,percent of total billed charges,Implant Devices,163.8,70,,163.8,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.2,
PARA P50-353-3530 LOCKING SCREW 3.5X30MM,C1713,HCPCS,,79009684,CDM,278,RC,,,both,,,791,312.18,39.4668,,312.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,268.94,34,,268.94,percent of total billed charges,Implant Device,268.94,34,,268.94,percent of total billed charges,Implant Device,268.94,34,,268.94,percent of total billed charges,Implant Device,268.94,34,,268.94,percent of total billed charges,Implant Device,268.94,34,,268.94,percent of total billed charges,Implant Device,268.94,34,,268.94,percent of total billed charges,Implant Device,276.85,35,,276.85,percent of total billed charges,Implant Device,268.94,34,"Charges > $500, x 34%",268.94,percent of total billed charges,Implant Device,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,316.4,40,,316.4,percent of total billed charges,Implant Devices,276.85,70,,276.85,percent of total billed charges,Implant Devices,268.94,34,,268.94,percent of total billed charges,Implant Devices,268.94,34,,268.94,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,316.4,
PARA P50-353-4234 LOCKING SCREW 4.2X34MM,C1713,HCPCS,,79009685,CDM,278,RC,,,both,,,816,322.05,39.4668,,322.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,285.6,35,,285.6,percent of total billed charges,Implant Device,277.44,34,"Charges > $500, x 34%",277.44,percent of total billed charges,Implant Device,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,326.4,40,,326.4,percent of total billed charges,Implant Devices,285.6,70,,285.6,percent of total billed charges,Implant Devices,277.44,34,,277.44,percent of total billed charges,Implant Devices,277.44,34,,277.44,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,326.4,
PARAGON 28 P99-192-2515 K WIRE 2.5MM,C1713,HCPCS,,79009686,CDM,278,RC,,,both,,,102,40.26,39.4668,,40.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,34.68,34,,34.68,percent of total billed charges,Implant Device,35.7,35,,35.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,40.8,40,,40.8,percent of total billed charges,Implant Devices,35.7,70,,35.7,percent of total billed charges,Implant Devices,34.68,34,,34.68,percent of total billed charges,Implant Devices,34.68,34,,34.68,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,35.7,35,,35.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40.8,
ARTHREX AR-8724V-10 LOCK SCREW 2.4X10,C1713,HCPCS,,79009700,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
DEPUY 04.005.424 LOCKING SCREW 4X34MM,C1713,HCPCS,,79009701,CDM,278,RC,,,both,,,364,143.66,39.4668,,143.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,145.6,40,,145.6,percent of total billed charges,Implant Devices,127.4,70,,127.4,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,145.6,
DEPUY 04.001.232S CANN HUM NAIL 7X260MM,C1713,HCPCS,,79009702,CDM,278,RC,,,both,,,3810,1503.69,39.4668,,1503.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1333.5,35,,1333.5,percent of total billed charges,Implant Device,1295.4,34,"Charges > $500, x 34%",1295.4,percent of total billed charges,Implant Device,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1524,40,,1524,percent of total billed charges,Implant Devices,1333.5,70,,1333.5,percent of total billed charges,Implant Devices,1295.4,34,,1295.4,percent of total billed charges,Implant Devices,1295.4,34,,1295.4,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1295.4,34,"If Charge > 2,000, then 34 percent",1295.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1524,
STRYKER 5017-3-150S HALF PIN SD 30X150MM,C1713,HCPCS,,79009704,CDM,278,RC,,,both,,,437,172.47,39.4668,,172.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.58,34,,148.58,percent of total billed charges,Implant Device,148.58,34,,148.58,percent of total billed charges,Implant Device,148.58,34,,148.58,percent of total billed charges,Implant Device,148.58,34,,148.58,percent of total billed charges,Implant Device,148.58,34,,148.58,percent of total billed charges,Implant Device,148.58,34,,148.58,percent of total billed charges,Implant Device,152.95,35,,152.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,152.95,35,,152.95,percent of total billed charges,Implant Devices,152.95,35,,152.95,percent of total billed charges,Implant Devices,152.95,35,,,percent of total billed charges,Implant Devices,152.95,35,,152.95,percent of total billed charges,Implant Devices,152.95,35,,152.95,percent of total billed charges,Implant Devices,174.8,40,,174.8,percent of total billed charges,Implant Devices,152.95,70,,152.95,percent of total billed charges,Implant Devices,148.58,34,,148.58,percent of total billed charges,Implant Devices,148.58,34,,148.58,percent of total billed charges,Implant Devices,152.95,35,,152.95,percent of total billed charges,Implant Devices,152.95,35,,152.95,percent of total billed charges,Implant Devices,152.95,35,,152.95,percent of total billed charges,Implant Devices,152.95,35,,152.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.8,
STRYKER 5038-1-080 APEX 3X80MM HALF PIN,C1713,HCPCS,,79009706,CDM,278,RC,,,both,,,114,44.99,39.4668,,44.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.76,34,,38.76,percent of total billed charges,Implant Device,38.76,34,,38.76,percent of total billed charges,Implant Device,38.76,34,,38.76,percent of total billed charges,Implant Device,38.76,34,,38.76,percent of total billed charges,Implant Device,38.76,34,,38.76,percent of total billed charges,Implant Device,38.76,34,,38.76,percent of total billed charges,Implant Device,39.9,35,,39.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.9,35,,39.9,percent of total billed charges,Implant Devices,39.9,35,,39.9,percent of total billed charges,Implant Devices,39.9,35,,,percent of total billed charges,Implant Devices,39.9,35,,39.9,percent of total billed charges,Implant Devices,39.9,35,,39.9,percent of total billed charges,Implant Devices,45.6,40,,45.6,percent of total billed charges,Implant Devices,39.9,70,,39.9,percent of total billed charges,Implant Devices,38.76,34,,38.76,percent of total billed charges,Implant Devices,38.76,34,,38.76,percent of total billed charges,Implant Devices,39.9,35,,39.9,percent of total billed charges,Implant Devices,39.9,35,,39.9,percent of total billed charges,Implant Devices,39.9,35,,39.9,percent of total billed charges,Implant Devices,39.9,35,,39.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.6,
STRYKER 5070-4-312 TRANSFIX 1.5X43,C1713,HCPCS,,79009707,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
ZIMMER 07.01595.001 TACKS,C1713,HCPCS,,79009711,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
ZIMMER 07.01616.005 INVIZIA PLATE 42MM,C1713,HCPCS,,79009713,CDM,278,RC,,,both,,,8985,3546.09,39.4668,,3546.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3144.75,35,,3144.75,percent of total billed charges,Implant Device,3054.9,34,"Charges > $500, x 34%",3054.9,percent of total billed charges,Implant Device,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3594,40,,3594,percent of total billed charges,Implant Devices,3144.75,70,,3144.75,percent of total billed charges,Implant Devices,3054.9,34,,3054.9,percent of total billed charges,Implant Devices,3054.9,34,,3054.9,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3054.9,34,"If Charge > 2,000, then 34 percent",3054.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3594,
ZIMMER 07.00812.007 VA SCREWS 16MM,C1713,HCPCS,,79009714,CDM,278,RC,,,both,,,1785,704.48,39.4668,,704.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,606.9,34,,606.9,percent of total billed charges,Implant Device,606.9,34,,606.9,percent of total billed charges,Implant Device,606.9,34,,606.9,percent of total billed charges,Implant Device,606.9,34,,606.9,percent of total billed charges,Implant Device,606.9,34,,606.9,percent of total billed charges,Implant Device,606.9,34,,606.9,percent of total billed charges,Implant Device,624.75,35,,624.75,percent of total billed charges,Implant Device,606.9,34,"Charges > $500, x 34%",606.9,percent of total billed charges,Implant Device,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,714,40,,714,percent of total billed charges,Implant Devices,624.75,70,,624.75,percent of total billed charges,Implant Devices,606.9,34,,606.9,percent of total billed charges,Implant Devices,606.9,34,,606.9,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,624.75,35,,624.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,714,
ZIMMER 8824-4707 MM CAGE 7X14X18,C1713,HCPCS,,79009715,CDM,278,RC,,,both,,,6015,2373.93,39.4668,,2373.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2105.25,35,,2105.25,percent of total billed charges,Implant Device,2045.1,34,"Charges > $500, x 34%",2045.1,percent of total billed charges,Implant Device,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2406,40,,2406,percent of total billed charges,Implant Devices,2105.25,70,,2105.25,percent of total billed charges,Implant Devices,2045.1,34,,2045.1,percent of total billed charges,Implant Devices,2045.1,34,,2045.1,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2045.1,34,"If Charge > 2,000, then 34 percent",2045.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2406,
ZIMMER CM68905 PLATFORM CM PUTTY 5CC,C1713,HCPCS,,79009716,CDM,278,RC,,,both,,,3309,1305.96,39.4668,,1305.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1125.06,34,,1125.06,percent of total billed charges,Implant Device,1125.06,34,,1125.06,percent of total billed charges,Implant Device,1125.06,34,,1125.06,percent of total billed charges,Implant Device,1125.06,34,,1125.06,percent of total billed charges,Implant Device,1125.06,34,,1125.06,percent of total billed charges,Implant Device,1125.06,34,,1125.06,percent of total billed charges,Implant Device,1158.15,35,,1158.15,percent of total billed charges,Implant Device,1125.06,34,"Charges > $500, x 34%",1125.06,percent of total billed charges,Implant Device,1158.15,35,,1158.15,percent of total billed charges,Implant Devices,1158.15,35,,1158.15,percent of total billed charges,Implant Devices,1158.15,35,,,percent of total billed charges,Implant Devices,1158.15,35,,1158.15,percent of total billed charges,Implant Devices,1158.15,35,,1158.15,percent of total billed charges,Implant Devices,1323.6,40,,1323.6,percent of total billed charges,Implant Devices,1158.15,70,,1158.15,percent of total billed charges,Implant Devices,1125.06,34,,1125.06,percent of total billed charges,Implant Devices,1125.06,34,,1125.06,percent of total billed charges,Implant Devices,1158.15,35,,1158.15,percent of total billed charges,Implant Devices,1158.15,35,,1158.15,percent of total billed charges,Implant Devices,1158.15,35,,1158.15,percent of total billed charges,Implant Devices,1158.15,35,,1158.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1125.06,34,"If Charge > 2,000, then 34 percent",1125.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1323.6,
ZIMMER 8824-4706 CAGE 6X14X18,C1713,HCPCS,,79009717,CDM,278,RC,,,both,,,6015,2373.93,39.4668,,2373.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2045.1,34,,2045.1,percent of total billed charges,Implant Device,2105.25,35,,2105.25,percent of total billed charges,Implant Device,2045.1,34,"Charges > $500, x 34%",2045.1,percent of total billed charges,Implant Device,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2406,40,,2406,percent of total billed charges,Implant Devices,2105.25,70,,2105.25,percent of total billed charges,Implant Devices,2045.1,34,,2045.1,percent of total billed charges,Implant Devices,2045.1,34,,2045.1,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,2105.25,35,,2105.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2045.1,34,"If Charge > 2,000, then 34 percent",2045.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2406,
LIFENET BL-1600-002 BONE MATRIX-MED-5.4,C1713,HCPCS,,79009721,CDM,278,RC,,,both,,,7344,2898.44,39.4668,,2898.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2496.96,34,,2496.96,percent of total billed charges,Implant Device,2496.96,34,,2496.96,percent of total billed charges,Implant Device,2496.96,34,,2496.96,percent of total billed charges,Implant Device,2496.96,34,,2496.96,percent of total billed charges,Implant Device,2496.96,34,,2496.96,percent of total billed charges,Implant Device,2496.96,34,,2496.96,percent of total billed charges,Implant Device,2570.4,35,,2570.4,percent of total billed charges,Implant Device,2496.96,34,"Charges > $500, x 34%",2496.96,percent of total billed charges,Implant Device,2570.4,35,,2570.4,percent of total billed charges,Implant Devices,2570.4,35,,2570.4,percent of total billed charges,Implant Devices,2570.4,35,,,percent of total billed charges,Implant Devices,2570.4,35,,2570.4,percent of total billed charges,Implant Devices,2570.4,35,,2570.4,percent of total billed charges,Implant Devices,2937.6,40,,2937.6,percent of total billed charges,Implant Devices,2570.4,70,,2570.4,percent of total billed charges,Implant Devices,2496.96,34,,2496.96,percent of total billed charges,Implant Devices,2496.96,34,,2496.96,percent of total billed charges,Implant Devices,2570.4,35,,2570.4,percent of total billed charges,Implant Devices,2570.4,35,,2570.4,percent of total billed charges,Implant Devices,2570.4,35,,2570.4,percent of total billed charges,Implant Devices,2570.4,35,,2570.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2496.96,34,"If Charge > 2,000, then 34 percent",2496.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2937.6,
ARTHREX AR-1371E INTERFERENCE SCREW 7X25,C1713,HCPCS,,79009723,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ARTHREX AR-1380E INTERFERENCE SCREW 8X20,C1713,HCPCS,,79009724,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ARTHREX AR-1381E INTERFERENCE SCREW 8X25,C1713,HCPCS,,79009725,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ZIMMER 00-2359-048-45 LOCK SCREW 4.5X48,C1713,HCPCS,,79009729,CDM,278,RC,,,both,,,445,175.63,39.4668,,175.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,178,40,,178,percent of total billed charges,Implant Devices,155.75,70,,155.75,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178,
DEPUY 224.571 LCP PLATE 7 HOLE 4.5X134MM,C1713,HCPCS,,79009731,CDM,278,RC,,,both,,,1156,456.24,39.4668,,456.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,393.04,34,,393.04,percent of total billed charges,Implant Device,393.04,34,,393.04,percent of total billed charges,Implant Device,393.04,34,,393.04,percent of total billed charges,Implant Device,393.04,34,,393.04,percent of total billed charges,Implant Device,393.04,34,,393.04,percent of total billed charges,Implant Device,393.04,34,,393.04,percent of total billed charges,Implant Device,404.6,35,,404.6,percent of total billed charges,Implant Device,393.04,34,"Charges > $500, x 34%",393.04,percent of total billed charges,Implant Device,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,462.4,40,,462.4,percent of total billed charges,Implant Devices,404.6,70,,404.6,percent of total billed charges,Implant Devices,393.04,34,,393.04,percent of total billed charges,Implant Devices,393.04,34,,393.04,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,404.6,35,,404.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,462.4,
STRYKER 607430 CANCELLOUS SCREW 4.0X4MM,C1713,HCPCS,,79009732,CDM,278,RC,,,both,,,137,54.07,39.4668,,54.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.58,34,,46.58,percent of total billed charges,Implant Device,46.58,34,,46.58,percent of total billed charges,Implant Device,46.58,34,,46.58,percent of total billed charges,Implant Device,46.58,34,,46.58,percent of total billed charges,Implant Device,46.58,34,,46.58,percent of total billed charges,Implant Device,46.58,34,,46.58,percent of total billed charges,Implant Device,47.95,35,,47.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.95,35,,47.95,percent of total billed charges,Implant Devices,47.95,35,,47.95,percent of total billed charges,Implant Devices,47.95,35,,,percent of total billed charges,Implant Devices,47.95,35,,47.95,percent of total billed charges,Implant Devices,47.95,35,,47.95,percent of total billed charges,Implant Devices,54.8,40,,54.8,percent of total billed charges,Implant Devices,47.95,70,,47.95,percent of total billed charges,Implant Devices,46.58,34,,46.58,percent of total billed charges,Implant Devices,46.58,34,,46.58,percent of total billed charges,Implant Devices,47.95,35,,47.95,percent of total billed charges,Implant Devices,47.95,35,,47.95,percent of total billed charges,Implant Devices,47.95,35,,47.95,percent of total billed charges,Implant Devices,47.95,35,,47.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.8,
STRYKER 627734 TIBIA PLATE RT 4H 71MM,C1713,HCPCS,,79009733,CDM,278,RC,,,both,,,6524,2574.81,39.4668,,2574.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2218.16,34,,2218.16,percent of total billed charges,Implant Device,2218.16,34,,2218.16,percent of total billed charges,Implant Device,2218.16,34,,2218.16,percent of total billed charges,Implant Device,2218.16,34,,2218.16,percent of total billed charges,Implant Device,2218.16,34,,2218.16,percent of total billed charges,Implant Device,2218.16,34,,2218.16,percent of total billed charges,Implant Device,2283.4,35,,2283.4,percent of total billed charges,Implant Device,2218.16,34,"Charges > $500, x 34%",2218.16,percent of total billed charges,Implant Device,2283.4,35,,2283.4,percent of total billed charges,Implant Devices,2283.4,35,,2283.4,percent of total billed charges,Implant Devices,2283.4,35,,,percent of total billed charges,Implant Devices,2283.4,35,,2283.4,percent of total billed charges,Implant Devices,2283.4,35,,2283.4,percent of total billed charges,Implant Devices,2609.6,40,,2609.6,percent of total billed charges,Implant Devices,2283.4,70,,2283.4,percent of total billed charges,Implant Devices,2218.16,34,,2218.16,percent of total billed charges,Implant Devices,2218.16,34,,2218.16,percent of total billed charges,Implant Devices,2283.4,35,,2283.4,percent of total billed charges,Implant Devices,2283.4,35,,2283.4,percent of total billed charges,Implant Devices,2283.4,35,,2283.4,percent of total billed charges,Implant Devices,2283.4,35,,2283.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2218.16,34,"If Charge > 2,000, then 34 percent",2218.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2609.6,
STRYKER 626984 SLIM Y-PLATE 4 HOLES,C1713,HCPCS,,79009735,CDM,278,RC,,,both,,,3200,1262.94,39.4668,,1262.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1088,34,,1088,percent of total billed charges,Implant Device,1088,34,,1088,percent of total billed charges,Implant Device,1088,34,,1088,percent of total billed charges,Implant Device,1088,34,,1088,percent of total billed charges,Implant Device,1088,34,,1088,percent of total billed charges,Implant Device,1088,34,,1088,percent of total billed charges,Implant Device,1120,35,,1120,percent of total billed charges,Implant Device,1088,34,"Charges > $500, x 34%",1088,percent of total billed charges,Implant Device,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1280,40,,1280,percent of total billed charges,Implant Devices,1120,70,,1120,percent of total billed charges,Implant Devices,1088,34,,1088,percent of total billed charges,Implant Devices,1088,34,,1088,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1088,34,"If Charge > 2,000, then 34 percent",1088,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1280,
STRYKER 656110 BONE SCREW 2.4X10MM,C1713,HCPCS,,79009736,CDM,278,RC,,,both,,,383,151.16,39.4668,,151.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,134.05,35,,134.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,153.2,40,,153.2,percent of total billed charges,Implant Devices,134.05,70,,134.05,percent of total billed charges,Implant Devices,130.22,34,,130.22,percent of total billed charges,Implant Devices,130.22,34,,130.22,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,153.2,
ARTHREX AR-2600SBS-8 SPEEDBRIDGE KIT,C1713,HCPCS,,79009740,CDM,278,RC,,,both,,,5730,2261.45,39.4668,,2261.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1948.2,34,,1948.2,percent of total billed charges,Implant Device,1948.2,34,,1948.2,percent of total billed charges,Implant Device,1948.2,34,,1948.2,percent of total billed charges,Implant Device,1948.2,34,,1948.2,percent of total billed charges,Implant Device,1948.2,34,,1948.2,percent of total billed charges,Implant Device,1948.2,34,,1948.2,percent of total billed charges,Implant Device,2005.5,35,,2005.5,percent of total billed charges,Implant Device,1948.2,34,"Charges > $500, x 34%",1948.2,percent of total billed charges,Implant Device,2005.5,35,,2005.5,percent of total billed charges,Implant Devices,2005.5,35,,2005.5,percent of total billed charges,Implant Devices,2005.5,35,,,percent of total billed charges,Implant Devices,2005.5,35,,2005.5,percent of total billed charges,Implant Devices,2005.5,35,,2005.5,percent of total billed charges,Implant Devices,2292,40,,2292,percent of total billed charges,Implant Devices,2005.5,70,,2005.5,percent of total billed charges,Implant Devices,1948.2,34,,1948.2,percent of total billed charges,Implant Devices,1948.2,34,,1948.2,percent of total billed charges,Implant Devices,2005.5,35,,2005.5,percent of total billed charges,Implant Devices,2005.5,35,,2005.5,percent of total billed charges,Implant Devices,2005.5,35,,2005.5,percent of total billed charges,Implant Devices,2005.5,35,,2005.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1948.2,34,"If Charge > 2,000, then 34 percent",1948.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2292,
STRYKER 40-35040 BONE SCREW 3.5X40MM,C1713,HCPCS,,79009741,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
ACUMED PL-LEM12 12H LOCKING MEDIAL PLT,C1713,HCPCS,,79009742,CDM,278,RC,,,both,,,4320,1704.97,39.4668,,1704.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1512,35,,1512,percent of total billed charges,Implant Device,1468.8,34,"Charges > $500, x 34%",1468.8,percent of total billed charges,Implant Device,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1728,40,,1728,percent of total billed charges,Implant Devices,1512,70,,1512,percent of total billed charges,Implant Devices,1468.8,34,,1468.8,percent of total billed charges,Implant Devices,1468.8,34,,1468.8,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1468.8,34,"If Charge > 2,000, then 34 percent",1468.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1728,
ACUMED PL-LEL10L LT 10H LOCK LATERAL PLT,C1713,HCPCS,,79009743,CDM,278,RC,,,both,,,4320,1704.97,39.4668,,1704.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1468.8,34,,1468.8,percent of total billed charges,Implant Device,1512,35,,1512,percent of total billed charges,Implant Device,1468.8,34,"Charges > $500, x 34%",1468.8,percent of total billed charges,Implant Device,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1728,40,,1728,percent of total billed charges,Implant Devices,1512,70,,1512,percent of total billed charges,Implant Devices,1468.8,34,,1468.8,percent of total billed charges,Implant Devices,1468.8,34,,1468.8,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,1512,35,,1512,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1468.8,34,"If Charge > 2,000, then 34 percent",1468.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1728,
ACUMED 30-0267 3.5X32 LOCK HEXALOBE SCRW,C1713,HCPCS,,79009744,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
ACUMED 30-0270 3.5X38 LOCK HEXALOBE SCRW,C1713,HCPCS,,79009745,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
ACUMED 30-0275 3.5X60 LOCK HEXALOBE SCRW,C1713,HCPCS,,79009746,CDM,278,RC,,,both,,,405,159.84,39.4668,,159.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,141.75,35,,141.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,162,40,,162,percent of total billed charges,Implant Devices,141.75,70,,141.75,percent of total billed charges,Implant Devices,137.7,34,,137.7,percent of total billed charges,Implant Devices,137.7,34,,137.7,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,162,
EXACTECH 314-13-22 GLENOID POST AUG LT,C1713,HCPCS,,79009749,CDM,278,RC,,,both,,,9834,3881.17,39.4668,,3881.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3441.9,35,,3441.9,percent of total billed charges,Implant Device,3343.56,34,"Charges > $500, x 34%",3343.56,percent of total billed charges,Implant Device,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3933.6,40,,3933.6,percent of total billed charges,Implant Devices,3441.9,70,,3441.9,percent of total billed charges,Implant Devices,3343.56,34,,3343.56,percent of total billed charges,Implant Devices,3343.56,34,,3343.56,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3343.56,34,"If Charge > 2,000, then 34 percent",3343.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3933.6,
DEPUY 04.005.434S LOCKING SCREW 4.0X44MM,C1713,HCPCS,,79009750,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 04.001.428S CANN HUM NAIL 9X240MM,C1713,HCPCS,,79009751,CDM,278,RC,,,both,,,3810,1503.69,39.4668,,1503.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1295.4,34,,1295.4,percent of total billed charges,Implant Device,1333.5,35,,1333.5,percent of total billed charges,Implant Device,1295.4,34,"Charges > $500, x 34%",1295.4,percent of total billed charges,Implant Device,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1524,40,,1524,percent of total billed charges,Implant Devices,1333.5,70,,1333.5,percent of total billed charges,Implant Devices,1295.4,34,,1295.4,percent of total billed charges,Implant Devices,1295.4,34,,1295.4,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,1333.5,35,,1333.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1295.4,34,"If Charge > 2,000, then 34 percent",1295.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1524,
KINAMED 35-100-1010 CERCLAGE SYSTEM,C1713,HCPCS,,79009752,CDM,278,RC,,,both,,,1305,515.04,39.4668,,515.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,456.75,35,,456.75,percent of total billed charges,Implant Device,443.7,34,"Charges > $500, x 34%",443.7,percent of total billed charges,Implant Device,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,522,40,,522,percent of total billed charges,Implant Devices,456.75,70,,456.75,percent of total billed charges,Implant Devices,443.7,34,,443.7,percent of total billed charges,Implant Devices,443.7,34,,443.7,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,522,
ACUMED AT2-C14-S MICRO SCREW 14MM,C1713,HCPCS,,79009754,CDM,278,RC,,,both,,,2448,966.15,39.4668,,966.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,832.32,34,,832.32,percent of total billed charges,Implant Device,832.32,34,,832.32,percent of total billed charges,Implant Device,832.32,34,,832.32,percent of total billed charges,Implant Device,832.32,34,,832.32,percent of total billed charges,Implant Device,832.32,34,,832.32,percent of total billed charges,Implant Device,832.32,34,,832.32,percent of total billed charges,Implant Device,856.8,35,,856.8,percent of total billed charges,Implant Device,832.32,34,"Charges > $500, x 34%",832.32,percent of total billed charges,Implant Device,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,979.2,40,,979.2,percent of total billed charges,Implant Devices,856.8,70,,856.8,percent of total billed charges,Implant Devices,832.32,34,,832.32,percent of total billed charges,Implant Devices,832.32,34,,832.32,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,832.32,34,"If Charge > 2,000, then 34 percent",832.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,979.2,
STRYKER 619920 WASHER T8 & T10 SCREWS,C1713,HCPCS,,79009758,CDM,278,RC,,,both,,,84,33.15,39.4668,,33.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,28.56,34,,28.56,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,33.6,40,,33.6,percent of total billed charges,Implant Devices,29.4,70,,29.4,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,28.56,34,,28.56,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,29.4,35,,29.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.6,
STRYKER 626880 LOCK PLATE TALAR NECK T8,C1713,HCPCS,,79009759,CDM,278,RC,,,both,,,5148,2031.75,39.4668,,2031.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1750.32,34,,1750.32,percent of total billed charges,Implant Device,1750.32,34,,1750.32,percent of total billed charges,Implant Device,1750.32,34,,1750.32,percent of total billed charges,Implant Device,1750.32,34,,1750.32,percent of total billed charges,Implant Device,1750.32,34,,1750.32,percent of total billed charges,Implant Device,1750.32,34,,1750.32,percent of total billed charges,Implant Device,1801.8,35,,1801.8,percent of total billed charges,Implant Device,1750.32,34,"Charges > $500, x 34%",1750.32,percent of total billed charges,Implant Device,1801.8,35,,1801.8,percent of total billed charges,Implant Devices,1801.8,35,,1801.8,percent of total billed charges,Implant Devices,1801.8,35,,,percent of total billed charges,Implant Devices,1801.8,35,,1801.8,percent of total billed charges,Implant Devices,1801.8,35,,1801.8,percent of total billed charges,Implant Devices,2059.2,40,,2059.2,percent of total billed charges,Implant Devices,1801.8,70,,1801.8,percent of total billed charges,Implant Devices,1750.32,34,,1750.32,percent of total billed charges,Implant Devices,1750.32,34,,1750.32,percent of total billed charges,Implant Devices,1801.8,35,,1801.8,percent of total billed charges,Implant Devices,1801.8,35,,1801.8,percent of total billed charges,Implant Devices,1801.8,35,,1801.8,percent of total billed charges,Implant Devices,1801.8,35,,1801.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1750.32,34,"If Charge > 2,000, then 34 percent",1750.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2059.2,
DEPUY 02.112.085 CLAVICLE PLT 8H 3.5X115,C1713,HCPCS,,79009760,CDM,278,RC,,,both,,,2523,995.75,39.4668,,995.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,857.82,34,,857.82,percent of total billed charges,Implant Device,857.82,34,,857.82,percent of total billed charges,Implant Device,857.82,34,,857.82,percent of total billed charges,Implant Device,857.82,34,,857.82,percent of total billed charges,Implant Device,857.82,34,,857.82,percent of total billed charges,Implant Device,857.82,34,,857.82,percent of total billed charges,Implant Device,883.05,35,,883.05,percent of total billed charges,Implant Device,857.82,34,"Charges > $500, x 34%",857.82,percent of total billed charges,Implant Device,883.05,35,,883.05,percent of total billed charges,Implant Devices,883.05,35,,883.05,percent of total billed charges,Implant Devices,883.05,35,,,percent of total billed charges,Implant Devices,883.05,35,,883.05,percent of total billed charges,Implant Devices,883.05,35,,883.05,percent of total billed charges,Implant Devices,1009.2,40,,1009.2,percent of total billed charges,Implant Devices,883.05,70,,883.05,percent of total billed charges,Implant Devices,857.82,34,,857.82,percent of total billed charges,Implant Devices,857.82,34,,857.82,percent of total billed charges,Implant Devices,883.05,35,,883.05,percent of total billed charges,Implant Devices,883.05,35,,883.05,percent of total billed charges,Implant Devices,883.05,35,,883.05,percent of total billed charges,Implant Devices,883.05,35,,883.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,857.82,34,"If Charge > 2,000, then 34 percent",857.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1009.2,
DEPUY 02.112.031 CLAVICLE PLT 8H 3.5X120,C1713,HCPCS,,79009761,CDM,278,RC,,,both,,,2549,1006.01,39.4668,,1006.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,866.66,34,,866.66,percent of total billed charges,Implant Device,866.66,34,,866.66,percent of total billed charges,Implant Device,866.66,34,,866.66,percent of total billed charges,Implant Device,866.66,34,,866.66,percent of total billed charges,Implant Device,866.66,34,,866.66,percent of total billed charges,Implant Device,866.66,34,,866.66,percent of total billed charges,Implant Device,892.15,35,,892.15,percent of total billed charges,Implant Device,866.66,34,"Charges > $500, x 34%",866.66,percent of total billed charges,Implant Device,892.15,35,,892.15,percent of total billed charges,Implant Devices,892.15,35,,892.15,percent of total billed charges,Implant Devices,892.15,35,,,percent of total billed charges,Implant Devices,892.15,35,,892.15,percent of total billed charges,Implant Devices,892.15,35,,892.15,percent of total billed charges,Implant Devices,1019.6,40,,1019.6,percent of total billed charges,Implant Devices,892.15,70,,892.15,percent of total billed charges,Implant Devices,866.66,34,,866.66,percent of total billed charges,Implant Devices,866.66,34,,866.66,percent of total billed charges,Implant Devices,892.15,35,,892.15,percent of total billed charges,Implant Devices,892.15,35,,892.15,percent of total billed charges,Implant Devices,892.15,35,,892.15,percent of total billed charges,Implant Devices,892.15,35,,892.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,866.66,34,"If Charge > 2,000, then 34 percent",866.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1019.6,
STRYKER 656328 LOCKING SCREW T8 2.7XL28,C1713,HCPCS,,79009762,CDM,278,RC,,,both,,,492,194.18,39.4668,,194.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,167.28,34,,167.28,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,196.8,40,,196.8,percent of total billed charges,Implant Devices,172.2,70,,172.2,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,167.28,34,,167.28,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,172.2,35,,172.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196.8,
IN2BONES P62 ST414 NON LOCK SCREW 2.4X14,C1713,HCPCS,,79009772,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ZIMMER 32-8105-027-04 HUMERAL ASSY 4',C1713,HCPCS,,79009777,CDM,278,RC,,,both,,,16200,6393.62,39.4668,,6393.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5508,34,,5508,percent of total billed charges,Implant Device,5508,34,,5508,percent of total billed charges,Implant Device,5508,34,,5508,percent of total billed charges,Implant Device,5508,34,,5508,percent of total billed charges,Implant Device,5508,34,,5508,percent of total billed charges,Implant Device,5508,34,,5508,percent of total billed charges,Implant Device,5670,35,,5670,percent of total billed charges,Implant Device,5508,34,"Charges > $500, x 34%",5508,percent of total billed charges,Implant Device,5670,35,,5670,percent of total billed charges,Implant Devices,5670,35,,5670,percent of total billed charges,Implant Devices,5670,35,,,percent of total billed charges,Implant Devices,5670,35,,5670,percent of total billed charges,Implant Devices,5670,35,,5670,percent of total billed charges,Implant Devices,6480,40,,6480,percent of total billed charges,Implant Devices,5670,70,,5670,percent of total billed charges,Implant Devices,5508,34,,5508,percent of total billed charges,Implant Devices,5508,34,,5508,percent of total billed charges,Implant Devices,5670,35,,5670,percent of total billed charges,Implant Devices,5670,35,,5670,percent of total billed charges,Implant Devices,5670,35,,5670,percent of total billed charges,Implant Devices,5670,35,,5670,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5508,34,"If Charge > 2,000, then 34 percent",5508,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6480,
"ZIMMER 32-8105-043-01 ULNA ASSEMBLY 3""",C1713,HCPCS,,79009778,CDM,278,RC,,,both,,,14700,5801.62,39.4668,,5801.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4998,34,,4998,percent of total billed charges,Implant Device,4998,34,,4998,percent of total billed charges,Implant Device,4998,34,,4998,percent of total billed charges,Implant Device,4998,34,,4998,percent of total billed charges,Implant Device,4998,34,,4998,percent of total billed charges,Implant Device,4998,34,,4998,percent of total billed charges,Implant Device,5145,35,,5145,percent of total billed charges,Implant Device,4998,34,"Charges > $500, x 34%",4998,percent of total billed charges,Implant Device,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5880,40,,5880,percent of total billed charges,Implant Devices,5145,70,,5145,percent of total billed charges,Implant Devices,4998,34,,4998,percent of total billed charges,Implant Devices,4998,34,,4998,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4998,34,"If Charge > 2,000, then 34 percent",4998,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5880,
ARTHREX AR-9943BL-04 LOCK DIS FIB PLT LT,C1713,HCPCS,,79009780,CDM,278,RC,,,both,,,2574,1015.88,39.4668,,1015.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,875.16,34,,875.16,percent of total billed charges,Implant Device,900.9,35,,900.9,percent of total billed charges,Implant Device,875.16,34,"Charges > $500, x 34%",875.16,percent of total billed charges,Implant Device,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,1029.6,40,,1029.6,percent of total billed charges,Implant Devices,900.9,70,,900.9,percent of total billed charges,Implant Devices,875.16,34,,875.16,percent of total billed charges,Implant Devices,875.16,34,,875.16,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,900.9,35,,900.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,875.16,34,"If Charge > 2,000, then 34 percent",875.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1029.6,
STRYKER 5018-6-200 APEX HALF PIN 5X200,C1713,HCPCS,,79009782,CDM,278,RC,,,both,,,257,101.43,39.4668,,101.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.38,34,,87.38,percent of total billed charges,Implant Device,87.38,34,,87.38,percent of total billed charges,Implant Device,87.38,34,,87.38,percent of total billed charges,Implant Device,87.38,34,,87.38,percent of total billed charges,Implant Device,87.38,34,,87.38,percent of total billed charges,Implant Device,87.38,34,,87.38,percent of total billed charges,Implant Device,89.95,35,,89.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,102.8,40,,102.8,percent of total billed charges,Implant Devices,89.95,70,,89.95,percent of total billed charges,Implant Devices,87.38,34,,87.38,percent of total billed charges,Implant Devices,87.38,34,,87.38,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,89.95,35,,89.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102.8,
IN2BONES V35 ST428 TRANSVERSE SCREW 2X28,C1713,HCPCS,,79009789,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P40 ST236 COLINK VIEW PLT 6H,C1713,HCPCS,,79009790,CDM,278,RC,,,both,,,6600,2604.81,39.4668,,2604.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2310,35,,2310,percent of total billed charges,Implant Device,2244,34,"Charges > $500, x 34%",2244,percent of total billed charges,Implant Device,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2640,40,,2640,percent of total billed charges,Implant Devices,2310,70,,2310,percent of total billed charges,Implant Devices,2244,34,,2244,percent of total billed charges,Implant Devices,2244,34,,2244,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2244,34,"If Charge > 2,000, then 34 percent",2244,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2640,
STRYKER IH3030 HEADLESS SCREW 3.0X30MM,C1713,HCPCS,,79009801,CDM,278,RC,,,both,,,784,309.42,39.4668,,309.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,266.56,34,,266.56,percent of total billed charges,Implant Device,266.56,34,,266.56,percent of total billed charges,Implant Device,266.56,34,,266.56,percent of total billed charges,Implant Device,266.56,34,,266.56,percent of total billed charges,Implant Device,266.56,34,,266.56,percent of total billed charges,Implant Device,266.56,34,,266.56,percent of total billed charges,Implant Device,274.4,35,,274.4,percent of total billed charges,Implant Device,266.56,34,"Charges > $500, x 34%",266.56,percent of total billed charges,Implant Device,274.4,35,,274.4,percent of total billed charges,Implant Devices,274.4,35,,274.4,percent of total billed charges,Implant Devices,274.4,35,,,percent of total billed charges,Implant Devices,274.4,35,,274.4,percent of total billed charges,Implant Devices,274.4,35,,274.4,percent of total billed charges,Implant Devices,313.6,40,,313.6,percent of total billed charges,Implant Devices,274.4,70,,274.4,percent of total billed charges,Implant Devices,266.56,34,,266.56,percent of total billed charges,Implant Devices,266.56,34,,266.56,percent of total billed charges,Implant Devices,274.4,35,,274.4,percent of total billed charges,Implant Devices,274.4,35,,274.4,percent of total billed charges,Implant Devices,274.4,35,,274.4,percent of total billed charges,Implant Devices,274.4,35,,274.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,313.6,
IN2BONES BGP001-01 BIO V PUTTY 1CC,C1713,HCPCS,,79009807,CDM,278,RC,,,both,,,2355,929.44,39.4668,,929.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,800.7,34,,800.7,percent of total billed charges,Implant Device,800.7,34,,800.7,percent of total billed charges,Implant Device,800.7,34,,800.7,percent of total billed charges,Implant Device,800.7,34,,800.7,percent of total billed charges,Implant Device,800.7,34,,800.7,percent of total billed charges,Implant Device,800.7,34,,800.7,percent of total billed charges,Implant Device,824.25,35,,824.25,percent of total billed charges,Implant Device,800.7,34,"Charges > $500, x 34%",800.7,percent of total billed charges,Implant Device,824.25,35,,824.25,percent of total billed charges,Implant Devices,824.25,35,,824.25,percent of total billed charges,Implant Devices,824.25,35,,,percent of total billed charges,Implant Devices,824.25,35,,824.25,percent of total billed charges,Implant Devices,824.25,35,,824.25,percent of total billed charges,Implant Devices,942,40,,942,percent of total billed charges,Implant Devices,824.25,70,,824.25,percent of total billed charges,Implant Devices,800.7,34,,800.7,percent of total billed charges,Implant Devices,800.7,34,,800.7,percent of total billed charges,Implant Devices,824.25,35,,824.25,percent of total billed charges,Implant Devices,824.25,35,,824.25,percent of total billed charges,Implant Devices,824.25,35,,824.25,percent of total billed charges,Implant Devices,824.25,35,,824.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,800.7,34,"If Charge > 2,000, then 34 percent",800.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,942,
IN2BONES P65 ST440 COLAG SCREW 4.0X40MM,C1713,HCPCS,,79009808,CDM,278,RC,,,both,,,1668,658.31,39.4668,,658.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,583.8,35,,583.8,percent of total billed charges,Implant Device,567.12,34,"Charges > $500, x 34%",567.12,percent of total billed charges,Implant Device,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,667.2,40,,667.2,percent of total billed charges,Implant Devices,583.8,70,,583.8,percent of total billed charges,Implant Devices,567.12,34,,567.12,percent of total billed charges,Implant Devices,567.12,34,,567.12,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667.2,
IN2BONES P40 ST255 LAPIDUS PLT +1MM LT,C1713,HCPCS,,79009812,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES V30 ST418 TRANS SCREW 3.0X18MM,C1713,HCPCS,,79009813,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P67 ST434 COLAG SCREW 4X34MM,C1713,HCPCS,,79009814,CDM,278,RC,,,both,,,1668,658.31,39.4668,,658.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,567.12,34,,567.12,percent of total billed charges,Implant Device,583.8,35,,583.8,percent of total billed charges,Implant Device,567.12,34,"Charges > $500, x 34%",567.12,percent of total billed charges,Implant Device,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,667.2,40,,667.2,percent of total billed charges,Implant Devices,583.8,70,,583.8,percent of total billed charges,Implant Devices,567.12,34,,567.12,percent of total billed charges,Implant Devices,567.12,34,,567.12,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,583.8,35,,583.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667.2,
ARTHREX AR-1288-70 ACL TIGHTROPE 7MM,C1713,HCPCS,,79009815,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
ARTHREX AR-1288-75 ACL TIGHTROPE 7.5MM,C1713,HCPCS,,79009816,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
ARTHREX AR-1288-80 ACL TIGHTROPE 8MM,C1713,HCPCS,,79009817,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
ARTHREX AR-1288-85 ACL TIGHTROPE 8.5MM,C1713,HCPCS,,79009818,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
ARTHREX AR-1288-90 ACL TIGHTROPE 9MM,C1713,HCPCS,,79009819,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
ARTHREX AR-1288-95 ACL TIGHTROPE 9.5MM,C1713,HCPCS,,79009820,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
ARTHREX AR-1288-100 ACL TIGHTROPE 10MM,C1713,HCPCS,,79009821,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
STRYKER 1832-1035S PROX HUM NAIL 8X100MM,C1713,HCPCS,,79009831,CDM,278,RC,,,both,,,4307,1699.84,39.4668,,1699.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1464.38,34,,1464.38,percent of total billed charges,Implant Device,1464.38,34,,1464.38,percent of total billed charges,Implant Device,1464.38,34,,1464.38,percent of total billed charges,Implant Device,1464.38,34,,1464.38,percent of total billed charges,Implant Device,1464.38,34,,1464.38,percent of total billed charges,Implant Device,1464.38,34,,1464.38,percent of total billed charges,Implant Device,1507.45,35,,1507.45,percent of total billed charges,Implant Device,1464.38,34,"Charges > $500, x 34%",1464.38,percent of total billed charges,Implant Device,1507.45,35,,1507.45,percent of total billed charges,Implant Devices,1507.45,35,,1507.45,percent of total billed charges,Implant Devices,1507.45,35,,,percent of total billed charges,Implant Devices,1507.45,35,,1507.45,percent of total billed charges,Implant Devices,1507.45,35,,1507.45,percent of total billed charges,Implant Devices,1722.8,40,,1722.8,percent of total billed charges,Implant Devices,1507.45,70,,1507.45,percent of total billed charges,Implant Devices,1464.38,34,,1464.38,percent of total billed charges,Implant Devices,1464.38,34,,1464.38,percent of total billed charges,Implant Devices,1507.45,35,,1507.45,percent of total billed charges,Implant Devices,1507.45,35,,1507.45,percent of total billed charges,Implant Devices,1507.45,35,,1507.45,percent of total billed charges,Implant Devices,1507.45,35,,1507.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1464.38,34,"If Charge > 2,000, then 34 percent",1464.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1722.8,
ARTHREX AFLEX500 ARTHROFLEX 30X40X.5MM,C1713,HCPCS,,79009833,CDM,278,RC,,,both,,,3345,1320.16,39.4668,,1320.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1137.3,34,,1137.3,percent of total billed charges,Implant Device,1137.3,34,,1137.3,percent of total billed charges,Implant Device,1137.3,34,,1137.3,percent of total billed charges,Implant Device,1137.3,34,,1137.3,percent of total billed charges,Implant Device,1137.3,34,,1137.3,percent of total billed charges,Implant Device,1137.3,34,,1137.3,percent of total billed charges,Implant Device,1170.75,35,,1170.75,percent of total billed charges,Implant Device,1137.3,34,"Charges > $500, x 34%",1137.3,percent of total billed charges,Implant Device,1170.75,35,,1170.75,percent of total billed charges,Implant Devices,1170.75,35,,1170.75,percent of total billed charges,Implant Devices,1170.75,35,,,percent of total billed charges,Implant Devices,1170.75,35,,1170.75,percent of total billed charges,Implant Devices,1170.75,35,,1170.75,percent of total billed charges,Implant Devices,1338,40,,1338,percent of total billed charges,Implant Devices,1170.75,70,,1170.75,percent of total billed charges,Implant Devices,1137.3,34,,1137.3,percent of total billed charges,Implant Devices,1137.3,34,,1137.3,percent of total billed charges,Implant Devices,1170.75,35,,1170.75,percent of total billed charges,Implant Devices,1170.75,35,,1170.75,percent of total billed charges,Implant Devices,1170.75,35,,1170.75,percent of total billed charges,Implant Devices,1170.75,35,,1170.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1137.3,34,"If Charge > 2,000, then 34 percent",1137.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1338,
STRYKER 1896-4030S LOCKING SCREW 4X30MM,C1713,HCPCS,,79009834,CDM,278,RC,,,both,,,405,159.84,39.4668,,159.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,137.7,34,,137.7,percent of total billed charges,Implant Device,141.75,35,,141.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,162,40,,162,percent of total billed charges,Implant Devices,141.75,70,,141.75,percent of total billed charges,Implant Devices,137.7,34,,137.7,percent of total billed charges,Implant Devices,137.7,34,,137.7,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,141.75,35,,141.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,162,
SI-BONE 7045M-90 IFUSE 3D 7X45MM,C1713,HCPCS,,79009842,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
SI-BONE 7035M-90 IFUSE -3D 7X35MM,C1713,HCPCS,,79009847,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
DEPUY 02.112.012 CLAVICLE PLT 3.5X94MM,C1713,HCPCS,,79009848,CDM,278,RC,,,both,,,2370,935.36,39.4668,,935.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,829.5,35,,829.5,percent of total billed charges,Implant Device,805.8,34,"Charges > $500, x 34%",805.8,percent of total billed charges,Implant Device,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,948,40,,948,percent of total billed charges,Implant Devices,829.5,70,,829.5,percent of total billed charges,Implant Devices,805.8,34,,805.8,percent of total billed charges,Implant Devices,805.8,34,,805.8,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,805.8,34,"If Charge > 2,000, then 34 percent",805.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,948,
DEPUY 201.762 CORTEX SCREW 2.4X12MM,C1713,HCPCS,,79009849,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
DEPUY 293.74 5.0MM STEINMAN PIN,C1713,HCPCS,,79009850,CDM,278,RC,,,both,,,505,199.31,39.4668,,199.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Device,171.7,34,"Charges > $500, x 34%",171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,202,40,,202,percent of total billed charges,Implant Devices,176.75,70,,176.75,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,202,
DEPUY 390.012 EXFIX 30DEG OUTRIGGER 11MM,C1713,HCPCS,,79009851,CDM,278,RC,,,both,,,522,206.02,39.4668,,206.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,177.48,34,,177.48,percent of total billed charges,Implant Device,182.7,35,,182.7,percent of total billed charges,Implant Device,177.48,34,"Charges > $500, x 34%",177.48,percent of total billed charges,Implant Device,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,208.8,40,,208.8,percent of total billed charges,Implant Devices,182.7,70,,182.7,percent of total billed charges,Implant Devices,177.48,34,,177.48,percent of total billed charges,Implant Devices,177.48,34,,177.48,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,182.7,35,,182.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,208.8,
DEPUY 390.010 LG EXFIX PIN CLAMP,C1713,HCPCS,,79009852,CDM,278,RC,,,both,,,946,373.36,39.4668,,373.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Device,321.64,34,"Charges > $500, x 34%",321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,378.4,40,,378.4,percent of total billed charges,Implant Devices,331.1,70,,331.1,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.4,
DEPUY 394.86 EXFIX 11MM CRB FBR ROD 350,C1713,HCPCS,,79009853,CDM,278,RC,,,both,,,1026,404.93,39.4668,,404.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,348.84,34,,348.84,percent of total billed charges,Implant Device,348.84,34,,348.84,percent of total billed charges,Implant Device,348.84,34,,348.84,percent of total billed charges,Implant Device,348.84,34,,348.84,percent of total billed charges,Implant Device,348.84,34,,348.84,percent of total billed charges,Implant Device,348.84,34,,348.84,percent of total billed charges,Implant Device,359.1,35,,359.1,percent of total billed charges,Implant Device,348.84,34,"Charges > $500, x 34%",348.84,percent of total billed charges,Implant Device,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,410.4,40,,410.4,percent of total billed charges,Implant Devices,359.1,70,,359.1,percent of total billed charges,Implant Devices,348.84,34,,348.84,percent of total billed charges,Implant Devices,348.84,34,,348.84,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,359.1,35,,359.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410.4,
DEPUY 294.785 5.0MM SCHANZ SCREW 60MM,C1713,HCPCS,,79009854,CDM,278,RC,,,both,,,305,120.37,39.4668,,120.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,106.75,35,,106.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,122,40,,122,percent of total billed charges,Implant Devices,106.75,70,,106.75,percent of total billed charges,Implant Devices,103.7,34,,103.7,percent of total billed charges,Implant Devices,103.7,34,,103.7,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122,
DEPUY 394.82 EXFIX 11MM CRBN FBR ROD 150,C1713,HCPCS,,79009855,CDM,278,RC,,,both,,,958,378.09,39.4668,,378.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,335.3,35,,335.3,percent of total billed charges,Implant Device,325.72,34,"Charges > $500, x 34%",325.72,percent of total billed charges,Implant Device,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,383.2,40,,383.2,percent of total billed charges,Implant Devices,335.3,70,,335.3,percent of total billed charges,Implant Devices,325.72,34,,325.72,percent of total billed charges,Implant Devices,325.72,34,,325.72,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.2,
DEPUY 394.83 EXFIX 11MM CRBN FBR ROD 200,C1713,HCPCS,,79009856,CDM,278,RC,,,both,,,958,378.09,39.4668,,378.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,325.72,34,,325.72,percent of total billed charges,Implant Device,335.3,35,,335.3,percent of total billed charges,Implant Device,325.72,34,"Charges > $500, x 34%",325.72,percent of total billed charges,Implant Device,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,383.2,40,,383.2,percent of total billed charges,Implant Devices,335.3,70,,335.3,percent of total billed charges,Implant Devices,325.72,34,,325.72,percent of total billed charges,Implant Devices,325.72,34,,325.72,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,335.3,35,,335.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.2,
STRYKER 3525-1380S NAIL KIT 11X38X125,C1713,HCPCS,,79009857,CDM,278,RC,,,both,,,5438,2146.2,39.4668,,2146.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Device,1848.92,34,"Charges > $500, x 34%",1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,2175.2,40,,2175.2,percent of total billed charges,Implant Devices,1903.3,70,,1903.3,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1848.92,34,"If Charge > 2,000, then 34 percent",1848.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2175.2,
STRYKER 54-25385 VOLAR SMARTLOCK DR PLT,C1713,HCPCS,,79009858,CDM,278,RC,,,both,,,2590,1022.19,39.4668,,1022.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,880.6,34,,880.6,percent of total billed charges,Implant Device,880.6,34,,880.6,percent of total billed charges,Implant Device,880.6,34,,880.6,percent of total billed charges,Implant Device,880.6,34,,880.6,percent of total billed charges,Implant Device,880.6,34,,880.6,percent of total billed charges,Implant Device,880.6,34,,880.6,percent of total billed charges,Implant Device,906.5,35,,906.5,percent of total billed charges,Implant Device,880.6,34,"Charges > $500, x 34%",880.6,percent of total billed charges,Implant Device,906.5,35,,906.5,percent of total billed charges,Implant Devices,906.5,35,,906.5,percent of total billed charges,Implant Devices,906.5,35,,,percent of total billed charges,Implant Devices,906.5,35,,906.5,percent of total billed charges,Implant Devices,906.5,35,,906.5,percent of total billed charges,Implant Devices,1036,40,,1036,percent of total billed charges,Implant Devices,906.5,70,,906.5,percent of total billed charges,Implant Devices,880.6,34,,880.6,percent of total billed charges,Implant Devices,880.6,34,,880.6,percent of total billed charges,Implant Devices,906.5,35,,906.5,percent of total billed charges,Implant Devices,906.5,35,,906.5,percent of total billed charges,Implant Devices,906.5,35,,906.5,percent of total billed charges,Implant Devices,906.5,35,,906.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,880.6,34,"If Charge > 2,000, then 34 percent",880.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1036,
STRYKER 3425-0420S GAMMA NAIL RT 10X420,C1713,HCPCS,,79009862,CDM,278,RC,,,both,,,4920,1941.77,39.4668,,1941.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1672.8,34,,1672.8,percent of total billed charges,Implant Device,1722,35,,1722,percent of total billed charges,Implant Device,1672.8,34,"Charges > $500, x 34%",1672.8,percent of total billed charges,Implant Device,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1968,40,,1968,percent of total billed charges,Implant Devices,1722,70,,1722,percent of total billed charges,Implant Devices,1672.8,34,,1672.8,percent of total billed charges,Implant Devices,1672.8,34,,1672.8,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,1722,35,,1722,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1672.8,34,"If Charge > 2,000, then 34 percent",1672.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1968,
STRYKER 3525-1360S NAIL KIT 11X360X125,C1713,HCPCS,,79009863,CDM,278,RC,,,both,,,4969,1961.11,39.4668,,1961.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Device,1689.46,34,"Charges > $500, x 34%",1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1987.6,40,,1987.6,percent of total billed charges,Implant Devices,1739.15,70,,1739.15,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.46,34,"If Charge > 2,000, then 34 percent",1689.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.6,
STRYKER 40-35044 BONE SCREW T10 3.5X44MM,C1713,HCPCS,,79009864,CDM,278,RC,,,both,,,163,64.33,39.4668,,64.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,57.05,35,,57.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,65.2,40,,65.2,percent of total billed charges,Implant Devices,57.05,70,,57.05,percent of total billed charges,Implant Devices,55.42,34,,55.42,percent of total billed charges,Implant Devices,55.42,34,,55.42,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,65.2,
STRYKER 4922-2-160 POST 90DEG ANGLE 11MM,C1713,HCPCS,,79009865,CDM,278,RC,,,both,,,435,171.68,39.4668,,171.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,147.9,34,,147.9,percent of total billed charges,Implant Device,147.9,34,,147.9,percent of total billed charges,Implant Device,147.9,34,,147.9,percent of total billed charges,Implant Device,147.9,34,,147.9,percent of total billed charges,Implant Device,147.9,34,,147.9,percent of total billed charges,Implant Device,147.9,34,,147.9,percent of total billed charges,Implant Device,152.25,35,,152.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,174,40,,174,percent of total billed charges,Implant Devices,152.25,70,,152.25,percent of total billed charges,Implant Devices,147.9,34,,147.9,percent of total billed charges,Implant Devices,147.9,34,,147.9,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174,
STRYKER 658050 HDLESS COMP SCREW 4X50MM,C1713,HCPCS,,79009867,CDM,278,RC,,,both,,,1983,782.63,39.4668,,782.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,674.22,34,,674.22,percent of total billed charges,Implant Device,674.22,34,,674.22,percent of total billed charges,Implant Device,674.22,34,,674.22,percent of total billed charges,Implant Device,674.22,34,,674.22,percent of total billed charges,Implant Device,674.22,34,,674.22,percent of total billed charges,Implant Device,674.22,34,,674.22,percent of total billed charges,Implant Device,694.05,35,,694.05,percent of total billed charges,Implant Device,674.22,34,"Charges > $500, x 34%",674.22,percent of total billed charges,Implant Device,694.05,35,,694.05,percent of total billed charges,Implant Devices,694.05,35,,694.05,percent of total billed charges,Implant Devices,694.05,35,,,percent of total billed charges,Implant Devices,694.05,35,,694.05,percent of total billed charges,Implant Devices,694.05,35,,694.05,percent of total billed charges,Implant Devices,793.2,40,,793.2,percent of total billed charges,Implant Devices,694.05,70,,694.05,percent of total billed charges,Implant Devices,674.22,34,,674.22,percent of total billed charges,Implant Devices,674.22,34,,674.22,percent of total billed charges,Implant Devices,694.05,35,,694.05,percent of total billed charges,Implant Devices,694.05,35,,694.05,percent of total billed charges,Implant Devices,694.05,35,,694.05,percent of total billed charges,Implant Devices,694.05,35,,694.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,793.2,
STRYKER 658580 HDLESS COMP SCREW 7X80MM,C1713,HCPCS,,79009868,CDM,278,RC,,,both,,,3351,1322.53,39.4668,,1322.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1172.85,35,,1172.85,percent of total billed charges,Implant Device,1139.34,34,"Charges > $500, x 34%",1139.34,percent of total billed charges,Implant Device,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1340.4,40,,1340.4,percent of total billed charges,Implant Devices,1172.85,70,,1172.85,percent of total billed charges,Implant Devices,1139.34,34,,1139.34,percent of total billed charges,Implant Devices,1139.34,34,,1139.34,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1139.34,34,"If Charge > 2,000, then 34 percent",1139.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1340.4,
STRYKER 658585 HDLESS COMP SCREW 7X85MM,C1713,HCPCS,,79009869,CDM,278,RC,,,both,,,3351,1322.53,39.4668,,1322.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1172.85,35,,1172.85,percent of total billed charges,Implant Device,1139.34,34,"Charges > $500, x 34%",1139.34,percent of total billed charges,Implant Device,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1340.4,40,,1340.4,percent of total billed charges,Implant Devices,1172.85,70,,1172.85,percent of total billed charges,Implant Devices,1139.34,34,,1139.34,percent of total billed charges,Implant Devices,1139.34,34,,1139.34,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1139.34,34,"If Charge > 2,000, then 34 percent",1139.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1340.4,
STRYKER 658590 HDLESS COMP SCREW 7X90MM,C1713,HCPCS,,79009870,CDM,278,RC,,,both,,,3351,1322.53,39.4668,,1322.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1139.34,34,,1139.34,percent of total billed charges,Implant Device,1172.85,35,,1172.85,percent of total billed charges,Implant Device,1139.34,34,"Charges > $500, x 34%",1139.34,percent of total billed charges,Implant Device,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1340.4,40,,1340.4,percent of total billed charges,Implant Devices,1172.85,70,,1172.85,percent of total billed charges,Implant Devices,1139.34,34,,1139.34,percent of total billed charges,Implant Devices,1139.34,34,,1139.34,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,1172.85,35,,1172.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1139.34,34,"If Charge > 2,000, then 34 percent",1139.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1340.4,
STRYKER EZXP20-16-16 STAPLE 20X26X16MM,C1713,HCPCS,,79009872,CDM,278,RC,,,both,,,7575,2989.61,39.4668,,2989.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2575.5,34,,2575.5,percent of total billed charges,Implant Device,2575.5,34,,2575.5,percent of total billed charges,Implant Device,2575.5,34,,2575.5,percent of total billed charges,Implant Device,2575.5,34,,2575.5,percent of total billed charges,Implant Device,2575.5,34,,2575.5,percent of total billed charges,Implant Device,2575.5,34,,2575.5,percent of total billed charges,Implant Device,2651.25,35,,2651.25,percent of total billed charges,Implant Device,2575.5,34,"Charges > $500, x 34%",2575.5,percent of total billed charges,Implant Device,2651.25,35,,2651.25,percent of total billed charges,Implant Devices,2651.25,35,,2651.25,percent of total billed charges,Implant Devices,2651.25,35,,,percent of total billed charges,Implant Devices,2651.25,35,,2651.25,percent of total billed charges,Implant Devices,2651.25,35,,2651.25,percent of total billed charges,Implant Devices,3030,40,,3030,percent of total billed charges,Implant Devices,2651.25,70,,2651.25,percent of total billed charges,Implant Devices,2575.5,34,,2575.5,percent of total billed charges,Implant Devices,2575.5,34,,2575.5,percent of total billed charges,Implant Devices,2651.25,35,,2651.25,percent of total billed charges,Implant Devices,2651.25,35,,2651.25,percent of total billed charges,Implant Devices,2651.25,35,,2651.25,percent of total billed charges,Implant Devices,2651.25,35,,2651.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2575.5,34,"If Charge > 2,000, then 34 percent",2575.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3030,
STRYKER IC4044 HEADED SCREW 4.0X44MM,C1713,HCPCS,,79009873,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ARTHREX AR-2323BCT-2 SWIVELOCK 4.75X22MM,C1713,HCPCS,,79009878,CDM,278,RC,,,both,,,255,100.64,39.4668,,100.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,89.25,35,,89.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,102,40,,102,percent of total billed charges,Implant Devices,89.25,70,,89.25,percent of total billed charges,Implant Devices,86.7,34,,86.7,percent of total billed charges,Implant Devices,86.7,34,,86.7,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102,
ZIMMER 00-2232-002-28 CBL ASSY CERCLAGE,C1713,HCPCS,,79009881,CDM,278,RC,,,both,,,1357,535.56,39.4668,,535.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,461.38,34,,461.38,percent of total billed charges,Implant Device,461.38,34,,461.38,percent of total billed charges,Implant Device,461.38,34,,461.38,percent of total billed charges,Implant Device,461.38,34,,461.38,percent of total billed charges,Implant Device,461.38,34,,461.38,percent of total billed charges,Implant Device,461.38,34,,461.38,percent of total billed charges,Implant Device,474.95,35,,474.95,percent of total billed charges,Implant Device,461.38,34,"Charges > $500, x 34%",461.38,percent of total billed charges,Implant Device,474.95,35,,474.95,percent of total billed charges,Implant Devices,474.95,35,,474.95,percent of total billed charges,Implant Devices,474.95,35,,,percent of total billed charges,Implant Devices,474.95,35,,474.95,percent of total billed charges,Implant Devices,474.95,35,,474.95,percent of total billed charges,Implant Devices,542.8,40,,542.8,percent of total billed charges,Implant Devices,474.95,70,,474.95,percent of total billed charges,Implant Devices,461.38,34,,461.38,percent of total billed charges,Implant Devices,461.38,34,,461.38,percent of total billed charges,Implant Devices,474.95,35,,474.95,percent of total billed charges,Implant Devices,474.95,35,,474.95,percent of total billed charges,Implant Devices,474.95,35,,474.95,percent of total billed charges,Implant Devices,474.95,35,,474.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,542.8,
ZIMMER 00-2232-005-18 CBL RDY GTR,C1713,HCPCS,,79009882,CDM,278,RC,,,both,,,845,333.49,39.4668,,333.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,287.3,34,,287.3,percent of total billed charges,Implant Device,287.3,34,,287.3,percent of total billed charges,Implant Device,287.3,34,,287.3,percent of total billed charges,Implant Device,287.3,34,,287.3,percent of total billed charges,Implant Device,287.3,34,,287.3,percent of total billed charges,Implant Device,287.3,34,,287.3,percent of total billed charges,Implant Device,295.75,35,,295.75,percent of total billed charges,Implant Device,287.3,34,"Charges > $500, x 34%",287.3,percent of total billed charges,Implant Device,295.75,35,,295.75,percent of total billed charges,Implant Devices,295.75,35,,295.75,percent of total billed charges,Implant Devices,295.75,35,,,percent of total billed charges,Implant Devices,295.75,35,,295.75,percent of total billed charges,Implant Devices,295.75,35,,295.75,percent of total billed charges,Implant Devices,338,40,,338,percent of total billed charges,Implant Devices,295.75,70,,295.75,percent of total billed charges,Implant Devices,287.3,34,,287.3,percent of total billed charges,Implant Devices,287.3,34,,287.3,percent of total billed charges,Implant Devices,295.75,35,,295.75,percent of total billed charges,Implant Devices,295.75,35,,295.75,percent of total billed charges,Implant Devices,295.75,35,,295.75,percent of total billed charges,Implant Devices,295.75,35,,295.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,338,
AESCULAP NR400Z NUT FOR FEMUR EXTENSTION,C1713,HCPCS,,79009886,CDM,278,RC,,,both,,,1890,745.92,39.4668,,745.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,661.5,35,,661.5,percent of total billed charges,Implant Device,642.6,34,"Charges > $500, x 34%",642.6,percent of total billed charges,Implant Device,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,756,40,,756,percent of total billed charges,Implant Devices,661.5,70,,661.5,percent of total billed charges,Implant Devices,642.6,34,,642.6,percent of total billed charges,Implant Devices,642.6,34,,642.6,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,756,
IN2BONES P35 ST424 TRANS SCREW 3.5X24MM,C1713,HCPCS,,79009912,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P40 ST136 COLINK PLATE 6 HOLE,C1713,HCPCS,,79009913,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES V35 ST312 LOCK SCREW 3.5X12MM,C1713,HCPCS,,79009914,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V35 ST420 TRANS SCREW 3.5X20MM,C1713,HCPCS,,79009915,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
STRYKER 663142 CANN COMP SCREW 5X42MM,C1713,HCPCS,,79009916,CDM,278,RC,,,both,,,2336,921.94,39.4668,,921.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,794.24,34,,794.24,percent of total billed charges,Implant Device,794.24,34,,794.24,percent of total billed charges,Implant Device,794.24,34,,794.24,percent of total billed charges,Implant Device,794.24,34,,794.24,percent of total billed charges,Implant Device,794.24,34,,794.24,percent of total billed charges,Implant Device,794.24,34,,794.24,percent of total billed charges,Implant Device,817.6,35,,817.6,percent of total billed charges,Implant Device,794.24,34,"Charges > $500, x 34%",794.24,percent of total billed charges,Implant Device,817.6,35,,817.6,percent of total billed charges,Implant Devices,817.6,35,,817.6,percent of total billed charges,Implant Devices,817.6,35,,,percent of total billed charges,Implant Devices,817.6,35,,817.6,percent of total billed charges,Implant Devices,817.6,35,,817.6,percent of total billed charges,Implant Devices,934.4,40,,934.4,percent of total billed charges,Implant Devices,817.6,70,,817.6,percent of total billed charges,Implant Devices,794.24,34,,794.24,percent of total billed charges,Implant Devices,794.24,34,,794.24,percent of total billed charges,Implant Devices,817.6,35,,817.6,percent of total billed charges,Implant Devices,817.6,35,,817.6,percent of total billed charges,Implant Devices,817.6,35,,817.6,percent of total billed charges,Implant Devices,817.6,35,,817.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,794.24,34,"If Charge > 2,000, then 34 percent",794.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,934.4,
DEPUY 456.307S TI HELICAL BLADE 11X110MM,C1713,HCPCS,,79009918,CDM,278,RC,,,both,,,1301,513.46,39.4668,,513.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,455.35,35,,455.35,percent of total billed charges,Implant Device,442.34,34,"Charges > $500, x 34%",442.34,percent of total billed charges,Implant Device,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,520.4,40,,520.4,percent of total billed charges,Implant Devices,455.35,70,,455.35,percent of total billed charges,Implant Devices,442.34,34,,442.34,percent of total billed charges,Implant Devices,442.34,34,,442.34,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,520.4,
DEPUY 02.112.010 CLAVICLE PLT 3.5X81MM,C1713,HCPCS,,79009919,CDM,278,RC,,,both,,,2331,919.97,39.4668,,919.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,792.54,34,,792.54,percent of total billed charges,Implant Device,792.54,34,,792.54,percent of total billed charges,Implant Device,792.54,34,,792.54,percent of total billed charges,Implant Device,792.54,34,,792.54,percent of total billed charges,Implant Device,792.54,34,,792.54,percent of total billed charges,Implant Device,792.54,34,,792.54,percent of total billed charges,Implant Device,815.85,35,,815.85,percent of total billed charges,Implant Device,792.54,34,"Charges > $500, x 34%",792.54,percent of total billed charges,Implant Device,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,932.4,40,,932.4,percent of total billed charges,Implant Devices,815.85,70,,815.85,percent of total billed charges,Implant Devices,792.54,34,,792.54,percent of total billed charges,Implant Devices,792.54,34,,792.54,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,792.54,34,"If Charge > 2,000, then 34 percent",792.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,932.4,
IN2BONES P60 ST021 PLANTAR PLT LRG 5H,C1713,HCPCS,,79009920,CDM,278,RC,,,both,,,5748,2268.55,39.4668,,2268.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,1954.32,34,,1954.32,percent of total billed charges,Implant Device,2011.8,35,,2011.8,percent of total billed charges,Implant Device,1954.32,34,"Charges > $500, x 34%",1954.32,percent of total billed charges,Implant Device,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2299.2,40,,2299.2,percent of total billed charges,Implant Devices,2011.8,70,,2011.8,percent of total billed charges,Implant Devices,1954.32,34,,1954.32,percent of total billed charges,Implant Devices,1954.32,34,,1954.32,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,2011.8,35,,2011.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1954.32,34,"If Charge > 2,000, then 34 percent",1954.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2299.2,
ARTHREX AR-3602 FIBERTAK W/SUTURETAPE,C1713,HCPCS,,79009922,CDM,278,RC,,,both,,,1065,420.32,39.4668,,420.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,372.75,35,,372.75,percent of total billed charges,Implant Device,362.1,34,"Charges > $500, x 34%",362.1,percent of total billed charges,Implant Device,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,426,40,,426,percent of total billed charges,Implant Devices,372.75,70,,372.75,percent of total billed charges,Implant Devices,362.1,34,,362.1,percent of total billed charges,Implant Devices,362.1,34,,362.1,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,426,
ARTHREX AR-3602-2 FIBERTAK W/SUTURETAPE,C1713,HCPCS,,79009923,CDM,278,RC,,,both,,,1110,438.08,39.4668,,438.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Device,377.4,34,"Charges > $500, x 34%",377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,444,40,,444,percent of total billed charges,Implant Devices,388.5,70,,388.5,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,444,
STRYKER 5018-5-200 5X200 APEX HALF PIN,C1713,HCPCS,,79009929,CDM,278,RC,,,both,,,297,117.22,39.4668,,117.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,100.98,34,,100.98,percent of total billed charges,Implant Device,103.95,35,,103.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,118.8,40,,118.8,percent of total billed charges,Implant Devices,103.95,70,,103.95,percent of total billed charges,Implant Devices,100.98,34,,100.98,percent of total billed charges,Implant Devices,100.98,34,,100.98,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,103.95,35,,103.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,118.8,
STRYKER 6519-1-040 FEMORAL HEAD 40MM,C1713,HCPCS,,79009931,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ARTHREX AR-8724V24 LOCK SCREW 2.4X24MM,C1713,HCPCS,,79009934,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ARTHREX AR-8735-12 CORT SCREW 3.5X12MM,C1713,HCPCS,,79009935,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ARTHREX AR-8735-13 CORT SCREW 3.5X13MM,C1713,HCPCS,,79009936,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ARTHREX AR-8735-14 CORT SCREW 3.5X14MM,C1713,HCPCS,,79009937,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ARTHREX AR-8735-16 CORT SCREW 3.5X16MM,C1713,HCPCS,,79009938,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
ARTHREX AR-8916VNL-03 DISTAL RADIUS PLT,C1713,HCPCS,,79009939,CDM,278,RC,,,both,,,2385,941.28,39.4668,,941.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,810.9,34,,810.9,percent of total billed charges,Implant Device,834.75,35,,834.75,percent of total billed charges,Implant Device,810.9,34,"Charges > $500, x 34%",810.9,percent of total billed charges,Implant Device,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,954,40,,954,percent of total billed charges,Implant Devices,834.75,70,,834.75,percent of total billed charges,Implant Devices,810.9,34,,810.9,percent of total billed charges,Implant Devices,810.9,34,,810.9,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,834.75,35,,834.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,810.9,34,"If Charge > 2,000, then 34 percent",810.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,954,
ZIMMER 110035368 BONE CEMENT R,C1713,HCPCS,,79009942,CDM,278,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,71.4,34,,71.4,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,84,40,,84,percent of total billed charges,Implant Devices,73.5,70,,73.5,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,71.4,34,,71.4,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,73.5,35,,73.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
ZIMMER 110034355 BONE CEMENT W/GENTAMICN,C1713,HCPCS,,79009943,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
MTF HP1412 FLEX HD PLIABLE ACELL DERMIS,C1713,HCPCS,,79009944,CDM,278,RC,,,both,,,3517,1388.05,39.4668,,1388.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1195.78,34,,1195.78,percent of total billed charges,Implant Device,1195.78,34,,1195.78,percent of total billed charges,Implant Device,1195.78,34,,1195.78,percent of total billed charges,Implant Device,1195.78,34,,1195.78,percent of total billed charges,Implant Device,1195.78,34,,1195.78,percent of total billed charges,Implant Device,1195.78,34,,1195.78,percent of total billed charges,Implant Device,1230.95,35,,1230.95,percent of total billed charges,Implant Device,1195.78,34,"Charges > $500, x 34%",1195.78,percent of total billed charges,Implant Device,1230.95,35,,1230.95,percent of total billed charges,Implant Devices,1230.95,35,,1230.95,percent of total billed charges,Implant Devices,1230.95,35,,,percent of total billed charges,Implant Devices,1230.95,35,,1230.95,percent of total billed charges,Implant Devices,1230.95,35,,1230.95,percent of total billed charges,Implant Devices,1406.8,40,,1406.8,percent of total billed charges,Implant Devices,1230.95,70,,1230.95,percent of total billed charges,Implant Devices,1195.78,34,,1195.78,percent of total billed charges,Implant Devices,1195.78,34,,1195.78,percent of total billed charges,Implant Devices,1230.95,35,,1230.95,percent of total billed charges,Implant Devices,1230.95,35,,1230.95,percent of total billed charges,Implant Devices,1230.95,35,,1230.95,percent of total billed charges,Implant Devices,1230.95,35,,1230.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1195.78,34,"If Charge > 2,000, then 34 percent",1195.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1406.8,
MTF HP 1816 FLEX PLIABLE ACELL DERMIS,C1713,HCPCS,,79009945,CDM,278,RC,,,both,,,9868,3894.58,39.4668,,3894.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3453.8,35,,3453.8,percent of total billed charges,Implant Device,3355.12,34,"Charges > $500, x 34%",3355.12,percent of total billed charges,Implant Device,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3947.2,40,,3947.2,percent of total billed charges,Implant Devices,3453.8,70,,3453.8,percent of total billed charges,Implant Devices,3355.12,34,,3355.12,percent of total billed charges,Implant Devices,3355.12,34,,3355.12,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3355.12,34,"If Charge > 2,000, then 34 percent",3355.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3947.2,
ZIMMER 8145-11-180 HIP FRAC NAIL 11X180,C1713,HCPCS,,79009956,CDM,278,RC,,,both,,,4464,1761.8,39.4668,,1761.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1562.4,35,,1562.4,percent of total billed charges,Implant Device,1517.76,34,"Charges > $500, x 34%",1517.76,percent of total billed charges,Implant Device,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1785.6,40,,1785.6,percent of total billed charges,Implant Devices,1562.4,70,,1562.4,percent of total billed charges,Implant Devices,1517.76,34,,1517.76,percent of total billed charges,Implant Devices,1517.76,34,,1517.76,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1517.76,34,"If Charge > 2,000, then 34 percent",1517.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1785.6,
IN2BONES P73 ST220 VAL SCREW 3.5X20MM,C1713,HCPCS,,79009960,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES V35 ST220 NON LOCK SCREW 3.5X20,C1713,HCPCS,,79009961,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
IN2BONES P72 ST018 NON LOCK SCREW 2.7X18,C1713,HCPCS,,79009962,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P72 ST112 LOCK SCREW 2.7X12MM,C1713,HCPCS,,79009963,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P70 ST105 LAT FIB PLT 5 HOLE RT,C1713,HCPCS,,79009964,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES P73 ST214 VAL SCREW 3.5MM,C1713,HCPCS,,79009965,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P72 ST116 LOCK SCREW 2.7X16MM,C1713,HCPCS,,79009966,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST214 VAL SCREW 3.5X14MM,C1713,HCPCS,,79009967,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P72 ST120 LOCK SCREW 2.7X20MM,C1713,HCPCS,,79009968,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P72 ST114 LOCK SCREW 2.7X14MM,C1713,HCPCS,,79009969,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ARTHREX AR-8990ST FIBERTAK SUTURE ANCHOR,C1713,HCPCS,,79009970,CDM,278,RC,,,both,,,1395,550.56,39.4668,,550.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,488.25,35,,488.25,percent of total billed charges,Implant Device,474.3,34,"Charges > $500, x 34%",474.3,percent of total billed charges,Implant Device,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,558,40,,558,percent of total billed charges,Implant Devices,488.25,70,,488.25,percent of total billed charges,Implant Devices,474.3,34,,474.3,percent of total billed charges,Implant Devices,474.3,34,,474.3,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,558,
ARTHREX AR-3632 FIBERTAK ANCHOR 2.6MM,C1713,HCPCS,,79009972,CDM,278,RC,,,both,,,1110,438.08,39.4668,,438.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,377.4,34,,377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Device,377.4,34,"Charges > $500, x 34%",377.4,percent of total billed charges,Implant Device,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,444,40,,444,percent of total billed charges,Implant Devices,388.5,70,,388.5,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,377.4,34,,377.4,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,388.5,35,,388.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,444,
ARTHREX AR-8925T TIGHTROPE TITANIUM,C1713,HCPCS,,79009975,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
STRYKER 627608 DIS LAT FEMUR PLT 8H L202,C1713,HCPCS,,79009995,CDM,278,RC,,,both,,,7501,2960.4,39.4668,,2960.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2625.35,35,,2625.35,percent of total billed charges,Implant Device,2550.34,34,"Charges > $500, x 34%",2550.34,percent of total billed charges,Implant Device,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,3000.4,40,,3000.4,percent of total billed charges,Implant Devices,2625.35,70,,2625.35,percent of total billed charges,Implant Devices,2550.34,34,,2550.34,percent of total billed charges,Implant Devices,2550.34,34,,2550.34,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550.34,34,"If Charge > 2,000, then 34 percent",2550.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000.4,
STRYKER 661144 LOCKING SCREW 5.0/L44MM,C1713,HCPCS,,79009996,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 661155 LOCKING SCREW 5.0/L55MM,C1713,HCPCS,,79009997,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 661740 LOCKING SCREW 4.5/L40MM,C1713,HCPCS,,79009998,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
STRYKER 661742 LOCKING SCREW 4.5/L42MM,C1713,HCPCS,,79009999,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
STRYKER 1850-1138S FEM NAIL LT 11X380MM,C1713,HCPCS,,79010000,CDM,278,RC,,,both,,,4545,1793.77,39.4668,,1793.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1590.75,35,,1590.75,percent of total billed charges,Implant Device,1545.3,34,"Charges > $500, x 34%",1545.3,percent of total billed charges,Implant Device,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1818,40,,1818,percent of total billed charges,Implant Devices,1590.75,70,,1590.75,percent of total billed charges,Implant Devices,1545.3,34,,1545.3,percent of total billed charges,Implant Devices,1545.3,34,,1545.3,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1545.3,34,"If Charge > 2,000, then 34 percent",1545.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1818,
DEPUY 1217-30-500 BONE SCREW 6.5X30MM,C1713,HCPCS,,79010002,CDM,278,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,91.2,40,,91.2,percent of total billed charges,Implant Devices,79.8,70,,79.8,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,91.2,
IN2BONES P72 ST014 LOCK SCREW 2.7X14MM,C1713,HCPCS,,79010004,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P72 ST110 LOCK SCREW 2.7X10MM,C1713,HCPCS,,79010005,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST110 LOCK SCREW 3.5X10MM,C1713,HCPCS,,79010006,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P72 ST108 LOCK SCREW 2.7X8MM,C1713,HCPCS,,79010007,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST010 LOCK SCREW 3.5X10MM,C1713,HCPCS,,79010008,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST112 LOCK SCREW 3.5X12MM,C1713,HCPCS,,79010009,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
STRYKER 3525-0440S 3 S NAIL 10X440X125MM,C1713,HCPCS,,79010010,CDM,278,RC,,,both,,,5438,2146.2,39.4668,,2146.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Device,1848.92,34,"Charges > $500, x 34%",1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,2175.2,40,,2175.2,percent of total billed charges,Implant Devices,1903.3,70,,1903.3,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1848.92,34,"If Charge > 2,000, then 34 percent",1848.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2175.2,
ARTHREX AR-8935-12 CORT SCREW 3.5X12MM,C1713,HCPCS,,79010011,CDM,278,RC,,,both,,,195,76.96,39.4668,,76.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,78,40,,78,percent of total billed charges,Implant Devices,68.25,70,,68.25,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78,
DEPUY 212.107 LOCKING SCREW 3.5X22MM,C1713,HCPCS,,79010018,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
DEPUY 02.127-220 3.5X117MM PROX TIB PLT,C1713,HCPCS,,79010021,CDM,278,RC,,,both,,,4394,1734.17,39.4668,,1734.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1493.96,34,,1493.96,percent of total billed charges,Implant Device,1537.9,35,,1537.9,percent of total billed charges,Implant Device,1493.96,34,"Charges > $500, x 34%",1493.96,percent of total billed charges,Implant Device,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1757.6,40,,1757.6,percent of total billed charges,Implant Devices,1537.9,70,,1537.9,percent of total billed charges,Implant Devices,1493.96,34,,1493.96,percent of total billed charges,Implant Devices,1493.96,34,,1493.96,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,1537.9,35,,1537.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1493.96,34,"If Charge > 2,000, then 34 percent",1493.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1757.6,
DEPUY 02.127.158 3.5X58MM ANG LOCK SCREW,C1713,HCPCS,,79010022,CDM,278,RC,,,both,,,427,168.52,39.4668,,168.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,170.8,40,,170.8,percent of total billed charges,Implant Devices,149.45,70,,149.45,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.8,
DEPUY 02.127.134 3.5X34MM ANG LOCK SCREW,C1713,HCPCS,,79010023,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
ARTHREX AR-8827-12 CORT SCREW 2.7X12MM,C1713,HCPCS,,79010026,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
ARTHREX AR-8840C-40 SCREW 4.0X40MM,C1713,HCPCS,,79010027,CDM,278,RC,,,both,,,708,279.42,39.4668,,279.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Device,240.72,34,"Charges > $500, x 34%",240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,283.2,40,,283.2,percent of total billed charges,Implant Devices,247.8,70,,247.8,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,283.2,
ARTHREX AR-8973DS FIBULOCK SYSTEM,C1713,HCPCS,,79010029,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
ARTHREX FIB30130R 3.0X130MM FIB NAIL RT,C1713,HCPCS,,79010030,CDM,278,RC,,,both,,,8985,3546.09,39.4668,,3546.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3144.75,35,,3144.75,percent of total billed charges,Implant Device,3054.9,34,"Charges > $500, x 34%",3054.9,percent of total billed charges,Implant Device,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3594,40,,3594,percent of total billed charges,Implant Devices,3144.75,70,,3144.75,percent of total billed charges,Implant Devices,3054.9,34,,3054.9,percent of total billed charges,Implant Devices,3054.9,34,,3054.9,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3054.9,34,"If Charge > 2,000, then 34 percent",3054.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3594,
IN2BONES P70 ST104 COLINK LAT FIB PLT 4H,C1713,HCPCS,,79010032,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES P73 ST016 CORT SCREW 3.5X16MM,C1713,HCPCS,,79010033,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
IN2BONES P73 ST018 CORT SCREW 3.5X18MM,C1713,HCPCS,,79010034,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
IN2BONES P72 ST020 CORT SCREW 2.7X20MM,C1713,HCPCS,,79010035,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
STRYKER 657460 BONE SCREW 3.5X44MM,C1713,HCPCS,,79010043,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 6704-3-091 DALL MILES GRIP PLATE,C1713,HCPCS,,79010058,CDM,278,RC,,,both,,,3607,1423.57,39.4668,,1423.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1226.38,34,,1226.38,percent of total billed charges,Implant Device,1226.38,34,,1226.38,percent of total billed charges,Implant Device,1226.38,34,,1226.38,percent of total billed charges,Implant Device,1226.38,34,,1226.38,percent of total billed charges,Implant Device,1226.38,34,,1226.38,percent of total billed charges,Implant Device,1226.38,34,,1226.38,percent of total billed charges,Implant Device,1262.45,35,,1262.45,percent of total billed charges,Implant Device,1226.38,34,"Charges > $500, x 34%",1226.38,percent of total billed charges,Implant Device,1262.45,35,,1262.45,percent of total billed charges,Implant Devices,1262.45,35,,1262.45,percent of total billed charges,Implant Devices,1262.45,35,,,percent of total billed charges,Implant Devices,1262.45,35,,1262.45,percent of total billed charges,Implant Devices,1262.45,35,,1262.45,percent of total billed charges,Implant Devices,1442.8,40,,1442.8,percent of total billed charges,Implant Devices,1262.45,70,,1262.45,percent of total billed charges,Implant Devices,1226.38,34,,1226.38,percent of total billed charges,Implant Devices,1226.38,34,,1226.38,percent of total billed charges,Implant Devices,1262.45,35,,1262.45,percent of total billed charges,Implant Devices,1262.45,35,,1262.45,percent of total billed charges,Implant Devices,1262.45,35,,1262.45,percent of total billed charges,Implant Devices,1262.45,35,,1262.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1226.38,34,"If Charge > 2,000, then 34 percent",1226.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1442.8,
MIMEDX TN-5220 AMNIOFIX WRAP 2X2CM,C1713,HCPCS,,79010061,CDM,278,RC,,,both,,,2175,858.4,39.4668,,858.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,761.25,35,,761.25,percent of total billed charges,Implant Device,739.5,34,"Charges > $500, x 34%",739.5,percent of total billed charges,Implant Device,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,870,40,,870,percent of total billed charges,Implant Devices,761.25,70,,761.25,percent of total billed charges,Implant Devices,739.5,34,,739.5,percent of total billed charges,Implant Devices,739.5,34,,739.5,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,739.5,34,"If Charge > 2,000, then 34 percent",739.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,870,
MIMEDX TN-5460 AMNIOFIX WRAP 4X6CM,C1713,HCPCS,,79010062,CDM,278,RC,,,both,,,8328,3286.8,39.4668,,3286.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2831.52,34,,2831.52,percent of total billed charges,Implant Device,2831.52,34,,2831.52,percent of total billed charges,Implant Device,2831.52,34,,2831.52,percent of total billed charges,Implant Device,2831.52,34,,2831.52,percent of total billed charges,Implant Device,2831.52,34,,2831.52,percent of total billed charges,Implant Device,2831.52,34,,2831.52,percent of total billed charges,Implant Device,2914.8,35,,2914.8,percent of total billed charges,Implant Device,2831.52,34,"Charges > $500, x 34%",2831.52,percent of total billed charges,Implant Device,2914.8,35,,2914.8,percent of total billed charges,Implant Devices,2914.8,35,,2914.8,percent of total billed charges,Implant Devices,2914.8,35,,,percent of total billed charges,Implant Devices,2914.8,35,,2914.8,percent of total billed charges,Implant Devices,2914.8,35,,2914.8,percent of total billed charges,Implant Devices,3331.2,40,,3331.2,percent of total billed charges,Implant Devices,2914.8,70,,2914.8,percent of total billed charges,Implant Devices,2831.52,34,,2831.52,percent of total billed charges,Implant Devices,2831.52,34,,2831.52,percent of total billed charges,Implant Devices,2914.8,35,,2914.8,percent of total billed charges,Implant Devices,2914.8,35,,2914.8,percent of total billed charges,Implant Devices,2914.8,35,,2914.8,percent of total billed charges,Implant Devices,2914.8,35,,2914.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2831.52,34,"If Charge > 2,000, then 34 percent",2831.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3331.2,
MIMEDX AU-5760 AMNIOFIX SURGICAL 7X6CM,C1713,HCPCS,,79010063,CDM,278,RC,,,both,,,7785,3072.49,39.4668,,3072.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2646.9,34,,2646.9,percent of total billed charges,Implant Device,2646.9,34,,2646.9,percent of total billed charges,Implant Device,2646.9,34,,2646.9,percent of total billed charges,Implant Device,2646.9,34,,2646.9,percent of total billed charges,Implant Device,2646.9,34,,2646.9,percent of total billed charges,Implant Device,2646.9,34,,2646.9,percent of total billed charges,Implant Device,2724.75,35,,2724.75,percent of total billed charges,Implant Device,2646.9,34,"Charges > $500, x 34%",2646.9,percent of total billed charges,Implant Device,2724.75,35,,2724.75,percent of total billed charges,Implant Devices,2724.75,35,,2724.75,percent of total billed charges,Implant Devices,2724.75,35,,,percent of total billed charges,Implant Devices,2724.75,35,,2724.75,percent of total billed charges,Implant Devices,2724.75,35,,2724.75,percent of total billed charges,Implant Devices,3114,40,,3114,percent of total billed charges,Implant Devices,2724.75,70,,2724.75,percent of total billed charges,Implant Devices,2646.9,34,,2646.9,percent of total billed charges,Implant Devices,2646.9,34,,2646.9,percent of total billed charges,Implant Devices,2724.75,35,,2724.75,percent of total billed charges,Implant Devices,2724.75,35,,2724.75,percent of total billed charges,Implant Devices,2724.75,35,,2724.75,percent of total billed charges,Implant Devices,2724.75,35,,2724.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2646.9,34,"If Charge > 2,000, then 34 percent",2646.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3114,
MIMEDX APS-5260 AMNIOFIX SURGICAL 2X6CM,C1713,HCPCS,,79010064,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MIMEDX APS-5212 AMNIOFIX SURGICAL 2X12CM,C1713,HCPCS,,79010065,CDM,278,RC,,,both,,,6165,2433.13,39.4668,,2433.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2096.1,34,,2096.1,percent of total billed charges,Implant Device,2096.1,34,,2096.1,percent of total billed charges,Implant Device,2096.1,34,,2096.1,percent of total billed charges,Implant Device,2096.1,34,,2096.1,percent of total billed charges,Implant Device,2096.1,34,,2096.1,percent of total billed charges,Implant Device,2096.1,34,,2096.1,percent of total billed charges,Implant Device,2157.75,35,,2157.75,percent of total billed charges,Implant Device,2096.1,34,"Charges > $500, x 34%",2096.1,percent of total billed charges,Implant Device,2157.75,35,,2157.75,percent of total billed charges,Implant Devices,2157.75,35,,2157.75,percent of total billed charges,Implant Devices,2157.75,35,,,percent of total billed charges,Implant Devices,2157.75,35,,2157.75,percent of total billed charges,Implant Devices,2157.75,35,,2157.75,percent of total billed charges,Implant Devices,2466,40,,2466,percent of total billed charges,Implant Devices,2157.75,70,,2157.75,percent of total billed charges,Implant Devices,2096.1,34,,2096.1,percent of total billed charges,Implant Devices,2096.1,34,,2096.1,percent of total billed charges,Implant Devices,2157.75,35,,2157.75,percent of total billed charges,Implant Devices,2157.75,35,,2157.75,percent of total billed charges,Implant Devices,2157.75,35,,2157.75,percent of total billed charges,Implant Devices,2157.75,35,,2157.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2096.1,34,"If Charge > 2,000, then 34 percent",2096.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2466,
MTF HP1616 FLEX HD PLIABLE ACELL DERMIS,C1713,HCPCS,,79010075,CDM,278,RC,,,both,,,7010,2766.62,39.4668,,2766.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2383.4,34,,2383.4,percent of total billed charges,Implant Device,2383.4,34,,2383.4,percent of total billed charges,Implant Device,2383.4,34,,2383.4,percent of total billed charges,Implant Device,2383.4,34,,2383.4,percent of total billed charges,Implant Device,2383.4,34,,2383.4,percent of total billed charges,Implant Device,2383.4,34,,2383.4,percent of total billed charges,Implant Device,2453.5,35,,2453.5,percent of total billed charges,Implant Device,2383.4,34,"Charges > $500, x 34%",2383.4,percent of total billed charges,Implant Device,2453.5,35,,2453.5,percent of total billed charges,Implant Devices,2453.5,35,,2453.5,percent of total billed charges,Implant Devices,2453.5,35,,,percent of total billed charges,Implant Devices,2453.5,35,,2453.5,percent of total billed charges,Implant Devices,2453.5,35,,2453.5,percent of total billed charges,Implant Devices,2804,40,,2804,percent of total billed charges,Implant Devices,2453.5,70,,2453.5,percent of total billed charges,Implant Devices,2383.4,34,,2383.4,percent of total billed charges,Implant Devices,2383.4,34,,2383.4,percent of total billed charges,Implant Devices,2453.5,35,,2453.5,percent of total billed charges,Implant Devices,2453.5,35,,2453.5,percent of total billed charges,Implant Devices,2453.5,35,,2453.5,percent of total billed charges,Implant Devices,2453.5,35,,2453.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2383.4,34,"If Charge > 2,000, then 34 percent",2383.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2804,
STRYKER 657308 LOCKING SCREW 3.5X8MM,C1713,HCPCS,,79010084,CDM,278,RC,,,both,,,494,194.97,39.4668,,194.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,197.6,40,,197.6,percent of total billed charges,Implant Devices,172.9,70,,172.9,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.6,
MTF 471816 FLEX HD ACELL DERMIS 8X16,C1713,HCPCS,,79010089,CDM,278,RC,,,both,,,9868,3894.58,39.4668,,3894.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3355.12,34,,3355.12,percent of total billed charges,Implant Device,3453.8,35,,3453.8,percent of total billed charges,Implant Device,3355.12,34,"Charges > $500, x 34%",3355.12,percent of total billed charges,Implant Device,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3947.2,40,,3947.2,percent of total billed charges,Implant Devices,3453.8,70,,3453.8,percent of total billed charges,Implant Devices,3355.12,34,,3355.12,percent of total billed charges,Implant Devices,3355.12,34,,3355.12,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,3453.8,35,,3453.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3355.12,34,"If Charge > 2,000, then 34 percent",3355.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3947.2,
STRYKER 7030-6535 HEX SCREW 6.5X35MM,C1713,HCPCS,,79010092,CDM,278,RC,,,both,,,159,62.75,39.4668,,62.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,63.6,40,,63.6,percent of total billed charges,Implant Devices,55.65,70,,55.65,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63.6,
ARTHREX AR-1675BC-CP LA ANKLE IMP SYS,C1713,HCPCS,,79010096,CDM,278,RC,,,both,,,5250,2072.01,39.4668,,2072.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Device,1785,34,"Charges > $500, x 34%",1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,2100,40,,2100,percent of total billed charges,Implant Devices,1837.5,70,,1837.5,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1785,34,"If Charge > 2,000, then 34 percent",1785,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2100,
DEPUY 02.123.029 PERIART HUM PLT 10H,C1713,HCPCS,,79010098,CDM,278,RC,,,both,,,4715,1860.86,39.4668,,1860.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1603.1,34,,1603.1,percent of total billed charges,Implant Device,1603.1,34,,1603.1,percent of total billed charges,Implant Device,1603.1,34,,1603.1,percent of total billed charges,Implant Device,1603.1,34,,1603.1,percent of total billed charges,Implant Device,1603.1,34,,1603.1,percent of total billed charges,Implant Device,1603.1,34,,1603.1,percent of total billed charges,Implant Device,1650.25,35,,1650.25,percent of total billed charges,Implant Device,1603.1,34,"Charges > $500, x 34%",1603.1,percent of total billed charges,Implant Device,1650.25,35,,1650.25,percent of total billed charges,Implant Devices,1650.25,35,,1650.25,percent of total billed charges,Implant Devices,1650.25,35,,,percent of total billed charges,Implant Devices,1650.25,35,,1650.25,percent of total billed charges,Implant Devices,1650.25,35,,1650.25,percent of total billed charges,Implant Devices,1886,40,,1886,percent of total billed charges,Implant Devices,1650.25,70,,1650.25,percent of total billed charges,Implant Devices,1603.1,34,,1603.1,percent of total billed charges,Implant Devices,1603.1,34,,1603.1,percent of total billed charges,Implant Devices,1650.25,35,,1650.25,percent of total billed charges,Implant Devices,1650.25,35,,1650.25,percent of total billed charges,Implant Devices,1650.25,35,,1650.25,percent of total billed charges,Implant Devices,1650.25,35,,1650.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1603.1,34,"If Charge > 2,000, then 34 percent",1603.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1886,
ARTHREX-AR-8945-32PT CANN SCREW 4.5X32MM,C1713,HCPCS,,79010099,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ARTHREX ABS-2013-05 ALLOSYNC BONE PUTTY,C1713,HCPCS,,79010100,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
STRYKER 626830 LAG SCREW 4.1X30MM,C1713,HCPCS,,79010102,CDM,278,RC,,,both,,,927,365.86,39.4668,,365.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,324.45,35,,324.45,percent of total billed charges,Implant Device,315.18,34,"Charges > $500, x 34%",315.18,percent of total billed charges,Implant Device,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,370.8,40,,370.8,percent of total billed charges,Implant Devices,324.45,70,,324.45,percent of total billed charges,Implant Devices,315.18,34,,315.18,percent of total billed charges,Implant Devices,315.18,34,,315.18,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,370.8,
STRYKER 626846 LAG SCREW 4.1X46MM,C1713,HCPCS,,79010103,CDM,278,RC,,,both,,,927,365.86,39.4668,,365.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,324.45,35,,324.45,percent of total billed charges,Implant Device,315.18,34,"Charges > $500, x 34%",315.18,percent of total billed charges,Implant Device,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,370.8,40,,370.8,percent of total billed charges,Implant Devices,324.45,70,,324.45,percent of total billed charges,Implant Devices,315.18,34,,315.18,percent of total billed charges,Implant Devices,315.18,34,,315.18,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,370.8,
STRYKER 626898 POLYAXIAL LOCK PLATE LONG,C1713,HCPCS,,79010104,CDM,278,RC,,,both,,,7729,3050.39,39.4668,,3050.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2627.86,34,,2627.86,percent of total billed charges,Implant Device,2627.86,34,,2627.86,percent of total billed charges,Implant Device,2627.86,34,,2627.86,percent of total billed charges,Implant Device,2627.86,34,,2627.86,percent of total billed charges,Implant Device,2627.86,34,,2627.86,percent of total billed charges,Implant Device,2627.86,34,,2627.86,percent of total billed charges,Implant Device,2705.15,35,,2705.15,percent of total billed charges,Implant Device,2627.86,34,"Charges > $500, x 34%",2627.86,percent of total billed charges,Implant Device,2705.15,35,,2705.15,percent of total billed charges,Implant Devices,2705.15,35,,2705.15,percent of total billed charges,Implant Devices,2705.15,35,,,percent of total billed charges,Implant Devices,2705.15,35,,2705.15,percent of total billed charges,Implant Devices,2705.15,35,,2705.15,percent of total billed charges,Implant Devices,3091.6,40,,3091.6,percent of total billed charges,Implant Devices,2705.15,70,,2705.15,percent of total billed charges,Implant Devices,2627.86,34,,2627.86,percent of total billed charges,Implant Devices,2627.86,34,,2627.86,percent of total billed charges,Implant Devices,2705.15,35,,2705.15,percent of total billed charges,Implant Devices,2705.15,35,,2705.15,percent of total billed charges,Implant Devices,2705.15,35,,2705.15,percent of total billed charges,Implant Devices,2705.15,35,,2705.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2627.86,34,"If Charge > 2,000, then 34 percent",2627.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3091.6,
DEPUY 208.409 6.5X70MM CANNULATED SCREW,C1713,HCPCS,,79010105,CDM,278,RC,,,both,,,683,269.56,39.4668,,269.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Device,232.22,34,"Charges > $500, x 34%",232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,273.2,40,,273.2,percent of total billed charges,Implant Devices,239.05,70,,239.05,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.2,
DEPUY 208.410 6.5X75MM CANNULATED SCREW,C1713,HCPCS,,79010106,CDM,278,RC,,,both,,,683,269.56,39.4668,,269.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Device,232.22,34,"Charges > $500, x 34%",232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,273.2,40,,273.2,percent of total billed charges,Implant Devices,239.05,70,,239.05,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.2,
DEPUY 208.473 6.5X85MM CANNULATED SCREW,C1713,HCPCS,,79010107,CDM,278,RC,,,both,,,683,269.56,39.4668,,269.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Device,232.22,34,"Charges > $500, x 34%",232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,273.2,40,,273.2,percent of total billed charges,Implant Devices,239.05,70,,239.05,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.2,
STRYKER 7030-6530 HEX SCREW 6.5X30MM,C1713,HCPCS,,79010115,CDM,278,RC,,,both,,,159,62.75,39.4668,,62.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,63.6,40,,63.6,percent of total billed charges,Implant Devices,55.65,70,,55.65,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63.6,
STRYKER EZMXP08-08-08 XPRESS STAPLE,C1713,HCPCS,,79010116,CDM,278,RC,,,both,,,3686,1454.75,39.4668,,1454.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1290.1,35,,1290.1,percent of total billed charges,Implant Device,1253.24,34,"Charges > $500, x 34%",1253.24,percent of total billed charges,Implant Device,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1474.4,40,,1474.4,percent of total billed charges,Implant Devices,1290.1,70,,1290.1,percent of total billed charges,Implant Devices,1253.24,34,,1253.24,percent of total billed charges,Implant Devices,1253.24,34,,1253.24,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1253.24,34,"If Charge > 2,000, then 34 percent",1253.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1474.4,
STRYKER EZMXP10-10-10 XPRESS STAPLE,C1713,HCPCS,,79010117,CDM,278,RC,,,both,,,3812,1504.47,39.4668,,1504.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1334.2,35,,1334.2,percent of total billed charges,Implant Device,1296.08,34,"Charges > $500, x 34%",1296.08,percent of total billed charges,Implant Device,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1524.8,40,,1524.8,percent of total billed charges,Implant Devices,1334.2,70,,1334.2,percent of total billed charges,Implant Devices,1296.08,34,,1296.08,percent of total billed charges,Implant Devices,1296.08,34,,1296.08,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1296.08,34,"If Charge > 2,000, then 34 percent",1296.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1524.8,
IN2BONES T50 SN012 COMP STAPLE 12X12X12,C1713,HCPCS,,79010119,CDM,278,RC,,,both,,,4860,1918.09,39.4668,,1918.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1652.4,34,,1652.4,percent of total billed charges,Implant Device,1701,35,,1701,percent of total billed charges,Implant Device,1652.4,34,"Charges > $500, x 34%",1652.4,percent of total billed charges,Implant Device,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1944,40,,1944,percent of total billed charges,Implant Devices,1701,70,,1701,percent of total billed charges,Implant Devices,1652.4,34,,1652.4,percent of total billed charges,Implant Devices,1652.4,34,,1652.4,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,1701,35,,1701,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1652.4,34,"If Charge > 2,000, then 34 percent",1652.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1944,
ZIMMER 1442565 STEINMAN PIN 1.6MMX6',C1713,HCPCS,,79010120,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
ZIMMER 110007549 CANN SCREW 4.0X34MM,C1713,HCPCS,,79010121,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
IN2BONES T50 SN015 COMP STAPLE 15X12X12,C1713,HCPCS,,79010122,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
ACUMED CA-4140 4X14MM CANCELLOUS SCREW,C1713,HCPCS,,79010123,CDM,278,RC,,,both,,,411,162.21,39.4668,,162.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,139.74,34,,139.74,percent of total billed charges,Implant Device,139.74,34,,139.74,percent of total billed charges,Implant Device,139.74,34,,139.74,percent of total billed charges,Implant Device,139.74,34,,139.74,percent of total billed charges,Implant Device,139.74,34,,139.74,percent of total billed charges,Implant Device,139.74,34,,139.74,percent of total billed charges,Implant Device,143.85,35,,143.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,164.4,40,,164.4,percent of total billed charges,Implant Devices,143.85,70,,143.85,percent of total billed charges,Implant Devices,139.74,34,,139.74,percent of total billed charges,Implant Devices,139.74,34,,139.74,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.4,
ACUMED CA-4160 4X16MM CANCELLOUS SCREW,C1713,HCPCS,,79010124,CDM,278,RC,,,both,,,411,162.21,39.4668,,162.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,139.74,34,,139.74,percent of total billed charges,Implant Device,139.74,34,,139.74,percent of total billed charges,Implant Device,139.74,34,,139.74,percent of total billed charges,Implant Device,139.74,34,,139.74,percent of total billed charges,Implant Device,139.74,34,,139.74,percent of total billed charges,Implant Device,139.74,34,,139.74,percent of total billed charges,Implant Device,143.85,35,,143.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,164.4,40,,164.4,percent of total billed charges,Implant Devices,143.85,70,,143.85,percent of total billed charges,Implant Devices,139.74,34,,139.74,percent of total billed charges,Implant Devices,139.74,34,,139.74,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,143.85,35,,143.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.4,
STRYKER 326100S ASNIS CANN 6.5MM DRILL,C1713,HCPCS,,79010129,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
STRYKER IC4034 HEADED SCREW 4.0X34MM,C1713,HCPCS,,79010130,CDM,278,RC,,,both,,,961,379.28,39.4668,,379.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,336.35,35,,336.35,percent of total billed charges,Implant Device,326.74,34,"Charges > $500, x 34%",326.74,percent of total billed charges,Implant Device,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,384.4,40,,384.4,percent of total billed charges,Implant Devices,336.35,70,,336.35,percent of total billed charges,Implant Devices,326.74,34,,326.74,percent of total billed charges,Implant Devices,326.74,34,,326.74,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384.4,
STRYKER 657426 BONE SCREW T10 FT,C1713,HCPCS,,79010134,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
LIFENET BL-1600-001 BONE MATRIX - 1CC,C1713,HCPCS,,79010135,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
LIFENET BL-1600-003 BONE MATRIX 10CC,C1713,HCPCS,,79010136,CDM,278,RC,,,both,,,13104,5171.73,39.4668,,5171.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4455.36,34,,4455.36,percent of total billed charges,Implant Device,4455.36,34,,4455.36,percent of total billed charges,Implant Device,4455.36,34,,4455.36,percent of total billed charges,Implant Device,4455.36,34,,4455.36,percent of total billed charges,Implant Device,4455.36,34,,4455.36,percent of total billed charges,Implant Device,4455.36,34,,4455.36,percent of total billed charges,Implant Device,4586.4,35,,4586.4,percent of total billed charges,Implant Device,4455.36,34,"Charges > $500, x 34%",4455.36,percent of total billed charges,Implant Device,4586.4,35,,4586.4,percent of total billed charges,Implant Devices,4586.4,35,,4586.4,percent of total billed charges,Implant Devices,4586.4,35,,,percent of total billed charges,Implant Devices,4586.4,35,,4586.4,percent of total billed charges,Implant Devices,4586.4,35,,4586.4,percent of total billed charges,Implant Devices,5241.6,40,,5241.6,percent of total billed charges,Implant Devices,4586.4,70,,4586.4,percent of total billed charges,Implant Devices,4455.36,34,,4455.36,percent of total billed charges,Implant Devices,4455.36,34,,4455.36,percent of total billed charges,Implant Devices,4586.4,35,,4586.4,percent of total billed charges,Implant Devices,4586.4,35,,4586.4,percent of total billed charges,Implant Devices,4586.4,35,,4586.4,percent of total billed charges,Implant Devices,4586.4,35,,4586.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4455.36,34,"If Charge > 2,000, then 34 percent",4455.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5241.6,
STRYKER 657470 BONE SCREW T10 3.5XL70MM,C1713,HCPCS,,79010137,CDM,278,RC,,,both,,,269,106.17,39.4668,,106.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,107.6,40,,107.6,percent of total billed charges,Implant Devices,94.15,70,,94.15,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.6,
STRYKER 2360-5037S IMN 5X37.5 LOCK SCREW,C1713,HCPCS,,79010144,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
STRYKER 2360-5040S IMN 5X40 LOCK SCREW,C1713,HCPCS,,79010145,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
STRYKER 2360-5042S IMN 5X42.5 LOCK SCREW,C1713,HCPCS,,79010146,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
STRYKER 2360-5047S IMN 5X47.5 LOCK SCREW,C1713,HCPCS,,79010147,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
STRYKER 2341-1033S TIBIAL NAIL 10X330MM,C1713,HCPCS,,79010148,CDM,278,RC,,,both,,,9801,3868.14,39.4668,,3868.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3332.34,34,,3332.34,percent of total billed charges,Implant Device,3332.34,34,,3332.34,percent of total billed charges,Implant Device,3332.34,34,,3332.34,percent of total billed charges,Implant Device,3332.34,34,,3332.34,percent of total billed charges,Implant Device,3332.34,34,,3332.34,percent of total billed charges,Implant Device,3332.34,34,,3332.34,percent of total billed charges,Implant Device,3430.35,35,,3430.35,percent of total billed charges,Implant Device,3332.34,34,"Charges > $500, x 34%",3332.34,percent of total billed charges,Implant Device,3430.35,35,,3430.35,percent of total billed charges,Implant Devices,3430.35,35,,3430.35,percent of total billed charges,Implant Devices,3430.35,35,,,percent of total billed charges,Implant Devices,3430.35,35,,3430.35,percent of total billed charges,Implant Devices,3430.35,35,,3430.35,percent of total billed charges,Implant Devices,3920.4,40,,3920.4,percent of total billed charges,Implant Devices,3430.35,70,,3430.35,percent of total billed charges,Implant Devices,3332.34,34,,3332.34,percent of total billed charges,Implant Devices,3332.34,34,,3332.34,percent of total billed charges,Implant Devices,3430.35,35,,3430.35,percent of total billed charges,Implant Devices,3430.35,35,,3430.35,percent of total billed charges,Implant Devices,3430.35,35,,3430.35,percent of total billed charges,Implant Devices,3430.35,35,,3430.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3332.34,34,"If Charge > 2,000, then 34 percent",3332.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3920.4,
STRYKER 658385 COMPRESSION SCREW 7X85MM,C1713,HCPCS,,79010152,CDM,278,RC,,,both,,,2471,975.22,39.4668,,975.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,864.85,35,,864.85,percent of total billed charges,Implant Device,840.14,34,"Charges > $500, x 34%",840.14,percent of total billed charges,Implant Device,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,988.4,40,,988.4,percent of total billed charges,Implant Devices,864.85,70,,864.85,percent of total billed charges,Implant Devices,840.14,34,,840.14,percent of total billed charges,Implant Devices,840.14,34,,840.14,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,840.14,34,"If Charge > 2,000, then 34 percent",840.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,988.4,
STRYKER 658380 COMPRESSION SCREW 7X80MM,C1713,HCPCS,,79010153,CDM,278,RC,,,both,,,2471,975.22,39.4668,,975.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,864.85,35,,864.85,percent of total billed charges,Implant Device,840.14,34,"Charges > $500, x 34%",840.14,percent of total billed charges,Implant Device,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,988.4,40,,988.4,percent of total billed charges,Implant Devices,864.85,70,,864.85,percent of total billed charges,Implant Devices,840.14,34,,840.14,percent of total billed charges,Implant Devices,840.14,34,,840.14,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,840.14,34,"If Charge > 2,000, then 34 percent",840.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,988.4,
STRYKER 626844 LAG SCREW 4.1X44MM,C1713,HCPCS,,79010154,CDM,278,RC,,,both,,,897,354.02,39.4668,,354.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,304.98,34,,304.98,percent of total billed charges,Implant Device,304.98,34,,304.98,percent of total billed charges,Implant Device,304.98,34,,304.98,percent of total billed charges,Implant Device,304.98,34,,304.98,percent of total billed charges,Implant Device,304.98,34,,304.98,percent of total billed charges,Implant Device,304.98,34,,304.98,percent of total billed charges,Implant Device,313.95,35,,313.95,percent of total billed charges,Implant Device,304.98,34,"Charges > $500, x 34%",304.98,percent of total billed charges,Implant Device,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,358.8,40,,358.8,percent of total billed charges,Implant Devices,313.95,70,,313.95,percent of total billed charges,Implant Devices,304.98,34,,304.98,percent of total billed charges,Implant Devices,304.98,34,,304.98,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,358.8,
STRYKER 626822 LAG SCREW 4.1X22MM,C1713,HCPCS,,79010155,CDM,278,RC,,,both,,,897,354.02,39.4668,,354.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,304.98,34,,304.98,percent of total billed charges,Implant Device,304.98,34,,304.98,percent of total billed charges,Implant Device,304.98,34,,304.98,percent of total billed charges,Implant Device,304.98,34,,304.98,percent of total billed charges,Implant Device,304.98,34,,304.98,percent of total billed charges,Implant Device,304.98,34,,304.98,percent of total billed charges,Implant Device,313.95,35,,313.95,percent of total billed charges,Implant Device,304.98,34,"Charges > $500, x 34%",304.98,percent of total billed charges,Implant Device,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,358.8,40,,358.8,percent of total billed charges,Implant Devices,313.95,70,,313.95,percent of total billed charges,Implant Devices,304.98,34,,304.98,percent of total billed charges,Implant Devices,304.98,34,,304.98,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,313.95,35,,313.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,358.8,
STRYKER 626993 BROAD Y-PLT 3 SHAFT HOLES,C1713,HCPCS,,79010156,CDM,278,RC,,,both,,,3757,1482.77,39.4668,,1482.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1314.95,35,,1314.95,percent of total billed charges,Implant Device,1277.38,34,"Charges > $500, x 34%",1277.38,percent of total billed charges,Implant Device,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1502.8,40,,1502.8,percent of total billed charges,Implant Devices,1314.95,70,,1314.95,percent of total billed charges,Implant Devices,1277.38,34,,1277.38,percent of total billed charges,Implant Devices,1277.38,34,,1277.38,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1277.38,34,"If Charge > 2,000, then 34 percent",1277.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1502.8,
SI-BONE 7050M-90 IFUSE 3D 7.0X50MM,C1713,HCPCS,,79010157,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
SI-BONE 7040M-90 IFUSE 3D 7.0X40MM,C1713,HCPCS,,79010158,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
SI-BONE 7055M-90 IFUSE 3D 7.0X55MM,C1713,HCPCS,,79010159,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
ARTHREX ABS-2810-1808 EVAN WEDGE 18X18X8,C1713,HCPCS,,79010166,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
STRYKER 3525-1340S NAIL KIT 11X340X125MM,C1713,HCPCS,,79010168,CDM,278,RC,,,both,,,4969,1961.11,39.4668,,1961.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Device,1689.46,34,"Charges > $500, x 34%",1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1987.6,40,,1987.6,percent of total billed charges,Implant Devices,1739.15,70,,1739.15,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.46,34,"If Charge > 2,000, then 34 percent",1689.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.6,
STRYKER 2341-1137S TIBIAL NAIL 11X375MM,C1713,HCPCS,,79010169,CDM,278,RC,,,both,,,6378,2517.19,39.4668,,2517.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Device,2168.52,34,"Charges > $500, x 34%",2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2551.2,40,,2551.2,percent of total billed charges,Implant Devices,2232.3,70,,2232.3,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2168.52,34,"If Charge > 2,000, then 34 percent",2168.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2551.2,
STRYKER 2360-5045S LOCK SCREW 5X45MM,C1713,HCPCS,,79010171,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
STRYKER 2360-5055S LOCK SCREW 5X55MM,C1713,HCPCS,,79010172,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
STRYKER 2361-5045S ADV LOCK SCREW 5X45MM,C1713,HCPCS,,79010173,CDM,278,RC,,,both,,,887,350.07,39.4668,,350.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Device,301.58,34,"Charges > $500, x 34%",301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,354.8,40,,354.8,percent of total billed charges,Implant Devices,310.45,70,,310.45,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.8,
STRYKER 2361-5052S ADV LOCK SCREW 5X52MM,C1713,HCPCS,,79010174,CDM,278,RC,,,both,,,956,377.3,39.4668,,377.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,334.6,35,,334.6,percent of total billed charges,Implant Device,325.04,34,"Charges > $500, x 34%",325.04,percent of total billed charges,Implant Device,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,382.4,40,,382.4,percent of total billed charges,Implant Devices,334.6,70,,334.6,percent of total billed charges,Implant Devices,325.04,34,,325.04,percent of total billed charges,Implant Devices,325.04,34,,325.04,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,382.4,
ARTHREX AR8717DS-0907 STAPLE 9X7MM W/INS,C1713,HCPCS,,79010175,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
EXACTECH 521-78-31 THREADED PIN 3.2MM,C1713,HCPCS,,79010176,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,420,
IN2BONES P70 ST205 FIB PLATE LEFT 5 HOLE,C1713,HCPCS,,79010178,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES P72 ST210 LOCK SCREW 2.7X10MM,C1713,HCPCS,,79010179,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P72 ST214 LOCK SCREW 2.7X14MM,C1713,HCPCS,,79010180,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P72 ST216 LOCK SCREW 2.7X16MM,C1713,HCPCS,,79010181,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST012 CORT SCREW 3.5X12MM,C1713,HCPCS,,79010182,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST014 CORT SCREW 3.5X14MM,C1713,HCPCS,,79010183,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
IN2BONES P67 ST415 COLAG SCREW 4.0X45MM,C1713,HCPCS,,79010184,CDM,278,RC,,,both,,,1485,586.08,39.4668,,586.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Device,504.9,34,"Charges > $500, x 34%",504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,594,40,,594,percent of total billed charges,Implant Devices,519.75,70,,519.75,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,594,
IN2BONES P72 ST212 LOCK SCREW 2.7X12MM,C1713,HCPCS,,79010199,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
WRIGHT 4151150030 VALOR SCREW 5X30MM,C1713,HCPCS,,79010202,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
WRIGHT 4151150040 VALOR SCREW 5X40MM,C1713,HCPCS,,79010203,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
WRIGHT 4151150075 VALOR SCREW 5X75MM,C1713,HCPCS,,79010204,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
WRIGHT 4151200003 VALOR NAIL END CAP,C1713,HCPCS,,79010205,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
WRIGHT 415101025L VALOR NAIL 10X250MM,C1713,HCPCS,,79010208,CDM,278,RC,,,both,,,10485,4138.09,39.4668,,4138.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3669.75,35,,3669.75,percent of total billed charges,Implant Device,3564.9,34,"Charges > $500, x 34%",3564.9,percent of total billed charges,Implant Device,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,4194,40,,4194,percent of total billed charges,Implant Devices,3669.75,70,,3669.75,percent of total billed charges,Implant Devices,3564.9,34,,3564.9,percent of total billed charges,Implant Devices,3564.9,34,,3564.9,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3564.9,34,"If Charge > 2,000, then 34 percent",3564.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194,
ZIMMER 00-8146-11-360 LONG NAIL 11X360MM,C1713,HCPCS,,79010209,CDM,278,RC,,,both,,,12150,4795.22,39.4668,,4795.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4131,34,,4131,percent of total billed charges,Implant Device,4131,34,,4131,percent of total billed charges,Implant Device,4131,34,,4131,percent of total billed charges,Implant Device,4131,34,,4131,percent of total billed charges,Implant Device,4131,34,,4131,percent of total billed charges,Implant Device,4131,34,,4131,percent of total billed charges,Implant Device,4252.5,35,,4252.5,percent of total billed charges,Implant Device,4131,34,"Charges > $500, x 34%",4131,percent of total billed charges,Implant Device,4252.5,35,,4252.5,percent of total billed charges,Implant Devices,4252.5,35,,4252.5,percent of total billed charges,Implant Devices,4252.5,35,,,percent of total billed charges,Implant Devices,4252.5,35,,4252.5,percent of total billed charges,Implant Devices,4252.5,35,,4252.5,percent of total billed charges,Implant Devices,4860,40,,4860,percent of total billed charges,Implant Devices,4252.5,70,,4252.5,percent of total billed charges,Implant Devices,4131,34,,4131,percent of total billed charges,Implant Devices,4131,34,,4131,percent of total billed charges,Implant Devices,4252.5,35,,4252.5,percent of total billed charges,Implant Devices,4252.5,35,,4252.5,percent of total billed charges,Implant Devices,4252.5,35,,4252.5,percent of total billed charges,Implant Devices,4252.5,35,,4252.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4131,34,"If Charge > 2,000, then 34 percent",4131,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4860,
ZIMMER 00-2359-014-45 LOCK SCREW 4.5X16,C1713,HCPCS,,79010210,CDM,278,RC,,,both,,,445,175.63,39.4668,,175.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,178,40,,178,percent of total billed charges,Implant Devices,155.75,70,,155.75,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178,
ARTHREX AR-1938PS SUTURE ANCHOR 3X12.7MM,C1713,HCPCS,,79010212,CDM,278,RC,,,both,,,1155,455.84,39.4668,,455.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,392.7,34,,392.7,percent of total billed charges,Implant Device,392.7,34,,392.7,percent of total billed charges,Implant Device,392.7,34,,392.7,percent of total billed charges,Implant Device,392.7,34,,392.7,percent of total billed charges,Implant Device,392.7,34,,392.7,percent of total billed charges,Implant Device,392.7,34,,392.7,percent of total billed charges,Implant Device,404.25,35,,404.25,percent of total billed charges,Implant Device,392.7,34,"Charges > $500, x 34%",392.7,percent of total billed charges,Implant Device,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,462,40,,462,percent of total billed charges,Implant Devices,404.25,70,,404.25,percent of total billed charges,Implant Devices,392.7,34,,392.7,percent of total billed charges,Implant Devices,392.7,34,,392.7,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,462,
STRYKER 3425-0440S GAMMA NAIL 10X440X125,C1713,HCPCS,,79010214,CDM,278,RC,,,both,,,5438,2146.2,39.4668,,2146.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Device,1848.92,34,"Charges > $500, x 34%",1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,2175.2,40,,2175.2,percent of total billed charges,Implant Devices,1903.3,70,,1903.3,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1848.92,34,"If Charge > 2,000, then 34 percent",1848.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2175.2,
ARTHREX AR-7297 TENDON DRESSING KIT,C1713,HCPCS,,79010216,CDM,278,RC,,,both,,,1800,710.4,39.4668,,710.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Device,612,34,"Charges > $500, x 34%",612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,720,40,,720,percent of total billed charges,Implant Devices,630,70,,630,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,720,
STRYKER 661485 CORTEX SCREW 3.5X85MM,C1713,HCPCS,,79010217,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
ARTHREX ABS-2012-05 ALLOSYNC DBM PUTTY,C1713,HCPCS,,79010220,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
ARTHREX AR-8967-1845 CANN SCREW 6.7X45MM,C1713,HCPCS,,79010221,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
STRYKER 601770S CANN SCREW 5X70MM,C1713,HCPCS,,79010244,CDM,278,RC,,,both,,,490,193.39,39.4668,,193.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,171.5,35,,171.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,196,40,,196,percent of total billed charges,Implant Devices,171.5,70,,171.5,percent of total billed charges,Implant Devices,166.6,34,,166.6,percent of total billed charges,Implant Devices,166.6,34,,166.6,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196,
STRYKER 604624 CANN SCREW 4.0X24MM,C1713,HCPCS,,79010245,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
STRYKER 626994 BROAD Y PLT 4 SHAFT HOLES,C1713,HCPCS,,79010246,CDM,278,RC,,,both,,,3757,1482.77,39.4668,,1482.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1314.95,35,,1314.95,percent of total billed charges,Implant Device,1277.38,34,"Charges > $500, x 34%",1277.38,percent of total billed charges,Implant Device,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1502.8,40,,1502.8,percent of total billed charges,Implant Devices,1314.95,70,,1314.95,percent of total billed charges,Implant Devices,1277.38,34,,1277.38,percent of total billed charges,Implant Devices,1277.38,34,,1277.38,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1277.38,34,"If Charge > 2,000, then 34 percent",1277.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1502.8,
STRYKER 2341-1237S TIBIAL NAIL 12X375MM,C1713,HCPCS,,79010248,CDM,278,RC,,,both,,,6378,2517.19,39.4668,,2517.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Device,2168.52,34,"Charges > $500, x 34%",2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2551.2,40,,2551.2,percent of total billed charges,Implant Devices,2232.3,70,,2232.3,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2168.52,34,"If Charge > 2,000, then 34 percent",2168.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2551.2,
STRYKER 2361-5037S LOCK SCREW 5X37.5MM,C1713,HCPCS,,79010249,CDM,278,RC,,,both,,,956,377.3,39.4668,,377.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,334.6,35,,334.6,percent of total billed charges,Implant Device,325.04,34,"Charges > $500, x 34%",325.04,percent of total billed charges,Implant Device,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,382.4,40,,382.4,percent of total billed charges,Implant Devices,334.6,70,,334.6,percent of total billed charges,Implant Devices,325.04,34,,325.04,percent of total billed charges,Implant Devices,325.04,34,,325.04,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,382.4,
STRYKER 2361-5050S LOCK SCREW 4X50MM,C1713,HCPCS,,79010250,CDM,278,RC,,,both,,,887,350.07,39.4668,,350.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Device,301.58,34,"Charges > $500, x 34%",301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,354.8,40,,354.8,percent of total billed charges,Implant Devices,310.45,70,,310.45,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.8,
IN2BONES P67 ST432 CANN SCREW 4.0X32MM,C1713,HCPCS,,79010252,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P72 ST016 NON LOCK SCREW 2.7X16,C1713,HCPCS,,79010255,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
EXACTECH 315-PEG DRILL GUIDE HOLDING PIN,C1713,HCPCS,,79010256,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
EXACTECH 311-01-41 SHORT HEAD TRIAL 41MM,C1713,HCPCS,,79010257,CDM,278,RC,,,both,,,456,179.97,39.4668,,179.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,182.4,40,,182.4,percent of total billed charges,Implant Devices,159.6,70,,159.6,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182.4,
EXACTECH 311-01-38 SHORT HEAD TRIAL 38MM,C1713,HCPCS,,79010258,CDM,278,RC,,,both,,,402,158.66,39.4668,,158.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,160.8,40,,160.8,percent of total billed charges,Implant Devices,140.7,70,,140.7,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,160.8,
STRYKER 602890 CANN SCREW 6.5X90MM,C1713,HCPCS,,79010259,CDM,278,RC,,,both,,,696,274.69,39.4668,,274.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Device,236.64,34,"Charges > $500, x 34%",236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,278.4,40,,278.4,percent of total billed charges,Implant Devices,243.6,70,,243.6,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,278.4,
ARTHREX AR-8952MT-03 T-PLATE 3 HOLE,C1713,HCPCS,,79010275,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
ARTHREX AR-8719DS-1515 STAPLE 15X15MM,C1713,HCPCS,,79010276,CDM,278,RC,,,both,,,6885,2717.29,39.4668,,2717.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2409.75,35,,2409.75,percent of total billed charges,Implant Device,2340.9,34,"Charges > $500, x 34%",2340.9,percent of total billed charges,Implant Device,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2754,40,,2754,percent of total billed charges,Implant Devices,2409.75,70,,2409.75,percent of total billed charges,Implant Devices,2340.9,34,,2340.9,percent of total billed charges,Implant Devices,2340.9,34,,2340.9,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2340.9,34,"If Charge > 2,000, then 34 percent",2340.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2754,
ARTHREX ABS-2810-1810 EVANS WEDGE 10MM,C1713,HCPCS,,79010277,CDM,278,RC,,,both,,,6645,2622.57,39.4668,,2622.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2325.75,35,,2325.75,percent of total billed charges,Implant Device,2259.3,34,"Charges > $500, x 34%",2259.3,percent of total billed charges,Implant Device,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2658,40,,2658,percent of total billed charges,Implant Devices,2325.75,70,,2325.75,percent of total billed charges,Implant Devices,2259.3,34,,2259.3,percent of total billed charges,Implant Devices,2259.3,34,,2259.3,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2259.3,34,"If Charge > 2,000, then 34 percent",2259.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2658,
ARTHREX ABS-2800-1665 COTTON WEDGE 6.5MM,C1713,HCPCS,,79010278,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
STRYKER 656120 BONE SCREW T8 2.4XL20MM,C1713,HCPCS,,79010281,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER 663038 COMP SCREW 4.0XL40MM,C1713,HCPCS,,79010282,CDM,278,RC,,,both,,,2559,1009.96,39.4668,,1009.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,895.65,35,,895.65,percent of total billed charges,Implant Device,870.06,34,"Charges > $500, x 34%",870.06,percent of total billed charges,Implant Device,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,1023.6,40,,1023.6,percent of total billed charges,Implant Devices,895.65,70,,895.65,percent of total billed charges,Implant Devices,870.06,34,,870.06,percent of total billed charges,Implant Devices,870.06,34,,870.06,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,870.06,34,"If Charge > 2,000, then 34 percent",870.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1023.6,
STRYKER 663040 COMP SCREW 4.0XL38MM,C1713,HCPCS,,79010283,CDM,278,RC,,,both,,,2559,1009.96,39.4668,,1009.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,895.65,35,,895.65,percent of total billed charges,Implant Device,870.06,34,"Charges > $500, x 34%",870.06,percent of total billed charges,Implant Device,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,1023.6,40,,1023.6,percent of total billed charges,Implant Devices,895.65,70,,895.65,percent of total billed charges,Implant Devices,870.06,34,,870.06,percent of total billed charges,Implant Devices,870.06,34,,870.06,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,870.06,34,"If Charge > 2,000, then 34 percent",870.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1023.6,
STRYKER 663044 COMP SCREW 4.0XL44MM,C1713,HCPCS,,79010284,CDM,278,RC,,,both,,,2559,1009.96,39.4668,,1009.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,895.65,35,,895.65,percent of total billed charges,Implant Device,870.06,34,"Charges > $500, x 34%",870.06,percent of total billed charges,Implant Device,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,1023.6,40,,1023.6,percent of total billed charges,Implant Devices,895.65,70,,895.65,percent of total billed charges,Implant Devices,870.06,34,,870.06,percent of total billed charges,Implant Devices,870.06,34,,870.06,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,870.06,34,"If Charge > 2,000, then 34 percent",870.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1023.6,
ARTHREX ABS-2800-1675 COTTON WEDGE 7.5MM,C1713,HCPCS,,79010289,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
IN2BONES V30 ST214 NON LOCK SCREW 3X14MM,C1713,HCPCS,,79010295,CDM,278,RC,,,both,,,735,290.08,39.4668,,290.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Device,249.9,34,"Charges > $500, x 34%",249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,294,40,,294,percent of total billed charges,Implant Devices,257.25,70,,257.25,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
ARTHREX ABS-2810-2010 EVAN WEDG 20X20X10,C1713,HCPCS,,79010296,CDM,278,RC,,,both,,,6858,2706.63,39.4668,,2706.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2331.72,34,,2331.72,percent of total billed charges,Implant Device,2331.72,34,,2331.72,percent of total billed charges,Implant Device,2331.72,34,,2331.72,percent of total billed charges,Implant Device,2331.72,34,,2331.72,percent of total billed charges,Implant Device,2331.72,34,,2331.72,percent of total billed charges,Implant Device,2331.72,34,,2331.72,percent of total billed charges,Implant Device,2400.3,35,,2400.3,percent of total billed charges,Implant Device,2331.72,34,"Charges > $500, x 34%",2331.72,percent of total billed charges,Implant Device,2400.3,35,,2400.3,percent of total billed charges,Implant Devices,2400.3,35,,2400.3,percent of total billed charges,Implant Devices,2400.3,35,,,percent of total billed charges,Implant Devices,2400.3,35,,2400.3,percent of total billed charges,Implant Devices,2400.3,35,,2400.3,percent of total billed charges,Implant Devices,2743.2,40,,2743.2,percent of total billed charges,Implant Devices,2400.3,70,,2400.3,percent of total billed charges,Implant Devices,2331.72,34,,2331.72,percent of total billed charges,Implant Devices,2331.72,34,,2331.72,percent of total billed charges,Implant Devices,2400.3,35,,2400.3,percent of total billed charges,Implant Devices,2400.3,35,,2400.3,percent of total billed charges,Implant Devices,2400.3,35,,2400.3,percent of total billed charges,Implant Devices,2400.3,35,,2400.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2331.72,34,"If Charge > 2,000, then 34 percent",2331.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2743.2,
EXACTECH 314-13-32 GLENOID POST AUGMENT,C1713,HCPCS,,79010298,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
EXACTECH SPC0423 TAPERED WEDGE 54MM LONG,C1713,HCPCS,,79010304,CDM,278,RC,,,both,,,10625,4193.35,39.4668,,4193.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3718.75,35,,3718.75,percent of total billed charges,Implant Device,3612.5,34,"Charges > $500, x 34%",3612.5,percent of total billed charges,Implant Device,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,4250,40,,4250,percent of total billed charges,Implant Devices,3718.75,70,,3718.75,percent of total billed charges,Implant Devices,3612.5,34,,3612.5,percent of total billed charges,Implant Devices,3612.5,34,,3612.5,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3612.5,34,"If Charge > 2,000, then 34 percent",3612.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4250,
DEPUY 02.112.018 CLAVICLE PLT 3.5X123MM,C1713,HCPCS,,79010309,CDM,278,RC,,,both,,,2459,970.49,39.4668,,970.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,836.06,34,,836.06,percent of total billed charges,Implant Device,860.65,35,,860.65,percent of total billed charges,Implant Device,836.06,34,"Charges > $500, x 34%",836.06,percent of total billed charges,Implant Device,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,983.6,40,,983.6,percent of total billed charges,Implant Devices,860.65,70,,860.65,percent of total billed charges,Implant Devices,836.06,34,,836.06,percent of total billed charges,Implant Devices,836.06,34,,836.06,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,860.65,35,,860.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,836.06,34,"If Charge > 2,000, then 34 percent",836.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,983.6,
IN2BONES P67 ST428 COLAG SCREW 4X28MM,C1713,HCPCS,,79010310,CDM,278,RC,,,both,,,1485,586.08,39.4668,,586.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Device,504.9,34,"Charges > $500, x 34%",504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,594,40,,594,percent of total billed charges,Implant Devices,519.75,70,,519.75,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,594,
STRYKER 3425-1380S NAIL KIT 11X380MMX125,C1713,HCPCS,,79010313,CDM,278,RC,,,both,,,5438,2146.2,39.4668,,2146.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Device,1848.92,34,"Charges > $500, x 34%",1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,2175.2,40,,2175.2,percent of total billed charges,Implant Devices,1903.3,70,,1903.3,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1848.92,34,"If Charge > 2,000, then 34 percent",1848.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2175.2,
ARTHREX AR-8643-34 HEADLESS SCRW 4.3X34,C1713,HCPCS,,79010322,CDM,278,RC,,,both,,,1608,634.63,39.4668,,634.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,562.8,35,,562.8,percent of total billed charges,Implant Device,546.72,34,"Charges > $500, x 34%",546.72,percent of total billed charges,Implant Device,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,643.2,40,,643.2,percent of total billed charges,Implant Devices,562.8,70,,562.8,percent of total billed charges,Implant Devices,546.72,34,,546.72,percent of total billed charges,Implant Devices,546.72,34,,546.72,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,643.2,
ARTHREX AR-8643-36 HEADLESS SCRW 4.3X36,C1713,HCPCS,,79010323,CDM,278,RC,,,both,,,1608,634.63,39.4668,,634.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,562.8,35,,562.8,percent of total billed charges,Implant Device,546.72,34,"Charges > $500, x 34%",546.72,percent of total billed charges,Implant Device,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,643.2,40,,643.2,percent of total billed charges,Implant Devices,562.8,70,,562.8,percent of total billed charges,Implant Devices,546.72,34,,546.72,percent of total billed charges,Implant Devices,546.72,34,,546.72,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,643.2,
ARTHREX AR-8941PS KNOTLESS CORKSCREW 3.9,C1713,HCPCS,,79010325,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ARTHREX AR-1941PS CORKSCREW 3.9X11.2MM,C1713,HCPCS,,79010344,CDM,278,RC,,,both,,,1155,455.84,39.4668,,455.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,392.7,34,,392.7,percent of total billed charges,Implant Device,392.7,34,,392.7,percent of total billed charges,Implant Device,392.7,34,,392.7,percent of total billed charges,Implant Device,392.7,34,,392.7,percent of total billed charges,Implant Device,392.7,34,,392.7,percent of total billed charges,Implant Device,392.7,34,,392.7,percent of total billed charges,Implant Device,404.25,35,,404.25,percent of total billed charges,Implant Device,392.7,34,"Charges > $500, x 34%",392.7,percent of total billed charges,Implant Device,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,462,40,,462,percent of total billed charges,Implant Devices,404.25,70,,404.25,percent of total billed charges,Implant Devices,392.7,34,,392.7,percent of total billed charges,Implant Devices,392.7,34,,392.7,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,404.25,35,,404.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,462,
DEPUY 458.948S 5.0X48MM TI LOCK SCREW,C1713,HCPCS,,79010351,CDM,278,RC,,,both,,,456,179.97,39.4668,,179.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,155.04,34,,155.04,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,182.4,40,,182.4,percent of total billed charges,Implant Devices,159.6,70,,159.6,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,155.04,34,,155.04,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,159.6,35,,159.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182.4,
DEPUY 456.418S 11X380MM TI FIX NAIL,C1713,HCPCS,,79010352,CDM,278,RC,,,both,,,364,143.66,39.4668,,143.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,123.76,34,,123.76,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,145.6,40,,145.6,percent of total billed charges,Implant Devices,127.4,70,,127.4,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,123.76,34,,123.76,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,127.4,35,,127.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,145.6,
ZIMMER 48-6001 BONUS TRIAD ALLOGRAFT 1CC,C1713,HCPCS,,79010379,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
ZIMMER 48-6005 BONUS TRIAD ALLOGRAFT 5CC,C1713,HCPCS,,79010380,CDM,278,RC,,,both,,,8550,3374.41,39.4668,,3374.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2992.5,35,,2992.5,percent of total billed charges,Implant Device,2907,34,"Charges > $500, x 34%",2907,percent of total billed charges,Implant Device,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,3420,40,,3420,percent of total billed charges,Implant Devices,2992.5,70,,2992.5,percent of total billed charges,Implant Devices,2907,34,,2907,percent of total billed charges,Implant Devices,2907,34,,2907,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2907,34,"If Charge > 2,000, then 34 percent",2907,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3420,
IN2BONES V35 ST218 NON LOCK SCREW 3.5X18,C1713,HCPCS,,79010383,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
EXACTECH 300-50-46 REPLICATOR PLT 4.5MM,C1713,HCPCS,,79010385,CDM,278,RC,,,both,,,2430,959.04,39.4668,,959.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,826.2,34,,826.2,percent of total billed charges,Implant Device,826.2,34,,826.2,percent of total billed charges,Implant Device,826.2,34,,826.2,percent of total billed charges,Implant Device,826.2,34,,826.2,percent of total billed charges,Implant Device,826.2,34,,826.2,percent of total billed charges,Implant Device,826.2,34,,826.2,percent of total billed charges,Implant Device,850.5,35,,850.5,percent of total billed charges,Implant Device,826.2,34,"Charges > $500, x 34%",826.2,percent of total billed charges,Implant Device,850.5,35,,850.5,percent of total billed charges,Implant Devices,850.5,35,,850.5,percent of total billed charges,Implant Devices,850.5,35,,,percent of total billed charges,Implant Devices,850.5,35,,850.5,percent of total billed charges,Implant Devices,850.5,35,,850.5,percent of total billed charges,Implant Devices,972,40,,972,percent of total billed charges,Implant Devices,850.5,70,,850.5,percent of total billed charges,Implant Devices,826.2,34,,826.2,percent of total billed charges,Implant Devices,826.2,34,,826.2,percent of total billed charges,Implant Devices,850.5,35,,850.5,percent of total billed charges,Implant Devices,850.5,35,,850.5,percent of total billed charges,Implant Devices,850.5,35,,850.5,percent of total billed charges,Implant Devices,850.5,35,,850.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,826.2,34,"If Charge > 2,000, then 34 percent",826.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,972,
STRYKER 1851-0938S FEMORAL NAIL 9X380,C1713,HCPCS,,79010387,CDM,278,RC,,,both,,,4545,1793.77,39.4668,,1793.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1545.3,34,,1545.3,percent of total billed charges,Implant Device,1590.75,35,,1590.75,percent of total billed charges,Implant Device,1545.3,34,"Charges > $500, x 34%",1545.3,percent of total billed charges,Implant Device,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1818,40,,1818,percent of total billed charges,Implant Devices,1590.75,70,,1590.75,percent of total billed charges,Implant Devices,1545.3,34,,1545.3,percent of total billed charges,Implant Devices,1545.3,34,,1545.3,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,1590.75,35,,1590.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1545.3,34,"If Charge > 2,000, then 34 percent",1545.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1818,
ZIMMER 8145-11-340 HIP FRAC NAIL 11X340,C1713,HCPCS,,79010397,CDM,278,RC,,,both,,,7290,2877.13,39.4668,,2877.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2551.5,35,,2551.5,percent of total billed charges,Implant Device,2478.6,34,"Charges > $500, x 34%",2478.6,percent of total billed charges,Implant Device,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2916,40,,2916,percent of total billed charges,Implant Devices,2551.5,70,,2551.5,percent of total billed charges,Implant Devices,2478.6,34,,2478.6,percent of total billed charges,Implant Devices,2478.6,34,,2478.6,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2478.6,34,"If Charge > 2,000, then 34 percent",2478.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2916,
ARTHREX AR-8862DS SUTURETAPE IMPLANT SYS,C1713,HCPCS,,79010398,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
ACUMED AT2-C30 ACUTRAK BONE SCREW 30MM,C1713,HCPCS,,79010404,CDM,278,RC,,,both,,,2448,966.15,39.4668,,966.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,832.32,34,,832.32,percent of total billed charges,Implant Device,832.32,34,,832.32,percent of total billed charges,Implant Device,832.32,34,,832.32,percent of total billed charges,Implant Device,832.32,34,,832.32,percent of total billed charges,Implant Device,832.32,34,,832.32,percent of total billed charges,Implant Device,832.32,34,,832.32,percent of total billed charges,Implant Device,856.8,35,,856.8,percent of total billed charges,Implant Device,832.32,34,"Charges > $500, x 34%",832.32,percent of total billed charges,Implant Device,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,979.2,40,,979.2,percent of total billed charges,Implant Devices,856.8,70,,856.8,percent of total billed charges,Implant Devices,832.32,34,,832.32,percent of total billed charges,Implant Devices,832.32,34,,832.32,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,856.8,35,,856.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,832.32,34,"If Charge > 2,000, then 34 percent",832.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,979.2,
STRYKER 626828 LAG SCREW 4.1X28MM,C1713,HCPCS,,79010406,CDM,278,RC,,,both,,,927,365.86,39.4668,,365.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,324.45,35,,324.45,percent of total billed charges,Implant Device,315.18,34,"Charges > $500, x 34%",315.18,percent of total billed charges,Implant Device,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,370.8,40,,370.8,percent of total billed charges,Implant Devices,324.45,70,,324.45,percent of total billed charges,Implant Devices,315.18,34,,315.18,percent of total billed charges,Implant Devices,315.18,34,,315.18,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,370.8,
ZIMMER SP26000 PEG SCREW 2.5X26MM,C1713,HCPCS,,79010425,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
ZIMMER TP18000 PARTIAL THREAD 2.5X18MM,C1713,HCPCS,,79010426,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
ZIMMER TP24000 PARTIAL THREAD 2.5X24MM,C1713,HCPCS,,79010427,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
DEPUY 214.054 CORTEX SCREW 4.5X54MM,C1713,HCPCS,,79010432,CDM,278,RC,,,both,,,59,23.29,39.4668,,23.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.06,34,,20.06,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,23.6,40,,23.6,percent of total billed charges,Implant Devices,20.65,70,,20.65,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.06,34,,20.06,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,20.65,35,,20.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,23.6,
STRYKER 628308 ANTERIOR MIDSHAFT PLT 8H,C1713,HCPCS,,79010433,CDM,278,RC,,,both,,,3069,1211.24,39.4668,,1211.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1074.15,35,,1074.15,percent of total billed charges,Implant Device,1043.46,34,"Charges > $500, x 34%",1043.46,percent of total billed charges,Implant Device,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1227.6,40,,1227.6,percent of total billed charges,Implant Devices,1074.15,70,,1074.15,percent of total billed charges,Implant Devices,1043.46,34,,1043.46,percent of total billed charges,Implant Devices,1043.46,34,,1043.46,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1043.46,34,"If Charge > 2,000, then 34 percent",1043.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1227.6,
STRYKER 657028 LOCKING SCREW 2.7X28MM,C1713,HCPCS,,79010434,CDM,278,RC,,,both,,,494,194.97,39.4668,,194.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,197.6,40,,197.6,percent of total billed charges,Implant Devices,172.9,70,,172.9,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.6,
STRYKER 657120 BONE SCREW 2.7X20MM,C1713,HCPCS,,79010435,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
ARTHREX AR-8724-10PT 2.4X10MM PT SCREW,C1713,HCPCS,,79010436,CDM,278,RC,,,both,,,624,246.27,39.4668,,246.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,218.4,35,,218.4,percent of total billed charges,Implant Device,212.16,34,"Charges > $500, x 34%",212.16,percent of total billed charges,Implant Device,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,249.6,40,,249.6,percent of total billed charges,Implant Devices,218.4,70,,218.4,percent of total billed charges,Implant Devices,212.16,34,,212.16,percent of total billed charges,Implant Devices,212.16,34,,212.16,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,249.6,
ARTHREX AR-8724-12PT 2.4X12MM PT SCREW,C1713,HCPCS,,79010437,CDM,278,RC,,,both,,,624,246.27,39.4668,,246.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,218.4,35,,218.4,percent of total billed charges,Implant Device,212.16,34,"Charges > $500, x 34%",212.16,percent of total billed charges,Implant Device,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,249.6,40,,249.6,percent of total billed charges,Implant Devices,218.4,70,,218.4,percent of total billed charges,Implant Devices,212.16,34,,212.16,percent of total billed charges,Implant Devices,212.16,34,,212.16,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,249.6,
ARTHREX AR-8724-14PT 2.4X14MM PT SCREW,C1713,HCPCS,,79010438,CDM,278,RC,,,both,,,624,246.27,39.4668,,246.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,218.4,35,,218.4,percent of total billed charges,Implant Device,212.16,34,"Charges > $500, x 34%",212.16,percent of total billed charges,Implant Device,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,249.6,40,,249.6,percent of total billed charges,Implant Devices,218.4,70,,218.4,percent of total billed charges,Implant Devices,212.16,34,,212.16,percent of total billed charges,Implant Devices,212.16,34,,212.16,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,249.6,
DEPUY 02.231.008S LOCKING SCREW 5X8MM,C1713,HCPCS,,79010445,CDM,278,RC,,,both,,,788,311,39.4668,,311,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,267.92,34,,267.92,percent of total billed charges,Implant Device,275.8,35,,275.8,percent of total billed charges,Implant Device,267.92,34,"Charges > $500, x 34%",267.92,percent of total billed charges,Implant Device,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,315.2,40,,315.2,percent of total billed charges,Implant Devices,275.8,70,,275.8,percent of total billed charges,Implant Devices,267.92,34,,267.92,percent of total billed charges,Implant Devices,267.92,34,,267.92,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,275.8,35,,275.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.2,
IN2BONES V35 ST216 NON-LOCK SCREW 3.5X16,C1713,HCPCS,,79010446,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ARTHREX AR-2326PSLC SWIVELOCK 3.9MM,C1713,HCPCS,,79010448,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
STRYKER 1832-3824S HUMERAL NAIL RT 240MM,C1713,HCPCS,,79010451,CDM,278,RC,,,both,,,4152,1638.66,39.4668,,1638.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1411.68,34,,1411.68,percent of total billed charges,Implant Device,1411.68,34,,1411.68,percent of total billed charges,Implant Device,1411.68,34,,1411.68,percent of total billed charges,Implant Device,1411.68,34,,1411.68,percent of total billed charges,Implant Device,1411.68,34,,1411.68,percent of total billed charges,Implant Device,1411.68,34,,1411.68,percent of total billed charges,Implant Device,1453.2,35,,1453.2,percent of total billed charges,Implant Device,1411.68,34,"Charges > $500, x 34%",1411.68,percent of total billed charges,Implant Device,1453.2,35,,1453.2,percent of total billed charges,Implant Devices,1453.2,35,,1453.2,percent of total billed charges,Implant Devices,1453.2,35,,,percent of total billed charges,Implant Devices,1453.2,35,,1453.2,percent of total billed charges,Implant Devices,1453.2,35,,1453.2,percent of total billed charges,Implant Devices,1660.8,40,,1660.8,percent of total billed charges,Implant Devices,1453.2,70,,1453.2,percent of total billed charges,Implant Devices,1411.68,34,,1411.68,percent of total billed charges,Implant Devices,1411.68,34,,1411.68,percent of total billed charges,Implant Devices,1453.2,35,,1453.2,percent of total billed charges,Implant Devices,1453.2,35,,1453.2,percent of total billed charges,Implant Devices,1453.2,35,,1453.2,percent of total billed charges,Implant Devices,1453.2,35,,1453.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1411.68,34,"If Charge > 2,000, then 34 percent",1411.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1660.8,
STRYKER AA01-43F54V 54MM OZARK PLATE,C1713,HCPCS,,79010467,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
STRYKER 8801-04014CA 4.0X14 VST SCREW,C1713,HCPCS,,79010468,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ULRICH CS 2250-12-24-6 SM VBR 12X24040MM,C1713,HCPCS,,79010471,CDM,278,RC,,,both,,,21735,8578.11,39.4668,,8578.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7389.9,34,,7389.9,percent of total billed charges,Implant Device,7389.9,34,,7389.9,percent of total billed charges,Implant Device,7389.9,34,,7389.9,percent of total billed charges,Implant Device,7389.9,34,,7389.9,percent of total billed charges,Implant Device,7389.9,34,,7389.9,percent of total billed charges,Implant Device,7389.9,34,,7389.9,percent of total billed charges,Implant Device,7607.25,35,,7607.25,percent of total billed charges,Implant Device,7389.9,34,"Charges > $500, x 34%",7389.9,percent of total billed charges,Implant Device,7607.25,35,,7607.25,percent of total billed charges,Implant Devices,7607.25,35,,7607.25,percent of total billed charges,Implant Devices,7607.25,35,,,percent of total billed charges,Implant Devices,7607.25,35,,7607.25,percent of total billed charges,Implant Devices,7607.25,35,,7607.25,percent of total billed charges,Implant Devices,8694,40,,8694,percent of total billed charges,Implant Devices,7607.25,70,,7607.25,percent of total billed charges,Implant Devices,7389.9,34,,7389.9,percent of total billed charges,Implant Devices,7389.9,34,,7389.9,percent of total billed charges,Implant Devices,7607.25,35,,7607.25,percent of total billed charges,Implant Devices,7607.25,35,,7607.25,percent of total billed charges,Implant Devices,7607.25,35,,7607.25,percent of total billed charges,Implant Devices,7607.25,35,,7607.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7389.9,34,"If Charge > 2,000, then 34 percent",7389.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8694,
ULRICH CS2259 SM VBR SCREW SET TI,C1713,HCPCS,,79010472,CDM,278,RC,,,both,,,2394,944.84,39.4668,,944.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,837.9,35,,837.9,percent of total billed charges,Implant Device,813.96,34,"Charges > $500, x 34%",813.96,percent of total billed charges,Implant Device,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,957.6,40,,957.6,percent of total billed charges,Implant Devices,837.9,70,,837.9,percent of total billed charges,Implant Devices,813.96,34,,813.96,percent of total billed charges,Implant Devices,813.96,34,,813.96,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,813.96,34,"If Charge > 2,000, then 34 percent",813.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,957.6,
WOUND WCI-05-SACRXP SURG COLLAGEN(PUTTY),C1713,HCPCS,,79010474,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
ARTHREX AR-5025B-18 BIOCOMP SCREW 18MM,C1713,HCPCS,,79010482,CDM,278,RC,,,both,,,1695,668.96,39.4668,,668.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,593.25,35,,593.25,percent of total billed charges,Implant Device,576.3,34,"Charges > $500, x 34%",576.3,percent of total billed charges,Implant Device,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,678,40,,678,percent of total billed charges,Implant Devices,593.25,70,,593.25,percent of total billed charges,Implant Devices,576.3,34,,576.3,percent of total billed charges,Implant Devices,576.3,34,,576.3,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,678,
ARTHREX AR-5025B-20 BIOCOMP SCREW 20MM,C1713,HCPCS,,79010483,CDM,278,RC,,,both,,,1695,668.96,39.4668,,668.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,576.3,34,,576.3,percent of total billed charges,Implant Device,593.25,35,,593.25,percent of total billed charges,Implant Device,576.3,34,"Charges > $500, x 34%",576.3,percent of total billed charges,Implant Device,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,678,40,,678,percent of total billed charges,Implant Devices,593.25,70,,593.25,percent of total billed charges,Implant Devices,576.3,34,,576.3,percent of total billed charges,Implant Devices,576.3,34,,576.3,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,593.25,35,,593.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,678,
ARTHREX AR-8978-CP INTERNAL BRACE,C1713,HCPCS,,79010488,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
ZIMMER SP16000 PEG SCREW 2.5X16MM,C1713,HCPCS,,79010489,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
ZIMMER SP18000 PEG SCREW 2.5X18MM,C1713,HCPCS,,79010490,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
STRYKER 1236-2-852 ADM X3 INSERT 28MM,C1713,HCPCS,,79010493,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 2341-1140S TIBIAL NAIL 11X405MM,C1713,HCPCS,,79010499,CDM,278,RC,,,both,,,6378,2517.19,39.4668,,2517.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Device,2168.52,34,"Charges > $500, x 34%",2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2551.2,40,,2551.2,percent of total billed charges,Implant Devices,2232.3,70,,2232.3,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2168.52,34,"If Charge > 2,000, then 34 percent",2168.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2551.2,
STRYKER 2361-5065S LOCKING SCREW 5X65MM,C1713,HCPCS,,79010501,CDM,278,RC,,,both,,,887,350.07,39.4668,,350.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Device,301.58,34,"Charges > $500, x 34%",301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,354.8,40,,354.8,percent of total billed charges,Implant Devices,310.45,70,,310.45,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.8,
ACUMED PL-UL06 ULNA SHORTENING PLATE 6H,C1713,HCPCS,,79010503,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
ACUMED 80-0422 SHORTENING REDUCTION PEG,C1713,HCPCS,,79010505,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
ACUMED 30-0233 LOCKING SCREW 3.5X10MM,C1713,HCPCS,,79010506,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
STRYKER KS14 FIXOS SNAP OFF 2.7X14MM,C1713,HCPCS,,79010507,CDM,278,RC,,,both,,,1250,493.34,39.4668,,493.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,425,34,,425,percent of total billed charges,Implant Device,425,34,,425,percent of total billed charges,Implant Device,425,34,,425,percent of total billed charges,Implant Device,425,34,,425,percent of total billed charges,Implant Device,425,34,,425,percent of total billed charges,Implant Device,425,34,,425,percent of total billed charges,Implant Device,437.5,35,,437.5,percent of total billed charges,Implant Device,425,34,"Charges > $500, x 34%",425,percent of total billed charges,Implant Device,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,500,40,,500,percent of total billed charges,Implant Devices,437.5,70,,437.5,percent of total billed charges,Implant Devices,425,34,,425,percent of total billed charges,Implant Devices,425,34,,425,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,437.5,35,,437.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,500,
STRYKER 40-20115S ASNIS MICRO 2.0X15/6MM,C1713,HCPCS,,79010508,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER 40-20113S ASNIS MICRO 2.0X13/6MM,C1713,HCPCS,,79010509,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER 3525-3400S LONG NAIL KIT R1/5 LT,C1713,HCPCS,,79010511,CDM,278,RC,,,both,,,5438,2146.2,39.4668,,2146.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Device,1848.92,34,"Charges > $500, x 34%",1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,2175.2,40,,2175.2,percent of total billed charges,Implant Devices,1903.3,70,,1903.3,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1848.92,34,"If Charge > 2,000, then 34 percent",1848.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2175.2,
ARTHREX AR-1288BTB-100 BTB TIGHTROPE,C1713,HCPCS,,79010513,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 656422 BONE SCREW 2.7X22MM,C1713,HCPCS,,79010515,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER 627304 TIBIA PLATE LEFT 4H 121MM,C1713,HCPCS,,79010516,CDM,278,RC,,,both,,,6049,2387.35,39.4668,,2387.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2056.66,34,,2056.66,percent of total billed charges,Implant Device,2117.15,35,,2117.15,percent of total billed charges,Implant Device,2056.66,34,"Charges > $500, x 34%",2056.66,percent of total billed charges,Implant Device,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2419.6,40,,2419.6,percent of total billed charges,Implant Devices,2117.15,70,,2117.15,percent of total billed charges,Implant Devices,2056.66,34,,2056.66,percent of total billed charges,Implant Devices,2056.66,34,,2056.66,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,2117.15,35,,2117.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2056.66,34,"If Charge > 2,000, then 34 percent",2056.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2419.6,
ZOOM 2232 NANOVA LARGE VAS-Q-CLIP,C1713,HCPCS,,79010517,CDM,278,RC,,,both,,,68,26.84,39.4668,,26.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.12,34,,23.12,percent of total billed charges,Implant Device,23.8,35,,23.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,27.2,40,,27.2,percent of total billed charges,Implant Devices,23.8,70,,23.8,percent of total billed charges,Implant Devices,23.12,34,,23.12,percent of total billed charges,Implant Devices,23.12,34,,23.12,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,23.8,35,,23.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27.2,
STRYKER 3425-1360S LONG NAIL KIT R1/5 RT,C1713,HCPCS,,79010518,CDM,278,RC,,,both,,,4969,1961.11,39.4668,,1961.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Device,1689.46,34,"Charges > $500, x 34%",1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1987.6,40,,1987.6,percent of total billed charges,Implant Devices,1739.15,70,,1739.15,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.46,34,"If Charge > 2,000, then 34 percent",1689.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.6,
ARTHREX AR-8940-28 CANCELLS SCREW,C1713,HCPCS,,79010519,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
EXACTECH SPC0523 TAPERED WEDGE 60MM,C1713,HCPCS,,79010539,CDM,278,RC,,,both,,,10625,4193.35,39.4668,,4193.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3718.75,35,,3718.75,percent of total billed charges,Implant Device,3612.5,34,"Charges > $500, x 34%",3612.5,percent of total billed charges,Implant Device,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,4250,40,,4250,percent of total billed charges,Implant Devices,3718.75,70,,3718.75,percent of total billed charges,Implant Devices,3612.5,34,,3612.5,percent of total billed charges,Implant Devices,3612.5,34,,3612.5,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3612.5,34,"If Charge > 2,000, then 34 percent",3612.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4250,
ZIMMER CS15000 CORTICAL SCREW 3.5X15MM,C1713,HCPCS,,79010540,CDM,278,RC,,,both,,,288,113.66,39.4668,,113.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,97.92,34,,97.92,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,115.2,40,,115.2,percent of total billed charges,Implant Devices,100.8,70,,100.8,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,97.92,34,,97.92,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,100.8,35,,100.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,115.2,
STRYKER 628227 LATERAL PLATE 7 HOLE RT,C1713,HCPCS,,79010541,CDM,278,RC,,,both,,,3785,1493.82,39.4668,,1493.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1324.75,35,,1324.75,percent of total billed charges,Implant Device,1286.9,34,"Charges > $500, x 34%",1286.9,percent of total billed charges,Implant Device,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1514,40,,1514,percent of total billed charges,Implant Devices,1324.75,70,,1324.75,percent of total billed charges,Implant Devices,1286.9,34,,1286.9,percent of total billed charges,Implant Devices,1286.9,34,,1286.9,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1286.9,34,"If Charge > 2,000, then 34 percent",1286.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1514,
STRYKER 657122 BONE SCREW 2.7X22MM,C1713,HCPCS,,79010542,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
STRYKER 657124 BONE SCREW 2.7X24MM,C1713,HCPCS,,79010543,CDM,278,RC,,,both,,,269,106.17,39.4668,,106.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,107.6,40,,107.6,percent of total billed charges,Implant Devices,94.15,70,,94.15,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.6,
STRYKER 657132 BONE SCREW 2.7X32MM,C1713,HCPCS,,79010544,CDM,278,RC,,,both,,,269,106.17,39.4668,,106.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,107.6,40,,107.6,percent of total billed charges,Implant Devices,94.15,70,,94.15,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.6,
ARTHREX AR-1662BCS =723S SWIVELOCK 7X23,C1713,HCPCS,,79010547,CDM,278,RC,,,both,,,2157,851.3,39.4668,,851.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,733.38,34,,733.38,percent of total billed charges,Implant Device,733.38,34,,733.38,percent of total billed charges,Implant Device,733.38,34,,733.38,percent of total billed charges,Implant Device,733.38,34,,733.38,percent of total billed charges,Implant Device,733.38,34,,733.38,percent of total billed charges,Implant Device,733.38,34,,733.38,percent of total billed charges,Implant Device,754.95,35,,754.95,percent of total billed charges,Implant Device,733.38,34,"Charges > $500, x 34%",733.38,percent of total billed charges,Implant Device,754.95,35,,754.95,percent of total billed charges,Implant Devices,754.95,35,,754.95,percent of total billed charges,Implant Devices,754.95,35,,,percent of total billed charges,Implant Devices,754.95,35,,754.95,percent of total billed charges,Implant Devices,754.95,35,,754.95,percent of total billed charges,Implant Devices,862.8,40,,862.8,percent of total billed charges,Implant Devices,754.95,70,,754.95,percent of total billed charges,Implant Devices,733.38,34,,733.38,percent of total billed charges,Implant Devices,733.38,34,,733.38,percent of total billed charges,Implant Devices,754.95,35,,754.95,percent of total billed charges,Implant Devices,754.95,35,,754.95,percent of total billed charges,Implant Devices,754.95,35,,754.95,percent of total billed charges,Implant Devices,754.95,35,,754.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,733.38,34,"If Charge > 2,000, then 34 percent",733.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,862.8,
DEPUY 02.112.013 CLAVICLE PLATE 3.5X94MM,C1713,HCPCS,,79010553,CDM,278,RC,,,both,,,2370,935.36,39.4668,,935.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,829.5,35,,829.5,percent of total billed charges,Implant Device,805.8,34,"Charges > $500, x 34%",805.8,percent of total billed charges,Implant Device,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,948,40,,948,percent of total billed charges,Implant Devices,829.5,70,,829.5,percent of total billed charges,Implant Devices,805.8,34,,805.8,percent of total billed charges,Implant Devices,805.8,34,,805.8,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,805.8,34,"If Charge > 2,000, then 34 percent",805.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,948,
STRYKER 658350 HEADLESS COMP SCREW 7X50,C1713,HCPCS,,79010555,CDM,278,RC,,,both,,,2079,820.51,39.4668,,820.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,727.65,35,,727.65,percent of total billed charges,Implant Device,706.86,34,"Charges > $500, x 34%",706.86,percent of total billed charges,Implant Device,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,831.6,40,,831.6,percent of total billed charges,Implant Devices,727.65,70,,727.65,percent of total billed charges,Implant Devices,706.86,34,,706.86,percent of total billed charges,Implant Devices,706.86,34,,706.86,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,706.86,34,"If Charge > 2,000, then 34 percent",706.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,831.6,
ARTHREX AR-2264 AC TIGHTROPE - TWIN TALE,C1713,HCPCS,,79010559,CDM,278,RC,,,both,,,1725,680.8,39.4668,,680.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,586.5,34,,586.5,percent of total billed charges,Implant Device,586.5,34,,586.5,percent of total billed charges,Implant Device,586.5,34,,586.5,percent of total billed charges,Implant Device,586.5,34,,586.5,percent of total billed charges,Implant Device,586.5,34,,586.5,percent of total billed charges,Implant Device,586.5,34,,586.5,percent of total billed charges,Implant Device,603.75,35,,603.75,percent of total billed charges,Implant Device,586.5,34,"Charges > $500, x 34%",586.5,percent of total billed charges,Implant Device,603.75,35,,603.75,percent of total billed charges,Implant Devices,603.75,35,,603.75,percent of total billed charges,Implant Devices,603.75,35,,,percent of total billed charges,Implant Devices,603.75,35,,603.75,percent of total billed charges,Implant Devices,603.75,35,,603.75,percent of total billed charges,Implant Devices,690,40,,690,percent of total billed charges,Implant Devices,603.75,70,,603.75,percent of total billed charges,Implant Devices,586.5,34,,586.5,percent of total billed charges,Implant Devices,586.5,34,,586.5,percent of total billed charges,Implant Devices,603.75,35,,603.75,percent of total billed charges,Implant Devices,603.75,35,,603.75,percent of total billed charges,Implant Devices,603.75,35,,603.75,percent of total billed charges,Implant Devices,603.75,35,,603.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,690,
STRYKER 5030-5-250 TRANSFIXING PIN,C1713,HCPCS,,79010565,CDM,278,RC,,,both,,,275,108.53,39.4668,,108.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.5,34,,93.5,percent of total billed charges,Implant Device,93.5,34,,93.5,percent of total billed charges,Implant Device,93.5,34,,93.5,percent of total billed charges,Implant Device,93.5,34,,93.5,percent of total billed charges,Implant Device,93.5,34,,93.5,percent of total billed charges,Implant Device,93.5,34,,93.5,percent of total billed charges,Implant Device,96.25,35,,96.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,110,40,,110,percent of total billed charges,Implant Devices,96.25,70,,96.25,percent of total billed charges,Implant Devices,93.5,34,,93.5,percent of total billed charges,Implant Devices,93.5,34,,93.5,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,96.25,35,,96.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110,
STRYKER 661146 5.6X46MM LOCKING SCREW,C1713,HCPCS,,79010566,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 661126 5X26MM LOCKING SCREW,C1713,HCPCS,,79010567,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 661180 5X80MM LOCKING SCREW,C1713,HCPCS,,79010568,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 608080 6X80MM CANCELLOUS SCREW,C1713,HCPCS,,79010569,CDM,278,RC,,,both,,,155,61.17,39.4668,,61.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,54.25,35,,54.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,62,40,,62,percent of total billed charges,Implant Devices,54.25,70,,54.25,percent of total billed charges,Implant Devices,52.7,34,,52.7,percent of total billed charges,Implant Devices,52.7,34,,52.7,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,62,
STRYKER 661736 4.5X36MM NON LOCK SCREW,C1713,HCPCS,,79010570,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
STRYKER 628008 PLATE 8 HOLE LEFT,C1713,HCPCS,,79010571,CDM,278,RC,,,both,,,3069,1211.24,39.4668,,1211.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1074.15,35,,1074.15,percent of total billed charges,Implant Device,1043.46,34,"Charges > $500, x 34%",1043.46,percent of total billed charges,Implant Device,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1227.6,40,,1227.6,percent of total billed charges,Implant Devices,1074.15,70,,1074.15,percent of total billed charges,Implant Devices,1043.46,34,,1043.46,percent of total billed charges,Implant Devices,1043.46,34,,1043.46,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1043.46,34,"If Charge > 2,000, then 34 percent",1043.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1227.6,
STRYKER 607346 4X4MM L46MM CAN TI SCREW,C1713,HCPCS,,79010576,CDM,278,RC,,,both,,,133,52.49,39.4668,,52.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,53.2,40,,53.2,percent of total billed charges,Implant Devices,46.55,70,,46.55,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
STRYKER 5026-8-120 HALF PIN 3/5X20X120MM,C1713,HCPCS,,79010577,CDM,278,RC,,,both,,,312,123.14,39.4668,,123.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,106.08,34,,106.08,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,124.8,40,,124.8,percent of total billed charges,Implant Devices,109.2,70,,109.2,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,106.08,34,,106.08,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,109.2,35,,109.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124.8,
STRYKER 629363 OLECRANON PLT RT 3H 65MM,C1713,HCPCS,,79010578,CDM,278,RC,,,both,,,2543,1003.64,39.4668,,1003.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Device,864.62,34,"Charges > $500, x 34%",864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,1017.2,40,,1017.2,percent of total billed charges,Implant Devices,890.05,70,,890.05,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,864.62,34,"If Charge > 2,000, then 34 percent",864.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1017.2,
DEPUY 04.005.420S LOCK SCREW 4X30MM,C1713,HCPCS,,79010580,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
DEPUY 02.211.139S 2.7X3.5MM DISTAL PLATE,C1713,HCPCS,,79010585,CDM,278,RC,,,both,,,1757,693.43,39.4668,,693.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,597.38,34,,597.38,percent of total billed charges,Implant Device,597.38,34,,597.38,percent of total billed charges,Implant Device,597.38,34,,597.38,percent of total billed charges,Implant Device,597.38,34,,597.38,percent of total billed charges,Implant Device,597.38,34,,597.38,percent of total billed charges,Implant Device,597.38,34,,597.38,percent of total billed charges,Implant Device,614.95,35,,614.95,percent of total billed charges,Implant Device,597.38,34,"Charges > $500, x 34%",597.38,percent of total billed charges,Implant Device,614.95,35,,614.95,percent of total billed charges,Implant Devices,614.95,35,,614.95,percent of total billed charges,Implant Devices,614.95,35,,,percent of total billed charges,Implant Devices,614.95,35,,614.95,percent of total billed charges,Implant Devices,614.95,35,,614.95,percent of total billed charges,Implant Devices,702.8,40,,702.8,percent of total billed charges,Implant Devices,614.95,70,,614.95,percent of total billed charges,Implant Devices,597.38,34,,597.38,percent of total billed charges,Implant Devices,597.38,34,,597.38,percent of total billed charges,Implant Devices,614.95,35,,614.95,percent of total billed charges,Implant Devices,614.95,35,,614.95,percent of total billed charges,Implant Devices,614.95,35,,614.95,percent of total billed charges,Implant Devices,614.95,35,,614.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,702.8,
STRYKER 1896-5025S TS2 LOCK SCREW 5X25MM,C1713,HCPCS,,79010586,CDM,278,RC,,,both,,,441,174.05,39.4668,,174.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,149.94,34,,149.94,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,176.4,40,,176.4,percent of total billed charges,Implant Devices,154.35,70,,154.35,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,149.94,34,,149.94,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,154.35,35,,154.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,176.4,
ZIMMER 00-5983-040-33 HEADED SCREW 33MM,C1713,HCPCS,,79010588,CDM,278,RC,,,both,,,237,93.54,39.4668,,93.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,80.58,34,,80.58,percent of total billed charges,Implant Device,80.58,34,,80.58,percent of total billed charges,Implant Device,80.58,34,,80.58,percent of total billed charges,Implant Device,80.58,34,,80.58,percent of total billed charges,Implant Device,80.58,34,,80.58,percent of total billed charges,Implant Device,80.58,34,,80.58,percent of total billed charges,Implant Device,82.95,35,,82.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,94.8,40,,94.8,percent of total billed charges,Implant Devices,82.95,70,,82.95,percent of total billed charges,Implant Devices,80.58,34,,80.58,percent of total billed charges,Implant Devices,80.58,34,,80.58,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,82.95,35,,82.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,94.8,
DEPUY 02.112.091 CLAV PLT 6H 3.5X105MM,C1713,HCPCS,,79010603,CDM,278,RC,,,both,,,2397,946.02,39.4668,,946.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,838.95,35,,838.95,percent of total billed charges,Implant Device,814.98,34,"Charges > $500, x 34%",814.98,percent of total billed charges,Implant Device,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,958.8,40,,958.8,percent of total billed charges,Implant Devices,838.95,70,,838.95,percent of total billed charges,Implant Devices,814.98,34,,814.98,percent of total billed charges,Implant Devices,814.98,34,,814.98,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,814.98,34,"If Charge > 2,000, then 34 percent",814.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,958.8,
DEPUY 201.368.97 CORTEX SCREW 2X18MM,C1713,HCPCS,,79010604,CDM,278,RC,,,both,,,93,36.7,39.4668,,36.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,32.55,35,,32.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,37.2,40,,37.2,percent of total billed charges,Implant Devices,32.55,70,,32.55,percent of total billed charges,Implant Devices,31.62,34,,31.62,percent of total billed charges,Implant Devices,31.62,34,,31.62,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,37.2,
STRYKER 1236-2-854 ADM X3 INSERT ID 28MM,C1713,HCPCS,,79010613,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 6210-0-710 FLEX OSTEO 12X120MM,C1713,HCPCS,,79010614,CDM,278,RC,,,both,,,1809,713.95,39.4668,,713.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,615.06,34,,615.06,percent of total billed charges,Implant Device,615.06,34,,615.06,percent of total billed charges,Implant Device,615.06,34,,615.06,percent of total billed charges,Implant Device,615.06,34,,615.06,percent of total billed charges,Implant Device,615.06,34,,615.06,percent of total billed charges,Implant Device,615.06,34,,615.06,percent of total billed charges,Implant Device,633.15,35,,633.15,percent of total billed charges,Implant Device,615.06,34,"Charges > $500, x 34%",615.06,percent of total billed charges,Implant Device,633.15,35,,633.15,percent of total billed charges,Implant Devices,633.15,35,,633.15,percent of total billed charges,Implant Devices,633.15,35,,,percent of total billed charges,Implant Devices,633.15,35,,633.15,percent of total billed charges,Implant Devices,633.15,35,,633.15,percent of total billed charges,Implant Devices,723.6,40,,723.6,percent of total billed charges,Implant Devices,633.15,70,,633.15,percent of total billed charges,Implant Devices,615.06,34,,615.06,percent of total billed charges,Implant Devices,615.06,34,,615.06,percent of total billed charges,Implant Devices,633.15,35,,633.15,percent of total billed charges,Implant Devices,633.15,35,,633.15,percent of total billed charges,Implant Devices,633.15,35,,633.15,percent of total billed charges,Implant Devices,633.15,35,,633.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,723.6,
STRYKER 2341-0931S TIBIAL NAIL 09X315MM,C1713,HCPCS,,79010617,CDM,278,RC,,,both,,,4792,1891.25,39.4668,,1891.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Device,1629.28,34,"Charges > $500, x 34%",1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1916.8,40,,1916.8,percent of total billed charges,Implant Devices,1677.2,70,,1677.2,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.28,34,"If Charge > 2,000, then 34 percent",1629.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1916.8,
STRYKER 2360-5035S LOCK SCREW 5X35MM,C1713,HCPCS,,79010618,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
STRYKER 2360-5050S LOCK SCREW 5X50MM,C1713,HCPCS,,79010619,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
DEPUY 456.396S FIXATION NAIL 11MM/126,C1713,HCPCS,,79010620,CDM,278,RC,,,both,,,3604,1422.38,39.4668,,1422.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1225.36,34,,1225.36,percent of total billed charges,Implant Device,1225.36,34,,1225.36,percent of total billed charges,Implant Device,1225.36,34,,1225.36,percent of total billed charges,Implant Device,1225.36,34,,1225.36,percent of total billed charges,Implant Device,1225.36,34,,1225.36,percent of total billed charges,Implant Device,1225.36,34,,1225.36,percent of total billed charges,Implant Device,1261.4,35,,1261.4,percent of total billed charges,Implant Device,1225.36,34,"Charges > $500, x 34%",1225.36,percent of total billed charges,Implant Device,1261.4,35,,1261.4,percent of total billed charges,Implant Devices,1261.4,35,,1261.4,percent of total billed charges,Implant Devices,1261.4,35,,,percent of total billed charges,Implant Devices,1261.4,35,,1261.4,percent of total billed charges,Implant Devices,1261.4,35,,1261.4,percent of total billed charges,Implant Devices,1441.6,40,,1441.6,percent of total billed charges,Implant Devices,1261.4,70,,1261.4,percent of total billed charges,Implant Devices,1225.36,34,,1225.36,percent of total billed charges,Implant Devices,1225.36,34,,1225.36,percent of total billed charges,Implant Devices,1261.4,35,,1261.4,percent of total billed charges,Implant Devices,1261.4,35,,1261.4,percent of total billed charges,Implant Devices,1261.4,35,,1261.4,percent of total billed charges,Implant Devices,1261.4,35,,1261.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1225.36,34,"If Charge > 2,000, then 34 percent",1225.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1441.6,
STRYKER 608070 6MM CANCELLOUS TI SCREW,C1713,HCPCS,,79010621,CDM,278,RC,,,both,,,155,61.17,39.4668,,61.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,52.7,34,,52.7,percent of total billed charges,Implant Device,54.25,35,,54.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,62,40,,62,percent of total billed charges,Implant Devices,54.25,70,,54.25,percent of total billed charges,Implant Devices,52.7,34,,52.7,percent of total billed charges,Implant Devices,52.7,34,,52.7,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,54.25,35,,54.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,62,
STRYKER 627642 DISTAL LATERAL PLATE 12H,C1713,HCPCS,,79010622,CDM,278,RC,,,both,,,7836,3092.62,39.4668,,3092.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2664.24,34,,2664.24,percent of total billed charges,Implant Device,2664.24,34,,2664.24,percent of total billed charges,Implant Device,2664.24,34,,2664.24,percent of total billed charges,Implant Device,2664.24,34,,2664.24,percent of total billed charges,Implant Device,2664.24,34,,2664.24,percent of total billed charges,Implant Device,2664.24,34,,2664.24,percent of total billed charges,Implant Device,2742.6,35,,2742.6,percent of total billed charges,Implant Device,2664.24,34,"Charges > $500, x 34%",2664.24,percent of total billed charges,Implant Device,2742.6,35,,2742.6,percent of total billed charges,Implant Devices,2742.6,35,,2742.6,percent of total billed charges,Implant Devices,2742.6,35,,,percent of total billed charges,Implant Devices,2742.6,35,,2742.6,percent of total billed charges,Implant Devices,2742.6,35,,2742.6,percent of total billed charges,Implant Devices,3134.4,40,,3134.4,percent of total billed charges,Implant Devices,2742.6,70,,2742.6,percent of total billed charges,Implant Devices,2664.24,34,,2664.24,percent of total billed charges,Implant Devices,2664.24,34,,2664.24,percent of total billed charges,Implant Devices,2742.6,35,,2742.6,percent of total billed charges,Implant Devices,2742.6,35,,2742.6,percent of total billed charges,Implant Devices,2742.6,35,,2742.6,percent of total billed charges,Implant Devices,2742.6,35,,2742.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2664.24,34,"If Charge > 2,000, then 34 percent",2664.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3134.4,
ZIMMER CS110000 CORTICAL SCREW 3.5X11MM,C1713,HCPCS,,79010623,CDM,278,RC,,,both,,,510,201.28,39.4668,,201.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Device,173.4,34,"Charges > $500, x 34%",173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,204,40,,204,percent of total billed charges,Implant Devices,178.5,70,,178.5,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204,
IN2BONES P65 ST555 COLAG SCREW 5.0X55MM,C1713,HCPCS,,79010627,CDM,278,RC,,,both,,,2508,989.83,39.4668,,989.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,852.72,34,,852.72,percent of total billed charges,Implant Device,852.72,34,,852.72,percent of total billed charges,Implant Device,852.72,34,,852.72,percent of total billed charges,Implant Device,852.72,34,,852.72,percent of total billed charges,Implant Device,852.72,34,,852.72,percent of total billed charges,Implant Device,852.72,34,,852.72,percent of total billed charges,Implant Device,877.8,35,,877.8,percent of total billed charges,Implant Device,852.72,34,"Charges > $500, x 34%",852.72,percent of total billed charges,Implant Device,877.8,35,,877.8,percent of total billed charges,Implant Devices,877.8,35,,877.8,percent of total billed charges,Implant Devices,877.8,35,,,percent of total billed charges,Implant Devices,877.8,35,,877.8,percent of total billed charges,Implant Devices,877.8,35,,877.8,percent of total billed charges,Implant Devices,1003.2,40,,1003.2,percent of total billed charges,Implant Devices,877.8,70,,877.8,percent of total billed charges,Implant Devices,852.72,34,,852.72,percent of total billed charges,Implant Devices,852.72,34,,852.72,percent of total billed charges,Implant Devices,877.8,35,,877.8,percent of total billed charges,Implant Devices,877.8,35,,877.8,percent of total billed charges,Implant Devices,877.8,35,,877.8,percent of total billed charges,Implant Devices,877.8,35,,877.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,852.72,34,"If Charge > 2,000, then 34 percent",852.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1003.2,
IN2BONES P65 ST050 WASHER 5.0MM,C1713,HCPCS,,79010628,CDM,278,RC,,,both,,,1185,467.68,39.4668,,467.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,402.9,34,,402.9,percent of total billed charges,Implant Device,402.9,34,,402.9,percent of total billed charges,Implant Device,402.9,34,,402.9,percent of total billed charges,Implant Device,402.9,34,,402.9,percent of total billed charges,Implant Device,402.9,34,,402.9,percent of total billed charges,Implant Device,402.9,34,,402.9,percent of total billed charges,Implant Device,414.75,35,,414.75,percent of total billed charges,Implant Device,402.9,34,"Charges > $500, x 34%",402.9,percent of total billed charges,Implant Device,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,474,40,,474,percent of total billed charges,Implant Devices,414.75,70,,414.75,percent of total billed charges,Implant Devices,402.9,34,,402.9,percent of total billed charges,Implant Devices,402.9,34,,402.9,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,414.75,35,,414.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,474,
STRYKER 657336 3.5/L36MM LOCKING SCREW,C1713,HCPCS,,79010639,CDM,278,RC,,,both,,,494,194.97,39.4668,,194.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,197.6,40,,197.6,percent of total billed charges,Implant Devices,172.9,70,,172.9,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.6,
STRYKER 657440 3.5/L40MM BONE SCREW,C1713,HCPCS,,79010640,CDM,278,RC,,,both,,,269,106.17,39.4668,,106.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,107.6,40,,107.6,percent of total billed charges,Implant Devices,94.15,70,,94.15,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.6,
IN2BONES P73 ST114 3.5X14MM LOCK SCREW,C1713,HCPCS,,79010641,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
EXACTECH 308-15-12 LOCK SCREW SIZE 12.5,C1713,HCPCS,,79010644,CDM,278,RC,,,both,,,1752,691.46,39.4668,,691.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,595.68,34,,595.68,percent of total billed charges,Implant Device,595.68,34,,595.68,percent of total billed charges,Implant Device,595.68,34,,595.68,percent of total billed charges,Implant Device,595.68,34,,595.68,percent of total billed charges,Implant Device,595.68,34,,595.68,percent of total billed charges,Implant Device,595.68,34,,595.68,percent of total billed charges,Implant Device,613.2,35,,613.2,percent of total billed charges,Implant Device,595.68,34,"Charges > $500, x 34%",595.68,percent of total billed charges,Implant Device,613.2,35,,613.2,percent of total billed charges,Implant Devices,613.2,35,,613.2,percent of total billed charges,Implant Devices,613.2,35,,,percent of total billed charges,Implant Devices,613.2,35,,613.2,percent of total billed charges,Implant Devices,613.2,35,,613.2,percent of total billed charges,Implant Devices,700.8,40,,700.8,percent of total billed charges,Implant Devices,613.2,70,,613.2,percent of total billed charges,Implant Devices,595.68,34,,595.68,percent of total billed charges,Implant Devices,595.68,34,,595.68,percent of total billed charges,Implant Devices,613.2,35,,613.2,percent of total billed charges,Implant Devices,613.2,35,,613.2,percent of total billed charges,Implant Devices,613.2,35,,613.2,percent of total billed charges,Implant Devices,613.2,35,,613.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,700.8,
ZIMMER 8163-35-020 MDS SCREW 3.5X20MM,C1713,HCPCS,,79010647,CDM,278,RC,,,both,,,1080,426.24,39.4668,,426.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,367.2,34,,367.2,percent of total billed charges,Implant Device,378,35,,378,percent of total billed charges,Implant Device,367.2,34,"Charges > $500, x 34%",367.2,percent of total billed charges,Implant Device,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,432,40,,432,percent of total billed charges,Implant Devices,378,70,,378,percent of total billed charges,Implant Devices,367.2,34,,367.2,percent of total billed charges,Implant Devices,367.2,34,,367.2,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,378,35,,378,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,432,
ZIMMER 8161-35-024 CORT SCRW 3.5X24MM,C1713,HCPCS,,79010648,CDM,278,RC,,,both,,,780,307.84,39.4668,,307.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Device,265.2,34,"Charges > $500, x 34%",265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,312,40,,312,percent of total billed charges,Implant Devices,273,70,,273,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,312,
IN2BONES P92 ST015 CORT SCREW 2.4X15MM,C1713,HCPCS,,79010650,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
IN2BONES P92 ST016 CORT SCREW 2.4X16MM,C1713,HCPCS,,79010651,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
STRYKER CALCANEUS MESH PLATE,C1713,HCPCS,,79010655,CDM,278,RC,,,both,,,2174,858.01,39.4668,,858.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,739.16,34,,739.16,percent of total billed charges,Implant Device,739.16,34,,739.16,percent of total billed charges,Implant Device,739.16,34,,739.16,percent of total billed charges,Implant Device,739.16,34,,739.16,percent of total billed charges,Implant Device,739.16,34,,739.16,percent of total billed charges,Implant Device,739.16,34,,739.16,percent of total billed charges,Implant Device,760.9,35,,760.9,percent of total billed charges,Implant Device,739.16,34,"Charges > $500, x 34%",739.16,percent of total billed charges,Implant Device,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,869.6,40,,869.6,percent of total billed charges,Implant Devices,760.9,70,,760.9,percent of total billed charges,Implant Devices,739.16,34,,739.16,percent of total billed charges,Implant Devices,739.16,34,,739.16,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,760.9,35,,760.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,739.16,34,"If Charge > 2,000, then 34 percent",739.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,869.6,
STRYKER 5027-4-180 APEX HALF PIN 4X180MM,C1713,HCPCS,,79010656,CDM,278,RC,,,both,,,148,58.41,39.4668,,58.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,50.32,34,,50.32,percent of total billed charges,Implant Device,51.8,35,,51.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,59.2,40,,59.2,percent of total billed charges,Implant Devices,51.8,70,,51.8,percent of total billed charges,Implant Devices,50.32,34,,50.32,percent of total billed charges,Implant Devices,50.32,34,,50.32,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,51.8,35,,51.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,59.2,
EXACTECH 314-13-24 CAGE GLENOID LEFT,C1713,HCPCS,,79010661,CDM,278,RC,,,both,,,9834,3881.17,39.4668,,3881.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3343.56,34,,3343.56,percent of total billed charges,Implant Device,3441.9,35,,3441.9,percent of total billed charges,Implant Device,3343.56,34,"Charges > $500, x 34%",3343.56,percent of total billed charges,Implant Device,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3933.6,40,,3933.6,percent of total billed charges,Implant Devices,3441.9,70,,3441.9,percent of total billed charges,Implant Devices,3343.56,34,,3343.56,percent of total billed charges,Implant Devices,3343.56,34,,3343.56,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,3441.9,35,,3441.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3343.56,34,"If Charge > 2,000, then 34 percent",3343.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3933.6,
IN2BONES P67 ST426 CANN SCREW 4.0X26MM,C1713,HCPCS,,79010665,CDM,278,RC,,,both,,,1485,586.08,39.4668,,586.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Device,504.9,34,"Charges > $500, x 34%",504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,594,40,,594,percent of total billed charges,Implant Devices,519.75,70,,519.75,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,594,
IN2BONES P67 ST430 CANN SCREW 4.0X30MM,C1713,HCPCS,,79010666,CDM,278,RC,,,both,,,1485,586.08,39.4668,,586.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Device,504.9,34,"Charges > $500, x 34%",504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,594,40,,594,percent of total billed charges,Implant Devices,519.75,70,,519.75,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,594,
IN2BONES P40 ST237 MTP PLATE LEFT,C1713,HCPCS,,79010667,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
STRYKER 57-10310 T PLATE 1.7MM 10 HOLE,C1713,HCPCS,,79010668,CDM,278,RC,,,both,,,1322,521.75,39.4668,,521.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,449.48,34,,449.48,percent of total billed charges,Implant Device,449.48,34,,449.48,percent of total billed charges,Implant Device,449.48,34,,449.48,percent of total billed charges,Implant Device,449.48,34,,449.48,percent of total billed charges,Implant Device,449.48,34,,449.48,percent of total billed charges,Implant Device,449.48,34,,449.48,percent of total billed charges,Implant Device,462.7,35,,462.7,percent of total billed charges,Implant Device,449.48,34,"Charges > $500, x 34%",449.48,percent of total billed charges,Implant Device,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,528.8,40,,528.8,percent of total billed charges,Implant Devices,462.7,70,,462.7,percent of total billed charges,Implant Devices,449.48,34,,449.48,percent of total billed charges,Implant Devices,449.48,34,,449.48,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,528.8,
STRYKER 623-10-36F INSERT 10 DEGREE 36MM,C1713,HCPCS,,79010669,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 57-10310 HAND LOCK T PLATE,C1713,HCPCS,,79010670,CDM,278,RC,,,both,,,1322,521.75,39.4668,,521.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,449.48,34,,449.48,percent of total billed charges,Implant Device,449.48,34,,449.48,percent of total billed charges,Implant Device,449.48,34,,449.48,percent of total billed charges,Implant Device,449.48,34,,449.48,percent of total billed charges,Implant Device,449.48,34,,449.48,percent of total billed charges,Implant Device,449.48,34,,449.48,percent of total billed charges,Implant Device,462.7,35,,462.7,percent of total billed charges,Implant Device,449.48,34,"Charges > $500, x 34%",449.48,percent of total billed charges,Implant Device,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,528.8,40,,528.8,percent of total billed charges,Implant Devices,462.7,70,,462.7,percent of total billed charges,Implant Devices,449.48,34,,449.48,percent of total billed charges,Implant Devices,449.48,34,,449.48,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,462.7,35,,462.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,528.8,
STRYKER 663711 LOCKING SCREW 2.3X11MM,C1713,HCPCS,,79010671,CDM,278,RC,,,both,,,468,184.7,39.4668,,184.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,187.2,40,,187.2,percent of total billed charges,Implant Devices,163.8,70,,163.8,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.2,
STRYKER 663712 LOCKING SCREW 2.3X12MM,C1713,HCPCS,,79010672,CDM,278,RC,,,both,,,468,184.7,39.4668,,184.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,159.12,34,,159.12,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,187.2,40,,187.2,percent of total billed charges,Implant Devices,163.8,70,,163.8,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,159.12,34,,159.12,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,163.8,35,,163.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,187.2,
STRYKER 663808 BONE SCREW 2.3X8MM,C1713,HCPCS,,79010673,CDM,278,RC,,,both,,,368,145.24,39.4668,,145.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,128.8,35,,128.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,147.2,40,,147.2,percent of total billed charges,Implant Devices,128.8,70,,128.8,percent of total billed charges,Implant Devices,125.12,34,,125.12,percent of total billed charges,Implant Devices,125.12,34,,125.12,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,147.2,
STRYKER 663812 BONE SCREW 2.3X12MM,C1713,HCPCS,,79010674,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER 663813 BONE SCREW 2.3X13MM,C1713,HCPCS,,79010675,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER 663815 BONE SCREW 2.3X15MM,C1713,HCPCS,,79010676,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER 2333-0934S FEMORAL NAIL 9X340MM,C1713,HCPCS,,79010678,CDM,278,RC,,,both,,,7570,2987.64,39.4668,,2987.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2649.5,35,,2649.5,percent of total billed charges,Implant Device,2573.8,34,"Charges > $500, x 34%",2573.8,percent of total billed charges,Implant Device,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,3028,40,,3028,percent of total billed charges,Implant Devices,2649.5,70,,2649.5,percent of total billed charges,Implant Devices,2573.8,34,,2573.8,percent of total billed charges,Implant Devices,2573.8,34,,2573.8,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2573.8,34,"If Charge > 2,000, then 34 percent",2573.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3028,
STRYKER 2360-5032S LOCKING SCREW 5X32MM,C1713,HCPCS,,79010679,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
STRYKER 2360-5052S LOCKING SCREW 5X52MM,C1713,HCPCS,,79010680,CDM,278,RC,,,both,,,762,300.74,39.4668,,300.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,266.7,35,,266.7,percent of total billed charges,Implant Device,259.08,34,"Charges > $500, x 34%",259.08,percent of total billed charges,Implant Device,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,304.8,40,,304.8,percent of total billed charges,Implant Devices,266.7,70,,266.7,percent of total billed charges,Implant Devices,259.08,34,,259.08,percent of total billed charges,Implant Devices,259.08,34,,259.08,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,304.8,
STRYKER 626983 Y PLATE 3 SHAFT HOLES,C1713,HCPCS,,79010683,CDM,278,RC,,,both,,,3198,1262.15,39.4668,,1262.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1087.32,34,,1087.32,percent of total billed charges,Implant Device,1087.32,34,,1087.32,percent of total billed charges,Implant Device,1087.32,34,,1087.32,percent of total billed charges,Implant Device,1087.32,34,,1087.32,percent of total billed charges,Implant Device,1087.32,34,,1087.32,percent of total billed charges,Implant Device,1087.32,34,,1087.32,percent of total billed charges,Implant Device,1119.3,35,,1119.3,percent of total billed charges,Implant Device,1087.32,34,"Charges > $500, x 34%",1087.32,percent of total billed charges,Implant Device,1119.3,35,,1119.3,percent of total billed charges,Implant Devices,1119.3,35,,1119.3,percent of total billed charges,Implant Devices,1119.3,35,,,percent of total billed charges,Implant Devices,1119.3,35,,1119.3,percent of total billed charges,Implant Devices,1119.3,35,,1119.3,percent of total billed charges,Implant Devices,1279.2,40,,1279.2,percent of total billed charges,Implant Devices,1119.3,70,,1119.3,percent of total billed charges,Implant Devices,1087.32,34,,1087.32,percent of total billed charges,Implant Devices,1087.32,34,,1087.32,percent of total billed charges,Implant Devices,1119.3,35,,1119.3,percent of total billed charges,Implant Devices,1119.3,35,,1119.3,percent of total billed charges,Implant Devices,1119.3,35,,1119.3,percent of total billed charges,Implant Devices,1119.3,35,,1119.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1087.32,34,"If Charge > 2,000, then 34 percent",1087.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1279.2,
ARTHREX AR-7234PSL SWIVERLOCK FORK 4.75,C1713,HCPCS,,79010685,CDM,278,RC,,,both,,,1305,515.04,39.4668,,515.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,456.75,35,,456.75,percent of total billed charges,Implant Device,443.7,34,"Charges > $500, x 34%",443.7,percent of total billed charges,Implant Device,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,522,40,,522,percent of total billed charges,Implant Devices,456.75,70,,456.75,percent of total billed charges,Implant Devices,443.7,34,,443.7,percent of total billed charges,Implant Devices,443.7,34,,443.7,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,522,
LIFENET HEALTH FCON FLEXIGRAFT TENDON,C1713,HCPCS,,79010686,CDM,278,RC,,,both,,,4314,1702.6,39.4668,,1702.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1466.76,34,,1466.76,percent of total billed charges,Implant Device,1466.76,34,,1466.76,percent of total billed charges,Implant Device,1466.76,34,,1466.76,percent of total billed charges,Implant Device,1466.76,34,,1466.76,percent of total billed charges,Implant Device,1466.76,34,,1466.76,percent of total billed charges,Implant Device,1466.76,34,,1466.76,percent of total billed charges,Implant Device,1509.9,35,,1509.9,percent of total billed charges,Implant Device,1466.76,34,"Charges > $500, x 34%",1466.76,percent of total billed charges,Implant Device,1509.9,35,,1509.9,percent of total billed charges,Implant Devices,1509.9,35,,1509.9,percent of total billed charges,Implant Devices,1509.9,35,,,percent of total billed charges,Implant Devices,1509.9,35,,1509.9,percent of total billed charges,Implant Devices,1509.9,35,,1509.9,percent of total billed charges,Implant Devices,1725.6,40,,1725.6,percent of total billed charges,Implant Devices,1509.9,70,,1509.9,percent of total billed charges,Implant Devices,1466.76,34,,1466.76,percent of total billed charges,Implant Devices,1466.76,34,,1466.76,percent of total billed charges,Implant Devices,1509.9,35,,1509.9,percent of total billed charges,Implant Devices,1509.9,35,,1509.9,percent of total billed charges,Implant Devices,1509.9,35,,1509.9,percent of total billed charges,Implant Devices,1509.9,35,,1509.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1466.76,34,"If Charge > 2,000, then 34 percent",1466.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1725.6,
DEPUY 202.222 2.7 x 22MM LOCKING SCREW,C1713,HCPCS,,79010687,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
DEPUY 02.112.011 CLAVCL PLATE 3.5 X 81MM,C1713,HCPCS,,79010688,CDM,278,RC,,,both,,,2331,919.97,39.4668,,919.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,792.54,34,,792.54,percent of total billed charges,Implant Device,792.54,34,,792.54,percent of total billed charges,Implant Device,792.54,34,,792.54,percent of total billed charges,Implant Device,792.54,34,,792.54,percent of total billed charges,Implant Device,792.54,34,,792.54,percent of total billed charges,Implant Device,792.54,34,,792.54,percent of total billed charges,Implant Device,815.85,35,,815.85,percent of total billed charges,Implant Device,792.54,34,"Charges > $500, x 34%",792.54,percent of total billed charges,Implant Device,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,932.4,40,,932.4,percent of total billed charges,Implant Devices,815.85,70,,815.85,percent of total billed charges,Implant Devices,792.54,34,,792.54,percent of total billed charges,Implant Devices,792.54,34,,792.54,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,815.85,35,,815.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,792.54,34,"If Charge > 2,000, then 34 percent",792.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,932.4,
ZIMMER 00-7711-012-10 FEMORAL STEM 12/14,C1713,HCPCS,,79010693,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
STRYKER 627344 LATERAL TIBIA PLATE HOLE,C1713,HCPCS,,79010696,CDM,278,RC,,,both,,,6669,2632.04,39.4668,,2632.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2267.46,34,,2267.46,percent of total billed charges,Implant Device,2267.46,34,,2267.46,percent of total billed charges,Implant Device,2267.46,34,,2267.46,percent of total billed charges,Implant Device,2267.46,34,,2267.46,percent of total billed charges,Implant Device,2267.46,34,,2267.46,percent of total billed charges,Implant Device,2267.46,34,,2267.46,percent of total billed charges,Implant Device,2334.15,35,,2334.15,percent of total billed charges,Implant Device,2267.46,34,"Charges > $500, x 34%",2267.46,percent of total billed charges,Implant Device,2334.15,35,,2334.15,percent of total billed charges,Implant Devices,2334.15,35,,2334.15,percent of total billed charges,Implant Devices,2334.15,35,,,percent of total billed charges,Implant Devices,2334.15,35,,2334.15,percent of total billed charges,Implant Devices,2334.15,35,,2334.15,percent of total billed charges,Implant Devices,2667.6,40,,2667.6,percent of total billed charges,Implant Devices,2334.15,70,,2334.15,percent of total billed charges,Implant Devices,2267.46,34,,2267.46,percent of total billed charges,Implant Devices,2267.46,34,,2267.46,percent of total billed charges,Implant Devices,2334.15,35,,2334.15,percent of total billed charges,Implant Devices,2334.15,35,,2334.15,percent of total billed charges,Implant Devices,2334.15,35,,2334.15,percent of total billed charges,Implant Devices,2334.15,35,,2334.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2267.46,34,"If Charge > 2,000, then 34 percent",2267.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2667.6,
STRYKER 7030-6515 SCREW 6.5X15MM,C1713,HCPCS,,79010705,CDM,278,RC,,,both,,,159,62.75,39.4668,,62.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,63.6,40,,63.6,percent of total billed charges,Implant Devices,55.65,70,,55.65,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63.6,
STRYKER 7030-6525 HEX SCREW 6.5X25MM,C1713,HCPCS,,79010709,CDM,278,RC,,,both,,,159,62.75,39.4668,,62.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,63.6,40,,63.6,percent of total billed charges,Implant Devices,55.65,70,,55.65,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63.6,
ARTHREX AR-8933V-14 3X14MM VAL SCREW,C1713,HCPCS,,79010736,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
ARTHREX AR-8935-10 3.5X10 LO PRO SCREW,C1713,HCPCS,,79010737,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-9943BL-05 LOCK DIS PLT LT,C1713,HCPCS,,79010739,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
STRYKER 629537 COMPRESSION PLT 7H 91MM,C1713,HCPCS,,79010752,CDM,278,RC,,,both,,,1172,462.55,39.4668,,462.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,398.48,34,,398.48,percent of total billed charges,Implant Device,398.48,34,,398.48,percent of total billed charges,Implant Device,398.48,34,,398.48,percent of total billed charges,Implant Device,398.48,34,,398.48,percent of total billed charges,Implant Device,398.48,34,,398.48,percent of total billed charges,Implant Device,398.48,34,,398.48,percent of total billed charges,Implant Device,410.2,35,,410.2,percent of total billed charges,Implant Device,398.48,34,"Charges > $500, x 34%",398.48,percent of total billed charges,Implant Device,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,468.8,40,,468.8,percent of total billed charges,Implant Devices,410.2,70,,410.2,percent of total billed charges,Implant Devices,398.48,34,,398.48,percent of total billed charges,Implant Devices,398.48,34,,398.48,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,468.8,
STRYKER 629746 BROAD LOCK PLATE 2.7X56MM,C1713,HCPCS,,79010753,CDM,278,RC,,,both,,,3318,1309.51,39.4668,,1309.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1161.3,35,,1161.3,percent of total billed charges,Implant Device,1128.12,34,"Charges > $500, x 34%",1128.12,percent of total billed charges,Implant Device,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1327.2,40,,1327.2,percent of total billed charges,Implant Devices,1161.3,70,,1161.3,percent of total billed charges,Implant Devices,1128.12,34,,1128.12,percent of total billed charges,Implant Devices,1128.12,34,,1128.12,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1128.12,34,"If Charge > 2,000, then 34 percent",1128.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1327.2,
STRYKER 656415 BONE SCREW 2.7X15MM,C1713,HCPCS,,79010754,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
STRYKER 628225 SUPERIOR LATERL PLATE 5,C1713,HCPCS,,79010761,CDM,278,RC,,,both,,,3069,1211.24,39.4668,,1211.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1074.15,35,,1074.15,percent of total billed charges,Implant Device,1043.46,34,"Charges > $500, x 34%",1043.46,percent of total billed charges,Implant Device,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1227.6,40,,1227.6,percent of total billed charges,Implant Devices,1074.15,70,,1074.15,percent of total billed charges,Implant Devices,1043.46,34,,1043.46,percent of total billed charges,Implant Devices,1043.46,34,,1043.46,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1043.46,34,"If Charge > 2,000, then 34 percent",1043.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1227.6,
STRYKER 657008 LOCKING SCREW 2.7X8MM,C1713,HCPCS,,79010762,CDM,278,RC,,,both,,,494,194.97,39.4668,,194.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,197.6,40,,197.6,percent of total billed charges,Implant Devices,172.9,70,,172.9,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.6,
STRYKER ORTHO 657110 BONE SCREW 2.7X10MM,C1713,HCPCS,,79010763,CDM,278,RC,,,both,,,269,106.17,39.4668,,106.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,91.46,34,,91.46,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,107.6,40,,107.6,percent of total billed charges,Implant Devices,94.15,70,,94.15,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,91.46,34,,91.46,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,94.15,35,,94.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,107.6,
STRYKER ORTHO 626982 PLATE 2 SHAFT HOLES,C1713,HCPCS,,79010764,CDM,278,RC,,,both,,,3200,1262.94,39.4668,,1262.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1088,34,,1088,percent of total billed charges,Implant Device,1088,34,,1088,percent of total billed charges,Implant Device,1088,34,,1088,percent of total billed charges,Implant Device,1088,34,,1088,percent of total billed charges,Implant Device,1088,34,,1088,percent of total billed charges,Implant Device,1088,34,,1088,percent of total billed charges,Implant Device,1120,35,,1120,percent of total billed charges,Implant Device,1088,34,"Charges > $500, x 34%",1088,percent of total billed charges,Implant Device,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1280,40,,1280,percent of total billed charges,Implant Devices,1120,70,,1120,percent of total billed charges,Implant Devices,1088,34,,1088,percent of total billed charges,Implant Devices,1088,34,,1088,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,1120,35,,1120,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1088,34,"If Charge > 2,000, then 34 percent",1088,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1280,
ARTHREX AR-8978P SWIVELOCK SL 3.5X8.5MM,C1713,HCPCS,,79010766,CDM,278,RC,,,both,,,1824,719.87,39.4668,,719.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,620.16,34,,620.16,percent of total billed charges,Implant Device,638.4,35,,638.4,percent of total billed charges,Implant Device,620.16,34,"Charges > $500, x 34%",620.16,percent of total billed charges,Implant Device,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,729.6,40,,729.6,percent of total billed charges,Implant Devices,638.4,70,,638.4,percent of total billed charges,Implant Devices,620.16,34,,620.16,percent of total billed charges,Implant Devices,620.16,34,,620.16,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,638.4,35,,638.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,729.6,
ZIMMER 8145-10-115 LAG SCREW 115X10.5MM,C1713,HCPCS,,79010769,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 8146-11-420 SCREW 130 DEG 11X420,C1713,HCPCS,,79010770,CDM,278,RC,,,both,,,12660,4996.5,39.4668,,4996.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4304.4,34,,4304.4,percent of total billed charges,Implant Device,4304.4,34,,4304.4,percent of total billed charges,Implant Device,4304.4,34,,4304.4,percent of total billed charges,Implant Device,4304.4,34,,4304.4,percent of total billed charges,Implant Device,4304.4,34,,4304.4,percent of total billed charges,Implant Device,4304.4,34,,4304.4,percent of total billed charges,Implant Device,4431,35,,4431,percent of total billed charges,Implant Device,4304.4,34,"Charges > $500, x 34%",4304.4,percent of total billed charges,Implant Device,4431,35,,4431,percent of total billed charges,Implant Devices,4431,35,,4431,percent of total billed charges,Implant Devices,4431,35,,,percent of total billed charges,Implant Devices,4431,35,,4431,percent of total billed charges,Implant Devices,4431,35,,4431,percent of total billed charges,Implant Devices,5064,40,,5064,percent of total billed charges,Implant Devices,4431,70,,4431,percent of total billed charges,Implant Devices,4304.4,34,,4304.4,percent of total billed charges,Implant Devices,4304.4,34,,4304.4,percent of total billed charges,Implant Devices,4431,35,,4431,percent of total billed charges,Implant Devices,4431,35,,4431,percent of total billed charges,Implant Devices,4431,35,,4431,percent of total billed charges,Implant Devices,4431,35,,4431,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4304.4,34,"If Charge > 2,000, then 34 percent",4304.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5064,
IN2BONES P92 ST013 SCREW 2.4X13MM,C1713,HCPCS,,79010777,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
ARTHREX AR-1788J-CP INTERNAL BRACE KIT,C1713,HCPCS,,79010778,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
DEPUY 02.118.556 SELF TAPPING SCREW,C1713,HCPCS,,79010782,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
DEPUY 04.037.053S TFN LONG NAIL 10X320MM,C1713,HCPCS,,79010785,CDM,278,RC,,,both,,,6153,2428.39,39.4668,,2428.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2092.02,34,,2092.02,percent of total billed charges,Implant Device,2092.02,34,,2092.02,percent of total billed charges,Implant Device,2092.02,34,,2092.02,percent of total billed charges,Implant Device,2092.02,34,,2092.02,percent of total billed charges,Implant Device,2092.02,34,,2092.02,percent of total billed charges,Implant Device,2092.02,34,,2092.02,percent of total billed charges,Implant Device,2153.55,35,,2153.55,percent of total billed charges,Implant Device,2092.02,34,"Charges > $500, x 34%",2092.02,percent of total billed charges,Implant Device,2153.55,35,,2153.55,percent of total billed charges,Implant Devices,2153.55,35,,2153.55,percent of total billed charges,Implant Devices,2153.55,35,,,percent of total billed charges,Implant Devices,2153.55,35,,2153.55,percent of total billed charges,Implant Devices,2153.55,35,,2153.55,percent of total billed charges,Implant Devices,2461.2,40,,2461.2,percent of total billed charges,Implant Devices,2153.55,70,,2153.55,percent of total billed charges,Implant Devices,2092.02,34,,2092.02,percent of total billed charges,Implant Devices,2092.02,34,,2092.02,percent of total billed charges,Implant Devices,2153.55,35,,2153.55,percent of total billed charges,Implant Devices,2153.55,35,,2153.55,percent of total billed charges,Implant Devices,2153.55,35,,2153.55,percent of total billed charges,Implant Devices,2153.55,35,,2153.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2092.02,34,"If Charge > 2,000, then 34 percent",2092.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2461.2,
IN2BONES P92 ST014 SCREW 2.4X14MM,C1713,HCPCS,,79010788,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
DEPUY 04.037.112S TFN NAIL 170X11 125DEG,C1713,HCPCS,,79010789,CDM,278,RC,,,both,,,3718,1467.38,39.4668,,1467.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1301.3,35,,1301.3,percent of total billed charges,Implant Device,1264.12,34,"Charges > $500, x 34%",1264.12,percent of total billed charges,Implant Device,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1487.2,40,,1487.2,percent of total billed charges,Implant Devices,1301.3,70,,1301.3,percent of total billed charges,Implant Devices,1264.12,34,,1264.12,percent of total billed charges,Implant Devices,1264.12,34,,1264.12,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1264.12,34,"If Charge > 2,000, then 34 percent",1264.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1487.2,
STRYKER 7030-6520 HEX SCREW 6.5X20MM,C1713,HCPCS,,79010797,CDM,278,RC,,,both,,,159,62.75,39.4668,,62.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,63.6,40,,63.6,percent of total billed charges,Implant Devices,55.65,70,,55.65,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63.6,
STRYKER 7030-6540 HEX SCREW 6.5X40MM,C1713,HCPCS,,79010798,CDM,278,RC,,,both,,,159,62.75,39.4668,,62.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,63.6,40,,63.6,percent of total billed charges,Implant Devices,55.65,70,,55.65,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63.6,
BAXTER HEMOSTATIC ADS201844 MATRIX,C1713,HCPCS,,79010803,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
STRYKER 663814 BONE SCREW 2.3X14MM,C1713,HCPCS,,79010804,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
SMITH & NEPHEW 4565 BIOINDUCTIVE IMPLANT,C1713,HCPCS,,79010805,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
SMITH & NEPHEW 4403 BONE ANCHORS,C1713,HCPCS,,79010806,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
SMITH & NEPHEW 2504-1 TENDON ANCHORS,C1713,HCPCS,,79010807,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
STRYKER 656413 BONE SCREW 2.7X13MM,C1713,HCPCS,,79010809,CDM,278,RC,,,both,,,389,153.53,39.4668,,153.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,136.15,35,,136.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,155.6,40,,155.6,percent of total billed charges,Implant Devices,136.15,70,,136.15,percent of total billed charges,Implant Devices,132.26,34,,132.26,percent of total billed charges,Implant Devices,132.26,34,,132.26,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,155.6,
IN2BONES P67 ST436 CANN SCREW 4X36MM,C1713,HCPCS,,79010817,CDM,278,RC,,,both,,,1485,586.08,39.4668,,586.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Device,504.9,34,"Charges > $500, x 34%",504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,594,40,,594,percent of total billed charges,Implant Devices,519.75,70,,519.75,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,594,
ACUMED 40-0027-S FIBULA ROD 3.0X145MM,C1713,HCPCS,,79010818,CDM,278,RC,,,both,,,5994,2365.64,39.4668,,2365.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2037.96,34,,2037.96,percent of total billed charges,Implant Device,2037.96,34,,2037.96,percent of total billed charges,Implant Device,2037.96,34,,2037.96,percent of total billed charges,Implant Device,2037.96,34,,2037.96,percent of total billed charges,Implant Device,2037.96,34,,2037.96,percent of total billed charges,Implant Device,2037.96,34,,2037.96,percent of total billed charges,Implant Device,2097.9,35,,2097.9,percent of total billed charges,Implant Device,2037.96,34,"Charges > $500, x 34%",2037.96,percent of total billed charges,Implant Device,2097.9,35,,2097.9,percent of total billed charges,Implant Devices,2097.9,35,,2097.9,percent of total billed charges,Implant Devices,2097.9,35,,,percent of total billed charges,Implant Devices,2097.9,35,,2097.9,percent of total billed charges,Implant Devices,2097.9,35,,2097.9,percent of total billed charges,Implant Devices,2397.6,40,,2397.6,percent of total billed charges,Implant Devices,2097.9,70,,2097.9,percent of total billed charges,Implant Devices,2037.96,34,,2037.96,percent of total billed charges,Implant Devices,2037.96,34,,2037.96,percent of total billed charges,Implant Devices,2097.9,35,,2097.9,percent of total billed charges,Implant Devices,2097.9,35,,2097.9,percent of total billed charges,Implant Devices,2097.9,35,,2097.9,percent of total billed charges,Implant Devices,2097.9,35,,2097.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2037.96,34,"If Charge > 2,000, then 34 percent",2037.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2397.6,
ACUMED CO-3200-S CORTICAL SCREW 3.5X20MM,C1713,HCPCS,,79010819,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ACUMED 3005-40040 CANN SCREW 4.0X40MM,C1713,HCPCS,,79010820,CDM,278,RC,,,both,,,849,335.07,39.4668,,335.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,288.66,34,,288.66,percent of total billed charges,Implant Device,288.66,34,,288.66,percent of total billed charges,Implant Device,288.66,34,,288.66,percent of total billed charges,Implant Device,288.66,34,,288.66,percent of total billed charges,Implant Device,288.66,34,,288.66,percent of total billed charges,Implant Device,288.66,34,,288.66,percent of total billed charges,Implant Device,297.15,35,,297.15,percent of total billed charges,Implant Device,288.66,34,"Charges > $500, x 34%",288.66,percent of total billed charges,Implant Device,297.15,35,,297.15,percent of total billed charges,Implant Devices,297.15,35,,297.15,percent of total billed charges,Implant Devices,297.15,35,,,percent of total billed charges,Implant Devices,297.15,35,,297.15,percent of total billed charges,Implant Devices,297.15,35,,297.15,percent of total billed charges,Implant Devices,339.6,40,,339.6,percent of total billed charges,Implant Devices,297.15,70,,297.15,percent of total billed charges,Implant Devices,288.66,34,,288.66,percent of total billed charges,Implant Devices,288.66,34,,288.66,percent of total billed charges,Implant Devices,297.15,35,,297.15,percent of total billed charges,Implant Devices,297.15,35,,297.15,percent of total billed charges,Implant Devices,297.15,35,,297.15,percent of total billed charges,Implant Devices,297.15,35,,297.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,339.6,
ZIMMER 00-5980-057-03 TIBIAL COMP SZ 9,C1713,HCPCS,,79010827,CDM,278,RC,,,both,,,2466,973.25,39.4668,,973.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,838.44,34,,838.44,percent of total billed charges,Implant Device,838.44,34,,838.44,percent of total billed charges,Implant Device,838.44,34,,838.44,percent of total billed charges,Implant Device,838.44,34,,838.44,percent of total billed charges,Implant Device,838.44,34,,838.44,percent of total billed charges,Implant Device,838.44,34,,838.44,percent of total billed charges,Implant Device,863.1,35,,863.1,percent of total billed charges,Implant Device,838.44,34,"Charges > $500, x 34%",838.44,percent of total billed charges,Implant Device,863.1,35,,863.1,percent of total billed charges,Implant Devices,863.1,35,,863.1,percent of total billed charges,Implant Devices,863.1,35,,,percent of total billed charges,Implant Devices,863.1,35,,863.1,percent of total billed charges,Implant Devices,863.1,35,,863.1,percent of total billed charges,Implant Devices,986.4,40,,986.4,percent of total billed charges,Implant Devices,863.1,70,,863.1,percent of total billed charges,Implant Devices,838.44,34,,838.44,percent of total billed charges,Implant Devices,838.44,34,,838.44,percent of total billed charges,Implant Devices,863.1,35,,863.1,percent of total billed charges,Implant Devices,863.1,35,,863.1,percent of total billed charges,Implant Devices,863.1,35,,863.1,percent of total billed charges,Implant Devices,863.1,35,,863.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,838.44,34,"If Charge > 2,000, then 34 percent",838.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,986.4,
"ZIMMER 32-8105-043-02 ULNA ASSEMBLY 3""",C1713,HCPCS,,79010828,CDM,278,RC,,,both,,,14700,5801.62,39.4668,,5801.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4998,34,,4998,percent of total billed charges,Implant Device,4998,34,,4998,percent of total billed charges,Implant Device,4998,34,,4998,percent of total billed charges,Implant Device,4998,34,,4998,percent of total billed charges,Implant Device,4998,34,,4998,percent of total billed charges,Implant Device,4998,34,,4998,percent of total billed charges,Implant Device,5145,35,,5145,percent of total billed charges,Implant Device,4998,34,"Charges > $500, x 34%",4998,percent of total billed charges,Implant Device,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5880,40,,5880,percent of total billed charges,Implant Devices,5145,70,,5145,percent of total billed charges,Implant Devices,4998,34,,4998,percent of total billed charges,Implant Devices,4998,34,,4998,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,5145,35,,5145,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4998,34,"If Charge > 2,000, then 34 percent",4998,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5880,
IN2BONES P92 ST011 CORT SCREW 2.4X11MM,C1713,HCPCS,,79010837,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
IN2BONES P92 ST012 CORT SCREW 2.4X12MM,C1713,HCPCS,,79010838,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
LIFENET RFP10 FRESH PLUG ALLOGRAFT 10MM,C1713,HCPCS,,79010840,CDM,278,RC,,,both,,,7125,2812.01,39.4668,,2812.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2422.5,34,,2422.5,percent of total billed charges,Implant Device,2422.5,34,,2422.5,percent of total billed charges,Implant Device,2422.5,34,,2422.5,percent of total billed charges,Implant Device,2422.5,34,,2422.5,percent of total billed charges,Implant Device,2422.5,34,,2422.5,percent of total billed charges,Implant Device,2422.5,34,,2422.5,percent of total billed charges,Implant Device,2493.75,35,,2493.75,percent of total billed charges,Implant Device,2422.5,34,"Charges > $500, x 34%",2422.5,percent of total billed charges,Implant Device,2493.75,35,,2493.75,percent of total billed charges,Implant Devices,2493.75,35,,2493.75,percent of total billed charges,Implant Devices,2493.75,35,,,percent of total billed charges,Implant Devices,2493.75,35,,2493.75,percent of total billed charges,Implant Devices,2493.75,35,,2493.75,percent of total billed charges,Implant Devices,2850,40,,2850,percent of total billed charges,Implant Devices,2493.75,70,,2493.75,percent of total billed charges,Implant Devices,2422.5,34,,2422.5,percent of total billed charges,Implant Devices,2422.5,34,,2422.5,percent of total billed charges,Implant Devices,2493.75,35,,2493.75,percent of total billed charges,Implant Devices,2493.75,35,,2493.75,percent of total billed charges,Implant Devices,2493.75,35,,2493.75,percent of total billed charges,Implant Devices,2493.75,35,,2493.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2422.5,34,"If Charge > 2,000, then 34 percent",2422.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2850,
EXACTECH SPC0323 TAPERED WEDGE STEM 46MM,C1713,HCPCS,,79010844,CDM,278,RC,,,both,,,10625,4193.35,39.4668,,4193.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3612.5,34,,3612.5,percent of total billed charges,Implant Device,3718.75,35,,3718.75,percent of total billed charges,Implant Device,3612.5,34,"Charges > $500, x 34%",3612.5,percent of total billed charges,Implant Device,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,4250,40,,4250,percent of total billed charges,Implant Devices,3718.75,70,,3718.75,percent of total billed charges,Implant Devices,3612.5,34,,3612.5,percent of total billed charges,Implant Devices,3612.5,34,,3612.5,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,3718.75,35,,3718.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3612.5,34,"If Charge > 2,000, then 34 percent",3612.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4250,
STRYKER 657018 LOCKING SCREW 2.7X18MM,C1713,HCPCS,,79010846,CDM,278,RC,,,both,,,494,194.97,39.4668,,194.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,167.96,34,,167.96,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,197.6,40,,197.6,percent of total billed charges,Implant Devices,172.9,70,,172.9,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,167.96,34,,167.96,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,172.9,35,,172.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.6,
ARTHREX AR-8949-050 CALCAC STEP PLT 5MM,C1713,HCPCS,,79010847,CDM,278,RC,,,both,,,4695,1852.97,39.4668,,1852.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1596.3,34,,1596.3,percent of total billed charges,Implant Device,1643.25,35,,1643.25,percent of total billed charges,Implant Device,1596.3,34,"Charges > $500, x 34%",1596.3,percent of total billed charges,Implant Device,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1878,40,,1878,percent of total billed charges,Implant Devices,1643.25,70,,1643.25,percent of total billed charges,Implant Devices,1596.3,34,,1596.3,percent of total billed charges,Implant Devices,1596.3,34,,1596.3,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,1643.25,35,,1643.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1596.3,34,"If Charge > 2,000, then 34 percent",1596.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1878,
STRYKER 325236S CANN SCREW 4X36MM,C1713,HCPCS,,79010848,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
STRYKER 325242S ASNIS CANN SCREW 4X42MM,C1713,HCPCS,,79010849,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
STRYKER 325246S ASNIS CANN SCREW 4X46MM,C1713,HCPCS,,79010850,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
STRYKER 325238 CANN SCREW 4X38MM,C1713,HCPCS,,79010852,CDM,278,RC,,,both,,,535,211.15,39.4668,,211.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,181.9,34,,181.9,percent of total billed charges,Implant Device,187.25,35,,187.25,percent of total billed charges,Implant Device,181.9,34,"Charges > $500, x 34%",181.9,percent of total billed charges,Implant Device,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,214,40,,214,percent of total billed charges,Implant Devices,187.25,70,,187.25,percent of total billed charges,Implant Devices,181.9,34,,181.9,percent of total billed charges,Implant Devices,181.9,34,,181.9,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,187.25,35,,187.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214,
ARTHREX AR-8958-02S PLATE 2 HOLE,C1713,HCPCS,,79010855,CDM,278,RC,,,both,,,3645,1438.56,39.4668,,1438.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1239.3,34,,1239.3,percent of total billed charges,Implant Device,1239.3,34,,1239.3,percent of total billed charges,Implant Device,1239.3,34,,1239.3,percent of total billed charges,Implant Device,1239.3,34,,1239.3,percent of total billed charges,Implant Device,1239.3,34,,1239.3,percent of total billed charges,Implant Device,1239.3,34,,1239.3,percent of total billed charges,Implant Device,1275.75,35,,1275.75,percent of total billed charges,Implant Device,1239.3,34,"Charges > $500, x 34%",1239.3,percent of total billed charges,Implant Device,1275.75,35,,1275.75,percent of total billed charges,Implant Devices,1275.75,35,,1275.75,percent of total billed charges,Implant Devices,1275.75,35,,,percent of total billed charges,Implant Devices,1275.75,35,,1275.75,percent of total billed charges,Implant Devices,1275.75,35,,1275.75,percent of total billed charges,Implant Devices,1458,40,,1458,percent of total billed charges,Implant Devices,1275.75,70,,1275.75,percent of total billed charges,Implant Devices,1239.3,34,,1239.3,percent of total billed charges,Implant Devices,1239.3,34,,1239.3,percent of total billed charges,Implant Devices,1275.75,35,,1275.75,percent of total billed charges,Implant Devices,1275.75,35,,1275.75,percent of total billed charges,Implant Devices,1275.75,35,,1275.75,percent of total billed charges,Implant Devices,1275.75,35,,1275.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1239.3,34,"If Charge > 2,000, then 34 percent",1239.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1458,
STRYKER 57-13108 COMPRESSION PLT 6 HOLE,C1713,HCPCS,,79010895,CDM,278,RC,,,both,,,951,375.33,39.4668,,375.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,323.34,34,,323.34,percent of total billed charges,Implant Device,323.34,34,,323.34,percent of total billed charges,Implant Device,323.34,34,,323.34,percent of total billed charges,Implant Device,323.34,34,,323.34,percent of total billed charges,Implant Device,323.34,34,,323.34,percent of total billed charges,Implant Device,323.34,34,,323.34,percent of total billed charges,Implant Device,332.85,35,,332.85,percent of total billed charges,Implant Device,323.34,34,"Charges > $500, x 34%",323.34,percent of total billed charges,Implant Device,332.85,35,,332.85,percent of total billed charges,Implant Devices,332.85,35,,332.85,percent of total billed charges,Implant Devices,332.85,35,,,percent of total billed charges,Implant Devices,332.85,35,,332.85,percent of total billed charges,Implant Devices,332.85,35,,332.85,percent of total billed charges,Implant Devices,380.4,40,,380.4,percent of total billed charges,Implant Devices,332.85,70,,332.85,percent of total billed charges,Implant Devices,323.34,34,,323.34,percent of total billed charges,Implant Devices,323.34,34,,323.34,percent of total billed charges,Implant Devices,332.85,35,,332.85,percent of total billed charges,Implant Devices,332.85,35,,332.85,percent of total billed charges,Implant Devices,332.85,35,,332.85,percent of total billed charges,Implant Devices,332.85,35,,332.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,380.4,
STRYKER 663809 BONE SCREW 2.3X9MM,C1713,HCPCS,,79010896,CDM,278,RC,,,both,,,368,145.24,39.4668,,145.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,128.8,35,,128.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,147.2,40,,147.2,percent of total billed charges,Implant Devices,128.8,70,,128.8,percent of total billed charges,Implant Devices,125.12,34,,125.12,percent of total billed charges,Implant Devices,125.12,34,,125.12,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,147.2,
STRYKER 663810 BONE SCREW 2.3X10MM,C1713,HCPCS,,79010897,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER 663811 BONE SCREW 2.3X11MM,C1713,HCPCS,,79010898,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
DEPUY 04.037.142S SHORT NAIL 11X130MM,C1713,HCPCS,,79010901,CDM,278,RC,,,both,,,3718,1467.38,39.4668,,1467.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1301.3,35,,1301.3,percent of total billed charges,Implant Device,1264.12,34,"Charges > $500, x 34%",1264.12,percent of total billed charges,Implant Device,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1487.2,40,,1487.2,percent of total billed charges,Implant Devices,1301.3,70,,1301.3,percent of total billed charges,Implant Devices,1264.12,34,,1264.12,percent of total billed charges,Implant Devices,1264.12,34,,1264.12,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1264.12,34,"If Charge > 2,000, then 34 percent",1264.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1487.2,
DEPUY 04.038.400S HELICAL BLADE 100MM,C1713,HCPCS,,79010902,CDM,278,RC,,,both,,,1766,696.98,39.4668,,696.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,618.1,35,,618.1,percent of total billed charges,Implant Device,600.44,34,"Charges > $500, x 34%",600.44,percent of total billed charges,Implant Device,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,706.4,40,,706.4,percent of total billed charges,Implant Devices,618.1,70,,618.1,percent of total billed charges,Implant Devices,600.44,34,,600.44,percent of total billed charges,Implant Devices,600.44,34,,600.44,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,706.4,
ZIMMER US 8145-09-180 HIP NAIL 9X180MM,C1713,HCPCS,,79010906,CDM,278,RC,,,both,,,4464,1761.8,39.4668,,1761.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1517.76,34,,1517.76,percent of total billed charges,Implant Device,1562.4,35,,1562.4,percent of total billed charges,Implant Device,1517.76,34,"Charges > $500, x 34%",1517.76,percent of total billed charges,Implant Device,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1785.6,40,,1785.6,percent of total billed charges,Implant Devices,1562.4,70,,1562.4,percent of total billed charges,Implant Devices,1517.76,34,,1517.76,percent of total billed charges,Implant Devices,1517.76,34,,1517.76,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,1562.4,35,,1562.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1517.76,34,"If Charge > 2,000, then 34 percent",1517.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1785.6,
STRYKER ORTHO 40-30128 SCREW 3.0X28MM,C1713,HCPCS,,79010913,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER ORTHO 40-30132 SCREW 3.0X32MM,C1713,HCPCS,,79010914,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER ORTHO 663036  SCREW 4.0X36MM,C1713,HCPCS,,79010915,CDM,278,RC,,,both,,,2559,1009.96,39.4668,,1009.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,870.06,34,,870.06,percent of total billed charges,Implant Device,895.65,35,,895.65,percent of total billed charges,Implant Device,870.06,34,"Charges > $500, x 34%",870.06,percent of total billed charges,Implant Device,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,1023.6,40,,1023.6,percent of total billed charges,Implant Devices,895.65,70,,895.65,percent of total billed charges,Implant Devices,870.06,34,,870.06,percent of total billed charges,Implant Devices,870.06,34,,870.06,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,895.65,35,,895.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,870.06,34,"If Charge > 2,000, then 34 percent",870.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1023.6,
DEPUY SYNTHES 04.038.405S BLADE 105MM,C1713,HCPCS,,79010917,CDM,278,RC,,,both,,,1766,696.98,39.4668,,696.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,618.1,35,,618.1,percent of total billed charges,Implant Device,600.44,34,"Charges > $500, x 34%",600.44,percent of total billed charges,Implant Device,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,706.4,40,,706.4,percent of total billed charges,Implant Devices,618.1,70,,618.1,percent of total billed charges,Implant Devices,600.44,34,,600.44,percent of total billed charges,Implant Devices,600.44,34,,600.44,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,706.4,
DEPUY 204.014 CORTEX SCREW 3.5X14MM,C1713,HCPCS,,79010920,CDM,278,RC,,,both,,,43,16.97,39.4668,,16.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14.62,34,,14.62,percent of total billed charges,Implant Device,14.62,34,,14.62,percent of total billed charges,Implant Device,14.62,34,,14.62,percent of total billed charges,Implant Device,14.62,34,,14.62,percent of total billed charges,Implant Device,14.62,34,,14.62,percent of total billed charges,Implant Device,14.62,34,,14.62,percent of total billed charges,Implant Device,15.05,35,,15.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,15.05,35,,15.05,percent of total billed charges,Implant Devices,15.05,35,,15.05,percent of total billed charges,Implant Devices,15.05,35,,,percent of total billed charges,Implant Devices,15.05,35,,15.05,percent of total billed charges,Implant Devices,15.05,35,,15.05,percent of total billed charges,Implant Devices,17.2,40,,17.2,percent of total billed charges,Implant Devices,15.05,70,,15.05,percent of total billed charges,Implant Devices,14.62,34,,14.62,percent of total billed charges,Implant Devices,14.62,34,,14.62,percent of total billed charges,Implant Devices,15.05,35,,15.05,percent of total billed charges,Implant Devices,15.05,35,,15.05,percent of total billed charges,Implant Devices,15.05,35,,15.05,percent of total billed charges,Implant Devices,15.05,35,,15.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,17.2,
DEPUY 212.120 LOCKING SCREW 3.5X20MM,C1713,HCPCS,,79010921,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
DEPUY 04.037.242S NAIL 170X12MM 130 DEG,C1713,HCPCS,,79010922,CDM,278,RC,,,both,,,4247,1676.15,39.4668,,1676.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1443.98,34,,1443.98,percent of total billed charges,Implant Device,1443.98,34,,1443.98,percent of total billed charges,Implant Device,1443.98,34,,1443.98,percent of total billed charges,Implant Device,1443.98,34,,1443.98,percent of total billed charges,Implant Device,1443.98,34,,1443.98,percent of total billed charges,Implant Device,1443.98,34,,1443.98,percent of total billed charges,Implant Device,1486.45,35,,1486.45,percent of total billed charges,Implant Device,1443.98,34,"Charges > $500, x 34%",1443.98,percent of total billed charges,Implant Device,1486.45,35,,1486.45,percent of total billed charges,Implant Devices,1486.45,35,,1486.45,percent of total billed charges,Implant Devices,1486.45,35,,,percent of total billed charges,Implant Devices,1486.45,35,,1486.45,percent of total billed charges,Implant Devices,1486.45,35,,1486.45,percent of total billed charges,Implant Devices,1698.8,40,,1698.8,percent of total billed charges,Implant Devices,1486.45,70,,1486.45,percent of total billed charges,Implant Devices,1443.98,34,,1443.98,percent of total billed charges,Implant Devices,1443.98,34,,1443.98,percent of total billed charges,Implant Devices,1486.45,35,,1486.45,percent of total billed charges,Implant Devices,1486.45,35,,1486.45,percent of total billed charges,Implant Devices,1486.45,35,,1486.45,percent of total billed charges,Implant Devices,1486.45,35,,1486.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1443.98,34,"If Charge > 2,000, then 34 percent",1443.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1698.8,
ARTHREX AR-9943BR-06 LOCK DIS FIB PLT RT,C1713,HCPCS,,79010933,CDM,278,RC,,,both,,,2325,917.6,39.4668,,917.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Device,790.5,34,"Charges > $500, x 34%",790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,930,40,,930,percent of total billed charges,Implant Devices,813.75,70,,813.75,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.5,34,"If Charge > 2,000, then 34 percent",790.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930,
ZIMMER 1318-11-050 DVR LOCK NARROW PLATE,C1713,HCPCS,,79010934,CDM,278,RC,,,both,,,2682,1058.5,39.4668,,1058.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,911.88,34,,911.88,percent of total billed charges,Implant Device,911.88,34,,911.88,percent of total billed charges,Implant Device,911.88,34,,911.88,percent of total billed charges,Implant Device,911.88,34,,911.88,percent of total billed charges,Implant Device,911.88,34,,911.88,percent of total billed charges,Implant Device,911.88,34,,911.88,percent of total billed charges,Implant Device,938.7,35,,938.7,percent of total billed charges,Implant Device,911.88,34,"Charges > $500, x 34%",911.88,percent of total billed charges,Implant Device,938.7,35,,938.7,percent of total billed charges,Implant Devices,938.7,35,,938.7,percent of total billed charges,Implant Devices,938.7,35,,,percent of total billed charges,Implant Devices,938.7,35,,938.7,percent of total billed charges,Implant Devices,938.7,35,,938.7,percent of total billed charges,Implant Devices,1072.8,40,,1072.8,percent of total billed charges,Implant Devices,938.7,70,,938.7,percent of total billed charges,Implant Devices,911.88,34,,911.88,percent of total billed charges,Implant Devices,911.88,34,,911.88,percent of total billed charges,Implant Devices,938.7,35,,938.7,percent of total billed charges,Implant Devices,938.7,35,,938.7,percent of total billed charges,Implant Devices,938.7,35,,938.7,percent of total billed charges,Implant Devices,938.7,35,,938.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,911.88,34,"If Charge > 2,000, then 34 percent",911.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1072.8,
ZIMMER 1312-27-213 NON LOCK SCREW 2.7X13,C1713,HCPCS,,79010936,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
ZIMMER 1312-27-214 NON LOCK SCREW 2.7X14,C1713,HCPCS,,79010937,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
ZIMMER 1312-27-215 NON LOCK SCREW 2.7X15,C1713,HCPCS,,79010938,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
ZIMMER 1312-27-112 LOCK SCREW 2.7X12MM,C1713,HCPCS,,79010939,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
ZIMMER 1312-27-114 LOCK SCREW 2.7X14MM,C1713,HCPCS,,79010940,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
ZIMMER 1312-27-116 LOCK SCREW 2.7X16MM,C1713,HCPCS,,79010941,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
ZIMMER 1312-27-118 LOCK SCREW 2.7X18MM,C1713,HCPCS,,79010942,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
ARTHREX AR-8923BC SUTURE ANCHOR 2.9MM,C1713,HCPCS,,79010949,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
STRYKER 629346 OLECRANON PLATE 6 HOLE LT,C1713,HCPCS,,79010959,CDM,278,RC,,,both,,,2804,1106.65,39.4668,,1106.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,953.36,34,,953.36,percent of total billed charges,Implant Device,981.4,35,,981.4,percent of total billed charges,Implant Device,953.36,34,"Charges > $500, x 34%",953.36,percent of total billed charges,Implant Device,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,1121.6,40,,1121.6,percent of total billed charges,Implant Devices,981.4,70,,981.4,percent of total billed charges,Implant Devices,953.36,34,,953.36,percent of total billed charges,Implant Devices,953.36,34,,953.36,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,981.4,35,,981.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,953.36,34,"If Charge > 2,000, then 34 percent",953.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1121.6,
ARTHREX AR-1530P-CP FOREFOOT IMPLANY SYS,C1713,HCPCS,,79010962,CDM,278,RC,,,both,,,4185,1651.69,39.4668,,1651.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1422.9,34,,1422.9,percent of total billed charges,Implant Device,1422.9,34,,1422.9,percent of total billed charges,Implant Device,1422.9,34,,1422.9,percent of total billed charges,Implant Device,1422.9,34,,1422.9,percent of total billed charges,Implant Device,1422.9,34,,1422.9,percent of total billed charges,Implant Device,1422.9,34,,1422.9,percent of total billed charges,Implant Device,1464.75,35,,1464.75,percent of total billed charges,Implant Device,1422.9,34,"Charges > $500, x 34%",1422.9,percent of total billed charges,Implant Device,1464.75,35,,1464.75,percent of total billed charges,Implant Devices,1464.75,35,,1464.75,percent of total billed charges,Implant Devices,1464.75,35,,,percent of total billed charges,Implant Devices,1464.75,35,,1464.75,percent of total billed charges,Implant Devices,1464.75,35,,1464.75,percent of total billed charges,Implant Devices,1674,40,,1674,percent of total billed charges,Implant Devices,1464.75,70,,1464.75,percent of total billed charges,Implant Devices,1422.9,34,,1422.9,percent of total billed charges,Implant Devices,1422.9,34,,1422.9,percent of total billed charges,Implant Devices,1464.75,35,,1464.75,percent of total billed charges,Implant Devices,1464.75,35,,1464.75,percent of total billed charges,Implant Devices,1464.75,35,,1464.75,percent of total billed charges,Implant Devices,1464.75,35,,1464.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1422.9,34,"If Charge > 2,000, then 34 percent",1422.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1674,
STRYKER 2341-1034S TIBIAL NAIL 10X345MM,C1713,HCPCS,,79010964,CDM,278,RC,,,both,,,6378,2517.19,39.4668,,2517.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Device,2168.52,34,"Charges > $500, x 34%",2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2551.2,40,,2551.2,percent of total billed charges,Implant Devices,2232.3,70,,2232.3,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2168.52,34,"If Charge > 2,000, then 34 percent",2168.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2551.2,
STRYKER 2360-5065S LOCKING SCREW 5X65MM,C1713,HCPCS,,79010965,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
IN2BONES P40 ST015 PLATE 5 HOLE,C1713,HCPCS,,79010968,CDM,278,RC,,,both,,,4611,1819.81,39.4668,,1819.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1613.85,35,,1613.85,percent of total billed charges,Implant Device,1567.74,34,"Charges > $500, x 34%",1567.74,percent of total billed charges,Implant Device,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1844.4,40,,1844.4,percent of total billed charges,Implant Devices,1613.85,70,,1613.85,percent of total billed charges,Implant Devices,1567.74,34,,1567.74,percent of total billed charges,Implant Devices,1567.74,34,,1567.74,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1567.74,34,"If Charge > 2,000, then 34 percent",1567.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1844.4,
IN2BONES V30 ST210 NON LOCK SCREW 3X10MM,C1713,HCPCS,,79010969,CDM,278,RC,,,both,,,735,290.08,39.4668,,290.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Device,249.9,34,"Charges > $500, x 34%",249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,294,40,,294,percent of total billed charges,Implant Devices,257.25,70,,257.25,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
STRYKER ORTHO 663812 BONE SCREW 2.3X12MM,C1713,HCPCS,,79010972,CDM,278,RC,,,both,,,368,145.24,39.4668,,145.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,125.12,34,,125.12,percent of total billed charges,Implant Device,128.8,35,,128.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,147.2,40,,147.2,percent of total billed charges,Implant Devices,128.8,70,,128.8,percent of total billed charges,Implant Devices,125.12,34,,125.12,percent of total billed charges,Implant Devices,125.12,34,,125.12,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,128.8,35,,128.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,147.2,
ZIMMER 8145-10-120 LAG SCREW 10.5X120MM,C1713,HCPCS,,79010974,CDM,278,RC,,,both,,,2052,809.86,39.4668,,809.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,718.2,35,,718.2,percent of total billed charges,Implant Device,697.68,34,"Charges > $500, x 34%",697.68,percent of total billed charges,Implant Device,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,820.8,40,,820.8,percent of total billed charges,Implant Devices,718.2,70,,718.2,percent of total billed charges,Implant Devices,697.68,34,,697.68,percent of total billed charges,Implant Devices,697.68,34,,697.68,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,697.68,34,"If Charge > 2,000, then 34 percent",697.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,820.8,
ARTHREX ABS-2810-1806 WEDGE 18X18X6.5MM,C1713,HCPCS,,79010979,CDM,278,RC,,,both,,,6645,2622.57,39.4668,,2622.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2259.3,34,,2259.3,percent of total billed charges,Implant Device,2325.75,35,,2325.75,percent of total billed charges,Implant Device,2259.3,34,"Charges > $500, x 34%",2259.3,percent of total billed charges,Implant Device,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2658,40,,2658,percent of total billed charges,Implant Devices,2325.75,70,,2325.75,percent of total billed charges,Implant Devices,2259.3,34,,2259.3,percent of total billed charges,Implant Devices,2259.3,34,,2259.3,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,2325.75,35,,2325.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2259.3,34,"If Charge > 2,000, then 34 percent",2259.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2658,
ARTHREX AR-8951ML LISFRANC PLATE MED LT,C1713,HCPCS,,79010980,CDM,278,RC,,,both,,,3429,1353.32,39.4668,,1353.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1165.86,34,,1165.86,percent of total billed charges,Implant Device,1200.15,35,,1200.15,percent of total billed charges,Implant Device,1165.86,34,"Charges > $500, x 34%",1165.86,percent of total billed charges,Implant Device,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1371.6,40,,1371.6,percent of total billed charges,Implant Devices,1200.15,70,,1200.15,percent of total billed charges,Implant Devices,1165.86,34,,1165.86,percent of total billed charges,Implant Devices,1165.86,34,,1165.86,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,1200.15,35,,1200.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1165.86,34,"If Charge > 2,000, then 34 percent",1165.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1371.6,
ARTHREX AR-2324BCCT SWIVELOCK 4.75,C1713,HCPCS,,79010981,CDM,278,RC,,,both,,,1590,627.52,39.4668,,627.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Device,540.6,34,"Charges > $500, x 34%",540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,636,40,,636,percent of total billed charges,Implant Devices,556.5,70,,556.5,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,636,
ARTHREX AR-2324BCCTT SWIVELOCK 4.75,C1713,HCPCS,,79010982,CDM,278,RC,,,both,,,1590,627.52,39.4668,,627.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Device,540.6,34,"Charges > $500, x 34%",540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,636,40,,636,percent of total billed charges,Implant Devices,556.5,70,,556.5,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,636,
IN2BONES USA P70 ST107 FIBULA PLATE,C1713,HCPCS,,79010983,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES USA P67 ST445 SCREW 4.0X45MM,C1713,HCPCS,,79010984,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES USA P73 ST212 SCREW 3.5X12MM,C1713,HCPCS,,79010985,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ARTHREX AR-1593BC ACL FIXATION SYSTEM,C1713,HCPCS,,79010986,CDM,278,RC,,,both,,,2175,858.4,39.4668,,858.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,761.25,35,,761.25,percent of total billed charges,Implant Device,739.5,34,"Charges > $500, x 34%",739.5,percent of total billed charges,Implant Device,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,870,40,,870,percent of total billed charges,Implant Devices,761.25,70,,761.25,percent of total billed charges,Implant Devices,739.5,34,,739.5,percent of total billed charges,Implant Devices,739.5,34,,739.5,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,739.5,34,"If Charge > 2,000, then 34 percent",739.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,870,
ARTHREX AR-1586RC-07 RETROSCREW 7X20MM,C1713,HCPCS,,79010988,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ARTHREX AR-1586RC-08 RETROSCREW 8X20MM,C1713,HCPCS,,79010989,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ARTHREX AR-1586RC-09 RETROSCREW 9X20MM,C1713,HCPCS,,79010990,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ARTHREX AR-1586RC-10 RETROSCREW 10X20MM,C1713,HCPCS,,79010991,CDM,278,RC,,,both,,,705,278.24,39.4668,,278.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,239.7,34,,239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Device,239.7,34,"Charges > $500, x 34%",239.7,percent of total billed charges,Implant Device,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,282,40,,282,percent of total billed charges,Implant Devices,246.75,70,,246.75,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,239.7,34,,239.7,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,246.75,35,,246.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282,
ARTHREX AR-1586RB-07 RETROSCREW 7X20MM,C1713,HCPCS,,79011003,CDM,278,RC,,,both,,,582,229.7,39.4668,,229.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,203.7,35,,203.7,percent of total billed charges,Implant Device,197.88,34,"Charges > $500, x 34%",197.88,percent of total billed charges,Implant Device,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,232.8,40,,232.8,percent of total billed charges,Implant Devices,203.7,70,,203.7,percent of total billed charges,Implant Devices,197.88,34,,197.88,percent of total billed charges,Implant Devices,197.88,34,,197.88,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.8,
ARTHREX AR-1586RB-09 RETROSCREW 9X20MM,C1713,HCPCS,,79011004,CDM,278,RC,,,both,,,582,229.7,39.4668,,229.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,203.7,35,,203.7,percent of total billed charges,Implant Device,197.88,34,"Charges > $500, x 34%",197.88,percent of total billed charges,Implant Device,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,232.8,40,,232.8,percent of total billed charges,Implant Devices,203.7,70,,203.7,percent of total billed charges,Implant Devices,197.88,34,,197.88,percent of total billed charges,Implant Devices,197.88,34,,197.88,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.8,
ARTHREX AR-1586RB-10 RETROCSREW 10/20MM,C1713,HCPCS,,79011005,CDM,278,RC,,,both,,,582,229.7,39.4668,,229.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,197.88,34,,197.88,percent of total billed charges,Implant Device,203.7,35,,203.7,percent of total billed charges,Implant Device,197.88,34,"Charges > $500, x 34%",197.88,percent of total billed charges,Implant Device,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,232.8,40,,232.8,percent of total billed charges,Implant Devices,203.7,70,,203.7,percent of total billed charges,Implant Devices,197.88,34,,197.88,percent of total billed charges,Implant Devices,197.88,34,,197.88,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,203.7,35,,203.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,232.8,
ARTHREX AR-3638 FIBERTAK KNOTLESS,C1713,HCPCS,,79011028,CDM,278,RC,,,both,,,1800,710.4,39.4668,,710.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Device,612,34,"Charges > $500, x 34%",612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,720,40,,720,percent of total billed charges,Implant Devices,630,70,,630,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,720,
ARTHREX AR-8740-40PTS CANN SCREWS 4.0X40,C1713,HCPCS,,79011030,CDM,278,RC,,,both,,,536,211.54,39.4668,,211.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,182.24,34,,182.24,percent of total billed charges,Implant Device,187.6,35,,187.6,percent of total billed charges,Implant Device,182.24,34,"Charges > $500, x 34%",182.24,percent of total billed charges,Implant Device,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,214.4,40,,214.4,percent of total billed charges,Implant Devices,187.6,70,,187.6,percent of total billed charges,Implant Devices,182.24,34,,182.24,percent of total billed charges,Implant Devices,182.24,34,,182.24,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,187.6,35,,187.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.4,
ARTHREX AR-8933V-10 VAL SCREW 3X10MM,C1713,HCPCS,,79011031,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
ARTHREX AR-8933V-16 VAL SCREW 3X16MM,C1713,HCPCS,,79011032,CDM,278,RC,,,both,,,569,224.57,39.4668,,224.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,193.46,34,,193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Device,193.46,34,"Charges > $500, x 34%",193.46,percent of total billed charges,Implant Device,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,227.6,40,,227.6,percent of total billed charges,Implant Devices,199.15,70,,199.15,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,193.46,34,,193.46,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,199.15,35,,199.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,227.6,
ARTHREX AR-9943BR-04 DIS FIB PLT RT 4H,C1713,HCPCS,,79011033,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
STRYKER 2331-1036S FEM NAIL LT 10X360MM,C1713,HCPCS,,79011034,CDM,278,RC,,,both,,,7570,2987.64,39.4668,,2987.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2573.8,34,,2573.8,percent of total billed charges,Implant Device,2649.5,35,,2649.5,percent of total billed charges,Implant Device,2573.8,34,"Charges > $500, x 34%",2573.8,percent of total billed charges,Implant Device,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,3028,40,,3028,percent of total billed charges,Implant Devices,2649.5,70,,2649.5,percent of total billed charges,Implant Devices,2573.8,34,,2573.8,percent of total billed charges,Implant Devices,2573.8,34,,2573.8,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,2649.5,35,,2649.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2573.8,34,"If Charge > 2,000, then 34 percent",2573.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3028,
STRYKER IC3014 HEADED SCREW 3X14MM,C1713,HCPCS,,79011035,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER IH3018 HEADLESS SCREW 3X18MM,C1713,HCPCS,,79011036,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
STRYKER 623-10-36E INSERT 10 DEGREE 36MM,C1713,HCPCS,,79011037,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 656326 LOCKING SCREW 2.7X26MM,C1713,HCPCS,,79011039,CDM,278,RC,,,both,,,443,174.84,39.4668,,174.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,177.2,40,,177.2,percent of total billed charges,Implant Devices,155.05,70,,155.05,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.2,
ARTHREX AR-8914DS MINI TIGHROPE 1.1MM,C1713,HCPCS,,79011040,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
ARTHREX AR-1662BCC-7 SWIVELOCK 7X19,C1713,HCPCS,,79011053,CDM,278,RC,,,both,,,1305,515.04,39.4668,,515.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,456.75,35,,456.75,percent of total billed charges,Implant Device,443.7,34,"Charges > $500, x 34%",443.7,percent of total billed charges,Implant Device,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,522,40,,522,percent of total billed charges,Implant Devices,456.75,70,,456.75,percent of total billed charges,Implant Devices,443.7,34,,443.7,percent of total billed charges,Implant Devices,443.7,34,,443.7,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,522,
STRYKER 3525-1400S LONG NAIL KIT 11X400,C1713,HCPCS,,79011058,CDM,278,RC,,,both,,,5438,2146.2,39.4668,,2146.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Device,1848.92,34,"Charges > $500, x 34%",1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,2175.2,40,,2175.2,percent of total billed charges,Implant Devices,1903.3,70,,1903.3,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1848.92,34,"If Charge > 2,000, then 34 percent",1848.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2175.2,
STRYKER 629626 NARROW LOCK PLT 2X34MM 6H,C1713,HCPCS,,79011066,CDM,278,RC,,,both,,,2268,895.11,39.4668,,895.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,793.8,35,,793.8,percent of total billed charges,Implant Device,771.12,34,"Charges > $500, x 34%",771.12,percent of total billed charges,Implant Device,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,907.2,40,,907.2,percent of total billed charges,Implant Devices,793.8,70,,793.8,percent of total billed charges,Implant Devices,771.12,34,,771.12,percent of total billed charges,Implant Devices,771.12,34,,771.12,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,771.12,34,"If Charge > 2,000, then 34 percent",771.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,907.2,
STRYKER 629628 NARROW LOCK PLT 2X46MM 8H,C1713,HCPCS,,79011067,CDM,278,RC,,,both,,,2268,895.11,39.4668,,895.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,793.8,35,,793.8,percent of total billed charges,Implant Device,771.12,34,"Charges > $500, x 34%",771.12,percent of total billed charges,Implant Device,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,907.2,40,,907.2,percent of total billed charges,Implant Devices,793.8,70,,793.8,percent of total billed charges,Implant Devices,771.12,34,,771.12,percent of total billed charges,Implant Devices,771.12,34,,771.12,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,771.12,34,"If Charge > 2,000, then 34 percent",771.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,907.2,
STRYKER 657610 LOCKING SCREW 2X10MM,C1713,HCPCS,,79011068,CDM,278,RC,,,both,,,443,174.84,39.4668,,174.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,177.2,40,,177.2,percent of total billed charges,Implant Devices,155.05,70,,155.05,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.2,
STRYKER 657612 LOCKING SCREW 2X12MM,C1713,HCPCS,,79011069,CDM,278,RC,,,both,,,676,266.8,39.4668,,266.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Device,229.84,34,"Charges > $500, x 34%",229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,270.4,40,,270.4,percent of total billed charges,Implant Devices,236.6,70,,236.6,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270.4,
STRYKER 657614 LOCKING SCREW 2X14MM,C1713,HCPCS,,79011070,CDM,278,RC,,,both,,,443,174.84,39.4668,,174.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,177.2,40,,177.2,percent of total billed charges,Implant Devices,155.05,70,,155.05,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.2,
ARTHREX AR-7267 FIBERTAPE CERCLAGESUTURE,C1713,HCPCS,,79011078,CDM,278,RC,,,both,,,1350,532.8,39.4668,,532.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Device,459,34,"Charges > $500, x 34%",459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,540,40,,540,percent of total billed charges,Implant Devices,472.5,70,,472.5,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,540,
ARTHREX AR-7267T TIGERTAPE CERCLAGESUTUR,C1713,HCPCS,,79011079,CDM,278,RC,,,both,,,1350,532.8,39.4668,,532.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Device,459,34,"Charges > $500, x 34%",459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,540,40,,540,percent of total billed charges,Implant Devices,472.5,70,,472.5,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,540,
DEPUY SYNTHES 04.037.042S NAIL 10X170MM,C1713,HCPCS,,79011082,CDM,278,RC,,,both,,,3718,1467.38,39.4668,,1467.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1301.3,35,,1301.3,percent of total billed charges,Implant Device,1264.12,34,"Charges > $500, x 34%",1264.12,percent of total billed charges,Implant Device,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1487.2,40,,1487.2,percent of total billed charges,Implant Devices,1301.3,70,,1301.3,percent of total billed charges,Implant Devices,1264.12,34,,1264.12,percent of total billed charges,Implant Devices,1264.12,34,,1264.12,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1264.12,34,"If Charge > 2,000, then 34 percent",1264.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1487.2,
ARTHREX AR-8935L-10 LOCK SCREW 3.5X10MM,C1713,HCPCS,,79011083,CDM,278,RC,,,both,,,645,254.56,39.4668,,254.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,219.3,34,,219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Device,219.3,34,"Charges > $500, x 34%",219.3,percent of total billed charges,Implant Device,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,258,40,,258,percent of total billed charges,Implant Devices,225.75,70,,225.75,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,219.3,34,,219.3,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,225.75,35,,225.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,258,
ARTHREX AR-8935L-12 LOCK SCREW 3.5X12MM,C1713,HCPCS,,79011084,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ARTHREX AR-8940-14 4.0X14MM,C1713,HCPCS,,79011085,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-9943T-08 TUBULAR PLATE 8H,C1713,HCPCS,,79011086,CDM,278,RC,,,both,,,1137,448.74,39.4668,,448.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,386.58,34,,386.58,percent of total billed charges,Implant Device,386.58,34,,386.58,percent of total billed charges,Implant Device,386.58,34,,386.58,percent of total billed charges,Implant Device,386.58,34,,386.58,percent of total billed charges,Implant Device,386.58,34,,386.58,percent of total billed charges,Implant Device,386.58,34,,386.58,percent of total billed charges,Implant Device,397.95,35,,397.95,percent of total billed charges,Implant Device,386.58,34,"Charges > $500, x 34%",386.58,percent of total billed charges,Implant Device,397.95,35,,397.95,percent of total billed charges,Implant Devices,397.95,35,,397.95,percent of total billed charges,Implant Devices,397.95,35,,,percent of total billed charges,Implant Devices,397.95,35,,397.95,percent of total billed charges,Implant Devices,397.95,35,,397.95,percent of total billed charges,Implant Devices,454.8,40,,454.8,percent of total billed charges,Implant Devices,397.95,70,,397.95,percent of total billed charges,Implant Devices,386.58,34,,386.58,percent of total billed charges,Implant Devices,386.58,34,,386.58,percent of total billed charges,Implant Devices,397.95,35,,397.95,percent of total billed charges,Implant Devices,397.95,35,,397.95,percent of total billed charges,Implant Devices,397.95,35,,397.95,percent of total billed charges,Implant Devices,397.95,35,,397.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,454.8,
STRYKER 7512-21646LO-G3 CORPECTMY W/SCRE,C1713,HCPCS,,79011089,CDM,278,RC,,,both,,,22050,8702.43,39.4668,,8702.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7497,34,,7497,percent of total billed charges,Implant Device,7497,34,,7497,percent of total billed charges,Implant Device,7497,34,,7497,percent of total billed charges,Implant Device,7497,34,,7497,percent of total billed charges,Implant Device,7497,34,,7497,percent of total billed charges,Implant Device,7497,34,,7497,percent of total billed charges,Implant Device,7717.5,35,,7717.5,percent of total billed charges,Implant Device,7497,34,"Charges > $500, x 34%",7497,percent of total billed charges,Implant Device,7717.5,35,,7717.5,percent of total billed charges,Implant Devices,7717.5,35,,7717.5,percent of total billed charges,Implant Devices,7717.5,35,,,percent of total billed charges,Implant Devices,7717.5,35,,7717.5,percent of total billed charges,Implant Devices,7717.5,35,,7717.5,percent of total billed charges,Implant Devices,8820,40,,8820,percent of total billed charges,Implant Devices,7717.5,70,,7717.5,percent of total billed charges,Implant Devices,7497,34,,7497,percent of total billed charges,Implant Devices,7497,34,,7497,percent of total billed charges,Implant Devices,7717.5,35,,7717.5,percent of total billed charges,Implant Devices,7717.5,35,,7717.5,percent of total billed charges,Implant Devices,7717.5,35,,7717.5,percent of total billed charges,Implant Devices,7717.5,35,,7717.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7497,34,"If Charge > 2,000, then 34 percent",7497,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8820,
STRYKER 2102-1905 VITOSS FOAM PACK 5CC,C1713,HCPCS,,79011090,CDM,278,RC,,,both,,,4505,1777.98,39.4668,,1777.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1531.7,34,,1531.7,percent of total billed charges,Implant Device,1531.7,34,,1531.7,percent of total billed charges,Implant Device,1531.7,34,,1531.7,percent of total billed charges,Implant Device,1531.7,34,,1531.7,percent of total billed charges,Implant Device,1531.7,34,,1531.7,percent of total billed charges,Implant Device,1531.7,34,,1531.7,percent of total billed charges,Implant Device,1576.75,35,,1576.75,percent of total billed charges,Implant Device,1531.7,34,"Charges > $500, x 34%",1531.7,percent of total billed charges,Implant Device,1576.75,35,,1576.75,percent of total billed charges,Implant Devices,1576.75,35,,1576.75,percent of total billed charges,Implant Devices,1576.75,35,,,percent of total billed charges,Implant Devices,1576.75,35,,1576.75,percent of total billed charges,Implant Devices,1576.75,35,,1576.75,percent of total billed charges,Implant Devices,1802,40,,1802,percent of total billed charges,Implant Devices,1576.75,70,,1576.75,percent of total billed charges,Implant Devices,1531.7,34,,1531.7,percent of total billed charges,Implant Devices,1531.7,34,,1531.7,percent of total billed charges,Implant Devices,1576.75,35,,1576.75,percent of total billed charges,Implant Devices,1576.75,35,,1576.75,percent of total billed charges,Implant Devices,1576.75,35,,1576.75,percent of total billed charges,Implant Devices,1576.75,35,,1576.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1531.7,34,"If Charge > 2,000, then 34 percent",1531.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1802,
STRYKER AA01-45F52V 2 LEVEL PLATE 52MM,C1713,HCPCS,,79011091,CDM,278,RC,,,both,,,3825,1509.61,39.4668,,1509.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1338.75,35,,1338.75,percent of total billed charges,Implant Device,1300.5,34,"Charges > $500, x 34%",1300.5,percent of total billed charges,Implant Device,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1530,40,,1530,percent of total billed charges,Implant Devices,1338.75,70,,1338.75,percent of total billed charges,Implant Devices,1300.5,34,,1300.5,percent of total billed charges,Implant Devices,1300.5,34,,1300.5,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1300.5,34,"If Charge > 2,000, then 34 percent",1300.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1530,
DEPUY 04.038.395S HELICAL BLADE 95MM,C1713,HCPCS,,79011093,CDM,278,RC,,,both,,,1766,696.98,39.4668,,696.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,618.1,35,,618.1,percent of total billed charges,Implant Device,600.44,34,"Charges > $500, x 34%",600.44,percent of total billed charges,Implant Device,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,706.4,40,,706.4,percent of total billed charges,Implant Devices,618.1,70,,618.1,percent of total billed charges,Implant Devices,600.44,34,,600.44,percent of total billed charges,Implant Devices,600.44,34,,600.44,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,706.4,
STRYKER 657126 BONE SCREW 2.7X26MM,C1713,HCPCS,,79011099,CDM,278,RC,,,both,,,294,116.03,39.4668,,116.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,99.96,34,,99.96,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,117.6,40,,117.6,percent of total billed charges,Implant Devices,102.9,70,,102.9,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,99.96,34,,99.96,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,102.9,35,,102.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
EXACTECH 314-13-34 POSTERIOR AUGMENT,C1713,HCPCS,,79011101,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
ACUMED CO-N2320 NON TOGGLING SCRW 2.3X20,C1713,HCPCS,,79011106,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ARTHREX AR-8730-24PT PT SCREW 3.0X24MM,C1713,HCPCS,,79011107,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
ARTHREX AR-8730-20PT PT SCREW 3.0X20MM,C1713,HCPCS,,79011108,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
ARTHREX AR-8944-P MTP SHORT PLATE,C1713,HCPCS,,79011109,CDM,278,RC,,,both,,,2685,1059.68,39.4668,,1059.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,912.9,34,,912.9,percent of total billed charges,Implant Device,912.9,34,,912.9,percent of total billed charges,Implant Device,912.9,34,,912.9,percent of total billed charges,Implant Device,912.9,34,,912.9,percent of total billed charges,Implant Device,912.9,34,,912.9,percent of total billed charges,Implant Device,912.9,34,,912.9,percent of total billed charges,Implant Device,939.75,35,,939.75,percent of total billed charges,Implant Device,912.9,34,"Charges > $500, x 34%",912.9,percent of total billed charges,Implant Device,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,1074,40,,1074,percent of total billed charges,Implant Devices,939.75,70,,939.75,percent of total billed charges,Implant Devices,912.9,34,,912.9,percent of total billed charges,Implant Devices,912.9,34,,912.9,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,939.75,35,,939.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,912.9,34,"If Charge > 2,000, then 34 percent",912.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1074,
ARTHREX AR-7298 UNIVERSAL SUTURE KIT,C1713,HCPCS,,79011113,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
ARTHREX AR-2324KBCCT SWIVELOCK 4.75X19.1,C1713,HCPCS,,79011118,CDM,278,RC,,,both,,,1590,627.52,39.4668,,627.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Device,540.6,34,"Charges > $500, x 34%",540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,636,40,,636,percent of total billed charges,Implant Devices,556.5,70,,556.5,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,636,
ARTHREX AR-2324KBCCTT SWIVELCK 4.75X19.1,C1713,HCPCS,,79011119,CDM,278,RC,,,both,,,1590,627.52,39.4668,,627.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Device,540.6,34,"Charges > $500, x 34%",540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,636,40,,636,percent of total billed charges,Implant Devices,556.5,70,,556.5,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,636,
STRYKER 2341-0933S TIBIAL NAIL 79X330MM,C1713,HCPCS,,79011133,CDM,278,RC,,,both,,,4792,1891.25,39.4668,,1891.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Device,1629.28,34,"Charges > $500, x 34%",1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1916.8,40,,1916.8,percent of total billed charges,Implant Devices,1677.2,70,,1677.2,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.28,34,"If Charge > 2,000, then 34 percent",1629.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1916.8,
STRYKER 657714 BONE SCREW 2.0X14MM,C1713,HCPCS,,79011134,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
STRYKER 657716 BONE SCREW 2.0X16MM,C1713,HCPCS,,79011135,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER 657718 BONE SCREW 2.0X18MM,C1713,HCPCS,,79011136,CDM,278,RC,,,both,,,389,153.53,39.4668,,153.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,136.15,35,,136.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,155.6,40,,155.6,percent of total billed charges,Implant Devices,136.15,70,,136.15,percent of total billed charges,Implant Devices,132.26,34,,132.26,percent of total billed charges,Implant Devices,132.26,34,,132.26,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,155.6,
STRYKER 656111 BONE SCREW 2.4X11MM,C1713,HCPCS,,79011139,CDM,278,RC,,,both,,,389,153.53,39.4668,,153.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,132.26,34,,132.26,percent of total billed charges,Implant Device,136.15,35,,136.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,155.6,40,,155.6,percent of total billed charges,Implant Devices,136.15,70,,136.15,percent of total billed charges,Implant Devices,132.26,34,,132.26,percent of total billed charges,Implant Devices,132.26,34,,132.26,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,136.15,35,,136.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,155.6,
STRYKER 656113 BONE SCREW 2.4X13MM,C1713,HCPCS,,79011140,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
STRYKER 657713 BONE SCREW 2.0X13MM,C1713,HCPCS,,79011141,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER 629512 COMP PLT NARROW 12H 150MM,C1713,HCPCS,,79011150,CDM,278,RC,,,both,,,2564,1011.93,39.4668,,1011.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,871.76,34,,871.76,percent of total billed charges,Implant Device,871.76,34,,871.76,percent of total billed charges,Implant Device,871.76,34,,871.76,percent of total billed charges,Implant Device,871.76,34,,871.76,percent of total billed charges,Implant Device,871.76,34,,871.76,percent of total billed charges,Implant Device,871.76,34,,871.76,percent of total billed charges,Implant Device,897.4,35,,897.4,percent of total billed charges,Implant Device,871.76,34,"Charges > $500, x 34%",871.76,percent of total billed charges,Implant Device,897.4,35,,897.4,percent of total billed charges,Implant Devices,897.4,35,,897.4,percent of total billed charges,Implant Devices,897.4,35,,,percent of total billed charges,Implant Devices,897.4,35,,897.4,percent of total billed charges,Implant Devices,897.4,35,,897.4,percent of total billed charges,Implant Devices,1025.6,40,,1025.6,percent of total billed charges,Implant Devices,897.4,70,,897.4,percent of total billed charges,Implant Devices,871.76,34,,871.76,percent of total billed charges,Implant Devices,871.76,34,,871.76,percent of total billed charges,Implant Devices,897.4,35,,897.4,percent of total billed charges,Implant Devices,897.4,35,,897.4,percent of total billed charges,Implant Devices,897.4,35,,897.4,percent of total billed charges,Implant Devices,897.4,35,,897.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,871.76,34,"If Charge > 2,000, then 34 percent",871.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1025.6,
IN2BONES P40 ST012 UNIVERSAL PLATE 2H,C1713,HCPCS,,79011151,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES V35 ST222 LOCK SCREW 3.5X22MM,C1713,HCPCS,,79011152,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P67 ST440 CANN SCREW 4.0X40MM,C1713,HCPCS,,79011153,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ARTHREX AR-2658 DISTAL CLAVICAL BUTTON,C1713,HCPCS,,79011155,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
STRYKER 629730 LOCK PLT NARROW 2.7X79MM,C1713,HCPCS,,79011162,CDM,278,RC,,,both,,,3108,1226.63,39.4668,,1226.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1056.72,34,,1056.72,percent of total billed charges,Implant Device,1087.8,35,,1087.8,percent of total billed charges,Implant Device,1056.72,34,"Charges > $500, x 34%",1056.72,percent of total billed charges,Implant Device,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1243.2,40,,1243.2,percent of total billed charges,Implant Devices,1087.8,70,,1087.8,percent of total billed charges,Implant Devices,1056.72,34,,1056.72,percent of total billed charges,Implant Devices,1056.72,34,,1056.72,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,1087.8,35,,1087.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1056.72,34,"If Charge > 2,000, then 34 percent",1056.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1243.2,
ARTHREX AR-3680 FIBERTAK BUTTON IMPL SYS,C1713,HCPCS,,79011164,CDM,278,RC,,,both,,,3384,1335.56,39.4668,,1335.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1150.56,34,,1150.56,percent of total billed charges,Implant Device,1150.56,34,,1150.56,percent of total billed charges,Implant Device,1150.56,34,,1150.56,percent of total billed charges,Implant Device,1150.56,34,,1150.56,percent of total billed charges,Implant Device,1150.56,34,,1150.56,percent of total billed charges,Implant Device,1150.56,34,,1150.56,percent of total billed charges,Implant Device,1184.4,35,,1184.4,percent of total billed charges,Implant Device,1150.56,34,"Charges > $500, x 34%",1150.56,percent of total billed charges,Implant Device,1184.4,35,,1184.4,percent of total billed charges,Implant Devices,1184.4,35,,1184.4,percent of total billed charges,Implant Devices,1184.4,35,,,percent of total billed charges,Implant Devices,1184.4,35,,1184.4,percent of total billed charges,Implant Devices,1184.4,35,,1184.4,percent of total billed charges,Implant Devices,1353.6,40,,1353.6,percent of total billed charges,Implant Devices,1184.4,70,,1184.4,percent of total billed charges,Implant Devices,1150.56,34,,1150.56,percent of total billed charges,Implant Devices,1150.56,34,,1150.56,percent of total billed charges,Implant Devices,1184.4,35,,1184.4,percent of total billed charges,Implant Devices,1184.4,35,,1184.4,percent of total billed charges,Implant Devices,1184.4,35,,1184.4,percent of total billed charges,Implant Devices,1184.4,35,,1184.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1150.56,34,"If Charge > 2,000, then 34 percent",1150.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1353.6,
ACUMED AT2-M20 BONE SCREW 20MM,C1713,HCPCS,,79011168,CDM,278,RC,,,both,,,1617,638.18,39.4668,,638.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,565.95,35,,565.95,percent of total billed charges,Implant Device,549.78,34,"Charges > $500, x 34%",549.78,percent of total billed charges,Implant Device,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,646.8,40,,646.8,percent of total billed charges,Implant Devices,565.95,70,,565.95,percent of total billed charges,Implant Devices,549.78,34,,549.78,percent of total billed charges,Implant Devices,549.78,34,,549.78,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,646.8,
STRYKER 629750 LOCK PLATE 2.7X9MM 10H,C1713,HCPCS,,79011186,CDM,278,RC,,,both,,,3318,1309.51,39.4668,,1309.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1161.3,35,,1161.3,percent of total billed charges,Implant Device,1128.12,34,"Charges > $500, x 34%",1128.12,percent of total billed charges,Implant Device,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1327.2,40,,1327.2,percent of total billed charges,Implant Devices,1161.3,70,,1161.3,percent of total billed charges,Implant Devices,1128.12,34,,1128.12,percent of total billed charges,Implant Devices,1128.12,34,,1128.12,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1128.12,34,"If Charge > 2,000, then 34 percent",1128.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1327.2,
STRYKER 626682 TUBULAR PLATE 12H 143MM,C1713,HCPCS,,79011189,CDM,278,RC,,,both,,,1097,432.95,39.4668,,432.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,372.98,34,,372.98,percent of total billed charges,Implant Device,372.98,34,,372.98,percent of total billed charges,Implant Device,372.98,34,,372.98,percent of total billed charges,Implant Device,372.98,34,,372.98,percent of total billed charges,Implant Device,372.98,34,,372.98,percent of total billed charges,Implant Device,372.98,34,,372.98,percent of total billed charges,Implant Device,383.95,35,,383.95,percent of total billed charges,Implant Device,372.98,34,"Charges > $500, x 34%",372.98,percent of total billed charges,Implant Device,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,438.8,40,,438.8,percent of total billed charges,Implant Devices,383.95,70,,383.95,percent of total billed charges,Implant Devices,372.98,34,,372.98,percent of total billed charges,Implant Devices,372.98,34,,372.98,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,383.95,35,,383.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,438.8,
IN2BONES T50 SN010 COMP STAPLE 10X10X10,C1713,HCPCS,,79011190,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
STRYKER 661416 CORTEX SCREW 73.5X16MM,C1713,HCPCS,,79011201,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
ZIMMER 00-1147-036-40 CANN SCREW 4X36MM,C1713,HCPCS,,79011204,CDM,278,RC,,,both,,,605,238.77,39.4668,,238.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,205.7,34,,205.7,percent of total billed charges,Implant Device,211.75,35,,211.75,percent of total billed charges,Implant Device,205.7,34,"Charges > $500, x 34%",205.7,percent of total billed charges,Implant Device,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,242,40,,242,percent of total billed charges,Implant Devices,211.75,70,,211.75,percent of total billed charges,Implant Devices,205.7,34,,205.7,percent of total billed charges,Implant Devices,205.7,34,,205.7,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,211.75,35,,211.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,242,
IN2BONES P40 ST137 MTP REVISION PLATE RT,C1713,HCPCS,,79011205,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
STRYKER IH2518 HEADLESS SCREW 2.5X18MM,C1713,HCPCS,,79011206,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
STRYKER IH2520 HEADLESS SCREW 2.5X20MM,C1713,HCPCS,,79011207,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ZIMMER 00-2359-032-45 LOCK SCREW 4.5X32,C1713,HCPCS,,79011212,CDM,278,RC,,,both,,,445,175.63,39.4668,,175.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,151.3,34,,151.3,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,178,40,,178,percent of total billed charges,Implant Devices,155.75,70,,155.75,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,151.3,34,,151.3,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,155.75,35,,155.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178,
DEPUY 02.112.009 LCP CLAVICLE PLATE 6H,C1713,HCPCS,,79011350,CDM,278,RC,,,both,,,2397,946.02,39.4668,,946.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,838.95,35,,838.95,percent of total billed charges,Implant Device,814.98,34,"Charges > $500, x 34%",814.98,percent of total billed charges,Implant Device,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,958.8,40,,958.8,percent of total billed charges,Implant Devices,838.95,70,,838.95,percent of total billed charges,Implant Devices,814.98,34,,814.98,percent of total billed charges,Implant Devices,814.98,34,,814.98,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,814.98,34,"If Charge > 2,000, then 34 percent",814.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,958.8,
ARTHREX AR-8830-14 CAN SCREW 3X14MM,C1713,HCPCS,,79011612,CDM,278,RC,,,both,,,105,41.44,39.4668,,41.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,35.7,34,,35.7,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,42,40,,42,percent of total billed charges,Implant Devices,36.75,70,,36.75,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,35.7,34,,35.7,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,36.75,35,,36.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,42,
ARTHREX AR-8870W CANN SCREW 4.0X44MM,C1713,HCPCS,,79011613,CDM,278,RC,,,both,,,138,54.46,39.4668,,54.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,55.2,40,,55.2,percent of total billed charges,Implant Devices,48.3,70,,48.3,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.2,
DEPUY 04.038.385S HELICAL BLADE 85MM,C1713,HCPCS,,79011614,CDM,278,RC,,,both,,,1766,696.98,39.4668,,696.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,618.1,35,,618.1,percent of total billed charges,Implant Device,600.44,34,"Charges > $500, x 34%",600.44,percent of total billed charges,Implant Device,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,706.4,40,,706.4,percent of total billed charges,Implant Devices,618.1,70,,618.1,percent of total billed charges,Implant Devices,600.44,34,,600.44,percent of total billed charges,Implant Devices,600.44,34,,600.44,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,706.4,
DEPUY 04.005.522S LOCK SCREW 5.0X32MM,C1713,HCPCS,,79011615,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
STRYKER 2341-1239S TIBIAL NAIL 12X390MM,C1713,HCPCS,,79011616,CDM,278,RC,,,both,,,6378,2517.19,39.4668,,2517.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Device,2168.52,34,"Charges > $500, x 34%",2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2551.2,40,,2551.2,percent of total billed charges,Implant Devices,2232.3,70,,2232.3,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2168.52,34,"If Charge > 2,000, then 34 percent",2168.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2551.2,
STRYKER 627510 LOCK COMP PLT 10H 136X4MM,C1713,HCPCS,,79011633,CDM,278,RC,,,both,,,4476,1766.53,39.4668,,1766.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1521.84,34,,1521.84,percent of total billed charges,Implant Device,1521.84,34,,1521.84,percent of total billed charges,Implant Device,1521.84,34,,1521.84,percent of total billed charges,Implant Device,1521.84,34,,1521.84,percent of total billed charges,Implant Device,1521.84,34,,1521.84,percent of total billed charges,Implant Device,1521.84,34,,1521.84,percent of total billed charges,Implant Device,1566.6,35,,1566.6,percent of total billed charges,Implant Device,1521.84,34,"Charges > $500, x 34%",1521.84,percent of total billed charges,Implant Device,1566.6,35,,1566.6,percent of total billed charges,Implant Devices,1566.6,35,,1566.6,percent of total billed charges,Implant Devices,1566.6,35,,,percent of total billed charges,Implant Devices,1566.6,35,,1566.6,percent of total billed charges,Implant Devices,1566.6,35,,1566.6,percent of total billed charges,Implant Devices,1790.4,40,,1790.4,percent of total billed charges,Implant Devices,1566.6,70,,1566.6,percent of total billed charges,Implant Devices,1521.84,34,,1521.84,percent of total billed charges,Implant Devices,1521.84,34,,1521.84,percent of total billed charges,Implant Devices,1566.6,35,,1566.6,percent of total billed charges,Implant Devices,1566.6,35,,1566.6,percent of total billed charges,Implant Devices,1566.6,35,,1566.6,percent of total billed charges,Implant Devices,1566.6,35,,1566.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1521.84,34,"If Charge > 2,000, then 34 percent",1521.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1790.4,
STRYKER 627589 LOCK COMP PLT 9H 173X5MM,C1713,HCPCS,,79011634,CDM,278,RC,,,both,,,5824,2298.55,39.4668,,2298.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1980.16,34,,1980.16,percent of total billed charges,Implant Device,1980.16,34,,1980.16,percent of total billed charges,Implant Device,1980.16,34,,1980.16,percent of total billed charges,Implant Device,1980.16,34,,1980.16,percent of total billed charges,Implant Device,1980.16,34,,1980.16,percent of total billed charges,Implant Device,1980.16,34,,1980.16,percent of total billed charges,Implant Device,2038.4,35,,2038.4,percent of total billed charges,Implant Device,1980.16,34,"Charges > $500, x 34%",1980.16,percent of total billed charges,Implant Device,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2329.6,40,,2329.6,percent of total billed charges,Implant Devices,2038.4,70,,2038.4,percent of total billed charges,Implant Devices,1980.16,34,,1980.16,percent of total billed charges,Implant Devices,1980.16,34,,1980.16,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1980.16,34,"If Charge > 2,000, then 34 percent",1980.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2329.6,
STRYKER 661718 CORTEX SCREW 4.5X18MM,C1713,HCPCS,,79011635,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
STRYKER 661726 CORTEX SCREW 4.5X26MM,C1713,HCPCS,,79011636,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
J&J 631-400 TRU-FILL N-BCA TWO VIALS,C1713,HCPCS,,79011637,CDM,278,RC,,,both,,,23250,9176.03,39.4668,,9176.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7905,34,,7905,percent of total billed charges,Implant Device,7905,34,,7905,percent of total billed charges,Implant Device,7905,34,,7905,percent of total billed charges,Implant Device,7905,34,,7905,percent of total billed charges,Implant Device,7905,34,,7905,percent of total billed charges,Implant Device,7905,34,,7905,percent of total billed charges,Implant Device,8137.5,35,,8137.5,percent of total billed charges,Implant Device,7905,34,"Charges > $500, x 34%",7905,percent of total billed charges,Implant Device,8137.5,35,,8137.5,percent of total billed charges,Implant Devices,8137.5,35,,8137.5,percent of total billed charges,Implant Devices,8137.5,35,,,percent of total billed charges,Implant Devices,8137.5,35,,8137.5,percent of total billed charges,Implant Devices,8137.5,35,,8137.5,percent of total billed charges,Implant Devices,9300,40,,9300,percent of total billed charges,Implant Devices,8137.5,70,,8137.5,percent of total billed charges,Implant Devices,7905,34,,7905,percent of total billed charges,Implant Devices,7905,34,,7905,percent of total billed charges,Implant Devices,8137.5,35,,8137.5,percent of total billed charges,Implant Devices,8137.5,35,,8137.5,percent of total billed charges,Implant Devices,8137.5,35,,8137.5,percent of total billed charges,Implant Devices,8137.5,35,,8137.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7905,34,"If Charge > 2,000, then 34 percent",7905,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9300,
J&J 631-500 TRU-FILL N-BCA SINGLE VIALS,C1713,HCPCS,,79011638,CDM,278,RC,,,both,,,13323,5258.16,39.4668,,5258.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4529.82,34,,4529.82,percent of total billed charges,Implant Device,4529.82,34,,4529.82,percent of total billed charges,Implant Device,4529.82,34,,4529.82,percent of total billed charges,Implant Device,4529.82,34,,4529.82,percent of total billed charges,Implant Device,4529.82,34,,4529.82,percent of total billed charges,Implant Device,4529.82,34,,4529.82,percent of total billed charges,Implant Device,4663.05,35,,4663.05,percent of total billed charges,Implant Device,4529.82,34,"Charges > $500, x 34%",4529.82,percent of total billed charges,Implant Device,4663.05,35,,4663.05,percent of total billed charges,Implant Devices,4663.05,35,,4663.05,percent of total billed charges,Implant Devices,4663.05,35,,,percent of total billed charges,Implant Devices,4663.05,35,,4663.05,percent of total billed charges,Implant Devices,4663.05,35,,4663.05,percent of total billed charges,Implant Devices,5329.2,40,,5329.2,percent of total billed charges,Implant Devices,4663.05,70,,4663.05,percent of total billed charges,Implant Devices,4529.82,34,,4529.82,percent of total billed charges,Implant Devices,4529.82,34,,4529.82,percent of total billed charges,Implant Devices,4663.05,35,,4663.05,percent of total billed charges,Implant Devices,4663.05,35,,4663.05,percent of total billed charges,Implant Devices,4663.05,35,,4663.05,percent of total billed charges,Implant Devices,4663.05,35,,4663.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4529.82,34,"If Charge > 2,000, then 34 percent",4529.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5329.2,
STRYKER 661414 CORTEX SCREW 3.5X14MM,C1713,HCPCS,,79011639,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
STRYKER 657712 BONE SCREW 2.0X12MM,C1713,HCPCS,,79011640,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
STRYKER 2341-1031S TIBIAL NAIL 10X315MM,C1713,HCPCS,,79011647,CDM,278,RC,,,both,,,4792,1891.25,39.4668,,1891.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Device,1629.28,34,"Charges > $500, x 34%",1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1916.8,40,,1916.8,percent of total billed charges,Implant Devices,1677.2,70,,1677.2,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.28,34,"If Charge > 2,000, then 34 percent",1629.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1916.8,
STRYKER 2361-5075S LOCKING SCREW 5X75MM,C1713,HCPCS,,79011648,CDM,278,RC,,,both,,,887,350.07,39.4668,,350.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Device,301.58,34,"Charges > $500, x 34%",301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,354.8,40,,354.8,percent of total billed charges,Implant Devices,310.45,70,,310.45,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.8,
STRYKER 607330 CANCELLOUS SCREW 4.0X30MM,C1713,HCPCS,,79011649,CDM,278,RC,,,both,,,133,52.49,39.4668,,52.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,53.2,40,,53.2,percent of total billed charges,Implant Devices,46.55,70,,46.55,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
STRYKER 607350 CANCELLOUS SCREW 4.0X50MM,C1713,HCPCS,,79011650,CDM,278,RC,,,both,,,133,52.49,39.4668,,52.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,53.2,40,,53.2,percent of total billed charges,Implant Devices,46.55,70,,46.55,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
IN2BONES P72 ST024 NON LOCK SCREW 2.7X24,C1713,HCPCS,,79011651,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES S65 ST170 CANN SCREW 6.5X70MM,C1713,HCPCS,,79011652,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
IN2BONES S65 ST175 CANN SCREW 6.5X75MM,C1713,HCPCS,,79011653,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
ARTHREX AR-1588RTT TIGHTROPE W/FIBERTAG,C1713,HCPCS,,79011654,CDM,278,RC,,,both,,,1575,621.6,39.4668,,621.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,551.25,35,,551.25,percent of total billed charges,Implant Device,535.5,34,"Charges > $500, x 34%",535.5,percent of total billed charges,Implant Device,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,630,40,,630,percent of total billed charges,Implant Devices,551.25,70,,551.25,percent of total billed charges,Implant Devices,535.5,34,,535.5,percent of total billed charges,Implant Devices,535.5,34,,535.5,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,630,
"ARTHREX AR-1588TNT TIGHTROPE W/FIB, ABS",C1713,HCPCS,,79011655,CDM,278,RC,,,both,,,1005,396.64,39.4668,,396.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,341.7,34,,341.7,percent of total billed charges,Implant Device,351.75,35,,351.75,percent of total billed charges,Implant Device,341.7,34,"Charges > $500, x 34%",341.7,percent of total billed charges,Implant Device,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,402,40,,402,percent of total billed charges,Implant Devices,351.75,70,,351.75,percent of total billed charges,Implant Devices,341.7,34,,341.7,percent of total billed charges,Implant Devices,341.7,34,,341.7,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,351.75,35,,351.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,402,
DEPUY 02.112.090 CLAVICLE PLT 6H 3.5X105,C1713,HCPCS,,79011656,CDM,278,RC,,,both,,,2397,946.02,39.4668,,946.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,838.95,35,,838.95,percent of total billed charges,Implant Device,814.98,34,"Charges > $500, x 34%",814.98,percent of total billed charges,Implant Device,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,958.8,40,,958.8,percent of total billed charges,Implant Devices,838.95,70,,838.95,percent of total billed charges,Implant Devices,814.98,34,,814.98,percent of total billed charges,Implant Devices,814.98,34,,814.98,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,814.98,34,"If Charge > 2,000, then 34 percent",814.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,958.8,
ZIMMER 110007541 CANN SCREW 4.0X26MM,C1713,HCPCS,,79011666,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
EXSOMED EXINN923640 INNATE IMPL 3.6X40MM,C1713,HCPCS,,79011667,CDM,278,RC,,,both,,,3885,1533.29,39.4668,,1533.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1359.75,35,,1359.75,percent of total billed charges,Implant Device,1320.9,34,"Charges > $500, x 34%",1320.9,percent of total billed charges,Implant Device,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1554,40,,1554,percent of total billed charges,Implant Devices,1359.75,70,,1359.75,percent of total billed charges,Implant Devices,1320.9,34,,1320.9,percent of total billed charges,Implant Devices,1320.9,34,,1320.9,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1320.9,34,"If Charge > 2,000, then 34 percent",1320.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1554,
EXSOMED EXINN913600 INNATE INSTR KIT 3.6,C1713,HCPCS,,79011668,CDM,278,RC,,,both,,,1095,432.16,39.4668,,432.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,372.3,34,,372.3,percent of total billed charges,Implant Device,372.3,34,,372.3,percent of total billed charges,Implant Device,372.3,34,,372.3,percent of total billed charges,Implant Device,372.3,34,,372.3,percent of total billed charges,Implant Device,372.3,34,,372.3,percent of total billed charges,Implant Device,372.3,34,,372.3,percent of total billed charges,Implant Device,383.25,35,,383.25,percent of total billed charges,Implant Device,372.3,34,"Charges > $500, x 34%",372.3,percent of total billed charges,Implant Device,383.25,35,,383.25,percent of total billed charges,Implant Devices,383.25,35,,383.25,percent of total billed charges,Implant Devices,383.25,35,,,percent of total billed charges,Implant Devices,383.25,35,,383.25,percent of total billed charges,Implant Devices,383.25,35,,383.25,percent of total billed charges,Implant Devices,438,40,,438,percent of total billed charges,Implant Devices,383.25,70,,383.25,percent of total billed charges,Implant Devices,372.3,34,,372.3,percent of total billed charges,Implant Devices,372.3,34,,372.3,percent of total billed charges,Implant Devices,383.25,35,,383.25,percent of total billed charges,Implant Devices,383.25,35,,383.25,percent of total billed charges,Implant Devices,383.25,35,,383.25,percent of total billed charges,Implant Devices,383.25,35,,383.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,438,
STRYKER 656115 BONE SCREW 2.4X15MM,C1713,HCPCS,,79011669,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
STRYKER 657715 BONE SCREW 2.0X15MM,C1713,HCPCS,,79011670,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
STRYKER IC3024 HEADED SCREW 3.0X24MM,C1713,HCPCS,,79011671,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER IC3026 HEADED SCREW 3.0X26MM,C1713,HCPCS,,79011672,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER IC3028 HEADED SCREW 3.0X28MM,C1713,HCPCS,,79011673,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER IH2530 HEADLESS SCREW 2.5X30MM,C1713,HCPCS,,79011674,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
STRYKER IH2536 HEADLESS SCREW 2.5X36MM,C1713,HCPCS,,79011675,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
STRYKER IH3026 HEADLESS SCREW 3.0X26MM,C1713,HCPCS,,79011676,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
STRYKER IH3036 HEADLESS SCREW 3.0X36MM,C1713,HCPCS,,79011677,CDM,278,RC,,,both,,,888,350.47,39.4668,,350.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,301.92,34,,301.92,percent of total billed charges,Implant Device,310.8,35,,310.8,percent of total billed charges,Implant Device,301.92,34,"Charges > $500, x 34%",301.92,percent of total billed charges,Implant Device,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,355.2,40,,355.2,percent of total billed charges,Implant Devices,310.8,70,,310.8,percent of total billed charges,Implant Devices,301.92,34,,301.92,percent of total billed charges,Implant Devices,301.92,34,,301.92,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,310.8,35,,310.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,355.2,
ARTHREX AR-1698-CP BRACE LISFRANC KIT,C1713,HCPCS,,79011681,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
ARTHREX AR-13227 BB-TAK MTP,C1713,HCPCS,,79011682,CDM,278,RC,,,both,,,163,64.33,39.4668,,64.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,55.42,34,,55.42,percent of total billed charges,Implant Device,57.05,35,,57.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,65.2,40,,65.2,percent of total billed charges,Implant Devices,57.05,70,,57.05,percent of total billed charges,Implant Devices,55.42,34,,55.42,percent of total billed charges,Implant Devices,55.42,34,,55.42,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,57.05,35,,57.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,65.2,
ARTHREX AR-9933-12 CORT SCREW 3.0X12MM,C1713,HCPCS,,79011683,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
ARTHREX AR-9933-14 CORT SCREW 3.0X14MM,C1713,HCPCS,,79011684,CDM,278,RC,,,both,,,537,211.94,39.4668,,211.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,182.58,34,,182.58,percent of total billed charges,Implant Device,187.95,35,,187.95,percent of total billed charges,Implant Device,182.58,34,"Charges > $500, x 34%",182.58,percent of total billed charges,Implant Device,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,214.8,40,,214.8,percent of total billed charges,Implant Devices,187.95,70,,187.95,percent of total billed charges,Implant Devices,182.58,34,,182.58,percent of total billed charges,Implant Devices,182.58,34,,182.58,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,187.95,35,,187.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.8,
ARTHREX AR-9944P-0L MAXFORCE MTP PLT LT,C1713,HCPCS,,79011685,CDM,278,RC,,,both,,,5985,2362.09,39.4668,,2362.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2094.75,35,,2094.75,percent of total billed charges,Implant Device,2034.9,34,"Charges > $500, x 34%",2034.9,percent of total billed charges,Implant Device,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2394,40,,2394,percent of total billed charges,Implant Devices,2094.75,70,,2094.75,percent of total billed charges,Implant Devices,2034.9,34,,2034.9,percent of total billed charges,Implant Devices,2034.9,34,,2034.9,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2034.9,34,"If Charge > 2,000, then 34 percent",2034.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2394,
STRYKER 1826-1034S SUPRCNDLR NAIL 10X340,C1713,HCPCS,,79011688,CDM,278,RC,,,both,,,4633,1828.5,39.4668,,1828.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1575.22,34,,1575.22,percent of total billed charges,Implant Device,1575.22,34,,1575.22,percent of total billed charges,Implant Device,1575.22,34,,1575.22,percent of total billed charges,Implant Device,1575.22,34,,1575.22,percent of total billed charges,Implant Device,1575.22,34,,1575.22,percent of total billed charges,Implant Device,1575.22,34,,1575.22,percent of total billed charges,Implant Device,1621.55,35,,1621.55,percent of total billed charges,Implant Device,1575.22,34,"Charges > $500, x 34%",1575.22,percent of total billed charges,Implant Device,1621.55,35,,1621.55,percent of total billed charges,Implant Devices,1621.55,35,,1621.55,percent of total billed charges,Implant Devices,1621.55,35,,,percent of total billed charges,Implant Devices,1621.55,35,,1621.55,percent of total billed charges,Implant Devices,1621.55,35,,1621.55,percent of total billed charges,Implant Devices,1853.2,40,,1853.2,percent of total billed charges,Implant Devices,1621.55,70,,1621.55,percent of total billed charges,Implant Devices,1575.22,34,,1575.22,percent of total billed charges,Implant Devices,1575.22,34,,1575.22,percent of total billed charges,Implant Devices,1621.55,35,,1621.55,percent of total billed charges,Implant Devices,1621.55,35,,1621.55,percent of total billed charges,Implant Devices,1621.55,35,,1621.55,percent of total billed charges,Implant Devices,1621.55,35,,1621.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1575.22,34,"If Charge > 2,000, then 34 percent",1575.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1853.2,
STRYKER 2360-5060S LOCK SCREW 5X60MM,C1713,HCPCS,,79011690,CDM,278,RC,,,both,,,762,300.74,39.4668,,300.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,266.7,35,,266.7,percent of total billed charges,Implant Device,259.08,34,"Charges > $500, x 34%",259.08,percent of total billed charges,Implant Device,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,304.8,40,,304.8,percent of total billed charges,Implant Devices,266.7,70,,266.7,percent of total billed charges,Implant Devices,259.08,34,,259.08,percent of total billed charges,Implant Devices,259.08,34,,259.08,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,304.8,
STRYKER 2360-5075S LOCK SCREW 5X75MM,C1713,HCPCS,,79011691,CDM,278,RC,,,both,,,956,377.3,39.4668,,377.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,334.6,35,,334.6,percent of total billed charges,Implant Device,325.04,34,"Charges > $500, x 34%",325.04,percent of total billed charges,Implant Device,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,382.4,40,,382.4,percent of total billed charges,Implant Devices,334.6,70,,334.6,percent of total billed charges,Implant Devices,325.04,34,,325.04,percent of total billed charges,Implant Devices,325.04,34,,325.04,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,382.4,
STRYKER 2360-5080S LOCK SCREW 5X80MM,C1713,HCPCS,,79011692,CDM,278,RC,,,both,,,762,300.74,39.4668,,300.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,266.7,35,,266.7,percent of total billed charges,Implant Device,259.08,34,"Charges > $500, x 34%",259.08,percent of total billed charges,Implant Device,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,304.8,40,,304.8,percent of total billed charges,Implant Devices,266.7,70,,266.7,percent of total billed charges,Implant Devices,259.08,34,,259.08,percent of total billed charges,Implant Devices,259.08,34,,259.08,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,304.8,
STRYKER 626673 TUBULAR PLATE 3 HOLE 35MM,C1713,HCPCS,,79011693,CDM,278,RC,,,both,,,759,299.55,39.4668,,299.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,258.06,34,,258.06,percent of total billed charges,Implant Device,265.65,35,,265.65,percent of total billed charges,Implant Device,258.06,34,"Charges > $500, x 34%",258.06,percent of total billed charges,Implant Device,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,303.6,40,,303.6,percent of total billed charges,Implant Devices,265.65,70,,265.65,percent of total billed charges,Implant Devices,258.06,34,,258.06,percent of total billed charges,Implant Devices,258.06,34,,258.06,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,265.65,35,,265.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,303.6,
WRIGHT FFNS1010 STAPLE NITINOL 10X10MM,C1713,HCPCS,,79011695,CDM,278,RC,,,both,,,5410,2135.15,39.4668,,2135.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1839.4,34,,1839.4,percent of total billed charges,Implant Device,1839.4,34,,1839.4,percent of total billed charges,Implant Device,1839.4,34,,1839.4,percent of total billed charges,Implant Device,1839.4,34,,1839.4,percent of total billed charges,Implant Device,1839.4,34,,1839.4,percent of total billed charges,Implant Device,1839.4,34,,1839.4,percent of total billed charges,Implant Device,1893.5,35,,1893.5,percent of total billed charges,Implant Device,1839.4,34,"Charges > $500, x 34%",1839.4,percent of total billed charges,Implant Device,1893.5,35,,1893.5,percent of total billed charges,Implant Devices,1893.5,35,,1893.5,percent of total billed charges,Implant Devices,1893.5,35,,,percent of total billed charges,Implant Devices,1893.5,35,,1893.5,percent of total billed charges,Implant Devices,1893.5,35,,1893.5,percent of total billed charges,Implant Devices,2164,40,,2164,percent of total billed charges,Implant Devices,1893.5,70,,1893.5,percent of total billed charges,Implant Devices,1839.4,34,,1839.4,percent of total billed charges,Implant Devices,1839.4,34,,1839.4,percent of total billed charges,Implant Devices,1893.5,35,,1893.5,percent of total billed charges,Implant Devices,1893.5,35,,1893.5,percent of total billed charges,Implant Devices,1893.5,35,,1893.5,percent of total billed charges,Implant Devices,1893.5,35,,1893.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1839.4,34,"If Charge > 2,000, then 34 percent",1839.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2164,
STRYKER 40-20114S CANN SCREW 2.0X14/6MM,C1713,HCPCS,,79011696,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER 40-30122S CANN SCREW 3.0X22/5MM,C1713,HCPCS,,79011697,CDM,278,RC,,,both,,,964,380.46,39.4668,,380.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Device,327.76,34,"Charges > $500, x 34%",327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,385.6,40,,385.6,percent of total billed charges,Implant Devices,337.4,70,,337.4,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,385.6,
STRYKER 40-301128S CANN SCREW 3.0X28/6MM,C1713,HCPCS,,79011698,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
DEPUY 02.112.008 CLAV PLT 3.5X108MM 6H,C1713,HCPCS,,79011699,CDM,278,RC,,,both,,,2397,946.02,39.4668,,946.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,814.98,34,,814.98,percent of total billed charges,Implant Device,838.95,35,,838.95,percent of total billed charges,Implant Device,814.98,34,"Charges > $500, x 34%",814.98,percent of total billed charges,Implant Device,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,958.8,40,,958.8,percent of total billed charges,Implant Devices,838.95,70,,838.95,percent of total billed charges,Implant Devices,814.98,34,,814.98,percent of total billed charges,Implant Devices,814.98,34,,814.98,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,838.95,35,,838.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,814.98,34,"If Charge > 2,000, then 34 percent",814.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,958.8,
STRYKER 3425-1400S LONG NAIL 11X400X125,C1713,HCPCS,,79011700,CDM,278,RC,,,both,,,4969,1961.11,39.4668,,1961.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Device,1689.46,34,"Charges > $500, x 34%",1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1987.6,40,,1987.6,percent of total billed charges,Implant Devices,1739.15,70,,1739.15,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.46,34,"If Charge > 2,000, then 34 percent",1689.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.6,
STRYKER 40-35034 LOCK BONE SCREW 3.5X34,C1713,HCPCS,,79011701,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
ARTHREX AR-8720-16PT CANN SCREW 2.0X16MM,C1713,HCPCS,,79011704,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ARTHREX AR-8720-18PT CANN SCREW 2.0X18MM,C1713,HCPCS,,79011705,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
ARTHREX AR-8724-16PT CANN SCREW 2.4X16MM,C1713,HCPCS,,79011706,CDM,278,RC,,,both,,,624,246.27,39.4668,,246.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,218.4,35,,218.4,percent of total billed charges,Implant Device,212.16,34,"Charges > $500, x 34%",212.16,percent of total billed charges,Implant Device,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,249.6,40,,249.6,percent of total billed charges,Implant Devices,218.4,70,,218.4,percent of total billed charges,Implant Devices,212.16,34,,212.16,percent of total billed charges,Implant Devices,212.16,34,,212.16,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,249.6,
ZIMMER 110007545 CANNULATED SCREW 4X30MM,C1713,HCPCS,,79011712,CDM,278,RC,,,both,,,510,201.28,39.4668,,201.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Device,173.4,34,"Charges > $500, x 34%",173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,204,40,,204,percent of total billed charges,Implant Devices,178.5,70,,178.5,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204,
ARTHREX AR-8643-28 HEADLESS SCRW 4.3X28,C1713,HCPCS,,79011714,CDM,278,RC,,,both,,,1608,634.63,39.4668,,634.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,546.72,34,,546.72,percent of total billed charges,Implant Device,562.8,35,,562.8,percent of total billed charges,Implant Device,546.72,34,"Charges > $500, x 34%",546.72,percent of total billed charges,Implant Device,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,643.2,40,,643.2,percent of total billed charges,Implant Devices,562.8,70,,562.8,percent of total billed charges,Implant Devices,546.72,34,,546.72,percent of total billed charges,Implant Devices,546.72,34,,546.72,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,562.8,35,,562.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,643.2,
"WRIGHT 52020212 PLT, STRAIGHT PINCH 6H",C1713,HCPCS,,79011715,CDM,278,RC,,,both,,,6888,2718.47,39.4668,,2718.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2341.92,34,,2341.92,percent of total billed charges,Implant Device,2341.92,34,,2341.92,percent of total billed charges,Implant Device,2341.92,34,,2341.92,percent of total billed charges,Implant Device,2341.92,34,,2341.92,percent of total billed charges,Implant Device,2341.92,34,,2341.92,percent of total billed charges,Implant Device,2341.92,34,,2341.92,percent of total billed charges,Implant Device,2410.8,35,,2410.8,percent of total billed charges,Implant Device,2341.92,34,"Charges > $500, x 34%",2341.92,percent of total billed charges,Implant Device,2410.8,35,,2410.8,percent of total billed charges,Implant Devices,2410.8,35,,2410.8,percent of total billed charges,Implant Devices,2410.8,35,,,percent of total billed charges,Implant Devices,2410.8,35,,2410.8,percent of total billed charges,Implant Devices,2410.8,35,,2410.8,percent of total billed charges,Implant Devices,2755.2,40,,2755.2,percent of total billed charges,Implant Devices,2410.8,70,,2410.8,percent of total billed charges,Implant Devices,2341.92,34,,2341.92,percent of total billed charges,Implant Devices,2341.92,34,,2341.92,percent of total billed charges,Implant Devices,2410.8,35,,2410.8,percent of total billed charges,Implant Devices,2410.8,35,,2410.8,percent of total billed charges,Implant Devices,2410.8,35,,2410.8,percent of total billed charges,Implant Devices,2410.8,35,,2410.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2341.92,34,"If Charge > 2,000, then 34 percent",2341.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2755.2,
WRIGHT 5201020008 LOCKING SCREW 2.0X8MM,C1713,HCPCS,,79011716,CDM,278,RC,,,both,,,1617,638.18,39.4668,,638.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,565.95,35,,565.95,percent of total billed charges,Implant Device,549.78,34,"Charges > $500, x 34%",549.78,percent of total billed charges,Implant Device,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,646.8,40,,646.8,percent of total billed charges,Implant Devices,565.95,70,,565.95,percent of total billed charges,Implant Devices,549.78,34,,549.78,percent of total billed charges,Implant Devices,549.78,34,,549.78,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,646.8,
WRIGHT 5201020010 LOCKING SCREW 2.0X10MM,C1713,HCPCS,,79011717,CDM,278,RC,,,both,,,1617,638.18,39.4668,,638.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,549.78,34,,549.78,percent of total billed charges,Implant Device,565.95,35,,565.95,percent of total billed charges,Implant Device,549.78,34,"Charges > $500, x 34%",549.78,percent of total billed charges,Implant Device,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,646.8,40,,646.8,percent of total billed charges,Implant Devices,565.95,70,,565.95,percent of total billed charges,Implant Devices,549.78,34,,549.78,percent of total billed charges,Implant Devices,549.78,34,,549.78,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,565.95,35,,565.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,646.8,
WRIGHT 5201120012 NON LOCK SCREW 2X12MM,C1713,HCPCS,,79011718,CDM,278,RC,,,both,,,684,269.95,39.4668,,269.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,232.56,34,,232.56,percent of total billed charges,Implant Device,239.4,35,,239.4,percent of total billed charges,Implant Device,232.56,34,"Charges > $500, x 34%",232.56,percent of total billed charges,Implant Device,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,273.6,40,,273.6,percent of total billed charges,Implant Devices,239.4,70,,239.4,percent of total billed charges,Implant Devices,232.56,34,,232.56,percent of total billed charges,Implant Devices,232.56,34,,232.56,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,239.4,35,,239.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.6,
STRYKER 657711 BONE SCREW 2.0X11MM,C1713,HCPCS,,79011731,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
STRYKER 627638 DIS LAT FEMUR PLT 8 HOLE,C1713,HCPCS,,79011733,CDM,278,RC,,,both,,,7501,2960.4,39.4668,,2960.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2550.34,34,,2550.34,percent of total billed charges,Implant Device,2625.35,35,,2625.35,percent of total billed charges,Implant Device,2550.34,34,"Charges > $500, x 34%",2550.34,percent of total billed charges,Implant Device,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,3000.4,40,,3000.4,percent of total billed charges,Implant Devices,2625.35,70,,2625.35,percent of total billed charges,Implant Devices,2550.34,34,,2550.34,percent of total billed charges,Implant Devices,2550.34,34,,2550.34,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,2625.35,35,,2625.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550.34,34,"If Charge > 2,000, then 34 percent",2550.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000.4,
STRYKER 661150 LOCKING SCREW 5.0X50MM,C1713,HCPCS,,79011734,CDM,278,RC,,,both,,,616,243.12,39.4668,,243.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,209.44,34,,209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Device,209.44,34,"Charges > $500, x 34%",209.44,percent of total billed charges,Implant Device,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,246.4,40,,246.4,percent of total billed charges,Implant Devices,215.6,70,,215.6,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,209.44,34,,209.44,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,215.6,35,,215.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.4,
STRYKER 661750 CORTEX SCREW 4.5X50MM,C1713,HCPCS,,79011735,CDM,278,RC,,,both,,,139,54.86,39.4668,,54.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,47.26,34,,47.26,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,55.6,40,,55.6,percent of total billed charges,Implant Devices,48.65,70,,48.65,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,47.26,34,,47.26,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,48.65,35,,48.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.6,
ARTHREX AR-1360TR-BC MPFL IMPLANT SYSTEM,C1713,HCPCS,,79011738,CDM,278,RC,,,both,,,5985,2362.09,39.4668,,2362.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2094.75,35,,2094.75,percent of total billed charges,Implant Device,2034.9,34,"Charges > $500, x 34%",2034.9,percent of total billed charges,Implant Device,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2394,40,,2394,percent of total billed charges,Implant Devices,2094.75,70,,2094.75,percent of total billed charges,Implant Devices,2034.9,34,,2034.9,percent of total billed charges,Implant Devices,2034.9,34,,2034.9,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2034.9,34,"If Charge > 2,000, then 34 percent",2034.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2394,
STRYKER 626832 LAG SCREW 4.1X132MM,C1713,HCPCS,,79011739,CDM,278,RC,,,both,,,927,365.86,39.4668,,365.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,324.45,35,,324.45,percent of total billed charges,Implant Device,315.18,34,"Charges > $500, x 34%",315.18,percent of total billed charges,Implant Device,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,370.8,40,,370.8,percent of total billed charges,Implant Devices,324.45,70,,324.45,percent of total billed charges,Implant Devices,315.18,34,,315.18,percent of total billed charges,Implant Devices,315.18,34,,315.18,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,370.8,
STRYKER 626965 PLATE STRAIGHT 5 HOLES,C1713,HCPCS,,79011740,CDM,278,RC,,,both,,,2921,1152.83,39.4668,,1152.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,993.14,34,,993.14,percent of total billed charges,Implant Device,993.14,34,,993.14,percent of total billed charges,Implant Device,993.14,34,,993.14,percent of total billed charges,Implant Device,993.14,34,,993.14,percent of total billed charges,Implant Device,993.14,34,,993.14,percent of total billed charges,Implant Device,993.14,34,,993.14,percent of total billed charges,Implant Device,1022.35,35,,1022.35,percent of total billed charges,Implant Device,993.14,34,"Charges > $500, x 34%",993.14,percent of total billed charges,Implant Device,1022.35,35,,1022.35,percent of total billed charges,Implant Devices,1022.35,35,,1022.35,percent of total billed charges,Implant Devices,1022.35,35,,,percent of total billed charges,Implant Devices,1022.35,35,,1022.35,percent of total billed charges,Implant Devices,1022.35,35,,1022.35,percent of total billed charges,Implant Devices,1168.4,40,,1168.4,percent of total billed charges,Implant Devices,1022.35,70,,1022.35,percent of total billed charges,Implant Devices,993.14,34,,993.14,percent of total billed charges,Implant Devices,993.14,34,,993.14,percent of total billed charges,Implant Devices,1022.35,35,,1022.35,percent of total billed charges,Implant Devices,1022.35,35,,1022.35,percent of total billed charges,Implant Devices,1022.35,35,,1022.35,percent of total billed charges,Implant Devices,1022.35,35,,1022.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,993.14,34,"If Charge > 2,000, then 34 percent",993.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1168.4,
STRYKER 658038 COMP SCRW HEADLESS 4X38MM,C1713,HCPCS,,79011741,CDM,278,RC,,,both,,,1242,490.18,39.4668,,490.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,422.28,34,,422.28,percent of total billed charges,Implant Device,422.28,34,,422.28,percent of total billed charges,Implant Device,422.28,34,,422.28,percent of total billed charges,Implant Device,422.28,34,,422.28,percent of total billed charges,Implant Device,422.28,34,,422.28,percent of total billed charges,Implant Device,422.28,34,,422.28,percent of total billed charges,Implant Device,434.7,35,,434.7,percent of total billed charges,Implant Device,422.28,34,"Charges > $500, x 34%",422.28,percent of total billed charges,Implant Device,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,496.8,40,,496.8,percent of total billed charges,Implant Devices,434.7,70,,434.7,percent of total billed charges,Implant Devices,422.28,34,,422.28,percent of total billed charges,Implant Devices,422.28,34,,422.28,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,496.8,
STRYKER 658575 COMP SCRW HEADLESS 7X75MM,C1713,HCPCS,,79011742,CDM,278,RC,,,both,,,2079,820.51,39.4668,,820.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,727.65,35,,727.65,percent of total billed charges,Implant Device,706.86,34,"Charges > $500, x 34%",706.86,percent of total billed charges,Implant Device,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,831.6,40,,831.6,percent of total billed charges,Implant Devices,727.65,70,,727.65,percent of total billed charges,Implant Devices,706.86,34,,706.86,percent of total billed charges,Implant Devices,706.86,34,,706.86,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,706.86,34,"If Charge > 2,000, then 34 percent",706.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,831.6,
STRYKER 658595 COMP SCRW HEADLESS 7X95MM,C1713,HCPCS,,79011743,CDM,278,RC,,,both,,,2079,820.51,39.4668,,820.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,727.65,35,,727.65,percent of total billed charges,Implant Device,706.86,34,"Charges > $500, x 34%",706.86,percent of total billed charges,Implant Device,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,831.6,40,,831.6,percent of total billed charges,Implant Devices,727.65,70,,727.65,percent of total billed charges,Implant Devices,706.86,34,,706.86,percent of total billed charges,Implant Devices,706.86,34,,706.86,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,706.86,34,"If Charge > 2,000, then 34 percent",706.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,831.6,
IN2BONES P70 ST204 PLATE 4 HOLE LEFT,C1713,HCPCS,,79011746,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
ZIMMER 110007555 CANNULATED SCREW 4X40MM,C1713,HCPCS,,79011747,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
ARTHREX AR-2600SBS-10 SPEEDBRIDGE KIT,C1713,HCPCS,,79011748,CDM,278,RC,,,both,,,6450,2545.61,39.4668,,2545.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2193,34,,2193,percent of total billed charges,Implant Device,2193,34,,2193,percent of total billed charges,Implant Device,2193,34,,2193,percent of total billed charges,Implant Device,2193,34,,2193,percent of total billed charges,Implant Device,2193,34,,2193,percent of total billed charges,Implant Device,2193,34,,2193,percent of total billed charges,Implant Device,2257.5,35,,2257.5,percent of total billed charges,Implant Device,2193,34,"Charges > $500, x 34%",2193,percent of total billed charges,Implant Device,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2580,40,,2580,percent of total billed charges,Implant Devices,2257.5,70,,2257.5,percent of total billed charges,Implant Devices,2193,34,,2193,percent of total billed charges,Implant Devices,2193,34,,2193,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,2257.5,35,,2257.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2193,34,"If Charge > 2,000, then 34 percent",2193,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2580,
J&J 202.622 CORTICAL SCREW 3.0X22MM,C1713,HCPCS,,79011755,CDM,278,RC,,,both,,,523,206.41,39.4668,,206.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Device,177.82,34,"Charges > $500, x 34%",177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,209.2,40,,209.2,percent of total billed charges,Implant Devices,183.05,70,,183.05,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.2,
ARTHREX AR-4570S FIBERSTITCH IMPLANT,C1713,HCPCS,,79011760,CDM,278,RC,,,both,,,1485,586.08,39.4668,,586.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Device,504.9,34,"Charges > $500, x 34%",504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,594,40,,594,percent of total billed charges,Implant Devices,519.75,70,,519.75,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,594,
ARTHREX AR-13227T-BB-TAK MTP THREADED,C1713,HCPCS,,79011766,CDM,278,RC,,,both,,,255,100.64,39.4668,,100.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,89.25,35,,89.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,102,40,,102,percent of total billed charges,Implant Devices,89.25,70,,89.25,percent of total billed charges,Implant Devices,86.7,34,,86.7,percent of total billed charges,Implant Devices,86.7,34,,86.7,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102,
ARTHREX AR-9933-16 CORTICAL SCREW 3X16MM,C1713,HCPCS,,79011767,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
ARTHREX AR-7324PSLC SWIVERLCK FORKED TIP,C1713,HCPCS,,79011768,CDM,278,RC,,,both,,,1305,515.04,39.4668,,515.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,456.75,35,,456.75,percent of total billed charges,Implant Device,443.7,34,"Charges > $500, x 34%",443.7,percent of total billed charges,Implant Device,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,522,40,,522,percent of total billed charges,Implant Devices,456.75,70,,456.75,percent of total billed charges,Implant Devices,443.7,34,,443.7,percent of total billed charges,Implant Devices,443.7,34,,443.7,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,522,
ARTHREX AR-4570 FIBERSTITCH 12 DEG CURVE,C1713,HCPCS,,79011769,CDM,278,RC,,,both,,,1485,586.08,39.4668,,586.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Device,504.9,34,"Charges > $500, x 34%",504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,594,40,,594,percent of total billed charges,Implant Devices,519.75,70,,519.75,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,594,
ARTHREX AR-4570R FIBERSTITCH REV ANGLE,C1713,HCPCS,,79011771,CDM,278,RC,,,both,,,1485,586.08,39.4668,,586.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Device,504.9,34,"Charges > $500, x 34%",504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,594,40,,594,percent of total billed charges,Implant Devices,519.75,70,,519.75,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,594,
ARTHREX AR-4570-24 FIBERSTITCH 24 DEG,C1713,HCPCS,,79011772,CDM,278,RC,,,both,,,1485,586.08,39.4668,,586.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,504.9,34,,504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Device,504.9,34,"Charges > $500, x 34%",504.9,percent of total billed charges,Implant Device,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,594,40,,594,percent of total billed charges,Implant Devices,519.75,70,,519.75,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,504.9,34,,504.9,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,519.75,35,,519.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,594,
JOINT VRG-351 VERSAGRAFT PRESUTURD TENDN,C1713,HCPCS,,79011773,CDM,278,RC,,,both,,,3870,1527.37,39.4668,,1527.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1354.5,35,,1354.5,percent of total billed charges,Implant Device,1315.8,34,"Charges > $500, x 34%",1315.8,percent of total billed charges,Implant Device,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1548,40,,1548,percent of total billed charges,Implant Devices,1354.5,70,,1354.5,percent of total billed charges,Implant Devices,1315.8,34,,1315.8,percent of total billed charges,Implant Devices,1315.8,34,,1315.8,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1315.8,34,"If Charge > 2,000, then 34 percent",1315.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1548,
ZIMMER 110007553 CANNULATED SCREW 4X38MM,C1713,HCPCS,,79011774,CDM,278,RC,,,both,,,529,208.78,39.4668,,208.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Device,179.86,34,"Charges > $500, x 34%",179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,211.6,40,,211.6,percent of total billed charges,Implant Devices,185.15,70,,185.15,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,211.6,
STRYKER 2341-0936S TIBIAL NAIL 9X360MM,C1713,HCPCS,,79011775,CDM,278,RC,,,both,,,6378,2517.19,39.4668,,2517.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Device,2168.52,34,"Charges > $500, x 34%",2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2551.2,40,,2551.2,percent of total billed charges,Implant Devices,2232.3,70,,2232.3,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2168.52,34,"If Charge > 2,000, then 34 percent",2168.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2551.2,
STRYKER 2361-5040S LOCKING SCREW 5X40MM,C1713,HCPCS,,79011776,CDM,278,RC,,,both,,,887,350.07,39.4668,,350.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Device,301.58,34,"Charges > $500, x 34%",301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,354.8,40,,354.8,percent of total billed charges,Implant Devices,310.45,70,,310.45,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.8,
DJO PR111-152-611 FEMORAL HEAD 28MM,C1713,HCPCS,,79011781,CDM,278,RC,,,both,,,4350,1716.81,39.4668,,1716.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1522.5,35,,1522.5,percent of total billed charges,Implant Device,1479,34,"Charges > $500, x 34%",1479,percent of total billed charges,Implant Device,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1740,40,,1740,percent of total billed charges,Implant Devices,1522.5,70,,1522.5,percent of total billed charges,Implant Devices,1479,34,,1479,percent of total billed charges,Implant Devices,1479,34,,1479,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1479,34,"If Charge > 2,000, then 34 percent",1479,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1740,
STRYKER 629546 COMPRESSION PLATE 6 HOLE,C1713,HCPCS,,79011784,CDM,278,RC,,,both,,,1172,462.55,39.4668,,462.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,398.48,34,,398.48,percent of total billed charges,Implant Device,398.48,34,,398.48,percent of total billed charges,Implant Device,398.48,34,,398.48,percent of total billed charges,Implant Device,398.48,34,,398.48,percent of total billed charges,Implant Device,398.48,34,,398.48,percent of total billed charges,Implant Device,398.48,34,,398.48,percent of total billed charges,Implant Device,410.2,35,,410.2,percent of total billed charges,Implant Device,398.48,34,"Charges > $500, x 34%",398.48,percent of total billed charges,Implant Device,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,468.8,40,,468.8,percent of total billed charges,Implant Devices,410.2,70,,410.2,percent of total billed charges,Implant Devices,398.48,34,,398.48,percent of total billed charges,Implant Devices,398.48,34,,398.48,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,410.2,35,,410.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,468.8,
IN2BONES P40 ST013 PLATE 3 HOLE,C1713,HCPCS,,79011789,CDM,278,RC,,,both,,,4611,1819.81,39.4668,,1819.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1567.74,34,,1567.74,percent of total billed charges,Implant Device,1613.85,35,,1613.85,percent of total billed charges,Implant Device,1567.74,34,"Charges > $500, x 34%",1567.74,percent of total billed charges,Implant Device,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1844.4,40,,1844.4,percent of total billed charges,Implant Devices,1613.85,70,,1613.85,percent of total billed charges,Implant Devices,1567.74,34,,1567.74,percent of total billed charges,Implant Devices,1567.74,34,,1567.74,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,1613.85,35,,1613.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1567.74,34,"If Charge > 2,000, then 34 percent",1567.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1844.4,
IN2BONES V35 ST310 LOCK SCREW 3.5X10MM,C1713,HCPCS,,79011790,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P65 ST675 COLOG SCREW 6.7X75MM,C1713,HCPCS,,79011791,CDM,278,RC,,,both,,,3225,1272.8,39.4668,,1272.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Device,1096.5,34,"Charges > $500, x 34%",1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1290,40,,1290,percent of total billed charges,Implant Devices,1128.75,70,,1128.75,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1096.5,34,"If Charge > 2,000, then 34 percent",1096.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1290,
ZIMMER 110007551 CANNULATED SCREW 4X36MM,C1713,HCPCS,,79011793,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
ZIMMER 110008349 FLAT WASHER 5.0MM,C1713,HCPCS,,79011794,CDM,278,RC,,,both,,,390,153.92,39.4668,,153.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,132.6,34,,132.6,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,156,40,,156,percent of total billed charges,Implant Devices,136.5,70,,136.5,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,132.6,34,,132.6,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,136.5,35,,136.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156,
J&J 02.240.056 CANNULATED SCREW 3.7X56MM,C1713,HCPCS,,79011802,CDM,278,RC,,,both,,,503,198.52,39.4668,,198.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,176.05,35,,176.05,percent of total billed charges,Implant Device,171.02,34,"Charges > $500, x 34%",171.02,percent of total billed charges,Implant Device,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,201.2,40,,201.2,percent of total billed charges,Implant Devices,176.05,70,,176.05,percent of total billed charges,Implant Devices,171.02,34,,171.02,percent of total billed charges,Implant Devices,171.02,34,,171.02,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.2,
J&J 02.240.024 CANNULATED SCREW 3.7X24MM,C1713,HCPCS,,79011803,CDM,278,RC,,,both,,,503,198.52,39.4668,,198.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,171.02,34,,171.02,percent of total billed charges,Implant Device,176.05,35,,176.05,percent of total billed charges,Implant Device,171.02,34,"Charges > $500, x 34%",171.02,percent of total billed charges,Implant Device,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,201.2,40,,201.2,percent of total billed charges,Implant Devices,176.05,70,,176.05,percent of total billed charges,Implant Devices,171.02,34,,171.02,percent of total billed charges,Implant Devices,171.02,34,,171.02,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,176.05,35,,176.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.2,
TRI-STATE OF2012430S FIXATION NAIL SYS,C1713,HCPCS,,79011804,CDM,278,RC,,,both,,,7485,2954.09,39.4668,,2954.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2619.75,35,,2619.75,percent of total billed charges,Implant Device,2544.9,34,"Charges > $500, x 34%",2544.9,percent of total billed charges,Implant Device,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2994,40,,2994,percent of total billed charges,Implant Devices,2619.75,70,,2619.75,percent of total billed charges,Implant Devices,2544.9,34,,2544.9,percent of total billed charges,Implant Devices,2544.9,34,,2544.9,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2544.9,34,"If Charge > 2,000, then 34 percent",2544.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2994,
STRYKER 2341-1131S TIBIAL NAIL 11X315MM,C1713,HCPCS,,79011805,CDM,278,RC,,,both,,,6378,2517.19,39.4668,,2517.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Device,2168.52,34,"Charges > $500, x 34%",2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2551.2,40,,2551.2,percent of total billed charges,Implant Devices,2232.3,70,,2232.3,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2168.52,34,"If Charge > 2,000, then 34 percent",2168.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2551.2,
STRYKER 2360-5057S LOCK SCREW 5X57.5MM,C1713,HCPCS,,79011806,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
STRYKER 2360-5070S LOCKING SCREW 5X70MM,C1713,HCPCS,,79011807,CDM,278,RC,,,both,,,762,300.74,39.4668,,300.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,259.08,34,,259.08,percent of total billed charges,Implant Device,266.7,35,,266.7,percent of total billed charges,Implant Device,259.08,34,"Charges > $500, x 34%",259.08,percent of total billed charges,Implant Device,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,304.8,40,,304.8,percent of total billed charges,Implant Devices,266.7,70,,266.7,percent of total billed charges,Implant Devices,259.08,34,,259.08,percent of total billed charges,Implant Devices,259.08,34,,259.08,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,266.7,35,,266.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,304.8,
JOINT VRG-001 VERSAGRAFT PRESUTURED TNDN,C1713,HCPCS,,79011818,CDM,278,RC,,,both,,,3870,1527.37,39.4668,,1527.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1354.5,35,,1354.5,percent of total billed charges,Implant Device,1315.8,34,"Charges > $500, x 34%",1315.8,percent of total billed charges,Implant Device,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1548,40,,1548,percent of total billed charges,Implant Devices,1354.5,70,,1354.5,percent of total billed charges,Implant Devices,1315.8,34,,1315.8,percent of total billed charges,Implant Devices,1315.8,34,,1315.8,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1315.8,34,"If Charge > 2,000, then 34 percent",1315.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1548,
ZIMMER 110007547 CANN SCREW 4.0X34MM,C1713,HCPCS,,79011824,CDM,278,RC,,,both,,,529,208.78,39.4668,,208.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Device,179.86,34,"Charges > $500, x 34%",179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,211.6,40,,211.6,percent of total billed charges,Implant Devices,185.15,70,,185.15,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,211.6,
IN2BONES V30 ST420 TRANSVERSE SCREW 3X20,C1713,HCPCS,,79011831,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ARTHREX AR-2271 ACUTE AC REPAIR KIT,C1713,HCPCS,,79011832,CDM,278,RC,,,both,,,3375,1332,39.4668,,1332,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1181.25,35,,1181.25,percent of total billed charges,Implant Device,1147.5,34,"Charges > $500, x 34%",1147.5,percent of total billed charges,Implant Device,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1350,40,,1350,percent of total billed charges,Implant Devices,1181.25,70,,1181.25,percent of total billed charges,Implant Devices,1147.5,34,,1147.5,percent of total billed charges,Implant Devices,1147.5,34,,1147.5,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1147.5,34,"If Charge > 2,000, then 34 percent",1147.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1350,
STRYKER 2361-5060S LOCKING SCREW 5X60MM,C1713,HCPCS,,79011842,CDM,278,RC,,,both,,,956,377.3,39.4668,,377.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,325.04,34,,325.04,percent of total billed charges,Implant Device,334.6,35,,334.6,percent of total billed charges,Implant Device,325.04,34,"Charges > $500, x 34%",325.04,percent of total billed charges,Implant Device,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,382.4,40,,382.4,percent of total billed charges,Implant Devices,334.6,70,,334.6,percent of total billed charges,Implant Devices,325.04,34,,325.04,percent of total billed charges,Implant Devices,325.04,34,,325.04,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,334.6,35,,334.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,382.4,
STRYKER 628205 SUPERIOR LATERAL PLT 5H,C1713,HCPCS,,79011845,CDM,278,RC,,,both,,,3069,1211.24,39.4668,,1211.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1043.46,34,,1043.46,percent of total billed charges,Implant Device,1074.15,35,,1074.15,percent of total billed charges,Implant Device,1043.46,34,"Charges > $500, x 34%",1043.46,percent of total billed charges,Implant Device,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1227.6,40,,1227.6,percent of total billed charges,Implant Devices,1074.15,70,,1074.15,percent of total billed charges,Implant Devices,1043.46,34,,1043.46,percent of total billed charges,Implant Devices,1043.46,34,,1043.46,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,1074.15,35,,1074.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1043.46,34,"If Charge > 2,000, then 34 percent",1043.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1227.6,
ARTHREX AR-8735L-12 LOCK SCREW 3.5X14MM,C1713,HCPCS,,79011849,CDM,278,RC,,,both,,,255,100.64,39.4668,,100.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,86.7,34,,86.7,percent of total billed charges,Implant Device,89.25,35,,89.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,102,40,,102,percent of total billed charges,Implant Devices,89.25,70,,89.25,percent of total billed charges,Implant Devices,86.7,34,,86.7,percent of total billed charges,Implant Devices,86.7,34,,86.7,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,89.25,35,,89.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,102,
WRIGHT K30003010 AUGMENT BONE GRAFT 3CC,C1713,HCPCS,,79011855,CDM,278,RC,,,both,,,13425,5298.42,39.4668,,5298.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4564.5,34,,4564.5,percent of total billed charges,Implant Device,4564.5,34,,4564.5,percent of total billed charges,Implant Device,4564.5,34,,4564.5,percent of total billed charges,Implant Device,4564.5,34,,4564.5,percent of total billed charges,Implant Device,4564.5,34,,4564.5,percent of total billed charges,Implant Device,4564.5,34,,4564.5,percent of total billed charges,Implant Device,4698.75,35,,4698.75,percent of total billed charges,Implant Device,4564.5,34,"Charges > $500, x 34%",4564.5,percent of total billed charges,Implant Device,4698.75,35,,4698.75,percent of total billed charges,Implant Devices,4698.75,35,,4698.75,percent of total billed charges,Implant Devices,4698.75,35,,,percent of total billed charges,Implant Devices,4698.75,35,,4698.75,percent of total billed charges,Implant Devices,4698.75,35,,4698.75,percent of total billed charges,Implant Devices,5370,40,,5370,percent of total billed charges,Implant Devices,4698.75,70,,4698.75,percent of total billed charges,Implant Devices,4564.5,34,,4564.5,percent of total billed charges,Implant Devices,4564.5,34,,4564.5,percent of total billed charges,Implant Devices,4698.75,35,,4698.75,percent of total billed charges,Implant Devices,4698.75,35,,4698.75,percent of total billed charges,Implant Devices,4698.75,35,,4698.75,percent of total billed charges,Implant Devices,4698.75,35,,4698.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4564.5,34,"If Charge > 2,000, then 34 percent",4564.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5370,
WRIGHT FFNS2020 STAPLE NITINOL 20X20MM,C1713,HCPCS,,79011856,CDM,278,RC,,,both,,,9396,3708.3,39.4668,,3708.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3194.64,34,,3194.64,percent of total billed charges,Implant Device,3194.64,34,,3194.64,percent of total billed charges,Implant Device,3194.64,34,,3194.64,percent of total billed charges,Implant Device,3194.64,34,,3194.64,percent of total billed charges,Implant Device,3194.64,34,,3194.64,percent of total billed charges,Implant Device,3194.64,34,,3194.64,percent of total billed charges,Implant Device,3288.6,35,,3288.6,percent of total billed charges,Implant Device,3194.64,34,"Charges > $500, x 34%",3194.64,percent of total billed charges,Implant Device,3288.6,35,,3288.6,percent of total billed charges,Implant Devices,3288.6,35,,3288.6,percent of total billed charges,Implant Devices,3288.6,35,,,percent of total billed charges,Implant Devices,3288.6,35,,3288.6,percent of total billed charges,Implant Devices,3288.6,35,,3288.6,percent of total billed charges,Implant Devices,3758.4,40,,3758.4,percent of total billed charges,Implant Devices,3288.6,70,,3288.6,percent of total billed charges,Implant Devices,3194.64,34,,3194.64,percent of total billed charges,Implant Devices,3194.64,34,,3194.64,percent of total billed charges,Implant Devices,3288.6,35,,3288.6,percent of total billed charges,Implant Devices,3288.6,35,,3288.6,percent of total billed charges,Implant Devices,3288.6,35,,3288.6,percent of total billed charges,Implant Devices,3288.6,35,,3288.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3194.64,34,"If Charge > 2,000, then 34 percent",3194.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3758.4,
STRYKER 602645S CANNULATED SCREW 6.5X45,C1713,HCPCS,,79011857,CDM,278,RC,,,both,,,696,274.69,39.4668,,274.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,236.64,34,,236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Device,236.64,34,"Charges > $500, x 34%",236.64,percent of total billed charges,Implant Device,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,278.4,40,,278.4,percent of total billed charges,Implant Devices,243.6,70,,243.6,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,236.64,34,,236.64,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,243.6,35,,243.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,278.4,
STRYKER 658375 COMPRESSION SCREW 7X75MM,C1713,HCPCS,,79011858,CDM,278,RC,,,both,,,2471,975.22,39.4668,,975.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,864.85,35,,864.85,percent of total billed charges,Implant Device,840.14,34,"Charges > $500, x 34%",840.14,percent of total billed charges,Implant Device,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,988.4,40,,988.4,percent of total billed charges,Implant Devices,864.85,70,,864.85,percent of total billed charges,Implant Devices,840.14,34,,840.14,percent of total billed charges,Implant Devices,840.14,34,,840.14,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,840.14,34,"If Charge > 2,000, then 34 percent",840.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,988.4,
J&J 04.001.430S HUMERAL NAIL 9X250MM,C1713,HCPCS,,79011859,CDM,278,RC,,,both,,,3772,1488.69,39.4668,,1488.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1282.48,34,,1282.48,percent of total billed charges,Implant Device,1320.2,35,,1320.2,percent of total billed charges,Implant Device,1282.48,34,"Charges > $500, x 34%",1282.48,percent of total billed charges,Implant Device,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1508.8,40,,1508.8,percent of total billed charges,Implant Devices,1320.2,70,,1320.2,percent of total billed charges,Implant Devices,1282.48,34,,1282.48,percent of total billed charges,Implant Devices,1282.48,34,,1282.48,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,1320.2,35,,1320.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1282.48,34,"If Charge > 2,000, then 34 percent",1282.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1508.8,
STRYKER 628207 SUPERIOR LAT PLT 7H LT,C1713,HCPCS,,79011899,CDM,278,RC,,,both,,,3785,1493.82,39.4668,,1493.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1286.9,34,,1286.9,percent of total billed charges,Implant Device,1324.75,35,,1324.75,percent of total billed charges,Implant Device,1286.9,34,"Charges > $500, x 34%",1286.9,percent of total billed charges,Implant Device,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1514,40,,1514,percent of total billed charges,Implant Devices,1324.75,70,,1324.75,percent of total billed charges,Implant Devices,1286.9,34,,1286.9,percent of total billed charges,Implant Devices,1286.9,34,,1286.9,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,1324.75,35,,1324.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1286.9,34,"If Charge > 2,000, then 34 percent",1286.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1514,
ARTHREX AR-8840CL-50 CANN SCREW 4X50MM,C1713,HCPCS,,79011900,CDM,278,RC,,,both,,,708,279.42,39.4668,,279.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,240.72,34,,240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Device,240.72,34,"Charges > $500, x 34%",240.72,percent of total billed charges,Implant Device,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,283.2,40,,283.2,percent of total billed charges,Implant Devices,247.8,70,,247.8,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,240.72,34,,240.72,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,247.8,35,,247.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,283.2,
ZIMMER 1318-14-050 DVR VOLAR PLATE RIGHT,C1713,HCPCS,,79011904,CDM,278,RC,,,both,,,2970,1172.16,39.4668,,1172.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Device,1009.8,34,"Charges > $500, x 34%",1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1188,40,,1188,percent of total billed charges,Implant Devices,1039.5,70,,1039.5,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1009.8,34,"If Charge > 2,000, then 34 percent",1009.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1188,
ZIMMER 1312-27-110 LOCK SCREW 2.7X10MM,C1713,HCPCS,,79011905,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
ZIMMER 1312-27-210 NON LOCK SCREW 2.7X10,C1713,HCPCS,,79011906,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
ZIMMER 1312-27-218 NON LOCK SCREW 2.7X18,C1713,HCPCS,,79011907,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
ZIMMER 02.03150.028 CORTICAL SCREW 5X28,C1713,HCPCS,,79011911,CDM,278,RC,,,both,,,523,206.41,39.4668,,206.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Device,177.82,34,"Charges > $500, x 34%",177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,209.2,40,,209.2,percent of total billed charges,Implant Devices,183.05,70,,183.05,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.2,
ZIMMER 02.3150.030 CORTICAL SCREW 5X30,C1713,HCPCS,,79011912,CDM,278,RC,,,both,,,523,206.41,39.4668,,206.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Device,177.82,34,"Charges > $500, x 34%",177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,209.2,40,,209.2,percent of total billed charges,Implant Devices,183.05,70,,183.05,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.2,
ZIMMER 02.03151.016 UNICORT SCREW 5X16,C1713,HCPCS,,79011913,CDM,278,RC,,,both,,,478,188.65,39.4668,,188.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,162.52,34,,162.52,percent of total billed charges,Implant Device,167.3,35,,167.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,191.2,40,,191.2,percent of total billed charges,Implant Devices,167.3,70,,167.3,percent of total billed charges,Implant Devices,162.52,34,,162.52,percent of total billed charges,Implant Devices,162.52,34,,162.52,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,167.3,35,,167.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,191.2,
ZIMMER 02.03150.026 CORTICAL SCREW 5X26,C1713,HCPCS,,79011914,CDM,278,RC,,,both,,,523,206.41,39.4668,,206.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,177.82,34,,177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Device,177.82,34,"Charges > $500, x 34%",177.82,percent of total billed charges,Implant Device,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,209.2,40,,209.2,percent of total billed charges,Implant Devices,183.05,70,,183.05,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,177.82,34,,177.82,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,183.05,35,,183.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.2,
STRYKER 326095 ASNIS CANN SCREW 6.5X95MM,C1713,HCPCS,,79011935,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
STRYKER 629688 NAR LOCK PLT 2.4X56MM 8HL,C1713,HCPCS,,79011937,CDM,278,RC,,,both,,,2688,1060.87,39.4668,,1060.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,913.92,34,,913.92,percent of total billed charges,Implant Device,913.92,34,,913.92,percent of total billed charges,Implant Device,913.92,34,,913.92,percent of total billed charges,Implant Device,913.92,34,,913.92,percent of total billed charges,Implant Device,913.92,34,,913.92,percent of total billed charges,Implant Device,913.92,34,,913.92,percent of total billed charges,Implant Device,940.8,35,,940.8,percent of total billed charges,Implant Device,913.92,34,"Charges > $500, x 34%",913.92,percent of total billed charges,Implant Device,940.8,35,,940.8,percent of total billed charges,Implant Devices,940.8,35,,940.8,percent of total billed charges,Implant Devices,940.8,35,,,percent of total billed charges,Implant Devices,940.8,35,,940.8,percent of total billed charges,Implant Devices,940.8,35,,940.8,percent of total billed charges,Implant Devices,1075.2,40,,1075.2,percent of total billed charges,Implant Devices,940.8,70,,940.8,percent of total billed charges,Implant Devices,913.92,34,,913.92,percent of total billed charges,Implant Devices,913.92,34,,913.92,percent of total billed charges,Implant Devices,940.8,35,,940.8,percent of total billed charges,Implant Devices,940.8,35,,940.8,percent of total billed charges,Implant Devices,940.8,35,,940.8,percent of total billed charges,Implant Devices,940.8,35,,940.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,913.92,34,"If Charge > 2,000, then 34 percent",913.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1075.2,
ARTHREX AR-8933V-20 LOCKING SCREW 3X20MM,C1713,HCPCS,,79011939,CDM,278,RC,,,both,,,525,207.2,39.4668,,207.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Device,178.5,34,"Charges > $500, x 34%",178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,210,40,,210,percent of total billed charges,Implant Devices,183.75,70,,183.75,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
J&J 202.880 CORTEX SCREW 2.7 X 20MM,C1713,HCPCS,,79011956,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
J&J 202.882 CORTEX SCREW 2.7 X 22MM,C1713,HCPCS,,79011957,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
J&J 02.112.625S LCP CLAVICLE PLATE 2.7MM,C1713,HCPCS,,79011958,CDM,278,RC,,,both,,,4130,1629.98,39.4668,,1629.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1404.2,34,,1404.2,percent of total billed charges,Implant Device,1404.2,34,,1404.2,percent of total billed charges,Implant Device,1404.2,34,,1404.2,percent of total billed charges,Implant Device,1404.2,34,,1404.2,percent of total billed charges,Implant Device,1404.2,34,,1404.2,percent of total billed charges,Implant Device,1404.2,34,,1404.2,percent of total billed charges,Implant Device,1445.5,35,,1445.5,percent of total billed charges,Implant Device,1404.2,34,"Charges > $500, x 34%",1404.2,percent of total billed charges,Implant Device,1445.5,35,,1445.5,percent of total billed charges,Implant Devices,1445.5,35,,1445.5,percent of total billed charges,Implant Devices,1445.5,35,,,percent of total billed charges,Implant Devices,1445.5,35,,1445.5,percent of total billed charges,Implant Devices,1445.5,35,,1445.5,percent of total billed charges,Implant Devices,1652,40,,1652,percent of total billed charges,Implant Devices,1445.5,70,,1445.5,percent of total billed charges,Implant Devices,1404.2,34,,1404.2,percent of total billed charges,Implant Devices,1404.2,34,,1404.2,percent of total billed charges,Implant Devices,1445.5,35,,1445.5,percent of total billed charges,Implant Devices,1445.5,35,,1445.5,percent of total billed charges,Implant Devices,1445.5,35,,1445.5,percent of total billed charges,Implant Devices,1445.5,35,,1445.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1404.2,34,"If Charge > 2,000, then 34 percent",1404.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1652,
ARTHREX AR-7000-26FT CANN SCRW 3.75X26MM,C1713,HCPCS,,79011959,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
IN2BONES P70 ST008 TUBULAR PLATE 8 HOLE,C1713,HCPCS,,79011971,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
stryker  629630 10 hole locking plate,C1713,HCPCS,,79011983,CDM,278,RC,,,both,,,2268,895.11,39.4668,,895.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,793.8,35,,793.8,percent of total billed charges,Implant Device,771.12,34,"Charges > $500, x 34%",771.12,percent of total billed charges,Implant Device,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,907.2,40,,907.2,percent of total billed charges,Implant Devices,793.8,70,,793.8,percent of total billed charges,Implant Devices,771.12,34,,771.12,percent of total billed charges,Implant Devices,771.12,34,,771.12,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,771.12,34,"If Charge > 2,000, then 34 percent",771.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,907.2,
Stryker 657720 bone screw 2mm l20mm,C1713,HCPCS,,79011984,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
ARTHREX AR-9943C-10 10 hole lock plate,C1713,HCPCS,,79011987,CDM,278,RC,,,both,,,2268,895.11,39.4668,,895.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,771.12,34,,771.12,percent of total billed charges,Implant Device,793.8,35,,793.8,percent of total billed charges,Implant Device,771.12,34,"Charges > $500, x 34%",771.12,percent of total billed charges,Implant Device,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,907.2,40,,907.2,percent of total billed charges,Implant Devices,793.8,70,,793.8,percent of total billed charges,Implant Devices,771.12,34,,771.12,percent of total billed charges,Implant Devices,771.12,34,,771.12,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,793.8,35,,793.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,771.12,34,"If Charge > 2,000, then 34 percent",771.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,907.2,
WRIGHT MED FFNS0808 NITINOL KIT 8MMX8MM,C1713,HCPCS,,79011988,CDM,278,RC,,,both,,,6951,2743.34,39.4668,,2743.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Device,2363.34,34,"Charges > $500, x 34%",2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2780.4,40,,2780.4,percent of total billed charges,Implant Devices,2432.85,70,,2432.85,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2363.34,34,"If Charge > 2,000, then 34 percent",2363.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2780.4,
STRYKER 40-30124 3.0 CANN SCREW 24MM,C1713,HCPCS,,79011989,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
STRYKER 40-30126 3.0 CANN SCREW 26MM,C1713,HCPCS,,79011990,CDM,278,RC,,,both,,,964,380.46,39.4668,,380.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Device,327.76,34,"Charges > $500, x 34%",327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,385.6,40,,385.6,percent of total billed charges,Implant Devices,337.4,70,,337.4,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,385.6,
KINAMED 35-100-1040 SUPRCABLCERCLGE SYST,C1713,HCPCS,,79011992,CDM,278,RC,,,both,,,1383,545.83,39.4668,,545.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,470.22,34,,470.22,percent of total billed charges,Implant Device,470.22,34,,470.22,percent of total billed charges,Implant Device,470.22,34,,470.22,percent of total billed charges,Implant Device,470.22,34,,470.22,percent of total billed charges,Implant Device,470.22,34,,470.22,percent of total billed charges,Implant Device,470.22,34,,470.22,percent of total billed charges,Implant Device,484.05,35,,484.05,percent of total billed charges,Implant Device,470.22,34,"Charges > $500, x 34%",470.22,percent of total billed charges,Implant Device,484.05,35,,484.05,percent of total billed charges,Implant Devices,484.05,35,,484.05,percent of total billed charges,Implant Devices,484.05,35,,,percent of total billed charges,Implant Devices,484.05,35,,484.05,percent of total billed charges,Implant Devices,484.05,35,,484.05,percent of total billed charges,Implant Devices,553.2,40,,553.2,percent of total billed charges,Implant Devices,484.05,70,,484.05,percent of total billed charges,Implant Devices,470.22,34,,470.22,percent of total billed charges,Implant Devices,470.22,34,,470.22,percent of total billed charges,Implant Devices,484.05,35,,484.05,percent of total billed charges,Implant Devices,484.05,35,,484.05,percent of total billed charges,Implant Devices,484.05,35,,484.05,percent of total billed charges,Implant Devices,484.05,35,,484.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,553.2,
IN2BONES P72 ST022 CORT SCREW 2.7X22MM,C1713,HCPCS,,79011995,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ZIMMER 110007561 CANNULATED SCREW 4X46MM,C1713,HCPCS,,79011997,CDM,278,RC,,,both,,,702,277.06,39.4668,,277.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,238.68,34,,238.68,percent of total billed charges,Implant Device,245.7,35,,245.7,percent of total billed charges,Implant Device,238.68,34,"Charges > $500, x 34%",238.68,percent of total billed charges,Implant Device,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,280.8,40,,280.8,percent of total billed charges,Implant Devices,245.7,70,,245.7,percent of total billed charges,Implant Devices,238.68,34,,238.68,percent of total billed charges,Implant Devices,238.68,34,,238.68,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,245.7,35,,245.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,280.8,
STRYKER 607438 CANCELLOUS SCREW 4X38X14,C1713,HCPCS,,79011998,CDM,278,RC,,,both,,,133,52.49,39.4668,,52.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,53.2,40,,53.2,percent of total billed charges,Implant Devices,46.55,70,,46.55,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
STRYKER 607442 CANCELLOUS SCREW 4X42X14,C1713,HCPCS,,79011999,CDM,278,RC,,,both,,,133,52.49,39.4668,,52.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,45.22,34,,45.22,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,53.2,40,,53.2,percent of total billed charges,Implant Devices,46.55,70,,46.55,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,45.22,34,,45.22,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,46.55,35,,46.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,53.2,
J&J 207.616 CANNULATED SCREW 4.0X16MM,C1713,HCPCS,,79012007,CDM,278,RC,,,both,,,519,204.83,39.4668,,204.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,176.46,34,,176.46,percent of total billed charges,Implant Device,176.46,34,,176.46,percent of total billed charges,Implant Device,176.46,34,,176.46,percent of total billed charges,Implant Device,176.46,34,,176.46,percent of total billed charges,Implant Device,176.46,34,,176.46,percent of total billed charges,Implant Device,176.46,34,,176.46,percent of total billed charges,Implant Device,181.65,35,,181.65,percent of total billed charges,Implant Device,176.46,34,"Charges > $500, x 34%",176.46,percent of total billed charges,Implant Device,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,207.6,40,,207.6,percent of total billed charges,Implant Devices,181.65,70,,181.65,percent of total billed charges,Implant Devices,176.46,34,,176.46,percent of total billed charges,Implant Devices,176.46,34,,176.46,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,181.65,35,,181.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,207.6,
STRYKER 658355 COMPRESSION SCREW 7X55MM,C1713,HCPCS,,79012009,CDM,278,RC,,,both,,,2079,820.51,39.4668,,820.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,727.65,35,,727.65,percent of total billed charges,Implant Device,706.86,34,"Charges > $500, x 34%",706.86,percent of total billed charges,Implant Device,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,831.6,40,,831.6,percent of total billed charges,Implant Devices,727.65,70,,727.65,percent of total billed charges,Implant Devices,706.86,34,,706.86,percent of total billed charges,Implant Devices,706.86,34,,706.86,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,706.86,34,"If Charge > 2,000, then 34 percent",706.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,831.6,
WRIGHT 59202010 LATERAL FUSION PLT SMALL,C1713,HCPCS,,79012012,CDM,278,RC,,,both,,,10353,4086,39.4668,,4086,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3520.02,34,,3520.02,percent of total billed charges,Implant Device,3520.02,34,,3520.02,percent of total billed charges,Implant Device,3520.02,34,,3520.02,percent of total billed charges,Implant Device,3520.02,34,,3520.02,percent of total billed charges,Implant Device,3520.02,34,,3520.02,percent of total billed charges,Implant Device,3520.02,34,,3520.02,percent of total billed charges,Implant Device,3623.55,35,,3623.55,percent of total billed charges,Implant Device,3520.02,34,"Charges > $500, x 34%",3520.02,percent of total billed charges,Implant Device,3623.55,35,,3623.55,percent of total billed charges,Implant Devices,3623.55,35,,3623.55,percent of total billed charges,Implant Devices,3623.55,35,,,percent of total billed charges,Implant Devices,3623.55,35,,3623.55,percent of total billed charges,Implant Devices,3623.55,35,,3623.55,percent of total billed charges,Implant Devices,4141.2,40,,4141.2,percent of total billed charges,Implant Devices,3623.55,70,,3623.55,percent of total billed charges,Implant Devices,3520.02,34,,3520.02,percent of total billed charges,Implant Devices,3520.02,34,,3520.02,percent of total billed charges,Implant Devices,3623.55,35,,3623.55,percent of total billed charges,Implant Devices,3623.55,35,,3623.55,percent of total billed charges,Implant Devices,3623.55,35,,3623.55,percent of total billed charges,Implant Devices,3623.55,35,,3623.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3520.02,34,"If Charge > 2,000, then 34 percent",3520.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4141.2,
WRIGHT 59215526 LOCKING SCREW 5.5X26MM,C1713,HCPCS,,79012013,CDM,278,RC,,,both,,,1341,529.25,39.4668,,529.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,469.35,35,,469.35,percent of total billed charges,Implant Device,455.94,34,"Charges > $500, x 34%",455.94,percent of total billed charges,Implant Device,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,536.4,40,,536.4,percent of total billed charges,Implant Devices,469.35,70,,469.35,percent of total billed charges,Implant Devices,455.94,34,,455.94,percent of total billed charges,Implant Devices,455.94,34,,455.94,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,536.4,
WRIGHT 59215528 LOCKING SCREW 5.5X28MM,C1713,HCPCS,,79012014,CDM,278,RC,,,both,,,1341,529.25,39.4668,,529.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,469.35,35,,469.35,percent of total billed charges,Implant Device,455.94,34,"Charges > $500, x 34%",455.94,percent of total billed charges,Implant Device,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,536.4,40,,536.4,percent of total billed charges,Implant Devices,469.35,70,,469.35,percent of total billed charges,Implant Devices,455.94,34,,455.94,percent of total billed charges,Implant Devices,455.94,34,,455.94,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,536.4,
WRIGHT 59215530 LOCKING SCREW 5.5X30MM,C1713,HCPCS,,79012015,CDM,278,RC,,,both,,,1341,529.25,39.4668,,529.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,455.94,34,,455.94,percent of total billed charges,Implant Device,469.35,35,,469.35,percent of total billed charges,Implant Device,455.94,34,"Charges > $500, x 34%",455.94,percent of total billed charges,Implant Device,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,536.4,40,,536.4,percent of total billed charges,Implant Devices,469.35,70,,469.35,percent of total billed charges,Implant Devices,455.94,34,,455.94,percent of total billed charges,Implant Devices,455.94,34,,455.94,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,469.35,35,,469.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,536.4,
WRIGHT 777654562 HEADED SCREW 6.5X16MM,C1713,HCPCS,,79012019,CDM,278,RC,,,both,,,2706,1067.97,39.4668,,1067.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,920.04,34,,920.04,percent of total billed charges,Implant Device,920.04,34,,920.04,percent of total billed charges,Implant Device,920.04,34,,920.04,percent of total billed charges,Implant Device,920.04,34,,920.04,percent of total billed charges,Implant Device,920.04,34,,920.04,percent of total billed charges,Implant Device,920.04,34,,920.04,percent of total billed charges,Implant Device,947.1,35,,947.1,percent of total billed charges,Implant Device,920.04,34,"Charges > $500, x 34%",920.04,percent of total billed charges,Implant Device,947.1,35,,947.1,percent of total billed charges,Implant Devices,947.1,35,,947.1,percent of total billed charges,Implant Devices,947.1,35,,,percent of total billed charges,Implant Devices,947.1,35,,947.1,percent of total billed charges,Implant Devices,947.1,35,,947.1,percent of total billed charges,Implant Devices,1082.4,40,,1082.4,percent of total billed charges,Implant Devices,947.1,70,,947.1,percent of total billed charges,Implant Devices,920.04,34,,920.04,percent of total billed charges,Implant Devices,920.04,34,,920.04,percent of total billed charges,Implant Devices,947.1,35,,947.1,percent of total billed charges,Implant Devices,947.1,35,,947.1,percent of total billed charges,Implant Devices,947.1,35,,947.1,percent of total billed charges,Implant Devices,947.1,35,,947.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,920.04,34,"If Charge > 2,000, then 34 percent",920.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1082.4,
WRIGHT 59225532 CORTICAL SCREW 5.5X32MM,C1713,HCPCS,,79012020,CDM,278,RC,,,both,,,567,223.78,39.4668,,223.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,198.45,35,,198.45,percent of total billed charges,Implant Device,192.78,34,"Charges > $500, x 34%",192.78,percent of total billed charges,Implant Device,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,226.8,40,,226.8,percent of total billed charges,Implant Devices,198.45,70,,198.45,percent of total billed charges,Implant Devices,192.78,34,,192.78,percent of total billed charges,Implant Devices,192.78,34,,192.78,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,226.8,
WRIGHT 59225538 CORTICAL SCREW 5.5X38MM,C1713,HCPCS,,79012021,CDM,278,RC,,,both,,,567,223.78,39.4668,,223.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,192.78,34,,192.78,percent of total billed charges,Implant Device,198.45,35,,198.45,percent of total billed charges,Implant Device,192.78,34,"Charges > $500, x 34%",192.78,percent of total billed charges,Implant Device,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,226.8,40,,226.8,percent of total billed charges,Implant Devices,198.45,70,,198.45,percent of total billed charges,Implant Devices,192.78,34,,192.78,percent of total billed charges,Implant Devices,192.78,34,,192.78,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,198.45,35,,198.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,226.8,
STRYKER 627235 HUMERUS PLATE 125MM 5 H,C1713,HCPCS,,79012023,CDM,278,RC,,,both,,,6151,2427.6,39.4668,,2427.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2091.34,34,,2091.34,percent of total billed charges,Implant Device,2152.85,35,,2152.85,percent of total billed charges,Implant Device,2091.34,34,"Charges > $500, x 34%",2091.34,percent of total billed charges,Implant Device,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2460.4,40,,2460.4,percent of total billed charges,Implant Devices,2152.85,70,,2152.85,percent of total billed charges,Implant Devices,2091.34,34,,2091.34,percent of total billed charges,Implant Devices,2091.34,34,,2091.34,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,2152.85,35,,2152.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2091.34,34,"If Charge > 2,000, then 34 percent",2091.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2460.4,
KINAMED 35-200-1020 GRIP PLATE 2 HOLE,C1713,HCPCS,,79012032,CDM,278,RC,,,both,,,7965,3143.53,39.4668,,3143.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2708.1,34,,2708.1,percent of total billed charges,Implant Device,2708.1,34,,2708.1,percent of total billed charges,Implant Device,2708.1,34,,2708.1,percent of total billed charges,Implant Device,2708.1,34,,2708.1,percent of total billed charges,Implant Device,2708.1,34,,2708.1,percent of total billed charges,Implant Device,2708.1,34,,2708.1,percent of total billed charges,Implant Device,2787.75,35,,2787.75,percent of total billed charges,Implant Device,2708.1,34,"Charges > $500, x 34%",2708.1,percent of total billed charges,Implant Device,2787.75,35,,2787.75,percent of total billed charges,Implant Devices,2787.75,35,,2787.75,percent of total billed charges,Implant Devices,2787.75,35,,,percent of total billed charges,Implant Devices,2787.75,35,,2787.75,percent of total billed charges,Implant Devices,2787.75,35,,2787.75,percent of total billed charges,Implant Devices,3186,40,,3186,percent of total billed charges,Implant Devices,2787.75,70,,2787.75,percent of total billed charges,Implant Devices,2708.1,34,,2708.1,percent of total billed charges,Implant Devices,2708.1,34,,2708.1,percent of total billed charges,Implant Devices,2787.75,35,,2787.75,percent of total billed charges,Implant Devices,2787.75,35,,2787.75,percent of total billed charges,Implant Devices,2787.75,35,,2787.75,percent of total billed charges,Implant Devices,2787.75,35,,2787.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2708.1,34,"If Charge > 2,000, then 34 percent",2708.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3186,
J&J 212.136 LOCKING SCREW 3.5X46MM,C1713,HCPCS,,79012034,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
J&J 212.116 LOCKING SCREW 3.5X38MM,C1713,HCPCS,,79012035,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
IN2BONES C20 ST171 COLINK NC PLATE RIGHT,C1713,HCPCS,,79012037,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES P73 ST122 LOCK SCREW 3.5X22MM,C1713,HCPCS,,79012039,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST120 LOCK SCREW 3.5X20MM,C1713,HCPCS,,79012040,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST116 LOCK SCREW 3.5X16MM,C1713,HCPCS,,79012041,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST216 VAL LOCK SCREW,C1713,HCPCS,,79012042,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
WRIGHT 58802710 LOCKING SCREW 2.7X10MM,C1713,HCPCS,,79012045,CDM,278,RC,,,both,,,1317,519.78,39.4668,,519.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,460.95,35,,460.95,percent of total billed charges,Implant Device,447.78,34,"Charges > $500, x 34%",447.78,percent of total billed charges,Implant Device,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,526.8,40,,526.8,percent of total billed charges,Implant Devices,460.95,70,,460.95,percent of total billed charges,Implant Devices,447.78,34,,447.78,percent of total billed charges,Implant Devices,447.78,34,,447.78,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,526.8,
WRIGHT 58813516 CORTICAL SCREW 3.5X16MM,C1713,HCPCS,,79012046,CDM,278,RC,,,both,,,672,265.22,39.4668,,265.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,235.2,35,,235.2,percent of total billed charges,Implant Device,228.48,34,"Charges > $500, x 34%",228.48,percent of total billed charges,Implant Device,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,268.8,40,,268.8,percent of total billed charges,Implant Devices,235.2,70,,235.2,percent of total billed charges,Implant Devices,228.48,34,,228.48,percent of total billed charges,Implant Devices,228.48,34,,228.48,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.8,
WRIGHT 58803512 LOCKING SCREW 3.5X12MM,C1713,HCPCS,,79012048,CDM,278,RC,,,both,,,1317,519.78,39.4668,,519.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,447.78,34,,447.78,percent of total billed charges,Implant Device,460.95,35,,460.95,percent of total billed charges,Implant Device,447.78,34,"Charges > $500, x 34%",447.78,percent of total billed charges,Implant Device,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,526.8,40,,526.8,percent of total billed charges,Implant Devices,460.95,70,,460.95,percent of total billed charges,Implant Devices,447.78,34,,447.78,percent of total billed charges,Implant Devices,447.78,34,,447.78,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,460.95,35,,460.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,526.8,
WRIGHT 58813518 CORTICAL SCREW 3.5X18MM,C1713,HCPCS,,79012051,CDM,278,RC,,,both,,,672,265.22,39.4668,,265.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,228.48,34,,228.48,percent of total billed charges,Implant Device,235.2,35,,235.2,percent of total billed charges,Implant Device,228.48,34,"Charges > $500, x 34%",228.48,percent of total billed charges,Implant Device,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,268.8,40,,268.8,percent of total billed charges,Implant Devices,235.2,70,,235.2,percent of total billed charges,Implant Devices,228.48,34,,228.48,percent of total billed charges,Implant Devices,228.48,34,,228.48,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,235.2,35,,235.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,268.8,
WRIGHT 587115RT MTP FUSION SM 3 DEG RT,C1713,HCPCS,,79012052,CDM,278,RC,,,both,,,8943,3529.52,39.4668,,3529.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3040.62,34,,3040.62,percent of total billed charges,Implant Device,3040.62,34,,3040.62,percent of total billed charges,Implant Device,3040.62,34,,3040.62,percent of total billed charges,Implant Device,3040.62,34,,3040.62,percent of total billed charges,Implant Device,3040.62,34,,3040.62,percent of total billed charges,Implant Device,3040.62,34,,3040.62,percent of total billed charges,Implant Device,3130.05,35,,3130.05,percent of total billed charges,Implant Device,3040.62,34,"Charges > $500, x 34%",3040.62,percent of total billed charges,Implant Device,3130.05,35,,3130.05,percent of total billed charges,Implant Devices,3130.05,35,,3130.05,percent of total billed charges,Implant Devices,3130.05,35,,,percent of total billed charges,Implant Devices,3130.05,35,,3130.05,percent of total billed charges,Implant Devices,3130.05,35,,3130.05,percent of total billed charges,Implant Devices,3577.2,40,,3577.2,percent of total billed charges,Implant Devices,3130.05,70,,3130.05,percent of total billed charges,Implant Devices,3040.62,34,,3040.62,percent of total billed charges,Implant Devices,3040.62,34,,3040.62,percent of total billed charges,Implant Devices,3130.05,35,,3130.05,percent of total billed charges,Implant Devices,3130.05,35,,3130.05,percent of total billed charges,Implant Devices,3130.05,35,,3130.05,percent of total billed charges,Implant Devices,3130.05,35,,3130.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3040.62,34,"If Charge > 2,000, then 34 percent",3040.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3577.2,
STRYKER 601634S CANN SCREW 5X34MM,C1713,HCPCS,,79012053,CDM,278,RC,,,both,,,490,193.39,39.4668,,193.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,171.5,35,,171.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,196,40,,196,percent of total billed charges,Implant Devices,171.5,70,,171.5,percent of total billed charges,Implant Devices,166.6,34,,166.6,percent of total billed charges,Implant Devices,166.6,34,,166.6,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196,
STRYKER 601650S CANN SCREW 5X50MM,C1713,HCPCS,,79012054,CDM,278,RC,,,both,,,490,193.39,39.4668,,193.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,171.5,35,,171.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,196,40,,196,percent of total billed charges,Implant Devices,171.5,70,,171.5,percent of total billed charges,Implant Devices,166.6,34,,166.6,percent of total billed charges,Implant Devices,166.6,34,,166.6,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196,
STRYKER 601655S CANN SCREW 4X55MM,C1713,HCPCS,,79012055,CDM,278,RC,,,both,,,490,193.39,39.4668,,193.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,166.6,34,,166.6,percent of total billed charges,Implant Device,171.5,35,,171.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,196,40,,196,percent of total billed charges,Implant Devices,171.5,70,,171.5,percent of total billed charges,Implant Devices,166.6,34,,166.6,percent of total billed charges,Implant Devices,166.6,34,,166.6,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,171.5,35,,171.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196,
STRYKER 658034 HEADLESS COMP SCRW 4X34MM,C1713,HCPCS,,79012056,CDM,278,RC,,,both,,,1242,490.18,39.4668,,490.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,422.28,34,,422.28,percent of total billed charges,Implant Device,422.28,34,,422.28,percent of total billed charges,Implant Device,422.28,34,,422.28,percent of total billed charges,Implant Device,422.28,34,,422.28,percent of total billed charges,Implant Device,422.28,34,,422.28,percent of total billed charges,Implant Device,422.28,34,,422.28,percent of total billed charges,Implant Device,434.7,35,,434.7,percent of total billed charges,Implant Device,422.28,34,"Charges > $500, x 34%",422.28,percent of total billed charges,Implant Device,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,496.8,40,,496.8,percent of total billed charges,Implant Devices,434.7,70,,434.7,percent of total billed charges,Implant Devices,422.28,34,,422.28,percent of total billed charges,Implant Devices,422.28,34,,422.28,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,434.7,35,,434.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,496.8,
STRYKER 658040 HEADLESS COMP SCRW 4X40MM,C1713,HCPCS,,79012057,CDM,278,RC,,,both,,,1266,499.65,39.4668,,499.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,443.1,35,,443.1,percent of total billed charges,Implant Device,430.44,34,"Charges > $500, x 34%",430.44,percent of total billed charges,Implant Device,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,506.4,40,,506.4,percent of total billed charges,Implant Devices,443.1,70,,443.1,percent of total billed charges,Implant Devices,430.44,34,,430.44,percent of total billed charges,Implant Devices,430.44,34,,430.44,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,506.4,
ZIMMER 110007559 CANNULATED SCREW 4X44MM,C1713,HCPCS,,79012060,CDM,278,RC,,,both,,,529,208.78,39.4668,,208.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Device,179.86,34,"Charges > $500, x 34%",179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,211.6,40,,211.6,percent of total billed charges,Implant Devices,185.15,70,,185.15,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,211.6,
J&J 02.124.416 CONDYLAR PLT 4.5MM 16H,C1713,HCPCS,,79012061,CDM,278,RC,,,both,,,5096,2011.23,39.4668,,2011.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1783.6,35,,1783.6,percent of total billed charges,Implant Device,1732.64,34,"Charges > $500, x 34%",1732.64,percent of total billed charges,Implant Device,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,2038.4,40,,2038.4,percent of total billed charges,Implant Devices,1783.6,70,,1783.6,percent of total billed charges,Implant Devices,1732.64,34,,1732.64,percent of total billed charges,Implant Devices,1732.64,34,,1732.64,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1732.64,34,"If Charge > 2,000, then 34 percent",1732.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2038.4,
J&J 214.844 CORTEX SCREW 4.5X44MM,C1713,HCPCS,,79012064,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
J&J 42.231.240 LOCKING SCREW 5X40MM,C1713,HCPCS,,79012066,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 42.231.275 LOCKING SCREW 5X75MM,C1713,HCPCS,,79012067,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 42.231.270 LOCKING SCREW 5X70MM,C1713,HCPCS,,79012068,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 42.231.265 LOCKING SCREW 5X65MM,C1713,HCPCS,,79012069,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 42.231.228 LOCKING SCREW 5X28MM,C1713,HCPCS,,79012070,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 42.231.232 LOCKING SCREW 5X32MM,C1713,HCPCS,,79012071,CDM,278,RC,,,both,,,529,208.78,39.4668,,208.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Device,179.86,34,"Charges > $500, x 34%",179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,211.6,40,,211.6,percent of total billed charges,Implant Devices,185.15,70,,185.15,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,211.6,
J&J 42.231.230 LOCKING SCREW 5X30MM,C1713,HCPCS,,79012072,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 42.231.226 LOCKING SCREW 5X26MM,C1713,HCPCS,,79012073,CDM,278,RC,,,both,,,529,208.78,39.4668,,208.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Device,179.86,34,"Charges > $500, x 34%",179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,211.6,40,,211.6,percent of total billed charges,Implant Devices,185.15,70,,185.15,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,211.6,
IN2BONES P43 ST016 CORTICAL SCREW 3X16MM,C1713,HCPCS,,79012074,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P43 ST116 LOCKING SCREW 3X16MM,C1713,HCPCS,,79012075,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST118 LOCKING SCREW 3.5X18,C1713,HCPCS,,79012076,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ARTHREX AR-18720-14 CORTICAL SCREW 2X14,C1713,HCPCS,,79012079,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
STRYKER 658345 COMPRESSION SCREW 7X45MM,C1713,HCPCS,,79012080,CDM,278,RC,,,both,,,2079,820.51,39.4668,,820.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,706.86,34,,706.86,percent of total billed charges,Implant Device,727.65,35,,727.65,percent of total billed charges,Implant Device,706.86,34,"Charges > $500, x 34%",706.86,percent of total billed charges,Implant Device,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,831.6,40,,831.6,percent of total billed charges,Implant Devices,727.65,70,,727.65,percent of total billed charges,Implant Devices,706.86,34,,706.86,percent of total billed charges,Implant Devices,706.86,34,,706.86,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,727.65,35,,727.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,706.86,34,"If Charge > 2,000, then 34 percent",706.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,831.6,
IN2BONES C20 ST031 LISFRANC PLATE SMALL,C1713,HCPCS,,79012081,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 3322020 BONE CEMENT 20G,C1713,HCPCS,,79012085,CDM,278,RC,,,both,,,627,247.46,39.4668,,247.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,219.45,35,,219.45,percent of total billed charges,Implant Device,213.18,34,"Charges > $500, x 34%",213.18,percent of total billed charges,Implant Device,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,250.8,40,,250.8,percent of total billed charges,Implant Devices,219.45,70,,219.45,percent of total billed charges,Implant Devices,213.18,34,,213.18,percent of total billed charges,Implant Devices,213.18,34,,213.18,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,250.8,
IN2BONES S27 S120 SNAP OFF SCREW 2.7X20,C1713,HCPCS,,79012086,CDM,278,RC,,,both,,,1275,503.2,39.4668,,503.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Device,433.5,34,"Charges > $500, x 34%",433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,510,40,,510,percent of total billed charges,Implant Devices,446.25,70,,446.25,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510,
IN2BONES P70 ST207 FIBULA PLATE LEFT,C1713,HCPCS,,79012087,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
ZIMMER 110007603 CANNULATED SCREW 4X38MM,C1713,HCPCS,,79012088,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
ZIMMER 110007605 CANULATED SCREW 4X40MM,C1713,HCPCS,,79012089,CDM,278,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,346.8,34,,346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Device,346.8,34,"Charges > $500, x 34%",346.8,percent of total billed charges,Implant Device,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,408,40,,408,percent of total billed charges,Implant Devices,357,70,,357,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,346.8,34,,346.8,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,357,35,,357,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,408,
J&J 02.112.622 CLAVICLE PLATE LEFT 2.7MM,C1713,HCPCS,,79012097,CDM,278,RC,,,both,,,3122,1232.15,39.4668,,1232.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1061.48,34,,1061.48,percent of total billed charges,Implant Device,1061.48,34,,1061.48,percent of total billed charges,Implant Device,1061.48,34,,1061.48,percent of total billed charges,Implant Device,1061.48,34,,1061.48,percent of total billed charges,Implant Device,1061.48,34,,1061.48,percent of total billed charges,Implant Device,1061.48,34,,1061.48,percent of total billed charges,Implant Device,1092.7,35,,1092.7,percent of total billed charges,Implant Device,1061.48,34,"Charges > $500, x 34%",1061.48,percent of total billed charges,Implant Device,1092.7,35,,1092.7,percent of total billed charges,Implant Devices,1092.7,35,,1092.7,percent of total billed charges,Implant Devices,1092.7,35,,,percent of total billed charges,Implant Devices,1092.7,35,,1092.7,percent of total billed charges,Implant Devices,1092.7,35,,1092.7,percent of total billed charges,Implant Devices,1248.8,40,,1248.8,percent of total billed charges,Implant Devices,1092.7,70,,1092.7,percent of total billed charges,Implant Devices,1061.48,34,,1061.48,percent of total billed charges,Implant Devices,1061.48,34,,1061.48,percent of total billed charges,Implant Devices,1092.7,35,,1092.7,percent of total billed charges,Implant Devices,1092.7,35,,1092.7,percent of total billed charges,Implant Devices,1092.7,35,,1092.7,percent of total billed charges,Implant Devices,1092.7,35,,1092.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1061.48,34,"If Charge > 2,000, then 34 percent",1061.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1248.8,
J&J 247.370 LCP PLATE 12 HOLE 2.7X97MM,C1713,HCPCS,,79012099,CDM,278,RC,,,both,,,1165,459.79,39.4668,,459.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,396.1,34,,396.1,percent of total billed charges,Implant Device,396.1,34,,396.1,percent of total billed charges,Implant Device,396.1,34,,396.1,percent of total billed charges,Implant Device,396.1,34,,396.1,percent of total billed charges,Implant Device,396.1,34,,396.1,percent of total billed charges,Implant Device,396.1,34,,396.1,percent of total billed charges,Implant Device,407.75,35,,407.75,percent of total billed charges,Implant Device,396.1,34,"Charges > $500, x 34%",396.1,percent of total billed charges,Implant Device,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,466,40,,466,percent of total billed charges,Implant Devices,407.75,70,,407.75,percent of total billed charges,Implant Devices,396.1,34,,396.1,percent of total billed charges,Implant Devices,396.1,34,,396.1,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,466,
J&J 02.124.415 LCP CURVED PLT 4.5X301MM,C1713,HCPCS,,79012101,CDM,278,RC,,,both,,,5157,2035.3,39.4668,,2035.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1753.38,34,,1753.38,percent of total billed charges,Implant Device,1753.38,34,,1753.38,percent of total billed charges,Implant Device,1753.38,34,,1753.38,percent of total billed charges,Implant Device,1753.38,34,,1753.38,percent of total billed charges,Implant Device,1753.38,34,,1753.38,percent of total billed charges,Implant Device,1753.38,34,,1753.38,percent of total billed charges,Implant Device,1804.95,35,,1804.95,percent of total billed charges,Implant Device,1753.38,34,"Charges > $500, x 34%",1753.38,percent of total billed charges,Implant Device,1804.95,35,,1804.95,percent of total billed charges,Implant Devices,1804.95,35,,1804.95,percent of total billed charges,Implant Devices,1804.95,35,,,percent of total billed charges,Implant Devices,1804.95,35,,1804.95,percent of total billed charges,Implant Devices,1804.95,35,,1804.95,percent of total billed charges,Implant Devices,2062.8,40,,2062.8,percent of total billed charges,Implant Devices,1804.95,70,,1804.95,percent of total billed charges,Implant Devices,1753.38,34,,1753.38,percent of total billed charges,Implant Devices,1753.38,34,,1753.38,percent of total billed charges,Implant Devices,1804.95,35,,1804.95,percent of total billed charges,Implant Devices,1804.95,35,,1804.95,percent of total billed charges,Implant Devices,1804.95,35,,1804.95,percent of total billed charges,Implant Devices,1804.95,35,,1804.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1753.38,34,"If Charge > 2,000, then 34 percent",1753.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2062.8,
J&J 42.231.280 SCREW SELF TAPPING 5X80MM,C1713,HCPCS,,79012102,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 04.013.616S FEMORAL NAIL 12X180MM,C1713,HCPCS,,79012103,CDM,278,RC,,,both,,,3094,1221.1,39.4668,,1221.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1051.96,34,,1051.96,percent of total billed charges,Implant Device,1051.96,34,,1051.96,percent of total billed charges,Implant Device,1051.96,34,,1051.96,percent of total billed charges,Implant Device,1051.96,34,,1051.96,percent of total billed charges,Implant Device,1051.96,34,,1051.96,percent of total billed charges,Implant Device,1051.96,34,,1051.96,percent of total billed charges,Implant Device,1082.9,35,,1082.9,percent of total billed charges,Implant Device,1051.96,34,"Charges > $500, x 34%",1051.96,percent of total billed charges,Implant Device,1082.9,35,,1082.9,percent of total billed charges,Implant Devices,1082.9,35,,1082.9,percent of total billed charges,Implant Devices,1082.9,35,,,percent of total billed charges,Implant Devices,1082.9,35,,1082.9,percent of total billed charges,Implant Devices,1082.9,35,,1082.9,percent of total billed charges,Implant Devices,1237.6,40,,1237.6,percent of total billed charges,Implant Devices,1082.9,70,,1082.9,percent of total billed charges,Implant Devices,1051.96,34,,1051.96,percent of total billed charges,Implant Devices,1051.96,34,,1051.96,percent of total billed charges,Implant Devices,1082.9,35,,1082.9,percent of total billed charges,Implant Devices,1082.9,35,,1082.9,percent of total billed charges,Implant Devices,1082.9,35,,1082.9,percent of total billed charges,Implant Devices,1082.9,35,,1082.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1051.96,34,"If Charge > 2,000, then 34 percent",1051.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1237.6,
STRYKER EZXP15-15-15 STAPLE 15X15X15MM,C1713,HCPCS,,79012108,CDM,278,RC,,,both,,,4274,1686.81,39.4668,,1686.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1453.16,34,,1453.16,percent of total billed charges,Implant Device,1453.16,34,,1453.16,percent of total billed charges,Implant Device,1453.16,34,,1453.16,percent of total billed charges,Implant Device,1453.16,34,,1453.16,percent of total billed charges,Implant Device,1453.16,34,,1453.16,percent of total billed charges,Implant Device,1453.16,34,,1453.16,percent of total billed charges,Implant Device,1495.9,35,,1495.9,percent of total billed charges,Implant Device,1453.16,34,"Charges > $500, x 34%",1453.16,percent of total billed charges,Implant Device,1495.9,35,,1495.9,percent of total billed charges,Implant Devices,1495.9,35,,1495.9,percent of total billed charges,Implant Devices,1495.9,35,,,percent of total billed charges,Implant Devices,1495.9,35,,1495.9,percent of total billed charges,Implant Devices,1495.9,35,,1495.9,percent of total billed charges,Implant Devices,1709.6,40,,1709.6,percent of total billed charges,Implant Devices,1495.9,70,,1495.9,percent of total billed charges,Implant Devices,1453.16,34,,1453.16,percent of total billed charges,Implant Devices,1453.16,34,,1453.16,percent of total billed charges,Implant Devices,1495.9,35,,1495.9,percent of total billed charges,Implant Devices,1495.9,35,,1495.9,percent of total billed charges,Implant Devices,1495.9,35,,1495.9,percent of total billed charges,Implant Devices,1495.9,35,,1495.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1453.16,34,"If Charge > 2,000, then 34 percent",1453.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1709.6,
WRIGHT FFNS1515 STAPLE 15X15MM,C1713,HCPCS,,79012109,CDM,278,RC,,,both,,,7517,2966.72,39.4668,,2966.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2555.78,34,,2555.78,percent of total billed charges,Implant Device,2630.95,35,,2630.95,percent of total billed charges,Implant Device,2555.78,34,"Charges > $500, x 34%",2555.78,percent of total billed charges,Implant Device,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,3006.8,40,,3006.8,percent of total billed charges,Implant Devices,2630.95,70,,2630.95,percent of total billed charges,Implant Devices,2555.78,34,,2555.78,percent of total billed charges,Implant Devices,2555.78,34,,2555.78,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,2630.95,35,,2630.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2555.78,34,"If Charge > 2,000, then 34 percent",2555.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3006.8,
WRIGHT 58820024 FIXATION PIN 1.4MM,C1713,HCPCS,,79012110,CDM,278,RC,,,both,,,341,134.58,39.4668,,134.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,119.35,35,,119.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,136.4,40,,136.4,percent of total billed charges,Implant Devices,119.35,70,,119.35,percent of total billed charges,Implant Devices,115.94,34,,115.94,percent of total billed charges,Implant Devices,115.94,34,,115.94,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,136.4,
J&J 42.231.255 LOCKING SCREW 5X55MM,C1713,HCPCS,,79012112,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 42.231.260 SELF TAPPING SCREW 5X60MM,C1713,HCPCS,,79012113,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 02.124.413 CURVED PLT 12H 266MM LT,C1713,HCPCS,,79012114,CDM,278,RC,,,both,,,4685,1849.02,39.4668,,1849.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1592.9,34,,1592.9,percent of total billed charges,Implant Device,1592.9,34,,1592.9,percent of total billed charges,Implant Device,1592.9,34,,1592.9,percent of total billed charges,Implant Device,1592.9,34,,1592.9,percent of total billed charges,Implant Device,1592.9,34,,1592.9,percent of total billed charges,Implant Device,1592.9,34,,1592.9,percent of total billed charges,Implant Device,1639.75,35,,1639.75,percent of total billed charges,Implant Device,1592.9,34,"Charges > $500, x 34%",1592.9,percent of total billed charges,Implant Device,1639.75,35,,1639.75,percent of total billed charges,Implant Devices,1639.75,35,,1639.75,percent of total billed charges,Implant Devices,1639.75,35,,,percent of total billed charges,Implant Devices,1639.75,35,,1639.75,percent of total billed charges,Implant Devices,1639.75,35,,1639.75,percent of total billed charges,Implant Devices,1874,40,,1874,percent of total billed charges,Implant Devices,1639.75,70,,1639.75,percent of total billed charges,Implant Devices,1592.9,34,,1592.9,percent of total billed charges,Implant Devices,1592.9,34,,1592.9,percent of total billed charges,Implant Devices,1639.75,35,,1639.75,percent of total billed charges,Implant Devices,1639.75,35,,1639.75,percent of total billed charges,Implant Devices,1639.75,35,,1639.75,percent of total billed charges,Implant Devices,1639.75,35,,1639.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1592.9,34,"If Charge > 2,000, then 34 percent",1592.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1874,
J&J 208.437 CANNULATED SCREW 6.5X75MM,C1713,HCPCS,,79012115,CDM,278,RC,,,both,,,683,269.56,39.4668,,269.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Device,232.22,34,"Charges > $500, x 34%",232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,273.2,40,,273.2,percent of total billed charges,Implant Devices,239.05,70,,239.05,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.2,
STRYKER 657615 LOCKING SCREW 2.0X15MM,C1713,HCPCS,,79012123,CDM,278,RC,,,both,,,443,174.84,39.4668,,174.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,150.62,34,,150.62,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,177.2,40,,177.2,percent of total billed charges,Implant Devices,155.05,70,,155.05,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,150.62,34,,150.62,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,155.05,35,,155.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.2,
IN2BONES V35 ST424 COLINK SCREW 3.5X24MM,C1713,HCPCS,,79012128,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
J&J 206.040 CANCELLOUS SCREW 4.0X40MM,C1713,HCPCS,,79012142,CDM,278,RC,,,both,,,47,18.55,39.4668,,18.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,16.45,35,,16.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,18.8,40,,18.8,percent of total billed charges,Implant Devices,16.45,70,,16.45,percent of total billed charges,Implant Devices,15.98,34,,15.98,percent of total billed charges,Implant Devices,15.98,34,,15.98,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18.8,
J&J 212.118 LOCKING SCREW 3.5X42MM,C1713,HCPCS,,79012143,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
J&J 212.112 LOCKING SCREW 3.5X32MM,C1713,HCPCS,,79012144,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
STRYKER 2341-0930S TIBIAL NAIL 9X300MM,C1713,HCPCS,,79012145,CDM,278,RC,,,both,,,6378,2517.19,39.4668,,2517.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Device,2168.52,34,"Charges > $500, x 34%",2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2551.2,40,,2551.2,percent of total billed charges,Implant Devices,2232.3,70,,2232.3,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2168.52,34,"If Charge > 2,000, then 34 percent",2168.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2551.2,
STRYKER IC4032 HEADED SCREW 4.0X32MM,C1713,HCPCS,,79012148,CDM,278,RC,,,both,,,961,379.28,39.4668,,379.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,336.35,35,,336.35,percent of total billed charges,Implant Device,326.74,34,"Charges > $500, x 34%",326.74,percent of total billed charges,Implant Device,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,384.4,40,,384.4,percent of total billed charges,Implant Devices,336.35,70,,336.35,percent of total billed charges,Implant Devices,326.74,34,,326.74,percent of total billed charges,Implant Devices,326.74,34,,326.74,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384.4,
STRYKER IC4036 HEADED SCREW 4.0X36MM,C1713,HCPCS,,79012149,CDM,278,RC,,,both,,,493,194.57,39.4668,,194.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,167.62,34,,167.62,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,197.2,40,,197.2,percent of total billed charges,Implant Devices,172.55,70,,172.55,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,167.62,34,,167.62,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,172.55,35,,172.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,197.2,
J&J 04.005.418S LOCKING SCREW 4.0X28MM,C1713,HCPCS,,79012150,CDM,278,RC,,,both,,,449,177.21,39.4668,,177.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,152.66,34,,152.66,percent of total billed charges,Implant Device,152.66,34,,152.66,percent of total billed charges,Implant Device,152.66,34,,152.66,percent of total billed charges,Implant Device,152.66,34,,152.66,percent of total billed charges,Implant Device,152.66,34,,152.66,percent of total billed charges,Implant Device,152.66,34,,152.66,percent of total billed charges,Implant Device,157.15,35,,157.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,179.6,40,,179.6,percent of total billed charges,Implant Devices,157.15,70,,157.15,percent of total billed charges,Implant Devices,152.66,34,,152.66,percent of total billed charges,Implant Devices,152.66,34,,152.66,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,157.15,35,,157.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,179.6,
J&J 202.870 CORTEX SCREW 2.7X10MM,C1713,HCPCS,,79012152,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
J&J 204.645 CORTEX SCREW 3.5X45MM,C1713,HCPCS,,79012155,CDM,278,RC,,,both,,,75,29.6,39.4668,,29.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,26.25,35,,26.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,30,40,,30,percent of total billed charges,Implant Devices,26.25,70,,26.25,percent of total billed charges,Implant Devices,25.5,34,,25.5,percent of total billed charges,Implant Devices,25.5,34,,25.5,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,30,
J&J 245.908 PLATE 8 HOLES 3.5MM,C1713,HCPCS,,79012156,CDM,278,RC,,,both,,,1202,474.39,39.4668,,474.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.68,34,,408.68,percent of total billed charges,Implant Device,408.68,34,,408.68,percent of total billed charges,Implant Device,408.68,34,,408.68,percent of total billed charges,Implant Device,408.68,34,,408.68,percent of total billed charges,Implant Device,408.68,34,,408.68,percent of total billed charges,Implant Device,408.68,34,,408.68,percent of total billed charges,Implant Device,420.7,35,,420.7,percent of total billed charges,Implant Device,408.68,34,"Charges > $500, x 34%",408.68,percent of total billed charges,Implant Device,420.7,35,,420.7,percent of total billed charges,Implant Devices,420.7,35,,420.7,percent of total billed charges,Implant Devices,420.7,35,,,percent of total billed charges,Implant Devices,420.7,35,,420.7,percent of total billed charges,Implant Devices,420.7,35,,420.7,percent of total billed charges,Implant Devices,480.8,40,,480.8,percent of total billed charges,Implant Devices,420.7,70,,420.7,percent of total billed charges,Implant Devices,408.68,34,,408.68,percent of total billed charges,Implant Devices,408.68,34,,408.68,percent of total billed charges,Implant Devices,420.7,35,,420.7,percent of total billed charges,Implant Devices,420.7,35,,420.7,percent of total billed charges,Implant Devices,420.7,35,,420.7,percent of total billed charges,Implant Devices,420.7,35,,420.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480.8,
J&J 204.665 CORTEX SCREW 3.5X65MM,C1713,HCPCS,,79012157,CDM,278,RC,,,both,,,75,29.6,39.4668,,29.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,26.25,35,,26.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,30,40,,30,percent of total billed charges,Implant Devices,26.25,70,,26.25,percent of total billed charges,Implant Devices,25.5,34,,25.5,percent of total billed charges,Implant Devices,25.5,34,,25.5,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,30,
J&J 204.650 CORTEX SCREW 3.5X50MM,C1713,HCPCS,,79012158,CDM,278,RC,,,both,,,75,29.6,39.4668,,29.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,26.25,35,,26.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,30,40,,30,percent of total billed charges,Implant Devices,26.25,70,,26.25,percent of total billed charges,Implant Devices,25.5,34,,25.5,percent of total billed charges,Implant Devices,25.5,34,,25.5,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,30,
J&J 204.640 CORTEX SCREW 3.5X40MM,C1713,HCPCS,,79012159,CDM,278,RC,,,both,,,75,29.6,39.4668,,29.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,25.5,34,,25.5,percent of total billed charges,Implant Device,26.25,35,,26.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,30,40,,30,percent of total billed charges,Implant Devices,26.25,70,,26.25,percent of total billed charges,Implant Devices,25.5,34,,25.5,percent of total billed charges,Implant Devices,25.5,34,,25.5,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,26.25,35,,26.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,30,
STRYKER 627570 COMPRESSION PLT 10H 5MM,C1713,HCPCS,,79012164,CDM,278,RC,,,both,,,5824,2298.55,39.4668,,2298.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1980.16,34,,1980.16,percent of total billed charges,Implant Device,1980.16,34,,1980.16,percent of total billed charges,Implant Device,1980.16,34,,1980.16,percent of total billed charges,Implant Device,1980.16,34,,1980.16,percent of total billed charges,Implant Device,1980.16,34,,1980.16,percent of total billed charges,Implant Device,1980.16,34,,1980.16,percent of total billed charges,Implant Device,2038.4,35,,2038.4,percent of total billed charges,Implant Device,1980.16,34,"Charges > $500, x 34%",1980.16,percent of total billed charges,Implant Device,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2329.6,40,,2329.6,percent of total billed charges,Implant Devices,2038.4,70,,2038.4,percent of total billed charges,Implant Devices,1980.16,34,,1980.16,percent of total billed charges,Implant Devices,1980.16,34,,1980.16,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,2038.4,35,,2038.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1980.16,34,"If Charge > 2,000, then 34 percent",1980.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2329.6,
J&J 04.038.200S TFNA SCREW 100MM,C1713,HCPCS,,79012165,CDM,278,RC,,,both,,,1693,668.17,39.4668,,668.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,592.55,35,,592.55,percent of total billed charges,Implant Device,575.62,34,"Charges > $500, x 34%",575.62,percent of total billed charges,Implant Device,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,677.2,40,,677.2,percent of total billed charges,Implant Devices,592.55,70,,592.55,percent of total billed charges,Implant Devices,575.62,34,,575.62,percent of total billed charges,Implant Devices,575.62,34,,575.62,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,677.2,
J&J 02.118.570 SELF TAP SCREW 2.7X70MM,C1713,HCPCS,,79012167,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
IN2BONES V35 ST426 COLINK SCREW 3.5X26MM,C1713,HCPCS,,79012169,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
TORNIER SPS00GT TUBEROSITY PLATE 53MM,C1713,HCPCS,,79012172,CDM,278,RC,,,both,,,11085,4374.89,39.4668,,4374.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3879.75,35,,3879.75,percent of total billed charges,Implant Device,3768.9,34,"Charges > $500, x 34%",3768.9,percent of total billed charges,Implant Device,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,4434,40,,4434,percent of total billed charges,Implant Devices,3879.75,70,,3879.75,percent of total billed charges,Implant Devices,3768.9,34,,3768.9,percent of total billed charges,Implant Devices,3768.9,34,,3768.9,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3768.9,34,"If Charge > 2,000, then 34 percent",3768.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4434,
TORNIER SPS224 NON LOCK SCREW 3.5X24MM,C1713,HCPCS,,79012173,CDM,278,RC,,,both,,,783,309.03,39.4668,,309.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,274.05,35,,274.05,percent of total billed charges,Implant Device,266.22,34,"Charges > $500, x 34%",266.22,percent of total billed charges,Implant Device,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,313.2,40,,313.2,percent of total billed charges,Implant Devices,274.05,70,,274.05,percent of total billed charges,Implant Devices,266.22,34,,266.22,percent of total billed charges,Implant Devices,266.22,34,,266.22,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,313.2,
TORNIER SPS226 NON LOCK SCREW 3.5X26MM,C1713,HCPCS,,79012174,CDM,278,RC,,,both,,,783,309.03,39.4668,,309.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,274.05,35,,274.05,percent of total billed charges,Implant Device,266.22,34,"Charges > $500, x 34%",266.22,percent of total billed charges,Implant Device,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,313.2,40,,313.2,percent of total billed charges,Implant Devices,274.05,70,,274.05,percent of total billed charges,Implant Devices,266.22,34,,266.22,percent of total billed charges,Implant Devices,266.22,34,,266.22,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,313.2,
TORNIER SPS428 LOCKING SCREW 3.5X28MM,C1713,HCPCS,,79012175,CDM,278,RC,,,both,,,783,309.03,39.4668,,309.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,274.05,35,,274.05,percent of total billed charges,Implant Device,266.22,34,"Charges > $500, x 34%",266.22,percent of total billed charges,Implant Device,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,313.2,40,,313.2,percent of total billed charges,Implant Devices,274.05,70,,274.05,percent of total billed charges,Implant Devices,266.22,34,,266.22,percent of total billed charges,Implant Devices,266.22,34,,266.22,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,313.2,
TORNIER SPS430 LOCKING SCREW 3.5X30MM,C1713,HCPCS,,79012176,CDM,278,RC,,,both,,,783,309.03,39.4668,,309.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,274.05,35,,274.05,percent of total billed charges,Implant Device,266.22,34,"Charges > $500, x 34%",266.22,percent of total billed charges,Implant Device,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,313.2,40,,313.2,percent of total billed charges,Implant Devices,274.05,70,,274.05,percent of total billed charges,Implant Devices,266.22,34,,266.22,percent of total billed charges,Implant Devices,266.22,34,,266.22,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,313.2,
TORNIER SPS434 LOCKING SCREW 3.5X34MM,C1713,HCPCS,,79012177,CDM,278,RC,,,both,,,783,309.03,39.4668,,309.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,266.22,34,,266.22,percent of total billed charges,Implant Device,274.05,35,,274.05,percent of total billed charges,Implant Device,266.22,34,"Charges > $500, x 34%",266.22,percent of total billed charges,Implant Device,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,313.2,40,,313.2,percent of total billed charges,Implant Devices,274.05,70,,274.05,percent of total billed charges,Implant Devices,266.22,34,,266.22,percent of total billed charges,Implant Devices,266.22,34,,266.22,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,274.05,35,,274.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,313.2,
STRYKER 2341-1134S TIBIAL NAIL 11X345MM,C1713,HCPCS,,79012178,CDM,278,RC,,,both,,,6378,2517.19,39.4668,,2517.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Device,2168.52,34,"Charges > $500, x 34%",2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2551.2,40,,2551.2,percent of total billed charges,Implant Devices,2232.3,70,,2232.3,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2168.52,34,"If Charge > 2,000, then 34 percent",2168.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2551.2,
IN2BONES S65 ST185 COMP SCREW 6.5X85MM,C1713,HCPCS,,79012182,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
IN2BONES S65 ST190 COMP SCREW 6.5X90MM,C1713,HCPCS,,79012183,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
ZIMMER 8145-01-090 HIP SCREW 90MM,C1713,HCPCS,,79012188,CDM,278,RC,,,both,,,734,289.69,39.4668,,289.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,256.9,35,,256.9,percent of total billed charges,Implant Device,249.56,34,"Charges > $500, x 34%",249.56,percent of total billed charges,Implant Device,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,293.6,40,,293.6,percent of total billed charges,Implant Devices,256.9,70,,256.9,percent of total billed charges,Implant Devices,249.56,34,,249.56,percent of total billed charges,Implant Devices,249.56,34,,249.56,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,293.6,
ZIMMER 8145-50-046 CORT BONE SCRW 5X46MM,C1713,HCPCS,,79012189,CDM,278,RC,,,both,,,594,234.43,39.4668,,234.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Device,201.96,34,"Charges > $500, x 34%",201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,237.6,40,,237.6,percent of total billed charges,Implant Devices,207.9,70,,207.9,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,237.6,
ARTHREX A1360FT-BC MPFL RECONTRUC KIT,C1713,HCPCS,,79012191,CDM,278,RC,,,both,,,5985,2362.09,39.4668,,2362.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2034.9,34,,2034.9,percent of total billed charges,Implant Device,2094.75,35,,2094.75,percent of total billed charges,Implant Device,2034.9,34,"Charges > $500, x 34%",2034.9,percent of total billed charges,Implant Device,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2394,40,,2394,percent of total billed charges,Implant Devices,2094.75,70,,2094.75,percent of total billed charges,Implant Devices,2034.9,34,,2034.9,percent of total billed charges,Implant Devices,2034.9,34,,2034.9,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,2094.75,35,,2094.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2034.9,34,"If Charge > 2,000, then 34 percent",2034.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2394,
J&J 02.112.621 CLAVICLE PLATE RT 2.7MM,C1713,HCPCS,,79012200,CDM,278,RC,,,both,,,3218,1270.04,39.4668,,1270.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1126.3,35,,1126.3,percent of total billed charges,Implant Device,1094.12,34,"Charges > $500, x 34%",1094.12,percent of total billed charges,Implant Device,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1287.2,40,,1287.2,percent of total billed charges,Implant Devices,1126.3,70,,1126.3,percent of total billed charges,Implant Devices,1094.12,34,,1094.12,percent of total billed charges,Implant Devices,1094.12,34,,1094.12,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1094.12,34,"If Charge > 2,000, then 34 percent",1094.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1287.2,
J&J 03.211.415 OLIVE WIRE 1.6MM,C1713,HCPCS,,79012201,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
J&J 02.111.903.01 K WIRE 2.0MM,C1713,HCPCS,,79012202,CDM,278,RC,,,both,,,112,44.2,39.4668,,44.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.08,34,,38.08,percent of total billed charges,Implant Device,38.08,34,,38.08,percent of total billed charges,Implant Device,38.08,34,,38.08,percent of total billed charges,Implant Device,38.08,34,,38.08,percent of total billed charges,Implant Device,38.08,34,,38.08,percent of total billed charges,Implant Device,38.08,34,,38.08,percent of total billed charges,Implant Device,39.2,35,,39.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.2,35,,39.2,percent of total billed charges,Implant Devices,39.2,35,,39.2,percent of total billed charges,Implant Devices,39.2,35,,,percent of total billed charges,Implant Devices,39.2,35,,39.2,percent of total billed charges,Implant Devices,39.2,35,,39.2,percent of total billed charges,Implant Devices,44.8,40,,44.8,percent of total billed charges,Implant Devices,39.2,70,,39.2,percent of total billed charges,Implant Devices,38.08,34,,38.08,percent of total billed charges,Implant Devices,38.08,34,,38.08,percent of total billed charges,Implant Devices,39.2,35,,39.2,percent of total billed charges,Implant Devices,39.2,35,,39.2,percent of total billed charges,Implant Devices,39.2,35,,39.2,percent of total billed charges,Implant Devices,39.2,35,,39.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,44.8,
J&J 212.115 LOCKING SCREW 3.5X36MM,C1713,HCPCS,,79012203,CDM,278,RC,,,both,,,327,129.06,39.4668,,129.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,111.18,34,,111.18,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,130.8,40,,130.8,percent of total billed charges,Implant Devices,114.45,70,,114.45,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,111.18,34,,111.18,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,114.45,35,,114.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,130.8,
J&J 242.07 TUBULAR PLATE QUARTER 7 H,C1713,HCPCS,,79012204,CDM,278,RC,,,both,,,274,108.14,39.4668,,108.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,93.16,34,,93.16,percent of total billed charges,Implant Device,95.9,35,,95.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,109.6,40,,109.6,percent of total billed charges,Implant Devices,95.9,70,,95.9,percent of total billed charges,Implant Devices,93.16,34,,93.16,percent of total billed charges,Implant Devices,93.16,34,,93.16,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,95.9,35,,95.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.6,
J&J 02.117.601 DIS HUMERUS PLT 2.7/3.5MM,C1713,HCPCS,,79012205,CDM,278,RC,,,both,,,3335,1316.22,39.4668,,1316.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1133.9,34,,1133.9,percent of total billed charges,Implant Device,1133.9,34,,1133.9,percent of total billed charges,Implant Device,1133.9,34,,1133.9,percent of total billed charges,Implant Device,1133.9,34,,1133.9,percent of total billed charges,Implant Device,1133.9,34,,1133.9,percent of total billed charges,Implant Device,1133.9,34,,1133.9,percent of total billed charges,Implant Device,1167.25,35,,1167.25,percent of total billed charges,Implant Device,1133.9,34,"Charges > $500, x 34%",1133.9,percent of total billed charges,Implant Device,1167.25,35,,1167.25,percent of total billed charges,Implant Devices,1167.25,35,,1167.25,percent of total billed charges,Implant Devices,1167.25,35,,,percent of total billed charges,Implant Devices,1167.25,35,,1167.25,percent of total billed charges,Implant Devices,1167.25,35,,1167.25,percent of total billed charges,Implant Devices,1334,40,,1334,percent of total billed charges,Implant Devices,1167.25,70,,1167.25,percent of total billed charges,Implant Devices,1133.9,34,,1133.9,percent of total billed charges,Implant Devices,1133.9,34,,1133.9,percent of total billed charges,Implant Devices,1167.25,35,,1167.25,percent of total billed charges,Implant Devices,1167.25,35,,1167.25,percent of total billed charges,Implant Devices,1167.25,35,,1167.25,percent of total billed charges,Implant Devices,1167.25,35,,1167.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1133.9,34,"If Charge > 2,000, then 34 percent",1133.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334,
J&J 02.118.536 SCREW 2.7X36MM,C1713,HCPCS,,79012206,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
J&J 02.211.054 LOCKING SCREW 2.7X54MM,C1713,HCPCS,,79012207,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
J&J 202.896 CORTEX SCREW 2.7X36MM,C1713,HCPCS,,79012208,CDM,278,RC,,,both,,,96,37.89,39.4668,,37.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,33.6,35,,33.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,38.4,40,,38.4,percent of total billed charges,Implant Devices,33.6,70,,33.6,percent of total billed charges,Implant Devices,32.64,34,,32.64,percent of total billed charges,Implant Devices,32.64,34,,32.64,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.4,
J&J 02.117.203 DIS HUMERUS PLT 2.7/3.5MM,C1713,HCPCS,,79012209,CDM,278,RC,,,both,,,3234,1276.36,39.4668,,1276.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1099.56,34,,1099.56,percent of total billed charges,Implant Device,1099.56,34,,1099.56,percent of total billed charges,Implant Device,1099.56,34,,1099.56,percent of total billed charges,Implant Device,1099.56,34,,1099.56,percent of total billed charges,Implant Device,1099.56,34,,1099.56,percent of total billed charges,Implant Device,1099.56,34,,1099.56,percent of total billed charges,Implant Device,1131.9,35,,1131.9,percent of total billed charges,Implant Device,1099.56,34,"Charges > $500, x 34%",1099.56,percent of total billed charges,Implant Device,1131.9,35,,1131.9,percent of total billed charges,Implant Devices,1131.9,35,,1131.9,percent of total billed charges,Implant Devices,1131.9,35,,,percent of total billed charges,Implant Devices,1131.9,35,,1131.9,percent of total billed charges,Implant Devices,1131.9,35,,1131.9,percent of total billed charges,Implant Devices,1293.6,40,,1293.6,percent of total billed charges,Implant Devices,1131.9,70,,1131.9,percent of total billed charges,Implant Devices,1099.56,34,,1099.56,percent of total billed charges,Implant Devices,1099.56,34,,1099.56,percent of total billed charges,Implant Devices,1131.9,35,,1131.9,percent of total billed charges,Implant Devices,1131.9,35,,1131.9,percent of total billed charges,Implant Devices,1131.9,35,,1131.9,percent of total billed charges,Implant Devices,1131.9,35,,1131.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1099.56,34,"If Charge > 2,000, then 34 percent",1099.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1293.6,
J&J 02.107.202 OLECRANON PLT 2.7/3.5MM,C1713,HCPCS,,79012210,CDM,278,RC,,,both,,,2826,1115.33,39.4668,,1115.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,960.84,34,,960.84,percent of total billed charges,Implant Device,989.1,35,,989.1,percent of total billed charges,Implant Device,960.84,34,"Charges > $500, x 34%",960.84,percent of total billed charges,Implant Device,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,1130.4,40,,1130.4,percent of total billed charges,Implant Devices,989.1,70,,989.1,percent of total billed charges,Implant Devices,960.84,34,,960.84,percent of total billed charges,Implant Devices,960.84,34,,960.84,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,989.1,35,,989.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,960.84,34,"If Charge > 2,000, then 34 percent",960.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1130.4,
J&J 02.118.550 SCREW 2.7X50MM,C1713,HCPCS,,79012211,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
J&J 02.118.560 SCREW 2.7X60MM,C1713,HCPCS,,79012212,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 02.211.028 LOCKING SCREW 2.7X10MM,C1713,HCPCS,,79012213,CDM,278,RC,,,both,,,357,140.9,39.4668,,140.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,121.38,34,,121.38,percent of total billed charges,Implant Device,124.95,35,,124.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,142.8,40,,142.8,percent of total billed charges,Implant Devices,124.95,70,,124.95,percent of total billed charges,Implant Devices,121.38,34,,121.38,percent of total billed charges,Implant Devices,121.38,34,,121.38,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,124.95,35,,124.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,142.8,
DJO 506-03-114 BONE SCREW 5.0X14MM,C1713,HCPCS,,79012217,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
J&J 02.112.614 CLAVICLE PLATE 2.7MM LT,C1713,HCPCS,,79012225,CDM,278,RC,,,both,,,3939,1554.6,39.4668,,1554.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1339.26,34,,1339.26,percent of total billed charges,Implant Device,1339.26,34,,1339.26,percent of total billed charges,Implant Device,1339.26,34,,1339.26,percent of total billed charges,Implant Device,1339.26,34,,1339.26,percent of total billed charges,Implant Device,1339.26,34,,1339.26,percent of total billed charges,Implant Device,1339.26,34,,1339.26,percent of total billed charges,Implant Device,1378.65,35,,1378.65,percent of total billed charges,Implant Device,1339.26,34,"Charges > $500, x 34%",1339.26,percent of total billed charges,Implant Device,1378.65,35,,1378.65,percent of total billed charges,Implant Devices,1378.65,35,,1378.65,percent of total billed charges,Implant Devices,1378.65,35,,,percent of total billed charges,Implant Devices,1378.65,35,,1378.65,percent of total billed charges,Implant Devices,1378.65,35,,1378.65,percent of total billed charges,Implant Devices,1575.6,40,,1575.6,percent of total billed charges,Implant Devices,1378.65,70,,1378.65,percent of total billed charges,Implant Devices,1339.26,34,,1339.26,percent of total billed charges,Implant Devices,1339.26,34,,1339.26,percent of total billed charges,Implant Devices,1378.65,35,,1378.65,percent of total billed charges,Implant Devices,1378.65,35,,1378.65,percent of total billed charges,Implant Devices,1378.65,35,,1378.65,percent of total billed charges,Implant Devices,1378.65,35,,1378.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1339.26,34,"If Charge > 2,000, then 34 percent",1339.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1575.6,
J&J 202.886 CORTEX SCREW 2.7X26MM,C1713,HCPCS,,79012226,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
J&J 202.888 CORTEX SCREW 2.7X28MM,C1713,HCPCS,,79012227,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
IN2BONES P80 ST221 CFX PLATE SMALL LEFT,C1713,HCPCS,,79012240,CDM,278,RC,,,both,,,7185,2835.69,39.4668,,2835.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2442.9,34,,2442.9,percent of total billed charges,Implant Device,2442.9,34,,2442.9,percent of total billed charges,Implant Device,2442.9,34,,2442.9,percent of total billed charges,Implant Device,2442.9,34,,2442.9,percent of total billed charges,Implant Device,2442.9,34,,2442.9,percent of total billed charges,Implant Device,2442.9,34,,2442.9,percent of total billed charges,Implant Device,2514.75,35,,2514.75,percent of total billed charges,Implant Device,2442.9,34,"Charges > $500, x 34%",2442.9,percent of total billed charges,Implant Device,2514.75,35,,2514.75,percent of total billed charges,Implant Devices,2514.75,35,,2514.75,percent of total billed charges,Implant Devices,2514.75,35,,,percent of total billed charges,Implant Devices,2514.75,35,,2514.75,percent of total billed charges,Implant Devices,2514.75,35,,2514.75,percent of total billed charges,Implant Devices,2874,40,,2874,percent of total billed charges,Implant Devices,2514.75,70,,2514.75,percent of total billed charges,Implant Devices,2442.9,34,,2442.9,percent of total billed charges,Implant Devices,2442.9,34,,2442.9,percent of total billed charges,Implant Devices,2514.75,35,,2514.75,percent of total billed charges,Implant Devices,2514.75,35,,2514.75,percent of total billed charges,Implant Devices,2514.75,35,,2514.75,percent of total billed charges,Implant Devices,2514.75,35,,2514.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2442.9,34,"If Charge > 2,000, then 34 percent",2442.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2874,
IN2BONES P73 ST020 CORTICAL SCREW 3.5X20,C1713,HCPCS,,79012241,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST130 LOCK SCREW 3.5X30MM,C1713,HCPCS,,79012242,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST124 LOCK SCREW 3.5X24MM,C1713,HCPCS,,79012243,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST134 LOCK SCREW 3.5X34MM,C1713,HCPCS,,79012244,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
IN2BONES P73 ST140 LOCK SCREW 3.5X40MM,C1713,HCPCS,,79012245,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ZIMMER 8145-01-085 HIP SCREW 85MM,C1713,HCPCS,,79012251,CDM,278,RC,,,both,,,734,289.69,39.4668,,289.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,249.56,34,,249.56,percent of total billed charges,Implant Device,256.9,35,,256.9,percent of total billed charges,Implant Device,249.56,34,"Charges > $500, x 34%",249.56,percent of total billed charges,Implant Device,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,293.6,40,,293.6,percent of total billed charges,Implant Devices,256.9,70,,256.9,percent of total billed charges,Implant Devices,249.56,34,,249.56,percent of total billed charges,Implant Devices,249.56,34,,249.56,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,256.9,35,,256.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,293.6,
J&J 42.231.224 OPTILINK SCREW 5.0X24MM,C1713,HCPCS,,79012254,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 42.231.285 OPTILINK SCREW 5.0X85MM,C1713,HCPCS,,79012255,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 02.124.417 CONDYLAR PLT 16H 4.5X336,C1713,HCPCS,,79012256,CDM,278,RC,,,both,,,5096,2011.23,39.4668,,2011.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1732.64,34,,1732.64,percent of total billed charges,Implant Device,1783.6,35,,1783.6,percent of total billed charges,Implant Device,1732.64,34,"Charges > $500, x 34%",1732.64,percent of total billed charges,Implant Device,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,2038.4,40,,2038.4,percent of total billed charges,Implant Devices,1783.6,70,,1783.6,percent of total billed charges,Implant Devices,1732.64,34,,1732.64,percent of total billed charges,Implant Devices,1732.64,34,,1732.64,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,1783.6,35,,1783.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1732.64,34,"If Charge > 2,000, then 34 percent",1732.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2038.4,
ZIMMER 11-302140 TROCHANTERIC BOLT 40MM,C1713,HCPCS,,79012261,CDM,278,RC,,,both,,,1812,715.14,39.4668,,715.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,616.08,34,,616.08,percent of total billed charges,Implant Device,616.08,34,,616.08,percent of total billed charges,Implant Device,616.08,34,,616.08,percent of total billed charges,Implant Device,616.08,34,,616.08,percent of total billed charges,Implant Device,616.08,34,,616.08,percent of total billed charges,Implant Device,616.08,34,,616.08,percent of total billed charges,Implant Device,634.2,35,,634.2,percent of total billed charges,Implant Device,616.08,34,"Charges > $500, x 34%",616.08,percent of total billed charges,Implant Device,634.2,35,,634.2,percent of total billed charges,Implant Devices,634.2,35,,634.2,percent of total billed charges,Implant Devices,634.2,35,,,percent of total billed charges,Implant Devices,634.2,35,,634.2,percent of total billed charges,Implant Devices,634.2,35,,634.2,percent of total billed charges,Implant Devices,724.8,40,,724.8,percent of total billed charges,Implant Devices,634.2,70,,634.2,percent of total billed charges,Implant Devices,616.08,34,,616.08,percent of total billed charges,Implant Devices,616.08,34,,616.08,percent of total billed charges,Implant Devices,634.2,35,,634.2,percent of total billed charges,Implant Devices,634.2,35,,634.2,percent of total billed charges,Implant Devices,634.2,35,,634.2,percent of total billed charges,Implant Devices,634.2,35,,634.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,724.8,
STRYKER 2361-5055S LOCKING SCREW 5X55MM,C1713,HCPCS,,79012266,CDM,278,RC,,,both,,,887,350.07,39.4668,,350.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Device,301.58,34,"Charges > $500, x 34%",301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,354.8,40,,354.8,percent of total billed charges,Implant Devices,310.45,70,,310.45,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.8,
J&J 42.231.250 LOCKING SCREW 5.0X50MM,C1713,HCPCS,,79012267,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 02.112.620 LCP CLAVICLE PLT 2.7MM,C1713,HCPCS,,79012269,CDM,278,RC,,,both,,,3218,1270.04,39.4668,,1270.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1094.12,34,,1094.12,percent of total billed charges,Implant Device,1126.3,35,,1126.3,percent of total billed charges,Implant Device,1094.12,34,"Charges > $500, x 34%",1094.12,percent of total billed charges,Implant Device,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1287.2,40,,1287.2,percent of total billed charges,Implant Devices,1126.3,70,,1126.3,percent of total billed charges,Implant Devices,1094.12,34,,1094.12,percent of total billed charges,Implant Devices,1094.12,34,,1094.12,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,1126.3,35,,1126.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1094.12,34,"If Charge > 2,000, then 34 percent",1094.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1287.2,
IN2BONES P73 ST022 CORT SCREW 3.5X22MM,C1713,HCPCS,,79012270,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
STRYKER 658360 COMPRESSION SCREW 7X60MM,C1713,HCPCS,,79012284,CDM,278,RC,,,both,,,2471,975.22,39.4668,,975.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,840.14,34,,840.14,percent of total billed charges,Implant Device,864.85,35,,864.85,percent of total billed charges,Implant Device,840.14,34,"Charges > $500, x 34%",840.14,percent of total billed charges,Implant Device,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,988.4,40,,988.4,percent of total billed charges,Implant Devices,864.85,70,,864.85,percent of total billed charges,Implant Devices,840.14,34,,840.14,percent of total billed charges,Implant Devices,840.14,34,,840.14,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,864.85,35,,864.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,840.14,34,"If Charge > 2,000, then 34 percent",840.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,988.4,
ZIMMER 8145-01-080 HIP SCREW 80MM,C1713,HCPCS,,79012291,CDM,278,RC,,,both,,,846,333.89,39.4668,,333.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Device,287.64,34,"Charges > $500, x 34%",287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,338.4,40,,338.4,percent of total billed charges,Implant Devices,296.1,70,,296.1,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,338.4,
J&J 02.210.124 LOCKING SCREW 2.4X24MM,C1713,HCPCS,,79012296,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
IN2BONES S27 ST014 SNAP OFF SCREW 2.7X14,C1713,HCPCS,,79012299,CDM,278,RC,,,both,,,1275,503.2,39.4668,,503.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Device,433.5,34,"Charges > $500, x 34%",433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,510,40,,510,percent of total billed charges,Implant Devices,446.25,70,,446.25,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510,
J&J SD900-500S TRUMATCH GRAFT CAGE,C1713,HCPCS,,79012344,CDM,278,RC,,,both,,,42750,16872.06,39.4668,,16872.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14535,34,,14535,percent of total billed charges,Implant Device,14535,34,,14535,percent of total billed charges,Implant Device,14535,34,,14535,percent of total billed charges,Implant Device,14535,34,,14535,percent of total billed charges,Implant Device,14535,34,,14535,percent of total billed charges,Implant Device,14535,34,,14535,percent of total billed charges,Implant Device,14962.5,35,,14962.5,percent of total billed charges,Implant Device,14535,34,"Charges > $500, x 34%",14535,percent of total billed charges,Implant Device,14962.5,35,,14962.5,percent of total billed charges,Implant Devices,14962.5,35,,14962.5,percent of total billed charges,Implant Devices,14962.5,35,,,percent of total billed charges,Implant Devices,14962.5,35,,14962.5,percent of total billed charges,Implant Devices,14962.5,35,,14962.5,percent of total billed charges,Implant Devices,17100,40,,17100,percent of total billed charges,Implant Devices,14962.5,70,,14962.5,percent of total billed charges,Implant Devices,14535,34,,14535,percent of total billed charges,Implant Devices,14535,34,,14535,percent of total billed charges,Implant Devices,14962.5,35,,14962.5,percent of total billed charges,Implant Devices,14962.5,35,,14962.5,percent of total billed charges,Implant Devices,14962.5,35,,14962.5,percent of total billed charges,Implant Devices,14962.5,35,,14962.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,14535,34,"If Charge > 2,000, then 34 percent",14535,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,17100,
ZIMMER 8145-50-054 CORT BONE SCREW 5X54,C1713,HCPCS,,79012349,CDM,278,RC,,,both,,,594,234.43,39.4668,,234.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Device,201.96,34,"Charges > $500, x 34%",201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,237.6,40,,237.6,percent of total billed charges,Implant Devices,207.9,70,,207.9,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,237.6,
J&J 412.215S LOCKING SCREW 5X42MM,C1713,HCPCS,,79012352,CDM,278,RC,,,both,,,505,199.31,39.4668,,199.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Device,171.7,34,"Charges > $500, x 34%",171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,202,40,,202,percent of total billed charges,Implant Devices,176.75,70,,176.75,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,202,
J&J 04.268.000S FEMORAL NECK SYS PLT,C1713,HCPCS,,79012353,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 04.168.290S BOLT FOR FEM NECK 90MM,C1713,HCPCS,,79012354,CDM,278,RC,,,both,,,633,249.82,39.4668,,249.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,221.55,35,,221.55,percent of total billed charges,Implant Device,215.22,34,"Charges > $500, x 34%",215.22,percent of total billed charges,Implant Device,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,253.2,40,,253.2,percent of total billed charges,Implant Devices,221.55,70,,221.55,percent of total billed charges,Implant Devices,215.22,34,,215.22,percent of total billed charges,Implant Devices,215.22,34,,215.22,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.2,
J&J 04.168.490S ANTIROTATION SCREW 90,C1713,HCPCS,,79012355,CDM,278,RC,,,both,,,182,71.83,39.4668,,71.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.88,34,,61.88,percent of total billed charges,Implant Device,61.88,34,,61.88,percent of total billed charges,Implant Device,61.88,34,,61.88,percent of total billed charges,Implant Device,61.88,34,,61.88,percent of total billed charges,Implant Device,61.88,34,,61.88,percent of total billed charges,Implant Device,61.88,34,,61.88,percent of total billed charges,Implant Device,63.7,35,,63.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63.7,35,,63.7,percent of total billed charges,Implant Devices,63.7,35,,63.7,percent of total billed charges,Implant Devices,63.7,35,,,percent of total billed charges,Implant Devices,63.7,35,,63.7,percent of total billed charges,Implant Devices,63.7,35,,63.7,percent of total billed charges,Implant Devices,72.8,40,,72.8,percent of total billed charges,Implant Devices,63.7,70,,63.7,percent of total billed charges,Implant Devices,61.88,34,,61.88,percent of total billed charges,Implant Devices,61.88,34,,61.88,percent of total billed charges,Implant Devices,63.7,35,,63.7,percent of total billed charges,Implant Devices,63.7,35,,63.7,percent of total billed charges,Implant Devices,63.7,35,,63.7,percent of total billed charges,Implant Devices,63.7,35,,63.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72.8,
ZIMMER 8145-50-050 CORT BONE SCREW 5X50,C1713,HCPCS,,79012356,CDM,278,RC,,,both,,,594,234.43,39.4668,,234.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Device,201.96,34,"Charges > $500, x 34%",201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,237.6,40,,237.6,percent of total billed charges,Implant Devices,207.9,70,,207.9,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,237.6,
STRYKER 57-10340 T-PLATE 6 HOLE 1.7MM,C1713,HCPCS,,79012357,CDM,278,RC,,,both,,,927,365.86,39.4668,,365.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,315.18,34,,315.18,percent of total billed charges,Implant Device,324.45,35,,324.45,percent of total billed charges,Implant Device,315.18,34,"Charges > $500, x 34%",315.18,percent of total billed charges,Implant Device,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,370.8,40,,370.8,percent of total billed charges,Implant Devices,324.45,70,,324.45,percent of total billed charges,Implant Devices,315.18,34,,315.18,percent of total billed charges,Implant Devices,315.18,34,,315.18,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,324.45,35,,324.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,370.8,
STRYKER 662509 LOCKING SCREW 1.7X9MM,C1713,HCPCS,,79012358,CDM,278,RC,,,both,,,413,163,39.4668,,163,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,144.55,35,,144.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,165.2,40,,165.2,percent of total billed charges,Implant Devices,144.55,70,,144.55,percent of total billed charges,Implant Devices,140.42,34,,140.42,percent of total billed charges,Implant Devices,140.42,34,,140.42,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
STRYKER 662510 LOCKING SCREW 1.7X10MM,C1713,HCPCS,,79012359,CDM,278,RC,,,both,,,413,163,39.4668,,163,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,144.55,35,,144.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,165.2,40,,165.2,percent of total billed charges,Implant Devices,144.55,70,,144.55,percent of total billed charges,Implant Devices,140.42,34,,140.42,percent of total billed charges,Implant Devices,140.42,34,,140.42,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
STRYKER 662607 BONE SCREW 1.7X7MM,C1713,HCPCS,,79012360,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER 662609 BONE SCREW 1.7X9MM,C1713,HCPCS,,79012361,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER 662610 BONE SCREW 1.7X10MM,C1713,HCPCS,,79012362,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
J&J 412.214S LOCKING SCREW 5.0X40MM,C1713,HCPCS,,79012363,CDM,278,RC,,,both,,,505,199.31,39.4668,,199.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Device,171.7,34,"Charges > $500, x 34%",171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,202,40,,202,percent of total billed charges,Implant Devices,176.75,70,,176.75,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,202,
STRYKER 629272S DIS POSTERIOR LAT PLT 12,C1713,HCPCS,,79012370,CDM,278,RC,,,both,,,3892,1536.05,39.4668,,1536.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1362.2,35,,1362.2,percent of total billed charges,Implant Device,1323.28,34,"Charges > $500, x 34%",1323.28,percent of total billed charges,Implant Device,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1556.8,40,,1556.8,percent of total billed charges,Implant Devices,1362.2,70,,1362.2,percent of total billed charges,Implant Devices,1323.28,34,,1323.28,percent of total billed charges,Implant Devices,1323.28,34,,1323.28,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1323.28,34,"If Charge > 2,000, then 34 percent",1323.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1556.8,
IN2BONES P67 ST442 COLAG SCREW 4X42.5MM,C1713,HCPCS,,79012372,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
J&J 04.015.535S LOCKING SCREW 5X45MM,C1713,HCPCS,,79012388,CDM,278,RC,,,both,,,454,179.18,39.4668,,179.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,181.6,40,,181.6,percent of total billed charges,Implant Devices,158.9,70,,158.9,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.6,
J&J 04.005.422S LOCKING SCREW 4X32MM,C1713,HCPCS,,79012389,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
WRIGHT FFNS1212 STAPLE NITINOL 12X12MM,C1713,HCPCS,,79012394,CDM,278,RC,,,both,,,8109,3200.36,39.4668,,3200.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2757.06,34,,2757.06,percent of total billed charges,Implant Device,2757.06,34,,2757.06,percent of total billed charges,Implant Device,2757.06,34,,2757.06,percent of total billed charges,Implant Device,2757.06,34,,2757.06,percent of total billed charges,Implant Device,2757.06,34,,2757.06,percent of total billed charges,Implant Device,2757.06,34,,2757.06,percent of total billed charges,Implant Device,2838.15,35,,2838.15,percent of total billed charges,Implant Device,2757.06,34,"Charges > $500, x 34%",2757.06,percent of total billed charges,Implant Device,2838.15,35,,2838.15,percent of total billed charges,Implant Devices,2838.15,35,,2838.15,percent of total billed charges,Implant Devices,2838.15,35,,,percent of total billed charges,Implant Devices,2838.15,35,,2838.15,percent of total billed charges,Implant Devices,2838.15,35,,2838.15,percent of total billed charges,Implant Devices,3243.6,40,,3243.6,percent of total billed charges,Implant Devices,2838.15,70,,2838.15,percent of total billed charges,Implant Devices,2757.06,34,,2757.06,percent of total billed charges,Implant Devices,2757.06,34,,2757.06,percent of total billed charges,Implant Devices,2838.15,35,,2838.15,percent of total billed charges,Implant Devices,2838.15,35,,2838.15,percent of total billed charges,Implant Devices,2838.15,35,,2838.15,percent of total billed charges,Implant Devices,2838.15,35,,2838.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2757.06,34,"If Charge > 2,000, then 34 percent",2757.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3243.6,
J&J 249.919 T-PLATE 2.4X66MM 13 HOLE,C1713,HCPCS,,79012403,CDM,278,RC,,,both,,,642,253.38,39.4668,,253.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,218.28,34,,218.28,percent of total billed charges,Implant Device,218.28,34,,218.28,percent of total billed charges,Implant Device,218.28,34,,218.28,percent of total billed charges,Implant Device,218.28,34,,218.28,percent of total billed charges,Implant Device,218.28,34,,218.28,percent of total billed charges,Implant Device,218.28,34,,218.28,percent of total billed charges,Implant Device,224.7,35,,224.7,percent of total billed charges,Implant Device,218.28,34,"Charges > $500, x 34%",218.28,percent of total billed charges,Implant Device,224.7,35,,224.7,percent of total billed charges,Implant Devices,224.7,35,,224.7,percent of total billed charges,Implant Devices,224.7,35,,,percent of total billed charges,Implant Devices,224.7,35,,224.7,percent of total billed charges,Implant Devices,224.7,35,,224.7,percent of total billed charges,Implant Devices,256.8,40,,256.8,percent of total billed charges,Implant Devices,224.7,70,,224.7,percent of total billed charges,Implant Devices,218.28,34,,218.28,percent of total billed charges,Implant Devices,218.28,34,,218.28,percent of total billed charges,Implant Devices,224.7,35,,224.7,percent of total billed charges,Implant Devices,224.7,35,,224.7,percent of total billed charges,Implant Devices,224.7,35,,224.7,percent of total billed charges,Implant Devices,224.7,35,,224.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,256.8,
J&J 201.776 CORTEX SCREW 2.4X26MM,C1713,HCPCS,,79012404,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 201.788 CORTEX SCREW 2.4X38MM,C1713,HCPCS,,79012405,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 201.784 CORTEX SCREW 2.4X34MM,C1713,HCPCS,,79012406,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 247.372 PLATE 2.7X76MM 8 HOLE,C1713,HCPCS,,79012407,CDM,278,RC,,,both,,,1057,417.16,39.4668,,417.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,369.95,35,,369.95,percent of total billed charges,Implant Device,359.38,34,"Charges > $500, x 34%",359.38,percent of total billed charges,Implant Device,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,422.8,40,,422.8,percent of total billed charges,Implant Devices,369.95,70,,369.95,percent of total billed charges,Implant Devices,359.38,34,,359.38,percent of total billed charges,Implant Devices,359.38,34,,359.38,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,422.8,
J&J 249.615 LCP PLATE 2.4MM 7 HOLE,C1713,HCPCS,,79012409,CDM,278,RC,,,both,,,1840,726.19,39.4668,,726.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,625.6,34,,625.6,percent of total billed charges,Implant Device,625.6,34,,625.6,percent of total billed charges,Implant Device,625.6,34,,625.6,percent of total billed charges,Implant Device,625.6,34,,625.6,percent of total billed charges,Implant Device,625.6,34,,625.6,percent of total billed charges,Implant Device,625.6,34,,625.6,percent of total billed charges,Implant Device,644,35,,644,percent of total billed charges,Implant Device,625.6,34,"Charges > $500, x 34%",625.6,percent of total billed charges,Implant Device,644,35,,644,percent of total billed charges,Implant Devices,644,35,,644,percent of total billed charges,Implant Devices,644,35,,,percent of total billed charges,Implant Devices,644,35,,644,percent of total billed charges,Implant Devices,644,35,,644,percent of total billed charges,Implant Devices,736,40,,736,percent of total billed charges,Implant Devices,644,70,,644,percent of total billed charges,Implant Devices,625.6,34,,625.6,percent of total billed charges,Implant Devices,625.6,34,,625.6,percent of total billed charges,Implant Devices,644,35,,644,percent of total billed charges,Implant Devices,644,35,,644,percent of total billed charges,Implant Devices,644,35,,644,percent of total billed charges,Implant Devices,644,35,,644,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,736,
J&J 201.790 CORTEX SCREW 2.4X40MM,C1713,HCPCS,,79012410,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 201.778 CORTEX SCREW 2.4X28MM,C1713,HCPCS,,79012411,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 224.591 LCP PLATE 4.5X170MM 9 HOLE,C1713,HCPCS,,79012412,CDM,278,RC,,,both,,,1282,505.96,39.4668,,505.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,435.88,34,,435.88,percent of total billed charges,Implant Device,435.88,34,,435.88,percent of total billed charges,Implant Device,435.88,34,,435.88,percent of total billed charges,Implant Device,435.88,34,,435.88,percent of total billed charges,Implant Device,435.88,34,,435.88,percent of total billed charges,Implant Device,435.88,34,,435.88,percent of total billed charges,Implant Device,448.7,35,,448.7,percent of total billed charges,Implant Device,435.88,34,"Charges > $500, x 34%",435.88,percent of total billed charges,Implant Device,448.7,35,,448.7,percent of total billed charges,Implant Devices,448.7,35,,448.7,percent of total billed charges,Implant Devices,448.7,35,,,percent of total billed charges,Implant Devices,448.7,35,,448.7,percent of total billed charges,Implant Devices,448.7,35,,448.7,percent of total billed charges,Implant Devices,512.8,40,,512.8,percent of total billed charges,Implant Devices,448.7,70,,448.7,percent of total billed charges,Implant Devices,435.88,34,,435.88,percent of total billed charges,Implant Devices,435.88,34,,435.88,percent of total billed charges,Implant Devices,448.7,35,,448.7,percent of total billed charges,Implant Devices,448.7,35,,448.7,percent of total billed charges,Implant Devices,448.7,35,,448.7,percent of total billed charges,Implant Devices,448.7,35,,448.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,512.8,
J&J 214.822 CORTEX SCREW 4.5X22MM,C1713,HCPCS,,79012413,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
STRYKER 656411 BONE SCREW 2.7X11MM,C1713,HCPCS,,79012415,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
J&J 02.124.418 CONDYLAR PLT 4.5X370 18H,C1713,HCPCS,,79012420,CDM,278,RC,,,both,,,5428,2142.26,39.4668,,2142.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1899.8,35,,1899.8,percent of total billed charges,Implant Device,1845.52,34,"Charges > $500, x 34%",1845.52,percent of total billed charges,Implant Device,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,2171.2,40,,2171.2,percent of total billed charges,Implant Devices,1899.8,70,,1899.8,percent of total billed charges,Implant Devices,1845.52,34,,1845.52,percent of total billed charges,Implant Devices,1845.52,34,,1845.52,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1845.52,34,"If Charge > 2,000, then 34 percent",1845.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2171.2,
J&J 214.848 CORTEX SCREW 4.5X48MM,C1713,HCPCS,,79012421,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
J&J 42.231.290 LOCKING SCREW 5.0X90MM,C1713,HCPCS,,79012422,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 04.005.432S LOCKING SCREW 4.0X42MM,C1713,HCPCS,,79012426,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
J&J 04.005.438S LOCKING SCREW 4.0X48MM,C1713,HCPCS,,79012427,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
J&J 04.005.426S LOCKING SCREW 4.0X36MM,C1713,HCPCS,,79012428,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
WRIGHT 58882010 HOOK PLATE SMALL,C1713,HCPCS,,79012430,CDM,278,RC,,,both,,,5835,2302.89,39.4668,,2302.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1983.9,34,,1983.9,percent of total billed charges,Implant Device,1983.9,34,,1983.9,percent of total billed charges,Implant Device,1983.9,34,,1983.9,percent of total billed charges,Implant Device,1983.9,34,,1983.9,percent of total billed charges,Implant Device,1983.9,34,,1983.9,percent of total billed charges,Implant Device,1983.9,34,,1983.9,percent of total billed charges,Implant Device,2042.25,35,,2042.25,percent of total billed charges,Implant Device,1983.9,34,"Charges > $500, x 34%",1983.9,percent of total billed charges,Implant Device,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2334,40,,2334,percent of total billed charges,Implant Devices,2042.25,70,,2042.25,percent of total billed charges,Implant Devices,1983.9,34,,1983.9,percent of total billed charges,Implant Devices,1983.9,34,,1983.9,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1983.9,34,"If Charge > 2,000, then 34 percent",1983.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2334,
WRIGHT 58882030 HOOK PLATE LARGE,C1713,HCPCS,,79012431,CDM,278,RC,,,both,,,5835,2302.89,39.4668,,2302.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1983.9,34,,1983.9,percent of total billed charges,Implant Device,1983.9,34,,1983.9,percent of total billed charges,Implant Device,1983.9,34,,1983.9,percent of total billed charges,Implant Device,1983.9,34,,1983.9,percent of total billed charges,Implant Device,1983.9,34,,1983.9,percent of total billed charges,Implant Device,1983.9,34,,1983.9,percent of total billed charges,Implant Device,2042.25,35,,2042.25,percent of total billed charges,Implant Device,1983.9,34,"Charges > $500, x 34%",1983.9,percent of total billed charges,Implant Device,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2334,40,,2334,percent of total billed charges,Implant Devices,2042.25,70,,2042.25,percent of total billed charges,Implant Devices,1983.9,34,,1983.9,percent of total billed charges,Implant Devices,1983.9,34,,1983.9,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,2042.25,35,,2042.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1983.9,34,"If Charge > 2,000, then 34 percent",1983.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2334,
WRIGHT 58803516 LOCKING SCREW 3.5X16MM,C1713,HCPCS,,79012432,CDM,278,RC,,,both,,,1145,451.89,39.4668,,451.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Device,389.3,34,"Charges > $500, x 34%",389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,458,40,,458,percent of total billed charges,Implant Devices,400.75,70,,400.75,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,458,
WRIGHT 5881003540 WASHER FOR 3.5/4 SCREW,C1713,HCPCS,,79012433,CDM,278,RC,,,both,,,122,48.15,39.4668,,48.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,41.48,34,,41.48,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,48.8,40,,48.8,percent of total billed charges,Implant Devices,42.7,70,,42.7,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,41.48,34,,41.48,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,42.7,35,,42.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.8,
WRIGHT 58813520 CORTICAL SCREW 3.5X20MM,C1713,HCPCS,,79012434,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 604634 CANNULATED SCREW 4.0X34MM,C1713,HCPCS,,79012435,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 629308 DISTAL MEDIAL PLT LT 8H,C1713,HCPCS,,79012447,CDM,278,RC,,,both,,,3892,1536.05,39.4668,,1536.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1323.28,34,,1323.28,percent of total billed charges,Implant Device,1362.2,35,,1362.2,percent of total billed charges,Implant Device,1323.28,34,"Charges > $500, x 34%",1323.28,percent of total billed charges,Implant Device,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1556.8,40,,1556.8,percent of total billed charges,Implant Devices,1362.2,70,,1362.2,percent of total billed charges,Implant Devices,1323.28,34,,1323.28,percent of total billed charges,Implant Devices,1323.28,34,,1323.28,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,1362.2,35,,1362.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1323.28,34,"If Charge > 2,000, then 34 percent",1323.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1556.8,
J&J 294.56 SCHANZ SCREW 5.0MM,C1713,HCPCS,,79012450,CDM,278,RC,,,both,,,183,72.22,39.4668,,72.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,62.22,34,,62.22,percent of total billed charges,Implant Device,62.22,34,,62.22,percent of total billed charges,Implant Device,62.22,34,,62.22,percent of total billed charges,Implant Device,62.22,34,,62.22,percent of total billed charges,Implant Device,62.22,34,,62.22,percent of total billed charges,Implant Device,62.22,34,,62.22,percent of total billed charges,Implant Device,64.05,35,,64.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,64.05,35,,64.05,percent of total billed charges,Implant Devices,64.05,35,,64.05,percent of total billed charges,Implant Devices,64.05,35,,,percent of total billed charges,Implant Devices,64.05,35,,64.05,percent of total billed charges,Implant Devices,64.05,35,,64.05,percent of total billed charges,Implant Devices,73.2,40,,73.2,percent of total billed charges,Implant Devices,64.05,70,,64.05,percent of total billed charges,Implant Devices,62.22,34,,62.22,percent of total billed charges,Implant Devices,62.22,34,,62.22,percent of total billed charges,Implant Devices,64.05,35,,64.05,percent of total billed charges,Implant Devices,64.05,35,,64.05,percent of total billed charges,Implant Devices,64.05,35,,64.05,percent of total billed charges,Implant Devices,64.05,35,,64.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,73.2,
J&J 294.950 TRANSFIXATION PIN 6X225MM,C1713,HCPCS,,79012451,CDM,278,RC,,,both,,,241,95.11,39.4668,,95.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,81.94,34,,81.94,percent of total billed charges,Implant Device,84.35,35,,84.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,96.4,40,,96.4,percent of total billed charges,Implant Devices,84.35,70,,84.35,percent of total billed charges,Implant Devices,81.94,34,,81.94,percent of total billed charges,Implant Devices,81.94,34,,81.94,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,84.35,35,,84.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96.4,
J&J 02.123.024 LCP PERI HUMERUS PLT 3.5,C1713,HCPCS,,79012456,CDM,278,RC,,,both,,,4266,1683.65,39.4668,,1683.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1493.1,35,,1493.1,percent of total billed charges,Implant Device,1450.44,34,"Charges > $500, x 34%",1450.44,percent of total billed charges,Implant Device,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1706.4,40,,1706.4,percent of total billed charges,Implant Devices,1493.1,70,,1493.1,percent of total billed charges,Implant Devices,1450.44,34,,1450.44,percent of total billed charges,Implant Devices,1450.44,34,,1450.44,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1450.44,34,"If Charge > 2,000, then 34 percent",1450.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1706.4,
J&J 02.127.144 LOCKING SCREW 3.5X44MM,C1713,HCPCS,,79012457,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.127.142 LOCKING SCREW 3.5X42MM,C1713,HCPCS,,79012458,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.127.146 LOCKING SCREW 3.5X46MM,C1713,HCPCS,,79012459,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.127.148 LOCKING SCREW 3.5X48MM,C1713,HCPCS,,79012460,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.127.261 PROXIMAL TIBIA PLT 3.5MM,C1713,HCPCS,,79012462,CDM,278,RC,,,both,,,5708,2252.76,39.4668,,2252.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1940.72,34,,1940.72,percent of total billed charges,Implant Device,1940.72,34,,1940.72,percent of total billed charges,Implant Device,1940.72,34,,1940.72,percent of total billed charges,Implant Device,1940.72,34,,1940.72,percent of total billed charges,Implant Device,1940.72,34,,1940.72,percent of total billed charges,Implant Device,1940.72,34,,1940.72,percent of total billed charges,Implant Device,1997.8,35,,1997.8,percent of total billed charges,Implant Device,1940.72,34,"Charges > $500, x 34%",1940.72,percent of total billed charges,Implant Device,1997.8,35,,1997.8,percent of total billed charges,Implant Devices,1997.8,35,,1997.8,percent of total billed charges,Implant Devices,1997.8,35,,,percent of total billed charges,Implant Devices,1997.8,35,,1997.8,percent of total billed charges,Implant Devices,1997.8,35,,1997.8,percent of total billed charges,Implant Devices,2283.2,40,,2283.2,percent of total billed charges,Implant Devices,1997.8,70,,1997.8,percent of total billed charges,Implant Devices,1940.72,34,,1940.72,percent of total billed charges,Implant Devices,1940.72,34,,1940.72,percent of total billed charges,Implant Devices,1997.8,35,,1997.8,percent of total billed charges,Implant Devices,1997.8,35,,1997.8,percent of total billed charges,Implant Devices,1997.8,35,,1997.8,percent of total billed charges,Implant Devices,1997.8,35,,1997.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1940.72,34,"If Charge > 2,000, then 34 percent",1940.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2283.2,
ZIMMER 141236 TIBIAL PLATE 83MM,C1713,HCPCS,,79012465,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
DJO 506-03-118 BONE SCREW 5.0X18MM,C1713,HCPCS,,79012467,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
DJO 415-00-100 CEMENT RESTRICTOR 10MM,C1713,HCPCS,,79012471,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
J&J 412.213S LOCKING SCREW 5.0X38MM,C1713,HCPCS,,79012472,CDM,278,RC,,,both,,,505,199.31,39.4668,,199.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Device,171.7,34,"Charges > $500, x 34%",171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,202,40,,202,percent of total billed charges,Implant Devices,176.75,70,,176.75,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,202,
J&J 04.168.295S BOLT FOR FEM NECK 95MM,C1713,HCPCS,,79012473,CDM,278,RC,,,both,,,633,249.82,39.4668,,249.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,221.55,35,,221.55,percent of total billed charges,Implant Device,215.22,34,"Charges > $500, x 34%",215.22,percent of total billed charges,Implant Device,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,253.2,40,,253.2,percent of total billed charges,Implant Devices,221.55,70,,221.55,percent of total billed charges,Implant Devices,215.22,34,,215.22,percent of total billed charges,Implant Devices,215.22,34,,215.22,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.2,
J&J 04.168.495S SCREW FOR FEM NECK 95MM,C1713,HCPCS,,79012474,CDM,278,RC,,,both,,,633,249.82,39.4668,,249.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,221.55,35,,221.55,percent of total billed charges,Implant Device,215.22,34,"Charges > $500, x 34%",215.22,percent of total billed charges,Implant Device,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,253.2,40,,253.2,percent of total billed charges,Implant Devices,221.55,70,,221.55,percent of total billed charges,Implant Devices,215.22,34,,215.22,percent of total billed charges,Implant Devices,215.22,34,,215.22,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.2,
ZIMMER 42-5400-000-29 PATELLA 29X8MM,C1713,HCPCS,,79012475,CDM,278,RC,,,both,,,1539,607.39,39.4668,,607.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,538.65,35,,538.65,percent of total billed charges,Implant Device,523.26,34,"Charges > $500, x 34%",523.26,percent of total billed charges,Implant Device,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,615.6,40,,615.6,percent of total billed charges,Implant Devices,538.65,70,,538.65,percent of total billed charges,Implant Devices,523.26,34,,523.26,percent of total billed charges,Implant Devices,523.26,34,,523.26,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,615.6,
STRYKER EZ15-15-15 FIXATION DEV 15X15X15,C1713,HCPCS,,79012493,CDM,278,RC,,,both,,,2888,1139.8,39.4668,,1139.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,981.92,34,,981.92,percent of total billed charges,Implant Device,981.92,34,,981.92,percent of total billed charges,Implant Device,981.92,34,,981.92,percent of total billed charges,Implant Device,981.92,34,,981.92,percent of total billed charges,Implant Device,981.92,34,,981.92,percent of total billed charges,Implant Device,981.92,34,,981.92,percent of total billed charges,Implant Device,1010.8,35,,1010.8,percent of total billed charges,Implant Device,981.92,34,"Charges > $500, x 34%",981.92,percent of total billed charges,Implant Device,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1155.2,40,,1155.2,percent of total billed charges,Implant Devices,1010.8,70,,1010.8,percent of total billed charges,Implant Devices,981.92,34,,981.92,percent of total billed charges,Implant Devices,981.92,34,,981.92,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,981.92,34,"If Charge > 2,000, then 34 percent",981.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1155.2,
WRIGHT 45110002 SNAP OFF SCREW 2.0X12MM,C1713,HCPCS,,79012501,CDM,278,RC,,,both,,,1069,421.9,39.4668,,421.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,363.46,34,,363.46,percent of total billed charges,Implant Device,363.46,34,,363.46,percent of total billed charges,Implant Device,363.46,34,,363.46,percent of total billed charges,Implant Device,363.46,34,,363.46,percent of total billed charges,Implant Device,363.46,34,,363.46,percent of total billed charges,Implant Device,363.46,34,,363.46,percent of total billed charges,Implant Device,374.15,35,,374.15,percent of total billed charges,Implant Device,363.46,34,"Charges > $500, x 34%",363.46,percent of total billed charges,Implant Device,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,427.6,40,,427.6,percent of total billed charges,Implant Devices,374.15,70,,374.15,percent of total billed charges,Implant Devices,363.46,34,,363.46,percent of total billed charges,Implant Devices,363.46,34,,363.46,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,427.6,
WRIGHT 45112013 SNAP OFF SCREW 2.0X13MM,C1713,HCPCS,,79012502,CDM,278,RC,,,both,,,1069,421.9,39.4668,,421.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,363.46,34,,363.46,percent of total billed charges,Implant Device,363.46,34,,363.46,percent of total billed charges,Implant Device,363.46,34,,363.46,percent of total billed charges,Implant Device,363.46,34,,363.46,percent of total billed charges,Implant Device,363.46,34,,363.46,percent of total billed charges,Implant Device,363.46,34,,363.46,percent of total billed charges,Implant Device,374.15,35,,374.15,percent of total billed charges,Implant Device,363.46,34,"Charges > $500, x 34%",363.46,percent of total billed charges,Implant Device,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,427.6,40,,427.6,percent of total billed charges,Implant Devices,374.15,70,,374.15,percent of total billed charges,Implant Devices,363.46,34,,363.46,percent of total billed charges,Implant Devices,363.46,34,,363.46,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,374.15,35,,374.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,427.6,
STRYKER EZ15-12-12 FIXATION DEV 15X12X12,C1713,HCPCS,,79012503,CDM,278,RC,,,both,,,2888,1139.8,39.4668,,1139.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,981.92,34,,981.92,percent of total billed charges,Implant Device,981.92,34,,981.92,percent of total billed charges,Implant Device,981.92,34,,981.92,percent of total billed charges,Implant Device,981.92,34,,981.92,percent of total billed charges,Implant Device,981.92,34,,981.92,percent of total billed charges,Implant Device,981.92,34,,981.92,percent of total billed charges,Implant Device,1010.8,35,,1010.8,percent of total billed charges,Implant Device,981.92,34,"Charges > $500, x 34%",981.92,percent of total billed charges,Implant Device,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1155.2,40,,1155.2,percent of total billed charges,Implant Devices,1010.8,70,,1010.8,percent of total billed charges,Implant Devices,981.92,34,,981.92,percent of total billed charges,Implant Devices,981.92,34,,981.92,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,1010.8,35,,1010.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,981.92,34,"If Charge > 2,000, then 34 percent",981.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1155.2,
STRYKER IC4030 HEADED SCREW 4.0X30MM,C1713,HCPCS,,79012504,CDM,278,RC,,,both,,,961,379.28,39.4668,,379.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,336.35,35,,336.35,percent of total billed charges,Implant Device,326.74,34,"Charges > $500, x 34%",326.74,percent of total billed charges,Implant Device,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,384.4,40,,384.4,percent of total billed charges,Implant Devices,336.35,70,,336.35,percent of total billed charges,Implant Devices,326.74,34,,326.74,percent of total billed charges,Implant Devices,326.74,34,,326.74,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384.4,
ZIMMER 8145-50-060 CORTICAL SCREW 5X60MM,C1713,HCPCS,,79012507,CDM,278,RC,,,both,,,594,234.43,39.4668,,234.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Device,201.96,34,"Charges > $500, x 34%",201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,237.6,40,,237.6,percent of total billed charges,Implant Devices,207.9,70,,207.9,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,237.6,
ZIMMER 8145-10-085 LAG SCREW 105X85MM,C1713,HCPCS,,79012508,CDM,278,RC,,,both,,,1786,704.88,39.4668,,704.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,607.24,34,,607.24,percent of total billed charges,Implant Device,625.1,35,,625.1,percent of total billed charges,Implant Device,607.24,34,"Charges > $500, x 34%",607.24,percent of total billed charges,Implant Device,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,714.4,40,,714.4,percent of total billed charges,Implant Devices,625.1,70,,625.1,percent of total billed charges,Implant Devices,607.24,34,,607.24,percent of total billed charges,Implant Devices,607.24,34,,607.24,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,625.1,35,,625.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,714.4,
ZIMMER 8145-01-075 SCRW ANTI-ROTATION 75,C1713,HCPCS,,79012509,CDM,278,RC,,,both,,,846,333.89,39.4668,,333.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Device,287.64,34,"Charges > $500, x 34%",287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,338.4,40,,338.4,percent of total billed charges,Implant Devices,296.1,70,,296.1,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,338.4,
ZIMMER 8145-50-056 CORTICAL SCREW 5X56MM,C1713,HCPCS,,79012510,CDM,278,RC,,,both,,,594,234.43,39.4668,,234.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Device,201.96,34,"Charges > $500, x 34%",201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,237.6,40,,237.6,percent of total billed charges,Implant Devices,207.9,70,,207.9,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,237.6,
J&J 02.127.140 LOCKING SCREW 3.5X40MM,C1713,HCPCS,,79012511,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.127.138 LOCKING SCREW 3.5X38MM,C1713,HCPCS,,79012512,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.127.150 LOCKING SCREW 3.5X50MM,C1713,HCPCS,,79012513,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.127.156 LOCKING SCREW 3.5X56MM,C1713,HCPCS,,79012514,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.221.101 TROCH RING PLT LT 3.5MM,C1713,HCPCS,,79012516,CDM,278,RC,,,both,,,5641,2226.32,39.4668,,2226.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1917.94,34,,1917.94,percent of total billed charges,Implant Device,1917.94,34,,1917.94,percent of total billed charges,Implant Device,1917.94,34,,1917.94,percent of total billed charges,Implant Device,1917.94,34,,1917.94,percent of total billed charges,Implant Device,1917.94,34,,1917.94,percent of total billed charges,Implant Device,1917.94,34,,1917.94,percent of total billed charges,Implant Device,1974.35,35,,1974.35,percent of total billed charges,Implant Device,1917.94,34,"Charges > $500, x 34%",1917.94,percent of total billed charges,Implant Device,1974.35,35,,1974.35,percent of total billed charges,Implant Devices,1974.35,35,,1974.35,percent of total billed charges,Implant Devices,1974.35,35,,,percent of total billed charges,Implant Devices,1974.35,35,,1974.35,percent of total billed charges,Implant Devices,1974.35,35,,1974.35,percent of total billed charges,Implant Devices,2256.4,40,,2256.4,percent of total billed charges,Implant Devices,1974.35,70,,1974.35,percent of total billed charges,Implant Devices,1917.94,34,,1917.94,percent of total billed charges,Implant Devices,1917.94,34,,1917.94,percent of total billed charges,Implant Devices,1974.35,35,,1974.35,percent of total billed charges,Implant Devices,1974.35,35,,1974.35,percent of total billed charges,Implant Devices,1974.35,35,,1974.35,percent of total billed charges,Implant Devices,1974.35,35,,1974.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1917.94,34,"If Charge > 2,000, then 34 percent",1917.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2256.4,
J&J 02.221.115 PROX FEMUR PLT 8H LT 3.5,C1713,HCPCS,,79012518,CDM,278,RC,,,both,,,9227,3641.6,39.4668,,3641.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3137.18,34,,3137.18,percent of total billed charges,Implant Device,3137.18,34,,3137.18,percent of total billed charges,Implant Device,3137.18,34,,3137.18,percent of total billed charges,Implant Device,3137.18,34,,3137.18,percent of total billed charges,Implant Device,3137.18,34,,3137.18,percent of total billed charges,Implant Device,3137.18,34,,3137.18,percent of total billed charges,Implant Device,3229.45,35,,3229.45,percent of total billed charges,Implant Device,3137.18,34,"Charges > $500, x 34%",3137.18,percent of total billed charges,Implant Device,3229.45,35,,3229.45,percent of total billed charges,Implant Devices,3229.45,35,,3229.45,percent of total billed charges,Implant Devices,3229.45,35,,,percent of total billed charges,Implant Devices,3229.45,35,,3229.45,percent of total billed charges,Implant Devices,3229.45,35,,3229.45,percent of total billed charges,Implant Devices,3690.8,40,,3690.8,percent of total billed charges,Implant Devices,3229.45,70,,3229.45,percent of total billed charges,Implant Devices,3137.18,34,,3137.18,percent of total billed charges,Implant Devices,3137.18,34,,3137.18,percent of total billed charges,Implant Devices,3229.45,35,,3229.45,percent of total billed charges,Implant Devices,3229.45,35,,3229.45,percent of total billed charges,Implant Devices,3229.45,35,,3229.45,percent of total billed charges,Implant Devices,3229.45,35,,3229.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3137.18,34,"If Charge > 2,000, then 34 percent",3137.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3690.8,
J&J 02.221.180S CONNECTING SCREW,C1713,HCPCS,,79012519,CDM,278,RC,,,both,,,714,281.79,39.4668,,281.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,242.76,34,,242.76,percent of total billed charges,Implant Device,249.9,35,,249.9,percent of total billed charges,Implant Device,242.76,34,"Charges > $500, x 34%",242.76,percent of total billed charges,Implant Device,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,285.6,40,,285.6,percent of total billed charges,Implant Devices,249.9,70,,249.9,percent of total billed charges,Implant Devices,242.76,34,,242.76,percent of total billed charges,Implant Devices,242.76,34,,242.76,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,249.9,35,,249.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,285.6,
ZIMMER 8145-10-080 LAG SCREW 1.5X80MM,C1713,HCPCS,,79012525,CDM,278,RC,,,both,,,2052,809.86,39.4668,,809.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,697.68,34,,697.68,percent of total billed charges,Implant Device,718.2,35,,718.2,percent of total billed charges,Implant Device,697.68,34,"Charges > $500, x 34%",697.68,percent of total billed charges,Implant Device,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,820.8,40,,820.8,percent of total billed charges,Implant Devices,718.2,70,,718.2,percent of total billed charges,Implant Devices,697.68,34,,697.68,percent of total billed charges,Implant Devices,697.68,34,,697.68,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,718.2,35,,718.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,697.68,34,"If Charge > 2,000, then 34 percent",697.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,820.8,
ZIMMER 8145-01-070 HIP FRAC NAIL 11X180,C1713,HCPCS,,79012526,CDM,278,RC,,,both,,,846,333.89,39.4668,,333.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,287.64,34,,287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Device,287.64,34,"Charges > $500, x 34%",287.64,percent of total billed charges,Implant Device,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,338.4,40,,338.4,percent of total billed charges,Implant Devices,296.1,70,,296.1,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,287.64,34,,287.64,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,296.1,35,,296.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,338.4,
J&J 202.826 CORTEX SCREW 2.7X26MM,C1713,HCPCS,,79012544,CDM,278,RC,,,both,,,85,33.55,39.4668,,33.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,34,40,,34,percent of total billed charges,Implant Devices,29.75,70,,29.75,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34,
J&J 202.822 CORTEX SCREW 2.7X22MM,C1713,HCPCS,,79012545,CDM,278,RC,,,both,,,85,33.55,39.4668,,33.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,34,40,,34,percent of total billed charges,Implant Devices,29.75,70,,29.75,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34,
J&J 02.123.027 PROX HUMERUS PLT 3.5MM,C1713,HCPCS,,79012546,CDM,278,RC,,,both,,,4431,1748.77,39.4668,,1748.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1506.54,34,,1506.54,percent of total billed charges,Implant Device,1550.85,35,,1550.85,percent of total billed charges,Implant Device,1506.54,34,"Charges > $500, x 34%",1506.54,percent of total billed charges,Implant Device,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1772.4,40,,1772.4,percent of total billed charges,Implant Devices,1550.85,70,,1550.85,percent of total billed charges,Implant Devices,1506.54,34,,1506.54,percent of total billed charges,Implant Devices,1506.54,34,,1506.54,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,1550.85,35,,1550.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1506.54,34,"If Charge > 2,000, then 34 percent",1506.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1772.4,
J&J 02.124.414 CONDYLAR PLT 14H 4.5MM,C1713,HCPCS,,79012549,CDM,278,RC,,,both,,,4999,1972.95,39.4668,,1972.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1699.66,34,,1699.66,percent of total billed charges,Implant Device,1699.66,34,,1699.66,percent of total billed charges,Implant Device,1699.66,34,,1699.66,percent of total billed charges,Implant Device,1699.66,34,,1699.66,percent of total billed charges,Implant Device,1699.66,34,,1699.66,percent of total billed charges,Implant Device,1699.66,34,,1699.66,percent of total billed charges,Implant Device,1749.65,35,,1749.65,percent of total billed charges,Implant Device,1699.66,34,"Charges > $500, x 34%",1699.66,percent of total billed charges,Implant Device,1749.65,35,,1749.65,percent of total billed charges,Implant Devices,1749.65,35,,1749.65,percent of total billed charges,Implant Devices,1749.65,35,,,percent of total billed charges,Implant Devices,1749.65,35,,1749.65,percent of total billed charges,Implant Devices,1749.65,35,,1749.65,percent of total billed charges,Implant Devices,1999.6,40,,1999.6,percent of total billed charges,Implant Devices,1749.65,70,,1749.65,percent of total billed charges,Implant Devices,1699.66,34,,1699.66,percent of total billed charges,Implant Devices,1699.66,34,,1699.66,percent of total billed charges,Implant Devices,1749.65,35,,1749.65,percent of total billed charges,Implant Devices,1749.65,35,,1749.65,percent of total billed charges,Implant Devices,1749.65,35,,1749.65,percent of total billed charges,Implant Devices,1749.65,35,,1749.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1699.66,34,"If Charge > 2,000, then 34 percent",1699.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1999.6,
J&J 78000110 FIBERGRAFT BG PUTTY 11CC,C1713,HCPCS,,79012550,CDM,278,RC,,,both,,,7032,2775.31,39.4668,,2775.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2390.88,34,,2390.88,percent of total billed charges,Implant Device,2390.88,34,,2390.88,percent of total billed charges,Implant Device,2390.88,34,,2390.88,percent of total billed charges,Implant Device,2390.88,34,,2390.88,percent of total billed charges,Implant Device,2390.88,34,,2390.88,percent of total billed charges,Implant Device,2390.88,34,,2390.88,percent of total billed charges,Implant Device,2461.2,35,,2461.2,percent of total billed charges,Implant Device,2390.88,34,"Charges > $500, x 34%",2390.88,percent of total billed charges,Implant Device,2461.2,35,,2461.2,percent of total billed charges,Implant Devices,2461.2,35,,2461.2,percent of total billed charges,Implant Devices,2461.2,35,,,percent of total billed charges,Implant Devices,2461.2,35,,2461.2,percent of total billed charges,Implant Devices,2461.2,35,,2461.2,percent of total billed charges,Implant Devices,2812.8,40,,2812.8,percent of total billed charges,Implant Devices,2461.2,70,,2461.2,percent of total billed charges,Implant Devices,2390.88,34,,2390.88,percent of total billed charges,Implant Devices,2390.88,34,,2390.88,percent of total billed charges,Implant Devices,2461.2,35,,2461.2,percent of total billed charges,Implant Devices,2461.2,35,,2461.2,percent of total billed charges,Implant Devices,2461.2,35,,2461.2,percent of total billed charges,Implant Devices,2461.2,35,,2461.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2390.88,34,"If Charge > 2,000, then 34 percent",2390.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2812.8,
J&J 247.377 LCP PLATE 7 HOLE 2.4MM,C1713,HCPCS,,79012551,CDM,278,RC,,,both,,,1002,395.46,39.4668,,395.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Device,340.68,34,"Charges > $500, x 34%",340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,400.8,40,,400.8,percent of total billed charges,Implant Devices,350.7,70,,350.7,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,400.8,
J&J 201.758 CORTEX SCREW 2.4X8MM,C1713,HCPCS,,79012552,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 201.780 CORTEX SCREW 2.4X30MM,C1713,HCPCS,,79012553,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 201.760 CORTEX SCREW 2.4X10MM,C1713,HCPCS,,79012554,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 04.005.566S LOCKING SCREW 5.0X76MM,C1713,HCPCS,,79012555,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
J&J 04.003.027S RECON SCREW 6.5X85MM,C1713,HCPCS,,79012556,CDM,278,RC,,,both,,,421,166.16,39.4668,,166.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,143.14,34,,143.14,percent of total billed charges,Implant Device,143.14,34,,143.14,percent of total billed charges,Implant Device,143.14,34,,143.14,percent of total billed charges,Implant Device,143.14,34,,143.14,percent of total billed charges,Implant Device,143.14,34,,143.14,percent of total billed charges,Implant Device,143.14,34,,143.14,percent of total billed charges,Implant Device,147.35,35,,147.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,168.4,40,,168.4,percent of total billed charges,Implant Devices,147.35,70,,147.35,percent of total billed charges,Implant Devices,143.14,34,,143.14,percent of total billed charges,Implant Devices,143.14,34,,143.14,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168.4,
J&J 04.003.026S RECON SCREW 6.5X80MM,C1713,HCPCS,,79012557,CDM,278,RC,,,both,,,421,166.16,39.4668,,166.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,143.14,34,,143.14,percent of total billed charges,Implant Device,143.14,34,,143.14,percent of total billed charges,Implant Device,143.14,34,,143.14,percent of total billed charges,Implant Device,143.14,34,,143.14,percent of total billed charges,Implant Device,143.14,34,,143.14,percent of total billed charges,Implant Device,143.14,34,,143.14,percent of total billed charges,Implant Device,147.35,35,,147.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,168.4,40,,168.4,percent of total billed charges,Implant Devices,147.35,70,,147.35,percent of total billed charges,Implant Devices,143.14,34,,143.14,percent of total billed charges,Implant Devices,143.14,34,,143.14,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,147.35,35,,147.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168.4,
J&J 78000060 FIBERGRAFT BG PUTTY 6CC,C1713,HCPCS,,79012558,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
J&J 7800040 FIBERGRAFT BG PUTTY 4CC,C1713,HCPCS,,79012560,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
J&J 04.033.067S FEMORAL NAIL SYS 10X360,C1713,HCPCS,,79012561,CDM,278,RC,,,both,,,5337,2106.34,39.4668,,2106.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1814.58,34,,1814.58,percent of total billed charges,Implant Device,1814.58,34,,1814.58,percent of total billed charges,Implant Device,1814.58,34,,1814.58,percent of total billed charges,Implant Device,1814.58,34,,1814.58,percent of total billed charges,Implant Device,1814.58,34,,1814.58,percent of total billed charges,Implant Device,1814.58,34,,1814.58,percent of total billed charges,Implant Device,1867.95,35,,1867.95,percent of total billed charges,Implant Device,1814.58,34,"Charges > $500, x 34%",1814.58,percent of total billed charges,Implant Device,1867.95,35,,1867.95,percent of total billed charges,Implant Devices,1867.95,35,,1867.95,percent of total billed charges,Implant Devices,1867.95,35,,,percent of total billed charges,Implant Devices,1867.95,35,,1867.95,percent of total billed charges,Implant Devices,1867.95,35,,1867.95,percent of total billed charges,Implant Devices,2134.8,40,,2134.8,percent of total billed charges,Implant Devices,1867.95,70,,1867.95,percent of total billed charges,Implant Devices,1814.58,34,,1814.58,percent of total billed charges,Implant Devices,1814.58,34,,1814.58,percent of total billed charges,Implant Devices,1867.95,35,,1867.95,percent of total billed charges,Implant Devices,1867.95,35,,1867.95,percent of total billed charges,Implant Devices,1867.95,35,,1867.95,percent of total billed charges,Implant Devices,1867.95,35,,1867.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1814.58,34,"If Charge > 2,000, then 34 percent",1814.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2134.8,
WRIGHT 58820006 FIXATION PIN 1.1MM,C1713,HCPCS,,79012562,CDM,278,RC,,,both,,,341,134.58,39.4668,,134.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,119.35,35,,119.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,136.4,40,,136.4,percent of total billed charges,Implant Devices,119.35,70,,119.35,percent of total billed charges,Implant Devices,115.94,34,,115.94,percent of total billed charges,Implant Devices,115.94,34,,115.94,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,136.4,
STRYKER 627214S PROX HUMERUS PLT LT 14H,C1713,HCPCS,,79012575,CDM,278,RC,,,both,,,8516,3360.99,39.4668,,3360.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2895.44,34,,2895.44,percent of total billed charges,Implant Device,2895.44,34,,2895.44,percent of total billed charges,Implant Device,2895.44,34,,2895.44,percent of total billed charges,Implant Device,2895.44,34,,2895.44,percent of total billed charges,Implant Device,2895.44,34,,2895.44,percent of total billed charges,Implant Device,2895.44,34,,2895.44,percent of total billed charges,Implant Device,2980.6,35,,2980.6,percent of total billed charges,Implant Device,2895.44,34,"Charges > $500, x 34%",2895.44,percent of total billed charges,Implant Device,2980.6,35,,2980.6,percent of total billed charges,Implant Devices,2980.6,35,,2980.6,percent of total billed charges,Implant Devices,2980.6,35,,,percent of total billed charges,Implant Devices,2980.6,35,,2980.6,percent of total billed charges,Implant Devices,2980.6,35,,2980.6,percent of total billed charges,Implant Devices,3406.4,40,,3406.4,percent of total billed charges,Implant Devices,2980.6,70,,2980.6,percent of total billed charges,Implant Devices,2895.44,34,,2895.44,percent of total billed charges,Implant Devices,2895.44,34,,2895.44,percent of total billed charges,Implant Devices,2980.6,35,,2980.6,percent of total billed charges,Implant Devices,2980.6,35,,2980.6,percent of total billed charges,Implant Devices,2980.6,35,,2980.6,percent of total billed charges,Implant Devices,2980.6,35,,2980.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2895.44,34,"If Charge > 2,000, then 34 percent",2895.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3406.4,
PARAGON P50-353-2722 LOCK SCREW 2.7X22MM,C1713,HCPCS,,79012576,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
PARAGON P50-353-2720 LOCK SCREW 2.7X20MM,C1713,HCPCS,,79012577,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
PARAGON P71-018-1818-S STAPLE 18X18X18MM,C1713,HCPCS,,79012578,CDM,278,RC,,,both,,,5450,2150.94,39.4668,,2150.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1853,34,,1853,percent of total billed charges,Implant Device,1853,34,,1853,percent of total billed charges,Implant Device,1853,34,,1853,percent of total billed charges,Implant Device,1853,34,,1853,percent of total billed charges,Implant Device,1853,34,,1853,percent of total billed charges,Implant Device,1853,34,,1853,percent of total billed charges,Implant Device,1907.5,35,,1907.5,percent of total billed charges,Implant Device,1853,34,"Charges > $500, x 34%",1853,percent of total billed charges,Implant Device,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,2180,40,,2180,percent of total billed charges,Implant Devices,1907.5,70,,1907.5,percent of total billed charges,Implant Devices,1853,34,,1853,percent of total billed charges,Implant Devices,1853,34,,1853,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1853,34,"If Charge > 2,000, then 34 percent",1853,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2180,
PARAGON P71-015-1515-S STAPLE 15X15X15MM,C1713,HCPCS,,79012579,CDM,278,RC,,,both,,,5450,2150.94,39.4668,,2150.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1853,34,,1853,percent of total billed charges,Implant Device,1853,34,,1853,percent of total billed charges,Implant Device,1853,34,,1853,percent of total billed charges,Implant Device,1853,34,,1853,percent of total billed charges,Implant Device,1853,34,,1853,percent of total billed charges,Implant Device,1853,34,,1853,percent of total billed charges,Implant Device,1907.5,35,,1907.5,percent of total billed charges,Implant Device,1853,34,"Charges > $500, x 34%",1853,percent of total billed charges,Implant Device,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,2180,40,,2180,percent of total billed charges,Implant Devices,1907.5,70,,1907.5,percent of total billed charges,Implant Devices,1853,34,,1853,percent of total billed charges,Implant Devices,1853,34,,1853,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,1907.5,35,,1907.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1853,34,"If Charge > 2,000, then 34 percent",1853,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2180,
STRYKER 604740S CANNULATED SCREW 4X40MM,C1713,HCPCS,,79012580,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 604742S CANNULATED SCREW 4X42MM,C1713,HCPCS,,79012581,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 604744S CANNULATED SCREW 4X44MM,C1713,HCPCS,,79012582,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 604746S CANNULATED SCREW 4X46MM,C1713,HCPCS,,79012583,CDM,278,RC,,,both,,,487,192.2,39.4668,,192.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.58,34,,165.58,percent of total billed charges,Implant Device,165.58,34,,165.58,percent of total billed charges,Implant Device,165.58,34,,165.58,percent of total billed charges,Implant Device,165.58,34,,165.58,percent of total billed charges,Implant Device,165.58,34,,165.58,percent of total billed charges,Implant Device,165.58,34,,165.58,percent of total billed charges,Implant Device,170.45,35,,170.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.45,35,,170.45,percent of total billed charges,Implant Devices,170.45,35,,170.45,percent of total billed charges,Implant Devices,170.45,35,,,percent of total billed charges,Implant Devices,170.45,35,,170.45,percent of total billed charges,Implant Devices,170.45,35,,170.45,percent of total billed charges,Implant Devices,194.8,40,,194.8,percent of total billed charges,Implant Devices,170.45,70,,170.45,percent of total billed charges,Implant Devices,165.58,34,,165.58,percent of total billed charges,Implant Devices,165.58,34,,165.58,percent of total billed charges,Implant Devices,170.45,35,,170.45,percent of total billed charges,Implant Devices,170.45,35,,170.45,percent of total billed charges,Implant Devices,170.45,35,,170.45,percent of total billed charges,Implant Devices,170.45,35,,170.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,194.8,
ZIMMER 8162-08-003 LOCK CALCANEUS PLT LT,C1713,HCPCS,,79012584,CDM,278,RC,,,both,,,2734,1079.02,39.4668,,1079.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,929.56,34,,929.56,percent of total billed charges,Implant Device,956.9,35,,956.9,percent of total billed charges,Implant Device,929.56,34,"Charges > $500, x 34%",929.56,percent of total billed charges,Implant Device,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,1093.6,40,,1093.6,percent of total billed charges,Implant Devices,956.9,70,,956.9,percent of total billed charges,Implant Devices,929.56,34,,929.56,percent of total billed charges,Implant Devices,929.56,34,,929.56,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,956.9,35,,956.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,929.56,34,"If Charge > 2,000, then 34 percent",929.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1093.6,
ZIMMER 1312-18-042 CORTICAL SCREW 3.5X42,C1713,HCPCS,,79012585,CDM,278,RC,,,both,,,216,85.25,39.4668,,85.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.4,
ZIMMER 8163-35-034 MULTIDIRECT SC 3.5X34,C1713,HCPCS,,79012586,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
ZIMMER 8163-35-042 MULTIDIRECT SC 3.5X42,C1713,HCPCS,,79012587,CDM,278,RC,,,both,,,612,241.54,39.4668,,241.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,208.08,34,,208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Device,208.08,34,"Charges > $500, x 34%",208.08,percent of total billed charges,Implant Device,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,244.8,40,,244.8,percent of total billed charges,Implant Devices,214.2,70,,214.2,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,208.08,34,,208.08,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,214.2,35,,214.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,244.8,
ZIMMER 8161-35-032 CORTICAL SCREW 3.5X32,C1713,HCPCS,,79012588,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
ZIMMER 8161-35-038 CORTICAL SCREW 3.5X38,C1713,HCPCS,,79012589,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
ZIMMER 8161-35-030 CORTICAL SCREW 3.5X30,C1713,HCPCS,,79012590,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
J&J 02.112.813S HOOK PLT LONG 2.7X12 RT,C1713,HCPCS,,79012594,CDM,278,RC,,,both,,,3870,1527.37,39.4668,,1527.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1354.5,35,,1354.5,percent of total billed charges,Implant Device,1315.8,34,"Charges > $500, x 34%",1315.8,percent of total billed charges,Implant Device,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1548,40,,1548,percent of total billed charges,Implant Devices,1354.5,70,,1354.5,percent of total billed charges,Implant Devices,1315.8,34,,1315.8,percent of total billed charges,Implant Devices,1315.8,34,,1315.8,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1315.8,34,"If Charge > 2,000, then 34 percent",1315.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1548,
J&J 02.112.811S HOOK PLT LONG 2.7X9MM RT,C1713,HCPCS,,79012595,CDM,278,RC,,,both,,,3870,1527.37,39.4668,,1527.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1315.8,34,,1315.8,percent of total billed charges,Implant Device,1354.5,35,,1354.5,percent of total billed charges,Implant Device,1315.8,34,"Charges > $500, x 34%",1315.8,percent of total billed charges,Implant Device,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1548,40,,1548,percent of total billed charges,Implant Devices,1354.5,70,,1354.5,percent of total billed charges,Implant Devices,1315.8,34,,1315.8,percent of total billed charges,Implant Devices,1315.8,34,,1315.8,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,1354.5,35,,1354.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1315.8,34,"If Charge > 2,000, then 34 percent",1315.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1548,
J&J 02.123.025 PROX HUMERUS PLT 3.5MM,C1713,HCPCS,,79012596,CDM,278,RC,,,both,,,4266,1683.65,39.4668,,1683.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1450.44,34,,1450.44,percent of total billed charges,Implant Device,1493.1,35,,1493.1,percent of total billed charges,Implant Device,1450.44,34,"Charges > $500, x 34%",1450.44,percent of total billed charges,Implant Device,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1706.4,40,,1706.4,percent of total billed charges,Implant Devices,1493.1,70,,1493.1,percent of total billed charges,Implant Devices,1450.44,34,,1450.44,percent of total billed charges,Implant Devices,1450.44,34,,1450.44,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,1493.1,35,,1493.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1450.44,34,"If Charge > 2,000, then 34 percent",1450.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1706.4,
J&J 206.035 CAN CELLOUS SCREW 4.0X35MM,C1713,HCPCS,,79012597,CDM,278,RC,,,both,,,47,18.55,39.4668,,18.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,16.45,35,,16.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,18.8,40,,18.8,percent of total billed charges,Implant Devices,16.45,70,,16.45,percent of total billed charges,Implant Devices,15.98,34,,15.98,percent of total billed charges,Implant Devices,15.98,34,,15.98,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18.8,
J&J 201.763 CORTEX SCREW 2.4X13MM,C1713,HCPCS,,79012598,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 02.112.623S CLAVICLE PLT RT 2.7MM,C1713,HCPCS,,79012599,CDM,278,RC,,,both,,,3434,1355.29,39.4668,,1355.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1201.9,35,,1201.9,percent of total billed charges,Implant Device,1167.56,34,"Charges > $500, x 34%",1167.56,percent of total billed charges,Implant Device,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1373.6,40,,1373.6,percent of total billed charges,Implant Devices,1201.9,70,,1201.9,percent of total billed charges,Implant Devices,1167.56,34,,1167.56,percent of total billed charges,Implant Devices,1167.56,34,,1167.56,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1167.56,34,"If Charge > 2,000, then 34 percent",1167.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1373.6,
J&J 04.038.210S TFNA SCREW 110MM,C1713,HCPCS,,79012600,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
J&J 207.740 CANNULATED SCREW 4X40MM,C1713,HCPCS,,79012605,CDM,278,RC,,,both,,,491,193.78,39.4668,,193.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,166.94,34,,166.94,percent of total billed charges,Implant Device,166.94,34,,166.94,percent of total billed charges,Implant Device,166.94,34,,166.94,percent of total billed charges,Implant Device,166.94,34,,166.94,percent of total billed charges,Implant Device,166.94,34,,166.94,percent of total billed charges,Implant Device,166.94,34,,166.94,percent of total billed charges,Implant Device,171.85,35,,171.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,196.4,40,,196.4,percent of total billed charges,Implant Devices,171.85,70,,171.85,percent of total billed charges,Implant Devices,166.94,34,,166.94,percent of total billed charges,Implant Devices,166.94,34,,166.94,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,171.85,35,,171.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,196.4,
ARTHREX AR-5051-32 CANNULATED SCREW 4X32,C1713,HCPCS,,79012608,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ARTHREX AR-5051-38 CANNULATED SCREW 4X38,C1713,HCPCS,,79012609,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ARTHREX AR-5051-36 CANNULATED SCREW 4X36,C1713,HCPCS,,79012610,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
ARTHREX AR-5051-40 CANNULATED SCREW 4X40,C1713,HCPCS,,79012611,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
IN2BONES A80 ST100 SYNDESMOSIS IMP SYS,C1713,HCPCS,,79012614,CDM,278,RC,,,both,,,6885,2717.29,39.4668,,2717.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2340.9,34,,2340.9,percent of total billed charges,Implant Device,2409.75,35,,2409.75,percent of total billed charges,Implant Device,2340.9,34,"Charges > $500, x 34%",2340.9,percent of total billed charges,Implant Device,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2754,40,,2754,percent of total billed charges,Implant Devices,2409.75,70,,2409.75,percent of total billed charges,Implant Devices,2340.9,34,,2340.9,percent of total billed charges,Implant Devices,2340.9,34,,2340.9,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,2409.75,35,,2409.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2340.9,34,"If Charge > 2,000, then 34 percent",2340.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2754,
TRILLIANT 300-93-004 LAT FIBULA PLT RT,C1713,HCPCS,,79012615,CDM,278,RC,,,both,,,4875,1924.01,39.4668,,1924.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1657.5,34,,1657.5,percent of total billed charges,Implant Device,1657.5,34,,1657.5,percent of total billed charges,Implant Device,1657.5,34,,1657.5,percent of total billed charges,Implant Device,1657.5,34,,1657.5,percent of total billed charges,Implant Device,1657.5,34,,1657.5,percent of total billed charges,Implant Device,1657.5,34,,1657.5,percent of total billed charges,Implant Device,1706.25,35,,1706.25,percent of total billed charges,Implant Device,1657.5,34,"Charges > $500, x 34%",1657.5,percent of total billed charges,Implant Device,1706.25,35,,1706.25,percent of total billed charges,Implant Devices,1706.25,35,,1706.25,percent of total billed charges,Implant Devices,1706.25,35,,,percent of total billed charges,Implant Devices,1706.25,35,,1706.25,percent of total billed charges,Implant Devices,1706.25,35,,1706.25,percent of total billed charges,Implant Devices,1950,40,,1950,percent of total billed charges,Implant Devices,1706.25,70,,1706.25,percent of total billed charges,Implant Devices,1657.5,34,,1657.5,percent of total billed charges,Implant Devices,1657.5,34,,1657.5,percent of total billed charges,Implant Devices,1706.25,35,,1706.25,percent of total billed charges,Implant Devices,1706.25,35,,1706.25,percent of total billed charges,Implant Devices,1706.25,35,,1706.25,percent of total billed charges,Implant Devices,1706.25,35,,1706.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1657.5,34,"If Charge > 2,000, then 34 percent",1657.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1950,
TRILLIANT 308-27-012 LOCK SCREW 2.7X12MM,C1713,HCPCS,,79012616,CDM,278,RC,,,both,,,780,307.84,39.4668,,307.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Device,265.2,34,"Charges > $500, x 34%",265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,312,40,,312,percent of total billed charges,Implant Devices,273,70,,273,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,312,
TRILLIANT 308-27-014 LOCK SCREW 2.7X14MM,C1713,HCPCS,,79012617,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
TRILLIANT 308-27-016 LOCK SCREW 2.7X16MM,C1713,HCPCS,,79012618,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
TRILLIANT 308-35-012 LOCK SCREW 3.5X12MM,C1713,HCPCS,,79012619,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
TRILLIANT 308-35-014 LOCK SCREW 3.5X14MM,C1713,HCPCS,,79012620,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
TRILLIANT 307-27-022 NON-LOCK SRW 2.7X22,C1713,HCPCS,,79012621,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
TRILLIANT 201-40-040 CANN SCREW 4.0X40MM,C1713,HCPCS,,79012622,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
STRYKER 658140 HEADLESS COMP SCREW 5X40,C1713,HCPCS,,79012631,CDM,278,RC,,,both,,,964,380.46,39.4668,,380.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Device,327.76,34,"Charges > $500, x 34%",327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,385.6,40,,385.6,percent of total billed charges,Implant Devices,337.4,70,,337.4,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,385.6,
J&J 02.112.149S DISTAL FIBULAR PLATE,C1713,HCPCS,,79012635,CDM,278,RC,,,both,,,1791,706.85,39.4668,,706.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,608.94,34,,608.94,percent of total billed charges,Implant Device,608.94,34,,608.94,percent of total billed charges,Implant Device,608.94,34,,608.94,percent of total billed charges,Implant Device,608.94,34,,608.94,percent of total billed charges,Implant Device,608.94,34,,608.94,percent of total billed charges,Implant Device,608.94,34,,608.94,percent of total billed charges,Implant Device,626.85,35,,626.85,percent of total billed charges,Implant Device,608.94,34,"Charges > $500, x 34%",608.94,percent of total billed charges,Implant Device,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,716.4,40,,716.4,percent of total billed charges,Implant Devices,626.85,70,,626.85,percent of total billed charges,Implant Devices,608.94,34,,608.94,percent of total billed charges,Implant Devices,608.94,34,,608.94,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,716.4,
J&J 243.234 T PLATE 2.0MM 3 HOLE,C1713,HCPCS,,79012636,CDM,278,RC,,,both,,,640,252.59,39.4668,,252.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,217.6,34,,217.6,percent of total billed charges,Implant Device,217.6,34,,217.6,percent of total billed charges,Implant Device,217.6,34,,217.6,percent of total billed charges,Implant Device,217.6,34,,217.6,percent of total billed charges,Implant Device,217.6,34,,217.6,percent of total billed charges,Implant Device,217.6,34,,217.6,percent of total billed charges,Implant Device,224,35,,224,percent of total billed charges,Implant Device,217.6,34,"Charges > $500, x 34%",217.6,percent of total billed charges,Implant Device,224,35,,224,percent of total billed charges,Implant Devices,224,35,,224,percent of total billed charges,Implant Devices,224,35,,,percent of total billed charges,Implant Devices,224,35,,224,percent of total billed charges,Implant Devices,224,35,,224,percent of total billed charges,Implant Devices,256,40,,256,percent of total billed charges,Implant Devices,224,70,,224,percent of total billed charges,Implant Devices,217.6,34,,217.6,percent of total billed charges,Implant Devices,217.6,34,,217.6,percent of total billed charges,Implant Devices,224,35,,224,percent of total billed charges,Implant Devices,224,35,,224,percent of total billed charges,Implant Devices,224,35,,224,percent of total billed charges,Implant Devices,224,35,,224,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,256,
J&J 201.700 CORTEX SCREW 2.4X60MM,C1713,HCPCS,,79012637,CDM,278,RC,,,both,,,153,60.38,39.4668,,60.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,61.2,40,,61.2,percent of total billed charges,Implant Devices,53.55,70,,53.55,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,61.2,
J&J 201.670 CORTEX SCREW 2.4X40MM,C1713,HCPCS,,79012638,CDM,278,RC,,,both,,,121,47.75,39.4668,,47.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,48.4,40,,48.4,percent of total billed charges,Implant Devices,42.35,70,,42.35,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.4,
J&J 201.658 CORTEX SCREW 2.4X28MM,C1713,HCPCS,,79012639,CDM,278,RC,,,both,,,121,47.75,39.4668,,47.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,48.4,40,,48.4,percent of total billed charges,Implant Devices,42.35,70,,42.35,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.4,
J&J 201.656 CORTEX SCREW 2.4X26MM,C1713,HCPCS,,79012640,CDM,278,RC,,,both,,,121,47.75,39.4668,,47.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,48.4,40,,48.4,percent of total billed charges,Implant Devices,42.35,70,,42.35,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.4,
J&J 201.666 CORTEX SCREW 2.4X36MM,C1713,HCPCS,,79012641,CDM,278,RC,,,both,,,121,47.75,39.4668,,47.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,48.4,40,,48.4,percent of total billed charges,Implant Devices,42.35,70,,42.35,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.4,
J&J 201.699 CORTEX SCREW 2.4X58MM,C1713,HCPCS,,79012642,CDM,278,RC,,,both,,,153,60.38,39.4668,,60.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,61.2,40,,61.2,percent of total billed charges,Implant Devices,53.55,70,,53.55,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,61.2,
J&J 247.615 LCP T PLATE 2.0MM,C1713,HCPCS,,79012643,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 201.786 CORTEX SCREW 2.4X36MM,C1713,HCPCS,,79012644,CDM,278,RC,,,both,,,130,51.31,39.4668,,51.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,44.2,34,,44.2,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,52,40,,52,percent of total billed charges,Implant Devices,45.5,70,,45.5,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,44.2,34,,44.2,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,45.5,35,,45.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,52,
J&J 02.112.144S LCP DISTAL FIB PLT 7H,C1713,HCPCS,,79012645,CDM,278,RC,,,both,,,1767,697.38,39.4668,,697.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,618.45,35,,618.45,percent of total billed charges,Implant Device,600.78,34,"Charges > $500, x 34%",600.78,percent of total billed charges,Implant Device,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,706.8,40,,706.8,percent of total billed charges,Implant Devices,618.45,70,,618.45,percent of total billed charges,Implant Devices,600.78,34,,600.78,percent of total billed charges,Implant Devices,600.78,34,,600.78,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,706.8,
J&J 02.104.010 LCP DIS HUMERUS PLT 3.5MM,C1713,HCPCS,,79012651,CDM,278,RC,,,both,,,3927,1549.86,39.4668,,1549.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1374.45,35,,1374.45,percent of total billed charges,Implant Device,1335.18,34,"Charges > $500, x 34%",1335.18,percent of total billed charges,Implant Device,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1570.8,40,,1570.8,percent of total billed charges,Implant Devices,1374.45,70,,1374.45,percent of total billed charges,Implant Devices,1335.18,34,,1335.18,percent of total billed charges,Implant Devices,1335.18,34,,1335.18,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1335.18,34,"If Charge > 2,000, then 34 percent",1335.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1570.8,
J&J 02.115.151 DISTAL RADIUS 90 DEG PLT,C1713,HCPCS,,79012652,CDM,278,RC,,,both,,,1405,554.51,39.4668,,554.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,477.7,34,,477.7,percent of total billed charges,Implant Device,477.7,34,,477.7,percent of total billed charges,Implant Device,477.7,34,,477.7,percent of total billed charges,Implant Device,477.7,34,,477.7,percent of total billed charges,Implant Device,477.7,34,,477.7,percent of total billed charges,Implant Device,477.7,34,,477.7,percent of total billed charges,Implant Device,491.75,35,,491.75,percent of total billed charges,Implant Device,477.7,34,"Charges > $500, x 34%",477.7,percent of total billed charges,Implant Device,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,562,40,,562,percent of total billed charges,Implant Devices,491.75,70,,491.75,percent of total billed charges,Implant Devices,477.7,34,,477.7,percent of total billed charges,Implant Devices,477.7,34,,477.7,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,562,
ARTHREX AR-8973R-30-130 FIBULOK NAIL RT,C1713,HCPCS,,79012654,CDM,278,RC,,,both,,,8985,3546.09,39.4668,,3546.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3054.9,34,,3054.9,percent of total billed charges,Implant Device,3144.75,35,,3144.75,percent of total billed charges,Implant Device,3054.9,34,"Charges > $500, x 34%",3054.9,percent of total billed charges,Implant Device,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3594,40,,3594,percent of total billed charges,Implant Devices,3144.75,70,,3144.75,percent of total billed charges,Implant Devices,3054.9,34,,3054.9,percent of total billed charges,Implant Devices,3054.9,34,,3054.9,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,3144.75,35,,3144.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3054.9,34,"If Charge > 2,000, then 34 percent",3054.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3594,
ARTHREX AR-8827-16 CORT SCREW 2.7X16MM,C1713,HCPCS,,79012655,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
ARTHREX AR-8827-20 CORT SCREW 2.7X20MM,C1713,HCPCS,,79012656,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
ARTHREX AR-8827-22 CORT SCREW 2.6X22MM,C1713,HCPCS,,79012657,CDM,278,RC,,,both,,,135,53.28,39.4668,,53.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,45.9,34,,45.9,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,54,40,,54,percent of total billed charges,Implant Devices,47.25,70,,47.25,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,45.9,34,,45.9,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,47.25,35,,47.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54,
MEDTRONIC 2300-5525 TAS SCREW 5.5X25MM,C1713,HCPCS,,79012661,CDM,278,RC,,,both,,,525,207.2,39.4668,,207.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,178.5,34,,178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Device,178.5,34,"Charges > $500, x 34%",178.5,percent of total billed charges,Implant Device,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,210,40,,210,percent of total billed charges,Implant Devices,183.75,70,,183.75,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,178.5,34,,178.5,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,183.75,35,,183.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210,
J&J 202.828 CORTEX SCREW 2.7X28MM,C1713,HCPCS,,79012662,CDM,278,RC,,,both,,,85,33.55,39.4668,,33.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,34,40,,34,percent of total billed charges,Implant Devices,29.75,70,,29.75,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34,
J&J 202.830 CORTEX SCREW 2.7X30MM,C1713,HCPCS,,79012663,CDM,278,RC,,,both,,,85,33.55,39.4668,,33.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,28.9,34,,28.9,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,34,40,,34,percent of total billed charges,Implant Devices,29.75,70,,29.75,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,28.9,34,,28.9,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,29.75,35,,29.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,34,
J&J 02.104.008 LCP DIS RAD PLT 8H 3.5MM,C1713,HCPCS,,79012664,CDM,278,RC,,,both,,,3711,1464.61,39.4668,,1464.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1261.74,34,,1261.74,percent of total billed charges,Implant Device,1261.74,34,,1261.74,percent of total billed charges,Implant Device,1261.74,34,,1261.74,percent of total billed charges,Implant Device,1261.74,34,,1261.74,percent of total billed charges,Implant Device,1261.74,34,,1261.74,percent of total billed charges,Implant Device,1261.74,34,,1261.74,percent of total billed charges,Implant Device,1298.85,35,,1298.85,percent of total billed charges,Implant Device,1261.74,34,"Charges > $500, x 34%",1261.74,percent of total billed charges,Implant Device,1298.85,35,,1298.85,percent of total billed charges,Implant Devices,1298.85,35,,1298.85,percent of total billed charges,Implant Devices,1298.85,35,,,percent of total billed charges,Implant Devices,1298.85,35,,1298.85,percent of total billed charges,Implant Devices,1298.85,35,,1298.85,percent of total billed charges,Implant Devices,1484.4,40,,1484.4,percent of total billed charges,Implant Devices,1298.85,70,,1298.85,percent of total billed charges,Implant Devices,1261.74,34,,1261.74,percent of total billed charges,Implant Devices,1261.74,34,,1261.74,percent of total billed charges,Implant Devices,1298.85,35,,1298.85,percent of total billed charges,Implant Devices,1298.85,35,,1298.85,percent of total billed charges,Implant Devices,1298.85,35,,1298.85,percent of total billed charges,Implant Devices,1298.85,35,,1298.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1261.74,34,"If Charge > 2,000, then 34 percent",1261.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1484.4,
J&J 294.772 SCHANZ SCREW 4.0X100MM,C1713,HCPCS,,79012665,CDM,278,RC,,,both,,,272,107.35,39.4668,,107.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,92.48,34,,92.48,percent of total billed charges,Implant Device,92.48,34,,92.48,percent of total billed charges,Implant Device,92.48,34,,92.48,percent of total billed charges,Implant Device,92.48,34,,92.48,percent of total billed charges,Implant Device,92.48,34,,92.48,percent of total billed charges,Implant Device,92.48,34,,92.48,percent of total billed charges,Implant Device,95.2,35,,95.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,108.8,40,,108.8,percent of total billed charges,Implant Devices,95.2,70,,95.2,percent of total billed charges,Implant Devices,92.48,34,,92.48,percent of total billed charges,Implant Devices,92.48,34,,92.48,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,95.2,35,,95.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,108.8,
J&J 02.111.651 DISTAL RADIUS PLT H 2.4MM,C1713,HCPCS,,79012668,CDM,278,RC,,,both,,,2499,986.28,39.4668,,986.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,874.65,35,,874.65,percent of total billed charges,Implant Device,849.66,34,"Charges > $500, x 34%",849.66,percent of total billed charges,Implant Device,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,999.6,40,,999.6,percent of total billed charges,Implant Devices,874.65,70,,874.65,percent of total billed charges,Implant Devices,849.66,34,,849.66,percent of total billed charges,Implant Devices,849.66,34,,849.66,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,849.66,34,"If Charge > 2,000, then 34 percent",849.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,999.6,
J&J 249.679 LCP CONDYLAR PLT 7H 2.4MM,C1713,HCPCS,,79012669,CDM,278,RC,,,both,,,1504,593.58,39.4668,,593.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,511.36,34,,511.36,percent of total billed charges,Implant Device,511.36,34,,511.36,percent of total billed charges,Implant Device,511.36,34,,511.36,percent of total billed charges,Implant Device,511.36,34,,511.36,percent of total billed charges,Implant Device,511.36,34,,511.36,percent of total billed charges,Implant Device,511.36,34,,511.36,percent of total billed charges,Implant Device,526.4,35,,526.4,percent of total billed charges,Implant Device,511.36,34,"Charges > $500, x 34%",511.36,percent of total billed charges,Implant Device,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,601.6,40,,601.6,percent of total billed charges,Implant Devices,526.4,70,,526.4,percent of total billed charges,Implant Devices,511.36,34,,511.36,percent of total billed charges,Implant Devices,511.36,34,,511.36,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,526.4,35,,526.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,601.6,
J&J 247.366 LCP ADAPTION PLT 12H 2.4MM,C1713,HCPCS,,79012670,CDM,278,RC,,,both,,,1165,459.79,39.4668,,459.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,396.1,34,,396.1,percent of total billed charges,Implant Device,396.1,34,,396.1,percent of total billed charges,Implant Device,396.1,34,,396.1,percent of total billed charges,Implant Device,396.1,34,,396.1,percent of total billed charges,Implant Device,396.1,34,,396.1,percent of total billed charges,Implant Device,396.1,34,,396.1,percent of total billed charges,Implant Device,407.75,35,,407.75,percent of total billed charges,Implant Device,396.1,34,"Charges > $500, x 34%",396.1,percent of total billed charges,Implant Device,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,466,40,,466,percent of total billed charges,Implant Devices,407.75,70,,407.75,percent of total billed charges,Implant Devices,396.1,34,,396.1,percent of total billed charges,Implant Devices,396.1,34,,396.1,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,407.75,35,,407.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,466,
J&J 02.127.220 PROX TIBIA PLT 3.5X117MM,C1713,HCPCS,,79012673,CDM,278,RC,,,both,,,4260,1681.29,39.4668,,1681.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1491,35,,1491,percent of total billed charges,Implant Device,1448.4,34,"Charges > $500, x 34%",1448.4,percent of total billed charges,Implant Device,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1704,40,,1704,percent of total billed charges,Implant Devices,1491,70,,1491,percent of total billed charges,Implant Devices,1448.4,34,,1448.4,percent of total billed charges,Implant Devices,1448.4,34,,1448.4,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1448.4,34,"If Charge > 2,000, then 34 percent",1448.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1704,
J&J 02.127.160 LOCKING SCREW 3.5X60MM,C1713,HCPCS,,79012674,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.118.411 FIBULAR PLT LT 9 HOLE,C1713,HCPCS,,79012676,CDM,278,RC,,,both,,,2775,1095.2,39.4668,,1095.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,943.5,34,,943.5,percent of total billed charges,Implant Device,943.5,34,,943.5,percent of total billed charges,Implant Device,943.5,34,,943.5,percent of total billed charges,Implant Device,943.5,34,,943.5,percent of total billed charges,Implant Device,943.5,34,,943.5,percent of total billed charges,Implant Device,943.5,34,,943.5,percent of total billed charges,Implant Device,971.25,35,,971.25,percent of total billed charges,Implant Device,943.5,34,"Charges > $500, x 34%",943.5,percent of total billed charges,Implant Device,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,1110,40,,1110,percent of total billed charges,Implant Devices,971.25,70,,971.25,percent of total billed charges,Implant Devices,943.5,34,,943.5,percent of total billed charges,Implant Devices,943.5,34,,943.5,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,971.25,35,,971.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,943.5,34,"If Charge > 2,000, then 34 percent",943.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1110,
J&J 02.206.230 CORTEX SCREW 2.5X30MM,C1713,HCPCS,,79012677,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
J&J 02.118.207 ANTEROLATERAL DIS PLT LT,C1713,HCPCS,,79012678,CDM,278,RC,,,both,,,4413,1741.67,39.4668,,1741.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1544.55,35,,1544.55,percent of total billed charges,Implant Device,1500.42,34,"Charges > $500, x 34%",1500.42,percent of total billed charges,Implant Device,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1765.2,40,,1765.2,percent of total billed charges,Implant Devices,1544.55,70,,1544.55,percent of total billed charges,Implant Devices,1500.42,34,,1500.42,percent of total billed charges,Implant Devices,1500.42,34,,1500.42,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1500.42,34,"If Charge > 2,000, then 34 percent",1500.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1765.2,
J&J 202.967 CORTEX SCREW 2.7X50MM,C1713,HCPCS,,79012679,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
J&J 02.206.232 CORTEX SCREW 2.5X32MM,C1713,HCPCS,,79012680,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
J&J 02.206.240 CORTEX SCREW 3.5X40MM,C1713,HCPCS,,79012681,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
J&J 76000060 FIBERGRAFT BG PUTTY 6CC,C1713,HCPCS,,79012682,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
J&J SE-2020TI SPEEDTITAN IMPLANT KIT,C1713,HCPCS,,79012684,CDM,278,RC,,,both,,,4512,1780.74,39.4668,,1780.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1579.2,35,,1579.2,percent of total billed charges,Implant Device,1534.08,34,"Charges > $500, x 34%",1534.08,percent of total billed charges,Implant Device,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1804.8,40,,1804.8,percent of total billed charges,Implant Devices,1579.2,70,,1579.2,percent of total billed charges,Implant Devices,1534.08,34,,1534.08,percent of total billed charges,Implant Devices,1534.08,34,,1534.08,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1534.08,34,"If Charge > 2,000, then 34 percent",1534.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1804.8,
J&J 214.820 CORTEX SCREW 4.5X20MM,C1713,HCPCS,,79012685,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
J&J 04.111.631 DISTAL RADIUS PLT 2.4MM,C1713,HCPCS,,79012697,CDM,278,RC,,,both,,,2323,916.81,39.4668,,916.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,789.82,34,,789.82,percent of total billed charges,Implant Device,813.05,35,,813.05,percent of total billed charges,Implant Device,789.82,34,"Charges > $500, x 34%",789.82,percent of total billed charges,Implant Device,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,929.2,40,,929.2,percent of total billed charges,Implant Devices,813.05,70,,813.05,percent of total billed charges,Implant Devices,789.82,34,,789.82,percent of total billed charges,Implant Devices,789.82,34,,789.82,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,813.05,35,,813.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,789.82,34,"If Charge > 2,000, then 34 percent",789.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,929.2,
J&J 401.764 CORTEX SCREW 2.4X14MM,C1713,HCPCS,,79012698,CDM,278,RC,,,both,,,172,67.88,39.4668,,67.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,58.48,34,,58.48,percent of total billed charges,Implant Device,58.48,34,,58.48,percent of total billed charges,Implant Device,58.48,34,,58.48,percent of total billed charges,Implant Device,58.48,34,,58.48,percent of total billed charges,Implant Device,58.48,34,,58.48,percent of total billed charges,Implant Device,58.48,34,,58.48,percent of total billed charges,Implant Device,60.2,35,,60.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,68.8,40,,68.8,percent of total billed charges,Implant Devices,60.2,70,,60.2,percent of total billed charges,Implant Devices,58.48,34,,58.48,percent of total billed charges,Implant Devices,58.48,34,,58.48,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,68.8,
J&J 04.210.122 LOCKING SCREW 2.4X22MM,C1713,HCPCS,,79012699,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
J&J 04.210.124 LOCKING SCREW 2.4X24MM,C1713,HCPCS,,79012700,CDM,278,RC,,,both,,,330,130.24,39.4668,,130.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,112.2,34,,112.2,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,132,40,,132,percent of total billed charges,Implant Devices,115.5,70,,115.5,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,112.2,34,,112.2,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,115.5,35,,115.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132,
J&J 401.762 CORTEX SCREW 2.4X12MM,C1713,HCPCS,,79012701,CDM,278,RC,,,both,,,172,67.88,39.4668,,67.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,58.48,34,,58.48,percent of total billed charges,Implant Device,58.48,34,,58.48,percent of total billed charges,Implant Device,58.48,34,,58.48,percent of total billed charges,Implant Device,58.48,34,,58.48,percent of total billed charges,Implant Device,58.48,34,,58.48,percent of total billed charges,Implant Device,58.48,34,,58.48,percent of total billed charges,Implant Device,60.2,35,,60.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,68.8,40,,68.8,percent of total billed charges,Implant Devices,60.2,70,,60.2,percent of total billed charges,Implant Devices,58.48,34,,58.48,percent of total billed charges,Implant Devices,58.48,34,,58.48,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,60.2,35,,60.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,68.8,
J&J 402.874 CORTEX SCREW 2.7X14MM,C1713,HCPCS,,79012702,CDM,278,RC,,,both,,,136,53.67,39.4668,,53.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,54.4,40,,54.4,percent of total billed charges,Implant Devices,47.6,70,,47.6,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.4,
J&J 02.117.801 LAT DISTAL HUMERUS PLT RT,C1713,HCPCS,,79012716,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
J&J 02.211.048 LOCKING SCREW 2.7X48MM,C1713,HCPCS,,79012717,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
J&J 02.211.058 LOCKING SCREW 2.7X58MM,C1713,HCPCS,,79012718,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
J&J 02.117.604 MEDIAL DIS RADIUS PLT RT,C1713,HCPCS,,79012719,CDM,278,RC,,,both,,,3201,1263.33,39.4668,,1263.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1088.34,34,,1088.34,percent of total billed charges,Implant Device,1088.34,34,,1088.34,percent of total billed charges,Implant Device,1088.34,34,,1088.34,percent of total billed charges,Implant Device,1088.34,34,,1088.34,percent of total billed charges,Implant Device,1088.34,34,,1088.34,percent of total billed charges,Implant Device,1088.34,34,,1088.34,percent of total billed charges,Implant Device,1120.35,35,,1120.35,percent of total billed charges,Implant Device,1088.34,34,"Charges > $500, x 34%",1088.34,percent of total billed charges,Implant Device,1120.35,35,,1120.35,percent of total billed charges,Implant Devices,1120.35,35,,1120.35,percent of total billed charges,Implant Devices,1120.35,35,,,percent of total billed charges,Implant Devices,1120.35,35,,1120.35,percent of total billed charges,Implant Devices,1120.35,35,,1120.35,percent of total billed charges,Implant Devices,1280.4,40,,1280.4,percent of total billed charges,Implant Devices,1120.35,70,,1120.35,percent of total billed charges,Implant Devices,1088.34,34,,1088.34,percent of total billed charges,Implant Devices,1088.34,34,,1088.34,percent of total billed charges,Implant Devices,1120.35,35,,1120.35,percent of total billed charges,Implant Devices,1120.35,35,,1120.35,percent of total billed charges,Implant Devices,1120.35,35,,1120.35,percent of total billed charges,Implant Devices,1120.35,35,,1120.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1088.34,34,"If Charge > 2,000, then 34 percent",1088.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1280.4,
J&J 02.117.204 LAT DISTAL HUMERUS PLT RT,C1713,HCPCS,,79012720,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
J&J 249.676 LCP PLATE 2.4X52MM,C1713,HCPCS,,79012721,CDM,278,RC,,,both,,,1002,395.46,39.4668,,395.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Device,340.68,34,"Charges > $500, x 34%",340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,400.8,40,,400.8,percent of total billed charges,Implant Devices,350.7,70,,350.7,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,400.8,
J&J 02.211.042 LOCKING SCREW 2.7X42MM,C1713,HCPCS,,79012722,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
J&J 02.118.530 METAPHYSEA SCREW 2.7X30MM,C1713,HCPCS,,79012723,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
STRYKER 629790 Y PLT NARROW 10H 2.4X81MM,C1713,HCPCS,,79012724,CDM,278,RC,,,both,,,3366,1328.45,39.4668,,1328.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1178.1,35,,1178.1,percent of total billed charges,Implant Device,1144.44,34,"Charges > $500, x 34%",1144.44,percent of total billed charges,Implant Device,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1346.4,40,,1346.4,percent of total billed charges,Implant Devices,1178.1,70,,1178.1,percent of total billed charges,Implant Devices,1144.44,34,,1144.44,percent of total billed charges,Implant Devices,1144.44,34,,1144.44,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1144.44,34,"If Charge > 2,000, then 34 percent",1144.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1346.4,
STRYKER 656011 LOCKING SCREW 2.4X11MM,C1713,HCPCS,,79012725,CDM,278,RC,,,both,,,676,266.8,39.4668,,266.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Device,229.84,34,"Charges > $500, x 34%",229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,270.4,40,,270.4,percent of total billed charges,Implant Devices,236.6,70,,236.6,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270.4,
STRYKER 656128 BONE SCREW 2.4X28MM,C1713,HCPCS,,79012726,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656134 BONE SCREW 2.4X34MM,C1713,HCPCS,,79012727,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656136 BONE SCREW 2.4X36MM,C1713,HCPCS,,79012728,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
J&J 02.127.130 LOCKING SCREW 3.5X30MM,C1713,HCPCS,,79012739,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.127.221 PROX TIBIA PLT 3.5X117MM,C1713,HCPCS,,79012740,CDM,278,RC,,,both,,,4260,1681.29,39.4668,,1681.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1491,35,,1491,percent of total billed charges,Implant Device,1448.4,34,"Charges > $500, x 34%",1448.4,percent of total billed charges,Implant Device,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1704,40,,1704,percent of total billed charges,Implant Devices,1491,70,,1491,percent of total billed charges,Implant Devices,1448.4,34,,1448.4,percent of total billed charges,Implant Devices,1448.4,34,,1448.4,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1448.4,34,"If Charge > 2,000, then 34 percent",1448.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1704,
J&J 223.601 LCP PLATE 10 HOLE,C1713,HCPCS,,79012742,CDM,278,RC,,,both,,,953,376.12,39.4668,,376.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,324.02,34,,324.02,percent of total billed charges,Implant Device,324.02,34,,324.02,percent of total billed charges,Implant Device,324.02,34,,324.02,percent of total billed charges,Implant Device,324.02,34,,324.02,percent of total billed charges,Implant Device,324.02,34,,324.02,percent of total billed charges,Implant Device,324.02,34,,324.02,percent of total billed charges,Implant Device,333.55,35,,333.55,percent of total billed charges,Implant Device,324.02,34,"Charges > $500, x 34%",324.02,percent of total billed charges,Implant Device,333.55,35,,333.55,percent of total billed charges,Implant Devices,333.55,35,,333.55,percent of total billed charges,Implant Devices,333.55,35,,,percent of total billed charges,Implant Devices,333.55,35,,333.55,percent of total billed charges,Implant Devices,333.55,35,,333.55,percent of total billed charges,Implant Devices,381.2,40,,381.2,percent of total billed charges,Implant Devices,333.55,70,,333.55,percent of total billed charges,Implant Devices,324.02,34,,324.02,percent of total billed charges,Implant Devices,324.02,34,,324.02,percent of total billed charges,Implant Devices,333.55,35,,333.55,percent of total billed charges,Implant Devices,333.55,35,,333.55,percent of total billed charges,Implant Devices,333.55,35,,333.55,percent of total billed charges,Implant Devices,333.55,35,,333.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.2,
STRYKER 626677 TUBULAR PLATE 7 HOLE 83MM,C1713,HCPCS,,79012744,CDM,278,RC,,,both,,,889,350.86,39.4668,,350.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,302.26,34,,302.26,percent of total billed charges,Implant Device,302.26,34,,302.26,percent of total billed charges,Implant Device,302.26,34,,302.26,percent of total billed charges,Implant Device,302.26,34,,302.26,percent of total billed charges,Implant Device,302.26,34,,302.26,percent of total billed charges,Implant Device,302.26,34,,302.26,percent of total billed charges,Implant Device,311.15,35,,311.15,percent of total billed charges,Implant Device,302.26,34,"Charges > $500, x 34%",302.26,percent of total billed charges,Implant Device,311.15,35,,311.15,percent of total billed charges,Implant Devices,311.15,35,,311.15,percent of total billed charges,Implant Devices,311.15,35,,,percent of total billed charges,Implant Devices,311.15,35,,311.15,percent of total billed charges,Implant Devices,311.15,35,,311.15,percent of total billed charges,Implant Devices,355.6,40,,355.6,percent of total billed charges,Implant Devices,311.15,70,,311.15,percent of total billed charges,Implant Devices,302.26,34,,302.26,percent of total billed charges,Implant Devices,302.26,34,,302.26,percent of total billed charges,Implant Devices,311.15,35,,311.15,percent of total billed charges,Implant Devices,311.15,35,,311.15,percent of total billed charges,Implant Devices,311.15,35,,311.15,percent of total billed charges,Implant Devices,311.15,35,,311.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,355.6,
J&J 02.112.622S LCP CLAVICLE PLT LT 2.7,C1713,HCPCS,,79012745,CDM,278,RC,,,both,,,3434,1355.29,39.4668,,1355.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1167.56,34,,1167.56,percent of total billed charges,Implant Device,1201.9,35,,1201.9,percent of total billed charges,Implant Device,1167.56,34,"Charges > $500, x 34%",1167.56,percent of total billed charges,Implant Device,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1373.6,40,,1373.6,percent of total billed charges,Implant Devices,1201.9,70,,1201.9,percent of total billed charges,Implant Devices,1167.56,34,,1167.56,percent of total billed charges,Implant Devices,1167.56,34,,1167.56,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,1201.9,35,,1201.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1167.56,34,"If Charge > 2,000, then 34 percent",1167.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1373.6,
J&J 239.954S PROX TIBIA PLT 4H 3.5X93MM,C1713,HCPCS,,79012746,CDM,278,RC,,,both,,,3765,1485.93,39.4668,,1485.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1317.75,35,,1317.75,percent of total billed charges,Implant Device,1280.1,34,"Charges > $500, x 34%",1280.1,percent of total billed charges,Implant Device,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1506,40,,1506,percent of total billed charges,Implant Devices,1317.75,70,,1317.75,percent of total billed charges,Implant Devices,1280.1,34,,1280.1,percent of total billed charges,Implant Devices,1280.1,34,,1280.1,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1280.1,34,"If Charge > 2,000, then 34 percent",1280.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1506,
J&J 412.218S LOCKING SCREW 5.0X48MM,C1713,HCPCS,,79012748,CDM,278,RC,,,both,,,505,199.31,39.4668,,199.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Device,171.7,34,"Charges > $500, x 34%",171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,202,40,,202,percent of total billed charges,Implant Devices,176.75,70,,176.75,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,202,
J&J 04.168.475S ANTIROTATION SCREW 75MM,C1713,HCPCS,,79012749,CDM,278,RC,,,both,,,633,249.82,39.4668,,249.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,221.55,35,,221.55,percent of total billed charges,Implant Device,215.22,34,"Charges > $500, x 34%",215.22,percent of total billed charges,Implant Device,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,253.2,40,,253.2,percent of total billed charges,Implant Devices,221.55,70,,221.55,percent of total billed charges,Implant Devices,215.22,34,,215.22,percent of total billed charges,Implant Devices,215.22,34,,215.22,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.2,
J&J 04.168.275S BOLT FOR FEM NECK 75MM,C1713,HCPCS,,79012750,CDM,278,RC,,,both,,,938,370.2,39.4668,,370.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,318.92,34,,318.92,percent of total billed charges,Implant Device,318.92,34,,318.92,percent of total billed charges,Implant Device,318.92,34,,318.92,percent of total billed charges,Implant Device,318.92,34,,318.92,percent of total billed charges,Implant Device,318.92,34,,318.92,percent of total billed charges,Implant Device,318.92,34,,318.92,percent of total billed charges,Implant Device,328.3,35,,328.3,percent of total billed charges,Implant Device,318.92,34,"Charges > $500, x 34%",318.92,percent of total billed charges,Implant Device,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,375.2,40,,375.2,percent of total billed charges,Implant Devices,328.3,70,,328.3,percent of total billed charges,Implant Devices,318.92,34,,318.92,percent of total billed charges,Implant Devices,318.92,34,,318.92,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,375.2,
J&J 239.955S LCP PROX TIBIA PLT 3.5X93,C1713,HCPCS,,79012756,CDM,278,RC,,,both,,,3765,1485.93,39.4668,,1485.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1280.1,34,,1280.1,percent of total billed charges,Implant Device,1317.75,35,,1317.75,percent of total billed charges,Implant Device,1280.1,34,"Charges > $500, x 34%",1280.1,percent of total billed charges,Implant Device,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1506,40,,1506,percent of total billed charges,Implant Devices,1317.75,70,,1317.75,percent of total billed charges,Implant Devices,1280.1,34,,1280.1,percent of total billed charges,Implant Devices,1280.1,34,,1280.1,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,1317.75,35,,1317.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1280.1,34,"If Charge > 2,000, then 34 percent",1280.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1506,
J&J 04.005.428S LOCKING SCREW 4.0X38MM,C1713,HCPCS,,79012757,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
J&J 04.015.540S LOCKING SCREW 5.0X50MM,C1713,HCPCS,,79012758,CDM,278,RC,,,both,,,454,179.18,39.4668,,179.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,181.6,40,,181.6,percent of total billed charges,Implant Devices,158.9,70,,158.9,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.6,
J&J 02.127.136 LOCKING SCREW 3.5X36MM,C1713,HCPCS,,79012760,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 02.117.502 MEDIAL PLATE 2.7/3.5MM 2H,C1713,HCPCS,,79012761,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
J&J 02.118.526 SELF TAP SCREW 2.7X26MM,C1713,HCPCS,,79012762,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
J&J 02.118.540 SELF TAP SCREW 2.7X40MM,C1713,HCPCS,,79012763,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
J&J 02.117.303 LATERAL PLT 2.7/3.5MM 3H,C1713,HCPCS,,79012764,CDM,278,RC,,,both,,,3105,1225.44,39.4668,,1225.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1055.7,34,,1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Device,1055.7,34,"Charges > $500, x 34%",1055.7,percent of total billed charges,Implant Device,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1242,40,,1242,percent of total billed charges,Implant Devices,1086.75,70,,1086.75,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1055.7,34,,1055.7,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,1086.75,35,,1086.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1055.7,34,"If Charge > 2,000, then 34 percent",1055.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1242,
STRYKER 626674 TUBULAR PLT 1/3 4H 47MM,C1713,HCPCS,,79012766,CDM,278,RC,,,both,,,890,351.25,39.4668,,351.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,302.6,34,,302.6,percent of total billed charges,Implant Device,302.6,34,,302.6,percent of total billed charges,Implant Device,302.6,34,,302.6,percent of total billed charges,Implant Device,302.6,34,,302.6,percent of total billed charges,Implant Device,302.6,34,,302.6,percent of total billed charges,Implant Device,302.6,34,,302.6,percent of total billed charges,Implant Device,311.5,35,,311.5,percent of total billed charges,Implant Device,302.6,34,"Charges > $500, x 34%",302.6,percent of total billed charges,Implant Device,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,356,40,,356,percent of total billed charges,Implant Devices,311.5,70,,311.5,percent of total billed charges,Implant Devices,302.6,34,,302.6,percent of total billed charges,Implant Devices,302.6,34,,302.6,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,356,
STRYKER 626675 TUBULAR PLT 1/3 5H 59MM,C1713,HCPCS,,79012767,CDM,278,RC,,,both,,,890,351.25,39.4668,,351.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,302.6,34,,302.6,percent of total billed charges,Implant Device,302.6,34,,302.6,percent of total billed charges,Implant Device,302.6,34,,302.6,percent of total billed charges,Implant Device,302.6,34,,302.6,percent of total billed charges,Implant Device,302.6,34,,302.6,percent of total billed charges,Implant Device,302.6,34,,302.6,percent of total billed charges,Implant Device,311.5,35,,311.5,percent of total billed charges,Implant Device,302.6,34,"Charges > $500, x 34%",302.6,percent of total billed charges,Implant Device,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,356,40,,356,percent of total billed charges,Implant Devices,311.5,70,,311.5,percent of total billed charges,Implant Devices,302.6,34,,302.6,percent of total billed charges,Implant Devices,302.6,34,,302.6,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,311.5,35,,311.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,356,
STRYKER 626684 TUBULAR PLT 1/3 14H 167MM,C1713,HCPCS,,79012768,CDM,278,RC,,,both,,,1649,650.81,39.4668,,650.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,560.66,34,,560.66,percent of total billed charges,Implant Device,560.66,34,,560.66,percent of total billed charges,Implant Device,560.66,34,,560.66,percent of total billed charges,Implant Device,560.66,34,,560.66,percent of total billed charges,Implant Device,560.66,34,,560.66,percent of total billed charges,Implant Device,560.66,34,,560.66,percent of total billed charges,Implant Device,577.15,35,,577.15,percent of total billed charges,Implant Device,560.66,34,"Charges > $500, x 34%",560.66,percent of total billed charges,Implant Device,577.15,35,,577.15,percent of total billed charges,Implant Devices,577.15,35,,577.15,percent of total billed charges,Implant Devices,577.15,35,,,percent of total billed charges,Implant Devices,577.15,35,,577.15,percent of total billed charges,Implant Devices,577.15,35,,577.15,percent of total billed charges,Implant Devices,659.6,40,,659.6,percent of total billed charges,Implant Devices,577.15,70,,577.15,percent of total billed charges,Implant Devices,560.66,34,,560.66,percent of total billed charges,Implant Devices,560.66,34,,560.66,percent of total billed charges,Implant Devices,577.15,35,,577.15,percent of total billed charges,Implant Devices,577.15,35,,577.15,percent of total billed charges,Implant Devices,577.15,35,,577.15,percent of total billed charges,Implant Devices,577.15,35,,577.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,659.6,
STRYKER 656424 BONE SCREW 2.7X24MM,C1713,HCPCS,,79012769,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656430 BONE SCREW 2.7X30MM,C1713,HCPCS,,79012770,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656446 BONE SCREW 2.7X46MM,C1713,HCPCS,,79012771,CDM,278,RC,,,both,,,306,120.77,39.4668,,120.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,104.04,34,,104.04,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,122.4,40,,122.4,percent of total billed charges,Implant Devices,107.1,70,,107.1,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,104.04,34,,104.04,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,107.1,35,,107.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122.4,
WRIGHT 86SYN005 GRAVITY SYNCHFIX SYNDES,C1713,HCPCS,,79012772,CDM,278,RC,,,both,,,3686,1454.75,39.4668,,1454.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1253.24,34,,1253.24,percent of total billed charges,Implant Device,1290.1,35,,1290.1,percent of total billed charges,Implant Device,1253.24,34,"Charges > $500, x 34%",1253.24,percent of total billed charges,Implant Device,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1474.4,40,,1474.4,percent of total billed charges,Implant Devices,1290.1,70,,1290.1,percent of total billed charges,Implant Devices,1253.24,34,,1253.24,percent of total billed charges,Implant Devices,1253.24,34,,1253.24,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,1290.1,35,,1290.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1253.24,34,"If Charge > 2,000, then 34 percent",1253.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1474.4,
ZIMMER 131218028 CORTICAL SCREW 3.5X28MM,C1713,HCPCS,,79012773,CDM,278,RC,,,both,,,187,73.8,39.4668,,73.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.58,34,,63.58,percent of total billed charges,Implant Device,63.58,34,,63.58,percent of total billed charges,Implant Device,63.58,34,,63.58,percent of total billed charges,Implant Device,63.58,34,,63.58,percent of total billed charges,Implant Device,63.58,34,,63.58,percent of total billed charges,Implant Device,63.58,34,,63.58,percent of total billed charges,Implant Device,65.45,35,,65.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,74.8,40,,74.8,percent of total billed charges,Implant Devices,65.45,70,,65.45,percent of total billed charges,Implant Devices,63.58,34,,63.58,percent of total billed charges,Implant Devices,63.58,34,,63.58,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.8,
ZIMMER 131218026 CORTICAL SCREW 3.5X26MM,C1713,HCPCS,,79012774,CDM,278,RC,,,both,,,187,73.8,39.4668,,73.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.58,34,,63.58,percent of total billed charges,Implant Device,63.58,34,,63.58,percent of total billed charges,Implant Device,63.58,34,,63.58,percent of total billed charges,Implant Device,63.58,34,,63.58,percent of total billed charges,Implant Device,63.58,34,,63.58,percent of total billed charges,Implant Device,63.58,34,,63.58,percent of total billed charges,Implant Device,65.45,35,,65.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,74.8,40,,74.8,percent of total billed charges,Implant Devices,65.45,70,,65.45,percent of total billed charges,Implant Devices,63.58,34,,63.58,percent of total billed charges,Implant Devices,63.58,34,,63.58,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,65.45,35,,65.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.8,
ZIMMER 824074001 MIDFOOT FUSION PLT SM,C1713,HCPCS,,79012776,CDM,278,RC,,,both,,,2573,1015.48,39.4668,,1015.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,874.82,34,,874.82,percent of total billed charges,Implant Device,874.82,34,,874.82,percent of total billed charges,Implant Device,874.82,34,,874.82,percent of total billed charges,Implant Device,874.82,34,,874.82,percent of total billed charges,Implant Device,874.82,34,,874.82,percent of total billed charges,Implant Device,874.82,34,,874.82,percent of total billed charges,Implant Device,900.55,35,,900.55,percent of total billed charges,Implant Device,874.82,34,"Charges > $500, x 34%",874.82,percent of total billed charges,Implant Device,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,1029.2,40,,1029.2,percent of total billed charges,Implant Devices,900.55,70,,900.55,percent of total billed charges,Implant Devices,874.82,34,,874.82,percent of total billed charges,Implant Devices,874.82,34,,874.82,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,874.82,34,"If Charge > 2,000, then 34 percent",874.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1029.2,
J&J 206.045 CANCELLOUS SCREW 4X45MM,C1713,HCPCS,,79012793,CDM,278,RC,,,both,,,47,18.55,39.4668,,18.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,15.98,34,,15.98,percent of total billed charges,Implant Device,16.45,35,,16.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,18.8,40,,18.8,percent of total billed charges,Implant Devices,16.45,70,,16.45,percent of total billed charges,Implant Devices,15.98,34,,15.98,percent of total billed charges,Implant Devices,15.98,34,,15.98,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,16.45,35,,16.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18.8,
ARTHREX AR-8970TT-04 TT PLATE 4 HOLE,C1713,HCPCS,,79012794,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
ARTHREX AR-8770-60H FT SCREW 7.0X4.0MM,C1713,HCPCS,,79012795,CDM,278,RC,,,both,,,2085,822.88,39.4668,,822.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,708.9,34,,708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Device,708.9,34,"Charges > $500, x 34%",708.9,percent of total billed charges,Implant Device,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,834,40,,834,percent of total billed charges,Implant Devices,729.75,70,,729.75,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,708.9,34,,708.9,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,729.75,35,,729.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,708.9,34,"If Charge > 2,000, then 34 percent",708.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,834,
ARTHREX AR-8545-42 CORT SCREW 4.5X42MM,C1713,HCPCS,,79012796,CDM,278,RC,,,both,,,225,88.8,39.4668,,88.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,76.5,34,,76.5,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,90,40,,90,percent of total billed charges,Implant Devices,78.75,70,,78.75,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,76.5,34,,76.5,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,78.75,35,,78.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,90,
ARTHREX AR-8545L-50 LOCK SCREW 4.5X5MM,C1713,HCPCS,,79012797,CDM,278,RC,,,both,,,585,230.88,39.4668,,230.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,204.75,35,,204.75,percent of total billed charges,Implant Device,198.9,34,"Charges > $500, x 34%",198.9,percent of total billed charges,Implant Device,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,234,40,,234,percent of total billed charges,Implant Devices,204.75,70,,204.75,percent of total billed charges,Implant Devices,198.9,34,,198.9,percent of total billed charges,Implant Devices,198.9,34,,198.9,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234,
J&J 02.118.544 METAPHYSEA SCREW 2.7X44MM,C1713,HCPCS,,79012812,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
J&J 04.045.034S LOCKING SCREW 5X34MM,C1713,HCPCS,,79012817,CDM,278,RC,,,both,,,687,271.14,39.4668,,271.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Device,233.58,34,"Charges > $500, x 34%",233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,274.8,40,,274.8,percent of total billed charges,Implant Devices,240.45,70,,240.45,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.8,
J&J 04.037.114S TFNA NAIL 11X125 125 DEG,C1713,HCPCS,,79012818,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
ZIMMER 115397 CENTRAL SCREW 6.5X35MM,C1713,HCPCS,,79012821,CDM,278,RC,,,both,,,211,83.27,39.4668,,83.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,73.85,35,,73.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,84.4,40,,84.4,percent of total billed charges,Implant Devices,73.85,70,,73.85,percent of total billed charges,Implant Devices,71.74,34,,71.74,percent of total billed charges,Implant Devices,71.74,34,,71.74,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84.4,
ZIMMER 180553 LOCKING SCREW 4.75X30MM,C1713,HCPCS,,79012822,CDM,278,RC,,,both,,,211,83.27,39.4668,,83.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,73.85,35,,73.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,84.4,40,,84.4,percent of total billed charges,Implant Devices,73.85,70,,73.85,percent of total billed charges,Implant Devices,71.74,34,,71.74,percent of total billed charges,Implant Devices,71.74,34,,71.74,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84.4,
STRYKER 57-10161 BONE PLATE 2.3MM 8 HOLE,C1713,HCPCS,,79012827,CDM,278,RC,,,both,,,799,315.34,39.4668,,315.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,271.66,34,,271.66,percent of total billed charges,Implant Device,271.66,34,,271.66,percent of total billed charges,Implant Device,271.66,34,,271.66,percent of total billed charges,Implant Device,271.66,34,,271.66,percent of total billed charges,Implant Device,271.66,34,,271.66,percent of total billed charges,Implant Device,271.66,34,,271.66,percent of total billed charges,Implant Device,279.65,35,,279.65,percent of total billed charges,Implant Device,271.66,34,"Charges > $500, x 34%",271.66,percent of total billed charges,Implant Device,279.65,35,,279.65,percent of total billed charges,Implant Devices,279.65,35,,279.65,percent of total billed charges,Implant Devices,279.65,35,,,percent of total billed charges,Implant Devices,279.65,35,,279.65,percent of total billed charges,Implant Devices,279.65,35,,279.65,percent of total billed charges,Implant Devices,319.6,40,,319.6,percent of total billed charges,Implant Devices,279.65,70,,279.65,percent of total billed charges,Implant Devices,271.66,34,,271.66,percent of total billed charges,Implant Devices,271.66,34,,271.66,percent of total billed charges,Implant Devices,279.65,35,,279.65,percent of total billed charges,Implant Devices,279.65,35,,279.65,percent of total billed charges,Implant Devices,279.65,35,,279.65,percent of total billed charges,Implant Devices,279.65,35,,279.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,319.6,
J&J 245.051 LCP PLATE 3.5MM 5 HOLE,C1713,HCPCS,,79012830,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
J&J 245.061 LCP PLATE 3.5MM 6 HOLE,C1713,HCPCS,,79012831,CDM,278,RC,,,both,,,1301,513.46,39.4668,,513.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,442.34,34,,442.34,percent of total billed charges,Implant Device,455.35,35,,455.35,percent of total billed charges,Implant Device,442.34,34,"Charges > $500, x 34%",442.34,percent of total billed charges,Implant Device,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,520.4,40,,520.4,percent of total billed charges,Implant Devices,455.35,70,,455.35,percent of total billed charges,Implant Devices,442.34,34,,442.34,percent of total billed charges,Implant Devices,442.34,34,,442.34,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,455.35,35,,455.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,520.4,
J&J 247.374 LCP PLATE 2.7X94MM 10 HOLE,C1713,HCPCS,,79012834,CDM,278,RC,,,both,,,1057,417.16,39.4668,,417.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,369.95,35,,369.95,percent of total billed charges,Implant Device,359.38,34,"Charges > $500, x 34%",359.38,percent of total billed charges,Implant Device,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,422.8,40,,422.8,percent of total billed charges,Implant Devices,369.95,70,,369.95,percent of total billed charges,Implant Devices,359.38,34,,359.38,percent of total billed charges,Implant Devices,359.38,34,,359.38,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,422.8,
J&J 202.900 CORTEX SCREW 2.7X40MM,C1713,HCPCS,,79012835,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
J&J 02.247.390S LCP PLATE 2.7X161MM 20H,C1713,HCPCS,,79012836,CDM,278,RC,,,both,,,1901,750.26,39.4668,,750.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,646.34,34,,646.34,percent of total billed charges,Implant Device,646.34,34,,646.34,percent of total billed charges,Implant Device,646.34,34,,646.34,percent of total billed charges,Implant Device,646.34,34,,646.34,percent of total billed charges,Implant Device,646.34,34,,646.34,percent of total billed charges,Implant Device,646.34,34,,646.34,percent of total billed charges,Implant Device,665.35,35,,665.35,percent of total billed charges,Implant Device,646.34,34,"Charges > $500, x 34%",646.34,percent of total billed charges,Implant Device,665.35,35,,665.35,percent of total billed charges,Implant Devices,665.35,35,,665.35,percent of total billed charges,Implant Devices,665.35,35,,,percent of total billed charges,Implant Devices,665.35,35,,665.35,percent of total billed charges,Implant Devices,665.35,35,,665.35,percent of total billed charges,Implant Devices,760.4,40,,760.4,percent of total billed charges,Implant Devices,665.35,70,,665.35,percent of total billed charges,Implant Devices,646.34,34,,646.34,percent of total billed charges,Implant Devices,646.34,34,,646.34,percent of total billed charges,Implant Devices,665.35,35,,665.35,percent of total billed charges,Implant Devices,665.35,35,,665.35,percent of total billed charges,Implant Devices,665.35,35,,665.35,percent of total billed charges,Implant Devices,665.35,35,,665.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,760.4,
J&J 02.118.211 VA PLATE 2.7/3.5MM 12H LT,C1713,HCPCS,,79012837,CDM,278,RC,,,both,,,5055,1995.05,39.4668,,1995.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1718.7,34,,1718.7,percent of total billed charges,Implant Device,1718.7,34,,1718.7,percent of total billed charges,Implant Device,1718.7,34,,1718.7,percent of total billed charges,Implant Device,1718.7,34,,1718.7,percent of total billed charges,Implant Device,1718.7,34,,1718.7,percent of total billed charges,Implant Device,1718.7,34,,1718.7,percent of total billed charges,Implant Device,1769.25,35,,1769.25,percent of total billed charges,Implant Device,1718.7,34,"Charges > $500, x 34%",1718.7,percent of total billed charges,Implant Device,1769.25,35,,1769.25,percent of total billed charges,Implant Devices,1769.25,35,,1769.25,percent of total billed charges,Implant Devices,1769.25,35,,,percent of total billed charges,Implant Devices,1769.25,35,,1769.25,percent of total billed charges,Implant Devices,1769.25,35,,1769.25,percent of total billed charges,Implant Devices,2022,40,,2022,percent of total billed charges,Implant Devices,1769.25,70,,1769.25,percent of total billed charges,Implant Devices,1718.7,34,,1718.7,percent of total billed charges,Implant Devices,1718.7,34,,1718.7,percent of total billed charges,Implant Devices,1769.25,35,,1769.25,percent of total billed charges,Implant Devices,1769.25,35,,1769.25,percent of total billed charges,Implant Devices,1769.25,35,,1769.25,percent of total billed charges,Implant Devices,1769.25,35,,1769.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1718.7,34,"If Charge > 2,000, then 34 percent",1718.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2022,
J&J 02.206.234 CORTEX SCREW 3.5X34MM,C1713,HCPCS,,79012838,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
J&J 02.206.248 CORTEX SCREW 3.5X48MM,C1713,HCPCS,,79012839,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
J&J 02.206.242 CORTEX SCREW 3.5XC42MM,C1713,HCPCS,,79012840,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
J&J 02.206.250 CORTEX SCREW 3X50MM,C1713,HCPCS,,79012841,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
J&J 02.211.044 LOCKING SCREW 2.7X44MM,C1713,HCPCS,,79012842,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
J&J 02.206.236 CORTEX SCREW 3.5X36MM,C1713,HCPCS,,79012843,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
STRYKER 629771 T PLATE NARROW 2X62MM 10H,C1713,HCPCS,,79012854,CDM,278,RC,,,both,,,2512,991.41,39.4668,,991.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,854.08,34,,854.08,percent of total billed charges,Implant Device,854.08,34,,854.08,percent of total billed charges,Implant Device,854.08,34,,854.08,percent of total billed charges,Implant Device,854.08,34,,854.08,percent of total billed charges,Implant Device,854.08,34,,854.08,percent of total billed charges,Implant Device,854.08,34,,854.08,percent of total billed charges,Implant Device,879.2,35,,879.2,percent of total billed charges,Implant Device,854.08,34,"Charges > $500, x 34%",854.08,percent of total billed charges,Implant Device,879.2,35,,879.2,percent of total billed charges,Implant Devices,879.2,35,,879.2,percent of total billed charges,Implant Devices,879.2,35,,,percent of total billed charges,Implant Devices,879.2,35,,879.2,percent of total billed charges,Implant Devices,879.2,35,,879.2,percent of total billed charges,Implant Devices,1004.8,40,,1004.8,percent of total billed charges,Implant Devices,879.2,70,,879.2,percent of total billed charges,Implant Devices,854.08,34,,854.08,percent of total billed charges,Implant Devices,854.08,34,,854.08,percent of total billed charges,Implant Devices,879.2,35,,879.2,percent of total billed charges,Implant Devices,879.2,35,,879.2,percent of total billed charges,Implant Devices,879.2,35,,879.2,percent of total billed charges,Implant Devices,879.2,35,,879.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,854.08,34,"If Charge > 2,000, then 34 percent",854.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1004.8,
STRYKER 657611 LOCKING SCREW 2.0X11MM,C1713,HCPCS,,79012855,CDM,278,RC,,,both,,,676,266.8,39.4668,,266.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Device,229.84,34,"Charges > $500, x 34%",229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,270.4,40,,270.4,percent of total billed charges,Implant Devices,236.6,70,,236.6,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270.4,
STRYKER 657616 LOCKING SCREW 2.0X10MM,C1713,HCPCS,,79012856,CDM,278,RC,,,both,,,676,266.8,39.4668,,266.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Device,229.84,34,"Charges > $500, x 34%",229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,270.4,40,,270.4,percent of total billed charges,Implant Devices,236.6,70,,236.6,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270.4,
STRYKER 657710 BONE SCREW 2.0X10MM,C1713,HCPCS,,79012857,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
ARTHREX AR-1588AU-CP GRAFTLINK ACL KIT,C1713,HCPCS,,79012864,CDM,278,RC,,,both,,,2040,805.12,39.4668,,805.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,693.6,34,,693.6,percent of total billed charges,Implant Device,693.6,34,,693.6,percent of total billed charges,Implant Device,693.6,34,,693.6,percent of total billed charges,Implant Device,693.6,34,,693.6,percent of total billed charges,Implant Device,693.6,34,,693.6,percent of total billed charges,Implant Device,693.6,34,,693.6,percent of total billed charges,Implant Device,714,35,,714,percent of total billed charges,Implant Device,693.6,34,"Charges > $500, x 34%",693.6,percent of total billed charges,Implant Device,714,35,,714,percent of total billed charges,Implant Devices,714,35,,714,percent of total billed charges,Implant Devices,714,35,,,percent of total billed charges,Implant Devices,714,35,,714,percent of total billed charges,Implant Devices,714,35,,714,percent of total billed charges,Implant Devices,816,40,,816,percent of total billed charges,Implant Devices,714,70,,714,percent of total billed charges,Implant Devices,693.6,34,,693.6,percent of total billed charges,Implant Devices,693.6,34,,693.6,percent of total billed charges,Implant Devices,714,35,,714,percent of total billed charges,Implant Devices,714,35,,714,percent of total billed charges,Implant Devices,714,35,,714,percent of total billed charges,Implant Devices,714,35,,714,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,693.6,34,"If Charge > 2,000, then 34 percent",693.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,816,
ARTHREX AR-3641SP FIBERTAK KNOTLESS 2.6,C1713,HCPCS,,79012865,CDM,278,RC,,,both,,,1350,532.8,39.4668,,532.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Device,459,34,"Charges > $500, x 34%",459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,540,40,,540,percent of total billed charges,Implant Devices,472.5,70,,472.5,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,540,
J&J 224.621 LCP PLATE 4.5MM 12 HOLE,C1713,HCPCS,,79012868,CDM,278,RC,,,both,,,1610,635.42,39.4668,,635.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,547.4,34,,547.4,percent of total billed charges,Implant Device,547.4,34,,547.4,percent of total billed charges,Implant Device,547.4,34,,547.4,percent of total billed charges,Implant Device,547.4,34,,547.4,percent of total billed charges,Implant Device,547.4,34,,547.4,percent of total billed charges,Implant Device,547.4,34,,547.4,percent of total billed charges,Implant Device,563.5,35,,563.5,percent of total billed charges,Implant Device,547.4,34,"Charges > $500, x 34%",547.4,percent of total billed charges,Implant Device,563.5,35,,563.5,percent of total billed charges,Implant Devices,563.5,35,,563.5,percent of total billed charges,Implant Devices,563.5,35,,,percent of total billed charges,Implant Devices,563.5,35,,563.5,percent of total billed charges,Implant Devices,563.5,35,,563.5,percent of total billed charges,Implant Devices,644,40,,644,percent of total billed charges,Implant Devices,563.5,70,,563.5,percent of total billed charges,Implant Devices,547.4,34,,547.4,percent of total billed charges,Implant Devices,547.4,34,,547.4,percent of total billed charges,Implant Devices,563.5,35,,563.5,percent of total billed charges,Implant Devices,563.5,35,,563.5,percent of total billed charges,Implant Devices,563.5,35,,563.5,percent of total billed charges,Implant Devices,563.5,35,,563.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,644,
J&J 02.115.150 VA DORSAL PLATE 2.4MM,C1713,HCPCS,,79012869,CDM,278,RC,,,both,,,1405,554.51,39.4668,,554.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,477.7,34,,477.7,percent of total billed charges,Implant Device,477.7,34,,477.7,percent of total billed charges,Implant Device,477.7,34,,477.7,percent of total billed charges,Implant Device,477.7,34,,477.7,percent of total billed charges,Implant Device,477.7,34,,477.7,percent of total billed charges,Implant Device,477.7,34,,477.7,percent of total billed charges,Implant Device,491.75,35,,491.75,percent of total billed charges,Implant Device,477.7,34,"Charges > $500, x 34%",477.7,percent of total billed charges,Implant Device,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,562,40,,562,percent of total billed charges,Implant Devices,491.75,70,,491.75,percent of total billed charges,Implant Devices,477.7,34,,477.7,percent of total billed charges,Implant Devices,477.7,34,,477.7,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,491.75,35,,491.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,562,
IN2BONES P72 ST118 LOCK SCREW 2.7X18MM,C1713,HCPCS,,79012875,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
J&J 02.211.036 LOCKING SCREW 2.7X36MM,C1713,HCPCS,,79012891,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
J&J 04.005.546S LOCKING SCREW 5.0X56MM,C1713,HCPCS,,79012901,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
J&J 04.037.129S TFNA NAIL 11X380 125 DEG,C1713,HCPCS,,79012902,CDM,278,RC,,,both,,,5467,2157.65,39.4668,,2157.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1913.45,35,,1913.45,percent of total billed charges,Implant Device,1858.78,34,"Charges > $500, x 34%",1858.78,percent of total billed charges,Implant Device,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,2186.8,40,,2186.8,percent of total billed charges,Implant Devices,1913.45,70,,1913.45,percent of total billed charges,Implant Devices,1858.78,34,,1858.78,percent of total billed charges,Implant Devices,1858.78,34,,1858.78,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1858.78,34,"If Charge > 2,000, then 34 percent",1858.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2186.8,
J&J 04.038.190S TFNA SCREW 90MM,C1713,HCPCS,,79012903,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
J&J 02.124.419 CONDYLAR PLT 4.5X370 18H,C1713,HCPCS,,79012904,CDM,278,RC,,,both,,,5428,2142.26,39.4668,,2142.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1845.52,34,,1845.52,percent of total billed charges,Implant Device,1899.8,35,,1899.8,percent of total billed charges,Implant Device,1845.52,34,"Charges > $500, x 34%",1845.52,percent of total billed charges,Implant Device,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,2171.2,40,,2171.2,percent of total billed charges,Implant Devices,1899.8,70,,1899.8,percent of total billed charges,Implant Devices,1845.52,34,,1845.52,percent of total billed charges,Implant Devices,1845.52,34,,1845.52,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,1899.8,35,,1899.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1845.52,34,"If Charge > 2,000, then 34 percent",1845.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2171.2,
J&J 3092040 BONE CEMENT 40G,C1713,HCPCS,,79012907,CDM,278,RC,,,both,,,711,280.61,39.4668,,280.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,241.74,34,,241.74,percent of total billed charges,Implant Device,248.85,35,,248.85,percent of total billed charges,Implant Device,241.74,34,"Charges > $500, x 34%",241.74,percent of total billed charges,Implant Device,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,284.4,40,,284.4,percent of total billed charges,Implant Devices,248.85,70,,248.85,percent of total billed charges,Implant Devices,241.74,34,,241.74,percent of total billed charges,Implant Devices,241.74,34,,241.74,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,248.85,35,,248.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,284.4,
J&J 04.038.185S TFNA FENESTATED SCREW 85,C1713,HCPCS,,79012908,CDM,278,RC,,,both,,,1693,668.17,39.4668,,668.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,592.55,35,,592.55,percent of total billed charges,Implant Device,575.62,34,"Charges > $500, x 34%",575.62,percent of total billed charges,Implant Device,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,677.2,40,,677.2,percent of total billed charges,Implant Devices,592.55,70,,592.55,percent of total billed charges,Implant Devices,575.62,34,,575.62,percent of total billed charges,Implant Devices,575.62,34,,575.62,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,677.2,
PARAGON P50-453-2715 NON LOCK SRW 2.7X15,C1713,HCPCS,,79012918,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
PARAGON P50-453-2724 NON LOCK SRW 2.7X24,C1713,HCPCS,,79012919,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
PARAGON P53-203-R009 FIBULAR PLT RT 9H,C1713,HCPCS,,79012920,CDM,278,RC,,,both,,,5240,2068.06,39.4668,,2068.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1834,35,,1834,percent of total billed charges,Implant Device,1781.6,34,"Charges > $500, x 34%",1781.6,percent of total billed charges,Implant Device,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,2096,40,,2096,percent of total billed charges,Implant Devices,1834,70,,1834,percent of total billed charges,Implant Devices,1781.6,34,,1781.6,percent of total billed charges,Implant Devices,1781.6,34,,1781.6,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1781.6,34,"If Charge > 2,000, then 34 percent",1781.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2096,
PARAGON P50-453-3512 NON LOCK SRW 3.5X12,C1713,HCPCS,,79012921,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
PARAGON P50-353-2715 LOCK SCREW 2.7X15,C1713,HCPCS,,79012922,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
PARAGON P50-353-2711 LOCK SCREW 2.7X11MM,C1713,HCPCS,,79012923,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
PARAGON P50-353-2714 LOCK SCREW 2.7X14MM,C1713,HCPCS,,79012924,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
PARAGON P50-353-3512 LOCK SCREW 3.5X12MM,C1713,HCPCS,,79012925,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
PARAGON P50-353-2713 LOCK SCREW 2.7X13MM,C1713,HCPCS,,79012926,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
PARAGON P20-130-030S THREAD HEAD SC 3X30,C1713,HCPCS,,79012927,CDM,278,RC,,,both,,,735,290.08,39.4668,,290.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Device,249.9,34,"Charges > $500, x 34%",249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,294,40,,294,percent of total billed charges,Implant Devices,257.25,70,,257.25,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,294,
PARAGON P20-030-DW00 WASHER 3.0MM,C1713,HCPCS,,79012929,CDM,278,RC,,,both,,,336,132.61,39.4668,,132.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,114.24,34,,114.24,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,134.4,40,,134.4,percent of total billed charges,Implant Devices,117.6,70,,117.6,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,114.24,34,,114.24,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,117.6,35,,117.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,134.4,
PARAGON P50-353-3514 LOCK SCREW 3.5X14MM,C1713,HCPCS,,79012932,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
STRYKER 662616 BONE SCREW 1.7X16MM,C1713,HCPCS,,79012936,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
J&J 02.127.311 PROX TIBIAL PLT 3.5X87MM,C1713,HCPCS,,79012938,CDM,278,RC,,,both,,,4211,1661.95,39.4668,,1661.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1431.74,34,,1431.74,percent of total billed charges,Implant Device,1431.74,34,,1431.74,percent of total billed charges,Implant Device,1431.74,34,,1431.74,percent of total billed charges,Implant Device,1431.74,34,,1431.74,percent of total billed charges,Implant Device,1431.74,34,,1431.74,percent of total billed charges,Implant Device,1431.74,34,,1431.74,percent of total billed charges,Implant Device,1473.85,35,,1473.85,percent of total billed charges,Implant Device,1431.74,34,"Charges > $500, x 34%",1431.74,percent of total billed charges,Implant Device,1473.85,35,,1473.85,percent of total billed charges,Implant Devices,1473.85,35,,1473.85,percent of total billed charges,Implant Devices,1473.85,35,,,percent of total billed charges,Implant Devices,1473.85,35,,1473.85,percent of total billed charges,Implant Devices,1473.85,35,,1473.85,percent of total billed charges,Implant Devices,1684.4,40,,1684.4,percent of total billed charges,Implant Devices,1473.85,70,,1473.85,percent of total billed charges,Implant Devices,1431.74,34,,1431.74,percent of total billed charges,Implant Devices,1431.74,34,,1431.74,percent of total billed charges,Implant Devices,1473.85,35,,1473.85,percent of total billed charges,Implant Devices,1473.85,35,,1473.85,percent of total billed charges,Implant Devices,1473.85,35,,1473.85,percent of total billed charges,Implant Devices,1473.85,35,,1473.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1431.74,34,"If Charge > 2,000, then 34 percent",1431.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1684.4,
J&J 204.842 CORTEX SCREW 3.5X42MM,C1713,HCPCS,,79012939,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
ARTHREX AR-1288QIS-110 QUAD IMPL SYS 11,C1713,HCPCS,,79012943,CDM,278,RC,,,both,,,6525,2575.21,39.4668,,2575.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2218.5,34,,2218.5,percent of total billed charges,Implant Device,2218.5,34,,2218.5,percent of total billed charges,Implant Device,2218.5,34,,2218.5,percent of total billed charges,Implant Device,2218.5,34,,2218.5,percent of total billed charges,Implant Device,2218.5,34,,2218.5,percent of total billed charges,Implant Device,2218.5,34,,2218.5,percent of total billed charges,Implant Device,2283.75,35,,2283.75,percent of total billed charges,Implant Device,2218.5,34,"Charges > $500, x 34%",2218.5,percent of total billed charges,Implant Device,2283.75,35,,2283.75,percent of total billed charges,Implant Devices,2283.75,35,,2283.75,percent of total billed charges,Implant Devices,2283.75,35,,,percent of total billed charges,Implant Devices,2283.75,35,,2283.75,percent of total billed charges,Implant Devices,2283.75,35,,2283.75,percent of total billed charges,Implant Devices,2610,40,,2610,percent of total billed charges,Implant Devices,2283.75,70,,2283.75,percent of total billed charges,Implant Devices,2218.5,34,,2218.5,percent of total billed charges,Implant Devices,2218.5,34,,2218.5,percent of total billed charges,Implant Devices,2283.75,35,,2283.75,percent of total billed charges,Implant Devices,2283.75,35,,2283.75,percent of total billed charges,Implant Devices,2283.75,35,,2283.75,percent of total billed charges,Implant Devices,2283.75,35,,2283.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2218.5,34,"If Charge > 2,000, then 34 percent",2218.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2610,
ARTHREX AR-1588RT-2J ACL KIT,C1713,HCPCS,,79012944,CDM,278,RC,,,both,,,1395,550.56,39.4668,,550.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,474.3,34,,474.3,percent of total billed charges,Implant Device,488.25,35,,488.25,percent of total billed charges,Implant Device,474.3,34,"Charges > $500, x 34%",474.3,percent of total billed charges,Implant Device,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,558,40,,558,percent of total billed charges,Implant Devices,488.25,70,,488.25,percent of total billed charges,Implant Devices,474.3,34,,474.3,percent of total billed charges,Implant Devices,474.3,34,,474.3,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,488.25,35,,488.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,558,
ARTHREX AR-8555-60 CANC SCREW 5.5X60MM,C1713,HCPCS,,79012945,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER 629728 LOCK PLATE 8H 2.7X64MM,C1713,HCPCS,,79012949,CDM,278,RC,,,both,,,3152,1243.99,39.4668,,1243.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071.68,34,,1071.68,percent of total billed charges,Implant Device,1071.68,34,,1071.68,percent of total billed charges,Implant Device,1071.68,34,,1071.68,percent of total billed charges,Implant Device,1071.68,34,,1071.68,percent of total billed charges,Implant Device,1071.68,34,,1071.68,percent of total billed charges,Implant Device,1071.68,34,,1071.68,percent of total billed charges,Implant Device,1103.2,35,,1103.2,percent of total billed charges,Implant Device,1071.68,34,"Charges > $500, x 34%",1071.68,percent of total billed charges,Implant Device,1103.2,35,,1103.2,percent of total billed charges,Implant Devices,1103.2,35,,1103.2,percent of total billed charges,Implant Devices,1103.2,35,,,percent of total billed charges,Implant Devices,1103.2,35,,1103.2,percent of total billed charges,Implant Devices,1103.2,35,,1103.2,percent of total billed charges,Implant Devices,1260.8,40,,1260.8,percent of total billed charges,Implant Devices,1103.2,70,,1103.2,percent of total billed charges,Implant Devices,1071.68,34,,1071.68,percent of total billed charges,Implant Devices,1071.68,34,,1071.68,percent of total billed charges,Implant Devices,1103.2,35,,1103.2,percent of total billed charges,Implant Devices,1103.2,35,,1103.2,percent of total billed charges,Implant Devices,1103.2,35,,1103.2,percent of total billed charges,Implant Devices,1103.2,35,,1103.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071.68,34,"If Charge > 2,000, then 34 percent",1071.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260.8,
STRYKER 629777 LOCK PLATE 10H 2.4X76MM,C1713,HCPCS,,79012950,CDM,278,RC,,,both,,,2938,1159.53,39.4668,,1159.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,998.92,34,,998.92,percent of total billed charges,Implant Device,998.92,34,,998.92,percent of total billed charges,Implant Device,998.92,34,,998.92,percent of total billed charges,Implant Device,998.92,34,,998.92,percent of total billed charges,Implant Device,998.92,34,,998.92,percent of total billed charges,Implant Device,998.92,34,,998.92,percent of total billed charges,Implant Device,1028.3,35,,1028.3,percent of total billed charges,Implant Device,998.92,34,"Charges > $500, x 34%",998.92,percent of total billed charges,Implant Device,1028.3,35,,1028.3,percent of total billed charges,Implant Devices,1028.3,35,,1028.3,percent of total billed charges,Implant Devices,1028.3,35,,,percent of total billed charges,Implant Devices,1028.3,35,,1028.3,percent of total billed charges,Implant Devices,1028.3,35,,1028.3,percent of total billed charges,Implant Devices,1175.2,40,,1175.2,percent of total billed charges,Implant Devices,1028.3,70,,1028.3,percent of total billed charges,Implant Devices,998.92,34,,998.92,percent of total billed charges,Implant Devices,998.92,34,,998.92,percent of total billed charges,Implant Devices,1028.3,35,,1028.3,percent of total billed charges,Implant Devices,1028.3,35,,1028.3,percent of total billed charges,Implant Devices,1028.3,35,,1028.3,percent of total billed charges,Implant Devices,1028.3,35,,1028.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,998.92,34,"If Charge > 2,000, then 34 percent",998.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1175.2,
STRYKER 656030 LOCKING SCREW 2.4X18MM,C1713,HCPCS,,79012951,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 656124 BONE SCREW 2.4X24MM,C1713,HCPCS,,79012952,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656126 BONE SCREW 2.4X26MM,C1713,HCPCS,,79012953,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656130 BONE SCREW 2.4X30MM,C1713,HCPCS,,79012954,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656432 BONE SCREW 2.7X32MM,C1713,HCPCS,,79012955,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656442 BONE SCREW 2.7X42MM,C1713,HCPCS,,79012956,CDM,278,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,95.88,34,,95.88,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,112.8,40,,112.8,percent of total billed charges,Implant Devices,98.7,70,,98.7,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,95.88,34,,95.88,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,98.7,35,,98.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.8,
STRYKER 656460 BONE SCREW 2.7X60MM,C1713,HCPCS,,79012957,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
STRYKER 2361-5070S LOCKING SCREW 5X55MM,C1713,HCPCS,,79012965,CDM,278,RC,,,both,,,887,350.07,39.4668,,350.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Device,301.58,34,"Charges > $500, x 34%",301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,354.8,40,,354.8,percent of total billed charges,Implant Devices,310.45,70,,310.45,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.8,
STRYKER 2361-5085S LOCKING SCREW 5X85MM,C1713,HCPCS,,79012966,CDM,278,RC,,,both,,,887,350.07,39.4668,,350.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Device,301.58,34,"Charges > $500, x 34%",301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,354.8,40,,354.8,percent of total billed charges,Implant Devices,310.45,70,,310.45,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.8,
J&J 02.112.148S 2.7/3.5 LCP PLATE RT 9H,C1713,HCPCS,,79012967,CDM,278,RC,,,both,,,1791,706.85,39.4668,,706.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,608.94,34,,608.94,percent of total billed charges,Implant Device,608.94,34,,608.94,percent of total billed charges,Implant Device,608.94,34,,608.94,percent of total billed charges,Implant Device,608.94,34,,608.94,percent of total billed charges,Implant Device,608.94,34,,608.94,percent of total billed charges,Implant Device,608.94,34,,608.94,percent of total billed charges,Implant Device,626.85,35,,626.85,percent of total billed charges,Implant Device,608.94,34,"Charges > $500, x 34%",608.94,percent of total billed charges,Implant Device,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,716.4,40,,716.4,percent of total billed charges,Implant Devices,626.85,70,,626.85,percent of total billed charges,Implant Devices,608.94,34,,608.94,percent of total billed charges,Implant Devices,608.94,34,,608.94,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,626.85,35,,626.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,716.4,
J&J 247.364 2.4 LCP PLATE 10 HOLE,C1713,HCPCS,,79012969,CDM,278,RC,,,both,,,1002,395.46,39.4668,,395.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Device,340.68,34,"Charges > $500, x 34%",340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,400.8,40,,400.8,percent of total billed charges,Implant Devices,350.7,70,,350.7,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,400.8,
J&J 02.188.206 2.7/3.5 8 HOLE PLT RT,C1713,HCPCS,,79012970,CDM,278,RC,,,both,,,4413,1741.67,39.4668,,1741.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1500.42,34,,1500.42,percent of total billed charges,Implant Device,1544.55,35,,1544.55,percent of total billed charges,Implant Device,1500.42,34,"Charges > $500, x 34%",1500.42,percent of total billed charges,Implant Device,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1765.2,40,,1765.2,percent of total billed charges,Implant Devices,1544.55,70,,1544.55,percent of total billed charges,Implant Devices,1500.42,34,,1500.42,percent of total billed charges,Implant Devices,1500.42,34,,1500.42,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,1544.55,35,,1544.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1500.42,34,"If Charge > 2,000, then 34 percent",1500.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1765.2,
J&J 02.211.054 2.7 LOCK SCREW 54MM,C1713,HCPCS,,79012971,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
J&J 02.211.048 2.7 LOCK SCREW 48MM,C1713,HCPCS,,79012972,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
J&J 02.123.022 3.5 RT LCP PLATE 4H,C1713,HCPCS,,79012973,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
MEDLINE MPP22001L LAPIDUS LEFT PLATE,C1713,HCPCS,,79012977,CDM,278,RC,,,both,,,6720,2652.17,39.4668,,2652.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2284.8,34,,2284.8,percent of total billed charges,Implant Device,2352,35,,2352,percent of total billed charges,Implant Device,2284.8,34,"Charges > $500, x 34%",2284.8,percent of total billed charges,Implant Device,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2688,40,,2688,percent of total billed charges,Implant Devices,2352,70,,2352,percent of total billed charges,Implant Devices,2284.8,34,,2284.8,percent of total billed charges,Implant Devices,2284.8,34,,2284.8,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,2352,35,,2352,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2284.8,34,"If Charge > 2,000, then 34 percent",2284.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2688,
MEDLINE MPSL3516 LOCK SCREW 3.5X16MM,C1713,HCPCS,,79012981,CDM,278,RC,,,both,,,795,313.76,39.4668,,313.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,270.3,34,,270.3,percent of total billed charges,Implant Device,270.3,34,,270.3,percent of total billed charges,Implant Device,270.3,34,,270.3,percent of total billed charges,Implant Device,270.3,34,,270.3,percent of total billed charges,Implant Device,270.3,34,,270.3,percent of total billed charges,Implant Device,270.3,34,,270.3,percent of total billed charges,Implant Device,278.25,35,,278.25,percent of total billed charges,Implant Device,270.3,34,"Charges > $500, x 34%",270.3,percent of total billed charges,Implant Device,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,318,40,,318,percent of total billed charges,Implant Devices,278.25,70,,278.25,percent of total billed charges,Implant Devices,270.3,34,,270.3,percent of total billed charges,Implant Devices,270.3,34,,270.3,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,318,
MEDLINE MPSL3518 LOCK SCREW 3.5X18MM,C1713,HCPCS,,79012982,CDM,278,RC,,,both,,,795,313.76,39.4668,,313.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,270.3,34,,270.3,percent of total billed charges,Implant Device,270.3,34,,270.3,percent of total billed charges,Implant Device,270.3,34,,270.3,percent of total billed charges,Implant Device,270.3,34,,270.3,percent of total billed charges,Implant Device,270.3,34,,270.3,percent of total billed charges,Implant Device,270.3,34,,270.3,percent of total billed charges,Implant Device,278.25,35,,278.25,percent of total billed charges,Implant Device,270.3,34,"Charges > $500, x 34%",270.3,percent of total billed charges,Implant Device,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,318,40,,318,percent of total billed charges,Implant Devices,278.25,70,,278.25,percent of total billed charges,Implant Devices,270.3,34,,270.3,percent of total billed charges,Implant Devices,270.3,34,,270.3,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,278.25,35,,278.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,318,
MEDLINE MPSX3534 CROSSPLATE SCREW 3.5X34,C1713,HCPCS,,79012983,CDM,278,RC,,,both,,,1065,420.32,39.4668,,420.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,372.75,35,,372.75,percent of total billed charges,Implant Device,362.1,34,"Charges > $500, x 34%",362.1,percent of total billed charges,Implant Device,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,426,40,,426,percent of total billed charges,Implant Devices,372.75,70,,372.75,percent of total billed charges,Implant Devices,362.1,34,,362.1,percent of total billed charges,Implant Devices,362.1,34,,362.1,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,426,
ARTHREX AR-8933VCL-14 KREULOCK SCRW 3X14,C1713,HCPCS,,79012985,CDM,278,RC,,,both,,,959,378.49,39.4668,,378.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Device,326.06,34,"Charges > $500, x 34%",326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,383.6,40,,383.6,percent of total billed charges,Implant Devices,335.65,70,,335.65,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.6,
ARTHREX AR-8933VCL-16 KREULOCK SCRW 3X16,C1713,HCPCS,,79012986,CDM,278,RC,,,both,,,959,378.49,39.4668,,378.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Device,326.06,34,"Charges > $500, x 34%",326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,383.6,40,,383.6,percent of total billed charges,Implant Devices,335.65,70,,335.65,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.6,
ARTHREX AR-8933VCL-18 KREULOCK SCRW 3X18,C1713,HCPCS,,79012987,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-8935CL-14 KREULOCK SRW 3.5X14,C1713,HCPCS,,79012988,CDM,278,RC,,,both,,,959,378.49,39.4668,,378.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Device,326.06,34,"Charges > $500, x 34%",326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,383.6,40,,383.6,percent of total billed charges,Implant Devices,335.65,70,,335.65,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.6,
ARTHREX AR-8935CL-18 KREULOCK SRW 3.5X18,C1713,HCPCS,,79012989,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-8935CL-16 KREULOCK SRW 3.5X16,C1713,HCPCS,,79012990,CDM,278,RC,,,both,,,959,378.49,39.4668,,378.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Device,326.06,34,"Charges > $500, x 34%",326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,383.6,40,,383.6,percent of total billed charges,Implant Devices,335.65,70,,335.65,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.6,
IN2BONES P07 ST207 AFX PLATE LEFT 7 HOLE,C1713,HCPCS,,79012992,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES C20 ST211 LIS FRANC PLATE,C1713,HCPCS,,79012993,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
MEDLINE MSD14020 HEADED SCREW 4.0X20MM,C1713,HCPCS,,79012994,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
MEDLINE MSD14022 HEADED SCREW 4.0X22MM,C1713,HCPCS,,79012995,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
MEDLINE MSD14030 HEADED SCREW 4.0X30MM,C1713,HCPCS,,79012996,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
MEDLINE MSD14034 HEADED SCREW 4.0X34MM,C1713,HCPCS,,79012997,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
MEDLINE MSD14038 HEADED SCREW 4.0X38MM,C1713,HCPCS,,79012998,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
STRYKER 607340 CANCELLOUS SCREW 4.0X40MM,C1713,HCPCS,,79013002,CDM,278,RC,,,both,,,144,56.83,39.4668,,56.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,50.4,35,,50.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,57.6,40,,57.6,percent of total billed charges,Implant Devices,50.4,70,,50.4,percent of total billed charges,Implant Devices,48.96,34,,48.96,percent of total billed charges,Implant Devices,48.96,34,,48.96,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,57.6,
STRYKER 607344 CANCELLOUS SCREW 4.0X44MM,C1713,HCPCS,,79013003,CDM,278,RC,,,both,,,144,56.83,39.4668,,56.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,48.96,34,,48.96,percent of total billed charges,Implant Device,50.4,35,,50.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,57.6,40,,57.6,percent of total billed charges,Implant Devices,50.4,70,,50.4,percent of total billed charges,Implant Devices,48.96,34,,48.96,percent of total billed charges,Implant Devices,48.96,34,,48.96,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,50.4,35,,50.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,57.6,
STRYKER 663816 BONE SCREW 2.3X16MM,C1713,HCPCS,,79013005,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
J&J 202.898 CORTEX SCREW 2.7X38MM,C1713,HCPCS,,79013009,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
STRYKER 40100479 LPL BONE PLTE ULNAR,C1713,HCPCS,,79013010,CDM,278,RC,,,both,,,3926,1549.47,39.4668,,1549.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1334.84,34,,1334.84,percent of total billed charges,Implant Device,1334.84,34,,1334.84,percent of total billed charges,Implant Device,1334.84,34,,1334.84,percent of total billed charges,Implant Device,1334.84,34,,1334.84,percent of total billed charges,Implant Device,1334.84,34,,1334.84,percent of total billed charges,Implant Device,1334.84,34,,1334.84,percent of total billed charges,Implant Device,1374.1,35,,1374.1,percent of total billed charges,Implant Device,1334.84,34,"Charges > $500, x 34%",1334.84,percent of total billed charges,Implant Device,1374.1,35,,1374.1,percent of total billed charges,Implant Devices,1374.1,35,,1374.1,percent of total billed charges,Implant Devices,1374.1,35,,,percent of total billed charges,Implant Devices,1374.1,35,,1374.1,percent of total billed charges,Implant Devices,1374.1,35,,1374.1,percent of total billed charges,Implant Devices,1570.4,40,,1570.4,percent of total billed charges,Implant Devices,1374.1,70,,1374.1,percent of total billed charges,Implant Devices,1334.84,34,,1334.84,percent of total billed charges,Implant Devices,1334.84,34,,1334.84,percent of total billed charges,Implant Devices,1374.1,35,,1374.1,percent of total billed charges,Implant Devices,1374.1,35,,1374.1,percent of total billed charges,Implant Devices,1374.1,35,,1374.1,percent of total billed charges,Implant Devices,1374.1,35,,1374.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1334.84,34,"If Charge > 2,000, then 34 percent",1334.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1570.4,
STRYKER 40100778 LOCKING SCREW 2.7X18MM,C1713,HCPCS,,79013016,CDM,278,RC,,,both,,,584,230.49,39.4668,,230.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.56,34,,198.56,percent of total billed charges,Implant Device,198.56,34,,198.56,percent of total billed charges,Implant Device,198.56,34,,198.56,percent of total billed charges,Implant Device,198.56,34,,198.56,percent of total billed charges,Implant Device,198.56,34,,198.56,percent of total billed charges,Implant Device,198.56,34,,198.56,percent of total billed charges,Implant Device,204.4,35,,204.4,percent of total billed charges,Implant Device,198.56,34,"Charges > $500, x 34%",198.56,percent of total billed charges,Implant Device,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,233.6,40,,233.6,percent of total billed charges,Implant Devices,204.4,70,,204.4,percent of total billed charges,Implant Devices,198.56,34,,198.56,percent of total billed charges,Implant Devices,198.56,34,,198.56,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.6,
STRYKER 40100782 LOCKING SCREW 2.7X22MM,C1713,HCPCS,,79013017,CDM,278,RC,,,both,,,584,230.49,39.4668,,230.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.56,34,,198.56,percent of total billed charges,Implant Device,198.56,34,,198.56,percent of total billed charges,Implant Device,198.56,34,,198.56,percent of total billed charges,Implant Device,198.56,34,,198.56,percent of total billed charges,Implant Device,198.56,34,,198.56,percent of total billed charges,Implant Device,198.56,34,,198.56,percent of total billed charges,Implant Device,204.4,35,,204.4,percent of total billed charges,Implant Device,198.56,34,"Charges > $500, x 34%",198.56,percent of total billed charges,Implant Device,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,233.6,40,,233.6,percent of total billed charges,Implant Devices,204.4,70,,204.4,percent of total billed charges,Implant Devices,198.56,34,,198.56,percent of total billed charges,Implant Devices,198.56,34,,198.56,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,204.4,35,,204.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.6,
STRYKER 40100916 CORTICAL SCREW 3.5X16MM,C1713,HCPCS,,79013018,CDM,278,RC,,,both,,,303,119.58,39.4668,,119.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,121.2,40,,121.2,percent of total billed charges,Implant Devices,106.05,70,,106.05,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.2,
STRYKER 40100918 CORTICAL SCREW 3.5X18MM,C1713,HCPCS,,79013019,CDM,278,RC,,,both,,,303,119.58,39.4668,,119.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,121.2,40,,121.2,percent of total billed charges,Implant Devices,106.05,70,,106.05,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.2,
STRYKER 40100920 CORTICAL SCREW 3.5X20MM,C1713,HCPCS,,79013020,CDM,278,RC,,,both,,,303,119.58,39.4668,,119.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,121.2,40,,121.2,percent of total billed charges,Implant Devices,106.05,70,,106.05,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.2,
STRYKER 40100922 CORTICAL SCREW 3.5X22MM,C1713,HCPCS,,79013021,CDM,278,RC,,,both,,,303,119.58,39.4668,,119.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,121.2,40,,121.2,percent of total billed charges,Implant Devices,106.05,70,,106.05,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.2,
STRYKER 40100924 CORTICAL SCREW 3.5X24MM,C1713,HCPCS,,79013022,CDM,278,RC,,,both,,,303,119.58,39.4668,,119.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,121.2,40,,121.2,percent of total billed charges,Implant Devices,106.05,70,,106.05,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.2,
STRYKER 40100960 CORTICAL SCREW 2.7X20MM,C1713,HCPCS,,79013023,CDM,278,RC,,,both,,,303,119.58,39.4668,,119.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,103.02,34,,103.02,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,121.2,40,,121.2,percent of total billed charges,Implant Devices,106.05,70,,106.05,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,103.02,34,,103.02,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,106.05,35,,106.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.2,
J&J 208.439 CANNULATED SCREW 6.5X85MM,C1713,HCPCS,,79013027,CDM,278,RC,,,both,,,683,269.56,39.4668,,269.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,232.22,34,,232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Device,232.22,34,"Charges > $500, x 34%",232.22,percent of total billed charges,Implant Device,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,273.2,40,,273.2,percent of total billed charges,Implant Devices,239.05,70,,239.05,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,232.22,34,,232.22,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,239.05,35,,239.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,273.2,
STRYKER 657022 LOCKING SCREW 2.7X22MM,C1713,HCPCS,,79013033,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
STRYKER 5065-9-015 HALF PIN 15MM,C1713,HCPCS,,79013040,CDM,278,RC,,,both,,,159,62.75,39.4668,,62.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,54.06,34,,54.06,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,63.6,40,,63.6,percent of total billed charges,Implant Devices,55.65,70,,55.65,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,54.06,34,,54.06,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,55.65,35,,55.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63.6,
STRYKER 5080-1-620 HALF PIN 1.65X45,C1713,HCPCS,,79013041,CDM,278,RC,,,both,,,184,72.62,39.4668,,72.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,62.56,34,,62.56,percent of total billed charges,Implant Device,62.56,34,,62.56,percent of total billed charges,Implant Device,62.56,34,,62.56,percent of total billed charges,Implant Device,62.56,34,,62.56,percent of total billed charges,Implant Device,62.56,34,,62.56,percent of total billed charges,Implant Device,62.56,34,,62.56,percent of total billed charges,Implant Device,64.4,35,,64.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,73.6,40,,73.6,percent of total billed charges,Implant Devices,64.4,70,,64.4,percent of total billed charges,Implant Devices,62.56,34,,62.56,percent of total billed charges,Implant Devices,62.56,34,,62.56,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,64.4,35,,64.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,73.6,
STRYKER 2360-4025S LOCKING SCREW 4X25MM,C1713,HCPCS,,79013042,CDM,278,RC,,,both,,,566,223.38,39.4668,,223.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,192.44,34,,192.44,percent of total billed charges,Implant Device,198.1,35,,198.1,percent of total billed charges,Implant Device,192.44,34,"Charges > $500, x 34%",192.44,percent of total billed charges,Implant Device,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,226.4,40,,226.4,percent of total billed charges,Implant Devices,198.1,70,,198.1,percent of total billed charges,Implant Devices,192.44,34,,192.44,percent of total billed charges,Implant Devices,192.44,34,,192.44,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,198.1,35,,198.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,226.4,
J&J 214.876 CORTEX SCREW 4.5X76MM,C1713,HCPCS,,79013044,CDM,278,RC,,,both,,,93,36.7,39.4668,,36.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,31.62,34,,31.62,percent of total billed charges,Implant Device,32.55,35,,32.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,37.2,40,,37.2,percent of total billed charges,Implant Devices,32.55,70,,32.55,percent of total billed charges,Implant Devices,31.62,34,,31.62,percent of total billed charges,Implant Devices,31.62,34,,31.62,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,32.55,35,,32.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,37.2,
J&J 04.038.180S FENESTRATED SCREW 80MM,C1713,HCPCS,,79013045,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
J&J 04.045.032S LOCKING SCREW 5X32MM,C1713,HCPCS,,79013046,CDM,278,RC,,,both,,,687,271.14,39.4668,,271.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Device,233.58,34,"Charges > $500, x 34%",233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,274.8,40,,274.8,percent of total billed charges,Implant Devices,240.45,70,,240.45,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.8,
ARTHREX AR-1288QT-100 FIBERTAG TIGHTROPE,C1713,HCPCS,,79013047,CDM,278,RC,,,both,,,2925,1154.4,39.4668,,1154.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,1023.75,35,,1023.75,percent of total billed charges,Implant Device,994.5,34,"Charges > $500, x 34%",994.5,percent of total billed charges,Implant Device,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1170,40,,1170,percent of total billed charges,Implant Devices,1023.75,70,,1023.75,percent of total billed charges,Implant Devices,994.5,34,,994.5,percent of total billed charges,Implant Devices,994.5,34,,994.5,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,994.5,34,"If Charge > 2,000, then 34 percent",994.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1170,
ARTHREX AR-1588TB-31B BUTTON FOR ACL'S,C1713,HCPCS,,79013048,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
J&J 04.038.195S FENESTRATED SCREW 95MM,C1713,HCPCS,,79013053,CDM,278,RC,,,both,,,1693,668.17,39.4668,,668.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,575.62,34,,575.62,percent of total billed charges,Implant Device,592.55,35,,592.55,percent of total billed charges,Implant Device,575.62,34,"Charges > $500, x 34%",575.62,percent of total billed charges,Implant Device,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,677.2,40,,677.2,percent of total billed charges,Implant Devices,592.55,70,,592.55,percent of total billed charges,Implant Devices,575.62,34,,575.62,percent of total billed charges,Implant Devices,575.62,34,,575.62,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,592.55,35,,592.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,677.2,
J&J 04.005.542S LOCKING SCREW 5.0X52MM,C1713,HCPCS,,79013054,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
J&J 04.005.562S LOCKING SCREW 5.0X72MM,C1713,HCPCS,,79013055,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
J&J 76000040 FIBERGRAFT PUTTY 4CC,C1713,HCPCS,,79013064,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ARTHREX AR-8933VCL-12 KREULOCK SRW 3X12,C1713,HCPCS,,79013080,CDM,278,RC,,,both,,,959,378.49,39.4668,,378.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Device,326.06,34,"Charges > $500, x 34%",326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,383.6,40,,383.6,percent of total billed charges,Implant Devices,335.65,70,,335.65,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.6,
ARTHREX AR-8935CLC-12 KREULOCK SR 3.5X12,C1713,HCPCS,,79013081,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-8935CLC-16 KREULOCK SR 3.5X16,C1713,HCPCS,,79013082,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-9943BR-05 PLATE 5 HOLE,C1713,HCPCS,,79013083,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
STRYKER 326080 CANNULATED SCREW 6.5X80MM,C1713,HCPCS,,79013085,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
J&J 04.045.038S LOCKING SCREW 5X38MM,C1713,HCPCS,,79013086,CDM,278,RC,,,both,,,687,271.14,39.4668,,271.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Device,233.58,34,"Charges > $500, x 34%",233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,274.8,40,,274.8,percent of total billed charges,Implant Devices,240.45,70,,240.45,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.8,
ARTHREX AR-8935-121 KREULOCK SRW 3.5X12,C1713,HCPCS,,79013088,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
J & J 04.015.525S LOCKING SCREW 5.0X35MM,C1713,HCPCS,,79013113,CDM,278,RC,,,both,,,454,179.18,39.4668,,179.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,154.36,34,,154.36,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,181.6,40,,181.6,percent of total billed charges,Implant Devices,158.9,70,,158.9,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,154.36,34,,154.36,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,158.9,35,,158.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,181.6,
J&J 02.112.140S DISTAL FIB PLT 2.7/3.5MM,C1713,HCPCS,,79013114,CDM,278,RC,,,both,,,1718,678.04,39.4668,,678.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,584.12,34,,584.12,percent of total billed charges,Implant Device,584.12,34,,584.12,percent of total billed charges,Implant Device,584.12,34,,584.12,percent of total billed charges,Implant Device,584.12,34,,584.12,percent of total billed charges,Implant Device,584.12,34,,584.12,percent of total billed charges,Implant Device,584.12,34,,584.12,percent of total billed charges,Implant Device,601.3,35,,601.3,percent of total billed charges,Implant Device,584.12,34,"Charges > $500, x 34%",584.12,percent of total billed charges,Implant Device,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,687.2,40,,687.2,percent of total billed charges,Implant Devices,601.3,70,,601.3,percent of total billed charges,Implant Devices,584.12,34,,584.12,percent of total billed charges,Implant Devices,584.12,34,,584.12,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,687.2,
J&J 04.045.036S LOCKING SCREW 5X36MM,C1713,HCPCS,,79013120,CDM,278,RC,,,both,,,687,271.14,39.4668,,271.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Device,233.58,34,"Charges > $500, x 34%",233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,274.8,40,,274.8,percent of total billed charges,Implant Devices,240.45,70,,240.45,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.8,
J&J 02.112.139S DIST FIB PLATE 2.7/3.5MM,C1713,HCPCS,,79013121,CDM,278,RC,,,both,,,1696,669.36,39.4668,,669.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,593.6,35,,593.6,percent of total billed charges,Implant Device,576.64,34,"Charges > $500, x 34%",576.64,percent of total billed charges,Implant Device,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,678.4,40,,678.4,percent of total billed charges,Implant Devices,593.6,70,,593.6,percent of total billed charges,Implant Devices,576.64,34,,576.64,percent of total billed charges,Implant Devices,576.64,34,,576.64,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,678.4,
STRYKER 2360-5030S LOCKING SCREW 5X30MM,C1713,HCPCS,,79013124,CDM,278,RC,,,both,,,682,269.16,39.4668,,269.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,231.88,34,,231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Device,231.88,34,"Charges > $500, x 34%",231.88,percent of total billed charges,Implant Device,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,272.8,40,,272.8,percent of total billed charges,Implant Devices,238.7,70,,238.7,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,231.88,34,,231.88,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,238.7,35,,238.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272.8,
J&J 04.045.376S LOCKING SCREW 5.0X76MM,C1713,HCPCS,,79013126,CDM,278,RC,,,both,,,813,320.87,39.4668,,320.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Device,276.42,34,"Charges > $500, x 34%",276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,325.2,40,,325.2,percent of total billed charges,Implant Devices,284.55,70,,284.55,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,325.2,
J & J 04.045.360S LOCKING SCREW 5.0X60MM,C1713,HCPCS,,79013127,CDM,278,RC,,,both,,,813,320.87,39.4668,,320.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Device,276.42,34,"Charges > $500, x 34%",276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,325.2,40,,325.2,percent of total billed charges,Implant Devices,284.55,70,,284.55,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,325.2,
J&J 02.124.411 COND PLATE 4.5MM 10 HOLE,C1713,HCPCS,,79013128,CDM,278,RC,,,both,,,4588,1810.74,39.4668,,1810.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1559.92,34,,1559.92,percent of total billed charges,Implant Device,1559.92,34,,1559.92,percent of total billed charges,Implant Device,1559.92,34,,1559.92,percent of total billed charges,Implant Device,1559.92,34,,1559.92,percent of total billed charges,Implant Device,1559.92,34,,1559.92,percent of total billed charges,Implant Device,1559.92,34,,1559.92,percent of total billed charges,Implant Device,1605.8,35,,1605.8,percent of total billed charges,Implant Device,1559.92,34,"Charges > $500, x 34%",1559.92,percent of total billed charges,Implant Device,1605.8,35,,1605.8,percent of total billed charges,Implant Devices,1605.8,35,,1605.8,percent of total billed charges,Implant Devices,1605.8,35,,,percent of total billed charges,Implant Devices,1605.8,35,,1605.8,percent of total billed charges,Implant Devices,1605.8,35,,1605.8,percent of total billed charges,Implant Devices,1835.2,40,,1835.2,percent of total billed charges,Implant Devices,1605.8,70,,1605.8,percent of total billed charges,Implant Devices,1559.92,34,,1559.92,percent of total billed charges,Implant Devices,1559.92,34,,1559.92,percent of total billed charges,Implant Devices,1605.8,35,,1605.8,percent of total billed charges,Implant Devices,1605.8,35,,1605.8,percent of total billed charges,Implant Devices,1605.8,35,,1605.8,percent of total billed charges,Implant Devices,1605.8,35,,1605.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1559.92,34,"If Charge > 2,000, then 34 percent",1559.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1835.2,
J&J 04.045.040S LOCK SCREW 5.0X40MM,C1713,HCPCS,,79013129,CDM,278,RC,,,both,,,687,271.14,39.4668,,271.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Device,233.58,34,"Charges > $500, x 34%",233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,274.8,40,,274.8,percent of total billed charges,Implant Devices,240.45,70,,240.45,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.8,
J&J 1217-35-500 CANC BONE SCREW 6.5X35MM,C1713,HCPCS,,79013137,CDM,278,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,91.2,40,,91.2,percent of total billed charges,Implant Devices,79.8,70,,79.8,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,91.2,
J&J 1217-40-500 CANC BONE SCREW 6.5X40MM,C1713,HCPCS,,79013138,CDM,278,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,91.2,40,,91.2,percent of total billed charges,Implant Devices,79.8,70,,79.8,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,91.2,
STRYKER ORT IC4046 HEADED SCREW 4.0X46MM,C1713,HCPCS,,79013142,CDM,278,RC,,,both,,,961,379.28,39.4668,,379.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,326.74,34,,326.74,percent of total billed charges,Implant Device,336.35,35,,336.35,percent of total billed charges,Implant Device,326.74,34,"Charges > $500, x 34%",326.74,percent of total billed charges,Implant Device,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,384.4,40,,384.4,percent of total billed charges,Implant Devices,336.35,70,,336.35,percent of total billed charges,Implant Devices,326.74,34,,326.74,percent of total billed charges,Implant Devices,326.74,34,,326.74,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,336.35,35,,336.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384.4,
STRYKER ORTHO 326105 CAN SCREW 6.5X105MM,C1713,HCPCS,,79013147,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
ARTHREX AR-3636 KNOTLESS FIBERTAK 1.8MM,C1713,HCPCS,,79013151,CDM,278,RC,,,both,,,1320,520.96,39.4668,,520.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,462,35,,462,percent of total billed charges,Implant Device,448.8,34,"Charges > $500, x 34%",448.8,percent of total billed charges,Implant Device,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,528,40,,528,percent of total billed charges,Implant Devices,462,70,,462,percent of total billed charges,Implant Devices,448.8,34,,448.8,percent of total billed charges,Implant Devices,448.8,34,,448.8,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,528,
J&J 04.005.548S LOCKING SCREW 5X58MM,C1713,HCPCS,,79013161,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
J&J 04.005.558S LOCKING SCREW 5X68MM,C1713,HCPCS,,79013162,CDM,278,RC,,,both,,,412,162.6,39.4668,,162.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,140.08,34,,140.08,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,164.8,40,,164.8,percent of total billed charges,Implant Devices,144.2,70,,144.2,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,140.08,34,,140.08,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,144.2,35,,144.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164.8,
STRYKER 2341-1036S TIBIAL NAIL 10X360MM,C1713,HCPCS,,79013164,CDM,278,RC,,,both,,,4792,1891.25,39.4668,,1891.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Device,1629.28,34,"Charges > $500, x 34%",1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1916.8,40,,1916.8,percent of total billed charges,Implant Devices,1677.2,70,,1677.2,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.28,34,"If Charge > 2,000, then 34 percent",1629.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1916.8,
IN2BONES P67 ST438 CANN SCREW 4X38MM,C1713,HCPCS,,79013177,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ARTHREX AR-8935CL-22 KREULOCK SRW 3.5X22,C1713,HCPCS,,79013178,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-8935L-22 LOCK SCREW 3.5X22MM,C1713,HCPCS,,79013179,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
PARAGON P50-353-2718 LOCK PLT SRW 2.7X18,C1713,HCPCS,,79013186,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
ARTHREX AR-1665KBCSL LOOP N TAK KIT,C1713,HCPCS,,79013187,CDM,278,RC,,,both,,,2796,1103.49,39.4668,,1103.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,950.64,34,,950.64,percent of total billed charges,Implant Device,950.64,34,,950.64,percent of total billed charges,Implant Device,950.64,34,,950.64,percent of total billed charges,Implant Device,950.64,34,,950.64,percent of total billed charges,Implant Device,950.64,34,,950.64,percent of total billed charges,Implant Device,950.64,34,,950.64,percent of total billed charges,Implant Device,978.6,35,,978.6,percent of total billed charges,Implant Device,950.64,34,"Charges > $500, x 34%",950.64,percent of total billed charges,Implant Device,978.6,35,,978.6,percent of total billed charges,Implant Devices,978.6,35,,978.6,percent of total billed charges,Implant Devices,978.6,35,,,percent of total billed charges,Implant Devices,978.6,35,,978.6,percent of total billed charges,Implant Devices,978.6,35,,978.6,percent of total billed charges,Implant Devices,1118.4,40,,1118.4,percent of total billed charges,Implant Devices,978.6,70,,978.6,percent of total billed charges,Implant Devices,950.64,34,,950.64,percent of total billed charges,Implant Devices,950.64,34,,950.64,percent of total billed charges,Implant Devices,978.6,35,,978.6,percent of total billed charges,Implant Devices,978.6,35,,978.6,percent of total billed charges,Implant Devices,978.6,35,,978.6,percent of total billed charges,Implant Devices,978.6,35,,978.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,950.64,34,"If Charge > 2,000, then 34 percent",950.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1118.4,
J&J 02.112.111S DIS FIBULA PLT 2.7/3.5,C1713,HCPCS,,79013188,CDM,278,RC,,,both,,,1718,678.04,39.4668,,678.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,584.12,34,,584.12,percent of total billed charges,Implant Device,584.12,34,,584.12,percent of total billed charges,Implant Device,584.12,34,,584.12,percent of total billed charges,Implant Device,584.12,34,,584.12,percent of total billed charges,Implant Device,584.12,34,,584.12,percent of total billed charges,Implant Device,584.12,34,,584.12,percent of total billed charges,Implant Device,601.3,35,,601.3,percent of total billed charges,Implant Device,584.12,34,"Charges > $500, x 34%",584.12,percent of total billed charges,Implant Device,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,687.2,40,,687.2,percent of total billed charges,Implant Devices,601.3,70,,601.3,percent of total billed charges,Implant Devices,584.12,34,,584.12,percent of total billed charges,Implant Devices,584.12,34,,584.12,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,601.3,35,,601.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,687.2,
J&J 201.691 CORTEX SCREW 2.4X42MM,C1713,HCPCS,,79013190,CDM,278,RC,,,both,,,153,60.38,39.4668,,60.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,61.2,40,,61.2,percent of total billed charges,Implant Devices,53.55,70,,53.55,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,61.2,
J&J 201.668 CORTEX SCREW 2.4X38MM,C1713,HCPCS,,79013191,CDM,278,RC,,,both,,,121,47.75,39.4668,,47.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,48.4,40,,48.4,percent of total billed charges,Implant Devices,42.35,70,,42.35,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.4,
J&J 201.662 CORTEX SCREW 2.4X32MM,C1713,HCPCS,,79013192,CDM,278,RC,,,both,,,121,47.75,39.4668,,47.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,48.4,40,,48.4,percent of total billed charges,Implant Devices,42.35,70,,42.35,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.4,
J&J 1217-25-500 CAN BONE SCREW 6.5X25MM,C1713,HCPCS,,79013197,CDM,278,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,91.2,40,,91.2,percent of total billed charges,Implant Devices,79.8,70,,79.8,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,91.2,
J&J 02.112.610 LCP CLAVICLE PLATE 2.7MM,C1713,HCPCS,,79013208,CDM,278,RC,,,both,,,3383,1335.16,39.4668,,1335.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1150.22,34,,1150.22,percent of total billed charges,Implant Device,1150.22,34,,1150.22,percent of total billed charges,Implant Device,1150.22,34,,1150.22,percent of total billed charges,Implant Device,1150.22,34,,1150.22,percent of total billed charges,Implant Device,1150.22,34,,1150.22,percent of total billed charges,Implant Device,1150.22,34,,1150.22,percent of total billed charges,Implant Device,1184.05,35,,1184.05,percent of total billed charges,Implant Device,1150.22,34,"Charges > $500, x 34%",1150.22,percent of total billed charges,Implant Device,1184.05,35,,1184.05,percent of total billed charges,Implant Devices,1184.05,35,,1184.05,percent of total billed charges,Implant Devices,1184.05,35,,,percent of total billed charges,Implant Devices,1184.05,35,,1184.05,percent of total billed charges,Implant Devices,1184.05,35,,1184.05,percent of total billed charges,Implant Devices,1353.2,40,,1353.2,percent of total billed charges,Implant Devices,1184.05,70,,1184.05,percent of total billed charges,Implant Devices,1150.22,34,,1150.22,percent of total billed charges,Implant Devices,1150.22,34,,1150.22,percent of total billed charges,Implant Devices,1184.05,35,,1184.05,percent of total billed charges,Implant Devices,1184.05,35,,1184.05,percent of total billed charges,Implant Devices,1184.05,35,,1184.05,percent of total billed charges,Implant Devices,1184.05,35,,1184.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1150.22,34,"If Charge > 2,000, then 34 percent",1150.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1353.2,
J&J 412.212S LOCKING SCREW 5.0X36MM,C1713,HCPCS,,79013209,CDM,278,RC,,,both,,,505,199.31,39.4668,,199.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Device,171.7,34,"Charges > $500, x 34%",171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,202,40,,202,percent of total billed charges,Implant Devices,176.75,70,,176.75,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,202,
J&J 412.211S LOCKING SCREW 5.0X34MM,C1713,HCPCS,,79013210,CDM,278,RC,,,both,,,505,199.31,39.4668,,199.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,171.7,34,,171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Device,171.7,34,"Charges > $500, x 34%",171.7,percent of total billed charges,Implant Device,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,202,40,,202,percent of total billed charges,Implant Devices,176.75,70,,176.75,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,171.7,34,,171.7,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,176.75,35,,176.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,202,
J&J 04.045.048S LOCKING SCREW 5.0X48MM,C1713,HCPCS,,79013218,CDM,278,RC,,,both,,,687,271.14,39.4668,,271.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Device,233.58,34,"Charges > $500, x 34%",233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,274.8,40,,274.8,percent of total billed charges,Implant Devices,240.45,70,,240.45,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.8,
J&J 04.045.336S LOCKING SCREW 5.0X36MM,C1713,HCPCS,,79013219,CDM,278,RC,,,both,,,813,320.87,39.4668,,320.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Device,276.42,34,"Charges > $500, x 34%",276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,325.2,40,,325.2,percent of total billed charges,Implant Devices,284.55,70,,284.55,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,325.2,
J&J 04.045.330S LOCKING SCREW 5.0X30MM,C1713,HCPCS,,79013220,CDM,278,RC,,,both,,,813,320.87,39.4668,,320.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Device,276.42,34,"Charges > $500, x 34%",276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,325.2,40,,325.2,percent of total billed charges,Implant Devices,284.55,70,,284.55,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,325.2,
STRYKER 604655 CANNULATED SCREW 4.0X55MM,C1713,HCPCS,,79013221,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 629785 NARROW LOCK T-PLT 2.7X87,C1713,HCPCS,,79013222,CDM,278,RC,,,both,,,3366,1328.45,39.4668,,1328.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1178.1,35,,1178.1,percent of total billed charges,Implant Device,1144.44,34,"Charges > $500, x 34%",1144.44,percent of total billed charges,Implant Device,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1346.4,40,,1346.4,percent of total billed charges,Implant Devices,1178.1,70,,1178.1,percent of total billed charges,Implant Devices,1144.44,34,,1144.44,percent of total billed charges,Implant Devices,1144.44,34,,1144.44,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1144.44,34,"If Charge > 2,000, then 34 percent",1144.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1346.4,
STRYKER 656340 LOCKING SCREW 2.7X40MM,C1713,HCPCS,,79013223,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 656346 LOCKING SCREW 2.7X46MM,C1713,HCPCS,,79013224,CDM,278,RC,,,both,,,676,266.8,39.4668,,266.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Device,229.84,34,"Charges > $500, x 34%",229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,270.4,40,,270.4,percent of total billed charges,Implant Devices,236.6,70,,236.6,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270.4,
DJO 533-10-108 HUMERAL STEM SM 10X108MM,C1713,HCPCS,,79013225,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
IN2BONES S22 ST014 SNAP OFF SCREW 22X14,C1713,HCPCS,,79013277,CDM,278,RC,,,both,,,1275,503.2,39.4668,,503.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Device,433.5,34,"Charges > $500, x 34%",433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,510,40,,510,percent of total billed charges,Implant Devices,446.25,70,,446.25,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510,
STRYKER 626985 SLIM Y-PLATE 5 SHAFT HOLE,C1713,HCPCS,,79013278,CDM,278,RC,,,both,,,3516,1387.65,39.4668,,1387.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1195.44,34,,1195.44,percent of total billed charges,Implant Device,1230.6,35,,1230.6,percent of total billed charges,Implant Device,1195.44,34,"Charges > $500, x 34%",1195.44,percent of total billed charges,Implant Device,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1406.4,40,,1406.4,percent of total billed charges,Implant Devices,1230.6,70,,1230.6,percent of total billed charges,Implant Devices,1195.44,34,,1195.44,percent of total billed charges,Implant Devices,1195.44,34,,1195.44,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,1230.6,35,,1230.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1195.44,34,"If Charge > 2,000, then 34 percent",1195.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1406.4,
J&J 02.118.542 SELF TAP SCREW 2.7X42MM,C1713,HCPCS,,79013279,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
J&J 02.118.534 SELF TAP SCREW 2.7X34MM,C1713,HCPCS,,79013280,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
J&J 02.137.001S PATELLA PLT 2.78MM 3H,C1713,HCPCS,,79013282,CDM,278,RC,,,both,,,6252,2467.46,39.4668,,2467.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2125.68,34,,2125.68,percent of total billed charges,Implant Device,2125.68,34,,2125.68,percent of total billed charges,Implant Device,2125.68,34,,2125.68,percent of total billed charges,Implant Device,2125.68,34,,2125.68,percent of total billed charges,Implant Device,2125.68,34,,2125.68,percent of total billed charges,Implant Device,2125.68,34,,2125.68,percent of total billed charges,Implant Device,2188.2,35,,2188.2,percent of total billed charges,Implant Device,2125.68,34,"Charges > $500, x 34%",2125.68,percent of total billed charges,Implant Device,2188.2,35,,2188.2,percent of total billed charges,Implant Devices,2188.2,35,,2188.2,percent of total billed charges,Implant Devices,2188.2,35,,,percent of total billed charges,Implant Devices,2188.2,35,,2188.2,percent of total billed charges,Implant Devices,2188.2,35,,2188.2,percent of total billed charges,Implant Devices,2500.8,40,,2500.8,percent of total billed charges,Implant Devices,2188.2,70,,2188.2,percent of total billed charges,Implant Devices,2125.68,34,,2125.68,percent of total billed charges,Implant Devices,2125.68,34,,2125.68,percent of total billed charges,Implant Devices,2188.2,35,,2188.2,percent of total billed charges,Implant Devices,2188.2,35,,2188.2,percent of total billed charges,Implant Devices,2188.2,35,,2188.2,percent of total billed charges,Implant Devices,2188.2,35,,2188.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2125.68,34,"If Charge > 2,000, then 34 percent",2125.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2500.8,
J&J 1975-20-075 CONICAL PROX BODY 20X75,C1713,HCPCS,,79013285,CDM,278,RC,,,both,,,19322,7625.78,39.4668,,7625.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6762.7,35,,6762.7,percent of total billed charges,Implant Device,6569.48,34,"Charges > $500, x 34%",6569.48,percent of total billed charges,Implant Device,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,7728.8,40,,7728.8,percent of total billed charges,Implant Devices,6762.7,70,,6762.7,percent of total billed charges,Implant Devices,6569.48,34,,6569.48,percent of total billed charges,Implant Devices,6569.48,34,,6569.48,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6569.48,34,"If Charge > 2,000, then 34 percent",6569.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7728.8,
STRYKER 663818 BONE SCREW 2.3X18MM,C1713,HCPCS,,79013287,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 115398 CENTRAL SCREW 6.5X40MM,C1713,HCPCS,,79013288,CDM,278,RC,,,both,,,211,83.27,39.4668,,83.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,71.74,34,,71.74,percent of total billed charges,Implant Device,73.85,35,,73.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,84.4,40,,84.4,percent of total billed charges,Implant Devices,73.85,70,,73.85,percent of total billed charges,Implant Devices,71.74,34,,71.74,percent of total billed charges,Implant Devices,71.74,34,,71.74,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,73.85,35,,73.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84.4,
J&J 02.221.088 PROX FEMUR PLT 4.5MM 8H,C1713,HCPCS,,79013291,CDM,278,RC,,,both,,,8692,3430.45,39.4668,,3430.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2955.28,34,,2955.28,percent of total billed charges,Implant Device,2955.28,34,,2955.28,percent of total billed charges,Implant Device,2955.28,34,,2955.28,percent of total billed charges,Implant Device,2955.28,34,,2955.28,percent of total billed charges,Implant Device,2955.28,34,,2955.28,percent of total billed charges,Implant Device,2955.28,34,,2955.28,percent of total billed charges,Implant Device,3042.2,35,,3042.2,percent of total billed charges,Implant Device,2955.28,34,"Charges > $500, x 34%",2955.28,percent of total billed charges,Implant Device,3042.2,35,,3042.2,percent of total billed charges,Implant Devices,3042.2,35,,3042.2,percent of total billed charges,Implant Devices,3042.2,35,,,percent of total billed charges,Implant Devices,3042.2,35,,3042.2,percent of total billed charges,Implant Devices,3042.2,35,,3042.2,percent of total billed charges,Implant Devices,3476.8,40,,3476.8,percent of total billed charges,Implant Devices,3042.2,70,,3042.2,percent of total billed charges,Implant Devices,2955.28,34,,2955.28,percent of total billed charges,Implant Devices,2955.28,34,,2955.28,percent of total billed charges,Implant Devices,3042.2,35,,3042.2,percent of total billed charges,Implant Devices,3042.2,35,,3042.2,percent of total billed charges,Implant Devices,3042.2,35,,3042.2,percent of total billed charges,Implant Devices,3042.2,35,,3042.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2955.28,34,"If Charge > 2,000, then 34 percent",2955.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3476.8,
J&J 02.127.116 LOCK SCREW 3.5X16MM,C1713,HCPCS,,79013292,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 136532710 FEMORAL HEAD 32MM,C1713,HCPCS,,79013293,CDM,278,RC,,,both,,,10476,4134.54,39.4668,,4134.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3666.6,35,,3666.6,percent of total billed charges,Implant Device,3561.84,34,"Charges > $500, x 34%",3561.84,percent of total billed charges,Implant Device,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,4190.4,40,,4190.4,percent of total billed charges,Implant Devices,3666.6,70,,3666.6,percent of total billed charges,Implant Devices,3561.84,34,,3561.84,percent of total billed charges,Implant Devices,3561.84,34,,3561.84,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3561.84,34,"If Charge > 2,000, then 34 percent",3561.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4190.4,
J&J 1365-28-310 CERAMIC FEM HEAD 28MM,C1713,HCPCS,,79013300,CDM,278,RC,,,both,,,1766,696.98,39.4668,,696.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,600.44,34,,600.44,percent of total billed charges,Implant Device,618.1,35,,618.1,percent of total billed charges,Implant Device,600.44,34,"Charges > $500, x 34%",600.44,percent of total billed charges,Implant Device,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,706.4,40,,706.4,percent of total billed charges,Implant Devices,618.1,70,,618.1,percent of total billed charges,Implant Devices,600.44,34,,600.44,percent of total billed charges,Implant Devices,600.44,34,,600.44,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,618.1,35,,618.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,706.4,
J&J 76000110 FIBERGRAFT BG PUTTY 11CC,C1713,HCPCS,,79013316,CDM,278,RC,,,both,,,18105,7145.46,39.4668,,7145.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6155.7,34,,6155.7,percent of total billed charges,Implant Device,6155.7,34,,6155.7,percent of total billed charges,Implant Device,6155.7,34,,6155.7,percent of total billed charges,Implant Device,6155.7,34,,6155.7,percent of total billed charges,Implant Device,6155.7,34,,6155.7,percent of total billed charges,Implant Device,6155.7,34,,6155.7,percent of total billed charges,Implant Device,6336.75,35,,6336.75,percent of total billed charges,Implant Device,6155.7,34,"Charges > $500, x 34%",6155.7,percent of total billed charges,Implant Device,6336.75,35,,6336.75,percent of total billed charges,Implant Devices,6336.75,35,,6336.75,percent of total billed charges,Implant Devices,6336.75,35,,,percent of total billed charges,Implant Devices,6336.75,35,,6336.75,percent of total billed charges,Implant Devices,6336.75,35,,6336.75,percent of total billed charges,Implant Devices,7242,40,,7242,percent of total billed charges,Implant Devices,6336.75,70,,6336.75,percent of total billed charges,Implant Devices,6155.7,34,,6155.7,percent of total billed charges,Implant Devices,6155.7,34,,6155.7,percent of total billed charges,Implant Devices,6336.75,35,,6336.75,percent of total billed charges,Implant Devices,6336.75,35,,6336.75,percent of total billed charges,Implant Devices,6336.75,35,,6336.75,percent of total billed charges,Implant Devices,6336.75,35,,6336.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6155.7,34,"If Charge > 2,000, then 34 percent",6155.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7242,
STRYKER 608065 CANCELLOUS SCREW 6.0X65MM,C1713,HCPCS,,79013317,CDM,278,RC,,,both,,,168,66.3,39.4668,,66.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,57.12,34,,57.12,percent of total billed charges,Implant Device,57.12,34,,57.12,percent of total billed charges,Implant Device,57.12,34,,57.12,percent of total billed charges,Implant Device,57.12,34,,57.12,percent of total billed charges,Implant Device,57.12,34,,57.12,percent of total billed charges,Implant Device,57.12,34,,57.12,percent of total billed charges,Implant Device,58.8,35,,58.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,67.2,40,,67.2,percent of total billed charges,Implant Devices,58.8,70,,58.8,percent of total billed charges,Implant Devices,57.12,34,,57.12,percent of total billed charges,Implant Devices,57.12,34,,57.12,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,67.2,
STRYKER 627640 DIS LAT FEMUR PLT 10H 238,C1713,HCPCS,,79013318,CDM,278,RC,,,both,,,8271,3264.3,39.4668,,3264.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2812.14,34,,2812.14,percent of total billed charges,Implant Device,2812.14,34,,2812.14,percent of total billed charges,Implant Device,2812.14,34,,2812.14,percent of total billed charges,Implant Device,2812.14,34,,2812.14,percent of total billed charges,Implant Device,2812.14,34,,2812.14,percent of total billed charges,Implant Device,2812.14,34,,2812.14,percent of total billed charges,Implant Device,2894.85,35,,2894.85,percent of total billed charges,Implant Device,2812.14,34,"Charges > $500, x 34%",2812.14,percent of total billed charges,Implant Device,2894.85,35,,2894.85,percent of total billed charges,Implant Devices,2894.85,35,,2894.85,percent of total billed charges,Implant Devices,2894.85,35,,,percent of total billed charges,Implant Devices,2894.85,35,,2894.85,percent of total billed charges,Implant Devices,2894.85,35,,2894.85,percent of total billed charges,Implant Devices,3308.4,40,,3308.4,percent of total billed charges,Implant Devices,2894.85,70,,2894.85,percent of total billed charges,Implant Devices,2812.14,34,,2812.14,percent of total billed charges,Implant Devices,2812.14,34,,2812.14,percent of total billed charges,Implant Devices,2894.85,35,,2894.85,percent of total billed charges,Implant Devices,2894.85,35,,2894.85,percent of total billed charges,Implant Devices,2894.85,35,,2894.85,percent of total billed charges,Implant Devices,2894.85,35,,2894.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2812.14,34,"If Charge > 2,000, then 34 percent",2812.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3308.4,
STRYKER 661128 LOCKING SCREW 5.0X28MM,C1713,HCPCS,,79013319,CDM,278,RC,,,both,,,664,262.06,39.4668,,262.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,225.76,34,,225.76,percent of total billed charges,Implant Device,225.76,34,,225.76,percent of total billed charges,Implant Device,225.76,34,,225.76,percent of total billed charges,Implant Device,225.76,34,,225.76,percent of total billed charges,Implant Device,225.76,34,,225.76,percent of total billed charges,Implant Device,225.76,34,,225.76,percent of total billed charges,Implant Device,232.4,35,,232.4,percent of total billed charges,Implant Device,225.76,34,"Charges > $500, x 34%",225.76,percent of total billed charges,Implant Device,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,265.6,40,,265.6,percent of total billed charges,Implant Devices,232.4,70,,232.4,percent of total billed charges,Implant Devices,225.76,34,,225.76,percent of total billed charges,Implant Devices,225.76,34,,225.76,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,232.4,35,,232.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,265.6,
J&J 201.691 CORTEX SCREW 2.4X42MM,C1713,HCPCS,,79013324,CDM,278,RC,,,both,,,153,60.38,39.4668,,60.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,61.2,40,,61.2,percent of total billed charges,Implant Devices,53.55,70,,53.55,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,61.2,
J&J 02.123.042 PROX HUMERUS PLT 5H 145MM,C1713,HCPCS,,79013325,CDM,278,RC,,,both,,,4148,1637.08,39.4668,,1637.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1410.32,34,,1410.32,percent of total billed charges,Implant Device,1410.32,34,,1410.32,percent of total billed charges,Implant Device,1410.32,34,,1410.32,percent of total billed charges,Implant Device,1410.32,34,,1410.32,percent of total billed charges,Implant Device,1410.32,34,,1410.32,percent of total billed charges,Implant Device,1410.32,34,,1410.32,percent of total billed charges,Implant Device,1451.8,35,,1451.8,percent of total billed charges,Implant Device,1410.32,34,"Charges > $500, x 34%",1410.32,percent of total billed charges,Implant Device,1451.8,35,,1451.8,percent of total billed charges,Implant Devices,1451.8,35,,1451.8,percent of total billed charges,Implant Devices,1451.8,35,,,percent of total billed charges,Implant Devices,1451.8,35,,1451.8,percent of total billed charges,Implant Devices,1451.8,35,,1451.8,percent of total billed charges,Implant Devices,1659.2,40,,1659.2,percent of total billed charges,Implant Devices,1451.8,70,,1451.8,percent of total billed charges,Implant Devices,1410.32,34,,1410.32,percent of total billed charges,Implant Devices,1410.32,34,,1410.32,percent of total billed charges,Implant Devices,1451.8,35,,1451.8,percent of total billed charges,Implant Devices,1451.8,35,,1451.8,percent of total billed charges,Implant Devices,1451.8,35,,1451.8,percent of total billed charges,Implant Devices,1451.8,35,,1451.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1410.32,34,"If Charge > 2,000, then 34 percent",1410.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1659.2,
STRYKER 2341-1128S TIBIAL NAIL 11X285MM,C1713,HCPCS,,79013326,CDM,278,RC,,,both,,,4792,1891.25,39.4668,,1891.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Device,1629.28,34,"Charges > $500, x 34%",1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1916.8,40,,1916.8,percent of total billed charges,Implant Devices,1677.2,70,,1677.2,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.28,34,"If Charge > 2,000, then 34 percent",1629.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1916.8,
J&J 04.334.128 CANN SCREW 2.5X28MM,C1713,HCPCS,,79013330,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 04.334.1124 CANN SCREW 2.5X24MM,C1713,HCPCS,,79013331,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 04.334.130 CANN SCREW 2.5X30MM,C1713,HCPCS,,79013332,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 04.037.033S CANN TFNA NAIL 10X420MM,C1713,HCPCS,,79013335,CDM,278,RC,,,both,,,5467,2157.65,39.4668,,2157.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1913.45,35,,1913.45,percent of total billed charges,Implant Device,1858.78,34,"Charges > $500, x 34%",1858.78,percent of total billed charges,Implant Device,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,2186.8,40,,2186.8,percent of total billed charges,Implant Devices,1913.45,70,,1913.45,percent of total billed charges,Implant Devices,1858.78,34,,1858.78,percent of total billed charges,Implant Devices,1858.78,34,,1858.78,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1858.78,34,"If Charge > 2,000, then 34 percent",1858.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2186.8,
J&J 04.045.358S LOCKING SCREW 5X58MM,C1713,HCPCS,,79013336,CDM,278,RC,,,both,,,813,320.87,39.4668,,320.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Device,276.42,34,"Charges > $500, x 34%",276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,325.2,40,,325.2,percent of total billed charges,Implant Devices,284.55,70,,284.55,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,325.2,
STRYKER 326050 CANN SCREW 6.5X50MM,C1713,HCPCS,,79013348,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
STRYKER 626800 LOCKING PLATE LATERAL,C1713,HCPCS,,79013353,CDM,278,RC,,,both,,,3589,1416.46,39.4668,,1416.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1220.26,34,,1220.26,percent of total billed charges,Implant Device,1220.26,34,,1220.26,percent of total billed charges,Implant Device,1220.26,34,,1220.26,percent of total billed charges,Implant Device,1220.26,34,,1220.26,percent of total billed charges,Implant Device,1220.26,34,,1220.26,percent of total billed charges,Implant Device,1220.26,34,,1220.26,percent of total billed charges,Implant Device,1256.15,35,,1256.15,percent of total billed charges,Implant Device,1220.26,34,"Charges > $500, x 34%",1220.26,percent of total billed charges,Implant Device,1256.15,35,,1256.15,percent of total billed charges,Implant Devices,1256.15,35,,1256.15,percent of total billed charges,Implant Devices,1256.15,35,,,percent of total billed charges,Implant Devices,1256.15,35,,1256.15,percent of total billed charges,Implant Devices,1256.15,35,,1256.15,percent of total billed charges,Implant Devices,1435.6,40,,1435.6,percent of total billed charges,Implant Devices,1256.15,70,,1256.15,percent of total billed charges,Implant Devices,1220.26,34,,1220.26,percent of total billed charges,Implant Devices,1220.26,34,,1220.26,percent of total billed charges,Implant Devices,1256.15,35,,1256.15,percent of total billed charges,Implant Devices,1256.15,35,,1256.15,percent of total billed charges,Implant Devices,1256.15,35,,1256.15,percent of total billed charges,Implant Devices,1256.15,35,,1256.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1220.26,34,"If Charge > 2,000, then 34 percent",1220.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1435.6,
STRYKER 70-812-0515 IMPLANT SYS 5X15MM,C1713,HCPCS,,79013354,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
STRYKER 58A91000 ORTHOLOC 3DI PLAT SYS,C1713,HCPCS,,79013355,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
STRYKER 86660800 BICORTICAL 8 EVANS WED,C1713,HCPCS,,79013356,CDM,278,RC,,,both,,,12114,4781.01,39.4668,,4781.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4118.76,34,,4118.76,percent of total billed charges,Implant Device,4118.76,34,,4118.76,percent of total billed charges,Implant Device,4118.76,34,,4118.76,percent of total billed charges,Implant Device,4118.76,34,,4118.76,percent of total billed charges,Implant Device,4118.76,34,,4118.76,percent of total billed charges,Implant Device,4118.76,34,,4118.76,percent of total billed charges,Implant Device,4239.9,35,,4239.9,percent of total billed charges,Implant Device,4118.76,34,"Charges > $500, x 34%",4118.76,percent of total billed charges,Implant Device,4239.9,35,,4239.9,percent of total billed charges,Implant Devices,4239.9,35,,4239.9,percent of total billed charges,Implant Devices,4239.9,35,,,percent of total billed charges,Implant Devices,4239.9,35,,4239.9,percent of total billed charges,Implant Devices,4239.9,35,,4239.9,percent of total billed charges,Implant Devices,4845.6,40,,4845.6,percent of total billed charges,Implant Devices,4239.9,70,,4239.9,percent of total billed charges,Implant Devices,4118.76,34,,4118.76,percent of total billed charges,Implant Devices,4118.76,34,,4118.76,percent of total billed charges,Implant Devices,4239.9,35,,4239.9,percent of total billed charges,Implant Devices,4239.9,35,,4239.9,percent of total billed charges,Implant Devices,4239.9,35,,4239.9,percent of total billed charges,Implant Devices,4239.9,35,,4239.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4118.76,34,"If Charge > 2,000, then 34 percent",4118.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4845.6,
STRYKER 8160-0095S LAG SCREW 10.5X95MM,C1713,HCPCS,,79013358,CDM,278,RC,,,both,,,1777,701.33,39.4668,,701.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Device,604.18,34,"Charges > $500, x 34%",604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,710.8,40,,710.8,percent of total billed charges,Implant Devices,621.95,70,,621.95,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.8,
STRYKER 8160-0100S LAG SCREW 10.5X100MM,C1713,HCPCS,,79013359,CDM,278,RC,,,both,,,1777,701.33,39.4668,,701.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Device,604.18,34,"Charges > $500, x 34%",604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,710.8,40,,710.8,percent of total billed charges,Implant Devices,621.95,70,,621.95,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.8,
STRYKER 8425-0360S NAIL RT 10X360X125DEG,C1713,HCPCS,,79013360,CDM,278,RC,,,both,,,7227,2852.27,39.4668,,2852.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Device,2457.18,34,"Charges > $500, x 34%",2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2890.8,40,,2890.8,percent of total billed charges,Implant Devices,2529.45,70,,2529.45,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2457.18,34,"If Charge > 2,000, then 34 percent",2457.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2890.8,
STRYKER 8525-0360S NAIL LT 10X360X125DEG,C1713,HCPCS,,79013361,CDM,278,RC,,,both,,,7227,2852.27,39.4668,,2852.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Device,2457.18,34,"Charges > $500, x 34%",2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2890.8,40,,2890.8,percent of total billed charges,Implant Devices,2529.45,70,,2529.45,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2457.18,34,"If Charge > 2,000, then 34 percent",2457.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2890.8,
J&J 04.168.285S BOLT FOR FEM NECK SYS 85,C1713,HCPCS,,79013365,CDM,278,RC,,,both,,,938,370.2,39.4668,,370.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,318.92,34,,318.92,percent of total billed charges,Implant Device,318.92,34,,318.92,percent of total billed charges,Implant Device,318.92,34,,318.92,percent of total billed charges,Implant Device,318.92,34,,318.92,percent of total billed charges,Implant Device,318.92,34,,318.92,percent of total billed charges,Implant Device,318.92,34,,318.92,percent of total billed charges,Implant Device,328.3,35,,328.3,percent of total billed charges,Implant Device,318.92,34,"Charges > $500, x 34%",318.92,percent of total billed charges,Implant Device,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,375.2,40,,375.2,percent of total billed charges,Implant Devices,328.3,70,,328.3,percent of total billed charges,Implant Devices,318.92,34,,318.92,percent of total billed charges,Implant Devices,318.92,34,,318.92,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,328.3,35,,328.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,375.2,
J&J 04.168.485S ANTIROTATION SCREW 85LEN,C1713,HCPCS,,79013366,CDM,278,RC,,,both,,,633,249.82,39.4668,,249.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,215.22,34,,215.22,percent of total billed charges,Implant Device,221.55,35,,221.55,percent of total billed charges,Implant Device,215.22,34,"Charges > $500, x 34%",215.22,percent of total billed charges,Implant Device,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,253.2,40,,253.2,percent of total billed charges,Implant Devices,221.55,70,,221.55,percent of total billed charges,Implant Devices,215.22,34,,215.22,percent of total billed charges,Implant Devices,215.22,34,,215.22,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,221.55,35,,221.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.2,
J&J 04.333.018 CANN HEADLESS SCREW 2X18,C1713,HCPCS,,79013377,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 04.333.020 HEADLESS SCREW 2X20,C1713,HCPCS,,79013378,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 02.112.142S LCP FIBULA PLT 2.7/3.5MM,C1713,HCPCS,,79013379,CDM,278,RC,,,both,,,1743,687.91,39.4668,,687.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,592.62,34,,592.62,percent of total billed charges,Implant Device,592.62,34,,592.62,percent of total billed charges,Implant Device,592.62,34,,592.62,percent of total billed charges,Implant Device,592.62,34,,592.62,percent of total billed charges,Implant Device,592.62,34,,592.62,percent of total billed charges,Implant Device,592.62,34,,592.62,percent of total billed charges,Implant Device,610.05,35,,610.05,percent of total billed charges,Implant Device,592.62,34,"Charges > $500, x 34%",592.62,percent of total billed charges,Implant Device,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,697.2,40,,697.2,percent of total billed charges,Implant Devices,610.05,70,,610.05,percent of total billed charges,Implant Devices,592.62,34,,592.62,percent of total billed charges,Implant Devices,592.62,34,,592.62,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,610.05,35,,610.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,697.2,
J&J 201.695 CORTEX SCREW 2.4X50MM,C1713,HCPCS,,79013380,CDM,278,RC,,,both,,,153,60.38,39.4668,,60.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,52.02,34,,52.02,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,61.2,40,,61.2,percent of total billed charges,Implant Devices,53.55,70,,53.55,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,52.02,34,,52.02,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,53.55,35,,53.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,61.2,
J&J 02.221.087 HOOK PLATE 3.5/4.5MM,C1713,HCPCS,,79013381,CDM,278,RC,,,both,,,7897,3116.69,39.4668,,3116.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2684.98,34,,2684.98,percent of total billed charges,Implant Device,2684.98,34,,2684.98,percent of total billed charges,Implant Device,2684.98,34,,2684.98,percent of total billed charges,Implant Device,2684.98,34,,2684.98,percent of total billed charges,Implant Device,2684.98,34,,2684.98,percent of total billed charges,Implant Device,2684.98,34,,2684.98,percent of total billed charges,Implant Device,2763.95,35,,2763.95,percent of total billed charges,Implant Device,2684.98,34,"Charges > $500, x 34%",2684.98,percent of total billed charges,Implant Device,2763.95,35,,2763.95,percent of total billed charges,Implant Devices,2763.95,35,,2763.95,percent of total billed charges,Implant Devices,2763.95,35,,,percent of total billed charges,Implant Devices,2763.95,35,,2763.95,percent of total billed charges,Implant Devices,2763.95,35,,2763.95,percent of total billed charges,Implant Devices,3158.8,40,,3158.8,percent of total billed charges,Implant Devices,2763.95,70,,2763.95,percent of total billed charges,Implant Devices,2684.98,34,,2684.98,percent of total billed charges,Implant Devices,2684.98,34,,2684.98,percent of total billed charges,Implant Devices,2763.95,35,,2763.95,percent of total billed charges,Implant Devices,2763.95,35,,2763.95,percent of total billed charges,Implant Devices,2763.95,35,,2763.95,percent of total billed charges,Implant Devices,2763.95,35,,2763.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2684.98,34,"If Charge > 2,000, then 34 percent",2684.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3158.8,
J&J 02.127.132 LOCKING SCREW 3.5X32MM,C1713,HCPCS,,79013382,CDM,278,RC,,,both,,,414,163.39,39.4668,,163.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,140.76,34,,140.76,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,165.6,40,,165.6,percent of total billed charges,Implant Devices,144.9,70,,144.9,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,140.76,34,,140.76,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,144.9,35,,144.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.6,
J&J 201.660 CORTEX SCREW 2.4X30MM,C1713,HCPCS,,79013383,CDM,278,RC,,,both,,,121,47.75,39.4668,,47.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,48.4,40,,48.4,percent of total billed charges,Implant Devices,42.35,70,,42.35,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.4,
STRYKER IC3022 HEADED SCREW 3.0X22MM,C1713,HCPCS,,79013396,CDM,278,RC,,,both,,,964,380.46,39.4668,,380.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Device,327.76,34,"Charges > $500, x 34%",327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,385.6,40,,385.6,percent of total billed charges,Implant Devices,337.4,70,,337.4,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,385.6,
STRYKER IC3032 HEADED SCREW 3.0X32MM,C1713,HCPCS,,79013397,CDM,278,RC,,,both,,,964,380.46,39.4668,,380.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Device,327.76,34,"Charges > $500, x 34%",327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,385.6,40,,385.6,percent of total billed charges,Implant Devices,337.4,70,,337.4,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,385.6,
STRYKER 587338RT RT ORTHOLOC PLNTING SYS,C1713,HCPCS,,79013398,CDM,278,RC,,,both,,,8494,3352.31,39.4668,,3352.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2887.96,34,,2887.96,percent of total billed charges,Implant Device,2887.96,34,,2887.96,percent of total billed charges,Implant Device,2887.96,34,,2887.96,percent of total billed charges,Implant Device,2887.96,34,,2887.96,percent of total billed charges,Implant Device,2887.96,34,,2887.96,percent of total billed charges,Implant Device,2887.96,34,,2887.96,percent of total billed charges,Implant Device,2972.9,35,,2972.9,percent of total billed charges,Implant Device,2887.96,34,"Charges > $500, x 34%",2887.96,percent of total billed charges,Implant Device,2972.9,35,,2972.9,percent of total billed charges,Implant Devices,2972.9,35,,2972.9,percent of total billed charges,Implant Devices,2972.9,35,,,percent of total billed charges,Implant Devices,2972.9,35,,2972.9,percent of total billed charges,Implant Devices,2972.9,35,,2972.9,percent of total billed charges,Implant Devices,3397.6,40,,3397.6,percent of total billed charges,Implant Devices,2972.9,70,,2972.9,percent of total billed charges,Implant Devices,2887.96,34,,2887.96,percent of total billed charges,Implant Devices,2887.96,34,,2887.96,percent of total billed charges,Implant Devices,2972.9,35,,2972.9,percent of total billed charges,Implant Devices,2972.9,35,,2972.9,percent of total billed charges,Implant Devices,2972.9,35,,2972.9,percent of total billed charges,Implant Devices,2972.9,35,,2972.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2887.96,34,"If Charge > 2,000, then 34 percent",2887.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3397.6,
STRYKER 58803510 LOCKING SCREW 3.5X10MM,C1713,HCPCS,,79013399,CDM,278,RC,,,both,,,1536,606.21,39.4668,,606.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Device,522.24,34,"Charges > $500, x 34%",522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,614.4,40,,614.4,percent of total billed charges,Implant Devices,537.6,70,,537.6,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,614.4,
STRYKER 58803514 LOCKING SCREW 3.5X14MM,C1713,HCPCS,,79013400,CDM,278,RC,,,both,,,1536,606.21,39.4668,,606.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Device,522.24,34,"Charges > $500, x 34%",522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,614.4,40,,614.4,percent of total billed charges,Implant Devices,537.6,70,,537.6,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,614.4,
ZIMMER 14-444224 FEMORAL NAIL 10.5X240MM,C1713,HCPCS,,79013414,CDM,278,RC,,,both,,,5715,2255.53,39.4668,,2255.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1943.1,34,,1943.1,percent of total billed charges,Implant Device,1943.1,34,,1943.1,percent of total billed charges,Implant Device,1943.1,34,,1943.1,percent of total billed charges,Implant Device,1943.1,34,,1943.1,percent of total billed charges,Implant Device,1943.1,34,,1943.1,percent of total billed charges,Implant Device,1943.1,34,,1943.1,percent of total billed charges,Implant Device,2000.25,35,,2000.25,percent of total billed charges,Implant Device,1943.1,34,"Charges > $500, x 34%",1943.1,percent of total billed charges,Implant Device,2000.25,35,,2000.25,percent of total billed charges,Implant Devices,2000.25,35,,2000.25,percent of total billed charges,Implant Devices,2000.25,35,,,percent of total billed charges,Implant Devices,2000.25,35,,2000.25,percent of total billed charges,Implant Devices,2000.25,35,,2000.25,percent of total billed charges,Implant Devices,2286,40,,2286,percent of total billed charges,Implant Devices,2000.25,70,,2000.25,percent of total billed charges,Implant Devices,1943.1,34,,1943.1,percent of total billed charges,Implant Devices,1943.1,34,,1943.1,percent of total billed charges,Implant Devices,2000.25,35,,2000.25,percent of total billed charges,Implant Devices,2000.25,35,,2000.25,percent of total billed charges,Implant Devices,2000.25,35,,2000.25,percent of total billed charges,Implant Devices,2000.25,35,,2000.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1943.1,34,"If Charge > 2,000, then 34 percent",1943.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2286,
ZIMMER 14-405050 CORTICAL SCREW 5.0X50MM,C1713,HCPCS,,79013415,CDM,278,RC,,,both,,,634,250.22,39.4668,,250.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Device,215.56,34,"Charges > $500, x 34%",215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,253.6,40,,253.6,percent of total billed charges,Implant Devices,221.9,70,,221.9,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.6,
ZIMMER 14-405070 CORTICAL SCREW 5.0X70MM,C1713,HCPCS,,79013416,CDM,278,RC,,,both,,,634,250.22,39.4668,,250.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Device,215.56,34,"Charges > $500, x 34%",215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,253.6,40,,253.6,percent of total billed charges,Implant Devices,221.9,70,,221.9,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.6,
ZIMMER 14-405090 CORTICAL SCREW 5X90MM,C1713,HCPCS,,79013417,CDM,278,RC,,,both,,,634,250.22,39.4668,,250.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Device,215.56,34,"Charges > $500, x 34%",215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,253.6,40,,253.6,percent of total billed charges,Implant Devices,221.9,70,,221.9,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.6,
ZIMMER 02.03264.112 NCB DIS FEM PLT 278,C1713,HCPCS,,79013418,CDM,278,RC,,,both,,,3859,1523.02,39.4668,,1523.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1312.06,34,,1312.06,percent of total billed charges,Implant Device,1312.06,34,,1312.06,percent of total billed charges,Implant Device,1312.06,34,,1312.06,percent of total billed charges,Implant Device,1312.06,34,,1312.06,percent of total billed charges,Implant Device,1312.06,34,,1312.06,percent of total billed charges,Implant Device,1312.06,34,,1312.06,percent of total billed charges,Implant Device,1350.65,35,,1350.65,percent of total billed charges,Implant Device,1312.06,34,"Charges > $500, x 34%",1312.06,percent of total billed charges,Implant Device,1350.65,35,,1350.65,percent of total billed charges,Implant Devices,1350.65,35,,1350.65,percent of total billed charges,Implant Devices,1350.65,35,,,percent of total billed charges,Implant Devices,1350.65,35,,1350.65,percent of total billed charges,Implant Devices,1350.65,35,,1350.65,percent of total billed charges,Implant Devices,1543.6,40,,1543.6,percent of total billed charges,Implant Devices,1350.65,70,,1350.65,percent of total billed charges,Implant Devices,1312.06,34,,1312.06,percent of total billed charges,Implant Devices,1312.06,34,,1312.06,percent of total billed charges,Implant Devices,1350.65,35,,1350.65,percent of total billed charges,Implant Devices,1350.65,35,,1350.65,percent of total billed charges,Implant Devices,1350.65,35,,1350.65,percent of total billed charges,Implant Devices,1350.65,35,,1350.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1312.06,34,"If Charge > 2,000, then 34 percent",1312.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1543.6,
ZIMMER 02.03152.050 CAN SCREW 5X50MM,C1713,HCPCS,,79013419,CDM,278,RC,,,both,,,403,159.05,39.4668,,159.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,137.02,34,,137.02,percent of total billed charges,Implant Device,137.02,34,,137.02,percent of total billed charges,Implant Device,137.02,34,,137.02,percent of total billed charges,Implant Device,137.02,34,,137.02,percent of total billed charges,Implant Device,137.02,34,,137.02,percent of total billed charges,Implant Device,137.02,34,,137.02,percent of total billed charges,Implant Device,141.05,35,,141.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,141.05,35,,141.05,percent of total billed charges,Implant Devices,141.05,35,,141.05,percent of total billed charges,Implant Devices,141.05,35,,,percent of total billed charges,Implant Devices,141.05,35,,141.05,percent of total billed charges,Implant Devices,141.05,35,,141.05,percent of total billed charges,Implant Devices,161.2,40,,161.2,percent of total billed charges,Implant Devices,141.05,70,,141.05,percent of total billed charges,Implant Devices,137.02,34,,137.02,percent of total billed charges,Implant Devices,137.02,34,,137.02,percent of total billed charges,Implant Devices,141.05,35,,141.05,percent of total billed charges,Implant Devices,141.05,35,,141.05,percent of total billed charges,Implant Devices,141.05,35,,141.05,percent of total billed charges,Implant Devices,141.05,35,,141.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,161.2,
ZIMMER 02.03150.060 CORT SCREW 5X60MM,C1713,HCPCS,,79013420,CDM,278,RC,,,both,,,475,187.47,39.4668,,187.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,190,40,,190,percent of total billed charges,Implant Devices,166.25,70,,166.25,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190,
ZIMMER 02.03150.055 CORT SCREW 5X55MM,C1713,HCPCS,,79013421,CDM,278,RC,,,both,,,475,187.47,39.4668,,187.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,190,40,,190,percent of total billed charges,Implant Devices,166.25,70,,166.25,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190,
ZIMMER 02.03151.020 UNCORT SCREW 5X20MM,C1713,HCPCS,,79013422,CDM,278,RC,,,both,,,446,176.02,39.4668,,176.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,151.64,34,,151.64,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,178.4,40,,178.4,percent of total billed charges,Implant Devices,156.1,70,,156.1,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,151.64,34,,151.64,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,156.1,35,,156.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,178.4,
ZIMMER 02.03150.038 CORT SCREW 5X38MM,C1713,HCPCS,,79013423,CDM,278,RC,,,both,,,475,187.47,39.4668,,187.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,190,40,,190,percent of total billed charges,Implant Devices,166.25,70,,166.25,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190,
STRYKER 625094 DORSAL PLT NARROW RT 58MM,C1713,HCPCS,,79013424,CDM,278,RC,,,both,,,3083,1216.76,39.4668,,1216.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1079.05,35,,1079.05,percent of total billed charges,Implant Device,1048.22,34,"Charges > $500, x 34%",1048.22,percent of total billed charges,Implant Device,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1233.2,40,,1233.2,percent of total billed charges,Implant Devices,1079.05,70,,1079.05,percent of total billed charges,Implant Devices,1048.22,34,,1048.22,percent of total billed charges,Implant Devices,1048.22,34,,1048.22,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1048.22,34,"If Charge > 2,000, then 34 percent",1048.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1233.2,
STRYKER 662511 LOCKING SCREW 1.7X11MM,C1713,HCPCS,,79013436,CDM,278,RC,,,both,,,413,163,39.4668,,163,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,144.55,35,,144.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,165.2,40,,165.2,percent of total billed charges,Implant Devices,144.55,70,,144.55,percent of total billed charges,Implant Devices,140.42,34,,140.42,percent of total billed charges,Implant Devices,140.42,34,,140.42,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
STRYKER 662512 LOCKING SCREW 1.7X12MM,C1713,HCPCS,,79013437,CDM,278,RC,,,both,,,413,163,39.4668,,163,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,144.55,35,,144.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,165.2,40,,165.2,percent of total billed charges,Implant Devices,144.55,70,,144.55,percent of total billed charges,Implant Devices,140.42,34,,140.42,percent of total billed charges,Implant Devices,140.42,34,,140.42,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
STRYKER 662611 LOCKING SCREW 1.7X11MM,C1713,HCPCS,,79013438,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ARTHREX AR-8933VCL-20 KREULOCK SCRW 3X20,C1713,HCPCS,,79013443,CDM,278,RC,,,both,,,885,349.28,39.4668,,349.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,300.9,34,,300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Device,300.9,34,"Charges > $500, x 34%",300.9,percent of total billed charges,Implant Device,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,354,40,,354,percent of total billed charges,Implant Devices,309.75,70,,309.75,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,300.9,34,,300.9,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,309.75,35,,309.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354,
ARTHREX AR-9933-22 CORT SCREW 3X22MM,C1713,HCPCS,,79013444,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
STRYKER 8160-0105S LAG SCREW 10.5X105MM,C1713,HCPCS,,79013483,CDM,278,RC,,,both,,,1777,701.33,39.4668,,701.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Device,604.18,34,"Charges > $500, x 34%",604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,710.8,40,,710.8,percent of total billed charges,Implant Devices,621.95,70,,621.95,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.8,
STRYKER 8425-1380S NAIL RT 11X380X125DEG,C1713,HCPCS,,79013484,CDM,278,RC,,,both,,,7227,2852.27,39.4668,,2852.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Device,2457.18,34,"Charges > $500, x 34%",2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2890.8,40,,2890.8,percent of total billed charges,Implant Devices,2529.45,70,,2529.45,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2457.18,34,"If Charge > 2,000, then 34 percent",2457.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2890.8,
J&J 04.354.432 CANNULATED 4.0X32MM,C1713,HCPCS,,79013494,CDM,278,RC,,,both,,,947,373.75,39.4668,,373.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,331.45,35,,331.45,percent of total billed charges,Implant Device,321.98,34,"Charges > $500, x 34%",321.98,percent of total billed charges,Implant Device,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,378.8,40,,378.8,percent of total billed charges,Implant Devices,331.45,70,,331.45,percent of total billed charges,Implant Devices,321.98,34,,321.98,percent of total billed charges,Implant Devices,321.98,34,,321.98,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.8,
J&J 04.354.450 CANNULATED SCREW 4.0X50MM,C1713,HCPCS,,79013495,CDM,278,RC,,,both,,,947,373.75,39.4668,,373.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,331.45,35,,331.45,percent of total billed charges,Implant Device,321.98,34,"Charges > $500, x 34%",321.98,percent of total billed charges,Implant Device,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,378.8,40,,378.8,percent of total billed charges,Implant Devices,331.45,70,,331.45,percent of total billed charges,Implant Devices,321.98,34,,321.98,percent of total billed charges,Implant Devices,321.98,34,,321.98,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.8,
J&J 04.354.438 CANNULATED SCREW 4.0X38MM,C1713,HCPCS,,79013497,CDM,278,RC,,,both,,,947,373.75,39.4668,,373.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,331.45,35,,331.45,percent of total billed charges,Implant Device,321.98,34,"Charges > $500, x 34%",321.98,percent of total billed charges,Implant Device,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,378.8,40,,378.8,percent of total billed charges,Implant Devices,331.45,70,,331.45,percent of total billed charges,Implant Devices,321.98,34,,321.98,percent of total billed charges,Implant Devices,321.98,34,,321.98,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.8,
J&J 04.354.454 CANNULATED SCREW 4.0X54MM,C1713,HCPCS,,79013498,CDM,278,RC,,,both,,,947,373.75,39.4668,,373.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,331.45,35,,331.45,percent of total billed charges,Implant Device,321.98,34,"Charges > $500, x 34%",321.98,percent of total billed charges,Implant Device,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,378.8,40,,378.8,percent of total billed charges,Implant Devices,331.45,70,,331.45,percent of total billed charges,Implant Devices,321.98,34,,321.98,percent of total billed charges,Implant Devices,321.98,34,,321.98,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.8,
J&J 04.354.456 CANNULATED SCREW 4.0X56MM,C1713,HCPCS,,79013499,CDM,278,RC,,,both,,,947,373.75,39.4668,,373.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,321.98,34,,321.98,percent of total billed charges,Implant Device,331.45,35,,331.45,percent of total billed charges,Implant Device,321.98,34,"Charges > $500, x 34%",321.98,percent of total billed charges,Implant Device,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,378.8,40,,378.8,percent of total billed charges,Implant Devices,331.45,70,,331.45,percent of total billed charges,Implant Devices,321.98,34,,321.98,percent of total billed charges,Implant Devices,321.98,34,,321.98,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,331.45,35,,331.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.8,
J&J 04.353.904S WASHER FOR 4 CANN SCREW,C1713,HCPCS,,79013500,CDM,278,RC,,,both,,,117,46.18,39.4668,,46.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.78,34,,39.78,percent of total billed charges,Implant Device,39.78,34,,39.78,percent of total billed charges,Implant Device,39.78,34,,39.78,percent of total billed charges,Implant Device,39.78,34,,39.78,percent of total billed charges,Implant Device,39.78,34,,39.78,percent of total billed charges,Implant Device,39.78,34,,39.78,percent of total billed charges,Implant Device,40.95,35,,40.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,46.8,40,,46.8,percent of total billed charges,Implant Devices,40.95,70,,40.95,percent of total billed charges,Implant Devices,39.78,34,,39.78,percent of total billed charges,Implant Devices,39.78,34,,39.78,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.8,
ARTHREX ABS-2010-05 ALLOSYNC PURE 5CC,C1713,HCPCS,,79013520,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
STRYKER 8125-1170S TROCHANT NAIL 11X170,C1713,HCPCS,,79013521,CDM,278,RC,,,both,,,4797,1893.22,39.4668,,1893.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Device,1630.98,34,"Charges > $500, x 34%",1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1918.8,40,,1918.8,percent of total billed charges,Implant Devices,1678.95,70,,1678.95,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1630.98,34,"If Charge > 2,000, then 34 percent",1630.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1918.8,
STRYKER 8160-0085S LAG SCREW 10.5X85MM,C1713,HCPCS,,79013522,CDM,278,RC,,,both,,,1777,701.33,39.4668,,701.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Device,604.18,34,"Charges > $500, x 34%",604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,710.8,40,,710.8,percent of total billed charges,Implant Devices,621.95,70,,621.95,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.8,
STRYKER 8125-0170S TROCHANT NAIL 10X170,C1713,HCPCS,,79013523,CDM,278,RC,,,both,,,4797,1893.22,39.4668,,1893.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Device,1630.98,34,"Charges > $500, x 34%",1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1918.8,40,,1918.8,percent of total billed charges,Implant Devices,1678.95,70,,1678.95,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1630.98,34,"If Charge > 2,000, then 34 percent",1630.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1918.8,
ARTHREX AR-7000-28FT CANN SCREW 3.75X28,C1713,HCPCS,,79013525,CDM,278,RC,,,both,,,651,256.93,39.4668,,256.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221.34,34,,221.34,percent of total billed charges,Implant Device,221.34,34,,221.34,percent of total billed charges,Implant Device,221.34,34,,221.34,percent of total billed charges,Implant Device,221.34,34,,221.34,percent of total billed charges,Implant Device,221.34,34,,221.34,percent of total billed charges,Implant Device,221.34,34,,221.34,percent of total billed charges,Implant Device,227.85,35,,227.85,percent of total billed charges,Implant Device,221.34,34,"Charges > $500, x 34%",221.34,percent of total billed charges,Implant Device,227.85,35,,227.85,percent of total billed charges,Implant Devices,227.85,35,,227.85,percent of total billed charges,Implant Devices,227.85,35,,,percent of total billed charges,Implant Devices,227.85,35,,227.85,percent of total billed charges,Implant Devices,227.85,35,,227.85,percent of total billed charges,Implant Devices,260.4,40,,260.4,percent of total billed charges,Implant Devices,227.85,70,,227.85,percent of total billed charges,Implant Devices,221.34,34,,221.34,percent of total billed charges,Implant Devices,221.34,34,,221.34,percent of total billed charges,Implant Devices,227.85,35,,227.85,percent of total billed charges,Implant Devices,227.85,35,,227.85,percent of total billed charges,Implant Devices,227.85,35,,227.85,percent of total billed charges,Implant Devices,227.85,35,,227.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,260.4,
STR 8525-01360S LG NL LT 11X360MMX125 DG,C1713,HCPCS,,79013527,CDM,278,RC,,,both,,,7227,2852.27,39.4668,,2852.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Device,2457.18,34,"Charges > $500, x 34%",2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2890.8,40,,2890.8,percent of total billed charges,Implant Devices,2529.45,70,,2529.45,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2457.18,34,"If Charge > 2,000, then 34 percent",2457.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2890.8,
ZIM US INC 14-405075 DB LD CRT 5.0X75MM,C1713,HCPCS,,79013528,CDM,278,RC,,,both,,,634,250.22,39.4668,,250.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Device,215.56,34,"Charges > $500, x 34%",215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,253.6,40,,253.6,percent of total billed charges,Implant Devices,221.9,70,,221.9,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.6,
ZIM US INC 14-444230 FM NL RE 10.5X300MM,C1713,HCPCS,,79013529,CDM,278,RC,,,both,,,5717,2256.32,39.4668,,2256.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1943.78,34,,1943.78,percent of total billed charges,Implant Device,1943.78,34,,1943.78,percent of total billed charges,Implant Device,1943.78,34,,1943.78,percent of total billed charges,Implant Device,1943.78,34,,1943.78,percent of total billed charges,Implant Device,1943.78,34,,1943.78,percent of total billed charges,Implant Device,1943.78,34,,1943.78,percent of total billed charges,Implant Device,2000.95,35,,2000.95,percent of total billed charges,Implant Device,1943.78,34,"Charges > $500, x 34%",1943.78,percent of total billed charges,Implant Device,2000.95,35,,2000.95,percent of total billed charges,Implant Devices,2000.95,35,,2000.95,percent of total billed charges,Implant Devices,2000.95,35,,,percent of total billed charges,Implant Devices,2000.95,35,,2000.95,percent of total billed charges,Implant Devices,2000.95,35,,2000.95,percent of total billed charges,Implant Devices,2286.8,40,,2286.8,percent of total billed charges,Implant Devices,2000.95,70,,2000.95,percent of total billed charges,Implant Devices,1943.78,34,,1943.78,percent of total billed charges,Implant Devices,1943.78,34,,1943.78,percent of total billed charges,Implant Devices,2000.95,35,,2000.95,percent of total billed charges,Implant Devices,2000.95,35,,2000.95,percent of total billed charges,Implant Devices,2000.95,35,,2000.95,percent of total billed charges,Implant Devices,2000.95,35,,2000.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1943.78,34,"If Charge > 2,000, then 34 percent",1943.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2286.8,
ZIM US INC 14-405058 DB LD CORT 5.0X58MM,C1713,HCPCS,,79013530,CDM,278,RC,,,both,,,634,250.22,39.4668,,250.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,215.56,34,,215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Device,215.56,34,"Charges > $500, x 34%",215.56,percent of total billed charges,Implant Device,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,253.6,40,,253.6,percent of total billed charges,Implant Devices,221.9,70,,221.9,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,215.56,34,,215.56,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,221.9,35,,221.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,253.6,
ZIM US INC 02.03150.050 COR SCR 5.0X50MM,C1713,HCPCS,,79013531,CDM,278,RC,,,both,,,475,187.47,39.4668,,187.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,190,40,,190,percent of total billed charges,Implant Devices,166.25,70,,166.25,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190,
ZIM US INC 02.03150.065 COR SCR 5.0X65MM,C1713,HCPCS,,79013532,CDM,278,RC,,,both,,,475,187.47,39.4668,,187.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,190,40,,190,percent of total billed charges,Implant Devices,166.25,70,,166.25,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190,
ZIM US INC 02.03263.018 PRX FEM PL 363MM,C1713,HCPCS,,79013533,CDM,278,RC,,,both,,,4291,1693.52,39.4668,,1693.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1458.94,34,,1458.94,percent of total billed charges,Implant Device,1458.94,34,,1458.94,percent of total billed charges,Implant Device,1458.94,34,,1458.94,percent of total billed charges,Implant Device,1458.94,34,,1458.94,percent of total billed charges,Implant Device,1458.94,34,,1458.94,percent of total billed charges,Implant Device,1458.94,34,,1458.94,percent of total billed charges,Implant Device,1501.85,35,,1501.85,percent of total billed charges,Implant Device,1458.94,34,"Charges > $500, x 34%",1458.94,percent of total billed charges,Implant Device,1501.85,35,,1501.85,percent of total billed charges,Implant Devices,1501.85,35,,1501.85,percent of total billed charges,Implant Devices,1501.85,35,,,percent of total billed charges,Implant Devices,1501.85,35,,1501.85,percent of total billed charges,Implant Devices,1501.85,35,,1501.85,percent of total billed charges,Implant Devices,1716.4,40,,1716.4,percent of total billed charges,Implant Devices,1501.85,70,,1501.85,percent of total billed charges,Implant Devices,1458.94,34,,1458.94,percent of total billed charges,Implant Devices,1458.94,34,,1458.94,percent of total billed charges,Implant Devices,1501.85,35,,1501.85,percent of total billed charges,Implant Devices,1501.85,35,,1501.85,percent of total billed charges,Implant Devices,1501.85,35,,1501.85,percent of total billed charges,Implant Devices,1501.85,35,,1501.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1458.94,34,"If Charge > 2,000, then 34 percent",1458.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1716.4,
J&J 02.130.251 STRGHT PLT 12 HOLES 1.5MM,C1713,HCPCS,,79013534,CDM,278,RC,,,both,,,1350,532.8,39.4668,,532.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,459,34,,459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Device,459,34,"Charges > $500, x 34%",459,percent of total billed charges,Implant Device,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,540,40,,540,percent of total billed charges,Implant Devices,472.5,70,,472.5,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,459,34,,459,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,472.5,35,,472.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,540,
J&J 02.214.111 CORTEX SCREW 1.5X11MM,C1713,HCPCS,,79013535,CDM,278,RC,,,both,,,110,43.41,39.4668,,43.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,38.5,35,,38.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,44,40,,44,percent of total billed charges,Implant Devices,38.5,70,,38.5,percent of total billed charges,Implant Devices,37.4,34,,37.4,percent of total billed charges,Implant Devices,37.4,34,,37.4,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,44,
J&J 02.214.110 CORTEX SCREW 1.5X10MM,C1713,HCPCS,,79013536,CDM,278,RC,,,both,,,110,43.41,39.4668,,43.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,38.5,35,,38.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,44,40,,44,percent of total billed charges,Implant Devices,38.5,70,,38.5,percent of total billed charges,Implant Devices,37.4,34,,37.4,percent of total billed charges,Implant Devices,37.4,34,,37.4,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,44,
J&J 02.214.112 CORTEX SCREW 1.5X12MM,C1713,HCPCS,,79013537,CDM,278,RC,,,both,,,110,43.41,39.4668,,43.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,37.4,34,,37.4,percent of total billed charges,Implant Device,38.5,35,,38.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,44,40,,44,percent of total billed charges,Implant Devices,38.5,70,,38.5,percent of total billed charges,Implant Devices,37.4,34,,37.4,percent of total billed charges,Implant Devices,37.4,34,,37.4,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,38.5,35,,38.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,44,
J&J 02.130.211 LOCKING SCREW 1.5X11MM,C1713,HCPCS,,79013538,CDM,278,RC,,,both,,,365,144.05,39.4668,,144.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,124.1,34,,124.1,percent of total billed charges,Implant Device,124.1,34,,124.1,percent of total billed charges,Implant Device,124.1,34,,124.1,percent of total billed charges,Implant Device,124.1,34,,124.1,percent of total billed charges,Implant Device,124.1,34,,124.1,percent of total billed charges,Implant Device,124.1,34,,124.1,percent of total billed charges,Implant Device,127.75,35,,127.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,146,40,,146,percent of total billed charges,Implant Devices,127.75,70,,127.75,percent of total billed charges,Implant Devices,124.1,34,,124.1,percent of total billed charges,Implant Devices,124.1,34,,124.1,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,146,
J&J 412.210S LOCKING SCREW 5.0X32MM,C1713,HCPCS,,79013539,CDM,278,RC,,,both,,,384,151.55,39.4668,,151.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,134.4,35,,134.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,153.6,40,,153.6,percent of total billed charges,Implant Devices,134.4,70,,134.4,percent of total billed charges,Implant Devices,130.56,34,,130.56,percent of total billed charges,Implant Devices,130.56,34,,130.56,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,153.6,
EXACTECH 320-20-02 MOD EXT & SCREW RIGHT,C1713,HCPCS,,79013540,CDM,278,RC,,,both,,,5999,2367.61,39.4668,,2367.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2039.66,34,,2039.66,percent of total billed charges,Implant Device,2039.66,34,,2039.66,percent of total billed charges,Implant Device,2039.66,34,,2039.66,percent of total billed charges,Implant Device,2039.66,34,,2039.66,percent of total billed charges,Implant Device,2039.66,34,,2039.66,percent of total billed charges,Implant Device,2039.66,34,,2039.66,percent of total billed charges,Implant Device,2099.65,35,,2099.65,percent of total billed charges,Implant Device,2039.66,34,"Charges > $500, x 34%",2039.66,percent of total billed charges,Implant Device,2099.65,35,,2099.65,percent of total billed charges,Implant Devices,2099.65,35,,2099.65,percent of total billed charges,Implant Devices,2099.65,35,,,percent of total billed charges,Implant Devices,2099.65,35,,2099.65,percent of total billed charges,Implant Devices,2099.65,35,,2099.65,percent of total billed charges,Implant Devices,2399.6,40,,2399.6,percent of total billed charges,Implant Devices,2099.65,70,,2099.65,percent of total billed charges,Implant Devices,2039.66,34,,2039.66,percent of total billed charges,Implant Devices,2039.66,34,,2039.66,percent of total billed charges,Implant Devices,2099.65,35,,2099.65,percent of total billed charges,Implant Devices,2099.65,35,,2099.65,percent of total billed charges,Implant Devices,2099.65,35,,2099.65,percent of total billed charges,Implant Devices,2099.65,35,,2099.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2039.66,34,"If Charge > 2,000, then 34 percent",2039.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2399.6,
PARAGON PCPT-181408 COTTON WEDGE 8MM,C1713,HCPCS,,79013558,CDM,278,RC,,,both,,,5198,2051.48,39.4668,,2051.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1767.32,34,,1767.32,percent of total billed charges,Implant Device,1819.3,35,,1819.3,percent of total billed charges,Implant Device,1767.32,34,"Charges > $500, x 34%",1767.32,percent of total billed charges,Implant Device,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,2079.2,40,,2079.2,percent of total billed charges,Implant Devices,1819.3,70,,1819.3,percent of total billed charges,Implant Devices,1767.32,34,,1767.32,percent of total billed charges,Implant Devices,1767.32,34,,1767.32,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,1819.3,35,,1819.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1767.32,34,"If Charge > 2,000, then 34 percent",1767.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2079.2,
J&J 247.345 LCP PLATE 2.0X38MM 5 HOLES,C1713,HCPCS,,79013559,CDM,278,RC,,,both,,,624,246.27,39.4668,,246.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,212.16,34,,212.16,percent of total billed charges,Implant Device,218.4,35,,218.4,percent of total billed charges,Implant Device,212.16,34,"Charges > $500, x 34%",212.16,percent of total billed charges,Implant Device,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,249.6,40,,249.6,percent of total billed charges,Implant Devices,218.4,70,,218.4,percent of total billed charges,Implant Devices,212.16,34,,212.16,percent of total billed charges,Implant Devices,212.16,34,,212.16,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,218.4,35,,218.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,249.6,
J&J 201.362.97 CORTEX SCREW 2.0X12MM,C1713,HCPCS,,79013560,CDM,278,RC,,,both,,,90,35.52,39.4668,,35.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,31.5,35,,31.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,36,40,,36,percent of total billed charges,Implant Devices,31.5,70,,31.5,percent of total billed charges,Implant Devices,30.6,34,,30.6,percent of total billed charges,Implant Devices,30.6,34,,30.6,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,36,
J&J 201.364.97 CORTEX SCREW 2.0X14MM,C1713,HCPCS,,79013561,CDM,278,RC,,,both,,,90,35.52,39.4668,,35.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,30.6,34,,30.6,percent of total billed charges,Implant Device,31.5,35,,31.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,36,40,,36,percent of total billed charges,Implant Devices,31.5,70,,31.5,percent of total billed charges,Implant Devices,30.6,34,,30.6,percent of total billed charges,Implant Devices,30.6,34,,30.6,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,31.5,35,,31.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,36,
J&J 02.112.138S LCP FIBULA PLT 2.7/3.5MM,C1713,HCPCS,,79013567,CDM,278,RC,,,both,,,1696,669.36,39.4668,,669.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,576.64,34,,576.64,percent of total billed charges,Implant Device,593.6,35,,593.6,percent of total billed charges,Implant Device,576.64,34,"Charges > $500, x 34%",576.64,percent of total billed charges,Implant Device,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,678.4,40,,678.4,percent of total billed charges,Implant Devices,593.6,70,,593.6,percent of total billed charges,Implant Devices,576.64,34,,576.64,percent of total billed charges,Implant Devices,576.64,34,,576.64,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,593.6,35,,593.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,678.4,
STRYKER 58802712 LOCKING SCREW 2.7X12MM,C1713,HCPCS,,79013579,CDM,278,RC,,,both,,,1145,451.89,39.4668,,451.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Device,389.3,34,"Charges > $500, x 34%",389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,458,40,,458,percent of total billed charges,Implant Devices,400.75,70,,400.75,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,458,
STRYKER 58802714 LOCKING SCREW 2.7X14MM,C1713,HCPCS,,79013580,CDM,278,RC,,,both,,,1536,606.21,39.4668,,606.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,522.24,34,,522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Device,522.24,34,"Charges > $500, x 34%",522.24,percent of total billed charges,Implant Device,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,614.4,40,,614.4,percent of total billed charges,Implant Devices,537.6,70,,537.6,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,522.24,34,,522.24,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,537.6,35,,537.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,614.4,
STRYKER 58803518 LOCKING SCREW 3.5X18MM,C1713,HCPCS,,79013581,CDM,278,RC,,,both,,,1145,451.89,39.4668,,451.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Device,389.3,34,"Charges > $500, x 34%",389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,458,40,,458,percent of total billed charges,Implant Devices,400.75,70,,400.75,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,458,
STRYKER D1140028 DART-FIRE EDGE COMP SCW,C1713,HCPCS,,79013584,CDM,278,RC,,,both,,,1845,728.16,39.4668,,728.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,627.3,34,,627.3,percent of total billed charges,Implant Device,627.3,34,,627.3,percent of total billed charges,Implant Device,627.3,34,,627.3,percent of total billed charges,Implant Device,627.3,34,,627.3,percent of total billed charges,Implant Device,627.3,34,,627.3,percent of total billed charges,Implant Device,627.3,34,,627.3,percent of total billed charges,Implant Device,645.75,35,,645.75,percent of total billed charges,Implant Device,627.3,34,"Charges > $500, x 34%",627.3,percent of total billed charges,Implant Device,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,738,40,,738,percent of total billed charges,Implant Devices,645.75,70,,645.75,percent of total billed charges,Implant Devices,627.3,34,,627.3,percent of total billed charges,Implant Devices,627.3,34,,627.3,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,738,
STRYKER D1140034 DART-FIRE EDGE COMP SRW,C1713,HCPCS,,79013585,CDM,278,RC,,,both,,,1845,728.16,39.4668,,728.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,627.3,34,,627.3,percent of total billed charges,Implant Device,627.3,34,,627.3,percent of total billed charges,Implant Device,627.3,34,,627.3,percent of total billed charges,Implant Device,627.3,34,,627.3,percent of total billed charges,Implant Device,627.3,34,,627.3,percent of total billed charges,Implant Device,627.3,34,,627.3,percent of total billed charges,Implant Device,645.75,35,,645.75,percent of total billed charges,Implant Device,627.3,34,"Charges > $500, x 34%",627.3,percent of total billed charges,Implant Device,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,738,40,,738,percent of total billed charges,Implant Devices,645.75,70,,645.75,percent of total billed charges,Implant Devices,627.3,34,,627.3,percent of total billed charges,Implant Devices,627.3,34,,627.3,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,645.75,35,,645.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,738,
STRYKER 326075 ASNIS CANN SCREW 6.5X75MM,C1713,HCPCS,,79013592,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
STRYKER 326675 ASNIS CANN SCREW 8X75MM,C1713,HCPCS,,79013593,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
STRYKER 326680 ASNIS CANN SCREW 8X80MM,C1713,HCPCS,,79013594,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
STRYKER 390016 ASNIS WASHER FOR 6.5/8MM,C1713,HCPCS,,79013595,CDM,278,RC,,,both,,,113,44.6,39.4668,,44.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,38.42,34,,38.42,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,45.2,40,,45.2,percent of total billed charges,Implant Devices,39.55,70,,39.55,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,38.42,34,,38.42,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,39.55,35,,39.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.2,
J&J 201.564 CORTEX SCREW 2.4X24MM,C1713,HCPCS,,79013596,CDM,278,RC,,,both,,,121,47.75,39.4668,,47.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,41.14,34,,41.14,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,48.4,40,,48.4,percent of total billed charges,Implant Devices,42.35,70,,42.35,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,41.14,34,,41.14,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,42.35,35,,42.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48.4,
STRYKER D1140040 EDGE CANN SCREW 4X40MM,C1713,HCPCS,,79013597,CDM,278,RC,,,both,,,1381,545.04,39.4668,,545.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,483.35,35,,483.35,percent of total billed charges,Implant Device,469.54,34,"Charges > $500, x 34%",469.54,percent of total billed charges,Implant Device,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,552.4,40,,552.4,percent of total billed charges,Implant Devices,483.35,70,,483.35,percent of total billed charges,Implant Devices,469.54,34,,469.54,percent of total billed charges,Implant Devices,469.54,34,,469.54,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552.4,
STRYKER D1140042 EDGE CANN SCREW 4X42MM,C1713,HCPCS,,79013598,CDM,278,RC,,,both,,,1381,545.04,39.4668,,545.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,483.35,35,,483.35,percent of total billed charges,Implant Device,469.54,34,"Charges > $500, x 34%",469.54,percent of total billed charges,Implant Device,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,552.4,40,,552.4,percent of total billed charges,Implant Devices,483.35,70,,483.35,percent of total billed charges,Implant Devices,469.54,34,,469.54,percent of total billed charges,Implant Devices,469.54,34,,469.54,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552.4,
STRYKER D1140046 EDGE CANN SCREW 4X46MM,C1713,HCPCS,,79013599,CDM,278,RC,,,both,,,1381,545.04,39.4668,,545.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,469.54,34,,469.54,percent of total billed charges,Implant Device,483.35,35,,483.35,percent of total billed charges,Implant Device,469.54,34,"Charges > $500, x 34%",469.54,percent of total billed charges,Implant Device,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,552.4,40,,552.4,percent of total billed charges,Implant Devices,483.35,70,,483.35,percent of total billed charges,Implant Devices,469.54,34,,469.54,percent of total billed charges,Implant Devices,469.54,34,,469.54,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,483.35,35,,483.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552.4,
J&J 212.123 LOCKING SCREW 3.5MMX55MM,C1713,HCPCS,,79013602,CDM,278,RC,,,both,,,315,124.32,39.4668,,124.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,107.1,34,,107.1,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,126,40,,126,percent of total billed charges,Implant Devices,110.25,70,,110.25,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,107.1,34,,107.1,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,110.25,35,,110.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126,
STRYKER 587220RT FUSION MED RT PLAT SYS,C1713,HCPCS,,79013605,CDM,278,RC,,,both,,,7776,3068.94,39.4668,,3068.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2721.6,35,,2721.6,percent of total billed charges,Implant Device,2643.84,34,"Charges > $500, x 34%",2643.84,percent of total billed charges,Implant Device,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,3110.4,40,,3110.4,percent of total billed charges,Implant Devices,2721.6,70,,2721.6,percent of total billed charges,Implant Devices,2643.84,34,,2643.84,percent of total billed charges,Implant Devices,2643.84,34,,2643.84,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2643.84,34,"If Charge > 2,000, then 34 percent",2643.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3110.4,
STRYKER 58AOMPX1R CROSSCHECK RT ORTHOLOC,C1713,HCPCS,,79013608,CDM,278,RC,,,both,,,9644,3806.18,39.4668,,3806.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3278.96,34,,3278.96,percent of total billed charges,Implant Device,3278.96,34,,3278.96,percent of total billed charges,Implant Device,3278.96,34,,3278.96,percent of total billed charges,Implant Device,3278.96,34,,3278.96,percent of total billed charges,Implant Device,3278.96,34,,3278.96,percent of total billed charges,Implant Device,3278.96,34,,3278.96,percent of total billed charges,Implant Device,3375.4,35,,3375.4,percent of total billed charges,Implant Device,3278.96,34,"Charges > $500, x 34%",3278.96,percent of total billed charges,Implant Device,3375.4,35,,3375.4,percent of total billed charges,Implant Devices,3375.4,35,,3375.4,percent of total billed charges,Implant Devices,3375.4,35,,,percent of total billed charges,Implant Devices,3375.4,35,,3375.4,percent of total billed charges,Implant Devices,3375.4,35,,3375.4,percent of total billed charges,Implant Devices,3857.6,40,,3857.6,percent of total billed charges,Implant Devices,3375.4,70,,3375.4,percent of total billed charges,Implant Devices,3278.96,34,,3278.96,percent of total billed charges,Implant Devices,3278.96,34,,3278.96,percent of total billed charges,Implant Devices,3375.4,35,,3375.4,percent of total billed charges,Implant Devices,3375.4,35,,3375.4,percent of total billed charges,Implant Devices,3375.4,35,,3375.4,percent of total billed charges,Implant Devices,3375.4,35,,3375.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3278.96,34,"If Charge > 2,000, then 34 percent",3278.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3857.6,
ARTHREX AR-8940-38 CANN SCREW 4X38MM,C1713,HCPCS,,79013610,CDM,278,RC,,,both,,,195,76.96,39.4668,,76.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,66.3,34,,66.3,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,78,40,,78,percent of total billed charges,Implant Devices,68.25,70,,68.25,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,66.3,34,,66.3,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,68.25,35,,68.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,78,
STRYKER 629604 PROFILE PLATE 4 H 2X22MM,C1713,HCPCS,,79013611,CDM,278,RC,,,both,,,1619,638.97,39.4668,,638.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,550.46,34,,550.46,percent of total billed charges,Implant Device,550.46,34,,550.46,percent of total billed charges,Implant Device,550.46,34,,550.46,percent of total billed charges,Implant Device,550.46,34,,550.46,percent of total billed charges,Implant Device,550.46,34,,550.46,percent of total billed charges,Implant Device,550.46,34,,550.46,percent of total billed charges,Implant Device,566.65,35,,566.65,percent of total billed charges,Implant Device,550.46,34,"Charges > $500, x 34%",550.46,percent of total billed charges,Implant Device,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,647.6,40,,647.6,percent of total billed charges,Implant Devices,566.65,70,,566.65,percent of total billed charges,Implant Devices,550.46,34,,550.46,percent of total billed charges,Implant Devices,550.46,34,,550.46,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,647.6,
STRYKER 629606 PROFILE PLATE 6 H 2X33MM,C1713,HCPCS,,79013612,CDM,278,RC,,,both,,,1619,638.97,39.4668,,638.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,550.46,34,,550.46,percent of total billed charges,Implant Device,550.46,34,,550.46,percent of total billed charges,Implant Device,550.46,34,,550.46,percent of total billed charges,Implant Device,550.46,34,,550.46,percent of total billed charges,Implant Device,550.46,34,,550.46,percent of total billed charges,Implant Device,550.46,34,,550.46,percent of total billed charges,Implant Device,566.65,35,,566.65,percent of total billed charges,Implant Device,550.46,34,"Charges > $500, x 34%",550.46,percent of total billed charges,Implant Device,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,647.6,40,,647.6,percent of total billed charges,Implant Devices,566.65,70,,566.65,percent of total billed charges,Implant Devices,550.46,34,,550.46,percent of total billed charges,Implant Devices,550.46,34,,550.46,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,566.65,35,,566.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,647.6,
STRYKER 657606 LOCKING SCREW 2X6MM,C1713,HCPCS,,79013613,CDM,278,RC,,,both,,,676,266.8,39.4668,,266.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Device,229.84,34,"Charges > $500, x 34%",229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,270.4,40,,270.4,percent of total billed charges,Implant Devices,236.6,70,,236.6,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270.4,
STRYKER 657608 LOCKING SCREW 2.0X8MM,C1713,HCPCS,,79013614,CDM,278,RC,,,both,,,676,266.8,39.4668,,266.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Device,229.84,34,"Charges > $500, x 34%",229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,270.4,40,,270.4,percent of total billed charges,Implant Devices,236.6,70,,236.6,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270.4,
STRYKER 657609 LOCKING SCREW 2.0X9MM,C1713,HCPCS,,79013615,CDM,278,RC,,,both,,,676,266.8,39.4668,,266.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Device,229.84,34,"Charges > $500, x 34%",229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,270.4,40,,270.4,percent of total billed charges,Implant Devices,236.6,70,,236.6,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270.4,
STRYKER 657706 BONE SCREW 2.0X6MM,C1713,HCPCS,,79013616,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
STRYKER 657708 BONE SCREW 2.0X8MM,C1713,HCPCS,,79013617,CDM,278,RC,,,both,,,395,155.89,39.4668,,155.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,134.3,34,,134.3,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,158,40,,158,percent of total billed charges,Implant Devices,138.25,70,,138.25,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,134.3,34,,134.3,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,138.25,35,,138.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158,
STRYKER 662612 BONE SCREW 1.7X12MM,C1713,HCPCS,,79013618,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER 662614 BONE SCREW 1.7X14MM,C1713,HCPCS,,79013619,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ZIMMER 02.03264.015 DISTAL FEMOR PLATE,C1713,HCPCS,,79013637,CDM,278,RC,,,both,,,4075,1608.27,39.4668,,1608.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1385.5,34,,1385.5,percent of total billed charges,Implant Device,1385.5,34,,1385.5,percent of total billed charges,Implant Device,1385.5,34,,1385.5,percent of total billed charges,Implant Device,1385.5,34,,1385.5,percent of total billed charges,Implant Device,1385.5,34,,1385.5,percent of total billed charges,Implant Device,1385.5,34,,1385.5,percent of total billed charges,Implant Device,1426.25,35,,1426.25,percent of total billed charges,Implant Device,1385.5,34,"Charges > $500, x 34%",1385.5,percent of total billed charges,Implant Device,1426.25,35,,1426.25,percent of total billed charges,Implant Devices,1426.25,35,,1426.25,percent of total billed charges,Implant Devices,1426.25,35,,,percent of total billed charges,Implant Devices,1426.25,35,,1426.25,percent of total billed charges,Implant Devices,1426.25,35,,1426.25,percent of total billed charges,Implant Devices,1630,40,,1630,percent of total billed charges,Implant Devices,1426.25,70,,1426.25,percent of total billed charges,Implant Devices,1385.5,34,,1385.5,percent of total billed charges,Implant Devices,1385.5,34,,1385.5,percent of total billed charges,Implant Devices,1426.25,35,,1426.25,percent of total billed charges,Implant Devices,1426.25,35,,1426.25,percent of total billed charges,Implant Devices,1426.25,35,,1426.25,percent of total billed charges,Implant Devices,1426.25,35,,1426.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1385.5,34,"If Charge > 2,000, then 34 percent",1385.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1630,
ZIMMER 02.03150.040 CORTICAL SCRW 5X40MM,C1713,HCPCS,,79013638,CDM,278,RC,,,both,,,475,187.47,39.4668,,187.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,190,40,,190,percent of total billed charges,Implant Devices,166.25,70,,166.25,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190,
ZIMMER 02.03150.046 CORTICAL SCRW 5X46MM,C1713,HCPCS,,79013639,CDM,278,RC,,,both,,,475,187.47,39.4668,,187.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,190,40,,190,percent of total billed charges,Implant Devices,166.25,70,,166.25,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190,
ZIMMER 02.03150.060 CORTICAL SCRW 5X60MM,C1713,HCPCS,,79013640,CDM,278,RC,,,both,,,475,187.47,39.4668,,187.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,161.5,34,,161.5,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,190,40,,190,percent of total billed charges,Implant Devices,166.25,70,,166.25,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,161.5,34,,161.5,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,166.25,35,,166.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,190,
ZIMMER 290.20.280 2.0MM WIRE,C1713,HCPCS,,79013641,CDM,278,RC,,,both,,,101,39.86,39.4668,,39.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,34.34,34,,34.34,percent of total billed charges,Implant Device,35.35,35,,35.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,40.4,40,,40.4,percent of total billed charges,Implant Devices,35.35,70,,35.35,percent of total billed charges,Implant Devices,34.34,34,,34.34,percent of total billed charges,Implant Devices,34.34,34,,34.34,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,35.35,35,,35.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40.4,
ZIMMER 47-2232-060-01 CABLE BUTTON,C1713,HCPCS,,79013643,CDM,278,RC,,,both,,,500,197.33,39.4668,,197.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,170,34,,170,percent of total billed charges,Implant Device,170,34,,170,percent of total billed charges,Implant Device,170,34,,170,percent of total billed charges,Implant Device,170,34,,170,percent of total billed charges,Implant Device,170,34,,170,percent of total billed charges,Implant Device,170,34,,170,percent of total billed charges,Implant Device,175,35,,175,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,175,35,,175,percent of total billed charges,Implant Devices,175,35,,175,percent of total billed charges,Implant Devices,175,35,,,percent of total billed charges,Implant Devices,175,35,,175,percent of total billed charges,Implant Devices,175,35,,175,percent of total billed charges,Implant Devices,200,40,,200,percent of total billed charges,Implant Devices,175,70,,175,percent of total billed charges,Implant Devices,170,34,,170,percent of total billed charges,Implant Devices,170,34,,170,percent of total billed charges,Implant Devices,175,35,,175,percent of total billed charges,Implant Devices,175,35,,175,percent of total billed charges,Implant Devices,175,35,,175,percent of total billed charges,Implant Devices,175,35,,175,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,200,
ZIMMER 814550030 CORT BONE SCREW 5X30MM,C1713,HCPCS,,79013644,CDM,278,RC,,,both,,,533,210.36,39.4668,,210.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,181.22,34,,181.22,percent of total billed charges,Implant Device,186.55,35,,186.55,percent of total billed charges,Implant Device,181.22,34,"Charges > $500, x 34%",181.22,percent of total billed charges,Implant Device,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,213.2,40,,213.2,percent of total billed charges,Implant Devices,186.55,70,,186.55,percent of total billed charges,Implant Devices,181.22,34,,181.22,percent of total billed charges,Implant Devices,181.22,34,,181.22,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,186.55,35,,186.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,213.2,
ARTHREX AR-8730-26PT CAN SCREW 3X26MM,C1713,HCPCS,,79013657,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
ARTHREX AR-8933VCL-10 KREULOCK SRW 3X10,C1713,HCPCS,,79013658,CDM,278,RC,,,both,,,959,378.49,39.4668,,378.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Device,326.06,34,"Charges > $500, x 34%",326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,383.6,40,,383.6,percent of total billed charges,Implant Devices,335.65,70,,335.65,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.6,
J&J 224.601 NARROW LCP PLATE 4.5X188 10H,C1713,HCPCS,,79013660,CDM,278,RC,,,both,,,1392,549.38,39.4668,,549.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,473.28,34,,473.28,percent of total billed charges,Implant Device,473.28,34,,473.28,percent of total billed charges,Implant Device,473.28,34,,473.28,percent of total billed charges,Implant Device,473.28,34,,473.28,percent of total billed charges,Implant Device,473.28,34,,473.28,percent of total billed charges,Implant Device,473.28,34,,473.28,percent of total billed charges,Implant Device,487.2,35,,487.2,percent of total billed charges,Implant Device,473.28,34,"Charges > $500, x 34%",473.28,percent of total billed charges,Implant Device,487.2,35,,487.2,percent of total billed charges,Implant Devices,487.2,35,,487.2,percent of total billed charges,Implant Devices,487.2,35,,,percent of total billed charges,Implant Devices,487.2,35,,487.2,percent of total billed charges,Implant Devices,487.2,35,,487.2,percent of total billed charges,Implant Devices,556.8,40,,556.8,percent of total billed charges,Implant Devices,487.2,70,,487.2,percent of total billed charges,Implant Devices,473.28,34,,473.28,percent of total billed charges,Implant Devices,473.28,34,,473.28,percent of total billed charges,Implant Devices,487.2,35,,487.2,percent of total billed charges,Implant Devices,487.2,35,,487.2,percent of total billed charges,Implant Devices,487.2,35,,487.2,percent of total billed charges,Implant Devices,487.2,35,,487.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.8,
STRYKER 326285 ASNIS CANN SCREW 6.5X85MM,C1713,HCPCS,,79013667,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
STRYKER 5048-5-300 CONNECT ROD 5X300MM,C1713,HCPCS,,79013668,CDM,278,RC,,,both,,,334,131.82,39.4668,,131.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,113.56,34,,113.56,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,133.6,40,,133.6,percent of total billed charges,Implant Devices,116.9,70,,116.9,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,113.56,34,,113.56,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,116.9,35,,116.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.6,
STRYKER 8125-2170S TROCHANT NAIL 12X170,C1713,HCPCS,,79013669,CDM,278,RC,,,both,,,4797,1893.22,39.4668,,1893.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Device,1630.98,34,"Charges > $500, x 34%",1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1918.8,40,,1918.8,percent of total billed charges,Implant Devices,1678.95,70,,1678.95,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1630.98,34,"If Charge > 2,000, then 34 percent",1630.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1918.8,
STRYKER 2341-1233S TIBIAL NAIL 12X330MM,C1713,HCPCS,,79013670,CDM,278,RC,,,both,,,4792,1891.25,39.4668,,1891.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Device,1629.28,34,"Charges > $500, x 34%",1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1916.8,40,,1916.8,percent of total billed charges,Implant Devices,1677.2,70,,1677.2,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.28,34,"If Charge > 2,000, then 34 percent",1629.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1916.8,
STRYKER 2341-1234S TIBIAL NAIL 12X345MM,C1713,HCPCS,,79013671,CDM,278,RC,,,both,,,4792,1891.25,39.4668,,1891.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Device,1629.28,34,"Charges > $500, x 34%",1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1916.8,40,,1916.8,percent of total billed charges,Implant Devices,1677.2,70,,1677.2,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.28,34,"If Charge > 2,000, then 34 percent",1629.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1916.8,
STRYKER 2341-1030S TIBIAL NAIL 10X300MM,C1713,HCPCS,,79013679,CDM,278,RC,,,both,,,4792,1891.25,39.4668,,1891.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Device,1629.28,34,"Charges > $500, x 34%",1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1916.8,40,,1916.8,percent of total billed charges,Implant Devices,1677.2,70,,1677.2,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.28,34,"If Charge > 2,000, then 34 percent",1629.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1916.8,
J&J 02.124.408 CONDYLAR PLT 8H 4.5X185MM,C1713,HCPCS,,79013681,CDM,278,RC,,,both,,,4381,1729.04,39.4668,,1729.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1533.35,35,,1533.35,percent of total billed charges,Implant Device,1489.54,34,"Charges > $500, x 34%",1489.54,percent of total billed charges,Implant Device,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1752.4,40,,1752.4,percent of total billed charges,Implant Devices,1533.35,70,,1533.35,percent of total billed charges,Implant Devices,1489.54,34,,1489.54,percent of total billed charges,Implant Devices,1489.54,34,,1489.54,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1489.54,34,"If Charge > 2,000, then 34 percent",1489.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1752.4,
J&J 42.231.244 LOCKING SCREW 5.0X60MM,C1713,HCPCS,,79013682,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
IN2BONES P60 ST032 LAT NECK PLT RT 6H,C1713,HCPCS,,79013683,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
IN2BONES P62 ST416 NON LOCK SCREW 2.4X16,C1713,HCPCS,,79013684,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
ALLOSOURCE 16517015 FIBULAR SEG/SHAFT,C1713,HCPCS,,79013685,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
ARTHREX AR-1934BCT-2 SUTURE ANCH 3X14.5,C1713,HCPCS,,79013687,CDM,278,RC,,,both,,,1170,461.76,39.4668,,461.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,397.8,34,,397.8,percent of total billed charges,Implant Device,409.5,35,,409.5,percent of total billed charges,Implant Device,397.8,34,"Charges > $500, x 34%",397.8,percent of total billed charges,Implant Device,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,468,40,,468,percent of total billed charges,Implant Devices,409.5,70,,409.5,percent of total billed charges,Implant Devices,397.8,34,,397.8,percent of total billed charges,Implant Devices,397.8,34,,397.8,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,409.5,35,,409.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,468,
J&J 02.111.650 DIS RADIUS PLT 2.4MM RT,C1713,HCPCS,,79013689,CDM,278,RC,,,both,,,2499,986.28,39.4668,,986.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,874.65,35,,874.65,percent of total billed charges,Implant Device,849.66,34,"Charges > $500, x 34%",849.66,percent of total billed charges,Implant Device,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,999.6,40,,999.6,percent of total billed charges,Implant Devices,874.65,70,,874.65,percent of total billed charges,Implant Devices,849.66,34,,849.66,percent of total billed charges,Implant Devices,849.66,34,,849.66,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,849.66,34,"If Charge > 2,000, then 34 percent",849.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,999.6,
J&J 202.892 CORTEX SCREW 2.7X32MM,C1713,HCPCS,,79013692,CDM,278,RC,,,both,,,88,34.73,39.4668,,34.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,29.92,34,,29.92,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,35.2,40,,35.2,percent of total billed charges,Implant Devices,30.8,70,,30.8,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,29.92,34,,29.92,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,30.8,35,,30.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,35.2,
ARTHREX AR-7822 FIBERTAPE CERCLAGE-LG,C1713,HCPCS,,79013693,CDM,278,RC,,,both,,,675,266.4,39.4668,,266.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,229.5,34,,229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Device,229.5,34,"Charges > $500, x 34%",229.5,percent of total billed charges,Implant Device,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,270,40,,270,percent of total billed charges,Implant Devices,236.25,70,,236.25,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,229.5,34,,229.5,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,236.25,35,,236.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270,
STRYKER 663912 EMERGENCY SCREW 2.5X12MM,C1713,HCPCS,,79013697,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
ARTHREX AR-8730-18PT CANN SCREW 3.0X18MM,C1713,HCPCS,,79013706,CDM,278,RC,,,both,,,488,192.6,39.4668,,192.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,165.92,34,,165.92,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,195.2,40,,195.2,percent of total billed charges,Implant Devices,170.8,70,,170.8,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,165.92,34,,165.92,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,170.8,35,,170.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,195.2,
STRYKER 2361-5080S LOCKING SCREW 5X80MM,C1713,HCPCS,,79013708,CDM,278,RC,,,both,,,887,350.07,39.4668,,350.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Device,301.58,34,"Charges > $500, x 34%",301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,354.8,40,,354.8,percent of total billed charges,Implant Devices,310.45,70,,310.45,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.8,
STRYKER 2361-5090S LOCKING SCREW 5X90MM,C1713,HCPCS,,79013709,CDM,278,RC,,,both,,,887,350.07,39.4668,,350.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,301.58,34,,301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Device,301.58,34,"Charges > $500, x 34%",301.58,percent of total billed charges,Implant Device,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,354.8,40,,354.8,percent of total billed charges,Implant Devices,310.45,70,,310.45,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,301.58,34,,301.58,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,310.45,35,,310.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.8,
J&J 02.104.006 ART DIS HUM PLT 3.5X158MM,C1713,HCPCS,,79013713,CDM,278,RC,,,both,,,3495,1379.36,39.4668,,1379.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1223.25,35,,1223.25,percent of total billed charges,Implant Device,1188.3,34,"Charges > $500, x 34%",1188.3,percent of total billed charges,Implant Device,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1398,40,,1398,percent of total billed charges,Implant Devices,1223.25,70,,1223.25,percent of total billed charges,Implant Devices,1188.3,34,,1188.3,percent of total billed charges,Implant Devices,1188.3,34,,1188.3,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1188.3,34,"If Charge > 2,000, then 34 percent",1188.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1398,
MEDLINE MPP1005L MTP FUSION PLT 5 DEG LT,C1713,HCPCS,,79013715,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
MEDLINE MPSL2710 LOCKING SCREW 2.7X10MM,C1713,HCPCS,,79013716,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
MEDLINE MPSL2712 LOCKING SCREW 2.7X12MM,C1713,HCPCS,,79013717,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
MEDLINE MPSN3518 NON LOCK SCREW 3.5X18MM,C1713,HCPCS,,79013718,CDM,278,RC,,,both,,,870,343.36,39.4668,,343.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,295.8,34,,295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Device,295.8,34,"Charges > $500, x 34%",295.8,percent of total billed charges,Implant Device,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,348,40,,348,percent of total billed charges,Implant Devices,304.5,70,,304.5,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,295.8,34,,295.8,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,304.5,35,,304.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348,
MEDLINE MSD14026 CANN SCREW 4.0X26MM,C1713,HCPCS,,79013719,CDM,278,RC,,,both,,,1275,503.2,39.4668,,503.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,433.5,34,,433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Device,433.5,34,"Charges > $500, x 34%",433.5,percent of total billed charges,Implant Device,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,510,40,,510,percent of total billed charges,Implant Devices,446.25,70,,446.25,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,433.5,34,,433.5,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,446.25,35,,446.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,510,
STRYKER IH2510 HEADLESS SCREW 2.5X10MM,C1713,HCPCS,,79013726,CDM,278,RC,,,both,,,1679,662.65,39.4668,,662.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,587.65,35,,587.65,percent of total billed charges,Implant Device,570.86,34,"Charges > $500, x 34%",570.86,percent of total billed charges,Implant Device,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,671.6,40,,671.6,percent of total billed charges,Implant Devices,587.65,70,,587.65,percent of total billed charges,Implant Devices,570.86,34,,570.86,percent of total billed charges,Implant Devices,570.86,34,,570.86,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,671.6,
STRYKER IH3010 HEADLESS SCREW 3.0X10MM,C1713,HCPCS,,79013727,CDM,278,RC,,,both,,,1679,662.65,39.4668,,662.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,587.65,35,,587.65,percent of total billed charges,Implant Device,570.86,34,"Charges > $500, x 34%",570.86,percent of total billed charges,Implant Device,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,671.6,40,,671.6,percent of total billed charges,Implant Devices,587.65,70,,587.65,percent of total billed charges,Implant Devices,570.86,34,,570.86,percent of total billed charges,Implant Devices,570.86,34,,570.86,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,671.6,
STRYKER IH3012 HEADLESS SCREW 3.0X12MM,C1713,HCPCS,,79013728,CDM,278,RC,,,both,,,1679,662.65,39.4668,,662.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,587.65,35,,587.65,percent of total billed charges,Implant Device,570.86,34,"Charges > $500, x 34%",570.86,percent of total billed charges,Implant Device,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,671.6,40,,671.6,percent of total billed charges,Implant Devices,587.65,70,,587.65,percent of total billed charges,Implant Devices,570.86,34,,570.86,percent of total billed charges,Implant Devices,570.86,34,,570.86,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,671.6,
SYNTHES 245.071 PLATE LCP 7 HOLE,C1713,HCPCS,,79013729,CDM,278,RC,,,both,,,1417,559.24,39.4668,,559.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,481.78,34,,481.78,percent of total billed charges,Implant Device,481.78,34,,481.78,percent of total billed charges,Implant Device,481.78,34,,481.78,percent of total billed charges,Implant Device,481.78,34,,481.78,percent of total billed charges,Implant Device,481.78,34,,481.78,percent of total billed charges,Implant Device,481.78,34,,481.78,percent of total billed charges,Implant Device,495.95,35,,495.95,percent of total billed charges,Implant Device,481.78,34,"Charges > $500, x 34%",481.78,percent of total billed charges,Implant Device,495.95,35,,495.95,percent of total billed charges,Implant Devices,495.95,35,,495.95,percent of total billed charges,Implant Devices,495.95,35,,,percent of total billed charges,Implant Devices,495.95,35,,495.95,percent of total billed charges,Implant Devices,495.95,35,,495.95,percent of total billed charges,Implant Devices,566.8,40,,566.8,percent of total billed charges,Implant Devices,495.95,70,,495.95,percent of total billed charges,Implant Devices,481.78,34,,481.78,percent of total billed charges,Implant Devices,481.78,34,,481.78,percent of total billed charges,Implant Devices,495.95,35,,495.95,percent of total billed charges,Implant Devices,495.95,35,,495.95,percent of total billed charges,Implant Devices,495.95,35,,495.95,percent of total billed charges,Implant Devices,495.95,35,,495.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,566.8,
STRYKER 601636S CANNULATED SCREW 5X36MM,C1713,HCPCS,,79013749,CDM,278,RC,,,both,,,529,208.78,39.4668,,208.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,179.86,34,,179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Device,179.86,34,"Charges > $500, x 34%",179.86,percent of total billed charges,Implant Device,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,211.6,40,,211.6,percent of total billed charges,Implant Devices,185.15,70,,185.15,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,179.86,34,,179.86,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,185.15,35,,185.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,211.6,
WRIGHT FFS21815 STAPLE 18X15NITINOL 2LEG,C1713,HCPCS,,79013751,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 02.111.551 DIS RADIUS PLT 5H 2.4MM,C1713,HCPCS,,79013758,CDM,278,RC,,,both,,,2499,986.28,39.4668,,986.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,849.66,34,,849.66,percent of total billed charges,Implant Device,874.65,35,,874.65,percent of total billed charges,Implant Device,849.66,34,"Charges > $500, x 34%",849.66,percent of total billed charges,Implant Device,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,999.6,40,,999.6,percent of total billed charges,Implant Devices,874.65,70,,874.65,percent of total billed charges,Implant Devices,849.66,34,,849.66,percent of total billed charges,Implant Devices,849.66,34,,849.66,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,874.65,35,,874.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,849.66,34,"If Charge > 2,000, then 34 percent",849.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,999.6,
J&J 04.333.222 HEADLESS SCREW 3.0X22MM,C1713,HCPCS,,79013760,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 04.333.232 HEADLESS SCREW 3.0X32MM,C1713,HCPCS,,79013761,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 04.333.224 HEADLESS SCREW 3.0X24MM,C1713,HCPCS,,79013762,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 04.334.232 HEADLESS SCREW 3.0X32MM,C1713,HCPCS,,79013763,CDM,278,RC,,,both,,,1105,436.11,39.4668,,436.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,375.7,34,,375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Device,375.7,34,"Charges > $500, x 34%",375.7,percent of total billed charges,Implant Device,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,442,40,,442,percent of total billed charges,Implant Devices,386.75,70,,386.75,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,375.7,34,,375.7,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,386.75,35,,386.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,442,
J&J 02.221.151 DISTAL FEM PLT 4 HOLE 3.5,C1713,HCPCS,,79013764,CDM,278,RC,,,both,,,4110,1622.09,39.4668,,1622.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1397.4,34,,1397.4,percent of total billed charges,Implant Device,1397.4,34,,1397.4,percent of total billed charges,Implant Device,1397.4,34,,1397.4,percent of total billed charges,Implant Device,1397.4,34,,1397.4,percent of total billed charges,Implant Device,1397.4,34,,1397.4,percent of total billed charges,Implant Device,1397.4,34,,1397.4,percent of total billed charges,Implant Device,1438.5,35,,1438.5,percent of total billed charges,Implant Device,1397.4,34,"Charges > $500, x 34%",1397.4,percent of total billed charges,Implant Device,1438.5,35,,1438.5,percent of total billed charges,Implant Devices,1438.5,35,,1438.5,percent of total billed charges,Implant Devices,1438.5,35,,,percent of total billed charges,Implant Devices,1438.5,35,,1438.5,percent of total billed charges,Implant Devices,1438.5,35,,1438.5,percent of total billed charges,Implant Devices,1644,40,,1644,percent of total billed charges,Implant Devices,1438.5,70,,1438.5,percent of total billed charges,Implant Devices,1397.4,34,,1397.4,percent of total billed charges,Implant Devices,1397.4,34,,1397.4,percent of total billed charges,Implant Devices,1438.5,35,,1438.5,percent of total billed charges,Implant Devices,1438.5,35,,1438.5,percent of total billed charges,Implant Devices,1438.5,35,,1438.5,percent of total billed charges,Implant Devices,1438.5,35,,1438.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1397.4,34,"If Charge > 2,000, then 34 percent",1397.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1644,
J&J 02.221.123 PROX FEMUR PLT 4.5X32 LT,C1713,HCPCS,,79013765,CDM,278,RC,,,both,,,8752,3454.13,39.4668,,3454.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2975.68,34,,2975.68,percent of total billed charges,Implant Device,2975.68,34,,2975.68,percent of total billed charges,Implant Device,2975.68,34,,2975.68,percent of total billed charges,Implant Device,2975.68,34,,2975.68,percent of total billed charges,Implant Device,2975.68,34,,2975.68,percent of total billed charges,Implant Device,2975.68,34,,2975.68,percent of total billed charges,Implant Device,3063.2,35,,3063.2,percent of total billed charges,Implant Device,2975.68,34,"Charges > $500, x 34%",2975.68,percent of total billed charges,Implant Device,3063.2,35,,3063.2,percent of total billed charges,Implant Devices,3063.2,35,,3063.2,percent of total billed charges,Implant Devices,3063.2,35,,,percent of total billed charges,Implant Devices,3063.2,35,,3063.2,percent of total billed charges,Implant Devices,3063.2,35,,3063.2,percent of total billed charges,Implant Devices,3500.8,40,,3500.8,percent of total billed charges,Implant Devices,3063.2,70,,3063.2,percent of total billed charges,Implant Devices,2975.68,34,,2975.68,percent of total billed charges,Implant Devices,2975.68,34,,2975.68,percent of total billed charges,Implant Devices,3063.2,35,,3063.2,percent of total billed charges,Implant Devices,3063.2,35,,3063.2,percent of total billed charges,Implant Devices,3063.2,35,,3063.2,percent of total billed charges,Implant Devices,3063.2,35,,3063.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2975.68,34,"If Charge > 2,000, then 34 percent",2975.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3500.8,
J&J 02.120.606 CONNECTING SCREW,C1713,HCPCS,,79013766,CDM,278,RC,,,both,,,419,165.37,39.4668,,165.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.46,34,,142.46,percent of total billed charges,Implant Device,142.46,34,,142.46,percent of total billed charges,Implant Device,142.46,34,,142.46,percent of total billed charges,Implant Device,142.46,34,,142.46,percent of total billed charges,Implant Device,142.46,34,,142.46,percent of total billed charges,Implant Device,142.46,34,,142.46,percent of total billed charges,Implant Device,146.65,35,,146.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,146.65,35,,146.65,percent of total billed charges,Implant Devices,146.65,35,,146.65,percent of total billed charges,Implant Devices,146.65,35,,,percent of total billed charges,Implant Devices,146.65,35,,146.65,percent of total billed charges,Implant Devices,146.65,35,,146.65,percent of total billed charges,Implant Devices,167.6,40,,167.6,percent of total billed charges,Implant Devices,146.65,70,,146.65,percent of total billed charges,Implant Devices,142.46,34,,142.46,percent of total billed charges,Implant Devices,142.46,34,,142.46,percent of total billed charges,Implant Devices,146.65,35,,146.65,percent of total billed charges,Implant Devices,146.65,35,,146.65,percent of total billed charges,Implant Devices,146.65,35,,146.65,percent of total billed charges,Implant Devices,146.65,35,,146.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,167.6,
J&J 02.200.034 CORTEX SCREW 3.5X34MM,C1713,HCPCS,,79013768,CDM,278,RC,,,both,,,63,24.86,39.4668,,24.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,22.05,35,,22.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,25.2,40,,25.2,percent of total billed charges,Implant Devices,22.05,70,,22.05,percent of total billed charges,Implant Devices,21.42,34,,21.42,percent of total billed charges,Implant Devices,21.42,34,,21.42,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,25.2,
J&J 02.200.040 CORTEX SCREW 3.5X40MM,C1713,HCPCS,,79013770,CDM,278,RC,,,both,,,63,24.86,39.4668,,24.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,22.05,35,,22.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,25.2,40,,25.2,percent of total billed charges,Implant Devices,22.05,70,,22.05,percent of total billed charges,Implant Devices,21.42,34,,21.42,percent of total billed charges,Implant Devices,21.42,34,,21.42,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,25.2,
J&J 02.200.044 CORTEX SCREW 3.5X44MM,C1713,HCPCS,,79013771,CDM,278,RC,,,both,,,63,24.86,39.4668,,24.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,21.42,34,,21.42,percent of total billed charges,Implant Device,22.05,35,,22.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,25.2,40,,25.2,percent of total billed charges,Implant Devices,22.05,70,,22.05,percent of total billed charges,Implant Devices,21.42,34,,21.42,percent of total billed charges,Implant Devices,21.42,34,,21.42,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,22.05,35,,22.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,25.2,
J&J 214.860 CORTEX SCREW 4.5X60MM,C1713,HCPCS,,79013772,CDM,278,RC,,,both,,,57,22.5,39.4668,,22.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.38,34,,19.38,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,22.8,40,,22.8,percent of total billed charges,Implant Devices,19.95,70,,19.95,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.38,34,,19.38,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,19.95,35,,19.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,22.8,
J&J 04.045.030S LOCKING SCREW 5X30MM,C1713,HCPCS,,79013773,CDM,278,RC,,,both,,,687,271.14,39.4668,,271.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Device,233.58,34,"Charges > $500, x 34%",233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,274.8,40,,274.8,percent of total billed charges,Implant Devices,240.45,70,,240.45,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.8,
ARTHREX AR-9055-50PT FX SCREW 5.5X50MM,C1713,HCPCS,,79013778,CDM,278,RC,,,both,,,2584,1019.82,39.4668,,1019.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,878.56,34,,878.56,percent of total billed charges,Implant Device,878.56,34,,878.56,percent of total billed charges,Implant Device,878.56,34,,878.56,percent of total billed charges,Implant Device,878.56,34,,878.56,percent of total billed charges,Implant Device,878.56,34,,878.56,percent of total billed charges,Implant Device,878.56,34,,878.56,percent of total billed charges,Implant Device,904.4,35,,904.4,percent of total billed charges,Implant Device,878.56,34,"Charges > $500, x 34%",878.56,percent of total billed charges,Implant Device,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,1033.6,40,,1033.6,percent of total billed charges,Implant Devices,904.4,70,,904.4,percent of total billed charges,Implant Devices,878.56,34,,878.56,percent of total billed charges,Implant Devices,878.56,34,,878.56,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,878.56,34,"If Charge > 2,000, then 34 percent",878.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1033.6,
ARTHREX AR-8750-55H HEADLESS SCREW 5X55,C1713,HCPCS,,79013781,CDM,278,RC,,,both,,,1544,609.37,39.4668,,609.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,524.96,34,,524.96,percent of total billed charges,Implant Device,524.96,34,,524.96,percent of total billed charges,Implant Device,524.96,34,,524.96,percent of total billed charges,Implant Device,524.96,34,,524.96,percent of total billed charges,Implant Device,524.96,34,,524.96,percent of total billed charges,Implant Device,524.96,34,,524.96,percent of total billed charges,Implant Device,540.4,35,,540.4,percent of total billed charges,Implant Device,524.96,34,"Charges > $500, x 34%",524.96,percent of total billed charges,Implant Device,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,617.6,40,,617.6,percent of total billed charges,Implant Devices,540.4,70,,540.4,percent of total billed charges,Implant Devices,524.96,34,,524.96,percent of total billed charges,Implant Devices,524.96,34,,524.96,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,617.6,
ARTHREX AR-8750-50H HEADLESS SCREW 5X50,C1713,HCPCS,,79013782,CDM,278,RC,,,both,,,1544,609.37,39.4668,,609.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,524.96,34,,524.96,percent of total billed charges,Implant Device,524.96,34,,524.96,percent of total billed charges,Implant Device,524.96,34,,524.96,percent of total billed charges,Implant Device,524.96,34,,524.96,percent of total billed charges,Implant Device,524.96,34,,524.96,percent of total billed charges,Implant Device,524.96,34,,524.96,percent of total billed charges,Implant Device,540.4,35,,540.4,percent of total billed charges,Implant Device,524.96,34,"Charges > $500, x 34%",524.96,percent of total billed charges,Implant Device,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,617.6,40,,617.6,percent of total billed charges,Implant Devices,540.4,70,,540.4,percent of total billed charges,Implant Devices,524.96,34,,524.96,percent of total billed charges,Implant Devices,524.96,34,,524.96,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,540.4,35,,540.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,617.6,
ARTHREX AR-8770-50H HEADLESS SCREW 7X50,C1713,HCPCS,,79013783,CDM,278,RC,,,both,,,2260,891.95,39.4668,,891.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,768.4,34,,768.4,percent of total billed charges,Implant Device,768.4,34,,768.4,percent of total billed charges,Implant Device,768.4,34,,768.4,percent of total billed charges,Implant Device,768.4,34,,768.4,percent of total billed charges,Implant Device,768.4,34,,768.4,percent of total billed charges,Implant Device,768.4,34,,768.4,percent of total billed charges,Implant Device,791,35,,791,percent of total billed charges,Implant Device,768.4,34,"Charges > $500, x 34%",768.4,percent of total billed charges,Implant Device,791,35,,791,percent of total billed charges,Implant Devices,791,35,,791,percent of total billed charges,Implant Devices,791,35,,,percent of total billed charges,Implant Devices,791,35,,791,percent of total billed charges,Implant Devices,791,35,,791,percent of total billed charges,Implant Devices,904,40,,904,percent of total billed charges,Implant Devices,791,70,,791,percent of total billed charges,Implant Devices,768.4,34,,768.4,percent of total billed charges,Implant Devices,768.4,34,,768.4,percent of total billed charges,Implant Devices,791,35,,791,percent of total billed charges,Implant Devices,791,35,,791,percent of total billed charges,Implant Devices,791,35,,791,percent of total billed charges,Implant Devices,791,35,,791,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,768.4,34,"If Charge > 2,000, then 34 percent",768.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,904,
STRYKER 8425-0380S LONG NAIL RT 10X380MM,C1713,HCPCS,,79013786,CDM,278,RC,,,both,,,7227,2852.27,39.4668,,2852.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Device,2457.18,34,"Charges > $500, x 34%",2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2890.8,40,,2890.8,percent of total billed charges,Implant Devices,2529.45,70,,2529.45,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2457.18,34,"If Charge > 2,000, then 34 percent",2457.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2890.8,
DJO 307-27-016 2.7X16MM NL SCREW,C1713,HCPCS,,79013793,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
DJO 307-27-018 2.7X18MM NL SCREW,C1713,HCPCS,,79013794,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
DJO 308-27-010 2.7X10MM L SCREW,C1713,HCPCS,,79013795,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
DJO 307-35-012 3.5X12MM NL SCREW,C1713,HCPCS,,79013796,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
DJO 307-35-014 3.5X14MM NL SCREW,C1713,HCPCS,,79013797,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
DJO 300-92-002 FIBULA PLATE 10 HOLE,C1713,HCPCS,,79013798,CDM,278,RC,,,both,,,4797,1893.22,39.4668,,1893.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Device,1630.98,34,"Charges > $500, x 34%",1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1918.8,40,,1918.8,percent of total billed charges,Implant Devices,1678.95,70,,1678.95,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1630.98,34,"If Charge > 2,000, then 34 percent",1630.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1918.8,
STRYKER 8130-1170S TROCH NAIL 1.5X100MM,C1713,HCPCS,,79013799,CDM,278,RC,,,both,,,4797,1893.22,39.4668,,1893.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Device,1630.98,34,"Charges > $500, x 34%",1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1918.8,40,,1918.8,percent of total billed charges,Implant Devices,1678.95,70,,1678.95,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1630.98,34,"If Charge > 2,000, then 34 percent",1630.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1918.8,
STRYKER 5612-P-511 HINGE INS SZ 5 11MM,C1713,HCPCS,,79013802,CDM,278,RC,,,both,,,11739,4633.01,39.4668,,4633.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3991.26,34,,3991.26,percent of total billed charges,Implant Device,3991.26,34,,3991.26,percent of total billed charges,Implant Device,3991.26,34,,3991.26,percent of total billed charges,Implant Device,3991.26,34,,3991.26,percent of total billed charges,Implant Device,3991.26,34,,3991.26,percent of total billed charges,Implant Device,3991.26,34,,3991.26,percent of total billed charges,Implant Device,4108.65,35,,4108.65,percent of total billed charges,Implant Device,3991.26,34,"Charges > $500, x 34%",3991.26,percent of total billed charges,Implant Device,4108.65,35,,4108.65,percent of total billed charges,Implant Devices,4108.65,35,,4108.65,percent of total billed charges,Implant Devices,4108.65,35,,,percent of total billed charges,Implant Devices,4108.65,35,,4108.65,percent of total billed charges,Implant Devices,4108.65,35,,4108.65,percent of total billed charges,Implant Devices,4695.6,40,,4695.6,percent of total billed charges,Implant Devices,4108.65,70,,4108.65,percent of total billed charges,Implant Devices,3991.26,34,,3991.26,percent of total billed charges,Implant Devices,3991.26,34,,3991.26,percent of total billed charges,Implant Devices,4108.65,35,,4108.65,percent of total billed charges,Implant Devices,4108.65,35,,4108.65,percent of total billed charges,Implant Devices,4108.65,35,,4108.65,percent of total billed charges,Implant Devices,4108.65,35,,4108.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3991.26,34,"If Charge > 2,000, then 34 percent",3991.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4695.6,
STRYKER 5612-005 HINGE TIB COMP SZ 5-6,C1713,HCPCS,,79013804,CDM,278,RC,,,both,,,17060,6733.04,39.4668,,6733.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5800.4,34,,5800.4,percent of total billed charges,Implant Device,5800.4,34,,5800.4,percent of total billed charges,Implant Device,5800.4,34,,5800.4,percent of total billed charges,Implant Device,5800.4,34,,5800.4,percent of total billed charges,Implant Device,5800.4,34,,5800.4,percent of total billed charges,Implant Device,5800.4,34,,5800.4,percent of total billed charges,Implant Device,5971,35,,5971,percent of total billed charges,Implant Device,5800.4,34,"Charges > $500, x 34%",5800.4,percent of total billed charges,Implant Device,5971,35,,5971,percent of total billed charges,Implant Devices,5971,35,,5971,percent of total billed charges,Implant Devices,5971,35,,,percent of total billed charges,Implant Devices,5971,35,,5971,percent of total billed charges,Implant Devices,5971,35,,5971,percent of total billed charges,Implant Devices,6824,40,,6824,percent of total billed charges,Implant Devices,5971,70,,5971,percent of total billed charges,Implant Devices,5800.4,34,,5800.4,percent of total billed charges,Implant Devices,5800.4,34,,5800.4,percent of total billed charges,Implant Devices,5971,35,,5971,percent of total billed charges,Implant Devices,5971,35,,5971,percent of total billed charges,Implant Devices,5971,35,,5971,percent of total billed charges,Implant Devices,5971,35,,5971,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5800.4,34,"If Charge > 2,000, then 34 percent",5800.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6824,
DJO 200-30-036 TIGER SCREW 3.0X36MM,C1713,HCPCS,,79013807,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
DJO 200-40-034 TIGER SCREW 4.0X34MM,C1713,HCPCS,,79013808,CDM,278,RC,,,both,,,495,195.36,39.4668,,195.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,168.3,34,,168.3,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,198,40,,198,percent of total billed charges,Implant Devices,173.25,70,,173.25,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,168.3,34,,168.3,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,173.25,35,,173.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198,
EXACTECH 313-35-00 K WIRE 3X250MM,C1713,HCPCS,,79013813,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
STRYKER 8130-0170S TROCH NAIL 10X170MM,C1713,HCPCS,,79013823,CDM,278,RC,,,both,,,4797,1893.22,39.4668,,1893.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1630.98,34,,1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Device,1630.98,34,"Charges > $500, x 34%",1630.98,percent of total billed charges,Implant Device,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1918.8,40,,1918.8,percent of total billed charges,Implant Devices,1678.95,70,,1678.95,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1630.98,34,,1630.98,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,1678.95,35,,1678.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1630.98,34,"If Charge > 2,000, then 34 percent",1630.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1918.8,
STRYKER 8160-0110S LAG SCREW 10.5X110MM,C1713,HCPCS,,79013824,CDM,278,RC,,,both,,,1777,701.33,39.4668,,701.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Device,604.18,34,"Charges > $500, x 34%",604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,710.8,40,,710.8,percent of total billed charges,Implant Devices,621.95,70,,621.95,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.8,
ARTHREX AR-1288QIS-110 4.75 SWIVELOCK,C1713,HCPCS,,79013829,CDM,278,RC,,,both,,,1529,603.45,39.4668,,603.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,519.86,34,,519.86,percent of total billed charges,Implant Device,519.86,34,,519.86,percent of total billed charges,Implant Device,519.86,34,,519.86,percent of total billed charges,Implant Device,519.86,34,,519.86,percent of total billed charges,Implant Device,519.86,34,,519.86,percent of total billed charges,Implant Device,519.86,34,,519.86,percent of total billed charges,Implant Device,535.15,35,,535.15,percent of total billed charges,Implant Device,519.86,34,"Charges > $500, x 34%",519.86,percent of total billed charges,Implant Device,535.15,35,,535.15,percent of total billed charges,Implant Devices,535.15,35,,535.15,percent of total billed charges,Implant Devices,535.15,35,,,percent of total billed charges,Implant Devices,535.15,35,,535.15,percent of total billed charges,Implant Devices,535.15,35,,535.15,percent of total billed charges,Implant Devices,611.6,40,,611.6,percent of total billed charges,Implant Devices,535.15,70,,535.15,percent of total billed charges,Implant Devices,519.86,34,,519.86,percent of total billed charges,Implant Devices,519.86,34,,519.86,percent of total billed charges,Implant Devices,535.15,35,,535.15,percent of total billed charges,Implant Devices,535.15,35,,535.15,percent of total billed charges,Implant Devices,535.15,35,,535.15,percent of total billed charges,Implant Devices,535.15,35,,535.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,611.6,
ARTHREX AR-2600FSB-2 2.6 SPEEDBRIDGE,C1713,HCPCS,,79013830,CDM,278,RC,,,both,,,9019,3559.51,39.4668,,3559.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3066.46,34,,3066.46,percent of total billed charges,Implant Device,3066.46,34,,3066.46,percent of total billed charges,Implant Device,3066.46,34,,3066.46,percent of total billed charges,Implant Device,3066.46,34,,3066.46,percent of total billed charges,Implant Device,3066.46,34,,3066.46,percent of total billed charges,Implant Device,3066.46,34,,3066.46,percent of total billed charges,Implant Device,3156.65,35,,3156.65,percent of total billed charges,Implant Device,3066.46,34,"Charges > $500, x 34%",3066.46,percent of total billed charges,Implant Device,3156.65,35,,3156.65,percent of total billed charges,Implant Devices,3156.65,35,,3156.65,percent of total billed charges,Implant Devices,3156.65,35,,,percent of total billed charges,Implant Devices,3156.65,35,,3156.65,percent of total billed charges,Implant Devices,3156.65,35,,3156.65,percent of total billed charges,Implant Devices,3607.6,40,,3607.6,percent of total billed charges,Implant Devices,3156.65,70,,3156.65,percent of total billed charges,Implant Devices,3066.46,34,,3066.46,percent of total billed charges,Implant Devices,3066.46,34,,3066.46,percent of total billed charges,Implant Devices,3156.65,35,,3156.65,percent of total billed charges,Implant Devices,3156.65,35,,3156.65,percent of total billed charges,Implant Devices,3156.65,35,,3156.65,percent of total billed charges,Implant Devices,3156.65,35,,3156.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3066.46,34,"If Charge > 2,000, then 34 percent",3066.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3607.6,
PARAGON P53-203-R011 FIBULAR PLT 11H RT,C1713,HCPCS,,79013841,CDM,278,RC,,,both,,,5240,2068.06,39.4668,,2068.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1781.6,34,,1781.6,percent of total billed charges,Implant Device,1834,35,,1834,percent of total billed charges,Implant Device,1781.6,34,"Charges > $500, x 34%",1781.6,percent of total billed charges,Implant Device,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,2096,40,,2096,percent of total billed charges,Implant Devices,1834,70,,1834,percent of total billed charges,Implant Devices,1781.6,34,,1781.6,percent of total billed charges,Implant Devices,1781.6,34,,1781.6,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,1834,35,,1834,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1781.6,34,"If Charge > 2,000, then 34 percent",1781.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2096,
PARAGON P50-453-2714 NON LOCK SRW 2.7X14,C1713,HCPCS,,79013842,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
PARAGON P50-453-2713 NON LOCK SRW 2.7X13,C1713,HCPCS,,79013843,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
PARAGON P20-140-040L LONG THRED 4X40,C1713,HCPCS,,79013844,CDM,278,RC,,,both,,,830,327.57,39.4668,,327.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,290.5,35,,290.5,percent of total billed charges,Implant Device,282.2,34,"Charges > $500, x 34%",282.2,percent of total billed charges,Implant Device,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,332,40,,332,percent of total billed charges,Implant Devices,290.5,70,,290.5,percent of total billed charges,Implant Devices,282.2,34,,282.2,percent of total billed charges,Implant Devices,282.2,34,,282.2,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,332,
PARAGON P20-140-038L LONG THRED SRW 4X38,C1713,HCPCS,,79013845,CDM,278,RC,,,both,,,830,327.57,39.4668,,327.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,290.5,35,,290.5,percent of total billed charges,Implant Device,282.2,34,"Charges > $500, x 34%",282.2,percent of total billed charges,Implant Device,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,332,40,,332,percent of total billed charges,Implant Devices,290.5,70,,290.5,percent of total billed charges,Implant Devices,282.2,34,,282.2,percent of total billed charges,Implant Devices,282.2,34,,282.2,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,332,
PARAGON P53-102-L101 SUPPORT PLT LT SM,C1713,HCPCS,,79013846,CDM,278,RC,,,both,,,4568,1802.84,39.4668,,1802.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1553.12,34,,1553.12,percent of total billed charges,Implant Device,1553.12,34,,1553.12,percent of total billed charges,Implant Device,1553.12,34,,1553.12,percent of total billed charges,Implant Device,1553.12,34,,1553.12,percent of total billed charges,Implant Device,1553.12,34,,1553.12,percent of total billed charges,Implant Device,1553.12,34,,1553.12,percent of total billed charges,Implant Device,1598.8,35,,1598.8,percent of total billed charges,Implant Device,1553.12,34,"Charges > $500, x 34%",1553.12,percent of total billed charges,Implant Device,1598.8,35,,1598.8,percent of total billed charges,Implant Devices,1598.8,35,,1598.8,percent of total billed charges,Implant Devices,1598.8,35,,,percent of total billed charges,Implant Devices,1598.8,35,,1598.8,percent of total billed charges,Implant Devices,1598.8,35,,1598.8,percent of total billed charges,Implant Devices,1827.2,40,,1827.2,percent of total billed charges,Implant Devices,1598.8,70,,1598.8,percent of total billed charges,Implant Devices,1553.12,34,,1553.12,percent of total billed charges,Implant Devices,1553.12,34,,1553.12,percent of total billed charges,Implant Devices,1598.8,35,,1598.8,percent of total billed charges,Implant Devices,1598.8,35,,1598.8,percent of total billed charges,Implant Devices,1598.8,35,,1598.8,percent of total billed charges,Implant Devices,1598.8,35,,1598.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1553.12,34,"If Charge > 2,000, then 34 percent",1553.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1827.2,
PARAGON P50-353-3524 LOCK PLT SRW 3.5X24,C1713,HCPCS,,79013847,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
PARAGON P50-353-3526 LOCK PLT SRW 3.5X26,C1713,HCPCS,,79013848,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
PARAGON P50-353-3532 LOCK PLT SRW 3.5X32,C1713,HCPCS,,79013849,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
STRYKER 629203 DIS LAT HUM PLT LT 3H 84,C1713,HCPCS,,79013850,CDM,278,RC,,,both,,,2766,1091.65,39.4668,,1091.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,940.44,34,,940.44,percent of total billed charges,Implant Device,940.44,34,,940.44,percent of total billed charges,Implant Device,940.44,34,,940.44,percent of total billed charges,Implant Device,940.44,34,,940.44,percent of total billed charges,Implant Device,940.44,34,,940.44,percent of total billed charges,Implant Device,940.44,34,,940.44,percent of total billed charges,Implant Device,968.1,35,,968.1,percent of total billed charges,Implant Device,940.44,34,"Charges > $500, x 34%",940.44,percent of total billed charges,Implant Device,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,1106.4,40,,1106.4,percent of total billed charges,Implant Devices,968.1,70,,968.1,percent of total billed charges,Implant Devices,940.44,34,,940.44,percent of total billed charges,Implant Devices,940.44,34,,940.44,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,968.1,35,,968.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,940.44,34,"If Charge > 2,000, then 34 percent",940.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1106.4,
STRYKER 657340 LOCKING SCREW 3.5X40MM,C1713,HCPCS,,79013851,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
J&J 04.045.042S LOCKING SCREW 5X42MM,C1713,HCPCS,,79013865,CDM,278,RC,,,both,,,687,271.14,39.4668,,271.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,233.58,34,,233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Device,233.58,34,"Charges > $500, x 34%",233.58,percent of total billed charges,Implant Device,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,274.8,40,,274.8,percent of total billed charges,Implant Devices,240.45,70,,240.45,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,233.58,34,,233.58,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,240.45,35,,240.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,274.8,
ZIMMER 42504605802 FEMUR RT SIZE 5,C1713,HCPCS,,79013892,CDM,278,RC,,,both,,,30828,12166.83,39.4668,,12166.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10481.52,34,,10481.52,percent of total billed charges,Implant Device,10481.52,34,,10481.52,percent of total billed charges,Implant Device,10481.52,34,,10481.52,percent of total billed charges,Implant Device,10481.52,34,,10481.52,percent of total billed charges,Implant Device,10481.52,34,,10481.52,percent of total billed charges,Implant Device,10481.52,34,,10481.52,percent of total billed charges,Implant Device,10789.8,35,,10789.8,percent of total billed charges,Implant Device,10481.52,34,"Charges > $500, x 34%",10481.52,percent of total billed charges,Implant Device,10789.8,35,,10789.8,percent of total billed charges,Implant Devices,10789.8,35,,10789.8,percent of total billed charges,Implant Devices,10789.8,35,,,percent of total billed charges,Implant Devices,10789.8,35,,10789.8,percent of total billed charges,Implant Devices,10789.8,35,,10789.8,percent of total billed charges,Implant Devices,12331.2,40,,12331.2,percent of total billed charges,Implant Devices,10789.8,70,,10789.8,percent of total billed charges,Implant Devices,10481.52,34,,10481.52,percent of total billed charges,Implant Devices,10481.52,34,,10481.52,percent of total billed charges,Implant Devices,10789.8,35,,10789.8,percent of total billed charges,Implant Devices,10789.8,35,,10789.8,percent of total billed charges,Implant Devices,10789.8,35,,10789.8,percent of total billed charges,Implant Devices,10789.8,35,,10789.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10481.52,34,"If Charge > 2,000, then 34 percent",10481.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12331.2,
STRYKER 628010 SUPER PLT DECREASE 10H LT,C1713,HCPCS,,79013896,CDM,278,RC,,,both,,,3342,1318.98,39.4668,,1318.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1136.28,34,,1136.28,percent of total billed charges,Implant Device,1169.7,35,,1169.7,percent of total billed charges,Implant Device,1136.28,34,"Charges > $500, x 34%",1136.28,percent of total billed charges,Implant Device,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1336.8,40,,1336.8,percent of total billed charges,Implant Devices,1169.7,70,,1169.7,percent of total billed charges,Implant Devices,1136.28,34,,1136.28,percent of total billed charges,Implant Devices,1136.28,34,,1136.28,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,1169.7,35,,1169.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1136.28,34,"If Charge > 2,000, then 34 percent",1136.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1336.8,
J&J 04.045.350S LOCKING SCREWS 5.0X50MM,C1713,HCPCS,,79013899,CDM,278,RC,,,both,,,813,320.87,39.4668,,320.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Device,276.42,34,"Charges > $500, x 34%",276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,325.2,40,,325.2,percent of total billed charges,Implant Devices,284.55,70,,284.55,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,325.2,
J&J 04.045.372S LOCKING SCREW 5.0X72MM,C1713,HCPCS,,79013900,CDM,278,RC,,,both,,,813,320.87,39.4668,,320.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Device,276.42,34,"Charges > $500, x 34%",276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,325.2,40,,325.2,percent of total billed charges,Implant Devices,284.55,70,,284.55,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,325.2,
J&J 04.045.340S LOCKING SCREW 5.0X40MM,C1713,HCPCS,,79013901,CDM,278,RC,,,both,,,813,320.87,39.4668,,320.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,276.42,34,,276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Device,276.42,34,"Charges > $500, x 34%",276.42,percent of total billed charges,Implant Device,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,325.2,40,,325.2,percent of total billed charges,Implant Devices,284.55,70,,284.55,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,276.42,34,,276.42,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,284.55,35,,284.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,325.2,
J&J 245.121 LCP RECON PLATE 3.5MM,C1713,HCPCS,,79013902,CDM,278,RC,,,both,,,1606,633.84,39.4668,,633.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,546.04,34,,546.04,percent of total billed charges,Implant Device,546.04,34,,546.04,percent of total billed charges,Implant Device,546.04,34,,546.04,percent of total billed charges,Implant Device,546.04,34,,546.04,percent of total billed charges,Implant Device,546.04,34,,546.04,percent of total billed charges,Implant Device,546.04,34,,546.04,percent of total billed charges,Implant Device,562.1,35,,562.1,percent of total billed charges,Implant Device,546.04,34,"Charges > $500, x 34%",546.04,percent of total billed charges,Implant Device,562.1,35,,562.1,percent of total billed charges,Implant Devices,562.1,35,,562.1,percent of total billed charges,Implant Devices,562.1,35,,,percent of total billed charges,Implant Devices,562.1,35,,562.1,percent of total billed charges,Implant Devices,562.1,35,,562.1,percent of total billed charges,Implant Devices,642.4,40,,642.4,percent of total billed charges,Implant Devices,562.1,70,,562.1,percent of total billed charges,Implant Devices,546.04,34,,546.04,percent of total billed charges,Implant Devices,546.04,34,,546.04,percent of total billed charges,Implant Devices,562.1,35,,562.1,percent of total billed charges,Implant Devices,562.1,35,,562.1,percent of total billed charges,Implant Devices,562.1,35,,562.1,percent of total billed charges,Implant Devices,562.1,35,,562.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,642.4,
STRYKER 657350 LOCKING SCREW 3.5X50MM,C1713,HCPCS,,79013903,CDM,278,RC,,,both,,,539,212.73,39.4668,,212.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,183.26,34,,183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Device,183.26,34,"Charges > $500, x 34%",183.26,percent of total billed charges,Implant Device,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,215.6,40,,215.6,percent of total billed charges,Implant Devices,188.65,70,,188.65,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,183.26,34,,183.26,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,188.65,35,,188.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,215.6,
MEDLINE MMSL2412 LOCKING SCREW 2.4X12MM,C1713,HCPCS,,79013904,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
MEDLINE MPPM301U PLATE 4 HOLE,C1713,HCPCS,,79013905,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
MEDLINE MSD03520 CANN SCREW 3.5X20MM,C1713,HCPCS,,79013906,CDM,278,RC,,,both,,,1125,444,39.4668,,444,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,382.5,34,,382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Device,382.5,34,"Charges > $500, x 34%",382.5,percent of total billed charges,Implant Device,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,450,40,,450,percent of total billed charges,Implant Devices,393.75,70,,393.75,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,382.5,34,,382.5,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,393.75,35,,393.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,450,
J&J 42.231.220 SELF TAP LOCK SCREW 5X20,C1713,HCPCS,,79013910,CDM,278,RC,,,both,,,513,202.46,39.4668,,202.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,174.42,34,,174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Device,174.42,34,"Charges > $500, x 34%",174.42,percent of total billed charges,Implant Device,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,205.2,40,,205.2,percent of total billed charges,Implant Devices,179.55,70,,179.55,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,174.42,34,,174.42,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,179.55,35,,179.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.2,
J&J 42.231.010 VA LOCKING SCREW 5.0X10MM,C1713,HCPCS,,79013911,CDM,278,RC,,,both,,,733,289.29,39.4668,,289.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,256.55,35,,256.55,percent of total billed charges,Implant Device,249.22,34,"Charges > $500, x 34%",249.22,percent of total billed charges,Implant Device,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,293.2,40,,293.2,percent of total billed charges,Implant Devices,256.55,70,,256.55,percent of total billed charges,Implant Devices,249.22,34,,249.22,percent of total billed charges,Implant Devices,249.22,34,,249.22,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,293.2,
GLOBUS 51422 BMAC KIT 60CC,C1713,HCPCS,,79013916,CDM,278,RC,,,both,,,5700,2249.61,39.4668,,2249.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1938,34,,1938,percent of total billed charges,Implant Device,1938,34,,1938,percent of total billed charges,Implant Device,1938,34,,1938,percent of total billed charges,Implant Device,1938,34,,1938,percent of total billed charges,Implant Device,1938,34,,1938,percent of total billed charges,Implant Device,1938,34,,1938,percent of total billed charges,Implant Device,1995,35,,1995,percent of total billed charges,Implant Device,1938,34,"Charges > $500, x 34%",1938,percent of total billed charges,Implant Device,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,2280,40,,2280,percent of total billed charges,Implant Devices,1995,70,,1995,percent of total billed charges,Implant Devices,1938,34,,1938,percent of total billed charges,Implant Devices,1938,34,,1938,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,1995,35,,1995,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1938,34,"If Charge > 2,000, then 34 percent",1938,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2280,
STRYKER 633820 BONE SCREW 2.3X20MM,C1713,HCPCS,,79013918,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
J&J 04.112.625 LCP CLAVICLE PLT 2.7MM RT,C1713,HCPCS,,79013919,CDM,278,RC,,,both,,,3495,1379.36,39.4668,,1379.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1188.3,34,,1188.3,percent of total billed charges,Implant Device,1223.25,35,,1223.25,percent of total billed charges,Implant Device,1188.3,34,"Charges > $500, x 34%",1188.3,percent of total billed charges,Implant Device,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1398,40,,1398,percent of total billed charges,Implant Devices,1223.25,70,,1223.25,percent of total billed charges,Implant Devices,1188.3,34,,1188.3,percent of total billed charges,Implant Devices,1188.3,34,,1188.3,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,1223.25,35,,1223.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1188.3,34,"If Charge > 2,000, then 34 percent",1188.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1398,
J&J 402.876 CORTEX SCREW 2.7X16MM,C1713,HCPCS,,79013920,CDM,278,RC,,,both,,,136,53.67,39.4668,,53.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,54.4,40,,54.4,percent of total billed charges,Implant Devices,47.6,70,,47.6,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.4,
J&J 402.880 CORTEX SCREW 2.7X20MM,C1713,HCPCS,,79013921,CDM,278,RC,,,both,,,136,53.67,39.4668,,53.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,54.4,40,,54.4,percent of total billed charges,Implant Devices,47.6,70,,47.6,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.4,
J&J 402.878 CORTEX SCREW 2.7X18MM,C1713,HCPCS,,79013922,CDM,278,RC,,,both,,,136,53.67,39.4668,,53.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,46.24,34,,46.24,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,54.4,40,,54.4,percent of total billed charges,Implant Devices,47.6,70,,47.6,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,46.24,34,,46.24,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,47.6,35,,47.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.4,
J&J 04.211.014 VAL SELF TAP SCREW 2.7X14,C1713,HCPCS,,79013924,CDM,278,RC,,,both,,,343,135.37,39.4668,,135.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,116.62,34,,116.62,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,137.2,40,,137.2,percent of total billed charges,Implant Devices,120.05,70,,120.05,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,116.62,34,,116.62,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,120.05,35,,120.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,137.2,
J&J 02.104.030 ARTI DIS HUM PLT 3.5.230,C1713,HCPCS,,79013927,CDM,278,RC,,,both,,,3927,1549.86,39.4668,,1549.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1335.18,34,,1335.18,percent of total billed charges,Implant Device,1374.45,35,,1374.45,percent of total billed charges,Implant Device,1335.18,34,"Charges > $500, x 34%",1335.18,percent of total billed charges,Implant Device,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1570.8,40,,1570.8,percent of total billed charges,Implant Devices,1374.45,70,,1374.45,percent of total billed charges,Implant Devices,1335.18,34,,1335.18,percent of total billed charges,Implant Devices,1335.18,34,,1335.18,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,1374.45,35,,1374.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1335.18,34,"If Charge > 2,000, then 34 percent",1335.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1570.8,
PARAGON P50-453-2718 LOCK PLT SCRW 2.7X1,C1713,HCPCS,,79013931,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
PARAGON P50-353-3510 LOCK PLT SRW 3.5X10,C1713,HCPCS,,79013932,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
PARAGON P50-353-27112 LOCK PL SRW 2.7X12,C1713,HCPCS,,79013933,CDM,278,RC,,,both,,,693,273.5,39.4668,,273.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,235.62,34,,235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Device,235.62,34,"Charges > $500, x 34%",235.62,percent of total billed charges,Implant Device,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,277.2,40,,277.2,percent of total billed charges,Implant Devices,242.55,70,,242.55,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,235.62,34,,235.62,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,242.55,35,,242.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,277.2,
J&J 3092020 SMARTSET BONE CEMENT 20G,C1713,HCPCS,,79013936,CDM,278,RC,,,both,,,627,247.46,39.4668,,247.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,213.18,34,,213.18,percent of total billed charges,Implant Device,219.45,35,,219.45,percent of total billed charges,Implant Device,213.18,34,"Charges > $500, x 34%",213.18,percent of total billed charges,Implant Device,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,250.8,40,,250.8,percent of total billed charges,Implant Devices,219.45,70,,219.45,percent of total billed charges,Implant Devices,213.18,34,,213.18,percent of total billed charges,Implant Devices,213.18,34,,213.18,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,219.45,35,,219.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,250.8,
BIOCOMP 660-001 BULLET MAT & INTRODUCER,C1713,HCPCS,,79013940,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 8160-0115S LAG SCREW 1.5X15MM,C1713,HCPCS,,79013947,CDM,278,RC,,,both,,,1777,701.33,39.4668,,701.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Device,604.18,34,"Charges > $500, x 34%",604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,710.8,40,,710.8,percent of total billed charges,Implant Devices,621.95,70,,621.95,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.8,
STRYKER 5820X3528 CROSSCHECK SCRW 3.5X28,C1713,HCPCS,,79013953,CDM,278,RC,,,both,,,1299,512.67,39.4668,,512.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,441.66,34,,441.66,percent of total billed charges,Implant Device,441.66,34,,441.66,percent of total billed charges,Implant Device,441.66,34,,441.66,percent of total billed charges,Implant Device,441.66,34,,441.66,percent of total billed charges,Implant Device,441.66,34,,441.66,percent of total billed charges,Implant Device,441.66,34,,441.66,percent of total billed charges,Implant Device,454.65,35,,454.65,percent of total billed charges,Implant Device,441.66,34,"Charges > $500, x 34%",441.66,percent of total billed charges,Implant Device,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,519.6,40,,519.6,percent of total billed charges,Implant Devices,454.65,70,,454.65,percent of total billed charges,Implant Devices,441.66,34,,441.66,percent of total billed charges,Implant Devices,441.66,34,,441.66,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,519.6,
STRYKER 5820X3530 CROSSCHECK SCRW 3.5X30,C1713,HCPCS,,79013954,CDM,278,RC,,,both,,,1299,512.67,39.4668,,512.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,441.66,34,,441.66,percent of total billed charges,Implant Device,441.66,34,,441.66,percent of total billed charges,Implant Device,441.66,34,,441.66,percent of total billed charges,Implant Device,441.66,34,,441.66,percent of total billed charges,Implant Device,441.66,34,,441.66,percent of total billed charges,Implant Device,441.66,34,,441.66,percent of total billed charges,Implant Device,454.65,35,,454.65,percent of total billed charges,Implant Device,441.66,34,"Charges > $500, x 34%",441.66,percent of total billed charges,Implant Device,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,519.6,40,,519.6,percent of total billed charges,Implant Devices,454.65,70,,454.65,percent of total billed charges,Implant Devices,441.66,34,,441.66,percent of total billed charges,Implant Devices,441.66,34,,441.66,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,454.65,35,,454.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,519.6,
STRYKER 628168 PT 8 HOLE BRIDGE/RIGHT,C1713,HCPCS,,79013960,CDM,278,RC,,,both,,,3672,1449.22,39.4668,,1449.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1248.48,34,,1248.48,percent of total billed charges,Implant Device,1248.48,34,,1248.48,percent of total billed charges,Implant Device,1248.48,34,,1248.48,percent of total billed charges,Implant Device,1248.48,34,,1248.48,percent of total billed charges,Implant Device,1248.48,34,,1248.48,percent of total billed charges,Implant Device,1248.48,34,,1248.48,percent of total billed charges,Implant Device,1285.2,35,,1285.2,percent of total billed charges,Implant Device,1248.48,34,"Charges > $500, x 34%",1248.48,percent of total billed charges,Implant Device,1285.2,35,,1285.2,percent of total billed charges,Implant Devices,1285.2,35,,1285.2,percent of total billed charges,Implant Devices,1285.2,35,,,percent of total billed charges,Implant Devices,1285.2,35,,1285.2,percent of total billed charges,Implant Devices,1285.2,35,,1285.2,percent of total billed charges,Implant Devices,1468.8,40,,1468.8,percent of total billed charges,Implant Devices,1285.2,70,,1285.2,percent of total billed charges,Implant Devices,1248.48,34,,1248.48,percent of total billed charges,Implant Devices,1248.48,34,,1248.48,percent of total billed charges,Implant Devices,1285.2,35,,1285.2,percent of total billed charges,Implant Devices,1285.2,35,,1285.2,percent of total billed charges,Implant Devices,1285.2,35,,1285.2,percent of total billed charges,Implant Devices,1285.2,35,,1285.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1248.48,34,"If Charge > 2,000, then 34 percent",1248.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1468.8,
STRYKER 629740 NARROW LOCK PLT 20 HOLE,C1713,HCPCS,,79013961,CDM,278,RC,,,both,,,3366,1328.45,39.4668,,1328.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1144.44,34,,1144.44,percent of total billed charges,Implant Device,1178.1,35,,1178.1,percent of total billed charges,Implant Device,1144.44,34,"Charges > $500, x 34%",1144.44,percent of total billed charges,Implant Device,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1346.4,40,,1346.4,percent of total billed charges,Implant Devices,1178.1,70,,1178.1,percent of total billed charges,Implant Devices,1144.44,34,,1144.44,percent of total billed charges,Implant Devices,1144.44,34,,1144.44,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,1178.1,35,,1178.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1144.44,34,"If Charge > 2,000, then 34 percent",1144.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1346.4,
STRYKER 627210 HUMERUS PLATE 10 HOLE,C1713,HCPCS,,79013962,CDM,278,RC,,,both,,,7656,3021.58,39.4668,,3021.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2603.04,34,,2603.04,percent of total billed charges,Implant Device,2603.04,34,,2603.04,percent of total billed charges,Implant Device,2603.04,34,,2603.04,percent of total billed charges,Implant Device,2603.04,34,,2603.04,percent of total billed charges,Implant Device,2603.04,34,,2603.04,percent of total billed charges,Implant Device,2603.04,34,,2603.04,percent of total billed charges,Implant Device,2679.6,35,,2679.6,percent of total billed charges,Implant Device,2603.04,34,"Charges > $500, x 34%",2603.04,percent of total billed charges,Implant Device,2679.6,35,,2679.6,percent of total billed charges,Implant Devices,2679.6,35,,2679.6,percent of total billed charges,Implant Devices,2679.6,35,,,percent of total billed charges,Implant Devices,2679.6,35,,2679.6,percent of total billed charges,Implant Devices,2679.6,35,,2679.6,percent of total billed charges,Implant Devices,3062.4,40,,3062.4,percent of total billed charges,Implant Devices,2679.6,70,,2679.6,percent of total billed charges,Implant Devices,2603.04,34,,2603.04,percent of total billed charges,Implant Devices,2603.04,34,,2603.04,percent of total billed charges,Implant Devices,2679.6,35,,2679.6,percent of total billed charges,Implant Devices,2679.6,35,,2679.6,percent of total billed charges,Implant Devices,2679.6,35,,2679.6,percent of total billed charges,Implant Devices,2679.6,35,,2679.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2603.04,34,"If Charge > 2,000, then 34 percent",2603.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3062.4,
STRYKER 8160-0090S LAG SCREW 10.5X90MM,C1713,HCPCS,,79013964,CDM,278,RC,,,both,,,1777,701.33,39.4668,,701.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Device,604.18,34,"Charges > $500, x 34%",604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,710.8,40,,710.8,percent of total billed charges,Implant Devices,621.95,70,,621.95,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.8,
STRYKER IH2512 HEADLESS SCREW 2.5X12MM,C1713,HCPCS,,79013968,CDM,278,RC,,,both,,,1679,662.65,39.4668,,662.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,570.86,34,,570.86,percent of total billed charges,Implant Device,587.65,35,,587.65,percent of total billed charges,Implant Device,570.86,34,"Charges > $500, x 34%",570.86,percent of total billed charges,Implant Device,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,671.6,40,,671.6,percent of total billed charges,Implant Devices,587.65,70,,587.65,percent of total billed charges,Implant Devices,570.86,34,,570.86,percent of total billed charges,Implant Devices,570.86,34,,570.86,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,587.65,35,,587.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,671.6,
STRYKER 8160-0120S LAG SCREW 10.5X120MM,C1713,HCPCS,,79013969,CDM,278,RC,,,both,,,1777,701.33,39.4668,,701.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,604.18,34,,604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Device,604.18,34,"Charges > $500, x 34%",604.18,percent of total billed charges,Implant Device,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,710.8,40,,710.8,percent of total billed charges,Implant Devices,621.95,70,,621.95,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,604.18,34,,604.18,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,621.95,35,,621.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.8,
STRYKER 8525-0420S NAIL LT 10X420X125DEG,C1713,HCPCS,,79013970,CDM,278,RC,,,both,,,7227,2852.27,39.4668,,2852.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2457.18,34,,2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Device,2457.18,34,"Charges > $500, x 34%",2457.18,percent of total billed charges,Implant Device,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2890.8,40,,2890.8,percent of total billed charges,Implant Devices,2529.45,70,,2529.45,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2457.18,34,,2457.18,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,2529.45,35,,2529.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2457.18,34,"If Charge > 2,000, then 34 percent",2457.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2890.8,
STRYKER 663810 BONE SCREW 2.3X19MM,C1713,HCPCS,,79013971,CDM,278,RC,,,both,,,324,127.87,39.4668,,127.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,110.16,34,,110.16,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,129.6,40,,129.6,percent of total billed charges,Implant Devices,113.4,70,,113.4,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,110.16,34,,110.16,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,113.4,35,,113.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,129.6,
STRYKER 663715 LOCKING SCREW 2.3X15MM,C1713,HCPCS,,79013972,CDM,278,RC,,,both,,,413,163,39.4668,,163,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,140.42,34,,140.42,percent of total billed charges,Implant Device,144.55,35,,144.55,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,165.2,40,,165.2,percent of total billed charges,Implant Devices,144.55,70,,144.55,percent of total billed charges,Implant Devices,140.42,34,,140.42,percent of total billed charges,Implant Devices,140.42,34,,140.42,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,144.55,35,,144.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,165.2,
J&J 249.682 LCP PLATE 6 HOLE 2.7MM,C1713,HCPCS,,79013978,CDM,278,RC,,,both,,,1057,417.16,39.4668,,417.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,359.38,34,,359.38,percent of total billed charges,Implant Device,369.95,35,,369.95,percent of total billed charges,Implant Device,359.38,34,"Charges > $500, x 34%",359.38,percent of total billed charges,Implant Device,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,422.8,40,,422.8,percent of total billed charges,Implant Devices,369.95,70,,369.95,percent of total billed charges,Implant Devices,359.38,34,,359.38,percent of total billed charges,Implant Devices,359.38,34,,359.38,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,369.95,35,,369.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,422.8,
J&J 02.247.380S LCP PLATE 16 HOLE 2.7MM,C1713,HCPCS,,79013979,CDM,278,RC,,,both,,,1590,627.52,39.4668,,627.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,540.6,34,,540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Device,540.6,34,"Charges > $500, x 34%",540.6,percent of total billed charges,Implant Device,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,636,40,,636,percent of total billed charges,Implant Devices,556.5,70,,556.5,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,540.6,34,,540.6,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,556.5,35,,556.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,636,
STRYKER 3102-1415 CANCELLOUS CHIPS 15CC,C1713,HCPCS,,79013986,CDM,278,RC,,,both,,,615,242.72,39.4668,,242.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.1,34,,209.1,percent of total billed charges,Implant Device,209.1,34,,209.1,percent of total billed charges,Implant Device,209.1,34,,209.1,percent of total billed charges,Implant Device,209.1,34,,209.1,percent of total billed charges,Implant Device,209.1,34,,209.1,percent of total billed charges,Implant Device,209.1,34,,209.1,percent of total billed charges,Implant Device,215.25,35,,215.25,percent of total billed charges,Implant Device,209.1,34,"Charges > $500, x 34%",209.1,percent of total billed charges,Implant Device,215.25,35,,215.25,percent of total billed charges,Implant Devices,215.25,35,,215.25,percent of total billed charges,Implant Devices,215.25,35,,,percent of total billed charges,Implant Devices,215.25,35,,215.25,percent of total billed charges,Implant Devices,215.25,35,,215.25,percent of total billed charges,Implant Devices,246,40,,246,percent of total billed charges,Implant Devices,215.25,70,,215.25,percent of total billed charges,Implant Devices,209.1,34,,209.1,percent of total billed charges,Implant Devices,209.1,34,,209.1,percent of total billed charges,Implant Devices,215.25,35,,215.25,percent of total billed charges,Implant Devices,215.25,35,,215.25,percent of total billed charges,Implant Devices,215.25,35,,215.25,percent of total billed charges,Implant Devices,215.25,35,,215.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246,
STRYKER 3102-1430 CANCELLOUS CHIPS 30CC,C1713,HCPCS,,79013987,CDM,278,RC,,,both,,,989,390.33,39.4668,,390.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,336.26,34,,336.26,percent of total billed charges,Implant Device,336.26,34,,336.26,percent of total billed charges,Implant Device,336.26,34,,336.26,percent of total billed charges,Implant Device,336.26,34,,336.26,percent of total billed charges,Implant Device,336.26,34,,336.26,percent of total billed charges,Implant Device,336.26,34,,336.26,percent of total billed charges,Implant Device,346.15,35,,346.15,percent of total billed charges,Implant Device,336.26,34,"Charges > $500, x 34%",336.26,percent of total billed charges,Implant Device,346.15,35,,346.15,percent of total billed charges,Implant Devices,346.15,35,,346.15,percent of total billed charges,Implant Devices,346.15,35,,,percent of total billed charges,Implant Devices,346.15,35,,346.15,percent of total billed charges,Implant Devices,346.15,35,,346.15,percent of total billed charges,Implant Devices,395.6,40,,395.6,percent of total billed charges,Implant Devices,346.15,70,,346.15,percent of total billed charges,Implant Devices,336.26,34,,336.26,percent of total billed charges,Implant Devices,336.26,34,,336.26,percent of total billed charges,Implant Devices,346.15,35,,346.15,percent of total billed charges,Implant Devices,346.15,35,,346.15,percent of total billed charges,Implant Devices,346.15,35,,346.15,percent of total billed charges,Implant Devices,346.15,35,,346.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,395.6,
STRYKER 3102-1460 CANCELLOUS CHIPS 60CC,C1713,HCPCS,,79013988,CDM,278,RC,,,both,,,1620,639.36,39.4668,,639.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,550.8,34,,550.8,percent of total billed charges,Implant Device,550.8,34,,550.8,percent of total billed charges,Implant Device,550.8,34,,550.8,percent of total billed charges,Implant Device,550.8,34,,550.8,percent of total billed charges,Implant Device,550.8,34,,550.8,percent of total billed charges,Implant Device,550.8,34,,550.8,percent of total billed charges,Implant Device,567,35,,567,percent of total billed charges,Implant Device,550.8,34,"Charges > $500, x 34%",550.8,percent of total billed charges,Implant Device,567,35,,567,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,567,35,,,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,648,40,,648,percent of total billed charges,Implant Devices,567,70,,567,percent of total billed charges,Implant Devices,550.8,34,,550.8,percent of total billed charges,Implant Devices,550.8,34,,550.8,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,648,
MEDLINE MSD14028 CANN SCREW 4.0X28MM,C1713,HCPCS,,79013989,CDM,278,RC,,,both,,,1305,515.04,39.4668,,515.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,443.7,34,,443.7,percent of total billed charges,Implant Device,456.75,35,,456.75,percent of total billed charges,Implant Device,443.7,34,"Charges > $500, x 34%",443.7,percent of total billed charges,Implant Device,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,522,40,,522,percent of total billed charges,Implant Devices,456.75,70,,456.75,percent of total billed charges,Implant Devices,443.7,34,,443.7,percent of total billed charges,Implant Devices,443.7,34,,443.7,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,456.75,35,,456.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,522,
WRIGHT 58510000 LAPIDUS PLATE 0MM,C1713,HCPCS,,79013995,CDM,278,RC,,,both,,,7776,3068.94,39.4668,,3068.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2643.84,34,,2643.84,percent of total billed charges,Implant Device,2721.6,35,,2721.6,percent of total billed charges,Implant Device,2643.84,34,"Charges > $500, x 34%",2643.84,percent of total billed charges,Implant Device,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,3110.4,40,,3110.4,percent of total billed charges,Implant Devices,2721.6,70,,2721.6,percent of total billed charges,Implant Devices,2643.84,34,,2643.84,percent of total billed charges,Implant Devices,2643.84,34,,2643.84,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,2721.6,35,,2721.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2643.84,34,"If Charge > 2,000, then 34 percent",2643.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3110.4,
WRIGHT 58812710 CORTICAL SCREW 2.7X10MM,C1713,HCPCS,,79013996,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
WRIGHT 58812714 CORTICAL SCREW 2.7X14MM,C1713,HCPCS,,79013997,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
J&J 42.231.018 LOCKING SCREW 5.018MM,C1713,HCPCS,,79013998,CDM,278,RC,,,both,,,733,289.29,39.4668,,289.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,256.55,35,,256.55,percent of total billed charges,Implant Device,249.22,34,"Charges > $500, x 34%",249.22,percent of total billed charges,Implant Device,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,293.2,40,,293.2,percent of total billed charges,Implant Devices,256.55,70,,256.55,percent of total billed charges,Implant Devices,249.22,34,,249.22,percent of total billed charges,Implant Devices,249.22,34,,249.22,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,293.2,
J&J 42.231.014 LOCKING SCREW 5.0X14MM,C1713,HCPCS,,79013999,CDM,278,RC,,,both,,,733,289.29,39.4668,,289.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,249.22,34,,249.22,percent of total billed charges,Implant Device,256.55,35,,256.55,percent of total billed charges,Implant Device,249.22,34,"Charges > $500, x 34%",249.22,percent of total billed charges,Implant Device,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,293.2,40,,293.2,percent of total billed charges,Implant Devices,256.55,70,,256.55,percent of total billed charges,Implant Devices,249.22,34,,249.22,percent of total billed charges,Implant Devices,249.22,34,,249.22,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,256.55,35,,256.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,293.2,
J&J 224.561 LCP PLATE 4.5X116MM 6 HOLE,C1713,HCPCS,,79014000,CDM,278,RC,,,both,,,999,394.27,39.4668,,394.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,339.66,34,,339.66,percent of total billed charges,Implant Device,339.66,34,,339.66,percent of total billed charges,Implant Device,339.66,34,,339.66,percent of total billed charges,Implant Device,339.66,34,,339.66,percent of total billed charges,Implant Device,339.66,34,,339.66,percent of total billed charges,Implant Device,339.66,34,,339.66,percent of total billed charges,Implant Device,349.65,35,,349.65,percent of total billed charges,Implant Device,339.66,34,"Charges > $500, x 34%",339.66,percent of total billed charges,Implant Device,349.65,35,,349.65,percent of total billed charges,Implant Devices,349.65,35,,349.65,percent of total billed charges,Implant Devices,349.65,35,,,percent of total billed charges,Implant Devices,349.65,35,,349.65,percent of total billed charges,Implant Devices,349.65,35,,349.65,percent of total billed charges,Implant Devices,399.6,40,,399.6,percent of total billed charges,Implant Devices,349.65,70,,349.65,percent of total billed charges,Implant Devices,339.66,34,,339.66,percent of total billed charges,Implant Devices,339.66,34,,339.66,percent of total billed charges,Implant Devices,349.65,35,,349.65,percent of total billed charges,Implant Devices,349.65,35,,349.65,percent of total billed charges,Implant Devices,349.65,35,,349.65,percent of total billed charges,Implant Devices,349.65,35,,349.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,399.6,
J&J 02.206.224 CORTEX SCREW 3.5X24MM,C1713,HCPCS,,79014001,CDM,278,RC,,,both,,,79,31.18,39.4668,,31.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,26.86,34,,26.86,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,31.6,40,,31.6,percent of total billed charges,Implant Devices,27.65,70,,27.65,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,26.86,34,,26.86,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,27.65,35,,27.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31.6,
J&J 02.118.217S DIS TIB PLT 18H 2.7/3.5,C1713,HCPCS,,79014002,CDM,278,RC,,,both,,,6033,2381.03,39.4668,,2381.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2051.22,34,,2051.22,percent of total billed charges,Implant Device,2051.22,34,,2051.22,percent of total billed charges,Implant Device,2051.22,34,,2051.22,percent of total billed charges,Implant Device,2051.22,34,,2051.22,percent of total billed charges,Implant Device,2051.22,34,,2051.22,percent of total billed charges,Implant Device,2051.22,34,,2051.22,percent of total billed charges,Implant Device,2111.55,35,,2111.55,percent of total billed charges,Implant Device,2051.22,34,"Charges > $500, x 34%",2051.22,percent of total billed charges,Implant Device,2111.55,35,,2111.55,percent of total billed charges,Implant Devices,2111.55,35,,2111.55,percent of total billed charges,Implant Devices,2111.55,35,,,percent of total billed charges,Implant Devices,2111.55,35,,2111.55,percent of total billed charges,Implant Devices,2111.55,35,,2111.55,percent of total billed charges,Implant Devices,2413.2,40,,2413.2,percent of total billed charges,Implant Devices,2111.55,70,,2111.55,percent of total billed charges,Implant Devices,2051.22,34,,2051.22,percent of total billed charges,Implant Devices,2051.22,34,,2051.22,percent of total billed charges,Implant Devices,2111.55,35,,2111.55,percent of total billed charges,Implant Devices,2111.55,35,,2111.55,percent of total billed charges,Implant Devices,2111.55,35,,2111.55,percent of total billed charges,Implant Devices,2111.55,35,,2111.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2051.22,34,"If Charge > 2,000, then 34 percent",2051.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2413.2,
J&J 04.037.031S CAN NAIL LT 10/125 DEG,C1713,HCPCS,,79014006,CDM,278,RC,,,both,,,98,38.68,39.4668,,38.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,33.32,34,,33.32,percent of total billed charges,Implant Device,33.32,34,,33.32,percent of total billed charges,Implant Device,33.32,34,,33.32,percent of total billed charges,Implant Device,33.32,34,,33.32,percent of total billed charges,Implant Device,33.32,34,,33.32,percent of total billed charges,Implant Device,33.32,34,,33.32,percent of total billed charges,Implant Device,34.3,35,,34.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,39.2,40,,39.2,percent of total billed charges,Implant Devices,34.3,70,,34.3,percent of total billed charges,Implant Devices,33.32,34,,33.32,percent of total billed charges,Implant Devices,33.32,34,,33.32,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,34.3,35,,34.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,39.2,
J&J 1217-22-052 ACETABULAR SHELL 52MM,C1713,HCPCS,,79014008,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
J&J 02.118.528 METAPHYSEA SCREW 2.7X28,C1713,HCPCS,,79014009,CDM,278,RC,,,both,,,125,49.33,39.4668,,49.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,42.5,34,,42.5,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,50,40,,50,percent of total billed charges,Implant Devices,43.75,70,,43.75,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,42.5,34,,42.5,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,43.75,35,,43.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50,
PAR 28 P20-140-036S CANN THREAD SRW 4X36,C1713,HCPCS,,79014014,CDM,278,RC,,,both,,,830,327.57,39.4668,,327.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,282.2,34,,282.2,percent of total billed charges,Implant Device,290.5,35,,290.5,percent of total billed charges,Implant Device,282.2,34,"Charges > $500, x 34%",282.2,percent of total billed charges,Implant Device,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,332,40,,332,percent of total billed charges,Implant Devices,290.5,70,,290.5,percent of total billed charges,Implant Devices,282.2,34,,282.2,percent of total billed charges,Implant Devices,282.2,34,,282.2,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,290.5,35,,290.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,332,
PAR28 P72-018-1818-S STAPLE KIT 18X18X18,C1713,HCPCS,,79014015,CDM,278,RC,,,both,,,8235,3250.09,39.4668,,3250.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2799.9,34,,2799.9,percent of total billed charges,Implant Device,2882.25,35,,2882.25,percent of total billed charges,Implant Device,2799.9,34,"Charges > $500, x 34%",2799.9,percent of total billed charges,Implant Device,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,3294,40,,3294,percent of total billed charges,Implant Devices,2882.25,70,,2882.25,percent of total billed charges,Implant Devices,2799.9,34,,2799.9,percent of total billed charges,Implant Devices,2799.9,34,,2799.9,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,2882.25,35,,2882.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2799.9,34,"If Charge > 2,000, then 34 percent",2799.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3294,
ARTHREX AR-8935CL-12 KREULOCK SRW 3.5X12,C1713,HCPCS,,79014018,CDM,278,RC,,,both,,,959,378.49,39.4668,,378.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,326.06,34,,326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Device,326.06,34,"Charges > $500, x 34%",326.06,percent of total billed charges,Implant Device,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,383.6,40,,383.6,percent of total billed charges,Implant Devices,335.65,70,,335.65,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,326.06,34,,326.06,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,335.65,35,,335.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,383.6,
STRYKER 5817001R MIDFOOT FUSION U PLT RT,C1713,HCPCS,,79014021,CDM,278,RC,,,both,,,8932,3525.17,39.4668,,3525.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3036.88,34,,3036.88,percent of total billed charges,Implant Device,3036.88,34,,3036.88,percent of total billed charges,Implant Device,3036.88,34,,3036.88,percent of total billed charges,Implant Device,3036.88,34,,3036.88,percent of total billed charges,Implant Device,3036.88,34,,3036.88,percent of total billed charges,Implant Device,3036.88,34,,3036.88,percent of total billed charges,Implant Device,3126.2,35,,3126.2,percent of total billed charges,Implant Device,3036.88,34,"Charges > $500, x 34%",3036.88,percent of total billed charges,Implant Device,3126.2,35,,3126.2,percent of total billed charges,Implant Devices,3126.2,35,,3126.2,percent of total billed charges,Implant Devices,3126.2,35,,,percent of total billed charges,Implant Devices,3126.2,35,,3126.2,percent of total billed charges,Implant Devices,3126.2,35,,3126.2,percent of total billed charges,Implant Devices,3572.8,40,,3572.8,percent of total billed charges,Implant Devices,3126.2,70,,3126.2,percent of total billed charges,Implant Devices,3036.88,34,,3036.88,percent of total billed charges,Implant Devices,3036.88,34,,3036.88,percent of total billed charges,Implant Devices,3126.2,35,,3126.2,percent of total billed charges,Implant Devices,3126.2,35,,3126.2,percent of total billed charges,Implant Devices,3126.2,35,,3126.2,percent of total billed charges,Implant Devices,3126.2,35,,3126.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3036.88,34,"If Charge > 2,000, then 34 percent",3036.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3572.8,
STRYKER 58180000 MIDFOOT FUSION STGT PLT,C1713,HCPCS,,79014022,CDM,278,RC,,,both,,,5608,2213.3,39.4668,,2213.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1906.72,34,,1906.72,percent of total billed charges,Implant Device,1906.72,34,,1906.72,percent of total billed charges,Implant Device,1906.72,34,,1906.72,percent of total billed charges,Implant Device,1906.72,34,,1906.72,percent of total billed charges,Implant Device,1906.72,34,,1906.72,percent of total billed charges,Implant Device,1906.72,34,,1906.72,percent of total billed charges,Implant Device,1962.8,35,,1962.8,percent of total billed charges,Implant Device,1906.72,34,"Charges > $500, x 34%",1906.72,percent of total billed charges,Implant Device,1962.8,35,,1962.8,percent of total billed charges,Implant Devices,1962.8,35,,1962.8,percent of total billed charges,Implant Devices,1962.8,35,,,percent of total billed charges,Implant Devices,1962.8,35,,1962.8,percent of total billed charges,Implant Devices,1962.8,35,,1962.8,percent of total billed charges,Implant Devices,2243.2,40,,2243.2,percent of total billed charges,Implant Devices,1962.8,70,,1962.8,percent of total billed charges,Implant Devices,1906.72,34,,1906.72,percent of total billed charges,Implant Devices,1906.72,34,,1906.72,percent of total billed charges,Implant Devices,1962.8,35,,1962.8,percent of total billed charges,Implant Devices,1962.8,35,,1962.8,percent of total billed charges,Implant Devices,1962.8,35,,1962.8,percent of total billed charges,Implant Devices,1962.8,35,,1962.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1906.72,34,"If Charge > 2,000, then 34 percent",1906.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2243.2,
STRYKER 58802716 LOCKING SCREW 2.7X16MM,C1713,HCPCS,,79014023,CDM,278,RC,,,both,,,1145,451.89,39.4668,,451.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Device,389.3,34,"Charges > $500, x 34%",389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,458,40,,458,percent of total billed charges,Implant Devices,400.75,70,,400.75,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,458,
STRYKER 58802718 LOCKING SCREW 2.7X18MM,C1713,HCPCS,,79014024,CDM,278,RC,,,both,,,1145,451.89,39.4668,,451.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,389.3,34,,389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Device,389.3,34,"Charges > $500, x 34%",389.3,percent of total billed charges,Implant Device,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,458,40,,458,percent of total billed charges,Implant Devices,400.75,70,,400.75,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,389.3,34,,389.3,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,400.75,35,,400.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,458,
STRYKER 58812718 CORTICAL SCREW 2.7X18MM,C1713,HCPCS,,79014025,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 58812720 CORTICAL SCREW 2.7X20MM,C1713,HCPCS,,79014026,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 58812722 CORTICAL SCREW 2.7X22MM,C1713,HCPCS,,79014027,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
STRYKER 58812724 CORTICAL SCREW 2.7X24MM,C1713,HCPCS,,79014028,CDM,278,RC,,,both,,,583,230.09,39.4668,,230.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,198.22,34,,198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Device,198.22,34,"Charges > $500, x 34%",198.22,percent of total billed charges,Implant Device,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,233.2,40,,233.2,percent of total billed charges,Implant Devices,204.05,70,,204.05,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,198.22,34,,198.22,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,204.05,35,,204.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,233.2,
MEDTRONIC DDBB1D1 EVERA XT ICD-DR,C1721,HCPCS,,79006835,CDM,278,RC,,,both,,,60608,23920.04,39.4668,,23920.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20606.72,34,,20606.72,percent of total billed charges,Implant Device,20606.72,34,,20606.72,percent of total billed charges,Implant Device,20606.72,34,,20606.72,percent of total billed charges,Implant Device,20606.72,34,,20606.72,percent of total billed charges,Implant Device,20606.72,34,,20606.72,percent of total billed charges,Implant Device,20606.72,34,,20606.72,percent of total billed charges,Implant Device,21212.8,35,,21212.8,percent of total billed charges,Implant Device,20606.72,34,"Charges > $500, x 34%",20606.72,percent of total billed charges,Implant Device,21212.8,35,,21212.8,percent of total billed charges,Implant Devices,21212.8,35,,21212.8,percent of total billed charges,Implant Devices,21212.8,35,,,percent of total billed charges,Implant Devices,21212.8,35,,21212.8,percent of total billed charges,Implant Devices,21212.8,35,,21212.8,percent of total billed charges,Implant Devices,24243.2,40,,24243.2,percent of total billed charges,Implant Devices,21212.8,70,,21212.8,percent of total billed charges,Implant Devices,20606.72,34,,20606.72,percent of total billed charges,Implant Devices,20606.72,34,,20606.72,percent of total billed charges,Implant Devices,21212.8,35,,21212.8,percent of total billed charges,Implant Devices,21212.8,35,,21212.8,percent of total billed charges,Implant Devices,21212.8,35,,21212.8,percent of total billed charges,Implant Devices,21212.8,35,,21212.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,20606.72,34,"If Charge > 2,000, then 34 percent",20606.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24243.2,
J&J 2205 BLAKE DRAIN 7MM FLUTD EVACUATOR,C1729,HCPCS,,79000707,CDM,278,RC,,,both,,,157,61.96,39.4668,,61.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,53.38,34,,53.38,percent of total billed charges,Implant Device,53.38,34,,53.38,percent of total billed charges,Implant Device,53.38,34,,53.38,percent of total billed charges,Implant Device,53.38,34,,53.38,percent of total billed charges,Implant Device,53.38,34,,53.38,percent of total billed charges,Implant Device,53.38,34,,53.38,percent of total billed charges,Implant Device,54.95,35,,54.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,54.95,35,,54.95,percent of total billed charges,Implant Devices,54.95,35,,54.95,percent of total billed charges,Implant Devices,54.95,35,,,percent of total billed charges,Implant Devices,54.95,35,,54.95,percent of total billed charges,Implant Devices,54.95,35,,54.95,percent of total billed charges,Implant Devices,62.8,40,,62.8,percent of total billed charges,Implant Devices,54.95,70,,54.95,percent of total billed charges,Implant Devices,53.38,34,,53.38,percent of total billed charges,Implant Devices,53.38,34,,53.38,percent of total billed charges,Implant Devices,54.95,35,,54.95,percent of total billed charges,Implant Devices,54.95,35,,54.95,percent of total billed charges,Implant Devices,54.95,35,,54.95,percent of total billed charges,Implant Devices,54.95,35,,54.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,62.8,
J&J 82-3111 HAKIM PROGRAMMABLE SHUNT,C1729,HCPCS,,79001528,CDM,278,RC,,,both,,,12942,5107.79,39.4668,,5107.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4400.28,34,,4400.28,percent of total billed charges,Implant Device,4400.28,34,,4400.28,percent of total billed charges,Implant Device,4400.28,34,,4400.28,percent of total billed charges,Implant Device,4400.28,34,,4400.28,percent of total billed charges,Implant Device,4400.28,34,,4400.28,percent of total billed charges,Implant Device,4400.28,34,,4400.28,percent of total billed charges,Implant Device,4529.7,35,,4529.7,percent of total billed charges,Implant Device,4400.28,34,"Charges > $500, x 34%",4400.28,percent of total billed charges,Implant Device,4529.7,35,,4529.7,percent of total billed charges,Implant Devices,4529.7,35,,4529.7,percent of total billed charges,Implant Devices,4529.7,35,,,percent of total billed charges,Implant Devices,4529.7,35,,4529.7,percent of total billed charges,Implant Devices,4529.7,35,,4529.7,percent of total billed charges,Implant Devices,5176.8,40,,5176.8,percent of total billed charges,Implant Devices,4529.7,70,,4529.7,percent of total billed charges,Implant Devices,4400.28,34,,4400.28,percent of total billed charges,Implant Devices,4400.28,34,,4400.28,percent of total billed charges,Implant Devices,4529.7,35,,4529.7,percent of total billed charges,Implant Devices,4529.7,35,,4529.7,percent of total billed charges,Implant Devices,4529.7,35,,4529.7,percent of total billed charges,Implant Devices,4529.7,35,,4529.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4400.28,34,"If Charge > 2,000, then 34 percent",4400.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5176.8,
CAREFUSION 50-9000B PLEURX CATHETER KIT,C1729,HCPCS,,79002097,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
BDC 50-7700 PLEURX PLEURAL CATH & KIT,C1729,HCPCS,,79010534,CDM,278,RC,,,both,,,2544,1004.04,39.4668,,1004.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,864.96,34,,864.96,percent of total billed charges,Implant Device,864.96,34,,864.96,percent of total billed charges,Implant Device,864.96,34,,864.96,percent of total billed charges,Implant Device,864.96,34,,864.96,percent of total billed charges,Implant Device,864.96,34,,864.96,percent of total billed charges,Implant Device,864.96,34,,864.96,percent of total billed charges,Implant Device,890.4,35,,890.4,percent of total billed charges,Implant Device,864.96,34,"Charges > $500, x 34%",864.96,percent of total billed charges,Implant Device,890.4,35,,890.4,percent of total billed charges,Implant Devices,890.4,35,,890.4,percent of total billed charges,Implant Devices,890.4,35,,,percent of total billed charges,Implant Devices,890.4,35,,890.4,percent of total billed charges,Implant Devices,890.4,35,,890.4,percent of total billed charges,Implant Devices,1017.6,40,,1017.6,percent of total billed charges,Implant Devices,890.4,70,,890.4,percent of total billed charges,Implant Devices,864.96,34,,864.96,percent of total billed charges,Implant Devices,864.96,34,,864.96,percent of total billed charges,Implant Devices,890.4,35,,890.4,percent of total billed charges,Implant Devices,890.4,35,,890.4,percent of total billed charges,Implant Devices,890.4,35,,890.4,percent of total billed charges,Implant Devices,890.4,35,,890.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,864.96,34,"If Charge > 2,000, then 34 percent",864.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1017.6,
WRIGHT 876P0040 MINI IGNITE 2 POWER MIX,C1734,HCPCS,,79012129,CDM,278,RC,,,both,,,8001,3157.74,39.4668,,3157.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2800.35,35,,2800.35,percent of total billed charges,Implant Device,2720.34,34,"Charges > $500, x 34%",2720.34,percent of total billed charges,Implant Device,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,3200.4,40,,3200.4,percent of total billed charges,Implant Devices,2800.35,70,,2800.35,percent of total billed charges,Implant Devices,2720.34,34,,2720.34,percent of total billed charges,Implant Devices,2720.34,34,,2720.34,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2720.34,34,"If Charge > 2,000, then 34 percent",2720.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3200.4,
J&J 07.704.105S PUTTY 5CC-FAST SET,C1734,HCPCS,,79012223,CDM,278,RC,,,both,,,3769,1487.5,39.4668,,1487.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1281.46,34,,1281.46,percent of total billed charges,Implant Device,1281.46,34,,1281.46,percent of total billed charges,Implant Device,1281.46,34,,1281.46,percent of total billed charges,Implant Device,1281.46,34,,1281.46,percent of total billed charges,Implant Device,1281.46,34,,1281.46,percent of total billed charges,Implant Device,1281.46,34,,1281.46,percent of total billed charges,Implant Device,1319.15,35,,1319.15,percent of total billed charges,Implant Device,1281.46,34,"Charges > $500, x 34%",1281.46,percent of total billed charges,Implant Device,1319.15,35,,1319.15,percent of total billed charges,Implant Devices,1319.15,35,,1319.15,percent of total billed charges,Implant Devices,1319.15,35,,,percent of total billed charges,Implant Devices,1319.15,35,,1319.15,percent of total billed charges,Implant Devices,1319.15,35,,1319.15,percent of total billed charges,Implant Devices,1507.6,40,,1507.6,percent of total billed charges,Implant Devices,1319.15,70,,1319.15,percent of total billed charges,Implant Devices,1281.46,34,,1281.46,percent of total billed charges,Implant Devices,1281.46,34,,1281.46,percent of total billed charges,Implant Devices,1319.15,35,,1319.15,percent of total billed charges,Implant Devices,1319.15,35,,1319.15,percent of total billed charges,Implant Devices,1319.15,35,,1319.15,percent of total billed charges,Implant Devices,1319.15,35,,1319.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1281.46,34,"If Charge > 2,000, then 34 percent",1281.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1507.6,
J&J 07.704.110S PUTTY 10CC-FAST SET,C1734,HCPCS,,79012228,CDM,278,RC,,,both,,,6941,2739.39,39.4668,,2739.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2359.94,34,,2359.94,percent of total billed charges,Implant Device,2359.94,34,,2359.94,percent of total billed charges,Implant Device,2359.94,34,,2359.94,percent of total billed charges,Implant Device,2359.94,34,,2359.94,percent of total billed charges,Implant Device,2359.94,34,,2359.94,percent of total billed charges,Implant Device,2359.94,34,,2359.94,percent of total billed charges,Implant Device,2429.35,35,,2429.35,percent of total billed charges,Implant Device,2359.94,34,"Charges > $500, x 34%",2359.94,percent of total billed charges,Implant Device,2429.35,35,,2429.35,percent of total billed charges,Implant Devices,2429.35,35,,2429.35,percent of total billed charges,Implant Devices,2429.35,35,,,percent of total billed charges,Implant Devices,2429.35,35,,2429.35,percent of total billed charges,Implant Devices,2429.35,35,,2429.35,percent of total billed charges,Implant Devices,2776.4,40,,2776.4,percent of total billed charges,Implant Devices,2429.35,70,,2429.35,percent of total billed charges,Implant Devices,2359.94,34,,2359.94,percent of total billed charges,Implant Devices,2359.94,34,,2359.94,percent of total billed charges,Implant Devices,2429.35,35,,2429.35,percent of total billed charges,Implant Devices,2429.35,35,,2429.35,percent of total billed charges,Implant Devices,2429.35,35,,2429.35,percent of total billed charges,Implant Devices,2429.35,35,,2429.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2359.94,34,"If Charge > 2,000, then 34 percent",2359.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2776.4,
STRYKER 3102-1205 DBM PUTTY W/CHIPS 5CC,C1734,HCPCS,,79012374,CDM,278,RC,,,both,,,1864,735.66,39.4668,,735.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,652.4,35,,652.4,percent of total billed charges,Implant Device,633.76,34,"Charges > $500, x 34%",633.76,percent of total billed charges,Implant Device,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,745.6,40,,745.6,percent of total billed charges,Implant Devices,652.4,70,,652.4,percent of total billed charges,Implant Devices,633.76,34,,633.76,percent of total billed charges,Implant Devices,633.76,34,,633.76,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,745.6,
STRTKER K30001510 AUGMENT INJECT KIT 1.5,C1734,HCPCS,,79014031,CDM,278,RC,,,both,,,7669,3026.71,39.4668,,3026.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2607.46,34,,2607.46,percent of total billed charges,Implant Device,2607.46,34,,2607.46,percent of total billed charges,Implant Device,2607.46,34,,2607.46,percent of total billed charges,Implant Device,2607.46,34,,2607.46,percent of total billed charges,Implant Device,2607.46,34,,2607.46,percent of total billed charges,Implant Device,2607.46,34,,2607.46,percent of total billed charges,Implant Device,2684.15,35,,2684.15,percent of total billed charges,Implant Device,2607.46,34,"Charges > $500, x 34%",2607.46,percent of total billed charges,Implant Device,2684.15,35,,2684.15,percent of total billed charges,Implant Devices,2684.15,35,,2684.15,percent of total billed charges,Implant Devices,2684.15,35,,,percent of total billed charges,Implant Devices,2684.15,35,,2684.15,percent of total billed charges,Implant Devices,2684.15,35,,2684.15,percent of total billed charges,Implant Devices,3067.6,40,,3067.6,percent of total billed charges,Implant Devices,2684.15,70,,2684.15,percent of total billed charges,Implant Devices,2607.46,34,,2607.46,percent of total billed charges,Implant Devices,2607.46,34,,2607.46,percent of total billed charges,Implant Devices,2684.15,35,,2684.15,percent of total billed charges,Implant Devices,2684.15,35,,2684.15,percent of total billed charges,Implant Devices,2684.15,35,,2684.15,percent of total billed charges,Implant Devices,2684.15,35,,2684.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2607.46,34,"If Charge > 2,000, then 34 percent",2607.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3067.6,
ARROW CS-15272-X CATHETER NEXT STEP 27CM,C1750,HCPCS,,79000292,CDM,278,RC,,,both,,,1002,395.46,39.4668,,395.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Device,340.68,34,"Charges > $500, x 34%",340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,400.8,40,,400.8,percent of total billed charges,Implant Devices,350.7,70,,350.7,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,400.8,
ARROW CS-15192-X NEXTSTEP DIAL CATH 19CM,C1750,HCPCS,,79000432,CDM,278,RC,,,both,,,1002,395.46,39.4668,,395.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Device,340.68,34,"Charges > $500, x 34%",340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,400.8,40,,400.8,percent of total billed charges,Implant Devices,350.7,70,,350.7,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,400.8,
ARROW CS-15232-X NEXTSTEP PERMACATH 23CM,C1750,HCPCS,,79000433,CDM,278,RC,,,both,,,1002,395.46,39.4668,,395.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,340.68,34,,340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Device,340.68,34,"Charges > $500, x 34%",340.68,percent of total billed charges,Implant Device,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,400.8,40,,400.8,percent of total billed charges,Implant Devices,350.7,70,,350.7,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,340.68,34,,340.68,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,350.7,35,,350.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,400.8,
ARROW CS-15282-SPM PERMACATH 23CM,C1750,HCPCS,,79000445,CDM,278,RC,,,both,,,997,393.48,39.4668,,393.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,338.98,34,,338.98,percent of total billed charges,Implant Device,338.98,34,,338.98,percent of total billed charges,Implant Device,338.98,34,,338.98,percent of total billed charges,Implant Device,338.98,34,,338.98,percent of total billed charges,Implant Device,338.98,34,,338.98,percent of total billed charges,Implant Device,338.98,34,,338.98,percent of total billed charges,Implant Device,348.95,35,,348.95,percent of total billed charges,Implant Device,338.98,34,"Charges > $500, x 34%",338.98,percent of total billed charges,Implant Device,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,398.8,40,,398.8,percent of total billed charges,Implant Devices,348.95,70,,348.95,percent of total billed charges,Implant Devices,338.98,34,,338.98,percent of total billed charges,Implant Devices,338.98,34,,338.98,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,398.8,
ARROW CS-15282-VSP CANNON PLUS CATH 15FR,C1750,HCPCS,,79000812,CDM,278,RC,,,both,,,1078,425.45,39.4668,,425.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,366.52,34,,366.52,percent of total billed charges,Implant Device,366.52,34,,366.52,percent of total billed charges,Implant Device,366.52,34,,366.52,percent of total billed charges,Implant Device,366.52,34,,366.52,percent of total billed charges,Implant Device,366.52,34,,366.52,percent of total billed charges,Implant Device,366.52,34,,366.52,percent of total billed charges,Implant Device,377.3,35,,377.3,percent of total billed charges,Implant Device,366.52,34,"Charges > $500, x 34%",366.52,percent of total billed charges,Implant Device,377.3,35,,377.3,percent of total billed charges,Implant Devices,377.3,35,,377.3,percent of total billed charges,Implant Devices,377.3,35,,,percent of total billed charges,Implant Devices,377.3,35,,377.3,percent of total billed charges,Implant Devices,377.3,35,,377.3,percent of total billed charges,Implant Devices,431.2,40,,431.2,percent of total billed charges,Implant Devices,377.3,70,,377.3,percent of total billed charges,Implant Devices,366.52,34,,366.52,percent of total billed charges,Implant Devices,366.52,34,,366.52,percent of total billed charges,Implant Devices,377.3,35,,377.3,percent of total billed charges,Implant Devices,377.3,35,,377.3,percent of total billed charges,Implant Devices,377.3,35,,377.3,percent of total billed charges,Implant Devices,377.3,35,,377.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,431.2,
ARROW CS-15272-X CATHETER NEXT STEP 27CM,C1750,HCPCS,,79000824,CDM,278,RC,,,both,,,902,355.99,39.4668,,355.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306.68,34,,306.68,percent of total billed charges,Implant Device,306.68,34,,306.68,percent of total billed charges,Implant Device,306.68,34,,306.68,percent of total billed charges,Implant Device,306.68,34,,306.68,percent of total billed charges,Implant Device,306.68,34,,306.68,percent of total billed charges,Implant Device,306.68,34,,306.68,percent of total billed charges,Implant Device,315.7,35,,315.7,percent of total billed charges,Implant Device,306.68,34,"Charges > $500, x 34%",306.68,percent of total billed charges,Implant Device,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,360.8,40,,360.8,percent of total billed charges,Implant Devices,315.7,70,,315.7,percent of total billed charges,Implant Devices,306.68,34,,306.68,percent of total billed charges,Implant Devices,306.68,34,,306.68,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.8,
HEMOSPHERE HERO 1002 ARTERIAL GRAFT COMP,C1750,HCPCS,,79001194,CDM,278,RC,,,both,,,2746,1083.76,39.4668,,1083.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,933.64,34,,933.64,percent of total billed charges,Implant Device,933.64,34,,933.64,percent of total billed charges,Implant Device,933.64,34,,933.64,percent of total billed charges,Implant Device,933.64,34,,933.64,percent of total billed charges,Implant Device,933.64,34,,933.64,percent of total billed charges,Implant Device,933.64,34,,933.64,percent of total billed charges,Implant Device,961.1,35,,961.1,percent of total billed charges,Implant Device,933.64,34,"Charges > $500, x 34%",933.64,percent of total billed charges,Implant Device,961.1,35,,961.1,percent of total billed charges,Implant Devices,961.1,35,,961.1,percent of total billed charges,Implant Devices,961.1,35,,,percent of total billed charges,Implant Devices,961.1,35,,961.1,percent of total billed charges,Implant Devices,961.1,35,,961.1,percent of total billed charges,Implant Devices,1098.4,40,,1098.4,percent of total billed charges,Implant Devices,961.1,70,,961.1,percent of total billed charges,Implant Devices,933.64,34,,933.64,percent of total billed charges,Implant Devices,933.64,34,,933.64,percent of total billed charges,Implant Devices,961.1,35,,961.1,percent of total billed charges,Implant Devices,961.1,35,,961.1,percent of total billed charges,Implant Devices,961.1,35,,961.1,percent of total billed charges,Implant Devices,961.1,35,,961.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,933.64,34,"If Charge > 2,000, then 34 percent",933.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1098.4,
ARROW CSD-15282-SP SPLIT CATH 15FRX11,C1750,HCPCS,,79001195,CDM,278,RC,,,both,,,796,314.16,39.4668,,314.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,270.64,34,,270.64,percent of total billed charges,Implant Device,270.64,34,,270.64,percent of total billed charges,Implant Device,270.64,34,,270.64,percent of total billed charges,Implant Device,270.64,34,,270.64,percent of total billed charges,Implant Device,270.64,34,,270.64,percent of total billed charges,Implant Device,270.64,34,,270.64,percent of total billed charges,Implant Device,278.6,35,,278.6,percent of total billed charges,Implant Device,270.64,34,"Charges > $500, x 34%",270.64,percent of total billed charges,Implant Device,278.6,35,,278.6,percent of total billed charges,Implant Devices,278.6,35,,278.6,percent of total billed charges,Implant Devices,278.6,35,,,percent of total billed charges,Implant Devices,278.6,35,,278.6,percent of total billed charges,Implant Devices,278.6,35,,278.6,percent of total billed charges,Implant Devices,318.4,40,,318.4,percent of total billed charges,Implant Devices,278.6,70,,278.6,percent of total billed charges,Implant Devices,270.64,34,,270.64,percent of total billed charges,Implant Devices,270.64,34,,270.64,percent of total billed charges,Implant Devices,278.6,35,,278.6,percent of total billed charges,Implant Devices,278.6,35,,278.6,percent of total billed charges,Implant Devices,278.6,35,,278.6,percent of total billed charges,Implant Devices,278.6,35,,278.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,318.4,
ARROW CSD-15242-SP SPLIT CATH 15FRX9.5,C1750,HCPCS,,79001196,CDM,278,RC,,,both,,,750,296,39.4668,,296,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,255,34,,255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Device,255,34,"Charges > $500, x 34%",255,percent of total billed charges,Implant Device,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,300,40,,300,percent of total billed charges,Implant Devices,262.5,70,,262.5,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,255,34,,255,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,262.5,35,,262.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,300,
ARROW CS-15282-SPM PERMACATH 23CM,C1750,HCPCS,,79001645,CDM,278,RC,,,both,,,1177,464.52,39.4668,,464.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,400.18,34,,400.18,percent of total billed charges,Implant Device,400.18,34,,400.18,percent of total billed charges,Implant Device,400.18,34,,400.18,percent of total billed charges,Implant Device,400.18,34,,400.18,percent of total billed charges,Implant Device,400.18,34,,400.18,percent of total billed charges,Implant Device,400.18,34,,400.18,percent of total billed charges,Implant Device,411.95,35,,411.95,percent of total billed charges,Implant Device,400.18,34,"Charges > $500, x 34%",400.18,percent of total billed charges,Implant Device,411.95,35,,411.95,percent of total billed charges,Implant Devices,411.95,35,,411.95,percent of total billed charges,Implant Devices,411.95,35,,,percent of total billed charges,Implant Devices,411.95,35,,411.95,percent of total billed charges,Implant Devices,411.95,35,,411.95,percent of total billed charges,Implant Devices,470.8,40,,470.8,percent of total billed charges,Implant Devices,411.95,70,,411.95,percent of total billed charges,Implant Devices,400.18,34,,400.18,percent of total billed charges,Implant Devices,400.18,34,,400.18,percent of total billed charges,Implant Devices,411.95,35,,411.95,percent of total billed charges,Implant Devices,411.95,35,,411.95,percent of total billed charges,Implant Devices,411.95,35,,411.95,percent of total billed charges,Implant Devices,411.95,35,,411.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,470.8,
ARROW CS-15232-X PERMACATH NEXTSTEP 23CM,C1750,HCPCS,,79001646,CDM,278,RC,,,both,,,902,355.99,39.4668,,355.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306.68,34,,306.68,percent of total billed charges,Implant Device,306.68,34,,306.68,percent of total billed charges,Implant Device,306.68,34,,306.68,percent of total billed charges,Implant Device,306.68,34,,306.68,percent of total billed charges,Implant Device,306.68,34,,306.68,percent of total billed charges,Implant Device,306.68,34,,306.68,percent of total billed charges,Implant Device,315.7,35,,315.7,percent of total billed charges,Implant Device,306.68,34,"Charges > $500, x 34%",306.68,percent of total billed charges,Implant Device,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,360.8,40,,360.8,percent of total billed charges,Implant Devices,315.7,70,,315.7,percent of total billed charges,Implant Devices,306.68,34,,306.68,percent of total billed charges,Implant Devices,306.68,34,,306.68,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,315.7,35,,315.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360.8,
ARROW CS-15312-X NEXTSTEP CATHETER 31CM,C1750,HCPCS,,79006697,CDM,278,RC,,,both,,,903,356.39,39.4668,,356.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,307.02,34,,307.02,percent of total billed charges,Implant Device,307.02,34,,307.02,percent of total billed charges,Implant Device,307.02,34,,307.02,percent of total billed charges,Implant Device,307.02,34,,307.02,percent of total billed charges,Implant Device,307.02,34,,307.02,percent of total billed charges,Implant Device,307.02,34,,307.02,percent of total billed charges,Implant Device,316.05,35,,316.05,percent of total billed charges,Implant Device,307.02,34,"Charges > $500, x 34%",307.02,percent of total billed charges,Implant Device,316.05,35,,316.05,percent of total billed charges,Implant Devices,316.05,35,,316.05,percent of total billed charges,Implant Devices,316.05,35,,,percent of total billed charges,Implant Devices,316.05,35,,316.05,percent of total billed charges,Implant Devices,316.05,35,,316.05,percent of total billed charges,Implant Devices,361.2,40,,361.2,percent of total billed charges,Implant Devices,316.05,70,,316.05,percent of total billed charges,Implant Devices,307.02,34,,307.02,percent of total billed charges,Implant Devices,307.02,34,,307.02,percent of total billed charges,Implant Devices,316.05,35,,316.05,percent of total billed charges,Implant Devices,316.05,35,,316.05,percent of total billed charges,Implant Devices,316.05,35,,316.05,percent of total billed charges,Implant Devices,316.05,35,,316.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,361.2,
ARROW CS-15192-SFX NEXT STEP CATH 19CM,C1750,HCPCS,,79007165,CDM,278,RC,,,both,,,946,373.36,39.4668,,373.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Device,321.64,34,"Charges > $500, x 34%",321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,378.4,40,,378.4,percent of total billed charges,Implant Devices,331.1,70,,331.1,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.4,
ARROW CS-15232-SFX NEXT STEP CATH 23CM,C1750,HCPCS,,79007166,CDM,278,RC,,,both,,,946,373.36,39.4668,,373.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Device,321.64,34,"Charges > $500, x 34%",321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,378.4,40,,378.4,percent of total billed charges,Implant Devices,331.1,70,,331.1,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.4,
ARROW CS-15272-SFX NEXT STEP CATH 27CM,C1750,HCPCS,,79007167,CDM,278,RC,,,both,,,946,373.36,39.4668,,373.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,321.64,34,,321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Device,321.64,34,"Charges > $500, x 34%",321.64,percent of total billed charges,Implant Device,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,378.4,40,,378.4,percent of total billed charges,Implant Devices,331.1,70,,331.1,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,321.64,34,,321.64,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,331.1,35,,331.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,378.4,
ARROW ACS-15192-VF VECTORFLOW 19CM CATH,C1750,HCPCS,,79007376,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ARROW ACS-15232-VF VECTORFLOW 23CM CATH,C1750,HCPCS,,79007377,CDM,278,RC,,,both,,,932,367.83,39.4668,,367.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,326.2,35,,326.2,percent of total billed charges,Implant Device,316.88,34,"Charges > $500, x 34%",316.88,percent of total billed charges,Implant Device,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,372.8,40,,372.8,percent of total billed charges,Implant Devices,326.2,70,,326.2,percent of total billed charges,Implant Devices,316.88,34,,316.88,percent of total billed charges,Implant Devices,316.88,34,,316.88,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,372.8,
ARROW ACS-15272-VF VECTORFLOW 27CM CATH,C1750,HCPCS,,79007378,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ARROW ACS-15312-VF VECTORFLOW 31CM CATH,C1750,HCPCS,,79007379,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ARROW ACS-15422-VF VECTORFLOW 42CM CATH,C1750,HCPCS,,79007380,CDM,278,RC,,,both,,,932,367.83,39.4668,,367.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,326.2,35,,326.2,percent of total billed charges,Implant Device,316.88,34,"Charges > $500, x 34%",316.88,percent of total billed charges,Implant Device,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,372.8,40,,372.8,percent of total billed charges,Implant Devices,326.2,70,,326.2,percent of total billed charges,Implant Devices,316.88,34,,316.88,percent of total billed charges,Implant Devices,316.88,34,,316.88,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,372.8,
ARROW ACS-15552-VF VECTORFLOW 55CM CATH,C1750,HCPCS,,79007381,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ARROW ACS-15192-VFI VECTORFLOW 19CM CATH,C1750,HCPCS,,79007382,CDM,278,RC,,,both,,,932,367.83,39.4668,,367.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,316.88,34,,316.88,percent of total billed charges,Implant Device,326.2,35,,326.2,percent of total billed charges,Implant Device,316.88,34,"Charges > $500, x 34%",316.88,percent of total billed charges,Implant Device,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,372.8,40,,372.8,percent of total billed charges,Implant Devices,326.2,70,,326.2,percent of total billed charges,Implant Devices,316.88,34,,316.88,percent of total billed charges,Implant Devices,316.88,34,,316.88,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,326.2,35,,326.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,372.8,
ARROW ACS-15232-VFI VECTORFLOW 23CM CATH,C1750,HCPCS,,79007383,CDM,278,RC,,,both,,,798,314.95,39.4668,,314.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,271.32,34,,271.32,percent of total billed charges,Implant Device,271.32,34,,271.32,percent of total billed charges,Implant Device,271.32,34,,271.32,percent of total billed charges,Implant Device,271.32,34,,271.32,percent of total billed charges,Implant Device,271.32,34,,271.32,percent of total billed charges,Implant Device,271.32,34,,271.32,percent of total billed charges,Implant Device,279.3,35,,279.3,percent of total billed charges,Implant Device,271.32,34,"Charges > $500, x 34%",271.32,percent of total billed charges,Implant Device,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,319.2,40,,319.2,percent of total billed charges,Implant Devices,279.3,70,,279.3,percent of total billed charges,Implant Devices,271.32,34,,271.32,percent of total billed charges,Implant Devices,271.32,34,,271.32,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,279.3,35,,279.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,319.2,
ARROW ACS-15272-VFI VECTORFLOW 27CM CATH,C1750,HCPCS,,79007384,CDM,278,RC,,,both,,,858,338.63,39.4668,,338.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,291.72,34,,291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Device,291.72,34,"Charges > $500, x 34%",291.72,percent of total billed charges,Implant Device,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,343.2,40,,343.2,percent of total billed charges,Implant Devices,300.3,70,,300.3,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,291.72,34,,291.72,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,300.3,35,,300.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,343.2,
ARROW CS-15312-VF VECTORFLOW 31CM CATH,C1750,HCPCS,,79007929,CDM,278,RC,,,both,,,995,392.69,39.4668,,392.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,338.3,34,,338.3,percent of total billed charges,Implant Device,338.3,34,,338.3,percent of total billed charges,Implant Device,338.3,34,,338.3,percent of total billed charges,Implant Device,338.3,34,,338.3,percent of total billed charges,Implant Device,338.3,34,,338.3,percent of total billed charges,Implant Device,338.3,34,,338.3,percent of total billed charges,Implant Device,348.25,35,,348.25,percent of total billed charges,Implant Device,338.3,34,"Charges > $500, x 34%",338.3,percent of total billed charges,Implant Device,348.25,35,,348.25,percent of total billed charges,Implant Devices,348.25,35,,348.25,percent of total billed charges,Implant Devices,348.25,35,,,percent of total billed charges,Implant Devices,348.25,35,,348.25,percent of total billed charges,Implant Devices,348.25,35,,348.25,percent of total billed charges,Implant Devices,398,40,,398,percent of total billed charges,Implant Devices,348.25,70,,348.25,percent of total billed charges,Implant Devices,338.3,34,,338.3,percent of total billed charges,Implant Devices,338.3,34,,338.3,percent of total billed charges,Implant Devices,348.25,35,,348.25,percent of total billed charges,Implant Devices,348.25,35,,348.25,percent of total billed charges,Implant Devices,348.25,35,,348.25,percent of total billed charges,Implant Devices,348.25,35,,348.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,398,
ARROW CS-15552-VF VECTORFLOW 55CM CATH,C1750,HCPCS,,79007930,CDM,278,RC,,,both,,,994,392.3,39.4668,,392.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,337.96,34,,337.96,percent of total billed charges,Implant Device,337.96,34,,337.96,percent of total billed charges,Implant Device,337.96,34,,337.96,percent of total billed charges,Implant Device,337.96,34,,337.96,percent of total billed charges,Implant Device,337.96,34,,337.96,percent of total billed charges,Implant Device,337.96,34,,337.96,percent of total billed charges,Implant Device,347.9,35,,347.9,percent of total billed charges,Implant Device,337.96,34,"Charges > $500, x 34%",337.96,percent of total billed charges,Implant Device,347.9,35,,347.9,percent of total billed charges,Implant Devices,347.9,35,,347.9,percent of total billed charges,Implant Devices,347.9,35,,,percent of total billed charges,Implant Devices,347.9,35,,347.9,percent of total billed charges,Implant Devices,347.9,35,,347.9,percent of total billed charges,Implant Devices,397.6,40,,397.6,percent of total billed charges,Implant Devices,347.9,70,,347.9,percent of total billed charges,Implant Devices,337.96,34,,337.96,percent of total billed charges,Implant Devices,337.96,34,,337.96,percent of total billed charges,Implant Devices,347.9,35,,347.9,percent of total billed charges,Implant Devices,347.9,35,,347.9,percent of total billed charges,Implant Devices,347.9,35,,347.9,percent of total billed charges,Implant Devices,347.9,35,,347.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,397.6,
ARROW CS-15232-VFM RETRO 19CM PERMACATH,C1750,HCPCS,,79009205,CDM,278,RC,,,both,,,1085,428.21,39.4668,,428.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,368.9,34,,368.9,percent of total billed charges,Implant Device,368.9,34,,368.9,percent of total billed charges,Implant Device,368.9,34,,368.9,percent of total billed charges,Implant Device,368.9,34,,368.9,percent of total billed charges,Implant Device,368.9,34,,368.9,percent of total billed charges,Implant Device,368.9,34,,368.9,percent of total billed charges,Implant Device,379.75,35,,379.75,percent of total billed charges,Implant Device,368.9,34,"Charges > $500, x 34%",368.9,percent of total billed charges,Implant Device,379.75,35,,379.75,percent of total billed charges,Implant Devices,379.75,35,,379.75,percent of total billed charges,Implant Devices,379.75,35,,,percent of total billed charges,Implant Devices,379.75,35,,379.75,percent of total billed charges,Implant Devices,379.75,35,,379.75,percent of total billed charges,Implant Devices,434,40,,434,percent of total billed charges,Implant Devices,379.75,70,,379.75,percent of total billed charges,Implant Devices,368.9,34,,368.9,percent of total billed charges,Implant Devices,368.9,34,,368.9,percent of total billed charges,Implant Devices,379.75,35,,379.75,percent of total billed charges,Implant Devices,379.75,35,,379.75,percent of total billed charges,Implant Devices,379.75,35,,379.75,percent of total billed charges,Implant Devices,379.75,35,,379.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,434,
ANGIODYNAMICS H965103038181 DURAMAX 19CM,C1750,HCPCS,,79009270,CDM,278,RC,,,both,,,834,329.15,39.4668,,329.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,291.9,35,,291.9,percent of total billed charges,Implant Device,283.56,34,"Charges > $500, x 34%",283.56,percent of total billed charges,Implant Device,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,333.6,40,,333.6,percent of total billed charges,Implant Devices,291.9,70,,291.9,percent of total billed charges,Implant Devices,283.56,34,,283.56,percent of total billed charges,Implant Devices,283.56,34,,283.56,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,333.6,
ANGIODYNAMICS H965103038191 DURAMAX 23CM,C1750,HCPCS,,79009271,CDM,278,RC,,,both,,,834,329.15,39.4668,,329.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,291.9,35,,291.9,percent of total billed charges,Implant Device,283.56,34,"Charges > $500, x 34%",283.56,percent of total billed charges,Implant Device,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,333.6,40,,333.6,percent of total billed charges,Implant Devices,291.9,70,,291.9,percent of total billed charges,Implant Devices,283.56,34,,283.56,percent of total billed charges,Implant Devices,283.56,34,,283.56,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,333.6,
ANGIODYNAMICS H965103038201 DURAMAX 27CM,C1750,HCPCS,,79009272,CDM,278,RC,,,both,,,834,329.15,39.4668,,329.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,283.56,34,,283.56,percent of total billed charges,Implant Device,291.9,35,,291.9,percent of total billed charges,Implant Device,283.56,34,"Charges > $500, x 34%",283.56,percent of total billed charges,Implant Device,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,333.6,40,,333.6,percent of total billed charges,Implant Devices,291.9,70,,291.9,percent of total billed charges,Implant Devices,283.56,34,,283.56,percent of total billed charges,Implant Devices,283.56,34,,283.56,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,291.9,35,,291.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,333.6,
ANGIODYNAMICS H787103028185 DURAMAX 19CM,C1750,HCPCS,,79009273,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
ANGIODYNAMICS H787103028195 DURAMAX 23CM,C1750,HCPCS,,79009274,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
ANGIODYNAMICS H787103028205 DURAMAX 27CM,C1750,HCPCS,,79009275,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
MEDLINE SWD890003 PED CATH 2 CUFF 37CM,C1750,HCPCS,,79012861,CDM,278,RC,,,both,,,138,54.46,39.4668,,54.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,55.2,40,,55.2,percent of total billed charges,Implant Devices,48.3,70,,48.3,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.2,
COVIDIEN 8810890003 PED CATH 2 CUFF 37CM,C1750,HCPCS,,79012862,CDM,278,RC,,,both,,,138,54.46,39.4668,,54.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,46.92,34,,46.92,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,55.2,40,,55.2,percent of total billed charges,Implant Devices,48.3,70,,48.3,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,46.92,34,,46.92,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,48.3,35,,48.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,55.2,
BARD 600620 12FR HICKMAN DUAL CV CATH,C1751,HCPCS,,79000069,CDM,278,RC,,,both,,,833,328.76,39.4668,,328.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,291.55,35,,291.55,percent of total billed charges,Implant Device,283.22,34,"Charges > $500, x 34%",283.22,percent of total billed charges,Implant Device,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,333.2,40,,333.2,percent of total billed charges,Implant Devices,291.55,70,,291.55,percent of total billed charges,Implant Devices,283.22,34,,283.22,percent of total billed charges,Implant Devices,283.22,34,,283.22,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,333.2,
NAVILYST 45-714 INJECTABLE PICC LINE 4FR,C1751,HCPCS,,79000107,CDM,278,RC,,,both,,,415,163.79,39.4668,,163.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,141.1,34,,141.1,percent of total billed charges,Implant Device,141.1,34,,141.1,percent of total billed charges,Implant Device,141.1,34,,141.1,percent of total billed charges,Implant Device,141.1,34,,141.1,percent of total billed charges,Implant Device,141.1,34,,141.1,percent of total billed charges,Implant Device,141.1,34,,141.1,percent of total billed charges,Implant Device,145.25,35,,145.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,145.25,35,,145.25,percent of total billed charges,Implant Devices,145.25,35,,145.25,percent of total billed charges,Implant Devices,145.25,35,,,percent of total billed charges,Implant Devices,145.25,35,,145.25,percent of total billed charges,Implant Devices,145.25,35,,145.25,percent of total billed charges,Implant Devices,166,40,,166,percent of total billed charges,Implant Devices,145.25,70,,145.25,percent of total billed charges,Implant Devices,141.1,34,,141.1,percent of total billed charges,Implant Devices,141.1,34,,141.1,percent of total billed charges,Implant Devices,145.25,35,,145.25,percent of total billed charges,Implant Devices,145.25,35,,145.25,percent of total billed charges,Implant Devices,145.25,35,,145.25,percent of total billed charges,Implant Devices,145.25,35,,145.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,166,
NAVILYST 45-7140 XCELA POWER PICC 4FR,C1751,HCPCS,,79000108,CDM,278,RC,,,both,,,400,157.87,39.4668,,157.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,136,34,,136,percent of total billed charges,Implant Device,136,34,,136,percent of total billed charges,Implant Device,136,34,,136,percent of total billed charges,Implant Device,136,34,,136,percent of total billed charges,Implant Device,136,34,,136,percent of total billed charges,Implant Device,136,34,,136,percent of total billed charges,Implant Device,140,35,,140,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,140,35,,140,percent of total billed charges,Implant Devices,140,35,,140,percent of total billed charges,Implant Devices,140,35,,,percent of total billed charges,Implant Devices,140,35,,140,percent of total billed charges,Implant Devices,140,35,,140,percent of total billed charges,Implant Devices,160,40,,160,percent of total billed charges,Implant Devices,140,70,,140,percent of total billed charges,Implant Devices,136,34,,136,percent of total billed charges,Implant Devices,136,34,,136,percent of total billed charges,Implant Devices,140,35,,140,percent of total billed charges,Implant Devices,140,35,,140,percent of total billed charges,Implant Devices,140,35,,140,percent of total billed charges,Implant Devices,140,35,,140,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,160,
NAVILYST 45-734 INJECTABLE PICC LINE 5FR,C1751,HCPCS,,79000129,CDM,278,RC,,,both,,,457,180.36,39.4668,,180.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.38,34,,155.38,percent of total billed charges,Implant Device,155.38,34,,155.38,percent of total billed charges,Implant Device,155.38,34,,155.38,percent of total billed charges,Implant Device,155.38,34,,155.38,percent of total billed charges,Implant Device,155.38,34,,155.38,percent of total billed charges,Implant Device,155.38,34,,155.38,percent of total billed charges,Implant Device,159.95,35,,159.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,182.8,40,,182.8,percent of total billed charges,Implant Devices,159.95,70,,159.95,percent of total billed charges,Implant Devices,155.38,34,,155.38,percent of total billed charges,Implant Devices,155.38,34,,155.38,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182.8,
NAVILYST 45-7340 XCELA POWER PICC 5FR,C1751,HCPCS,,79000130,CDM,278,RC,,,both,,,439,173.26,39.4668,,173.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.26,34,,149.26,percent of total billed charges,Implant Device,149.26,34,,149.26,percent of total billed charges,Implant Device,149.26,34,,149.26,percent of total billed charges,Implant Device,149.26,34,,149.26,percent of total billed charges,Implant Device,149.26,34,,149.26,percent of total billed charges,Implant Device,149.26,34,,149.26,percent of total billed charges,Implant Device,153.65,35,,153.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,175.6,40,,175.6,percent of total billed charges,Implant Devices,153.65,70,,153.65,percent of total billed charges,Implant Devices,149.26,34,,149.26,percent of total billed charges,Implant Devices,149.26,34,,149.26,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,153.65,35,,153.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,175.6,
STRYKER 45-595 5FR PICC LINE CLAMPABLE,C1751,HCPCS,,79000133,CDM,278,RC,,,both,,,290,114.45,39.4668,,114.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,98.6,34,,98.6,percent of total billed charges,Implant Device,101.5,35,,101.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,116,40,,116,percent of total billed charges,Implant Devices,101.5,70,,101.5,percent of total billed charges,Implant Devices,98.6,34,,98.6,percent of total billed charges,Implant Devices,98.6,34,,98.6,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,101.5,35,,101.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,116,
NAVILYST 45-598 5FR PICC LINE CATHETER,C1751,HCPCS,,79000134,CDM,278,RC,,,both,,,365,144.05,39.4668,,144.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,124.1,34,,124.1,percent of total billed charges,Implant Device,124.1,34,,124.1,percent of total billed charges,Implant Device,124.1,34,,124.1,percent of total billed charges,Implant Device,124.1,34,,124.1,percent of total billed charges,Implant Device,124.1,34,,124.1,percent of total billed charges,Implant Device,124.1,34,,124.1,percent of total billed charges,Implant Device,127.75,35,,127.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,146,40,,146,percent of total billed charges,Implant Devices,127.75,70,,127.75,percent of total billed charges,Implant Devices,124.1,34,,124.1,percent of total billed charges,Implant Devices,124.1,34,,124.1,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,127.75,35,,127.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,146,
BARD 600604 9FR HICKMAN CATHETER,C1751,HCPCS,,79000252,CDM,278,RC,,,both,,,1297,511.88,39.4668,,511.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,453.95,35,,453.95,percent of total billed charges,Implant Device,440.98,34,"Charges > $500, x 34%",440.98,percent of total billed charges,Implant Device,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,518.8,40,,518.8,percent of total billed charges,Implant Devices,453.95,70,,453.95,percent of total billed charges,Implant Devices,440.98,34,,440.98,percent of total billed charges,Implant Devices,440.98,34,,440.98,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,518.8,
BOST SCI 550304 FASTTRACKER 325 INF CATH,C1751,HCPCS,,79000357,CDM,278,RC,,,both,,,1390,548.59,39.4668,,548.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.6,34,,472.6,percent of total billed charges,Implant Device,472.6,34,,472.6,percent of total billed charges,Implant Device,472.6,34,,472.6,percent of total billed charges,Implant Device,472.6,34,,472.6,percent of total billed charges,Implant Device,472.6,34,,472.6,percent of total billed charges,Implant Device,472.6,34,,472.6,percent of total billed charges,Implant Device,486.5,35,,486.5,percent of total billed charges,Implant Device,472.6,34,"Charges > $500, x 34%",472.6,percent of total billed charges,Implant Device,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,556,40,,556,percent of total billed charges,Implant Devices,486.5,70,,486.5,percent of total billed charges,Implant Devices,472.6,34,,472.6,percent of total billed charges,Implant Devices,472.6,34,,472.6,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,486.5,35,,486.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556,
NAVILYST 45-594 PICC VAXCEL MST KIT 4FR,C1751,HCPCS,,79000446,CDM,278,RC,,,both,,,384,151.55,39.4668,,151.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,134.4,35,,134.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,153.6,40,,153.6,percent of total billed charges,Implant Devices,134.4,70,,134.4,percent of total billed charges,Implant Devices,130.56,34,,130.56,percent of total billed charges,Implant Devices,130.56,34,,130.56,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,153.6,
BARD 600620 CATH BOVIAC HICKMAN 12FR,C1751,HCPCS,,79000594,CDM,278,RC,,,both,,,644,254.17,39.4668,,254.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,218.96,34,,218.96,percent of total billed charges,Implant Device,218.96,34,,218.96,percent of total billed charges,Implant Device,218.96,34,,218.96,percent of total billed charges,Implant Device,218.96,34,,218.96,percent of total billed charges,Implant Device,218.96,34,,218.96,percent of total billed charges,Implant Device,218.96,34,,218.96,percent of total billed charges,Implant Device,225.4,35,,225.4,percent of total billed charges,Implant Device,218.96,34,"Charges > $500, x 34%",218.96,percent of total billed charges,Implant Device,225.4,35,,225.4,percent of total billed charges,Implant Devices,225.4,35,,225.4,percent of total billed charges,Implant Devices,225.4,35,,,percent of total billed charges,Implant Devices,225.4,35,,225.4,percent of total billed charges,Implant Devices,225.4,35,,225.4,percent of total billed charges,Implant Devices,257.6,40,,257.6,percent of total billed charges,Implant Devices,225.4,70,,225.4,percent of total billed charges,Implant Devices,218.96,34,,218.96,percent of total billed charges,Implant Devices,218.96,34,,218.96,percent of total billed charges,Implant Devices,225.4,35,,225.4,percent of total billed charges,Implant Devices,225.4,35,,225.4,percent of total billed charges,Implant Devices,225.4,35,,225.4,percent of total billed charges,Implant Devices,225.4,35,,225.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,257.6,
ARROW AK15703SP CATH TRIPLE LUMEN 20CM,C1751,HCPCS,,79000644,CDM,278,RC,,,both,,,103,40.65,39.4668,,40.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,35.02,34,,35.02,percent of total billed charges,Implant Device,36.05,35,,36.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,41.2,40,,41.2,percent of total billed charges,Implant Devices,36.05,70,,36.05,percent of total billed charges,Implant Devices,35.02,34,,35.02,percent of total billed charges,Implant Devices,35.02,34,,35.02,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,36.05,35,,36.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,41.2,
BARD 600604 HICKMAN CATHETER,C1751,HCPCS,,79000935,CDM,278,RC,,,both,,,833,328.76,39.4668,,328.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,291.55,35,,291.55,percent of total billed charges,Implant Device,283.22,34,"Charges > $500, x 34%",283.22,percent of total billed charges,Implant Device,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,333.2,40,,333.2,percent of total billed charges,Implant Devices,291.55,70,,291.55,percent of total billed charges,Implant Devices,283.22,34,,283.22,percent of total billed charges,Implant Devices,283.22,34,,283.22,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,333.2,
BARD 600574 HICKMAN CATHETER 7FR,C1751,HCPCS,,79000936,CDM,278,RC,,,both,,,833,328.76,39.4668,,328.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,283.22,34,,283.22,percent of total billed charges,Implant Device,291.55,35,,291.55,percent of total billed charges,Implant Device,283.22,34,"Charges > $500, x 34%",283.22,percent of total billed charges,Implant Device,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,333.2,40,,333.2,percent of total billed charges,Implant Devices,291.55,70,,291.55,percent of total billed charges,Implant Devices,283.22,34,,283.22,percent of total billed charges,Implant Devices,283.22,34,,283.22,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,291.55,35,,291.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,333.2,
BARD 600654 HICKMAN CATH 12.5FR,C1751,HCPCS,,79000937,CDM,278,RC,,,both,,,878,346.52,39.4668,,346.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,298.52,34,,298.52,percent of total billed charges,Implant Device,298.52,34,,298.52,percent of total billed charges,Implant Device,298.52,34,,298.52,percent of total billed charges,Implant Device,298.52,34,,298.52,percent of total billed charges,Implant Device,298.52,34,,298.52,percent of total billed charges,Implant Device,298.52,34,,298.52,percent of total billed charges,Implant Device,307.3,35,,307.3,percent of total billed charges,Implant Device,298.52,34,"Charges > $500, x 34%",298.52,percent of total billed charges,Implant Device,307.3,35,,307.3,percent of total billed charges,Implant Devices,307.3,35,,307.3,percent of total billed charges,Implant Devices,307.3,35,,,percent of total billed charges,Implant Devices,307.3,35,,307.3,percent of total billed charges,Implant Devices,307.3,35,,307.3,percent of total billed charges,Implant Devices,351.2,40,,351.2,percent of total billed charges,Implant Devices,307.3,70,,307.3,percent of total billed charges,Implant Devices,298.52,34,,298.52,percent of total billed charges,Implant Devices,298.52,34,,298.52,percent of total billed charges,Implant Devices,307.3,35,,307.3,percent of total billed charges,Implant Devices,307.3,35,,307.3,percent of total billed charges,Implant Devices,307.3,35,,307.3,percent of total billed charges,Implant Devices,307.3,35,,307.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,351.2,
NAVILYST 165451020 INFUSAPORT KIT 8FR,C1751,HCPCS,,79004017,CDM,278,RC,,,both,,,898,354.41,39.4668,,354.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,305.32,34,,305.32,percent of total billed charges,Implant Device,305.32,34,,305.32,percent of total billed charges,Implant Device,305.32,34,,305.32,percent of total billed charges,Implant Device,305.32,34,,305.32,percent of total billed charges,Implant Device,305.32,34,,305.32,percent of total billed charges,Implant Device,305.32,34,,305.32,percent of total billed charges,Implant Device,314.3,35,,314.3,percent of total billed charges,Implant Device,305.32,34,"Charges > $500, x 34%",305.32,percent of total billed charges,Implant Device,314.3,35,,314.3,percent of total billed charges,Implant Devices,314.3,35,,314.3,percent of total billed charges,Implant Devices,314.3,35,,,percent of total billed charges,Implant Devices,314.3,35,,314.3,percent of total billed charges,Implant Devices,314.3,35,,314.3,percent of total billed charges,Implant Devices,359.2,40,,359.2,percent of total billed charges,Implant Devices,314.3,70,,314.3,percent of total billed charges,Implant Devices,305.32,34,,305.32,percent of total billed charges,Implant Devices,305.32,34,,305.32,percent of total billed charges,Implant Devices,314.3,35,,314.3,percent of total billed charges,Implant Devices,314.3,35,,314.3,percent of total billed charges,Implant Devices,314.3,35,,314.3,percent of total billed charges,Implant Devices,314.3,35,,314.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,359.2,
MTI 41047-01RR INFUSION CATH 5FRX65CM,C1751,HCPCS,,79005673,CDM,278,RC,,,both,,,156,61.57,39.4668,,61.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,53.04,34,,53.04,percent of total billed charges,Implant Device,53.04,34,,53.04,percent of total billed charges,Implant Device,53.04,34,,53.04,percent of total billed charges,Implant Device,53.04,34,,53.04,percent of total billed charges,Implant Device,53.04,34,,53.04,percent of total billed charges,Implant Device,53.04,34,,53.04,percent of total billed charges,Implant Device,54.6,35,,54.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,54.6,35,,54.6,percent of total billed charges,Implant Devices,54.6,35,,54.6,percent of total billed charges,Implant Devices,54.6,35,,,percent of total billed charges,Implant Devices,54.6,35,,54.6,percent of total billed charges,Implant Devices,54.6,35,,54.6,percent of total billed charges,Implant Devices,62.4,40,,62.4,percent of total billed charges,Implant Devices,54.6,70,,54.6,percent of total billed charges,Implant Devices,53.04,34,,53.04,percent of total billed charges,Implant Devices,53.04,34,,53.04,percent of total billed charges,Implant Devices,54.6,35,,54.6,percent of total billed charges,Implant Devices,54.6,35,,54.6,percent of total billed charges,Implant Devices,54.6,35,,54.6,percent of total billed charges,Implant Devices,54.6,35,,54.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,62.4,
ANGIODYNAMICS H965460120 4FR MIDLNE CATH,C1751,HCPCS,,79008908,CDM,278,RC,,,both,,,375,148,39.4668,,148,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,127.5,34,,127.5,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,150,40,,150,percent of total billed charges,Implant Devices,131.25,70,,131.25,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,127.5,34,,127.5,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,131.25,35,,131.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150,
ANGIODYNAMICS H965460161 4FR MIDLNE CATH,C1751,HCPCS,,79008909,CDM,278,RC,,,both,,,510,201.28,39.4668,,201.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Device,173.4,34,"Charges > $500, x 34%",173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,204,40,,204,percent of total billed charges,Implant Devices,178.5,70,,178.5,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204,
ARROW CDC-45541-TTS 1L 4.5FR 55CM PICC,C1751,HCPCS,,79009513,CDM,278,RC,,,both,,,690,272.32,39.4668,,272.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,241.5,35,,241.5,percent of total billed charges,Implant Device,234.6,34,"Charges > $500, x 34%",234.6,percent of total billed charges,Implant Device,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,276,40,,276,percent of total billed charges,Implant Devices,241.5,70,,241.5,percent of total billed charges,Implant Devices,234.6,34,,234.6,percent of total billed charges,Implant Devices,234.6,34,,234.6,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,276,
ARROW CDC-45552-TTS 2L 5.5FR 55CM PICC,C1751,HCPCS,,79009514,CDM,278,RC,,,both,,,690,272.32,39.4668,,272.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,234.6,34,,234.6,percent of total billed charges,Implant Device,241.5,35,,241.5,percent of total billed charges,Implant Device,234.6,34,"Charges > $500, x 34%",234.6,percent of total billed charges,Implant Device,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,276,40,,276,percent of total billed charges,Implant Devices,241.5,70,,241.5,percent of total billed charges,Implant Devices,234.6,34,,234.6,percent of total billed charges,Implant Devices,234.6,34,,234.6,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,241.5,35,,241.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,276,
BARD DAVOL 0600580 9 FR DUAL LUMEN CATH,C1751,HCPCS,,79009518,CDM,278,RC,,,both,,,585,230.88,39.4668,,230.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,198.9,34,,198.9,percent of total billed charges,Implant Device,204.75,35,,204.75,percent of total billed charges,Implant Device,198.9,34,"Charges > $500, x 34%",198.9,percent of total billed charges,Implant Device,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,234,40,,234,percent of total billed charges,Implant Devices,204.75,70,,204.75,percent of total billed charges,Implant Devices,198.9,34,,198.9,percent of total billed charges,Implant Devices,198.9,34,,198.9,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,204.75,35,,204.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,234,
BARD DAVOL 0805910 HICKMAN 9.5 DUAL CATH,C1751,HCPCS,,79009520,CDM,278,RC,,,both,,,1476,582.53,39.4668,,582.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,501.84,34,,501.84,percent of total billed charges,Implant Device,501.84,34,,501.84,percent of total billed charges,Implant Device,501.84,34,,501.84,percent of total billed charges,Implant Device,501.84,34,,501.84,percent of total billed charges,Implant Device,501.84,34,,501.84,percent of total billed charges,Implant Device,501.84,34,,501.84,percent of total billed charges,Implant Device,516.6,35,,516.6,percent of total billed charges,Implant Device,501.84,34,"Charges > $500, x 34%",501.84,percent of total billed charges,Implant Device,516.6,35,,516.6,percent of total billed charges,Implant Devices,516.6,35,,516.6,percent of total billed charges,Implant Devices,516.6,35,,,percent of total billed charges,Implant Devices,516.6,35,,516.6,percent of total billed charges,Implant Devices,516.6,35,,516.6,percent of total billed charges,Implant Devices,590.4,40,,590.4,percent of total billed charges,Implant Devices,516.6,70,,516.6,percent of total billed charges,Implant Devices,501.84,34,,501.84,percent of total billed charges,Implant Devices,501.84,34,,501.84,percent of total billed charges,Implant Devices,516.6,35,,516.6,percent of total billed charges,Implant Devices,516.6,35,,516.6,percent of total billed charges,Implant Devices,516.6,35,,516.6,percent of total billed charges,Implant Devices,516.6,35,,516.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,590.4,
ANGIODYNAMICS H965458800 BIO-STABLE 4FR,C1751,HCPCS,,79012649,CDM,278,RC,,,both,,,816,322.05,39.4668,,322.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,277.44,34,,277.44,percent of total billed charges,Implant Device,285.6,35,,285.6,percent of total billed charges,Implant Device,277.44,34,"Charges > $500, x 34%",277.44,percent of total billed charges,Implant Device,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,326.4,40,,326.4,percent of total billed charges,Implant Devices,285.6,70,,285.6,percent of total billed charges,Implant Devices,277.44,34,,277.44,percent of total billed charges,Implant Devices,277.44,34,,277.44,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,285.6,35,,285.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,326.4,
ANGIODYNAMICS H965750171 BIOFLO PICC 55,C1751,HCPCS,,79012650,CDM,278,RC,,,both,,,599,236.41,39.4668,,236.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,203.66,34,,203.66,percent of total billed charges,Implant Device,203.66,34,,203.66,percent of total billed charges,Implant Device,203.66,34,,203.66,percent of total billed charges,Implant Device,203.66,34,,203.66,percent of total billed charges,Implant Device,203.66,34,,203.66,percent of total billed charges,Implant Device,203.66,34,,203.66,percent of total billed charges,Implant Device,209.65,35,,209.65,percent of total billed charges,Implant Device,203.66,34,"Charges > $500, x 34%",203.66,percent of total billed charges,Implant Device,209.65,35,,209.65,percent of total billed charges,Implant Devices,209.65,35,,209.65,percent of total billed charges,Implant Devices,209.65,35,,,percent of total billed charges,Implant Devices,209.65,35,,209.65,percent of total billed charges,Implant Devices,209.65,35,,209.65,percent of total billed charges,Implant Devices,239.6,40,,239.6,percent of total billed charges,Implant Devices,209.65,70,,209.65,percent of total billed charges,Implant Devices,203.66,34,,203.66,percent of total billed charges,Implant Devices,203.66,34,,203.66,percent of total billed charges,Implant Devices,209.65,35,,209.65,percent of total billed charges,Implant Devices,209.65,35,,209.65,percent of total billed charges,Implant Devices,209.65,35,,209.65,percent of total billed charges,Implant Devices,209.65,35,,209.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,239.6,
BARD 0700515 POWERLINE LUMEN CATH 5FR,C1751,HCPCS,,79013166,CDM,278,RC,,,both,,,774,305.47,39.4668,,305.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,263.16,34,,263.16,percent of total billed charges,Implant Device,263.16,34,,263.16,percent of total billed charges,Implant Device,263.16,34,,263.16,percent of total billed charges,Implant Device,263.16,34,,263.16,percent of total billed charges,Implant Device,263.16,34,,263.16,percent of total billed charges,Implant Device,263.16,34,,263.16,percent of total billed charges,Implant Device,270.9,35,,270.9,percent of total billed charges,Implant Device,263.16,34,"Charges > $500, x 34%",263.16,percent of total billed charges,Implant Device,270.9,35,,270.9,percent of total billed charges,Implant Devices,270.9,35,,270.9,percent of total billed charges,Implant Devices,270.9,35,,,percent of total billed charges,Implant Devices,270.9,35,,270.9,percent of total billed charges,Implant Devices,270.9,35,,270.9,percent of total billed charges,Implant Devices,309.6,40,,309.6,percent of total billed charges,Implant Devices,270.9,70,,270.9,percent of total billed charges,Implant Devices,263.16,34,,263.16,percent of total billed charges,Implant Devices,263.16,34,,263.16,percent of total billed charges,Implant Devices,270.9,35,,270.9,percent of total billed charges,Implant Devices,270.9,35,,270.9,percent of total billed charges,Implant Devices,270.9,35,,270.9,percent of total billed charges,Implant Devices,270.9,35,,270.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,309.6,
ARROW AU-22122-F DIALYSIS CATH STR 16CM,C1752,HCPCS,,79000708,CDM,278,RC,,,both,,,239,94.33,39.4668,,94.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.26,34,,81.26,percent of total billed charges,Implant Device,81.26,34,,81.26,percent of total billed charges,Implant Device,81.26,34,,81.26,percent of total billed charges,Implant Device,81.26,34,,81.26,percent of total billed charges,Implant Device,81.26,34,,81.26,percent of total billed charges,Implant Device,81.26,34,,81.26,percent of total billed charges,Implant Device,83.65,35,,83.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,95.6,40,,95.6,percent of total billed charges,Implant Devices,83.65,70,,83.65,percent of total billed charges,Implant Devices,81.26,34,,81.26,percent of total billed charges,Implant Devices,81.26,34,,81.26,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,95.6,
ARROW AU-25122-F DIALYSIS JUG CATH 20CM,C1752,HCPCS,,79000709,CDM,278,RC,,,both,,,239,94.33,39.4668,,94.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.26,34,,81.26,percent of total billed charges,Implant Device,81.26,34,,81.26,percent of total billed charges,Implant Device,81.26,34,,81.26,percent of total billed charges,Implant Device,81.26,34,,81.26,percent of total billed charges,Implant Device,81.26,34,,81.26,percent of total billed charges,Implant Device,81.26,34,,81.26,percent of total billed charges,Implant Device,83.65,35,,83.65,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,95.6,40,,95.6,percent of total billed charges,Implant Devices,83.65,70,,83.65,percent of total billed charges,Implant Devices,81.26,34,,81.26,percent of total billed charges,Implant Devices,81.26,34,,81.26,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,83.65,35,,83.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,95.6,
ARROW AU-22122-FRR DIALYSIS CATH 12X16,C1752,HCPCS,,79005682,CDM,278,RC,,,both,,,100,39.47,39.4668,,39.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,34,34,,34,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,40,40,,40,percent of total billed charges,Implant Devices,35,70,,35,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,34,34,,34,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,35,35,,35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,40,
ARROW CS-15122-F 12FRX20CM VENOUS CATH,C1752,HCPCS,,79008478,CDM,278,RC,,,both,,,177,69.86,39.4668,,69.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.18,34,,60.18,percent of total billed charges,Implant Device,60.18,34,,60.18,percent of total billed charges,Implant Device,60.18,34,,60.18,percent of total billed charges,Implant Device,60.18,34,,60.18,percent of total billed charges,Implant Device,60.18,34,,60.18,percent of total billed charges,Implant Device,60.18,34,,60.18,percent of total billed charges,Implant Device,61.95,35,,61.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,61.95,35,,61.95,percent of total billed charges,Implant Devices,61.95,35,,61.95,percent of total billed charges,Implant Devices,61.95,35,,,percent of total billed charges,Implant Devices,61.95,35,,61.95,percent of total billed charges,Implant Devices,61.95,35,,61.95,percent of total billed charges,Implant Devices,70.8,40,,70.8,percent of total billed charges,Implant Devices,61.95,70,,61.95,percent of total billed charges,Implant Devices,60.18,34,,60.18,percent of total billed charges,Implant Devices,60.18,34,,60.18,percent of total billed charges,Implant Devices,61.95,35,,61.95,percent of total billed charges,Implant Devices,61.95,35,,61.95,percent of total billed charges,Implant Devices,61.95,35,,61.95,percent of total billed charges,Implant Devices,61.95,35,,61.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,70.8,
PHILIPS 88901 PV .035 DIGITAL IVUS CATH,C1753,HCPCS,,79011110,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
PHILIPS 014R PV .014P DIGITAL IVUS CATH,C1753,HCPCS,,79011111,CDM,278,RC,,,both,,,2625,1036,39.4668,,1036,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,918.75,35,,918.75,percent of total billed charges,Implant Device,892.5,34,"Charges > $500, x 34%",892.5,percent of total billed charges,Implant Device,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,1050,40,,1050,percent of total billed charges,Implant Devices,918.75,70,,918.75,percent of total billed charges,Implant Devices,892.5,34,,892.5,percent of total billed charges,Implant Devices,892.5,34,,892.5,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,892.5,34,"If Charge > 2,000, then 34 percent",892.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1050,
SUTURE EXP 175-263 STENT PERCUFLEX 6X26,C1758,HCPCS,,79001730,CDM,278,RC,,,both,,,342,134.98,39.4668,,134.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,119.7,35,,119.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,136.8,40,,136.8,percent of total billed charges,Implant Devices,119.7,70,,119.7,percent of total billed charges,Implant Devices,116.28,34,,116.28,percent of total billed charges,Implant Devices,116.28,34,,116.28,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,136.8,
POLARIS 190-131 0 URETERAL STENT,C1758,HCPCS,,79001963,CDM,278,RC,,,both,,,1234,487.02,39.4668,,487.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,419.56,34,,419.56,percent of total billed charges,Implant Device,419.56,34,,419.56,percent of total billed charges,Implant Device,419.56,34,,419.56,percent of total billed charges,Implant Device,419.56,34,,419.56,percent of total billed charges,Implant Device,419.56,34,,419.56,percent of total billed charges,Implant Device,419.56,34,,419.56,percent of total billed charges,Implant Device,431.9,35,,431.9,percent of total billed charges,Implant Device,419.56,34,"Charges > $500, x 34%",419.56,percent of total billed charges,Implant Device,431.9,35,,431.9,percent of total billed charges,Implant Devices,431.9,35,,431.9,percent of total billed charges,Implant Devices,431.9,35,,,percent of total billed charges,Implant Devices,431.9,35,,431.9,percent of total billed charges,Implant Devices,431.9,35,,431.9,percent of total billed charges,Implant Devices,493.6,40,,493.6,percent of total billed charges,Implant Devices,431.9,70,,431.9,percent of total billed charges,Implant Devices,419.56,34,,419.56,percent of total billed charges,Implant Devices,419.56,34,,419.56,percent of total billed charges,Implant Devices,431.9,35,,431.9,percent of total billed charges,Implant Devices,431.9,35,,431.9,percent of total billed charges,Implant Devices,431.9,35,,431.9,percent of total billed charges,Implant Devices,431.9,35,,431.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,493.6,
POLARIS 190-134 0 URETERAL STENT,C1758,HCPCS,,79001964,CDM,278,RC,,,both,,,1266,499.65,39.4668,,499.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,430.44,34,,430.44,percent of total billed charges,Implant Device,443.1,35,,443.1,percent of total billed charges,Implant Device,430.44,34,"Charges > $500, x 34%",430.44,percent of total billed charges,Implant Device,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,506.4,40,,506.4,percent of total billed charges,Implant Devices,443.1,70,,443.1,percent of total billed charges,Implant Devices,430.44,34,,430.44,percent of total billed charges,Implant Devices,430.44,34,,430.44,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,443.1,35,,443.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,506.4,
STRYKER 192-134-R POLARIS STENT 6X28CM,C1758,HCPCS,,79006273,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
STRYKER 192-151-R POLARIS STENT 8X22CM,C1758,HCPCS,,79006274,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
WRIGHT 8600-5X05 GRAFT JACKET,C1762,HCPCS,,79001516,CDM,278,RC,,,both,,,7666,3025.52,39.4668,,3025.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2606.44,34,,2606.44,percent of total billed charges,Implant Device,2606.44,34,,2606.44,percent of total billed charges,Implant Device,2606.44,34,,2606.44,percent of total billed charges,Implant Device,2606.44,34,,2606.44,percent of total billed charges,Implant Device,2606.44,34,,2606.44,percent of total billed charges,Implant Device,2606.44,34,,2606.44,percent of total billed charges,Implant Device,2683.1,35,,2683.1,percent of total billed charges,Implant Device,2606.44,34,"Charges > $500, x 34%",2606.44,percent of total billed charges,Implant Device,2683.1,35,,2683.1,percent of total billed charges,Implant Devices,2683.1,35,,2683.1,percent of total billed charges,Implant Devices,2683.1,35,,,percent of total billed charges,Implant Devices,2683.1,35,,2683.1,percent of total billed charges,Implant Devices,2683.1,35,,2683.1,percent of total billed charges,Implant Devices,3066.4,40,,3066.4,percent of total billed charges,Implant Devices,2683.1,70,,2683.1,percent of total billed charges,Implant Devices,2606.44,34,,2606.44,percent of total billed charges,Implant Devices,2606.44,34,,2606.44,percent of total billed charges,Implant Devices,2683.1,35,,2683.1,percent of total billed charges,Implant Devices,2683.1,35,,2683.1,percent of total billed charges,Implant Devices,2683.1,35,,2683.1,percent of total billed charges,Implant Devices,2683.1,35,,2683.1,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,2606.44,34,"If Charge > 2,000, then 34 percent",2606.44,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
BIOMET 45-0054 ILIAC CREST WEDGE 19X21,C1762,HCPCS,,79001560,CDM,278,RC,,,both,,,2482,979.57,39.4668,,979.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,843.88,34,,843.88,percent of total billed charges,Implant Device,843.88,34,,843.88,percent of total billed charges,Implant Device,843.88,34,,843.88,percent of total billed charges,Implant Device,843.88,34,,843.88,percent of total billed charges,Implant Device,843.88,34,,843.88,percent of total billed charges,Implant Device,843.88,34,,843.88,percent of total billed charges,Implant Device,868.7,35,,868.7,percent of total billed charges,Implant Device,843.88,34,"Charges > $500, x 34%",843.88,percent of total billed charges,Implant Device,868.7,35,,868.7,percent of total billed charges,Implant Devices,868.7,35,,868.7,percent of total billed charges,Implant Devices,868.7,35,,,percent of total billed charges,Implant Devices,868.7,35,,868.7,percent of total billed charges,Implant Devices,868.7,35,,868.7,percent of total billed charges,Implant Devices,992.8,40,,992.8,percent of total billed charges,Implant Devices,868.7,70,,868.7,percent of total billed charges,Implant Devices,843.88,34,,843.88,percent of total billed charges,Implant Devices,843.88,34,,843.88,percent of total billed charges,Implant Devices,868.7,35,,868.7,percent of total billed charges,Implant Devices,868.7,35,,868.7,percent of total billed charges,Implant Devices,868.7,35,,868.7,percent of total billed charges,Implant Devices,868.7,35,,868.7,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,843.88,34,"If Charge > 2,000, then 34 percent",843.88,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
JRF 1020-14 CTS TIBIALIS ANTERIOR TISSUE,C1762,HCPCS,,79001908,CDM,278,RC,,,both,,,5850,2308.81,39.4668,,2308.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Device,1989,34,"Charges > $500, x 34%",1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2340,40,,2340,percent of total billed charges,Implant Devices,2047.5,70,,2047.5,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1989,34,"If Charge > 2,000, then 34 percent",1989,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
JRF 1025-14-CTS ACHILLES TENDON TISSUE,C1762,HCPCS,,79001909,CDM,278,RC,,,both,,,5850,2308.81,39.4668,,2308.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Device,1989,34,"Charges > $500, x 34%",1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2340,40,,2340,percent of total billed charges,Implant Devices,2047.5,70,,2047.5,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1989,34,"If Charge > 2,000, then 34 percent",1989,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
ALAMO TISSUE SVC AT393FF GRACILIS TENDON,C1762,HCPCS,,79005623,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
ALAMO AT290FF ACHILLES TENDON W/CALCNEUS,C1762,HCPCS,,79005637,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
LIFENET AFLEX100 DECELLURIZED DERMIS,C1762,HCPCS,,79005688,CDM,278,RC,,,both,,,5986,2362.48,39.4668,,2362.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2035.24,34,,2035.24,percent of total billed charges,Implant Device,2035.24,34,,2035.24,percent of total billed charges,Implant Device,2035.24,34,,2035.24,percent of total billed charges,Implant Device,2035.24,34,,2035.24,percent of total billed charges,Implant Device,2035.24,34,,2035.24,percent of total billed charges,Implant Device,2035.24,34,,2035.24,percent of total billed charges,Implant Device,2095.1,35,,2095.1,percent of total billed charges,Implant Device,2035.24,34,"Charges > $500, x 34%",2035.24,percent of total billed charges,Implant Device,2095.1,35,,2095.1,percent of total billed charges,Implant Devices,2095.1,35,,2095.1,percent of total billed charges,Implant Devices,2095.1,35,,,percent of total billed charges,Implant Devices,2095.1,35,,2095.1,percent of total billed charges,Implant Devices,2095.1,35,,2095.1,percent of total billed charges,Implant Devices,2394.4,40,,2394.4,percent of total billed charges,Implant Devices,2095.1,70,,2095.1,percent of total billed charges,Implant Devices,2035.24,34,,2035.24,percent of total billed charges,Implant Devices,2035.24,34,,2035.24,percent of total billed charges,Implant Devices,2095.1,35,,2095.1,percent of total billed charges,Implant Devices,2095.1,35,,2095.1,percent of total billed charges,Implant Devices,2095.1,35,,2095.1,percent of total billed charges,Implant Devices,2095.1,35,,2095.1,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,2035.24,34,"If Charge > 2,000, then 34 percent",2035.24,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
LIFENET AFLEX103 DERMIS PATCH 50X90MM,C1762,HCPCS,,79007422,CDM,278,RC,,,both,,,10395,4102.57,39.4668,,4102.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3534.3,34,,3534.3,percent of total billed charges,Implant Device,3534.3,34,,3534.3,percent of total billed charges,Implant Device,3534.3,34,,3534.3,percent of total billed charges,Implant Device,3534.3,34,,3534.3,percent of total billed charges,Implant Device,3534.3,34,,3534.3,percent of total billed charges,Implant Device,3534.3,34,,3534.3,percent of total billed charges,Implant Device,3638.25,35,,3638.25,percent of total billed charges,Implant Device,3534.3,34,"Charges > $500, x 34%",3534.3,percent of total billed charges,Implant Device,3638.25,35,,3638.25,percent of total billed charges,Implant Devices,3638.25,35,,3638.25,percent of total billed charges,Implant Devices,3638.25,35,,,percent of total billed charges,Implant Devices,3638.25,35,,3638.25,percent of total billed charges,Implant Devices,3638.25,35,,3638.25,percent of total billed charges,Implant Devices,4158,40,,4158,percent of total billed charges,Implant Devices,3638.25,70,,3638.25,percent of total billed charges,Implant Devices,3534.3,34,,3534.3,percent of total billed charges,Implant Devices,3534.3,34,,3534.3,percent of total billed charges,Implant Devices,3638.25,35,,3638.25,percent of total billed charges,Implant Devices,3638.25,35,,3638.25,percent of total billed charges,Implant Devices,3638.25,35,,3638.25,percent of total billed charges,Implant Devices,3638.25,35,,3638.25,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,3534.3,34,"If Charge > 2,000, then 34 percent",3534.3,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,4158,
MTF 400405 ILIAC CREST WEDGE 13-15MM,C1762,HCPCS,,79008257,CDM,278,RC,,,both,,,2740,1081.39,39.4668,,1081.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,931.6,34,,931.6,percent of total billed charges,Implant Device,931.6,34,,931.6,percent of total billed charges,Implant Device,931.6,34,,931.6,percent of total billed charges,Implant Device,931.6,34,,931.6,percent of total billed charges,Implant Device,931.6,34,,931.6,percent of total billed charges,Implant Device,931.6,34,,931.6,percent of total billed charges,Implant Device,959,35,,959,percent of total billed charges,Implant Device,931.6,34,"Charges > $500, x 34%",931.6,percent of total billed charges,Implant Device,959,35,,959,percent of total billed charges,Implant Devices,959,35,,959,percent of total billed charges,Implant Devices,959,35,,,percent of total billed charges,Implant Devices,959,35,,959,percent of total billed charges,Implant Devices,959,35,,959,percent of total billed charges,Implant Devices,1096,40,,1096,percent of total billed charges,Implant Devices,959,70,,959,percent of total billed charges,Implant Devices,931.6,34,,931.6,percent of total billed charges,Implant Devices,931.6,34,,931.6,percent of total billed charges,Implant Devices,959,35,,959,percent of total billed charges,Implant Devices,959,35,,959,percent of total billed charges,Implant Devices,959,35,,959,percent of total billed charges,Implant Devices,959,35,,959,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,931.6,34,"If Charge > 2,000, then 34 percent",931.6,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
ALAMO PS290FD ACHILLES TENDON,C1762,HCPCS,,79008298,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
JOINT RESTOR FOUND SPD-001 PRESUT TENDON,C1762,HCPCS,,79010701,CDM,278,RC,,,both,,,6975,2752.81,39.4668,,2752.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2371.5,34,,2371.5,percent of total billed charges,Implant Device,2371.5,34,,2371.5,percent of total billed charges,Implant Device,2371.5,34,,2371.5,percent of total billed charges,Implant Device,2371.5,34,,2371.5,percent of total billed charges,Implant Device,2371.5,34,,2371.5,percent of total billed charges,Implant Device,2371.5,34,,2371.5,percent of total billed charges,Implant Device,2441.25,35,,2441.25,percent of total billed charges,Implant Device,2371.5,34,"Charges > $500, x 34%",2371.5,percent of total billed charges,Implant Device,2441.25,35,,2441.25,percent of total billed charges,Implant Devices,2441.25,35,,2441.25,percent of total billed charges,Implant Devices,2441.25,35,,,percent of total billed charges,Implant Devices,2441.25,35,,2441.25,percent of total billed charges,Implant Devices,2441.25,35,,2441.25,percent of total billed charges,Implant Devices,2790,40,,2790,percent of total billed charges,Implant Devices,2441.25,70,,2441.25,percent of total billed charges,Implant Devices,2371.5,34,,2371.5,percent of total billed charges,Implant Devices,2371.5,34,,2371.5,percent of total billed charges,Implant Devices,2441.25,35,,2441.25,percent of total billed charges,Implant Devices,2441.25,35,,2441.25,percent of total billed charges,Implant Devices,2441.25,35,,2441.25,percent of total billed charges,Implant Devices,2441.25,35,,2441.25,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,2371.5,34,"If Charge > 2,000, then 34 percent",2371.5,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
stryker 3102-1001 allograft dbm putty1cc,C1762,HCPCS,,79011985,CDM,278,RC,,,both,,,309,121.95,39.4668,,121.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,105.06,34,,105.06,percent of total billed charges,Implant Device,105.06,34,,105.06,percent of total billed charges,Implant Device,105.06,34,,105.06,percent of total billed charges,Implant Device,105.06,34,,105.06,percent of total billed charges,Implant Device,105.06,34,,105.06,percent of total billed charges,Implant Device,105.06,34,,105.06,percent of total billed charges,Implant Device,108.15,35,,108.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,108.15,35,,108.15,percent of total billed charges,Implant Devices,108.15,35,,108.15,percent of total billed charges,Implant Devices,108.15,35,,,percent of total billed charges,Implant Devices,108.15,35,,108.15,percent of total billed charges,Implant Devices,108.15,35,,108.15,percent of total billed charges,Implant Devices,123.6,40,,123.6,percent of total billed charges,Implant Devices,108.15,70,,108.15,percent of total billed charges,Implant Devices,105.06,34,,105.06,percent of total billed charges,Implant Devices,105.06,34,,105.06,percent of total billed charges,Implant Devices,108.15,35,,108.15,percent of total billed charges,Implant Devices,108.15,35,,108.15,percent of total billed charges,Implant Devices,108.15,35,,108.15,percent of total billed charges,Implant Devices,108.15,35,,108.15,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
WRIGHT OP101024 TRICORTICAL WEDGE LARGE,C1762,HCPCS,,79012043,CDM,278,RC,,,both,,,10839,4277.81,39.4668,,4277.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3685.26,34,,3685.26,percent of total billed charges,Implant Device,3685.26,34,,3685.26,percent of total billed charges,Implant Device,3685.26,34,,3685.26,percent of total billed charges,Implant Device,3685.26,34,,3685.26,percent of total billed charges,Implant Device,3685.26,34,,3685.26,percent of total billed charges,Implant Device,3685.26,34,,3685.26,percent of total billed charges,Implant Device,3793.65,35,,3793.65,percent of total billed charges,Implant Device,3685.26,34,"Charges > $500, x 34%",3685.26,percent of total billed charges,Implant Device,3793.65,35,,3793.65,percent of total billed charges,Implant Devices,3793.65,35,,3793.65,percent of total billed charges,Implant Devices,3793.65,35,,,percent of total billed charges,Implant Devices,3793.65,35,,3793.65,percent of total billed charges,Implant Devices,3793.65,35,,3793.65,percent of total billed charges,Implant Devices,4335.6,40,,4335.6,percent of total billed charges,Implant Devices,3793.65,70,,3793.65,percent of total billed charges,Implant Devices,3685.26,34,,3685.26,percent of total billed charges,Implant Devices,3685.26,34,,3685.26,percent of total billed charges,Implant Devices,3793.65,35,,3793.65,percent of total billed charges,Implant Devices,3793.65,35,,3793.65,percent of total billed charges,Implant Devices,3793.65,35,,3793.65,percent of total billed charges,Implant Devices,3793.65,35,,3793.65,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,3685.26,34,"If Charge > 2,000, then 34 percent",3685.26,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,4335.6,
STRYKER 3102-1002 DBM PUTTY 2.5CC,C1762,HCPCS,,79012094,CDM,278,RC,,,both,,,735,290.08,39.4668,,290.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,249.9,34,,249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Device,249.9,34,"Charges > $500, x 34%",249.9,percent of total billed charges,Implant Device,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,294,40,,294,percent of total billed charges,Implant Devices,257.25,70,,257.25,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,249.9,34,,249.9,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,257.25,35,,257.25,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
STRYKER 3102-1005 DBM PUTTY 5CC,C1762,HCPCS,,79012095,CDM,278,RC,,,both,,,1577,622.39,39.4668,,622.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,536.18,34,,536.18,percent of total billed charges,Implant Device,536.18,34,,536.18,percent of total billed charges,Implant Device,536.18,34,,536.18,percent of total billed charges,Implant Device,536.18,34,,536.18,percent of total billed charges,Implant Device,536.18,34,,536.18,percent of total billed charges,Implant Device,536.18,34,,536.18,percent of total billed charges,Implant Device,551.95,35,,551.95,percent of total billed charges,Implant Device,536.18,34,"Charges > $500, x 34%",536.18,percent of total billed charges,Implant Device,551.95,35,,551.95,percent of total billed charges,Implant Devices,551.95,35,,551.95,percent of total billed charges,Implant Devices,551.95,35,,,percent of total billed charges,Implant Devices,551.95,35,,551.95,percent of total billed charges,Implant Devices,551.95,35,,551.95,percent of total billed charges,Implant Devices,630.8,40,,630.8,percent of total billed charges,Implant Devices,551.95,70,,551.95,percent of total billed charges,Implant Devices,536.18,34,,536.18,percent of total billed charges,Implant Devices,536.18,34,,536.18,percent of total billed charges,Implant Devices,551.95,35,,551.95,percent of total billed charges,Implant Devices,551.95,35,,551.95,percent of total billed charges,Implant Devices,551.95,35,,551.95,percent of total billed charges,Implant Devices,551.95,35,,551.95,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
STRYKER 3102-1010 DBM PUTTY 10CC,C1762,HCPCS,,79012096,CDM,278,RC,,,both,,,2460,970.88,39.4668,,970.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,836.4,34,,836.4,percent of total billed charges,Implant Device,836.4,34,,836.4,percent of total billed charges,Implant Device,836.4,34,,836.4,percent of total billed charges,Implant Device,836.4,34,,836.4,percent of total billed charges,Implant Device,836.4,34,,836.4,percent of total billed charges,Implant Device,836.4,34,,836.4,percent of total billed charges,Implant Device,861,35,,861,percent of total billed charges,Implant Device,836.4,34,"Charges > $500, x 34%",836.4,percent of total billed charges,Implant Device,861,35,,861,percent of total billed charges,Implant Devices,861,35,,861,percent of total billed charges,Implant Devices,861,35,,,percent of total billed charges,Implant Devices,861,35,,861,percent of total billed charges,Implant Devices,861,35,,861,percent of total billed charges,Implant Devices,984,40,,984,percent of total billed charges,Implant Devices,861,70,,861,percent of total billed charges,Implant Devices,836.4,34,,836.4,percent of total billed charges,Implant Devices,836.4,34,,836.4,percent of total billed charges,Implant Devices,861,35,,861,percent of total billed charges,Implant Devices,861,35,,861,percent of total billed charges,Implant Devices,861,35,,861,percent of total billed charges,Implant Devices,861,35,,861,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,836.4,34,"If Charge > 2,000, then 34 percent",836.4,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
STRYKER 3102-1910 EVANS WEDGE 10X22X20MM,C1762,HCPCS,,79012107,CDM,278,RC,,,both,,,8151,3216.94,39.4668,,3216.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2771.34,34,,2771.34,percent of total billed charges,Implant Device,2852.85,35,,2852.85,percent of total billed charges,Implant Device,2771.34,34,"Charges > $500, x 34%",2771.34,percent of total billed charges,Implant Device,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,3260.4,40,,3260.4,percent of total billed charges,Implant Devices,2852.85,70,,2852.85,percent of total billed charges,Implant Devices,2771.34,34,,2771.34,percent of total billed charges,Implant Devices,2771.34,34,,2771.34,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,2852.85,35,,2852.85,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,2771.34,34,"If Charge > 2,000, then 34 percent",2771.34,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3260.4,
STRYKER 41517000 ANTERIOR TIBIALIS GRAFT,C1762,HCPCS,,79012130,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
STRYKER 44317002 GRACILIS STRAND,C1762,HCPCS,,79012192,CDM,278,RC,,,both,,,2625,1036,39.4668,,1036,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,918.75,35,,918.75,percent of total billed charges,Implant Device,892.5,34,"Charges > $500, x 34%",892.5,percent of total billed charges,Implant Device,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,1050,40,,1050,percent of total billed charges,Implant Devices,918.75,70,,918.75,percent of total billed charges,Implant Devices,892.5,34,,892.5,percent of total billed charges,Implant Devices,892.5,34,,892.5,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,892.5,34,"If Charge > 2,000, then 34 percent",892.5,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
STRYKER 10017000 ACHILLES W/ ALLOGRAFT,C1762,HCPCS,,79012448,CDM,278,RC,,,both,,,4438,1751.54,39.4668,,1751.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1508.92,34,,1508.92,percent of total billed charges,Implant Device,1508.92,34,,1508.92,percent of total billed charges,Implant Device,1508.92,34,,1508.92,percent of total billed charges,Implant Device,1508.92,34,,1508.92,percent of total billed charges,Implant Device,1508.92,34,,1508.92,percent of total billed charges,Implant Device,1508.92,34,,1508.92,percent of total billed charges,Implant Device,1553.3,35,,1553.3,percent of total billed charges,Implant Device,1508.92,34,"Charges > $500, x 34%",1508.92,percent of total billed charges,Implant Device,1553.3,35,,1553.3,percent of total billed charges,Implant Devices,1553.3,35,,1553.3,percent of total billed charges,Implant Devices,1553.3,35,,,percent of total billed charges,Implant Devices,1553.3,35,,1553.3,percent of total billed charges,Implant Devices,1553.3,35,,1553.3,percent of total billed charges,Implant Devices,1775.2,40,,1775.2,percent of total billed charges,Implant Devices,1553.3,70,,1553.3,percent of total billed charges,Implant Devices,1508.92,34,,1508.92,percent of total billed charges,Implant Devices,1508.92,34,,1508.92,percent of total billed charges,Implant Devices,1553.3,35,,1553.3,percent of total billed charges,Implant Devices,1553.3,35,,1553.3,percent of total billed charges,Implant Devices,1553.3,35,,1553.3,percent of total billed charges,Implant Devices,1553.3,35,,1553.3,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1508.92,34,"If Charge > 2,000, then 34 percent",1508.92,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
STRYKER 18722000 TENODESIS ALLOGRAFT,C1762,HCPCS,,79012449,CDM,278,RC,,,both,,,4688,1850.2,39.4668,,1850.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1593.92,34,,1593.92,percent of total billed charges,Implant Device,1593.92,34,,1593.92,percent of total billed charges,Implant Device,1593.92,34,,1593.92,percent of total billed charges,Implant Device,1593.92,34,,1593.92,percent of total billed charges,Implant Device,1593.92,34,,1593.92,percent of total billed charges,Implant Device,1593.92,34,,1593.92,percent of total billed charges,Implant Device,1640.8,35,,1640.8,percent of total billed charges,Implant Device,1593.92,34,"Charges > $500, x 34%",1593.92,percent of total billed charges,Implant Device,1640.8,35,,1640.8,percent of total billed charges,Implant Devices,1640.8,35,,1640.8,percent of total billed charges,Implant Devices,1640.8,35,,,percent of total billed charges,Implant Devices,1640.8,35,,1640.8,percent of total billed charges,Implant Devices,1640.8,35,,1640.8,percent of total billed charges,Implant Devices,1875.2,40,,1875.2,percent of total billed charges,Implant Devices,1640.8,70,,1640.8,percent of total billed charges,Implant Devices,1593.92,34,,1593.92,percent of total billed charges,Implant Devices,1593.92,34,,1593.92,percent of total billed charges,Implant Devices,1640.8,35,,1640.8,percent of total billed charges,Implant Devices,1640.8,35,,1640.8,percent of total billed charges,Implant Devices,1640.8,35,,1640.8,percent of total billed charges,Implant Devices,1640.8,35,,1640.8,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1593.92,34,"If Charge > 2,000, then 34 percent",1593.92,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
STRYKER 18717000 SEMI TENODESIS GRAFT,C1762,HCPCS,,79012505,CDM,278,RC,,,both,,,4120,1626.03,39.4668,,1626.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1400.8,34,,1400.8,percent of total billed charges,Implant Device,1400.8,34,,1400.8,percent of total billed charges,Implant Device,1400.8,34,,1400.8,percent of total billed charges,Implant Device,1400.8,34,,1400.8,percent of total billed charges,Implant Device,1400.8,34,,1400.8,percent of total billed charges,Implant Device,1400.8,34,,1400.8,percent of total billed charges,Implant Device,1442,35,,1442,percent of total billed charges,Implant Device,1400.8,34,"Charges > $500, x 34%",1400.8,percent of total billed charges,Implant Device,1442,35,,1442,percent of total billed charges,Implant Devices,1442,35,,1442,percent of total billed charges,Implant Devices,1442,35,,,percent of total billed charges,Implant Devices,1442,35,,1442,percent of total billed charges,Implant Devices,1442,35,,1442,percent of total billed charges,Implant Devices,1648,40,,1648,percent of total billed charges,Implant Devices,1442,70,,1442,percent of total billed charges,Implant Devices,1400.8,34,,1400.8,percent of total billed charges,Implant Devices,1400.8,34,,1400.8,percent of total billed charges,Implant Devices,1442,35,,1442,percent of total billed charges,Implant Devices,1442,35,,1442,percent of total billed charges,Implant Devices,1442,35,,1442,percent of total billed charges,Implant Devices,1442,35,,1442,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1400.8,34,"If Charge > 2,000, then 34 percent",1400.8,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
LIFENET PCDXL14 CANN REVISION DOWEL 14MM,C1762,HCPCS,,79013801,CDM,278,RC,,,both,,,3443,1358.84,39.4668,,1358.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1170.62,34,,1170.62,percent of total billed charges,Implant Device,1170.62,34,,1170.62,percent of total billed charges,Implant Device,1170.62,34,,1170.62,percent of total billed charges,Implant Device,1170.62,34,,1170.62,percent of total billed charges,Implant Device,1170.62,34,,1170.62,percent of total billed charges,Implant Device,1170.62,34,,1170.62,percent of total billed charges,Implant Device,1205.05,35,,1205.05,percent of total billed charges,Implant Device,1170.62,34,"Charges > $500, x 34%",1170.62,percent of total billed charges,Implant Device,1205.05,35,,1205.05,percent of total billed charges,Implant Devices,1205.05,35,,1205.05,percent of total billed charges,Implant Devices,1205.05,35,,,percent of total billed charges,Implant Devices,1205.05,35,,1205.05,percent of total billed charges,Implant Devices,1205.05,35,,1205.05,percent of total billed charges,Implant Devices,1377.2,40,,1377.2,percent of total billed charges,Implant Devices,1205.05,70,,1205.05,percent of total billed charges,Implant Devices,1170.62,34,,1170.62,percent of total billed charges,Implant Devices,1170.62,34,,1170.62,percent of total billed charges,Implant Devices,1205.05,35,,1205.05,percent of total billed charges,Implant Devices,1205.05,35,,1205.05,percent of total billed charges,Implant Devices,1205.05,35,,1205.05,percent of total billed charges,Implant Devices,1205.05,35,,1205.05,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1170.62,34,"If Charge > 2,000, then 34 percent",1170.62,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
BARD 651005 CONTIGEN COLLAGEN IMPLANT,C1763,HCPCS,,79001392,CDM,278,RC,,,both,,,1050,414.4,39.4668,,414.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,357,34,,357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Device,357,34,"Charges > $500, x 34%",357,percent of total billed charges,Implant Device,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,420,40,,420,percent of total billed charges,Implant Devices,367.5,70,,367.5,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,357,34,,357,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,367.5,35,,367.5,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
OSTEOSET MINI BEAD FAST CURE 5CC,C1763,HCPCS,,79011993,CDM,278,RC,,,both,,,3561,1405.41,39.4668,,1405.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1210.74,34,,1210.74,percent of total billed charges,Implant Device,1210.74,34,,1210.74,percent of total billed charges,Implant Device,1210.74,34,,1210.74,percent of total billed charges,Implant Device,1210.74,34,,1210.74,percent of total billed charges,Implant Device,1210.74,34,,1210.74,percent of total billed charges,Implant Device,1210.74,34,,1210.74,percent of total billed charges,Implant Device,1246.35,35,,1246.35,percent of total billed charges,Implant Device,1210.74,34,"Charges > $500, x 34%",1210.74,percent of total billed charges,Implant Device,1246.35,35,,1246.35,percent of total billed charges,Implant Devices,1246.35,35,,1246.35,percent of total billed charges,Implant Devices,1246.35,35,,,percent of total billed charges,Implant Devices,1246.35,35,,1246.35,percent of total billed charges,Implant Devices,1246.35,35,,1246.35,percent of total billed charges,Implant Devices,1424.4,40,,1424.4,percent of total billed charges,Implant Devices,1246.35,70,,1246.35,percent of total billed charges,Implant Devices,1210.74,34,,1210.74,percent of total billed charges,Implant Devices,1210.74,34,,1210.74,percent of total billed charges,Implant Devices,1246.35,35,,1246.35,percent of total billed charges,Implant Devices,1246.35,35,,1246.35,percent of total billed charges,Implant Devices,1246.35,35,,1246.35,percent of total billed charges,Implant Devices,1246.35,35,,1246.35,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1210.74,34,"If Charge > 2,000, then 34 percent",1210.74,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
IN2BONES M80 SB008 COLLAGEN IMP 7.5X40,C1763,HCPCS,,79013777,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
MEDTRONIC LNQ22 ICM LINQ II,C1764,HCPCS,,79003624,CDM,278,RC,,,both,,,14535,5736.5,39.4668,,5736.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4941.9,34,,4941.9,percent of total billed charges,Implant Device,4941.9,34,,4941.9,percent of total billed charges,Implant Device,4941.9,34,,4941.9,percent of total billed charges,Implant Device,4941.9,34,,4941.9,percent of total billed charges,Implant Device,4941.9,34,,4941.9,percent of total billed charges,Implant Device,4941.9,34,,4941.9,percent of total billed charges,Implant Device,5087.25,35,,5087.25,percent of total billed charges,Implant Device,4941.9,34,"Charges > $500, x 34%",4941.9,percent of total billed charges,Implant Device,5087.25,35,,5087.25,percent of total billed charges,Implant Devices,5087.25,35,,5087.25,percent of total billed charges,Implant Devices,5087.25,35,,,percent of total billed charges,Implant Devices,5087.25,35,,5087.25,percent of total billed charges,Implant Devices,5087.25,35,,5087.25,percent of total billed charges,Implant Devices,5814,40,,5814,percent of total billed charges,Implant Devices,5087.25,70,,5087.25,percent of total billed charges,Implant Devices,4941.9,34,,4941.9,percent of total billed charges,Implant Devices,4941.9,34,,4941.9,percent of total billed charges,Implant Devices,5087.25,35,,5087.25,percent of total billed charges,Implant Devices,5087.25,35,,5087.25,percent of total billed charges,Implant Devices,5087.25,35,,5087.25,percent of total billed charges,Implant Devices,5087.25,35,,5087.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4941.9,34,"If Charge > 2,000, then 34 percent",4941.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5814,
ST JUDE DM3500 CONFIRM RX,C1764,HCPCS,,79009168,CDM,278,RC,,,both,,,13800,5446.42,39.4668,,5446.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4692,34,,4692,percent of total billed charges,Implant Device,4692,34,,4692,percent of total billed charges,Implant Device,4692,34,,4692,percent of total billed charges,Implant Device,4692,34,,4692,percent of total billed charges,Implant Device,4692,34,,4692,percent of total billed charges,Implant Device,4692,34,,4692,percent of total billed charges,Implant Device,4830,35,,4830,percent of total billed charges,Implant Device,4692,34,"Charges > $500, x 34%",4692,percent of total billed charges,Implant Device,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,5520,40,,5520,percent of total billed charges,Implant Devices,4830,70,,4830,percent of total billed charges,Implant Devices,4692,34,,4692,percent of total billed charges,Implant Devices,4692,34,,4692,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4692,34,"If Charge > 2,000, then 34 percent",4692,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5520,
BIOTRONIK 471155 BIOMONITOR IV,C1764,HCPCS,,79013838,CDM,278,RC,,,both,,,12600,4972.82,39.4668,,4972.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4410,35,,4410,percent of total billed charges,Implant Device,4284,34,"Charges > $500, x 34%",4284,percent of total billed charges,Implant Device,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,5040,40,,5040,percent of total billed charges,Implant Devices,4410,70,,4410,percent of total billed charges,Implant Devices,4284,34,,4284,percent of total billed charges,Implant Devices,4284,34,,4284,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4284,34,"If Charge > 2,000, then 34 percent",4284,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5040,
ABBOTT DM5500 ASSERT-IQ EL+,C1764,HCPCS,,79013852,CDM,278,RC,,,both,,,13800,5446.42,39.4668,,5446.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4692,34,,4692,percent of total billed charges,Implant Device,4692,34,,4692,percent of total billed charges,Implant Device,4692,34,,4692,percent of total billed charges,Implant Device,4692,34,,4692,percent of total billed charges,Implant Device,4692,34,,4692,percent of total billed charges,Implant Device,4692,34,,4692,percent of total billed charges,Implant Device,4830,35,,4830,percent of total billed charges,Implant Device,4692,34,"Charges > $500, x 34%",4692,percent of total billed charges,Implant Device,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,5520,40,,5520,percent of total billed charges,Implant Devices,4830,70,,4830,percent of total billed charges,Implant Devices,4692,34,,4692,percent of total billed charges,Implant Devices,4692,34,,4692,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,4830,35,,4830,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4692,34,"If Charge > 2,000, then 34 percent",4692,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5520,
MEDTRONIC 3058 INTERSTIM,C1767,HCPCS,,79002657,CDM,278,RC,,,both,,,33675,13290.44,39.4668,,13290.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11449.5,34,,11449.5,percent of total billed charges,Implant Device,11449.5,34,,11449.5,percent of total billed charges,Implant Device,11449.5,34,,11449.5,percent of total billed charges,Implant Device,11449.5,34,,11449.5,percent of total billed charges,Implant Device,11449.5,34,,11449.5,percent of total billed charges,Implant Device,11449.5,34,,11449.5,percent of total billed charges,Implant Device,11786.25,35,,11786.25,percent of total billed charges,Implant Device,11449.5,34,"Charges > $500, x 34%",11449.5,percent of total billed charges,Implant Device,11786.25,35,,11786.25,percent of total billed charges,Implant Devices,11786.25,35,,11786.25,percent of total billed charges,Implant Devices,11786.25,35,,,percent of total billed charges,Implant Devices,11786.25,35,,11786.25,percent of total billed charges,Implant Devices,11786.25,35,,11786.25,percent of total billed charges,Implant Devices,13470,40,,13470,percent of total billed charges,Implant Devices,11786.25,70,,11786.25,percent of total billed charges,Implant Devices,11449.5,34,,11449.5,percent of total billed charges,Implant Devices,11449.5,34,,11449.5,percent of total billed charges,Implant Devices,11786.25,35,,11786.25,percent of total billed charges,Implant Devices,11786.25,35,,11786.25,percent of total billed charges,Implant Devices,11786.25,35,,11786.25,percent of total billed charges,Implant Devices,11786.25,35,,11786.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11449.5,34,"If Charge > 2,000, then 34 percent",11449.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13470,
ABBOTT 3660 PROCLAIM XR 5 IPG,C1767,HCPCS,,79011951,CDM,278,RC,,,both,,,76410,30156.58,39.4668,,30156.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25979.4,34,,25979.4,percent of total billed charges,Implant Device,25979.4,34,,25979.4,percent of total billed charges,Implant Device,25979.4,34,,25979.4,percent of total billed charges,Implant Device,25979.4,34,,25979.4,percent of total billed charges,Implant Device,25979.4,34,,25979.4,percent of total billed charges,Implant Device,25979.4,34,,25979.4,percent of total billed charges,Implant Device,26743.5,35,,26743.5,percent of total billed charges,Implant Device,25979.4,34,"Charges > $500, x 34%",25979.4,percent of total billed charges,Implant Device,26743.5,35,,26743.5,percent of total billed charges,Implant Devices,26743.5,35,,26743.5,percent of total billed charges,Implant Devices,26743.5,35,,,percent of total billed charges,Implant Devices,26743.5,35,,26743.5,percent of total billed charges,Implant Devices,26743.5,35,,26743.5,percent of total billed charges,Implant Devices,30564,40,,30564,percent of total billed charges,Implant Devices,26743.5,70,,26743.5,percent of total billed charges,Implant Devices,25979.4,34,,25979.4,percent of total billed charges,Implant Devices,25979.4,34,,25979.4,percent of total billed charges,Implant Devices,26743.5,35,,26743.5,percent of total billed charges,Implant Devices,26743.5,35,,26743.5,percent of total billed charges,Implant Devices,26743.5,35,,26743.5,percent of total billed charges,Implant Devices,26743.5,35,,26743.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,25979.4,34,"If Charge > 2,000, then 34 percent",25979.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,30564,
BARD FAF07050 7X50 FLAIR STENT GRAFT,C1768,HCPCS,,79000227,CDM,278,RC,,,both,,,8890,3508.6,39.4668,,3508.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3022.6,34,,3022.6,percent of total billed charges,Implant Device,3022.6,34,,3022.6,percent of total billed charges,Implant Device,3022.6,34,,3022.6,percent of total billed charges,Implant Device,3022.6,34,,3022.6,percent of total billed charges,Implant Device,3022.6,34,,3022.6,percent of total billed charges,Implant Device,3022.6,34,,3022.6,percent of total billed charges,Implant Device,3111.5,35,,3111.5,percent of total billed charges,Implant Device,3022.6,34,"Charges > $500, x 34%",3022.6,percent of total billed charges,Implant Device,3111.5,35,,3111.5,percent of total billed charges,Implant Devices,3111.5,35,,3111.5,percent of total billed charges,Implant Devices,3111.5,35,,,percent of total billed charges,Implant Devices,3111.5,35,,3111.5,percent of total billed charges,Implant Devices,3111.5,35,,3111.5,percent of total billed charges,Implant Devices,3556,40,,3556,percent of total billed charges,Implant Devices,3111.5,70,,3111.5,percent of total billed charges,Implant Devices,3022.6,34,,3022.6,percent of total billed charges,Implant Devices,3022.6,34,,3022.6,percent of total billed charges,Implant Devices,3111.5,35,,3111.5,percent of total billed charges,Implant Devices,3111.5,35,,3111.5,percent of total billed charges,Implant Devices,3111.5,35,,3111.5,percent of total billed charges,Implant Devices,3111.5,35,,3111.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3022.6,34,"If Charge > 2,000, then 34 percent",3022.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3556,
GORE SBT1601D BIFURCATED GRAFT 40X168CM,C1768,HCPCS,,79001223,CDM,278,RC,,,both,,,2742,1082.18,39.4668,,1082.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,932.28,34,,932.28,percent of total billed charges,Implant Device,932.28,34,,932.28,percent of total billed charges,Implant Device,932.28,34,,932.28,percent of total billed charges,Implant Device,932.28,34,,932.28,percent of total billed charges,Implant Device,932.28,34,,932.28,percent of total billed charges,Implant Device,932.28,34,,932.28,percent of total billed charges,Implant Device,959.7,35,,959.7,percent of total billed charges,Implant Device,932.28,34,"Charges > $500, x 34%",932.28,percent of total billed charges,Implant Device,959.7,35,,959.7,percent of total billed charges,Implant Devices,959.7,35,,959.7,percent of total billed charges,Implant Devices,959.7,35,,,percent of total billed charges,Implant Devices,959.7,35,,959.7,percent of total billed charges,Implant Devices,959.7,35,,959.7,percent of total billed charges,Implant Devices,1096.8,40,,1096.8,percent of total billed charges,Implant Devices,959.7,70,,959.7,percent of total billed charges,Implant Devices,932.28,34,,932.28,percent of total billed charges,Implant Devices,932.28,34,,932.28,percent of total billed charges,Implant Devices,959.7,35,,959.7,percent of total billed charges,Implant Devices,959.7,35,,959.7,percent of total billed charges,Implant Devices,959.7,35,,959.7,percent of total billed charges,Implant Devices,959.7,35,,959.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,932.28,34,"If Charge > 2,000, then 34 percent",932.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1096.8,
GORE HT060040A GRAFT 6X40,C1768,HCPCS,,79001506,CDM,278,RC,,,both,,,3738,1475.27,39.4668,,1475.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1270.92,34,,1270.92,percent of total billed charges,Implant Device,1270.92,34,,1270.92,percent of total billed charges,Implant Device,1270.92,34,,1270.92,percent of total billed charges,Implant Device,1270.92,34,,1270.92,percent of total billed charges,Implant Device,1270.92,34,,1270.92,percent of total billed charges,Implant Device,1270.92,34,,1270.92,percent of total billed charges,Implant Device,1308.3,35,,1308.3,percent of total billed charges,Implant Device,1270.92,34,"Charges > $500, x 34%",1270.92,percent of total billed charges,Implant Device,1308.3,35,,1308.3,percent of total billed charges,Implant Devices,1308.3,35,,1308.3,percent of total billed charges,Implant Devices,1308.3,35,,,percent of total billed charges,Implant Devices,1308.3,35,,1308.3,percent of total billed charges,Implant Devices,1308.3,35,,1308.3,percent of total billed charges,Implant Devices,1495.2,40,,1495.2,percent of total billed charges,Implant Devices,1308.3,70,,1308.3,percent of total billed charges,Implant Devices,1270.92,34,,1270.92,percent of total billed charges,Implant Devices,1270.92,34,,1270.92,percent of total billed charges,Implant Devices,1308.3,35,,1308.3,percent of total billed charges,Implant Devices,1308.3,35,,1308.3,percent of total billed charges,Implant Devices,1308.3,35,,1308.3,percent of total billed charges,Implant Devices,1308.3,35,,1308.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1270.92,34,"If Charge > 2,000, then 34 percent",1270.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1495.2,
GORE HT060080A GRAFT 6X80,C1768,HCPCS,,79001507,CDM,278,RC,,,both,,,6990,2758.73,39.4668,,2758.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2446.5,35,,2446.5,percent of total billed charges,Implant Device,2376.6,34,"Charges > $500, x 34%",2376.6,percent of total billed charges,Implant Device,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2796,40,,2796,percent of total billed charges,Implant Devices,2446.5,70,,2446.5,percent of total billed charges,Implant Devices,2376.6,34,,2376.6,percent of total billed charges,Implant Devices,2376.6,34,,2376.6,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2376.6,34,"If Charge > 2,000, then 34 percent",2376.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2796,
GORE HT080040A GRAFT 8X40,C1768,HCPCS,,79001508,CDM,278,RC,,,both,,,3636,1435.01,39.4668,,1435.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1236.24,34,,1236.24,percent of total billed charges,Implant Device,1236.24,34,,1236.24,percent of total billed charges,Implant Device,1236.24,34,,1236.24,percent of total billed charges,Implant Device,1236.24,34,,1236.24,percent of total billed charges,Implant Device,1236.24,34,,1236.24,percent of total billed charges,Implant Device,1236.24,34,,1236.24,percent of total billed charges,Implant Device,1272.6,35,,1272.6,percent of total billed charges,Implant Device,1236.24,34,"Charges > $500, x 34%",1236.24,percent of total billed charges,Implant Device,1272.6,35,,1272.6,percent of total billed charges,Implant Devices,1272.6,35,,1272.6,percent of total billed charges,Implant Devices,1272.6,35,,,percent of total billed charges,Implant Devices,1272.6,35,,1272.6,percent of total billed charges,Implant Devices,1272.6,35,,1272.6,percent of total billed charges,Implant Devices,1454.4,40,,1454.4,percent of total billed charges,Implant Devices,1272.6,70,,1272.6,percent of total billed charges,Implant Devices,1236.24,34,,1236.24,percent of total billed charges,Implant Devices,1236.24,34,,1236.24,percent of total billed charges,Implant Devices,1272.6,35,,1272.6,percent of total billed charges,Implant Devices,1272.6,35,,1272.6,percent of total billed charges,Implant Devices,1272.6,35,,1272.6,percent of total billed charges,Implant Devices,1272.6,35,,1272.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1236.24,34,"If Charge > 2,000, then 34 percent",1236.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1454.4,
GORE HT080080A GRAFT 8X80,C1768,HCPCS,,79001509,CDM,278,RC,,,both,,,6990,2758.73,39.4668,,2758.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2376.6,34,,2376.6,percent of total billed charges,Implant Device,2446.5,35,,2446.5,percent of total billed charges,Implant Device,2376.6,34,"Charges > $500, x 34%",2376.6,percent of total billed charges,Implant Device,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2796,40,,2796,percent of total billed charges,Implant Devices,2446.5,70,,2446.5,percent of total billed charges,Implant Devices,2376.6,34,,2376.6,percent of total billed charges,Implant Devices,2376.6,34,,2376.6,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,2446.5,35,,2446.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2376.6,34,"If Charge > 2,000, then 34 percent",2376.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2796,
GORE IRST06080080L GRAFT 6MM X 80CM,C1768,HCPCS,,79001511,CDM,278,RC,,,both,,,4132,1630.77,39.4668,,1630.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1404.88,34,,1404.88,percent of total billed charges,Implant Device,1404.88,34,,1404.88,percent of total billed charges,Implant Device,1404.88,34,,1404.88,percent of total billed charges,Implant Device,1404.88,34,,1404.88,percent of total billed charges,Implant Device,1404.88,34,,1404.88,percent of total billed charges,Implant Device,1404.88,34,,1404.88,percent of total billed charges,Implant Device,1446.2,35,,1446.2,percent of total billed charges,Implant Device,1404.88,34,"Charges > $500, x 34%",1404.88,percent of total billed charges,Implant Device,1446.2,35,,1446.2,percent of total billed charges,Implant Devices,1446.2,35,,1446.2,percent of total billed charges,Implant Devices,1446.2,35,,,percent of total billed charges,Implant Devices,1446.2,35,,1446.2,percent of total billed charges,Implant Devices,1446.2,35,,1446.2,percent of total billed charges,Implant Devices,1652.8,40,,1652.8,percent of total billed charges,Implant Devices,1446.2,70,,1446.2,percent of total billed charges,Implant Devices,1404.88,34,,1404.88,percent of total billed charges,Implant Devices,1404.88,34,,1404.88,percent of total billed charges,Implant Devices,1446.2,35,,1446.2,percent of total billed charges,Implant Devices,1446.2,35,,1446.2,percent of total billed charges,Implant Devices,1446.2,35,,1446.2,percent of total billed charges,Implant Devices,1446.2,35,,1446.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1404.88,34,"If Charge > 2,000, then 34 percent",1404.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1652.8,
BARD DFM8006SC GRAFT DISTAFLO 6 X 80,C1768,HCPCS,,79001512,CDM,278,RC,,,both,,,8098,3196.02,39.4668,,3196.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2753.32,34,,2753.32,percent of total billed charges,Implant Device,2753.32,34,,2753.32,percent of total billed charges,Implant Device,2753.32,34,,2753.32,percent of total billed charges,Implant Device,2753.32,34,,2753.32,percent of total billed charges,Implant Device,2753.32,34,,2753.32,percent of total billed charges,Implant Device,2753.32,34,,2753.32,percent of total billed charges,Implant Device,2834.3,35,,2834.3,percent of total billed charges,Implant Device,2753.32,34,"Charges > $500, x 34%",2753.32,percent of total billed charges,Implant Device,2834.3,35,,2834.3,percent of total billed charges,Implant Devices,2834.3,35,,2834.3,percent of total billed charges,Implant Devices,2834.3,35,,,percent of total billed charges,Implant Devices,2834.3,35,,2834.3,percent of total billed charges,Implant Devices,2834.3,35,,2834.3,percent of total billed charges,Implant Devices,3239.2,40,,3239.2,percent of total billed charges,Implant Devices,2834.3,70,,2834.3,percent of total billed charges,Implant Devices,2753.32,34,,2753.32,percent of total billed charges,Implant Devices,2753.32,34,,2753.32,percent of total billed charges,Implant Devices,2834.3,35,,2834.3,percent of total billed charges,Implant Devices,2834.3,35,,2834.3,percent of total billed charges,Implant Devices,2834.3,35,,2834.3,percent of total billed charges,Implant Devices,2834.3,35,,2834.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2753.32,34,"If Charge > 2,000, then 34 percent",2753.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3239.2,
ATRIUM 25052 GRAFT FLIXENE VASCULAR 6X50,C1768,HCPCS,,79001513,CDM,278,RC,,,both,,,3145,1241.23,39.4668,,1241.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1069.3,34,,1069.3,percent of total billed charges,Implant Device,1069.3,34,,1069.3,percent of total billed charges,Implant Device,1069.3,34,,1069.3,percent of total billed charges,Implant Device,1069.3,34,,1069.3,percent of total billed charges,Implant Device,1069.3,34,,1069.3,percent of total billed charges,Implant Device,1069.3,34,,1069.3,percent of total billed charges,Implant Device,1100.75,35,,1100.75,percent of total billed charges,Implant Device,1069.3,34,"Charges > $500, x 34%",1069.3,percent of total billed charges,Implant Device,1100.75,35,,1100.75,percent of total billed charges,Implant Devices,1100.75,35,,1100.75,percent of total billed charges,Implant Devices,1100.75,35,,,percent of total billed charges,Implant Devices,1100.75,35,,1100.75,percent of total billed charges,Implant Devices,1100.75,35,,1100.75,percent of total billed charges,Implant Devices,1258,40,,1258,percent of total billed charges,Implant Devices,1100.75,70,,1100.75,percent of total billed charges,Implant Devices,1069.3,34,,1069.3,percent of total billed charges,Implant Devices,1069.3,34,,1069.3,percent of total billed charges,Implant Devices,1100.75,35,,1100.75,percent of total billed charges,Implant Devices,1100.75,35,,1100.75,percent of total billed charges,Implant Devices,1100.75,35,,1100.75,percent of total billed charges,Implant Devices,1100.75,35,,1100.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1069.3,34,"If Charge > 2,000, then 34 percent",1069.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1258,
GORE 0650HYB0905A GRAFT HYBRID LARGE,C1768,HCPCS,,79001514,CDM,278,RC,,,both,,,7350,2900.81,39.4668,,2900.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Device,2499,34,"Charges > $500, x 34%",2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2940,40,,2940,percent of total billed charges,Implant Devices,2572.5,70,,2572.5,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2499,34,"If Charge > 2,000, then 34 percent",2499,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
GORE 0650HYB0605A GRAFT HYBRID SMALL,C1768,HCPCS,,79001515,CDM,278,RC,,,both,,,7350,2900.81,39.4668,,2900.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Device,2499,34,"Charges > $500, x 34%",2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2940,40,,2940,percent of total billed charges,Implant Devices,2572.5,70,,2572.5,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2499,34,"If Charge > 2,000, then 34 percent",2499,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
GORE STO604 GRAFT STRETCH 6X40,C1768,HCPCS,,79001520,CDM,278,RC,,,both,,,1774,700.14,39.4668,,700.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.16,34,,603.16,percent of total billed charges,Implant Device,603.16,34,,603.16,percent of total billed charges,Implant Device,603.16,34,,603.16,percent of total billed charges,Implant Device,603.16,34,,603.16,percent of total billed charges,Implant Device,603.16,34,,603.16,percent of total billed charges,Implant Device,603.16,34,,603.16,percent of total billed charges,Implant Device,620.9,35,,620.9,percent of total billed charges,Implant Device,603.16,34,"Charges > $500, x 34%",603.16,percent of total billed charges,Implant Device,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,709.6,40,,709.6,percent of total billed charges,Implant Devices,620.9,70,,620.9,percent of total billed charges,Implant Devices,603.16,34,,603.16,percent of total billed charges,Implant Devices,603.16,34,,603.16,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,709.6,
GORE SRD06005045L GRAFT STRETCH 6X45,C1768,HCPCS,,79001521,CDM,278,RC,,,both,,,2368,934.57,39.4668,,934.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,805.12,34,,805.12,percent of total billed charges,Implant Device,805.12,34,,805.12,percent of total billed charges,Implant Device,805.12,34,,805.12,percent of total billed charges,Implant Device,805.12,34,,805.12,percent of total billed charges,Implant Device,805.12,34,,805.12,percent of total billed charges,Implant Device,805.12,34,,805.12,percent of total billed charges,Implant Device,828.8,35,,828.8,percent of total billed charges,Implant Device,805.12,34,"Charges > $500, x 34%",805.12,percent of total billed charges,Implant Device,828.8,35,,828.8,percent of total billed charges,Implant Devices,828.8,35,,828.8,percent of total billed charges,Implant Devices,828.8,35,,,percent of total billed charges,Implant Devices,828.8,35,,828.8,percent of total billed charges,Implant Devices,828.8,35,,828.8,percent of total billed charges,Implant Devices,947.2,40,,947.2,percent of total billed charges,Implant Devices,828.8,70,,828.8,percent of total billed charges,Implant Devices,805.12,34,,805.12,percent of total billed charges,Implant Devices,805.12,34,,805.12,percent of total billed charges,Implant Devices,828.8,35,,828.8,percent of total billed charges,Implant Devices,828.8,35,,828.8,percent of total billed charges,Implant Devices,828.8,35,,828.8,percent of total billed charges,Implant Devices,828.8,35,,828.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,805.12,34,"If Charge > 2,000, then 34 percent",805.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,947.2,
GORE V47050L GRAFT TAPERED 47 X 50CM,C1768,HCPCS,,79001522,CDM,278,RC,,,both,,,1672,659.88,39.4668,,659.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,568.48,34,,568.48,percent of total billed charges,Implant Device,568.48,34,,568.48,percent of total billed charges,Implant Device,568.48,34,,568.48,percent of total billed charges,Implant Device,568.48,34,,568.48,percent of total billed charges,Implant Device,568.48,34,,568.48,percent of total billed charges,Implant Device,568.48,34,,568.48,percent of total billed charges,Implant Device,585.2,35,,585.2,percent of total billed charges,Implant Device,568.48,34,"Charges > $500, x 34%",568.48,percent of total billed charges,Implant Device,585.2,35,,585.2,percent of total billed charges,Implant Devices,585.2,35,,585.2,percent of total billed charges,Implant Devices,585.2,35,,,percent of total billed charges,Implant Devices,585.2,35,,585.2,percent of total billed charges,Implant Devices,585.2,35,,585.2,percent of total billed charges,Implant Devices,668.8,40,,668.8,percent of total billed charges,Implant Devices,585.2,70,,585.2,percent of total billed charges,Implant Devices,568.48,34,,568.48,percent of total billed charges,Implant Devices,568.48,34,,568.48,percent of total billed charges,Implant Devices,585.2,35,,585.2,percent of total billed charges,Implant Devices,585.2,35,,585.2,percent of total billed charges,Implant Devices,585.2,35,,585.2,percent of total billed charges,Implant Devices,585.2,35,,585.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,668.8,
GORE ST0608 GRAFT THIN WALL STRETCH 6X80,C1768,HCPCS,,79001523,CDM,278,RC,,,both,,,3174,1252.68,39.4668,,1252.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1110.9,35,,1110.9,percent of total billed charges,Implant Device,1079.16,34,"Charges > $500, x 34%",1079.16,percent of total billed charges,Implant Device,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1269.6,40,,1269.6,percent of total billed charges,Implant Devices,1110.9,70,,1110.9,percent of total billed charges,Implant Devices,1079.16,34,,1079.16,percent of total billed charges,Implant Devices,1079.16,34,,1079.16,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1079.16,34,"If Charge > 2,000, then 34 percent",1079.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1269.6,
GORE ST0804 GRAFT THIN WALL STRETCH 8X40,C1768,HCPCS,,79001524,CDM,278,RC,,,both,,,1774,700.14,39.4668,,700.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.16,34,,603.16,percent of total billed charges,Implant Device,603.16,34,,603.16,percent of total billed charges,Implant Device,603.16,34,,603.16,percent of total billed charges,Implant Device,603.16,34,,603.16,percent of total billed charges,Implant Device,603.16,34,,603.16,percent of total billed charges,Implant Device,603.16,34,,603.16,percent of total billed charges,Implant Device,620.9,35,,620.9,percent of total billed charges,Implant Device,603.16,34,"Charges > $500, x 34%",603.16,percent of total billed charges,Implant Device,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,709.6,40,,709.6,percent of total billed charges,Implant Devices,620.9,70,,620.9,percent of total billed charges,Implant Devices,603.16,34,,603.16,percent of total billed charges,Implant Devices,603.16,34,,603.16,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,620.9,35,,620.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,709.6,
GORE ST0808 GRAFT THIN WALL STRETCH 8X80,C1768,HCPCS,,79001525,CDM,278,RC,,,both,,,3318,1309.51,39.4668,,1309.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1128.12,34,,1128.12,percent of total billed charges,Implant Device,1161.3,35,,1161.3,percent of total billed charges,Implant Device,1128.12,34,"Charges > $500, x 34%",1128.12,percent of total billed charges,Implant Device,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1327.2,40,,1327.2,percent of total billed charges,Implant Devices,1161.3,70,,1161.3,percent of total billed charges,Implant Devices,1128.12,34,,1128.12,percent of total billed charges,Implant Devices,1128.12,34,,1128.12,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,1161.3,35,,1161.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1128.12,34,"If Charge > 2,000, then 34 percent",1128.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1327.2,
GORE VT06080L GRAFT VASC THIN WALL 6MM,C1768,HCPCS,,79001526,CDM,278,RC,,,both,,,2628,1037.19,39.4668,,1037.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,893.52,34,,893.52,percent of total billed charges,Implant Device,893.52,34,,893.52,percent of total billed charges,Implant Device,893.52,34,,893.52,percent of total billed charges,Implant Device,893.52,34,,893.52,percent of total billed charges,Implant Device,893.52,34,,893.52,percent of total billed charges,Implant Device,893.52,34,,893.52,percent of total billed charges,Implant Device,919.8,35,,919.8,percent of total billed charges,Implant Device,893.52,34,"Charges > $500, x 34%",893.52,percent of total billed charges,Implant Device,919.8,35,,919.8,percent of total billed charges,Implant Devices,919.8,35,,919.8,percent of total billed charges,Implant Devices,919.8,35,,,percent of total billed charges,Implant Devices,919.8,35,,919.8,percent of total billed charges,Implant Devices,919.8,35,,919.8,percent of total billed charges,Implant Devices,1051.2,40,,1051.2,percent of total billed charges,Implant Devices,919.8,70,,919.8,percent of total billed charges,Implant Devices,893.52,34,,893.52,percent of total billed charges,Implant Devices,893.52,34,,893.52,percent of total billed charges,Implant Devices,919.8,35,,919.8,percent of total billed charges,Implant Devices,919.8,35,,919.8,percent of total billed charges,Implant Devices,919.8,35,,919.8,percent of total billed charges,Implant Devices,919.8,35,,919.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,893.52,34,"If Charge > 2,000, then 34 percent",893.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1051.2,
GORE VT08080L GRAFT VASC THIN WALL 8MM,C1768,HCPCS,,79001527,CDM,278,RC,,,both,,,2352,928.26,39.4668,,928.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,799.68,34,,799.68,percent of total billed charges,Implant Device,799.68,34,,799.68,percent of total billed charges,Implant Device,799.68,34,,799.68,percent of total billed charges,Implant Device,799.68,34,,799.68,percent of total billed charges,Implant Device,799.68,34,,799.68,percent of total billed charges,Implant Device,799.68,34,,799.68,percent of total billed charges,Implant Device,823.2,35,,823.2,percent of total billed charges,Implant Device,799.68,34,"Charges > $500, x 34%",799.68,percent of total billed charges,Implant Device,823.2,35,,823.2,percent of total billed charges,Implant Devices,823.2,35,,823.2,percent of total billed charges,Implant Devices,823.2,35,,,percent of total billed charges,Implant Devices,823.2,35,,823.2,percent of total billed charges,Implant Devices,823.2,35,,823.2,percent of total billed charges,Implant Devices,940.8,40,,940.8,percent of total billed charges,Implant Devices,823.2,70,,823.2,percent of total billed charges,Implant Devices,799.68,34,,799.68,percent of total billed charges,Implant Devices,799.68,34,,799.68,percent of total billed charges,Implant Devices,823.2,35,,823.2,percent of total billed charges,Implant Devices,823.2,35,,823.2,percent of total billed charges,Implant Devices,823.2,35,,823.2,percent of total billed charges,Implant Devices,823.2,35,,823.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,799.68,34,"If Charge > 2,000, then 34 percent",799.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,940.8,
MAQUET 85168 HEMASHIELD GRAFT 16X8MM,C1768,HCPCS,,79001531,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
MAQUET 85189 HEMASHIELD GRAFT 18X9MM,C1768,HCPCS,,79001532,CDM,278,RC,,,both,,,2600,1026.14,39.4668,,1026.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,884,34,,884,percent of total billed charges,Implant Device,884,34,,884,percent of total billed charges,Implant Device,884,34,,884,percent of total billed charges,Implant Device,884,34,,884,percent of total billed charges,Implant Device,884,34,,884,percent of total billed charges,Implant Device,884,34,,884,percent of total billed charges,Implant Device,910,35,,910,percent of total billed charges,Implant Device,884,34,"Charges > $500, x 34%",884,percent of total billed charges,Implant Device,910,35,,910,percent of total billed charges,Implant Devices,910,35,,910,percent of total billed charges,Implant Devices,910,35,,,percent of total billed charges,Implant Devices,910,35,,910,percent of total billed charges,Implant Devices,910,35,,910,percent of total billed charges,Implant Devices,1040,40,,1040,percent of total billed charges,Implant Devices,910,70,,910,percent of total billed charges,Implant Devices,884,34,,884,percent of total billed charges,Implant Devices,884,34,,884,percent of total billed charges,Implant Devices,910,35,,910,percent of total billed charges,Implant Devices,910,35,,910,percent of total billed charges,Implant Devices,910,35,,910,percent of total billed charges,Implant Devices,910,35,,910,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,884,34,"If Charge > 2,000, then 34 percent",884,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1040,
BOST SCI 95410 HEMASHIELD GRAFT 10X30CM,C1768,HCPCS,,79001533,CDM,278,RC,,,both,,,1686,665.41,39.4668,,665.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,590.1,35,,590.1,percent of total billed charges,Implant Device,573.24,34,"Charges > $500, x 34%",573.24,percent of total billed charges,Implant Device,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,674.4,40,,674.4,percent of total billed charges,Implant Devices,590.1,70,,590.1,percent of total billed charges,Implant Devices,573.24,34,,573.24,percent of total billed charges,Implant Devices,573.24,34,,573.24,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,674.4,
BOST SCI 95412 HEMASHIELD GRAFT 12X30CM,C1768,HCPCS,,79001534,CDM,278,RC,,,both,,,1686,665.41,39.4668,,665.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,590.1,35,,590.1,percent of total billed charges,Implant Device,573.24,34,"Charges > $500, x 34%",573.24,percent of total billed charges,Implant Device,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,674.4,40,,674.4,percent of total billed charges,Implant Devices,590.1,70,,590.1,percent of total billed charges,Implant Devices,573.24,34,,573.24,percent of total billed charges,Implant Devices,573.24,34,,573.24,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,674.4,
BOST SCI 95214 HEMASHIELD GRAFT 14X30CM,C1768,HCPCS,,79001535,CDM,278,RC,,,both,,,1746,689.09,39.4668,,689.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Device,593.64,34,"Charges > $500, x 34%",593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,698.4,40,,698.4,percent of total billed charges,Implant Devices,611.1,70,,611.1,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,698.4,
BOST SCI 95216 HEMASHIELD GRAFT 16X30CM,C1768,HCPCS,,79001536,CDM,278,RC,,,both,,,1746,689.09,39.4668,,689.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Device,593.64,34,"Charges > $500, x 34%",593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,698.4,40,,698.4,percent of total billed charges,Implant Devices,611.1,70,,611.1,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,698.4,
BOST SCI 95218 HEMASHIELD GRAFT 18X30CM,C1768,HCPCS,,79001537,CDM,278,RC,,,both,,,1746,689.09,39.4668,,689.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Device,593.64,34,"Charges > $500, x 34%",593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,698.4,40,,698.4,percent of total billed charges,Implant Devices,611.1,70,,611.1,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,698.4,
BOST SCI 95220 HEMASHIELD GRAFT 20X30CM,C1768,HCPCS,,79001538,CDM,278,RC,,,both,,,1746,689.09,39.4668,,689.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Device,593.64,34,"Charges > $500, x 34%",593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,698.4,40,,698.4,percent of total billed charges,Implant Devices,611.1,70,,611.1,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,698.4,
BOST SCI 95222 HEMASHIELD GRAFT 22X30CM,C1768,HCPCS,,79001539,CDM,278,RC,,,both,,,1746,689.09,39.4668,,689.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,593.64,34,,593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Device,593.64,34,"Charges > $500, x 34%",593.64,percent of total billed charges,Implant Device,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,698.4,40,,698.4,percent of total billed charges,Implant Devices,611.1,70,,611.1,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,593.64,34,,593.64,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,611.1,35,,611.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,698.4,
BOST SCI 95408 HEMASHIELD GRAFT 8X30CM,C1768,HCPCS,,79001540,CDM,278,RC,,,both,,,1686,665.41,39.4668,,665.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,573.24,34,,573.24,percent of total billed charges,Implant Device,590.1,35,,590.1,percent of total billed charges,Implant Device,573.24,34,"Charges > $500, x 34%",573.24,percent of total billed charges,Implant Device,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,674.4,40,,674.4,percent of total billed charges,Implant Devices,590.1,70,,590.1,percent of total billed charges,Implant Devices,573.24,34,,573.24,percent of total billed charges,Implant Devices,573.24,34,,573.24,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,590.1,35,,590.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,674.4,
GORE SBT1401D HEMASHIELD GRAFT 14 X 7CM,C1768,HCPCS,,79001541,CDM,278,RC,,,both,,,2811,1109.41,39.4668,,1109.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,955.74,34,,955.74,percent of total billed charges,Implant Device,955.74,34,,955.74,percent of total billed charges,Implant Device,955.74,34,,955.74,percent of total billed charges,Implant Device,955.74,34,,955.74,percent of total billed charges,Implant Device,955.74,34,,955.74,percent of total billed charges,Implant Device,955.74,34,,955.74,percent of total billed charges,Implant Device,983.85,35,,983.85,percent of total billed charges,Implant Device,955.74,34,"Charges > $500, x 34%",955.74,percent of total billed charges,Implant Device,983.85,35,,983.85,percent of total billed charges,Implant Devices,983.85,35,,983.85,percent of total billed charges,Implant Devices,983.85,35,,,percent of total billed charges,Implant Devices,983.85,35,,983.85,percent of total billed charges,Implant Devices,983.85,35,,983.85,percent of total billed charges,Implant Devices,1124.4,40,,1124.4,percent of total billed charges,Implant Devices,983.85,70,,983.85,percent of total billed charges,Implant Devices,955.74,34,,955.74,percent of total billed charges,Implant Devices,955.74,34,,955.74,percent of total billed charges,Implant Devices,983.85,35,,983.85,percent of total billed charges,Implant Devices,983.85,35,,983.85,percent of total billed charges,Implant Devices,983.85,35,,983.85,percent of total billed charges,Implant Devices,983.85,35,,983.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,955.74,34,"If Charge > 2,000, then 34 percent",955.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1124.4,
GORE SAX01 STRETCH VASCULAR GRAFT RINGED,C1768,HCPCS,,79001732,CDM,278,RC,,,both,,,6690,2640.33,39.4668,,2640.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2274.6,34,,2274.6,percent of total billed charges,Implant Device,2274.6,34,,2274.6,percent of total billed charges,Implant Device,2274.6,34,,2274.6,percent of total billed charges,Implant Device,2274.6,34,,2274.6,percent of total billed charges,Implant Device,2274.6,34,,2274.6,percent of total billed charges,Implant Device,2274.6,34,,2274.6,percent of total billed charges,Implant Device,2341.5,35,,2341.5,percent of total billed charges,Implant Device,2274.6,34,"Charges > $500, x 34%",2274.6,percent of total billed charges,Implant Device,2341.5,35,,2341.5,percent of total billed charges,Implant Devices,2341.5,35,,2341.5,percent of total billed charges,Implant Devices,2341.5,35,,,percent of total billed charges,Implant Devices,2341.5,35,,2341.5,percent of total billed charges,Implant Devices,2341.5,35,,2341.5,percent of total billed charges,Implant Devices,2676,40,,2676,percent of total billed charges,Implant Devices,2341.5,70,,2341.5,percent of total billed charges,Implant Devices,2274.6,34,,2274.6,percent of total billed charges,Implant Devices,2274.6,34,,2274.6,percent of total billed charges,Implant Devices,2341.5,35,,2341.5,percent of total billed charges,Implant Devices,2341.5,35,,2341.5,percent of total billed charges,Implant Devices,2341.5,35,,2341.5,percent of total billed charges,Implant Devices,2341.5,35,,2341.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2274.6,34,"If Charge > 2,000, then 34 percent",2274.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2676,
GORE SA1803 VASCUALR GRAFT 18X30,C1768,HCPCS,,79001754,CDM,278,RC,,,both,,,1659,654.75,39.4668,,654.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,564.06,34,,564.06,percent of total billed charges,Implant Device,564.06,34,,564.06,percent of total billed charges,Implant Device,564.06,34,,564.06,percent of total billed charges,Implant Device,564.06,34,,564.06,percent of total billed charges,Implant Device,564.06,34,,564.06,percent of total billed charges,Implant Device,564.06,34,,564.06,percent of total billed charges,Implant Device,580.65,35,,580.65,percent of total billed charges,Implant Device,564.06,34,"Charges > $500, x 34%",564.06,percent of total billed charges,Implant Device,580.65,35,,580.65,percent of total billed charges,Implant Devices,580.65,35,,580.65,percent of total billed charges,Implant Devices,580.65,35,,,percent of total billed charges,Implant Devices,580.65,35,,580.65,percent of total billed charges,Implant Devices,580.65,35,,580.65,percent of total billed charges,Implant Devices,663.6,40,,663.6,percent of total billed charges,Implant Devices,580.65,70,,580.65,percent of total billed charges,Implant Devices,564.06,34,,564.06,percent of total billed charges,Implant Devices,564.06,34,,564.06,percent of total billed charges,Implant Devices,580.65,35,,580.65,percent of total billed charges,Implant Devices,580.65,35,,580.65,percent of total billed charges,Implant Devices,580.65,35,,580.65,percent of total billed charges,Implant Devices,580.65,35,,580.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,663.6,
GORE S1004 VASCULAR GRAFT 10 X 40,C1768,HCPCS,,79001755,CDM,278,RC,,,both,,,1491,588.45,39.4668,,588.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,506.94,34,,506.94,percent of total billed charges,Implant Device,506.94,34,,506.94,percent of total billed charges,Implant Device,506.94,34,,506.94,percent of total billed charges,Implant Device,506.94,34,,506.94,percent of total billed charges,Implant Device,506.94,34,,506.94,percent of total billed charges,Implant Device,506.94,34,,506.94,percent of total billed charges,Implant Device,521.85,35,,521.85,percent of total billed charges,Implant Device,506.94,34,"Charges > $500, x 34%",506.94,percent of total billed charges,Implant Device,521.85,35,,521.85,percent of total billed charges,Implant Devices,521.85,35,,521.85,percent of total billed charges,Implant Devices,521.85,35,,,percent of total billed charges,Implant Devices,521.85,35,,521.85,percent of total billed charges,Implant Devices,521.85,35,,521.85,percent of total billed charges,Implant Devices,596.4,40,,596.4,percent of total billed charges,Implant Devices,521.85,70,,521.85,percent of total billed charges,Implant Devices,506.94,34,,506.94,percent of total billed charges,Implant Devices,506.94,34,,506.94,percent of total billed charges,Implant Devices,521.85,35,,521.85,percent of total billed charges,Implant Devices,521.85,35,,521.85,percent of total billed charges,Implant Devices,521.85,35,,521.85,percent of total billed charges,Implant Devices,521.85,35,,521.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,596.4,
GORE V06070L VASCULAR GRAFT 6 X 70 ST,C1768,HCPCS,,79001756,CDM,278,RC,,,both,,,1858,733.29,39.4668,,733.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,631.72,34,,631.72,percent of total billed charges,Implant Device,631.72,34,,631.72,percent of total billed charges,Implant Device,631.72,34,,631.72,percent of total billed charges,Implant Device,631.72,34,,631.72,percent of total billed charges,Implant Device,631.72,34,,631.72,percent of total billed charges,Implant Device,631.72,34,,631.72,percent of total billed charges,Implant Device,650.3,35,,650.3,percent of total billed charges,Implant Device,631.72,34,"Charges > $500, x 34%",631.72,percent of total billed charges,Implant Device,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,743.2,40,,743.2,percent of total billed charges,Implant Devices,650.3,70,,650.3,percent of total billed charges,Implant Devices,631.72,34,,631.72,percent of total billed charges,Implant Devices,631.72,34,,631.72,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,743.2,
GORE V08070L VASCULAR GRAFT 8 X 70 ST,C1768,HCPCS,,79001757,CDM,278,RC,,,both,,,1858,733.29,39.4668,,733.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,631.72,34,,631.72,percent of total billed charges,Implant Device,631.72,34,,631.72,percent of total billed charges,Implant Device,631.72,34,,631.72,percent of total billed charges,Implant Device,631.72,34,,631.72,percent of total billed charges,Implant Device,631.72,34,,631.72,percent of total billed charges,Implant Device,631.72,34,,631.72,percent of total billed charges,Implant Device,650.3,35,,650.3,percent of total billed charges,Implant Device,631.72,34,"Charges > $500, x 34%",631.72,percent of total billed charges,Implant Device,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,743.2,40,,743.2,percent of total billed charges,Implant Devices,650.3,70,,650.3,percent of total billed charges,Implant Devices,631.72,34,,631.72,percent of total billed charges,Implant Devices,631.72,34,,631.72,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,650.3,35,,650.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,743.2,
GORE V47020L VASCULAR GRAFT TAPER 47,C1768,HCPCS,,79001758,CDM,278,RC,,,both,,,666,262.85,39.4668,,262.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,226.44,34,,226.44,percent of total billed charges,Implant Device,233.1,35,,233.1,percent of total billed charges,Implant Device,226.44,34,"Charges > $500, x 34%",226.44,percent of total billed charges,Implant Device,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,266.4,40,,266.4,percent of total billed charges,Implant Devices,233.1,70,,233.1,percent of total billed charges,Implant Devices,226.44,34,,226.44,percent of total billed charges,Implant Devices,226.44,34,,226.44,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,233.1,35,,233.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,266.4,
HEMOSPHERE HERO 1001 VENOUS OUTFLOW COMP,C1768,HCPCS,,79001759,CDM,278,RC,,,both,,,5850,2308.81,39.4668,,2308.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Device,1989,34,"Charges > $500, x 34%",1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2340,40,,2340,percent of total billed charges,Implant Devices,2047.5,70,,2047.5,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1989,34,"If Charge > 2,000, then 34 percent",1989,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2340,
GORE 0650HYB0705A VASCULAR GRAFT,C1768,HCPCS,,79001904,CDM,278,RC,,,both,,,7350,2900.81,39.4668,,2900.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Device,2499,34,"Charges > $500, x 34%",2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2940,40,,2940,percent of total billed charges,Implant Devices,2572.5,70,,2572.5,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2499,34,"If Charge > 2,000, then 34 percent",2499,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
GORE 0650HYB0805A VASCULAR GRAFT,C1768,HCPCS,,79001905,CDM,278,RC,,,both,,,7350,2900.81,39.4668,,2900.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Device,2499,34,"Charges > $500, x 34%",2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2940,40,,2940,percent of total billed charges,Implant Devices,2572.5,70,,2572.5,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2499,34,"If Charge > 2,000, then 34 percent",2499,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
GORE V10040L VASCULAR GRAFT,C1768,HCPCS,,79004211,CDM,278,RC,,,both,,,1630,643.31,39.4668,,643.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,554.2,34,,554.2,percent of total billed charges,Implant Device,554.2,34,,554.2,percent of total billed charges,Implant Device,554.2,34,,554.2,percent of total billed charges,Implant Device,554.2,34,,554.2,percent of total billed charges,Implant Device,554.2,34,,554.2,percent of total billed charges,Implant Device,554.2,34,,554.2,percent of total billed charges,Implant Device,570.5,35,,570.5,percent of total billed charges,Implant Device,554.2,34,"Charges > $500, x 34%",554.2,percent of total billed charges,Implant Device,570.5,35,,570.5,percent of total billed charges,Implant Devices,570.5,35,,570.5,percent of total billed charges,Implant Devices,570.5,35,,,percent of total billed charges,Implant Devices,570.5,35,,570.5,percent of total billed charges,Implant Devices,570.5,35,,570.5,percent of total billed charges,Implant Devices,652,40,,652,percent of total billed charges,Implant Devices,570.5,70,,570.5,percent of total billed charges,Implant Devices,554.2,34,,554.2,percent of total billed charges,Implant Devices,554.2,34,,554.2,percent of total billed charges,Implant Devices,570.5,35,,570.5,percent of total billed charges,Implant Devices,570.5,35,,570.5,percent of total billed charges,Implant Devices,570.5,35,,570.5,percent of total billed charges,Implant Devices,570.5,35,,570.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,652,
GORE ECH060040A VASCULAR GRAFT,C1768,HCPCS,,79005112,CDM,278,RC,,,both,,,3840,1515.53,39.4668,,1515.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1344,35,,1344,percent of total billed charges,Implant Device,1305.6,34,"Charges > $500, x 34%",1305.6,percent of total billed charges,Implant Device,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1536,40,,1536,percent of total billed charges,Implant Devices,1344,70,,1344,percent of total billed charges,Implant Devices,1305.6,34,,1305.6,percent of total billed charges,Implant Devices,1305.6,34,,1305.6,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1305.6,34,"If Charge > 2,000, then 34 percent",1305.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1536,
GORE RLT351414 EXCLUDER ENDOPROS GRAFT,C1768,HCPCS,,79005472,CDM,278,RC,,,both,,,32250,12728.04,39.4668,,12728.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,11287.5,35,,11287.5,percent of total billed charges,Implant Device,10965,34,"Charges > $500, x 34%",10965,percent of total billed charges,Implant Device,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,12900,40,,12900,percent of total billed charges,Implant Devices,11287.5,70,,11287.5,percent of total billed charges,Implant Devices,10965,34,,10965,percent of total billed charges,Implant Devices,10965,34,,10965,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10965,34,"If Charge > 2,000, then 34 percent",10965,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12900,
GORE PLC181200 EXCLUDER ENDOPROS GRAFT,C1768,HCPCS,,79005473,CDM,278,RC,,,both,,,12600,4972.82,39.4668,,4972.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4410,35,,4410,percent of total billed charges,Implant Device,4284,34,"Charges > $500, x 34%",4284,percent of total billed charges,Implant Device,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,5040,40,,5040,percent of total billed charges,Implant Devices,4410,70,,4410,percent of total billed charges,Implant Devices,4284,34,,4284,percent of total billed charges,Implant Devices,4284,34,,4284,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4284,34,"If Charge > 2,000, then 34 percent",4284,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5040,
BARD D8006C DISTAFLO VASCULAR GRAFT,C1768,HCPCS,,79005624,CDM,278,RC,,,both,,,5231,2064.51,39.4668,,2064.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1778.54,34,,1778.54,percent of total billed charges,Implant Device,1778.54,34,,1778.54,percent of total billed charges,Implant Device,1778.54,34,,1778.54,percent of total billed charges,Implant Device,1778.54,34,,1778.54,percent of total billed charges,Implant Device,1778.54,34,,1778.54,percent of total billed charges,Implant Device,1778.54,34,,1778.54,percent of total billed charges,Implant Device,1830.85,35,,1830.85,percent of total billed charges,Implant Device,1778.54,34,"Charges > $500, x 34%",1778.54,percent of total billed charges,Implant Device,1830.85,35,,1830.85,percent of total billed charges,Implant Devices,1830.85,35,,1830.85,percent of total billed charges,Implant Devices,1830.85,35,,,percent of total billed charges,Implant Devices,1830.85,35,,1830.85,percent of total billed charges,Implant Devices,1830.85,35,,1830.85,percent of total billed charges,Implant Devices,2092.4,40,,2092.4,percent of total billed charges,Implant Devices,1830.85,70,,1830.85,percent of total billed charges,Implant Devices,1778.54,34,,1778.54,percent of total billed charges,Implant Devices,1778.54,34,,1778.54,percent of total billed charges,Implant Devices,1830.85,35,,1830.85,percent of total billed charges,Implant Devices,1830.85,35,,1830.85,percent of total billed charges,Implant Devices,1830.85,35,,1830.85,percent of total billed charges,Implant Devices,1830.85,35,,1830.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1778.54,34,"If Charge > 2,000, then 34 percent",1778.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2092.4,
ATRIUM 085201 HEMASHIELD VASCULAR GRAFT,C1768,HCPCS,,79005707,CDM,278,RC,,,both,,,2437,961.81,39.4668,,961.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,828.58,34,,828.58,percent of total billed charges,Implant Device,828.58,34,,828.58,percent of total billed charges,Implant Device,828.58,34,,828.58,percent of total billed charges,Implant Device,828.58,34,,828.58,percent of total billed charges,Implant Device,828.58,34,,828.58,percent of total billed charges,Implant Device,828.58,34,,828.58,percent of total billed charges,Implant Device,852.95,35,,852.95,percent of total billed charges,Implant Device,828.58,34,"Charges > $500, x 34%",828.58,percent of total billed charges,Implant Device,852.95,35,,852.95,percent of total billed charges,Implant Devices,852.95,35,,852.95,percent of total billed charges,Implant Devices,852.95,35,,,percent of total billed charges,Implant Devices,852.95,35,,852.95,percent of total billed charges,Implant Devices,852.95,35,,852.95,percent of total billed charges,Implant Devices,974.8,40,,974.8,percent of total billed charges,Implant Devices,852.95,70,,852.95,percent of total billed charges,Implant Devices,828.58,34,,828.58,percent of total billed charges,Implant Devices,828.58,34,,828.58,percent of total billed charges,Implant Devices,852.95,35,,852.95,percent of total billed charges,Implant Devices,852.95,35,,852.95,percent of total billed charges,Implant Devices,852.95,35,,852.95,percent of total billed charges,Implant Devices,852.95,35,,852.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,828.58,34,"If Charge > 2,000, then 34 percent",828.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,974.8,
GORE TGU404010 THORACIC ENDOPROS GRAFT,C1768,HCPCS,,79006070,CDM,278,RC,,,both,,,46500,18352.06,39.4668,,18352.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15810,34,,15810,percent of total billed charges,Implant Device,15810,34,,15810,percent of total billed charges,Implant Device,15810,34,,15810,percent of total billed charges,Implant Device,15810,34,,15810,percent of total billed charges,Implant Device,15810,34,,15810,percent of total billed charges,Implant Device,15810,34,,15810,percent of total billed charges,Implant Device,16275,35,,16275,percent of total billed charges,Implant Device,15810,34,"Charges > $500, x 34%",15810,percent of total billed charges,Implant Device,16275,35,,16275,percent of total billed charges,Implant Devices,16275,35,,16275,percent of total billed charges,Implant Devices,16275,35,,,percent of total billed charges,Implant Devices,16275,35,,16275,percent of total billed charges,Implant Devices,16275,35,,16275,percent of total billed charges,Implant Devices,18600,40,,18600,percent of total billed charges,Implant Devices,16275,70,,16275,percent of total billed charges,Implant Devices,15810,34,,15810,percent of total billed charges,Implant Devices,15810,34,,15810,percent of total billed charges,Implant Devices,16275,35,,16275,percent of total billed charges,Implant Devices,16275,35,,16275,percent of total billed charges,Implant Devices,16275,35,,16275,percent of total billed charges,Implant Devices,16275,35,,16275,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,15810,34,"If Charge > 2,000, then 34 percent",15810,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18600,
GORE 0650HYB0810A VASCULAR GRAFT 8X10,C1768,HCPCS,,79006224,CDM,278,RC,,,both,,,8340,3291.53,39.4668,,3291.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2919,35,,2919,percent of total billed charges,Implant Device,2835.6,34,"Charges > $500, x 34%",2835.6,percent of total billed charges,Implant Device,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,3336,40,,3336,percent of total billed charges,Implant Devices,2919,70,,2919,percent of total billed charges,Implant Devices,2835.6,34,,2835.6,percent of total billed charges,Implant Devices,2835.6,34,,2835.6,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2835.6,34,"If Charge > 2,000, then 34 percent",2835.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3336,
GORE 0650HYB0910A VASCULAR GRAFT 9X10,C1768,HCPCS,,79006225,CDM,278,RC,,,both,,,8340,3291.53,39.4668,,3291.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2919,35,,2919,percent of total billed charges,Implant Device,2835.6,34,"Charges > $500, x 34%",2835.6,percent of total billed charges,Implant Device,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,3336,40,,3336,percent of total billed charges,Implant Devices,2919,70,,2919,percent of total billed charges,Implant Devices,2835.6,34,,2835.6,percent of total billed charges,Implant Devices,2835.6,34,,2835.6,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2835.6,34,"If Charge > 2,000, then 34 percent",2835.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3336,
GORE 0650HYB0610A VASCULAR GRAFT 6X10,C1768,HCPCS,,79006232,CDM,278,RC,,,both,,,8340,3291.53,39.4668,,3291.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2835.6,34,,2835.6,percent of total billed charges,Implant Device,2919,35,,2919,percent of total billed charges,Implant Device,2835.6,34,"Charges > $500, x 34%",2835.6,percent of total billed charges,Implant Device,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,3336,40,,3336,percent of total billed charges,Implant Devices,2919,70,,2919,percent of total billed charges,Implant Devices,2835.6,34,,2835.6,percent of total billed charges,Implant Devices,2835.6,34,,2835.6,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,2919,35,,2919,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2835.6,34,"If Charge > 2,000, then 34 percent",2835.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3336,
GORE RLT311413 EXCLUDER ENDOPROS GRAFT,C1768,HCPCS,,79006626,CDM,278,RC,,,both,,,32250,12728.04,39.4668,,12728.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,11287.5,35,,11287.5,percent of total billed charges,Implant Device,10965,34,"Charges > $500, x 34%",10965,percent of total billed charges,Implant Device,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,12900,40,,12900,percent of total billed charges,Implant Devices,11287.5,70,,11287.5,percent of total billed charges,Implant Devices,10965,34,,10965,percent of total billed charges,Implant Devices,10965,34,,10965,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10965,34,"If Charge > 2,000, then 34 percent",10965,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12900,
GORE RLT261216 EXCLUDER ENDOPROS GRAFT,C1768,HCPCS,,79006815,CDM,278,RC,,,both,,,31500,12432.04,39.4668,,12432.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Device,10710,34,"Charges > $500, x 34%",10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,12600,40,,12600,percent of total billed charges,Implant Devices,11025,70,,11025,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10710,34,"If Charge > 2,000, then 34 percent",10710,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12600,
GORE RLT311415 EXCLUDER ENDOPROS GRAFT,C1768,HCPCS,,79007078,CDM,278,RC,,,both,,,32250,12728.04,39.4668,,12728.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,11287.5,35,,11287.5,percent of total billed charges,Implant Device,10965,34,"Charges > $500, x 34%",10965,percent of total billed charges,Implant Device,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,12900,40,,12900,percent of total billed charges,Implant Devices,11287.5,70,,11287.5,percent of total billed charges,Implant Devices,10965,34,,10965,percent of total billed charges,Implant Devices,10965,34,,10965,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10965,34,"If Charge > 2,000, then 34 percent",10965,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12900,
GORE TGU454510 THORACIC ENDOPRS 45X45X10,C1768,HCPCS,,79007432,CDM,278,RC,,,both,,,47625,18796.06,39.4668,,18796.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,16192.5,34,,16192.5,percent of total billed charges,Implant Device,16192.5,34,,16192.5,percent of total billed charges,Implant Device,16192.5,34,,16192.5,percent of total billed charges,Implant Device,16192.5,34,,16192.5,percent of total billed charges,Implant Device,16192.5,34,,16192.5,percent of total billed charges,Implant Device,16192.5,34,,16192.5,percent of total billed charges,Implant Device,16668.75,35,,16668.75,percent of total billed charges,Implant Device,16192.5,34,"Charges > $500, x 34%",16192.5,percent of total billed charges,Implant Device,16668.75,35,,16668.75,percent of total billed charges,Implant Devices,16668.75,35,,16668.75,percent of total billed charges,Implant Devices,16668.75,35,,,percent of total billed charges,Implant Devices,16668.75,35,,16668.75,percent of total billed charges,Implant Devices,16668.75,35,,16668.75,percent of total billed charges,Implant Devices,19050,40,,19050,percent of total billed charges,Implant Devices,16668.75,70,,16668.75,percent of total billed charges,Implant Devices,16192.5,34,,16192.5,percent of total billed charges,Implant Devices,16192.5,34,,16192.5,percent of total billed charges,Implant Devices,16668.75,35,,16668.75,percent of total billed charges,Implant Devices,16668.75,35,,16668.75,percent of total billed charges,Implant Devices,16668.75,35,,16668.75,percent of total billed charges,Implant Devices,16668.75,35,,16668.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,16192.5,34,"If Charge > 2,000, then 34 percent",16192.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,19050,
GORE RLT281412 EXCLUDER ENDOPROS GRAFT,C1768,HCPCS,,79007433,CDM,278,RC,,,both,,,35538,14025.71,39.4668,,14025.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12438.3,35,,12438.3,percent of total billed charges,Implant Device,12082.92,34,"Charges > $500, x 34%",12082.92,percent of total billed charges,Implant Device,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,14215.2,40,,14215.2,percent of total billed charges,Implant Devices,12438.3,70,,12438.3,percent of total billed charges,Implant Devices,12082.92,34,,12082.92,percent of total billed charges,Implant Devices,12082.92,34,,12082.92,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,12082.92,34,"If Charge > 2,000, then 34 percent",12082.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14215.2,
GORE RLT261414 EXCLUDER ENDOPROS GRAFT,C1768,HCPCS,,79007464,CDM,278,RC,,,both,,,33825,13349.65,39.4668,,13349.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11838.75,35,,11838.75,percent of total billed charges,Implant Device,11500.5,34,"Charges > $500, x 34%",11500.5,percent of total billed charges,Implant Device,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,13530,40,,13530,percent of total billed charges,Implant Devices,11838.75,70,,11838.75,percent of total billed charges,Implant Devices,11500.5,34,,11500.5,percent of total billed charges,Implant Devices,11500.5,34,,11500.5,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11500.5,34,"If Charge > 2,000, then 34 percent",11500.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13530,
GORE RLT231412 EXCLUDER ENDOPROS GRAFT,C1768,HCPCS,,79008073,CDM,278,RC,,,both,,,33000,13024.04,39.4668,,13024.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11550,35,,11550,percent of total billed charges,Implant Device,11220,34,"Charges > $500, x 34%",11220,percent of total billed charges,Implant Device,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,13200,40,,13200,percent of total billed charges,Implant Devices,11550,70,,11550,percent of total billed charges,Implant Devices,11220,34,,11220,percent of total billed charges,Implant Devices,11220,34,,11220,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11220,34,"If Charge > 2,000, then 34 percent",11220,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13200,
GORE RLT281414 EXCLUDER ENDO VASC GRAFT,C1768,HCPCS,,79008163,CDM,278,RC,,,both,,,33000,13024.04,39.4668,,13024.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11220,34,,11220,percent of total billed charges,Implant Device,11550,35,,11550,percent of total billed charges,Implant Device,11220,34,"Charges > $500, x 34%",11220,percent of total billed charges,Implant Device,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,13200,40,,13200,percent of total billed charges,Implant Devices,11550,70,,11550,percent of total billed charges,Implant Devices,11220,34,,11220,percent of total billed charges,Implant Devices,11220,34,,11220,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,11550,35,,11550,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11220,34,"If Charge > 2,000, then 34 percent",11220,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13200,
GORE SBT1602 BIFURCATED GRAFT 16X8MM,C1768,HCPCS,,79008771,CDM,278,RC,,,both,,,3513,1386.47,39.4668,,1386.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1194.42,34,,1194.42,percent of total billed charges,Implant Device,1194.42,34,,1194.42,percent of total billed charges,Implant Device,1194.42,34,,1194.42,percent of total billed charges,Implant Device,1194.42,34,,1194.42,percent of total billed charges,Implant Device,1194.42,34,,1194.42,percent of total billed charges,Implant Device,1194.42,34,,1194.42,percent of total billed charges,Implant Device,1229.55,35,,1229.55,percent of total billed charges,Implant Device,1194.42,34,"Charges > $500, x 34%",1194.42,percent of total billed charges,Implant Device,1229.55,35,,1229.55,percent of total billed charges,Implant Devices,1229.55,35,,1229.55,percent of total billed charges,Implant Devices,1229.55,35,,,percent of total billed charges,Implant Devices,1229.55,35,,1229.55,percent of total billed charges,Implant Devices,1229.55,35,,1229.55,percent of total billed charges,Implant Devices,1405.2,40,,1405.2,percent of total billed charges,Implant Devices,1229.55,70,,1229.55,percent of total billed charges,Implant Devices,1194.42,34,,1194.42,percent of total billed charges,Implant Devices,1194.42,34,,1194.42,percent of total billed charges,Implant Devices,1229.55,35,,1229.55,percent of total billed charges,Implant Devices,1229.55,35,,1229.55,percent of total billed charges,Implant Devices,1229.55,35,,1229.55,percent of total billed charges,Implant Devices,1229.55,35,,1229.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1194.42,34,"If Charge > 2,000, then 34 percent",1194.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1405.2,
GORE SA1602 VASCULAR GRAFT 16MM 20CM,C1768,HCPCS,,79008772,CDM,278,RC,,,both,,,1164,459.39,39.4668,,459.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,395.76,34,,395.76,percent of total billed charges,Implant Device,395.76,34,,395.76,percent of total billed charges,Implant Device,395.76,34,,395.76,percent of total billed charges,Implant Device,395.76,34,,395.76,percent of total billed charges,Implant Device,395.76,34,,395.76,percent of total billed charges,Implant Device,395.76,34,,395.76,percent of total billed charges,Implant Device,407.4,35,,407.4,percent of total billed charges,Implant Device,395.76,34,"Charges > $500, x 34%",395.76,percent of total billed charges,Implant Device,407.4,35,,407.4,percent of total billed charges,Implant Devices,407.4,35,,407.4,percent of total billed charges,Implant Devices,407.4,35,,,percent of total billed charges,Implant Devices,407.4,35,,407.4,percent of total billed charges,Implant Devices,407.4,35,,407.4,percent of total billed charges,Implant Devices,465.6,40,,465.6,percent of total billed charges,Implant Devices,407.4,70,,407.4,percent of total billed charges,Implant Devices,395.76,34,,395.76,percent of total billed charges,Implant Devices,395.76,34,,395.76,percent of total billed charges,Implant Devices,407.4,35,,407.4,percent of total billed charges,Implant Devices,407.4,35,,407.4,percent of total billed charges,Implant Devices,407.4,35,,407.4,percent of total billed charges,Implant Devices,407.4,35,,407.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,465.6,
GORE RLT281418 ENDO GRAFT 28.5X14.5X18CM,C1768,HCPCS,,79008835,CDM,278,RC,,,both,,,33825,13349.65,39.4668,,13349.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11500.5,34,,11500.5,percent of total billed charges,Implant Device,11838.75,35,,11838.75,percent of total billed charges,Implant Device,11500.5,34,"Charges > $500, x 34%",11500.5,percent of total billed charges,Implant Device,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,13530,40,,13530,percent of total billed charges,Implant Devices,11838.75,70,,11838.75,percent of total billed charges,Implant Devices,11500.5,34,,11500.5,percent of total billed charges,Implant Devices,11500.5,34,,11500.5,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,11838.75,35,,11838.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11500.5,34,"If Charge > 2,000, then 34 percent",11500.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13530,
GORE RLT261412 EXCLUDER ENDOPROS GRAFT,C1768,HCPCS,,79008947,CDM,278,RC,,,both,,,35538,14025.71,39.4668,,14025.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12082.92,34,,12082.92,percent of total billed charges,Implant Device,12438.3,35,,12438.3,percent of total billed charges,Implant Device,12082.92,34,"Charges > $500, x 34%",12082.92,percent of total billed charges,Implant Device,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,14215.2,40,,14215.2,percent of total billed charges,Implant Devices,12438.3,70,,12438.3,percent of total billed charges,Implant Devices,12082.92,34,,12082.92,percent of total billed charges,Implant Devices,12082.92,34,,12082.92,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,12438.3,35,,12438.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,12082.92,34,"If Charge > 2,000, then 34 percent",12082.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14215.2,
GORE RLT281416 EXCLUDER ENDOPROSTHESIS,C1768,HCPCS,,79009222,CDM,278,RC,,,both,,,34671,13683.53,39.4668,,13683.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11788.14,34,,11788.14,percent of total billed charges,Implant Device,11788.14,34,,11788.14,percent of total billed charges,Implant Device,11788.14,34,,11788.14,percent of total billed charges,Implant Device,11788.14,34,,11788.14,percent of total billed charges,Implant Device,11788.14,34,,11788.14,percent of total billed charges,Implant Device,11788.14,34,,11788.14,percent of total billed charges,Implant Device,12134.85,35,,12134.85,percent of total billed charges,Implant Device,11788.14,34,"Charges > $500, x 34%",11788.14,percent of total billed charges,Implant Device,12134.85,35,,12134.85,percent of total billed charges,Implant Devices,12134.85,35,,12134.85,percent of total billed charges,Implant Devices,12134.85,35,,,percent of total billed charges,Implant Devices,12134.85,35,,12134.85,percent of total billed charges,Implant Devices,12134.85,35,,12134.85,percent of total billed charges,Implant Devices,13868.4,40,,13868.4,percent of total billed charges,Implant Devices,12134.85,70,,12134.85,percent of total billed charges,Implant Devices,11788.14,34,,11788.14,percent of total billed charges,Implant Devices,11788.14,34,,11788.14,percent of total billed charges,Implant Devices,12134.85,35,,12134.85,percent of total billed charges,Implant Devices,12134.85,35,,12134.85,percent of total billed charges,Implant Devices,12134.85,35,,12134.85,percent of total billed charges,Implant Devices,12134.85,35,,12134.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11788.14,34,"If Charge > 2,000, then 34 percent",11788.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13868.4,
GORE HA70045A PROPATEN VASCULAR GRAFT,C1768,HCPCS,,79010792,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
ORGANOGENSIS 515-008 PURAPLY GRAFT 5X5CM,C1768,HCPCS,,79011056,CDM,278,RC,,,both,,,8250,3256.01,39.4668,,3256.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2805,34,,2805,percent of total billed charges,Implant Device,2805,34,,2805,percent of total billed charges,Implant Device,2805,34,,2805,percent of total billed charges,Implant Device,2805,34,,2805,percent of total billed charges,Implant Device,2805,34,,2805,percent of total billed charges,Implant Device,2805,34,,2805,percent of total billed charges,Implant Device,2887.5,35,,2887.5,percent of total billed charges,Implant Device,2805,34,"Charges > $500, x 34%",2805,percent of total billed charges,Implant Device,2887.5,35,,2887.5,percent of total billed charges,Implant Devices,2887.5,35,,2887.5,percent of total billed charges,Implant Devices,2887.5,35,,,percent of total billed charges,Implant Devices,2887.5,35,,2887.5,percent of total billed charges,Implant Devices,2887.5,35,,2887.5,percent of total billed charges,Implant Devices,3300,40,,3300,percent of total billed charges,Implant Devices,2887.5,70,,2887.5,percent of total billed charges,Implant Devices,2805,34,,2805,percent of total billed charges,Implant Devices,2805,34,,2805,percent of total billed charges,Implant Devices,2887.5,35,,2887.5,percent of total billed charges,Implant Devices,2887.5,35,,2887.5,percent of total billed charges,Implant Devices,2887.5,35,,2887.5,percent of total billed charges,Implant Devices,2887.5,35,,2887.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2805,34,"If Charge > 2,000, then 34 percent",2805,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3300,
GORE SBT-1602D BIFURCATED GRAFT 16X8X50,C1768,HCPCS,,79012874,CDM,278,RC,,,both,,,3246,1281.09,39.4668,,1281.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1103.64,34,,1103.64,percent of total billed charges,Implant Device,1103.64,34,,1103.64,percent of total billed charges,Implant Device,1103.64,34,,1103.64,percent of total billed charges,Implant Device,1103.64,34,,1103.64,percent of total billed charges,Implant Device,1103.64,34,,1103.64,percent of total billed charges,Implant Device,1103.64,34,,1103.64,percent of total billed charges,Implant Device,1136.1,35,,1136.1,percent of total billed charges,Implant Device,1103.64,34,"Charges > $500, x 34%",1103.64,percent of total billed charges,Implant Device,1136.1,35,,1136.1,percent of total billed charges,Implant Devices,1136.1,35,,1136.1,percent of total billed charges,Implant Devices,1136.1,35,,,percent of total billed charges,Implant Devices,1136.1,35,,1136.1,percent of total billed charges,Implant Devices,1136.1,35,,1136.1,percent of total billed charges,Implant Devices,1298.4,40,,1298.4,percent of total billed charges,Implant Devices,1136.1,70,,1136.1,percent of total billed charges,Implant Devices,1103.64,34,,1103.64,percent of total billed charges,Implant Devices,1103.64,34,,1103.64,percent of total billed charges,Implant Devices,1136.1,35,,1136.1,percent of total billed charges,Implant Devices,1136.1,35,,1136.1,percent of total billed charges,Implant Devices,1136.1,35,,1136.1,percent of total billed charges,Implant Devices,1136.1,35,,1136.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1103.64,34,"If Charge > 2,000, then 34 percent",1103.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1298.4,
GORE ECH470045A ACUSEAL VASCULAR GRAFT,C1768,HCPCS,,79012963,CDM,278,RC,,,both,,,4404,1738.12,39.4668,,1738.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.36,34,,1497.36,percent of total billed charges,Implant Device,1497.36,34,,1497.36,percent of total billed charges,Implant Device,1497.36,34,,1497.36,percent of total billed charges,Implant Device,1497.36,34,,1497.36,percent of total billed charges,Implant Device,1497.36,34,,1497.36,percent of total billed charges,Implant Device,1497.36,34,,1497.36,percent of total billed charges,Implant Device,1541.4,35,,1541.4,percent of total billed charges,Implant Device,1497.36,34,"Charges > $500, x 34%",1497.36,percent of total billed charges,Implant Device,1541.4,35,,1541.4,percent of total billed charges,Implant Devices,1541.4,35,,1541.4,percent of total billed charges,Implant Devices,1541.4,35,,,percent of total billed charges,Implant Devices,1541.4,35,,1541.4,percent of total billed charges,Implant Devices,1541.4,35,,1541.4,percent of total billed charges,Implant Devices,1761.6,40,,1761.6,percent of total billed charges,Implant Devices,1541.4,70,,1541.4,percent of total billed charges,Implant Devices,1497.36,34,,1497.36,percent of total billed charges,Implant Devices,1497.36,34,,1497.36,percent of total billed charges,Implant Devices,1541.4,35,,1541.4,percent of total billed charges,Implant Devices,1541.4,35,,1541.4,percent of total billed charges,Implant Devices,1541.4,35,,1541.4,percent of total billed charges,Implant Devices,1541.4,35,,1541.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.36,34,"If Charge > 2,000, then 34 percent",1497.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.6,
GORE SRRT06060080L VASC GRAFT RING 6X40,C1768,HCPCS,,79014033,CDM,278,RC,,,both,,,4074,1607.88,39.4668,,1607.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1385.16,34,,1385.16,percent of total billed charges,Implant Device,1385.16,34,,1385.16,percent of total billed charges,Implant Device,1385.16,34,,1385.16,percent of total billed charges,Implant Device,1385.16,34,,1385.16,percent of total billed charges,Implant Device,1385.16,34,,1385.16,percent of total billed charges,Implant Device,1385.16,34,,1385.16,percent of total billed charges,Implant Device,1425.9,35,,1425.9,percent of total billed charges,Implant Device,1385.16,34,"Charges > $500, x 34%",1385.16,percent of total billed charges,Implant Device,1425.9,35,,1425.9,percent of total billed charges,Implant Devices,1425.9,35,,1425.9,percent of total billed charges,Implant Devices,1425.9,35,,,percent of total billed charges,Implant Devices,1425.9,35,,1425.9,percent of total billed charges,Implant Devices,1425.9,35,,1425.9,percent of total billed charges,Implant Devices,1629.6,40,,1629.6,percent of total billed charges,Implant Devices,1425.9,70,,1425.9,percent of total billed charges,Implant Devices,1385.16,34,,1385.16,percent of total billed charges,Implant Devices,1385.16,34,,1385.16,percent of total billed charges,Implant Devices,1425.9,35,,1425.9,percent of total billed charges,Implant Devices,1425.9,35,,1425.9,percent of total billed charges,Implant Devices,1425.9,35,,1425.9,percent of total billed charges,Implant Devices,1425.9,35,,1425.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1385.16,34,"If Charge > 2,000, then 34 percent",1385.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1629.6,
GORE SRRT08070080L VASC GRAFT RING 8X80,C1768,HCPCS,,79014034,CDM,278,RC,,,both,,,4899,1933.48,39.4668,,1933.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1665.66,34,,1665.66,percent of total billed charges,Implant Device,1665.66,34,,1665.66,percent of total billed charges,Implant Device,1665.66,34,,1665.66,percent of total billed charges,Implant Device,1665.66,34,,1665.66,percent of total billed charges,Implant Device,1665.66,34,,1665.66,percent of total billed charges,Implant Device,1665.66,34,,1665.66,percent of total billed charges,Implant Device,1714.65,35,,1714.65,percent of total billed charges,Implant Device,1665.66,34,"Charges > $500, x 34%",1665.66,percent of total billed charges,Implant Device,1714.65,35,,1714.65,percent of total billed charges,Implant Devices,1714.65,35,,1714.65,percent of total billed charges,Implant Devices,1714.65,35,,,percent of total billed charges,Implant Devices,1714.65,35,,1714.65,percent of total billed charges,Implant Devices,1714.65,35,,1714.65,percent of total billed charges,Implant Devices,1959.6,40,,1959.6,percent of total billed charges,Implant Devices,1714.65,70,,1714.65,percent of total billed charges,Implant Devices,1665.66,34,,1665.66,percent of total billed charges,Implant Devices,1665.66,34,,1665.66,percent of total billed charges,Implant Devices,1714.65,35,,1714.65,percent of total billed charges,Implant Devices,1714.65,35,,1714.65,percent of total billed charges,Implant Devices,1714.65,35,,1714.65,percent of total billed charges,Implant Devices,1714.65,35,,1714.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1665.66,34,"If Charge > 2,000, then 34 percent",1665.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1959.6,
J&J 03.045.018 GWIRE W/DRILL TIP 3.2MM,C1769,HCPCS,,79013125,CDM,278,RC,,,both,,,300,118.4,39.4668,,118.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,102,34,,102,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,120,40,,120,percent of total billed charges,Implant Devices,105,70,,105,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,102,34,,102,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,105,35,,105,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,120,
DESARA SLING SYSTEM,C1771,HCPCS,,79001486,CDM,278,RC,,,both,,,2686,1060.08,39.4668,,1060.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,940.1,35,,940.1,percent of total billed charges,Implant Device,913.24,34,"Charges > $500, x 34%",913.24,percent of total billed charges,Implant Device,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,1074.4,40,,1074.4,percent of total billed charges,Implant Devices,940.1,70,,940.1,percent of total billed charges,Implant Devices,913.24,34,,913.24,percent of total billed charges,Implant Devices,913.24,34,,913.24,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,913.24,34,"If Charge > 2,000, then 34 percent",913.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1074.4,
J&J 810041A TVT DEVICE W/ABDOMINAL GUIDE,C1771,HCPCS,,79001750,CDM,278,RC,,,both,,,3270,1290.56,39.4668,,1290.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1111.8,34,,1111.8,percent of total billed charges,Implant Device,1111.8,34,,1111.8,percent of total billed charges,Implant Device,1111.8,34,,1111.8,percent of total billed charges,Implant Device,1111.8,34,,1111.8,percent of total billed charges,Implant Device,1111.8,34,,1111.8,percent of total billed charges,Implant Device,1111.8,34,,1111.8,percent of total billed charges,Implant Device,1144.5,35,,1144.5,percent of total billed charges,Implant Device,1111.8,34,"Charges > $500, x 34%",1111.8,percent of total billed charges,Implant Device,1144.5,35,,1144.5,percent of total billed charges,Implant Devices,1144.5,35,,1144.5,percent of total billed charges,Implant Devices,1144.5,35,,,percent of total billed charges,Implant Devices,1144.5,35,,1144.5,percent of total billed charges,Implant Devices,1144.5,35,,1144.5,percent of total billed charges,Implant Devices,1308,40,,1308,percent of total billed charges,Implant Devices,1144.5,70,,1144.5,percent of total billed charges,Implant Devices,1111.8,34,,1111.8,percent of total billed charges,Implant Devices,1111.8,34,,1111.8,percent of total billed charges,Implant Devices,1144.5,35,,1144.5,percent of total billed charges,Implant Devices,1144.5,35,,1144.5,percent of total billed charges,Implant Devices,1144.5,35,,1144.5,percent of total billed charges,Implant Devices,1144.5,35,,1144.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1111.8,34,"If Charge > 2,000, then 34 percent",1111.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1308,
CL MEDICAL IS-5 I-STOP DEVICE,C1771,HCPCS,,79005614,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
BOST SCI M0068502120 ADVANTAGE FIT SYS,C1771,HCPCS,,79012184,CDM,278,RC,,,both,,,3668,1447.64,39.4668,,1447.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1283.8,35,,1283.8,percent of total billed charges,Implant Device,1247.12,34,"Charges > $500, x 34%",1247.12,percent of total billed charges,Implant Device,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1467.2,40,,1467.2,percent of total billed charges,Implant Devices,1283.8,70,,1283.8,percent of total billed charges,Implant Devices,1247.12,34,,1247.12,percent of total billed charges,Implant Devices,1247.12,34,,1247.12,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1247.12,34,"If Charge > 2,000, then 34 percent",1247.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1467.2,
BOST M0068502110 ADVANTAGE FIT - CLEAR,C1771,HCPCS,,79012917,CDM,278,RC,,,both,,,3668,1447.64,39.4668,,1447.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1247.12,34,,1247.12,percent of total billed charges,Implant Device,1283.8,35,,1283.8,percent of total billed charges,Implant Device,1247.12,34,"Charges > $500, x 34%",1247.12,percent of total billed charges,Implant Device,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1467.2,40,,1467.2,percent of total billed charges,Implant Devices,1283.8,70,,1283.8,percent of total billed charges,Implant Devices,1247.12,34,,1247.12,percent of total billed charges,Implant Devices,1247.12,34,,1247.12,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,1283.8,35,,1283.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1247.12,34,"If Charge > 2,000, then 34 percent",1247.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1467.2,
ALPHATEC 25200-112 SOLUS LUMBAR 7DEGX12M,C1773,HCPCS,,79008371,CDM,278,RC,,,both,,,24000,9472.03,39.4668,,9472.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8160,34,,8160,percent of total billed charges,Implant Device,8160,34,,8160,percent of total billed charges,Implant Device,8160,34,,8160,percent of total billed charges,Implant Device,8160,34,,8160,percent of total billed charges,Implant Device,8160,34,,8160,percent of total billed charges,Implant Device,8160,34,,8160,percent of total billed charges,Implant Device,8400,35,,8400,percent of total billed charges,Implant Device,8160,34,"Charges > $500, x 34%",8160,percent of total billed charges,Implant Device,8400,35,,8400,percent of total billed charges,Implant Devices,8400,35,,8400,percent of total billed charges,Implant Devices,8400,35,,,percent of total billed charges,Implant Devices,8400,35,,8400,percent of total billed charges,Implant Devices,8400,35,,8400,percent of total billed charges,Implant Devices,9600,40,,9600,percent of total billed charges,Implant Devices,8400,70,,8400,percent of total billed charges,Implant Devices,8160,34,,8160,percent of total billed charges,Implant Devices,8160,34,,8160,percent of total billed charges,Implant Devices,8400,35,,8400,percent of total billed charges,Implant Devices,8400,35,,8400,percent of total billed charges,Implant Devices,8400,35,,8400,percent of total billed charges,Implant Devices,8400,35,,8400,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8160,34,"If Charge > 2,000, then 34 percent",8160,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9600,
ALPHATEC 64411-210 NOVEL LUMBER 7DEGX10M,C1773,HCPCS,,79008372,CDM,278,RC,,,both,,,12000,4736.02,39.4668,,4736.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4200,35,,4200,percent of total billed charges,Implant Device,4080,34,"Charges > $500, x 34%",4080,percent of total billed charges,Implant Device,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4800,40,,4800,percent of total billed charges,Implant Devices,4200,70,,4200,percent of total billed charges,Implant Devices,4080,34,,4080,percent of total billed charges,Implant Devices,4080,34,,4080,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4080,34,"If Charge > 2,000, then 34 percent",4080,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4800,
ALPHATEC SPINE 62004-10 ROD 100MM,C1773,HCPCS,,79008374,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
ZIMMER 00-2347-023-75 SCREW 4.5X75MM,C1773,HCPCS,,79008444,CDM,278,RC,,,both,,,109,43.02,39.4668,,43.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,37.06,34,,37.06,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,43.6,40,,43.6,percent of total billed charges,Implant Devices,38.15,70,,38.15,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,37.06,34,,37.06,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,38.15,35,,38.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,43.6,
ALPHATEC SPINE 62004-04 ROD 40MM,C1773,HCPCS,,79008489,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
BIOMET 45-0039 FEMORAL HEAD FREEZE DRIED,C1776,HCPCS,,79001502,CDM,278,RC,,,both,,,3174,1252.68,39.4668,,1252.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1079.16,34,,1079.16,percent of total billed charges,Implant Device,1110.9,35,,1110.9,percent of total billed charges,Implant Device,1079.16,34,"Charges > $500, x 34%",1079.16,percent of total billed charges,Implant Device,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1269.6,40,,1269.6,percent of total billed charges,Implant Devices,1110.9,70,,1110.9,percent of total billed charges,Implant Devices,1079.16,34,,1079.16,percent of total billed charges,Implant Devices,1079.16,34,,1079.16,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,1110.9,35,,1110.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1079.16,34,"If Charge > 2,000, then 34 percent",1079.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1269.6,
BIOMET 45-0037 FEMORAL PLATE FREEZEDRIED,C1776,HCPCS,,79001503,CDM,278,RC,,,both,,,2169,856.03,39.4668,,856.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,737.46,34,,737.46,percent of total billed charges,Implant Device,737.46,34,,737.46,percent of total billed charges,Implant Device,737.46,34,,737.46,percent of total billed charges,Implant Device,737.46,34,,737.46,percent of total billed charges,Implant Device,737.46,34,,737.46,percent of total billed charges,Implant Device,737.46,34,,737.46,percent of total billed charges,Implant Device,759.15,35,,759.15,percent of total billed charges,Implant Device,737.46,34,"Charges > $500, x 34%",737.46,percent of total billed charges,Implant Device,759.15,35,,759.15,percent of total billed charges,Implant Devices,759.15,35,,759.15,percent of total billed charges,Implant Devices,759.15,35,,,percent of total billed charges,Implant Devices,759.15,35,,759.15,percent of total billed charges,Implant Devices,759.15,35,,759.15,percent of total billed charges,Implant Devices,867.6,40,,867.6,percent of total billed charges,Implant Devices,759.15,70,,759.15,percent of total billed charges,Implant Devices,737.46,34,,737.46,percent of total billed charges,Implant Devices,737.46,34,,737.46,percent of total billed charges,Implant Devices,759.15,35,,759.15,percent of total billed charges,Implant Devices,759.15,35,,759.15,percent of total billed charges,Implant Devices,759.15,35,,759.15,percent of total billed charges,Implant Devices,759.15,35,,759.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,737.46,34,"If Charge > 2,000, then 34 percent",737.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,867.6,
SGARLATO 70-100-02 HAMMERTOE IMPLANT MED,C1776,HCPCS,,79001529,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
SGARLATO 70-100-01 HAMMERTOE IMPLANT SM,C1776,HCPCS,,79001530,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
ZIMMER 400500-38 MOORE HIP 1 1/2 38MM,C1776,HCPCS,,79001622,CDM,278,RC,,,both,,,2987,1178.87,39.4668,,1178.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Device,1015.58,34,"Charges > $500, x 34%",1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1194.8,40,,1194.8,percent of total billed charges,Implant Devices,1045.45,70,,1045.45,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.58,34,"If Charge > 2,000, then 34 percent",1015.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.8,
ZIMMER 400500-46 MOORE HIP 1 13/16 46MM,C1776,HCPCS,,79001623,CDM,278,RC,,,both,,,2987,1178.87,39.4668,,1178.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Device,1015.58,34,"Charges > $500, x 34%",1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1194.8,40,,1194.8,percent of total billed charges,Implant Devices,1045.45,70,,1045.45,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.58,34,"If Charge > 2,000, then 34 percent",1015.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.8,
ZIMMER 400500-49 MOORE HIP 1 15/16 49MM,C1776,HCPCS,,79001624,CDM,278,RC,,,both,,,2987,1178.87,39.4668,,1178.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Device,1015.58,34,"Charges > $500, x 34%",1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1194.8,40,,1194.8,percent of total billed charges,Implant Devices,1045.45,70,,1045.45,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.58,34,"If Charge > 2,000, then 34 percent",1015.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.8,
ZIMMER 400500-42 MOORE HIP 1 21/32 42MM,C1776,HCPCS,,79001625,CDM,278,RC,,,both,,,2987,1178.87,39.4668,,1178.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Device,1015.58,34,"Charges > $500, x 34%",1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1194.8,40,,1194.8,percent of total billed charges,Implant Devices,1045.45,70,,1045.45,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.58,34,"If Charge > 2,000, then 34 percent",1015.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.8,
ZIMMER 400500-44 MOORE HIP 1 3/4 44MM,C1776,HCPCS,,79001626,CDM,278,RC,,,both,,,3847,1518.29,39.4668,,1518.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1307.98,34,,1307.98,percent of total billed charges,Implant Device,1346.45,35,,1346.45,percent of total billed charges,Implant Device,1307.98,34,"Charges > $500, x 34%",1307.98,percent of total billed charges,Implant Device,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1538.8,40,,1538.8,percent of total billed charges,Implant Devices,1346.45,70,,1346.45,percent of total billed charges,Implant Devices,1307.98,34,,1307.98,percent of total billed charges,Implant Devices,1307.98,34,,1307.98,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,1346.45,35,,1346.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1307.98,34,"If Charge > 2,000, then 34 percent",1307.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1538.8,
ZIMMER 400500-41 MOORE HIP 1 5/8 41MM,C1776,HCPCS,,79001627,CDM,278,RC,,,both,,,2987,1178.87,39.4668,,1178.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Device,1015.58,34,"Charges > $500, x 34%",1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1194.8,40,,1194.8,percent of total billed charges,Implant Devices,1045.45,70,,1045.45,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.58,34,"If Charge > 2,000, then 34 percent",1015.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.8,
ZIMMER 400500-48 MOORE HIP 1 7/8 48MM,C1776,HCPCS,,79001628,CDM,278,RC,,,both,,,3790,1495.79,39.4668,,1495.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1288.6,34,,1288.6,percent of total billed charges,Implant Device,1288.6,34,,1288.6,percent of total billed charges,Implant Device,1288.6,34,,1288.6,percent of total billed charges,Implant Device,1288.6,34,,1288.6,percent of total billed charges,Implant Device,1288.6,34,,1288.6,percent of total billed charges,Implant Device,1288.6,34,,1288.6,percent of total billed charges,Implant Device,1326.5,35,,1326.5,percent of total billed charges,Implant Device,1288.6,34,"Charges > $500, x 34%",1288.6,percent of total billed charges,Implant Device,1326.5,35,,1326.5,percent of total billed charges,Implant Devices,1326.5,35,,1326.5,percent of total billed charges,Implant Devices,1326.5,35,,,percent of total billed charges,Implant Devices,1326.5,35,,1326.5,percent of total billed charges,Implant Devices,1326.5,35,,1326.5,percent of total billed charges,Implant Devices,1516,40,,1516,percent of total billed charges,Implant Devices,1326.5,70,,1326.5,percent of total billed charges,Implant Devices,1288.6,34,,1288.6,percent of total billed charges,Implant Devices,1288.6,34,,1288.6,percent of total billed charges,Implant Devices,1326.5,35,,1326.5,percent of total billed charges,Implant Devices,1326.5,35,,1326.5,percent of total billed charges,Implant Devices,1326.5,35,,1326.5,percent of total billed charges,Implant Devices,1326.5,35,,1326.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1288.6,34,"If Charge > 2,000, then 34 percent",1288.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1516,
ZIMMER 400500-40 MOORE HIP 1 9/16 40MM,C1776,HCPCS,,79001629,CDM,278,RC,,,both,,,2987,1178.87,39.4668,,1178.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Device,1015.58,34,"Charges > $500, x 34%",1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1194.8,40,,1194.8,percent of total billed charges,Implant Devices,1045.45,70,,1045.45,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.58,34,"If Charge > 2,000, then 34 percent",1015.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.8,
ZIMMER 4005-00-51 MOORE HIP 51MM,C1776,HCPCS,,79001630,CDM,278,RC,,,both,,,3136,1237.68,39.4668,,1237.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1066.24,34,,1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Device,1066.24,34,"Charges > $500, x 34%",1066.24,percent of total billed charges,Implant Device,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1254.4,40,,1254.4,percent of total billed charges,Implant Devices,1097.6,70,,1097.6,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1066.24,34,,1066.24,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,1097.6,35,,1097.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1066.24,34,"If Charge > 2,000, then 34 percent",1066.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1254.4,
ZIMMER 4005-00-57 MOORE HIP 57MM,C1776,HCPCS,,79001631,CDM,278,RC,,,both,,,2987,1178.87,39.4668,,1178.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1015.58,34,,1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Device,1015.58,34,"Charges > $500, x 34%",1015.58,percent of total billed charges,Implant Device,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1194.8,40,,1194.8,percent of total billed charges,Implant Devices,1045.45,70,,1045.45,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1015.58,34,,1015.58,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,1045.45,35,,1045.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.58,34,"If Charge > 2,000, then 34 percent",1015.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.8,
SGARLATO LABS 8-100-01 TOE LONGHAMMER,C1776,HCPCS,,79001749,CDM,278,RC,,,both,,,976,385.2,39.4668,,385.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,331.84,34,,331.84,percent of total billed charges,Implant Device,331.84,34,,331.84,percent of total billed charges,Implant Device,331.84,34,,331.84,percent of total billed charges,Implant Device,331.84,34,,331.84,percent of total billed charges,Implant Device,331.84,34,,331.84,percent of total billed charges,Implant Device,331.84,34,,331.84,percent of total billed charges,Implant Device,341.6,35,,341.6,percent of total billed charges,Implant Device,331.84,34,"Charges > $500, x 34%",331.84,percent of total billed charges,Implant Device,341.6,35,,341.6,percent of total billed charges,Implant Devices,341.6,35,,341.6,percent of total billed charges,Implant Devices,341.6,35,,,percent of total billed charges,Implant Devices,341.6,35,,341.6,percent of total billed charges,Implant Devices,341.6,35,,341.6,percent of total billed charges,Implant Devices,390.4,40,,390.4,percent of total billed charges,Implant Devices,341.6,70,,341.6,percent of total billed charges,Implant Devices,331.84,34,,331.84,percent of total billed charges,Implant Devices,331.84,34,,331.84,percent of total billed charges,Implant Devices,341.6,35,,341.6,percent of total billed charges,Implant Devices,341.6,35,,341.6,percent of total billed charges,Implant Devices,341.6,35,,341.6,percent of total billed charges,Implant Devices,341.6,35,,341.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,390.4,
BIOMET 113032 MODULAR HEAD,C1776,HCPCS,,79001791,CDM,278,RC,,,both,,,9120,3599.37,39.4668,,3599.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3192,35,,3192,percent of total billed charges,Implant Device,3100.8,34,"Charges > $500, x 34%",3100.8,percent of total billed charges,Implant Device,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3648,40,,3648,percent of total billed charges,Implant Devices,3192,70,,3192,percent of total billed charges,Implant Devices,3100.8,34,,3100.8,percent of total billed charges,Implant Devices,3100.8,34,,3100.8,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3100.8,34,"If Charge > 2,000, then 34 percent",3100.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3648,
BIOMET 113652 STEM,C1776,HCPCS,,79001792,CDM,278,RC,,,both,,,18630,7352.66,39.4668,,7352.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6520.5,35,,6520.5,percent of total billed charges,Implant Device,6334.2,34,"Charges > $500, x 34%",6334.2,percent of total billed charges,Implant Device,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,7452,40,,7452,percent of total billed charges,Implant Devices,6520.5,70,,6520.5,percent of total billed charges,Implant Devices,6334.2,34,,6334.2,percent of total billed charges,Implant Devices,6334.2,34,,6334.2,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6334.2,34,"If Charge > 2,000, then 34 percent",6334.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7452,
BIOMET 113766 HUMERAL HEAD,C1776,HCPCS,,79001793,CDM,278,RC,,,both,,,7080,2794.25,39.4668,,2794.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2407.2,34,,2407.2,percent of total billed charges,Implant Device,2407.2,34,,2407.2,percent of total billed charges,Implant Device,2407.2,34,,2407.2,percent of total billed charges,Implant Device,2407.2,34,,2407.2,percent of total billed charges,Implant Device,2407.2,34,,2407.2,percent of total billed charges,Implant Device,2407.2,34,,2407.2,percent of total billed charges,Implant Device,2478,35,,2478,percent of total billed charges,Implant Device,2407.2,34,"Charges > $500, x 34%",2407.2,percent of total billed charges,Implant Device,2478,35,,2478,percent of total billed charges,Implant Devices,2478,35,,2478,percent of total billed charges,Implant Devices,2478,35,,,percent of total billed charges,Implant Devices,2478,35,,2478,percent of total billed charges,Implant Devices,2478,35,,2478,percent of total billed charges,Implant Devices,2832,40,,2832,percent of total billed charges,Implant Devices,2478,70,,2478,percent of total billed charges,Implant Devices,2407.2,34,,2407.2,percent of total billed charges,Implant Devices,2407.2,34,,2407.2,percent of total billed charges,Implant Devices,2478,35,,2478,percent of total billed charges,Implant Devices,2478,35,,2478,percent of total billed charges,Implant Devices,2478,35,,2478,percent of total billed charges,Implant Devices,2478,35,,2478,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2407.2,34,"If Charge > 2,000, then 34 percent",2407.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2832,
BIOMET 115310 GLENOSPHERE,C1776,HCPCS,,79001794,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
BIOMET 115330 GLENOSPHERE,C1776,HCPCS,,79001795,CDM,278,RC,,,both,,,7950,3137.61,39.4668,,3137.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2703,34,,2703,percent of total billed charges,Implant Device,2782.5,35,,2782.5,percent of total billed charges,Implant Device,2703,34,"Charges > $500, x 34%",2703,percent of total billed charges,Implant Device,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,3180,40,,3180,percent of total billed charges,Implant Devices,2782.5,70,,2782.5,percent of total billed charges,Implant Devices,2703,34,,2703,percent of total billed charges,Implant Devices,2703,34,,2703,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,2782.5,35,,2782.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2703,34,"If Charge > 2,000, then 34 percent",2703,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3180,
BIOMET 115370 STEM,C1776,HCPCS,,79001797,CDM,278,RC,,,both,,,8670,3421.77,39.4668,,3421.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2947.8,34,,2947.8,percent of total billed charges,Implant Device,2947.8,34,,2947.8,percent of total billed charges,Implant Device,2947.8,34,,2947.8,percent of total billed charges,Implant Device,2947.8,34,,2947.8,percent of total billed charges,Implant Device,2947.8,34,,2947.8,percent of total billed charges,Implant Device,2947.8,34,,2947.8,percent of total billed charges,Implant Device,3034.5,35,,3034.5,percent of total billed charges,Implant Device,2947.8,34,"Charges > $500, x 34%",2947.8,percent of total billed charges,Implant Device,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3468,40,,3468,percent of total billed charges,Implant Devices,3034.5,70,,3034.5,percent of total billed charges,Implant Devices,2947.8,34,,2947.8,percent of total billed charges,Implant Devices,2947.8,34,,2947.8,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2947.8,34,"If Charge > 2,000, then 34 percent",2947.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3468,
BIOMET 115382 SHOULDER,C1776,HCPCS,,79001798,CDM,278,RC,,,both,,,526,207.6,39.4668,,207.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,178.84,34,,178.84,percent of total billed charges,Implant Device,178.84,34,,178.84,percent of total billed charges,Implant Device,178.84,34,,178.84,percent of total billed charges,Implant Device,178.84,34,,178.84,percent of total billed charges,Implant Device,178.84,34,,178.84,percent of total billed charges,Implant Device,178.84,34,,178.84,percent of total billed charges,Implant Device,184.1,35,,184.1,percent of total billed charges,Implant Device,178.84,34,"Charges > $500, x 34%",178.84,percent of total billed charges,Implant Device,184.1,35,,184.1,percent of total billed charges,Implant Devices,184.1,35,,184.1,percent of total billed charges,Implant Devices,184.1,35,,,percent of total billed charges,Implant Devices,184.1,35,,184.1,percent of total billed charges,Implant Devices,184.1,35,,184.1,percent of total billed charges,Implant Devices,210.4,40,,210.4,percent of total billed charges,Implant Devices,184.1,70,,184.1,percent of total billed charges,Implant Devices,178.84,34,,178.84,percent of total billed charges,Implant Devices,178.84,34,,178.84,percent of total billed charges,Implant Devices,184.1,35,,184.1,percent of total billed charges,Implant Devices,184.1,35,,184.1,percent of total billed charges,Implant Devices,184.1,35,,184.1,percent of total billed charges,Implant Devices,184.1,35,,184.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,210.4,
BIOMET 139246 TAPER ADAPTER,C1776,HCPCS,,79001799,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
BIOMET 154601 FEMORAL STEM,C1776,HCPCS,,79001800,CDM,278,RC,,,both,,,8544,3372.04,39.4668,,3372.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2904.96,34,,2904.96,percent of total billed charges,Implant Device,2904.96,34,,2904.96,percent of total billed charges,Implant Device,2904.96,34,,2904.96,percent of total billed charges,Implant Device,2904.96,34,,2904.96,percent of total billed charges,Implant Device,2904.96,34,,2904.96,percent of total billed charges,Implant Device,2904.96,34,,2904.96,percent of total billed charges,Implant Device,2990.4,35,,2990.4,percent of total billed charges,Implant Device,2904.96,34,"Charges > $500, x 34%",2904.96,percent of total billed charges,Implant Device,2990.4,35,,2990.4,percent of total billed charges,Implant Devices,2990.4,35,,2990.4,percent of total billed charges,Implant Devices,2990.4,35,,,percent of total billed charges,Implant Devices,2990.4,35,,2990.4,percent of total billed charges,Implant Devices,2990.4,35,,2990.4,percent of total billed charges,Implant Devices,3417.6,40,,3417.6,percent of total billed charges,Implant Devices,2990.4,70,,2990.4,percent of total billed charges,Implant Devices,2904.96,34,,2904.96,percent of total billed charges,Implant Devices,2904.96,34,,2904.96,percent of total billed charges,Implant Devices,2990.4,35,,2990.4,percent of total billed charges,Implant Devices,2990.4,35,,2990.4,percent of total billed charges,Implant Devices,2990.4,35,,2990.4,percent of total billed charges,Implant Devices,2990.4,35,,2990.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2904.96,34,"If Charge > 2,000, then 34 percent",2904.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3417.6,
BIOMET 180501 SCREW,C1776,HCPCS,,79001801,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
BIOMET 180507 SCREW,C1776,HCPCS,,79001802,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
STRYKER 06-2600 TAPER,C1776,HCPCS,,79001804,CDM,278,RC,,,both,,,3008,1187.16,39.4668,,1187.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1052.8,35,,1052.8,percent of total billed charges,Implant Device,1022.72,34,"Charges > $500, x 34%",1022.72,percent of total billed charges,Implant Device,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1203.2,40,,1203.2,percent of total billed charges,Implant Devices,1052.8,70,,1052.8,percent of total billed charges,Implant Devices,1022.72,34,,1022.72,percent of total billed charges,Implant Devices,1022.72,34,,1022.72,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1022.72,34,"If Charge > 2,000, then 34 percent",1022.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1203.2,
BIOMET 431196 STEM,C1776,HCPCS,,79001816,CDM,278,RC,,,both,,,5098,2012.02,39.4668,,2012.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1733.32,34,,1733.32,percent of total billed charges,Implant Device,1733.32,34,,1733.32,percent of total billed charges,Implant Device,1733.32,34,,1733.32,percent of total billed charges,Implant Device,1733.32,34,,1733.32,percent of total billed charges,Implant Device,1733.32,34,,1733.32,percent of total billed charges,Implant Device,1733.32,34,,1733.32,percent of total billed charges,Implant Device,1784.3,35,,1784.3,percent of total billed charges,Implant Device,1733.32,34,"Charges > $500, x 34%",1733.32,percent of total billed charges,Implant Device,1784.3,35,,1784.3,percent of total billed charges,Implant Devices,1784.3,35,,1784.3,percent of total billed charges,Implant Devices,1784.3,35,,,percent of total billed charges,Implant Devices,1784.3,35,,1784.3,percent of total billed charges,Implant Devices,1784.3,35,,1784.3,percent of total billed charges,Implant Devices,2039.2,40,,2039.2,percent of total billed charges,Implant Devices,1784.3,70,,1784.3,percent of total billed charges,Implant Devices,1733.32,34,,1733.32,percent of total billed charges,Implant Devices,1733.32,34,,1733.32,percent of total billed charges,Implant Devices,1784.3,35,,1784.3,percent of total billed charges,Implant Devices,1784.3,35,,1784.3,percent of total billed charges,Implant Devices,1784.3,35,,1784.3,percent of total billed charges,Implant Devices,1784.3,35,,1784.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1733.32,34,"If Charge > 2,000, then 34 percent",1733.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2039.2,
BIOMET 432160 SPACER MOLD,C1776,HCPCS,,79001817,CDM,278,RC,,,both,,,8490,3350.73,39.4668,,3350.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2971.5,35,,2971.5,percent of total billed charges,Implant Device,2886.6,34,"Charges > $500, x 34%",2886.6,percent of total billed charges,Implant Device,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,3396,40,,3396,percent of total billed charges,Implant Devices,2971.5,70,,2971.5,percent of total billed charges,Implant Devices,2886.6,34,,2886.6,percent of total billed charges,Implant Devices,2886.6,34,,2886.6,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2886.6,34,"If Charge > 2,000, then 34 percent",2886.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3396,
BIOMET 432165 SPACER MOLD,C1776,HCPCS,,79001818,CDM,278,RC,,,both,,,8490,3350.73,39.4668,,3350.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2886.6,34,,2886.6,percent of total billed charges,Implant Device,2971.5,35,,2971.5,percent of total billed charges,Implant Device,2886.6,34,"Charges > $500, x 34%",2886.6,percent of total billed charges,Implant Device,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,3396,40,,3396,percent of total billed charges,Implant Devices,2971.5,70,,2971.5,percent of total billed charges,Implant Devices,2886.6,34,,2886.6,percent of total billed charges,Implant Devices,2886.6,34,,2886.6,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,2971.5,35,,2971.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2886.6,34,"If Charge > 2,000, then 34 percent",2886.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3396,
BIOMET 433170 SPACER MOLD,C1776,HCPCS,,79001819,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
BIOMET 433180 SPACER MOLD,C1776,HCPCS,,79001820,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
ZIMMER 00-5001-052-00 BIPOLAR SHELL,C1776,HCPCS,,79001855,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
ZIMMER 00-5450-013-31-REV TIBIAL CONE,C1776,HCPCS,,79001857,CDM,278,RC,,,both,,,12646,4990.97,39.4668,,4990.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4426.1,35,,4426.1,percent of total billed charges,Implant Device,4299.64,34,"Charges > $500, x 34%",4299.64,percent of total billed charges,Implant Device,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,5058.4,40,,5058.4,percent of total billed charges,Implant Devices,4426.1,70,,4426.1,percent of total billed charges,Implant Devices,4299.64,34,,4299.64,percent of total billed charges,Implant Devices,4299.64,34,,4299.64,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4299.64,34,"If Charge > 2,000, then 34 percent",4299.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5058.4,
ZIMMER 00-7000-056-20-REV REV SHELL,C1776,HCPCS,,79001861,CDM,278,RC,,,both,,,15450,6097.62,39.4668,,6097.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5253,34,,5253,percent of total billed charges,Implant Device,5253,34,,5253,percent of total billed charges,Implant Device,5253,34,,5253,percent of total billed charges,Implant Device,5253,34,,5253,percent of total billed charges,Implant Device,5253,34,,5253,percent of total billed charges,Implant Device,5253,34,,5253,percent of total billed charges,Implant Device,5407.5,35,,5407.5,percent of total billed charges,Implant Device,5253,34,"Charges > $500, x 34%",5253,percent of total billed charges,Implant Device,5407.5,35,,5407.5,percent of total billed charges,Implant Devices,5407.5,35,,5407.5,percent of total billed charges,Implant Devices,5407.5,35,,,percent of total billed charges,Implant Devices,5407.5,35,,5407.5,percent of total billed charges,Implant Devices,5407.5,35,,5407.5,percent of total billed charges,Implant Devices,6180,40,,6180,percent of total billed charges,Implant Devices,5407.5,70,,5407.5,percent of total billed charges,Implant Devices,5253,34,,5253,percent of total billed charges,Implant Devices,5253,34,,5253,percent of total billed charges,Implant Devices,5407.5,35,,5407.5,percent of total billed charges,Implant Devices,5407.5,35,,5407.5,percent of total billed charges,Implant Devices,5407.5,35,,5407.5,percent of total billed charges,Implant Devices,5407.5,35,,5407.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5253,34,"If Charge > 2,000, then 34 percent",5253,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6180,
ZIMMER 00-7123-056-48-REV REV CAGE,C1776,HCPCS,,79001862,CDM,278,RC,,,both,,,14640,5777.94,39.4668,,5777.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4977.6,34,,4977.6,percent of total billed charges,Implant Device,4977.6,34,,4977.6,percent of total billed charges,Implant Device,4977.6,34,,4977.6,percent of total billed charges,Implant Device,4977.6,34,,4977.6,percent of total billed charges,Implant Device,4977.6,34,,4977.6,percent of total billed charges,Implant Device,4977.6,34,,4977.6,percent of total billed charges,Implant Device,5124,35,,5124,percent of total billed charges,Implant Device,4977.6,34,"Charges > $500, x 34%",4977.6,percent of total billed charges,Implant Device,5124,35,,5124,percent of total billed charges,Implant Devices,5124,35,,5124,percent of total billed charges,Implant Devices,5124,35,,,percent of total billed charges,Implant Devices,5124,35,,5124,percent of total billed charges,Implant Devices,5124,35,,5124,percent of total billed charges,Implant Devices,5856,40,,5856,percent of total billed charges,Implant Devices,5124,70,,5124,percent of total billed charges,Implant Devices,4977.6,34,,4977.6,percent of total billed charges,Implant Devices,4977.6,34,,4977.6,percent of total billed charges,Implant Devices,5124,35,,5124,percent of total billed charges,Implant Devices,5124,35,,5124,percent of total billed charges,Implant Devices,5124,35,,5124,percent of total billed charges,Implant Devices,5124,35,,5124,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4977.6,34,"If Charge > 2,000, then 34 percent",4977.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5856,
ZIMMER 00-7133-056-48-REV REV CAGE,C1776,HCPCS,,79001863,CDM,278,RC,,,both,,,1344,530.43,39.4668,,530.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,456.96,34,,456.96,percent of total billed charges,Implant Device,456.96,34,,456.96,percent of total billed charges,Implant Device,456.96,34,,456.96,percent of total billed charges,Implant Device,456.96,34,,456.96,percent of total billed charges,Implant Device,456.96,34,,456.96,percent of total billed charges,Implant Device,456.96,34,,456.96,percent of total billed charges,Implant Device,470.4,35,,470.4,percent of total billed charges,Implant Device,456.96,34,"Charges > $500, x 34%",456.96,percent of total billed charges,Implant Device,470.4,35,,470.4,percent of total billed charges,Implant Devices,470.4,35,,470.4,percent of total billed charges,Implant Devices,470.4,35,,,percent of total billed charges,Implant Devices,470.4,35,,470.4,percent of total billed charges,Implant Devices,470.4,35,,470.4,percent of total billed charges,Implant Devices,537.6,40,,537.6,percent of total billed charges,Implant Devices,470.4,70,,470.4,percent of total billed charges,Implant Devices,456.96,34,,456.96,percent of total billed charges,Implant Devices,456.96,34,,456.96,percent of total billed charges,Implant Devices,470.4,35,,470.4,percent of total billed charges,Implant Devices,470.4,35,,470.4,percent of total billed charges,Implant Devices,470.4,35,,470.4,percent of total billed charges,Implant Devices,470.4,35,,470.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,537.6,
ZIMMER 00-7848-024-00-REV MODULAR NECK,C1776,HCPCS,,79001864,CDM,278,RC,,,both,,,2998,1183.21,39.4668,,1183.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1049.3,35,,1049.3,percent of total billed charges,Implant Device,1019.32,34,"Charges > $500, x 34%",1019.32,percent of total billed charges,Implant Device,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1199.2,40,,1199.2,percent of total billed charges,Implant Devices,1049.3,70,,1049.3,percent of total billed charges,Implant Devices,1019.32,34,,1019.32,percent of total billed charges,Implant Devices,1019.32,34,,1019.32,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1019.32,34,"If Charge > 2,000, then 34 percent",1019.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1199.2,
ZIMMER 00-8751-010-36-REV NEUTRAL LINER,C1776,HCPCS,,79001865,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8751-011-36-REV NEUTRAL LINER,C1776,HCPCS,,79001866,CDM,278,RC,,,both,,,5483,2163.96,39.4668,,2163.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Device,1864.22,34,"Charges > $500, x 34%",1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,2193.2,40,,2193.2,percent of total billed charges,Implant Devices,1919.05,70,,1919.05,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1864.22,34,"If Charge > 2,000, then 34 percent",1864.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2193.2,
ZIMMER 00-8751-012-36-REV NEUTRAL LINER,C1776,HCPCS,,79001867,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8751-01336-REV NEUTRAL LINER,C1776,HCPCS,,79001868,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8751-013-40-REV NEUTRAL LINER,C1776,HCPCS,,79001869,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8751-014-40-REV NEUTRAL LINER,C1776,HCPCS,,79001870,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8751-052-01-REV METAL SHELL,C1776,HCPCS,,79001871,CDM,278,RC,,,both,,,7829,3089.86,39.4668,,3089.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2661.86,34,,2661.86,percent of total billed charges,Implant Device,2661.86,34,,2661.86,percent of total billed charges,Implant Device,2661.86,34,,2661.86,percent of total billed charges,Implant Device,2661.86,34,,2661.86,percent of total billed charges,Implant Device,2661.86,34,,2661.86,percent of total billed charges,Implant Device,2661.86,34,,2661.86,percent of total billed charges,Implant Device,2740.15,35,,2740.15,percent of total billed charges,Implant Device,2661.86,34,"Charges > $500, x 34%",2661.86,percent of total billed charges,Implant Device,2740.15,35,,2740.15,percent of total billed charges,Implant Devices,2740.15,35,,2740.15,percent of total billed charges,Implant Devices,2740.15,35,,,percent of total billed charges,Implant Devices,2740.15,35,,2740.15,percent of total billed charges,Implant Devices,2740.15,35,,2740.15,percent of total billed charges,Implant Devices,3131.6,40,,3131.6,percent of total billed charges,Implant Devices,2740.15,70,,2740.15,percent of total billed charges,Implant Devices,2661.86,34,,2661.86,percent of total billed charges,Implant Devices,2661.86,34,,2661.86,percent of total billed charges,Implant Devices,2740.15,35,,2740.15,percent of total billed charges,Implant Devices,2740.15,35,,2740.15,percent of total billed charges,Implant Devices,2740.15,35,,2740.15,percent of total billed charges,Implant Devices,2740.15,35,,2740.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2661.86,34,"If Charge > 2,000, then 34 percent",2661.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3131.6,
ZIMMER 00-8752-008-32-REV POLY LINER,C1776,HCPCS,,79001872,CDM,278,RC,,,both,,,4027,1589.33,39.4668,,1589.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1369.18,34,,1369.18,percent of total billed charges,Implant Device,1369.18,34,,1369.18,percent of total billed charges,Implant Device,1369.18,34,,1369.18,percent of total billed charges,Implant Device,1369.18,34,,1369.18,percent of total billed charges,Implant Device,1369.18,34,,1369.18,percent of total billed charges,Implant Device,1369.18,34,,1369.18,percent of total billed charges,Implant Device,1409.45,35,,1409.45,percent of total billed charges,Implant Device,1369.18,34,"Charges > $500, x 34%",1369.18,percent of total billed charges,Implant Device,1409.45,35,,1409.45,percent of total billed charges,Implant Devices,1409.45,35,,1409.45,percent of total billed charges,Implant Devices,1409.45,35,,,percent of total billed charges,Implant Devices,1409.45,35,,1409.45,percent of total billed charges,Implant Devices,1409.45,35,,1409.45,percent of total billed charges,Implant Devices,1610.8,40,,1610.8,percent of total billed charges,Implant Devices,1409.45,70,,1409.45,percent of total billed charges,Implant Devices,1369.18,34,,1369.18,percent of total billed charges,Implant Devices,1369.18,34,,1369.18,percent of total billed charges,Implant Devices,1409.45,35,,1409.45,percent of total billed charges,Implant Devices,1409.45,35,,1409.45,percent of total billed charges,Implant Devices,1409.45,35,,1409.45,percent of total billed charges,Implant Devices,1409.45,35,,1409.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1369.18,34,"If Charge > 2,000, then 34 percent",1369.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1610.8,
ZIMMER 00-8752-010-36-REV POLY LINER,C1776,HCPCS,,79001873,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8752-013-36-REV POLY LINER,C1776,HCPCS,,79001874,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8752-014-36-REV POLY LINER,C1776,HCPCS,,79001875,CDM,278,RC,,,both,,,4972,1962.29,39.4668,,1962.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.48,34,,1690.48,percent of total billed charges,Implant Device,1690.48,34,,1690.48,percent of total billed charges,Implant Device,1690.48,34,,1690.48,percent of total billed charges,Implant Device,1690.48,34,,1690.48,percent of total billed charges,Implant Device,1690.48,34,,1690.48,percent of total billed charges,Implant Device,1690.48,34,,1690.48,percent of total billed charges,Implant Device,1740.2,35,,1740.2,percent of total billed charges,Implant Device,1690.48,34,"Charges > $500, x 34%",1690.48,percent of total billed charges,Implant Device,1740.2,35,,1740.2,percent of total billed charges,Implant Devices,1740.2,35,,1740.2,percent of total billed charges,Implant Devices,1740.2,35,,,percent of total billed charges,Implant Devices,1740.2,35,,1740.2,percent of total billed charges,Implant Devices,1740.2,35,,1740.2,percent of total billed charges,Implant Devices,1988.8,40,,1988.8,percent of total billed charges,Implant Devices,1740.2,70,,1740.2,percent of total billed charges,Implant Devices,1690.48,34,,1690.48,percent of total billed charges,Implant Devices,1690.48,34,,1690.48,percent of total billed charges,Implant Devices,1740.2,35,,1740.2,percent of total billed charges,Implant Devices,1740.2,35,,1740.2,percent of total billed charges,Implant Devices,1740.2,35,,1740.2,percent of total billed charges,Implant Devices,1740.2,35,,1740.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.48,34,"If Charge > 2,000, then 34 percent",1690.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1988.8,
ZIMMER 00-8752-016-36-REV LINER,C1776,HCPCS,,79001876,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8755-009-32-REV LINER,C1776,HCPCS,,79001877,CDM,278,RC,,,both,,,5483,2163.96,39.4668,,2163.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1864.22,34,,1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Device,1864.22,34,"Charges > $500, x 34%",1864.22,percent of total billed charges,Implant Device,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,2193.2,40,,2193.2,percent of total billed charges,Implant Devices,1919.05,70,,1919.05,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1864.22,34,,1864.22,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,1919.05,35,,1919.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1864.22,34,"If Charge > 2,000, then 34 percent",1864.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2193.2,
ZIMMER 00-8755-010-36-REV LINER,C1776,HCPCS,,79001878,CDM,278,RC,,,both,,,5482,2163.57,39.4668,,2163.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1863.88,34,,1863.88,percent of total billed charges,Implant Device,1863.88,34,,1863.88,percent of total billed charges,Implant Device,1863.88,34,,1863.88,percent of total billed charges,Implant Device,1863.88,34,,1863.88,percent of total billed charges,Implant Device,1863.88,34,,1863.88,percent of total billed charges,Implant Device,1863.88,34,,1863.88,percent of total billed charges,Implant Device,1918.7,35,,1918.7,percent of total billed charges,Implant Device,1863.88,34,"Charges > $500, x 34%",1863.88,percent of total billed charges,Implant Device,1918.7,35,,1918.7,percent of total billed charges,Implant Devices,1918.7,35,,1918.7,percent of total billed charges,Implant Devices,1918.7,35,,,percent of total billed charges,Implant Devices,1918.7,35,,1918.7,percent of total billed charges,Implant Devices,1918.7,35,,1918.7,percent of total billed charges,Implant Devices,2192.8,40,,2192.8,percent of total billed charges,Implant Devices,1918.7,70,,1918.7,percent of total billed charges,Implant Devices,1863.88,34,,1863.88,percent of total billed charges,Implant Devices,1863.88,34,,1863.88,percent of total billed charges,Implant Devices,1918.7,35,,1918.7,percent of total billed charges,Implant Devices,1918.7,35,,1918.7,percent of total billed charges,Implant Devices,1918.7,35,,1918.7,percent of total billed charges,Implant Devices,1918.7,35,,1918.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1863.88,34,"If Charge > 2,000, then 34 percent",1863.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2192.8,
ZIMMER 00-8755-014-36-REV LINER,C1776,HCPCS,,79001879,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8755-015-36-REV LINER,C1776,HCPCS,,79001880,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8757-050-01 SHELL,C1776,HCPCS,,79001881,CDM,278,RC,,,both,,,19566,7722.07,39.4668,,7722.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6652.44,34,,6652.44,percent of total billed charges,Implant Device,6652.44,34,,6652.44,percent of total billed charges,Implant Device,6652.44,34,,6652.44,percent of total billed charges,Implant Device,6652.44,34,,6652.44,percent of total billed charges,Implant Device,6652.44,34,,6652.44,percent of total billed charges,Implant Device,6652.44,34,,6652.44,percent of total billed charges,Implant Device,6848.1,35,,6848.1,percent of total billed charges,Implant Device,6652.44,34,"Charges > $500, x 34%",6652.44,percent of total billed charges,Implant Device,6848.1,35,,6848.1,percent of total billed charges,Implant Devices,6848.1,35,,6848.1,percent of total billed charges,Implant Devices,6848.1,35,,,percent of total billed charges,Implant Devices,6848.1,35,,6848.1,percent of total billed charges,Implant Devices,6848.1,35,,6848.1,percent of total billed charges,Implant Devices,7826.4,40,,7826.4,percent of total billed charges,Implant Devices,6848.1,70,,6848.1,percent of total billed charges,Implant Devices,6652.44,34,,6652.44,percent of total billed charges,Implant Devices,6652.44,34,,6652.44,percent of total billed charges,Implant Devices,6848.1,35,,6848.1,percent of total billed charges,Implant Devices,6848.1,35,,6848.1,percent of total billed charges,Implant Devices,6848.1,35,,6848.1,percent of total billed charges,Implant Devices,6848.1,35,,6848.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6652.44,34,"If Charge > 2,000, then 34 percent",6652.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7826.4,
ZIMMER 00-8757-050-01-REV SHELL,C1776,HCPCS,,79001882,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
ZIMMER 00-8757-052-01 SHELL,C1776,HCPCS,,79001883,CDM,278,RC,,,both,,,4145,1635.9,39.4668,,1635.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Device,1409.3,34,"Charges > $500, x 34%",1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1658,40,,1658,percent of total billed charges,Implant Devices,1450.75,70,,1450.75,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1409.3,34,"If Charge > 2,000, then 34 percent",1409.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1658,
ZIMMER 00-8757-052-01-REV SHELL,C1776,HCPCS,,79001884,CDM,278,RC,,,both,,,7608,3002.63,39.4668,,3002.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2586.72,34,,2586.72,percent of total billed charges,Implant Device,2586.72,34,,2586.72,percent of total billed charges,Implant Device,2586.72,34,,2586.72,percent of total billed charges,Implant Device,2586.72,34,,2586.72,percent of total billed charges,Implant Device,2586.72,34,,2586.72,percent of total billed charges,Implant Device,2586.72,34,,2586.72,percent of total billed charges,Implant Device,2662.8,35,,2662.8,percent of total billed charges,Implant Device,2586.72,34,"Charges > $500, x 34%",2586.72,percent of total billed charges,Implant Device,2662.8,35,,2662.8,percent of total billed charges,Implant Devices,2662.8,35,,2662.8,percent of total billed charges,Implant Devices,2662.8,35,,,percent of total billed charges,Implant Devices,2662.8,35,,2662.8,percent of total billed charges,Implant Devices,2662.8,35,,2662.8,percent of total billed charges,Implant Devices,3043.2,40,,3043.2,percent of total billed charges,Implant Devices,2662.8,70,,2662.8,percent of total billed charges,Implant Devices,2586.72,34,,2586.72,percent of total billed charges,Implant Devices,2586.72,34,,2586.72,percent of total billed charges,Implant Devices,2662.8,35,,2662.8,percent of total billed charges,Implant Devices,2662.8,35,,2662.8,percent of total billed charges,Implant Devices,2662.8,35,,2662.8,percent of total billed charges,Implant Devices,2662.8,35,,2662.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2586.72,34,"If Charge > 2,000, then 34 percent",2586.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3043.2,
ZIMMER 00-8757-052-02-REV SHELL,C1776,HCPCS,,79001885,CDM,278,RC,,,both,,,7133,2815.17,39.4668,,2815.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2425.22,34,,2425.22,percent of total billed charges,Implant Device,2425.22,34,,2425.22,percent of total billed charges,Implant Device,2425.22,34,,2425.22,percent of total billed charges,Implant Device,2425.22,34,,2425.22,percent of total billed charges,Implant Device,2425.22,34,,2425.22,percent of total billed charges,Implant Device,2425.22,34,,2425.22,percent of total billed charges,Implant Device,2496.55,35,,2496.55,percent of total billed charges,Implant Device,2425.22,34,"Charges > $500, x 34%",2425.22,percent of total billed charges,Implant Device,2496.55,35,,2496.55,percent of total billed charges,Implant Devices,2496.55,35,,2496.55,percent of total billed charges,Implant Devices,2496.55,35,,,percent of total billed charges,Implant Devices,2496.55,35,,2496.55,percent of total billed charges,Implant Devices,2496.55,35,,2496.55,percent of total billed charges,Implant Devices,2853.2,40,,2853.2,percent of total billed charges,Implant Devices,2496.55,70,,2496.55,percent of total billed charges,Implant Devices,2425.22,34,,2425.22,percent of total billed charges,Implant Devices,2425.22,34,,2425.22,percent of total billed charges,Implant Devices,2496.55,35,,2496.55,percent of total billed charges,Implant Devices,2496.55,35,,2496.55,percent of total billed charges,Implant Devices,2496.55,35,,2496.55,percent of total billed charges,Implant Devices,2496.55,35,,2496.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2425.22,34,"If Charge > 2,000, then 34 percent",2425.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2853.2,
ZIMMER 00-8757-054-01-REV SHELL,C1776,HCPCS,,79001886,CDM,278,RC,,,both,,,4145,1635.9,39.4668,,1635.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Device,1409.3,34,"Charges > $500, x 34%",1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1658,40,,1658,percent of total billed charges,Implant Devices,1450.75,70,,1450.75,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1409.3,34,"If Charge > 2,000, then 34 percent",1409.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1658,
ZIMMER 00-8757-058-01-REV SHELL,C1776,HCPCS,,79001887,CDM,278,RC,,,both,,,4145,1635.9,39.4668,,1635.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Device,1409.3,34,"Charges > $500, x 34%",1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1658,40,,1658,percent of total billed charges,Implant Devices,1450.75,70,,1450.75,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1409.3,34,"If Charge > 2,000, then 34 percent",1409.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1658,
ZIMMER 00-8757-060-01-REV SHELL,C1776,HCPCS,,79001888,CDM,278,RC,,,both,,,4145,1635.9,39.4668,,1635.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Device,1409.3,34,"Charges > $500, x 34%",1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1658,40,,1658,percent of total billed charges,Implant Devices,1450.75,70,,1450.75,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1409.3,34,"If Charge > 2,000, then 34 percent",1409.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1658,
ZIMMER 00-8757-062-02-REV SHELL,C1776,HCPCS,,79001889,CDM,278,RC,,,both,,,9203,3632.13,39.4668,,3632.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3221.05,35,,3221.05,percent of total billed charges,Implant Device,3129.02,34,"Charges > $500, x 34%",3129.02,percent of total billed charges,Implant Device,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3681.2,40,,3681.2,percent of total billed charges,Implant Devices,3221.05,70,,3221.05,percent of total billed charges,Implant Devices,3129.02,34,,3129.02,percent of total billed charges,Implant Devices,3129.02,34,,3129.02,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3129.02,34,"If Charge > 2,000, then 34 percent",3129.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3681.2,
ZIMMER 00-8757-064-02-REV SHELL,C1776,HCPCS,,79001890,CDM,278,RC,,,both,,,9203,3632.13,39.4668,,3632.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3221.05,35,,3221.05,percent of total billed charges,Implant Device,3129.02,34,"Charges > $500, x 34%",3129.02,percent of total billed charges,Implant Device,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3681.2,40,,3681.2,percent of total billed charges,Implant Devices,3221.05,70,,3221.05,percent of total billed charges,Implant Devices,3129.02,34,,3129.02,percent of total billed charges,Implant Devices,3129.02,34,,3129.02,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3129.02,34,"If Charge > 2,000, then 34 percent",3129.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3681.2,
ZIMMER 00-8775-036-03-REV FEMORAL HEAD,C1776,HCPCS,,79001891,CDM,278,RC,,,both,,,3834,1513.16,39.4668,,1513.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1341.9,35,,1341.9,percent of total billed charges,Implant Device,1303.56,34,"Charges > $500, x 34%",1303.56,percent of total billed charges,Implant Device,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1533.6,40,,1533.6,percent of total billed charges,Implant Devices,1341.9,70,,1341.9,percent of total billed charges,Implant Devices,1303.56,34,,1303.56,percent of total billed charges,Implant Devices,1303.56,34,,1303.56,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1303.56,34,"If Charge > 2,000, then 34 percent",1303.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1533.6,
ZIMMER 00-8775-036-04-REV TRACH IMPLANT,C1776,HCPCS,,79001892,CDM,278,RC,,,both,,,3834,1513.16,39.4668,,1513.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1341.9,35,,1341.9,percent of total billed charges,Implant Device,1303.56,34,"Charges > $500, x 34%",1303.56,percent of total billed charges,Implant Device,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1533.6,40,,1533.6,percent of total billed charges,Implant Devices,1341.9,70,,1341.9,percent of total billed charges,Implant Devices,1303.56,34,,1303.56,percent of total billed charges,Implant Devices,1303.56,34,,1303.56,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1303.56,34,"If Charge > 2,000, then 34 percent",1303.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1533.6,
DEPUY 00-8775-040-02-REV FEMORAL HEAD,C1776,HCPCS,,79001893,CDM,278,RC,,,both,,,6526,2575.6,39.4668,,2575.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2218.84,34,,2218.84,percent of total billed charges,Implant Device,2218.84,34,,2218.84,percent of total billed charges,Implant Device,2218.84,34,,2218.84,percent of total billed charges,Implant Device,2218.84,34,,2218.84,percent of total billed charges,Implant Device,2218.84,34,,2218.84,percent of total billed charges,Implant Device,2218.84,34,,2218.84,percent of total billed charges,Implant Device,2284.1,35,,2284.1,percent of total billed charges,Implant Device,2218.84,34,"Charges > $500, x 34%",2218.84,percent of total billed charges,Implant Device,2284.1,35,,2284.1,percent of total billed charges,Implant Devices,2284.1,35,,2284.1,percent of total billed charges,Implant Devices,2284.1,35,,,percent of total billed charges,Implant Devices,2284.1,35,,2284.1,percent of total billed charges,Implant Devices,2284.1,35,,2284.1,percent of total billed charges,Implant Devices,2610.4,40,,2610.4,percent of total billed charges,Implant Devices,2284.1,70,,2284.1,percent of total billed charges,Implant Devices,2218.84,34,,2218.84,percent of total billed charges,Implant Devices,2218.84,34,,2218.84,percent of total billed charges,Implant Devices,2284.1,35,,2284.1,percent of total billed charges,Implant Devices,2284.1,35,,2284.1,percent of total billed charges,Implant Devices,2284.1,35,,2284.1,percent of total billed charges,Implant Devices,2284.1,35,,2284.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2218.84,34,"If Charge > 2,000, then 34 percent",2218.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2610.4,
DEPUY 1018-36-508-REV FEMORAL HEAD,C1776,HCPCS,,79001906,CDM,278,RC,,,both,,,5471,2159.23,39.4668,,2159.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1860.14,34,,1860.14,percent of total billed charges,Implant Device,1860.14,34,,1860.14,percent of total billed charges,Implant Device,1860.14,34,,1860.14,percent of total billed charges,Implant Device,1860.14,34,,1860.14,percent of total billed charges,Implant Device,1860.14,34,,1860.14,percent of total billed charges,Implant Device,1860.14,34,,1860.14,percent of total billed charges,Implant Device,1914.85,35,,1914.85,percent of total billed charges,Implant Device,1860.14,34,"Charges > $500, x 34%",1860.14,percent of total billed charges,Implant Device,1914.85,35,,1914.85,percent of total billed charges,Implant Devices,1914.85,35,,1914.85,percent of total billed charges,Implant Devices,1914.85,35,,,percent of total billed charges,Implant Devices,1914.85,35,,1914.85,percent of total billed charges,Implant Devices,1914.85,35,,1914.85,percent of total billed charges,Implant Devices,2188.4,40,,2188.4,percent of total billed charges,Implant Devices,1914.85,70,,1914.85,percent of total billed charges,Implant Devices,1860.14,34,,1860.14,percent of total billed charges,Implant Devices,1860.14,34,,1860.14,percent of total billed charges,Implant Devices,1914.85,35,,1914.85,percent of total billed charges,Implant Devices,1914.85,35,,1914.85,percent of total billed charges,Implant Devices,1914.85,35,,1914.85,percent of total billed charges,Implant Devices,1914.85,35,,1914.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1860.14,34,"If Charge > 2,000, then 34 percent",1860.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2188.4,
ZIMMER 1018-36-511-REV FEMORAL HEAD,C1776,HCPCS,,79001907,CDM,278,RC,,,both,,,4818,1901.51,39.4668,,1901.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1638.12,34,,1638.12,percent of total billed charges,Implant Device,1638.12,34,,1638.12,percent of total billed charges,Implant Device,1638.12,34,,1638.12,percent of total billed charges,Implant Device,1638.12,34,,1638.12,percent of total billed charges,Implant Device,1638.12,34,,1638.12,percent of total billed charges,Implant Device,1638.12,34,,1638.12,percent of total billed charges,Implant Device,1686.3,35,,1686.3,percent of total billed charges,Implant Device,1638.12,34,"Charges > $500, x 34%",1638.12,percent of total billed charges,Implant Device,1686.3,35,,1686.3,percent of total billed charges,Implant Devices,1686.3,35,,1686.3,percent of total billed charges,Implant Devices,1686.3,35,,,percent of total billed charges,Implant Devices,1686.3,35,,1686.3,percent of total billed charges,Implant Devices,1686.3,35,,1686.3,percent of total billed charges,Implant Devices,1927.2,40,,1927.2,percent of total billed charges,Implant Devices,1686.3,70,,1686.3,percent of total billed charges,Implant Devices,1638.12,34,,1638.12,percent of total billed charges,Implant Devices,1638.12,34,,1638.12,percent of total billed charges,Implant Devices,1686.3,35,,1686.3,percent of total billed charges,Implant Devices,1686.3,35,,1686.3,percent of total billed charges,Implant Devices,1686.3,35,,1686.3,percent of total billed charges,Implant Devices,1686.3,35,,1686.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1638.12,34,"If Charge > 2,000, then 34 percent",1638.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1927.2,
BIOMET 11-107018-REV MOD HEAD,C1776,HCPCS,,79001910,CDM,278,RC,,,both,,,7920,3125.77,39.4668,,3125.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2772,35,,2772,percent of total billed charges,Implant Device,2692.8,34,"Charges > $500, x 34%",2692.8,percent of total billed charges,Implant Device,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,3168,40,,3168,percent of total billed charges,Implant Devices,2772,70,,2772,percent of total billed charges,Implant Devices,2692.8,34,,2692.8,percent of total billed charges,Implant Devices,2692.8,34,,2692.8,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2692.8,34,"If Charge > 2,000, then 34 percent",2692.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3168,
BIOMET 11-107019-REV MOD HEAD,C1776,HCPCS,,79001911,CDM,278,RC,,,both,,,4722,1863.62,39.4668,,1863.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1652.7,35,,1652.7,percent of total billed charges,Implant Device,1605.48,34,"Charges > $500, x 34%",1605.48,percent of total billed charges,Implant Device,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1888.8,40,,1888.8,percent of total billed charges,Implant Devices,1652.7,70,,1652.7,percent of total billed charges,Implant Devices,1605.48,34,,1605.48,percent of total billed charges,Implant Devices,1605.48,34,,1605.48,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1605.48,34,"If Charge > 2,000, then 34 percent",1605.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1888.8,
BIOMET 11-107122-REV ACETABULAR CUP,C1776,HCPCS,,79001912,CDM,278,RC,,,both,,,7714,3044.47,39.4668,,3044.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2622.76,34,,2622.76,percent of total billed charges,Implant Device,2622.76,34,,2622.76,percent of total billed charges,Implant Device,2622.76,34,,2622.76,percent of total billed charges,Implant Device,2622.76,34,,2622.76,percent of total billed charges,Implant Device,2622.76,34,,2622.76,percent of total billed charges,Implant Device,2622.76,34,,2622.76,percent of total billed charges,Implant Device,2699.9,35,,2699.9,percent of total billed charges,Implant Device,2622.76,34,"Charges > $500, x 34%",2622.76,percent of total billed charges,Implant Device,2699.9,35,,2699.9,percent of total billed charges,Implant Devices,2699.9,35,,2699.9,percent of total billed charges,Implant Devices,2699.9,35,,,percent of total billed charges,Implant Devices,2699.9,35,,2699.9,percent of total billed charges,Implant Devices,2699.9,35,,2699.9,percent of total billed charges,Implant Devices,3085.6,40,,3085.6,percent of total billed charges,Implant Devices,2699.9,70,,2699.9,percent of total billed charges,Implant Devices,2622.76,34,,2622.76,percent of total billed charges,Implant Devices,2622.76,34,,2622.76,percent of total billed charges,Implant Devices,2699.9,35,,2699.9,percent of total billed charges,Implant Devices,2699.9,35,,2699.9,percent of total billed charges,Implant Devices,2699.9,35,,2699.9,percent of total billed charges,Implant Devices,2699.9,35,,2699.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2622.76,34,"If Charge > 2,000, then 34 percent",2622.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3085.6,
BIOMET 11-113556 HUMERAL FRACTURE STEM,C1776,HCPCS,,79001913,CDM,278,RC,,,both,,,19710,7778.91,39.4668,,7778.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6701.4,34,,6701.4,percent of total billed charges,Implant Device,6701.4,34,,6701.4,percent of total billed charges,Implant Device,6701.4,34,,6701.4,percent of total billed charges,Implant Device,6701.4,34,,6701.4,percent of total billed charges,Implant Device,6701.4,34,,6701.4,percent of total billed charges,Implant Device,6701.4,34,,6701.4,percent of total billed charges,Implant Device,6898.5,35,,6898.5,percent of total billed charges,Implant Device,6701.4,34,"Charges > $500, x 34%",6701.4,percent of total billed charges,Implant Device,6898.5,35,,6898.5,percent of total billed charges,Implant Devices,6898.5,35,,6898.5,percent of total billed charges,Implant Devices,6898.5,35,,,percent of total billed charges,Implant Devices,6898.5,35,,6898.5,percent of total billed charges,Implant Devices,6898.5,35,,6898.5,percent of total billed charges,Implant Devices,7884,40,,7884,percent of total billed charges,Implant Devices,6898.5,70,,6898.5,percent of total billed charges,Implant Devices,6701.4,34,,6701.4,percent of total billed charges,Implant Devices,6701.4,34,,6701.4,percent of total billed charges,Implant Devices,6898.5,35,,6898.5,percent of total billed charges,Implant Devices,6898.5,35,,6898.5,percent of total billed charges,Implant Devices,6898.5,35,,6898.5,percent of total billed charges,Implant Devices,6898.5,35,,6898.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6701.4,34,"If Charge > 2,000, then 34 percent",6701.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7884,
BIOMET 11-300920 DISTAL STEM,C1776,HCPCS,,79001914,CDM,278,RC,,,both,,,11059,4364.63,39.4668,,4364.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3870.65,35,,3870.65,percent of total billed charges,Implant Device,3760.06,34,"Charges > $500, x 34%",3760.06,percent of total billed charges,Implant Device,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,4423.6,40,,4423.6,percent of total billed charges,Implant Devices,3870.65,70,,3870.65,percent of total billed charges,Implant Devices,3760.06,34,,3760.06,percent of total billed charges,Implant Devices,3760.06,34,,3760.06,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3760.06,34,"If Charge > 2,000, then 34 percent",3760.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4423.6,
BIOMET 12-139010 ENDO II HEAD,C1776,HCPCS,,79001916,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
BIOMET 12-139014 ENDO II HEAD,C1776,HCPCS,,79001917,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
DEPUY 12-139022 ENDO II HEAD,C1776,HCPCS,,79001918,CDM,278,RC,,,both,,,1380,544.64,39.4668,,544.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Device,469.2,34,"Charges > $500, x 34%",469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,552,40,,552,percent of total billed charges,Implant Devices,483,70,,483,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552,
BIOMET 12-139024 ENDO II HEAD,C1776,HCPCS,,79001919,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
BIOMET 12-139026 ENDO II HEAD,C1776,HCPCS,,79001920,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
BIOMET 12-139028 ENDO II HEAD,C1776,HCPCS,,79001921,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
BIOMET 12-139030 ENDO II HEAD 53MM,C1776,HCPCS,,79001922,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
DEPUY 12-150309 FEMORAL HEAD,C1776,HCPCS,,79001923,CDM,278,RC,,,both,,,15240,6014.74,39.4668,,6014.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5334,35,,5334,percent of total billed charges,Implant Device,5181.6,34,"Charges > $500, x 34%",5181.6,percent of total billed charges,Implant Device,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,6096,40,,6096,percent of total billed charges,Implant Devices,5334,70,,5334,percent of total billed charges,Implant Devices,5181.6,34,,5181.6,percent of total billed charges,Implant Devices,5181.6,34,,5181.6,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5181.6,34,"If Charge > 2,000, then 34 percent",5181.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6096,
BIOMET 12-150311 FEMORAL COMPONENT,C1776,HCPCS,,79001924,CDM,278,RC,,,both,,,15240,6014.74,39.4668,,6014.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5334,35,,5334,percent of total billed charges,Implant Device,5181.6,34,"Charges > $500, x 34%",5181.6,percent of total billed charges,Implant Device,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,6096,40,,6096,percent of total billed charges,Implant Devices,5334,70,,5334,percent of total billed charges,Implant Devices,5181.6,34,,5181.6,percent of total billed charges,Implant Devices,5181.6,34,,5181.6,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5181.6,34,"If Charge > 2,000, then 34 percent",5181.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6096,
BIOMET 12-151307 FEMORAL COMPONENT,C1776,HCPCS,,79001925,CDM,278,RC,,,both,,,8820,3480.97,39.4668,,3480.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,3087,35,,3087,percent of total billed charges,Implant Device,2998.8,34,"Charges > $500, x 34%",2998.8,percent of total billed charges,Implant Device,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3528,40,,3528,percent of total billed charges,Implant Devices,3087,70,,3087,percent of total billed charges,Implant Devices,2998.8,34,,2998.8,percent of total billed charges,Implant Devices,2998.8,34,,2998.8,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2998.8,34,"If Charge > 2,000, then 34 percent",2998.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3528,
BIOMET 12-151309 FEMORAL COMP 9X130MM,C1776,HCPCS,,79001926,CDM,278,RC,,,both,,,8820,3480.97,39.4668,,3480.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,3087,35,,3087,percent of total billed charges,Implant Device,2998.8,34,"Charges > $500, x 34%",2998.8,percent of total billed charges,Implant Device,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3528,40,,3528,percent of total billed charges,Implant Devices,3087,70,,3087,percent of total billed charges,Implant Devices,2998.8,34,,2998.8,percent of total billed charges,Implant Devices,2998.8,34,,2998.8,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2998.8,34,"If Charge > 2,000, then 34 percent",2998.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3528,
BIOMET 12-151313 FEMORAL COMP 13X150MM,C1776,HCPCS,,79001927,CDM,278,RC,,,both,,,8820,3480.97,39.4668,,3480.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,3087,35,,3087,percent of total billed charges,Implant Device,2998.8,34,"Charges > $500, x 34%",2998.8,percent of total billed charges,Implant Device,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3528,40,,3528,percent of total billed charges,Implant Devices,3087,70,,3087,percent of total billed charges,Implant Devices,2998.8,34,,2998.8,percent of total billed charges,Implant Devices,2998.8,34,,2998.8,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2998.8,34,"If Charge > 2,000, then 34 percent",2998.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3528,
DEPUY 1221-36-158-REV ACETABULAR LINER,C1776,HCPCS,,79001928,CDM,278,RC,,,both,,,5109,2016.36,39.4668,,2016.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1737.06,34,,1737.06,percent of total billed charges,Implant Device,1737.06,34,,1737.06,percent of total billed charges,Implant Device,1737.06,34,,1737.06,percent of total billed charges,Implant Device,1737.06,34,,1737.06,percent of total billed charges,Implant Device,1737.06,34,,1737.06,percent of total billed charges,Implant Device,1737.06,34,,1737.06,percent of total billed charges,Implant Device,1788.15,35,,1788.15,percent of total billed charges,Implant Device,1737.06,34,"Charges > $500, x 34%",1737.06,percent of total billed charges,Implant Device,1788.15,35,,1788.15,percent of total billed charges,Implant Devices,1788.15,35,,1788.15,percent of total billed charges,Implant Devices,1788.15,35,,,percent of total billed charges,Implant Devices,1788.15,35,,1788.15,percent of total billed charges,Implant Devices,1788.15,35,,1788.15,percent of total billed charges,Implant Devices,2043.6,40,,2043.6,percent of total billed charges,Implant Devices,1788.15,70,,1788.15,percent of total billed charges,Implant Devices,1737.06,34,,1737.06,percent of total billed charges,Implant Devices,1737.06,34,,1737.06,percent of total billed charges,Implant Devices,1788.15,35,,1788.15,percent of total billed charges,Implant Devices,1788.15,35,,1788.15,percent of total billed charges,Implant Devices,1788.15,35,,1788.15,percent of total billed charges,Implant Devices,1788.15,35,,1788.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1737.06,34,"If Charge > 2,000, then 34 percent",1737.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2043.6,
DEPUY 1294-35-125-REV TIBIAL TRAY,C1776,HCPCS,,79001929,CDM,278,RC,,,both,,,19157,7560.65,39.4668,,7560.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6704.95,35,,6704.95,percent of total billed charges,Implant Device,6513.38,34,"Charges > $500, x 34%",6513.38,percent of total billed charges,Implant Device,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,7662.8,40,,7662.8,percent of total billed charges,Implant Devices,6704.95,70,,6704.95,percent of total billed charges,Implant Devices,6513.38,34,,6513.38,percent of total billed charges,Implant Devices,6513.38,34,,6513.38,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6513.38,34,"If Charge > 2,000, then 34 percent",6513.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7662.8,
DEPUY 1294-35-130-REV TIBIAL TRAY,C1776,HCPCS,,79001930,CDM,278,RC,,,both,,,21319,8413.93,39.4668,,8413.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7248.46,34,,7248.46,percent of total billed charges,Implant Device,7248.46,34,,7248.46,percent of total billed charges,Implant Device,7248.46,34,,7248.46,percent of total billed charges,Implant Device,7248.46,34,,7248.46,percent of total billed charges,Implant Device,7248.46,34,,7248.46,percent of total billed charges,Implant Device,7248.46,34,,7248.46,percent of total billed charges,Implant Device,7461.65,35,,7461.65,percent of total billed charges,Implant Device,7248.46,34,"Charges > $500, x 34%",7248.46,percent of total billed charges,Implant Device,7461.65,35,,7461.65,percent of total billed charges,Implant Devices,7461.65,35,,7461.65,percent of total billed charges,Implant Devices,7461.65,35,,,percent of total billed charges,Implant Devices,7461.65,35,,7461.65,percent of total billed charges,Implant Devices,7461.65,35,,7461.65,percent of total billed charges,Implant Devices,8527.6,40,,8527.6,percent of total billed charges,Implant Devices,7461.65,70,,7461.65,percent of total billed charges,Implant Devices,7248.46,34,,7248.46,percent of total billed charges,Implant Devices,7248.46,34,,7248.46,percent of total billed charges,Implant Devices,7461.65,35,,7461.65,percent of total billed charges,Implant Devices,7461.65,35,,7461.65,percent of total billed charges,Implant Devices,7461.65,35,,7461.65,percent of total billed charges,Implant Devices,7461.65,35,,7461.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7248.46,34,"If Charge > 2,000, then 34 percent",7248.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8527.6,
DEPUY 1294-35-140-REV TIBIAL TRAY,C1776,HCPCS,,79001931,CDM,278,RC,,,both,,,15538,6132.35,39.4668,,6132.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5282.92,34,,5282.92,percent of total billed charges,Implant Device,5282.92,34,,5282.92,percent of total billed charges,Implant Device,5282.92,34,,5282.92,percent of total billed charges,Implant Device,5282.92,34,,5282.92,percent of total billed charges,Implant Device,5282.92,34,,5282.92,percent of total billed charges,Implant Device,5282.92,34,,5282.92,percent of total billed charges,Implant Device,5438.3,35,,5438.3,percent of total billed charges,Implant Device,5282.92,34,"Charges > $500, x 34%",5282.92,percent of total billed charges,Implant Device,5438.3,35,,5438.3,percent of total billed charges,Implant Devices,5438.3,35,,5438.3,percent of total billed charges,Implant Devices,5438.3,35,,,percent of total billed charges,Implant Devices,5438.3,35,,5438.3,percent of total billed charges,Implant Devices,5438.3,35,,5438.3,percent of total billed charges,Implant Devices,6215.2,40,,6215.2,percent of total billed charges,Implant Devices,5438.3,70,,5438.3,percent of total billed charges,Implant Devices,5282.92,34,,5282.92,percent of total billed charges,Implant Devices,5282.92,34,,5282.92,percent of total billed charges,Implant Devices,5438.3,35,,5438.3,percent of total billed charges,Implant Devices,5438.3,35,,5438.3,percent of total billed charges,Implant Devices,5438.3,35,,5438.3,percent of total billed charges,Implant Devices,5438.3,35,,5438.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5282.92,34,"If Charge > 2,000, then 34 percent",5282.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6215.2,
DEPUY 1294-45-120-REV TRAY SLEEVE,C1776,HCPCS,,79001932,CDM,278,RC,,,both,,,9565,3775,39.4668,,3775,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3347.75,35,,3347.75,percent of total billed charges,Implant Device,3252.1,34,"Charges > $500, x 34%",3252.1,percent of total billed charges,Implant Device,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3826,40,,3826,percent of total billed charges,Implant Devices,3347.75,70,,3347.75,percent of total billed charges,Implant Devices,3252.1,34,,3252.1,percent of total billed charges,Implant Devices,3252.1,34,,3252.1,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3252.1,34,"If Charge > 2,000, then 34 percent",3252.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3826,
DEPUY 1294-53-216-REV FEMORAL SLEEVE,C1776,HCPCS,,79001933,CDM,278,RC,,,both,,,9797,3866.56,39.4668,,3866.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3428.95,35,,3428.95,percent of total billed charges,Implant Device,3330.98,34,"Charges > $500, x 34%",3330.98,percent of total billed charges,Implant Device,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3918.8,40,,3918.8,percent of total billed charges,Implant Devices,3428.95,70,,3428.95,percent of total billed charges,Implant Devices,3330.98,34,,3330.98,percent of total billed charges,Implant Devices,3330.98,34,,3330.98,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3330.98,34,"If Charge > 2,000, then 34 percent",3330.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3918.8,
DEPUY 1294-53-226-REV FEMORAL SLEEVE,C1776,HCPCS,,79001934,CDM,278,RC,,,both,,,10111,3990.49,39.4668,,3990.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3437.74,34,,3437.74,percent of total billed charges,Implant Device,3437.74,34,,3437.74,percent of total billed charges,Implant Device,3437.74,34,,3437.74,percent of total billed charges,Implant Device,3437.74,34,,3437.74,percent of total billed charges,Implant Device,3437.74,34,,3437.74,percent of total billed charges,Implant Device,3437.74,34,,3437.74,percent of total billed charges,Implant Device,3538.85,35,,3538.85,percent of total billed charges,Implant Device,3437.74,34,"Charges > $500, x 34%",3437.74,percent of total billed charges,Implant Device,3538.85,35,,3538.85,percent of total billed charges,Implant Devices,3538.85,35,,3538.85,percent of total billed charges,Implant Devices,3538.85,35,,,percent of total billed charges,Implant Devices,3538.85,35,,3538.85,percent of total billed charges,Implant Devices,3538.85,35,,3538.85,percent of total billed charges,Implant Devices,4044.4,40,,4044.4,percent of total billed charges,Implant Devices,3538.85,70,,3538.85,percent of total billed charges,Implant Devices,3437.74,34,,3437.74,percent of total billed charges,Implant Devices,3437.74,34,,3437.74,percent of total billed charges,Implant Devices,3538.85,35,,3538.85,percent of total billed charges,Implant Devices,3538.85,35,,3538.85,percent of total billed charges,Implant Devices,3538.85,35,,3538.85,percent of total billed charges,Implant Devices,3538.85,35,,3538.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3437.74,34,"If Charge > 2,000, then 34 percent",3437.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4044.4,
DEPUY 1294-53-236-REV FEMORAL SLEEVE,C1776,HCPCS,,79001935,CDM,278,RC,,,both,,,9797,3866.56,39.4668,,3866.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3330.98,34,,3330.98,percent of total billed charges,Implant Device,3428.95,35,,3428.95,percent of total billed charges,Implant Device,3330.98,34,"Charges > $500, x 34%",3330.98,percent of total billed charges,Implant Device,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3918.8,40,,3918.8,percent of total billed charges,Implant Devices,3428.95,70,,3428.95,percent of total billed charges,Implant Devices,3330.98,34,,3330.98,percent of total billed charges,Implant Devices,3330.98,34,,3330.98,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,3428.95,35,,3428.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3330.98,34,"If Charge > 2,000, then 34 percent",3330.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3918.8,
DEPUY 1294-53-246-REV FEMORAL SLEEVE,C1776,HCPCS,,79001936,CDM,278,RC,,,both,,,11959,4719.83,39.4668,,4719.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4066.06,34,,4066.06,percent of total billed charges,Implant Device,4066.06,34,,4066.06,percent of total billed charges,Implant Device,4066.06,34,,4066.06,percent of total billed charges,Implant Device,4066.06,34,,4066.06,percent of total billed charges,Implant Device,4066.06,34,,4066.06,percent of total billed charges,Implant Device,4066.06,34,,4066.06,percent of total billed charges,Implant Device,4185.65,35,,4185.65,percent of total billed charges,Implant Device,4066.06,34,"Charges > $500, x 34%",4066.06,percent of total billed charges,Implant Device,4185.65,35,,4185.65,percent of total billed charges,Implant Devices,4185.65,35,,4185.65,percent of total billed charges,Implant Devices,4185.65,35,,,percent of total billed charges,Implant Devices,4185.65,35,,4185.65,percent of total billed charges,Implant Devices,4185.65,35,,4185.65,percent of total billed charges,Implant Devices,4783.6,40,,4783.6,percent of total billed charges,Implant Devices,4185.65,70,,4185.65,percent of total billed charges,Implant Devices,4066.06,34,,4066.06,percent of total billed charges,Implant Devices,4066.06,34,,4066.06,percent of total billed charges,Implant Devices,4185.65,35,,4185.65,percent of total billed charges,Implant Devices,4185.65,35,,4185.65,percent of total billed charges,Implant Devices,4185.65,35,,4185.65,percent of total billed charges,Implant Devices,4185.65,35,,4185.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4066.06,34,"If Charge > 2,000, then 34 percent",4066.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4783.6,
DEPUY 1294-54-000-REV TRAY SLEEVE,C1776,HCPCS,,79001937,CDM,278,RC,,,both,,,8813,3478.21,39.4668,,3478.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2996.42,34,,2996.42,percent of total billed charges,Implant Device,2996.42,34,,2996.42,percent of total billed charges,Implant Device,2996.42,34,,2996.42,percent of total billed charges,Implant Device,2996.42,34,,2996.42,percent of total billed charges,Implant Device,2996.42,34,,2996.42,percent of total billed charges,Implant Device,2996.42,34,,2996.42,percent of total billed charges,Implant Device,3084.55,35,,3084.55,percent of total billed charges,Implant Device,2996.42,34,"Charges > $500, x 34%",2996.42,percent of total billed charges,Implant Device,3084.55,35,,3084.55,percent of total billed charges,Implant Devices,3084.55,35,,3084.55,percent of total billed charges,Implant Devices,3084.55,35,,,percent of total billed charges,Implant Devices,3084.55,35,,3084.55,percent of total billed charges,Implant Devices,3084.55,35,,3084.55,percent of total billed charges,Implant Devices,3525.2,40,,3525.2,percent of total billed charges,Implant Devices,3084.55,70,,3084.55,percent of total billed charges,Implant Devices,2996.42,34,,2996.42,percent of total billed charges,Implant Devices,2996.42,34,,2996.42,percent of total billed charges,Implant Devices,3084.55,35,,3084.55,percent of total billed charges,Implant Devices,3084.55,35,,3084.55,percent of total billed charges,Implant Devices,3084.55,35,,3084.55,percent of total billed charges,Implant Devices,3084.55,35,,3084.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2996.42,34,"If Charge > 2,000, then 34 percent",2996.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3525.2,
DEPUY 1294-54-130-REV TRAY SLEEVE,C1776,HCPCS,,79001939,CDM,278,RC,,,both,,,9565,3775,39.4668,,3775,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3252.1,34,,3252.1,percent of total billed charges,Implant Device,3347.75,35,,3347.75,percent of total billed charges,Implant Device,3252.1,34,"Charges > $500, x 34%",3252.1,percent of total billed charges,Implant Device,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3826,40,,3826,percent of total billed charges,Implant Devices,3347.75,70,,3347.75,percent of total billed charges,Implant Devices,3252.1,34,,3252.1,percent of total billed charges,Implant Devices,3252.1,34,,3252.1,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,3347.75,35,,3347.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3252.1,34,"If Charge > 2,000, then 34 percent",3252.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3826,
DEPUY 1294-56-126-REV WEDGE,C1776,HCPCS,,79001940,CDM,278,RC,,,both,,,6337,2501.01,39.4668,,2501.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2154.58,34,,2154.58,percent of total billed charges,Implant Device,2154.58,34,,2154.58,percent of total billed charges,Implant Device,2154.58,34,,2154.58,percent of total billed charges,Implant Device,2154.58,34,,2154.58,percent of total billed charges,Implant Device,2154.58,34,,2154.58,percent of total billed charges,Implant Device,2154.58,34,,2154.58,percent of total billed charges,Implant Device,2217.95,35,,2217.95,percent of total billed charges,Implant Device,2154.58,34,"Charges > $500, x 34%",2154.58,percent of total billed charges,Implant Device,2217.95,35,,2217.95,percent of total billed charges,Implant Devices,2217.95,35,,2217.95,percent of total billed charges,Implant Devices,2217.95,35,,,percent of total billed charges,Implant Devices,2217.95,35,,2217.95,percent of total billed charges,Implant Devices,2217.95,35,,2217.95,percent of total billed charges,Implant Devices,2534.8,40,,2534.8,percent of total billed charges,Implant Devices,2217.95,70,,2217.95,percent of total billed charges,Implant Devices,2154.58,34,,2154.58,percent of total billed charges,Implant Devices,2154.58,34,,2154.58,percent of total billed charges,Implant Devices,2217.95,35,,2217.95,percent of total billed charges,Implant Devices,2217.95,35,,2217.95,percent of total billed charges,Implant Devices,2217.95,35,,2217.95,percent of total billed charges,Implant Devices,2217.95,35,,2217.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2154.58,34,"If Charge > 2,000, then 34 percent",2154.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2534.8,
DEPUY 1365-36-210-REV FEMORAL HEAD,C1776,HCPCS,,79001942,CDM,278,RC,,,both,,,4747,1873.49,39.4668,,1873.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1613.98,34,,1613.98,percent of total billed charges,Implant Device,1613.98,34,,1613.98,percent of total billed charges,Implant Device,1613.98,34,,1613.98,percent of total billed charges,Implant Device,1613.98,34,,1613.98,percent of total billed charges,Implant Device,1613.98,34,,1613.98,percent of total billed charges,Implant Device,1613.98,34,,1613.98,percent of total billed charges,Implant Device,1661.45,35,,1661.45,percent of total billed charges,Implant Device,1613.98,34,"Charges > $500, x 34%",1613.98,percent of total billed charges,Implant Device,1661.45,35,,1661.45,percent of total billed charges,Implant Devices,1661.45,35,,1661.45,percent of total billed charges,Implant Devices,1661.45,35,,,percent of total billed charges,Implant Devices,1661.45,35,,1661.45,percent of total billed charges,Implant Devices,1661.45,35,,1661.45,percent of total billed charges,Implant Devices,1898.8,40,,1898.8,percent of total billed charges,Implant Devices,1661.45,70,,1661.45,percent of total billed charges,Implant Devices,1613.98,34,,1613.98,percent of total billed charges,Implant Devices,1613.98,34,,1613.98,percent of total billed charges,Implant Devices,1661.45,35,,1661.45,percent of total billed charges,Implant Devices,1661.45,35,,1661.45,percent of total billed charges,Implant Devices,1661.45,35,,1661.45,percent of total billed charges,Implant Devices,1661.45,35,,1661.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1613.98,34,"If Charge > 2,000, then 34 percent",1613.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1898.8,
DEPUY 1581-24-115-REV STABILIZED INSERT,C1776,HCPCS,,79001956,CDM,278,RC,,,both,,,4175,1647.74,39.4668,,1647.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1419.5,34,,1419.5,percent of total billed charges,Implant Device,1419.5,34,,1419.5,percent of total billed charges,Implant Device,1419.5,34,,1419.5,percent of total billed charges,Implant Device,1419.5,34,,1419.5,percent of total billed charges,Implant Device,1419.5,34,,1419.5,percent of total billed charges,Implant Device,1419.5,34,,1419.5,percent of total billed charges,Implant Device,1461.25,35,,1461.25,percent of total billed charges,Implant Device,1419.5,34,"Charges > $500, x 34%",1419.5,percent of total billed charges,Implant Device,1461.25,35,,1461.25,percent of total billed charges,Implant Devices,1461.25,35,,1461.25,percent of total billed charges,Implant Devices,1461.25,35,,,percent of total billed charges,Implant Devices,1461.25,35,,1461.25,percent of total billed charges,Implant Devices,1461.25,35,,1461.25,percent of total billed charges,Implant Devices,1670,40,,1670,percent of total billed charges,Implant Devices,1461.25,70,,1461.25,percent of total billed charges,Implant Devices,1419.5,34,,1419.5,percent of total billed charges,Implant Devices,1419.5,34,,1419.5,percent of total billed charges,Implant Devices,1461.25,35,,1461.25,percent of total billed charges,Implant Devices,1461.25,35,,1461.25,percent of total billed charges,Implant Devices,1461.25,35,,1461.25,percent of total billed charges,Implant Devices,1461.25,35,,1461.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1419.5,34,"If Charge > 2,000, then 34 percent",1419.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1670,
DEPUY 1987-27-112-REV HINGE INSERT,C1776,HCPCS,,79001965,CDM,278,RC,,,both,,,10692,4219.79,39.4668,,4219.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3742.2,35,,3742.2,percent of total billed charges,Implant Device,3635.28,34,"Charges > $500, x 34%",3635.28,percent of total billed charges,Implant Device,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,4276.8,40,,4276.8,percent of total billed charges,Implant Devices,3742.2,70,,3742.2,percent of total billed charges,Implant Devices,3635.28,34,,3635.28,percent of total billed charges,Implant Devices,3635.28,34,,3635.28,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3635.28,34,"If Charge > 2,000, then 34 percent",3635.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4276.8,
EXACTECH 300-01-07 HUMERAL STEM,C1776,HCPCS,,79001991,CDM,278,RC,,,both,,,4425,1746.41,39.4668,,1746.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Device,1504.5,34,"Charges > $500, x 34%",1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1770,40,,1770,percent of total billed charges,Implant Devices,1548.75,70,,1548.75,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1504.5,34,"If Charge > 2,000, then 34 percent",1504.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1770,
EXACTECH 300-01-17 HUMERAL STEM,C1776,HCPCS,,79001992,CDM,278,RC,,,both,,,4425,1746.41,39.4668,,1746.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Device,1504.5,34,"Charges > $500, x 34%",1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1770,40,,1770,percent of total billed charges,Implant Devices,1548.75,70,,1548.75,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1504.5,34,"If Charge > 2,000, then 34 percent",1504.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1770,
EXACTECH 300-21-00 OMM KIT,C1776,HCPCS,,79001994,CDM,278,RC,,,both,,,1890,745.92,39.4668,,745.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,642.6,34,,642.6,percent of total billed charges,Implant Device,661.5,35,,661.5,percent of total billed charges,Implant Device,642.6,34,"Charges > $500, x 34%",642.6,percent of total billed charges,Implant Device,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,756,40,,756,percent of total billed charges,Implant Devices,661.5,70,,661.5,percent of total billed charges,Implant Devices,642.6,34,,642.6,percent of total billed charges,Implant Devices,642.6,34,,642.6,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,661.5,35,,661.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,756,
EXACTECH 304-21-07 FRACTURE STEM,C1776,HCPCS,,79002006,CDM,278,RC,,,both,,,6225,2456.81,39.4668,,2456.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Device,2116.5,34,"Charges > $500, x 34%",2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2490,40,,2490,percent of total billed charges,Implant Devices,2178.75,70,,2178.75,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2116.5,34,"If Charge > 2,000, then 34 percent",2116.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2490,
EXACTECH 304-22-11 HUMERAL STEM,C1776,HCPCS,,79002008,CDM,278,RC,,,both,,,6225,2456.81,39.4668,,2456.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Device,2116.5,34,"Charges > $500, x 34%",2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2490,40,,2490,percent of total billed charges,Implant Devices,2178.75,70,,2178.75,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2116.5,34,"If Charge > 2,000, then 34 percent",2116.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2490,
EXACTECH 306-01-08 HUMERAL STEM,C1776,HCPCS,,79002009,CDM,278,RC,,,both,,,12852,5072.27,39.4668,,5072.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4498.2,35,,4498.2,percent of total billed charges,Implant Device,4369.68,34,"Charges > $500, x 34%",4369.68,percent of total billed charges,Implant Device,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,5140.8,40,,5140.8,percent of total billed charges,Implant Devices,4498.2,70,,4498.2,percent of total billed charges,Implant Devices,4369.68,34,,4369.68,percent of total billed charges,Implant Devices,4369.68,34,,4369.68,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4369.68,34,"If Charge > 2,000, then 34 percent",4369.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5140.8,
EXACTECH 310-01-38 HUMERAL HEAD,C1776,HCPCS,,79002010,CDM,278,RC,,,both,,,4968,1960.71,39.4668,,1960.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Device,1689.12,34,"Charges > $500, x 34%",1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1987.2,40,,1987.2,percent of total billed charges,Implant Devices,1738.8,70,,1738.8,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.12,34,"If Charge > 2,000, then 34 percent",1689.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.2,
EXACTECH 310-01-50 HUMERAL HEAD,C1776,HCPCS,,79002011,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
EXACTECH 314-02-34 GLENOID POST,C1776,HCPCS,,79002013,CDM,278,RC,,,both,,,7992,3154.19,39.4668,,3154.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2797.2,35,,2797.2,percent of total billed charges,Implant Device,2717.28,34,"Charges > $500, x 34%",2717.28,percent of total billed charges,Implant Device,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,3196.8,40,,3196.8,percent of total billed charges,Implant Devices,2797.2,70,,2797.2,percent of total billed charges,Implant Devices,2717.28,34,,2717.28,percent of total billed charges,Implant Devices,2717.28,34,,2717.28,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2717.28,34,"If Charge > 2,000, then 34 percent",2717.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3196.8,
EXACTECH 320-01-42 GLENOSPHERE,C1776,HCPCS,,79002014,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
EXACTECH 320-02-42 GLENOSPHERE,C1776,HCPCS,,79002015,CDM,278,RC,,,both,,,10020,3954.57,39.4668,,3954.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3406.8,34,,3406.8,percent of total billed charges,Implant Device,3507,35,,3507,percent of total billed charges,Implant Device,3406.8,34,"Charges > $500, x 34%",3406.8,percent of total billed charges,Implant Device,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,4008,40,,4008,percent of total billed charges,Implant Devices,3507,70,,3507,percent of total billed charges,Implant Devices,3406.8,34,,3406.8,percent of total billed charges,Implant Devices,3406.8,34,,3406.8,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,3507,35,,3507,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3406.8,34,"If Charge > 2,000, then 34 percent",3406.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4008,
EXACTECH 320-15-02 GLENOID PLATE,C1776,HCPCS,,79002016,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
EXACTECH 320-42-00 HUMERAL LINER,C1776,HCPCS,,79002017,CDM,278,RC,,,both,,,2325,917.6,39.4668,,917.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Device,790.5,34,"Charges > $500, x 34%",790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,930,40,,930,percent of total billed charges,Implant Devices,813.75,70,,813.75,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.5,34,"If Charge > 2,000, then 34 percent",790.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930,
EXACTECH 320-42-03 HUMERAL LINER,C1776,HCPCS,,79002018,CDM,278,RC,,,both,,,2325,917.6,39.4668,,917.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Device,790.5,34,"Charges > $500, x 34%",790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,930,40,,930,percent of total billed charges,Implant Devices,813.75,70,,813.75,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.5,34,"If Charge > 2,000, then 34 percent",790.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930,
ZIMMER 32-7828-85-01-REV LINER,C1776,HCPCS,,79002020,CDM,278,RC,,,both,,,5287,2086.61,39.4668,,2086.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1797.58,34,,1797.58,percent of total billed charges,Implant Device,1797.58,34,,1797.58,percent of total billed charges,Implant Device,1797.58,34,,1797.58,percent of total billed charges,Implant Device,1797.58,34,,1797.58,percent of total billed charges,Implant Device,1797.58,34,,1797.58,percent of total billed charges,Implant Device,1797.58,34,,1797.58,percent of total billed charges,Implant Device,1850.45,35,,1850.45,percent of total billed charges,Implant Device,1797.58,34,"Charges > $500, x 34%",1797.58,percent of total billed charges,Implant Device,1850.45,35,,1850.45,percent of total billed charges,Implant Devices,1850.45,35,,1850.45,percent of total billed charges,Implant Devices,1850.45,35,,,percent of total billed charges,Implant Devices,1850.45,35,,1850.45,percent of total billed charges,Implant Devices,1850.45,35,,1850.45,percent of total billed charges,Implant Devices,2114.8,40,,2114.8,percent of total billed charges,Implant Devices,1850.45,70,,1850.45,percent of total billed charges,Implant Devices,1797.58,34,,1797.58,percent of total billed charges,Implant Devices,1797.58,34,,1797.58,percent of total billed charges,Implant Devices,1850.45,35,,1850.45,percent of total billed charges,Implant Devices,1850.45,35,,1850.45,percent of total billed charges,Implant Devices,1850.45,35,,1850.45,percent of total billed charges,Implant Devices,1850.45,35,,1850.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1797.58,34,"If Charge > 2,000, then 34 percent",1797.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2114.8,
STRYKER 40-20903 FIBULA 77MM 3 HOLE,C1776,HCPCS,,79002035,CDM,278,RC,,,both,,,1867,736.85,39.4668,,736.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,634.78,34,,634.78,percent of total billed charges,Implant Device,653.45,35,,653.45,percent of total billed charges,Implant Device,634.78,34,"Charges > $500, x 34%",634.78,percent of total billed charges,Implant Device,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,746.8,40,,746.8,percent of total billed charges,Implant Devices,653.45,70,,653.45,percent of total billed charges,Implant Devices,634.78,34,,634.78,percent of total billed charges,Implant Devices,634.78,34,,634.78,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,653.45,35,,653.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,746.8,
BIOMET 431196-REV SPACER STEM,C1776,HCPCS,,79002051,CDM,278,RC,,,both,,,6570,2592.97,39.4668,,2592.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2299.5,35,,2299.5,percent of total billed charges,Implant Device,2233.8,34,"Charges > $500, x 34%",2233.8,percent of total billed charges,Implant Device,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2628,40,,2628,percent of total billed charges,Implant Devices,2299.5,70,,2299.5,percent of total billed charges,Implant Devices,2233.8,34,,2233.8,percent of total billed charges,Implant Devices,2233.8,34,,2233.8,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2233.8,34,"If Charge > 2,000, then 34 percent",2233.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2628,
BIOMET 431197-REV SPACER STEM,C1776,HCPCS,,79002052,CDM,278,RC,,,both,,,6570,2592.97,39.4668,,2592.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2299.5,35,,2299.5,percent of total billed charges,Implant Device,2233.8,34,"Charges > $500, x 34%",2233.8,percent of total billed charges,Implant Device,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2628,40,,2628,percent of total billed charges,Implant Devices,2299.5,70,,2299.5,percent of total billed charges,Implant Devices,2233.8,34,,2233.8,percent of total billed charges,Implant Devices,2233.8,34,,2233.8,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2233.8,34,"If Charge > 2,000, then 34 percent",2233.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2628,
STRYKER ORTHO 500-03-54E BACK SHELL,C1776,HCPCS,,79002091,CDM,278,RC,,,both,,,5185,2046.35,39.4668,,2046.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1762.9,34,,1762.9,percent of total billed charges,Implant Device,1762.9,34,,1762.9,percent of total billed charges,Implant Device,1762.9,34,,1762.9,percent of total billed charges,Implant Device,1762.9,34,,1762.9,percent of total billed charges,Implant Device,1762.9,34,,1762.9,percent of total billed charges,Implant Device,1762.9,34,,1762.9,percent of total billed charges,Implant Device,1814.75,35,,1814.75,percent of total billed charges,Implant Device,1762.9,34,"Charges > $500, x 34%",1762.9,percent of total billed charges,Implant Device,1814.75,35,,1814.75,percent of total billed charges,Implant Devices,1814.75,35,,1814.75,percent of total billed charges,Implant Devices,1814.75,35,,,percent of total billed charges,Implant Devices,1814.75,35,,1814.75,percent of total billed charges,Implant Devices,1814.75,35,,1814.75,percent of total billed charges,Implant Devices,2074,40,,2074,percent of total billed charges,Implant Devices,1814.75,70,,1814.75,percent of total billed charges,Implant Devices,1762.9,34,,1762.9,percent of total billed charges,Implant Devices,1762.9,34,,1762.9,percent of total billed charges,Implant Devices,1814.75,35,,1814.75,percent of total billed charges,Implant Devices,1814.75,35,,1814.75,percent of total billed charges,Implant Devices,1814.75,35,,1814.75,percent of total billed charges,Implant Devices,1814.75,35,,1814.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1762.9,34,"If Charge > 2,000, then 34 percent",1762.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2074,
STRYKER 502-03-52D-REV SHELL,C1776,HCPCS,,79002092,CDM,278,RC,,,both,,,9823,3876.82,39.4668,,3876.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3438.05,35,,3438.05,percent of total billed charges,Implant Device,3339.82,34,"Charges > $500, x 34%",3339.82,percent of total billed charges,Implant Device,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3929.2,40,,3929.2,percent of total billed charges,Implant Devices,3438.05,70,,3438.05,percent of total billed charges,Implant Devices,3339.82,34,,3339.82,percent of total billed charges,Implant Devices,3339.82,34,,3339.82,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3339.82,34,"If Charge > 2,000, then 34 percent",3339.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3929.2,
STRYKER 5029-8-200 ROD,C1776,HCPCS,,79002093,CDM,278,RC,,,both,,,217,85.64,39.4668,,85.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.78,34,,73.78,percent of total billed charges,Implant Device,73.78,34,,73.78,percent of total billed charges,Implant Device,73.78,34,,73.78,percent of total billed charges,Implant Device,73.78,34,,73.78,percent of total billed charges,Implant Device,73.78,34,,73.78,percent of total billed charges,Implant Device,73.78,34,,73.78,percent of total billed charges,Implant Device,75.95,35,,75.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.95,35,,75.95,percent of total billed charges,Implant Devices,75.95,35,,75.95,percent of total billed charges,Implant Devices,75.95,35,,,percent of total billed charges,Implant Devices,75.95,35,,75.95,percent of total billed charges,Implant Devices,75.95,35,,75.95,percent of total billed charges,Implant Devices,86.8,40,,86.8,percent of total billed charges,Implant Devices,75.95,70,,75.95,percent of total billed charges,Implant Devices,73.78,34,,73.78,percent of total billed charges,Implant Devices,73.78,34,,73.78,percent of total billed charges,Implant Devices,75.95,35,,75.95,percent of total billed charges,Implant Devices,75.95,35,,75.95,percent of total billed charges,Implant Devices,75.95,35,,75.95,percent of total billed charges,Implant Devices,75.95,35,,75.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,86.8,
DEPUY 52-3293-REV FEMORAL STEM,C1776,HCPCS,,79002098,CDM,278,RC,,,both,,,8245,3254.04,39.4668,,3254.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2803.3,34,,2803.3,percent of total billed charges,Implant Device,2803.3,34,,2803.3,percent of total billed charges,Implant Device,2803.3,34,,2803.3,percent of total billed charges,Implant Device,2803.3,34,,2803.3,percent of total billed charges,Implant Device,2803.3,34,,2803.3,percent of total billed charges,Implant Device,2803.3,34,,2803.3,percent of total billed charges,Implant Device,2885.75,35,,2885.75,percent of total billed charges,Implant Device,2803.3,34,"Charges > $500, x 34%",2803.3,percent of total billed charges,Implant Device,2885.75,35,,2885.75,percent of total billed charges,Implant Devices,2885.75,35,,2885.75,percent of total billed charges,Implant Devices,2885.75,35,,,percent of total billed charges,Implant Devices,2885.75,35,,2885.75,percent of total billed charges,Implant Devices,2885.75,35,,2885.75,percent of total billed charges,Implant Devices,3298,40,,3298,percent of total billed charges,Implant Devices,2885.75,70,,2885.75,percent of total billed charges,Implant Devices,2803.3,34,,2803.3,percent of total billed charges,Implant Devices,2803.3,34,,2803.3,percent of total billed charges,Implant Devices,2885.75,35,,2885.75,percent of total billed charges,Implant Devices,2885.75,35,,2885.75,percent of total billed charges,Implant Devices,2885.75,35,,2885.75,percent of total billed charges,Implant Devices,2885.75,35,,2885.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2803.3,34,"If Charge > 2,000, then 34 percent",2803.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3298,
DEPUY 55-0524-REV PROXIMAL SLEEVE,C1776,HCPCS,,79002105,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
ZIMMER 5842-03-02-UNI TIBIAL COMPONENT,C1776,HCPCS,,79002111,CDM,278,RC,,,both,,,6346,2504.56,39.4668,,2504.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Device,2157.64,34,"Charges > $500, x 34%",2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2538.4,40,,2538.4,percent of total billed charges,Implant Devices,2221.1,70,,2221.1,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2157.64,34,"If Charge > 2,000, then 34 percent",2157.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2538.4,
ZIMMER 5842-05-01-UNI TIBIAL COMPONENT,C1776,HCPCS,,79002112,CDM,278,RC,,,both,,,6346,2504.56,39.4668,,2504.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Device,2157.64,34,"Charges > $500, x 34%",2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2538.4,40,,2538.4,percent of total billed charges,Implant Devices,2221.1,70,,2221.1,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2157.64,34,"If Charge > 2,000, then 34 percent",2157.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2538.4,
ZIMMER 5842-05-02-UNI TIBIAL COMPONENT,C1776,HCPCS,,79002113,CDM,278,RC,,,both,,,6346,2504.56,39.4668,,2504.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Device,2157.64,34,"Charges > $500, x 34%",2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2538.4,40,,2538.4,percent of total billed charges,Implant Devices,2221.1,70,,2221.1,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2157.64,34,"If Charge > 2,000, then 34 percent",2157.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2538.4,
ZIMMER 5842-14-02-UNI FEMORAL COMPONENT,C1776,HCPCS,,79002114,CDM,278,RC,,,both,,,10486,4138.49,39.4668,,4138.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Device,3565.24,34,"Charges > $500, x 34%",3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,4194.4,40,,4194.4,percent of total billed charges,Implant Devices,3670.1,70,,3670.1,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3565.24,34,"If Charge > 2,000, then 34 percent",3565.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194.4,
ZIMMER 5842-15-01-UNI FEMORAL COMPONENT,C1776,HCPCS,,79002115,CDM,278,RC,,,both,,,10486,4138.49,39.4668,,4138.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Device,3565.24,34,"Charges > $500, x 34%",3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,4194.4,40,,4194.4,percent of total billed charges,Implant Devices,3670.1,70,,3670.1,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3565.24,34,"If Charge > 2,000, then 34 percent",3565.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194.4,
ZIMMER 5842-15-02-UNI FEMORAL COMPONENT,C1776,HCPCS,,79002116,CDM,278,RC,,,both,,,10486,4138.49,39.4668,,4138.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Device,3565.24,34,"Charges > $500, x 34%",3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,4194.4,40,,4194.4,percent of total billed charges,Implant Devices,3670.1,70,,3670.1,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3565.24,34,"If Charge > 2,000, then 34 percent",3565.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194.4,
ZIMMER 5842-23-08-UNI ARTICULAR SURFACE,C1776,HCPCS,,79002117,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
ZIMMER 5842-25-09-UNI ARTICULAR SURFACE,C1776,HCPCS,,79002118,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
ZIMMER 5842-25-10-UNI ARTICULAR SURFACE,C1776,HCPCS,,79002119,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
ZIMMER 5842-52-01-UNI ARTICULAR SURFACE,C1776,HCPCS,,79002120,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ZIMMER 5880-04-REV TIBIAL COMPONENT,C1776,HCPCS,,79002121,CDM,278,RC,,,both,,,13631,5379.72,39.4668,,5379.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4634.54,34,,4634.54,percent of total billed charges,Implant Device,4634.54,34,,4634.54,percent of total billed charges,Implant Device,4634.54,34,,4634.54,percent of total billed charges,Implant Device,4634.54,34,,4634.54,percent of total billed charges,Implant Device,4634.54,34,,4634.54,percent of total billed charges,Implant Device,4634.54,34,,4634.54,percent of total billed charges,Implant Device,4770.85,35,,4770.85,percent of total billed charges,Implant Device,4634.54,34,"Charges > $500, x 34%",4634.54,percent of total billed charges,Implant Device,4770.85,35,,4770.85,percent of total billed charges,Implant Devices,4770.85,35,,4770.85,percent of total billed charges,Implant Devices,4770.85,35,,,percent of total billed charges,Implant Devices,4770.85,35,,4770.85,percent of total billed charges,Implant Devices,4770.85,35,,4770.85,percent of total billed charges,Implant Devices,5452.4,40,,5452.4,percent of total billed charges,Implant Devices,4770.85,70,,4770.85,percent of total billed charges,Implant Devices,4634.54,34,,4634.54,percent of total billed charges,Implant Devices,4634.54,34,,4634.54,percent of total billed charges,Implant Devices,4770.85,35,,4770.85,percent of total billed charges,Implant Devices,4770.85,35,,4770.85,percent of total billed charges,Implant Devices,4770.85,35,,4770.85,percent of total billed charges,Implant Devices,4770.85,35,,4770.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4634.54,34,"If Charge > 2,000, then 34 percent",4634.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5452.4,
ZIMMER 5880-06-REV TIBIAL COMPONENT,C1776,HCPCS,,79002122,CDM,278,RC,,,both,,,13023,5139.76,39.4668,,5139.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4558.05,35,,4558.05,percent of total billed charges,Implant Device,4427.82,34,"Charges > $500, x 34%",4427.82,percent of total billed charges,Implant Device,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,5209.2,40,,5209.2,percent of total billed charges,Implant Devices,4558.05,70,,4558.05,percent of total billed charges,Implant Devices,4427.82,34,,4427.82,percent of total billed charges,Implant Devices,4427.82,34,,4427.82,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4427.82,34,"If Charge > 2,000, then 34 percent",4427.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5209.2,
ZIMMER 5880-15-02-REV FEMORAL COMPONENT,C1776,HCPCS,,79002123,CDM,278,RC,,,both,,,25560,10087.71,39.4668,,10087.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8946,35,,8946,percent of total billed charges,Implant Device,8690.4,34,"Charges > $500, x 34%",8690.4,percent of total billed charges,Implant Device,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,10224,40,,10224,percent of total billed charges,Implant Devices,8946,70,,8946,percent of total billed charges,Implant Devices,8690.4,34,,8690.4,percent of total billed charges,Implant Devices,8690.4,34,,8690.4,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8690.4,34,"If Charge > 2,000, then 34 percent",8690.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10224,
ZIMMER 5880-16-01-REV FEMORAL COMPONENT,C1776,HCPCS,,79002124,CDM,278,RC,,,both,,,25560,10087.71,39.4668,,10087.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8690.4,34,,8690.4,percent of total billed charges,Implant Device,8946,35,,8946,percent of total billed charges,Implant Device,8690.4,34,"Charges > $500, x 34%",8690.4,percent of total billed charges,Implant Device,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,10224,40,,10224,percent of total billed charges,Implant Devices,8946,70,,8946,percent of total billed charges,Implant Devices,8690.4,34,,8690.4,percent of total billed charges,Implant Devices,8690.4,34,,8690.4,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,8946,35,,8946,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8690.4,34,"If Charge > 2,000, then 34 percent",8690.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10224,
ZIMMER 5880-50-14-REV ARTICULAR SURFACE,C1776,HCPCS,,79002125,CDM,278,RC,,,both,,,5603,2211.32,39.4668,,2211.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1961.05,35,,1961.05,percent of total billed charges,Implant Device,1905.02,34,"Charges > $500, x 34%",1905.02,percent of total billed charges,Implant Device,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,2241.2,40,,2241.2,percent of total billed charges,Implant Devices,1961.05,70,,1961.05,percent of total billed charges,Implant Devices,1905.02,34,,1905.02,percent of total billed charges,Implant Devices,1905.02,34,,1905.02,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1905.02,34,"If Charge > 2,000, then 34 percent",1905.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2241.2,
ZIMMER 5880-60-12-REV ARTICULAR SURFACE,C1776,HCPCS,,79002126,CDM,278,RC,,,both,,,7128,2813.19,39.4668,,2813.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2423.52,34,,2423.52,percent of total billed charges,Implant Device,2423.52,34,,2423.52,percent of total billed charges,Implant Device,2423.52,34,,2423.52,percent of total billed charges,Implant Device,2423.52,34,,2423.52,percent of total billed charges,Implant Device,2423.52,34,,2423.52,percent of total billed charges,Implant Device,2423.52,34,,2423.52,percent of total billed charges,Implant Device,2494.8,35,,2494.8,percent of total billed charges,Implant Device,2423.52,34,"Charges > $500, x 34%",2423.52,percent of total billed charges,Implant Device,2494.8,35,,2494.8,percent of total billed charges,Implant Devices,2494.8,35,,2494.8,percent of total billed charges,Implant Devices,2494.8,35,,,percent of total billed charges,Implant Devices,2494.8,35,,2494.8,percent of total billed charges,Implant Devices,2494.8,35,,2494.8,percent of total billed charges,Implant Devices,2851.2,40,,2851.2,percent of total billed charges,Implant Devices,2494.8,70,,2494.8,percent of total billed charges,Implant Devices,2423.52,34,,2423.52,percent of total billed charges,Implant Devices,2423.52,34,,2423.52,percent of total billed charges,Implant Devices,2494.8,35,,2494.8,percent of total billed charges,Implant Devices,2494.8,35,,2494.8,percent of total billed charges,Implant Devices,2494.8,35,,2494.8,percent of total billed charges,Implant Devices,2494.8,35,,2494.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2423.52,34,"If Charge > 2,000, then 34 percent",2423.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2851.2,
ZIMMER 5952-30-10 ARTICULAR SURFACE,C1776,HCPCS,,79002127,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
ZIMMER 5952-30-14 ARTICULAR SURFACE,C1776,HCPCS,,79002128,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
ZIMMER 5952-30-14-REV ARTICULAR SURFACE,C1776,HCPCS,,79002129,CDM,278,RC,,,both,,,5107,2015.57,39.4668,,2015.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1787.45,35,,1787.45,percent of total billed charges,Implant Device,1736.38,34,"Charges > $500, x 34%",1736.38,percent of total billed charges,Implant Device,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,2042.8,40,,2042.8,percent of total billed charges,Implant Devices,1787.45,70,,1787.45,percent of total billed charges,Implant Devices,1736.38,34,,1736.38,percent of total billed charges,Implant Devices,1736.38,34,,1736.38,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1736.38,34,"If Charge > 2,000, then 34 percent",1736.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2042.8,
ZIMMER 5952-50-12 ARTICULAR SURFACE,C1776,HCPCS,,79002130,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
ZIMMER 5952-50-14 ARTICULAR SURFACE,C1776,HCPCS,,79002131,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
ZIMMER 5952-50-14-REV ARTICULAR SURFACE,C1776,HCPCS,,79002132,CDM,278,RC,,,both,,,3406,1344.24,39.4668,,1344.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1158.04,34,,1158.04,percent of total billed charges,Implant Device,1158.04,34,,1158.04,percent of total billed charges,Implant Device,1158.04,34,,1158.04,percent of total billed charges,Implant Device,1158.04,34,,1158.04,percent of total billed charges,Implant Device,1158.04,34,,1158.04,percent of total billed charges,Implant Device,1158.04,34,,1158.04,percent of total billed charges,Implant Device,1192.1,35,,1192.1,percent of total billed charges,Implant Device,1158.04,34,"Charges > $500, x 34%",1158.04,percent of total billed charges,Implant Device,1192.1,35,,1192.1,percent of total billed charges,Implant Devices,1192.1,35,,1192.1,percent of total billed charges,Implant Devices,1192.1,35,,,percent of total billed charges,Implant Devices,1192.1,35,,1192.1,percent of total billed charges,Implant Devices,1192.1,35,,1192.1,percent of total billed charges,Implant Devices,1362.4,40,,1362.4,percent of total billed charges,Implant Devices,1192.1,70,,1192.1,percent of total billed charges,Implant Devices,1158.04,34,,1158.04,percent of total billed charges,Implant Devices,1158.04,34,,1158.04,percent of total billed charges,Implant Devices,1192.1,35,,1192.1,percent of total billed charges,Implant Devices,1192.1,35,,1192.1,percent of total billed charges,Implant Devices,1192.1,35,,1192.1,percent of total billed charges,Implant Devices,1192.1,35,,1192.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1158.04,34,"If Charge > 2,000, then 34 percent",1158.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1362.4,
ZIMMER 5962-32-17-REV ARTICULAR SURFACE,C1776,HCPCS,,79002133,CDM,278,RC,,,both,,,6292,2483.25,39.4668,,2483.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2139.28,34,,2139.28,percent of total billed charges,Implant Device,2139.28,34,,2139.28,percent of total billed charges,Implant Device,2139.28,34,,2139.28,percent of total billed charges,Implant Device,2139.28,34,,2139.28,percent of total billed charges,Implant Device,2139.28,34,,2139.28,percent of total billed charges,Implant Device,2139.28,34,,2139.28,percent of total billed charges,Implant Device,2202.2,35,,2202.2,percent of total billed charges,Implant Device,2139.28,34,"Charges > $500, x 34%",2139.28,percent of total billed charges,Implant Device,2202.2,35,,2202.2,percent of total billed charges,Implant Devices,2202.2,35,,2202.2,percent of total billed charges,Implant Devices,2202.2,35,,,percent of total billed charges,Implant Devices,2202.2,35,,2202.2,percent of total billed charges,Implant Devices,2202.2,35,,2202.2,percent of total billed charges,Implant Devices,2516.8,40,,2516.8,percent of total billed charges,Implant Devices,2202.2,70,,2202.2,percent of total billed charges,Implant Devices,2139.28,34,,2139.28,percent of total billed charges,Implant Devices,2139.28,34,,2139.28,percent of total billed charges,Implant Devices,2202.2,35,,2202.2,percent of total billed charges,Implant Devices,2202.2,35,,2202.2,percent of total billed charges,Implant Devices,2202.2,35,,2202.2,percent of total billed charges,Implant Devices,2202.2,35,,2202.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2139.28,34,"If Charge > 2,000, then 34 percent",2139.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2516.8,
ZIMMER 5972-65-29-REV ALL POLY PATELLA,C1776,HCPCS,,79002134,CDM,278,RC,,,both,,,2881,1137.04,39.4668,,1137.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.54,34,,979.54,percent of total billed charges,Implant Device,979.54,34,,979.54,percent of total billed charges,Implant Device,979.54,34,,979.54,percent of total billed charges,Implant Device,979.54,34,,979.54,percent of total billed charges,Implant Device,979.54,34,,979.54,percent of total billed charges,Implant Device,979.54,34,,979.54,percent of total billed charges,Implant Device,1008.35,35,,1008.35,percent of total billed charges,Implant Device,979.54,34,"Charges > $500, x 34%",979.54,percent of total billed charges,Implant Device,1008.35,35,,1008.35,percent of total billed charges,Implant Devices,1008.35,35,,1008.35,percent of total billed charges,Implant Devices,1008.35,35,,,percent of total billed charges,Implant Devices,1008.35,35,,1008.35,percent of total billed charges,Implant Devices,1008.35,35,,1008.35,percent of total billed charges,Implant Devices,1152.4,40,,1152.4,percent of total billed charges,Implant Devices,1008.35,70,,1008.35,percent of total billed charges,Implant Devices,979.54,34,,979.54,percent of total billed charges,Implant Devices,979.54,34,,979.54,percent of total billed charges,Implant Devices,1008.35,35,,1008.35,percent of total billed charges,Implant Devices,1008.35,35,,1008.35,percent of total billed charges,Implant Devices,1008.35,35,,1008.35,percent of total billed charges,Implant Devices,1008.35,35,,1008.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.54,34,"If Charge > 2,000, then 34 percent",979.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152.4,
ZIMMER 5976-30-14-REV ARTICULAR SURFACE,C1776,HCPCS,,79002135,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
ZIMMER 5976-30-17-REV ARTICULAR SURFACE,C1776,HCPCS,,79002136,CDM,278,RC,,,both,,,3826,1510,39.4668,,1510,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1300.84,34,,1300.84,percent of total billed charges,Implant Device,1300.84,34,,1300.84,percent of total billed charges,Implant Device,1300.84,34,,1300.84,percent of total billed charges,Implant Device,1300.84,34,,1300.84,percent of total billed charges,Implant Device,1300.84,34,,1300.84,percent of total billed charges,Implant Device,1300.84,34,,1300.84,percent of total billed charges,Implant Device,1339.1,35,,1339.1,percent of total billed charges,Implant Device,1300.84,34,"Charges > $500, x 34%",1300.84,percent of total billed charges,Implant Device,1339.1,35,,1339.1,percent of total billed charges,Implant Devices,1339.1,35,,1339.1,percent of total billed charges,Implant Devices,1339.1,35,,,percent of total billed charges,Implant Devices,1339.1,35,,1339.1,percent of total billed charges,Implant Devices,1339.1,35,,1339.1,percent of total billed charges,Implant Devices,1530.4,40,,1530.4,percent of total billed charges,Implant Devices,1339.1,70,,1339.1,percent of total billed charges,Implant Devices,1300.84,34,,1300.84,percent of total billed charges,Implant Devices,1300.84,34,,1300.84,percent of total billed charges,Implant Devices,1339.1,35,,1339.1,percent of total billed charges,Implant Devices,1339.1,35,,1339.1,percent of total billed charges,Implant Devices,1339.1,35,,1339.1,percent of total billed charges,Implant Devices,1339.1,35,,1339.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1300.84,34,"If Charge > 2,000, then 34 percent",1300.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1530.4,
ZIMMER 5976-40-12-REV ARTICULAR SURFACE,C1776,HCPCS,,79002137,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
ZIMMER 5980-37-01-REV TIBIAL COMPONENT,C1776,HCPCS,,79002138,CDM,278,RC,,,both,,,6616,2611.12,39.4668,,2611.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2315.6,35,,2315.6,percent of total billed charges,Implant Device,2249.44,34,"Charges > $500, x 34%",2249.44,percent of total billed charges,Implant Device,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2646.4,40,,2646.4,percent of total billed charges,Implant Devices,2315.6,70,,2315.6,percent of total billed charges,Implant Devices,2249.44,34,,2249.44,percent of total billed charges,Implant Devices,2249.44,34,,2249.44,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2249.44,34,"If Charge > 2,000, then 34 percent",2249.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2646.4,
ZIMMER 5980-37-02-REV TIBIAL COMPONENT,C1776,HCPCS,,79002139,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 5980-47-01-REV TIBIAL COMPONENT,C1776,HCPCS,,79002140,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 5980-57-01-REV TIBIAL COMPONENT,C1776,HCPCS,,79002141,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 5988-03-REV TIBIAL COMPONENT,C1776,HCPCS,,79002142,CDM,278,RC,,,both,,,8416,3321.53,39.4668,,3321.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2861.44,34,,2861.44,percent of total billed charges,Implant Device,2861.44,34,,2861.44,percent of total billed charges,Implant Device,2861.44,34,,2861.44,percent of total billed charges,Implant Device,2861.44,34,,2861.44,percent of total billed charges,Implant Device,2861.44,34,,2861.44,percent of total billed charges,Implant Device,2861.44,34,,2861.44,percent of total billed charges,Implant Device,2945.6,35,,2945.6,percent of total billed charges,Implant Device,2861.44,34,"Charges > $500, x 34%",2861.44,percent of total billed charges,Implant Device,2945.6,35,,2945.6,percent of total billed charges,Implant Devices,2945.6,35,,2945.6,percent of total billed charges,Implant Devices,2945.6,35,,,percent of total billed charges,Implant Devices,2945.6,35,,2945.6,percent of total billed charges,Implant Devices,2945.6,35,,2945.6,percent of total billed charges,Implant Devices,3366.4,40,,3366.4,percent of total billed charges,Implant Devices,2945.6,70,,2945.6,percent of total billed charges,Implant Devices,2861.44,34,,2861.44,percent of total billed charges,Implant Devices,2861.44,34,,2861.44,percent of total billed charges,Implant Devices,2945.6,35,,2945.6,percent of total billed charges,Implant Devices,2945.6,35,,2945.6,percent of total billed charges,Implant Devices,2945.6,35,,2945.6,percent of total billed charges,Implant Devices,2945.6,35,,2945.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2861.44,34,"If Charge > 2,000, then 34 percent",2861.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3366.4,
ZIMMER 5988-04-REV TIBIAL COMPONENT,C1776,HCPCS,,79002143,CDM,278,RC,,,both,,,7740,3054.73,39.4668,,3054.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2709,35,,2709,percent of total billed charges,Implant Device,2631.6,34,"Charges > $500, x 34%",2631.6,percent of total billed charges,Implant Device,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,3096,40,,3096,percent of total billed charges,Implant Devices,2709,70,,2709,percent of total billed charges,Implant Devices,2631.6,34,,2631.6,percent of total billed charges,Implant Devices,2631.6,34,,2631.6,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2631.6,34,"If Charge > 2,000, then 34 percent",2631.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3096,
ZIMMER 5988-05-10-REV TIBIAL COMPONENT,C1776,HCPCS,,79002144,CDM,278,RC,,,both,,,3968,1566.04,39.4668,,1566.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1388.8,35,,1388.8,percent of total billed charges,Implant Device,1349.12,34,"Charges > $500, x 34%",1349.12,percent of total billed charges,Implant Device,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1587.2,40,,1587.2,percent of total billed charges,Implant Devices,1388.8,70,,1388.8,percent of total billed charges,Implant Devices,1349.12,34,,1349.12,percent of total billed charges,Implant Devices,1349.12,34,,1349.12,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1349.12,34,"If Charge > 2,000, then 34 percent",1349.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1587.2,
ZIMMER 5988-10-12-REV STEM EXTENSION,C1776,HCPCS,,79002145,CDM,278,RC,,,both,,,3756,1482.37,39.4668,,1482.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1277.04,34,,1277.04,percent of total billed charges,Implant Device,1277.04,34,,1277.04,percent of total billed charges,Implant Device,1277.04,34,,1277.04,percent of total billed charges,Implant Device,1277.04,34,,1277.04,percent of total billed charges,Implant Device,1277.04,34,,1277.04,percent of total billed charges,Implant Device,1277.04,34,,1277.04,percent of total billed charges,Implant Device,1314.6,35,,1314.6,percent of total billed charges,Implant Device,1277.04,34,"Charges > $500, x 34%",1277.04,percent of total billed charges,Implant Device,1314.6,35,,1314.6,percent of total billed charges,Implant Devices,1314.6,35,,1314.6,percent of total billed charges,Implant Devices,1314.6,35,,,percent of total billed charges,Implant Devices,1314.6,35,,1314.6,percent of total billed charges,Implant Devices,1314.6,35,,1314.6,percent of total billed charges,Implant Devices,1502.4,40,,1502.4,percent of total billed charges,Implant Devices,1314.6,70,,1314.6,percent of total billed charges,Implant Devices,1277.04,34,,1277.04,percent of total billed charges,Implant Devices,1277.04,34,,1277.04,percent of total billed charges,Implant Devices,1314.6,35,,1314.6,percent of total billed charges,Implant Devices,1314.6,35,,1314.6,percent of total billed charges,Implant Devices,1314.6,35,,1314.6,percent of total billed charges,Implant Devices,1314.6,35,,1314.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1277.04,34,"If Charge > 2,000, then 34 percent",1277.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1502.4,
ZIMMER 5988-10-13-REV STEM EXTENSION,C1776,HCPCS,,79002146,CDM,278,RC,,,both,,,3325,1312.27,39.4668,,1312.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Device,1130.5,34,"Charges > $500, x 34%",1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1330,40,,1330,percent of total billed charges,Implant Devices,1163.75,70,,1163.75,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.5,34,"If Charge > 2,000, then 34 percent",1130.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1330,
ZIMMER 5988-10-14-REV STEM EXTENSION,C1776,HCPCS,,79002147,CDM,278,RC,,,both,,,3325,1312.27,39.4668,,1312.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Device,1130.5,34,"Charges > $500, x 34%",1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1330,40,,1330,percent of total billed charges,Implant Devices,1163.75,70,,1163.75,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.5,34,"If Charge > 2,000, then 34 percent",1130.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1330,
ZIMMER 5988-10-15-REV STEM EXTENSION,C1776,HCPCS,,79002148,CDM,278,RC,,,both,,,2970,1172.16,39.4668,,1172.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Device,1009.8,34,"Charges > $500, x 34%",1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1188,40,,1188,percent of total billed charges,Implant Devices,1039.5,70,,1039.5,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1009.8,34,"If Charge > 2,000, then 34 percent",1009.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1188,
ZIMMER 5988-10-16-REV STEM EXTENSION,C1776,HCPCS,,79002149,CDM,278,RC,,,both,,,3325,1312.27,39.4668,,1312.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Device,1130.5,34,"Charges > $500, x 34%",1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1330,40,,1330,percent of total billed charges,Implant Devices,1163.75,70,,1163.75,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.5,34,"If Charge > 2,000, then 34 percent",1130.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1330,
ZIMMER 5988-10-18-REV STEM EXTENSION,C1776,HCPCS,,79002150,CDM,278,RC,,,both,,,3758,1483.16,39.4668,,1483.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1315.3,35,,1315.3,percent of total billed charges,Implant Device,1277.72,34,"Charges > $500, x 34%",1277.72,percent of total billed charges,Implant Device,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1503.2,40,,1503.2,percent of total billed charges,Implant Devices,1315.3,70,,1315.3,percent of total billed charges,Implant Devices,1277.72,34,,1277.72,percent of total billed charges,Implant Devices,1277.72,34,,1277.72,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1277.72,34,"If Charge > 2,000, then 34 percent",1277.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1503.2,
ZIMMER 5988-10-20-REV STEM EXTENSION,C1776,HCPCS,,79002151,CDM,278,RC,,,both,,,3325,1312.27,39.4668,,1312.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Device,1130.5,34,"Charges > $500, x 34%",1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1330,40,,1330,percent of total billed charges,Implant Devices,1163.75,70,,1163.75,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.5,34,"If Charge > 2,000, then 34 percent",1130.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1330,
ZIMMER 5988-11-12-REV STEM EXTENSION,C1776,HCPCS,,79002152,CDM,278,RC,,,both,,,3325,1312.27,39.4668,,1312.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Device,1130.5,34,"Charges > $500, x 34%",1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1330,40,,1330,percent of total billed charges,Implant Devices,1163.75,70,,1163.75,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.5,34,"If Charge > 2,000, then 34 percent",1130.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1330,
ZIMMER 5988-11-14-REV STEM EXTENSION,C1776,HCPCS,,79002153,CDM,278,RC,,,both,,,3324,1311.88,39.4668,,1311.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1163.4,35,,1163.4,percent of total billed charges,Implant Device,1130.16,34,"Charges > $500, x 34%",1130.16,percent of total billed charges,Implant Device,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1329.6,40,,1329.6,percent of total billed charges,Implant Devices,1163.4,70,,1163.4,percent of total billed charges,Implant Devices,1130.16,34,,1130.16,percent of total billed charges,Implant Devices,1130.16,34,,1130.16,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.16,34,"If Charge > 2,000, then 34 percent",1130.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1329.6,
ZIMMER 5988-11-15-REV STEM EXTENSION,C1776,HCPCS,,79002154,CDM,278,RC,,,both,,,3758,1483.16,39.4668,,1483.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1277.72,34,,1277.72,percent of total billed charges,Implant Device,1315.3,35,,1315.3,percent of total billed charges,Implant Device,1277.72,34,"Charges > $500, x 34%",1277.72,percent of total billed charges,Implant Device,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1503.2,40,,1503.2,percent of total billed charges,Implant Devices,1315.3,70,,1315.3,percent of total billed charges,Implant Devices,1277.72,34,,1277.72,percent of total billed charges,Implant Devices,1277.72,34,,1277.72,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,1315.3,35,,1315.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1277.72,34,"If Charge > 2,000, then 34 percent",1277.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1503.2,
ZIMMER 5988-12-15-REV STEM EXTENSION,C1776,HCPCS,,79002155,CDM,278,RC,,,both,,,3324,1311.88,39.4668,,1311.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1163.4,35,,1163.4,percent of total billed charges,Implant Device,1130.16,34,"Charges > $500, x 34%",1130.16,percent of total billed charges,Implant Device,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1329.6,40,,1329.6,percent of total billed charges,Implant Devices,1163.4,70,,1163.4,percent of total billed charges,Implant Devices,1130.16,34,,1130.16,percent of total billed charges,Implant Devices,1130.16,34,,1130.16,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.16,34,"If Charge > 2,000, then 34 percent",1130.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1329.6,
ZIMMER 5990-33-10-REV FEMORAL AUGMENT,C1776,HCPCS,,79002156,CDM,278,RC,,,both,,,3240,1278.72,39.4668,,1278.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1134,35,,1134,percent of total billed charges,Implant Device,1101.6,34,"Charges > $500, x 34%",1101.6,percent of total billed charges,Implant Device,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1296,40,,1296,percent of total billed charges,Implant Devices,1134,70,,1134,percent of total billed charges,Implant Devices,1101.6,34,,1101.6,percent of total billed charges,Implant Devices,1101.6,34,,1101.6,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1101.6,34,"If Charge > 2,000, then 34 percent",1101.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1296,
ZIMMER 5990-34-10-REV FEMORAL AUGMENT,C1776,HCPCS,,79002157,CDM,278,RC,,,both,,,2993,1181.24,39.4668,,1181.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1047.55,35,,1047.55,percent of total billed charges,Implant Device,1017.62,34,"Charges > $500, x 34%",1017.62,percent of total billed charges,Implant Device,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1197.2,40,,1197.2,percent of total billed charges,Implant Devices,1047.55,70,,1047.55,percent of total billed charges,Implant Devices,1017.62,34,,1017.62,percent of total billed charges,Implant Devices,1017.62,34,,1017.62,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1017.62,34,"If Charge > 2,000, then 34 percent",1017.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1197.2,
ZIMMER 5990-34-21-REV FEMORAL AUGMENT,C1776,HCPCS,,79002158,CDM,278,RC,,,both,,,3520,1389.23,39.4668,,1389.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1232,35,,1232,percent of total billed charges,Implant Device,1196.8,34,"Charges > $500, x 34%",1196.8,percent of total billed charges,Implant Device,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1408,40,,1408,percent of total billed charges,Implant Devices,1232,70,,1232,percent of total billed charges,Implant Devices,1196.8,34,,1196.8,percent of total billed charges,Implant Devices,1196.8,34,,1196.8,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1196.8,34,"If Charge > 2,000, then 34 percent",1196.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1408,
ZIMMER 5994-13-92-REV FEMORAL COMPONENT,C1776,HCPCS,,79002159,CDM,278,RC,,,both,,,20430,8063.07,39.4668,,8063.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6946.2,34,,6946.2,percent of total billed charges,Implant Device,6946.2,34,,6946.2,percent of total billed charges,Implant Device,6946.2,34,,6946.2,percent of total billed charges,Implant Device,6946.2,34,,6946.2,percent of total billed charges,Implant Device,6946.2,34,,6946.2,percent of total billed charges,Implant Device,6946.2,34,,6946.2,percent of total billed charges,Implant Device,7150.5,35,,7150.5,percent of total billed charges,Implant Device,6946.2,34,"Charges > $500, x 34%",6946.2,percent of total billed charges,Implant Device,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,8172,40,,8172,percent of total billed charges,Implant Devices,7150.5,70,,7150.5,percent of total billed charges,Implant Devices,6946.2,34,,6946.2,percent of total billed charges,Implant Devices,6946.2,34,,6946.2,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6946.2,34,"If Charge > 2,000, then 34 percent",6946.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8172,
ZIMMER 5994-14-91-REV FEMORAL COMPONENT,C1776,HCPCS,,79002160,CDM,278,RC,,,both,,,17989,7099.68,39.4668,,7099.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6296.15,35,,6296.15,percent of total billed charges,Implant Device,6116.26,34,"Charges > $500, x 34%",6116.26,percent of total billed charges,Implant Device,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,7195.6,40,,7195.6,percent of total billed charges,Implant Devices,6296.15,70,,6296.15,percent of total billed charges,Implant Devices,6116.26,34,,6116.26,percent of total billed charges,Implant Devices,6116.26,34,,6116.26,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6116.26,34,"If Charge > 2,000, then 34 percent",6116.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7195.6,
ZIMMER 5994-14-92-REV FEMORAL COMPONENT,C1776,HCPCS,,79002161,CDM,278,RC,,,both,,,20430,8063.07,39.4668,,8063.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6946.2,34,,6946.2,percent of total billed charges,Implant Device,6946.2,34,,6946.2,percent of total billed charges,Implant Device,6946.2,34,,6946.2,percent of total billed charges,Implant Device,6946.2,34,,6946.2,percent of total billed charges,Implant Device,6946.2,34,,6946.2,percent of total billed charges,Implant Device,6946.2,34,,6946.2,percent of total billed charges,Implant Device,7150.5,35,,7150.5,percent of total billed charges,Implant Device,6946.2,34,"Charges > $500, x 34%",6946.2,percent of total billed charges,Implant Device,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,8172,40,,8172,percent of total billed charges,Implant Devices,7150.5,70,,7150.5,percent of total billed charges,Implant Devices,6946.2,34,,6946.2,percent of total billed charges,Implant Devices,6946.2,34,,6946.2,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,7150.5,35,,7150.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6946.2,34,"If Charge > 2,000, then 34 percent",6946.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8172,
ZIMMER 5994-15-91-REV FEMORAL COMPONENT,C1776,HCPCS,,79002162,CDM,278,RC,,,both,,,17989,7099.68,39.4668,,7099.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6296.15,35,,6296.15,percent of total billed charges,Implant Device,6116.26,34,"Charges > $500, x 34%",6116.26,percent of total billed charges,Implant Device,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,7195.6,40,,7195.6,percent of total billed charges,Implant Devices,6296.15,70,,6296.15,percent of total billed charges,Implant Devices,6116.26,34,,6116.26,percent of total billed charges,Implant Devices,6116.26,34,,6116.26,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6116.26,34,"If Charge > 2,000, then 34 percent",6116.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7195.6,
ZIMMER 5994-15-92-REV FEMORAL COMPONENT,C1776,HCPCS,,79002163,CDM,278,RC,,,both,,,18586,7335.3,39.4668,,7335.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6505.1,35,,6505.1,percent of total billed charges,Implant Device,6319.24,34,"Charges > $500, x 34%",6319.24,percent of total billed charges,Implant Device,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,7434.4,40,,7434.4,percent of total billed charges,Implant Devices,6505.1,70,,6505.1,percent of total billed charges,Implant Devices,6319.24,34,,6319.24,percent of total billed charges,Implant Devices,6319.24,34,,6319.24,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6319.24,34,"If Charge > 2,000, then 34 percent",6319.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7434.4,
ZIMMER 5994-17-92-REV FEMORAL COMPONENT,C1776,HCPCS,,79002164,CDM,278,RC,,,both,,,17989,7099.68,39.4668,,7099.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6296.15,35,,6296.15,percent of total billed charges,Implant Device,6116.26,34,"Charges > $500, x 34%",6116.26,percent of total billed charges,Implant Device,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,7195.6,40,,7195.6,percent of total billed charges,Implant Devices,6296.15,70,,6296.15,percent of total billed charges,Implant Devices,6116.26,34,,6116.26,percent of total billed charges,Implant Devices,6116.26,34,,6116.26,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6116.26,34,"If Charge > 2,000, then 34 percent",6116.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7195.6,
ZIMMER 5994-30-12-REV ARTICULAR SURFACE,C1776,HCPCS,,79002165,CDM,278,RC,,,both,,,6257,2469.44,39.4668,,2469.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Device,2127.38,34,"Charges > $500, x 34%",2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2502.8,40,,2502.8,percent of total billed charges,Implant Devices,2189.95,70,,2189.95,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2127.38,34,"If Charge > 2,000, then 34 percent",2127.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2502.8,
ZIMMER 5994-30-17-REV ARTICULAR SURFACE,C1776,HCPCS,,79002166,CDM,278,RC,,,both,,,6773,2673.09,39.4668,,2673.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Device,2302.82,34,"Charges > $500, x 34%",2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2709.2,40,,2709.2,percent of total billed charges,Implant Devices,2370.55,70,,2370.55,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2302.82,34,"If Charge > 2,000, then 34 percent",2302.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2709.2,
ZIMMER 5994-40-014-REV ARTICULAR SURFACE,C1776,HCPCS,,79002167,CDM,278,RC,,,both,,,6257,2469.44,39.4668,,2469.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Device,2127.38,34,"Charges > $500, x 34%",2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2502.8,40,,2502.8,percent of total billed charges,Implant Devices,2189.95,70,,2189.95,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2127.38,34,"If Charge > 2,000, then 34 percent",2127.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2502.8,
ZIMMER 5994-50-17-REV ARTICULAR SURFACE,C1776,HCPCS,,79002168,CDM,278,RC,,,both,,,6257,2469.44,39.4668,,2469.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Device,2127.38,34,"Charges > $500, x 34%",2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2502.8,40,,2502.8,percent of total billed charges,Implant Devices,2189.95,70,,2189.95,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2127.38,34,"If Charge > 2,000, then 34 percent",2127.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2502.8,
ZIMMER 5994-51-14-REV ARTICULAR SURFACE,C1776,HCPCS,,79002169,CDM,278,RC,,,both,,,6773,2673.09,39.4668,,2673.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Device,2302.82,34,"Charges > $500, x 34%",2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2709.2,40,,2709.2,percent of total billed charges,Implant Devices,2370.55,70,,2370.55,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2302.82,34,"If Charge > 2,000, then 34 percent",2302.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2709.2,
STRYKER 6097-0530 FEMORAL STEM,C1776,HCPCS,,79002175,CDM,278,RC,,,both,,,12044,4753.38,39.4668,,4753.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4215.4,35,,4215.4,percent of total billed charges,Implant Device,4094.96,34,"Charges > $500, x 34%",4094.96,percent of total billed charges,Implant Device,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4817.6,40,,4817.6,percent of total billed charges,Implant Devices,4215.4,70,,4215.4,percent of total billed charges,Implant Devices,4094.96,34,,4094.96,percent of total billed charges,Implant Devices,4094.96,34,,4094.96,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4094.96,34,"If Charge > 2,000, then 34 percent",4094.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4817.6,
STRYKER 6097-0630 FEMORAL STEM,C1776,HCPCS,,79002176,CDM,278,RC,,,both,,,5797,2287.89,39.4668,,2287.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1970.98,34,,1970.98,percent of total billed charges,Implant Device,1970.98,34,,1970.98,percent of total billed charges,Implant Device,1970.98,34,,1970.98,percent of total billed charges,Implant Device,1970.98,34,,1970.98,percent of total billed charges,Implant Device,1970.98,34,,1970.98,percent of total billed charges,Implant Device,1970.98,34,,1970.98,percent of total billed charges,Implant Device,2028.95,35,,2028.95,percent of total billed charges,Implant Device,1970.98,34,"Charges > $500, x 34%",1970.98,percent of total billed charges,Implant Device,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2318.8,40,,2318.8,percent of total billed charges,Implant Devices,2028.95,70,,2028.95,percent of total billed charges,Implant Devices,1970.98,34,,1970.98,percent of total billed charges,Implant Devices,1970.98,34,,1970.98,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1970.98,34,"If Charge > 2,000, then 34 percent",1970.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2318.8,
STRYKER 6097-0735 FEMORAL STEM,C1776,HCPCS,,79002177,CDM,278,RC,,,both,,,11810,4661.03,39.4668,,4661.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4015.4,34,,4015.4,percent of total billed charges,Implant Device,4015.4,34,,4015.4,percent of total billed charges,Implant Device,4015.4,34,,4015.4,percent of total billed charges,Implant Device,4015.4,34,,4015.4,percent of total billed charges,Implant Device,4015.4,34,,4015.4,percent of total billed charges,Implant Device,4015.4,34,,4015.4,percent of total billed charges,Implant Device,4133.5,35,,4133.5,percent of total billed charges,Implant Device,4015.4,34,"Charges > $500, x 34%",4015.4,percent of total billed charges,Implant Device,4133.5,35,,4133.5,percent of total billed charges,Implant Devices,4133.5,35,,4133.5,percent of total billed charges,Implant Devices,4133.5,35,,,percent of total billed charges,Implant Devices,4133.5,35,,4133.5,percent of total billed charges,Implant Devices,4133.5,35,,4133.5,percent of total billed charges,Implant Devices,4724,40,,4724,percent of total billed charges,Implant Devices,4133.5,70,,4133.5,percent of total billed charges,Implant Devices,4015.4,34,,4015.4,percent of total billed charges,Implant Devices,4015.4,34,,4015.4,percent of total billed charges,Implant Devices,4133.5,35,,4133.5,percent of total billed charges,Implant Devices,4133.5,35,,4133.5,percent of total billed charges,Implant Devices,4133.5,35,,4133.5,percent of total billed charges,Implant Devices,4133.5,35,,4133.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4015.4,34,"If Charge > 2,000, then 34 percent",4015.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4724,
STRYKER 6098-0425 FEMORAL STEM,C1776,HCPCS,,79002178,CDM,278,RC,,,both,,,13114,5175.68,39.4668,,5175.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4458.76,34,,4458.76,percent of total billed charges,Implant Device,4458.76,34,,4458.76,percent of total billed charges,Implant Device,4458.76,34,,4458.76,percent of total billed charges,Implant Device,4458.76,34,,4458.76,percent of total billed charges,Implant Device,4458.76,34,,4458.76,percent of total billed charges,Implant Device,4458.76,34,,4458.76,percent of total billed charges,Implant Device,4589.9,35,,4589.9,percent of total billed charges,Implant Device,4458.76,34,"Charges > $500, x 34%",4458.76,percent of total billed charges,Implant Device,4589.9,35,,4589.9,percent of total billed charges,Implant Devices,4589.9,35,,4589.9,percent of total billed charges,Implant Devices,4589.9,35,,,percent of total billed charges,Implant Devices,4589.9,35,,4589.9,percent of total billed charges,Implant Devices,4589.9,35,,4589.9,percent of total billed charges,Implant Devices,5245.6,40,,5245.6,percent of total billed charges,Implant Devices,4589.9,70,,4589.9,percent of total billed charges,Implant Devices,4458.76,34,,4458.76,percent of total billed charges,Implant Devices,4458.76,34,,4458.76,percent of total billed charges,Implant Devices,4589.9,35,,4589.9,percent of total billed charges,Implant Devices,4589.9,35,,4589.9,percent of total billed charges,Implant Devices,4589.9,35,,4589.9,percent of total billed charges,Implant Devices,4589.9,35,,4589.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4458.76,34,"If Charge > 2,000, then 34 percent",4458.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5245.6,
STRYKER 6098-0530 FEMORAL STEM,C1776,HCPCS,,79002179,CDM,278,RC,,,both,,,11809,4660.63,39.4668,,4660.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4015.06,34,,4015.06,percent of total billed charges,Implant Device,4015.06,34,,4015.06,percent of total billed charges,Implant Device,4015.06,34,,4015.06,percent of total billed charges,Implant Device,4015.06,34,,4015.06,percent of total billed charges,Implant Device,4015.06,34,,4015.06,percent of total billed charges,Implant Device,4015.06,34,,4015.06,percent of total billed charges,Implant Device,4133.15,35,,4133.15,percent of total billed charges,Implant Device,4015.06,34,"Charges > $500, x 34%",4015.06,percent of total billed charges,Implant Device,4133.15,35,,4133.15,percent of total billed charges,Implant Devices,4133.15,35,,4133.15,percent of total billed charges,Implant Devices,4133.15,35,,,percent of total billed charges,Implant Devices,4133.15,35,,4133.15,percent of total billed charges,Implant Devices,4133.15,35,,4133.15,percent of total billed charges,Implant Devices,4723.6,40,,4723.6,percent of total billed charges,Implant Devices,4133.15,70,,4133.15,percent of total billed charges,Implant Devices,4015.06,34,,4015.06,percent of total billed charges,Implant Devices,4015.06,34,,4015.06,percent of total billed charges,Implant Devices,4133.15,35,,4133.15,percent of total billed charges,Implant Devices,4133.15,35,,4133.15,percent of total billed charges,Implant Devices,4133.15,35,,4133.15,percent of total billed charges,Implant Devices,4133.15,35,,4133.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4015.06,34,"If Charge > 2,000, then 34 percent",4015.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4723.6,
STRYKER 6098-0735 FEMORAL STEM,C1776,HCPCS,,79002180,CDM,278,RC,,,both,,,12044,4753.38,39.4668,,4753.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4094.96,34,,4094.96,percent of total billed charges,Implant Device,4215.4,35,,4215.4,percent of total billed charges,Implant Device,4094.96,34,"Charges > $500, x 34%",4094.96,percent of total billed charges,Implant Device,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4817.6,40,,4817.6,percent of total billed charges,Implant Devices,4215.4,70,,4215.4,percent of total billed charges,Implant Devices,4094.96,34,,4094.96,percent of total billed charges,Implant Devices,4094.96,34,,4094.96,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,4215.4,35,,4215.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4094.96,34,"If Charge > 2,000, then 34 percent",4094.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4817.6,
PAC 3 62004-05 CURVED ROD,C1776,HCPCS,,79002183,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
PAC 3 62004-06 CURVED ROD,C1776,HCPCS,,79002184,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
PAC 3 62004-08 CURVED ROD,C1776,HCPCS,,79002185,CDM,278,RC,,,both,,,600,236.8,39.4668,,236.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,204,34,,204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Device,204,34,"Charges > $500, x 34%",204,percent of total billed charges,Implant Device,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,240,40,,240,percent of total billed charges,Implant Devices,210,70,,210,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,204,34,,204,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,210,35,,210,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240,
PAC 3 62004-13 CURVED ROD,C1776,HCPCS,,79002186,CDM,278,RC,,,both,,,676,266.8,39.4668,,266.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Device,229.84,34,"Charges > $500, x 34%",229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,270.4,40,,270.4,percent of total billed charges,Implant Devices,236.6,70,,236.6,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270.4,
STRYKER 623-00-36D-REV INSERT,C1776,HCPCS,,79002196,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 623-00-40E INSERT,C1776,HCPCS,,79002197,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
DEPUY 62-3421-REV KNEE SYSTEM,C1776,HCPCS,,79002198,CDM,278,RC,,,both,,,21192,8363.8,39.4668,,8363.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7205.28,34,,7205.28,percent of total billed charges,Implant Device,7205.28,34,,7205.28,percent of total billed charges,Implant Device,7205.28,34,,7205.28,percent of total billed charges,Implant Device,7205.28,34,,7205.28,percent of total billed charges,Implant Device,7205.28,34,,7205.28,percent of total billed charges,Implant Device,7205.28,34,,7205.28,percent of total billed charges,Implant Device,7417.2,35,,7417.2,percent of total billed charges,Implant Device,7205.28,34,"Charges > $500, x 34%",7205.28,percent of total billed charges,Implant Device,7417.2,35,,7417.2,percent of total billed charges,Implant Devices,7417.2,35,,7417.2,percent of total billed charges,Implant Devices,7417.2,35,,,percent of total billed charges,Implant Devices,7417.2,35,,7417.2,percent of total billed charges,Implant Devices,7417.2,35,,7417.2,percent of total billed charges,Implant Devices,8476.8,40,,8476.8,percent of total billed charges,Implant Devices,7417.2,70,,7417.2,percent of total billed charges,Implant Devices,7205.28,34,,7205.28,percent of total billed charges,Implant Devices,7205.28,34,,7205.28,percent of total billed charges,Implant Devices,7417.2,35,,7417.2,percent of total billed charges,Implant Devices,7417.2,35,,7417.2,percent of total billed charges,Implant Devices,7417.2,35,,7417.2,percent of total billed charges,Implant Devices,7417.2,35,,7417.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7205.28,34,"If Charge > 2,000, then 34 percent",7205.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8476.8,
DEPUY 62-3805-REV FEMORAL AUGMENT,C1776,HCPCS,,79002199,CDM,278,RC,,,both,,,2653,1047.05,39.4668,,1047.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,902.02,34,,902.02,percent of total billed charges,Implant Device,902.02,34,,902.02,percent of total billed charges,Implant Device,902.02,34,,902.02,percent of total billed charges,Implant Device,902.02,34,,902.02,percent of total billed charges,Implant Device,902.02,34,,902.02,percent of total billed charges,Implant Device,902.02,34,,902.02,percent of total billed charges,Implant Device,928.55,35,,928.55,percent of total billed charges,Implant Device,902.02,34,"Charges > $500, x 34%",902.02,percent of total billed charges,Implant Device,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,1061.2,40,,1061.2,percent of total billed charges,Implant Devices,928.55,70,,928.55,percent of total billed charges,Implant Devices,902.02,34,,902.02,percent of total billed charges,Implant Devices,902.02,34,,902.02,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,902.02,34,"If Charge > 2,000, then 34 percent",902.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1061.2,
DEPUY 62-3810-REV FEMORAL AUGMENT,C1776,HCPCS,,79002200,CDM,278,RC,,,both,,,2653,1047.05,39.4668,,1047.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,902.02,34,,902.02,percent of total billed charges,Implant Device,902.02,34,,902.02,percent of total billed charges,Implant Device,902.02,34,,902.02,percent of total billed charges,Implant Device,902.02,34,,902.02,percent of total billed charges,Implant Device,902.02,34,,902.02,percent of total billed charges,Implant Device,902.02,34,,902.02,percent of total billed charges,Implant Device,928.55,35,,928.55,percent of total billed charges,Implant Device,902.02,34,"Charges > $500, x 34%",902.02,percent of total billed charges,Implant Device,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,1061.2,40,,1061.2,percent of total billed charges,Implant Devices,928.55,70,,928.55,percent of total billed charges,Implant Devices,902.02,34,,902.02,percent of total billed charges,Implant Devices,902.02,34,,902.02,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,928.55,35,,928.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,902.02,34,"If Charge > 2,000, then 34 percent",902.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1061.2,
STRYKER 6259-8-100 STEM CENTRALIZER,C1776,HCPCS,,79002208,CDM,278,RC,,,both,,,497,196.15,39.4668,,196.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.98,34,,168.98,percent of total billed charges,Implant Device,168.98,34,,168.98,percent of total billed charges,Implant Device,168.98,34,,168.98,percent of total billed charges,Implant Device,168.98,34,,168.98,percent of total billed charges,Implant Device,168.98,34,,168.98,percent of total billed charges,Implant Device,168.98,34,,168.98,percent of total billed charges,Implant Device,173.95,35,,173.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,173.95,35,,173.95,percent of total billed charges,Implant Devices,173.95,35,,173.95,percent of total billed charges,Implant Devices,173.95,35,,,percent of total billed charges,Implant Devices,173.95,35,,173.95,percent of total billed charges,Implant Devices,173.95,35,,173.95,percent of total billed charges,Implant Devices,198.8,40,,198.8,percent of total billed charges,Implant Devices,173.95,70,,173.95,percent of total billed charges,Implant Devices,168.98,34,,168.98,percent of total billed charges,Implant Devices,168.98,34,,168.98,percent of total billed charges,Implant Devices,173.95,35,,173.95,percent of total billed charges,Implant Devices,173.95,35,,173.95,percent of total billed charges,Implant Devices,173.95,35,,173.95,percent of total billed charges,Implant Devices,173.95,35,,173.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,198.8,
STRYKER 6259-8-110 STEM CENTRALIZER,C1776,HCPCS,,79002209,CDM,278,RC,,,both,,,486,191.81,39.4668,,191.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,165.24,34,,165.24,percent of total billed charges,Implant Device,165.24,34,,165.24,percent of total billed charges,Implant Device,165.24,34,,165.24,percent of total billed charges,Implant Device,165.24,34,,165.24,percent of total billed charges,Implant Device,165.24,34,,165.24,percent of total billed charges,Implant Device,165.24,34,,165.24,percent of total billed charges,Implant Device,170.1,35,,170.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,170.1,35,,170.1,percent of total billed charges,Implant Devices,170.1,35,,170.1,percent of total billed charges,Implant Devices,170.1,35,,,percent of total billed charges,Implant Devices,170.1,35,,170.1,percent of total billed charges,Implant Devices,170.1,35,,170.1,percent of total billed charges,Implant Devices,194.4,40,,194.4,percent of total billed charges,Implant Devices,170.1,70,,170.1,percent of total billed charges,Implant Devices,165.24,34,,165.24,percent of total billed charges,Implant Devices,165.24,34,,165.24,percent of total billed charges,Implant Devices,170.1,35,,170.1,percent of total billed charges,Implant Devices,170.1,35,,170.1,percent of total billed charges,Implant Devices,170.1,35,,170.1,percent of total billed charges,Implant Devices,170.1,35,,170.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,194.4,
STRYKER 626-00-42E LINER,C1776,HCPCS,,79002210,CDM,278,RC,,,both,,,3893,1536.44,39.4668,,1536.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1362.55,35,,1362.55,percent of total billed charges,Implant Device,1323.62,34,"Charges > $500, x 34%",1323.62,percent of total billed charges,Implant Device,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1557.2,40,,1557.2,percent of total billed charges,Implant Devices,1362.55,70,,1362.55,percent of total billed charges,Implant Devices,1323.62,34,,1323.62,percent of total billed charges,Implant Devices,1323.62,34,,1323.62,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1323.62,34,"If Charge > 2,000, then 34 percent",1323.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1557.2,
STRYKER 6260-9-032-REV FEMORAL HEAD,C1776,HCPCS,,79002211,CDM,278,RC,,,both,,,3067,1210.45,39.4668,,1210.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1073.45,35,,1073.45,percent of total billed charges,Implant Device,1042.78,34,"Charges > $500, x 34%",1042.78,percent of total billed charges,Implant Device,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1226.8,40,,1226.8,percent of total billed charges,Implant Devices,1073.45,70,,1073.45,percent of total billed charges,Implant Devices,1042.78,34,,1042.78,percent of total billed charges,Implant Devices,1042.78,34,,1042.78,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1042.78,34,"If Charge > 2,000, then 34 percent",1042.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1226.8,
STRYKER 6260-9-036-REV FEMORAL HEAD,C1776,HCPCS,,79002212,CDM,278,RC,,,both,,,5832,2301.7,39.4668,,2301.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,2041.2,35,,2041.2,percent of total billed charges,Implant Device,1982.88,34,"Charges > $500, x 34%",1982.88,percent of total billed charges,Implant Device,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2332.8,40,,2332.8,percent of total billed charges,Implant Devices,2041.2,70,,2041.2,percent of total billed charges,Implant Devices,1982.88,34,,1982.88,percent of total billed charges,Implant Devices,1982.88,34,,1982.88,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1982.88,34,"If Charge > 2,000, then 34 percent",1982.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2332.8,
STRYKER 6260-9-132-REV FEMORAL HEAD,C1776,HCPCS,,79002213,CDM,278,RC,,,both,,,3067,1210.45,39.4668,,1210.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1073.45,35,,1073.45,percent of total billed charges,Implant Device,1042.78,34,"Charges > $500, x 34%",1042.78,percent of total billed charges,Implant Device,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1226.8,40,,1226.8,percent of total billed charges,Implant Devices,1073.45,70,,1073.45,percent of total billed charges,Implant Devices,1042.78,34,,1042.78,percent of total billed charges,Implant Devices,1042.78,34,,1042.78,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1042.78,34,"If Charge > 2,000, then 34 percent",1042.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1226.8,
STRYKER 6260-9-1440-REV FEMORAL HEAD,C1776,HCPCS,,79002214,CDM,278,RC,,,both,,,5832,2301.7,39.4668,,2301.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,2041.2,35,,2041.2,percent of total billed charges,Implant Device,1982.88,34,"Charges > $500, x 34%",1982.88,percent of total billed charges,Implant Device,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2332.8,40,,2332.8,percent of total billed charges,Implant Devices,2041.2,70,,2041.2,percent of total billed charges,Implant Devices,1982.88,34,,1982.88,percent of total billed charges,Implant Devices,1982.88,34,,1982.88,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1982.88,34,"If Charge > 2,000, then 34 percent",1982.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2332.8,
STRYKER 6260-9-228-REV FEMORAL HEAD,C1776,HCPCS,,79002215,CDM,278,RC,,,both,,,3067,1210.45,39.4668,,1210.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1073.45,35,,1073.45,percent of total billed charges,Implant Device,1042.78,34,"Charges > $500, x 34%",1042.78,percent of total billed charges,Implant Device,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1226.8,40,,1226.8,percent of total billed charges,Implant Devices,1073.45,70,,1073.45,percent of total billed charges,Implant Devices,1042.78,34,,1042.78,percent of total billed charges,Implant Devices,1042.78,34,,1042.78,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1042.78,34,"If Charge > 2,000, then 34 percent",1042.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1226.8,
STRYKER 6260-9-236-REV FEMORAL HEAD,C1776,HCPCS,,79002216,CDM,278,RC,,,both,,,5832,2301.7,39.4668,,2301.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,1982.88,34,,1982.88,percent of total billed charges,Implant Device,2041.2,35,,2041.2,percent of total billed charges,Implant Device,1982.88,34,"Charges > $500, x 34%",1982.88,percent of total billed charges,Implant Device,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2332.8,40,,2332.8,percent of total billed charges,Implant Devices,2041.2,70,,2041.2,percent of total billed charges,Implant Devices,1982.88,34,,1982.88,percent of total billed charges,Implant Devices,1982.88,34,,1982.88,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,2041.2,35,,2041.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1982.88,34,"If Charge > 2,000, then 34 percent",1982.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2332.8,
STRYKER 6260-9-326-REV FEMORAL HEAD,C1776,HCPCS,,79002217,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
ZIMMER 6260-9-332-REV FEMORAL HEAD,C1776,HCPCS,,79002218,CDM,278,RC,,,both,,,3067,1210.45,39.4668,,1210.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1042.78,34,,1042.78,percent of total billed charges,Implant Device,1073.45,35,,1073.45,percent of total billed charges,Implant Device,1042.78,34,"Charges > $500, x 34%",1042.78,percent of total billed charges,Implant Device,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1226.8,40,,1226.8,percent of total billed charges,Implant Devices,1073.45,70,,1073.45,percent of total billed charges,Implant Devices,1042.78,34,,1042.78,percent of total billed charges,Implant Devices,1042.78,34,,1042.78,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,1073.45,35,,1073.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1042.78,34,"If Charge > 2,000, then 34 percent",1042.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1226.8,
STRYKER 6260-9-336-REV FEMORAL HEAD,C1776,HCPCS,,79002219,CDM,278,RC,,,both,,,6232,2459.57,39.4668,,2459.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2181.2,35,,2181.2,percent of total billed charges,Implant Device,2118.88,34,"Charges > $500, x 34%",2118.88,percent of total billed charges,Implant Device,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2492.8,40,,2492.8,percent of total billed charges,Implant Devices,2181.2,70,,2181.2,percent of total billed charges,Implant Devices,2118.88,34,,2118.88,percent of total billed charges,Implant Devices,2118.88,34,,2118.88,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2118.88,34,"If Charge > 2,000, then 34 percent",2118.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2492.8,
HOWMEDICA 6265-2-000 STEM,C1776,HCPCS,,79002220,CDM,278,RC,,,both,,,5797,2287.89,39.4668,,2287.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1970.98,34,,1970.98,percent of total billed charges,Implant Device,1970.98,34,,1970.98,percent of total billed charges,Implant Device,1970.98,34,,1970.98,percent of total billed charges,Implant Device,1970.98,34,,1970.98,percent of total billed charges,Implant Device,1970.98,34,,1970.98,percent of total billed charges,Implant Device,1970.98,34,,1970.98,percent of total billed charges,Implant Device,2028.95,35,,2028.95,percent of total billed charges,Implant Device,1970.98,34,"Charges > $500, x 34%",1970.98,percent of total billed charges,Implant Device,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2318.8,40,,2318.8,percent of total billed charges,Implant Devices,2028.95,70,,2028.95,percent of total billed charges,Implant Devices,1970.98,34,,1970.98,percent of total billed charges,Implant Devices,1970.98,34,,1970.98,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,2028.95,35,,2028.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1970.98,34,"If Charge > 2,000, then 34 percent",1970.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2318.8,
STRYKER 6276-1-021-REV MODULAR HIP,C1776,HCPCS,,79002221,CDM,278,RC,,,both,,,11948,4715.49,39.4668,,4715.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4181.8,35,,4181.8,percent of total billed charges,Implant Device,4062.32,34,"Charges > $500, x 34%",4062.32,percent of total billed charges,Implant Device,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4779.2,40,,4779.2,percent of total billed charges,Implant Devices,4181.8,70,,4181.8,percent of total billed charges,Implant Devices,4062.32,34,,4062.32,percent of total billed charges,Implant Devices,4062.32,34,,4062.32,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4062.32,34,"If Charge > 2,000, then 34 percent",4062.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4779.2,
STRYKER 6276-1-023-REV MODULAR HIP,C1776,HCPCS,,79002222,CDM,278,RC,,,both,,,11948,4715.49,39.4668,,4715.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4181.8,35,,4181.8,percent of total billed charges,Implant Device,4062.32,34,"Charges > $500, x 34%",4062.32,percent of total billed charges,Implant Device,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4779.2,40,,4779.2,percent of total billed charges,Implant Devices,4181.8,70,,4181.8,percent of total billed charges,Implant Devices,4062.32,34,,4062.32,percent of total billed charges,Implant Devices,4062.32,34,,4062.32,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4062.32,34,"If Charge > 2,000, then 34 percent",4062.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4779.2,
STRYKER 6276-1-025-REV MODULAR HIP,C1776,HCPCS,,79002223,CDM,278,RC,,,both,,,19494,7693.66,39.4668,,7693.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6627.96,34,,6627.96,percent of total billed charges,Implant Device,6627.96,34,,6627.96,percent of total billed charges,Implant Device,6627.96,34,,6627.96,percent of total billed charges,Implant Device,6627.96,34,,6627.96,percent of total billed charges,Implant Device,6627.96,34,,6627.96,percent of total billed charges,Implant Device,6627.96,34,,6627.96,percent of total billed charges,Implant Device,6822.9,35,,6822.9,percent of total billed charges,Implant Device,6627.96,34,"Charges > $500, x 34%",6627.96,percent of total billed charges,Implant Device,6822.9,35,,6822.9,percent of total billed charges,Implant Devices,6822.9,35,,6822.9,percent of total billed charges,Implant Devices,6822.9,35,,,percent of total billed charges,Implant Devices,6822.9,35,,6822.9,percent of total billed charges,Implant Devices,6822.9,35,,6822.9,percent of total billed charges,Implant Devices,7797.6,40,,7797.6,percent of total billed charges,Implant Devices,6822.9,70,,6822.9,percent of total billed charges,Implant Devices,6627.96,34,,6627.96,percent of total billed charges,Implant Devices,6627.96,34,,6627.96,percent of total billed charges,Implant Devices,6822.9,35,,6822.9,percent of total billed charges,Implant Devices,6822.9,35,,6822.9,percent of total billed charges,Implant Devices,6822.9,35,,6822.9,percent of total billed charges,Implant Devices,6822.9,35,,6822.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6627.96,34,"If Charge > 2,000, then 34 percent",6627.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7797.6,
STRYKER 6276-1-121-REV MODULAR HIP,C1776,HCPCS,,79002224,CDM,278,RC,,,both,,,21084,8321.18,39.4668,,8321.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7168.56,34,,7168.56,percent of total billed charges,Implant Device,7168.56,34,,7168.56,percent of total billed charges,Implant Device,7168.56,34,,7168.56,percent of total billed charges,Implant Device,7168.56,34,,7168.56,percent of total billed charges,Implant Device,7168.56,34,,7168.56,percent of total billed charges,Implant Device,7168.56,34,,7168.56,percent of total billed charges,Implant Device,7379.4,35,,7379.4,percent of total billed charges,Implant Device,7168.56,34,"Charges > $500, x 34%",7168.56,percent of total billed charges,Implant Device,7379.4,35,,7379.4,percent of total billed charges,Implant Devices,7379.4,35,,7379.4,percent of total billed charges,Implant Devices,7379.4,35,,,percent of total billed charges,Implant Devices,7379.4,35,,7379.4,percent of total billed charges,Implant Devices,7379.4,35,,7379.4,percent of total billed charges,Implant Devices,8433.6,40,,8433.6,percent of total billed charges,Implant Devices,7379.4,70,,7379.4,percent of total billed charges,Implant Devices,7168.56,34,,7168.56,percent of total billed charges,Implant Devices,7168.56,34,,7168.56,percent of total billed charges,Implant Devices,7379.4,35,,7379.4,percent of total billed charges,Implant Devices,7379.4,35,,7379.4,percent of total billed charges,Implant Devices,7379.4,35,,7379.4,percent of total billed charges,Implant Devices,7379.4,35,,7379.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7168.56,34,"If Charge > 2,000, then 34 percent",7168.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8433.6,
STRYKER 6276-1-123-REV MODULAR HIP,C1776,HCPCS,,79002225,CDM,278,RC,,,both,,,19076,7528.69,39.4668,,7528.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6676.6,35,,6676.6,percent of total billed charges,Implant Device,6485.84,34,"Charges > $500, x 34%",6485.84,percent of total billed charges,Implant Device,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,7630.4,40,,7630.4,percent of total billed charges,Implant Devices,6676.6,70,,6676.6,percent of total billed charges,Implant Devices,6485.84,34,,6485.84,percent of total billed charges,Implant Devices,6485.84,34,,6485.84,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6485.84,34,"If Charge > 2,000, then 34 percent",6485.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7630.4,
STRYKER 6276-1-221-REV MODULAR HIP,C1776,HCPCS,,79002226,CDM,278,RC,,,both,,,17088,6744.09,39.4668,,6744.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5980.8,35,,5980.8,percent of total billed charges,Implant Device,5809.92,34,"Charges > $500, x 34%",5809.92,percent of total billed charges,Implant Device,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,6835.2,40,,6835.2,percent of total billed charges,Implant Devices,5980.8,70,,5980.8,percent of total billed charges,Implant Devices,5809.92,34,,5809.92,percent of total billed charges,Implant Devices,5809.92,34,,5809.92,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5809.92,34,"If Charge > 2,000, then 34 percent",5809.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6835.2,
STRYKER 6276-1-225-REV MODULAR HIPO,C1776,HCPCS,,79002227,CDM,278,RC,,,both,,,17088,6744.09,39.4668,,6744.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5809.92,34,,5809.92,percent of total billed charges,Implant Device,5980.8,35,,5980.8,percent of total billed charges,Implant Device,5809.92,34,"Charges > $500, x 34%",5809.92,percent of total billed charges,Implant Device,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,6835.2,40,,6835.2,percent of total billed charges,Implant Devices,5980.8,70,,5980.8,percent of total billed charges,Implant Devices,5809.92,34,,5809.92,percent of total billed charges,Implant Devices,5809.92,34,,5809.92,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,5980.8,35,,5980.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5809.92,34,"If Charge > 2,000, then 34 percent",5809.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6835.2,
STRYKER 6276-7-016-REV MODULAR HIP,C1776,HCPCS,,79002228,CDM,278,RC,,,both,,,9112,3596.21,39.4668,,3596.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3189.2,35,,3189.2,percent of total billed charges,Implant Device,3098.08,34,"Charges > $500, x 34%",3098.08,percent of total billed charges,Implant Device,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3644.8,40,,3644.8,percent of total billed charges,Implant Devices,3189.2,70,,3189.2,percent of total billed charges,Implant Devices,3098.08,34,,3098.08,percent of total billed charges,Implant Devices,3098.08,34,,3098.08,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3098.08,34,"If Charge > 2,000, then 34 percent",3098.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3644.8,
STRYKER 6276-7-020-REV MODULAR HIP,C1776,HCPCS,,79002229,CDM,278,RC,,,both,,,12245,4832.71,39.4668,,4832.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4163.3,34,,4163.3,percent of total billed charges,Implant Device,4163.3,34,,4163.3,percent of total billed charges,Implant Device,4163.3,34,,4163.3,percent of total billed charges,Implant Device,4163.3,34,,4163.3,percent of total billed charges,Implant Device,4163.3,34,,4163.3,percent of total billed charges,Implant Device,4163.3,34,,4163.3,percent of total billed charges,Implant Device,4285.75,35,,4285.75,percent of total billed charges,Implant Device,4163.3,34,"Charges > $500, x 34%",4163.3,percent of total billed charges,Implant Device,4285.75,35,,4285.75,percent of total billed charges,Implant Devices,4285.75,35,,4285.75,percent of total billed charges,Implant Devices,4285.75,35,,,percent of total billed charges,Implant Devices,4285.75,35,,4285.75,percent of total billed charges,Implant Devices,4285.75,35,,4285.75,percent of total billed charges,Implant Devices,4898,40,,4898,percent of total billed charges,Implant Devices,4285.75,70,,4285.75,percent of total billed charges,Implant Devices,4163.3,34,,4163.3,percent of total billed charges,Implant Devices,4163.3,34,,4163.3,percent of total billed charges,Implant Devices,4285.75,35,,4285.75,percent of total billed charges,Implant Devices,4285.75,35,,4285.75,percent of total billed charges,Implant Devices,4285.75,35,,4285.75,percent of total billed charges,Implant Devices,4285.75,35,,4285.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4163.3,34,"If Charge > 2,000, then 34 percent",4163.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4898,
STRYKER 6276-7-114-REV MODULAR HIP,C1776,HCPCS,,79002230,CDM,278,RC,,,both,,,12966,5117.27,39.4668,,5117.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4538.1,35,,4538.1,percent of total billed charges,Implant Device,4408.44,34,"Charges > $500, x 34%",4408.44,percent of total billed charges,Implant Device,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,5186.4,40,,5186.4,percent of total billed charges,Implant Devices,4538.1,70,,4538.1,percent of total billed charges,Implant Devices,4408.44,34,,4408.44,percent of total billed charges,Implant Devices,4408.44,34,,4408.44,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4408.44,34,"If Charge > 2,000, then 34 percent",4408.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5186.4,
STRYKER 6276-7-115-REV MODULAR HIP,C1776,HCPCS,,79002231,CDM,278,RC,,,both,,,13484,5321.7,39.4668,,5321.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4584.56,34,,4584.56,percent of total billed charges,Implant Device,4584.56,34,,4584.56,percent of total billed charges,Implant Device,4584.56,34,,4584.56,percent of total billed charges,Implant Device,4584.56,34,,4584.56,percent of total billed charges,Implant Device,4584.56,34,,4584.56,percent of total billed charges,Implant Device,4584.56,34,,4584.56,percent of total billed charges,Implant Device,4719.4,35,,4719.4,percent of total billed charges,Implant Device,4584.56,34,"Charges > $500, x 34%",4584.56,percent of total billed charges,Implant Device,4719.4,35,,4719.4,percent of total billed charges,Implant Devices,4719.4,35,,4719.4,percent of total billed charges,Implant Devices,4719.4,35,,,percent of total billed charges,Implant Devices,4719.4,35,,4719.4,percent of total billed charges,Implant Devices,4719.4,35,,4719.4,percent of total billed charges,Implant Devices,5393.6,40,,5393.6,percent of total billed charges,Implant Devices,4719.4,70,,4719.4,percent of total billed charges,Implant Devices,4584.56,34,,4584.56,percent of total billed charges,Implant Devices,4584.56,34,,4584.56,percent of total billed charges,Implant Devices,4719.4,35,,4719.4,percent of total billed charges,Implant Devices,4719.4,35,,4719.4,percent of total billed charges,Implant Devices,4719.4,35,,4719.4,percent of total billed charges,Implant Devices,4719.4,35,,4719.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4584.56,34,"If Charge > 2,000, then 34 percent",4584.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5393.6,
STRYKER 6276-7-116-REV MODULAR HIP,C1776,HCPCS,,79002232,CDM,278,RC,,,both,,,12964,5116.48,39.4668,,5116.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4537.4,35,,4537.4,percent of total billed charges,Implant Device,4407.76,34,"Charges > $500, x 34%",4407.76,percent of total billed charges,Implant Device,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,5185.6,40,,5185.6,percent of total billed charges,Implant Devices,4537.4,70,,4537.4,percent of total billed charges,Implant Devices,4407.76,34,,4407.76,percent of total billed charges,Implant Devices,4407.76,34,,4407.76,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4407.76,34,"If Charge > 2,000, then 34 percent",4407.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5185.6,
STRYKER 6276-7-117-REV MODULAR HIP,C1776,HCPCS,,79002233,CDM,278,RC,,,both,,,12966,5117.27,39.4668,,5117.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4408.44,34,,4408.44,percent of total billed charges,Implant Device,4538.1,35,,4538.1,percent of total billed charges,Implant Device,4408.44,34,"Charges > $500, x 34%",4408.44,percent of total billed charges,Implant Device,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,5186.4,40,,5186.4,percent of total billed charges,Implant Devices,4538.1,70,,4538.1,percent of total billed charges,Implant Devices,4408.44,34,,4408.44,percent of total billed charges,Implant Devices,4408.44,34,,4408.44,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,4538.1,35,,4538.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4408.44,34,"If Charge > 2,000, then 34 percent",4408.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5186.4,
STRYKER 6276-7-118-REV MODULAR HIP,C1776,HCPCS,,79002234,CDM,278,RC,,,both,,,12964,5116.48,39.4668,,5116.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4407.76,34,,4407.76,percent of total billed charges,Implant Device,4537.4,35,,4537.4,percent of total billed charges,Implant Device,4407.76,34,"Charges > $500, x 34%",4407.76,percent of total billed charges,Implant Device,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,5185.6,40,,5185.6,percent of total billed charges,Implant Devices,4537.4,70,,4537.4,percent of total billed charges,Implant Devices,4407.76,34,,4407.76,percent of total billed charges,Implant Devices,4407.76,34,,4407.76,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,4537.4,35,,4537.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4407.76,34,"If Charge > 2,000, then 34 percent",4407.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5185.6,
STRYKER 6276-7-120-REV MODULAR HIP,C1776,HCPCS,,79002235,CDM,278,RC,,,both,,,9648,3807.76,39.4668,,3807.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3280.32,34,,3280.32,percent of total billed charges,Implant Device,3280.32,34,,3280.32,percent of total billed charges,Implant Device,3280.32,34,,3280.32,percent of total billed charges,Implant Device,3280.32,34,,3280.32,percent of total billed charges,Implant Device,3280.32,34,,3280.32,percent of total billed charges,Implant Device,3280.32,34,,3280.32,percent of total billed charges,Implant Device,3376.8,35,,3376.8,percent of total billed charges,Implant Device,3280.32,34,"Charges > $500, x 34%",3280.32,percent of total billed charges,Implant Device,3376.8,35,,3376.8,percent of total billed charges,Implant Devices,3376.8,35,,3376.8,percent of total billed charges,Implant Devices,3376.8,35,,,percent of total billed charges,Implant Devices,3376.8,35,,3376.8,percent of total billed charges,Implant Devices,3376.8,35,,3376.8,percent of total billed charges,Implant Devices,3859.2,40,,3859.2,percent of total billed charges,Implant Devices,3376.8,70,,3376.8,percent of total billed charges,Implant Devices,3280.32,34,,3280.32,percent of total billed charges,Implant Devices,3280.32,34,,3280.32,percent of total billed charges,Implant Devices,3376.8,35,,3376.8,percent of total billed charges,Implant Devices,3376.8,35,,3376.8,percent of total billed charges,Implant Devices,3376.8,35,,3376.8,percent of total billed charges,Implant Devices,3376.8,35,,3376.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3280.32,34,"If Charge > 2,000, then 34 percent",3280.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3859.2,
STRYKER 6276-7-218-REV DISTAL STEM,C1776,HCPCS,,79002236,CDM,278,RC,,,both,,,13684,5400.64,39.4668,,5400.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4652.56,34,,4652.56,percent of total billed charges,Implant Device,4652.56,34,,4652.56,percent of total billed charges,Implant Device,4652.56,34,,4652.56,percent of total billed charges,Implant Device,4652.56,34,,4652.56,percent of total billed charges,Implant Device,4652.56,34,,4652.56,percent of total billed charges,Implant Device,4652.56,34,,4652.56,percent of total billed charges,Implant Device,4789.4,35,,4789.4,percent of total billed charges,Implant Device,4652.56,34,"Charges > $500, x 34%",4652.56,percent of total billed charges,Implant Device,4789.4,35,,4789.4,percent of total billed charges,Implant Devices,4789.4,35,,4789.4,percent of total billed charges,Implant Devices,4789.4,35,,,percent of total billed charges,Implant Devices,4789.4,35,,4789.4,percent of total billed charges,Implant Devices,4789.4,35,,4789.4,percent of total billed charges,Implant Devices,5473.6,40,,5473.6,percent of total billed charges,Implant Devices,4789.4,70,,4789.4,percent of total billed charges,Implant Devices,4652.56,34,,4652.56,percent of total billed charges,Implant Devices,4652.56,34,,4652.56,percent of total billed charges,Implant Devices,4789.4,35,,4789.4,percent of total billed charges,Implant Devices,4789.4,35,,4789.4,percent of total billed charges,Implant Devices,4789.4,35,,4789.4,percent of total billed charges,Implant Devices,4789.4,35,,4789.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4652.56,34,"If Charge > 2,000, then 34 percent",4652.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5473.6,
STRYKER 6276-7-323-REV MODULAR HIP SYS,C1776,HCPCS,,79002237,CDM,278,RC,,,both,,,14405,5685.19,39.4668,,5685.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4897.7,34,,4897.7,percent of total billed charges,Implant Device,4897.7,34,,4897.7,percent of total billed charges,Implant Device,4897.7,34,,4897.7,percent of total billed charges,Implant Device,4897.7,34,,4897.7,percent of total billed charges,Implant Device,4897.7,34,,4897.7,percent of total billed charges,Implant Device,4897.7,34,,4897.7,percent of total billed charges,Implant Device,5041.75,35,,5041.75,percent of total billed charges,Implant Device,4897.7,34,"Charges > $500, x 34%",4897.7,percent of total billed charges,Implant Device,5041.75,35,,5041.75,percent of total billed charges,Implant Devices,5041.75,35,,5041.75,percent of total billed charges,Implant Devices,5041.75,35,,,percent of total billed charges,Implant Devices,5041.75,35,,5041.75,percent of total billed charges,Implant Devices,5041.75,35,,5041.75,percent of total billed charges,Implant Devices,5762,40,,5762,percent of total billed charges,Implant Devices,5041.75,70,,5041.75,percent of total billed charges,Implant Devices,4897.7,34,,4897.7,percent of total billed charges,Implant Devices,4897.7,34,,4897.7,percent of total billed charges,Implant Devices,5041.75,35,,5041.75,percent of total billed charges,Implant Devices,5041.75,35,,5041.75,percent of total billed charges,Implant Devices,5041.75,35,,5041.75,percent of total billed charges,Implant Devices,5041.75,35,,5041.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4897.7,34,"If Charge > 2,000, then 34 percent",4897.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5762,
STRYKER 6570-0-036-REV FEMORAL HEAD,C1776,HCPCS,,79002240,CDM,278,RC,,,both,,,6914,2728.73,39.4668,,2728.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.76,34,,2350.76,percent of total billed charges,Implant Device,2350.76,34,,2350.76,percent of total billed charges,Implant Device,2350.76,34,,2350.76,percent of total billed charges,Implant Device,2350.76,34,,2350.76,percent of total billed charges,Implant Device,2350.76,34,,2350.76,percent of total billed charges,Implant Device,2350.76,34,,2350.76,percent of total billed charges,Implant Device,2419.9,35,,2419.9,percent of total billed charges,Implant Device,2350.76,34,"Charges > $500, x 34%",2350.76,percent of total billed charges,Implant Device,2419.9,35,,2419.9,percent of total billed charges,Implant Devices,2419.9,35,,2419.9,percent of total billed charges,Implant Devices,2419.9,35,,,percent of total billed charges,Implant Devices,2419.9,35,,2419.9,percent of total billed charges,Implant Devices,2419.9,35,,2419.9,percent of total billed charges,Implant Devices,2765.6,40,,2765.6,percent of total billed charges,Implant Devices,2419.9,70,,2419.9,percent of total billed charges,Implant Devices,2350.76,34,,2350.76,percent of total billed charges,Implant Devices,2350.76,34,,2350.76,percent of total billed charges,Implant Devices,2419.9,35,,2419.9,percent of total billed charges,Implant Devices,2419.9,35,,2419.9,percent of total billed charges,Implant Devices,2419.9,35,,2419.9,percent of total billed charges,Implant Devices,2419.9,35,,2419.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.76,34,"If Charge > 2,000, then 34 percent",2350.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2765.6,
STRYKER 6570-0-536-REV FEMORAL HEAD,C1776,HCPCS,,79002241,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 6570-0-736-REV FEMORAL HEAD,C1776,HCPCS,,79002242,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
ZIMMER 7110-48-28-REV TRABECULAR SHELL,C1776,HCPCS,,79002263,CDM,278,RC,,,both,,,7620,3007.37,39.4668,,3007.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2590.8,34,,2590.8,percent of total billed charges,Implant Device,2590.8,34,,2590.8,percent of total billed charges,Implant Device,2590.8,34,,2590.8,percent of total billed charges,Implant Device,2590.8,34,,2590.8,percent of total billed charges,Implant Device,2590.8,34,,2590.8,percent of total billed charges,Implant Device,2590.8,34,,2590.8,percent of total billed charges,Implant Device,2667,35,,2667,percent of total billed charges,Implant Device,2590.8,34,"Charges > $500, x 34%",2590.8,percent of total billed charges,Implant Device,2667,35,,2667,percent of total billed charges,Implant Devices,2667,35,,2667,percent of total billed charges,Implant Devices,2667,35,,,percent of total billed charges,Implant Devices,2667,35,,2667,percent of total billed charges,Implant Devices,2667,35,,2667,percent of total billed charges,Implant Devices,3048,40,,3048,percent of total billed charges,Implant Devices,2667,70,,2667,percent of total billed charges,Implant Devices,2590.8,34,,2590.8,percent of total billed charges,Implant Devices,2590.8,34,,2590.8,percent of total billed charges,Implant Devices,2667,35,,2667,percent of total billed charges,Implant Devices,2667,35,,2667,percent of total billed charges,Implant Devices,2667,35,,2667,percent of total billed charges,Implant Devices,2667,35,,2667,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2590.8,34,"If Charge > 2,000, then 34 percent",2590.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3048,
S&N 71303604-REV FEMORAL HEAD,C1776,HCPCS,,79002264,CDM,278,RC,,,both,,,2573,1015.48,39.4668,,1015.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,874.82,34,,874.82,percent of total billed charges,Implant Device,874.82,34,,874.82,percent of total billed charges,Implant Device,874.82,34,,874.82,percent of total billed charges,Implant Device,874.82,34,,874.82,percent of total billed charges,Implant Device,874.82,34,,874.82,percent of total billed charges,Implant Device,874.82,34,,874.82,percent of total billed charges,Implant Device,900.55,35,,900.55,percent of total billed charges,Implant Device,874.82,34,"Charges > $500, x 34%",874.82,percent of total billed charges,Implant Device,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,1029.2,40,,1029.2,percent of total billed charges,Implant Devices,900.55,70,,900.55,percent of total billed charges,Implant Devices,874.82,34,,874.82,percent of total billed charges,Implant Devices,874.82,34,,874.82,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,900.55,35,,900.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,874.82,34,"If Charge > 2,000, then 34 percent",874.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1029.2,
S&N 71306613-REV FEMORAL COMP,C1776,HCPCS,,79002265,CDM,278,RC,,,both,,,8988,3547.28,39.4668,,3547.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3055.92,34,,3055.92,percent of total billed charges,Implant Device,3055.92,34,,3055.92,percent of total billed charges,Implant Device,3055.92,34,,3055.92,percent of total billed charges,Implant Device,3055.92,34,,3055.92,percent of total billed charges,Implant Device,3055.92,34,,3055.92,percent of total billed charges,Implant Device,3055.92,34,,3055.92,percent of total billed charges,Implant Device,3145.8,35,,3145.8,percent of total billed charges,Implant Device,3055.92,34,"Charges > $500, x 34%",3055.92,percent of total billed charges,Implant Device,3145.8,35,,3145.8,percent of total billed charges,Implant Devices,3145.8,35,,3145.8,percent of total billed charges,Implant Devices,3145.8,35,,,percent of total billed charges,Implant Devices,3145.8,35,,3145.8,percent of total billed charges,Implant Devices,3145.8,35,,3145.8,percent of total billed charges,Implant Devices,3595.2,40,,3595.2,percent of total billed charges,Implant Devices,3145.8,70,,3145.8,percent of total billed charges,Implant Devices,3055.92,34,,3055.92,percent of total billed charges,Implant Devices,3055.92,34,,3055.92,percent of total billed charges,Implant Devices,3145.8,35,,3145.8,percent of total billed charges,Implant Devices,3145.8,35,,3145.8,percent of total billed charges,Implant Devices,3145.8,35,,3145.8,percent of total billed charges,Implant Devices,3145.8,35,,3145.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3055.92,34,"If Charge > 2,000, then 34 percent",3055.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3595.2,
S&N 7133345-REV ADCET LINER,C1776,HCPCS,,79002266,CDM,278,RC,,,both,,,3852,1520.26,39.4668,,1520.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1309.68,34,,1309.68,percent of total billed charges,Implant Device,1309.68,34,,1309.68,percent of total billed charges,Implant Device,1309.68,34,,1309.68,percent of total billed charges,Implant Device,1309.68,34,,1309.68,percent of total billed charges,Implant Device,1309.68,34,,1309.68,percent of total billed charges,Implant Device,1309.68,34,,1309.68,percent of total billed charges,Implant Device,1348.2,35,,1348.2,percent of total billed charges,Implant Device,1309.68,34,"Charges > $500, x 34%",1309.68,percent of total billed charges,Implant Device,1348.2,35,,1348.2,percent of total billed charges,Implant Devices,1348.2,35,,1348.2,percent of total billed charges,Implant Devices,1348.2,35,,,percent of total billed charges,Implant Devices,1348.2,35,,1348.2,percent of total billed charges,Implant Devices,1348.2,35,,1348.2,percent of total billed charges,Implant Devices,1540.8,40,,1540.8,percent of total billed charges,Implant Devices,1348.2,70,,1348.2,percent of total billed charges,Implant Devices,1309.68,34,,1309.68,percent of total billed charges,Implant Devices,1309.68,34,,1309.68,percent of total billed charges,Implant Devices,1348.2,35,,1348.2,percent of total billed charges,Implant Devices,1348.2,35,,1348.2,percent of total billed charges,Implant Devices,1348.2,35,,1348.2,percent of total billed charges,Implant Devices,1348.2,35,,1348.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1309.68,34,"If Charge > 2,000, then 34 percent",1309.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1540.8,
S&N 71420504-REV ART INSERT,C1776,HCPCS,,79002267,CDM,278,RC,,,both,,,2962,1169.01,39.4668,,1169.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1007.08,34,,1007.08,percent of total billed charges,Implant Device,1007.08,34,,1007.08,percent of total billed charges,Implant Device,1007.08,34,,1007.08,percent of total billed charges,Implant Device,1007.08,34,,1007.08,percent of total billed charges,Implant Device,1007.08,34,,1007.08,percent of total billed charges,Implant Device,1007.08,34,,1007.08,percent of total billed charges,Implant Device,1036.7,35,,1036.7,percent of total billed charges,Implant Device,1007.08,34,"Charges > $500, x 34%",1007.08,percent of total billed charges,Implant Device,1036.7,35,,1036.7,percent of total billed charges,Implant Devices,1036.7,35,,1036.7,percent of total billed charges,Implant Devices,1036.7,35,,,percent of total billed charges,Implant Devices,1036.7,35,,1036.7,percent of total billed charges,Implant Devices,1036.7,35,,1036.7,percent of total billed charges,Implant Devices,1184.8,40,,1184.8,percent of total billed charges,Implant Devices,1036.7,70,,1036.7,percent of total billed charges,Implant Devices,1007.08,34,,1007.08,percent of total billed charges,Implant Devices,1007.08,34,,1007.08,percent of total billed charges,Implant Devices,1036.7,35,,1036.7,percent of total billed charges,Implant Devices,1036.7,35,,1036.7,percent of total billed charges,Implant Devices,1036.7,35,,1036.7,percent of total billed charges,Implant Devices,1036.7,35,,1036.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1007.08,34,"If Charge > 2,000, then 34 percent",1007.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1184.8,
S&N 71420551-REV ART INSERT,C1776,HCPCS,,79002268,CDM,278,RC,,,both,,,8700,3433.61,39.4668,,3433.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2958,34,,2958,percent of total billed charges,Implant Device,2958,34,,2958,percent of total billed charges,Implant Device,2958,34,,2958,percent of total billed charges,Implant Device,2958,34,,2958,percent of total billed charges,Implant Device,2958,34,,2958,percent of total billed charges,Implant Device,2958,34,,2958,percent of total billed charges,Implant Device,3045,35,,3045,percent of total billed charges,Implant Device,2958,34,"Charges > $500, x 34%",2958,percent of total billed charges,Implant Device,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3480,40,,3480,percent of total billed charges,Implant Devices,3045,70,,3045,percent of total billed charges,Implant Devices,2958,34,,2958,percent of total billed charges,Implant Devices,2958,34,,2958,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2958,34,"If Charge > 2,000, then 34 percent",2958,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3480,
S&N 71420554-REV ART INSERT,C1776,HCPCS,,79002269,CDM,278,RC,,,both,,,8700,3433.61,39.4668,,3433.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2958,34,,2958,percent of total billed charges,Implant Device,2958,34,,2958,percent of total billed charges,Implant Device,2958,34,,2958,percent of total billed charges,Implant Device,2958,34,,2958,percent of total billed charges,Implant Device,2958,34,,2958,percent of total billed charges,Implant Device,2958,34,,2958,percent of total billed charges,Implant Device,3045,35,,3045,percent of total billed charges,Implant Device,2958,34,"Charges > $500, x 34%",2958,percent of total billed charges,Implant Device,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3480,40,,3480,percent of total billed charges,Implant Devices,3045,70,,3045,percent of total billed charges,Implant Devices,2958,34,,2958,percent of total billed charges,Implant Devices,2958,34,,2958,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,3045,35,,3045,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2958,34,"If Charge > 2,000, then 34 percent",2958,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3480,
S&N 71420574-REV PATELLA COMP,C1776,HCPCS,,79002270,CDM,278,RC,,,both,,,1815,716.32,39.4668,,716.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,617.1,34,,617.1,percent of total billed charges,Implant Device,617.1,34,,617.1,percent of total billed charges,Implant Device,617.1,34,,617.1,percent of total billed charges,Implant Device,617.1,34,,617.1,percent of total billed charges,Implant Device,617.1,34,,617.1,percent of total billed charges,Implant Device,617.1,34,,617.1,percent of total billed charges,Implant Device,635.25,35,,635.25,percent of total billed charges,Implant Device,617.1,34,"Charges > $500, x 34%",617.1,percent of total billed charges,Implant Device,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,726,40,,726,percent of total billed charges,Implant Devices,635.25,70,,635.25,percent of total billed charges,Implant Devices,617.1,34,,617.1,percent of total billed charges,Implant Devices,617.1,34,,617.1,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,726,
S&N 71420576-REV PATELLA COMP,C1776,HCPCS,,79002271,CDM,278,RC,,,both,,,1816,716.72,39.4668,,716.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,617.44,34,,617.44,percent of total billed charges,Implant Device,617.44,34,,617.44,percent of total billed charges,Implant Device,617.44,34,,617.44,percent of total billed charges,Implant Device,617.44,34,,617.44,percent of total billed charges,Implant Device,617.44,34,,617.44,percent of total billed charges,Implant Device,617.44,34,,617.44,percent of total billed charges,Implant Device,635.6,35,,635.6,percent of total billed charges,Implant Device,617.44,34,"Charges > $500, x 34%",617.44,percent of total billed charges,Implant Device,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,726.4,40,,726.4,percent of total billed charges,Implant Devices,635.6,70,,635.6,percent of total billed charges,Implant Devices,617.44,34,,617.44,percent of total billed charges,Implant Devices,617.44,34,,617.44,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,726.4,
S&N 71420580-REV PATELLA COMP,C1776,HCPCS,,79002272,CDM,278,RC,,,both,,,1816,716.72,39.4668,,716.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,617.44,34,,617.44,percent of total billed charges,Implant Device,617.44,34,,617.44,percent of total billed charges,Implant Device,617.44,34,,617.44,percent of total billed charges,Implant Device,617.44,34,,617.44,percent of total billed charges,Implant Device,617.44,34,,617.44,percent of total billed charges,Implant Device,617.44,34,,617.44,percent of total billed charges,Implant Device,635.6,35,,635.6,percent of total billed charges,Implant Device,617.44,34,"Charges > $500, x 34%",617.44,percent of total billed charges,Implant Device,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,726.4,40,,726.4,percent of total billed charges,Implant Devices,635.6,70,,635.6,percent of total billed charges,Implant Devices,617.44,34,,617.44,percent of total billed charges,Implant Devices,617.44,34,,617.44,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,635.6,35,,635.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,726.4,
S&N 71420792-REV ART INSERT,C1776,HCPCS,,79002273,CDM,278,RC,,,both,,,3457,1364.37,39.4668,,1364.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.38,34,,1175.38,percent of total billed charges,Implant Device,1175.38,34,,1175.38,percent of total billed charges,Implant Device,1175.38,34,,1175.38,percent of total billed charges,Implant Device,1175.38,34,,1175.38,percent of total billed charges,Implant Device,1175.38,34,,1175.38,percent of total billed charges,Implant Device,1175.38,34,,1175.38,percent of total billed charges,Implant Device,1209.95,35,,1209.95,percent of total billed charges,Implant Device,1175.38,34,"Charges > $500, x 34%",1175.38,percent of total billed charges,Implant Device,1209.95,35,,1209.95,percent of total billed charges,Implant Devices,1209.95,35,,1209.95,percent of total billed charges,Implant Devices,1209.95,35,,,percent of total billed charges,Implant Devices,1209.95,35,,1209.95,percent of total billed charges,Implant Devices,1209.95,35,,1209.95,percent of total billed charges,Implant Devices,1382.8,40,,1382.8,percent of total billed charges,Implant Devices,1209.95,70,,1209.95,percent of total billed charges,Implant Devices,1175.38,34,,1175.38,percent of total billed charges,Implant Devices,1175.38,34,,1175.38,percent of total billed charges,Implant Devices,1209.95,35,,1209.95,percent of total billed charges,Implant Devices,1209.95,35,,1209.95,percent of total billed charges,Implant Devices,1209.95,35,,1209.95,percent of total billed charges,Implant Devices,1209.95,35,,1209.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.38,34,"If Charge > 2,000, then 34 percent",1175.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.8,
S&N 71421168-REV FEMORAL COMP,C1776,HCPCS,,79002274,CDM,278,RC,,,both,,,27360,10798.12,39.4668,,10798.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,9302.4,34,,9302.4,percent of total billed charges,Implant Device,9302.4,34,,9302.4,percent of total billed charges,Implant Device,9302.4,34,,9302.4,percent of total billed charges,Implant Device,9302.4,34,,9302.4,percent of total billed charges,Implant Device,9302.4,34,,9302.4,percent of total billed charges,Implant Device,9302.4,34,,9302.4,percent of total billed charges,Implant Device,9576,35,,9576,percent of total billed charges,Implant Device,9302.4,34,"Charges > $500, x 34%",9302.4,percent of total billed charges,Implant Device,9576,35,,9576,percent of total billed charges,Implant Devices,9576,35,,9576,percent of total billed charges,Implant Devices,9576,35,,,percent of total billed charges,Implant Devices,9576,35,,9576,percent of total billed charges,Implant Devices,9576,35,,9576,percent of total billed charges,Implant Devices,10944,40,,10944,percent of total billed charges,Implant Devices,9576,70,,9576,percent of total billed charges,Implant Devices,9302.4,34,,9302.4,percent of total billed charges,Implant Devices,9302.4,34,,9302.4,percent of total billed charges,Implant Devices,9576,35,,9576,percent of total billed charges,Implant Devices,9576,35,,9576,percent of total billed charges,Implant Devices,9576,35,,9576,percent of total billed charges,Implant Devices,9576,35,,9576,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,9302.4,34,"If Charge > 2,000, then 34 percent",9302.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10944,
S&N 71421324-REV STEM,C1776,HCPCS,,79002275,CDM,278,RC,,,both,,,5746,2267.76,39.4668,,2267.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1953.64,34,,1953.64,percent of total billed charges,Implant Device,1953.64,34,,1953.64,percent of total billed charges,Implant Device,1953.64,34,,1953.64,percent of total billed charges,Implant Device,1953.64,34,,1953.64,percent of total billed charges,Implant Device,1953.64,34,,1953.64,percent of total billed charges,Implant Device,1953.64,34,,1953.64,percent of total billed charges,Implant Device,2011.1,35,,2011.1,percent of total billed charges,Implant Device,1953.64,34,"Charges > $500, x 34%",1953.64,percent of total billed charges,Implant Device,2011.1,35,,2011.1,percent of total billed charges,Implant Devices,2011.1,35,,2011.1,percent of total billed charges,Implant Devices,2011.1,35,,,percent of total billed charges,Implant Devices,2011.1,35,,2011.1,percent of total billed charges,Implant Devices,2011.1,35,,2011.1,percent of total billed charges,Implant Devices,2298.4,40,,2298.4,percent of total billed charges,Implant Devices,2011.1,70,,2011.1,percent of total billed charges,Implant Devices,1953.64,34,,1953.64,percent of total billed charges,Implant Devices,1953.64,34,,1953.64,percent of total billed charges,Implant Devices,2011.1,35,,2011.1,percent of total billed charges,Implant Devices,2011.1,35,,2011.1,percent of total billed charges,Implant Devices,2011.1,35,,2011.1,percent of total billed charges,Implant Devices,2011.1,35,,2011.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1953.64,34,"If Charge > 2,000, then 34 percent",1953.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2298.4,
S&N 71421674-REV FEM WEDGE,C1776,HCPCS,,79002276,CDM,278,RC,,,both,,,5130,2024.65,39.4668,,2024.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1795.5,35,,1795.5,percent of total billed charges,Implant Device,1744.2,34,"Charges > $500, x 34%",1744.2,percent of total billed charges,Implant Device,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,2052,40,,2052,percent of total billed charges,Implant Devices,1795.5,70,,1795.5,percent of total billed charges,Implant Devices,1744.2,34,,1744.2,percent of total billed charges,Implant Devices,1744.2,34,,1744.2,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1744.2,34,"If Charge > 2,000, then 34 percent",1744.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2052,
S&N 71421771-REV FEM WEDGE,C1776,HCPCS,,79002277,CDM,278,RC,,,both,,,11520,4546.58,39.4668,,4546.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3916.8,34,,3916.8,percent of total billed charges,Implant Device,3916.8,34,,3916.8,percent of total billed charges,Implant Device,3916.8,34,,3916.8,percent of total billed charges,Implant Device,3916.8,34,,3916.8,percent of total billed charges,Implant Device,3916.8,34,,3916.8,percent of total billed charges,Implant Device,3916.8,34,,3916.8,percent of total billed charges,Implant Device,4032,35,,4032,percent of total billed charges,Implant Device,3916.8,34,"Charges > $500, x 34%",3916.8,percent of total billed charges,Implant Device,4032,35,,4032,percent of total billed charges,Implant Devices,4032,35,,4032,percent of total billed charges,Implant Devices,4032,35,,,percent of total billed charges,Implant Devices,4032,35,,4032,percent of total billed charges,Implant Devices,4032,35,,4032,percent of total billed charges,Implant Devices,4608,40,,4608,percent of total billed charges,Implant Devices,4032,70,,4032,percent of total billed charges,Implant Devices,3916.8,34,,3916.8,percent of total billed charges,Implant Devices,3916.8,34,,3916.8,percent of total billed charges,Implant Devices,4032,35,,4032,percent of total billed charges,Implant Devices,4032,35,,4032,percent of total billed charges,Implant Devices,4032,35,,4032,percent of total billed charges,Implant Devices,4032,35,,4032,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3916.8,34,"If Charge > 2,000, then 34 percent",3916.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4608,
S&N 71424007-REV BASEPLATE,C1776,HCPCS,,79002278,CDM,278,RC,,,both,,,11970,4724.18,39.4668,,4724.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4189.5,35,,4189.5,percent of total billed charges,Implant Device,4069.8,34,"Charges > $500, x 34%",4069.8,percent of total billed charges,Implant Device,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4788,40,,4788,percent of total billed charges,Implant Devices,4189.5,70,,4189.5,percent of total billed charges,Implant Devices,4069.8,34,,4069.8,percent of total billed charges,Implant Devices,4069.8,34,,4069.8,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4069.8,34,"If Charge > 2,000, then 34 percent",4069.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4788,
S&N 71424015-REV BASEPLATE,C1776,HCPCS,,79002279,CDM,278,RC,,,both,,,11970,4724.18,39.4668,,4724.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4189.5,35,,4189.5,percent of total billed charges,Implant Device,4069.8,34,"Charges > $500, x 34%",4069.8,percent of total billed charges,Implant Device,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4788,40,,4788,percent of total billed charges,Implant Devices,4189.5,70,,4189.5,percent of total billed charges,Implant Devices,4069.8,34,,4069.8,percent of total billed charges,Implant Devices,4069.8,34,,4069.8,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4069.8,34,"If Charge > 2,000, then 34 percent",4069.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4788,
S&N 71424027-REV STEM,C1776,HCPCS,,79002280,CDM,278,RC,,,both,,,5520,2178.57,39.4668,,2178.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1876.8,34,,1876.8,percent of total billed charges,Implant Device,1876.8,34,,1876.8,percent of total billed charges,Implant Device,1876.8,34,,1876.8,percent of total billed charges,Implant Device,1876.8,34,,1876.8,percent of total billed charges,Implant Device,1876.8,34,,1876.8,percent of total billed charges,Implant Device,1876.8,34,,1876.8,percent of total billed charges,Implant Device,1932,35,,1932,percent of total billed charges,Implant Device,1876.8,34,"Charges > $500, x 34%",1876.8,percent of total billed charges,Implant Device,1932,35,,1932,percent of total billed charges,Implant Devices,1932,35,,1932,percent of total billed charges,Implant Devices,1932,35,,,percent of total billed charges,Implant Devices,1932,35,,1932,percent of total billed charges,Implant Devices,1932,35,,1932,percent of total billed charges,Implant Devices,2208,40,,2208,percent of total billed charges,Implant Devices,1932,70,,1932,percent of total billed charges,Implant Devices,1876.8,34,,1876.8,percent of total billed charges,Implant Devices,1876.8,34,,1876.8,percent of total billed charges,Implant Devices,1932,35,,1932,percent of total billed charges,Implant Devices,1932,35,,1932,percent of total billed charges,Implant Devices,1932,35,,1932,percent of total billed charges,Implant Devices,1932,35,,1932,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1876.8,34,"If Charge > 2,000, then 34 percent",1876.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2208,
S&N 71424051-REV STEM,C1776,HCPCS,,79002281,CDM,278,RC,,,both,,,4734,1868.36,39.4668,,1868.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1609.56,34,,1609.56,percent of total billed charges,Implant Device,1609.56,34,,1609.56,percent of total billed charges,Implant Device,1609.56,34,,1609.56,percent of total billed charges,Implant Device,1609.56,34,,1609.56,percent of total billed charges,Implant Device,1609.56,34,,1609.56,percent of total billed charges,Implant Device,1609.56,34,,1609.56,percent of total billed charges,Implant Device,1656.9,35,,1656.9,percent of total billed charges,Implant Device,1609.56,34,"Charges > $500, x 34%",1609.56,percent of total billed charges,Implant Device,1656.9,35,,1656.9,percent of total billed charges,Implant Devices,1656.9,35,,1656.9,percent of total billed charges,Implant Devices,1656.9,35,,,percent of total billed charges,Implant Devices,1656.9,35,,1656.9,percent of total billed charges,Implant Devices,1656.9,35,,1656.9,percent of total billed charges,Implant Devices,1893.6,40,,1893.6,percent of total billed charges,Implant Devices,1656.9,70,,1656.9,percent of total billed charges,Implant Devices,1609.56,34,,1609.56,percent of total billed charges,Implant Devices,1609.56,34,,1609.56,percent of total billed charges,Implant Devices,1656.9,35,,1656.9,percent of total billed charges,Implant Devices,1656.9,35,,1656.9,percent of total billed charges,Implant Devices,1656.9,35,,1656.9,percent of total billed charges,Implant Devices,1656.9,35,,1656.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1609.56,34,"If Charge > 2,000, then 34 percent",1609.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1893.6,
S&N 71424206-REV STEM,C1776,HCPCS,,79002282,CDM,278,RC,,,both,,,5760,2273.29,39.4668,,2273.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,2016,35,,2016,percent of total billed charges,Implant Device,1958.4,34,"Charges > $500, x 34%",1958.4,percent of total billed charges,Implant Device,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2304,40,,2304,percent of total billed charges,Implant Devices,2016,70,,2016,percent of total billed charges,Implant Devices,1958.4,34,,1958.4,percent of total billed charges,Implant Devices,1958.4,34,,1958.4,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1958.4,34,"If Charge > 2,000, then 34 percent",1958.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2304,
S&N 71424210-REV STEM,C1776,HCPCS,,79002283,CDM,278,RC,,,both,,,5760,2273.29,39.4668,,2273.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,2016,35,,2016,percent of total billed charges,Implant Device,1958.4,34,"Charges > $500, x 34%",1958.4,percent of total billed charges,Implant Device,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2304,40,,2304,percent of total billed charges,Implant Devices,2016,70,,2016,percent of total billed charges,Implant Devices,1958.4,34,,1958.4,percent of total billed charges,Implant Devices,1958.4,34,,1958.4,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1958.4,34,"If Charge > 2,000, then 34 percent",1958.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2304,
S&N 74022217-REV BASEPLATE,C1776,HCPCS,,79002284,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
S&N 74023274-REV ART INSERT,C1776,HCPCS,,79002285,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
S&N 74023285-REV ART INSERT,C1776,HCPCS,,79002286,CDM,278,RC,,,both,,,7200,2841.61,39.4668,,2841.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2520,35,,2520,percent of total billed charges,Implant Device,2448,34,"Charges > $500, x 34%",2448,percent of total billed charges,Implant Device,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2880,40,,2880,percent of total billed charges,Implant Devices,2520,70,,2520,percent of total billed charges,Implant Devices,2448,34,,2448,percent of total billed charges,Implant Devices,2448,34,,2448,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2448,34,"If Charge > 2,000, then 34 percent",2448,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2880,
ZIMMER 7818-46-REV FEMORAL HEAD,C1776,HCPCS,,79002287,CDM,278,RC,,,both,,,1759,694.22,39.4668,,694.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,598.06,34,,598.06,percent of total billed charges,Implant Device,598.06,34,,598.06,percent of total billed charges,Implant Device,598.06,34,,598.06,percent of total billed charges,Implant Device,598.06,34,,598.06,percent of total billed charges,Implant Device,598.06,34,,598.06,percent of total billed charges,Implant Device,598.06,34,,598.06,percent of total billed charges,Implant Device,615.65,35,,615.65,percent of total billed charges,Implant Device,598.06,34,"Charges > $500, x 34%",598.06,percent of total billed charges,Implant Device,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,703.6,40,,703.6,percent of total billed charges,Implant Devices,615.65,70,,615.65,percent of total billed charges,Implant Devices,598.06,34,,598.06,percent of total billed charges,Implant Devices,598.06,34,,598.06,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,703.6,
ZIMMER 7818-47-REV FEMORAL HEAD,C1776,HCPCS,,79002288,CDM,278,RC,,,both,,,1620,639.36,39.4668,,639.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,550.8,34,,550.8,percent of total billed charges,Implant Device,550.8,34,,550.8,percent of total billed charges,Implant Device,550.8,34,,550.8,percent of total billed charges,Implant Device,550.8,34,,550.8,percent of total billed charges,Implant Device,550.8,34,,550.8,percent of total billed charges,Implant Device,550.8,34,,550.8,percent of total billed charges,Implant Device,567,35,,567,percent of total billed charges,Implant Device,550.8,34,"Charges > $500, x 34%",550.8,percent of total billed charges,Implant Device,567,35,,567,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,567,35,,,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,648,40,,648,percent of total billed charges,Implant Devices,567,70,,567,percent of total billed charges,Implant Devices,550.8,34,,550.8,percent of total billed charges,Implant Devices,550.8,34,,550.8,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,567,35,,567,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,648,
ZIMMER 7818-99-01 REV FEMORAL HEAD,C1776,HCPCS,,79002289,CDM,278,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,156.4,34,,156.4,percent of total billed charges,Implant Device,161,35,,161,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,184,40,,184,percent of total billed charges,Implant Devices,161,70,,161,percent of total billed charges,Implant Devices,156.4,34,,156.4,percent of total billed charges,Implant Devices,156.4,34,,156.4,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,161,35,,161,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,184,
ZIMMER 7818-99-02 REV FEM HEAD ADAPTOR,C1776,HCPCS,,79002290,CDM,278,RC,,,both,,,427,168.52,39.4668,,168.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,170.8,40,,170.8,percent of total billed charges,Implant Devices,149.45,70,,149.45,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.8,
ZIMMER 7843-14-06-REV FEMORAL STEM,C1776,HCPCS,,79002291,CDM,278,RC,,,both,,,17374,6856.96,39.4668,,6856.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5907.16,34,,5907.16,percent of total billed charges,Implant Device,5907.16,34,,5907.16,percent of total billed charges,Implant Device,5907.16,34,,5907.16,percent of total billed charges,Implant Device,5907.16,34,,5907.16,percent of total billed charges,Implant Device,5907.16,34,,5907.16,percent of total billed charges,Implant Device,5907.16,34,,5907.16,percent of total billed charges,Implant Device,6080.9,35,,6080.9,percent of total billed charges,Implant Device,5907.16,34,"Charges > $500, x 34%",5907.16,percent of total billed charges,Implant Device,6080.9,35,,6080.9,percent of total billed charges,Implant Devices,6080.9,35,,6080.9,percent of total billed charges,Implant Devices,6080.9,35,,,percent of total billed charges,Implant Devices,6080.9,35,,6080.9,percent of total billed charges,Implant Devices,6080.9,35,,6080.9,percent of total billed charges,Implant Devices,6949.6,40,,6949.6,percent of total billed charges,Implant Devices,6080.9,70,,6080.9,percent of total billed charges,Implant Devices,5907.16,34,,5907.16,percent of total billed charges,Implant Devices,5907.16,34,,5907.16,percent of total billed charges,Implant Devices,6080.9,35,,6080.9,percent of total billed charges,Implant Devices,6080.9,35,,6080.9,percent of total billed charges,Implant Devices,6080.9,35,,6080.9,percent of total billed charges,Implant Devices,6080.9,35,,6080.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5907.16,34,"If Charge > 2,000, then 34 percent",5907.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6949.6,
ZIMMER 7843-14-36-REV FEMORAL HEAD,C1776,HCPCS,,79002292,CDM,278,RC,,,both,,,18648,7359.77,39.4668,,7359.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6340.32,34,,6340.32,percent of total billed charges,Implant Device,6340.32,34,,6340.32,percent of total billed charges,Implant Device,6340.32,34,,6340.32,percent of total billed charges,Implant Device,6340.32,34,,6340.32,percent of total billed charges,Implant Device,6340.32,34,,6340.32,percent of total billed charges,Implant Device,6340.32,34,,6340.32,percent of total billed charges,Implant Device,6526.8,35,,6526.8,percent of total billed charges,Implant Device,6340.32,34,"Charges > $500, x 34%",6340.32,percent of total billed charges,Implant Device,6526.8,35,,6526.8,percent of total billed charges,Implant Devices,6526.8,35,,6526.8,percent of total billed charges,Implant Devices,6526.8,35,,,percent of total billed charges,Implant Devices,6526.8,35,,6526.8,percent of total billed charges,Implant Devices,6526.8,35,,6526.8,percent of total billed charges,Implant Devices,7459.2,40,,7459.2,percent of total billed charges,Implant Devices,6526.8,70,,6526.8,percent of total billed charges,Implant Devices,6340.32,34,,6340.32,percent of total billed charges,Implant Devices,6340.32,34,,6340.32,percent of total billed charges,Implant Devices,6526.8,35,,6526.8,percent of total billed charges,Implant Devices,6526.8,35,,6526.8,percent of total billed charges,Implant Devices,6526.8,35,,6526.8,percent of total billed charges,Implant Devices,6526.8,35,,6526.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6340.32,34,"If Charge > 2,000, then 34 percent",6340.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7459.2,
ZIMMER 7843-15-18-REV FEMORAL STEM,C1776,HCPCS,,79002293,CDM,278,RC,,,both,,,22968,9064.73,39.4668,,9064.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7809.12,34,,7809.12,percent of total billed charges,Implant Device,7809.12,34,,7809.12,percent of total billed charges,Implant Device,7809.12,34,,7809.12,percent of total billed charges,Implant Device,7809.12,34,,7809.12,percent of total billed charges,Implant Device,7809.12,34,,7809.12,percent of total billed charges,Implant Device,7809.12,34,,7809.12,percent of total billed charges,Implant Device,8038.8,35,,8038.8,percent of total billed charges,Implant Device,7809.12,34,"Charges > $500, x 34%",7809.12,percent of total billed charges,Implant Device,8038.8,35,,8038.8,percent of total billed charges,Implant Devices,8038.8,35,,8038.8,percent of total billed charges,Implant Devices,8038.8,35,,,percent of total billed charges,Implant Devices,8038.8,35,,8038.8,percent of total billed charges,Implant Devices,8038.8,35,,8038.8,percent of total billed charges,Implant Devices,9187.2,40,,9187.2,percent of total billed charges,Implant Devices,8038.8,70,,8038.8,percent of total billed charges,Implant Devices,7809.12,34,,7809.12,percent of total billed charges,Implant Devices,7809.12,34,,7809.12,percent of total billed charges,Implant Devices,8038.8,35,,8038.8,percent of total billed charges,Implant Devices,8038.8,35,,8038.8,percent of total billed charges,Implant Devices,8038.8,35,,8038.8,percent of total billed charges,Implant Devices,8038.8,35,,8038.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7809.12,34,"If Charge > 2,000, then 34 percent",7809.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9187.2,
ZIMMER 7850-12-REV FEMORAL STEM,C1776,HCPCS,,79002294,CDM,278,RC,,,both,,,11730,4629.46,39.4668,,4629.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3988.2,34,,3988.2,percent of total billed charges,Implant Device,3988.2,34,,3988.2,percent of total billed charges,Implant Device,3988.2,34,,3988.2,percent of total billed charges,Implant Device,3988.2,34,,3988.2,percent of total billed charges,Implant Device,3988.2,34,,3988.2,percent of total billed charges,Implant Device,3988.2,34,,3988.2,percent of total billed charges,Implant Device,4105.5,35,,4105.5,percent of total billed charges,Implant Device,3988.2,34,"Charges > $500, x 34%",3988.2,percent of total billed charges,Implant Device,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4692,40,,4692,percent of total billed charges,Implant Devices,4105.5,70,,4105.5,percent of total billed charges,Implant Devices,3988.2,34,,3988.2,percent of total billed charges,Implant Devices,3988.2,34,,3988.2,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3988.2,34,"If Charge > 2,000, then 34 percent",3988.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4692,
ZIMMER 7850-15-REV FEMORAL STEM,C1776,HCPCS,,79002295,CDM,278,RC,,,both,,,8532,3367.31,39.4668,,3367.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2900.88,34,,2900.88,percent of total billed charges,Implant Device,2900.88,34,,2900.88,percent of total billed charges,Implant Device,2900.88,34,,2900.88,percent of total billed charges,Implant Device,2900.88,34,,2900.88,percent of total billed charges,Implant Device,2900.88,34,,2900.88,percent of total billed charges,Implant Device,2900.88,34,,2900.88,percent of total billed charges,Implant Device,2986.2,35,,2986.2,percent of total billed charges,Implant Device,2900.88,34,"Charges > $500, x 34%",2900.88,percent of total billed charges,Implant Device,2986.2,35,,2986.2,percent of total billed charges,Implant Devices,2986.2,35,,2986.2,percent of total billed charges,Implant Devices,2986.2,35,,,percent of total billed charges,Implant Devices,2986.2,35,,2986.2,percent of total billed charges,Implant Devices,2986.2,35,,2986.2,percent of total billed charges,Implant Devices,3412.8,40,,3412.8,percent of total billed charges,Implant Devices,2986.2,70,,2986.2,percent of total billed charges,Implant Devices,2900.88,34,,2900.88,percent of total billed charges,Implant Devices,2900.88,34,,2900.88,percent of total billed charges,Implant Devices,2986.2,35,,2986.2,percent of total billed charges,Implant Devices,2986.2,35,,2986.2,percent of total billed charges,Implant Devices,2986.2,35,,2986.2,percent of total billed charges,Implant Devices,2986.2,35,,2986.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2900.88,34,"If Charge > 2,000, then 34 percent",2900.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3412.8,
ZIMMER 7859-12-REV DISTAL CENTRALIZER,C1776,HCPCS,,79002296,CDM,278,RC,,,both,,,383,151.16,39.4668,,151.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,134.05,35,,134.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,153.2,40,,153.2,percent of total billed charges,Implant Devices,134.05,70,,134.05,percent of total billed charges,Implant Devices,130.22,34,,130.22,percent of total billed charges,Implant Devices,130.22,34,,130.22,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,153.2,
ZIMMER 7859-14-REV DISTAL CENTRALIZER,C1776,HCPCS,,79002297,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
ZIMMER 7871-15-61-REV FEMORAL STEM,C1776,HCPCS,,79002298,CDM,278,RC,,,both,,,17550,6926.42,39.4668,,6926.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5967,34,,5967,percent of total billed charges,Implant Device,5967,34,,5967,percent of total billed charges,Implant Device,5967,34,,5967,percent of total billed charges,Implant Device,5967,34,,5967,percent of total billed charges,Implant Device,5967,34,,5967,percent of total billed charges,Implant Device,5967,34,,5967,percent of total billed charges,Implant Device,6142.5,35,,6142.5,percent of total billed charges,Implant Device,5967,34,"Charges > $500, x 34%",5967,percent of total billed charges,Implant Device,6142.5,35,,6142.5,percent of total billed charges,Implant Devices,6142.5,35,,6142.5,percent of total billed charges,Implant Devices,6142.5,35,,,percent of total billed charges,Implant Devices,6142.5,35,,6142.5,percent of total billed charges,Implant Devices,6142.5,35,,6142.5,percent of total billed charges,Implant Devices,7020,40,,7020,percent of total billed charges,Implant Devices,6142.5,70,,6142.5,percent of total billed charges,Implant Devices,5967,34,,5967,percent of total billed charges,Implant Devices,5967,34,,5967,percent of total billed charges,Implant Devices,6142.5,35,,6142.5,percent of total billed charges,Implant Devices,6142.5,35,,6142.5,percent of total billed charges,Implant Devices,6142.5,35,,6142.5,percent of total billed charges,Implant Devices,6142.5,35,,6142.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5967,34,"If Charge > 2,000, then 34 percent",5967,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7020,
ZIMMER 8018-32-02-REV FEMORAL HEAD,C1776,HCPCS,,79002300,CDM,278,RC,,,both,,,2034,802.75,39.4668,,802.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,691.56,34,,691.56,percent of total billed charges,Implant Device,691.56,34,,691.56,percent of total billed charges,Implant Device,691.56,34,,691.56,percent of total billed charges,Implant Device,691.56,34,,691.56,percent of total billed charges,Implant Device,691.56,34,,691.56,percent of total billed charges,Implant Device,691.56,34,,691.56,percent of total billed charges,Implant Device,711.9,35,,711.9,percent of total billed charges,Implant Device,691.56,34,"Charges > $500, x 34%",691.56,percent of total billed charges,Implant Device,711.9,35,,711.9,percent of total billed charges,Implant Devices,711.9,35,,711.9,percent of total billed charges,Implant Devices,711.9,35,,,percent of total billed charges,Implant Devices,711.9,35,,711.9,percent of total billed charges,Implant Devices,711.9,35,,711.9,percent of total billed charges,Implant Devices,813.6,40,,813.6,percent of total billed charges,Implant Devices,711.9,70,,711.9,percent of total billed charges,Implant Devices,691.56,34,,691.56,percent of total billed charges,Implant Devices,691.56,34,,691.56,percent of total billed charges,Implant Devices,711.9,35,,711.9,percent of total billed charges,Implant Devices,711.9,35,,711.9,percent of total billed charges,Implant Devices,711.9,35,,711.9,percent of total billed charges,Implant Devices,711.9,35,,711.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,691.56,34,"If Charge > 2,000, then 34 percent",691.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,813.6,
ZIMMER 8018-32-03-REV FEMORAL HEAD,C1776,HCPCS,,79002301,CDM,278,RC,,,both,,,2729,1077.05,39.4668,,1077.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,927.86,34,,927.86,percent of total billed charges,Implant Device,927.86,34,,927.86,percent of total billed charges,Implant Device,927.86,34,,927.86,percent of total billed charges,Implant Device,927.86,34,,927.86,percent of total billed charges,Implant Device,927.86,34,,927.86,percent of total billed charges,Implant Device,927.86,34,,927.86,percent of total billed charges,Implant Device,955.15,35,,955.15,percent of total billed charges,Implant Device,927.86,34,"Charges > $500, x 34%",927.86,percent of total billed charges,Implant Device,955.15,35,,955.15,percent of total billed charges,Implant Devices,955.15,35,,955.15,percent of total billed charges,Implant Devices,955.15,35,,,percent of total billed charges,Implant Devices,955.15,35,,955.15,percent of total billed charges,Implant Devices,955.15,35,,955.15,percent of total billed charges,Implant Devices,1091.6,40,,1091.6,percent of total billed charges,Implant Devices,955.15,70,,955.15,percent of total billed charges,Implant Devices,927.86,34,,927.86,percent of total billed charges,Implant Devices,927.86,34,,927.86,percent of total billed charges,Implant Devices,955.15,35,,955.15,percent of total billed charges,Implant Devices,955.15,35,,955.15,percent of total billed charges,Implant Devices,955.15,35,,955.15,percent of total billed charges,Implant Devices,955.15,35,,955.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,927.86,34,"If Charge > 2,000, then 34 percent",927.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1091.6,
ZIMMER 8018-36-01-REV FEMORAL HEAD,C1776,HCPCS,,79002302,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
ZIMMER 8018-36-02-REV FEMORAL HEAD,C1776,HCPCS,,79002303,CDM,278,RC,,,both,,,3391,1338.32,39.4668,,1338.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1186.85,35,,1186.85,percent of total billed charges,Implant Device,1152.94,34,"Charges > $500, x 34%",1152.94,percent of total billed charges,Implant Device,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1356.4,40,,1356.4,percent of total billed charges,Implant Devices,1186.85,70,,1186.85,percent of total billed charges,Implant Devices,1152.94,34,,1152.94,percent of total billed charges,Implant Devices,1152.94,34,,1152.94,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1152.94,34,"If Charge > 2,000, then 34 percent",1152.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1356.4,
ZIMMER 8018-36-04-REV FEMORAL HEAD,C1776,HCPCS,,79002304,CDM,278,RC,,,both,,,3391,1338.32,39.4668,,1338.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1186.85,35,,1186.85,percent of total billed charges,Implant Device,1152.94,34,"Charges > $500, x 34%",1152.94,percent of total billed charges,Implant Device,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1356.4,40,,1356.4,percent of total billed charges,Implant Devices,1186.85,70,,1186.85,percent of total billed charges,Implant Devices,1152.94,34,,1152.94,percent of total billed charges,Implant Devices,1152.94,34,,1152.94,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1152.94,34,"If Charge > 2,000, then 34 percent",1152.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1356.4,
ARTHROSURFACE 8156-0032-W TAPER POST,C1776,HCPCS,,79002307,CDM,278,RC,,,both,,,2478,977.99,39.4668,,977.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,842.52,34,,842.52,percent of total billed charges,Implant Device,842.52,34,,842.52,percent of total billed charges,Implant Device,842.52,34,,842.52,percent of total billed charges,Implant Device,842.52,34,,842.52,percent of total billed charges,Implant Device,842.52,34,,842.52,percent of total billed charges,Implant Device,842.52,34,,842.52,percent of total billed charges,Implant Device,867.3,35,,867.3,percent of total billed charges,Implant Device,842.52,34,"Charges > $500, x 34%",842.52,percent of total billed charges,Implant Device,867.3,35,,867.3,percent of total billed charges,Implant Devices,867.3,35,,867.3,percent of total billed charges,Implant Devices,867.3,35,,,percent of total billed charges,Implant Devices,867.3,35,,867.3,percent of total billed charges,Implant Devices,867.3,35,,867.3,percent of total billed charges,Implant Devices,991.2,40,,991.2,percent of total billed charges,Implant Devices,867.3,70,,867.3,percent of total billed charges,Implant Devices,842.52,34,,842.52,percent of total billed charges,Implant Devices,842.52,34,,842.52,percent of total billed charges,Implant Devices,867.3,35,,867.3,percent of total billed charges,Implant Devices,867.3,35,,867.3,percent of total billed charges,Implant Devices,867.3,35,,867.3,percent of total billed charges,Implant Devices,867.3,35,,867.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,842.52,34,"If Charge > 2,000, then 34 percent",842.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,991.2,
DEPUY 86-7410-REV STEM,C1776,HCPCS,,79002321,CDM,278,RC,,,both,,,6144,2424.84,39.4668,,2424.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2150.4,35,,2150.4,percent of total billed charges,Implant Device,2088.96,34,"Charges > $500, x 34%",2088.96,percent of total billed charges,Implant Device,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2457.6,40,,2457.6,percent of total billed charges,Implant Devices,2150.4,70,,2150.4,percent of total billed charges,Implant Devices,2088.96,34,,2088.96,percent of total billed charges,Implant Devices,2088.96,34,,2088.96,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2088.96,34,"If Charge > 2,000, then 34 percent",2088.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2457.6,
DEPUY 86-7414-REV STEM,C1776,HCPCS,,79002322,CDM,278,RC,,,both,,,4886,1928.35,39.4668,,1928.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1710.1,35,,1710.1,percent of total billed charges,Implant Device,1661.24,34,"Charges > $500, x 34%",1661.24,percent of total billed charges,Implant Device,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1954.4,40,,1954.4,percent of total billed charges,Implant Devices,1710.1,70,,1710.1,percent of total billed charges,Implant Devices,1661.24,34,,1661.24,percent of total billed charges,Implant Devices,1661.24,34,,1661.24,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1661.24,34,"If Charge > 2,000, then 34 percent",1661.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1954.4,
DEPUY 86-7416-REV STEM,C1776,HCPCS,,79002323,CDM,278,RC,,,both,,,4886,1928.35,39.4668,,1928.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1710.1,35,,1710.1,percent of total billed charges,Implant Device,1661.24,34,"Charges > $500, x 34%",1661.24,percent of total billed charges,Implant Device,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1954.4,40,,1954.4,percent of total billed charges,Implant Devices,1710.1,70,,1710.1,percent of total billed charges,Implant Devices,1661.24,34,,1661.24,percent of total billed charges,Implant Devices,1661.24,34,,1661.24,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1661.24,34,"If Charge > 2,000, then 34 percent",1661.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1954.4,
DEPUY 86-7418-REV STEM,C1776,HCPCS,,79002324,CDM,278,RC,,,both,,,5042,1989.92,39.4668,,1989.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1714.28,34,,1714.28,percent of total billed charges,Implant Device,1714.28,34,,1714.28,percent of total billed charges,Implant Device,1714.28,34,,1714.28,percent of total billed charges,Implant Device,1714.28,34,,1714.28,percent of total billed charges,Implant Device,1714.28,34,,1714.28,percent of total billed charges,Implant Device,1714.28,34,,1714.28,percent of total billed charges,Implant Device,1764.7,35,,1764.7,percent of total billed charges,Implant Device,1714.28,34,"Charges > $500, x 34%",1714.28,percent of total billed charges,Implant Device,1764.7,35,,1764.7,percent of total billed charges,Implant Devices,1764.7,35,,1764.7,percent of total billed charges,Implant Devices,1764.7,35,,,percent of total billed charges,Implant Devices,1764.7,35,,1764.7,percent of total billed charges,Implant Devices,1764.7,35,,1764.7,percent of total billed charges,Implant Devices,2016.8,40,,2016.8,percent of total billed charges,Implant Devices,1764.7,70,,1764.7,percent of total billed charges,Implant Devices,1714.28,34,,1714.28,percent of total billed charges,Implant Devices,1714.28,34,,1714.28,percent of total billed charges,Implant Devices,1764.7,35,,1764.7,percent of total billed charges,Implant Devices,1764.7,35,,1764.7,percent of total billed charges,Implant Devices,1764.7,35,,1764.7,percent of total billed charges,Implant Devices,1764.7,35,,1764.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1714.28,34,"If Charge > 2,000, then 34 percent",1714.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2016.8,
DEPUY 86-7419-REV STEM,C1776,HCPCS,,79002325,CDM,278,RC,,,both,,,4886,1928.35,39.4668,,1928.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1710.1,35,,1710.1,percent of total billed charges,Implant Device,1661.24,34,"Charges > $500, x 34%",1661.24,percent of total billed charges,Implant Device,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1954.4,40,,1954.4,percent of total billed charges,Implant Devices,1710.1,70,,1710.1,percent of total billed charges,Implant Devices,1661.24,34,,1661.24,percent of total billed charges,Implant Devices,1661.24,34,,1661.24,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1661.24,34,"If Charge > 2,000, then 34 percent",1661.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1954.4,
DEPUY 86-7428-REV STEM,C1776,HCPCS,,79002326,CDM,278,RC,,,both,,,4886,1928.35,39.4668,,1928.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1661.24,34,,1661.24,percent of total billed charges,Implant Device,1710.1,35,,1710.1,percent of total billed charges,Implant Device,1661.24,34,"Charges > $500, x 34%",1661.24,percent of total billed charges,Implant Device,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1954.4,40,,1954.4,percent of total billed charges,Implant Devices,1710.1,70,,1710.1,percent of total billed charges,Implant Devices,1661.24,34,,1661.24,percent of total billed charges,Implant Devices,1661.24,34,,1661.24,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,1710.1,35,,1710.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1661.24,34,"If Charge > 2,000, then 34 percent",1661.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1954.4,
DEPUY 86-7430-REV STEM,C1776,HCPCS,,79002327,CDM,278,RC,,,both,,,6144,2424.84,39.4668,,2424.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2150.4,35,,2150.4,percent of total billed charges,Implant Device,2088.96,34,"Charges > $500, x 34%",2088.96,percent of total billed charges,Implant Device,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2457.6,40,,2457.6,percent of total billed charges,Implant Devices,2150.4,70,,2150.4,percent of total billed charges,Implant Devices,2088.96,34,,2088.96,percent of total billed charges,Implant Devices,2088.96,34,,2088.96,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2088.96,34,"If Charge > 2,000, then 34 percent",2088.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2457.6,
DEPUY 86-7432-REV STEM,C1776,HCPCS,,79002328,CDM,278,RC,,,both,,,5472,2159.62,39.4668,,2159.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1860.48,34,,1860.48,percent of total billed charges,Implant Device,1860.48,34,,1860.48,percent of total billed charges,Implant Device,1860.48,34,,1860.48,percent of total billed charges,Implant Device,1860.48,34,,1860.48,percent of total billed charges,Implant Device,1860.48,34,,1860.48,percent of total billed charges,Implant Device,1860.48,34,,1860.48,percent of total billed charges,Implant Device,1915.2,35,,1915.2,percent of total billed charges,Implant Device,1860.48,34,"Charges > $500, x 34%",1860.48,percent of total billed charges,Implant Device,1915.2,35,,1915.2,percent of total billed charges,Implant Devices,1915.2,35,,1915.2,percent of total billed charges,Implant Devices,1915.2,35,,,percent of total billed charges,Implant Devices,1915.2,35,,1915.2,percent of total billed charges,Implant Devices,1915.2,35,,1915.2,percent of total billed charges,Implant Devices,2188.8,40,,2188.8,percent of total billed charges,Implant Devices,1915.2,70,,1915.2,percent of total billed charges,Implant Devices,1860.48,34,,1860.48,percent of total billed charges,Implant Devices,1860.48,34,,1860.48,percent of total billed charges,Implant Devices,1915.2,35,,1915.2,percent of total billed charges,Implant Devices,1915.2,35,,1915.2,percent of total billed charges,Implant Devices,1915.2,35,,1915.2,percent of total billed charges,Implant Devices,1915.2,35,,1915.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1860.48,34,"If Charge > 2,000, then 34 percent",1860.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2188.8,
ARTHROSURFACE 8H02-5652-W ART COMPONENT,C1776,HCPCS,,79002329,CDM,278,RC,,,both,,,17436,6881.43,39.4668,,6881.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5928.24,34,,5928.24,percent of total billed charges,Implant Device,5928.24,34,,5928.24,percent of total billed charges,Implant Device,5928.24,34,,5928.24,percent of total billed charges,Implant Device,5928.24,34,,5928.24,percent of total billed charges,Implant Device,5928.24,34,,5928.24,percent of total billed charges,Implant Device,5928.24,34,,5928.24,percent of total billed charges,Implant Device,6102.6,35,,6102.6,percent of total billed charges,Implant Device,5928.24,34,"Charges > $500, x 34%",5928.24,percent of total billed charges,Implant Device,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6974.4,40,,6974.4,percent of total billed charges,Implant Devices,6102.6,70,,6102.6,percent of total billed charges,Implant Devices,5928.24,34,,5928.24,percent of total billed charges,Implant Devices,5928.24,34,,5928.24,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5928.24,34,"If Charge > 2,000, then 34 percent",5928.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6974.4,
ZIMMER 9026-29-358-REV FEMORAL HEAD,C1776,HCPCS,,79002330,CDM,278,RC,,,both,,,2497,985.49,39.4668,,985.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.98,34,,848.98,percent of total billed charges,Implant Device,848.98,34,,848.98,percent of total billed charges,Implant Device,848.98,34,,848.98,percent of total billed charges,Implant Device,848.98,34,,848.98,percent of total billed charges,Implant Device,848.98,34,,848.98,percent of total billed charges,Implant Device,848.98,34,,848.98,percent of total billed charges,Implant Device,873.95,35,,873.95,percent of total billed charges,Implant Device,848.98,34,"Charges > $500, x 34%",848.98,percent of total billed charges,Implant Device,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,998.8,40,,998.8,percent of total billed charges,Implant Devices,873.95,70,,873.95,percent of total billed charges,Implant Devices,848.98,34,,848.98,percent of total billed charges,Implant Devices,848.98,34,,848.98,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,873.95,35,,873.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.98,34,"If Charge > 2,000, then 34 percent",848.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.8,
ZIMMER 90-5952-40-17 REV ART SURFACE,C1776,HCPCS,,79002331,CDM,278,RC,,,both,,,5107,2015.57,39.4668,,2015.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1787.45,35,,1787.45,percent of total billed charges,Implant Device,1736.38,34,"Charges > $500, x 34%",1736.38,percent of total billed charges,Implant Device,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,2042.8,40,,2042.8,percent of total billed charges,Implant Devices,1787.45,70,,1787.45,percent of total billed charges,Implant Devices,1736.38,34,,1736.38,percent of total billed charges,Implant Devices,1736.38,34,,1736.38,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1736.38,34,"If Charge > 2,000, then 34 percent",1736.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2042.8,
DEPUY 96-0003-REV FEMORAL COMPONENT,C1776,HCPCS,,79002333,CDM,278,RC,,,both,,,7104,2803.72,39.4668,,2803.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2486.4,35,,2486.4,percent of total billed charges,Implant Device,2415.36,34,"Charges > $500, x 34%",2415.36,percent of total billed charges,Implant Device,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2841.6,40,,2841.6,percent of total billed charges,Implant Devices,2486.4,70,,2486.4,percent of total billed charges,Implant Devices,2415.36,34,,2415.36,percent of total billed charges,Implant Devices,2415.36,34,,2415.36,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2415.36,34,"If Charge > 2,000, then 34 percent",2415.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2841.6,
DEPUY 96-0082-REV FEMORAL COMPONENT,C1776,HCPCS,,79002334,CDM,278,RC,,,both,,,19650,7755.23,39.4668,,7755.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6681,34,,6681,percent of total billed charges,Implant Device,6681,34,,6681,percent of total billed charges,Implant Device,6681,34,,6681,percent of total billed charges,Implant Device,6681,34,,6681,percent of total billed charges,Implant Device,6681,34,,6681,percent of total billed charges,Implant Device,6681,34,,6681,percent of total billed charges,Implant Device,6877.5,35,,6877.5,percent of total billed charges,Implant Device,6681,34,"Charges > $500, x 34%",6681,percent of total billed charges,Implant Device,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,7860,40,,7860,percent of total billed charges,Implant Devices,6877.5,70,,6877.5,percent of total billed charges,Implant Devices,6681,34,,6681,percent of total billed charges,Implant Devices,6681,34,,6681,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6681,34,"If Charge > 2,000, then 34 percent",6681,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7860,
DEPUY 96-0084-REV FEMORAL COMPONENT,C1776,HCPCS,,79002335,CDM,278,RC,,,both,,,19650,7755.23,39.4668,,7755.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6681,34,,6681,percent of total billed charges,Implant Device,6681,34,,6681,percent of total billed charges,Implant Device,6681,34,,6681,percent of total billed charges,Implant Device,6681,34,,6681,percent of total billed charges,Implant Device,6681,34,,6681,percent of total billed charges,Implant Device,6681,34,,6681,percent of total billed charges,Implant Device,6877.5,35,,6877.5,percent of total billed charges,Implant Device,6681,34,"Charges > $500, x 34%",6681,percent of total billed charges,Implant Device,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,7860,40,,7860,percent of total billed charges,Implant Devices,6877.5,70,,6877.5,percent of total billed charges,Implant Devices,6681,34,,6681,percent of total billed charges,Implant Devices,6681,34,,6681,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,6877.5,35,,6877.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6681,34,"If Charge > 2,000, then 34 percent",6681,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7860,
DEPUY 96-0089-REV FEMORAL COMPONENT,C1776,HCPCS,,79002336,CDM,278,RC,,,both,,,21616,8531.14,39.4668,,8531.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7349.44,34,,7349.44,percent of total billed charges,Implant Device,7349.44,34,,7349.44,percent of total billed charges,Implant Device,7349.44,34,,7349.44,percent of total billed charges,Implant Device,7349.44,34,,7349.44,percent of total billed charges,Implant Device,7349.44,34,,7349.44,percent of total billed charges,Implant Device,7349.44,34,,7349.44,percent of total billed charges,Implant Device,7565.6,35,,7565.6,percent of total billed charges,Implant Device,7349.44,34,"Charges > $500, x 34%",7349.44,percent of total billed charges,Implant Device,7565.6,35,,7565.6,percent of total billed charges,Implant Devices,7565.6,35,,7565.6,percent of total billed charges,Implant Devices,7565.6,35,,,percent of total billed charges,Implant Devices,7565.6,35,,7565.6,percent of total billed charges,Implant Devices,7565.6,35,,7565.6,percent of total billed charges,Implant Devices,8646.4,40,,8646.4,percent of total billed charges,Implant Devices,7565.6,70,,7565.6,percent of total billed charges,Implant Devices,7349.44,34,,7349.44,percent of total billed charges,Implant Devices,7349.44,34,,7349.44,percent of total billed charges,Implant Devices,7565.6,35,,7565.6,percent of total billed charges,Implant Devices,7565.6,35,,7565.6,percent of total billed charges,Implant Devices,7565.6,35,,7565.6,percent of total billed charges,Implant Devices,7565.6,35,,7565.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7349.44,34,"If Charge > 2,000, then 34 percent",7349.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8646.4,
DEPUY 96-0090-REV FEMORAL COMPONENT,C1776,HCPCS,,79002337,CDM,278,RC,,,both,,,20279,8003.47,39.4668,,8003.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6894.86,34,,6894.86,percent of total billed charges,Implant Device,6894.86,34,,6894.86,percent of total billed charges,Implant Device,6894.86,34,,6894.86,percent of total billed charges,Implant Device,6894.86,34,,6894.86,percent of total billed charges,Implant Device,6894.86,34,,6894.86,percent of total billed charges,Implant Device,6894.86,34,,6894.86,percent of total billed charges,Implant Device,7097.65,35,,7097.65,percent of total billed charges,Implant Device,6894.86,34,"Charges > $500, x 34%",6894.86,percent of total billed charges,Implant Device,7097.65,35,,7097.65,percent of total billed charges,Implant Devices,7097.65,35,,7097.65,percent of total billed charges,Implant Devices,7097.65,35,,,percent of total billed charges,Implant Devices,7097.65,35,,7097.65,percent of total billed charges,Implant Devices,7097.65,35,,7097.65,percent of total billed charges,Implant Devices,8111.6,40,,8111.6,percent of total billed charges,Implant Devices,7097.65,70,,7097.65,percent of total billed charges,Implant Devices,6894.86,34,,6894.86,percent of total billed charges,Implant Devices,6894.86,34,,6894.86,percent of total billed charges,Implant Devices,7097.65,35,,7097.65,percent of total billed charges,Implant Devices,7097.65,35,,7097.65,percent of total billed charges,Implant Devices,7097.65,35,,7097.65,percent of total billed charges,Implant Devices,7097.65,35,,7097.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6894.86,34,"If Charge > 2,000, then 34 percent",6894.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8111.6,
DEPUY 96-0101-REV PATELLA,C1776,HCPCS,,79002338,CDM,278,RC,,,both,,,2024,798.81,39.4668,,798.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,688.16,34,,688.16,percent of total billed charges,Implant Device,688.16,34,,688.16,percent of total billed charges,Implant Device,688.16,34,,688.16,percent of total billed charges,Implant Device,688.16,34,,688.16,percent of total billed charges,Implant Device,688.16,34,,688.16,percent of total billed charges,Implant Device,688.16,34,,688.16,percent of total billed charges,Implant Device,708.4,35,,708.4,percent of total billed charges,Implant Device,688.16,34,"Charges > $500, x 34%",688.16,percent of total billed charges,Implant Device,708.4,35,,708.4,percent of total billed charges,Implant Devices,708.4,35,,708.4,percent of total billed charges,Implant Devices,708.4,35,,,percent of total billed charges,Implant Devices,708.4,35,,708.4,percent of total billed charges,Implant Devices,708.4,35,,708.4,percent of total billed charges,Implant Devices,809.6,40,,809.6,percent of total billed charges,Implant Devices,708.4,70,,708.4,percent of total billed charges,Implant Devices,688.16,34,,688.16,percent of total billed charges,Implant Devices,688.16,34,,688.16,percent of total billed charges,Implant Devices,708.4,35,,708.4,percent of total billed charges,Implant Devices,708.4,35,,708.4,percent of total billed charges,Implant Devices,708.4,35,,708.4,percent of total billed charges,Implant Devices,708.4,35,,708.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,688.16,34,"If Charge > 2,000, then 34 percent",688.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,809.6,
DEPUY 96-0781-REV FEMORAL COMPONENT,C1776,HCPCS,,79002339,CDM,278,RC,,,both,,,8558,3377.57,39.4668,,3377.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2909.72,34,,2909.72,percent of total billed charges,Implant Device,2909.72,34,,2909.72,percent of total billed charges,Implant Device,2909.72,34,,2909.72,percent of total billed charges,Implant Device,2909.72,34,,2909.72,percent of total billed charges,Implant Device,2909.72,34,,2909.72,percent of total billed charges,Implant Device,2909.72,34,,2909.72,percent of total billed charges,Implant Device,2995.3,35,,2995.3,percent of total billed charges,Implant Device,2909.72,34,"Charges > $500, x 34%",2909.72,percent of total billed charges,Implant Device,2995.3,35,,2995.3,percent of total billed charges,Implant Devices,2995.3,35,,2995.3,percent of total billed charges,Implant Devices,2995.3,35,,,percent of total billed charges,Implant Devices,2995.3,35,,2995.3,percent of total billed charges,Implant Devices,2995.3,35,,2995.3,percent of total billed charges,Implant Devices,3423.2,40,,3423.2,percent of total billed charges,Implant Devices,2995.3,70,,2995.3,percent of total billed charges,Implant Devices,2909.72,34,,2909.72,percent of total billed charges,Implant Devices,2909.72,34,,2909.72,percent of total billed charges,Implant Devices,2995.3,35,,2995.3,percent of total billed charges,Implant Devices,2995.3,35,,2995.3,percent of total billed charges,Implant Devices,2995.3,35,,2995.3,percent of total billed charges,Implant Devices,2995.3,35,,2995.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2909.72,34,"If Charge > 2,000, then 34 percent",2909.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3423.2,
DEPUY 96-0783-REV FEMORAL ADAPTER,C1776,HCPCS,,79002340,CDM,278,RC,,,both,,,1088,429.4,39.4668,,429.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,369.92,34,,369.92,percent of total billed charges,Implant Device,369.92,34,,369.92,percent of total billed charges,Implant Device,369.92,34,,369.92,percent of total billed charges,Implant Device,369.92,34,,369.92,percent of total billed charges,Implant Device,369.92,34,,369.92,percent of total billed charges,Implant Device,369.92,34,,369.92,percent of total billed charges,Implant Device,380.8,35,,380.8,percent of total billed charges,Implant Device,369.92,34,"Charges > $500, x 34%",369.92,percent of total billed charges,Implant Device,380.8,35,,380.8,percent of total billed charges,Implant Devices,380.8,35,,380.8,percent of total billed charges,Implant Devices,380.8,35,,,percent of total billed charges,Implant Devices,380.8,35,,380.8,percent of total billed charges,Implant Devices,380.8,35,,380.8,percent of total billed charges,Implant Devices,435.2,40,,435.2,percent of total billed charges,Implant Devices,380.8,70,,380.8,percent of total billed charges,Implant Devices,369.92,34,,369.92,percent of total billed charges,Implant Devices,369.92,34,,369.92,percent of total billed charges,Implant Devices,380.8,35,,380.8,percent of total billed charges,Implant Devices,380.8,35,,380.8,percent of total billed charges,Implant Devices,380.8,35,,380.8,percent of total billed charges,Implant Devices,380.8,35,,380.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,435.2,
DEPUY 96-0784-REV FEMORAL ADAPTER,C1776,HCPCS,,79002341,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
DEPUY 96-0862-REV DISTAL AUGMENT,C1776,HCPCS,,79002342,CDM,278,RC,,,both,,,3371,1330.43,39.4668,,1330.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1179.85,35,,1179.85,percent of total billed charges,Implant Device,1146.14,34,"Charges > $500, x 34%",1146.14,percent of total billed charges,Implant Device,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1348.4,40,,1348.4,percent of total billed charges,Implant Devices,1179.85,70,,1179.85,percent of total billed charges,Implant Devices,1146.14,34,,1146.14,percent of total billed charges,Implant Devices,1146.14,34,,1146.14,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1146.14,34,"If Charge > 2,000, then 34 percent",1146.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1348.4,
DEPUY 96-0868-REV POST AUGMENT,C1776,HCPCS,,79002343,CDM,278,RC,,,both,,,3371,1330.43,39.4668,,1330.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1179.85,35,,1179.85,percent of total billed charges,Implant Device,1146.14,34,"Charges > $500, x 34%",1146.14,percent of total billed charges,Implant Device,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1348.4,40,,1348.4,percent of total billed charges,Implant Devices,1179.85,70,,1179.85,percent of total billed charges,Implant Devices,1146.14,34,,1146.14,percent of total billed charges,Implant Devices,1146.14,34,,1146.14,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1146.14,34,"If Charge > 2,000, then 34 percent",1146.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1348.4,
DEPUY 96-0869-REV DISTAL AUGMENT,C1776,HCPCS,,79002344,CDM,278,RC,,,both,,,3371,1330.43,39.4668,,1330.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1146.14,34,,1146.14,percent of total billed charges,Implant Device,1179.85,35,,1179.85,percent of total billed charges,Implant Device,1146.14,34,"Charges > $500, x 34%",1146.14,percent of total billed charges,Implant Device,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1348.4,40,,1348.4,percent of total billed charges,Implant Devices,1179.85,70,,1179.85,percent of total billed charges,Implant Devices,1146.14,34,,1146.14,percent of total billed charges,Implant Devices,1146.14,34,,1146.14,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,1179.85,35,,1179.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1146.14,34,"If Charge > 2,000, then 34 percent",1146.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1348.4,
DEPUY 96-0883-REV DISTAL AUGMENT,C1776,HCPCS,,79002345,CDM,278,RC,,,both,,,3708,1463.43,39.4668,,1463.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1297.8,35,,1297.8,percent of total billed charges,Implant Device,1260.72,34,"Charges > $500, x 34%",1260.72,percent of total billed charges,Implant Device,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1483.2,40,,1483.2,percent of total billed charges,Implant Devices,1297.8,70,,1297.8,percent of total billed charges,Implant Devices,1260.72,34,,1260.72,percent of total billed charges,Implant Devices,1260.72,34,,1260.72,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1260.72,34,"If Charge > 2,000, then 34 percent",1260.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1483.2,
DEPUY 96-0886-REV POST AUGMENT,C1776,HCPCS,,79002346,CDM,278,RC,,,both,,,3929,1550.65,39.4668,,1550.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1375.15,35,,1375.15,percent of total billed charges,Implant Device,1335.86,34,"Charges > $500, x 34%",1335.86,percent of total billed charges,Implant Device,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1571.6,40,,1571.6,percent of total billed charges,Implant Devices,1375.15,70,,1375.15,percent of total billed charges,Implant Devices,1335.86,34,,1335.86,percent of total billed charges,Implant Devices,1335.86,34,,1335.86,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1335.86,34,"If Charge > 2,000, then 34 percent",1335.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1571.6,
DEPUY 96-0890-REV DISTAL AUGMENT,C1776,HCPCS,,79002347,CDM,278,RC,,,both,,,3708,1463.43,39.4668,,1463.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1297.8,35,,1297.8,percent of total billed charges,Implant Device,1260.72,34,"Charges > $500, x 34%",1260.72,percent of total billed charges,Implant Device,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1483.2,40,,1483.2,percent of total billed charges,Implant Devices,1297.8,70,,1297.8,percent of total billed charges,Implant Devices,1260.72,34,,1260.72,percent of total billed charges,Implant Devices,1260.72,34,,1260.72,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1260.72,34,"If Charge > 2,000, then 34 percent",1260.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1483.2,
DEPUY 96-0900-REV DISTAL AUGMENT,C1776,HCPCS,,79002348,CDM,278,RC,,,both,,,3708,1463.43,39.4668,,1463.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1260.72,34,,1260.72,percent of total billed charges,Implant Device,1297.8,35,,1297.8,percent of total billed charges,Implant Device,1260.72,34,"Charges > $500, x 34%",1260.72,percent of total billed charges,Implant Device,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1483.2,40,,1483.2,percent of total billed charges,Implant Devices,1297.8,70,,1297.8,percent of total billed charges,Implant Devices,1260.72,34,,1260.72,percent of total billed charges,Implant Devices,1260.72,34,,1260.72,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,1297.8,35,,1297.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1260.72,34,"If Charge > 2,000, then 34 percent",1260.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1483.2,
DEPUY 96-0903-REV DISTAL AUGMENT,C1776,HCPCS,,79002349,CDM,278,RC,,,both,,,3479,1373.05,39.4668,,1373.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1217.65,35,,1217.65,percent of total billed charges,Implant Device,1182.86,34,"Charges > $500, x 34%",1182.86,percent of total billed charges,Implant Device,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1391.6,40,,1391.6,percent of total billed charges,Implant Devices,1217.65,70,,1217.65,percent of total billed charges,Implant Devices,1182.86,34,,1182.86,percent of total billed charges,Implant Devices,1182.86,34,,1182.86,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1182.86,34,"If Charge > 2,000, then 34 percent",1182.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1391.6,
DEPUY 96-0906-REV AUGMENTATION COMBO,C1776,HCPCS,,79002350,CDM,278,RC,,,both,,,3479,1373.05,39.4668,,1373.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1217.65,35,,1217.65,percent of total billed charges,Implant Device,1182.86,34,"Charges > $500, x 34%",1182.86,percent of total billed charges,Implant Device,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1391.6,40,,1391.6,percent of total billed charges,Implant Devices,1217.65,70,,1217.65,percent of total billed charges,Implant Devices,1182.86,34,,1182.86,percent of total billed charges,Implant Devices,1182.86,34,,1182.86,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1182.86,34,"If Charge > 2,000, then 34 percent",1182.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1391.6,
DEPUY 96-0910-REV DISTAL AUGMENT,C1776,HCPCS,,79002351,CDM,278,RC,,,both,,,3479,1373.05,39.4668,,1373.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1182.86,34,,1182.86,percent of total billed charges,Implant Device,1217.65,35,,1217.65,percent of total billed charges,Implant Device,1182.86,34,"Charges > $500, x 34%",1182.86,percent of total billed charges,Implant Device,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1391.6,40,,1391.6,percent of total billed charges,Implant Devices,1217.65,70,,1217.65,percent of total billed charges,Implant Devices,1182.86,34,,1182.86,percent of total billed charges,Implant Devices,1182.86,34,,1182.86,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,1217.65,35,,1217.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1182.86,34,"If Charge > 2,000, then 34 percent",1182.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1391.6,
DEPUY 96-2031-REV TIBIAL INSERT,C1776,HCPCS,,79002352,CDM,278,RC,,,both,,,3514,1386.86,39.4668,,1386.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1194.76,34,,1194.76,percent of total billed charges,Implant Device,1194.76,34,,1194.76,percent of total billed charges,Implant Device,1194.76,34,,1194.76,percent of total billed charges,Implant Device,1194.76,34,,1194.76,percent of total billed charges,Implant Device,1194.76,34,,1194.76,percent of total billed charges,Implant Device,1194.76,34,,1194.76,percent of total billed charges,Implant Device,1229.9,35,,1229.9,percent of total billed charges,Implant Device,1194.76,34,"Charges > $500, x 34%",1194.76,percent of total billed charges,Implant Device,1229.9,35,,1229.9,percent of total billed charges,Implant Devices,1229.9,35,,1229.9,percent of total billed charges,Implant Devices,1229.9,35,,,percent of total billed charges,Implant Devices,1229.9,35,,1229.9,percent of total billed charges,Implant Devices,1229.9,35,,1229.9,percent of total billed charges,Implant Devices,1405.6,40,,1405.6,percent of total billed charges,Implant Devices,1229.9,70,,1229.9,percent of total billed charges,Implant Devices,1194.76,34,,1194.76,percent of total billed charges,Implant Devices,1194.76,34,,1194.76,percent of total billed charges,Implant Devices,1229.9,35,,1229.9,percent of total billed charges,Implant Devices,1229.9,35,,1229.9,percent of total billed charges,Implant Devices,1229.9,35,,1229.9,percent of total billed charges,Implant Devices,1229.9,35,,1229.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1194.76,34,"If Charge > 2,000, then 34 percent",1194.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1405.6,
DEPUY 96-2123-REV TIBIAL INSERT,C1776,HCPCS,,79002353,CDM,278,RC,,,both,,,3775,1489.87,39.4668,,1489.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1283.5,34,,1283.5,percent of total billed charges,Implant Device,1283.5,34,,1283.5,percent of total billed charges,Implant Device,1283.5,34,,1283.5,percent of total billed charges,Implant Device,1283.5,34,,1283.5,percent of total billed charges,Implant Device,1283.5,34,,1283.5,percent of total billed charges,Implant Device,1283.5,34,,1283.5,percent of total billed charges,Implant Device,1321.25,35,,1321.25,percent of total billed charges,Implant Device,1283.5,34,"Charges > $500, x 34%",1283.5,percent of total billed charges,Implant Device,1321.25,35,,1321.25,percent of total billed charges,Implant Devices,1321.25,35,,1321.25,percent of total billed charges,Implant Devices,1321.25,35,,,percent of total billed charges,Implant Devices,1321.25,35,,1321.25,percent of total billed charges,Implant Devices,1321.25,35,,1321.25,percent of total billed charges,Implant Devices,1510,40,,1510,percent of total billed charges,Implant Devices,1321.25,70,,1321.25,percent of total billed charges,Implant Devices,1283.5,34,,1283.5,percent of total billed charges,Implant Devices,1283.5,34,,1283.5,percent of total billed charges,Implant Devices,1321.25,35,,1321.25,percent of total billed charges,Implant Devices,1321.25,35,,1321.25,percent of total billed charges,Implant Devices,1321.25,35,,1321.25,percent of total billed charges,Implant Devices,1321.25,35,,1321.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1283.5,34,"If Charge > 2,000, then 34 percent",1283.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1510,
DEPUY 96-2355-REV TIBIAL INSERT,C1776,HCPCS,,79002354,CDM,278,RC,,,both,,,9342,3686.99,39.4668,,3686.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3269.7,35,,3269.7,percent of total billed charges,Implant Device,3176.28,34,"Charges > $500, x 34%",3176.28,percent of total billed charges,Implant Device,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3736.8,40,,3736.8,percent of total billed charges,Implant Devices,3269.7,70,,3269.7,percent of total billed charges,Implant Devices,3176.28,34,,3176.28,percent of total billed charges,Implant Devices,3176.28,34,,3176.28,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3176.28,34,"If Charge > 2,000, then 34 percent",3176.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3736.8,
DEPUY 96-2361-REV INSERT,C1776,HCPCS,,79002355,CDM,278,RC,,,both,,,9342,3686.99,39.4668,,3686.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3176.28,34,,3176.28,percent of total billed charges,Implant Device,3269.7,35,,3269.7,percent of total billed charges,Implant Device,3176.28,34,"Charges > $500, x 34%",3176.28,percent of total billed charges,Implant Device,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3736.8,40,,3736.8,percent of total billed charges,Implant Devices,3269.7,70,,3269.7,percent of total billed charges,Implant Devices,3176.28,34,,3176.28,percent of total billed charges,Implant Devices,3176.28,34,,3176.28,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,3269.7,35,,3269.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3176.28,34,"If Charge > 2,000, then 34 percent",3176.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3736.8,
DEPUY 96-2362-REV INSERT,C1776,HCPCS,,79002356,CDM,278,RC,,,both,,,8341,3291.93,39.4668,,3291.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2835.94,34,,2835.94,percent of total billed charges,Implant Device,2835.94,34,,2835.94,percent of total billed charges,Implant Device,2835.94,34,,2835.94,percent of total billed charges,Implant Device,2835.94,34,,2835.94,percent of total billed charges,Implant Device,2835.94,34,,2835.94,percent of total billed charges,Implant Device,2835.94,34,,2835.94,percent of total billed charges,Implant Device,2919.35,35,,2919.35,percent of total billed charges,Implant Device,2835.94,34,"Charges > $500, x 34%",2835.94,percent of total billed charges,Implant Device,2919.35,35,,2919.35,percent of total billed charges,Implant Devices,2919.35,35,,2919.35,percent of total billed charges,Implant Devices,2919.35,35,,,percent of total billed charges,Implant Devices,2919.35,35,,2919.35,percent of total billed charges,Implant Devices,2919.35,35,,2919.35,percent of total billed charges,Implant Devices,3336.4,40,,3336.4,percent of total billed charges,Implant Devices,2919.35,70,,2919.35,percent of total billed charges,Implant Devices,2835.94,34,,2835.94,percent of total billed charges,Implant Devices,2835.94,34,,2835.94,percent of total billed charges,Implant Devices,2919.35,35,,2919.35,percent of total billed charges,Implant Devices,2919.35,35,,2919.35,percent of total billed charges,Implant Devices,2919.35,35,,2919.35,percent of total billed charges,Implant Devices,2919.35,35,,2919.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2835.94,34,"If Charge > 2,000, then 34 percent",2835.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3336.4,
ZIMMER 9943-16-35-REV FEMORAL BODY,C1776,HCPCS,,79002357,CDM,278,RC,,,both,,,14407,5685.98,39.4668,,5685.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4898.38,34,,4898.38,percent of total billed charges,Implant Device,4898.38,34,,4898.38,percent of total billed charges,Implant Device,4898.38,34,,4898.38,percent of total billed charges,Implant Device,4898.38,34,,4898.38,percent of total billed charges,Implant Device,4898.38,34,,4898.38,percent of total billed charges,Implant Device,4898.38,34,,4898.38,percent of total billed charges,Implant Device,5042.45,35,,5042.45,percent of total billed charges,Implant Device,4898.38,34,"Charges > $500, x 34%",4898.38,percent of total billed charges,Implant Device,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5762.8,40,,5762.8,percent of total billed charges,Implant Devices,5042.45,70,,5042.45,percent of total billed charges,Implant Devices,4898.38,34,,4898.38,percent of total billed charges,Implant Devices,4898.38,34,,4898.38,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4898.38,34,"If Charge > 2,000, then 34 percent",4898.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5762.8,
ZIMMER 9982-16-18-REV FEMORAL HEAD,C1776,HCPCS,,79002358,CDM,278,RC,,,both,,,10966,4327.93,39.4668,,4327.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3838.1,35,,3838.1,percent of total billed charges,Implant Device,3728.44,34,"Charges > $500, x 34%",3728.44,percent of total billed charges,Implant Device,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,4386.4,40,,4386.4,percent of total billed charges,Implant Devices,3838.1,70,,3838.1,percent of total billed charges,Implant Devices,3728.44,34,,3728.44,percent of total billed charges,Implant Devices,3728.44,34,,3728.44,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3728.44,34,"If Charge > 2,000, then 34 percent",3728.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4386.4,
ZIMMER 9982-19-13-REV FEMORAL STEM,C1776,HCPCS,,79002359,CDM,278,RC,,,both,,,9588,3784.08,39.4668,,3784.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3259.92,34,,3259.92,percent of total billed charges,Implant Device,3259.92,34,,3259.92,percent of total billed charges,Implant Device,3259.92,34,,3259.92,percent of total billed charges,Implant Device,3259.92,34,,3259.92,percent of total billed charges,Implant Device,3259.92,34,,3259.92,percent of total billed charges,Implant Device,3259.92,34,,3259.92,percent of total billed charges,Implant Device,3355.8,35,,3355.8,percent of total billed charges,Implant Device,3259.92,34,"Charges > $500, x 34%",3259.92,percent of total billed charges,Implant Device,3355.8,35,,3355.8,percent of total billed charges,Implant Devices,3355.8,35,,3355.8,percent of total billed charges,Implant Devices,3355.8,35,,,percent of total billed charges,Implant Devices,3355.8,35,,3355.8,percent of total billed charges,Implant Devices,3355.8,35,,3355.8,percent of total billed charges,Implant Devices,3835.2,40,,3835.2,percent of total billed charges,Implant Devices,3355.8,70,,3355.8,percent of total billed charges,Implant Devices,3259.92,34,,3259.92,percent of total billed charges,Implant Devices,3259.92,34,,3259.92,percent of total billed charges,Implant Devices,3355.8,35,,3355.8,percent of total billed charges,Implant Devices,3355.8,35,,3355.8,percent of total billed charges,Implant Devices,3355.8,35,,3355.8,percent of total billed charges,Implant Devices,3355.8,35,,3355.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3259.92,34,"If Charge > 2,000, then 34 percent",3259.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3835.2,
ZIMMER 9996-17-45-REV FEMORAL BODY,C1776,HCPCS,,79002360,CDM,278,RC,,,both,,,14407,5685.98,39.4668,,5685.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4898.38,34,,4898.38,percent of total billed charges,Implant Device,4898.38,34,,4898.38,percent of total billed charges,Implant Device,4898.38,34,,4898.38,percent of total billed charges,Implant Device,4898.38,34,,4898.38,percent of total billed charges,Implant Device,4898.38,34,,4898.38,percent of total billed charges,Implant Device,4898.38,34,,4898.38,percent of total billed charges,Implant Device,5042.45,35,,5042.45,percent of total billed charges,Implant Device,4898.38,34,"Charges > $500, x 34%",4898.38,percent of total billed charges,Implant Device,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5762.8,40,,5762.8,percent of total billed charges,Implant Devices,5042.45,70,,5042.45,percent of total billed charges,Implant Devices,4898.38,34,,4898.38,percent of total billed charges,Implant Devices,4898.38,34,,4898.38,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,5042.45,35,,5042.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4898.38,34,"If Charge > 2,000, then 34 percent",4898.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5762.8,
ARTHREX AR-1310T-05.0 PLATE,C1776,HCPCS,,79002368,CDM,278,RC,,,both,,,2686,1060.08,39.4668,,1060.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,940.1,35,,940.1,percent of total billed charges,Implant Device,913.24,34,"Charges > $500, x 34%",913.24,percent of total billed charges,Implant Device,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,1074.4,40,,1074.4,percent of total billed charges,Implant Devices,940.1,70,,940.1,percent of total billed charges,Implant Devices,913.24,34,,913.24,percent of total billed charges,Implant Devices,913.24,34,,913.24,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,913.24,34,"If Charge > 2,000, then 34 percent",913.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1074.4,
CAYENNE CM-3009C TIBIAL PEEK IMPLANT,C1776,HCPCS,,79002474,CDM,278,RC,,,both,,,1426,562.8,39.4668,,562.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,499.1,35,,499.1,percent of total billed charges,Implant Device,484.84,34,"Charges > $500, x 34%",484.84,percent of total billed charges,Implant Device,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,570.4,40,,570.4,percent of total billed charges,Implant Devices,499.1,70,,499.1,percent of total billed charges,Implant Devices,484.84,34,,484.84,percent of total billed charges,Implant Devices,484.84,34,,484.84,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,570.4,
CAYENNE CM-3010C TIBIAL PEEK IMPLANT,C1776,HCPCS,,79002475,CDM,278,RC,,,both,,,1426,562.8,39.4668,,562.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,484.84,34,,484.84,percent of total billed charges,Implant Device,499.1,35,,499.1,percent of total billed charges,Implant Device,484.84,34,"Charges > $500, x 34%",484.84,percent of total billed charges,Implant Device,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,570.4,40,,570.4,percent of total billed charges,Implant Devices,499.1,70,,499.1,percent of total billed charges,Implant Devices,484.84,34,,484.84,percent of total billed charges,Implant Devices,484.84,34,,484.84,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,499.1,35,,499.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,570.4,
SOLANA MD103 METATARSAL IMPLANT,C1776,HCPCS,,79002527,CDM,278,RC,,,both,,,9886,3901.69,39.4668,,3901.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3361.24,34,,3361.24,percent of total billed charges,Implant Device,3361.24,34,,3361.24,percent of total billed charges,Implant Device,3361.24,34,,3361.24,percent of total billed charges,Implant Device,3361.24,34,,3361.24,percent of total billed charges,Implant Device,3361.24,34,,3361.24,percent of total billed charges,Implant Device,3361.24,34,,3361.24,percent of total billed charges,Implant Device,3460.1,35,,3460.1,percent of total billed charges,Implant Device,3361.24,34,"Charges > $500, x 34%",3361.24,percent of total billed charges,Implant Device,3460.1,35,,3460.1,percent of total billed charges,Implant Devices,3460.1,35,,3460.1,percent of total billed charges,Implant Devices,3460.1,35,,,percent of total billed charges,Implant Devices,3460.1,35,,3460.1,percent of total billed charges,Implant Devices,3460.1,35,,3460.1,percent of total billed charges,Implant Devices,3954.4,40,,3954.4,percent of total billed charges,Implant Devices,3460.1,70,,3460.1,percent of total billed charges,Implant Devices,3361.24,34,,3361.24,percent of total billed charges,Implant Devices,3361.24,34,,3361.24,percent of total billed charges,Implant Devices,3460.1,35,,3460.1,percent of total billed charges,Implant Devices,3460.1,35,,3460.1,percent of total billed charges,Implant Devices,3460.1,35,,3460.1,percent of total billed charges,Implant Devices,3460.1,35,,3460.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3361.24,34,"If Charge > 2,000, then 34 percent",3361.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3954.4,
STRYKER NLS-301600P MODULAR NECK,C1776,HCPCS,,79002576,CDM,278,RC,,,both,,,2009,792.89,39.4668,,792.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.06,34,,683.06,percent of total billed charges,Implant Device,683.06,34,,683.06,percent of total billed charges,Implant Device,683.06,34,,683.06,percent of total billed charges,Implant Device,683.06,34,,683.06,percent of total billed charges,Implant Device,683.06,34,,683.06,percent of total billed charges,Implant Device,683.06,34,,683.06,percent of total billed charges,Implant Device,703.15,35,,703.15,percent of total billed charges,Implant Device,683.06,34,"Charges > $500, x 34%",683.06,percent of total billed charges,Implant Device,703.15,35,,703.15,percent of total billed charges,Implant Devices,703.15,35,,703.15,percent of total billed charges,Implant Devices,703.15,35,,,percent of total billed charges,Implant Devices,703.15,35,,703.15,percent of total billed charges,Implant Devices,703.15,35,,703.15,percent of total billed charges,Implant Devices,803.6,40,,803.6,percent of total billed charges,Implant Devices,703.15,70,,703.15,percent of total billed charges,Implant Devices,683.06,34,,683.06,percent of total billed charges,Implant Devices,683.06,34,,683.06,percent of total billed charges,Implant Devices,703.15,35,,703.15,percent of total billed charges,Implant Devices,703.15,35,,703.15,percent of total billed charges,Implant Devices,703.15,35,,703.15,percent of total billed charges,Implant Devices,703.15,35,,703.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.06,34,"If Charge > 2,000, then 34 percent",683.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,803.6,
STRYKER UH1-41-26 HEAD,C1776,HCPCS,,79002618,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER UH1-46-26-REV HEAD,C1776,HCPCS,,79002619,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER UH1-47-26 HEAD,C1776,HCPCS,,79002620,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
BIOMET XL-115363 HUMERAL BEARING,C1776,HCPCS,,79002628,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
BIOMET XL-115364 HUMERAL BEARING,C1776,HCPCS,,79002629,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
TOTAL HIP HIGH CAP,C1776,HCPCS,,79002646,CDM,278,RC,,,both,,,21000,8288.03,39.4668,,8288.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7140,34,,7140,percent of total billed charges,Implant Device,7140,34,,7140,percent of total billed charges,Implant Device,7140,34,,7140,percent of total billed charges,Implant Device,7140,34,,7140,percent of total billed charges,Implant Device,7140,34,,7140,percent of total billed charges,Implant Device,7140,34,,7140,percent of total billed charges,Implant Device,7350,35,,7350,percent of total billed charges,Implant Device,7140,34,"Charges > $500, x 34%",7140,percent of total billed charges,Implant Device,7350,35,,7350,percent of total billed charges,Implant Devices,7350,35,,7350,percent of total billed charges,Implant Devices,7350,35,,,percent of total billed charges,Implant Devices,7350,35,,7350,percent of total billed charges,Implant Devices,7350,35,,7350,percent of total billed charges,Implant Devices,8400,40,,8400,percent of total billed charges,Implant Devices,7350,70,,7350,percent of total billed charges,Implant Devices,7140,34,,7140,percent of total billed charges,Implant Devices,7140,34,,7140,percent of total billed charges,Implant Devices,7350,35,,7350,percent of total billed charges,Implant Devices,7350,35,,7350,percent of total billed charges,Implant Devices,7350,35,,7350,percent of total billed charges,Implant Devices,7350,35,,7350,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7140,34,"If Charge > 2,000, then 34 percent",7140,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8400,
TOTAL HIP LOW CAP,C1776,HCPCS,,79002647,CDM,278,RC,,,both,,,19200,7577.63,39.4668,,7577.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6528,34,,6528,percent of total billed charges,Implant Device,6528,34,,6528,percent of total billed charges,Implant Device,6528,34,,6528,percent of total billed charges,Implant Device,6528,34,,6528,percent of total billed charges,Implant Device,6528,34,,6528,percent of total billed charges,Implant Device,6528,34,,6528,percent of total billed charges,Implant Device,6720,35,,6720,percent of total billed charges,Implant Device,6528,34,"Charges > $500, x 34%",6528,percent of total billed charges,Implant Device,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,7680,40,,7680,percent of total billed charges,Implant Devices,6720,70,,6720,percent of total billed charges,Implant Devices,6528,34,,6528,percent of total billed charges,Implant Devices,6528,34,,6528,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6528,34,"If Charge > 2,000, then 34 percent",6528,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7680,
TOTAL KNEE HIGH CAP,C1776,HCPCS,,79002648,CDM,278,RC,,,both,,,19200,7577.63,39.4668,,7577.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6528,34,,6528,percent of total billed charges,Implant Device,6528,34,,6528,percent of total billed charges,Implant Device,6528,34,,6528,percent of total billed charges,Implant Device,6528,34,,6528,percent of total billed charges,Implant Device,6528,34,,6528,percent of total billed charges,Implant Device,6528,34,,6528,percent of total billed charges,Implant Device,6720,35,,6720,percent of total billed charges,Implant Device,6528,34,"Charges > $500, x 34%",6528,percent of total billed charges,Implant Device,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,7680,40,,7680,percent of total billed charges,Implant Devices,6720,70,,6720,percent of total billed charges,Implant Devices,6528,34,,6528,percent of total billed charges,Implant Devices,6528,34,,6528,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,6720,35,,6720,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6528,34,"If Charge > 2,000, then 34 percent",6528,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7680,
TOTAL KNEE LOW CAP,C1776,HCPCS,,79002649,CDM,278,RC,,,both,,,15900,6275.22,39.4668,,6275.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5406,34,,5406,percent of total billed charges,Implant Device,5406,34,,5406,percent of total billed charges,Implant Device,5406,34,,5406,percent of total billed charges,Implant Device,5406,34,,5406,percent of total billed charges,Implant Device,5406,34,,5406,percent of total billed charges,Implant Device,5406,34,,5406,percent of total billed charges,Implant Device,5565,35,,5565,percent of total billed charges,Implant Device,5406,34,"Charges > $500, x 34%",5406,percent of total billed charges,Implant Device,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,6360,40,,6360,percent of total billed charges,Implant Devices,5565,70,,5565,percent of total billed charges,Implant Devices,5406,34,,5406,percent of total billed charges,Implant Devices,5406,34,,5406,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5406,34,"If Charge > 2,000, then 34 percent",5406,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6360,
STRYKER HEMIARTHROPLASTY HIP,C1776,HCPCS,,79002802,CDM,278,RC,,,both,,,13209,5213.17,39.4668,,5213.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4623.15,35,,4623.15,percent of total billed charges,Implant Device,4491.06,34,"Charges > $500, x 34%",4491.06,percent of total billed charges,Implant Device,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,5283.6,40,,5283.6,percent of total billed charges,Implant Devices,4623.15,70,,4623.15,percent of total billed charges,Implant Devices,4491.06,34,,4491.06,percent of total billed charges,Implant Devices,4491.06,34,,4491.06,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4491.06,34,"If Charge > 2,000, then 34 percent",4491.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5283.6,
ZIMMER 00-5988-011-13-REV STEM,C1776,HCPCS,,79002814,CDM,278,RC,,,both,,,2970,1172.16,39.4668,,1172.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Device,1009.8,34,"Charges > $500, x 34%",1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1188,40,,1188,percent of total billed charges,Implant Devices,1039.5,70,,1039.5,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1009.8,34,"If Charge > 2,000, then 34 percent",1009.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1188,
ZIMMER 00-5990-0136-01-REV AUGMENT BLOCK,C1776,HCPCS,,79002815,CDM,278,RC,,,both,,,3240,1278.72,39.4668,,1278.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1134,35,,1134,percent of total billed charges,Implant Device,1101.6,34,"Charges > $500, x 34%",1101.6,percent of total billed charges,Implant Device,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1296,40,,1296,percent of total billed charges,Implant Devices,1134,70,,1134,percent of total billed charges,Implant Devices,1101.6,34,,1101.6,percent of total billed charges,Implant Devices,1101.6,34,,1101.6,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1101.6,34,"If Charge > 2,000, then 34 percent",1101.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1296,
ZIMMER 00-5990-036-20-REV AUGMENT BLOCK,C1776,HCPCS,,79002816,CDM,278,RC,,,both,,,2963,1169.4,39.4668,,1169.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Device,1007.42,34,"Charges > $500, x 34%",1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1185.2,40,,1185.2,percent of total billed charges,Implant Devices,1037.05,70,,1037.05,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1007.42,34,"If Charge > 2,000, then 34 percent",1007.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1185.2,
ZIMMER 00-5994-016-92-REV FEM COMPONENT,C1776,HCPCS,,79002817,CDM,278,RC,,,both,,,17989,7099.68,39.4668,,7099.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6116.26,34,,6116.26,percent of total billed charges,Implant Device,6296.15,35,,6296.15,percent of total billed charges,Implant Device,6116.26,34,"Charges > $500, x 34%",6116.26,percent of total billed charges,Implant Device,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,7195.6,40,,7195.6,percent of total billed charges,Implant Devices,6296.15,70,,6296.15,percent of total billed charges,Implant Devices,6116.26,34,,6116.26,percent of total billed charges,Implant Devices,6116.26,34,,6116.26,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,6296.15,35,,6296.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6116.26,34,"If Charge > 2,000, then 34 percent",6116.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7195.6,
ZIMMER 00-5994-032-14-REV ARTICULAR SURF,C1776,HCPCS,,79002818,CDM,278,RC,,,both,,,6465,2551.53,39.4668,,2551.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Device,2198.1,34,"Charges > $500, x 34%",2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2586,40,,2586,percent of total billed charges,Implant Devices,2262.75,70,,2262.75,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2198.1,34,"If Charge > 2,000, then 34 percent",2198.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2586,
STRYKER ORTHO R5351-4510 HUMERAL COMP,C1776,HCPCS,,79002821,CDM,278,RC,,,both,,,14089,5560.48,39.4668,,5560.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4790.26,34,,4790.26,percent of total billed charges,Implant Device,4790.26,34,,4790.26,percent of total billed charges,Implant Device,4790.26,34,,4790.26,percent of total billed charges,Implant Device,4790.26,34,,4790.26,percent of total billed charges,Implant Device,4790.26,34,,4790.26,percent of total billed charges,Implant Device,4790.26,34,,4790.26,percent of total billed charges,Implant Device,4931.15,35,,4931.15,percent of total billed charges,Implant Device,4790.26,34,"Charges > $500, x 34%",4790.26,percent of total billed charges,Implant Device,4931.15,35,,4931.15,percent of total billed charges,Implant Devices,4931.15,35,,4931.15,percent of total billed charges,Implant Devices,4931.15,35,,,percent of total billed charges,Implant Devices,4931.15,35,,4931.15,percent of total billed charges,Implant Devices,4931.15,35,,4931.15,percent of total billed charges,Implant Devices,5635.6,40,,5635.6,percent of total billed charges,Implant Devices,4931.15,70,,4931.15,percent of total billed charges,Implant Devices,4790.26,34,,4790.26,percent of total billed charges,Implant Devices,4790.26,34,,4790.26,percent of total billed charges,Implant Devices,4931.15,35,,4931.15,percent of total billed charges,Implant Devices,4931.15,35,,4931.15,percent of total billed charges,Implant Devices,4931.15,35,,4931.15,percent of total billed charges,Implant Devices,4931.15,35,,4931.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4790.26,34,"If Charge > 2,000, then 34 percent",4790.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5635.6,
STRYKER ORTHO R5350-5024 SHLDR HUM HEAD,C1776,HCPCS,,79002822,CDM,278,RC,,,both,,,7018,2769.78,39.4668,,2769.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2386.12,34,,2386.12,percent of total billed charges,Implant Device,2386.12,34,,2386.12,percent of total billed charges,Implant Device,2386.12,34,,2386.12,percent of total billed charges,Implant Device,2386.12,34,,2386.12,percent of total billed charges,Implant Device,2386.12,34,,2386.12,percent of total billed charges,Implant Device,2386.12,34,,2386.12,percent of total billed charges,Implant Device,2456.3,35,,2456.3,percent of total billed charges,Implant Device,2386.12,34,"Charges > $500, x 34%",2386.12,percent of total billed charges,Implant Device,2456.3,35,,2456.3,percent of total billed charges,Implant Devices,2456.3,35,,2456.3,percent of total billed charges,Implant Devices,2456.3,35,,,percent of total billed charges,Implant Devices,2456.3,35,,2456.3,percent of total billed charges,Implant Devices,2456.3,35,,2456.3,percent of total billed charges,Implant Devices,2807.2,40,,2807.2,percent of total billed charges,Implant Devices,2456.3,70,,2456.3,percent of total billed charges,Implant Devices,2386.12,34,,2386.12,percent of total billed charges,Implant Devices,2386.12,34,,2386.12,percent of total billed charges,Implant Devices,2456.3,35,,2456.3,percent of total billed charges,Implant Devices,2456.3,35,,2456.3,percent of total billed charges,Implant Devices,2456.3,35,,2456.3,percent of total billed charges,Implant Devices,2456.3,35,,2456.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2386.12,34,"If Charge > 2,000, then 34 percent",2386.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2807.2,
ZIMMER 00-5988-010-12-REV STR STEM EXT,C1776,HCPCS,,79002849,CDM,278,RC,,,both,,,3325,1312.27,39.4668,,1312.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Device,1130.5,34,"Charges > $500, x 34%",1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1330,40,,1330,percent of total billed charges,Implant Devices,1163.75,70,,1163.75,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.5,34,"If Charge > 2,000, then 34 percent",1130.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1330,
STRYKER ST0-16P SMART TOE,C1776,HCPCS,,79002911,CDM,278,RC,,,both,,,3582,1413.7,39.4668,,1413.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1253.7,35,,1253.7,percent of total billed charges,Implant Device,1217.88,34,"Charges > $500, x 34%",1217.88,percent of total billed charges,Implant Device,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1432.8,40,,1432.8,percent of total billed charges,Implant Devices,1253.7,70,,1253.7,percent of total billed charges,Implant Devices,1217.88,34,,1217.88,percent of total billed charges,Implant Devices,1217.88,34,,1217.88,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1217.88,34,"If Charge > 2,000, then 34 percent",1217.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1432.8,
STRYKER ST0A-16P SMART TOE,C1776,HCPCS,,79002912,CDM,278,RC,,,both,,,3582,1413.7,39.4668,,1413.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1253.7,35,,1253.7,percent of total billed charges,Implant Device,1217.88,34,"Charges > $500, x 34%",1217.88,percent of total billed charges,Implant Device,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1432.8,40,,1432.8,percent of total billed charges,Implant Devices,1253.7,70,,1253.7,percent of total billed charges,Implant Devices,1217.88,34,,1217.88,percent of total billed charges,Implant Devices,1217.88,34,,1217.88,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1217.88,34,"If Charge > 2,000, then 34 percent",1217.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1432.8,
ZIMMER 00-5952-050-14-REV ART SURF 14MM,C1776,HCPCS,,79002924,CDM,278,RC,,,both,,,5107,2015.57,39.4668,,2015.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1787.45,35,,1787.45,percent of total billed charges,Implant Device,1736.38,34,"Charges > $500, x 34%",1736.38,percent of total billed charges,Implant Device,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,2042.8,40,,2042.8,percent of total billed charges,Implant Devices,1787.45,70,,1787.45,percent of total billed charges,Implant Devices,1736.38,34,,1736.38,percent of total billed charges,Implant Devices,1736.38,34,,1736.38,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1736.38,34,"If Charge > 2,000, then 34 percent",1736.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2042.8,
S&N 71322052 SHELL 28X52MM,C1776,HCPCS,,79002986,CDM,278,RC,,,both,,,5596,2208.56,39.4668,,2208.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1902.64,34,,1902.64,percent of total billed charges,Implant Device,1902.64,34,,1902.64,percent of total billed charges,Implant Device,1902.64,34,,1902.64,percent of total billed charges,Implant Device,1902.64,34,,1902.64,percent of total billed charges,Implant Device,1902.64,34,,1902.64,percent of total billed charges,Implant Device,1902.64,34,,1902.64,percent of total billed charges,Implant Device,1958.6,35,,1958.6,percent of total billed charges,Implant Device,1902.64,34,"Charges > $500, x 34%",1902.64,percent of total billed charges,Implant Device,1958.6,35,,1958.6,percent of total billed charges,Implant Devices,1958.6,35,,1958.6,percent of total billed charges,Implant Devices,1958.6,35,,,percent of total billed charges,Implant Devices,1958.6,35,,1958.6,percent of total billed charges,Implant Devices,1958.6,35,,1958.6,percent of total billed charges,Implant Devices,2238.4,40,,2238.4,percent of total billed charges,Implant Devices,1958.6,70,,1958.6,percent of total billed charges,Implant Devices,1902.64,34,,1902.64,percent of total billed charges,Implant Devices,1902.64,34,,1902.64,percent of total billed charges,Implant Devices,1958.6,35,,1958.6,percent of total billed charges,Implant Devices,1958.6,35,,1958.6,percent of total billed charges,Implant Devices,1958.6,35,,1958.6,percent of total billed charges,Implant Devices,1958.6,35,,1958.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1902.64,34,"If Charge > 2,000, then 34 percent",1902.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2238.4,
S&N 71313209 CENTRALIZER 9MM,C1776,HCPCS,,79002987,CDM,278,RC,,,both,,,281,110.9,39.4668,,110.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,95.54,34,,95.54,percent of total billed charges,Implant Device,98.35,35,,98.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,112.4,40,,112.4,percent of total billed charges,Implant Devices,98.35,70,,98.35,percent of total billed charges,Implant Devices,95.54,34,,95.54,percent of total billed charges,Implant Devices,95.54,34,,95.54,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,98.35,35,,98.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.4,
S&N 71312112 FEM COMP 12/14,C1776,HCPCS,,79002988,CDM,278,RC,,,both,,,8550,3374.41,39.4668,,3374.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2992.5,35,,2992.5,percent of total billed charges,Implant Device,2907,34,"Charges > $500, x 34%",2907,percent of total billed charges,Implant Device,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,3420,40,,3420,percent of total billed charges,Implant Devices,2992.5,70,,2992.5,percent of total billed charges,Implant Devices,2907,34,,2907,percent of total billed charges,Implant Devices,2907,34,,2907,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2907,34,"If Charge > 2,000, then 34 percent",2907,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3420,
S&N 71302804 FEMORAL HEAD 12/14,C1776,HCPCS,,79002989,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
ZIMMER 00-8757-056-02-REV SHELL,C1776,HCPCS,,79003035,CDM,278,RC,,,both,,,9203,3632.13,39.4668,,3632.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3129.02,34,,3129.02,percent of total billed charges,Implant Device,3221.05,35,,3221.05,percent of total billed charges,Implant Device,3129.02,34,"Charges > $500, x 34%",3129.02,percent of total billed charges,Implant Device,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3681.2,40,,3681.2,percent of total billed charges,Implant Devices,3221.05,70,,3221.05,percent of total billed charges,Implant Devices,3129.02,34,,3129.02,percent of total billed charges,Implant Devices,3129.02,34,,3129.02,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,3221.05,35,,3221.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3129.02,34,"If Charge > 2,000, then 34 percent",3129.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3681.2,
ZIMMER 00-4894-05-20-REV ACETAB AUGMENT,C1776,HCPCS,,79003036,CDM,278,RC,,,both,,,8370,3303.37,39.4668,,3303.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2929.5,35,,2929.5,percent of total billed charges,Implant Device,2845.8,34,"Charges > $500, x 34%",2845.8,percent of total billed charges,Implant Device,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,3348,40,,3348,percent of total billed charges,Implant Devices,2929.5,70,,2929.5,percent of total billed charges,Implant Devices,2845.8,34,,2845.8,percent of total billed charges,Implant Devices,2845.8,34,,2845.8,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2845.8,34,"If Charge > 2,000, then 34 percent",2845.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3348,
ZIMMER 00-8752-012-36-REV LINER,C1776,HCPCS,,79003037,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
STRYKER 6570-0-136-REV FEMORAL HEAD,C1776,HCPCS,,79003039,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 6570-0-236-REV FEMORAL HEAD,C1776,HCPCS,,79003040,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
EXACTECH 320-15-01 GLENOID PLATE,C1776,HCPCS,,79003047,CDM,278,RC,,,both,,,5374,2120.95,39.4668,,2120.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1827.16,34,,1827.16,percent of total billed charges,Implant Device,1827.16,34,,1827.16,percent of total billed charges,Implant Device,1827.16,34,,1827.16,percent of total billed charges,Implant Device,1827.16,34,,1827.16,percent of total billed charges,Implant Device,1827.16,34,,1827.16,percent of total billed charges,Implant Device,1827.16,34,,1827.16,percent of total billed charges,Implant Device,1880.9,35,,1880.9,percent of total billed charges,Implant Device,1827.16,34,"Charges > $500, x 34%",1827.16,percent of total billed charges,Implant Device,1880.9,35,,1880.9,percent of total billed charges,Implant Devices,1880.9,35,,1880.9,percent of total billed charges,Implant Devices,1880.9,35,,,percent of total billed charges,Implant Devices,1880.9,35,,1880.9,percent of total billed charges,Implant Devices,1880.9,35,,1880.9,percent of total billed charges,Implant Devices,2149.6,40,,2149.6,percent of total billed charges,Implant Devices,1880.9,70,,1880.9,percent of total billed charges,Implant Devices,1827.16,34,,1827.16,percent of total billed charges,Implant Devices,1827.16,34,,1827.16,percent of total billed charges,Implant Devices,1880.9,35,,1880.9,percent of total billed charges,Implant Devices,1880.9,35,,1880.9,percent of total billed charges,Implant Devices,1880.9,35,,1880.9,percent of total billed charges,Implant Devices,1880.9,35,,1880.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1827.16,34,"If Charge > 2,000, then 34 percent",1827.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2149.6,
EXACTECH 320-01-38 GLENOSPHERE 38MM,C1776,HCPCS,,79003053,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
EXACTECH 300-01-09 HUMERAL STEM 9MM,C1776,HCPCS,,79003054,CDM,278,RC,,,both,,,4425,1746.41,39.4668,,1746.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Device,1504.5,34,"Charges > $500, x 34%",1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1770,40,,1770,percent of total billed charges,Implant Devices,1548.75,70,,1548.75,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1504.5,34,"If Charge > 2,000, then 34 percent",1504.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1770,
EXACTECH 320-10-00 HUMERAL ADAPTOR TRAY,C1776,HCPCS,,79003056,CDM,278,RC,,,both,,,4950,1953.61,39.4668,,1953.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Device,1683,34,"Charges > $500, x 34%",1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1980,40,,1980,percent of total billed charges,Implant Devices,1732.5,70,,1732.5,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1683,34,"If Charge > 2,000, then 34 percent",1683,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1980,
EXACTECH 320-38-00 HUMERAL LINER 38 +0MM,C1776,HCPCS,,79003057,CDM,278,RC,,,both,,,2836,1119.28,39.4668,,1119.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,964.24,34,,964.24,percent of total billed charges,Implant Device,964.24,34,,964.24,percent of total billed charges,Implant Device,964.24,34,,964.24,percent of total billed charges,Implant Device,964.24,34,,964.24,percent of total billed charges,Implant Device,964.24,34,,964.24,percent of total billed charges,Implant Device,964.24,34,,964.24,percent of total billed charges,Implant Device,992.6,35,,992.6,percent of total billed charges,Implant Device,964.24,34,"Charges > $500, x 34%",964.24,percent of total billed charges,Implant Device,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,1134.4,40,,1134.4,percent of total billed charges,Implant Devices,992.6,70,,992.6,percent of total billed charges,Implant Devices,964.24,34,,964.24,percent of total billed charges,Implant Devices,964.24,34,,964.24,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,964.24,34,"If Charge > 2,000, then 34 percent",964.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1134.4,
ZIMMER 00-5842-004-01-UNI TIBIAL COMP S4,C1776,HCPCS,,79003299,CDM,278,RC,,,both,,,6346,2504.56,39.4668,,2504.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Device,2157.64,34,"Charges > $500, x 34%",2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2538.4,40,,2538.4,percent of total billed charges,Implant Devices,2221.1,70,,2221.1,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2157.64,34,"If Charge > 2,000, then 34 percent",2157.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2538.4,
ZIMMER 00-5842-015-01-UNI FEM COMP SZ E,C1776,HCPCS,,79003300,CDM,278,RC,,,both,,,10486,4138.49,39.4668,,4138.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Device,3565.24,34,"Charges > $500, x 34%",3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,4194.4,40,,4194.4,percent of total billed charges,Implant Devices,3670.1,70,,3670.1,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3565.24,34,"If Charge > 2,000, then 34 percent",3565.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194.4,
ZIMMER 00-5842-024-11-UNI ART SURF SZ 4,C1776,HCPCS,,79003301,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
ZIMMER 5988-11-16-REV STEM EXT 16X155MM,C1776,HCPCS,,79003347,CDM,278,RC,,,both,,,2970,1172.16,39.4668,,1172.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Device,1009.8,34,"Charges > $500, x 34%",1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1188,40,,1188,percent of total billed charges,Implant Devices,1039.5,70,,1039.5,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1009.8,34,"If Charge > 2,000, then 34 percent",1009.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1188,
ZIMMER 00-5450-013-46-REV TRAB TIB CONE,C1776,HCPCS,,79003348,CDM,278,RC,,,both,,,13113,5175.28,39.4668,,5175.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4458.42,34,,4458.42,percent of total billed charges,Implant Device,4458.42,34,,4458.42,percent of total billed charges,Implant Device,4458.42,34,,4458.42,percent of total billed charges,Implant Device,4458.42,34,,4458.42,percent of total billed charges,Implant Device,4458.42,34,,4458.42,percent of total billed charges,Implant Device,4458.42,34,,4458.42,percent of total billed charges,Implant Device,4589.55,35,,4589.55,percent of total billed charges,Implant Device,4458.42,34,"Charges > $500, x 34%",4458.42,percent of total billed charges,Implant Device,4589.55,35,,4589.55,percent of total billed charges,Implant Devices,4589.55,35,,4589.55,percent of total billed charges,Implant Devices,4589.55,35,,,percent of total billed charges,Implant Devices,4589.55,35,,4589.55,percent of total billed charges,Implant Devices,4589.55,35,,4589.55,percent of total billed charges,Implant Devices,5245.2,40,,5245.2,percent of total billed charges,Implant Devices,4589.55,70,,4589.55,percent of total billed charges,Implant Devices,4458.42,34,,4458.42,percent of total billed charges,Implant Devices,4458.42,34,,4458.42,percent of total billed charges,Implant Devices,4589.55,35,,4589.55,percent of total billed charges,Implant Devices,4589.55,35,,4589.55,percent of total billed charges,Implant Devices,4589.55,35,,4589.55,percent of total billed charges,Implant Devices,4589.55,35,,4589.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4458.42,34,"If Charge > 2,000, then 34 percent",4458.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5245.2,
ZIMMER 5980-47-02-REV NEXGEN TIBIAL COMP,C1776,HCPCS,,79003350,CDM,278,RC,,,both,,,6616,2611.12,39.4668,,2611.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2249.44,34,,2249.44,percent of total billed charges,Implant Device,2315.6,35,,2315.6,percent of total billed charges,Implant Device,2249.44,34,"Charges > $500, x 34%",2249.44,percent of total billed charges,Implant Device,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2646.4,40,,2646.4,percent of total billed charges,Implant Devices,2315.6,70,,2315.6,percent of total billed charges,Implant Devices,2249.44,34,,2249.44,percent of total billed charges,Implant Devices,2249.44,34,,2249.44,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,2315.6,35,,2315.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2249.44,34,"If Charge > 2,000, then 34 percent",2249.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2646.4,
ZIMMER 90-5952-40-17-REV NEXGEN ART SURF,C1776,HCPCS,,79003351,CDM,278,RC,,,both,,,5107,2015.57,39.4668,,2015.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1736.38,34,,1736.38,percent of total billed charges,Implant Device,1787.45,35,,1787.45,percent of total billed charges,Implant Device,1736.38,34,"Charges > $500, x 34%",1736.38,percent of total billed charges,Implant Device,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,2042.8,40,,2042.8,percent of total billed charges,Implant Devices,1787.45,70,,1787.45,percent of total billed charges,Implant Devices,1736.38,34,,1736.38,percent of total billed charges,Implant Devices,1736.38,34,,1736.38,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,1787.45,35,,1787.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1736.38,34,"If Charge > 2,000, then 34 percent",1736.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2042.8,
EXACTECH 300-01-11 HUMERAL STEM 11MM,C1776,HCPCS,,79003362,CDM,278,RC,,,both,,,4425,1746.41,39.4668,,1746.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Device,1504.5,34,"Charges > $500, x 34%",1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1770,40,,1770,percent of total billed charges,Implant Devices,1548.75,70,,1548.75,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1504.5,34,"If Charge > 2,000, then 34 percent",1504.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1770,
EXACTECH 320-10-05 HUMERAL ADAPTOR +5MM,C1776,HCPCS,,79003392,CDM,278,RC,,,both,,,6480,2557.45,39.4668,,2557.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2268,35,,2268,percent of total billed charges,Implant Device,2203.2,34,"Charges > $500, x 34%",2203.2,percent of total billed charges,Implant Device,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2592,40,,2592,percent of total billed charges,Implant Devices,2268,70,,2268,percent of total billed charges,Implant Devices,2203.2,34,,2203.2,percent of total billed charges,Implant Devices,2203.2,34,,2203.2,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2203.2,34,"If Charge > 2,000, then 34 percent",2203.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2592,
EXACTECH 320-380-00 HUMERAL LINER 38MM+0,C1776,HCPCS,,79003393,CDM,278,RC,,,both,,,2836,1119.28,39.4668,,1119.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,964.24,34,,964.24,percent of total billed charges,Implant Device,964.24,34,,964.24,percent of total billed charges,Implant Device,964.24,34,,964.24,percent of total billed charges,Implant Device,964.24,34,,964.24,percent of total billed charges,Implant Device,964.24,34,,964.24,percent of total billed charges,Implant Device,964.24,34,,964.24,percent of total billed charges,Implant Device,992.6,35,,992.6,percent of total billed charges,Implant Device,964.24,34,"Charges > $500, x 34%",964.24,percent of total billed charges,Implant Device,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,1134.4,40,,1134.4,percent of total billed charges,Implant Devices,992.6,70,,992.6,percent of total billed charges,Implant Devices,964.24,34,,964.24,percent of total billed charges,Implant Devices,964.24,34,,964.24,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,992.6,35,,992.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,964.24,34,"If Charge > 2,000, then 34 percent",964.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1134.4,
EXACTECH 320-10-05 HUMERAL ADAPTOR +5MM,C1776,HCPCS,,79003410,CDM,278,RC,,,both,,,4950,1953.61,39.4668,,1953.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Device,1683,34,"Charges > $500, x 34%",1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1980,40,,1980,percent of total billed charges,Implant Devices,1732.5,70,,1732.5,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1683,34,"If Charge > 2,000, then 34 percent",1683,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1980,
ZIMMER 5842-13-01-UNI FEM COMP SZC-UNI,C1776,HCPCS,,79003450,CDM,278,RC,,,both,,,10486,4138.49,39.4668,,4138.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Device,3565.24,34,"Charges > $500, x 34%",3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,4194.4,40,,4194.4,percent of total billed charges,Implant Devices,3670.1,70,,3670.1,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3565.24,34,"If Charge > 2,000, then 34 percent",3565.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194.4,
ZIMMER 5842-02-01-UNI TIB COMP SZ 2-UNI,C1776,HCPCS,,79003451,CDM,278,RC,,,both,,,6346,2504.56,39.4668,,2504.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Device,2157.64,34,"Charges > $500, x 34%",2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2538.4,40,,2538.4,percent of total billed charges,Implant Devices,2221.1,70,,2221.1,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2157.64,34,"If Charge > 2,000, then 34 percent",2157.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2538.4,
ZIMMER 5842-22-12-UNI ART SURF FEM SZA-G,C1776,HCPCS,,79003452,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
EXACTECH 320-15-04 GLENOID PLATE 8DEG,C1776,HCPCS,,79003485,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
EXACTECH 320-15-01 GLENOID PLATE,C1776,HCPCS,,79003487,CDM,278,RC,,,both,,,4350,1716.81,39.4668,,1716.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1522.5,35,,1522.5,percent of total billed charges,Implant Device,1479,34,"Charges > $500, x 34%",1479,percent of total billed charges,Implant Device,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1740,40,,1740,percent of total billed charges,Implant Devices,1522.5,70,,1522.5,percent of total billed charges,Implant Devices,1479,34,,1479,percent of total billed charges,Implant Devices,1479,34,,1479,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1479,34,"If Charge > 2,000, then 34 percent",1479,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1740,
EXACTECH 304-22-13 FRACTURE STEM 12.5MM,C1776,HCPCS,,79003490,CDM,278,RC,,,both,,,6225,2456.81,39.4668,,2456.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Device,2116.5,34,"Charges > $500, x 34%",2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2490,40,,2490,percent of total billed charges,Implant Devices,2178.75,70,,2178.75,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2116.5,34,"If Charge > 2,000, then 34 percent",2116.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2490,
EXACTECH 320-10-00 HUM ADAPTOR TRAY +0MM,C1776,HCPCS,,79003493,CDM,278,RC,,,both,,,6480,2557.45,39.4668,,2557.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2203.2,34,,2203.2,percent of total billed charges,Implant Device,2268,35,,2268,percent of total billed charges,Implant Device,2203.2,34,"Charges > $500, x 34%",2203.2,percent of total billed charges,Implant Device,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2592,40,,2592,percent of total billed charges,Implant Devices,2268,70,,2268,percent of total billed charges,Implant Devices,2203.2,34,,2203.2,percent of total billed charges,Implant Devices,2203.2,34,,2203.2,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,2268,35,,2268,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2203.2,34,"If Charge > 2,000, then 34 percent",2203.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2592,
BIOMET 12-150307 FEMORAL HIP 7X120MM,C1776,HCPCS,,79003507,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
BIOMET 010000589 GLENOSPHERE 25MM,C1776,HCPCS,,79003512,CDM,278,RC,,,both,,,9630,3800.65,39.4668,,3800.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3274.2,34,,3274.2,percent of total billed charges,Implant Device,3274.2,34,,3274.2,percent of total billed charges,Implant Device,3274.2,34,,3274.2,percent of total billed charges,Implant Device,3274.2,34,,3274.2,percent of total billed charges,Implant Device,3274.2,34,,3274.2,percent of total billed charges,Implant Device,3274.2,34,,3274.2,percent of total billed charges,Implant Device,3370.5,35,,3370.5,percent of total billed charges,Implant Device,3274.2,34,"Charges > $500, x 34%",3274.2,percent of total billed charges,Implant Device,3370.5,35,,3370.5,percent of total billed charges,Implant Devices,3370.5,35,,3370.5,percent of total billed charges,Implant Devices,3370.5,35,,,percent of total billed charges,Implant Devices,3370.5,35,,3370.5,percent of total billed charges,Implant Devices,3370.5,35,,3370.5,percent of total billed charges,Implant Devices,3852,40,,3852,percent of total billed charges,Implant Devices,3370.5,70,,3370.5,percent of total billed charges,Implant Devices,3274.2,34,,3274.2,percent of total billed charges,Implant Devices,3274.2,34,,3274.2,percent of total billed charges,Implant Devices,3370.5,35,,3370.5,percent of total billed charges,Implant Devices,3370.5,35,,3370.5,percent of total billed charges,Implant Devices,3370.5,35,,3370.5,percent of total billed charges,Implant Devices,3370.5,35,,3370.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3274.2,34,"If Charge > 2,000, then 34 percent",3274.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3852,
BIOMET 113654 SHLDR STEM STD LEN 14X122,C1776,HCPCS,,79003514,CDM,278,RC,,,both,,,18630,7352.66,39.4668,,7352.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6520.5,35,,6520.5,percent of total billed charges,Implant Device,6334.2,34,"Charges > $500, x 34%",6334.2,percent of total billed charges,Implant Device,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,7452,40,,7452,percent of total billed charges,Implant Devices,6520.5,70,,6520.5,percent of total billed charges,Implant Devices,6334.2,34,,6334.2,percent of total billed charges,Implant Devices,6334.2,34,,6334.2,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6334.2,34,"If Charge > 2,000, then 34 percent",6334.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7452,
BIOMET 115-382 COMPRSNSV REV SHLDR 6.5MM,C1776,HCPCS,,79003555,CDM,278,RC,,,both,,,780,307.84,39.4668,,307.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,265.2,34,,265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Device,265.2,34,"Charges > $500, x 34%",265.2,percent of total billed charges,Implant Device,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,312,40,,312,percent of total billed charges,Implant Devices,273,70,,273,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,265.2,34,,265.2,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,273,35,,273,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,312,
BIOMET 11-165218 ACETABULAR CUP 28X47MM,C1776,HCPCS,,79003567,CDM,278,RC,,,both,,,6540,2581.13,39.4668,,2581.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2289,35,,2289,percent of total billed charges,Implant Device,2223.6,34,"Charges > $500, x 34%",2223.6,percent of total billed charges,Implant Device,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2616,40,,2616,percent of total billed charges,Implant Devices,2289,70,,2289,percent of total billed charges,Implant Devices,2223.6,34,,2223.6,percent of total billed charges,Implant Devices,2223.6,34,,2223.6,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2223.6,34,"If Charge > 2,000, then 34 percent",2223.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2616,
BIOMET 163662 MOD HEAD COMP 28X6MM,C1776,HCPCS,,79003568,CDM,278,RC,,,both,,,4830,1906.25,39.4668,,1906.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1690.5,35,,1690.5,percent of total billed charges,Implant Device,1642.2,34,"Charges > $500, x 34%",1642.2,percent of total billed charges,Implant Device,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1932,40,,1932,percent of total billed charges,Implant Devices,1690.5,70,,1690.5,percent of total billed charges,Implant Devices,1642.2,34,,1642.2,percent of total billed charges,Implant Devices,1642.2,34,,1642.2,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1642.2,34,"If Charge > 2,000, then 34 percent",1642.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1932,
EXACTECH 314-02-02 PEGGED GLENOID SMALL,C1776,HCPCS,,79003588,CDM,278,RC,,,both,,,4333,1710.1,39.4668,,1710.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1516.55,35,,1516.55,percent of total billed charges,Implant Device,1473.22,34,"Charges > $500, x 34%",1473.22,percent of total billed charges,Implant Device,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1733.2,40,,1733.2,percent of total billed charges,Implant Devices,1516.55,70,,1516.55,percent of total billed charges,Implant Devices,1473.22,34,,1473.22,percent of total billed charges,Implant Devices,1473.22,34,,1473.22,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1473.22,34,"If Charge > 2,000, then 34 percent",1473.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1733.2,
EXACTECH 310-01-44 HUMERAL HEAD 44 SHORT,C1776,HCPCS,,79003591,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
ZIMMER 5952-21-14 CR HIGHLY CROSSLINKED,C1776,HCPCS,,79003616,CDM,278,RC,,,both,,,3496,1379.76,39.4668,,1379.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1188.64,34,,1188.64,percent of total billed charges,Implant Device,1223.6,35,,1223.6,percent of total billed charges,Implant Device,1188.64,34,"Charges > $500, x 34%",1188.64,percent of total billed charges,Implant Device,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1398.4,40,,1398.4,percent of total billed charges,Implant Devices,1223.6,70,,1223.6,percent of total billed charges,Implant Devices,1188.64,34,,1188.64,percent of total billed charges,Implant Devices,1188.64,34,,1188.64,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,1223.6,35,,1223.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1188.64,34,"If Charge > 2,000, then 34 percent",1188.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1398.4,
WRIGHT MEDICAL 4260030 FLEX HINGE SIZE 3,C1776,HCPCS,,79003638,CDM,278,RC,,,both,,,3634,1434.22,39.4668,,1434.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1271.9,35,,1271.9,percent of total billed charges,Implant Device,1235.56,34,"Charges > $500, x 34%",1235.56,percent of total billed charges,Implant Device,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1453.6,40,,1453.6,percent of total billed charges,Implant Devices,1271.9,70,,1271.9,percent of total billed charges,Implant Devices,1235.56,34,,1235.56,percent of total billed charges,Implant Devices,1235.56,34,,1235.56,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1235.56,34,"If Charge > 2,000, then 34 percent",1235.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1453.6,
ZIMMER 5001-044-28 BIPOLAR LINER 44-46MM,C1776,HCPCS,,79003640,CDM,278,RC,,,both,,,789,311.39,39.4668,,311.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Device,268.26,34,"Charges > $500, x 34%",268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,315.6,40,,315.6,percent of total billed charges,Implant Devices,276.15,70,,276.15,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.6,
ZIMMER 7711-007-00 M/L TAPER 7.5 STD,C1776,HCPCS,,79003641,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
WRIGHT 4700002 FINGER JOINT IMPLANT SZ 2,C1776,HCPCS,,79003646,CDM,278,RC,,,both,,,6756,2666.38,39.4668,,2666.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2364.6,35,,2364.6,percent of total billed charges,Implant Device,2297.04,34,"Charges > $500, x 34%",2297.04,percent of total billed charges,Implant Device,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2702.4,40,,2702.4,percent of total billed charges,Implant Devices,2364.6,70,,2364.6,percent of total billed charges,Implant Devices,2297.04,34,,2297.04,percent of total billed charges,Implant Devices,2297.04,34,,2297.04,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2297.04,34,"If Charge > 2,000, then 34 percent",2297.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2702.4,
WRIGHT G4700004 FINGER JOINT IMPLNT SZ 4,C1776,HCPCS,,79003647,CDM,278,RC,,,both,,,6756,2666.38,39.4668,,2666.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2364.6,35,,2364.6,percent of total billed charges,Implant Device,2297.04,34,"Charges > $500, x 34%",2297.04,percent of total billed charges,Implant Device,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2702.4,40,,2702.4,percent of total billed charges,Implant Devices,2364.6,70,,2364.6,percent of total billed charges,Implant Devices,2297.04,34,,2297.04,percent of total billed charges,Implant Devices,2297.04,34,,2297.04,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2297.04,34,"If Charge > 2,000, then 34 percent",2297.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2702.4,
EXACTECH 320-38-03 HUMERAL LINER 38X25MM,C1776,HCPCS,,79003650,CDM,278,RC,,,both,,,2325,917.6,39.4668,,917.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Device,790.5,34,"Charges > $500, x 34%",790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,930,40,,930,percent of total billed charges,Implant Devices,813.75,70,,813.75,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.5,34,"If Charge > 2,000, then 34 percent",790.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930,
BIOMET EP-183440 TIBIAL BEARING 18X71/75,C1776,HCPCS,,79003651,CDM,278,RC,,,both,,,12510,4937.3,39.4668,,4937.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4253.4,34,,4253.4,percent of total billed charges,Implant Device,4253.4,34,,4253.4,percent of total billed charges,Implant Device,4253.4,34,,4253.4,percent of total billed charges,Implant Device,4253.4,34,,4253.4,percent of total billed charges,Implant Device,4253.4,34,,4253.4,percent of total billed charges,Implant Device,4253.4,34,,4253.4,percent of total billed charges,Implant Device,4378.5,35,,4378.5,percent of total billed charges,Implant Device,4253.4,34,"Charges > $500, x 34%",4253.4,percent of total billed charges,Implant Device,4378.5,35,,4378.5,percent of total billed charges,Implant Devices,4378.5,35,,4378.5,percent of total billed charges,Implant Devices,4378.5,35,,,percent of total billed charges,Implant Devices,4378.5,35,,4378.5,percent of total billed charges,Implant Devices,4378.5,35,,4378.5,percent of total billed charges,Implant Devices,5004,40,,5004,percent of total billed charges,Implant Devices,4378.5,70,,4378.5,percent of total billed charges,Implant Devices,4253.4,34,,4253.4,percent of total billed charges,Implant Devices,4253.4,34,,4253.4,percent of total billed charges,Implant Devices,4378.5,35,,4378.5,percent of total billed charges,Implant Devices,4378.5,35,,4378.5,percent of total billed charges,Implant Devices,4378.5,35,,4378.5,percent of total billed charges,Implant Devices,4378.5,35,,4378.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4253.4,34,"If Charge > 2,000, then 34 percent",4253.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5004,
BIOMET 141205 MODULAR TIBIAL LOCK BAR,C1776,HCPCS,,79003652,CDM,278,RC,,,both,,,384,151.55,39.4668,,151.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,134.4,35,,134.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,153.6,40,,153.6,percent of total billed charges,Implant Devices,134.4,70,,134.4,percent of total billed charges,Implant Devices,130.56,34,,130.56,percent of total billed charges,Implant Devices,130.56,34,,130.56,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,153.6,
ZIMMER 5001-46 BIPOLAR CUP SHELL 46MM OD,C1776,HCPCS,,79003656,CDM,278,RC,,,both,,,2026,799.6,39.4668,,799.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,688.84,34,,688.84,percent of total billed charges,Implant Device,688.84,34,,688.84,percent of total billed charges,Implant Device,688.84,34,,688.84,percent of total billed charges,Implant Device,688.84,34,,688.84,percent of total billed charges,Implant Device,688.84,34,,688.84,percent of total billed charges,Implant Device,688.84,34,,688.84,percent of total billed charges,Implant Device,709.1,35,,709.1,percent of total billed charges,Implant Device,688.84,34,"Charges > $500, x 34%",688.84,percent of total billed charges,Implant Device,709.1,35,,709.1,percent of total billed charges,Implant Devices,709.1,35,,709.1,percent of total billed charges,Implant Devices,709.1,35,,,percent of total billed charges,Implant Devices,709.1,35,,709.1,percent of total billed charges,Implant Devices,709.1,35,,709.1,percent of total billed charges,Implant Devices,810.4,40,,810.4,percent of total billed charges,Implant Devices,709.1,70,,709.1,percent of total billed charges,Implant Devices,688.84,34,,688.84,percent of total billed charges,Implant Devices,688.84,34,,688.84,percent of total billed charges,Implant Devices,709.1,35,,709.1,percent of total billed charges,Implant Devices,709.1,35,,709.1,percent of total billed charges,Implant Devices,709.1,35,,709.1,percent of total billed charges,Implant Devices,709.1,35,,709.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,688.84,34,"If Charge > 2,000, then 34 percent",688.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,810.4,
ZIMMER 8018-28-02 VERSYS FEMRL HEAD 26MM,C1776,HCPCS,,79003657,CDM,278,RC,,,both,,,2543,1003.64,39.4668,,1003.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Device,864.62,34,"Charges > $500, x 34%",864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,1017.2,40,,1017.2,percent of total billed charges,Implant Devices,890.05,70,,890.05,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,864.62,34,"If Charge > 2,000, then 34 percent",864.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1017.2,
ARTHROSURFACE 8H02-5450-W ART COMP 54X50,C1776,HCPCS,,79003664,CDM,278,RC,,,both,,,16764,6616.21,39.4668,,6616.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5867.4,35,,5867.4,percent of total billed charges,Implant Device,5699.76,34,"Charges > $500, x 34%",5699.76,percent of total billed charges,Implant Device,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,6705.6,40,,6705.6,percent of total billed charges,Implant Devices,5867.4,70,,5867.4,percent of total billed charges,Implant Devices,5699.76,34,,5699.76,percent of total billed charges,Implant Devices,5699.76,34,,5699.76,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5699.76,34,"If Charge > 2,000, then 34 percent",5699.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6705.6,
ZIMMER 00-8757-052-02-RV TRAB SHELL 52MM,C1776,HCPCS,,79003681,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
ZIMMER 00-8752-010-36-RV POLY LINR SZ 11,C1776,HCPCS,,79003682,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8775-036-01-REV FEM HEAD,C1776,HCPCS,,79003683,CDM,278,RC,,,both,,,3834,1513.16,39.4668,,1513.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1341.9,35,,1341.9,percent of total billed charges,Implant Device,1303.56,34,"Charges > $500, x 34%",1303.56,percent of total billed charges,Implant Device,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1533.6,40,,1533.6,percent of total billed charges,Implant Devices,1341.9,70,,1341.9,percent of total billed charges,Implant Devices,1303.56,34,,1303.56,percent of total billed charges,Implant Devices,1303.56,34,,1303.56,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1303.56,34,"If Charge > 2,000, then 34 percent",1303.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1533.6,
SGARLATO LABS 80-100-01 HAMMERTOE IMP-LG,C1776,HCPCS,,79003685,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
ZIMMER 5960-99 NEXGEN TAPER STEM PLUG,C1776,HCPCS,,79003717,CDM,278,RC,,,both,,,2476,977.2,39.4668,,977.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.84,34,,841.84,percent of total billed charges,Implant Device,841.84,34,,841.84,percent of total billed charges,Implant Device,841.84,34,,841.84,percent of total billed charges,Implant Device,841.84,34,,841.84,percent of total billed charges,Implant Device,841.84,34,,841.84,percent of total billed charges,Implant Device,841.84,34,,841.84,percent of total billed charges,Implant Device,866.6,35,,866.6,percent of total billed charges,Implant Device,841.84,34,"Charges > $500, x 34%",841.84,percent of total billed charges,Implant Device,866.6,35,,866.6,percent of total billed charges,Implant Devices,866.6,35,,866.6,percent of total billed charges,Implant Devices,866.6,35,,,percent of total billed charges,Implant Devices,866.6,35,,866.6,percent of total billed charges,Implant Devices,866.6,35,,866.6,percent of total billed charges,Implant Devices,990.4,40,,990.4,percent of total billed charges,Implant Devices,866.6,70,,866.6,percent of total billed charges,Implant Devices,841.84,34,,841.84,percent of total billed charges,Implant Devices,841.84,34,,841.84,percent of total billed charges,Implant Devices,866.6,35,,866.6,percent of total billed charges,Implant Devices,866.6,35,,866.6,percent of total billed charges,Implant Devices,866.6,35,,866.6,percent of total billed charges,Implant Devices,866.6,35,,866.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.84,34,"If Charge > 2,000, then 34 percent",841.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990.4,
ZIMMER 00-8751-010-36 POLY LINER 36MM,C1776,HCPCS,,79003718,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
STRYKER 6260-9-126 FEMORAL HEAD 26X+0MM,C1776,HCPCS,,79003719,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 6495-1-102 FEMORAL COMP LT,C1776,HCPCS,,79003720,CDM,278,RC,,,both,,,20749,8188.97,39.4668,,8188.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7054.66,34,,7054.66,percent of total billed charges,Implant Device,7054.66,34,,7054.66,percent of total billed charges,Implant Device,7054.66,34,,7054.66,percent of total billed charges,Implant Device,7054.66,34,,7054.66,percent of total billed charges,Implant Device,7054.66,34,,7054.66,percent of total billed charges,Implant Device,7054.66,34,,7054.66,percent of total billed charges,Implant Device,7262.15,35,,7262.15,percent of total billed charges,Implant Device,7054.66,34,"Charges > $500, x 34%",7054.66,percent of total billed charges,Implant Device,7262.15,35,,7262.15,percent of total billed charges,Implant Devices,7262.15,35,,7262.15,percent of total billed charges,Implant Devices,7262.15,35,,,percent of total billed charges,Implant Devices,7262.15,35,,7262.15,percent of total billed charges,Implant Devices,7262.15,35,,7262.15,percent of total billed charges,Implant Devices,8299.6,40,,8299.6,percent of total billed charges,Implant Devices,7262.15,70,,7262.15,percent of total billed charges,Implant Devices,7054.66,34,,7054.66,percent of total billed charges,Implant Devices,7054.66,34,,7054.66,percent of total billed charges,Implant Devices,7262.15,35,,7262.15,percent of total billed charges,Implant Devices,7262.15,35,,7262.15,percent of total billed charges,Implant Devices,7262.15,35,,7262.15,percent of total billed charges,Implant Devices,7262.15,35,,7262.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7054.66,34,"If Charge > 2,000, then 34 percent",7054.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8299.6,
STRYKER 6495-6-080 GMRS EXT PIECE 80MM,C1776,HCPCS,,79003721,CDM,278,RC,,,both,,,11686,4612.09,39.4668,,4612.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,4090.1,35,,4090.1,percent of total billed charges,Implant Device,3973.24,34,"Charges > $500, x 34%",3973.24,percent of total billed charges,Implant Device,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4674.4,40,,4674.4,percent of total billed charges,Implant Devices,4090.1,70,,4090.1,percent of total billed charges,Implant Devices,3973.24,34,,3973.24,percent of total billed charges,Implant Devices,3973.24,34,,3973.24,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3973.24,34,"If Charge > 2,000, then 34 percent",3973.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4674.4,
STRYKER UH1-55-26 UNIVERSAL HEAD 55X26MM,C1776,HCPCS,,79003722,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 6495-6-030 GMRS EXT PIECE 30MM,C1776,HCPCS,,79003723,CDM,278,RC,,,both,,,7856,3100.51,39.4668,,3100.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2671.04,34,,2671.04,percent of total billed charges,Implant Device,2671.04,34,,2671.04,percent of total billed charges,Implant Device,2671.04,34,,2671.04,percent of total billed charges,Implant Device,2671.04,34,,2671.04,percent of total billed charges,Implant Device,2671.04,34,,2671.04,percent of total billed charges,Implant Device,2671.04,34,,2671.04,percent of total billed charges,Implant Device,2749.6,35,,2749.6,percent of total billed charges,Implant Device,2671.04,34,"Charges > $500, x 34%",2671.04,percent of total billed charges,Implant Device,2749.6,35,,2749.6,percent of total billed charges,Implant Devices,2749.6,35,,2749.6,percent of total billed charges,Implant Devices,2749.6,35,,,percent of total billed charges,Implant Devices,2749.6,35,,2749.6,percent of total billed charges,Implant Devices,2749.6,35,,2749.6,percent of total billed charges,Implant Devices,3142.4,40,,3142.4,percent of total billed charges,Implant Devices,2749.6,70,,2749.6,percent of total billed charges,Implant Devices,2671.04,34,,2671.04,percent of total billed charges,Implant Devices,2671.04,34,,2671.04,percent of total billed charges,Implant Devices,2749.6,35,,2749.6,percent of total billed charges,Implant Devices,2749.6,35,,2749.6,percent of total billed charges,Implant Devices,2749.6,35,,2749.6,percent of total billed charges,Implant Devices,2749.6,35,,2749.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2671.04,34,"If Charge > 2,000, then 34 percent",2671.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3142.4,
STRYKER 8485-3-113 STRAIGHT STEM 13X127,C1776,HCPCS,,79003724,CDM,278,RC,,,both,,,10792,4259.26,39.4668,,4259.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3669.28,34,,3669.28,percent of total billed charges,Implant Device,3669.28,34,,3669.28,percent of total billed charges,Implant Device,3669.28,34,,3669.28,percent of total billed charges,Implant Device,3669.28,34,,3669.28,percent of total billed charges,Implant Device,3669.28,34,,3669.28,percent of total billed charges,Implant Device,3669.28,34,,3669.28,percent of total billed charges,Implant Device,3777.2,35,,3777.2,percent of total billed charges,Implant Device,3669.28,34,"Charges > $500, x 34%",3669.28,percent of total billed charges,Implant Device,3777.2,35,,3777.2,percent of total billed charges,Implant Devices,3777.2,35,,3777.2,percent of total billed charges,Implant Devices,3777.2,35,,,percent of total billed charges,Implant Devices,3777.2,35,,3777.2,percent of total billed charges,Implant Devices,3777.2,35,,3777.2,percent of total billed charges,Implant Devices,4316.8,40,,4316.8,percent of total billed charges,Implant Devices,3777.2,70,,3777.2,percent of total billed charges,Implant Devices,3669.28,34,,3669.28,percent of total billed charges,Implant Devices,3669.28,34,,3669.28,percent of total billed charges,Implant Devices,3777.2,35,,3777.2,percent of total billed charges,Implant Devices,3777.2,35,,3777.2,percent of total billed charges,Implant Devices,3777.2,35,,3777.2,percent of total billed charges,Implant Devices,3777.2,35,,3777.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3669.28,34,"If Charge > 2,000, then 34 percent",3669.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4316.8,
ACUMED TR-H240R-S RADIAL HD RIGHT 24MM,C1776,HCPCS,,79003734,CDM,278,RC,,,both,,,8176,3226.81,39.4668,,3226.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2861.6,35,,2861.6,percent of total billed charges,Implant Device,2779.84,34,"Charges > $500, x 34%",2779.84,percent of total billed charges,Implant Device,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,3270.4,40,,3270.4,percent of total billed charges,Implant Devices,2861.6,70,,2861.6,percent of total billed charges,Implant Devices,2779.84,34,,2779.84,percent of total billed charges,Implant Devices,2779.84,34,,2779.84,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2779.84,34,"If Charge > 2,000, then 34 percent",2779.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3270.4,
ACUMED TR-S0800-S STEM 8.0X0MM,C1776,HCPCS,,79003737,CDM,278,RC,,,both,,,6951,2743.34,39.4668,,2743.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Device,2363.34,34,"Charges > $500, x 34%",2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2780.4,40,,2780.4,percent of total billed charges,Implant Devices,2432.85,70,,2432.85,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2363.34,34,"If Charge > 2,000, then 34 percent",2363.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2780.4,
ACUMED TR-H200R-S RADIAL HEAD 20MM RT,C1776,HCPCS,,79003745,CDM,278,RC,,,both,,,8176,3226.81,39.4668,,3226.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2779.84,34,,2779.84,percent of total billed charges,Implant Device,2861.6,35,,2861.6,percent of total billed charges,Implant Device,2779.84,34,"Charges > $500, x 34%",2779.84,percent of total billed charges,Implant Device,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,3270.4,40,,3270.4,percent of total billed charges,Implant Devices,2861.6,70,,2861.6,percent of total billed charges,Implant Devices,2779.84,34,,2779.84,percent of total billed charges,Implant Devices,2779.84,34,,2779.84,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,2861.6,35,,2861.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2779.84,34,"If Charge > 2,000, then 34 percent",2779.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3270.4,
ARTHROSURFACE 9122-1015-W ART COMP 1X1.5,C1776,HCPCS,,79003782,CDM,278,RC,,,both,,,6612,2609.54,39.4668,,2609.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2248.08,34,,2248.08,percent of total billed charges,Implant Device,2248.08,34,,2248.08,percent of total billed charges,Implant Device,2248.08,34,,2248.08,percent of total billed charges,Implant Device,2248.08,34,,2248.08,percent of total billed charges,Implant Device,2248.08,34,,2248.08,percent of total billed charges,Implant Device,2248.08,34,,2248.08,percent of total billed charges,Implant Device,2314.2,35,,2314.2,percent of total billed charges,Implant Device,2248.08,34,"Charges > $500, x 34%",2248.08,percent of total billed charges,Implant Device,2314.2,35,,2314.2,percent of total billed charges,Implant Devices,2314.2,35,,2314.2,percent of total billed charges,Implant Devices,2314.2,35,,,percent of total billed charges,Implant Devices,2314.2,35,,2314.2,percent of total billed charges,Implant Devices,2314.2,35,,2314.2,percent of total billed charges,Implant Devices,2644.8,40,,2644.8,percent of total billed charges,Implant Devices,2314.2,70,,2314.2,percent of total billed charges,Implant Devices,2248.08,34,,2248.08,percent of total billed charges,Implant Devices,2248.08,34,,2248.08,percent of total billed charges,Implant Devices,2314.2,35,,2314.2,percent of total billed charges,Implant Devices,2314.2,35,,2314.2,percent of total billed charges,Implant Devices,2314.2,35,,2314.2,percent of total billed charges,Implant Devices,2314.2,35,,2314.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2248.08,34,"If Charge > 2,000, then 34 percent",2248.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2644.8,
BIOMET 154722 TIBIAL IMPLANT SIZE C LEFT,C1776,HCPCS,,79003789,CDM,278,RC,,,both,,,11070,4368.97,39.4668,,4368.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3763.8,34,,3763.8,percent of total billed charges,Implant Device,3763.8,34,,3763.8,percent of total billed charges,Implant Device,3763.8,34,,3763.8,percent of total billed charges,Implant Device,3763.8,34,,3763.8,percent of total billed charges,Implant Device,3763.8,34,,3763.8,percent of total billed charges,Implant Device,3763.8,34,,3763.8,percent of total billed charges,Implant Device,3874.5,35,,3874.5,percent of total billed charges,Implant Device,3763.8,34,"Charges > $500, x 34%",3763.8,percent of total billed charges,Implant Device,3874.5,35,,3874.5,percent of total billed charges,Implant Devices,3874.5,35,,3874.5,percent of total billed charges,Implant Devices,3874.5,35,,,percent of total billed charges,Implant Devices,3874.5,35,,3874.5,percent of total billed charges,Implant Devices,3874.5,35,,3874.5,percent of total billed charges,Implant Devices,4428,40,,4428,percent of total billed charges,Implant Devices,3874.5,70,,3874.5,percent of total billed charges,Implant Devices,3763.8,34,,3763.8,percent of total billed charges,Implant Devices,3763.8,34,,3763.8,percent of total billed charges,Implant Devices,3874.5,35,,3874.5,percent of total billed charges,Implant Devices,3874.5,35,,3874.5,percent of total billed charges,Implant Devices,3874.5,35,,3874.5,percent of total billed charges,Implant Devices,3874.5,35,,3874.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3763.8,34,"If Charge > 2,000, then 34 percent",3763.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4428,
BIOMET 26128 TIBIA PLATE LEFT LAT PROX,C1776,HCPCS,,79003796,CDM,278,RC,,,both,,,6930,2735.05,39.4668,,2735.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2356.2,34,,2356.2,percent of total billed charges,Implant Device,2356.2,34,,2356.2,percent of total billed charges,Implant Device,2356.2,34,,2356.2,percent of total billed charges,Implant Device,2356.2,34,,2356.2,percent of total billed charges,Implant Device,2356.2,34,,2356.2,percent of total billed charges,Implant Device,2356.2,34,,2356.2,percent of total billed charges,Implant Device,2425.5,35,,2425.5,percent of total billed charges,Implant Device,2356.2,34,"Charges > $500, x 34%",2356.2,percent of total billed charges,Implant Device,2425.5,35,,2425.5,percent of total billed charges,Implant Devices,2425.5,35,,2425.5,percent of total billed charges,Implant Devices,2425.5,35,,,percent of total billed charges,Implant Devices,2425.5,35,,2425.5,percent of total billed charges,Implant Devices,2425.5,35,,2425.5,percent of total billed charges,Implant Devices,2772,40,,2772,percent of total billed charges,Implant Devices,2425.5,70,,2425.5,percent of total billed charges,Implant Devices,2356.2,34,,2356.2,percent of total billed charges,Implant Devices,2356.2,34,,2356.2,percent of total billed charges,Implant Devices,2425.5,35,,2425.5,percent of total billed charges,Implant Devices,2425.5,35,,2425.5,percent of total billed charges,Implant Devices,2425.5,35,,2425.5,percent of total billed charges,Implant Devices,2425.5,35,,2425.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2356.2,34,"If Charge > 2,000, then 34 percent",2356.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2772,
BIOMET 11-107128 ACETAB CUP W LINR 62X36,C1776,HCPCS,,79003799,CDM,278,RC,,,both,,,12900,5091.22,39.4668,,5091.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4515,35,,4515,percent of total billed charges,Implant Device,4386,34,"Charges > $500, x 34%",4386,percent of total billed charges,Implant Device,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,5160,40,,5160,percent of total billed charges,Implant Devices,4515,70,,4515,percent of total billed charges,Implant Devices,4386,34,,4386,percent of total billed charges,Implant Devices,4386,34,,4386,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4386,34,"If Charge > 2,000, then 34 percent",4386,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5160,
BIOMET 11-107019 MODULAR HEAD 36X3MM,C1776,HCPCS,,79003801,CDM,278,RC,,,both,,,7920,3125.77,39.4668,,3125.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2772,35,,2772,percent of total billed charges,Implant Device,2692.8,34,"Charges > $500, x 34%",2692.8,percent of total billed charges,Implant Device,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,3168,40,,3168,percent of total billed charges,Implant Devices,2772,70,,2772,percent of total billed charges,Implant Devices,2692.8,34,,2692.8,percent of total billed charges,Implant Devices,2692.8,34,,2692.8,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2692.8,34,"If Charge > 2,000, then 34 percent",2692.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3168,
BIOMET 11-107122 ACETAB CUP 50X36MM,C1776,HCPCS,,79003803,CDM,278,RC,,,both,,,12900,5091.22,39.4668,,5091.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4515,35,,4515,percent of total billed charges,Implant Device,4386,34,"Charges > $500, x 34%",4386,percent of total billed charges,Implant Device,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,5160,40,,5160,percent of total billed charges,Implant Devices,4515,70,,4515,percent of total billed charges,Implant Devices,4386,34,,4386,percent of total billed charges,Implant Devices,4386,34,,4386,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4386,34,"If Charge > 2,000, then 34 percent",4386,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5160,
BIOMET 163660 HEAD COMPONET 28X6MM,C1776,HCPCS,,79003805,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
BIOMET 103202 MOD TAPER LOCK FEM 7.5X135,C1776,HCPCS,,79003807,CDM,278,RC,,,both,,,25920,10229.79,39.4668,,10229.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8812.8,34,,8812.8,percent of total billed charges,Implant Device,8812.8,34,,8812.8,percent of total billed charges,Implant Device,8812.8,34,,8812.8,percent of total billed charges,Implant Device,8812.8,34,,8812.8,percent of total billed charges,Implant Device,8812.8,34,,8812.8,percent of total billed charges,Implant Device,8812.8,34,,8812.8,percent of total billed charges,Implant Device,9072,35,,9072,percent of total billed charges,Implant Device,8812.8,34,"Charges > $500, x 34%",8812.8,percent of total billed charges,Implant Device,9072,35,,9072,percent of total billed charges,Implant Devices,9072,35,,9072,percent of total billed charges,Implant Devices,9072,35,,,percent of total billed charges,Implant Devices,9072,35,,9072,percent of total billed charges,Implant Devices,9072,35,,9072,percent of total billed charges,Implant Devices,10368,40,,10368,percent of total billed charges,Implant Devices,9072,70,,9072,percent of total billed charges,Implant Devices,8812.8,34,,8812.8,percent of total billed charges,Implant Devices,8812.8,34,,8812.8,percent of total billed charges,Implant Devices,9072,35,,9072,percent of total billed charges,Implant Devices,9072,35,,9072,percent of total billed charges,Implant Devices,9072,35,,9072,percent of total billed charges,Implant Devices,9072,35,,9072,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8812.8,34,"If Charge > 2,000, then 34 percent",8812.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10368,
BIOMET 211-242 MODULAR STEM 8X150MM,C1776,HCPCS,,79003808,CDM,278,RC,,,both,,,18834,7433.18,39.4668,,7433.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6403.56,34,,6403.56,percent of total billed charges,Implant Device,6403.56,34,,6403.56,percent of total billed charges,Implant Device,6403.56,34,,6403.56,percent of total billed charges,Implant Device,6403.56,34,,6403.56,percent of total billed charges,Implant Device,6403.56,34,,6403.56,percent of total billed charges,Implant Device,6403.56,34,,6403.56,percent of total billed charges,Implant Device,6591.9,35,,6591.9,percent of total billed charges,Implant Device,6403.56,34,"Charges > $500, x 34%",6403.56,percent of total billed charges,Implant Device,6591.9,35,,6591.9,percent of total billed charges,Implant Devices,6591.9,35,,6591.9,percent of total billed charges,Implant Devices,6591.9,35,,,percent of total billed charges,Implant Devices,6591.9,35,,6591.9,percent of total billed charges,Implant Devices,6591.9,35,,6591.9,percent of total billed charges,Implant Devices,7533.6,40,,7533.6,percent of total billed charges,Implant Devices,6591.9,70,,6591.9,percent of total billed charges,Implant Devices,6403.56,34,,6403.56,percent of total billed charges,Implant Devices,6403.56,34,,6403.56,percent of total billed charges,Implant Devices,6591.9,35,,6591.9,percent of total billed charges,Implant Devices,6591.9,35,,6591.9,percent of total billed charges,Implant Devices,6591.9,35,,6591.9,percent of total billed charges,Implant Devices,6591.9,35,,6591.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6403.56,34,"If Charge > 2,000, then 34 percent",6403.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7533.6,
BIOMET 11-107017 MOD HEAD 36X3MM TAPER,C1776,HCPCS,,79003811,CDM,278,RC,,,both,,,7920,3125.77,39.4668,,3125.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2692.8,34,,2692.8,percent of total billed charges,Implant Device,2772,35,,2772,percent of total billed charges,Implant Device,2692.8,34,"Charges > $500, x 34%",2692.8,percent of total billed charges,Implant Device,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,3168,40,,3168,percent of total billed charges,Implant Devices,2772,70,,2772,percent of total billed charges,Implant Devices,2692.8,34,,2692.8,percent of total billed charges,Implant Devices,2692.8,34,,2692.8,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,2772,35,,2772,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2692.8,34,"If Charge > 2,000, then 34 percent",2692.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3168,
BIOMET 211242 COMPRHNSV SEG STEM 8X150MM,C1776,HCPCS,,79003812,CDM,278,RC,,,both,,,18180,7175.06,39.4668,,7175.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6181.2,34,,6181.2,percent of total billed charges,Implant Device,6181.2,34,,6181.2,percent of total billed charges,Implant Device,6181.2,34,,6181.2,percent of total billed charges,Implant Device,6181.2,34,,6181.2,percent of total billed charges,Implant Device,6181.2,34,,6181.2,percent of total billed charges,Implant Device,6181.2,34,,6181.2,percent of total billed charges,Implant Device,6363,35,,6363,percent of total billed charges,Implant Device,6181.2,34,"Charges > $500, x 34%",6181.2,percent of total billed charges,Implant Device,6363,35,,6363,percent of total billed charges,Implant Devices,6363,35,,6363,percent of total billed charges,Implant Devices,6363,35,,,percent of total billed charges,Implant Devices,6363,35,,6363,percent of total billed charges,Implant Devices,6363,35,,6363,percent of total billed charges,Implant Devices,7272,40,,7272,percent of total billed charges,Implant Devices,6363,70,,6363,percent of total billed charges,Implant Devices,6181.2,34,,6181.2,percent of total billed charges,Implant Devices,6181.2,34,,6181.2,percent of total billed charges,Implant Devices,6363,35,,6363,percent of total billed charges,Implant Devices,6363,35,,6363,percent of total billed charges,Implant Devices,6363,35,,6363,percent of total billed charges,Implant Devices,6363,35,,6363,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6181.2,34,"If Charge > 2,000, then 34 percent",6181.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7272,
BIOMET 2000-5145 CURVED ROD 45MM,C1776,HCPCS,,79003814,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
BIOMET 113022 VERSA-DIAL SHOULDER SYS,C1776,HCPCS,,79003815,CDM,278,RC,,,both,,,9120,3599.37,39.4668,,3599.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3192,35,,3192,percent of total billed charges,Implant Device,3100.8,34,"Charges > $500, x 34%",3100.8,percent of total billed charges,Implant Device,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3648,40,,3648,percent of total billed charges,Implant Devices,3192,70,,3192,percent of total billed charges,Implant Devices,3100.8,34,,3100.8,percent of total billed charges,Implant Devices,3100.8,34,,3100.8,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3100.8,34,"If Charge > 2,000, then 34 percent",3100.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3648,
BIOMET 162657 DISTAL CENTRALIZER 11MM,C1776,HCPCS,,79003825,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
BIOMET 154602 FEMORAL IMPLANT LARGE,C1776,HCPCS,,79003826,CDM,278,RC,,,both,,,21360,8430.11,39.4668,,8430.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7262.4,34,,7262.4,percent of total billed charges,Implant Device,7262.4,34,,7262.4,percent of total billed charges,Implant Device,7262.4,34,,7262.4,percent of total billed charges,Implant Device,7262.4,34,,7262.4,percent of total billed charges,Implant Device,7262.4,34,,7262.4,percent of total billed charges,Implant Device,7262.4,34,,7262.4,percent of total billed charges,Implant Device,7476,35,,7476,percent of total billed charges,Implant Device,7262.4,34,"Charges > $500, x 34%",7262.4,percent of total billed charges,Implant Device,7476,35,,7476,percent of total billed charges,Implant Devices,7476,35,,7476,percent of total billed charges,Implant Devices,7476,35,,,percent of total billed charges,Implant Devices,7476,35,,7476,percent of total billed charges,Implant Devices,7476,35,,7476,percent of total billed charges,Implant Devices,8544,40,,8544,percent of total billed charges,Implant Devices,7476,70,,7476,percent of total billed charges,Implant Devices,7262.4,34,,7262.4,percent of total billed charges,Implant Devices,7262.4,34,,7262.4,percent of total billed charges,Implant Devices,7476,35,,7476,percent of total billed charges,Implant Devices,7476,35,,7476,percent of total billed charges,Implant Devices,7476,35,,7476,percent of total billed charges,Implant Devices,7476,35,,7476,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7262.4,34,"If Charge > 2,000, then 34 percent",7262.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8544,
BIOMET 159575 MENISCAL BEARING MED RT3MM,C1776,HCPCS,,79003827,CDM,278,RC,,,both,,,5190,2048.33,39.4668,,2048.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1816.5,35,,1816.5,percent of total billed charges,Implant Device,1764.6,34,"Charges > $500, x 34%",1764.6,percent of total billed charges,Implant Device,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,2076,40,,2076,percent of total billed charges,Implant Devices,1816.5,70,,1816.5,percent of total billed charges,Implant Devices,1764.6,34,,1764.6,percent of total billed charges,Implant Devices,1764.6,34,,1764.6,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1764.6,34,"If Charge > 2,000, then 34 percent",1764.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2076,
BIOMET 113952 HYBRIDD GLENOID BASE 4MM,C1776,HCPCS,,79003829,CDM,278,RC,,,both,,,7800,3078.41,39.4668,,3078.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2730,35,,2730,percent of total billed charges,Implant Device,2652,34,"Charges > $500, x 34%",2652,percent of total billed charges,Implant Device,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,3120,40,,3120,percent of total billed charges,Implant Devices,2730,70,,2730,percent of total billed charges,Implant Devices,2652,34,,2652,percent of total billed charges,Implant Devices,2652,34,,2652,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2652,34,"If Charge > 2,000, then 34 percent",2652,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3120,
BIOMET 11-114644 HUMERAL HEAD SIZE 4,C1776,HCPCS,,79003834,CDM,278,RC,,,both,,,21990,8678.75,39.4668,,8678.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7476.6,34,,7476.6,percent of total billed charges,Implant Device,7476.6,34,,7476.6,percent of total billed charges,Implant Device,7476.6,34,,7476.6,percent of total billed charges,Implant Device,7476.6,34,,7476.6,percent of total billed charges,Implant Device,7476.6,34,,7476.6,percent of total billed charges,Implant Device,7476.6,34,,7476.6,percent of total billed charges,Implant Device,7696.5,35,,7696.5,percent of total billed charges,Implant Device,7476.6,34,"Charges > $500, x 34%",7476.6,percent of total billed charges,Implant Device,7696.5,35,,7696.5,percent of total billed charges,Implant Devices,7696.5,35,,7696.5,percent of total billed charges,Implant Devices,7696.5,35,,,percent of total billed charges,Implant Devices,7696.5,35,,7696.5,percent of total billed charges,Implant Devices,7696.5,35,,7696.5,percent of total billed charges,Implant Devices,8796,40,,8796,percent of total billed charges,Implant Devices,7696.5,70,,7696.5,percent of total billed charges,Implant Devices,7476.6,34,,7476.6,percent of total billed charges,Implant Devices,7476.6,34,,7476.6,percent of total billed charges,Implant Devices,7696.5,35,,7696.5,percent of total billed charges,Implant Devices,7696.5,35,,7696.5,percent of total billed charges,Implant Devices,7696.5,35,,7696.5,percent of total billed charges,Implant Devices,7696.5,35,,7696.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7476.6,34,"If Charge > 2,000, then 34 percent",7476.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8796,
BIOMET 11-165214 ACETABULAR CUP 28X45MM,C1776,HCPCS,,79003835,CDM,278,RC,,,both,,,6540,2581.13,39.4668,,2581.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2289,35,,2289,percent of total billed charges,Implant Device,2223.6,34,"Charges > $500, x 34%",2223.6,percent of total billed charges,Implant Device,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2616,40,,2616,percent of total billed charges,Implant Devices,2289,70,,2289,percent of total billed charges,Implant Devices,2223.6,34,,2223.6,percent of total billed charges,Implant Devices,2223.6,34,,2223.6,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2223.6,34,"If Charge > 2,000, then 34 percent",2223.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2616,
EXACTECH 300-01-13 HUMERAL STEM 13MM,C1776,HCPCS,,79003855,CDM,278,RC,,,both,,,4425,1746.41,39.4668,,1746.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Device,1504.5,34,"Charges > $500, x 34%",1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1770,40,,1770,percent of total billed charges,Implant Devices,1548.75,70,,1548.75,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1504.5,34,"If Charge > 2,000, then 34 percent",1504.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1770,
EXACTECH 314-02-13 GLENOID CEMENTED MED,C1776,HCPCS,,79003856,CDM,278,RC,,,both,,,4333,1710.1,39.4668,,1710.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1473.22,34,,1473.22,percent of total billed charges,Implant Device,1516.55,35,,1516.55,percent of total billed charges,Implant Device,1473.22,34,"Charges > $500, x 34%",1473.22,percent of total billed charges,Implant Device,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1733.2,40,,1733.2,percent of total billed charges,Implant Devices,1516.55,70,,1516.55,percent of total billed charges,Implant Devices,1473.22,34,,1473.22,percent of total billed charges,Implant Devices,1473.22,34,,1473.22,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,1516.55,35,,1516.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1473.22,34,"If Charge > 2,000, then 34 percent",1473.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1733.2,
EXACTECH 310-01-47 HUMERAL HEAD 47X18MM,C1776,HCPCS,,79003857,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
BIOMET 8352-7070-W HEMICAP 35MM ART COMP,C1776,HCPCS,,79003867,CDM,278,RC,,,both,,,13824,5455.89,39.4668,,5455.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4700.16,34,,4700.16,percent of total billed charges,Implant Device,4700.16,34,,4700.16,percent of total billed charges,Implant Device,4700.16,34,,4700.16,percent of total billed charges,Implant Device,4700.16,34,,4700.16,percent of total billed charges,Implant Device,4700.16,34,,4700.16,percent of total billed charges,Implant Device,4700.16,34,,4700.16,percent of total billed charges,Implant Device,4838.4,35,,4838.4,percent of total billed charges,Implant Device,4700.16,34,"Charges > $500, x 34%",4700.16,percent of total billed charges,Implant Device,4838.4,35,,4838.4,percent of total billed charges,Implant Devices,4838.4,35,,4838.4,percent of total billed charges,Implant Devices,4838.4,35,,,percent of total billed charges,Implant Devices,4838.4,35,,4838.4,percent of total billed charges,Implant Devices,4838.4,35,,4838.4,percent of total billed charges,Implant Devices,5529.6,40,,5529.6,percent of total billed charges,Implant Devices,4838.4,70,,4838.4,percent of total billed charges,Implant Devices,4700.16,34,,4700.16,percent of total billed charges,Implant Devices,4700.16,34,,4700.16,percent of total billed charges,Implant Devices,4838.4,35,,4838.4,percent of total billed charges,Implant Devices,4838.4,35,,4838.4,percent of total billed charges,Implant Devices,4838.4,35,,4838.4,percent of total billed charges,Implant Devices,4838.4,35,,4838.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4700.16,34,"If Charge > 2,000, then 34 percent",4700.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5529.6,
BIOMET 159560 MENISCAL BEARING LG LT 9MM,C1776,HCPCS,,79003869,CDM,278,RC,,,both,,,5190,2048.33,39.4668,,2048.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1764.6,34,,1764.6,percent of total billed charges,Implant Device,1816.5,35,,1816.5,percent of total billed charges,Implant Device,1764.6,34,"Charges > $500, x 34%",1764.6,percent of total billed charges,Implant Device,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,2076,40,,2076,percent of total billed charges,Implant Devices,1816.5,70,,1816.5,percent of total billed charges,Implant Devices,1764.6,34,,1764.6,percent of total billed charges,Implant Devices,1764.6,34,,1764.6,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,1816.5,35,,1816.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1764.6,34,"If Charge > 2,000, then 34 percent",1764.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2076,
BIOMET 162659 CENTRALIZER DISTAL 15MM,C1776,HCPCS,,79003871,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
DEPUY 1570-11-090 FEM STEM 12/14 TAPER,C1776,HCPCS,,79003884,CDM,278,RC,,,both,,,10469,4131.78,39.4668,,4131.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3664.15,35,,3664.15,percent of total billed charges,Implant Device,3559.46,34,"Charges > $500, x 34%",3559.46,percent of total billed charges,Implant Device,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,4187.6,40,,4187.6,percent of total billed charges,Implant Devices,3664.15,70,,3664.15,percent of total billed charges,Implant Devices,3559.46,34,,3559.46,percent of total billed charges,Implant Devices,3559.46,34,,3559.46,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3559.46,34,"If Charge > 2,000, then 34 percent",3559.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4187.6,
DEPUY 1570-06-150 BASIC CEMENTED SZ8,C1776,HCPCS,,79003885,CDM,278,RC,,,both,,,4692,1851.78,39.4668,,1851.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1595.28,34,,1595.28,percent of total billed charges,Implant Device,1595.28,34,,1595.28,percent of total billed charges,Implant Device,1595.28,34,,1595.28,percent of total billed charges,Implant Device,1595.28,34,,1595.28,percent of total billed charges,Implant Device,1595.28,34,,1595.28,percent of total billed charges,Implant Device,1595.28,34,,1595.28,percent of total billed charges,Implant Device,1642.2,35,,1642.2,percent of total billed charges,Implant Device,1595.28,34,"Charges > $500, x 34%",1595.28,percent of total billed charges,Implant Device,1642.2,35,,1642.2,percent of total billed charges,Implant Devices,1642.2,35,,1642.2,percent of total billed charges,Implant Devices,1642.2,35,,,percent of total billed charges,Implant Devices,1642.2,35,,1642.2,percent of total billed charges,Implant Devices,1642.2,35,,1642.2,percent of total billed charges,Implant Devices,1876.8,40,,1876.8,percent of total billed charges,Implant Devices,1642.2,70,,1642.2,percent of total billed charges,Implant Devices,1595.28,34,,1595.28,percent of total billed charges,Implant Devices,1595.28,34,,1595.28,percent of total billed charges,Implant Devices,1642.2,35,,1642.2,percent of total billed charges,Implant Devices,1642.2,35,,1642.2,percent of total billed charges,Implant Devices,1642.2,35,,1642.2,percent of total billed charges,Implant Devices,1642.2,35,,1642.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1595.28,34,"If Charge > 2,000, then 34 percent",1595.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1876.8,
DEPUY 1570-01-120 FEM STEM 12/14 TAPER,C1776,HCPCS,,79003890,CDM,278,RC,,,both,,,11846,4675.24,39.4668,,4675.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4146.1,35,,4146.1,percent of total billed charges,Implant Device,4027.64,34,"Charges > $500, x 34%",4027.64,percent of total billed charges,Implant Device,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4738.4,40,,4738.4,percent of total billed charges,Implant Devices,4146.1,70,,4146.1,percent of total billed charges,Implant Devices,4027.64,34,,4027.64,percent of total billed charges,Implant Devices,4027.64,34,,4027.64,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4027.64,34,"If Charge > 2,000, then 34 percent",4027.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4738.4,
DEPUY 1570-01-110 FEM STEM 12/14 TAPER,C1776,HCPCS,,79003893,CDM,278,RC,,,both,,,11846,4675.24,39.4668,,4675.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4146.1,35,,4146.1,percent of total billed charges,Implant Device,4027.64,34,"Charges > $500, x 34%",4027.64,percent of total billed charges,Implant Device,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4738.4,40,,4738.4,percent of total billed charges,Implant Devices,4146.1,70,,4146.1,percent of total billed charges,Implant Devices,4027.64,34,,4027.64,percent of total billed charges,Implant Devices,4027.64,34,,4027.64,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4027.64,34,"If Charge > 2,000, then 34 percent",4027.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4738.4,
DEPUY 1987-25-414 STEM STR CMTD 14X125,C1776,HCPCS,,79003897,CDM,278,RC,,,both,,,11555,4560.39,39.4668,,4560.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3928.7,34,,3928.7,percent of total billed charges,Implant Device,3928.7,34,,3928.7,percent of total billed charges,Implant Device,3928.7,34,,3928.7,percent of total billed charges,Implant Device,3928.7,34,,3928.7,percent of total billed charges,Implant Device,3928.7,34,,3928.7,percent of total billed charges,Implant Device,3928.7,34,,3928.7,percent of total billed charges,Implant Device,4044.25,35,,4044.25,percent of total billed charges,Implant Device,3928.7,34,"Charges > $500, x 34%",3928.7,percent of total billed charges,Implant Device,4044.25,35,,4044.25,percent of total billed charges,Implant Devices,4044.25,35,,4044.25,percent of total billed charges,Implant Devices,4044.25,35,,,percent of total billed charges,Implant Devices,4044.25,35,,4044.25,percent of total billed charges,Implant Devices,4044.25,35,,4044.25,percent of total billed charges,Implant Devices,4622,40,,4622,percent of total billed charges,Implant Devices,4044.25,70,,4044.25,percent of total billed charges,Implant Devices,3928.7,34,,3928.7,percent of total billed charges,Implant Devices,3928.7,34,,3928.7,percent of total billed charges,Implant Devices,4044.25,35,,4044.25,percent of total billed charges,Implant Devices,4044.25,35,,4044.25,percent of total billed charges,Implant Devices,4044.25,35,,4044.25,percent of total billed charges,Implant Devices,4044.25,35,,4044.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3928.7,34,"If Charge > 2,000, then 34 percent",3928.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4622,
DEPUY 1570-01-135 FEM STEM TAPRD SZ 7,C1776,HCPCS,,79003898,CDM,278,RC,,,both,,,11846,4675.24,39.4668,,4675.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4146.1,35,,4146.1,percent of total billed charges,Implant Device,4027.64,34,"Charges > $500, x 34%",4027.64,percent of total billed charges,Implant Device,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4738.4,40,,4738.4,percent of total billed charges,Implant Devices,4146.1,70,,4146.1,percent of total billed charges,Implant Devices,4027.64,34,,4027.64,percent of total billed charges,Implant Devices,4027.64,34,,4027.64,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4027.64,34,"If Charge > 2,000, then 34 percent",4027.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4738.4,
DEPUY 1376-47-000 STEM CENTRALIZR 9.25MM,C1776,HCPCS,,79003900,CDM,278,RC,,,both,,,524,206.81,39.4668,,206.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,178.16,34,,178.16,percent of total billed charges,Implant Device,178.16,34,,178.16,percent of total billed charges,Implant Device,178.16,34,,178.16,percent of total billed charges,Implant Device,178.16,34,,178.16,percent of total billed charges,Implant Device,178.16,34,,178.16,percent of total billed charges,Implant Device,178.16,34,,178.16,percent of total billed charges,Implant Device,183.4,35,,183.4,percent of total billed charges,Implant Device,178.16,34,"Charges > $500, x 34%",178.16,percent of total billed charges,Implant Device,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,209.6,40,,209.6,percent of total billed charges,Implant Devices,183.4,70,,183.4,percent of total billed charges,Implant Devices,178.16,34,,178.16,percent of total billed charges,Implant Devices,178.16,34,,178.16,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,183.4,35,,183.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.6,
DEPUY 1365-36-310 FEMORAL HEAD +1.5 36MM,C1776,HCPCS,,79003901,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
DEPUY 1365-14-000 FEM HEAD 12/14 CONE,C1776,HCPCS,,79003905,CDM,278,RC,,,both,,,1710,674.88,39.4668,,674.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,598.5,35,,598.5,percent of total billed charges,Implant Device,581.4,34,"Charges > $500, x 34%",581.4,percent of total billed charges,Implant Device,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,684,40,,684,percent of total billed charges,Implant Devices,598.5,70,,598.5,percent of total billed charges,Implant Devices,581.4,34,,581.4,percent of total billed charges,Implant Devices,581.4,34,,581.4,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,684,
DEPUY 1987-14-111 DIST FEM COMP SZ XSM,C1776,HCPCS,,79003909,CDM,278,RC,,,both,,,32693,12902.88,39.4668,,12902.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11442.55,35,,11442.55,percent of total billed charges,Implant Device,11115.62,34,"Charges > $500, x 34%",11115.62,percent of total billed charges,Implant Device,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,13077.2,40,,13077.2,percent of total billed charges,Implant Devices,11442.55,70,,11442.55,percent of total billed charges,Implant Devices,11115.62,34,,11115.62,percent of total billed charges,Implant Devices,11115.62,34,,11115.62,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11115.62,34,"If Charge > 2,000, then 34 percent",11115.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13077.2,
DEPUY 1570-01-165 FEM STEM 12/14 TAPER,C1776,HCPCS,,79003912,CDM,278,RC,,,both,,,10992,4338.19,39.4668,,4338.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3737.28,34,,3737.28,percent of total billed charges,Implant Device,3737.28,34,,3737.28,percent of total billed charges,Implant Device,3737.28,34,,3737.28,percent of total billed charges,Implant Device,3737.28,34,,3737.28,percent of total billed charges,Implant Device,3737.28,34,,3737.28,percent of total billed charges,Implant Device,3737.28,34,,3737.28,percent of total billed charges,Implant Device,3847.2,35,,3847.2,percent of total billed charges,Implant Device,3737.28,34,"Charges > $500, x 34%",3737.28,percent of total billed charges,Implant Device,3847.2,35,,3847.2,percent of total billed charges,Implant Devices,3847.2,35,,3847.2,percent of total billed charges,Implant Devices,3847.2,35,,,percent of total billed charges,Implant Devices,3847.2,35,,3847.2,percent of total billed charges,Implant Devices,3847.2,35,,3847.2,percent of total billed charges,Implant Devices,4396.8,40,,4396.8,percent of total billed charges,Implant Devices,3847.2,70,,3847.2,percent of total billed charges,Implant Devices,3737.28,34,,3737.28,percent of total billed charges,Implant Devices,3737.28,34,,3737.28,percent of total billed charges,Implant Devices,3847.2,35,,3847.2,percent of total billed charges,Implant Devices,3847.2,35,,3847.2,percent of total billed charges,Implant Devices,3847.2,35,,3847.2,percent of total billed charges,Implant Devices,3847.2,35,,3847.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3737.28,34,"If Charge > 2,000, then 34 percent",3737.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4396.8,
DEPUY 1365-36-710-REV FEM HEAD 36MM,C1776,HCPCS,,79003914,CDM,278,RC,,,both,,,9349,3689.75,39.4668,,3689.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3272.15,35,,3272.15,percent of total billed charges,Implant Device,3178.66,34,"Charges > $500, x 34%",3178.66,percent of total billed charges,Implant Device,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3739.6,40,,3739.6,percent of total billed charges,Implant Devices,3272.15,70,,3272.15,percent of total billed charges,Implant Devices,3178.66,34,,3178.66,percent of total billed charges,Implant Devices,3178.66,34,,3178.66,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3178.66,34,"If Charge > 2,000, then 34 percent",3178.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3739.6,
DEPUY 1987-14-105 FEM COMP XS RIGHT,C1776,HCPCS,,79003916,CDM,278,RC,,,both,,,26440,10435.02,39.4668,,10435.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8989.6,34,,8989.6,percent of total billed charges,Implant Device,8989.6,34,,8989.6,percent of total billed charges,Implant Device,8989.6,34,,8989.6,percent of total billed charges,Implant Device,8989.6,34,,8989.6,percent of total billed charges,Implant Device,8989.6,34,,8989.6,percent of total billed charges,Implant Device,8989.6,34,,8989.6,percent of total billed charges,Implant Device,9254,35,,9254,percent of total billed charges,Implant Device,8989.6,34,"Charges > $500, x 34%",8989.6,percent of total billed charges,Implant Device,9254,35,,9254,percent of total billed charges,Implant Devices,9254,35,,9254,percent of total billed charges,Implant Devices,9254,35,,,percent of total billed charges,Implant Devices,9254,35,,9254,percent of total billed charges,Implant Devices,9254,35,,9254,percent of total billed charges,Implant Devices,10576,40,,10576,percent of total billed charges,Implant Devices,9254,70,,9254,percent of total billed charges,Implant Devices,8989.6,34,,8989.6,percent of total billed charges,Implant Devices,8989.6,34,,8989.6,percent of total billed charges,Implant Devices,9254,35,,9254,percent of total billed charges,Implant Devices,9254,35,,9254,percent of total billed charges,Implant Devices,9254,35,,9254,percent of total billed charges,Implant Devices,9254,35,,9254,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8989.6,34,"If Charge > 2,000, then 34 percent",8989.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10576,
DEPUY 1363-51-000 FRACTURE HEAD HIP 51MM,C1776,HCPCS,,79003919,CDM,278,RC,,,both,,,894,352.83,39.4668,,352.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,303.96,34,,303.96,percent of total billed charges,Implant Device,303.96,34,,303.96,percent of total billed charges,Implant Device,303.96,34,,303.96,percent of total billed charges,Implant Device,303.96,34,,303.96,percent of total billed charges,Implant Device,303.96,34,,303.96,percent of total billed charges,Implant Device,303.96,34,,303.96,percent of total billed charges,Implant Device,312.9,35,,312.9,percent of total billed charges,Implant Device,303.96,34,"Charges > $500, x 34%",303.96,percent of total billed charges,Implant Device,312.9,35,,312.9,percent of total billed charges,Implant Devices,312.9,35,,312.9,percent of total billed charges,Implant Devices,312.9,35,,,percent of total billed charges,Implant Devices,312.9,35,,312.9,percent of total billed charges,Implant Devices,312.9,35,,312.9,percent of total billed charges,Implant Devices,357.6,40,,357.6,percent of total billed charges,Implant Devices,312.9,70,,312.9,percent of total billed charges,Implant Devices,303.96,34,,303.96,percent of total billed charges,Implant Devices,303.96,34,,303.96,percent of total billed charges,Implant Devices,312.9,35,,312.9,percent of total billed charges,Implant Devices,312.9,35,,312.9,percent of total billed charges,Implant Devices,312.9,35,,312.9,percent of total billed charges,Implant Devices,312.9,35,,312.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357.6,
DEPUY 1987-07-045 LPS SEGMENTAL COMP 45M,C1776,HCPCS,,79003922,CDM,278,RC,,,both,,,6266,2472.99,39.4668,,2472.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2130.44,34,,2130.44,percent of total billed charges,Implant Device,2130.44,34,,2130.44,percent of total billed charges,Implant Device,2130.44,34,,2130.44,percent of total billed charges,Implant Device,2130.44,34,,2130.44,percent of total billed charges,Implant Device,2130.44,34,,2130.44,percent of total billed charges,Implant Device,2130.44,34,,2130.44,percent of total billed charges,Implant Device,2193.1,35,,2193.1,percent of total billed charges,Implant Device,2130.44,34,"Charges > $500, x 34%",2130.44,percent of total billed charges,Implant Device,2193.1,35,,2193.1,percent of total billed charges,Implant Devices,2193.1,35,,2193.1,percent of total billed charges,Implant Devices,2193.1,35,,,percent of total billed charges,Implant Devices,2193.1,35,,2193.1,percent of total billed charges,Implant Devices,2193.1,35,,2193.1,percent of total billed charges,Implant Devices,2506.4,40,,2506.4,percent of total billed charges,Implant Devices,2193.1,70,,2193.1,percent of total billed charges,Implant Devices,2130.44,34,,2130.44,percent of total billed charges,Implant Devices,2130.44,34,,2130.44,percent of total billed charges,Implant Devices,2193.1,35,,2193.1,percent of total billed charges,Implant Devices,2193.1,35,,2193.1,percent of total billed charges,Implant Devices,2193.1,35,,2193.1,percent of total billed charges,Implant Devices,2193.1,35,,2193.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2130.44,34,"If Charge > 2,000, then 34 percent",2130.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2506.4,
DEPUY 8141-32-005 POLYAX TIB PLATE 5HOLE,C1776,HCPCS,,79003923,CDM,278,RC,,,both,,,7320,2888.97,39.4668,,2888.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Device,2488.8,34,"Charges > $500, x 34%",2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2928,40,,2928,percent of total billed charges,Implant Devices,2562,70,,2562,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2488.8,34,"If Charge > 2,000, then 34 percent",2488.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2928,
DEPUY 1217-32-052 ACETABLR SHELL 52MM,C1776,HCPCS,,79003924,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1368,
DEPUY 1987-25-112 CEMENTED STEM 12X100MM,C1776,HCPCS,,79003937,CDM,278,RC,,,both,,,11197,4419.1,39.4668,,4419.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3806.98,34,,3806.98,percent of total billed charges,Implant Device,3806.98,34,,3806.98,percent of total billed charges,Implant Device,3806.98,34,,3806.98,percent of total billed charges,Implant Device,3806.98,34,,3806.98,percent of total billed charges,Implant Device,3806.98,34,,3806.98,percent of total billed charges,Implant Device,3806.98,34,,3806.98,percent of total billed charges,Implant Device,3918.95,35,,3918.95,percent of total billed charges,Implant Device,3806.98,34,"Charges > $500, x 34%",3806.98,percent of total billed charges,Implant Device,3918.95,35,,3918.95,percent of total billed charges,Implant Devices,3918.95,35,,3918.95,percent of total billed charges,Implant Devices,3918.95,35,,,percent of total billed charges,Implant Devices,3918.95,35,,3918.95,percent of total billed charges,Implant Devices,3918.95,35,,3918.95,percent of total billed charges,Implant Devices,4478.8,40,,4478.8,percent of total billed charges,Implant Devices,3918.95,70,,3918.95,percent of total billed charges,Implant Devices,3806.98,34,,3806.98,percent of total billed charges,Implant Devices,3806.98,34,,3806.98,percent of total billed charges,Implant Devices,3918.95,35,,3918.95,percent of total billed charges,Implant Devices,3918.95,35,,3918.95,percent of total billed charges,Implant Devices,3918.95,35,,3918.95,percent of total billed charges,Implant Devices,3918.95,35,,3918.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3806.98,34,"If Charge > 2,000, then 34 percent",3806.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4478.8,
DEPUY 1570-06-090 SUMMIT BASIC CEM SZ 3,C1776,HCPCS,,79003939,CDM,278,RC,,,both,,,5575,2200.27,39.4668,,2200.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1951.25,35,,1951.25,percent of total billed charges,Implant Device,1895.5,34,"Charges > $500, x 34%",1895.5,percent of total billed charges,Implant Device,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,2230,40,,2230,percent of total billed charges,Implant Devices,1951.25,70,,1951.25,percent of total billed charges,Implant Devices,1895.5,34,,1895.5,percent of total billed charges,Implant Devices,1895.5,34,,1895.5,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1895.5,34,"If Charge > 2,000, then 34 percent",1895.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2230,
DEPUY 1035-50-000 BIPOLAR SELF CNT 28X50,C1776,HCPCS,,79003940,CDM,278,RC,,,both,,,1733,683.96,39.4668,,683.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Device,589.22,34,"Charges > $500, x 34%",589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,693.2,40,,693.2,percent of total billed charges,Implant Devices,606.55,70,,606.55,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,693.2,
DEPUY 1035-45-000 HEAD BIPOLAR 28X45MM,C1776,HCPCS,,79003941,CDM,278,RC,,,both,,,4030,1590.51,39.4668,,1590.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Device,1370.2,34,"Charges > $500, x 34%",1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1612,40,,1612,percent of total billed charges,Implant Devices,1410.5,70,,1410.5,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1370.2,34,"If Charge > 2,000, then 34 percent",1370.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1612,
DEPUY 1376-21-000 CENTRALIZER DIA 12MM,C1776,HCPCS,,79003942,CDM,278,RC,,,both,,,5280,2083.85,39.4668,,2083.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1795.2,34,,1795.2,percent of total billed charges,Implant Device,1795.2,34,,1795.2,percent of total billed charges,Implant Device,1795.2,34,,1795.2,percent of total billed charges,Implant Device,1795.2,34,,1795.2,percent of total billed charges,Implant Device,1795.2,34,,1795.2,percent of total billed charges,Implant Device,1795.2,34,,1795.2,percent of total billed charges,Implant Device,1848,35,,1848,percent of total billed charges,Implant Device,1795.2,34,"Charges > $500, x 34%",1795.2,percent of total billed charges,Implant Device,1848,35,,1848,percent of total billed charges,Implant Devices,1848,35,,1848,percent of total billed charges,Implant Devices,1848,35,,,percent of total billed charges,Implant Devices,1848,35,,1848,percent of total billed charges,Implant Devices,1848,35,,1848,percent of total billed charges,Implant Devices,2112,40,,2112,percent of total billed charges,Implant Devices,1848,70,,1848,percent of total billed charges,Implant Devices,1795.2,34,,1795.2,percent of total billed charges,Implant Devices,1795.2,34,,1795.2,percent of total billed charges,Implant Devices,1848,35,,1848,percent of total billed charges,Implant Devices,1848,35,,1848,percent of total billed charges,Implant Devices,1848,35,,1848,percent of total billed charges,Implant Devices,1848,35,,1848,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1795.2,34,"If Charge > 2,000, then 34 percent",1795.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2112,
DEPUY 1570-11-100 HIP SYS 12/14SZ4 140MM,C1776,HCPCS,,79003954,CDM,278,RC,,,both,,,10469,4131.78,39.4668,,4131.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3559.46,34,,3559.46,percent of total billed charges,Implant Device,3664.15,35,,3664.15,percent of total billed charges,Implant Device,3559.46,34,"Charges > $500, x 34%",3559.46,percent of total billed charges,Implant Device,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,4187.6,40,,4187.6,percent of total billed charges,Implant Devices,3664.15,70,,3664.15,percent of total billed charges,Implant Devices,3559.46,34,,3559.46,percent of total billed charges,Implant Devices,3559.46,34,,3559.46,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,3664.15,35,,3664.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3559.46,34,"If Charge > 2,000, then 34 percent",3559.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4187.6,
DEPUY 1221-36-152 POLY LINER 36X52MM,C1776,HCPCS,,79003959,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
DEPUY 1294-35-125 TIB TRAY SZ 2.5,C1776,HCPCS,,79003961,CDM,278,RC,,,both,,,11227,4430.94,39.4668,,4430.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3929.45,35,,3929.45,percent of total billed charges,Implant Device,3817.18,34,"Charges > $500, x 34%",3817.18,percent of total billed charges,Implant Device,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,4490.8,40,,4490.8,percent of total billed charges,Implant Devices,3929.45,70,,3929.45,percent of total billed charges,Implant Devices,3817.18,34,,3817.18,percent of total billed charges,Implant Devices,3817.18,34,,3817.18,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3817.18,34,"If Charge > 2,000, then 34 percent",3817.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4490.8,
DEPUY 1035-48-000 BIPOLAR HEAD 28MM,C1776,HCPCS,,79003962,CDM,278,RC,,,both,,,4030,1590.51,39.4668,,1590.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Device,1370.2,34,"Charges > $500, x 34%",1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1612,40,,1612,percent of total billed charges,Implant Devices,1410.5,70,,1410.5,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1370.2,34,"If Charge > 2,000, then 34 percent",1370.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1612,
DEPUY 1035-55-000 BIPOLAR HEAD 28X55MM,C1776,HCPCS,,79003963,CDM,278,RC,,,both,,,1733,683.96,39.4668,,683.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Device,589.22,34,"Charges > $500, x 34%",589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,693.2,40,,693.2,percent of total billed charges,Implant Devices,606.55,70,,606.55,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,693.2,
STRYKER 6276-7-216 HIP STEM 195X16MM,C1776,HCPCS,,79003965,CDM,278,RC,,,both,,,15612,6161.56,39.4668,,6161.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5308.08,34,,5308.08,percent of total billed charges,Implant Device,5308.08,34,,5308.08,percent of total billed charges,Implant Device,5308.08,34,,5308.08,percent of total billed charges,Implant Device,5308.08,34,,5308.08,percent of total billed charges,Implant Device,5308.08,34,,5308.08,percent of total billed charges,Implant Device,5308.08,34,,5308.08,percent of total billed charges,Implant Device,5464.2,35,,5464.2,percent of total billed charges,Implant Device,5308.08,34,"Charges > $500, x 34%",5308.08,percent of total billed charges,Implant Device,5464.2,35,,5464.2,percent of total billed charges,Implant Devices,5464.2,35,,5464.2,percent of total billed charges,Implant Devices,5464.2,35,,,percent of total billed charges,Implant Devices,5464.2,35,,5464.2,percent of total billed charges,Implant Devices,5464.2,35,,5464.2,percent of total billed charges,Implant Devices,6244.8,40,,6244.8,percent of total billed charges,Implant Devices,5464.2,70,,5464.2,percent of total billed charges,Implant Devices,5308.08,34,,5308.08,percent of total billed charges,Implant Devices,5308.08,34,,5308.08,percent of total billed charges,Implant Devices,5464.2,35,,5464.2,percent of total billed charges,Implant Devices,5464.2,35,,5464.2,percent of total billed charges,Implant Devices,5464.2,35,,5464.2,percent of total billed charges,Implant Devices,5464.2,35,,5464.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5308.08,34,"If Charge > 2,000, then 34 percent",5308.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6244.8,
DEPUY 1365-12-000 ATRICULEZE FEM HD 28MM,C1776,HCPCS,,79003975,CDM,278,RC,,,both,,,1856,732.5,39.4668,,732.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,631.04,34,,631.04,percent of total billed charges,Implant Device,631.04,34,,631.04,percent of total billed charges,Implant Device,631.04,34,,631.04,percent of total billed charges,Implant Device,631.04,34,,631.04,percent of total billed charges,Implant Device,631.04,34,,631.04,percent of total billed charges,Implant Device,631.04,34,,631.04,percent of total billed charges,Implant Device,649.6,35,,649.6,percent of total billed charges,Implant Device,631.04,34,"Charges > $500, x 34%",631.04,percent of total billed charges,Implant Device,649.6,35,,649.6,percent of total billed charges,Implant Devices,649.6,35,,649.6,percent of total billed charges,Implant Devices,649.6,35,,,percent of total billed charges,Implant Devices,649.6,35,,649.6,percent of total billed charges,Implant Devices,649.6,35,,649.6,percent of total billed charges,Implant Devices,742.4,40,,742.4,percent of total billed charges,Implant Devices,649.6,70,,649.6,percent of total billed charges,Implant Devices,631.04,34,,631.04,percent of total billed charges,Implant Devices,631.04,34,,631.04,percent of total billed charges,Implant Devices,649.6,35,,649.6,percent of total billed charges,Implant Devices,649.6,35,,649.6,percent of total billed charges,Implant Devices,649.6,35,,649.6,percent of total billed charges,Implant Devices,649.6,35,,649.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,742.4,
DEPUY 1987-07-025 SEGMENTED COMP 25MM,C1776,HCPCS,,79003977,CDM,278,RC,,,both,,,5969,2355.77,39.4668,,2355.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2029.46,34,,2029.46,percent of total billed charges,Implant Device,2089.15,35,,2089.15,percent of total billed charges,Implant Device,2029.46,34,"Charges > $500, x 34%",2029.46,percent of total billed charges,Implant Device,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2387.6,40,,2387.6,percent of total billed charges,Implant Devices,2089.15,70,,2089.15,percent of total billed charges,Implant Devices,2029.46,34,,2029.46,percent of total billed charges,Implant Devices,2029.46,34,,2029.46,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,2089.15,35,,2089.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2029.46,34,"If Charge > 2,000, then 34 percent",2029.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2387.6,
SMITH & NEPHEW 71338667 ACE SHELL 56MM,C1776,HCPCS,,79004031,CDM,278,RC,,,both,,,4632,1828.1,39.4668,,1828.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1574.88,34,,1574.88,percent of total billed charges,Implant Device,1574.88,34,,1574.88,percent of total billed charges,Implant Device,1574.88,34,,1574.88,percent of total billed charges,Implant Device,1574.88,34,,1574.88,percent of total billed charges,Implant Device,1574.88,34,,1574.88,percent of total billed charges,Implant Device,1574.88,34,,1574.88,percent of total billed charges,Implant Device,1621.2,35,,1621.2,percent of total billed charges,Implant Device,1574.88,34,"Charges > $500, x 34%",1574.88,percent of total billed charges,Implant Device,1621.2,35,,1621.2,percent of total billed charges,Implant Devices,1621.2,35,,1621.2,percent of total billed charges,Implant Devices,1621.2,35,,,percent of total billed charges,Implant Devices,1621.2,35,,1621.2,percent of total billed charges,Implant Devices,1621.2,35,,1621.2,percent of total billed charges,Implant Devices,1852.8,40,,1852.8,percent of total billed charges,Implant Devices,1621.2,70,,1621.2,percent of total billed charges,Implant Devices,1574.88,34,,1574.88,percent of total billed charges,Implant Devices,1574.88,34,,1574.88,percent of total billed charges,Implant Devices,1621.2,35,,1621.2,percent of total billed charges,Implant Devices,1621.2,35,,1621.2,percent of total billed charges,Implant Devices,1621.2,35,,1621.2,percent of total billed charges,Implant Devices,1621.2,35,,1621.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1574.88,34,"If Charge > 2,000, then 34 percent",1574.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1852.8,
SMITH & NEPHEW 71335756 ACE LINER 36X56,C1776,HCPCS,,79004032,CDM,278,RC,,,both,,,3096,1221.89,39.4668,,1221.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1052.64,34,,1052.64,percent of total billed charges,Implant Device,1052.64,34,,1052.64,percent of total billed charges,Implant Device,1052.64,34,,1052.64,percent of total billed charges,Implant Device,1052.64,34,,1052.64,percent of total billed charges,Implant Device,1052.64,34,,1052.64,percent of total billed charges,Implant Device,1052.64,34,,1052.64,percent of total billed charges,Implant Device,1083.6,35,,1083.6,percent of total billed charges,Implant Device,1052.64,34,"Charges > $500, x 34%",1052.64,percent of total billed charges,Implant Device,1083.6,35,,1083.6,percent of total billed charges,Implant Devices,1083.6,35,,1083.6,percent of total billed charges,Implant Devices,1083.6,35,,,percent of total billed charges,Implant Devices,1083.6,35,,1083.6,percent of total billed charges,Implant Devices,1083.6,35,,1083.6,percent of total billed charges,Implant Devices,1238.4,40,,1238.4,percent of total billed charges,Implant Devices,1083.6,70,,1083.6,percent of total billed charges,Implant Devices,1052.64,34,,1052.64,percent of total billed charges,Implant Devices,1052.64,34,,1052.64,percent of total billed charges,Implant Devices,1083.6,35,,1083.6,percent of total billed charges,Implant Devices,1083.6,35,,1083.6,percent of total billed charges,Implant Devices,1083.6,35,,1083.6,percent of total billed charges,Implant Devices,1083.6,35,,1083.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1052.64,34,"If Charge > 2,000, then 34 percent",1052.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1238.4,
SMITH & NEPHEW 71302204 FEMORL HEAD 22MM,C1776,HCPCS,,79004034,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
SMITH & NEPHEW 71430891 ART TRIAL SZ 7-8,C1776,HCPCS,,79004037,CDM,278,RC,,,both,,,540,213.12,39.4668,,213.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,183.6,34,,183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Device,183.6,34,"Charges > $500, x 34%",183.6,percent of total billed charges,Implant Device,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,216,40,,216,percent of total billed charges,Implant Devices,189,70,,189,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,183.6,34,,183.6,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,189,35,,189,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,216,
SMITH & NEPH 71322042 LINR BIPOLR 22X42,C1776,HCPCS,,79004038,CDM,278,RC,,,both,,,4770,1882.57,39.4668,,1882.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1621.8,34,,1621.8,percent of total billed charges,Implant Device,1621.8,34,,1621.8,percent of total billed charges,Implant Device,1621.8,34,,1621.8,percent of total billed charges,Implant Device,1621.8,34,,1621.8,percent of total billed charges,Implant Device,1621.8,34,,1621.8,percent of total billed charges,Implant Device,1621.8,34,,1621.8,percent of total billed charges,Implant Device,1669.5,35,,1669.5,percent of total billed charges,Implant Device,1621.8,34,"Charges > $500, x 34%",1621.8,percent of total billed charges,Implant Device,1669.5,35,,1669.5,percent of total billed charges,Implant Devices,1669.5,35,,1669.5,percent of total billed charges,Implant Devices,1669.5,35,,,percent of total billed charges,Implant Devices,1669.5,35,,1669.5,percent of total billed charges,Implant Devices,1669.5,35,,1669.5,percent of total billed charges,Implant Devices,1908,40,,1908,percent of total billed charges,Implant Devices,1669.5,70,,1669.5,percent of total billed charges,Implant Devices,1621.8,34,,1621.8,percent of total billed charges,Implant Devices,1621.8,34,,1621.8,percent of total billed charges,Implant Devices,1669.5,35,,1669.5,percent of total billed charges,Implant Devices,1669.5,35,,1669.5,percent of total billed charges,Implant Devices,1669.5,35,,1669.5,percent of total billed charges,Implant Devices,1669.5,35,,1669.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1621.8,34,"If Charge > 2,000, then 34 percent",1621.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1908,
STRYKER 00-7818-050-00 UNI FEM HEAD 50MM,C1776,HCPCS,,79004047,CDM,278,RC,,,both,,,1886,744.34,39.4668,,744.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,660.1,35,,660.1,percent of total billed charges,Implant Device,641.24,34,"Charges > $500, x 34%",641.24,percent of total billed charges,Implant Device,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,754.4,40,,754.4,percent of total billed charges,Implant Devices,660.1,70,,660.1,percent of total billed charges,Implant Devices,641.24,34,,641.24,percent of total billed charges,Implant Devices,641.24,34,,641.24,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,754.4,
STRYKER 1363-50-000 FXHEAD HIP BALL 50MM,C1776,HCPCS,,79004049,CDM,278,RC,,,both,,,922,363.88,39.4668,,363.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,313.48,34,,313.48,percent of total billed charges,Implant Device,313.48,34,,313.48,percent of total billed charges,Implant Device,313.48,34,,313.48,percent of total billed charges,Implant Device,313.48,34,,313.48,percent of total billed charges,Implant Device,313.48,34,,313.48,percent of total billed charges,Implant Device,313.48,34,,313.48,percent of total billed charges,Implant Device,322.7,35,,322.7,percent of total billed charges,Implant Device,313.48,34,"Charges > $500, x 34%",313.48,percent of total billed charges,Implant Device,322.7,35,,322.7,percent of total billed charges,Implant Devices,322.7,35,,322.7,percent of total billed charges,Implant Devices,322.7,35,,,percent of total billed charges,Implant Devices,322.7,35,,322.7,percent of total billed charges,Implant Devices,322.7,35,,322.7,percent of total billed charges,Implant Devices,368.8,40,,368.8,percent of total billed charges,Implant Devices,322.7,70,,322.7,percent of total billed charges,Implant Devices,313.48,34,,313.48,percent of total billed charges,Implant Devices,313.48,34,,313.48,percent of total billed charges,Implant Devices,322.7,35,,322.7,percent of total billed charges,Implant Devices,322.7,35,,322.7,percent of total billed charges,Implant Devices,322.7,35,,322.7,percent of total billed charges,Implant Devices,322.7,35,,322.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,368.8,
STRYKER 5542-P-0048 TSA GLENOID SZ48,C1776,HCPCS,,79004050,CDM,278,RC,,,both,,,8856,3495.18,39.4668,,3495.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3011.04,34,,3011.04,percent of total billed charges,Implant Device,3011.04,34,,3011.04,percent of total billed charges,Implant Device,3011.04,34,,3011.04,percent of total billed charges,Implant Device,3011.04,34,,3011.04,percent of total billed charges,Implant Device,3011.04,34,,3011.04,percent of total billed charges,Implant Device,3011.04,34,,3011.04,percent of total billed charges,Implant Device,3099.6,35,,3099.6,percent of total billed charges,Implant Device,3011.04,34,"Charges > $500, x 34%",3011.04,percent of total billed charges,Implant Device,3099.6,35,,3099.6,percent of total billed charges,Implant Devices,3099.6,35,,3099.6,percent of total billed charges,Implant Devices,3099.6,35,,,percent of total billed charges,Implant Devices,3099.6,35,,3099.6,percent of total billed charges,Implant Devices,3099.6,35,,3099.6,percent of total billed charges,Implant Devices,3542.4,40,,3542.4,percent of total billed charges,Implant Devices,3099.6,70,,3099.6,percent of total billed charges,Implant Devices,3011.04,34,,3011.04,percent of total billed charges,Implant Devices,3011.04,34,,3011.04,percent of total billed charges,Implant Devices,3099.6,35,,3099.6,percent of total billed charges,Implant Devices,3099.6,35,,3099.6,percent of total billed charges,Implant Devices,3099.6,35,,3099.6,percent of total billed charges,Implant Devices,3099.6,35,,3099.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3011.04,34,"If Charge > 2,000, then 34 percent",3011.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3542.4,
STRYKER 5552-E-4416 TSA HUMERAL HEAD,C1776,HCPCS,,79004051,CDM,278,RC,,,both,,,3675,1450.4,39.4668,,1450.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Device,1249.5,34,"Charges > $500, x 34%",1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1470,40,,1470,percent of total billed charges,Implant Devices,1286.25,70,,1286.25,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.5,34,"If Charge > 2,000, then 34 percent",1249.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470,
STRYKER 6570-0-128 DELTA V40 FEM HD 28MM,C1776,HCPCS,,79004056,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 6495-2-030 DIST FEM COMP LT 65MM,C1776,HCPCS,,79004059,CDM,278,RC,,,both,,,19753,7795.88,39.4668,,7795.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6716.02,34,,6716.02,percent of total billed charges,Implant Device,6716.02,34,,6716.02,percent of total billed charges,Implant Device,6716.02,34,,6716.02,percent of total billed charges,Implant Device,6716.02,34,,6716.02,percent of total billed charges,Implant Device,6716.02,34,,6716.02,percent of total billed charges,Implant Device,6716.02,34,,6716.02,percent of total billed charges,Implant Device,6913.55,35,,6913.55,percent of total billed charges,Implant Device,6716.02,34,"Charges > $500, x 34%",6716.02,percent of total billed charges,Implant Device,6913.55,35,,6913.55,percent of total billed charges,Implant Devices,6913.55,35,,6913.55,percent of total billed charges,Implant Devices,6913.55,35,,,percent of total billed charges,Implant Devices,6913.55,35,,6913.55,percent of total billed charges,Implant Devices,6913.55,35,,6913.55,percent of total billed charges,Implant Devices,7901.2,40,,7901.2,percent of total billed charges,Implant Devices,6913.55,70,,6913.55,percent of total billed charges,Implant Devices,6716.02,34,,6716.02,percent of total billed charges,Implant Devices,6716.02,34,,6716.02,percent of total billed charges,Implant Devices,6913.55,35,,6913.55,percent of total billed charges,Implant Devices,6913.55,35,,6913.55,percent of total billed charges,Implant Devices,6913.55,35,,6913.55,percent of total billed charges,Implant Devices,6913.55,35,,6913.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6716.02,34,"If Charge > 2,000, then 34 percent",6716.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7901.2,
STRYKER 006-4000 C-TAPER FEM HEAD 40MM,C1776,HCPCS,,79004065,CDM,278,RC,,,both,,,5719,2257.11,39.4668,,2257.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1944.46,34,,1944.46,percent of total billed charges,Implant Device,1944.46,34,,1944.46,percent of total billed charges,Implant Device,1944.46,34,,1944.46,percent of total billed charges,Implant Device,1944.46,34,,1944.46,percent of total billed charges,Implant Device,1944.46,34,,1944.46,percent of total billed charges,Implant Device,1944.46,34,,1944.46,percent of total billed charges,Implant Device,2001.65,35,,2001.65,percent of total billed charges,Implant Device,1944.46,34,"Charges > $500, x 34%",1944.46,percent of total billed charges,Implant Device,2001.65,35,,2001.65,percent of total billed charges,Implant Devices,2001.65,35,,2001.65,percent of total billed charges,Implant Devices,2001.65,35,,,percent of total billed charges,Implant Devices,2001.65,35,,2001.65,percent of total billed charges,Implant Devices,2001.65,35,,2001.65,percent of total billed charges,Implant Devices,2287.6,40,,2287.6,percent of total billed charges,Implant Devices,2001.65,70,,2001.65,percent of total billed charges,Implant Devices,1944.46,34,,1944.46,percent of total billed charges,Implant Devices,1944.46,34,,1944.46,percent of total billed charges,Implant Devices,2001.65,35,,2001.65,percent of total billed charges,Implant Devices,2001.65,35,,2001.65,percent of total billed charges,Implant Devices,2001.65,35,,2001.65,percent of total billed charges,Implant Devices,2001.65,35,,2001.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1944.46,34,"If Charge > 2,000, then 34 percent",1944.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2287.6,
STRYKER 6495-6-040 GMRS EXT 40MM,C1776,HCPCS,,79004068,CDM,278,RC,,,both,,,12541,4949.53,39.4668,,4949.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4263.94,34,,4263.94,percent of total billed charges,Implant Device,4263.94,34,,4263.94,percent of total billed charges,Implant Device,4263.94,34,,4263.94,percent of total billed charges,Implant Device,4263.94,34,,4263.94,percent of total billed charges,Implant Device,4263.94,34,,4263.94,percent of total billed charges,Implant Device,4263.94,34,,4263.94,percent of total billed charges,Implant Device,4389.35,35,,4389.35,percent of total billed charges,Implant Device,4263.94,34,"Charges > $500, x 34%",4263.94,percent of total billed charges,Implant Device,4389.35,35,,4389.35,percent of total billed charges,Implant Devices,4389.35,35,,4389.35,percent of total billed charges,Implant Devices,4389.35,35,,,percent of total billed charges,Implant Devices,4389.35,35,,4389.35,percent of total billed charges,Implant Devices,4389.35,35,,4389.35,percent of total billed charges,Implant Devices,5016.4,40,,5016.4,percent of total billed charges,Implant Devices,4389.35,70,,4389.35,percent of total billed charges,Implant Devices,4263.94,34,,4263.94,percent of total billed charges,Implant Devices,4263.94,34,,4263.94,percent of total billed charges,Implant Devices,4389.35,35,,4389.35,percent of total billed charges,Implant Devices,4389.35,35,,4389.35,percent of total billed charges,Implant Devices,4389.35,35,,4389.35,percent of total billed charges,Implant Devices,4389.35,35,,4389.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4263.94,34,"If Charge > 2,000, then 34 percent",4263.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5016.4,
STRYKER 502-03-56E CLSTR HOLE SHELL 56MM,C1776,HCPCS,,79004072,CDM,278,RC,,,both,,,8929,3523.99,39.4668,,3523.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3035.86,34,,3035.86,percent of total billed charges,Implant Device,3035.86,34,,3035.86,percent of total billed charges,Implant Device,3035.86,34,,3035.86,percent of total billed charges,Implant Device,3035.86,34,,3035.86,percent of total billed charges,Implant Device,3035.86,34,,3035.86,percent of total billed charges,Implant Device,3035.86,34,,3035.86,percent of total billed charges,Implant Device,3125.15,35,,3125.15,percent of total billed charges,Implant Device,3035.86,34,"Charges > $500, x 34%",3035.86,percent of total billed charges,Implant Device,3125.15,35,,3125.15,percent of total billed charges,Implant Devices,3125.15,35,,3125.15,percent of total billed charges,Implant Devices,3125.15,35,,,percent of total billed charges,Implant Devices,3125.15,35,,3125.15,percent of total billed charges,Implant Devices,3125.15,35,,3125.15,percent of total billed charges,Implant Devices,3571.6,40,,3571.6,percent of total billed charges,Implant Devices,3125.15,70,,3125.15,percent of total billed charges,Implant Devices,3035.86,34,,3035.86,percent of total billed charges,Implant Devices,3035.86,34,,3035.86,percent of total billed charges,Implant Devices,3125.15,35,,3125.15,percent of total billed charges,Implant Devices,3125.15,35,,3125.15,percent of total billed charges,Implant Devices,3125.15,35,,3125.15,percent of total billed charges,Implant Devices,3125.15,35,,3125.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3035.86,34,"If Charge > 2,000, then 34 percent",3035.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3571.6,
STRYKER 06 2605 C-TAPR LFIT HEAD LO FRIC,C1776,HCPCS,,79004076,CDM,278,RC,,,both,,,3008,1187.16,39.4668,,1187.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1022.72,34,,1022.72,percent of total billed charges,Implant Device,1052.8,35,,1052.8,percent of total billed charges,Implant Device,1022.72,34,"Charges > $500, x 34%",1022.72,percent of total billed charges,Implant Device,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1203.2,40,,1203.2,percent of total billed charges,Implant Devices,1052.8,70,,1052.8,percent of total billed charges,Implant Devices,1022.72,34,,1022.72,percent of total billed charges,Implant Devices,1022.72,34,,1022.72,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,1052.8,35,,1052.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1022.72,34,"If Charge > 2,000, then 34 percent",1022.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1203.2,
STRYKER 5569-P-2014 HUMERAL STEM 14X133,C1776,HCPCS,,79004077,CDM,278,RC,,,both,,,12382,4886.78,39.4668,,4886.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4209.88,34,,4209.88,percent of total billed charges,Implant Device,4209.88,34,,4209.88,percent of total billed charges,Implant Device,4209.88,34,,4209.88,percent of total billed charges,Implant Device,4209.88,34,,4209.88,percent of total billed charges,Implant Device,4209.88,34,,4209.88,percent of total billed charges,Implant Device,4209.88,34,,4209.88,percent of total billed charges,Implant Device,4333.7,35,,4333.7,percent of total billed charges,Implant Device,4209.88,34,"Charges > $500, x 34%",4209.88,percent of total billed charges,Implant Device,4333.7,35,,4333.7,percent of total billed charges,Implant Devices,4333.7,35,,4333.7,percent of total billed charges,Implant Devices,4333.7,35,,,percent of total billed charges,Implant Devices,4333.7,35,,4333.7,percent of total billed charges,Implant Devices,4333.7,35,,4333.7,percent of total billed charges,Implant Devices,4952.8,40,,4952.8,percent of total billed charges,Implant Devices,4333.7,70,,4333.7,percent of total billed charges,Implant Devices,4209.88,34,,4209.88,percent of total billed charges,Implant Devices,4209.88,34,,4209.88,percent of total billed charges,Implant Devices,4333.7,35,,4333.7,percent of total billed charges,Implant Devices,4333.7,35,,4333.7,percent of total billed charges,Implant Devices,4333.7,35,,4333.7,percent of total billed charges,Implant Devices,4333.7,35,,4333.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4209.88,34,"If Charge > 2,000, then 34 percent",4209.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4952.8,
STRYKER 19-0000T C-TAPER ADAPTOR SLEEVE,C1776,HCPCS,,79004090,CDM,278,RC,,,both,,,427,168.52,39.4668,,168.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,170.8,40,,170.8,percent of total billed charges,Implant Devices,149.45,70,,149.45,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.8,
STRYKER 6481-2-133 MRH KNEE BUMPER INSRT,C1776,HCPCS,,79004091,CDM,278,RC,,,both,,,1599,631.07,39.4668,,631.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,543.66,34,,543.66,percent of total billed charges,Implant Device,543.66,34,,543.66,percent of total billed charges,Implant Device,543.66,34,,543.66,percent of total billed charges,Implant Device,543.66,34,,543.66,percent of total billed charges,Implant Device,543.66,34,,543.66,percent of total billed charges,Implant Device,543.66,34,,543.66,percent of total billed charges,Implant Device,559.65,35,,559.65,percent of total billed charges,Implant Device,543.66,34,"Charges > $500, x 34%",543.66,percent of total billed charges,Implant Device,559.65,35,,559.65,percent of total billed charges,Implant Devices,559.65,35,,559.65,percent of total billed charges,Implant Devices,559.65,35,,,percent of total billed charges,Implant Devices,559.65,35,,559.65,percent of total billed charges,Implant Devices,559.65,35,,559.65,percent of total billed charges,Implant Devices,639.6,40,,639.6,percent of total billed charges,Implant Devices,559.65,70,,559.65,percent of total billed charges,Implant Devices,543.66,34,,543.66,percent of total billed charges,Implant Devices,543.66,34,,543.66,percent of total billed charges,Implant Devices,559.65,35,,559.65,percent of total billed charges,Implant Devices,559.65,35,,559.65,percent of total billed charges,Implant Devices,559.65,35,,559.65,percent of total billed charges,Implant Devices,559.65,35,,559.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,639.6,
STRYKER 6485-3-111 CEMENTD STEM 11X127MM,C1776,HCPCS,,79004102,CDM,278,RC,,,both,,,9974,3936.42,39.4668,,3936.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3391.16,34,,3391.16,percent of total billed charges,Implant Device,3391.16,34,,3391.16,percent of total billed charges,Implant Device,3391.16,34,,3391.16,percent of total billed charges,Implant Device,3391.16,34,,3391.16,percent of total billed charges,Implant Device,3391.16,34,,3391.16,percent of total billed charges,Implant Device,3391.16,34,,3391.16,percent of total billed charges,Implant Device,3490.9,35,,3490.9,percent of total billed charges,Implant Device,3391.16,34,"Charges > $500, x 34%",3391.16,percent of total billed charges,Implant Device,3490.9,35,,3490.9,percent of total billed charges,Implant Devices,3490.9,35,,3490.9,percent of total billed charges,Implant Devices,3490.9,35,,,percent of total billed charges,Implant Devices,3490.9,35,,3490.9,percent of total billed charges,Implant Devices,3490.9,35,,3490.9,percent of total billed charges,Implant Devices,3989.6,40,,3989.6,percent of total billed charges,Implant Devices,3490.9,70,,3490.9,percent of total billed charges,Implant Devices,3391.16,34,,3391.16,percent of total billed charges,Implant Devices,3391.16,34,,3391.16,percent of total billed charges,Implant Devices,3490.9,35,,3490.9,percent of total billed charges,Implant Devices,3490.9,35,,3490.9,percent of total billed charges,Implant Devices,3490.9,35,,3490.9,percent of total billed charges,Implant Devices,3490.9,35,,3490.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3391.16,34,"If Charge > 2,000, then 34 percent",3391.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3989.6,
STRYKER UH1-45-26 UNIVERSAL HEAD 45X26MM,C1776,HCPCS,,79004115,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 623-00-36D POLY INSERT 36MM D,C1776,HCPCS,,79004117,CDM,278,RC,,,both,,,6575,2594.94,39.4668,,2594.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2235.5,34,,2235.5,percent of total billed charges,Implant Device,2235.5,34,,2235.5,percent of total billed charges,Implant Device,2235.5,34,,2235.5,percent of total billed charges,Implant Device,2235.5,34,,2235.5,percent of total billed charges,Implant Device,2235.5,34,,2235.5,percent of total billed charges,Implant Device,2235.5,34,,2235.5,percent of total billed charges,Implant Device,2301.25,35,,2301.25,percent of total billed charges,Implant Device,2235.5,34,"Charges > $500, x 34%",2235.5,percent of total billed charges,Implant Device,2301.25,35,,2301.25,percent of total billed charges,Implant Devices,2301.25,35,,2301.25,percent of total billed charges,Implant Devices,2301.25,35,,,percent of total billed charges,Implant Devices,2301.25,35,,2301.25,percent of total billed charges,Implant Devices,2301.25,35,,2301.25,percent of total billed charges,Implant Devices,2630,40,,2630,percent of total billed charges,Implant Devices,2301.25,70,,2301.25,percent of total billed charges,Implant Devices,2235.5,34,,2235.5,percent of total billed charges,Implant Devices,2235.5,34,,2235.5,percent of total billed charges,Implant Devices,2301.25,35,,2301.25,percent of total billed charges,Implant Devices,2301.25,35,,2301.25,percent of total billed charges,Implant Devices,2301.25,35,,2301.25,percent of total billed charges,Implant Devices,2301.25,35,,2301.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2235.5,34,"If Charge > 2,000, then 34 percent",2235.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2630,
STRYKER S-2337-HF09 CEMENTLESS HIP STEM,C1776,HCPCS,,79004127,CDM,278,RC,,,both,,,10716,4229.26,39.4668,,4229.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3643.44,34,,3643.44,percent of total billed charges,Implant Device,3643.44,34,,3643.44,percent of total billed charges,Implant Device,3643.44,34,,3643.44,percent of total billed charges,Implant Device,3643.44,34,,3643.44,percent of total billed charges,Implant Device,3643.44,34,,3643.44,percent of total billed charges,Implant Device,3643.44,34,,3643.44,percent of total billed charges,Implant Device,3750.6,35,,3750.6,percent of total billed charges,Implant Device,3643.44,34,"Charges > $500, x 34%",3643.44,percent of total billed charges,Implant Device,3750.6,35,,3750.6,percent of total billed charges,Implant Devices,3750.6,35,,3750.6,percent of total billed charges,Implant Devices,3750.6,35,,,percent of total billed charges,Implant Devices,3750.6,35,,3750.6,percent of total billed charges,Implant Devices,3750.6,35,,3750.6,percent of total billed charges,Implant Devices,4286.4,40,,4286.4,percent of total billed charges,Implant Devices,3750.6,70,,3750.6,percent of total billed charges,Implant Devices,3643.44,34,,3643.44,percent of total billed charges,Implant Devices,3643.44,34,,3643.44,percent of total billed charges,Implant Devices,3750.6,35,,3750.6,percent of total billed charges,Implant Devices,3750.6,35,,3750.6,percent of total billed charges,Implant Devices,3750.6,35,,3750.6,percent of total billed charges,Implant Devices,3750.6,35,,3750.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3643.44,34,"If Charge > 2,000, then 34 percent",3643.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4286.4,
STRYKER 6481-2-103 MRH TIBIAL COMPONENT,C1776,HCPCS,,79004130,CDM,278,RC,,,both,,,8368,3302.58,39.4668,,3302.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2845.12,34,,2845.12,percent of total billed charges,Implant Device,2845.12,34,,2845.12,percent of total billed charges,Implant Device,2845.12,34,,2845.12,percent of total billed charges,Implant Device,2845.12,34,,2845.12,percent of total billed charges,Implant Device,2845.12,34,,2845.12,percent of total billed charges,Implant Device,2845.12,34,,2845.12,percent of total billed charges,Implant Device,2928.8,35,,2928.8,percent of total billed charges,Implant Device,2845.12,34,"Charges > $500, x 34%",2845.12,percent of total billed charges,Implant Device,2928.8,35,,2928.8,percent of total billed charges,Implant Devices,2928.8,35,,2928.8,percent of total billed charges,Implant Devices,2928.8,35,,,percent of total billed charges,Implant Devices,2928.8,35,,2928.8,percent of total billed charges,Implant Devices,2928.8,35,,2928.8,percent of total billed charges,Implant Devices,3347.2,40,,3347.2,percent of total billed charges,Implant Devices,2928.8,70,,2928.8,percent of total billed charges,Implant Devices,2845.12,34,,2845.12,percent of total billed charges,Implant Devices,2845.12,34,,2845.12,percent of total billed charges,Implant Devices,2928.8,35,,2928.8,percent of total billed charges,Implant Devices,2928.8,35,,2928.8,percent of total billed charges,Implant Devices,2928.8,35,,2928.8,percent of total billed charges,Implant Devices,2928.8,35,,2928.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2845.12,34,"If Charge > 2,000, then 34 percent",2845.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3347.2,
STRYKER 6485-3-000 MRS STEM 10X102MM,C1776,HCPCS,,79004131,CDM,278,RC,,,both,,,13768,5433.79,39.4668,,5433.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4681.12,34,,4681.12,percent of total billed charges,Implant Device,4681.12,34,,4681.12,percent of total billed charges,Implant Device,4681.12,34,,4681.12,percent of total billed charges,Implant Device,4681.12,34,,4681.12,percent of total billed charges,Implant Device,4681.12,34,,4681.12,percent of total billed charges,Implant Device,4681.12,34,,4681.12,percent of total billed charges,Implant Device,4818.8,35,,4818.8,percent of total billed charges,Implant Device,4681.12,34,"Charges > $500, x 34%",4681.12,percent of total billed charges,Implant Device,4818.8,35,,4818.8,percent of total billed charges,Implant Devices,4818.8,35,,4818.8,percent of total billed charges,Implant Devices,4818.8,35,,,percent of total billed charges,Implant Devices,4818.8,35,,4818.8,percent of total billed charges,Implant Devices,4818.8,35,,4818.8,percent of total billed charges,Implant Devices,5507.2,40,,5507.2,percent of total billed charges,Implant Devices,4818.8,70,,4818.8,percent of total billed charges,Implant Devices,4681.12,34,,4681.12,percent of total billed charges,Implant Devices,4681.12,34,,4681.12,percent of total billed charges,Implant Devices,4818.8,35,,4818.8,percent of total billed charges,Implant Devices,4818.8,35,,4818.8,percent of total billed charges,Implant Devices,4818.8,35,,4818.8,percent of total billed charges,Implant Devices,4818.8,35,,4818.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4681.12,34,"If Charge > 2,000, then 34 percent",4681.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5507.2,
STRYKER 6485-2-108 ROTATNG HING KNEE 8MM,C1776,HCPCS,,79004132,CDM,278,RC,,,both,,,5424,2140.68,39.4668,,2140.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1844.16,34,,1844.16,percent of total billed charges,Implant Device,1844.16,34,,1844.16,percent of total billed charges,Implant Device,1844.16,34,,1844.16,percent of total billed charges,Implant Device,1844.16,34,,1844.16,percent of total billed charges,Implant Device,1844.16,34,,1844.16,percent of total billed charges,Implant Device,1844.16,34,,1844.16,percent of total billed charges,Implant Device,1898.4,35,,1898.4,percent of total billed charges,Implant Device,1844.16,34,"Charges > $500, x 34%",1844.16,percent of total billed charges,Implant Device,1898.4,35,,1898.4,percent of total billed charges,Implant Devices,1898.4,35,,1898.4,percent of total billed charges,Implant Devices,1898.4,35,,,percent of total billed charges,Implant Devices,1898.4,35,,1898.4,percent of total billed charges,Implant Devices,1898.4,35,,1898.4,percent of total billed charges,Implant Devices,2169.6,40,,2169.6,percent of total billed charges,Implant Devices,1898.4,70,,1898.4,percent of total billed charges,Implant Devices,1844.16,34,,1844.16,percent of total billed charges,Implant Devices,1844.16,34,,1844.16,percent of total billed charges,Implant Devices,1898.4,35,,1898.4,percent of total billed charges,Implant Devices,1898.4,35,,1898.4,percent of total billed charges,Implant Devices,1898.4,35,,1898.4,percent of total billed charges,Implant Devices,1898.4,35,,1898.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1844.16,34,"If Charge > 2,000, then 34 percent",1844.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2169.6,
STRYKER 1067-0010 DIST CEMENT SPACR 10MM,C1776,HCPCS,,79004133,CDM,278,RC,,,both,,,341,134.58,39.4668,,134.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,115.94,34,,115.94,percent of total billed charges,Implant Device,119.35,35,,119.35,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,136.4,40,,136.4,percent of total billed charges,Implant Devices,119.35,70,,119.35,percent of total billed charges,Implant Devices,115.94,34,,115.94,percent of total billed charges,Implant Devices,115.94,34,,115.94,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,119.35,35,,119.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,136.4,
STRYKER 18-3600 C-TAPER FEM HEAD 36MM,C1776,HCPCS,,79004167,CDM,278,RC,,,both,,,7366,2907.12,39.4668,,2907.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2504.44,34,,2504.44,percent of total billed charges,Implant Device,2504.44,34,,2504.44,percent of total billed charges,Implant Device,2504.44,34,,2504.44,percent of total billed charges,Implant Device,2504.44,34,,2504.44,percent of total billed charges,Implant Device,2504.44,34,,2504.44,percent of total billed charges,Implant Device,2504.44,34,,2504.44,percent of total billed charges,Implant Device,2578.1,35,,2578.1,percent of total billed charges,Implant Device,2504.44,34,"Charges > $500, x 34%",2504.44,percent of total billed charges,Implant Device,2578.1,35,,2578.1,percent of total billed charges,Implant Devices,2578.1,35,,2578.1,percent of total billed charges,Implant Devices,2578.1,35,,,percent of total billed charges,Implant Devices,2578.1,35,,2578.1,percent of total billed charges,Implant Devices,2578.1,35,,2578.1,percent of total billed charges,Implant Devices,2946.4,40,,2946.4,percent of total billed charges,Implant Devices,2578.1,70,,2578.1,percent of total billed charges,Implant Devices,2504.44,34,,2504.44,percent of total billed charges,Implant Devices,2504.44,34,,2504.44,percent of total billed charges,Implant Devices,2578.1,35,,2578.1,percent of total billed charges,Implant Devices,2578.1,35,,2578.1,percent of total billed charges,Implant Devices,2578.1,35,,2578.1,percent of total billed charges,Implant Devices,2578.1,35,,2578.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2504.44,34,"If Charge > 2,000, then 34 percent",2504.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2946.4,
STRYKER 113649 COMP SHOULDER SYSTEM STEM,C1776,HCPCS,,79004176,CDM,278,RC,,,both,,,12564,4958.61,39.4668,,4958.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4271.76,34,,4271.76,percent of total billed charges,Implant Device,4271.76,34,,4271.76,percent of total billed charges,Implant Device,4271.76,34,,4271.76,percent of total billed charges,Implant Device,4271.76,34,,4271.76,percent of total billed charges,Implant Device,4271.76,34,,4271.76,percent of total billed charges,Implant Device,4271.76,34,,4271.76,percent of total billed charges,Implant Device,4397.4,35,,4397.4,percent of total billed charges,Implant Device,4271.76,34,"Charges > $500, x 34%",4271.76,percent of total billed charges,Implant Device,4397.4,35,,4397.4,percent of total billed charges,Implant Devices,4397.4,35,,4397.4,percent of total billed charges,Implant Devices,4397.4,35,,,percent of total billed charges,Implant Devices,4397.4,35,,4397.4,percent of total billed charges,Implant Devices,4397.4,35,,4397.4,percent of total billed charges,Implant Devices,5025.6,40,,5025.6,percent of total billed charges,Implant Devices,4397.4,70,,4397.4,percent of total billed charges,Implant Devices,4271.76,34,,4271.76,percent of total billed charges,Implant Devices,4271.76,34,,4271.76,percent of total billed charges,Implant Devices,4397.4,35,,4397.4,percent of total billed charges,Implant Devices,4397.4,35,,4397.4,percent of total billed charges,Implant Devices,4397.4,35,,4397.4,percent of total billed charges,Implant Devices,4397.4,35,,4397.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4271.76,34,"If Charge > 2,000, then 34 percent",4271.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5025.6,
STRYKER SPT-080000S MODULAR STEM SZ 8,C1776,HCPCS,,79004177,CDM,278,RC,,,both,,,10481,4136.52,39.4668,,4136.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3563.54,34,,3563.54,percent of total billed charges,Implant Device,3563.54,34,,3563.54,percent of total billed charges,Implant Device,3563.54,34,,3563.54,percent of total billed charges,Implant Device,3563.54,34,,3563.54,percent of total billed charges,Implant Device,3563.54,34,,3563.54,percent of total billed charges,Implant Device,3563.54,34,,3563.54,percent of total billed charges,Implant Device,3668.35,35,,3668.35,percent of total billed charges,Implant Device,3563.54,34,"Charges > $500, x 34%",3563.54,percent of total billed charges,Implant Device,3668.35,35,,3668.35,percent of total billed charges,Implant Devices,3668.35,35,,3668.35,percent of total billed charges,Implant Devices,3668.35,35,,,percent of total billed charges,Implant Devices,3668.35,35,,3668.35,percent of total billed charges,Implant Devices,3668.35,35,,3668.35,percent of total billed charges,Implant Devices,4192.4,40,,4192.4,percent of total billed charges,Implant Devices,3668.35,70,,3668.35,percent of total billed charges,Implant Devices,3563.54,34,,3563.54,percent of total billed charges,Implant Devices,3563.54,34,,3563.54,percent of total billed charges,Implant Devices,3668.35,35,,3668.35,percent of total billed charges,Implant Devices,3668.35,35,,3668.35,percent of total billed charges,Implant Devices,3668.35,35,,3668.35,percent of total billed charges,Implant Devices,3668.35,35,,3668.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3563.54,34,"If Charge > 2,000, then 34 percent",3563.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4192.4,
STRYKER 6481-2-120 MOD ROTATNG HING KNEE,C1776,HCPCS,,79004179,CDM,278,RC,,,both,,,2664,1051.4,39.4668,,1051.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,905.76,34,,905.76,percent of total billed charges,Implant Device,905.76,34,,905.76,percent of total billed charges,Implant Device,905.76,34,,905.76,percent of total billed charges,Implant Device,905.76,34,,905.76,percent of total billed charges,Implant Device,905.76,34,,905.76,percent of total billed charges,Implant Device,905.76,34,,905.76,percent of total billed charges,Implant Device,932.4,35,,932.4,percent of total billed charges,Implant Device,905.76,34,"Charges > $500, x 34%",905.76,percent of total billed charges,Implant Device,932.4,35,,932.4,percent of total billed charges,Implant Devices,932.4,35,,932.4,percent of total billed charges,Implant Devices,932.4,35,,,percent of total billed charges,Implant Devices,932.4,35,,932.4,percent of total billed charges,Implant Devices,932.4,35,,932.4,percent of total billed charges,Implant Devices,1065.6,40,,1065.6,percent of total billed charges,Implant Devices,932.4,70,,932.4,percent of total billed charges,Implant Devices,905.76,34,,905.76,percent of total billed charges,Implant Devices,905.76,34,,905.76,percent of total billed charges,Implant Devices,932.4,35,,932.4,percent of total billed charges,Implant Devices,932.4,35,,932.4,percent of total billed charges,Implant Devices,932.4,35,,932.4,percent of total billed charges,Implant Devices,932.4,35,,932.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,905.76,34,"If Charge > 2,000, then 34 percent",905.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1065.6,
STRYKER 7818-51 FEMORAL HEAD 12/14 51MM,C1776,HCPCS,,79004184,CDM,278,RC,,,both,,,1886,744.34,39.4668,,744.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,660.1,35,,660.1,percent of total billed charges,Implant Device,641.24,34,"Charges > $500, x 34%",641.24,percent of total billed charges,Implant Device,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,754.4,40,,754.4,percent of total billed charges,Implant Devices,660.1,70,,660.1,percent of total billed charges,Implant Devices,641.24,34,,641.24,percent of total billed charges,Implant Devices,641.24,34,,641.24,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,754.4,
STRYKER NLV-340800G MOD NECK 34MM V40,C1776,HCPCS,,79004191,CDM,278,RC,,,both,,,1568,618.84,39.4668,,618.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,533.12,34,,533.12,percent of total billed charges,Implant Device,533.12,34,,533.12,percent of total billed charges,Implant Device,533.12,34,,533.12,percent of total billed charges,Implant Device,533.12,34,,533.12,percent of total billed charges,Implant Device,533.12,34,,533.12,percent of total billed charges,Implant Device,533.12,34,,533.12,percent of total billed charges,Implant Device,548.8,35,,548.8,percent of total billed charges,Implant Device,533.12,34,"Charges > $500, x 34%",533.12,percent of total billed charges,Implant Device,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,627.2,40,,627.2,percent of total billed charges,Implant Devices,548.8,70,,548.8,percent of total billed charges,Implant Devices,533.12,34,,533.12,percent of total billed charges,Implant Devices,533.12,34,,533.12,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,627.2,
STRYKER 6481-2-110 MRH FEMORAL BUSHING,C1776,HCPCS,,79004199,CDM,278,RC,,,both,,,779,307.45,39.4668,,307.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,264.86,34,,264.86,percent of total billed charges,Implant Device,264.86,34,,264.86,percent of total billed charges,Implant Device,264.86,34,,264.86,percent of total billed charges,Implant Device,264.86,34,,264.86,percent of total billed charges,Implant Device,264.86,34,,264.86,percent of total billed charges,Implant Device,264.86,34,,264.86,percent of total billed charges,Implant Device,272.65,35,,272.65,percent of total billed charges,Implant Device,264.86,34,"Charges > $500, x 34%",264.86,percent of total billed charges,Implant Device,272.65,35,,272.65,percent of total billed charges,Implant Devices,272.65,35,,272.65,percent of total billed charges,Implant Devices,272.65,35,,,percent of total billed charges,Implant Devices,272.65,35,,272.65,percent of total billed charges,Implant Devices,272.65,35,,272.65,percent of total billed charges,Implant Devices,311.6,40,,311.6,percent of total billed charges,Implant Devices,272.65,70,,272.65,percent of total billed charges,Implant Devices,264.86,34,,264.86,percent of total billed charges,Implant Devices,264.86,34,,264.86,percent of total billed charges,Implant Devices,272.65,35,,272.65,percent of total billed charges,Implant Devices,272.65,35,,272.65,percent of total billed charges,Implant Devices,272.65,35,,272.65,percent of total billed charges,Implant Devices,272.65,35,,272.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,311.6,
WRIGHT G426-0010 FLEXIBLE HINGE TOE IMP,C1776,HCPCS,,79004232,CDM,278,RC,,,both,,,5130,2024.65,39.4668,,2024.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1744.2,34,,1744.2,percent of total billed charges,Implant Device,1795.5,35,,1795.5,percent of total billed charges,Implant Device,1744.2,34,"Charges > $500, x 34%",1744.2,percent of total billed charges,Implant Device,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,2052,40,,2052,percent of total billed charges,Implant Devices,1795.5,70,,1795.5,percent of total billed charges,Implant Devices,1744.2,34,,1744.2,percent of total billed charges,Implant Devices,1744.2,34,,1744.2,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,1795.5,35,,1795.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1744.2,34,"If Charge > 2,000, then 34 percent",1744.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2052,
ZIMMER 7818-46 FEM HEAD 12/14 TAPER 46MM,C1776,HCPCS,,79004244,CDM,278,RC,,,both,,,1759,694.22,39.4668,,694.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,598.06,34,,598.06,percent of total billed charges,Implant Device,598.06,34,,598.06,percent of total billed charges,Implant Device,598.06,34,,598.06,percent of total billed charges,Implant Device,598.06,34,,598.06,percent of total billed charges,Implant Device,598.06,34,,598.06,percent of total billed charges,Implant Device,598.06,34,,598.06,percent of total billed charges,Implant Device,615.65,35,,615.65,percent of total billed charges,Implant Device,598.06,34,"Charges > $500, x 34%",598.06,percent of total billed charges,Implant Device,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,703.6,40,,703.6,percent of total billed charges,Implant Devices,615.65,70,,615.65,percent of total billed charges,Implant Devices,598.06,34,,598.06,percent of total billed charges,Implant Devices,598.06,34,,598.06,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,615.65,35,,615.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,703.6,
ZIMMER 7818-43 FEM HEAD 12/14 TAPER 43MM,C1776,HCPCS,,79004245,CDM,278,RC,,,both,,,1885,743.95,39.4668,,743.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,640.9,34,,640.9,percent of total billed charges,Implant Device,640.9,34,,640.9,percent of total billed charges,Implant Device,640.9,34,,640.9,percent of total billed charges,Implant Device,640.9,34,,640.9,percent of total billed charges,Implant Device,640.9,34,,640.9,percent of total billed charges,Implant Device,640.9,34,,640.9,percent of total billed charges,Implant Device,659.75,35,,659.75,percent of total billed charges,Implant Device,640.9,34,"Charges > $500, x 34%",640.9,percent of total billed charges,Implant Device,659.75,35,,659.75,percent of total billed charges,Implant Devices,659.75,35,,659.75,percent of total billed charges,Implant Devices,659.75,35,,,percent of total billed charges,Implant Devices,659.75,35,,659.75,percent of total billed charges,Implant Devices,659.75,35,,659.75,percent of total billed charges,Implant Devices,754,40,,754,percent of total billed charges,Implant Devices,659.75,70,,659.75,percent of total billed charges,Implant Devices,640.9,34,,640.9,percent of total billed charges,Implant Devices,640.9,34,,640.9,percent of total billed charges,Implant Devices,659.75,35,,659.75,percent of total billed charges,Implant Devices,659.75,35,,659.75,percent of total billed charges,Implant Devices,659.75,35,,659.75,percent of total billed charges,Implant Devices,659.75,35,,659.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,754,
ZIMMER 771301100 M/L TAPER KINECTIV STEM,C1776,HCPCS,,79004249,CDM,278,RC,,,both,,,11160,4404.49,39.4668,,4404.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3794.4,34,,3794.4,percent of total billed charges,Implant Device,3794.4,34,,3794.4,percent of total billed charges,Implant Device,3794.4,34,,3794.4,percent of total billed charges,Implant Device,3794.4,34,,3794.4,percent of total billed charges,Implant Device,3794.4,34,,3794.4,percent of total billed charges,Implant Device,3794.4,34,,3794.4,percent of total billed charges,Implant Device,3906,35,,3906,percent of total billed charges,Implant Device,3794.4,34,"Charges > $500, x 34%",3794.4,percent of total billed charges,Implant Device,3906,35,,3906,percent of total billed charges,Implant Devices,3906,35,,3906,percent of total billed charges,Implant Devices,3906,35,,,percent of total billed charges,Implant Devices,3906,35,,3906,percent of total billed charges,Implant Devices,3906,35,,3906,percent of total billed charges,Implant Devices,4464,40,,4464,percent of total billed charges,Implant Devices,3906,70,,3906,percent of total billed charges,Implant Devices,3794.4,34,,3794.4,percent of total billed charges,Implant Devices,3794.4,34,,3794.4,percent of total billed charges,Implant Devices,3906,35,,3906,percent of total billed charges,Implant Devices,3906,35,,3906,percent of total billed charges,Implant Devices,3906,35,,3906,percent of total billed charges,Implant Devices,3906,35,,3906,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3794.4,34,"If Charge > 2,000, then 34 percent",3794.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4464,
ZIMMER 5990-084-01 FEM AUGMENT BLOCK,C1776,HCPCS,,79004265,CDM,278,RC,,,both,,,3520,1389.23,39.4668,,1389.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1196.8,34,,1196.8,percent of total billed charges,Implant Device,1232,35,,1232,percent of total billed charges,Implant Device,1196.8,34,"Charges > $500, x 34%",1196.8,percent of total billed charges,Implant Device,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1408,40,,1408,percent of total billed charges,Implant Devices,1232,70,,1232,percent of total billed charges,Implant Devices,1196.8,34,,1196.8,percent of total billed charges,Implant Devices,1196.8,34,,1196.8,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,1232,35,,1232,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1196.8,34,"If Charge > 2,000, then 34 percent",1196.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1408,
ZIMMER 7818-53 ENDO FEM HEAD 12/14 TAPER,C1776,HCPCS,,79004267,CDM,278,RC,,,both,,,1886,744.34,39.4668,,744.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,660.1,35,,660.1,percent of total billed charges,Implant Device,641.24,34,"Charges > $500, x 34%",641.24,percent of total billed charges,Implant Device,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,754.4,40,,754.4,percent of total billed charges,Implant Devices,660.1,70,,660.1,percent of total billed charges,Implant Devices,641.24,34,,641.24,percent of total billed charges,Implant Devices,641.24,34,,641.24,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,754.4,
ZIMMER 5001-57-28 BIPOLAR CUP LINER 28MM,C1776,HCPCS,,79004269,CDM,278,RC,,,both,,,1297,511.88,39.4668,,511.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,453.95,35,,453.95,percent of total billed charges,Implant Device,440.98,34,"Charges > $500, x 34%",440.98,percent of total billed charges,Implant Device,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,518.8,40,,518.8,percent of total billed charges,Implant Devices,453.95,70,,453.95,percent of total billed charges,Implant Devices,440.98,34,,440.98,percent of total billed charges,Implant Devices,440.98,34,,440.98,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,518.8,
ZIMMER 00-7818-044-00 UNI FEM HEAD 44MM,C1776,HCPCS,,79004278,CDM,278,RC,,,both,,,1886,744.34,39.4668,,744.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,660.1,35,,660.1,percent of total billed charges,Implant Device,641.24,34,"Charges > $500, x 34%",641.24,percent of total billed charges,Implant Device,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,754.4,40,,754.4,percent of total billed charges,Implant Devices,660.1,70,,660.1,percent of total billed charges,Implant Devices,641.24,34,,641.24,percent of total billed charges,Implant Devices,641.24,34,,641.24,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,754.4,
ZIMMER 7818-52 FEM HEAD 12/14 TAPER 52MM,C1776,HCPCS,,79004293,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
ZIMMER 5001-47 BIPOLAR CUP SHELL 47MM,C1776,HCPCS,,79004295,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
ZIMMER 7711-10 HIP FEM STEM 12/14 SZ10,C1776,HCPCS,,79004300,CDM,278,RC,,,both,,,13500,5328.02,39.4668,,5328.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Device,4590,34,"Charges > $500, x 34%",4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,5400,40,,5400,percent of total billed charges,Implant Devices,4725,70,,4725,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4590,34,"If Charge > 2,000, then 34 percent",4590,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5400,
ZIMMER 5001-42-22 MULTI CUP LINER 22MM,C1776,HCPCS,,79004302,CDM,278,RC,,,both,,,1297,511.88,39.4668,,511.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,440.98,34,,440.98,percent of total billed charges,Implant Device,453.95,35,,453.95,percent of total billed charges,Implant Device,440.98,34,"Charges > $500, x 34%",440.98,percent of total billed charges,Implant Device,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,518.8,40,,518.8,percent of total billed charges,Implant Devices,453.95,70,,453.95,percent of total billed charges,Implant Devices,440.98,34,,440.98,percent of total billed charges,Implant Devices,440.98,34,,440.98,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,453.95,35,,453.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,518.8,
ZIMMER 06-136-30111 TRAB METAL SHELL,C1776,HCPCS,,79004308,CDM,278,RC,,,both,,,19074,7527.9,39.4668,,7527.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6675.9,35,,6675.9,percent of total billed charges,Implant Device,6485.16,34,"Charges > $500, x 34%",6485.16,percent of total billed charges,Implant Device,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,7629.6,40,,7629.6,percent of total billed charges,Implant Devices,6675.9,70,,6675.9,percent of total billed charges,Implant Devices,6485.16,34,,6485.16,percent of total billed charges,Implant Devices,6485.16,34,,6485.16,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6485.16,34,"If Charge > 2,000, then 34 percent",6485.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7629.6,
ZIMMER 5001-50-28 BIPOLAR LINER 50-52X28,C1776,HCPCS,,79004317,CDM,278,RC,,,both,,,789,311.39,39.4668,,311.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Device,268.26,34,"Charges > $500, x 34%",268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,315.6,40,,315.6,percent of total billed charges,Implant Devices,276.15,70,,276.15,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.6,
ZIMMER 5001-57 MULTIPOLAR CUP SHELL 57MM,C1776,HCPCS,,79004319,CDM,278,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,117.3,34,,117.3,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,138,40,,138,percent of total billed charges,Implant Devices,120.75,70,,120.75,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,117.3,34,,117.3,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,120.75,35,,120.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138,
ZIMMER 5001-47-28 MULTIPOLAR LINER 28MM,C1776,HCPCS,,79004333,CDM,278,RC,,,both,,,789,311.39,39.4668,,311.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Device,268.26,34,"Charges > $500, x 34%",268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,315.6,40,,315.6,percent of total billed charges,Implant Devices,276.15,70,,276.15,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.6,
ZIMMER 00-7848-002-00 KINECT MOD NECK K,C1776,HCPCS,,79004344,CDM,278,RC,,,both,,,5064,1998.6,39.4668,,1998.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1721.76,34,,1721.76,percent of total billed charges,Implant Device,1721.76,34,,1721.76,percent of total billed charges,Implant Device,1721.76,34,,1721.76,percent of total billed charges,Implant Device,1721.76,34,,1721.76,percent of total billed charges,Implant Device,1721.76,34,,1721.76,percent of total billed charges,Implant Device,1721.76,34,,1721.76,percent of total billed charges,Implant Device,1772.4,35,,1772.4,percent of total billed charges,Implant Device,1721.76,34,"Charges > $500, x 34%",1721.76,percent of total billed charges,Implant Device,1772.4,35,,1772.4,percent of total billed charges,Implant Devices,1772.4,35,,1772.4,percent of total billed charges,Implant Devices,1772.4,35,,,percent of total billed charges,Implant Devices,1772.4,35,,1772.4,percent of total billed charges,Implant Devices,1772.4,35,,1772.4,percent of total billed charges,Implant Devices,2025.6,40,,2025.6,percent of total billed charges,Implant Devices,1772.4,70,,1772.4,percent of total billed charges,Implant Devices,1721.76,34,,1721.76,percent of total billed charges,Implant Devices,1721.76,34,,1721.76,percent of total billed charges,Implant Devices,1772.4,35,,1772.4,percent of total billed charges,Implant Devices,1772.4,35,,1772.4,percent of total billed charges,Implant Devices,1772.4,35,,1772.4,percent of total billed charges,Implant Devices,1772.4,35,,1772.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1721.76,34,"If Charge > 2,000, then 34 percent",1721.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2025.6,
ZIMMER 00-7713-005-00 MOD FEM STEM SZ 5,C1776,HCPCS,,79004649,CDM,278,RC,,,both,,,14400,5683.22,39.4668,,5683.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Device,4896,34,"Charges > $500, x 34%",4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5760,40,,5760,percent of total billed charges,Implant Devices,5040,70,,5040,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4896,34,"If Charge > 2,000, then 34 percent",4896,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5760,
ZIMMER 7711-13-REV FEMORAL STEM SZ13.5,C1776,HCPCS,,79004655,CDM,278,RC,,,both,,,14400,5683.22,39.4668,,5683.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Device,4896,34,"Charges > $500, x 34%",4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5760,40,,5760,percent of total billed charges,Implant Devices,5040,70,,5040,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4896,34,"If Charge > 2,000, then 34 percent",4896,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5760,
ZIMMER 7859-12 DISTAL CENTRALIZER 12MM,C1776,HCPCS,,79004658,CDM,278,RC,,,both,,,383,151.16,39.4668,,151.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,130.22,34,,130.22,percent of total billed charges,Implant Device,134.05,35,,134.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,153.2,40,,153.2,percent of total billed charges,Implant Devices,134.05,70,,134.05,percent of total billed charges,Implant Devices,130.22,34,,130.22,percent of total billed charges,Implant Devices,130.22,34,,130.22,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,134.05,35,,134.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,153.2,
ZIMMER 32-8105-53-01 C/M ULNA ASSMBLY,C1776,HCPCS,,79004659,CDM,278,RC,,,both,,,14400,5683.22,39.4668,,5683.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Device,4896,34,"Charges > $500, x 34%",4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5760,40,,5760,percent of total billed charges,Implant Devices,5040,70,,5040,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4896,34,"If Charge > 2,000, then 34 percent",4896,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5760,
ZIMMER 8018-36-02 VERSYS FEM HEAD 36MM,C1776,HCPCS,,79004660,CDM,278,RC,,,both,,,1680,663.04,39.4668,,663.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,571.2,34,,571.2,percent of total billed charges,Implant Device,571.2,34,,571.2,percent of total billed charges,Implant Device,571.2,34,,571.2,percent of total billed charges,Implant Device,571.2,34,,571.2,percent of total billed charges,Implant Device,571.2,34,,571.2,percent of total billed charges,Implant Device,571.2,34,,571.2,percent of total billed charges,Implant Device,588,35,,588,percent of total billed charges,Implant Device,571.2,34,"Charges > $500, x 34%",571.2,percent of total billed charges,Implant Device,588,35,,588,percent of total billed charges,Implant Devices,588,35,,588,percent of total billed charges,Implant Devices,588,35,,,percent of total billed charges,Implant Devices,588,35,,588,percent of total billed charges,Implant Devices,588,35,,588,percent of total billed charges,Implant Devices,672,40,,672,percent of total billed charges,Implant Devices,588,70,,588,percent of total billed charges,Implant Devices,571.2,34,,571.2,percent of total billed charges,Implant Devices,571.2,34,,571.2,percent of total billed charges,Implant Devices,588,35,,588,percent of total billed charges,Implant Devices,588,35,,588,percent of total billed charges,Implant Devices,588,35,,588,percent of total billed charges,Implant Devices,588,35,,588,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,672,
ZIMMER 50-5994-014-91 NEX FEM COMP SZ D,C1776,HCPCS,,79004665,CDM,278,RC,,,both,,,21420,8453.79,39.4668,,8453.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7282.8,34,,7282.8,percent of total billed charges,Implant Device,7282.8,34,,7282.8,percent of total billed charges,Implant Device,7282.8,34,,7282.8,percent of total billed charges,Implant Device,7282.8,34,,7282.8,percent of total billed charges,Implant Device,7282.8,34,,7282.8,percent of total billed charges,Implant Device,7282.8,34,,7282.8,percent of total billed charges,Implant Device,7497,35,,7497,percent of total billed charges,Implant Device,7282.8,34,"Charges > $500, x 34%",7282.8,percent of total billed charges,Implant Device,7497,35,,7497,percent of total billed charges,Implant Devices,7497,35,,7497,percent of total billed charges,Implant Devices,7497,35,,,percent of total billed charges,Implant Devices,7497,35,,7497,percent of total billed charges,Implant Devices,7497,35,,7497,percent of total billed charges,Implant Devices,8568,40,,8568,percent of total billed charges,Implant Devices,7497,70,,7497,percent of total billed charges,Implant Devices,7282.8,34,,7282.8,percent of total billed charges,Implant Devices,7282.8,34,,7282.8,percent of total billed charges,Implant Devices,7497,35,,7497,percent of total billed charges,Implant Devices,7497,35,,7497,percent of total billed charges,Implant Devices,7497,35,,7497,percent of total billed charges,Implant Devices,7497,35,,7497,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7282.8,34,"If Charge > 2,000, then 34 percent",7282.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8568,
ZIMMER 32-8105-26-06 C/M HUM ASSMBLY 6IN,C1776,HCPCS,,79004668,CDM,278,RC,,,both,,,15209,6002.51,39.4668,,6002.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5323.15,35,,5323.15,percent of total billed charges,Implant Device,5171.06,34,"Charges > $500, x 34%",5171.06,percent of total billed charges,Implant Device,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,6083.6,40,,6083.6,percent of total billed charges,Implant Devices,5323.15,70,,5323.15,percent of total billed charges,Implant Devices,5171.06,34,,5171.06,percent of total billed charges,Implant Devices,5171.06,34,,5171.06,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5171.06,34,"If Charge > 2,000, then 34 percent",5171.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6083.6,
ZIMMER 00-7848-012-00 KINECTIV MOD NECK,C1776,HCPCS,,79004687,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
ZIMMER 00-7713-012-00 M/L TPR FEM STEM,C1776,HCPCS,,79004691,CDM,278,RC,,,both,,,13500,5328.02,39.4668,,5328.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Device,4590,34,"Charges > $500, x 34%",4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,5400,40,,5400,percent of total billed charges,Implant Devices,4725,70,,4725,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4590,34,"If Charge > 2,000, then 34 percent",4590,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5400,
ZIMMER 7850-13 VERSYS CEMNTD STD COLLAR,C1776,HCPCS,,79004692,CDM,278,RC,,,both,,,11730,4629.46,39.4668,,4629.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3988.2,34,,3988.2,percent of total billed charges,Implant Device,3988.2,34,,3988.2,percent of total billed charges,Implant Device,3988.2,34,,3988.2,percent of total billed charges,Implant Device,3988.2,34,,3988.2,percent of total billed charges,Implant Device,3988.2,34,,3988.2,percent of total billed charges,Implant Device,3988.2,34,,3988.2,percent of total billed charges,Implant Device,4105.5,35,,4105.5,percent of total billed charges,Implant Device,3988.2,34,"Charges > $500, x 34%",3988.2,percent of total billed charges,Implant Device,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4692,40,,4692,percent of total billed charges,Implant Devices,4105.5,70,,4105.5,percent of total billed charges,Implant Devices,3988.2,34,,3988.2,percent of total billed charges,Implant Devices,3988.2,34,,3988.2,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,4105.5,35,,4105.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3988.2,34,"If Charge > 2,000, then 34 percent",3988.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4692,
ZIMMER 32-8105-26-04 HUMRL ASSMBLY REG 4,C1776,HCPCS,,79004694,CDM,278,RC,,,both,,,15209,6002.51,39.4668,,6002.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5171.06,34,,5171.06,percent of total billed charges,Implant Device,5323.15,35,,5323.15,percent of total billed charges,Implant Device,5171.06,34,"Charges > $500, x 34%",5171.06,percent of total billed charges,Implant Device,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,6083.6,40,,6083.6,percent of total billed charges,Implant Devices,5323.15,70,,5323.15,percent of total billed charges,Implant Devices,5171.06,34,,5171.06,percent of total billed charges,Implant Devices,5171.06,34,,5171.06,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,5323.15,35,,5323.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5171.06,34,"If Charge > 2,000, then 34 percent",5171.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6083.6,
ZIMMER 7711-16 TAPER HIP FEM STEM 12/14,C1776,HCPCS,,79004712,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 7818-45 HIP SYSTEM 12/14 TAPR 45,C1776,HCPCS,,79004713,CDM,278,RC,,,both,,,1886,744.34,39.4668,,744.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,641.24,34,,641.24,percent of total billed charges,Implant Device,660.1,35,,660.1,percent of total billed charges,Implant Device,641.24,34,"Charges > $500, x 34%",641.24,percent of total billed charges,Implant Device,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,754.4,40,,754.4,percent of total billed charges,Implant Devices,660.1,70,,660.1,percent of total billed charges,Implant Devices,641.24,34,,641.24,percent of total billed charges,Implant Devices,641.24,34,,641.24,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,660.1,35,,660.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,754.4,
ZIMMER 8018-22-02 HIP SYS FEM HD 22MM,C1776,HCPCS,,79004714,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
ZIMMER 5001-52 BIPOLAR CUP LINER 52MM,C1776,HCPCS,,79004724,CDM,278,RC,,,both,,,2273,897.08,39.4668,,897.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Device,772.82,34,"Charges > $500, x 34%",772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,909.2,40,,909.2,percent of total billed charges,Implant Devices,795.55,70,,795.55,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,772.82,34,"If Charge > 2,000, then 34 percent",772.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,909.2,
ZIMMER 32-8105-53-02 ULNAR ASSMBLY SM3 R,C1776,HCPCS,,79004725,CDM,278,RC,,,both,,,11108,4383.97,39.4668,,4383.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3776.72,34,,3776.72,percent of total billed charges,Implant Device,3776.72,34,,3776.72,percent of total billed charges,Implant Device,3776.72,34,,3776.72,percent of total billed charges,Implant Device,3776.72,34,,3776.72,percent of total billed charges,Implant Device,3776.72,34,,3776.72,percent of total billed charges,Implant Device,3776.72,34,,3776.72,percent of total billed charges,Implant Device,3887.8,35,,3887.8,percent of total billed charges,Implant Device,3776.72,34,"Charges > $500, x 34%",3776.72,percent of total billed charges,Implant Device,3887.8,35,,3887.8,percent of total billed charges,Implant Devices,3887.8,35,,3887.8,percent of total billed charges,Implant Devices,3887.8,35,,,percent of total billed charges,Implant Devices,3887.8,35,,3887.8,percent of total billed charges,Implant Devices,3887.8,35,,3887.8,percent of total billed charges,Implant Devices,4443.2,40,,4443.2,percent of total billed charges,Implant Devices,3887.8,70,,3887.8,percent of total billed charges,Implant Devices,3776.72,34,,3776.72,percent of total billed charges,Implant Devices,3776.72,34,,3776.72,percent of total billed charges,Implant Devices,3887.8,35,,3887.8,percent of total billed charges,Implant Devices,3887.8,35,,3887.8,percent of total billed charges,Implant Devices,3887.8,35,,3887.8,percent of total billed charges,Implant Devices,3887.8,35,,3887.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3776.72,34,"If Charge > 2,000, then 34 percent",3776.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4443.2,
ZIMMER 06-131-10082 SPNL TRBCLR MTL IMP,C1776,HCPCS,,79004729,CDM,278,RC,,,both,,,19074,7527.9,39.4668,,7527.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6485.16,34,,6485.16,percent of total billed charges,Implant Device,6675.9,35,,6675.9,percent of total billed charges,Implant Device,6485.16,34,"Charges > $500, x 34%",6485.16,percent of total billed charges,Implant Device,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,7629.6,40,,7629.6,percent of total billed charges,Implant Devices,6675.9,70,,6675.9,percent of total billed charges,Implant Devices,6485.16,34,,6485.16,percent of total billed charges,Implant Devices,6485.16,34,,6485.16,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,6675.9,35,,6675.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6485.16,34,"If Charge > 2,000, then 34 percent",6485.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7629.6,
ZIMMER 00-5750-014-06 FLX FEM COMP SZ D,C1776,HCPCS,,79004753,CDM,278,RC,,,both,,,10966,4327.93,39.4668,,4327.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3728.44,34,,3728.44,percent of total billed charges,Implant Device,3838.1,35,,3838.1,percent of total billed charges,Implant Device,3728.44,34,"Charges > $500, x 34%",3728.44,percent of total billed charges,Implant Device,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,4386.4,40,,4386.4,percent of total billed charges,Implant Devices,3838.1,70,,3838.1,percent of total billed charges,Implant Devices,3728.44,34,,3728.44,percent of total billed charges,Implant Devices,3728.44,34,,3728.44,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,3838.1,35,,3838.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3728.44,34,"If Charge > 2,000, then 34 percent",3728.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4386.4,
ZIMMER 00-7713-016-00 M/L FEM STEM 16.25,C1776,HCPCS,,79004756,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
ZIMMER 00-7848-022-00 KINECTIV MOD NECK,C1776,HCPCS,,79004757,CDM,278,RC,,,both,,,2998,1183.21,39.4668,,1183.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1019.32,34,,1019.32,percent of total billed charges,Implant Device,1049.3,35,,1049.3,percent of total billed charges,Implant Device,1019.32,34,"Charges > $500, x 34%",1019.32,percent of total billed charges,Implant Device,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1199.2,40,,1199.2,percent of total billed charges,Implant Devices,1049.3,70,,1049.3,percent of total billed charges,Implant Devices,1019.32,34,,1019.32,percent of total billed charges,Implant Devices,1019.32,34,,1019.32,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,1049.3,35,,1049.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1019.32,34,"If Charge > 2,000, then 34 percent",1019.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1199.2,
ZIMMER 00-7713-009-00 M/L KINEC STEM SZ9,C1776,HCPCS,,79004759,CDM,278,RC,,,both,,,12000,4736.02,39.4668,,4736.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4200,35,,4200,percent of total billed charges,Implant Device,4080,34,"Charges > $500, x 34%",4080,percent of total billed charges,Implant Device,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4800,40,,4800,percent of total billed charges,Implant Devices,4200,70,,4200,percent of total billed charges,Implant Devices,4080,34,,4080,percent of total billed charges,Implant Devices,4080,34,,4080,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4080,34,"If Charge > 2,000, then 34 percent",4080,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4800,
ZIMMER 00-9026-036-10 FEM HEAD TPR 36X52,C1776,HCPCS,,79004760,CDM,278,RC,,,both,,,3391,1338.32,39.4668,,1338.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1152.94,34,,1152.94,percent of total billed charges,Implant Device,1186.85,35,,1186.85,percent of total billed charges,Implant Device,1152.94,34,"Charges > $500, x 34%",1152.94,percent of total billed charges,Implant Device,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1356.4,40,,1356.4,percent of total billed charges,Implant Devices,1186.85,70,,1186.85,percent of total billed charges,Implant Devices,1152.94,34,,1152.94,percent of total billed charges,Implant Devices,1152.94,34,,1152.94,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,1186.85,35,,1186.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1152.94,34,"If Charge > 2,000, then 34 percent",1152.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1356.4,
ZIMMER 00-7713-007-00 MOD FEM STEM SZ7.5,C1776,HCPCS,,79004767,CDM,278,RC,,,both,,,10500,4144.01,39.4668,,4144.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Device,3570,34,"Charges > $500, x 34%",3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,4200,40,,4200,percent of total billed charges,Implant Devices,3675,70,,3675,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3570,34,"If Charge > 2,000, then 34 percent",3570,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4200,
ZIMMER 5001-43 MULTIPOLAR CUP SHELL 43MM,C1776,HCPCS,,79004788,CDM,278,RC,,,both,,,2292,904.58,39.4668,,904.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,802.2,35,,802.2,percent of total billed charges,Implant Device,779.28,34,"Charges > $500, x 34%",779.28,percent of total billed charges,Implant Device,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,916.8,40,,916.8,percent of total billed charges,Implant Devices,802.2,70,,802.2,percent of total billed charges,Implant Devices,779.28,34,,779.28,percent of total billed charges,Implant Devices,779.28,34,,779.28,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,779.28,34,"If Charge > 2,000, then 34 percent",779.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,916.8,
ZIMMER 5972-65-29 POLY PATELLA 29X8.0MM,C1776,HCPCS,,79004810,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 5990-35-01 POST FEM AUG BLOCK 5MM,C1776,HCPCS,,79004822,CDM,278,RC,,,both,,,2963,1169.4,39.4668,,1169.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Device,1007.42,34,"Charges > $500, x 34%",1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1185.2,40,,1185.2,percent of total billed charges,Implant Devices,1037.05,70,,1037.05,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1007.42,34,"If Charge > 2,000, then 34 percent",1007.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1185.2,
ZIMMER 5990-35-10 DIST FEM AUG BLOCK 5MM,C1776,HCPCS,,79004823,CDM,278,RC,,,both,,,2963,1169.4,39.4668,,1169.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Device,1007.42,34,"Charges > $500, x 34%",1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1185.2,40,,1185.2,percent of total billed charges,Implant Devices,1037.05,70,,1037.05,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1007.42,34,"If Charge > 2,000, then 34 percent",1007.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1185.2,
ZIMMER 5994-32-23 LCCK ART SURF 23MM,C1776,HCPCS,,79004824,CDM,278,RC,,,both,,,6773,2673.09,39.4668,,2673.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Device,2302.82,34,"Charges > $500, x 34%",2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2709.2,40,,2709.2,percent of total billed charges,Implant Devices,2370.55,70,,2370.55,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2302.82,34,"If Charge > 2,000, then 34 percent",2302.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2709.2,
WRIGHT 4260020 FLEX HINGE TOE IMP SZ 2,C1776,HCPCS,,79004843,CDM,278,RC,,,both,,,3634,1434.22,39.4668,,1434.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1271.9,35,,1271.9,percent of total billed charges,Implant Device,1235.56,34,"Charges > $500, x 34%",1235.56,percent of total billed charges,Implant Device,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1453.6,40,,1453.6,percent of total billed charges,Implant Devices,1271.9,70,,1271.9,percent of total billed charges,Implant Devices,1235.56,34,,1235.56,percent of total billed charges,Implant Devices,1235.56,34,,1235.56,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1235.56,34,"If Charge > 2,000, then 34 percent",1235.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1453.6,
WRIGHT G4260003 FLEX HINGE TOE IMP SZ 3,C1776,HCPCS,,79004844,CDM,278,RC,,,both,,,3634,1434.22,39.4668,,1434.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1235.56,34,,1235.56,percent of total billed charges,Implant Device,1271.9,35,,1271.9,percent of total billed charges,Implant Device,1235.56,34,"Charges > $500, x 34%",1235.56,percent of total billed charges,Implant Device,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1453.6,40,,1453.6,percent of total billed charges,Implant Devices,1271.9,70,,1271.9,percent of total billed charges,Implant Devices,1235.56,34,,1235.56,percent of total billed charges,Implant Devices,1235.56,34,,1235.56,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,1271.9,35,,1271.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1235.56,34,"If Charge > 2,000, then 34 percent",1235.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1453.6,
STRYKER 690-00-22E ACETABULAR INSRT SZ E,C1776,HCPCS,,79004868,CDM,278,RC,,,both,,,12217,4821.66,39.4668,,4821.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4153.78,34,,4153.78,percent of total billed charges,Implant Device,4153.78,34,,4153.78,percent of total billed charges,Implant Device,4153.78,34,,4153.78,percent of total billed charges,Implant Device,4153.78,34,,4153.78,percent of total billed charges,Implant Device,4153.78,34,,4153.78,percent of total billed charges,Implant Device,4153.78,34,,4153.78,percent of total billed charges,Implant Device,4275.95,35,,4275.95,percent of total billed charges,Implant Device,4153.78,34,"Charges > $500, x 34%",4153.78,percent of total billed charges,Implant Device,4275.95,35,,4275.95,percent of total billed charges,Implant Devices,4275.95,35,,4275.95,percent of total billed charges,Implant Devices,4275.95,35,,,percent of total billed charges,Implant Devices,4275.95,35,,4275.95,percent of total billed charges,Implant Devices,4275.95,35,,4275.95,percent of total billed charges,Implant Devices,4886.8,40,,4886.8,percent of total billed charges,Implant Devices,4275.95,70,,4275.95,percent of total billed charges,Implant Devices,4153.78,34,,4153.78,percent of total billed charges,Implant Devices,4153.78,34,,4153.78,percent of total billed charges,Implant Devices,4275.95,35,,4275.95,percent of total billed charges,Implant Devices,4275.95,35,,4275.95,percent of total billed charges,Implant Devices,4275.95,35,,4275.95,percent of total billed charges,Implant Devices,4275.95,35,,4275.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4153.78,34,"If Charge > 2,000, then 34 percent",4153.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4886.8,
STRYKER 06-2200 C-TAPER LFIT HEAD 22MM,C1776,HCPCS,,79004869,CDM,278,RC,,,both,,,3175,1253.07,39.4668,,1253.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1079.5,34,,1079.5,percent of total billed charges,Implant Device,1079.5,34,,1079.5,percent of total billed charges,Implant Device,1079.5,34,,1079.5,percent of total billed charges,Implant Device,1079.5,34,,1079.5,percent of total billed charges,Implant Device,1079.5,34,,1079.5,percent of total billed charges,Implant Device,1079.5,34,,1079.5,percent of total billed charges,Implant Device,1111.25,35,,1111.25,percent of total billed charges,Implant Device,1079.5,34,"Charges > $500, x 34%",1079.5,percent of total billed charges,Implant Device,1111.25,35,,1111.25,percent of total billed charges,Implant Devices,1111.25,35,,1111.25,percent of total billed charges,Implant Devices,1111.25,35,,,percent of total billed charges,Implant Devices,1111.25,35,,1111.25,percent of total billed charges,Implant Devices,1111.25,35,,1111.25,percent of total billed charges,Implant Devices,1270,40,,1270,percent of total billed charges,Implant Devices,1111.25,70,,1111.25,percent of total billed charges,Implant Devices,1079.5,34,,1079.5,percent of total billed charges,Implant Devices,1079.5,34,,1079.5,percent of total billed charges,Implant Devices,1111.25,35,,1111.25,percent of total billed charges,Implant Devices,1111.25,35,,1111.25,percent of total billed charges,Implant Devices,1111.25,35,,1111.25,percent of total billed charges,Implant Devices,1111.25,35,,1111.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1079.5,34,"If Charge > 2,000, then 34 percent",1079.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1270,
EXACTECH 310-01-41 HUMERAL HEAD 41X16MM,C1776,HCPCS,,79004906,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
ZIMMER 00-5880-003-00 TIBIAL COMP SZ 3,C1776,HCPCS,,79004931,CDM,278,RC,,,both,,,12690,5008.34,39.4668,,5008.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4314.6,34,,4314.6,percent of total billed charges,Implant Device,4314.6,34,,4314.6,percent of total billed charges,Implant Device,4314.6,34,,4314.6,percent of total billed charges,Implant Device,4314.6,34,,4314.6,percent of total billed charges,Implant Device,4314.6,34,,4314.6,percent of total billed charges,Implant Device,4314.6,34,,4314.6,percent of total billed charges,Implant Device,4441.5,35,,4441.5,percent of total billed charges,Implant Device,4314.6,34,"Charges > $500, x 34%",4314.6,percent of total billed charges,Implant Device,4441.5,35,,4441.5,percent of total billed charges,Implant Devices,4441.5,35,,4441.5,percent of total billed charges,Implant Devices,4441.5,35,,,percent of total billed charges,Implant Devices,4441.5,35,,4441.5,percent of total billed charges,Implant Devices,4441.5,35,,4441.5,percent of total billed charges,Implant Devices,5076,40,,5076,percent of total billed charges,Implant Devices,4441.5,70,,4441.5,percent of total billed charges,Implant Devices,4314.6,34,,4314.6,percent of total billed charges,Implant Devices,4314.6,34,,4314.6,percent of total billed charges,Implant Devices,4441.5,35,,4441.5,percent of total billed charges,Implant Devices,4441.5,35,,4441.5,percent of total billed charges,Implant Devices,4441.5,35,,4441.5,percent of total billed charges,Implant Devices,4441.5,35,,4441.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4314.6,34,"If Charge > 2,000, then 34 percent",4314.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5076,
ZIMMER 00-5988-010-11 STEM EXT 11X100MM,C1776,HCPCS,,79004932,CDM,278,RC,,,both,,,2970,1172.16,39.4668,,1172.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Device,1009.8,34,"Charges > $500, x 34%",1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1188,40,,1188,percent of total billed charges,Implant Devices,1039.5,70,,1039.5,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1009.8,34,"If Charge > 2,000, then 34 percent",1009.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1188,
ZIMMER 00-5850-012-01 DIST FEM COMP SZ B,C1776,HCPCS,,79004933,CDM,278,RC,,,both,,,24705,9750.27,39.4668,,9750.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8646.75,35,,8646.75,percent of total billed charges,Implant Device,8399.7,34,"Charges > $500, x 34%",8399.7,percent of total billed charges,Implant Device,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,9882,40,,9882,percent of total billed charges,Implant Devices,8646.75,70,,8646.75,percent of total billed charges,Implant Devices,8399.7,34,,8399.7,percent of total billed charges,Implant Devices,8399.7,34,,8399.7,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8399.7,34,"If Charge > 2,000, then 34 percent",8399.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9882,
ZIMMER 00-5850-012-95 POLY INSERT SZ B,C1776,HCPCS,,79004934,CDM,278,RC,,,both,,,967,381.64,39.4668,,381.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,328.78,34,,328.78,percent of total billed charges,Implant Device,328.78,34,,328.78,percent of total billed charges,Implant Device,328.78,34,,328.78,percent of total billed charges,Implant Device,328.78,34,,328.78,percent of total billed charges,Implant Device,328.78,34,,328.78,percent of total billed charges,Implant Device,328.78,34,,328.78,percent of total billed charges,Implant Device,338.45,35,,338.45,percent of total billed charges,Implant Device,328.78,34,"Charges > $500, x 34%",328.78,percent of total billed charges,Implant Device,338.45,35,,338.45,percent of total billed charges,Implant Devices,338.45,35,,338.45,percent of total billed charges,Implant Devices,338.45,35,,,percent of total billed charges,Implant Devices,338.45,35,,338.45,percent of total billed charges,Implant Devices,338.45,35,,338.45,percent of total billed charges,Implant Devices,386.8,40,,386.8,percent of total billed charges,Implant Devices,338.45,70,,338.45,percent of total billed charges,Implant Devices,328.78,34,,328.78,percent of total billed charges,Implant Devices,328.78,34,,328.78,percent of total billed charges,Implant Devices,338.45,35,,338.45,percent of total billed charges,Implant Devices,338.45,35,,338.45,percent of total billed charges,Implant Devices,338.45,35,,338.45,percent of total billed charges,Implant Devices,338.45,35,,338.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,386.8,
ZIMMER 00-5850-020-17 ART SURF SZ B 17MM,C1776,HCPCS,,79004935,CDM,278,RC,,,both,,,5602,2210.93,39.4668,,2210.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1904.68,34,,1904.68,percent of total billed charges,Implant Device,1904.68,34,,1904.68,percent of total billed charges,Implant Device,1904.68,34,,1904.68,percent of total billed charges,Implant Device,1904.68,34,,1904.68,percent of total billed charges,Implant Device,1904.68,34,,1904.68,percent of total billed charges,Implant Device,1904.68,34,,1904.68,percent of total billed charges,Implant Device,1960.7,35,,1960.7,percent of total billed charges,Implant Device,1904.68,34,"Charges > $500, x 34%",1904.68,percent of total billed charges,Implant Device,1960.7,35,,1960.7,percent of total billed charges,Implant Devices,1960.7,35,,1960.7,percent of total billed charges,Implant Devices,1960.7,35,,,percent of total billed charges,Implant Devices,1960.7,35,,1960.7,percent of total billed charges,Implant Devices,1960.7,35,,1960.7,percent of total billed charges,Implant Devices,2240.8,40,,2240.8,percent of total billed charges,Implant Devices,1960.7,70,,1960.7,percent of total billed charges,Implant Devices,1904.68,34,,1904.68,percent of total billed charges,Implant Devices,1904.68,34,,1904.68,percent of total billed charges,Implant Devices,1960.7,35,,1960.7,percent of total billed charges,Implant Devices,1960.7,35,,1960.7,percent of total billed charges,Implant Devices,1960.7,35,,1960.7,percent of total billed charges,Implant Devices,1960.7,35,,1960.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1904.68,34,"If Charge > 2,000, then 34 percent",1904.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2240.8,
ZIMMER 00-5850-046-04 SEGMENT TAPER 40MM,C1776,HCPCS,,79004936,CDM,278,RC,,,both,,,10306,4067.45,39.4668,,4067.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3504.04,34,,3504.04,percent of total billed charges,Implant Device,3504.04,34,,3504.04,percent of total billed charges,Implant Device,3504.04,34,,3504.04,percent of total billed charges,Implant Device,3504.04,34,,3504.04,percent of total billed charges,Implant Device,3504.04,34,,3504.04,percent of total billed charges,Implant Device,3504.04,34,,3504.04,percent of total billed charges,Implant Device,3607.1,35,,3607.1,percent of total billed charges,Implant Device,3504.04,34,"Charges > $500, x 34%",3504.04,percent of total billed charges,Implant Device,3607.1,35,,3607.1,percent of total billed charges,Implant Devices,3607.1,35,,3607.1,percent of total billed charges,Implant Devices,3607.1,35,,,percent of total billed charges,Implant Devices,3607.1,35,,3607.1,percent of total billed charges,Implant Devices,3607.1,35,,3607.1,percent of total billed charges,Implant Devices,4122.4,40,,4122.4,percent of total billed charges,Implant Devices,3607.1,70,,3607.1,percent of total billed charges,Implant Devices,3504.04,34,,3504.04,percent of total billed charges,Implant Devices,3504.04,34,,3504.04,percent of total billed charges,Implant Devices,3607.1,35,,3607.1,percent of total billed charges,Implant Devices,3607.1,35,,3607.1,percent of total billed charges,Implant Devices,3607.1,35,,3607.1,percent of total billed charges,Implant Devices,3607.1,35,,3607.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3504.04,34,"If Charge > 2,000, then 34 percent",3504.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4122.4,
ZIMMER 00-5850-070-12 FEM HINGE KIT SZ B,C1776,HCPCS,,79004937,CDM,278,RC,,,both,,,6143,2424.45,39.4668,,2424.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2088.62,34,,2088.62,percent of total billed charges,Implant Device,2088.62,34,,2088.62,percent of total billed charges,Implant Device,2088.62,34,,2088.62,percent of total billed charges,Implant Device,2088.62,34,,2088.62,percent of total billed charges,Implant Device,2088.62,34,,2088.62,percent of total billed charges,Implant Device,2088.62,34,,2088.62,percent of total billed charges,Implant Device,2150.05,35,,2150.05,percent of total billed charges,Implant Device,2088.62,34,"Charges > $500, x 34%",2088.62,percent of total billed charges,Implant Device,2150.05,35,,2150.05,percent of total billed charges,Implant Devices,2150.05,35,,2150.05,percent of total billed charges,Implant Devices,2150.05,35,,,percent of total billed charges,Implant Devices,2150.05,35,,2150.05,percent of total billed charges,Implant Devices,2150.05,35,,2150.05,percent of total billed charges,Implant Devices,2457.2,40,,2457.2,percent of total billed charges,Implant Devices,2150.05,70,,2150.05,percent of total billed charges,Implant Devices,2088.62,34,,2088.62,percent of total billed charges,Implant Devices,2088.62,34,,2088.62,percent of total billed charges,Implant Devices,2150.05,35,,2150.05,percent of total billed charges,Implant Devices,2150.05,35,,2150.05,percent of total billed charges,Implant Devices,2150.05,35,,2150.05,percent of total billed charges,Implant Devices,2150.05,35,,2150.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2088.62,34,"If Charge > 2,000, then 34 percent",2088.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2457.2,
ZIMMER 00-5852-042-09 STEM COLLAR 30MM,C1776,HCPCS,,79004938,CDM,278,RC,,,both,,,5737,2264.21,39.4668,,2264.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1950.58,34,,1950.58,percent of total billed charges,Implant Device,1950.58,34,,1950.58,percent of total billed charges,Implant Device,1950.58,34,,1950.58,percent of total billed charges,Implant Device,1950.58,34,,1950.58,percent of total billed charges,Implant Device,1950.58,34,,1950.58,percent of total billed charges,Implant Device,1950.58,34,,1950.58,percent of total billed charges,Implant Device,2007.95,35,,2007.95,percent of total billed charges,Implant Device,1950.58,34,"Charges > $500, x 34%",1950.58,percent of total billed charges,Implant Device,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2294.8,40,,2294.8,percent of total billed charges,Implant Devices,2007.95,70,,2007.95,percent of total billed charges,Implant Devices,1950.58,34,,1950.58,percent of total billed charges,Implant Devices,1950.58,34,,1950.58,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1950.58,34,"If Charge > 2,000, then 34 percent",1950.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2294.8,
ZIMMER 00-5852-050-14 STEM EXT 14X130MM,C1776,HCPCS,,79004939,CDM,278,RC,,,both,,,12540,4949.14,39.4668,,4949.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4263.6,34,,4263.6,percent of total billed charges,Implant Device,4263.6,34,,4263.6,percent of total billed charges,Implant Device,4263.6,34,,4263.6,percent of total billed charges,Implant Device,4263.6,34,,4263.6,percent of total billed charges,Implant Device,4263.6,34,,4263.6,percent of total billed charges,Implant Device,4263.6,34,,4263.6,percent of total billed charges,Implant Device,4389,35,,4389,percent of total billed charges,Implant Device,4263.6,34,"Charges > $500, x 34%",4263.6,percent of total billed charges,Implant Device,4389,35,,4389,percent of total billed charges,Implant Devices,4389,35,,4389,percent of total billed charges,Implant Devices,4389,35,,,percent of total billed charges,Implant Devices,4389,35,,4389,percent of total billed charges,Implant Devices,4389,35,,4389,percent of total billed charges,Implant Devices,5016,40,,5016,percent of total billed charges,Implant Devices,4389,70,,4389,percent of total billed charges,Implant Devices,4263.6,34,,4263.6,percent of total billed charges,Implant Devices,4263.6,34,,4263.6,percent of total billed charges,Implant Devices,4389,35,,4389,percent of total billed charges,Implant Devices,4389,35,,4389,percent of total billed charges,Implant Devices,4389,35,,4389,percent of total billed charges,Implant Devices,4389,35,,4389,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4263.6,34,"If Charge > 2,000, then 34 percent",4263.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5016,
ZIMMER 00-5880-003-00 TIBIAL COMP SZ 3,C1776,HCPCS,,79004940,CDM,278,RC,,,both,,,13023,5139.76,39.4668,,5139.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4558.05,35,,4558.05,percent of total billed charges,Implant Device,4427.82,34,"Charges > $500, x 34%",4427.82,percent of total billed charges,Implant Device,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,5209.2,40,,5209.2,percent of total billed charges,Implant Devices,4558.05,70,,4558.05,percent of total billed charges,Implant Devices,4427.82,34,,4427.82,percent of total billed charges,Implant Devices,4427.82,34,,4427.82,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4427.82,34,"If Charge > 2,000, then 34 percent",4427.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5209.2,
ZIMMER 00-8757-056-01 TRAB SHELL 56MM,C1776,HCPCS,,79004991,CDM,278,RC,,,both,,,4145,1635.9,39.4668,,1635.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Device,1409.3,34,"Charges > $500, x 34%",1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1658,40,,1658,percent of total billed charges,Implant Devices,1450.75,70,,1450.75,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1409.3,34,"If Charge > 2,000, then 34 percent",1409.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1658,
ZIMMER 00-7711-010-20 FEM STEM SZ 10,C1776,HCPCS,,79004992,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 00-8775-036-02 FEMORAL HEAD,C1776,HCPCS,,79004993,CDM,278,RC,,,both,,,3834,1513.16,39.4668,,1513.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1303.56,34,,1303.56,percent of total billed charges,Implant Device,1341.9,35,,1341.9,percent of total billed charges,Implant Device,1303.56,34,"Charges > $500, x 34%",1303.56,percent of total billed charges,Implant Device,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1533.6,40,,1533.6,percent of total billed charges,Implant Devices,1341.9,70,,1341.9,percent of total billed charges,Implant Devices,1303.56,34,,1303.56,percent of total billed charges,Implant Devices,1303.56,34,,1303.56,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,1341.9,35,,1341.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1303.56,34,"If Charge > 2,000, then 34 percent",1303.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1533.6,
ARTHROSURF 9070-0013-W TAPER POST 7MM,C1776,HCPCS,,79005061,CDM,278,RC,,,both,,,1308,516.23,39.4668,,516.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,444.72,34,,444.72,percent of total billed charges,Implant Device,444.72,34,,444.72,percent of total billed charges,Implant Device,444.72,34,,444.72,percent of total billed charges,Implant Device,444.72,34,,444.72,percent of total billed charges,Implant Device,444.72,34,,444.72,percent of total billed charges,Implant Device,444.72,34,,444.72,percent of total billed charges,Implant Device,457.8,35,,457.8,percent of total billed charges,Implant Device,444.72,34,"Charges > $500, x 34%",444.72,percent of total billed charges,Implant Device,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,523.2,40,,523.2,percent of total billed charges,Implant Devices,457.8,70,,457.8,percent of total billed charges,Implant Devices,444.72,34,,444.72,percent of total billed charges,Implant Devices,444.72,34,,444.72,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,457.8,35,,457.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,523.2,
ZIMMER 5001-049-00 BIPOLAR SHELL 49MM OD,C1776,HCPCS,,79005081,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
ZIMMER 8018-028-01 COCR FEM HEAD 28MM,C1776,HCPCS,,79005082,CDM,278,RC,,,both,,,2543,1003.64,39.4668,,1003.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Device,864.62,34,"Charges > $500, x 34%",864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,1017.2,40,,1017.2,percent of total billed charges,Implant Devices,890.05,70,,890.05,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,864.62,34,"If Charge > 2,000, then 34 percent",864.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1017.2,
STRYKER ST0XS-11 SMART TOE -11,C1776,HCPCS,,79005085,CDM,278,RC,,,both,,,3582,1413.7,39.4668,,1413.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1253.7,35,,1253.7,percent of total billed charges,Implant Device,1217.88,34,"Charges > $500, x 34%",1217.88,percent of total billed charges,Implant Device,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1432.8,40,,1432.8,percent of total billed charges,Implant Devices,1253.7,70,,1253.7,percent of total billed charges,Implant Devices,1217.88,34,,1217.88,percent of total billed charges,Implant Devices,1217.88,34,,1217.88,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1217.88,34,"If Charge > 2,000, then 34 percent",1217.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1432.8,
ZIMMER 5971-65-32 PATELLA 8.5MM,C1776,HCPCS,,79005087,CDM,278,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,40.8,34,,40.8,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,48,40,,48,percent of total billed charges,Implant Devices,42,70,,42,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,40.8,34,,40.8,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,42,35,,42,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,48,
STRYKER 5512-F-401 FEMORAL COMPONENT SZ4,C1776,HCPCS,,79005090,CDM,278,RC,,,both,,,26158,10323.73,39.4668,,10323.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8893.72,34,,8893.72,percent of total billed charges,Implant Device,8893.72,34,,8893.72,percent of total billed charges,Implant Device,8893.72,34,,8893.72,percent of total billed charges,Implant Device,8893.72,34,,8893.72,percent of total billed charges,Implant Device,8893.72,34,,8893.72,percent of total billed charges,Implant Device,8893.72,34,,8893.72,percent of total billed charges,Implant Device,9155.3,35,,9155.3,percent of total billed charges,Implant Device,8893.72,34,"Charges > $500, x 34%",8893.72,percent of total billed charges,Implant Device,9155.3,35,,9155.3,percent of total billed charges,Implant Devices,9155.3,35,,9155.3,percent of total billed charges,Implant Devices,9155.3,35,,,percent of total billed charges,Implant Devices,9155.3,35,,9155.3,percent of total billed charges,Implant Devices,9155.3,35,,9155.3,percent of total billed charges,Implant Devices,10463.2,40,,10463.2,percent of total billed charges,Implant Devices,9155.3,70,,9155.3,percent of total billed charges,Implant Devices,8893.72,34,,8893.72,percent of total billed charges,Implant Devices,8893.72,34,,8893.72,percent of total billed charges,Implant Devices,9155.3,35,,9155.3,percent of total billed charges,Implant Devices,9155.3,35,,9155.3,percent of total billed charges,Implant Devices,9155.3,35,,9155.3,percent of total billed charges,Implant Devices,9155.3,35,,9155.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8893.72,34,"If Charge > 2,000, then 34 percent",8893.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10463.2,
STRYKER 5521-B-400 TIBIAL BASEPLATE SZ 4,C1776,HCPCS,,79005091,CDM,278,RC,,,both,,,3337,1317.01,39.4668,,1317.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Device,1134.58,34,"Charges > $500, x 34%",1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1334.8,40,,1334.8,percent of total billed charges,Implant Devices,1167.95,70,,1167.95,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1134.58,34,"If Charge > 2,000, then 34 percent",1134.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334.8,
STRYKER 5551-G-320 PATELLA SZ A32X10MM,C1776,HCPCS,,79005092,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
STRYKER 5537-G-409 TIBIAL INSRT SZ 4X9MM,C1776,HCPCS,,79005093,CDM,278,RC,,,both,,,10128,3997.2,39.4668,,3997.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3443.52,34,,3443.52,percent of total billed charges,Implant Device,3443.52,34,,3443.52,percent of total billed charges,Implant Device,3443.52,34,,3443.52,percent of total billed charges,Implant Device,3443.52,34,,3443.52,percent of total billed charges,Implant Device,3443.52,34,,3443.52,percent of total billed charges,Implant Device,3443.52,34,,3443.52,percent of total billed charges,Implant Device,3544.8,35,,3544.8,percent of total billed charges,Implant Device,3443.52,34,"Charges > $500, x 34%",3443.52,percent of total billed charges,Implant Device,3544.8,35,,3544.8,percent of total billed charges,Implant Devices,3544.8,35,,3544.8,percent of total billed charges,Implant Devices,3544.8,35,,,percent of total billed charges,Implant Devices,3544.8,35,,3544.8,percent of total billed charges,Implant Devices,3544.8,35,,3544.8,percent of total billed charges,Implant Devices,4051.2,40,,4051.2,percent of total billed charges,Implant Devices,3544.8,70,,3544.8,percent of total billed charges,Implant Devices,3443.52,34,,3443.52,percent of total billed charges,Implant Devices,3443.52,34,,3443.52,percent of total billed charges,Implant Devices,3544.8,35,,3544.8,percent of total billed charges,Implant Devices,3544.8,35,,3544.8,percent of total billed charges,Implant Devices,3544.8,35,,3544.8,percent of total billed charges,Implant Devices,3544.8,35,,3544.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3443.52,34,"If Charge > 2,000, then 34 percent",3443.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4051.2,
STRYKER 5566-S-013 FLUTED STEM 13X150MM,C1776,HCPCS,,79005094,CDM,278,RC,,,both,,,5527,2181.33,39.4668,,2181.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1934.45,35,,1934.45,percent of total billed charges,Implant Device,1879.18,34,"Charges > $500, x 34%",1879.18,percent of total billed charges,Implant Device,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,2210.8,40,,2210.8,percent of total billed charges,Implant Devices,1934.45,70,,1934.45,percent of total billed charges,Implant Devices,1879.18,34,,1879.18,percent of total billed charges,Implant Devices,1879.18,34,,1879.18,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1879.18,34,"If Charge > 2,000, then 34 percent",1879.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2210.8,
STRYKER 5566-S-015 FLUTED STEM 15X150MM,C1776,HCPCS,,79005095,CDM,278,RC,,,both,,,5527,2181.33,39.4668,,2181.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1879.18,34,,1879.18,percent of total billed charges,Implant Device,1934.45,35,,1934.45,percent of total billed charges,Implant Device,1879.18,34,"Charges > $500, x 34%",1879.18,percent of total billed charges,Implant Device,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,2210.8,40,,2210.8,percent of total billed charges,Implant Devices,1934.45,70,,1934.45,percent of total billed charges,Implant Devices,1879.18,34,,1879.18,percent of total billed charges,Implant Devices,1879.18,34,,1879.18,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,1934.45,35,,1934.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1879.18,34,"If Charge > 2,000, then 34 percent",1879.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2210.8,
STRYKER 5546-A-402 TIBIAL AUG SZ 4 10MM,C1776,HCPCS,,79005096,CDM,278,RC,,,both,,,4493,1773.24,39.4668,,1773.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1527.62,34,,1527.62,percent of total billed charges,Implant Device,1527.62,34,,1527.62,percent of total billed charges,Implant Device,1527.62,34,,1527.62,percent of total billed charges,Implant Device,1527.62,34,,1527.62,percent of total billed charges,Implant Device,1527.62,34,,1527.62,percent of total billed charges,Implant Device,1527.62,34,,1527.62,percent of total billed charges,Implant Device,1572.55,35,,1572.55,percent of total billed charges,Implant Device,1527.62,34,"Charges > $500, x 34%",1527.62,percent of total billed charges,Implant Device,1572.55,35,,1572.55,percent of total billed charges,Implant Devices,1572.55,35,,1572.55,percent of total billed charges,Implant Devices,1572.55,35,,,percent of total billed charges,Implant Devices,1572.55,35,,1572.55,percent of total billed charges,Implant Devices,1572.55,35,,1572.55,percent of total billed charges,Implant Devices,1797.2,40,,1797.2,percent of total billed charges,Implant Devices,1572.55,70,,1572.55,percent of total billed charges,Implant Devices,1527.62,34,,1527.62,percent of total billed charges,Implant Devices,1527.62,34,,1527.62,percent of total billed charges,Implant Devices,1572.55,35,,1572.55,percent of total billed charges,Implant Devices,1572.55,35,,1572.55,percent of total billed charges,Implant Devices,1572.55,35,,1572.55,percent of total billed charges,Implant Devices,1572.55,35,,1572.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1527.62,34,"If Charge > 2,000, then 34 percent",1527.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1797.2,
STRYKER 5543-A-400 FEMORAL AUGMENT 5MM,C1776,HCPCS,,79005097,CDM,278,RC,,,both,,,5041,1989.52,39.4668,,1989.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1713.94,34,,1713.94,percent of total billed charges,Implant Device,1713.94,34,,1713.94,percent of total billed charges,Implant Device,1713.94,34,,1713.94,percent of total billed charges,Implant Device,1713.94,34,,1713.94,percent of total billed charges,Implant Device,1713.94,34,,1713.94,percent of total billed charges,Implant Device,1713.94,34,,1713.94,percent of total billed charges,Implant Device,1764.35,35,,1764.35,percent of total billed charges,Implant Device,1713.94,34,"Charges > $500, x 34%",1713.94,percent of total billed charges,Implant Device,1764.35,35,,1764.35,percent of total billed charges,Implant Devices,1764.35,35,,1764.35,percent of total billed charges,Implant Devices,1764.35,35,,,percent of total billed charges,Implant Devices,1764.35,35,,1764.35,percent of total billed charges,Implant Devices,1764.35,35,,1764.35,percent of total billed charges,Implant Devices,2016.4,40,,2016.4,percent of total billed charges,Implant Devices,1764.35,70,,1764.35,percent of total billed charges,Implant Devices,1713.94,34,,1713.94,percent of total billed charges,Implant Devices,1713.94,34,,1713.94,percent of total billed charges,Implant Devices,1764.35,35,,1764.35,percent of total billed charges,Implant Devices,1764.35,35,,1764.35,percent of total billed charges,Implant Devices,1764.35,35,,1764.35,percent of total billed charges,Implant Devices,1764.35,35,,1764.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1713.94,34,"If Charge > 2,000, then 34 percent",1713.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2016.4,
ZIMMER 5988-10-17 STEM EXT STR 17X100MM,C1776,HCPCS,,79005098,CDM,278,RC,,,both,,,2970,1172.16,39.4668,,1172.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Device,1009.8,34,"Charges > $500, x 34%",1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1188,40,,1188,percent of total billed charges,Implant Devices,1039.5,70,,1039.5,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1009.8,34,"If Charge > 2,000, then 34 percent",1009.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1188,
ZIMMER 5994-32-14 ARTICULAR SURFACE 14MM,C1776,HCPCS,,79005099,CDM,278,RC,,,both,,,6773,2673.09,39.4668,,2673.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Device,2302.82,34,"Charges > $500, x 34%",2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2709.2,40,,2709.2,percent of total billed charges,Implant Devices,2370.55,70,,2370.55,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2302.82,34,"If Charge > 2,000, then 34 percent",2302.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2709.2,
EXACTECH 320-38-00 HUMERAL LINER 38 +0MM,C1776,HCPCS,,79005111,CDM,278,RC,,,both,,,2325,917.6,39.4668,,917.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Device,790.5,34,"Charges > $500, x 34%",790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,930,40,,930,percent of total billed charges,Implant Devices,813.75,70,,813.75,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.5,34,"If Charge > 2,000, then 34 percent",790.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930,
BIOMET 0495 FEMUR HEAD 45-0039,C1776,HCPCS,,79005115,CDM,278,RC,,,both,,,4044,1596.04,39.4668,,1596.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1415.4,35,,1415.4,percent of total billed charges,Implant Device,1374.96,34,"Charges > $500, x 34%",1374.96,percent of total billed charges,Implant Device,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1617.6,40,,1617.6,percent of total billed charges,Implant Devices,1415.4,70,,1415.4,percent of total billed charges,Implant Devices,1374.96,34,,1374.96,percent of total billed charges,Implant Devices,1374.96,34,,1374.96,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1374.96,34,"If Charge > 2,000, then 34 percent",1374.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1617.6,
WRIGHT G47000003 FINGER JOINT IMP SZ 3,C1776,HCPCS,,79005134,CDM,278,RC,,,both,,,6756,2666.38,39.4668,,2666.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2297.04,34,,2297.04,percent of total billed charges,Implant Device,2364.6,35,,2364.6,percent of total billed charges,Implant Device,2297.04,34,"Charges > $500, x 34%",2297.04,percent of total billed charges,Implant Device,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2702.4,40,,2702.4,percent of total billed charges,Implant Devices,2364.6,70,,2364.6,percent of total billed charges,Implant Devices,2297.04,34,,2297.04,percent of total billed charges,Implant Devices,2297.04,34,,2297.04,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,2364.6,35,,2364.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2297.04,34,"If Charge > 2,000, then 34 percent",2297.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2702.4,
ARTHREX 6265-2-005 RELAINCE STR HIP SZ5,C1776,HCPCS,,79005156,CDM,278,RC,,,both,,,3511,1385.68,39.4668,,1385.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1193.74,34,,1193.74,percent of total billed charges,Implant Device,1193.74,34,,1193.74,percent of total billed charges,Implant Device,1193.74,34,,1193.74,percent of total billed charges,Implant Device,1193.74,34,,1193.74,percent of total billed charges,Implant Device,1193.74,34,,1193.74,percent of total billed charges,Implant Device,1193.74,34,,1193.74,percent of total billed charges,Implant Device,1228.85,35,,1228.85,percent of total billed charges,Implant Device,1193.74,34,"Charges > $500, x 34%",1193.74,percent of total billed charges,Implant Device,1228.85,35,,1228.85,percent of total billed charges,Implant Devices,1228.85,35,,1228.85,percent of total billed charges,Implant Devices,1228.85,35,,,percent of total billed charges,Implant Devices,1228.85,35,,1228.85,percent of total billed charges,Implant Devices,1228.85,35,,1228.85,percent of total billed charges,Implant Devices,1404.4,40,,1404.4,percent of total billed charges,Implant Devices,1228.85,70,,1228.85,percent of total billed charges,Implant Devices,1193.74,34,,1193.74,percent of total billed charges,Implant Devices,1193.74,34,,1193.74,percent of total billed charges,Implant Devices,1228.85,35,,1228.85,percent of total billed charges,Implant Devices,1228.85,35,,1228.85,percent of total billed charges,Implant Devices,1228.85,35,,1228.85,percent of total billed charges,Implant Devices,1228.85,35,,1228.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1193.74,34,"If Charge > 2,000, then 34 percent",1193.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1404.4,
ZIMMER 5842-04-02 TIBIAL COMPONENT SZ 4,C1776,HCPCS,,79005180,CDM,278,RC,,,both,,,6346,2504.56,39.4668,,2504.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Device,2157.64,34,"Charges > $500, x 34%",2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2538.4,40,,2538.4,percent of total billed charges,Implant Devices,2221.1,70,,2221.1,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2157.64,34,"If Charge > 2,000, then 34 percent",2157.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2538.4,
ZIMMER 5842-24-08 ART SURF FEM SZ4 8MM,C1776,HCPCS,,79005181,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
ZIMMER 5972-65-35 PATELLA SZ 35 9MM,C1776,HCPCS,,79005182,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 5988-10-11 STEM EXT 11X100MM,C1776,HCPCS,,79005183,CDM,278,RC,,,both,,,3757,1482.77,39.4668,,1482.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1277.38,34,,1277.38,percent of total billed charges,Implant Device,1314.95,35,,1314.95,percent of total billed charges,Implant Device,1277.38,34,"Charges > $500, x 34%",1277.38,percent of total billed charges,Implant Device,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1502.8,40,,1502.8,percent of total billed charges,Implant Devices,1314.95,70,,1314.95,percent of total billed charges,Implant Devices,1277.38,34,,1277.38,percent of total billed charges,Implant Devices,1277.38,34,,1277.38,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,1314.95,35,,1314.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1277.38,34,"If Charge > 2,000, then 34 percent",1277.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1502.8,
ZIMMER 5990-35-20 FEM AUG BLOCK SZ E,C1776,HCPCS,,79005184,CDM,278,RC,,,both,,,2963,1169.4,39.4668,,1169.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Device,1007.42,34,"Charges > $500, x 34%",1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1185.2,40,,1185.2,percent of total billed charges,Implant Devices,1037.05,70,,1037.05,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1007.42,34,"If Charge > 2,000, then 34 percent",1007.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1185.2,
ZIMMER 5994-32-17 ART SURF 17MM,C1776,HCPCS,,79005185,CDM,278,RC,,,both,,,6465,2551.53,39.4668,,2551.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Device,2198.1,34,"Charges > $500, x 34%",2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2586,40,,2586,percent of total billed charges,Implant Devices,2262.75,70,,2262.75,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2198.1,34,"If Charge > 2,000, then 34 percent",2198.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2586,
STRYKER 6276-7-215 MOD HIP SYS 195X15MM,C1776,HCPCS,,79005204,CDM,278,RC,,,both,,,15277,6029.34,39.4668,,6029.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5346.95,35,,5346.95,percent of total billed charges,Implant Device,5194.18,34,"Charges > $500, x 34%",5194.18,percent of total billed charges,Implant Device,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,6110.8,40,,6110.8,percent of total billed charges,Implant Devices,5346.95,70,,5346.95,percent of total billed charges,Implant Devices,5194.18,34,,5194.18,percent of total billed charges,Implant Devices,5194.18,34,,5194.18,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5194.18,34,"If Charge > 2,000, then 34 percent",5194.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6110.8,
STRYKER 6276-1-125 MOD HIP SYS V40 25MM,C1776,HCPCS,,79005205,CDM,278,RC,,,both,,,19076,7528.69,39.4668,,7528.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6676.6,35,,6676.6,percent of total billed charges,Implant Device,6485.84,34,"Charges > $500, x 34%",6485.84,percent of total billed charges,Implant Device,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,7630.4,40,,7630.4,percent of total billed charges,Implant Devices,6676.6,70,,6676.6,percent of total billed charges,Implant Devices,6485.84,34,,6485.84,percent of total billed charges,Implant Devices,6485.84,34,,6485.84,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6485.84,34,"If Charge > 2,000, then 34 percent",6485.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7630.4,
STRYKER UH1-42-26 UNI HEAD 42X26MM,C1776,HCPCS,,79005206,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 06-4000 ANATOMIC FEM HEAD 40X0MM,C1776,HCPCS,,79005209,CDM,278,RC,,,both,,,6232,2459.57,39.4668,,2459.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2181.2,35,,2181.2,percent of total billed charges,Implant Device,2118.88,34,"Charges > $500, x 34%",2118.88,percent of total billed charges,Implant Device,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2492.8,40,,2492.8,percent of total billed charges,Implant Devices,2181.2,70,,2181.2,percent of total billed charges,Implant Devices,2118.88,34,,2118.88,percent of total billed charges,Implant Devices,2118.88,34,,2118.88,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2118.88,34,"If Charge > 2,000, then 34 percent",2118.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2492.8,
STRYKER 502-03-54E CLUST HOLE SHELL 54MM,C1776,HCPCS,,79005211,CDM,278,RC,,,both,,,9823,3876.82,39.4668,,3876.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3339.82,34,,3339.82,percent of total billed charges,Implant Device,3438.05,35,,3438.05,percent of total billed charges,Implant Device,3339.82,34,"Charges > $500, x 34%",3339.82,percent of total billed charges,Implant Device,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3929.2,40,,3929.2,percent of total billed charges,Implant Devices,3438.05,70,,3438.05,percent of total billed charges,Implant Devices,3339.82,34,,3339.82,percent of total billed charges,Implant Devices,3339.82,34,,3339.82,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,3438.05,35,,3438.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3339.82,34,"If Charge > 2,000, then 34 percent",3339.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3929.2,
ZIMMER 00-5850-020-12 ART SUR SZ B 12MM,C1776,HCPCS,,79005212,CDM,278,RC,,,both,,,5603,2211.32,39.4668,,2211.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1961.05,35,,1961.05,percent of total billed charges,Implant Device,1905.02,34,"Charges > $500, x 34%",1905.02,percent of total billed charges,Implant Device,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,2241.2,40,,2241.2,percent of total billed charges,Implant Devices,1961.05,70,,1961.05,percent of total billed charges,Implant Devices,1905.02,34,,1905.02,percent of total billed charges,Implant Devices,1905.02,34,,1905.02,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1905.02,34,"If Charge > 2,000, then 34 percent",1905.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2241.2,
ZIMMER 00-5852-050-12 STEM EXT 12X130MM,C1776,HCPCS,,79005213,CDM,278,RC,,,both,,,11453,4520.13,39.4668,,4520.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,4008.55,35,,4008.55,percent of total billed charges,Implant Device,3894.02,34,"Charges > $500, x 34%",3894.02,percent of total billed charges,Implant Device,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4581.2,40,,4581.2,percent of total billed charges,Implant Devices,4008.55,70,,4008.55,percent of total billed charges,Implant Devices,3894.02,34,,3894.02,percent of total billed charges,Implant Devices,3894.02,34,,3894.02,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3894.02,34,"If Charge > 2,000, then 34 percent",3894.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4581.2,
ZIMMER 00-5852-040-35 STEM COLLAR 35MM,C1776,HCPCS,,79005214,CDM,278,RC,,,both,,,7874,3107.62,39.4668,,3107.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2677.16,34,,2677.16,percent of total billed charges,Implant Device,2677.16,34,,2677.16,percent of total billed charges,Implant Device,2677.16,34,,2677.16,percent of total billed charges,Implant Device,2677.16,34,,2677.16,percent of total billed charges,Implant Device,2677.16,34,,2677.16,percent of total billed charges,Implant Device,2677.16,34,,2677.16,percent of total billed charges,Implant Device,2755.9,35,,2755.9,percent of total billed charges,Implant Device,2677.16,34,"Charges > $500, x 34%",2677.16,percent of total billed charges,Implant Device,2755.9,35,,2755.9,percent of total billed charges,Implant Devices,2755.9,35,,2755.9,percent of total billed charges,Implant Devices,2755.9,35,,,percent of total billed charges,Implant Devices,2755.9,35,,2755.9,percent of total billed charges,Implant Devices,2755.9,35,,2755.9,percent of total billed charges,Implant Devices,3149.6,40,,3149.6,percent of total billed charges,Implant Devices,2755.9,70,,2755.9,percent of total billed charges,Implant Devices,2677.16,34,,2677.16,percent of total billed charges,Implant Devices,2677.16,34,,2677.16,percent of total billed charges,Implant Devices,2755.9,35,,2755.9,percent of total billed charges,Implant Devices,2755.9,35,,2755.9,percent of total billed charges,Implant Devices,2755.9,35,,2755.9,percent of total billed charges,Implant Devices,2755.9,35,,2755.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2677.16,34,"If Charge > 2,000, then 34 percent",2677.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3149.6,
ZIMMER 00-5850-012-02 DIST FEM COMP SZ B,C1776,HCPCS,,79005215,CDM,278,RC,,,both,,,24706,9750.67,39.4668,,9750.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8400.04,34,,8400.04,percent of total billed charges,Implant Device,8400.04,34,,8400.04,percent of total billed charges,Implant Device,8400.04,34,,8400.04,percent of total billed charges,Implant Device,8400.04,34,,8400.04,percent of total billed charges,Implant Device,8400.04,34,,8400.04,percent of total billed charges,Implant Device,8400.04,34,,8400.04,percent of total billed charges,Implant Device,8647.1,35,,8647.1,percent of total billed charges,Implant Device,8400.04,34,"Charges > $500, x 34%",8400.04,percent of total billed charges,Implant Device,8647.1,35,,8647.1,percent of total billed charges,Implant Devices,8647.1,35,,8647.1,percent of total billed charges,Implant Devices,8647.1,35,,,percent of total billed charges,Implant Devices,8647.1,35,,8647.1,percent of total billed charges,Implant Devices,8647.1,35,,8647.1,percent of total billed charges,Implant Devices,9882.4,40,,9882.4,percent of total billed charges,Implant Devices,8647.1,70,,8647.1,percent of total billed charges,Implant Devices,8400.04,34,,8400.04,percent of total billed charges,Implant Devices,8400.04,34,,8400.04,percent of total billed charges,Implant Devices,8647.1,35,,8647.1,percent of total billed charges,Implant Devices,8647.1,35,,8647.1,percent of total billed charges,Implant Devices,8647.1,35,,8647.1,percent of total billed charges,Implant Devices,8647.1,35,,8647.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8400.04,34,"If Charge > 2,000, then 34 percent",8400.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9882.4,
EXACTECH 310-02-41 HUMERAL HEAD 41X20MM,C1776,HCPCS,,79005225,CDM,278,RC,,,both,,,4968,1960.71,39.4668,,1960.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Device,1689.12,34,"Charges > $500, x 34%",1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1987.2,40,,1987.2,percent of total billed charges,Implant Devices,1738.8,70,,1738.8,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.12,34,"If Charge > 2,000, then 34 percent",1689.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.2,
EXACTECH 314-02-23 POST GLENOID AUGMENT,C1776,HCPCS,,79005226,CDM,278,RC,,,both,,,7992,3154.19,39.4668,,3154.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2717.28,34,,2717.28,percent of total billed charges,Implant Device,2797.2,35,,2797.2,percent of total billed charges,Implant Device,2717.28,34,"Charges > $500, x 34%",2717.28,percent of total billed charges,Implant Device,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,3196.8,40,,3196.8,percent of total billed charges,Implant Devices,2797.2,70,,2797.2,percent of total billed charges,Implant Devices,2717.28,34,,2717.28,percent of total billed charges,Implant Devices,2717.28,34,,2717.28,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,2797.2,35,,2797.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2717.28,34,"If Charge > 2,000, then 34 percent",2717.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3196.8,
ZIMMER 5001-50 BIPOLAR CUP SHELL 50MM,C1776,HCPCS,,79005262,CDM,278,RC,,,both,,,2273,897.08,39.4668,,897.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Device,772.82,34,"Charges > $500, x 34%",772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,909.2,40,,909.2,percent of total billed charges,Implant Devices,795.55,70,,795.55,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,772.82,34,"If Charge > 2,000, then 34 percent",772.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,909.2,
ZIMMER 7711-09 FEM STEM 12/14 NECK SZ 9,C1776,HCPCS,,79005263,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
"ZIMMER 32-8105-35-06 HUM LONG FLANGE 6""",C1776,HCPCS,,79005289,CDM,278,RC,,,both,,,15900,6275.22,39.4668,,6275.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5406,34,,5406,percent of total billed charges,Implant Device,5406,34,,5406,percent of total billed charges,Implant Device,5406,34,,5406,percent of total billed charges,Implant Device,5406,34,,5406,percent of total billed charges,Implant Device,5406,34,,5406,percent of total billed charges,Implant Device,5406,34,,5406,percent of total billed charges,Implant Device,5565,35,,5565,percent of total billed charges,Implant Device,5406,34,"Charges > $500, x 34%",5406,percent of total billed charges,Implant Device,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,6360,40,,6360,percent of total billed charges,Implant Devices,5565,70,,5565,percent of total billed charges,Implant Devices,5406,34,,5406,percent of total billed charges,Implant Devices,5406,34,,5406,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,5565,35,,5565,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5406,34,"If Charge > 2,000, then 34 percent",5406,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6360,
EXACTECH 320-02-38 GLENOSPHERE 38X44MM,C1776,HCPCS,,79005295,CDM,278,RC,,,both,,,9018,3559.12,39.4668,,3559.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3156.3,35,,3156.3,percent of total billed charges,Implant Device,3066.12,34,"Charges > $500, x 34%",3066.12,percent of total billed charges,Implant Device,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3607.2,40,,3607.2,percent of total billed charges,Implant Devices,3156.3,70,,3156.3,percent of total billed charges,Implant Devices,3066.12,34,,3066.12,percent of total billed charges,Implant Devices,3066.12,34,,3066.12,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3066.12,34,"If Charge > 2,000, then 34 percent",3066.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3607.2,
ZIMMER 7711-015-00 M/L TAPER 15 STD,C1776,HCPCS,,79005299,CDM,278,RC,,,both,,,13500,5328.02,39.4668,,5328.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Device,4590,34,"Charges > $500, x 34%",4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,5400,40,,5400,percent of total billed charges,Implant Devices,4725,70,,4725,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4590,34,"If Charge > 2,000, then 34 percent",4590,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5400,
ZIMMER 5001-055-00 BIPOLAR CUPSHELL 55MM,C1776,HCPCS,,79005300,CDM,278,RC,,,both,,,1568,618.84,39.4668,,618.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,533.12,34,,533.12,percent of total billed charges,Implant Device,533.12,34,,533.12,percent of total billed charges,Implant Device,533.12,34,,533.12,percent of total billed charges,Implant Device,533.12,34,,533.12,percent of total billed charges,Implant Device,533.12,34,,533.12,percent of total billed charges,Implant Device,533.12,34,,533.12,percent of total billed charges,Implant Device,548.8,35,,548.8,percent of total billed charges,Implant Device,533.12,34,"Charges > $500, x 34%",533.12,percent of total billed charges,Implant Device,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,627.2,40,,627.2,percent of total billed charges,Implant Devices,548.8,70,,548.8,percent of total billed charges,Implant Devices,533.12,34,,533.12,percent of total billed charges,Implant Devices,533.12,34,,533.12,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,548.8,35,,548.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,627.2,
ZIMMER 5001-053-28 BIPOLAR LINER 28MM,C1776,HCPCS,,79005301,CDM,278,RC,,,both,,,789,311.39,39.4668,,311.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Device,268.26,34,"Charges > $500, x 34%",268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,315.6,40,,315.6,percent of total billed charges,Implant Devices,276.15,70,,276.15,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.6,
STRYKER 6260-9-128 FEM HEAD 28MM +0MM,C1776,HCPCS,,79005303,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
ZIMMER 7711-13 FEMORAL STEM SIZE 13.5,C1776,HCPCS,,79005321,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
S&N 71453232 ARTICULAR INSERT 11MM,C1776,HCPCS,,79005366,CDM,278,RC,,,both,,,5212,2057.01,39.4668,,2057.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Device,1772.08,34,"Charges > $500, x 34%",1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,2084.8,40,,2084.8,percent of total billed charges,Implant Devices,1824.2,70,,1824.2,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1772.08,34,"If Charge > 2,000, then 34 percent",1772.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2084.8,
S&N 71453233 ARTICULAR INSERT 13MM,C1776,HCPCS,,79005367,CDM,278,RC,,,both,,,5212,2057.01,39.4668,,2057.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Device,1772.08,34,"Charges > $500, x 34%",1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,2084.8,40,,2084.8,percent of total billed charges,Implant Devices,1824.2,70,,1824.2,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1772.08,34,"If Charge > 2,000, then 34 percent",1772.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2084.8,
DEPUY HEMIARTHROPLASTY HIP PRIMARY STEM,C1776,HCPCS,,79005369,CDM,278,RC,,,both,,,12000,4736.02,39.4668,,4736.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4080,34,,4080,percent of total billed charges,Implant Device,4200,35,,4200,percent of total billed charges,Implant Device,4080,34,"Charges > $500, x 34%",4080,percent of total billed charges,Implant Device,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4800,40,,4800,percent of total billed charges,Implant Devices,4200,70,,4200,percent of total billed charges,Implant Devices,4080,34,,4080,percent of total billed charges,Implant Devices,4080,34,,4080,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,4200,35,,4200,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4080,34,"If Charge > 2,000, then 34 percent",4080,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4800,
STRYKER 6704-3-092 TROCHANTRC GRIP PLATE,C1776,HCPCS,,79005370,CDM,278,RC,,,both,,,7050,2782.41,39.4668,,2782.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2397,34,,2397,percent of total billed charges,Implant Device,2397,34,,2397,percent of total billed charges,Implant Device,2397,34,,2397,percent of total billed charges,Implant Device,2397,34,,2397,percent of total billed charges,Implant Device,2397,34,,2397,percent of total billed charges,Implant Device,2397,34,,2397,percent of total billed charges,Implant Device,2467.5,35,,2467.5,percent of total billed charges,Implant Device,2397,34,"Charges > $500, x 34%",2397,percent of total billed charges,Implant Device,2467.5,35,,2467.5,percent of total billed charges,Implant Devices,2467.5,35,,2467.5,percent of total billed charges,Implant Devices,2467.5,35,,,percent of total billed charges,Implant Devices,2467.5,35,,2467.5,percent of total billed charges,Implant Devices,2467.5,35,,2467.5,percent of total billed charges,Implant Devices,2820,40,,2820,percent of total billed charges,Implant Devices,2467.5,70,,2467.5,percent of total billed charges,Implant Devices,2397,34,,2397,percent of total billed charges,Implant Devices,2397,34,,2397,percent of total billed charges,Implant Devices,2467.5,35,,2467.5,percent of total billed charges,Implant Devices,2467.5,35,,2467.5,percent of total billed charges,Implant Devices,2467.5,35,,2467.5,percent of total billed charges,Implant Devices,2467.5,35,,2467.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2397,34,"If Charge > 2,000, then 34 percent",2397,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2820,
STRYKER 6276-7-317 MOD HIP SYS 235X17MM,C1776,HCPCS,,79005371,CDM,278,RC,,,both,,,16433,6485.58,39.4668,,6485.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5587.22,34,,5587.22,percent of total billed charges,Implant Device,5587.22,34,,5587.22,percent of total billed charges,Implant Device,5587.22,34,,5587.22,percent of total billed charges,Implant Device,5587.22,34,,5587.22,percent of total billed charges,Implant Device,5587.22,34,,5587.22,percent of total billed charges,Implant Device,5587.22,34,,5587.22,percent of total billed charges,Implant Device,5751.55,35,,5751.55,percent of total billed charges,Implant Device,5587.22,34,"Charges > $500, x 34%",5587.22,percent of total billed charges,Implant Device,5751.55,35,,5751.55,percent of total billed charges,Implant Devices,5751.55,35,,5751.55,percent of total billed charges,Implant Devices,5751.55,35,,,percent of total billed charges,Implant Devices,5751.55,35,,5751.55,percent of total billed charges,Implant Devices,5751.55,35,,5751.55,percent of total billed charges,Implant Devices,6573.2,40,,6573.2,percent of total billed charges,Implant Devices,5751.55,70,,5751.55,percent of total billed charges,Implant Devices,5587.22,34,,5587.22,percent of total billed charges,Implant Devices,5587.22,34,,5587.22,percent of total billed charges,Implant Devices,5751.55,35,,5751.55,percent of total billed charges,Implant Devices,5751.55,35,,5751.55,percent of total billed charges,Implant Devices,5751.55,35,,5751.55,percent of total billed charges,Implant Devices,5751.55,35,,5751.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5587.22,34,"If Charge > 2,000, then 34 percent",5587.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6573.2,
STRYKER 6570-0-032 V40 FEM HEAD 32X-4MM,C1776,HCPCS,,79005372,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 6570-0-436 V40 FEM HEAD 36X-2.5,C1776,HCPCS,,79005373,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
ZIMMER 7110-54-32 TRAB RV SHELL LNR 32MM,C1776,HCPCS,,79005374,CDM,278,RC,,,both,,,5603,2211.32,39.4668,,2211.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1961.05,35,,1961.05,percent of total billed charges,Implant Device,1905.02,34,"Charges > $500, x 34%",1905.02,percent of total billed charges,Implant Device,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,2241.2,40,,2241.2,percent of total billed charges,Implant Devices,1961.05,70,,1961.05,percent of total billed charges,Implant Devices,1905.02,34,,1905.02,percent of total billed charges,Implant Devices,1905.02,34,,1905.02,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1905.02,34,"If Charge > 2,000, then 34 percent",1905.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2241.2,
ZIMMER 00-8752-011-36 RIM LNR 36MM SZ JJ,C1776,HCPCS,,79005375,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ARTHROSURFACE 8H02-4844-W ART COMP 48X44,C1776,HCPCS,,79005385,CDM,278,RC,,,both,,,16764,6616.21,39.4668,,6616.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5699.76,34,,5699.76,percent of total billed charges,Implant Device,5867.4,35,,5867.4,percent of total billed charges,Implant Device,5699.76,34,"Charges > $500, x 34%",5699.76,percent of total billed charges,Implant Device,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,6705.6,40,,6705.6,percent of total billed charges,Implant Devices,5867.4,70,,5867.4,percent of total billed charges,Implant Devices,5699.76,34,,5699.76,percent of total billed charges,Implant Devices,5699.76,34,,5699.76,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,5867.4,35,,5867.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5699.76,34,"If Charge > 2,000, then 34 percent",5699.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6705.6,
ZIMMER  00-5450-019-31 FEMORAL CONE 30MM,C1776,HCPCS,,79005434,CDM,278,RC,,,both,,,12646,4990.97,39.4668,,4990.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4299.64,34,,4299.64,percent of total billed charges,Implant Device,4426.1,35,,4426.1,percent of total billed charges,Implant Device,4299.64,34,"Charges > $500, x 34%",4299.64,percent of total billed charges,Implant Device,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,5058.4,40,,5058.4,percent of total billed charges,Implant Devices,4426.1,70,,4426.1,percent of total billed charges,Implant Devices,4299.64,34,,4299.64,percent of total billed charges,Implant Devices,4299.64,34,,4299.64,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,4426.1,35,,4426.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4299.64,34,"If Charge > 2,000, then 34 percent",4299.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5058.4,
ZIMMER  00-5450-020-36 FEMORAL CONE 35MM,C1776,HCPCS,,79005435,CDM,278,RC,,,both,,,14400,5683.22,39.4668,,5683.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Device,4896,34,"Charges > $500, x 34%",4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5760,40,,5760,percent of total billed charges,Implant Devices,5040,70,,5040,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4896,34,"If Charge > 2,000, then 34 percent",4896,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5760,
ZIMMER  5994-40-20 ART SURFACE 5-6 20MM,C1776,HCPCS,,79005436,CDM,278,RC,,,both,,,6773,2673.09,39.4668,,2673.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Device,2302.82,34,"Charges > $500, x 34%",2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2709.2,40,,2709.2,percent of total billed charges,Implant Devices,2370.55,70,,2370.55,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2302.82,34,"If Charge > 2,000, then 34 percent",2302.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2709.2,
BIOMET 139247 ENDO II HEAD 48MM,C1776,HCPCS,,79005461,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
BIOMET 12-139020 ENDO II HEAD 48MM,C1776,HCPCS,,79005462,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
BIOMET 139248 ENDO II TAPER INSERT 3MM,C1776,HCPCS,,79005487,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
STRYKER 437226 DISTAL MEDIAL TIBIA 120MM,C1776,HCPCS,,79005573,CDM,278,RC,,,both,,,5480,2162.78,39.4668,,2162.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1863.2,34,,1863.2,percent of total billed charges,Implant Device,1863.2,34,,1863.2,percent of total billed charges,Implant Device,1863.2,34,,1863.2,percent of total billed charges,Implant Device,1863.2,34,,1863.2,percent of total billed charges,Implant Device,1863.2,34,,1863.2,percent of total billed charges,Implant Device,1863.2,34,,1863.2,percent of total billed charges,Implant Device,1918,35,,1918,percent of total billed charges,Implant Device,1863.2,34,"Charges > $500, x 34%",1863.2,percent of total billed charges,Implant Device,1918,35,,1918,percent of total billed charges,Implant Devices,1918,35,,1918,percent of total billed charges,Implant Devices,1918,35,,,percent of total billed charges,Implant Devices,1918,35,,1918,percent of total billed charges,Implant Devices,1918,35,,1918,percent of total billed charges,Implant Devices,2192,40,,2192,percent of total billed charges,Implant Devices,1918,70,,1918,percent of total billed charges,Implant Devices,1863.2,34,,1863.2,percent of total billed charges,Implant Devices,1863.2,34,,1863.2,percent of total billed charges,Implant Devices,1918,35,,1918,percent of total billed charges,Implant Devices,1918,35,,1918,percent of total billed charges,Implant Devices,1918,35,,1918,percent of total billed charges,Implant Devices,1918,35,,1918,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1863.2,34,"If Charge > 2,000, then 34 percent",1863.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2192,
EXACTECH 304-21-11 PLATFORM STEM LT 10.5,C1776,HCPCS,,79005582,CDM,278,RC,,,both,,,6225,2456.81,39.4668,,2456.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Device,2116.5,34,"Charges > $500, x 34%",2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2490,40,,2490,percent of total billed charges,Implant Devices,2178.75,70,,2178.75,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2116.5,34,"If Charge > 2,000, then 34 percent",2116.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2490,
BIOMET 11-165212 BIPOLAR ACETAB CUP 28MM,C1776,HCPCS,,79005583,CDM,278,RC,,,both,,,6540,2581.13,39.4668,,2581.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2289,35,,2289,percent of total billed charges,Implant Device,2223.6,34,"Charges > $500, x 34%",2223.6,percent of total billed charges,Implant Device,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2616,40,,2616,percent of total billed charges,Implant Devices,2289,70,,2289,percent of total billed charges,Implant Devices,2223.6,34,,2223.6,percent of total billed charges,Implant Devices,2223.6,34,,2223.6,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2223.6,34,"If Charge > 2,000, then 34 percent",2223.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2616,
BIOMET 12-150312 ECHO HIP 12X145MM,C1776,HCPCS,,79005584,CDM,278,RC,,,both,,,15240,6014.74,39.4668,,6014.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5334,35,,5334,percent of total billed charges,Implant Device,5181.6,34,"Charges > $500, x 34%",5181.6,percent of total billed charges,Implant Device,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,6096,40,,6096,percent of total billed charges,Implant Devices,5334,70,,5334,percent of total billed charges,Implant Devices,5181.6,34,,5181.6,percent of total billed charges,Implant Devices,5181.6,34,,5181.6,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5181.6,34,"If Charge > 2,000, then 34 percent",5181.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6096,
ZIMMER 5952-40-10 ART SURF SZ GRN/C-H 10,C1776,HCPCS,,79005586,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
BIOMET 162658 DISTAL CENTRALIZER 13MM,C1776,HCPCS,,79005588,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
BIOMET 12-151311 ECHO HIP 11X148MM,C1776,HCPCS,,79005589,CDM,278,RC,,,both,,,8820,3480.97,39.4668,,3480.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,2998.8,34,,2998.8,percent of total billed charges,Implant Device,3087,35,,3087,percent of total billed charges,Implant Device,2998.8,34,"Charges > $500, x 34%",2998.8,percent of total billed charges,Implant Device,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3528,40,,3528,percent of total billed charges,Implant Devices,3087,70,,3087,percent of total billed charges,Implant Devices,2998.8,34,,2998.8,percent of total billed charges,Implant Devices,2998.8,34,,2998.8,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,3087,35,,3087,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2998.8,34,"If Charge > 2,000, then 34 percent",2998.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3528,
ZIMMER 5842-03-01 TIBIAL COMPONENT SZ 3,C1776,HCPCS,,79005598,CDM,278,RC,,,both,,,6346,2504.56,39.4668,,2504.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Device,2157.64,34,"Charges > $500, x 34%",2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2538.4,40,,2538.4,percent of total billed charges,Implant Devices,2221.1,70,,2221.1,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2157.64,34,"If Charge > 2,000, then 34 percent",2157.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2538.4,
ZIMMER 5842-14-01 FEMORAL COMPONENT SZ D,C1776,HCPCS,,79005599,CDM,278,RC,,,both,,,10486,4138.49,39.4668,,4138.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Device,3565.24,34,"Charges > $500, x 34%",3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,4194.4,40,,4194.4,percent of total billed charges,Implant Devices,3670.1,70,,3670.1,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3565.24,34,"If Charge > 2,000, then 34 percent",3565.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194.4,
ZIMMER 5842-24-09 ARTICULAR SURFACE SZ 4,C1776,HCPCS,,79005600,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
STRYKER 437322 PROX LATERAL TIBIA PLATE,C1776,HCPCS,,79005601,CDM,278,RC,,,both,,,5315,2097.66,39.4668,,2097.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1807.1,34,,1807.1,percent of total billed charges,Implant Device,1860.25,35,,1860.25,percent of total billed charges,Implant Device,1807.1,34,"Charges > $500, x 34%",1807.1,percent of total billed charges,Implant Device,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,2126,40,,2126,percent of total billed charges,Implant Devices,1860.25,70,,1860.25,percent of total billed charges,Implant Devices,1807.1,34,,1807.1,percent of total billed charges,Implant Devices,1807.1,34,,1807.1,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,1860.25,35,,1860.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1807.1,34,"If Charge > 2,000, then 34 percent",1807.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2126,
DEPUY 1035-49-000 BIPOLAR HEAD 28X49MM,C1776,HCPCS,,79005603,CDM,278,RC,,,both,,,4030,1590.51,39.4668,,1590.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Device,1370.2,34,"Charges > $500, x 34%",1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1612,40,,1612,percent of total billed charges,Implant Devices,1410.5,70,,1410.5,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1370.2,34,"If Charge > 2,000, then 34 percent",1370.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1612,
DEPUY 1365-11-000 FEMORAL HEAD 28MM,C1776,HCPCS,,79005604,CDM,278,RC,,,both,,,1710,674.88,39.4668,,674.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,598.5,35,,598.5,percent of total billed charges,Implant Device,581.4,34,"Charges > $500, x 34%",581.4,percent of total billed charges,Implant Device,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,684,40,,684,percent of total billed charges,Implant Devices,598.5,70,,598.5,percent of total billed charges,Implant Devices,581.4,34,,581.4,percent of total billed charges,Implant Devices,581.4,34,,581.4,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,684,
DEPUY 1976-15-140 RECLAIM STEM 15X140,C1776,HCPCS,,79005606,CDM,278,RC,,,both,,,14138,5579.82,39.4668,,5579.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4806.92,34,,4806.92,percent of total billed charges,Implant Device,4806.92,34,,4806.92,percent of total billed charges,Implant Device,4806.92,34,,4806.92,percent of total billed charges,Implant Device,4806.92,34,,4806.92,percent of total billed charges,Implant Device,4806.92,34,,4806.92,percent of total billed charges,Implant Device,4806.92,34,,4806.92,percent of total billed charges,Implant Device,4948.3,35,,4948.3,percent of total billed charges,Implant Device,4806.92,34,"Charges > $500, x 34%",4806.92,percent of total billed charges,Implant Device,4948.3,35,,4948.3,percent of total billed charges,Implant Devices,4948.3,35,,4948.3,percent of total billed charges,Implant Devices,4948.3,35,,,percent of total billed charges,Implant Devices,4948.3,35,,4948.3,percent of total billed charges,Implant Devices,4948.3,35,,4948.3,percent of total billed charges,Implant Devices,5655.2,40,,5655.2,percent of total billed charges,Implant Devices,4948.3,70,,4948.3,percent of total billed charges,Implant Devices,4806.92,34,,4806.92,percent of total billed charges,Implant Devices,4806.92,34,,4806.92,percent of total billed charges,Implant Devices,4948.3,35,,4948.3,percent of total billed charges,Implant Devices,4948.3,35,,4948.3,percent of total billed charges,Implant Devices,4948.3,35,,4948.3,percent of total billed charges,Implant Devices,4948.3,35,,4948.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4806.92,34,"If Charge > 2,000, then 34 percent",4806.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5655.2,
DEPUY 86-7426 UNI STEM FLUTED 115X12MM,C1776,HCPCS,,79005628,CDM,278,RC,,,both,,,5964,2353.8,39.4668,,2353.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2087.4,35,,2087.4,percent of total billed charges,Implant Device,2027.76,34,"Charges > $500, x 34%",2027.76,percent of total billed charges,Implant Device,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2385.6,40,,2385.6,percent of total billed charges,Implant Devices,2087.4,70,,2087.4,percent of total billed charges,Implant Devices,2027.76,34,,2027.76,percent of total billed charges,Implant Devices,2027.76,34,,2027.76,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2027.76,34,"If Charge > 2,000, then 34 percent",2027.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2385.6,
DEPUY 1294-35-150 REV CEM TIB TRAY SZ 5,C1776,HCPCS,,79005629,CDM,278,RC,,,both,,,18967,7485.67,39.4668,,7485.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6448.78,34,,6448.78,percent of total billed charges,Implant Device,6448.78,34,,6448.78,percent of total billed charges,Implant Device,6448.78,34,,6448.78,percent of total billed charges,Implant Device,6448.78,34,,6448.78,percent of total billed charges,Implant Device,6448.78,34,,6448.78,percent of total billed charges,Implant Device,6448.78,34,,6448.78,percent of total billed charges,Implant Device,6638.45,35,,6638.45,percent of total billed charges,Implant Device,6448.78,34,"Charges > $500, x 34%",6448.78,percent of total billed charges,Implant Device,6638.45,35,,6638.45,percent of total billed charges,Implant Devices,6638.45,35,,6638.45,percent of total billed charges,Implant Devices,6638.45,35,,,percent of total billed charges,Implant Devices,6638.45,35,,6638.45,percent of total billed charges,Implant Devices,6638.45,35,,6638.45,percent of total billed charges,Implant Devices,7586.8,40,,7586.8,percent of total billed charges,Implant Devices,6638.45,70,,6638.45,percent of total billed charges,Implant Devices,6448.78,34,,6448.78,percent of total billed charges,Implant Devices,6448.78,34,,6448.78,percent of total billed charges,Implant Devices,6638.45,35,,6638.45,percent of total billed charges,Implant Devices,6638.45,35,,6638.45,percent of total billed charges,Implant Devices,6638.45,35,,6638.45,percent of total billed charges,Implant Devices,6638.45,35,,6638.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6448.78,34,"If Charge > 2,000, then 34 percent",6448.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7586.8,
DEPUY 1294-53-216 UNI FEMORL SLEEVE 31MM,C1776,HCPCS,,79005630,CDM,278,RC,,,both,,,12557,4955.85,39.4668,,4955.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4269.38,34,,4269.38,percent of total billed charges,Implant Device,4269.38,34,,4269.38,percent of total billed charges,Implant Device,4269.38,34,,4269.38,percent of total billed charges,Implant Device,4269.38,34,,4269.38,percent of total billed charges,Implant Device,4269.38,34,,4269.38,percent of total billed charges,Implant Device,4269.38,34,,4269.38,percent of total billed charges,Implant Device,4394.95,35,,4394.95,percent of total billed charges,Implant Device,4269.38,34,"Charges > $500, x 34%",4269.38,percent of total billed charges,Implant Device,4394.95,35,,4394.95,percent of total billed charges,Implant Devices,4394.95,35,,4394.95,percent of total billed charges,Implant Devices,4394.95,35,,,percent of total billed charges,Implant Devices,4394.95,35,,4394.95,percent of total billed charges,Implant Devices,4394.95,35,,4394.95,percent of total billed charges,Implant Devices,5022.8,40,,5022.8,percent of total billed charges,Implant Devices,4394.95,70,,4394.95,percent of total billed charges,Implant Devices,4269.38,34,,4269.38,percent of total billed charges,Implant Devices,4269.38,34,,4269.38,percent of total billed charges,Implant Devices,4394.95,35,,4394.95,percent of total billed charges,Implant Devices,4394.95,35,,4394.95,percent of total billed charges,Implant Devices,4394.95,35,,4394.95,percent of total billed charges,Implant Devices,4394.95,35,,4394.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4269.38,34,"If Charge > 2,000, then 34 percent",4269.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5022.8,
DEPUY 1987-06-005 FEMORL SLEEVE ADAPT +5,C1776,HCPCS,,79005631,CDM,278,RC,,,both,,,2124,838.27,39.4668,,838.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,722.16,34,,722.16,percent of total billed charges,Implant Device,743.4,35,,743.4,percent of total billed charges,Implant Device,722.16,34,"Charges > $500, x 34%",722.16,percent of total billed charges,Implant Device,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,849.6,40,,849.6,percent of total billed charges,Implant Devices,743.4,70,,743.4,percent of total billed charges,Implant Devices,722.16,34,,722.16,percent of total billed charges,Implant Devices,722.16,34,,722.16,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,743.4,35,,743.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,722.16,34,"If Charge > 2,000, then 34 percent",722.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,849.6,
DEPUY 1987-14-105 LPS DIST FEM COMP XS,C1776,HCPCS,,79005632,CDM,278,RC,,,both,,,32693,12902.88,39.4668,,12902.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11115.62,34,,11115.62,percent of total billed charges,Implant Device,11442.55,35,,11442.55,percent of total billed charges,Implant Device,11115.62,34,"Charges > $500, x 34%",11115.62,percent of total billed charges,Implant Device,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,13077.2,40,,13077.2,percent of total billed charges,Implant Devices,11442.55,70,,11442.55,percent of total billed charges,Implant Devices,11115.62,34,,11115.62,percent of total billed charges,Implant Devices,11115.62,34,,11115.62,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,11442.55,35,,11442.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11115.62,34,"If Charge > 2,000, then 34 percent",11115.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13077.2,
DEPUY 1987-27-112 LPS HINGE XSMALL 12MM,C1776,HCPCS,,79005633,CDM,278,RC,,,both,,,11227,4430.94,39.4668,,4430.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3929.45,35,,3929.45,percent of total billed charges,Implant Device,3817.18,34,"Charges > $500, x 34%",3817.18,percent of total billed charges,Implant Device,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,4490.8,40,,4490.8,percent of total billed charges,Implant Devices,3929.45,70,,3929.45,percent of total billed charges,Implant Devices,3817.18,34,,3817.18,percent of total billed charges,Implant Devices,3817.18,34,,3817.18,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3817.18,34,"If Charge > 2,000, then 34 percent",3817.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4490.8,
DEPUY 86-7428 UNI STEM FLUTED 115X14MM,C1776,HCPCS,,79005634,CDM,278,RC,,,both,,,5964,2353.8,39.4668,,2353.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2087.4,35,,2087.4,percent of total billed charges,Implant Device,2027.76,34,"Charges > $500, x 34%",2027.76,percent of total billed charges,Implant Device,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2385.6,40,,2385.6,percent of total billed charges,Implant Devices,2087.4,70,,2087.4,percent of total billed charges,Implant Devices,2027.76,34,,2027.76,percent of total billed charges,Implant Devices,2027.76,34,,2027.76,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2027.76,34,"If Charge > 2,000, then 34 percent",2027.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2385.6,
ZIMMER 00-8758-014-36 LINR 36MM ID SZ MM,C1776,HCPCS,,79005646,CDM,278,RC,,,both,,,11566,4564.73,39.4668,,4564.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3932.44,34,,3932.44,percent of total billed charges,Implant Device,3932.44,34,,3932.44,percent of total billed charges,Implant Device,3932.44,34,,3932.44,percent of total billed charges,Implant Device,3932.44,34,,3932.44,percent of total billed charges,Implant Device,3932.44,34,,3932.44,percent of total billed charges,Implant Device,3932.44,34,,3932.44,percent of total billed charges,Implant Device,4048.1,35,,4048.1,percent of total billed charges,Implant Device,3932.44,34,"Charges > $500, x 34%",3932.44,percent of total billed charges,Implant Device,4048.1,35,,4048.1,percent of total billed charges,Implant Devices,4048.1,35,,4048.1,percent of total billed charges,Implant Devices,4048.1,35,,,percent of total billed charges,Implant Devices,4048.1,35,,4048.1,percent of total billed charges,Implant Devices,4048.1,35,,4048.1,percent of total billed charges,Implant Devices,4626.4,40,,4626.4,percent of total billed charges,Implant Devices,4048.1,70,,4048.1,percent of total billed charges,Implant Devices,3932.44,34,,3932.44,percent of total billed charges,Implant Devices,3932.44,34,,3932.44,percent of total billed charges,Implant Devices,4048.1,35,,4048.1,percent of total billed charges,Implant Devices,4048.1,35,,4048.1,percent of total billed charges,Implant Devices,4048.1,35,,4048.1,percent of total billed charges,Implant Devices,4048.1,35,,4048.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3932.44,34,"If Charge > 2,000, then 34 percent",3932.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4626.4,
EXACTECH 314-13-03 CAGE GLENOID MED,C1776,HCPCS,,79005650,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
STRYKER 6276-7-316 MOD HIP SYS 235X16MM,C1776,HCPCS,,79005698,CDM,278,RC,,,both,,,16079,6345.87,39.4668,,6345.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5627.65,35,,5627.65,percent of total billed charges,Implant Device,5466.86,34,"Charges > $500, x 34%",5466.86,percent of total billed charges,Implant Device,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,6431.6,40,,6431.6,percent of total billed charges,Implant Devices,5627.65,70,,5627.65,percent of total billed charges,Implant Devices,5466.86,34,,5466.86,percent of total billed charges,Implant Devices,5466.86,34,,5466.86,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5466.86,34,"If Charge > 2,000, then 34 percent",5466.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6431.6,
ZIMMER 5990-35-21 FEM AUG BLCK SZ E 10MM,C1776,HCPCS,,79005750,CDM,278,RC,,,both,,,3240,1278.72,39.4668,,1278.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1134,35,,1134,percent of total billed charges,Implant Device,1101.6,34,"Charges > $500, x 34%",1101.6,percent of total billed charges,Implant Device,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1296,40,,1296,percent of total billed charges,Implant Devices,1134,70,,1134,percent of total billed charges,Implant Devices,1101.6,34,,1101.6,percent of total billed charges,Implant Devices,1101.6,34,,1101.6,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1101.6,34,"If Charge > 2,000, then 34 percent",1101.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1296,
ZIMMER 5988-10-10 STEM EXTNSION 10X100MM,C1776,HCPCS,,79005751,CDM,278,RC,,,both,,,3325,1312.27,39.4668,,1312.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1130.5,34,,1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Device,1130.5,34,"Charges > $500, x 34%",1130.5,percent of total billed charges,Implant Device,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1330,40,,1330,percent of total billed charges,Implant Devices,1163.75,70,,1163.75,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1130.5,34,,1130.5,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,1163.75,35,,1163.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.5,34,"If Charge > 2,000, then 34 percent",1130.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1330,
ZIMMER 5994-40-10 ART SURF SZ GREEN 10MM,C1776,HCPCS,,79005752,CDM,278,RC,,,both,,,6465,2551.53,39.4668,,2551.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Device,2198.1,34,"Charges > $500, x 34%",2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2586,40,,2586,percent of total billed charges,Implant Devices,2262.75,70,,2262.75,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2198.1,34,"If Charge > 2,000, then 34 percent",2198.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2586,
BIOMET 1817-01-101 UNIV HUMERAL ADD 10MM,C1776,HCPCS,,79005756,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
S&N 71453223 ART INSERT 13MM SIZE 5-8,C1776,HCPCS,,79005766,CDM,278,RC,,,both,,,5212,2057.01,39.4668,,2057.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Device,1772.08,34,"Charges > $500, x 34%",1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,2084.8,40,,2084.8,percent of total billed charges,Implant Devices,1824.2,70,,1824.2,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1772.08,34,"If Charge > 2,000, then 34 percent",1772.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2084.8,
BIOMET 113653 SHOULDER STEM 13X122MM,C1776,HCPCS,,79005767,CDM,278,RC,,,both,,,18630,7352.66,39.4668,,7352.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6334.2,34,,6334.2,percent of total billed charges,Implant Device,6520.5,35,,6520.5,percent of total billed charges,Implant Device,6334.2,34,"Charges > $500, x 34%",6334.2,percent of total billed charges,Implant Device,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,7452,40,,7452,percent of total billed charges,Implant Devices,6520.5,70,,6520.5,percent of total billed charges,Implant Devices,6334.2,34,,6334.2,percent of total billed charges,Implant Devices,6334.2,34,,6334.2,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,6520.5,35,,6520.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6334.2,34,"If Charge > 2,000, then 34 percent",6334.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7452,
BIOMET 113053 HUMERAL HEAD 50X21X57MM,C1776,HCPCS,,79005768,CDM,278,RC,,,both,,,9120,3599.37,39.4668,,3599.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3192,35,,3192,percent of total billed charges,Implant Device,3100.8,34,"Charges > $500, x 34%",3100.8,percent of total billed charges,Implant Device,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3648,40,,3648,percent of total billed charges,Implant Devices,3192,70,,3192,percent of total billed charges,Implant Devices,3100.8,34,,3100.8,percent of total billed charges,Implant Devices,3100.8,34,,3100.8,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3100.8,34,"If Charge > 2,000, then 34 percent",3100.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3648,
BIOMET 113954 GLENOID BASE 4MM,C1776,HCPCS,,79005769,CDM,278,RC,,,both,,,7800,3078.41,39.4668,,3078.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2730,35,,2730,percent of total billed charges,Implant Device,2652,34,"Charges > $500, x 34%",2652,percent of total billed charges,Implant Device,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,3120,40,,3120,percent of total billed charges,Implant Devices,2730,70,,2730,percent of total billed charges,Implant Devices,2652,34,,2652,percent of total billed charges,Implant Devices,2652,34,,2652,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2652,34,"If Charge > 2,000, then 34 percent",2652,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3120,
BIOMET 12-139040 ENDO II MOD HEAD SZ 58,C1776,HCPCS,,79005792,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
DEPUY 1987-07-065 SEGMENTAL COMP 65MM,C1776,HCPCS,,79005818,CDM,278,RC,,,both,,,5686,2244.08,39.4668,,2244.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1990.1,35,,1990.1,percent of total billed charges,Implant Device,1933.24,34,"Charges > $500, x 34%",1933.24,percent of total billed charges,Implant Device,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,2274.4,40,,2274.4,percent of total billed charges,Implant Devices,1990.1,70,,1990.1,percent of total billed charges,Implant Devices,1933.24,34,,1933.24,percent of total billed charges,Implant Devices,1933.24,34,,1933.24,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1933.24,34,"If Charge > 2,000, then 34 percent",1933.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2274.4,
DEPUY 1987-15-215 FEMORAL STEM 15X150MM,C1776,HCPCS,,79005819,CDM,278,RC,,,both,,,13620,5375.38,39.4668,,5375.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4767,35,,4767,percent of total billed charges,Implant Device,4630.8,34,"Charges > $500, x 34%",4630.8,percent of total billed charges,Implant Device,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,5448,40,,5448,percent of total billed charges,Implant Devices,4767,70,,4767,percent of total billed charges,Implant Devices,4630.8,34,,4630.8,percent of total billed charges,Implant Devices,4630.8,34,,4630.8,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4630.8,34,"If Charge > 2,000, then 34 percent",4630.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5448,
DEPUY 1987-15-212 FEMORAL STEM 12X150MM,C1776,HCPCS,,79005831,CDM,278,RC,,,both,,,13620,5375.38,39.4668,,5375.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4630.8,34,,4630.8,percent of total billed charges,Implant Device,4767,35,,4767,percent of total billed charges,Implant Device,4630.8,34,"Charges > $500, x 34%",4630.8,percent of total billed charges,Implant Device,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,5448,40,,5448,percent of total billed charges,Implant Devices,4767,70,,4767,percent of total billed charges,Implant Devices,4630.8,34,,4630.8,percent of total billed charges,Implant Devices,4630.8,34,,4630.8,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,4767,35,,4767,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4630.8,34,"If Charge > 2,000, then 34 percent",4630.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5448,
ZIMMER 5001-045-00 BIPOLAR SHELL 45MM OD,C1776,HCPCS,,79005919,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
ZIMMER 7850-014-00 VERSYS STEM 14X135,C1776,HCPCS,,79005920,CDM,278,RC,,,both,,,5760,2273.29,39.4668,,2273.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,1958.4,34,,1958.4,percent of total billed charges,Implant Device,2016,35,,2016,percent of total billed charges,Implant Device,1958.4,34,"Charges > $500, x 34%",1958.4,percent of total billed charges,Implant Device,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2304,40,,2304,percent of total billed charges,Implant Devices,2016,70,,2016,percent of total billed charges,Implant Devices,1958.4,34,,1958.4,percent of total billed charges,Implant Devices,1958.4,34,,1958.4,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,2016,35,,2016,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1958.4,34,"If Charge > 2,000, then 34 percent",1958.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2304,
ZIMMER 7859-012-00 VERSYS CENTRALZR 12MM,C1776,HCPCS,,79005921,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
DEPUY TOTAL KNEE HIGH CAP,C1776,HCPCS,,79005932,CDM,278,RC,,,both,,,16350,6452.82,39.4668,,6452.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5559,34,,5559,percent of total billed charges,Implant Device,5559,34,,5559,percent of total billed charges,Implant Device,5559,34,,5559,percent of total billed charges,Implant Device,5559,34,,5559,percent of total billed charges,Implant Device,5559,34,,5559,percent of total billed charges,Implant Device,5559,34,,5559,percent of total billed charges,Implant Device,5722.5,35,,5722.5,percent of total billed charges,Implant Device,5559,34,"Charges > $500, x 34%",5559,percent of total billed charges,Implant Device,5722.5,35,,5722.5,percent of total billed charges,Implant Devices,5722.5,35,,5722.5,percent of total billed charges,Implant Devices,5722.5,35,,,percent of total billed charges,Implant Devices,5722.5,35,,5722.5,percent of total billed charges,Implant Devices,5722.5,35,,5722.5,percent of total billed charges,Implant Devices,6540,40,,6540,percent of total billed charges,Implant Devices,5722.5,70,,5722.5,percent of total billed charges,Implant Devices,5559,34,,5559,percent of total billed charges,Implant Devices,5559,34,,5559,percent of total billed charges,Implant Devices,5722.5,35,,5722.5,percent of total billed charges,Implant Devices,5722.5,35,,5722.5,percent of total billed charges,Implant Devices,5722.5,35,,5722.5,percent of total billed charges,Implant Devices,5722.5,35,,5722.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5559,34,"If Charge > 2,000, then 34 percent",5559,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6540,
DEPUY TOTAL KNEE LOW CAP,C1776,HCPCS,,79005933,CDM,278,RC,,,both,,,15106,5961.85,39.4668,,5961.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5136.04,34,,5136.04,percent of total billed charges,Implant Device,5136.04,34,,5136.04,percent of total billed charges,Implant Device,5136.04,34,,5136.04,percent of total billed charges,Implant Device,5136.04,34,,5136.04,percent of total billed charges,Implant Device,5136.04,34,,5136.04,percent of total billed charges,Implant Device,5136.04,34,,5136.04,percent of total billed charges,Implant Device,5287.1,35,,5287.1,percent of total billed charges,Implant Device,5136.04,34,"Charges > $500, x 34%",5136.04,percent of total billed charges,Implant Device,5287.1,35,,5287.1,percent of total billed charges,Implant Devices,5287.1,35,,5287.1,percent of total billed charges,Implant Devices,5287.1,35,,,percent of total billed charges,Implant Devices,5287.1,35,,5287.1,percent of total billed charges,Implant Devices,5287.1,35,,5287.1,percent of total billed charges,Implant Devices,6042.4,40,,6042.4,percent of total billed charges,Implant Devices,5287.1,70,,5287.1,percent of total billed charges,Implant Devices,5136.04,34,,5136.04,percent of total billed charges,Implant Devices,5136.04,34,,5136.04,percent of total billed charges,Implant Devices,5287.1,35,,5287.1,percent of total billed charges,Implant Devices,5287.1,35,,5287.1,percent of total billed charges,Implant Devices,5287.1,35,,5287.1,percent of total billed charges,Implant Devices,5287.1,35,,5287.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5136.04,34,"If Charge > 2,000, then 34 percent",5136.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6042.4,
STRYKER 18-3675 FEMORAL HEAD 36X+7.5MM,C1776,HCPCS,,79005953,CDM,278,RC,,,both,,,8038,3172.34,39.4668,,3172.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2732.92,34,,2732.92,percent of total billed charges,Implant Device,2732.92,34,,2732.92,percent of total billed charges,Implant Device,2732.92,34,,2732.92,percent of total billed charges,Implant Device,2732.92,34,,2732.92,percent of total billed charges,Implant Device,2732.92,34,,2732.92,percent of total billed charges,Implant Device,2732.92,34,,2732.92,percent of total billed charges,Implant Device,2813.3,35,,2813.3,percent of total billed charges,Implant Device,2732.92,34,"Charges > $500, x 34%",2732.92,percent of total billed charges,Implant Device,2813.3,35,,2813.3,percent of total billed charges,Implant Devices,2813.3,35,,2813.3,percent of total billed charges,Implant Devices,2813.3,35,,,percent of total billed charges,Implant Devices,2813.3,35,,2813.3,percent of total billed charges,Implant Devices,2813.3,35,,2813.3,percent of total billed charges,Implant Devices,3215.2,40,,3215.2,percent of total billed charges,Implant Devices,2813.3,70,,2813.3,percent of total billed charges,Implant Devices,2732.92,34,,2732.92,percent of total billed charges,Implant Devices,2732.92,34,,2732.92,percent of total billed charges,Implant Devices,2813.3,35,,2813.3,percent of total billed charges,Implant Devices,2813.3,35,,2813.3,percent of total billed charges,Implant Devices,2813.3,35,,2813.3,percent of total billed charges,Implant Devices,2813.3,35,,2813.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2732.92,34,"If Charge > 2,000, then 34 percent",2732.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3215.2,
STRYKER 06-3610 FEMORAL HEAD 36X+10MM,C1776,HCPCS,,79005954,CDM,278,RC,,,both,,,6232,2459.57,39.4668,,2459.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2118.88,34,,2118.88,percent of total billed charges,Implant Device,2181.2,35,,2181.2,percent of total billed charges,Implant Device,2118.88,34,"Charges > $500, x 34%",2118.88,percent of total billed charges,Implant Device,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2492.8,40,,2492.8,percent of total billed charges,Implant Devices,2181.2,70,,2181.2,percent of total billed charges,Implant Devices,2118.88,34,,2118.88,percent of total billed charges,Implant Devices,2118.88,34,,2118.88,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,2181.2,35,,2181.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2118.88,34,"If Charge > 2,000, then 34 percent",2118.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2492.8,
ZIMMER 5952-40-12 ART SURF SZ GREEN 12MM,C1776,HCPCS,,79005956,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
BIOMET 12-150310 ECHO STD FEMORAL 10MM,C1776,HCPCS,,79005961,CDM,278,RC,,,both,,,15240,6014.74,39.4668,,6014.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5334,35,,5334,percent of total billed charges,Implant Device,5181.6,34,"Charges > $500, x 34%",5181.6,percent of total billed charges,Implant Device,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,6096,40,,6096,percent of total billed charges,Implant Devices,5334,70,,5334,percent of total billed charges,Implant Devices,5181.6,34,,5181.6,percent of total billed charges,Implant Devices,5181.6,34,,5181.6,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5181.6,34,"If Charge > 2,000, then 34 percent",5181.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6096,
BIOMET 11-165240 BIPOLAR RINGLOC 28X58MM,C1776,HCPCS,,79005962,CDM,278,RC,,,both,,,6540,2581.13,39.4668,,2581.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2289,35,,2289,percent of total billed charges,Implant Device,2223.6,34,"Charges > $500, x 34%",2223.6,percent of total billed charges,Implant Device,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2616,40,,2616,percent of total billed charges,Implant Devices,2289,70,,2289,percent of total billed charges,Implant Devices,2223.6,34,,2223.6,percent of total billed charges,Implant Devices,2223.6,34,,2223.6,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2223.6,34,"If Charge > 2,000, then 34 percent",2223.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2616,
BIOMET DVRANL DVR ANATOMIC PLATE LT,C1776,HCPCS,,79005971,CDM,278,RC,,,both,,,2394,944.84,39.4668,,944.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,813.96,34,,813.96,percent of total billed charges,Implant Device,837.9,35,,837.9,percent of total billed charges,Implant Device,813.96,34,"Charges > $500, x 34%",813.96,percent of total billed charges,Implant Device,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,957.6,40,,957.6,percent of total billed charges,Implant Devices,837.9,70,,837.9,percent of total billed charges,Implant Devices,813.96,34,,813.96,percent of total billed charges,Implant Devices,813.96,34,,813.96,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,837.9,35,,837.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,813.96,34,"If Charge > 2,000, then 34 percent",813.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,957.6,
S&N 71420634 GENESIS II LONG STEM 16X100,C1776,HCPCS,,79006005,CDM,278,RC,,,both,,,4006,1581.04,39.4668,,1581.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1362.04,34,,1362.04,percent of total billed charges,Implant Device,1362.04,34,,1362.04,percent of total billed charges,Implant Device,1362.04,34,,1362.04,percent of total billed charges,Implant Device,1362.04,34,,1362.04,percent of total billed charges,Implant Device,1362.04,34,,1362.04,percent of total billed charges,Implant Device,1362.04,34,,1362.04,percent of total billed charges,Implant Device,1402.1,35,,1402.1,percent of total billed charges,Implant Device,1362.04,34,"Charges > $500, x 34%",1362.04,percent of total billed charges,Implant Device,1402.1,35,,1402.1,percent of total billed charges,Implant Devices,1402.1,35,,1402.1,percent of total billed charges,Implant Devices,1402.1,35,,,percent of total billed charges,Implant Devices,1402.1,35,,1402.1,percent of total billed charges,Implant Devices,1402.1,35,,1402.1,percent of total billed charges,Implant Devices,1602.4,40,,1602.4,percent of total billed charges,Implant Devices,1402.1,70,,1402.1,percent of total billed charges,Implant Devices,1362.04,34,,1362.04,percent of total billed charges,Implant Devices,1362.04,34,,1362.04,percent of total billed charges,Implant Devices,1402.1,35,,1402.1,percent of total billed charges,Implant Devices,1402.1,35,,1402.1,percent of total billed charges,Implant Devices,1402.1,35,,1402.1,percent of total billed charges,Implant Devices,1402.1,35,,1402.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1362.04,34,"If Charge > 2,000, then 34 percent",1362.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602.4,
ZIMMER 7711-05 FEML STEM 12/14 NECK SZ 5,C1776,HCPCS,,79006051,CDM,278,RC,,,both,,,2273,897.08,39.4668,,897.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Device,772.82,34,"Charges > $500, x 34%",772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,909.2,40,,909.2,percent of total billed charges,Implant Devices,795.55,70,,795.55,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,772.82,34,"If Charge > 2,000, then 34 percent",772.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,909.2,
ZIMMER 5001-42 BIPOLAR CUP SHELL 42MM,C1776,HCPCS,,79006052,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
ZIMMER 5994-30-14 ART SURF S YELLOW 14MM,C1776,HCPCS,,79006066,CDM,278,RC,,,both,,,6465,2551.53,39.4668,,2551.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Device,2198.1,34,"Charges > $500, x 34%",2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2586,40,,2586,percent of total billed charges,Implant Devices,2262.75,70,,2262.75,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2198.1,34,"If Charge > 2,000, then 34 percent",2198.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2586,
STRYKER 6276-7-017 MOD HIP SYS 155X17MM,C1776,HCPCS,,79006090,CDM,278,RC,,,both,,,8561,3378.75,39.4668,,3378.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2996.35,35,,2996.35,percent of total billed charges,Implant Device,2910.74,34,"Charges > $500, x 34%",2910.74,percent of total billed charges,Implant Device,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,3424.4,40,,3424.4,percent of total billed charges,Implant Devices,2996.35,70,,2996.35,percent of total billed charges,Implant Devices,2910.74,34,,2910.74,percent of total billed charges,Implant Devices,2910.74,34,,2910.74,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2910.74,34,"If Charge > 2,000, then 34 percent",2910.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3424.4,
ZIMMER 5842-22-08 ART SURFACE SZ 2 8MM,C1776,HCPCS,,79006097,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
ZIMMER 5842-12-01 FEM COMP SZ B,C1776,HCPCS,,79006098,CDM,278,RC,,,both,,,10486,4138.49,39.4668,,4138.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Device,3565.24,34,"Charges > $500, x 34%",3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,4194.4,40,,4194.4,percent of total billed charges,Implant Devices,3670.1,70,,3670.1,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3565.24,34,"If Charge > 2,000, then 34 percent",3565.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194.4,
ZIMMER 00-8775-028-02 FEM HEAD 28/+0MM,C1776,HCPCS,,79006099,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
ZIMMER 7711-04-10 FEM STEM SIZE 4,C1776,HCPCS,,79006100,CDM,278,RC,,,both,,,8910,3516.49,39.4668,,3516.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Device,3029.4,34,"Charges > $500, x 34%",3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3564,40,,3564,percent of total billed charges,Implant Devices,3118.5,70,,3118.5,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3029.4,34,"If Charge > 2,000, then 34 percent",3029.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3564,
ZIMMER 5001-44 BIPOLAR SHELL 44MM OD,C1776,HCPCS,,79006101,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
EXACTECH 310-02-47 HUMERAL HEAD 47MM,C1776,HCPCS,,79006115,CDM,278,RC,,,both,,,4968,1960.71,39.4668,,1960.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Device,1689.12,34,"Charges > $500, x 34%",1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1987.2,40,,1987.2,percent of total billed charges,Implant Devices,1738.8,70,,1738.8,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.12,34,"If Charge > 2,000, then 34 percent",1689.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.2,
EXACTECH 300-01-15 HUMERAL STEM 15MM,C1776,HCPCS,,79006116,CDM,278,RC,,,both,,,4425,1746.41,39.4668,,1746.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Device,1504.5,34,"Charges > $500, x 34%",1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1770,40,,1770,percent of total billed charges,Implant Devices,1548.75,70,,1548.75,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1504.5,34,"If Charge > 2,000, then 34 percent",1504.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1770,
BIOMET/EBI 12-139016 ENDO HEAD SZ 46MM,C1776,HCPCS,,79006135,CDM,278,RC,,,both,,,2280,899.84,39.4668,,899.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,775.2,34,,775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Device,775.2,34,"Charges > $500, x 34%",775.2,percent of total billed charges,Implant Device,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,912,40,,912,percent of total billed charges,Implant Devices,798,70,,798,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,775.2,34,,775.2,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,798,35,,798,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,775.2,34,"If Charge > 2,000, then 34 percent",775.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,912,
STRYKER 5551-G-381 PATELLA A38X11MM,C1776,HCPCS,,79006160,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
BIOMET 12-151309 ECHO HIP FEMORL 9X130MM,C1776,HCPCS,,79006163,CDM,278,RC,,,both,,,4992,1970.18,39.4668,,1970.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1747.2,35,,1747.2,percent of total billed charges,Implant Device,1697.28,34,"Charges > $500, x 34%",1697.28,percent of total billed charges,Implant Device,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1996.8,40,,1996.8,percent of total billed charges,Implant Devices,1747.2,70,,1747.2,percent of total billed charges,Implant Devices,1697.28,34,,1697.28,percent of total billed charges,Implant Devices,1697.28,34,,1697.28,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1697.28,34,"If Charge > 2,000, then 34 percent",1697.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1996.8,
ARTHREX AR-8943BR-04 FIBULA PLATE 4 HOLE,C1776,HCPCS,,79006164,CDM,278,RC,,,both,,,2358,930.63,39.4668,,930.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,801.72,34,,801.72,percent of total billed charges,Implant Device,801.72,34,,801.72,percent of total billed charges,Implant Device,801.72,34,,801.72,percent of total billed charges,Implant Device,801.72,34,,801.72,percent of total billed charges,Implant Device,801.72,34,,801.72,percent of total billed charges,Implant Device,801.72,34,,801.72,percent of total billed charges,Implant Device,825.3,35,,825.3,percent of total billed charges,Implant Device,801.72,34,"Charges > $500, x 34%",801.72,percent of total billed charges,Implant Device,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,943.2,40,,943.2,percent of total billed charges,Implant Devices,825.3,70,,825.3,percent of total billed charges,Implant Devices,801.72,34,,801.72,percent of total billed charges,Implant Devices,801.72,34,,801.72,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,825.3,35,,825.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,801.72,34,"If Charge > 2,000, then 34 percent",801.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,943.2,
DEPUY 1987-25-412 LPS STEM STR 12X125MM,C1776,HCPCS,,79006166,CDM,278,RC,,,both,,,19157,7560.65,39.4668,,7560.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6704.95,35,,6704.95,percent of total billed charges,Implant Device,6513.38,34,"Charges > $500, x 34%",6513.38,percent of total billed charges,Implant Device,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,7662.8,40,,7662.8,percent of total billed charges,Implant Devices,6704.95,70,,6704.95,percent of total billed charges,Implant Devices,6513.38,34,,6513.38,percent of total billed charges,Implant Devices,6513.38,34,,6513.38,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6513.38,34,"If Charge > 2,000, then 34 percent",6513.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7662.8,
DEPUY 1987-07-035 LPS SEGMENT COMP 35MM,C1776,HCPCS,,79006167,CDM,278,RC,,,both,,,5686,2244.08,39.4668,,2244.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1933.24,34,,1933.24,percent of total billed charges,Implant Device,1990.1,35,,1990.1,percent of total billed charges,Implant Device,1933.24,34,"Charges > $500, x 34%",1933.24,percent of total billed charges,Implant Device,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,2274.4,40,,2274.4,percent of total billed charges,Implant Devices,1990.1,70,,1990.1,percent of total billed charges,Implant Devices,1933.24,34,,1933.24,percent of total billed charges,Implant Devices,1933.24,34,,1933.24,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,1990.1,35,,1990.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1933.24,34,"If Charge > 2,000, then 34 percent",1933.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2274.4,
DEPUY 1987-27-014 LPS TIB INS HINGE 14MM,C1776,HCPCS,,79006168,CDM,278,RC,,,both,,,11227,4430.94,39.4668,,4430.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3817.18,34,,3817.18,percent of total billed charges,Implant Device,3929.45,35,,3929.45,percent of total billed charges,Implant Device,3817.18,34,"Charges > $500, x 34%",3817.18,percent of total billed charges,Implant Device,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,4490.8,40,,4490.8,percent of total billed charges,Implant Devices,3929.45,70,,3929.45,percent of total billed charges,Implant Devices,3817.18,34,,3817.18,percent of total billed charges,Implant Devices,3817.18,34,,3817.18,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,3929.45,35,,3929.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3817.18,34,"If Charge > 2,000, then 34 percent",3817.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4490.8,
STRYKER R5350-4021 SHLDR HUM HD 40X21MM,C1776,HCPCS,,79006171,CDM,278,RC,,,both,,,7523,2969.09,39.4668,,2969.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2557.82,34,,2557.82,percent of total billed charges,Implant Device,2557.82,34,,2557.82,percent of total billed charges,Implant Device,2557.82,34,,2557.82,percent of total billed charges,Implant Device,2557.82,34,,2557.82,percent of total billed charges,Implant Device,2557.82,34,,2557.82,percent of total billed charges,Implant Device,2557.82,34,,2557.82,percent of total billed charges,Implant Device,2633.05,35,,2633.05,percent of total billed charges,Implant Device,2557.82,34,"Charges > $500, x 34%",2557.82,percent of total billed charges,Implant Device,2633.05,35,,2633.05,percent of total billed charges,Implant Devices,2633.05,35,,2633.05,percent of total billed charges,Implant Devices,2633.05,35,,,percent of total billed charges,Implant Devices,2633.05,35,,2633.05,percent of total billed charges,Implant Devices,2633.05,35,,2633.05,percent of total billed charges,Implant Devices,3009.2,40,,3009.2,percent of total billed charges,Implant Devices,2633.05,70,,2633.05,percent of total billed charges,Implant Devices,2557.82,34,,2557.82,percent of total billed charges,Implant Devices,2557.82,34,,2557.82,percent of total billed charges,Implant Devices,2633.05,35,,2633.05,percent of total billed charges,Implant Devices,2633.05,35,,2633.05,percent of total billed charges,Implant Devices,2633.05,35,,2633.05,percent of total billed charges,Implant Devices,2633.05,35,,2633.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2557.82,34,"If Charge > 2,000, then 34 percent",2557.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3009.2,
STRYKER R5351-4509 REUNION HA STEM COMP,C1776,HCPCS,,79006172,CDM,278,RC,,,both,,,14372,5672.17,39.4668,,5672.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4886.48,34,,4886.48,percent of total billed charges,Implant Device,4886.48,34,,4886.48,percent of total billed charges,Implant Device,4886.48,34,,4886.48,percent of total billed charges,Implant Device,4886.48,34,,4886.48,percent of total billed charges,Implant Device,4886.48,34,,4886.48,percent of total billed charges,Implant Device,4886.48,34,,4886.48,percent of total billed charges,Implant Device,5030.2,35,,5030.2,percent of total billed charges,Implant Device,4886.48,34,"Charges > $500, x 34%",4886.48,percent of total billed charges,Implant Device,5030.2,35,,5030.2,percent of total billed charges,Implant Devices,5030.2,35,,5030.2,percent of total billed charges,Implant Devices,5030.2,35,,,percent of total billed charges,Implant Devices,5030.2,35,,5030.2,percent of total billed charges,Implant Devices,5030.2,35,,5030.2,percent of total billed charges,Implant Devices,5748.8,40,,5748.8,percent of total billed charges,Implant Devices,5030.2,70,,5030.2,percent of total billed charges,Implant Devices,4886.48,34,,4886.48,percent of total billed charges,Implant Devices,4886.48,34,,4886.48,percent of total billed charges,Implant Devices,5030.2,35,,5030.2,percent of total billed charges,Implant Devices,5030.2,35,,5030.2,percent of total billed charges,Implant Devices,5030.2,35,,5030.2,percent of total billed charges,Implant Devices,5030.2,35,,5030.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4886.48,34,"If Charge > 2,000, then 34 percent",4886.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5748.8,
ZIMMER 5842-04-01 TIBIAL COMPONENT SZ 4,C1776,HCPCS,,79006177,CDM,278,RC,,,both,,,6346,2504.56,39.4668,,2504.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2157.64,34,,2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Device,2157.64,34,"Charges > $500, x 34%",2157.64,percent of total billed charges,Implant Device,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2538.4,40,,2538.4,percent of total billed charges,Implant Devices,2221.1,70,,2221.1,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2157.64,34,,2157.64,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,2221.1,35,,2221.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2157.64,34,"If Charge > 2,000, then 34 percent",2157.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2538.4,
ZIMMER 5842-24-10 ARTCLR SURF SZ 4 10MM,C1776,HCPCS,,79006178,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
ZIMMER 7711-010-00  M/L TAPER 10 STD,C1776,HCPCS,,79006211,CDM,278,RC,,,both,,,7398,2919.75,39.4668,,2919.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2589.3,35,,2589.3,percent of total billed charges,Implant Device,2515.32,34,"Charges > $500, x 34%",2515.32,percent of total billed charges,Implant Device,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2959.2,40,,2959.2,percent of total billed charges,Implant Devices,2589.3,70,,2589.3,percent of total billed charges,Implant Devices,2515.32,34,,2515.32,percent of total billed charges,Implant Devices,2515.32,34,,2515.32,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2515.32,34,"If Charge > 2,000, then 34 percent",2515.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2959.2,
ZIMMER 5880-15-01 FEMORAL COMP SZ E LT,C1776,HCPCS,,79006230,CDM,278,RC,,,both,,,26254,10361.61,39.4668,,10361.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,9188.9,35,,9188.9,percent of total billed charges,Implant Device,8926.36,34,"Charges > $500, x 34%",8926.36,percent of total billed charges,Implant Device,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,10501.6,40,,10501.6,percent of total billed charges,Implant Devices,9188.9,70,,9188.9,percent of total billed charges,Implant Devices,8926.36,34,,8926.36,percent of total billed charges,Implant Devices,8926.36,34,,8926.36,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8926.36,34,"If Charge > 2,000, then 34 percent",8926.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10501.6,
ZIMMER 5972-65-32 PATELLA SZ 32 8.5MM,C1776,HCPCS,,79006231,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 5842-13-02 FEM COMP SZ C,C1776,HCPCS,,79006279,CDM,278,RC,,,both,,,10486,4138.49,39.4668,,4138.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3565.24,34,,3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Device,3565.24,34,"Charges > $500, x 34%",3565.24,percent of total billed charges,Implant Device,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,4194.4,40,,4194.4,percent of total billed charges,Implant Devices,3670.1,70,,3670.1,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3565.24,34,,3565.24,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,3670.1,35,,3670.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3565.24,34,"If Charge > 2,000, then 34 percent",3565.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194.4,
ZIMMER 5842-23-11 ART SURF SZ 3 11MM,C1776,HCPCS,,79006280,CDM,278,RC,,,both,,,2677,1056.53,39.4668,,1056.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,910.18,34,,910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Device,910.18,34,"Charges > $500, x 34%",910.18,percent of total billed charges,Implant Device,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,1070.8,40,,1070.8,percent of total billed charges,Implant Devices,936.95,70,,936.95,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,910.18,34,,910.18,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,936.95,35,,936.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,910.18,34,"If Charge > 2,000, then 34 percent",910.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1070.8,
BIOMET 115378 HUMERAL TRAY 44MM,C1776,HCPCS,,79006304,CDM,278,RC,,,both,,,8670,3421.77,39.4668,,3421.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2947.8,34,,2947.8,percent of total billed charges,Implant Device,2947.8,34,,2947.8,percent of total billed charges,Implant Device,2947.8,34,,2947.8,percent of total billed charges,Implant Device,2947.8,34,,2947.8,percent of total billed charges,Implant Device,2947.8,34,,2947.8,percent of total billed charges,Implant Device,2947.8,34,,2947.8,percent of total billed charges,Implant Device,3034.5,35,,3034.5,percent of total billed charges,Implant Device,2947.8,34,"Charges > $500, x 34%",2947.8,percent of total billed charges,Implant Device,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3468,40,,3468,percent of total billed charges,Implant Devices,3034.5,70,,3034.5,percent of total billed charges,Implant Devices,2947.8,34,,2947.8,percent of total billed charges,Implant Devices,2947.8,34,,2947.8,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,3034.5,35,,3034.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2947.8,34,"If Charge > 2,000, then 34 percent",2947.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3468,
BIOMET 115313 GLENOSPHERE 36MM DIA,C1776,HCPCS,,79006307,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
BIOMET EP-115394 HUMERAL BEARING 44-36MM,C1776,HCPCS,,79006309,CDM,278,RC,,,both,,,7740,3054.73,39.4668,,3054.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2709,35,,2709,percent of total billed charges,Implant Device,2631.6,34,"Charges > $500, x 34%",2631.6,percent of total billed charges,Implant Device,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,3096,40,,3096,percent of total billed charges,Implant Devices,2709,70,,2709,percent of total billed charges,Implant Devices,2631.6,34,,2631.6,percent of total billed charges,Implant Devices,2631.6,34,,2631.6,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2631.6,34,"If Charge > 2,000, then 34 percent",2631.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3096,
DEPUY HEMIARTHROPLASTY HIP FRACTURE STEM,C1776,HCPCS,,79006341,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
ZIMMER 5001-50-00 BIPOLAR SHELL 50MM,C1776,HCPCS,,79006347,CDM,278,RC,,,both,,,2273,897.08,39.4668,,897.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Device,772.82,34,"Charges > $500, x 34%",772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,909.2,40,,909.2,percent of total billed charges,Implant Devices,795.55,70,,795.55,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,772.82,34,"If Charge > 2,000, then 34 percent",772.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,909.2,
ZIMMER 5001-50-28 BIPLR LINR 50-52X28MM,C1776,HCPCS,,79006348,CDM,278,RC,,,both,,,1373,541.88,39.4668,,541.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,466.82,34,,466.82,percent of total billed charges,Implant Device,466.82,34,,466.82,percent of total billed charges,Implant Device,466.82,34,,466.82,percent of total billed charges,Implant Device,466.82,34,,466.82,percent of total billed charges,Implant Device,466.82,34,,466.82,percent of total billed charges,Implant Device,466.82,34,,466.82,percent of total billed charges,Implant Device,480.55,35,,480.55,percent of total billed charges,Implant Device,466.82,34,"Charges > $500, x 34%",466.82,percent of total billed charges,Implant Device,480.55,35,,480.55,percent of total billed charges,Implant Devices,480.55,35,,480.55,percent of total billed charges,Implant Devices,480.55,35,,,percent of total billed charges,Implant Devices,480.55,35,,480.55,percent of total billed charges,Implant Devices,480.55,35,,480.55,percent of total billed charges,Implant Devices,549.2,40,,549.2,percent of total billed charges,Implant Devices,480.55,70,,480.55,percent of total billed charges,Implant Devices,466.82,34,,466.82,percent of total billed charges,Implant Devices,466.82,34,,466.82,percent of total billed charges,Implant Devices,480.55,35,,480.55,percent of total billed charges,Implant Devices,480.55,35,,480.55,percent of total billed charges,Implant Devices,480.55,35,,480.55,percent of total billed charges,Implant Devices,480.55,35,,480.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,549.2,
ZIMMER 7711-10-40 M/L TAPER 10 EXT NECK,C1776,HCPCS,,79006350,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 8775-28-01 BIOLOX FEM HD 28X-3.5,C1776,HCPCS,,79006351,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
BIOMET 113042 VERSDIAL SHOULDER 46X18MM,C1776,HCPCS,,79006406,CDM,278,RC,,,both,,,9120,3599.37,39.4668,,3599.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3100.8,34,,3100.8,percent of total billed charges,Implant Device,3192,35,,3192,percent of total billed charges,Implant Device,3100.8,34,"Charges > $500, x 34%",3100.8,percent of total billed charges,Implant Device,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3648,40,,3648,percent of total billed charges,Implant Devices,3192,70,,3192,percent of total billed charges,Implant Devices,3100.8,34,,3100.8,percent of total billed charges,Implant Devices,3100.8,34,,3100.8,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,3192,35,,3192,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3100.8,34,"If Charge > 2,000, then 34 percent",3100.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3648,
ZIMMER 00-8775-032-02 FEM HEAD 32M 12/14,C1776,HCPCS,,79006410,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
BIOMET 92-0495 FEMUR HEAD FD IR 43MM,C1776,HCPCS,,79006422,CDM,278,RC,,,both,,,4044,1596.04,39.4668,,1596.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1374.96,34,,1374.96,percent of total billed charges,Implant Device,1415.4,35,,1415.4,percent of total billed charges,Implant Device,1374.96,34,"Charges > $500, x 34%",1374.96,percent of total billed charges,Implant Device,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1617.6,40,,1617.6,percent of total billed charges,Implant Devices,1415.4,70,,1415.4,percent of total billed charges,Implant Devices,1374.96,34,,1374.96,percent of total billed charges,Implant Devices,1374.96,34,,1374.96,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,1415.4,35,,1415.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1374.96,34,"If Charge > 2,000, then 34 percent",1374.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1617.6,
ZIMMER 5001-44-28 BIPOLAR LINER 28MM ID,C1776,HCPCS,,79006431,CDM,278,RC,,,both,,,789,311.39,39.4668,,311.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Device,268.26,34,"Charges > $500, x 34%",268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,315.6,40,,315.6,percent of total billed charges,Implant Devices,276.15,70,,276.15,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.6,
ZIMMER 5001-45 BIPOLAR SHELL 45MM OD,C1776,HCPCS,,79006432,CDM,278,RC,,,both,,,2273,897.08,39.4668,,897.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,772.82,34,,772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Device,772.82,34,"Charges > $500, x 34%",772.82,percent of total billed charges,Implant Device,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,909.2,40,,909.2,percent of total billed charges,Implant Devices,795.55,70,,795.55,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,772.82,34,,772.82,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,795.55,35,,795.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,772.82,34,"If Charge > 2,000, then 34 percent",772.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,909.2,
ZIMMER 7859-13 DISTAL CENTRALIZER 13MM,C1776,HCPCS,,79006433,CDM,278,RC,,,both,,,192,75.78,39.4668,,75.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,65.28,34,,65.28,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,76.8,40,,76.8,percent of total billed charges,Implant Devices,67.2,70,,67.2,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,65.28,34,,65.28,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,67.2,35,,67.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.8,
ZIMMER 00-8775-028-03 FEM HEAD 28MM,C1776,HCPCS,,79006434,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
EXACTECH SPS0021K INTERSPACE SHOULDR KIT,C1776,HCPCS,,79006435,CDM,278,RC,,,both,,,11761,4641.69,39.4668,,4641.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3998.74,34,,3998.74,percent of total billed charges,Implant Device,3998.74,34,,3998.74,percent of total billed charges,Implant Device,3998.74,34,,3998.74,percent of total billed charges,Implant Device,3998.74,34,,3998.74,percent of total billed charges,Implant Device,3998.74,34,,3998.74,percent of total billed charges,Implant Device,3998.74,34,,3998.74,percent of total billed charges,Implant Device,4116.35,35,,4116.35,percent of total billed charges,Implant Device,3998.74,34,"Charges > $500, x 34%",3998.74,percent of total billed charges,Implant Device,4116.35,35,,4116.35,percent of total billed charges,Implant Devices,4116.35,35,,4116.35,percent of total billed charges,Implant Devices,4116.35,35,,,percent of total billed charges,Implant Devices,4116.35,35,,4116.35,percent of total billed charges,Implant Devices,4116.35,35,,4116.35,percent of total billed charges,Implant Devices,4704.4,40,,4704.4,percent of total billed charges,Implant Devices,4116.35,70,,4116.35,percent of total billed charges,Implant Devices,3998.74,34,,3998.74,percent of total billed charges,Implant Devices,3998.74,34,,3998.74,percent of total billed charges,Implant Devices,4116.35,35,,4116.35,percent of total billed charges,Implant Devices,4116.35,35,,4116.35,percent of total billed charges,Implant Devices,4116.35,35,,4116.35,percent of total billed charges,Implant Devices,4116.35,35,,4116.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3998.74,34,"If Charge > 2,000, then 34 percent",3998.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4704.4,
DEPUY 1294-35-115 TIBIAL TRAY SZ 1.5,C1776,HCPCS,,79006489,CDM,278,RC,,,both,,,19157,7560.65,39.4668,,7560.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6513.38,34,,6513.38,percent of total billed charges,Implant Device,6704.95,35,,6704.95,percent of total billed charges,Implant Device,6513.38,34,"Charges > $500, x 34%",6513.38,percent of total billed charges,Implant Device,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,7662.8,40,,7662.8,percent of total billed charges,Implant Devices,6704.95,70,,6704.95,percent of total billed charges,Implant Devices,6513.38,34,,6513.38,percent of total billed charges,Implant Devices,6513.38,34,,6513.38,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,6704.95,35,,6704.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6513.38,34,"If Charge > 2,000, then 34 percent",6513.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7662.8,
DEPUY 1987-27-121 TIBIAL INSERT SM 21MM,C1776,HCPCS,,79006490,CDM,278,RC,,,both,,,10692,4219.79,39.4668,,4219.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3635.28,34,,3635.28,percent of total billed charges,Implant Device,3742.2,35,,3742.2,percent of total billed charges,Implant Device,3635.28,34,"Charges > $500, x 34%",3635.28,percent of total billed charges,Implant Device,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,4276.8,40,,4276.8,percent of total billed charges,Implant Devices,3742.2,70,,3742.2,percent of total billed charges,Implant Devices,3635.28,34,,3635.28,percent of total billed charges,Implant Devices,3635.28,34,,3635.28,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,3742.2,35,,3742.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3635.28,34,"If Charge > 2,000, then 34 percent",3635.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4276.8,
DEPUY 62-3421R FEMORAL ROTATING HINGE RT,C1776,HCPCS,,79006491,CDM,278,RC,,,both,,,24955,9848.94,39.4668,,9848.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8484.7,34,,8484.7,percent of total billed charges,Implant Device,8484.7,34,,8484.7,percent of total billed charges,Implant Device,8484.7,34,,8484.7,percent of total billed charges,Implant Device,8484.7,34,,8484.7,percent of total billed charges,Implant Device,8484.7,34,,8484.7,percent of total billed charges,Implant Device,8484.7,34,,8484.7,percent of total billed charges,Implant Device,8734.25,35,,8734.25,percent of total billed charges,Implant Device,8484.7,34,"Charges > $500, x 34%",8484.7,percent of total billed charges,Implant Device,8734.25,35,,8734.25,percent of total billed charges,Implant Devices,8734.25,35,,8734.25,percent of total billed charges,Implant Devices,8734.25,35,,,percent of total billed charges,Implant Devices,8734.25,35,,8734.25,percent of total billed charges,Implant Devices,8734.25,35,,8734.25,percent of total billed charges,Implant Devices,9982,40,,9982,percent of total billed charges,Implant Devices,8734.25,70,,8734.25,percent of total billed charges,Implant Devices,8484.7,34,,8484.7,percent of total billed charges,Implant Devices,8484.7,34,,8484.7,percent of total billed charges,Implant Devices,8734.25,35,,8734.25,percent of total billed charges,Implant Devices,8734.25,35,,8734.25,percent of total billed charges,Implant Devices,8734.25,35,,8734.25,percent of total billed charges,Implant Devices,8734.25,35,,8734.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8484.7,34,"If Charge > 2,000, then 34 percent",8484.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9982,
DEPUY 62-3810 DISTAL FEM AUG BLOCK 10MM,C1776,HCPCS,,79006492,CDM,278,RC,,,both,,,3065,1209.66,39.4668,,1209.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1042.1,34,,1042.1,percent of total billed charges,Implant Device,1042.1,34,,1042.1,percent of total billed charges,Implant Device,1042.1,34,,1042.1,percent of total billed charges,Implant Device,1042.1,34,,1042.1,percent of total billed charges,Implant Device,1042.1,34,,1042.1,percent of total billed charges,Implant Device,1042.1,34,,1042.1,percent of total billed charges,Implant Device,1072.75,35,,1072.75,percent of total billed charges,Implant Device,1042.1,34,"Charges > $500, x 34%",1042.1,percent of total billed charges,Implant Device,1072.75,35,,1072.75,percent of total billed charges,Implant Devices,1072.75,35,,1072.75,percent of total billed charges,Implant Devices,1072.75,35,,,percent of total billed charges,Implant Devices,1072.75,35,,1072.75,percent of total billed charges,Implant Devices,1072.75,35,,1072.75,percent of total billed charges,Implant Devices,1226,40,,1226,percent of total billed charges,Implant Devices,1072.75,70,,1072.75,percent of total billed charges,Implant Devices,1042.1,34,,1042.1,percent of total billed charges,Implant Devices,1042.1,34,,1042.1,percent of total billed charges,Implant Devices,1072.75,35,,1072.75,percent of total billed charges,Implant Devices,1072.75,35,,1072.75,percent of total billed charges,Implant Devices,1072.75,35,,1072.75,percent of total billed charges,Implant Devices,1072.75,35,,1072.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1042.1,34,"If Charge > 2,000, then 34 percent",1042.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1226,
DEPUY 86-7442 UNVRSL STEM FLUTED 150X14,C1776,HCPCS,,79006493,CDM,278,RC,,,both,,,5964,2353.8,39.4668,,2353.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2027.76,34,,2027.76,percent of total billed charges,Implant Device,2087.4,35,,2087.4,percent of total billed charges,Implant Device,2027.76,34,"Charges > $500, x 34%",2027.76,percent of total billed charges,Implant Device,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2385.6,40,,2385.6,percent of total billed charges,Implant Devices,2087.4,70,,2087.4,percent of total billed charges,Implant Devices,2027.76,34,,2027.76,percent of total billed charges,Implant Devices,2027.76,34,,2027.76,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,2087.4,35,,2087.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2027.76,34,"If Charge > 2,000, then 34 percent",2027.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2385.6,
EXACTECH 314-13-14 CAGED GLENOID LARGE,C1776,HCPCS,,79006496,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
METASURG DF2510 DIGIFUSE 2.5MM-10 ANGLE,C1776,HCPCS,,79006497,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
METASURG TQ2012 QUICK SNAP IMPLANT,C1776,HCPCS,,79006498,CDM,278,RC,,,both,,,720,284.16,39.4668,,284.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,244.8,34,,244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Device,244.8,34,"Charges > $500, x 34%",244.8,percent of total billed charges,Implant Device,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,288,40,,288,percent of total billed charges,Implant Devices,252,70,,252,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,244.8,34,,244.8,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,252,35,,252,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,288,
ZIMMER 00-5880-005-00 TIBIAL COMP SIZE 5,C1776,HCPCS,,79006506,CDM,278,RC,,,both,,,13023,5139.76,39.4668,,5139.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4427.82,34,,4427.82,percent of total billed charges,Implant Device,4558.05,35,,4558.05,percent of total billed charges,Implant Device,4427.82,34,"Charges > $500, x 34%",4427.82,percent of total billed charges,Implant Device,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,5209.2,40,,5209.2,percent of total billed charges,Implant Devices,4558.05,70,,4558.05,percent of total billed charges,Implant Devices,4427.82,34,,4427.82,percent of total billed charges,Implant Devices,4427.82,34,,4427.82,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,4558.05,35,,4558.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4427.82,34,"If Charge > 2,000, then 34 percent",4427.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5209.2,
ZIMMER 00-5880-016-02 FEM COMP SIZE F RT,C1776,HCPCS,,79006507,CDM,278,RC,,,both,,,26254,10361.61,39.4668,,10361.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,9188.9,35,,9188.9,percent of total billed charges,Implant Device,8926.36,34,"Charges > $500, x 34%",8926.36,percent of total billed charges,Implant Device,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,10501.6,40,,10501.6,percent of total billed charges,Implant Devices,9188.9,70,,9188.9,percent of total billed charges,Implant Devices,8926.36,34,,8926.36,percent of total billed charges,Implant Devices,8926.36,34,,8926.36,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8926.36,34,"If Charge > 2,000, then 34 percent",8926.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10501.6,
ZIMMER 00-5880-060-20 ART SURF SZ F 20MM,C1776,HCPCS,,79006508,CDM,278,RC,,,both,,,5603,2211.32,39.4668,,2211.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1961.05,35,,1961.05,percent of total billed charges,Implant Device,1905.02,34,"Charges > $500, x 34%",1905.02,percent of total billed charges,Implant Device,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,2241.2,40,,2241.2,percent of total billed charges,Implant Devices,1961.05,70,,1961.05,percent of total billed charges,Implant Devices,1905.02,34,,1905.02,percent of total billed charges,Implant Devices,1905.02,34,,1905.02,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1905.02,34,"If Charge > 2,000, then 34 percent",1905.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2241.2,
DEPUY 1035-42-000 BI-POLAR HEAD 28X42MM,C1776,HCPCS,,79006509,CDM,278,RC,,,both,,,3314,1307.93,39.4668,,1307.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1126.76,34,,1126.76,percent of total billed charges,Implant Device,1126.76,34,,1126.76,percent of total billed charges,Implant Device,1126.76,34,,1126.76,percent of total billed charges,Implant Device,1126.76,34,,1126.76,percent of total billed charges,Implant Device,1126.76,34,,1126.76,percent of total billed charges,Implant Device,1126.76,34,,1126.76,percent of total billed charges,Implant Device,1159.9,35,,1159.9,percent of total billed charges,Implant Device,1126.76,34,"Charges > $500, x 34%",1126.76,percent of total billed charges,Implant Device,1159.9,35,,1159.9,percent of total billed charges,Implant Devices,1159.9,35,,1159.9,percent of total billed charges,Implant Devices,1159.9,35,,,percent of total billed charges,Implant Devices,1159.9,35,,1159.9,percent of total billed charges,Implant Devices,1159.9,35,,1159.9,percent of total billed charges,Implant Devices,1325.6,40,,1325.6,percent of total billed charges,Implant Devices,1159.9,70,,1159.9,percent of total billed charges,Implant Devices,1126.76,34,,1126.76,percent of total billed charges,Implant Devices,1126.76,34,,1126.76,percent of total billed charges,Implant Devices,1159.9,35,,1159.9,percent of total billed charges,Implant Devices,1159.9,35,,1159.9,percent of total billed charges,Implant Devices,1159.9,35,,1159.9,percent of total billed charges,Implant Devices,1159.9,35,,1159.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1126.76,34,"If Charge > 2,000, then 34 percent",1126.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1325.6,
DEPUY 1365-28-330 FEMORAL HEAD +8.5 28MM,C1776,HCPCS,,79006510,CDM,278,RC,,,both,,,4746,1873.09,39.4668,,1873.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1613.64,34,,1613.64,percent of total billed charges,Implant Device,1613.64,34,,1613.64,percent of total billed charges,Implant Device,1613.64,34,,1613.64,percent of total billed charges,Implant Device,1613.64,34,,1613.64,percent of total billed charges,Implant Device,1613.64,34,,1613.64,percent of total billed charges,Implant Device,1613.64,34,,1613.64,percent of total billed charges,Implant Device,1661.1,35,,1661.1,percent of total billed charges,Implant Device,1613.64,34,"Charges > $500, x 34%",1613.64,percent of total billed charges,Implant Device,1661.1,35,,1661.1,percent of total billed charges,Implant Devices,1661.1,35,,1661.1,percent of total billed charges,Implant Devices,1661.1,35,,,percent of total billed charges,Implant Devices,1661.1,35,,1661.1,percent of total billed charges,Implant Devices,1661.1,35,,1661.1,percent of total billed charges,Implant Devices,1898.4,40,,1898.4,percent of total billed charges,Implant Devices,1661.1,70,,1661.1,percent of total billed charges,Implant Devices,1613.64,34,,1613.64,percent of total billed charges,Implant Devices,1613.64,34,,1613.64,percent of total billed charges,Implant Devices,1661.1,35,,1661.1,percent of total billed charges,Implant Devices,1661.1,35,,1661.1,percent of total billed charges,Implant Devices,1661.1,35,,1661.1,percent of total billed charges,Implant Devices,1661.1,35,,1661.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1613.64,34,"If Charge > 2,000, then 34 percent",1613.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1898.4,
DEPUY 1365-28-310 FEM HEAD +1.5 28MM DIA,C1776,HCPCS,,79006514,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
DEPUY 3L92501 FEM STEM SZ 11 STND COLLAR,C1776,HCPCS,,79006515,CDM,278,RC,,,both,,,13446,5306.71,39.4668,,5306.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Device,4571.64,34,"Charges > $500, x 34%",4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,5378.4,40,,5378.4,percent of total billed charges,Implant Devices,4706.1,70,,4706.1,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4571.64,34,"If Charge > 2,000, then 34 percent",4571.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5378.4,
DEPUY 1365-23-000 FEM HEAD 32MM +9 12/14,C1776,HCPCS,,79006531,CDM,278,RC,,,both,,,1792,707.25,39.4668,,707.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,609.28,34,,609.28,percent of total billed charges,Implant Device,609.28,34,,609.28,percent of total billed charges,Implant Device,609.28,34,,609.28,percent of total billed charges,Implant Device,609.28,34,,609.28,percent of total billed charges,Implant Device,609.28,34,,609.28,percent of total billed charges,Implant Device,609.28,34,,609.28,percent of total billed charges,Implant Device,627.2,35,,627.2,percent of total billed charges,Implant Device,609.28,34,"Charges > $500, x 34%",609.28,percent of total billed charges,Implant Device,627.2,35,,627.2,percent of total billed charges,Implant Devices,627.2,35,,627.2,percent of total billed charges,Implant Devices,627.2,35,,,percent of total billed charges,Implant Devices,627.2,35,,627.2,percent of total billed charges,Implant Devices,627.2,35,,627.2,percent of total billed charges,Implant Devices,716.8,40,,716.8,percent of total billed charges,Implant Devices,627.2,70,,627.2,percent of total billed charges,Implant Devices,609.28,34,,609.28,percent of total billed charges,Implant Devices,609.28,34,,609.28,percent of total billed charges,Implant Devices,627.2,35,,627.2,percent of total billed charges,Implant Devices,627.2,35,,627.2,percent of total billed charges,Implant Devices,627.2,35,,627.2,percent of total billed charges,Implant Devices,627.2,35,,627.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,716.8,
DEPUY 1541-18-000 HIP STEM SIZE 3 150MM,C1776,HCPCS,,79006532,CDM,278,RC,,,both,,,13615,5373.4,39.4668,,5373.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4629.1,34,,4629.1,percent of total billed charges,Implant Device,4629.1,34,,4629.1,percent of total billed charges,Implant Device,4629.1,34,,4629.1,percent of total billed charges,Implant Device,4629.1,34,,4629.1,percent of total billed charges,Implant Device,4629.1,34,,4629.1,percent of total billed charges,Implant Device,4629.1,34,,4629.1,percent of total billed charges,Implant Device,4765.25,35,,4765.25,percent of total billed charges,Implant Device,4629.1,34,"Charges > $500, x 34%",4629.1,percent of total billed charges,Implant Device,4765.25,35,,4765.25,percent of total billed charges,Implant Devices,4765.25,35,,4765.25,percent of total billed charges,Implant Devices,4765.25,35,,,percent of total billed charges,Implant Devices,4765.25,35,,4765.25,percent of total billed charges,Implant Devices,4765.25,35,,4765.25,percent of total billed charges,Implant Devices,5446,40,,5446,percent of total billed charges,Implant Devices,4765.25,70,,4765.25,percent of total billed charges,Implant Devices,4629.1,34,,4629.1,percent of total billed charges,Implant Devices,4629.1,34,,4629.1,percent of total billed charges,Implant Devices,4765.25,35,,4765.25,percent of total billed charges,Implant Devices,4765.25,35,,4765.25,percent of total billed charges,Implant Devices,4765.25,35,,4765.25,percent of total billed charges,Implant Devices,4765.25,35,,4765.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4629.1,34,"If Charge > 2,000, then 34 percent",4629.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5446,
DEPUY 1541-42-320 ACETABULAR CUP 42X32MM,C1776,HCPCS,,79006533,CDM,278,RC,,,both,,,2834,1118.49,39.4668,,1118.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,963.56,34,,963.56,percent of total billed charges,Implant Device,991.9,35,,991.9,percent of total billed charges,Implant Device,963.56,34,"Charges > $500, x 34%",963.56,percent of total billed charges,Implant Device,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,1133.6,40,,1133.6,percent of total billed charges,Implant Devices,991.9,70,,991.9,percent of total billed charges,Implant Devices,963.56,34,,963.56,percent of total billed charges,Implant Devices,963.56,34,,963.56,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,991.9,35,,991.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,963.56,34,"If Charge > 2,000, then 34 percent",963.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1133.6,
ZIMMER 00-5994-016-91 FEMORAL COMP SZ F,C1776,HCPCS,,79006562,CDM,278,RC,,,both,,,18586,7335.3,39.4668,,7335.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6319.24,34,,6319.24,percent of total billed charges,Implant Device,6505.1,35,,6505.1,percent of total billed charges,Implant Device,6319.24,34,"Charges > $500, x 34%",6319.24,percent of total billed charges,Implant Device,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,7434.4,40,,7434.4,percent of total billed charges,Implant Devices,6505.1,70,,6505.1,percent of total billed charges,Implant Devices,6319.24,34,,6319.24,percent of total billed charges,Implant Devices,6319.24,34,,6319.24,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,6505.1,35,,6505.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6319.24,34,"If Charge > 2,000, then 34 percent",6319.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7434.4,
DEPUY 1035-44-000 BI POLAR HEAD 28X44MM,C1776,HCPCS,,79006576,CDM,278,RC,,,both,,,1733,683.96,39.4668,,683.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Device,589.22,34,"Charges > $500, x 34%",589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,693.2,40,,693.2,percent of total billed charges,Implant Devices,606.55,70,,606.55,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,693.2,
DEPUY 1960-40-300 FEM POST STABLZD SZ 3,C1776,HCPCS,,79006609,CDM,278,RC,,,both,,,7927,3128.53,39.4668,,3128.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2774.45,35,,2774.45,percent of total billed charges,Implant Device,2695.18,34,"Charges > $500, x 34%",2695.18,percent of total billed charges,Implant Device,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,3170.8,40,,3170.8,percent of total billed charges,Implant Devices,2774.45,70,,2774.45,percent of total billed charges,Implant Devices,2695.18,34,,2695.18,percent of total billed charges,Implant Devices,2695.18,34,,2695.18,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2695.18,34,"If Charge > 2,000, then 34 percent",2695.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3170.8,
DEPUY 96-0100 DOME PATELLA 3-PEG 32MM,C1776,HCPCS,,79006610,CDM,278,RC,,,both,,,1836,724.61,39.4668,,724.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,624.24,34,,624.24,percent of total billed charges,Implant Device,624.24,34,,624.24,percent of total billed charges,Implant Device,624.24,34,,624.24,percent of total billed charges,Implant Device,624.24,34,,624.24,percent of total billed charges,Implant Device,624.24,34,,624.24,percent of total billed charges,Implant Device,624.24,34,,624.24,percent of total billed charges,Implant Device,642.6,35,,642.6,percent of total billed charges,Implant Device,624.24,34,"Charges > $500, x 34%",624.24,percent of total billed charges,Implant Device,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,734.4,40,,734.4,percent of total billed charges,Implant Devices,642.6,70,,642.6,percent of total billed charges,Implant Devices,624.24,34,,624.24,percent of total billed charges,Implant Devices,624.24,34,,624.24,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,734.4,
DEPUY 96-2132 TIBIAL INS ROTATING 12.5MM,C1776,HCPCS,,79006611,CDM,278,RC,,,both,,,4080,1610.25,39.4668,,1610.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1428,35,,1428,percent of total billed charges,Implant Device,1387.2,34,"Charges > $500, x 34%",1387.2,percent of total billed charges,Implant Device,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1632,40,,1632,percent of total billed charges,Implant Devices,1428,70,,1428,percent of total billed charges,Implant Devices,1387.2,34,,1387.2,percent of total billed charges,Implant Devices,1387.2,34,,1387.2,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1387.2,34,"If Charge > 2,000, then 34 percent",1387.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1632,
DEPUY ORTHO TOTAL ATTUNE RP KNEE CAP,C1776,HCPCS,,79006617,CDM,278,RC,,,both,,,17985,7098.1,39.4668,,7098.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6114.9,34,,6114.9,percent of total billed charges,Implant Device,6114.9,34,,6114.9,percent of total billed charges,Implant Device,6114.9,34,,6114.9,percent of total billed charges,Implant Device,6114.9,34,,6114.9,percent of total billed charges,Implant Device,6114.9,34,,6114.9,percent of total billed charges,Implant Device,6114.9,34,,6114.9,percent of total billed charges,Implant Device,6294.75,35,,6294.75,percent of total billed charges,Implant Device,6114.9,34,"Charges > $500, x 34%",6114.9,percent of total billed charges,Implant Device,6294.75,35,,6294.75,percent of total billed charges,Implant Devices,6294.75,35,,6294.75,percent of total billed charges,Implant Devices,6294.75,35,,,percent of total billed charges,Implant Devices,6294.75,35,,6294.75,percent of total billed charges,Implant Devices,6294.75,35,,6294.75,percent of total billed charges,Implant Devices,7194,40,,7194,percent of total billed charges,Implant Devices,6294.75,70,,6294.75,percent of total billed charges,Implant Devices,6114.9,34,,6114.9,percent of total billed charges,Implant Devices,6114.9,34,,6114.9,percent of total billed charges,Implant Devices,6294.75,35,,6294.75,percent of total billed charges,Implant Devices,6294.75,35,,6294.75,percent of total billed charges,Implant Devices,6294.75,35,,6294.75,percent of total billed charges,Implant Devices,6294.75,35,,6294.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6114.9,34,"If Charge > 2,000, then 34 percent",6114.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7194,
DEPUY 1960-50-300 FEM POST STABL SZ 3 RT,C1776,HCPCS,,79006717,CDM,278,RC,,,both,,,7927,3128.53,39.4668,,3128.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2695.18,34,,2695.18,percent of total billed charges,Implant Device,2774.45,35,,2774.45,percent of total billed charges,Implant Device,2695.18,34,"Charges > $500, x 34%",2695.18,percent of total billed charges,Implant Device,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,3170.8,40,,3170.8,percent of total billed charges,Implant Devices,2774.45,70,,2774.45,percent of total billed charges,Implant Devices,2695.18,34,,2695.18,percent of total billed charges,Implant Devices,2695.18,34,,2695.18,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,2774.45,35,,2774.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2695.18,34,"If Charge > 2,000, then 34 percent",2695.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3170.8,
DEPUY 96-2131 TIBIAL INSERT 10MM,C1776,HCPCS,,79006718,CDM,278,RC,,,both,,,4080,1610.25,39.4668,,1610.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1387.2,34,,1387.2,percent of total billed charges,Implant Device,1428,35,,1428,percent of total billed charges,Implant Device,1387.2,34,"Charges > $500, x 34%",1387.2,percent of total billed charges,Implant Device,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1632,40,,1632,percent of total billed charges,Implant Devices,1428,70,,1428,percent of total billed charges,Implant Devices,1387.2,34,,1387.2,percent of total billed charges,Implant Devices,1387.2,34,,1387.2,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,1428,35,,1428,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1387.2,34,"If Charge > 2,000, then 34 percent",1387.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1632,
DEPUY 1024-08-400 FEM UNICONDYLAR SZ 4,C1776,HCPCS,,79006719,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
DEPUY 1024-52-300 TIBIAL TRAY UNICND SZ3,C1776,HCPCS,,79006720,CDM,278,RC,,,both,,,4157,1640.63,39.4668,,1640.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1413.38,34,,1413.38,percent of total billed charges,Implant Device,1413.38,34,,1413.38,percent of total billed charges,Implant Device,1413.38,34,,1413.38,percent of total billed charges,Implant Device,1413.38,34,,1413.38,percent of total billed charges,Implant Device,1413.38,34,,1413.38,percent of total billed charges,Implant Device,1413.38,34,,1413.38,percent of total billed charges,Implant Device,1454.95,35,,1454.95,percent of total billed charges,Implant Device,1413.38,34,"Charges > $500, x 34%",1413.38,percent of total billed charges,Implant Device,1454.95,35,,1454.95,percent of total billed charges,Implant Devices,1454.95,35,,1454.95,percent of total billed charges,Implant Devices,1454.95,35,,,percent of total billed charges,Implant Devices,1454.95,35,,1454.95,percent of total billed charges,Implant Devices,1454.95,35,,1454.95,percent of total billed charges,Implant Devices,1662.8,40,,1662.8,percent of total billed charges,Implant Devices,1454.95,70,,1454.95,percent of total billed charges,Implant Devices,1413.38,34,,1413.38,percent of total billed charges,Implant Devices,1413.38,34,,1413.38,percent of total billed charges,Implant Devices,1454.95,35,,1454.95,percent of total billed charges,Implant Devices,1454.95,35,,1454.95,percent of total billed charges,Implant Devices,1454.95,35,,1454.95,percent of total billed charges,Implant Devices,1454.95,35,,1454.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1413.38,34,"If Charge > 2,000, then 34 percent",1413.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1662.8,
DEPUY 1024-54-307 TIBIAL INS UNICND SZ3,C1776,HCPCS,,79006721,CDM,278,RC,,,both,,,2423,956.28,39.4668,,956.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,823.82,34,,823.82,percent of total billed charges,Implant Device,823.82,34,,823.82,percent of total billed charges,Implant Device,823.82,34,,823.82,percent of total billed charges,Implant Device,823.82,34,,823.82,percent of total billed charges,Implant Device,823.82,34,,823.82,percent of total billed charges,Implant Device,823.82,34,,823.82,percent of total billed charges,Implant Device,848.05,35,,848.05,percent of total billed charges,Implant Device,823.82,34,"Charges > $500, x 34%",823.82,percent of total billed charges,Implant Device,848.05,35,,848.05,percent of total billed charges,Implant Devices,848.05,35,,848.05,percent of total billed charges,Implant Devices,848.05,35,,,percent of total billed charges,Implant Devices,848.05,35,,848.05,percent of total billed charges,Implant Devices,848.05,35,,848.05,percent of total billed charges,Implant Devices,969.2,40,,969.2,percent of total billed charges,Implant Devices,848.05,70,,848.05,percent of total billed charges,Implant Devices,823.82,34,,823.82,percent of total billed charges,Implant Devices,823.82,34,,823.82,percent of total billed charges,Implant Devices,848.05,35,,848.05,percent of total billed charges,Implant Devices,848.05,35,,848.05,percent of total billed charges,Implant Devices,848.05,35,,848.05,percent of total billed charges,Implant Devices,848.05,35,,848.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,823.82,34,"If Charge > 2,000, then 34 percent",823.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,969.2,
STRYKER 5630-G-428 TIBIAL INSERT 4X8MM,C1776,HCPCS,,79006732,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
STRYKER 5610-F-502 FEMORAL COMP SZ 5,C1776,HCPCS,,79006734,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
ZIMMER 5001-46 BIPOLAR CUP SHELL 46MM OD,C1776,HCPCS,,79006746,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
STRYKER 5620-B-502 TIBIAL BASEPLATE SZ 5,C1776,HCPCS,,79006747,CDM,278,RC,,,both,,,4937,1948.48,39.4668,,1948.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Device,1678.58,34,"Charges > $500, x 34%",1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1974.8,40,,1974.8,percent of total billed charges,Implant Devices,1727.95,70,,1727.95,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.58,34,"If Charge > 2,000, then 34 percent",1678.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.8,
STRYKER 5630-G-528 TIBIAL INSRT SZ 5 8MM,C1776,HCPCS,,79006748,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
EXACTECH 310-03-50 HUMERAL HEAD 50X27MM,C1776,HCPCS,,79006754,CDM,278,RC,,,both,,,4968,1960.71,39.4668,,1960.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Device,1689.12,34,"Charges > $500, x 34%",1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1987.2,40,,1987.2,percent of total billed charges,Implant Devices,1738.8,70,,1738.8,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.12,34,"If Charge > 2,000, then 34 percent",1689.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.2,
DEPUY 1100-08-100 GLOBE UNITE STEM SZ 8,C1776,HCPCS,,79006757,CDM,278,RC,,,both,,,9828,3878.8,39.4668,,3878.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3341.52,34,,3341.52,percent of total billed charges,Implant Device,3439.8,35,,3439.8,percent of total billed charges,Implant Device,3341.52,34,"Charges > $500, x 34%",3341.52,percent of total billed charges,Implant Device,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3931.2,40,,3931.2,percent of total billed charges,Implant Devices,3439.8,70,,3439.8,percent of total billed charges,Implant Devices,3341.52,34,,3341.52,percent of total billed charges,Implant Devices,3341.52,34,,3341.52,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,3439.8,35,,3439.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3341.52,34,"If Charge > 2,000, then 34 percent",3341.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3931.2,
DEPUY 1100-20-200 GLOBE UNTE COLLAR SZ44,C1776,HCPCS,,79006758,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
DEPUY 1100-30-110 GLOBE UNITE BODY SZ10,C1776,HCPCS,,79006759,CDM,278,RC,,,both,,,4474,1765.74,39.4668,,1765.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1521.16,34,,1521.16,percent of total billed charges,Implant Device,1521.16,34,,1521.16,percent of total billed charges,Implant Device,1521.16,34,,1521.16,percent of total billed charges,Implant Device,1521.16,34,,1521.16,percent of total billed charges,Implant Device,1521.16,34,,1521.16,percent of total billed charges,Implant Device,1521.16,34,,1521.16,percent of total billed charges,Implant Device,1565.9,35,,1565.9,percent of total billed charges,Implant Device,1521.16,34,"Charges > $500, x 34%",1521.16,percent of total billed charges,Implant Device,1565.9,35,,1565.9,percent of total billed charges,Implant Devices,1565.9,35,,1565.9,percent of total billed charges,Implant Devices,1565.9,35,,,percent of total billed charges,Implant Devices,1565.9,35,,1565.9,percent of total billed charges,Implant Devices,1565.9,35,,1565.9,percent of total billed charges,Implant Devices,1789.6,40,,1789.6,percent of total billed charges,Implant Devices,1565.9,70,,1565.9,percent of total billed charges,Implant Devices,1521.16,34,,1521.16,percent of total billed charges,Implant Devices,1521.16,34,,1521.16,percent of total billed charges,Implant Devices,1565.9,35,,1565.9,percent of total billed charges,Implant Devices,1565.9,35,,1565.9,percent of total billed charges,Implant Devices,1565.9,35,,1565.9,percent of total billed charges,Implant Devices,1565.9,35,,1565.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1521.16,34,"If Charge > 2,000, then 34 percent",1521.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1789.6,
DEPUY 1100-44-510 GLOBE UNITE HEAD 44X18,C1776,HCPCS,,79006760,CDM,278,RC,,,both,,,6442,2542.45,39.4668,,2542.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2190.28,34,,2190.28,percent of total billed charges,Implant Device,2190.28,34,,2190.28,percent of total billed charges,Implant Device,2190.28,34,,2190.28,percent of total billed charges,Implant Device,2190.28,34,,2190.28,percent of total billed charges,Implant Device,2190.28,34,,2190.28,percent of total billed charges,Implant Device,2190.28,34,,2190.28,percent of total billed charges,Implant Device,2254.7,35,,2254.7,percent of total billed charges,Implant Device,2190.28,34,"Charges > $500, x 34%",2190.28,percent of total billed charges,Implant Device,2254.7,35,,2254.7,percent of total billed charges,Implant Devices,2254.7,35,,2254.7,percent of total billed charges,Implant Devices,2254.7,35,,,percent of total billed charges,Implant Devices,2254.7,35,,2254.7,percent of total billed charges,Implant Devices,2254.7,35,,2254.7,percent of total billed charges,Implant Devices,2576.8,40,,2576.8,percent of total billed charges,Implant Devices,2254.7,70,,2254.7,percent of total billed charges,Implant Devices,2190.28,34,,2190.28,percent of total billed charges,Implant Devices,2190.28,34,,2190.28,percent of total billed charges,Implant Devices,2254.7,35,,2254.7,percent of total billed charges,Implant Devices,2254.7,35,,2254.7,percent of total billed charges,Implant Devices,2254.7,35,,2254.7,percent of total billed charges,Implant Devices,2254.7,35,,2254.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2190.28,34,"If Charge > 2,000, then 34 percent",2190.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2576.8,
STRYKER 5610-F-602 FEM COMPONENT SZ 6,C1776,HCPCS,,79006764,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
STRYKER 5620-B-602 TIBIAL BASEPLATE SZ 6,C1776,HCPCS,,79006765,CDM,278,RC,,,both,,,4937,1948.48,39.4668,,1948.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Device,1678.58,34,"Charges > $500, x 34%",1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1974.8,40,,1974.8,percent of total billed charges,Implant Devices,1727.95,70,,1727.95,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.58,34,"If Charge > 2,000, then 34 percent",1678.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.8,
STRYKER 5630-G-628 TIBIAL INSRT SZ 6X8MM,C1776,HCPCS,,79006766,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
ZIMMER 00-8752-015-36 EL RIM LINER 36X62,C1776,HCPCS,,79006769,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8757-062-01 TRAB METL SHELL 62,C1776,HCPCS,,79006770,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
STRYKER 6276-7-219 RM HIP SYSTEM 195X19,C1776,HCPCS,,79006775,CDM,278,RC,,,both,,,9569,3776.58,39.4668,,3776.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3253.46,34,,3253.46,percent of total billed charges,Implant Device,3253.46,34,,3253.46,percent of total billed charges,Implant Device,3253.46,34,,3253.46,percent of total billed charges,Implant Device,3253.46,34,,3253.46,percent of total billed charges,Implant Device,3253.46,34,,3253.46,percent of total billed charges,Implant Device,3253.46,34,,3253.46,percent of total billed charges,Implant Device,3349.15,35,,3349.15,percent of total billed charges,Implant Device,3253.46,34,"Charges > $500, x 34%",3253.46,percent of total billed charges,Implant Device,3349.15,35,,3349.15,percent of total billed charges,Implant Devices,3349.15,35,,3349.15,percent of total billed charges,Implant Devices,3349.15,35,,,percent of total billed charges,Implant Devices,3349.15,35,,3349.15,percent of total billed charges,Implant Devices,3349.15,35,,3349.15,percent of total billed charges,Implant Devices,3827.6,40,,3827.6,percent of total billed charges,Implant Devices,3349.15,70,,3349.15,percent of total billed charges,Implant Devices,3253.46,34,,3253.46,percent of total billed charges,Implant Devices,3253.46,34,,3253.46,percent of total billed charges,Implant Devices,3349.15,35,,3349.15,percent of total billed charges,Implant Devices,3349.15,35,,3349.15,percent of total billed charges,Implant Devices,3349.15,35,,3349.15,percent of total billed charges,Implant Devices,3349.15,35,,3349.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3253.46,34,"If Charge > 2,000, then 34 percent",3253.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3827.6,
STRYKER 5620-B-401 TIBIAL BASEPLATE SZ 4,C1776,HCPCS,,79006794,CDM,278,RC,,,both,,,4937,1948.48,39.4668,,1948.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Device,1678.58,34,"Charges > $500, x 34%",1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1974.8,40,,1974.8,percent of total billed charges,Implant Devices,1727.95,70,,1727.95,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.58,34,"If Charge > 2,000, then 34 percent",1678.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.8,
STRYKER 5610-F-501 FEMORAL COMP SZ 5,C1776,HCPCS,,79006795,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
STRYKER 5630-G-408 TIBIAL INSERT 4X8MM,C1776,HCPCS,,79006796,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
STRYKER 5630-G-508 TIBIAL INSERT 5X8MM,C1776,HCPCS,,79006797,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
STRYKER 5620-B-501 TIBIAL BASEPLATE SZ 5,C1776,HCPCS,,79006798,CDM,278,RC,,,both,,,4937,1948.48,39.4668,,1948.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Device,1678.58,34,"Charges > $500, x 34%",1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1974.8,40,,1974.8,percent of total billed charges,Implant Devices,1727.95,70,,1727.95,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.58,34,"If Charge > 2,000, then 34 percent",1678.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.8,
STRYKER 5610-F-601 FEMORAL COMP SZ 6,C1776,HCPCS,,79006799,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
STRYKER 5630-G-328 TIB INSERT SZ 3X8MM,C1776,HCPCS,,79006828,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
STRYKER 5620-B-302 TIBIAL BASEPLATE SZ 3,C1776,HCPCS,,79006829,CDM,278,RC,,,both,,,4937,1948.48,39.4668,,1948.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Device,1678.58,34,"Charges > $500, x 34%",1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1974.8,40,,1974.8,percent of total billed charges,Implant Devices,1727.95,70,,1727.95,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.58,34,"If Charge > 2,000, then 34 percent",1678.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.8,
STRYKER 5610-F-402 FEMORAL COMP SIZE 4,C1776,HCPCS,,79006830,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
ZIMMER 5630-G-608 TIBIAL INSERT #6 X 8MM,C1776,HCPCS,,79006850,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
ZIMMER 5620-B-601 TIBIAL BASEPLATE #6,C1776,HCPCS,,79006851,CDM,278,RC,,,both,,,4937,1948.48,39.4668,,1948.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Device,1678.58,34,"Charges > $500, x 34%",1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1974.8,40,,1974.8,percent of total billed charges,Implant Devices,1727.95,70,,1727.95,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.58,34,"If Charge > 2,000, then 34 percent",1678.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.8,
ZIMMER 5001-051-00 BIPOLAR SHELL 51MM OD,C1776,HCPCS,,79006878,CDM,278,RC,,,both,,,1323,522.15,39.4668,,522.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,449.82,34,,449.82,percent of total billed charges,Implant Device,449.82,34,,449.82,percent of total billed charges,Implant Device,449.82,34,,449.82,percent of total billed charges,Implant Device,449.82,34,,449.82,percent of total billed charges,Implant Device,449.82,34,,449.82,percent of total billed charges,Implant Device,449.82,34,,449.82,percent of total billed charges,Implant Device,463.05,35,,463.05,percent of total billed charges,Implant Device,449.82,34,"Charges > $500, x 34%",449.82,percent of total billed charges,Implant Device,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,529.2,40,,529.2,percent of total billed charges,Implant Devices,463.05,70,,463.05,percent of total billed charges,Implant Devices,449.82,34,,449.82,percent of total billed charges,Implant Devices,449.82,34,,449.82,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,529.2,
EXACTECH 314-13-13 CAGED GLENOID MEDIUM,C1776,HCPCS,,79006881,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
EXACTECH 310-02-50 HUMERAL HEAD 50X23MM,C1776,HCPCS,,79006882,CDM,278,RC,,,both,,,4968,1960.71,39.4668,,1960.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Device,1689.12,34,"Charges > $500, x 34%",1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1987.2,40,,1987.2,percent of total billed charges,Implant Devices,1738.8,70,,1738.8,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.12,34,"If Charge > 2,000, then 34 percent",1689.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.2,
STRYKER 5630-G-228 TIBIAL INSERT 2X8MM,C1776,HCPCS,,79006885,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
STRYKER 5620-B-202 TIBIAL BASEPLATE SZ 2,C1776,HCPCS,,79006886,CDM,278,RC,,,both,,,4937,1948.48,39.4668,,1948.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Device,1678.58,34,"Charges > $500, x 34%",1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1974.8,40,,1974.8,percent of total billed charges,Implant Devices,1727.95,70,,1727.95,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.58,34,"If Charge > 2,000, then 34 percent",1678.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.8,
STRYKER 5610-F-202 FEMORAL COMPONENT SZ,C1776,HCPCS,,79006887,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
ZIMMER 00-8751-015-36 LINER 36MM SZ NN,C1776,HCPCS,,79006896,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
BIOMET 11-165226 RINGLOC ACETABULAR CUP,C1776,HCPCS,,79006897,CDM,278,RC,,,both,,,6540,2581.13,39.4668,,2581.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2223.6,34,,2223.6,percent of total billed charges,Implant Device,2289,35,,2289,percent of total billed charges,Implant Device,2223.6,34,"Charges > $500, x 34%",2223.6,percent of total billed charges,Implant Device,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2616,40,,2616,percent of total billed charges,Implant Devices,2289,70,,2289,percent of total billed charges,Implant Devices,2223.6,34,,2223.6,percent of total billed charges,Implant Devices,2223.6,34,,2223.6,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,2289,35,,2289,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2223.6,34,"If Charge > 2,000, then 34 percent",2223.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2616,
BIOMET 12-150313 ECHO PRESSFIT FEMORAL,C1776,HCPCS,,79006898,CDM,278,RC,,,both,,,15240,6014.74,39.4668,,6014.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5181.6,34,,5181.6,percent of total billed charges,Implant Device,5334,35,,5334,percent of total billed charges,Implant Device,5181.6,34,"Charges > $500, x 34%",5181.6,percent of total billed charges,Implant Device,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,6096,40,,6096,percent of total billed charges,Implant Devices,5334,70,,5334,percent of total billed charges,Implant Devices,5181.6,34,,5181.6,percent of total billed charges,Implant Devices,5181.6,34,,5181.6,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,5334,35,,5334,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5181.6,34,"If Charge > 2,000, then 34 percent",5181.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6096,
BIOMET 163661 MODULAR HEAD 28-3MM NECK,C1776,HCPCS,,79006899,CDM,278,RC,,,both,,,4830,1906.25,39.4668,,1906.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1690.5,35,,1690.5,percent of total billed charges,Implant Device,1642.2,34,"Charges > $500, x 34%",1642.2,percent of total billed charges,Implant Device,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1932,40,,1932,percent of total billed charges,Implant Devices,1690.5,70,,1690.5,percent of total billed charges,Implant Devices,1642.2,34,,1642.2,percent of total billed charges,Implant Devices,1642.2,34,,1642.2,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1642.2,34,"If Charge > 2,000, then 34 percent",1642.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1932,
STRYKER 6570-0-132 FEM HEAD V40 32MM +O,C1776,HCPCS,,79006903,CDM,278,RC,,,both,,,7139,2817.53,39.4668,,2817.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2427.26,34,,2427.26,percent of total billed charges,Implant Device,2427.26,34,,2427.26,percent of total billed charges,Implant Device,2427.26,34,,2427.26,percent of total billed charges,Implant Device,2427.26,34,,2427.26,percent of total billed charges,Implant Device,2427.26,34,,2427.26,percent of total billed charges,Implant Device,2427.26,34,,2427.26,percent of total billed charges,Implant Device,2498.65,35,,2498.65,percent of total billed charges,Implant Device,2427.26,34,"Charges > $500, x 34%",2427.26,percent of total billed charges,Implant Device,2498.65,35,,2498.65,percent of total billed charges,Implant Devices,2498.65,35,,2498.65,percent of total billed charges,Implant Devices,2498.65,35,,,percent of total billed charges,Implant Devices,2498.65,35,,2498.65,percent of total billed charges,Implant Devices,2498.65,35,,2498.65,percent of total billed charges,Implant Devices,2855.6,40,,2855.6,percent of total billed charges,Implant Devices,2498.65,70,,2498.65,percent of total billed charges,Implant Devices,2427.26,34,,2427.26,percent of total billed charges,Implant Devices,2427.26,34,,2427.26,percent of total billed charges,Implant Devices,2498.65,35,,2498.65,percent of total billed charges,Implant Devices,2498.65,35,,2498.65,percent of total billed charges,Implant Devices,2498.65,35,,2498.65,percent of total billed charges,Implant Devices,2498.65,35,,2498.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2427.26,34,"If Charge > 2,000, then 34 percent",2427.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2855.6,
STRYKER 6276-7-318 MODULAR HIP 235X18MM,C1776,HCPCS,,79006904,CDM,278,RC,,,both,,,16079,6345.87,39.4668,,6345.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5627.65,35,,5627.65,percent of total billed charges,Implant Device,5466.86,34,"Charges > $500, x 34%",5466.86,percent of total billed charges,Implant Device,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,6431.6,40,,6431.6,percent of total billed charges,Implant Devices,5627.65,70,,5627.65,percent of total billed charges,Implant Devices,5466.86,34,,5466.86,percent of total billed charges,Implant Devices,5466.86,34,,5466.86,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5466.86,34,"If Charge > 2,000, then 34 percent",5466.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6431.6,
STRYKER 5620-B-201 TIBIAL BASEPLATE SZ 2,C1776,HCPCS,,79006905,CDM,278,RC,,,both,,,4937,1948.48,39.4668,,1948.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Device,1678.58,34,"Charges > $500, x 34%",1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1974.8,40,,1974.8,percent of total billed charges,Implant Devices,1727.95,70,,1727.95,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.58,34,"If Charge > 2,000, then 34 percent",1678.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.8,
STRYKER 5610-F-201 FEMORAL COMPNENT SZ 2,C1776,HCPCS,,79006906,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
STRYKER 5630-G-208 TIBIAL INSRT SZ 2 8MM,C1776,HCPCS,,79006907,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
ZIMMER 00-8852-012-36 RIM LINER 36MM KK,C1776,HCPCS,,79006937,CDM,278,RC,,,both,,,4403,1737.72,39.4668,,1737.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Device,1497.02,34,"Charges > $500, x 34%",1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1761.2,40,,1761.2,percent of total billed charges,Implant Devices,1541.05,70,,1541.05,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.02,34,"If Charge > 2,000, then 34 percent",1497.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.2,
ZIMMER 00-8755-012-36 LINER 36X56MM,C1776,HCPCS,,79006940,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-5994-040-17 ART SURF 17MM 5-6,C1776,HCPCS,,79006942,CDM,278,RC,,,both,,,6257,2469.44,39.4668,,2469.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Device,2127.38,34,"Charges > $500, x 34%",2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2502.8,40,,2502.8,percent of total billed charges,Implant Devices,2189.95,70,,2189.95,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2127.38,34,"If Charge > 2,000, then 34 percent",2127.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2502.8,
STRYKER 5630-G-629 TIBIAL INSRT 6X9MM,C1776,HCPCS,,79006968,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
STRYKER 180705-2 RESTORIS TIBIAL INS 5X9,C1776,HCPCS,,79006969,CDM,278,RC,,,both,,,4156,1640.24,39.4668,,1640.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1413.04,34,,1413.04,percent of total billed charges,Implant Device,1413.04,34,,1413.04,percent of total billed charges,Implant Device,1413.04,34,,1413.04,percent of total billed charges,Implant Device,1413.04,34,,1413.04,percent of total billed charges,Implant Device,1413.04,34,,1413.04,percent of total billed charges,Implant Device,1413.04,34,,1413.04,percent of total billed charges,Implant Device,1454.6,35,,1454.6,percent of total billed charges,Implant Device,1413.04,34,"Charges > $500, x 34%",1413.04,percent of total billed charges,Implant Device,1454.6,35,,1454.6,percent of total billed charges,Implant Devices,1454.6,35,,1454.6,percent of total billed charges,Implant Devices,1454.6,35,,,percent of total billed charges,Implant Devices,1454.6,35,,1454.6,percent of total billed charges,Implant Devices,1454.6,35,,1454.6,percent of total billed charges,Implant Devices,1662.4,40,,1662.4,percent of total billed charges,Implant Devices,1454.6,70,,1454.6,percent of total billed charges,Implant Devices,1413.04,34,,1413.04,percent of total billed charges,Implant Devices,1413.04,34,,1413.04,percent of total billed charges,Implant Devices,1454.6,35,,1454.6,percent of total billed charges,Implant Devices,1454.6,35,,1454.6,percent of total billed charges,Implant Devices,1454.6,35,,1454.6,percent of total billed charges,Implant Devices,1454.6,35,,1454.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1413.04,34,"If Charge > 2,000, then 34 percent",1413.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1662.4,
EXACTECH SPC0522 INTERSPACE HIP INS 60MM,C1776,HCPCS,,79006987,CDM,278,RC,,,both,,,9774,3857.49,39.4668,,3857.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3323.16,34,,3323.16,percent of total billed charges,Implant Device,3323.16,34,,3323.16,percent of total billed charges,Implant Device,3323.16,34,,3323.16,percent of total billed charges,Implant Device,3323.16,34,,3323.16,percent of total billed charges,Implant Device,3323.16,34,,3323.16,percent of total billed charges,Implant Device,3323.16,34,,3323.16,percent of total billed charges,Implant Device,3420.9,35,,3420.9,percent of total billed charges,Implant Device,3323.16,34,"Charges > $500, x 34%",3323.16,percent of total billed charges,Implant Device,3420.9,35,,3420.9,percent of total billed charges,Implant Devices,3420.9,35,,3420.9,percent of total billed charges,Implant Devices,3420.9,35,,,percent of total billed charges,Implant Devices,3420.9,35,,3420.9,percent of total billed charges,Implant Devices,3420.9,35,,3420.9,percent of total billed charges,Implant Devices,3909.6,40,,3909.6,percent of total billed charges,Implant Devices,3420.9,70,,3420.9,percent of total billed charges,Implant Devices,3323.16,34,,3323.16,percent of total billed charges,Implant Devices,3323.16,34,,3323.16,percent of total billed charges,Implant Devices,3420.9,35,,3420.9,percent of total billed charges,Implant Devices,3420.9,35,,3420.9,percent of total billed charges,Implant Devices,3420.9,35,,3420.9,percent of total billed charges,Implant Devices,3420.9,35,,3420.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3323.16,34,"If Charge > 2,000, then 34 percent",3323.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3909.6,
EXACTECH SPK0122 INTERSPAC KNEE INS 64MM,C1776,HCPCS,,79006988,CDM,278,RC,,,both,,,9776,3858.27,39.4668,,3858.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3323.84,34,,3323.84,percent of total billed charges,Implant Device,3323.84,34,,3323.84,percent of total billed charges,Implant Device,3323.84,34,,3323.84,percent of total billed charges,Implant Device,3323.84,34,,3323.84,percent of total billed charges,Implant Device,3323.84,34,,3323.84,percent of total billed charges,Implant Device,3323.84,34,,3323.84,percent of total billed charges,Implant Device,3421.6,35,,3421.6,percent of total billed charges,Implant Device,3323.84,34,"Charges > $500, x 34%",3323.84,percent of total billed charges,Implant Device,3421.6,35,,3421.6,percent of total billed charges,Implant Devices,3421.6,35,,3421.6,percent of total billed charges,Implant Devices,3421.6,35,,,percent of total billed charges,Implant Devices,3421.6,35,,3421.6,percent of total billed charges,Implant Devices,3421.6,35,,3421.6,percent of total billed charges,Implant Devices,3910.4,40,,3910.4,percent of total billed charges,Implant Devices,3421.6,70,,3421.6,percent of total billed charges,Implant Devices,3323.84,34,,3323.84,percent of total billed charges,Implant Devices,3323.84,34,,3323.84,percent of total billed charges,Implant Devices,3421.6,35,,3421.6,percent of total billed charges,Implant Devices,3421.6,35,,3421.6,percent of total billed charges,Implant Devices,3421.6,35,,3421.6,percent of total billed charges,Implant Devices,3421.6,35,,3421.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3323.84,34,"If Charge > 2,000, then 34 percent",3323.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3910.4,
DEPUY 1365-32-320 FEM HEAD +5.0 32MM,C1776,HCPCS,,79007003,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
DEPUY 1365-32-330 FEM HEAD +9 32MM DIA,C1776,HCPCS,,79007004,CDM,278,RC,,,both,,,4764,1880.2,39.4668,,1880.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1619.76,34,,1619.76,percent of total billed charges,Implant Device,1619.76,34,,1619.76,percent of total billed charges,Implant Device,1619.76,34,,1619.76,percent of total billed charges,Implant Device,1619.76,34,,1619.76,percent of total billed charges,Implant Device,1619.76,34,,1619.76,percent of total billed charges,Implant Device,1619.76,34,,1619.76,percent of total billed charges,Implant Device,1667.4,35,,1667.4,percent of total billed charges,Implant Device,1619.76,34,"Charges > $500, x 34%",1619.76,percent of total billed charges,Implant Device,1667.4,35,,1667.4,percent of total billed charges,Implant Devices,1667.4,35,,1667.4,percent of total billed charges,Implant Devices,1667.4,35,,,percent of total billed charges,Implant Devices,1667.4,35,,1667.4,percent of total billed charges,Implant Devices,1667.4,35,,1667.4,percent of total billed charges,Implant Devices,1905.6,40,,1905.6,percent of total billed charges,Implant Devices,1667.4,70,,1667.4,percent of total billed charges,Implant Devices,1619.76,34,,1619.76,percent of total billed charges,Implant Devices,1619.76,34,,1619.76,percent of total billed charges,Implant Devices,1667.4,35,,1667.4,percent of total billed charges,Implant Devices,1667.4,35,,1667.4,percent of total billed charges,Implant Devices,1667.4,35,,1667.4,percent of total billed charges,Implant Devices,1667.4,35,,1667.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1619.76,34,"If Charge > 2,000, then 34 percent",1619.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1905.6,
DEPUY 1541-28-000 HIP STEM SZ 3 200MM,C1776,HCPCS,,79007005,CDM,278,RC,,,both,,,14227,5614.94,39.4668,,5614.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4979.45,35,,4979.45,percent of total billed charges,Implant Device,4837.18,34,"Charges > $500, x 34%",4837.18,percent of total billed charges,Implant Device,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,5690.8,40,,5690.8,percent of total billed charges,Implant Devices,4979.45,70,,4979.45,percent of total billed charges,Implant Devices,4837.18,34,,4837.18,percent of total billed charges,Implant Devices,4837.18,34,,4837.18,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4837.18,34,"If Charge > 2,000, then 34 percent",4837.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5690.8,
EXACTECH SPC0422 HIP INSERT 54MM XLONG,C1776,HCPCS,,79007029,CDM,278,RC,,,both,,,9775,3857.88,39.4668,,3857.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3323.5,34,,3323.5,percent of total billed charges,Implant Device,3323.5,34,,3323.5,percent of total billed charges,Implant Device,3323.5,34,,3323.5,percent of total billed charges,Implant Device,3323.5,34,,3323.5,percent of total billed charges,Implant Device,3323.5,34,,3323.5,percent of total billed charges,Implant Device,3323.5,34,,3323.5,percent of total billed charges,Implant Device,3421.25,35,,3421.25,percent of total billed charges,Implant Device,3323.5,34,"Charges > $500, x 34%",3323.5,percent of total billed charges,Implant Device,3421.25,35,,3421.25,percent of total billed charges,Implant Devices,3421.25,35,,3421.25,percent of total billed charges,Implant Devices,3421.25,35,,,percent of total billed charges,Implant Devices,3421.25,35,,3421.25,percent of total billed charges,Implant Devices,3421.25,35,,3421.25,percent of total billed charges,Implant Devices,3910,40,,3910,percent of total billed charges,Implant Devices,3421.25,70,,3421.25,percent of total billed charges,Implant Devices,3323.5,34,,3323.5,percent of total billed charges,Implant Devices,3323.5,34,,3323.5,percent of total billed charges,Implant Devices,3421.25,35,,3421.25,percent of total billed charges,Implant Devices,3421.25,35,,3421.25,percent of total billed charges,Implant Devices,3421.25,35,,3421.25,percent of total billed charges,Implant Devices,3421.25,35,,3421.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3323.5,34,"If Charge > 2,000, then 34 percent",3323.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3910,
ZIMMER 00-5852-50-09 FLUTED STEM 9X130MM,C1776,HCPCS,,79007037,CDM,278,RC,,,both,,,11453,4520.13,39.4668,,4520.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,3894.02,34,,3894.02,percent of total billed charges,Implant Device,4008.55,35,,4008.55,percent of total billed charges,Implant Device,3894.02,34,"Charges > $500, x 34%",3894.02,percent of total billed charges,Implant Device,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4581.2,40,,4581.2,percent of total billed charges,Implant Devices,4008.55,70,,4008.55,percent of total billed charges,Implant Devices,3894.02,34,,3894.02,percent of total billed charges,Implant Devices,3894.02,34,,3894.02,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,4008.55,35,,4008.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3894.02,34,"If Charge > 2,000, then 34 percent",3894.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4581.2,
METASURG DF2010 DIGIFUSE DF2010,C1776,HCPCS,,79007041,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
DEPUY 3L92503 CORAIL FEMORAL STEM SZ 13,C1776,HCPCS,,79007060,CDM,278,RC,,,both,,,13446,5306.71,39.4668,,5306.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Device,4571.64,34,"Charges > $500, x 34%",4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,5378.4,40,,5378.4,percent of total billed charges,Implant Devices,4706.1,70,,4706.1,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4571.64,34,"If Charge > 2,000, then 34 percent",4571.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5378.4,
STRYKER 6276-7-217 RESTMOD HIP SYS 195MM,C1776,HCPCS,,79007061,CDM,278,RC,,,both,,,15277,6029.34,39.4668,,6029.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5346.95,35,,5346.95,percent of total billed charges,Implant Device,5194.18,34,"Charges > $500, x 34%",5194.18,percent of total billed charges,Implant Device,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,6110.8,40,,6110.8,percent of total billed charges,Implant Devices,5346.95,70,,5346.95,percent of total billed charges,Implant Devices,5194.18,34,,5194.18,percent of total billed charges,Implant Devices,5194.18,34,,5194.18,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5194.18,34,"If Charge > 2,000, then 34 percent",5194.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6110.8,
ZIMMER 00-5952-050-10 NEXGEN ART SURF 10,C1776,HCPCS,,79007075,CDM,278,RC,,,both,,,2672,1054.55,39.4668,,1054.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,908.48,34,,908.48,percent of total billed charges,Implant Device,908.48,34,,908.48,percent of total billed charges,Implant Device,908.48,34,,908.48,percent of total billed charges,Implant Device,908.48,34,,908.48,percent of total billed charges,Implant Device,908.48,34,,908.48,percent of total billed charges,Implant Device,908.48,34,,908.48,percent of total billed charges,Implant Device,935.2,35,,935.2,percent of total billed charges,Implant Device,908.48,34,"Charges > $500, x 34%",908.48,percent of total billed charges,Implant Device,935.2,35,,935.2,percent of total billed charges,Implant Devices,935.2,35,,935.2,percent of total billed charges,Implant Devices,935.2,35,,,percent of total billed charges,Implant Devices,935.2,35,,935.2,percent of total billed charges,Implant Devices,935.2,35,,935.2,percent of total billed charges,Implant Devices,1068.8,40,,1068.8,percent of total billed charges,Implant Devices,935.2,70,,935.2,percent of total billed charges,Implant Devices,908.48,34,,908.48,percent of total billed charges,Implant Devices,908.48,34,,908.48,percent of total billed charges,Implant Devices,935.2,35,,935.2,percent of total billed charges,Implant Devices,935.2,35,,935.2,percent of total billed charges,Implant Devices,935.2,35,,935.2,percent of total billed charges,Implant Devices,935.2,35,,935.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,908.48,34,"If Charge > 2,000, then 34 percent",908.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1068.8,
DEPUY ORTHO TOTAL ATTUNE FB KNEE CAP,C1776,HCPCS,,79007076,CDM,278,RC,,,both,,,17334,6841.18,39.4668,,6841.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5893.56,34,,5893.56,percent of total billed charges,Implant Device,5893.56,34,,5893.56,percent of total billed charges,Implant Device,5893.56,34,,5893.56,percent of total billed charges,Implant Device,5893.56,34,,5893.56,percent of total billed charges,Implant Device,5893.56,34,,5893.56,percent of total billed charges,Implant Device,5893.56,34,,5893.56,percent of total billed charges,Implant Device,6066.9,35,,6066.9,percent of total billed charges,Implant Device,5893.56,34,"Charges > $500, x 34%",5893.56,percent of total billed charges,Implant Device,6066.9,35,,6066.9,percent of total billed charges,Implant Devices,6066.9,35,,6066.9,percent of total billed charges,Implant Devices,6066.9,35,,,percent of total billed charges,Implant Devices,6066.9,35,,6066.9,percent of total billed charges,Implant Devices,6066.9,35,,6066.9,percent of total billed charges,Implant Devices,6933.6,40,,6933.6,percent of total billed charges,Implant Devices,6066.9,70,,6066.9,percent of total billed charges,Implant Devices,5893.56,34,,5893.56,percent of total billed charges,Implant Devices,5893.56,34,,5893.56,percent of total billed charges,Implant Devices,6066.9,35,,6066.9,percent of total billed charges,Implant Devices,6066.9,35,,6066.9,percent of total billed charges,Implant Devices,6066.9,35,,6066.9,percent of total billed charges,Implant Devices,6066.9,35,,6066.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5893.56,34,"If Charge > 2,000, then 34 percent",5893.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6933.6,
DEPUY 1221-36-456 ACETAB LINR +4 36X56MM,C1776,HCPCS,,79007077,CDM,278,RC,,,both,,,4743,1871.91,39.4668,,1871.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1660.05,35,,1660.05,percent of total billed charges,Implant Device,1612.62,34,"Charges > $500, x 34%",1612.62,percent of total billed charges,Implant Device,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1897.2,40,,1897.2,percent of total billed charges,Implant Devices,1660.05,70,,1660.05,percent of total billed charges,Implant Devices,1612.62,34,,1612.62,percent of total billed charges,Implant Devices,1612.62,34,,1612.62,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1612.62,34,"If Charge > 2,000, then 34 percent",1612.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1897.2,
EXACTECH SPK0222 INTERSPACE KNEE SPACER,C1776,HCPCS,,79007096,CDM,278,RC,,,both,,,8505,3356.65,39.4668,,3356.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2891.7,34,,2891.7,percent of total billed charges,Implant Device,2891.7,34,,2891.7,percent of total billed charges,Implant Device,2891.7,34,,2891.7,percent of total billed charges,Implant Device,2891.7,34,,2891.7,percent of total billed charges,Implant Device,2891.7,34,,2891.7,percent of total billed charges,Implant Device,2891.7,34,,2891.7,percent of total billed charges,Implant Device,2976.75,35,,2976.75,percent of total billed charges,Implant Device,2891.7,34,"Charges > $500, x 34%",2891.7,percent of total billed charges,Implant Device,2976.75,35,,2976.75,percent of total billed charges,Implant Devices,2976.75,35,,2976.75,percent of total billed charges,Implant Devices,2976.75,35,,,percent of total billed charges,Implant Devices,2976.75,35,,2976.75,percent of total billed charges,Implant Devices,2976.75,35,,2976.75,percent of total billed charges,Implant Devices,3402,40,,3402,percent of total billed charges,Implant Devices,2976.75,70,,2976.75,percent of total billed charges,Implant Devices,2891.7,34,,2891.7,percent of total billed charges,Implant Devices,2891.7,34,,2891.7,percent of total billed charges,Implant Devices,2976.75,35,,2976.75,percent of total billed charges,Implant Devices,2976.75,35,,2976.75,percent of total billed charges,Implant Devices,2976.75,35,,2976.75,percent of total billed charges,Implant Devices,2976.75,35,,2976.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2891.7,34,"If Charge > 2,000, then 34 percent",2891.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3402,
STRYKER STRYKER BIPOLAR HIP-CAP,C1776,HCPCS,,79007117,CDM,278,RC,,,both,,,13209,5213.17,39.4668,,5213.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4491.06,34,,4491.06,percent of total billed charges,Implant Device,4623.15,35,,4623.15,percent of total billed charges,Implant Device,4491.06,34,"Charges > $500, x 34%",4491.06,percent of total billed charges,Implant Device,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,5283.6,40,,5283.6,percent of total billed charges,Implant Devices,4623.15,70,,4623.15,percent of total billed charges,Implant Devices,4491.06,34,,4491.06,percent of total billed charges,Implant Devices,4491.06,34,,4491.06,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,4623.15,35,,4623.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4491.06,34,"If Charge > 2,000, then 34 percent",4491.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5283.6,
STRYKER 5630-G-409 TIBIAL INSRT SZ 4 9MM,C1776,HCPCS,,79007133,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
STRYKER 5610-F-401 FEMORAL COMP SZ 4,C1776,HCPCS,,79007134,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
DEPUY 1035-51-000 BIPOLAR HEAD 28X51MM,C1776,HCPCS,,79007143,CDM,278,RC,,,both,,,4030,1590.51,39.4668,,1590.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Device,1370.2,34,"Charges > $500, x 34%",1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1612,40,,1612,percent of total billed charges,Implant Devices,1410.5,70,,1410.5,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1370.2,34,"If Charge > 2,000, then 34 percent",1370.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1612,
DEPUY 1365-28-320 FEM HEAD 28MM +5MM,C1776,HCPCS,,79007144,CDM,278,RC,,,both,,,4539,1791.4,39.4668,,1791.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1543.26,34,,1543.26,percent of total billed charges,Implant Device,1543.26,34,,1543.26,percent of total billed charges,Implant Device,1543.26,34,,1543.26,percent of total billed charges,Implant Device,1543.26,34,,1543.26,percent of total billed charges,Implant Device,1543.26,34,,1543.26,percent of total billed charges,Implant Device,1543.26,34,,1543.26,percent of total billed charges,Implant Device,1588.65,35,,1588.65,percent of total billed charges,Implant Device,1543.26,34,"Charges > $500, x 34%",1543.26,percent of total billed charges,Implant Device,1588.65,35,,1588.65,percent of total billed charges,Implant Devices,1588.65,35,,1588.65,percent of total billed charges,Implant Devices,1588.65,35,,,percent of total billed charges,Implant Devices,1588.65,35,,1588.65,percent of total billed charges,Implant Devices,1588.65,35,,1588.65,percent of total billed charges,Implant Devices,1815.6,40,,1815.6,percent of total billed charges,Implant Devices,1588.65,70,,1588.65,percent of total billed charges,Implant Devices,1543.26,34,,1543.26,percent of total billed charges,Implant Devices,1543.26,34,,1543.26,percent of total billed charges,Implant Devices,1588.65,35,,1588.65,percent of total billed charges,Implant Devices,1588.65,35,,1588.65,percent of total billed charges,Implant Devices,1588.65,35,,1588.65,percent of total billed charges,Implant Devices,1588.65,35,,1588.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1543.26,34,"If Charge > 2,000, then 34 percent",1543.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1815.6,
DEPUY 3L93716 CORAIL 2 LAT SZ 16,C1776,HCPCS,,79007145,CDM,278,RC,,,both,,,12861,5075.83,39.4668,,5075.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4501.35,35,,4501.35,percent of total billed charges,Implant Device,4372.74,34,"Charges > $500, x 34%",4372.74,percent of total billed charges,Implant Device,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,5144.4,40,,5144.4,percent of total billed charges,Implant Devices,4501.35,70,,4501.35,percent of total billed charges,Implant Devices,4372.74,34,,4372.74,percent of total billed charges,Implant Devices,4372.74,34,,4372.74,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4372.74,34,"If Charge > 2,000, then 34 percent",4372.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5144.4,
BIOMET EP-115395 E1 HUMERAL BEARING +3MM,C1776,HCPCS,,79007146,CDM,278,RC,,,both,,,7740,3054.73,39.4668,,3054.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2631.6,34,,2631.6,percent of total billed charges,Implant Device,2709,35,,2709,percent of total billed charges,Implant Device,2631.6,34,"Charges > $500, x 34%",2631.6,percent of total billed charges,Implant Device,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,3096,40,,3096,percent of total billed charges,Implant Devices,2709,70,,2709,percent of total billed charges,Implant Devices,2631.6,34,,2631.6,percent of total billed charges,Implant Devices,2631.6,34,,2631.6,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,2709,35,,2709,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2631.6,34,"If Charge > 2,000, then 34 percent",2631.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3096,
STRYKER 5630-G-308 TIBIAL INSRT SZ 3 8MM,C1776,HCPCS,,79007158,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
STRYKER 5620-B-301 TIBIAL BASEPLATE SZ 3,C1776,HCPCS,,79007159,CDM,278,RC,,,both,,,4937,1948.48,39.4668,,1948.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1678.58,34,,1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Device,1678.58,34,"Charges > $500, x 34%",1678.58,percent of total billed charges,Implant Device,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1974.8,40,,1974.8,percent of total billed charges,Implant Devices,1727.95,70,,1727.95,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1678.58,34,,1678.58,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,1727.95,35,,1727.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.58,34,"If Charge > 2,000, then 34 percent",1678.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.8,
STRYKER 5610-F-301 FEMORAL COMPNENT SZ 3,C1776,HCPCS,,79007160,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
EXACTECH 304-21-13 HUMERAL STEM 12.5MM,C1776,HCPCS,,79007170,CDM,278,RC,,,both,,,12015,4741.94,39.4668,,4741.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4085.1,34,,4085.1,percent of total billed charges,Implant Device,4085.1,34,,4085.1,percent of total billed charges,Implant Device,4085.1,34,,4085.1,percent of total billed charges,Implant Device,4085.1,34,,4085.1,percent of total billed charges,Implant Device,4085.1,34,,4085.1,percent of total billed charges,Implant Device,4085.1,34,,4085.1,percent of total billed charges,Implant Device,4205.25,35,,4205.25,percent of total billed charges,Implant Device,4085.1,34,"Charges > $500, x 34%",4085.1,percent of total billed charges,Implant Device,4205.25,35,,4205.25,percent of total billed charges,Implant Devices,4205.25,35,,4205.25,percent of total billed charges,Implant Devices,4205.25,35,,,percent of total billed charges,Implant Devices,4205.25,35,,4205.25,percent of total billed charges,Implant Devices,4205.25,35,,4205.25,percent of total billed charges,Implant Devices,4806,40,,4806,percent of total billed charges,Implant Devices,4205.25,70,,4205.25,percent of total billed charges,Implant Devices,4085.1,34,,4085.1,percent of total billed charges,Implant Devices,4085.1,34,,4085.1,percent of total billed charges,Implant Devices,4205.25,35,,4205.25,percent of total billed charges,Implant Devices,4205.25,35,,4205.25,percent of total billed charges,Implant Devices,4205.25,35,,4205.25,percent of total billed charges,Implant Devices,4205.25,35,,4205.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4085.1,34,"If Charge > 2,000, then 34 percent",4085.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4806,
DEPUY 96-2135 TIBIAL INSERT #3 20MM,C1776,HCPCS,,79007185,CDM,278,RC,,,both,,,4121,1626.43,39.4668,,1626.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1401.14,34,,1401.14,percent of total billed charges,Implant Device,1401.14,34,,1401.14,percent of total billed charges,Implant Device,1401.14,34,,1401.14,percent of total billed charges,Implant Device,1401.14,34,,1401.14,percent of total billed charges,Implant Device,1401.14,34,,1401.14,percent of total billed charges,Implant Device,1401.14,34,,1401.14,percent of total billed charges,Implant Device,1442.35,35,,1442.35,percent of total billed charges,Implant Device,1401.14,34,"Charges > $500, x 34%",1401.14,percent of total billed charges,Implant Device,1442.35,35,,1442.35,percent of total billed charges,Implant Devices,1442.35,35,,1442.35,percent of total billed charges,Implant Devices,1442.35,35,,,percent of total billed charges,Implant Devices,1442.35,35,,1442.35,percent of total billed charges,Implant Devices,1442.35,35,,1442.35,percent of total billed charges,Implant Devices,1648.4,40,,1648.4,percent of total billed charges,Implant Devices,1442.35,70,,1442.35,percent of total billed charges,Implant Devices,1401.14,34,,1401.14,percent of total billed charges,Implant Devices,1401.14,34,,1401.14,percent of total billed charges,Implant Devices,1442.35,35,,1442.35,percent of total billed charges,Implant Devices,1442.35,35,,1442.35,percent of total billed charges,Implant Devices,1442.35,35,,1442.35,percent of total billed charges,Implant Devices,1442.35,35,,1442.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1401.14,34,"If Charge > 2,000, then 34 percent",1401.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1648.4,
ZIMMER 00-7711-011-00 FEMORAL STEM SZ 11,C1776,HCPCS,,79007186,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 00-8852-011-36 RIM LINER 36MM JJ,C1776,HCPCS,,79007199,CDM,278,RC,,,both,,,4403,1737.72,39.4668,,1737.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Device,1497.02,34,"Charges > $500, x 34%",1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1761.2,40,,1761.2,percent of total billed charges,Implant Devices,1541.05,70,,1541.05,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.02,34,"If Charge > 2,000, then 34 percent",1497.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.2,
STRYKER 6276-7-319 REST MOD HIP 235X19MM,C1776,HCPCS,,79007201,CDM,278,RC,,,both,,,16079,6345.87,39.4668,,6345.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5627.65,35,,5627.65,percent of total billed charges,Implant Device,5466.86,34,"Charges > $500, x 34%",5466.86,percent of total billed charges,Implant Device,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,6431.6,40,,6431.6,percent of total billed charges,Implant Devices,5627.65,70,,5627.65,percent of total billed charges,Implant Devices,5466.86,34,,5466.86,percent of total billed charges,Implant Devices,5466.86,34,,5466.86,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5466.86,34,"If Charge > 2,000, then 34 percent",5466.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6431.6,
EXACTECH 310-21-47 HUMERAL HEAD 47MM,C1776,HCPCS,,79007202,CDM,278,RC,,,both,,,8910,3516.49,39.4668,,3516.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Device,3029.4,34,"Charges > $500, x 34%",3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3564,40,,3564,percent of total billed charges,Implant Devices,3118.5,70,,3118.5,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3029.4,34,"If Charge > 2,000, then 34 percent",3029.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3564,
ZIMMER 00-8852-010-36 RIM LINER 36MM,C1776,HCPCS,,79007216,CDM,278,RC,,,both,,,4403,1737.72,39.4668,,1737.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Device,1497.02,34,"Charges > $500, x 34%",1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1761.2,40,,1761.2,percent of total billed charges,Implant Devices,1541.05,70,,1541.05,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.02,34,"If Charge > 2,000, then 34 percent",1497.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.2,
TRILLIANT 204-30-006 HAMMERTOE IMP 3.4X6,C1776,HCPCS,,79007222,CDM,278,RC,,,both,,,2370,935.36,39.4668,,935.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,805.8,34,,805.8,percent of total billed charges,Implant Device,829.5,35,,829.5,percent of total billed charges,Implant Device,805.8,34,"Charges > $500, x 34%",805.8,percent of total billed charges,Implant Device,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,948,40,,948,percent of total billed charges,Implant Devices,829.5,70,,829.5,percent of total billed charges,Implant Devices,805.8,34,,805.8,percent of total billed charges,Implant Devices,805.8,34,,805.8,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,829.5,35,,829.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,805.8,34,"If Charge > 2,000, then 34 percent",805.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,948,
STRYKER 6260-9-326 FEMORAL HD 26MM,C1776,HCPCS,,79007227,CDM,278,RC,,,both,,,3278,1293.72,39.4668,,1293.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1114.52,34,,1114.52,percent of total billed charges,Implant Device,1114.52,34,,1114.52,percent of total billed charges,Implant Device,1114.52,34,,1114.52,percent of total billed charges,Implant Device,1114.52,34,,1114.52,percent of total billed charges,Implant Device,1114.52,34,,1114.52,percent of total billed charges,Implant Device,1114.52,34,,1114.52,percent of total billed charges,Implant Device,1147.3,35,,1147.3,percent of total billed charges,Implant Device,1114.52,34,"Charges > $500, x 34%",1114.52,percent of total billed charges,Implant Device,1147.3,35,,1147.3,percent of total billed charges,Implant Devices,1147.3,35,,1147.3,percent of total billed charges,Implant Devices,1147.3,35,,,percent of total billed charges,Implant Devices,1147.3,35,,1147.3,percent of total billed charges,Implant Devices,1147.3,35,,1147.3,percent of total billed charges,Implant Devices,1311.2,40,,1311.2,percent of total billed charges,Implant Devices,1147.3,70,,1147.3,percent of total billed charges,Implant Devices,1114.52,34,,1114.52,percent of total billed charges,Implant Devices,1114.52,34,,1114.52,percent of total billed charges,Implant Devices,1147.3,35,,1147.3,percent of total billed charges,Implant Devices,1147.3,35,,1147.3,percent of total billed charges,Implant Devices,1147.3,35,,1147.3,percent of total billed charges,Implant Devices,1147.3,35,,1147.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1114.52,34,"If Charge > 2,000, then 34 percent",1114.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1311.2,
STRYKER UH1-56-26 UHR UNI HD 56X26MM,C1776,HCPCS,,79007228,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 6276-1-123 REST MOD HIP 23X10MM,C1776,HCPCS,,79007229,CDM,278,RC,,,both,,,19076,7528.69,39.4668,,7528.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6485.84,34,,6485.84,percent of total billed charges,Implant Device,6676.6,35,,6676.6,percent of total billed charges,Implant Device,6485.84,34,"Charges > $500, x 34%",6485.84,percent of total billed charges,Implant Device,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,7630.4,40,,7630.4,percent of total billed charges,Implant Devices,6676.6,70,,6676.6,percent of total billed charges,Implant Devices,6485.84,34,,6485.84,percent of total billed charges,Implant Devices,6485.84,34,,6485.84,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,6676.6,35,,6676.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6485.84,34,"If Charge > 2,000, then 34 percent",6485.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7630.4,
S&N 71420578 GENESIS PATELLAR COMP 35MM,C1776,HCPCS,,79007236,CDM,278,RC,,,both,,,1815,716.32,39.4668,,716.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,617.1,34,,617.1,percent of total billed charges,Implant Device,617.1,34,,617.1,percent of total billed charges,Implant Device,617.1,34,,617.1,percent of total billed charges,Implant Device,617.1,34,,617.1,percent of total billed charges,Implant Device,617.1,34,,617.1,percent of total billed charges,Implant Device,617.1,34,,617.1,percent of total billed charges,Implant Device,635.25,35,,635.25,percent of total billed charges,Implant Device,617.1,34,"Charges > $500, x 34%",617.1,percent of total billed charges,Implant Device,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,726,40,,726,percent of total billed charges,Implant Devices,635.25,70,,635.25,percent of total billed charges,Implant Devices,617.1,34,,617.1,percent of total billed charges,Implant Devices,617.1,34,,617.1,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,635.25,35,,635.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,726,
S&N 71421167 LEGION FEMORAL COMP SZ 7 LT,C1776,HCPCS,,79007237,CDM,278,RC,,,both,,,24904,9828.81,39.4668,,9828.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8467.36,34,,8467.36,percent of total billed charges,Implant Device,8467.36,34,,8467.36,percent of total billed charges,Implant Device,8467.36,34,,8467.36,percent of total billed charges,Implant Device,8467.36,34,,8467.36,percent of total billed charges,Implant Device,8467.36,34,,8467.36,percent of total billed charges,Implant Device,8467.36,34,,8467.36,percent of total billed charges,Implant Device,8716.4,35,,8716.4,percent of total billed charges,Implant Device,8467.36,34,"Charges > $500, x 34%",8467.36,percent of total billed charges,Implant Device,8716.4,35,,8716.4,percent of total billed charges,Implant Devices,8716.4,35,,8716.4,percent of total billed charges,Implant Devices,8716.4,35,,,percent of total billed charges,Implant Devices,8716.4,35,,8716.4,percent of total billed charges,Implant Devices,8716.4,35,,8716.4,percent of total billed charges,Implant Devices,9961.6,40,,9961.6,percent of total billed charges,Implant Devices,8716.4,70,,8716.4,percent of total billed charges,Implant Devices,8467.36,34,,8467.36,percent of total billed charges,Implant Devices,8467.36,34,,8467.36,percent of total billed charges,Implant Devices,8716.4,35,,8716.4,percent of total billed charges,Implant Devices,8716.4,35,,8716.4,percent of total billed charges,Implant Devices,8716.4,35,,8716.4,percent of total billed charges,Implant Devices,8716.4,35,,8716.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8467.36,34,"If Charge > 2,000, then 34 percent",8467.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9961.6,
S&N 71424227 LEGION OFFSET COUPLER 6MM,C1776,HCPCS,,79007238,CDM,278,RC,,,both,,,4726,1865.2,39.4668,,1865.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.84,34,,1606.84,percent of total billed charges,Implant Device,1606.84,34,,1606.84,percent of total billed charges,Implant Device,1606.84,34,,1606.84,percent of total billed charges,Implant Device,1606.84,34,,1606.84,percent of total billed charges,Implant Device,1606.84,34,,1606.84,percent of total billed charges,Implant Device,1606.84,34,,1606.84,percent of total billed charges,Implant Device,1654.1,35,,1654.1,percent of total billed charges,Implant Device,1606.84,34,"Charges > $500, x 34%",1606.84,percent of total billed charges,Implant Device,1654.1,35,,1654.1,percent of total billed charges,Implant Devices,1654.1,35,,1654.1,percent of total billed charges,Implant Devices,1654.1,35,,,percent of total billed charges,Implant Devices,1654.1,35,,1654.1,percent of total billed charges,Implant Devices,1654.1,35,,1654.1,percent of total billed charges,Implant Devices,1890.4,40,,1890.4,percent of total billed charges,Implant Devices,1654.1,70,,1654.1,percent of total billed charges,Implant Devices,1606.84,34,,1606.84,percent of total billed charges,Implant Devices,1606.84,34,,1606.84,percent of total billed charges,Implant Devices,1654.1,35,,1654.1,percent of total billed charges,Implant Devices,1654.1,35,,1654.1,percent of total billed charges,Implant Devices,1654.1,35,,1654.1,percent of total billed charges,Implant Devices,1654.1,35,,1654.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.84,34,"If Charge > 2,000, then 34 percent",1606.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890.4,
S&N 71420832 GENESIS ART INS SZ 5-6 11MM,C1776,HCPCS,,79007239,CDM,278,RC,,,both,,,3044,1201.37,39.4668,,1201.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1034.96,34,,1034.96,percent of total billed charges,Implant Device,1034.96,34,,1034.96,percent of total billed charges,Implant Device,1034.96,34,,1034.96,percent of total billed charges,Implant Device,1034.96,34,,1034.96,percent of total billed charges,Implant Device,1034.96,34,,1034.96,percent of total billed charges,Implant Device,1034.96,34,,1034.96,percent of total billed charges,Implant Device,1065.4,35,,1065.4,percent of total billed charges,Implant Device,1034.96,34,"Charges > $500, x 34%",1034.96,percent of total billed charges,Implant Device,1065.4,35,,1065.4,percent of total billed charges,Implant Devices,1065.4,35,,1065.4,percent of total billed charges,Implant Devices,1065.4,35,,,percent of total billed charges,Implant Devices,1065.4,35,,1065.4,percent of total billed charges,Implant Devices,1065.4,35,,1065.4,percent of total billed charges,Implant Devices,1217.6,40,,1217.6,percent of total billed charges,Implant Devices,1065.4,70,,1065.4,percent of total billed charges,Implant Devices,1034.96,34,,1034.96,percent of total billed charges,Implant Devices,1034.96,34,,1034.96,percent of total billed charges,Implant Devices,1065.4,35,,1065.4,percent of total billed charges,Implant Devices,1065.4,35,,1065.4,percent of total billed charges,Implant Devices,1065.4,35,,1065.4,percent of total billed charges,Implant Devices,1065.4,35,,1065.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1034.96,34,"If Charge > 2,000, then 34 percent",1034.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1217.6,
S&N 71420170 GENESIS TIBIAL BASEPLT SZ 6,C1776,HCPCS,,79007240,CDM,278,RC,,,both,,,4538,1791,39.4668,,1791,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1542.92,34,,1542.92,percent of total billed charges,Implant Device,1542.92,34,,1542.92,percent of total billed charges,Implant Device,1542.92,34,,1542.92,percent of total billed charges,Implant Device,1542.92,34,,1542.92,percent of total billed charges,Implant Device,1542.92,34,,1542.92,percent of total billed charges,Implant Device,1542.92,34,,1542.92,percent of total billed charges,Implant Device,1588.3,35,,1588.3,percent of total billed charges,Implant Device,1542.92,34,"Charges > $500, x 34%",1542.92,percent of total billed charges,Implant Device,1588.3,35,,1588.3,percent of total billed charges,Implant Devices,1588.3,35,,1588.3,percent of total billed charges,Implant Devices,1588.3,35,,,percent of total billed charges,Implant Devices,1588.3,35,,1588.3,percent of total billed charges,Implant Devices,1588.3,35,,1588.3,percent of total billed charges,Implant Devices,1815.2,40,,1815.2,percent of total billed charges,Implant Devices,1588.3,70,,1588.3,percent of total billed charges,Implant Devices,1542.92,34,,1542.92,percent of total billed charges,Implant Devices,1542.92,34,,1542.92,percent of total billed charges,Implant Devices,1588.3,35,,1588.3,percent of total billed charges,Implant Devices,1588.3,35,,1588.3,percent of total billed charges,Implant Devices,1588.3,35,,1588.3,percent of total billed charges,Implant Devices,1588.3,35,,1588.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1542.92,34,"If Charge > 2,000, then 34 percent",1542.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1815.2,
S&N 71420650 GENESIS LONG STEM 16X150MM,C1776,HCPCS,,79007241,CDM,278,RC,,,both,,,7350,2900.81,39.4668,,2900.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Device,2499,34,"Charges > $500, x 34%",2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2940,40,,2940,percent of total billed charges,Implant Devices,2572.5,70,,2572.5,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2499,34,"If Charge > 2,000, then 34 percent",2499,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
DEPUY 96-2365 TIBIAL INSERT TC3 SZ5 20MM,C1776,HCPCS,,79007251,CDM,278,RC,,,both,,,10896,4300.3,39.4668,,4300.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3813.6,35,,3813.6,percent of total billed charges,Implant Device,3704.64,34,"Charges > $500, x 34%",3704.64,percent of total billed charges,Implant Device,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,4358.4,40,,4358.4,percent of total billed charges,Implant Devices,3813.6,70,,3813.6,percent of total billed charges,Implant Devices,3704.64,34,,3704.64,percent of total billed charges,Implant Devices,3704.64,34,,3704.64,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3704.64,34,"If Charge > 2,000, then 34 percent",3704.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4358.4,
DEPUY 02.127.210 TIB PLATE 4HOLE 3.5X87,C1776,HCPCS,,79007253,CDM,278,RC,,,both,,,6315,2492.33,39.4668,,2492.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2147.1,34,,2147.1,percent of total billed charges,Implant Device,2147.1,34,,2147.1,percent of total billed charges,Implant Device,2147.1,34,,2147.1,percent of total billed charges,Implant Device,2147.1,34,,2147.1,percent of total billed charges,Implant Device,2147.1,34,,2147.1,percent of total billed charges,Implant Device,2147.1,34,,2147.1,percent of total billed charges,Implant Device,2210.25,35,,2210.25,percent of total billed charges,Implant Device,2147.1,34,"Charges > $500, x 34%",2147.1,percent of total billed charges,Implant Device,2210.25,35,,2210.25,percent of total billed charges,Implant Devices,2210.25,35,,2210.25,percent of total billed charges,Implant Devices,2210.25,35,,,percent of total billed charges,Implant Devices,2210.25,35,,2210.25,percent of total billed charges,Implant Devices,2210.25,35,,2210.25,percent of total billed charges,Implant Devices,2526,40,,2526,percent of total billed charges,Implant Devices,2210.25,70,,2210.25,percent of total billed charges,Implant Devices,2147.1,34,,2147.1,percent of total billed charges,Implant Devices,2147.1,34,,2147.1,percent of total billed charges,Implant Devices,2210.25,35,,2210.25,percent of total billed charges,Implant Devices,2210.25,35,,2210.25,percent of total billed charges,Implant Devices,2210.25,35,,2210.25,percent of total billed charges,Implant Devices,2210.25,35,,2210.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2147.1,34,"If Charge > 2,000, then 34 percent",2147.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2526,
DEPUY 1221-36-154 ACETABLR LINER 36X54MM,C1776,HCPCS,,79007269,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
DEPUY 1365-36-230 FEM HEAD 36MM 11/13,C1776,HCPCS,,79007270,CDM,278,RC,,,both,,,5549,2190.01,39.4668,,2190.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1942.15,35,,1942.15,percent of total billed charges,Implant Device,1886.66,34,"Charges > $500, x 34%",1886.66,percent of total billed charges,Implant Device,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,2219.6,40,,2219.6,percent of total billed charges,Implant Devices,1942.15,70,,1942.15,percent of total billed charges,Implant Devices,1886.66,34,,1886.66,percent of total billed charges,Implant Devices,1886.66,34,,1886.66,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1886.66,34,"If Charge > 2,000, then 34 percent",1886.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2219.6,
DEPUY TOTAL KNEE WITH REVISION COMPONENT,C1776,HCPCS,,79007273,CDM,278,RC,,,both,,,24297,9589.25,39.4668,,9589.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8260.98,34,,8260.98,percent of total billed charges,Implant Device,8260.98,34,,8260.98,percent of total billed charges,Implant Device,8260.98,34,,8260.98,percent of total billed charges,Implant Device,8260.98,34,,8260.98,percent of total billed charges,Implant Device,8260.98,34,,8260.98,percent of total billed charges,Implant Device,8260.98,34,,8260.98,percent of total billed charges,Implant Device,8503.95,35,,8503.95,percent of total billed charges,Implant Device,8260.98,34,"Charges > $500, x 34%",8260.98,percent of total billed charges,Implant Device,8503.95,35,,8503.95,percent of total billed charges,Implant Devices,8503.95,35,,8503.95,percent of total billed charges,Implant Devices,8503.95,35,,,percent of total billed charges,Implant Devices,8503.95,35,,8503.95,percent of total billed charges,Implant Devices,8503.95,35,,8503.95,percent of total billed charges,Implant Devices,9718.8,40,,9718.8,percent of total billed charges,Implant Devices,8503.95,70,,8503.95,percent of total billed charges,Implant Devices,8260.98,34,,8260.98,percent of total billed charges,Implant Devices,8260.98,34,,8260.98,percent of total billed charges,Implant Devices,8503.95,35,,8503.95,percent of total billed charges,Implant Devices,8503.95,35,,8503.95,percent of total billed charges,Implant Devices,8503.95,35,,8503.95,percent of total billed charges,Implant Devices,8503.95,35,,8503.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8260.98,34,"If Charge > 2,000, then 34 percent",8260.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9718.8,
DEPUY 1987-13-111 LPS DIST FEM COMPONENT,C1776,HCPCS,,79007330,CDM,278,RC,,,both,,,41585,16412.27,39.4668,,16412.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14138.9,34,,14138.9,percent of total billed charges,Implant Device,14138.9,34,,14138.9,percent of total billed charges,Implant Device,14138.9,34,,14138.9,percent of total billed charges,Implant Device,14138.9,34,,14138.9,percent of total billed charges,Implant Device,14138.9,34,,14138.9,percent of total billed charges,Implant Device,14138.9,34,,14138.9,percent of total billed charges,Implant Device,14554.75,35,,14554.75,percent of total billed charges,Implant Device,14138.9,34,"Charges > $500, x 34%",14138.9,percent of total billed charges,Implant Device,14554.75,35,,14554.75,percent of total billed charges,Implant Devices,14554.75,35,,14554.75,percent of total billed charges,Implant Devices,14554.75,35,,,percent of total billed charges,Implant Devices,14554.75,35,,14554.75,percent of total billed charges,Implant Devices,14554.75,35,,14554.75,percent of total billed charges,Implant Devices,16634,40,,16634,percent of total billed charges,Implant Devices,14554.75,70,,14554.75,percent of total billed charges,Implant Devices,14138.9,34,,14138.9,percent of total billed charges,Implant Devices,14138.9,34,,14138.9,percent of total billed charges,Implant Devices,14554.75,35,,14554.75,percent of total billed charges,Implant Devices,14554.75,35,,14554.75,percent of total billed charges,Implant Devices,14554.75,35,,14554.75,percent of total billed charges,Implant Devices,14554.75,35,,14554.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,14138.9,34,"If Charge > 2,000, then 34 percent",14138.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,16634,
DEPUY 1987-27-016 LPS TIBIAL INSERT 16MM,C1776,HCPCS,,79007331,CDM,278,RC,,,both,,,14280,5635.86,39.4668,,5635.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4855.2,34,,4855.2,percent of total billed charges,Implant Device,4855.2,34,,4855.2,percent of total billed charges,Implant Device,4855.2,34,,4855.2,percent of total billed charges,Implant Device,4855.2,34,,4855.2,percent of total billed charges,Implant Device,4855.2,34,,4855.2,percent of total billed charges,Implant Device,4855.2,34,,4855.2,percent of total billed charges,Implant Device,4998,35,,4998,percent of total billed charges,Implant Device,4855.2,34,"Charges > $500, x 34%",4855.2,percent of total billed charges,Implant Device,4998,35,,4998,percent of total billed charges,Implant Devices,4998,35,,4998,percent of total billed charges,Implant Devices,4998,35,,,percent of total billed charges,Implant Devices,4998,35,,4998,percent of total billed charges,Implant Devices,4998,35,,4998,percent of total billed charges,Implant Devices,5712,40,,5712,percent of total billed charges,Implant Devices,4998,70,,4998,percent of total billed charges,Implant Devices,4855.2,34,,4855.2,percent of total billed charges,Implant Devices,4855.2,34,,4855.2,percent of total billed charges,Implant Devices,4998,35,,4998,percent of total billed charges,Implant Devices,4998,35,,4998,percent of total billed charges,Implant Devices,4998,35,,4998,percent of total billed charges,Implant Devices,4998,35,,4998,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4855.2,34,"If Charge > 2,000, then 34 percent",4855.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5712,
DEPUY 86-7414 UNI STEM 75X14MM FLUTED,C1776,HCPCS,,79007332,CDM,278,RC,,,both,,,6144,2424.84,39.4668,,2424.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2088.96,34,,2088.96,percent of total billed charges,Implant Device,2150.4,35,,2150.4,percent of total billed charges,Implant Device,2088.96,34,"Charges > $500, x 34%",2088.96,percent of total billed charges,Implant Device,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2457.6,40,,2457.6,percent of total billed charges,Implant Devices,2150.4,70,,2150.4,percent of total billed charges,Implant Devices,2088.96,34,,2088.96,percent of total billed charges,Implant Devices,2088.96,34,,2088.96,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,2150.4,35,,2150.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2088.96,34,"If Charge > 2,000, then 34 percent",2088.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2457.6,
STRYKER 6276-7-221 MODULAR HIP 195X21MM,C1776,HCPCS,,79007355,CDM,278,RC,,,both,,,15277,6029.34,39.4668,,6029.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5346.95,35,,5346.95,percent of total billed charges,Implant Device,5194.18,34,"Charges > $500, x 34%",5194.18,percent of total billed charges,Implant Device,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,6110.8,40,,6110.8,percent of total billed charges,Implant Devices,5346.95,70,,5346.95,percent of total billed charges,Implant Devices,5194.18,34,,5194.18,percent of total billed charges,Implant Devices,5194.18,34,,5194.18,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5194.18,34,"If Charge > 2,000, then 34 percent",5194.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6110.8,
S&N 71453254 ARTICULAR INSERT SZ5-6 13MM,C1776,HCPCS,,79007359,CDM,278,RC,,,both,,,5528,2181.72,39.4668,,2181.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1879.52,34,,1879.52,percent of total billed charges,Implant Device,1934.8,35,,1934.8,percent of total billed charges,Implant Device,1879.52,34,"Charges > $500, x 34%",1879.52,percent of total billed charges,Implant Device,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,2211.2,40,,2211.2,percent of total billed charges,Implant Devices,1934.8,70,,1934.8,percent of total billed charges,Implant Devices,1879.52,34,,1879.52,percent of total billed charges,Implant Devices,1879.52,34,,1879.52,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,1934.8,35,,1934.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1879.52,34,"If Charge > 2,000, then 34 percent",1879.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2211.2,
DEPUY 1024-08-300 FEMORAL INS SZ 3 RM/LL,C1776,HCPCS,,79007361,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
ZIMMER 00-5001-048-00 BIPOLAR SHELL 48MM,C1776,HCPCS,,79007373,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
STRYKER 5610-F-302 FEMORAL COMPNENT SZ 3,C1776,HCPCS,,79007405,CDM,278,RC,,,both,,,8352,3296.27,39.4668,,3296.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2839.68,34,,2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Device,2839.68,34,"Charges > $500, x 34%",2839.68,percent of total billed charges,Implant Device,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,3340.8,40,,3340.8,percent of total billed charges,Implant Devices,2923.2,70,,2923.2,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2839.68,34,,2839.68,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,2923.2,35,,2923.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2839.68,34,"If Charge > 2,000, then 34 percent",2839.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3340.8,
ZIMMER 00-5990-034-20 FEM AUG BLOCK SZ D,C1776,HCPCS,,79007407,CDM,278,RC,,,both,,,2993,1181.24,39.4668,,1181.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1047.55,35,,1047.55,percent of total billed charges,Implant Device,1017.62,34,"Charges > $500, x 34%",1017.62,percent of total billed charges,Implant Device,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1197.2,40,,1197.2,percent of total billed charges,Implant Devices,1047.55,70,,1047.55,percent of total billed charges,Implant Devices,1017.62,34,,1017.62,percent of total billed charges,Implant Devices,1017.62,34,,1017.62,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1017.62,34,"If Charge > 2,000, then 34 percent",1017.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1197.2,
ZIMMER 00-5994-041-14 ART SURF SZ C D,C1776,HCPCS,,79007408,CDM,278,RC,,,both,,,6773,2673.09,39.4668,,2673.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Device,2302.82,34,"Charges > $500, x 34%",2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2709.2,40,,2709.2,percent of total billed charges,Implant Devices,2370.55,70,,2370.55,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2302.82,34,"If Charge > 2,000, then 34 percent",2302.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2709.2,
DEPUY 1541-23-000 HIP STEM SZ 3 200MM LT,C1776,HCPCS,,79007429,CDM,278,RC,,,both,,,14227,5614.94,39.4668,,5614.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4837.18,34,,4837.18,percent of total billed charges,Implant Device,4979.45,35,,4979.45,percent of total billed charges,Implant Device,4837.18,34,"Charges > $500, x 34%",4837.18,percent of total billed charges,Implant Device,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,5690.8,40,,5690.8,percent of total billed charges,Implant Devices,4979.45,70,,4979.45,percent of total billed charges,Implant Devices,4837.18,34,,4837.18,percent of total billed charges,Implant Devices,4837.18,34,,4837.18,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,4979.45,35,,4979.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4837.18,34,"If Charge > 2,000, then 34 percent",4837.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5690.8,
ZIMMER 00-8757-066-01 TRAB SHELL 66MM,C1776,HCPCS,,79007447,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
ZIMMER 00-8852-017-36 ELE RIM LINER 36MM,C1776,HCPCS,,79007448,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 00-8757-064-01 TRAB SHELL 64MM,C1776,HCPCS,,79007449,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
ZIMMER 00-5850-048-09 SEGMT FEM/TIB 90MM,C1776,HCPCS,,79007450,CDM,278,RC,,,both,,,10305,4067.05,39.4668,,4067.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3606.75,35,,3606.75,percent of total billed charges,Implant Device,3503.7,34,"Charges > $500, x 34%",3503.7,percent of total billed charges,Implant Device,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,4122,40,,4122,percent of total billed charges,Implant Devices,3606.75,70,,3606.75,percent of total billed charges,Implant Devices,3503.7,34,,3503.7,percent of total billed charges,Implant Devices,3503.7,34,,3503.7,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3503.7,34,"If Charge > 2,000, then 34 percent",3503.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4122,
ZIMMER 00-5850-032-46 TRAB FEM COMP 46MM,C1776,HCPCS,,79007451,CDM,278,RC,,,both,,,32319,12755.28,39.4668,,12755.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10988.46,34,,10988.46,percent of total billed charges,Implant Device,10988.46,34,,10988.46,percent of total billed charges,Implant Device,10988.46,34,,10988.46,percent of total billed charges,Implant Device,10988.46,34,,10988.46,percent of total billed charges,Implant Device,10988.46,34,,10988.46,percent of total billed charges,Implant Device,10988.46,34,,10988.46,percent of total billed charges,Implant Device,11311.65,35,,11311.65,percent of total billed charges,Implant Device,10988.46,34,"Charges > $500, x 34%",10988.46,percent of total billed charges,Implant Device,11311.65,35,,11311.65,percent of total billed charges,Implant Devices,11311.65,35,,11311.65,percent of total billed charges,Implant Devices,11311.65,35,,,percent of total billed charges,Implant Devices,11311.65,35,,11311.65,percent of total billed charges,Implant Devices,11311.65,35,,11311.65,percent of total billed charges,Implant Devices,12927.6,40,,12927.6,percent of total billed charges,Implant Devices,11311.65,70,,11311.65,percent of total billed charges,Implant Devices,10988.46,34,,10988.46,percent of total billed charges,Implant Devices,10988.46,34,,10988.46,percent of total billed charges,Implant Devices,11311.65,35,,11311.65,percent of total billed charges,Implant Devices,11311.65,35,,11311.65,percent of total billed charges,Implant Devices,11311.65,35,,11311.65,percent of total billed charges,Implant Devices,11311.65,35,,11311.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10988.46,34,"If Charge > 2,000, then 34 percent",10988.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12927.6,
ZIMMER 00-5850-046-16 SEGMENT 160MM,C1776,HCPCS,,79007453,CDM,278,RC,,,both,,,10305,4067.05,39.4668,,4067.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3503.7,34,,3503.7,percent of total billed charges,Implant Device,3606.75,35,,3606.75,percent of total billed charges,Implant Device,3503.7,34,"Charges > $500, x 34%",3503.7,percent of total billed charges,Implant Device,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,4122,40,,4122,percent of total billed charges,Implant Devices,3606.75,70,,3606.75,percent of total billed charges,Implant Devices,3503.7,34,,3503.7,percent of total billed charges,Implant Devices,3503.7,34,,3503.7,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,3606.75,35,,3606.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3503.7,34,"If Charge > 2,000, then 34 percent",3503.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4122,
DEPUY 09.402.220S COCR RADIAL HD 20X14MM,C1776,HCPCS,,79007455,CDM,278,RC,,,both,,,7443,2937.51,39.4668,,2937.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2605.05,35,,2605.05,percent of total billed charges,Implant Device,2530.62,34,"Charges > $500, x 34%",2530.62,percent of total billed charges,Implant Device,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2977.2,40,,2977.2,percent of total billed charges,Implant Devices,2605.05,70,,2605.05,percent of total billed charges,Implant Devices,2530.62,34,,2530.62,percent of total billed charges,Implant Devices,2530.62,34,,2530.62,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2530.62,34,"If Charge > 2,000, then 34 percent",2530.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2977.2,
DEPUY 04.402.007S STR RADIAL STEM 7X26MM,C1776,HCPCS,,79007456,CDM,278,RC,,,both,,,7443,2937.51,39.4668,,2937.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2530.62,34,,2530.62,percent of total billed charges,Implant Device,2605.05,35,,2605.05,percent of total billed charges,Implant Device,2530.62,34,"Charges > $500, x 34%",2530.62,percent of total billed charges,Implant Device,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2977.2,40,,2977.2,percent of total billed charges,Implant Devices,2605.05,70,,2605.05,percent of total billed charges,Implant Devices,2530.62,34,,2530.62,percent of total billed charges,Implant Devices,2530.62,34,,2530.62,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,2605.05,35,,2605.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2530.62,34,"If Charge > 2,000, then 34 percent",2530.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2977.2,
STRYKER 5630-G-510 TIBIAL INSRT SZ5 10MM,C1776,HCPCS,,79007471,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
ZIMMER 00-5990-036-01 FEM AUG BLOCK SZ F,C1776,HCPCS,,79007486,CDM,278,RC,,,both,,,3061,1208.08,39.4668,,1208.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1071.35,35,,1071.35,percent of total billed charges,Implant Device,1040.74,34,"Charges > $500, x 34%",1040.74,percent of total billed charges,Implant Device,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1224.4,40,,1224.4,percent of total billed charges,Implant Devices,1071.35,70,,1071.35,percent of total billed charges,Implant Devices,1040.74,34,,1040.74,percent of total billed charges,Implant Devices,1040.74,34,,1040.74,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1040.74,34,"If Charge > 2,000, then 34 percent",1040.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1224.4,
ZIMMER 00-5990-036-21 FEM AUG BLOCK SZ F,C1776,HCPCS,,79007487,CDM,278,RC,,,both,,,3240,1278.72,39.4668,,1278.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1101.6,34,,1101.6,percent of total billed charges,Implant Device,1134,35,,1134,percent of total billed charges,Implant Device,1101.6,34,"Charges > $500, x 34%",1101.6,percent of total billed charges,Implant Device,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1296,40,,1296,percent of total billed charges,Implant Devices,1134,70,,1134,percent of total billed charges,Implant Devices,1101.6,34,,1101.6,percent of total billed charges,Implant Devices,1101.6,34,,1101.6,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,1134,35,,1134,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1101.6,34,"If Charge > 2,000, then 34 percent",1101.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1296,
ZIMMER 00-5988-011-18 STEM EXT 18X155MM,C1776,HCPCS,,79007488,CDM,278,RC,,,both,,,3358,1325.3,39.4668,,1325.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1141.72,34,,1141.72,percent of total billed charges,Implant Device,1141.72,34,,1141.72,percent of total billed charges,Implant Device,1141.72,34,,1141.72,percent of total billed charges,Implant Device,1141.72,34,,1141.72,percent of total billed charges,Implant Device,1141.72,34,,1141.72,percent of total billed charges,Implant Device,1141.72,34,,1141.72,percent of total billed charges,Implant Device,1175.3,35,,1175.3,percent of total billed charges,Implant Device,1141.72,34,"Charges > $500, x 34%",1141.72,percent of total billed charges,Implant Device,1175.3,35,,1175.3,percent of total billed charges,Implant Devices,1175.3,35,,1175.3,percent of total billed charges,Implant Devices,1175.3,35,,,percent of total billed charges,Implant Devices,1175.3,35,,1175.3,percent of total billed charges,Implant Devices,1175.3,35,,1175.3,percent of total billed charges,Implant Devices,1343.2,40,,1343.2,percent of total billed charges,Implant Devices,1175.3,70,,1175.3,percent of total billed charges,Implant Devices,1141.72,34,,1141.72,percent of total billed charges,Implant Devices,1141.72,34,,1141.72,percent of total billed charges,Implant Devices,1175.3,35,,1175.3,percent of total billed charges,Implant Devices,1175.3,35,,1175.3,percent of total billed charges,Implant Devices,1175.3,35,,1175.3,percent of total billed charges,Implant Devices,1175.3,35,,1175.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1141.72,34,"If Charge > 2,000, then 34 percent",1141.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1343.2,
WRIGHT G4260004 SWANSON SZ 4 TOE IMPLANT,C1776,HCPCS,,79007498,CDM,278,RC,,,both,,,3966,1565.25,39.4668,,1565.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1348.44,34,,1348.44,percent of total billed charges,Implant Device,1348.44,34,,1348.44,percent of total billed charges,Implant Device,1348.44,34,,1348.44,percent of total billed charges,Implant Device,1348.44,34,,1348.44,percent of total billed charges,Implant Device,1348.44,34,,1348.44,percent of total billed charges,Implant Device,1348.44,34,,1348.44,percent of total billed charges,Implant Device,1388.1,35,,1388.1,percent of total billed charges,Implant Device,1348.44,34,"Charges > $500, x 34%",1348.44,percent of total billed charges,Implant Device,1388.1,35,,1388.1,percent of total billed charges,Implant Devices,1388.1,35,,1388.1,percent of total billed charges,Implant Devices,1388.1,35,,,percent of total billed charges,Implant Devices,1388.1,35,,1388.1,percent of total billed charges,Implant Devices,1388.1,35,,1388.1,percent of total billed charges,Implant Devices,1586.4,40,,1586.4,percent of total billed charges,Implant Devices,1388.1,70,,1388.1,percent of total billed charges,Implant Devices,1348.44,34,,1348.44,percent of total billed charges,Implant Devices,1348.44,34,,1348.44,percent of total billed charges,Implant Devices,1388.1,35,,1388.1,percent of total billed charges,Implant Devices,1388.1,35,,1388.1,percent of total billed charges,Implant Devices,1388.1,35,,1388.1,percent of total billed charges,Implant Devices,1388.1,35,,1388.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1348.44,34,"If Charge > 2,000, then 34 percent",1348.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1586.4,
STRYKER 5552-E-4821 HUMERAL HEAD 48X21MM,C1776,HCPCS,,79007512,CDM,278,RC,,,both,,,10713,4228.08,39.4668,,4228.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3642.42,34,,3642.42,percent of total billed charges,Implant Device,3642.42,34,,3642.42,percent of total billed charges,Implant Device,3642.42,34,,3642.42,percent of total billed charges,Implant Device,3642.42,34,,3642.42,percent of total billed charges,Implant Device,3642.42,34,,3642.42,percent of total billed charges,Implant Device,3642.42,34,,3642.42,percent of total billed charges,Implant Device,3749.55,35,,3749.55,percent of total billed charges,Implant Device,3642.42,34,"Charges > $500, x 34%",3642.42,percent of total billed charges,Implant Device,3749.55,35,,3749.55,percent of total billed charges,Implant Devices,3749.55,35,,3749.55,percent of total billed charges,Implant Devices,3749.55,35,,,percent of total billed charges,Implant Devices,3749.55,35,,3749.55,percent of total billed charges,Implant Devices,3749.55,35,,3749.55,percent of total billed charges,Implant Devices,4285.2,40,,4285.2,percent of total billed charges,Implant Devices,3749.55,70,,3749.55,percent of total billed charges,Implant Devices,3642.42,34,,3642.42,percent of total billed charges,Implant Devices,3642.42,34,,3642.42,percent of total billed charges,Implant Devices,3749.55,35,,3749.55,percent of total billed charges,Implant Devices,3749.55,35,,3749.55,percent of total billed charges,Implant Devices,3749.55,35,,3749.55,percent of total billed charges,Implant Devices,3749.55,35,,3749.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3642.42,34,"If Charge > 2,000, then 34 percent",3642.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4285.2,
STRYKER 5569-P-2015 HUMRAL STEM 14X133MM,C1776,HCPCS,,79007513,CDM,278,RC,,,both,,,15293,6035.66,39.4668,,6035.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5199.62,34,,5199.62,percent of total billed charges,Implant Device,5199.62,34,,5199.62,percent of total billed charges,Implant Device,5199.62,34,,5199.62,percent of total billed charges,Implant Device,5199.62,34,,5199.62,percent of total billed charges,Implant Device,5199.62,34,,5199.62,percent of total billed charges,Implant Device,5199.62,34,,5199.62,percent of total billed charges,Implant Device,5352.55,35,,5352.55,percent of total billed charges,Implant Device,5199.62,34,"Charges > $500, x 34%",5199.62,percent of total billed charges,Implant Device,5352.55,35,,5352.55,percent of total billed charges,Implant Devices,5352.55,35,,5352.55,percent of total billed charges,Implant Devices,5352.55,35,,,percent of total billed charges,Implant Devices,5352.55,35,,5352.55,percent of total billed charges,Implant Devices,5352.55,35,,5352.55,percent of total billed charges,Implant Devices,6117.2,40,,6117.2,percent of total billed charges,Implant Devices,5352.55,70,,5352.55,percent of total billed charges,Implant Devices,5199.62,34,,5199.62,percent of total billed charges,Implant Devices,5199.62,34,,5199.62,percent of total billed charges,Implant Devices,5352.55,35,,5352.55,percent of total billed charges,Implant Devices,5352.55,35,,5352.55,percent of total billed charges,Implant Devices,5352.55,35,,5352.55,percent of total billed charges,Implant Devices,5352.55,35,,5352.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5199.62,34,"If Charge > 2,000, then 34 percent",5199.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6117.2,
DEPUY 1035-47-000 BIPOLAR HEAD 28X47MM,C1776,HCPCS,,79007542,CDM,278,RC,,,both,,,1733,683.96,39.4668,,683.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Device,589.22,34,"Charges > $500, x 34%",589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,693.2,40,,693.2,percent of total billed charges,Implant Devices,606.55,70,,606.55,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,693.2,
STRYKER 6276-7-315 MOD HIP SYS 235X15MM,C1776,HCPCS,,79007561,CDM,278,RC,,,both,,,16079,6345.87,39.4668,,6345.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5466.86,34,,5466.86,percent of total billed charges,Implant Device,5627.65,35,,5627.65,percent of total billed charges,Implant Device,5466.86,34,"Charges > $500, x 34%",5466.86,percent of total billed charges,Implant Device,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,6431.6,40,,6431.6,percent of total billed charges,Implant Devices,5627.65,70,,5627.65,percent of total billed charges,Implant Devices,5466.86,34,,5466.86,percent of total billed charges,Implant Devices,5466.86,34,,5466.86,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,5627.65,35,,5627.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5466.86,34,"If Charge > 2,000, then 34 percent",5466.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6431.6,
STRYKER UH1-51-26 BIPOLAR COMP 51X26MM,C1776,HCPCS,,79007562,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
WRIGHT 4700001 FINGER JOINT IMPLANT SZ 1,C1776,HCPCS,,79007582,CDM,278,RC,,,both,,,4140,1633.93,39.4668,,1633.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1449,35,,1449,percent of total billed charges,Implant Device,1407.6,34,"Charges > $500, x 34%",1407.6,percent of total billed charges,Implant Device,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1656,40,,1656,percent of total billed charges,Implant Devices,1449,70,,1449,percent of total billed charges,Implant Devices,1407.6,34,,1407.6,percent of total billed charges,Implant Devices,1407.6,34,,1407.6,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1407.6,34,"If Charge > 2,000, then 34 percent",1407.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1656,
ZIMMER 8018-028-05 COCR FEM HEAD 28+10.5,C1776,HCPCS,,79007602,CDM,278,RC,,,both,,,2543,1003.64,39.4668,,1003.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Device,864.62,34,"Charges > $500, x 34%",864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,1017.2,40,,1017.2,percent of total billed charges,Implant Devices,890.05,70,,890.05,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,864.62,34,"If Charge > 2,000, then 34 percent",864.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1017.2,
STRYKER 5630-G-309 TIB INSERT SZ 3 9MM,C1776,HCPCS,,79007616,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
STRYKER 5542-P-0040 TSA GLENOID SZ 40,C1776,HCPCS,,79007651,CDM,278,RC,,,both,,,3675,1450.4,39.4668,,1450.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Device,1249.5,34,"Charges > $500, x 34%",1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1470,40,,1470,percent of total billed charges,Implant Devices,1286.25,70,,1286.25,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.5,34,"If Charge > 2,000, then 34 percent",1249.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470,
STRYKER 5552-E-4419 HUMERAL HEAD 44X19MM,C1776,HCPCS,,79007652,CDM,278,RC,,,both,,,5355,2113.45,39.4668,,2113.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1820.7,34,,1820.7,percent of total billed charges,Implant Device,1820.7,34,,1820.7,percent of total billed charges,Implant Device,1820.7,34,,1820.7,percent of total billed charges,Implant Device,1820.7,34,,1820.7,percent of total billed charges,Implant Device,1820.7,34,,1820.7,percent of total billed charges,Implant Device,1820.7,34,,1820.7,percent of total billed charges,Implant Device,1874.25,35,,1874.25,percent of total billed charges,Implant Device,1820.7,34,"Charges > $500, x 34%",1820.7,percent of total billed charges,Implant Device,1874.25,35,,1874.25,percent of total billed charges,Implant Devices,1874.25,35,,1874.25,percent of total billed charges,Implant Devices,1874.25,35,,,percent of total billed charges,Implant Devices,1874.25,35,,1874.25,percent of total billed charges,Implant Devices,1874.25,35,,1874.25,percent of total billed charges,Implant Devices,2142,40,,2142,percent of total billed charges,Implant Devices,1874.25,70,,1874.25,percent of total billed charges,Implant Devices,1820.7,34,,1820.7,percent of total billed charges,Implant Devices,1820.7,34,,1820.7,percent of total billed charges,Implant Devices,1874.25,35,,1874.25,percent of total billed charges,Implant Devices,1874.25,35,,1874.25,percent of total billed charges,Implant Devices,1874.25,35,,1874.25,percent of total billed charges,Implant Devices,1874.25,35,,1874.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1820.7,34,"If Charge > 2,000, then 34 percent",1820.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2142,
STRYKER 5569-P-2012 HUMERAL STEM 12X128,C1776,HCPCS,,79007653,CDM,278,RC,,,both,,,22716,8965.28,39.4668,,8965.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7723.44,34,,7723.44,percent of total billed charges,Implant Device,7723.44,34,,7723.44,percent of total billed charges,Implant Device,7723.44,34,,7723.44,percent of total billed charges,Implant Device,7723.44,34,,7723.44,percent of total billed charges,Implant Device,7723.44,34,,7723.44,percent of total billed charges,Implant Device,7723.44,34,,7723.44,percent of total billed charges,Implant Device,7950.6,35,,7950.6,percent of total billed charges,Implant Device,7723.44,34,"Charges > $500, x 34%",7723.44,percent of total billed charges,Implant Device,7950.6,35,,7950.6,percent of total billed charges,Implant Devices,7950.6,35,,7950.6,percent of total billed charges,Implant Devices,7950.6,35,,,percent of total billed charges,Implant Devices,7950.6,35,,7950.6,percent of total billed charges,Implant Devices,7950.6,35,,7950.6,percent of total billed charges,Implant Devices,9086.4,40,,9086.4,percent of total billed charges,Implant Devices,7950.6,70,,7950.6,percent of total billed charges,Implant Devices,7723.44,34,,7723.44,percent of total billed charges,Implant Devices,7723.44,34,,7723.44,percent of total billed charges,Implant Devices,7950.6,35,,7950.6,percent of total billed charges,Implant Devices,7950.6,35,,7950.6,percent of total billed charges,Implant Devices,7950.6,35,,7950.6,percent of total billed charges,Implant Devices,7950.6,35,,7950.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7723.44,34,"If Charge > 2,000, then 34 percent",7723.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9086.4,
ZIMMER 00-5952-030-12 ARTICULR SURF 12MM,C1776,HCPCS,,79007659,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
STRYKER 6276-7-214 MOD HIP SYSTEM 195X14,C1776,HCPCS,,79007665,CDM,278,RC,,,both,,,15277,6029.34,39.4668,,6029.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5194.18,34,,5194.18,percent of total billed charges,Implant Device,5346.95,35,,5346.95,percent of total billed charges,Implant Device,5194.18,34,"Charges > $500, x 34%",5194.18,percent of total billed charges,Implant Device,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,6110.8,40,,6110.8,percent of total billed charges,Implant Devices,5346.95,70,,5346.95,percent of total billed charges,Implant Devices,5194.18,34,,5194.18,percent of total billed charges,Implant Devices,5194.18,34,,5194.18,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,5346.95,35,,5346.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5194.18,34,"If Charge > 2,000, then 34 percent",5194.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6110.8,
DEPUY 1516-30-407 ROTATING PLATFORM SZ 4,C1776,HCPCS,,79007676,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
STRYKER 5630-G-509 TIBIAL INS SZ 5 9MM,C1776,HCPCS,,79007680,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
ZIMMER 00-5994-040-12 ARTSURF GREEN 12MM,C1776,HCPCS,,79007696,CDM,278,RC,,,both,,,6257,2469.44,39.4668,,2469.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Device,2127.38,34,"Charges > $500, x 34%",2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2502.8,40,,2502.8,percent of total billed charges,Implant Devices,2189.95,70,,2189.95,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2127.38,34,"If Charge > 2,000, then 34 percent",2127.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2502.8,
WRIGHT MEDICAL MD102 MDI IMPLANT SIZE 2,C1776,HCPCS,,79007704,CDM,278,RC,,,both,,,14817,5847.8,39.4668,,5847.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5037.78,34,,5037.78,percent of total billed charges,Implant Device,5037.78,34,,5037.78,percent of total billed charges,Implant Device,5037.78,34,,5037.78,percent of total billed charges,Implant Device,5037.78,34,,5037.78,percent of total billed charges,Implant Device,5037.78,34,,5037.78,percent of total billed charges,Implant Device,5037.78,34,,5037.78,percent of total billed charges,Implant Device,5185.95,35,,5185.95,percent of total billed charges,Implant Device,5037.78,34,"Charges > $500, x 34%",5037.78,percent of total billed charges,Implant Device,5185.95,35,,5185.95,percent of total billed charges,Implant Devices,5185.95,35,,5185.95,percent of total billed charges,Implant Devices,5185.95,35,,,percent of total billed charges,Implant Devices,5185.95,35,,5185.95,percent of total billed charges,Implant Devices,5185.95,35,,5185.95,percent of total billed charges,Implant Devices,5926.8,40,,5926.8,percent of total billed charges,Implant Devices,5185.95,70,,5185.95,percent of total billed charges,Implant Devices,5037.78,34,,5037.78,percent of total billed charges,Implant Devices,5037.78,34,,5037.78,percent of total billed charges,Implant Devices,5185.95,35,,5185.95,percent of total billed charges,Implant Devices,5185.95,35,,5185.95,percent of total billed charges,Implant Devices,5185.95,35,,5185.95,percent of total billed charges,Implant Devices,5185.95,35,,5185.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5037.78,34,"If Charge > 2,000, then 34 percent",5037.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5926.8,
DEPUY 1570-01-100 FEM STEM 12/14 TAPER,C1776,HCPCS,,79007705,CDM,278,RC,,,both,,,11331,4471.98,39.4668,,4471.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3852.54,34,,3852.54,percent of total billed charges,Implant Device,3852.54,34,,3852.54,percent of total billed charges,Implant Device,3852.54,34,,3852.54,percent of total billed charges,Implant Device,3852.54,34,,3852.54,percent of total billed charges,Implant Device,3852.54,34,,3852.54,percent of total billed charges,Implant Device,3852.54,34,,3852.54,percent of total billed charges,Implant Device,3965.85,35,,3965.85,percent of total billed charges,Implant Device,3852.54,34,"Charges > $500, x 34%",3852.54,percent of total billed charges,Implant Device,3965.85,35,,3965.85,percent of total billed charges,Implant Devices,3965.85,35,,3965.85,percent of total billed charges,Implant Devices,3965.85,35,,,percent of total billed charges,Implant Devices,3965.85,35,,3965.85,percent of total billed charges,Implant Devices,3965.85,35,,3965.85,percent of total billed charges,Implant Devices,4532.4,40,,4532.4,percent of total billed charges,Implant Devices,3965.85,70,,3965.85,percent of total billed charges,Implant Devices,3852.54,34,,3852.54,percent of total billed charges,Implant Devices,3852.54,34,,3852.54,percent of total billed charges,Implant Devices,3965.85,35,,3965.85,percent of total billed charges,Implant Devices,3965.85,35,,3965.85,percent of total billed charges,Implant Devices,3965.85,35,,3965.85,percent of total billed charges,Implant Devices,3965.85,35,,3965.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3852.54,34,"If Charge > 2,000, then 34 percent",3852.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4532.4,
SMITH & NEPHEW TOTAL KNEE NARROW CAP,C1776,HCPCS,,79007722,CDM,278,RC,,,both,,,17700,6985.62,39.4668,,6985.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6018,34,,6018,percent of total billed charges,Implant Device,6018,34,,6018,percent of total billed charges,Implant Device,6018,34,,6018,percent of total billed charges,Implant Device,6018,34,,6018,percent of total billed charges,Implant Device,6018,34,,6018,percent of total billed charges,Implant Device,6018,34,,6018,percent of total billed charges,Implant Device,6195,35,,6195,percent of total billed charges,Implant Device,6018,34,"Charges > $500, x 34%",6018,percent of total billed charges,Implant Device,6195,35,,6195,percent of total billed charges,Implant Devices,6195,35,,6195,percent of total billed charges,Implant Devices,6195,35,,,percent of total billed charges,Implant Devices,6195,35,,6195,percent of total billed charges,Implant Devices,6195,35,,6195,percent of total billed charges,Implant Devices,7080,40,,7080,percent of total billed charges,Implant Devices,6195,70,,6195,percent of total billed charges,Implant Devices,6018,34,,6018,percent of total billed charges,Implant Devices,6018,34,,6018,percent of total billed charges,Implant Devices,6195,35,,6195,percent of total billed charges,Implant Devices,6195,35,,6195,percent of total billed charges,Implant Devices,6195,35,,6195,percent of total billed charges,Implant Devices,6195,35,,6195,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6018,34,"If Charge > 2,000, then 34 percent",6018,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7080,
ZIMMER 00-8852-014-36 RIM LINER 36X60MM,C1776,HCPCS,,79007735,CDM,278,RC,,,both,,,4403,1737.72,39.4668,,1737.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Device,1497.02,34,"Charges > $500, x 34%",1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1761.2,40,,1761.2,percent of total billed charges,Implant Devices,1541.05,70,,1541.05,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.02,34,"If Charge > 2,000, then 34 percent",1497.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.2,
S&N 71453214 ARTICULAR INSRT SZ 3-4 15MM,C1776,HCPCS,,79007773,CDM,278,RC,,,both,,,5212,2057.01,39.4668,,2057.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Device,1772.08,34,"Charges > $500, x 34%",1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,2084.8,40,,2084.8,percent of total billed charges,Implant Devices,1824.2,70,,1824.2,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1772.08,34,"If Charge > 2,000, then 34 percent",1772.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2084.8,
ZIMMER 00-5994-050-12 ART SURF 7-10 12MM,C1776,HCPCS,,79007780,CDM,278,RC,,,both,,,6773,2673.09,39.4668,,2673.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2302.82,34,,2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Device,2302.82,34,"Charges > $500, x 34%",2302.82,percent of total billed charges,Implant Device,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2709.2,40,,2709.2,percent of total billed charges,Implant Devices,2370.55,70,,2370.55,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2302.82,34,,2302.82,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,2370.55,35,,2370.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2302.82,34,"If Charge > 2,000, then 34 percent",2302.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2709.2,
ZIMMER 00-8851-011-36 NEUTRAL LINR 36X54,C1776,HCPCS,,79007792,CDM,278,RC,,,both,,,4403,1737.72,39.4668,,1737.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Device,1497.02,34,"Charges > $500, x 34%",1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1761.2,40,,1761.2,percent of total billed charges,Implant Devices,1541.05,70,,1541.05,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.02,34,"If Charge > 2,000, then 34 percent",1497.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.2,
DEPUY 86-6402 MODULAR STEM 13X60MM,C1776,HCPCS,,79007804,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
DEPUY 96-0081 FEMORAL CEMENTED LEFT SZ 2,C1776,HCPCS,,79007805,CDM,278,RC,,,both,,,23138,9131.83,39.4668,,9131.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7866.92,34,,7866.92,percent of total billed charges,Implant Device,7866.92,34,,7866.92,percent of total billed charges,Implant Device,7866.92,34,,7866.92,percent of total billed charges,Implant Device,7866.92,34,,7866.92,percent of total billed charges,Implant Device,7866.92,34,,7866.92,percent of total billed charges,Implant Device,7866.92,34,,7866.92,percent of total billed charges,Implant Device,8098.3,35,,8098.3,percent of total billed charges,Implant Device,7866.92,34,"Charges > $500, x 34%",7866.92,percent of total billed charges,Implant Device,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,9255.2,40,,9255.2,percent of total billed charges,Implant Devices,8098.3,70,,8098.3,percent of total billed charges,Implant Devices,7866.92,34,,7866.92,percent of total billed charges,Implant Devices,7866.92,34,,7866.92,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7866.92,34,"If Charge > 2,000, then 34 percent",7866.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9255.2,
DEPUY 96-0820 DISTAL AUGMENT SZ 2 4MM LT,C1776,HCPCS,,79007806,CDM,278,RC,,,both,,,3929,1550.65,39.4668,,1550.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1375.15,35,,1375.15,percent of total billed charges,Implant Device,1335.86,34,"Charges > $500, x 34%",1335.86,percent of total billed charges,Implant Device,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1571.6,40,,1571.6,percent of total billed charges,Implant Devices,1375.15,70,,1375.15,percent of total billed charges,Implant Devices,1335.86,34,,1335.86,percent of total billed charges,Implant Devices,1335.86,34,,1335.86,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1335.86,34,"If Charge > 2,000, then 34 percent",1335.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1571.6,
DEPUY 96-2325 TIBIAL INSERT SZ 2 20MM,C1776,HCPCS,,79007807,CDM,278,RC,,,both,,,10896,4300.3,39.4668,,4300.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3813.6,35,,3813.6,percent of total billed charges,Implant Device,3704.64,34,"Charges > $500, x 34%",3704.64,percent of total billed charges,Implant Device,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,4358.4,40,,4358.4,percent of total billed charges,Implant Devices,3813.6,70,,3813.6,percent of total billed charges,Implant Devices,3704.64,34,,3704.64,percent of total billed charges,Implant Devices,3704.64,34,,3704.64,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3704.64,34,"If Charge > 2,000, then 34 percent",3704.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4358.4,
STRYKER 5569-P-2011 HUMERAL STEM SZ 11,C1776,HCPCS,,79007843,CDM,278,RC,,,both,,,10500,4144.01,39.4668,,4144.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Device,3570,34,"Charges > $500, x 34%",3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,4200,40,,4200,percent of total billed charges,Implant Devices,3675,70,,3675,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3570,34,"If Charge > 2,000, then 34 percent",3570,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4200,
DEPUY 1035-57-000 SELF CNT HIP 57X28MM,C1776,HCPCS,,79007852,CDM,278,RC,,,both,,,4030,1590.51,39.4668,,1590.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Device,1370.2,34,"Charges > $500, x 34%",1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1612,40,,1612,percent of total billed charges,Implant Devices,1410.5,70,,1410.5,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1370.2,34,"If Charge > 2,000, then 34 percent",1370.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1612,
DEPUY 3L92505 CORAIL FEMORAL STEM SZ 15,C1776,HCPCS,,79007853,CDM,278,RC,,,both,,,13446,5306.71,39.4668,,5306.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Device,4571.64,34,"Charges > $500, x 34%",4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,5378.4,40,,5378.4,percent of total billed charges,Implant Devices,4706.1,70,,4706.1,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4571.64,34,"If Charge > 2,000, then 34 percent",4571.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5378.4,
STRYKER 5630-G-429 TIBIAL INSRT SZ 4X9MM,C1776,HCPCS,,79007854,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
DEPUY 3L92502 FEMORAL STEM STD SZ 12,C1776,HCPCS,,79007906,CDM,278,RC,,,both,,,13446,5306.71,39.4668,,5306.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Device,4571.64,34,"Charges > $500, x 34%",4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,5378.4,40,,5378.4,percent of total billed charges,Implant Devices,4706.1,70,,4706.1,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4571.64,34,"If Charge > 2,000, then 34 percent",4571.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5378.4,
S&N 71424004 TIBIAL BASEPLATE SZ 4 LEFT,C1776,HCPCS,,79007912,CDM,278,RC,,,both,,,9954,3928.53,39.4668,,3928.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3384.36,34,,3384.36,percent of total billed charges,Implant Device,3384.36,34,,3384.36,percent of total billed charges,Implant Device,3384.36,34,,3384.36,percent of total billed charges,Implant Device,3384.36,34,,3384.36,percent of total billed charges,Implant Device,3384.36,34,,3384.36,percent of total billed charges,Implant Device,3384.36,34,,3384.36,percent of total billed charges,Implant Device,3483.9,35,,3483.9,percent of total billed charges,Implant Device,3384.36,34,"Charges > $500, x 34%",3384.36,percent of total billed charges,Implant Device,3483.9,35,,3483.9,percent of total billed charges,Implant Devices,3483.9,35,,3483.9,percent of total billed charges,Implant Devices,3483.9,35,,,percent of total billed charges,Implant Devices,3483.9,35,,3483.9,percent of total billed charges,Implant Devices,3483.9,35,,3483.9,percent of total billed charges,Implant Devices,3981.6,40,,3981.6,percent of total billed charges,Implant Devices,3483.9,70,,3483.9,percent of total billed charges,Implant Devices,3384.36,34,,3384.36,percent of total billed charges,Implant Devices,3384.36,34,,3384.36,percent of total billed charges,Implant Devices,3483.9,35,,3483.9,percent of total billed charges,Implant Devices,3483.9,35,,3483.9,percent of total billed charges,Implant Devices,3483.9,35,,3483.9,percent of total billed charges,Implant Devices,3483.9,35,,3483.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3384.36,34,"If Charge > 2,000, then 34 percent",3384.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3981.6,
S&N 71424225 OFFSET COUPLER 4MM,C1776,HCPCS,,79007913,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
ZIMMER 00-8851-015-36 NEUTRAL LINER 36MM,C1776,HCPCS,,79007960,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 0-8018-028-03 FEMORAL HD 3.5X28,C1776,HCPCS,,79007961,CDM,278,RC,,,both,,,2543,1003.64,39.4668,,1003.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,864.62,34,,864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Device,864.62,34,"Charges > $500, x 34%",864.62,percent of total billed charges,Implant Device,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,1017.2,40,,1017.2,percent of total billed charges,Implant Devices,890.05,70,,890.05,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,864.62,34,,864.62,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,890.05,35,,890.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,864.62,34,"If Charge > 2,000, then 34 percent",864.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1017.2,
ARTHROSURFACE 8H02-5248 ART COMP 52X48MM,C1776,HCPCS,,79007970,CDM,278,RC,,,both,,,17436,6881.43,39.4668,,6881.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5928.24,34,,5928.24,percent of total billed charges,Implant Device,5928.24,34,,5928.24,percent of total billed charges,Implant Device,5928.24,34,,5928.24,percent of total billed charges,Implant Device,5928.24,34,,5928.24,percent of total billed charges,Implant Device,5928.24,34,,5928.24,percent of total billed charges,Implant Device,5928.24,34,,5928.24,percent of total billed charges,Implant Device,6102.6,35,,6102.6,percent of total billed charges,Implant Device,5928.24,34,"Charges > $500, x 34%",5928.24,percent of total billed charges,Implant Device,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6974.4,40,,6974.4,percent of total billed charges,Implant Devices,6102.6,70,,6102.6,percent of total billed charges,Implant Devices,5928.24,34,,5928.24,percent of total billed charges,Implant Devices,5928.24,34,,5928.24,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,6102.6,35,,6102.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5928.24,34,"If Charge > 2,000, then 34 percent",5928.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6974.4,
ZIMMER 00-5880-050-12 ART SURF SZ 3 12MM,C1776,HCPCS,,79008017,CDM,278,RC,,,both,,,5765,2275.26,39.4668,,2275.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,2017.75,35,,2017.75,percent of total billed charges,Implant Device,1960.1,34,"Charges > $500, x 34%",1960.1,percent of total billed charges,Implant Device,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2306,40,,2306,percent of total billed charges,Implant Devices,2017.75,70,,2017.75,percent of total billed charges,Implant Devices,1960.1,34,,1960.1,percent of total billed charges,Implant Devices,1960.1,34,,1960.1,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1960.1,34,"If Charge > 2,000, then 34 percent",1960.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2306,
EXACTECH 320-42-10 HUMERAL LINER 42X+0MM,C1776,HCPCS,,79008020,CDM,278,RC,,,both,,,2835,1118.88,39.4668,,1118.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,992.25,35,,992.25,percent of total billed charges,Implant Device,963.9,34,"Charges > $500, x 34%",963.9,percent of total billed charges,Implant Device,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,1134,40,,1134,percent of total billed charges,Implant Devices,992.25,70,,992.25,percent of total billed charges,Implant Devices,963.9,34,,963.9,percent of total billed charges,Implant Devices,963.9,34,,963.9,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,963.9,34,"If Charge > 2,000, then 34 percent",963.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1134,
DEPUY 3L93710 CORAIL FEMORAL STEM SZ10,C1776,HCPCS,,79008036,CDM,278,RC,,,both,,,12861,5075.83,39.4668,,5075.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4372.74,34,,4372.74,percent of total billed charges,Implant Device,4501.35,35,,4501.35,percent of total billed charges,Implant Device,4372.74,34,"Charges > $500, x 34%",4372.74,percent of total billed charges,Implant Device,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,5144.4,40,,5144.4,percent of total billed charges,Implant Devices,4501.35,70,,4501.35,percent of total billed charges,Implant Devices,4372.74,34,,4372.74,percent of total billed charges,Implant Devices,4372.74,34,,4372.74,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,4501.35,35,,4501.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4372.74,34,"If Charge > 2,000, then 34 percent",4372.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5144.4,
ZIMMER 00-5990-035-24 FEM AUG BLOCK E 20,C1776,HCPCS,,79008062,CDM,278,RC,,,both,,,3488,1376.6,39.4668,,1376.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1220.8,35,,1220.8,percent of total billed charges,Implant Device,1185.92,34,"Charges > $500, x 34%",1185.92,percent of total billed charges,Implant Device,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1395.2,40,,1395.2,percent of total billed charges,Implant Devices,1220.8,70,,1220.8,percent of total billed charges,Implant Devices,1185.92,34,,1185.92,percent of total billed charges,Implant Devices,1185.92,34,,1185.92,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1185.92,34,"If Charge > 2,000, then 34 percent",1185.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1395.2,
DEPUY 1365-36-320 FEMORAL HEAD 36MM,C1776,HCPCS,,79008075,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
ACUMED TR-S0804-S STEM 8.0X4.0MM,C1776,HCPCS,,79008079,CDM,278,RC,,,both,,,6069,2395.24,39.4668,,2395.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2124.15,35,,2124.15,percent of total billed charges,Implant Device,2063.46,34,"Charges > $500, x 34%",2063.46,percent of total billed charges,Implant Device,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2427.6,40,,2427.6,percent of total billed charges,Implant Devices,2124.15,70,,2124.15,percent of total billed charges,Implant Devices,2063.46,34,,2063.46,percent of total billed charges,Implant Devices,2063.46,34,,2063.46,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2063.46,34,"If Charge > 2,000, then 34 percent",2063.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2427.6,
ACUMED TR-H220L-S RADIAL HEAD 22MM LEFT,C1776,HCPCS,,79008080,CDM,278,RC,,,both,,,9966,3933.26,39.4668,,3933.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3388.44,34,,3388.44,percent of total billed charges,Implant Device,3388.44,34,,3388.44,percent of total billed charges,Implant Device,3388.44,34,,3388.44,percent of total billed charges,Implant Device,3388.44,34,,3388.44,percent of total billed charges,Implant Device,3388.44,34,,3388.44,percent of total billed charges,Implant Device,3388.44,34,,3388.44,percent of total billed charges,Implant Device,3488.1,35,,3488.1,percent of total billed charges,Implant Device,3388.44,34,"Charges > $500, x 34%",3388.44,percent of total billed charges,Implant Device,3488.1,35,,3488.1,percent of total billed charges,Implant Devices,3488.1,35,,3488.1,percent of total billed charges,Implant Devices,3488.1,35,,,percent of total billed charges,Implant Devices,3488.1,35,,3488.1,percent of total billed charges,Implant Devices,3488.1,35,,3488.1,percent of total billed charges,Implant Devices,3986.4,40,,3986.4,percent of total billed charges,Implant Devices,3488.1,70,,3488.1,percent of total billed charges,Implant Devices,3388.44,34,,3388.44,percent of total billed charges,Implant Devices,3388.44,34,,3388.44,percent of total billed charges,Implant Devices,3488.1,35,,3488.1,percent of total billed charges,Implant Devices,3488.1,35,,3488.1,percent of total billed charges,Implant Devices,3488.1,35,,3488.1,percent of total billed charges,Implant Devices,3488.1,35,,3488.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3388.44,34,"If Charge > 2,000, then 34 percent",3388.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3986.4,
DEPUY 1376-22-000 STEM CENTRALIZER 13MM,C1776,HCPCS,,79008108,CDM,278,RC,,,both,,,305,120.37,39.4668,,120.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,103.7,34,,103.7,percent of total billed charges,Implant Device,106.75,35,,106.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,122,40,,122,percent of total billed charges,Implant Devices,106.75,70,,106.75,percent of total billed charges,Implant Devices,103.7,34,,103.7,percent of total billed charges,Implant Devices,103.7,34,,103.7,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,106.75,35,,106.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,122,
DEPUY 1570-06-135 FEMORAL STEM S7 133MM,C1776,HCPCS,,79008109,CDM,278,RC,,,both,,,5575,2200.27,39.4668,,2200.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1951.25,35,,1951.25,percent of total billed charges,Implant Device,1895.5,34,"Charges > $500, x 34%",1895.5,percent of total billed charges,Implant Device,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,2230,40,,2230,percent of total billed charges,Implant Devices,1951.25,70,,1951.25,percent of total billed charges,Implant Devices,1895.5,34,,1895.5,percent of total billed charges,Implant Devices,1895.5,34,,1895.5,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1895.5,34,"If Charge > 2,000, then 34 percent",1895.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2230,
STRYKER ST0A-15P SMART TOE 15MM ANGLED,C1776,HCPCS,,79008110,CDM,278,RC,,,both,,,4395,1734.57,39.4668,,1734.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1494.3,34,,1494.3,percent of total billed charges,Implant Device,1494.3,34,,1494.3,percent of total billed charges,Implant Device,1494.3,34,,1494.3,percent of total billed charges,Implant Device,1494.3,34,,1494.3,percent of total billed charges,Implant Device,1494.3,34,,1494.3,percent of total billed charges,Implant Device,1494.3,34,,1494.3,percent of total billed charges,Implant Device,1538.25,35,,1538.25,percent of total billed charges,Implant Device,1494.3,34,"Charges > $500, x 34%",1494.3,percent of total billed charges,Implant Device,1538.25,35,,1538.25,percent of total billed charges,Implant Devices,1538.25,35,,1538.25,percent of total billed charges,Implant Devices,1538.25,35,,,percent of total billed charges,Implant Devices,1538.25,35,,1538.25,percent of total billed charges,Implant Devices,1538.25,35,,1538.25,percent of total billed charges,Implant Devices,1758,40,,1758,percent of total billed charges,Implant Devices,1538.25,70,,1538.25,percent of total billed charges,Implant Devices,1494.3,34,,1494.3,percent of total billed charges,Implant Devices,1494.3,34,,1494.3,percent of total billed charges,Implant Devices,1538.25,35,,1538.25,percent of total billed charges,Implant Devices,1538.25,35,,1538.25,percent of total billed charges,Implant Devices,1538.25,35,,1538.25,percent of total billed charges,Implant Devices,1538.25,35,,1538.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1494.3,34,"If Charge > 2,000, then 34 percent",1494.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1758,
S&N 71204532 ARTICULAR INSERT XLG 8MM,C1776,HCPCS,,79008119,CDM,278,RC,,,both,,,6270,2474.57,39.4668,,2474.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2131.8,34,,2131.8,percent of total billed charges,Implant Device,2194.5,35,,2194.5,percent of total billed charges,Implant Device,2131.8,34,"Charges > $500, x 34%",2131.8,percent of total billed charges,Implant Device,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2508,40,,2508,percent of total billed charges,Implant Devices,2194.5,70,,2194.5,percent of total billed charges,Implant Devices,2131.8,34,,2131.8,percent of total billed charges,Implant Devices,2131.8,34,,2131.8,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,2194.5,35,,2194.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2131.8,34,"If Charge > 2,000, then 34 percent",2131.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2508,
DEPUY 1506-10-005 ATTUNE TIBIAL BASE SZ5,C1776,HCPCS,,79008120,CDM,278,RC,,,both,,,6675,2634.41,39.4668,,2634.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2269.5,34,,2269.5,percent of total billed charges,Implant Device,2269.5,34,,2269.5,percent of total billed charges,Implant Device,2269.5,34,,2269.5,percent of total billed charges,Implant Device,2269.5,34,,2269.5,percent of total billed charges,Implant Device,2269.5,34,,2269.5,percent of total billed charges,Implant Device,2269.5,34,,2269.5,percent of total billed charges,Implant Device,2336.25,35,,2336.25,percent of total billed charges,Implant Device,2269.5,34,"Charges > $500, x 34%",2269.5,percent of total billed charges,Implant Device,2336.25,35,,2336.25,percent of total billed charges,Implant Devices,2336.25,35,,2336.25,percent of total billed charges,Implant Devices,2336.25,35,,,percent of total billed charges,Implant Devices,2336.25,35,,2336.25,percent of total billed charges,Implant Devices,2336.25,35,,2336.25,percent of total billed charges,Implant Devices,2670,40,,2670,percent of total billed charges,Implant Devices,2336.25,70,,2336.25,percent of total billed charges,Implant Devices,2269.5,34,,2269.5,percent of total billed charges,Implant Devices,2269.5,34,,2269.5,percent of total billed charges,Implant Devices,2336.25,35,,2336.25,percent of total billed charges,Implant Devices,2336.25,35,,2336.25,percent of total billed charges,Implant Devices,2336.25,35,,2336.25,percent of total billed charges,Implant Devices,2336.25,35,,2336.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2269.5,34,"If Charge > 2,000, then 34 percent",2269.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2670,
DEPUY 1516-30-610 ATTUNE TIBIAL INS SZ6,C1776,HCPCS,,79008121,CDM,278,RC,,,both,,,5250,2072.01,39.4668,,2072.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Device,1785,34,"Charges > $500, x 34%",1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,2100,40,,2100,percent of total billed charges,Implant Devices,1837.5,70,,1837.5,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1785,34,"If Charge > 2,000, then 34 percent",1785,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2100,
STRYKER ST0-15P SMART TOE 15MM,C1776,HCPCS,,79008126,CDM,278,RC,,,both,,,4704,1856.52,39.4668,,1856.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1599.36,34,,1599.36,percent of total billed charges,Implant Device,1599.36,34,,1599.36,percent of total billed charges,Implant Device,1599.36,34,,1599.36,percent of total billed charges,Implant Device,1599.36,34,,1599.36,percent of total billed charges,Implant Device,1599.36,34,,1599.36,percent of total billed charges,Implant Device,1599.36,34,,1599.36,percent of total billed charges,Implant Device,1646.4,35,,1646.4,percent of total billed charges,Implant Device,1599.36,34,"Charges > $500, x 34%",1599.36,percent of total billed charges,Implant Device,1646.4,35,,1646.4,percent of total billed charges,Implant Devices,1646.4,35,,1646.4,percent of total billed charges,Implant Devices,1646.4,35,,,percent of total billed charges,Implant Devices,1646.4,35,,1646.4,percent of total billed charges,Implant Devices,1646.4,35,,1646.4,percent of total billed charges,Implant Devices,1881.6,40,,1881.6,percent of total billed charges,Implant Devices,1646.4,70,,1646.4,percent of total billed charges,Implant Devices,1599.36,34,,1599.36,percent of total billed charges,Implant Devices,1599.36,34,,1599.36,percent of total billed charges,Implant Devices,1646.4,35,,1646.4,percent of total billed charges,Implant Devices,1646.4,35,,1646.4,percent of total billed charges,Implant Devices,1646.4,35,,1646.4,percent of total billed charges,Implant Devices,1646.4,35,,1646.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1599.36,34,"If Charge > 2,000, then 34 percent",1599.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1881.6,
ZIMMER 431184 60MM HEAD HIP MOLD W/INS,C1776,HCPCS,,79008128,CDM,278,RC,,,both,,,5250,2072.01,39.4668,,2072.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Device,1785,34,"Charges > $500, x 34%",1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,2100,40,,2100,percent of total billed charges,Implant Devices,1837.5,70,,1837.5,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1785,34,"If Charge > 2,000, then 34 percent",1785,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2100,
ZIMMER 431187 HIP NECK LENGTH ADPTR +6MM,C1776,HCPCS,,79008129,CDM,278,RC,,,both,,,1320,520.96,39.4668,,520.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,448.8,34,,448.8,percent of total billed charges,Implant Device,462,35,,462,percent of total billed charges,Implant Device,448.8,34,"Charges > $500, x 34%",448.8,percent of total billed charges,Implant Device,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,528,40,,528,percent of total billed charges,Implant Devices,462,70,,462,percent of total billed charges,Implant Devices,448.8,34,,448.8,percent of total billed charges,Implant Devices,448.8,34,,448.8,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,462,35,,462,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,528,
ZIMMER 431194 HIP MOLD STEM 17X165,C1776,HCPCS,,79008130,CDM,278,RC,,,both,,,6570,2592.97,39.4668,,2592.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2233.8,34,,2233.8,percent of total billed charges,Implant Device,2299.5,35,,2299.5,percent of total billed charges,Implant Device,2233.8,34,"Charges > $500, x 34%",2233.8,percent of total billed charges,Implant Device,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2628,40,,2628,percent of total billed charges,Implant Devices,2299.5,70,,2299.5,percent of total billed charges,Implant Devices,2233.8,34,,2233.8,percent of total billed charges,Implant Devices,2233.8,34,,2233.8,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,2299.5,35,,2299.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2233.8,34,"If Charge > 2,000, then 34 percent",2233.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2628,
BIOMET 11-300917 ARCOS 17X190MM SPL TPR,C1776,HCPCS,,79008131,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
BIOMET 11-301332 ARCOS CPMS SZ B HI 70MM,C1776,HCPCS,,79008132,CDM,278,RC,,,both,,,19784,7808.11,39.4668,,7808.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Device,6726.56,34,"Charges > $500, x 34%",6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,7913.6,40,,7913.6,percent of total billed charges,Implant Devices,6924.4,70,,6924.4,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6726.56,34,"If Charge > 2,000, then 34 percent",6726.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7913.6,
BIOMET 163638 28MM COCR MOD HEAD +6MM,C1776,HCPCS,,79008133,CDM,278,RC,,,both,,,4830,1906.25,39.4668,,1906.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1642.2,34,,1642.2,percent of total billed charges,Implant Device,1690.5,35,,1690.5,percent of total billed charges,Implant Device,1642.2,34,"Charges > $500, x 34%",1642.2,percent of total billed charges,Implant Device,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1932,40,,1932,percent of total billed charges,Implant Devices,1690.5,70,,1690.5,percent of total billed charges,Implant Devices,1642.2,34,,1642.2,percent of total billed charges,Implant Devices,1642.2,34,,1642.2,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,1690.5,35,,1690.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1642.2,34,"If Charge > 2,000, then 34 percent",1642.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1932,
BIOMET 11-300916 ARCOS STS STEM 16X190MM,C1776,HCPCS,,79008135,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
BIOMET 11-301302 ARCOS STAND CONE SZB 60,C1776,HCPCS,,79008136,CDM,278,RC,,,both,,,19784,7808.11,39.4668,,7808.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Device,6726.56,34,"Charges > $500, x 34%",6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,7913.6,40,,7913.6,percent of total billed charges,Implant Devices,6924.4,70,,6924.4,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6726.56,34,"If Charge > 2,000, then 34 percent",6726.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7913.6,
WRIGHT G4700005 FINGER JOINT IMPLNT SZ 5,C1776,HCPCS,,79008139,CDM,278,RC,,,both,,,4140,1633.93,39.4668,,1633.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1407.6,34,,1407.6,percent of total billed charges,Implant Device,1449,35,,1449,percent of total billed charges,Implant Device,1407.6,34,"Charges > $500, x 34%",1407.6,percent of total billed charges,Implant Device,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1656,40,,1656,percent of total billed charges,Implant Devices,1449,70,,1449,percent of total billed charges,Implant Devices,1407.6,34,,1407.6,percent of total billed charges,Implant Devices,1407.6,34,,1407.6,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,1449,35,,1449,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1407.6,34,"If Charge > 2,000, then 34 percent",1407.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1656,
STRYKER 5630-G-310 TIBIAL INS SZ 3 10MM,C1776,HCPCS,,79008179,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
BIOMET 12-115122 MODULAR HEAD 36MM,C1776,HCPCS,,79008211,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
ZIMMER 00-8852-013-36 LINER 36MM SZ LL,C1776,HCPCS,,79008212,CDM,278,RC,,,both,,,4403,1737.72,39.4668,,1737.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Device,1497.02,34,"Charges > $500, x 34%",1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1761.2,40,,1761.2,percent of total billed charges,Implant Devices,1541.05,70,,1541.05,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.02,34,"If Charge > 2,000, then 34 percent",1497.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.2,
STRYKER ST0A-19P SMART TOE 19MM,C1776,HCPCS,,79008221,CDM,278,RC,,,both,,,3582,1413.7,39.4668,,1413.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1217.88,34,,1217.88,percent of total billed charges,Implant Device,1253.7,35,,1253.7,percent of total billed charges,Implant Device,1217.88,34,"Charges > $500, x 34%",1217.88,percent of total billed charges,Implant Device,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1432.8,40,,1432.8,percent of total billed charges,Implant Devices,1253.7,70,,1253.7,percent of total billed charges,Implant Devices,1217.88,34,,1217.88,percent of total billed charges,Implant Devices,1217.88,34,,1217.88,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,1253.7,35,,1253.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1217.88,34,"If Charge > 2,000, then 34 percent",1217.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1432.8,
BIOMET 11-300919 TAPER DIST STEM 19X190,C1776,HCPCS,,79008247,CDM,278,RC,,,both,,,13543,5344.99,39.4668,,5344.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4604.62,34,,4604.62,percent of total billed charges,Implant Device,4604.62,34,,4604.62,percent of total billed charges,Implant Device,4604.62,34,,4604.62,percent of total billed charges,Implant Device,4604.62,34,,4604.62,percent of total billed charges,Implant Device,4604.62,34,,4604.62,percent of total billed charges,Implant Device,4604.62,34,,4604.62,percent of total billed charges,Implant Device,4740.05,35,,4740.05,percent of total billed charges,Implant Device,4604.62,34,"Charges > $500, x 34%",4604.62,percent of total billed charges,Implant Device,4740.05,35,,4740.05,percent of total billed charges,Implant Devices,4740.05,35,,4740.05,percent of total billed charges,Implant Devices,4740.05,35,,,percent of total billed charges,Implant Devices,4740.05,35,,4740.05,percent of total billed charges,Implant Devices,4740.05,35,,4740.05,percent of total billed charges,Implant Devices,5417.2,40,,5417.2,percent of total billed charges,Implant Devices,4740.05,70,,4740.05,percent of total billed charges,Implant Devices,4604.62,34,,4604.62,percent of total billed charges,Implant Devices,4604.62,34,,4604.62,percent of total billed charges,Implant Devices,4740.05,35,,4740.05,percent of total billed charges,Implant Devices,4740.05,35,,4740.05,percent of total billed charges,Implant Devices,4740.05,35,,4740.05,percent of total billed charges,Implant Devices,4740.05,35,,4740.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4604.62,34,"If Charge > 2,000, then 34 percent",4604.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5417.2,
BIOMET 11-301304 CONE PROXIMAL BODY 60MM,C1776,HCPCS,,79008248,CDM,278,RC,,,both,,,19784,7808.11,39.4668,,7808.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Device,6726.56,34,"Charges > $500, x 34%",6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,7913.6,40,,7913.6,percent of total billed charges,Implant Devices,6924.4,70,,6924.4,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6726.56,34,"If Charge > 2,000, then 34 percent",6726.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7913.6,
BIOMET 12-115121 MOD CERAMIC HEAD 36MM,C1776,HCPCS,,79008249,CDM,278,RC,,,both,,,3083,1216.76,39.4668,,1216.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1048.22,34,,1048.22,percent of total billed charges,Implant Device,1079.05,35,,1079.05,percent of total billed charges,Implant Device,1048.22,34,"Charges > $500, x 34%",1048.22,percent of total billed charges,Implant Device,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1233.2,40,,1233.2,percent of total billed charges,Implant Devices,1079.05,70,,1079.05,percent of total billed charges,Implant Devices,1048.22,34,,1048.22,percent of total billed charges,Implant Devices,1048.22,34,,1048.22,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,1079.05,35,,1079.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1048.22,34,"If Charge > 2,000, then 34 percent",1048.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1233.2,
ZIMMER 00-8852-016-36 RIM LINER 36MM,C1776,HCPCS,,79008258,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
BIOMET 11-300921 ST5 DISTL STEM 21X190MM,C1776,HCPCS,,79008259,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
BIOMET 11-301335 CONE PROXIMAL SZ E 70MM,C1776,HCPCS,,79008260,CDM,278,RC,,,both,,,36210,14290.93,39.4668,,14290.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12673.5,35,,12673.5,percent of total billed charges,Implant Device,12311.4,34,"Charges > $500, x 34%",12311.4,percent of total billed charges,Implant Device,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,14484,40,,14484,percent of total billed charges,Implant Devices,12673.5,70,,12673.5,percent of total billed charges,Implant Devices,12311.4,34,,12311.4,percent of total billed charges,Implant Devices,12311.4,34,,12311.4,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,12311.4,34,"If Charge > 2,000, then 34 percent",12311.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14484,
EXACTECH 306-02-08 HUMERAL STEM 8X215MM,C1776,HCPCS,,79008261,CDM,278,RC,,,both,,,12852,5072.27,39.4668,,5072.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4369.68,34,,4369.68,percent of total billed charges,Implant Device,4498.2,35,,4498.2,percent of total billed charges,Implant Device,4369.68,34,"Charges > $500, x 34%",4369.68,percent of total billed charges,Implant Device,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,5140.8,40,,5140.8,percent of total billed charges,Implant Devices,4498.2,70,,4498.2,percent of total billed charges,Implant Devices,4369.68,34,,4369.68,percent of total billed charges,Implant Devices,4369.68,34,,4369.68,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,4498.2,35,,4498.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4369.68,34,"If Charge > 2,000, then 34 percent",4369.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5140.8,
S&N 74023247 ART SURF 27MM SZ 3-4 LEFT,C1776,HCPCS,,79008265,CDM,278,RC,,,both,,,5625,2220.01,39.4668,,2220.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1912.5,34,,1912.5,percent of total billed charges,Implant Device,1912.5,34,,1912.5,percent of total billed charges,Implant Device,1912.5,34,,1912.5,percent of total billed charges,Implant Device,1912.5,34,,1912.5,percent of total billed charges,Implant Device,1912.5,34,,1912.5,percent of total billed charges,Implant Device,1912.5,34,,1912.5,percent of total billed charges,Implant Device,1968.75,35,,1968.75,percent of total billed charges,Implant Device,1912.5,34,"Charges > $500, x 34%",1912.5,percent of total billed charges,Implant Device,1968.75,35,,1968.75,percent of total billed charges,Implant Devices,1968.75,35,,1968.75,percent of total billed charges,Implant Devices,1968.75,35,,,percent of total billed charges,Implant Devices,1968.75,35,,1968.75,percent of total billed charges,Implant Devices,1968.75,35,,1968.75,percent of total billed charges,Implant Devices,2250,40,,2250,percent of total billed charges,Implant Devices,1968.75,70,,1968.75,percent of total billed charges,Implant Devices,1912.5,34,,1912.5,percent of total billed charges,Implant Devices,1912.5,34,,1912.5,percent of total billed charges,Implant Devices,1968.75,35,,1968.75,percent of total billed charges,Implant Devices,1968.75,35,,1968.75,percent of total billed charges,Implant Devices,1968.75,35,,1968.75,percent of total billed charges,Implant Devices,1968.75,35,,1968.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1912.5,34,"If Charge > 2,000, then 34 percent",1912.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2250,
EXACTECH 308-02-09 HUM DIST STEM 9X120MM,C1776,HCPCS,,79008274,CDM,278,RC,,,both,,,16020,6322.58,39.4668,,6322.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5446.8,34,,5446.8,percent of total billed charges,Implant Device,5446.8,34,,5446.8,percent of total billed charges,Implant Device,5446.8,34,,5446.8,percent of total billed charges,Implant Device,5446.8,34,,5446.8,percent of total billed charges,Implant Device,5446.8,34,,5446.8,percent of total billed charges,Implant Device,5446.8,34,,5446.8,percent of total billed charges,Implant Device,5607,35,,5607,percent of total billed charges,Implant Device,5446.8,34,"Charges > $500, x 34%",5446.8,percent of total billed charges,Implant Device,5607,35,,5607,percent of total billed charges,Implant Devices,5607,35,,5607,percent of total billed charges,Implant Devices,5607,35,,,percent of total billed charges,Implant Devices,5607,35,,5607,percent of total billed charges,Implant Devices,5607,35,,5607,percent of total billed charges,Implant Devices,6408,40,,6408,percent of total billed charges,Implant Devices,5607,70,,5607,percent of total billed charges,Implant Devices,5446.8,34,,5446.8,percent of total billed charges,Implant Devices,5446.8,34,,5446.8,percent of total billed charges,Implant Devices,5607,35,,5607,percent of total billed charges,Implant Devices,5607,35,,5607,percent of total billed charges,Implant Devices,5607,35,,5607,percent of total billed charges,Implant Devices,5607,35,,5607,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5446.8,34,"If Charge > 2,000, then 34 percent",5446.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6408,
EXACTECH 308-05-18 HUM FIXTN RING 18.5MM,C1776,HCPCS,,79008275,CDM,278,RC,,,both,,,5145,2030.57,39.4668,,2030.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1749.3,34,,1749.3,percent of total billed charges,Implant Device,1749.3,34,,1749.3,percent of total billed charges,Implant Device,1749.3,34,,1749.3,percent of total billed charges,Implant Device,1749.3,34,,1749.3,percent of total billed charges,Implant Device,1749.3,34,,1749.3,percent of total billed charges,Implant Device,1749.3,34,,1749.3,percent of total billed charges,Implant Device,1800.75,35,,1800.75,percent of total billed charges,Implant Device,1749.3,34,"Charges > $500, x 34%",1749.3,percent of total billed charges,Implant Device,1800.75,35,,1800.75,percent of total billed charges,Implant Devices,1800.75,35,,1800.75,percent of total billed charges,Implant Devices,1800.75,35,,,percent of total billed charges,Implant Devices,1800.75,35,,1800.75,percent of total billed charges,Implant Devices,1800.75,35,,1800.75,percent of total billed charges,Implant Devices,2058,40,,2058,percent of total billed charges,Implant Devices,1800.75,70,,1800.75,percent of total billed charges,Implant Devices,1749.3,34,,1749.3,percent of total billed charges,Implant Devices,1749.3,34,,1749.3,percent of total billed charges,Implant Devices,1800.75,35,,1800.75,percent of total billed charges,Implant Devices,1800.75,35,,1800.75,percent of total billed charges,Implant Devices,1800.75,35,,1800.75,percent of total billed charges,Implant Devices,1800.75,35,,1800.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1749.3,34,"If Charge > 2,000, then 34 percent",1749.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2058,
EXACTECH 308-10-50 HUM MID SEGMENT 50MM,C1776,HCPCS,,79008276,CDM,278,RC,,,both,,,30210,11922.92,39.4668,,11922.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10271.4,34,,10271.4,percent of total billed charges,Implant Device,10271.4,34,,10271.4,percent of total billed charges,Implant Device,10271.4,34,,10271.4,percent of total billed charges,Implant Device,10271.4,34,,10271.4,percent of total billed charges,Implant Device,10271.4,34,,10271.4,percent of total billed charges,Implant Device,10271.4,34,,10271.4,percent of total billed charges,Implant Device,10573.5,35,,10573.5,percent of total billed charges,Implant Device,10271.4,34,"Charges > $500, x 34%",10271.4,percent of total billed charges,Implant Device,10573.5,35,,10573.5,percent of total billed charges,Implant Devices,10573.5,35,,10573.5,percent of total billed charges,Implant Devices,10573.5,35,,,percent of total billed charges,Implant Devices,10573.5,35,,10573.5,percent of total billed charges,Implant Devices,10573.5,35,,10573.5,percent of total billed charges,Implant Devices,12084,40,,12084,percent of total billed charges,Implant Devices,10573.5,70,,10573.5,percent of total billed charges,Implant Devices,10271.4,34,,10271.4,percent of total billed charges,Implant Devices,10271.4,34,,10271.4,percent of total billed charges,Implant Devices,10573.5,35,,10573.5,percent of total billed charges,Implant Devices,10573.5,35,,10573.5,percent of total billed charges,Implant Devices,10573.5,35,,10573.5,percent of total billed charges,Implant Devices,10573.5,35,,10573.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10271.4,34,"If Charge > 2,000, then 34 percent",10271.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12084,
EXACTECH 308-09-00 HUM PROX BODY SM +0MM,C1776,HCPCS,,79008277,CDM,278,RC,,,both,,,16725,6600.82,39.4668,,6600.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5686.5,34,,5686.5,percent of total billed charges,Implant Device,5686.5,34,,5686.5,percent of total billed charges,Implant Device,5686.5,34,,5686.5,percent of total billed charges,Implant Device,5686.5,34,,5686.5,percent of total billed charges,Implant Device,5686.5,34,,5686.5,percent of total billed charges,Implant Device,5686.5,34,,5686.5,percent of total billed charges,Implant Device,5853.75,35,,5853.75,percent of total billed charges,Implant Device,5686.5,34,"Charges > $500, x 34%",5686.5,percent of total billed charges,Implant Device,5853.75,35,,5853.75,percent of total billed charges,Implant Devices,5853.75,35,,5853.75,percent of total billed charges,Implant Devices,5853.75,35,,,percent of total billed charges,Implant Devices,5853.75,35,,5853.75,percent of total billed charges,Implant Devices,5853.75,35,,5853.75,percent of total billed charges,Implant Devices,6690,40,,6690,percent of total billed charges,Implant Devices,5853.75,70,,5853.75,percent of total billed charges,Implant Devices,5686.5,34,,5686.5,percent of total billed charges,Implant Devices,5686.5,34,,5686.5,percent of total billed charges,Implant Devices,5853.75,35,,5853.75,percent of total billed charges,Implant Devices,5853.75,35,,5853.75,percent of total billed charges,Implant Devices,5853.75,35,,5853.75,percent of total billed charges,Implant Devices,5853.75,35,,5853.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5686.5,34,"If Charge > 2,000, then 34 percent",5686.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6690,
EXACTECH 320-38-10 HUMERAL LINER 38MM +0,C1776,HCPCS,,79008279,CDM,278,RC,,,both,,,2835,1118.88,39.4668,,1118.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,992.25,35,,992.25,percent of total billed charges,Implant Device,963.9,34,"Charges > $500, x 34%",963.9,percent of total billed charges,Implant Device,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,1134,40,,1134,percent of total billed charges,Implant Devices,992.25,70,,992.25,percent of total billed charges,Implant Devices,963.9,34,,963.9,percent of total billed charges,Implant Devices,963.9,34,,963.9,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,963.9,34,"If Charge > 2,000, then 34 percent",963.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1134,
DEPUY 09.402.422S RADIAL HEAD 22X4X16.5,C1776,HCPCS,,79008291,CDM,278,RC,,,both,,,6996,2761.1,39.4668,,2761.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2448.6,35,,2448.6,percent of total billed charges,Implant Device,2378.64,34,"Charges > $500, x 34%",2378.64,percent of total billed charges,Implant Device,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2798.4,40,,2798.4,percent of total billed charges,Implant Devices,2448.6,70,,2448.6,percent of total billed charges,Implant Devices,2378.64,34,,2378.64,percent of total billed charges,Implant Devices,2378.64,34,,2378.64,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2378.64,34,"If Charge > 2,000, then 34 percent",2378.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2798.4,
DEPUY 04.402.009S RADIAL STEM 9X30MM,C1776,HCPCS,,79008292,CDM,278,RC,,,both,,,6996,2761.1,39.4668,,2761.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2448.6,35,,2448.6,percent of total billed charges,Implant Device,2378.64,34,"Charges > $500, x 34%",2378.64,percent of total billed charges,Implant Device,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2798.4,40,,2798.4,percent of total billed charges,Implant Devices,2448.6,70,,2448.6,percent of total billed charges,Implant Devices,2378.64,34,,2378.64,percent of total billed charges,Implant Devices,2378.64,34,,2378.64,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2378.64,34,"If Charge > 2,000, then 34 percent",2378.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2798.4,
DEPUY 1221-36-162 ACET LINER 36X62MM,C1776,HCPCS,,79008302,CDM,278,RC,,,both,,,4743,1871.91,39.4668,,1871.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1612.62,34,,1612.62,percent of total billed charges,Implant Device,1660.05,35,,1660.05,percent of total billed charges,Implant Device,1612.62,34,"Charges > $500, x 34%",1612.62,percent of total billed charges,Implant Device,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1897.2,40,,1897.2,percent of total billed charges,Implant Devices,1660.05,70,,1660.05,percent of total billed charges,Implant Devices,1612.62,34,,1612.62,percent of total billed charges,Implant Devices,1612.62,34,,1612.62,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,1660.05,35,,1660.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1612.62,34,"If Charge > 2,000, then 34 percent",1612.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1897.2,
BIMET 11-301315 CONE PRX BODY SZ E 60MM,C1776,HCPCS,,79008303,CDM,278,RC,,,both,,,36210,14290.93,39.4668,,14290.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12673.5,35,,12673.5,percent of total billed charges,Implant Device,12311.4,34,"Charges > $500, x 34%",12311.4,percent of total billed charges,Implant Device,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,14484,40,,14484,percent of total billed charges,Implant Devices,12673.5,70,,12673.5,percent of total billed charges,Implant Devices,12311.4,34,,12311.4,percent of total billed charges,Implant Devices,12311.4,34,,12311.4,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,12311.4,34,"If Charge > 2,000, then 34 percent",12311.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14484,
ZIMMER 00-5990-037-10 AUG BLOCK GX5MM,C1776,HCPCS,,79008314,CDM,278,RC,,,both,,,2963,1169.4,39.4668,,1169.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Device,1007.42,34,"Charges > $500, x 34%",1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1185.2,40,,1185.2,percent of total billed charges,Implant Devices,1037.05,70,,1037.05,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1007.42,34,"If Charge > 2,000, then 34 percent",1007.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1185.2,
DEPUY 09.402.024S COCR RAD HEAD 24X13MM,C1776,HCPCS,,79008326,CDM,278,RC,,,both,,,6996,2761.1,39.4668,,2761.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2448.6,35,,2448.6,percent of total billed charges,Implant Device,2378.64,34,"Charges > $500, x 34%",2378.64,percent of total billed charges,Implant Device,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2798.4,40,,2798.4,percent of total billed charges,Implant Devices,2448.6,70,,2448.6,percent of total billed charges,Implant Devices,2378.64,34,,2378.64,percent of total billed charges,Implant Devices,2378.64,34,,2378.64,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2378.64,34,"If Charge > 2,000, then 34 percent",2378.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2798.4,
DEPUY 04.402.008S STR RADIAL STEM 8X28MM,C1776,HCPCS,,79008327,CDM,278,RC,,,both,,,6996,2761.1,39.4668,,2761.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2378.64,34,,2378.64,percent of total billed charges,Implant Device,2448.6,35,,2448.6,percent of total billed charges,Implant Device,2378.64,34,"Charges > $500, x 34%",2378.64,percent of total billed charges,Implant Device,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2798.4,40,,2798.4,percent of total billed charges,Implant Devices,2448.6,70,,2448.6,percent of total billed charges,Implant Devices,2378.64,34,,2378.64,percent of total billed charges,Implant Devices,2378.64,34,,2378.64,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,2448.6,35,,2448.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2378.64,34,"If Charge > 2,000, then 34 percent",2378.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2798.4,
S&N 71333434 ACETAB LINER 32MM+4MM SZ E,C1776,HCPCS,,79008338,CDM,278,RC,,,both,,,15660,6180.5,39.4668,,6180.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5481,35,,5481,percent of total billed charges,Implant Device,5324.4,34,"Charges > $500, x 34%",5324.4,percent of total billed charges,Implant Device,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,6264,40,,6264,percent of total billed charges,Implant Devices,5481,70,,5481,percent of total billed charges,Implant Devices,5324.4,34,,5324.4,percent of total billed charges,Implant Devices,5324.4,34,,5324.4,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5324.4,34,"If Charge > 2,000, then 34 percent",5324.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6264,
S&N 71343208 FEMORAL HEAD 32MM +8 12/14,C1776,HCPCS,,79008339,CDM,278,RC,,,both,,,4851,1914.53,39.4668,,1914.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1649.34,34,,1649.34,percent of total billed charges,Implant Device,1697.85,35,,1697.85,percent of total billed charges,Implant Device,1649.34,34,"Charges > $500, x 34%",1649.34,percent of total billed charges,Implant Device,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1940.4,40,,1940.4,percent of total billed charges,Implant Devices,1697.85,70,,1697.85,percent of total billed charges,Implant Devices,1649.34,34,,1649.34,percent of total billed charges,Implant Devices,1649.34,34,,1649.34,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,1697.85,35,,1697.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1649.34,34,"If Charge > 2,000, then 34 percent",1649.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1940.4,
S&N 71333334 ACETAB LINER 32MM SZ E,C1776,HCPCS,,79008341,CDM,278,RC,,,both,,,3398,1341.08,39.4668,,1341.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1189.3,35,,1189.3,percent of total billed charges,Implant Device,1155.32,34,"Charges > $500, x 34%",1155.32,percent of total billed charges,Implant Device,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1359.2,40,,1359.2,percent of total billed charges,Implant Devices,1189.3,70,,1189.3,percent of total billed charges,Implant Devices,1155.32,34,,1155.32,percent of total billed charges,Implant Devices,1155.32,34,,1155.32,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1155.32,34,"If Charge > 2,000, then 34 percent",1155.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1359.2,
BIOMET 431185 HIP HEAD CEMENT SPACR 64MM,C1776,HCPCS,,79008363,CDM,278,RC,,,both,,,5250,2072.01,39.4668,,2072.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Device,1785,34,"Charges > $500, x 34%",1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,2100,40,,2100,percent of total billed charges,Implant Devices,1837.5,70,,1837.5,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1785,34,"If Charge > 2,000, then 34 percent",1785,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2100,
ZIMMER 00-5994-051-12 ART SURF E.F 12MM,C1776,HCPCS,,79008365,CDM,278,RC,,,both,,,6465,2551.53,39.4668,,2551.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Device,2198.1,34,"Charges > $500, x 34%",2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2586,40,,2586,percent of total billed charges,Implant Devices,2262.75,70,,2262.75,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2198.1,34,"If Charge > 2,000, then 34 percent",2198.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2586,
BIOMET 11-301300 ARCOS CONE PRX BDY 50MM,C1776,HCPCS,,79008367,CDM,278,RC,,,both,,,26253,10361.22,39.4668,,10361.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8926.02,34,,8926.02,percent of total billed charges,Implant Device,8926.02,34,,8926.02,percent of total billed charges,Implant Device,8926.02,34,,8926.02,percent of total billed charges,Implant Device,8926.02,34,,8926.02,percent of total billed charges,Implant Device,8926.02,34,,8926.02,percent of total billed charges,Implant Device,8926.02,34,,8926.02,percent of total billed charges,Implant Device,9188.55,35,,9188.55,percent of total billed charges,Implant Device,8926.02,34,"Charges > $500, x 34%",8926.02,percent of total billed charges,Implant Device,9188.55,35,,9188.55,percent of total billed charges,Implant Devices,9188.55,35,,9188.55,percent of total billed charges,Implant Devices,9188.55,35,,,percent of total billed charges,Implant Devices,9188.55,35,,9188.55,percent of total billed charges,Implant Devices,9188.55,35,,9188.55,percent of total billed charges,Implant Devices,10501.2,40,,10501.2,percent of total billed charges,Implant Devices,9188.55,70,,9188.55,percent of total billed charges,Implant Devices,8926.02,34,,8926.02,percent of total billed charges,Implant Devices,8926.02,34,,8926.02,percent of total billed charges,Implant Devices,9188.55,35,,9188.55,percent of total billed charges,Implant Devices,9188.55,35,,9188.55,percent of total billed charges,Implant Devices,9188.55,35,,9188.55,percent of total billed charges,Implant Devices,9188.55,35,,9188.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8926.02,34,"If Charge > 2,000, then 34 percent",8926.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10501.2,
BIOMET 12-115123 MOD HEAD 36MM +6 NECK,C1776,HCPCS,,79008368,CDM,278,RC,,,both,,,3075,1213.6,39.4668,,1213.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1076.25,35,,1076.25,percent of total billed charges,Implant Device,1045.5,34,"Charges > $500, x 34%",1045.5,percent of total billed charges,Implant Device,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1230,40,,1230,percent of total billed charges,Implant Devices,1076.25,70,,1076.25,percent of total billed charges,Implant Devices,1045.5,34,,1045.5,percent of total billed charges,Implant Devices,1045.5,34,,1045.5,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1045.5,34,"If Charge > 2,000, then 34 percent",1045.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1230,
DEPUY 1570-01-090 FEM STEM SZ 3 154MM,C1776,HCPCS,,79008381,CDM,278,RC,,,both,,,11846,4675.24,39.4668,,4675.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4027.64,34,,4027.64,percent of total billed charges,Implant Device,4146.1,35,,4146.1,percent of total billed charges,Implant Device,4027.64,34,"Charges > $500, x 34%",4027.64,percent of total billed charges,Implant Device,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4738.4,40,,4738.4,percent of total billed charges,Implant Devices,4146.1,70,,4146.1,percent of total billed charges,Implant Devices,4027.64,34,,4027.64,percent of total billed charges,Implant Devices,4027.64,34,,4027.64,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,4146.1,35,,4146.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4027.64,34,"If Charge > 2,000, then 34 percent",4027.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4738.4,
ZIMMER 00-5988-021-18 OFFSET STEM 18X200,C1776,HCPCS,,79008392,CDM,278,RC,,,both,,,4905,1935.85,39.4668,,1935.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1667.7,34,,1667.7,percent of total billed charges,Implant Device,1667.7,34,,1667.7,percent of total billed charges,Implant Device,1667.7,34,,1667.7,percent of total billed charges,Implant Device,1667.7,34,,1667.7,percent of total billed charges,Implant Device,1667.7,34,,1667.7,percent of total billed charges,Implant Device,1667.7,34,,1667.7,percent of total billed charges,Implant Device,1716.75,35,,1716.75,percent of total billed charges,Implant Device,1667.7,34,"Charges > $500, x 34%",1667.7,percent of total billed charges,Implant Device,1716.75,35,,1716.75,percent of total billed charges,Implant Devices,1716.75,35,,1716.75,percent of total billed charges,Implant Devices,1716.75,35,,,percent of total billed charges,Implant Devices,1716.75,35,,1716.75,percent of total billed charges,Implant Devices,1716.75,35,,1716.75,percent of total billed charges,Implant Devices,1962,40,,1962,percent of total billed charges,Implant Devices,1716.75,70,,1716.75,percent of total billed charges,Implant Devices,1667.7,34,,1667.7,percent of total billed charges,Implant Devices,1667.7,34,,1667.7,percent of total billed charges,Implant Devices,1716.75,35,,1716.75,percent of total billed charges,Implant Devices,1716.75,35,,1716.75,percent of total billed charges,Implant Devices,1716.75,35,,1716.75,percent of total billed charges,Implant Devices,1716.75,35,,1716.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1667.7,34,"If Charge > 2,000, then 34 percent",1667.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1962,
ZIMMER 00-5988-008-10 TIB AUG 10MM SZ 8,C1776,HCPCS,,79008394,CDM,278,RC,,,both,,,3968,1566.04,39.4668,,1566.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1388.8,35,,1388.8,percent of total billed charges,Implant Device,1349.12,34,"Charges > $500, x 34%",1349.12,percent of total billed charges,Implant Device,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1587.2,40,,1587.2,percent of total billed charges,Implant Devices,1388.8,70,,1388.8,percent of total billed charges,Implant Devices,1349.12,34,,1349.12,percent of total billed charges,Implant Devices,1349.12,34,,1349.12,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1349.12,34,"If Charge > 2,000, then 34 percent",1349.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1587.2,
DEPUY 1024-52-400 TIBIAL TRAY SZ 4 RM/LL,C1776,HCPCS,,79008395,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
DEPUY 1024-54-408 TIB INSERT SZ 4RM/LL 8,C1776,HCPCS,,79008396,CDM,278,RC,,,both,,,2495,984.7,39.4668,,984.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,873.25,35,,873.25,percent of total billed charges,Implant Device,848.3,34,"Charges > $500, x 34%",848.3,percent of total billed charges,Implant Device,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,998,40,,998,percent of total billed charges,Implant Devices,873.25,70,,873.25,percent of total billed charges,Implant Devices,848.3,34,,848.3,percent of total billed charges,Implant Devices,848.3,34,,848.3,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.3,34,"If Charge > 2,000, then 34 percent",848.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998,
S&N 71342364 FEM HEAD 14/16 TAPER 36MM,C1776,HCPCS,,79008411,CDM,278,RC,,,both,,,5318,2098.84,39.4668,,2098.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1808.12,34,,1808.12,percent of total billed charges,Implant Device,1808.12,34,,1808.12,percent of total billed charges,Implant Device,1808.12,34,,1808.12,percent of total billed charges,Implant Device,1808.12,34,,1808.12,percent of total billed charges,Implant Device,1808.12,34,,1808.12,percent of total billed charges,Implant Device,1808.12,34,,1808.12,percent of total billed charges,Implant Device,1861.3,35,,1861.3,percent of total billed charges,Implant Device,1808.12,34,"Charges > $500, x 34%",1808.12,percent of total billed charges,Implant Device,1861.3,35,,1861.3,percent of total billed charges,Implant Devices,1861.3,35,,1861.3,percent of total billed charges,Implant Devices,1861.3,35,,,percent of total billed charges,Implant Devices,1861.3,35,,1861.3,percent of total billed charges,Implant Devices,1861.3,35,,1861.3,percent of total billed charges,Implant Devices,2127.2,40,,2127.2,percent of total billed charges,Implant Devices,1861.3,70,,1861.3,percent of total billed charges,Implant Devices,1808.12,34,,1808.12,percent of total billed charges,Implant Devices,1808.12,34,,1808.12,percent of total billed charges,Implant Devices,1861.3,35,,1861.3,percent of total billed charges,Implant Devices,1861.3,35,,1861.3,percent of total billed charges,Implant Devices,1861.3,35,,1861.3,percent of total billed charges,Implant Devices,1861.3,35,,1861.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1808.12,34,"If Charge > 2,000, then 34 percent",1808.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2127.2,
S&N 71333586 ACETAB LINER 26MM 46-48 OD,C1776,HCPCS,,79008412,CDM,278,RC,,,both,,,3398,1341.08,39.4668,,1341.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1155.32,34,,1155.32,percent of total billed charges,Implant Device,1189.3,35,,1189.3,percent of total billed charges,Implant Device,1155.32,34,"Charges > $500, x 34%",1155.32,percent of total billed charges,Implant Device,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1359.2,40,,1359.2,percent of total billed charges,Implant Devices,1189.3,70,,1189.3,percent of total billed charges,Implant Devices,1155.32,34,,1155.32,percent of total billed charges,Implant Devices,1155.32,34,,1155.32,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,1189.3,35,,1189.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1155.32,34,"If Charge > 2,000, then 34 percent",1155.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1359.2,
ZIMMER 00-8852-008-32 RIM LINER 32MM,C1776,HCPCS,,79008440,CDM,278,RC,,,both,,,4845,1912.17,39.4668,,1912.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1695.75,35,,1695.75,percent of total billed charges,Implant Device,1647.3,34,"Charges > $500, x 34%",1647.3,percent of total billed charges,Implant Device,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1938,40,,1938,percent of total billed charges,Implant Devices,1695.75,70,,1695.75,percent of total billed charges,Implant Devices,1647.3,34,,1647.3,percent of total billed charges,Implant Devices,1647.3,34,,1647.3,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1647.3,34,"If Charge > 2,000, then 34 percent",1647.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1938,
BIOMET 12-115115 CERAMIC HEAD 32MM,C1776,HCPCS,,79008441,CDM,278,RC,,,both,,,10170,4013.77,39.4668,,4013.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3457.8,34,,3457.8,percent of total billed charges,Implant Device,3457.8,34,,3457.8,percent of total billed charges,Implant Device,3457.8,34,,3457.8,percent of total billed charges,Implant Device,3457.8,34,,3457.8,percent of total billed charges,Implant Device,3457.8,34,,3457.8,percent of total billed charges,Implant Device,3457.8,34,,3457.8,percent of total billed charges,Implant Device,3559.5,35,,3559.5,percent of total billed charges,Implant Device,3457.8,34,"Charges > $500, x 34%",3457.8,percent of total billed charges,Implant Device,3559.5,35,,3559.5,percent of total billed charges,Implant Devices,3559.5,35,,3559.5,percent of total billed charges,Implant Devices,3559.5,35,,,percent of total billed charges,Implant Devices,3559.5,35,,3559.5,percent of total billed charges,Implant Devices,3559.5,35,,3559.5,percent of total billed charges,Implant Devices,4068,40,,4068,percent of total billed charges,Implant Devices,3559.5,70,,3559.5,percent of total billed charges,Implant Devices,3457.8,34,,3457.8,percent of total billed charges,Implant Devices,3457.8,34,,3457.8,percent of total billed charges,Implant Devices,3559.5,35,,3559.5,percent of total billed charges,Implant Devices,3559.5,35,,3559.5,percent of total billed charges,Implant Devices,3559.5,35,,3559.5,percent of total billed charges,Implant Devices,3559.5,35,,3559.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3457.8,34,"If Charge > 2,000, then 34 percent",3457.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4068,
BIOMET 11-301016 DISTAL STEM 16X250MM,C1776,HCPCS,,79008442,CDM,278,RC,,,both,,,14559,5745.97,39.4668,,5745.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4950.06,34,,4950.06,percent of total billed charges,Implant Device,4950.06,34,,4950.06,percent of total billed charges,Implant Device,4950.06,34,,4950.06,percent of total billed charges,Implant Device,4950.06,34,,4950.06,percent of total billed charges,Implant Device,4950.06,34,,4950.06,percent of total billed charges,Implant Device,4950.06,34,,4950.06,percent of total billed charges,Implant Device,5095.65,35,,5095.65,percent of total billed charges,Implant Device,4950.06,34,"Charges > $500, x 34%",4950.06,percent of total billed charges,Implant Device,5095.65,35,,5095.65,percent of total billed charges,Implant Devices,5095.65,35,,5095.65,percent of total billed charges,Implant Devices,5095.65,35,,,percent of total billed charges,Implant Devices,5095.65,35,,5095.65,percent of total billed charges,Implant Devices,5095.65,35,,5095.65,percent of total billed charges,Implant Devices,5823.6,40,,5823.6,percent of total billed charges,Implant Devices,5095.65,70,,5095.65,percent of total billed charges,Implant Devices,4950.06,34,,4950.06,percent of total billed charges,Implant Devices,4950.06,34,,4950.06,percent of total billed charges,Implant Devices,5095.65,35,,5095.65,percent of total billed charges,Implant Devices,5095.65,35,,5095.65,percent of total billed charges,Implant Devices,5095.65,35,,5095.65,percent of total billed charges,Implant Devices,5095.65,35,,5095.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4950.06,34,"If Charge > 2,000, then 34 percent",4950.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5823.6,
BIOMET 11-300923 DISTAL STEM 23X190MM,C1776,HCPCS,,79008445,CDM,278,RC,,,both,,,18660,7364.5,39.4668,,7364.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6344.4,34,,6344.4,percent of total billed charges,Implant Device,6531,35,,6531,percent of total billed charges,Implant Device,6344.4,34,"Charges > $500, x 34%",6344.4,percent of total billed charges,Implant Device,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,7464,40,,7464,percent of total billed charges,Implant Devices,6531,70,,6531,percent of total billed charges,Implant Devices,6344.4,34,,6344.4,percent of total billed charges,Implant Devices,6344.4,34,,6344.4,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,6531,35,,6531,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6344.4,34,"If Charge > 2,000, then 34 percent",6344.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7464,
BIOMET 11-301301 CONE PRX BODY 60MM SZ A,C1776,HCPCS,,79008446,CDM,278,RC,,,both,,,19784,7808.11,39.4668,,7808.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Device,6726.56,34,"Charges > $500, x 34%",6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,7913.6,40,,7913.6,percent of total billed charges,Implant Devices,6924.4,70,,6924.4,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6726.56,34,"If Charge > 2,000, then 34 percent",6726.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7913.6,
BIOMET 11-363665 HEAD COMP +9 NECK 36MM,C1776,HCPCS,,79008447,CDM,278,RC,,,both,,,5370,2119.37,39.4668,,2119.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1879.5,35,,1879.5,percent of total billed charges,Implant Device,1825.8,34,"Charges > $500, x 34%",1825.8,percent of total billed charges,Implant Device,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,2148,40,,2148,percent of total billed charges,Implant Devices,1879.5,70,,1879.5,percent of total billed charges,Implant Devices,1825.8,34,,1825.8,percent of total billed charges,Implant Devices,1825.8,34,,1825.8,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1825.8,34,"If Charge > 2,000, then 34 percent",1825.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2148,
DEPUY 1024-08-200 FEM UNICONDLR 2 RM/LL,C1776,HCPCS,,79008448,CDM,278,RC,,,both,,,6846,2701.9,39.4668,,2701.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2327.64,34,,2327.64,percent of total billed charges,Implant Device,2327.64,34,,2327.64,percent of total billed charges,Implant Device,2327.64,34,,2327.64,percent of total billed charges,Implant Device,2327.64,34,,2327.64,percent of total billed charges,Implant Device,2327.64,34,,2327.64,percent of total billed charges,Implant Device,2327.64,34,,2327.64,percent of total billed charges,Implant Device,2396.1,35,,2396.1,percent of total billed charges,Implant Device,2327.64,34,"Charges > $500, x 34%",2327.64,percent of total billed charges,Implant Device,2396.1,35,,2396.1,percent of total billed charges,Implant Devices,2396.1,35,,2396.1,percent of total billed charges,Implant Devices,2396.1,35,,,percent of total billed charges,Implant Devices,2396.1,35,,2396.1,percent of total billed charges,Implant Devices,2396.1,35,,2396.1,percent of total billed charges,Implant Devices,2738.4,40,,2738.4,percent of total billed charges,Implant Devices,2396.1,70,,2396.1,percent of total billed charges,Implant Devices,2327.64,34,,2327.64,percent of total billed charges,Implant Devices,2327.64,34,,2327.64,percent of total billed charges,Implant Devices,2396.1,35,,2396.1,percent of total billed charges,Implant Devices,2396.1,35,,2396.1,percent of total billed charges,Implant Devices,2396.1,35,,2396.1,percent of total billed charges,Implant Devices,2396.1,35,,2396.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2327.64,34,"If Charge > 2,000, then 34 percent",2327.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2738.4,
DEPUY 1024-52-200 TIBIAL TRAY SZ 2 RM/LL,C1776,HCPCS,,79008449,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
DEPUY 1024-54-207 TIBIAL INS SZ 2 RM/LL,C1776,HCPCS,,79008450,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
STRYKER 40-20907 DISTL FIB PLATE 7 HOLE,C1776,HCPCS,,79008483,CDM,278,RC,,,both,,,1836,724.61,39.4668,,724.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,624.24,34,,624.24,percent of total billed charges,Implant Device,624.24,34,,624.24,percent of total billed charges,Implant Device,624.24,34,,624.24,percent of total billed charges,Implant Device,624.24,34,,624.24,percent of total billed charges,Implant Device,624.24,34,,624.24,percent of total billed charges,Implant Device,624.24,34,,624.24,percent of total billed charges,Implant Device,642.6,35,,642.6,percent of total billed charges,Implant Device,624.24,34,"Charges > $500, x 34%",624.24,percent of total billed charges,Implant Device,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,734.4,40,,734.4,percent of total billed charges,Implant Devices,642.6,70,,642.6,percent of total billed charges,Implant Devices,624.24,34,,624.24,percent of total billed charges,Implant Devices,624.24,34,,624.24,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,642.6,35,,642.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,734.4,
STABILITY 1148-14 DISTAL HEAD HUM SHAFT,C1776,HCPCS,,79008484,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STABILITY SB1153-14 HUM W/ DIS AND PROX,C1776,HCPCS,,79008488,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
ZIMMER 00-8754-012-36 OFFSET LINER 36X56,C1776,HCPCS,,79008490,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
STRYKER 5571-S-3604 HUMERAL INSRT 36X4MM,C1776,HCPCS,,79008492,CDM,278,RC,,,both,,,3525,1391.2,39.4668,,1391.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Device,1198.5,34,"Charges > $500, x 34%",1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1410,40,,1410,percent of total billed charges,Implant Devices,1233.75,70,,1233.75,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1198.5,34,"If Charge > 2,000, then 34 percent",1198.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1410,
STRYKER 5572-2800 GLENOID BASEPLATE 28MM,C1776,HCPCS,,79008494,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
STRYKER 5570-3604 HUMERAL CUP 36X4MM,C1776,HCPCS,,79008495,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
STRYKER 5573-2E-3602 GELNOSPHERE 36X2MM,C1776,HCPCS,,79008499,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
STRYKER 310-0002 RHEAD LATERAL STEM SZ 3,C1776,HCPCS,,79008509,CDM,278,RC,,,both,,,11244,4437.65,39.4668,,4437.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3822.96,34,,3822.96,percent of total billed charges,Implant Device,3822.96,34,,3822.96,percent of total billed charges,Implant Device,3822.96,34,,3822.96,percent of total billed charges,Implant Device,3822.96,34,,3822.96,percent of total billed charges,Implant Device,3822.96,34,,3822.96,percent of total billed charges,Implant Device,3822.96,34,,3822.96,percent of total billed charges,Implant Device,3935.4,35,,3935.4,percent of total billed charges,Implant Device,3822.96,34,"Charges > $500, x 34%",3822.96,percent of total billed charges,Implant Device,3935.4,35,,3935.4,percent of total billed charges,Implant Devices,3935.4,35,,3935.4,percent of total billed charges,Implant Devices,3935.4,35,,,percent of total billed charges,Implant Devices,3935.4,35,,3935.4,percent of total billed charges,Implant Devices,3935.4,35,,3935.4,percent of total billed charges,Implant Devices,4497.6,40,,4497.6,percent of total billed charges,Implant Devices,3935.4,70,,3935.4,percent of total billed charges,Implant Devices,3822.96,34,,3822.96,percent of total billed charges,Implant Devices,3822.96,34,,3822.96,percent of total billed charges,Implant Devices,3935.4,35,,3935.4,percent of total billed charges,Implant Devices,3935.4,35,,3935.4,percent of total billed charges,Implant Devices,3935.4,35,,3935.4,percent of total billed charges,Implant Devices,3935.4,35,,3935.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3822.96,34,"If Charge > 2,000, then 34 percent",3822.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4497.6,
STRYKER 310-0010 RHEAD LAT RAD HD SZ 4,C1776,HCPCS,,79008510,CDM,278,RC,,,both,,,7599,2999.08,39.4668,,2999.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2583.66,34,,2583.66,percent of total billed charges,Implant Device,2583.66,34,,2583.66,percent of total billed charges,Implant Device,2583.66,34,,2583.66,percent of total billed charges,Implant Device,2583.66,34,,2583.66,percent of total billed charges,Implant Device,2583.66,34,,2583.66,percent of total billed charges,Implant Device,2583.66,34,,2583.66,percent of total billed charges,Implant Device,2659.65,35,,2659.65,percent of total billed charges,Implant Device,2583.66,34,"Charges > $500, x 34%",2583.66,percent of total billed charges,Implant Device,2659.65,35,,2659.65,percent of total billed charges,Implant Devices,2659.65,35,,2659.65,percent of total billed charges,Implant Devices,2659.65,35,,,percent of total billed charges,Implant Devices,2659.65,35,,2659.65,percent of total billed charges,Implant Devices,2659.65,35,,2659.65,percent of total billed charges,Implant Devices,3039.6,40,,3039.6,percent of total billed charges,Implant Devices,2659.65,70,,2659.65,percent of total billed charges,Implant Devices,2583.66,34,,2583.66,percent of total billed charges,Implant Devices,2583.66,34,,2583.66,percent of total billed charges,Implant Devices,2659.65,35,,2659.65,percent of total billed charges,Implant Devices,2659.65,35,,2659.65,percent of total billed charges,Implant Devices,2659.65,35,,2659.65,percent of total billed charges,Implant Devices,2659.65,35,,2659.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2583.66,34,"If Charge > 2,000, then 34 percent",2583.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3039.6,
ZIMMER 00-5994-050-14 ART SURF SZ 14MM,C1776,HCPCS,,79008511,CDM,278,RC,,,both,,,6465,2551.53,39.4668,,2551.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Device,2198.1,34,"Charges > $500, x 34%",2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2586,40,,2586,percent of total billed charges,Implant Devices,2262.75,70,,2262.75,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2198.1,34,"If Charge > 2,000, then 34 percent",2198.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2586,
ZIMMER 00-8755-011-36 OBLIQUE LINER 36MM,C1776,HCPCS,,79008517,CDM,278,RC,,,both,,,4973,1962.68,39.4668,,1962.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1690.82,34,,1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Device,1690.82,34,"Charges > $500, x 34%",1690.82,percent of total billed charges,Implant Device,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1989.2,40,,1989.2,percent of total billed charges,Implant Devices,1740.55,70,,1740.55,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1690.82,34,,1690.82,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,1740.55,35,,1740.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1690.82,34,"If Charge > 2,000, then 34 percent",1690.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1989.2,
ZIMMER 00-8018-036-05 FEMORAL HEAD 36X54,C1776,HCPCS,,79008518,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
ZIMMER 00-5850-030-17 ART SURF 17MM SZ C,C1776,HCPCS,,79008519,CDM,278,RC,,,both,,,6546,2583.5,39.4668,,2583.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2225.64,34,,2225.64,percent of total billed charges,Implant Device,2225.64,34,,2225.64,percent of total billed charges,Implant Device,2225.64,34,,2225.64,percent of total billed charges,Implant Device,2225.64,34,,2225.64,percent of total billed charges,Implant Device,2225.64,34,,2225.64,percent of total billed charges,Implant Device,2225.64,34,,2225.64,percent of total billed charges,Implant Device,2291.1,35,,2291.1,percent of total billed charges,Implant Device,2225.64,34,"Charges > $500, x 34%",2225.64,percent of total billed charges,Implant Device,2291.1,35,,2291.1,percent of total billed charges,Implant Devices,2291.1,35,,2291.1,percent of total billed charges,Implant Devices,2291.1,35,,,percent of total billed charges,Implant Devices,2291.1,35,,2291.1,percent of total billed charges,Implant Devices,2291.1,35,,2291.1,percent of total billed charges,Implant Devices,2618.4,40,,2618.4,percent of total billed charges,Implant Devices,2291.1,70,,2291.1,percent of total billed charges,Implant Devices,2225.64,34,,2225.64,percent of total billed charges,Implant Devices,2225.64,34,,2225.64,percent of total billed charges,Implant Devices,2291.1,35,,2291.1,percent of total billed charges,Implant Devices,2291.1,35,,2291.1,percent of total billed charges,Implant Devices,2291.1,35,,2291.1,percent of total billed charges,Implant Devices,2291.1,35,,2291.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2225.64,34,"If Charge > 2,000, then 34 percent",2225.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2618.4,
ZIMMER 00-5850-013-01 DIS FEM COMP SZ C,C1776,HCPCS,,79008520,CDM,278,RC,,,both,,,24705,9750.27,39.4668,,9750.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8399.7,34,,8399.7,percent of total billed charges,Implant Device,8646.75,35,,8646.75,percent of total billed charges,Implant Device,8399.7,34,"Charges > $500, x 34%",8399.7,percent of total billed charges,Implant Device,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,9882,40,,9882,percent of total billed charges,Implant Devices,8646.75,70,,8646.75,percent of total billed charges,Implant Devices,8399.7,34,,8399.7,percent of total billed charges,Implant Devices,8399.7,34,,8399.7,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,8646.75,35,,8646.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8399.7,34,"If Charge > 2,000, then 34 percent",8399.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9882,
ZIMMER 00-5850-030-26 ART SURF 26MM SZ C,C1776,HCPCS,,79008521,CDM,278,RC,,,both,,,5603,2211.32,39.4668,,2211.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1905.02,34,,1905.02,percent of total billed charges,Implant Device,1961.05,35,,1961.05,percent of total billed charges,Implant Device,1905.02,34,"Charges > $500, x 34%",1905.02,percent of total billed charges,Implant Device,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,2241.2,40,,2241.2,percent of total billed charges,Implant Devices,1961.05,70,,1961.05,percent of total billed charges,Implant Devices,1905.02,34,,1905.02,percent of total billed charges,Implant Devices,1905.02,34,,1905.02,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,1961.05,35,,1961.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1905.02,34,"If Charge > 2,000, then 34 percent",1905.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2241.2,
DEPUY 96-0083 FEMORAL TC3 CEMENTED SZ 4,C1776,HCPCS,,79008522,CDM,278,RC,,,both,,,23138,9131.83,39.4668,,9131.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7866.92,34,,7866.92,percent of total billed charges,Implant Device,7866.92,34,,7866.92,percent of total billed charges,Implant Device,7866.92,34,,7866.92,percent of total billed charges,Implant Device,7866.92,34,,7866.92,percent of total billed charges,Implant Device,7866.92,34,,7866.92,percent of total billed charges,Implant Device,7866.92,34,,7866.92,percent of total billed charges,Implant Device,8098.3,35,,8098.3,percent of total billed charges,Implant Device,7866.92,34,"Charges > $500, x 34%",7866.92,percent of total billed charges,Implant Device,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,9255.2,40,,9255.2,percent of total billed charges,Implant Devices,8098.3,70,,8098.3,percent of total billed charges,Implant Devices,7866.92,34,,7866.92,percent of total billed charges,Implant Devices,7866.92,34,,7866.92,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,8098.3,35,,8098.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7866.92,34,"If Charge > 2,000, then 34 percent",7866.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9255.2,
DEPUY 96-0880 DISTAL AUGMENT 4MM SIZE 4,C1776,HCPCS,,79008523,CDM,278,RC,,,both,,,3929,1550.65,39.4668,,1550.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1335.86,34,,1335.86,percent of total billed charges,Implant Device,1375.15,35,,1375.15,percent of total billed charges,Implant Device,1335.86,34,"Charges > $500, x 34%",1335.86,percent of total billed charges,Implant Device,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1571.6,40,,1571.6,percent of total billed charges,Implant Devices,1375.15,70,,1375.15,percent of total billed charges,Implant Devices,1335.86,34,,1335.86,percent of total billed charges,Implant Devices,1335.86,34,,1335.86,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,1375.15,35,,1375.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1335.86,34,"If Charge > 2,000, then 34 percent",1335.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1571.6,
DEPUY 96-2353 TIBIAL INSERT 15MM SIZE 4,C1776,HCPCS,,79008524,CDM,278,RC,,,both,,,10896,4300.3,39.4668,,4300.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3704.64,34,,3704.64,percent of total billed charges,Implant Device,3813.6,35,,3813.6,percent of total billed charges,Implant Device,3704.64,34,"Charges > $500, x 34%",3704.64,percent of total billed charges,Implant Device,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,4358.4,40,,4358.4,percent of total billed charges,Implant Devices,3813.6,70,,3813.6,percent of total billed charges,Implant Devices,3704.64,34,,3704.64,percent of total billed charges,Implant Devices,3704.64,34,,3704.64,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,3813.6,35,,3813.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3704.64,34,"If Charge > 2,000, then 34 percent",3704.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4358.4,
DEPUY 1961-92-152 TIBIAL INSERT SZ 6,C1776,HCPCS,,79008527,CDM,278,RC,,,both,,,5568,2197.51,39.4668,,2197.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1893.12,34,,1893.12,percent of total billed charges,Implant Device,1893.12,34,,1893.12,percent of total billed charges,Implant Device,1893.12,34,,1893.12,percent of total billed charges,Implant Device,1893.12,34,,1893.12,percent of total billed charges,Implant Device,1893.12,34,,1893.12,percent of total billed charges,Implant Device,1893.12,34,,1893.12,percent of total billed charges,Implant Device,1948.8,35,,1948.8,percent of total billed charges,Implant Device,1893.12,34,"Charges > $500, x 34%",1893.12,percent of total billed charges,Implant Device,1948.8,35,,1948.8,percent of total billed charges,Implant Devices,1948.8,35,,1948.8,percent of total billed charges,Implant Devices,1948.8,35,,,percent of total billed charges,Implant Devices,1948.8,35,,1948.8,percent of total billed charges,Implant Devices,1948.8,35,,1948.8,percent of total billed charges,Implant Devices,2227.2,40,,2227.2,percent of total billed charges,Implant Devices,1948.8,70,,1948.8,percent of total billed charges,Implant Devices,1893.12,34,,1893.12,percent of total billed charges,Implant Devices,1893.12,34,,1893.12,percent of total billed charges,Implant Devices,1948.8,35,,1948.8,percent of total billed charges,Implant Devices,1948.8,35,,1948.8,percent of total billed charges,Implant Devices,1948.8,35,,1948.8,percent of total billed charges,Implant Devices,1948.8,35,,1948.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1893.12,34,"If Charge > 2,000, then 34 percent",1893.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2227.2,
STRYKER 5630-G-212 TIBIAL INSERT SIZE 2,C1776,HCPCS,,79008535,CDM,278,RC,,,both,,,3232,1275.57,39.4668,,1275.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1098.88,34,,1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Device,1098.88,34,"Charges > $500, x 34%",1098.88,percent of total billed charges,Implant Device,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1292.8,40,,1292.8,percent of total billed charges,Implant Devices,1131.2,70,,1131.2,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1098.88,34,,1098.88,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,1131.2,35,,1131.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1098.88,34,"If Charge > 2,000, then 34 percent",1098.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1292.8,
BIOMET 11-301321 ARCOS CONE PROX SZ 1,C1776,HCPCS,,79008538,CDM,278,RC,,,both,,,20382,8044.12,39.4668,,8044.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6929.88,34,,6929.88,percent of total billed charges,Implant Device,6929.88,34,,6929.88,percent of total billed charges,Implant Device,6929.88,34,,6929.88,percent of total billed charges,Implant Device,6929.88,34,,6929.88,percent of total billed charges,Implant Device,6929.88,34,,6929.88,percent of total billed charges,Implant Device,6929.88,34,,6929.88,percent of total billed charges,Implant Device,7133.7,35,,7133.7,percent of total billed charges,Implant Device,6929.88,34,"Charges > $500, x 34%",6929.88,percent of total billed charges,Implant Device,7133.7,35,,7133.7,percent of total billed charges,Implant Devices,7133.7,35,,7133.7,percent of total billed charges,Implant Devices,7133.7,35,,,percent of total billed charges,Implant Devices,7133.7,35,,7133.7,percent of total billed charges,Implant Devices,7133.7,35,,7133.7,percent of total billed charges,Implant Devices,8152.8,40,,8152.8,percent of total billed charges,Implant Devices,7133.7,70,,7133.7,percent of total billed charges,Implant Devices,6929.88,34,,6929.88,percent of total billed charges,Implant Devices,6929.88,34,,6929.88,percent of total billed charges,Implant Devices,7133.7,35,,7133.7,percent of total billed charges,Implant Devices,7133.7,35,,7133.7,percent of total billed charges,Implant Devices,7133.7,35,,7133.7,percent of total billed charges,Implant Devices,7133.7,35,,7133.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6929.88,34,"If Charge > 2,000, then 34 percent",6929.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8152.8,
ZIMMER 00-5976-050-12 ART SURF SZ 14MM,C1776,HCPCS,,79008550,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
BIOMET 431182 HIP SPACER HEAD MOLD 52MM,C1776,HCPCS,,79008551,CDM,278,RC,,,both,,,5250,2072.01,39.4668,,2072.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Device,1785,34,"Charges > $500, x 34%",1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,2100,40,,2100,percent of total billed charges,Implant Devices,1837.5,70,,1837.5,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1785,34,"If Charge > 2,000, then 34 percent",1785,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2100,
STRYKER 5573-C-3602 GLENOSPHERE 36MM,C1776,HCPCS,,79008553,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
STRYKER 5569-P-2010 HUM STEM SZ10 123MM,C1776,HCPCS,,79008555,CDM,278,RC,,,both,,,10500,4144.01,39.4668,,4144.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Device,3570,34,"Charges > $500, x 34%",3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,4200,40,,4200,percent of total billed charges,Implant Devices,3675,70,,3675,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3570,34,"If Charge > 2,000, then 34 percent",3570,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4200,
BIOMET 11-301303 CONE PROX BODY 60MM,C1776,HCPCS,,79008558,CDM,278,RC,,,both,,,24006,9474.4,39.4668,,9474.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8402.1,35,,8402.1,percent of total billed charges,Implant Device,8162.04,34,"Charges > $500, x 34%",8162.04,percent of total billed charges,Implant Device,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,9602.4,40,,9602.4,percent of total billed charges,Implant Devices,8402.1,70,,8402.1,percent of total billed charges,Implant Devices,8162.04,34,,8162.04,percent of total billed charges,Implant Devices,8162.04,34,,8162.04,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8162.04,34,"If Charge > 2,000, then 34 percent",8162.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9602.4,
BIOMET 11-300915 DISTAL STEM 15X190MM,C1776,HCPCS,,79008571,CDM,278,RC,,,both,,,11059,4364.63,39.4668,,4364.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3870.65,35,,3870.65,percent of total billed charges,Implant Device,3760.06,34,"Charges > $500, x 34%",3760.06,percent of total billed charges,Implant Device,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,4423.6,40,,4423.6,percent of total billed charges,Implant Devices,3870.65,70,,3870.65,percent of total billed charges,Implant Devices,3760.06,34,,3760.06,percent of total billed charges,Implant Devices,3760.06,34,,3760.06,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3760.06,34,"If Charge > 2,000, then 34 percent",3760.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4423.6,
DEPUY 1024-54-308 TIBIAL INS SZ 3 RM/LL,C1776,HCPCS,,79008586,CDM,278,RC,,,both,,,2495,984.7,39.4668,,984.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,873.25,35,,873.25,percent of total billed charges,Implant Device,848.3,34,"Charges > $500, x 34%",848.3,percent of total billed charges,Implant Device,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,998,40,,998,percent of total billed charges,Implant Devices,873.25,70,,873.25,percent of total billed charges,Implant Devices,848.3,34,,848.3,percent of total billed charges,Implant Devices,848.3,34,,848.3,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.3,34,"If Charge > 2,000, then 34 percent",848.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998,
DEPUY 1516-30-910 TIBIAL INS SZ 9 10MM,C1776,HCPCS,,79008611,CDM,278,RC,,,both,,,5250,2072.01,39.4668,,2072.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Device,1785,34,"Charges > $500, x 34%",1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,2100,40,,2100,percent of total billed charges,Implant Devices,1837.5,70,,1837.5,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1785,34,"If Charge > 2,000, then 34 percent",1785,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2100,
ZIMMER 00-5850-013-96 INSERT XL SZ C,C1776,HCPCS,,79008613,CDM,278,RC,,,both,,,1074,423.87,39.4668,,423.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,365.16,34,,365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Device,365.16,34,"Charges > $500, x 34%",365.16,percent of total billed charges,Implant Device,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,429.6,40,,429.6,percent of total billed charges,Implant Devices,375.9,70,,375.9,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,365.16,34,,365.16,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,375.9,35,,375.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,429.6,
ZIMMER 00-5850-043-01 DIST FEM COMP SZ C,C1776,HCPCS,,79008614,CDM,278,RC,,,both,,,25907,10224.66,39.4668,,10224.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8808.38,34,,8808.38,percent of total billed charges,Implant Device,8808.38,34,,8808.38,percent of total billed charges,Implant Device,8808.38,34,,8808.38,percent of total billed charges,Implant Device,8808.38,34,,8808.38,percent of total billed charges,Implant Device,8808.38,34,,8808.38,percent of total billed charges,Implant Device,8808.38,34,,8808.38,percent of total billed charges,Implant Device,9067.45,35,,9067.45,percent of total billed charges,Implant Device,8808.38,34,"Charges > $500, x 34%",8808.38,percent of total billed charges,Implant Device,9067.45,35,,9067.45,percent of total billed charges,Implant Devices,9067.45,35,,9067.45,percent of total billed charges,Implant Devices,9067.45,35,,,percent of total billed charges,Implant Devices,9067.45,35,,9067.45,percent of total billed charges,Implant Devices,9067.45,35,,9067.45,percent of total billed charges,Implant Devices,10362.8,40,,10362.8,percent of total billed charges,Implant Devices,9067.45,70,,9067.45,percent of total billed charges,Implant Devices,8808.38,34,,8808.38,percent of total billed charges,Implant Devices,8808.38,34,,8808.38,percent of total billed charges,Implant Devices,9067.45,35,,9067.45,percent of total billed charges,Implant Devices,9067.45,35,,9067.45,percent of total billed charges,Implant Devices,9067.45,35,,9067.45,percent of total billed charges,Implant Devices,9067.45,35,,9067.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8808.38,34,"If Charge > 2,000, then 34 percent",8808.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10362.8,
VILEX CHI-3TH HEMI IMPLANT W/ COATING,C1776,HCPCS,,79008629,CDM,278,RC,,,both,,,1988,784.6,39.4668,,784.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,675.92,34,,675.92,percent of total billed charges,Implant Device,675.92,34,,675.92,percent of total billed charges,Implant Device,675.92,34,,675.92,percent of total billed charges,Implant Device,675.92,34,,675.92,percent of total billed charges,Implant Device,675.92,34,,675.92,percent of total billed charges,Implant Device,675.92,34,,675.92,percent of total billed charges,Implant Device,695.8,35,,695.8,percent of total billed charges,Implant Device,675.92,34,"Charges > $500, x 34%",675.92,percent of total billed charges,Implant Device,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,795.2,40,,795.2,percent of total billed charges,Implant Devices,695.8,70,,695.8,percent of total billed charges,Implant Devices,675.92,34,,675.92,percent of total billed charges,Implant Devices,675.92,34,,675.92,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,795.2,
DEPUY 1516-31-005 TIBIAL INSRT SZ 10 5MM,C1776,HCPCS,,79008634,CDM,278,RC,,,both,,,5250,2072.01,39.4668,,2072.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1785,34,,1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Device,1785,34,"Charges > $500, x 34%",1785,percent of total billed charges,Implant Device,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,2100,40,,2100,percent of total billed charges,Implant Devices,1837.5,70,,1837.5,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1785,34,,1785,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,1837.5,35,,1837.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1785,34,"If Charge > 2,000, then 34 percent",1785,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2100,
DEPUY 1975-24-085 CONICL PROX BODY 24X85,C1776,HCPCS,,79008637,CDM,278,RC,,,both,,,17671,6974.18,39.4668,,6974.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6008.14,34,,6008.14,percent of total billed charges,Implant Device,6008.14,34,,6008.14,percent of total billed charges,Implant Device,6008.14,34,,6008.14,percent of total billed charges,Implant Device,6008.14,34,,6008.14,percent of total billed charges,Implant Device,6008.14,34,,6008.14,percent of total billed charges,Implant Device,6008.14,34,,6008.14,percent of total billed charges,Implant Device,6184.85,35,,6184.85,percent of total billed charges,Implant Device,6008.14,34,"Charges > $500, x 34%",6008.14,percent of total billed charges,Implant Device,6184.85,35,,6184.85,percent of total billed charges,Implant Devices,6184.85,35,,6184.85,percent of total billed charges,Implant Devices,6184.85,35,,,percent of total billed charges,Implant Devices,6184.85,35,,6184.85,percent of total billed charges,Implant Devices,6184.85,35,,6184.85,percent of total billed charges,Implant Devices,7068.4,40,,7068.4,percent of total billed charges,Implant Devices,6184.85,70,,6184.85,percent of total billed charges,Implant Devices,6008.14,34,,6008.14,percent of total billed charges,Implant Devices,6008.14,34,,6008.14,percent of total billed charges,Implant Devices,6184.85,35,,6184.85,percent of total billed charges,Implant Devices,6184.85,35,,6184.85,percent of total billed charges,Implant Devices,6184.85,35,,6184.85,percent of total billed charges,Implant Devices,6184.85,35,,6184.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6008.14,34,"If Charge > 2,000, then 34 percent",6008.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7068.4,
DEPUY 1976-19-190 DIS TAPERD STEM 19X190,C1776,HCPCS,,79008638,CDM,278,RC,,,both,,,15478,6108.67,39.4668,,6108.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5262.52,34,,5262.52,percent of total billed charges,Implant Device,5262.52,34,,5262.52,percent of total billed charges,Implant Device,5262.52,34,,5262.52,percent of total billed charges,Implant Device,5262.52,34,,5262.52,percent of total billed charges,Implant Device,5262.52,34,,5262.52,percent of total billed charges,Implant Device,5262.52,34,,5262.52,percent of total billed charges,Implant Device,5417.3,35,,5417.3,percent of total billed charges,Implant Device,5262.52,34,"Charges > $500, x 34%",5262.52,percent of total billed charges,Implant Device,5417.3,35,,5417.3,percent of total billed charges,Implant Devices,5417.3,35,,5417.3,percent of total billed charges,Implant Devices,5417.3,35,,,percent of total billed charges,Implant Devices,5417.3,35,,5417.3,percent of total billed charges,Implant Devices,5417.3,35,,5417.3,percent of total billed charges,Implant Devices,6191.2,40,,6191.2,percent of total billed charges,Implant Devices,5417.3,70,,5417.3,percent of total billed charges,Implant Devices,5262.52,34,,5262.52,percent of total billed charges,Implant Devices,5262.52,34,,5262.52,percent of total billed charges,Implant Devices,5417.3,35,,5417.3,percent of total billed charges,Implant Devices,5417.3,35,,5417.3,percent of total billed charges,Implant Devices,5417.3,35,,5417.3,percent of total billed charges,Implant Devices,5417.3,35,,5417.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5262.52,34,"If Charge > 2,000, then 34 percent",5262.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6191.2,
VILEX CHI-2TH HEMI IMPLANT W/ COATING,C1776,HCPCS,,79008669,CDM,278,RC,,,both,,,1988,784.6,39.4668,,784.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,675.92,34,,675.92,percent of total billed charges,Implant Device,675.92,34,,675.92,percent of total billed charges,Implant Device,675.92,34,,675.92,percent of total billed charges,Implant Device,675.92,34,,675.92,percent of total billed charges,Implant Device,675.92,34,,675.92,percent of total billed charges,Implant Device,675.92,34,,675.92,percent of total billed charges,Implant Device,695.8,35,,695.8,percent of total billed charges,Implant Device,675.92,34,"Charges > $500, x 34%",675.92,percent of total billed charges,Implant Device,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,795.2,40,,795.2,percent of total billed charges,Implant Devices,695.8,70,,695.8,percent of total billed charges,Implant Devices,675.92,34,,675.92,percent of total billed charges,Implant Devices,675.92,34,,675.92,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,695.8,35,,695.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,795.2,
DEPUY 1024-07-400 FEM CEMENTED SIZE 4,C1776,HCPCS,,79008673,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
DEPUY 1024-53-307 TIBIAL INS SZ 3 LW/RL,C1776,HCPCS,,79008674,CDM,278,RC,,,both,,,2495,984.7,39.4668,,984.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,873.25,35,,873.25,percent of total billed charges,Implant Device,848.3,34,"Charges > $500, x 34%",848.3,percent of total billed charges,Implant Device,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,998,40,,998,percent of total billed charges,Implant Devices,873.25,70,,873.25,percent of total billed charges,Implant Devices,848.3,34,,848.3,percent of total billed charges,Implant Devices,848.3,34,,848.3,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.3,34,"If Charge > 2,000, then 34 percent",848.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998,
DEPUY 1024-51-300 TIBIAL TRAY SZ 3 LM.RL,C1776,HCPCS,,79008675,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
STRYKER 6495-2-040 GMRS DIST FEM COMP 65,C1776,HCPCS,,79008677,CDM,278,RC,,,both,,,18561,7325.43,39.4668,,7325.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6310.74,34,,6310.74,percent of total billed charges,Implant Device,6310.74,34,,6310.74,percent of total billed charges,Implant Device,6310.74,34,,6310.74,percent of total billed charges,Implant Device,6310.74,34,,6310.74,percent of total billed charges,Implant Device,6310.74,34,,6310.74,percent of total billed charges,Implant Device,6310.74,34,,6310.74,percent of total billed charges,Implant Device,6496.35,35,,6496.35,percent of total billed charges,Implant Device,6310.74,34,"Charges > $500, x 34%",6310.74,percent of total billed charges,Implant Device,6496.35,35,,6496.35,percent of total billed charges,Implant Devices,6496.35,35,,6496.35,percent of total billed charges,Implant Devices,6496.35,35,,,percent of total billed charges,Implant Devices,6496.35,35,,6496.35,percent of total billed charges,Implant Devices,6496.35,35,,6496.35,percent of total billed charges,Implant Devices,7424.4,40,,7424.4,percent of total billed charges,Implant Devices,6496.35,70,,6496.35,percent of total billed charges,Implant Devices,6310.74,34,,6310.74,percent of total billed charges,Implant Devices,6310.74,34,,6310.74,percent of total billed charges,Implant Devices,6496.35,35,,6496.35,percent of total billed charges,Implant Devices,6496.35,35,,6496.35,percent of total billed charges,Implant Devices,6496.35,35,,6496.35,percent of total billed charges,Implant Devices,6496.35,35,,6496.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6310.74,34,"If Charge > 2,000, then 34 percent",6310.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7424.4,
STRYKER 6485-3-013 MRS STR STEM 13X127MM,C1776,HCPCS,,79008678,CDM,278,RC,,,both,,,16989,6705.01,39.4668,,6705.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5776.26,34,,5776.26,percent of total billed charges,Implant Device,5776.26,34,,5776.26,percent of total billed charges,Implant Device,5776.26,34,,5776.26,percent of total billed charges,Implant Device,5776.26,34,,5776.26,percent of total billed charges,Implant Device,5776.26,34,,5776.26,percent of total billed charges,Implant Device,5776.26,34,,5776.26,percent of total billed charges,Implant Device,5946.15,35,,5946.15,percent of total billed charges,Implant Device,5776.26,34,"Charges > $500, x 34%",5776.26,percent of total billed charges,Implant Device,5946.15,35,,5946.15,percent of total billed charges,Implant Devices,5946.15,35,,5946.15,percent of total billed charges,Implant Devices,5946.15,35,,,percent of total billed charges,Implant Devices,5946.15,35,,5946.15,percent of total billed charges,Implant Devices,5946.15,35,,5946.15,percent of total billed charges,Implant Devices,6795.6,40,,6795.6,percent of total billed charges,Implant Devices,5946.15,70,,5946.15,percent of total billed charges,Implant Devices,5776.26,34,,5776.26,percent of total billed charges,Implant Devices,5776.26,34,,5776.26,percent of total billed charges,Implant Devices,5946.15,35,,5946.15,percent of total billed charges,Implant Devices,5946.15,35,,5946.15,percent of total billed charges,Implant Devices,5946.15,35,,5946.15,percent of total billed charges,Implant Devices,5946.15,35,,5946.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5776.26,34,"If Charge > 2,000, then 34 percent",5776.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6795.6,
STRYKER 6495-6-060 GMRS EX PIECE,C1776,HCPCS,,79008679,CDM,278,RC,,,both,,,8361,3299.82,39.4668,,3299.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2842.74,34,,2842.74,percent of total billed charges,Implant Device,2842.74,34,,2842.74,percent of total billed charges,Implant Device,2842.74,34,,2842.74,percent of total billed charges,Implant Device,2842.74,34,,2842.74,percent of total billed charges,Implant Device,2842.74,34,,2842.74,percent of total billed charges,Implant Device,2842.74,34,,2842.74,percent of total billed charges,Implant Device,2926.35,35,,2926.35,percent of total billed charges,Implant Device,2842.74,34,"Charges > $500, x 34%",2842.74,percent of total billed charges,Implant Device,2926.35,35,,2926.35,percent of total billed charges,Implant Devices,2926.35,35,,2926.35,percent of total billed charges,Implant Devices,2926.35,35,,,percent of total billed charges,Implant Devices,2926.35,35,,2926.35,percent of total billed charges,Implant Devices,2926.35,35,,2926.35,percent of total billed charges,Implant Devices,3344.4,40,,3344.4,percent of total billed charges,Implant Devices,2926.35,70,,2926.35,percent of total billed charges,Implant Devices,2842.74,34,,2842.74,percent of total billed charges,Implant Devices,2842.74,34,,2842.74,percent of total billed charges,Implant Devices,2926.35,35,,2926.35,percent of total billed charges,Implant Devices,2926.35,35,,2926.35,percent of total billed charges,Implant Devices,2926.35,35,,2926.35,percent of total billed charges,Implant Devices,2926.35,35,,2926.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2842.74,34,"If Charge > 2,000, then 34 percent",2842.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3344.4,
STRYKER 6481-2-100 MRH TIBIAL COMPONENT,C1776,HCPCS,,79008680,CDM,278,RC,,,both,,,7694,3036.58,39.4668,,3036.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2615.96,34,,2615.96,percent of total billed charges,Implant Device,2615.96,34,,2615.96,percent of total billed charges,Implant Device,2615.96,34,,2615.96,percent of total billed charges,Implant Device,2615.96,34,,2615.96,percent of total billed charges,Implant Device,2615.96,34,,2615.96,percent of total billed charges,Implant Device,2615.96,34,,2615.96,percent of total billed charges,Implant Device,2692.9,35,,2692.9,percent of total billed charges,Implant Device,2615.96,34,"Charges > $500, x 34%",2615.96,percent of total billed charges,Implant Device,2692.9,35,,2692.9,percent of total billed charges,Implant Devices,2692.9,35,,2692.9,percent of total billed charges,Implant Devices,2692.9,35,,,percent of total billed charges,Implant Devices,2692.9,35,,2692.9,percent of total billed charges,Implant Devices,2692.9,35,,2692.9,percent of total billed charges,Implant Devices,3077.6,40,,3077.6,percent of total billed charges,Implant Devices,2692.9,70,,2692.9,percent of total billed charges,Implant Devices,2615.96,34,,2615.96,percent of total billed charges,Implant Devices,2615.96,34,,2615.96,percent of total billed charges,Implant Devices,2692.9,35,,2692.9,percent of total billed charges,Implant Devices,2692.9,35,,2692.9,percent of total billed charges,Implant Devices,2692.9,35,,2692.9,percent of total billed charges,Implant Devices,2692.9,35,,2692.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2615.96,34,"If Charge > 2,000, then 34 percent",2615.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3077.6,
STRYKER 6485-2-208 KINEMATIC HINGE KNEE,C1776,HCPCS,,79008681,CDM,278,RC,,,both,,,6693,2641.51,39.4668,,2641.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2275.62,34,,2275.62,percent of total billed charges,Implant Device,2275.62,34,,2275.62,percent of total billed charges,Implant Device,2275.62,34,,2275.62,percent of total billed charges,Implant Device,2275.62,34,,2275.62,percent of total billed charges,Implant Device,2275.62,34,,2275.62,percent of total billed charges,Implant Device,2275.62,34,,2275.62,percent of total billed charges,Implant Device,2342.55,35,,2342.55,percent of total billed charges,Implant Device,2275.62,34,"Charges > $500, x 34%",2275.62,percent of total billed charges,Implant Device,2342.55,35,,2342.55,percent of total billed charges,Implant Devices,2342.55,35,,2342.55,percent of total billed charges,Implant Devices,2342.55,35,,,percent of total billed charges,Implant Devices,2342.55,35,,2342.55,percent of total billed charges,Implant Devices,2342.55,35,,2342.55,percent of total billed charges,Implant Devices,2677.2,40,,2677.2,percent of total billed charges,Implant Devices,2342.55,70,,2342.55,percent of total billed charges,Implant Devices,2275.62,34,,2275.62,percent of total billed charges,Implant Devices,2275.62,34,,2275.62,percent of total billed charges,Implant Devices,2342.55,35,,2342.55,percent of total billed charges,Implant Devices,2342.55,35,,2342.55,percent of total billed charges,Implant Devices,2342.55,35,,2342.55,percent of total billed charges,Implant Devices,2342.55,35,,2342.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2275.62,34,"If Charge > 2,000, then 34 percent",2275.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2677.2,
ZIMMER 00-5976-040-14 ART SURF SZ BLUE,C1776,HCPCS,,79008699,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
ZIMMER 00-5988-006-27 TIBIAL BLOCK SZ 6,C1776,HCPCS,,79008700,CDM,278,RC,,,both,,,2993,1181.24,39.4668,,1181.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1047.55,35,,1047.55,percent of total billed charges,Implant Device,1017.62,34,"Charges > $500, x 34%",1017.62,percent of total billed charges,Implant Device,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1197.2,40,,1197.2,percent of total billed charges,Implant Devices,1047.55,70,,1047.55,percent of total billed charges,Implant Devices,1017.62,34,,1017.62,percent of total billed charges,Implant Devices,1017.62,34,,1017.62,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1017.62,34,"If Charge > 2,000, then 34 percent",1017.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1197.2,
ZIMMER 00-5950-016-01 FEM COMPONENT SZ F,C1776,HCPCS,,79008701,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 00-8018-022-30 FEMORAL HEAD 22MM,C1776,HCPCS,,79008703,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 00-7711-004-40 FEM STEM SIZE 4,C1776,HCPCS,,79008704,CDM,278,RC,,,both,,,10830,4274.25,39.4668,,4274.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3682.2,34,,3682.2,percent of total billed charges,Implant Device,3682.2,34,,3682.2,percent of total billed charges,Implant Device,3682.2,34,,3682.2,percent of total billed charges,Implant Device,3682.2,34,,3682.2,percent of total billed charges,Implant Device,3682.2,34,,3682.2,percent of total billed charges,Implant Device,3682.2,34,,3682.2,percent of total billed charges,Implant Device,3790.5,35,,3790.5,percent of total billed charges,Implant Device,3682.2,34,"Charges > $500, x 34%",3682.2,percent of total billed charges,Implant Device,3790.5,35,,3790.5,percent of total billed charges,Implant Devices,3790.5,35,,3790.5,percent of total billed charges,Implant Devices,3790.5,35,,,percent of total billed charges,Implant Devices,3790.5,35,,3790.5,percent of total billed charges,Implant Devices,3790.5,35,,3790.5,percent of total billed charges,Implant Devices,4332,40,,4332,percent of total billed charges,Implant Devices,3790.5,70,,3790.5,percent of total billed charges,Implant Devices,3682.2,34,,3682.2,percent of total billed charges,Implant Devices,3682.2,34,,3682.2,percent of total billed charges,Implant Devices,3790.5,35,,3790.5,percent of total billed charges,Implant Devices,3790.5,35,,3790.5,percent of total billed charges,Implant Devices,3790.5,35,,3790.5,percent of total billed charges,Implant Devices,3790.5,35,,3790.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3682.2,34,"If Charge > 2,000, then 34 percent",3682.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4332,
ZIMMER 00-5001-040-22 BI CUP LINER 22MM,C1776,HCPCS,,79008705,CDM,278,RC,,,both,,,797,314.55,39.4668,,314.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,270.98,34,,270.98,percent of total billed charges,Implant Device,270.98,34,,270.98,percent of total billed charges,Implant Device,270.98,34,,270.98,percent of total billed charges,Implant Device,270.98,34,,270.98,percent of total billed charges,Implant Device,270.98,34,,270.98,percent of total billed charges,Implant Device,270.98,34,,270.98,percent of total billed charges,Implant Device,278.95,35,,278.95,percent of total billed charges,Implant Device,270.98,34,"Charges > $500, x 34%",270.98,percent of total billed charges,Implant Device,278.95,35,,278.95,percent of total billed charges,Implant Devices,278.95,35,,278.95,percent of total billed charges,Implant Devices,278.95,35,,,percent of total billed charges,Implant Devices,278.95,35,,278.95,percent of total billed charges,Implant Devices,278.95,35,,278.95,percent of total billed charges,Implant Devices,318.8,40,,318.8,percent of total billed charges,Implant Devices,278.95,70,,278.95,percent of total billed charges,Implant Devices,270.98,34,,270.98,percent of total billed charges,Implant Devices,270.98,34,,270.98,percent of total billed charges,Implant Devices,278.95,35,,278.95,percent of total billed charges,Implant Devices,278.95,35,,278.95,percent of total billed charges,Implant Devices,278.95,35,,278.95,percent of total billed charges,Implant Devices,278.95,35,,278.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,318.8,
ZIMMER 00-5001-041-00 BI CUP SHELL 41MM,C1776,HCPCS,,79008706,CDM,278,RC,,,both,,,1323,522.15,39.4668,,522.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,449.82,34,,449.82,percent of total billed charges,Implant Device,449.82,34,,449.82,percent of total billed charges,Implant Device,449.82,34,,449.82,percent of total billed charges,Implant Device,449.82,34,,449.82,percent of total billed charges,Implant Device,449.82,34,,449.82,percent of total billed charges,Implant Device,449.82,34,,449.82,percent of total billed charges,Implant Device,463.05,35,,463.05,percent of total billed charges,Implant Device,449.82,34,"Charges > $500, x 34%",449.82,percent of total billed charges,Implant Device,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,529.2,40,,529.2,percent of total billed charges,Implant Devices,463.05,70,,463.05,percent of total billed charges,Implant Devices,449.82,34,,449.82,percent of total billed charges,Implant Devices,449.82,34,,449.82,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,463.05,35,,463.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,529.2,
STRYKER 1830-0926S HUMERAL KNEE 9X260MM,C1776,HCPCS,,79008715,CDM,278,RC,,,both,,,6661,2628.88,39.4668,,2628.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2264.74,34,,2264.74,percent of total billed charges,Implant Device,2331.35,35,,2331.35,percent of total billed charges,Implant Device,2264.74,34,"Charges > $500, x 34%",2264.74,percent of total billed charges,Implant Device,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2664.4,40,,2664.4,percent of total billed charges,Implant Devices,2331.35,70,,2331.35,percent of total billed charges,Implant Devices,2264.74,34,,2264.74,percent of total billed charges,Implant Devices,2264.74,34,,2264.74,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,2331.35,35,,2331.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2264.74,34,"If Charge > 2,000, then 34 percent",2264.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2664.4,
BIOMET 11-301310 CONE PROX BODY SZ1 50MM,C1776,HCPCS,,79008721,CDM,278,RC,,,both,,,36210,14290.93,39.4668,,14290.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12673.5,35,,12673.5,percent of total billed charges,Implant Device,12311.4,34,"Charges > $500, x 34%",12311.4,percent of total billed charges,Implant Device,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,14484,40,,14484,percent of total billed charges,Implant Devices,12673.5,70,,12673.5,percent of total billed charges,Implant Devices,12311.4,34,,12311.4,percent of total billed charges,Implant Devices,12311.4,34,,12311.4,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,12311.4,34,"If Charge > 2,000, then 34 percent",12311.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14484,
BIOMET 11-300918 STS DIS STEM 18X190MM,C1776,HCPCS,,79008722,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
BIOMET 12-115120 MODULAR HEAD -3 NECK,C1776,HCPCS,,79008723,CDM,278,RC,,,both,,,3075,1213.6,39.4668,,1213.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1076.25,35,,1076.25,percent of total billed charges,Implant Device,1045.5,34,"Charges > $500, x 34%",1045.5,percent of total billed charges,Implant Device,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1230,40,,1230,percent of total billed charges,Implant Devices,1076.25,70,,1076.25,percent of total billed charges,Implant Devices,1045.5,34,,1045.5,percent of total billed charges,Implant Devices,1045.5,34,,1045.5,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1045.5,34,"If Charge > 2,000, then 34 percent",1045.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1230,
STRYKER 623-00-36E INSERT ID 36MM CODE E,C1776,HCPCS,,79008725,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
DEPUY 1035-43-000 BI-POLAR HEAD 28X43MM,C1776,HCPCS,,79008764,CDM,278,RC,,,both,,,4030,1590.51,39.4668,,1590.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Device,1370.2,34,"Charges > $500, x 34%",1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1612,40,,1612,percent of total billed charges,Implant Devices,1410.5,70,,1410.5,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1370.2,34,"If Charge > 2,000, then 34 percent",1370.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1612,
ZIMMER 00-5853-050-15 FLUTED STEM 15X130,C1776,HCPCS,,79008814,CDM,278,RC,,,both,,,11878,4687.87,39.4668,,4687.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4157.3,35,,4157.3,percent of total billed charges,Implant Device,4038.52,34,"Charges > $500, x 34%",4038.52,percent of total billed charges,Implant Device,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4751.2,40,,4751.2,percent of total billed charges,Implant Devices,4157.3,70,,4157.3,percent of total billed charges,Implant Devices,4038.52,34,,4038.52,percent of total billed charges,Implant Devices,4038.52,34,,4038.52,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4038.52,34,"If Charge > 2,000, then 34 percent",4038.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4751.2,
ZIMMER 00-5850-030-12 ART SURF SZ C 12MM,C1776,HCPCS,,79008815,CDM,278,RC,,,both,,,6200,2446.94,39.4668,,2446.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2170,35,,2170,percent of total billed charges,Implant Device,2108,34,"Charges > $500, x 34%",2108,percent of total billed charges,Implant Device,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2480,40,,2480,percent of total billed charges,Implant Devices,2170,70,,2170,percent of total billed charges,Implant Devices,2108,34,,2108,percent of total billed charges,Implant Devices,2108,34,,2108,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2108,34,"If Charge > 2,000, then 34 percent",2108,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2480,
ZIMMER 00-8851-013-36 NEUTRAL LINER 36MM,C1776,HCPCS,,79008820,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 00-5990-036-23 AUG BLOCK F 15MM,C1776,HCPCS,,79008821,CDM,278,RC,,,both,,,3488,1376.6,39.4668,,1376.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1220.8,35,,1220.8,percent of total billed charges,Implant Device,1185.92,34,"Charges > $500, x 34%",1185.92,percent of total billed charges,Implant Device,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1395.2,40,,1395.2,percent of total billed charges,Implant Devices,1220.8,70,,1220.8,percent of total billed charges,Implant Devices,1185.92,34,,1185.92,percent of total billed charges,Implant Devices,1185.92,34,,1185.92,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1185.92,34,"If Charge > 2,000, then 34 percent",1185.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1395.2,
ZIMMER 00-7711-012-40 M/L TAPER NECK,C1776,HCPCS,,79008831,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
BIOMET 11-301333 MOD REV SYS SZ CX70MM,C1776,HCPCS,,79008859,CDM,278,RC,,,both,,,36210,14290.93,39.4668,,14290.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12311.4,34,,12311.4,percent of total billed charges,Implant Device,12673.5,35,,12673.5,percent of total billed charges,Implant Device,12311.4,34,"Charges > $500, x 34%",12311.4,percent of total billed charges,Implant Device,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,14484,40,,14484,percent of total billed charges,Implant Devices,12673.5,70,,12673.5,percent of total billed charges,Implant Devices,12311.4,34,,12311.4,percent of total billed charges,Implant Devices,12311.4,34,,12311.4,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,12673.5,35,,12673.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,12311.4,34,"If Charge > 2,000, then 34 percent",12311.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14484,
BIOMET 11-363663 MOD HEAD COMP +3MM NECK,C1776,HCPCS,,79008860,CDM,278,RC,,,both,,,5370,2119.37,39.4668,,2119.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1825.8,34,,1825.8,percent of total billed charges,Implant Device,1879.5,35,,1879.5,percent of total billed charges,Implant Device,1825.8,34,"Charges > $500, x 34%",1825.8,percent of total billed charges,Implant Device,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,2148,40,,2148,percent of total billed charges,Implant Devices,1879.5,70,,1879.5,percent of total billed charges,Implant Devices,1825.8,34,,1825.8,percent of total billed charges,Implant Devices,1825.8,34,,1825.8,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,1879.5,35,,1879.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1825.8,34,"If Charge > 2,000, then 34 percent",1825.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2148,
ZIMMER 00-8755-018-36 OBLIQUE LINER 36MM,C1776,HCPCS,,79008866,CDM,278,RC,,,both,,,3705,1462.24,39.4668,,1462.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1259.7,34,,1259.7,percent of total billed charges,Implant Device,1259.7,34,,1259.7,percent of total billed charges,Implant Device,1259.7,34,,1259.7,percent of total billed charges,Implant Device,1259.7,34,,1259.7,percent of total billed charges,Implant Device,1259.7,34,,1259.7,percent of total billed charges,Implant Device,1259.7,34,,1259.7,percent of total billed charges,Implant Device,1296.75,35,,1296.75,percent of total billed charges,Implant Device,1259.7,34,"Charges > $500, x 34%",1259.7,percent of total billed charges,Implant Device,1296.75,35,,1296.75,percent of total billed charges,Implant Devices,1296.75,35,,1296.75,percent of total billed charges,Implant Devices,1296.75,35,,,percent of total billed charges,Implant Devices,1296.75,35,,1296.75,percent of total billed charges,Implant Devices,1296.75,35,,1296.75,percent of total billed charges,Implant Devices,1482,40,,1482,percent of total billed charges,Implant Devices,1296.75,70,,1296.75,percent of total billed charges,Implant Devices,1259.7,34,,1259.7,percent of total billed charges,Implant Devices,1259.7,34,,1259.7,percent of total billed charges,Implant Devices,1296.75,35,,1296.75,percent of total billed charges,Implant Devices,1296.75,35,,1296.75,percent of total billed charges,Implant Devices,1296.75,35,,1296.75,percent of total billed charges,Implant Devices,1296.75,35,,1296.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1259.7,34,"If Charge > 2,000, then 34 percent",1259.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1482,
ZIMMER 00-8757-068-01 ACETAB SHELL 68MM,C1776,HCPCS,,79008867,CDM,278,RC,,,both,,,4145,1635.9,39.4668,,1635.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1409.3,34,,1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Device,1409.3,34,"Charges > $500, x 34%",1409.3,percent of total billed charges,Implant Device,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1658,40,,1658,percent of total billed charges,Implant Devices,1450.75,70,,1450.75,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1409.3,34,,1409.3,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,1450.75,35,,1450.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1409.3,34,"If Charge > 2,000, then 34 percent",1409.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1658,
DEPUY 1035-56-000 BIPOLAR HEAD 28MM,C1776,HCPCS,,79008869,CDM,278,RC,,,both,,,4030,1590.51,39.4668,,1590.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1370.2,34,,1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Device,1370.2,34,"Charges > $500, x 34%",1370.2,percent of total billed charges,Implant Device,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1612,40,,1612,percent of total billed charges,Implant Devices,1410.5,70,,1410.5,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1370.2,34,,1370.2,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,1410.5,35,,1410.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1370.2,34,"If Charge > 2,000, then 34 percent",1370.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1612,
ZIMMER 00-5880-003-10 TIBIAL AUG SZ 3,C1776,HCPCS,,79008912,CDM,278,RC,,,both,,,4756,1877.04,39.4668,,1877.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1664.6,35,,1664.6,percent of total billed charges,Implant Device,1617.04,34,"Charges > $500, x 34%",1617.04,percent of total billed charges,Implant Device,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1902.4,40,,1902.4,percent of total billed charges,Implant Devices,1664.6,70,,1664.6,percent of total billed charges,Implant Devices,1617.04,34,,1617.04,percent of total billed charges,Implant Devices,1617.04,34,,1617.04,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1617.04,34,"If Charge > 2,000, then 34 percent",1617.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1902.4,
ZIMMER 00-5850-046-06 SEG TAPER 60MM,C1776,HCPCS,,79008913,CDM,278,RC,,,both,,,10705,4224.92,39.4668,,4224.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3746.75,35,,3746.75,percent of total billed charges,Implant Device,3639.7,34,"Charges > $500, x 34%",3639.7,percent of total billed charges,Implant Device,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,4282,40,,4282,percent of total billed charges,Implant Devices,3746.75,70,,3746.75,percent of total billed charges,Implant Devices,3639.7,34,,3639.7,percent of total billed charges,Implant Devices,3639.7,34,,3639.7,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3639.7,34,"If Charge > 2,000, then 34 percent",3639.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4282,
BIOMET 11-300816 DISTAL STEM 16X150MM,C1776,HCPCS,,79008949,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
TORNIER 7122881 HUMERAL HEAD 44X18MM,C1776,HCPCS,,79008956,CDM,278,RC,,,both,,,16246,6411.78,39.4668,,6411.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5523.64,34,,5523.64,percent of total billed charges,Implant Device,5523.64,34,,5523.64,percent of total billed charges,Implant Device,5523.64,34,,5523.64,percent of total billed charges,Implant Device,5523.64,34,,5523.64,percent of total billed charges,Implant Device,5523.64,34,,5523.64,percent of total billed charges,Implant Device,5523.64,34,,5523.64,percent of total billed charges,Implant Device,5686.1,35,,5686.1,percent of total billed charges,Implant Device,5523.64,34,"Charges > $500, x 34%",5523.64,percent of total billed charges,Implant Device,5686.1,35,,5686.1,percent of total billed charges,Implant Devices,5686.1,35,,5686.1,percent of total billed charges,Implant Devices,5686.1,35,,,percent of total billed charges,Implant Devices,5686.1,35,,5686.1,percent of total billed charges,Implant Devices,5686.1,35,,5686.1,percent of total billed charges,Implant Devices,6498.4,40,,6498.4,percent of total billed charges,Implant Devices,5686.1,70,,5686.1,percent of total billed charges,Implant Devices,5523.64,34,,5523.64,percent of total billed charges,Implant Devices,5523.64,34,,5523.64,percent of total billed charges,Implant Devices,5686.1,35,,5686.1,percent of total billed charges,Implant Devices,5686.1,35,,5686.1,percent of total billed charges,Implant Devices,5686.1,35,,5686.1,percent of total billed charges,Implant Devices,5686.1,35,,5686.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5523.64,34,"If Charge > 2,000, then 34 percent",5523.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6498.4,
TORNIER DWE403 GLENOID CORTILOC S40,C1776,HCPCS,,79008958,CDM,278,RC,,,both,,,10164,4011.41,39.4668,,4011.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3455.76,34,,3455.76,percent of total billed charges,Implant Device,3455.76,34,,3455.76,percent of total billed charges,Implant Device,3455.76,34,,3455.76,percent of total billed charges,Implant Device,3455.76,34,,3455.76,percent of total billed charges,Implant Device,3455.76,34,,3455.76,percent of total billed charges,Implant Device,3455.76,34,,3455.76,percent of total billed charges,Implant Device,3557.4,35,,3557.4,percent of total billed charges,Implant Device,3455.76,34,"Charges > $500, x 34%",3455.76,percent of total billed charges,Implant Device,3557.4,35,,3557.4,percent of total billed charges,Implant Devices,3557.4,35,,3557.4,percent of total billed charges,Implant Devices,3557.4,35,,,percent of total billed charges,Implant Devices,3557.4,35,,3557.4,percent of total billed charges,Implant Devices,3557.4,35,,3557.4,percent of total billed charges,Implant Devices,4065.6,40,,4065.6,percent of total billed charges,Implant Devices,3557.4,70,,3557.4,percent of total billed charges,Implant Devices,3455.76,34,,3455.76,percent of total billed charges,Implant Devices,3455.76,34,,3455.76,percent of total billed charges,Implant Devices,3557.4,35,,3557.4,percent of total billed charges,Implant Devices,3557.4,35,,3557.4,percent of total billed charges,Implant Devices,3557.4,35,,3557.4,percent of total billed charges,Implant Devices,3557.4,35,,3557.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3455.76,34,"If Charge > 2,000, then 34 percent",3455.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4065.6,
TORNIER DWG402 SIMPLICITI NUCLEUS SZ 2,C1776,HCPCS,,79008959,CDM,278,RC,,,both,,,20533,8103.72,39.4668,,8103.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6981.22,34,,6981.22,percent of total billed charges,Implant Device,6981.22,34,,6981.22,percent of total billed charges,Implant Device,6981.22,34,,6981.22,percent of total billed charges,Implant Device,6981.22,34,,6981.22,percent of total billed charges,Implant Device,6981.22,34,,6981.22,percent of total billed charges,Implant Device,6981.22,34,,6981.22,percent of total billed charges,Implant Device,7186.55,35,,7186.55,percent of total billed charges,Implant Device,6981.22,34,"Charges > $500, x 34%",6981.22,percent of total billed charges,Implant Device,7186.55,35,,7186.55,percent of total billed charges,Implant Devices,7186.55,35,,7186.55,percent of total billed charges,Implant Devices,7186.55,35,,,percent of total billed charges,Implant Devices,7186.55,35,,7186.55,percent of total billed charges,Implant Devices,7186.55,35,,7186.55,percent of total billed charges,Implant Devices,8213.2,40,,8213.2,percent of total billed charges,Implant Devices,7186.55,70,,7186.55,percent of total billed charges,Implant Devices,6981.22,34,,6981.22,percent of total billed charges,Implant Devices,6981.22,34,,6981.22,percent of total billed charges,Implant Devices,7186.55,35,,7186.55,percent of total billed charges,Implant Devices,7186.55,35,,7186.55,percent of total billed charges,Implant Devices,7186.55,35,,7186.55,percent of total billed charges,Implant Devices,7186.55,35,,7186.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6981.22,34,"If Charge > 2,000, then 34 percent",6981.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8213.2,
EXACTECH SPS0121K INTERSPACE SHOULDR KIT,C1776,HCPCS,,79008971,CDM,278,RC,,,both,,,11942,4713.13,39.4668,,4713.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4060.28,34,,4060.28,percent of total billed charges,Implant Device,4060.28,34,,4060.28,percent of total billed charges,Implant Device,4060.28,34,,4060.28,percent of total billed charges,Implant Device,4060.28,34,,4060.28,percent of total billed charges,Implant Device,4060.28,34,,4060.28,percent of total billed charges,Implant Device,4060.28,34,,4060.28,percent of total billed charges,Implant Device,4179.7,35,,4179.7,percent of total billed charges,Implant Device,4060.28,34,"Charges > $500, x 34%",4060.28,percent of total billed charges,Implant Device,4179.7,35,,4179.7,percent of total billed charges,Implant Devices,4179.7,35,,4179.7,percent of total billed charges,Implant Devices,4179.7,35,,,percent of total billed charges,Implant Devices,4179.7,35,,4179.7,percent of total billed charges,Implant Devices,4179.7,35,,4179.7,percent of total billed charges,Implant Devices,4776.8,40,,4776.8,percent of total billed charges,Implant Devices,4179.7,70,,4179.7,percent of total billed charges,Implant Devices,4060.28,34,,4060.28,percent of total billed charges,Implant Devices,4060.28,34,,4060.28,percent of total billed charges,Implant Devices,4179.7,35,,4179.7,percent of total billed charges,Implant Devices,4179.7,35,,4179.7,percent of total billed charges,Implant Devices,4179.7,35,,4179.7,percent of total billed charges,Implant Devices,4179.7,35,,4179.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4060.28,34,"If Charge > 2,000, then 34 percent",4060.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4776.8,
ZIMMER 00-7711-013-20 M/L TAPER 13.5 EXT,C1776,HCPCS,,79009006,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 00-5988-020-15 STEM EXT 15X100MM,C1776,HCPCS,,79009016,CDM,278,RC,,,both,,,4381,1729.04,39.4668,,1729.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1489.54,34,,1489.54,percent of total billed charges,Implant Device,1533.35,35,,1533.35,percent of total billed charges,Implant Device,1489.54,34,"Charges > $500, x 34%",1489.54,percent of total billed charges,Implant Device,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1752.4,40,,1752.4,percent of total billed charges,Implant Devices,1533.35,70,,1533.35,percent of total billed charges,Implant Devices,1489.54,34,,1489.54,percent of total billed charges,Implant Devices,1489.54,34,,1489.54,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,1533.35,35,,1533.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1489.54,34,"If Charge > 2,000, then 34 percent",1489.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1752.4,
EXACTECH 304-22-07 FRAC HUM STEM 5.6 RT,C1776,HCPCS,,79009068,CDM,278,RC,,,both,,,6225,2456.81,39.4668,,2456.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2116.5,34,,2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Device,2116.5,34,"Charges > $500, x 34%",2116.5,percent of total billed charges,Implant Device,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2490,40,,2490,percent of total billed charges,Implant Devices,2178.75,70,,2178.75,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2116.5,34,,2116.5,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,2178.75,35,,2178.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2116.5,34,"If Charge > 2,000, then 34 percent",2116.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2490,
STRYKER 5552-E-4014 HUMERAL HEAD 40X14MM,C1776,HCPCS,,79009083,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
DEPUY 1961-92-032 TIBIAL INSERT SZ 3 2.5,C1776,HCPCS,,79009095,CDM,278,RC,,,both,,,5735,2263.42,39.4668,,2263.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,2007.25,35,,2007.25,percent of total billed charges,Implant Device,1949.9,34,"Charges > $500, x 34%",1949.9,percent of total billed charges,Implant Device,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2294,40,,2294,percent of total billed charges,Implant Devices,2007.25,70,,2007.25,percent of total billed charges,Implant Devices,1949.9,34,,1949.9,percent of total billed charges,Implant Devices,1949.9,34,,1949.9,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1949.9,34,"If Charge > 2,000, then 34 percent",1949.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2294,
ZIMMER 00-5976-030-12 ART SURF SZ 12MM,C1776,HCPCS,,79009126,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
ZIMMER 00-5950-015-02 FEM COMP SZ E RT,C1776,HCPCS,,79009127,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
STRYKER UH1-58-26 UHR UNIV HEAD 58X26MM,C1776,HCPCS,,79009128,CDM,278,RC,,,both,,,2667,1052.58,39.4668,,1052.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,906.78,34,,906.78,percent of total billed charges,Implant Device,906.78,34,,906.78,percent of total billed charges,Implant Device,906.78,34,,906.78,percent of total billed charges,Implant Device,906.78,34,,906.78,percent of total billed charges,Implant Device,906.78,34,,906.78,percent of total billed charges,Implant Device,906.78,34,,906.78,percent of total billed charges,Implant Device,933.45,35,,933.45,percent of total billed charges,Implant Device,906.78,34,"Charges > $500, x 34%",906.78,percent of total billed charges,Implant Device,933.45,35,,933.45,percent of total billed charges,Implant Devices,933.45,35,,933.45,percent of total billed charges,Implant Devices,933.45,35,,,percent of total billed charges,Implant Devices,933.45,35,,933.45,percent of total billed charges,Implant Devices,933.45,35,,933.45,percent of total billed charges,Implant Devices,1066.8,40,,1066.8,percent of total billed charges,Implant Devices,933.45,70,,933.45,percent of total billed charges,Implant Devices,906.78,34,,906.78,percent of total billed charges,Implant Devices,906.78,34,,906.78,percent of total billed charges,Implant Devices,933.45,35,,933.45,percent of total billed charges,Implant Devices,933.45,35,,933.45,percent of total billed charges,Implant Devices,933.45,35,,933.45,percent of total billed charges,Implant Devices,933.45,35,,933.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,906.78,34,"If Charge > 2,000, then 34 percent",906.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1066.8,
DEPUY 1570-06-120 FEM STEM SZ 6 127MM,C1776,HCPCS,,79009131,CDM,278,RC,,,both,,,5575,2200.27,39.4668,,2200.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1951.25,35,,1951.25,percent of total billed charges,Implant Device,1895.5,34,"Charges > $500, x 34%",1895.5,percent of total billed charges,Implant Device,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,2230,40,,2230,percent of total billed charges,Implant Devices,1951.25,70,,1951.25,percent of total billed charges,Implant Devices,1895.5,34,,1895.5,percent of total billed charges,Implant Devices,1895.5,34,,1895.5,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1895.5,34,"If Charge > 2,000, then 34 percent",1895.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2230,
DEPUY 1376-38-000 STEM CENTRALIZER 10.5M,C1776,HCPCS,,79009132,CDM,278,RC,,,both,,,276,108.93,39.4668,,108.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,93.84,34,,93.84,percent of total billed charges,Implant Device,96.6,35,,96.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,110.4,40,,110.4,percent of total billed charges,Implant Devices,96.6,70,,96.6,percent of total billed charges,Implant Devices,93.84,34,,93.84,percent of total billed charges,Implant Devices,93.84,34,,93.84,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,96.6,35,,96.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.4,
S&N 71420570 PATELLAR COMPONENT 29MM,C1776,HCPCS,,79009137,CDM,278,RC,,,both,,,2030,801.18,39.4668,,801.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,690.2,34,,690.2,percent of total billed charges,Implant Device,690.2,34,,690.2,percent of total billed charges,Implant Device,690.2,34,,690.2,percent of total billed charges,Implant Device,690.2,34,,690.2,percent of total billed charges,Implant Device,690.2,34,,690.2,percent of total billed charges,Implant Device,690.2,34,,690.2,percent of total billed charges,Implant Device,710.5,35,,710.5,percent of total billed charges,Implant Device,690.2,34,"Charges > $500, x 34%",690.2,percent of total billed charges,Implant Device,710.5,35,,710.5,percent of total billed charges,Implant Devices,710.5,35,,710.5,percent of total billed charges,Implant Devices,710.5,35,,,percent of total billed charges,Implant Devices,710.5,35,,710.5,percent of total billed charges,Implant Devices,710.5,35,,710.5,percent of total billed charges,Implant Devices,812,40,,812,percent of total billed charges,Implant Devices,710.5,70,,710.5,percent of total billed charges,Implant Devices,690.2,34,,690.2,percent of total billed charges,Implant Devices,690.2,34,,690.2,percent of total billed charges,Implant Devices,710.5,35,,710.5,percent of total billed charges,Implant Devices,710.5,35,,710.5,percent of total billed charges,Implant Devices,710.5,35,,710.5,percent of total billed charges,Implant Devices,710.5,35,,710.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,690.2,34,"If Charge > 2,000, then 34 percent",690.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,812,
STRYKER 00-8851-010-32 LINER 32X52MM,C1776,HCPCS,,79009159,CDM,278,RC,,,both,,,4845,1912.17,39.4668,,1912.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1647.3,34,,1647.3,percent of total billed charges,Implant Device,1695.75,35,,1695.75,percent of total billed charges,Implant Device,1647.3,34,"Charges > $500, x 34%",1647.3,percent of total billed charges,Implant Device,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1938,40,,1938,percent of total billed charges,Implant Devices,1695.75,70,,1695.75,percent of total billed charges,Implant Devices,1647.3,34,,1647.3,percent of total billed charges,Implant Devices,1647.3,34,,1647.3,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,1695.75,35,,1695.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1647.3,34,"If Charge > 2,000, then 34 percent",1647.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1938,
ZIMMER 00-5988-006-26 TIBIAL BLOCK 6X5MM,C1776,HCPCS,,79009174,CDM,278,RC,,,both,,,2993,1181.24,39.4668,,1181.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1017.62,34,,1017.62,percent of total billed charges,Implant Device,1047.55,35,,1047.55,percent of total billed charges,Implant Device,1017.62,34,"Charges > $500, x 34%",1017.62,percent of total billed charges,Implant Device,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1197.2,40,,1197.2,percent of total billed charges,Implant Devices,1047.55,70,,1047.55,percent of total billed charges,Implant Devices,1017.62,34,,1017.62,percent of total billed charges,Implant Devices,1017.62,34,,1017.62,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,1047.55,35,,1047.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1017.62,34,"If Charge > 2,000, then 34 percent",1017.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1197.2,
ZIMMER 00-5990-037-23 FEM AUG BLOCK 15MM,C1776,HCPCS,,79009175,CDM,278,RC,,,both,,,3488,1376.6,39.4668,,1376.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1185.92,34,,1185.92,percent of total billed charges,Implant Device,1220.8,35,,1220.8,percent of total billed charges,Implant Device,1185.92,34,"Charges > $500, x 34%",1185.92,percent of total billed charges,Implant Device,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1395.2,40,,1395.2,percent of total billed charges,Implant Devices,1220.8,70,,1220.8,percent of total billed charges,Implant Devices,1185.92,34,,1185.92,percent of total billed charges,Implant Devices,1185.92,34,,1185.92,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,1220.8,35,,1220.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1185.92,34,"If Charge > 2,000, then 34 percent",1185.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1395.2,
ZIMMER 00-5994-042-12 ART SURF SZ G 12MM,C1776,HCPCS,,79009176,CDM,278,RC,,,both,,,6320,2494.3,39.4668,,2494.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2212,35,,2212,percent of total billed charges,Implant Device,2148.8,34,"Charges > $500, x 34%",2148.8,percent of total billed charges,Implant Device,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2528,40,,2528,percent of total billed charges,Implant Devices,2212,70,,2212,percent of total billed charges,Implant Devices,2148.8,34,,2148.8,percent of total billed charges,Implant Devices,2148.8,34,,2148.8,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2148.8,34,"If Charge > 2,000, then 34 percent",2148.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2528,
DEPUY 1961-92-034 TIB INSERT SZ 3 17.5MM,C1776,HCPCS,,79009185,CDM,278,RC,,,both,,,5735,2263.42,39.4668,,2263.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,2007.25,35,,2007.25,percent of total billed charges,Implant Device,1949.9,34,"Charges > $500, x 34%",1949.9,percent of total billed charges,Implant Device,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2294,40,,2294,percent of total billed charges,Implant Devices,2007.25,70,,2007.25,percent of total billed charges,Implant Devices,1949.9,34,,1949.9,percent of total billed charges,Implant Devices,1949.9,34,,1949.9,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1949.9,34,"If Charge > 2,000, then 34 percent",1949.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2294,
LIFECELL 1516128 ALLODERM 8X16 RTU THIN,C1776,HCPCS,,79009186,CDM,278,RC,,,both,,,15309,6041.97,39.4668,,6041.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5358.15,35,,5358.15,percent of total billed charges,Implant Device,5205.06,34,"Charges > $500, x 34%",5205.06,percent of total billed charges,Implant Device,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,6123.6,40,,6123.6,percent of total billed charges,Implant Devices,5358.15,70,,5358.15,percent of total billed charges,Implant Devices,5205.06,34,,5205.06,percent of total billed charges,Implant Devices,5205.06,34,,5205.06,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5205.06,34,"If Charge > 2,000, then 34 percent",5205.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6123.6,
ZIMMER 11-300818 DISTAL STEM 18X150MM,C1776,HCPCS,,79009188,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
DEPUY 1570-06-080 FEM STEM SZ 2 97MM,C1776,HCPCS,,79009195,CDM,278,RC,,,both,,,5575,2200.27,39.4668,,2200.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1895.5,34,,1895.5,percent of total billed charges,Implant Device,1951.25,35,,1951.25,percent of total billed charges,Implant Device,1895.5,34,"Charges > $500, x 34%",1895.5,percent of total billed charges,Implant Device,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,2230,40,,2230,percent of total billed charges,Implant Devices,1951.25,70,,1951.25,percent of total billed charges,Implant Devices,1895.5,34,,1895.5,percent of total billed charges,Implant Devices,1895.5,34,,1895.5,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,1951.25,35,,1951.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1895.5,34,"If Charge > 2,000, then 34 percent",1895.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2230,
DEPUY 1570-06-080 FEMORAL 26-3MM,C1776,HCPCS,,79009196,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
DEPUY 3L92504 CORAIL AMT COLLAR SIZE 14,C1776,HCPCS,,79009212,CDM,278,RC,,,both,,,13446,5306.71,39.4668,,5306.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Device,4571.64,34,"Charges > $500, x 34%",4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,5378.4,40,,5378.4,percent of total billed charges,Implant Devices,4706.1,70,,4706.1,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4571.64,34,"If Charge > 2,000, then 34 percent",4571.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5378.4,
ZIMMER 00-7711-006-00 M/L TAPER 6 STD,C1776,HCPCS,,79009265,CDM,278,RC,,,both,,,8910,3516.49,39.4668,,3516.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Device,3029.4,34,"Charges > $500, x 34%",3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3564,40,,3564,percent of total billed charges,Implant Devices,3118.5,70,,3118.5,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3029.4,34,"If Charge > 2,000, then 34 percent",3029.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3564,
ZIMMER 00-7711-017-20 M/L TAPER 17.5 EXT,C1776,HCPCS,,79009267,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
DEPUY 3L92500 CORAIL HIP COLLAR SZ 10,C1776,HCPCS,,79009268,CDM,278,RC,,,both,,,13446,5306.71,39.4668,,5306.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Device,4571.64,34,"Charges > $500, x 34%",4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,5378.4,40,,5378.4,percent of total billed charges,Implant Devices,4706.1,70,,4706.1,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4571.64,34,"If Charge > 2,000, then 34 percent",4571.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5378.4,
STRYKER 6276-015 MODULAR HIP 155X15MM,C1776,HCPCS,,79009269,CDM,278,RC,,,both,,,15107,5962.25,39.4668,,5962.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5136.38,34,,5136.38,percent of total billed charges,Implant Device,5136.38,34,,5136.38,percent of total billed charges,Implant Device,5136.38,34,,5136.38,percent of total billed charges,Implant Device,5136.38,34,,5136.38,percent of total billed charges,Implant Device,5136.38,34,,5136.38,percent of total billed charges,Implant Device,5136.38,34,,5136.38,percent of total billed charges,Implant Device,5287.45,35,,5287.45,percent of total billed charges,Implant Device,5136.38,34,"Charges > $500, x 34%",5136.38,percent of total billed charges,Implant Device,5287.45,35,,5287.45,percent of total billed charges,Implant Devices,5287.45,35,,5287.45,percent of total billed charges,Implant Devices,5287.45,35,,,percent of total billed charges,Implant Devices,5287.45,35,,5287.45,percent of total billed charges,Implant Devices,5287.45,35,,5287.45,percent of total billed charges,Implant Devices,6042.8,40,,6042.8,percent of total billed charges,Implant Devices,5287.45,70,,5287.45,percent of total billed charges,Implant Devices,5136.38,34,,5136.38,percent of total billed charges,Implant Devices,5136.38,34,,5136.38,percent of total billed charges,Implant Devices,5287.45,35,,5287.45,percent of total billed charges,Implant Devices,5287.45,35,,5287.45,percent of total billed charges,Implant Devices,5287.45,35,,5287.45,percent of total billed charges,Implant Devices,5287.45,35,,5287.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5136.38,34,"If Charge > 2,000, then 34 percent",5136.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6042.8,
ZIMMER 00-5988-003-10 TIBIAL BLOCK 10MM,C1776,HCPCS,,79009296,CDM,278,RC,,,both,,,4343,1714.04,39.4668,,1714.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1520.05,35,,1520.05,percent of total billed charges,Implant Device,1476.62,34,"Charges > $500, x 34%",1476.62,percent of total billed charges,Implant Device,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1737.2,40,,1737.2,percent of total billed charges,Implant Devices,1520.05,70,,1520.05,percent of total billed charges,Implant Devices,1476.62,34,,1476.62,percent of total billed charges,Implant Devices,1476.62,34,,1476.62,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1476.62,34,"If Charge > 2,000, then 34 percent",1476.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1737.2,
ZIMMER 00-5994-032-10 ART SURFACE 10MM,C1776,HCPCS,,79009297,CDM,278,RC,,,both,,,6465,2551.53,39.4668,,2551.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Device,2198.1,34,"Charges > $500, x 34%",2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2586,40,,2586,percent of total billed charges,Implant Devices,2262.75,70,,2262.75,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2198.1,34,"If Charge > 2,000, then 34 percent",2198.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2586,
DEPUY 1516-50-410 TIB INSERT SZ 4 10MM,C1776,HCPCS,,79009330,CDM,278,RC,,,both,,,5624,2219.61,39.4668,,2219.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1968.4,35,,1968.4,percent of total billed charges,Implant Device,1912.16,34,"Charges > $500, x 34%",1912.16,percent of total billed charges,Implant Device,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,2249.6,40,,2249.6,percent of total billed charges,Implant Devices,1968.4,70,,1968.4,percent of total billed charges,Implant Devices,1912.16,34,,1912.16,percent of total billed charges,Implant Devices,1912.16,34,,1912.16,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1912.16,34,"If Charge > 2,000, then 34 percent",1912.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2249.6,
ZIMMER 11-300817 DISTAL STEM 17X150MM,C1776,HCPCS,,79009331,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
ZIMMER 00-12-115109 BIOLOZ MOD HEAD 28MM,C1776,HCPCS,,79009340,CDM,278,RC,,,both,,,5908,2331.7,39.4668,,2331.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2008.72,34,,2008.72,percent of total billed charges,Implant Device,2008.72,34,,2008.72,percent of total billed charges,Implant Device,2008.72,34,,2008.72,percent of total billed charges,Implant Device,2008.72,34,,2008.72,percent of total billed charges,Implant Device,2008.72,34,,2008.72,percent of total billed charges,Implant Device,2008.72,34,,2008.72,percent of total billed charges,Implant Device,2067.8,35,,2067.8,percent of total billed charges,Implant Device,2008.72,34,"Charges > $500, x 34%",2008.72,percent of total billed charges,Implant Device,2067.8,35,,2067.8,percent of total billed charges,Implant Devices,2067.8,35,,2067.8,percent of total billed charges,Implant Devices,2067.8,35,,,percent of total billed charges,Implant Devices,2067.8,35,,2067.8,percent of total billed charges,Implant Devices,2067.8,35,,2067.8,percent of total billed charges,Implant Devices,2363.2,40,,2363.2,percent of total billed charges,Implant Devices,2067.8,70,,2067.8,percent of total billed charges,Implant Devices,2008.72,34,,2008.72,percent of total billed charges,Implant Devices,2008.72,34,,2008.72,percent of total billed charges,Implant Devices,2067.8,35,,2067.8,percent of total billed charges,Implant Devices,2067.8,35,,2067.8,percent of total billed charges,Implant Devices,2067.8,35,,2067.8,percent of total billed charges,Implant Devices,2067.8,35,,2067.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2008.72,34,"If Charge > 2,000, then 34 percent",2008.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2363.2,
ZIMMER 00-11-3000820 20X150 SPL TPR DIST,C1776,HCPCS,,79009341,CDM,278,RC,,,both,,,10506,4146.38,39.4668,,4146.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3572.04,34,,3572.04,percent of total billed charges,Implant Device,3572.04,34,,3572.04,percent of total billed charges,Implant Device,3572.04,34,,3572.04,percent of total billed charges,Implant Device,3572.04,34,,3572.04,percent of total billed charges,Implant Device,3572.04,34,,3572.04,percent of total billed charges,Implant Device,3572.04,34,,3572.04,percent of total billed charges,Implant Device,3677.1,35,,3677.1,percent of total billed charges,Implant Device,3572.04,34,"Charges > $500, x 34%",3572.04,percent of total billed charges,Implant Device,3677.1,35,,3677.1,percent of total billed charges,Implant Devices,3677.1,35,,3677.1,percent of total billed charges,Implant Devices,3677.1,35,,,percent of total billed charges,Implant Devices,3677.1,35,,3677.1,percent of total billed charges,Implant Devices,3677.1,35,,3677.1,percent of total billed charges,Implant Devices,4202.4,40,,4202.4,percent of total billed charges,Implant Devices,3677.1,70,,3677.1,percent of total billed charges,Implant Devices,3572.04,34,,3572.04,percent of total billed charges,Implant Devices,3572.04,34,,3572.04,percent of total billed charges,Implant Devices,3677.1,35,,3677.1,percent of total billed charges,Implant Devices,3677.1,35,,3677.1,percent of total billed charges,Implant Devices,3677.1,35,,3677.1,percent of total billed charges,Implant Devices,3677.1,35,,3677.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3572.04,34,"If Charge > 2,000, then 34 percent",3572.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4202.4,
ZIMMER 00-5950-016-05 FEM COMP SZ F LT,C1776,HCPCS,,79009360,CDM,278,RC,,,both,,,14693,5798.86,39.4668,,5798.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4995.62,34,,4995.62,percent of total billed charges,Implant Device,4995.62,34,,4995.62,percent of total billed charges,Implant Device,4995.62,34,,4995.62,percent of total billed charges,Implant Device,4995.62,34,,4995.62,percent of total billed charges,Implant Device,4995.62,34,,4995.62,percent of total billed charges,Implant Device,4995.62,34,,4995.62,percent of total billed charges,Implant Device,5142.55,35,,5142.55,percent of total billed charges,Implant Device,4995.62,34,"Charges > $500, x 34%",4995.62,percent of total billed charges,Implant Device,5142.55,35,,5142.55,percent of total billed charges,Implant Devices,5142.55,35,,5142.55,percent of total billed charges,Implant Devices,5142.55,35,,,percent of total billed charges,Implant Devices,5142.55,35,,5142.55,percent of total billed charges,Implant Devices,5142.55,35,,5142.55,percent of total billed charges,Implant Devices,5877.2,40,,5877.2,percent of total billed charges,Implant Devices,5142.55,70,,5142.55,percent of total billed charges,Implant Devices,4995.62,34,,4995.62,percent of total billed charges,Implant Devices,4995.62,34,,4995.62,percent of total billed charges,Implant Devices,5142.55,35,,5142.55,percent of total billed charges,Implant Devices,5142.55,35,,5142.55,percent of total billed charges,Implant Devices,5142.55,35,,5142.55,percent of total billed charges,Implant Devices,5142.55,35,,5142.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4995.62,34,"If Charge > 2,000, then 34 percent",4995.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5877.2,
DEPUY SYNTHES L98014 CONRAIL REV STEM 14,C1776,HCPCS,,79009374,CDM,278,RC,,,both,,,23137,9131.43,39.4668,,9131.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7866.58,34,,7866.58,percent of total billed charges,Implant Device,7866.58,34,,7866.58,percent of total billed charges,Implant Device,7866.58,34,,7866.58,percent of total billed charges,Implant Device,7866.58,34,,7866.58,percent of total billed charges,Implant Device,7866.58,34,,7866.58,percent of total billed charges,Implant Device,7866.58,34,,7866.58,percent of total billed charges,Implant Device,8097.95,35,,8097.95,percent of total billed charges,Implant Device,7866.58,34,"Charges > $500, x 34%",7866.58,percent of total billed charges,Implant Device,8097.95,35,,8097.95,percent of total billed charges,Implant Devices,8097.95,35,,8097.95,percent of total billed charges,Implant Devices,8097.95,35,,,percent of total billed charges,Implant Devices,8097.95,35,,8097.95,percent of total billed charges,Implant Devices,8097.95,35,,8097.95,percent of total billed charges,Implant Devices,9254.8,40,,9254.8,percent of total billed charges,Implant Devices,8097.95,70,,8097.95,percent of total billed charges,Implant Devices,7866.58,34,,7866.58,percent of total billed charges,Implant Devices,7866.58,34,,7866.58,percent of total billed charges,Implant Devices,8097.95,35,,8097.95,percent of total billed charges,Implant Devices,8097.95,35,,8097.95,percent of total billed charges,Implant Devices,8097.95,35,,8097.95,percent of total billed charges,Implant Devices,8097.95,35,,8097.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7866.58,34,"If Charge > 2,000, then 34 percent",7866.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9254.8,
DEPUY 1217-01-056 PINNACLE ACET CUP 56MM,C1776,HCPCS,,79009375,CDM,278,RC,,,both,,,4967,1960.32,39.4668,,1960.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1688.78,34,,1688.78,percent of total billed charges,Implant Device,1688.78,34,,1688.78,percent of total billed charges,Implant Device,1688.78,34,,1688.78,percent of total billed charges,Implant Device,1688.78,34,,1688.78,percent of total billed charges,Implant Device,1688.78,34,,1688.78,percent of total billed charges,Implant Device,1688.78,34,,1688.78,percent of total billed charges,Implant Device,1738.45,35,,1738.45,percent of total billed charges,Implant Device,1688.78,34,"Charges > $500, x 34%",1688.78,percent of total billed charges,Implant Device,1738.45,35,,1738.45,percent of total billed charges,Implant Devices,1738.45,35,,1738.45,percent of total billed charges,Implant Devices,1738.45,35,,,percent of total billed charges,Implant Devices,1738.45,35,,1738.45,percent of total billed charges,Implant Devices,1738.45,35,,1738.45,percent of total billed charges,Implant Devices,1986.8,40,,1986.8,percent of total billed charges,Implant Devices,1738.45,70,,1738.45,percent of total billed charges,Implant Devices,1688.78,34,,1688.78,percent of total billed charges,Implant Devices,1688.78,34,,1688.78,percent of total billed charges,Implant Devices,1738.45,35,,1738.45,percent of total billed charges,Implant Devices,1738.45,35,,1738.45,percent of total billed charges,Implant Devices,1738.45,35,,1738.45,percent of total billed charges,Implant Devices,1738.45,35,,1738.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1688.78,34,"If Charge > 2,000, then 34 percent",1688.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1986.8,
DEPUY 1221-36-156 ALTRX +4 10D 36IDX560D,C1776,HCPCS,,79009376,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
DEPUY 1516-30-707 TIBIAL INSERT SZ 7 7MM,C1776,HCPCS,,79009380,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
WRIGHT 4260050 FLEX HINGE TOE IMP SZ 5,C1776,HCPCS,,79009382,CDM,278,RC,,,both,,,4296,1695.49,39.4668,,1695.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1460.64,34,,1460.64,percent of total billed charges,Implant Device,1460.64,34,,1460.64,percent of total billed charges,Implant Device,1460.64,34,,1460.64,percent of total billed charges,Implant Device,1460.64,34,,1460.64,percent of total billed charges,Implant Device,1460.64,34,,1460.64,percent of total billed charges,Implant Device,1460.64,34,,1460.64,percent of total billed charges,Implant Device,1503.6,35,,1503.6,percent of total billed charges,Implant Device,1460.64,34,"Charges > $500, x 34%",1460.64,percent of total billed charges,Implant Device,1503.6,35,,1503.6,percent of total billed charges,Implant Devices,1503.6,35,,1503.6,percent of total billed charges,Implant Devices,1503.6,35,,,percent of total billed charges,Implant Devices,1503.6,35,,1503.6,percent of total billed charges,Implant Devices,1503.6,35,,1503.6,percent of total billed charges,Implant Devices,1718.4,40,,1718.4,percent of total billed charges,Implant Devices,1503.6,70,,1503.6,percent of total billed charges,Implant Devices,1460.64,34,,1460.64,percent of total billed charges,Implant Devices,1460.64,34,,1460.64,percent of total billed charges,Implant Devices,1503.6,35,,1503.6,percent of total billed charges,Implant Devices,1503.6,35,,1503.6,percent of total billed charges,Implant Devices,1503.6,35,,1503.6,percent of total billed charges,Implant Devices,1503.6,35,,1503.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1460.64,34,"If Charge > 2,000, then 34 percent",1460.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1718.4,
EXACTECH 300-01-10 HUMERAL STEM 10MM,C1776,HCPCS,,79009383,CDM,278,RC,,,both,,,4425,1746.41,39.4668,,1746.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Device,1504.5,34,"Charges > $500, x 34%",1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1770,40,,1770,percent of total billed charges,Implant Devices,1548.75,70,,1548.75,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1504.5,34,"If Charge > 2,000, then 34 percent",1504.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1770,
DEPUY 1035-46-000 SELF CTR HIP 46X28,C1776,HCPCS,,79009405,CDM,278,RC,,,both,,,1733,683.96,39.4668,,683.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Device,589.22,34,"Charges > $500, x 34%",589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,693.2,40,,693.2,percent of total billed charges,Implant Devices,606.55,70,,606.55,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,693.2,
ZIMMER 00-8851-014-36 NEUTRAL LINER 36MM,C1776,HCPCS,,79009418,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
STRYKER 5570-3204 HUMERAL CAP 32X4MM,C1776,HCPCS,,79009436,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
STRYKER 5571-S-3204 HUMERAL INSERT 32X4,C1776,HCPCS,,79009437,CDM,278,RC,,,both,,,7353,2901.99,39.4668,,2901.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2500.02,34,,2500.02,percent of total billed charges,Implant Device,2500.02,34,,2500.02,percent of total billed charges,Implant Device,2500.02,34,,2500.02,percent of total billed charges,Implant Device,2500.02,34,,2500.02,percent of total billed charges,Implant Device,2500.02,34,,2500.02,percent of total billed charges,Implant Device,2500.02,34,,2500.02,percent of total billed charges,Implant Device,2573.55,35,,2573.55,percent of total billed charges,Implant Device,2500.02,34,"Charges > $500, x 34%",2500.02,percent of total billed charges,Implant Device,2573.55,35,,2573.55,percent of total billed charges,Implant Devices,2573.55,35,,2573.55,percent of total billed charges,Implant Devices,2573.55,35,,,percent of total billed charges,Implant Devices,2573.55,35,,2573.55,percent of total billed charges,Implant Devices,2573.55,35,,2573.55,percent of total billed charges,Implant Devices,2941.2,40,,2941.2,percent of total billed charges,Implant Devices,2573.55,70,,2573.55,percent of total billed charges,Implant Devices,2500.02,34,,2500.02,percent of total billed charges,Implant Devices,2500.02,34,,2500.02,percent of total billed charges,Implant Devices,2573.55,35,,2573.55,percent of total billed charges,Implant Devices,2573.55,35,,2573.55,percent of total billed charges,Implant Devices,2573.55,35,,2573.55,percent of total billed charges,Implant Devices,2573.55,35,,2573.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2500.02,34,"If Charge > 2,000, then 34 percent",2500.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2941.2,
STRYKER 5573-C-3202 GLENOSPHERE 32X2MM,C1776,HCPCS,,79009438,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
DEPUY 1365-36-340 FEMORAL HEAD +12.36MM,C1776,HCPCS,,79009456,CDM,278,RC,,,both,,,5253,2073.19,39.4668,,2073.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1786.02,34,,1786.02,percent of total billed charges,Implant Device,1786.02,34,,1786.02,percent of total billed charges,Implant Device,1786.02,34,,1786.02,percent of total billed charges,Implant Device,1786.02,34,,1786.02,percent of total billed charges,Implant Device,1786.02,34,,1786.02,percent of total billed charges,Implant Device,1786.02,34,,1786.02,percent of total billed charges,Implant Device,1838.55,35,,1838.55,percent of total billed charges,Implant Device,1786.02,34,"Charges > $500, x 34%",1786.02,percent of total billed charges,Implant Device,1838.55,35,,1838.55,percent of total billed charges,Implant Devices,1838.55,35,,1838.55,percent of total billed charges,Implant Devices,1838.55,35,,,percent of total billed charges,Implant Devices,1838.55,35,,1838.55,percent of total billed charges,Implant Devices,1838.55,35,,1838.55,percent of total billed charges,Implant Devices,2101.2,40,,2101.2,percent of total billed charges,Implant Devices,1838.55,70,,1838.55,percent of total billed charges,Implant Devices,1786.02,34,,1786.02,percent of total billed charges,Implant Devices,1786.02,34,,1786.02,percent of total billed charges,Implant Devices,1838.55,35,,1838.55,percent of total billed charges,Implant Devices,1838.55,35,,1838.55,percent of total billed charges,Implant Devices,1838.55,35,,1838.55,percent of total billed charges,Implant Devices,1838.55,35,,1838.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1786.02,34,"If Charge > 2,000, then 34 percent",1786.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2101.2,
DEPUY 1018-36-511 FEMORAL HEAD 036MM,C1776,HCPCS,,79009464,CDM,278,RC,,,both,,,6682,2637.17,39.4668,,2637.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2271.88,34,,2271.88,percent of total billed charges,Implant Device,2271.88,34,,2271.88,percent of total billed charges,Implant Device,2271.88,34,,2271.88,percent of total billed charges,Implant Device,2271.88,34,,2271.88,percent of total billed charges,Implant Device,2271.88,34,,2271.88,percent of total billed charges,Implant Device,2271.88,34,,2271.88,percent of total billed charges,Implant Device,2338.7,35,,2338.7,percent of total billed charges,Implant Device,2271.88,34,"Charges > $500, x 34%",2271.88,percent of total billed charges,Implant Device,2338.7,35,,2338.7,percent of total billed charges,Implant Devices,2338.7,35,,2338.7,percent of total billed charges,Implant Devices,2338.7,35,,,percent of total billed charges,Implant Devices,2338.7,35,,2338.7,percent of total billed charges,Implant Devices,2338.7,35,,2338.7,percent of total billed charges,Implant Devices,2672.8,40,,2672.8,percent of total billed charges,Implant Devices,2338.7,70,,2338.7,percent of total billed charges,Implant Devices,2271.88,34,,2271.88,percent of total billed charges,Implant Devices,2271.88,34,,2271.88,percent of total billed charges,Implant Devices,2338.7,35,,2338.7,percent of total billed charges,Implant Devices,2338.7,35,,2338.7,percent of total billed charges,Implant Devices,2338.7,35,,2338.7,percent of total billed charges,Implant Devices,2338.7,35,,2338.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2271.88,34,"If Charge > 2,000, then 34 percent",2271.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2672.8,
ZIMMER 00-5952-040-14 ARTICULR SURF 14MM,C1776,HCPCS,,79009472,CDM,278,RC,,,both,,,2496,985.09,39.4668,,985.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,848.64,34,,848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Device,848.64,34,"Charges > $500, x 34%",848.64,percent of total billed charges,Implant Device,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,998.4,40,,998.4,percent of total billed charges,Implant Devices,873.6,70,,873.6,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,848.64,34,,848.64,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,873.6,35,,873.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.64,34,"If Charge > 2,000, then 34 percent",848.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998.4,
ZIMMER 00-5994-051-17 ARTICULR SURF 17MM,C1776,HCPCS,,79009473,CDM,278,RC,,,both,,,6257,2469.44,39.4668,,2469.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Device,2127.38,34,"Charges > $500, x 34%",2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2502.8,40,,2502.8,percent of total billed charges,Implant Devices,2189.95,70,,2189.95,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2127.38,34,"If Charge > 2,000, then 34 percent",2127.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2502.8,
ZIMMER 00-5976-030-10 ART SURF SZ 10MM,C1776,HCPCS,,79009483,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
ARTHREX AR-8943T-07 7H TUBULAR PLATE,C1776,HCPCS,,79009499,CDM,278,RC,,,both,,,765,301.92,39.4668,,301.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,260.1,34,,260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Device,260.1,34,"Charges > $500, x 34%",260.1,percent of total billed charges,Implant Device,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,306,40,,306,percent of total billed charges,Implant Devices,267.75,70,,267.75,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,260.1,34,,260.1,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,267.75,35,,267.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,306,
ACUMED 70-0307 OLECRANON PLATE STD 7H RT,C1776,HCPCS,,79009502,CDM,278,RC,,,both,,,4128,1629.19,39.4668,,1629.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1403.52,34,,1403.52,percent of total billed charges,Implant Device,1444.8,35,,1444.8,percent of total billed charges,Implant Device,1403.52,34,"Charges > $500, x 34%",1403.52,percent of total billed charges,Implant Device,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1651.2,40,,1651.2,percent of total billed charges,Implant Devices,1444.8,70,,1444.8,percent of total billed charges,Implant Devices,1403.52,34,,1403.52,percent of total billed charges,Implant Devices,1403.52,34,,1403.52,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,1444.8,35,,1444.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1403.52,34,"If Charge > 2,000, then 34 percent",1403.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1651.2,
ACUMED TS-S0904-S STEM 9.0X4.0MM,C1776,HCPCS,,79009506,CDM,278,RC,,,both,,,6069,2395.24,39.4668,,2395.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2124.15,35,,2124.15,percent of total billed charges,Implant Device,2063.46,34,"Charges > $500, x 34%",2063.46,percent of total billed charges,Implant Device,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2427.6,40,,2427.6,percent of total billed charges,Implant Devices,2124.15,70,,2124.15,percent of total billed charges,Implant Devices,2063.46,34,,2063.46,percent of total billed charges,Implant Devices,2063.46,34,,2063.46,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2063.46,34,"If Charge > 2,000, then 34 percent",2063.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2427.6,
ACUMED 5001-0226R-S HEAD 26MM RIGHT,C1776,HCPCS,,79009507,CDM,278,RC,,,both,,,9279,3662.12,39.4668,,3662.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3154.86,34,,3154.86,percent of total billed charges,Implant Device,3154.86,34,,3154.86,percent of total billed charges,Implant Device,3154.86,34,,3154.86,percent of total billed charges,Implant Device,3154.86,34,,3154.86,percent of total billed charges,Implant Device,3154.86,34,,3154.86,percent of total billed charges,Implant Device,3154.86,34,,3154.86,percent of total billed charges,Implant Device,3247.65,35,,3247.65,percent of total billed charges,Implant Device,3154.86,34,"Charges > $500, x 34%",3154.86,percent of total billed charges,Implant Device,3247.65,35,,3247.65,percent of total billed charges,Implant Devices,3247.65,35,,3247.65,percent of total billed charges,Implant Devices,3247.65,35,,,percent of total billed charges,Implant Devices,3247.65,35,,3247.65,percent of total billed charges,Implant Devices,3247.65,35,,3247.65,percent of total billed charges,Implant Devices,3711.6,40,,3711.6,percent of total billed charges,Implant Devices,3247.65,70,,3247.65,percent of total billed charges,Implant Devices,3154.86,34,,3154.86,percent of total billed charges,Implant Devices,3154.86,34,,3154.86,percent of total billed charges,Implant Devices,3247.65,35,,3247.65,percent of total billed charges,Implant Devices,3247.65,35,,3247.65,percent of total billed charges,Implant Devices,3247.65,35,,3247.65,percent of total billed charges,Implant Devices,3247.65,35,,3247.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3154.86,34,"If Charge > 2,000, then 34 percent",3154.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3711.6,
DEPUY 1035-52-000 SELF CTR HIP 52X28 BLU,C1776,HCPCS,,79009509,CDM,278,RC,,,both,,,1733,683.96,39.4668,,683.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Device,589.22,34,"Charges > $500, x 34%",589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,693.2,40,,693.2,percent of total billed charges,Implant Devices,606.55,70,,606.55,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,693.2,
EXACTECH 310-03-47 HUMERAL HEAD 47X26MM,C1776,HCPCS,,79009516,CDM,278,RC,,,both,,,2484,980.36,39.4668,,980.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,844.56,34,,844.56,percent of total billed charges,Implant Device,869.4,35,,869.4,percent of total billed charges,Implant Device,844.56,34,"Charges > $500, x 34%",844.56,percent of total billed charges,Implant Device,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,993.6,40,,993.6,percent of total billed charges,Implant Devices,869.4,70,,869.4,percent of total billed charges,Implant Devices,844.56,34,,844.56,percent of total billed charges,Implant Devices,844.56,34,,844.56,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,869.4,35,,869.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,844.56,34,"If Charge > 2,000, then 34 percent",844.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,993.6,
STRYKER 5569-P-2009 TSA HUM STEM 9X118MM,C1776,HCPCS,,79009525,CDM,278,RC,,,both,,,10500,4144.01,39.4668,,4144.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Device,3570,34,"Charges > $500, x 34%",3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,4200,40,,4200,percent of total billed charges,Implant Devices,3675,70,,3675,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3570,34,"If Charge > 2,000, then 34 percent",3570,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4200,
STRYKER 5542-P-0044 TSA GLENOID SZ 44,C1776,HCPCS,,79009527,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
STRYKER 5552-E-4818 TSA HUMERAL HD SZ18,C1776,HCPCS,,79009528,CDM,278,RC,,,both,,,10203,4026.8,39.4668,,4026.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3469.02,34,,3469.02,percent of total billed charges,Implant Device,3469.02,34,,3469.02,percent of total billed charges,Implant Device,3469.02,34,,3469.02,percent of total billed charges,Implant Device,3469.02,34,,3469.02,percent of total billed charges,Implant Device,3469.02,34,,3469.02,percent of total billed charges,Implant Device,3469.02,34,,3469.02,percent of total billed charges,Implant Device,3571.05,35,,3571.05,percent of total billed charges,Implant Device,3469.02,34,"Charges > $500, x 34%",3469.02,percent of total billed charges,Implant Device,3571.05,35,,3571.05,percent of total billed charges,Implant Devices,3571.05,35,,3571.05,percent of total billed charges,Implant Devices,3571.05,35,,,percent of total billed charges,Implant Devices,3571.05,35,,3571.05,percent of total billed charges,Implant Devices,3571.05,35,,3571.05,percent of total billed charges,Implant Devices,4081.2,40,,4081.2,percent of total billed charges,Implant Devices,3571.05,70,,3571.05,percent of total billed charges,Implant Devices,3469.02,34,,3469.02,percent of total billed charges,Implant Devices,3469.02,34,,3469.02,percent of total billed charges,Implant Devices,3571.05,35,,3571.05,percent of total billed charges,Implant Devices,3571.05,35,,3571.05,percent of total billed charges,Implant Devices,3571.05,35,,3571.05,percent of total billed charges,Implant Devices,3571.05,35,,3571.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3469.02,34,"If Charge > 2,000, then 34 percent",3469.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4081.2,
ZIMMER 00-8851-017-36 LINER 36X66MM,C1776,HCPCS,,79009535,CDM,278,RC,,,both,,,4403,1737.72,39.4668,,1737.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Device,1497.02,34,"Charges > $500, x 34%",1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1761.2,40,,1761.2,percent of total billed charges,Implant Devices,1541.05,70,,1541.05,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.02,34,"If Charge > 2,000, then 34 percent",1497.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.2,
ZIMMER 00-5750-015-02 FEM COMP SZ E-RT,C1776,HCPCS,,79009555,CDM,278,RC,,,both,,,5175,2042.41,39.4668,,2042.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1811.25,35,,1811.25,percent of total billed charges,Implant Device,1759.5,34,"Charges > $500, x 34%",1759.5,percent of total billed charges,Implant Device,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,2070,40,,2070,percent of total billed charges,Implant Devices,1811.25,70,,1811.25,percent of total billed charges,Implant Devices,1759.5,34,,1759.5,percent of total billed charges,Implant Devices,1759.5,34,,1759.5,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1759.5,34,"If Charge > 2,000, then 34 percent",1759.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2070,
ZIMMER 00-5950-017-02 FEM COMP SZ G-RT,C1776,HCPCS,,79009569,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 00-5972-065-38 PATELLA 38X9.5MM,C1776,HCPCS,,79009570,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 00-8851-018-36 LINER 36MM SIZE QU,C1776,HCPCS,,79009571,CDM,278,RC,,,both,,,4403,1737.72,39.4668,,1737.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Device,1497.02,34,"Charges > $500, x 34%",1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1761.2,40,,1761.2,percent of total billed charges,Implant Devices,1541.05,70,,1541.05,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.02,34,"If Charge > 2,000, then 34 percent",1497.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.2,
DEPUY 1516-50-216 TIB INSERT SIZE 2 16MM,C1776,HCPCS,,79009572,CDM,278,RC,,,both,,,5624,2219.61,39.4668,,2219.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1968.4,35,,1968.4,percent of total billed charges,Implant Device,1912.16,34,"Charges > $500, x 34%",1912.16,percent of total billed charges,Implant Device,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,2249.6,40,,2249.6,percent of total billed charges,Implant Devices,1968.4,70,,1968.4,percent of total billed charges,Implant Devices,1912.16,34,,1912.16,percent of total billed charges,Implant Devices,1912.16,34,,1912.16,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1912.16,34,"If Charge > 2,000, then 34 percent",1912.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2249.6,
DEPUY 1516-50-214 TIB INSERT SIZE 2 14MM,C1776,HCPCS,,79009574,CDM,278,RC,,,both,,,5624,2219.61,39.4668,,2219.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1912.16,34,,1912.16,percent of total billed charges,Implant Device,1968.4,35,,1968.4,percent of total billed charges,Implant Device,1912.16,34,"Charges > $500, x 34%",1912.16,percent of total billed charges,Implant Device,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,2249.6,40,,2249.6,percent of total billed charges,Implant Devices,1968.4,70,,1968.4,percent of total billed charges,Implant Devices,1912.16,34,,1912.16,percent of total billed charges,Implant Devices,1912.16,34,,1912.16,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,1968.4,35,,1968.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1912.16,34,"If Charge > 2,000, then 34 percent",1912.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2249.6,
ZIMMER 00-5950-016-02 FEM COMPONENT SZ F,C1776,HCPCS,,79009575,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 00-5750-016-01 FEM COMPONENT SZ F,C1776,HCPCS,,79009576,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 00-5976-050-10 ART SURF SZ 10MM,C1776,HCPCS,,79009577,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
ZIMMER 00-5950-017-01 FEM COMPONENT SZ G,C1776,HCPCS,,79009578,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
DEPUY 1516-50-412 TIB INSERT SZ 4 12MM,C1776,HCPCS,,79009579,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
ACUMED TR-S0802-S RADIAL STEM 8X2MM,C1776,HCPCS,,79009581,CDM,278,RC,,,both,,,6069,2395.24,39.4668,,2395.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2063.46,34,,2063.46,percent of total billed charges,Implant Device,2124.15,35,,2124.15,percent of total billed charges,Implant Device,2063.46,34,"Charges > $500, x 34%",2063.46,percent of total billed charges,Implant Device,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2427.6,40,,2427.6,percent of total billed charges,Implant Devices,2124.15,70,,2124.15,percent of total billed charges,Implant Devices,2063.46,34,,2063.46,percent of total billed charges,Implant Devices,2063.46,34,,2063.46,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,2124.15,35,,2124.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2063.46,34,"If Charge > 2,000, then 34 percent",2063.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2427.6,
ACUMED 5001-0224R-S RADIAL HEAD RT 24MM,C1776,HCPCS,,79009582,CDM,278,RC,,,both,,,11871,4685.1,39.4668,,4685.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4154.85,35,,4154.85,percent of total billed charges,Implant Device,4036.14,34,"Charges > $500, x 34%",4036.14,percent of total billed charges,Implant Device,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4748.4,40,,4748.4,percent of total billed charges,Implant Devices,4154.85,70,,4154.85,percent of total billed charges,Implant Devices,4036.14,34,,4036.14,percent of total billed charges,Implant Devices,4036.14,34,,4036.14,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4036.14,34,"If Charge > 2,000, then 34 percent",4036.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4748.4,
ZIMMER 00-7711-009-20 M/L TAPER 9 EXT,C1776,HCPCS,,79009620,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 00-7711-006-10 M/L TAPER 6 STD,C1776,HCPCS,,79009621,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 00-8851-010-36 VIVACIT-E LINER,C1776,HCPCS,,79009622,CDM,278,RC,,,both,,,4403,1737.72,39.4668,,1737.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Device,1497.02,34,"Charges > $500, x 34%",1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1761.2,40,,1761.2,percent of total billed charges,Implant Devices,1541.05,70,,1541.05,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.02,34,"If Charge > 2,000, then 34 percent",1497.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.2,
ZIMMER 11-300813 ARCOS 13X150MM SPL TPR,C1776,HCPCS,,79009623,CDM,278,RC,,,both,,,12371,4882.44,39.4668,,4882.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4206.14,34,,4206.14,percent of total billed charges,Implant Device,4206.14,34,,4206.14,percent of total billed charges,Implant Device,4206.14,34,,4206.14,percent of total billed charges,Implant Device,4206.14,34,,4206.14,percent of total billed charges,Implant Device,4206.14,34,,4206.14,percent of total billed charges,Implant Device,4206.14,34,,4206.14,percent of total billed charges,Implant Device,4329.85,35,,4329.85,percent of total billed charges,Implant Device,4206.14,34,"Charges > $500, x 34%",4206.14,percent of total billed charges,Implant Device,4329.85,35,,4329.85,percent of total billed charges,Implant Devices,4329.85,35,,4329.85,percent of total billed charges,Implant Devices,4329.85,35,,,percent of total billed charges,Implant Devices,4329.85,35,,4329.85,percent of total billed charges,Implant Devices,4329.85,35,,4329.85,percent of total billed charges,Implant Devices,4948.4,40,,4948.4,percent of total billed charges,Implant Devices,4329.85,70,,4329.85,percent of total billed charges,Implant Devices,4206.14,34,,4206.14,percent of total billed charges,Implant Devices,4206.14,34,,4206.14,percent of total billed charges,Implant Devices,4329.85,35,,4329.85,percent of total billed charges,Implant Devices,4329.85,35,,4329.85,percent of total billed charges,Implant Devices,4329.85,35,,4329.85,percent of total billed charges,Implant Devices,4329.85,35,,4329.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4206.14,34,"If Charge > 2,000, then 34 percent",4206.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4948.4,
ZIMMER 00-7711-007-40 LINER 36X52MM,C1776,HCPCS,,79009650,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 00-8851-012-36 LINER SIZE KK 36MM,C1776,HCPCS,,79009655,CDM,278,RC,,,both,,,4403,1737.72,39.4668,,1737.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1497.02,34,,1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Device,1497.02,34,"Charges > $500, x 34%",1497.02,percent of total billed charges,Implant Device,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1761.2,40,,1761.2,percent of total billed charges,Implant Devices,1541.05,70,,1541.05,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1497.02,34,,1497.02,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,1541.05,35,,1541.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1497.02,34,"If Charge > 2,000, then 34 percent",1497.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1761.2,
ZIMMER 00-5880-040-12 ART SURF SZ D 12MM,C1776,HCPCS,,79009656,CDM,278,RC,,,both,,,5823,2298.15,39.4668,,2298.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1979.82,34,,1979.82,percent of total billed charges,Implant Device,1979.82,34,,1979.82,percent of total billed charges,Implant Device,1979.82,34,,1979.82,percent of total billed charges,Implant Device,1979.82,34,,1979.82,percent of total billed charges,Implant Device,1979.82,34,,1979.82,percent of total billed charges,Implant Device,1979.82,34,,1979.82,percent of total billed charges,Implant Device,2038.05,35,,2038.05,percent of total billed charges,Implant Device,1979.82,34,"Charges > $500, x 34%",1979.82,percent of total billed charges,Implant Device,2038.05,35,,2038.05,percent of total billed charges,Implant Devices,2038.05,35,,2038.05,percent of total billed charges,Implant Devices,2038.05,35,,,percent of total billed charges,Implant Devices,2038.05,35,,2038.05,percent of total billed charges,Implant Devices,2038.05,35,,2038.05,percent of total billed charges,Implant Devices,2329.2,40,,2329.2,percent of total billed charges,Implant Devices,2038.05,70,,2038.05,percent of total billed charges,Implant Devices,1979.82,34,,1979.82,percent of total billed charges,Implant Devices,1979.82,34,,1979.82,percent of total billed charges,Implant Devices,2038.05,35,,2038.05,percent of total billed charges,Implant Devices,2038.05,35,,2038.05,percent of total billed charges,Implant Devices,2038.05,35,,2038.05,percent of total billed charges,Implant Devices,2038.05,35,,2038.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1979.82,34,"If Charge > 2,000, then 34 percent",1979.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2329.2,
ZIMMER 00-5880-014-02 FEM COMP SZ D RT,C1776,HCPCS,,79009657,CDM,278,RC,,,both,,,26520,10466.6,39.4668,,10466.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,9016.8,34,,9016.8,percent of total billed charges,Implant Device,9016.8,34,,9016.8,percent of total billed charges,Implant Device,9016.8,34,,9016.8,percent of total billed charges,Implant Device,9016.8,34,,9016.8,percent of total billed charges,Implant Device,9016.8,34,,9016.8,percent of total billed charges,Implant Device,9016.8,34,,9016.8,percent of total billed charges,Implant Device,9282,35,,9282,percent of total billed charges,Implant Device,9016.8,34,"Charges > $500, x 34%",9016.8,percent of total billed charges,Implant Device,9282,35,,9282,percent of total billed charges,Implant Devices,9282,35,,9282,percent of total billed charges,Implant Devices,9282,35,,,percent of total billed charges,Implant Devices,9282,35,,9282,percent of total billed charges,Implant Devices,9282,35,,9282,percent of total billed charges,Implant Devices,10608,40,,10608,percent of total billed charges,Implant Devices,9282,70,,9282,percent of total billed charges,Implant Devices,9016.8,34,,9016.8,percent of total billed charges,Implant Devices,9016.8,34,,9016.8,percent of total billed charges,Implant Devices,9282,35,,9282,percent of total billed charges,Implant Devices,9282,35,,9282,percent of total billed charges,Implant Devices,9282,35,,9282,percent of total billed charges,Implant Devices,9282,35,,9282,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,9016.8,34,"If Charge > 2,000, then 34 percent",9016.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10608,
DEPSYN 1221-32-050 ACET LINER 32 X50 MM,C1776,HCPCS,,79009683,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
ZIMMER 11-363660 MODULAR HEAD COMP 6MM,C1776,HCPCS,,79009698,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 11-300815 STS DISTAL STEM 15X150,C1776,HCPCS,,79009699,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
ZIMMER 00-7711-011-10 FEMORAL STEM 12/14,C1776,HCPCS,,79009708,CDM,278,RC,,,both,,,8910,3516.49,39.4668,,3516.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Device,3029.4,34,"Charges > $500, x 34%",3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3564,40,,3564,percent of total billed charges,Implant Devices,3118.5,70,,3118.5,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3029.4,34,"If Charge > 2,000, then 34 percent",3029.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3564,
ZIMMER 00-5976-050-17 ART SURF SZ 17MM,C1776,HCPCS,,79009709,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
ZIMMER 00-8852-015-36 RIM LINER SZ 36MM,C1776,HCPCS,,79009710,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 00-5976-040-10 ART SURF SZ 10MM,C1776,HCPCS,,79009719,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
STRYKER 5568-0009 HUMERAL FRACTURE STEM,C1776,HCPCS,,79009722,CDM,278,RC,,,both,,,11250,4440.02,39.4668,,4440.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3825,34,,3825,percent of total billed charges,Implant Device,3825,34,,3825,percent of total billed charges,Implant Device,3825,34,,3825,percent of total billed charges,Implant Device,3825,34,,3825,percent of total billed charges,Implant Device,3825,34,,3825,percent of total billed charges,Implant Device,3825,34,,3825,percent of total billed charges,Implant Device,3937.5,35,,3937.5,percent of total billed charges,Implant Device,3825,34,"Charges > $500, x 34%",3825,percent of total billed charges,Implant Device,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,4500,40,,4500,percent of total billed charges,Implant Devices,3937.5,70,,3937.5,percent of total billed charges,Implant Devices,3825,34,,3825,percent of total billed charges,Implant Devices,3825,34,,3825,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,3937.5,35,,3937.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3825,34,"If Charge > 2,000, then 34 percent",3825,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4500,
ZIMMER 00-5950-014-01 FEM COMP SZ D-LT,C1776,HCPCS,,79009726,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 00-7711-009-40 FEMORAL STEM 12/14,C1776,HCPCS,,79009727,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 00-5750-015-01 FEM COMP SZ 3 LT,C1776,HCPCS,,79009728,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
STRYKER 6721-0737 NECK ANGLE HIP STERN,C1776,HCPCS,,79009734,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
STRYKER 5569-P-2008 MODULAR HUMERAL STEM,C1776,HCPCS,,79009738,CDM,278,RC,,,both,,,23397,9234.05,39.4668,,9234.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7954.98,34,,7954.98,percent of total billed charges,Implant Device,7954.98,34,,7954.98,percent of total billed charges,Implant Device,7954.98,34,,7954.98,percent of total billed charges,Implant Device,7954.98,34,,7954.98,percent of total billed charges,Implant Device,7954.98,34,,7954.98,percent of total billed charges,Implant Device,7954.98,34,,7954.98,percent of total billed charges,Implant Device,8188.95,35,,8188.95,percent of total billed charges,Implant Device,7954.98,34,"Charges > $500, x 34%",7954.98,percent of total billed charges,Implant Device,8188.95,35,,8188.95,percent of total billed charges,Implant Devices,8188.95,35,,8188.95,percent of total billed charges,Implant Devices,8188.95,35,,,percent of total billed charges,Implant Devices,8188.95,35,,8188.95,percent of total billed charges,Implant Devices,8188.95,35,,8188.95,percent of total billed charges,Implant Devices,9358.8,40,,9358.8,percent of total billed charges,Implant Devices,8188.95,70,,8188.95,percent of total billed charges,Implant Devices,7954.98,34,,7954.98,percent of total billed charges,Implant Devices,7954.98,34,,7954.98,percent of total billed charges,Implant Devices,8188.95,35,,8188.95,percent of total billed charges,Implant Devices,8188.95,35,,8188.95,percent of total billed charges,Implant Devices,8188.95,35,,8188.95,percent of total billed charges,Implant Devices,8188.95,35,,8188.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7954.98,34,"If Charge > 2,000, then 34 percent",7954.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9358.8,
ZIMMER 00-5750-014-01 FEMORAL COMP SZ D,C1776,HCPCS,,79009747,CDM,278,RC,,,both,,,9450,3729.61,39.4668,,3729.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Device,3213,34,"Charges > $500, x 34%",3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3780,40,,3780,percent of total billed charges,Implant Devices,3307.5,70,,3307.5,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3213,34,"If Charge > 2,000, then 34 percent",3213,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3780,
ZIMMER 00-5970-018-01 FEMORAL COMP SZ H,C1776,HCPCS,,79009748,CDM,278,RC,,,both,,,5415,2137.13,39.4668,,2137.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1841.1,34,,1841.1,percent of total billed charges,Implant Device,1841.1,34,,1841.1,percent of total billed charges,Implant Device,1841.1,34,,1841.1,percent of total billed charges,Implant Device,1841.1,34,,1841.1,percent of total billed charges,Implant Device,1841.1,34,,1841.1,percent of total billed charges,Implant Device,1841.1,34,,1841.1,percent of total billed charges,Implant Device,1895.25,35,,1895.25,percent of total billed charges,Implant Device,1841.1,34,"Charges > $500, x 34%",1841.1,percent of total billed charges,Implant Device,1895.25,35,,1895.25,percent of total billed charges,Implant Devices,1895.25,35,,1895.25,percent of total billed charges,Implant Devices,1895.25,35,,,percent of total billed charges,Implant Devices,1895.25,35,,1895.25,percent of total billed charges,Implant Devices,1895.25,35,,1895.25,percent of total billed charges,Implant Devices,2166,40,,2166,percent of total billed charges,Implant Devices,1895.25,70,,1895.25,percent of total billed charges,Implant Devices,1841.1,34,,1841.1,percent of total billed charges,Implant Devices,1841.1,34,,1841.1,percent of total billed charges,Implant Devices,1895.25,35,,1895.25,percent of total billed charges,Implant Devices,1895.25,35,,1895.25,percent of total billed charges,Implant Devices,1895.25,35,,1895.25,percent of total billed charges,Implant Devices,1895.25,35,,1895.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1841.1,34,"If Charge > 2,000, then 34 percent",1841.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2166,
ZIMMER 00-5950-015-01 FEM COMP SZ E-LT,C1776,HCPCS,,79009753,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
DEPUY 1365-36-330 FEM HEAD 12.14 36MM,C1776,HCPCS,,79009756,CDM,278,RC,,,both,,,5255,2073.98,39.4668,,2073.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1786.7,34,,1786.7,percent of total billed charges,Implant Device,1786.7,34,,1786.7,percent of total billed charges,Implant Device,1786.7,34,,1786.7,percent of total billed charges,Implant Device,1786.7,34,,1786.7,percent of total billed charges,Implant Device,1786.7,34,,1786.7,percent of total billed charges,Implant Device,1786.7,34,,1786.7,percent of total billed charges,Implant Device,1839.25,35,,1839.25,percent of total billed charges,Implant Device,1786.7,34,"Charges > $500, x 34%",1786.7,percent of total billed charges,Implant Device,1839.25,35,,1839.25,percent of total billed charges,Implant Devices,1839.25,35,,1839.25,percent of total billed charges,Implant Devices,1839.25,35,,,percent of total billed charges,Implant Devices,1839.25,35,,1839.25,percent of total billed charges,Implant Devices,1839.25,35,,1839.25,percent of total billed charges,Implant Devices,2102,40,,2102,percent of total billed charges,Implant Devices,1839.25,70,,1839.25,percent of total billed charges,Implant Devices,1786.7,34,,1786.7,percent of total billed charges,Implant Devices,1786.7,34,,1786.7,percent of total billed charges,Implant Devices,1839.25,35,,1839.25,percent of total billed charges,Implant Devices,1839.25,35,,1839.25,percent of total billed charges,Implant Devices,1839.25,35,,1839.25,percent of total billed charges,Implant Devices,1839.25,35,,1839.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1786.7,34,"If Charge > 2,000, then 34 percent",1786.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2102,
ACUMED TR-S1004-S STEM 10X4MM,C1776,HCPCS,,79009757,CDM,278,RC,,,both,,,6951,2743.34,39.4668,,2743.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Device,2363.34,34,"Charges > $500, x 34%",2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2780.4,40,,2780.4,percent of total billed charges,Implant Devices,2432.85,70,,2432.85,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2363.34,34,"If Charge > 2,000, then 34 percent",2363.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2780.4,
ZIMMER 00-7711-011-20 M/L TAPER 11MM,C1776,HCPCS,,79009763,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
S&N 71333436 ACETAB LINER SZ G 32X+4MM,C1776,HCPCS,,79009766,CDM,278,RC,,,both,,,4516,1782.32,39.4668,,1782.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1535.44,34,,1535.44,percent of total billed charges,Implant Device,1535.44,34,,1535.44,percent of total billed charges,Implant Device,1535.44,34,,1535.44,percent of total billed charges,Implant Device,1535.44,34,,1535.44,percent of total billed charges,Implant Device,1535.44,34,,1535.44,percent of total billed charges,Implant Device,1535.44,34,,1535.44,percent of total billed charges,Implant Device,1580.6,35,,1580.6,percent of total billed charges,Implant Device,1535.44,34,"Charges > $500, x 34%",1535.44,percent of total billed charges,Implant Device,1580.6,35,,1580.6,percent of total billed charges,Implant Devices,1580.6,35,,1580.6,percent of total billed charges,Implant Devices,1580.6,35,,,percent of total billed charges,Implant Devices,1580.6,35,,1580.6,percent of total billed charges,Implant Devices,1580.6,35,,1580.6,percent of total billed charges,Implant Devices,1806.4,40,,1806.4,percent of total billed charges,Implant Devices,1580.6,70,,1580.6,percent of total billed charges,Implant Devices,1535.44,34,,1535.44,percent of total billed charges,Implant Devices,1535.44,34,,1535.44,percent of total billed charges,Implant Devices,1580.6,35,,1580.6,percent of total billed charges,Implant Devices,1580.6,35,,1580.6,percent of total billed charges,Implant Devices,1580.6,35,,1580.6,percent of total billed charges,Implant Devices,1580.6,35,,1580.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1535.44,34,"If Charge > 2,000, then 34 percent",1535.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1806.4,
S&N 71343216 FEM HEAD 12/14 TAPER 32MM,C1776,HCPCS,,79009767,CDM,278,RC,,,both,,,5554,2191.99,39.4668,,2191.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1888.36,34,,1888.36,percent of total billed charges,Implant Device,1888.36,34,,1888.36,percent of total billed charges,Implant Device,1888.36,34,,1888.36,percent of total billed charges,Implant Device,1888.36,34,,1888.36,percent of total billed charges,Implant Device,1888.36,34,,1888.36,percent of total billed charges,Implant Device,1888.36,34,,1888.36,percent of total billed charges,Implant Device,1943.9,35,,1943.9,percent of total billed charges,Implant Device,1888.36,34,"Charges > $500, x 34%",1888.36,percent of total billed charges,Implant Device,1943.9,35,,1943.9,percent of total billed charges,Implant Devices,1943.9,35,,1943.9,percent of total billed charges,Implant Devices,1943.9,35,,,percent of total billed charges,Implant Devices,1943.9,35,,1943.9,percent of total billed charges,Implant Devices,1943.9,35,,1943.9,percent of total billed charges,Implant Devices,2221.6,40,,2221.6,percent of total billed charges,Implant Devices,1943.9,70,,1943.9,percent of total billed charges,Implant Devices,1888.36,34,,1888.36,percent of total billed charges,Implant Devices,1888.36,34,,1888.36,percent of total billed charges,Implant Devices,1943.9,35,,1943.9,percent of total billed charges,Implant Devices,1943.9,35,,1943.9,percent of total billed charges,Implant Devices,1943.9,35,,1943.9,percent of total billed charges,Implant Devices,1943.9,35,,1943.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1888.36,34,"If Charge > 2,000, then 34 percent",1888.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2221.6,
ZIMMER 00-5994-051-10 ART SURF E.F 10MM,C1776,HCPCS,,79009770,CDM,278,RC,,,both,,,6320,2494.3,39.4668,,2494.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2148.8,34,,2148.8,percent of total billed charges,Implant Device,2212,35,,2212,percent of total billed charges,Implant Device,2148.8,34,"Charges > $500, x 34%",2148.8,percent of total billed charges,Implant Device,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2528,40,,2528,percent of total billed charges,Implant Devices,2212,70,,2212,percent of total billed charges,Implant Devices,2148.8,34,,2148.8,percent of total billed charges,Implant Devices,2148.8,34,,2148.8,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,2212,35,,2212,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2148.8,34,"If Charge > 2,000, then 34 percent",2148.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2528,
DEPUY 1221-40-156 ACET LINER+4 X 40X56MM,C1776,HCPCS,,79009775,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
DEPUY 1365-42-500 FEM HEAD 40MM 11/13,C1776,HCPCS,,79009776,CDM,278,RC,,,both,,,4572,1804.42,39.4668,,1804.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1554.48,34,,1554.48,percent of total billed charges,Implant Device,1600.2,35,,1600.2,percent of total billed charges,Implant Device,1554.48,34,"Charges > $500, x 34%",1554.48,percent of total billed charges,Implant Device,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1828.8,40,,1828.8,percent of total billed charges,Implant Devices,1600.2,70,,1600.2,percent of total billed charges,Implant Devices,1554.48,34,,1554.48,percent of total billed charges,Implant Devices,1554.48,34,,1554.48,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,1600.2,35,,1600.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1554.48,34,"If Charge > 2,000, then 34 percent",1554.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1828.8,
DEPUY 1221-32-150 ACETABULAR LINER 32X50,C1776,HCPCS,,79009783,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
ZIMMER 00-5850-030-14 SEG SYS SZ C 14MM,C1776,HCPCS,,79009784,CDM,278,RC,,,both,,,6200,2446.94,39.4668,,2446.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2170,35,,2170,percent of total billed charges,Implant Device,2108,34,"Charges > $500, x 34%",2108,percent of total billed charges,Implant Device,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2480,40,,2480,percent of total billed charges,Implant Devices,2170,70,,2170,percent of total billed charges,Implant Devices,2108,34,,2108,percent of total billed charges,Implant Devices,2108,34,,2108,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2108,34,"If Charge > 2,000, then 34 percent",2108,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2480,
ZIMMER 00-5850-071-13 SEG SYS HINGE KIT,C1776,HCPCS,,79009785,CDM,278,RC,,,both,,,6857,2706.24,39.4668,,2706.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2331.38,34,,2331.38,percent of total billed charges,Implant Device,2331.38,34,,2331.38,percent of total billed charges,Implant Device,2331.38,34,,2331.38,percent of total billed charges,Implant Device,2331.38,34,,2331.38,percent of total billed charges,Implant Device,2331.38,34,,2331.38,percent of total billed charges,Implant Device,2331.38,34,,2331.38,percent of total billed charges,Implant Device,2399.95,35,,2399.95,percent of total billed charges,Implant Device,2331.38,34,"Charges > $500, x 34%",2331.38,percent of total billed charges,Implant Device,2399.95,35,,2399.95,percent of total billed charges,Implant Devices,2399.95,35,,2399.95,percent of total billed charges,Implant Devices,2399.95,35,,,percent of total billed charges,Implant Devices,2399.95,35,,2399.95,percent of total billed charges,Implant Devices,2399.95,35,,2399.95,percent of total billed charges,Implant Devices,2742.8,40,,2742.8,percent of total billed charges,Implant Devices,2399.95,70,,2399.95,percent of total billed charges,Implant Devices,2331.38,34,,2331.38,percent of total billed charges,Implant Devices,2331.38,34,,2331.38,percent of total billed charges,Implant Devices,2399.95,35,,2399.95,percent of total billed charges,Implant Devices,2399.95,35,,2399.95,percent of total billed charges,Implant Devices,2399.95,35,,2399.95,percent of total billed charges,Implant Devices,2399.95,35,,2399.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2331.38,34,"If Charge > 2,000, then 34 percent",2331.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2742.8,
ZIMMER 00-5852-050-16 FLUTED STEM 16X130,C1776,HCPCS,,79009786,CDM,278,RC,,,both,,,11878,4687.87,39.4668,,4687.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4038.52,34,,4038.52,percent of total billed charges,Implant Device,4157.3,35,,4157.3,percent of total billed charges,Implant Device,4038.52,34,"Charges > $500, x 34%",4038.52,percent of total billed charges,Implant Device,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4751.2,40,,4751.2,percent of total billed charges,Implant Devices,4157.3,70,,4157.3,percent of total billed charges,Implant Devices,4038.52,34,,4038.52,percent of total billed charges,Implant Devices,4038.52,34,,4038.52,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,4157.3,35,,4157.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4038.52,34,"If Charge > 2,000, then 34 percent",4038.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4751.2,
ZIMMER 00-5850-043-01 SEG FEM/TIB 80MM,C1776,HCPCS,,79009787,CDM,278,RC,,,both,,,10705,4224.92,39.4668,,4224.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3639.7,34,,3639.7,percent of total billed charges,Implant Device,3746.75,35,,3746.75,percent of total billed charges,Implant Device,3639.7,34,"Charges > $500, x 34%",3639.7,percent of total billed charges,Implant Device,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,4282,40,,4282,percent of total billed charges,Implant Devices,3746.75,70,,3746.75,percent of total billed charges,Implant Devices,3639.7,34,,3639.7,percent of total billed charges,Implant Devices,3639.7,34,,3639.7,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,3746.75,35,,3746.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3639.7,34,"If Charge > 2,000, then 34 percent",3639.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4282,
STRYKER 1221-36-056 ACETAB LINER 35X55MM,C1776,HCPCS,,79009811,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
STRYKER 5568-0010 HUM FRACTURE STEM 10MM,C1776,HCPCS,,79009840,CDM,278,RC,,,both,,,23622,9322.85,39.4668,,9322.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8031.48,34,,8031.48,percent of total billed charges,Implant Device,8031.48,34,,8031.48,percent of total billed charges,Implant Device,8031.48,34,,8031.48,percent of total billed charges,Implant Device,8031.48,34,,8031.48,percent of total billed charges,Implant Device,8031.48,34,,8031.48,percent of total billed charges,Implant Device,8031.48,34,,8031.48,percent of total billed charges,Implant Device,8267.7,35,,8267.7,percent of total billed charges,Implant Device,8031.48,34,"Charges > $500, x 34%",8031.48,percent of total billed charges,Implant Device,8267.7,35,,8267.7,percent of total billed charges,Implant Devices,8267.7,35,,8267.7,percent of total billed charges,Implant Devices,8267.7,35,,,percent of total billed charges,Implant Devices,8267.7,35,,8267.7,percent of total billed charges,Implant Devices,8267.7,35,,8267.7,percent of total billed charges,Implant Devices,9448.8,40,,9448.8,percent of total billed charges,Implant Devices,8267.7,70,,8267.7,percent of total billed charges,Implant Devices,8031.48,34,,8031.48,percent of total billed charges,Implant Devices,8031.48,34,,8031.48,percent of total billed charges,Implant Devices,8267.7,35,,8267.7,percent of total billed charges,Implant Devices,8267.7,35,,8267.7,percent of total billed charges,Implant Devices,8267.7,35,,8267.7,percent of total billed charges,Implant Devices,8267.7,35,,8267.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8031.48,34,"If Charge > 2,000, then 34 percent",8031.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9448.8,
STRYKER 1024-54-409 TIB INSERT SZ 4X9MM,C1776,HCPCS,,79009866,CDM,278,RC,,,both,,,2495,984.7,39.4668,,984.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,848.3,34,,848.3,percent of total billed charges,Implant Device,873.25,35,,873.25,percent of total billed charges,Implant Device,848.3,34,"Charges > $500, x 34%",848.3,percent of total billed charges,Implant Device,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,998,40,,998,percent of total billed charges,Implant Devices,873.25,70,,873.25,percent of total billed charges,Implant Devices,848.3,34,,848.3,percent of total billed charges,Implant Devices,848.3,34,,848.3,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,873.25,35,,873.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,848.3,34,"If Charge > 2,000, then 34 percent",848.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,998,
ZIMMER 11-301352 ARCOS CON SZ B 80MM,C1776,HCPCS,,79009879,CDM,278,RC,,,both,,,24006,9474.4,39.4668,,9474.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8162.04,34,,8162.04,percent of total billed charges,Implant Device,8402.1,35,,8402.1,percent of total billed charges,Implant Device,8162.04,34,"Charges > $500, x 34%",8162.04,percent of total billed charges,Implant Device,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,9602.4,40,,9602.4,percent of total billed charges,Implant Devices,8402.1,70,,8402.1,percent of total billed charges,Implant Devices,8162.04,34,,8162.04,percent of total billed charges,Implant Devices,8162.04,34,,8162.04,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,8402.1,35,,8402.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8162.04,34,"If Charge > 2,000, then 34 percent",8162.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9602.4,
ZIMMER 12-115116 CER BIOLOXD MOD 32MM,C1776,HCPCS,,79009880,CDM,278,RC,,,both,,,3075,1213.6,39.4668,,1213.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1076.25,35,,1076.25,percent of total billed charges,Implant Device,1045.5,34,"Charges > $500, x 34%",1045.5,percent of total billed charges,Implant Device,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1230,40,,1230,percent of total billed charges,Implant Devices,1076.25,70,,1076.25,percent of total billed charges,Implant Devices,1045.5,34,,1045.5,percent of total billed charges,Implant Devices,1045.5,34,,1045.5,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1045.5,34,"If Charge > 2,000, then 34 percent",1045.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1230,
AESULAP NB012Z ENDURO TIBIAL COMP SZ T2,C1776,HCPCS,,79009883,CDM,278,RC,,,both,,,10710,4226.89,39.4668,,4226.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3641.4,34,,3641.4,percent of total billed charges,Implant Device,3641.4,34,,3641.4,percent of total billed charges,Implant Device,3641.4,34,,3641.4,percent of total billed charges,Implant Device,3641.4,34,,3641.4,percent of total billed charges,Implant Device,3641.4,34,,3641.4,percent of total billed charges,Implant Device,3641.4,34,,3641.4,percent of total billed charges,Implant Device,3748.5,35,,3748.5,percent of total billed charges,Implant Device,3641.4,34,"Charges > $500, x 34%",3641.4,percent of total billed charges,Implant Device,3748.5,35,,3748.5,percent of total billed charges,Implant Devices,3748.5,35,,3748.5,percent of total billed charges,Implant Devices,3748.5,35,,,percent of total billed charges,Implant Devices,3748.5,35,,3748.5,percent of total billed charges,Implant Devices,3748.5,35,,3748.5,percent of total billed charges,Implant Devices,4284,40,,4284,percent of total billed charges,Implant Devices,3748.5,70,,3748.5,percent of total billed charges,Implant Devices,3641.4,34,,3641.4,percent of total billed charges,Implant Devices,3641.4,34,,3641.4,percent of total billed charges,Implant Devices,3748.5,35,,3748.5,percent of total billed charges,Implant Devices,3748.5,35,,3748.5,percent of total billed charges,Implant Devices,3748.5,35,,3748.5,percent of total billed charges,Implant Devices,3748.5,35,,3748.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3641.4,34,"If Charge > 2,000, then 34 percent",3641.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4284,
AESULAP NB018Z ENDURO FEM COMP SZ F2R,C1776,HCPCS,,79009884,CDM,278,RC,,,both,,,21900,8643.23,39.4668,,8643.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7446,34,,7446,percent of total billed charges,Implant Device,7446,34,,7446,percent of total billed charges,Implant Device,7446,34,,7446,percent of total billed charges,Implant Device,7446,34,,7446,percent of total billed charges,Implant Device,7446,34,,7446,percent of total billed charges,Implant Device,7446,34,,7446,percent of total billed charges,Implant Device,7665,35,,7665,percent of total billed charges,Implant Device,7446,34,"Charges > $500, x 34%",7446,percent of total billed charges,Implant Device,7665,35,,7665,percent of total billed charges,Implant Devices,7665,35,,7665,percent of total billed charges,Implant Devices,7665,35,,,percent of total billed charges,Implant Devices,7665,35,,7665,percent of total billed charges,Implant Devices,7665,35,,7665,percent of total billed charges,Implant Devices,8760,40,,8760,percent of total billed charges,Implant Devices,7665,70,,7665,percent of total billed charges,Implant Devices,7446,34,,7446,percent of total billed charges,Implant Devices,7446,34,,7446,percent of total billed charges,Implant Devices,7665,35,,7665,percent of total billed charges,Implant Devices,7665,35,,7665,percent of total billed charges,Implant Devices,7665,35,,7665,percent of total billed charges,Implant Devices,7665,35,,7665,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7446,34,"If Charge > 2,000, then 34 percent",7446,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8760,
AESULAP NR192Z TIBIA OFFSET STEM 15X52,C1776,HCPCS,,79009885,CDM,278,RC,,,both,,,7560,2983.69,39.4668,,2983.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2570.4,34,,2570.4,percent of total billed charges,Implant Device,2646,35,,2646,percent of total billed charges,Implant Device,2570.4,34,"Charges > $500, x 34%",2570.4,percent of total billed charges,Implant Device,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,3024,40,,3024,percent of total billed charges,Implant Devices,2646,70,,2646,percent of total billed charges,Implant Devices,2570.4,34,,2570.4,percent of total billed charges,Implant Devices,2570.4,34,,2570.4,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,2646,35,,2646,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2570.4,34,"If Charge > 2,000, then 34 percent",2570.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3024,
AESCULAP NR409Z FEMUR EXT STEM 19X117MM,C1776,HCPCS,,79009887,CDM,278,RC,,,both,,,8580,3386.25,39.4668,,3386.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2917.2,34,,2917.2,percent of total billed charges,Implant Device,2917.2,34,,2917.2,percent of total billed charges,Implant Device,2917.2,34,,2917.2,percent of total billed charges,Implant Device,2917.2,34,,2917.2,percent of total billed charges,Implant Device,2917.2,34,,2917.2,percent of total billed charges,Implant Device,2917.2,34,,2917.2,percent of total billed charges,Implant Device,3003,35,,3003,percent of total billed charges,Implant Device,2917.2,34,"Charges > $500, x 34%",2917.2,percent of total billed charges,Implant Device,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3432,40,,3432,percent of total billed charges,Implant Devices,3003,70,,3003,percent of total billed charges,Implant Devices,2917.2,34,,2917.2,percent of total billed charges,Implant Devices,2917.2,34,,2917.2,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2917.2,34,"If Charge > 2,000, then 34 percent",2917.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3432,
AESCULAP NR882Z ENDURO MENISCAL COMP 14,C1776,HCPCS,,79009888,CDM,278,RC,,,both,,,4455,1758.25,39.4668,,1758.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1514.7,34,,1514.7,percent of total billed charges,Implant Device,1514.7,34,,1514.7,percent of total billed charges,Implant Device,1514.7,34,,1514.7,percent of total billed charges,Implant Device,1514.7,34,,1514.7,percent of total billed charges,Implant Device,1514.7,34,,1514.7,percent of total billed charges,Implant Device,1514.7,34,,1514.7,percent of total billed charges,Implant Device,1559.25,35,,1559.25,percent of total billed charges,Implant Device,1514.7,34,"Charges > $500, x 34%",1514.7,percent of total billed charges,Implant Device,1559.25,35,,1559.25,percent of total billed charges,Implant Devices,1559.25,35,,1559.25,percent of total billed charges,Implant Devices,1559.25,35,,,percent of total billed charges,Implant Devices,1559.25,35,,1559.25,percent of total billed charges,Implant Devices,1559.25,35,,1559.25,percent of total billed charges,Implant Devices,1782,40,,1782,percent of total billed charges,Implant Devices,1559.25,70,,1559.25,percent of total billed charges,Implant Devices,1514.7,34,,1514.7,percent of total billed charges,Implant Devices,1514.7,34,,1514.7,percent of total billed charges,Implant Devices,1559.25,35,,1559.25,percent of total billed charges,Implant Devices,1559.25,35,,1559.25,percent of total billed charges,Implant Devices,1559.25,35,,1559.25,percent of total billed charges,Implant Devices,1559.25,35,,1559.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1514.7,34,"If Charge > 2,000, then 34 percent",1514.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1782,
AESCULAP NX043 PATELLA 3-PEGS P3,C1776,HCPCS,,79009889,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
STRYKER 5510-F-401 FEMORAL COMP SZ 4 LT,C1776,HCPCS,,79009892,CDM,278,RC,,,both,,,4450,1756.27,39.4668,,1756.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1557.5,35,,1557.5,percent of total billed charges,Implant Device,1513,34,"Charges > $500, x 34%",1513,percent of total billed charges,Implant Device,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1780,40,,1780,percent of total billed charges,Implant Devices,1557.5,70,,1557.5,percent of total billed charges,Implant Devices,1513,34,,1513,percent of total billed charges,Implant Devices,1513,34,,1513,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1513,34,"If Charge > 2,000, then 34 percent",1513,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1780,
STRYKER 5520-B-400 TIBIAL BASEPLATE SZ 4,C1776,HCPCS,,79009893,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 5530-G-409 TIB INSERT SZ 4 9MM,C1776,HCPCS,,79009894,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 502-11-52E ACETABULAR SHELL 52MM,C1776,HCPCS,,79009930,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
STRYKER 6519-T-100 ADAPTOR SLEEVE V40,C1776,HCPCS,,79009932,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
STRYKER 6721-0435 HIP STEM SZ 4 35X105MM,C1776,HCPCS,,79009933,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
ZIMMER 00-7711-007-20 FEM STEM SIZE 7.5,C1776,HCPCS,,79009941,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
DEPUY 1960-40-450 FEM POST STABLZD SZ 4N,C1776,HCPCS,,79009976,CDM,278,RC,,,both,,,8580,3386.25,39.4668,,3386.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2917.2,34,,2917.2,percent of total billed charges,Implant Device,2917.2,34,,2917.2,percent of total billed charges,Implant Device,2917.2,34,,2917.2,percent of total billed charges,Implant Device,2917.2,34,,2917.2,percent of total billed charges,Implant Device,2917.2,34,,2917.2,percent of total billed charges,Implant Device,2917.2,34,,2917.2,percent of total billed charges,Implant Device,3003,35,,3003,percent of total billed charges,Implant Device,2917.2,34,"Charges > $500, x 34%",2917.2,percent of total billed charges,Implant Device,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3432,40,,3432,percent of total billed charges,Implant Devices,3003,70,,3003,percent of total billed charges,Implant Devices,2917.2,34,,2917.2,percent of total billed charges,Implant Devices,2917.2,34,,2917.2,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,3003,35,,3003,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2917.2,34,"If Charge > 2,000, then 34 percent",2917.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3432,
DEPUY 1961-92-141 TIBIAL INSERT SZ4 10MM,C1776,HCPCS,,79009977,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
ZIMMER 00-7711-016-20 M/L TAPER 16.25MM,C1776,HCPCS,,79009978,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 00-7711-006-40 M/L TAPER 7.5MM,C1776,HCPCS,,79009979,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ALLERGAN 1516616 ALLODERM RTU 6X16CM,C1776,HCPCS,,79009991,CDM,278,RC,,,both,,,13401,5288.95,39.4668,,5288.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4556.34,34,,4556.34,percent of total billed charges,Implant Device,4556.34,34,,4556.34,percent of total billed charges,Implant Device,4556.34,34,,4556.34,percent of total billed charges,Implant Device,4556.34,34,,4556.34,percent of total billed charges,Implant Device,4556.34,34,,4556.34,percent of total billed charges,Implant Device,4556.34,34,,4556.34,percent of total billed charges,Implant Device,4690.35,35,,4690.35,percent of total billed charges,Implant Device,4556.34,34,"Charges > $500, x 34%",4556.34,percent of total billed charges,Implant Device,4690.35,35,,4690.35,percent of total billed charges,Implant Devices,4690.35,35,,4690.35,percent of total billed charges,Implant Devices,4690.35,35,,,percent of total billed charges,Implant Devices,4690.35,35,,4690.35,percent of total billed charges,Implant Devices,4690.35,35,,4690.35,percent of total billed charges,Implant Devices,5360.4,40,,5360.4,percent of total billed charges,Implant Devices,4690.35,70,,4690.35,percent of total billed charges,Implant Devices,4556.34,34,,4556.34,percent of total billed charges,Implant Devices,4556.34,34,,4556.34,percent of total billed charges,Implant Devices,4690.35,35,,4690.35,percent of total billed charges,Implant Devices,4690.35,35,,4690.35,percent of total billed charges,Implant Devices,4690.35,35,,4690.35,percent of total billed charges,Implant Devices,4690.35,35,,4690.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4556.34,34,"If Charge > 2,000, then 34 percent",4556.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5360.4,
STRYKER 6721-0535 HIP STEM SIZE 5 127',C1776,HCPCS,,79009993,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
STRYKER UH1-53-26 UHR BIPOLAR 26X53MM,C1776,HCPCS,,79009994,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
ZIMMER 00-7711-007-10 FEM STEM 7.5 12/14,C1776,HCPCS,,79010001,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
STRYKER 5510-F-602 FEM COMP SZ 6 RT,C1776,HCPCS,,79010012,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
STRYKER 5520-B-600 TIBIAL BASEPLATE SZ 6,C1776,HCPCS,,79010013,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 5530-G-613 TIB BEARING SZ 6 13MM,C1776,HCPCS,,79010014,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 5551-G-350 PATELLA SIZE A35 10MM,C1776,HCPCS,,79010015,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
ZIMMER 00-5950-016-06 FEM COMP SZ F -RT,C1776,HCPCS,,79010016,CDM,278,RC,,,both,,,5175,2042.41,39.4668,,2042.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1811.25,35,,1811.25,percent of total billed charges,Implant Device,1759.5,34,"Charges > $500, x 34%",1759.5,percent of total billed charges,Implant Device,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,2070,40,,2070,percent of total billed charges,Implant Devices,1811.25,70,,1811.25,percent of total billed charges,Implant Devices,1759.5,34,,1759.5,percent of total billed charges,Implant Devices,1759.5,34,,1759.5,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1759.5,34,"If Charge > 2,000, then 34 percent",1759.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2070,
ZIMMER 00-5994-042-14 ART SURF 14MM,C1776,HCPCS,,79010017,CDM,278,RC,,,both,,,6465,2551.53,39.4668,,2551.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2198.1,34,,2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Device,2198.1,34,"Charges > $500, x 34%",2198.1,percent of total billed charges,Implant Device,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2586,40,,2586,percent of total billed charges,Implant Devices,2262.75,70,,2262.75,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2198.1,34,,2198.1,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,2262.75,35,,2262.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2198.1,34,"If Charge > 2,000, then 34 percent",2198.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2586,
ZIMMER 00-5988-006-38 TIB AUG SZ 6 15MM,C1776,HCPCS,,79010019,CDM,278,RC,,,both,,,3617,1427.51,39.4668,,1427.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1229.78,34,,1229.78,percent of total billed charges,Implant Device,1265.95,35,,1265.95,percent of total billed charges,Implant Device,1229.78,34,"Charges > $500, x 34%",1229.78,percent of total billed charges,Implant Device,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1446.8,40,,1446.8,percent of total billed charges,Implant Devices,1265.95,70,,1265.95,percent of total billed charges,Implant Devices,1229.78,34,,1229.78,percent of total billed charges,Implant Devices,1229.78,34,,1229.78,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,1265.95,35,,1265.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1229.78,34,"If Charge > 2,000, then 34 percent",1229.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1446.8,
ZIMMER 00-5988-011-17 STEM EXT 17X155MM,C1776,HCPCS,,79010020,CDM,278,RC,,,both,,,2970,1172.16,39.4668,,1172.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1009.8,34,,1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Device,1009.8,34,"Charges > $500, x 34%",1009.8,percent of total billed charges,Implant Device,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1188,40,,1188,percent of total billed charges,Implant Devices,1039.5,70,,1039.5,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1009.8,34,,1009.8,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,1039.5,35,,1039.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1009.8,34,"If Charge > 2,000, then 34 percent",1009.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1188,
ZIMMER 11-301311 ARCOS CON SZ A HI 60MM,C1776,HCPCS,,79010036,CDM,278,RC,,,both,,,19784,7808.11,39.4668,,7808.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Device,6726.56,34,"Charges > $500, x 34%",6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,7913.6,40,,7913.6,percent of total billed charges,Implant Devices,6924.4,70,,6924.4,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6726.56,34,"If Charge > 2,000, then 34 percent",6726.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7913.6,
STRYKER 502-11-58F ACETABULAR SHELL 58MM,C1776,HCPCS,,79010037,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
STRYKER 623-00-44F INSERT 44MM,C1776,HCPCS,,79010038,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 6721-0837 HIP STEM 37X117MM SZ 8,C1776,HCPCS,,79010039,CDM,278,RC,,,both,,,6750,2664.01,39.4668,,2664.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2295,34,,2295,percent of total billed charges,Implant Device,2295,34,,2295,percent of total billed charges,Implant Device,2295,34,,2295,percent of total billed charges,Implant Device,2295,34,,2295,percent of total billed charges,Implant Device,2295,34,,2295,percent of total billed charges,Implant Device,2295,34,,2295,percent of total billed charges,Implant Device,2362.5,35,,2362.5,percent of total billed charges,Implant Device,2295,34,"Charges > $500, x 34%",2295,percent of total billed charges,Implant Device,2362.5,35,,2362.5,percent of total billed charges,Implant Devices,2362.5,35,,2362.5,percent of total billed charges,Implant Devices,2362.5,35,,,percent of total billed charges,Implant Devices,2362.5,35,,2362.5,percent of total billed charges,Implant Devices,2362.5,35,,2362.5,percent of total billed charges,Implant Devices,2700,40,,2700,percent of total billed charges,Implant Devices,2362.5,70,,2362.5,percent of total billed charges,Implant Devices,2295,34,,2295,percent of total billed charges,Implant Devices,2295,34,,2295,percent of total billed charges,Implant Devices,2362.5,35,,2362.5,percent of total billed charges,Implant Devices,2362.5,35,,2362.5,percent of total billed charges,Implant Devices,2362.5,35,,2362.5,percent of total billed charges,Implant Devices,2362.5,35,,2362.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2295,34,"If Charge > 2,000, then 34 percent",2295,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2700,
STRYKER 6519-1-044 FEMORAL HEAD 44MM,C1776,HCPCS,,79010040,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
STRYKER 5510-F-502 FEMORAL COMP SZ 5 RT,C1776,HCPCS,,79010046,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
STRYKER 5520-B-500 TIBIAL BASEPLATE SZ 5,C1776,HCPCS,,79010047,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 5530-G-509 TIBIAL BEARING INSERT,C1776,HCPCS,,79010048,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 5510-F-202 FEMORAL COMP SZ 2 RT,C1776,HCPCS,,79010049,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
STRYKER 5520-B-200 TIBIAL BASEPLATE SZ 2,C1776,HCPCS,,79010050,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 5530-G-209 TIBIAL BEARING INSERT,C1776,HCPCS,,79010051,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 5551-G-299 PATELLA SIZE A29X9MM,C1776,HCPCS,,79010052,CDM,278,RC,,,both,,,1669,658.7,39.4668,,658.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,584.15,35,,584.15,percent of total billed charges,Implant Device,567.46,34,"Charges > $500, x 34%",567.46,percent of total billed charges,Implant Device,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,667.6,40,,667.6,percent of total billed charges,Implant Devices,584.15,70,,584.15,percent of total billed charges,Implant Devices,567.46,34,,567.46,percent of total billed charges,Implant Devices,567.46,34,,567.46,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667.6,
ZIMMER 00-5988-007-26 TIB BLOCK SZ 7 5MM,C1776,HCPCS,,79010057,CDM,278,RC,,,both,,,3061,1208.08,39.4668,,1208.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1040.74,34,,1040.74,percent of total billed charges,Implant Device,1071.35,35,,1071.35,percent of total billed charges,Implant Device,1040.74,34,"Charges > $500, x 34%",1040.74,percent of total billed charges,Implant Device,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1224.4,40,,1224.4,percent of total billed charges,Implant Devices,1071.35,70,,1071.35,percent of total billed charges,Implant Devices,1040.74,34,,1040.74,percent of total billed charges,Implant Devices,1040.74,34,,1040.74,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,1071.35,35,,1071.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1040.74,34,"If Charge > 2,000, then 34 percent",1040.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1224.4,
ACUMED TR-50904-5 RADIAL 9X4MM,C1776,HCPCS,,79010059,CDM,278,RC,,,both,,,6951,2743.34,39.4668,,2743.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Device,2363.34,34,"Charges > $500, x 34%",2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2780.4,40,,2780.4,percent of total billed charges,Implant Devices,2432.85,70,,2432.85,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2363.34,34,"If Charge > 2,000, then 34 percent",2363.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2780.4,
ACUMED 5001-0222L-S RADIAL HEAD LT 22MM,C1776,HCPCS,,79010060,CDM,278,RC,,,both,,,11196,4418.7,39.4668,,4418.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3918.6,35,,3918.6,percent of total billed charges,Implant Device,3806.64,34,"Charges > $500, x 34%",3806.64,percent of total billed charges,Implant Device,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,4478.4,40,,4478.4,percent of total billed charges,Implant Devices,3918.6,70,,3918.6,percent of total billed charges,Implant Devices,3806.64,34,,3806.64,percent of total billed charges,Implant Devices,3806.64,34,,3806.64,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3806.64,34,"If Charge > 2,000, then 34 percent",3806.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4478.4,
STRYKER 5510-F-301 FEMORAL COMP SZ 3 LT,C1776,HCPCS,,79010066,CDM,278,RC,,,both,,,4450,1756.27,39.4668,,1756.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1557.5,35,,1557.5,percent of total billed charges,Implant Device,1513,34,"Charges > $500, x 34%",1513,percent of total billed charges,Implant Device,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1780,40,,1780,percent of total billed charges,Implant Devices,1557.5,70,,1557.5,percent of total billed charges,Implant Devices,1513,34,,1513,percent of total billed charges,Implant Devices,1513,34,,1513,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1513,34,"If Charge > 2,000, then 34 percent",1513,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1780,
STRYKER 5520-B-300 TIB BASEPLATE SZ 3,C1776,HCPCS,,79010067,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 5530-G-311 TIB INSERT SZ 3 11MM,C1776,HCPCS,,79010068,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
WRIGHT 4700010 SWANSON FINGER JOINT #0,C1776,HCPCS,,79010069,CDM,278,RC,,,both,,,4989,1969,39.4668,,1969,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1696.26,34,,1696.26,percent of total billed charges,Implant Device,1696.26,34,,1696.26,percent of total billed charges,Implant Device,1696.26,34,,1696.26,percent of total billed charges,Implant Device,1696.26,34,,1696.26,percent of total billed charges,Implant Device,1696.26,34,,1696.26,percent of total billed charges,Implant Device,1696.26,34,,1696.26,percent of total billed charges,Implant Device,1746.15,35,,1746.15,percent of total billed charges,Implant Device,1696.26,34,"Charges > $500, x 34%",1696.26,percent of total billed charges,Implant Device,1746.15,35,,1746.15,percent of total billed charges,Implant Devices,1746.15,35,,1746.15,percent of total billed charges,Implant Devices,1746.15,35,,,percent of total billed charges,Implant Devices,1746.15,35,,1746.15,percent of total billed charges,Implant Devices,1746.15,35,,1746.15,percent of total billed charges,Implant Devices,1995.6,40,,1995.6,percent of total billed charges,Implant Devices,1746.15,70,,1746.15,percent of total billed charges,Implant Devices,1696.26,34,,1696.26,percent of total billed charges,Implant Devices,1696.26,34,,1696.26,percent of total billed charges,Implant Devices,1746.15,35,,1746.15,percent of total billed charges,Implant Devices,1746.15,35,,1746.15,percent of total billed charges,Implant Devices,1746.15,35,,1746.15,percent of total billed charges,Implant Devices,1746.15,35,,1746.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1696.26,34,"If Charge > 2,000, then 34 percent",1696.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1995.6,
ZIMMER 00-7711-005-10 FEM STEM SZ 5,C1776,HCPCS,,79010070,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 00-5976-050-14 ART SURF BLUE 14MM,C1776,HCPCS,,79010072,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
ZIMMER 00-5950-014-02 FEM COMP SZ D RT,C1776,HCPCS,,79010073,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 11-301313 CONE PRX BODY SZ C 60MM,C1776,HCPCS,,79010074,CDM,278,RC,,,both,,,21456,8468,39.4668,,8468,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7295.04,34,,7295.04,percent of total billed charges,Implant Device,7295.04,34,,7295.04,percent of total billed charges,Implant Device,7295.04,34,,7295.04,percent of total billed charges,Implant Device,7295.04,34,,7295.04,percent of total billed charges,Implant Device,7295.04,34,,7295.04,percent of total billed charges,Implant Device,7295.04,34,,7295.04,percent of total billed charges,Implant Device,7509.6,35,,7509.6,percent of total billed charges,Implant Device,7295.04,34,"Charges > $500, x 34%",7295.04,percent of total billed charges,Implant Device,7509.6,35,,7509.6,percent of total billed charges,Implant Devices,7509.6,35,,7509.6,percent of total billed charges,Implant Devices,7509.6,35,,,percent of total billed charges,Implant Devices,7509.6,35,,7509.6,percent of total billed charges,Implant Devices,7509.6,35,,7509.6,percent of total billed charges,Implant Devices,8582.4,40,,8582.4,percent of total billed charges,Implant Devices,7509.6,70,,7509.6,percent of total billed charges,Implant Devices,7295.04,34,,7295.04,percent of total billed charges,Implant Devices,7295.04,34,,7295.04,percent of total billed charges,Implant Devices,7509.6,35,,7509.6,percent of total billed charges,Implant Devices,7509.6,35,,7509.6,percent of total billed charges,Implant Devices,7509.6,35,,7509.6,percent of total billed charges,Implant Devices,7509.6,35,,7509.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7295.04,34,"If Charge > 2,000, then 34 percent",7295.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8582.4,
STRYKER 6720-0435 HIP STEM SZ 4 35X105MM,C1776,HCPCS,,79010090,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
STRYKER 702-04-56F ACETABULAR SHELL 56MM,C1776,HCPCS,,79010091,CDM,278,RC,,,both,,,3337,1317.01,39.4668,,1317.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Device,1134.58,34,"Charges > $500, x 34%",1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1334.8,40,,1334.8,percent of total billed charges,Implant Devices,1167.95,70,,1167.95,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1134.58,34,"If Charge > 2,000, then 34 percent",1134.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334.8,
EXACTECH 308-10-00 PROX BODY MED +0MM,C1776,HCPCS,,79010093,CDM,278,RC,,,both,,,17730,6997.46,39.4668,,6997.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6028.2,34,,6028.2,percent of total billed charges,Implant Device,6028.2,34,,6028.2,percent of total billed charges,Implant Device,6028.2,34,,6028.2,percent of total billed charges,Implant Device,6028.2,34,,6028.2,percent of total billed charges,Implant Device,6028.2,34,,6028.2,percent of total billed charges,Implant Device,6028.2,34,,6028.2,percent of total billed charges,Implant Device,6205.5,35,,6205.5,percent of total billed charges,Implant Device,6028.2,34,"Charges > $500, x 34%",6028.2,percent of total billed charges,Implant Device,6205.5,35,,6205.5,percent of total billed charges,Implant Devices,6205.5,35,,6205.5,percent of total billed charges,Implant Devices,6205.5,35,,,percent of total billed charges,Implant Devices,6205.5,35,,6205.5,percent of total billed charges,Implant Devices,6205.5,35,,6205.5,percent of total billed charges,Implant Devices,7092,40,,7092,percent of total billed charges,Implant Devices,6205.5,70,,6205.5,percent of total billed charges,Implant Devices,6028.2,34,,6028.2,percent of total billed charges,Implant Devices,6028.2,34,,6028.2,percent of total billed charges,Implant Devices,6205.5,35,,6205.5,percent of total billed charges,Implant Devices,6205.5,35,,6205.5,percent of total billed charges,Implant Devices,6205.5,35,,6205.5,percent of total billed charges,Implant Devices,6205.5,35,,6205.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6028.2,34,"If Charge > 2,000, then 34 percent",6028.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7092,
EXACTECH 308-01-11 DISTAL STEM 11X80MM,C1776,HCPCS,,79010094,CDM,278,RC,,,both,,,16980,6701.46,39.4668,,6701.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5773.2,34,,5773.2,percent of total billed charges,Implant Device,5773.2,34,,5773.2,percent of total billed charges,Implant Device,5773.2,34,,5773.2,percent of total billed charges,Implant Device,5773.2,34,,5773.2,percent of total billed charges,Implant Device,5773.2,34,,5773.2,percent of total billed charges,Implant Device,5773.2,34,,5773.2,percent of total billed charges,Implant Device,5943,35,,5943,percent of total billed charges,Implant Device,5773.2,34,"Charges > $500, x 34%",5773.2,percent of total billed charges,Implant Device,5943,35,,5943,percent of total billed charges,Implant Devices,5943,35,,5943,percent of total billed charges,Implant Devices,5943,35,,,percent of total billed charges,Implant Devices,5943,35,,5943,percent of total billed charges,Implant Devices,5943,35,,5943,percent of total billed charges,Implant Devices,6792,40,,6792,percent of total billed charges,Implant Devices,5943,70,,5943,percent of total billed charges,Implant Devices,5773.2,34,,5773.2,percent of total billed charges,Implant Devices,5773.2,34,,5773.2,percent of total billed charges,Implant Devices,5943,35,,5943,percent of total billed charges,Implant Devices,5943,35,,5943,percent of total billed charges,Implant Devices,5943,35,,5943,percent of total billed charges,Implant Devices,5943,35,,5943,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5773.2,34,"If Charge > 2,000, then 34 percent",5773.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6792,
EXACTECH 308-05-31 DIS FIXTN RING 31.5MM,C1776,HCPCS,,79010095,CDM,278,RC,,,both,,,5454,2152.52,39.4668,,2152.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1854.36,34,,1854.36,percent of total billed charges,Implant Device,1854.36,34,,1854.36,percent of total billed charges,Implant Device,1854.36,34,,1854.36,percent of total billed charges,Implant Device,1854.36,34,,1854.36,percent of total billed charges,Implant Device,1854.36,34,,1854.36,percent of total billed charges,Implant Device,1854.36,34,,1854.36,percent of total billed charges,Implant Device,1908.9,35,,1908.9,percent of total billed charges,Implant Device,1854.36,34,"Charges > $500, x 34%",1854.36,percent of total billed charges,Implant Device,1908.9,35,,1908.9,percent of total billed charges,Implant Devices,1908.9,35,,1908.9,percent of total billed charges,Implant Devices,1908.9,35,,,percent of total billed charges,Implant Devices,1908.9,35,,1908.9,percent of total billed charges,Implant Devices,1908.9,35,,1908.9,percent of total billed charges,Implant Devices,2181.6,40,,2181.6,percent of total billed charges,Implant Devices,1908.9,70,,1908.9,percent of total billed charges,Implant Devices,1854.36,34,,1854.36,percent of total billed charges,Implant Devices,1854.36,34,,1854.36,percent of total billed charges,Implant Devices,1908.9,35,,1908.9,percent of total billed charges,Implant Devices,1908.9,35,,1908.9,percent of total billed charges,Implant Devices,1908.9,35,,1908.9,percent of total billed charges,Implant Devices,1908.9,35,,1908.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1854.36,34,"If Charge > 2,000, then 34 percent",1854.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2181.6,
STRYKER 6260-9-028 V40 LIFT HEAD 28MM/-4,C1776,HCPCS,,79010108,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER UH1-48-28 UHR BIPOLAR 28X48MM,C1776,HCPCS,,79010109,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 6265-2-003 RELIANCE PF HIP #3/13,C1776,HCPCS,,79010110,CDM,278,RC,,,both,,,3750,1480.01,39.4668,,1480.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Device,1275,34,"Charges > $500, x 34%",1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1500,40,,1500,percent of total billed charges,Implant Devices,1312.5,70,,1312.5,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1275,34,"If Charge > 2,000, then 34 percent",1275,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
STRYKER UH1-54-28 UHR BIPOLAR 28X54MM,C1776,HCPCS,,79010111,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
STRYKER 702-04-52E ACETABULAR SHELL 52MM,C1776,HCPCS,,79010113,CDM,278,RC,,,both,,,3337,1317.01,39.4668,,1317.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Device,1134.58,34,"Charges > $500, x 34%",1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1334.8,40,,1334.8,percent of total billed charges,Implant Devices,1167.95,70,,1167.95,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1134.58,34,"If Charge > 2,000, then 34 percent",1134.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334.8,
STRYKER 6519-T-204 ADAPTOR SLEEVE +4MM,C1776,HCPCS,,79010114,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
EXACTECH 320-15-08 HUMERAL LINER 42MM,C1776,HCPCS,,79010126,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
STRYKER 5569-P-2013 HUMERAL STEM 13MM,C1776,HCPCS,,79010127,CDM,278,RC,,,both,,,10500,4144.01,39.4668,,4144.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Device,3570,34,"Charges > $500, x 34%",3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,4200,40,,4200,percent of total billed charges,Implant Devices,3675,70,,3675,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3570,34,"If Charge > 2,000, then 34 percent",3570,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4200,
STRYKER 5530-G-309 TIB INSERT SZ 3 9MM,C1776,HCPCS,,79010128,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
DEPUY 3L92508 CORAIL COLLAR SIZE 18,C1776,HCPCS,,79010133,CDM,278,RC,,,both,,,13446,5306.71,39.4668,,5306.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Device,4571.64,34,"Charges > $500, x 34%",4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,5378.4,40,,5378.4,percent of total billed charges,Implant Devices,4706.1,70,,4706.1,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4571.64,34,"If Charge > 2,000, then 34 percent",4571.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5378.4,
LSI 021030 RDQLU 2-0 MONOGLIDE,C1776,HCPCS,,79010142,CDM,278,RC,,,both,,,96,37.89,39.4668,,37.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,32.64,34,,32.64,percent of total billed charges,Implant Device,33.6,35,,33.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,38.4,40,,38.4,percent of total billed charges,Implant Devices,33.6,70,,33.6,percent of total billed charges,Implant Devices,32.64,34,,32.64,percent of total billed charges,Implant Devices,32.64,34,,32.64,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,33.6,35,,33.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,38.4,
EXACTECH 320-36-00 HUMERAL LINER 36MM,C1776,HCPCS,,79010143,CDM,278,RC,,,both,,,2325,917.6,39.4668,,917.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Device,790.5,34,"Charges > $500, x 34%",790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,930,40,,930,percent of total billed charges,Implant Devices,813.75,70,,813.75,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.5,34,"If Charge > 2,000, then 34 percent",790.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930,
EXACTECH 320-01-36 GLENOSPHERE 36MM,C1776,HCPCS,,79010151,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
STRYKER 6721-0635 HIP STEM SZ 0 35X111MM,C1776,HCPCS,,79010160,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
STRYKER 5510-F-402 RETAINING FEM SZ 4 RT,C1776,HCPCS,,79010161,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
STRYKER 5530-G-311-E TIB INSERT SZ3 11MM,C1776,HCPCS,,79010162,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
EXACTECH 300-01-12 HUMERAL STEM 12MM,C1776,HCPCS,,79010177,CDM,278,RC,,,both,,,4425,1746.41,39.4668,,1746.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Device,1504.5,34,"Charges > $500, x 34%",1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1770,40,,1770,percent of total billed charges,Implant Devices,1548.75,70,,1548.75,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1504.5,34,"If Charge > 2,000, then 34 percent",1504.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1770,
STRYKER 5510-F-302 FEM COMPONENT SZ 3,C1776,HCPCS,,79010211,CDM,278,RC,,,both,,,4450,1756.27,39.4668,,1756.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1557.5,35,,1557.5,percent of total billed charges,Implant Device,1513,34,"Charges > $500, x 34%",1513,percent of total billed charges,Implant Device,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1780,40,,1780,percent of total billed charges,Implant Devices,1557.5,70,,1557.5,percent of total billed charges,Implant Devices,1513,34,,1513,percent of total billed charges,Implant Devices,1513,34,,1513,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1513,34,"If Charge > 2,000, then 34 percent",1513,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1780,
DEPUY 3L93711 CONRAIL2 LAT COX SIZE 11,C1776,HCPCS,,79010215,CDM,278,RC,,,both,,,13446,5306.71,39.4668,,5306.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Device,4571.64,34,"Charges > $500, x 34%",4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,5378.4,40,,5378.4,percent of total billed charges,Implant Devices,4706.1,70,,4706.1,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4571.64,34,"If Charge > 2,000, then 34 percent",4571.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5378.4,
STRYKER UH1-50-26 UHR BIPOLAR 26X50MM,C1776,HCPCS,,79010222,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 6721-0330 ACCOLADE II 127 SZ3,C1776,HCPCS,,79010223,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
STRYKER UH1-44026 UHR BIPOLAR 26X44MM,C1776,HCPCS,,79010224,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
DJO 130-03-032 PATELLA DOME 3D 32MM,C1776,HCPCS,,79010225,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
DJO 242-01-106 FEMUR SIZE 6 LEFT,C1776,HCPCS,,79010226,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
DJO 343-10-755 TIBIAL INSERT SIZE 5 10MM,C1776,HCPCS,,79010227,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
DJO 351-01-105 FINNED BASEPLATE SZ 5 LT,C1776,HCPCS,,79010228,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
DJO 130-03-035 PATELLA DOME 3D 35MM,C1776,HCPCS,,79010229,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
DJO 242-01-108 FEMUR SIZE 8 LEFT,C1776,HCPCS,,79010230,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
DJO 343-10-708 TIBIAL INSERT SIZE 8 10MM,C1776,HCPCS,,79010231,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
DJO 351-01-108 FINNED BASEPLATE SZ 8 LT,C1776,HCPCS,,79010232,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
DJO 343-10-706 TIBIAL INSERT SIZE 6 10MM,C1776,HCPCS,,79010233,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
DJO 351-01-106 FINNED BASEPLATE SZ 6 LT,C1776,HCPCS,,79010234,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
DJO 430-99-054 HEMISPHERICAL SHELL 54MM,C1776,HCPCS,,79010237,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
DJO 932-36-754 ACETABULAR LINER 36MM,C1776,HCPCS,,79010238,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
DJO D111-18-1102 HIP STEM SIZE 11,C1776,HCPCS,,79010239,CDM,278,RC,,,both,,,7320,2888.97,39.4668,,2888.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Device,2488.8,34,"Charges > $500, x 34%",2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2928,40,,2928,percent of total billed charges,Implant Devices,2562,70,,2562,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2488.8,34,"If Charge > 2,000, then 34 percent",2488.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2928,
DJO D111-152-632 FEMORAL HEAD SIZE 36MM,C1776,HCPCS,,79010240,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
DJO 242-02-10-8 FEMUR SIZE 8 RIGHT,C1776,HCPCS,,79010241,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
DJO 343-11-708 TIBIAL INSERT SIZE 8 11MM,C1776,HCPCS,,79010242,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
DJO 351-02-108 FINNED BASEPLATE SZ 8 RT,C1776,HCPCS,,79010243,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
EXACTECH 320-15-07 GLENOID BASEPLATE LT,C1776,HCPCS,,79010253,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
ZIMMER 11-301331 CONE PROX BODY SZ A 70,C1776,HCPCS,,79010260,CDM,278,RC,,,both,,,19784,7808.11,39.4668,,7808.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Device,6726.56,34,"Charges > $500, x 34%",6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,7913.6,40,,7913.6,percent of total billed charges,Implant Devices,6924.4,70,,6924.4,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6726.56,34,"If Charge > 2,000, then 34 percent",6726.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7913.6,
ZIMMER 11-301312 CONE PROX BODY SZ B 60,C1776,HCPCS,,79010261,CDM,278,RC,,,both,,,19784,7808.11,39.4668,,7808.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Device,6726.56,34,"Charges > $500, x 34%",6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,7913.6,40,,7913.6,percent of total billed charges,Implant Devices,6924.4,70,,6924.4,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6726.56,34,"If Charge > 2,000, then 34 percent",6726.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7913.6,
ZIMMER 00-7711-010-10 FEM STEM SIZE 10,C1776,HCPCS,,79010262,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
ZIMMER 11-300814 DISTAL STEM 14X150MM,C1776,HCPCS,,79010263,CDM,278,RC,,,both,,,11059,4364.63,39.4668,,4364.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3760.06,34,,3760.06,percent of total billed charges,Implant Device,3870.65,35,,3870.65,percent of total billed charges,Implant Device,3760.06,34,"Charges > $500, x 34%",3760.06,percent of total billed charges,Implant Device,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,4423.6,40,,4423.6,percent of total billed charges,Implant Devices,3870.65,70,,3870.65,percent of total billed charges,Implant Devices,3760.06,34,,3760.06,percent of total billed charges,Implant Devices,3760.06,34,,3760.06,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,3870.65,35,,3870.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3760.06,34,"If Charge > 2,000, then 34 percent",3760.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4423.6,
DJO 242-01-107 FEMUR SIZE 7L,C1776,HCPCS,,79010285,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
DJO 430-99-058 HEMI SHELL 58MM,C1776,HCPCS,,79010286,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
DJO 935-36-256 ACETABULAR LINER 36MM,C1776,HCPCS,,79010287,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
DJO D111-18-1402 HIP STEM SIZE 14,C1776,HCPCS,,79010288,CDM,278,RC,,,both,,,7320,2888.97,39.4668,,2888.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Device,2488.8,34,"Charges > $500, x 34%",2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2928,40,,2928,percent of total billed charges,Implant Devices,2562,70,,2562,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2488.8,34,"If Charge > 2,000, then 34 percent",2488.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2928,
DEPUY 1961-92-145 TIBIAL INSERT SZ4 20MM,C1776,HCPCS,,79010297,CDM,278,RC,,,both,,,5735,2263.42,39.4668,,2263.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,1949.9,34,,1949.9,percent of total billed charges,Implant Device,2007.25,35,,2007.25,percent of total billed charges,Implant Device,1949.9,34,"Charges > $500, x 34%",1949.9,percent of total billed charges,Implant Device,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2294,40,,2294,percent of total billed charges,Implant Devices,2007.25,70,,2007.25,percent of total billed charges,Implant Devices,1949.9,34,,1949.9,percent of total billed charges,Implant Devices,1949.9,34,,1949.9,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,2007.25,35,,2007.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1949.9,34,"If Charge > 2,000, then 34 percent",1949.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2294,
ACUMED 5001-02244L-S RADIAL HEAD 24MM L,C1776,HCPCS,,79010299,CDM,278,RC,,,both,,,11196,4418.7,39.4668,,4418.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3806.64,34,,3806.64,percent of total billed charges,Implant Device,3918.6,35,,3918.6,percent of total billed charges,Implant Device,3806.64,34,"Charges > $500, x 34%",3806.64,percent of total billed charges,Implant Device,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,4478.4,40,,4478.4,percent of total billed charges,Implant Devices,3918.6,70,,3918.6,percent of total billed charges,Implant Devices,3806.64,34,,3806.64,percent of total billed charges,Implant Devices,3806.64,34,,3806.64,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,3918.6,35,,3918.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3806.64,34,"If Charge > 2,000, then 34 percent",3806.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4478.4,
ACUMED TR-S0902-S STEM 9.0X2.0MM,C1776,HCPCS,,79010305,CDM,278,RC,,,both,,,6951,2743.34,39.4668,,2743.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Device,2363.34,34,"Charges > $500, x 34%",2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2780.4,40,,2780.4,percent of total billed charges,Implant Devices,2432.85,70,,2432.85,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2363.34,34,"If Charge > 2,000, then 34 percent",2363.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2780.4,
ZIMMER 00-7711-009-10 FEM STEM SIZE 9,C1776,HCPCS,,79010306,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 00-5988-004-39 TIB AUG BLOCK 20MM,C1776,HCPCS,,79010308,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 00-5976-040-17 ART SURF SZ 17MM,C1776,HCPCS,,79010312,CDM,278,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,765,34,,765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Device,765,34,"Charges > $500, x 34%",765,percent of total billed charges,Implant Device,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,900,40,,900,percent of total billed charges,Implant Devices,787.5,70,,787.5,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,765,34,,765,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,787.5,35,,787.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,765,34,"If Charge > 2,000, then 34 percent",765,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,900,
STRYKER 5530-G-409-E TIB INSERT SZ 4 9MM,C1776,HCPCS,,79010314,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
DJO 241-01-105 FEMUR SIZE 5 LEFT,C1776,HCPCS,,79010315,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
DJO 341-10-705 TIBIAL INSERT SIZE 5 10MM,C1776,HCPCS,,79010316,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
DJO 241-01-106 FEMUR SIZE 6 LEFT,C1776,HCPCS,,79010317,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
DJO 341-10-706 TIBIAL INSERT SIZE 6 10MM,C1776,HCPCS,,79010318,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
DJO 351-03-106 BASEPLATE SIZE 6 LEFT,C1776,HCPCS,,79010319,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
ZIMMER 00-8851-016-36 LINER 36MM SZ 00,C1776,HCPCS,,79010324,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
DEPUY 1365-36-730 FEM HEAD 12/14 36MM,C1776,HCPCS,,79010354,CDM,278,RC,,,both,,,8077,3187.73,39.4668,,3187.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2826.95,35,,2826.95,percent of total billed charges,Implant Device,2746.18,34,"Charges > $500, x 34%",2746.18,percent of total billed charges,Implant Device,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,3230.8,40,,3230.8,percent of total billed charges,Implant Devices,2826.95,70,,2826.95,percent of total billed charges,Implant Devices,2746.18,34,,2746.18,percent of total billed charges,Implant Devices,2746.18,34,,2746.18,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2746.18,34,"If Charge > 2,000, then 34 percent",2746.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3230.8,
ZIMMER 42-5570-001-14 STEM EXT 14X-30MM,C1776,HCPCS,,79010361,CDM,278,RC,,,both,,,5850,2308.81,39.4668,,2308.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Device,1989,34,"Charges > $500, x 34%",1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2340,40,,2340,percent of total billed charges,Implant Devices,2047.5,70,,2047.5,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1989,34,"If Charge > 2,000, then 34 percent",1989,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2340,
ZIMMER 42-5400-000-32 PATELLA 32X8.5MM,C1776,HCPCS,,79010362,CDM,278,RC,,,both,,,1539,607.39,39.4668,,607.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,538.65,35,,538.65,percent of total billed charges,Implant Device,523.26,34,"Charges > $500, x 34%",523.26,percent of total billed charges,Implant Device,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,615.6,40,,615.6,percent of total billed charges,Implant Devices,538.65,70,,538.65,percent of total billed charges,Implant Devices,523.26,34,,523.26,percent of total billed charges,Implant Devices,523.26,34,,523.26,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,615.6,
ZIMMER 42-5320-075-01 TIBIA LEFT SIZE F,C1776,HCPCS,,79010363,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 42-5026-064-01 FEMUR LEFT SIZE 8,C1776,HCPCS,,79010364,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 42-5121-008-10 ACT SURF LT 10MM,C1776,HCPCS,,79010365,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5320-075-02 TIBIA RT SIZE F,C1776,HCPCS,,79010366,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 42-5221-008-12 ART SURF RT 12MM,C1776,HCPCS,,79010367,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
ZIMMER 42-5026-068-02 FEMUR RT SIZE 10,C1776,HCPCS,,79010368,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
STRYKER 1059-2310 ACCOLADE DISTAL SPACER,C1776,HCPCS,,79010369,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
STRYKER 6057-0335D ACCOLADE C CS 127NK,C1776,HCPCS,,79010370,CDM,278,RC,,,both,,,5006,1975.71,39.4668,,1975.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1752.1,35,,1752.1,percent of total billed charges,Implant Device,1702.04,34,"Charges > $500, x 34%",1702.04,percent of total billed charges,Implant Device,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,2002.4,40,,2002.4,percent of total billed charges,Implant Devices,1752.1,70,,1752.1,percent of total billed charges,Implant Devices,1702.04,34,,1702.04,percent of total billed charges,Implant Devices,1702.04,34,,1702.04,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1702.04,34,"If Charge > 2,000, then 34 percent",1702.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2002.4,
STRYKER 6260-9-026 V440 COCR LFIT HEAD,C1776,HCPCS,,79010371,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
DEPUY 1221-36-052 ACETAB LINER 36/52MM,C1776,HCPCS,,79010378,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
DEPUY 3L92506 CONRAIL AMT COLLAR SZ 16,C1776,HCPCS,,79010381,CDM,278,RC,,,both,,,13446,5306.71,39.4668,,5306.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4571.64,34,,4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Device,4571.64,34,"Charges > $500, x 34%",4571.64,percent of total billed charges,Implant Device,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,5378.4,40,,5378.4,percent of total billed charges,Implant Devices,4706.1,70,,4706.1,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4571.64,34,,4571.64,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,4706.1,35,,4706.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4571.64,34,"If Charge > 2,000, then 34 percent",4571.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5378.4,
DEPUY 1221-36-054 ACETAB LINER 36IDX54OD,C1776,HCPCS,,79010382,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
EXACTECH 310-00-44 HUMERAL HEAD 44X14MM,C1776,HCPCS,,79010384,CDM,278,RC,,,both,,,4968,1960.71,39.4668,,1960.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1689.12,34,,1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Device,1689.12,34,"Charges > $500, x 34%",1689.12,percent of total billed charges,Implant Device,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1987.2,40,,1987.2,percent of total billed charges,Implant Devices,1738.8,70,,1738.8,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1689.12,34,,1689.12,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,1738.8,35,,1738.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.12,34,"If Charge > 2,000, then 34 percent",1689.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.2,
EXACTECH 300-30-06 PRESERVE STEM 6MM,C1776,HCPCS,,79010386,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
DEPUY 1365-36-720 FEM HEAD 12.14 TAPER,C1776,HCPCS,,79010399,CDM,278,RC,,,both,,,8077,3187.73,39.4668,,3187.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2746.18,34,,2746.18,percent of total billed charges,Implant Device,2826.95,35,,2826.95,percent of total billed charges,Implant Device,2746.18,34,"Charges > $500, x 34%",2746.18,percent of total billed charges,Implant Device,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,3230.8,40,,3230.8,percent of total billed charges,Implant Devices,2826.95,70,,2826.95,percent of total billed charges,Implant Devices,2746.18,34,,2746.18,percent of total billed charges,Implant Devices,2746.18,34,,2746.18,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,2826.95,35,,2826.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2746.18,34,"If Charge > 2,000, then 34 percent",2746.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3230.8,
STRYKER 5571-S-3606 X3 HUMRAL INSRT 36X6,C1776,HCPCS,,79010402,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
STRYKER 5510-F-501 FEMORAL COMP SZ 5 LT,C1776,HCPCS,,79010403,CDM,278,RC,,,both,,,4450,1756.27,39.4668,,1756.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1513,34,,1513,percent of total billed charges,Implant Device,1557.5,35,,1557.5,percent of total billed charges,Implant Device,1513,34,"Charges > $500, x 34%",1513,percent of total billed charges,Implant Device,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1780,40,,1780,percent of total billed charges,Implant Devices,1557.5,70,,1557.5,percent of total billed charges,Implant Devices,1513,34,,1513,percent of total billed charges,Implant Devices,1513,34,,1513,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,1557.5,35,,1557.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1513,34,"If Charge > 2,000, then 34 percent",1513,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1780,
ZIMMER 42-5026-062-01 FEMUR STANDARD LT,C1776,HCPCS,,79010422,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
ZIMMER 42-5320-071-01 TIBIA 5 DEG LT,C1776,HCPCS,,79010423,CDM,278,RC,,,both,,,4433,1749.56,39.4668,,1749.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Device,1507.22,34,"Charges > $500, x 34%",1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1773.2,40,,1773.2,percent of total billed charges,Implant Devices,1551.55,70,,1551.55,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1507.22,34,"If Charge > 2,000, then 34 percent",1507.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1773.2,
ZIMMER 42-5121-007-10 ART SURF LT 10MM,C1776,HCPCS,,79010424,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
STRYKER 5510-F-701 FEMORAL COMP #7 LT,C1776,HCPCS,,79010440,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
STRYKER 5530-G-611 TIB INSERT SZ 6 11MM,C1776,HCPCS,,79010441,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
ZIMMER 00-5750-014-02 FEMORAL COMP SZ D,C1776,HCPCS,,79010442,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
EXACTECH 320-31-36 GLENOSPHERE 36MM,C1776,HCPCS,,79010452,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
EXACTECH 320-35-02 GLENOID BASEPLT 10DEG,C1776,HCPCS,,79010453,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
EXACTECH 320-35-08 GLENOID BASEPLATE RT,C1776,HCPCS,,79010454,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
STRYKER 5510-F-601 RETAINING FEM SZ 8 LT,C1776,HCPCS,,79010455,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
STRYKER 5530-G-509-E TIB BEARING INSERT,C1776,HCPCS,,79010456,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
EXACTECH 320-40-00 HUMERAL LINER 40MM,C1776,HCPCS,,79010457,CDM,278,RC,,,both,,,2325,917.6,39.4668,,917.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Device,790.5,34,"Charges > $500, x 34%",790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,930,40,,930,percent of total billed charges,Implant Devices,813.75,70,,813.75,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.5,34,"If Charge > 2,000, then 34 percent",790.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930,
EXACTECH 320-31-40 GLENOSPHERE 40MM,C1776,HCPCS,,79010458,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
EXACTECH 320-35-01 SM GLENOID PLATE,C1776,HCPCS,,79010459,CDM,278,RC,,,both,,,4590,1811.53,39.4668,,1811.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1560.6,34,,1560.6,percent of total billed charges,Implant Device,1606.5,35,,1606.5,percent of total billed charges,Implant Device,1560.6,34,"Charges > $500, x 34%",1560.6,percent of total billed charges,Implant Device,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1836,40,,1836,percent of total billed charges,Implant Devices,1606.5,70,,1606.5,percent of total billed charges,Implant Devices,1560.6,34,,1560.6,percent of total billed charges,Implant Devices,1560.6,34,,1560.6,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,1606.5,35,,1606.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1560.6,34,"If Charge > 2,000, then 34 percent",1560.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1836,
DEPUY 1365-36-740 FEMORAL HEAD 36MM,C1776,HCPCS,,79010481,CDM,278,RC,,,both,,,9349,3689.75,39.4668,,3689.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3178.66,34,,3178.66,percent of total billed charges,Implant Device,3272.15,35,,3272.15,percent of total billed charges,Implant Device,3178.66,34,"Charges > $500, x 34%",3178.66,percent of total billed charges,Implant Device,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3739.6,40,,3739.6,percent of total billed charges,Implant Devices,3272.15,70,,3272.15,percent of total billed charges,Implant Devices,3178.66,34,,3178.66,percent of total billed charges,Implant Devices,3178.66,34,,3178.66,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,3272.15,35,,3272.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3178.66,34,"If Charge > 2,000, then 34 percent",3178.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3739.6,
ZIMMER 00-8755-013-36 LINER 36MM SIZE LL,C1776,HCPCS,,79010487,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
WRIGHT 4310001 SWANSON HAMMERTOE SZ 1,C1776,HCPCS,,79010492,CDM,278,RC,,,both,,,3390,1337.92,39.4668,,1337.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1152.6,34,,1152.6,percent of total billed charges,Implant Device,1186.5,35,,1186.5,percent of total billed charges,Implant Device,1152.6,34,"Charges > $500, x 34%",1152.6,percent of total billed charges,Implant Device,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1356,40,,1356,percent of total billed charges,Implant Devices,1186.5,70,,1186.5,percent of total billed charges,Implant Devices,1152.6,34,,1152.6,percent of total billed charges,Implant Devices,1152.6,34,,1152.6,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,1186.5,35,,1186.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1152.6,34,"If Charge > 2,000, then 34 percent",1152.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1356,
STRYKER 626-00-46F MDM COCR LINER 46MM F,C1776,HCPCS,,79010494,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 6485-3-815 15X127 CUR FEM STEM,C1776,HCPCS,,79010495,CDM,278,RC,,,both,,,7722,3047.63,39.4668,,3047.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2702.7,35,,2702.7,percent of total billed charges,Implant Device,2625.48,34,"Charges > $500, x 34%",2625.48,percent of total billed charges,Implant Device,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,3088.8,40,,3088.8,percent of total billed charges,Implant Devices,2702.7,70,,2702.7,percent of total billed charges,Implant Devices,2625.48,34,,2625.48,percent of total billed charges,Implant Devices,2625.48,34,,2625.48,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2625.48,34,"If Charge > 2,000, then 34 percent",2625.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3088.8,
STRYKER 6491-1-001 PROXIMAL FEMUR NEU,C1776,HCPCS,,79010496,CDM,278,RC,,,both,,,13833,5459.44,39.4668,,5459.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4703.22,34,,4703.22,percent of total billed charges,Implant Device,4703.22,34,,4703.22,percent of total billed charges,Implant Device,4703.22,34,,4703.22,percent of total billed charges,Implant Device,4703.22,34,,4703.22,percent of total billed charges,Implant Device,4703.22,34,,4703.22,percent of total billed charges,Implant Device,4703.22,34,,4703.22,percent of total billed charges,Implant Device,4841.55,35,,4841.55,percent of total billed charges,Implant Device,4703.22,34,"Charges > $500, x 34%",4703.22,percent of total billed charges,Implant Device,4841.55,35,,4841.55,percent of total billed charges,Implant Devices,4841.55,35,,4841.55,percent of total billed charges,Implant Devices,4841.55,35,,,percent of total billed charges,Implant Devices,4841.55,35,,4841.55,percent of total billed charges,Implant Devices,4841.55,35,,4841.55,percent of total billed charges,Implant Devices,5533.2,40,,5533.2,percent of total billed charges,Implant Devices,4841.55,70,,4841.55,percent of total billed charges,Implant Devices,4703.22,34,,4703.22,percent of total billed charges,Implant Devices,4703.22,34,,4703.22,percent of total billed charges,Implant Devices,4841.55,35,,4841.55,percent of total billed charges,Implant Devices,4841.55,35,,4841.55,percent of total billed charges,Implant Devices,4841.55,35,,4841.55,percent of total billed charges,Implant Devices,4841.55,35,,4841.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4703.22,34,"If Charge > 2,000, then 34 percent",4703.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5533.2,
ZIMMER 00-5988-007-10 TIB AUG SZ 7 10MM,C1776,HCPCS,,79010497,CDM,278,RC,,,both,,,3968,1566.04,39.4668,,1566.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1349.12,34,,1349.12,percent of total billed charges,Implant Device,1388.8,35,,1388.8,percent of total billed charges,Implant Device,1349.12,34,"Charges > $500, x 34%",1349.12,percent of total billed charges,Implant Device,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1587.2,40,,1587.2,percent of total billed charges,Implant Devices,1388.8,70,,1388.8,percent of total billed charges,Implant Devices,1349.12,34,,1349.12,percent of total billed charges,Implant Devices,1349.12,34,,1349.12,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,1388.8,35,,1388.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1349.12,34,"If Charge > 2,000, then 34 percent",1349.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1587.2,
STRYKER UH1-52-26 UHR BIPOLAR 26X52MM,C1776,HCPCS,,79010498,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
STRYKER 6260-9-226 V40 COCR LFIT HEAD 26,C1776,HCPCS,,79010510,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 5530-G-609 TIBIAL INSERT SZ6 9MM,C1776,HCPCS,,79010512,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 5571-S-3206 X3 HUMRAL INSRT 32X6,C1776,HCPCS,,79010533,CDM,278,RC,,,both,,,3525,1391.2,39.4668,,1391.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Device,1198.5,34,"Charges > $500, x 34%",1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1410,40,,1410,percent of total billed charges,Implant Devices,1233.75,70,,1233.75,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1198.5,34,"If Charge > 2,000, then 34 percent",1198.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1410,
STRYKER UH1-47-28 UHR BIPOLAR 28X47MM,C1776,HCPCS,,79010535,CDM,278,RC,,,both,,,1500,592,39.4668,,592,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,510,34,,510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Device,510,34,"Charges > $500, x 34%",510,percent of total billed charges,Implant Device,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,600,40,,600,percent of total billed charges,Implant Devices,525,70,,525,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,510,34,,510,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,525,35,,525,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,600,
ZIMMER 00-5964-017-51 FLEX FEM SZ G-LT,C1776,HCPCS,,79010536,CDM,278,RC,,,both,,,5175,2042.41,39.4668,,2042.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1759.5,34,,1759.5,percent of total billed charges,Implant Device,1811.25,35,,1811.25,percent of total billed charges,Implant Device,1759.5,34,"Charges > $500, x 34%",1759.5,percent of total billed charges,Implant Device,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,2070,40,,2070,percent of total billed charges,Implant Devices,1811.25,70,,1811.25,percent of total billed charges,Implant Devices,1759.5,34,,1759.5,percent of total billed charges,Implant Devices,1759.5,34,,1759.5,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,1811.25,35,,1811.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1759.5,34,"If Charge > 2,000, then 34 percent",1759.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2070,
ZIMMER 00-5996-025-17 ALL POLY TIB SZ 5,C1776,HCPCS,,79010537,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
ZIMMER 110010265 ACETABULAR SHELL 54MM,C1776,HCPCS,,79010560,CDM,278,RC,,,both,,,11515,4544.6,39.4668,,4544.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3915.1,34,,3915.1,percent of total billed charges,Implant Device,3915.1,34,,3915.1,percent of total billed charges,Implant Device,3915.1,34,,3915.1,percent of total billed charges,Implant Device,3915.1,34,,3915.1,percent of total billed charges,Implant Device,3915.1,34,,3915.1,percent of total billed charges,Implant Device,3915.1,34,,3915.1,percent of total billed charges,Implant Device,4030.25,35,,4030.25,percent of total billed charges,Implant Device,3915.1,34,"Charges > $500, x 34%",3915.1,percent of total billed charges,Implant Device,4030.25,35,,4030.25,percent of total billed charges,Implant Devices,4030.25,35,,4030.25,percent of total billed charges,Implant Devices,4030.25,35,,,percent of total billed charges,Implant Devices,4030.25,35,,4030.25,percent of total billed charges,Implant Devices,4030.25,35,,4030.25,percent of total billed charges,Implant Devices,4606,40,,4606,percent of total billed charges,Implant Devices,4030.25,70,,4030.25,percent of total billed charges,Implant Devices,3915.1,34,,3915.1,percent of total billed charges,Implant Devices,3915.1,34,,3915.1,percent of total billed charges,Implant Devices,4030.25,35,,4030.25,percent of total billed charges,Implant Devices,4030.25,35,,4030.25,percent of total billed charges,Implant Devices,4030.25,35,,4030.25,percent of total billed charges,Implant Devices,4030.25,35,,4030.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3915.1,34,"If Charge > 2,000, then 34 percent",3915.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4606,
ZIMMER 110024464 ACETABULAR LINER 44MM,C1776,HCPCS,,79010561,CDM,278,RC,,,both,,,3840,1515.53,39.4668,,1515.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1344,35,,1344,percent of total billed charges,Implant Device,1305.6,34,"Charges > $500, x 34%",1305.6,percent of total billed charges,Implant Device,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1536,40,,1536,percent of total billed charges,Implant Devices,1344,70,,1344,percent of total billed charges,Implant Devices,1305.6,34,,1305.6,percent of total billed charges,Implant Devices,1305.6,34,,1305.6,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1305.6,34,"If Charge > 2,000, then 34 percent",1305.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1536,
ZIMMER EP-200150 BEARING 28MMX44MM SZ F,C1776,HCPCS,,79010562,CDM,278,RC,,,both,,,3675,1450.4,39.4668,,1450.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Device,1249.5,34,"Charges > $500, x 34%",1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1470,40,,1470,percent of total billed charges,Implant Devices,1286.25,70,,1286.25,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.5,34,"If Charge > 2,000, then 34 percent",1249.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470,
ZIMMER 650-1055 CERAMIC HEAD 28MM,C1776,HCPCS,,79010563,CDM,278,RC,,,both,,,3075,1213.6,39.4668,,1213.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1076.25,35,,1076.25,percent of total billed charges,Implant Device,1045.5,34,"Charges > $500, x 34%",1045.5,percent of total billed charges,Implant Device,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1230,40,,1230,percent of total billed charges,Implant Devices,1076.25,70,,1076.25,percent of total billed charges,Implant Devices,1045.5,34,,1045.5,percent of total billed charges,Implant Devices,1045.5,34,,1045.5,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1045.5,34,"If Charge > 2,000, then 34 percent",1045.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1230,
ZIMMER 650-1065 ADAPTER TYPE 1 TAPER,C1776,HCPCS,,79010564,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
STRYKER 542-11-50E TRIDENT PSL HA CLUSTE,C1776,HCPCS,,79010581,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
DEPUY 1365-36-240 FEM HEAD +9 36MM,C1776,HCPCS,,79010582,CDM,278,RC,,,both,,,5549,2190.01,39.4668,,2190.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1942.15,35,,1942.15,percent of total billed charges,Implant Device,1886.66,34,"Charges > $500, x 34%",1886.66,percent of total billed charges,Implant Device,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,2219.6,40,,2219.6,percent of total billed charges,Implant Devices,1942.15,70,,1942.15,percent of total billed charges,Implant Devices,1886.66,34,,1886.66,percent of total billed charges,Implant Devices,1886.66,34,,1886.66,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1886.66,34,"If Charge > 2,000, then 34 percent",1886.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2219.6,
DEPUY 1365-36-250 FEM HEAD +12 36MM,C1776,HCPCS,,79010583,CDM,278,RC,,,both,,,5549,2190.01,39.4668,,2190.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1886.66,34,,1886.66,percent of total billed charges,Implant Device,1942.15,35,,1942.15,percent of total billed charges,Implant Device,1886.66,34,"Charges > $500, x 34%",1886.66,percent of total billed charges,Implant Device,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,2219.6,40,,2219.6,percent of total billed charges,Implant Devices,1942.15,70,,1942.15,percent of total billed charges,Implant Devices,1886.66,34,,1886.66,percent of total billed charges,Implant Devices,1886.66,34,,1886.66,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,1942.15,35,,1942.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1886.66,34,"If Charge > 2,000, then 34 percent",1886.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2219.6,
ZIMMER 42-5299-003-01 ART SURF INSERTER,C1776,HCPCS,,79010587,CDM,278,RC,,,both,,,420,165.76,39.4668,,165.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,142.8,34,,142.8,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,168,40,,168,percent of total billed charges,Implant Devices,147,70,,147,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,142.8,34,,142.8,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,147,35,,147,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,168,
ZIMMER 42-5580-004-02 PARTIAL FEMUR SZ 4,C1776,HCPCS,,79010589,CDM,278,RC,,,both,,,5550,2190.41,39.4668,,2190.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Device,1887,34,"Charges > $500, x 34%",1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,2220,40,,2220,percent of total billed charges,Implant Devices,1942.5,70,,1942.5,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1887,34,"If Charge > 2,000, then 34 percent",1887,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2220,
ZIMMER 42-5380-007-02 PARTIAL TIB SZ G,C1776,HCPCS,,79010590,CDM,278,RC,,,both,,,2325,917.6,39.4668,,917.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Device,790.5,34,"Charges > $500, x 34%",790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,930,40,,930,percent of total billed charges,Implant Devices,813.75,70,,813.75,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.5,34,"If Charge > 2,000, then 34 percent",790.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930,
ZIMMER 42-5282-007-08 ART SURF SZ G 8MM,C1776,HCPCS,,79010591,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
EXACTECH 320-32-36 GLENOSPHERE 36MM,C1776,HCPCS,,79010606,CDM,278,RC,,,both,,,9018,3559.12,39.4668,,3559.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3066.12,34,,3066.12,percent of total billed charges,Implant Device,3156.3,35,,3156.3,percent of total billed charges,Implant Device,3066.12,34,"Charges > $500, x 34%",3066.12,percent of total billed charges,Implant Device,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3607.2,40,,3607.2,percent of total billed charges,Implant Devices,3156.3,70,,3156.3,percent of total billed charges,Implant Devices,3066.12,34,,3066.12,percent of total billed charges,Implant Devices,3066.12,34,,3066.12,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,3156.3,35,,3156.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3066.12,34,"If Charge > 2,000, then 34 percent",3066.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3607.2,
STRYKER 5510-F-702 FEM COMP SZ 7 RT,C1776,HCPCS,,79010607,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
STRYKER 5521-B-600 TIB BASEPLATE SZ 6 LT,C1776,HCPCS,,79010608,CDM,278,RC,,,both,,,3337,1317.01,39.4668,,1317.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Device,1134.58,34,"Charges > $500, x 34%",1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1334.8,40,,1334.8,percent of total billed charges,Implant Devices,1167.95,70,,1167.95,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1134.58,34,"If Charge > 2,000, then 34 percent",1134.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334.8,
STRYKER 5531-G-613 TIB INSERT SZ 6 13MM,C1776,HCPCS,,79010609,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
STRYKER 6276-1-325 MOD PROX CONE BODY 25,C1776,HCPCS,,79010615,CDM,278,RC,,,both,,,12717,5018.99,39.4668,,5018.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4323.78,34,,4323.78,percent of total billed charges,Implant Device,4323.78,34,,4323.78,percent of total billed charges,Implant Device,4323.78,34,,4323.78,percent of total billed charges,Implant Device,4323.78,34,,4323.78,percent of total billed charges,Implant Device,4323.78,34,,4323.78,percent of total billed charges,Implant Device,4323.78,34,,4323.78,percent of total billed charges,Implant Device,4450.95,35,,4450.95,percent of total billed charges,Implant Device,4323.78,34,"Charges > $500, x 34%",4323.78,percent of total billed charges,Implant Device,4450.95,35,,4450.95,percent of total billed charges,Implant Devices,4450.95,35,,4450.95,percent of total billed charges,Implant Devices,4450.95,35,,,percent of total billed charges,Implant Devices,4450.95,35,,4450.95,percent of total billed charges,Implant Devices,4450.95,35,,4450.95,percent of total billed charges,Implant Devices,5086.8,40,,5086.8,percent of total billed charges,Implant Devices,4450.95,70,,4450.95,percent of total billed charges,Implant Devices,4323.78,34,,4323.78,percent of total billed charges,Implant Devices,4323.78,34,,4323.78,percent of total billed charges,Implant Devices,4450.95,35,,4450.95,percent of total billed charges,Implant Devices,4450.95,35,,4450.95,percent of total billed charges,Implant Devices,4450.95,35,,4450.95,percent of total billed charges,Implant Devices,4450.95,35,,4450.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4323.78,34,"If Charge > 2,000, then 34 percent",4323.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5086.8,
STRYKER 6570-0-228 DELTA V-40 CERAMIC HD,C1776,HCPCS,,79010616,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
OSSIO OF10129190 HAMMERTOE IMPL 2.9X19MM,C1776,HCPCS,,79010625,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
ZIMMER 00-5850-043-20 DISTAL FEM XT SZ C,C1776,HCPCS,,79010626,CDM,278,RC,,,both,,,27047,10674.59,39.4668,,10674.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,9195.98,34,,9195.98,percent of total billed charges,Implant Device,9195.98,34,,9195.98,percent of total billed charges,Implant Device,9195.98,34,,9195.98,percent of total billed charges,Implant Device,9195.98,34,,9195.98,percent of total billed charges,Implant Device,9195.98,34,,9195.98,percent of total billed charges,Implant Device,9195.98,34,,9195.98,percent of total billed charges,Implant Device,9466.45,35,,9466.45,percent of total billed charges,Implant Device,9195.98,34,"Charges > $500, x 34%",9195.98,percent of total billed charges,Implant Device,9466.45,35,,9466.45,percent of total billed charges,Implant Devices,9466.45,35,,9466.45,percent of total billed charges,Implant Devices,9466.45,35,,,percent of total billed charges,Implant Devices,9466.45,35,,9466.45,percent of total billed charges,Implant Devices,9466.45,35,,9466.45,percent of total billed charges,Implant Devices,10818.8,40,,10818.8,percent of total billed charges,Implant Devices,9466.45,70,,9466.45,percent of total billed charges,Implant Devices,9195.98,34,,9195.98,percent of total billed charges,Implant Devices,9195.98,34,,9195.98,percent of total billed charges,Implant Devices,9466.45,35,,9466.45,percent of total billed charges,Implant Devices,9466.45,35,,9466.45,percent of total billed charges,Implant Devices,9466.45,35,,9466.45,percent of total billed charges,Implant Devices,9466.45,35,,9466.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,9195.98,34,"If Charge > 2,000, then 34 percent",9195.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10818.8,
DEPUY L20316 CONRAIL 2 SZ 16,C1776,HCPCS,,79010637,CDM,278,RC,,,both,,,14060,5549.03,39.4668,,5549.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4780.4,34,,4780.4,percent of total billed charges,Implant Device,4780.4,34,,4780.4,percent of total billed charges,Implant Device,4780.4,34,,4780.4,percent of total billed charges,Implant Device,4780.4,34,,4780.4,percent of total billed charges,Implant Device,4780.4,34,,4780.4,percent of total billed charges,Implant Device,4780.4,34,,4780.4,percent of total billed charges,Implant Device,4921,35,,4921,percent of total billed charges,Implant Device,4780.4,34,"Charges > $500, x 34%",4780.4,percent of total billed charges,Implant Device,4921,35,,4921,percent of total billed charges,Implant Devices,4921,35,,4921,percent of total billed charges,Implant Devices,4921,35,,,percent of total billed charges,Implant Devices,4921,35,,4921,percent of total billed charges,Implant Devices,4921,35,,4921,percent of total billed charges,Implant Devices,5624,40,,5624,percent of total billed charges,Implant Devices,4921,70,,4921,percent of total billed charges,Implant Devices,4780.4,34,,4780.4,percent of total billed charges,Implant Devices,4780.4,34,,4780.4,percent of total billed charges,Implant Devices,4921,35,,4921,percent of total billed charges,Implant Devices,4921,35,,4921,percent of total billed charges,Implant Devices,4921,35,,4921,percent of total billed charges,Implant Devices,4921,35,,4921,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4780.4,34,"If Charge > 2,000, then 34 percent",4780.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5624,
EXACTECH 320-40-13 HUMERAL LINER +2.5 40,C1776,HCPCS,,79010642,CDM,278,RC,,,both,,,2835,1118.88,39.4668,,1118.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,963.9,34,,963.9,percent of total billed charges,Implant Device,992.25,35,,992.25,percent of total billed charges,Implant Device,963.9,34,"Charges > $500, x 34%",963.9,percent of total billed charges,Implant Device,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,1134,40,,1134,percent of total billed charges,Implant Devices,992.25,70,,992.25,percent of total billed charges,Implant Devices,963.9,34,,963.9,percent of total billed charges,Implant Devices,963.9,34,,963.9,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,992.25,35,,992.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,963.9,34,"If Charge > 2,000, then 34 percent",963.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1134,
EXACTECH 308-08-12 PROXIMAL BODY +12.5MM,C1776,HCPCS,,79010643,CDM,278,RC,,,both,,,21732,8576.92,39.4668,,8576.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7388.88,34,,7388.88,percent of total billed charges,Implant Device,7388.88,34,,7388.88,percent of total billed charges,Implant Device,7388.88,34,,7388.88,percent of total billed charges,Implant Device,7388.88,34,,7388.88,percent of total billed charges,Implant Device,7388.88,34,,7388.88,percent of total billed charges,Implant Device,7388.88,34,,7388.88,percent of total billed charges,Implant Device,7606.2,35,,7606.2,percent of total billed charges,Implant Device,7388.88,34,"Charges > $500, x 34%",7388.88,percent of total billed charges,Implant Device,7606.2,35,,7606.2,percent of total billed charges,Implant Devices,7606.2,35,,7606.2,percent of total billed charges,Implant Devices,7606.2,35,,,percent of total billed charges,Implant Devices,7606.2,35,,7606.2,percent of total billed charges,Implant Devices,7606.2,35,,7606.2,percent of total billed charges,Implant Devices,8692.8,40,,8692.8,percent of total billed charges,Implant Devices,7606.2,70,,7606.2,percent of total billed charges,Implant Devices,7388.88,34,,7388.88,percent of total billed charges,Implant Devices,7388.88,34,,7388.88,percent of total billed charges,Implant Devices,7606.2,35,,7606.2,percent of total billed charges,Implant Devices,7606.2,35,,7606.2,percent of total billed charges,Implant Devices,7606.2,35,,7606.2,percent of total billed charges,Implant Devices,7606.2,35,,7606.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7388.88,34,"If Charge > 2,000, then 34 percent",7388.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8692.8,
EXACTECH 308-01-09 DISTAL STEM 9X80MM,C1776,HCPCS,,79010645,CDM,278,RC,,,both,,,17490,6902.74,39.4668,,6902.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5946.6,34,,5946.6,percent of total billed charges,Implant Device,5946.6,34,,5946.6,percent of total billed charges,Implant Device,5946.6,34,,5946.6,percent of total billed charges,Implant Device,5946.6,34,,5946.6,percent of total billed charges,Implant Device,5946.6,34,,5946.6,percent of total billed charges,Implant Device,5946.6,34,,5946.6,percent of total billed charges,Implant Device,6121.5,35,,6121.5,percent of total billed charges,Implant Device,5946.6,34,"Charges > $500, x 34%",5946.6,percent of total billed charges,Implant Device,6121.5,35,,6121.5,percent of total billed charges,Implant Devices,6121.5,35,,6121.5,percent of total billed charges,Implant Devices,6121.5,35,,,percent of total billed charges,Implant Devices,6121.5,35,,6121.5,percent of total billed charges,Implant Devices,6121.5,35,,6121.5,percent of total billed charges,Implant Devices,6996,40,,6996,percent of total billed charges,Implant Devices,6121.5,70,,6121.5,percent of total billed charges,Implant Devices,5946.6,34,,5946.6,percent of total billed charges,Implant Devices,5946.6,34,,5946.6,percent of total billed charges,Implant Devices,6121.5,35,,6121.5,percent of total billed charges,Implant Devices,6121.5,35,,6121.5,percent of total billed charges,Implant Devices,6121.5,35,,6121.5,percent of total billed charges,Implant Devices,6121.5,35,,6121.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5946.6,34,"If Charge > 2,000, then 34 percent",5946.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6996,
EXACTECH 308-05-20 DISTAL FIX RING 20.5,C1776,HCPCS,,79010646,CDM,278,RC,,,both,,,5619,2217.64,39.4668,,2217.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1910.46,34,,1910.46,percent of total billed charges,Implant Device,1910.46,34,,1910.46,percent of total billed charges,Implant Device,1910.46,34,,1910.46,percent of total billed charges,Implant Device,1910.46,34,,1910.46,percent of total billed charges,Implant Device,1910.46,34,,1910.46,percent of total billed charges,Implant Device,1910.46,34,,1910.46,percent of total billed charges,Implant Device,1966.65,35,,1966.65,percent of total billed charges,Implant Device,1910.46,34,"Charges > $500, x 34%",1910.46,percent of total billed charges,Implant Device,1966.65,35,,1966.65,percent of total billed charges,Implant Devices,1966.65,35,,1966.65,percent of total billed charges,Implant Devices,1966.65,35,,,percent of total billed charges,Implant Devices,1966.65,35,,1966.65,percent of total billed charges,Implant Devices,1966.65,35,,1966.65,percent of total billed charges,Implant Devices,2247.6,40,,2247.6,percent of total billed charges,Implant Devices,1966.65,70,,1966.65,percent of total billed charges,Implant Devices,1910.46,34,,1910.46,percent of total billed charges,Implant Devices,1910.46,34,,1910.46,percent of total billed charges,Implant Devices,1966.65,35,,1966.65,percent of total billed charges,Implant Devices,1966.65,35,,1966.65,percent of total billed charges,Implant Devices,1966.65,35,,1966.65,percent of total billed charges,Implant Devices,1966.65,35,,1966.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1910.46,34,"If Charge > 2,000, then 34 percent",1910.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2247.6,
STRYKER 702-04-58F SHELL SIZE 58MM,C1776,HCPCS,,79010677,CDM,278,RC,,,both,,,3750,1480.01,39.4668,,1480.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Device,1275,34,"Charges > $500, x 34%",1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1500,40,,1500,percent of total billed charges,Implant Devices,1312.5,70,,1312.5,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1275,34,"If Charge > 2,000, then 34 percent",1275,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
STRYKER 1059-4514 ACCOLADE SPACER,C1776,HCPCS,,79010681,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
STRYKER 6057-0537D ACCOLADE FEM STEM,C1776,HCPCS,,79010682,CDM,278,RC,,,both,,,3750,1480.01,39.4668,,1480.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Device,1275,34,"Charges > $500, x 34%",1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1500,40,,1500,percent of total billed charges,Implant Devices,1312.5,70,,1312.5,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1275,34,"If Charge > 2,000, then 34 percent",1275,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
STRYKER 5552-S-4416 REUNION HUMERAL HD,C1776,HCPCS,,79010689,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
CER BIOLOXD MOD HD 28MM STD,C1776,HCPCS,,79010691,CDM,278,RC,,,both,,,3075,1213.6,39.4668,,1213.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1045.5,34,,1045.5,percent of total billed charges,Implant Device,1076.25,35,,1076.25,percent of total billed charges,Implant Device,1045.5,34,"Charges > $500, x 34%",1045.5,percent of total billed charges,Implant Device,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1230,40,,1230,percent of total billed charges,Implant Devices,1076.25,70,,1076.25,percent of total billed charges,Implant Devices,1045.5,34,,1045.5,percent of total billed charges,Implant Devices,1045.5,34,,1045.5,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,1076.25,35,,1076.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1045.5,34,"If Charge > 2,000, then 34 percent",1045.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1230,
ZIMMER 00-5001-053-00 BIPOLAR SHELL 53MM,C1776,HCPCS,,79010692,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
ZIMMER 00-5988-020-10 STEM EXT 16X145MM,C1776,HCPCS,,79010695,CDM,278,RC,,,both,,,4481,1768.51,39.4668,,1768.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1523.54,34,,1523.54,percent of total billed charges,Implant Device,1523.54,34,,1523.54,percent of total billed charges,Implant Device,1523.54,34,,1523.54,percent of total billed charges,Implant Device,1523.54,34,,1523.54,percent of total billed charges,Implant Device,1523.54,34,,1523.54,percent of total billed charges,Implant Device,1523.54,34,,1523.54,percent of total billed charges,Implant Device,1568.35,35,,1568.35,percent of total billed charges,Implant Device,1523.54,34,"Charges > $500, x 34%",1523.54,percent of total billed charges,Implant Device,1568.35,35,,1568.35,percent of total billed charges,Implant Devices,1568.35,35,,1568.35,percent of total billed charges,Implant Devices,1568.35,35,,,percent of total billed charges,Implant Devices,1568.35,35,,1568.35,percent of total billed charges,Implant Devices,1568.35,35,,1568.35,percent of total billed charges,Implant Devices,1792.4,40,,1792.4,percent of total billed charges,Implant Devices,1568.35,70,,1568.35,percent of total billed charges,Implant Devices,1523.54,34,,1523.54,percent of total billed charges,Implant Devices,1523.54,34,,1523.54,percent of total billed charges,Implant Devices,1568.35,35,,1568.35,percent of total billed charges,Implant Devices,1568.35,35,,1568.35,percent of total billed charges,Implant Devices,1568.35,35,,1568.35,percent of total billed charges,Implant Devices,1568.35,35,,1568.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1523.54,34,"If Charge > 2,000, then 34 percent",1523.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1792.4,
EXACTECH 320-35-04 GLENOID PLATE SMALL,C1776,HCPCS,,79010702,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
STRYKER 6280-0-336 FEMORAL HEAD 36X10MM,C1776,HCPCS,,79010703,CDM,278,RC,,,both,,,7362,2905.55,39.4668,,2905.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2503.08,34,,2503.08,percent of total billed charges,Implant Device,2503.08,34,,2503.08,percent of total billed charges,Implant Device,2503.08,34,,2503.08,percent of total billed charges,Implant Device,2503.08,34,,2503.08,percent of total billed charges,Implant Device,2503.08,34,,2503.08,percent of total billed charges,Implant Device,2503.08,34,,2503.08,percent of total billed charges,Implant Device,2576.7,35,,2576.7,percent of total billed charges,Implant Device,2503.08,34,"Charges > $500, x 34%",2503.08,percent of total billed charges,Implant Device,2576.7,35,,2576.7,percent of total billed charges,Implant Devices,2576.7,35,,2576.7,percent of total billed charges,Implant Devices,2576.7,35,,,percent of total billed charges,Implant Devices,2576.7,35,,2576.7,percent of total billed charges,Implant Devices,2576.7,35,,2576.7,percent of total billed charges,Implant Devices,2944.8,40,,2944.8,percent of total billed charges,Implant Devices,2576.7,70,,2576.7,percent of total billed charges,Implant Devices,2503.08,34,,2503.08,percent of total billed charges,Implant Devices,2503.08,34,,2503.08,percent of total billed charges,Implant Devices,2576.7,35,,2576.7,percent of total billed charges,Implant Devices,2576.7,35,,2576.7,percent of total billed charges,Implant Devices,2576.7,35,,2576.7,percent of total billed charges,Implant Devices,2576.7,35,,2576.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2503.08,34,"If Charge > 2,000, then 34 percent",2503.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2944.8,
STRYKER 663-10-36H INSERT TRIDENT 36MM,C1776,HCPCS,,79010704,CDM,278,RC,,,both,,,5222,2060.96,39.4668,,2060.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1775.48,34,,1775.48,percent of total billed charges,Implant Device,1827.7,35,,1827.7,percent of total billed charges,Implant Device,1775.48,34,"Charges > $500, x 34%",1775.48,percent of total billed charges,Implant Device,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,2088.8,40,,2088.8,percent of total billed charges,Implant Devices,1827.7,70,,1827.7,percent of total billed charges,Implant Devices,1775.48,34,,1775.48,percent of total billed charges,Implant Devices,1775.48,34,,1775.48,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,1827.7,35,,1827.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1775.48,34,"If Charge > 2,000, then 34 percent",1775.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2088.8,
STRYKER 709-04-66H ACETABULAR SHELL 66MM,C1776,HCPCS,,79010706,CDM,278,RC,,,both,,,9155,3613.19,39.4668,,3613.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3204.25,35,,3204.25,percent of total billed charges,Implant Device,3112.7,34,"Charges > $500, x 34%",3112.7,percent of total billed charges,Implant Device,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3662,40,,3662,percent of total billed charges,Implant Devices,3204.25,70,,3204.25,percent of total billed charges,Implant Devices,3112.7,34,,3112.7,percent of total billed charges,Implant Devices,3112.7,34,,3112.7,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3112.7,34,"If Charge > 2,000, then 34 percent",3112.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3662,
STRYKER 6519-1-028 FEMORAL HEAD 28MM,C1776,HCPCS,,79010707,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
STRYKER 702-04-54E ACETABULAR SHELL 54MM,C1776,HCPCS,,79010708,CDM,278,RC,,,both,,,3337,1317.01,39.4668,,1317.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Device,1134.58,34,"Charges > $500, x 34%",1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1334.8,40,,1334.8,percent of total billed charges,Implant Devices,1167.95,70,,1167.95,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1134.58,34,"If Charge > 2,000, then 34 percent",1134.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334.8,
STRYKER 7030-6525 HEX SCREW 6.5X25MM,C1776,HCPCS,,79010710,CDM,278,RC,,,both,,,8474,3344.42,39.4668,,3344.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2881.16,34,,2881.16,percent of total billed charges,Implant Device,2881.16,34,,2881.16,percent of total billed charges,Implant Device,2881.16,34,,2881.16,percent of total billed charges,Implant Device,2881.16,34,,2881.16,percent of total billed charges,Implant Device,2881.16,34,,2881.16,percent of total billed charges,Implant Device,2881.16,34,,2881.16,percent of total billed charges,Implant Device,2965.9,35,,2965.9,percent of total billed charges,Implant Device,2881.16,34,"Charges > $500, x 34%",2881.16,percent of total billed charges,Implant Device,2965.9,35,,2965.9,percent of total billed charges,Implant Devices,2965.9,35,,2965.9,percent of total billed charges,Implant Devices,2965.9,35,,,percent of total billed charges,Implant Devices,2965.9,35,,2965.9,percent of total billed charges,Implant Devices,2965.9,35,,2965.9,percent of total billed charges,Implant Devices,3389.6,40,,3389.6,percent of total billed charges,Implant Devices,2965.9,70,,2965.9,percent of total billed charges,Implant Devices,2881.16,34,,2881.16,percent of total billed charges,Implant Devices,2881.16,34,,2881.16,percent of total billed charges,Implant Devices,2965.9,35,,2965.9,percent of total billed charges,Implant Devices,2965.9,35,,2965.9,percent of total billed charges,Implant Devices,2965.9,35,,2965.9,percent of total billed charges,Implant Devices,2965.9,35,,2965.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2881.16,34,"If Charge > 2,000, then 34 percent",2881.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3389.6,
EXACTECH 300-30-10 PRESERVE STEM 10MM,C1776,HCPCS,,79010711,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
DEPUY SYNTHES 02.112.006 CLAVICLE PLATE,C1776,HCPCS,,79010712,CDM,278,RC,,,both,,,2292,904.58,39.4668,,904.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,779.28,34,,779.28,percent of total billed charges,Implant Device,802.2,35,,802.2,percent of total billed charges,Implant Device,779.28,34,"Charges > $500, x 34%",779.28,percent of total billed charges,Implant Device,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,916.8,40,,916.8,percent of total billed charges,Implant Devices,802.2,70,,802.2,percent of total billed charges,Implant Devices,779.28,34,,779.28,percent of total billed charges,Implant Devices,779.28,34,,779.28,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,802.2,35,,802.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,779.28,34,"If Charge > 2,000, then 34 percent",779.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,916.8,
STRYKER 5567-P-3011 PRESS-FIT HUMRL STEM,C1776,HCPCS,,79010718,CDM,278,RC,,,both,,,8925,3522.41,39.4668,,3522.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Device,3034.5,34,"Charges > $500, x 34%",3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3570,40,,3570,percent of total billed charges,Implant Devices,3123.75,70,,3123.75,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3034.5,34,"If Charge > 2,000, then 34 percent",3034.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3570,
STRYKER 6057-0435D CEMENTED HIP STEM,C1776,HCPCS,,79010734,CDM,278,RC,,,both,,,5006,1975.71,39.4668,,1975.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1752.1,35,,1752.1,percent of total billed charges,Implant Device,1702.04,34,"Charges > $500, x 34%",1702.04,percent of total billed charges,Implant Device,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,2002.4,40,,2002.4,percent of total billed charges,Implant Devices,1752.1,70,,1752.1,percent of total billed charges,Implant Devices,1702.04,34,,1702.04,percent of total billed charges,Implant Devices,1702.04,34,,1702.04,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1702.04,34,"If Charge > 2,000, then 34 percent",1702.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2002.4,
STRYKER 709-04-60G TRITANIUM MULTIHOLE,C1776,HCPCS,,79010740,CDM,278,RC,,,both,,,9155,3613.19,39.4668,,3613.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3112.7,34,,3112.7,percent of total billed charges,Implant Device,3204.25,35,,3204.25,percent of total billed charges,Implant Device,3112.7,34,"Charges > $500, x 34%",3112.7,percent of total billed charges,Implant Device,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3662,40,,3662,percent of total billed charges,Implant Devices,3204.25,70,,3204.25,percent of total billed charges,Implant Devices,3112.7,34,,3112.7,percent of total billed charges,Implant Devices,3112.7,34,,3112.7,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,3204.25,35,,3204.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3112.7,34,"If Charge > 2,000, then 34 percent",3112.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3662,
STRYKER 626-00-48G MDM COCR LINER 48MM G,C1776,HCPCS,,79010741,CDM,278,RC,,,both,,,3893,1536.44,39.4668,,1536.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1362.55,35,,1362.55,percent of total billed charges,Implant Device,1323.62,34,"Charges > $500, x 34%",1323.62,percent of total billed charges,Implant Device,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1557.2,40,,1557.2,percent of total billed charges,Implant Devices,1362.55,70,,1362.55,percent of total billed charges,Implant Devices,1323.62,34,,1323.62,percent of total billed charges,Implant Devices,1323.62,34,,1323.62,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1323.62,34,"If Charge > 2,000, then 34 percent",1323.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1557.2,
STRYKER 6276-7-019 DISTAL STEM 19X155MM,C1776,HCPCS,,79010742,CDM,278,RC,,,both,,,9112,3596.21,39.4668,,3596.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3098.08,34,,3098.08,percent of total billed charges,Implant Device,3189.2,35,,3189.2,percent of total billed charges,Implant Device,3098.08,34,"Charges > $500, x 34%",3098.08,percent of total billed charges,Implant Device,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3644.8,40,,3644.8,percent of total billed charges,Implant Devices,3189.2,70,,3189.2,percent of total billed charges,Implant Devices,3098.08,34,,3098.08,percent of total billed charges,Implant Devices,3098.08,34,,3098.08,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,3189.2,35,,3189.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3098.08,34,"If Charge > 2,000, then 34 percent",3098.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3644.8,
STRYKER 6570-0-028 CERAMIC HEAD 28/-4,C1776,HCPCS,,79010743,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 1059-6715 ACCOLADE DISTAL SPACER,C1776,HCPCS,,79010744,CDM,278,RC,,,both,,,150,59.2,39.4668,,59.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,51,34,,51,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,60,40,,60,percent of total billed charges,Implant Devices,52.5,70,,52.5,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,51,34,,51,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,52.5,35,,52.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,60,
STRYKER 6057-0637D FEMORAL STEM SZ 6,C1776,HCPCS,,79010745,CDM,278,RC,,,both,,,3750,1480.01,39.4668,,1480.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Device,1275,34,"Charges > $500, x 34%",1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1500,40,,1500,percent of total billed charges,Implant Devices,1312.5,70,,1312.5,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1275,34,"If Charge > 2,000, then 34 percent",1275,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
STRYKER 623-00-36F TRIDENT INSERT 36MM,C1776,HCPCS,,79010751,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 5517-F-601 FEM COMP SZ 6 LT,C1776,HCPCS,,79010755,CDM,278,RC,,,both,,,5840,2304.86,39.4668,,2304.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,2044,35,,2044,percent of total billed charges,Implant Device,1985.6,34,"Charges > $500, x 34%",1985.6,percent of total billed charges,Implant Device,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2336,40,,2336,percent of total billed charges,Implant Devices,2044,70,,2044,percent of total billed charges,Implant Devices,1985.6,34,,1985.6,percent of total billed charges,Implant Devices,1985.6,34,,1985.6,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1985.6,34,"If Charge > 2,000, then 34 percent",1985.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2336,
STRYKER 5531-G-609-E TIB INSERT SZ 6 9MM,C1776,HCPCS,,79010756,CDM,278,RC,,,both,,,2781,1097.57,39.4668,,1097.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Device,945.54,34,"Charges > $500, x 34%",945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,1112.4,40,,1112.4,percent of total billed charges,Implant Devices,973.35,70,,973.35,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.54,34,"If Charge > 2,000, then 34 percent",945.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112.4,
STRYKER 5536-B-600 BASEPLATE SIZE 6,C1776,HCPCS,,79010757,CDM,278,RC,,,both,,,4172,1646.55,39.4668,,1646.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1460.2,35,,1460.2,percent of total billed charges,Implant Device,1418.48,34,"Charges > $500, x 34%",1418.48,percent of total billed charges,Implant Device,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1668.8,40,,1668.8,percent of total billed charges,Implant Devices,1460.2,70,,1460.2,percent of total billed charges,Implant Devices,1418.48,34,,1418.48,percent of total billed charges,Implant Devices,1418.48,34,,1418.48,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1418.48,34,"If Charge > 2,000, then 34 percent",1418.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1668.8,
STRYKER 5552-L-381 PATELLA 38X11MM,C1776,HCPCS,,79010759,CDM,278,RC,,,both,,,2225,878.14,39.4668,,878.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,778.75,35,,778.75,percent of total billed charges,Implant Device,756.5,34,"Charges > $500, x 34%",756.5,percent of total billed charges,Implant Device,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,890,40,,890,percent of total billed charges,Implant Devices,778.75,70,,778.75,percent of total billed charges,Implant Devices,756.5,34,,756.5,percent of total billed charges,Implant Devices,756.5,34,,756.5,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,756.5,34,"If Charge > 2,000, then 34 percent",756.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,890,
ZIMMER 00-7818-099-00 FEM HEAD 12/14,C1776,HCPCS,,79010767,CDM,278,RC,,,both,,,480,189.44,39.4668,,189.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,163.2,34,,163.2,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,192,40,,192,percent of total billed charges,Implant Devices,168,70,,168,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,163.2,34,,163.2,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,168,35,,168,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192,
ZIMMER 00-7818-045-00 FEM HEAD 12/14,C1776,HCPCS,,79010768,CDM,278,RC,,,both,,,1245,491.36,39.4668,,491.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,423.3,34,,423.3,percent of total billed charges,Implant Device,423.3,34,,423.3,percent of total billed charges,Implant Device,423.3,34,,423.3,percent of total billed charges,Implant Device,423.3,34,,423.3,percent of total billed charges,Implant Device,423.3,34,,423.3,percent of total billed charges,Implant Device,423.3,34,,423.3,percent of total billed charges,Implant Device,435.75,35,,435.75,percent of total billed charges,Implant Device,423.3,34,"Charges > $500, x 34%",423.3,percent of total billed charges,Implant Device,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,498,40,,498,percent of total billed charges,Implant Devices,435.75,70,,435.75,percent of total billed charges,Implant Devices,423.3,34,,423.3,percent of total billed charges,Implant Devices,423.3,34,,423.3,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,435.75,35,,435.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,498,
STRYKER 702-04-48D TRITANIUM CLUSTERHOLE,C1776,HCPCS,,79010771,CDM,278,RC,,,both,,,3337,1317.01,39.4668,,1317.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Device,1134.58,34,"Charges > $500, x 34%",1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1334.8,40,,1334.8,percent of total billed charges,Implant Devices,1167.95,70,,1167.95,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1134.58,34,"If Charge > 2,000, then 34 percent",1134.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334.8,
STRYKER 5517-F-502 FEMORAL COMP SZ 5 RT,C1776,HCPCS,,79010772,CDM,278,RC,,,both,,,6600,2604.81,39.4668,,2604.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2310,35,,2310,percent of total billed charges,Implant Device,2244,34,"Charges > $500, x 34%",2244,percent of total billed charges,Implant Device,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2640,40,,2640,percent of total billed charges,Implant Devices,2310,70,,2310,percent of total billed charges,Implant Devices,2244,34,,2244,percent of total billed charges,Implant Devices,2244,34,,2244,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2244,34,"If Charge > 2,000, then 34 percent",2244,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2640,
STRYKER 5531-G-409-E TIB BEARING INS SZ4,C1776,HCPCS,,79010773,CDM,278,RC,,,both,,,2781,1097.57,39.4668,,1097.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Device,945.54,34,"Charges > $500, x 34%",945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,1112.4,40,,1112.4,percent of total billed charges,Implant Devices,973.35,70,,973.35,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.54,34,"If Charge > 2,000, then 34 percent",945.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112.4,
STRYKER 5536-B-400 TIBIAL BASEPLATE SZ 4,C1776,HCPCS,,79010774,CDM,278,RC,,,both,,,4172,1646.55,39.4668,,1646.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1460.2,35,,1460.2,percent of total billed charges,Implant Device,1418.48,34,"Charges > $500, x 34%",1418.48,percent of total billed charges,Implant Device,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1668.8,40,,1668.8,percent of total billed charges,Implant Devices,1460.2,70,,1460.2,percent of total billed charges,Implant Devices,1418.48,34,,1418.48,percent of total billed charges,Implant Devices,1418.48,34,,1418.48,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1418.48,34,"If Charge > 2,000, then 34 percent",1418.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1668.8,
STRYKER 5552-L-299 PATELLA 29X9MM,C1776,HCPCS,,79010775,CDM,278,RC,,,both,,,1800,710.4,39.4668,,710.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Device,612,34,"Charges > $500, x 34%",612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,720,40,,720,percent of total billed charges,Implant Devices,630,70,,630,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,720,
STRYKER 702-04-50D TRITANIUM CLUSTERHOLE,C1776,HCPCS,,79010776,CDM,278,RC,,,both,,,3337,1317.01,39.4668,,1317.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Device,1134.58,34,"Charges > $500, x 34%",1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1334.8,40,,1334.8,percent of total billed charges,Implant Devices,1167.95,70,,1167.95,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1134.58,34,"If Charge > 2,000, then 34 percent",1134.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334.8,
STRYKER 6485-2-211 FEM BUSHING 11MM,C1776,HCPCS,,79010779,CDM,278,RC,,,both,,,4199,1657.21,39.4668,,1657.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1427.66,34,,1427.66,percent of total billed charges,Implant Device,1427.66,34,,1427.66,percent of total billed charges,Implant Device,1427.66,34,,1427.66,percent of total billed charges,Implant Device,1427.66,34,,1427.66,percent of total billed charges,Implant Device,1427.66,34,,1427.66,percent of total billed charges,Implant Device,1427.66,34,,1427.66,percent of total billed charges,Implant Device,1469.65,35,,1469.65,percent of total billed charges,Implant Device,1427.66,34,"Charges > $500, x 34%",1427.66,percent of total billed charges,Implant Device,1469.65,35,,1469.65,percent of total billed charges,Implant Devices,1469.65,35,,1469.65,percent of total billed charges,Implant Devices,1469.65,35,,,percent of total billed charges,Implant Devices,1469.65,35,,1469.65,percent of total billed charges,Implant Devices,1469.65,35,,1469.65,percent of total billed charges,Implant Devices,1679.6,40,,1679.6,percent of total billed charges,Implant Devices,1469.65,70,,1469.65,percent of total billed charges,Implant Devices,1427.66,34,,1427.66,percent of total billed charges,Implant Devices,1427.66,34,,1427.66,percent of total billed charges,Implant Devices,1469.65,35,,1469.65,percent of total billed charges,Implant Devices,1469.65,35,,1469.65,percent of total billed charges,Implant Devices,1469.65,35,,1469.65,percent of total billed charges,Implant Devices,1469.65,35,,1469.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1427.66,34,"If Charge > 2,000, then 34 percent",1427.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1679.6,
STRYKER 6485-3-115 CEMENTED STEM 15X127,C1776,HCPCS,,79010780,CDM,278,RC,,,both,,,7722,3047.63,39.4668,,3047.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2625.48,34,,2625.48,percent of total billed charges,Implant Device,2702.7,35,,2702.7,percent of total billed charges,Implant Device,2625.48,34,"Charges > $500, x 34%",2625.48,percent of total billed charges,Implant Device,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,3088.8,40,,3088.8,percent of total billed charges,Implant Devices,2702.7,70,,2702.7,percent of total billed charges,Implant Devices,2625.48,34,,2625.48,percent of total billed charges,Implant Devices,2625.48,34,,2625.48,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,2702.7,35,,2702.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2625.48,34,"If Charge > 2,000, then 34 percent",2625.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3088.8,
STRYKER 623-00-36G POLY INSERT 36MM,C1776,HCPCS,,79010793,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 702-04-60G ACETABULAR SHELL 60MM,C1776,HCPCS,,79010794,CDM,278,RC,,,both,,,3337,1317.01,39.4668,,1317.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Device,1134.58,34,"Charges > $500, x 34%",1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1334.8,40,,1334.8,percent of total billed charges,Implant Devices,1167.95,70,,1167.95,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1134.58,34,"If Charge > 2,000, then 34 percent",1134.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334.8,
STRYKER 6276-1-227 MODULAR HIP SYS 27MM,C1776,HCPCS,,79010795,CDM,278,RC,,,both,,,11948,4715.49,39.4668,,4715.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4181.8,35,,4181.8,percent of total billed charges,Implant Device,4062.32,34,"Charges > $500, x 34%",4062.32,percent of total billed charges,Implant Device,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4779.2,40,,4779.2,percent of total billed charges,Implant Devices,4181.8,70,,4181.8,percent of total billed charges,Implant Devices,4062.32,34,,4062.32,percent of total billed charges,Implant Devices,4062.32,34,,4062.32,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4062.32,34,"If Charge > 2,000, then 34 percent",4062.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4779.2,
STRYKER 663-00-36G ECCENTRIC INSERT SZ36,C1776,HCPCS,,79010796,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER 709-04-62G ACETABULAR SHELL 62MM,C1776,HCPCS,,79010799,CDM,278,RC,,,both,,,9269,3658.18,39.4668,,3658.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3151.46,34,,3151.46,percent of total billed charges,Implant Device,3151.46,34,,3151.46,percent of total billed charges,Implant Device,3151.46,34,,3151.46,percent of total billed charges,Implant Device,3151.46,34,,3151.46,percent of total billed charges,Implant Device,3151.46,34,,3151.46,percent of total billed charges,Implant Device,3151.46,34,,3151.46,percent of total billed charges,Implant Device,3244.15,35,,3244.15,percent of total billed charges,Implant Device,3151.46,34,"Charges > $500, x 34%",3151.46,percent of total billed charges,Implant Device,3244.15,35,,3244.15,percent of total billed charges,Implant Devices,3244.15,35,,3244.15,percent of total billed charges,Implant Devices,3244.15,35,,,percent of total billed charges,Implant Devices,3244.15,35,,3244.15,percent of total billed charges,Implant Devices,3244.15,35,,3244.15,percent of total billed charges,Implant Devices,3707.6,40,,3707.6,percent of total billed charges,Implant Devices,3244.15,70,,3244.15,percent of total billed charges,Implant Devices,3151.46,34,,3151.46,percent of total billed charges,Implant Devices,3151.46,34,,3151.46,percent of total billed charges,Implant Devices,3244.15,35,,3244.15,percent of total billed charges,Implant Devices,3244.15,35,,3244.15,percent of total billed charges,Implant Devices,3244.15,35,,3244.15,percent of total billed charges,Implant Devices,3244.15,35,,3244.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3151.46,34,"If Charge > 2,000, then 34 percent",3151.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3707.6,
EXACTECH 320-35-07 GLENOID BASEPLATE,C1776,HCPCS,,79010808,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
EXACTECH 320-35-03 GLENOID PLATE LEFT,C1776,HCPCS,,79010825,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
ZIMMER 574201040 FEM STEM 12/14 SZ 4,C1776,HCPCS,,79010826,CDM,278,RC,,,both,,,7398,2919.75,39.4668,,2919.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2515.32,34,,2515.32,percent of total billed charges,Implant Device,2589.3,35,,2589.3,percent of total billed charges,Implant Device,2515.32,34,"Charges > $500, x 34%",2515.32,percent of total billed charges,Implant Device,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2959.2,40,,2959.2,percent of total billed charges,Implant Devices,2589.3,70,,2589.3,percent of total billed charges,Implant Devices,2515.32,34,,2515.32,percent of total billed charges,Implant Devices,2515.32,34,,2515.32,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,2589.3,35,,2589.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2515.32,34,"If Charge > 2,000, then 34 percent",2515.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2959.2,
STRYKER UH1-50-28 BIPOLAR COMP 50X28MM,C1776,HCPCS,,79010841,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
ZIMMER 574201060 FEM STEM 12/14 SIZE 6,C1776,HCPCS,,79010842,CDM,278,RC,,,both,,,8573,3383.49,39.4668,,3383.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Device,2914.82,34,"Charges > $500, x 34%",2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3429.2,40,,3429.2,percent of total billed charges,Implant Devices,3000.55,70,,3000.55,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2914.82,34,"If Charge > 2,000, then 34 percent",2914.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3429.2,
ZIMMER 00-5950-013-02 FEM COMP SZ C RT,C1776,HCPCS,,79010843,CDM,278,RC,,,both,,,7200,2841.61,39.4668,,2841.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2520,35,,2520,percent of total billed charges,Implant Device,2448,34,"Charges > $500, x 34%",2448,percent of total billed charges,Implant Device,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2880,40,,2880,percent of total billed charges,Implant Devices,2520,70,,2520,percent of total billed charges,Implant Devices,2448,34,,2448,percent of total billed charges,Implant Devices,2448,34,,2448,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2448,34,"If Charge > 2,000, then 34 percent",2448,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2880,
EXACTECH 300-30-08 HUMERAL STEM 8MM,C1776,HCPCS,,79010845,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
STRYKER 5534-A-309 TIBIA COMP SZ 3 9MM,C1776,HCPCS,,79010853,CDM,278,RC,,,both,,,3337,1317.01,39.4668,,1317.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Device,1134.58,34,"Charges > $500, x 34%",1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1334.8,40,,1334.8,percent of total billed charges,Implant Devices,1167.95,70,,1167.95,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1134.58,34,"If Charge > 2,000, then 34 percent",1134.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334.8,
STRYKER 5517-F-602 FEMORAL COMP SIZE 6,C1776,HCPCS,,79010856,CDM,278,RC,,,both,,,5840,2304.86,39.4668,,2304.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,2044,35,,2044,percent of total billed charges,Implant Device,1985.6,34,"Charges > $500, x 34%",1985.6,percent of total billed charges,Implant Device,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2336,40,,2336,percent of total billed charges,Implant Devices,2044,70,,2044,percent of total billed charges,Implant Devices,1985.6,34,,1985.6,percent of total billed charges,Implant Devices,1985.6,34,,1985.6,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1985.6,34,"If Charge > 2,000, then 34 percent",1985.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2336,
STRYKER 5531-G-511-E TIB BEARING INSERT,C1776,HCPCS,,79010857,CDM,278,RC,,,both,,,2781,1097.57,39.4668,,1097.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Device,945.54,34,"Charges > $500, x 34%",945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,1112.4,40,,1112.4,percent of total billed charges,Implant Devices,973.35,70,,973.35,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.54,34,"If Charge > 2,000, then 34 percent",945.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112.4,
STRYKER 5536-B-500 TIB BASEPLATE SIZE 5,C1776,HCPCS,,79010858,CDM,278,RC,,,both,,,4172,1646.55,39.4668,,1646.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1460.2,35,,1460.2,percent of total billed charges,Implant Device,1418.48,34,"Charges > $500, x 34%",1418.48,percent of total billed charges,Implant Device,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1668.8,40,,1668.8,percent of total billed charges,Implant Devices,1460.2,70,,1460.2,percent of total billed charges,Implant Devices,1418.48,34,,1418.48,percent of total billed charges,Implant Devices,1418.48,34,,1418.48,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1418.48,34,"If Charge > 2,000, then 34 percent",1418.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1668.8,
STRYKER 5552-L-350 PATELLA 35X10MM,C1776,HCPCS,,79010859,CDM,278,RC,,,both,,,2225,878.14,39.4668,,878.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,778.75,35,,778.75,percent of total billed charges,Implant Device,756.5,34,"Charges > $500, x 34%",756.5,percent of total billed charges,Implant Device,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,890,40,,890,percent of total billed charges,Implant Devices,778.75,70,,778.75,percent of total billed charges,Implant Devices,756.5,34,,756.5,percent of total billed charges,Implant Devices,756.5,34,,756.5,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,756.5,34,"If Charge > 2,000, then 34 percent",756.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,890,
STRYKER 6478-6-605 STEM 11X80MM,C1776,HCPCS,,79010860,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
STRYKER 6481-2-140 TIBIAL SLEEVE,C1776,HCPCS,,79010861,CDM,278,RC,,,both,,,1337,527.67,39.4668,,527.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,454.58,34,,454.58,percent of total billed charges,Implant Device,454.58,34,,454.58,percent of total billed charges,Implant Device,454.58,34,,454.58,percent of total billed charges,Implant Device,454.58,34,,454.58,percent of total billed charges,Implant Device,454.58,34,,454.58,percent of total billed charges,Implant Device,454.58,34,,454.58,percent of total billed charges,Implant Device,467.95,35,,467.95,percent of total billed charges,Implant Device,454.58,34,"Charges > $500, x 34%",454.58,percent of total billed charges,Implant Device,467.95,35,,467.95,percent of total billed charges,Implant Devices,467.95,35,,467.95,percent of total billed charges,Implant Devices,467.95,35,,,percent of total billed charges,Implant Devices,467.95,35,,467.95,percent of total billed charges,Implant Devices,467.95,35,,467.95,percent of total billed charges,Implant Devices,534.8,40,,534.8,percent of total billed charges,Implant Devices,467.95,70,,467.95,percent of total billed charges,Implant Devices,454.58,34,,454.58,percent of total billed charges,Implant Devices,454.58,34,,454.58,percent of total billed charges,Implant Devices,467.95,35,,467.95,percent of total billed charges,Implant Devices,467.95,35,,467.95,percent of total billed charges,Implant Devices,467.95,35,,467.95,percent of total billed charges,Implant Devices,467.95,35,,467.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,534.8,
STRYKER 6481-3-111 TIBIAL BASEPLATE SZ 2,C1776,HCPCS,,79010862,CDM,278,RC,,,both,,,8597,3392.96,39.4668,,3392.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2922.98,34,,2922.98,percent of total billed charges,Implant Device,2922.98,34,,2922.98,percent of total billed charges,Implant Device,2922.98,34,,2922.98,percent of total billed charges,Implant Device,2922.98,34,,2922.98,percent of total billed charges,Implant Device,2922.98,34,,2922.98,percent of total billed charges,Implant Device,2922.98,34,,2922.98,percent of total billed charges,Implant Device,3008.95,35,,3008.95,percent of total billed charges,Implant Device,2922.98,34,"Charges > $500, x 34%",2922.98,percent of total billed charges,Implant Device,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3438.8,40,,3438.8,percent of total billed charges,Implant Devices,3008.95,70,,3008.95,percent of total billed charges,Implant Devices,2922.98,34,,2922.98,percent of total billed charges,Implant Devices,2922.98,34,,2922.98,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2922.98,34,"If Charge > 2,000, then 34 percent",2922.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3438.8,
STRYKER 6481-3-210 TIBIAL INSERT 10MM,C1776,HCPCS,,79010863,CDM,278,RC,,,both,,,2973,1173.35,39.4668,,1173.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1010.82,34,,1010.82,percent of total billed charges,Implant Device,1040.55,35,,1040.55,percent of total billed charges,Implant Device,1010.82,34,"Charges > $500, x 34%",1010.82,percent of total billed charges,Implant Device,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1189.2,40,,1189.2,percent of total billed charges,Implant Devices,1040.55,70,,1040.55,percent of total billed charges,Implant Devices,1010.82,34,,1010.82,percent of total billed charges,Implant Devices,1010.82,34,,1010.82,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,1040.55,35,,1040.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1010.82,34,"If Charge > 2,000, then 34 percent",1010.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1189.2,
STRYKER 6485-3-113 FEMORAL STEM 13X127MM,C1776,HCPCS,,79010864,CDM,278,RC,,,both,,,7254,2862.92,39.4668,,2862.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2538.9,35,,2538.9,percent of total billed charges,Implant Device,2466.36,34,"Charges > $500, x 34%",2466.36,percent of total billed charges,Implant Device,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2901.6,40,,2901.6,percent of total billed charges,Implant Devices,2538.9,70,,2538.9,percent of total billed charges,Implant Devices,2466.36,34,,2466.36,percent of total billed charges,Implant Devices,2466.36,34,,2466.36,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2466.36,34,"If Charge > 2,000, then 34 percent",2466.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2901.6,
EXACTECH 300-30-09 PRESERVE STEM 9MM,C1776,HCPCS,,79010894,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
ZIMMER US 574202020 ACETABULAR SYST 36MM,C1776,HCPCS,,79010904,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER US 574203030 FEMORAL HEAD 12/14,C1776,HCPCS,,79010905,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER US 574201050 FEMORAL STEM SIZE 5,C1776,HCPCS,,79010907,CDM,278,RC,,,both,,,8573,3383.49,39.4668,,3383.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Device,2914.82,34,"Charges > $500, x 34%",2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3429.2,40,,3429.2,percent of total billed charges,Implant Devices,3000.55,70,,3000.55,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2914.82,34,"If Charge > 2,000, then 34 percent",2914.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3429.2,
ONIC NEURO CX01A BONE CEMENT,C1776,HCPCS,,79010910,CDM,278,RC,,,both,,,1063,419.53,39.4668,,419.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,372.05,35,,372.05,percent of total billed charges,Implant Device,361.42,34,"Charges > $500, x 34%",361.42,percent of total billed charges,Implant Device,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,425.2,40,,425.2,percent of total billed charges,Implant Devices,372.05,70,,372.05,percent of total billed charges,Implant Devices,361.42,34,,361.42,percent of total billed charges,Implant Devices,361.42,34,,361.42,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,425.2,
ZIMMER 574202050 FEMORAL STEM 12/14 SZ 5,C1776,HCPCS,,79010930,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 574203020 FEM STEM 12/14 SZ 2,C1776,HCPCS,,79010931,CDM,278,RC,,,both,,,8573,3383.49,39.4668,,3383.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Device,2914.82,34,"Charges > $500, x 34%",2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3429.2,40,,3429.2,percent of total billed charges,Implant Devices,3000.55,70,,3000.55,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2914.82,34,"If Charge > 2,000, then 34 percent",2914.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3429.2,
ZIMMER 574201010 FEM STEM 12/14 SZ 1,C1776,HCPCS,,79010932,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
STRYKER STO-16P SMART TOE 16MM,C1776,HCPCS,,79010943,CDM,278,RC,,,both,,,1999,788.94,39.4668,,788.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,699.65,35,,699.65,percent of total billed charges,Implant Device,679.66,34,"Charges > $500, x 34%",679.66,percent of total billed charges,Implant Device,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,799.6,40,,799.6,percent of total billed charges,Implant Devices,699.65,70,,699.65,percent of total billed charges,Implant Devices,679.66,34,,679.66,percent of total billed charges,Implant Devices,679.66,34,,679.66,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,799.6,
STRYKER STOXS-13 SMART TOE 13MM,C1776,HCPCS,,79010944,CDM,278,RC,,,both,,,1999,788.94,39.4668,,788.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,699.65,35,,699.65,percent of total billed charges,Implant Device,679.66,34,"Charges > $500, x 34%",679.66,percent of total billed charges,Implant Device,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,799.6,40,,799.6,percent of total billed charges,Implant Devices,699.65,70,,699.65,percent of total billed charges,Implant Devices,679.66,34,,679.66,percent of total billed charges,Implant Devices,679.66,34,,679.66,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,799.6,
STRYKER UH1-49-26 BIPOLAR COMP 49X26MM,C1776,HCPCS,,79010948,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 5517-F-402 FEMORAL COMP SZ 4 RT,C1776,HCPCS,,79010951,CDM,278,RC,,,both,,,5840,2304.86,39.4668,,2304.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,2044,35,,2044,percent of total billed charges,Implant Device,1985.6,34,"Charges > $500, x 34%",1985.6,percent of total billed charges,Implant Device,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2336,40,,2336,percent of total billed charges,Implant Devices,2044,70,,2044,percent of total billed charges,Implant Devices,1985.6,34,,1985.6,percent of total billed charges,Implant Devices,1985.6,34,,1985.6,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1985.6,34,"If Charge > 2,000, then 34 percent",1985.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2336,
STRYKER 5552-L-320 PATELLA 32X10MM,C1776,HCPCS,,79010952,CDM,278,RC,,,both,,,2225,878.14,39.4668,,878.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,756.5,34,,756.5,percent of total billed charges,Implant Device,778.75,35,,778.75,percent of total billed charges,Implant Device,756.5,34,"Charges > $500, x 34%",756.5,percent of total billed charges,Implant Device,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,890,40,,890,percent of total billed charges,Implant Devices,778.75,70,,778.75,percent of total billed charges,Implant Devices,756.5,34,,756.5,percent of total billed charges,Implant Devices,756.5,34,,756.5,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,778.75,35,,778.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,756.5,34,"If Charge > 2,000, then 34 percent",756.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,890,
STRYKER 5531-G-411-E TIB BEARING INS 11,C1776,HCPCS,,79010953,CDM,278,RC,,,both,,,2781,1097.57,39.4668,,1097.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Device,945.54,34,"Charges > $500, x 34%",945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,1112.4,40,,1112.4,percent of total billed charges,Implant Devices,973.35,70,,973.35,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.54,34,"If Charge > 2,000, then 34 percent",945.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112.4,
STRYKER 5531-G-509-E TIB BEARING INS 9MM,C1776,HCPCS,,79010954,CDM,278,RC,,,both,,,2781,1097.57,39.4668,,1097.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Device,945.54,34,"Charges > $500, x 34%",945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,1112.4,40,,1112.4,percent of total billed charges,Implant Devices,973.35,70,,973.35,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.54,34,"If Charge > 2,000, then 34 percent",945.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112.4,
STRYKER 5517-F-501 FEMORAL COMP SZ 5 LT,C1776,HCPCS,,79010955,CDM,278,RC,,,both,,,5840,2304.86,39.4668,,2304.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,2044,35,,2044,percent of total billed charges,Implant Device,1985.6,34,"Charges > $500, x 34%",1985.6,percent of total billed charges,Implant Device,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2336,40,,2336,percent of total billed charges,Implant Devices,2044,70,,2044,percent of total billed charges,Implant Devices,1985.6,34,,1985.6,percent of total billed charges,Implant Devices,1985.6,34,,1985.6,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1985.6,34,"If Charge > 2,000, then 34 percent",1985.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2336,
STRYKER 5517-F-701 FEMORAL COMP SZ 7 LT,C1776,HCPCS,,79010956,CDM,278,RC,,,both,,,5840,2304.86,39.4668,,2304.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,1985.6,34,,1985.6,percent of total billed charges,Implant Device,2044,35,,2044,percent of total billed charges,Implant Device,1985.6,34,"Charges > $500, x 34%",1985.6,percent of total billed charges,Implant Device,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2336,40,,2336,percent of total billed charges,Implant Devices,2044,70,,2044,percent of total billed charges,Implant Devices,1985.6,34,,1985.6,percent of total billed charges,Implant Devices,1985.6,34,,1985.6,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,2044,35,,2044,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1985.6,34,"If Charge > 2,000, then 34 percent",1985.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2336,
STRYKER 5531-G-709-E TIB BEARING INS 9MM,C1776,HCPCS,,79010957,CDM,278,RC,,,both,,,2781,1097.57,39.4668,,1097.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Device,945.54,34,"Charges > $500, x 34%",945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,1112.4,40,,1112.4,percent of total billed charges,Implant Devices,973.35,70,,973.35,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.54,34,"If Charge > 2,000, then 34 percent",945.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112.4,
STRYKER 5536-B-700 TIB BASEPLT COMP SZ 7,C1776,HCPCS,,79010958,CDM,278,RC,,,both,,,4172,1646.55,39.4668,,1646.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1418.48,34,,1418.48,percent of total billed charges,Implant Device,1460.2,35,,1460.2,percent of total billed charges,Implant Device,1418.48,34,"Charges > $500, x 34%",1418.48,percent of total billed charges,Implant Device,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1668.8,40,,1668.8,percent of total billed charges,Implant Devices,1460.2,70,,1460.2,percent of total billed charges,Implant Devices,1418.48,34,,1418.48,percent of total billed charges,Implant Devices,1418.48,34,,1418.48,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,1460.2,35,,1460.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1418.48,34,"If Charge > 2,000, then 34 percent",1418.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1668.8,
STRYKER 5571-S-3608 HUM INSERT 36X8MM,C1776,HCPCS,,79010963,CDM,278,RC,,,both,,,3525,1391.2,39.4668,,1391.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Device,1198.5,34,"Charges > $500, x 34%",1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1410,40,,1410,percent of total billed charges,Implant Devices,1233.75,70,,1233.75,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1198.5,34,"If Charge > 2,000, then 34 percent",1198.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1410,
STRYKER UH1-54-26 BIPOLAR COMP 26X54MM,C1776,HCPCS,,79010966,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
ZIMMER US 574201030 FEM STEM 12/14 TAPER,C1776,HCPCS,,79010971,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
STRYKER 6570-0-328 FEMORAL HEAD 28X-2.7,C1776,HCPCS,,79010977,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
EXACTECH 320-36-03 HUMERAL LINER 36MM,C1776,HCPCS,,79010987,CDM,278,RC,,,both,,,2325,917.6,39.4668,,917.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Device,790.5,34,"Charges > $500, x 34%",790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,930,40,,930,percent of total billed charges,Implant Devices,813.75,70,,813.75,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.5,34,"If Charge > 2,000, then 34 percent",790.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930,
ZIMMER 574201020 FEMORAL STEM 12/14 SZ 2,C1776,HCPCS,,79011026,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 574201065 FEM STEM 12/14 SZ 6.5,C1776,HCPCS,,79011027,CDM,278,RC,,,both,,,8573,3383.49,39.4668,,3383.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Device,2914.82,34,"Charges > $500, x 34%",2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3429.2,40,,3429.2,percent of total billed charges,Implant Devices,3000.55,70,,3000.55,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2914.82,34,"If Charge > 2,000, then 34 percent",2914.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3429.2,
STRYKER 6276-7-025 MOD HIP SYS 155X25MM,C1776,HCPCS,,79011041,CDM,278,RC,,,both,,,8561,3378.75,39.4668,,3378.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2996.35,35,,2996.35,percent of total billed charges,Implant Device,2910.74,34,"Charges > $500, x 34%",2910.74,percent of total billed charges,Implant Device,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,3424.4,40,,3424.4,percent of total billed charges,Implant Devices,2996.35,70,,2996.35,percent of total billed charges,Implant Devices,2910.74,34,,2910.74,percent of total billed charges,Implant Devices,2910.74,34,,2910.74,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2910.74,34,"If Charge > 2,000, then 34 percent",2910.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3424.4,
STRYKER 5531-G-611-E TIB BEARING INS SZ6,C1776,HCPCS,,79011042,CDM,278,RC,,,both,,,2781,1097.57,39.4668,,1097.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Device,945.54,34,"Charges > $500, x 34%",945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,1112.4,40,,1112.4,percent of total billed charges,Implant Devices,973.35,70,,973.35,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.54,34,"If Charge > 2,000, then 34 percent",945.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112.4,
STRYKER 5551-G-381-E PATELLA SZ A38 11MM,C1776,HCPCS,,79011043,CDM,278,RC,,,both,,,1669,658.7,39.4668,,658.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,584.15,35,,584.15,percent of total billed charges,Implant Device,567.46,34,"Charges > $500, x 34%",567.46,percent of total billed charges,Implant Device,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,667.6,40,,667.6,percent of total billed charges,Implant Devices,584.15,70,,584.15,percent of total billed charges,Implant Devices,567.46,34,,567.46,percent of total billed charges,Implant Devices,567.46,34,,567.46,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667.6,
STRYKER 5560-S-115 CEMENTED STEM 15X50,C1776,HCPCS,,79011046,CDM,278,RC,,,both,,,3324,1311.88,39.4668,,1311.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1163.4,35,,1163.4,percent of total billed charges,Implant Device,1130.16,34,"Charges > $500, x 34%",1130.16,percent of total billed charges,Implant Device,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1329.6,40,,1329.6,percent of total billed charges,Implant Devices,1163.4,70,,1163.4,percent of total billed charges,Implant Devices,1130.16,34,,1130.16,percent of total billed charges,Implant Devices,1130.16,34,,1130.16,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.16,34,"If Charge > 2,000, then 34 percent",1130.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1329.6,
STRYKER 5551-G-299-E PATELLA SZ A29 9MM,C1776,HCPCS,,79011047,CDM,278,RC,,,both,,,1669,658.7,39.4668,,658.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,584.15,35,,584.15,percent of total billed charges,Implant Device,567.46,34,"Charges > $500, x 34%",567.46,percent of total billed charges,Implant Device,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,667.6,40,,667.6,percent of total billed charges,Implant Devices,584.15,70,,584.15,percent of total billed charges,Implant Devices,567.46,34,,567.46,percent of total billed charges,Implant Devices,567.46,34,,567.46,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667.6,
STRYKER 5521-B-500 TIBIAL BASEPLATE SZ 5,C1776,HCPCS,,79011050,CDM,278,RC,,,both,,,3337,1317.01,39.4668,,1317.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1134.58,34,,1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Device,1134.58,34,"Charges > $500, x 34%",1134.58,percent of total billed charges,Implant Device,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1334.8,40,,1334.8,percent of total billed charges,Implant Devices,1167.95,70,,1167.95,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1134.58,34,,1134.58,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,1167.95,35,,1167.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1134.58,34,"If Charge > 2,000, then 34 percent",1134.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1334.8,
STRYKER 5551-G-320-E PATELLA SZ A32 10MM,C1776,HCPCS,,79011051,CDM,278,RC,,,both,,,1669,658.7,39.4668,,658.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,567.46,34,,567.46,percent of total billed charges,Implant Device,584.15,35,,584.15,percent of total billed charges,Implant Device,567.46,34,"Charges > $500, x 34%",567.46,percent of total billed charges,Implant Device,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,667.6,40,,667.6,percent of total billed charges,Implant Devices,584.15,70,,584.15,percent of total billed charges,Implant Devices,567.46,34,,567.46,percent of total billed charges,Implant Devices,567.46,34,,567.46,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,584.15,35,,584.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667.6,
STRYKER ORTHO 6276-1-223 HIP SYS 23MM,C1776,HCPCS,,79011054,CDM,278,RC,,,both,,,11948,4715.49,39.4668,,4715.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4062.32,34,,4062.32,percent of total billed charges,Implant Device,4181.8,35,,4181.8,percent of total billed charges,Implant Device,4062.32,34,"Charges > $500, x 34%",4062.32,percent of total billed charges,Implant Device,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4779.2,40,,4779.2,percent of total billed charges,Implant Devices,4181.8,70,,4181.8,percent of total billed charges,Implant Devices,4062.32,34,,4062.32,percent of total billed charges,Implant Devices,4062.32,34,,4062.32,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,4181.8,35,,4181.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4062.32,34,"If Charge > 2,000, then 34 percent",4062.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4779.2,
STRYKER ORTHO 6276-7-018 STEM 155X18MM,C1776,HCPCS,,79011055,CDM,278,RC,,,both,,,8561,3378.75,39.4668,,3378.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2910.74,34,,2910.74,percent of total billed charges,Implant Device,2996.35,35,,2996.35,percent of total billed charges,Implant Device,2910.74,34,"Charges > $500, x 34%",2910.74,percent of total billed charges,Implant Device,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,3424.4,40,,3424.4,percent of total billed charges,Implant Devices,2996.35,70,,2996.35,percent of total billed charges,Implant Devices,2910.74,34,,2910.74,percent of total billed charges,Implant Devices,2910.74,34,,2910.74,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,2996.35,35,,2996.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2910.74,34,"If Charge > 2,000, then 34 percent",2910.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3424.4,
STRYKER 6057-0230D HIP STEM SZ 2 30X124,C1776,HCPCS,,79011059,CDM,278,RC,,,both,,,5006,1975.71,39.4668,,1975.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1702.04,34,,1702.04,percent of total billed charges,Implant Device,1752.1,35,,1752.1,percent of total billed charges,Implant Device,1702.04,34,"Charges > $500, x 34%",1702.04,percent of total billed charges,Implant Device,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,2002.4,40,,2002.4,percent of total billed charges,Implant Devices,1752.1,70,,1752.1,percent of total billed charges,Implant Devices,1702.04,34,,1702.04,percent of total billed charges,Implant Devices,1702.04,34,,1702.04,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,1752.1,35,,1752.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1702.04,34,"If Charge > 2,000, then 34 percent",1702.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2002.4,
DEPUY 1294-35-120 TIB TRAY ROTATING SZ 2,C1776,HCPCS,,79011060,CDM,278,RC,,,both,,,14804,5842.67,39.4668,,5842.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5033.36,34,,5033.36,percent of total billed charges,Implant Device,5033.36,34,,5033.36,percent of total billed charges,Implant Device,5033.36,34,,5033.36,percent of total billed charges,Implant Device,5033.36,34,,5033.36,percent of total billed charges,Implant Device,5033.36,34,,5033.36,percent of total billed charges,Implant Device,5033.36,34,,5033.36,percent of total billed charges,Implant Device,5181.4,35,,5181.4,percent of total billed charges,Implant Device,5033.36,34,"Charges > $500, x 34%",5033.36,percent of total billed charges,Implant Device,5181.4,35,,5181.4,percent of total billed charges,Implant Devices,5181.4,35,,5181.4,percent of total billed charges,Implant Devices,5181.4,35,,,percent of total billed charges,Implant Devices,5181.4,35,,5181.4,percent of total billed charges,Implant Devices,5181.4,35,,5181.4,percent of total billed charges,Implant Devices,5921.6,40,,5921.6,percent of total billed charges,Implant Devices,5181.4,70,,5181.4,percent of total billed charges,Implant Devices,5033.36,34,,5033.36,percent of total billed charges,Implant Devices,5033.36,34,,5033.36,percent of total billed charges,Implant Devices,5181.4,35,,5181.4,percent of total billed charges,Implant Devices,5181.4,35,,5181.4,percent of total billed charges,Implant Devices,5181.4,35,,5181.4,percent of total billed charges,Implant Devices,5181.4,35,,5181.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5033.36,34,"If Charge > 2,000, then 34 percent",5033.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5921.6,
ZIMMER 574201040 FEMORAL STEM 12/14 SZ 4,C1776,HCPCS,,79011061,CDM,278,RC,,,both,,,8573,3383.49,39.4668,,3383.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Device,2914.82,34,"Charges > $500, x 34%",2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3429.2,40,,3429.2,percent of total billed charges,Implant Devices,3000.55,70,,3000.55,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2914.82,34,"If Charge > 2,000, then 34 percent",2914.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3429.2,
ZIMMER 00-8775-032-04 FEM HEAD 32X+7MM,C1776,HCPCS,,79011073,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
ZIMMER 105424 ACETABULAR LOCK RING SZ 24,C1776,HCPCS,,79011074,CDM,278,RC,,,both,,,338,133.4,39.4668,,133.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.92,34,,114.92,percent of total billed charges,Implant Device,114.92,34,,114.92,percent of total billed charges,Implant Device,114.92,34,,114.92,percent of total billed charges,Implant Device,114.92,34,,114.92,percent of total billed charges,Implant Device,114.92,34,,114.92,percent of total billed charges,Implant Device,114.92,34,,114.92,percent of total billed charges,Implant Device,118.3,35,,118.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,135.2,40,,135.2,percent of total billed charges,Implant Devices,118.3,70,,118.3,percent of total billed charges,Implant Devices,114.92,34,,114.92,percent of total billed charges,Implant Devices,114.92,34,,114.92,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,135.2,
ZIMMER 105423 ACETABULAR LOCK RING SZ 23,C1776,HCPCS,,79011075,CDM,278,RC,,,both,,,338,133.4,39.4668,,133.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,114.92,34,,114.92,percent of total billed charges,Implant Device,114.92,34,,114.92,percent of total billed charges,Implant Device,114.92,34,,114.92,percent of total billed charges,Implant Device,114.92,34,,114.92,percent of total billed charges,Implant Device,114.92,34,,114.92,percent of total billed charges,Implant Device,114.92,34,,114.92,percent of total billed charges,Implant Device,118.3,35,,118.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,135.2,40,,135.2,percent of total billed charges,Implant Devices,118.3,70,,118.3,percent of total billed charges,Implant Devices,114.92,34,,114.92,percent of total billed charges,Implant Devices,114.92,34,,114.92,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,118.3,35,,118.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,135.2,
ZIMMER 11-363666 MODULAR HEAD COMP 36MM,C1776,HCPCS,,79011076,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER EP-108524 ACETABULAR LINER 40MM,C1776,HCPCS,,79011077,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 42-5121-009-11 ARTICULR SURF LT 8,C1776,HCPCS,,79011094,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5400-000-35 PATELLA 35X9MM,C1776,HCPCS,,79011095,CDM,278,RC,,,both,,,1539,607.39,39.4668,,607.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,538.65,35,,538.65,percent of total billed charges,Implant Device,523.26,34,"Charges > $500, x 34%",523.26,percent of total billed charges,Implant Device,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,615.6,40,,615.6,percent of total billed charges,Implant Devices,538.65,70,,538.65,percent of total billed charges,Implant Devices,523.26,34,,523.26,percent of total billed charges,Implant Devices,523.26,34,,523.26,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,615.6,
ZIMMER 42-5320-079-01 TIBIA 5 DEG SZ G,C1776,HCPCS,,79011096,CDM,278,RC,,,both,,,4433,1749.56,39.4668,,1749.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Device,1507.22,34,"Charges > $500, x 34%",1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1773.2,40,,1773.2,percent of total billed charges,Implant Devices,1551.55,70,,1551.55,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1507.22,34,"If Charge > 2,000, then 34 percent",1507.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1773.2,
ZIMMER 42-5026-070-01 FEMUR LEFT SZ 11,C1776,HCPCS,,79011097,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
ZIMMER 574202030 FEMORAL STEM 12/14 SZ 3,C1776,HCPCS,,79011098,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
EXACTECH 300-30-07 HUMERAL STEM 7MM,C1776,HCPCS,,79011102,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
STRYKER 6720-0635 HIP STEM 132 DEGREE,C1776,HCPCS,,79011103,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
STRYKER UH1-43-26 UNIVERSAL HEAD 43X26MM,C1776,HCPCS,,79011104,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 5552-S-4020 HUM HEAD SZ 40X20MM,C1776,HCPCS,,79011105,CDM,278,RC,,,both,,,3675,1450.4,39.4668,,1450.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Device,1249.5,34,"Charges > $500, x 34%",1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1470,40,,1470,percent of total billed charges,Implant Devices,1286.25,70,,1286.25,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.5,34,"If Charge > 2,000, then 34 percent",1249.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470,
STRYKER 5567-P-3010 HUMERAL STEM 10X94MM,C1776,HCPCS,,79011120,CDM,278,RC,,,both,,,8925,3522.41,39.4668,,3522.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Device,3034.5,34,"Charges > $500, x 34%",3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3570,40,,3570,percent of total billed charges,Implant Devices,3123.75,70,,3123.75,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3034.5,34,"If Charge > 2,000, then 34 percent",3034.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3570,
STRYKER 5571-C-3604 HUMERAL INS 36X4MM,C1776,HCPCS,,79011121,CDM,278,RC,,,both,,,3525,1391.2,39.4668,,1391.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Device,1198.5,34,"Charges > $500, x 34%",1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1410,40,,1410,percent of total billed charges,Implant Devices,1233.75,70,,1233.75,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1198.5,34,"If Charge > 2,000, then 34 percent",1198.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1410,
S&N 71343212 FEM HEAD 12/14 32MM +12,C1776,HCPCS,,79011122,CDM,278,RC,,,both,,,15660,6180.5,39.4668,,6180.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5324.4,34,,5324.4,percent of total billed charges,Implant Device,5481,35,,5481,percent of total billed charges,Implant Device,5324.4,34,"Charges > $500, x 34%",5324.4,percent of total billed charges,Implant Device,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,6264,40,,6264,percent of total billed charges,Implant Devices,5481,70,,5481,percent of total billed charges,Implant Devices,5324.4,34,,5324.4,percent of total billed charges,Implant Devices,5324.4,34,,5324.4,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,5481,35,,5481,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5324.4,34,"If Charge > 2,000, then 34 percent",5324.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6264,
EXACTECH 300-30-11 PRESERVE STEM 11MM,C1776,HCPCS,,79011138,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
ZIMMER 00-5880-040-14 ROTATIN HINGE 14MM,C1776,HCPCS,,79011146,CDM,278,RC,,,both,,,5765,2275.26,39.4668,,2275.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,2017.75,35,,2017.75,percent of total billed charges,Implant Device,1960.1,34,"Charges > $500, x 34%",1960.1,percent of total billed charges,Implant Device,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2306,40,,2306,percent of total billed charges,Implant Devices,2017.75,70,,2017.75,percent of total billed charges,Implant Devices,1960.1,34,,1960.1,percent of total billed charges,Implant Devices,1960.1,34,,1960.1,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1960.1,34,"If Charge > 2,000, then 34 percent",1960.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2306,
ZIMMER 00-5880-014-01 ROTATING HINGE FEM,C1776,HCPCS,,79011147,CDM,278,RC,,,both,,,26254,10361.61,39.4668,,10361.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,8926.36,34,,8926.36,percent of total billed charges,Implant Device,9188.9,35,,9188.9,percent of total billed charges,Implant Device,8926.36,34,"Charges > $500, x 34%",8926.36,percent of total billed charges,Implant Device,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,10501.6,40,,10501.6,percent of total billed charges,Implant Devices,9188.9,70,,9188.9,percent of total billed charges,Implant Devices,8926.36,34,,8926.36,percent of total billed charges,Implant Devices,8926.36,34,,8926.36,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,9188.9,35,,9188.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8926.36,34,"If Charge > 2,000, then 34 percent",8926.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10501.6,
ZIMMER 00-5880-040-17 ART SURF 17MM,C1776,HCPCS,,79011148,CDM,278,RC,,,both,,,5765,2275.26,39.4668,,2275.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,1960.1,34,,1960.1,percent of total billed charges,Implant Device,2017.75,35,,2017.75,percent of total billed charges,Implant Device,1960.1,34,"Charges > $500, x 34%",1960.1,percent of total billed charges,Implant Device,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2306,40,,2306,percent of total billed charges,Implant Devices,2017.75,70,,2017.75,percent of total billed charges,Implant Devices,1960.1,34,,1960.1,percent of total billed charges,Implant Devices,1960.1,34,,1960.1,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,2017.75,35,,2017.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1960.1,34,"If Charge > 2,000, then 34 percent",1960.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2306,
J&J 151650805 TIBIAL INSERT SIZE 8 5MM,C1776,HCPCS,,79011149,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
EXACTECH 306-02-10 HUMERAL STEM 10X200MM,C1776,HCPCS,,79011154,CDM,278,RC,,,both,,,12672,5001.23,39.4668,,5001.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4435.2,35,,4435.2,percent of total billed charges,Implant Device,4308.48,34,"Charges > $500, x 34%",4308.48,percent of total billed charges,Implant Device,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,5068.8,40,,5068.8,percent of total billed charges,Implant Devices,4435.2,70,,4435.2,percent of total billed charges,Implant Devices,4308.48,34,,4308.48,percent of total billed charges,Implant Devices,4308.48,34,,4308.48,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4308.48,34,"If Charge > 2,000, then 34 percent",4308.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5068.8,
ACUMED TR-S1002-S STEM 10X2.0MM,C1776,HCPCS,,79011166,CDM,278,RC,,,both,,,6951,2743.34,39.4668,,2743.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2363.34,34,,2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Device,2363.34,34,"Charges > $500, x 34%",2363.34,percent of total billed charges,Implant Device,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2780.4,40,,2780.4,percent of total billed charges,Implant Devices,2432.85,70,,2432.85,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2363.34,34,,2363.34,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,2432.85,35,,2432.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2363.34,34,"If Charge > 2,000, then 34 percent",2363.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2780.4,
ACUMED 5001-0524L-S HEAD 24MM LEFT,C1776,HCPCS,,79011167,CDM,278,RC,,,both,,,11871,4685.1,39.4668,,4685.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4036.14,34,,4036.14,percent of total billed charges,Implant Device,4154.85,35,,4154.85,percent of total billed charges,Implant Device,4036.14,34,"Charges > $500, x 34%",4036.14,percent of total billed charges,Implant Device,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4748.4,40,,4748.4,percent of total billed charges,Implant Devices,4154.85,70,,4154.85,percent of total billed charges,Implant Devices,4036.14,34,,4036.14,percent of total billed charges,Implant Devices,4036.14,34,,4036.14,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,4154.85,35,,4154.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4036.14,34,"If Charge > 2,000, then 34 percent",4036.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4748.4,
ZIMMER 110010244 ACETABULAR SHELL 52MM,C1776,HCPCS,,79011191,CDM,278,RC,,,both,,,8602,3394.93,39.4668,,3394.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Device,2924.68,34,"Charges > $500, x 34%",2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3440.8,40,,3440.8,percent of total billed charges,Implant Devices,3010.7,70,,3010.7,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2924.68,34,"If Charge > 2,000, then 34 percent",2924.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3440.8,
ZIMMER 30123605 LINER 36MM SIZE E,C1776,HCPCS,,79011192,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 574202000 FEM STEM 12/14 TAPER,C1776,HCPCS,,79011193,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 110010245 ACETABULAR SHELL 54MM,C1776,HCPCS,,79011194,CDM,278,RC,,,both,,,8602,3394.93,39.4668,,3394.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Device,2924.68,34,"Charges > $500, x 34%",2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3440.8,40,,3440.8,percent of total billed charges,Implant Devices,3010.7,70,,3010.7,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2924.68,34,"If Charge > 2,000, then 34 percent",2924.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3440.8,
ZIMMER 30103606 LINER 36MM SIZE F,C1776,HCPCS,,79011195,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 650-0661 CERAMIC HEAD 36MM TYPE 1,C1776,HCPCS,,79011196,CDM,278,RC,,,both,,,3825,1509.61,39.4668,,1509.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1300.5,34,,1300.5,percent of total billed charges,Implant Device,1338.75,35,,1338.75,percent of total billed charges,Implant Device,1300.5,34,"Charges > $500, x 34%",1300.5,percent of total billed charges,Implant Device,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1530,40,,1530,percent of total billed charges,Implant Devices,1338.75,70,,1338.75,percent of total billed charges,Implant Devices,1300.5,34,,1300.5,percent of total billed charges,Implant Devices,1300.5,34,,1300.5,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,1338.75,35,,1338.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1300.5,34,"If Charge > 2,000, then 34 percent",1300.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1530,
ZIMMER 30123607 LINER 36MM SIZE G,C1776,HCPCS,,79011197,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 110010248 ACETABULAR SHELL 60MM,C1776,HCPCS,,79011198,CDM,278,RC,,,both,,,8602,3394.93,39.4668,,3394.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Device,2924.68,34,"Charges > $500, x 34%",2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3440.8,40,,3440.8,percent of total billed charges,Implant Devices,3010.7,70,,3010.7,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2924.68,34,"If Charge > 2,000, then 34 percent",2924.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3440.8,
STRYKER 709-04-52E ACETABULAR SHELL 52MM,C1776,HCPCS,,79011199,CDM,278,RC,,,both,,,9296,3668.83,39.4668,,3668.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3160.64,34,,3160.64,percent of total billed charges,Implant Device,3160.64,34,,3160.64,percent of total billed charges,Implant Device,3160.64,34,,3160.64,percent of total billed charges,Implant Device,3160.64,34,,3160.64,percent of total billed charges,Implant Device,3160.64,34,,3160.64,percent of total billed charges,Implant Device,3160.64,34,,3160.64,percent of total billed charges,Implant Device,3253.6,35,,3253.6,percent of total billed charges,Implant Device,3160.64,34,"Charges > $500, x 34%",3160.64,percent of total billed charges,Implant Device,3253.6,35,,3253.6,percent of total billed charges,Implant Devices,3253.6,35,,3253.6,percent of total billed charges,Implant Devices,3253.6,35,,,percent of total billed charges,Implant Devices,3253.6,35,,3253.6,percent of total billed charges,Implant Devices,3253.6,35,,3253.6,percent of total billed charges,Implant Devices,3718.4,40,,3718.4,percent of total billed charges,Implant Devices,3253.6,70,,3253.6,percent of total billed charges,Implant Devices,3160.64,34,,3160.64,percent of total billed charges,Implant Devices,3160.64,34,,3160.64,percent of total billed charges,Implant Devices,3253.6,35,,3253.6,percent of total billed charges,Implant Devices,3253.6,35,,3253.6,percent of total billed charges,Implant Devices,3253.6,35,,3253.6,percent of total billed charges,Implant Devices,3253.6,35,,3253.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3160.64,34,"If Charge > 2,000, then 34 percent",3160.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3718.4,
STRYKER 5537-G-422 TIB INSERT SZ 4 22MM,C1776,HCPCS,,79011202,CDM,278,RC,,,both,,,6650,2624.54,39.4668,,2624.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2261,34,,2261,percent of total billed charges,Implant Device,2261,34,,2261,percent of total billed charges,Implant Device,2261,34,,2261,percent of total billed charges,Implant Device,2261,34,,2261,percent of total billed charges,Implant Device,2261,34,,2261,percent of total billed charges,Implant Device,2261,34,,2261,percent of total billed charges,Implant Device,2327.5,35,,2327.5,percent of total billed charges,Implant Device,2261,34,"Charges > $500, x 34%",2261,percent of total billed charges,Implant Device,2327.5,35,,2327.5,percent of total billed charges,Implant Devices,2327.5,35,,2327.5,percent of total billed charges,Implant Devices,2327.5,35,,,percent of total billed charges,Implant Devices,2327.5,35,,2327.5,percent of total billed charges,Implant Devices,2327.5,35,,2327.5,percent of total billed charges,Implant Devices,2660,40,,2660,percent of total billed charges,Implant Devices,2327.5,70,,2327.5,percent of total billed charges,Implant Devices,2261,34,,2261,percent of total billed charges,Implant Devices,2261,34,,2261,percent of total billed charges,Implant Devices,2327.5,35,,2327.5,percent of total billed charges,Implant Devices,2327.5,35,,2327.5,percent of total billed charges,Implant Devices,2327.5,35,,2327.5,percent of total billed charges,Implant Devices,2327.5,35,,2327.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2261,34,"If Charge > 2,000, then 34 percent",2261,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2660,
STRYKER 5560-S-112 STEM 12X50MM,C1776,HCPCS,,79011203,CDM,278,RC,,,both,,,3324,1311.88,39.4668,,1311.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1130.16,34,,1130.16,percent of total billed charges,Implant Device,1163.4,35,,1163.4,percent of total billed charges,Implant Device,1130.16,34,"Charges > $500, x 34%",1130.16,percent of total billed charges,Implant Device,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1329.6,40,,1329.6,percent of total billed charges,Implant Devices,1163.4,70,,1163.4,percent of total billed charges,Implant Devices,1130.16,34,,1130.16,percent of total billed charges,Implant Devices,1130.16,34,,1130.16,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,1163.4,35,,1163.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1130.16,34,"If Charge > 2,000, then 34 percent",1130.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1329.6,
STRYKER 5542-P-0056 PEGGED GLENOID SZ 56,C1776,HCPCS,,79011461,CDM,278,RC,,,both,,,3675,1450.4,39.4668,,1450.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Device,1249.5,34,"Charges > $500, x 34%",1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1470,40,,1470,percent of total billed charges,Implant Devices,1286.25,70,,1286.25,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.5,34,"If Charge > 2,000, then 34 percent",1249.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470,
STRYKER 5552-E-5217 HUM HEAD SZ 52X17MM,C1776,HCPCS,,79011462,CDM,278,RC,,,both,,,3675,1450.4,39.4668,,1450.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Device,1249.5,34,"Charges > $500, x 34%",1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1470,40,,1470,percent of total billed charges,Implant Devices,1286.25,70,,1286.25,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.5,34,"If Charge > 2,000, then 34 percent",1249.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470,
STRYKER 5567-P-3017 HUM STEM 17X102MM,C1776,HCPCS,,79011463,CDM,278,RC,,,both,,,16950,6689.62,39.4668,,6689.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5763,34,,5763,percent of total billed charges,Implant Device,5763,34,,5763,percent of total billed charges,Implant Device,5763,34,,5763,percent of total billed charges,Implant Device,5763,34,,5763,percent of total billed charges,Implant Device,5763,34,,5763,percent of total billed charges,Implant Device,5763,34,,5763,percent of total billed charges,Implant Device,5932.5,35,,5932.5,percent of total billed charges,Implant Device,5763,34,"Charges > $500, x 34%",5763,percent of total billed charges,Implant Device,5932.5,35,,5932.5,percent of total billed charges,Implant Devices,5932.5,35,,5932.5,percent of total billed charges,Implant Devices,5932.5,35,,,percent of total billed charges,Implant Devices,5932.5,35,,5932.5,percent of total billed charges,Implant Devices,5932.5,35,,5932.5,percent of total billed charges,Implant Devices,6780,40,,6780,percent of total billed charges,Implant Devices,5932.5,70,,5932.5,percent of total billed charges,Implant Devices,5763,34,,5763,percent of total billed charges,Implant Devices,5763,34,,5763,percent of total billed charges,Implant Devices,5932.5,35,,5932.5,percent of total billed charges,Implant Devices,5932.5,35,,5932.5,percent of total billed charges,Implant Devices,5932.5,35,,5932.5,percent of total billed charges,Implant Devices,5932.5,35,,5932.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5763,34,"If Charge > 2,000, then 34 percent",5763,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6780,
EXACTECH 320-40-03 HUM LINER 40MM +2.5,C1776,HCPCS,,79011567,CDM,278,RC,,,both,,,2325,917.6,39.4668,,917.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,790.5,34,,790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Device,790.5,34,"Charges > $500, x 34%",790.5,percent of total billed charges,Implant Device,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,930,40,,930,percent of total billed charges,Implant Devices,813.75,70,,813.75,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,790.5,34,,790.5,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,813.75,35,,813.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.5,34,"If Charge > 2,000, then 34 percent",790.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930,
STRYKER 5567-P-3012 HUMERAL STEM 12X96MM,C1776,HCPCS,,79011659,CDM,278,RC,,,both,,,8925,3522.41,39.4668,,3522.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Device,3034.5,34,"Charges > $500, x 34%",3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3570,40,,3570,percent of total billed charges,Implant Devices,3123.75,70,,3123.75,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3034.5,34,"If Charge > 2,000, then 34 percent",3034.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3570,
ZIMMER 574202060 FEM STEM 12/14 TAPER,C1776,HCPCS,,79011660,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
STRYKER 5567-P-3015 HUMERAL STEM 15X99MM,C1776,HCPCS,,79011679,CDM,278,RC,,,both,,,8925,3522.41,39.4668,,3522.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Device,3034.5,34,"Charges > $500, x 34%",3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3570,40,,3570,percent of total billed charges,Implant Devices,3123.75,70,,3123.75,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3034.5,34,"If Charge > 2,000, then 34 percent",3034.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3570,
ZIMMER 574202080 FEMORAL STEM 12/14 SZ 8,C1776,HCPCS,,79011703,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 00-5750-016-02 FEM COMP SZ F RT,C1776,HCPCS,,79011709,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 00-5972-065-41 PATELLA SZ 41 10MM,C1776,HCPCS,,79011710,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 00-8852-009-32 LINER 32X50 SZ HH,C1776,HCPCS,,79011722,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 574203010 FEM STEM 12/14 SZ 1,C1776,HCPCS,,79011723,CDM,278,RC,,,both,,,8573,3383.49,39.4668,,3383.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Device,2914.82,34,"Charges > $500, x 34%",2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3429.2,40,,3429.2,percent of total billed charges,Implant Devices,3000.55,70,,3000.55,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2914.82,34,"If Charge > 2,000, then 34 percent",2914.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3429.2,
J&J 1506-11-009 TIBIAL BASE SIZE 9,C1776,HCPCS,,79011724,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
J&J 1504-11-208 FEMORAL COMPONENT SIZE 8,C1776,HCPCS,,79011725,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1518-20-038 PATELLA MEDIAL 38MM,C1776,HCPCS,,79011726,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J 1516-50-807 TIBIAL INSERT 7MM SIZE 8,C1776,HCPCS,,79011727,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
J&J 1024-53-408 TIBIAL INSERT 8MM SIZE 4,C1776,HCPCS,,79011728,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
J&J 1024-51-400 TIBIAL TRAY SIZE 4,C1776,HCPCS,,79011729,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
J&J 1024-07-500 FEMORAL COMPONENTS SZ 5,C1776,HCPCS,,79011730,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
J&J 1504-10-226 FEMORAL COMPONENT SIZE 6,C1776,HCPCS,,79011749,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1506-80-005 TIBIAL BASE SIZE 5,C1776,HCPCS,,79011750,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
J&J 1518-20-035 PATELLA 35MM,C1776,HCPCS,,79011751,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J 1516-50-608 TIBIAL INSERT SIZE 6 8MM,C1776,HCPCS,,79011752,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
ZIMMER 574202075 FEM STEM 12/14 TAPER,C1776,HCPCS,,79011753,CDM,278,RC,,,both,,,8573,3383.49,39.4668,,3383.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Device,2914.82,34,"Charges > $500, x 34%",2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3429.2,40,,3429.2,percent of total billed charges,Implant Devices,3000.55,70,,3000.55,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2914.82,34,"If Charge > 2,000, then 34 percent",2914.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3429.2,
ZIMMER 574202040 FEM STEM 12/14 TAPER,C1776,HCPCS,,79011754,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 650-0660 CERAMIC HEAD 36/-3MM,C1776,HCPCS,,79011756,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
ZIMMER 11-300914 DISTAL STEM 14X190MM,C1776,HCPCS,,79011757,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
ZIMMER 163667 MOD HEAD COMP 32X-6MM NECK,C1776,HCPCS,,79011758,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 00-8851-009-32 LINER 32MM SIZE HH,C1776,HCPCS,,79011759,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
J&J 1516-50-706 TIBIAL INSERT SIZE 7 6MM,C1776,HCPCS,,79011762,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
J&J 1504-11-207 FEMORAL COMP SZ 7 RT,C1776,HCPCS,,79011763,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1506-11-008 TIBIAL BASE SIZE 8,C1776,HCPCS,,79011764,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
J&J 1518-20-041 PATELLA DOME 41MM,C1776,HCPCS,,79011765,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
DJO 412-02-052 BIPOLAR MODULAR 52X29MM,C1776,HCPCS,,79011780,CDM,278,RC,,,both,,,1380,544.64,39.4668,,544.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Device,469.2,34,"Charges > $500, x 34%",469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,552,40,,552,percent of total billed charges,Implant Devices,483,70,,483,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552,
DJO D111-18-1304 HIP STEM SIZE 13,C1776,HCPCS,,79011782,CDM,278,RC,,,both,,,7320,2888.97,39.4668,,2888.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Device,2488.8,34,"Charges > $500, x 34%",2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2928,40,,2928,percent of total billed charges,Implant Devices,2562,70,,2562,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2488.8,34,"If Charge > 2,000, then 34 percent",2488.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2928,
EXACTECH 320-06-38 GLENOSPHERE 38MM,C1776,HCPCS,,79011783,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
EXACTECH 320-08-38 GLENOSPHERE 38MM +4MM,C1776,HCPCS,,79011795,CDM,278,RC,,,both,,,5610,2214.09,39.4668,,2214.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1963.5,35,,1963.5,percent of total billed charges,Implant Device,1907.4,34,"Charges > $500, x 34%",1907.4,percent of total billed charges,Implant Device,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,2244,40,,2244,percent of total billed charges,Implant Devices,1963.5,70,,1963.5,percent of total billed charges,Implant Devices,1907.4,34,,1907.4,percent of total billed charges,Implant Devices,1907.4,34,,1907.4,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1907.4,34,"If Charge > 2,000, then 34 percent",1907.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2244,
ZIMMER 00-5001-042-22 LINER 22MM,C1776,HCPCS,,79011796,CDM,278,RC,,,both,,,789,311.39,39.4668,,311.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Device,268.26,34,"Charges > $500, x 34%",268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,315.6,40,,315.6,percent of total billed charges,Implant Devices,276.15,70,,276.15,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.6,
ZIMMER 00-8018-022-02 FEM HEAD 12/14,C1776,HCPCS,,79011797,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
J&J 1504-10-105 FEM POSTERIOR SZ 5 LT,C1776,HCPCS,,79011798,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1516-50-505 TIBIAL INSERT SIZE 5X5MM,C1776,HCPCS,,79011799,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1024-53-309 TIBIAL INSERT SIZE 3X9MM,C1776,HCPCS,,79011800,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
J&J 1024-53-409 TIBIAL INSERT SIZE 4X9MM,C1776,HCPCS,,79011801,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
STRYKER 6720-0535 HIP STEM SZ 5 132 DEG,C1776,HCPCS,,79011820,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
J&J 1504-11-125 FEMORAL COMPONENT SIZE 5,C1776,HCPCS,,79011821,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1516-50-510 TIBIAL INSERT 10MM SZ 5,C1776,HCPCS,,79011822,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
J&J 1506-11-005 TIBIAL BASE SIZE 5,C1776,HCPCS,,79011823,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
EXACTECH 320-06-42 GLENOSPHERE 42MM,C1776,HCPCS,,79011833,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
J&J 1504-10-126 FEMORAL COMPONENET SZ 6,C1776,HCPCS,,79011844,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
STRYKER 5567-P-3013 HUMERAL STEM 13X97MM,C1776,HCPCS,,79011848,CDM,278,RC,,,both,,,8925,3522.41,39.4668,,3522.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Device,3034.5,34,"Charges > $500, x 34%",3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3570,40,,3570,percent of total billed charges,Implant Devices,3123.75,70,,3123.75,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3034.5,34,"If Charge > 2,000, then 34 percent",3034.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3570,
ZIMMER 00-5001-042-00 BIPOLAR CUP SHELL,C1776,HCPCS,,79011860,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 802202202 FEMORAL HEAD 22MM,C1776,HCPCS,,79011861,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
STRYKER 5567-P-3016 HUM STEM 16X101MM,C1776,HCPCS,,79011903,CDM,278,RC,,,both,,,8925,3522.41,39.4668,,3522.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Device,3034.5,34,"Charges > $500, x 34%",3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3570,40,,3570,percent of total billed charges,Implant Devices,3123.75,70,,3123.75,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3034.5,34,"If Charge > 2,000, then 34 percent",3034.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3570,
ZIMMER 574203040 FEM STEM 12/14 SZ 4,C1776,HCPCS,,79011940,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
J&J 1516-50-506 TIBIAL INSERT 4MM SIZE 5,C1776,HCPCS,,79011942,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1504-11-105 FEMORAL COMP SIZE 5 LT,C1776,HCPCS,,79011943,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
STRYKER 6721-0230 HIP STEM 127 DEGREE,C1776,HCPCS,,79011945,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
J&J 1504-11-225 FEMORAL COMP SZ 5 RT,C1776,HCPCS,,79011952,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1504-10-207 FEMORAL COMP SZ 7 RT,C1776,HCPCS,,79011953,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1516-50-705 TIBIAL INSERT SIZE 7 5MM,C1776,HCPCS,,79011954,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1506-80-006 TIBIAL BASE SIZE 6,C1776,HCPCS,,79011955,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
DJO 940-01-52F ACETABULAR CUP 52MM,C1776,HCPCS,,79011960,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
DJ0 942-01-36F LINER 36MM,C1776,HCPCS,,79011961,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
DJO 111-18-1403 HIP STEM SIZE 14,C1776,HCPCS,,79011963,CDM,278,RC,,,both,,,8400,3315.21,39.4668,,3315.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2856,34,,2856,percent of total billed charges,Implant Device,2856,34,,2856,percent of total billed charges,Implant Device,2856,34,,2856,percent of total billed charges,Implant Device,2856,34,,2856,percent of total billed charges,Implant Device,2856,34,,2856,percent of total billed charges,Implant Device,2856,34,,2856,percent of total billed charges,Implant Device,2940,35,,2940,percent of total billed charges,Implant Device,2856,34,"Charges > $500, x 34%",2856,percent of total billed charges,Implant Device,2940,35,,2940,percent of total billed charges,Implant Devices,2940,35,,2940,percent of total billed charges,Implant Devices,2940,35,,,percent of total billed charges,Implant Devices,2940,35,,2940,percent of total billed charges,Implant Devices,2940,35,,2940,percent of total billed charges,Implant Devices,3360,40,,3360,percent of total billed charges,Implant Devices,2940,70,,2940,percent of total billed charges,Implant Devices,2856,34,,2856,percent of total billed charges,Implant Devices,2856,34,,2856,percent of total billed charges,Implant Devices,2940,35,,2940,percent of total billed charges,Implant Devices,2940,35,,2940,percent of total billed charges,Implant Devices,2940,35,,2940,percent of total billed charges,Implant Devices,2940,35,,2940,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2856,34,"If Charge > 2,000, then 34 percent",2856,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3360,
ZIMMER 42-5121-008-12 ART SURFACE LT12MM,C1776,HCPCS,,79011972,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5221-009-11 ART SURFACE RT11MM,C1776,HCPCS,,79011973,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5026-070-02 FEMUR RT SIZE 11,C1776,HCPCS,,79011974,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 42-5320-079-02 TIBIA 5° RT SZ G,C1776,HCPCS,,79011975,CDM,278,RC,,,both,,,4433,1749.56,39.4668,,1749.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Device,1507.22,34,"Charges > $500, x 34%",1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1773.2,40,,1773.2,percent of total billed charges,Implant Devices,1551.55,70,,1551.55,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1507.22,34,"If Charge > 2,000, then 34 percent",1507.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1773.2,
ZIMMER 42-5121-008-13 ART SURFACE LT13MM,C1776,HCPCS,,79011976,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5221-009-14 ART SURFACE RT14mm,C1776,HCPCS,,79011982,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
J&J  1506-11-006 tibial base size 6,C1776,HCPCS,,79011986,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
Zimmer00-5001-047-00 BIPOLAR SHELL 47mm,C1776,HCPCS,,79011991,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
EXACTECH 320-08-42 GLENOSPHERE&LOCK CAP,C1776,HCPCS,,79011996,CDM,278,RC,,,both,,,5610,2214.09,39.4668,,2214.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1907.4,34,,1907.4,percent of total billed charges,Implant Device,1963.5,35,,1963.5,percent of total billed charges,Implant Device,1907.4,34,"Charges > $500, x 34%",1907.4,percent of total billed charges,Implant Device,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,2244,40,,2244,percent of total billed charges,Implant Devices,1963.5,70,,1963.5,percent of total billed charges,Implant Devices,1907.4,34,,1907.4,percent of total billed charges,Implant Devices,1907.4,34,,1907.4,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,1963.5,35,,1963.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1907.4,34,"If Charge > 2,000, then 34 percent",1907.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2244,
J&J 1504-10-107 FEM POSTERIOR SZ 7 LT,C1776,HCPCS,,79012000,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1506-80-007 TIBIAL BASE SZ 7,C1776,HCPCS,,79012001,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
J&J 1516-50-708 TIBIAL INSERT 8MM SZ 7,C1776,HCPCS,,79012002,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1504-11-206 FEM POSTERIOR SZ 6 RT,C1776,HCPCS,,79012003,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1516-50-605 TIBIAL INSERT 5MM SZ 6,C1776,HCPCS,,79012004,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1024-56-207 TIBIAL INSERT 7MM SIZE 2,C1776,HCPCS,,79012011,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
ZIMMER 45-5221-008-11 ART SURF RT SZ 11M,C1776,HCPCS,,79012028,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5320-083-02 TIBIA STEM 5 DEG H,C1776,HCPCS,,79012030,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 42-5221-009-12 ART SURF RT 12MM,C1776,HCPCS,,79012031,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 45-5026-064-02 FEMUR RIGHT SIZE 8,C1776,HCPCS,,79012033,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
EXACTECH 300-01-14 HUMERAL STEM 14MM,C1776,HCPCS,,79012036,CDM,278,RC,,,both,,,4425,1746.41,39.4668,,1746.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Device,1504.5,34,"Charges > $500, x 34%",1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1770,40,,1770,percent of total billed charges,Implant Devices,1548.75,70,,1548.75,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1504.5,34,"If Charge > 2,000, then 34 percent",1504.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1770,
J&J 1504-11-210 FEMORAL COMPONENT SZ 10,C1776,HCPCS,,79012082,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1516-51-006 TIBIAL INSERT 6MM SZ 10,C1776,HCPCS,,79012083,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
J&J 1506-11-010 TIBIAL BASE SZ 10,C1776,HCPCS,,79012084,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 183008 FEMORAL CEMENTED RT 65MM,C1776,HCPCS,,79012090,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 141233 TIBIAL PLATE 71MM,C1776,HCPCS,,79012091,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER EP-189062 TIBIAL BEARING 12X71MM,C1776,HCPCS,,79012092,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 184764 PATELLA 3 PEG STD 31X8MM,C1776,HCPCS,,79012093,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 42-5121-009-13 ARTIC SURF LT 13MM,C1776,HCPCS,,79012117,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
ZIMMER 42-5026-066-01 FEMUR LEFT SIZE 9,C1776,HCPCS,,79012118,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
ZIMMER 42-5121-009-12 ARTIC SURF LT 12MM,C1776,HCPCS,,79012119,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
J&J 1504-10-109 FEMORAL COMPONENT SIZE 9,C1776,HCPCS,,79012120,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1516-50-905 TIBIAL INSERT SIZE 9 5MM,C1776,HCPCS,,79012121,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
J&J 1506-80-008 TIBIAL BASE SIZE 8,C1776,HCPCS,,79012122,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
J&J 1506-60-008 TIBIAL BASE SIZE 8,C1776,HCPCS,,79012124,CDM,278,RC,,,both,,,15558,6140.24,39.4668,,6140.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5445.3,35,,5445.3,percent of total billed charges,Implant Device,5289.72,34,"Charges > $500, x 34%",5289.72,percent of total billed charges,Implant Device,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,6223.2,40,,6223.2,percent of total billed charges,Implant Devices,5445.3,70,,5445.3,percent of total billed charges,Implant Devices,5289.72,34,,5289.72,percent of total billed charges,Implant Devices,5289.72,34,,5289.72,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5289.72,34,"If Charge > 2,000, then 34 percent",5289.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6223.2,
J&J 1512-14-030 STEM 14X30MM,C1776,HCPCS,,79012125,CDM,278,RC,,,both,,,3315,1308.32,39.4668,,1308.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1160.25,35,,1160.25,percent of total billed charges,Implant Device,1127.1,34,"Charges > $500, x 34%",1127.1,percent of total billed charges,Implant Device,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1326,40,,1326,percent of total billed charges,Implant Devices,1160.25,70,,1160.25,percent of total billed charges,Implant Devices,1127.1,34,,1127.1,percent of total billed charges,Implant Devices,1127.1,34,,1127.1,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1127.1,34,"If Charge > 2,000, then 34 percent",1127.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1326,
IN2BONES P40 ST614 COMPRESSION INSERT,C1776,HCPCS,,79012127,CDM,278,RC,,,both,,,825,325.6,39.4668,,325.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,280.5,34,,280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Device,280.5,34,"Charges > $500, x 34%",280.5,percent of total billed charges,Implant Device,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,330,40,,330,percent of total billed charges,Implant Devices,288.75,70,,288.75,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,280.5,34,,280.5,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,288.75,35,,288.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330,
ZIMMER 42-5026-066-02 FEMUR RIGHT SIZE 9,C1776,HCPCS,,79012131,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
ZIMMER 42-5221-008-14 ARTIC SURF RT 14MM,C1776,HCPCS,,79012132,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5320-071-02 TIBIA STEM 5 DEG,C1776,HCPCS,,79012133,CDM,278,RC,,,both,,,4433,1749.56,39.4668,,1749.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Device,1507.22,34,"Charges > $500, x 34%",1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1773.2,40,,1773.2,percent of total billed charges,Implant Devices,1551.55,70,,1551.55,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1507.22,34,"If Charge > 2,000, then 34 percent",1507.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1773.2,
ZIMMER 42-5221-003-12 ARTIC SURF RT 12MM,C1776,HCPCS,,79012134,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5026-058-02 FEMUR RIGHT SIZE 5,C1776,HCPCS,,79012135,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 42-5320-067-02 TIBIA STEM 5 DEG,C1776,HCPCS,,79012136,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 00-8757-058-02 TRAB METL SHELL 58,C1776,HCPCS,,79012141,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
ZIMMER 00-8018-028-14 FEMORAL HEAD +7 28,C1776,HCPCS,,79012146,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER 574101040 FEMORAL STEM SIZE 4,C1776,HCPCS,,79012153,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
J&J 1504-11-108 FEMORAL COMP SZ 8 LT,C1776,HCPCS,,79012179,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1506-11-007 TIBIAL BASE SIZE 7,C1776,HCPCS,,79012180,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
J&J 1504-11-106 FEMORAL COMPONENT SZ 6,C1776,HCPCS,,79012181,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
ZIMMER 574102020 FEMORAL STEM SIZE 2,C1776,HCPCS,,79012185,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 30123606 LINER 36MM SIZE F,C1776,HCPCS,,79012186,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 42-5221-007-12 ART SURFACE RT 12,C1776,HCPCS,,79012193,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5026-062-02 FEMUR RIGHT SIZE 7,C1776,HCPCS,,79012194,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
ZIMMER 00-5988-005-26 TIBIAL BLOCK SZ 5,C1776,HCPCS,,79012195,CDM,278,RC,,,both,,,2963,1169.4,39.4668,,1169.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1007.42,34,,1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Device,1007.42,34,"Charges > $500, x 34%",1007.42,percent of total billed charges,Implant Device,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1185.2,40,,1185.2,percent of total billed charges,Implant Devices,1037.05,70,,1037.05,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1007.42,34,,1007.42,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,1037.05,35,,1037.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1007.42,34,"If Charge > 2,000, then 34 percent",1007.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1185.2,
ZIMMER 00-5988-021-14 STEM EXT 14X155MM,C1776,HCPCS,,79012196,CDM,278,RC,,,both,,,4337,1711.68,39.4668,,1711.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1474.58,34,,1474.58,percent of total billed charges,Implant Device,1474.58,34,,1474.58,percent of total billed charges,Implant Device,1474.58,34,,1474.58,percent of total billed charges,Implant Device,1474.58,34,,1474.58,percent of total billed charges,Implant Device,1474.58,34,,1474.58,percent of total billed charges,Implant Device,1474.58,34,,1474.58,percent of total billed charges,Implant Device,1517.95,35,,1517.95,percent of total billed charges,Implant Device,1474.58,34,"Charges > $500, x 34%",1474.58,percent of total billed charges,Implant Device,1517.95,35,,1517.95,percent of total billed charges,Implant Devices,1517.95,35,,1517.95,percent of total billed charges,Implant Devices,1517.95,35,,,percent of total billed charges,Implant Devices,1517.95,35,,1517.95,percent of total billed charges,Implant Devices,1517.95,35,,1517.95,percent of total billed charges,Implant Devices,1734.8,40,,1734.8,percent of total billed charges,Implant Devices,1517.95,70,,1517.95,percent of total billed charges,Implant Devices,1474.58,34,,1474.58,percent of total billed charges,Implant Devices,1474.58,34,,1474.58,percent of total billed charges,Implant Devices,1517.95,35,,1517.95,percent of total billed charges,Implant Devices,1517.95,35,,1517.95,percent of total billed charges,Implant Devices,1517.95,35,,1517.95,percent of total billed charges,Implant Devices,1517.95,35,,1517.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1474.58,34,"If Charge > 2,000, then 34 percent",1474.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1734.8,
STRYKER 6720-0937 HIP STEM SZ 9 37X120MM,C1776,HCPCS,,79012197,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
ZIMMER 574202065 FEMORAL STEM SIZE 6.5,C1776,HCPCS,,79012198,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 183006 FEMORAL RIGHT 62.5MM,C1776,HCPCS,,79012199,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
DJO 508-32-204 GLENOID BASE PLATE 30MM,C1776,HCPCS,,79012214,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
DJO 506-03-130 BONE SCREW 5.0X30MM,C1776,HCPCS,,79012215,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
DJO 506-03-122 BONE SCREW 5.0X22MM,C1776,HCPCS,,79012216,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
DJO 508-36-101 GLENOID HEAD 36MM,C1776,HCPCS,,79012218,CDM,278,RC,,,both,,,4440,1752.33,39.4668,,1752.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1554,35,,1554,percent of total billed charges,Implant Device,1509.6,34,"Charges > $500, x 34%",1509.6,percent of total billed charges,Implant Device,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1776,40,,1776,percent of total billed charges,Implant Devices,1554,70,,1554,percent of total billed charges,Implant Devices,1509.6,34,,1509.6,percent of total billed charges,Implant Devices,1509.6,34,,1509.6,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1509.6,34,"If Charge > 2,000, then 34 percent",1509.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1776,
DJO 509-00-036 HUMRAL SOCKET INS 36MM,C1776,HCPCS,,79012219,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
DJO 530-10-108 HUMERAL STEM SZ 10X108MM,C1776,HCPCS,,79012220,CDM,278,RC,,,both,,,14400,5683.22,39.4668,,5683.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Device,4896,34,"Charges > $500, x 34%",4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5760,40,,5760,percent of total billed charges,Implant Devices,5040,70,,5040,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4896,34,"If Charge > 2,000, then 34 percent",4896,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5760,
DJO 510-08-000 MONOBLOCK SPACER W/ SCREW,C1776,HCPCS,,79012222,CDM,278,RC,,,both,,,5582,2203.04,39.4668,,2203.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1897.88,34,,1897.88,percent of total billed charges,Implant Device,1897.88,34,,1897.88,percent of total billed charges,Implant Device,1897.88,34,,1897.88,percent of total billed charges,Implant Device,1897.88,34,,1897.88,percent of total billed charges,Implant Device,1897.88,34,,1897.88,percent of total billed charges,Implant Device,1897.88,34,,1897.88,percent of total billed charges,Implant Device,1953.7,35,,1953.7,percent of total billed charges,Implant Device,1897.88,34,"Charges > $500, x 34%",1897.88,percent of total billed charges,Implant Device,1953.7,35,,1953.7,percent of total billed charges,Implant Devices,1953.7,35,,1953.7,percent of total billed charges,Implant Devices,1953.7,35,,,percent of total billed charges,Implant Devices,1953.7,35,,1953.7,percent of total billed charges,Implant Devices,1953.7,35,,1953.7,percent of total billed charges,Implant Devices,2232.8,40,,2232.8,percent of total billed charges,Implant Devices,1953.7,70,,1953.7,percent of total billed charges,Implant Devices,1897.88,34,,1897.88,percent of total billed charges,Implant Devices,1897.88,34,,1897.88,percent of total billed charges,Implant Devices,1953.7,35,,1953.7,percent of total billed charges,Implant Devices,1953.7,35,,1953.7,percent of total billed charges,Implant Devices,1953.7,35,,1953.7,percent of total billed charges,Implant Devices,1953.7,35,,1953.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1897.88,34,"If Charge > 2,000, then 34 percent",1897.88,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2232.8,
ZIMMER 574101085 FEMORAL STEM SIZE 8.5,C1776,HCPCS,,79012229,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 574201090 FEMORAL STEM SIZE 9,C1776,HCPCS,,79012230,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 00-5001-057-28 BIPOLAR CUP LINER,C1776,HCPCS,,79012231,CDM,278,RC,,,both,,,789,311.39,39.4668,,311.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,268.26,34,,268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Device,268.26,34,"Charges > $500, x 34%",268.26,percent of total billed charges,Implant Device,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,315.6,40,,315.6,percent of total billed charges,Implant Devices,276.15,70,,276.15,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,268.26,34,,268.26,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,276.15,35,,276.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,315.6,
ZIMMER 00-5001-057-00 BIPOLAR CUP SHELL,C1776,HCPCS,,79012232,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
DJO 412-02-049 BIPOLAR MODULAR 49X28MM,C1776,HCPCS,,79012233,CDM,278,RC,,,both,,,1380,544.64,39.4668,,544.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Device,469.2,34,"Charges > $500, x 34%",469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,552,40,,552,percent of total billed charges,Implant Devices,483,70,,483,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552,
DJO 400-03-281 FEMORAL HEAD 28MM,C1776,HCPCS,,79012234,CDM,278,RC,,,both,,,4350,1716.81,39.4668,,1716.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1522.5,35,,1522.5,percent of total billed charges,Implant Device,1479,34,"Charges > $500, x 34%",1479,percent of total billed charges,Implant Device,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1740,40,,1740,percent of total billed charges,Implant Devices,1522.5,70,,1522.5,percent of total billed charges,Implant Devices,1479,34,,1479,percent of total billed charges,Implant Devices,1479,34,,1479,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1479,34,"If Charge > 2,000, then 34 percent",1479,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1740,
ZIMMER 42-5221-009-10 ART SURF RT 10MM,C1776,HCPCS,,79012237,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5221-009-13 ART SURF RT 13MM,C1776,HCPCS,,79012238,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 110031000 BEARING SIZE F 28X44MM,C1776,HCPCS,,79012249,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 650-1158 CERAMIC HEAD TYPE 1 28MM,C1776,HCPCS,,79012250,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
ZIMMER 574102065 FEMORAL STEM SIZE 6.5,C1776,HCPCS,,79012257,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 11-301019 DISTAL STEM 19X250MM,C1776,HCPCS,,79012258,CDM,278,RC,,,both,,,11996,4734.44,39.4668,,4734.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4078.64,34,,4078.64,percent of total billed charges,Implant Device,4078.64,34,,4078.64,percent of total billed charges,Implant Device,4078.64,34,,4078.64,percent of total billed charges,Implant Device,4078.64,34,,4078.64,percent of total billed charges,Implant Device,4078.64,34,,4078.64,percent of total billed charges,Implant Device,4078.64,34,,4078.64,percent of total billed charges,Implant Device,4198.6,35,,4198.6,percent of total billed charges,Implant Device,4078.64,34,"Charges > $500, x 34%",4078.64,percent of total billed charges,Implant Device,4198.6,35,,4198.6,percent of total billed charges,Implant Devices,4198.6,35,,4198.6,percent of total billed charges,Implant Devices,4198.6,35,,,percent of total billed charges,Implant Devices,4198.6,35,,4198.6,percent of total billed charges,Implant Devices,4198.6,35,,4198.6,percent of total billed charges,Implant Devices,4798.4,40,,4798.4,percent of total billed charges,Implant Devices,4198.6,70,,4198.6,percent of total billed charges,Implant Devices,4078.64,34,,4078.64,percent of total billed charges,Implant Devices,4078.64,34,,4078.64,percent of total billed charges,Implant Devices,4198.6,35,,4198.6,percent of total billed charges,Implant Devices,4198.6,35,,4198.6,percent of total billed charges,Implant Devices,4198.6,35,,4198.6,percent of total billed charges,Implant Devices,4198.6,35,,4198.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4078.64,34,"If Charge > 2,000, then 34 percent",4078.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4798.4,
ZIMMER 650-1163 CERAMIC HEAD 32MM TYPE 1,C1776,HCPCS,,79012259,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
ZIMMER 11-302102 TROCHANTERIC CLAW 100MM,C1776,HCPCS,,79012260,CDM,278,RC,,,both,,,2903,1145.72,39.4668,,1145.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,987.02,34,,987.02,percent of total billed charges,Implant Device,987.02,34,,987.02,percent of total billed charges,Implant Device,987.02,34,,987.02,percent of total billed charges,Implant Device,987.02,34,,987.02,percent of total billed charges,Implant Device,987.02,34,,987.02,percent of total billed charges,Implant Device,987.02,34,,987.02,percent of total billed charges,Implant Device,1016.05,35,,1016.05,percent of total billed charges,Implant Device,987.02,34,"Charges > $500, x 34%",987.02,percent of total billed charges,Implant Device,1016.05,35,,1016.05,percent of total billed charges,Implant Devices,1016.05,35,,1016.05,percent of total billed charges,Implant Devices,1016.05,35,,,percent of total billed charges,Implant Devices,1016.05,35,,1016.05,percent of total billed charges,Implant Devices,1016.05,35,,1016.05,percent of total billed charges,Implant Devices,1161.2,40,,1161.2,percent of total billed charges,Implant Devices,1016.05,70,,1016.05,percent of total billed charges,Implant Devices,987.02,34,,987.02,percent of total billed charges,Implant Devices,987.02,34,,987.02,percent of total billed charges,Implant Devices,1016.05,35,,1016.05,percent of total billed charges,Implant Devices,1016.05,35,,1016.05,percent of total billed charges,Implant Devices,1016.05,35,,1016.05,percent of total billed charges,Implant Devices,1016.05,35,,1016.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,987.02,34,"If Charge > 2,000, then 34 percent",987.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1161.2,
ZIMMER 00-5001-054-00 BIPOLAR SHELL 54MM,C1776,HCPCS,,79012262,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
ZIMMER 110010246 ACETABULAR SHELL 4H 56,C1776,HCPCS,,79012280,CDM,278,RC,,,both,,,8602,3394.93,39.4668,,3394.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Device,2924.68,34,"Charges > $500, x 34%",2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3440.8,40,,3440.8,percent of total billed charges,Implant Devices,3010.7,70,,3010.7,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2924.68,34,"If Charge > 2,000, then 34 percent",2924.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3440.8,
ZIMMER 574101050 FEMORAL STEM SIZE 5,C1776,HCPCS,,79012281,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 574101030 FEMORAL STEM SIZE 3,C1776,HCPCS,,79012289,CDM,278,RC,,,both,,,8573,3383.49,39.4668,,3383.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Device,2914.82,34,"Charges > $500, x 34%",2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3429.2,40,,3429.2,percent of total billed charges,Implant Devices,3000.55,70,,3000.55,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2914.82,34,"If Charge > 2,000, then 34 percent",2914.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3429.2,
ZIMMER 30103605 LINER 36MM SIZE E,C1776,HCPCS,,79012290,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 183012 FEMORAL RIGHT 70MM,C1776,HCPCS,,79012292,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 141234 TIBIAL PLATE 75MM,C1776,HCPCS,,79012293,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 184766 PATELLA 34X8.5MM,C1776,HCPCS,,79012294,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER VE189080 TIBIAL BEARING 75X10MM,C1776,HCPCS,,79012295,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
J&J 1516-50-707 TIBIAL INSERT SZ 7 7MM,C1776,HCPCS,,79012297,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
ZIMMER 42-5221-008-10 ART SURF RT 10MM,C1776,HCPCS,,79012314,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 110010247 ACETAB SHELL 4H SZ G 58,C1776,HCPCS,,79012383,CDM,278,RC,,,both,,,8602,3394.93,39.4668,,3394.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Device,2924.68,34,"Charges > $500, x 34%",2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3440.8,40,,3440.8,percent of total billed charges,Implant Devices,3010.7,70,,3010.7,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2924.68,34,"If Charge > 2,000, then 34 percent",2924.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3440.8,
ZIMMER 30103607 LINER SIZE 6 36MM,C1776,HCPCS,,79012384,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 574101065 FEMORAL STEM SIZE 6.5,C1776,HCPCS,,79012385,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 57401070 FEMORAL STEM SIZE 7,C1776,HCPCS,,79012386,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 574102040 FEMORAL STEM SIZE 4,C1776,HCPCS,,79012387,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 183032 FEMORAL LEFT 70MM,C1776,HCPCS,,79012399,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER EP-189040 TIBIAL BEARING 10X67MM,C1776,HCPCS,,79012400,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 141232 TIBIAL PLATE 67MM,C1776,HCPCS,,79012401,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 110010264 ACETABULAR SHELL 52MM,C1776,HCPCS,,79012402,CDM,278,RC,,,both,,,10383,4097.84,39.4668,,4097.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3530.22,34,,3530.22,percent of total billed charges,Implant Device,3530.22,34,,3530.22,percent of total billed charges,Implant Device,3530.22,34,,3530.22,percent of total billed charges,Implant Device,3530.22,34,,3530.22,percent of total billed charges,Implant Device,3530.22,34,,3530.22,percent of total billed charges,Implant Device,3530.22,34,,3530.22,percent of total billed charges,Implant Device,3634.05,35,,3634.05,percent of total billed charges,Implant Device,3530.22,34,"Charges > $500, x 34%",3530.22,percent of total billed charges,Implant Device,3634.05,35,,3634.05,percent of total billed charges,Implant Devices,3634.05,35,,3634.05,percent of total billed charges,Implant Devices,3634.05,35,,,percent of total billed charges,Implant Devices,3634.05,35,,3634.05,percent of total billed charges,Implant Devices,3634.05,35,,3634.05,percent of total billed charges,Implant Devices,4153.2,40,,4153.2,percent of total billed charges,Implant Devices,3634.05,70,,3634.05,percent of total billed charges,Implant Devices,3530.22,34,,3530.22,percent of total billed charges,Implant Devices,3530.22,34,,3530.22,percent of total billed charges,Implant Devices,3634.05,35,,3634.05,percent of total billed charges,Implant Devices,3634.05,35,,3634.05,percent of total billed charges,Implant Devices,3634.05,35,,3634.05,percent of total billed charges,Implant Devices,3634.05,35,,3634.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3530.22,34,"If Charge > 2,000, then 34 percent",3530.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4153.2,
WRIGHT 496H020 EVOLVE HEAD 20MM,C1776,HCPCS,,79012417,CDM,278,RC,,,both,,,10086,3980.62,39.4668,,3980.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3429.24,34,,3429.24,percent of total billed charges,Implant Device,3429.24,34,,3429.24,percent of total billed charges,Implant Device,3429.24,34,,3429.24,percent of total billed charges,Implant Device,3429.24,34,,3429.24,percent of total billed charges,Implant Device,3429.24,34,,3429.24,percent of total billed charges,Implant Device,3429.24,34,,3429.24,percent of total billed charges,Implant Device,3530.1,35,,3530.1,percent of total billed charges,Implant Device,3429.24,34,"Charges > $500, x 34%",3429.24,percent of total billed charges,Implant Device,3530.1,35,,3530.1,percent of total billed charges,Implant Devices,3530.1,35,,3530.1,percent of total billed charges,Implant Devices,3530.1,35,,,percent of total billed charges,Implant Devices,3530.1,35,,3530.1,percent of total billed charges,Implant Devices,3530.1,35,,3530.1,percent of total billed charges,Implant Devices,4034.4,40,,4034.4,percent of total billed charges,Implant Devices,3530.1,70,,3530.1,percent of total billed charges,Implant Devices,3429.24,34,,3429.24,percent of total billed charges,Implant Devices,3429.24,34,,3429.24,percent of total billed charges,Implant Devices,3530.1,35,,3530.1,percent of total billed charges,Implant Devices,3530.1,35,,3530.1,percent of total billed charges,Implant Devices,3530.1,35,,3530.1,percent of total billed charges,Implant Devices,3530.1,35,,3530.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3429.24,34,"If Charge > 2,000, then 34 percent",3429.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4034.4,
WRIGHT 496S085 EVOLVE STEM 8.5MM,C1776,HCPCS,,79012418,CDM,278,RC,,,both,,,11985,4730.1,39.4668,,4730.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4074.9,34,,4074.9,percent of total billed charges,Implant Device,4074.9,34,,4074.9,percent of total billed charges,Implant Device,4074.9,34,,4074.9,percent of total billed charges,Implant Device,4074.9,34,,4074.9,percent of total billed charges,Implant Device,4074.9,34,,4074.9,percent of total billed charges,Implant Device,4074.9,34,,4074.9,percent of total billed charges,Implant Device,4194.75,35,,4194.75,percent of total billed charges,Implant Device,4074.9,34,"Charges > $500, x 34%",4074.9,percent of total billed charges,Implant Device,4194.75,35,,4194.75,percent of total billed charges,Implant Devices,4194.75,35,,4194.75,percent of total billed charges,Implant Devices,4194.75,35,,,percent of total billed charges,Implant Devices,4194.75,35,,4194.75,percent of total billed charges,Implant Devices,4194.75,35,,4194.75,percent of total billed charges,Implant Devices,4794,40,,4794,percent of total billed charges,Implant Devices,4194.75,70,,4194.75,percent of total billed charges,Implant Devices,4074.9,34,,4074.9,percent of total billed charges,Implant Devices,4074.9,34,,4074.9,percent of total billed charges,Implant Devices,4194.75,35,,4194.75,percent of total billed charges,Implant Devices,4194.75,35,,4194.75,percent of total billed charges,Implant Devices,4194.75,35,,4194.75,percent of total billed charges,Implant Devices,4194.75,35,,4194.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4074.9,34,"If Charge > 2,000, then 34 percent",4074.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4794,
ZIMMER 183024 FEMORAL LEFT 60MM,C1776,HCPCS,,79012437,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER VE189044 TIBIAL BEARING 67X14MM,C1776,HCPCS,,79012438,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
STRYKER 0030721 HUMERAL STEM LRG LT 83MM,C1776,HCPCS,,79012439,CDM,278,RC,,,both,,,28299,11168.71,39.4668,,11168.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,9621.66,34,,9621.66,percent of total billed charges,Implant Device,9621.66,34,,9621.66,percent of total billed charges,Implant Device,9621.66,34,,9621.66,percent of total billed charges,Implant Device,9621.66,34,,9621.66,percent of total billed charges,Implant Device,9621.66,34,,9621.66,percent of total billed charges,Implant Device,9621.66,34,,9621.66,percent of total billed charges,Implant Device,9904.65,35,,9904.65,percent of total billed charges,Implant Device,9621.66,34,"Charges > $500, x 34%",9621.66,percent of total billed charges,Implant Device,9904.65,35,,9904.65,percent of total billed charges,Implant Devices,9904.65,35,,9904.65,percent of total billed charges,Implant Devices,9904.65,35,,,percent of total billed charges,Implant Devices,9904.65,35,,9904.65,percent of total billed charges,Implant Devices,9904.65,35,,9904.65,percent of total billed charges,Implant Devices,11319.6,40,,11319.6,percent of total billed charges,Implant Devices,9904.65,70,,9904.65,percent of total billed charges,Implant Devices,9621.66,34,,9621.66,percent of total billed charges,Implant Devices,9621.66,34,,9621.66,percent of total billed charges,Implant Devices,9904.65,35,,9904.65,percent of total billed charges,Implant Devices,9904.65,35,,9904.65,percent of total billed charges,Implant Devices,9904.65,35,,9904.65,percent of total billed charges,Implant Devices,9904.65,35,,9904.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,9621.66,34,"If Charge > 2,000, then 34 percent",9621.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11319.6,
STRYKER DKY216 HUMERAL SPOOL LARGE LEFT,C1776,HCPCS,,79012441,CDM,278,RC,,,both,,,14151,5584.95,39.4668,,5584.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4811.34,34,,4811.34,percent of total billed charges,Implant Device,4811.34,34,,4811.34,percent of total billed charges,Implant Device,4811.34,34,,4811.34,percent of total billed charges,Implant Device,4811.34,34,,4811.34,percent of total billed charges,Implant Device,4811.34,34,,4811.34,percent of total billed charges,Implant Device,4811.34,34,,4811.34,percent of total billed charges,Implant Device,4952.85,35,,4952.85,percent of total billed charges,Implant Device,4811.34,34,"Charges > $500, x 34%",4811.34,percent of total billed charges,Implant Device,4952.85,35,,4952.85,percent of total billed charges,Implant Devices,4952.85,35,,4952.85,percent of total billed charges,Implant Devices,4952.85,35,,,percent of total billed charges,Implant Devices,4952.85,35,,4952.85,percent of total billed charges,Implant Devices,4952.85,35,,4952.85,percent of total billed charges,Implant Devices,5660.4,40,,5660.4,percent of total billed charges,Implant Devices,4952.85,70,,4952.85,percent of total billed charges,Implant Devices,4811.34,34,,4811.34,percent of total billed charges,Implant Devices,4811.34,34,,4811.34,percent of total billed charges,Implant Devices,4952.85,35,,4952.85,percent of total billed charges,Implant Devices,4952.85,35,,4952.85,percent of total billed charges,Implant Devices,4952.85,35,,4952.85,percent of total billed charges,Implant Devices,4952.85,35,,4952.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4811.34,34,"If Charge > 2,000, then 34 percent",4811.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5660.4,
STRYKER EBO101 CEMENT RESTRICTOR 24MM,C1776,HCPCS,,79012443,CDM,278,RC,,,both,,,1221,481.89,39.4668,,481.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,415.14,34,,415.14,percent of total billed charges,Implant Device,415.14,34,,415.14,percent of total billed charges,Implant Device,415.14,34,,415.14,percent of total billed charges,Implant Device,415.14,34,,415.14,percent of total billed charges,Implant Device,415.14,34,,415.14,percent of total billed charges,Implant Device,415.14,34,,415.14,percent of total billed charges,Implant Device,427.35,35,,427.35,percent of total billed charges,Implant Device,415.14,34,"Charges > $500, x 34%",415.14,percent of total billed charges,Implant Device,427.35,35,,427.35,percent of total billed charges,Implant Devices,427.35,35,,427.35,percent of total billed charges,Implant Devices,427.35,35,,,percent of total billed charges,Implant Devices,427.35,35,,427.35,percent of total billed charges,Implant Devices,427.35,35,,427.35,percent of total billed charges,Implant Devices,488.4,40,,488.4,percent of total billed charges,Implant Devices,427.35,70,,427.35,percent of total billed charges,Implant Devices,415.14,34,,415.14,percent of total billed charges,Implant Devices,415.14,34,,415.14,percent of total billed charges,Implant Devices,427.35,35,,427.35,percent of total billed charges,Implant Devices,427.35,35,,427.35,percent of total billed charges,Implant Devices,427.35,35,,427.35,percent of total billed charges,Implant Devices,427.35,35,,427.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,488.4,
ZIMMER 42-5020-064-02 FEMUR RIGHT SIZE 8,C1776,HCPCS,,79012444,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 42-5121-007-11 ARTI SURF LT 11MM,C1776,HCPCS,,79012445,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5020-062-01 FEMUR LEFT SIZE 7,C1776,HCPCS,,79012446,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
J&J 09.405.960S RADIAL HEAD 19X6.5X9MM,C1776,HCPCS,,79012454,CDM,278,RC,,,both,,,10092,3982.99,39.4668,,3982.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3431.28,34,,3431.28,percent of total billed charges,Implant Device,3431.28,34,,3431.28,percent of total billed charges,Implant Device,3431.28,34,,3431.28,percent of total billed charges,Implant Device,3431.28,34,,3431.28,percent of total billed charges,Implant Device,3431.28,34,,3431.28,percent of total billed charges,Implant Device,3431.28,34,,3431.28,percent of total billed charges,Implant Device,3532.2,35,,3532.2,percent of total billed charges,Implant Device,3431.28,34,"Charges > $500, x 34%",3431.28,percent of total billed charges,Implant Device,3532.2,35,,3532.2,percent of total billed charges,Implant Devices,3532.2,35,,3532.2,percent of total billed charges,Implant Devices,3532.2,35,,,percent of total billed charges,Implant Devices,3532.2,35,,3532.2,percent of total billed charges,Implant Devices,3532.2,35,,3532.2,percent of total billed charges,Implant Devices,4036.8,40,,4036.8,percent of total billed charges,Implant Devices,3532.2,70,,3532.2,percent of total billed charges,Implant Devices,3431.28,34,,3431.28,percent of total billed charges,Implant Devices,3431.28,34,,3431.28,percent of total billed charges,Implant Devices,3532.2,35,,3532.2,percent of total billed charges,Implant Devices,3532.2,35,,3532.2,percent of total billed charges,Implant Devices,3532.2,35,,3532.2,percent of total billed charges,Implant Devices,3532.2,35,,3532.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3431.28,34,"If Charge > 2,000, then 34 percent",3431.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4036.8,
J&J 03.405.000S RADIAL HEAD INSTRU KIT,C1776,HCPCS,,79012455,CDM,278,RC,,,both,,,1062,419.14,39.4668,,419.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,361.08,34,,361.08,percent of total billed charges,Implant Device,361.08,34,,361.08,percent of total billed charges,Implant Device,361.08,34,,361.08,percent of total billed charges,Implant Device,361.08,34,,361.08,percent of total billed charges,Implant Device,361.08,34,,361.08,percent of total billed charges,Implant Device,361.08,34,,361.08,percent of total billed charges,Implant Device,371.7,35,,371.7,percent of total billed charges,Implant Device,361.08,34,"Charges > $500, x 34%",361.08,percent of total billed charges,Implant Device,371.7,35,,371.7,percent of total billed charges,Implant Devices,371.7,35,,371.7,percent of total billed charges,Implant Devices,371.7,35,,,percent of total billed charges,Implant Devices,371.7,35,,371.7,percent of total billed charges,Implant Devices,371.7,35,,371.7,percent of total billed charges,Implant Devices,424.8,40,,424.8,percent of total billed charges,Implant Devices,371.7,70,,371.7,percent of total billed charges,Implant Devices,361.08,34,,361.08,percent of total billed charges,Implant Devices,361.08,34,,361.08,percent of total billed charges,Implant Devices,371.7,35,,371.7,percent of total billed charges,Implant Devices,371.7,35,,371.7,percent of total billed charges,Implant Devices,371.7,35,,371.7,percent of total billed charges,Implant Devices,371.7,35,,371.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,424.8,
ZIMMER 183034 FEMORAL LEFT 75MM,C1776,HCPCS,,79012464,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER VE189120 TIBIAL BEARING 83X10MM,C1776,HCPCS,,79012466,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
DJO 508-32-103 GLENOID HEAD W/ RETAIN SR,C1776,HCPCS,,79012468,CDM,278,RC,,,both,,,4440,1752.33,39.4668,,1752.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1509.6,34,,1509.6,percent of total billed charges,Implant Device,1554,35,,1554,percent of total billed charges,Implant Device,1509.6,34,"Charges > $500, x 34%",1509.6,percent of total billed charges,Implant Device,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1776,40,,1776,percent of total billed charges,Implant Devices,1554,70,,1554,percent of total billed charges,Implant Devices,1509.6,34,,1509.6,percent of total billed charges,Implant Devices,1509.6,34,,1509.6,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,1554,35,,1554,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1509.6,34,"If Charge > 2,000, then 34 percent",1509.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1776,
DJO 509-02-032 SMALL SOCKET INSERT 32MM,C1776,HCPCS,,79012469,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
DJO 533-08-108 HUMERAL STEM 8X108MM,C1776,HCPCS,,79012470,CDM,278,RC,,,both,,,14400,5683.22,39.4668,,5683.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Device,4896,34,"Charges > $500, x 34%",4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5760,40,,5760,percent of total billed charges,Implant Devices,5040,70,,5040,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4896,34,"If Charge > 2,000, then 34 percent",4896,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5760,
ZIMMER 42-5221-004-14 ART SURF RT 14MM,C1776,HCPCS,,79012476,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 184768 PATELLA 37X10MM,C1776,HCPCS,,79012486,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER VE189060 TIBIAL BEARING 71X10MM,C1776,HCPCS,,79012487,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 183033 FEMORAL LEFT 72.5MM,C1776,HCPCS,,79012488,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 00-5966-015-01 FEM COMP LT SZ E,C1776,HCPCS,,79012489,CDM,278,RC,,,both,,,4608,1818.63,39.4668,,1818.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1566.72,34,,1566.72,percent of total billed charges,Implant Device,1612.8,35,,1612.8,percent of total billed charges,Implant Device,1566.72,34,"Charges > $500, x 34%",1566.72,percent of total billed charges,Implant Device,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1843.2,40,,1843.2,percent of total billed charges,Implant Devices,1612.8,70,,1612.8,percent of total billed charges,Implant Devices,1566.72,34,,1566.72,percent of total billed charges,Implant Devices,1566.72,34,,1566.72,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,1612.8,35,,1612.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1566.72,34,"If Charge > 2,000, then 34 percent",1566.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1843.2,
ZIMMER 00-5966-005-14 TIBIAL COMP 14MM,C1776,HCPCS,,79012490,CDM,278,RC,,,both,,,2673,1054.95,39.4668,,1054.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,908.82,34,,908.82,percent of total billed charges,Implant Device,908.82,34,,908.82,percent of total billed charges,Implant Device,908.82,34,,908.82,percent of total billed charges,Implant Device,908.82,34,,908.82,percent of total billed charges,Implant Device,908.82,34,,908.82,percent of total billed charges,Implant Device,908.82,34,,908.82,percent of total billed charges,Implant Device,935.55,35,,935.55,percent of total billed charges,Implant Device,908.82,34,"Charges > $500, x 34%",908.82,percent of total billed charges,Implant Device,935.55,35,,935.55,percent of total billed charges,Implant Devices,935.55,35,,935.55,percent of total billed charges,Implant Devices,935.55,35,,,percent of total billed charges,Implant Devices,935.55,35,,935.55,percent of total billed charges,Implant Devices,935.55,35,,935.55,percent of total billed charges,Implant Devices,1069.2,40,,1069.2,percent of total billed charges,Implant Devices,935.55,70,,935.55,percent of total billed charges,Implant Devices,908.82,34,,908.82,percent of total billed charges,Implant Devices,908.82,34,,908.82,percent of total billed charges,Implant Devices,935.55,35,,935.55,percent of total billed charges,Implant Devices,935.55,35,,935.55,percent of total billed charges,Implant Devices,935.55,35,,935.55,percent of total billed charges,Implant Devices,935.55,35,,935.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,908.82,34,"If Charge > 2,000, then 34 percent",908.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1069.2,
ZIMMER 183002 FEMORAL RIGHT 57.5MM,C1776,HCPCS,,79012494,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 141231 TIBIAL PLATE 63MM,C1776,HCPCS,,79012495,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER VE189020 TIBIAL BEARING 63X10MM,C1776,HCPCS,,79012496,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 184762 PATELLA 28X8MM,C1776,HCPCS,,79012497,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
J&J 1504-11-226 FEMORAL COMP RT SZ 6,C1776,HCPCS,,79012499,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1516-50-606 TIBIAL INSERT 6MM SZ 6,C1776,HCPCS,,79012500,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
EXACTECH SPC0123 TAPERED WEDGE 54 SHORT,C1776,HCPCS,,79012522,CDM,278,RC,,,both,,,10085,3980.23,39.4668,,3980.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3428.9,34,,3428.9,percent of total billed charges,Implant Device,3428.9,34,,3428.9,percent of total billed charges,Implant Device,3428.9,34,,3428.9,percent of total billed charges,Implant Device,3428.9,34,,3428.9,percent of total billed charges,Implant Device,3428.9,34,,3428.9,percent of total billed charges,Implant Device,3428.9,34,,3428.9,percent of total billed charges,Implant Device,3529.75,35,,3529.75,percent of total billed charges,Implant Device,3428.9,34,"Charges > $500, x 34%",3428.9,percent of total billed charges,Implant Device,3529.75,35,,3529.75,percent of total billed charges,Implant Devices,3529.75,35,,3529.75,percent of total billed charges,Implant Devices,3529.75,35,,,percent of total billed charges,Implant Devices,3529.75,35,,3529.75,percent of total billed charges,Implant Devices,3529.75,35,,3529.75,percent of total billed charges,Implant Devices,4034,40,,4034,percent of total billed charges,Implant Devices,3529.75,70,,3529.75,percent of total billed charges,Implant Devices,3428.9,34,,3428.9,percent of total billed charges,Implant Devices,3428.9,34,,3428.9,percent of total billed charges,Implant Devices,3529.75,35,,3529.75,percent of total billed charges,Implant Devices,3529.75,35,,3529.75,percent of total billed charges,Implant Devices,3529.75,35,,3529.75,percent of total billed charges,Implant Devices,3529.75,35,,3529.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3428.9,34,"If Charge > 2,000, then 34 percent",3428.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4034,
ZIMMER 42-5121-009-10 ARTIC SURF LT 10MM,C1776,HCPCS,,79012523,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
ZIMMER 574101075 FEMORAL STEM SIZE 7.5,C1776,HCPCS,,79012524,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 42-5221-007-10 ART SURFACE RT 10,C1776,HCPCS,,79012530,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
J&J 1504-11-107 FEMORAL COMP SZ 7 LT,C1776,HCPCS,,79012531,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1506-60-007 TIBIAL BASE SIZE 7,C1776,HCPCS,,79012535,CDM,278,RC,,,both,,,12965,5116.87,39.4668,,5116.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4408.1,34,,4408.1,percent of total billed charges,Implant Device,4408.1,34,,4408.1,percent of total billed charges,Implant Device,4408.1,34,,4408.1,percent of total billed charges,Implant Device,4408.1,34,,4408.1,percent of total billed charges,Implant Device,4408.1,34,,4408.1,percent of total billed charges,Implant Device,4408.1,34,,4408.1,percent of total billed charges,Implant Device,4537.75,35,,4537.75,percent of total billed charges,Implant Device,4408.1,34,"Charges > $500, x 34%",4408.1,percent of total billed charges,Implant Device,4537.75,35,,4537.75,percent of total billed charges,Implant Devices,4537.75,35,,4537.75,percent of total billed charges,Implant Devices,4537.75,35,,,percent of total billed charges,Implant Devices,4537.75,35,,4537.75,percent of total billed charges,Implant Devices,4537.75,35,,4537.75,percent of total billed charges,Implant Devices,5186,40,,5186,percent of total billed charges,Implant Devices,4537.75,70,,4537.75,percent of total billed charges,Implant Devices,4408.1,34,,4408.1,percent of total billed charges,Implant Devices,4408.1,34,,4408.1,percent of total billed charges,Implant Devices,4537.75,35,,4537.75,percent of total billed charges,Implant Devices,4537.75,35,,4537.75,percent of total billed charges,Implant Devices,4537.75,35,,4537.75,percent of total billed charges,Implant Devices,4537.75,35,,4537.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4408.1,34,"If Charge > 2,000, then 34 percent",4408.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5186,
DJO 412-02-050 BIPOLAR MODULAR 50X28MM,C1776,HCPCS,,79012537,CDM,278,RC,,,both,,,1150,453.87,39.4668,,453.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391,34,,391,percent of total billed charges,Implant Device,391,34,,391,percent of total billed charges,Implant Device,391,34,,391,percent of total billed charges,Implant Device,391,34,,391,percent of total billed charges,Implant Device,391,34,,391,percent of total billed charges,Implant Device,391,34,,391,percent of total billed charges,Implant Device,402.5,35,,402.5,percent of total billed charges,Implant Device,391,34,"Charges > $500, x 34%",391,percent of total billed charges,Implant Device,402.5,35,,402.5,percent of total billed charges,Implant Devices,402.5,35,,402.5,percent of total billed charges,Implant Devices,402.5,35,,,percent of total billed charges,Implant Devices,402.5,35,,402.5,percent of total billed charges,Implant Devices,402.5,35,,402.5,percent of total billed charges,Implant Devices,460,40,,460,percent of total billed charges,Implant Devices,402.5,70,,402.5,percent of total billed charges,Implant Devices,391,34,,391,percent of total billed charges,Implant Devices,391,34,,391,percent of total billed charges,Implant Devices,402.5,35,,402.5,percent of total billed charges,Implant Devices,402.5,35,,402.5,percent of total billed charges,Implant Devices,402.5,35,,402.5,percent of total billed charges,Implant Devices,402.5,35,,402.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460,
J&J 1504-11-126 FEMORAL COMP SIZE 6,C1776,HCPCS,,79012541,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1518-20-032 PATELLA 32MM,C1776,HCPCS,,79012542,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
ZIMMER 183030 FEMORAL LEFT 67.5MM,C1776,HCPCS,,79012547,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
DJO 412-02-045 BIPOLAR MODULAR 45X28MM,C1776,HCPCS,,79012568,CDM,278,RC,,,both,,,1380,544.64,39.4668,,544.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,469.2,34,,469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Device,469.2,34,"Charges > $500, x 34%",469.2,percent of total billed charges,Implant Device,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,552,40,,552,percent of total billed charges,Implant Devices,483,70,,483,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,469.2,34,,469.2,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,483,35,,483,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552,
ZIMMER 574101010 FEMORAL STEM SIZE 1,C1776,HCPCS,,79012591,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 110010243 ACETABULAR SHELL 50MM,C1776,HCPCS,,79012592,CDM,278,RC,,,both,,,8602,3394.93,39.4668,,3394.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,2924.68,34,,2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Device,2924.68,34,"Charges > $500, x 34%",2924.68,percent of total billed charges,Implant Device,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3440.8,40,,3440.8,percent of total billed charges,Implant Devices,3010.7,70,,3010.7,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,2924.68,34,,2924.68,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,3010.7,35,,3010.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2924.68,34,"If Charge > 2,000, then 34 percent",2924.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3440.8,
ZIMMER 30123604 LINER SIZE 3 36MM,C1776,HCPCS,,79012593,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 42-5026-068-01 FEMUR LEFT SIZE 10,C1776,HCPCS,,79012601,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
ZIMMER 42-5221-007-16 ART SURF RT 16MM,C1776,HCPCS,,79012602,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 574203050 FEMORAL STEM SIZE 5,C1776,HCPCS,,79012603,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
J&J 1506-11-004 TIBIAL BASEPLATE SZ 4,C1776,HCPCS,,79012606,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
J&J 1504-10-106 FEMORAL COMP LT SZ 6,C1776,HCPCS,,79012607,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
ZIMMER 574102060 FEMORAL STEM SIZE 6.5,C1776,HCPCS,,79012629,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 183022 FEMORAL LEFT 57.5MM,C1776,HCPCS,,79012630,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER EP-189044 TIBIAL BEARING 14X67MM,C1776,HCPCS,,79012634,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 183013 FEMORAL RIGHT 72.5MM,C1776,HCPCS,,79012653,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
STRYKER 723-00-36D TRIDENT INSERT 36MM,C1776,HCPCS,,79012658,CDM,278,RC,,,both,,,2503,987.85,39.4668,,987.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,851.02,34,,851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Device,851.02,34,"Charges > $500, x 34%",851.02,percent of total billed charges,Implant Device,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,1001.2,40,,1001.2,percent of total billed charges,Implant Devices,876.05,70,,876.05,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,851.02,34,,851.02,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,876.05,35,,876.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,851.02,34,"If Charge > 2,000, then 34 percent",851.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1001.2,
STRYKER UH1-46-28 BIPOLAR COMP 28X+0MM,C1776,HCPCS,,79012675,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
ZIMMER EP-189060 TIBIAL BEARING 10X71MM,C1776,HCPCS,,79012683,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5221-007-14 ART SURF 14MM,C1776,HCPCS,,79012686,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5221-004-10 ART SURF 10MM,C1776,HCPCS,,79012687,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5020-060-02 FEMUR RIGHT SIZE 6,C1776,HCPCS,,79012688,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 42-5121-003-12 ART SURF LT 12MM,C1776,HCPCS,,79012690,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5026-058-01 FEMUR LEFT SIZE 5,C1776,HCPCS,,79012691,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
ZIMMER 42-5320-067-01 TIBIA 5DEG LT SZ D,C1776,HCPCS,,79012692,CDM,278,RC,,,both,,,4433,1749.56,39.4668,,1749.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Device,1507.22,34,"Charges > $500, x 34%",1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1773.2,40,,1773.2,percent of total billed charges,Implant Devices,1551.55,70,,1551.55,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1507.22,34,"If Charge > 2,000, then 34 percent",1507.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1773.2,
ZIMMER 189082 TIBIAL BEARING 12X75MM,C1776,HCPCS,,79012693,CDM,278,RC,,,both,,,1920,757.76,39.4668,,757.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,652.8,34,,652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Device,652.8,34,"Charges > $500, x 34%",652.8,percent of total billed charges,Implant Device,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,768,40,,768,percent of total billed charges,Implant Devices,672,70,,672,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,652.8,34,,652.8,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,672,35,,672,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,768,
ZIMMER 42-5026-056-02 FEMUR RIGHT SZ 4,C1776,HCPCS,,79012694,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 42-5221-003-10 ART SURF RT 10MM,C1776,HCPCS,,79012695,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
STRYKER 6495-1-002 PROXIMAL FEM COMP V40,C1776,HCPCS,,79012731,CDM,278,RC,,,both,,,12998,5129.89,39.4668,,5129.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4419.32,34,,4419.32,percent of total billed charges,Implant Device,4419.32,34,,4419.32,percent of total billed charges,Implant Device,4419.32,34,,4419.32,percent of total billed charges,Implant Device,4419.32,34,,4419.32,percent of total billed charges,Implant Device,4419.32,34,,4419.32,percent of total billed charges,Implant Device,4419.32,34,,4419.32,percent of total billed charges,Implant Device,4549.3,35,,4549.3,percent of total billed charges,Implant Device,4419.32,34,"Charges > $500, x 34%",4419.32,percent of total billed charges,Implant Device,4549.3,35,,4549.3,percent of total billed charges,Implant Devices,4549.3,35,,4549.3,percent of total billed charges,Implant Devices,4549.3,35,,,percent of total billed charges,Implant Devices,4549.3,35,,4549.3,percent of total billed charges,Implant Devices,4549.3,35,,4549.3,percent of total billed charges,Implant Devices,5199.2,40,,5199.2,percent of total billed charges,Implant Devices,4549.3,70,,4549.3,percent of total billed charges,Implant Devices,4419.32,34,,4419.32,percent of total billed charges,Implant Devices,4419.32,34,,4419.32,percent of total billed charges,Implant Devices,4549.3,35,,4549.3,percent of total billed charges,Implant Devices,4549.3,35,,4549.3,percent of total billed charges,Implant Devices,4549.3,35,,4549.3,percent of total billed charges,Implant Devices,4549.3,35,,4549.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4419.32,34,"If Charge > 2,000, then 34 percent",4419.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5199.2,
STRYKER UH1-48-26 BIPOLAR COMP 48X26MM,C1776,HCPCS,,79012732,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 6485-3-713 FEMORAL STEM 13X127MM,C1776,HCPCS,,79012733,CDM,278,RC,,,both,,,10014,3952.21,39.4668,,3952.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3404.76,34,,3404.76,percent of total billed charges,Implant Device,3504.9,35,,3504.9,percent of total billed charges,Implant Device,3404.76,34,"Charges > $500, x 34%",3404.76,percent of total billed charges,Implant Device,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,4005.6,40,,4005.6,percent of total billed charges,Implant Devices,3504.9,70,,3504.9,percent of total billed charges,Implant Devices,3404.76,34,,3404.76,percent of total billed charges,Implant Devices,3404.76,34,,3404.76,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,3504.9,35,,3504.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3404.76,34,"If Charge > 2,000, then 34 percent",3404.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4005.6,
J&J 1516-50-710 TIBAL INSERT SZ 7 10MM,C1776,HCPCS,,79012738,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
ZIMMER 650-0662 CERAMIC HEAD 36MM +3,C1776,HCPCS,,79012751,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
STRYKER 5552-E-4017 HUMERAL HEAD 40X17,C1776,HCPCS,,79012752,CDM,278,RC,,,both,,,3675,1450.4,39.4668,,1450.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Device,1249.5,34,"Charges > $500, x 34%",1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1470,40,,1470,percent of total billed charges,Implant Devices,1286.25,70,,1286.25,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.5,34,"If Charge > 2,000, then 34 percent",1249.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470,
ZIMMER VE189046 TIBIAL BEARING 67X16MM,C1776,HCPCS,,79012755,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 110027734 COMPREHEN VRS GLENOID,C1776,HCPCS,,79012779,CDM,278,RC,,,both,,,38815,15319.04,39.4668,,15319.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,13197.1,34,,13197.1,percent of total billed charges,Implant Device,13197.1,34,,13197.1,percent of total billed charges,Implant Device,13197.1,34,,13197.1,percent of total billed charges,Implant Device,13197.1,34,,13197.1,percent of total billed charges,Implant Device,13197.1,34,,13197.1,percent of total billed charges,Implant Device,13197.1,34,,13197.1,percent of total billed charges,Implant Device,13585.25,35,,13585.25,percent of total billed charges,Implant Device,13197.1,34,"Charges > $500, x 34%",13197.1,percent of total billed charges,Implant Device,13585.25,35,,13585.25,percent of total billed charges,Implant Devices,13585.25,35,,13585.25,percent of total billed charges,Implant Devices,13585.25,35,,,percent of total billed charges,Implant Devices,13585.25,35,,13585.25,percent of total billed charges,Implant Devices,13585.25,35,,13585.25,percent of total billed charges,Implant Devices,15526,40,,15526,percent of total billed charges,Implant Devices,13585.25,70,,13585.25,percent of total billed charges,Implant Devices,13197.1,34,,13197.1,percent of total billed charges,Implant Devices,13197.1,34,,13197.1,percent of total billed charges,Implant Devices,13585.25,35,,13585.25,percent of total billed charges,Implant Devices,13585.25,35,,13585.25,percent of total billed charges,Implant Devices,13585.25,35,,13585.25,percent of total billed charges,Implant Devices,13585.25,35,,13585.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,13197.1,34,"If Charge > 2,000, then 34 percent",13197.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,15526,
ZIMMER 141235 TIBIAL PLATE 79MM,C1776,HCPCS,,79012782,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER VE189100 TIBIAL BEARING 79X10MM,C1776,HCPCS,,79012783,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
"J&J 09.405.563S RADIAL HEAD 25, 6.5 STEM",C1776,HCPCS,,79012785,CDM,278,RC,,,both,,,9560,3773.03,39.4668,,3773.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3346,35,,3346,percent of total billed charges,Implant Device,3250.4,34,"Charges > $500, x 34%",3250.4,percent of total billed charges,Implant Device,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3824,40,,3824,percent of total billed charges,Implant Devices,3346,70,,3346,percent of total billed charges,Implant Devices,3250.4,34,,3250.4,percent of total billed charges,Implant Devices,3250.4,34,,3250.4,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3250.4,34,"If Charge > 2,000, then 34 percent",3250.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3824,
J&J 1024-56-407 TIBIAL INSERT 7MM SZ 4,C1776,HCPCS,,79012788,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
J&J 1504-11-205 FEMORAL COMP RT SZ 5,C1776,HCPCS,,79012789,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
ZIMMER 42-5026-060-02 FEMUR RT SZ 6,C1776,HCPCS,,79012790,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
EXACTECH 306-02-12 HUM LONG STEM 12X20,C1776,HCPCS,,79012791,CDM,278,RC,,,both,,,12672,5001.23,39.4668,,5001.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4308.48,34,,4308.48,percent of total billed charges,Implant Device,4435.2,35,,4435.2,percent of total billed charges,Implant Device,4308.48,34,"Charges > $500, x 34%",4308.48,percent of total billed charges,Implant Device,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,5068.8,40,,5068.8,percent of total billed charges,Implant Devices,4435.2,70,,4435.2,percent of total billed charges,Implant Devices,4308.48,34,,4308.48,percent of total billed charges,Implant Devices,4308.48,34,,4308.48,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,4435.2,35,,4435.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4308.48,34,"If Charge > 2,000, then 34 percent",4308.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5068.8,
EXACTECH 320-00-12 LAT RT HUMERAL TRAY,C1776,HCPCS,,79012792,CDM,278,RC,,,both,,,13500,5328.02,39.4668,,5328.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Device,4590,34,"Charges > $500, x 34%",4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,5400,40,,5400,percent of total billed charges,Implant Devices,4725,70,,4725,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4590,34,"If Charge > 2,000, then 34 percent",4590,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5400,
ZMMER 574101060 FEMORAL STEM SZ 6.5,C1776,HCPCS,,79012799,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 183010 FEMORAL RIGHT 67.5MM,C1776,HCPCS,,79012809,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER EP-189082 TIBIAL BEARING 12X75MM,C1776,HCPCS,,79012810,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
J&J 09.405.260S RADIAL HEAD 22X6.5MM,C1776,HCPCS,,79012814,CDM,278,RC,,,both,,,10622,4192.16,39.4668,,4192.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3717.7,35,,3717.7,percent of total billed charges,Implant Device,3611.48,34,"Charges > $500, x 34%",3611.48,percent of total billed charges,Implant Device,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,4248.8,40,,4248.8,percent of total billed charges,Implant Devices,3717.7,70,,3717.7,percent of total billed charges,Implant Devices,3611.48,34,,3611.48,percent of total billed charges,Implant Devices,3611.48,34,,3611.48,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3611.48,34,"If Charge > 2,000, then 34 percent",3611.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4248.8,
ZIMMER 00-8852-012-32 RIM LINER 32 SZ KK,C1776,HCPCS,,79012815,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER VE189108 TIBIAL BEARING 79X18MM,C1776,HCPCS,,79012816,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
J&J 1504-11-109 FEMORAL COMP LT SZ 9,C1776,HCPCS,,79012819,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
STRYKER 6720-0127 HIP STEM SZ 1 27X96MM,C1776,HCPCS,,79012820,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
ZIMMER TI-115310 GLENOSPHERE 36MM,C1776,HCPCS,,79012823,CDM,278,RC,,,both,,,5261,2076.35,39.4668,,2076.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1788.74,34,,1788.74,percent of total billed charges,Implant Device,1788.74,34,,1788.74,percent of total billed charges,Implant Device,1788.74,34,,1788.74,percent of total billed charges,Implant Device,1788.74,34,,1788.74,percent of total billed charges,Implant Device,1788.74,34,,1788.74,percent of total billed charges,Implant Device,1788.74,34,,1788.74,percent of total billed charges,Implant Device,1841.35,35,,1841.35,percent of total billed charges,Implant Device,1788.74,34,"Charges > $500, x 34%",1788.74,percent of total billed charges,Implant Device,1841.35,35,,1841.35,percent of total billed charges,Implant Devices,1841.35,35,,1841.35,percent of total billed charges,Implant Devices,1841.35,35,,,percent of total billed charges,Implant Devices,1841.35,35,,1841.35,percent of total billed charges,Implant Devices,1841.35,35,,1841.35,percent of total billed charges,Implant Devices,2104.4,40,,2104.4,percent of total billed charges,Implant Devices,1841.35,70,,1841.35,percent of total billed charges,Implant Devices,1788.74,34,,1788.74,percent of total billed charges,Implant Devices,1788.74,34,,1788.74,percent of total billed charges,Implant Devices,1841.35,35,,1841.35,percent of total billed charges,Implant Devices,1841.35,35,,1841.35,percent of total billed charges,Implant Devices,1841.35,35,,1841.35,percent of total billed charges,Implant Devices,1841.35,35,,1841.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1788.74,34,"If Charge > 2,000, then 34 percent",1788.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2104.4,
ZIMMER 113630 MINI HUMERAL STEM 10X83MM,C1776,HCPCS,,79012824,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
ZIMMER 110031408 MINI HUMERAL TRAY 40MM,C1776,HCPCS,,79012825,CDM,278,RC,,,both,,,4416,1742.85,39.4668,,1742.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1545.6,35,,1545.6,percent of total billed charges,Implant Device,1501.44,34,"Charges > $500, x 34%",1501.44,percent of total billed charges,Implant Device,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1766.4,40,,1766.4,percent of total billed charges,Implant Devices,1545.6,70,,1545.6,percent of total billed charges,Implant Devices,1501.44,34,,1501.44,percent of total billed charges,Implant Devices,1501.44,34,,1501.44,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1501.44,34,"If Charge > 2,000, then 34 percent",1501.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1766.4,
ZIMMER 110031424 BEARING 36MM,C1776,HCPCS,,79012826,CDM,278,RC,,,both,,,4992,1970.18,39.4668,,1970.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1697.28,34,,1697.28,percent of total billed charges,Implant Device,1747.2,35,,1747.2,percent of total billed charges,Implant Device,1697.28,34,"Charges > $500, x 34%",1697.28,percent of total billed charges,Implant Device,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1996.8,40,,1996.8,percent of total billed charges,Implant Devices,1747.2,70,,1747.2,percent of total billed charges,Implant Devices,1697.28,34,,1697.28,percent of total billed charges,Implant Devices,1697.28,34,,1697.28,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,1747.2,35,,1747.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1697.28,34,"If Charge > 2,000, then 34 percent",1697.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1996.8,
DJO 509-02-036 SMALL SOCKET INSERT 36MM,C1776,HCPCS,,79012832,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
DJO 533-12-108 HUMERAL STEM 12X108MM,C1776,HCPCS,,79012833,CDM,278,RC,,,both,,,14400,5683.22,39.4668,,5683.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Device,4896,34,"Charges > $500, x 34%",4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5760,40,,5760,percent of total billed charges,Implant Devices,5040,70,,5040,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4896,34,"If Charge > 2,000, then 34 percent",4896,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5760,
ZIMMER VE189040 TIBIAL BEARING 67X10MM,C1776,HCPCS,,79012844,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 183028 FEMORAL LEFT 65MM,C1776,HCPCS,,79012845,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
EXACTECH 320-05-12 HUM AUG TRAY +5 RT,C1776,HCPCS,,79012852,CDM,278,RC,,,both,,,13500,5328.02,39.4668,,5328.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Device,4590,34,"Charges > $500, x 34%",4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,5400,40,,5400,percent of total billed charges,Implant Devices,4725,70,,4725,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4590,34,"If Charge > 2,000, then 34 percent",4590,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5400,
ZIMMER 574101000 FEMORAL STEM SIZE 0,C1776,HCPCS,,79012853,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 51-106130 STEM 13X111MM,C1776,HCPCS,,79012858,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
J&J 09.405.560S RADIAL HEAD 25X6.5X11MM,C1776,HCPCS,,79012859,CDM,278,RC,,,both,,,10622,4192.16,39.4668,,4192.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3611.48,34,,3611.48,percent of total billed charges,Implant Device,3717.7,35,,3717.7,percent of total billed charges,Implant Device,3611.48,34,"Charges > $500, x 34%",3611.48,percent of total billed charges,Implant Device,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,4248.8,40,,4248.8,percent of total billed charges,Implant Devices,3717.7,70,,3717.7,percent of total billed charges,Implant Devices,3611.48,34,,3611.48,percent of total billed charges,Implant Devices,3611.48,34,,3611.48,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,3717.7,35,,3717.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3611.48,34,"If Charge > 2,000, then 34 percent",3611.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4248.8,
ZIMMER 42-5121-007-12 ART SURF LT 12MM,C1776,HCPCS,,79012860,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
ZIMMER 00-8757-050-02 SHELL 50MM SIZE HH,C1776,HCPCS,,79012870,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
ZIMMER 42-5121-009-16 ART SURF LT 16MM,C1776,HCPCS,,79012872,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
STRYKER 5567-P-3009 HUMERAL STEM 9X93MM,C1776,HCPCS,,79012885,CDM,278,RC,,,both,,,8925,3522.41,39.4668,,3522.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Device,3034.5,34,"Charges > $500, x 34%",3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3570,40,,3570,percent of total billed charges,Implant Devices,3123.75,70,,3123.75,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3034.5,34,"If Charge > 2,000, then 34 percent",3034.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3570,
STRYKER 5570-3202 HUMERAL CUP 32X2MM,C1776,HCPCS,,79012886,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
STRYKER 5572-2802 BASEPLATE 28X10.05MM,C1776,HCPCS,,79012887,CDM,278,RC,,,both,,,6600,2604.81,39.4668,,2604.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2244,34,,2244,percent of total billed charges,Implant Device,2310,35,,2310,percent of total billed charges,Implant Device,2244,34,"Charges > $500, x 34%",2244,percent of total billed charges,Implant Device,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2640,40,,2640,percent of total billed charges,Implant Devices,2310,70,,2310,percent of total billed charges,Implant Devices,2244,34,,2244,percent of total billed charges,Implant Devices,2244,34,,2244,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,2310,35,,2310,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2244,34,"If Charge > 2,000, then 34 percent",2244,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2640,
ZIMMER 183070 FEMORAL LEFT 67.5MM,C1776,HCPCS,,79012888,CDM,278,RC,,,both,,,7104,2803.72,39.4668,,2803.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2486.4,35,,2486.4,percent of total billed charges,Implant Device,2415.36,34,"Charges > $500, x 34%",2415.36,percent of total billed charges,Implant Device,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2841.6,40,,2841.6,percent of total billed charges,Implant Devices,2486.4,70,,2486.4,percent of total billed charges,Implant Devices,2415.36,34,,2415.36,percent of total billed charges,Implant Devices,2415.36,34,,2415.36,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2415.36,34,"If Charge > 2,000, then 34 percent",2415.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2841.6,
ZIMMER 184788 PATELLA 37X8.6MM,C1776,HCPCS,,79012889,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
ZIMMER EP-189084 TIBIAL BEARING 14X75MM,C1776,HCPCS,,79012890,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 00-8757-048-01 SHELL 48MM SIZE GG,C1776,HCPCS,,79012892,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380,
ZIMMER 00-8851-008-32 LINER 32MM SIZE GG,C1776,HCPCS,,79012893,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 183004 FEMORAL RIGHT 60MM,C1776,HCPCS,,79012895,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
J&J 1504-10-206 FEMORAL RIGHT SIZE 6,C1776,HCPCS,,79012906,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
ZIMMER 42-5020-068-01 FEMUR LT SZ 10,C1776,HCPCS,,79012913,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 42-5400-000-38 PATELLA 38X9.5MM,C1776,HCPCS,,79012914,CDM,278,RC,,,both,,,1539,607.39,39.4668,,607.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,523.26,34,,523.26,percent of total billed charges,Implant Device,538.65,35,,538.65,percent of total billed charges,Implant Device,523.26,34,"Charges > $500, x 34%",523.26,percent of total billed charges,Implant Device,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,615.6,40,,615.6,percent of total billed charges,Implant Devices,538.65,70,,538.65,percent of total billed charges,Implant Devices,523.26,34,,523.26,percent of total billed charges,Implant Devices,523.26,34,,523.26,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,538.65,35,,538.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,615.6,
ZIMMER 42-5221-003-13 ART SURF RT 13MM,C1776,HCPCS,,79012915,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 00-8755-008-32 LINER 32MM SIZE GG,C1776,HCPCS,,79012933,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER VE189022 TIBIAL BEARING 63X12MM,C1776,HCPCS,,79012934,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
STRYKER 6721-0027 HIP STEM SX 0 27X93MM,C1776,HCPCS,,79012937,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
ZIMMER 42-5320-064-01 TIBIA 5DEG LT SZ C,C1776,HCPCS,,79012940,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 42-5026-056-01 FEMUR LEFT SIZE 4,C1776,HCPCS,,79012941,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 42-5121-003-10 ART SURF LT 10MM,C1776,HCPCS,,79012942,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
STRYKER 6485-3-813 STEM 13X127MM,C1776,HCPCS,,79012958,CDM,278,RC,,,both,,,7254,2862.92,39.4668,,2862.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2538.9,35,,2538.9,percent of total billed charges,Implant Device,2466.36,34,"Charges > $500, x 34%",2466.36,percent of total billed charges,Implant Device,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2901.6,40,,2901.6,percent of total billed charges,Implant Devices,2538.9,70,,2538.9,percent of total billed charges,Implant Devices,2466.36,34,,2466.36,percent of total billed charges,Implant Devices,2466.36,34,,2466.36,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2466.36,34,"If Charge > 2,000, then 34 percent",2466.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2901.6,
"STRYKER 6481-2-150 BUSHING, SLEEVE",C1776,HCPCS,,79012959,CDM,278,RC,,,both,,,4203,1658.79,39.4668,,1658.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1429.02,34,,1429.02,percent of total billed charges,Implant Device,1429.02,34,,1429.02,percent of total billed charges,Implant Device,1429.02,34,,1429.02,percent of total billed charges,Implant Device,1429.02,34,,1429.02,percent of total billed charges,Implant Device,1429.02,34,,1429.02,percent of total billed charges,Implant Device,1429.02,34,,1429.02,percent of total billed charges,Implant Device,1471.05,35,,1471.05,percent of total billed charges,Implant Device,1429.02,34,"Charges > $500, x 34%",1429.02,percent of total billed charges,Implant Device,1471.05,35,,1471.05,percent of total billed charges,Implant Devices,1471.05,35,,1471.05,percent of total billed charges,Implant Devices,1471.05,35,,,percent of total billed charges,Implant Devices,1471.05,35,,1471.05,percent of total billed charges,Implant Devices,1471.05,35,,1471.05,percent of total billed charges,Implant Devices,1681.2,40,,1681.2,percent of total billed charges,Implant Devices,1471.05,70,,1471.05,percent of total billed charges,Implant Devices,1429.02,34,,1429.02,percent of total billed charges,Implant Devices,1429.02,34,,1429.02,percent of total billed charges,Implant Devices,1471.05,35,,1471.05,percent of total billed charges,Implant Devices,1471.05,35,,1471.05,percent of total billed charges,Implant Devices,1471.05,35,,1471.05,percent of total billed charges,Implant Devices,1471.05,35,,1471.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1429.02,34,"If Charge > 2,000, then 34 percent",1429.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1681.2,
STRYKER 6481-3-310 TIBIAL INSERT 10MM,C1776,HCPCS,,79012960,CDM,278,RC,,,both,,,2997,1182.82,39.4668,,1182.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1018.98,34,,1018.98,percent of total billed charges,Implant Device,1018.98,34,,1018.98,percent of total billed charges,Implant Device,1018.98,34,,1018.98,percent of total billed charges,Implant Device,1018.98,34,,1018.98,percent of total billed charges,Implant Device,1018.98,34,,1018.98,percent of total billed charges,Implant Device,1018.98,34,,1018.98,percent of total billed charges,Implant Device,1048.95,35,,1048.95,percent of total billed charges,Implant Device,1018.98,34,"Charges > $500, x 34%",1018.98,percent of total billed charges,Implant Device,1048.95,35,,1048.95,percent of total billed charges,Implant Devices,1048.95,35,,1048.95,percent of total billed charges,Implant Devices,1048.95,35,,,percent of total billed charges,Implant Devices,1048.95,35,,1048.95,percent of total billed charges,Implant Devices,1048.95,35,,1048.95,percent of total billed charges,Implant Devices,1198.8,40,,1198.8,percent of total billed charges,Implant Devices,1048.95,70,,1048.95,percent of total billed charges,Implant Devices,1018.98,34,,1018.98,percent of total billed charges,Implant Devices,1018.98,34,,1018.98,percent of total billed charges,Implant Devices,1048.95,35,,1048.95,percent of total billed charges,Implant Devices,1048.95,35,,1048.95,percent of total billed charges,Implant Devices,1048.95,35,,1048.95,percent of total billed charges,Implant Devices,1048.95,35,,1048.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1018.98,34,"If Charge > 2,000, then 34 percent",1018.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1198.8,
STRYKER 6481-3-112 TIBIAL BASEPLT SZ M-2,C1776,HCPCS,,79012961,CDM,278,RC,,,both,,,8597,3392.96,39.4668,,3392.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2922.98,34,,2922.98,percent of total billed charges,Implant Device,2922.98,34,,2922.98,percent of total billed charges,Implant Device,2922.98,34,,2922.98,percent of total billed charges,Implant Device,2922.98,34,,2922.98,percent of total billed charges,Implant Device,2922.98,34,,2922.98,percent of total billed charges,Implant Device,2922.98,34,,2922.98,percent of total billed charges,Implant Device,3008.95,35,,3008.95,percent of total billed charges,Implant Device,2922.98,34,"Charges > $500, x 34%",2922.98,percent of total billed charges,Implant Device,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3438.8,40,,3438.8,percent of total billed charges,Implant Devices,3008.95,70,,3008.95,percent of total billed charges,Implant Devices,2922.98,34,,2922.98,percent of total billed charges,Implant Devices,2922.98,34,,2922.98,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,3008.95,35,,3008.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2922.98,34,"If Charge > 2,000, then 34 percent",2922.98,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3438.8,
J&J 09.405.263S RADIAL HEAD 10 +3,C1776,HCPCS,,79012974,CDM,278,RC,,,both,,,9560,3773.03,39.4668,,3773.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3250.4,34,,3250.4,percent of total billed charges,Implant Device,3346,35,,3346,percent of total billed charges,Implant Device,3250.4,34,"Charges > $500, x 34%",3250.4,percent of total billed charges,Implant Device,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3824,40,,3824,percent of total billed charges,Implant Devices,3346,70,,3346,percent of total billed charges,Implant Devices,3250.4,34,,3250.4,percent of total billed charges,Implant Devices,3250.4,34,,3250.4,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,3346,35,,3346,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3250.4,34,"If Charge > 2,000, then 34 percent",3250.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3824,
ZIMMER 110031013 BEARING 28X46MM SIZE G,C1776,HCPCS,,79013024,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 110024465 ACETABU LINER 46MM SZ G,C1776,HCPCS,,79013025,CDM,278,RC,,,both,,,3840,1515.53,39.4668,,1515.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1344,35,,1344,percent of total billed charges,Implant Device,1305.6,34,"Charges > $500, x 34%",1305.6,percent of total billed charges,Implant Device,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1536,40,,1536,percent of total billed charges,Implant Devices,1344,70,,1344,percent of total billed charges,Implant Devices,1305.6,34,,1305.6,percent of total billed charges,Implant Devices,1305.6,34,,1305.6,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1305.6,34,"If Charge > 2,000, then 34 percent",1305.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1536,
ZIMMER 183014 FEMORAL RIGHT 75MM,C1776,HCPCS,,79013026,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 42-5121-009-14 ART SURF LT 14,C1776,HCPCS,,79013028,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
ZIMMER 11-300819 DISTAL STEM 19X150MM,C1776,HCPCS,,79013030,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
ZIMMER 42-5121-004-11 ARTIC SURF LT 11MM,C1776,HCPCS,,79013032,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
STRYKER 5569-P-2016 HUMERAL STEM 16MM,C1776,HCPCS,,79013049,CDM,278,RC,,,both,,,8925,3522.41,39.4668,,3522.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Device,3034.5,34,"Charges > $500, x 34%",3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3570,40,,3570,percent of total billed charges,Implant Devices,3123.75,70,,3123.75,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3034.5,34,"If Charge > 2,000, then 34 percent",3034.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3570,
STRYKER 5571-S-3604-E HUM INSERT 36X4MM,C1776,HCPCS,,79013050,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
STRYKER 5573-C-3606 GLENOSPHERE 36X6MM,C1776,HCPCS,,79013051,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
ZIMMER 00-8777-028-04 FEM HEAD 28X+7MM,C1776,HCPCS,,79013062,CDM,278,RC,,,both,,,4950,1953.61,39.4668,,1953.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Device,1683,34,"Charges > $500, x 34%",1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1980,40,,1980,percent of total billed charges,Implant Devices,1732.5,70,,1732.5,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1683,34,"If Charge > 2,000, then 34 percent",1683,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1980,
ZIMMER 110031001 BEARING 28X46MM,C1776,HCPCS,,79013063,CDM,278,RC,,,both,,,2304,909.32,39.4668,,909.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,783.36,34,,783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Device,783.36,34,"Charges > $500, x 34%",783.36,percent of total billed charges,Implant Device,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,921.6,40,,921.6,percent of total billed charges,Implant Devices,806.4,70,,806.4,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,783.36,34,,783.36,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,806.4,35,,806.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,783.36,34,"If Charge > 2,000, then 34 percent",783.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,921.6,
ZIMMER 574203000 FEMORAL STEM SIZE 0,C1776,HCPCS,,79013076,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
ZIMMER 802202201 FEMORAL HEAD 22MM,C1776,HCPCS,,79013077,CDM,278,RC,,,both,,,1445,570.3,39.4668,,570.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,491.3,34,,491.3,percent of total billed charges,Implant Device,491.3,34,,491.3,percent of total billed charges,Implant Device,491.3,34,,491.3,percent of total billed charges,Implant Device,491.3,34,,491.3,percent of total billed charges,Implant Device,491.3,34,,491.3,percent of total billed charges,Implant Device,491.3,34,,491.3,percent of total billed charges,Implant Device,505.75,35,,505.75,percent of total billed charges,Implant Device,491.3,34,"Charges > $500, x 34%",491.3,percent of total billed charges,Implant Device,505.75,35,,505.75,percent of total billed charges,Implant Devices,505.75,35,,505.75,percent of total billed charges,Implant Devices,505.75,35,,,percent of total billed charges,Implant Devices,505.75,35,,505.75,percent of total billed charges,Implant Devices,505.75,35,,505.75,percent of total billed charges,Implant Devices,578,40,,578,percent of total billed charges,Implant Devices,505.75,70,,505.75,percent of total billed charges,Implant Devices,491.3,34,,491.3,percent of total billed charges,Implant Devices,491.3,34,,491.3,percent of total billed charges,Implant Devices,505.75,35,,505.75,percent of total billed charges,Implant Devices,505.75,35,,505.75,percent of total billed charges,Implant Devices,505.75,35,,505.75,percent of total billed charges,Implant Devices,505.75,35,,505.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,578,
ZIMMER 42-5221-009-18 ART SURF RT 18MM,C1776,HCPCS,,79013084,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 574102085 FEMORAL HEAD 36X3.5MM,C1776,HCPCS,,79013087,CDM,278,RC,,,both,,,6912,2727.95,39.4668,,2727.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2350.08,34,,2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Device,2350.08,34,"Charges > $500, x 34%",2350.08,percent of total billed charges,Implant Device,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2764.8,40,,2764.8,percent of total billed charges,Implant Devices,2419.2,70,,2419.2,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2350.08,34,,2350.08,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,2419.2,35,,2419.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2350.08,34,"If Charge > 2,000, then 34 percent",2350.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2764.8,
STRYKER 1059-4513 DISTAL SPACER MED 13MM,C1776,HCPCS,,79013091,CDM,278,RC,,,both,,,168,66.3,39.4668,,66.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,57.12,34,,57.12,percent of total billed charges,Implant Device,57.12,34,,57.12,percent of total billed charges,Implant Device,57.12,34,,57.12,percent of total billed charges,Implant Device,57.12,34,,57.12,percent of total billed charges,Implant Device,57.12,34,,57.12,percent of total billed charges,Implant Device,57.12,34,,57.12,percent of total billed charges,Implant Device,58.8,35,,58.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,67.2,40,,67.2,percent of total billed charges,Implant Devices,58.8,70,,58.8,percent of total billed charges,Implant Devices,57.12,34,,57.12,percent of total billed charges,Implant Devices,57.12,34,,57.12,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,58.8,35,,58.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,67.2,
STRYKER 6364-2-126 FEMORAL HEAD 26X0MM,C1776,HCPCS,,79013092,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
STRYKER 6485-3-817 FEMORAL STEM 17X127,C1776,HCPCS,,79013093,CDM,278,RC,,,both,,,7254,2862.92,39.4668,,2862.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2466.36,34,,2466.36,percent of total billed charges,Implant Device,2538.9,35,,2538.9,percent of total billed charges,Implant Device,2466.36,34,"Charges > $500, x 34%",2466.36,percent of total billed charges,Implant Device,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2901.6,40,,2901.6,percent of total billed charges,Implant Devices,2538.9,70,,2538.9,percent of total billed charges,Implant Devices,2466.36,34,,2466.36,percent of total billed charges,Implant Devices,2466.36,34,,2466.36,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,2538.9,35,,2538.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2466.36,34,"If Charge > 2,000, then 34 percent",2466.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2901.6,
J&J 1504-00-204 FEMORAL SIZE 4 RIGHT,C1776,HCPCS,,79013094,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J  1506-80-003 TIBIAL BASE SIZE 3,C1776,HCPCS,,79013095,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
J&J 1516-30-405 TIBIAL INSERT SIZE 4 5MM,C1776,HCPCS,,79013096,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1516-30-408 TIBIAL INSERT SZIE 4 8MM,C1776,HCPCS,,79013097,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1504-00-205 FEMORAL SIZE 5 RIGHT,C1776,HCPCS,,79013098,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1506-80-004 TIBAL BASE SIZE 4,C1776,HCPCS,,79013099,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
J&J 1516-30-505 TIBIAL INSERT SIZE 5 5MM,C1776,HCPCS,,79013100,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
ZIMMER 42-5221-006-10 ARTIC SURF RT 10MM,C1776,HCPCS,,79013101,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
J&J 1010-11-020 FEMORAL STEM SIZE 2,C1776,HCPCS,,79013102,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1217-32-048 ACETABULAR SHELL 48MM,C1776,HCPCS,,79013103,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1368,
J&J 1221-32-048 ACETABULAR LINER 48MM,C1776,HCPCS,,79013104,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
J&J 1365-32-310 FEMORAL HEAD 32MM,C1776,HCPCS,,79013105,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
ZIMMER 42-5121-003-13 ARTIC SURF 13MM,C1776,HCPCS,,79013106,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
J & J 1010-11-060 FEMORAL STEM SIZE 6,C1776,HCPCS,,79013107,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J & J 1010-21-060 FEMORAL STEM SIZE 6,C1776,HCPCS,,79013108,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1217-32-056 ACETABULAR SHELL 56MM,C1776,HCPCS,,79013109,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1368,
J&J 1221-40-056 ACETABULAR LINER 40X56MM,C1776,HCPCS,,79013110,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
J & J 1365-54-710 FEMORAL HEAD 40MM,C1776,HCPCS,,79013111,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
STRYKER UH1-52-28 BIPOLAR COMP 52X28MM,C1776,HCPCS,,79013122,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
J & J 1504-40-104 FEMORAL LEFT SIZE 4,C1776,HCPCS,,79013131,CDM,278,RC,,,both,,,21434,8459.31,39.4668,,8459.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7501.9,35,,7501.9,percent of total billed charges,Implant Device,7287.56,34,"Charges > $500, x 34%",7287.56,percent of total billed charges,Implant Device,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,8573.6,40,,8573.6,percent of total billed charges,Implant Devices,7501.9,70,,7501.9,percent of total billed charges,Implant Devices,7287.56,34,,7287.56,percent of total billed charges,Implant Devices,7287.56,34,,7287.56,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7287.56,34,"If Charge > 2,000, then 34 percent",7287.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8573.6,
J & J 1506-60-003 TIBAIL BASE SIZE 3,C1776,HCPCS,,79013132,CDM,278,RC,,,both,,,15558,6140.24,39.4668,,6140.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5445.3,35,,5445.3,percent of total billed charges,Implant Device,5289.72,34,"Charges > $500, x 34%",5289.72,percent of total billed charges,Implant Device,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,6223.2,40,,6223.2,percent of total billed charges,Implant Devices,5445.3,70,,5445.3,percent of total billed charges,Implant Devices,5289.72,34,,5289.72,percent of total billed charges,Implant Devices,5289.72,34,,5289.72,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5289.72,34,"If Charge > 2,000, then 34 percent",5289.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6223.2,
J & J 1512-14-050 STEM 14X50MM,C1776,HCPCS,,79013133,CDM,278,RC,,,both,,,3315,1308.32,39.4668,,1308.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1160.25,35,,1160.25,percent of total billed charges,Implant Device,1127.1,34,"Charges > $500, x 34%",1127.1,percent of total billed charges,Implant Device,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1326,40,,1326,percent of total billed charges,Implant Devices,1160.25,70,,1160.25,percent of total billed charges,Implant Devices,1127.1,34,,1127.1,percent of total billed charges,Implant Devices,1127.1,34,,1127.1,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1127.1,34,"If Charge > 2,000, then 34 percent",1127.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1326,
J & J 1010-12-060 FEMORAL STEM SIZE 6,C1776,HCPCS,,79013135,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J & J 1217-32-058 ACETABULAR SHELL 58MM,C1776,HCPCS,,79013136,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1368,
J&J 1221-40-058 ACETABULAR LINER 40X58MM,C1776,HCPCS,,79013139,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
J & J 1365-40-710 FEMORAL HEAD 40MM,C1776,HCPCS,,79013140,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
DJO SURG 533-06-108 HUM STEM 6X108MM,C1776,HCPCS,,79013146,CDM,278,RC,,,both,,,14400,5683.22,39.4668,,5683.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Device,4896,34,"Charges > $500, x 34%",4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5760,40,,5760,percent of total billed charges,Implant Devices,5040,70,,5040,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4896,34,"If Charge > 2,000, then 34 percent",4896,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5760,
J & J 1010-11-010 FEMORAL STEM SIZE 1,C1776,HCPCS,,79013148,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1506-60-005 TIBIAL BASE SIZE 5,C1776,HCPCS,,79013149,CDM,278,RC,,,both,,,15558,6140.24,39.4668,,6140.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5445.3,35,,5445.3,percent of total billed charges,Implant Device,5289.72,34,"Charges > $500, x 34%",5289.72,percent of total billed charges,Implant Device,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,6223.2,40,,6223.2,percent of total billed charges,Implant Devices,5445.3,70,,5445.3,percent of total billed charges,Implant Devices,5289.72,34,,5289.72,percent of total billed charges,Implant Devices,5289.72,34,,5289.72,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5289.72,34,"If Charge > 2,000, then 34 percent",5289.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6223.2,
J&J 1516-50-614 INSERT 14MM SIZE 6,C1776,HCPCS,,79013150,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
STRYKER 5567-P-3014 HUMERAL STEM 14X98MM,C1776,HCPCS,,79013167,CDM,278,RC,,,both,,,8925,3522.41,39.4668,,3522.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3034.5,34,,3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Device,3034.5,34,"Charges > $500, x 34%",3034.5,percent of total billed charges,Implant Device,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3570,40,,3570,percent of total billed charges,Implant Devices,3123.75,70,,3123.75,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3034.5,34,,3034.5,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,3123.75,35,,3123.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3034.5,34,"If Charge > 2,000, then 34 percent",3034.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3570,
STRYKER 5571-S-3206-E HUM INSERT 32XC6MM,C1776,HCPCS,,79013168,CDM,278,RC,,,both,,,3525,1391.2,39.4668,,1391.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Device,1198.5,34,"Charges > $500, x 34%",1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1410,40,,1410,percent of total billed charges,Implant Devices,1233.75,70,,1233.75,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1198.5,34,"If Charge > 2,000, then 34 percent",1198.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1410,
STRYKER 5573-C-3206 GLENOSPHERE 32X6MM,C1776,HCPCS,,79013169,CDM,278,RC,,,both,,,4125,1628.01,39.4668,,1628.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1402.5,34,,1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Device,1402.5,34,"Charges > $500, x 34%",1402.5,percent of total billed charges,Implant Device,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1650,40,,1650,percent of total billed charges,Implant Devices,1443.75,70,,1443.75,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1402.5,34,,1402.5,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,1443.75,35,,1443.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.5,34,"If Charge > 2,000, then 34 percent",1402.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650,
J&J 1217-32-054 ACETAB SHELL 54MM SZ F,C1776,HCPCS,,79013170,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1368,
J&J 1010-11-040 FEMORAL STEM SIZE 4,C1776,HCPCS,,79013171,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1217-30-046 ACETABULAR SHELL 46MM,C1776,HCPCS,,79013172,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1368,
J&J 1221-28-046 ACETABULAR LINER 28X46MM,C1776,HCPCS,,79013173,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
ZIMMER 42-5020-068-02 FEMUR RIGHT SZ 10,C1776,HCPCS,,79013174,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
J&J 1010-12-050 FEMORAL STEM SIZE 5,C1776,HCPCS,,79013175,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
ZIMMER 42-5221-008-16 ART SURF RT 16MM,C1776,HCPCS,,79013176,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 00-5994-032-20 ART SURFACE 20MM,C1776,HCPCS,,79013181,CDM,278,RC,,,both,,,6257,2469.44,39.4668,,2469.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2127.38,34,,2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Device,2127.38,34,"Charges > $500, x 34%",2127.38,percent of total billed charges,Implant Device,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2502.8,40,,2502.8,percent of total billed charges,Implant Devices,2189.95,70,,2189.95,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2127.38,34,,2127.38,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,2189.95,35,,2189.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2127.38,34,"If Charge > 2,000, then 34 percent",2127.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2502.8,
ZIMMER 42-5121-004-10 ART SURFACE 10 LT,C1776,HCPCS,,79013182,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5026-060-01 FEMUR LEFT SIZE 6,C1776,HCPCS,,79013183,CDM,278,RC,,,both,,,10200,4025.61,39.4668,,4025.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3468,34,,3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Device,3468,34,"Charges > $500, x 34%",3468,percent of total billed charges,Implant Device,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,4080,40,,4080,percent of total billed charges,Implant Devices,3570,70,,3570,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3468,34,,3468,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,3570,35,,3570,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3468,34,"If Charge > 2,000, then 34 percent",3468,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4080,
J&J 1218-52-045 PINNACLE LINER 52/45,C1776,HCPCS,,79013193,CDM,278,RC,,,both,,,3465,1367.52,39.4668,,1367.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1212.75,35,,1212.75,percent of total billed charges,Implant Device,1178.1,34,"Charges > $500, x 34%",1178.1,percent of total billed charges,Implant Device,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1386,40,,1386,percent of total billed charges,Implant Devices,1212.75,70,,1212.75,percent of total billed charges,Implant Devices,1178.1,34,,1178.1,percent of total billed charges,Implant Devices,1178.1,34,,1178.1,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1178.1,34,"If Charge > 2,000, then 34 percent",1178.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1386,
J&J 1365-29-000 FEMORAL HEAD 225MM,C1776,HCPCS,,79013194,CDM,278,RC,,,both,,,1710,674.88,39.4668,,674.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,598.5,35,,598.5,percent of total billed charges,Implant Device,581.4,34,"Charges > $500, x 34%",581.4,percent of total billed charges,Implant Device,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,684,40,,684,percent of total billed charges,Implant Devices,598.5,70,,598.5,percent of total billed charges,Implant Devices,581.4,34,,581.4,percent of total billed charges,Implant Devices,581.4,34,,581.4,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,684,
"J&J DS10014522 LINER 22,2/45",C1776,HCPCS,,79013195,CDM,278,RC,,,both,,,3465,1367.52,39.4668,,1367.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1212.75,35,,1212.75,percent of total billed charges,Implant Device,1178.1,34,"Charges > $500, x 34%",1178.1,percent of total billed charges,Implant Device,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1386,40,,1386,percent of total billed charges,Implant Devices,1212.75,70,,1212.75,percent of total billed charges,Implant Devices,1178.1,34,,1178.1,percent of total billed charges,Implant Devices,1178.1,34,,1178.1,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1178.1,34,"If Charge > 2,000, then 34 percent",1178.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1386,
J&J 1010-11-090 FEMORAL STEM SIZE 9,C1776,HCPCS,,79013196,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1217-32-062 ACETABULAR SHELL 62MM,C1776,HCPCS,,79013198,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1368,
J&J 1221-40-062 ACETABULAR LINER 40X62MM,C1776,HCPCS,,79013199,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
ZIMMER 1100-31-012 BEARING 28X44MM,C1776,HCPCS,,79013200,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 11-301351 PROXIMAL BODY SZ 1 80MM,C1776,HCPCS,,79013201,CDM,278,RC,,,both,,,19784,7808.11,39.4668,,7808.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6726.56,34,,6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Device,6726.56,34,"Charges > $500, x 34%",6726.56,percent of total billed charges,Implant Device,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,7913.6,40,,7913.6,percent of total billed charges,Implant Devices,6924.4,70,,6924.4,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6726.56,34,,6726.56,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,6924.4,35,,6924.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6726.56,34,"If Charge > 2,000, then 34 percent",6726.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7913.6,
J&J 1504-01-107 ATTUNE FEMORAL LEFT SZ 7,C1776,HCPCS,,79013211,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1516-30-705 TIBIAL INSERT SZ 7 5MM,C1776,HCPCS,,79013212,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1504-01-105 ATTUNE FEMORAL LEFT SZ 5,C1776,HCPCS,,79013213,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1516-30-512 TIBAIL INSERT SZ 5 12MM,C1776,HCPCS,,79013214,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1516-50-806 TIBIAL INSERT SIZE 8 6MM,C1776,HCPCS,,79013215,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1504-40-207 REVISION FEMORAL RT SZ 7,C1776,HCPCS,,79013227,CDM,278,RC,,,both,,,21434,8459.31,39.4668,,8459.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7501.9,35,,7501.9,percent of total billed charges,Implant Device,7287.56,34,"Charges > $500, x 34%",7287.56,percent of total billed charges,Implant Device,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,8573.6,40,,8573.6,percent of total billed charges,Implant Devices,7501.9,70,,7501.9,percent of total billed charges,Implant Devices,7287.56,34,,7287.56,percent of total billed charges,Implant Devices,7287.56,34,,7287.56,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7287.56,34,"If Charge > 2,000, then 34 percent",7287.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8573.6,
J&J 1506-60-006 REVISION TIBIAL BASE SZ6,C1776,HCPCS,,79013228,CDM,278,RC,,,both,,,15558,6140.24,39.4668,,6140.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5445.3,35,,5445.3,percent of total billed charges,Implant Device,5289.72,34,"Charges > $500, x 34%",5289.72,percent of total billed charges,Implant Device,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,6223.2,40,,6223.2,percent of total billed charges,Implant Devices,5445.3,70,,5445.3,percent of total billed charges,Implant Devices,5289.72,34,,5289.72,percent of total billed charges,Implant Devices,5289.72,34,,5289.72,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5289.72,34,"If Charge > 2,000, then 34 percent",5289.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6223.2,
J&J 1512-16-080 CEMENTED STEM RT SZ 7,C1776,HCPCS,,79013229,CDM,278,RC,,,both,,,3315,1308.32,39.4668,,1308.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1160.25,35,,1160.25,percent of total billed charges,Implant Device,1127.1,34,"Charges > $500, x 34%",1127.1,percent of total billed charges,Implant Device,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1326,40,,1326,percent of total billed charges,Implant Devices,1160.25,70,,1160.25,percent of total billed charges,Implant Devices,1127.1,34,,1127.1,percent of total billed charges,Implant Devices,1127.1,34,,1127.1,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1127.1,34,"If Charge > 2,000, then 34 percent",1127.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1326,
J&J 1517-10-710 REVISION INSERT SZ7 10,C1776,HCPCS,,79013230,CDM,278,RC,,,both,,,9286,3664.89,39.4668,,3664.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3250.1,35,,3250.1,percent of total billed charges,Implant Device,3157.24,34,"Charges > $500, x 34%",3157.24,percent of total billed charges,Implant Device,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3714.4,40,,3714.4,percent of total billed charges,Implant Devices,3250.1,70,,3250.1,percent of total billed charges,Implant Devices,3157.24,34,,3157.24,percent of total billed charges,Implant Devices,3157.24,34,,3157.24,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3157.24,34,"If Charge > 2,000, then 34 percent",3157.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3714.4,
J&J 1547-07-001 DISTAL FEM SZ 7 4MM,C1776,HCPCS,,79013231,CDM,278,RC,,,both,,,3848,1518.68,39.4668,,1518.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1346.8,35,,1346.8,percent of total billed charges,Implant Device,1308.32,34,"Charges > $500, x 34%",1308.32,percent of total billed charges,Implant Device,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1539.2,40,,1539.2,percent of total billed charges,Implant Devices,1346.8,70,,1346.8,percent of total billed charges,Implant Devices,1308.32,34,,1308.32,percent of total billed charges,Implant Devices,1308.32,34,,1308.32,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1308.32,34,"If Charge > 2,000, then 34 percent",1308.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1539.2,
J&J 1547-07-002 DISTAL FEM SZ 7 8MM,C1776,HCPCS,,79013232,CDM,278,RC,,,both,,,3848,1518.68,39.4668,,1518.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1346.8,35,,1346.8,percent of total billed charges,Implant Device,1308.32,34,"Charges > $500, x 34%",1308.32,percent of total billed charges,Implant Device,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1539.2,40,,1539.2,percent of total billed charges,Implant Devices,1346.8,70,,1346.8,percent of total billed charges,Implant Devices,1308.32,34,,1308.32,percent of total billed charges,Implant Devices,1308.32,34,,1308.32,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1308.32,34,"If Charge > 2,000, then 34 percent",1308.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1539.2,
J&J 1549-07-001 FEMORAL SIZE 7 4MM,C1776,HCPCS,,79013233,CDM,278,RC,,,both,,,3848,1518.68,39.4668,,1518.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1346.8,35,,1346.8,percent of total billed charges,Implant Device,1308.32,34,"Charges > $500, x 34%",1308.32,percent of total billed charges,Implant Device,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1539.2,40,,1539.2,percent of total billed charges,Implant Devices,1346.8,70,,1346.8,percent of total billed charges,Implant Devices,1308.32,34,,1308.32,percent of total billed charges,Implant Devices,1308.32,34,,1308.32,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1308.32,34,"If Charge > 2,000, then 34 percent",1308.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1539.2,
OSTEOREMEDIES RHACSM ACETAB CUP 46/54MM,C1776,HCPCS,,79013247,CDM,278,RC,,,both,,,4190,1653.66,39.4668,,1653.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1466.5,35,,1466.5,percent of total billed charges,Implant Device,1424.6,34,"Charges > $500, x 34%",1424.6,percent of total billed charges,Implant Device,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1676,40,,1676,percent of total billed charges,Implant Devices,1466.5,70,,1466.5,percent of total billed charges,Implant Devices,1424.6,34,,1424.6,percent of total billed charges,Implant Devices,1424.6,34,,1424.6,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1424.6,34,"If Charge > 2,000, then 34 percent",1424.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1676,
OSTEOREMEDIES RHACXS ACETAB CUP 40/48MM,C1776,HCPCS,,79013248,CDM,278,RC,,,both,,,4190,1653.66,39.4668,,1653.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1424.6,34,,1424.6,percent of total billed charges,Implant Device,1466.5,35,,1466.5,percent of total billed charges,Implant Device,1424.6,34,"Charges > $500, x 34%",1424.6,percent of total billed charges,Implant Device,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1676,40,,1676,percent of total billed charges,Implant Devices,1466.5,70,,1466.5,percent of total billed charges,Implant Devices,1424.6,34,,1424.6,percent of total billed charges,Implant Devices,1424.6,34,,1424.6,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,1466.5,35,,1466.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1424.6,34,"If Charge > 2,000, then 34 percent",1424.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1676,
OSTEOREMEDIES RHHDLG MODULAR HEAD 60MM,C1776,HCPCS,,79013249,CDM,278,RC,,,both,,,4794,1892.04,39.4668,,1892.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1677.9,35,,1677.9,percent of total billed charges,Implant Device,1629.96,34,"Charges > $500, x 34%",1629.96,percent of total billed charges,Implant Device,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1917.6,40,,1917.6,percent of total billed charges,Implant Devices,1677.9,70,,1677.9,percent of total billed charges,Implant Devices,1629.96,34,,1629.96,percent of total billed charges,Implant Devices,1629.96,34,,1629.96,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.96,34,"If Charge > 2,000, then 34 percent",1629.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1917.6,
OSTEOREMEDIES RHHDMD MODULAR HEAD 54MM,C1776,HCPCS,,79013250,CDM,278,RC,,,both,,,4794,1892.04,39.4668,,1892.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1677.9,35,,1677.9,percent of total billed charges,Implant Device,1629.96,34,"Charges > $500, x 34%",1629.96,percent of total billed charges,Implant Device,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1917.6,40,,1917.6,percent of total billed charges,Implant Devices,1677.9,70,,1677.9,percent of total billed charges,Implant Devices,1629.96,34,,1629.96,percent of total billed charges,Implant Devices,1629.96,34,,1629.96,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.96,34,"If Charge > 2,000, then 34 percent",1629.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1917.6,
OSTEOREMEDIES RHHDSM MODULAR HEAD 46MM,C1776,HCPCS,,79013251,CDM,278,RC,,,both,,,4794,1892.04,39.4668,,1892.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1629.96,34,,1629.96,percent of total billed charges,Implant Device,1677.9,35,,1677.9,percent of total billed charges,Implant Device,1629.96,34,"Charges > $500, x 34%",1629.96,percent of total billed charges,Implant Device,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1917.6,40,,1917.6,percent of total billed charges,Implant Devices,1677.9,70,,1677.9,percent of total billed charges,Implant Devices,1629.96,34,,1629.96,percent of total billed charges,Implant Devices,1629.96,34,,1629.96,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,1677.9,35,,1677.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.96,34,"If Charge > 2,000, then 34 percent",1629.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1917.6,
OSTEOREMEDIES RHLSLG MOD LONG STEM LG,C1776,HCPCS,,79013252,CDM,278,RC,,,both,,,7020,2770.57,39.4668,,2770.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2457,35,,2457,percent of total billed charges,Implant Device,2386.8,34,"Charges > $500, x 34%",2386.8,percent of total billed charges,Implant Device,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2808,40,,2808,percent of total billed charges,Implant Devices,2457,70,,2457,percent of total billed charges,Implant Devices,2386.8,34,,2386.8,percent of total billed charges,Implant Devices,2386.8,34,,2386.8,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2386.8,34,"If Charge > 2,000, then 34 percent",2386.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2808,
OSTEOREMEDIES RHLSMD MOD LONG STEM MED,C1776,HCPCS,,79013253,CDM,278,RC,,,both,,,7020,2770.57,39.4668,,2770.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2457,35,,2457,percent of total billed charges,Implant Device,2386.8,34,"Charges > $500, x 34%",2386.8,percent of total billed charges,Implant Device,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2808,40,,2808,percent of total billed charges,Implant Devices,2457,70,,2457,percent of total billed charges,Implant Devices,2386.8,34,,2386.8,percent of total billed charges,Implant Devices,2386.8,34,,2386.8,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2386.8,34,"If Charge > 2,000, then 34 percent",2386.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2808,
OSTEOREMEDIES RHLSSM MOD LONG STEM SM,C1776,HCPCS,,79013254,CDM,278,RC,,,both,,,7020,2770.57,39.4668,,2770.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2386.8,34,,2386.8,percent of total billed charges,Implant Device,2457,35,,2457,percent of total billed charges,Implant Device,2386.8,34,"Charges > $500, x 34%",2386.8,percent of total billed charges,Implant Device,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2808,40,,2808,percent of total billed charges,Implant Devices,2457,70,,2457,percent of total billed charges,Implant Devices,2386.8,34,,2386.8,percent of total billed charges,Implant Devices,2386.8,34,,2386.8,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,2457,35,,2457,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2386.8,34,"If Charge > 2,000, then 34 percent",2386.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2808,
OSTEOREMEDIES RHSTLG MODULAR STEM LARGE,C1776,HCPCS,,79013255,CDM,278,RC,,,both,,,6762,2668.75,39.4668,,2668.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2366.7,35,,2366.7,percent of total billed charges,Implant Device,2299.08,34,"Charges > $500, x 34%",2299.08,percent of total billed charges,Implant Device,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2704.8,40,,2704.8,percent of total billed charges,Implant Devices,2366.7,70,,2366.7,percent of total billed charges,Implant Devices,2299.08,34,,2299.08,percent of total billed charges,Implant Devices,2299.08,34,,2299.08,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2299.08,34,"If Charge > 2,000, then 34 percent",2299.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2704.8,
OSTEOREMEDIES RHSTMD MODULAR STEM MEDIUM,C1776,HCPCS,,79013256,CDM,278,RC,,,both,,,6762,2668.75,39.4668,,2668.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2366.7,35,,2366.7,percent of total billed charges,Implant Device,2299.08,34,"Charges > $500, x 34%",2299.08,percent of total billed charges,Implant Device,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2704.8,40,,2704.8,percent of total billed charges,Implant Devices,2366.7,70,,2366.7,percent of total billed charges,Implant Devices,2299.08,34,,2299.08,percent of total billed charges,Implant Devices,2299.08,34,,2299.08,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2299.08,34,"If Charge > 2,000, then 34 percent",2299.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2704.8,
OSTEOREMEDIES RHSTSM MODULAR STEM SMALL,C1776,HCPCS,,79013257,CDM,278,RC,,,both,,,6762,2668.75,39.4668,,2668.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2299.08,34,,2299.08,percent of total billed charges,Implant Device,2366.7,35,,2366.7,percent of total billed charges,Implant Device,2299.08,34,"Charges > $500, x 34%",2299.08,percent of total billed charges,Implant Device,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2704.8,40,,2704.8,percent of total billed charges,Implant Devices,2366.7,70,,2366.7,percent of total billed charges,Implant Devices,2299.08,34,,2299.08,percent of total billed charges,Implant Devices,2299.08,34,,2299.08,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,2366.7,35,,2366.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2299.08,34,"If Charge > 2,000, then 34 percent",2299.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2704.8,
OSTEOREMEDIES RKFMLG FEMORAL COMP LARGE,C1776,HCPCS,,79013258,CDM,278,RC,,,both,,,6006,2370.38,39.4668,,2370.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2102.1,35,,2102.1,percent of total billed charges,Implant Device,2042.04,34,"Charges > $500, x 34%",2042.04,percent of total billed charges,Implant Device,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2402.4,40,,2402.4,percent of total billed charges,Implant Devices,2102.1,70,,2102.1,percent of total billed charges,Implant Devices,2042.04,34,,2042.04,percent of total billed charges,Implant Devices,2042.04,34,,2042.04,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2042.04,34,"If Charge > 2,000, then 34 percent",2042.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2402.4,
OSTEOREMEDIES RKFMMD FEMORAL COMP MEDIUM,C1776,HCPCS,,79013259,CDM,278,RC,,,both,,,6006,2370.38,39.4668,,2370.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2102.1,35,,2102.1,percent of total billed charges,Implant Device,2042.04,34,"Charges > $500, x 34%",2042.04,percent of total billed charges,Implant Device,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2402.4,40,,2402.4,percent of total billed charges,Implant Devices,2102.1,70,,2102.1,percent of total billed charges,Implant Devices,2042.04,34,,2042.04,percent of total billed charges,Implant Devices,2042.04,34,,2042.04,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2042.04,34,"If Charge > 2,000, then 34 percent",2042.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2402.4,
OSTEOREMEDIES RKFMSM FEMORAL COMP SMALL,C1776,HCPCS,,79013260,CDM,278,RC,,,both,,,6006,2370.38,39.4668,,2370.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2042.04,34,,2042.04,percent of total billed charges,Implant Device,2102.1,35,,2102.1,percent of total billed charges,Implant Device,2042.04,34,"Charges > $500, x 34%",2042.04,percent of total billed charges,Implant Device,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2402.4,40,,2402.4,percent of total billed charges,Implant Devices,2102.1,70,,2102.1,percent of total billed charges,Implant Devices,2042.04,34,,2042.04,percent of total billed charges,Implant Devices,2042.04,34,,2042.04,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,2102.1,35,,2102.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2042.04,34,"If Charge > 2,000, then 34 percent",2042.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2402.4,
OSTEOREMEDIES RKINLG TIB INSERT WEDGE LG,C1776,HCPCS,,79013261,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
OSTEOREMEDIES RKINMD TIB INS WEDGE MED,C1776,HCPCS,,79013262,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
OSTEOREMEDIES RKINSM TIB INSERT WEDGE SM,C1776,HCPCS,,79013263,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
OSTEOREMEDIES RKTBLG TIBIAL COMP LARGE,C1776,HCPCS,,79013264,CDM,278,RC,,,both,,,5814,2294.6,39.4668,,2294.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,2034.9,35,,2034.9,percent of total billed charges,Implant Device,1976.76,34,"Charges > $500, x 34%",1976.76,percent of total billed charges,Implant Device,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2325.6,40,,2325.6,percent of total billed charges,Implant Devices,2034.9,70,,2034.9,percent of total billed charges,Implant Devices,1976.76,34,,1976.76,percent of total billed charges,Implant Devices,1976.76,34,,1976.76,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1976.76,34,"If Charge > 2,000, then 34 percent",1976.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2325.6,
OSTEOREMEDIES RKTBMD TIBIAL COMP MED,C1776,HCPCS,,79013265,CDM,278,RC,,,both,,,5814,2294.6,39.4668,,2294.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,2034.9,35,,2034.9,percent of total billed charges,Implant Device,1976.76,34,"Charges > $500, x 34%",1976.76,percent of total billed charges,Implant Device,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2325.6,40,,2325.6,percent of total billed charges,Implant Devices,2034.9,70,,2034.9,percent of total billed charges,Implant Devices,1976.76,34,,1976.76,percent of total billed charges,Implant Devices,1976.76,34,,1976.76,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1976.76,34,"If Charge > 2,000, then 34 percent",1976.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2325.6,
OSTEOREMEDIES RKTBSM TIBIAL COMP SM,C1776,HCPCS,,79013266,CDM,278,RC,,,both,,,5814,2294.6,39.4668,,2294.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,1976.76,34,,1976.76,percent of total billed charges,Implant Device,2034.9,35,,2034.9,percent of total billed charges,Implant Device,1976.76,34,"Charges > $500, x 34%",1976.76,percent of total billed charges,Implant Device,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2325.6,40,,2325.6,percent of total billed charges,Implant Devices,2034.9,70,,2034.9,percent of total billed charges,Implant Devices,1976.76,34,,1976.76,percent of total billed charges,Implant Devices,1976.76,34,,1976.76,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,2034.9,35,,2034.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1976.76,34,"If Charge > 2,000, then 34 percent",1976.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2325.6,
OSTEOREMEDIES RSK100 STEM EXTENSION 100,C1776,HCPCS,,79013267,CDM,278,RC,,,both,,,2873,1133.88,39.4668,,1133.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,976.82,34,,976.82,percent of total billed charges,Implant Device,976.82,34,,976.82,percent of total billed charges,Implant Device,976.82,34,,976.82,percent of total billed charges,Implant Device,976.82,34,,976.82,percent of total billed charges,Implant Device,976.82,34,,976.82,percent of total billed charges,Implant Device,976.82,34,,976.82,percent of total billed charges,Implant Device,1005.55,35,,1005.55,percent of total billed charges,Implant Device,976.82,34,"Charges > $500, x 34%",976.82,percent of total billed charges,Implant Device,1005.55,35,,1005.55,percent of total billed charges,Implant Devices,1005.55,35,,1005.55,percent of total billed charges,Implant Devices,1005.55,35,,,percent of total billed charges,Implant Devices,1005.55,35,,1005.55,percent of total billed charges,Implant Devices,1005.55,35,,1005.55,percent of total billed charges,Implant Devices,1149.2,40,,1149.2,percent of total billed charges,Implant Devices,1005.55,70,,1005.55,percent of total billed charges,Implant Devices,976.82,34,,976.82,percent of total billed charges,Implant Devices,976.82,34,,976.82,percent of total billed charges,Implant Devices,1005.55,35,,1005.55,percent of total billed charges,Implant Devices,1005.55,35,,1005.55,percent of total billed charges,Implant Devices,1005.55,35,,1005.55,percent of total billed charges,Implant Devices,1005.55,35,,1005.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,976.82,34,"If Charge > 2,000, then 34 percent",976.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1149.2,
OSTEOREMEDIES RSK175 STEM EXTENSION 175,C1776,HCPCS,,79013268,CDM,278,RC,,,both,,,3030,1195.84,39.4668,,1195.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1030.2,34,,1030.2,percent of total billed charges,Implant Device,1030.2,34,,1030.2,percent of total billed charges,Implant Device,1030.2,34,,1030.2,percent of total billed charges,Implant Device,1030.2,34,,1030.2,percent of total billed charges,Implant Device,1030.2,34,,1030.2,percent of total billed charges,Implant Device,1030.2,34,,1030.2,percent of total billed charges,Implant Device,1060.5,35,,1060.5,percent of total billed charges,Implant Device,1030.2,34,"Charges > $500, x 34%",1030.2,percent of total billed charges,Implant Device,1060.5,35,,1060.5,percent of total billed charges,Implant Devices,1060.5,35,,1060.5,percent of total billed charges,Implant Devices,1060.5,35,,,percent of total billed charges,Implant Devices,1060.5,35,,1060.5,percent of total billed charges,Implant Devices,1060.5,35,,1060.5,percent of total billed charges,Implant Devices,1212,40,,1212,percent of total billed charges,Implant Devices,1060.5,70,,1060.5,percent of total billed charges,Implant Devices,1030.2,34,,1030.2,percent of total billed charges,Implant Devices,1030.2,34,,1030.2,percent of total billed charges,Implant Devices,1060.5,35,,1060.5,percent of total billed charges,Implant Devices,1060.5,35,,1060.5,percent of total billed charges,Implant Devices,1060.5,35,,1060.5,percent of total billed charges,Implant Devices,1060.5,35,,1060.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1030.2,34,"If Charge > 2,000, then 34 percent",1030.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1212,
OSTEOREMEDIES RSKFLG STEMMED FEM COMP LG,C1776,HCPCS,,79013269,CDM,278,RC,,,both,,,6400,2525.88,39.4668,,2525.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2240,35,,2240,percent of total billed charges,Implant Device,2176,34,"Charges > $500, x 34%",2176,percent of total billed charges,Implant Device,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2560,40,,2560,percent of total billed charges,Implant Devices,2240,70,,2240,percent of total billed charges,Implant Devices,2176,34,,2176,percent of total billed charges,Implant Devices,2176,34,,2176,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2176,34,"If Charge > 2,000, then 34 percent",2176,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2560,
OSTEOREMEDIES RSKFMD STEM FEM COMP MED,C1776,HCPCS,,79013270,CDM,278,RC,,,both,,,6400,2525.88,39.4668,,2525.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2240,35,,2240,percent of total billed charges,Implant Device,2176,34,"Charges > $500, x 34%",2176,percent of total billed charges,Implant Device,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2560,40,,2560,percent of total billed charges,Implant Devices,2240,70,,2240,percent of total billed charges,Implant Devices,2176,34,,2176,percent of total billed charges,Implant Devices,2176,34,,2176,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2176,34,"If Charge > 2,000, then 34 percent",2176,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2560,
OSTEOREMEDIES RSKFSM STEM FEM COMP SM,C1776,HCPCS,,79013271,CDM,278,RC,,,both,,,6400,2525.88,39.4668,,2525.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2240,35,,2240,percent of total billed charges,Implant Device,2176,34,"Charges > $500, x 34%",2176,percent of total billed charges,Implant Device,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2560,40,,2560,percent of total billed charges,Implant Devices,2240,70,,2240,percent of total billed charges,Implant Devices,2176,34,,2176,percent of total billed charges,Implant Devices,2176,34,,2176,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2176,34,"If Charge > 2,000, then 34 percent",2176,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2560,
OSTEOREMEDIES RSKFXL STEM FEM COMP EX LG,C1776,HCPCS,,79013272,CDM,278,RC,,,both,,,6400,2525.88,39.4668,,2525.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2176,34,,2176,percent of total billed charges,Implant Device,2240,35,,2240,percent of total billed charges,Implant Device,2176,34,"Charges > $500, x 34%",2176,percent of total billed charges,Implant Device,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2560,40,,2560,percent of total billed charges,Implant Devices,2240,70,,2240,percent of total billed charges,Implant Devices,2176,34,,2176,percent of total billed charges,Implant Devices,2176,34,,2176,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,2240,35,,2240,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2176,34,"If Charge > 2,000, then 34 percent",2176,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2560,
OSTEOREMEDIES RSKTLG STEM TIBIAL COMP LG,C1776,HCPCS,,79013273,CDM,278,RC,,,both,,,6200,2446.94,39.4668,,2446.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2170,35,,2170,percent of total billed charges,Implant Device,2108,34,"Charges > $500, x 34%",2108,percent of total billed charges,Implant Device,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2480,40,,2480,percent of total billed charges,Implant Devices,2170,70,,2170,percent of total billed charges,Implant Devices,2108,34,,2108,percent of total billed charges,Implant Devices,2108,34,,2108,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2108,34,"If Charge > 2,000, then 34 percent",2108,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2480,
OSTEOREMEDIES RSKTMD STEM TIB COMP MED,C1776,HCPCS,,79013274,CDM,278,RC,,,both,,,6200,2446.94,39.4668,,2446.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2170,35,,2170,percent of total billed charges,Implant Device,2108,34,"Charges > $500, x 34%",2108,percent of total billed charges,Implant Device,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2480,40,,2480,percent of total billed charges,Implant Devices,2170,70,,2170,percent of total billed charges,Implant Devices,2108,34,,2108,percent of total billed charges,Implant Devices,2108,34,,2108,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2108,34,"If Charge > 2,000, then 34 percent",2108,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2480,
OSTEOREMEDIES RSKTSM STEM TIB COMP SM,C1776,HCPCS,,79013275,CDM,278,RC,,,both,,,6200,2446.94,39.4668,,2446.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2108,34,,2108,percent of total billed charges,Implant Device,2170,35,,2170,percent of total billed charges,Implant Device,2108,34,"Charges > $500, x 34%",2108,percent of total billed charges,Implant Device,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2480,40,,2480,percent of total billed charges,Implant Devices,2170,70,,2170,percent of total billed charges,Implant Devices,2108,34,,2108,percent of total billed charges,Implant Devices,2108,34,,2108,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,2170,35,,2170,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2108,34,"If Charge > 2,000, then 34 percent",2108,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2480,
J&J 1010-12-040 FEMORAL STEM SIZE 4,C1776,HCPCS,,79013283,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1217-15-500 BONE SCREW 6.5X15MM,C1776,HCPCS,,79013284,CDM,278,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,77.52,34,,77.52,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,91.2,40,,91.2,percent of total billed charges,Implant Devices,79.8,70,,79.8,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,77.52,34,,77.52,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,79.8,35,,79.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,91.2,
J&J 1976-16-190 DIS TAPERED STEM 16X190,C1776,HCPCS,,79013286,CDM,278,RC,,,both,,,16454,6493.87,39.4668,,6493.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5594.36,34,,5594.36,percent of total billed charges,Implant Device,5594.36,34,,5594.36,percent of total billed charges,Implant Device,5594.36,34,,5594.36,percent of total billed charges,Implant Device,5594.36,34,,5594.36,percent of total billed charges,Implant Device,5594.36,34,,5594.36,percent of total billed charges,Implant Device,5594.36,34,,5594.36,percent of total billed charges,Implant Device,5758.9,35,,5758.9,percent of total billed charges,Implant Device,5594.36,34,"Charges > $500, x 34%",5594.36,percent of total billed charges,Implant Device,5758.9,35,,5758.9,percent of total billed charges,Implant Devices,5758.9,35,,5758.9,percent of total billed charges,Implant Devices,5758.9,35,,,percent of total billed charges,Implant Devices,5758.9,35,,5758.9,percent of total billed charges,Implant Devices,5758.9,35,,5758.9,percent of total billed charges,Implant Devices,6581.6,40,,6581.6,percent of total billed charges,Implant Devices,5758.9,70,,5758.9,percent of total billed charges,Implant Devices,5594.36,34,,5594.36,percent of total billed charges,Implant Devices,5594.36,34,,5594.36,percent of total billed charges,Implant Devices,5758.9,35,,5758.9,percent of total billed charges,Implant Devices,5758.9,35,,5758.9,percent of total billed charges,Implant Devices,5758.9,35,,5758.9,percent of total billed charges,Implant Devices,5758.9,35,,5758.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5594.36,34,"If Charge > 2,000, then 34 percent",5594.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6581.6,
ZIMMER 115310 GLENOSPHERE 36MM,C1776,HCPCS,,79013289,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
ZIMMER 110031403 MINI HUMERAL TRAY 40MM,C1776,HCPCS,,79013290,CDM,278,RC,,,both,,,4416,1742.85,39.4668,,1742.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1501.44,34,,1501.44,percent of total billed charges,Implant Device,1545.6,35,,1545.6,percent of total billed charges,Implant Device,1501.44,34,"Charges > $500, x 34%",1501.44,percent of total billed charges,Implant Device,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1766.4,40,,1766.4,percent of total billed charges,Implant Devices,1545.6,70,,1545.6,percent of total billed charges,Implant Devices,1501.44,34,,1501.44,percent of total billed charges,Implant Devices,1501.44,34,,1501.44,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,1545.6,35,,1545.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1501.44,34,"If Charge > 2,000, then 34 percent",1501.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1766.4,
J&J 1506-11-003 TIBIAL BASE SIZE 3,C1776,HCPCS,,79013294,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
J&J 1504-11-224 FEM COMP SIZE 4N RIGHT,C1776,HCPCS,,79013295,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1516-50-405 TIBIAL INSERT 5MM SZ 4,C1776,HCPCS,,79013296,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
EXACTECH 300-30-13 HUMERAL STEM 13MM,C1776,HCPCS,,79013298,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 101011080 FEMORAL STEM SIZE 8,C1776,HCPCS,,79013299,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
STRYKER 5571-S-3204-E HUM INSERT 32X4MM,C1776,HCPCS,,79013320,CDM,278,RC,,,both,,,3525,1391.2,39.4668,,1391.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Device,1198.5,34,"Charges > $500, x 34%",1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1410,40,,1410,percent of total billed charges,Implant Devices,1233.75,70,,1233.75,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1198.5,34,"If Charge > 2,000, then 34 percent",1198.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1410,
J&J 1504-00-108 ATTUNE FEMORAL LT SIZE 8,C1776,HCPCS,,79013321,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1516-30-806 TIBIAL INSERT SIZE 8 6MM,C1776,HCPCS,,79013322,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
DJO 940-01-48D ACETABULAR CUP 48MM,C1776,HCPCS,,79013327,CDM,278,RC,,,both,,,4362,1721.54,39.4668,,1721.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1526.7,35,,1526.7,percent of total billed charges,Implant Device,1483.08,34,"Charges > $500, x 34%",1483.08,percent of total billed charges,Implant Device,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1744.8,40,,1744.8,percent of total billed charges,Implant Devices,1526.7,70,,1526.7,percent of total billed charges,Implant Devices,1483.08,34,,1483.08,percent of total billed charges,Implant Devices,1483.08,34,,1483.08,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1483.08,34,"If Charge > 2,000, then 34 percent",1483.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1744.8,
DJO 951-01-38D LINER METAL 38D,C1776,HCPCS,,79013328,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
J&J 1504-00-104 FEMORAL SIZE 4 LEFT,C1776,HCPCS,,79013333,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1010-11-070 FEMORAL STEM SIZE 7,C1776,HCPCS,,79013334,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
ZIMMER 42-5121-010-13 ARTI SURF LT 13MM,C1776,HCPCS,,79013337,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5320-083-01 TIB 5 DEG LT SZ H,C1776,HCPCS,,79013338,CDM,278,RC,,,both,,,4433,1749.56,39.4668,,1749.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1507.22,34,,1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Device,1507.22,34,"Charges > $500, x 34%",1507.22,percent of total billed charges,Implant Device,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1773.2,40,,1773.2,percent of total billed charges,Implant Devices,1551.55,70,,1551.55,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1507.22,34,,1507.22,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,1551.55,35,,1551.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1507.22,34,"If Charge > 2,000, then 34 percent",1507.22,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1773.2,
ZIMMER 42-5026-074-01 FEMUR LT SIZE 12,C1776,HCPCS,,79013339,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
ZIMMER 42-5121-004-12 ART SURF LT 12MM,C1776,HCPCS,,79013340,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5601-135-14 STEM EXT 11MM,C1776,HCPCS,,79013341,CDM,278,RC,,,both,,,5299,2091.35,39.4668,,2091.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1854.65,35,,1854.65,percent of total billed charges,Implant Device,1801.66,34,"Charges > $500, x 34%",1801.66,percent of total billed charges,Implant Device,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,2119.6,40,,2119.6,percent of total billed charges,Implant Devices,1854.65,70,,1854.65,percent of total billed charges,Implant Devices,1801.66,34,,1801.66,percent of total billed charges,Implant Devices,1801.66,34,,1801.66,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1801.66,34,"If Charge > 2,000, then 34 percent",1801.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2119.6,
ZIMMER 42-5566-058-05 FEM DIS AUG SZ 5 5,C1776,HCPCS,,79013342,CDM,278,RC,,,both,,,3379,1333.58,39.4668,,1333.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1148.86,34,,1148.86,percent of total billed charges,Implant Device,1148.86,34,,1148.86,percent of total billed charges,Implant Device,1148.86,34,,1148.86,percent of total billed charges,Implant Device,1148.86,34,,1148.86,percent of total billed charges,Implant Device,1148.86,34,,1148.86,percent of total billed charges,Implant Device,1148.86,34,,1148.86,percent of total billed charges,Implant Device,1182.65,35,,1182.65,percent of total billed charges,Implant Device,1148.86,34,"Charges > $500, x 34%",1148.86,percent of total billed charges,Implant Device,1182.65,35,,1182.65,percent of total billed charges,Implant Devices,1182.65,35,,1182.65,percent of total billed charges,Implant Devices,1182.65,35,,,percent of total billed charges,Implant Devices,1182.65,35,,1182.65,percent of total billed charges,Implant Devices,1182.65,35,,1182.65,percent of total billed charges,Implant Devices,1351.6,40,,1351.6,percent of total billed charges,Implant Devices,1182.65,70,,1182.65,percent of total billed charges,Implant Devices,1148.86,34,,1148.86,percent of total billed charges,Implant Devices,1148.86,34,,1148.86,percent of total billed charges,Implant Devices,1182.65,35,,1182.65,percent of total billed charges,Implant Devices,1182.65,35,,1182.65,percent of total billed charges,Implant Devices,1182.65,35,,1182.65,percent of total billed charges,Implant Devices,1182.65,35,,1182.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1148.86,34,"If Charge > 2,000, then 34 percent",1148.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1351.6,
ZIMMER 42-5420-071-01 TIBIA LEFT SIZE E,C1776,HCPCS,,79013343,CDM,278,RC,,,both,,,7834,3091.83,39.4668,,3091.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2741.9,35,,2741.9,percent of total billed charges,Implant Device,2663.56,34,"Charges > $500, x 34%",2663.56,percent of total billed charges,Implant Device,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,3133.6,40,,3133.6,percent of total billed charges,Implant Devices,2741.9,70,,2741.9,percent of total billed charges,Implant Devices,2663.56,34,,2663.56,percent of total billed charges,Implant Devices,2663.56,34,,2663.56,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2663.56,34,"If Charge > 2,000, then 34 percent",2663.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3133.6,
ZIMMER 42-5601-135-11 STEM EXTEN 11MM,C1776,HCPCS,,79013344,CDM,278,RC,,,both,,,5299,2091.35,39.4668,,2091.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1854.65,35,,1854.65,percent of total billed charges,Implant Device,1801.66,34,"Charges > $500, x 34%",1801.66,percent of total billed charges,Implant Device,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,2119.6,40,,2119.6,percent of total billed charges,Implant Devices,1854.65,70,,1854.65,percent of total billed charges,Implant Devices,1801.66,34,,1801.66,percent of total billed charges,Implant Devices,1801.66,34,,1801.66,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1801.66,34,"If Charge > 2,000, then 34 percent",1801.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2119.6,
ZIMMER 42-5128-006-14 ART SURF LT 14MM,C1776,HCPCS,,79013345,CDM,278,RC,,,both,,,7680,3031.05,39.4668,,3031.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2688,35,,2688,percent of total billed charges,Implant Device,2611.2,34,"Charges > $500, x 34%",2611.2,percent of total billed charges,Implant Device,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,3072,40,,3072,percent of total billed charges,Implant Devices,2688,70,,2688,percent of total billed charges,Implant Devices,2611.2,34,,2611.2,percent of total billed charges,Implant Devices,2611.2,34,,2611.2,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2611.2,34,"If Charge > 2,000, then 34 percent",2611.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3072,
ZIMMER 42-5450-005-08 TRAB METAL CONE,C1776,HCPCS,,79013346,CDM,278,RC,,,both,,,22176,8752.16,39.4668,,8752.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7539.84,34,,7539.84,percent of total billed charges,Implant Device,7539.84,34,,7539.84,percent of total billed charges,Implant Device,7539.84,34,,7539.84,percent of total billed charges,Implant Device,7539.84,34,,7539.84,percent of total billed charges,Implant Device,7539.84,34,,7539.84,percent of total billed charges,Implant Device,7539.84,34,,7539.84,percent of total billed charges,Implant Device,7761.6,35,,7761.6,percent of total billed charges,Implant Device,7539.84,34,"Charges > $500, x 34%",7539.84,percent of total billed charges,Implant Device,7761.6,35,,7761.6,percent of total billed charges,Implant Devices,7761.6,35,,7761.6,percent of total billed charges,Implant Devices,7761.6,35,,,percent of total billed charges,Implant Devices,7761.6,35,,7761.6,percent of total billed charges,Implant Devices,7761.6,35,,7761.6,percent of total billed charges,Implant Devices,8870.4,40,,8870.4,percent of total billed charges,Implant Devices,7761.6,70,,7761.6,percent of total billed charges,Implant Devices,7539.84,34,,7539.84,percent of total billed charges,Implant Devices,7539.84,34,,7539.84,percent of total billed charges,Implant Devices,7761.6,35,,7761.6,percent of total billed charges,Implant Devices,7761.6,35,,7761.6,percent of total billed charges,Implant Devices,7761.6,35,,7761.6,percent of total billed charges,Implant Devices,7761.6,35,,7761.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7539.84,34,"If Charge > 2,000, then 34 percent",7539.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8870.4,
ZIMMER 42-5046-058-11 FEMUR LEFT SIZE 5+,C1776,HCPCS,,79013347,CDM,278,RC,,,both,,,23424,9244.7,39.4668,,9244.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7964.16,34,,7964.16,percent of total billed charges,Implant Device,7964.16,34,,7964.16,percent of total billed charges,Implant Device,7964.16,34,,7964.16,percent of total billed charges,Implant Device,7964.16,34,,7964.16,percent of total billed charges,Implant Device,7964.16,34,,7964.16,percent of total billed charges,Implant Device,7964.16,34,,7964.16,percent of total billed charges,Implant Device,8198.4,35,,8198.4,percent of total billed charges,Implant Device,7964.16,34,"Charges > $500, x 34%",7964.16,percent of total billed charges,Implant Device,8198.4,35,,8198.4,percent of total billed charges,Implant Devices,8198.4,35,,8198.4,percent of total billed charges,Implant Devices,8198.4,35,,,percent of total billed charges,Implant Devices,8198.4,35,,8198.4,percent of total billed charges,Implant Devices,8198.4,35,,8198.4,percent of total billed charges,Implant Devices,9369.6,40,,9369.6,percent of total billed charges,Implant Devices,8198.4,70,,8198.4,percent of total billed charges,Implant Devices,7964.16,34,,7964.16,percent of total billed charges,Implant Devices,7964.16,34,,7964.16,percent of total billed charges,Implant Devices,8198.4,35,,8198.4,percent of total billed charges,Implant Devices,8198.4,35,,8198.4,percent of total billed charges,Implant Devices,8198.4,35,,8198.4,percent of total billed charges,Implant Devices,8198.4,35,,8198.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7964.16,34,"If Charge > 2,000, then 34 percent",7964.16,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9369.6,
STRYKER 1217-32-050 ACETAB SHELL 50MM,C1776,HCPCS,,79013362,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1368,
J&J 1010-11-050 FEM STEM 12/14 TAPER SZ5,C1776,HCPCS,,79013367,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1504-01-225 ATTUNE FEM SZ 5 5MM,C1776,HCPCS,,79013368,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1504-00-208 FEM SIZE 8 RT,C1776,HCPCS,,79013369,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1516-30-805 TIBIAL INSERT SZ 8 5MM,C1776,HCPCS,,79013370,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
"DJO 952-28-38D BEARING ID28, OD38",C1776,HCPCS,,79013384,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
STRYKER 6720-0330 132 NECK ANGLE HIP STE,C1776,HCPCS,,79013386,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
STRYKER 6260-5-226 FEMORAL HEAD 26X4MM,C1776,HCPCS,,79013387,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
ZIMMER 42-5600-075-14 STEM EXT 14X75MM,C1776,HCPCS,,79013388,CDM,278,RC,,,both,,,4946,1952.03,39.4668,,1952.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1681.64,34,,1681.64,percent of total billed charges,Implant Device,1681.64,34,,1681.64,percent of total billed charges,Implant Device,1681.64,34,,1681.64,percent of total billed charges,Implant Device,1681.64,34,,1681.64,percent of total billed charges,Implant Device,1681.64,34,,1681.64,percent of total billed charges,Implant Device,1681.64,34,,1681.64,percent of total billed charges,Implant Device,1731.1,35,,1731.1,percent of total billed charges,Implant Device,1681.64,34,"Charges > $500, x 34%",1681.64,percent of total billed charges,Implant Device,1731.1,35,,1731.1,percent of total billed charges,Implant Devices,1731.1,35,,1731.1,percent of total billed charges,Implant Devices,1731.1,35,,,percent of total billed charges,Implant Devices,1731.1,35,,1731.1,percent of total billed charges,Implant Devices,1731.1,35,,1731.1,percent of total billed charges,Implant Devices,1978.4,40,,1978.4,percent of total billed charges,Implant Devices,1731.1,70,,1731.1,percent of total billed charges,Implant Devices,1681.64,34,,1681.64,percent of total billed charges,Implant Devices,1681.64,34,,1681.64,percent of total billed charges,Implant Devices,1731.1,35,,1731.1,percent of total billed charges,Implant Devices,1731.1,35,,1731.1,percent of total billed charges,Implant Devices,1731.1,35,,1731.1,percent of total billed charges,Implant Devices,1731.1,35,,1731.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1681.64,34,"If Charge > 2,000, then 34 percent",1681.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1978.4,
ZIMMER 42-5128-007-12 ART SURF LT 12MM,C1776,HCPCS,,79013389,CDM,278,RC,,,both,,,7680,3031.05,39.4668,,3031.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2611.2,34,,2611.2,percent of total billed charges,Implant Device,2688,35,,2688,percent of total billed charges,Implant Device,2611.2,34,"Charges > $500, x 34%",2611.2,percent of total billed charges,Implant Device,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,3072,40,,3072,percent of total billed charges,Implant Devices,2688,70,,2688,percent of total billed charges,Implant Devices,2611.2,34,,2611.2,percent of total billed charges,Implant Devices,2611.2,34,,2611.2,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,2688,35,,2688,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2611.2,34,"If Charge > 2,000, then 34 percent",2611.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3072,
ZIMMER 42-5046-062-01 FEMUR LEFT SIZE 7,C1776,HCPCS,,79013390,CDM,278,RC,,,both,,,21888,8638.49,39.4668,,8638.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7441.92,34,,7441.92,percent of total billed charges,Implant Device,7441.92,34,,7441.92,percent of total billed charges,Implant Device,7441.92,34,,7441.92,percent of total billed charges,Implant Device,7441.92,34,,7441.92,percent of total billed charges,Implant Device,7441.92,34,,7441.92,percent of total billed charges,Implant Device,7441.92,34,,7441.92,percent of total billed charges,Implant Device,7660.8,35,,7660.8,percent of total billed charges,Implant Device,7441.92,34,"Charges > $500, x 34%",7441.92,percent of total billed charges,Implant Device,7660.8,35,,7660.8,percent of total billed charges,Implant Devices,7660.8,35,,7660.8,percent of total billed charges,Implant Devices,7660.8,35,,,percent of total billed charges,Implant Devices,7660.8,35,,7660.8,percent of total billed charges,Implant Devices,7660.8,35,,7660.8,percent of total billed charges,Implant Devices,8755.2,40,,8755.2,percent of total billed charges,Implant Devices,7660.8,70,,7660.8,percent of total billed charges,Implant Devices,7441.92,34,,7441.92,percent of total billed charges,Implant Devices,7441.92,34,,7441.92,percent of total billed charges,Implant Devices,7660.8,35,,7660.8,percent of total billed charges,Implant Devices,7660.8,35,,7660.8,percent of total billed charges,Implant Devices,7660.8,35,,7660.8,percent of total billed charges,Implant Devices,7660.8,35,,7660.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7441.92,34,"If Charge > 2,000, then 34 percent",7441.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8755.2,
ZIMMER 42-5420-075-01 TIB FIXED LT SZ F,C1776,HCPCS,,79013391,CDM,278,RC,,,both,,,7834,3091.83,39.4668,,3091.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2663.56,34,,2663.56,percent of total billed charges,Implant Device,2741.9,35,,2741.9,percent of total billed charges,Implant Device,2663.56,34,"Charges > $500, x 34%",2663.56,percent of total billed charges,Implant Device,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,3133.6,40,,3133.6,percent of total billed charges,Implant Devices,2741.9,70,,2741.9,percent of total billed charges,Implant Devices,2663.56,34,,2663.56,percent of total billed charges,Implant Devices,2663.56,34,,2663.56,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,2741.9,35,,2741.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2663.56,34,"If Charge > 2,000, then 34 percent",2663.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3133.6,
ZIMMER 42-5601-135-12 STEM EXT 12X135MM,C1776,HCPCS,,79013392,CDM,278,RC,,,both,,,5299,2091.35,39.4668,,2091.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1854.65,35,,1854.65,percent of total billed charges,Implant Device,1801.66,34,"Charges > $500, x 34%",1801.66,percent of total billed charges,Implant Device,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,2119.6,40,,2119.6,percent of total billed charges,Implant Devices,1854.65,70,,1854.65,percent of total billed charges,Implant Devices,1801.66,34,,1801.66,percent of total billed charges,Implant Devices,1801.66,34,,1801.66,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1801.66,34,"If Charge > 2,000, then 34 percent",1801.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2119.6,
ZIMMER 42-5601-135-10 STEM EXT 10X135MM,C1776,HCPCS,,79013393,CDM,278,RC,,,both,,,5299,2091.35,39.4668,,2091.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1801.66,34,,1801.66,percent of total billed charges,Implant Device,1854.65,35,,1854.65,percent of total billed charges,Implant Device,1801.66,34,"Charges > $500, x 34%",1801.66,percent of total billed charges,Implant Device,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,2119.6,40,,2119.6,percent of total billed charges,Implant Devices,1854.65,70,,1854.65,percent of total billed charges,Implant Devices,1801.66,34,,1801.66,percent of total billed charges,Implant Devices,1801.66,34,,1801.66,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,1854.65,35,,1854.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1801.66,34,"If Charge > 2,000, then 34 percent",1801.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2119.6,
EXACTECH 300-01-08 HUMERAL STEM 8MM,C1776,HCPCS,,79013402,CDM,278,RC,,,both,,,4425,1746.41,39.4668,,1746.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1504.5,34,,1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Device,1504.5,34,"Charges > $500, x 34%",1504.5,percent of total billed charges,Implant Device,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1770,40,,1770,percent of total billed charges,Implant Devices,1548.75,70,,1548.75,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1504.5,34,,1504.5,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,1548.75,35,,1548.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1504.5,34,"If Charge > 2,000, then 34 percent",1504.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1770,
J&J 1516-30-506 ATTUNE TIB INS SZ 5 6MM,C1776,HCPCS,,79013411,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1504-00-124 ATTUNE FEMORAL SZ 4N LT,C1776,HCPCS,,79013412,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1506-80-002 ATTUNE TIB INS SZ 4 8MM,C1776,HCPCS,,79013413,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
J&J 1010-11-110 FEMORAL STEM SIZE 11,C1776,HCPCS,,79013425,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1504-10-108 ATTUNE FEMORAL SIZE 8 LT,C1776,HCPCS,,79013426,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1516-50-810 TIBIAL INSERT SZ 8 10MM,C1776,HCPCS,,79013427,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1010-11-030 FEMORAL STEM SIZE 3,C1776,HCPCS,,79013435,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
DJO 940-01-50E ACETABULAR CUP 50MM,C1776,HCPCS,,79013486,CDM,278,RC,,,both,,,4362,1721.54,39.4668,,1721.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1483.08,34,,1483.08,percent of total billed charges,Implant Device,1526.7,35,,1526.7,percent of total billed charges,Implant Device,1483.08,34,"Charges > $500, x 34%",1483.08,percent of total billed charges,Implant Device,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1744.8,40,,1744.8,percent of total billed charges,Implant Devices,1526.7,70,,1526.7,percent of total billed charges,Implant Devices,1483.08,34,,1483.08,percent of total billed charges,Implant Devices,1483.08,34,,1483.08,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,1526.7,35,,1526.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1483.08,34,"If Charge > 2,000, then 34 percent",1483.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1744.8,
DJO 951-01-40E EMPOWER METAL LINER,C1776,HCPCS,,79013487,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
DJO 952-28-40E EMPOWER POLY BEARING,C1776,HCPCS,,79013488,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
DJO D111-18-1104 ORIGIN HIP STEM SIZE 11,C1776,HCPCS,,79013489,CDM,278,RC,,,both,,,7320,2888.97,39.4668,,2888.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2488.8,34,,2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Device,2488.8,34,"Charges > $500, x 34%",2488.8,percent of total billed charges,Implant Device,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2928,40,,2928,percent of total billed charges,Implant Devices,2562,70,,2562,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2488.8,34,,2488.8,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,2562,35,,2562,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2488.8,34,"If Charge > 2,000, then 34 percent",2488.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2928,
J&J 1504-01-106 FEMORAL POROCOAT LT SZ 6,C1776,HCPCS,,79013490,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1516-30-605 TIBIAL INSERT 5MM SIZE 6,C1776,HCPCS,,79013491,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1365-32-720 CERAMIC FEMORAL HEAD 32,C1776,HCPCS,,79013502,CDM,278,RC,,,both,,,10476,4134.54,39.4668,,4134.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3561.84,34,,3561.84,percent of total billed charges,Implant Device,3666.6,35,,3666.6,percent of total billed charges,Implant Device,3561.84,34,"Charges > $500, x 34%",3561.84,percent of total billed charges,Implant Device,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,4190.4,40,,4190.4,percent of total billed charges,Implant Devices,3666.6,70,,3666.6,percent of total billed charges,Implant Devices,3561.84,34,,3561.84,percent of total billed charges,Implant Devices,3561.84,34,,3561.84,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,3666.6,35,,3666.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3561.84,34,"If Charge > 2,000, then 34 percent",3561.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4190.4,
EXACTECH 320-00-11 HUM AUG TRAY +0MM LT,C1776,HCPCS,,79013503,CDM,278,RC,,,both,,,13500,5328.02,39.4668,,5328.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Device,4590,34,"Charges > $500, x 34%",4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,5400,40,,5400,percent of total billed charges,Implant Devices,4725,70,,4725,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4590,34,"If Charge > 2,000, then 34 percent",4590,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5400,
J&J 1975-20-095 CONICAL PROZ BODY 20X95,C1776,HCPCS,,79013504,CDM,278,RC,,,both,,,19322,7625.78,39.4668,,7625.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6569.48,34,,6569.48,percent of total billed charges,Implant Device,6762.7,35,,6762.7,percent of total billed charges,Implant Device,6569.48,34,"Charges > $500, x 34%",6569.48,percent of total billed charges,Implant Device,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,7728.8,40,,7728.8,percent of total billed charges,Implant Devices,6762.7,70,,6762.7,percent of total billed charges,Implant Devices,6569.48,34,,6569.48,percent of total billed charges,Implant Devices,6569.48,34,,6569.48,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,6762.7,35,,6762.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6569.48,34,"If Charge > 2,000, then 34 percent",6569.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7728.8,
J&J 1976-16-140 DIS TAPERED STEM 16X140,C1776,HCPCS,,79013505,CDM,278,RC,,,both,,,15708,6199.44,39.4668,,6199.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5340.72,34,,5340.72,percent of total billed charges,Implant Device,5340.72,34,,5340.72,percent of total billed charges,Implant Device,5340.72,34,,5340.72,percent of total billed charges,Implant Device,5340.72,34,,5340.72,percent of total billed charges,Implant Device,5340.72,34,,5340.72,percent of total billed charges,Implant Device,5340.72,34,,5340.72,percent of total billed charges,Implant Device,5497.8,35,,5497.8,percent of total billed charges,Implant Device,5340.72,34,"Charges > $500, x 34%",5340.72,percent of total billed charges,Implant Device,5497.8,35,,5497.8,percent of total billed charges,Implant Devices,5497.8,35,,5497.8,percent of total billed charges,Implant Devices,5497.8,35,,,percent of total billed charges,Implant Devices,5497.8,35,,5497.8,percent of total billed charges,Implant Devices,5497.8,35,,5497.8,percent of total billed charges,Implant Devices,6283.2,40,,6283.2,percent of total billed charges,Implant Devices,5497.8,70,,5497.8,percent of total billed charges,Implant Devices,5340.72,34,,5340.72,percent of total billed charges,Implant Devices,5340.72,34,,5340.72,percent of total billed charges,Implant Devices,5497.8,35,,5497.8,percent of total billed charges,Implant Devices,5497.8,35,,5497.8,percent of total billed charges,Implant Devices,5497.8,35,,5497.8,percent of total billed charges,Implant Devices,5497.8,35,,5497.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5340.72,34,"If Charge > 2,000, then 34 percent",5340.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6283.2,
J&J 1504-10-103 ATTUNE FEMORAL SIZE 3 LT,C1776,HCPCS,,79013508,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1516-50-312 ATTUNE TIB INS SZ 3 12MM,C1776,HCPCS,,79013509,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1504-40-205 ATTUNE REV CRS FEM SZ 5,C1776,HCPCS,,79013510,CDM,278,RC,,,both,,,21434,8459.31,39.4668,,8459.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7501.9,35,,7501.9,percent of total billed charges,Implant Device,7287.56,34,"Charges > $500, x 34%",7287.56,percent of total billed charges,Implant Device,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,8573.6,40,,8573.6,percent of total billed charges,Implant Devices,7501.9,70,,7501.9,percent of total billed charges,Implant Devices,7287.56,34,,7287.56,percent of total billed charges,Implant Devices,7287.56,34,,7287.56,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7287.56,34,"If Charge > 2,000, then 34 percent",7287.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8573.6,
J&J 1506-60-004 ATTUNE REV TIB BASE SZ 4,C1776,HCPCS,,79013511,CDM,278,RC,,,both,,,15558,6140.24,39.4668,,6140.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5289.72,34,,5289.72,percent of total billed charges,Implant Device,5445.3,35,,5445.3,percent of total billed charges,Implant Device,5289.72,34,"Charges > $500, x 34%",5289.72,percent of total billed charges,Implant Device,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,6223.2,40,,6223.2,percent of total billed charges,Implant Devices,5445.3,70,,5445.3,percent of total billed charges,Implant Devices,5289.72,34,,5289.72,percent of total billed charges,Implant Devices,5289.72,34,,5289.72,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,5445.3,35,,5445.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5289.72,34,"If Charge > 2,000, then 34 percent",5289.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6223.2,
J&J 1511-11-102 ATTUNE REV TIB SLEEVE 37,C1776,HCPCS,,79013512,CDM,278,RC,,,both,,,11771,4645.64,39.4668,,4645.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4119.85,35,,4119.85,percent of total billed charges,Implant Device,4002.14,34,"Charges > $500, x 34%",4002.14,percent of total billed charges,Implant Device,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4708.4,40,,4708.4,percent of total billed charges,Implant Devices,4119.85,70,,4119.85,percent of total billed charges,Implant Devices,4002.14,34,,4002.14,percent of total billed charges,Implant Devices,4002.14,34,,4002.14,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4002.14,34,"If Charge > 2,000, then 34 percent",4002.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4708.4,
J&J 1512-14-080 ATTUNE REV CEMENT STEM,C1776,HCPCS,,79013513,CDM,278,RC,,,both,,,3315,1308.32,39.4668,,1308.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1127.1,34,,1127.1,percent of total billed charges,Implant Device,1160.25,35,,1160.25,percent of total billed charges,Implant Device,1127.1,34,"Charges > $500, x 34%",1127.1,percent of total billed charges,Implant Device,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1326,40,,1326,percent of total billed charges,Implant Devices,1160.25,70,,1160.25,percent of total billed charges,Implant Devices,1127.1,34,,1127.1,percent of total billed charges,Implant Devices,1127.1,34,,1127.1,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,1160.25,35,,1160.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1127.1,34,"If Charge > 2,000, then 34 percent",1127.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1326,
J&J 1513-18-060 ATTUNE REV PRESSFIT STEM,C1776,HCPCS,,79013514,CDM,278,RC,,,both,,,5239,2067.67,39.4668,,2067.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1833.65,35,,1833.65,percent of total billed charges,Implant Device,1781.26,34,"Charges > $500, x 34%",1781.26,percent of total billed charges,Implant Device,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,2095.6,40,,2095.6,percent of total billed charges,Implant Devices,1833.65,70,,1833.65,percent of total billed charges,Implant Devices,1781.26,34,,1781.26,percent of total billed charges,Implant Devices,1781.26,34,,1781.26,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1781.26,34,"If Charge > 2,000, then 34 percent",1781.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2095.6,
J&J 1504-10-125 ATTUNE FEM SZ 5N LEFT,C1776,HCPCS,,79013515,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1517-10-512 ATTUNE REV CRS INS SZ 5,C1776,HCPCS,,79013516,CDM,278,RC,,,both,,,9286,3664.89,39.4668,,3664.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3250.1,35,,3250.1,percent of total billed charges,Implant Device,3157.24,34,"Charges > $500, x 34%",3157.24,percent of total billed charges,Implant Device,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3714.4,40,,3714.4,percent of total billed charges,Implant Devices,3250.1,70,,3250.1,percent of total billed charges,Implant Devices,3157.24,34,,3157.24,percent of total billed charges,Implant Devices,3157.24,34,,3157.24,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3157.24,34,"If Charge > 2,000, then 34 percent",3157.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3714.4,
J&J 1517-10-518 ATTUNE REVISION INS SZ 5,C1776,HCPCS,,79013517,CDM,278,RC,,,both,,,9286,3664.89,39.4668,,3664.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3250.1,35,,3250.1,percent of total billed charges,Implant Device,3157.24,34,"Charges > $500, x 34%",3157.24,percent of total billed charges,Implant Device,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3714.4,40,,3714.4,percent of total billed charges,Implant Devices,3250.1,70,,3250.1,percent of total billed charges,Implant Devices,3157.24,34,,3157.24,percent of total billed charges,Implant Devices,3157.24,34,,3157.24,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3157.24,34,"If Charge > 2,000, then 34 percent",3157.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3714.4,
EXACTECH 320-05-22 HML AUGMT TRY +5MM RT,C1776,HCPCS,,79013541,CDM,278,RC,,,both,,,13500,5328.02,39.4668,,5328.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Device,4590,34,"Charges > $500, x 34%",4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,5400,40,,5400,percent of total billed charges,Implant Devices,4725,70,,4725,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4590,34,"If Charge > 2,000, then 34 percent",4590,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5400,
ZIM US INC 42-5221-007-11 ART SF RT 11MM,C1776,HCPCS,,79013542,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
ZIM US INC 42-5726-062-02 FEM RT SIZE 7,C1776,HCPCS,,79013543,CDM,278,RC,,,both,,,7104,2803.72,39.4668,,2803.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2415.36,34,,2415.36,percent of total billed charges,Implant Device,2486.4,35,,2486.4,percent of total billed charges,Implant Device,2415.36,34,"Charges > $500, x 34%",2415.36,percent of total billed charges,Implant Device,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2841.6,40,,2841.6,percent of total billed charges,Implant Devices,2486.4,70,,2486.4,percent of total billed charges,Implant Devices,2415.36,34,,2415.36,percent of total billed charges,Implant Devices,2415.36,34,,2415.36,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,2486.4,35,,2486.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2415.36,34,"If Charge > 2,000, then 34 percent",2415.36,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2841.6,
J&J 1504-00-206 ATTUNE FEMORAL RT SZ 6,C1776,HCPCS,,79013544,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1010-12-030 FEMORAL STEM SIZE 3,C1776,HCPCS,,79013548,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1516-30-606 TIBIAL INSERT 6MM SIZE 6,C1776,HCPCS,,79013549,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1504-01-104 ATTUNE FEMORAL LT SZ 4,C1776,HCPCS,,79013550,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1218-50-043 DUAL LINER W/ACE SHELL,C1776,HCPCS,,79013563,CDM,278,RC,,,both,,,3465,1367.52,39.4668,,1367.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1178.1,34,,1178.1,percent of total billed charges,Implant Device,1212.75,35,,1212.75,percent of total billed charges,Implant Device,1178.1,34,"Charges > $500, x 34%",1178.1,percent of total billed charges,Implant Device,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1386,40,,1386,percent of total billed charges,Implant Devices,1212.75,70,,1212.75,percent of total billed charges,Implant Devices,1178.1,34,,1178.1,percent of total billed charges,Implant Devices,1178.1,34,,1178.1,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,1212.75,35,,1212.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1178.1,34,"If Charge > 2,000, then 34 percent",1178.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1386,
J&J 1221-22-043 ALTRX LINER 43/22,C1776,HCPCS,,79013564,CDM,278,RC,,,both,,,3506,1383.71,39.4668,,1383.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1227.1,35,,1227.1,percent of total billed charges,Implant Device,1192.04,34,"Charges > $500, x 34%",1192.04,percent of total billed charges,Implant Device,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1402.4,40,,1402.4,percent of total billed charges,Implant Devices,1227.1,70,,1227.1,percent of total billed charges,Implant Devices,1192.04,34,,1192.04,percent of total billed charges,Implant Devices,1192.04,34,,1192.04,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1192.04,34,"If Charge > 2,000, then 34 percent",1192.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1402.4,
J&J 1365-30-000 FEMORAL HEAD 12/14 TAPER,C1776,HCPCS,,79013565,CDM,278,RC,,,both,,,1710,674.88,39.4668,,674.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,581.4,34,,581.4,percent of total billed charges,Implant Device,598.5,35,,598.5,percent of total billed charges,Implant Device,581.4,34,"Charges > $500, x 34%",581.4,percent of total billed charges,Implant Device,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,684,40,,684,percent of total billed charges,Implant Devices,598.5,70,,598.5,percent of total billed charges,Implant Devices,581.4,34,,581.4,percent of total billed charges,Implant Devices,581.4,34,,581.4,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,598.5,35,,598.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,684,
J&J 1516-30-708 TIBIAL INSERT SZ 7 8MM,C1776,HCPCS,,79013566,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
ZIMMER 11-300913 DIS STEM 13X190 W/ SRW,C1776,HCPCS,,79013600,CDM,278,RC,,,both,,,10199,4025.22,39.4668,,4025.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3467.66,34,,3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Device,3467.66,34,"Charges > $500, x 34%",3467.66,percent of total billed charges,Implant Device,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,4079.6,40,,4079.6,percent of total billed charges,Implant Devices,3569.65,70,,3569.65,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3467.66,34,,3467.66,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,3569.65,35,,3569.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3467.66,34,"If Charge > 2,000, then 34 percent",3467.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4079.6,
ZIMMER 11-301322 CONE PROX BODY SZ B 70,C1776,HCPCS,,79013601,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
DJO 506-03-126 LOCKING SCREW 5X28MM,C1776,HCPCS,,79013603,CDM,278,RC,,,both,,,360,142.08,39.4668,,142.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,122.4,34,,122.4,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,144,40,,144,percent of total billed charges,Implant Devices,126,70,,126,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,122.4,34,,122.4,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,126,35,,126,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,144,
DJO 509-02-432 SOCKET INSERT 32MM,C1776,HCPCS,,79013604,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
J&J 1504-00-107 ATTUNE FEMORAL SIZE 7 LT,C1776,HCPCS,,79013609,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
ZIMMER 42-5020-060-01 FEMUR NARW LT SZ 6,C1776,HCPCS,,79013620,CDM,278,RC,,,both,,,6300,2486.41,39.4668,,2486.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2142,34,,2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Device,2142,34,"Charges > $500, x 34%",2142,percent of total billed charges,Implant Device,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2520,40,,2520,percent of total billed charges,Implant Devices,2205,70,,2205,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2142,34,,2142,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,2205,35,,2205,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2142,34,"If Charge > 2,000, then 34 percent",2142,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2520,
EXACTECH 310-02-44 HUM HEAD TALL 44MM,C1776,HCPCS,,79013659,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
J&J 150401204 ATTUNE FEMORAL RIGHT SZ 4,C1776,HCPCS,,79013661,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 151630406 ATTUNE TIBIAL INSERT SZ 4,C1776,HCPCS,,79013662,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 150400105 ATTUNE FEMORAL LT SIZE 5,C1776,HCPCS,,79013663,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 101012080 ACTIS FEMORAL STEM SIZE 8,C1776,HCPCS,,79013664,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 121732060 ACEBULAR SHELL 60MM,C1776,HCPCS,,79013665,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1368,
J&J 122140060 ACETABULAR LINER 40X60MM,C1776,HCPCS,,79013666,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
ZIMMER 110031010 CROSSLINK BEARING 28X40,C1776,HCPCS,,79013672,CDM,278,RC,,,both,,,3456,1363.97,39.4668,,1363.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1175.04,34,,1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Device,1175.04,34,"Charges > $500, x 34%",1175.04,percent of total billed charges,Implant Device,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1382.4,40,,1382.4,percent of total billed charges,Implant Devices,1209.6,70,,1209.6,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1175.04,34,,1175.04,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,1209.6,35,,1209.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1175.04,34,"If Charge > 2,000, then 34 percent",1175.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1382.4,
ZIMMER 650-1159 CERAMIC HEAD 28-3MM NECK,C1776,HCPCS,,79013673,CDM,278,RC,,,both,,,2880,1136.64,39.4668,,1136.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,979.2,34,,979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Device,979.2,34,"Charges > $500, x 34%",979.2,percent of total billed charges,Implant Device,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1152,40,,1152,percent of total billed charges,Implant Devices,1008,70,,1008,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,979.2,34,,979.2,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,1008,35,,1008,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,979.2,34,"If Charge > 2,000, then 34 percent",979.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1152,
ZIMMER 110024462 ACETAULAR LINER 40 SZD,C1776,HCPCS,,79013674,CDM,278,RC,,,both,,,3840,1515.53,39.4668,,1515.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1305.6,34,,1305.6,percent of total billed charges,Implant Device,1344,35,,1344,percent of total billed charges,Implant Device,1305.6,34,"Charges > $500, x 34%",1305.6,percent of total billed charges,Implant Device,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1536,40,,1536,percent of total billed charges,Implant Devices,1344,70,,1344,percent of total billed charges,Implant Devices,1305.6,34,,1305.6,percent of total billed charges,Implant Devices,1305.6,34,,1305.6,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,1344,35,,1344,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1305.6,34,"If Charge > 2,000, then 34 percent",1305.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1536,
J&J 1221-32-148 ACETAB SHELL SECTOR 48MM,C1776,HCPCS,,79013680,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
J&J 1504-00-207 ATTUNE FEMORAL SZ 7 RT,C1776,HCPCS,,79013690,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1504-01-206 ATTUNE FEMORAL SZ 6 RT,C1776,HCPCS,,79013691,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 150401207 ATTUNE FEMORAL SIZE 7 RT,C1776,HCPCS,,79013695,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1504-01-205 ATTUNE FEMORAL SIZE 5 RT,C1776,HCPCS,,79013698,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1516-30-608 TIBIAL INSERT SIZE 6 8MM,C1776,HCPCS,,79013699,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
EXACTECH 320-00-02 HUM AUGMENTED TRAY,C1776,HCPCS,,79013700,CDM,278,RC,,,both,,,13500,5328.02,39.4668,,5328.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4590,34,,4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Device,4590,34,"Charges > $500, x 34%",4590,percent of total billed charges,Implant Device,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,5400,40,,5400,percent of total billed charges,Implant Devices,4725,70,,4725,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4590,34,,4590,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,4725,35,,4725,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4590,34,"If Charge > 2,000, then 34 percent",4590,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5400,
J&J 151630508 ATTUNE TIB INSERT SZ 5 8MM,C1776,HCPCS,,79013701,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1516-50-712 TIBIAL INSERT SZ 7 12MM,C1776,HCPCS,,79013704,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1516-50-906 TIBIAL INSERT SZ 9 6MM,C1776,HCPCS,,79013710,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1010-11-100 FEMORAL STEM SIZE 10,C1776,HCPCS,,79013730,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
STRYKER 5901-6056 HUM CUP TRAIL ADAPTOR,C1776,HCPCS,,79013752,CDM,278,RC,,,both,,,1767,697.38,39.4668,,697.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,600.78,34,,600.78,percent of total billed charges,Implant Device,618.45,35,,618.45,percent of total billed charges,Implant Device,600.78,34,"Charges > $500, x 34%",600.78,percent of total billed charges,Implant Device,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,706.8,40,,706.8,percent of total billed charges,Implant Devices,618.45,70,,618.45,percent of total billed charges,Implant Devices,600.78,34,,600.78,percent of total billed charges,Implant Devices,600.78,34,,600.78,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,618.45,35,,618.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,706.8,
STRYKER 5571-S-3210 HUMERAL INS 32X10MM,C1776,HCPCS,,79013753,CDM,278,RC,,,both,,,3525,1391.2,39.4668,,1391.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Device,1198.5,34,"Charges > $500, x 34%",1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1410,40,,1410,percent of total billed charges,Implant Devices,1233.75,70,,1233.75,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1198.5,34,"If Charge > 2,000, then 34 percent",1198.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1410,
J&J 1504-00-106 ATTUNE FEMORAL SZ 6 LT,C1776,HCPCS,,79013754,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1516-30-612 ATTUNE TIB INS SZ 6 12MM,C1776,HCPCS,,79013755,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1504-01-108 ATTUNE FEMORAL SZ 8 LT,C1776,HCPCS,,79013756,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
J&J 1516-30-807 ATTUNE TIB INS SZ 8 7MM,C1776,HCPCS,,79013757,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
ZIMMER 42-5221-008-13 ART SURF RT 13MM,C1776,HCPCS,,79013774,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
ZIMMER 42-5121-008-16 ART SURF LT 18MM,C1776,HCPCS,,79013775,CDM,278,RC,,,both,,,3648,1439.75,39.4668,,1439.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1240.32,34,,1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Device,1240.32,34,"Charges > $500, x 34%",1240.32,percent of total billed charges,Implant Device,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1459.2,40,,1459.2,percent of total billed charges,Implant Devices,1276.8,70,,1276.8,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1240.32,34,,1240.32,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,1276.8,35,,1276.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1240.32,34,"If Charge > 2,000, then 34 percent",1240.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1459.2,
STRYKER 6495-2-115 GMRS AXLE SMALL,C1776,HCPCS,,79013803,CDM,278,RC,,,both,,,2670,1053.76,39.4668,,1053.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,907.8,34,,907.8,percent of total billed charges,Implant Device,934.5,35,,934.5,percent of total billed charges,Implant Device,907.8,34,"Charges > $500, x 34%",907.8,percent of total billed charges,Implant Device,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,1068,40,,1068,percent of total billed charges,Implant Devices,934.5,70,,934.5,percent of total billed charges,Implant Devices,907.8,34,,907.8,percent of total billed charges,Implant Devices,907.8,34,,907.8,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,934.5,35,,934.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,907.8,34,"If Charge > 2,000, then 34 percent",907.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1068,
STRYKER 5612-4-003 HINGE BUMPER +3 DEG,C1776,HCPCS,,79013805,CDM,278,RC,,,both,,,3263,1287.8,39.4668,,1287.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1109.42,34,,1109.42,percent of total billed charges,Implant Device,1109.42,34,,1109.42,percent of total billed charges,Implant Device,1109.42,34,,1109.42,percent of total billed charges,Implant Device,1109.42,34,,1109.42,percent of total billed charges,Implant Device,1109.42,34,,1109.42,percent of total billed charges,Implant Device,1109.42,34,,1109.42,percent of total billed charges,Implant Device,1142.05,35,,1142.05,percent of total billed charges,Implant Device,1109.42,34,"Charges > $500, x 34%",1109.42,percent of total billed charges,Implant Device,1142.05,35,,1142.05,percent of total billed charges,Implant Devices,1142.05,35,,1142.05,percent of total billed charges,Implant Devices,1142.05,35,,,percent of total billed charges,Implant Devices,1142.05,35,,1142.05,percent of total billed charges,Implant Devices,1142.05,35,,1142.05,percent of total billed charges,Implant Devices,1305.2,40,,1305.2,percent of total billed charges,Implant Devices,1142.05,70,,1142.05,percent of total billed charges,Implant Devices,1109.42,34,,1109.42,percent of total billed charges,Implant Devices,1109.42,34,,1109.42,percent of total billed charges,Implant Devices,1142.05,35,,1142.05,percent of total billed charges,Implant Devices,1142.05,35,,1142.05,percent of total billed charges,Implant Devices,1142.05,35,,1142.05,percent of total billed charges,Implant Devices,1142.05,35,,1142.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1109.42,34,"If Charge > 2,000, then 34 percent",1109.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1305.2,
STRYKER 5612-B-500 REV TIB BASEPLT SZ 5,C1776,HCPCS,,79013806,CDM,278,RC,,,both,,,15530,6129.19,39.4668,,6129.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5280.2,34,,5280.2,percent of total billed charges,Implant Device,5280.2,34,,5280.2,percent of total billed charges,Implant Device,5280.2,34,,5280.2,percent of total billed charges,Implant Device,5280.2,34,,5280.2,percent of total billed charges,Implant Device,5280.2,34,,5280.2,percent of total billed charges,Implant Device,5280.2,34,,5280.2,percent of total billed charges,Implant Device,5435.5,35,,5435.5,percent of total billed charges,Implant Device,5280.2,34,"Charges > $500, x 34%",5280.2,percent of total billed charges,Implant Device,5435.5,35,,5435.5,percent of total billed charges,Implant Devices,5435.5,35,,5435.5,percent of total billed charges,Implant Devices,5435.5,35,,,percent of total billed charges,Implant Devices,5435.5,35,,5435.5,percent of total billed charges,Implant Devices,5435.5,35,,5435.5,percent of total billed charges,Implant Devices,6212,40,,6212,percent of total billed charges,Implant Devices,5435.5,70,,5435.5,percent of total billed charges,Implant Devices,5280.2,34,,5280.2,percent of total billed charges,Implant Devices,5280.2,34,,5280.2,percent of total billed charges,Implant Devices,5435.5,35,,5435.5,percent of total billed charges,Implant Devices,5435.5,35,,5435.5,percent of total billed charges,Implant Devices,5435.5,35,,5435.5,percent of total billed charges,Implant Devices,5435.5,35,,5435.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5280.2,34,"If Charge > 2,000, then 34 percent",5280.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6212,
STRYKER 5531-G-711-E TIB BEAR INS 11MM,C1776,HCPCS,,79013810,CDM,278,RC,,,both,,,2781,1097.57,39.4668,,1097.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Device,945.54,34,"Charges > $500, x 34%",945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,1112.4,40,,1112.4,percent of total billed charges,Implant Devices,973.35,70,,973.35,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.54,34,"If Charge > 2,000, then 34 percent",945.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112.4,
EXACTECH 312-01-44 RESURFACING HUM HEAD,C1776,HCPCS,,79013811,CDM,278,RC,,,both,,,9240,3646.73,39.4668,,3646.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3141.6,34,,3141.6,percent of total billed charges,Implant Device,3141.6,34,,3141.6,percent of total billed charges,Implant Device,3141.6,34,,3141.6,percent of total billed charges,Implant Device,3141.6,34,,3141.6,percent of total billed charges,Implant Device,3141.6,34,,3141.6,percent of total billed charges,Implant Device,3141.6,34,,3141.6,percent of total billed charges,Implant Device,3234,35,,3234,percent of total billed charges,Implant Device,3141.6,34,"Charges > $500, x 34%",3141.6,percent of total billed charges,Implant Device,3234,35,,3234,percent of total billed charges,Implant Devices,3234,35,,3234,percent of total billed charges,Implant Devices,3234,35,,,percent of total billed charges,Implant Devices,3234,35,,3234,percent of total billed charges,Implant Devices,3234,35,,3234,percent of total billed charges,Implant Devices,3696,40,,3696,percent of total billed charges,Implant Devices,3234,70,,3234,percent of total billed charges,Implant Devices,3141.6,34,,3141.6,percent of total billed charges,Implant Devices,3141.6,34,,3141.6,percent of total billed charges,Implant Devices,3234,35,,3234,percent of total billed charges,Implant Devices,3234,35,,3234,percent of total billed charges,Implant Devices,3234,35,,3234,percent of total billed charges,Implant Devices,3234,35,,3234,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3141.6,34,"If Charge > 2,000, then 34 percent",3141.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3696,
EXACTECH 312-01-01 RESURFACING CAGE 25MM,C1776,HCPCS,,79013812,CDM,278,RC,,,both,,,1665,657.12,39.4668,,657.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,566.1,34,,566.1,percent of total billed charges,Implant Device,566.1,34,,566.1,percent of total billed charges,Implant Device,566.1,34,,566.1,percent of total billed charges,Implant Device,566.1,34,,566.1,percent of total billed charges,Implant Device,566.1,34,,566.1,percent of total billed charges,Implant Device,566.1,34,,566.1,percent of total billed charges,Implant Device,582.75,35,,582.75,percent of total billed charges,Implant Device,566.1,34,"Charges > $500, x 34%",566.1,percent of total billed charges,Implant Device,582.75,35,,582.75,percent of total billed charges,Implant Devices,582.75,35,,582.75,percent of total billed charges,Implant Devices,582.75,35,,,percent of total billed charges,Implant Devices,582.75,35,,582.75,percent of total billed charges,Implant Devices,582.75,35,,582.75,percent of total billed charges,Implant Devices,666,40,,666,percent of total billed charges,Implant Devices,582.75,70,,582.75,percent of total billed charges,Implant Devices,566.1,34,,566.1,percent of total billed charges,Implant Devices,566.1,34,,566.1,percent of total billed charges,Implant Devices,582.75,35,,582.75,percent of total billed charges,Implant Devices,582.75,35,,582.75,percent of total billed charges,Implant Devices,582.75,35,,582.75,percent of total billed charges,Implant Devices,582.75,35,,582.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,666,
J&J 1504-10-209 ATTUNE FEMORAL SIZE 9,C1776,HCPCS,,79013815,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1506-80-009 ATTUNE TIBIAL BASE SZ 9,C1776,HCPCS,,79013816,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
J&J 1010-12-020 FEMORAL STEM SIZE 2,C1776,HCPCS,,79013820,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
ZIMMER 42-5121-008-11 ART SURF LT 11MM,C1776,HCPCS,,79013825,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
ZIMMER 42-5121-007-13 ART SURF LT 13MM,C1776,HCPCS,,79013827,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
ZIMMER 42-5121-007-16 ART SURF LT 16MM,C1776,HCPCS,,79013828,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
J&J 1010-12-070 FEM STEM 12.14 TAP SZ 7,C1776,HCPCS,,79013831,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 136540730 FEMORAL HEAD 40MM +8.5,C1776,HCPCS,,79013832,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
J&J 1010-12-110 FEM STEM 12/14 TAP SZ 11,C1776,HCPCS,,79013833,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1221-40-158 ACE LINER +4 10DEG 40X58,C1776,HCPCS,,79013834,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
ARTHREX 1035-40-000 BI-POLAR HEAD 40X28,C1776,HCPCS,,79013839,CDM,278,RC,,,both,,,1733,683.96,39.4668,,683.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,589.22,34,,589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Device,589.22,34,"Charges > $500, x 34%",589.22,percent of total billed charges,Implant Device,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,693.2,40,,693.2,percent of total billed charges,Implant Devices,606.55,70,,606.55,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,589.22,34,,589.22,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,606.55,35,,606.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,693.2,
J&J 150440106 ATTUNE REV CRS FEM LT SZ 6,C1776,HCPCS,,79013853,CDM,278,RC,,,both,,,21434,8459.31,39.4668,,8459.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7287.56,34,,7287.56,percent of total billed charges,Implant Device,7501.9,35,,7501.9,percent of total billed charges,Implant Device,7287.56,34,"Charges > $500, x 34%",7287.56,percent of total billed charges,Implant Device,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,8573.6,40,,8573.6,percent of total billed charges,Implant Devices,7501.9,70,,7501.9,percent of total billed charges,Implant Devices,7287.56,34,,7287.56,percent of total billed charges,Implant Devices,7287.56,34,,7287.56,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,7501.9,35,,7501.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7287.56,34,"If Charge > 2,000, then 34 percent",7287.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8573.6,
J&J 151101204 ATTUNE REV FEM SLEEVE 40MM,C1776,HCPCS,,79013854,CDM,278,RC,,,both,,,10428,4115.6,39.4668,,4115.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3545.52,34,,3545.52,percent of total billed charges,Implant Device,3545.52,34,,3545.52,percent of total billed charges,Implant Device,3545.52,34,,3545.52,percent of total billed charges,Implant Device,3545.52,34,,3545.52,percent of total billed charges,Implant Device,3545.52,34,,3545.52,percent of total billed charges,Implant Device,3545.52,34,,3545.52,percent of total billed charges,Implant Device,3649.8,35,,3649.8,percent of total billed charges,Implant Device,3545.52,34,"Charges > $500, x 34%",3545.52,percent of total billed charges,Implant Device,3649.8,35,,3649.8,percent of total billed charges,Implant Devices,3649.8,35,,3649.8,percent of total billed charges,Implant Devices,3649.8,35,,,percent of total billed charges,Implant Devices,3649.8,35,,3649.8,percent of total billed charges,Implant Devices,3649.8,35,,3649.8,percent of total billed charges,Implant Devices,4171.2,40,,4171.2,percent of total billed charges,Implant Devices,3649.8,70,,3649.8,percent of total billed charges,Implant Devices,3545.52,34,,3545.52,percent of total billed charges,Implant Devices,3545.52,34,,3545.52,percent of total billed charges,Implant Devices,3649.8,35,,3649.8,percent of total billed charges,Implant Devices,3649.8,35,,3649.8,percent of total billed charges,Implant Devices,3649.8,35,,3649.8,percent of total billed charges,Implant Devices,3649.8,35,,3649.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3545.52,34,"If Charge > 2,000, then 34 percent",3545.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4171.2,
J&J 151111202 ATTUNE REV TIB SLEEVE 37MM,C1776,HCPCS,,79013855,CDM,278,RC,,,both,,,11771,4645.64,39.4668,,4645.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4002.14,34,,4002.14,percent of total billed charges,Implant Device,4119.85,35,,4119.85,percent of total billed charges,Implant Device,4002.14,34,"Charges > $500, x 34%",4002.14,percent of total billed charges,Implant Device,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4708.4,40,,4708.4,percent of total billed charges,Implant Devices,4119.85,70,,4119.85,percent of total billed charges,Implant Devices,4002.14,34,,4002.14,percent of total billed charges,Implant Devices,4002.14,34,,4002.14,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,4119.85,35,,4119.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4002.14,34,"If Charge > 2,000, then 34 percent",4002.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4708.4,
J&J 151314060 REV PRESSFIT STEM 14X60MM,C1776,HCPCS,,79013856,CDM,278,RC,,,both,,,5239,2067.67,39.4668,,2067.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1833.65,35,,1833.65,percent of total billed charges,Implant Device,1781.26,34,"Charges > $500, x 34%",1781.26,percent of total billed charges,Implant Device,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,2095.6,40,,2095.6,percent of total billed charges,Implant Devices,1833.65,70,,1833.65,percent of total billed charges,Implant Devices,1781.26,34,,1781.26,percent of total billed charges,Implant Devices,1781.26,34,,1781.26,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1781.26,34,"If Charge > 2,000, then 34 percent",1781.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2095.6,
J&J 151316060 REV PRESSFIT STEM 16X60MM,C1776,HCPCS,,79013857,CDM,278,RC,,,both,,,5239,2067.67,39.4668,,2067.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1781.26,34,,1781.26,percent of total billed charges,Implant Device,1833.65,35,,1833.65,percent of total billed charges,Implant Device,1781.26,34,"Charges > $500, x 34%",1781.26,percent of total billed charges,Implant Device,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,2095.6,40,,2095.6,percent of total billed charges,Implant Devices,1833.65,70,,1833.65,percent of total billed charges,Implant Devices,1781.26,34,,1781.26,percent of total billed charges,Implant Devices,1781.26,34,,1781.26,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,1833.65,35,,1833.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1781.26,34,"If Charge > 2,000, then 34 percent",1781.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2095.6,
J&J 151710608 REV ROTATING PLATFORM INS,C1776,HCPCS,,79013858,CDM,278,RC,,,both,,,9286,3664.89,39.4668,,3664.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3157.24,34,,3157.24,percent of total billed charges,Implant Device,3250.1,35,,3250.1,percent of total billed charges,Implant Device,3157.24,34,"Charges > $500, x 34%",3157.24,percent of total billed charges,Implant Device,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3714.4,40,,3714.4,percent of total billed charges,Implant Devices,3250.1,70,,3250.1,percent of total billed charges,Implant Devices,3157.24,34,,3157.24,percent of total billed charges,Implant Devices,3157.24,34,,3157.24,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,3250.1,35,,3250.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3157.24,34,"If Charge > 2,000, then 34 percent",3157.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3714.4,
J&J 154706002 ATTUNE REV DIS FEM SZ6 8MM,C1776,HCPCS,,79013859,CDM,278,RC,,,both,,,3848,1518.68,39.4668,,1518.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1346.8,35,,1346.8,percent of total billed charges,Implant Device,1308.32,34,"Charges > $500, x 34%",1308.32,percent of total billed charges,Implant Device,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1539.2,40,,1539.2,percent of total billed charges,Implant Devices,1346.8,70,,1346.8,percent of total billed charges,Implant Devices,1308.32,34,,1308.32,percent of total billed charges,Implant Devices,1308.32,34,,1308.32,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1308.32,34,"If Charge > 2,000, then 34 percent",1308.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1539.2,
J&J 154906001 ATTUNE POSTER FEM SZ6 4MM,C1776,HCPCS,,79013860,CDM,278,RC,,,both,,,3848,1518.68,39.4668,,1518.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1308.32,34,,1308.32,percent of total billed charges,Implant Device,1346.8,35,,1346.8,percent of total billed charges,Implant Device,1308.32,34,"Charges > $500, x 34%",1308.32,percent of total billed charges,Implant Device,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1539.2,40,,1539.2,percent of total billed charges,Implant Devices,1346.8,70,,1346.8,percent of total billed charges,Implant Devices,1308.32,34,,1308.32,percent of total billed charges,Implant Devices,1308.32,34,,1308.32,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,1346.8,35,,1346.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1308.32,34,"If Charge > 2,000, then 34 percent",1308.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1539.2,
ZIMMER 110031399 MINI HUM TRAY 40MM,C1776,HCPCS,,79013862,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
ZIMMER 113628 MINI HUM STEM 8X83MM LONG,C1776,HCPCS,,79013863,CDM,278,RC,,,both,,,13200,5209.62,39.4668,,5209.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Device,4488,34,"Charges > $500, x 34%",4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,5280,40,,5280,percent of total billed charges,Implant Devices,4620,70,,4620,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4488,34,"If Charge > 2,000, then 34 percent",4488,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5280,
ZIMMER 42560113513 STEM EXT 13X135MM,C1776,HCPCS,,79013890,CDM,278,RC,,,both,,,7476,2950.54,39.4668,,2950.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2541.84,34,,2541.84,percent of total billed charges,Implant Device,2541.84,34,,2541.84,percent of total billed charges,Implant Device,2541.84,34,,2541.84,percent of total billed charges,Implant Device,2541.84,34,,2541.84,percent of total billed charges,Implant Device,2541.84,34,,2541.84,percent of total billed charges,Implant Device,2541.84,34,,2541.84,percent of total billed charges,Implant Device,2616.6,35,,2616.6,percent of total billed charges,Implant Device,2541.84,34,"Charges > $500, x 34%",2541.84,percent of total billed charges,Implant Device,2616.6,35,,2616.6,percent of total billed charges,Implant Devices,2616.6,35,,2616.6,percent of total billed charges,Implant Devices,2616.6,35,,,percent of total billed charges,Implant Devices,2616.6,35,,2616.6,percent of total billed charges,Implant Devices,2616.6,35,,2616.6,percent of total billed charges,Implant Devices,2990.4,40,,2990.4,percent of total billed charges,Implant Devices,2616.6,70,,2616.6,percent of total billed charges,Implant Devices,2541.84,34,,2541.84,percent of total billed charges,Implant Devices,2541.84,34,,2541.84,percent of total billed charges,Implant Devices,2616.6,35,,2616.6,percent of total billed charges,Implant Devices,2616.6,35,,2616.6,percent of total billed charges,Implant Devices,2616.6,35,,2616.6,percent of total billed charges,Implant Devices,2616.6,35,,2616.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2541.84,34,"If Charge > 2,000, then 34 percent",2541.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2990.4,
ZIMMER 42522800420 ART SURF RT 20MM,C1776,HCPCS,,79013891,CDM,278,RC,,,both,,,10815,4268.33,39.4668,,4268.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3677.1,34,,3677.1,percent of total billed charges,Implant Device,3677.1,34,,3677.1,percent of total billed charges,Implant Device,3677.1,34,,3677.1,percent of total billed charges,Implant Device,3677.1,34,,3677.1,percent of total billed charges,Implant Device,3677.1,34,,3677.1,percent of total billed charges,Implant Device,3677.1,34,,3677.1,percent of total billed charges,Implant Device,3785.25,35,,3785.25,percent of total billed charges,Implant Device,3677.1,34,"Charges > $500, x 34%",3677.1,percent of total billed charges,Implant Device,3785.25,35,,3785.25,percent of total billed charges,Implant Devices,3785.25,35,,3785.25,percent of total billed charges,Implant Devices,3785.25,35,,,percent of total billed charges,Implant Devices,3785.25,35,,3785.25,percent of total billed charges,Implant Devices,3785.25,35,,3785.25,percent of total billed charges,Implant Devices,4326,40,,4326,percent of total billed charges,Implant Devices,3785.25,70,,3785.25,percent of total billed charges,Implant Devices,3677.1,34,,3677.1,percent of total billed charges,Implant Devices,3677.1,34,,3677.1,percent of total billed charges,Implant Devices,3785.25,35,,3785.25,percent of total billed charges,Implant Devices,3785.25,35,,3785.25,percent of total billed charges,Implant Devices,3785.25,35,,3785.25,percent of total billed charges,Implant Devices,3785.25,35,,3785.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3677.1,34,"If Charge > 2,000, then 34 percent",3677.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4326,
ZIMMER 42556605810 FEM DIS AUG SZ 5 10MM,C1776,HCPCS,,79013893,CDM,278,RC,,,both,,,4767,1881.38,39.4668,,1881.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1668.45,35,,1668.45,percent of total billed charges,Implant Device,1620.78,34,"Charges > $500, x 34%",1620.78,percent of total billed charges,Implant Device,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1906.8,40,,1906.8,percent of total billed charges,Implant Devices,1668.45,70,,1668.45,percent of total billed charges,Implant Devices,1620.78,34,,1620.78,percent of total billed charges,Implant Devices,1620.78,34,,1620.78,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1620.78,34,"If Charge > 2,000, then 34 percent",1620.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1906.8,
ZIMMER 42556605815 FEM DIS AUG SZ 5 15MM,C1776,HCPCS,,79013894,CDM,278,RC,,,both,,,4767,1881.38,39.4668,,1881.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1620.78,34,,1620.78,percent of total billed charges,Implant Device,1668.45,35,,1668.45,percent of total billed charges,Implant Device,1620.78,34,"Charges > $500, x 34%",1620.78,percent of total billed charges,Implant Device,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1906.8,40,,1906.8,percent of total billed charges,Implant Devices,1668.45,70,,1668.45,percent of total billed charges,Implant Devices,1620.78,34,,1620.78,percent of total billed charges,Implant Devices,1620.78,34,,1620.78,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,1668.45,35,,1668.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1620.78,34,"If Charge > 2,000, then 34 percent",1620.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1906.8,
ZIMMER 42542006702 TIBIA RT SIZE D,C1776,HCPCS,,79013895,CDM,278,RC,,,both,,,11046,4359.5,39.4668,,4359.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3755.64,34,,3755.64,percent of total billed charges,Implant Device,3755.64,34,,3755.64,percent of total billed charges,Implant Device,3755.64,34,,3755.64,percent of total billed charges,Implant Device,3755.64,34,,3755.64,percent of total billed charges,Implant Device,3755.64,34,,3755.64,percent of total billed charges,Implant Device,3755.64,34,,3755.64,percent of total billed charges,Implant Device,3866.1,35,,3866.1,percent of total billed charges,Implant Device,3755.64,34,"Charges > $500, x 34%",3755.64,percent of total billed charges,Implant Device,3866.1,35,,3866.1,percent of total billed charges,Implant Devices,3866.1,35,,3866.1,percent of total billed charges,Implant Devices,3866.1,35,,,percent of total billed charges,Implant Devices,3866.1,35,,3866.1,percent of total billed charges,Implant Devices,3866.1,35,,3866.1,percent of total billed charges,Implant Devices,4418.4,40,,4418.4,percent of total billed charges,Implant Devices,3866.1,70,,3866.1,percent of total billed charges,Implant Devices,3755.64,34,,3755.64,percent of total billed charges,Implant Devices,3755.64,34,,3755.64,percent of total billed charges,Implant Devices,3866.1,35,,3866.1,percent of total billed charges,Implant Devices,3866.1,35,,3866.1,percent of total billed charges,Implant Devices,3866.1,35,,3866.1,percent of total billed charges,Implant Devices,3866.1,35,,3866.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3755.64,34,"If Charge > 2,000, then 34 percent",3755.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4418.4,
J&J 1010-12-090 FEMORAL STEM SIZE 9,C1776,HCPCS,,79013912,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1516-30-808 TIBIAL INSERT 8MM SIZE 8,C1776,HCPCS,,79013913,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
STRYKER 5532-G-509-E TIB BEARING INS 9MM,C1776,HCPCS,,79013914,CDM,278,RC,,,both,,,2781,1097.57,39.4668,,1097.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,945.54,34,,945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Device,945.54,34,"Charges > $500, x 34%",945.54,percent of total billed charges,Implant Device,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,1112.4,40,,1112.4,percent of total billed charges,Implant Devices,973.35,70,,973.35,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,945.54,34,,945.54,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,973.35,35,,973.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,945.54,34,"If Charge > 2,000, then 34 percent",945.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1112.4,
ZIMMER 574203065 FEMORAL STEM SIZE 6.5,C1776,HCPCS,,79013926,CDM,278,RC,,,both,,,8573,3383.49,39.4668,,3383.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,2914.82,34,,2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Device,2914.82,34,"Charges > $500, x 34%",2914.82,percent of total billed charges,Implant Device,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3429.2,40,,3429.2,percent of total billed charges,Implant Devices,3000.55,70,,3000.55,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,2914.82,34,,2914.82,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,3000.55,35,,3000.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2914.82,34,"If Charge > 2,000, then 34 percent",2914.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3429.2,
J&J 1516-30-507 TIBIAL INSERT SIZE 5 7MM,C1776,HCPCS,,79013928,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1221-40-162 ACETABULAR LINER 40X62MM,C1776,HCPCS,,79013929,CDM,278,RC,,,both,,,2565,1012.32,39.4668,,1012.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,872.1,34,,872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Device,872.1,34,"Charges > $500, x 34%",872.1,percent of total billed charges,Implant Device,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,1026,40,,1026,percent of total billed charges,Implant Devices,897.75,70,,897.75,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,872.1,34,,872.1,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,897.75,35,,897.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,872.1,34,"If Charge > 2,000, then 34 percent",872.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1026,
J&J 1365-40-720 FEMORAL HEAD 40MM +5,C1776,HCPCS,,79013930,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
ZIMMER 42-5221-007-13 ARTI SURF RT 13MM,C1776,HCPCS,,79013935,CDM,278,RC,,,both,,,4116,1624.45,39.4668,,1624.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1399.44,34,,1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Device,1399.44,34,"Charges > $500, x 34%",1399.44,percent of total billed charges,Implant Device,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1646.4,40,,1646.4,percent of total billed charges,Implant Devices,1440.6,70,,1440.6,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1399.44,34,,1399.44,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,1440.6,35,,1440.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1399.44,34,"If Charge > 2,000, then 34 percent",1399.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1646.4,
J&J 1010-112-100 FEMORAL STEM SIZE 10,C1776,HCPCS,,79013939,CDM,278,RC,,,both,,,7410,2924.49,39.4668,,2924.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2519.4,34,,2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Device,2519.4,34,"Charges > $500, x 34%",2519.4,percent of total billed charges,Implant Device,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2964,40,,2964,percent of total billed charges,Implant Devices,2593.5,70,,2593.5,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2519.4,34,,2519.4,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,2593.5,35,,2593.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.4,34,"If Charge > 2,000, then 34 percent",2519.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2964,
J&J 1516-30-706 TIBIAL INSERT SIZE 7 6MM,C1776,HCPCS,,79013941,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1518-20-029 PATELLA DOME 29MM,C1776,HCPCS,,79013942,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J 1504-00-203 ATTUNE FEMORAL SZ 3 RT,C1776,HCPCS,,79013943,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
J&J 1516-30-306 ATTUNE TIB INS SZ 3 6MM,C1776,HCPCS,,79013944,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
STRYKER 5542-P-0052 PEG GLENOID SZ 52,C1776,HCPCS,,79013946,CDM,278,RC,,,both,,,3675,1450.4,39.4668,,1450.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1249.5,34,,1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Device,1249.5,34,"Charges > $500, x 34%",1249.5,percent of total billed charges,Implant Device,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1470,40,,1470,percent of total billed charges,Implant Devices,1286.25,70,,1286.25,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1249.5,34,,1249.5,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,1286.25,35,,1286.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.5,34,"If Charge > 2,000, then 34 percent",1249.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470,
STRYKER 6721-0937 HIP STEM 127DEG 37X120,C1776,HCPCS,,79013948,CDM,278,RC,,,both,,,6953,2744.13,39.4668,,2744.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2364.02,34,,2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Device,2364.02,34,"Charges > $500, x 34%",2364.02,percent of total billed charges,Implant Device,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2781.2,40,,2781.2,percent of total billed charges,Implant Devices,2433.55,70,,2433.55,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2364.02,34,,2364.02,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,2433.55,35,,2433.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2364.02,34,"If Charge > 2,000, then 34 percent",2364.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2781.2,
STRYKER 5901-6053 HUM HEAD TRIAL ADAPTOR,C1776,HCPCS,,79013951,CDM,278,RC,,,both,,,2481,979.17,39.4668,,979.17,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,843.54,34,,843.54,percent of total billed charges,Implant Device,843.54,34,,843.54,percent of total billed charges,Implant Device,843.54,34,,843.54,percent of total billed charges,Implant Device,843.54,34,,843.54,percent of total billed charges,Implant Device,843.54,34,,843.54,percent of total billed charges,Implant Device,843.54,34,,843.54,percent of total billed charges,Implant Device,868.35,35,,868.35,percent of total billed charges,Implant Device,843.54,34,"Charges > $500, x 34%",843.54,percent of total billed charges,Implant Device,868.35,35,,868.35,percent of total billed charges,Implant Devices,868.35,35,,868.35,percent of total billed charges,Implant Devices,868.35,35,,,percent of total billed charges,Implant Devices,868.35,35,,868.35,percent of total billed charges,Implant Devices,868.35,35,,868.35,percent of total billed charges,Implant Devices,992.4,40,,992.4,percent of total billed charges,Implant Devices,868.35,70,,868.35,percent of total billed charges,Implant Devices,843.54,34,,843.54,percent of total billed charges,Implant Devices,843.54,34,,843.54,percent of total billed charges,Implant Devices,868.35,35,,868.35,percent of total billed charges,Implant Devices,868.35,35,,868.35,percent of total billed charges,Implant Devices,868.35,35,,868.35,percent of total billed charges,Implant Devices,868.35,35,,868.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,843.54,34,"If Charge > 2,000, then 34 percent",843.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,992.4,
STRYKER 1516-30-905 ATTUNE INS SZ 9 5MM,C1776,HCPCS,,79013952,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
STRYKER 1516-30-710 ATTUNE SIZE 7 10MM,C1776,HCPCS,,79013963,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
EXACTECH 314-23-13 LASER CAGE GLENOID MD,C1776,HCPCS,,79013965,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
STRYKER 6260-5-126 FEMORAL HEAD 26MM,C1776,HCPCS,,79013966,CDM,278,RC,,,both,,,1391,548.98,39.4668,,548.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,472.94,34,,472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Device,472.94,34,"Charges > $500, x 34%",472.94,percent of total billed charges,Implant Device,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,556.4,40,,556.4,percent of total billed charges,Implant Devices,486.85,70,,486.85,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,472.94,34,,472.94,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,486.85,35,,486.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,556.4,
J&J 1516-50-607 ATTUNE INSERT SIZE 6 7MM,C1776,HCPCS,,79013967,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
DJO 392-09-704 TIB KNEE INS E-PLUS SZ 4,C1776,HCPCS,,79013980,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J 96-0087 FEMORAL TC3 CEMENTED SZ 2 RT,C1776,HCPCS,,79013983,CDM,278,RC,,,both,,,18244,7200.32,39.4668,,7200.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6202.96,34,,6202.96,percent of total billed charges,Implant Device,6202.96,34,,6202.96,percent of total billed charges,Implant Device,6202.96,34,,6202.96,percent of total billed charges,Implant Device,6202.96,34,,6202.96,percent of total billed charges,Implant Device,6202.96,34,,6202.96,percent of total billed charges,Implant Device,6202.96,34,,6202.96,percent of total billed charges,Implant Device,6385.4,35,,6385.4,percent of total billed charges,Implant Device,6202.96,34,"Charges > $500, x 34%",6202.96,percent of total billed charges,Implant Device,6385.4,35,,6385.4,percent of total billed charges,Implant Devices,6385.4,35,,6385.4,percent of total billed charges,Implant Devices,6385.4,35,,,percent of total billed charges,Implant Devices,6385.4,35,,6385.4,percent of total billed charges,Implant Devices,6385.4,35,,6385.4,percent of total billed charges,Implant Devices,7297.6,40,,7297.6,percent of total billed charges,Implant Devices,6385.4,70,,6385.4,percent of total billed charges,Implant Devices,6202.96,34,,6202.96,percent of total billed charges,Implant Devices,6202.96,34,,6202.96,percent of total billed charges,Implant Devices,6385.4,35,,6385.4,percent of total billed charges,Implant Devices,6385.4,35,,6385.4,percent of total billed charges,Implant Devices,6385.4,35,,6385.4,percent of total billed charges,Implant Devices,6385.4,35,,6385.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6202.96,34,"If Charge > 2,000, then 34 percent",6202.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7297.6,
J&J 96-0822 DISTAL AUGMENT SIZE 2 8MM LT,C1776,HCPCS,,79013984,CDM,278,RC,,,both,,,3099,1223.08,39.4668,,1223.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1053.66,34,,1053.66,percent of total billed charges,Implant Device,1053.66,34,,1053.66,percent of total billed charges,Implant Device,1053.66,34,,1053.66,percent of total billed charges,Implant Device,1053.66,34,,1053.66,percent of total billed charges,Implant Device,1053.66,34,,1053.66,percent of total billed charges,Implant Device,1053.66,34,,1053.66,percent of total billed charges,Implant Device,1084.65,35,,1084.65,percent of total billed charges,Implant Device,1053.66,34,"Charges > $500, x 34%",1053.66,percent of total billed charges,Implant Device,1084.65,35,,1084.65,percent of total billed charges,Implant Devices,1084.65,35,,1084.65,percent of total billed charges,Implant Devices,1084.65,35,,,percent of total billed charges,Implant Devices,1084.65,35,,1084.65,percent of total billed charges,Implant Devices,1084.65,35,,1084.65,percent of total billed charges,Implant Devices,1239.6,40,,1239.6,percent of total billed charges,Implant Devices,1084.65,70,,1084.65,percent of total billed charges,Implant Devices,1053.66,34,,1053.66,percent of total billed charges,Implant Devices,1053.66,34,,1053.66,percent of total billed charges,Implant Devices,1084.65,35,,1084.65,percent of total billed charges,Implant Devices,1084.65,35,,1084.65,percent of total billed charges,Implant Devices,1084.65,35,,1084.65,percent of total billed charges,Implant Devices,1084.65,35,,1084.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1053.66,34,"If Charge > 2,000, then 34 percent",1053.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1239.6,
J&J 96-2321 TIBIAL INSERT SIZE 2 10MM,C1776,HCPCS,,79013985,CDM,278,RC,,,both,,,8758,3456.5,39.4668,,3456.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2977.72,34,,2977.72,percent of total billed charges,Implant Device,2977.72,34,,2977.72,percent of total billed charges,Implant Device,2977.72,34,,2977.72,percent of total billed charges,Implant Device,2977.72,34,,2977.72,percent of total billed charges,Implant Device,2977.72,34,,2977.72,percent of total billed charges,Implant Device,2977.72,34,,2977.72,percent of total billed charges,Implant Device,3065.3,35,,3065.3,percent of total billed charges,Implant Device,2977.72,34,"Charges > $500, x 34%",2977.72,percent of total billed charges,Implant Device,3065.3,35,,3065.3,percent of total billed charges,Implant Devices,3065.3,35,,3065.3,percent of total billed charges,Implant Devices,3065.3,35,,,percent of total billed charges,Implant Devices,3065.3,35,,3065.3,percent of total billed charges,Implant Devices,3065.3,35,,3065.3,percent of total billed charges,Implant Devices,3503.2,40,,3503.2,percent of total billed charges,Implant Devices,3065.3,70,,3065.3,percent of total billed charges,Implant Devices,2977.72,34,,2977.72,percent of total billed charges,Implant Devices,2977.72,34,,2977.72,percent of total billed charges,Implant Devices,3065.3,35,,3065.3,percent of total billed charges,Implant Devices,3065.3,35,,3065.3,percent of total billed charges,Implant Devices,3065.3,35,,3065.3,percent of total billed charges,Implant Devices,3065.3,35,,3065.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2977.72,34,"If Charge > 2,000, then 34 percent",2977.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3503.2,
DJO 530-06-108 HUM STEM REVERSE 6X108,C1776,HCPCS,,79014010,CDM,278,RC,,,both,,,14400,5683.22,39.4668,,5683.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,4896,34,,4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Device,4896,34,"Charges > $500, x 34%",4896,percent of total billed charges,Implant Device,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5760,40,,5760,percent of total billed charges,Implant Devices,5040,70,,5040,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,4896,34,,4896,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,5040,35,,5040,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4896,34,"If Charge > 2,000, then 34 percent",4896,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5760,
J&J 1516-30-516 INSERT SIZE 5 16MM,C1776,HCPCS,,79014011,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
J&J 1217-22-052 PINNACLE SECTOR II CUP52,C1776,HCPCS,,79014012,CDM,278,RC,,,both,,,2636,1040.34,39.4668,,1040.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,896.24,34,,896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Device,896.24,34,"Charges > $500, x 34%",896.24,percent of total billed charges,Implant Device,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,1054.4,40,,1054.4,percent of total billed charges,Implant Devices,922.6,70,,922.6,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,896.24,34,,896.24,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,922.6,35,,922.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,896.24,34,"If Charge > 2,000, then 34 percent",896.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1054.4,
EXACTECH 314-24-24 LASER CAGE GLENOID 8,C1776,HCPCS,,79014013,CDM,278,RC,,,both,,,7725,3048.81,39.4668,,3048.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2703.75,35,,2703.75,percent of total billed charges,Implant Device,2626.5,34,"Charges > $500, x 34%",2626.5,percent of total billed charges,Implant Device,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,3090,40,,3090,percent of total billed charges,Implant Devices,2703.75,70,,2703.75,percent of total billed charges,Implant Devices,2626.5,34,,2626.5,percent of total billed charges,Implant Devices,2626.5,34,,2626.5,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2626.5,34,"If Charge > 2,000, then 34 percent",2626.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3090,
EXACTECH 320-10-10 EQUINOX REV TRAY ADA,C1776,HCPCS,,79014017,CDM,278,RC,,,both,,,4950,1953.61,39.4668,,1953.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Device,1683,34,"Charges > $500, x 34%",1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1980,40,,1980,percent of total billed charges,Implant Devices,1732.5,70,,1732.5,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1683,34,"If Charge > 2,000, then 34 percent",1683,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1980,
STRYKER 5570-3602 HUMERAL CUP 36X2MM,C1776,HCPCS,,79014020,CDM,278,RC,,,both,,,6000,2368.01,39.4668,,2368.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2040,34,,2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Device,2040,34,"Charges > $500, x 34%",2040,percent of total billed charges,Implant Device,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2400,40,,2400,percent of total billed charges,Implant Devices,2100,70,,2100,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2040,34,,2040,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,2100,35,,2100,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2040,34,"If Charge > 2,000, then 34 percent",2040,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2400,
MEDTRONIC 6935M SERIES QUATRO SEC S LEAD,C1777,HCPCS,,79003625,CDM,278,RC,,,both,,,16564,6537.28,39.4668,,6537.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5631.76,34,,5631.76,percent of total billed charges,Implant Device,5631.76,34,,5631.76,percent of total billed charges,Implant Device,5631.76,34,,5631.76,percent of total billed charges,Implant Device,5631.76,34,,5631.76,percent of total billed charges,Implant Device,5631.76,34,,5631.76,percent of total billed charges,Implant Device,5631.76,34,,5631.76,percent of total billed charges,Implant Device,5797.4,35,,5797.4,percent of total billed charges,Implant Device,5631.76,34,"Charges > $500, x 34%",5631.76,percent of total billed charges,Implant Device,5797.4,35,,5797.4,percent of total billed charges,Implant Devices,5797.4,35,,5797.4,percent of total billed charges,Implant Devices,5797.4,35,,,percent of total billed charges,Implant Devices,5797.4,35,,5797.4,percent of total billed charges,Implant Devices,5797.4,35,,5797.4,percent of total billed charges,Implant Devices,6625.6,40,,6625.6,percent of total billed charges,Implant Devices,5797.4,70,,5797.4,percent of total billed charges,Implant Devices,5631.76,34,,5631.76,percent of total billed charges,Implant Devices,5631.76,34,,5631.76,percent of total billed charges,Implant Devices,5797.4,35,,5797.4,percent of total billed charges,Implant Devices,5797.4,35,,5797.4,percent of total billed charges,Implant Devices,5797.4,35,,5797.4,percent of total billed charges,Implant Devices,5797.4,35,,5797.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5631.76,34,"If Charge > 2,000, then 34 percent",5631.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6625.6,
MEDTRONIC 3889-28 LEAD KIT SHORT,C1778,HCPCS,,79001572,CDM,278,RC,,,both,,,10246,4043.77,39.4668,,4043.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3483.64,34,,3483.64,percent of total billed charges,Implant Device,3483.64,34,,3483.64,percent of total billed charges,Implant Device,3483.64,34,,3483.64,percent of total billed charges,Implant Device,3483.64,34,,3483.64,percent of total billed charges,Implant Device,3483.64,34,,3483.64,percent of total billed charges,Implant Device,3483.64,34,,3483.64,percent of total billed charges,Implant Device,3586.1,35,,3586.1,percent of total billed charges,Implant Device,3483.64,34,"Charges > $500, x 34%",3483.64,percent of total billed charges,Implant Device,3586.1,35,,3586.1,percent of total billed charges,Implant Devices,3586.1,35,,3586.1,percent of total billed charges,Implant Devices,3586.1,35,,,percent of total billed charges,Implant Devices,3586.1,35,,3586.1,percent of total billed charges,Implant Devices,3586.1,35,,3586.1,percent of total billed charges,Implant Devices,4098.4,40,,4098.4,percent of total billed charges,Implant Devices,3586.1,70,,3586.1,percent of total billed charges,Implant Devices,3483.64,34,,3483.64,percent of total billed charges,Implant Devices,3483.64,34,,3483.64,percent of total billed charges,Implant Devices,3586.1,35,,3586.1,percent of total billed charges,Implant Devices,3586.1,35,,3586.1,percent of total billed charges,Implant Devices,3586.1,35,,3586.1,percent of total billed charges,Implant Devices,3586.1,35,,3586.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3483.64,34,"If Charge > 2,000, then 34 percent",3483.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4098.4,
MEDTRONIC 30571SC INTERSTIM TEMP LEAD,C1778,HCPCS,,79002660,CDM,278,RC,,,both,,,346,136.56,39.4668,,136.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,117.64,34,,117.64,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,138.4,40,,138.4,percent of total billed charges,Implant Devices,121.1,70,,121.1,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,117.64,34,,117.64,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,121.1,35,,121.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,138.4,
MEDTRONIC 3550-18 INTRODUCER LEAD KIT,C1778,HCPCS,,79002661,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
MEDTRONIC 3889-28 LEAD KIT,C1778,HCPCS,,79002662,CDM,278,RC,,,both,,,9856,3889.85,39.4668,,3889.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3351.04,34,,3351.04,percent of total billed charges,Implant Device,3351.04,34,,3351.04,percent of total billed charges,Implant Device,3351.04,34,,3351.04,percent of total billed charges,Implant Device,3351.04,34,,3351.04,percent of total billed charges,Implant Device,3351.04,34,,3351.04,percent of total billed charges,Implant Device,3351.04,34,,3351.04,percent of total billed charges,Implant Device,3449.6,35,,3449.6,percent of total billed charges,Implant Device,3351.04,34,"Charges > $500, x 34%",3351.04,percent of total billed charges,Implant Device,3449.6,35,,3449.6,percent of total billed charges,Implant Devices,3449.6,35,,3449.6,percent of total billed charges,Implant Devices,3449.6,35,,,percent of total billed charges,Implant Devices,3449.6,35,,3449.6,percent of total billed charges,Implant Devices,3449.6,35,,3449.6,percent of total billed charges,Implant Devices,3942.4,40,,3942.4,percent of total billed charges,Implant Devices,3449.6,70,,3449.6,percent of total billed charges,Implant Devices,3351.04,34,,3351.04,percent of total billed charges,Implant Devices,3351.04,34,,3351.04,percent of total billed charges,Implant Devices,3449.6,35,,3449.6,percent of total billed charges,Implant Devices,3449.6,35,,3449.6,percent of total billed charges,Implant Devices,3449.6,35,,3449.6,percent of total billed charges,Implant Devices,3449.6,35,,3449.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3351.04,34,"If Charge > 2,000, then 34 percent",3351.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3942.4,
ABBOTT MN10450-90A SLIM TIP DRG LEAD,C1778,HCPCS,,79011949,CDM,278,RC,,,both,,,7800,3078.41,39.4668,,3078.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2730,35,,2730,percent of total billed charges,Implant Device,2652,34,"Charges > $500, x 34%",2652,percent of total billed charges,Implant Device,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,3120,40,,3120,percent of total billed charges,Implant Devices,2730,70,,2730,percent of total billed charges,Implant Devices,2652,34,,2652,percent of total billed charges,Implant Devices,2652,34,,2652,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2652,34,"If Charge > 2,000, then 34 percent",2652,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3120,
MEDTRONIC 97800 NEURO STIM IPG EXT KIT,C1778,HCPCS,,79012571,CDM,278,RC,,,both,,,30762,12140.78,39.4668,,12140.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10459.08,34,,10459.08,percent of total billed charges,Implant Device,10459.08,34,,10459.08,percent of total billed charges,Implant Device,10459.08,34,,10459.08,percent of total billed charges,Implant Device,10459.08,34,,10459.08,percent of total billed charges,Implant Device,10459.08,34,,10459.08,percent of total billed charges,Implant Device,10459.08,34,,10459.08,percent of total billed charges,Implant Device,10766.7,35,,10766.7,percent of total billed charges,Implant Device,10459.08,34,"Charges > $500, x 34%",10459.08,percent of total billed charges,Implant Device,10766.7,35,,10766.7,percent of total billed charges,Implant Devices,10766.7,35,,10766.7,percent of total billed charges,Implant Devices,10766.7,35,,,percent of total billed charges,Implant Devices,10766.7,35,,10766.7,percent of total billed charges,Implant Devices,10766.7,35,,10766.7,percent of total billed charges,Implant Devices,12304.8,40,,12304.8,percent of total billed charges,Implant Devices,10766.7,70,,10766.7,percent of total billed charges,Implant Devices,10459.08,34,,10459.08,percent of total billed charges,Implant Devices,10459.08,34,,10459.08,percent of total billed charges,Implant Devices,10766.7,35,,10766.7,percent of total billed charges,Implant Devices,10766.7,35,,10766.7,percent of total billed charges,Implant Devices,10766.7,35,,10766.7,percent of total billed charges,Implant Devices,10766.7,35,,10766.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10459.08,34,"If Charge > 2,000, then 34 percent",10459.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12304.8,
BOST SC-2408-56 AVISTA MRI 56CM LEAD KIT,C1778,HCPCS,,79012705,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
BOST SC-2408-74 AVISTA MRI 74CM LEAD KIT,C1778,HCPCS,,79012811,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1920,
BOST SC-2317-50 CONTACT LEAD KIT 50CM,C1778,HCPCS,,79012911,CDM,278,RC,,,both,,,7800,3078.41,39.4668,,3078.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2730,35,,2730,percent of total billed charges,Implant Device,2652,34,"Charges > $500, x 34%",2652,percent of total billed charges,Implant Device,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,3120,40,,3120,percent of total billed charges,Implant Devices,2730,70,,2730,percent of total billed charges,Implant Devices,2652,34,,2652,percent of total billed charges,Implant Devices,2652,34,,2652,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2652,34,"If Charge > 2,000, then 34 percent",2652,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3120,
SYNTHES XM106.0816S BIOLOGIC TISSUE 8X16,C1781,HCPCS,,79001237,CDM,278,RC,,,both,,,12567,4959.79,39.4668,,4959.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4272.78,34,,4272.78,percent of total billed charges,Implant Device,4272.78,34,,4272.78,percent of total billed charges,Implant Device,4272.78,34,,4272.78,percent of total billed charges,Implant Device,4272.78,34,,4272.78,percent of total billed charges,Implant Device,4272.78,34,,4272.78,percent of total billed charges,Implant Device,4272.78,34,,4272.78,percent of total billed charges,Implant Device,4398.45,35,,4398.45,percent of total billed charges,Implant Device,4272.78,34,"Charges > $500, x 34%",4272.78,percent of total billed charges,Implant Device,4398.45,35,,4398.45,percent of total billed charges,Implant Devices,4398.45,35,,4398.45,percent of total billed charges,Implant Devices,4398.45,35,,,percent of total billed charges,Implant Devices,4398.45,35,,4398.45,percent of total billed charges,Implant Devices,4398.45,35,,4398.45,percent of total billed charges,Implant Devices,5026.8,40,,5026.8,percent of total billed charges,Implant Devices,4398.45,70,,4398.45,percent of total billed charges,Implant Devices,4272.78,34,,4272.78,percent of total billed charges,Implant Devices,4272.78,34,,4272.78,percent of total billed charges,Implant Devices,4398.45,35,,4398.45,percent of total billed charges,Implant Devices,4398.45,35,,4398.45,percent of total billed charges,Implant Devices,4398.45,35,,4398.45,percent of total billed charges,Implant Devices,4398.45,35,,4398.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4272.78,34,"If Charge > 2,000, then 34 percent",4272.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5026.8,
BARD 0123790 COMPOSIX E/X MESH,C1781,HCPCS,,79001387,CDM,278,RC,,,both,,,3426,1352.13,39.4668,,1352.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1164.84,34,,1164.84,percent of total billed charges,Implant Device,1164.84,34,,1164.84,percent of total billed charges,Implant Device,1164.84,34,,1164.84,percent of total billed charges,Implant Device,1164.84,34,,1164.84,percent of total billed charges,Implant Device,1164.84,34,,1164.84,percent of total billed charges,Implant Device,1164.84,34,,1164.84,percent of total billed charges,Implant Device,1199.1,35,,1199.1,percent of total billed charges,Implant Device,1164.84,34,"Charges > $500, x 34%",1164.84,percent of total billed charges,Implant Device,1199.1,35,,1199.1,percent of total billed charges,Implant Devices,1199.1,35,,1199.1,percent of total billed charges,Implant Devices,1199.1,35,,,percent of total billed charges,Implant Devices,1199.1,35,,1199.1,percent of total billed charges,Implant Devices,1199.1,35,,1199.1,percent of total billed charges,Implant Devices,1370.4,40,,1370.4,percent of total billed charges,Implant Devices,1199.1,70,,1199.1,percent of total billed charges,Implant Devices,1164.84,34,,1164.84,percent of total billed charges,Implant Devices,1164.84,34,,1164.84,percent of total billed charges,Implant Devices,1199.1,35,,1199.1,percent of total billed charges,Implant Devices,1199.1,35,,1199.1,percent of total billed charges,Implant Devices,1199.1,35,,1199.1,percent of total billed charges,Implant Devices,1199.1,35,,1199.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1164.84,34,"If Charge > 2,000, then 34 percent",1164.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1370.4,
COMPOSIX KUGEL MESH PATCH   CIRCLE,C1781,HCPCS,,79001388,CDM,278,RC,,,both,,,2262,892.74,39.4668,,892.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,769.08,34,,769.08,percent of total billed charges,Implant Device,769.08,34,,769.08,percent of total billed charges,Implant Device,769.08,34,,769.08,percent of total billed charges,Implant Device,769.08,34,,769.08,percent of total billed charges,Implant Device,769.08,34,,769.08,percent of total billed charges,Implant Device,769.08,34,,769.08,percent of total billed charges,Implant Device,791.7,35,,791.7,percent of total billed charges,Implant Device,769.08,34,"Charges > $500, x 34%",769.08,percent of total billed charges,Implant Device,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,904.8,40,,904.8,percent of total billed charges,Implant Devices,791.7,70,,791.7,percent of total billed charges,Implant Devices,769.08,34,,769.08,percent of total billed charges,Implant Devices,769.08,34,,769.08,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,769.08,34,"If Charge > 2,000, then 34 percent",769.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,904.8,
COMPOSIX KUGEL MESH XL OVAL 10.8X13.7,C1781,HCPCS,,79001389,CDM,278,RC,,,both,,,3184,1256.62,39.4668,,1256.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1082.56,34,,1082.56,percent of total billed charges,Implant Device,1082.56,34,,1082.56,percent of total billed charges,Implant Device,1082.56,34,,1082.56,percent of total billed charges,Implant Device,1082.56,34,,1082.56,percent of total billed charges,Implant Device,1082.56,34,,1082.56,percent of total billed charges,Implant Device,1082.56,34,,1082.56,percent of total billed charges,Implant Device,1114.4,35,,1114.4,percent of total billed charges,Implant Device,1082.56,34,"Charges > $500, x 34%",1082.56,percent of total billed charges,Implant Device,1114.4,35,,1114.4,percent of total billed charges,Implant Devices,1114.4,35,,1114.4,percent of total billed charges,Implant Devices,1114.4,35,,,percent of total billed charges,Implant Devices,1114.4,35,,1114.4,percent of total billed charges,Implant Devices,1114.4,35,,1114.4,percent of total billed charges,Implant Devices,1273.6,40,,1273.6,percent of total billed charges,Implant Devices,1114.4,70,,1114.4,percent of total billed charges,Implant Devices,1082.56,34,,1082.56,percent of total billed charges,Implant Devices,1082.56,34,,1082.56,percent of total billed charges,Implant Devices,1114.4,35,,1114.4,percent of total billed charges,Implant Devices,1114.4,35,,1114.4,percent of total billed charges,Implant Devices,1114.4,35,,1114.4,percent of total billed charges,Implant Devices,1114.4,35,,1114.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1082.56,34,"If Charge > 2,000, then 34 percent",1082.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1273.6,
COMPOSIX KUGEL MESH XL OVAL 7.7 X9.7,C1781,HCPCS,,79001390,CDM,278,RC,,,both,,,2243,885.24,39.4668,,885.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,762.62,34,,762.62,percent of total billed charges,Implant Device,762.62,34,,762.62,percent of total billed charges,Implant Device,762.62,34,,762.62,percent of total billed charges,Implant Device,762.62,34,,762.62,percent of total billed charges,Implant Device,762.62,34,,762.62,percent of total billed charges,Implant Device,762.62,34,,762.62,percent of total billed charges,Implant Device,785.05,35,,785.05,percent of total billed charges,Implant Device,762.62,34,"Charges > $500, x 34%",762.62,percent of total billed charges,Implant Device,785.05,35,,785.05,percent of total billed charges,Implant Devices,785.05,35,,785.05,percent of total billed charges,Implant Devices,785.05,35,,,percent of total billed charges,Implant Devices,785.05,35,,785.05,percent of total billed charges,Implant Devices,785.05,35,,785.05,percent of total billed charges,Implant Devices,897.2,40,,897.2,percent of total billed charges,Implant Devices,785.05,70,,785.05,percent of total billed charges,Implant Devices,762.62,34,,762.62,percent of total billed charges,Implant Devices,762.62,34,,762.62,percent of total billed charges,Implant Devices,785.05,35,,785.05,percent of total billed charges,Implant Devices,785.05,35,,785.05,percent of total billed charges,Implant Devices,785.05,35,,785.05,percent of total billed charges,Implant Devices,785.05,35,,785.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,762.62,34,"If Charge > 2,000, then 34 percent",762.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,897.2,
BARD DAVOL INC. 123460 COMPOSIX MESH,C1781,HCPCS,,79001391,CDM,278,RC,,,both,,,721,284.56,39.4668,,284.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,245.14,34,,245.14,percent of total billed charges,Implant Device,245.14,34,,245.14,percent of total billed charges,Implant Device,245.14,34,,245.14,percent of total billed charges,Implant Device,245.14,34,,245.14,percent of total billed charges,Implant Device,245.14,34,,245.14,percent of total billed charges,Implant Device,245.14,34,,245.14,percent of total billed charges,Implant Device,252.35,35,,252.35,percent of total billed charges,Implant Device,245.14,34,"Charges > $500, x 34%",245.14,percent of total billed charges,Implant Device,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,288.4,40,,288.4,percent of total billed charges,Implant Devices,252.35,70,,252.35,percent of total billed charges,Implant Devices,245.14,34,,245.14,percent of total billed charges,Implant Devices,245.14,34,,245.14,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,252.35,35,,252.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,288.4,
ATRIUM 31526 C-QUR MESH 3 X 6,C1781,HCPCS,,79001465,CDM,278,RC,,,both,,,926,365.46,39.4668,,365.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,314.84,34,,314.84,percent of total billed charges,Implant Device,314.84,34,,314.84,percent of total billed charges,Implant Device,314.84,34,,314.84,percent of total billed charges,Implant Device,314.84,34,,314.84,percent of total billed charges,Implant Device,314.84,34,,314.84,percent of total billed charges,Implant Device,314.84,34,,314.84,percent of total billed charges,Implant Device,324.1,35,,324.1,percent of total billed charges,Implant Device,314.84,34,"Charges > $500, x 34%",314.84,percent of total billed charges,Implant Device,324.1,35,,324.1,percent of total billed charges,Implant Devices,324.1,35,,324.1,percent of total billed charges,Implant Devices,324.1,35,,,percent of total billed charges,Implant Devices,324.1,35,,324.1,percent of total billed charges,Implant Devices,324.1,35,,324.1,percent of total billed charges,Implant Devices,370.4,40,,370.4,percent of total billed charges,Implant Devices,324.1,70,,324.1,percent of total billed charges,Implant Devices,314.84,34,,314.84,percent of total billed charges,Implant Devices,314.84,34,,314.84,percent of total billed charges,Implant Devices,324.1,35,,324.1,percent of total billed charges,Implant Devices,324.1,35,,324.1,percent of total billed charges,Implant Devices,324.1,35,,324.1,percent of total billed charges,Implant Devices,324.1,35,,324.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,370.4,
ATRIUM 31543 C-QUR MESH 3.5 X3.5,C1781,HCPCS,,79001466,CDM,278,RC,,,both,,,728,287.32,39.4668,,287.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,247.52,34,,247.52,percent of total billed charges,Implant Device,247.52,34,,247.52,percent of total billed charges,Implant Device,247.52,34,,247.52,percent of total billed charges,Implant Device,247.52,34,,247.52,percent of total billed charges,Implant Device,247.52,34,,247.52,percent of total billed charges,Implant Device,247.52,34,,247.52,percent of total billed charges,Implant Device,254.8,35,,254.8,percent of total billed charges,Implant Device,247.52,34,"Charges > $500, x 34%",247.52,percent of total billed charges,Implant Device,254.8,35,,254.8,percent of total billed charges,Implant Devices,254.8,35,,254.8,percent of total billed charges,Implant Devices,254.8,35,,,percent of total billed charges,Implant Devices,254.8,35,,254.8,percent of total billed charges,Implant Devices,254.8,35,,254.8,percent of total billed charges,Implant Devices,291.2,40,,291.2,percent of total billed charges,Implant Devices,254.8,70,,254.8,percent of total billed charges,Implant Devices,247.52,34,,247.52,percent of total billed charges,Implant Devices,247.52,34,,247.52,percent of total billed charges,Implant Devices,254.8,35,,254.8,percent of total billed charges,Implant Devices,254.8,35,,254.8,percent of total billed charges,Implant Devices,254.8,35,,254.8,percent of total billed charges,Implant Devices,254.8,35,,254.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,291.2,
ATRIUM 31527 C-QUR MESH 4.3 X 5.5,C1781,HCPCS,,79001467,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,384,
ATRIUM 31544 C-QUR MESH 5 X 5,C1781,HCPCS,,79001468,CDM,278,RC,,,both,,,1083,427.43,39.4668,,427.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,368.22,34,,368.22,percent of total billed charges,Implant Device,368.22,34,,368.22,percent of total billed charges,Implant Device,368.22,34,,368.22,percent of total billed charges,Implant Device,368.22,34,,368.22,percent of total billed charges,Implant Device,368.22,34,,368.22,percent of total billed charges,Implant Device,368.22,34,,368.22,percent of total billed charges,Implant Device,379.05,35,,379.05,percent of total billed charges,Implant Device,368.22,34,"Charges > $500, x 34%",368.22,percent of total billed charges,Implant Device,379.05,35,,379.05,percent of total billed charges,Implant Devices,379.05,35,,379.05,percent of total billed charges,Implant Devices,379.05,35,,,percent of total billed charges,Implant Devices,379.05,35,,379.05,percent of total billed charges,Implant Devices,379.05,35,,379.05,percent of total billed charges,Implant Devices,433.2,40,,433.2,percent of total billed charges,Implant Devices,379.05,70,,379.05,percent of total billed charges,Implant Devices,368.22,34,,368.22,percent of total billed charges,Implant Devices,368.22,34,,368.22,percent of total billed charges,Implant Devices,379.05,35,,379.05,percent of total billed charges,Implant Devices,379.05,35,,379.05,percent of total billed charges,Implant Devices,379.05,35,,379.05,percent of total billed charges,Implant Devices,379.05,35,,379.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,433.2,
ATRIUM 31531 C-QUR MESH 5.4 X 7,C1781,HCPCS,,79001469,CDM,278,RC,,,both,,,1528,603.05,39.4668,,603.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,519.52,34,,519.52,percent of total billed charges,Implant Device,519.52,34,,519.52,percent of total billed charges,Implant Device,519.52,34,,519.52,percent of total billed charges,Implant Device,519.52,34,,519.52,percent of total billed charges,Implant Device,519.52,34,,519.52,percent of total billed charges,Implant Device,519.52,34,,519.52,percent of total billed charges,Implant Device,534.8,35,,534.8,percent of total billed charges,Implant Device,519.52,34,"Charges > $500, x 34%",519.52,percent of total billed charges,Implant Device,534.8,35,,534.8,percent of total billed charges,Implant Devices,534.8,35,,534.8,percent of total billed charges,Implant Devices,534.8,35,,,percent of total billed charges,Implant Devices,534.8,35,,534.8,percent of total billed charges,Implant Devices,534.8,35,,534.8,percent of total billed charges,Implant Devices,611.2,40,,611.2,percent of total billed charges,Implant Devices,534.8,70,,534.8,percent of total billed charges,Implant Devices,519.52,34,,519.52,percent of total billed charges,Implant Devices,519.52,34,,519.52,percent of total billed charges,Implant Devices,534.8,35,,534.8,percent of total billed charges,Implant Devices,534.8,35,,534.8,percent of total billed charges,Implant Devices,534.8,35,,534.8,percent of total billed charges,Implant Devices,534.8,35,,534.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,611.2,
ATRIUM 31534 C-QUR MESH 6 X 9,C1781,HCPCS,,79001470,CDM,278,RC,,,both,,,2392,944.05,39.4668,,944.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,813.28,34,,813.28,percent of total billed charges,Implant Device,813.28,34,,813.28,percent of total billed charges,Implant Device,813.28,34,,813.28,percent of total billed charges,Implant Device,813.28,34,,813.28,percent of total billed charges,Implant Device,813.28,34,,813.28,percent of total billed charges,Implant Device,813.28,34,,813.28,percent of total billed charges,Implant Device,837.2,35,,837.2,percent of total billed charges,Implant Device,813.28,34,"Charges > $500, x 34%",813.28,percent of total billed charges,Implant Device,837.2,35,,837.2,percent of total billed charges,Implant Devices,837.2,35,,837.2,percent of total billed charges,Implant Devices,837.2,35,,,percent of total billed charges,Implant Devices,837.2,35,,837.2,percent of total billed charges,Implant Devices,837.2,35,,837.2,percent of total billed charges,Implant Devices,956.8,40,,956.8,percent of total billed charges,Implant Devices,837.2,70,,837.2,percent of total billed charges,Implant Devices,813.28,34,,813.28,percent of total billed charges,Implant Devices,813.28,34,,813.28,percent of total billed charges,Implant Devices,837.2,35,,837.2,percent of total billed charges,Implant Devices,837.2,35,,837.2,percent of total billed charges,Implant Devices,837.2,35,,837.2,percent of total billed charges,Implant Devices,837.2,35,,837.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,813.28,34,"If Charge > 2,000, then 34 percent",813.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,956.8,
ATRIUM 31537 C-QUR MESH 8 X 12,C1781,HCPCS,,79001471,CDM,278,RC,,,both,,,3714,1465.8,39.4668,,1465.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1262.76,34,,1262.76,percent of total billed charges,Implant Device,1262.76,34,,1262.76,percent of total billed charges,Implant Device,1262.76,34,,1262.76,percent of total billed charges,Implant Device,1262.76,34,,1262.76,percent of total billed charges,Implant Device,1262.76,34,,1262.76,percent of total billed charges,Implant Device,1262.76,34,,1262.76,percent of total billed charges,Implant Device,1299.9,35,,1299.9,percent of total billed charges,Implant Device,1262.76,34,"Charges > $500, x 34%",1262.76,percent of total billed charges,Implant Device,1299.9,35,,1299.9,percent of total billed charges,Implant Devices,1299.9,35,,1299.9,percent of total billed charges,Implant Devices,1299.9,35,,,percent of total billed charges,Implant Devices,1299.9,35,,1299.9,percent of total billed charges,Implant Devices,1299.9,35,,1299.9,percent of total billed charges,Implant Devices,1485.6,40,,1485.6,percent of total billed charges,Implant Devices,1299.9,70,,1299.9,percent of total billed charges,Implant Devices,1262.76,34,,1262.76,percent of total billed charges,Implant Devices,1262.76,34,,1262.76,percent of total billed charges,Implant Devices,1299.9,35,,1299.9,percent of total billed charges,Implant Devices,1299.9,35,,1299.9,percent of total billed charges,Implant Devices,1299.9,35,,1299.9,percent of total billed charges,Implant Devices,1299.9,35,,1299.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1262.76,34,"If Charge > 2,000, then 34 percent",1262.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1485.6,
ATRIUM 31628 C-QUR TACSHIELD 4 X 6,C1781,HCPCS,,79001472,CDM,278,RC,,,both,,,1382,545.43,39.4668,,545.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.88,34,,469.88,percent of total billed charges,Implant Device,469.88,34,,469.88,percent of total billed charges,Implant Device,469.88,34,,469.88,percent of total billed charges,Implant Device,469.88,34,,469.88,percent of total billed charges,Implant Device,469.88,34,,469.88,percent of total billed charges,Implant Device,469.88,34,,469.88,percent of total billed charges,Implant Device,483.7,35,,483.7,percent of total billed charges,Implant Device,469.88,34,"Charges > $500, x 34%",469.88,percent of total billed charges,Implant Device,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,552.8,40,,552.8,percent of total billed charges,Implant Devices,483.7,70,,483.7,percent of total billed charges,Implant Devices,469.88,34,,469.88,percent of total billed charges,Implant Devices,469.88,34,,469.88,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552.8,
ATRIUM 31644 C-QUR TACSHIELD 5 X 5,C1781,HCPCS,,79001473,CDM,278,RC,,,both,,,1382,545.43,39.4668,,545.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,469.88,34,,469.88,percent of total billed charges,Implant Device,469.88,34,,469.88,percent of total billed charges,Implant Device,469.88,34,,469.88,percent of total billed charges,Implant Device,469.88,34,,469.88,percent of total billed charges,Implant Device,469.88,34,,469.88,percent of total billed charges,Implant Device,469.88,34,,469.88,percent of total billed charges,Implant Device,483.7,35,,483.7,percent of total billed charges,Implant Device,469.88,34,"Charges > $500, x 34%",469.88,percent of total billed charges,Implant Device,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,552.8,40,,552.8,percent of total billed charges,Implant Devices,483.7,70,,483.7,percent of total billed charges,Implant Devices,469.88,34,,469.88,percent of total billed charges,Implant Devices,469.88,34,,469.88,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,483.7,35,,483.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,552.8,
ATRIUM 31633 C-QUR TACSHIELD 6 X 8,C1781,HCPCS,,79001474,CDM,278,RC,,,both,,,2434,960.62,39.4668,,960.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,827.56,34,,827.56,percent of total billed charges,Implant Device,827.56,34,,827.56,percent of total billed charges,Implant Device,827.56,34,,827.56,percent of total billed charges,Implant Device,827.56,34,,827.56,percent of total billed charges,Implant Device,827.56,34,,827.56,percent of total billed charges,Implant Device,827.56,34,,827.56,percent of total billed charges,Implant Device,851.9,35,,851.9,percent of total billed charges,Implant Device,827.56,34,"Charges > $500, x 34%",827.56,percent of total billed charges,Implant Device,851.9,35,,851.9,percent of total billed charges,Implant Devices,851.9,35,,851.9,percent of total billed charges,Implant Devices,851.9,35,,,percent of total billed charges,Implant Devices,851.9,35,,851.9,percent of total billed charges,Implant Devices,851.9,35,,851.9,percent of total billed charges,Implant Devices,973.6,40,,973.6,percent of total billed charges,Implant Devices,851.9,70,,851.9,percent of total billed charges,Implant Devices,827.56,34,,827.56,percent of total billed charges,Implant Devices,827.56,34,,827.56,percent of total billed charges,Implant Devices,851.9,35,,851.9,percent of total billed charges,Implant Devices,851.9,35,,851.9,percent of total billed charges,Implant Devices,851.9,35,,851.9,percent of total billed charges,Implant Devices,851.9,35,,851.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,827.56,34,"If Charge > 2,000, then 34 percent",827.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,973.6,
ATRIUM 31637 C-QUR TACSHIELD 8 X 12,C1781,HCPCS,,79001475,CDM,278,RC,,,both,,,4056,1600.77,39.4668,,1600.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1379.04,34,,1379.04,percent of total billed charges,Implant Device,1379.04,34,,1379.04,percent of total billed charges,Implant Device,1379.04,34,,1379.04,percent of total billed charges,Implant Device,1379.04,34,,1379.04,percent of total billed charges,Implant Device,1379.04,34,,1379.04,percent of total billed charges,Implant Device,1379.04,34,,1379.04,percent of total billed charges,Implant Device,1419.6,35,,1419.6,percent of total billed charges,Implant Device,1379.04,34,"Charges > $500, x 34%",1379.04,percent of total billed charges,Implant Device,1419.6,35,,1419.6,percent of total billed charges,Implant Devices,1419.6,35,,1419.6,percent of total billed charges,Implant Devices,1419.6,35,,,percent of total billed charges,Implant Devices,1419.6,35,,1419.6,percent of total billed charges,Implant Devices,1419.6,35,,1419.6,percent of total billed charges,Implant Devices,1622.4,40,,1622.4,percent of total billed charges,Implant Devices,1419.6,70,,1419.6,percent of total billed charges,Implant Devices,1379.04,34,,1379.04,percent of total billed charges,Implant Devices,1379.04,34,,1379.04,percent of total billed charges,Implant Devices,1419.6,35,,1419.6,percent of total billed charges,Implant Devices,1419.6,35,,1419.6,percent of total billed charges,Implant Devices,1419.6,35,,1419.6,percent of total billed charges,Implant Devices,1419.6,35,,1419.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1379.04,34,"If Charge > 2,000, then 34 percent",1379.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1622.4,
ATRIUM 31201 C-QUR V PATCH MED 2.5X2.5,C1781,HCPCS,,79001476,CDM,278,RC,,,both,,,1327,523.72,39.4668,,523.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,451.18,34,,451.18,percent of total billed charges,Implant Device,451.18,34,,451.18,percent of total billed charges,Implant Device,451.18,34,,451.18,percent of total billed charges,Implant Device,451.18,34,,451.18,percent of total billed charges,Implant Device,451.18,34,,451.18,percent of total billed charges,Implant Device,451.18,34,,451.18,percent of total billed charges,Implant Device,464.45,35,,464.45,percent of total billed charges,Implant Device,451.18,34,"Charges > $500, x 34%",451.18,percent of total billed charges,Implant Device,464.45,35,,464.45,percent of total billed charges,Implant Devices,464.45,35,,464.45,percent of total billed charges,Implant Devices,464.45,35,,,percent of total billed charges,Implant Devices,464.45,35,,464.45,percent of total billed charges,Implant Devices,464.45,35,,464.45,percent of total billed charges,Implant Devices,530.8,40,,530.8,percent of total billed charges,Implant Devices,464.45,70,,464.45,percent of total billed charges,Implant Devices,451.18,34,,451.18,percent of total billed charges,Implant Devices,451.18,34,,451.18,percent of total billed charges,Implant Devices,464.45,35,,464.45,percent of total billed charges,Implant Devices,464.45,35,,464.45,percent of total billed charges,Implant Devices,464.45,35,,464.45,percent of total billed charges,Implant Devices,464.45,35,,464.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,530.8,
ATRIUM 31200 C-QUR V PATCH SMALL 1.7X1.7,C1781,HCPCS,,79001477,CDM,278,RC,,,both,,,1013,399.8,39.4668,,399.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,344.42,34,,344.42,percent of total billed charges,Implant Device,344.42,34,,344.42,percent of total billed charges,Implant Device,344.42,34,,344.42,percent of total billed charges,Implant Device,344.42,34,,344.42,percent of total billed charges,Implant Device,344.42,34,,344.42,percent of total billed charges,Implant Device,344.42,34,,344.42,percent of total billed charges,Implant Device,354.55,35,,354.55,percent of total billed charges,Implant Device,344.42,34,"Charges > $500, x 34%",344.42,percent of total billed charges,Implant Device,354.55,35,,354.55,percent of total billed charges,Implant Devices,354.55,35,,354.55,percent of total billed charges,Implant Devices,354.55,35,,,percent of total billed charges,Implant Devices,354.55,35,,354.55,percent of total billed charges,Implant Devices,354.55,35,,354.55,percent of total billed charges,Implant Devices,405.2,40,,405.2,percent of total billed charges,Implant Devices,354.55,70,,354.55,percent of total billed charges,Implant Devices,344.42,34,,344.42,percent of total billed charges,Implant Devices,344.42,34,,344.42,percent of total billed charges,Implant Devices,354.55,35,,354.55,percent of total billed charges,Implant Devices,354.55,35,,354.55,percent of total billed charges,Implant Devices,354.55,35,,354.55,percent of total billed charges,Implant Devices,354.55,35,,354.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,405.2,
ATRIUM 31202 C-QURV PATCH LARGE 3.2X3.2,C1781,HCPCS,,79001478,CDM,278,RC,,,both,,,1667,657.91,39.4668,,657.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,566.78,34,,566.78,percent of total billed charges,Implant Device,566.78,34,,566.78,percent of total billed charges,Implant Device,566.78,34,,566.78,percent of total billed charges,Implant Device,566.78,34,,566.78,percent of total billed charges,Implant Device,566.78,34,,566.78,percent of total billed charges,Implant Device,566.78,34,,566.78,percent of total billed charges,Implant Device,583.45,35,,583.45,percent of total billed charges,Implant Device,566.78,34,"Charges > $500, x 34%",566.78,percent of total billed charges,Implant Device,583.45,35,,583.45,percent of total billed charges,Implant Devices,583.45,35,,583.45,percent of total billed charges,Implant Devices,583.45,35,,,percent of total billed charges,Implant Devices,583.45,35,,583.45,percent of total billed charges,Implant Devices,583.45,35,,583.45,percent of total billed charges,Implant Devices,666.8,40,,666.8,percent of total billed charges,Implant Devices,583.45,70,,583.45,percent of total billed charges,Implant Devices,566.78,34,,566.78,percent of total billed charges,Implant Devices,566.78,34,,566.78,percent of total billed charges,Implant Devices,583.45,35,,583.45,percent of total billed charges,Implant Devices,583.45,35,,583.45,percent of total billed charges,Implant Devices,583.45,35,,583.45,percent of total billed charges,Implant Devices,583.45,35,,583.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,666.8,
CARDIO MEDICAL DG-0209SN DURAGUARD 2X9CM,C1781,HCPCS,,79001487,CDM,278,RC,,,both,,,466,183.92,39.4668,,183.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,158.44,34,,158.44,percent of total billed charges,Implant Device,163.1,35,,163.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,186.4,40,,186.4,percent of total billed charges,Implant Devices,163.1,70,,163.1,percent of total billed charges,Implant Devices,158.44,34,,158.44,percent of total billed charges,Implant Devices,158.44,34,,158.44,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,163.1,35,,163.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,186.4,
CARDIO MEDICAL DG-0608SN DURAGUARD 6X8CM,C1781,HCPCS,,79001488,CDM,278,RC,,,both,,,826,326,39.4668,,326,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.84,34,,280.84,percent of total billed charges,Implant Device,280.84,34,,280.84,percent of total billed charges,Implant Device,280.84,34,,280.84,percent of total billed charges,Implant Device,280.84,34,,280.84,percent of total billed charges,Implant Device,280.84,34,,280.84,percent of total billed charges,Implant Device,280.84,34,,280.84,percent of total billed charges,Implant Device,289.1,35,,289.1,percent of total billed charges,Implant Device,280.84,34,"Charges > $500, x 34%",280.84,percent of total billed charges,Implant Device,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,330.4,40,,330.4,percent of total billed charges,Implant Devices,289.1,70,,289.1,percent of total billed charges,Implant Devices,280.84,34,,280.84,percent of total billed charges,Implant Devices,280.84,34,,280.84,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,289.1,35,,289.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,330.4,
AMERICAN MED SYS 720093-01 ELEVATE AAPR,C1781,HCPCS,,79001497,CDM,278,RC,,,both,,,5550,2190.41,39.4668,,2190.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Device,1887,34,"Charges > $500, x 34%",1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,2220,40,,2220,percent of total billed charges,Implant Devices,1942.5,70,,1942.5,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1887,34,"If Charge > 2,000, then 34 percent",1887,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2220,
GORE HT064050A GRAFT RINGED 6X40,C1781,HCPCS,,79001510,CDM,278,RC,,,both,,,5194,2049.91,39.4668,,2049.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1765.96,34,,1765.96,percent of total billed charges,Implant Device,1765.96,34,,1765.96,percent of total billed charges,Implant Device,1765.96,34,,1765.96,percent of total billed charges,Implant Device,1765.96,34,,1765.96,percent of total billed charges,Implant Device,1765.96,34,,1765.96,percent of total billed charges,Implant Device,1765.96,34,,1765.96,percent of total billed charges,Implant Device,1817.9,35,,1817.9,percent of total billed charges,Implant Device,1765.96,34,"Charges > $500, x 34%",1765.96,percent of total billed charges,Implant Device,1817.9,35,,1817.9,percent of total billed charges,Implant Devices,1817.9,35,,1817.9,percent of total billed charges,Implant Devices,1817.9,35,,,percent of total billed charges,Implant Devices,1817.9,35,,1817.9,percent of total billed charges,Implant Devices,1817.9,35,,1817.9,percent of total billed charges,Implant Devices,2077.6,40,,2077.6,percent of total billed charges,Implant Devices,1817.9,70,,1817.9,percent of total billed charges,Implant Devices,1765.96,34,,1765.96,percent of total billed charges,Implant Devices,1765.96,34,,1765.96,percent of total billed charges,Implant Devices,1817.9,35,,1817.9,percent of total billed charges,Implant Devices,1817.9,35,,1817.9,percent of total billed charges,Implant Devices,1817.9,35,,1817.9,percent of total billed charges,Implant Devices,1817.9,35,,1817.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1765.96,34,"If Charge > 2,000, then 34 percent",1765.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2077.6,
GORE RR47010045L GRAFT REMOTE RNG 4.7X45,C1781,HCPCS,,79001517,CDM,278,RC,,,both,,,1932,762.5,39.4668,,762.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,656.88,34,,656.88,percent of total billed charges,Implant Device,656.88,34,,656.88,percent of total billed charges,Implant Device,656.88,34,,656.88,percent of total billed charges,Implant Device,656.88,34,,656.88,percent of total billed charges,Implant Device,656.88,34,,656.88,percent of total billed charges,Implant Device,656.88,34,,656.88,percent of total billed charges,Implant Device,676.2,35,,676.2,percent of total billed charges,Implant Device,656.88,34,"Charges > $500, x 34%",656.88,percent of total billed charges,Implant Device,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,772.8,40,,772.8,percent of total billed charges,Implant Devices,676.2,70,,676.2,percent of total billed charges,Implant Devices,656.88,34,,656.88,percent of total billed charges,Implant Devices,656.88,34,,656.88,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,676.2,35,,676.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,772.8,
GORE RRT06060080L GRAFT REMOTE RING 6X80,C1781,HCPCS,,79001518,CDM,278,RC,,,both,,,3376,1332.4,39.4668,,1332.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1181.6,35,,1181.6,percent of total billed charges,Implant Device,1147.84,34,"Charges > $500, x 34%",1147.84,percent of total billed charges,Implant Device,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1350.4,40,,1350.4,percent of total billed charges,Implant Devices,1181.6,70,,1181.6,percent of total billed charges,Implant Devices,1147.84,34,,1147.84,percent of total billed charges,Implant Devices,1147.84,34,,1147.84,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1147.84,34,"If Charge > 2,000, then 34 percent",1147.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1350.4,
GORE RRT08070080L GRAFT REMOTE RING 8X80,C1781,HCPCS,,79001519,CDM,278,RC,,,both,,,3376,1332.4,39.4668,,1332.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1147.84,34,,1147.84,percent of total billed charges,Implant Device,1181.6,35,,1181.6,percent of total billed charges,Implant Device,1147.84,34,"Charges > $500, x 34%",1147.84,percent of total billed charges,Implant Device,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1350.4,40,,1350.4,percent of total billed charges,Implant Devices,1181.6,70,,1181.6,percent of total billed charges,Implant Devices,1147.84,34,,1147.84,percent of total billed charges,Implant Devices,1147.84,34,,1147.84,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,1181.6,35,,1181.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1147.84,34,"If Charge > 2,000, then 34 percent",1147.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1350.4,
KUGEL HERNIA PATCH 12 X12,C1781,HCPCS,,79001565,CDM,278,RC,,,both,,,504,198.91,39.4668,,198.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,171.36,34,,171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Device,171.36,34,"Charges > $500, x 34%",171.36,percent of total billed charges,Implant Device,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,201.6,40,,201.6,percent of total billed charges,Implant Devices,176.4,70,,176.4,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,171.36,34,,171.36,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,176.4,35,,176.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,201.6,
BARD 10102 KUGEL HERNIA PATCH OVAL 5.5X7,C1781,HCPCS,,79001566,CDM,278,RC,,,both,,,1200,473.6,39.4668,,473.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,408,34,,408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Device,408,34,"Charges > $500, x 34%",408,percent of total billed charges,Implant Device,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,480,40,,480,percent of total billed charges,Implant Devices,420,70,,420,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,408,34,,408,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,420,35,,420,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,480,
KUGEL HERNIA PATCH MEDIUM,C1781,HCPCS,,79001567,CDM,278,RC,,,both,,,1063,419.53,39.4668,,419.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,372.05,35,,372.05,percent of total billed charges,Implant Device,361.42,34,"Charges > $500, x 34%",361.42,percent of total billed charges,Implant Device,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,425.2,40,,425.2,percent of total billed charges,Implant Devices,372.05,70,,372.05,percent of total billed charges,Implant Devices,361.42,34,,361.42,percent of total billed charges,Implant Devices,361.42,34,,361.42,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,425.2,
BARD 10103 KUGEL HERNIA PATCH 3X3,C1781,HCPCS,,79001568,CDM,278,RC,,,both,,,964,380.46,39.4668,,380.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,327.76,34,,327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Device,327.76,34,"Charges > $500, x 34%",327.76,percent of total billed charges,Implant Device,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,385.6,40,,385.6,percent of total billed charges,Implant Devices,337.4,70,,337.4,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,327.76,34,,327.76,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,337.4,35,,337.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,385.6,
KUGEL HERNIA PATCH SMALL CIRCLE,C1781,HCPCS,,79001569,CDM,278,RC,,,both,,,680,268.37,39.4668,,268.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,231.2,34,,231.2,percent of total billed charges,Implant Device,231.2,34,,231.2,percent of total billed charges,Implant Device,231.2,34,,231.2,percent of total billed charges,Implant Device,231.2,34,,231.2,percent of total billed charges,Implant Device,231.2,34,,231.2,percent of total billed charges,Implant Device,231.2,34,,231.2,percent of total billed charges,Implant Device,238,35,,238,percent of total billed charges,Implant Device,231.2,34,"Charges > $500, x 34%",231.2,percent of total billed charges,Implant Device,238,35,,238,percent of total billed charges,Implant Devices,238,35,,238,percent of total billed charges,Implant Devices,238,35,,,percent of total billed charges,Implant Devices,238,35,,238,percent of total billed charges,Implant Devices,238,35,,238,percent of total billed charges,Implant Devices,272,40,,272,percent of total billed charges,Implant Devices,238,70,,238,percent of total billed charges,Implant Devices,231.2,34,,231.2,percent of total billed charges,Implant Devices,231.2,34,,231.2,percent of total billed charges,Implant Devices,238,35,,238,percent of total billed charges,Implant Devices,238,35,,238,percent of total billed charges,Implant Devices,238,35,,238,percent of total billed charges,Implant Devices,238,35,,238,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,272,
KUGEL HERNIA PATCH SMALL OVAL 3 X 5,C1781,HCPCS,,79001570,CDM,278,RC,,,both,,,886,349.68,39.4668,,349.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,301.24,34,,301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Device,301.24,34,"Charges > $500, x 34%",301.24,percent of total billed charges,Implant Device,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,354.4,40,,354.4,percent of total billed charges,Implant Devices,310.1,70,,310.1,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,301.24,34,,301.24,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,310.1,35,,310.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,354.4,
BARD 10101 KUGEL HERNIA PATCH OVAL 3X4.6,C1781,HCPCS,,79001571,CDM,278,RC,,,both,,,791,312.18,39.4668,,312.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,268.94,34,,268.94,percent of total billed charges,Implant Device,268.94,34,,268.94,percent of total billed charges,Implant Device,268.94,34,,268.94,percent of total billed charges,Implant Device,268.94,34,,268.94,percent of total billed charges,Implant Device,268.94,34,,268.94,percent of total billed charges,Implant Device,268.94,34,,268.94,percent of total billed charges,Implant Device,276.85,35,,276.85,percent of total billed charges,Implant Device,268.94,34,"Charges > $500, x 34%",268.94,percent of total billed charges,Implant Device,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,316.4,40,,316.4,percent of total billed charges,Implant Devices,276.85,70,,276.85,percent of total billed charges,Implant Devices,268.94,34,,268.94,percent of total billed charges,Implant Devices,268.94,34,,268.94,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,276.85,35,,276.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,316.4,
ATRIUM 1000204-00 MESH PROLITE POLY 2X4,C1781,HCPCS,,79001619,CDM,278,RC,,,both,,,457,180.36,39.4668,,180.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.38,34,,155.38,percent of total billed charges,Implant Device,155.38,34,,155.38,percent of total billed charges,Implant Device,155.38,34,,155.38,percent of total billed charges,Implant Device,155.38,34,,155.38,percent of total billed charges,Implant Device,155.38,34,,155.38,percent of total billed charges,Implant Device,155.38,34,,155.38,percent of total billed charges,Implant Device,159.95,35,,159.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,182.8,40,,182.8,percent of total billed charges,Implant Devices,159.95,70,,159.95,percent of total billed charges,Implant Devices,155.38,34,,155.38,percent of total billed charges,Implant Devices,155.38,34,,155.38,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,159.95,35,,159.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,182.8,
US SURG P101010 PERMACOL COLLAGEN 10X10,C1781,HCPCS,,79001647,CDM,278,RC,,,both,,,6490,2561.4,39.4668,,2561.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2206.6,34,,2206.6,percent of total billed charges,Implant Device,2206.6,34,,2206.6,percent of total billed charges,Implant Device,2206.6,34,,2206.6,percent of total billed charges,Implant Device,2206.6,34,,2206.6,percent of total billed charges,Implant Device,2206.6,34,,2206.6,percent of total billed charges,Implant Device,2206.6,34,,2206.6,percent of total billed charges,Implant Device,2271.5,35,,2271.5,percent of total billed charges,Implant Device,2206.6,34,"Charges > $500, x 34%",2206.6,percent of total billed charges,Implant Device,2271.5,35,,2271.5,percent of total billed charges,Implant Devices,2271.5,35,,2271.5,percent of total billed charges,Implant Devices,2271.5,35,,,percent of total billed charges,Implant Devices,2271.5,35,,2271.5,percent of total billed charges,Implant Devices,2271.5,35,,2271.5,percent of total billed charges,Implant Devices,2596,40,,2596,percent of total billed charges,Implant Devices,2271.5,70,,2271.5,percent of total billed charges,Implant Devices,2206.6,34,,2206.6,percent of total billed charges,Implant Devices,2206.6,34,,2206.6,percent of total billed charges,Implant Devices,2271.5,35,,2271.5,percent of total billed charges,Implant Devices,2271.5,35,,2271.5,percent of total billed charges,Implant Devices,2271.5,35,,2271.5,percent of total billed charges,Implant Devices,2271.5,35,,2271.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2206.6,34,"If Charge > 2,000, then 34 percent",2206.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2596,
SUTURE EXPRESS 101010 PERMACOL IMPLANT,C1781,HCPCS,,79001648,CDM,278,RC,,,both,,,6667,2631.25,39.4668,,2631.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2266.78,34,,2266.78,percent of total billed charges,Implant Device,2266.78,34,,2266.78,percent of total billed charges,Implant Device,2266.78,34,,2266.78,percent of total billed charges,Implant Device,2266.78,34,,2266.78,percent of total billed charges,Implant Device,2266.78,34,,2266.78,percent of total billed charges,Implant Device,2266.78,34,,2266.78,percent of total billed charges,Implant Device,2333.45,35,,2333.45,percent of total billed charges,Implant Device,2266.78,34,"Charges > $500, x 34%",2266.78,percent of total billed charges,Implant Device,2333.45,35,,2333.45,percent of total billed charges,Implant Devices,2333.45,35,,2333.45,percent of total billed charges,Implant Devices,2333.45,35,,,percent of total billed charges,Implant Devices,2333.45,35,,2333.45,percent of total billed charges,Implant Devices,2333.45,35,,2333.45,percent of total billed charges,Implant Devices,2666.8,40,,2666.8,percent of total billed charges,Implant Devices,2333.45,70,,2333.45,percent of total billed charges,Implant Devices,2266.78,34,,2266.78,percent of total billed charges,Implant Devices,2266.78,34,,2266.78,percent of total billed charges,Implant Devices,2333.45,35,,2333.45,percent of total billed charges,Implant Devices,2333.45,35,,2333.45,percent of total billed charges,Implant Devices,2333.45,35,,2333.45,percent of total billed charges,Implant Devices,2333.45,35,,2333.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2266.78,34,"If Charge > 2,000, then 34 percent",2266.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2666.8,
ATRIUM 30902 PLUG LARGE,C1781,HCPCS,,79001682,CDM,278,RC,,,both,,,392,154.71,39.4668,,154.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,156.8,40,,156.8,percent of total billed charges,Implant Devices,137.2,70,,137.2,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156.8,
ATRIUM 30901 PLUG MEDIUM,C1781,HCPCS,,79001683,CDM,278,RC,,,both,,,392,154.71,39.4668,,154.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,156.8,40,,156.8,percent of total billed charges,Implant Devices,137.2,70,,137.2,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156.8,
ATRIUM 30900 PLUG SMALL,C1781,HCPCS,,79001684,CDM,278,RC,,,both,,,392,154.71,39.4668,,154.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,156.8,40,,156.8,percent of total billed charges,Implant Devices,137.2,70,,137.2,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156.8,
BARD 112980 PLUG X LARGE,C1781,HCPCS,,79001685,CDM,278,RC,,,both,,,952,375.72,39.4668,,375.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,323.68,34,,323.68,percent of total billed charges,Implant Device,323.68,34,,323.68,percent of total billed charges,Implant Device,323.68,34,,323.68,percent of total billed charges,Implant Device,323.68,34,,323.68,percent of total billed charges,Implant Device,323.68,34,,323.68,percent of total billed charges,Implant Device,323.68,34,,323.68,percent of total billed charges,Implant Device,333.2,35,,333.2,percent of total billed charges,Implant Device,323.68,34,"Charges > $500, x 34%",323.68,percent of total billed charges,Implant Device,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,380.8,40,,380.8,percent of total billed charges,Implant Devices,333.2,70,,333.2,percent of total billed charges,Implant Devices,323.68,34,,323.68,percent of total billed charges,Implant Devices,323.68,34,,323.68,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,333.2,35,,333.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,380.8,
ATRIUM 30909 PLUG MEDIUM,C1781,HCPCS,,79001686,CDM,278,RC,,,both,,,800,315.73,39.4668,,315.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,272,34,,272,percent of total billed charges,Implant Device,272,34,,272,percent of total billed charges,Implant Device,272,34,,272,percent of total billed charges,Implant Device,272,34,,272,percent of total billed charges,Implant Device,272,34,,272,percent of total billed charges,Implant Device,272,34,,272,percent of total billed charges,Implant Device,280,35,,280,percent of total billed charges,Implant Device,272,34,"Charges > $500, x 34%",272,percent of total billed charges,Implant Device,280,35,,280,percent of total billed charges,Implant Devices,280,35,,280,percent of total billed charges,Implant Devices,280,35,,,percent of total billed charges,Implant Devices,280,35,,280,percent of total billed charges,Implant Devices,280,35,,280,percent of total billed charges,Implant Devices,320,40,,320,percent of total billed charges,Implant Devices,280,70,,280,percent of total billed charges,Implant Devices,272,34,,272,percent of total billed charges,Implant Devices,272,34,,272,percent of total billed charges,Implant Devices,280,35,,280,percent of total billed charges,Implant Devices,280,35,,280,percent of total billed charges,Implant Devices,280,35,,280,percent of total billed charges,Implant Devices,280,35,,280,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,320,
ATRIUM 30903 PLUG XLARGE,C1781,HCPCS,,79001687,CDM,278,RC,,,both,,,428,168.92,39.4668,,168.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,171.2,40,,171.2,percent of total billed charges,Implant Devices,149.8,70,,149.8,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,171.2,
GORE RT06050080L RING THINWALL 6 X 80,C1781,HCPCS,,79001703,CDM,278,RC,,,both,,,3262,1287.41,39.4668,,1287.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1109.08,34,,1109.08,percent of total billed charges,Implant Device,1109.08,34,,1109.08,percent of total billed charges,Implant Device,1109.08,34,,1109.08,percent of total billed charges,Implant Device,1109.08,34,,1109.08,percent of total billed charges,Implant Device,1109.08,34,,1109.08,percent of total billed charges,Implant Device,1109.08,34,,1109.08,percent of total billed charges,Implant Device,1141.7,35,,1141.7,percent of total billed charges,Implant Device,1109.08,34,"Charges > $500, x 34%",1109.08,percent of total billed charges,Implant Device,1141.7,35,,1141.7,percent of total billed charges,Implant Devices,1141.7,35,,1141.7,percent of total billed charges,Implant Devices,1141.7,35,,,percent of total billed charges,Implant Devices,1141.7,35,,1141.7,percent of total billed charges,Implant Devices,1141.7,35,,1141.7,percent of total billed charges,Implant Devices,1304.8,40,,1304.8,percent of total billed charges,Implant Devices,1141.7,70,,1141.7,percent of total billed charges,Implant Devices,1109.08,34,,1109.08,percent of total billed charges,Implant Devices,1109.08,34,,1109.08,percent of total billed charges,Implant Devices,1141.7,35,,1141.7,percent of total billed charges,Implant Devices,1141.7,35,,1141.7,percent of total billed charges,Implant Devices,1141.7,35,,1141.7,percent of total billed charges,Implant Devices,1141.7,35,,1141.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1109.08,34,"If Charge > 2,000, then 34 percent",1109.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1304.8,
SUT EXP SPMM35 SURGIPRO MESH 3 X 5,C1781,HCPCS,,79001733,CDM,278,RC,,,both,,,117,46.18,39.4668,,46.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.78,34,,39.78,percent of total billed charges,Implant Device,39.78,34,,39.78,percent of total billed charges,Implant Device,39.78,34,,39.78,percent of total billed charges,Implant Device,39.78,34,,39.78,percent of total billed charges,Implant Device,39.78,34,,39.78,percent of total billed charges,Implant Device,39.78,34,,39.78,percent of total billed charges,Implant Device,40.95,35,,40.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,46.8,40,,46.8,percent of total billed charges,Implant Devices,40.95,70,,40.95,percent of total billed charges,Implant Devices,39.78,34,,39.78,percent of total billed charges,Implant Devices,39.78,34,,39.78,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,40.95,35,,40.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,46.8,
SUTURE EXPRESS SPMM66 SURGIPRO MESH 6X6,C1781,HCPCS,,79001734,CDM,278,RC,,,both,,,92,36.31,39.4668,,36.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,31.28,34,,31.28,percent of total billed charges,Implant Device,31.28,34,,31.28,percent of total billed charges,Implant Device,31.28,34,,31.28,percent of total billed charges,Implant Device,31.28,34,,31.28,percent of total billed charges,Implant Device,31.28,34,,31.28,percent of total billed charges,Implant Device,31.28,34,,31.28,percent of total billed charges,Implant Device,32.2,35,,32.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,36.8,40,,36.8,percent of total billed charges,Implant Devices,32.2,70,,32.2,percent of total billed charges,Implant Devices,31.28,34,,31.28,percent of total billed charges,Implant Devices,31.28,34,,31.28,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,32.2,35,,32.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,36.8,
SUT EXP VKML VICRYL KNITTED MESH 12X12,C1781,HCPCS,,79001760,CDM,278,RC,,,both,,,3451,1362,39.4668,,1362,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173.34,34,,1173.34,percent of total billed charges,Implant Device,1173.34,34,,1173.34,percent of total billed charges,Implant Device,1173.34,34,,1173.34,percent of total billed charges,Implant Device,1173.34,34,,1173.34,percent of total billed charges,Implant Device,1173.34,34,,1173.34,percent of total billed charges,Implant Device,1173.34,34,,1173.34,percent of total billed charges,Implant Device,1207.85,35,,1207.85,percent of total billed charges,Implant Device,1173.34,34,"Charges > $500, x 34%",1173.34,percent of total billed charges,Implant Device,1207.85,35,,1207.85,percent of total billed charges,Implant Devices,1207.85,35,,1207.85,percent of total billed charges,Implant Devices,1207.85,35,,,percent of total billed charges,Implant Devices,1207.85,35,,1207.85,percent of total billed charges,Implant Devices,1207.85,35,,1207.85,percent of total billed charges,Implant Devices,1380.4,40,,1380.4,percent of total billed charges,Implant Devices,1207.85,70,,1207.85,percent of total billed charges,Implant Devices,1173.34,34,,1173.34,percent of total billed charges,Implant Devices,1173.34,34,,1173.34,percent of total billed charges,Implant Devices,1207.85,35,,1207.85,percent of total billed charges,Implant Devices,1207.85,35,,1207.85,percent of total billed charges,Implant Devices,1207.85,35,,1207.85,percent of total billed charges,Implant Devices,1207.85,35,,1207.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1173.34,34,"If Charge > 2,000, then 34 percent",1173.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380.4,
SUTURE EXPRESS VWML VICRYL MESH 12X12,C1781,HCPCS,,79001761,CDM,278,RC,,,both,,,2173,857.61,39.4668,,857.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,738.82,34,,738.82,percent of total billed charges,Implant Device,738.82,34,,738.82,percent of total billed charges,Implant Device,738.82,34,,738.82,percent of total billed charges,Implant Device,738.82,34,,738.82,percent of total billed charges,Implant Device,738.82,34,,738.82,percent of total billed charges,Implant Device,738.82,34,,738.82,percent of total billed charges,Implant Device,760.55,35,,760.55,percent of total billed charges,Implant Device,738.82,34,"Charges > $500, x 34%",738.82,percent of total billed charges,Implant Device,760.55,35,,760.55,percent of total billed charges,Implant Devices,760.55,35,,760.55,percent of total billed charges,Implant Devices,760.55,35,,,percent of total billed charges,Implant Devices,760.55,35,,760.55,percent of total billed charges,Implant Devices,760.55,35,,760.55,percent of total billed charges,Implant Devices,869.2,40,,869.2,percent of total billed charges,Implant Devices,760.55,70,,760.55,percent of total billed charges,Implant Devices,738.82,34,,738.82,percent of total billed charges,Implant Devices,738.82,34,,738.82,percent of total billed charges,Implant Devices,760.55,35,,760.55,percent of total billed charges,Implant Devices,760.55,35,,760.55,percent of total billed charges,Implant Devices,760.55,35,,760.55,percent of total billed charges,Implant Devices,760.55,35,,760.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,738.82,34,"If Charge > 2,000, then 34 percent",738.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,869.2,
ATRIUM 30908 MESH PLUG,C1781,HCPCS,,79001788,CDM,278,RC,,,both,,,370,146.03,39.4668,,146.03,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,125.8,34,,125.8,percent of total billed charges,Implant Device,129.5,35,,129.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,148,40,,148,percent of total billed charges,Implant Devices,129.5,70,,129.5,percent of total billed charges,Implant Devices,125.8,34,,125.8,percent of total billed charges,Implant Devices,125.8,34,,125.8,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,129.5,35,,129.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,148,
LIFE CELL 1520128 ALLODERM 8X16,C1781,HCPCS,,79001833,CDM,278,RC,,,both,,,16188,6388.89,39.4668,,6388.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5503.92,34,,5503.92,percent of total billed charges,Implant Device,5503.92,34,,5503.92,percent of total billed charges,Implant Device,5503.92,34,,5503.92,percent of total billed charges,Implant Device,5503.92,34,,5503.92,percent of total billed charges,Implant Device,5503.92,34,,5503.92,percent of total billed charges,Implant Device,5503.92,34,,5503.92,percent of total billed charges,Implant Device,5665.8,35,,5665.8,percent of total billed charges,Implant Device,5503.92,34,"Charges > $500, x 34%",5503.92,percent of total billed charges,Implant Device,5665.8,35,,5665.8,percent of total billed charges,Implant Devices,5665.8,35,,5665.8,percent of total billed charges,Implant Devices,5665.8,35,,,percent of total billed charges,Implant Devices,5665.8,35,,5665.8,percent of total billed charges,Implant Devices,5665.8,35,,5665.8,percent of total billed charges,Implant Devices,6475.2,40,,6475.2,percent of total billed charges,Implant Devices,5665.8,70,,5665.8,percent of total billed charges,Implant Devices,5503.92,34,,5503.92,percent of total billed charges,Implant Devices,5503.92,34,,5503.92,percent of total billed charges,Implant Devices,5665.8,35,,5665.8,percent of total billed charges,Implant Devices,5665.8,35,,5665.8,percent of total billed charges,Implant Devices,5665.8,35,,5665.8,percent of total billed charges,Implant Devices,5665.8,35,,5665.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5503.92,34,"If Charge > 2,000, then 34 percent",5503.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6475.2,
STRYKER ORTHO 6495-9-001 TISSUEMEND,C1781,HCPCS,,79002238,CDM,278,RC,,,both,,,6900,2723.21,39.4668,,2723.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2346,34,,2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Device,2346,34,"Charges > $500, x 34%",2346,percent of total billed charges,Implant Device,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2760,40,,2760,percent of total billed charges,Implant Devices,2415,70,,2415,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2346,34,,2346,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,2415,35,,2415,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2346,34,"If Charge > 2,000, then 34 percent",2346,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2760,
STRYKER 6495-9-004 TISSUEMEND,C1781,HCPCS,,79002239,CDM,278,RC,,,both,,,8972,3540.96,39.4668,,3540.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3050.48,34,,3050.48,percent of total billed charges,Implant Device,3050.48,34,,3050.48,percent of total billed charges,Implant Device,3050.48,34,,3050.48,percent of total billed charges,Implant Device,3050.48,34,,3050.48,percent of total billed charges,Implant Device,3050.48,34,,3050.48,percent of total billed charges,Implant Device,3050.48,34,,3050.48,percent of total billed charges,Implant Device,3140.2,35,,3140.2,percent of total billed charges,Implant Device,3050.48,34,"Charges > $500, x 34%",3050.48,percent of total billed charges,Implant Device,3140.2,35,,3140.2,percent of total billed charges,Implant Devices,3140.2,35,,3140.2,percent of total billed charges,Implant Devices,3140.2,35,,,percent of total billed charges,Implant Devices,3140.2,35,,3140.2,percent of total billed charges,Implant Devices,3140.2,35,,3140.2,percent of total billed charges,Implant Devices,3588.8,40,,3588.8,percent of total billed charges,Implant Devices,3140.2,70,,3140.2,percent of total billed charges,Implant Devices,3050.48,34,,3050.48,percent of total billed charges,Implant Devices,3050.48,34,,3050.48,percent of total billed charges,Implant Devices,3140.2,35,,3140.2,percent of total billed charges,Implant Devices,3140.2,35,,3140.2,percent of total billed charges,Implant Devices,3140.2,35,,3140.2,percent of total billed charges,Implant Devices,3140.2,35,,3140.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3050.48,34,"If Charge > 2,000, then 34 percent",3050.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3588.8,
CALDERA MEDICAL CAL-DSO1A SLING SYSTEM,C1781,HCPCS,,79002472,CDM,278,RC,,,both,,,2686,1060.08,39.4668,,1060.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,913.24,34,,913.24,percent of total billed charges,Implant Device,940.1,35,,940.1,percent of total billed charges,Implant Device,913.24,34,"Charges > $500, x 34%",913.24,percent of total billed charges,Implant Device,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,1074.4,40,,1074.4,percent of total billed charges,Implant Devices,940.1,70,,940.1,percent of total billed charges,Implant Devices,913.24,34,,913.24,percent of total billed charges,Implant Devices,913.24,34,,913.24,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,940.1,35,,940.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,913.24,34,"If Charge > 2,000, then 34 percent",913.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1074.4,
SUTURE EXPRESS SPM-148 SURGIPRO MESH,C1781,HCPCS,,79003418,CDM,278,RC,,,both,,,397,156.68,39.4668,,156.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,134.98,34,,134.98,percent of total billed charges,Implant Device,134.98,34,,134.98,percent of total billed charges,Implant Device,134.98,34,,134.98,percent of total billed charges,Implant Device,134.98,34,,134.98,percent of total billed charges,Implant Device,134.98,34,,134.98,percent of total billed charges,Implant Device,134.98,34,,134.98,percent of total billed charges,Implant Device,138.95,35,,138.95,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,138.95,35,,138.95,percent of total billed charges,Implant Devices,138.95,35,,138.95,percent of total billed charges,Implant Devices,138.95,35,,,percent of total billed charges,Implant Devices,138.95,35,,138.95,percent of total billed charges,Implant Devices,138.95,35,,138.95,percent of total billed charges,Implant Devices,158.8,40,,158.8,percent of total billed charges,Implant Devices,138.95,70,,138.95,percent of total billed charges,Implant Devices,134.98,34,,134.98,percent of total billed charges,Implant Devices,134.98,34,,134.98,percent of total billed charges,Implant Devices,138.95,35,,138.95,percent of total billed charges,Implant Devices,138.95,35,,138.95,percent of total billed charges,Implant Devices,138.95,35,,138.95,percent of total billed charges,Implant Devices,138.95,35,,138.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,158.8,
ATRIUM 31506 CQUR MESH ROUND 13X13CM,C1781,HCPCS,,79003784,CDM,278,RC,,,both,,,1025,404.53,39.4668,,404.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,348.5,34,,348.5,percent of total billed charges,Implant Device,348.5,34,,348.5,percent of total billed charges,Implant Device,348.5,34,,348.5,percent of total billed charges,Implant Device,348.5,34,,348.5,percent of total billed charges,Implant Device,348.5,34,,348.5,percent of total billed charges,Implant Device,348.5,34,,348.5,percent of total billed charges,Implant Device,358.75,35,,358.75,percent of total billed charges,Implant Device,348.5,34,"Charges > $500, x 34%",348.5,percent of total billed charges,Implant Device,358.75,35,,358.75,percent of total billed charges,Implant Devices,358.75,35,,358.75,percent of total billed charges,Implant Devices,358.75,35,,,percent of total billed charges,Implant Devices,358.75,35,,358.75,percent of total billed charges,Implant Devices,358.75,35,,358.75,percent of total billed charges,Implant Devices,410,40,,410,percent of total billed charges,Implant Devices,358.75,70,,358.75,percent of total billed charges,Implant Devices,348.5,34,,348.5,percent of total billed charges,Implant Devices,348.5,34,,348.5,percent of total billed charges,Implant Devices,358.75,35,,358.75,percent of total billed charges,Implant Devices,358.75,35,,358.75,percent of total billed charges,Implant Devices,358.75,35,,358.75,percent of total billed charges,Implant Devices,358.75,35,,358.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,410,
ATRIUM 31505 CQUR MESH ROUND 9X9CM,C1781,HCPCS,,79003785,CDM,278,RC,,,both,,,740,292.05,39.4668,,292.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,251.6,34,,251.6,percent of total billed charges,Implant Device,251.6,34,,251.6,percent of total billed charges,Implant Device,251.6,34,,251.6,percent of total billed charges,Implant Device,251.6,34,,251.6,percent of total billed charges,Implant Device,251.6,34,,251.6,percent of total billed charges,Implant Device,251.6,34,,251.6,percent of total billed charges,Implant Device,259,35,,259,percent of total billed charges,Implant Device,251.6,34,"Charges > $500, x 34%",251.6,percent of total billed charges,Implant Device,259,35,,259,percent of total billed charges,Implant Devices,259,35,,259,percent of total billed charges,Implant Devices,259,35,,,percent of total billed charges,Implant Devices,259,35,,259,percent of total billed charges,Implant Devices,259,35,,259,percent of total billed charges,Implant Devices,296,40,,296,percent of total billed charges,Implant Devices,259,70,,259,percent of total billed charges,Implant Devices,251.6,34,,251.6,percent of total billed charges,Implant Devices,251.6,34,,251.6,percent of total billed charges,Implant Devices,259,35,,259,percent of total billed charges,Implant Devices,259,35,,259,percent of total billed charges,Implant Devices,259,35,,259,percent of total billed charges,Implant Devices,259,35,,259,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,296,
ATRIUM 31507 CQUR MESH ROUND 15X15CM,C1781,HCPCS,,79003786,CDM,278,RC,,,both,,,1420,560.43,39.4668,,560.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,482.8,34,,482.8,percent of total billed charges,Implant Device,482.8,34,,482.8,percent of total billed charges,Implant Device,482.8,34,,482.8,percent of total billed charges,Implant Device,482.8,34,,482.8,percent of total billed charges,Implant Device,482.8,34,,482.8,percent of total billed charges,Implant Device,482.8,34,,482.8,percent of total billed charges,Implant Device,497,35,,497,percent of total billed charges,Implant Device,482.8,34,"Charges > $500, x 34%",482.8,percent of total billed charges,Implant Device,497,35,,497,percent of total billed charges,Implant Devices,497,35,,497,percent of total billed charges,Implant Devices,497,35,,,percent of total billed charges,Implant Devices,497,35,,497,percent of total billed charges,Implant Devices,497,35,,497,percent of total billed charges,Implant Devices,568,40,,568,percent of total billed charges,Implant Devices,497,70,,497,percent of total billed charges,Implant Devices,482.8,34,,482.8,percent of total billed charges,Implant Devices,482.8,34,,482.8,percent of total billed charges,Implant Devices,497,35,,497,percent of total billed charges,Implant Devices,497,35,,497,percent of total billed charges,Implant Devices,497,35,,497,percent of total billed charges,Implant Devices,497,35,,497,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,568,
BARD OO10105 HERNIA PATCH OVAL 11X14CM,C1781,HCPCS,,79003876,CDM,278,RC,,,both,,,1063,419.53,39.4668,,419.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,361.42,34,,361.42,percent of total billed charges,Implant Device,372.05,35,,372.05,percent of total billed charges,Implant Device,361.42,34,"Charges > $500, x 34%",361.42,percent of total billed charges,Implant Device,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,425.2,40,,425.2,percent of total billed charges,Implant Devices,372.05,70,,372.05,percent of total billed charges,Implant Devices,361.42,34,,361.42,percent of total billed charges,Implant Devices,361.42,34,,361.42,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,372.05,35,,372.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,425.2,
J&J PVPM PROCEED VENTL PATCH MD CIR 2.5,C1781,HCPCS,,79003991,CDM,278,RC,,,both,,,1940,765.66,39.4668,,765.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,659.6,34,,659.6,percent of total billed charges,Implant Device,659.6,34,,659.6,percent of total billed charges,Implant Device,659.6,34,,659.6,percent of total billed charges,Implant Device,659.6,34,,659.6,percent of total billed charges,Implant Device,659.6,34,,659.6,percent of total billed charges,Implant Device,659.6,34,,659.6,percent of total billed charges,Implant Device,679,35,,679,percent of total billed charges,Implant Device,659.6,34,"Charges > $500, x 34%",659.6,percent of total billed charges,Implant Device,679,35,,679,percent of total billed charges,Implant Devices,679,35,,679,percent of total billed charges,Implant Devices,679,35,,,percent of total billed charges,Implant Devices,679,35,,679,percent of total billed charges,Implant Devices,679,35,,679,percent of total billed charges,Implant Devices,776,40,,776,percent of total billed charges,Implant Devices,679,70,,679,percent of total billed charges,Implant Devices,659.6,34,,659.6,percent of total billed charges,Implant Devices,659.6,34,,659.6,percent of total billed charges,Implant Devices,679,35,,679,percent of total billed charges,Implant Devices,679,35,,679,percent of total billed charges,Implant Devices,679,35,,679,percent of total billed charges,Implant Devices,679,35,,679,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,776,
MEDLINE SMS38PL59P DOME LG 5.2X9CM,C1781,HCPCS,,79004001,CDM,278,RC,,,both,,,450,177.6,39.4668,,177.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,153,34,,153,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,180,40,,180,percent of total billed charges,Implant Devices,157.5,70,,157.5,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,153,34,,153,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,157.5,35,,157.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,180,
MEDLINE SMS30PM59P DOME MED 5.2X9CM,C1781,HCPCS,,79004002,CDM,278,RC,,,both,,,463,182.73,39.4668,,182.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,157.42,34,,157.42,percent of total billed charges,Implant Device,157.42,34,,157.42,percent of total billed charges,Implant Device,157.42,34,,157.42,percent of total billed charges,Implant Device,157.42,34,,157.42,percent of total billed charges,Implant Device,157.42,34,,157.42,percent of total billed charges,Implant Device,157.42,34,,157.42,percent of total billed charges,Implant Device,162.05,35,,162.05,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,162.05,35,,162.05,percent of total billed charges,Implant Devices,162.05,35,,162.05,percent of total billed charges,Implant Devices,162.05,35,,,percent of total billed charges,Implant Devices,162.05,35,,162.05,percent of total billed charges,Implant Devices,162.05,35,,162.05,percent of total billed charges,Implant Devices,185.2,40,,185.2,percent of total billed charges,Implant Devices,162.05,70,,162.05,percent of total billed charges,Implant Devices,157.42,34,,157.42,percent of total billed charges,Implant Devices,157.42,34,,157.42,percent of total billed charges,Implant Devices,162.05,35,,162.05,percent of total billed charges,Implant Devices,162.05,35,,162.05,percent of total billed charges,Implant Devices,162.05,35,,162.05,percent of total billed charges,Implant Devices,162.05,35,,162.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,185.2,
LIFE CELL 1520160 ALLODERM RTU 8X20CM,C1781,HCPCS,,79004967,CDM,278,RC,,,both,,,20244,7989.66,39.4668,,7989.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6882.96,34,,6882.96,percent of total billed charges,Implant Device,6882.96,34,,6882.96,percent of total billed charges,Implant Device,6882.96,34,,6882.96,percent of total billed charges,Implant Device,6882.96,34,,6882.96,percent of total billed charges,Implant Device,6882.96,34,,6882.96,percent of total billed charges,Implant Device,6882.96,34,,6882.96,percent of total billed charges,Implant Device,7085.4,35,,7085.4,percent of total billed charges,Implant Device,6882.96,34,"Charges > $500, x 34%",6882.96,percent of total billed charges,Implant Device,7085.4,35,,7085.4,percent of total billed charges,Implant Devices,7085.4,35,,7085.4,percent of total billed charges,Implant Devices,7085.4,35,,,percent of total billed charges,Implant Devices,7085.4,35,,7085.4,percent of total billed charges,Implant Devices,7085.4,35,,7085.4,percent of total billed charges,Implant Devices,8097.6,40,,8097.6,percent of total billed charges,Implant Devices,7085.4,70,,7085.4,percent of total billed charges,Implant Devices,6882.96,34,,6882.96,percent of total billed charges,Implant Devices,6882.96,34,,6882.96,percent of total billed charges,Implant Devices,7085.4,35,,7085.4,percent of total billed charges,Implant Devices,7085.4,35,,7085.4,percent of total billed charges,Implant Devices,7085.4,35,,7085.4,percent of total billed charges,Implant Devices,7085.4,35,,7085.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6882.96,34,"If Charge > 2,000, then 34 percent",6882.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8097.6,
ATRIUM 31626 3X6 TAC SHIELD,C1781,HCPCS,,79005294,CDM,278,RC,,,both,,,1280,505.18,39.4668,,505.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,435.2,34,,435.2,percent of total billed charges,Implant Device,435.2,34,,435.2,percent of total billed charges,Implant Device,435.2,34,,435.2,percent of total billed charges,Implant Device,435.2,34,,435.2,percent of total billed charges,Implant Device,435.2,34,,435.2,percent of total billed charges,Implant Device,435.2,34,,435.2,percent of total billed charges,Implant Device,448,35,,448,percent of total billed charges,Implant Device,435.2,34,"Charges > $500, x 34%",435.2,percent of total billed charges,Implant Device,448,35,,448,percent of total billed charges,Implant Devices,448,35,,448,percent of total billed charges,Implant Devices,448,35,,,percent of total billed charges,Implant Devices,448,35,,448,percent of total billed charges,Implant Devices,448,35,,448,percent of total billed charges,Implant Devices,512,40,,512,percent of total billed charges,Implant Devices,448,70,,448,percent of total billed charges,Implant Devices,435.2,34,,435.2,percent of total billed charges,Implant Devices,435.2,34,,435.2,percent of total billed charges,Implant Devices,448,35,,448,percent of total billed charges,Implant Devices,448,35,,448,percent of total billed charges,Implant Devices,448,35,,448,percent of total billed charges,Implant Devices,448,35,,448,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,512,
AMS 720127-01 ELEVATE POSTERIOR SLING,C1781,HCPCS,,79005613,CDM,278,RC,,,both,,,4500,1776.01,39.4668,,1776.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1530,34,,1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Device,1530,34,"Charges > $500, x 34%",1530,percent of total billed charges,Implant Device,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1800,40,,1800,percent of total billed charges,Implant Devices,1575,70,,1575,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1530,34,,1530,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,1575,35,,1575,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1530,34,"If Charge > 2,000, then 34 percent",1530,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1800,
BARD 0010101 KUGEL PATCH 3.25X4.75 OVAL,C1781,HCPCS,,79005715,CDM,278,RC,,,both,,,804,317.31,39.4668,,317.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,273.36,34,,273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Device,273.36,34,"Charges > $500, x 34%",273.36,percent of total billed charges,Implant Device,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,321.6,40,,321.6,percent of total billed charges,Implant Devices,281.4,70,,281.4,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,273.36,34,,273.36,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,281.4,35,,281.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,321.6,
BARD 0010102 KUGEL PATCH 5.5X7,C1781,HCPCS,,79005716,CDM,278,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,391.68,34,,391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Device,391.68,34,"Charges > $500, x 34%",391.68,percent of total billed charges,Implant Device,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,460.8,40,,460.8,percent of total billed charges,Implant Devices,403.2,70,,403.2,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,391.68,34,,391.68,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,403.2,35,,403.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,460.8,
BARD 0010103 CIRCLE HERNIA PATCH,C1781,HCPCS,,79005717,CDM,278,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,306,34,,306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Device,306,34,"Charges > $500, x 34%",306,percent of total billed charges,Implant Device,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,360,40,,360,percent of total billed charges,Implant Devices,315,70,,315,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,306,34,,306,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,315,35,,315,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,360,
BARD 0010104 KUGEL PATCH 12X12,C1781,HCPCS,,79005718,CDM,278,RC,,,both,,,1008,397.83,39.4668,,397.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,342.72,34,,342.72,percent of total billed charges,Implant Device,352.8,35,,352.8,percent of total billed charges,Implant Device,342.72,34,"Charges > $500, x 34%",342.72,percent of total billed charges,Implant Device,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,403.2,40,,403.2,percent of total billed charges,Implant Devices,352.8,70,,352.8,percent of total billed charges,Implant Devices,342.72,34,,342.72,percent of total billed charges,Implant Devices,342.72,34,,342.72,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,352.8,35,,352.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,403.2,
TYRX CMRM6122US-S PM ANTIBAC ENVELOPE,C1781,HCPCS,,79005793,CDM,278,RC,,,both,,,2985,1178.08,39.4668,,1178.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1014.9,34,,1014.9,percent of total billed charges,Implant Device,1014.9,34,,1014.9,percent of total billed charges,Implant Device,1014.9,34,,1014.9,percent of total billed charges,Implant Device,1014.9,34,,1014.9,percent of total billed charges,Implant Device,1014.9,34,,1014.9,percent of total billed charges,Implant Device,1014.9,34,,1014.9,percent of total billed charges,Implant Device,1044.75,35,,1044.75,percent of total billed charges,Implant Device,1014.9,34,"Charges > $500, x 34%",1014.9,percent of total billed charges,Implant Device,1044.75,35,,1044.75,percent of total billed charges,Implant Devices,1044.75,35,,1044.75,percent of total billed charges,Implant Devices,1044.75,35,,,percent of total billed charges,Implant Devices,1044.75,35,,1044.75,percent of total billed charges,Implant Devices,1044.75,35,,1044.75,percent of total billed charges,Implant Devices,1194,40,,1194,percent of total billed charges,Implant Devices,1044.75,70,,1044.75,percent of total billed charges,Implant Devices,1014.9,34,,1014.9,percent of total billed charges,Implant Devices,1014.9,34,,1014.9,percent of total billed charges,Implant Devices,1044.75,35,,1044.75,percent of total billed charges,Implant Devices,1044.75,35,,1044.75,percent of total billed charges,Implant Devices,1044.75,35,,1044.75,percent of total billed charges,Implant Devices,1044.75,35,,1044.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1014.9,34,"If Charge > 2,000, then 34 percent",1014.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194,
AMS 9000262 ARC RETROPUBIC SLING SYSTEM,C1781,HCPCS,,79005922,CDM,278,RC,,,both,,,2400,947.2,39.4668,,947.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,816,34,,816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Device,816,34,"Charges > $500, x 34%",816,percent of total billed charges,Implant Device,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,960,40,,960,percent of total billed charges,Implant Devices,840,70,,840,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,816,34,,816,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,840,35,,840,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,816,34,"If Charge > 2,000, then 34 percent",816,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,960,
MARQUET PPBF3030 VITAMESH BLUE 12X12,C1781,HCPCS,,79006067,CDM,278,RC,,,both,,,517,204.04,39.4668,,204.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,175.78,34,,175.78,percent of total billed charges,Implant Device,175.78,34,,175.78,percent of total billed charges,Implant Device,175.78,34,,175.78,percent of total billed charges,Implant Device,175.78,34,,175.78,percent of total billed charges,Implant Device,175.78,34,,175.78,percent of total billed charges,Implant Device,175.78,34,,175.78,percent of total billed charges,Implant Device,180.95,35,,180.95,percent of total billed charges,Implant Device,175.78,34,"Charges > $500, x 34%",175.78,percent of total billed charges,Implant Device,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,206.8,40,,206.8,percent of total billed charges,Implant Devices,180.95,70,,180.95,percent of total billed charges,Implant Devices,175.78,34,,175.78,percent of total billed charges,Implant Devices,175.78,34,,175.78,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,206.8,
MARQUET PPVF1515 VITAMESH  RECTANGLE 6X6,C1781,HCPCS,,79006068,CDM,278,RC,,,both,,,185,73.01,39.4668,,73.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,62.9,34,,62.9,percent of total billed charges,Implant Device,62.9,34,,62.9,percent of total billed charges,Implant Device,62.9,34,,62.9,percent of total billed charges,Implant Device,62.9,34,,62.9,percent of total billed charges,Implant Device,62.9,34,,62.9,percent of total billed charges,Implant Device,62.9,34,,62.9,percent of total billed charges,Implant Device,64.75,35,,64.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,64.75,35,,64.75,percent of total billed charges,Implant Devices,64.75,35,,64.75,percent of total billed charges,Implant Devices,64.75,35,,,percent of total billed charges,Implant Devices,64.75,35,,64.75,percent of total billed charges,Implant Devices,64.75,35,,64.75,percent of total billed charges,Implant Devices,74,40,,74,percent of total billed charges,Implant Devices,64.75,70,,64.75,percent of total billed charges,Implant Devices,62.9,34,,62.9,percent of total billed charges,Implant Devices,62.9,34,,62.9,percent of total billed charges,Implant Devices,64.75,35,,64.75,percent of total billed charges,Implant Devices,64.75,35,,64.75,percent of total billed charges,Implant Devices,64.75,35,,64.75,percent of total billed charges,Implant Devices,64.75,35,,64.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74,
MAQUET 31144 CQUR MOSAC MESH 12.5X12.5CM,C1781,HCPCS,,79006427,CDM,278,RC,,,both,,,1187,468.47,39.4668,,468.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,403.58,34,,403.58,percent of total billed charges,Implant Device,403.58,34,,403.58,percent of total billed charges,Implant Device,403.58,34,,403.58,percent of total billed charges,Implant Device,403.58,34,,403.58,percent of total billed charges,Implant Device,403.58,34,,403.58,percent of total billed charges,Implant Device,403.58,34,,403.58,percent of total billed charges,Implant Device,415.45,35,,415.45,percent of total billed charges,Implant Device,403.58,34,"Charges > $500, x 34%",403.58,percent of total billed charges,Implant Device,415.45,35,,415.45,percent of total billed charges,Implant Devices,415.45,35,,415.45,percent of total billed charges,Implant Devices,415.45,35,,,percent of total billed charges,Implant Devices,415.45,35,,415.45,percent of total billed charges,Implant Devices,415.45,35,,415.45,percent of total billed charges,Implant Devices,474.8,40,,474.8,percent of total billed charges,Implant Devices,415.45,70,,415.45,percent of total billed charges,Implant Devices,403.58,34,,403.58,percent of total billed charges,Implant Devices,403.58,34,,403.58,percent of total billed charges,Implant Devices,415.45,35,,415.45,percent of total billed charges,Implant Devices,415.45,35,,415.45,percent of total billed charges,Implant Devices,415.45,35,,415.45,percent of total billed charges,Implant Devices,415.45,35,,415.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,474.8,
MAQUET 31143 CQUR MOSAIC MESH 8.9X8.9CM,C1781,HCPCS,,79006428,CDM,278,RC,,,both,,,853,336.65,39.4668,,336.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,290.02,34,,290.02,percent of total billed charges,Implant Device,290.02,34,,290.02,percent of total billed charges,Implant Device,290.02,34,,290.02,percent of total billed charges,Implant Device,290.02,34,,290.02,percent of total billed charges,Implant Device,290.02,34,,290.02,percent of total billed charges,Implant Device,290.02,34,,290.02,percent of total billed charges,Implant Device,298.55,35,,298.55,percent of total billed charges,Implant Device,290.02,34,"Charges > $500, x 34%",290.02,percent of total billed charges,Implant Device,298.55,35,,298.55,percent of total billed charges,Implant Devices,298.55,35,,298.55,percent of total billed charges,Implant Devices,298.55,35,,,percent of total billed charges,Implant Devices,298.55,35,,298.55,percent of total billed charges,Implant Devices,298.55,35,,298.55,percent of total billed charges,Implant Devices,341.2,40,,341.2,percent of total billed charges,Implant Devices,298.55,70,,298.55,percent of total billed charges,Implant Devices,290.02,34,,290.02,percent of total billed charges,Implant Devices,290.02,34,,290.02,percent of total billed charges,Implant Devices,298.55,35,,298.55,percent of total billed charges,Implant Devices,298.55,35,,298.55,percent of total billed charges,Implant Devices,298.55,35,,298.55,percent of total billed charges,Implant Devices,298.55,35,,298.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,341.2,
MAQUET 31133 CQUR MOSAIC MESH 6X8,C1781,HCPCS,,79006436,CDM,278,RC,,,both,,,1877,740.79,39.4668,,740.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,638.18,34,,638.18,percent of total billed charges,Implant Device,656.95,35,,656.95,percent of total billed charges,Implant Device,638.18,34,"Charges > $500, x 34%",638.18,percent of total billed charges,Implant Device,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,750.8,40,,750.8,percent of total billed charges,Implant Devices,656.95,70,,656.95,percent of total billed charges,Implant Devices,638.18,34,,638.18,percent of total billed charges,Implant Devices,638.18,34,,638.18,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,656.95,35,,656.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,750.8,
MAQUET PPBF1515 VITAMESH BLUE 15X15CM,C1781,HCPCS,,79006553,CDM,278,RC,,,both,,,553,218.25,39.4668,,218.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,193.55,35,,193.55,percent of total billed charges,Implant Device,188.02,34,"Charges > $500, x 34%",188.02,percent of total billed charges,Implant Device,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,221.2,40,,221.2,percent of total billed charges,Implant Devices,193.55,70,,193.55,percent of total billed charges,Implant Devices,188.02,34,,188.02,percent of total billed charges,Implant Devices,188.02,34,,188.02,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
MAQUET PPVF3030 VITAMESH 30X30CM,C1781,HCPCS,,79006554,CDM,278,RC,,,both,,,517,204.04,39.4668,,204.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,175.78,34,,175.78,percent of total billed charges,Implant Device,175.78,34,,175.78,percent of total billed charges,Implant Device,175.78,34,,175.78,percent of total billed charges,Implant Device,175.78,34,,175.78,percent of total billed charges,Implant Device,175.78,34,,175.78,percent of total billed charges,Implant Device,175.78,34,,175.78,percent of total billed charges,Implant Device,180.95,35,,180.95,percent of total billed charges,Implant Device,175.78,34,"Charges > $500, x 34%",175.78,percent of total billed charges,Implant Device,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,206.8,40,,206.8,percent of total billed charges,Implant Devices,180.95,70,,180.95,percent of total billed charges,Implant Devices,175.78,34,,175.78,percent of total billed charges,Implant Devices,175.78,34,,175.78,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,180.95,35,,180.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,206.8,
GORE HH0710 GORE BIO-A TISSUE MESH,C1781,HCPCS,,79007274,CDM,278,RC,,,both,,,1864,735.66,39.4668,,735.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,652.4,35,,652.4,percent of total billed charges,Implant Device,633.76,34,"Charges > $500, x 34%",633.76,percent of total billed charges,Implant Device,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,745.6,40,,745.6,percent of total billed charges,Implant Devices,652.4,70,,652.4,percent of total billed charges,Implant Devices,633.76,34,,633.76,percent of total billed charges,Implant Devices,633.76,34,,633.76,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,745.6,
LIFE CELL CM1520P ALLODERM RTM 9.6X19.3,C1781,HCPCS,,79007733,CDM,278,RC,,,both,,,17706,6987.99,39.4668,,6987.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6020.04,34,,6020.04,percent of total billed charges,Implant Device,6020.04,34,,6020.04,percent of total billed charges,Implant Device,6020.04,34,,6020.04,percent of total billed charges,Implant Device,6020.04,34,,6020.04,percent of total billed charges,Implant Device,6020.04,34,,6020.04,percent of total billed charges,Implant Device,6020.04,34,,6020.04,percent of total billed charges,Implant Device,6197.1,35,,6197.1,percent of total billed charges,Implant Device,6020.04,34,"Charges > $500, x 34%",6020.04,percent of total billed charges,Implant Device,6197.1,35,,6197.1,percent of total billed charges,Implant Devices,6197.1,35,,6197.1,percent of total billed charges,Implant Devices,6197.1,35,,,percent of total billed charges,Implant Devices,6197.1,35,,6197.1,percent of total billed charges,Implant Devices,6197.1,35,,6197.1,percent of total billed charges,Implant Devices,7082.4,40,,7082.4,percent of total billed charges,Implant Devices,6197.1,70,,6197.1,percent of total billed charges,Implant Devices,6020.04,34,,6020.04,percent of total billed charges,Implant Devices,6020.04,34,,6020.04,percent of total billed charges,Implant Devices,6197.1,35,,6197.1,percent of total billed charges,Implant Devices,6197.1,35,,6197.1,percent of total billed charges,Implant Devices,6197.1,35,,6197.1,percent of total billed charges,Implant Devices,6197.1,35,,6197.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6020.04,34,"If Charge > 2,000, then 34 percent",6020.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7082.4,
MEDLINE PCO2015X PARIETEX MESH 20X15CM,C1781,HCPCS,,79007845,CDM,278,RC,,,both,,,2971,1172.56,39.4668,,1172.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1010.14,34,,1010.14,percent of total billed charges,Implant Device,1010.14,34,,1010.14,percent of total billed charges,Implant Device,1010.14,34,,1010.14,percent of total billed charges,Implant Device,1010.14,34,,1010.14,percent of total billed charges,Implant Device,1010.14,34,,1010.14,percent of total billed charges,Implant Device,1010.14,34,,1010.14,percent of total billed charges,Implant Device,1039.85,35,,1039.85,percent of total billed charges,Implant Device,1010.14,34,"Charges > $500, x 34%",1010.14,percent of total billed charges,Implant Device,1039.85,35,,1039.85,percent of total billed charges,Implant Devices,1039.85,35,,1039.85,percent of total billed charges,Implant Devices,1039.85,35,,,percent of total billed charges,Implant Devices,1039.85,35,,1039.85,percent of total billed charges,Implant Devices,1039.85,35,,1039.85,percent of total billed charges,Implant Devices,1188.4,40,,1188.4,percent of total billed charges,Implant Devices,1039.85,70,,1039.85,percent of total billed charges,Implant Devices,1010.14,34,,1010.14,percent of total billed charges,Implant Devices,1010.14,34,,1010.14,percent of total billed charges,Implant Devices,1039.85,35,,1039.85,percent of total billed charges,Implant Devices,1039.85,35,,1039.85,percent of total billed charges,Implant Devices,1039.85,35,,1039.85,percent of total billed charges,Implant Devices,1039.85,35,,1039.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1010.14,34,"If Charge > 2,000, then 34 percent",1010.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1188.4,
MAQUET PPBF1015 VITAMESH BLUE 4X6,C1781,HCPCS,,79007870,CDM,278,RC,,,both,,,166,65.51,39.4668,,65.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,56.44,34,,56.44,percent of total billed charges,Implant Device,56.44,34,,56.44,percent of total billed charges,Implant Device,56.44,34,,56.44,percent of total billed charges,Implant Device,56.44,34,,56.44,percent of total billed charges,Implant Device,56.44,34,,56.44,percent of total billed charges,Implant Device,56.44,34,,56.44,percent of total billed charges,Implant Device,58.1,35,,58.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,58.1,35,,58.1,percent of total billed charges,Implant Devices,58.1,35,,58.1,percent of total billed charges,Implant Devices,58.1,35,,,percent of total billed charges,Implant Devices,58.1,35,,58.1,percent of total billed charges,Implant Devices,58.1,35,,58.1,percent of total billed charges,Implant Devices,66.4,40,,66.4,percent of total billed charges,Implant Devices,58.1,70,,58.1,percent of total billed charges,Implant Devices,56.44,34,,56.44,percent of total billed charges,Implant Devices,56.44,34,,56.44,percent of total billed charges,Implant Devices,58.1,35,,58.1,percent of total billed charges,Implant Devices,58.1,35,,58.1,percent of total billed charges,Implant Devices,58.1,35,,58.1,percent of total billed charges,Implant Devices,58.1,35,,58.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,66.4,
MEDTRONIC CMRM6133US-S ICD ANTIBAC ENVLP,C1781,HCPCS,,79007872,CDM,278,RC,,,both,,,2986,1178.48,39.4668,,1178.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1045.1,35,,1045.1,percent of total billed charges,Implant Device,1015.24,34,"Charges > $500, x 34%",1015.24,percent of total billed charges,Implant Device,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1194.4,40,,1194.4,percent of total billed charges,Implant Devices,1045.1,70,,1045.1,percent of total billed charges,Implant Devices,1015.24,34,,1015.24,percent of total billed charges,Implant Devices,1015.24,34,,1015.24,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.24,34,"If Charge > 2,000, then 34 percent",1015.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.4,
BARD-DAVOL 0115311 3D MAX MESH LG LT,C1781,HCPCS,,79007976,CDM,278,RC,,,both,,,743,293.24,39.4668,,293.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,252.62,34,,252.62,percent of total billed charges,Implant Device,252.62,34,,252.62,percent of total billed charges,Implant Device,252.62,34,,252.62,percent of total billed charges,Implant Device,252.62,34,,252.62,percent of total billed charges,Implant Device,252.62,34,,252.62,percent of total billed charges,Implant Device,252.62,34,,252.62,percent of total billed charges,Implant Device,260.05,35,,260.05,percent of total billed charges,Implant Device,252.62,34,"Charges > $500, x 34%",252.62,percent of total billed charges,Implant Device,260.05,35,,260.05,percent of total billed charges,Implant Devices,260.05,35,,260.05,percent of total billed charges,Implant Devices,260.05,35,,,percent of total billed charges,Implant Devices,260.05,35,,260.05,percent of total billed charges,Implant Devices,260.05,35,,260.05,percent of total billed charges,Implant Devices,297.2,40,,297.2,percent of total billed charges,Implant Devices,260.05,70,,260.05,percent of total billed charges,Implant Devices,252.62,34,,252.62,percent of total billed charges,Implant Devices,252.62,34,,252.62,percent of total billed charges,Implant Devices,260.05,35,,260.05,percent of total billed charges,Implant Devices,260.05,35,,260.05,percent of total billed charges,Implant Devices,260.05,35,,260.05,percent of total billed charges,Implant Devices,260.05,35,,260.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,297.2,
BARD-DAVOL 0115312 3D MAX MESH XL LT,C1781,HCPCS,,79007977,CDM,278,RC,,,both,,,773,305.08,39.4668,,305.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,270.55,35,,270.55,percent of total billed charges,Implant Device,262.82,34,"Charges > $500, x 34%",262.82,percent of total billed charges,Implant Device,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,309.2,40,,309.2,percent of total billed charges,Implant Devices,270.55,70,,270.55,percent of total billed charges,Implant Devices,262.82,34,,262.82,percent of total billed charges,Implant Devices,262.82,34,,262.82,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,309.2,
BARD-DAVOL 0115321 3D MAX MESH LG RT,C1781,HCPCS,,79007978,CDM,278,RC,,,both,,,510,201.28,39.4668,,201.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,173.4,34,,173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Device,173.4,34,"Charges > $500, x 34%",173.4,percent of total billed charges,Implant Device,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,204,40,,204,percent of total billed charges,Implant Devices,178.5,70,,178.5,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,173.4,34,,173.4,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,178.5,35,,178.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,204,
BARD-DAVOL 0115322 3D MAX MESH XL RT,C1781,HCPCS,,79007979,CDM,278,RC,,,both,,,773,305.08,39.4668,,305.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,262.82,34,,262.82,percent of total billed charges,Implant Device,270.55,35,,270.55,percent of total billed charges,Implant Device,262.82,34,"Charges > $500, x 34%",262.82,percent of total billed charges,Implant Device,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,309.2,40,,309.2,percent of total billed charges,Implant Devices,270.55,70,,270.55,percent of total billed charges,Implant Devices,262.82,34,,262.82,percent of total billed charges,Implant Devices,262.82,34,,262.82,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,270.55,35,,270.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,309.2,
INTEGRA 606-200-006 10X15 SURGIMEND MESH,C1781,HCPCS,,79008084,CDM,278,RC,,,both,,,8550,3374.41,39.4668,,3374.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2992.5,35,,2992.5,percent of total billed charges,Implant Device,2907,34,"Charges > $500, x 34%",2907,percent of total billed charges,Implant Device,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,3420,40,,3420,percent of total billed charges,Implant Devices,2992.5,70,,2992.5,percent of total billed charges,Implant Devices,2907,34,,2907,percent of total billed charges,Implant Devices,2907,34,,2907,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2907,34,"If Charge > 2,000, then 34 percent",2907,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3420,
INTEGRA 606-200-008 16X20 SURGIMEND MESH,C1781,HCPCS,,79008085,CDM,278,RC,,,both,,,18240,7198.74,39.4668,,7198.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6384,35,,6384,percent of total billed charges,Implant Device,6201.6,34,"Charges > $500, x 34%",6201.6,percent of total billed charges,Implant Device,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,7296,40,,7296,percent of total billed charges,Implant Devices,6384,70,,6384,percent of total billed charges,Implant Devices,6201.6,34,,6201.6,percent of total billed charges,Implant Devices,6201.6,34,,6201.6,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6201.6,34,"If Charge > 2,000, then 34 percent",6201.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7296,
INTEGRA 606-200-009 13X25 SURGIMEND MESH,C1781,HCPCS,,79008086,CDM,278,RC,,,both,,,18525,7311.22,39.4668,,7311.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6483.75,35,,6483.75,percent of total billed charges,Implant Device,6298.5,34,"Charges > $500, x 34%",6298.5,percent of total billed charges,Implant Device,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,7410,40,,7410,percent of total billed charges,Implant Devices,6483.75,70,,6483.75,percent of total billed charges,Implant Devices,6298.5,34,,6298.5,percent of total billed charges,Implant Devices,6298.5,34,,6298.5,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6298.5,34,"If Charge > 2,000, then 34 percent",6298.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7410,
INTEGRA 606-200-017 20X30 SURGIMEND MESH,C1781,HCPCS,,79008087,CDM,278,RC,,,both,,,34200,13497.65,39.4668,,13497.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11628,34,,11628,percent of total billed charges,Implant Device,11628,34,,11628,percent of total billed charges,Implant Device,11628,34,,11628,percent of total billed charges,Implant Device,11628,34,,11628,percent of total billed charges,Implant Device,11628,34,,11628,percent of total billed charges,Implant Device,11628,34,,11628,percent of total billed charges,Implant Device,11970,35,,11970,percent of total billed charges,Implant Device,11628,34,"Charges > $500, x 34%",11628,percent of total billed charges,Implant Device,11970,35,,11970,percent of total billed charges,Implant Devices,11970,35,,11970,percent of total billed charges,Implant Devices,11970,35,,,percent of total billed charges,Implant Devices,11970,35,,11970,percent of total billed charges,Implant Devices,11970,35,,11970,percent of total billed charges,Implant Devices,13680,40,,13680,percent of total billed charges,Implant Devices,11970,70,,11970,percent of total billed charges,Implant Devices,11628,34,,11628,percent of total billed charges,Implant Devices,11628,34,,11628,percent of total billed charges,Implant Devices,11970,35,,11970,percent of total billed charges,Implant Devices,11970,35,,11970,percent of total billed charges,Implant Devices,11970,35,,11970,percent of total billed charges,Implant Devices,11970,35,,11970,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11628,34,"If Charge > 2,000, then 34 percent",11628,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13680,
BARD 5955450 VENTRALIGHT MESH ECHO 4.5,C1781,HCPCS,,79008149,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1368,
COVIDIEN PC03020X PARIETEX MESH 20X30,C1781,HCPCS,,79008397,CDM,278,RC,,,both,,,5737,2264.21,39.4668,,2264.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1950.58,34,,1950.58,percent of total billed charges,Implant Device,1950.58,34,,1950.58,percent of total billed charges,Implant Device,1950.58,34,,1950.58,percent of total billed charges,Implant Device,1950.58,34,,1950.58,percent of total billed charges,Implant Device,1950.58,34,,1950.58,percent of total billed charges,Implant Device,1950.58,34,,1950.58,percent of total billed charges,Implant Device,2007.95,35,,2007.95,percent of total billed charges,Implant Device,1950.58,34,"Charges > $500, x 34%",1950.58,percent of total billed charges,Implant Device,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2294.8,40,,2294.8,percent of total billed charges,Implant Devices,2007.95,70,,2007.95,percent of total billed charges,Implant Devices,1950.58,34,,1950.58,percent of total billed charges,Implant Devices,1950.58,34,,1950.58,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,2007.95,35,,2007.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1950.58,34,"If Charge > 2,000, then 34 percent",1950.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2294.8,
MEDLINE USUPC09X PARIETEX MESH 9CM CIRC,C1781,HCPCS,,79008431,CDM,278,RC,,,both,,,1351,533.2,39.4668,,533.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,459.34,34,,459.34,percent of total billed charges,Implant Device,459.34,34,,459.34,percent of total billed charges,Implant Device,459.34,34,,459.34,percent of total billed charges,Implant Device,459.34,34,,459.34,percent of total billed charges,Implant Device,459.34,34,,459.34,percent of total billed charges,Implant Device,459.34,34,,459.34,percent of total billed charges,Implant Device,472.85,35,,472.85,percent of total billed charges,Implant Device,459.34,34,"Charges > $500, x 34%",459.34,percent of total billed charges,Implant Device,472.85,35,,472.85,percent of total billed charges,Implant Devices,472.85,35,,472.85,percent of total billed charges,Implant Devices,472.85,35,,,percent of total billed charges,Implant Devices,472.85,35,,472.85,percent of total billed charges,Implant Devices,472.85,35,,472.85,percent of total billed charges,Implant Devices,540.4,40,,540.4,percent of total billed charges,Implant Devices,472.85,70,,472.85,percent of total billed charges,Implant Devices,459.34,34,,459.34,percent of total billed charges,Implant Devices,459.34,34,,459.34,percent of total billed charges,Implant Devices,472.85,35,,472.85,percent of total billed charges,Implant Devices,472.85,35,,472.85,percent of total billed charges,Implant Devices,472.85,35,,472.85,percent of total billed charges,Implant Devices,472.85,35,,472.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,540.4,
COVIDIEN PCO1510X PARIETEX MESH 15X10MM,C1781,HCPCS,,79008542,CDM,278,RC,,,both,,,1999,788.94,39.4668,,788.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,679.66,34,,679.66,percent of total billed charges,Implant Device,699.65,35,,699.65,percent of total billed charges,Implant Device,679.66,34,"Charges > $500, x 34%",679.66,percent of total billed charges,Implant Device,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,799.6,40,,799.6,percent of total billed charges,Implant Devices,699.65,70,,699.65,percent of total billed charges,Implant Devices,679.66,34,,679.66,percent of total billed charges,Implant Devices,679.66,34,,679.66,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,699.65,35,,699.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,799.6,
MAQUET 1000204-01 PROLITE MESH,C1781,HCPCS,,79008968,CDM,278,RC,,,both,,,118,46.57,39.4668,,46.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,40.12,34,,40.12,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,47.2,40,,47.2,percent of total billed charges,Implant Devices,41.3,70,,41.3,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,40.12,34,,40.12,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,41.3,35,,41.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,47.2,
INTEGRA 606-206-002 SURGIMEND MP 16X20CM,C1781,HCPCS,,79009345,CDM,278,RC,,,both,,,18240,7198.74,39.4668,,7198.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6384,35,,6384,percent of total billed charges,Implant Device,6201.6,34,"Charges > $500, x 34%",6201.6,percent of total billed charges,Implant Device,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,7296,40,,7296,percent of total billed charges,Implant Devices,6384,70,,6384,percent of total billed charges,Implant Devices,6201.6,34,,6201.6,percent of total billed charges,Implant Devices,6201.6,34,,6201.6,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6201.6,34,"If Charge > 2,000, then 34 percent",6201.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7296,
INTEGRA 606-206-003 SURGIMEND MP 13X25CM,C1781,HCPCS,,79009346,CDM,278,RC,,,both,,,18525,7311.22,39.4668,,7311.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6298.5,34,,6298.5,percent of total billed charges,Implant Device,6483.75,35,,6483.75,percent of total billed charges,Implant Device,6298.5,34,"Charges > $500, x 34%",6298.5,percent of total billed charges,Implant Device,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,7410,40,,7410,percent of total billed charges,Implant Devices,6483.75,70,,6483.75,percent of total billed charges,Implant Devices,6298.5,34,,6298.5,percent of total billed charges,Implant Devices,6298.5,34,,6298.5,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,6483.75,35,,6483.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6298.5,34,"If Charge > 2,000, then 34 percent",6298.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7410,
INTEGRA 606-206-004 SURGIMEND MP 20X20CM,C1781,HCPCS,,79009347,CDM,278,RC,,,both,,,18240,7198.74,39.4668,,7198.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6201.6,34,,6201.6,percent of total billed charges,Implant Device,6384,35,,6384,percent of total billed charges,Implant Device,6201.6,34,"Charges > $500, x 34%",6201.6,percent of total billed charges,Implant Device,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,7296,40,,7296,percent of total billed charges,Implant Devices,6384,70,,6384,percent of total billed charges,Implant Devices,6201.6,34,,6201.6,percent of total billed charges,Implant Devices,6201.6,34,,6201.6,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,6384,35,,6384,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6201.6,34,"If Charge > 2,000, then 34 percent",6201.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7296,
INTEGRA 606-300-009 SURIGMEND MESH 3.0,C1781,HCPCS,,79009417,CDM,278,RC,,,both,,,21450,8465.63,39.4668,,8465.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7293,34,,7293,percent of total billed charges,Implant Device,7293,34,,7293,percent of total billed charges,Implant Device,7293,34,,7293,percent of total billed charges,Implant Device,7293,34,,7293,percent of total billed charges,Implant Device,7293,34,,7293,percent of total billed charges,Implant Device,7293,34,,7293,percent of total billed charges,Implant Device,7507.5,35,,7507.5,percent of total billed charges,Implant Device,7293,34,"Charges > $500, x 34%",7293,percent of total billed charges,Implant Device,7507.5,35,,7507.5,percent of total billed charges,Implant Devices,7507.5,35,,7507.5,percent of total billed charges,Implant Devices,7507.5,35,,,percent of total billed charges,Implant Devices,7507.5,35,,7507.5,percent of total billed charges,Implant Devices,7507.5,35,,7507.5,percent of total billed charges,Implant Devices,8580,40,,8580,percent of total billed charges,Implant Devices,7507.5,70,,7507.5,percent of total billed charges,Implant Devices,7293,34,,7293,percent of total billed charges,Implant Devices,7293,34,,7293,percent of total billed charges,Implant Devices,7507.5,35,,7507.5,percent of total billed charges,Implant Devices,7507.5,35,,7507.5,percent of total billed charges,Implant Devices,7507.5,35,,7507.5,percent of total billed charges,Implant Devices,7507.5,35,,7507.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7293,34,"If Charge > 2,000, then 34 percent",7293,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8580,
ALLERGAN 1518128 ALLODERM 8X16CM RTU MED,C1781,HCPCS,,79009573,CDM,278,RC,,,both,,,15309,6041.97,39.4668,,6041.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5205.06,34,,5205.06,percent of total billed charges,Implant Device,5358.15,35,,5358.15,percent of total billed charges,Implant Device,5205.06,34,"Charges > $500, x 34%",5205.06,percent of total billed charges,Implant Device,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,6123.6,40,,6123.6,percent of total billed charges,Implant Devices,5358.15,70,,5358.15,percent of total billed charges,Implant Devices,5205.06,34,,5205.06,percent of total billed charges,Implant Devices,5205.06,34,,5205.06,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,5358.15,35,,5358.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5205.06,34,"If Charge > 2,000, then 34 percent",5205.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6123.6,
ALLERGAN 151672 ALLODERM 6X12CM RTU THIN,C1781,HCPCS,,79009697,CDM,278,RC,,,both,,,9510,3753.29,39.4668,,3753.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3233.4,34,,3233.4,percent of total billed charges,Implant Device,3328.5,35,,3328.5,percent of total billed charges,Implant Device,3233.4,34,"Charges > $500, x 34%",3233.4,percent of total billed charges,Implant Device,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3804,40,,3804,percent of total billed charges,Implant Devices,3328.5,70,,3328.5,percent of total billed charges,Implant Devices,3233.4,34,,3233.4,percent of total billed charges,Implant Devices,3233.4,34,,3233.4,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,3328.5,35,,3328.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3233.4,34,"If Charge > 2,000, then 34 percent",3233.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3804,
ALLERGAN CM1516 ALLODERM CONTOUR THIN,C1781,HCPCS,,79009768,CDM,278,RC,,,both,,,18426,7272.15,39.4668,,7272.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6264.84,34,,6264.84,percent of total billed charges,Implant Device,6264.84,34,,6264.84,percent of total billed charges,Implant Device,6264.84,34,,6264.84,percent of total billed charges,Implant Device,6264.84,34,,6264.84,percent of total billed charges,Implant Device,6264.84,34,,6264.84,percent of total billed charges,Implant Device,6264.84,34,,6264.84,percent of total billed charges,Implant Device,6449.1,35,,6449.1,percent of total billed charges,Implant Device,6264.84,34,"Charges > $500, x 34%",6264.84,percent of total billed charges,Implant Device,6449.1,35,,6449.1,percent of total billed charges,Implant Devices,6449.1,35,,6449.1,percent of total billed charges,Implant Devices,6449.1,35,,,percent of total billed charges,Implant Devices,6449.1,35,,6449.1,percent of total billed charges,Implant Devices,6449.1,35,,6449.1,percent of total billed charges,Implant Devices,7370.4,40,,7370.4,percent of total billed charges,Implant Devices,6449.1,70,,6449.1,percent of total billed charges,Implant Devices,6264.84,34,,6264.84,percent of total billed charges,Implant Devices,6264.84,34,,6264.84,percent of total billed charges,Implant Devices,6449.1,35,,6449.1,percent of total billed charges,Implant Devices,6449.1,35,,6449.1,percent of total billed charges,Implant Devices,6449.1,35,,6449.1,percent of total billed charges,Implant Devices,6449.1,35,,6449.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6264.84,34,"If Charge > 2,000, then 34 percent",6264.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7370.4,
ALLERGAN CS1516 ALLODERM CONTOUR THIN,C1781,HCPCS,,79009769,CDM,278,RC,,,both,,,10749,4242.29,39.4668,,4242.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3654.66,34,,3654.66,percent of total billed charges,Implant Device,3654.66,34,,3654.66,percent of total billed charges,Implant Device,3654.66,34,,3654.66,percent of total billed charges,Implant Device,3654.66,34,,3654.66,percent of total billed charges,Implant Device,3654.66,34,,3654.66,percent of total billed charges,Implant Device,3654.66,34,,3654.66,percent of total billed charges,Implant Device,3762.15,35,,3762.15,percent of total billed charges,Implant Device,3654.66,34,"Charges > $500, x 34%",3654.66,percent of total billed charges,Implant Device,3762.15,35,,3762.15,percent of total billed charges,Implant Devices,3762.15,35,,3762.15,percent of total billed charges,Implant Devices,3762.15,35,,,percent of total billed charges,Implant Devices,3762.15,35,,3762.15,percent of total billed charges,Implant Devices,3762.15,35,,3762.15,percent of total billed charges,Implant Devices,4299.6,40,,4299.6,percent of total billed charges,Implant Devices,3762.15,70,,3762.15,percent of total billed charges,Implant Devices,3654.66,34,,3654.66,percent of total billed charges,Implant Devices,3654.66,34,,3654.66,percent of total billed charges,Implant Devices,3762.15,35,,3762.15,percent of total billed charges,Implant Devices,3762.15,35,,3762.15,percent of total billed charges,Implant Devices,3762.15,35,,3762.15,percent of total billed charges,Implant Devices,3762.15,35,,3762.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3654.66,34,"If Charge > 2,000, then 34 percent",3654.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4299.6,
SUTURE PC09X PARIETEX MESH ROUND 9CM,C1781,HCPCS,,79009802,CDM,278,RC,,,both,,,1354,534.38,39.4668,,534.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,460.36,34,,460.36,percent of total billed charges,Implant Device,460.36,34,,460.36,percent of total billed charges,Implant Device,460.36,34,,460.36,percent of total billed charges,Implant Device,460.36,34,,460.36,percent of total billed charges,Implant Device,460.36,34,,460.36,percent of total billed charges,Implant Device,460.36,34,,460.36,percent of total billed charges,Implant Device,473.9,35,,473.9,percent of total billed charges,Implant Device,460.36,34,"Charges > $500, x 34%",460.36,percent of total billed charges,Implant Device,473.9,35,,473.9,percent of total billed charges,Implant Devices,473.9,35,,473.9,percent of total billed charges,Implant Devices,473.9,35,,,percent of total billed charges,Implant Devices,473.9,35,,473.9,percent of total billed charges,Implant Devices,473.9,35,,473.9,percent of total billed charges,Implant Devices,541.6,40,,541.6,percent of total billed charges,Implant Devices,473.9,70,,473.9,percent of total billed charges,Implant Devices,460.36,34,,460.36,percent of total billed charges,Implant Devices,460.36,34,,460.36,percent of total billed charges,Implant Devices,473.9,35,,473.9,percent of total billed charges,Implant Devices,473.9,35,,473.9,percent of total billed charges,Implant Devices,473.9,35,,473.9,percent of total billed charges,Implant Devices,473.9,35,,473.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,541.6,
ALLERGAN 15181216 ALLODERM RTU 12X16CM,C1781,HCPCS,,79010097,CDM,278,RC,,,both,,,15303,6039.6,39.4668,,6039.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5203.02,34,,5203.02,percent of total billed charges,Implant Device,5203.02,34,,5203.02,percent of total billed charges,Implant Device,5203.02,34,,5203.02,percent of total billed charges,Implant Device,5203.02,34,,5203.02,percent of total billed charges,Implant Device,5203.02,34,,5203.02,percent of total billed charges,Implant Device,5203.02,34,,5203.02,percent of total billed charges,Implant Device,5356.05,35,,5356.05,percent of total billed charges,Implant Device,5203.02,34,"Charges > $500, x 34%",5203.02,percent of total billed charges,Implant Device,5356.05,35,,5356.05,percent of total billed charges,Implant Devices,5356.05,35,,5356.05,percent of total billed charges,Implant Devices,5356.05,35,,,percent of total billed charges,Implant Devices,5356.05,35,,5356.05,percent of total billed charges,Implant Devices,5356.05,35,,5356.05,percent of total billed charges,Implant Devices,6121.2,40,,6121.2,percent of total billed charges,Implant Devices,5356.05,70,,5356.05,percent of total billed charges,Implant Devices,5203.02,34,,5203.02,percent of total billed charges,Implant Devices,5203.02,34,,5203.02,percent of total billed charges,Implant Devices,5356.05,35,,5356.05,percent of total billed charges,Implant Devices,5356.05,35,,5356.05,percent of total billed charges,Implant Devices,5356.05,35,,5356.05,percent of total billed charges,Implant Devices,5356.05,35,,5356.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5203.02,34,"If Charge > 2,000, then 34 percent",5203.02,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6121.2,
BARD 5957750 VENTRALIGHT ST 4.5' CIRCLE,C1781,HCPCS,,79010592,CDM,278,RC,,,both,,,1458,575.43,39.4668,,575.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,495.72,34,,495.72,percent of total billed charges,Implant Device,495.72,34,,495.72,percent of total billed charges,Implant Device,495.72,34,,495.72,percent of total billed charges,Implant Device,495.72,34,,495.72,percent of total billed charges,Implant Device,495.72,34,,495.72,percent of total billed charges,Implant Device,495.72,34,,495.72,percent of total billed charges,Implant Device,510.3,35,,510.3,percent of total billed charges,Implant Device,495.72,34,"Charges > $500, x 34%",495.72,percent of total billed charges,Implant Device,510.3,35,,510.3,percent of total billed charges,Implant Devices,510.3,35,,510.3,percent of total billed charges,Implant Devices,510.3,35,,,percent of total billed charges,Implant Devices,510.3,35,,510.3,percent of total billed charges,Implant Devices,510.3,35,,510.3,percent of total billed charges,Implant Devices,583.2,40,,583.2,percent of total billed charges,Implant Devices,510.3,70,,510.3,percent of total billed charges,Implant Devices,495.72,34,,495.72,percent of total billed charges,Implant Devices,495.72,34,,495.72,percent of total billed charges,Implant Devices,510.3,35,,510.3,percent of total billed charges,Implant Devices,510.3,35,,510.3,percent of total billed charges,Implant Devices,510.3,35,,510.3,percent of total billed charges,Implant Devices,510.3,35,,510.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,583.2,
BARD 5954460 VENTRALIGHT ST 4X6,C1781,HCPCS,,79010593,CDM,278,RC,,,both,,,2175,858.4,39.4668,,858.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,739.5,34,,739.5,percent of total billed charges,Implant Device,761.25,35,,761.25,percent of total billed charges,Implant Device,739.5,34,"Charges > $500, x 34%",739.5,percent of total billed charges,Implant Device,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,870,40,,870,percent of total billed charges,Implant Devices,761.25,70,,761.25,percent of total billed charges,Implant Devices,739.5,34,,739.5,percent of total billed charges,Implant Devices,739.5,34,,739.5,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,761.25,35,,761.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,739.5,34,"If Charge > 2,000, then 34 percent",739.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,870,
BARD 5954680 VENTRALIGHT ST 6X8',C1781,HCPCS,,79010594,CDM,278,RC,,,both,,,3590,1416.86,39.4668,,1416.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1220.6,34,,1220.6,percent of total billed charges,Implant Device,1256.5,35,,1256.5,percent of total billed charges,Implant Device,1220.6,34,"Charges > $500, x 34%",1220.6,percent of total billed charges,Implant Device,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1436,40,,1436,percent of total billed charges,Implant Devices,1256.5,70,,1256.5,percent of total billed charges,Implant Devices,1220.6,34,,1220.6,percent of total billed charges,Implant Devices,1220.6,34,,1220.6,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,1256.5,35,,1256.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1220.6,34,"If Charge > 2,000, then 34 percent",1220.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1436,
BARD 0112950 PERFIX PLUG SMALL,C1781,HCPCS,,79010595,CDM,278,RC,,,both,,,803,316.92,39.4668,,316.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,273.02,34,,273.02,percent of total billed charges,Implant Device,273.02,34,,273.02,percent of total billed charges,Implant Device,273.02,34,,273.02,percent of total billed charges,Implant Device,273.02,34,,273.02,percent of total billed charges,Implant Device,273.02,34,,273.02,percent of total billed charges,Implant Device,273.02,34,,273.02,percent of total billed charges,Implant Device,281.05,35,,281.05,percent of total billed charges,Implant Device,273.02,34,"Charges > $500, x 34%",273.02,percent of total billed charges,Implant Device,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,321.2,40,,321.2,percent of total billed charges,Implant Devices,281.05,70,,281.05,percent of total billed charges,Implant Devices,273.02,34,,273.02,percent of total billed charges,Implant Devices,273.02,34,,273.02,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,281.05,35,,281.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,321.2,
BARD 0112960 PERFIX PLUG MED,C1781,HCPCS,,79010596,CDM,278,RC,,,both,,,810,319.68,39.4668,,319.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,275.4,34,,275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Device,275.4,34,"Charges > $500, x 34%",275.4,percent of total billed charges,Implant Device,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,324,40,,324,percent of total billed charges,Implant Devices,283.5,70,,283.5,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,275.4,34,,275.4,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,283.5,35,,283.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,324,
BARD 0112970 PERFIX PLUG LG,C1781,HCPCS,,79010597,CDM,278,RC,,,both,,,818,322.84,39.4668,,322.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,278.12,34,,278.12,percent of total billed charges,Implant Device,278.12,34,,278.12,percent of total billed charges,Implant Device,278.12,34,,278.12,percent of total billed charges,Implant Device,278.12,34,,278.12,percent of total billed charges,Implant Device,278.12,34,,278.12,percent of total billed charges,Implant Device,278.12,34,,278.12,percent of total billed charges,Implant Device,286.3,35,,286.3,percent of total billed charges,Implant Device,278.12,34,"Charges > $500, x 34%",278.12,percent of total billed charges,Implant Device,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,327.2,40,,327.2,percent of total billed charges,Implant Devices,286.3,70,,286.3,percent of total billed charges,Implant Devices,278.12,34,,278.12,percent of total billed charges,Implant Devices,278.12,34,,278.12,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,286.3,35,,286.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,327.2,
BARD 0112980 PERFIX PLUG XL,C1781,HCPCS,,79010598,CDM,278,RC,,,both,,,948,374.15,39.4668,,374.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,322.32,34,,322.32,percent of total billed charges,Implant Device,322.32,34,,322.32,percent of total billed charges,Implant Device,322.32,34,,322.32,percent of total billed charges,Implant Device,322.32,34,,322.32,percent of total billed charges,Implant Device,322.32,34,,322.32,percent of total billed charges,Implant Device,322.32,34,,322.32,percent of total billed charges,Implant Device,331.8,35,,331.8,percent of total billed charges,Implant Device,322.32,34,"Charges > $500, x 34%",322.32,percent of total billed charges,Implant Device,331.8,35,,331.8,percent of total billed charges,Implant Devices,331.8,35,,331.8,percent of total billed charges,Implant Devices,331.8,35,,,percent of total billed charges,Implant Devices,331.8,35,,331.8,percent of total billed charges,Implant Devices,331.8,35,,331.8,percent of total billed charges,Implant Devices,379.2,40,,379.2,percent of total billed charges,Implant Devices,331.8,70,,331.8,percent of total billed charges,Implant Devices,322.32,34,,322.32,percent of total billed charges,Implant Devices,322.32,34,,322.32,percent of total billed charges,Implant Devices,331.8,35,,331.8,percent of total billed charges,Implant Devices,331.8,35,,331.8,percent of total billed charges,Implant Devices,331.8,35,,331.8,percent of total billed charges,Implant Devices,331.8,35,,331.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,379.2,
BARD 5954460 VENTRALEX SR SMALKL,C1781,HCPCS,,79010599,CDM,278,RC,,,both,,,1770,698.56,39.4668,,698.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,601.8,34,,601.8,percent of total billed charges,Implant Device,601.8,34,,601.8,percent of total billed charges,Implant Device,601.8,34,,601.8,percent of total billed charges,Implant Device,601.8,34,,601.8,percent of total billed charges,Implant Device,601.8,34,,601.8,percent of total billed charges,Implant Device,601.8,34,,601.8,percent of total billed charges,Implant Device,619.5,35,,619.5,percent of total billed charges,Implant Device,601.8,34,"Charges > $500, x 34%",601.8,percent of total billed charges,Implant Device,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,708,40,,708,percent of total billed charges,Implant Devices,619.5,70,,619.5,percent of total billed charges,Implant Devices,601.8,34,,601.8,percent of total billed charges,Implant Devices,601.8,34,,601.8,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,619.5,35,,619.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,708,
BARD 5950009 VENTRALEX SR XL,C1781,HCPCS,,79010600,CDM,278,RC,,,both,,,2580,1018.24,39.4668,,1018.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,877.2,34,,877.2,percent of total billed charges,Implant Device,877.2,34,,877.2,percent of total billed charges,Implant Device,877.2,34,,877.2,percent of total billed charges,Implant Device,877.2,34,,877.2,percent of total billed charges,Implant Device,877.2,34,,877.2,percent of total billed charges,Implant Device,877.2,34,,877.2,percent of total billed charges,Implant Device,903,35,,903,percent of total billed charges,Implant Device,877.2,34,"Charges > $500, x 34%",877.2,percent of total billed charges,Implant Device,903,35,,903,percent of total billed charges,Implant Devices,903,35,,903,percent of total billed charges,Implant Devices,903,35,,,percent of total billed charges,Implant Devices,903,35,,903,percent of total billed charges,Implant Devices,903,35,,903,percent of total billed charges,Implant Devices,1032,40,,1032,percent of total billed charges,Implant Devices,903,70,,903,percent of total billed charges,Implant Devices,877.2,34,,877.2,percent of total billed charges,Implant Devices,877.2,34,,877.2,percent of total billed charges,Implant Devices,903,35,,903,percent of total billed charges,Implant Devices,903,35,,903,percent of total billed charges,Implant Devices,903,35,,903,percent of total billed charges,Implant Devices,903,35,,903,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,877.2,34,"If Charge > 2,000, then 34 percent",877.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1032,
BARD 0117016 BARD SOFT MESH 12X12',C1781,HCPCS,,79010601,CDM,278,RC,,,both,,,639,252.19,39.4668,,252.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,217.26,34,,217.26,percent of total billed charges,Implant Device,217.26,34,,217.26,percent of total billed charges,Implant Device,217.26,34,,217.26,percent of total billed charges,Implant Device,217.26,34,,217.26,percent of total billed charges,Implant Device,217.26,34,,217.26,percent of total billed charges,Implant Device,217.26,34,,217.26,percent of total billed charges,Implant Device,223.65,35,,223.65,percent of total billed charges,Implant Device,217.26,34,"Charges > $500, x 34%",217.26,percent of total billed charges,Implant Device,223.65,35,,223.65,percent of total billed charges,Implant Devices,223.65,35,,223.65,percent of total billed charges,Implant Devices,223.65,35,,,percent of total billed charges,Implant Devices,223.65,35,,223.65,percent of total billed charges,Implant Devices,223.65,35,,223.65,percent of total billed charges,Implant Devices,255.6,40,,255.6,percent of total billed charges,Implant Devices,223.65,70,,223.65,percent of total billed charges,Implant Devices,217.26,34,,217.26,percent of total billed charges,Implant Devices,217.26,34,,217.26,percent of total billed charges,Implant Devices,223.65,35,,223.65,percent of total billed charges,Implant Devices,223.65,35,,223.65,percent of total billed charges,Implant Devices,223.65,35,,223.65,percent of total billed charges,Implant Devices,223.65,35,,223.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,255.6,
BARD 0117011 BARD SOFT MESH 6X6',C1781,HCPCS,,79010602,CDM,278,RC,,,both,,,1386,547.01,39.4668,,547.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,471.24,34,,471.24,percent of total billed charges,Implant Device,471.24,34,,471.24,percent of total billed charges,Implant Device,471.24,34,,471.24,percent of total billed charges,Implant Device,471.24,34,,471.24,percent of total billed charges,Implant Device,471.24,34,,471.24,percent of total billed charges,Implant Device,471.24,34,,471.24,percent of total billed charges,Implant Device,485.1,35,,485.1,percent of total billed charges,Implant Device,471.24,34,"Charges > $500, x 34%",471.24,percent of total billed charges,Implant Device,485.1,35,,485.1,percent of total billed charges,Implant Devices,485.1,35,,485.1,percent of total billed charges,Implant Devices,485.1,35,,,percent of total billed charges,Implant Devices,485.1,35,,485.1,percent of total billed charges,Implant Devices,485.1,35,,485.1,percent of total billed charges,Implant Devices,554.4,40,,554.4,percent of total billed charges,Implant Devices,485.1,70,,485.1,percent of total billed charges,Implant Devices,471.24,34,,471.24,percent of total billed charges,Implant Devices,471.24,34,,471.24,percent of total billed charges,Implant Devices,485.1,35,,485.1,percent of total billed charges,Implant Devices,485.1,35,,485.1,percent of total billed charges,Implant Devices,485.1,35,,485.1,percent of total billed charges,Implant Devices,485.1,35,,485.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,554.4,
BARD 0112770 MESH PERFIX PLUG 0112770,C1781,HCPCS,,79010654,CDM,278,RC,,,both,,,435,171.68,39.4668,,171.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,147.9,34,,147.9,percent of total billed charges,Implant Device,147.9,34,,147.9,percent of total billed charges,Implant Device,147.9,34,,147.9,percent of total billed charges,Implant Device,147.9,34,,147.9,percent of total billed charges,Implant Device,147.9,34,,147.9,percent of total billed charges,Implant Device,147.9,34,,147.9,percent of total billed charges,Implant Device,152.25,35,,152.25,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,174,40,,174,percent of total billed charges,Implant Devices,152.25,70,,152.25,percent of total billed charges,Implant Devices,147.9,34,,147.9,percent of total billed charges,Implant Devices,147.9,34,,147.9,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,152.25,35,,152.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174,
BARD 5950030 VENTRIO ST 3.1X4.7,C1781,HCPCS,,79010662,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
BARD 5950008 VENTRALEX ST M,C1781,HCPCS,,79010663,CDM,278,RC,,,both,,,1359,536.35,39.4668,,536.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,462.06,34,,462.06,percent of total billed charges,Implant Device,462.06,34,,462.06,percent of total billed charges,Implant Device,462.06,34,,462.06,percent of total billed charges,Implant Device,462.06,34,,462.06,percent of total billed charges,Implant Device,462.06,34,,462.06,percent of total billed charges,Implant Device,462.06,34,,462.06,percent of total billed charges,Implant Device,475.65,35,,475.65,percent of total billed charges,Implant Device,462.06,34,"Charges > $500, x 34%",462.06,percent of total billed charges,Implant Device,475.65,35,,475.65,percent of total billed charges,Implant Devices,475.65,35,,475.65,percent of total billed charges,Implant Devices,475.65,35,,,percent of total billed charges,Implant Devices,475.65,35,,475.65,percent of total billed charges,Implant Devices,475.65,35,,475.65,percent of total billed charges,Implant Devices,543.6,40,,543.6,percent of total billed charges,Implant Devices,475.65,70,,475.65,percent of total billed charges,Implant Devices,462.06,34,,462.06,percent of total billed charges,Implant Devices,462.06,34,,462.06,percent of total billed charges,Implant Devices,475.65,35,,475.65,percent of total billed charges,Implant Devices,475.65,35,,475.65,percent of total billed charges,Implant Devices,475.65,35,,475.65,percent of total billed charges,Implant Devices,475.65,35,,475.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,543.6,
BARD 5950070 VENTRIO ST XL 7.7X9.7,C1781,HCPCS,,79010664,CDM,278,RC,,,both,,,4512,1780.74,39.4668,,1780.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1534.08,34,,1534.08,percent of total billed charges,Implant Device,1579.2,35,,1579.2,percent of total billed charges,Implant Device,1534.08,34,"Charges > $500, x 34%",1534.08,percent of total billed charges,Implant Device,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1804.8,40,,1804.8,percent of total billed charges,Implant Devices,1579.2,70,,1579.2,percent of total billed charges,Implant Devices,1534.08,34,,1534.08,percent of total billed charges,Implant Devices,1534.08,34,,1534.08,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,1579.2,35,,1579.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1534.08,34,"If Charge > 2,000, then 34 percent",1534.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1804.8,
ALLERGAN 151664 ALLODERM THIN 4 X 16CM,C1781,HCPCS,,79010733,CDM,278,RC,,,both,,,8451,3335.34,39.4668,,3335.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2873.34,34,,2873.34,percent of total billed charges,Implant Device,2873.34,34,,2873.34,percent of total billed charges,Implant Device,2873.34,34,,2873.34,percent of total billed charges,Implant Device,2873.34,34,,2873.34,percent of total billed charges,Implant Device,2873.34,34,,2873.34,percent of total billed charges,Implant Device,2873.34,34,,2873.34,percent of total billed charges,Implant Device,2957.85,35,,2957.85,percent of total billed charges,Implant Device,2873.34,34,"Charges > $500, x 34%",2873.34,percent of total billed charges,Implant Device,2957.85,35,,2957.85,percent of total billed charges,Implant Devices,2957.85,35,,2957.85,percent of total billed charges,Implant Devices,2957.85,35,,,percent of total billed charges,Implant Devices,2957.85,35,,2957.85,percent of total billed charges,Implant Devices,2957.85,35,,2957.85,percent of total billed charges,Implant Devices,3380.4,40,,3380.4,percent of total billed charges,Implant Devices,2957.85,70,,2957.85,percent of total billed charges,Implant Devices,2873.34,34,,2873.34,percent of total billed charges,Implant Devices,2873.34,34,,2873.34,percent of total billed charges,Implant Devices,2957.85,35,,2957.85,percent of total billed charges,Implant Devices,2957.85,35,,2957.85,percent of total billed charges,Implant Devices,2957.85,35,,2957.85,percent of total billed charges,Implant Devices,2957.85,35,,2957.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2873.34,34,"If Charge > 2,000, then 34 percent",2873.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3380.4,
ALLERGAN 151648 ALLODERM THIN 4 X 12CM,C1781,HCPCS,,79010735,CDM,278,RC,,,both,,,6339,2501.8,39.4668,,2501.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2155.26,34,,2155.26,percent of total billed charges,Implant Device,2155.26,34,,2155.26,percent of total billed charges,Implant Device,2155.26,34,,2155.26,percent of total billed charges,Implant Device,2155.26,34,,2155.26,percent of total billed charges,Implant Device,2155.26,34,,2155.26,percent of total billed charges,Implant Device,2155.26,34,,2155.26,percent of total billed charges,Implant Device,2218.65,35,,2218.65,percent of total billed charges,Implant Device,2155.26,34,"Charges > $500, x 34%",2155.26,percent of total billed charges,Implant Device,2218.65,35,,2218.65,percent of total billed charges,Implant Devices,2218.65,35,,2218.65,percent of total billed charges,Implant Devices,2218.65,35,,,percent of total billed charges,Implant Devices,2218.65,35,,2218.65,percent of total billed charges,Implant Devices,2218.65,35,,2218.65,percent of total billed charges,Implant Devices,2535.6,40,,2535.6,percent of total billed charges,Implant Devices,2218.65,70,,2218.65,percent of total billed charges,Implant Devices,2155.26,34,,2155.26,percent of total billed charges,Implant Devices,2155.26,34,,2155.26,percent of total billed charges,Implant Devices,2218.65,35,,2218.65,percent of total billed charges,Implant Devices,2218.65,35,,2218.65,percent of total billed charges,Implant Devices,2218.65,35,,2218.65,percent of total billed charges,Implant Devices,2218.65,35,,2218.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2155.26,34,"If Charge > 2,000, then 34 percent",2155.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2535.6,
BARD 1201015 PHASIX ST 10X15CM MESH,C1781,HCPCS,,79010812,CDM,278,RC,,,both,,,8001,3157.74,39.4668,,3157.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2720.34,34,,2720.34,percent of total billed charges,Implant Device,2800.35,35,,2800.35,percent of total billed charges,Implant Device,2720.34,34,"Charges > $500, x 34%",2720.34,percent of total billed charges,Implant Device,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,3200.4,40,,3200.4,percent of total billed charges,Implant Devices,2800.35,70,,2800.35,percent of total billed charges,Implant Devices,2720.34,34,,2720.34,percent of total billed charges,Implant Devices,2720.34,34,,2720.34,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,2800.35,35,,2800.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2720.34,34,"If Charge > 2,000, then 34 percent",2720.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3200.4,
BARD 1201520 PHASIX ST 15X20CM MESH,C1781,HCPCS,,79010813,CDM,278,RC,,,both,,,14889,5876.21,39.4668,,5876.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5062.26,34,,5062.26,percent of total billed charges,Implant Device,5062.26,34,,5062.26,percent of total billed charges,Implant Device,5062.26,34,,5062.26,percent of total billed charges,Implant Device,5062.26,34,,5062.26,percent of total billed charges,Implant Device,5062.26,34,,5062.26,percent of total billed charges,Implant Device,5062.26,34,,5062.26,percent of total billed charges,Implant Device,5211.15,35,,5211.15,percent of total billed charges,Implant Device,5062.26,34,"Charges > $500, x 34%",5062.26,percent of total billed charges,Implant Device,5211.15,35,,5211.15,percent of total billed charges,Implant Devices,5211.15,35,,5211.15,percent of total billed charges,Implant Devices,5211.15,35,,,percent of total billed charges,Implant Devices,5211.15,35,,5211.15,percent of total billed charges,Implant Devices,5211.15,35,,5211.15,percent of total billed charges,Implant Devices,5955.6,40,,5955.6,percent of total billed charges,Implant Devices,5211.15,70,,5211.15,percent of total billed charges,Implant Devices,5062.26,34,,5062.26,percent of total billed charges,Implant Devices,5062.26,34,,5062.26,percent of total billed charges,Implant Devices,5211.15,35,,5211.15,percent of total billed charges,Implant Devices,5211.15,35,,5211.15,percent of total billed charges,Implant Devices,5211.15,35,,5211.15,percent of total billed charges,Implant Devices,5211.15,35,,5211.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5062.26,34,"If Charge > 2,000, then 34 percent",5062.26,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5955.6,
BARD 1201325 PHASIX ST 13X25CM MESH,C1781,HCPCS,,79010814,CDM,278,RC,,,both,,,15678,6187.6,39.4668,,6187.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5330.52,34,,5330.52,percent of total billed charges,Implant Device,5330.52,34,,5330.52,percent of total billed charges,Implant Device,5330.52,34,,5330.52,percent of total billed charges,Implant Device,5330.52,34,,5330.52,percent of total billed charges,Implant Device,5330.52,34,,5330.52,percent of total billed charges,Implant Device,5330.52,34,,5330.52,percent of total billed charges,Implant Device,5487.3,35,,5487.3,percent of total billed charges,Implant Device,5330.52,34,"Charges > $500, x 34%",5330.52,percent of total billed charges,Implant Device,5487.3,35,,5487.3,percent of total billed charges,Implant Devices,5487.3,35,,5487.3,percent of total billed charges,Implant Devices,5487.3,35,,,percent of total billed charges,Implant Devices,5487.3,35,,5487.3,percent of total billed charges,Implant Devices,5487.3,35,,5487.3,percent of total billed charges,Implant Devices,6271.2,40,,6271.2,percent of total billed charges,Implant Devices,5487.3,70,,5487.3,percent of total billed charges,Implant Devices,5330.52,34,,5330.52,percent of total billed charges,Implant Devices,5330.52,34,,5330.52,percent of total billed charges,Implant Devices,5487.3,35,,5487.3,percent of total billed charges,Implant Devices,5487.3,35,,5487.3,percent of total billed charges,Implant Devices,5487.3,35,,5487.3,percent of total billed charges,Implant Devices,5487.3,35,,5487.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5330.52,34,"If Charge > 2,000, then 34 percent",5330.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6271.2,
BARD 1202025 PHASIX ST 20X25CM MESH,C1781,HCPCS,,79010815,CDM,278,RC,,,both,,,24309,9593.98,39.4668,,9593.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,8265.06,34,,8265.06,percent of total billed charges,Implant Device,8265.06,34,,8265.06,percent of total billed charges,Implant Device,8265.06,34,,8265.06,percent of total billed charges,Implant Device,8265.06,34,,8265.06,percent of total billed charges,Implant Device,8265.06,34,,8265.06,percent of total billed charges,Implant Device,8265.06,34,,8265.06,percent of total billed charges,Implant Device,8508.15,35,,8508.15,percent of total billed charges,Implant Device,8265.06,34,"Charges > $500, x 34%",8265.06,percent of total billed charges,Implant Device,8508.15,35,,8508.15,percent of total billed charges,Implant Devices,8508.15,35,,8508.15,percent of total billed charges,Implant Devices,8508.15,35,,,percent of total billed charges,Implant Devices,8508.15,35,,8508.15,percent of total billed charges,Implant Devices,8508.15,35,,8508.15,percent of total billed charges,Implant Devices,9723.6,40,,9723.6,percent of total billed charges,Implant Devices,8508.15,70,,8508.15,percent of total billed charges,Implant Devices,8265.06,34,,8265.06,percent of total billed charges,Implant Devices,8265.06,34,,8265.06,percent of total billed charges,Implant Devices,8508.15,35,,8508.15,percent of total billed charges,Implant Devices,8508.15,35,,8508.15,percent of total billed charges,Implant Devices,8508.15,35,,8508.15,percent of total billed charges,Implant Devices,8508.15,35,,8508.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,8265.06,34,"If Charge > 2,000, then 34 percent",8265.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9723.6,
MEDTRONIC NMRM6122 TYRX NEURO ENVELOPE,C1781,HCPCS,,79010836,CDM,278,RC,,,both,,,3885,1533.29,39.4668,,1533.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1320.9,34,,1320.9,percent of total billed charges,Implant Device,1359.75,35,,1359.75,percent of total billed charges,Implant Device,1320.9,34,"Charges > $500, x 34%",1320.9,percent of total billed charges,Implant Device,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1554,40,,1554,percent of total billed charges,Implant Devices,1359.75,70,,1359.75,percent of total billed charges,Implant Devices,1320.9,34,,1320.9,percent of total billed charges,Implant Devices,1320.9,34,,1320.9,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,1359.75,35,,1359.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1320.9,34,"If Charge > 2,000, then 34 percent",1320.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1554,
ALLERGAN CM1516P ALLODERM CONTOUR MEDIUM,C1781,HCPCS,,79010892,CDM,278,RC,,,both,,,11292,4456.59,39.4668,,4456.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3839.28,34,,3839.28,percent of total billed charges,Implant Device,3839.28,34,,3839.28,percent of total billed charges,Implant Device,3839.28,34,,3839.28,percent of total billed charges,Implant Device,3839.28,34,,3839.28,percent of total billed charges,Implant Device,3839.28,34,,3839.28,percent of total billed charges,Implant Device,3839.28,34,,3839.28,percent of total billed charges,Implant Device,3952.2,35,,3952.2,percent of total billed charges,Implant Device,3839.28,34,"Charges > $500, x 34%",3839.28,percent of total billed charges,Implant Device,3952.2,35,,3952.2,percent of total billed charges,Implant Devices,3952.2,35,,3952.2,percent of total billed charges,Implant Devices,3952.2,35,,,percent of total billed charges,Implant Devices,3952.2,35,,3952.2,percent of total billed charges,Implant Devices,3952.2,35,,3952.2,percent of total billed charges,Implant Devices,4516.8,40,,4516.8,percent of total billed charges,Implant Devices,3952.2,70,,3952.2,percent of total billed charges,Implant Devices,3839.28,34,,3839.28,percent of total billed charges,Implant Devices,3839.28,34,,3839.28,percent of total billed charges,Implant Devices,3952.2,35,,3952.2,percent of total billed charges,Implant Devices,3952.2,35,,3952.2,percent of total billed charges,Implant Devices,3952.2,35,,3952.2,percent of total billed charges,Implant Devices,3952.2,35,,3952.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3839.28,34,"If Charge > 2,000, then 34 percent",3839.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4516.8,
ALLERGAN CS1516P ALLODERM CONTOUR SMALL,C1781,HCPCS,,79010893,CDM,278,RC,,,both,,,6588,2600.07,39.4668,,2600.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2239.92,34,,2239.92,percent of total billed charges,Implant Device,2305.8,35,,2305.8,percent of total billed charges,Implant Device,2239.92,34,"Charges > $500, x 34%",2239.92,percent of total billed charges,Implant Device,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2635.2,40,,2635.2,percent of total billed charges,Implant Devices,2305.8,70,,2305.8,percent of total billed charges,Implant Devices,2239.92,34,,2239.92,percent of total billed charges,Implant Devices,2239.92,34,,2239.92,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,2305.8,35,,2305.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2239.92,34,"If Charge > 2,000, then 34 percent",2239.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2635.2,
BARD 0115310 MEDIUM LEFT 3DMAX 3X5,C1781,HCPCS,,79011328,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
BARD 0115320 MEDIUM RIGHT 3DMAX 3X5,C1781,HCPCS,,79011329,CDM,278,RC,,,both,,,474,187.07,39.4668,,187.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,161.16,34,,161.16,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,189.6,40,,189.6,percent of total billed charges,Implant Devices,165.9,70,,165.9,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,161.16,34,,161.16,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,165.9,35,,165.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.6,
DAVOL 5950040 VENTRIO ST HERNIA PATCH,C1781,HCPCS,,79013814,CDM,278,RC,,,both,,,2671,1054.16,39.4668,,1054.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,908.14,34,,908.14,percent of total billed charges,Implant Device,908.14,34,,908.14,percent of total billed charges,Implant Device,908.14,34,,908.14,percent of total billed charges,Implant Device,908.14,34,,908.14,percent of total billed charges,Implant Device,908.14,34,,908.14,percent of total billed charges,Implant Device,908.14,34,,908.14,percent of total billed charges,Implant Device,934.85,35,,934.85,percent of total billed charges,Implant Device,908.14,34,"Charges > $500, x 34%",908.14,percent of total billed charges,Implant Device,934.85,35,,934.85,percent of total billed charges,Implant Devices,934.85,35,,934.85,percent of total billed charges,Implant Devices,934.85,35,,,percent of total billed charges,Implant Devices,934.85,35,,934.85,percent of total billed charges,Implant Devices,934.85,35,,934.85,percent of total billed charges,Implant Devices,1068.4,40,,1068.4,percent of total billed charges,Implant Devices,934.85,70,,934.85,percent of total billed charges,Implant Devices,908.14,34,,908.14,percent of total billed charges,Implant Devices,908.14,34,,908.14,percent of total billed charges,Implant Devices,934.85,35,,934.85,percent of total billed charges,Implant Devices,934.85,35,,934.85,percent of total billed charges,Implant Devices,934.85,35,,934.85,percent of total billed charges,Implant Devices,934.85,35,,934.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,908.14,34,"If Charge > 2,000, then 34 percent",908.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1068.4,
MEDTRONIC PRB35-08-150-120 EVERFLX STENT,C1786,HCPCS,,79009344,CDM,278,RC,,,both,,,2625,1036,39.4668,,1036,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,918.75,35,,918.75,percent of total billed charges,Implant Device,892.5,34,"Charges > $500, x 34%",892.5,percent of total billed charges,Implant Device,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,1050,40,,1050,percent of total billed charges,Implant Devices,918.75,70,,918.75,percent of total billed charges,Implant Devices,892.5,34,,892.5,percent of total billed charges,Implant Devices,892.5,34,,892.5,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,892.5,34,"If Charge > 2,000, then 34 percent",892.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1050,
MEDTRONIC NEURO TH90G01 PROGRAMMER,C1787,HCPCS,,79010715,CDM,278,RC,,,both,,,5850,2308.81,39.4668,,2308.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Device,1989,34,"Charges > $500, x 34%",1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2340,40,,2340,percent of total billed charges,Implant Devices,2047.5,70,,2047.5,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1989,34,"If Charge > 2,000, then 34 percent",1989,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2340,
MEDTRONIC TH90P01 PATIENT PROGRAMMER,C1787,HCPCS,,79010929,CDM,278,RC,,,both,,,4722,1863.62,39.4668,,1863.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1652.7,35,,1652.7,percent of total billed charges,Implant Device,1605.48,34,"Charges > $500, x 34%",1605.48,percent of total billed charges,Implant Device,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1888.8,40,,1888.8,percent of total billed charges,Implant Devices,1652.7,70,,1652.7,percent of total billed charges,Implant Devices,1605.48,34,,1605.48,percent of total billed charges,Implant Devices,1605.48,34,,1605.48,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1605.48,34,"If Charge > 2,000, then 34 percent",1605.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1888.8,
MEDTRONIC TH90Q01 PATIENT PROGRAMMER,C1787,HCPCS,,79012572,CDM,278,RC,,,both,,,4722,1863.62,39.4668,,1863.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1605.48,34,,1605.48,percent of total billed charges,Implant Device,1652.7,35,,1652.7,percent of total billed charges,Implant Device,1605.48,34,"Charges > $500, x 34%",1605.48,percent of total billed charges,Implant Device,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1888.8,40,,1888.8,percent of total billed charges,Implant Devices,1652.7,70,,1652.7,percent of total billed charges,Implant Devices,1605.48,34,,1605.48,percent of total billed charges,Implant Devices,1605.48,34,,1605.48,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,1652.7,35,,1652.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1605.48,34,"If Charge > 2,000, then 34 percent",1605.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1888.8,
NAVILYST H965451030 POWER PORT 8FR,C1788,HCPCS,,79000456,CDM,278,RC,,,both,,,924,364.67,39.4668,,364.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,323.4,35,,323.4,percent of total billed charges,Implant Device,314.16,34,"Charges > $500, x 34%",314.16,percent of total billed charges,Implant Device,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,369.6,40,,369.6,percent of total billed charges,Implant Devices,323.4,70,,323.4,percent of total billed charges,Implant Devices,314.16,34,,314.16,percent of total billed charges,Implant Devices,314.16,34,,314.16,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,369.6,
CARDIO 6110210075-A INFUSAPORT DUAL LUMN,C1788,HCPCS,,79001561,CDM,278,RC,,,both,,,1176,464.13,39.4668,,464.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,399.84,34,,399.84,percent of total billed charges,Implant Device,399.84,34,,399.84,percent of total billed charges,Implant Device,399.84,34,,399.84,percent of total billed charges,Implant Device,399.84,34,,399.84,percent of total billed charges,Implant Device,399.84,34,,399.84,percent of total billed charges,Implant Device,399.84,34,,399.84,percent of total billed charges,Implant Device,411.6,35,,411.6,percent of total billed charges,Implant Device,399.84,34,"Charges > $500, x 34%",399.84,percent of total billed charges,Implant Device,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,470.4,40,,470.4,percent of total billed charges,Implant Devices,411.6,70,,411.6,percent of total billed charges,Implant Devices,399.84,34,,399.84,percent of total billed charges,Implant Devices,399.84,34,,399.84,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,411.6,35,,411.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,470.4,
CARDIO 6113651080A PORT-A-CATH TITANIUM,C1788,HCPCS,,79001689,CDM,278,RC,,,both,,,618,243.9,39.4668,,243.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,210.12,34,,210.12,percent of total billed charges,Implant Device,210.12,34,,210.12,percent of total billed charges,Implant Device,210.12,34,,210.12,percent of total billed charges,Implant Device,210.12,34,,210.12,percent of total billed charges,Implant Device,210.12,34,,210.12,percent of total billed charges,Implant Device,210.12,34,,210.12,percent of total billed charges,Implant Device,216.3,35,,216.3,percent of total billed charges,Implant Device,210.12,34,"Charges > $500, x 34%",210.12,percent of total billed charges,Implant Device,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,247.2,40,,247.2,percent of total billed charges,Implant Devices,216.3,70,,216.3,percent of total billed charges,Implant Devices,210.12,34,,210.12,percent of total billed charges,Implant Devices,210.12,34,,210.12,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,247.2,
CARDIO 6164651075-A PORT-A-CATH SILICON,C1788,HCPCS,,79001690,CDM,278,RC,,,both,,,618,243.9,39.4668,,243.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,210.12,34,,210.12,percent of total billed charges,Implant Device,210.12,34,,210.12,percent of total billed charges,Implant Device,210.12,34,,210.12,percent of total billed charges,Implant Device,210.12,34,,210.12,percent of total billed charges,Implant Device,210.12,34,,210.12,percent of total billed charges,Implant Device,210.12,34,,210.12,percent of total billed charges,Implant Device,216.3,35,,216.3,percent of total billed charges,Implant Device,210.12,34,"Charges > $500, x 34%",210.12,percent of total billed charges,Implant Device,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,247.2,40,,247.2,percent of total billed charges,Implant Devices,216.3,70,,216.3,percent of total billed charges,Implant Devices,210.12,34,,210.12,percent of total billed charges,Implant Devices,210.12,34,,210.12,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,216.3,35,,216.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,247.2,
NAVILYST H965451030 POWER PORT 8FR,C1788,HCPCS,,79001691,CDM,278,RC,,,both,,,924,364.67,39.4668,,364.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,323.4,35,,323.4,percent of total billed charges,Implant Device,314.16,34,"Charges > $500, x 34%",314.16,percent of total billed charges,Implant Device,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,369.6,40,,369.6,percent of total billed charges,Implant Devices,323.4,70,,323.4,percent of total billed charges,Implant Devices,314.16,34,,314.16,percent of total billed charges,Implant Devices,314.16,34,,314.16,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,369.6,
BARD 1808050 POWERPORT,C1788,HCPCS,,79001692,CDM,278,RC,,,both,,,1498,591.21,39.4668,,591.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,509.32,34,,509.32,percent of total billed charges,Implant Device,509.32,34,,509.32,percent of total billed charges,Implant Device,509.32,34,,509.32,percent of total billed charges,Implant Device,509.32,34,,509.32,percent of total billed charges,Implant Device,509.32,34,,509.32,percent of total billed charges,Implant Device,509.32,34,,509.32,percent of total billed charges,Implant Device,524.3,35,,524.3,percent of total billed charges,Implant Device,509.32,34,"Charges > $500, x 34%",509.32,percent of total billed charges,Implant Device,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,599.2,40,,599.2,percent of total billed charges,Implant Devices,524.3,70,,524.3,percent of total billed charges,Implant Devices,509.32,34,,509.32,percent of total billed charges,Implant Devices,509.32,34,,509.32,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,599.2,
BARD 1808560 POWERPORT,C1788,HCPCS,,79001693,CDM,278,RC,,,both,,,1575,621.6,39.4668,,621.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,551.25,35,,551.25,percent of total billed charges,Implant Device,535.5,34,"Charges > $500, x 34%",535.5,percent of total billed charges,Implant Device,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,630,40,,630,percent of total billed charges,Implant Devices,551.25,70,,551.25,percent of total billed charges,Implant Devices,535.5,34,,535.5,percent of total billed charges,Implant Devices,535.5,34,,535.5,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,630,
BARD 1808560 POWERPORT,C1788,HCPCS,,79001834,CDM,278,RC,,,both,,,1636,645.68,39.4668,,645.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,556.24,34,,556.24,percent of total billed charges,Implant Device,556.24,34,,556.24,percent of total billed charges,Implant Device,556.24,34,,556.24,percent of total billed charges,Implant Device,556.24,34,,556.24,percent of total billed charges,Implant Device,556.24,34,,556.24,percent of total billed charges,Implant Device,556.24,34,,556.24,percent of total billed charges,Implant Device,572.6,35,,572.6,percent of total billed charges,Implant Device,556.24,34,"Charges > $500, x 34%",556.24,percent of total billed charges,Implant Device,572.6,35,,572.6,percent of total billed charges,Implant Devices,572.6,35,,572.6,percent of total billed charges,Implant Devices,572.6,35,,,percent of total billed charges,Implant Devices,572.6,35,,572.6,percent of total billed charges,Implant Devices,572.6,35,,572.6,percent of total billed charges,Implant Devices,654.4,40,,654.4,percent of total billed charges,Implant Devices,572.6,70,,572.6,percent of total billed charges,Implant Devices,556.24,34,,556.24,percent of total billed charges,Implant Devices,556.24,34,,556.24,percent of total billed charges,Implant Devices,572.6,35,,572.6,percent of total billed charges,Implant Devices,572.6,35,,572.6,percent of total billed charges,Implant Devices,572.6,35,,572.6,percent of total billed charges,Implant Devices,572.6,35,,572.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,654.4,
NAVILYST H965451270 POWERPORT PLASTIC,C1788,HCPCS,,79002708,CDM,278,RC,,,both,,,924,364.67,39.4668,,364.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,314.16,34,,314.16,percent of total billed charges,Implant Device,323.4,35,,323.4,percent of total billed charges,Implant Device,314.16,34,"Charges > $500, x 34%",314.16,percent of total billed charges,Implant Device,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,369.6,40,,369.6,percent of total billed charges,Implant Devices,323.4,70,,323.4,percent of total billed charges,Implant Devices,314.16,34,,314.16,percent of total billed charges,Implant Devices,314.16,34,,314.16,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,323.4,35,,323.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,369.6,
ANGIODYNAMICS H965451830 POWER PORT 8FR,C1788,HCPCS,,79008960,CDM,278,RC,,,both,,,1575,621.6,39.4668,,621.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,535.5,34,,535.5,percent of total billed charges,Implant Device,551.25,35,,551.25,percent of total billed charges,Implant Device,535.5,34,"Charges > $500, x 34%",535.5,percent of total billed charges,Implant Device,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,630,40,,630,percent of total billed charges,Implant Devices,551.25,70,,551.25,percent of total billed charges,Implant Devices,535.5,34,,535.5,percent of total billed charges,Implant Devices,535.5,34,,535.5,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,551.25,35,,551.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,630,
MENTOR 350-1610 BREAST IMPLANT 125CC,C1789,HCPCS,,79001287,CDM,278,RC,,,both,,,1936,764.08,39.4668,,764.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,677.6,35,,677.6,percent of total billed charges,Implant Device,658.24,34,"Charges > $500, x 34%",658.24,percent of total billed charges,Implant Device,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,774.4,40,,774.4,percent of total billed charges,Implant Devices,677.6,70,,677.6,percent of total billed charges,Implant Devices,658.24,34,,658.24,percent of total billed charges,Implant Devices,658.24,34,,658.24,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,774.4,
MENTOR 350-1615 BREAST IMPLANT 150CC,C1789,HCPCS,,79001288,CDM,278,RC,,,both,,,1936,764.08,39.4668,,764.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,677.6,35,,677.6,percent of total billed charges,Implant Device,658.24,34,"Charges > $500, x 34%",658.24,percent of total billed charges,Implant Device,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,774.4,40,,774.4,percent of total billed charges,Implant Devices,677.6,70,,677.6,percent of total billed charges,Implant Devices,658.24,34,,658.24,percent of total billed charges,Implant Devices,658.24,34,,658.24,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,774.4,
MENTOR 350-1630 BREAST IMPLANT 225CC,C1789,HCPCS,,79001289,CDM,278,RC,,,both,,,1876,740.4,39.4668,,740.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,637.84,34,,637.84,percent of total billed charges,Implant Device,637.84,34,,637.84,percent of total billed charges,Implant Device,637.84,34,,637.84,percent of total billed charges,Implant Device,637.84,34,,637.84,percent of total billed charges,Implant Device,637.84,34,,637.84,percent of total billed charges,Implant Device,637.84,34,,637.84,percent of total billed charges,Implant Device,656.6,35,,656.6,percent of total billed charges,Implant Device,637.84,34,"Charges > $500, x 34%",637.84,percent of total billed charges,Implant Device,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,750.4,40,,750.4,percent of total billed charges,Implant Devices,656.6,70,,656.6,percent of total billed charges,Implant Devices,637.84,34,,637.84,percent of total billed charges,Implant Devices,637.84,34,,637.84,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,750.4,
MENTOR 350-2225 BREAST IMPLANT 225CC,C1789,HCPCS,,79001290,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 350-3230 BREAST IMPLANT 230CC,C1789,HCPCS,,79001291,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
MENTOR 350-2275 BREAST IMPLANT 275CC,C1789,HCPCS,,79001292,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 350-3330 BREAST IMPLANT 330CC,C1789,HCPCS,,79001293,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
MENTOR 354-2512 BREAST IMPLANT 350CC,C1789,HCPCS,,79001294,CDM,278,RC,,,both,,,3676,1450.8,39.4668,,1450.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1286.6,35,,1286.6,percent of total billed charges,Implant Device,1249.84,34,"Charges > $500, x 34%",1249.84,percent of total billed charges,Implant Device,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1470.4,40,,1470.4,percent of total billed charges,Implant Devices,1286.6,70,,1286.6,percent of total billed charges,Implant Devices,1249.84,34,,1249.84,percent of total billed charges,Implant Devices,1249.84,34,,1249.84,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.84,34,"If Charge > 2,000, then 34 percent",1249.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470.4,
MENTOR 354-6212 BREAST IMPLANT 350CC,C1789,HCPCS,,79001295,CDM,278,RC,,,both,,,4276,1687.6,39.4668,,1687.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1496.6,35,,1496.6,percent of total billed charges,Implant Device,1453.84,34,"Charges > $500, x 34%",1453.84,percent of total billed charges,Implant Device,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1710.4,40,,1710.4,percent of total billed charges,Implant Devices,1496.6,70,,1496.6,percent of total billed charges,Implant Devices,1453.84,34,,1453.84,percent of total billed charges,Implant Devices,1453.84,34,,1453.84,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1453.84,34,"If Charge > 2,000, then 34 percent",1453.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1710.4,
MENTOR 354-7212 BREAST IMPLANT 350CC,C1789,HCPCS,,79001296,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
MENTOR 350-1460 BREAST IMPLANT 375CC,C1789,HCPCS,,79001297,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
MENTOR 350-3420 BREAST IMPLANT 420CC,C1789,HCPCS,,79001298,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
MENTOR 354-2513 BREAST IMPLANT 450CC,C1789,HCPCS,,79001299,CDM,278,RC,,,both,,,3676,1450.8,39.4668,,1450.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1286.6,35,,1286.6,percent of total billed charges,Implant Device,1249.84,34,"Charges > $500, x 34%",1249.84,percent of total billed charges,Implant Device,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1470.4,40,,1470.4,percent of total billed charges,Implant Devices,1286.6,70,,1286.6,percent of total billed charges,Implant Devices,1249.84,34,,1249.84,percent of total billed charges,Implant Devices,1249.84,34,,1249.84,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.84,34,"If Charge > 2,000, then 34 percent",1249.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470.4,
MENTOR 354-6213 BREAST IMPLANT 450CC,C1789,HCPCS,,79001300,CDM,278,RC,,,both,,,4276,1687.6,39.4668,,1687.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1496.6,35,,1496.6,percent of total billed charges,Implant Device,1453.84,34,"Charges > $500, x 34%",1453.84,percent of total billed charges,Implant Device,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1710.4,40,,1710.4,percent of total billed charges,Implant Devices,1496.6,70,,1496.6,percent of total billed charges,Implant Devices,1453.84,34,,1453.84,percent of total billed charges,Implant Devices,1453.84,34,,1453.84,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1453.84,34,"If Charge > 2,000, then 34 percent",1453.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1710.4,
MENTOR 354-7213 BREAST IMPLANT 450CC,C1789,HCPCS,,79001301,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
MENTOR 354-2514 BREAST IMPLANT 550CC,C1789,HCPCS,,79001302,CDM,278,RC,,,both,,,3676,1450.8,39.4668,,1450.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1286.6,35,,1286.6,percent of total billed charges,Implant Device,1249.84,34,"Charges > $500, x 34%",1249.84,percent of total billed charges,Implant Device,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1470.4,40,,1470.4,percent of total billed charges,Implant Devices,1286.6,70,,1286.6,percent of total billed charges,Implant Devices,1249.84,34,,1249.84,percent of total billed charges,Implant Devices,1249.84,34,,1249.84,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.84,34,"If Charge > 2,000, then 34 percent",1249.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470.4,
MENTOR 354-6214 BREAST IMPLANT 550CC,C1789,HCPCS,,79001303,CDM,278,RC,,,both,,,4276,1687.6,39.4668,,1687.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1496.6,35,,1496.6,percent of total billed charges,Implant Device,1453.84,34,"Charges > $500, x 34%",1453.84,percent of total billed charges,Implant Device,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1710.4,40,,1710.4,percent of total billed charges,Implant Devices,1496.6,70,,1496.6,percent of total billed charges,Implant Devices,1453.84,34,,1453.84,percent of total billed charges,Implant Devices,1453.84,34,,1453.84,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1453.84,34,"If Charge > 2,000, then 34 percent",1453.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1710.4,
MENTOR 354-7214 BREAST IMPLANT 550CC,C1789,HCPCS,,79001304,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
MENTOR 354-2515 BREAST IMPLANT 650CC,C1789,HCPCS,,79001305,CDM,278,RC,,,both,,,3676,1450.8,39.4668,,1450.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1249.84,34,,1249.84,percent of total billed charges,Implant Device,1286.6,35,,1286.6,percent of total billed charges,Implant Device,1249.84,34,"Charges > $500, x 34%",1249.84,percent of total billed charges,Implant Device,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1470.4,40,,1470.4,percent of total billed charges,Implant Devices,1286.6,70,,1286.6,percent of total billed charges,Implant Devices,1249.84,34,,1249.84,percent of total billed charges,Implant Devices,1249.84,34,,1249.84,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,1286.6,35,,1286.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1249.84,34,"If Charge > 2,000, then 34 percent",1249.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1470.4,
MENTOR 354-6215 BREAST IMPLANT 650CC,C1789,HCPCS,,79001306,CDM,278,RC,,,both,,,4276,1687.6,39.4668,,1687.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1496.6,35,,1496.6,percent of total billed charges,Implant Device,1453.84,34,"Charges > $500, x 34%",1453.84,percent of total billed charges,Implant Device,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1710.4,40,,1710.4,percent of total billed charges,Implant Devices,1496.6,70,,1496.6,percent of total billed charges,Implant Devices,1453.84,34,,1453.84,percent of total billed charges,Implant Devices,1453.84,34,,1453.84,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1453.84,34,"If Charge > 2,000, then 34 percent",1453.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1710.4,
MENTOR 354-7215 BREAST IMPLANT 650CC,C1789,HCPCS,,79001307,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
MENTOR 350-1645 BREAST IMPLANT,C1789,HCPCS,,79002021,CDM,278,RC,,,both,,,1876,740.4,39.4668,,740.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,637.84,34,,637.84,percent of total billed charges,Implant Device,637.84,34,,637.84,percent of total billed charges,Implant Device,637.84,34,,637.84,percent of total billed charges,Implant Device,637.84,34,,637.84,percent of total billed charges,Implant Device,637.84,34,,637.84,percent of total billed charges,Implant Device,637.84,34,,637.84,percent of total billed charges,Implant Device,656.6,35,,656.6,percent of total billed charges,Implant Device,637.84,34,"Charges > $500, x 34%",637.84,percent of total billed charges,Implant Device,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,750.4,40,,750.4,percent of total billed charges,Implant Devices,656.6,70,,656.6,percent of total billed charges,Implant Devices,637.84,34,,637.84,percent of total billed charges,Implant Devices,637.84,34,,637.84,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,656.6,35,,656.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,750.4,
MENTOR 350-2300 BREAST IMPLANT 300CC,C1789,HCPCS,,79002022,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 350-2500 BREAST IMPLANT,C1789,HCPCS,,79002023,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 350-2600 BREAST IMPLANT,C1789,HCPCS,,79002024,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
MENTOR 350-3250 BREAST IMPLANT,C1789,HCPCS,,79002025,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
MENTOR 350-7004BC BREAST IMPLANT,C1789,HCPCS,,79002026,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
MENTOR 354-6216 TISSUE EXPANDER,C1789,HCPCS,,79002027,CDM,278,RC,,,both,,,4276,1687.6,39.4668,,1687.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1453.84,34,,1453.84,percent of total billed charges,Implant Device,1496.6,35,,1496.6,percent of total billed charges,Implant Device,1453.84,34,"Charges > $500, x 34%",1453.84,percent of total billed charges,Implant Device,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1710.4,40,,1710.4,percent of total billed charges,Implant Devices,1496.6,70,,1496.6,percent of total billed charges,Implant Devices,1453.84,34,,1453.84,percent of total billed charges,Implant Devices,1453.84,34,,1453.84,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,1496.6,35,,1496.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1453.84,34,"If Charge > 2,000, then 34 percent",1453.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1710.4,
MENTOR 350-2200 BREAST IMPLANT,C1789,HCPCS,,79002846,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 350-1660 BREAST IMPLANT,C1789,HCPCS,,79003027,CDM,278,RC,,,both,,,1936,764.08,39.4668,,764.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,658.24,34,,658.24,percent of total billed charges,Implant Device,677.6,35,,677.6,percent of total billed charges,Implant Device,658.24,34,"Charges > $500, x 34%",658.24,percent of total billed charges,Implant Device,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,774.4,40,,774.4,percent of total billed charges,Implant Devices,677.6,70,,677.6,percent of total billed charges,Implant Devices,658.24,34,,658.24,percent of total billed charges,Implant Devices,658.24,34,,658.24,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,677.6,35,,677.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,774.4,
MENTOR 354-9314 BREAST IMPLANT,C1789,HCPCS,,79004965,CDM,278,RC,,,both,,,5085,2006.89,39.4668,,2006.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Device,1728.9,34,"Charges > $500, x 34%",1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,2034,40,,2034,percent of total billed charges,Implant Devices,1779.75,70,,1779.75,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1728.9,34,"If Charge > 2,000, then 34 percent",1728.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2034,
MENTOR 354-0315 BREAST IMPLANT,C1789,HCPCS,,79004966,CDM,278,RC,,,both,,,4936,1948.08,39.4668,,1948.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1678.24,34,,1678.24,percent of total billed charges,Implant Device,1678.24,34,,1678.24,percent of total billed charges,Implant Device,1678.24,34,,1678.24,percent of total billed charges,Implant Device,1678.24,34,,1678.24,percent of total billed charges,Implant Device,1678.24,34,,1678.24,percent of total billed charges,Implant Device,1678.24,34,,1678.24,percent of total billed charges,Implant Device,1727.6,35,,1727.6,percent of total billed charges,Implant Device,1678.24,34,"Charges > $500, x 34%",1678.24,percent of total billed charges,Implant Device,1727.6,35,,1727.6,percent of total billed charges,Implant Devices,1727.6,35,,1727.6,percent of total billed charges,Implant Devices,1727.6,35,,,percent of total billed charges,Implant Devices,1727.6,35,,1727.6,percent of total billed charges,Implant Devices,1727.6,35,,1727.6,percent of total billed charges,Implant Devices,1974.4,40,,1974.4,percent of total billed charges,Implant Devices,1727.6,70,,1727.6,percent of total billed charges,Implant Devices,1678.24,34,,1678.24,percent of total billed charges,Implant Devices,1678.24,34,,1678.24,percent of total billed charges,Implant Devices,1727.6,35,,1727.6,percent of total billed charges,Implant Devices,1727.6,35,,1727.6,percent of total billed charges,Implant Devices,1727.6,35,,1727.6,percent of total billed charges,Implant Devices,1727.6,35,,1727.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1678.24,34,"If Charge > 2,000, then 34 percent",1678.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974.4,
MENTOR H/S 350-2425 SILICONE IMPLANT,C1789,HCPCS,,79005132,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 350-2375 BREAST IMPLANT,C1789,HCPCS,,79005280,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
ALLERGAN 133MX-12-T TISSUE EXPANDER,C1789,HCPCS,,79005703,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN 133MX-15-T TISSUE EXPANDER,C1789,HCPCS,,79005704,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN 133MX-16-T TISSUE EXPANDER,C1789,HCPCS,,79005705,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN 133FX-14T TISSUE EXPANDER,C1789,HCPCS,,79005886,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN FM410550 SILICONE IMPLANT,C1789,HCPCS,,79005887,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN FM410605 SILICONE IMPLANT,C1789,HCPCS,,79005888,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN FM410655 SILICONE IMPLANT,C1789,HCPCS,,79005889,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
MENTOR 350-2350 BREAST IMPLANT,C1789,HCPCS,,79005898,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
ALLERGAN 133MV-15-T BREAST EXPANDER,C1789,HCPCS,,79005900,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN 133MV-16-T BREAST EXPANDER,C1789,HCPCS,,79005901,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN FF410535 SILICONE IMPLANT,C1789,HCPCS,,79006475,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN FF410475 SILICONE IMPLANT,C1789,HCPCS,,79006476,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN FF410595 SILICONE IMPLANT,C1789,HCPCS,,79006477,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN 133MV-11-T TISSUE EXPANDER,C1789,HCPCS,,79006486,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN 133MV-12-T TISSUE EXPANDER,C1789,HCPCS,,79006487,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
MENTOR 350-2475 BREAST IMPLANT 425CC,C1789,HCPCS,,79006542,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
ALLERGAN 133MV-13-T TISSUE EXPANDER,C1789,HCPCS,,79006556,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN 133MV-14-T TISSUE EXPANDER,C1789,HCPCS,,79006557,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN 133MX-13-T TISSUE EXPANDER,C1789,HCPCS,,79006558,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
MENTOR 350-2250 BREAST IMPLANT,C1789,HCPCS,,79006563,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
ALLERGAN 133MX-11-T TISSUE EXPANDER,C1789,HCPCS,,79006564,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN MM-410280 SILICONE BREAST IMP,C1789,HCPCS,,79006565,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN MM-410320 SILICONE BREAST IMP,C1789,HCPCS,,79006566,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN MM-410360 SILICONE BREAST IMP,C1789,HCPCS,,79006567,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
MENTOR 350-3501BC BREAST IMPLANT 350CC,C1789,HCPCS,,79006620,CDM,278,RC,,,both,,,2866,1131.12,39.4668,,1131.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.44,34,,974.44,percent of total billed charges,Implant Device,974.44,34,,974.44,percent of total billed charges,Implant Device,974.44,34,,974.44,percent of total billed charges,Implant Device,974.44,34,,974.44,percent of total billed charges,Implant Device,974.44,34,,974.44,percent of total billed charges,Implant Device,974.44,34,,974.44,percent of total billed charges,Implant Device,1003.1,35,,1003.1,percent of total billed charges,Implant Device,974.44,34,"Charges > $500, x 34%",974.44,percent of total billed charges,Implant Device,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1146.4,40,,1146.4,percent of total billed charges,Implant Devices,1003.1,70,,1003.1,percent of total billed charges,Implant Devices,974.44,34,,974.44,percent of total billed charges,Implant Devices,974.44,34,,974.44,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.44,34,"If Charge > 2,000, then 34 percent",974.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146.4,
MENTOR 350-3001BC BREAST IMPLANT 300CC,C1789,HCPCS,,79006621,CDM,278,RC,,,both,,,2866,1131.12,39.4668,,1131.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.44,34,,974.44,percent of total billed charges,Implant Device,974.44,34,,974.44,percent of total billed charges,Implant Device,974.44,34,,974.44,percent of total billed charges,Implant Device,974.44,34,,974.44,percent of total billed charges,Implant Device,974.44,34,,974.44,percent of total billed charges,Implant Device,974.44,34,,974.44,percent of total billed charges,Implant Device,1003.1,35,,1003.1,percent of total billed charges,Implant Device,974.44,34,"Charges > $500, x 34%",974.44,percent of total billed charges,Implant Device,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1146.4,40,,1146.4,percent of total billed charges,Implant Devices,1003.1,70,,1003.1,percent of total billed charges,Implant Devices,974.44,34,,974.44,percent of total billed charges,Implant Devices,974.44,34,,974.44,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,1003.1,35,,1003.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.44,34,"If Charge > 2,000, then 34 percent",974.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146.4,
ALLERGAN MM410215 SILICON BREAST IMPLANT,C1789,HCPCS,,79006702,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN MF410225 SILICON BREAST IMPLANT,C1789,HCPCS,,79006703,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
SIENTRA 20645-250MP BREAST IMPLANT,C1789,HCPCS,,79006712,CDM,278,RC,,,both,,,2986,1178.48,39.4668,,1178.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1045.1,35,,1045.1,percent of total billed charges,Implant Device,1015.24,34,"Charges > $500, x 34%",1015.24,percent of total billed charges,Implant Device,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1194.4,40,,1194.4,percent of total billed charges,Implant Devices,1045.1,70,,1045.1,percent of total billed charges,Implant Devices,1015.24,34,,1015.24,percent of total billed charges,Implant Devices,1015.24,34,,1015.24,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.24,34,"If Charge > 2,000, then 34 percent",1015.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.4,
SIENTRA 20645-290MP BREAST IMPLANT,C1789,HCPCS,,79006713,CDM,278,RC,,,both,,,2986,1178.48,39.4668,,1178.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1045.1,35,,1045.1,percent of total billed charges,Implant Device,1015.24,34,"Charges > $500, x 34%",1015.24,percent of total billed charges,Implant Device,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1194.4,40,,1194.4,percent of total billed charges,Implant Devices,1045.1,70,,1045.1,percent of total billed charges,Implant Devices,1015.24,34,,1015.24,percent of total billed charges,Implant Devices,1015.24,34,,1015.24,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.24,34,"If Charge > 2,000, then 34 percent",1015.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.4,
SIENTRA 20645-330MP BREAST IMPLANT,C1789,HCPCS,,79006714,CDM,278,RC,,,both,,,2986,1178.48,39.4668,,1178.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1015.24,34,,1015.24,percent of total billed charges,Implant Device,1045.1,35,,1045.1,percent of total billed charges,Implant Device,1015.24,34,"Charges > $500, x 34%",1015.24,percent of total billed charges,Implant Device,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1194.4,40,,1194.4,percent of total billed charges,Implant Devices,1045.1,70,,1045.1,percent of total billed charges,Implant Devices,1015.24,34,,1015.24,percent of total billed charges,Implant Devices,1015.24,34,,1015.24,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,1045.1,35,,1045.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1015.24,34,"If Charge > 2,000, then 34 percent",1015.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1194.4,
ALLERGAN 133MX-14-T TISSUE EXPANDER,C1789,HCPCS,,79006722,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN MF410525 SILICONE BREAST IMPLNT,C1789,HCPCS,,79006933,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN MF420580 SILICONE BREAST IMPLNT,C1789,HCPCS,,79006934,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
ALLERGAN MF410640 SILICONE BREAST IMPLNT,C1789,HCPCS,,79006935,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN LM-410320 SILICONE IMPLANT,C1789,HCPCS,,79007890,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
ALLERGAN MF410470 SILICONE IMPLANT,C1789,HCPCS,,79008041,CDM,278,RC,,,both,,,3976,1569.2,39.4668,,1569.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1351.84,34,,1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Device,1351.84,34,"Charges > $500, x 34%",1351.84,percent of total billed charges,Implant Device,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1590.4,40,,1590.4,percent of total billed charges,Implant Devices,1391.6,70,,1391.6,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1351.84,34,,1351.84,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,1391.6,35,,1391.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.84,34,"If Charge > 2,000, then 34 percent",1351.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590.4,
MENTOR 350-5800BC BREAST IMPLANT,C1789,HCPCS,,79008159,CDM,278,RC,,,both,,,3015,1189.92,39.4668,,1189.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1025.1,34,,1025.1,percent of total billed charges,Implant Device,1025.1,34,,1025.1,percent of total billed charges,Implant Device,1025.1,34,,1025.1,percent of total billed charges,Implant Device,1025.1,34,,1025.1,percent of total billed charges,Implant Device,1025.1,34,,1025.1,percent of total billed charges,Implant Device,1025.1,34,,1025.1,percent of total billed charges,Implant Device,1055.25,35,,1055.25,percent of total billed charges,Implant Device,1025.1,34,"Charges > $500, x 34%",1025.1,percent of total billed charges,Implant Device,1055.25,35,,1055.25,percent of total billed charges,Implant Devices,1055.25,35,,1055.25,percent of total billed charges,Implant Devices,1055.25,35,,,percent of total billed charges,Implant Devices,1055.25,35,,1055.25,percent of total billed charges,Implant Devices,1055.25,35,,1055.25,percent of total billed charges,Implant Devices,1206,40,,1206,percent of total billed charges,Implant Devices,1055.25,70,,1055.25,percent of total billed charges,Implant Devices,1025.1,34,,1025.1,percent of total billed charges,Implant Devices,1025.1,34,,1025.1,percent of total billed charges,Implant Devices,1055.25,35,,1055.25,percent of total billed charges,Implant Devices,1055.25,35,,1055.25,percent of total billed charges,Implant Devices,1055.25,35,,1055.25,percent of total billed charges,Implant Devices,1055.25,35,,1055.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1025.1,34,"If Charge > 2,000, then 34 percent",1025.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1206,
MENTOR  350-2400 SALINE BREAST IMPLANTS,C1789,HCPCS,,79008195,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 354-2911 BREAST IMPLANT-SALINE,C1789,HCPCS,,79008218,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
MENTOR TEXP110RH TISSUE EXPANDER 300CC,C1789,HCPCS,,79008253,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MENTOR TEXP120RH TISSUE EXPANDER 375CC,C1789,HCPCS,,79008254,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MENTOR TEXP130RH TISSUE EXPANDER 475CC,C1789,HCPCS,,79008255,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
ALLERGAN INC 133SV-15-T TISSUE EXPANDER,C1789,HCPCS,,79008409,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN INC 133SV-16-T TISSUE EXPANDER,C1789,HCPCS,,79008410,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
MENTOR 350-2501BC BREAST IMPLANT 250CC,C1789,HCPCS,,79008587,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 350-7235MC BREAST IMPLANT 235CC,C1789,HCPCS,,79008588,CDM,278,RC,,,both,,,2790,1101.12,39.4668,,1101.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Device,948.6,34,"Charges > $500, x 34%",948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,1116,40,,1116,percent of total billed charges,Implant Devices,976.5,70,,976.5,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,948.6,34,"If Charge > 2,000, then 34 percent",948.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1116,
MENTOR 350-7255MC BREAST IMPLANT 255CC,C1789,HCPCS,,79008589,CDM,278,RC,,,both,,,2790,1101.12,39.4668,,1101.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Device,948.6,34,"Charges > $500, x 34%",948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,1116,40,,1116,percent of total billed charges,Implant Devices,976.5,70,,976.5,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,948.6,34,"If Charge > 2,000, then 34 percent",948.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1116,
MENTOR 334-1155 BREAST IMPLANT 295CC,C1789,HCPCS,,79008590,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
MENTOR 334-1105 BREAST IMPLANT 255CC,C1789,HCPCS,,79008591,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
MENTOR 354-1158 BREAST IMPLANT 245CC,C1789,HCPCS,,79008592,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
MENTOR 354-1208 BREAST IMPLANT 280CC,C1789,HCPCS,,79008593,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
MENTOR 350-1751BC BREAST IMPLANT 175CC,C1789,HCPCS,,79008661,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 350-3751BC BREAST IMPLANT 375CC,C1789,HCPCS,,79008662,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 354-9114 TISSUE EXPANDER 550CC,C1789,HCPCS,,79008665,CDM,278,RC,,,both,,,4935,1947.69,39.4668,,1947.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1677.9,34,,1677.9,percent of total billed charges,Implant Device,1727.25,35,,1727.25,percent of total billed charges,Implant Device,1677.9,34,"Charges > $500, x 34%",1677.9,percent of total billed charges,Implant Device,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1974,40,,1974,percent of total billed charges,Implant Devices,1727.25,70,,1727.25,percent of total billed charges,Implant Devices,1677.9,34,,1677.9,percent of total billed charges,Implant Devices,1677.9,34,,1677.9,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,1727.25,35,,1727.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1677.9,34,"If Charge > 2,000, then 34 percent",1677.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1974,
MENTOR 354-9214 TISSUE EXPANDER 550CC,C1789,HCPCS,,79008666,CDM,278,RC,,,both,,,5085,2006.89,39.4668,,2006.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Device,1728.9,34,"Charges > $500, x 34%",1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,2034,40,,2034,percent of total billed charges,Implant Devices,1779.75,70,,1779.75,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1728.9,34,"If Charge > 2,000, then 34 percent",1728.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2034,
MENTOR TEXP140RH TISSUE EXPANDER 600CC,C1789,HCPCS,,79008667,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MENTOR 350-2450 BREAST IMPLANT 450CC,C1789,HCPCS,,79008807,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 354-9213 TISSUE EXPANDER 450CC,C1789,HCPCS,,79008828,CDM,278,RC,,,both,,,5085,2006.89,39.4668,,2006.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Device,1728.9,34,"Charges > $500, x 34%",1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,2034,40,,2034,percent of total billed charges,Implant Devices,1779.75,70,,1779.75,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1728.9,34,"If Charge > 2,000, then 34 percent",1728.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2034,
MENTOR 354-9211 TISSUE EXPANDER 275CC,C1789,HCPCS,,79008853,CDM,278,RC,,,both,,,5085,2006.89,39.4668,,2006.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Device,1728.9,34,"Charges > $500, x 34%",1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,2034,40,,2034,percent of total billed charges,Implant Devices,1779.75,70,,1779.75,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1728.9,34,"If Charge > 2,000, then 34 percent",1728.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2034,
MENTOR 350-3560 BREAST IMPLANT 560CC,C1789,HCPCS,,79008905,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 350-2550 BREAST IMPLANT 550CC,C1789,HCPCS,,79008906,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 350-1430 IMPLANT SMOOTH ROUND 225,C1789,HCPCS,,79009010,CDM,278,RC,,,both,,,2625,1036,39.4668,,1036,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,892.5,34,,892.5,percent of total billed charges,Implant Device,918.75,35,,918.75,percent of total billed charges,Implant Device,892.5,34,"Charges > $500, x 34%",892.5,percent of total billed charges,Implant Device,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,1050,40,,1050,percent of total billed charges,Implant Devices,918.75,70,,918.75,percent of total billed charges,Implant Devices,892.5,34,,892.5,percent of total billed charges,Implant Devices,892.5,34,,892.5,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,918.75,35,,918.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,892.5,34,"If Charge > 2,000, then 34 percent",892.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1050,
MENTOR 354-9215 TISSUE EXPANDER CPX4 650,C1789,HCPCS,,79009187,CDM,278,RC,,,both,,,5085,2006.89,39.4668,,2006.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Device,1728.9,34,"Charges > $500, x 34%",1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,2034,40,,2034,percent of total billed charges,Implant Devices,1779.75,70,,1779.75,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1728.9,34,"If Charge > 2,000, then 34 percent",1728.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2034,
AIRXPANDERS BR140-600 TISSUE EXPANDER,C1789,HCPCS,,79009203,CDM,278,RC,,,both,,,7323,2890.15,39.4668,,2890.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2489.82,34,,2489.82,percent of total billed charges,Implant Device,2489.82,34,,2489.82,percent of total billed charges,Implant Device,2489.82,34,,2489.82,percent of total billed charges,Implant Device,2489.82,34,,2489.82,percent of total billed charges,Implant Device,2489.82,34,,2489.82,percent of total billed charges,Implant Device,2489.82,34,,2489.82,percent of total billed charges,Implant Device,2563.05,35,,2563.05,percent of total billed charges,Implant Device,2489.82,34,"Charges > $500, x 34%",2489.82,percent of total billed charges,Implant Device,2563.05,35,,2563.05,percent of total billed charges,Implant Devices,2563.05,35,,2563.05,percent of total billed charges,Implant Devices,2563.05,35,,,percent of total billed charges,Implant Devices,2563.05,35,,2563.05,percent of total billed charges,Implant Devices,2563.05,35,,2563.05,percent of total billed charges,Implant Devices,2929.2,40,,2929.2,percent of total billed charges,Implant Devices,2563.05,70,,2563.05,percent of total billed charges,Implant Devices,2489.82,34,,2489.82,percent of total billed charges,Implant Devices,2489.82,34,,2489.82,percent of total billed charges,Implant Devices,2563.05,35,,2563.05,percent of total billed charges,Implant Devices,2563.05,35,,2563.05,percent of total billed charges,Implant Devices,2563.05,35,,2563.05,percent of total billed charges,Implant Devices,2563.05,35,,2563.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2489.82,34,"If Charge > 2,000, then 34 percent",2489.82,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2929.2,
MENTOR 350-4001BC BREAST IMPLANT 400CC,C1789,HCPCS,,79009251,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 350-4501BC BREAST IMPLANT 450CC,C1789,HCPCS,,79009252,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 350-6004BC BREAST IMPLANT 600CC,C1789,HCPCS,,79009253,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
MENTOR 350-6001BC BREAST IMPLANT 600CC,C1789,HCPCS,,79009254,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 350-5501BC BREAST IMPLANT 550CC,C1789,HCPCS,,79009255,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 350-5751BC BREAST IMPLANT 575CC,C1789,HCPCS,,79009256,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR SMPX-370 ROUND GEL BREAST IMPLANT,C1789,HCPCS,,79009420,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR SMPX-405 ROUND GEL BREAST IMPLANT,C1789,HCPCS,,79009421,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR SMPX-440 ROUND GEL BREAST IMPLANT,C1789,HCPCS,,79009422,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR SMPX-465 ROUND GEL BREAST IMPLANT,C1789,HCPCS,,79009423,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR SMPX-490 ROUND GEL BREAST IMPLANT,C1789,HCPCS,,79009424,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR 350-3251BC GEL BREAST IMPLANT,C1789,HCPCS,,79009430,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 354-9212 TISSUE EXPANDER 350CC,C1789,HCPCS,,79009450,CDM,278,RC,,,both,,,5085,2006.89,39.4668,,2006.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Device,1728.9,34,"Charges > $500, x 34%",1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,2034,40,,2034,percent of total billed charges,Implant Devices,1779.75,70,,1779.75,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1728.9,34,"If Charge > 2,000, then 34 percent",1728.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2034,
MENTOR 354-9111 TISSUE EXPANDER 250CC,C1789,HCPCS,,79009451,CDM,278,RC,,,both,,,5085,2006.89,39.4668,,2006.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Device,1728.9,34,"Charges > $500, x 34%",1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,2034,40,,2034,percent of total billed charges,Implant Devices,1779.75,70,,1779.75,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1728.9,34,"If Charge > 2,000, then 34 percent",1728.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2034,
MENTOR 350-2751BC BREAST IMPLANT 275CC,C1789,HCPCS,,79009452,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 350-3500 BREAST IMPLANT 500CC,C1789,HCPCS,,79009454,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
MENTOR 354-9113 TISSUE EXPANDER 400CC,C1789,HCPCS,,79009490,CDM,278,RC,,,both,,,5085,2006.89,39.4668,,2006.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1728.9,34,,1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Device,1728.9,34,"Charges > $500, x 34%",1728.9,percent of total billed charges,Implant Device,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,2034,40,,2034,percent of total billed charges,Implant Devices,1779.75,70,,1779.75,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1728.9,34,,1728.9,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,1779.75,35,,1779.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1728.9,34,"If Charge > 2,000, then 34 percent",1728.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2034,
MENTOR 350-7300MC GEL IMPLANT 300CC,C1789,HCPCS,,79009491,CDM,278,RC,,,both,,,2790,1101.12,39.4668,,1101.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Device,948.6,34,"Charges > $500, x 34%",948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,1116,40,,1116,percent of total billed charges,Implant Devices,976.5,70,,976.5,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,948.6,34,"If Charge > 2,000, then 34 percent",948.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1116,
MENTOR 350-7340MC GEL IMPLANT 340CC,C1789,HCPCS,,79009492,CDM,278,RC,,,both,,,2790,1101.12,39.4668,,1101.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Device,948.6,34,"Charges > $500, x 34%",948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,1116,40,,1116,percent of total billed charges,Implant Devices,976.5,70,,976.5,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,948.6,34,"If Charge > 2,000, then 34 percent",948.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1116,
MENTOR 350-7320MC GEL IMPLANT 320CC,C1789,HCPCS,,79009493,CDM,278,RC,,,both,,,2790,1101.12,39.4668,,1101.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Device,948.6,34,"Charges > $500, x 34%",948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,1116,40,,1116,percent of total billed charges,Implant Devices,976.5,70,,976.5,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,948.6,34,"If Charge > 2,000, then 34 percent",948.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1116,
MENTOR SMXP-120RH BREAST TISSUE EXPANDER,C1789,HCPCS,,79009556,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MENTOR SMPX-350 BREAST TISSUE EXPANDER,C1789,HCPCS,,79009557,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR SMPX-325 BREAST TISSUE EXPANDER,C1789,HCPCS,,79009558,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR 350-4004BC MEMORY GEL IMPLANT,C1789,HCPCS,,79009561,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
MENTOR 350-3754BC MEMORY GEL IMPLANT,C1789,HCPCS,,79009562,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
MENTOR 350-3504BC MEMORY GEL IMPLANT,C1789,HCPCS,,79009563,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
MENTOR 350-3254BC MEMORY GEL IMPLANT,C1789,HCPCS,,79009564,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
MENTOR SMPX-215 GEL BREAST IMPLANT 215CC,C1789,HCPCS,,79009661,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR SMPX-240 GEL BREAST IMPLANT 240CC,C1789,HCPCS,,79009662,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR SMPX-270 GEL BREAST IMPLANT 270CC,C1789,HCPCS,,79009663,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR SMPX-295 GEL BREAST IMPLANT 295CC,C1789,HCPCS,,79009664,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MW SMXP150RH BRST TISSUE EXPANDERS 750CC,C1789,HCPCS,,79009690,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MW SMXP155RH BRST TISSUE EXPANDERS 850CC,C1789,HCPCS,,79009691,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MW SMPX605 MEMORY GEL IMPLANTS 605CC,C1789,HCPCS,,79009692,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MW SMPX630 MEMORY GEL IMPLANTS 630CC,C1789,HCPCS,,79009693,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MW SMPX685 MEMORY GEL IMPLANTS 685CC,C1789,HCPCS,,79009694,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MW SMPX755 MEMORY GEL IMPLANTS 755CC,C1789,HCPCS,,79009695,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR 350-9113 BREAST EXPANDER 450CC,C1789,HCPCS,,79009764,CDM,278,RC,,,both,,,5475,2160.81,39.4668,,2160.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Device,1861.5,34,"Charges > $500, x 34%",1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,2190,40,,2190,percent of total billed charges,Implant Devices,1916.25,70,,1916.25,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1861.5,34,"If Charge > 2,000, then 34 percent",1861.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2190,
MENTOR 350-9214 BREAST EXPANDER 550CC,C1789,HCPCS,,79009765,CDM,278,RC,,,both,,,5475,2160.81,39.4668,,2160.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Device,1861.5,34,"Charges > $500, x 34%",1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,2190,40,,2190,percent of total billed charges,Implant Devices,1916.25,70,,1916.25,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1861.5,34,"If Charge > 2,000, then 34 percent",1861.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2190,
MENTOR SMXP130RH BREAST EXPANDER 475CC,C1789,HCPCS,,79009773,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MENTOR SMXP136RH BREAST EXPANDER 500CC,C1789,HCPCS,,79009774,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MENTOR 350-2650 BREAST IMPLANT 650CC,C1789,HCPCS,,79009891,CDM,278,RC,,,both,,,2010,793.28,39.4668,,793.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,683.4,34,,683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Device,683.4,34,"Charges > $500, x 34%",683.4,percent of total billed charges,Implant Device,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,804,40,,804,percent of total billed charges,Implant Devices,703.5,70,,703.5,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,683.4,34,,683.4,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,703.5,35,,703.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,683.4,34,"If Charge > 2,000, then 34 percent",683.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,804,
ALLERGAN SCF-365 BREAST IMPLANT 365CC,C1789,HCPCS,,79009895,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGEN SCF-385 BREAST IMPLANT 385CC,C1789,HCPCS,,79009896,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGEN SCF-415 BREAST IMPLANT 415CC,C1789,HCPCS,,79009897,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGEN SCF-450 BREAST IMPLANT 450CC,C1789,HCPCS,,79009898,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGEN SCF-485 BREAST IMPLANT 485CC,C1789,HCPCS,,79009899,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGEN SCM-345 BREAST IMPLANT 345CC,C1789,HCPCS,,79009900,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGEN SCM-360 BREAST IMPLANT 360CC,C1789,HCPCS,,79009901,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGEN SCM-375 BREAST IMPLANT 375CC,C1789,HCPCS,,79009902,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
STRYKER DCELL205 DERMACELL TISSUE 8X16CM,C1789,HCPCS,,79009921,CDM,278,RC,,,both,,,10500,4144.01,39.4668,,4144.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3570,34,,3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Device,3570,34,"Charges > $500, x 34%",3570,percent of total billed charges,Implant Device,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,4200,40,,4200,percent of total billed charges,Implant Devices,3675,70,,3675,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3570,34,,3570,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,3675,35,,3675,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3570,34,"If Charge > 2,000, then 34 percent",3570,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4200,
MENTOR 350-9111 BREAST TISSUE EXPANDER,C1789,HCPCS,,79009946,CDM,278,RC,,,both,,,5475,2160.81,39.4668,,2160.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Device,1861.5,34,"Charges > $500, x 34%",1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,2190,40,,2190,percent of total billed charges,Implant Devices,1916.25,70,,1916.25,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1861.5,34,"If Charge > 2,000, then 34 percent",1861.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2190,
MENTOR 350-9112 BREAST TISSUE EXPANDER,C1789,HCPCS,,79009947,CDM,278,RC,,,both,,,5475,2160.81,39.4668,,2160.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Device,1861.5,34,"Charges > $500, x 34%",1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,2190,40,,2190,percent of total billed charges,Implant Devices,1916.25,70,,1916.25,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1861.5,34,"If Charge > 2,000, then 34 percent",1861.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2190,
MENTOR 350-7275MC GEL IMPLANT 275CC,C1789,HCPCS,,79009948,CDM,278,RC,,,both,,,2790,1101.12,39.4668,,1101.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,948.6,34,,948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Device,948.6,34,"Charges > $500, x 34%",948.6,percent of total billed charges,Implant Device,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,1116,40,,1116,percent of total billed charges,Implant Devices,976.5,70,,976.5,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,948.6,34,,948.6,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,976.5,35,,976.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,948.6,34,"If Charge > 2,000, then 34 percent",948.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1116,
ALLERGAN SCLP-300 BREAST IMPLANT 300CC,C1789,HCPCS,,79009950,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCL-230 BREAST IMPLANT 230CC,C1789,HCPCS,,79009952,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCL-260 BREAST IMPLANT 260CC,C1789,HCPCS,,79009953,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
MENTOR 350-2251BC SILICONE IMPLANT 225CC,C1789,HCPCS,,79009983,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR SMPX270 SILICONE IMPLANT 270CC,C1789,HCPCS,,79009985,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR SMPX295 SILICONE IMPLANT 295CC,C1789,HCPCS,,79009986,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR SMPX325 SILICONE IMPLANT 325CC,C1789,HCPCS,,79009987,CDM,278,RC,,,both,,,3684,1453.96,39.4668,,1453.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1252.56,34,,1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Device,1252.56,34,"Charges > $500, x 34%",1252.56,percent of total billed charges,Implant Device,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1473.6,40,,1473.6,percent of total billed charges,Implant Devices,1289.4,70,,1289.4,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1252.56,34,,1252.56,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,1289.4,35,,1289.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1252.56,34,"If Charge > 2,000, then 34 percent",1252.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1473.6,
MENTOR 350-4751BC GEL IMPLANT 475CC,C1789,HCPCS,,79010076,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 350-5251BC GEL IMPLANT 525CC,C1789,HCPCS,,79010077,CDM,278,RC,,,both,,,2865,1130.72,39.4668,,1130.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,974.1,34,,974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Device,974.1,34,"Charges > $500, x 34%",974.1,percent of total billed charges,Implant Device,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1146,40,,1146,percent of total billed charges,Implant Devices,1002.75,70,,1002.75,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,974.1,34,,974.1,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,1002.75,35,,1002.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,974.1,34,"If Charge > 2,000, then 34 percent",974.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1146,
MENTOR 350-9114 BREAST TISSUE EXPANDER,C1789,HCPCS,,79010078,CDM,278,RC,,,both,,,5475,2160.81,39.4668,,2160.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Device,1861.5,34,"Charges > $500, x 34%",1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,2190,40,,2190,percent of total billed charges,Implant Devices,1916.25,70,,1916.25,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1861.5,34,"If Charge > 2,000, then 34 percent",1861.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2190,
MENTOR 350-9215 BREAST TISSUE EXPANDER,C1789,HCPCS,,79010079,CDM,278,RC,,,both,,,5475,2160.81,39.4668,,2160.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Device,1861.5,34,"Charges > $500, x 34%",1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,2190,40,,2190,percent of total billed charges,Implant Devices,1916.25,70,,1916.25,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1861.5,34,"If Charge > 2,000, then 34 percent",1861.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2190,
ALLERGAN SCM-240 GEL BREAST IMPLANT 240,C1789,HCPCS,,79010185,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCM-275 GEL BREAST IMPLANT 275,C1789,HCPCS,,79010186,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-14 GEL BREAST IMPLANT 145,C1789,HCPCS,,79010189,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-190 GEL BREAST IMPLANT 190,C1789,HCPCS,,79010190,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-220 GEL BREAST IMPLANT 220,C1789,HCPCS,,79010191,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-250 GEL BREAST IMPLANT 250,C1789,HCPCS,,79010192,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
MENTOR SMXP100RH TISSUE EXPANDER 225CC,C1789,HCPCS,,79010197,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MENTOR SMXP110RH TISSUE EXPANDER 110CC,C1789,HCPCS,,79010198,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MENTOR SMXP140RH TISSUE EXPANDER 600CC,C1789,HCPCS,,79010264,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
ALLERGAN SCM-445 GEL BREAST IMPLANTS 445,C1789,HCPCS,,79010265,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCM-485 GEL BREAST IMPLANTS 485,C1789,HCPCS,,79010266,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-320 GEL BREAST IMPLANT 320,C1789,HCPCS,,79010269,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-360 GEL BREAST IMPLANT 360,C1789,HCPCS,,79010270,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-400 GEL BREAST IMPLANT 400,C1789,HCPCS,,79010271,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
STRYKER DCELL214 DERMACELL TISSUE 6X16CM,C1789,HCPCS,,79010279,CDM,278,RC,,,both,,,7875,3108.01,39.4668,,3108.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2756.25,35,,2756.25,percent of total billed charges,Implant Device,2677.5,34,"Charges > $500, x 34%",2677.5,percent of total billed charges,Implant Device,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,3150,40,,3150,percent of total billed charges,Implant Devices,2756.25,70,,2756.25,percent of total billed charges,Implant Devices,2677.5,34,,2677.5,percent of total billed charges,Implant Devices,2677.5,34,,2677.5,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2677.5,34,"If Charge > 2,000, then 34 percent",2677.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3150,
ALLERGAN SCL-170 BREAST IMPLANT 170CC,C1789,HCPCS,,79010300,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCL-200 BREAST IMPLANT 200CC,C1789,HCPCS,,79010301,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCL-140 BREAST IMPLANT 140CC,C1789,HCPCS,,79010349,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
MENTOR 350-9213 BREAST TISSUE EXPANDER,C1789,HCPCS,,79010389,CDM,278,RC,,,both,,,5475,2160.81,39.4668,,2160.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1861.5,34,,1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Device,1861.5,34,"Charges > $500, x 34%",1861.5,percent of total billed charges,Implant Device,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,2190,40,,2190,percent of total billed charges,Implant Devices,1916.25,70,,1916.25,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1861.5,34,,1861.5,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,1916.25,35,,1916.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1861.5,34,"If Charge > 2,000, then 34 percent",1861.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2190,
ALLERGAN SCM-330 BREAST IMPLANT 330CC,C1789,HCPCS,,79010390,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-265 BREAST IMPLANT 265CC,C1789,HCPCS,,79010392,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-280 BREAST IMPLANT 280CC,C1789,HCPCS,,79010393,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN 133-MV-14-T TISSUE EXPANDER 500,C1789,HCPCS,,79010410,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
ALLERGAN 133-MV-15-T TISSUE EXPANDER 600,C1789,HCPCS,,79010411,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
ALLERGAN 133-MV-16-T TISSUE EXPANDER 700,C1789,HCPCS,,79010412,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
ALLERGAN SSM-485 BREAST IMPLANT 485CC,C1789,HCPCS,,79010413,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SSM-520 BREAST IMPLANT 520CC,C1789,HCPCS,,79010414,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SSM-560 BREAST IMPLANT 560CC,C1789,HCPCS,,79010415,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SSM-600 BREAST IMPLANT 600CC,C1789,HCPCS,,79010416,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN 133S-MV-14-T TISSUE EXPANDR 500,C1789,HCPCS,,79010428,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
ALLERGAN 133S-MV-15-T TISSUE EXPANDR 600,C1789,HCPCS,,79010429,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
ALLERGAN 133S-MV-16-T TISSUE EXPANDR 700,C1789,HCPCS,,79010430,CDM,278,RC,,,both,,,4725,1864.81,39.4668,,1864.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1606.5,34,,1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Device,1606.5,34,"Charges > $500, x 34%",1606.5,percent of total billed charges,Implant Device,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1890,40,,1890,percent of total billed charges,Implant Devices,1653.75,70,,1653.75,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1606.5,34,,1606.5,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,1653.75,35,,1653.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1606.5,34,"If Charge > 2,000, then 34 percent",1606.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1890,
ALLERGAN SCLP-165 BREAST IMPLANT 165CC,C1789,HCPCS,,79010463,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCF-560 BREAST IMPLANT 560CC,C1789,HCPCS,,79010525,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCF-520 BREAST IMPLANT 520CC,C1789,HCPCS,,79010526,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCM-405 BREAST IMPLANT 405CC,C1789,HCPCS,,79010527,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-340 BREAST IMPLANT 340CC,C1789,HCPCS,,79010528,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
STRYKER DCELL204 SOFT TISSUE 6X16CM,C1789,HCPCS,,79010538,CDM,278,RC,,,both,,,7875,3108.01,39.4668,,3108.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2677.5,34,,2677.5,percent of total billed charges,Implant Device,2756.25,35,,2756.25,percent of total billed charges,Implant Device,2677.5,34,"Charges > $500, x 34%",2677.5,percent of total billed charges,Implant Device,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,3150,40,,3150,percent of total billed charges,Implant Devices,2756.25,70,,2756.25,percent of total billed charges,Implant Devices,2677.5,34,,2677.5,percent of total billed charges,Implant Devices,2677.5,34,,2677.5,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,2756.25,35,,2756.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2677.5,34,"If Charge > 2,000, then 34 percent",2677.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3150,
STRYKER DCELL203 TISSUE5X16CM 0.75-150MM,C1789,HCPCS,,79010684,CDM,278,RC,,,both,,,9750,3848.01,39.4668,,3848.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3315,34,,3315,percent of total billed charges,Implant Device,3315,34,,3315,percent of total billed charges,Implant Device,3315,34,,3315,percent of total billed charges,Implant Device,3315,34,,3315,percent of total billed charges,Implant Device,3315,34,,3315,percent of total billed charges,Implant Device,3315,34,,3315,percent of total billed charges,Implant Device,3412.5,35,,3412.5,percent of total billed charges,Implant Device,3315,34,"Charges > $500, x 34%",3315,percent of total billed charges,Implant Device,3412.5,35,,3412.5,percent of total billed charges,Implant Devices,3412.5,35,,3412.5,percent of total billed charges,Implant Devices,3412.5,35,,,percent of total billed charges,Implant Devices,3412.5,35,,3412.5,percent of total billed charges,Implant Devices,3412.5,35,,3412.5,percent of total billed charges,Implant Devices,3900,40,,3900,percent of total billed charges,Implant Devices,3412.5,70,,3412.5,percent of total billed charges,Implant Devices,3315,34,,3315,percent of total billed charges,Implant Devices,3315,34,,3315,percent of total billed charges,Implant Devices,3412.5,35,,3412.5,percent of total billed charges,Implant Devices,3412.5,35,,3412.5,percent of total billed charges,Implant Devices,3412.5,35,,3412.5,percent of total billed charges,Implant Devices,3412.5,35,,3412.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3315,34,"If Charge > 2,000, then 34 percent",3315,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3900,
STRYKER DCELL202 SOFT TISSUE 4X16CM,C1789,HCPCS,,79010694,CDM,278,RC,,,both,,,7799,3078.02,39.4668,,3078.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2651.66,34,,2651.66,percent of total billed charges,Implant Device,2651.66,34,,2651.66,percent of total billed charges,Implant Device,2651.66,34,,2651.66,percent of total billed charges,Implant Device,2651.66,34,,2651.66,percent of total billed charges,Implant Device,2651.66,34,,2651.66,percent of total billed charges,Implant Device,2651.66,34,,2651.66,percent of total billed charges,Implant Device,2729.65,35,,2729.65,percent of total billed charges,Implant Device,2651.66,34,"Charges > $500, x 34%",2651.66,percent of total billed charges,Implant Device,2729.65,35,,2729.65,percent of total billed charges,Implant Devices,2729.65,35,,2729.65,percent of total billed charges,Implant Devices,2729.65,35,,,percent of total billed charges,Implant Devices,2729.65,35,,2729.65,percent of total billed charges,Implant Devices,2729.65,35,,2729.65,percent of total billed charges,Implant Devices,3119.6,40,,3119.6,percent of total billed charges,Implant Devices,2729.65,70,,2729.65,percent of total billed charges,Implant Devices,2651.66,34,,2651.66,percent of total billed charges,Implant Devices,2651.66,34,,2651.66,percent of total billed charges,Implant Devices,2729.65,35,,2729.65,percent of total billed charges,Implant Devices,2729.65,35,,2729.65,percent of total billed charges,Implant Devices,2729.65,35,,2729.65,percent of total billed charges,Implant Devices,2729.65,35,,2729.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2651.66,34,"If Charge > 2,000, then 34 percent",2651.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3119.6,
ALLERGAN SCLP-440 GEL BREAST IMPLANT 440,C1789,HCPCS,,79010719,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-490 GEL BREAST IMPLANT 490,C1789,HCPCS,,79010720,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-540 GEL BREAST IMPLANT,C1789,HCPCS,,79010721,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCL-350 GEL BREAST IMPLANT,C1789,HCPCS,,79010722,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCL-380 BREAST IMPLANT 380CC,C1789,HCPCS,,79010723,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCL-410 BREAST IMPLANT 410CC,C1789,HCPCS,,79010724,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCL-460 BREAST IMPLANT 460CC,C1789,HCPCS,,79010725,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCL-290 BREAST IMPLANT 290CC,C1789,HCPCS,,79010790,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN 133S-MV-12-T TISSUE EXPANDER,C1789,HCPCS,,79010800,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
ALLERGAN 133S-MV-13-T TISSUE EXPANDER,C1789,HCPCS,,79010801,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
ALLERGAN 68HP-320 SALINE IMPLANT 320CC,C1789,HCPCS,,79010865,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 68HP-350 SALINE IMPLANT 350CC,C1789,HCPCS,,79010866,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 68HP-400 SALINE IMPLANT 400CC,C1789,HCPCS,,79010867,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 68HP-425 SALINE IMPLANT 425CC,C1789,HCPCS,,79010868,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 68HP-465 SALINE IMPLANT 465CC,C1789,HCPCS,,79010869,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 68-270 SALINE IMPLANT 270CC,C1789,HCPCS,,79010870,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 68-300 SALINE IMPLANT 300CC,C1789,HCPCS,,79010871,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 68-330 SALINE IMPLANT 330CC,C1789,HCPCS,,79010872,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 133S-MX12T TISSUE EXPANDER,C1789,HCPCS,,79010881,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
ALLERGAN 133X-MX13T TISSUE EXPANDER,C1789,HCPCS,,79010882,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
ALLERGAN 133S-SV-11-T TISSUE EXPANDER,C1789,HCPCS,,79010883,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
ALLERGAN 133S-SV-T TISSUE EXPANDER,C1789,HCPCS,,79010884,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
ALLERGAN 68LP-175 SALINE IMPLANT 175CC,C1789,HCPCS,,79010885,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 68LP-200 SALINE IMPLANT 200CC,C1789,HCPCS,,79010886,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 68LP-225 SALINE IMPLANT 225CC,C1789,HCPCS,,79010887,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN 68LP-250 SALINE IMPLANT 250CC,C1789,HCPCS,,79010888,CDM,278,RC,,,both,,,1776,700.93,39.4668,,700.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,603.84,34,,603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Device,603.84,34,"Charges > $500, x 34%",603.84,percent of total billed charges,Implant Device,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,710.4,40,,710.4,percent of total billed charges,Implant Devices,621.6,70,,621.6,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,603.84,34,,603.84,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,621.6,35,,621.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,710.4,
ALLERGAN SCM-520 BREAST IMPLANT 520CC,C1789,HCPCS,,79011169,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCM-560 BREAST IMPLANT 560CC,C1789,HCPCS,,79011170,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCM-600 BREAST IMPLANT 600CC,C1789,HCPCS,,79011171,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCM-640 BREAST IMPLANT 640CC,C1789,HCPCS,,79011172,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN 133S-FV-14-T EXPANDER 600CC,C1789,HCPCS,,79011174,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
ALLERGAN 133S-FV-15-T EXPANDER 750CC,C1789,HCPCS,,79011175,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
ALLERGAN 133S-FV-16-T EXPANDER 850CC,C1789,HCPCS,,79011176,CDM,278,RC,,,both,,,4785,1888.49,39.4668,,1888.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1626.9,34,,1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Device,1626.9,34,"Charges > $500, x 34%",1626.9,percent of total billed charges,Implant Device,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1914,40,,1914,percent of total billed charges,Implant Devices,1674.75,70,,1674.75,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1626.9,34,,1626.9,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,1674.75,35,,1674.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1626.9,34,"If Charge > 2,000, then 34 percent",1626.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1914,
ALLERGAN SCM-685 BREAST IMPLANT 685CC,C1789,HCPCS,,79011177,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCM-755 BREAST IMPLANT 755CC,C1789,HCPCS,,79011178,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-590 BREAST IMPLANT 5900CC,C1789,HCPCS,,79011179,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCLP-640 BREAST IMPLANT 640CC,C1789,HCPCS,,79011180,CDM,278,RC,,,both,,,4005,1580.65,39.4668,,1580.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1361.7,34,,1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Device,1361.7,34,"Charges > $500, x 34%",1361.7,percent of total billed charges,Implant Device,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1602,40,,1602,percent of total billed charges,Implant Devices,1401.75,70,,1401.75,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1361.7,34,,1361.7,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,1401.75,35,,1401.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1361.7,34,"If Charge > 2,000, then 34 percent",1361.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1602,
ALLERGAN SCL-320 BREAST IMPLANT 320CC,C1789,HCPCS,,79011786,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
ALLERGAN 133S-MX-13-T TISSUE EXPANDER,C1789,HCPCS,,79012345,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN 133S-MX-14-T TISSUE EXPANDER,C1789,HCPCS,,79012346,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN 133S-MX-15-T TISSUE EXPANDER,C1789,HCPCS,,79012347,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN 133S-MX-12-T TISSUE EXPANDER,C1789,HCPCS,,79012364,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN SCF-325 BREAST IMPLANT 325CC,C1789,HCPCS,,79013065,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
ALLERGAN SCF-335 BREAST IMPLANT 335CC,C1789,HCPCS,,79013066,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
ALLERGAN SCF-345 BREAST IMPLANT 345CC,C1789,HCPCS,,79013067,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
ALLERGAN SCM-295 BREAST IMPLANT 295CC,C1789,HCPCS,,79013071,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
ALLERGAN SCM-310 BREAST IMPLANT 310CC,C1789,HCPCS,,79013072,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
MENTOR 350-5480BC BREAST IMPLANT 480CC,C1789,HCPCS,,79013990,CDM,278,RC,,,both,,,3225,1272.8,39.4668,,1272.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Device,1096.5,34,"Charges > $500, x 34%",1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1290,40,,1290,percent of total billed charges,Implant Devices,1128.75,70,,1128.75,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1096.5,34,"If Charge > 2,000, then 34 percent",1096.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1290,
MENTOR 350-3460BC BREAST IMPLANT 460CC,C1789,HCPCS,,79013991,CDM,278,RC,,,both,,,3225,1272.8,39.4668,,1272.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Device,1096.5,34,"Charges > $500, x 34%",1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1290,40,,1290,percent of total billed charges,Implant Devices,1128.75,70,,1128.75,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1096.5,34,"If Charge > 2,000, then 34 percent",1096.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1290,
MENTOR 350-3460 BREAST IMPLANT 460CC,C1789,HCPCS,,79013993,CDM,278,RC,,,both,,,1545,609.76,39.4668,,609.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,525.3,34,,525.3,percent of total billed charges,Implant Device,540.75,35,,540.75,percent of total billed charges,Implant Device,525.3,34,"Charges > $500, x 34%",525.3,percent of total billed charges,Implant Device,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,618,40,,618,percent of total billed charges,Implant Devices,540.75,70,,540.75,percent of total billed charges,Implant Devices,525.3,34,,525.3,percent of total billed charges,Implant Devices,525.3,34,,525.3,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,540.75,35,,540.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,618,
BOST SCI 72401850 AMS 700 PENILE PROSTH,C1813,HCPCS,,79009441,CDM,278,RC,,,both,,,2910,1148.48,39.4668,,1148.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,989.4,34,,989.4,percent of total billed charges,Implant Device,989.4,34,,989.4,percent of total billed charges,Implant Device,989.4,34,,989.4,percent of total billed charges,Implant Device,989.4,34,,989.4,percent of total billed charges,Implant Device,989.4,34,,989.4,percent of total billed charges,Implant Device,989.4,34,,989.4,percent of total billed charges,Implant Device,1018.5,35,,1018.5,percent of total billed charges,Implant Device,989.4,34,"Charges > $500, x 34%",989.4,percent of total billed charges,Implant Device,1018.5,35,,1018.5,percent of total billed charges,Implant Devices,1018.5,35,,1018.5,percent of total billed charges,Implant Devices,1018.5,35,,,percent of total billed charges,Implant Devices,1018.5,35,,1018.5,percent of total billed charges,Implant Devices,1018.5,35,,1018.5,percent of total billed charges,Implant Devices,1164,40,,1164,percent of total billed charges,Implant Devices,1018.5,70,,1018.5,percent of total billed charges,Implant Devices,989.4,34,,989.4,percent of total billed charges,Implant Devices,989.4,34,,989.4,percent of total billed charges,Implant Devices,1018.5,35,,1018.5,percent of total billed charges,Implant Devices,1018.5,35,,1018.5,percent of total billed charges,Implant Devices,1018.5,35,,1018.5,percent of total billed charges,Implant Devices,1018.5,35,,1018.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,989.4,34,"If Charge > 2,000, then 34 percent",989.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1164,
BOST SCI 720185-01 AMS CONCEAL RESERVOIR,C1813,HCPCS,,79011810,CDM,278,RC,,,both,,,8895,3510.57,39.4668,,3510.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3024.3,34,,3024.3,percent of total billed charges,Implant Device,3113.25,35,,3113.25,percent of total billed charges,Implant Device,3024.3,34,"Charges > $500, x 34%",3024.3,percent of total billed charges,Implant Device,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3558,40,,3558,percent of total billed charges,Implant Devices,3113.25,70,,3113.25,percent of total billed charges,Implant Devices,3024.3,34,,3024.3,percent of total billed charges,Implant Devices,3024.3,34,,3024.3,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,3113.25,35,,3113.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3024.3,34,"If Charge > 2,000, then 34 percent",3024.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3558,
BOST SCI 72404237 AMS 700 CX MS PUMP,C1813,HCPCS,,79011811,CDM,278,RC,,,both,,,33765,13325.97,39.4668,,13325.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11480.1,34,,11480.1,percent of total billed charges,Implant Device,11480.1,34,,11480.1,percent of total billed charges,Implant Device,11480.1,34,,11480.1,percent of total billed charges,Implant Device,11480.1,34,,11480.1,percent of total billed charges,Implant Device,11480.1,34,,11480.1,percent of total billed charges,Implant Device,11480.1,34,,11480.1,percent of total billed charges,Implant Device,11817.75,35,,11817.75,percent of total billed charges,Implant Device,11480.1,34,"Charges > $500, x 34%",11480.1,percent of total billed charges,Implant Device,11817.75,35,,11817.75,percent of total billed charges,Implant Devices,11817.75,35,,11817.75,percent of total billed charges,Implant Devices,11817.75,35,,,percent of total billed charges,Implant Devices,11817.75,35,,11817.75,percent of total billed charges,Implant Devices,11817.75,35,,11817.75,percent of total billed charges,Implant Devices,13506,40,,13506,percent of total billed charges,Implant Devices,11817.75,70,,11817.75,percent of total billed charges,Implant Devices,11480.1,34,,11480.1,percent of total billed charges,Implant Devices,11480.1,34,,11480.1,percent of total billed charges,Implant Devices,11817.75,35,,11817.75,percent of total billed charges,Implant Devices,11817.75,35,,11817.75,percent of total billed charges,Implant Devices,11817.75,35,,11817.75,percent of total billed charges,Implant Devices,11817.75,35,,11817.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11480.1,34,"If Charge > 2,000, then 34 percent",11480.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13506,
BOST 72404239 AMS 700 CX MS PUMP 12X24CM,C1813,HCPCS,,79012689,CDM,278,RC,,,both,,,34785,13728.53,39.4668,,13728.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,11826.9,34,,11826.9,percent of total billed charges,Implant Device,11826.9,34,,11826.9,percent of total billed charges,Implant Device,11826.9,34,,11826.9,percent of total billed charges,Implant Device,11826.9,34,,11826.9,percent of total billed charges,Implant Device,11826.9,34,,11826.9,percent of total billed charges,Implant Device,11826.9,34,,11826.9,percent of total billed charges,Implant Device,12174.75,35,,12174.75,percent of total billed charges,Implant Device,11826.9,34,"Charges > $500, x 34%",11826.9,percent of total billed charges,Implant Device,12174.75,35,,12174.75,percent of total billed charges,Implant Devices,12174.75,35,,12174.75,percent of total billed charges,Implant Devices,12174.75,35,,,percent of total billed charges,Implant Devices,12174.75,35,,12174.75,percent of total billed charges,Implant Devices,12174.75,35,,12174.75,percent of total billed charges,Implant Devices,13914,40,,13914,percent of total billed charges,Implant Devices,12174.75,70,,12174.75,percent of total billed charges,Implant Devices,11826.9,34,,11826.9,percent of total billed charges,Implant Devices,11826.9,34,,11826.9,percent of total billed charges,Implant Devices,12174.75,35,,12174.75,percent of total billed charges,Implant Devices,12174.75,35,,12174.75,percent of total billed charges,Implant Devices,12174.75,35,,12174.75,percent of total billed charges,Implant Devices,12174.75,35,,12174.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,11826.9,34,"If Charge > 2,000, then 34 percent",11826.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13914,
BOST SCI 72404132 AMS 800 CUFF WITH IZ,C1815,HCPCS,,79012024,CDM,278,RC,,,both,,,19815,7820.35,39.4668,,7820.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6737.1,34,,6737.1,percent of total billed charges,Implant Device,6737.1,34,,6737.1,percent of total billed charges,Implant Device,6737.1,34,,6737.1,percent of total billed charges,Implant Device,6737.1,34,,6737.1,percent of total billed charges,Implant Device,6737.1,34,,6737.1,percent of total billed charges,Implant Device,6737.1,34,,6737.1,percent of total billed charges,Implant Device,6935.25,35,,6935.25,percent of total billed charges,Implant Device,6737.1,34,"Charges > $500, x 34%",6737.1,percent of total billed charges,Implant Device,6935.25,35,,6935.25,percent of total billed charges,Implant Devices,6935.25,35,,6935.25,percent of total billed charges,Implant Devices,6935.25,35,,,percent of total billed charges,Implant Devices,6935.25,35,,6935.25,percent of total billed charges,Implant Devices,6935.25,35,,6935.25,percent of total billed charges,Implant Devices,7926,40,,7926,percent of total billed charges,Implant Devices,6935.25,70,,6935.25,percent of total billed charges,Implant Devices,6737.1,34,,6737.1,percent of total billed charges,Implant Devices,6737.1,34,,6737.1,percent of total billed charges,Implant Devices,6935.25,35,,6935.25,percent of total billed charges,Implant Devices,6935.25,35,,6935.25,percent of total billed charges,Implant Devices,6935.25,35,,6935.25,percent of total billed charges,Implant Devices,6935.25,35,,6935.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6737.1,34,"If Charge > 2,000, then 34 percent",6737.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7926,
BOST 72400024 AMS 800 PRESS REG BALLOON,C1815,HCPCS,,79012025,CDM,278,RC,,,both,,,9540,3765.13,39.4668,,3765.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3243.6,34,,3243.6,percent of total billed charges,Implant Device,3243.6,34,,3243.6,percent of total billed charges,Implant Device,3243.6,34,,3243.6,percent of total billed charges,Implant Device,3243.6,34,,3243.6,percent of total billed charges,Implant Device,3243.6,34,,3243.6,percent of total billed charges,Implant Device,3243.6,34,,3243.6,percent of total billed charges,Implant Device,3339,35,,3339,percent of total billed charges,Implant Device,3243.6,34,"Charges > $500, x 34%",3243.6,percent of total billed charges,Implant Device,3339,35,,3339,percent of total billed charges,Implant Devices,3339,35,,3339,percent of total billed charges,Implant Devices,3339,35,,,percent of total billed charges,Implant Devices,3339,35,,3339,percent of total billed charges,Implant Devices,3339,35,,3339,percent of total billed charges,Implant Devices,3816,40,,3816,percent of total billed charges,Implant Devices,3339,70,,3339,percent of total billed charges,Implant Devices,3243.6,34,,3243.6,percent of total billed charges,Implant Devices,3243.6,34,,3243.6,percent of total billed charges,Implant Devices,3339,35,,3339,percent of total billed charges,Implant Devices,3339,35,,3339,percent of total billed charges,Implant Devices,3339,35,,3339,percent of total billed charges,Implant Devices,3339,35,,3339,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3243.6,34,"If Charge > 2,000, then 34 percent",3243.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3816,
BOST SCI 72404127 AMS 800 PUMP WITH IZ,C1815,HCPCS,,79012026,CDM,278,RC,,,both,,,20085,7926.91,39.4668,,7926.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6828.9,34,,6828.9,percent of total billed charges,Implant Device,6828.9,34,,6828.9,percent of total billed charges,Implant Device,6828.9,34,,6828.9,percent of total billed charges,Implant Device,6828.9,34,,6828.9,percent of total billed charges,Implant Device,6828.9,34,,6828.9,percent of total billed charges,Implant Device,6828.9,34,,6828.9,percent of total billed charges,Implant Device,7029.75,35,,7029.75,percent of total billed charges,Implant Device,6828.9,34,"Charges > $500, x 34%",6828.9,percent of total billed charges,Implant Device,7029.75,35,,7029.75,percent of total billed charges,Implant Devices,7029.75,35,,7029.75,percent of total billed charges,Implant Devices,7029.75,35,,,percent of total billed charges,Implant Devices,7029.75,35,,7029.75,percent of total billed charges,Implant Devices,7029.75,35,,7029.75,percent of total billed charges,Implant Devices,8034,40,,8034,percent of total billed charges,Implant Devices,7029.75,70,,7029.75,percent of total billed charges,Implant Devices,6828.9,34,,6828.9,percent of total billed charges,Implant Devices,6828.9,34,,6828.9,percent of total billed charges,Implant Devices,7029.75,35,,7029.75,percent of total billed charges,Implant Devices,7029.75,35,,7029.75,percent of total billed charges,Implant Devices,7029.75,35,,7029.75,percent of total billed charges,Implant Devices,7029.75,35,,7029.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6828.9,34,"If Charge > 2,000, then 34 percent",6828.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8034,
BOST SCI 72404130 ART URINARY SPHINCTER,C1815,HCPCS,,79012029,CDM,278,RC,,,both,,,20850,8228.83,39.4668,,8228.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7089,34,,7089,percent of total billed charges,Implant Device,7089,34,,7089,percent of total billed charges,Implant Device,7089,34,,7089,percent of total billed charges,Implant Device,7089,34,,7089,percent of total billed charges,Implant Device,7089,34,,7089,percent of total billed charges,Implant Device,7089,34,,7089,percent of total billed charges,Implant Device,7297.5,35,,7297.5,percent of total billed charges,Implant Device,7089,34,"Charges > $500, x 34%",7089,percent of total billed charges,Implant Device,7297.5,35,,7297.5,percent of total billed charges,Implant Devices,7297.5,35,,7297.5,percent of total billed charges,Implant Devices,7297.5,35,,,percent of total billed charges,Implant Devices,7297.5,35,,7297.5,percent of total billed charges,Implant Devices,7297.5,35,,7297.5,percent of total billed charges,Implant Devices,8340,40,,8340,percent of total billed charges,Implant Devices,7297.5,70,,7297.5,percent of total billed charges,Implant Devices,7089,34,,7089,percent of total billed charges,Implant Devices,7089,34,,7089,percent of total billed charges,Implant Devices,7297.5,35,,7297.5,percent of total billed charges,Implant Devices,7297.5,35,,7297.5,percent of total billed charges,Implant Devices,7297.5,35,,7297.5,percent of total billed charges,Implant Devices,7297.5,35,,7297.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,7089,34,"If Charge > 2,000, then 34 percent",7089,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8340,
BOST SC-1216 WAVEWRITER GENERATOR KIT,C1820,HCPCS,,79012777,CDM,278,RC,,,both,,,49800,19654.47,39.4668,,19654.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,16932,34,,16932,percent of total billed charges,Implant Device,16932,34,,16932,percent of total billed charges,Implant Device,16932,34,,16932,percent of total billed charges,Implant Device,16932,34,,16932,percent of total billed charges,Implant Device,16932,34,,16932,percent of total billed charges,Implant Device,16932,34,,16932,percent of total billed charges,Implant Device,17430,35,,17430,percent of total billed charges,Implant Device,16932,34,"Charges > $500, x 34%",16932,percent of total billed charges,Implant Device,17430,35,,17430,percent of total billed charges,Implant Devices,17430,35,,17430,percent of total billed charges,Implant Devices,17430,35,,,percent of total billed charges,Implant Devices,17430,35,,17430,percent of total billed charges,Implant Devices,17430,35,,17430,percent of total billed charges,Implant Devices,19920,40,,19920,percent of total billed charges,Implant Devices,17430,70,,17430,percent of total billed charges,Implant Devices,16932,34,,16932,percent of total billed charges,Implant Devices,16932,34,,16932,percent of total billed charges,Implant Devices,17430,35,,17430,percent of total billed charges,Implant Devices,17430,35,,17430,percent of total billed charges,Implant Devices,17430,35,,17430,percent of total billed charges,Implant Devices,17430,35,,17430,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,16932,34,"If Charge > 2,000, then 34 percent",16932,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,19920,
FLUENCY STENT,C1874,HCPCS,,79000369,CDM,278,RC,,,both,,,6886,2717.68,39.4668,,2717.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2410.1,35,,2410.1,percent of total billed charges,Implant Device,2341.24,34,"Charges > $500, x 34%",2341.24,percent of total billed charges,Implant Device,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2754.4,40,,2754.4,percent of total billed charges,Implant Devices,2410.1,70,,2410.1,percent of total billed charges,Implant Devices,2341.24,34,,2341.24,percent of total billed charges,Implant Devices,2341.24,34,,2341.24,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2341.24,34,"If Charge > 2,000, then 34 percent",2341.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2754.4,
BARD FAS08050 STENTGRAFT FLAIR 8X50,C1874,HCPCS,,79000525,CDM,278,RC,,,both,,,7485,2954.09,39.4668,,2954.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2544.9,34,,2544.9,percent of total billed charges,Implant Device,2619.75,35,,2619.75,percent of total billed charges,Implant Device,2544.9,34,"Charges > $500, x 34%",2544.9,percent of total billed charges,Implant Device,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2994,40,,2994,percent of total billed charges,Implant Devices,2619.75,70,,2619.75,percent of total billed charges,Implant Devices,2544.9,34,,2544.9,percent of total billed charges,Implant Devices,2544.9,34,,2544.9,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,2619.75,35,,2619.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2544.9,34,"If Charge > 2,000, then 34 percent",2544.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2994,
BARD FTL06060 STENTGRAFT FLUENCY 6X60,C1874,HCPCS,,79000526,CDM,278,RC,,,both,,,6585,2598.89,39.4668,,2598.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2304.75,35,,2304.75,percent of total billed charges,Implant Device,2238.9,34,"Charges > $500, x 34%",2238.9,percent of total billed charges,Implant Device,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2634,40,,2634,percent of total billed charges,Implant Devices,2304.75,70,,2304.75,percent of total billed charges,Implant Devices,2238.9,34,,2238.9,percent of total billed charges,Implant Devices,2238.9,34,,2238.9,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2238.9,34,"If Charge > 2,000, then 34 percent",2238.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2634,
BARD FAS08040 STENTGRAFT FLUENCY 8X40,C1874,HCPCS,,79000527,CDM,278,RC,,,both,,,7186,2836.08,39.4668,,2836.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2443.24,34,,2443.24,percent of total billed charges,Implant Device,2443.24,34,,2443.24,percent of total billed charges,Implant Device,2443.24,34,,2443.24,percent of total billed charges,Implant Device,2443.24,34,,2443.24,percent of total billed charges,Implant Device,2443.24,34,,2443.24,percent of total billed charges,Implant Device,2443.24,34,,2443.24,percent of total billed charges,Implant Device,2515.1,35,,2515.1,percent of total billed charges,Implant Device,2443.24,34,"Charges > $500, x 34%",2443.24,percent of total billed charges,Implant Device,2515.1,35,,2515.1,percent of total billed charges,Implant Devices,2515.1,35,,2515.1,percent of total billed charges,Implant Devices,2515.1,35,,,percent of total billed charges,Implant Devices,2515.1,35,,2515.1,percent of total billed charges,Implant Devices,2515.1,35,,2515.1,percent of total billed charges,Implant Devices,2874.4,40,,2874.4,percent of total billed charges,Implant Devices,2515.1,70,,2515.1,percent of total billed charges,Implant Devices,2443.24,34,,2443.24,percent of total billed charges,Implant Devices,2443.24,34,,2443.24,percent of total billed charges,Implant Devices,2515.1,35,,2515.1,percent of total billed charges,Implant Devices,2515.1,35,,2515.1,percent of total billed charges,Implant Devices,2515.1,35,,2515.1,percent of total billed charges,Implant Devices,2515.1,35,,2515.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2443.24,34,"If Charge > 2,000, then 34 percent",2443.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2874.4,
BARD FTL08060 STENTGRAFT FLUENCY 8X60,C1874,HCPCS,,79000528,CDM,278,RC,,,both,,,6886,2717.68,39.4668,,2717.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2341.24,34,,2341.24,percent of total billed charges,Implant Device,2410.1,35,,2410.1,percent of total billed charges,Implant Device,2341.24,34,"Charges > $500, x 34%",2341.24,percent of total billed charges,Implant Device,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2754.4,40,,2754.4,percent of total billed charges,Implant Devices,2410.1,70,,2410.1,percent of total billed charges,Implant Devices,2341.24,34,,2341.24,percent of total billed charges,Implant Devices,2341.24,34,,2341.24,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,2410.1,35,,2410.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2341.24,34,"If Charge > 2,000, then 34 percent",2341.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2754.4,
GORE VBH050502 VIABHN STENTGRAFT 5X5X120,C1874,HCPCS,,79000554,CDM,278,RC,,,both,,,7140,2817.93,39.4668,,2817.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2427.6,34,,2427.6,percent of total billed charges,Implant Device,2499,35,,2499,percent of total billed charges,Implant Device,2427.6,34,"Charges > $500, x 34%",2427.6,percent of total billed charges,Implant Device,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2856,40,,2856,percent of total billed charges,Implant Devices,2499,70,,2499,percent of total billed charges,Implant Devices,2427.6,34,,2427.6,percent of total billed charges,Implant Devices,2427.6,34,,2427.6,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,2499,35,,2499,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2427.6,34,"If Charge > 2,000, then 34 percent",2427.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2856,
J&J FTL10060 STENT,C1874,HCPCS,,79002521,CDM,278,RC,,,both,,,8142,3213.39,39.4668,,3213.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2849.7,35,,2849.7,percent of total billed charges,Implant Device,2768.28,34,"Charges > $500, x 34%",2768.28,percent of total billed charges,Implant Device,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,3256.8,40,,3256.8,percent of total billed charges,Implant Devices,2849.7,70,,2849.7,percent of total billed charges,Implant Devices,2768.28,34,,2768.28,percent of total billed charges,Implant Devices,2768.28,34,,2768.28,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2768.28,34,"If Charge > 2,000, then 34 percent",2768.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3256.8,
COOK G53703 MEDICAL STENT,C1874,HCPCS,,79002522,CDM,278,RC,,,both,,,264,104.19,39.4668,,104.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,89.76,34,,89.76,percent of total billed charges,Implant Device,89.76,34,,89.76,percent of total billed charges,Implant Device,89.76,34,,89.76,percent of total billed charges,Implant Device,89.76,34,,89.76,percent of total billed charges,Implant Device,89.76,34,,89.76,percent of total billed charges,Implant Device,89.76,34,,89.76,percent of total billed charges,Implant Device,92.4,35,,92.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,105.6,40,,105.6,percent of total billed charges,Implant Devices,92.4,70,,92.4,percent of total billed charges,Implant Devices,89.76,34,,89.76,percent of total billed charges,Implant Devices,89.76,34,,89.76,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105.6,
GORE PXA280300 STENT,C1874,HCPCS,,79002580,CDM,278,RC,,,both,,,9300,3670.41,39.4668,,3670.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3162,34,,3162,percent of total billed charges,Implant Device,3162,34,,3162,percent of total billed charges,Implant Device,3162,34,,3162,percent of total billed charges,Implant Device,3162,34,,3162,percent of total billed charges,Implant Device,3162,34,,3162,percent of total billed charges,Implant Device,3162,34,,3162,percent of total billed charges,Implant Device,3255,35,,3255,percent of total billed charges,Implant Device,3162,34,"Charges > $500, x 34%",3162,percent of total billed charges,Implant Device,3255,35,,3255,percent of total billed charges,Implant Devices,3255,35,,3255,percent of total billed charges,Implant Devices,3255,35,,,percent of total billed charges,Implant Devices,3255,35,,3255,percent of total billed charges,Implant Devices,3255,35,,3255,percent of total billed charges,Implant Devices,3720,40,,3720,percent of total billed charges,Implant Devices,3255,70,,3255,percent of total billed charges,Implant Devices,3162,34,,3162,percent of total billed charges,Implant Devices,3162,34,,3162,percent of total billed charges,Implant Devices,3255,35,,3255,percent of total billed charges,Implant Devices,3255,35,,3255,percent of total billed charges,Implant Devices,3255,35,,3255,percent of total billed charges,Implant Devices,3255,35,,3255,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3162,34,"If Charge > 2,000, then 34 percent",3162,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3720,
GORE PXC121400 STENT,C1874,HCPCS,,79002581,CDM,278,RC,,,both,,,12300,4854.42,39.4668,,4854.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Device,4182,34,"Charges > $500, x 34%",4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4920,40,,4920,percent of total billed charges,Implant Devices,4305,70,,4305,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4182,34,"If Charge > 2,000, then 34 percent",4182,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4920,
GORE PXC141000 STENT,C1874,HCPCS,,79002582,CDM,278,RC,,,both,,,13530,5339.86,39.4668,,5339.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4735.5,35,,4735.5,percent of total billed charges,Implant Device,4600.2,34,"Charges > $500, x 34%",4600.2,percent of total billed charges,Implant Device,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,5412,40,,5412,percent of total billed charges,Implant Devices,4735.5,70,,4735.5,percent of total billed charges,Implant Devices,4600.2,34,,4600.2,percent of total billed charges,Implant Devices,4600.2,34,,4600.2,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4600.2,34,"If Charge > 2,000, then 34 percent",4600.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5412,
GORE PXC141200 STENT,C1874,HCPCS,,79002583,CDM,278,RC,,,both,,,13200,5209.62,39.4668,,5209.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Device,4488,34,"Charges > $500, x 34%",4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,5280,40,,5280,percent of total billed charges,Implant Devices,4620,70,,4620,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4488,34,"If Charge > 2,000, then 34 percent",4488,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5280,
GORE PXC161000 STENT,C1874,HCPCS,,79002584,CDM,278,RC,,,both,,,12300,4854.42,39.4668,,4854.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Device,4182,34,"Charges > $500, x 34%",4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4920,40,,4920,percent of total billed charges,Implant Devices,4305,70,,4305,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4182,34,"If Charge > 2,000, then 34 percent",4182,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4920,
GORE PXC181000 STENT,C1874,HCPCS,,79002585,CDM,278,RC,,,both,,,12300,4854.42,39.4668,,4854.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Device,4182,34,"Charges > $500, x 34%",4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4920,40,,4920,percent of total billed charges,Implant Devices,4305,70,,4305,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4182,34,"If Charge > 2,000, then 34 percent",4182,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4920,
GORE PXC201000 STENT,C1874,HCPCS,,79002586,CDM,278,RC,,,both,,,11940,4712.34,39.4668,,4712.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4179,35,,4179,percent of total billed charges,Implant Device,4059.6,34,"Charges > $500, x 34%",4059.6,percent of total billed charges,Implant Device,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4776,40,,4776,percent of total billed charges,Implant Devices,4179,70,,4179,percent of total billed charges,Implant Devices,4059.6,34,,4059.6,percent of total billed charges,Implant Devices,4059.6,34,,4059.6,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4059.6,34,"If Charge > 2,000, then 34 percent",4059.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4776,
GORE PXC201400 STENT,C1874,HCPCS,,79002587,CDM,278,RC,,,both,,,12300,4854.42,39.4668,,4854.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Device,4182,34,"Charges > $500, x 34%",4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4920,40,,4920,percent of total billed charges,Implant Devices,4305,70,,4305,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4182,34,"If Charge > 2,000, then 34 percent",4182,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4920,
GORE PXC231000 STENT,C1874,HCPCS,,79002588,CDM,278,RC,,,both,,,12300,4854.42,39.4668,,4854.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Device,4182,34,"Charges > $500, x 34%",4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4920,40,,4920,percent of total billed charges,Implant Devices,4305,70,,4305,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4182,34,"If Charge > 2,000, then 34 percent",4182,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4920,
GORE PXC231200 STENT,C1874,HCPCS,,79002589,CDM,278,RC,,,both,,,12300,4854.42,39.4668,,4854.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Device,4182,34,"Charges > $500, x 34%",4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4920,40,,4920,percent of total billed charges,Implant Devices,4305,70,,4305,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4182,34,"If Charge > 2,000, then 34 percent",4182,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4920,
GORE PXC271200 STENT,C1874,HCPCS,,79002590,CDM,278,RC,,,both,,,12300,4854.42,39.4668,,4854.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4182,34,,4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Device,4182,34,"Charges > $500, x 34%",4182,percent of total billed charges,Implant Device,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4920,40,,4920,percent of total billed charges,Implant Devices,4305,70,,4305,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4182,34,,4182,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,4305,35,,4305,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4182,34,"If Charge > 2,000, then 34 percent",4182,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4920,
GORE PXL161207 STENT,C1874,HCPCS,,79002591,CDM,278,RC,,,both,,,8626,3404.41,39.4668,,3404.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2932.84,34,,2932.84,percent of total billed charges,Implant Device,2932.84,34,,2932.84,percent of total billed charges,Implant Device,2932.84,34,,2932.84,percent of total billed charges,Implant Device,2932.84,34,,2932.84,percent of total billed charges,Implant Device,2932.84,34,,2932.84,percent of total billed charges,Implant Device,2932.84,34,,2932.84,percent of total billed charges,Implant Device,3019.1,35,,3019.1,percent of total billed charges,Implant Device,2932.84,34,"Charges > $500, x 34%",2932.84,percent of total billed charges,Implant Device,3019.1,35,,3019.1,percent of total billed charges,Implant Devices,3019.1,35,,3019.1,percent of total billed charges,Implant Devices,3019.1,35,,,percent of total billed charges,Implant Devices,3019.1,35,,3019.1,percent of total billed charges,Implant Devices,3019.1,35,,3019.1,percent of total billed charges,Implant Devices,3450.4,40,,3450.4,percent of total billed charges,Implant Devices,3019.1,70,,3019.1,percent of total billed charges,Implant Devices,2932.84,34,,2932.84,percent of total billed charges,Implant Devices,2932.84,34,,2932.84,percent of total billed charges,Implant Devices,3019.1,35,,3019.1,percent of total billed charges,Implant Devices,3019.1,35,,3019.1,percent of total billed charges,Implant Devices,3019.1,35,,3019.1,percent of total billed charges,Implant Devices,3019.1,35,,3019.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2932.84,34,"If Charge > 2,000, then 34 percent",2932.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3450.4,
GORE RMT231412 STENT,C1874,HCPCS,,79002595,CDM,278,RC,,,both,,,29986,11834.51,39.4668,,11834.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10495.1,35,,10495.1,percent of total billed charges,Implant Device,10195.24,34,"Charges > $500, x 34%",10195.24,percent of total billed charges,Implant Device,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,11994.4,40,,11994.4,percent of total billed charges,Implant Devices,10495.1,70,,10495.1,percent of total billed charges,Implant Devices,10195.24,34,,10195.24,percent of total billed charges,Implant Devices,10195.24,34,,10195.24,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10195.24,34,"If Charge > 2,000, then 34 percent",10195.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11994.4,
GORE RMT231416 STENT,C1874,HCPCS,,79002596,CDM,278,RC,,,both,,,31500,12432.04,39.4668,,12432.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Device,10710,34,"Charges > $500, x 34%",10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,12600,40,,12600,percent of total billed charges,Implant Devices,11025,70,,11025,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10710,34,"If Charge > 2,000, then 34 percent",10710,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12600,
GORE RMT261218 STENT,C1874,HCPCS,,79002597,CDM,278,RC,,,both,,,29986,11834.51,39.4668,,11834.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10495.1,35,,10495.1,percent of total billed charges,Implant Device,10195.24,34,"Charges > $500, x 34%",10195.24,percent of total billed charges,Implant Device,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,11994.4,40,,11994.4,percent of total billed charges,Implant Devices,10495.1,70,,10495.1,percent of total billed charges,Implant Devices,10195.24,34,,10195.24,percent of total billed charges,Implant Devices,10195.24,34,,10195.24,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10195.24,34,"If Charge > 2,000, then 34 percent",10195.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11994.4,
GORE RMT261412 STENT,C1874,HCPCS,,79002598,CDM,278,RC,,,both,,,30736,12130.52,39.4668,,12130.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10757.6,35,,10757.6,percent of total billed charges,Implant Device,10450.24,34,"Charges > $500, x 34%",10450.24,percent of total billed charges,Implant Device,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,12294.4,40,,12294.4,percent of total billed charges,Implant Devices,10757.6,70,,10757.6,percent of total billed charges,Implant Devices,10450.24,34,,10450.24,percent of total billed charges,Implant Devices,10450.24,34,,10450.24,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10450.24,34,"If Charge > 2,000, then 34 percent",10450.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12294.4,
GORE RMT261414 STENT,C1874,HCPCS,,79002599,CDM,278,RC,,,both,,,31500,12432.04,39.4668,,12432.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Device,10710,34,"Charges > $500, x 34%",10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,12600,40,,12600,percent of total billed charges,Implant Devices,11025,70,,11025,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10710,34,"If Charge > 2,000, then 34 percent",10710,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12600,
GORE RMT281412 STENT,C1874,HCPCS,,79002600,CDM,278,RC,,,both,,,31500,12432.04,39.4668,,12432.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Device,10710,34,"Charges > $500, x 34%",10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,12600,40,,12600,percent of total billed charges,Implant Devices,11025,70,,11025,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10710,34,"If Charge > 2,000, then 34 percent",10710,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12600,
GORE RMT281414 STENT,C1874,HCPCS,,79002601,CDM,278,RC,,,both,,,32250,12728.04,39.4668,,12728.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,11287.5,35,,11287.5,percent of total billed charges,Implant Device,10965,34,"Charges > $500, x 34%",10965,percent of total billed charges,Implant Device,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,12900,40,,12900,percent of total billed charges,Implant Devices,11287.5,70,,11287.5,percent of total billed charges,Implant Devices,10965,34,,10965,percent of total billed charges,Implant Devices,10965,34,,10965,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10965,34,"If Charge > 2,000, then 34 percent",10965,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12900,
GORE RMT311413 STENT,C1874,HCPCS,,79002602,CDM,278,RC,,,both,,,29986,11834.51,39.4668,,11834.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10495.1,35,,10495.1,percent of total billed charges,Implant Device,10195.24,34,"Charges > $500, x 34%",10195.24,percent of total billed charges,Implant Device,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,11994.4,40,,11994.4,percent of total billed charges,Implant Devices,10495.1,70,,10495.1,percent of total billed charges,Implant Devices,10195.24,34,,10195.24,percent of total billed charges,Implant Devices,10195.24,34,,10195.24,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10195.24,34,"If Charge > 2,000, then 34 percent",10195.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11994.4,
GORE RMT311417 STENT,C1874,HCPCS,,79002603,CDM,278,RC,,,both,,,29986,11834.51,39.4668,,11834.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10495.1,35,,10495.1,percent of total billed charges,Implant Device,10195.24,34,"Charges > $500, x 34%",10195.24,percent of total billed charges,Implant Device,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,11994.4,40,,11994.4,percent of total billed charges,Implant Devices,10495.1,70,,10495.1,percent of total billed charges,Implant Devices,10195.24,34,,10195.24,percent of total billed charges,Implant Devices,10195.24,34,,10195.24,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10195.24,34,"If Charge > 2,000, then 34 percent",10195.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11994.4,
BARD FAS07050 7X50 STRT FLAIR STENT GRAF,C1874,HCPCS,,79003156,CDM,278,RC,,,both,,,7936,3132.09,39.4668,,3132.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2698.24,34,,2698.24,percent of total billed charges,Implant Device,2698.24,34,,2698.24,percent of total billed charges,Implant Device,2698.24,34,,2698.24,percent of total billed charges,Implant Device,2698.24,34,,2698.24,percent of total billed charges,Implant Device,2698.24,34,,2698.24,percent of total billed charges,Implant Device,2698.24,34,,2698.24,percent of total billed charges,Implant Device,2777.6,35,,2777.6,percent of total billed charges,Implant Device,2698.24,34,"Charges > $500, x 34%",2698.24,percent of total billed charges,Implant Device,2777.6,35,,2777.6,percent of total billed charges,Implant Devices,2777.6,35,,2777.6,percent of total billed charges,Implant Devices,2777.6,35,,,percent of total billed charges,Implant Devices,2777.6,35,,2777.6,percent of total billed charges,Implant Devices,2777.6,35,,2777.6,percent of total billed charges,Implant Devices,3174.4,40,,3174.4,percent of total billed charges,Implant Devices,2777.6,70,,2777.6,percent of total billed charges,Implant Devices,2698.24,34,,2698.24,percent of total billed charges,Implant Devices,2698.24,34,,2698.24,percent of total billed charges,Implant Devices,2777.6,35,,2777.6,percent of total billed charges,Implant Devices,2777.6,35,,2777.6,percent of total billed charges,Implant Devices,2777.6,35,,2777.6,percent of total billed charges,Implant Devices,2777.6,35,,2777.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2698.24,34,"If Charge > 2,000, then 34 percent",2698.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3174.4,
ATRIUM 85453 COVERED STENT 6X22X120,C1874,HCPCS,,79003157,CDM,278,RC,,,both,,,7546,2978.16,39.4668,,2978.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2641.1,35,,2641.1,percent of total billed charges,Implant Device,2565.64,34,"Charges > $500, x 34%",2565.64,percent of total billed charges,Implant Device,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,3018.4,40,,3018.4,percent of total billed charges,Implant Devices,2641.1,70,,2641.1,percent of total billed charges,Implant Devices,2565.64,34,,2565.64,percent of total billed charges,Implant Devices,2565.64,34,,2565.64,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2565.64,34,"If Charge > 2,000, then 34 percent",2565.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3018.4,
ATRIUM 85413 COVERED STENT 6X59X120,C1874,HCPCS,,79003158,CDM,278,RC,,,both,,,8326,3286.01,39.4668,,3286.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2914.1,35,,2914.1,percent of total billed charges,Implant Device,2830.84,34,"Charges > $500, x 34%",2830.84,percent of total billed charges,Implant Device,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,3330.4,40,,3330.4,percent of total billed charges,Implant Devices,2914.1,70,,2914.1,percent of total billed charges,Implant Devices,2830.84,34,,2830.84,percent of total billed charges,Implant Devices,2830.84,34,,2830.84,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2830.84,34,"If Charge > 2,000, then 34 percent",2830.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3330.4,
GORE VBJ070502 VIABAHN STENT  7X5X120,C1874,HCPCS,,79003160,CDM,278,RC,,,both,,,9586,3783.29,39.4668,,3783.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3259.24,34,,3259.24,percent of total billed charges,Implant Device,3259.24,34,,3259.24,percent of total billed charges,Implant Device,3259.24,34,,3259.24,percent of total billed charges,Implant Device,3259.24,34,,3259.24,percent of total billed charges,Implant Device,3259.24,34,,3259.24,percent of total billed charges,Implant Device,3259.24,34,,3259.24,percent of total billed charges,Implant Device,3355.1,35,,3355.1,percent of total billed charges,Implant Device,3259.24,34,"Charges > $500, x 34%",3259.24,percent of total billed charges,Implant Device,3355.1,35,,3355.1,percent of total billed charges,Implant Devices,3355.1,35,,3355.1,percent of total billed charges,Implant Devices,3355.1,35,,,percent of total billed charges,Implant Devices,3355.1,35,,3355.1,percent of total billed charges,Implant Devices,3355.1,35,,3355.1,percent of total billed charges,Implant Devices,3834.4,40,,3834.4,percent of total billed charges,Implant Devices,3355.1,70,,3355.1,percent of total billed charges,Implant Devices,3259.24,34,,3259.24,percent of total billed charges,Implant Devices,3259.24,34,,3259.24,percent of total billed charges,Implant Devices,3355.1,35,,3355.1,percent of total billed charges,Implant Devices,3355.1,35,,3355.1,percent of total billed charges,Implant Devices,3355.1,35,,3355.1,percent of total billed charges,Implant Devices,3355.1,35,,3355.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3259.24,34,"If Charge > 2,000, then 34 percent",3259.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3834.4,
GORE PLA360400 EXCLUDER ENDOPROSTHETIC,C1874,HCPCS,,79003642,CDM,278,RC,,,both,,,8850,3492.81,39.4668,,3492.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3097.5,35,,3097.5,percent of total billed charges,Implant Device,3009,34,"Charges > $500, x 34%",3009,percent of total billed charges,Implant Device,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3540,40,,3540,percent of total billed charges,Implant Devices,3097.5,70,,3097.5,percent of total billed charges,Implant Devices,3009,34,,3009,percent of total billed charges,Implant Devices,3009,34,,3009,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3009,34,"If Charge > 2,000, then 34 percent",3009,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3540,
BARD FTL10060 FLUENCY STENT GRAFT 10X60,C1874,HCPCS,,79003716,CDM,278,RC,,,both,,,10917,4308.59,39.4668,,4308.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3820.95,35,,3820.95,percent of total billed charges,Implant Device,3711.78,34,"Charges > $500, x 34%",3711.78,percent of total billed charges,Implant Device,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,4366.8,40,,4366.8,percent of total billed charges,Implant Devices,3820.95,70,,3820.95,percent of total billed charges,Implant Devices,3711.78,34,,3711.78,percent of total billed charges,Implant Devices,3711.78,34,,3711.78,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3711.78,34,"If Charge > 2,000, then 34 percent",3711.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4366.8,
MEDTRONIC 1LXCH161685 VASC STENT GRAFT,C1874,HCPCS,,79004013,CDM,278,RC,,,both,,,9450,3729.61,39.4668,,3729.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3213,34,,3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Device,3213,34,"Charges > $500, x 34%",3213,percent of total billed charges,Implant Device,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3780,40,,3780,percent of total billed charges,Implant Devices,3307.5,70,,3307.5,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3213,34,,3213,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,3307.5,35,,3307.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3213,34,"If Charge > 2,000, then 34 percent",3213,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3780,
GORE PXC181400 LEG ENDOPROS 18X13.5MM,C1874,HCPCS,,79004209,CDM,278,RC,,,both,,,11940,4712.34,39.4668,,4712.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4179,35,,4179,percent of total billed charges,Implant Device,4059.6,34,"Charges > $500, x 34%",4059.6,percent of total billed charges,Implant Device,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4776,40,,4776,percent of total billed charges,Implant Devices,4179,70,,4179,percent of total billed charges,Implant Devices,4059.6,34,,4059.6,percent of total billed charges,Implant Devices,4059.6,34,,4059.6,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4059.6,34,"If Charge > 2,000, then 34 percent",4059.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4776,
GORE PXA260300 AORTIC EXT ENDOPRS 26X30,C1874,HCPCS,,79004210,CDM,278,RC,,,both,,,8850,3492.81,39.4668,,3492.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3009,34,,3009,percent of total billed charges,Implant Device,3097.5,35,,3097.5,percent of total billed charges,Implant Device,3009,34,"Charges > $500, x 34%",3009,percent of total billed charges,Implant Device,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3540,40,,3540,percent of total billed charges,Implant Devices,3097.5,70,,3097.5,percent of total billed charges,Implant Devices,3009,34,,3009,percent of total billed charges,Implant Devices,3009,34,,3009,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,3097.5,35,,3097.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3009,34,"If Charge > 2,000, then 34 percent",3009,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3540,
GORE PXC201200 LEG ENDOPROS 20X11.5,C1874,HCPCS,,79004212,CDM,278,RC,,,both,,,11940,4712.34,39.4668,,4712.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4179,35,,4179,percent of total billed charges,Implant Device,4059.6,34,"Charges > $500, x 34%",4059.6,percent of total billed charges,Implant Device,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4776,40,,4776,percent of total billed charges,Implant Devices,4179,70,,4179,percent of total billed charges,Implant Devices,4059.6,34,,4059.6,percent of total billed charges,Implant Devices,4059.6,34,,4059.6,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4059.6,34,"If Charge > 2,000, then 34 percent",4059.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4776,
GORE PXC181200 LEG ENDOPROS 18X11.5MM,C1874,HCPCS,,79004213,CDM,278,RC,,,both,,,11940,4712.34,39.4668,,4712.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4059.6,34,,4059.6,percent of total billed charges,Implant Device,4179,35,,4179,percent of total billed charges,Implant Device,4059.6,34,"Charges > $500, x 34%",4059.6,percent of total billed charges,Implant Device,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4776,40,,4776,percent of total billed charges,Implant Devices,4179,70,,4179,percent of total billed charges,Implant Devices,4059.6,34,,4059.6,percent of total billed charges,Implant Devices,4059.6,34,,4059.6,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,4179,35,,4179,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4059.6,34,"If Charge > 2,000, then 34 percent",4059.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4776,
GORE RMT311415 LEG ENDOPROS 31X14.5X15CM,C1874,HCPCS,,79004214,CDM,278,RC,,,both,,,29986,11834.51,39.4668,,11834.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10195.24,34,,10195.24,percent of total billed charges,Implant Device,10495.1,35,,10495.1,percent of total billed charges,Implant Device,10195.24,34,"Charges > $500, x 34%",10195.24,percent of total billed charges,Implant Device,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,11994.4,40,,11994.4,percent of total billed charges,Implant Devices,10495.1,70,,10495.1,percent of total billed charges,Implant Devices,10195.24,34,,10195.24,percent of total billed charges,Implant Devices,10195.24,34,,10195.24,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,10495.1,35,,10495.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10195.24,34,"If Charge > 2,000, then 34 percent",10195.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11994.4,
GORE PXA230300 AORTIC EXT ENDOPROS 23X33,C1874,HCPCS,,79004215,CDM,278,RC,,,both,,,8370,3303.37,39.4668,,3303.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2845.8,34,,2845.8,percent of total billed charges,Implant Device,2929.5,35,,2929.5,percent of total billed charges,Implant Device,2845.8,34,"Charges > $500, x 34%",2845.8,percent of total billed charges,Implant Device,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,3348,40,,3348,percent of total billed charges,Implant Devices,2929.5,70,,2929.5,percent of total billed charges,Implant Devices,2845.8,34,,2845.8,percent of total billed charges,Implant Devices,2845.8,34,,2845.8,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,2929.5,35,,2929.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2845.8,34,"If Charge > 2,000, then 34 percent",2845.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3348,
GORE RMT261416 EXCLUDER AAA ENDOPROS,C1874,HCPCS,,79004962,CDM,278,RC,,,both,,,30736,12130.52,39.4668,,12130.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10757.6,35,,10757.6,percent of total billed charges,Implant Device,10450.24,34,"Charges > $500, x 34%",10450.24,percent of total billed charges,Implant Device,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,12294.4,40,,12294.4,percent of total billed charges,Implant Devices,10757.6,70,,10757.6,percent of total billed charges,Implant Devices,10450.24,34,,10450.24,percent of total billed charges,Implant Devices,10450.24,34,,10450.24,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10450.24,34,"If Charge > 2,000, then 34 percent",10450.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12294.4,
GORE PXL161007 EXCLUDER AAA ENDOPROS,C1874,HCPCS,,79004964,CDM,278,RC,,,both,,,9076,3582.01,39.4668,,3582.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3085.84,34,,3085.84,percent of total billed charges,Implant Device,3085.84,34,,3085.84,percent of total billed charges,Implant Device,3085.84,34,,3085.84,percent of total billed charges,Implant Device,3085.84,34,,3085.84,percent of total billed charges,Implant Device,3085.84,34,,3085.84,percent of total billed charges,Implant Device,3085.84,34,,3085.84,percent of total billed charges,Implant Device,3176.6,35,,3176.6,percent of total billed charges,Implant Device,3085.84,34,"Charges > $500, x 34%",3085.84,percent of total billed charges,Implant Device,3176.6,35,,3176.6,percent of total billed charges,Implant Devices,3176.6,35,,3176.6,percent of total billed charges,Implant Devices,3176.6,35,,,percent of total billed charges,Implant Devices,3176.6,35,,3176.6,percent of total billed charges,Implant Devices,3176.6,35,,3176.6,percent of total billed charges,Implant Devices,3630.4,40,,3630.4,percent of total billed charges,Implant Devices,3176.6,70,,3176.6,percent of total billed charges,Implant Devices,3085.84,34,,3085.84,percent of total billed charges,Implant Devices,3085.84,34,,3085.84,percent of total billed charges,Implant Devices,3176.6,35,,3176.6,percent of total billed charges,Implant Devices,3176.6,35,,3176.6,percent of total billed charges,Implant Devices,3176.6,35,,3176.6,percent of total billed charges,Implant Devices,3176.6,35,,3176.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3085.84,34,"If Charge > 2,000, then 34 percent",3085.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3630.4,
GORE VBJ081502 8X15X120 VIABAHN ENDOPROS,C1874,HCPCS,,79004977,CDM,278,RC,,,both,,,11686,4612.09,39.4668,,4612.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,4090.1,35,,4090.1,percent of total billed charges,Implant Device,3973.24,34,"Charges > $500, x 34%",3973.24,percent of total billed charges,Implant Device,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4674.4,40,,4674.4,percent of total billed charges,Implant Devices,4090.1,70,,4090.1,percent of total billed charges,Implant Devices,3973.24,34,,3973.24,percent of total billed charges,Implant Devices,3973.24,34,,3973.24,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3973.24,34,"If Charge > 2,000, then 34 percent",3973.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4674.4,
GORE RMT231212 EXCLUDER AAA ENDO GRAFT,C1874,HCPCS,,79005216,CDM,278,RC,,,both,,,30736,12130.52,39.4668,,12130.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10450.24,34,,10450.24,percent of total billed charges,Implant Device,10757.6,35,,10757.6,percent of total billed charges,Implant Device,10450.24,34,"Charges > $500, x 34%",10450.24,percent of total billed charges,Implant Device,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,12294.4,40,,12294.4,percent of total billed charges,Implant Devices,10757.6,70,,10757.6,percent of total billed charges,Implant Devices,10450.24,34,,10450.24,percent of total billed charges,Implant Devices,10450.24,34,,10450.24,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,10757.6,35,,10757.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10450.24,34,"If Charge > 2,000, then 34 percent",10450.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12294.4,
GORE PXC121200 EXCLUDER AAA ENDO GRAFT,C1874,HCPCS,,79005217,CDM,278,RC,,,both,,,13200,5209.62,39.4668,,5209.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Device,4488,34,"Charges > $500, x 34%",4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,5280,40,,5280,percent of total billed charges,Implant Devices,4620,70,,4620,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4488,34,"If Charge > 2,000, then 34 percent",4488,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5280,
GORE PLC161000 ENDOPROSTHESIS GRAFT,C1874,HCPCS,,79005252,CDM,278,RC,,,both,,,14217,5610.99,39.4668,,5610.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4975.95,35,,4975.95,percent of total billed charges,Implant Device,4833.78,34,"Charges > $500, x 34%",4833.78,percent of total billed charges,Implant Device,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,5686.8,40,,5686.8,percent of total billed charges,Implant Devices,4975.95,70,,4975.95,percent of total billed charges,Implant Devices,4833.78,34,,4833.78,percent of total billed charges,Implant Devices,4833.78,34,,4833.78,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4833.78,34,"If Charge > 2,000, then 34 percent",4833.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5686.8,
GORE PLC161200 ENDOPROSTHESIS GRAFT,C1874,HCPCS,,79005253,CDM,278,RC,,,both,,,13869,5473.65,39.4668,,5473.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4854.15,35,,4854.15,percent of total billed charges,Implant Device,4715.46,34,"Charges > $500, x 34%",4715.46,percent of total billed charges,Implant Device,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,5547.6,40,,5547.6,percent of total billed charges,Implant Devices,4854.15,70,,4854.15,percent of total billed charges,Implant Devices,4715.46,34,,4715.46,percent of total billed charges,Implant Devices,4715.46,34,,4715.46,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4715.46,34,"If Charge > 2,000, then 34 percent",4715.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5547.6,
GORE RMT281416 EXCLUDER ENDOPROS GRAFT,C1874,HCPCS,,79005337,CDM,278,RC,,,both,,,31500,12432.04,39.4668,,12432.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Device,10710,34,"Charges > $500, x 34%",10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,12600,40,,12600,percent of total billed charges,Implant Devices,11025,70,,11025,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10710,34,"If Charge > 2,000, then 34 percent",10710,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12600,
ATRIUM 85455 ICAST STENT GRAFT 7X22X120,C1874,HCPCS,,79005471,CDM,278,RC,,,both,,,7546,2978.16,39.4668,,2978.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2641.1,35,,2641.1,percent of total billed charges,Implant Device,2565.64,34,"Charges > $500, x 34%",2565.64,percent of total billed charges,Implant Device,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,3018.4,40,,3018.4,percent of total billed charges,Implant Devices,2641.1,70,,2641.1,percent of total billed charges,Implant Devices,2565.64,34,,2565.64,percent of total billed charges,Implant Devices,2565.64,34,,2565.64,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2565.64,34,"If Charge > 2,000, then 34 percent",2565.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3018.4,
GORE PLC181400 EXCLUDER ENDOPROSTHETIC,C1874,HCPCS,,79005491,CDM,278,RC,,,both,,,12900,5091.22,39.4668,,5091.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4515,35,,4515,percent of total billed charges,Implant Device,4386,34,"Charges > $500, x 34%",4386,percent of total billed charges,Implant Device,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,5160,40,,5160,percent of total billed charges,Implant Devices,4515,70,,4515,percent of total billed charges,Implant Devices,4386,34,,4386,percent of total billed charges,Implant Devices,4386,34,,4386,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4386,34,"If Charge > 2,000, then 34 percent",4386,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5160,
BOST SCI 7054 WALL STENT BILIARY 10X80,C1874,HCPCS,,79005531,CDM,278,RC,,,both,,,8550,3374.41,39.4668,,3374.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2907,34,,2907,percent of total billed charges,Implant Device,2992.5,35,,2992.5,percent of total billed charges,Implant Device,2907,34,"Charges > $500, x 34%",2907,percent of total billed charges,Implant Device,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,3420,40,,3420,percent of total billed charges,Implant Devices,2992.5,70,,2992.5,percent of total billed charges,Implant Devices,2907,34,,2907,percent of total billed charges,Implant Devices,2907,34,,2907,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,2992.5,35,,2992.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2907,34,"If Charge > 2,000, then 34 percent",2907,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3420,
BOST SCI 1415 ULTRAFLEX ESOPH METL STENT,C1874,HCPCS,,79005541,CDM,278,RC,,,both,,,4756,1877.04,39.4668,,1877.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1617.04,34,,1617.04,percent of total billed charges,Implant Device,1664.6,35,,1664.6,percent of total billed charges,Implant Device,1617.04,34,"Charges > $500, x 34%",1617.04,percent of total billed charges,Implant Device,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1902.4,40,,1902.4,percent of total billed charges,Implant Devices,1664.6,70,,1664.6,percent of total billed charges,Implant Devices,1617.04,34,,1617.04,percent of total billed charges,Implant Devices,1617.04,34,,1617.04,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,1664.6,35,,1664.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1617.04,34,"If Charge > 2,000, then 34 percent",1617.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1902.4,
GORE PLC231000 EXCLUDER ENDOPROS 23X10CM,C1874,HCPCS,,79006117,CDM,278,RC,,,both,,,12900,5091.22,39.4668,,5091.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4515,35,,4515,percent of total billed charges,Implant Device,4386,34,"Charges > $500, x 34%",4386,percent of total billed charges,Implant Device,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,5160,40,,5160,percent of total billed charges,Implant Devices,4515,70,,4515,percent of total billed charges,Implant Devices,4386,34,,4386,percent of total billed charges,Implant Devices,4386,34,,4386,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4386,34,"If Charge > 2,000, then 34 percent",4386,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5160,
GORE PLC181000 EXCLUDER ENDOPROS 18X3.5,C1874,HCPCS,,79006141,CDM,278,RC,,,both,,,12900,5091.22,39.4668,,5091.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4386,34,,4386,percent of total billed charges,Implant Device,4515,35,,4515,percent of total billed charges,Implant Device,4386,34,"Charges > $500, x 34%",4386,percent of total billed charges,Implant Device,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,5160,40,,5160,percent of total billed charges,Implant Devices,4515,70,,4515,percent of total billed charges,Implant Devices,4386,34,,4386,percent of total billed charges,Implant Devices,4386,34,,4386,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,4515,35,,4515,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4386,34,"If Charge > 2,000, then 34 percent",4386,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5160,
GORE PLC271400 EXCLUDER ENDOPROS 27X14,C1874,HCPCS,,79006142,CDM,278,RC,,,both,,,13869,5473.65,39.4668,,5473.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4715.46,34,,4715.46,percent of total billed charges,Implant Device,4854.15,35,,4854.15,percent of total billed charges,Implant Device,4715.46,34,"Charges > $500, x 34%",4715.46,percent of total billed charges,Implant Device,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,5547.6,40,,5547.6,percent of total billed charges,Implant Devices,4854.15,70,,4854.15,percent of total billed charges,Implant Devices,4715.46,34,,4715.46,percent of total billed charges,Implant Devices,4715.46,34,,4715.46,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,4854.15,35,,4854.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4715.46,34,"If Charge > 2,000, then 34 percent",4715.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5547.6,
GORE RMT281212 EXCLUDER GRAFT 28.5X12X18,C1874,HCPCS,,79006393,CDM,278,RC,,,both,,,31500,12432.04,39.4668,,12432.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Device,10710,34,"Charges > $500, x 34%",10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,12600,40,,12600,percent of total billed charges,Implant Devices,11025,70,,11025,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10710,34,"If Charge > 2,000, then 34 percent",10710,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12600,
GORE RMT281418 EXCLUDER AAA ENDO GRAFT,C1874,HCPCS,,79006479,CDM,278,RC,,,both,,,31500,12432.04,39.4668,,12432.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Device,10710,34,"Charges > $500, x 34%",10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,12600,40,,12600,percent of total billed charges,Implant Devices,11025,70,,11025,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10710,34,"If Charge > 2,000, then 34 percent",10710,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12600,
GORE PXL161407 EXCLUDER AAA ENDO GRAFT,C1874,HCPCS,,79006480,CDM,278,RC,,,both,,,9525,3759.21,39.4668,,3759.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3238.5,34,,3238.5,percent of total billed charges,Implant Device,3238.5,34,,3238.5,percent of total billed charges,Implant Device,3238.5,34,,3238.5,percent of total billed charges,Implant Device,3238.5,34,,3238.5,percent of total billed charges,Implant Device,3238.5,34,,3238.5,percent of total billed charges,Implant Device,3238.5,34,,3238.5,percent of total billed charges,Implant Device,3333.75,35,,3333.75,percent of total billed charges,Implant Device,3238.5,34,"Charges > $500, x 34%",3238.5,percent of total billed charges,Implant Device,3333.75,35,,3333.75,percent of total billed charges,Implant Devices,3333.75,35,,3333.75,percent of total billed charges,Implant Devices,3333.75,35,,,percent of total billed charges,Implant Devices,3333.75,35,,3333.75,percent of total billed charges,Implant Devices,3333.75,35,,3333.75,percent of total billed charges,Implant Devices,3810,40,,3810,percent of total billed charges,Implant Devices,3333.75,70,,3333.75,percent of total billed charges,Implant Devices,3238.5,34,,3238.5,percent of total billed charges,Implant Devices,3238.5,34,,3238.5,percent of total billed charges,Implant Devices,3333.75,35,,3333.75,percent of total billed charges,Implant Devices,3333.75,35,,3333.75,percent of total billed charges,Implant Devices,3333.75,35,,3333.75,percent of total billed charges,Implant Devices,3333.75,35,,3333.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3238.5,34,"If Charge > 2,000, then 34 percent",3238.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3810,
GORE PXC141400 EXCLUDER AAA ENDO GRAFT,C1874,HCPCS,,79006481,CDM,278,RC,,,both,,,13530,5339.86,39.4668,,5339.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4600.2,34,,4600.2,percent of total billed charges,Implant Device,4735.5,35,,4735.5,percent of total billed charges,Implant Device,4600.2,34,"Charges > $500, x 34%",4600.2,percent of total billed charges,Implant Device,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,5412,40,,5412,percent of total billed charges,Implant Devices,4735.5,70,,4735.5,percent of total billed charges,Implant Devices,4600.2,34,,4600.2,percent of total billed charges,Implant Devices,4600.2,34,,4600.2,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,4735.5,35,,4735.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4600.2,34,"If Charge > 2,000, then 34 percent",4600.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5412,
GORE RLT351418 EXCLUDER ENDOPROS GRAFT,C1874,HCPCS,,79006547,CDM,278,RC,,,both,,,31500,12432.04,39.4668,,12432.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Device,10710,34,"Charges > $500, x 34%",10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,12600,40,,12600,percent of total billed charges,Implant Devices,11025,70,,11025,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10710,34,"If Charge > 2,000, then 34 percent",10710,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12600,
GORE PLC231200 EXCLUDER ENDOPROS GRAFT,C1874,HCPCS,,79006548,CDM,278,RC,,,both,,,14571,5750.71,39.4668,,5750.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,5099.85,35,,5099.85,percent of total billed charges,Implant Device,4954.14,34,"Charges > $500, x 34%",4954.14,percent of total billed charges,Implant Device,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5828.4,40,,5828.4,percent of total billed charges,Implant Devices,5099.85,70,,5099.85,percent of total billed charges,Implant Devices,4954.14,34,,4954.14,percent of total billed charges,Implant Devices,4954.14,34,,4954.14,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4954.14,34,"If Charge > 2,000, then 34 percent",4954.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5828.4,
MAQUET 85407 8X59X80 ATRIUM COVER STENT,C1874,HCPCS,,79006661,CDM,278,RC,,,both,,,8325,3285.61,39.4668,,3285.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2830.5,34,,2830.5,percent of total billed charges,Implant Device,2830.5,34,,2830.5,percent of total billed charges,Implant Device,2830.5,34,,2830.5,percent of total billed charges,Implant Device,2830.5,34,,2830.5,percent of total billed charges,Implant Device,2830.5,34,,2830.5,percent of total billed charges,Implant Device,2830.5,34,,2830.5,percent of total billed charges,Implant Device,2913.75,35,,2913.75,percent of total billed charges,Implant Device,2830.5,34,"Charges > $500, x 34%",2830.5,percent of total billed charges,Implant Device,2913.75,35,,2913.75,percent of total billed charges,Implant Devices,2913.75,35,,2913.75,percent of total billed charges,Implant Devices,2913.75,35,,,percent of total billed charges,Implant Devices,2913.75,35,,2913.75,percent of total billed charges,Implant Devices,2913.75,35,,2913.75,percent of total billed charges,Implant Devices,3330,40,,3330,percent of total billed charges,Implant Devices,2913.75,70,,2913.75,percent of total billed charges,Implant Devices,2830.5,34,,2830.5,percent of total billed charges,Implant Devices,2830.5,34,,2830.5,percent of total billed charges,Implant Devices,2913.75,35,,2913.75,percent of total billed charges,Implant Devices,2913.75,35,,2913.75,percent of total billed charges,Implant Devices,2913.75,35,,2913.75,percent of total billed charges,Implant Devices,2913.75,35,,2913.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2830.5,34,"If Charge > 2,000, then 34 percent",2830.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3330,
BOST SCI M00616720 18X153 ESOPH STENT,C1874,HCPCS,,79006844,CDM,278,RC,,,both,,,7726,3049.2,39.4668,,3049.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2704.1,35,,2704.1,percent of total billed charges,Implant Device,2626.84,34,"Charges > $500, x 34%",2626.84,percent of total billed charges,Implant Device,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,3090.4,40,,3090.4,percent of total billed charges,Implant Devices,2704.1,70,,2704.1,percent of total billed charges,Implant Devices,2626.84,34,,2626.84,percent of total billed charges,Implant Devices,2626.84,34,,2626.84,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2626.84,34,"If Charge > 2,000, then 34 percent",2626.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3090.4,
GORE RLT261218 EXCLUDER ENDOPROS GRAFT,C1874,HCPCS,,79006961,CDM,278,RC,,,both,,,31500,12432.04,39.4668,,12432.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,10710,34,,10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Device,10710,34,"Charges > $500, x 34%",10710,percent of total billed charges,Implant Device,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,12600,40,,12600,percent of total billed charges,Implant Devices,11025,70,,11025,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,10710,34,,10710,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,11025,35,,11025,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10710,34,"If Charge > 2,000, then 34 percent",10710,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12600,
GORE PLC231400 EXCLUDER ENDOPROS GRAFT,C1874,HCPCS,,79006962,CDM,278,RC,,,both,,,13200,5209.62,39.4668,,5209.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Device,4488,34,"Charges > $500, x 34%",4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,5280,40,,5280,percent of total billed charges,Implant Devices,4620,70,,4620,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4488,34,"If Charge > 2,000, then 34 percent",4488,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5280,
GORE PXC121000 EXCLUDER ENDOPROS GRAFT,C1874,HCPCS,,79006963,CDM,278,RC,,,both,,,13200,5209.62,39.4668,,5209.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Device,4488,34,"Charges > $500, x 34%",4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,5280,40,,5280,percent of total billed charges,Implant Devices,4620,70,,4620,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4488,34,"If Charge > 2,000, then 34 percent",4488,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5280,
GORE VBJ071502 VIABAHN 7MMX15CM STENT,C1874,HCPCS,,79007035,CDM,278,RC,,,both,,,11686,4612.09,39.4668,,4612.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,3973.24,34,,3973.24,percent of total billed charges,Implant Device,4090.1,35,,4090.1,percent of total billed charges,Implant Device,3973.24,34,"Charges > $500, x 34%",3973.24,percent of total billed charges,Implant Device,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4674.4,40,,4674.4,percent of total billed charges,Implant Devices,4090.1,70,,4090.1,percent of total billed charges,Implant Devices,3973.24,34,,3973.24,percent of total billed charges,Implant Devices,3973.24,34,,3973.24,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,4090.1,35,,4090.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3973.24,34,"If Charge > 2,000, then 34 percent",3973.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4674.4,
GORE VBH091502 VIABAHN 9MMX15CM STENT,C1874,HCPCS,,79007036,CDM,278,RC,,,both,,,11386,4493.69,39.4668,,4493.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3871.24,34,,3871.24,percent of total billed charges,Implant Device,3871.24,34,,3871.24,percent of total billed charges,Implant Device,3871.24,34,,3871.24,percent of total billed charges,Implant Device,3871.24,34,,3871.24,percent of total billed charges,Implant Device,3871.24,34,,3871.24,percent of total billed charges,Implant Device,3871.24,34,,3871.24,percent of total billed charges,Implant Device,3985.1,35,,3985.1,percent of total billed charges,Implant Device,3871.24,34,"Charges > $500, x 34%",3871.24,percent of total billed charges,Implant Device,3985.1,35,,3985.1,percent of total billed charges,Implant Devices,3985.1,35,,3985.1,percent of total billed charges,Implant Devices,3985.1,35,,,percent of total billed charges,Implant Devices,3985.1,35,,3985.1,percent of total billed charges,Implant Devices,3985.1,35,,3985.1,percent of total billed charges,Implant Devices,4554.4,40,,4554.4,percent of total billed charges,Implant Devices,3985.1,70,,3985.1,percent of total billed charges,Implant Devices,3871.24,34,,3871.24,percent of total billed charges,Implant Devices,3871.24,34,,3871.24,percent of total billed charges,Implant Devices,3985.1,35,,3985.1,percent of total billed charges,Implant Devices,3985.1,35,,3985.1,percent of total billed charges,Implant Devices,3985.1,35,,3985.1,percent of total billed charges,Implant Devices,3985.1,35,,3985.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3871.24,34,"If Charge > 2,000, then 34 percent",3871.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4554.4,
GORE PLC271000 EXCLUDER ENDOPROS GRAFT,C1874,HCPCS,,79007311,CDM,278,RC,,,both,,,14571,5750.71,39.4668,,5750.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,5099.85,35,,5099.85,percent of total billed charges,Implant Device,4954.14,34,"Charges > $500, x 34%",4954.14,percent of total billed charges,Implant Device,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5828.4,40,,5828.4,percent of total billed charges,Implant Devices,5099.85,70,,5099.85,percent of total billed charges,Implant Devices,4954.14,34,,4954.14,percent of total billed charges,Implant Devices,4954.14,34,,4954.14,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4954.14,34,"If Charge > 2,000, then 34 percent",4954.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5828.4,
GORE VBJ081002 VIABAHN 8X10 COVERD STENT,C1874,HCPCS,,79007435,CDM,278,RC,,,both,,,10485,4138.09,39.4668,,4138.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3564.9,34,,3564.9,percent of total billed charges,Implant Device,3669.75,35,,3669.75,percent of total billed charges,Implant Device,3564.9,34,"Charges > $500, x 34%",3564.9,percent of total billed charges,Implant Device,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,4194,40,,4194,percent of total billed charges,Implant Devices,3669.75,70,,3669.75,percent of total billed charges,Implant Devices,3564.9,34,,3564.9,percent of total billed charges,Implant Devices,3564.9,34,,3564.9,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,3669.75,35,,3669.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3564.9,34,"If Charge > 2,000, then 34 percent",3564.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4194,
GORE VBJR081502A VIABAHN 8X15 STENT,C1874,HCPCS,,79007436,CDM,278,RC,,,both,,,11685,4611.7,39.4668,,4611.7,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3972.9,34,,3972.9,percent of total billed charges,Implant Device,3972.9,34,,3972.9,percent of total billed charges,Implant Device,3972.9,34,,3972.9,percent of total billed charges,Implant Device,3972.9,34,,3972.9,percent of total billed charges,Implant Device,3972.9,34,,3972.9,percent of total billed charges,Implant Device,3972.9,34,,3972.9,percent of total billed charges,Implant Device,4089.75,35,,4089.75,percent of total billed charges,Implant Device,3972.9,34,"Charges > $500, x 34%",3972.9,percent of total billed charges,Implant Device,4089.75,35,,4089.75,percent of total billed charges,Implant Devices,4089.75,35,,4089.75,percent of total billed charges,Implant Devices,4089.75,35,,,percent of total billed charges,Implant Devices,4089.75,35,,4089.75,percent of total billed charges,Implant Devices,4089.75,35,,4089.75,percent of total billed charges,Implant Devices,4674,40,,4674,percent of total billed charges,Implant Devices,4089.75,70,,4089.75,percent of total billed charges,Implant Devices,3972.9,34,,3972.9,percent of total billed charges,Implant Devices,3972.9,34,,3972.9,percent of total billed charges,Implant Devices,4089.75,35,,4089.75,percent of total billed charges,Implant Devices,4089.75,35,,4089.75,percent of total billed charges,Implant Devices,4089.75,35,,4089.75,percent of total billed charges,Implant Devices,4089.75,35,,4089.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3972.9,34,"If Charge > 2,000, then 34 percent",3972.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4674,
GORE VBJR082502A VIABAHN 8X25 STENT,C1874,HCPCS,,79007437,CDM,278,RC,,,both,,,19186,7572.1,39.4668,,7572.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6523.24,34,,6523.24,percent of total billed charges,Implant Device,6523.24,34,,6523.24,percent of total billed charges,Implant Device,6523.24,34,,6523.24,percent of total billed charges,Implant Device,6523.24,34,,6523.24,percent of total billed charges,Implant Device,6523.24,34,,6523.24,percent of total billed charges,Implant Device,6523.24,34,,6523.24,percent of total billed charges,Implant Device,6715.1,35,,6715.1,percent of total billed charges,Implant Device,6523.24,34,"Charges > $500, x 34%",6523.24,percent of total billed charges,Implant Device,6715.1,35,,6715.1,percent of total billed charges,Implant Devices,6715.1,35,,6715.1,percent of total billed charges,Implant Devices,6715.1,35,,,percent of total billed charges,Implant Devices,6715.1,35,,6715.1,percent of total billed charges,Implant Devices,6715.1,35,,6715.1,percent of total billed charges,Implant Devices,7674.4,40,,7674.4,percent of total billed charges,Implant Devices,6715.1,70,,6715.1,percent of total billed charges,Implant Devices,6523.24,34,,6523.24,percent of total billed charges,Implant Devices,6523.24,34,,6523.24,percent of total billed charges,Implant Devices,6715.1,35,,6715.1,percent of total billed charges,Implant Devices,6715.1,35,,6715.1,percent of total billed charges,Implant Devices,6715.1,35,,6715.1,percent of total billed charges,Implant Devices,6715.1,35,,6715.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,6523.24,34,"If Charge > 2,000, then 34 percent",6523.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7674.4,
GORE VBJR080502A VIABAHN 8X5 STENT,C1874,HCPCS,,79007438,CDM,278,RC,,,both,,,10311,4069.42,39.4668,,4069.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3505.74,34,,3505.74,percent of total billed charges,Implant Device,3505.74,34,,3505.74,percent of total billed charges,Implant Device,3505.74,34,,3505.74,percent of total billed charges,Implant Device,3505.74,34,,3505.74,percent of total billed charges,Implant Device,3505.74,34,,3505.74,percent of total billed charges,Implant Device,3505.74,34,,3505.74,percent of total billed charges,Implant Device,3608.85,35,,3608.85,percent of total billed charges,Implant Device,3505.74,34,"Charges > $500, x 34%",3505.74,percent of total billed charges,Implant Device,3608.85,35,,3608.85,percent of total billed charges,Implant Devices,3608.85,35,,3608.85,percent of total billed charges,Implant Devices,3608.85,35,,,percent of total billed charges,Implant Devices,3608.85,35,,3608.85,percent of total billed charges,Implant Devices,3608.85,35,,3608.85,percent of total billed charges,Implant Devices,4124.4,40,,4124.4,percent of total billed charges,Implant Devices,3608.85,70,,3608.85,percent of total billed charges,Implant Devices,3505.74,34,,3505.74,percent of total billed charges,Implant Devices,3505.74,34,,3505.74,percent of total billed charges,Implant Devices,3608.85,35,,3608.85,percent of total billed charges,Implant Devices,3608.85,35,,3608.85,percent of total billed charges,Implant Devices,3608.85,35,,3608.85,percent of total billed charges,Implant Devices,3608.85,35,,3608.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3505.74,34,"If Charge > 2,000, then 34 percent",3505.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4124.4,
BARD FEM07060 FLUENCY 7X60X80 COVD STENT,C1874,HCPCS,,79007596,CDM,278,RC,,,both,,,10917,4308.59,39.4668,,4308.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3711.78,34,,3711.78,percent of total billed charges,Implant Device,3820.95,35,,3820.95,percent of total billed charges,Implant Device,3711.78,34,"Charges > $500, x 34%",3711.78,percent of total billed charges,Implant Device,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,4366.8,40,,4366.8,percent of total billed charges,Implant Devices,3820.95,70,,3820.95,percent of total billed charges,Implant Devices,3711.78,34,,3711.78,percent of total billed charges,Implant Devices,3711.78,34,,3711.78,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,3820.95,35,,3820.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3711.78,34,"If Charge > 2,000, then 34 percent",3711.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4366.8,
BARD FEM06060 FLUENCY 6X60X80 COVD STENT,C1874,HCPCS,,79007597,CDM,278,RC,,,both,,,10398,4103.76,39.4668,,4103.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3535.32,34,,3535.32,percent of total billed charges,Implant Device,3535.32,34,,3535.32,percent of total billed charges,Implant Device,3535.32,34,,3535.32,percent of total billed charges,Implant Device,3535.32,34,,3535.32,percent of total billed charges,Implant Device,3535.32,34,,3535.32,percent of total billed charges,Implant Device,3535.32,34,,3535.32,percent of total billed charges,Implant Device,3639.3,35,,3639.3,percent of total billed charges,Implant Device,3535.32,34,"Charges > $500, x 34%",3535.32,percent of total billed charges,Implant Device,3639.3,35,,3639.3,percent of total billed charges,Implant Devices,3639.3,35,,3639.3,percent of total billed charges,Implant Devices,3639.3,35,,,percent of total billed charges,Implant Devices,3639.3,35,,3639.3,percent of total billed charges,Implant Devices,3639.3,35,,3639.3,percent of total billed charges,Implant Devices,4159.2,40,,4159.2,percent of total billed charges,Implant Devices,3639.3,70,,3639.3,percent of total billed charges,Implant Devices,3535.32,34,,3535.32,percent of total billed charges,Implant Devices,3535.32,34,,3535.32,percent of total billed charges,Implant Devices,3639.3,35,,3639.3,percent of total billed charges,Implant Devices,3639.3,35,,3639.3,percent of total billed charges,Implant Devices,3639.3,35,,3639.3,percent of total billed charges,Implant Devices,3639.3,35,,3639.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3535.32,34,"If Charge > 2,000, then 34 percent",3535.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4159.2,
BOST SCI M00516700  8X103 ESOPH STENT,C1874,HCPCS,,79007601,CDM,278,RC,,,both,,,7409,2924.1,39.4668,,2924.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2593.15,35,,2593.15,percent of total billed charges,Implant Device,2519.06,34,"Charges > $500, x 34%",2519.06,percent of total billed charges,Implant Device,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2963.6,40,,2963.6,percent of total billed charges,Implant Devices,2593.15,70,,2593.15,percent of total billed charges,Implant Devices,2519.06,34,,2519.06,percent of total billed charges,Implant Devices,2519.06,34,,2519.06,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.06,34,"If Charge > 2,000, then 34 percent",2519.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2963.6,
GORE RLT261416 EXCLUDER ENDOPROSTHESIS,C1874,HCPCS,,79007622,CDM,278,RC,,,both,,,32250,12728.04,39.4668,,12728.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,10965,34,,10965,percent of total billed charges,Implant Device,11287.5,35,,11287.5,percent of total billed charges,Implant Device,10965,34,"Charges > $500, x 34%",10965,percent of total billed charges,Implant Device,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,12900,40,,12900,percent of total billed charges,Implant Devices,11287.5,70,,11287.5,percent of total billed charges,Implant Devices,10965,34,,10965,percent of total billed charges,Implant Devices,10965,34,,10965,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,11287.5,35,,11287.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10965,34,"If Charge > 2,000, then 34 percent",10965,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12900,
BOST SCI M00570630 BILARY STENT 8X100MM,C1874,HCPCS,,79007774,CDM,278,RC,,,both,,,5550,2190.41,39.4668,,2190.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Device,1887,34,"Charges > $500, x 34%",1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,2220,40,,2220,percent of total billed charges,Implant Devices,1942.5,70,,1942.5,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1887,34,"If Charge > 2,000, then 34 percent",1887,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2220,
GORE PLC201000 EXCLUDER ENDOPROS 20X9.5,C1874,HCPCS,,79007782,CDM,278,RC,,,both,,,13200,5209.62,39.4668,,5209.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4488,34,,4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Device,4488,34,"Charges > $500, x 34%",4488,percent of total billed charges,Implant Device,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,5280,40,,5280,percent of total billed charges,Implant Devices,4620,70,,4620,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4488,34,,4488,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,4620,35,,4620,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4488,34,"If Charge > 2,000, then 34 percent",4488,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5280,
GORE VBJR060502A VIABAHN 6MMX5CM STENT,C1874,HCPCS,,79008018,CDM,278,RC,,,both,,,10065,3972.33,39.4668,,3972.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3522.75,35,,3522.75,percent of total billed charges,Implant Device,3422.1,34,"Charges > $500, x 34%",3422.1,percent of total billed charges,Implant Device,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,4026,40,,4026,percent of total billed charges,Implant Devices,3522.75,70,,3522.75,percent of total billed charges,Implant Devices,3422.1,34,,3422.1,percent of total billed charges,Implant Devices,3422.1,34,,3422.1,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3422.1,34,"If Charge > 2,000, then 34 percent",3422.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4026,
GORE PLC161400 EXCL ENDOPROSTHESIS GRAFT,C1874,HCPCS,,79008074,CDM,278,RC,,,both,,,14571,5750.71,39.4668,,5750.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,5099.85,35,,5099.85,percent of total billed charges,Implant Device,4954.14,34,"Charges > $500, x 34%",4954.14,percent of total billed charges,Implant Device,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5828.4,40,,5828.4,percent of total billed charges,Implant Devices,5099.85,70,,5099.85,percent of total billed charges,Implant Devices,4954.14,34,,4954.14,percent of total billed charges,Implant Devices,4954.14,34,,4954.14,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4954.14,34,"If Charge > 2,000, then 34 percent",4954.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5828.4,
GORE VBJR070502A 7MMX5CM COVERED STENT,C1874,HCPCS,,79008567,CDM,278,RC,,,both,,,10065,3972.33,39.4668,,3972.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3422.1,34,,3422.1,percent of total billed charges,Implant Device,3522.75,35,,3522.75,percent of total billed charges,Implant Device,3422.1,34,"Charges > $500, x 34%",3422.1,percent of total billed charges,Implant Device,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,4026,40,,4026,percent of total billed charges,Implant Devices,3522.75,70,,3522.75,percent of total billed charges,Implant Devices,3422.1,34,,3422.1,percent of total billed charges,Implant Devices,3422.1,34,,3422.1,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,3522.75,35,,3522.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3422.1,34,"If Charge > 2,000, then 34 percent",3422.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4026,
BOSTON M00516900 ESOPHAGEAL STENT 18X103,C1874,HCPCS,,79008670,CDM,278,RC,,,both,,,7222,2850.29,39.4668,,2850.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2455.48,34,,2455.48,percent of total billed charges,Implant Device,2455.48,34,,2455.48,percent of total billed charges,Implant Device,2455.48,34,,2455.48,percent of total billed charges,Implant Device,2455.48,34,,2455.48,percent of total billed charges,Implant Device,2455.48,34,,2455.48,percent of total billed charges,Implant Device,2455.48,34,,2455.48,percent of total billed charges,Implant Device,2527.7,35,,2527.7,percent of total billed charges,Implant Device,2455.48,34,"Charges > $500, x 34%",2455.48,percent of total billed charges,Implant Device,2527.7,35,,2527.7,percent of total billed charges,Implant Devices,2527.7,35,,2527.7,percent of total billed charges,Implant Devices,2527.7,35,,,percent of total billed charges,Implant Devices,2527.7,35,,2527.7,percent of total billed charges,Implant Devices,2527.7,35,,2527.7,percent of total billed charges,Implant Devices,2888.8,40,,2888.8,percent of total billed charges,Implant Devices,2527.7,70,,2527.7,percent of total billed charges,Implant Devices,2455.48,34,,2455.48,percent of total billed charges,Implant Devices,2455.48,34,,2455.48,percent of total billed charges,Implant Devices,2527.7,35,,2527.7,percent of total billed charges,Implant Devices,2527.7,35,,2527.7,percent of total billed charges,Implant Devices,2527.7,35,,2527.7,percent of total billed charges,Implant Devices,2527.7,35,,2527.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2455.48,34,"If Charge > 2,000, then 34 percent",2455.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2888.8,
GORE BXA095902A VBX VIABAHN 9X59MM STENT,C1874,HCPCS,,79008770,CDM,278,RC,,,both,,,9765,3853.93,39.4668,,3853.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Device,3320.1,34,"Charges > $500, x 34%",3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3906,40,,3906,percent of total billed charges,Implant Devices,3417.75,70,,3417.75,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3320.1,34,"If Charge > 2,000, then 34 percent",3320.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3906,
GORE BXA085902A VBX VIABAHN 8X59MM STENT,C1874,HCPCS,,79008792,CDM,278,RC,,,both,,,9765,3853.93,39.4668,,3853.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Device,3320.1,34,"Charges > $500, x 34%",3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3906,40,,3906,percent of total billed charges,Implant Devices,3417.75,70,,3417.75,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3320.1,34,"If Charge > 2,000, then 34 percent",3320.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3906,
GORE VBJR061002A VIABAHN 6MMX10CM STENT,C1874,HCPCS,,79008793,CDM,278,RC,,,both,,,11010,4345.29,39.4668,,4345.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3853.5,35,,3853.5,percent of total billed charges,Implant Device,3743.4,34,"Charges > $500, x 34%",3743.4,percent of total billed charges,Implant Device,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,4404,40,,4404,percent of total billed charges,Implant Devices,3853.5,70,,3853.5,percent of total billed charges,Implant Devices,3743.4,34,,3743.4,percent of total billed charges,Implant Devices,3743.4,34,,3743.4,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3743.4,34,"If Charge > 2,000, then 34 percent",3743.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4404,
GORE VBJR071002A VIABAHN ENDOPROSTHESIS,C1874,HCPCS,,79008805,CDM,278,RC,,,both,,,11010,4345.29,39.4668,,4345.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3853.5,35,,3853.5,percent of total billed charges,Implant Device,3743.4,34,"Charges > $500, x 34%",3743.4,percent of total billed charges,Implant Device,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,4404,40,,4404,percent of total billed charges,Implant Devices,3853.5,70,,3853.5,percent of total billed charges,Implant Devices,3743.4,34,,3743.4,percent of total billed charges,Implant Devices,3743.4,34,,3743.4,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3743.4,34,"If Charge > 2,000, then 34 percent",3743.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4404,
BARD FEM08080 FLUENCY 8X80X80 COVD STENT,C1874,HCPCS,,79009094,CDM,278,RC,,,both,,,11844,4674.45,39.4668,,4674.45,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4026.96,34,,4026.96,percent of total billed charges,Implant Device,4026.96,34,,4026.96,percent of total billed charges,Implant Device,4026.96,34,,4026.96,percent of total billed charges,Implant Device,4026.96,34,,4026.96,percent of total billed charges,Implant Device,4026.96,34,,4026.96,percent of total billed charges,Implant Device,4026.96,34,,4026.96,percent of total billed charges,Implant Device,4145.4,35,,4145.4,percent of total billed charges,Implant Device,4026.96,34,"Charges > $500, x 34%",4026.96,percent of total billed charges,Implant Device,4145.4,35,,4145.4,percent of total billed charges,Implant Devices,4145.4,35,,4145.4,percent of total billed charges,Implant Devices,4145.4,35,,,percent of total billed charges,Implant Devices,4145.4,35,,4145.4,percent of total billed charges,Implant Devices,4145.4,35,,4145.4,percent of total billed charges,Implant Devices,4737.6,40,,4737.6,percent of total billed charges,Implant Devices,4145.4,70,,4145.4,percent of total billed charges,Implant Devices,4026.96,34,,4026.96,percent of total billed charges,Implant Devices,4026.96,34,,4026.96,percent of total billed charges,Implant Devices,4145.4,35,,4145.4,percent of total billed charges,Implant Devices,4145.4,35,,4145.4,percent of total billed charges,Implant Devices,4145.4,35,,4145.4,percent of total billed charges,Implant Devices,4145.4,35,,4145.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4026.96,34,"If Charge > 2,000, then 34 percent",4026.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4737.6,
GORE BXA105902A VBX VIABAHN 10X59 STENT,C1874,HCPCS,,79009129,CDM,278,RC,,,both,,,9765,3853.93,39.4668,,3853.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Device,3320.1,34,"Charges > $500, x 34%",3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3906,40,,3906,percent of total billed charges,Implant Devices,3417.75,70,,3417.75,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3320.1,34,"If Charge > 2,000, then 34 percent",3320.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3906,
GORE BXA075902A VBX VIABAHN 7X59 STENT,C1874,HCPCS,,79009130,CDM,278,RC,,,both,,,9765,3853.93,39.4668,,3853.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Device,3320.1,34,"Charges > $500, x 34%",3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3906,40,,3906,percent of total billed charges,Implant Devices,3417.75,70,,3417.75,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3320.1,34,"If Charge > 2,000, then 34 percent",3320.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3906,
GORE VBJR070702A VIABAHN ENDOPROSTHESIS,C1874,HCPCS,,79009170,CDM,278,RC,,,both,,,11010,4345.29,39.4668,,4345.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3743.4,34,,3743.4,percent of total billed charges,Implant Device,3853.5,35,,3853.5,percent of total billed charges,Implant Device,3743.4,34,"Charges > $500, x 34%",3743.4,percent of total billed charges,Implant Device,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,4404,40,,4404,percent of total billed charges,Implant Devices,3853.5,70,,3853.5,percent of total billed charges,Implant Devices,3743.4,34,,3743.4,percent of total billed charges,Implant Devices,3743.4,34,,3743.4,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,3853.5,35,,3853.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3743.4,34,"If Charge > 2,000, then 34 percent",3743.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4404,
BOST SCI M00516720 ESOPH STENT 18X123MM,C1874,HCPCS,,79009193,CDM,278,RC,,,both,,,7409,2924.1,39.4668,,2924.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2519.06,34,,2519.06,percent of total billed charges,Implant Device,2593.15,35,,2593.15,percent of total billed charges,Implant Device,2519.06,34,"Charges > $500, x 34%",2519.06,percent of total billed charges,Implant Device,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2963.6,40,,2963.6,percent of total billed charges,Implant Devices,2593.15,70,,2593.15,percent of total billed charges,Implant Devices,2519.06,34,,2519.06,percent of total billed charges,Implant Devices,2519.06,34,,2519.06,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,2593.15,35,,2593.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2519.06,34,"If Charge > 2,000, then 34 percent",2519.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2963.6,
GORE PLC271200 EXCLUDER ENDOPROS 27X12CM,C1874,HCPCS,,79009214,CDM,278,RC,,,both,,,14217,5610.99,39.4668,,5610.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4975.95,35,,4975.95,percent of total billed charges,Implant Device,4833.78,34,"Charges > $500, x 34%",4833.78,percent of total billed charges,Implant Device,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,5686.8,40,,5686.8,percent of total billed charges,Implant Devices,4975.95,70,,4975.95,percent of total billed charges,Implant Devices,4833.78,34,,4833.78,percent of total billed charges,Implant Devices,4833.78,34,,4833.78,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4833.78,34,"If Charge > 2,000, then 34 percent",4833.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5686.8,
GORE PLC201400 EXCLUDER ENDOPROS 20X13.5,C1874,HCPCS,,79009215,CDM,278,RC,,,both,,,14217,5610.99,39.4668,,5610.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4975.95,35,,4975.95,percent of total billed charges,Implant Device,4833.78,34,"Charges > $500, x 34%",4833.78,percent of total billed charges,Implant Device,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,5686.8,40,,5686.8,percent of total billed charges,Implant Devices,4975.95,70,,4975.95,percent of total billed charges,Implant Devices,4833.78,34,,4833.78,percent of total billed charges,Implant Devices,4833.78,34,,4833.78,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4833.78,34,"If Charge > 2,000, then 34 percent",4833.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5686.8,
GORE PLL161407 EXCLUDER ENDOPROS 14.5X7,C1874,HCPCS,,79009216,CDM,278,RC,,,both,,,10005,3948.65,39.4668,,3948.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3401.7,34,,3401.7,percent of total billed charges,Implant Device,3401.7,34,,3401.7,percent of total billed charges,Implant Device,3401.7,34,,3401.7,percent of total billed charges,Implant Device,3401.7,34,,3401.7,percent of total billed charges,Implant Device,3401.7,34,,3401.7,percent of total billed charges,Implant Device,3401.7,34,,3401.7,percent of total billed charges,Implant Device,3501.75,35,,3501.75,percent of total billed charges,Implant Device,3401.7,34,"Charges > $500, x 34%",3401.7,percent of total billed charges,Implant Device,3501.75,35,,3501.75,percent of total billed charges,Implant Devices,3501.75,35,,3501.75,percent of total billed charges,Implant Devices,3501.75,35,,,percent of total billed charges,Implant Devices,3501.75,35,,3501.75,percent of total billed charges,Implant Devices,3501.75,35,,3501.75,percent of total billed charges,Implant Devices,4002,40,,4002,percent of total billed charges,Implant Devices,3501.75,70,,3501.75,percent of total billed charges,Implant Devices,3401.7,34,,3401.7,percent of total billed charges,Implant Devices,3401.7,34,,3401.7,percent of total billed charges,Implant Devices,3501.75,35,,3501.75,percent of total billed charges,Implant Devices,3501.75,35,,3501.75,percent of total billed charges,Implant Devices,3501.75,35,,3501.75,percent of total billed charges,Implant Devices,3501.75,35,,3501.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3401.7,34,"If Charge > 2,000, then 34 percent",3401.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4002,
GORE PLC141400 EXCLUDER ENDOPROS 14.5X10,C1874,HCPCS,,79009217,CDM,278,RC,,,both,,,14217,5610.99,39.4668,,5610.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4975.95,35,,4975.95,percent of total billed charges,Implant Device,4833.78,34,"Charges > $500, x 34%",4833.78,percent of total billed charges,Implant Device,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,5686.8,40,,5686.8,percent of total billed charges,Implant Devices,4975.95,70,,4975.95,percent of total billed charges,Implant Devices,4833.78,34,,4833.78,percent of total billed charges,Implant Devices,4833.78,34,,4833.78,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4833.78,34,"If Charge > 2,000, then 34 percent",4833.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5686.8,
GORE PLC141000 EXCL ENDOPROS 14.5MMX10CM,C1874,HCPCS,,79009534,CDM,278,RC,,,both,,,14217,5610.99,39.4668,,5610.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4833.78,34,,4833.78,percent of total billed charges,Implant Device,4975.95,35,,4975.95,percent of total billed charges,Implant Device,4833.78,34,"Charges > $500, x 34%",4833.78,percent of total billed charges,Implant Device,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,5686.8,40,,5686.8,percent of total billed charges,Implant Devices,4975.95,70,,4975.95,percent of total billed charges,Implant Devices,4833.78,34,,4833.78,percent of total billed charges,Implant Devices,4833.78,34,,4833.78,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,4975.95,35,,4975.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4833.78,34,"If Charge > 2,000, then 34 percent",4833.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5686.8,
GORE PLC141200 EXCL ENDOPROS 14.5MMX12CM,C1874,HCPCS,,79010163,CDM,278,RC,,,both,,,14571,5750.71,39.4668,,5750.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,4954.14,34,,4954.14,percent of total billed charges,Implant Device,5099.85,35,,5099.85,percent of total billed charges,Implant Device,4954.14,34,"Charges > $500, x 34%",4954.14,percent of total billed charges,Implant Device,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5828.4,40,,5828.4,percent of total billed charges,Implant Devices,5099.85,70,,5099.85,percent of total billed charges,Implant Devices,4954.14,34,,4954.14,percent of total billed charges,Implant Devices,4954.14,34,,4954.14,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,5099.85,35,,5099.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4954.14,34,"If Charge > 2,000, then 34 percent",4954.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5828.4,
BOST SCI M0061456170 7X20 URETERAL STENT,C1874,HCPCS,,79010355,CDM,278,RC,,,both,,,410,161.81,39.4668,,161.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,143.5,35,,143.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,164,40,,164,percent of total billed charges,Implant Devices,143.5,70,,143.5,percent of total billed charges,Implant Devices,139.4,34,,139.4,percent of total billed charges,Implant Devices,139.4,34,,139.4,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164,
BOST SCI M0061456500 7X22 URETERAL STENT,C1874,HCPCS,,79010356,CDM,278,RC,,,both,,,410,161.81,39.4668,,161.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,143.5,35,,143.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,164,40,,164,percent of total billed charges,Implant Devices,143.5,70,,143.5,percent of total billed charges,Implant Devices,139.4,34,,139.4,percent of total billed charges,Implant Devices,139.4,34,,139.4,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164,
BOST SCI M0061456510 7X24 URETERAL STENT,C1874,HCPCS,,79010357,CDM,278,RC,,,both,,,410,161.81,39.4668,,161.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,143.5,35,,143.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,164,40,,164,percent of total billed charges,Implant Devices,143.5,70,,143.5,percent of total billed charges,Implant Devices,139.4,34,,139.4,percent of total billed charges,Implant Devices,139.4,34,,139.4,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164,
BOST SCI M0061456520 7X26 URETERAL STENT,C1874,HCPCS,,79010358,CDM,278,RC,,,both,,,410,161.81,39.4668,,161.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,139.4,34,,139.4,percent of total billed charges,Implant Device,143.5,35,,143.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,164,40,,164,percent of total billed charges,Implant Devices,143.5,70,,143.5,percent of total billed charges,Implant Devices,139.4,34,,139.4,percent of total billed charges,Implant Devices,139.4,34,,139.4,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,143.5,35,,143.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,164,
BOST SCI M0061752820 8X24 URETERAL STENT,C1874,HCPCS,,79010359,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
BOST SCI M0061752830 8X26 URETERAL STENT,C1874,HCPCS,,79010360,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
BOS SCI M0061802300 CONTOUR STENT 7FRX20,C1874,HCPCS,,79010372,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
BOS SCI M0061802310 CONTOUR STENT 7FRX22,C1874,HCPCS,,79010373,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
BOS SCI M0061802320 CONTOUR STENT 7FRX24,C1874,HCPCS,,79010374,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
BOS SCI M0061802320 CONTOUR STENT 7FRX26,C1874,HCPCS,,79010375,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
BOS SCI M0061802340 CONTOR STENT 7FRX28,C1874,HCPCS,,79010431,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
BOST SCI M00516710 ESOPHAGEAL 18X123MM,C1874,HCPCS,,79010444,CDM,278,RC,,,both,,,6649,2624.15,39.4668,,2624.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2260.66,34,,2260.66,percent of total billed charges,Implant Device,2260.66,34,,2260.66,percent of total billed charges,Implant Device,2260.66,34,,2260.66,percent of total billed charges,Implant Device,2260.66,34,,2260.66,percent of total billed charges,Implant Device,2260.66,34,,2260.66,percent of total billed charges,Implant Device,2260.66,34,,2260.66,percent of total billed charges,Implant Device,2327.15,35,,2327.15,percent of total billed charges,Implant Device,2260.66,34,"Charges > $500, x 34%",2260.66,percent of total billed charges,Implant Device,2327.15,35,,2327.15,percent of total billed charges,Implant Devices,2327.15,35,,2327.15,percent of total billed charges,Implant Devices,2327.15,35,,,percent of total billed charges,Implant Devices,2327.15,35,,2327.15,percent of total billed charges,Implant Devices,2327.15,35,,2327.15,percent of total billed charges,Implant Devices,2659.6,40,,2659.6,percent of total billed charges,Implant Devices,2327.15,70,,2327.15,percent of total billed charges,Implant Devices,2260.66,34,,2260.66,percent of total billed charges,Implant Devices,2260.66,34,,2260.66,percent of total billed charges,Implant Devices,2327.15,35,,2327.15,percent of total billed charges,Implant Devices,2327.15,35,,2327.15,percent of total billed charges,Implant Devices,2327.15,35,,2327.15,percent of total billed charges,Implant Devices,2327.15,35,,2327.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2260.66,34,"If Charge > 2,000, then 34 percent",2260.66,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2659.6,
BOST SCI 180-221 CONTOUR STENT W/O WIRE,C1874,HCPCS,,79010520,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
BOST SCI 180-222 CONTOUR STENT W/O WIRE,C1874,HCPCS,,79010521,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
BOST SCI 180-223 CONTOUR STENT W/O WIRE,C1874,HCPCS,,79010522,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
BOST SCI 180-224 CONTOUR STENT W/O WIRE,C1874,HCPCS,,79010523,CDM,278,RC,,,both,,,425,167.73,39.4668,,167.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,144.5,34,,144.5,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,170,40,,170,percent of total billed charges,Implant Devices,148.75,70,,148.75,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,144.5,34,,144.5,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,148.75,35,,148.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170,
GORE PLC121200 EXCL CONTRAL LEG 16X12X12,C1874,HCPCS,,79010610,CDM,278,RC,,,both,,,14934,5893.97,39.4668,,5893.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5077.56,34,,5077.56,percent of total billed charges,Implant Device,5077.56,34,,5077.56,percent of total billed charges,Implant Device,5077.56,34,,5077.56,percent of total billed charges,Implant Device,5077.56,34,,5077.56,percent of total billed charges,Implant Device,5077.56,34,,5077.56,percent of total billed charges,Implant Device,5077.56,34,,5077.56,percent of total billed charges,Implant Device,5226.9,35,,5226.9,percent of total billed charges,Implant Device,5077.56,34,"Charges > $500, x 34%",5077.56,percent of total billed charges,Implant Device,5226.9,35,,5226.9,percent of total billed charges,Implant Devices,5226.9,35,,5226.9,percent of total billed charges,Implant Devices,5226.9,35,,,percent of total billed charges,Implant Devices,5226.9,35,,5226.9,percent of total billed charges,Implant Devices,5226.9,35,,5226.9,percent of total billed charges,Implant Devices,5973.6,40,,5973.6,percent of total billed charges,Implant Devices,5226.9,70,,5226.9,percent of total billed charges,Implant Devices,5077.56,34,,5077.56,percent of total billed charges,Implant Devices,5077.56,34,,5077.56,percent of total billed charges,Implant Devices,5226.9,35,,5226.9,percent of total billed charges,Implant Devices,5226.9,35,,5226.9,percent of total billed charges,Implant Devices,5226.9,35,,5226.9,percent of total billed charges,Implant Devices,5226.9,35,,5226.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5077.56,34,"If Charge > 2,000, then 34 percent",5077.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5973.6,
GORE PLL161007 EXCLUDER ILIAC EX 16X10X7,C1874,HCPCS,,79010611,CDM,278,RC,,,both,,,10509,4147.57,39.4668,,4147.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3573.06,34,,3573.06,percent of total billed charges,Implant Device,3573.06,34,,3573.06,percent of total billed charges,Implant Device,3573.06,34,,3573.06,percent of total billed charges,Implant Device,3573.06,34,,3573.06,percent of total billed charges,Implant Device,3573.06,34,,3573.06,percent of total billed charges,Implant Device,3573.06,34,,3573.06,percent of total billed charges,Implant Device,3678.15,35,,3678.15,percent of total billed charges,Implant Device,3573.06,34,"Charges > $500, x 34%",3573.06,percent of total billed charges,Implant Device,3678.15,35,,3678.15,percent of total billed charges,Implant Devices,3678.15,35,,3678.15,percent of total billed charges,Implant Devices,3678.15,35,,,percent of total billed charges,Implant Devices,3678.15,35,,3678.15,percent of total billed charges,Implant Devices,3678.15,35,,3678.15,percent of total billed charges,Implant Devices,4203.6,40,,4203.6,percent of total billed charges,Implant Devices,3678.15,70,,3678.15,percent of total billed charges,Implant Devices,3573.06,34,,3573.06,percent of total billed charges,Implant Devices,3573.06,34,,3573.06,percent of total billed charges,Implant Devices,3678.15,35,,3678.15,percent of total billed charges,Implant Devices,3678.15,35,,3678.15,percent of total billed charges,Implant Devices,3678.15,35,,3678.15,percent of total billed charges,Implant Devices,3678.15,35,,3678.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3573.06,34,"If Charge > 2,000, then 34 percent",3573.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4203.6,
GORE RLT231216 EXCLUDER TRUNK 23X12X16,C1874,HCPCS,,79010612,CDM,278,RC,,,both,,,36426,14376.18,39.4668,,14376.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12384.84,34,,12384.84,percent of total billed charges,Implant Device,12384.84,34,,12384.84,percent of total billed charges,Implant Device,12384.84,34,,12384.84,percent of total billed charges,Implant Device,12384.84,34,,12384.84,percent of total billed charges,Implant Device,12384.84,34,,12384.84,percent of total billed charges,Implant Device,12384.84,34,,12384.84,percent of total billed charges,Implant Device,12749.1,35,,12749.1,percent of total billed charges,Implant Device,12384.84,34,"Charges > $500, x 34%",12384.84,percent of total billed charges,Implant Device,12749.1,35,,12749.1,percent of total billed charges,Implant Devices,12749.1,35,,12749.1,percent of total billed charges,Implant Devices,12749.1,35,,,percent of total billed charges,Implant Devices,12749.1,35,,12749.1,percent of total billed charges,Implant Devices,12749.1,35,,12749.1,percent of total billed charges,Implant Devices,14570.4,40,,14570.4,percent of total billed charges,Implant Devices,12749.1,70,,12749.1,percent of total billed charges,Implant Devices,12384.84,34,,12384.84,percent of total billed charges,Implant Devices,12384.84,34,,12384.84,percent of total billed charges,Implant Devices,12749.1,35,,12749.1,percent of total billed charges,Implant Devices,12749.1,35,,12749.1,percent of total billed charges,Implant Devices,12749.1,35,,12749.1,percent of total billed charges,Implant Devices,12749.1,35,,12749.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,12384.84,34,"If Charge > 2,000, then 34 percent",12384.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,14570.4,
BOS SCI M0061801560 CONTOUR 6FRX22-30,C1874,HCPCS,,79010750,CDM,278,RC,,,both,,,428,168.92,39.4668,,168.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,145.52,34,,145.52,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,171.2,40,,171.2,percent of total billed charges,Implant Devices,149.8,70,,149.8,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,145.52,34,,145.52,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,149.8,35,,149.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,171.2,
GORE BXA051901A VBX VIABAHN 5X19X80,C1874,HCPCS,,79010975,CDM,278,RC,,,both,,,9765,3853.93,39.4668,,3853.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Device,3320.1,34,"Charges > $500, x 34%",3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3906,40,,3906,percent of total billed charges,Implant Devices,3417.75,70,,3417.75,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3320.1,34,"If Charge > 2,000, then 34 percent",3320.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3906,
GORE BXA052901A VBX VIABAHN 5X29X80,C1874,HCPCS,,79010976,CDM,278,RC,,,both,,,9765,3853.93,39.4668,,3853.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3320.1,34,,3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Device,3320.1,34,"Charges > $500, x 34%",3320.1,percent of total billed charges,Implant Device,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3906,40,,3906,percent of total billed charges,Implant Devices,3417.75,70,,3417.75,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3320.1,34,,3320.1,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,3417.75,35,,3417.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3320.1,34,"If Charge > 2,000, then 34 percent",3320.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3906,
MEDTRONIC RONYX20008UX ONYX DES 2X8MM,C1874,HCPCS,,79011213,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX20012UX ONYX DES 2X12MM,C1874,HCPCS,,79011214,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX20015UX ONYX DES 2X15MM,C1874,HCPCS,,79011215,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX20018UX DES 2X18MM,C1874,HCPCS,,79011216,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX20022UX ONYX DES 2X22MM,C1874,HCPCS,,79011217,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX22508UX ONYX DES 2.25X8MM,C1874,HCPCS,,79011218,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX22512UX ONYX DES 2.25X12,C1874,HCPCS,,79011219,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX22515UX ONYX DES 2.25X15,C1874,HCPCS,,79011220,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX22518UX ONYX DES 2.25X18,C1874,HCPCS,,79011221,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX22522UX ONYX DES 2.25X22,C1874,HCPCS,,79011222,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX22526UX ONYX DES 2.25X26,C1874,HCPCS,,79011223,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX22530UX ONYX DES 2.25X30,C1874,HCPCS,,79011224,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX22534UX ONYX DES 2.25X34,C1874,HCPCS,,79011225,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX22538UX ONYX DES 2.25X38,C1874,HCPCS,,79011226,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX25008UX ONYX DES 2.5X8MM,C1874,HCPCS,,79011227,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX25012UX ONYX DES 2.5X12MM,C1874,HCPCS,,79011228,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX25015UX ONYX DES 2.5X15MM,C1874,HCPCS,,79011229,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX25018UX ONYX DES 2.5X18MM,C1874,HCPCS,,79011230,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX25022UX ONYX DES 2.5X22MM,C1874,HCPCS,,79011231,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MDTRONIC RONYX25026UX ONYX DES 2.5X26MM,C1874,HCPCS,,79011232,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX25030UX ONYX DES 2.5X30MM,C1874,HCPCS,,79011233,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX25034UX ONYX DES 2.5X34MM,C1874,HCPCS,,79011234,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX25038UX ONYX DES 2.5X38MM,C1874,HCPCS,,79011235,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX27508UX ONYX DES 2.75X8MM,C1874,HCPCS,,79011236,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX27512UX ONYX DES 2.75X12,C1874,HCPCS,,79011237,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX27515UX ONYX DES 2.75X15,C1874,HCPCS,,79011238,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX27518UX ONYX DES 2.75X18,C1874,HCPCS,,79011239,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX27522UX ONYX DES 2.75X22,C1874,HCPCS,,79011240,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX27526UX ONYX DES 2.75X26,C1874,HCPCS,,79011241,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX27530UX ONYX DES 2.75X30,C1874,HCPCS,,79011242,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX27534UX ONYX DES 2.75X34,C1874,HCPCS,,79011243,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX27538UX ONYX DES 2.75X38,C1874,HCPCS,,79011244,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX30008UX ONYX DES 3X8MM,C1874,HCPCS,,79011245,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX30012UX ONYX DES 3X12MM,C1874,HCPCS,,79011246,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX30015UX ONYX DES 3X15MM,C1874,HCPCS,,79011247,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX30018UX ONYX DES 3X18MM,C1874,HCPCS,,79011248,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX30022UX ONYX DES 3X22MM,C1874,HCPCS,,79011249,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX30026UX ONYX DES 3X26MM,C1874,HCPCS,,79011250,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX30030UX ONYX DES 3X30MM,C1874,HCPCS,,79011251,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX30034UX ONYX DES 3X34MM,C1874,HCPCS,,79011252,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX30038UX ONYX DES 3X38MM,C1874,HCPCS,,79011253,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX35008UX ONYX DES 3.5X8MM,C1874,HCPCS,,79011254,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX35012UX ONYX DES 3.5X12MM,C1874,HCPCS,,79011255,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX35015UX ONYX DES 3.5X15MM,C1874,HCPCS,,79011256,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX35018UX ONYX DES 3.5X18MM,C1874,HCPCS,,79011257,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX35022UX ONYX DES 3.5X22MM,C1874,HCPCS,,79011258,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX35026UX ONYX DES 3.5X26MM,C1874,HCPCS,,79011259,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX35030UX ONYX DES 3.5X30MM,C1874,HCPCS,,79011260,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX35034UX ONYX DES 3.5X34MM,C1874,HCPCS,,79011261,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX35038UX ONYX DES 3.5X38MM,C1874,HCPCS,,79011262,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX40008UX ONYX DES 4X8MM,C1874,HCPCS,,79011263,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX40012UX ONYX DES 4X12MM,C1874,HCPCS,,79011264,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX40015UX ONYX DES 4X15MM,C1874,HCPCS,,79011265,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX40018UX ONYX DES 4X18MM,C1874,HCPCS,,79011266,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX40022UX ONYX DES 4X22MM,C1874,HCPCS,,79011267,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX40026UX ONYX DES 4X26MM,C1874,HCPCS,,79011268,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX40030UX ONYX DES 4X30MM,C1874,HCPCS,,79011269,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX40034UX ONYX DES 4X34MM,C1874,HCPCS,,79011270,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX40038UX ONYX DES 4X38MM,C1874,HCPCS,,79011271,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX45015UX ONYX DES 4.5X15MM,C1874,HCPCS,,79011272,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX45018UX ONYX DES 4.5X18MM,C1874,HCPCS,,79011273,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX45022UX ONYX DES 4.5X22MM,C1874,HCPCS,,79011274,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX50015UX ONYX DES 5X15MM,C1874,HCPCS,,79011275,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX50018UX ONYX DES 5X18MM,C1874,HCPCS,,79011276,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
MEDTRONIC RONYX50022UX ONYX DES 5X22MM,C1874,HCPCS,,79011277,CDM,278,RC,,,both,,,2475,976.8,39.4668,,976.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,841.5,34,,841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Device,841.5,34,"Charges > $500, x 34%",841.5,percent of total billed charges,Implant Device,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,990,40,,990,percent of total billed charges,Implant Devices,866.25,70,,866.25,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,841.5,34,,841.5,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,866.25,35,,866.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,841.5,34,"If Charge > 2,000, then 34 percent",841.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,990,
ABBOTT 1550225-08 SIERRA DES 2.25X8MM,C1874,HCPCS,,79011278,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550225-12 SIERRA DES 2.25X12MM,C1874,HCPCS,,79011279,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550225-15 SIERRA DES 2.25X15MM,C1874,HCPCS,,79011280,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550225-18 SIERRA DES 2.25X18MM,C1874,HCPCS,,79011281,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550225-23 SIERRA DES 2.25X23MM,C1874,HCPCS,,79011282,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550225-28 SIERRA DES 2.25X28MM,C1874,HCPCS,,79011283,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550225-33 SIERRA DES 2.25X33MM,C1874,HCPCS,,79011284,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550225-38 SIERRA DES 2.25X38MM,C1874,HCPCS,,79011285,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550250-08 SIERRA DES 2.5X8MM,C1874,HCPCS,,79011286,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550250-12 SIERRA DES 2.5X12MM,C1874,HCPCS,,79011287,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550250-15 SIERRA DES 2.5X15MM,C1874,HCPCS,,79011288,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550250-18 SIERRA DES 2.5X18MM,C1874,HCPCS,,79011289,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550250-23 SIERRA DES 2.5X23MM,C1874,HCPCS,,79011290,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550250-28 SIERRA DES 2.5X28MM,C1874,HCPCS,,79011291,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550250-35 SIERRA DES 2.5X33MM,C1874,HCPCS,,79011292,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550250-38 SIERRA DES 2.5X38MM,C1874,HCPCS,,79011293,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550275-08 SIERRA DES 2.75X8MM,C1874,HCPCS,,79011294,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550275-12 SIERRA DES 2.75X12MM,C1874,HCPCS,,79011295,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550275-15 SIERRA DES 2.75X15MM,C1874,HCPCS,,79011296,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550275-18 SIERRA DES 2.75X18MM,C1874,HCPCS,,79011297,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550275-23 SIERRA DES 2.75X23MM,C1874,HCPCS,,79011298,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550275-28 SIERRA DES 2.75X28MM,C1874,HCPCS,,79011299,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550275-33 SIERRA DES 2.75X33MM,C1874,HCPCS,,79011300,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550275-38 SIERRA DES 2.75X38MM,C1874,HCPCS,,79011301,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550300-08 SIERRA DES 3X8MM,C1874,HCPCS,,79011302,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550300-12 SIERRA DES 3X12MM,C1874,HCPCS,,79011303,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550300-15 SIERRA DES 3X15MM,C1874,HCPCS,,79011304,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550300-18 SIERRA DES 3X18MM,C1874,HCPCS,,79011305,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550300-23 SIERRA DES 3X23MM,C1874,HCPCS,,79011306,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550300-28 SIERRA DES 3X28MM,C1874,HCPCS,,79011307,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550300-33 SIERRA DES 3X33MM,C1874,HCPCS,,79011308,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550300-38 SIERRA DES 3X38MM,C1874,HCPCS,,79011309,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550325-08 SIERRA DES 3.25X8MM,C1874,HCPCS,,79011310,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550325-12 SIERRA DES 3.25X12MM,C1874,HCPCS,,79011311,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550325-15 SIERRA DES 3.25X15MM,C1874,HCPCS,,79011312,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550325-18 SIERRA DES 3.25X18MM,C1874,HCPCS,,79011313,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550325-23 SIERRA DES 3.25X23MM,C1874,HCPCS,,79011314,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550325-28 SIERRA DES 3.25X28MM,C1874,HCPCS,,79011315,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550325-33 SIERRA DES 3.25X33MM,C1874,HCPCS,,79011316,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550325-38 SIERRA DES 3.25X38MM,C1874,HCPCS,,79011317,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550350-08 SIERRA DES 3.5X8MM,C1874,HCPCS,,79011318,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550350-12 SIERRA DES 3.5X12MM,C1874,HCPCS,,79011319,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550350-15 SIERRA DES 3.5X15MM,C1874,HCPCS,,79011320,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550350-18 SIERRA DES 3.5X18MM,C1874,HCPCS,,79011321,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550350-23 SIERRA DES 3.5X23MM,C1874,HCPCS,,79011322,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550350-28 SIERRA DES 3.5X28MM,C1874,HCPCS,,79011323,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550350-33 SIERRA DES 3.5X33MM,C1874,HCPCS,,79011324,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550350-38 SIERRA DES 3.5X38MM,C1874,HCPCS,,79011325,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550400-08 SIERRA DES 4X8MM,C1874,HCPCS,,79011326,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550400-12 SIERRA DES 4X12MM,C1874,HCPCS,,79011327,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550400-15 SIERRA DES 4X15MM,C1874,HCPCS,,79011330,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550400-18 SIERRA DES 4X18MM,C1874,HCPCS,,79011331,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550400-23 SIERRA DES 4X23MM,C1874,HCPCS,,79011332,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550400-28 SIERRA DES 4X28MM,C1874,HCPCS,,79011333,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550400-33 SIERRA DES 4X33MM,C1874,HCPCS,,79011334,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
ABBOTT 1550400-38 SIERRA DES 4X38MM,C1874,HCPCS,,79011335,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
BIOTRONIK 434887 PK PAPYRUS 2.5X15MM,C1874,HCPCS,,79011480,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
BIOTRONIK 434888 PK PAPYRUS 3.0X15MM,C1874,HCPCS,,79011481,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
BIOTRONIK 434889 PK PAPYRUS 3.5X15MM,C1874,HCPCS,,79011482,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
BIOTRONIK 434895 PK PAPYRUS 3.5X20MM,C1874,HCPCS,,79011483,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
BIOTRONIK 434893 PK PAPYRUS 2.5X20MM,C1874,HCPCS,,79011589,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
BIOTRONIK 434894 PK PAPYRUS 3X20MM,C1874,HCPCS,,79011590,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
BIOTRONIK 434890 PK PAPYRUS 4X15MM,C1874,HCPCS,,79011591,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
BIOTRONIK 434896 PK PAPYRUS 4X20MM,C1874,HCPCS,,79011592,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
BIOTRONIK 434891 PK PAPYRUS 4.5X15MM,C1874,HCPCS,,79011593,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
BIOTRONIK 434892 PK PAPYRUS 5X15MM,C1874,HCPCS,,79011594,CDM,278,RC,,,both,,,9000,3552.01,39.4668,,3552.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3060,34,,3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Device,3060,34,"Charges > $500, x 34%",3060,percent of total billed charges,Implant Device,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3600,40,,3600,percent of total billed charges,Implant Devices,3150,70,,3150,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3060,34,,3060,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,3150,35,,3150,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3060,34,"If Charge > 2,000, then 34 percent",3060,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3600,
GORE BXA083901A VIABAHN 8X39MM STENT,C1874,HCPCS,,79011839,CDM,278,RC,,,both,,,10722,4231.63,39.4668,,4231.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3645.48,34,,3645.48,percent of total billed charges,Implant Device,3645.48,34,,3645.48,percent of total billed charges,Implant Device,3645.48,34,,3645.48,percent of total billed charges,Implant Device,3645.48,34,,3645.48,percent of total billed charges,Implant Device,3645.48,34,,3645.48,percent of total billed charges,Implant Device,3645.48,34,,3645.48,percent of total billed charges,Implant Device,3752.7,35,,3752.7,percent of total billed charges,Implant Device,3645.48,34,"Charges > $500, x 34%",3645.48,percent of total billed charges,Implant Device,3752.7,35,,3752.7,percent of total billed charges,Implant Devices,3752.7,35,,3752.7,percent of total billed charges,Implant Devices,3752.7,35,,,percent of total billed charges,Implant Devices,3752.7,35,,3752.7,percent of total billed charges,Implant Devices,3752.7,35,,3752.7,percent of total billed charges,Implant Devices,4288.8,40,,4288.8,percent of total billed charges,Implant Devices,3752.7,70,,3752.7,percent of total billed charges,Implant Devices,3645.48,34,,3645.48,percent of total billed charges,Implant Devices,3645.48,34,,3645.48,percent of total billed charges,Implant Devices,3752.7,35,,3752.7,percent of total billed charges,Implant Devices,3752.7,35,,3752.7,percent of total billed charges,Implant Devices,3752.7,35,,3752.7,percent of total billed charges,Implant Devices,3752.7,35,,3752.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3645.48,34,"If Charge > 2,000, then 34 percent",3645.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4288.8,
BOST H74939294600410 6X40X130 ELU STENT,C1874,HCPCS,,79011893,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
BOST H74939294600810 6X80X130 ELU STENT,C1874,HCPCS,,79011894,CDM,278,RC,,,both,,,7725,3048.81,39.4668,,3048.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2703.75,35,,2703.75,percent of total billed charges,Implant Device,2626.5,34,"Charges > $500, x 34%",2626.5,percent of total billed charges,Implant Device,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,3090,40,,3090,percent of total billed charges,Implant Devices,2703.75,70,,2703.75,percent of total billed charges,Implant Devices,2626.5,34,,2626.5,percent of total billed charges,Implant Devices,2626.5,34,,2626.5,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2626.5,34,"If Charge > 2,000, then 34 percent",2626.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3090,
BOST H74939294601210 6X120X130 ELU STENT,C1874,HCPCS,,79011895,CDM,278,RC,,,both,,,8625,3404.01,39.4668,,3404.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,3018.75,35,,3018.75,percent of total billed charges,Implant Device,2932.5,34,"Charges > $500, x 34%",2932.5,percent of total billed charges,Implant Device,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3450,40,,3450,percent of total billed charges,Implant Devices,3018.75,70,,3018.75,percent of total billed charges,Implant Devices,2932.5,34,,2932.5,percent of total billed charges,Implant Devices,2932.5,34,,2932.5,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2932.5,34,"If Charge > 2,000, then 34 percent",2932.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3450,
BOST H74939294700410 7X40X130 ELU STENT,C1874,HCPCS,,79011896,CDM,278,RC,,,both,,,5925,2338.41,39.4668,,2338.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2014.5,34,,2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Device,2014.5,34,"Charges > $500, x 34%",2014.5,percent of total billed charges,Implant Device,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2370,40,,2370,percent of total billed charges,Implant Devices,2073.75,70,,2073.75,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2014.5,34,,2014.5,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,2073.75,35,,2073.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2014.5,34,"If Charge > 2,000, then 34 percent",2014.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2370,
BOST H74939294700810 7X80X130 ELU STENT,C1874,HCPCS,,79011897,CDM,278,RC,,,both,,,7725,3048.81,39.4668,,3048.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2703.75,35,,2703.75,percent of total billed charges,Implant Device,2626.5,34,"Charges > $500, x 34%",2626.5,percent of total billed charges,Implant Device,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,3090,40,,3090,percent of total billed charges,Implant Devices,2703.75,70,,2703.75,percent of total billed charges,Implant Devices,2626.5,34,,2626.5,percent of total billed charges,Implant Devices,2626.5,34,,2626.5,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2626.5,34,"If Charge > 2,000, then 34 percent",2626.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3090,
BOST H74939294701210 7X120X130 ELU STENT,C1874,HCPCS,,79011898,CDM,278,RC,,,both,,,8625,3404.01,39.4668,,3404.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,2932.5,34,,2932.5,percent of total billed charges,Implant Device,3018.75,35,,3018.75,percent of total billed charges,Implant Device,2932.5,34,"Charges > $500, x 34%",2932.5,percent of total billed charges,Implant Device,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3450,40,,3450,percent of total billed charges,Implant Devices,3018.75,70,,3018.75,percent of total billed charges,Implant Devices,2932.5,34,,2932.5,percent of total billed charges,Implant Devices,2932.5,34,,2932.5,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,3018.75,35,,3018.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2932.5,34,"If Charge > 2,000, then 34 percent",2932.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3450,
BOST H74939294601010 6X100X130 ELU STENT,C1874,HCPCS,,79011901,CDM,278,RC,,,both,,,7725,3048.81,39.4668,,3048.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2703.75,35,,2703.75,percent of total billed charges,Implant Device,2626.5,34,"Charges > $500, x 34%",2626.5,percent of total billed charges,Implant Device,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,3090,40,,3090,percent of total billed charges,Implant Devices,2703.75,70,,2703.75,percent of total billed charges,Implant Devices,2626.5,34,,2626.5,percent of total billed charges,Implant Devices,2626.5,34,,2626.5,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2626.5,34,"If Charge > 2,000, then 34 percent",2626.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3090,
BOST 39294-60061 6X60X130CM ELUVIA STENT,C1874,HCPCS,,79012315,CDM,278,RC,,,both,,,6825,2693.61,39.4668,,2693.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2388.75,35,,2388.75,percent of total billed charges,Implant Device,2320.5,34,"Charges > $500, x 34%",2320.5,percent of total billed charges,Implant Device,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2730,40,,2730,percent of total billed charges,Implant Devices,2388.75,70,,2388.75,percent of total billed charges,Implant Devices,2320.5,34,,2320.5,percent of total billed charges,Implant Devices,2320.5,34,,2320.5,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2320.5,34,"If Charge > 2,000, then 34 percent",2320.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2730,
BOST 39294-70061 7X60X130CM ELUVIA STENT,C1874,HCPCS,,79012316,CDM,278,RC,,,both,,,6825,2693.61,39.4668,,2693.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2388.75,35,,2388.75,percent of total billed charges,Implant Device,2320.5,34,"Charges > $500, x 34%",2320.5,percent of total billed charges,Implant Device,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2730,40,,2730,percent of total billed charges,Implant Devices,2388.75,70,,2388.75,percent of total billed charges,Implant Devices,2320.5,34,,2320.5,percent of total billed charges,Implant Devices,2320.5,34,,2320.5,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2320.5,34,"If Charge > 2,000, then 34 percent",2320.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2730,
BOST 39294-70101 7X100X130 ELUVIA STENT,C1874,HCPCS,,79012317,CDM,278,RC,,,both,,,7725,3048.81,39.4668,,3048.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2626.5,34,,2626.5,percent of total billed charges,Implant Device,2703.75,35,,2703.75,percent of total billed charges,Implant Device,2626.5,34,"Charges > $500, x 34%",2626.5,percent of total billed charges,Implant Device,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,3090,40,,3090,percent of total billed charges,Implant Devices,2703.75,70,,2703.75,percent of total billed charges,Implant Devices,2626.5,34,,2626.5,percent of total billed charges,Implant Devices,2626.5,34,,2626.5,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,2703.75,35,,2703.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2626.5,34,"If Charge > 2,000, then 34 percent",2626.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3090,
GORE BXA072901A VIABAHN 7X29X80CM STENT,C1874,HCPCS,,79012565,CDM,278,RC,,,both,,,11151,4400.94,39.4668,,4400.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3902.85,35,,3902.85,percent of total billed charges,Implant Device,3791.34,34,"Charges > $500, x 34%",3791.34,percent of total billed charges,Implant Device,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,4460.4,40,,4460.4,percent of total billed charges,Implant Devices,3902.85,70,,3902.85,percent of total billed charges,Implant Devices,3791.34,34,,3791.34,percent of total billed charges,Implant Devices,3791.34,34,,3791.34,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3791.34,34,"If Charge > 2,000, then 34 percent",3791.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4460.4,
GORE BXA075901A VIABAHN 7X59X80CM STENT,C1874,HCPCS,,79012566,CDM,278,RC,,,both,,,11151,4400.94,39.4668,,4400.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3902.85,35,,3902.85,percent of total billed charges,Implant Device,3791.34,34,"Charges > $500, x 34%",3791.34,percent of total billed charges,Implant Device,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,4460.4,40,,4460.4,percent of total billed charges,Implant Devices,3902.85,70,,3902.85,percent of total billed charges,Implant Devices,3791.34,34,,3791.34,percent of total billed charges,Implant Devices,3791.34,34,,3791.34,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3791.34,34,"If Charge > 2,000, then 34 percent",3791.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4460.4,
GORE BXA082901A 7FR 80CM VIABAHN STENTS,C1874,HCPCS,,79012729,CDM,278,RC,,,both,,,11151,4400.94,39.4668,,4400.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3791.34,34,,3791.34,percent of total billed charges,Implant Device,3902.85,35,,3902.85,percent of total billed charges,Implant Device,3791.34,34,"Charges > $500, x 34%",3791.34,percent of total billed charges,Implant Device,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,4460.4,40,,4460.4,percent of total billed charges,Implant Devices,3902.85,70,,3902.85,percent of total billed charges,Implant Devices,3791.34,34,,3791.34,percent of total billed charges,Implant Devices,3791.34,34,,3791.34,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,3902.85,35,,3902.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3791.34,34,"If Charge > 2,000, then 34 percent",3791.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4460.4,
BOST M00517240 ESOPHAGEAL STENT 18X59MM,C1874,HCPCS,,79012871,CDM,278,RC,,,both,,,8678,3424.93,39.4668,,3424.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2950.52,34,,2950.52,percent of total billed charges,Implant Device,2950.52,34,,2950.52,percent of total billed charges,Implant Device,2950.52,34,,2950.52,percent of total billed charges,Implant Device,2950.52,34,,2950.52,percent of total billed charges,Implant Device,2950.52,34,,2950.52,percent of total billed charges,Implant Device,2950.52,34,,2950.52,percent of total billed charges,Implant Device,3037.3,35,,3037.3,percent of total billed charges,Implant Device,2950.52,34,"Charges > $500, x 34%",2950.52,percent of total billed charges,Implant Device,3037.3,35,,3037.3,percent of total billed charges,Implant Devices,3037.3,35,,3037.3,percent of total billed charges,Implant Devices,3037.3,35,,,percent of total billed charges,Implant Devices,3037.3,35,,3037.3,percent of total billed charges,Implant Devices,3037.3,35,,3037.3,percent of total billed charges,Implant Devices,3471.2,40,,3471.2,percent of total billed charges,Implant Devices,3037.3,70,,3037.3,percent of total billed charges,Implant Devices,2950.52,34,,2950.52,percent of total billed charges,Implant Devices,2950.52,34,,2950.52,percent of total billed charges,Implant Devices,3037.3,35,,3037.3,percent of total billed charges,Implant Devices,3037.3,35,,3037.3,percent of total billed charges,Implant Devices,3037.3,35,,3037.3,percent of total billed charges,Implant Devices,3037.3,35,,3037.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2950.52,34,"If Charge > 2,000, then 34 percent",2950.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3471.2,
BIOTRONIK 434899 PK PAPYRUS 3MMX26MM,C1874,HCPCS,,79013204,CDM,278,RC,,,both,,,8910,3516.49,39.4668,,3516.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Device,3029.4,34,"Charges > $500, x 34%",3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3564,40,,3564,percent of total billed charges,Implant Devices,3118.5,70,,3118.5,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3029.4,34,"If Charge > 2,000, then 34 percent",3029.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3564,
BIOTRONIK 434901 PK PAPYRUS 4MMX26MM,C1874,HCPCS,,79013205,CDM,278,RC,,,both,,,8910,3516.49,39.4668,,3516.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Device,3029.4,34,"Charges > $500, x 34%",3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3564,40,,3564,percent of total billed charges,Implant Devices,3118.5,70,,3118.5,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3029.4,34,"If Charge > 2,000, then 34 percent",3029.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3564,
BIOTRONIK 434897 PK PAPYRUS 4.5MMX20MM,C1874,HCPCS,,79013206,CDM,278,RC,,,both,,,8910,3516.49,39.4668,,3516.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Device,3029.4,34,"Charges > $500, x 34%",3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3564,40,,3564,percent of total billed charges,Implant Devices,3118.5,70,,3118.5,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3029.4,34,"If Charge > 2,000, then 34 percent",3029.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3564,
BIOTRONIK 434903 PK PAPYRUS 5MMX26MM,C1874,HCPCS,,79013207,CDM,278,RC,,,both,,,8910,3516.49,39.4668,,3516.49,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3029.4,34,,3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Device,3029.4,34,"Charges > $500, x 34%",3029.4,percent of total billed charges,Implant Device,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3564,40,,3564,percent of total billed charges,Implant Devices,3118.5,70,,3118.5,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3029.4,34,,3029.4,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,3118.5,35,,3118.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3029.4,34,"If Charge > 2,000, then 34 percent",3029.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3564,
GORE BXA093901A VBX VIABAHN 9X38MM STENT,C1874,HCPCS,,79013403,CDM,278,RC,,,both,,,11541,4554.86,39.4668,,4554.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,4039.35,35,,4039.35,percent of total billed charges,Implant Device,3923.94,34,"Charges > $500, x 34%",3923.94,percent of total billed charges,Implant Device,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4616.4,40,,4616.4,percent of total billed charges,Implant Devices,4039.35,70,,4039.35,percent of total billed charges,Implant Devices,3923.94,34,,3923.94,percent of total billed charges,Implant Devices,3923.94,34,,3923.94,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3923.94,34,"If Charge > 2,000, then 34 percent",3923.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4616.4,
GORE BXA095901A VBX VIABAHN 9X59MM STENT,C1874,HCPCS,,79013404,CDM,278,RC,,,both,,,11541,4554.86,39.4668,,4554.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,4039.35,35,,4039.35,percent of total billed charges,Implant Device,3923.94,34,"Charges > $500, x 34%",3923.94,percent of total billed charges,Implant Device,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4616.4,40,,4616.4,percent of total billed charges,Implant Devices,4039.35,70,,4039.35,percent of total billed charges,Implant Devices,3923.94,34,,3923.94,percent of total billed charges,Implant Devices,3923.94,34,,3923.94,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3923.94,34,"If Charge > 2,000, then 34 percent",3923.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4616.4,
GORE BXA113901A VIABAHN 11X39MM STENT,C1874,HCPCS,,79013405,CDM,278,RC,,,both,,,11541,4554.86,39.4668,,4554.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,4039.35,35,,4039.35,percent of total billed charges,Implant Device,3923.94,34,"Charges > $500, x 34%",3923.94,percent of total billed charges,Implant Device,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4616.4,40,,4616.4,percent of total billed charges,Implant Devices,4039.35,70,,4039.35,percent of total billed charges,Implant Devices,3923.94,34,,3923.94,percent of total billed charges,Implant Devices,3923.94,34,,3923.94,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3923.94,34,"If Charge > 2,000, then 34 percent",3923.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4616.4,
GORE BXA115901A VIABAHN 11X59MM STENT,C1874,HCPCS,,79013406,CDM,278,RC,,,both,,,11541,4554.86,39.4668,,4554.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,3923.94,34,,3923.94,percent of total billed charges,Implant Device,4039.35,35,,4039.35,percent of total billed charges,Implant Device,3923.94,34,"Charges > $500, x 34%",3923.94,percent of total billed charges,Implant Device,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4616.4,40,,4616.4,percent of total billed charges,Implant Devices,4039.35,70,,4039.35,percent of total billed charges,Implant Devices,3923.94,34,,3923.94,percent of total billed charges,Implant Devices,3923.94,34,,3923.94,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,4039.35,35,,4039.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3923.94,34,"If Charge > 2,000, then 34 percent",3923.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4616.4,
BOST H7493929460061 6X60X130 ELU STENT,C1874,HCPCS,,79013428,CDM,278,RC,,,both,,,6825,2693.61,39.4668,,2693.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2388.75,35,,2388.75,percent of total billed charges,Implant Device,2320.5,34,"Charges > $500, x 34%",2320.5,percent of total billed charges,Implant Device,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2730,40,,2730,percent of total billed charges,Implant Devices,2388.75,70,,2388.75,percent of total billed charges,Implant Devices,2320.5,34,,2320.5,percent of total billed charges,Implant Devices,2320.5,34,,2320.5,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2320.5,34,"If Charge > 2,000, then 34 percent",2320.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2730,
BOST H7493929460151 6X150X130 ELU STENT,C1874,HCPCS,,79013429,CDM,278,RC,,,both,,,11085,4374.89,39.4668,,4374.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3768.9,34,,3768.9,percent of total billed charges,Implant Device,3879.75,35,,3879.75,percent of total billed charges,Implant Device,3768.9,34,"Charges > $500, x 34%",3768.9,percent of total billed charges,Implant Device,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,4434,40,,4434,percent of total billed charges,Implant Devices,3879.75,70,,3879.75,percent of total billed charges,Implant Devices,3768.9,34,,3768.9,percent of total billed charges,Implant Devices,3768.9,34,,3768.9,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,3879.75,35,,3879.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3768.9,34,"If Charge > 2,000, then 34 percent",3768.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4434,
BOST H7493929470061 7X60X130 ELU STENT,C1874,HCPCS,,79013430,CDM,278,RC,,,both,,,6825,2693.61,39.4668,,2693.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2320.5,34,,2320.5,percent of total billed charges,Implant Device,2388.75,35,,2388.75,percent of total billed charges,Implant Device,2320.5,34,"Charges > $500, x 34%",2320.5,percent of total billed charges,Implant Device,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2730,40,,2730,percent of total billed charges,Implant Devices,2388.75,70,,2388.75,percent of total billed charges,Implant Devices,2320.5,34,,2320.5,percent of total billed charges,Implant Devices,2320.5,34,,2320.5,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,2388.75,35,,2388.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2320.5,34,"If Charge > 2,000, then 34 percent",2320.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2730,
BARD LSMU1350616 5X26X135 COVERED STENT,C1874,HCPCS,,79013553,CDM,278,RC,,,both,,,7350,2900.81,39.4668,,2900.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Device,2499,34,"Charges > $500, x 34%",2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2940,40,,2940,percent of total billed charges,Implant Devices,2572.5,70,,2572.5,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2499,34,"If Charge > 2,000, then 34 percent",2499,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
BARD LSMU1350526 6X16X135 COVERED STENT,C1874,HCPCS,,79013554,CDM,278,RC,,,both,,,7350,2900.81,39.4668,,2900.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2499,34,,2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Device,2499,34,"Charges > $500, x 34%",2499,percent of total billed charges,Implant Device,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2940,40,,2940,percent of total billed charges,Implant Devices,2572.5,70,,2572.5,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2499,34,,2499,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,2572.5,35,,2572.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2499,34,"If Charge > 2,000, then 34 percent",2499,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2940,
BARD FTM10040 FLUENCY COVERED STENT,C1875,HCPCS,,79000063,CDM,278,RC,,,both,,,8142,3213.39,39.4668,,3213.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2768.28,34,,2768.28,percent of total billed charges,Implant Device,2849.7,35,,2849.7,percent of total billed charges,Implant Device,2768.28,34,"Charges > $500, x 34%",2768.28,percent of total billed charges,Implant Device,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,3256.8,40,,3256.8,percent of total billed charges,Implant Devices,2849.7,70,,2849.7,percent of total billed charges,Implant Devices,2768.28,34,,2768.28,percent of total billed charges,Implant Devices,2768.28,34,,2768.28,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,2849.7,35,,2849.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2768.28,34,"If Charge > 2,000, then 34 percent",2768.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3256.8,
BARD FAS09050 FLAIR STR COVERED STENT,C1875,HCPCS,,79000259,CDM,278,RC,,,both,,,7486,2954.48,39.4668,,2954.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2545.24,34,,2545.24,percent of total billed charges,Implant Device,2545.24,34,,2545.24,percent of total billed charges,Implant Device,2545.24,34,,2545.24,percent of total billed charges,Implant Device,2545.24,34,,2545.24,percent of total billed charges,Implant Device,2545.24,34,,2545.24,percent of total billed charges,Implant Device,2545.24,34,,2545.24,percent of total billed charges,Implant Device,2620.1,35,,2620.1,percent of total billed charges,Implant Device,2545.24,34,"Charges > $500, x 34%",2545.24,percent of total billed charges,Implant Device,2620.1,35,,2620.1,percent of total billed charges,Implant Devices,2620.1,35,,2620.1,percent of total billed charges,Implant Devices,2620.1,35,,,percent of total billed charges,Implant Devices,2620.1,35,,2620.1,percent of total billed charges,Implant Devices,2620.1,35,,2620.1,percent of total billed charges,Implant Devices,2994.4,40,,2994.4,percent of total billed charges,Implant Devices,2620.1,70,,2620.1,percent of total billed charges,Implant Devices,2545.24,34,,2545.24,percent of total billed charges,Implant Devices,2545.24,34,,2545.24,percent of total billed charges,Implant Devices,2620.1,35,,2620.1,percent of total billed charges,Implant Devices,2620.1,35,,2620.1,percent of total billed charges,Implant Devices,2620.1,35,,2620.1,percent of total billed charges,Implant Devices,2620.1,35,,2620.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2545.24,34,"If Charge > 2,000, then 34 percent",2545.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2994.4,
SUTURE EXPRESS B3837 STENT 4 X 26,C1875,HCPCS,,79001718,CDM,278,RC,,,both,,,409,161.42,39.4668,,161.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,139.06,34,,139.06,percent of total billed charges,Implant Device,139.06,34,,139.06,percent of total billed charges,Implant Device,139.06,34,,139.06,percent of total billed charges,Implant Device,139.06,34,,139.06,percent of total billed charges,Implant Device,139.06,34,,139.06,percent of total billed charges,Implant Device,139.06,34,,139.06,percent of total billed charges,Implant Device,143.15,35,,143.15,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,163.6,40,,163.6,percent of total billed charges,Implant Devices,143.15,70,,143.15,percent of total billed charges,Implant Devices,139.06,34,,139.06,percent of total billed charges,Implant Devices,139.06,34,,139.06,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,143.15,35,,143.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,163.6,
BOST SCI 192-123 STENT 5 X 26,C1875,HCPCS,,79001719,CDM,278,RC,,,both,,,431,170.1,39.4668,,170.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,172.4,40,,172.4,percent of total billed charges,Implant Devices,150.85,70,,150.85,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.4,
BOST SCI 192-124 STENT 5 X 28,C1875,HCPCS,,79001720,CDM,278,RC,,,both,,,431,170.1,39.4668,,170.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,172.4,40,,172.4,percent of total billed charges,Implant Devices,150.85,70,,150.85,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.4,
BOST SCI 192-122 STENT 5 X24,C1875,HCPCS,,79001721,CDM,278,RC,,,both,,,431,170.1,39.4668,,170.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,172.4,40,,172.4,percent of total billed charges,Implant Devices,150.85,70,,150.85,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.4,
BOST SCI 192-131 STENT 6 X 22 POLARIS,C1875,HCPCS,,79001722,CDM,278,RC,,,both,,,431,170.1,39.4668,,170.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,172.4,40,,172.4,percent of total billed charges,Implant Devices,150.85,70,,150.85,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.4,
BOST SCI 192-132 STENT 6 X 24 POLARIS,C1875,HCPCS,,79001723,CDM,278,RC,,,both,,,431,170.1,39.4668,,170.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,172.4,40,,172.4,percent of total billed charges,Implant Devices,150.85,70,,150.85,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.4,
BOST SCI 192-133 STENT 6 X 26 POLARIS,C1875,HCPCS,,79001724,CDM,278,RC,,,both,,,431,170.1,39.4668,,170.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,172.4,40,,172.4,percent of total billed charges,Implant Devices,150.85,70,,150.85,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.4,
BOST SCI 192-134 STENT 6 X 28 POLARIS,C1875,HCPCS,,79001725,CDM,278,RC,,,both,,,427,168.52,39.4668,,168.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,170.8,40,,170.8,percent of total billed charges,Implant Devices,149.45,70,,149.45,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.8,
BOST SCI 192-143 STENT 7 X 26,C1875,HCPCS,,79001726,CDM,278,RC,,,both,,,427,168.52,39.4668,,168.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,145.18,34,,145.18,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,170.8,40,,170.8,percent of total billed charges,Implant Devices,149.45,70,,149.45,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,145.18,34,,145.18,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,149.45,35,,149.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.8,
BOST SCI 192-151 STENT 8 X 22 POLARIS,C1875,HCPCS,,79001727,CDM,278,RC,,,both,,,431,170.1,39.4668,,170.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,172.4,40,,172.4,percent of total billed charges,Implant Devices,150.85,70,,150.85,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.4,
BOST SCI 192-152 STENT 8 X 24 POLARIS,C1875,HCPCS,,79001728,CDM,278,RC,,,both,,,431,170.1,39.4668,,170.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,172.4,40,,172.4,percent of total billed charges,Implant Devices,150.85,70,,150.85,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.4,
BOST SCI 192-153 STENT 8 X 26 POLARIS,C1875,HCPCS,,79001729,CDM,278,RC,,,both,,,431,170.1,39.4668,,170.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,172.4,40,,172.4,percent of total billed charges,Implant Devices,150.85,70,,150.85,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.4,
EV3 PXB35-10-27-080 VISI-PRO STENT,C1876,HCPCS,,79000058,CDM,278,RC,,,both,,,3119,1230.97,39.4668,,1230.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Device,1060.46,34,"Charges > $500, x 34%",1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1247.6,40,,1247.6,percent of total billed charges,Implant Devices,1091.65,70,,1091.65,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1060.46,34,"If Charge > 2,000, then 34 percent",1060.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1247.6,
EV3 SERB65-10-40-80 PROTOGE STENT,C1876,HCPCS,,79000062,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 SERB65-10-60-80 PROTOGE STENT,C1876,HCPCS,,79000065,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
EV3 SERB65-12-40-80 PROTOGE STENT,C1876,HCPCS,,79000074,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
J&J C12040SB 12X40X80 SMARTSTENT,C1876,HCPCS,,79000075,CDM,278,RC,,,both,,,4607,1818.24,39.4668,,1818.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1612.45,35,,1612.45,percent of total billed charges,Implant Device,1566.38,34,"Charges > $500, x 34%",1566.38,percent of total billed charges,Implant Device,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1842.8,40,,1842.8,percent of total billed charges,Implant Devices,1612.45,70,,1612.45,percent of total billed charges,Implant Devices,1566.38,34,,1566.38,percent of total billed charges,Implant Devices,1566.38,34,,1566.38,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1566.38,34,"If Charge > 2,000, then 34 percent",1566.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1842.8,
J&J C12060SB 12X60X80 SMARTSTENT,C1876,HCPCS,,79000076,CDM,278,RC,,,both,,,2584,1019.82,39.4668,,1019.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,878.56,34,,878.56,percent of total billed charges,Implant Device,878.56,34,,878.56,percent of total billed charges,Implant Device,878.56,34,,878.56,percent of total billed charges,Implant Device,878.56,34,,878.56,percent of total billed charges,Implant Device,878.56,34,,878.56,percent of total billed charges,Implant Device,878.56,34,,878.56,percent of total billed charges,Implant Device,904.4,35,,904.4,percent of total billed charges,Implant Device,878.56,34,"Charges > $500, x 34%",878.56,percent of total billed charges,Implant Device,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,1033.6,40,,1033.6,percent of total billed charges,Implant Devices,904.4,70,,904.4,percent of total billed charges,Implant Devices,878.56,34,,878.56,percent of total billed charges,Implant Devices,878.56,34,,878.56,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,904.4,35,,904.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,878.56,34,"If Charge > 2,000, then 34 percent",878.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1033.6,
J&J C14040SB 14X40X80 SMARTSTENT,C1876,HCPCS,,79000081,CDM,278,RC,,,both,,,4607,1818.24,39.4668,,1818.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1566.38,34,,1566.38,percent of total billed charges,Implant Device,1612.45,35,,1612.45,percent of total billed charges,Implant Device,1566.38,34,"Charges > $500, x 34%",1566.38,percent of total billed charges,Implant Device,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1842.8,40,,1842.8,percent of total billed charges,Implant Devices,1612.45,70,,1612.45,percent of total billed charges,Implant Devices,1566.38,34,,1566.38,percent of total billed charges,Implant Devices,1566.38,34,,1566.38,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,1612.45,35,,1612.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1566.38,34,"If Charge > 2,000, then 34 percent",1566.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1842.8,
BOST SCI 37911-41515 EXPRESS SD STENT,C1876,HCPCS,,79000115,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
BOST SCI 37912-51915 EXPRESS RENAL STENT,C1876,HCPCS,,79000157,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
EV3 PRB35-05-080-120 EVERFLEX STENT,C1876,HCPCS,,79000162,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
J&J C06120MB SMART CONTROL STENT,C1876,HCPCS,,79000185,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
BARD EX061203CS 6X120X130 LIFE STENT,C1876,HCPCS,,79000186,CDM,278,RC,,,both,,,3750,1480.01,39.4668,,1480.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1275,34,,1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Device,1275,34,"Charges > $500, x 34%",1275,percent of total billed charges,Implant Device,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1500,40,,1500,percent of total billed charges,Implant Devices,1312.5,70,,1312.5,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1275,34,,1275,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,1312.5,35,,1312.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1275,34,"If Charge > 2,000, then 34 percent",1275,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
BARD EX061503CS 6X150X130 LIFESTENT XL,C1876,HCPCS,,79000188,CDM,278,RC,,,both,,,4350,1716.81,39.4668,,1716.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1522.5,35,,1522.5,percent of total billed charges,Implant Device,1479,34,"Charges > $500, x 34%",1479,percent of total billed charges,Implant Device,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1740,40,,1740,percent of total billed charges,Implant Devices,1522.5,70,,1522.5,percent of total billed charges,Implant Devices,1479,34,,1479,percent of total billed charges,Implant Devices,1479,34,,1479,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1479,34,"If Charge > 2,000, then 34 percent",1479,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1740,
BARD EX061703CS 6X170X130 LIFESTENT XL,C1876,HCPCS,,79000191,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
BOST SCI 37912-61815 EXPRESS RENAL STENT,C1876,HCPCS,,79000192,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
BOST SCI 38046-64075 EXPRESS STENT,C1876,HCPCS,,79000197,CDM,278,RC,,,both,,,3851,1519.87,39.4668,,1519.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1309.34,34,,1309.34,percent of total billed charges,Implant Device,1309.34,34,,1309.34,percent of total billed charges,Implant Device,1309.34,34,,1309.34,percent of total billed charges,Implant Device,1309.34,34,,1309.34,percent of total billed charges,Implant Device,1309.34,34,,1309.34,percent of total billed charges,Implant Device,1309.34,34,,1309.34,percent of total billed charges,Implant Device,1347.85,35,,1347.85,percent of total billed charges,Implant Device,1309.34,34,"Charges > $500, x 34%",1309.34,percent of total billed charges,Implant Device,1347.85,35,,1347.85,percent of total billed charges,Implant Devices,1347.85,35,,1347.85,percent of total billed charges,Implant Devices,1347.85,35,,,percent of total billed charges,Implant Devices,1347.85,35,,1347.85,percent of total billed charges,Implant Devices,1347.85,35,,1347.85,percent of total billed charges,Implant Devices,1540.4,40,,1540.4,percent of total billed charges,Implant Devices,1347.85,70,,1347.85,percent of total billed charges,Implant Devices,1309.34,34,,1309.34,percent of total billed charges,Implant Devices,1309.34,34,,1309.34,percent of total billed charges,Implant Devices,1347.85,35,,1347.85,percent of total billed charges,Implant Devices,1347.85,35,,1347.85,percent of total billed charges,Implant Devices,1347.85,35,,1347.85,percent of total billed charges,Implant Devices,1347.85,35,,1347.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1309.34,34,"If Charge > 2,000, then 34 percent",1309.34,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1540.4,
EV3 PRB35-06-040-120 EVERFLEX STENT,C1876,HCPCS,,79000198,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
J&J C06040SL 6X40X80 SMARTSTENT,C1876,HCPCS,,79000200,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
BARD EX060603CS 6X60X130 LIFE STENT,C1876,HCPCS,,79000201,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
J&J C06060SL 6X60X80 SMARTSTENT,C1876,HCPCS,,79000202,CDM,278,RC,,,both,,,4343,1714.04,39.4668,,1714.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1476.62,34,,1476.62,percent of total billed charges,Implant Device,1520.05,35,,1520.05,percent of total billed charges,Implant Device,1476.62,34,"Charges > $500, x 34%",1476.62,percent of total billed charges,Implant Device,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1737.2,40,,1737.2,percent of total billed charges,Implant Devices,1520.05,70,,1520.05,percent of total billed charges,Implant Devices,1476.62,34,,1476.62,percent of total billed charges,Implant Devices,1476.62,34,,1476.62,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,1520.05,35,,1520.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1476.62,34,"If Charge > 2,000, then 34 percent",1476.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1737.2,
BARD EX071503CS 7X150X130 LIFE STENT,C1876,HCPCS,,79000216,CDM,278,RC,,,both,,,4350,1716.81,39.4668,,1716.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1479,34,,1479,percent of total billed charges,Implant Device,1522.5,35,,1522.5,percent of total billed charges,Implant Device,1479,34,"Charges > $500, x 34%",1479,percent of total billed charges,Implant Device,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1740,40,,1740,percent of total billed charges,Implant Devices,1522.5,70,,1522.5,percent of total billed charges,Implant Devices,1479,34,,1479,percent of total billed charges,Implant Devices,1479,34,,1479,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,1522.5,35,,1522.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1479,34,"If Charge > 2,000, then 34 percent",1479,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1740,
BOST SCI 37911-71515 7X15 EXPRESS STENT,C1876,HCPCS,,79000219,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
BARD EX071703CS 7X170X130CM LIFE STENT,C1876,HCPCS,,79000220,CDM,278,RC,,,both,,,5100,2012.81,39.4668,,2012.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1734,34,,1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Device,1734,34,"Charges > $500, x 34%",1734,percent of total billed charges,Implant Device,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,2040,40,,2040,percent of total billed charges,Implant Devices,1785,70,,1785,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1734,34,,1734,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,1785,35,,1785,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1734,34,"If Charge > 2,000, then 34 percent",1734,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2040,
J&J C07030ML 7X30X80 SMARTSTENT,C1876,HCPCS,,79000222,CDM,278,RC,,,both,,,4429,1747.98,39.4668,,1747.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1550.15,35,,1550.15,percent of total billed charges,Implant Device,1505.86,34,"Charges > $500, x 34%",1505.86,percent of total billed charges,Implant Device,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1771.6,40,,1771.6,percent of total billed charges,Implant Devices,1550.15,70,,1550.15,percent of total billed charges,Implant Devices,1505.86,34,,1505.86,percent of total billed charges,Implant Devices,1505.86,34,,1505.86,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1505.86,34,"If Charge > 2,000, then 34 percent",1505.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1771.6,
J&J C07080ML 7X80 SMARTSTENT,C1876,HCPCS,,79000229,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J C08100ML 8X100X125 SMARTSTENT,C1876,HCPCS,,79000241,CDM,278,RC,,,both,,,5587,2205.01,39.4668,,2205.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1899.58,34,,1899.58,percent of total billed charges,Implant Device,1899.58,34,,1899.58,percent of total billed charges,Implant Device,1899.58,34,,1899.58,percent of total billed charges,Implant Device,1899.58,34,,1899.58,percent of total billed charges,Implant Device,1899.58,34,,1899.58,percent of total billed charges,Implant Device,1899.58,34,,1899.58,percent of total billed charges,Implant Device,1955.45,35,,1955.45,percent of total billed charges,Implant Device,1899.58,34,"Charges > $500, x 34%",1899.58,percent of total billed charges,Implant Device,1955.45,35,,1955.45,percent of total billed charges,Implant Devices,1955.45,35,,1955.45,percent of total billed charges,Implant Devices,1955.45,35,,,percent of total billed charges,Implant Devices,1955.45,35,,1955.45,percent of total billed charges,Implant Devices,1955.45,35,,1955.45,percent of total billed charges,Implant Devices,2234.8,40,,2234.8,percent of total billed charges,Implant Devices,1955.45,70,,1955.45,percent of total billed charges,Implant Devices,1899.58,34,,1899.58,percent of total billed charges,Implant Devices,1899.58,34,,1899.58,percent of total billed charges,Implant Devices,1955.45,35,,1955.45,percent of total billed charges,Implant Devices,1955.45,35,,1955.45,percent of total billed charges,Implant Devices,1955.45,35,,1955.45,percent of total billed charges,Implant Devices,1955.45,35,,1955.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1899.58,34,"If Charge > 2,000, then 34 percent",1899.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2234.8,
EV3 PXB35-08-27-080 8X27X80 VISPRO STENT,C1876,HCPCS,,79000243,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
J&J C08030SL 8X30X80 SMARTSTENT,C1876,HCPCS,,79000244,CDM,278,RC,,,both,,,4429,1747.98,39.4668,,1747.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1550.15,35,,1550.15,percent of total billed charges,Implant Device,1505.86,34,"Charges > $500, x 34%",1505.86,percent of total billed charges,Implant Device,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1771.6,40,,1771.6,percent of total billed charges,Implant Devices,1550.15,70,,1550.15,percent of total billed charges,Implant Devices,1505.86,34,,1505.86,percent of total billed charges,Implant Devices,1505.86,34,,1505.86,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1505.86,34,"If Charge > 2,000, then 34 percent",1505.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1771.6,
J&J C08040MB SMARTSTENT 8X40X120CM,C1876,HCPCS,,79000245,CDM,278,RC,,,both,,,2027,799.99,39.4668,,799.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Device,689.18,34,"Charges > $500, x 34%",689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,810.8,40,,810.8,percent of total billed charges,Implant Devices,709.45,70,,709.45,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,689.18,34,"If Charge > 2,000, then 34 percent",689.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,810.8,
EV3 PRB35-08-080-080 EVERFLEXT STENT,C1876,HCPCS,,79000249,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
EV3 SERB65-09-60-80 PROTOGE GPS STENT,C1876,HCPCS,,79000260,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-08-060-080 EVERFLEX STENT,C1876,HCPCS,,79000351,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
BOST SCI 38046-83075 EXPRESS STENT 8X75,C1876,HCPCS,,79000352,CDM,278,RC,,,both,,,3575,1410.94,39.4668,,1410.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Device,1215.5,34,"Charges > $500, x 34%",1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1430,40,,1430,percent of total billed charges,Implant Devices,1251.25,70,,1251.25,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1215.5,34,"If Charge > 2,000, then 34 percent",1215.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1430,
BOST SCI 37911-61415 EXPRESS SD STENT,C1876,HCPCS,,79000353,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
BOST SCI 38046-10407 EXPRESS STENT 10X37,C1876,HCPCS,,79000354,CDM,278,RC,,,both,,,3575,1410.94,39.4668,,1410.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Device,1215.5,34,"Charges > $500, x 34%",1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1430,40,,1430,percent of total billed charges,Implant Devices,1251.25,70,,1251.25,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1215.5,34,"If Charge > 2,000, then 34 percent",1215.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1430,
BOST SCI 38046-84075 EXPRESS STENT 8X75,C1876,HCPCS,,79000355,CDM,278,RC,,,both,,,3575,1410.94,39.4668,,1410.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Device,1215.5,34,"Charges > $500, x 34%",1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1430,40,,1430,percent of total billed charges,Implant Devices,1251.25,70,,1251.25,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1215.5,34,"If Charge > 2,000, then 34 percent",1215.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1430,
BOST SCI 38046-86075 EXPRESS STENT,C1876,HCPCS,,79000356,CDM,278,RC,,,both,,,4126,1628.4,39.4668,,1628.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1402.84,34,,1402.84,percent of total billed charges,Implant Device,1402.84,34,,1402.84,percent of total billed charges,Implant Device,1402.84,34,,1402.84,percent of total billed charges,Implant Device,1402.84,34,,1402.84,percent of total billed charges,Implant Device,1402.84,34,,1402.84,percent of total billed charges,Implant Device,1402.84,34,,1402.84,percent of total billed charges,Implant Device,1444.1,35,,1444.1,percent of total billed charges,Implant Device,1402.84,34,"Charges > $500, x 34%",1402.84,percent of total billed charges,Implant Device,1444.1,35,,1444.1,percent of total billed charges,Implant Devices,1444.1,35,,1444.1,percent of total billed charges,Implant Devices,1444.1,35,,,percent of total billed charges,Implant Devices,1444.1,35,,1444.1,percent of total billed charges,Implant Devices,1444.1,35,,1444.1,percent of total billed charges,Implant Devices,1650.4,40,,1650.4,percent of total billed charges,Implant Devices,1444.1,70,,1444.1,percent of total billed charges,Implant Devices,1402.84,34,,1402.84,percent of total billed charges,Implant Devices,1402.84,34,,1402.84,percent of total billed charges,Implant Devices,1444.1,35,,1444.1,percent of total billed charges,Implant Devices,1444.1,35,,1444.1,percent of total billed charges,Implant Devices,1444.1,35,,1444.1,percent of total billed charges,Implant Devices,1444.1,35,,1444.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1402.84,34,"If Charge > 2,000, then 34 percent",1402.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1650.4,
J&J P5010 PALMZ STENT 10MM X 50MM,C1876,HCPCS,,79000442,CDM,278,RC,,,both,,,4295,1695.1,39.4668,,1695.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1460.3,34,,1460.3,percent of total billed charges,Implant Device,1460.3,34,,1460.3,percent of total billed charges,Implant Device,1460.3,34,,1460.3,percent of total billed charges,Implant Device,1460.3,34,,1460.3,percent of total billed charges,Implant Device,1460.3,34,,1460.3,percent of total billed charges,Implant Device,1460.3,34,,1460.3,percent of total billed charges,Implant Device,1503.25,35,,1503.25,percent of total billed charges,Implant Device,1460.3,34,"Charges > $500, x 34%",1460.3,percent of total billed charges,Implant Device,1503.25,35,,1503.25,percent of total billed charges,Implant Devices,1503.25,35,,1503.25,percent of total billed charges,Implant Devices,1503.25,35,,,percent of total billed charges,Implant Devices,1503.25,35,,1503.25,percent of total billed charges,Implant Devices,1503.25,35,,1503.25,percent of total billed charges,Implant Devices,1718,40,,1718,percent of total billed charges,Implant Devices,1503.25,70,,1503.25,percent of total billed charges,Implant Devices,1460.3,34,,1460.3,percent of total billed charges,Implant Devices,1460.3,34,,1460.3,percent of total billed charges,Implant Devices,1503.25,35,,1503.25,percent of total billed charges,Implant Devices,1503.25,35,,1503.25,percent of total billed charges,Implant Devices,1503.25,35,,1503.25,percent of total billed charges,Implant Devices,1503.25,35,,1503.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1460.3,34,"If Charge > 2,000, then 34 percent",1460.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1718,
EV3 SERB65-09-40-80 PROTEGE 6FR 9X40X80,C1876,HCPCS,,79000459,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-06-100-120 PROTEGE EVERFLEX,C1876,HCPCS,,79000460,CDM,278,RC,,,both,,,5070,2000.97,39.4668,,2000.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1774.5,35,,1774.5,percent of total billed charges,Implant Device,1723.8,34,"Charges > $500, x 34%",1723.8,percent of total billed charges,Implant Device,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,2028,40,,2028,percent of total billed charges,Implant Devices,1774.5,70,,1774.5,percent of total billed charges,Implant Devices,1723.8,34,,1723.8,percent of total billed charges,Implant Devices,1723.8,34,,1723.8,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1723.8,34,"If Charge > 2,000, then 34 percent",1723.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2028,
EV3 PRB35-06-120-120 PROTEGE EVERFLEX,C1876,HCPCS,,79000461,CDM,278,RC,,,both,,,4950,1953.61,39.4668,,1953.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Device,1683,34,"Charges > $500, x 34%",1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1980,40,,1980,percent of total billed charges,Implant Devices,1732.5,70,,1732.5,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1683,34,"If Charge > 2,000, then 34 percent",1683,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1980,
EV3 PRB35-06-150-120 PROTEGE EVERFLEX,C1876,HCPCS,,79000462,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
EV3 PRB35-06-060-120 PROTEGE EVERFLEX,C1876,HCPCS,,79000463,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
EV3 PRB35-06-080-120 PROTEGE EVERFLEX,C1876,HCPCS,,79000464,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-07-120-120 PROTEGE EVERFLEX,C1876,HCPCS,,79000465,CDM,278,RC,,,both,,,4950,1953.61,39.4668,,1953.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Device,1683,34,"Charges > $500, x 34%",1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1980,40,,1980,percent of total billed charges,Implant Devices,1732.5,70,,1732.5,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1683,34,"If Charge > 2,000, then 34 percent",1683,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1980,
EV3 PRB35-07-150-120 PROTEGE EVERFLEX,C1876,HCPCS,,79000466,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2160,
EV3 PRB35-07-040-080 PROTEGE EVERFLEX,C1876,HCPCS,,79000467,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
EV3 PRB35-07-060-120 PROTEGE EVERFLEX,C1876,HCPCS,,79000468,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-07-060-080 PROTEGE EVERFLEX,C1876,HCPCS,,79000469,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
EV3 PRB35-08-030-080 PROTEGE EVERFLEX,C1876,HCPCS,,79000470,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-08-040-080 PROTEGE EVERFLEX,C1876,HCPCS,,79000471,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
J&J PG2910BPS GENESIS STENT AVIATOR10X29,C1876,HCPCS,,79000481,CDM,278,RC,,,both,,,3506,1383.71,39.4668,,1383.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1227.1,35,,1227.1,percent of total billed charges,Implant Device,1192.04,34,"Charges > $500, x 34%",1192.04,percent of total billed charges,Implant Device,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1402.4,40,,1402.4,percent of total billed charges,Implant Devices,1227.1,70,,1227.1,percent of total billed charges,Implant Devices,1192.04,34,,1192.04,percent of total billed charges,Implant Devices,1192.04,34,,1192.04,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1192.04,34,"If Charge > 2,000, then 34 percent",1192.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1402.4,
J&J PG2450BAX GENESIS STENT AVIATOR 5X24,C1876,HCPCS,,79000482,CDM,278,RC,,,both,,,3812,1504.47,39.4668,,1504.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1334.2,35,,1334.2,percent of total billed charges,Implant Device,1296.08,34,"Charges > $500, x 34%",1296.08,percent of total billed charges,Implant Device,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1524.8,40,,1524.8,percent of total billed charges,Implant Devices,1334.2,70,,1334.2,percent of total billed charges,Implant Devices,1296.08,34,,1296.08,percent of total billed charges,Implant Devices,1296.08,34,,1296.08,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1296.08,34,"If Charge > 2,000, then 34 percent",1296.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1524.8,
J&J PG2460BAX GENESIS STENT AVIATOR 6X24,C1876,HCPCS,,79000483,CDM,278,RC,,,both,,,3812,1504.47,39.4668,,1504.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1334.2,35,,1334.2,percent of total billed charges,Implant Device,1296.08,34,"Charges > $500, x 34%",1296.08,percent of total billed charges,Implant Device,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1524.8,40,,1524.8,percent of total billed charges,Implant Devices,1334.2,70,,1334.2,percent of total billed charges,Implant Devices,1296.08,34,,1296.08,percent of total billed charges,Implant Devices,1296.08,34,,1296.08,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1296.08,34,"If Charge > 2,000, then 34 percent",1296.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1524.8,
J&J PG2960BPS GENESIS STENT AVIATOR 6X29,C1876,HCPCS,,79000484,CDM,278,RC,,,both,,,3506,1383.71,39.4668,,1383.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1227.1,35,,1227.1,percent of total billed charges,Implant Device,1192.04,34,"Charges > $500, x 34%",1192.04,percent of total billed charges,Implant Device,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1402.4,40,,1402.4,percent of total billed charges,Implant Devices,1227.1,70,,1227.1,percent of total billed charges,Implant Devices,1192.04,34,,1192.04,percent of total billed charges,Implant Devices,1192.04,34,,1192.04,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1192.04,34,"If Charge > 2,000, then 34 percent",1192.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1402.4,
J&J PG1870BAX GENESIS STENT AVIATOR 7X18,C1876,HCPCS,,79000485,CDM,278,RC,,,both,,,3761,1484.35,39.4668,,1484.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1278.74,34,,1278.74,percent of total billed charges,Implant Device,1278.74,34,,1278.74,percent of total billed charges,Implant Device,1278.74,34,,1278.74,percent of total billed charges,Implant Device,1278.74,34,,1278.74,percent of total billed charges,Implant Device,1278.74,34,,1278.74,percent of total billed charges,Implant Device,1278.74,34,,1278.74,percent of total billed charges,Implant Device,1316.35,35,,1316.35,percent of total billed charges,Implant Device,1278.74,34,"Charges > $500, x 34%",1278.74,percent of total billed charges,Implant Device,1316.35,35,,1316.35,percent of total billed charges,Implant Devices,1316.35,35,,1316.35,percent of total billed charges,Implant Devices,1316.35,35,,,percent of total billed charges,Implant Devices,1316.35,35,,1316.35,percent of total billed charges,Implant Devices,1316.35,35,,1316.35,percent of total billed charges,Implant Devices,1504.4,40,,1504.4,percent of total billed charges,Implant Devices,1316.35,70,,1316.35,percent of total billed charges,Implant Devices,1278.74,34,,1278.74,percent of total billed charges,Implant Devices,1278.74,34,,1278.74,percent of total billed charges,Implant Devices,1316.35,35,,1316.35,percent of total billed charges,Implant Devices,1316.35,35,,1316.35,percent of total billed charges,Implant Devices,1316.35,35,,1316.35,percent of total billed charges,Implant Devices,1316.35,35,,1316.35,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1278.74,34,"If Charge > 2,000, then 34 percent",1278.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1504.4,
J&J PG2470BAX GENESIS STENT AVIATOR 7X24,C1876,HCPCS,,79000486,CDM,278,RC,,,both,,,3812,1504.47,39.4668,,1504.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1296.08,34,,1296.08,percent of total billed charges,Implant Device,1334.2,35,,1334.2,percent of total billed charges,Implant Device,1296.08,34,"Charges > $500, x 34%",1296.08,percent of total billed charges,Implant Device,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1524.8,40,,1524.8,percent of total billed charges,Implant Devices,1334.2,70,,1334.2,percent of total billed charges,Implant Devices,1296.08,34,,1296.08,percent of total billed charges,Implant Devices,1296.08,34,,1296.08,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,1334.2,35,,1334.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1296.08,34,"If Charge > 2,000, then 34 percent",1296.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1524.8,
J&J PG2970BPS GENESIS STENT AVIATOR 7X29,C1876,HCPCS,,79000487,CDM,278,RC,,,both,,,3506,1383.71,39.4668,,1383.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1192.04,34,,1192.04,percent of total billed charges,Implant Device,1227.1,35,,1227.1,percent of total billed charges,Implant Device,1192.04,34,"Charges > $500, x 34%",1192.04,percent of total billed charges,Implant Device,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1402.4,40,,1402.4,percent of total billed charges,Implant Devices,1227.1,70,,1227.1,percent of total billed charges,Implant Devices,1192.04,34,,1192.04,percent of total billed charges,Implant Devices,1192.04,34,,1192.04,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,1227.1,35,,1227.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1192.04,34,"If Charge > 2,000, then 34 percent",1192.04,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1402.4,
J&J PG3970BPS GENESIS STENT AVIATOR 7X39,C1876,HCPCS,,79000488,CDM,278,RC,,,both,,,3557,1403.83,39.4668,,1403.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1244.95,35,,1244.95,percent of total billed charges,Implant Device,1209.38,34,"Charges > $500, x 34%",1209.38,percent of total billed charges,Implant Device,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1422.8,40,,1422.8,percent of total billed charges,Implant Devices,1244.95,70,,1244.95,percent of total billed charges,Implant Devices,1209.38,34,,1209.38,percent of total billed charges,Implant Devices,1209.38,34,,1209.38,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1209.38,34,"If Charge > 2,000, then 34 percent",1209.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1422.8,
J&J PG2980BPS GENESIS STENT AVIATOR 8X29,C1876,HCPCS,,79000489,CDM,278,RC,,,both,,,2643,1043.11,39.4668,,1043.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,898.62,34,,898.62,percent of total billed charges,Implant Device,898.62,34,,898.62,percent of total billed charges,Implant Device,898.62,34,,898.62,percent of total billed charges,Implant Device,898.62,34,,898.62,percent of total billed charges,Implant Device,898.62,34,,898.62,percent of total billed charges,Implant Device,898.62,34,,898.62,percent of total billed charges,Implant Device,925.05,35,,925.05,percent of total billed charges,Implant Device,898.62,34,"Charges > $500, x 34%",898.62,percent of total billed charges,Implant Device,925.05,35,,925.05,percent of total billed charges,Implant Devices,925.05,35,,925.05,percent of total billed charges,Implant Devices,925.05,35,,,percent of total billed charges,Implant Devices,925.05,35,,925.05,percent of total billed charges,Implant Devices,925.05,35,,925.05,percent of total billed charges,Implant Devices,1057.2,40,,1057.2,percent of total billed charges,Implant Devices,925.05,70,,925.05,percent of total billed charges,Implant Devices,898.62,34,,898.62,percent of total billed charges,Implant Devices,898.62,34,,898.62,percent of total billed charges,Implant Devices,925.05,35,,925.05,percent of total billed charges,Implant Devices,925.05,35,,925.05,percent of total billed charges,Implant Devices,925.05,35,,925.05,percent of total billed charges,Implant Devices,925.05,35,,925.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,898.62,34,"If Charge > 2,000, then 34 percent",898.62,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1057.2,
J&J PG3980BPS GENESIS STENT AVIATOR 8X39,C1876,HCPCS,,79000490,CDM,278,RC,,,both,,,3557,1403.83,39.4668,,1403.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1209.38,34,,1209.38,percent of total billed charges,Implant Device,1244.95,35,,1244.95,percent of total billed charges,Implant Device,1209.38,34,"Charges > $500, x 34%",1209.38,percent of total billed charges,Implant Device,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1422.8,40,,1422.8,percent of total billed charges,Implant Devices,1244.95,70,,1244.95,percent of total billed charges,Implant Devices,1209.38,34,,1209.38,percent of total billed charges,Implant Devices,1209.38,34,,1209.38,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,1244.95,35,,1244.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1209.38,34,"If Charge > 2,000, then 34 percent",1209.38,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1422.8,
J&J PG2990BPS GENESIS STENT AVIATOR 9X29,C1876,HCPCS,,79000491,CDM,278,RC,,,both,,,3430,1353.71,39.4668,,1353.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1166.2,34,,1166.2,percent of total billed charges,Implant Device,1200.5,35,,1200.5,percent of total billed charges,Implant Device,1166.2,34,"Charges > $500, x 34%",1166.2,percent of total billed charges,Implant Device,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1372,40,,1372,percent of total billed charges,Implant Devices,1200.5,70,,1200.5,percent of total billed charges,Implant Devices,1166.2,34,,1166.2,percent of total billed charges,Implant Devices,1166.2,34,,1166.2,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,1200.5,35,,1200.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1166.2,34,"If Charge > 2,000, then 34 percent",1166.2,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1372,
J&J C07040ML SMARTSTENT BILIARY 7X40X120,C1876,HCPCS,,79000500,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J C07040SL SMARTSTENT BILIARY 7X40X80,C1876,HCPCS,,79000501,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J C07100ML SMARTSTENT BILI 7X100X120,C1876,HCPCS,,79000502,CDM,278,RC,,,both,,,2027,799.99,39.4668,,799.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Device,689.18,34,"Charges > $500, x 34%",689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,810.8,40,,810.8,percent of total billed charges,Implant Devices,709.45,70,,709.45,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,689.18,34,"If Charge > 2,000, then 34 percent",689.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,810.8,
J&J C10040SL SMARTSTENT BILIARY 10X40X80,C1876,HCPCS,,79000503,CDM,278,RC,,,both,,,4195,1655.63,39.4668,,1655.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1468.25,35,,1468.25,percent of total billed charges,Implant Device,1426.3,34,"Charges > $500, x 34%",1426.3,percent of total billed charges,Implant Device,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1678,40,,1678,percent of total billed charges,Implant Devices,1468.25,70,,1468.25,percent of total billed charges,Implant Devices,1426.3,34,,1426.3,percent of total billed charges,Implant Devices,1426.3,34,,1426.3,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1426.3,34,"If Charge > 2,000, then 34 percent",1426.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1678,
J&J C10060SL SMARTSTENT BILIARY 10X60X80,C1876,HCPCS,,79000504,CDM,278,RC,,,both,,,4195,1655.63,39.4668,,1655.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1468.25,35,,1468.25,percent of total billed charges,Implant Device,1426.3,34,"Charges > $500, x 34%",1426.3,percent of total billed charges,Implant Device,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1678,40,,1678,percent of total billed charges,Implant Devices,1468.25,70,,1468.25,percent of total billed charges,Implant Devices,1426.3,34,,1426.3,percent of total billed charges,Implant Devices,1426.3,34,,1426.3,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1426.3,34,"If Charge > 2,000, then 34 percent",1426.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1678,
J&J C06040ML SMARTSTENT BILIARY 6X40X120,C1876,HCPCS,,79000505,CDM,278,RC,,,both,,,2027,799.99,39.4668,,799.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Device,689.18,34,"Charges > $500, x 34%",689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,810.8,40,,810.8,percent of total billed charges,Implant Devices,709.45,70,,709.45,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,689.18,34,"If Charge > 2,000, then 34 percent",689.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,810.8,
J&J C06060ML SMARTSTENT BILIARY 6X60X120,C1876,HCPCS,,79000506,CDM,278,RC,,,both,,,4195,1655.63,39.4668,,1655.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1468.25,35,,1468.25,percent of total billed charges,Implant Device,1426.3,34,"Charges > $500, x 34%",1426.3,percent of total billed charges,Implant Device,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1678,40,,1678,percent of total billed charges,Implant Devices,1468.25,70,,1468.25,percent of total billed charges,Implant Devices,1426.3,34,,1426.3,percent of total billed charges,Implant Devices,1426.3,34,,1426.3,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1426.3,34,"If Charge > 2,000, then 34 percent",1426.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1678,
J&J C06080ML SMARTSTENT BILIARY 6X80X120,C1876,HCPCS,,79000507,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J C06100ML SMARTSTENT BILARY 6X100X120,C1876,HCPCS,,79000508,CDM,278,RC,,,both,,,5291,2088.19,39.4668,,2088.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1798.94,34,,1798.94,percent of total billed charges,Implant Device,1798.94,34,,1798.94,percent of total billed charges,Implant Device,1798.94,34,,1798.94,percent of total billed charges,Implant Device,1798.94,34,,1798.94,percent of total billed charges,Implant Device,1798.94,34,,1798.94,percent of total billed charges,Implant Device,1798.94,34,,1798.94,percent of total billed charges,Implant Device,1851.85,35,,1851.85,percent of total billed charges,Implant Device,1798.94,34,"Charges > $500, x 34%",1798.94,percent of total billed charges,Implant Device,1851.85,35,,1851.85,percent of total billed charges,Implant Devices,1851.85,35,,1851.85,percent of total billed charges,Implant Devices,1851.85,35,,,percent of total billed charges,Implant Devices,1851.85,35,,1851.85,percent of total billed charges,Implant Devices,1851.85,35,,1851.85,percent of total billed charges,Implant Devices,2116.4,40,,2116.4,percent of total billed charges,Implant Devices,1851.85,70,,1851.85,percent of total billed charges,Implant Devices,1798.94,34,,1798.94,percent of total billed charges,Implant Devices,1798.94,34,,1798.94,percent of total billed charges,Implant Devices,1851.85,35,,1851.85,percent of total billed charges,Implant Devices,1851.85,35,,1851.85,percent of total billed charges,Implant Devices,1851.85,35,,1851.85,percent of total billed charges,Implant Devices,1851.85,35,,1851.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1798.94,34,"If Charge > 2,000, then 34 percent",1798.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2116.4,
J&J C06150MB SMARTSTENT BILARY 6X150X120,C1876,HCPCS,,79000509,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
J&J C07030SL SMARTSTENT BILIARY 7X30X80,C1876,HCPCS,,79000510,CDM,278,RC,,,both,,,4195,1655.63,39.4668,,1655.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1426.3,34,,1426.3,percent of total billed charges,Implant Device,1468.25,35,,1468.25,percent of total billed charges,Implant Device,1426.3,34,"Charges > $500, x 34%",1426.3,percent of total billed charges,Implant Device,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1678,40,,1678,percent of total billed charges,Implant Devices,1468.25,70,,1468.25,percent of total billed charges,Implant Devices,1426.3,34,,1426.3,percent of total billed charges,Implant Devices,1426.3,34,,1426.3,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,1468.25,35,,1468.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1426.3,34,"If Charge > 2,000, then 34 percent",1426.3,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1678,
SMART STENT BILIARY PKG ASSY 7X150X80,C1876,HCPCS,,79000511,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
J&J C08040ML SMARTSTENT BILIARY 8X40X120,C1876,HCPCS,,79000512,CDM,278,RC,,,both,,,2027,799.99,39.4668,,799.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Device,689.18,34,"Charges > $500, x 34%",689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,810.8,40,,810.8,percent of total billed charges,Implant Devices,709.45,70,,709.45,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,689.18,34,"If Charge > 2,000, then 34 percent",689.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,810.8,
J&J C08040SL SMARTSTENT BILIARY 8X40X80,C1876,HCPCS,,79000513,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J C08060SL SMARTSTENT BILIARY 8X60X80,C1876,HCPCS,,79000514,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J C08080SL SMARTSTENT BILIARY 8X80X80,C1876,HCPCS,,79000515,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J C09030SL SMARTSTENT BILIARY 9X30X80,C1876,HCPCS,,79000516,CDM,278,RC,,,both,,,2027,799.99,39.4668,,799.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Device,689.18,34,"Charges > $500, x 34%",689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,810.8,40,,810.8,percent of total billed charges,Implant Devices,709.45,70,,709.45,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,689.18,34,"If Charge > 2,000, then 34 percent",689.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,810.8,
BOST SCI 37911-51515 EXPRESS SD STENT,C1876,HCPCS,,79000522,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
BOST SCI 37912-61890 EXPRESS SD STENT,C1876,HCPCS,,79000523,CDM,278,RC,,,both,,,3600,1420.8,39.4668,,1420.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1224,34,,1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Device,1224,34,"Charges > $500, x 34%",1224,percent of total billed charges,Implant Device,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1440,40,,1440,percent of total billed charges,Implant Devices,1260,70,,1260,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1224,34,,1224,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,1260,35,,1260,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1224,34,"If Charge > 2,000, then 34 percent",1224,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1440,
BOST SCI 38046-73075 7X75 EXPRESS STENT,C1876,HCPCS,,79000524,CDM,278,RC,,,both,,,3575,1410.94,39.4668,,1410.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Device,1215.5,34,"Charges > $500, x 34%",1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1430,40,,1430,percent of total billed charges,Implant Devices,1251.25,70,,1251.25,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1215.5,34,"If Charge > 2,000, then 34 percent",1215.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1430,
MEDTRONIC ENBF2513C124E STENT,C1876,HCPCS,,79002505,CDM,278,RC,,,both,,,29926,11810.83,39.4668,,11810.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10474.1,35,,10474.1,percent of total billed charges,Implant Device,10174.84,34,"Charges > $500, x 34%",10174.84,percent of total billed charges,Implant Device,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,11970.4,40,,11970.4,percent of total billed charges,Implant Devices,10474.1,70,,10474.1,percent of total billed charges,Implant Devices,10174.84,34,,10174.84,percent of total billed charges,Implant Devices,10174.84,34,,10174.84,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10174.84,34,"If Charge > 2,000, then 34 percent",10174.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11970.4,
MEDTRONIC ENBF2816C124E STENT,C1876,HCPCS,,79002506,CDM,278,RC,,,both,,,29926,11810.83,39.4668,,11810.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10474.1,35,,10474.1,percent of total billed charges,Implant Device,10174.84,34,"Charges > $500, x 34%",10174.84,percent of total billed charges,Implant Device,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,11970.4,40,,11970.4,percent of total billed charges,Implant Devices,10474.1,70,,10474.1,percent of total billed charges,Implant Devices,10174.84,34,,10174.84,percent of total billed charges,Implant Devices,10174.84,34,,10174.84,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10174.84,34,"If Charge > 2,000, then 34 percent",10174.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11970.4,
MEDTRONIC ENBF2816C166E STENT,C1876,HCPCS,,79002507,CDM,278,RC,,,both,,,29926,11810.83,39.4668,,11810.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10474.1,35,,10474.1,percent of total billed charges,Implant Device,10174.84,34,"Charges > $500, x 34%",10174.84,percent of total billed charges,Implant Device,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,11970.4,40,,11970.4,percent of total billed charges,Implant Devices,10474.1,70,,10474.1,percent of total billed charges,Implant Devices,10174.84,34,,10174.84,percent of total billed charges,Implant Devices,10174.84,34,,10174.84,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10174.84,34,"If Charge > 2,000, then 34 percent",10174.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11970.4,
MEDTRONIC ENBF3216C145E STENT,C1876,HCPCS,,79002508,CDM,278,RC,,,both,,,29926,11810.83,39.4668,,11810.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10474.1,35,,10474.1,percent of total billed charges,Implant Device,10174.84,34,"Charges > $500, x 34%",10174.84,percent of total billed charges,Implant Device,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,11970.4,40,,11970.4,percent of total billed charges,Implant Devices,10474.1,70,,10474.1,percent of total billed charges,Implant Devices,10174.84,34,,10174.84,percent of total billed charges,Implant Devices,10174.84,34,,10174.84,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10174.84,34,"If Charge > 2,000, then 34 percent",10174.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11970.4,
MEDTRONIC ENBF3616C145E STENT,C1876,HCPCS,,79002509,CDM,278,RC,,,both,,,29926,11810.83,39.4668,,11810.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10174.84,34,,10174.84,percent of total billed charges,Implant Device,10474.1,35,,10474.1,percent of total billed charges,Implant Device,10174.84,34,"Charges > $500, x 34%",10174.84,percent of total billed charges,Implant Device,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,11970.4,40,,11970.4,percent of total billed charges,Implant Devices,10474.1,70,,10474.1,percent of total billed charges,Implant Devices,10174.84,34,,10174.84,percent of total billed charges,Implant Devices,10174.84,34,,10174.84,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,10474.1,35,,10474.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,10174.84,34,"If Charge > 2,000, then 34 percent",10174.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,11970.4,
MEDTRONIC ENEW2424C832E STENT,C1876,HCPCS,,79002510,CDM,278,RC,,,both,,,14776,5831.61,39.4668,,5831.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5171.6,35,,5171.6,percent of total billed charges,Implant Device,5023.84,34,"Charges > $500, x 34%",5023.84,percent of total billed charges,Implant Device,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5910.4,40,,5910.4,percent of total billed charges,Implant Devices,5171.6,70,,5171.6,percent of total billed charges,Implant Devices,5023.84,34,,5023.84,percent of total billed charges,Implant Devices,5023.84,34,,5023.84,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5023.84,34,"If Charge > 2,000, then 34 percent",5023.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5910.4,
MEDTRONIC ENLW1610C124E STENT,C1876,HCPCS,,79002511,CDM,278,RC,,,both,,,14926,5890.81,39.4668,,5890.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5224.1,35,,5224.1,percent of total billed charges,Implant Device,5074.84,34,"Charges > $500, x 34%",5074.84,percent of total billed charges,Implant Device,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5970.4,40,,5970.4,percent of total billed charges,Implant Devices,5224.1,70,,5224.1,percent of total billed charges,Implant Devices,5074.84,34,,5074.84,percent of total billed charges,Implant Devices,5074.84,34,,5074.84,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5074.84,34,"If Charge > 2,000, then 34 percent",5074.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5970.4,
MEDTRONIC ENLW1613C124E STENT,C1876,HCPCS,,79002512,CDM,278,RC,,,both,,,14926,5890.81,39.4668,,5890.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5224.1,35,,5224.1,percent of total billed charges,Implant Device,5074.84,34,"Charges > $500, x 34%",5074.84,percent of total billed charges,Implant Device,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5970.4,40,,5970.4,percent of total billed charges,Implant Devices,5224.1,70,,5224.1,percent of total billed charges,Implant Devices,5074.84,34,,5074.84,percent of total billed charges,Implant Devices,5074.84,34,,5074.84,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5074.84,34,"If Charge > 2,000, then 34 percent",5074.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5970.4,
MEDTRONIC ENLW1616C124E STENT,C1876,HCPCS,,79002513,CDM,278,RC,,,both,,,14776,5831.61,39.4668,,5831.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5171.6,35,,5171.6,percent of total billed charges,Implant Device,5023.84,34,"Charges > $500, x 34%",5023.84,percent of total billed charges,Implant Device,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5910.4,40,,5910.4,percent of total billed charges,Implant Devices,5171.6,70,,5171.6,percent of total billed charges,Implant Devices,5023.84,34,,5023.84,percent of total billed charges,Implant Devices,5023.84,34,,5023.84,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5023.84,34,"If Charge > 2,000, then 34 percent",5023.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5910.4,
MEDTRONIC ENLW1616C82E STENT,C1876,HCPCS,,79002514,CDM,278,RC,,,both,,,13426,5298.81,39.4668,,5298.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4564.84,34,,4564.84,percent of total billed charges,Implant Device,4564.84,34,,4564.84,percent of total billed charges,Implant Device,4564.84,34,,4564.84,percent of total billed charges,Implant Device,4564.84,34,,4564.84,percent of total billed charges,Implant Device,4564.84,34,,4564.84,percent of total billed charges,Implant Device,4564.84,34,,4564.84,percent of total billed charges,Implant Device,4699.1,35,,4699.1,percent of total billed charges,Implant Device,4564.84,34,"Charges > $500, x 34%",4564.84,percent of total billed charges,Implant Device,4699.1,35,,4699.1,percent of total billed charges,Implant Devices,4699.1,35,,4699.1,percent of total billed charges,Implant Devices,4699.1,35,,,percent of total billed charges,Implant Devices,4699.1,35,,4699.1,percent of total billed charges,Implant Devices,4699.1,35,,4699.1,percent of total billed charges,Implant Devices,5370.4,40,,5370.4,percent of total billed charges,Implant Devices,4699.1,70,,4699.1,percent of total billed charges,Implant Devices,4564.84,34,,4564.84,percent of total billed charges,Implant Devices,4564.84,34,,4564.84,percent of total billed charges,Implant Devices,4699.1,35,,4699.1,percent of total billed charges,Implant Devices,4699.1,35,,4699.1,percent of total billed charges,Implant Devices,4699.1,35,,4699.1,percent of total billed charges,Implant Devices,4699.1,35,,4699.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4564.84,34,"If Charge > 2,000, then 34 percent",4564.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5370.4,
MEDTRONIC ENLW1620C93E STENT,C1876,HCPCS,,79002515,CDM,278,RC,,,both,,,14776,5831.61,39.4668,,5831.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5171.6,35,,5171.6,percent of total billed charges,Implant Device,5023.84,34,"Charges > $500, x 34%",5023.84,percent of total billed charges,Implant Device,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5910.4,40,,5910.4,percent of total billed charges,Implant Devices,5171.6,70,,5171.6,percent of total billed charges,Implant Devices,5023.84,34,,5023.84,percent of total billed charges,Implant Devices,5023.84,34,,5023.84,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5023.84,34,"If Charge > 2,000, then 34 percent",5023.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5910.4,
MEDTRONIC ENLW1624C82E STENT,C1876,HCPCS,,79002516,CDM,278,RC,,,both,,,14550,5742.42,39.4668,,5742.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4947,34,,4947,percent of total billed charges,Implant Device,4947,34,,4947,percent of total billed charges,Implant Device,4947,34,,4947,percent of total billed charges,Implant Device,4947,34,,4947,percent of total billed charges,Implant Device,4947,34,,4947,percent of total billed charges,Implant Device,4947,34,,4947,percent of total billed charges,Implant Device,5092.5,35,,5092.5,percent of total billed charges,Implant Device,4947,34,"Charges > $500, x 34%",4947,percent of total billed charges,Implant Device,5092.5,35,,5092.5,percent of total billed charges,Implant Devices,5092.5,35,,5092.5,percent of total billed charges,Implant Devices,5092.5,35,,,percent of total billed charges,Implant Devices,5092.5,35,,5092.5,percent of total billed charges,Implant Devices,5092.5,35,,5092.5,percent of total billed charges,Implant Devices,5820,40,,5820,percent of total billed charges,Implant Devices,5092.5,70,,5092.5,percent of total billed charges,Implant Devices,4947,34,,4947,percent of total billed charges,Implant Devices,4947,34,,4947,percent of total billed charges,Implant Devices,5092.5,35,,5092.5,percent of total billed charges,Implant Devices,5092.5,35,,5092.5,percent of total billed charges,Implant Devices,5092.5,35,,5092.5,percent of total billed charges,Implant Devices,5092.5,35,,5092.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4947,34,"If Charge > 2,000, then 34 percent",4947,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5820,
MEDTRONIC ENLW1624C93E STENT,C1876,HCPCS,,79002517,CDM,278,RC,,,both,,,14776,5831.61,39.4668,,5831.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5023.84,34,,5023.84,percent of total billed charges,Implant Device,5171.6,35,,5171.6,percent of total billed charges,Implant Device,5023.84,34,"Charges > $500, x 34%",5023.84,percent of total billed charges,Implant Device,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5910.4,40,,5910.4,percent of total billed charges,Implant Devices,5171.6,70,,5171.6,percent of total billed charges,Implant Devices,5023.84,34,,5023.84,percent of total billed charges,Implant Devices,5023.84,34,,5023.84,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,5171.6,35,,5171.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5023.84,34,"If Charge > 2,000, then 34 percent",5023.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5910.4,
MEDTRONIC ETLW1610C124E STENT,C1876,HCPCS,,79002518,CDM,278,RC,,,both,,,14926,5890.81,39.4668,,5890.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5224.1,35,,5224.1,percent of total billed charges,Implant Device,5074.84,34,"Charges > $500, x 34%",5074.84,percent of total billed charges,Implant Device,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5970.4,40,,5970.4,percent of total billed charges,Implant Devices,5224.1,70,,5224.1,percent of total billed charges,Implant Devices,5074.84,34,,5074.84,percent of total billed charges,Implant Devices,5074.84,34,,5074.84,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5074.84,34,"If Charge > 2,000, then 34 percent",5074.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5970.4,
MEDTRONIC ETLW1624C124E STENT,C1876,HCPCS,,79002519,CDM,278,RC,,,both,,,14926,5890.81,39.4668,,5890.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5224.1,35,,5224.1,percent of total billed charges,Implant Device,5074.84,34,"Charges > $500, x 34%",5074.84,percent of total billed charges,Implant Device,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5970.4,40,,5970.4,percent of total billed charges,Implant Devices,5224.1,70,,5224.1,percent of total billed charges,Implant Devices,5074.84,34,,5074.84,percent of total billed charges,Implant Devices,5074.84,34,,5074.84,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5074.84,34,"If Charge > 2,000, then 34 percent",5074.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5970.4,
MEDTRONIC ETLW1624C156E STENT,C1876,HCPCS,,79002520,CDM,278,RC,,,both,,,14926,5890.81,39.4668,,5890.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5074.84,34,,5074.84,percent of total billed charges,Implant Device,5224.1,35,,5224.1,percent of total billed charges,Implant Device,5074.84,34,"Charges > $500, x 34%",5074.84,percent of total billed charges,Implant Device,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5970.4,40,,5970.4,percent of total billed charges,Implant Devices,5224.1,70,,5224.1,percent of total billed charges,Implant Devices,5074.84,34,,5074.84,percent of total billed charges,Implant Devices,5074.84,34,,5074.84,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,5224.1,35,,5224.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5074.84,34,"If Charge > 2,000, then 34 percent",5074.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5970.4,
EV3 PRB35-06-200-120 EVERFLEX STENT,C1876,HCPCS,,79003029,CDM,278,RC,,,both,,,9687,3823.15,39.4668,,3823.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3390.45,35,,3390.45,percent of total billed charges,Implant Device,3293.58,34,"Charges > $500, x 34%",3293.58,percent of total billed charges,Implant Device,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3874.8,40,,3874.8,percent of total billed charges,Implant Devices,3390.45,70,,3390.45,percent of total billed charges,Implant Devices,3293.58,34,,3293.58,percent of total billed charges,Implant Devices,3293.58,34,,3293.58,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3293.58,34,"If Charge > 2,000, then 34 percent",3293.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3874.8,
EV3 PRB35-07-200-120 EVERFLEX STENT,C1876,HCPCS,,79003030,CDM,278,RC,,,both,,,9687,3823.15,39.4668,,3823.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3293.58,34,,3293.58,percent of total billed charges,Implant Device,3390.45,35,,3390.45,percent of total billed charges,Implant Device,3293.58,34,"Charges > $500, x 34%",3293.58,percent of total billed charges,Implant Device,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3874.8,40,,3874.8,percent of total billed charges,Implant Devices,3390.45,70,,3390.45,percent of total billed charges,Implant Devices,3293.58,34,,3293.58,percent of total billed charges,Implant Devices,3293.58,34,,3293.58,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,3390.45,35,,3390.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3293.58,34,"If Charge > 2,000, then 34 percent",3293.58,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3874.8,
BOST SCI 38046-74075 7X37X75 XPRSS STENT,C1876,HCPCS,,79003162,CDM,278,RC,,,both,,,3575,1410.94,39.4668,,1410.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Device,1215.5,34,"Charges > $500, x 34%",1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1430,40,,1430,percent of total billed charges,Implant Devices,1251.25,70,,1251.25,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1215.5,34,"If Charge > 2,000, then 34 percent",1215.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1430,
BOST SCI 38046-76075 7X57X75 XPRSS STENT,C1876,HCPCS,,79003163,CDM,278,RC,,,both,,,3575,1410.94,39.4668,,1410.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Device,1215.5,34,"Charges > $500, x 34%",1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1430,40,,1430,percent of total billed charges,Implant Devices,1251.25,70,,1251.25,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1215.5,34,"If Charge > 2,000, then 34 percent",1215.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1430,
BOST SCI 38046-94075 9X37X75 XPRSS STENT,C1876,HCPCS,,79003164,CDM,278,RC,,,both,,,3575,1410.94,39.4668,,1410.94,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1215.5,34,,1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Device,1215.5,34,"Charges > $500, x 34%",1215.5,percent of total billed charges,Implant Device,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1430,40,,1430,percent of total billed charges,Implant Devices,1251.25,70,,1251.25,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1215.5,34,,1215.5,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,1251.25,35,,1251.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1215.5,34,"If Charge > 2,000, then 34 percent",1215.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1430,
BOST SCI 40312 14X60X75 WALLSTENT,C1876,HCPCS,,79003165,CDM,278,RC,,,both,,,3192,1259.78,39.4668,,1259.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1117.2,35,,1117.2,percent of total billed charges,Implant Device,1085.28,34,"Charges > $500, x 34%",1085.28,percent of total billed charges,Implant Device,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1276.8,40,,1276.8,percent of total billed charges,Implant Devices,1117.2,70,,1117.2,percent of total billed charges,Implant Devices,1085.28,34,,1085.28,percent of total billed charges,Implant Devices,1085.28,34,,1085.28,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1085.28,34,"If Charge > 2,000, then 34 percent",1085.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1276.8,
BOST SCI 40313 14X90X75 WALLSTENT,C1876,HCPCS,,79003166,CDM,278,RC,,,both,,,3229,1274.38,39.4668,,1274.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1097.86,34,,1097.86,percent of total billed charges,Implant Device,1097.86,34,,1097.86,percent of total billed charges,Implant Device,1097.86,34,,1097.86,percent of total billed charges,Implant Device,1097.86,34,,1097.86,percent of total billed charges,Implant Device,1097.86,34,,1097.86,percent of total billed charges,Implant Device,1097.86,34,,1097.86,percent of total billed charges,Implant Device,1130.15,35,,1130.15,percent of total billed charges,Implant Device,1097.86,34,"Charges > $500, x 34%",1097.86,percent of total billed charges,Implant Device,1130.15,35,,1130.15,percent of total billed charges,Implant Devices,1130.15,35,,1130.15,percent of total billed charges,Implant Devices,1130.15,35,,,percent of total billed charges,Implant Devices,1130.15,35,,1130.15,percent of total billed charges,Implant Devices,1130.15,35,,1130.15,percent of total billed charges,Implant Devices,1291.6,40,,1291.6,percent of total billed charges,Implant Devices,1130.15,70,,1130.15,percent of total billed charges,Implant Devices,1097.86,34,,1097.86,percent of total billed charges,Implant Devices,1097.86,34,,1097.86,percent of total billed charges,Implant Devices,1130.15,35,,1130.15,percent of total billed charges,Implant Devices,1130.15,35,,1130.15,percent of total billed charges,Implant Devices,1130.15,35,,1130.15,percent of total billed charges,Implant Devices,1130.15,35,,1130.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1097.86,34,"If Charge > 2,000, then 34 percent",1097.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1291.6,
BOST SCI 40331 16X40X75 WALLSTENT,C1876,HCPCS,,79003167,CDM,278,RC,,,both,,,3192,1259.78,39.4668,,1259.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1117.2,35,,1117.2,percent of total billed charges,Implant Device,1085.28,34,"Charges > $500, x 34%",1085.28,percent of total billed charges,Implant Device,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1276.8,40,,1276.8,percent of total billed charges,Implant Devices,1117.2,70,,1117.2,percent of total billed charges,Implant Devices,1085.28,34,,1085.28,percent of total billed charges,Implant Devices,1085.28,34,,1085.28,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1085.28,34,"If Charge > 2,000, then 34 percent",1085.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1276.8,
BOST SCI 40332 16X60X75 WALLSTENT,C1876,HCPCS,,79003168,CDM,278,RC,,,both,,,3192,1259.78,39.4668,,1259.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1085.28,34,,1085.28,percent of total billed charges,Implant Device,1117.2,35,,1117.2,percent of total billed charges,Implant Device,1085.28,34,"Charges > $500, x 34%",1085.28,percent of total billed charges,Implant Device,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1276.8,40,,1276.8,percent of total billed charges,Implant Devices,1117.2,70,,1117.2,percent of total billed charges,Implant Devices,1085.28,34,,1085.28,percent of total billed charges,Implant Devices,1085.28,34,,1085.28,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,1117.2,35,,1117.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1085.28,34,"If Charge > 2,000, then 34 percent",1085.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1276.8,
BOST SCI 40333 16X90X75 WALLSTENT,C1876,HCPCS,,79003169,CDM,278,RC,,,both,,,5417,2137.92,39.4668,,2137.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1841.78,34,,1841.78,percent of total billed charges,Implant Device,1841.78,34,,1841.78,percent of total billed charges,Implant Device,1841.78,34,,1841.78,percent of total billed charges,Implant Device,1841.78,34,,1841.78,percent of total billed charges,Implant Device,1841.78,34,,1841.78,percent of total billed charges,Implant Device,1841.78,34,,1841.78,percent of total billed charges,Implant Device,1895.95,35,,1895.95,percent of total billed charges,Implant Device,1841.78,34,"Charges > $500, x 34%",1841.78,percent of total billed charges,Implant Device,1895.95,35,,1895.95,percent of total billed charges,Implant Devices,1895.95,35,,1895.95,percent of total billed charges,Implant Devices,1895.95,35,,,percent of total billed charges,Implant Devices,1895.95,35,,1895.95,percent of total billed charges,Implant Devices,1895.95,35,,1895.95,percent of total billed charges,Implant Devices,2166.8,40,,2166.8,percent of total billed charges,Implant Devices,1895.95,70,,1895.95,percent of total billed charges,Implant Devices,1841.78,34,,1841.78,percent of total billed charges,Implant Devices,1841.78,34,,1841.78,percent of total billed charges,Implant Devices,1895.95,35,,1895.95,percent of total billed charges,Implant Devices,1895.95,35,,1895.95,percent of total billed charges,Implant Devices,1895.95,35,,1895.95,percent of total billed charges,Implant Devices,1895.95,35,,1895.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1841.78,34,"If Charge > 2,000, then 34 percent",1841.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2166.8,
BOST SCI 40411 18X40X75 WALLSTENT,C1876,HCPCS,,79003170,CDM,278,RC,,,both,,,3548,1400.28,39.4668,,1400.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1241.8,35,,1241.8,percent of total billed charges,Implant Device,1206.32,34,"Charges > $500, x 34%",1206.32,percent of total billed charges,Implant Device,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1419.2,40,,1419.2,percent of total billed charges,Implant Devices,1241.8,70,,1241.8,percent of total billed charges,Implant Devices,1206.32,34,,1206.32,percent of total billed charges,Implant Devices,1206.32,34,,1206.32,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1206.32,34,"If Charge > 2,000, then 34 percent",1206.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1419.2,
J&J C06030SL 6X30X80 SMART STENT,C1876,HCPCS,,79003171,CDM,278,RC,,,both,,,2027,799.99,39.4668,,799.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Device,689.18,34,"Charges > $500, x 34%",689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,810.8,40,,810.8,percent of total billed charges,Implant Devices,709.45,70,,709.45,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,689.18,34,"If Charge > 2,000, then 34 percent",689.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,810.8,
J&J C07060SL 7X60X80 SMART STENT,C1876,HCPCS,,79003172,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
J&J C08030ML 8X30X120 SMART STENT,C1876,HCPCS,,79003173,CDM,278,RC,,,both,,,2027,799.99,39.4668,,799.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,689.18,34,,689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Device,689.18,34,"Charges > $500, x 34%",689.18,percent of total billed charges,Implant Device,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,810.8,40,,810.8,percent of total billed charges,Implant Devices,709.45,70,,709.45,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,689.18,34,,689.18,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,709.45,35,,709.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,689.18,34,"If Charge > 2,000, then 34 percent",689.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,810.8,
J&J C09040SL 9X40X80 SMART STENT,C1876,HCPCS,,79003174,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
BARD ZMB08060 8X60X80 E-LUMINEXX STENT,C1876,HCPCS,,79003175,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
BARD ZMB10060 10X60X80 E-LUMINEXX STENT,C1876,HCPCS,,79003176,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
BARD EX060403CS 6X40X130 LIFESTENT,C1876,HCPCS,,79003177,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
BARD EX060803CS 6X80X130 LIFESTENT,C1876,HCPCS,,79003178,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
BARD EX061003CS 6X100X130 LIFESTENT,C1876,HCPCS,,79003179,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
BARD EX062003CL 6X200X135 LIFESTENT SOLO,C1876,HCPCS,,79003180,CDM,278,RC,,,both,,,5850,2308.81,39.4668,,2308.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Device,1989,34,"Charges > $500, x 34%",1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2340,40,,2340,percent of total billed charges,Implant Devices,2047.5,70,,2047.5,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1989,34,"If Charge > 2,000, then 34 percent",1989,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2340,
BARD EX070403CS 7X40X130 LIFESTENT,C1876,HCPCS,,79003181,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
BARD EX070803CS 7X80X130 LIFESTENT,C1876,HCPCS,,79003182,CDM,278,RC,,,both,,,2850,1124.8,39.4668,,1124.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,969,34,,969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Device,969,34,"Charges > $500, x 34%",969,percent of total billed charges,Implant Device,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,1140,40,,1140,percent of total billed charges,Implant Devices,997.5,70,,997.5,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,969,34,,969,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,997.5,35,,997.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,969,34,"If Charge > 2,000, then 34 percent",969,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1140,
BARD EX071003CS 7X100X130 LIFESTENT,C1876,HCPCS,,79003183,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
BARD EX071203CS 7X120X130 LIFESTENT,C1876,HCPCS,,79003184,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
BARD EX072003CL 7X200X135 LIFESTENT SOLO,C1876,HCPCS,,79003185,CDM,278,RC,,,both,,,5850,2308.81,39.4668,,2308.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,1989,34,,1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Device,1989,34,"Charges > $500, x 34%",1989,percent of total billed charges,Implant Device,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2340,40,,2340,percent of total billed charges,Implant Devices,2047.5,70,,2047.5,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,1989,34,,1989,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,2047.5,35,,2047.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1989,34,"If Charge > 2,000, then 34 percent",1989,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2340,
EV3 PRB35-05-060-120 EVERFLEX STENT,C1876,HCPCS,,79003186,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
EV3 PRB35-05-100-120 EVERFLEX STENT,C1876,HCPCS,,79003187,CDM,278,RC,,,both,,,2326,918,39.4668,,918,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,790.84,34,,790.84,percent of total billed charges,Implant Device,790.84,34,,790.84,percent of total billed charges,Implant Device,790.84,34,,790.84,percent of total billed charges,Implant Device,790.84,34,,790.84,percent of total billed charges,Implant Device,790.84,34,,790.84,percent of total billed charges,Implant Device,790.84,34,,790.84,percent of total billed charges,Implant Device,814.1,35,,814.1,percent of total billed charges,Implant Device,790.84,34,"Charges > $500, x 34%",790.84,percent of total billed charges,Implant Device,814.1,35,,814.1,percent of total billed charges,Implant Devices,814.1,35,,814.1,percent of total billed charges,Implant Devices,814.1,35,,,percent of total billed charges,Implant Devices,814.1,35,,814.1,percent of total billed charges,Implant Devices,814.1,35,,814.1,percent of total billed charges,Implant Devices,930.4,40,,930.4,percent of total billed charges,Implant Devices,814.1,70,,814.1,percent of total billed charges,Implant Devices,790.84,34,,790.84,percent of total billed charges,Implant Devices,790.84,34,,790.84,percent of total billed charges,Implant Devices,814.1,35,,814.1,percent of total billed charges,Implant Devices,814.1,35,,814.1,percent of total billed charges,Implant Devices,814.1,35,,814.1,percent of total billed charges,Implant Devices,814.1,35,,814.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,790.84,34,"If Charge > 2,000, then 34 percent",790.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,930.4,
EV3 PRB35-06-020-120 EVERFLEX STENT,C1876,HCPCS,,79003188,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-06-080-080 EVERFLEX STENT,C1876,HCPCS,,79003189,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-07-080-080 EVERFLEX STENT,C1876,HCPCS,,79003190,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-07-100-120 EVERFLEX STENT,C1876,HCPCS,,79003191,CDM,278,RC,,,both,,,5070,2000.97,39.4668,,2000.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1774.5,35,,1774.5,percent of total billed charges,Implant Device,1723.8,34,"Charges > $500, x 34%",1723.8,percent of total billed charges,Implant Device,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,2028,40,,2028,percent of total billed charges,Implant Devices,1774.5,70,,1774.5,percent of total billed charges,Implant Devices,1723.8,34,,1723.8,percent of total billed charges,Implant Devices,1723.8,34,,1723.8,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1723.8,34,"If Charge > 2,000, then 34 percent",1723.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2028,
EV3 PRB35-08-100-080 EVERFLEX STENT,C1876,HCPCS,,79003192,CDM,278,RC,,,both,,,5070,2000.97,39.4668,,2000.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1723.8,34,,1723.8,percent of total billed charges,Implant Device,1774.5,35,,1774.5,percent of total billed charges,Implant Device,1723.8,34,"Charges > $500, x 34%",1723.8,percent of total billed charges,Implant Device,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,2028,40,,2028,percent of total billed charges,Implant Devices,1774.5,70,,1774.5,percent of total billed charges,Implant Devices,1723.8,34,,1723.8,percent of total billed charges,Implant Devices,1723.8,34,,1723.8,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,1774.5,35,,1774.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1723.8,34,"If Charge > 2,000, then 34 percent",1723.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2028,
EV3 PXB35-07-27-080 VISIPRO STENT,C1876,HCPCS,,79003193,CDM,278,RC,,,both,,,3119,1230.97,39.4668,,1230.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Device,1060.46,34,"Charges > $500, x 34%",1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1247.6,40,,1247.6,percent of total billed charges,Implant Devices,1091.65,70,,1091.65,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1060.46,34,"If Charge > 2,000, then 34 percent",1060.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1247.6,
EV3 PXB35-07-57-080 VISIPRO STENT,C1876,HCPCS,,79003194,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PXB35-09-27-080 VISIPRO STENT,C1876,HCPCS,,79003195,CDM,278,RC,,,both,,,3119,1230.97,39.4668,,1230.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Device,1060.46,34,"Charges > $500, x 34%",1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1247.6,40,,1247.6,percent of total billed charges,Implant Devices,1091.65,70,,1091.65,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1060.46,34,"If Charge > 2,000, then 34 percent",1060.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1247.6,
EV3 PXB35-09-37-080 VISIPRO STENT,C1876,HCPCS,,79003196,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PXB35-10-37-080 VISIPRO STENT,C1876,HCPCS,,79003197,CDM,278,RC,,,both,,,3119,1230.97,39.4668,,1230.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Device,1060.46,34,"Charges > $500, x 34%",1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1247.6,40,,1247.6,percent of total billed charges,Implant Devices,1091.65,70,,1091.65,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1060.46,34,"If Charge > 2,000, then 34 percent",1060.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1247.6,
EV3 SERB65-12-60-80 PROTEGE STENT,C1876,HCPCS,,79003198,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 SERB65-14-40-80 PROTOGE STENT,C1876,HCPCS,,79003199,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 SERB65-14-60-80 PROTEGE STENT,C1876,HCPCS,,79003515,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
BOST SCI 65-02 WALLFELX DUODENAL 22X90MM,C1876,HCPCS,,79003875,CDM,278,RC,,,both,,,7786,3072.89,39.4668,,3072.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2647.24,34,,2647.24,percent of total billed charges,Implant Device,2647.24,34,,2647.24,percent of total billed charges,Implant Device,2647.24,34,,2647.24,percent of total billed charges,Implant Device,2647.24,34,,2647.24,percent of total billed charges,Implant Device,2647.24,34,,2647.24,percent of total billed charges,Implant Device,2647.24,34,,2647.24,percent of total billed charges,Implant Device,2725.1,35,,2725.1,percent of total billed charges,Implant Device,2647.24,34,"Charges > $500, x 34%",2647.24,percent of total billed charges,Implant Device,2725.1,35,,2725.1,percent of total billed charges,Implant Devices,2725.1,35,,2725.1,percent of total billed charges,Implant Devices,2725.1,35,,,percent of total billed charges,Implant Devices,2725.1,35,,2725.1,percent of total billed charges,Implant Devices,2725.1,35,,2725.1,percent of total billed charges,Implant Devices,3114.4,40,,3114.4,percent of total billed charges,Implant Devices,2725.1,70,,2725.1,percent of total billed charges,Implant Devices,2647.24,34,,2647.24,percent of total billed charges,Implant Devices,2647.24,34,,2647.24,percent of total billed charges,Implant Devices,2725.1,35,,2725.1,percent of total billed charges,Implant Devices,2725.1,35,,2725.1,percent of total billed charges,Implant Devices,2725.1,35,,2725.1,percent of total billed charges,Implant Devices,2725.1,35,,2725.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2647.24,34,"If Charge > 2,000, then 34 percent",2647.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3114.4,
J&J HEALTH C08060SL SMART STENT 8X60MM,C1876,HCPCS,,79003992,CDM,278,RC,,,both,,,4429,1747.98,39.4668,,1747.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1505.86,34,,1505.86,percent of total billed charges,Implant Device,1550.15,35,,1550.15,percent of total billed charges,Implant Device,1505.86,34,"Charges > $500, x 34%",1505.86,percent of total billed charges,Implant Device,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1771.6,40,,1771.6,percent of total billed charges,Implant Devices,1550.15,70,,1550.15,percent of total billed charges,Implant Devices,1505.86,34,,1505.86,percent of total billed charges,Implant Devices,1505.86,34,,1505.86,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,1550.15,35,,1550.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1505.86,34,"If Charge > 2,000, then 34 percent",1505.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1771.6,
BOST SCI 7053 WALL STENT BILIARY 10X60,C1876,HCPCS,,79004929,CDM,278,RC,,,both,,,8272,3264.69,39.4668,,3264.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2812.48,34,,2812.48,percent of total billed charges,Implant Device,2812.48,34,,2812.48,percent of total billed charges,Implant Device,2812.48,34,,2812.48,percent of total billed charges,Implant Device,2812.48,34,,2812.48,percent of total billed charges,Implant Device,2812.48,34,,2812.48,percent of total billed charges,Implant Device,2812.48,34,,2812.48,percent of total billed charges,Implant Device,2895.2,35,,2895.2,percent of total billed charges,Implant Device,2812.48,34,"Charges > $500, x 34%",2812.48,percent of total billed charges,Implant Device,2895.2,35,,2895.2,percent of total billed charges,Implant Devices,2895.2,35,,2895.2,percent of total billed charges,Implant Devices,2895.2,35,,,percent of total billed charges,Implant Devices,2895.2,35,,2895.2,percent of total billed charges,Implant Devices,2895.2,35,,2895.2,percent of total billed charges,Implant Devices,3308.8,40,,3308.8,percent of total billed charges,Implant Devices,2895.2,70,,2895.2,percent of total billed charges,Implant Devices,2812.48,34,,2812.48,percent of total billed charges,Implant Devices,2812.48,34,,2812.48,percent of total billed charges,Implant Devices,2895.2,35,,2895.2,percent of total billed charges,Implant Devices,2895.2,35,,2895.2,percent of total billed charges,Implant Devices,2895.2,35,,2895.2,percent of total billed charges,Implant Devices,2895.2,35,,2895.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2812.48,34,"If Charge > 2,000, then 34 percent",2812.48,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3308.8,
COOK G43827 7X60X125 ZILVER 635 STENT,C1876,HCPCS,,79005171,CDM,278,RC,,,both,,,4050,1598.41,39.4668,,1598.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1377,34,,1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Device,1377,34,"Charges > $500, x 34%",1377,percent of total billed charges,Implant Device,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1620,40,,1620,percent of total billed charges,Implant Devices,1417.5,70,,1417.5,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1377,34,,1377,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,1417.5,35,,1417.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1377,34,"If Charge > 2,000, then 34 percent",1377,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1620,
J&J C07060ML 7X60X120CM SMART STENT,C1876,HCPCS,,79005365,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
EV3 PRB35-08-030-120 PROTEGE STENT,C1876,HCPCS,,79005391,CDM,278,RC,,,both,,,3900,1539.21,39.4668,,1539.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1326,34,,1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Device,1326,34,"Charges > $500, x 34%",1326,percent of total billed charges,Implant Device,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1560,40,,1560,percent of total billed charges,Implant Devices,1365,70,,1365,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1326,34,,1326,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,1365,35,,1365,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1326,34,"If Charge > 2,000, then 34 percent",1326,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1560,
EV3 PXB35-06-37-080 VISI-PRO STENT,C1876,HCPCS,,79005417,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PXB35-07-27-135 VISI-PRO STENT,C1876,HCPCS,,79005418,CDM,278,RC,,,both,,,3119,1230.97,39.4668,,1230.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Device,1060.46,34,"Charges > $500, x 34%",1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1247.6,40,,1247.6,percent of total billed charges,Implant Devices,1091.65,70,,1091.65,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1060.46,34,"If Charge > 2,000, then 34 percent",1060.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1247.6,
EV3 PXB35-07-37-80 VISI-PRO STENT,C1876,HCPCS,,79005419,CDM,278,RC,,,both,,,3119,1230.97,39.4668,,1230.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Device,1060.46,34,"Charges > $500, x 34%",1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1247.6,40,,1247.6,percent of total billed charges,Implant Devices,1091.65,70,,1091.65,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1060.46,34,"If Charge > 2,000, then 34 percent",1060.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1247.6,
EV3 PXB35-07-37-135 VISI-PRO STENT,C1876,HCPCS,,79005420,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PXB35-08-37-080 VISI-PRO STENT,C1876,HCPCS,,79005421,CDM,278,RC,,,both,,,3119,1230.97,39.4668,,1230.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Device,1060.46,34,"Charges > $500, x 34%",1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1247.6,40,,1247.6,percent of total billed charges,Implant Devices,1091.65,70,,1091.65,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1060.46,34,"If Charge > 2,000, then 34 percent",1060.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1247.6,
EV3 PXB35-08-57-080 VISI-PRO STENT,C1876,HCPCS,,79005422,CDM,278,RC,,,both,,,3119,1230.97,39.4668,,1230.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Device,1060.46,34,"Charges > $500, x 34%",1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1247.6,40,,1247.6,percent of total billed charges,Implant Devices,1091.65,70,,1091.65,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1060.46,34,"If Charge > 2,000, then 34 percent",1060.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1247.6,
EV3 SERB65-09-30-80 PROTEGE STENT,C1876,HCPCS,,79005423,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-07-030-080 EVERFLEX STENT,C1876,HCPCS,,79005424,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
EV3 PRB35-06060-080 EVERFLEX STENT,C1876,HCPCS,,79005425,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-06-040-080 EVERFLEX STENT,C1876,HCPCS,,79005426,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
EV3 PRB35-06-030-080 EVERFLEX STENT,C1876,HCPCS,,79005427,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-08-060-120 EVERFLEX STENT,C1876,HCPCS,,79005428,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
EV3 PRB35-07-040-120 EVERFLEX STENT,C1876,HCPCS,,79005429,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PRB35-07-080-120 EVERFLEX STENT,C1876,HCPCS,,79005430,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
EV3 PRB35-05-120-120 EVERFLEX STENT,C1876,HCPCS,,79005431,CDM,278,RC,,,both,,,4950,1953.61,39.4668,,1953.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1683,34,,1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Device,1683,34,"Charges > $500, x 34%",1683,percent of total billed charges,Implant Device,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1980,40,,1980,percent of total billed charges,Implant Devices,1732.5,70,,1732.5,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1683,34,,1683,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,1732.5,35,,1732.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1683,34,"If Charge > 2,000, then 34 percent",1683,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1980,
EV3 PRB35-08-040-120 EVERFLEX STENT,C1876,HCPCS,,79005443,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PMB8-5-18-80 PARAMOUNT MIN GPS STENT,C1876,HCPCS,,79005444,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PMB8-6-18-80 PARAMOUNT MIN GPS STENT,C1876,HCPCS,,79005445,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PMB8-7-18-80 PARAMOUNT MIN GPS STENT,C1876,HCPCS,,79005446,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PMB8-7-21-80 PARAMOUNT MIN GPS STENT,C1876,HCPCS,,79005447,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
BOST SCI 1670 18X20 WALL FLEX,C1876,HCPCS,,79005506,CDM,278,RC,,,both,,,7726,3049.2,39.4668,,3049.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2704.1,35,,2704.1,percent of total billed charges,Implant Device,2626.84,34,"Charges > $500, x 34%",2626.84,percent of total billed charges,Implant Device,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,3090.4,40,,3090.4,percent of total billed charges,Implant Devices,2704.1,70,,2704.1,percent of total billed charges,Implant Devices,2626.84,34,,2626.84,percent of total billed charges,Implant Devices,2626.84,34,,2626.84,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2626.84,34,"If Charge > 2,000, then 34 percent",2626.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3090.4,
BOST SCI 1671 WALL FLEX ESOPH 18/23-25MM,C1876,HCPCS,,79005507,CDM,278,RC,,,both,,,7726,3049.2,39.4668,,3049.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2626.84,34,,2626.84,percent of total billed charges,Implant Device,2704.1,35,,2704.1,percent of total billed charges,Implant Device,2626.84,34,"Charges > $500, x 34%",2626.84,percent of total billed charges,Implant Device,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,3090.4,40,,3090.4,percent of total billed charges,Implant Devices,2704.1,70,,2704.1,percent of total billed charges,Implant Devices,2626.84,34,,2626.84,percent of total billed charges,Implant Devices,2626.84,34,,2626.84,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,2704.1,35,,2704.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2626.84,34,"If Charge > 2,000, then 34 percent",2626.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3090.4,
BOST SCI 7065 WALLFLEX BILIARY 10X80MM,C1876,HCPCS,,79005594,CDM,278,RC,,,both,,,5550,2190.41,39.4668,,2190.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1887,34,,1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Device,1887,34,"Charges > $500, x 34%",1887,percent of total billed charges,Implant Device,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,2220,40,,2220,percent of total billed charges,Implant Devices,1942.5,70,,1942.5,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1887,34,,1887,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,1942.5,35,,1942.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1887,34,"If Charge > 2,000, then 34 percent",1887,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2220,
BOST SCI 38046-73075RR EXPRESS LD STENT,C1876,HCPCS,,79005671,CDM,278,RC,,,both,,,1410,556.48,39.4668,,556.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,479.4,34,,479.4,percent of total billed charges,Implant Device,479.4,34,,479.4,percent of total billed charges,Implant Device,479.4,34,,479.4,percent of total billed charges,Implant Device,479.4,34,,479.4,percent of total billed charges,Implant Device,479.4,34,,479.4,percent of total billed charges,Implant Device,479.4,34,,479.4,percent of total billed charges,Implant Device,493.5,35,,493.5,percent of total billed charges,Implant Device,479.4,34,"Charges > $500, x 34%",479.4,percent of total billed charges,Implant Device,493.5,35,,493.5,percent of total billed charges,Implant Devices,493.5,35,,493.5,percent of total billed charges,Implant Devices,493.5,35,,,percent of total billed charges,Implant Devices,493.5,35,,493.5,percent of total billed charges,Implant Devices,493.5,35,,493.5,percent of total billed charges,Implant Devices,564,40,,564,percent of total billed charges,Implant Devices,493.5,70,,493.5,percent of total billed charges,Implant Devices,479.4,34,,479.4,percent of total billed charges,Implant Devices,479.4,34,,479.4,percent of total billed charges,Implant Devices,493.5,35,,493.5,percent of total billed charges,Implant Devices,493.5,35,,493.5,percent of total billed charges,Implant Devices,493.5,35,,493.5,percent of total billed charges,Implant Devices,493.5,35,,493.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,564,
EV3 PMB4-5-14-80 PARAMOUNT STENT 5X14X80,C1876,HCPCS,,79006179,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PMB4-5-18-80 PARAMOUNT STENT 5X18X80,C1876,HCPCS,,79006180,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PMB8-6-14-80 PARAMOUNT STENT 6X14X80,C1876,HCPCS,,79006181,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PMB4-6-14-80 PARAMOUNT STENT 6X14X80,C1876,HCPCS,,79006182,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PMB4-6-18-80 PARAMOUNT STENT 6X18X80,C1876,HCPCS,,79006183,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PMB8-6-21-80 PARAMOUNT STENT 6X21X80,C1876,HCPCS,,79006185,CDM,278,RC,,,both,,,3119,1230.97,39.4668,,1230.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1060.46,34,,1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Device,1060.46,34,"Charges > $500, x 34%",1060.46,percent of total billed charges,Implant Device,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1247.6,40,,1247.6,percent of total billed charges,Implant Devices,1091.65,70,,1091.65,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1060.46,34,,1060.46,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,1091.65,35,,1091.65,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1060.46,34,"If Charge > 2,000, then 34 percent",1060.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1247.6,
EV3 PMB4-7-14-80 PARAMOUNT STENT 7X14X80,C1876,HCPCS,,79006186,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 PMB4-7-18-80 PARAMOUNT STENT 7X18X80,C1876,HCPCS,,79006187,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
EV3 SF07150MB SMART FLEX 7X150MM STENT,C1876,HCPCS,,79006234,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
BOST SCI 40430 WALL STENT 20MMX40MMX75CM,C1876,HCPCS,,79006303,CDM,278,RC,,,both,,,3548,1400.28,39.4668,,1400.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1206.32,34,,1206.32,percent of total billed charges,Implant Device,1241.8,35,,1241.8,percent of total billed charges,Implant Device,1206.32,34,"Charges > $500, x 34%",1206.32,percent of total billed charges,Implant Device,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1419.2,40,,1419.2,percent of total billed charges,Implant Devices,1241.8,70,,1241.8,percent of total billed charges,Implant Devices,1206.32,34,,1206.32,percent of total billed charges,Implant Devices,1206.32,34,,1206.32,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,1241.8,35,,1241.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1206.32,34,"If Charge > 2,000, then 34 percent",1206.32,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1419.2,
BOST SCI 1690 WALLFLEX ESPH STENT 18X103,C1876,HCPCS,,79006430,CDM,278,RC,,,both,,,7516,2966.32,39.4668,,2966.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2555.44,34,,2555.44,percent of total billed charges,Implant Device,2555.44,34,,2555.44,percent of total billed charges,Implant Device,2555.44,34,,2555.44,percent of total billed charges,Implant Device,2555.44,34,,2555.44,percent of total billed charges,Implant Device,2555.44,34,,2555.44,percent of total billed charges,Implant Device,2555.44,34,,2555.44,percent of total billed charges,Implant Device,2630.6,35,,2630.6,percent of total billed charges,Implant Device,2555.44,34,"Charges > $500, x 34%",2555.44,percent of total billed charges,Implant Device,2630.6,35,,2630.6,percent of total billed charges,Implant Devices,2630.6,35,,2630.6,percent of total billed charges,Implant Devices,2630.6,35,,,percent of total billed charges,Implant Devices,2630.6,35,,2630.6,percent of total billed charges,Implant Devices,2630.6,35,,2630.6,percent of total billed charges,Implant Devices,3006.4,40,,3006.4,percent of total billed charges,Implant Devices,2630.6,70,,2630.6,percent of total billed charges,Implant Devices,2555.44,34,,2555.44,percent of total billed charges,Implant Devices,2555.44,34,,2555.44,percent of total billed charges,Implant Devices,2630.6,35,,2630.6,percent of total billed charges,Implant Devices,2630.6,35,,2630.6,percent of total billed charges,Implant Devices,2630.6,35,,2630.6,percent of total billed charges,Implant Devices,2630.6,35,,2630.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2555.44,34,"If Charge > 2,000, then 34 percent",2555.44,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3006.4,
J&J SF06150MB SMART FLEX 6X150MM STENT,C1876,HCPCS,,79006561,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
GORE VBJ061002 VIABAHN 6MMX10CM STENT,C1876,HCPCS,,79006839,CDM,278,RC,,,both,,,10185,4019.69,39.4668,,4019.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3462.9,34,,3462.9,percent of total billed charges,Implant Device,3462.9,34,,3462.9,percent of total billed charges,Implant Device,3462.9,34,,3462.9,percent of total billed charges,Implant Device,3462.9,34,,3462.9,percent of total billed charges,Implant Device,3462.9,34,,3462.9,percent of total billed charges,Implant Device,3462.9,34,,3462.9,percent of total billed charges,Implant Device,3564.75,35,,3564.75,percent of total billed charges,Implant Device,3462.9,34,"Charges > $500, x 34%",3462.9,percent of total billed charges,Implant Device,3564.75,35,,3564.75,percent of total billed charges,Implant Devices,3564.75,35,,3564.75,percent of total billed charges,Implant Devices,3564.75,35,,,percent of total billed charges,Implant Devices,3564.75,35,,3564.75,percent of total billed charges,Implant Devices,3564.75,35,,3564.75,percent of total billed charges,Implant Devices,4074,40,,4074,percent of total billed charges,Implant Devices,3564.75,70,,3564.75,percent of total billed charges,Implant Devices,3462.9,34,,3462.9,percent of total billed charges,Implant Devices,3462.9,34,,3462.9,percent of total billed charges,Implant Devices,3564.75,35,,3564.75,percent of total billed charges,Implant Devices,3564.75,35,,3564.75,percent of total billed charges,Implant Devices,3564.75,35,,3564.75,percent of total billed charges,Implant Devices,3564.75,35,,3564.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3462.9,34,"If Charge > 2,000, then 34 percent",3462.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4074,
GORE VBJ061502 VIABAHN 6MMX15CM STENT,C1876,HCPCS,,79006840,CDM,278,RC,,,both,,,12270,4842.58,39.4668,,4842.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4171.8,34,,4171.8,percent of total billed charges,Implant Device,4171.8,34,,4171.8,percent of total billed charges,Implant Device,4171.8,34,,4171.8,percent of total billed charges,Implant Device,4171.8,34,,4171.8,percent of total billed charges,Implant Device,4171.8,34,,4171.8,percent of total billed charges,Implant Device,4171.8,34,,4171.8,percent of total billed charges,Implant Device,4294.5,35,,4294.5,percent of total billed charges,Implant Device,4171.8,34,"Charges > $500, x 34%",4171.8,percent of total billed charges,Implant Device,4294.5,35,,4294.5,percent of total billed charges,Implant Devices,4294.5,35,,4294.5,percent of total billed charges,Implant Devices,4294.5,35,,,percent of total billed charges,Implant Devices,4294.5,35,,4294.5,percent of total billed charges,Implant Devices,4294.5,35,,4294.5,percent of total billed charges,Implant Devices,4908,40,,4908,percent of total billed charges,Implant Devices,4294.5,70,,4294.5,percent of total billed charges,Implant Devices,4171.8,34,,4171.8,percent of total billed charges,Implant Devices,4171.8,34,,4171.8,percent of total billed charges,Implant Devices,4294.5,35,,4294.5,percent of total billed charges,Implant Devices,4294.5,35,,4294.5,percent of total billed charges,Implant Devices,4294.5,35,,4294.5,percent of total billed charges,Implant Devices,4294.5,35,,4294.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4171.8,34,"If Charge > 2,000, then 34 percent",4171.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4908,
GORE VBJR07150A VIABAHN 7MMX15CM STENT,C1876,HCPCS,,79006956,CDM,278,RC,,,both,,,11970,4724.18,39.4668,,4724.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4069.8,34,,4069.8,percent of total billed charges,Implant Device,4189.5,35,,4189.5,percent of total billed charges,Implant Device,4069.8,34,"Charges > $500, x 34%",4069.8,percent of total billed charges,Implant Device,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4788,40,,4788,percent of total billed charges,Implant Devices,4189.5,70,,4189.5,percent of total billed charges,Implant Devices,4069.8,34,,4069.8,percent of total billed charges,Implant Devices,4069.8,34,,4069.8,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,4189.5,35,,4189.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4069.8,34,"If Charge > 2,000, then 34 percent",4069.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4788,
BOST SCI 39200-08407 8X41X75 EPIC STENT,C1876,HCPCS,,79007346,CDM,278,RC,,,both,,,2550,1006.4,39.4668,,1006.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,867,34,,867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Device,867,34,"Charges > $500, x 34%",867,percent of total billed charges,Implant Device,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,1020,40,,1020,percent of total billed charges,Implant Devices,892.5,70,,892.5,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,867,34,,867,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,892.5,35,,892.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,867,34,"If Charge > 2,000, then 34 percent",867,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1020,
J&J SF06100MB SMART FLEX 6X100MM STENT,C1876,HCPCS,,79007603,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
CARDINAL SF06060MB SMART FLEX 6X60 STENT,C1876,HCPCS,,79007958,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
CH 07120ML SMART STENT 7X120X120CM,C1876,HCPCS,,79008505,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
GORE PHA060602A TIGRIS 6MMX60MM STENT,C1876,HCPCS,,79008768,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
GORE PHA061002A TIGRIS 6MMX100MM STENT,C1876,HCPCS,,79008769,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
GORE PHA070802A TIGRIS 7MMX80MM STENT,C1876,HCPCS,,79008951,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
BARD AVSM06060 6X60X80CM VASCULAR STENT,C1876,HCPCS,,79010290,CDM,278,RC,,,both,,,9585,3782.89,39.4668,,3782.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3354.75,35,,3354.75,percent of total billed charges,Implant Device,3258.9,34,"Charges > $500, x 34%",3258.9,percent of total billed charges,Implant Device,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3834,40,,3834,percent of total billed charges,Implant Devices,3354.75,70,,3354.75,percent of total billed charges,Implant Devices,3258.9,34,,3258.9,percent of total billed charges,Implant Devices,3258.9,34,,3258.9,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3258.9,34,"If Charge > 2,000, then 34 percent",3258.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3834,
BARD AVSM06080 6X80X80CM VASCULAR STENT,C1876,HCPCS,,79010291,CDM,278,RC,,,both,,,14250,5624.02,39.4668,,5624.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4845,34,,4845,percent of total billed charges,Implant Device,4845,34,,4845,percent of total billed charges,Implant Device,4845,34,,4845,percent of total billed charges,Implant Device,4845,34,,4845,percent of total billed charges,Implant Device,4845,34,,4845,percent of total billed charges,Implant Device,4845,34,,4845,percent of total billed charges,Implant Device,4987.5,35,,4987.5,percent of total billed charges,Implant Device,4845,34,"Charges > $500, x 34%",4845,percent of total billed charges,Implant Device,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,5700,40,,5700,percent of total billed charges,Implant Devices,4987.5,70,,4987.5,percent of total billed charges,Implant Devices,4845,34,,4845,percent of total billed charges,Implant Devices,4845,34,,4845,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4845,34,"If Charge > 2,000, then 34 percent",4845,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5700,
BARD AVSM08080 8X80X80CM VASCULAR STENT,C1876,HCPCS,,79010292,CDM,278,RC,,,both,,,14250,5624.02,39.4668,,5624.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4845,34,,4845,percent of total billed charges,Implant Device,4845,34,,4845,percent of total billed charges,Implant Device,4845,34,,4845,percent of total billed charges,Implant Device,4845,34,,4845,percent of total billed charges,Implant Device,4845,34,,4845,percent of total billed charges,Implant Device,4845,34,,4845,percent of total billed charges,Implant Device,4987.5,35,,4987.5,percent of total billed charges,Implant Device,4845,34,"Charges > $500, x 34%",4845,percent of total billed charges,Implant Device,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,5700,40,,5700,percent of total billed charges,Implant Devices,4987.5,70,,4987.5,percent of total billed charges,Implant Devices,4845,34,,4845,percent of total billed charges,Implant Devices,4845,34,,4845,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,4987.5,35,,4987.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4845,34,"If Charge > 2,000, then 34 percent",4845,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5700,
BARD AVSM10040 10X40X80CM VASCULAR STENT,C1876,HCPCS,,79010293,CDM,278,RC,,,both,,,9585,3782.89,39.4668,,3782.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3354.75,35,,3354.75,percent of total billed charges,Implant Device,3258.9,34,"Charges > $500, x 34%",3258.9,percent of total billed charges,Implant Device,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3834,40,,3834,percent of total billed charges,Implant Devices,3354.75,70,,3354.75,percent of total billed charges,Implant Devices,3258.9,34,,3258.9,percent of total billed charges,Implant Devices,3258.9,34,,3258.9,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3258.9,34,"If Charge > 2,000, then 34 percent",3258.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3834,
BARD AVSM10060 10X60X80CM VASCULAR STENT,C1876,HCPCS,,79010294,CDM,278,RC,,,both,,,9585,3782.89,39.4668,,3782.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3258.9,34,,3258.9,percent of total billed charges,Implant Device,3354.75,35,,3354.75,percent of total billed charges,Implant Device,3258.9,34,"Charges > $500, x 34%",3258.9,percent of total billed charges,Implant Device,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3834,40,,3834,percent of total billed charges,Implant Devices,3354.75,70,,3354.75,percent of total billed charges,Implant Devices,3258.9,34,,3258.9,percent of total billed charges,Implant Devices,3258.9,34,,3258.9,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,3354.75,35,,3354.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3258.9,34,"If Charge > 2,000, then 34 percent",3258.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3834,
MEDTRONIC AB9U14100090 14X100 ABRE STENT,C1876,HCPCS,,79011123,CDM,278,RC,,,both,,,5685,2243.69,39.4668,,2243.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Device,1932.9,34,"Charges > $500, x 34%",1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,2274,40,,2274,percent of total billed charges,Implant Devices,1989.75,70,,1989.75,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1932.9,34,"If Charge > 2,000, then 34 percent",1932.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2274,
MEDTRONIC AB9U16100090 16X100 ABRE STENT,C1876,HCPCS,,79011124,CDM,278,RC,,,both,,,5685,2243.69,39.4668,,2243.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Device,1932.9,34,"Charges > $500, x 34%",1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,2274,40,,2274,percent of total billed charges,Implant Devices,1989.75,70,,1989.75,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1932.9,34,"If Charge > 2,000, then 34 percent",1932.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2274,
MEDTRONIC AB9U18100090 18X100 ABRE STENT,C1876,HCPCS,,79011125,CDM,278,RC,,,both,,,5685,2243.69,39.4668,,2243.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Device,1932.9,34,"Charges > $500, x 34%",1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,2274,40,,2274,percent of total billed charges,Implant Devices,1989.75,70,,1989.75,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1932.9,34,"If Charge > 2,000, then 34 percent",1932.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2274,
MEDTRONIC AB9U14120090 14X120 ABRE STENT,C1876,HCPCS,,79011126,CDM,278,RC,,,both,,,5685,2243.69,39.4668,,2243.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Device,1932.9,34,"Charges > $500, x 34%",1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,2274,40,,2274,percent of total billed charges,Implant Devices,1989.75,70,,1989.75,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1932.9,34,"If Charge > 2,000, then 34 percent",1932.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2274,
MEDTRONIC AB9U16120090 16X120 ABRE STENT,C1876,HCPCS,,79011127,CDM,278,RC,,,both,,,5685,2243.69,39.4668,,2243.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Device,1932.9,34,"Charges > $500, x 34%",1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,2274,40,,2274,percent of total billed charges,Implant Devices,1989.75,70,,1989.75,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1932.9,34,"If Charge > 2,000, then 34 percent",1932.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2274,
MEDTRONIC AB9U18120090 18X120 ABRE STENT,C1876,HCPCS,,79011128,CDM,278,RC,,,both,,,5685,2243.69,39.4668,,2243.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Device,1932.9,34,"Charges > $500, x 34%",1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,2274,40,,2274,percent of total billed charges,Implant Devices,1989.75,70,,1989.75,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1932.9,34,"If Charge > 2,000, then 34 percent",1932.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2274,
MEDTRONIC AB9U14150090 14X150 ABRE STENT,C1876,HCPCS,,79011129,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MEDTRONIC AB9U16150090 16X150 ABRE STENT,C1876,HCPCS,,79011130,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
MEDTRONIC AB9U18150090 18X150 ABRE STENT,C1876,HCPCS,,79011131,CDM,278,RC,,,both,,,6375,2516.01,39.4668,,2516.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2167.5,34,,2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Device,2167.5,34,"Charges > $500, x 34%",2167.5,percent of total billed charges,Implant Device,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2550,40,,2550,percent of total billed charges,Implant Devices,2231.25,70,,2231.25,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2167.5,34,,2167.5,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,2231.25,35,,2231.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2167.5,34,"If Charge > 2,000, then 34 percent",2167.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2550,
BARD AVSM08100 8X100X80CM VASCULAR STENT,C1876,HCPCS,,79011661,CDM,278,RC,,,both,,,8100,3196.81,39.4668,,3196.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2754,34,,2754,percent of total billed charges,Implant Device,2754,34,,2754,percent of total billed charges,Implant Device,2754,34,,2754,percent of total billed charges,Implant Device,2754,34,,2754,percent of total billed charges,Implant Device,2754,34,,2754,percent of total billed charges,Implant Device,2754,34,,2754,percent of total billed charges,Implant Device,2835,35,,2835,percent of total billed charges,Implant Device,2754,34,"Charges > $500, x 34%",2754,percent of total billed charges,Implant Device,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,3240,40,,3240,percent of total billed charges,Implant Devices,2835,70,,2835,percent of total billed charges,Implant Devices,2754,34,,2754,percent of total billed charges,Implant Devices,2754,34,,2754,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2754,34,"If Charge > 2,000, then 34 percent",2754,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3240,
BOST H74938046660750 6X60X75CM LD STENT,C1876,HCPCS,,79011872,CDM,278,RC,,,both,,,1976,779.86,39.4668,,779.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Device,671.84,34,"Charges > $500, x 34%",671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,790.4,40,,790.4,percent of total billed charges,Implant Devices,691.6,70,,691.6,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,790.4,
BOST H74938046920750 9X30X75CM LD STENT,C1876,HCPCS,,79011873,CDM,278,RC,,,both,,,1976,779.86,39.4668,,779.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Device,671.84,34,"Charges > $500, x 34%",671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,790.4,40,,790.4,percent of total billed charges,Implant Devices,691.6,70,,691.6,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,790.4,
BOST H74938047630130 6X30X135CM LD STENT,C1876,HCPCS,,79011874,CDM,278,RC,,,both,,,1976,779.86,39.4668,,779.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Device,671.84,34,"Charges > $500, x 34%",671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,790.4,40,,790.4,percent of total billed charges,Implant Devices,691.6,70,,691.6,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,790.4,
BOST H74938047730130 7X30X135CM LD STENT,C1876,HCPCS,,79011875,CDM,278,RC,,,both,,,1976,779.86,39.4668,,779.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Device,671.84,34,"Charges > $500, x 34%",671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,790.4,40,,790.4,percent of total billed charges,Implant Devices,691.6,70,,691.6,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,790.4,
BOST H74937912719150 7X19X150CM SD STENT,C1876,HCPCS,,79011876,CDM,278,RC,,,both,,,1976,779.86,39.4668,,779.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Device,671.84,34,"Charges > $500, x 34%",671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,790.4,40,,790.4,percent of total billed charges,Implant Devices,691.6,70,,691.6,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,790.4,
BOST H74939293064030 6X40X130CM STENT,C1876,HCPCS,,79011877,CDM,278,RC,,,both,,,1623,640.55,39.4668,,640.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Device,551.82,34,"Charges > $500, x 34%",551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,649.2,40,,649.2,percent of total billed charges,Implant Devices,568.05,70,,568.05,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,649.2,
BOST H74939293068030 6X80X130CM STENT,C1876,HCPCS,,79011878,CDM,278,RC,,,both,,,1623,640.55,39.4668,,640.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Device,551.82,34,"Charges > $500, x 34%",551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,649.2,40,,649.2,percent of total billed charges,Implant Devices,568.05,70,,568.05,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,649.2,
BOST H74939293061030 6X100X130CM STENT,C1876,HCPCS,,79011879,CDM,278,RC,,,both,,,1623,640.55,39.4668,,640.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Device,551.82,34,"Charges > $500, x 34%",551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,649.2,40,,649.2,percent of total billed charges,Implant Devices,568.05,70,,568.05,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,649.2,
BOST H74939293061530 6X150X130CM STENT,C1876,HCPCS,,79011880,CDM,278,RC,,,both,,,2117,835.51,39.4668,,835.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,719.78,34,,719.78,percent of total billed charges,Implant Device,719.78,34,,719.78,percent of total billed charges,Implant Device,719.78,34,,719.78,percent of total billed charges,Implant Device,719.78,34,,719.78,percent of total billed charges,Implant Device,719.78,34,,719.78,percent of total billed charges,Implant Device,719.78,34,,719.78,percent of total billed charges,Implant Device,740.95,35,,740.95,percent of total billed charges,Implant Device,719.78,34,"Charges > $500, x 34%",719.78,percent of total billed charges,Implant Device,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,846.8,40,,846.8,percent of total billed charges,Implant Devices,740.95,70,,740.95,percent of total billed charges,Implant Devices,719.78,34,,719.78,percent of total billed charges,Implant Devices,719.78,34,,719.78,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,719.78,34,"If Charge > 2,000, then 34 percent",719.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,846.8,
BOST H74939293074030 7X40X130CM STENT,C1876,HCPCS,,79011881,CDM,278,RC,,,both,,,1623,640.55,39.4668,,640.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Device,551.82,34,"Charges > $500, x 34%",551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,649.2,40,,649.2,percent of total billed charges,Implant Devices,568.05,70,,568.05,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,649.2,
BOST H74939293078030 7X80X130CM STENT,C1876,HCPCS,,79011882,CDM,278,RC,,,both,,,1623,640.55,39.4668,,640.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Device,551.82,34,"Charges > $500, x 34%",551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,649.2,40,,649.2,percent of total billed charges,Implant Devices,568.05,70,,568.05,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,649.2,
BOST H74939293071030 7X100X130CM STENT,C1876,HCPCS,,79011883,CDM,278,RC,,,both,,,1623,640.55,39.4668,,640.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,551.82,34,,551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Device,551.82,34,"Charges > $500, x 34%",551.82,percent of total billed charges,Implant Device,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,649.2,40,,649.2,percent of total billed charges,Implant Devices,568.05,70,,568.05,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,551.82,34,,551.82,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,568.05,35,,568.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,649.2,
BOST H74939293071530 7X150X130CM STENT,C1876,HCPCS,,79011884,CDM,278,RC,,,both,,,2117,835.51,39.4668,,835.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,719.78,34,,719.78,percent of total billed charges,Implant Device,719.78,34,,719.78,percent of total billed charges,Implant Device,719.78,34,,719.78,percent of total billed charges,Implant Device,719.78,34,,719.78,percent of total billed charges,Implant Device,719.78,34,,719.78,percent of total billed charges,Implant Device,719.78,34,,719.78,percent of total billed charges,Implant Device,740.95,35,,740.95,percent of total billed charges,Implant Device,719.78,34,"Charges > $500, x 34%",719.78,percent of total billed charges,Implant Device,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,846.8,40,,846.8,percent of total billed charges,Implant Devices,740.95,70,,740.95,percent of total billed charges,Implant Devices,719.78,34,,719.78,percent of total billed charges,Implant Devices,719.78,34,,719.78,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,740.95,35,,740.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,719.78,34,"If Charge > 2,000, then 34 percent",719.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,846.8,
BOST H74939200084070 8X40X75 EPIC STENT,C1876,HCPCS,,79011885,CDM,278,RC,,,both,,,1553,612.92,39.4668,,612.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Device,528.02,34,"Charges > $500, x 34%",528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,621.2,40,,621.2,percent of total billed charges,Implant Devices,543.55,70,,543.55,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,621.2,
BOST H74939200088070 8X80X75 EPIC STENT,C1876,HCPCS,,79011886,CDM,278,RC,,,both,,,1553,612.92,39.4668,,612.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Device,528.02,34,"Charges > $500, x 34%",528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,621.2,40,,621.2,percent of total billed charges,Implant Devices,543.55,70,,543.55,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,621.2,
BOST H74939200094070 9X40X75 EPIC STENT,C1876,HCPCS,,79011887,CDM,278,RC,,,both,,,1553,612.92,39.4668,,612.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Device,528.02,34,"Charges > $500, x 34%",528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,621.2,40,,621.2,percent of total billed charges,Implant Devices,543.55,70,,543.55,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,621.2,
BOST H74939200096070 9X60X75 EPIC STENT,C1876,HCPCS,,79011888,CDM,278,RC,,,both,,,1553,612.92,39.4668,,612.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Device,528.02,34,"Charges > $500, x 34%",528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,621.2,40,,621.2,percent of total billed charges,Implant Devices,543.55,70,,543.55,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,621.2,
BOST H74939200104070 10X40X75 EPIC STENT,C1876,HCPCS,,79011889,CDM,278,RC,,,both,,,1553,612.92,39.4668,,612.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Device,528.02,34,"Charges > $500, x 34%",528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,621.2,40,,621.2,percent of total billed charges,Implant Devices,543.55,70,,543.55,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,621.2,
BOST H74939200106070 EPIC STENT,C1876,HCPCS,,79011890,CDM,278,RC,,,both,,,1553,612.92,39.4668,,612.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Device,528.02,34,"Charges > $500, x 34%",528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,621.2,40,,621.2,percent of total billed charges,Implant Devices,543.55,70,,543.55,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,621.2,
BOST H74939200124070 12X40X75 EPIC STENT,C1876,HCPCS,,79011891,CDM,278,RC,,,both,,,1553,612.92,39.4668,,612.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Device,528.02,34,"Charges > $500, x 34%",528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,621.2,40,,621.2,percent of total billed charges,Implant Devices,543.55,70,,543.55,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,621.2,
BOST H74939200126070 12X60X75 EPIC STENT,C1876,HCPCS,,79011892,CDM,278,RC,,,both,,,1553,612.92,39.4668,,612.92,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,528.02,34,,528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Device,528.02,34,"Charges > $500, x 34%",528.02,percent of total billed charges,Implant Device,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,621.2,40,,621.2,percent of total billed charges,Implant Devices,543.55,70,,543.55,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,528.02,34,,528.02,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,543.55,35,,543.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,621.2,
BARD AVSM06100 6X100X80CM VASCULAR STENT,C1876,HCPCS,,79012285,CDM,278,RC,,,both,,,8100,3196.81,39.4668,,3196.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2754,34,,2754,percent of total billed charges,Implant Device,2754,34,,2754,percent of total billed charges,Implant Device,2754,34,,2754,percent of total billed charges,Implant Device,2754,34,,2754,percent of total billed charges,Implant Device,2754,34,,2754,percent of total billed charges,Implant Device,2754,34,,2754,percent of total billed charges,Implant Device,2835,35,,2835,percent of total billed charges,Implant Device,2754,34,"Charges > $500, x 34%",2754,percent of total billed charges,Implant Device,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,3240,40,,3240,percent of total billed charges,Implant Devices,2835,70,,2835,percent of total billed charges,Implant Devices,2754,34,,2754,percent of total billed charges,Implant Devices,2754,34,,2754,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,2835,35,,2835,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2754,34,"If Charge > 2,000, then 34 percent",2754,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3240,
BOST H74938046640750 EXP LD 6X37X75CM,C1876,HCPCS,,79013431,CDM,278,RC,,,both,,,1976,779.86,39.4668,,779.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Device,671.84,34,"Charges > $500, x 34%",671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,790.4,40,,790.4,percent of total billed charges,Implant Devices,691.6,70,,691.6,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,790.4,
BOST H74938046830750 EXP LD 8X27X75CM,C1876,HCPCS,,79013432,CDM,278,RC,,,both,,,1976,779.86,39.4668,,779.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Device,671.84,34,"Charges > $500, x 34%",671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,790.4,40,,790.4,percent of total billed charges,Implant Devices,691.6,70,,691.6,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,790.4,
BOST H74938046760750 EXP LD 7X57X75CM,C1876,HCPCS,,79013433,CDM,278,RC,,,both,,,1976,779.86,39.4668,,779.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Device,671.84,34,"Charges > $500, x 34%",671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,790.4,40,,790.4,percent of total billed charges,Implant Devices,691.6,70,,691.6,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,790.4,
BOST H47937911715150 7X15X150 EXP STENT,C1876,HCPCS,,79013434,CDM,278,RC,,,both,,,1976,779.86,39.4668,,779.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Device,671.84,34,"Charges > $500, x 34%",671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,790.4,40,,790.4,percent of total billed charges,Implant Devices,691.6,70,,691.6,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,790.4,
BOST H74912044146070 14X60X75CM STENT,C1876,HCPCS,,79013648,CDM,278,RC,,,both,,,2665,1051.79,39.4668,,1051.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,932.75,35,,932.75,percent of total billed charges,Implant Device,906.1,34,"Charges > $500, x 34%",906.1,percent of total billed charges,Implant Device,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,1066,40,,1066,percent of total billed charges,Implant Devices,932.75,70,,932.75,percent of total billed charges,Implant Devices,906.1,34,,906.1,percent of total billed charges,Implant Devices,906.1,34,,906.1,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,906.1,34,"If Charge > 2,000, then 34 percent",906.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1066,
BOST H74912044166070 16X60X75CM STENT,C1876,HCPCS,,79013649,CDM,278,RC,,,both,,,2665,1051.79,39.4668,,1051.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,932.75,35,,932.75,percent of total billed charges,Implant Device,906.1,34,"Charges > $500, x 34%",906.1,percent of total billed charges,Implant Device,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,1066,40,,1066,percent of total billed charges,Implant Devices,932.75,70,,932.75,percent of total billed charges,Implant Devices,906.1,34,,906.1,percent of total billed charges,Implant Devices,906.1,34,,906.1,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,906.1,34,"If Charge > 2,000, then 34 percent",906.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1066,
BOST H74912044169070 16X90X75CM STENT,C1876,HCPCS,,79013650,CDM,278,RC,,,both,,,2665,1051.79,39.4668,,1051.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,932.75,35,,932.75,percent of total billed charges,Implant Device,906.1,34,"Charges > $500, x 34%",906.1,percent of total billed charges,Implant Device,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,1066,40,,1066,percent of total billed charges,Implant Devices,932.75,70,,932.75,percent of total billed charges,Implant Devices,906.1,34,,906.1,percent of total billed charges,Implant Devices,906.1,34,,906.1,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,906.1,34,"If Charge > 2,000, then 34 percent",906.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1066,
BOST H74912044186070 18X60X75CM STENT,C1876,HCPCS,,79013651,CDM,278,RC,,,both,,,2665,1051.79,39.4668,,1051.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,906.1,34,,906.1,percent of total billed charges,Implant Device,932.75,35,,932.75,percent of total billed charges,Implant Device,906.1,34,"Charges > $500, x 34%",906.1,percent of total billed charges,Implant Device,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,1066,40,,1066,percent of total billed charges,Implant Devices,932.75,70,,932.75,percent of total billed charges,Implant Devices,906.1,34,,906.1,percent of total billed charges,Implant Devices,906.1,34,,906.1,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,932.75,35,,932.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,906.1,34,"If Charge > 2,000, then 34 percent",906.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1066,
BOST H74938046830750 8X27X75CM EXP STENT,C1876,HCPCS,,79013725,CDM,278,RC,,,both,,,1976,779.86,39.4668,,779.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,671.84,34,,671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Device,671.84,34,"Charges > $500, x 34%",671.84,percent of total billed charges,Implant Device,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,790.4,40,,790.4,percent of total billed charges,Implant Devices,691.6,70,,691.6,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,671.84,34,,671.84,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,691.6,35,,691.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,790.4,
MEDTRONIC AB9U16060090 16X60 STENT SYS,C1876,HCPCS,,79013790,CDM,278,RC,,,both,,,5685,2243.69,39.4668,,2243.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Device,1932.9,34,"Charges > $500, x 34%",1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,2274,40,,2274,percent of total billed charges,Implant Devices,1989.75,70,,1989.75,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1932.9,34,"If Charge > 2,000, then 34 percent",1932.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2274,
MEDTRONIC AB9U16080090 16X80 STENT SYS,C1876,HCPCS,,79013791,CDM,278,RC,,,both,,,5685,2243.69,39.4668,,2243.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1932.9,34,,1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Device,1932.9,34,"Charges > $500, x 34%",1932.9,percent of total billed charges,Implant Device,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,2274,40,,2274,percent of total billed charges,Implant Devices,1989.75,70,,1989.75,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1932.9,34,,1932.9,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,1989.75,35,,1989.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1932.9,34,"If Charge > 2,000, then 34 percent",1932.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2274,
ATRIUM 85409 COVERED STENT 9X59X80,C1877,HCPCS,,79000325,CDM,278,RC,,,both,,,8326,3286.01,39.4668,,3286.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2830.84,34,,2830.84,percent of total billed charges,Implant Device,2914.1,35,,2914.1,percent of total billed charges,Implant Device,2830.84,34,"Charges > $500, x 34%",2830.84,percent of total billed charges,Implant Device,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,3330.4,40,,3330.4,percent of total billed charges,Implant Devices,2914.1,70,,2914.1,percent of total billed charges,Implant Devices,2830.84,34,,2830.84,percent of total billed charges,Implant Devices,2830.84,34,,2830.84,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,2914.1,35,,2914.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2830.84,34,"If Charge > 2,000, then 34 percent",2830.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3330.4,
POLARIS STENT 24FR,C1877,HCPCS,,79001688,CDM,278,RC,,,both,,,431,170.1,39.4668,,170.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,146.54,34,,146.54,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,172.4,40,,172.4,percent of total billed charges,Implant Devices,150.85,70,,150.85,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,146.54,34,,146.54,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,150.85,35,,150.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.4,
BARD RF400F FEMORAL RECOVERY VC FILTER,C1880,HCPCS,,79000358,CDM,278,RC,,,both,,,4336,1711.28,39.4668,,1711.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1474.24,34,,1474.24,percent of total billed charges,Implant Device,1517.6,35,,1517.6,percent of total billed charges,Implant Device,1474.24,34,"Charges > $500, x 34%",1474.24,percent of total billed charges,Implant Device,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1734.4,40,,1734.4,percent of total billed charges,Implant Devices,1517.6,70,,1517.6,percent of total billed charges,Implant Devices,1474.24,34,,1474.24,percent of total billed charges,Implant Devices,1474.24,34,,1474.24,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,1517.6,35,,1517.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1474.24,34,"If Charge > 2,000, then 34 percent",1474.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1734.4,
J&J 466-F220A OPTEASE VC FILTER 55CM,C1880,HCPCS,,79000360,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
ARGON 352506070 OPTION FILTER 70CM,C1880,HCPCS,,79000439,CDM,278,RC,,,both,,,3150,1243.2,39.4668,,1243.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1071,34,,1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Device,1071,34,"Charges > $500, x 34%",1071,percent of total billed charges,Implant Device,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1260,40,,1260,percent of total billed charges,Implant Devices,1102.5,70,,1102.5,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1071,34,,1071,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,1102.5,35,,1102.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1071,34,"If Charge > 2,000, then 34 percent",1071,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1260,
J&J 466-P-306BU TRAPEASE FILTER IVC 90CM,C1880,HCPCS,,79000547,CDM,278,RC,,,both,,,4036,1592.88,39.4668,,1592.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1372.24,34,,1372.24,percent of total billed charges,Implant Device,1372.24,34,,1372.24,percent of total billed charges,Implant Device,1372.24,34,,1372.24,percent of total billed charges,Implant Device,1372.24,34,,1372.24,percent of total billed charges,Implant Device,1372.24,34,,1372.24,percent of total billed charges,Implant Device,1372.24,34,,1372.24,percent of total billed charges,Implant Device,1412.6,35,,1412.6,percent of total billed charges,Implant Device,1372.24,34,"Charges > $500, x 34%",1372.24,percent of total billed charges,Implant Device,1412.6,35,,1412.6,percent of total billed charges,Implant Devices,1412.6,35,,1412.6,percent of total billed charges,Implant Devices,1412.6,35,,,percent of total billed charges,Implant Devices,1412.6,35,,1412.6,percent of total billed charges,Implant Devices,1412.6,35,,1412.6,percent of total billed charges,Implant Devices,1614.4,40,,1614.4,percent of total billed charges,Implant Devices,1412.6,70,,1412.6,percent of total billed charges,Implant Devices,1372.24,34,,1372.24,percent of total billed charges,Implant Devices,1372.24,34,,1372.24,percent of total billed charges,Implant Devices,1412.6,35,,1412.6,percent of total billed charges,Implant Devices,1412.6,35,,1412.6,percent of total billed charges,Implant Devices,1412.6,35,,1412.6,percent of total billed charges,Implant Devices,1412.6,35,,1412.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1372.24,34,"If Charge > 2,000, then 34 percent",1372.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1614.4,
TRAPEASE FILTER IVC 55CM,C1880,HCPCS,,79000548,CDM,278,RC,,,both,,,2296,906.16,39.4668,,906.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,780.64,34,,780.64,percent of total billed charges,Implant Device,780.64,34,,780.64,percent of total billed charges,Implant Device,780.64,34,,780.64,percent of total billed charges,Implant Device,780.64,34,,780.64,percent of total billed charges,Implant Device,780.64,34,,780.64,percent of total billed charges,Implant Device,780.64,34,,780.64,percent of total billed charges,Implant Device,803.6,35,,803.6,percent of total billed charges,Implant Device,780.64,34,"Charges > $500, x 34%",780.64,percent of total billed charges,Implant Device,803.6,35,,803.6,percent of total billed charges,Implant Devices,803.6,35,,803.6,percent of total billed charges,Implant Devices,803.6,35,,,percent of total billed charges,Implant Devices,803.6,35,,803.6,percent of total billed charges,Implant Devices,803.6,35,,803.6,percent of total billed charges,Implant Devices,918.4,40,,918.4,percent of total billed charges,Implant Devices,803.6,70,,803.6,percent of total billed charges,Implant Devices,780.64,34,,780.64,percent of total billed charges,Implant Devices,780.64,34,,780.64,percent of total billed charges,Implant Devices,803.6,35,,803.6,percent of total billed charges,Implant Devices,803.6,35,,803.6,percent of total billed charges,Implant Devices,803.6,35,,803.6,percent of total billed charges,Implant Devices,803.6,35,,803.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,780.64,34,"If Charge > 2,000, then 34 percent",780.64,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,918.4,
ARGON MED 352508070 VENA CAVA FILTER,C1880,HCPCS,,79001847,CDM,278,RC,,,both,,,3300,1302.4,39.4668,,1302.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1122,34,,1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Device,1122,34,"Charges > $500, x 34%",1122,percent of total billed charges,Implant Device,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1320,40,,1320,percent of total billed charges,Implant Devices,1155,70,,1155,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1122,34,,1122,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,1155,35,,1155,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1122,34,"If Charge > 2,000, then 34 percent",1122,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1320,
IGTCFS-65-1-FEM-CELECT COOK VENACAVAFILT,C1880,HCPCS,,79003243,CDM,278,RC,,,both,,,4260,1681.29,39.4668,,1681.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1448.4,34,,1448.4,percent of total billed charges,Implant Device,1491,35,,1491,percent of total billed charges,Implant Device,1448.4,34,"Charges > $500, x 34%",1448.4,percent of total billed charges,Implant Device,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1704,40,,1704,percent of total billed charges,Implant Devices,1491,70,,1491,percent of total billed charges,Implant Devices,1448.4,34,,1448.4,percent of total billed charges,Implant Devices,1448.4,34,,1448.4,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,1491,35,,1491,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1448.4,34,"If Charge > 2,000, then 34 percent",1448.4,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1704,
ARGON 352506070 OPTION VENA CAVA FILTER,C1880,HCPCS,,79003747,CDM,278,RC,,,both,,,5086,2007.28,39.4668,,2007.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1729.24,34,,1729.24,percent of total billed charges,Implant Device,1729.24,34,,1729.24,percent of total billed charges,Implant Device,1729.24,34,,1729.24,percent of total billed charges,Implant Device,1729.24,34,,1729.24,percent of total billed charges,Implant Device,1729.24,34,,1729.24,percent of total billed charges,Implant Device,1729.24,34,,1729.24,percent of total billed charges,Implant Device,1780.1,35,,1780.1,percent of total billed charges,Implant Device,1729.24,34,"Charges > $500, x 34%",1729.24,percent of total billed charges,Implant Device,1780.1,35,,1780.1,percent of total billed charges,Implant Devices,1780.1,35,,1780.1,percent of total billed charges,Implant Devices,1780.1,35,,,percent of total billed charges,Implant Devices,1780.1,35,,1780.1,percent of total billed charges,Implant Devices,1780.1,35,,1780.1,percent of total billed charges,Implant Devices,2034.4,40,,2034.4,percent of total billed charges,Implant Devices,1780.1,70,,1780.1,percent of total billed charges,Implant Devices,1729.24,34,,1729.24,percent of total billed charges,Implant Devices,1729.24,34,,1729.24,percent of total billed charges,Implant Devices,1780.1,35,,1780.1,percent of total billed charges,Implant Devices,1780.1,35,,1780.1,percent of total billed charges,Implant Devices,1780.1,35,,1780.1,percent of total billed charges,Implant Devices,1780.1,35,,1780.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1729.24,34,"If Charge > 2,000, then 34 percent",1729.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2034.4,
BARD DL900F DENALI VENA CAVA FILTER 55CM,C1880,HCPCS,,79006407,CDM,278,RC,,,both,,,3000,1184,39.4668,,1184,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1020,34,,1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Device,1020,34,"Charges > $500, x 34%",1020,percent of total billed charges,Implant Device,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1200,40,,1200,percent of total billed charges,Implant Devices,1050,70,,1050,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1020,34,,1020,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,1050,35,,1050,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1020,34,"If Charge > 2,000, then 34 percent",1020,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1200,
J&J 466F230BJ OPTEASE VENA CAVA FILTER,C1880,HCPCS,,79007406,CDM,278,RC,,,both,,,3111,1227.81,39.4668,,1227.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1057.74,34,,1057.74,percent of total billed charges,Implant Device,1057.74,34,,1057.74,percent of total billed charges,Implant Device,1057.74,34,,1057.74,percent of total billed charges,Implant Device,1057.74,34,,1057.74,percent of total billed charges,Implant Device,1057.74,34,,1057.74,percent of total billed charges,Implant Device,1057.74,34,,1057.74,percent of total billed charges,Implant Device,1088.85,35,,1088.85,percent of total billed charges,Implant Device,1057.74,34,"Charges > $500, x 34%",1057.74,percent of total billed charges,Implant Device,1088.85,35,,1088.85,percent of total billed charges,Implant Devices,1088.85,35,,1088.85,percent of total billed charges,Implant Devices,1088.85,35,,,percent of total billed charges,Implant Devices,1088.85,35,,1088.85,percent of total billed charges,Implant Devices,1088.85,35,,1088.85,percent of total billed charges,Implant Devices,1244.4,40,,1244.4,percent of total billed charges,Implant Devices,1088.85,70,,1088.85,percent of total billed charges,Implant Devices,1057.74,34,,1057.74,percent of total billed charges,Implant Devices,1057.74,34,,1057.74,percent of total billed charges,Implant Devices,1088.85,35,,1088.85,percent of total billed charges,Implant Devices,1088.85,35,,1088.85,percent of total billed charges,Implant Devices,1088.85,35,,1088.85,percent of total billed charges,Implant Devices,1088.85,35,,1088.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1057.74,34,"If Charge > 2,000, then 34 percent",1057.74,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1244.4,
CORDIS 466-F210AF OPTEASE VC FILTER KIT,C1880,HCPCS,,79008836,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
CORDIS 466-F210AJ OPTEASE VC FILTER KIT,C1880,HCPCS,,79008837,CDM,278,RC,,,both,,,4200,1657.61,39.4668,,1657.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1428,34,,1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Device,1428,34,"Charges > $500, x 34%",1428,percent of total billed charges,Implant Device,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1680,40,,1680,percent of total billed charges,Implant Devices,1470,70,,1470,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1428,34,,1428,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,1470,35,,1470,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1428,34,"If Charge > 2,000, then 34 percent",1428,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1680,
MEDTRONIC D314TRM PROTECTA XT CRT-D,C1882,HCPCS,,79003628,CDM,278,RC,,,both,,,78718,31067.48,39.4668,,31067.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26764.12,34,,26764.12,percent of total billed charges,Implant Device,26764.12,34,,26764.12,percent of total billed charges,Implant Device,26764.12,34,,26764.12,percent of total billed charges,Implant Device,26764.12,34,,26764.12,percent of total billed charges,Implant Device,26764.12,34,,26764.12,percent of total billed charges,Implant Device,26764.12,34,,26764.12,percent of total billed charges,Implant Device,27551.3,35,,27551.3,percent of total billed charges,Implant Device,26764.12,34,"Charges > $500, x 34%",26764.12,percent of total billed charges,Implant Device,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,31487.2,40,,31487.2,percent of total billed charges,Implant Devices,27551.3,70,,27551.3,percent of total billed charges,Implant Devices,26764.12,34,,26764.12,percent of total billed charges,Implant Devices,26764.12,34,,26764.12,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,27551.3,35,,27551.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,26764.12,34,"If Charge > 2,000, then 34 percent",26764.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,31487.2,
MEDTRONIC DTBA1Q1 VIVA QUAD XT CRT-D,C1882,HCPCS,,79006836,CDM,278,RC,,,both,,,75731,29888.6,39.4668,,29888.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25748.54,34,,25748.54,percent of total billed charges,Implant Device,25748.54,34,,25748.54,percent of total billed charges,Implant Device,25748.54,34,,25748.54,percent of total billed charges,Implant Device,25748.54,34,,25748.54,percent of total billed charges,Implant Device,25748.54,34,,25748.54,percent of total billed charges,Implant Device,25748.54,34,,25748.54,percent of total billed charges,Implant Device,26505.85,35,,26505.85,percent of total billed charges,Implant Device,25748.54,34,"Charges > $500, x 34%",25748.54,percent of total billed charges,Implant Device,26505.85,35,,26505.85,percent of total billed charges,Implant Devices,26505.85,35,,26505.85,percent of total billed charges,Implant Devices,26505.85,35,,,percent of total billed charges,Implant Devices,26505.85,35,,26505.85,percent of total billed charges,Implant Devices,26505.85,35,,26505.85,percent of total billed charges,Implant Devices,30292.4,40,,30292.4,percent of total billed charges,Implant Devices,26505.85,70,,26505.85,percent of total billed charges,Implant Devices,25748.54,34,,25748.54,percent of total billed charges,Implant Devices,25748.54,34,,25748.54,percent of total billed charges,Implant Devices,26505.85,35,,26505.85,percent of total billed charges,Implant Devices,26505.85,35,,26505.85,percent of total billed charges,Implant Devices,26505.85,35,,26505.85,percent of total billed charges,Implant Devices,26505.85,35,,26505.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,25748.54,34,"If Charge > 2,000, then 34 percent",25748.54,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,30292.4,
ARTHREX AR-8929 PARS QUAD REPAIR KIT,C1882,HCPCS,,79011646,CDM,278,RC,,,both,,,7500,2960.01,39.4668,,2960.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2550,34,,2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Device,2550,34,"Charges > $500, x 34%",2550,percent of total billed charges,Implant Device,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,3000,40,,3000,percent of total billed charges,Implant Devices,2625,70,,2625,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2550,34,,2550,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,2625,35,,2625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2550,34,"If Charge > 2,000, then 34 percent",2550,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3000,
STRYKER 1822-0828S TIBIAL NAIL 8 X 285MM,C1889,HCPCS,,79011962,CDM,278,RC,,,both,,,3529,1392.78,39.4668,,1392.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1199.86,34,,1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Device,1199.86,34,"Charges > $500, x 34%",1199.86,percent of total billed charges,Implant Device,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1411.6,40,,1411.6,percent of total billed charges,Implant Devices,1235.15,70,,1235.15,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1199.86,34,,1199.86,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,1235.15,35,,1235.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1199.86,34,"If Charge > 2,000, then 34 percent",1199.86,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1411.6,
J&J 04.013.544S FEMORAL NAIL 11MM,C1889,HCPCS,,79012111,CDM,278,RC,,,both,,,3375,1332,39.4668,,1332,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1147.5,34,,1147.5,percent of total billed charges,Implant Device,1181.25,35,,1181.25,percent of total billed charges,Implant Device,1147.5,34,"Charges > $500, x 34%",1147.5,percent of total billed charges,Implant Device,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1350,40,,1350,percent of total billed charges,Implant Devices,1181.25,70,,1181.25,percent of total billed charges,Implant Devices,1147.5,34,,1147.5,percent of total billed charges,Implant Devices,1147.5,34,,1147.5,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,1181.25,35,,1181.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1147.5,34,"If Charge > 2,000, then 34 percent",1147.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1350,
STRYKER 2341-0934S TIBIAL NAIL 9X345MM,C1889,HCPCS,,79012116,CDM,278,RC,,,both,,,6378,2517.19,39.4668,,2517.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2168.52,34,,2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Device,2168.52,34,"Charges > $500, x 34%",2168.52,percent of total billed charges,Implant Device,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2551.2,40,,2551.2,percent of total billed charges,Implant Devices,2232.3,70,,2232.3,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2168.52,34,,2168.52,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,2232.3,35,,2232.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2168.52,34,"If Charge > 2,000, then 34 percent",2168.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2551.2,
STRYKER 3525-1420S NAIL KIT 11X420C450MM,C1889,HCPCS,,79012147,CDM,278,RC,,,both,,,5438,2146.2,39.4668,,2146.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1848.92,34,,1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Device,1848.92,34,"Charges > $500, x 34%",1848.92,percent of total billed charges,Implant Device,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,2175.2,40,,2175.2,percent of total billed charges,Implant Devices,1903.3,70,,1903.3,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1848.92,34,,1848.92,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,1903.3,35,,1903.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1848.92,34,"If Charge > 2,000, then 34 percent",1848.92,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2175.2,
ZIMMER 8144-11-420 HIP FRACTURE NAIL,C1889,HCPCS,,79012187,CDM,278,RC,,,both,,,7290,2877.13,39.4668,,2877.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2551.5,35,,2551.5,percent of total billed charges,Implant Device,2478.6,34,"Charges > $500, x 34%",2478.6,percent of total billed charges,Implant Device,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2916,40,,2916,percent of total billed charges,Implant Devices,2551.5,70,,2551.5,percent of total billed charges,Implant Devices,2478.6,34,,2478.6,percent of total billed charges,Implant Devices,2478.6,34,,2478.6,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2478.6,34,"If Charge > 2,000, then 34 percent",2478.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2916,
DJO 415-00-140 CEMENT RESTRICTOR SZ 14MM,C1889,HCPCS,,79012221,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
STRYKER 1822-1028S TIBIAL NAIL 5X35MM,C1889,HCPCS,,79012248,CDM,278,RC,,,both,,,3017,1190.71,39.4668,,1190.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1055.95,35,,1055.95,percent of total billed charges,Implant Device,1025.78,34,"Charges > $500, x 34%",1025.78,percent of total billed charges,Implant Device,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1206.8,40,,1206.8,percent of total billed charges,Implant Devices,1055.95,70,,1055.95,percent of total billed charges,Implant Devices,1025.78,34,,1025.78,percent of total billed charges,Implant Devices,1025.78,34,,1025.78,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1025.78,34,"If Charge > 2,000, then 34 percent",1025.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1206.8,
J&J 04.037.212S TFNA NAIL 12X170MM,C1889,HCPCS,,79012252,CDM,278,RC,,,both,,,3718,1467.38,39.4668,,1467.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1301.3,35,,1301.3,percent of total billed charges,Implant Device,1264.12,34,"Charges > $500, x 34%",1264.12,percent of total billed charges,Implant Device,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1487.2,40,,1487.2,percent of total billed charges,Implant Devices,1301.3,70,,1301.3,percent of total billed charges,Implant Devices,1264.12,34,,1264.12,percent of total billed charges,Implant Devices,1264.12,34,,1264.12,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1264.12,34,"If Charge > 2,000, then 34 percent",1264.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1487.2,
STRYKER 3130-0170S TROCH NAIL KIT 10X170,C1889,HCPCS,,79012271,CDM,278,RC,,,both,,,2928,1155.59,39.4668,,1155.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,995.52,34,,995.52,percent of total billed charges,Implant Device,1024.8,35,,1024.8,percent of total billed charges,Implant Device,995.52,34,"Charges > $500, x 34%",995.52,percent of total billed charges,Implant Device,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1171.2,40,,1171.2,percent of total billed charges,Implant Devices,1024.8,70,,1024.8,percent of total billed charges,Implant Devices,995.52,34,,995.52,percent of total billed charges,Implant Devices,995.52,34,,995.52,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,1024.8,35,,1024.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,995.52,34,"If Charge > 2,000, then 34 percent",995.52,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1171.2,
STRYKER 1822-1134S TIBIAL NAIL 11X345MM,C1889,HCPCS,,79012286,CDM,278,RC,,,both,,,3017,1190.71,39.4668,,1190.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1025.78,34,,1025.78,percent of total billed charges,Implant Device,1055.95,35,,1055.95,percent of total billed charges,Implant Device,1025.78,34,"Charges > $500, x 34%",1025.78,percent of total billed charges,Implant Device,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1206.8,40,,1206.8,percent of total billed charges,Implant Devices,1055.95,70,,1055.95,percent of total billed charges,Implant Devices,1025.78,34,,1025.78,percent of total billed charges,Implant Devices,1025.78,34,,1025.78,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,1055.95,35,,1055.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1025.78,34,"If Charge > 2,000, then 34 percent",1025.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1206.8,
ZIMMER 8143-09-380 HIP FRAC NAIL 9X380MM,C1889,HCPCS,,79012348,CDM,278,RC,,,both,,,7290,2877.13,39.4668,,2877.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2551.5,35,,2551.5,percent of total billed charges,Implant Device,2478.6,34,"Charges > $500, x 34%",2478.6,percent of total billed charges,Implant Device,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2916,40,,2916,percent of total billed charges,Implant Devices,2551.5,70,,2551.5,percent of total billed charges,Implant Devices,2478.6,34,,2478.6,percent of total billed charges,Implant Devices,2478.6,34,,2478.6,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2478.6,34,"If Charge > 2,000, then 34 percent",2478.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2916,
J&J 04.034.340S TIBIAL NAIL 9X300MM,C1889,HCPCS,,79012390,CDM,278,RC,,,both,,,2765,1091.26,39.4668,,1091.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,967.75,35,,967.75,percent of total billed charges,Implant Device,940.1,34,"Charges > $500, x 34%",940.1,percent of total billed charges,Implant Device,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,1106,40,,1106,percent of total billed charges,Implant Devices,967.75,70,,967.75,percent of total billed charges,Implant Devices,940.1,34,,940.1,percent of total billed charges,Implant Devices,940.1,34,,940.1,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,940.1,34,"If Charge > 2,000, then 34 percent",940.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1106,
J&J 04.034.449S TIBAIL NAIL 10X345MM,C1889,HCPCS,,79012393,CDM,278,RC,,,both,,,2765,1091.26,39.4668,,1091.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,967.75,35,,967.75,percent of total billed charges,Implant Device,940.1,34,"Charges > $500, x 34%",940.1,percent of total billed charges,Implant Device,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,1106,40,,1106,percent of total billed charges,Implant Devices,967.75,70,,967.75,percent of total billed charges,Implant Devices,940.1,34,,940.1,percent of total billed charges,Implant Devices,940.1,34,,940.1,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,940.1,34,"If Charge > 2,000, then 34 percent",940.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1106,
J&J 04.037.165S TFNA NAIL 11X440 130 DEG,C1889,HCPCS,,79012395,CDM,278,RC,,,both,,,5212,2057.01,39.4668,,2057.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Device,1772.08,34,"Charges > $500, x 34%",1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,2084.8,40,,2084.8,percent of total billed charges,Implant Devices,1824.2,70,,1824.2,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1772.08,34,"If Charge > 2,000, then 34 percent",1772.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2084.8,
J&J 04.038.420S HELICAL BLADE 120MM,C1889,HCPCS,,79012396,CDM,278,RC,,,both,,,1864,735.66,39.4668,,735.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,633.76,34,,633.76,percent of total billed charges,Implant Device,652.4,35,,652.4,percent of total billed charges,Implant Device,633.76,34,"Charges > $500, x 34%",633.76,percent of total billed charges,Implant Device,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,745.6,40,,745.6,percent of total billed charges,Implant Devices,652.4,70,,652.4,percent of total billed charges,Implant Devices,633.76,34,,633.76,percent of total billed charges,Implant Devices,633.76,34,,633.76,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,652.4,35,,652.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,745.6,
STRYKER 2341-1133S TIBIAL NAIL 11X330MM,C1889,HCPCS,,79012397,CDM,278,RC,,,both,,,4792,1891.25,39.4668,,1891.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Device,1629.28,34,"Charges > $500, x 34%",1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1916.8,40,,1916.8,percent of total billed charges,Implant Devices,1677.2,70,,1677.2,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.28,34,"If Charge > 2,000, then 34 percent",1629.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1916.8,
J&J 04.034.355S TIBIAL NAIL 9X375MM,C1889,HCPCS,,79012429,CDM,278,RC,,,both,,,2765,1091.26,39.4668,,1091.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,967.75,35,,967.75,percent of total billed charges,Implant Device,940.1,34,"Charges > $500, x 34%",940.1,percent of total billed charges,Implant Device,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,1106,40,,1106,percent of total billed charges,Implant Devices,967.75,70,,967.75,percent of total billed charges,Implant Devices,940.1,34,,940.1,percent of total billed charges,Implant Devices,940.1,34,,940.1,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,940.1,34,"If Charge > 2,000, then 34 percent",940.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1106,
J&J 04.037.012S TFNA NAIL 10X170MM 125,C1889,HCPCS,,79012481,CDM,278,RC,,,both,,,3718,1467.38,39.4668,,1467.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1264.12,34,,1264.12,percent of total billed charges,Implant Device,1301.3,35,,1301.3,percent of total billed charges,Implant Device,1264.12,34,"Charges > $500, x 34%",1264.12,percent of total billed charges,Implant Device,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1487.2,40,,1487.2,percent of total billed charges,Implant Devices,1301.3,70,,1301.3,percent of total billed charges,Implant Devices,1264.12,34,,1264.12,percent of total billed charges,Implant Devices,1264.12,34,,1264.12,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,1301.3,35,,1301.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1264.12,34,"If Charge > 2,000, then 34 percent",1264.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1487.2,
BOST SCI M00562321 OVAL STIFF SNARE 13MM,C1889,HCPCS,,79012483,CDM,278,RC,,,both,,,32,12.63,39.4668,,12.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10.88,34,,10.88,percent of total billed charges,Implant Device,10.88,34,,10.88,percent of total billed charges,Implant Device,10.88,34,,10.88,percent of total billed charges,Implant Device,10.88,34,,10.88,percent of total billed charges,Implant Device,10.88,34,,10.88,percent of total billed charges,Implant Device,10.88,34,,10.88,percent of total billed charges,Implant Device,11.2,35,,11.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,11.2,35,,11.2,percent of total billed charges,Implant Devices,11.2,35,,11.2,percent of total billed charges,Implant Devices,11.2,35,,,percent of total billed charges,Implant Devices,11.2,35,,11.2,percent of total billed charges,Implant Devices,11.2,35,,11.2,percent of total billed charges,Implant Devices,12.8,40,,12.8,percent of total billed charges,Implant Devices,11.2,70,,11.2,percent of total billed charges,Implant Devices,10.88,34,,10.88,percent of total billed charges,Implant Devices,10.88,34,,10.88,percent of total billed charges,Implant Devices,11.2,35,,11.2,percent of total billed charges,Implant Devices,11.2,35,,11.2,percent of total billed charges,Implant Devices,11.2,35,,11.2,percent of total billed charges,Implant Devices,11.2,35,,11.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,12.8,
ZIMMER 8143-11-400 HIP FRAC NAIL 11X400,C1889,HCPCS,,79012506,CDM,278,RC,,,both,,,7290,2877.13,39.4668,,2877.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2478.6,34,,2478.6,percent of total billed charges,Implant Device,2551.5,35,,2551.5,percent of total billed charges,Implant Device,2478.6,34,"Charges > $500, x 34%",2478.6,percent of total billed charges,Implant Device,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2916,40,,2916,percent of total billed charges,Implant Devices,2551.5,70,,2551.5,percent of total billed charges,Implant Devices,2478.6,34,,2478.6,percent of total billed charges,Implant Devices,2478.6,34,,2478.6,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,2551.5,35,,2551.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2478.6,34,"If Charge > 2,000, then 34 percent",2478.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2916,
J&J 04.037.161S TFNA NAIL 11/130 DEG LT,C1889,HCPCS,,79012712,CDM,278,RC,,,both,,,5212,2057.01,39.4668,,2057.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Device,1772.08,34,"Charges > $500, x 34%",1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,2084.8,40,,2084.8,percent of total billed charges,Implant Devices,1824.2,70,,1824.2,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1772.08,34,"If Charge > 2,000, then 34 percent",1772.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2084.8,
J&J 04.034.352S CANN TIBIAL NAIL 360MM,C1889,HCPCS,,79012759,CDM,278,RC,,,both,,,2765,1091.26,39.4668,,1091.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,967.75,35,,967.75,percent of total billed charges,Implant Device,940.1,34,"Charges > $500, x 34%",940.1,percent of total billed charges,Implant Device,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,1106,40,,1106,percent of total billed charges,Implant Devices,967.75,70,,967.75,percent of total billed charges,Implant Devices,940.1,34,,940.1,percent of total billed charges,Implant Devices,940.1,34,,940.1,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,940.1,34,"If Charge > 2,000, then 34 percent",940.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1106,
STRYKER 2339-1332S FEMORAL NAIL 13X320MM,C1889,HCPCS,,79012964,CDM,278,RC,,,both,,,6585,2598.89,39.4668,,2598.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2304.75,35,,2304.75,percent of total billed charges,Implant Device,2238.9,34,"Charges > $500, x 34%",2238.9,percent of total billed charges,Implant Device,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2634,40,,2634,percent of total billed charges,Implant Devices,2304.75,70,,2304.75,percent of total billed charges,Implant Devices,2238.9,34,,2238.9,percent of total billed charges,Implant Devices,2238.9,34,,2238.9,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2238.9,34,"If Charge > 2,000, then 34 percent",2238.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2634,
IMPLANT/ INSERT DEVICE,C1889,HCPCS,,79013001,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
STRYKER 2339-1334S FEMORAL NAIL 13X340MM,C1889,HCPCS,,79013031,CDM,278,RC,,,both,,,6585,2598.89,39.4668,,2598.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2304.75,35,,2304.75,percent of total billed charges,Implant Device,2238.9,34,"Charges > $500, x 34%",2238.9,percent of total billed charges,Implant Device,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2634,40,,2634,percent of total billed charges,Implant Devices,2304.75,70,,2304.75,percent of total billed charges,Implant Devices,2238.9,34,,2238.9,percent of total billed charges,Implant Devices,2238.9,34,,2238.9,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2238.9,34,"If Charge > 2,000, then 34 percent",2238.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2634,
J&J 04.037.230S TFNA NAIL 12X400 125 DEG,C1889,HCPCS,,79013056,CDM,278,RC,,,both,,,5467,2157.65,39.4668,,2157.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1913.45,35,,1913.45,percent of total billed charges,Implant Device,1858.78,34,"Charges > $500, x 34%",1858.78,percent of total billed charges,Implant Device,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,2186.8,40,,2186.8,percent of total billed charges,Implant Devices,1913.45,70,,1913.45,percent of total billed charges,Implant Devices,1858.78,34,,1858.78,percent of total billed charges,Implant Devices,1858.78,34,,1858.78,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1858.78,34,"If Charge > 2,000, then 34 percent",1858.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2186.8,
J & J 04.037.156S TFNA CAN NAIL 11X130MM,C1889,HCPCS,,79013112,CDM,278,RC,,,both,,,5212,2057.01,39.4668,,2057.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1772.08,34,,1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Device,1772.08,34,"Charges > $500, x 34%",1772.08,percent of total billed charges,Implant Device,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,2084.8,40,,2084.8,percent of total billed charges,Implant Devices,1824.2,70,,1824.2,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1772.08,34,,1772.08,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,1824.2,35,,1824.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1772.08,34,"If Charge > 2,000, then 34 percent",1772.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2084.8,
J & J 04.034.443S TIBIAL NAIL 10X315MM,C1889,HCPCS,,79013115,CDM,278,RC,,,both,,,2765,1091.26,39.4668,,1091.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,940.1,34,,940.1,percent of total billed charges,Implant Device,967.75,35,,967.75,percent of total billed charges,Implant Device,940.1,34,"Charges > $500, x 34%",940.1,percent of total billed charges,Implant Device,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,1106,40,,1106,percent of total billed charges,Implant Devices,967.75,70,,967.75,percent of total billed charges,Implant Devices,940.1,34,,940.1,percent of total billed charges,Implant Devices,940.1,34,,940.1,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,967.75,35,,967.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,940.1,34,"If Charge > 2,000, then 34 percent",940.1,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1106,
STRYKER 3430-0380S GAM NAIL RT 10X380MM,C1889,HCPCS,,79013116,CDM,278,RC,,,both,,,4969,1961.11,39.4668,,1961.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1689.46,34,,1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Device,1689.46,34,"Charges > $500, x 34%",1689.46,percent of total billed charges,Implant Device,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1987.6,40,,1987.6,percent of total billed charges,Implant Devices,1739.15,70,,1739.15,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1689.46,34,,1689.46,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,1739.15,35,,1739.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1689.46,34,"If Charge > 2,000, then 34 percent",1689.46,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1987.6,
J&J 04.037.245S TFNA CANN NAIL 12X235MM,C1889,HCPCS,,79013119,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
STRYKER 2341-1027S TIBIAL NAIL 10X270MM,C1889,HCPCS,,79013123,CDM,278,RC,,,both,,,4792,1891.25,39.4668,,1891.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1629.28,34,,1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Device,1629.28,34,"Charges > $500, x 34%",1629.28,percent of total billed charges,Implant Device,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1916.8,40,,1916.8,percent of total billed charges,Implant Devices,1677.2,70,,1677.2,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1629.28,34,,1629.28,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,1677.2,35,,1677.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1629.28,34,"If Charge > 2,000, then 34 percent",1629.28,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1916.8,
J & J 04.233.036S RFNA NAIL 10X360MM,C1889,HCPCS,,79013130,CDM,278,RC,,,both,,,5409,2134.76,39.4668,,2134.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1839.06,34,,1839.06,percent of total billed charges,Implant Device,1839.06,34,,1839.06,percent of total billed charges,Implant Device,1839.06,34,,1839.06,percent of total billed charges,Implant Device,1839.06,34,,1839.06,percent of total billed charges,Implant Device,1839.06,34,,1839.06,percent of total billed charges,Implant Device,1839.06,34,,1839.06,percent of total billed charges,Implant Device,1893.15,35,,1893.15,percent of total billed charges,Implant Device,1839.06,34,"Charges > $500, x 34%",1839.06,percent of total billed charges,Implant Device,1893.15,35,,1893.15,percent of total billed charges,Implant Devices,1893.15,35,,1893.15,percent of total billed charges,Implant Devices,1893.15,35,,,percent of total billed charges,Implant Devices,1893.15,35,,1893.15,percent of total billed charges,Implant Devices,1893.15,35,,1893.15,percent of total billed charges,Implant Devices,2163.6,40,,2163.6,percent of total billed charges,Implant Devices,1893.15,70,,1893.15,percent of total billed charges,Implant Devices,1839.06,34,,1839.06,percent of total billed charges,Implant Devices,1839.06,34,,1839.06,percent of total billed charges,Implant Devices,1893.15,35,,1893.15,percent of total billed charges,Implant Devices,1893.15,35,,1893.15,percent of total billed charges,Implant Devices,1893.15,35,,1893.15,percent of total billed charges,Implant Devices,1893.15,35,,1893.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1839.06,34,"If Charge > 2,000, then 34 percent",1839.06,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2163.6,
DJO 415-00-080 CEMENT RESTRICTOR 8MM,C1889,HCPCS,,79013154,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
J&J 04.037.233S TFNA CANN NAIL 12X420MM,C1889,HCPCS,,79013163,CDM,278,RC,,,both,,,5467,2157.65,39.4668,,2157.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1858.78,34,,1858.78,percent of total billed charges,Implant Device,1913.45,35,,1913.45,percent of total billed charges,Implant Device,1858.78,34,"Charges > $500, x 34%",1858.78,percent of total billed charges,Implant Device,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,2186.8,40,,2186.8,percent of total billed charges,Implant Devices,1913.45,70,,1913.45,percent of total billed charges,Implant Devices,1858.78,34,,1858.78,percent of total billed charges,Implant Devices,1858.78,34,,1858.78,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,1913.45,35,,1913.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1858.78,34,"If Charge > 2,000, then 34 percent",1858.78,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2186.8,
J&J 04.043.225S TIBIAL NAIL 10X315MM,C1889,HCPCS,,79013216,CDM,278,RC,,,both,,,4527,1786.66,39.4668,,1786.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1584.45,35,,1584.45,percent of total billed charges,Implant Device,1539.18,34,"Charges > $500, x 34%",1539.18,percent of total billed charges,Implant Device,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1810.8,40,,1810.8,percent of total billed charges,Implant Devices,1584.45,70,,1584.45,percent of total billed charges,Implant Devices,1539.18,34,,1539.18,percent of total billed charges,Implant Devices,1539.18,34,,1539.18,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1539.18,34,"If Charge > 2,000, then 34 percent",1539.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1810.8,
J&J 04.043.220S TIBIAL NAIL 10X300MM,C1889,HCPCS,,79013217,CDM,278,RC,,,both,,,4527,1786.66,39.4668,,1786.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1539.18,34,,1539.18,percent of total billed charges,Implant Device,1584.45,35,,1584.45,percent of total billed charges,Implant Device,1539.18,34,"Charges > $500, x 34%",1539.18,percent of total billed charges,Implant Device,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1810.8,40,,1810.8,percent of total billed charges,Implant Devices,1584.45,70,,1584.45,percent of total billed charges,Implant Devices,1539.18,34,,1539.18,percent of total billed charges,Implant Devices,1539.18,34,,1539.18,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,1584.45,35,,1584.45,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1539.18,34,"If Charge > 2,000, then 34 percent",1539.18,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1810.8,
DJO 415-00-120 CEMENT RESTRICTOR 12MM,C1889,HCPCS,,79013226,CDM,278,RC,,,both,,,240,94.72,39.4668,,94.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,81.6,34,,81.6,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,96,40,,96,percent of total billed charges,Implant Devices,84,70,,84,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,81.6,34,,81.6,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,84,35,,84,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,96,
STRYKER 2339-1336S DEM NAIL RETRO 13X360,C1889,HCPCS,,79013707,CDM,278,RC,,,both,,,6585,2598.89,39.4668,,2598.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2304.75,35,,2304.75,percent of total billed charges,Implant Device,2238.9,34,"Charges > $500, x 34%",2238.9,percent of total billed charges,Implant Device,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2634,40,,2634,percent of total billed charges,Implant Devices,2304.75,70,,2304.75,percent of total billed charges,Implant Devices,2238.9,34,,2238.9,percent of total billed charges,Implant Devices,2238.9,34,,2238.9,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2238.9,34,"If Charge > 2,000, then 34 percent",2238.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2634,
AMERISOURCE 10263069 BARRIGEL PROC PACK,C1889,HCPCS,,79013826,CDM,278,RC,,,both,,,10050,3966.41,39.4668,,3966.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3417,34,,3417,percent of total billed charges,Implant Device,3417,34,,3417,percent of total billed charges,Implant Device,3417,34,,3417,percent of total billed charges,Implant Device,3417,34,,3417,percent of total billed charges,Implant Device,3417,34,,3417,percent of total billed charges,Implant Device,3417,34,,3417,percent of total billed charges,Implant Device,3517.5,35,,3517.5,percent of total billed charges,Implant Device,3417,34,"Charges > $500, x 34%",3417,percent of total billed charges,Implant Device,3517.5,35,,3517.5,percent of total billed charges,Implant Devices,3517.5,35,,3517.5,percent of total billed charges,Implant Devices,3517.5,35,,,percent of total billed charges,Implant Devices,3517.5,35,,3517.5,percent of total billed charges,Implant Devices,3517.5,35,,3517.5,percent of total billed charges,Implant Devices,4020,40,,4020,percent of total billed charges,Implant Devices,3517.5,70,,3517.5,percent of total billed charges,Implant Devices,3417,34,,3417,percent of total billed charges,Implant Devices,3417,34,,3417,percent of total billed charges,Implant Devices,3517.5,35,,3517.5,percent of total billed charges,Implant Devices,3517.5,35,,3517.5,percent of total billed charges,Implant Devices,3517.5,35,,3517.5,percent of total billed charges,Implant Devices,3517.5,35,,3517.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3417,34,"If Charge > 2,000, then 34 percent",3417,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4020,
STRYKER 2339-0932S FEMORAL NAIL 9X320MM,C1889,HCPCS,,79013835,CDM,278,RC,,,both,,,6585,2598.89,39.4668,,2598.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2238.9,34,,2238.9,percent of total billed charges,Implant Device,2304.75,35,,2304.75,percent of total billed charges,Implant Device,2238.9,34,"Charges > $500, x 34%",2238.9,percent of total billed charges,Implant Device,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2634,40,,2634,percent of total billed charges,Implant Devices,2304.75,70,,2304.75,percent of total billed charges,Implant Devices,2238.9,34,,2238.9,percent of total billed charges,Implant Devices,2238.9,34,,2238.9,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,2304.75,35,,2304.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2238.9,34,"If Charge > 2,000, then 34 percent",2238.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2634,
J&J 04.037.215S TFNA NAIL 125DEG 12X235,C1889,HCPCS,,79013937,CDM,278,RC,,,both,,,4485,1770.09,39.4668,,1770.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1524.9,34,,1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Device,1524.9,34,"Charges > $500, x 34%",1524.9,percent of total billed charges,Implant Device,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1794,40,,1794,percent of total billed charges,Implant Devices,1569.75,70,,1569.75,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1524.9,34,,1524.9,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,1569.75,35,,1569.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1524.9,34,"If Charge > 2,000, then 34 percent",1524.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1794,
MEDTRONIC 6935 SERIES SPRINT LEADS,C1895,HCPCS,,79002669,CDM,278,RC,,,both,,,16563,6536.89,39.4668,,6536.89,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5631.42,34,,5631.42,percent of total billed charges,Implant Device,5631.42,34,,5631.42,percent of total billed charges,Implant Device,5631.42,34,,5631.42,percent of total billed charges,Implant Device,5631.42,34,,5631.42,percent of total billed charges,Implant Device,5631.42,34,,5631.42,percent of total billed charges,Implant Device,5631.42,34,,5631.42,percent of total billed charges,Implant Device,5797.05,35,,5797.05,percent of total billed charges,Implant Device,5631.42,34,"Charges > $500, x 34%",5631.42,percent of total billed charges,Implant Device,5797.05,35,,5797.05,percent of total billed charges,Implant Devices,5797.05,35,,5797.05,percent of total billed charges,Implant Devices,5797.05,35,,,percent of total billed charges,Implant Devices,5797.05,35,,5797.05,percent of total billed charges,Implant Devices,5797.05,35,,5797.05,percent of total billed charges,Implant Devices,6625.2,40,,6625.2,percent of total billed charges,Implant Devices,5797.05,70,,5797.05,percent of total billed charges,Implant Devices,5631.42,34,,5631.42,percent of total billed charges,Implant Devices,5631.42,34,,5631.42,percent of total billed charges,Implant Devices,5797.05,35,,5797.05,percent of total billed charges,Implant Devices,5797.05,35,,5797.05,percent of total billed charges,Implant Devices,5797.05,35,,5797.05,percent of total billed charges,Implant Devices,5797.05,35,,5797.05,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5631.42,34,"If Charge > 2,000, then 34 percent",5631.42,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6625.2,
MEDTRONIC 6947 SERIES SPRINT LEADS,C1895,HCPCS,,79002670,CDM,278,RC,,,both,,,16018,6321.79,39.4668,,6321.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5446.12,34,,5446.12,percent of total billed charges,Implant Device,5446.12,34,,5446.12,percent of total billed charges,Implant Device,5446.12,34,,5446.12,percent of total billed charges,Implant Device,5446.12,34,,5446.12,percent of total billed charges,Implant Device,5446.12,34,,5446.12,percent of total billed charges,Implant Device,5446.12,34,,5446.12,percent of total billed charges,Implant Device,5606.3,35,,5606.3,percent of total billed charges,Implant Device,5446.12,34,"Charges > $500, x 34%",5446.12,percent of total billed charges,Implant Device,5606.3,35,,5606.3,percent of total billed charges,Implant Devices,5606.3,35,,5606.3,percent of total billed charges,Implant Devices,5606.3,35,,,percent of total billed charges,Implant Devices,5606.3,35,,5606.3,percent of total billed charges,Implant Devices,5606.3,35,,5606.3,percent of total billed charges,Implant Devices,6407.2,40,,6407.2,percent of total billed charges,Implant Devices,5606.3,70,,5606.3,percent of total billed charges,Implant Devices,5446.12,34,,5446.12,percent of total billed charges,Implant Devices,5446.12,34,,5446.12,percent of total billed charges,Implant Devices,5606.3,35,,5606.3,percent of total billed charges,Implant Devices,5606.3,35,,5606.3,percent of total billed charges,Implant Devices,5606.3,35,,5606.3,percent of total billed charges,Implant Devices,5606.3,35,,5606.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5446.12,34,"If Charge > 2,000, then 34 percent",5446.12,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6407.2,
ST JUDE 7120Q/58 DURATA  SJ4-ACTIVE,C1895,HCPCS,,79002698,CDM,278,RC,,,both,,,14164,5590.08,39.4668,,5590.08,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4815.76,34,,4815.76,percent of total billed charges,Implant Device,4815.76,34,,4815.76,percent of total billed charges,Implant Device,4815.76,34,,4815.76,percent of total billed charges,Implant Device,4815.76,34,,4815.76,percent of total billed charges,Implant Device,4815.76,34,,4815.76,percent of total billed charges,Implant Device,4815.76,34,,4815.76,percent of total billed charges,Implant Device,4957.4,35,,4957.4,percent of total billed charges,Implant Device,4815.76,34,"Charges > $500, x 34%",4815.76,percent of total billed charges,Implant Device,4957.4,35,,4957.4,percent of total billed charges,Implant Devices,4957.4,35,,4957.4,percent of total billed charges,Implant Devices,4957.4,35,,,percent of total billed charges,Implant Devices,4957.4,35,,4957.4,percent of total billed charges,Implant Devices,4957.4,35,,4957.4,percent of total billed charges,Implant Devices,5665.6,40,,5665.6,percent of total billed charges,Implant Devices,4957.4,70,,4957.4,percent of total billed charges,Implant Devices,4815.76,34,,4815.76,percent of total billed charges,Implant Devices,4815.76,34,,4815.76,percent of total billed charges,Implant Devices,4957.4,35,,4957.4,percent of total billed charges,Implant Devices,4957.4,35,,4957.4,percent of total billed charges,Implant Devices,4957.4,35,,4957.4,percent of total billed charges,Implant Devices,4957.4,35,,4957.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4815.76,34,"If Charge > 2,000, then 34 percent",4815.76,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5665.6,
ST JUDE 7120Q/65 DURATA LEAD,C1895,HCPCS,,79002699,CDM,278,RC,,,both,,,11471,4527.24,39.4668,,4527.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,4014.85,35,,4014.85,percent of total billed charges,Implant Device,3900.14,34,"Charges > $500, x 34%",3900.14,percent of total billed charges,Implant Device,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4588.4,40,,4588.4,percent of total billed charges,Implant Devices,4014.85,70,,4014.85,percent of total billed charges,Implant Devices,3900.14,34,,3900.14,percent of total billed charges,Implant Devices,3900.14,34,,3900.14,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3900.14,34,"If Charge > 2,000, then 34 percent",3900.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4588.4,
BIOTRONIK 365500 LINOX LEAD 65/15,C1895,HCPCS,,79003043,CDM,278,RC,,,both,,,12600,4972.82,39.4668,,4972.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4284,34,,4284,percent of total billed charges,Implant Device,4410,35,,4410,percent of total billed charges,Implant Device,4284,34,"Charges > $500, x 34%",4284,percent of total billed charges,Implant Device,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,5040,40,,5040,percent of total billed charges,Implant Devices,4410,70,,4410,percent of total billed charges,Implant Devices,4284,34,,4284,percent of total billed charges,Implant Devices,4284,34,,4284,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,4410,35,,4410,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4284,34,"If Charge > 2,000, then 34 percent",4284,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5040,
BIOTRONIK 365501 LINOX LEAD 65/17,C1895,HCPCS,,79003044,CDM,278,RC,,,both,,,12702,5013.07,39.4668,,5013.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4318.68,34,,4318.68,percent of total billed charges,Implant Device,4318.68,34,,4318.68,percent of total billed charges,Implant Device,4318.68,34,,4318.68,percent of total billed charges,Implant Device,4318.68,34,,4318.68,percent of total billed charges,Implant Device,4318.68,34,,4318.68,percent of total billed charges,Implant Device,4318.68,34,,4318.68,percent of total billed charges,Implant Device,4445.7,35,,4445.7,percent of total billed charges,Implant Device,4318.68,34,"Charges > $500, x 34%",4318.68,percent of total billed charges,Implant Device,4445.7,35,,4445.7,percent of total billed charges,Implant Devices,4445.7,35,,4445.7,percent of total billed charges,Implant Devices,4445.7,35,,,percent of total billed charges,Implant Devices,4445.7,35,,4445.7,percent of total billed charges,Implant Devices,4445.7,35,,4445.7,percent of total billed charges,Implant Devices,5080.8,40,,5080.8,percent of total billed charges,Implant Devices,4445.7,70,,4445.7,percent of total billed charges,Implant Devices,4318.68,34,,4318.68,percent of total billed charges,Implant Devices,4318.68,34,,4318.68,percent of total billed charges,Implant Devices,4445.7,35,,4445.7,percent of total billed charges,Implant Devices,4445.7,35,,4445.7,percent of total billed charges,Implant Devices,4445.7,35,,4445.7,percent of total billed charges,Implant Devices,4445.7,35,,4445.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,4318.68,34,"If Charge > 2,000, then 34 percent",4318.68,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5080.8,
ST JUDE 7122Q/58 DURATA ACTIVE LEAD,C1895,HCPCS,,79005068,CDM,278,RC,,,both,,,11471,4527.24,39.4668,,4527.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,4014.85,35,,4014.85,percent of total billed charges,Implant Device,3900.14,34,"Charges > $500, x 34%",3900.14,percent of total billed charges,Implant Device,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4588.4,40,,4588.4,percent of total billed charges,Implant Devices,4014.85,70,,4014.85,percent of total billed charges,Implant Devices,3900.14,34,,3900.14,percent of total billed charges,Implant Devices,3900.14,34,,3900.14,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3900.14,34,"If Charge > 2,000, then 34 percent",3900.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4588.4,
ST JUDE 7122Q/65 DURATA ACTIVE LEAD,C1895,HCPCS,,79005814,CDM,278,RC,,,both,,,11471,4527.24,39.4668,,4527.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,3900.14,34,,3900.14,percent of total billed charges,Implant Device,4014.85,35,,4014.85,percent of total billed charges,Implant Device,3900.14,34,"Charges > $500, x 34%",3900.14,percent of total billed charges,Implant Device,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4588.4,40,,4588.4,percent of total billed charges,Implant Devices,4014.85,70,,4014.85,percent of total billed charges,Implant Devices,3900.14,34,,3900.14,percent of total billed charges,Implant Devices,3900.14,34,,3900.14,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,4014.85,35,,4014.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,3900.14,34,"If Charge > 2,000, then 34 percent",3900.14,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4588.4,
MEDTRONIC 3065USC INTERSTIM TEST KIT,C1897,HCPCS,,79002671,CDM,278,RC,,,both,,,916,361.52,39.4668,,361.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,311.44,34,,311.44,percent of total billed charges,Implant Device,311.44,34,,311.44,percent of total billed charges,Implant Device,311.44,34,,311.44,percent of total billed charges,Implant Device,311.44,34,,311.44,percent of total billed charges,Implant Device,311.44,34,,311.44,percent of total billed charges,Implant Device,311.44,34,,311.44,percent of total billed charges,Implant Device,320.6,35,,320.6,percent of total billed charges,Implant Device,311.44,34,"Charges > $500, x 34%",311.44,percent of total billed charges,Implant Device,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,366.4,40,,366.4,percent of total billed charges,Implant Devices,320.6,70,,320.6,percent of total billed charges,Implant Devices,311.44,34,,311.44,percent of total billed charges,Implant Devices,311.44,34,,311.44,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,320.6,35,,320.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,366.4,
MEDTRONIC 3350-18 INTRODUCER LEAD KIT,C1897,HCPCS,,79002913,CDM,278,RC,,,both,,,840,331.52,39.4668,,331.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,285.6,34,,285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Device,285.6,34,"Charges > $500, x 34%",285.6,percent of total billed charges,Implant Device,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,336,40,,336,percent of total billed charges,Implant Devices,294,70,,294,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,285.6,34,,285.6,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,294,35,,294,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,336,
MEDTRONIC 5086-MRI45 BRADYCARDIA LEAD,C1898,HCPCS,,79002094,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
MEDTRONIC 5086-MRI52 BRADYCARDIA LEAD,C1898,HCPCS,,79002095,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
MEDTRONIC 5086-MRI58 BRADYCARDIA LEAD,C1898,HCPCS,,79002096,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
MEDTRONIC 4076 5076 SERIES CAPSURE LEADS,C1898,HCPCS,,79002672,CDM,278,RC,,,both,,,1489,587.66,39.4668,,587.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,506.26,34,,506.26,percent of total billed charges,Implant Device,506.26,34,,506.26,percent of total billed charges,Implant Device,506.26,34,,506.26,percent of total billed charges,Implant Device,506.26,34,,506.26,percent of total billed charges,Implant Device,506.26,34,,506.26,percent of total billed charges,Implant Device,506.26,34,,506.26,percent of total billed charges,Implant Device,521.15,35,,521.15,percent of total billed charges,Implant Device,506.26,34,"Charges > $500, x 34%",506.26,percent of total billed charges,Implant Device,521.15,35,,521.15,percent of total billed charges,Implant Devices,521.15,35,,521.15,percent of total billed charges,Implant Devices,521.15,35,,,percent of total billed charges,Implant Devices,521.15,35,,521.15,percent of total billed charges,Implant Devices,521.15,35,,521.15,percent of total billed charges,Implant Devices,595.6,40,,595.6,percent of total billed charges,Implant Devices,521.15,70,,521.15,percent of total billed charges,Implant Devices,506.26,34,,506.26,percent of total billed charges,Implant Devices,506.26,34,,506.26,percent of total billed charges,Implant Devices,521.15,35,,521.15,percent of total billed charges,Implant Devices,521.15,35,,521.15,percent of total billed charges,Implant Devices,521.15,35,,521.15,percent of total billed charges,Implant Devices,521.15,35,,521.15,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,595.6,
MEDTRONIC 5086MRI SRS CAPSURE FIX LEAD,C1898,HCPCS,,79002673,CDM,278,RC,,,both,,,2808,1108.23,39.4668,,1108.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,982.8,35,,982.8,percent of total billed charges,Implant Device,954.72,34,"Charges > $500, x 34%",954.72,percent of total billed charges,Implant Device,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,1123.2,40,,1123.2,percent of total billed charges,Implant Devices,982.8,70,,982.8,percent of total billed charges,Implant Devices,954.72,34,,954.72,percent of total billed charges,Implant Devices,954.72,34,,954.72,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,954.72,34,"If Charge > 2,000, then 34 percent",954.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1123.2,
MEDTRONIC 5086MRI 52 LEAD CAPSURE FIX,C1898,HCPCS,,79002674,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
MEDTRONIC 5086MRI 58 LEAD CAPSURE FIX,C1898,HCPCS,,79002675,CDM,278,RC,,,both,,,2940,1160.32,39.4668,,1160.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,999.6,34,,999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Device,999.6,34,"Charges > $500, x 34%",999.6,percent of total billed charges,Implant Device,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1176,40,,1176,percent of total billed charges,Implant Devices,1029,70,,1029,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,999.6,34,,999.6,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,1029,35,,1029,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,999.6,34,"If Charge > 2,000, then 34 percent",999.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1176,
ST JUDE 1888TC/46 TENDRIL ST OPTIM 46 CM,C1898,HCPCS,,79002700,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ST JUDE 1888TC/52 TENDRIL ST OPTIM 52 CM,C1898,HCPCS,,79002701,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ST JUDE 1888TC/58 TENDRIL ST OPTIM 58 CM,C1898,HCPCS,,79002702,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ST JUDE 1999/52 OPTISENSE LEAD,C1898,HCPCS,,79002703,CDM,278,RC,,,both,,,2262,892.74,39.4668,,892.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,769.08,34,,769.08,percent of total billed charges,Implant Device,769.08,34,,769.08,percent of total billed charges,Implant Device,769.08,34,,769.08,percent of total billed charges,Implant Device,769.08,34,,769.08,percent of total billed charges,Implant Device,769.08,34,,769.08,percent of total billed charges,Implant Device,769.08,34,,769.08,percent of total billed charges,Implant Device,791.7,35,,791.7,percent of total billed charges,Implant Device,769.08,34,"Charges > $500, x 34%",769.08,percent of total billed charges,Implant Device,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,904.8,40,,904.8,percent of total billed charges,Implant Devices,791.7,70,,791.7,percent of total billed charges,Implant Devices,769.08,34,,769.08,percent of total billed charges,Implant Devices,769.08,34,,769.08,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,791.7,35,,791.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,769.08,34,"If Charge > 2,000, then 34 percent",769.08,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,904.8,
MEDTRONIC 5086MRI45 BRADYCRDIA LEAD 45CM,C1898,HCPCS,,79004003,CDM,278,RC,,,both,,,2808,1108.23,39.4668,,1108.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,982.8,35,,982.8,percent of total billed charges,Implant Device,954.72,34,"Charges > $500, x 34%",954.72,percent of total billed charges,Implant Device,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,1123.2,40,,1123.2,percent of total billed charges,Implant Devices,982.8,70,,982.8,percent of total billed charges,Implant Devices,954.72,34,,954.72,percent of total billed charges,Implant Devices,954.72,34,,954.72,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,954.72,34,"If Charge > 2,000, then 34 percent",954.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1123.2,
MEDTRONIC 5086MRI58 BRADYCRDIA LEAD 58CM,C1898,HCPCS,,79004006,CDM,278,RC,,,both,,,2808,1108.23,39.4668,,1108.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,982.8,35,,982.8,percent of total billed charges,Implant Device,954.72,34,"Charges > $500, x 34%",954.72,percent of total billed charges,Implant Device,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,1123.2,40,,1123.2,percent of total billed charges,Implant Devices,982.8,70,,982.8,percent of total billed charges,Implant Devices,954.72,34,,954.72,percent of total billed charges,Implant Devices,954.72,34,,954.72,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,954.72,34,"If Charge > 2,000, then 34 percent",954.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1123.2,
MEDTRONIC 5086MRI52 BRADYCRDIA LEAD 52CM,C1898,HCPCS,,79004009,CDM,278,RC,,,both,,,2808,1108.23,39.4668,,1108.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,954.72,34,,954.72,percent of total billed charges,Implant Device,982.8,35,,982.8,percent of total billed charges,Implant Device,954.72,34,"Charges > $500, x 34%",954.72,percent of total billed charges,Implant Device,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,1123.2,40,,1123.2,percent of total billed charges,Implant Devices,982.8,70,,982.8,percent of total billed charges,Implant Devices,954.72,34,,954.72,percent of total billed charges,Implant Devices,954.72,34,,954.72,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,982.8,35,,982.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,954.72,34,"If Charge > 2,000, then 34 percent",954.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1123.2,
ST JUDE 2088TC TENDRIL STS 58CM,C1898,HCPCS,,79004044,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
MEDTRONIC 407645 CAPSUREFIX NOVUS LEAD,C1898,HCPCS,,79006094,CDM,278,RC,,,both,,,2058,812.23,39.4668,,812.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,720.3,35,,720.3,percent of total billed charges,Implant Device,699.72,34,"Charges > $500, x 34%",699.72,percent of total billed charges,Implant Device,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,823.2,40,,823.2,percent of total billed charges,Implant Devices,720.3,70,,720.3,percent of total billed charges,Implant Devices,699.72,34,,699.72,percent of total billed charges,Implant Devices,699.72,34,,699.72,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,699.72,34,"If Charge > 2,000, then 34 percent",699.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,823.2,
MEDTRONIC 407652 CAPSURE NOVUS LEAD 52CM,C1898,HCPCS,,79006618,CDM,278,RC,,,both,,,2058,812.23,39.4668,,812.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,720.3,35,,720.3,percent of total billed charges,Implant Device,699.72,34,"Charges > $500, x 34%",699.72,percent of total billed charges,Implant Device,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,823.2,40,,823.2,percent of total billed charges,Implant Devices,720.3,70,,720.3,percent of total billed charges,Implant Devices,699.72,34,,699.72,percent of total billed charges,Implant Devices,699.72,34,,699.72,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,699.72,34,"If Charge > 2,000, then 34 percent",699.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,823.2,
MEDTRONIC 407658 CAPSURE NOVUS LEAD 58CM,C1898,HCPCS,,79006619,CDM,278,RC,,,both,,,2058,812.23,39.4668,,812.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,699.72,34,,699.72,percent of total billed charges,Implant Device,720.3,35,,720.3,percent of total billed charges,Implant Device,699.72,34,"Charges > $500, x 34%",699.72,percent of total billed charges,Implant Device,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,823.2,40,,823.2,percent of total billed charges,Implant Devices,720.3,70,,720.3,percent of total billed charges,Implant Devices,699.72,34,,699.72,percent of total billed charges,Implant Devices,699.72,34,,699.72,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,720.3,35,,720.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,699.72,34,"If Charge > 2,000, then 34 percent",699.72,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,823.2,
BIOTRONIK 350974 SETROX S 53 LEAD,C1898,HCPCS,,79007543,CDM,278,RC,,,both,,,1800,710.4,39.4668,,710.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,612,34,,612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Device,612,34,"Charges > $500, x 34%",612,percent of total billed charges,Implant Device,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,720,40,,720,percent of total billed charges,Implant Devices,630,70,,630,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,612,34,,612,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,630,35,,630,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,720,
ST JUDE 2088TC/46 TENDRIL LEAD 46CM,C1898,HCPCS,,79007583,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
ST JUDE 2088TC/52 TENDRIL STS LEAD 52CM,C1898,HCPCS,,79007584,CDM,278,RC,,,both,,,1650,651.2,39.4668,,651.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,561,34,,561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Device,561,34,"Charges > $500, x 34%",561,percent of total billed charges,Implant Device,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,660,40,,660,percent of total billed charges,Implant Devices,577.5,70,,577.5,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,561,34,,561,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,577.5,35,,577.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,660,
BIOTRONIK 377176 SOLIA S 45 PACING LEAD,C1898,HCPCS,,79009649,CDM,278,RC,,,both,,,1950,769.6,39.4668,,769.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,663,34,,663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Device,663,34,"Charges > $500, x 34%",663,percent of total billed charges,Implant Device,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,780,40,,780,percent of total billed charges,Implant Devices,682.5,70,,682.5,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,663,34,,663,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,682.5,35,,682.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,780,
ABBOTT MN10450-50A SLIMTIP DRG LEAD,C1898,HCPCS,,79011777,CDM,278,RC,,,both,,,7800,3078.41,39.4668,,3078.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2652,34,,2652,percent of total billed charges,Implant Device,2730,35,,2730,percent of total billed charges,Implant Device,2652,34,"Charges > $500, x 34%",2652,percent of total billed charges,Implant Device,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,3120,40,,3120,percent of total billed charges,Implant Devices,2730,70,,2730,percent of total billed charges,Implant Devices,2652,34,,2652,percent of total billed charges,Implant Devices,2652,34,,2652,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,2730,35,,2730,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2652,34,"If Charge > 2,000, then 34 percent",2652,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3120,
ABBOTT MN10350-50A SLIMTIP DRG LEAD,C1898,HCPCS,,79011853,CDM,278,RC,,,both,,,2100,828.8,39.4668,,828.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,714,34,,714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Device,714,34,"Charges > $500, x 34%",714,percent of total billed charges,Implant Device,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,840,40,,840,percent of total billed charges,Implant Devices,735,70,,735,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,714,34,,714,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,735,35,,735,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,714,34,"If Charge > 2,000, then 34 percent",714,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,840,
MEDTRONIC 4194-78 LEAD PACE TRANSV,C1900,HCPCS,,79002676,CDM,278,RC,,,both,,,5626,2220.4,39.4668,,2220.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1912.84,34,,1912.84,percent of total billed charges,Implant Device,1912.84,34,,1912.84,percent of total billed charges,Implant Device,1912.84,34,,1912.84,percent of total billed charges,Implant Device,1912.84,34,,1912.84,percent of total billed charges,Implant Device,1912.84,34,,1912.84,percent of total billed charges,Implant Device,1912.84,34,,1912.84,percent of total billed charges,Implant Device,1969.1,35,,1969.1,percent of total billed charges,Implant Device,1912.84,34,"Charges > $500, x 34%",1912.84,percent of total billed charges,Implant Device,1969.1,35,,1969.1,percent of total billed charges,Implant Devices,1969.1,35,,1969.1,percent of total billed charges,Implant Devices,1969.1,35,,,percent of total billed charges,Implant Devices,1969.1,35,,1969.1,percent of total billed charges,Implant Devices,1969.1,35,,1969.1,percent of total billed charges,Implant Devices,2250.4,40,,2250.4,percent of total billed charges,Implant Devices,1969.1,70,,1969.1,percent of total billed charges,Implant Devices,1912.84,34,,1912.84,percent of total billed charges,Implant Devices,1912.84,34,,1912.84,percent of total billed charges,Implant Devices,1969.1,35,,1969.1,percent of total billed charges,Implant Devices,1969.1,35,,1969.1,percent of total billed charges,Implant Devices,1969.1,35,,1969.1,percent of total billed charges,Implant Devices,1969.1,35,,1969.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1912.84,34,"If Charge > 2,000, then 34 percent",1912.84,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2250.4,
MEDTRONIC 419478 LEAD PACE TRANSV,C1900,HCPCS,,79002677,CDM,278,RC,,,both,,,6120,2415.37,39.4668,,2415.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2080.8,34,,2080.8,percent of total billed charges,Implant Device,2080.8,34,,2080.8,percent of total billed charges,Implant Device,2080.8,34,,2080.8,percent of total billed charges,Implant Device,2080.8,34,,2080.8,percent of total billed charges,Implant Device,2080.8,34,,2080.8,percent of total billed charges,Implant Device,2080.8,34,,2080.8,percent of total billed charges,Implant Device,2142,35,,2142,percent of total billed charges,Implant Device,2080.8,34,"Charges > $500, x 34%",2080.8,percent of total billed charges,Implant Device,2142,35,,2142,percent of total billed charges,Implant Devices,2142,35,,2142,percent of total billed charges,Implant Devices,2142,35,,,percent of total billed charges,Implant Devices,2142,35,,2142,percent of total billed charges,Implant Devices,2142,35,,2142,percent of total billed charges,Implant Devices,2448,40,,2448,percent of total billed charges,Implant Devices,2142,70,,2142,percent of total billed charges,Implant Devices,2080.8,34,,2080.8,percent of total billed charges,Implant Devices,2080.8,34,,2080.8,percent of total billed charges,Implant Devices,2142,35,,2142,percent of total billed charges,Implant Devices,2142,35,,2142,percent of total billed charges,Implant Devices,2142,35,,2142,percent of total billed charges,Implant Devices,2142,35,,2142,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2080.8,34,"If Charge > 2,000, then 34 percent",2080.8,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2448,
MEDTRONIC 4196 ATTAIN ABILITY LEAD,C1900,HCPCS,,79002678,CDM,278,RC,,,both,,,7590,2995.53,39.4668,,2995.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2580.6,34,,2580.6,percent of total billed charges,Implant Device,2580.6,34,,2580.6,percent of total billed charges,Implant Device,2580.6,34,,2580.6,percent of total billed charges,Implant Device,2580.6,34,,2580.6,percent of total billed charges,Implant Device,2580.6,34,,2580.6,percent of total billed charges,Implant Device,2580.6,34,,2580.6,percent of total billed charges,Implant Device,2656.5,35,,2656.5,percent of total billed charges,Implant Device,2580.6,34,"Charges > $500, x 34%",2580.6,percent of total billed charges,Implant Device,2656.5,35,,2656.5,percent of total billed charges,Implant Devices,2656.5,35,,2656.5,percent of total billed charges,Implant Devices,2656.5,35,,,percent of total billed charges,Implant Devices,2656.5,35,,2656.5,percent of total billed charges,Implant Devices,2656.5,35,,2656.5,percent of total billed charges,Implant Devices,3036,40,,3036,percent of total billed charges,Implant Devices,2656.5,70,,2656.5,percent of total billed charges,Implant Devices,2580.6,34,,2580.6,percent of total billed charges,Implant Devices,2580.6,34,,2580.6,percent of total billed charges,Implant Devices,2656.5,35,,2656.5,percent of total billed charges,Implant Devices,2656.5,35,,2656.5,percent of total billed charges,Implant Devices,2656.5,35,,2656.5,percent of total billed charges,Implant Devices,2656.5,35,,2656.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2580.6,34,"If Charge > 2,000, then 34 percent",2580.6,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3036,
MEDTRONIC 419678 ATTAIN ABILITY LEAD,C1900,HCPCS,,79006093,CDM,278,RC,,,both,,,7236,2855.82,39.4668,,2855.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2532.6,35,,2532.6,percent of total billed charges,Implant Device,2460.24,34,"Charges > $500, x 34%",2460.24,percent of total billed charges,Implant Device,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2894.4,40,,2894.4,percent of total billed charges,Implant Devices,2532.6,70,,2532.6,percent of total billed charges,Implant Devices,2460.24,34,,2460.24,percent of total billed charges,Implant Devices,2460.24,34,,2460.24,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2460.24,34,"If Charge > 2,000, then 34 percent",2460.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2894.4,
MEDTRONIC 429678 ATTAIN ABILITY PLUS,C1900,HCPCS,,79006627,CDM,278,RC,,,both,,,7236,2855.82,39.4668,,2855.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2532.6,35,,2532.6,percent of total billed charges,Implant Device,2460.24,34,"Charges > $500, x 34%",2460.24,percent of total billed charges,Implant Device,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2894.4,40,,2894.4,percent of total billed charges,Implant Devices,2532.6,70,,2532.6,percent of total billed charges,Implant Devices,2460.24,34,,2460.24,percent of total billed charges,Implant Devices,2460.24,34,,2460.24,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2460.24,34,"If Charge > 2,000, then 34 percent",2460.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2894.4,
MEDTRONIC 4298XX ATTAIN PERFORMA LEAD,C1900,HCPCS,,79006838,CDM,278,RC,,,both,,,6875,2713.34,39.4668,,2713.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2337.5,34,,2337.5,percent of total billed charges,Implant Device,2337.5,34,,2337.5,percent of total billed charges,Implant Device,2337.5,34,,2337.5,percent of total billed charges,Implant Device,2337.5,34,,2337.5,percent of total billed charges,Implant Device,2337.5,34,,2337.5,percent of total billed charges,Implant Device,2337.5,34,,2337.5,percent of total billed charges,Implant Device,2406.25,35,,2406.25,percent of total billed charges,Implant Device,2337.5,34,"Charges > $500, x 34%",2337.5,percent of total billed charges,Implant Device,2406.25,35,,2406.25,percent of total billed charges,Implant Devices,2406.25,35,,2406.25,percent of total billed charges,Implant Devices,2406.25,35,,,percent of total billed charges,Implant Devices,2406.25,35,,2406.25,percent of total billed charges,Implant Devices,2406.25,35,,2406.25,percent of total billed charges,Implant Devices,2750,40,,2750,percent of total billed charges,Implant Devices,2406.25,70,,2406.25,percent of total billed charges,Implant Devices,2337.5,34,,2337.5,percent of total billed charges,Implant Devices,2337.5,34,,2337.5,percent of total billed charges,Implant Devices,2406.25,35,,2406.25,percent of total billed charges,Implant Devices,2406.25,35,,2406.25,percent of total billed charges,Implant Devices,2406.25,35,,2406.25,percent of total billed charges,Implant Devices,2406.25,35,,2406.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2337.5,34,"If Charge > 2,000, then 34 percent",2337.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2750,
MEDTRONIC 429878 ATTAIN PERFORMA LEAD,C1900,HCPCS,,79007179,CDM,278,RC,,,both,,,7236,2855.82,39.4668,,2855.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2532.6,35,,2532.6,percent of total billed charges,Implant Device,2460.24,34,"Charges > $500, x 34%",2460.24,percent of total billed charges,Implant Device,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2894.4,40,,2894.4,percent of total billed charges,Implant Devices,2532.6,70,,2532.6,percent of total billed charges,Implant Devices,2460.24,34,,2460.24,percent of total billed charges,Implant Devices,2460.24,34,,2460.24,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2460.24,34,"If Charge > 2,000, then 34 percent",2460.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2894.4,
MEDTRONIC 429888 ATTAIN PERFORMA LEAD,C1900,HCPCS,,79007180,CDM,278,RC,,,both,,,7236,2855.82,39.4668,,2855.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2460.24,34,,2460.24,percent of total billed charges,Implant Device,2532.6,35,,2532.6,percent of total billed charges,Implant Device,2460.24,34,"Charges > $500, x 34%",2460.24,percent of total billed charges,Implant Device,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2894.4,40,,2894.4,percent of total billed charges,Implant Devices,2532.6,70,,2532.6,percent of total billed charges,Implant Devices,2460.24,34,,2460.24,percent of total billed charges,Implant Devices,2460.24,34,,2460.24,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,2532.6,35,,2532.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2460.24,34,"If Charge > 2,000, then 34 percent",2460.24,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2894.4,
BAXTER 1501236 TISSEEL 2ML FIBRIN,C2615,HCPCS,,79001744,CDM,278,RC,,,both,,,402,158.66,39.4668,,158.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,136.68,34,,136.68,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,160.8,40,,160.8,percent of total billed charges,Implant Devices,140.7,70,,140.7,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,136.68,34,,136.68,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,140.7,35,,140.7,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
J&J 3902 EVICEL FIBRIN SEALANT 2ML,C2615,HCPCS,,79001745,CDM,278,RC,,,both,,,997,393.48,39.4668,,393.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,338.98,34,,338.98,percent of total billed charges,Implant Device,338.98,34,,338.98,percent of total billed charges,Implant Device,338.98,34,,338.98,percent of total billed charges,Implant Device,338.98,34,,338.98,percent of total billed charges,Implant Device,338.98,34,,338.98,percent of total billed charges,Implant Device,338.98,34,,338.98,percent of total billed charges,Implant Device,348.95,35,,348.95,percent of total billed charges,Implant Device,338.98,34,"Charges > $500, x 34%",338.98,percent of total billed charges,Implant Device,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,398.8,40,,398.8,percent of total billed charges,Implant Devices,348.95,70,,348.95,percent of total billed charges,Implant Devices,338.98,34,,338.98,percent of total billed charges,Implant Devices,338.98,34,,338.98,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,348.95,35,,348.95,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
BAXTER 1501237 TISSEEL 4ML FIBRIN,C2615,HCPCS,,79001746,CDM,278,RC,,,both,,,676,266.8,39.4668,,266.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,229.84,34,,229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Device,229.84,34,"Charges > $500, x 34%",229.84,percent of total billed charges,Implant Device,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,270.4,40,,270.4,percent of total billed charges,Implant Devices,236.6,70,,236.6,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,229.84,34,,229.84,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,236.6,35,,236.6,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
BAXTER 921030 TISSEEL 5ML KIT,C2615,HCPCS,,79001747,CDM,278,RC,,,both,,,1498,591.21,39.4668,,591.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,509.32,34,,509.32,percent of total billed charges,Implant Device,509.32,34,,509.32,percent of total billed charges,Implant Device,509.32,34,,509.32,percent of total billed charges,Implant Device,509.32,34,,509.32,percent of total billed charges,Implant Device,509.32,34,,509.32,percent of total billed charges,Implant Device,509.32,34,,509.32,percent of total billed charges,Implant Device,524.3,35,,524.3,percent of total billed charges,Implant Device,509.32,34,"Charges > $500, x 34%",509.32,percent of total billed charges,Implant Device,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,599.2,40,,599.2,percent of total billed charges,Implant Devices,524.3,70,,524.3,percent of total billed charges,Implant Devices,509.32,34,,509.32,percent of total billed charges,Implant Devices,509.32,34,,509.32,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,524.3,35,,524.3,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
BAXTER 921028 TISSEEL IML KIT,C2615,HCPCS,,79001748,CDM,278,RC,,,both,,,246,97.09,39.4668,,97.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,83.64,34,,83.64,percent of total billed charges,Implant Device,83.64,34,,83.64,percent of total billed charges,Implant Device,83.64,34,,83.64,percent of total billed charges,Implant Device,83.64,34,,83.64,percent of total billed charges,Implant Device,83.64,34,,83.64,percent of total billed charges,Implant Device,83.64,34,,83.64,percent of total billed charges,Implant Device,86.1,35,,86.1,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,86.1,35,,86.1,percent of total billed charges,Implant Devices,86.1,35,,86.1,percent of total billed charges,Implant Devices,86.1,35,,,percent of total billed charges,Implant Devices,86.1,35,,86.1,percent of total billed charges,Implant Devices,86.1,35,,86.1,percent of total billed charges,Implant Devices,98.4,40,,98.4,percent of total billed charges,Implant Devices,86.1,70,,86.1,percent of total billed charges,Implant Devices,83.64,34,,83.64,percent of total billed charges,Implant Devices,83.64,34,,83.64,percent of total billed charges,Implant Devices,86.1,35,,86.1,percent of total billed charges,Implant Devices,86.1,35,,86.1,percent of total billed charges,Implant Devices,86.1,35,,86.1,percent of total billed charges,Implant Devices,86.1,35,,86.1,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
BAXTER 1501261 TISSEEL 2ML - FROZEN,C2615,HCPCS,,79008826,CDM,278,RC,,,both,,,374,147.61,39.4668,,147.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,127.16,34,,127.16,percent of total billed charges,Implant Device,130.9,35,,130.9,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,149.6,40,,149.6,percent of total billed charges,Implant Devices,130.9,70,,130.9,percent of total billed charges,Implant Devices,127.16,34,,127.16,percent of total billed charges,Implant Devices,127.16,34,,127.16,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,130.9,35,,130.9,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
BAXTER 1501262 TISSEEL 4ML - FROZEN,C2615,HCPCS,,79008827,CDM,278,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,213.52,34,,213.52,percent of total billed charges,Implant Device,213.52,34,,213.52,percent of total billed charges,Implant Device,213.52,34,,213.52,percent of total billed charges,Implant Device,213.52,34,,213.52,percent of total billed charges,Implant Device,213.52,34,,213.52,percent of total billed charges,Implant Device,213.52,34,,213.52,percent of total billed charges,Implant Device,219.8,35,,219.8,percent of total billed charges,Implant Device,213.52,34,"Charges > $500, x 34%",213.52,percent of total billed charges,Implant Device,219.8,35,,219.8,percent of total billed charges,Implant Devices,219.8,35,,219.8,percent of total billed charges,Implant Devices,219.8,35,,,percent of total billed charges,Implant Devices,219.8,35,,219.8,percent of total billed charges,Implant Devices,219.8,35,,219.8,percent of total billed charges,Implant Devices,251.2,40,,251.2,percent of total billed charges,Implant Devices,219.8,70,,219.8,percent of total billed charges,Implant Devices,213.52,34,,213.52,percent of total billed charges,Implant Devices,213.52,34,,213.52,percent of total billed charges,Implant Devices,219.8,35,,219.8,percent of total billed charges,Implant Devices,219.8,35,,219.8,percent of total billed charges,Implant Devices,219.8,35,,219.8,percent of total billed charges,Implant Devices,219.8,35,,219.8,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
BOST SCI 27-411 6FR URETERAL STENT SYS,C2617,HCPCS,,79000176,CDM,278,RC,,,both,,,572,225.75,39.4668,,225.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,200.2,35,,200.2,percent of total billed charges,Implant Device,194.48,34,"Charges > $500, x 34%",194.48,percent of total billed charges,Implant Device,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,228.8,40,,228.8,percent of total billed charges,Implant Devices,200.2,70,,200.2,percent of total billed charges,Implant Devices,194.48,34,,194.48,percent of total billed charges,Implant Devices,194.48,34,,194.48,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228.8,
BOST SCI 27-412 6X24CM URETERAL STENT,C2617,HCPCS,,79000195,CDM,278,RC,,,both,,,572,225.75,39.4668,,225.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,200.2,35,,200.2,percent of total billed charges,Implant Device,194.48,34,"Charges > $500, x 34%",194.48,percent of total billed charges,Implant Device,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,228.8,40,,228.8,percent of total billed charges,Implant Devices,200.2,70,,200.2,percent of total billed charges,Implant Devices,194.48,34,,194.48,percent of total billed charges,Implant Devices,194.48,34,,194.48,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228.8,
BOST SCI 27-413 6X26CM URETERAL STENT,C2617,HCPCS,,79000196,CDM,278,RC,,,both,,,572,225.75,39.4668,,225.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,200.2,35,,200.2,percent of total billed charges,Implant Device,194.48,34,"Charges > $500, x 34%",194.48,percent of total billed charges,Implant Device,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,228.8,40,,228.8,percent of total billed charges,Implant Devices,200.2,70,,200.2,percent of total billed charges,Implant Devices,194.48,34,,194.48,percent of total billed charges,Implant Devices,194.48,34,,194.48,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228.8,
BOST SCI 22-136 8FRX22CM STENT SYSTEM,C2617,HCPCS,,79000238,CDM,278,RC,,,both,,,310,122.35,39.4668,,122.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,108.5,35,,108.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,124,40,,124,percent of total billed charges,Implant Devices,108.5,70,,108.5,percent of total billed charges,Implant Devices,105.4,34,,105.4,percent of total billed charges,Implant Devices,105.4,34,,105.4,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124,
BOST SCI 22-143 NEPHROURETRAL STENT,C2617,HCPCS,,79000431,CDM,278,RC,,,both,,,310,122.35,39.4668,,122.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,105.4,34,,105.4,percent of total billed charges,Implant Device,108.5,35,,108.5,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,124,40,,124,percent of total billed charges,Implant Devices,108.5,70,,108.5,percent of total billed charges,Implant Devices,105.4,34,,105.4,percent of total billed charges,Implant Devices,105.4,34,,105.4,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,108.5,35,,108.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,124,
STRYKER 27-401 URETERAL STENT US-8-22CM,C2617,HCPCS,,79000552,CDM,278,RC,,,both,,,342,134.98,39.4668,,134.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,119.7,35,,119.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,136.8,40,,136.8,percent of total billed charges,Implant Devices,119.7,70,,119.7,percent of total billed charges,Implant Devices,116.28,34,,116.28,percent of total billed charges,Implant Devices,116.28,34,,116.28,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,136.8,
STRYKER 27-402 URETERAL STENT US-8-24CM,C2617,HCPCS,,79000553,CDM,278,RC,,,both,,,342,134.98,39.4668,,134.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,116.28,34,,116.28,percent of total billed charges,Implant Device,119.7,35,,119.7,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,136.8,40,,136.8,percent of total billed charges,Implant Devices,119.7,70,,119.7,percent of total billed charges,Implant Devices,116.28,34,,116.28,percent of total billed charges,Implant Devices,116.28,34,,116.28,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,119.7,35,,119.7,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,136.8,
BOST SCI 126-531 MARDIS SOFTSTENT 6X22CM,C2617,HCPCS,,79001614,CDM,278,RC,,,both,,,554,218.65,39.4668,,218.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,188.36,34,,188.36,percent of total billed charges,Implant Device,188.36,34,,188.36,percent of total billed charges,Implant Device,188.36,34,,188.36,percent of total billed charges,Implant Device,188.36,34,,188.36,percent of total billed charges,Implant Device,188.36,34,,188.36,percent of total billed charges,Implant Device,188.36,34,,188.36,percent of total billed charges,Implant Device,193.9,35,,193.9,percent of total billed charges,Implant Device,188.36,34,"Charges > $500, x 34%",188.36,percent of total billed charges,Implant Device,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,221.6,40,,221.6,percent of total billed charges,Implant Devices,193.9,70,,193.9,percent of total billed charges,Implant Devices,188.36,34,,188.36,percent of total billed charges,Implant Devices,188.36,34,,188.36,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.6,
BOST SCI 126-533 MARDIS SOFTSTENT 6X26CM,C2617,HCPCS,,79001615,CDM,278,RC,,,both,,,617,243.51,39.4668,,243.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,209.78,34,,209.78,percent of total billed charges,Implant Device,209.78,34,,209.78,percent of total billed charges,Implant Device,209.78,34,,209.78,percent of total billed charges,Implant Device,209.78,34,,209.78,percent of total billed charges,Implant Device,209.78,34,,209.78,percent of total billed charges,Implant Device,209.78,34,,209.78,percent of total billed charges,Implant Device,215.95,35,,215.95,percent of total billed charges,Implant Device,209.78,34,"Charges > $500, x 34%",209.78,percent of total billed charges,Implant Device,215.95,35,,215.95,percent of total billed charges,Implant Devices,215.95,35,,215.95,percent of total billed charges,Implant Devices,215.95,35,,,percent of total billed charges,Implant Devices,215.95,35,,215.95,percent of total billed charges,Implant Devices,215.95,35,,215.95,percent of total billed charges,Implant Devices,246.8,40,,246.8,percent of total billed charges,Implant Devices,215.95,70,,215.95,percent of total billed charges,Implant Devices,209.78,34,,209.78,percent of total billed charges,Implant Devices,209.78,34,,209.78,percent of total billed charges,Implant Devices,215.95,35,,215.95,percent of total billed charges,Implant Devices,215.95,35,,215.95,percent of total billed charges,Implant Devices,215.95,35,,215.95,percent of total billed charges,Implant Devices,215.95,35,,215.95,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,246.8,
BOST SCI 126-534 MARDIS SOFTSTENT 6X28CM,C2617,HCPCS,,79001616,CDM,278,RC,,,both,,,554,218.65,39.4668,,218.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,188.36,34,,188.36,percent of total billed charges,Implant Device,188.36,34,,188.36,percent of total billed charges,Implant Device,188.36,34,,188.36,percent of total billed charges,Implant Device,188.36,34,,188.36,percent of total billed charges,Implant Device,188.36,34,,188.36,percent of total billed charges,Implant Device,188.36,34,,188.36,percent of total billed charges,Implant Device,193.9,35,,193.9,percent of total billed charges,Implant Device,188.36,34,"Charges > $500, x 34%",188.36,percent of total billed charges,Implant Device,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,221.6,40,,221.6,percent of total billed charges,Implant Devices,193.9,70,,193.9,percent of total billed charges,Implant Devices,188.36,34,,188.36,percent of total billed charges,Implant Devices,188.36,34,,188.36,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,193.9,35,,193.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.6,
BOST SCI 126-532 MARDIS SOFTSTENT 6X24CM,C2617,HCPCS,,79001617,CDM,278,RC,,,both,,,626,247.06,39.4668,,247.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,212.84,34,,212.84,percent of total billed charges,Implant Device,212.84,34,,212.84,percent of total billed charges,Implant Device,212.84,34,,212.84,percent of total billed charges,Implant Device,212.84,34,,212.84,percent of total billed charges,Implant Device,212.84,34,,212.84,percent of total billed charges,Implant Device,212.84,34,,212.84,percent of total billed charges,Implant Device,219.1,35,,219.1,percent of total billed charges,Implant Device,212.84,34,"Charges > $500, x 34%",212.84,percent of total billed charges,Implant Device,219.1,35,,219.1,percent of total billed charges,Implant Devices,219.1,35,,219.1,percent of total billed charges,Implant Devices,219.1,35,,,percent of total billed charges,Implant Devices,219.1,35,,219.1,percent of total billed charges,Implant Devices,219.1,35,,219.1,percent of total billed charges,Implant Devices,250.4,40,,250.4,percent of total billed charges,Implant Devices,219.1,70,,219.1,percent of total billed charges,Implant Devices,212.84,34,,212.84,percent of total billed charges,Implant Devices,212.84,34,,212.84,percent of total billed charges,Implant Devices,219.1,35,,219.1,percent of total billed charges,Implant Devices,219.1,35,,219.1,percent of total billed charges,Implant Devices,219.1,35,,219.1,percent of total billed charges,Implant Devices,219.1,35,,219.1,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,250.4,
BOST SCI 126-553 MARDIS SOFTSTENT 8X26CM,C2617,HCPCS,,79001618,CDM,278,RC,,,both,,,553,218.25,39.4668,,218.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,188.02,34,,188.02,percent of total billed charges,Implant Device,193.55,35,,193.55,percent of total billed charges,Implant Device,188.02,34,"Charges > $500, x 34%",188.02,percent of total billed charges,Implant Device,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,221.2,40,,221.2,percent of total billed charges,Implant Devices,193.55,70,,193.55,percent of total billed charges,Implant Devices,188.02,34,,188.02,percent of total billed charges,Implant Devices,188.02,34,,188.02,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,193.55,35,,193.55,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,221.2,
COOK G16996 URETERAL DIVERSION STENT SET,C2617,HCPCS,,79001753,CDM,278,RC,,,both,,,258,101.82,39.4668,,101.82,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,87.72,34,,87.72,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,103.2,40,,103.2,percent of total billed charges,Implant Devices,90.3,70,,90.3,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,87.72,34,,87.72,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,90.3,35,,90.3,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,103.2,
COOK MEDICAL GPSO-5-3 STENT 5FRX3CM,C2617,HCPCS,,79003665,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
COOK US-600 SOFTEX STENT MULTI LENGTH,C2617,HCPCS,,79003679,CDM,278,RC,,,both,,,264,104.19,39.4668,,104.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,89.76,34,,89.76,percent of total billed charges,Implant Device,89.76,34,,89.76,percent of total billed charges,Implant Device,89.76,34,,89.76,percent of total billed charges,Implant Device,89.76,34,,89.76,percent of total billed charges,Implant Device,89.76,34,,89.76,percent of total billed charges,Implant Device,89.76,34,,89.76,percent of total billed charges,Implant Device,92.4,35,,92.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,105.6,40,,105.6,percent of total billed charges,Implant Devices,92.4,70,,92.4,percent of total billed charges,Implant Devices,89.76,34,,89.76,percent of total billed charges,Implant Devices,89.76,34,,89.76,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,92.4,35,,92.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,105.6,
COOK G49668 PANCREATIC STENT 5FRX30,C2617,HCPCS,,79003713,CDM,278,RC,,,both,,,291,114.85,39.4668,,114.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,98.94,34,,98.94,percent of total billed charges,Implant Device,98.94,34,,98.94,percent of total billed charges,Implant Device,98.94,34,,98.94,percent of total billed charges,Implant Device,98.94,34,,98.94,percent of total billed charges,Implant Device,98.94,34,,98.94,percent of total billed charges,Implant Device,98.94,34,,98.94,percent of total billed charges,Implant Device,101.85,35,,101.85,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,101.85,35,,101.85,percent of total billed charges,Implant Devices,101.85,35,,101.85,percent of total billed charges,Implant Devices,101.85,35,,,percent of total billed charges,Implant Devices,101.85,35,,101.85,percent of total billed charges,Implant Devices,101.85,35,,101.85,percent of total billed charges,Implant Devices,116.4,40,,116.4,percent of total billed charges,Implant Devices,101.85,70,,101.85,percent of total billed charges,Implant Devices,98.94,34,,98.94,percent of total billed charges,Implant Devices,98.94,34,,98.94,percent of total billed charges,Implant Devices,101.85,35,,101.85,percent of total billed charges,Implant Devices,101.85,35,,101.85,percent of total billed charges,Implant Devices,101.85,35,,101.85,percent of total billed charges,Implant Devices,101.85,35,,101.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,116.4,
COOK G27192 STENT GEENEN PANCR 3FRX8CM1,C2617,HCPCS,,79005546,CDM,278,RC,,,both,,,180,71.04,39.4668,,71.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,61.2,34,,61.2,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,72,40,,72,percent of total billed charges,Implant Devices,63,70,,63,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,61.2,34,,61.2,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,63,35,,63,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,72,
COOK G53688 STENT & POSITIONER 5FR,C2617,HCPCS,,79007225,CDM,278,RC,,,both,,,392,154.71,39.4668,,154.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,156.8,40,,156.8,percent of total billed charges,Implant Devices,137.2,70,,137.2,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156.8,
COOK G53704 STENT & POSITIONER 6FR,C2617,HCPCS,,79007226,CDM,278,RC,,,both,,,392,154.71,39.4668,,154.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,133.28,34,,133.28,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,156.8,40,,156.8,percent of total billed charges,Implant Devices,137.2,70,,137.2,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,133.28,34,,133.28,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,137.2,35,,137.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,156.8,
BOST SCI 22-140 NEPHRO STENT 10FRX22CM,C2617,HCPCS,,79008297,CDM,278,RC,,,both,,,316,124.72,39.4668,,124.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,107.44,34,,107.44,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,126.4,40,,126.4,percent of total billed charges,Implant Devices,110.6,70,,110.6,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,107.44,34,,107.44,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,110.6,35,,110.6,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,126.4,
BOST SCI 27-414 6FRX28CM URETERAL STENT,C2617,HCPCS,,79009197,CDM,278,RC,,,both,,,572,225.75,39.4668,,225.75,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,194.48,34,,194.48,percent of total billed charges,Implant Device,200.2,35,,200.2,percent of total billed charges,Implant Device,194.48,34,"Charges > $500, x 34%",194.48,percent of total billed charges,Implant Device,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,228.8,40,,228.8,percent of total billed charges,Implant Devices,200.2,70,,200.2,percent of total billed charges,Implant Devices,194.48,34,,194.48,percent of total billed charges,Implant Devices,194.48,34,,194.48,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,200.2,35,,200.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,228.8,
MEDTRONIC NEURO 3560031 REVISION KIT,C2623,HCPCS,,79011994,CDM,278,RC,,,both,,,1065,420.32,39.4668,,420.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,362.1,34,,362.1,percent of total billed charges,Implant Device,372.75,35,,372.75,percent of total billed charges,Implant Device,362.1,34,"Charges > $500, x 34%",362.1,percent of total billed charges,Implant Device,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,426,40,,426,percent of total billed charges,Implant Devices,372.75,70,,372.75,percent of total billed charges,Implant Devices,362.1,34,,362.1,percent of total billed charges,Implant Devices,362.1,34,,362.1,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,372.75,35,,372.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,426,
ST JUDE CM2000 CARDIOMEMS WIRELESS SENSR,C2624,HCPCS,,79007836,CDM,278,RC,,,both,,,67500,26640.09,39.4668,,26640.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,22950,34,,22950,percent of total billed charges,Implant Device,22950,34,,22950,percent of total billed charges,Implant Device,22950,34,,22950,percent of total billed charges,Implant Device,22950,34,,22950,percent of total billed charges,Implant Device,22950,34,,22950,percent of total billed charges,Implant Device,22950,34,,22950,percent of total billed charges,Implant Device,23625,35,,23625,percent of total billed charges,Implant Device,22950,34,"Charges > $500, x 34%",22950,percent of total billed charges,Implant Device,23625,35,,23625,percent of total billed charges,Implant Devices,23625,35,,23625,percent of total billed charges,Implant Devices,23625,35,,,percent of total billed charges,Implant Devices,23625,35,,23625,percent of total billed charges,Implant Devices,23625,35,,23625,percent of total billed charges,Implant Devices,27000,40,,27000,percent of total billed charges,Implant Devices,23625,70,,23625,percent of total billed charges,Implant Devices,22950,34,,22950,percent of total billed charges,Implant Devices,22950,34,,22950,percent of total billed charges,Implant Devices,23625,35,,23625,percent of total billed charges,Implant Devices,23625,35,,23625,percent of total billed charges,Implant Devices,23625,35,,23625,percent of total billed charges,Implant Devices,23625,35,,23625,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,22950,34,"If Charge > 2,000, then 34 percent",22950,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,27000,
BOST SCI 4563 RE STENT 10FRX12CM,C2625,HCPCS,,79005179,CDM,278,RC,,,both,,,444,175.23,39.4668,,175.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,177.6,40,,177.6,percent of total billed charges,Implant Devices,155.4,70,,155.4,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.6,
BOST SCI 4556 RE STENTS 7FRX7CM,C2625,HCPCS,,79005512,CDM,278,RC,,,both,,,444,175.23,39.4668,,175.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,177.6,40,,177.6,percent of total billed charges,Implant Devices,155.4,70,,155.4,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.6,
BOST SCI 4557 RE STENTS 7FRX10CM,C2625,HCPCS,,79005513,CDM,278,RC,,,both,,,444,175.23,39.4668,,175.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,177.6,40,,177.6,percent of total billed charges,Implant Devices,155.4,70,,155.4,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.6,
BOST SCI 4560 RE STENTS 10FRX5CM,C2625,HCPCS,,79005514,CDM,278,RC,,,both,,,444,175.23,39.4668,,175.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,177.6,40,,177.6,percent of total billed charges,Implant Devices,155.4,70,,155.4,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.6,
BOST SCI 4561 RE STENTS 10FRX7CM,C2625,HCPCS,,79005515,CDM,278,RC,,,both,,,444,175.23,39.4668,,175.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,177.6,40,,177.6,percent of total billed charges,Implant Devices,155.4,70,,155.4,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.6,
BOST SCI 4562 RE STENTS 10FRX10CM,C2625,HCPCS,,79005516,CDM,278,RC,,,both,,,444,175.23,39.4668,,175.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,177.6,40,,177.6,percent of total billed charges,Implant Devices,155.4,70,,155.4,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.6,
BOST SCI 4555 RE STENTS 7FR X 5CM,C2625,HCPCS,,79005536,CDM,278,RC,,,both,,,444,175.23,39.4668,,175.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,150.96,34,,150.96,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,177.6,40,,177.6,percent of total billed charges,Implant Devices,155.4,70,,155.4,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,150.96,34,,150.96,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,155.4,35,,155.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,177.6,
BOST SCI 4558 RE STENTS 7FR X 12CM,C2625,HCPCS,,79005537,CDM,278,RC,,,both,,,384,151.55,39.4668,,151.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,130.56,34,,130.56,percent of total billed charges,Implant Device,134.4,35,,134.4,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,153.6,40,,153.6,percent of total billed charges,Implant Devices,134.4,70,,134.4,percent of total billed charges,Implant Devices,130.56,34,,130.56,percent of total billed charges,Implant Devices,130.56,34,,130.56,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,134.4,35,,134.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,153.6,
BOST SCI 3420 ADVANIX DOUDENAL BEND 7X5,C2625,HCPCS,,79006671,CDM,278,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,149.6,34,,149.6,percent of total billed charges,Implant Device,154,35,,154,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,176,40,,176,percent of total billed charges,Implant Devices,154,70,,154,percent of total billed charges,Implant Devices,149.6,34,,149.6,percent of total billed charges,Implant Devices,149.6,34,,149.6,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,154,35,,154,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,176,
BOST SCI 3420 ADVANIX DOUDENAL BEND 7X7,C2625,HCPCS,,79006672,CDM,278,RC,,,both,,,514,202.86,39.4668,,202.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,174.76,34,,174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Device,174.76,34,"Charges > $500, x 34%",174.76,percent of total billed charges,Implant Device,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,205.6,40,,205.6,percent of total billed charges,Implant Devices,179.9,70,,179.9,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,174.76,34,,174.76,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,179.9,35,,179.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,205.6,
BOST SCI 3420 ADVANIX DOUDENAL BEND 7X9,C2625,HCPCS,,79006673,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
BOST SCI 3420 ADVANIX DOUDENAL BEND 10X5,C2625,HCPCS,,79006674,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
BOST SCI 3420 ADVANIX DOUDENAL BEND 10X7,C2625,HCPCS,,79006675,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
BOST SCI 3420 ADVANIX DOUDENAL BEND 10X9,C2625,HCPCS,,79006676,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
BOST SCI 3435 ADVANX DOUDENAL BEND 10X12,C2625,HCPCS,,79006677,CDM,278,RC,,,both,,,432,170.5,39.4668,,170.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,146.88,34,,146.88,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,172.8,40,,172.8,percent of total billed charges,Implant Devices,151.2,70,,151.2,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,146.88,34,,146.88,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,151.2,35,,151.2,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,172.8,
BOST SCI M0053750 5FRX3CM STENT NO BARB,C2625,HCPCS,,79007485,CDM,278,RC,,,both,,,630,248.64,39.4668,,248.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,214.2,34,,214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Device,214.2,34,"Charges > $500, x 34%",214.2,percent of total billed charges,Implant Device,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,252,40,,252,percent of total billed charges,Implant Devices,220.5,70,,220.5,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,214.2,34,,214.2,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,220.5,35,,220.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,252,
ELLIK EVACUATOR,C2631,HCPCS,,79001498,CDM,278,RC,,,both,,,594,234.43,39.4668,,234.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,201.96,34,,201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Device,201.96,34,"Charges > $500, x 34%",201.96,percent of total billed charges,Implant Device,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,237.6,40,,237.6,percent of total billed charges,Implant Devices,207.9,70,,207.9,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,201.96,34,,201.96,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,207.9,35,,207.9,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,237.6,
BARD 0450M ELLIK EVACUATOR SET,C2631,HCPCS,,79001499,CDM,278,RC,,,both,,,348,137.34,39.4668,,137.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,118.32,34,,118.32,percent of total billed charges,Implant Device,118.32,34,,118.32,percent of total billed charges,Implant Device,118.32,34,,118.32,percent of total billed charges,Implant Device,118.32,34,,118.32,percent of total billed charges,Implant Device,118.32,34,,118.32,percent of total billed charges,Implant Device,118.32,34,,118.32,percent of total billed charges,Implant Device,121.8,35,,121.8,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,139.2,40,,139.2,percent of total billed charges,Implant Devices,121.8,70,,121.8,percent of total billed charges,Implant Devices,118.32,34,,118.32,percent of total billed charges,Implant Devices,118.32,34,,118.32,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,121.8,35,,121.8,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,139.2,
INTEGRA TG221 TENOGLIDE SHEET 2X2,C9356,HCPCS,,79005552,CDM,278,RC,,,both,,,7276,2871.6,39.4668,,2871.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2473.84,34,,2473.84,percent of total billed charges,Implant Device,2473.84,34,,2473.84,percent of total billed charges,Implant Device,2473.84,34,,2473.84,percent of total billed charges,Implant Device,2473.84,34,,2473.84,percent of total billed charges,Implant Device,2473.84,34,,2473.84,percent of total billed charges,Implant Device,2473.84,34,,2473.84,percent of total billed charges,Implant Device,2546.6,35,,2546.6,percent of total billed charges,Implant Device,2473.84,34,"Charges > $500, x 34%",2473.84,percent of total billed charges,Implant Device,2546.6,35,,2546.6,percent of total billed charges,Implant Devices,2546.6,35,,2546.6,percent of total billed charges,Implant Devices,2546.6,35,,,percent of total billed charges,Implant Devices,2546.6,35,,2546.6,percent of total billed charges,Implant Devices,2546.6,35,,2546.6,percent of total billed charges,Implant Devices,2910.4,40,,2910.4,percent of total billed charges,Implant Devices,2546.6,70,,2546.6,percent of total billed charges,Implant Devices,2473.84,34,,2473.84,percent of total billed charges,Implant Devices,2473.84,34,,2473.84,percent of total billed charges,Implant Devices,2546.6,35,,2546.6,percent of total billed charges,Implant Devices,2546.6,35,,2546.6,percent of total billed charges,Implant Devices,2546.6,35,,2546.6,percent of total billed charges,Implant Devices,2546.6,35,,2546.6,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,2473.84,34,"If Charge > 2,000, then 34 percent",2473.84,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
BIOSTRUCTURES OMCS10 OSTEOMATRX COLLAGEN,C9359,HCPCS,,79001635,CDM,278,RC,,,both,,,4800,1894.41,39.4668,,1894.41,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1632,34,,1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Device,1632,34,"Charges > $500, x 34%",1632,percent of total billed charges,Implant Device,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1920,40,,1920,percent of total billed charges,Implant Devices,1680,70,,1680,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1632,34,,1632,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,1680,35,,1680,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,1632,34,"If Charge > 2,000, then 34 percent",1632,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
STRYKER CNW12025 NEUROMEND,C9361,HCPCS,,79002476,CDM,278,RC,,,both,,,4570,1803.63,39.4668,,1803.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1553.8,34,,1553.8,percent of total billed charges,Implant Device,1553.8,34,,1553.8,percent of total billed charges,Implant Device,1553.8,34,,1553.8,percent of total billed charges,Implant Device,1553.8,34,,1553.8,percent of total billed charges,Implant Device,1553.8,34,,1553.8,percent of total billed charges,Implant Device,1553.8,34,,1553.8,percent of total billed charges,Implant Device,1599.5,35,,1599.5,percent of total billed charges,Implant Device,1553.8,34,"Charges > $500, x 34%",1553.8,percent of total billed charges,Implant Device,1599.5,35,,1599.5,percent of total billed charges,Implant Devices,1599.5,35,,1599.5,percent of total billed charges,Implant Devices,1599.5,35,,,percent of total billed charges,Implant Devices,1599.5,35,,1599.5,percent of total billed charges,Implant Devices,1599.5,35,,1599.5,percent of total billed charges,Implant Devices,1828,40,,1828,percent of total billed charges,Implant Devices,1599.5,70,,1599.5,percent of total billed charges,Implant Devices,1553.8,34,,1553.8,percent of total billed charges,Implant Devices,1553.8,34,,1553.8,percent of total billed charges,Implant Devices,1599.5,35,,1599.5,percent of total billed charges,Implant Devices,1599.5,35,,1599.5,percent of total billed charges,Implant Devices,1599.5,35,,1599.5,percent of total billed charges,Implant Devices,1599.5,35,,1599.5,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,1553.8,34,"If Charge > 2,000, then 34 percent",1553.8,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
INTEGRA MWM2021 WOUND MATRIX 2X2,C9363,HCPCS,,79005551,CDM,278,RC,,,both,,,7546,2978.16,39.4668,,2978.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2565.64,34,,2565.64,percent of total billed charges,Implant Device,2641.1,35,,2641.1,percent of total billed charges,Implant Device,2565.64,34,"Charges > $500, x 34%",2565.64,percent of total billed charges,Implant Device,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,3018.4,40,,3018.4,percent of total billed charges,Implant Devices,2641.1,70,,2641.1,percent of total billed charges,Implant Devices,2565.64,34,,2565.64,percent of total billed charges,Implant Devices,2565.64,34,,2565.64,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,2641.1,35,,2641.1,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,2565.64,34,"If Charge > 2,000, then 34 percent",2565.64,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
ALLERGAN 133S-MV-11-T EXPANDER 250CC,L8600,HCPCS,,79011946,CDM,278,RC,,,both,,,4650,1835.21,39.4668,,1835.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1581,34,,1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Device,1581,34,"Charges > $500, x 34%",1581,percent of total billed charges,Implant Device,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1860,40,,1860,percent of total billed charges,Implant Devices,1627.5,70,,1627.5,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1581,34,,1581,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,1627.5,35,,1627.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1581,34,"If Charge > 2,000, then 34 percent",1581,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1860,
ALLERGAN SCL-110 GEL BREAST IMPL 110CC,L8600,HCPCS,,79011947,CDM,278,RC,,,both,,,3975,1568.81,39.4668,,1568.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1351.5,34,,1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Device,1351.5,34,"Charges > $500, x 34%",1351.5,percent of total billed charges,Implant Device,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1590,40,,1590,percent of total billed charges,Implant Devices,1391.25,70,,1391.25,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1351.5,34,,1351.5,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,1391.25,35,,1391.25,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1351.5,34,"If Charge > 2,000, then 34 percent",1351.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1590,
MPQ-2.5 UROPLASTY MACROPLASTIQUE IMPLANT,L8606,HCPCS,,79002542,CDM,278,RC,,,both,,,1486,586.48,39.4668,,586.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,505.24,34,,505.24,percent of total billed charges,Implant Device,505.24,34,,505.24,percent of total billed charges,Implant Device,505.24,34,,505.24,percent of total billed charges,Implant Device,505.24,34,,505.24,percent of total billed charges,Implant Device,505.24,34,,505.24,percent of total billed charges,Implant Device,505.24,34,,505.24,percent of total billed charges,Implant Device,520.1,35,,520.1,percent of total billed charges,Implant Device,505.24,34,"Charges > $500, x 34%",505.24,percent of total billed charges,Implant Device,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,594.4,40,,594.4,percent of total billed charges,Implant Devices,520.1,70,,520.1,percent of total billed charges,Implant Devices,505.24,34,,505.24,percent of total billed charges,Implant Devices,505.24,34,,505.24,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,520.1,35,,520.1,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
AXONICS 50050 URETHERAL BULKING SYSTEM,L8606,HCPCS,,79012106,CDM,278,RC,,,both,,,3450,1361.6,39.4668,,1361.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1173,34,,1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Device,1173,34,"Charges > $500, x 34%",1173,percent of total billed charges,Implant Device,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1380,40,,1380,percent of total billed charges,Implant Devices,1207.5,70,,1207.5,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1173,34,,1173,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,1207.5,35,,1207.5,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,1173,34,"If Charge > 2,000, then 34 percent",1173,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
ARTHROSURFACE 9M52-1535-W ART COMPONENT,L8641,HCPCS,,79002361,CDM,278,RC,,,both,,,7384,2914.23,39.4668,,2914.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2510.56,34,,2510.56,percent of total billed charges,Implant Device,2510.56,34,,2510.56,percent of total billed charges,Implant Device,2510.56,34,,2510.56,percent of total billed charges,Implant Device,2510.56,34,,2510.56,percent of total billed charges,Implant Device,2510.56,34,,2510.56,percent of total billed charges,Implant Device,2510.56,34,,2510.56,percent of total billed charges,Implant Device,2584.4,35,,2584.4,percent of total billed charges,Implant Device,2510.56,34,"Charges > $500, x 34%",2510.56,percent of total billed charges,Implant Device,2584.4,35,,2584.4,percent of total billed charges,Implant Devices,2584.4,35,,2584.4,percent of total billed charges,Implant Devices,2584.4,35,,,percent of total billed charges,Implant Devices,2584.4,35,,2584.4,percent of total billed charges,Implant Devices,2584.4,35,,2584.4,percent of total billed charges,Implant Devices,2953.6,40,,2953.6,percent of total billed charges,Implant Devices,2584.4,70,,2584.4,percent of total billed charges,Implant Devices,2510.56,34,,2510.56,percent of total billed charges,Implant Devices,2510.56,34,,2510.56,percent of total billed charges,Implant Devices,2584.4,35,,2584.4,percent of total billed charges,Implant Devices,2584.4,35,,2584.4,percent of total billed charges,Implant Devices,2584.4,35,,2584.4,percent of total billed charges,Implant Devices,2584.4,35,,2584.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2510.56,34,"If Charge > 2,000, then 34 percent",2510.56,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2953.6,
ARTHROSURFACE 9M52-2545-W ART COMPONENT,L8641,HCPCS,,79010400,CDM,278,RC,,,both,,,5205,2054.25,39.4668,,2054.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1821.75,35,,1821.75,percent of total billed charges,Implant Device,1769.7,34,"Charges > $500, x 34%",1769.7,percent of total billed charges,Implant Device,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,2082,40,,2082,percent of total billed charges,Implant Devices,1821.75,70,,1821.75,percent of total billed charges,Implant Devices,1769.7,34,,1769.7,percent of total billed charges,Implant Devices,1769.7,34,,1769.7,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1769.7,34,"If Charge > 2,000, then 34 percent",1769.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2082,
ARTHOSURFACE 9M52-1545-W 15MM ART COMP,L8641,HCPCS,,79012059,CDM,278,RC,,,both,,,5205,2054.25,39.4668,,2054.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1821.75,35,,1821.75,percent of total billed charges,Implant Device,1769.7,34,"Charges > $500, x 34%",1769.7,percent of total billed charges,Implant Device,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,2082,40,,2082,percent of total billed charges,Implant Devices,1821.75,70,,1821.75,percent of total billed charges,Implant Devices,1769.7,34,,1769.7,percent of total billed charges,Implant Devices,1769.7,34,,1769.7,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1769.7,34,"If Charge > 2,000, then 34 percent",1769.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2082,
ARTHRO 9M52-2535-W ARTICULAR COMP 15MM,L8642,HCPCS,,79013203,CDM,278,RC,,,both,,,5205,2054.25,39.4668,,2054.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1769.7,34,,1769.7,percent of total billed charges,Implant Device,1821.75,35,,1821.75,percent of total billed charges,Implant Device,1769.7,34,"Charges > $500, x 34%",1769.7,percent of total billed charges,Implant Device,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,2082,40,,2082,percent of total billed charges,Implant Devices,1821.75,70,,1821.75,percent of total billed charges,Implant Devices,1769.7,34,,1769.7,percent of total billed charges,Implant Devices,1769.7,34,,1769.7,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,1821.75,35,,1821.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1769.7,34,"If Charge > 2,000, then 34 percent",1769.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2082,
BOST SCI SC-1232 ALPHA PULSE GENERTR KIT,L8679,HCPCS,,79012706,CDM,278,RC,,,both,,,51000,20128.07,39.4668,,20128.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17340,34,,17340,percent of total billed charges,Implant Device,17340,34,,17340,percent of total billed charges,Implant Device,17340,34,,17340,percent of total billed charges,Implant Device,17340,34,,17340,percent of total billed charges,Implant Device,17340,34,,17340,percent of total billed charges,Implant Device,17340,34,,17340,percent of total billed charges,Implant Device,17850,35,,17850,percent of total billed charges,Implant Device,17340,34,"Charges > $500, x 34%",17340,percent of total billed charges,Implant Device,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,20400,40,,20400,percent of total billed charges,Implant Devices,17850,70,,17850,percent of total billed charges,Implant Devices,17340,34,,17340,percent of total billed charges,Implant Devices,17340,34,,17340,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,17850,35,,17850,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,17340,34,"If Charge > 2,000, then 34 percent",17340,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,20400,
MEDTRONIC 7510600 INFUSE BONE GRAFT KIT,L8699,HCPCS,,79008356,CDM,278,RC,,,both,,,17205,6790.26,39.4668,,6790.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5849.7,34,,5849.7,percent of total billed charges,Implant Device,5849.7,34,,5849.7,percent of total billed charges,Implant Device,5849.7,34,,5849.7,percent of total billed charges,Implant Device,5849.7,34,,5849.7,percent of total billed charges,Implant Device,5849.7,34,,5849.7,percent of total billed charges,Implant Device,5849.7,34,,5849.7,percent of total billed charges,Implant Device,6021.75,35,,6021.75,percent of total billed charges,Implant Device,5849.7,34,"Charges > $500, x 34%",5849.7,percent of total billed charges,Implant Device,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6882,40,,6882,percent of total billed charges,Implant Devices,6021.75,70,,6021.75,percent of total billed charges,Implant Devices,5849.7,34,,5849.7,percent of total billed charges,Implant Devices,5849.7,34,,5849.7,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,6021.75,35,,6021.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5849.7,34,"If Charge > 2,000, then 34 percent",5849.7,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6882,
NEOTRACT UL400-4 UROLIFT SYSTEM,L8699,HCPCS,,79010088,CDM,278,RC,,,both,,,2925,1154.4,39.4668,,1154.4,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,994.5,34,,994.5,percent of total billed charges,Implant Device,1023.75,35,,1023.75,percent of total billed charges,Implant Device,994.5,34,"Charges > $500, x 34%",994.5,percent of total billed charges,Implant Device,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1170,40,,1170,percent of total billed charges,Implant Devices,1023.75,70,,1023.75,percent of total billed charges,Implant Devices,994.5,34,,994.5,percent of total billed charges,Implant Devices,994.5,34,,994.5,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,1023.75,35,,1023.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,994.5,34,"If Charge > 2,000, then 34 percent",994.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1170,
MEDTRONIC 2307-0110-N TAS IMPLANT 7 DEG,L8699,HCPCS,,79012660,CDM,278,RC,,,both,,,27150,10715.24,39.4668,,10715.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,9231,34,,9231,percent of total billed charges,Implant Device,9231,34,,9231,percent of total billed charges,Implant Device,9231,34,,9231,percent of total billed charges,Implant Device,9231,34,,9231,percent of total billed charges,Implant Device,9231,34,,9231,percent of total billed charges,Implant Device,9231,34,,9231,percent of total billed charges,Implant Device,9502.5,35,,9502.5,percent of total billed charges,Implant Device,9231,34,"Charges > $500, x 34%",9231,percent of total billed charges,Implant Device,9502.5,35,,9502.5,percent of total billed charges,Implant Devices,9502.5,35,,9502.5,percent of total billed charges,Implant Devices,9502.5,35,,,percent of total billed charges,Implant Devices,9502.5,35,,9502.5,percent of total billed charges,Implant Devices,9502.5,35,,9502.5,percent of total billed charges,Implant Devices,10860,40,,10860,percent of total billed charges,Implant Devices,9502.5,70,,9502.5,percent of total billed charges,Implant Devices,9231,34,,9231,percent of total billed charges,Implant Devices,9231,34,,9231,percent of total billed charges,Implant Devices,9502.5,35,,9502.5,percent of total billed charges,Implant Devices,9502.5,35,,9502.5,percent of total billed charges,Implant Devices,9502.5,35,,9502.5,percent of total billed charges,Implant Devices,9502.5,35,,9502.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,9231,34,"If Charge > 2,000, then 34 percent",9231,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10860,
BOST SCI SC-4319 CLIK X MRI ANCHOR,L8699,HCPCS,,79012709,CDM,278,RC,,,both,,,930,367.04,39.4668,,367.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Device,316.2,34,"Charges > $500, x 34%",316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,372,40,,372,percent of total billed charges,Implant Devices,325.5,70,,325.5,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,372,
TELEFLEX UL2-C UROLIFT CARTRIDGES,L8699,HCPCS,,79012753,CDM,278,RC,,,both,,,3225,1272.8,39.4668,,1272.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1096.5,34,,1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Device,1096.5,34,"Charges > $500, x 34%",1096.5,percent of total billed charges,Implant Device,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1290,40,,1290,percent of total billed charges,Implant Devices,1128.75,70,,1128.75,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1096.5,34,,1096.5,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,1128.75,35,,1128.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1096.5,34,"If Charge > 2,000, then 34 percent",1096.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1290,
TELEFLEX UL400ATC UROLIFT DEVICE & IMPL,L8699,HCPCS,,79012808,CDM,278,RC,,,both,,,3525,1391.2,39.4668,,1391.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1198.5,34,,1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Device,1198.5,34,"Charges > $500, x 34%",1198.5,percent of total billed charges,Implant Device,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1410,40,,1410,percent of total billed charges,Implant Devices,1233.75,70,,1233.75,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1198.5,34,,1198.5,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,1233.75,35,,1233.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1198.5,34,"If Charge > 2,000, then 34 percent",1198.5,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1410,
BOST SCI SC-4318 CLIK X ANCHOR,L8699,HCPCS,,79012912,CDM,278,RC,,,both,,,930,367.04,39.4668,,367.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,316.2,34,,316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Device,316.2,34,"Charges > $500, x 34%",316.2,percent of total billed charges,Implant Device,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,372,40,,372,percent of total billed charges,Implant Devices,325.5,70,,325.5,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,316.2,34,,316.2,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,325.5,35,,325.5,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,372,
OSTEOREMEDIES GVHDLG GV FEM HEAD 60MM,L8699,HCPCS,,79013237,CDM,278,RC,,,both,,,5444,2148.57,39.4668,,2148.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1905.4,35,,1905.4,percent of total billed charges,Implant Device,1850.96,34,"Charges > $500, x 34%",1850.96,percent of total billed charges,Implant Device,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,2177.6,40,,2177.6,percent of total billed charges,Implant Devices,1905.4,70,,1905.4,percent of total billed charges,Implant Devices,1850.96,34,,1850.96,percent of total billed charges,Implant Devices,1850.96,34,,1850.96,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1850.96,34,"If Charge > 2,000, then 34 percent",1850.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2177.6,
OSTEOREMEDIES GVHDMD GV FEM HEAD 54MM,L8699,HCPCS,,79013238,CDM,278,RC,,,both,,,5444,2148.57,39.4668,,2148.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1905.4,35,,1905.4,percent of total billed charges,Implant Device,1850.96,34,"Charges > $500, x 34%",1850.96,percent of total billed charges,Implant Device,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,2177.6,40,,2177.6,percent of total billed charges,Implant Devices,1905.4,70,,1905.4,percent of total billed charges,Implant Devices,1850.96,34,,1850.96,percent of total billed charges,Implant Devices,1850.96,34,,1850.96,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1850.96,34,"If Charge > 2,000, then 34 percent",1850.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2177.6,
OSTEOREMEDIES GVHDSM GV FEM HEAD 46MM,L8699,HCPCS,,79013239,CDM,278,RC,,,both,,,5444,2148.57,39.4668,,2148.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1905.4,35,,1905.4,percent of total billed charges,Implant Device,1850.96,34,"Charges > $500, x 34%",1850.96,percent of total billed charges,Implant Device,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,2177.6,40,,2177.6,percent of total billed charges,Implant Devices,1905.4,70,,1905.4,percent of total billed charges,Implant Devices,1850.96,34,,1850.96,percent of total billed charges,Implant Devices,1850.96,34,,1850.96,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1850.96,34,"If Charge > 2,000, then 34 percent",1850.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2177.6,
OSTEOREMEDIES GVHDXS GV FEM HEAD 40MM,L8699,HCPCS,,79013240,CDM,278,RC,,,both,,,5444,2148.57,39.4668,,2148.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1850.96,34,,1850.96,percent of total billed charges,Implant Device,1905.4,35,,1905.4,percent of total billed charges,Implant Device,1850.96,34,"Charges > $500, x 34%",1850.96,percent of total billed charges,Implant Device,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,2177.6,40,,2177.6,percent of total billed charges,Implant Devices,1905.4,70,,1905.4,percent of total billed charges,Implant Devices,1850.96,34,,1850.96,percent of total billed charges,Implant Devices,1850.96,34,,1850.96,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,1905.4,35,,1905.4,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1850.96,34,"If Charge > 2,000, then 34 percent",1850.96,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2177.6,
OSTEOREMEDIES GVLSLG GV FEM LONG STEM LG,L8699,HCPCS,,79013241,CDM,278,RC,,,both,,,7991,3153.79,39.4668,,3153.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2796.85,35,,2796.85,percent of total billed charges,Implant Device,2716.94,34,"Charges > $500, x 34%",2716.94,percent of total billed charges,Implant Device,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,3196.4,40,,3196.4,percent of total billed charges,Implant Devices,2796.85,70,,2796.85,percent of total billed charges,Implant Devices,2716.94,34,,2716.94,percent of total billed charges,Implant Devices,2716.94,34,,2716.94,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2716.94,34,"If Charge > 2,000, then 34 percent",2716.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3196.4,
OSTEOREMEDIES GVLSMD GV FEM LONG STEM MD,L8699,HCPCS,,79013242,CDM,278,RC,,,both,,,7991,3153.79,39.4668,,3153.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2796.85,35,,2796.85,percent of total billed charges,Implant Device,2716.94,34,"Charges > $500, x 34%",2716.94,percent of total billed charges,Implant Device,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,3196.4,40,,3196.4,percent of total billed charges,Implant Devices,2796.85,70,,2796.85,percent of total billed charges,Implant Devices,2716.94,34,,2716.94,percent of total billed charges,Implant Devices,2716.94,34,,2716.94,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2716.94,34,"If Charge > 2,000, then 34 percent",2716.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3196.4,
OSTEOREMEDIES GVLSSM GV FEM LONG STEM SM,L8699,HCPCS,,79013243,CDM,278,RC,,,both,,,7991,3153.79,39.4668,,3153.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2716.94,34,,2716.94,percent of total billed charges,Implant Device,2796.85,35,,2796.85,percent of total billed charges,Implant Device,2716.94,34,"Charges > $500, x 34%",2716.94,percent of total billed charges,Implant Device,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,3196.4,40,,3196.4,percent of total billed charges,Implant Devices,2796.85,70,,2796.85,percent of total billed charges,Implant Devices,2716.94,34,,2716.94,percent of total billed charges,Implant Devices,2716.94,34,,2716.94,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,2796.85,35,,2796.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2716.94,34,"If Charge > 2,000, then 34 percent",2716.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3196.4,
OSTEOREMEDIES GVSTLG GV FEMORAL STEM LG,L8699,HCPCS,,79013244,CDM,278,RC,,,both,,,7691,3035.39,39.4668,,3035.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2691.85,35,,2691.85,percent of total billed charges,Implant Device,2614.94,34,"Charges > $500, x 34%",2614.94,percent of total billed charges,Implant Device,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,3076.4,40,,3076.4,percent of total billed charges,Implant Devices,2691.85,70,,2691.85,percent of total billed charges,Implant Devices,2614.94,34,,2614.94,percent of total billed charges,Implant Devices,2614.94,34,,2614.94,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2614.94,34,"If Charge > 2,000, then 34 percent",2614.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3076.4,
OSTEOREMEDIES GVSTMD GV FEMORAL STEM MD,L8699,HCPCS,,79013245,CDM,278,RC,,,both,,,7691,3035.39,39.4668,,3035.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2691.85,35,,2691.85,percent of total billed charges,Implant Device,2614.94,34,"Charges > $500, x 34%",2614.94,percent of total billed charges,Implant Device,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,3076.4,40,,3076.4,percent of total billed charges,Implant Devices,2691.85,70,,2691.85,percent of total billed charges,Implant Devices,2614.94,34,,2614.94,percent of total billed charges,Implant Devices,2614.94,34,,2614.94,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2614.94,34,"If Charge > 2,000, then 34 percent",2614.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3076.4,
OSTEOREMEDIES GVSTSM GV FEMORAL STEM SM,L8699,HCPCS,,79013246,CDM,278,RC,,,both,,,7691,3035.39,39.4668,,3035.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2614.94,34,,2614.94,percent of total billed charges,Implant Device,2691.85,35,,2691.85,percent of total billed charges,Implant Device,2614.94,34,"Charges > $500, x 34%",2614.94,percent of total billed charges,Implant Device,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,3076.4,40,,3076.4,percent of total billed charges,Implant Devices,2691.85,70,,2691.85,percent of total billed charges,Implant Devices,2614.94,34,,2614.94,percent of total billed charges,Implant Devices,2614.94,34,,2614.94,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,2691.85,35,,2691.85,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,2614.94,34,"If Charge > 2,000, then 34 percent",2614.94,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3076.4,
TRILLIANT 3200-01-7080 DYNANAIL HALIX,L8699,HCPCS,,79013917,CDM,278,RC,,,both,,,15285,6032.5,39.4668,,6032.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5196.9,34,,5196.9,percent of total billed charges,Implant Device,5196.9,34,,5196.9,percent of total billed charges,Implant Device,5196.9,34,,5196.9,percent of total billed charges,Implant Device,5196.9,34,,5196.9,percent of total billed charges,Implant Device,5196.9,34,,5196.9,percent of total billed charges,Implant Device,5196.9,34,,5196.9,percent of total billed charges,Implant Device,5349.75,35,,5349.75,percent of total billed charges,Implant Device,5196.9,34,"Charges > $500, x 34%",5196.9,percent of total billed charges,Implant Device,5349.75,35,,5349.75,percent of total billed charges,Implant Devices,5349.75,35,,5349.75,percent of total billed charges,Implant Devices,5349.75,35,,,percent of total billed charges,Implant Devices,5349.75,35,,5349.75,percent of total billed charges,Implant Devices,5349.75,35,,5349.75,percent of total billed charges,Implant Devices,6114,40,,6114,percent of total billed charges,Implant Devices,5349.75,70,,5349.75,percent of total billed charges,Implant Devices,5196.9,34,,5196.9,percent of total billed charges,Implant Devices,5196.9,34,,5196.9,percent of total billed charges,Implant Devices,5349.75,35,,5349.75,percent of total billed charges,Implant Devices,5349.75,35,,5349.75,percent of total billed charges,Implant Devices,5349.75,35,,5349.75,percent of total billed charges,Implant Devices,5349.75,35,,5349.75,percent of total billed charges,Implant Devices,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,5196.9,34,"If Charge > 2,000, then 34 percent",5196.9,percent of total billed charges,Implants,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6114,
INTEGRA DP1013 DURAGEN PLUS MATRIX 1X3',Q4100,HCPCS,,79012873,CDM,278,RC,,,both,,,960,378.88,39.4668,,378.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,326.4,34,,326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Device,326.4,34,"Charges > $500, x 34%",326.4,percent of total billed charges,Implant Device,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,384,40,,384,percent of total billed charges,Implant Devices,336,70,,336,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,326.4,34,,326.4,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,336,35,,336,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
LIFE CELL 102128 ALLODERM 8 X 16CM THICK,Q4116,HCPCS,JC,79001190,CDM,278,RC,,,both,,,14670,5789.78,39.4668,,5789.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4987.8,34,,4987.8,percent of total billed charges,Implant Device,4987.8,34,,4987.8,percent of total billed charges,Implant Device,4987.8,34,,4987.8,percent of total billed charges,Implant Device,4987.8,34,,4987.8,percent of total billed charges,Implant Device,4987.8,34,,4987.8,percent of total billed charges,Implant Device,4987.8,34,,4987.8,percent of total billed charges,Implant Device,5134.5,35,,5134.5,percent of total billed charges,Implant Device,4987.8,34,"Charges > $500, x 34%",4987.8,percent of total billed charges,Implant Device,5134.5,35,,5134.5,percent of total billed charges,Implant Devices,5134.5,35,,5134.5,percent of total billed charges,Implant Devices,5134.5,35,,,percent of total billed charges,Implant Devices,5134.5,35,,5134.5,percent of total billed charges,Implant Devices,5134.5,35,,5134.5,percent of total billed charges,Implant Devices,5868,40,,5868,percent of total billed charges,Implant Devices,5134.5,70,,5134.5,percent of total billed charges,Implant Devices,4987.8,34,,4987.8,percent of total billed charges,Implant Devices,4987.8,34,,4987.8,percent of total billed charges,Implant Devices,5134.5,35,,5134.5,percent of total billed charges,Implant Devices,5134.5,35,,5134.5,percent of total billed charges,Implant Devices,5134.5,35,,5134.5,percent of total billed charges,Implant Devices,5134.5,35,,5134.5,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,4987.8,34,"If Charge > 2,000, then 34 percent",4987.8,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,5868,
LIFE CELL 102016 ALLODERM 8 X 2CM,Q4116,HCPCS,JC,79001191,CDM,278,RC,,,both,,,18346,7240.58,39.4668,,7240.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6237.64,34,,6237.64,percent of total billed charges,Implant Device,6237.64,34,,6237.64,percent of total billed charges,Implant Device,6237.64,34,,6237.64,percent of total billed charges,Implant Device,6237.64,34,,6237.64,percent of total billed charges,Implant Device,6237.64,34,,6237.64,percent of total billed charges,Implant Device,6237.64,34,,6237.64,percent of total billed charges,Implant Device,6421.1,35,,6421.1,percent of total billed charges,Implant Device,6237.64,34,"Charges > $500, x 34%",6237.64,percent of total billed charges,Implant Device,6421.1,35,,6421.1,percent of total billed charges,Implant Devices,6421.1,35,,6421.1,percent of total billed charges,Implant Devices,6421.1,35,,,percent of total billed charges,Implant Devices,6421.1,35,,6421.1,percent of total billed charges,Implant Devices,6421.1,35,,6421.1,percent of total billed charges,Implant Devices,7338.4,40,,7338.4,percent of total billed charges,Implant Devices,6421.1,70,,6421.1,percent of total billed charges,Implant Devices,6237.64,34,,6237.64,percent of total billed charges,Implant Devices,6237.64,34,,6237.64,percent of total billed charges,Implant Devices,6421.1,35,,6421.1,percent of total billed charges,Implant Devices,6421.1,35,,6421.1,percent of total billed charges,Implant Devices,6421.1,35,,6421.1,percent of total billed charges,Implant Devices,6421.1,35,,6421.1,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,6237.64,34,"If Charge > 2,000, then 34 percent",6237.64,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,7338.4,
LIFE CELL 102050 ALLODERM 4 X 12CM,Q4116,HCPCS,JC,79001192,CDM,278,RC,,,both,,,5056,1995.44,39.4668,,1995.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1719.04,34,,1719.04,percent of total billed charges,Implant Device,1769.6,35,,1769.6,percent of total billed charges,Implant Device,1719.04,34,"Charges > $500, x 34%",1719.04,percent of total billed charges,Implant Device,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,2022.4,40,,2022.4,percent of total billed charges,Implant Devices,1769.6,70,,1769.6,percent of total billed charges,Implant Devices,1719.04,34,,1719.04,percent of total billed charges,Implant Devices,1719.04,34,,1719.04,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,1769.6,35,,1769.6,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,1719.04,34,"If Charge > 2,000, then 34 percent",1719.04,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
LIFE CELL CL1520P ALLODERM PREFORATED,Q4116,HCPCS,,79007892,CDM,278,RC,,,both,,,21996,8681.12,39.4668,,8681.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7478.64,34,,7478.64,percent of total billed charges,Implant Device,7478.64,34,,7478.64,percent of total billed charges,Implant Device,7478.64,34,,7478.64,percent of total billed charges,Implant Device,7478.64,34,,7478.64,percent of total billed charges,Implant Device,7478.64,34,,7478.64,percent of total billed charges,Implant Device,7478.64,34,,7478.64,percent of total billed charges,Implant Device,7698.6,35,,7698.6,percent of total billed charges,Implant Device,7478.64,34,"Charges > $500, x 34%",7478.64,percent of total billed charges,Implant Device,7698.6,35,,7698.6,percent of total billed charges,Implant Devices,7698.6,35,,7698.6,percent of total billed charges,Implant Devices,7698.6,35,,,percent of total billed charges,Implant Devices,7698.6,35,,7698.6,percent of total billed charges,Implant Devices,7698.6,35,,7698.6,percent of total billed charges,Implant Devices,8798.4,40,,8798.4,percent of total billed charges,Implant Devices,7698.6,70,,7698.6,percent of total billed charges,Implant Devices,7478.64,34,,7478.64,percent of total billed charges,Implant Devices,7478.64,34,,7478.64,percent of total billed charges,Implant Devices,7698.6,35,,7698.6,percent of total billed charges,Implant Devices,7698.6,35,,7698.6,percent of total billed charges,Implant Devices,7698.6,35,,7698.6,percent of total billed charges,Implant Devices,7698.6,35,,7698.6,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,7478.64,34,"If Charge > 2,000, then 34 percent",7478.64,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,8798.4,
LIFE CELL CS1520P ALLODERM RTU SMALL,Q4116,HCPCS,,79008256,CDM,278,RC,,,both,,,10332,4077.71,39.4668,,4077.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3512.88,34,,3512.88,percent of total billed charges,Implant Device,3512.88,34,,3512.88,percent of total billed charges,Implant Device,3512.88,34,,3512.88,percent of total billed charges,Implant Device,3512.88,34,,3512.88,percent of total billed charges,Implant Device,3512.88,34,,3512.88,percent of total billed charges,Implant Device,3512.88,34,,3512.88,percent of total billed charges,Implant Device,3616.2,35,,3616.2,percent of total billed charges,Implant Device,3512.88,34,"Charges > $500, x 34%",3512.88,percent of total billed charges,Implant Device,3616.2,35,,3616.2,percent of total billed charges,Implant Devices,3616.2,35,,3616.2,percent of total billed charges,Implant Devices,3616.2,35,,,percent of total billed charges,Implant Devices,3616.2,35,,3616.2,percent of total billed charges,Implant Devices,3616.2,35,,3616.2,percent of total billed charges,Implant Devices,4132.8,40,,4132.8,percent of total billed charges,Implant Devices,3616.2,70,,3616.2,percent of total billed charges,Implant Devices,3512.88,34,,3512.88,percent of total billed charges,Implant Devices,3512.88,34,,3512.88,percent of total billed charges,Implant Devices,3616.2,35,,3616.2,percent of total billed charges,Implant Devices,3616.2,35,,3616.2,percent of total billed charges,Implant Devices,3616.2,35,,3616.2,percent of total billed charges,Implant Devices,3616.2,35,,3616.2,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,3512.88,34,"If Charge > 2,000, then 34 percent",3512.88,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,4132.8,
ALLERGAN 1518320P ALLODERM MED 16X20CM,Q4116,HCPCS,,79012543,CDM,278,RC,,,both,,,22813,9003.56,39.4668,,9003.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7756.42,34,,7756.42,percent of total billed charges,Implant Device,7756.42,34,,7756.42,percent of total billed charges,Implant Device,7756.42,34,,7756.42,percent of total billed charges,Implant Device,7756.42,34,,7756.42,percent of total billed charges,Implant Device,7756.42,34,,7756.42,percent of total billed charges,Implant Device,7756.42,34,,7756.42,percent of total billed charges,Implant Device,7984.55,35,,7984.55,percent of total billed charges,Implant Device,7756.42,34,"Charges > $500, x 34%",7756.42,percent of total billed charges,Implant Device,7984.55,35,,7984.55,percent of total billed charges,Implant Devices,7984.55,35,,7984.55,percent of total billed charges,Implant Devices,7984.55,35,,,percent of total billed charges,Implant Devices,7984.55,35,,7984.55,percent of total billed charges,Implant Devices,7984.55,35,,7984.55,percent of total billed charges,Implant Devices,9125.2,40,,9125.2,percent of total billed charges,Implant Devices,7984.55,70,,7984.55,percent of total billed charges,Implant Devices,7756.42,34,,7756.42,percent of total billed charges,Implant Devices,7756.42,34,,7756.42,percent of total billed charges,Implant Devices,7984.55,35,,7984.55,percent of total billed charges,Implant Devices,7984.55,35,,7984.55,percent of total billed charges,Implant Devices,7984.55,35,,7984.55,percent of total billed charges,Implant Devices,7984.55,35,,7984.55,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,7756.42,34,"If Charge > 2,000, then 34 percent",7756.42,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,9125.2,
LIFENET AFLEX402 DECELLUR DERMIS 20X25MM,Q4125,HCPCS,,79013155,CDM,278,RC,,,both,,,3135,1237.28,39.4668,,1237.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1065.9,34,,1065.9,percent of total billed charges,Implant Device,1097.25,35,,1097.25,percent of total billed charges,Implant Device,1065.9,34,"Charges > $500, x 34%",1065.9,percent of total billed charges,Implant Device,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1254,40,,1254,percent of total billed charges,Implant Devices,1097.25,70,,1097.25,percent of total billed charges,Implant Devices,1065.9,34,,1065.9,percent of total billed charges,Implant Devices,1065.9,34,,1065.9,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,1097.25,35,,1097.25,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1065.9,34,"If Charge > 2,000, then 34 percent",1065.9,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
LIFENET AFLEX403 DECELLUR DERMIS 25X30MM,Q4125,HCPCS,,79013156,CDM,278,RC,,,both,,,3420,1349.76,39.4668,,1349.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1162.8,34,,1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Device,1162.8,34,"Charges > $500, x 34%",1162.8,percent of total billed charges,Implant Device,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1368,40,,1368,percent of total billed charges,Implant Devices,1197,70,,1197,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1162.8,34,,1162.8,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,1197,35,,1197,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1162.8,34,"If Charge > 2,000, then 34 percent",1162.8,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
STRYKER 3102-2544 DERMAL MATRIX 4X4CM,Q4142,HCPCS,,79009027,CDM,278,RC,,,both,,,5400,2131.21,39.4668,,2131.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1836,34,,1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Device,1836,34,"Charges > $500, x 34%",1836,percent of total billed charges,Implant Device,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,2160,40,,2160,percent of total billed charges,Implant Devices,1890,70,,1890,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1836,34,,1836,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,1890,35,,1890,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,1836,34,"If Charge > 2,000, then 34 percent",1836,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
STRYKER 3102-2004 ALLOWRAP DS 2X4CM,Q4150,HCPCS,,79009011,CDM,278,RC,,,both,,,7267,127.7,,,127.7,Other,150% of Medicare + 9.63% HCRA Surcharge,77.66,,ASP x 6,77.66,Other,ASP,2470.78,34,,2470.78,percent of total billed charges,Implant Device,2470.78,34,,2470.78,percent of total billed charges,Implant Device,2470.78,34,,2470.78,percent of total billed charges,Implant Device,2470.78,34,,2470.78,percent of total billed charges,Implant Device,2470.78,34,,2470.78,percent of total billed charges,Implant Device,2470.78,34,,2470.78,percent of total billed charges,Implant Device,2543.45,35,,2543.45,percent of total billed charges,Implant Device,2470.78,34,"Charges > $500, x 34%",2470.78,percent of total billed charges,Implant Device,2543.45,35,,2543.45,percent of total billed charges,Implant Devices,2543.45,35,,2543.45,percent of total billed charges,Implant Devices,2543.45,35,,,percent of total billed charges,Implant Devices,2543.45,35,,2543.45,percent of total billed charges,Implant Devices,2543.45,35,,2543.45,percent of total billed charges,Implant Devices,2906.8,40,,2906.8,percent of total billed charges,Implant Devices,2543.45,70,,2543.45,percent of total billed charges,Implant Devices,2470.78,34,,2470.78,percent of total billed charges,Implant Devices,2470.78,34,,2470.78,percent of total billed charges,Implant Devices,2543.45,35,,2543.45,percent of total billed charges,Implant Devices,2543.45,35,,2543.45,percent of total billed charges,Implant Devices,2543.45,35,,2543.45,percent of total billed charges,Implant Devices,2543.45,35,,2543.45,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,2470.78,34,"If Charge > 2,000, then 34 percent",2470.78,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,77.66,3186.59,
STRYKER 3102-2008 ALLOWRAP 4X8CM,Q4150,HCPCS,,79009125,CDM,278,RC,,,both,,,14685,127.7,,,127.7,Other,150% of Medicare + 9.63% HCRA Surcharge,77.66,,ASP x 6,77.66,Other,ASP,4992.9,34,,4992.9,percent of total billed charges,Implant Device,4992.9,34,,4992.9,percent of total billed charges,Implant Device,4992.9,34,,4992.9,percent of total billed charges,Implant Device,4992.9,34,,4992.9,percent of total billed charges,Implant Device,4992.9,34,,4992.9,percent of total billed charges,Implant Device,4992.9,34,,4992.9,percent of total billed charges,Implant Device,5139.75,35,,5139.75,percent of total billed charges,Implant Device,4992.9,34,"Charges > $500, x 34%",4992.9,percent of total billed charges,Implant Device,5139.75,35,,5139.75,percent of total billed charges,Implant Devices,5139.75,35,,5139.75,percent of total billed charges,Implant Devices,5139.75,35,,,percent of total billed charges,Implant Devices,5139.75,35,,5139.75,percent of total billed charges,Implant Devices,5139.75,35,,5139.75,percent of total billed charges,Implant Devices,5874,40,,5874,percent of total billed charges,Implant Devices,5139.75,70,,5139.75,percent of total billed charges,Implant Devices,4992.9,34,,4992.9,percent of total billed charges,Implant Devices,4992.9,34,,4992.9,percent of total billed charges,Implant Devices,5139.75,35,,5139.75,percent of total billed charges,Implant Devices,5139.75,35,,5139.75,percent of total billed charges,Implant Devices,5139.75,35,,5139.75,percent of total billed charges,Implant Devices,5139.75,35,,5139.75,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,4992.9,34,"If Charge > 2,000, then 34 percent",4992.9,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,77.66,5874,
STRYKER 3102-2006 ALLOWRAP 4X4CM,Q4150,HCPCS,,79009890,CDM,278,RC,,,both,,,7200,127.7,,,127.7,Other,150% of Medicare + 9.63% HCRA Surcharge,77.66,,ASP x 6,77.66,Other,ASP,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2448,34,,2448,percent of total billed charges,Implant Device,2520,35,,2520,percent of total billed charges,Implant Device,2448,34,"Charges > $500, x 34%",2448,percent of total billed charges,Implant Device,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2880,40,,2880,percent of total billed charges,Implant Devices,2520,70,,2520,percent of total billed charges,Implant Devices,2448,34,,2448,percent of total billed charges,Implant Devices,2448,34,,2448,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,2520,35,,2520,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,2448,34,"If Charge > 2,000, then 34 percent",2448,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,77.66,3186.59,
MIMEDX ES-4400 EPIFIX 4.0X4.5CM,Q4186,HCPCS,,79008765,CDM,278,RC,,,both,,,216,249.3,,,249.3,Other,150% of Medicare + 9.63% HCRA Surcharge,151.6,,ASP x 6,151.6,Other,ASP,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,73.44,34,,73.44,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Device,0.01,34,"Charges > $500, x 34%",0.01,percent of total billed charges,Implant Device,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,86.4,40,,86.4,percent of total billed charges,Implant Devices,75.6,70,,75.6,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,73.44,34,,73.44,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,75.6,35,,75.6,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,0.01,3186.61,
MIMEDX GS-5440 EPIFIX 4X4CM,Q4186,HCPCS,,79010311,CDM,278,RC,,,both,,,8685,249.3,,,249.3,Other,150% of Medicare + 9.63% HCRA Surcharge,151.6,,ASP x 6,151.6,Other,ASP,2952.9,34,,2952.9,percent of total billed charges,Implant Device,2952.9,34,,2952.9,percent of total billed charges,Implant Device,2952.9,34,,2952.9,percent of total billed charges,Implant Device,2952.9,34,,2952.9,percent of total billed charges,Implant Device,2952.9,34,,2952.9,percent of total billed charges,Implant Device,2952.9,34,,2952.9,percent of total billed charges,Implant Device,3039.75,35,,3039.75,percent of total billed charges,Implant Device,2952.9,34,"Charges > $500, x 34%",2952.9,percent of total billed charges,Implant Device,3039.75,35,,3039.75,percent of total billed charges,Implant Devices,3039.75,35,,3039.75,percent of total billed charges,Implant Devices,3039.75,35,,,percent of total billed charges,Implant Devices,3039.75,35,,3039.75,percent of total billed charges,Implant Devices,3039.75,35,,3039.75,percent of total billed charges,Implant Devices,3474,40,,3474,percent of total billed charges,Implant Devices,3039.75,70,,3039.75,percent of total billed charges,Implant Devices,2952.9,34,,2952.9,percent of total billed charges,Implant Devices,2952.9,34,,2952.9,percent of total billed charges,Implant Devices,3039.75,35,,3039.75,percent of total billed charges,Implant Devices,3039.75,35,,3039.75,percent of total billed charges,Implant Devices,3039.75,35,,3039.75,percent of total billed charges,Implant Devices,3039.75,35,,3039.75,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1504.79,,,1504.79,Other,153% of Medicaid,2212.92,,,2212.92,Other,225% of Medicaid,1376.93,,,1376.93,Other,140% of Medicaid,2952.9,34,"If Charge > 2,000, then 34 percent",2952.9,percent of total billed charges,Implants,2557.15,,,2557.15,Other,250% of Medicaid,3186.61,,,3186.61,Other,324% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,2114.57,,,2114.57,Other,215% of Medicaid,1229.4,,,1229.4,Other,125% of Medicaid,151.6,3474,
TIDES MEDICAL TAH1202 AMNIOHEAL PLUS 2X2,V2790,HCPCS,,79006879,CDM,278,RC,,,both,,,2693,1062.84,39.4668,,1062.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,915.62,34,,915.62,percent of total billed charges,Implant Device,915.62,34,,915.62,percent of total billed charges,Implant Device,915.62,34,,915.62,percent of total billed charges,Implant Device,915.62,34,,915.62,percent of total billed charges,Implant Device,915.62,34,,915.62,percent of total billed charges,Implant Device,915.62,34,,915.62,percent of total billed charges,Implant Device,942.55,35,,942.55,percent of total billed charges,Implant Device,915.62,34,"Charges > $500, x 34%",915.62,percent of total billed charges,Implant Device,942.55,35,,942.55,percent of total billed charges,Implant Devices,942.55,35,,942.55,percent of total billed charges,Implant Devices,942.55,35,,,percent of total billed charges,Implant Devices,942.55,35,,942.55,percent of total billed charges,Implant Devices,942.55,35,,942.55,percent of total billed charges,Implant Devices,1077.2,40,,1077.2,percent of total billed charges,Implant Devices,942.55,70,,942.55,percent of total billed charges,Implant Devices,915.62,34,,915.62,percent of total billed charges,Implant Devices,915.62,34,,915.62,percent of total billed charges,Implant Devices,942.55,35,,942.55,percent of total billed charges,Implant Devices,942.55,35,,942.55,percent of total billed charges,Implant Devices,942.55,35,,942.55,percent of total billed charges,Implant Devices,942.55,35,,942.55,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,915.62,34,"If Charge > 2,000, then 34 percent",915.62,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
TIDES MEDICAL TAH1203 AMNIOHEAL PLUS 2X3,V2790,HCPCS,,79006880,CDM,278,RC,,,both,,,3893,1536.44,39.4668,,1536.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1323.62,34,,1323.62,percent of total billed charges,Implant Device,1362.55,35,,1362.55,percent of total billed charges,Implant Device,1323.62,34,"Charges > $500, x 34%",1323.62,percent of total billed charges,Implant Device,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1557.2,40,,1557.2,percent of total billed charges,Implant Devices,1362.55,70,,1362.55,percent of total billed charges,Implant Devices,1323.62,34,,1323.62,percent of total billed charges,Implant Devices,1323.62,34,,1323.62,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,1362.55,35,,1362.55,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,1323.62,34,"If Charge > 2,000, then 34 percent",1323.62,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
TIDES MEDICAL TAH1406 AMNIOHEAL 4X6CM,V2790,HCPCS,,79007073,CDM,278,RC,,,both,,,10493,4141.25,39.4668,,4141.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3567.62,34,,3567.62,percent of total billed charges,Implant Device,3567.62,34,,3567.62,percent of total billed charges,Implant Device,3567.62,34,,3567.62,percent of total billed charges,Implant Device,3567.62,34,,3567.62,percent of total billed charges,Implant Device,3567.62,34,,3567.62,percent of total billed charges,Implant Device,3567.62,34,,3567.62,percent of total billed charges,Implant Device,3672.55,35,,3672.55,percent of total billed charges,Implant Device,3567.62,34,"Charges > $500, x 34%",3567.62,percent of total billed charges,Implant Device,3672.55,35,,3672.55,percent of total billed charges,Implant Devices,3672.55,35,,3672.55,percent of total billed charges,Implant Devices,3672.55,35,,,percent of total billed charges,Implant Devices,3672.55,35,,3672.55,percent of total billed charges,Implant Devices,3672.55,35,,3672.55,percent of total billed charges,Implant Devices,4197.2,40,,4197.2,percent of total billed charges,Implant Devices,3672.55,70,,3672.55,percent of total billed charges,Implant Devices,3567.62,34,,3567.62,percent of total billed charges,Implant Devices,3567.62,34,,3567.62,percent of total billed charges,Implant Devices,3672.55,35,,3672.55,percent of total billed charges,Implant Devices,3672.55,35,,3672.55,percent of total billed charges,Implant Devices,3672.55,35,,3672.55,percent of total billed charges,Implant Devices,3672.55,35,,3672.55,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,3567.62,34,"If Charge > 2,000, then 34 percent",3567.62,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,4197.2,
TIDES TAH1408 AMNIOHEAL ALLOGRAFT 4X8CM,V2790,HCPCS,,79008897,CDM,278,RC,,,both,,,14993,5917.26,39.4668,,5917.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5097.62,34,,5097.62,percent of total billed charges,Implant Device,5097.62,34,,5097.62,percent of total billed charges,Implant Device,5097.62,34,,5097.62,percent of total billed charges,Implant Device,5097.62,34,,5097.62,percent of total billed charges,Implant Device,5097.62,34,,5097.62,percent of total billed charges,Implant Device,5097.62,34,,5097.62,percent of total billed charges,Implant Device,5247.55,35,,5247.55,percent of total billed charges,Implant Device,5097.62,34,"Charges > $500, x 34%",5097.62,percent of total billed charges,Implant Device,5247.55,35,,5247.55,percent of total billed charges,Implant Devices,5247.55,35,,5247.55,percent of total billed charges,Implant Devices,5247.55,35,,,percent of total billed charges,Implant Devices,5247.55,35,,5247.55,percent of total billed charges,Implant Devices,5247.55,35,,5247.55,percent of total billed charges,Implant Devices,5997.2,40,,5997.2,percent of total billed charges,Implant Devices,5247.55,70,,5247.55,percent of total billed charges,Implant Devices,5097.62,34,,5097.62,percent of total billed charges,Implant Devices,5097.62,34,,5097.62,percent of total billed charges,Implant Devices,5247.55,35,,5247.55,percent of total billed charges,Implant Devices,5247.55,35,,5247.55,percent of total billed charges,Implant Devices,5247.55,35,,5247.55,percent of total billed charges,Implant Devices,5247.55,35,,5247.55,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,5097.62,34,"If Charge > 2,000, then 34 percent",5097.62,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,5997.2,
TIDES TAH1404 AMNIOHEAL PLUS 4X4CM,V2790,HCPCS,,79009062,CDM,278,RC,,,both,,,7493,2957.25,39.4668,,2957.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2547.62,34,,2547.62,percent of total billed charges,Implant Device,2547.62,34,,2547.62,percent of total billed charges,Implant Device,2547.62,34,,2547.62,percent of total billed charges,Implant Device,2547.62,34,,2547.62,percent of total billed charges,Implant Device,2547.62,34,,2547.62,percent of total billed charges,Implant Device,2547.62,34,,2547.62,percent of total billed charges,Implant Device,2622.55,35,,2622.55,percent of total billed charges,Implant Device,2547.62,34,"Charges > $500, x 34%",2547.62,percent of total billed charges,Implant Device,2622.55,35,,2622.55,percent of total billed charges,Implant Devices,2622.55,35,,2622.55,percent of total billed charges,Implant Devices,2622.55,35,,,percent of total billed charges,Implant Devices,2622.55,35,,2622.55,percent of total billed charges,Implant Devices,2622.55,35,,2622.55,percent of total billed charges,Implant Devices,2997.2,40,,2997.2,percent of total billed charges,Implant Devices,2622.55,70,,2622.55,percent of total billed charges,Implant Devices,2547.62,34,,2547.62,percent of total billed charges,Implant Devices,2547.62,34,,2547.62,percent of total billed charges,Implant Devices,2622.55,35,,2622.55,percent of total billed charges,Implant Devices,2622.55,35,,2622.55,percent of total billed charges,Implant Devices,2622.55,35,,2622.55,percent of total billed charges,Implant Devices,2622.55,35,,2622.55,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,2547.62,34,"If Charge > 2,000, then 34 percent",2547.62,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
TIDES TAH1101 AMNIOHEAL PLUS 1X1CM,V2790,HCPCS,,79009124,CDM,278,RC,,,both,,,1343,530.04,39.4668,,530.04,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,456.62,34,,456.62,percent of total billed charges,Implant Device,456.62,34,,456.62,percent of total billed charges,Implant Device,456.62,34,,456.62,percent of total billed charges,Implant Device,456.62,34,,456.62,percent of total billed charges,Implant Device,456.62,34,,456.62,percent of total billed charges,Implant Device,456.62,34,,456.62,percent of total billed charges,Implant Device,470.05,35,,470.05,percent of total billed charges,Implant Device,456.62,34,"Charges > $500, x 34%",456.62,percent of total billed charges,Implant Device,470.05,35,,470.05,percent of total billed charges,Implant Devices,470.05,35,,470.05,percent of total billed charges,Implant Devices,470.05,35,,,percent of total billed charges,Implant Devices,470.05,35,,470.05,percent of total billed charges,Implant Devices,470.05,35,,470.05,percent of total billed charges,Implant Devices,537.2,40,,537.2,percent of total billed charges,Implant Devices,470.05,70,,470.05,percent of total billed charges,Implant Devices,456.62,34,,456.62,percent of total billed charges,Implant Devices,456.62,34,,456.62,percent of total billed charges,Implant Devices,470.05,35,,470.05,percent of total billed charges,Implant Devices,470.05,35,,470.05,percent of total billed charges,Implant Devices,470.05,35,,470.05,percent of total billed charges,Implant Devices,470.05,35,,470.05,percent of total billed charges,Implant Devices,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,983.52,,,983.52,Other,100% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1504.78,,,1504.78,Other,153% of Medicaid,2212.91,,,2212.91,Other,225% of Medicaid,1376.92,,,1376.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Implants,2557.14,,,2557.14,Other,250% of Medicaid,3186.59,,,3186.59,Other,324% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,2114.56,,,2114.56,Other,215% of Medicaid,1229.39,,,1229.39,Other,125% of Medicaid,0.01,3186.59,
EMERG RESP INSTALL & TEST,S5160,HCPCS,,84000002,CDM,291,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,70,,63,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,63,
EMERG RESPONSE MONTHLY FEE,S5161,HCPCS,,84000001,CDM,291,RC,,,both,,,40,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,28,70,,28,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28,
EMERG RESPONSE MONTHLY FEE WIRELESS,S5161,HCPCS,U1,84000003,CDM,291,RC,,,both,,,40,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,28,70,,28,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,28,
LIVER DIS 10 ASSAYS W/NASH,0003M,HCPCS,,78000019,CDM,300,RC,,,both,,,1587,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,1515.23,,,1515.23,Fee Schedule,,1364.21,,,1364.21,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,1110.9,70,,1110.9,percent of total billed charges,All Other,1585.71,,,1585.71,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1867.61,,,1867.61,Fee Schedule,,983.94,,,983.94,Fee Schedule,,1057.14,,,,Fee Schedule,,1867.61,,,1867.61,Fee Schedule,,983.94,,,983.94,Fee Schedule,,1988.43,,,1988.43,Fee Schedule,,1110.9,70,,1110.9,percent of total billed charges,,2385.63,,,2385.63,Fee Schedule,,2021.97,,,2021.97,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2385.63,
NFCT DS VIR RESP RNA 4 TRGT,0241U,HCPCS,,78000020,CDM,300,RC,,,both,,,450,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,429.32,,,429.32,Fee Schedule,,386.53,,,386.53,Fee Schedule,,142.63,,,142.63,Fee Schedule,,142.63,,,142.63,Fee Schedule,,142.63,,,142.63,Fee Schedule,,315,70,,315,percent of total billed charges,All Other,449.28,,,449.28,Fee Schedule,,81,,,81,Other,186% of Medicaid,529.16,,,529.16,Fee Schedule,,279,,,279,Fee Schedule,,299.52,,,,Fee Schedule,,529.16,,,529.16,Fee Schedule,,279,,,279,Fee Schedule,,563.39,,,563.39,Fee Schedule,,315,70,,315,percent of total billed charges,,675.93,,,675.93,Fee Schedule,,572.89,,,572.89,Fee Schedule,,213.9,,,213.9,Fee Schedule,,213.9,,,213.9,Fee Schedule,,213.9,,,213.9,Fee Schedule,,213.9,,,213.9,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,675.93,
ROUTINE VENIPUNCTURE,36415,CPT,,30036415,CDM,300,RC,,,both,,,21,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,16.44,,,16.44,Fee Schedule,,14.79,,,14.79,Fee Schedule,,13.98,,,13.98,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,All Other,27.81,,,27.81,Fee Schedule,,75,,,75,Other,186% of Medicaid,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,18.54,,,,Fee Schedule,,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,34.88,,,34.88,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,,14.22,,,14.22,Fee Schedule,,12.05,,,12.05,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
NURSE VENIPUNCTURE,36415,CPT,,34036415,CDM,300,RC,,,both,,,21,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,16.44,,,16.44,Fee Schedule,,14.79,,,14.79,Fee Schedule,,13.98,,,13.98,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,All Other,27.81,,,27.81,Fee Schedule,,75,,,75,Other,186% of Medicaid,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,18.54,,,,Fee Schedule,,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,34.88,,,34.88,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,,14.22,,,14.22,Fee Schedule,,12.05,,,12.05,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
ROUTINE VENIPUNCTURE,36415,CPT,,46036415,CDM,300,RC,,,both,,,21,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,16.44,,,16.44,Fee Schedule,,14.79,,,14.79,Fee Schedule,,13.98,,,13.98,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,All Other,27.81,,,27.81,Fee Schedule,,75,,,75,Other,186% of Medicaid,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,18.54,,,,Fee Schedule,,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,34.88,,,34.88,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,,14.22,,,14.22,Fee Schedule,,12.05,,,12.05,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
ROUTINE VENIPUNCTURE,36415,CPT,,47036415,CDM,300,RC,,,both,,,21,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,16.44,,,16.44,Fee Schedule,,14.79,,,14.79,Fee Schedule,,13.98,,,13.98,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,All Other,27.81,,,27.81,Fee Schedule,,75,,,75,Other,186% of Medicaid,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,18.54,,,,Fee Schedule,,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,34.88,,,34.88,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,,14.22,,,14.22,Fee Schedule,,12.05,,,12.05,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
NURSE VENIPUNCTURE,36415,CPT,,75036415,CDM,300,RC,,,both,,,21,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,16.44,,,16.44,Fee Schedule,,14.79,,,14.79,Fee Schedule,,13.98,,,13.98,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,All Other,27.81,,,27.81,Fee Schedule,,75,,,75,Other,186% of Medicaid,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,18.54,,,,Fee Schedule,,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,34.88,,,34.88,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,,14.22,,,14.22,Fee Schedule,,12.05,,,12.05,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
ROUTINE VENIPUNCTURE,36415,CPT,,78036415,CDM,300,RC,,,both,,,21,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,16.44,,,16.44,Fee Schedule,,14.79,,,14.79,Fee Schedule,,13.98,,,13.98,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,All Other,27.81,,,27.81,Fee Schedule,,75,,,75,Other,186% of Medicaid,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,18.54,,,,Fee Schedule,,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,34.88,,,34.88,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,,14.22,,,14.22,Fee Schedule,,12.05,,,12.05,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
ROUTINE VENIPUNCTURE,36415,CPT,,82036415,CDM,300,RC,,,both,,,21,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,16.44,,,16.44,Fee Schedule,,14.79,,,14.79,Fee Schedule,,13.98,,,13.98,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,All Other,27.81,,,27.81,Fee Schedule,,75,,,75,Other,186% of Medicaid,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,18.54,,,,Fee Schedule,,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,34.88,,,34.88,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,,14.22,,,14.22,Fee Schedule,,12.05,,,12.05,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
CAPILLARY BLOOD DRAW,36416,CPT,,34036416,CDM,300,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.22,,,1.22,Fee Schedule,,1.22,,,1.22,Fee Schedule,,1.22,,,1.22,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,27.88,68,,27.88,percent of total billed charges,All Other,75,,,75,Other,186% of Medicaid,34.03,80,,34.03,percent of total billed charges,All Other,25.42,83,,25.42,percent of total billed charges,All Other,22.55,83,,,percent of total billed charges,All Other,34.03,80,,34.03,percent of total billed charges,All Other,25.42,83,,25.42,percent of total billed charges,All Other,32.8,80,,32.8,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,,26.65,65,,26.65,percent of total billed charges,All Other,26.65,65,,26.65,percent of total billed charges,All Other,4.34,,,4.34,Fee Schedule,,4.34,,,4.34,Fee Schedule,,4.34,,,4.34,Fee Schedule,,4.34,,,4.34,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
CAPILLARY BLOOD DRAW,36416,CPT,,78036416,CDM,300,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.22,,,1.22,Fee Schedule,,1.22,,,1.22,Fee Schedule,,1.22,,,1.22,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,27.88,68,,27.88,percent of total billed charges,All Other,75,,,75,Other,186% of Medicaid,34.03,80,,34.03,percent of total billed charges,All Other,25.42,83,,25.42,percent of total billed charges,All Other,22.55,83,,,percent of total billed charges,All Other,34.03,80,,34.03,percent of total billed charges,All Other,25.42,83,,25.42,percent of total billed charges,All Other,32.8,80,,32.8,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,,26.65,65,,26.65,percent of total billed charges,All Other,26.65,65,,26.65,percent of total billed charges,All Other,4.34,,,4.34,Fee Schedule,,4.34,,,4.34,Fee Schedule,,4.34,,,4.34,Fee Schedule,,4.34,,,4.34,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
CAPILLARY BLOOD DRAW,36416,CPT,,82036416,CDM,300,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1.22,,,1.22,Fee Schedule,,1.22,,,1.22,Fee Schedule,,1.22,,,1.22,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,27.88,68,,27.88,percent of total billed charges,All Other,75,,,75,Other,186% of Medicaid,34.03,80,,34.03,percent of total billed charges,All Other,25.42,83,,25.42,percent of total billed charges,All Other,22.55,83,,,percent of total billed charges,All Other,34.03,80,,34.03,percent of total billed charges,All Other,25.42,83,,25.42,percent of total billed charges,All Other,32.8,80,,32.8,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,,26.65,65,,26.65,percent of total billed charges,All Other,26.65,65,,26.65,percent of total billed charges,All Other,4.34,,,4.34,Fee Schedule,,4.34,,,4.34,Fee Schedule,,4.34,,,4.34,Fee Schedule,,4.34,,,4.34,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
COLLECT BLOOD FROM VAD,36591,CPT,,78036591,CDM,300,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,90.63,,,90.63,Fee Schedule,,81.6,,,81.6,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,94.85,,,94.85,Fee Schedule,,63,,,63,Other,186% of Medicaid,111.71,,,111.71,Fee Schedule,,163.06,,,163.06,Fee Schedule,,63.23,,,,Fee Schedule,,111.71,,,111.71,Fee Schedule,,163.06,,,163.06,Fee Schedule,,118.93,,,118.93,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,230.83,
COLLECT BLOOD FROM PICC,36592,CPT,,34036592,CDM,300,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,98.28,,,98.28,Fee Schedule,,88.48,,,88.48,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,102.85,,,102.85,Fee Schedule,,63,,,63,Other,186% of Medicaid,121.13,,,121.13,Fee Schedule,,163.06,,,163.06,Fee Schedule,,68.57,,,,Fee Schedule,,121.13,,,121.13,Fee Schedule,,163.06,,,163.06,Fee Schedule,,128.97,,,128.97,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,230.83,
COLLECT BLOOD FROM PICC,36592,CPT,,78036592,CDM,300,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,98.28,,,98.28,Fee Schedule,,88.48,,,88.48,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,102.85,,,102.85,Fee Schedule,,63,,,63,Other,186% of Medicaid,121.13,,,121.13,Fee Schedule,,163.06,,,163.06,Fee Schedule,,68.57,,,,Fee Schedule,,121.13,,,121.13,Fee Schedule,,163.06,,,163.06,Fee Schedule,,128.97,,,128.97,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,230.83,
COLLECT BLOOD FROM PICC,36592,CPT,,82036592,CDM,300,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,98.28,,,98.28,Fee Schedule,,88.48,,,88.48,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,102.85,,,102.85,Fee Schedule,,63,,,63,Other,186% of Medicaid,121.13,,,121.13,Fee Schedule,,163.06,,,163.06,Fee Schedule,,68.57,,,,Fee Schedule,,121.13,,,121.13,Fee Schedule,,163.06,,,163.06,Fee Schedule,,128.97,,,128.97,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,230.83,
ASSAY OF AMIKACIN,80150,CPT,,78080150,CDM,300,RC,,,both,,,260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,45.39,,,45.39,Fee Schedule,,40.87,,,40.87,Fee Schedule,,116.23,,,116.23,Fee Schedule,,104.57,,,104.57,Fee Schedule,,98.84,,,98.84,Fee Schedule,,182,70,,182,percent of total billed charges,All Other,47.5,,,47.5,Fee Schedule,,20,,,20,Other,186% of Medicaid,55.95,,,55.95,Fee Schedule,,161.2,,,161.2,Fee Schedule,,31.67,,,,Fee Schedule,,55.95,,,55.95,Fee Schedule,,161.2,,,161.2,Fee Schedule,,59.57,,,59.57,Fee Schedule,,182,70,,182,percent of total billed charges,,71.46,,,71.46,Fee Schedule,,60.57,,,60.57,Fee Schedule,,22.62,,,22.62,Fee Schedule,,22.62,,,22.62,Fee Schedule,,22.62,,,22.62,Fee Schedule,,22.62,,,22.62,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,182,
ASSAY OF DIGOXIN,80162,CPT,,78080162,CDM,300,RC,,,both,,,168,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.97,,,39.97,Fee Schedule,,35.99,,,35.99,Fee Schedule,,102.42,,,102.42,Fee Schedule,,92.14,,,92.14,Fee Schedule,,87.1,,,87.1,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,All Other,41.83,,,41.83,Fee Schedule,,20,,,20,Other,186% of Medicaid,49.27,,,49.27,Fee Schedule,,104.16,,,104.16,Fee Schedule,,27.89,,,,Fee Schedule,,49.27,,,49.27,Fee Schedule,,104.16,,,104.16,Fee Schedule,,52.46,,,52.46,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,,62.93,,,62.93,Fee Schedule,,53.34,,,53.34,Fee Schedule,,19.92,,,19.92,Fee Schedule,,19.92,,,19.92,Fee Schedule,,19.92,,,19.92,Fee Schedule,,19.92,,,19.92,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,117.6,
ASSAY OF PHENYTOIN TOTAL,80185,CPT,,78080185,CDM,300,RC,,,both,,,196,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.88,,,39.88,Fee Schedule,,35.91,,,35.91,Fee Schedule,,102.26,,,102.26,Fee Schedule,,91.99,,,91.99,Fee Schedule,,86.96,,,86.96,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,All Other,41.74,,,41.74,Fee Schedule,,20,,,20,Other,186% of Medicaid,49.16,,,49.16,Fee Schedule,,121.52,,,121.52,Fee Schedule,,27.83,,,,Fee Schedule,,49.16,,,49.16,Fee Schedule,,121.52,,,121.52,Fee Schedule,,52.34,,,52.34,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,,62.79,,,62.79,Fee Schedule,,53.22,,,53.22,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,137.2,
ASSAY OF TACROLIMUS,80197,CPT,,78080197,CDM,300,RC,,,both,,,315,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.33,,,41.33,Fee Schedule,,37.21,,,37.21,Fee Schedule,,105.87,,,105.87,Fee Schedule,,95.25,,,95.25,Fee Schedule,,90.03,,,90.03,Fee Schedule,,220.5,70,,220.5,percent of total billed charges,All Other,43.25,,,43.25,Fee Schedule,,20,,,20,Other,186% of Medicaid,50.94,,,50.94,Fee Schedule,,195.3,,,195.3,Fee Schedule,,28.83,,,,Fee Schedule,,50.94,,,50.94,Fee Schedule,,195.3,,,195.3,Fee Schedule,,54.23,,,54.23,Fee Schedule,,220.5,70,,220.5,percent of total billed charges,,65.07,,,65.07,Fee Schedule,,55.15,,,55.15,Fee Schedule,,20.6,,,20.6,Fee Schedule,,20.6,,,20.6,Fee Schedule,,20.6,,,20.6,Fee Schedule,,20.6,,,20.6,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,220.5,
URINALYSIS AUTO W/O SCOPE,81003,CPT,,78081003,CDM,300,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,6.77,,,6.77,Fee Schedule,,6.1,,,6.1,Fee Schedule,,17.32,,,17.32,Fee Schedule,,15.58,,,15.58,Fee Schedule,,14.73,,,14.73,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,7.09,,,7.09,Fee Schedule,,4,,,4,Other,186% of Medicaid,8.35,,,8.35,Fee Schedule,,25.42,,,25.42,Fee Schedule,,4.73,,,,Fee Schedule,,8.35,,,8.35,Fee Schedule,,25.42,,,25.42,Fee Schedule,,8.89,,,8.89,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,10.66,,,10.66,Fee Schedule,,9.04,,,9.04,Fee Schedule,,3.38,,,3.38,Fee Schedule,,3.38,,,3.38,Fee Schedule,,3.38,,,3.38,Fee Schedule,,3.38,,,3.38,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,28.7,
URINE PREGNANCY TEST,81025,CPT,,78081025,CDM,300,RC,,,both,,,57,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,25.92,,,25.92,Fee Schedule,,23.33,,,23.33,Fee Schedule,,48.77,,,48.77,Fee Schedule,,43.88,,,43.88,Fee Schedule,,41.47,,,41.47,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,All Other,27.12,,,27.12,Fee Schedule,,4,,,4,Other,186% of Medicaid,31.94,,,31.94,Fee Schedule,,35.34,,,35.34,Fee Schedule,,18.08,,,,Fee Schedule,,31.94,,,31.94,Fee Schedule,,35.34,,,35.34,Fee Schedule,,34.01,,,34.01,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,,40.8,,,40.8,Fee Schedule,,34.58,,,34.58,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,48.77,
CALR GENE COM VARIANTS,81219,CPT,,78081219,CDM,300,RC,,,both,,,348,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,366.11,,,366.11,Fee Schedule,,329.62,,,329.62,Fee Schedule,,66.27,,,66.27,Fee Schedule,,66.27,,,66.27,Fee Schedule,,66.27,,,66.27,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,All Other,383.13,,,383.13,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,451.25,,,451.25,Fee Schedule,,215.76,,,215.76,Fee Schedule,,255.42,,,,Fee Schedule,,451.25,,,451.25,Fee Schedule,,215.76,,,215.76,Fee Schedule,,480.44,,,480.44,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,,576.41,,,576.41,Fee Schedule,,488.54,,,488.54,Fee Schedule,,182.45,,,182.45,Fee Schedule,,182.45,,,182.45,Fee Schedule,,182.45,,,182.45,Fee Schedule,,182.45,,,182.45,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,576.41,
IGH VARI REGIONAL MUTATION,81263,CPT,,78081263,CDM,300,RC,,,both,,,900,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,886.51,,,886.51,Fee Schedule,,798.15,,,798.15,Fee Schedule,,51.44,,,51.44,Fee Schedule,,51.44,,,51.44,Fee Schedule,,51.44,,,51.44,Fee Schedule,,630,70,,630,percent of total billed charges,All Other,927.74,,,927.74,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1092.67,,,1092.67,Fee Schedule,,558,,,558,Fee Schedule,,618.49,,,,Fee Schedule,,1092.67,,,1092.67,Fee Schedule,,558,,,558,Fee Schedule,,1163.35,,,1163.35,Fee Schedule,,630,70,,630,percent of total billed charges,,1395.74,,,1395.74,Fee Schedule,,1182.98,,,1182.98,Fee Schedule,,441.78,,,441.78,Fee Schedule,,441.78,,,441.78,Fee Schedule,,441.78,,,441.78,Fee Schedule,,441.78,,,441.78,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1395.74,
STR MARKERS SPECIMEN ANAL,81265,CPT,,78081265,CDM,300,RC,,,both,,,735,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,701.54,,,701.54,Fee Schedule,,631.62,,,631.62,Fee Schedule,,76.58,,,76.58,Fee Schedule,,76.58,,,76.58,Fee Schedule,,76.58,,,76.58,Fee Schedule,,514.5,70,,514.5,percent of total billed charges,All Other,734.17,,,734.17,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,864.69,,,864.69,Fee Schedule,,455.7,,,455.7,Fee Schedule,,489.45,,,,Fee Schedule,,864.69,,,864.69,Fee Schedule,,455.7,,,455.7,Fee Schedule,,920.63,,,920.63,Fee Schedule,,514.5,70,,514.5,percent of total billed charges,,1104.53,,,1104.53,Fee Schedule,,936.15,,,936.15,Fee Schedule,,349.61,,,349.61,Fee Schedule,,349.61,,,349.61,Fee Schedule,,349.61,,,349.61,Fee Schedule,,349.61,,,349.61,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1104.53,
KIT GENE TARGETED SEQ ANALYS,81272,CPT,,78081272,CDM,300,RC,,,both,,,918,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,991.83,,,991.83,Fee Schedule,,892.97,,,892.97,Fee Schedule,,131.8,,,131.8,Fee Schedule,,131.8,,,131.8,Fee Schedule,,131.8,,,131.8,Fee Schedule,,642.6,70,,642.6,percent of total billed charges,All Other,1037.96,,,1037.96,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1222.48,,,1222.48,Fee Schedule,,569.16,,,569.16,Fee Schedule,,691.97,,,,Fee Schedule,,1222.48,,,1222.48,Fee Schedule,,569.16,,,569.16,Fee Schedule,,1301.56,,,1301.56,Fee Schedule,,642.6,70,,642.6,percent of total billed charges,,1561.56,,,1561.56,Fee Schedule,,1323.52,,,1323.52,Fee Schedule,,494.27,,,494.27,Fee Schedule,,494.27,,,494.27,Fee Schedule,,494.27,,,494.27,Fee Schedule,,494.27,,,494.27,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1561.56,
SMN1 GENE DOS/DELETION ALYS,81329,CPT,,78081329,CDM,300,RC,,,both,,,364,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,412.37,,,412.37,Fee Schedule,,371.27,,,371.27,Fee Schedule,,137,,,137,Fee Schedule,,137,,,137,Fee Schedule,,137,,,137,Fee Schedule,,254.8,70,,254.8,percent of total billed charges,All Other,431.55,,,431.55,Fee Schedule,,156,,,156,Other,186% of Medicaid,508.27,,,508.27,Fee Schedule,,225.68,,,225.68,Fee Schedule,,287.7,,,,Fee Schedule,,508.27,,,508.27,Fee Schedule,,225.68,,,225.68,Fee Schedule,,541.15,,,541.15,Fee Schedule,,254.8,70,,254.8,percent of total billed charges,,649.25,,,649.25,Fee Schedule,,550.28,,,550.28,Fee Schedule,,205.5,,,205.5,Fee Schedule,,205.5,,,205.5,Fee Schedule,,205.5,,,205.5,Fee Schedule,,205.5,,,205.5,Fee Schedule,,83.83,,,83.83,Other,100% of Medicaid,83.83,,,83.83,Other,100% of Medicaid,83.83,,,83.83,Other,100% of Medicaid,83.83,,,83.83,Other,100% of Medicaid,188.62,,,188.62,Other,225% of Medicaid,128.26,,,128.26,Other,153% of Medicaid,188.62,,,188.62,Other,225% of Medicaid,117.36,,,117.36,Other,140% of Medicaid,188.62,,,188.62,Other,225% of Medicaid,217.96,,,217.96,Other,250% of Medicaid,271.61,,,271.61,Other,324% of Medicaid,180.23,,,180.23,Other,215% of Medicaid,180.23,,,180.23,Other,215% of Medicaid,104.79,,,104.79,Other,125% of Medicaid,0.01,649.25,
MOPATH PROCEDURE LEVEL 3,81402,CPT,,78081402,CDM,300,RC,,,both,,,417,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,452.49,,,452.49,Fee Schedule,,407.39,,,407.39,Fee Schedule,,51.6,,,51.6,Fee Schedule,,51.6,,,51.6,Fee Schedule,,51.6,,,51.6,Fee Schedule,,291.9,70,,291.9,percent of total billed charges,All Other,473.54,,,473.54,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,557.72,,,557.72,Fee Schedule,,258.54,,,258.54,Fee Schedule,,315.69,,,,Fee Schedule,,557.72,,,557.72,Fee Schedule,,258.54,,,258.54,Fee Schedule,,593.8,,,593.8,Fee Schedule,,291.9,70,,291.9,percent of total billed charges,,712.42,,,712.42,Fee Schedule,,603.82,,,603.82,Fee Schedule,,225.5,,,225.5,Fee Schedule,,225.5,,,225.5,Fee Schedule,,225.5,,,225.5,Fee Schedule,,225.5,,,225.5,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,712.42,
AUTOIMMUNE RHEMATOID ARTHR,81490,CPT,,78081490,CDM,300,RC,,,both,,,2118,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,2530.36,,,2530.36,Fee Schedule,,2278.16,,,2278.16,Fee Schedule,,420.33,,,420.33,Fee Schedule,,420.33,,,420.33,Fee Schedule,,420.33,,,420.33,Fee Schedule,,1482.6,70,,1482.6,percent of total billed charges,All Other,2648.05,,,2648.05,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,3118.81,,,3118.81,Fee Schedule,,1313.16,,,1313.16,Fee Schedule,,1765.37,,,,Fee Schedule,,3118.81,,,3118.81,Fee Schedule,,1313.16,,,1313.16,Fee Schedule,,3320.57,,,3320.57,Fee Schedule,,1482.6,70,,1482.6,percent of total billed charges,,3983.87,,,3983.87,Fee Schedule,,3376.57,,,3376.57,Fee Schedule,,1260.98,,,1260.98,Fee Schedule,,1260.98,,,1260.98,Fee Schedule,,1260.98,,,1260.98,Fee Schedule,,1260.98,,,1260.98,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3983.87,
ALPHA-1-ANTITRYPSIN TOTAL,82103,CPT,,78082103,CDM,300,RC,,,both,,,224,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,40.45,,,40.45,Fee Schedule,,36.42,,,36.42,Fee Schedule,,103.63,,,103.63,Fee Schedule,,93.23,,,93.23,Fee Schedule,,88.12,,,88.12,Fee Schedule,,156.8,70,,156.8,percent of total billed charges,All Other,42.34,,,42.34,Fee Schedule,,23,,,23,Other,186% of Medicaid,49.86,,,49.86,Fee Schedule,,138.88,,,138.88,Fee Schedule,,28.22,,,,Fee Schedule,,49.86,,,49.86,Fee Schedule,,138.88,,,138.88,Fee Schedule,,53.09,,,53.09,Fee Schedule,,156.8,70,,156.8,percent of total billed charges,,63.69,,,63.69,Fee Schedule,,53.98,,,53.98,Fee Schedule,,20.16,,,20.16,Fee Schedule,,20.16,,,20.16,Fee Schedule,,20.16,,,20.16,Fee Schedule,,20.16,,,20.16,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,156.8,
ASSAY TEST FOR BLOOD FECAL,82274,CPT,,78082274,CDM,300,RC,,,both,,,103,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.92,,,47.92,Fee Schedule,,43.14,,,43.14,Fee Schedule,,122.64,,,122.64,Fee Schedule,,110.33,,,110.33,Fee Schedule,,104.29,,,104.29,Fee Schedule,,72.1,70,,72.1,percent of total billed charges,All Other,50.15,,,50.15,Fee Schedule,,6,,,6,Other,186% of Medicaid,59.06,,,59.06,Fee Schedule,,63.86,,,63.86,Fee Schedule,,33.43,,,,Fee Schedule,,59.06,,,59.06,Fee Schedule,,63.86,,,63.86,Fee Schedule,,62.88,,,62.88,Fee Schedule,,72.1,70,,72.1,percent of total billed charges,,75.45,,,75.45,Fee Schedule,,63.94,,,63.94,Fee Schedule,,23.88,,,23.88,Fee Schedule,,23.88,,,23.88,Fee Schedule,,23.88,,,23.88,Fee Schedule,,23.88,,,23.88,Fee Schedule,,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,5.25,,,5.25,Other,153% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,4.81,,,4.81,Other,140% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,8.93,,,8.93,Other,250% of Medicaid,11.13,,,11.13,Other,324% of Medicaid,7.38,,,7.38,Other,215% of Medicaid,7.38,,,7.38,Other,215% of Medicaid,4.29,,,4.29,Other,125% of Medicaid,0.01,122.64,
ASSAY CARBOXYHB QUANT,82375,CPT,,78082375,CDM,300,RC,,,both,,,160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,37.08,,,37.08,Fee Schedule,,33.39,,,33.39,Fee Schedule,,95.08,,,95.08,Fee Schedule,,85.54,,,85.54,Fee Schedule,,80.85,,,80.85,Fee Schedule,,112,70,,112,percent of total billed charges,All Other,38.81,,,38.81,Fee Schedule,,21,,,21,Other,186% of Medicaid,45.71,,,45.71,Fee Schedule,,99.2,,,99.2,Fee Schedule,,25.87,,,,Fee Schedule,,45.71,,,45.71,Fee Schedule,,99.2,,,99.2,Fee Schedule,,48.66,,,48.66,Fee Schedule,,112,70,,112,percent of total billed charges,,58.38,,,58.38,Fee Schedule,,49.48,,,49.48,Fee Schedule,,18.48,,,18.48,Fee Schedule,,18.48,,,18.48,Fee Schedule,,18.48,,,18.48,Fee Schedule,,18.48,,,18.48,Fee Schedule,,11.11,,,11.11,Other,100% of Medicaid,11.11,,,11.11,Other,100% of Medicaid,11.11,,,11.11,Other,100% of Medicaid,11.11,,,11.11,Other,100% of Medicaid,25,,,25,Other,225% of Medicaid,17,,,17,Other,153% of Medicaid,25,,,25,Other,225% of Medicaid,15.55,,,15.55,Other,140% of Medicaid,25,,,25,Other,225% of Medicaid,28.89,,,28.89,Other,250% of Medicaid,36,,,36,Other,324% of Medicaid,23.89,,,23.89,Other,215% of Medicaid,23.89,,,23.89,Other,215% of Medicaid,13.89,,,13.89,Other,125% of Medicaid,0.01,112,
ASSAY OF CARNITINE,82379,CPT,,78082379,CDM,300,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.78,,,50.78,Fee Schedule,,45.72,,,45.72,Fee Schedule,,111.13,,,111.13,Fee Schedule,,99.98,,,99.98,Fee Schedule,,94.5,,,94.5,Fee Schedule,,73.5,70,,73.5,percent of total billed charges,All Other,53.14,,,53.14,Fee Schedule,,20,,,20,Other,186% of Medicaid,62.59,,,62.59,Fee Schedule,,65.1,,,65.1,Fee Schedule,,35.43,,,,Fee Schedule,,62.59,,,62.59,Fee Schedule,,65.1,,,65.1,Fee Schedule,,66.64,,,66.64,Fee Schedule,,73.5,70,,73.5,percent of total billed charges,,79.95,,,79.95,Fee Schedule,,67.76,,,67.76,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,111.13,
ENZYME CELL ACTIVITY,82657,CPT,,78082657,CDM,300,RC,,,both,,,108,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,66.73,,,66.73,Fee Schedule,,60.08,,,60.08,Fee Schedule,,139.25,,,139.25,Fee Schedule,,125.27,,,125.27,Fee Schedule,,118.41,,,118.41,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,All Other,69.84,,,69.84,Fee Schedule,,33,,,33,Other,186% of Medicaid,82.25,,,82.25,Fee Schedule,,66.96,,,66.96,Fee Schedule,,46.56,,,,Fee Schedule,,82.25,,,82.25,Fee Schedule,,66.96,,,66.96,Fee Schedule,,87.57,,,87.57,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,,105.06,,,105.06,Fee Schedule,,89.05,,,89.05,Fee Schedule,,33.26,,,33.26,Fee Schedule,,33.26,,,33.26,Fee Schedule,,33.26,,,33.26,Fee Schedule,,33.26,,,33.26,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,139.25,
ELECTROPHORETIC TEST,82664,CPT,,78082664,CDM,300,RC,,,both,,,412,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,185.12,,,185.12,Fee Schedule,,166.67,,,166.67,Fee Schedule,,228.9,,,228.9,Fee Schedule,,205.93,,,205.93,Fee Schedule,,194.65,,,194.65,Fee Schedule,,288.4,70,,288.4,percent of total billed charges,All Other,193.73,,,193.73,Fee Schedule,,73,,,73,Other,186% of Medicaid,228.17,,,228.17,Fee Schedule,,255.44,,,255.44,Fee Schedule,,129.15,,,,Fee Schedule,,228.17,,,228.17,Fee Schedule,,255.44,,,255.44,Fee Schedule,,242.93,,,242.93,Fee Schedule,,288.4,70,,288.4,percent of total billed charges,,291.45,,,291.45,Fee Schedule,,247.02,,,247.02,Fee Schedule,,92.25,,,92.25,Fee Schedule,,92.25,,,92.25,Fee Schedule,,92.25,,,92.25,Fee Schedule,,92.25,,,92.25,Fee Schedule,,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,59.9,,,59.9,Other,153% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,54.81,,,54.81,Other,140% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,101.8,,,101.8,Other,250% of Medicaid,126.86,,,126.86,Other,324% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,48.94,,,48.94,Other,125% of Medicaid,0.01,291.45,
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,,78082784,CDM,300,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,27.99,,,27.99,Fee Schedule,,25.2,,,25.2,Fee Schedule,,71.73,,,71.73,Fee Schedule,,64.53,,,64.53,Fee Schedule,,61,,,61,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,29.3,,,29.3,Fee Schedule,,17,,,17,Other,186% of Medicaid,34.5,,,34.5,Fee Schedule,,73.78,,,73.78,Fee Schedule,,19.53,,,,Fee Schedule,,34.5,,,34.5,Fee Schedule,,73.78,,,73.78,Fee Schedule,,36.74,,,36.74,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,,44.07,,,44.07,Fee Schedule,,37.35,,,37.35,Fee Schedule,,13.95,,,13.95,Fee Schedule,,13.95,,,13.95,Fee Schedule,,13.95,,,13.95,Fee Schedule,,13.95,,,13.95,Fee Schedule,,9.3,,,9.3,Other,100% of Medicaid,9.3,,,9.3,Other,100% of Medicaid,9.3,,,9.3,Other,100% of Medicaid,9.3,,,9.3,Other,100% of Medicaid,20.93,,,20.93,Other,225% of Medicaid,14.23,,,14.23,Other,153% of Medicaid,20.93,,,20.93,Other,225% of Medicaid,13.02,,,13.02,Other,140% of Medicaid,20.93,,,20.93,Other,225% of Medicaid,24.18,,,24.18,Other,250% of Medicaid,30.13,,,30.13,Other,324% of Medicaid,20,,,20,Other,215% of Medicaid,20,,,20,Other,215% of Medicaid,11.63,,,11.63,Other,125% of Medicaid,0.01,83.3,
IGG 1 2 3 OR 4 EACH,82787,CPT,,78082787,CDM,300,RC,,,both,,,192,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.14,,,24.14,Fee Schedule,,21.73,,,21.73,Fee Schedule,,32.28,,,32.28,Fee Schedule,,29.04,,,29.04,Fee Schedule,,27.45,,,27.45,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,All Other,25.26,,,25.26,Fee Schedule,,11,,,11,Other,186% of Medicaid,29.75,,,29.75,Fee Schedule,,119.04,,,119.04,Fee Schedule,,16.84,,,,Fee Schedule,,29.75,,,29.75,Fee Schedule,,119.04,,,119.04,Fee Schedule,,31.68,,,31.68,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,,38.01,,,38.01,Fee Schedule,,32.21,,,32.21,Fee Schedule,,12.03,,,12.03,Fee Schedule,,12.03,,,12.03,Fee Schedule,,12.03,,,12.03,Fee Schedule,,12.03,,,12.03,Fee Schedule,,5.96,,,5.96,Other,100% of Medicaid,5.96,,,5.96,Other,100% of Medicaid,5.96,,,5.96,Other,100% of Medicaid,5.96,,,5.96,Other,100% of Medicaid,13.41,,,13.41,Other,225% of Medicaid,9.12,,,9.12,Other,153% of Medicaid,13.41,,,13.41,Other,225% of Medicaid,8.34,,,8.34,Other,140% of Medicaid,13.41,,,13.41,Other,225% of Medicaid,15.49,,,15.49,Other,250% of Medicaid,19.31,,,19.31,Other,324% of Medicaid,12.81,,,12.81,Other,215% of Medicaid,12.81,,,12.81,Other,215% of Medicaid,7.45,,,7.45,Other,125% of Medicaid,0.01,134.4,
BLOOD GASES O2 SAT ONLY,82810,CPT,,49082810,CDM,300,RC,,,both,,,51,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,29.41,,,29.41,Fee Schedule,,26.48,,,26.48,Fee Schedule,,67.29,,,67.29,Fee Schedule,,60.54,,,60.54,Fee Schedule,,57.22,,,57.22,Fee Schedule,,35.7,70,,35.7,percent of total billed charges,All Other,30.78,,,30.78,Fee Schedule,,18,,,18,Other,186% of Medicaid,36.25,,,36.25,Fee Schedule,,31.62,,,31.62,Fee Schedule,,20.52,,,,Fee Schedule,,36.25,,,36.25,Fee Schedule,,31.62,,,31.62,Fee Schedule,,38.59,,,38.59,Fee Schedule,,35.7,70,,35.7,percent of total billed charges,,46.3,,,46.3,Fee Schedule,,39.24,,,39.24,Fee Schedule,,14.66,,,14.66,Fee Schedule,,14.66,,,14.66,Fee Schedule,,14.66,,,14.66,Fee Schedule,,14.66,,,14.66,Fee Schedule,,9.77,,,9.77,Other,100% of Medicaid,9.77,,,9.77,Other,100% of Medicaid,9.77,,,9.77,Other,100% of Medicaid,9.77,,,9.77,Other,100% of Medicaid,21.98,,,21.98,Other,225% of Medicaid,14.95,,,14.95,Other,153% of Medicaid,21.98,,,21.98,Other,225% of Medicaid,13.68,,,13.68,Other,140% of Medicaid,21.98,,,21.98,Other,225% of Medicaid,25.4,,,25.4,Other,250% of Medicaid,31.65,,,31.65,Other,324% of Medicaid,21.01,,,21.01,Other,215% of Medicaid,21.01,,,21.01,Other,215% of Medicaid,12.21,,,12.21,Other,125% of Medicaid,0.01,67.29,
REAGENT STRIP/BLOOD GLUCOSE,82948,CPT,,30082948,CDM,300,RC,,,both,,,29,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15.17,,,15.17,Fee Schedule,,13.66,,,13.66,Fee Schedule,,24.39,,,24.39,Fee Schedule,,21.94,,,21.94,Fee Schedule,,20.74,,,20.74,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,All Other,15.88,,,15.88,Fee Schedule,,4,,,4,Other,186% of Medicaid,18.7,,,18.7,Fee Schedule,,17.98,,,17.98,Fee Schedule,,10.58,,,,Fee Schedule,,18.7,,,18.7,Fee Schedule,,17.98,,,17.98,Fee Schedule,,19.91,,,19.91,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,,23.88,,,23.88,Fee Schedule,,20.24,,,20.24,Fee Schedule,,7.56,,,7.56,Fee Schedule,,7.56,,,7.56,Fee Schedule,,7.56,,,7.56,Fee Schedule,,7.56,,,7.56,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,24.39,
REAGENT STRIP/BLOOD GLUCOSE,82948,CPT,,78082948,CDM,300,RC,,,both,,,29,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15.17,,,15.17,Fee Schedule,,13.66,,,13.66,Fee Schedule,,24.39,,,24.39,Fee Schedule,,21.94,,,21.94,Fee Schedule,,20.74,,,20.74,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,All Other,15.88,,,15.88,Fee Schedule,,4,,,4,Other,186% of Medicaid,18.7,,,18.7,Fee Schedule,,17.98,,,17.98,Fee Schedule,,10.58,,,,Fee Schedule,,18.7,,,18.7,Fee Schedule,,17.98,,,17.98,Fee Schedule,,19.91,,,19.91,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,,23.88,,,23.88,Fee Schedule,,20.24,,,20.24,Fee Schedule,,7.56,,,7.56,Fee Schedule,,7.56,,,7.56,Fee Schedule,,7.56,,,7.56,Fee Schedule,,7.56,,,7.56,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,24.39,
REAGENT STRIP/BLOOD GLUCOSE,82948,CPT,,82082948,CDM,300,RC,,,both,,,29,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15.17,,,15.17,Fee Schedule,,13.66,,,13.66,Fee Schedule,,24.39,,,24.39,Fee Schedule,,21.94,,,21.94,Fee Schedule,,20.74,,,20.74,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,All Other,15.88,,,15.88,Fee Schedule,,4,,,4,Other,186% of Medicaid,18.7,,,18.7,Fee Schedule,,17.98,,,17.98,Fee Schedule,,10.58,,,,Fee Schedule,,18.7,,,18.7,Fee Schedule,,17.98,,,17.98,Fee Schedule,,19.91,,,19.91,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,,23.88,,,23.88,Fee Schedule,,20.24,,,20.24,Fee Schedule,,7.56,,,7.56,Fee Schedule,,7.56,,,7.56,Fee Schedule,,7.56,,,7.56,Fee Schedule,,7.56,,,7.56,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,24.39,
GLUCOSE; BLD BY MONITOR DEVICE,82962,CPT,,34082962,CDM,300,RC,,,both,,,31,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,9.87,,,9.87,Fee Schedule,,8.89,,,8.89,Fee Schedule,,16.77,,,16.77,Fee Schedule,,15.09,,,15.09,Fee Schedule,,14.26,,,14.26,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,All Other,10.33,,,10.33,Fee Schedule,,26,,,26,Other,186% of Medicaid,12.17,,,12.17,Fee Schedule,,19.22,,,19.22,Fee Schedule,,6.89,,,,Fee Schedule,,12.17,,,12.17,Fee Schedule,,19.22,,,19.22,Fee Schedule,,12.96,,,12.96,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,,15.54,,,15.54,Fee Schedule,,13.17,,,13.17,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
GLUCOSE; BLD BY MONITOR DEVICE,82962,CPT,,73082962,CDM,300,RC,,,both,,,31,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,9.87,,,9.87,Fee Schedule,,8.89,,,8.89,Fee Schedule,,16.77,,,16.77,Fee Schedule,,15.09,,,15.09,Fee Schedule,,14.26,,,14.26,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,All Other,10.33,,,10.33,Fee Schedule,,26,,,26,Other,186% of Medicaid,12.17,,,12.17,Fee Schedule,,19.22,,,19.22,Fee Schedule,,6.89,,,,Fee Schedule,,12.17,,,12.17,Fee Schedule,,19.22,,,19.22,Fee Schedule,,12.96,,,12.96,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,,15.54,,,15.54,Fee Schedule,,13.17,,,13.17,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
GLUCOSE; BLD BY MONITOR DEVICE,82962,CPT,,74082962,CDM,300,RC,,,both,,,31,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,9.87,,,9.87,Fee Schedule,,8.89,,,8.89,Fee Schedule,,16.77,,,16.77,Fee Schedule,,15.09,,,15.09,Fee Schedule,,14.26,,,14.26,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,All Other,10.33,,,10.33,Fee Schedule,,26,,,26,Other,186% of Medicaid,12.17,,,12.17,Fee Schedule,,19.22,,,19.22,Fee Schedule,,6.89,,,,Fee Schedule,,12.17,,,12.17,Fee Schedule,,19.22,,,19.22,Fee Schedule,,12.96,,,12.96,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,,15.54,,,15.54,Fee Schedule,,13.17,,,13.17,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
ASSAY TOTAL HYDROXYPROLINE,83505,CPT,,78083505,CDM,300,RC,,,both,,,382,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.14,,,73.14,Fee Schedule,,65.85,,,65.85,Fee Schedule,,187.47,,,187.47,Fee Schedule,,168.66,,,168.66,Fee Schedule,,159.42,,,159.42,Fee Schedule,,267.4,70,,267.4,percent of total billed charges,All Other,76.55,,,76.55,Fee Schedule,,45,,,45,Other,186% of Medicaid,90.15,,,90.15,Fee Schedule,,236.84,,,236.84,Fee Schedule,,51.03,,,,Fee Schedule,,90.15,,,90.15,Fee Schedule,,236.84,,,236.84,Fee Schedule,,95.99,,,95.99,Fee Schedule,,267.4,70,,267.4,percent of total billed charges,,115.16,,,115.16,Fee Schedule,,97.6,,,97.6,Fee Schedule,,36.45,,,36.45,Fee Schedule,,36.45,,,36.45,Fee Schedule,,36.45,,,36.45,Fee Schedule,,36.45,,,36.45,Fee Schedule,,24.3,,,24.3,Other,100% of Medicaid,24.3,,,24.3,Other,100% of Medicaid,24.3,,,24.3,Other,100% of Medicaid,24.3,,,24.3,Other,100% of Medicaid,54.68,,,54.68,Other,225% of Medicaid,37.18,,,37.18,Other,153% of Medicaid,54.68,,,54.68,Other,225% of Medicaid,34.02,,,34.02,Other,140% of Medicaid,54.68,,,54.68,Other,225% of Medicaid,63.18,,,63.18,Other,250% of Medicaid,78.73,,,78.73,Other,324% of Medicaid,52.25,,,52.25,Other,215% of Medicaid,52.25,,,52.25,Other,215% of Medicaid,30.38,,,30.38,Other,125% of Medicaid,0.01,267.4,
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,,78083520,CDM,300,RC,,,both,,,348,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,51.98,,,51.98,Fee Schedule,,46.8,,,46.8,Fee Schedule,,99.85,,,99.85,Fee Schedule,,89.82,,,89.82,Fee Schedule,,84.91,,,84.91,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,All Other,54.4,,,54.4,Fee Schedule,,33,,,33,Other,186% of Medicaid,64.07,,,64.07,Fee Schedule,,215.76,,,215.76,Fee Schedule,,36.27,,,,Fee Schedule,,64.07,,,64.07,Fee Schedule,,215.76,,,215.76,Fee Schedule,,68.22,,,68.22,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,,81.84,,,81.84,Fee Schedule,,69.37,,,69.37,Fee Schedule,,25.91,,,25.91,Fee Schedule,,25.91,,,25.91,Fee Schedule,,25.91,,,25.91,Fee Schedule,,25.91,,,25.91,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,243.6,
ASSAY OF LACTIC ACID,83605,CPT,,78083605,CDM,300,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.83,,,34.83,Fee Schedule,,31.35,,,31.35,Fee Schedule,,66.64,,,66.64,Fee Schedule,,59.95,,,59.95,Fee Schedule,,56.67,,,56.67,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,36.45,,,36.45,Fee Schedule,,17,,,17,Other,186% of Medicaid,42.92,,,42.92,Fee Schedule,,119.66,,,119.66,Fee Schedule,,24.3,,,,Fee Schedule,,42.92,,,42.92,Fee Schedule,,119.66,,,119.66,Fee Schedule,,45.7,,,45.7,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,,54.83,,,54.83,Fee Schedule,,46.47,,,46.47,Fee Schedule,,17.36,,,17.36,Fee Schedule,,17.36,,,17.36,Fee Schedule,,17.36,,,17.36,Fee Schedule,,17.36,,,17.36,Fee Schedule,,9.39,,,9.39,Other,100% of Medicaid,9.39,,,9.39,Other,100% of Medicaid,9.39,,,9.39,Other,100% of Medicaid,9.39,,,9.39,Other,100% of Medicaid,21.13,,,21.13,Other,225% of Medicaid,14.37,,,14.37,Other,153% of Medicaid,21.13,,,21.13,Other,225% of Medicaid,13.15,,,13.15,Other,140% of Medicaid,21.13,,,21.13,Other,225% of Medicaid,24.42,,,24.42,Other,250% of Medicaid,30.43,,,30.43,Other,324% of Medicaid,20.19,,,20.19,Other,215% of Medicaid,20.19,,,20.19,Other,215% of Medicaid,11.74,,,11.74,Other,125% of Medicaid,0.01,135.1,
ASSAY LIPOPROTEIN PLA2,83698,CPT,,78083698,CDM,300,RC,,,both,,,202,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,139.39,,,139.39,Fee Schedule,,125.5,,,125.5,Fee Schedule,,261.78,,,261.78,Fee Schedule,,235.51,,,235.51,Fee Schedule,,222.61,,,222.61,Fee Schedule,,141.4,70,,141.4,percent of total billed charges,All Other,145.88,,,145.88,Fee Schedule,,73,,,73,Other,186% of Medicaid,171.81,,,171.81,Fee Schedule,,125.24,,,125.24,Fee Schedule,,97.25,,,,Fee Schedule,,171.81,,,171.81,Fee Schedule,,125.24,,,125.24,Fee Schedule,,182.92,,,182.92,Fee Schedule,,141.4,70,,141.4,percent of total billed charges,,219.46,,,219.46,Fee Schedule,,186.01,,,186.01,Fee Schedule,,69.47,,,69.47,Fee Schedule,,69.47,,,69.47,Fee Schedule,,69.47,,,69.47,Fee Schedule,,69.47,,,69.47,Fee Schedule,,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,59.9,,,59.9,Other,153% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,54.81,,,54.81,Other,140% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,101.8,,,101.8,Other,250% of Medicaid,126.86,,,126.86,Other,324% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,48.94,,,48.94,Other,125% of Medicaid,0.01,261.78,
LIPOPROTEIN BLD HR FRACTION,83701,CPT,,78083701,CDM,300,RC,,,both,,,131,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,101.92,,,101.92,Fee Schedule,,91.76,,,91.76,Fee Schedule,,111.96,,,111.96,Fee Schedule,,100.72,,,100.72,Fee Schedule,,95.2,,,95.2,Fee Schedule,,91.7,70,,91.7,percent of total billed charges,All Other,106.66,,,106.66,Fee Schedule,,73,,,73,Other,186% of Medicaid,125.62,,,125.62,Fee Schedule,,81.22,,,81.22,Fee Schedule,,71.11,,,,Fee Schedule,,125.62,,,125.62,Fee Schedule,,81.22,,,81.22,Fee Schedule,,133.75,,,133.75,Fee Schedule,,91.7,70,,91.7,percent of total billed charges,,160.46,,,160.46,Fee Schedule,,136,,,136,Fee Schedule,,50.79,,,50.79,Fee Schedule,,50.79,,,50.79,Fee Schedule,,50.79,,,50.79,Fee Schedule,,50.79,,,50.79,Fee Schedule,,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,59.9,,,59.9,Other,153% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,54.81,,,54.81,Other,140% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,101.8,,,101.8,Other,250% of Medicaid,126.86,,,126.86,Other,324% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,48.94,,,48.94,Other,125% of Medicaid,0.01,160.46,
ASSAY OF PARATHORMONE,83970,CPT,,78083970,CDM,300,RC,,,both,,,566,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,124.25,,,124.25,Fee Schedule,,111.87,,,111.87,Fee Schedule,,318.28,,,318.28,Fee Schedule,,286.33,,,286.33,Fee Schedule,,270.65,,,270.65,Fee Schedule,,396.2,70,,396.2,percent of total billed charges,All Other,130.03,,,130.03,Fee Schedule,,77,,,77,Other,186% of Medicaid,153.15,,,153.15,Fee Schedule,,350.92,,,350.92,Fee Schedule,,86.69,,,,Fee Schedule,,153.15,,,153.15,Fee Schedule,,350.92,,,350.92,Fee Schedule,,163.06,,,163.06,Fee Schedule,,396.2,70,,396.2,percent of total billed charges,,195.63,,,195.63,Fee Schedule,,165.81,,,165.81,Fee Schedule,,61.92,,,61.92,Fee Schedule,,61.92,,,61.92,Fee Schedule,,61.92,,,61.92,Fee Schedule,,61.92,,,61.92,Fee Schedule,,41.28,,,41.28,Other,100% of Medicaid,41.28,,,41.28,Other,100% of Medicaid,41.28,,,41.28,Other,100% of Medicaid,41.28,,,41.28,Other,100% of Medicaid,92.88,,,92.88,Other,225% of Medicaid,63.16,,,63.16,Other,153% of Medicaid,92.88,,,92.88,Other,225% of Medicaid,57.79,,,57.79,Other,140% of Medicaid,92.88,,,92.88,Other,225% of Medicaid,107.33,,,107.33,Other,250% of Medicaid,133.75,,,133.75,Other,324% of Medicaid,88.75,,,88.75,Other,215% of Medicaid,88.75,,,88.75,Other,215% of Medicaid,51.6,,,51.6,Other,125% of Medicaid,0.01,396.2,
ASSAY OF PSA COMPLEXED,84152,CPT,,78084152,CDM,300,RC,,,both,,,135,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.35,,,55.35,Fee Schedule,,49.84,,,49.84,Fee Schedule,,141.88,,,141.88,Fee Schedule,,127.64,,,127.64,Fee Schedule,,120.65,,,120.65,Fee Schedule,,94.5,70,,94.5,percent of total billed charges,All Other,57.93,,,57.93,Fee Schedule,,34,,,34,Other,186% of Medicaid,68.23,,,68.23,Fee Schedule,,83.7,,,83.7,Fee Schedule,,38.62,,,,Fee Schedule,,68.23,,,68.23,Fee Schedule,,83.7,,,83.7,Fee Schedule,,72.64,,,72.64,Fee Schedule,,94.5,70,,94.5,percent of total billed charges,,87.15,,,87.15,Fee Schedule,,73.87,,,73.87,Fee Schedule,,27.59,,,27.59,Fee Schedule,,27.59,,,27.59,Fee Schedule,,27.59,,,27.59,Fee Schedule,,27.59,,,27.59,Fee Schedule,,18.39,,,18.39,Other,100% of Medicaid,18.39,,,18.39,Other,100% of Medicaid,18.39,,,18.39,Other,100% of Medicaid,18.39,,,18.39,Other,100% of Medicaid,41.38,,,41.38,Other,225% of Medicaid,28.14,,,28.14,Other,153% of Medicaid,41.38,,,41.38,Other,225% of Medicaid,25.75,,,25.75,Other,140% of Medicaid,41.38,,,41.38,Other,225% of Medicaid,47.81,,,47.81,Other,250% of Medicaid,59.58,,,59.58,Other,324% of Medicaid,39.54,,,39.54,Other,215% of Medicaid,39.54,,,39.54,Other,215% of Medicaid,22.99,,,22.99,Other,125% of Medicaid,0.01,141.88,
ASSAY OF PROTEIN OTHER,84157,CPT,,78084157,CDM,300,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.04,,,12.04,Fee Schedule,,10.84,,,10.84,Fee Schedule,,28.28,,,28.28,Fee Schedule,,25.44,,,25.44,Fee Schedule,,24.05,,,24.05,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,All Other,12.6,,,12.6,Fee Schedule,,7,,,7,Other,186% of Medicaid,14.84,,,14.84,Fee Schedule,,40.3,,,40.3,Fee Schedule,,8.4,,,,Fee Schedule,,14.84,,,14.84,Fee Schedule,,40.3,,,40.3,Fee Schedule,,15.8,,,15.8,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,,18.96,,,18.96,Fee Schedule,,16.07,,,16.07,Fee Schedule,,6,,,6,Fee Schedule,,6,,,6,Fee Schedule,,6,,,6,Fee Schedule,,6,,,6,Fee Schedule,,4,,,4,Other,100% of Medicaid,4,,,4,Other,100% of Medicaid,4,,,4,Other,100% of Medicaid,4,,,4,Other,100% of Medicaid,9,,,9,Other,225% of Medicaid,6.12,,,6.12,Other,153% of Medicaid,9,,,9,Other,225% of Medicaid,5.6,,,5.6,Other,140% of Medicaid,9,,,9,Other,225% of Medicaid,10.4,,,10.4,Other,250% of Medicaid,12.96,,,12.96,Other,324% of Medicaid,8.6,,,8.6,Other,215% of Medicaid,8.6,,,8.6,Other,215% of Medicaid,5,,,5,Other,125% of Medicaid,0.01,45.5,
ASSAY OF PROINSULIN,84206,CPT,,78084206,CDM,300,RC,,,both,,,115,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,80.34,,,80.34,Fee Schedule,,72.33,,,72.33,Fee Schedule,,137.38,,,137.38,Fee Schedule,,123.6,,,123.6,Fee Schedule,,116.83,,,116.83,Fee Schedule,,80.5,70,,80.5,percent of total billed charges,All Other,84.07,,,84.07,Fee Schedule,,58,,,58,Other,186% of Medicaid,99.02,,,99.02,Fee Schedule,,71.3,,,71.3,Fee Schedule,,56.05,,,,Fee Schedule,,99.02,,,99.02,Fee Schedule,,71.3,,,71.3,Fee Schedule,,105.43,,,105.43,Fee Schedule,,80.5,70,,80.5,percent of total billed charges,,126.48,,,126.48,Fee Schedule,,107.2,,,107.2,Fee Schedule,,40.04,,,40.04,Fee Schedule,,40.04,,,40.04,Fee Schedule,,40.04,,,40.04,Fee Schedule,,40.04,,,40.04,Fee Schedule,,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,47.87,,,47.87,Other,153% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,43.8,,,43.8,Other,140% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,81.35,,,81.35,Other,250% of Medicaid,101.38,,,101.38,Other,324% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,39.11,,,39.11,Other,125% of Medicaid,0.01,137.38,
ASSAY OF SEX HORMONE GLOBUL,84270,CPT,,78084270,CDM,300,RC,,,both,,,139,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,65.41,,,65.41,Fee Schedule,,58.89,,,58.89,Fee Schedule,,167.58,,,167.58,Fee Schedule,,150.76,,,150.76,Fee Schedule,,142.5,,,142.5,Fee Schedule,,97.3,70,,97.3,percent of total billed charges,All Other,68.45,,,68.45,Fee Schedule,,33,,,33,Other,186% of Medicaid,80.62,,,80.62,Fee Schedule,,86.18,,,86.18,Fee Schedule,,45.63,,,,Fee Schedule,,80.62,,,80.62,Fee Schedule,,86.18,,,86.18,Fee Schedule,,85.83,,,85.83,Fee Schedule,,97.3,70,,97.3,percent of total billed charges,,102.98,,,102.98,Fee Schedule,,87.28,,,87.28,Fee Schedule,,32.6,,,32.6,Fee Schedule,,32.6,,,32.6,Fee Schedule,,32.6,,,32.6,Fee Schedule,,32.6,,,32.6,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,167.58,
CLINICAL CHEMISTRY TEST,84999,CPT,,78084999,CDM,300,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.25,65,,68.25,percent of total billed charges,All Other,61.95,59,,61.95,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,73.5,70,,73.5,percent of total billed charges,All Other,71.4,68,,71.4,percent of total billed charges,All Other,33,,,33,Other,186% of Medicaid,87.15,80,,87.15,percent of total billed charges,All Other,65.1,83,,65.1,percent of total billed charges,All Other,57.75,83,,,percent of total billed charges,All Other,87.15,80,,87.15,percent of total billed charges,All Other,65.1,83,,65.1,percent of total billed charges,All Other,84,80,,84,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,,68.25,65,,68.25,percent of total billed charges,All Other,68.25,65,,68.25,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,87.15,
SPUN MICROHEMATOCRIT,85013,CPT,,78085013,CDM,300,RC,,,both,,,30,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.07,,,21.07,Fee Schedule,,18.97,,,18.97,Fee Schedule,,18.25,,,18.25,Fee Schedule,,16.42,,,16.42,Fee Schedule,,15.52,,,15.52,Fee Schedule,,21,70,,21,percent of total billed charges,All Other,22.05,,,22.05,Fee Schedule,,4,,,4,Other,186% of Medicaid,25.97,,,25.97,Fee Schedule,,18.6,,,18.6,Fee Schedule,,14.7,,,,Fee Schedule,,25.97,,,25.97,Fee Schedule,,18.6,,,18.6,Fee Schedule,,27.65,,,27.65,Fee Schedule,,21,70,,21,percent of total billed charges,,33.17,,,33.17,Fee Schedule,,28.12,,,28.12,Fee Schedule,,10.5,,,10.5,Fee Schedule,,10.5,,,10.5,Fee Schedule,,10.5,,,10.5,Fee Schedule,,10.5,,,10.5,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,33.17,
HEMATOCRIT,85014,CPT,,78085014,CDM,300,RC,,,both,,,40,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,7.13,,,7.13,Fee Schedule,,6.42,,,6.42,Fee Schedule,,18.25,,,18.25,Fee Schedule,,16.42,,,16.42,Fee Schedule,,15.52,,,15.52,Fee Schedule,,28,70,,28,percent of total billed charges,All Other,7.47,,,7.47,Fee Schedule,,4,,,4,Other,186% of Medicaid,8.79,,,8.79,Fee Schedule,,24.8,,,24.8,Fee Schedule,,4.98,,,,Fee Schedule,,8.79,,,8.79,Fee Schedule,,24.8,,,24.8,Fee Schedule,,9.36,,,9.36,Fee Schedule,,28,70,,28,percent of total billed charges,,11.23,,,11.23,Fee Schedule,,9.52,,,9.52,Fee Schedule,,3.56,,,3.56,Fee Schedule,,3.56,,,3.56,Fee Schedule,,3.56,,,3.56,Fee Schedule,,3.56,,,3.56,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,28,
HEMATOCRIT,85014,CPT,QW,78185014,CDM,300,RC,,,both,,,40,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,7.13,,,7.13,Fee Schedule,,6.42,,,6.42,Fee Schedule,,18.25,,,18.25,Fee Schedule,,16.42,,,16.42,Fee Schedule,,15.52,,,15.52,Fee Schedule,,28,70,,28,percent of total billed charges,All Other,7.47,,,7.47,Fee Schedule,,4,,,4,Other,186% of Medicaid,8.79,,,8.79,Fee Schedule,,24.8,,,24.8,Fee Schedule,,4.98,,,,Fee Schedule,,8.79,,,8.79,Fee Schedule,,24.8,,,24.8,Fee Schedule,,9.36,,,9.36,Fee Schedule,,28,70,,28,percent of total billed charges,,11.23,,,11.23,Fee Schedule,,9.52,,,9.52,Fee Schedule,,3.56,,,3.56,Fee Schedule,,3.56,,,3.56,Fee Schedule,,3.56,,,3.56,Fee Schedule,,3.56,,,3.56,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,28,
AUTOMATED PLATELET COUNT,85049,CPT,,78085049,CDM,300,RC,,,both,,,45,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,13.48,,,13.48,Fee Schedule,,12.14,,,12.14,Fee Schedule,,34.47,,,34.47,Fee Schedule,,31.01,,,31.01,Fee Schedule,,29.31,,,29.31,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,All Other,14.11,,,14.11,Fee Schedule,,6,,,6,Other,186% of Medicaid,16.62,,,16.62,Fee Schedule,,27.9,,,27.9,Fee Schedule,,9.41,,,,Fee Schedule,,16.62,,,16.62,Fee Schedule,,27.9,,,27.9,Fee Schedule,,17.7,,,17.7,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,,21.23,,,21.23,Fee Schedule,,17.99,,,17.99,Fee Schedule,,6.72,,,6.72,Fee Schedule,,6.72,,,6.72,Fee Schedule,,6.72,,,6.72,Fee Schedule,,6.72,,,6.72,Fee Schedule,,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,4.9,,,4.9,Other,153% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,4.48,,,4.48,Other,140% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,8.32,,,8.32,Other,250% of Medicaid,10.37,,,10.37,Other,324% of Medicaid,6.88,,,6.88,Other,215% of Medicaid,6.88,,,6.88,Other,215% of Medicaid,4,,,4,Other,125% of Medicaid,0.01,34.47,
BLOOD SMEAR INTERPRETATION,85060,CPT,,78085060,CDM,300,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,74.14,,,74.14,Fee Schedule,,66.75,,,66.75,Fee Schedule,,143.03,,,143.03,Fee Schedule,,128.67,,,128.67,Fee Schedule,,121.63,,,121.63,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,77.58,,,77.58,Fee Schedule,,38,,,38,Other,186% of Medicaid,91.38,,,91.38,Fee Schedule,,73.78,,,73.78,Fee Schedule,,51.72,,,,Fee Schedule,,91.38,,,91.38,Fee Schedule,,73.78,,,73.78,Fee Schedule,,97.29,,,97.29,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,37.89,,,37.89,Fee Schedule,,37.89,,,37.89,Fee Schedule,,37.89,,,37.89,Fee Schedule,,37.89,,,37.89,Fee Schedule,,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,31.25,,,31.25,Other,153% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,28.59,,,28.59,Other,140% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,53.1,,,53.1,Other,250% of Medicaid,66.17,,,66.17,Other,324% of Medicaid,43.91,,,43.91,Other,215% of Medicaid,43.91,,,43.91,Other,215% of Medicaid,25.53,,,25.53,Other,125% of Medicaid,0.01,143.03,
PHOSPHOLIPID PLTLT NEUTRALIZ,85597,CPT,,78085597,CDM,300,RC,,,both,,,88,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,54.12,,,54.12,Fee Schedule,,48.73,,,48.73,Fee Schedule,,104.12,,,104.12,Fee Schedule,,93.67,,,93.67,Fee Schedule,,88.54,,,88.54,Fee Schedule,,61.6,70,,61.6,percent of total billed charges,All Other,56.64,,,56.64,Fee Schedule,,37,,,37,Other,186% of Medicaid,66.71,,,66.71,Fee Schedule,,54.56,,,54.56,Fee Schedule,,37.76,,,,Fee Schedule,,66.71,,,66.71,Fee Schedule,,54.56,,,54.56,Fee Schedule,,71.02,,,71.02,Fee Schedule,,61.6,70,,61.6,percent of total billed charges,,85.21,,,85.21,Fee Schedule,,72.22,,,72.22,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,30.62,,,30.62,Other,153% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,28.02,,,28.02,Other,140% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,52.04,,,52.04,Other,250% of Medicaid,64.84,,,64.84,Other,324% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,25.02,,,25.02,Other,125% of Medicaid,0.01,104.12,
PROTHROMBIN TEST,85611,CPT,,78085611,CDM,300,RC,,,both,,,38,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,11.86,,,11.86,Fee Schedule,,10.68,,,10.68,Fee Schedule,,30.36,,,30.36,Fee Schedule,,27.31,,,27.31,Fee Schedule,,25.82,,,25.82,Fee Schedule,,26.6,70,,26.6,percent of total billed charges,All Other,12.41,,,12.41,Fee Schedule,,37,,,37,Other,186% of Medicaid,14.62,,,14.62,Fee Schedule,,23.56,,,23.56,Fee Schedule,,8.27,,,,Fee Schedule,,14.62,,,14.62,Fee Schedule,,23.56,,,23.56,Fee Schedule,,15.56,,,15.56,Fee Schedule,,26.6,70,,26.6,percent of total billed charges,,18.67,,,18.67,Fee Schedule,,15.83,,,15.83,Fee Schedule,,5.91,,,5.91,Fee Schedule,,5.91,,,5.91,Fee Schedule,,5.91,,,5.91,Fee Schedule,,5.91,,,5.91,Fee Schedule,,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,30.62,,,30.62,Other,153% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,28.02,,,28.02,Other,140% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,52.04,,,52.04,Other,250% of Medicaid,64.84,,,64.84,Other,324% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,25.02,,,25.02,Other,125% of Medicaid,0.01,64.84,
THROMBOPLASTIN TIME PARTIAL,85730,CPT,,78085730,CDM,300,RC,,,both,,,155,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,18.09,,,18.09,Fee Schedule,,16.29,,,16.29,Fee Schedule,,46.31,,,46.31,Fee Schedule,,41.66,,,41.66,Fee Schedule,,39.38,,,39.38,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,All Other,18.93,,,18.93,Fee Schedule,,11,,,11,Other,186% of Medicaid,22.3,,,22.3,Fee Schedule,,96.1,,,96.1,Fee Schedule,,12.62,,,,Fee Schedule,,22.3,,,22.3,Fee Schedule,,96.1,,,96.1,Fee Schedule,,23.74,,,23.74,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,,28.48,,,28.48,Fee Schedule,,24.14,,,24.14,Fee Schedule,,9.02,,,9.02,Fee Schedule,,9.02,,,9.02,Fee Schedule,,9.02,,,9.02,Fee Schedule,,9.02,,,9.02,Fee Schedule,,6.01,,,6.01,Other,100% of Medicaid,6.01,,,6.01,Other,100% of Medicaid,6.01,,,6.01,Other,100% of Medicaid,6.01,,,6.01,Other,100% of Medicaid,13.52,,,13.52,Other,225% of Medicaid,9.2,,,9.2,Other,153% of Medicaid,13.52,,,13.52,Other,225% of Medicaid,8.41,,,8.41,Other,140% of Medicaid,13.52,,,13.52,Other,225% of Medicaid,15.63,,,15.63,Other,250% of Medicaid,19.47,,,19.47,Other,324% of Medicaid,12.92,,,12.92,Other,215% of Medicaid,12.92,,,12.92,Other,215% of Medicaid,7.51,,,7.51,Other,125% of Medicaid,0.01,108.5,
THROMBOPLASTIN TIME PARTIAL,85732,CPT,,78085732,CDM,300,RC,,,both,,,155,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.47,,,19.47,Fee Schedule,,17.53,,,17.53,Fee Schedule,,49.92,,,49.92,Fee Schedule,,44.91,,,44.91,Fee Schedule,,42.45,,,42.45,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,All Other,20.38,,,20.38,Fee Schedule,,12,,,12,Other,186% of Medicaid,24,,,24,Fee Schedule,,96.1,,,96.1,Fee Schedule,,13.59,,,,Fee Schedule,,24,,,24,Fee Schedule,,96.1,,,96.1,Fee Schedule,,25.56,,,25.56,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,,30.66,,,30.66,Fee Schedule,,25.99,,,25.99,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,6.25,,,6.25,Other,100% of Medicaid,6.25,,,6.25,Other,100% of Medicaid,6.25,,,6.25,Other,100% of Medicaid,6.25,,,6.25,Other,100% of Medicaid,14.07,,,14.07,Other,225% of Medicaid,9.57,,,9.57,Other,153% of Medicaid,14.07,,,14.07,Other,225% of Medicaid,8.75,,,8.75,Other,140% of Medicaid,14.07,,,14.07,Other,225% of Medicaid,16.25,,,16.25,Other,250% of Medicaid,20.26,,,20.26,Other,324% of Medicaid,13.44,,,13.44,Other,215% of Medicaid,13.44,,,13.44,Other,215% of Medicaid,7.81,,,7.81,Other,125% of Medicaid,0.01,108.5,
AGGLUTININS FEBRILE,86000,CPT,,78086000,CDM,300,RC,,,both,,,278,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,21.01,,,21.01,Fee Schedule,,18.92,,,18.92,Fee Schedule,,53.81,,,53.81,Fee Schedule,,48.41,,,48.41,Fee Schedule,,45.76,,,45.76,Fee Schedule,,194.6,70,,194.6,percent of total billed charges,All Other,21.99,,,21.99,Fee Schedule,,32,,,32,Other,186% of Medicaid,25.9,,,25.9,Fee Schedule,,172.36,,,172.36,Fee Schedule,,14.66,,,,Fee Schedule,,25.9,,,25.9,Fee Schedule,,172.36,,,172.36,Fee Schedule,,27.57,,,27.57,Fee Schedule,,194.6,70,,194.6,percent of total billed charges,,33.08,,,33.08,Fee Schedule,,28.04,,,28.04,Fee Schedule,,10.47,,,10.47,Fee Schedule,,10.47,,,10.47,Fee Schedule,,10.47,,,10.47,Fee Schedule,,10.47,,,10.47,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,194.6,
GLYCOPROTEIN ANTIBODY,86146,CPT,,78086146,CDM,300,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,76.6,,,76.6,Fee Schedule,,68.97,,,68.97,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,109.9,70,,109.9,percent of total billed charges,All Other,80.17,,,80.17,Fee Schedule,,15,,,15,Other,186% of Medicaid,94.42,,,94.42,Fee Schedule,,97.34,,,97.34,Fee Schedule,,53.45,,,,Fee Schedule,,94.42,,,94.42,Fee Schedule,,97.34,,,97.34,Fee Schedule,,100.53,,,100.53,Fee Schedule,,109.9,70,,109.9,percent of total billed charges,,120.61,,,120.61,Fee Schedule,,102.22,,,102.22,Fee Schedule,,38.18,,,38.18,Fee Schedule,,38.18,,,38.18,Fee Schedule,,38.18,,,38.18,Fee Schedule,,38.18,,,38.18,Fee Schedule,,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,12.08,,,12.08,Other,153% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,11.06,,,11.06,Other,140% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,20.54,,,20.54,Other,250% of Medicaid,25.59,,,25.59,Other,324% of Medicaid,16.98,,,16.98,Other,215% of Medicaid,16.98,,,16.98,Other,215% of Medicaid,9.87,,,9.87,Other,125% of Medicaid,0.01,120.61,
CARDIOLIPIN ANTIBODY,86147,CPT,,78086147,CDM,300,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,76.6,,,76.6,Fee Schedule,,68.97,,,68.97,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,109.9,70,,109.9,percent of total billed charges,All Other,80.17,,,80.17,Fee Schedule,,15,,,15,Other,186% of Medicaid,94.42,,,94.42,Fee Schedule,,97.34,,,97.34,Fee Schedule,,53.45,,,,Fee Schedule,,94.42,,,94.42,Fee Schedule,,97.34,,,97.34,Fee Schedule,,100.53,,,100.53,Fee Schedule,,109.9,70,,109.9,percent of total billed charges,,120.61,,,120.61,Fee Schedule,,102.22,,,102.22,Fee Schedule,,38.18,,,38.18,Fee Schedule,,38.18,,,38.18,Fee Schedule,,38.18,,,38.18,Fee Schedule,,38.18,,,38.18,Fee Schedule,,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,12.08,,,12.08,Other,153% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,11.06,,,11.06,Other,140% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,20.54,,,20.54,Other,250% of Medicaid,25.59,,,25.59,Other,324% of Medicaid,16.98,,,16.98,Other,215% of Medicaid,16.98,,,16.98,Other,215% of Medicaid,9.87,,,9.87,Other,125% of Medicaid,0.01,120.61,
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,,78086235,CDM,300,RC,,,both,,,218,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.97,,,53.97,Fee Schedule,,48.59,,,48.59,Fee Schedule,,138.26,,,138.26,Fee Schedule,,124.38,,,124.38,Fee Schedule,,117.57,,,117.57,Fee Schedule,,152.6,70,,152.6,percent of total billed charges,All Other,56.48,,,56.48,Fee Schedule,,10,,,10,Other,186% of Medicaid,66.52,,,66.52,Fee Schedule,,135.16,,,135.16,Fee Schedule,,37.65,,,,Fee Schedule,,66.52,,,66.52,Fee Schedule,,135.16,,,135.16,Fee Schedule,,70.82,,,70.82,Fee Schedule,,152.6,70,,152.6,percent of total billed charges,,84.97,,,84.97,Fee Schedule,,72.02,,,72.02,Fee Schedule,,26.9,,,26.9,Fee Schedule,,26.9,,,26.9,Fee Schedule,,26.9,,,26.9,Fee Schedule,,26.9,,,26.9,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,152.6,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,,78086255,CDM,300,RC,,,both,,,216,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.27,,,36.27,Fee Schedule,,32.66,,,32.66,Fee Schedule,,92.94,,,92.94,Fee Schedule,,83.61,,,83.61,Fee Schedule,,79.03,,,79.03,Fee Schedule,,151.2,70,,151.2,percent of total billed charges,All Other,37.96,,,37.96,Fee Schedule,,10,,,10,Other,186% of Medicaid,44.71,,,44.71,Fee Schedule,,133.92,,,133.92,Fee Schedule,,25.31,,,,Fee Schedule,,44.71,,,44.71,Fee Schedule,,133.92,,,133.92,Fee Schedule,,47.6,,,47.6,Fee Schedule,,151.2,70,,151.2,percent of total billed charges,,57.11,,,57.11,Fee Schedule,,48.4,,,48.4,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,151.2,
FLUORESCENT ANTIBODY TITER,86256,CPT,,78086256,CDM,300,RC,,,both,,,216,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.27,,,36.27,Fee Schedule,,32.66,,,32.66,Fee Schedule,,92.94,,,92.94,Fee Schedule,,83.61,,,83.61,Fee Schedule,,79.03,,,79.03,Fee Schedule,,151.2,70,,151.2,percent of total billed charges,All Other,37.96,,,37.96,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,44.71,,,44.71,Fee Schedule,,133.92,,,133.92,Fee Schedule,,25.31,,,,Fee Schedule,,44.71,,,44.71,Fee Schedule,,133.92,,,133.92,Fee Schedule,,47.6,,,47.6,Fee Schedule,,151.2,70,,151.2,percent of total billed charges,,57.11,,,57.11,Fee Schedule,,48.4,,,48.4,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,151.2,
IMMUNFIX E-PHORSIS/URINE/CSF,86335,CPT,,78086335,CDM,300,RC,,,both,,,187,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,88.34,,,88.34,Fee Schedule,,79.54,,,79.54,Fee Schedule,,226.32,,,226.32,Fee Schedule,,203.61,,,203.61,Fee Schedule,,192.46,,,192.46,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,All Other,92.45,,,92.45,Fee Schedule,,55,,,55,Other,186% of Medicaid,108.89,,,108.89,Fee Schedule,,115.94,,,115.94,Fee Schedule,,61.64,,,,Fee Schedule,,108.89,,,108.89,Fee Schedule,,115.94,,,115.94,Fee Schedule,,115.93,,,115.93,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,,139.09,,,139.09,Fee Schedule,,117.89,,,117.89,Fee Schedule,,44.03,,,44.03,Fee Schedule,,44.03,,,44.03,Fee Schedule,,44.03,,,44.03,Fee Schedule,,44.03,,,44.03,Fee Schedule,,29.35,,,29.35,Other,100% of Medicaid,29.35,,,29.35,Other,100% of Medicaid,29.35,,,29.35,Other,100% of Medicaid,29.35,,,29.35,Other,100% of Medicaid,66.04,,,66.04,Other,225% of Medicaid,44.91,,,44.91,Other,153% of Medicaid,66.04,,,66.04,Other,225% of Medicaid,41.09,,,41.09,Other,140% of Medicaid,66.04,,,66.04,Other,225% of Medicaid,76.31,,,76.31,Other,250% of Medicaid,95.09,,,95.09,Other,324% of Medicaid,63.1,,,63.1,Other,215% of Medicaid,63.1,,,63.1,Other,215% of Medicaid,36.69,,,36.69,Other,125% of Medicaid,0.01,226.32,
TB AG RESPONSE T-CELL SUSP,86481,CPT,,78086481,CDM,300,RC,,,both,,,315,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,301,,,301,Fee Schedule,,271,,,271,Fee Schedule,,477.97,,,477.97,Fee Schedule,,429.99,,,429.99,Fee Schedule,,406.45,,,406.45,Fee Schedule,,220.5,70,,220.5,percent of total billed charges,All Other,315,,,315,Fee Schedule,,94,,,94,Other,186% of Medicaid,371,,,371,Fee Schedule,,195.3,,,195.3,Fee Schedule,,210,,,,Fee Schedule,,371,,,371,Fee Schedule,,195.3,,,195.3,Fee Schedule,,395,,,395,Fee Schedule,,220.5,70,,220.5,percent of total billed charges,,473.9,,,473.9,Fee Schedule,,401.66,,,401.66,Fee Schedule,,150,,,150,Fee Schedule,,150,,,150,Fee Schedule,,150,,,150,Fee Schedule,,150,,,150,Fee Schedule,,50.5,,,50.5,Other,100% of Medicaid,50.5,,,50.5,Other,100% of Medicaid,50.5,,,50.5,Other,100% of Medicaid,50.5,,,50.5,Other,100% of Medicaid,113.63,,,113.63,Other,225% of Medicaid,77.27,,,77.27,Other,153% of Medicaid,113.63,,,113.63,Other,225% of Medicaid,70.7,,,70.7,Other,140% of Medicaid,113.63,,,113.63,Other,225% of Medicaid,131.3,,,131.3,Other,250% of Medicaid,163.62,,,163.62,Other,324% of Medicaid,108.58,,,108.58,Other,215% of Medicaid,108.58,,,108.58,Other,215% of Medicaid,63.13,,,63.13,Other,125% of Medicaid,0.01,477.97,
ADENOVIRUS ANTIBODY,86603,CPT,,78086603,CDM,300,RC,,,both,,,254,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.74,,,38.74,Fee Schedule,,34.88,,,34.88,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,177.8,70,,177.8,percent of total billed charges,All Other,40.54,,,40.54,Fee Schedule,,15,,,15,Other,186% of Medicaid,47.75,,,47.75,Fee Schedule,,157.48,,,157.48,Fee Schedule,,27.03,,,,Fee Schedule,,47.75,,,47.75,Fee Schedule,,157.48,,,157.48,Fee Schedule,,50.84,,,50.84,Fee Schedule,,177.8,70,,177.8,percent of total billed charges,,60.99,,,60.99,Fee Schedule,,51.69,,,51.69,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,177.8,
LYME DISEASE ANTIBODY,86617,CPT,,78086617,CDM,300,RC,,,both,,,466,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.62,,,46.62,Fee Schedule,,41.98,,,41.98,Fee Schedule,,119.46,,,119.46,Fee Schedule,,107.47,,,107.47,Fee Schedule,,101.59,,,101.59,Fee Schedule,,326.2,70,,326.2,percent of total billed charges,All Other,48.79,,,48.79,Fee Schedule,,29,,,29,Other,186% of Medicaid,57.47,,,57.47,Fee Schedule,,288.92,,,288.92,Fee Schedule,,32.53,,,,Fee Schedule,,57.47,,,57.47,Fee Schedule,,288.92,,,288.92,Fee Schedule,,61.19,,,61.19,Fee Schedule,,326.2,70,,326.2,percent of total billed charges,,73.41,,,73.41,Fee Schedule,,62.22,,,62.22,Fee Schedule,,23.24,,,23.24,Fee Schedule,,23.24,,,23.24,Fee Schedule,,23.24,,,23.24,Fee Schedule,,23.24,,,23.24,Fee Schedule,,15.49,,,15.49,Other,100% of Medicaid,15.49,,,15.49,Other,100% of Medicaid,15.49,,,15.49,Other,100% of Medicaid,15.49,,,15.49,Other,100% of Medicaid,34.85,,,34.85,Other,225% of Medicaid,23.7,,,23.7,Other,153% of Medicaid,34.85,,,34.85,Other,225% of Medicaid,21.69,,,21.69,Other,140% of Medicaid,34.85,,,34.85,Other,225% of Medicaid,40.27,,,40.27,Other,250% of Medicaid,50.19,,,50.19,Other,324% of Medicaid,33.3,,,33.3,Other,215% of Medicaid,33.3,,,33.3,Other,215% of Medicaid,19.36,,,19.36,Other,125% of Medicaid,0.01,326.2,
BRUCELLA ANTIBODY,86622,CPT,,78086622,CDM,300,RC,,,both,,,55,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,26.88,,,26.88,Fee Schedule,,24.2,,,24.2,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,All Other,28.13,,,28.13,Fee Schedule,,15,,,15,Other,186% of Medicaid,33.13,,,33.13,Fee Schedule,,34.1,,,34.1,Fee Schedule,,18.75,,,,Fee Schedule,,33.13,,,33.13,Fee Schedule,,34.1,,,34.1,Fee Schedule,,35.27,,,35.27,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,,42.32,,,42.32,Fee Schedule,,35.87,,,35.87,Fee Schedule,,13.4,,,13.4,Fee Schedule,,13.4,,,13.4,Fee Schedule,,13.4,,,13.4,Fee Schedule,,13.4,,,13.4,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,44.83,
ENCEPHALITIS ANTIBODY,86652,CPT,,78086652,CDM,300,RC,,,both,,,83,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.7,,,39.7,Fee Schedule,,35.74,,,35.74,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,All Other,41.55,,,41.55,Fee Schedule,,15,,,15,Other,186% of Medicaid,48.93,,,48.93,Fee Schedule,,51.46,,,51.46,Fee Schedule,,27.7,,,,Fee Schedule,,48.93,,,48.93,Fee Schedule,,51.46,,,51.46,Fee Schedule,,52.1,,,52.1,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,,62.51,,,62.51,Fee Schedule,,52.98,,,52.98,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,62.51,
EHRLICHIA ANTIBODY,86666,CPT,,78086666,CDM,300,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,30.64,,,30.64,Fee Schedule,,27.59,,,27.59,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,32.07,,,32.07,Fee Schedule,,15,,,15,Other,186% of Medicaid,37.77,,,37.77,Fee Schedule,,25.42,,,25.42,Fee Schedule,,21.38,,,,Fee Schedule,,37.77,,,37.77,Fee Schedule,,25.42,,,25.42,Fee Schedule,,40.21,,,40.21,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,48.24,,,48.24,Fee Schedule,,40.89,,,40.89,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,48.24,
HELICOBACTER PYHLORI,86677,CPT,,78086677,CDM,300,RC,,,both,,,420,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,50.72,,,50.72,Fee Schedule,,45.66,,,45.66,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,294,70,,294,percent of total billed charges,All Other,53.08,,,53.08,Fee Schedule,,15,,,15,Other,186% of Medicaid,62.51,,,62.51,Fee Schedule,,260.4,,,260.4,Fee Schedule,,35.39,,,,Fee Schedule,,62.51,,,62.51,Fee Schedule,,260.4,,,260.4,Fee Schedule,,66.56,,,66.56,Fee Schedule,,294,70,,294,percent of total billed charges,,79.85,,,79.85,Fee Schedule,,67.68,,,67.68,Fee Schedule,,25.28,,,25.28,Fee Schedule,,25.28,,,25.28,Fee Schedule,,25.28,,,25.28,Fee Schedule,,25.28,,,25.28,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,294,
HERPES SIMPLEX TEST,86695,CPT,,78086695,CDM,300,RC,,,both,,,271,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.7,,,39.7,Fee Schedule,,35.74,,,35.74,Fee Schedule,,101.71,,,101.71,Fee Schedule,,91.5,,,91.5,Fee Schedule,,86.49,,,86.49,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,All Other,41.55,,,41.55,Fee Schedule,,32,,,32,Other,186% of Medicaid,48.93,,,48.93,Fee Schedule,,168.02,,,168.02,Fee Schedule,,27.7,,,,Fee Schedule,,48.93,,,48.93,Fee Schedule,,168.02,,,168.02,Fee Schedule,,52.1,,,52.1,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,,62.51,,,62.51,Fee Schedule,,52.98,,,52.98,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,189.7,
HERPES SIMPLEX TYPE 2,86696,CPT,,78086696,CDM,300,RC,,,both,,,271,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,58.24,,,58.24,Fee Schedule,,52.44,,,52.44,Fee Schedule,,149.22,,,149.22,Fee Schedule,,134.24,,,134.24,Fee Schedule,,126.89,,,126.89,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,All Other,60.95,,,60.95,Fee Schedule,,27,,,27,Other,186% of Medicaid,71.79,,,71.79,Fee Schedule,,168.02,,,168.02,Fee Schedule,,40.64,,,,Fee Schedule,,71.79,,,71.79,Fee Schedule,,168.02,,,168.02,Fee Schedule,,76.43,,,76.43,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,,91.7,,,91.7,Fee Schedule,,77.72,,,77.72,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,14.65,,,14.65,Other,100% of Medicaid,14.65,,,14.65,Other,100% of Medicaid,14.65,,,14.65,Other,100% of Medicaid,14.65,,,14.65,Other,100% of Medicaid,32.95,,,32.95,Other,225% of Medicaid,22.41,,,22.41,Other,153% of Medicaid,32.95,,,32.95,Other,225% of Medicaid,20.5,,,20.5,Other,140% of Medicaid,32.95,,,32.95,Other,225% of Medicaid,38.08,,,38.08,Other,250% of Medicaid,47.45,,,47.45,Other,324% of Medicaid,31.49,,,31.49,Other,215% of Medicaid,31.49,,,31.49,Other,215% of Medicaid,18.31,,,18.31,Other,125% of Medicaid,0.01,189.7,
HIV-1,86701,CPT,,78086701,CDM,300,RC,,,both,,,294,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,26.76,,,26.76,Fee Schedule,,24.09,,,24.09,Fee Schedule,,68.5,,,68.5,Fee Schedule,,61.63,,,61.63,Fee Schedule,,58.25,,,58.25,Fee Schedule,,205.8,70,,205.8,percent of total billed charges,All Other,28,,,28,Fee Schedule,,17,,,17,Other,186% of Medicaid,32.98,,,32.98,Fee Schedule,,182.28,,,182.28,Fee Schedule,,18.67,,,,Fee Schedule,,32.98,,,32.98,Fee Schedule,,182.28,,,182.28,Fee Schedule,,35.12,,,35.12,Fee Schedule,,205.8,70,,205.8,percent of total billed charges,,42.13,,,42.13,Fee Schedule,,35.71,,,35.71,Fee Schedule,,13.34,,,13.34,Fee Schedule,,13.34,,,13.34,Fee Schedule,,13.34,,,13.34,Fee Schedule,,13.34,,,13.34,Fee Schedule,,8.89,,,8.89,Other,100% of Medicaid,8.89,,,8.89,Other,100% of Medicaid,8.89,,,8.89,Other,100% of Medicaid,8.89,,,8.89,Other,100% of Medicaid,20,,,20,Other,225% of Medicaid,13.6,,,13.6,Other,153% of Medicaid,20,,,20,Other,225% of Medicaid,12.45,,,12.45,Other,140% of Medicaid,20,,,20,Other,225% of Medicaid,23.11,,,23.11,Other,250% of Medicaid,28.8,,,28.8,Other,324% of Medicaid,19.11,,,19.11,Other,215% of Medicaid,19.11,,,19.11,Other,215% of Medicaid,11.11,,,11.11,Other,125% of Medicaid,0.01,205.8,
MUMPS ANTIBODY,86735,CPT,,78086735,CDM,300,RC,,,both,,,198,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.28,,,39.28,Fee Schedule,,35.37,,,35.37,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,All Other,41.11,,,41.11,Fee Schedule,,15,,,15,Other,186% of Medicaid,48.42,,,48.42,Fee Schedule,,122.76,,,122.76,Fee Schedule,,27.41,,,,Fee Schedule,,48.42,,,48.42,Fee Schedule,,122.76,,,122.76,Fee Schedule,,51.55,,,51.55,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,,61.84,,,61.84,Fee Schedule,,52.42,,,52.42,Fee Schedule,,19.58,,,19.58,Fee Schedule,,19.58,,,19.58,Fee Schedule,,19.58,,,19.58,Fee Schedule,,19.58,,,19.58,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,138.6,
PROTOZOA ANTIBODY NOS,86753,CPT,,78086753,CDM,300,RC,,,both,,,76,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,37.29,,,37.29,Fee Schedule,,33.58,,,33.58,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,53.2,70,,53.2,percent of total billed charges,All Other,39.03,,,39.03,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,45.97,,,45.97,Fee Schedule,,47.12,,,47.12,Fee Schedule,,26.02,,,,Fee Schedule,,45.97,,,45.97,Fee Schedule,,47.12,,,47.12,Fee Schedule,,48.94,,,48.94,Fee Schedule,,53.2,70,,53.2,percent of total billed charges,,58.72,,,58.72,Fee Schedule,,49.77,,,49.77,Fee Schedule,,18.59,,,18.59,Fee Schedule,,18.59,,,18.59,Fee Schedule,,18.59,,,18.59,Fee Schedule,,18.59,,,18.59,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,58.72,
TOXOPLASMA,86777,CPT,,78086777,CDM,300,RC,,,both,,,210,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.31,,,43.31,Fee Schedule,,39,,,39,Fee Schedule,,110.97,,,110.97,Fee Schedule,,99.83,,,99.83,Fee Schedule,,94.37,,,94.37,Fee Schedule,,147,70,,147,percent of total billed charges,All Other,45.33,,,45.33,Fee Schedule,,27,,,27,Other,186% of Medicaid,53.39,,,53.39,Fee Schedule,,130.2,,,130.2,Fee Schedule,,30.22,,,,Fee Schedule,,53.39,,,53.39,Fee Schedule,,130.2,,,130.2,Fee Schedule,,56.84,,,56.84,Fee Schedule,,147,70,,147,percent of total billed charges,,68.19,,,68.19,Fee Schedule,,57.8,,,57.8,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,22.02,,,22.02,Other,153% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,20.15,,,20.15,Other,140% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,37.41,,,37.41,Other,250% of Medicaid,46.62,,,46.62,Other,324% of Medicaid,30.94,,,30.94,Other,215% of Medicaid,30.94,,,30.94,Other,215% of Medicaid,17.99,,,17.99,Other,125% of Medicaid,0.01,147,
RBC ANTIBODY SCREEN,86850,CPT,,77086850,CDM,300,RC,,,both,,,184,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Fee Schedule,,29.41,,,29.41,Fee Schedule,,26.48,,,26.48,Fee Schedule,,6.54,,,6.54,Fee Schedule,,6.54,,,6.54,Fee Schedule,,6.54,,,6.54,Fee Schedule,,128.8,70,,128.8,percent of total billed charges,All Other,30.78,,,30.78,Fee Schedule,,10,,,10,Other,186% of Medicaid,36.25,,,36.25,Fee Schedule,,114.08,,,114.08,Fee Schedule,,20.52,,,,Fee Schedule,,36.25,,,36.25,Fee Schedule,,114.08,,,114.08,Fee Schedule,,38.59,,,38.59,Fee Schedule,,128.8,70,,128.8,percent of total billed charges,,46.3,,,46.3,Fee Schedule,,39.24,,,39.24,Fee Schedule,,14.66,,,14.66,Fee Schedule,,14.66,,,14.66,Fee Schedule,,14.66,,,14.66,Fee Schedule,,14.66,,,14.66,Fee Schedule,,5.61,,,5.61,Other,100% of Medicaid,5.61,,,5.61,Other,100% of Medicaid,5.61,,,5.61,Other,100% of Medicaid,5.61,,,5.61,Other,100% of Medicaid,12.61,,,12.61,Other,225% of Medicaid,8.58,,,8.58,Other,153% of Medicaid,12.61,,,12.61,Other,225% of Medicaid,7.85,,,7.85,Other,140% of Medicaid,12.61,,,12.61,Other,225% of Medicaid,14.57,,,14.57,Other,250% of Medicaid,18.16,,,18.16,Other,324% of Medicaid,12.05,,,12.05,Other,215% of Medicaid,12.05,,,12.05,Other,215% of Medicaid,7.01,,,7.01,Other,125% of Medicaid,5.61,128.8,
RBC ANTIBODY SCREEN,86850,CPT,,78086850,CDM,300,RC,,,both,,,184,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Fee Schedule,,29.41,,,29.41,Fee Schedule,,26.48,,,26.48,Fee Schedule,,6.54,,,6.54,Fee Schedule,,6.54,,,6.54,Fee Schedule,,6.54,,,6.54,Fee Schedule,,128.8,70,,128.8,percent of total billed charges,All Other,30.78,,,30.78,Fee Schedule,,10,,,10,Other,186% of Medicaid,36.25,,,36.25,Fee Schedule,,114.08,,,114.08,Fee Schedule,,20.52,,,,Fee Schedule,,36.25,,,36.25,Fee Schedule,,114.08,,,114.08,Fee Schedule,,38.59,,,38.59,Fee Schedule,,128.8,70,,128.8,percent of total billed charges,,46.3,,,46.3,Fee Schedule,,39.24,,,39.24,Fee Schedule,,14.66,,,14.66,Fee Schedule,,14.66,,,14.66,Fee Schedule,,14.66,,,14.66,Fee Schedule,,14.66,,,14.66,Fee Schedule,,5.61,,,5.61,Other,100% of Medicaid,5.61,,,5.61,Other,100% of Medicaid,5.61,,,5.61,Other,100% of Medicaid,5.61,,,5.61,Other,100% of Medicaid,12.61,,,12.61,Other,225% of Medicaid,8.58,,,8.58,Other,153% of Medicaid,12.61,,,12.61,Other,225% of Medicaid,7.85,,,7.85,Other,140% of Medicaid,12.61,,,12.61,Other,225% of Medicaid,14.57,,,14.57,Other,250% of Medicaid,18.16,,,18.16,Other,324% of Medicaid,12.05,,,12.05,Other,215% of Medicaid,12.05,,,12.05,Other,215% of Medicaid,7.01,,,7.01,Other,125% of Medicaid,5.61,128.8,
AUTOLOG BLOOD PREDEPOSITED,86890,CPT,,77086890,CDM,300,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,230.75,65,,230.75,percent of total billed charges,All Other,209.45,59,,209.45,percent of total billed charges,All Other,271.58,76.5,,271.58,percent of total billed charges,All Other,244.95,69,,244.95,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,All Other,241.4,68,,241.4,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,195.25,83,,,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,284,80,,284,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,,230.75,65,,230.75,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,308.64,
AUTOLOG BLOOD OP SALVAGE,86891,CPT,,77086891,CDM,300,RC,,,both,,,1749,1553.82,,,1553.82,Other,150% of Medicare + 9.63% HCRA Surcharge,944.89,,,944.89,Other,Medicare OPPS,1136.85,65,,1136.85,percent of total billed charges,All Other,1031.91,59,,1031.91,percent of total billed charges,All Other,1337.99,76.5,,1337.99,percent of total billed charges,All Other,1206.81,69,,1206.81,percent of total billed charges,All Other,1136.85,65,,1136.85,percent of total billed charges,All Other,1224.3,70,,1224.3,percent of total billed charges,All Other,1189.32,68,,1189.32,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,1451.67,80,,1451.67,percent of total billed charges,All Other,1084.38,83,,1084.38,percent of total billed charges,All Other,961.95,83,,,percent of total billed charges,All Other,1451.67,80,,1451.67,percent of total billed charges,All Other,1084.38,83,,1084.38,percent of total billed charges,All Other,1399.2,80,,1399.2,percent of total billed charges,All Other,1224.3,70,,1224.3,percent of total billed charges,,1136.85,65,,1136.85,percent of total billed charges,All Other,1136.85,65,,1136.85,percent of total billed charges,All Other,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,1553.82,
BLOOD TYPING; ABO,86900,CPT,,77086900,CDM,300,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Fee Schedule,,9,,,9,Fee Schedule,,8.1,,,8.1,Fee Schedule,,23.02,,,23.02,Fee Schedule,,20.71,,,20.71,Fee Schedule,,19.57,,,19.57,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,9.42,,,9.42,Fee Schedule,,6,,,6,Other,186% of Medicaid,11.09,,,11.09,Fee Schedule,,163.06,,,163.06,Fee Schedule,,6.28,,,,Fee Schedule,,11.09,,,11.09,Fee Schedule,,163.06,,,163.06,Fee Schedule,,11.81,,,11.81,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,,14.17,,,14.17,Fee Schedule,,12.01,,,12.01,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,4.57,,,4.57,Other,153% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,4.19,,,4.19,Other,140% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,7.77,,,7.77,Other,250% of Medicaid,9.69,,,9.69,Other,324% of Medicaid,6.43,,,6.43,Other,215% of Medicaid,6.43,,,6.43,Other,215% of Medicaid,3.74,,,3.74,Other,125% of Medicaid,2.99,230.83,
BLOOD TYPING RH(D),86901,CPT,,77086901,CDM,300,RC,,,both,,,138,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Fee Schedule,,9,,,9,Fee Schedule,,8.1,,,8.1,Fee Schedule,,23.02,,,23.02,Fee Schedule,,20.71,,,20.71,Fee Schedule,,19.57,,,19.57,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,All Other,9.42,,,9.42,Fee Schedule,,6,,,6,Other,186% of Medicaid,11.09,,,11.09,Fee Schedule,,85.56,,,85.56,Fee Schedule,,6.28,,,,Fee Schedule,,11.09,,,11.09,Fee Schedule,,85.56,,,85.56,Fee Schedule,,11.81,,,11.81,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,,14.17,,,14.17,Fee Schedule,,12.01,,,12.01,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,4.57,,,4.57,Other,153% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,4.19,,,4.19,Other,140% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,7.77,,,7.77,Other,250% of Medicaid,9.69,,,9.69,Other,324% of Medicaid,6.43,,,6.43,Other,215% of Medicaid,6.43,,,6.43,Other,215% of Medicaid,3.74,,,3.74,Other,125% of Medicaid,2.99,96.6,
BLOOD TYPING RH (D),86901,CPT,,78086901,CDM,300,RC,,,both,,,138,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Fee Schedule,,9,,,9,Fee Schedule,,8.1,,,8.1,Fee Schedule,,23.02,,,23.02,Fee Schedule,,20.71,,,20.71,Fee Schedule,,19.57,,,19.57,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,All Other,9.42,,,9.42,Fee Schedule,,6,,,6,Other,186% of Medicaid,11.09,,,11.09,Fee Schedule,,85.56,,,85.56,Fee Schedule,,6.28,,,,Fee Schedule,,11.09,,,11.09,Fee Schedule,,85.56,,,85.56,Fee Schedule,,11.81,,,11.81,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,,14.17,,,14.17,Fee Schedule,,12.01,,,12.01,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,4.57,,,4.57,Other,153% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,4.19,,,4.19,Other,140% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,7.77,,,7.77,Other,250% of Medicaid,9.69,,,9.69,Other,324% of Medicaid,6.43,,,6.43,Other,215% of Medicaid,6.43,,,6.43,Other,215% of Medicaid,3.74,,,3.74,Other,125% of Medicaid,2.99,96.6,
BLD TYPE; RBC AG NOT ABO/RHD,86905,CPT,,77086905,CDM,300,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Fee Schedule,,11.53,,,11.53,Fee Schedule,,10.38,,,10.38,Fee Schedule,,29.48,,,29.48,Fee Schedule,,26.52,,,26.52,Fee Schedule,,25.07,,,25.07,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,12.06,,,12.06,Fee Schedule,,7,,,7,Other,186% of Medicaid,14.21,,,14.21,Fee Schedule,,453.22,,,453.22,Fee Schedule,,8.04,,,,Fee Schedule,,14.21,,,14.21,Fee Schedule,,453.22,,,453.22,Fee Schedule,,15.13,,,15.13,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,18.15,,,18.15,Fee Schedule,,15.38,,,15.38,Fee Schedule,,5.75,,,5.75,Fee Schedule,,5.75,,,5.75,Fee Schedule,,5.75,,,5.75,Fee Schedule,,5.75,,,5.75,Fee Schedule,,3.83,,,3.83,Other,100% of Medicaid,3.83,,,3.83,Other,100% of Medicaid,3.83,,,3.83,Other,100% of Medicaid,3.83,,,3.83,Other,100% of Medicaid,8.62,,,8.62,Other,225% of Medicaid,5.86,,,5.86,Other,153% of Medicaid,8.62,,,8.62,Other,225% of Medicaid,5.36,,,5.36,Other,140% of Medicaid,8.62,,,8.62,Other,225% of Medicaid,9.96,,,9.96,Other,250% of Medicaid,12.41,,,12.41,Other,324% of Medicaid,8.23,,,8.23,Other,215% of Medicaid,8.23,,,8.23,Other,215% of Medicaid,4.79,,,4.79,Other,125% of Medicaid,3.83,649.53,
COMPATIBILITY TEST SPIN,86920,CPT,,77086920,CDM,300,RC,,,both,,,357,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,232.05,65,,232.05,percent of total billed charges,All Other,210.63,59,,210.63,percent of total billed charges,All Other,9.4,,,9.4,Fee Schedule,,9.4,,,9.4,Fee Schedule,,9.4,,,9.4,Fee Schedule,,249.9,70,,249.9,percent of total billed charges,All Other,242.76,68,,242.76,percent of total billed charges,All Other,86,,,86,Other,186% of Medicaid,296.31,80,,296.31,percent of total billed charges,All Other,221.34,83,,221.34,percent of total billed charges,All Other,196.35,83,,,percent of total billed charges,All Other,296.31,80,,296.31,percent of total billed charges,All Other,221.34,83,,221.34,percent of total billed charges,All Other,285.6,80,,285.6,percent of total billed charges,All Other,249.9,70,,249.9,percent of total billed charges,,232.05,65,,232.05,percent of total billed charges,All Other,232.05,65,,232.05,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,64.75,,,64.75,Other,140% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,120.26,,,120.26,Other,250% of Medicaid,149.86,,,149.86,Other,324% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,9.4,308.64,
COMPATIBILITY TEST SPIN,86920,CPT,,78086920,CDM,300,RC,,,both,,,357,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,232.05,65,,232.05,percent of total billed charges,All Other,210.63,59,,210.63,percent of total billed charges,All Other,9.4,,,9.4,Fee Schedule,,9.4,,,9.4,Fee Schedule,,9.4,,,9.4,Fee Schedule,,249.9,70,,249.9,percent of total billed charges,All Other,242.76,68,,242.76,percent of total billed charges,All Other,86,,,86,Other,186% of Medicaid,296.31,80,,296.31,percent of total billed charges,All Other,221.34,83,,221.34,percent of total billed charges,All Other,196.35,83,,,percent of total billed charges,All Other,296.31,80,,296.31,percent of total billed charges,All Other,221.34,83,,221.34,percent of total billed charges,All Other,285.6,80,,285.6,percent of total billed charges,All Other,249.9,70,,249.9,percent of total billed charges,,232.05,65,,232.05,percent of total billed charges,All Other,232.05,65,,232.05,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,64.75,,,64.75,Other,140% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,120.26,,,120.26,Other,250% of Medicaid,149.86,,,149.86,Other,324% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,9.4,308.64,
COMPATIBILITY TEST INCUBATE,86921,CPT,,77086921,CDM,300,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,230.75,65,,230.75,percent of total billed charges,All Other,209.45,59,,209.45,percent of total billed charges,All Other,8.44,,,8.44,Fee Schedule,,8.44,,,8.44,Fee Schedule,,8.44,,,8.44,Fee Schedule,,248.5,70,,248.5,percent of total billed charges,All Other,241.4,68,,241.4,percent of total billed charges,All Other,86,,,86,Other,186% of Medicaid,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,195.25,83,,,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,284,80,,284,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,,230.75,65,,230.75,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,64.75,,,64.75,Other,140% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,120.26,,,120.26,Other,250% of Medicaid,149.86,,,149.86,Other,324% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,8.44,308.64,
COMPATIBILITY TEST INCUBATE,86921,CPT,,78086921,CDM,300,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,230.75,65,,230.75,percent of total billed charges,All Other,209.45,59,,209.45,percent of total billed charges,All Other,8.44,,,8.44,Fee Schedule,,8.44,,,8.44,Fee Schedule,,8.44,,,8.44,Fee Schedule,,248.5,70,,248.5,percent of total billed charges,All Other,241.4,68,,241.4,percent of total billed charges,All Other,86,,,86,Other,186% of Medicaid,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,195.25,83,,,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,284,80,,284,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,,230.75,65,,230.75,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,64.75,,,64.75,Other,140% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,120.26,,,120.26,Other,250% of Medicaid,149.86,,,149.86,Other,324% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,8.44,308.64,
FFP THAWING EA UNIT,86927,CPT,,77086927,CDM,300,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,230.75,65,,230.75,percent of total billed charges,All Other,209.45,59,,209.45,percent of total billed charges,All Other,271.58,76.5,,271.58,percent of total billed charges,All Other,244.95,69,,244.95,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,All Other,241.4,68,,241.4,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,195.25,83,,,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,284,80,,284,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,,230.75,65,,230.75,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,308.64,
FROZEN BLOOD PREP,86930,CPT,,77086930,CDM,300,RC,,,both,,,731,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,475.15,65,,475.15,percent of total billed charges,All Other,431.29,59,,431.29,percent of total billed charges,All Other,559.22,76.5,,559.22,percent of total billed charges,All Other,504.39,69,,504.39,percent of total billed charges,All Other,475.15,65,,475.15,percent of total billed charges,All Other,511.7,70,,511.7,percent of total billed charges,All Other,497.08,68,,497.08,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,606.73,80,,606.73,percent of total billed charges,All Other,453.22,83,,453.22,percent of total billed charges,All Other,402.05,83,,,percent of total billed charges,All Other,606.73,80,,606.73,percent of total billed charges,All Other,453.22,83,,453.22,percent of total billed charges,All Other,584.8,80,,584.8,percent of total billed charges,All Other,511.7,70,,511.7,percent of total billed charges,,475.15,65,,475.15,percent of total billed charges,All Other,475.15,65,,475.15,percent of total billed charges,All Other,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,606.73,
FROZEN BLOOD THAW,86931,CPT,,77086931,CDM,300,RC,,,both,,,731,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,475.15,65,,475.15,percent of total billed charges,All Other,431.29,59,,431.29,percent of total billed charges,All Other,559.22,76.5,,559.22,percent of total billed charges,All Other,504.39,69,,504.39,percent of total billed charges,All Other,475.15,65,,475.15,percent of total billed charges,All Other,511.7,70,,511.7,percent of total billed charges,All Other,497.08,68,,497.08,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,606.73,80,,606.73,percent of total billed charges,All Other,453.22,83,,453.22,percent of total billed charges,All Other,402.05,83,,,percent of total billed charges,All Other,606.73,80,,606.73,percent of total billed charges,All Other,453.22,83,,453.22,percent of total billed charges,All Other,584.8,80,,584.8,percent of total billed charges,All Other,511.7,70,,511.7,percent of total billed charges,,475.15,65,,475.15,percent of total billed charges,All Other,475.15,65,,475.15,percent of total billed charges,All Other,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,606.73,
FROZEN BLOOD FREEZE & THAW,86932,CPT,,77086932,CDM,300,RC,,,both,,,78,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,50.7,65,,50.7,percent of total billed charges,All Other,46.02,59,,46.02,percent of total billed charges,All Other,59.67,76.5,,59.67,percent of total billed charges,All Other,53.82,69,,53.82,percent of total billed charges,All Other,50.7,65,,50.7,percent of total billed charges,All Other,54.6,70,,54.6,percent of total billed charges,All Other,53.04,68,,53.04,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,64.74,80,,64.74,percent of total billed charges,All Other,48.36,83,,48.36,percent of total billed charges,All Other,42.9,83,,,percent of total billed charges,All Other,64.74,80,,64.74,percent of total billed charges,All Other,48.36,83,,48.36,percent of total billed charges,All Other,62.4,80,,62.4,percent of total billed charges,All Other,54.6,70,,54.6,percent of total billed charges,,50.7,65,,50.7,percent of total billed charges,All Other,50.7,65,,50.7,percent of total billed charges,All Other,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,42.9,148.19,
HEMOLYSINS/AGGLLUTININS,86941,CPT,,78086941,CDM,300,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.45,,,36.45,Fee Schedule,,32.82,,,32.82,Fee Schedule,,93.38,,,93.38,Fee Schedule,,84.01,,,84.01,Fee Schedule,,79.41,,,79.41,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,38.15,,,38.15,Fee Schedule,,19,,,19,Other,186% of Medicaid,44.93,,,44.93,Fee Schedule,,45.88,,,45.88,Fee Schedule,,25.43,,,,Fee Schedule,,44.93,,,44.93,Fee Schedule,,45.88,,,45.88,Fee Schedule,,47.83,,,47.83,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,57.39,,,57.39,Fee Schedule,,48.64,,,48.64,Fee Schedule,,18.17,,,18.17,Fee Schedule,,18.17,,,18.17,Fee Schedule,,18.17,,,18.17,Fee Schedule,,18.17,,,18.17,Fee Schedule,,10.37,,,10.37,Other,100% of Medicaid,10.37,,,10.37,Other,100% of Medicaid,10.37,,,10.37,Other,100% of Medicaid,10.37,,,10.37,Other,100% of Medicaid,23.34,,,23.34,Other,225% of Medicaid,15.87,,,15.87,Other,153% of Medicaid,23.34,,,23.34,Other,225% of Medicaid,14.52,,,14.52,Other,140% of Medicaid,23.34,,,23.34,Other,225% of Medicaid,26.97,,,26.97,Other,250% of Medicaid,33.61,,,33.61,Other,324% of Medicaid,22.3,,,22.3,Other,215% of Medicaid,22.3,,,22.3,Other,215% of Medicaid,12.97,,,12.97,Other,125% of Medicaid,0.01,93.38,
IRRADIATE BLD PRODUCT EA UNIT,86945,CPT,,77086945,CDM,300,RC,,,both,,,78,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,50.7,65,,50.7,percent of total billed charges,All Other,46.02,59,,46.02,percent of total billed charges,All Other,7.9,,,7.9,Fee Schedule,,7.9,,,7.9,Fee Schedule,,7.9,,,7.9,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,All Other,53.04,68,,53.04,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,64.74,80,,64.74,percent of total billed charges,All Other,48.36,83,,48.36,percent of total billed charges,All Other,42.9,83,,,percent of total billed charges,All Other,64.74,80,,64.74,percent of total billed charges,All Other,48.36,83,,48.36,percent of total billed charges,All Other,62.4,80,,62.4,percent of total billed charges,All Other,54.6,70,,54.6,percent of total billed charges,,50.7,65,,50.7,percent of total billed charges,All Other,50.7,65,,50.7,percent of total billed charges,All Other,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,7.9,148.19,
POOLING BLOOD PLATELETS,86965,CPT,,78086965,CDM,300,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,248.5,70,,248.5,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,All Other,241.4,67,,241.4,percent of total billed charges,All Other,85,70,,85,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,195.25,83,,,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,284,80,,284,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,237.85,67,,237.85,percent of total billed charges,All Other,237.85,67,,237.85,percent of total billed charges,All Other,237.85,67,,237.85,percent of total billed charges,All Other,237.85,67,,237.85,percent of total billed charges,All Other,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,308.64,
RBC PRETREATMENT SERUM,86978,CPT,,78086978,CDM,300,RC,,,both,,,122,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,79.3,65,,79.3,percent of total billed charges,All Other,71.98,59,,71.98,percent of total billed charges,All Other,93.33,76.5,,93.33,percent of total billed charges,All Other,84.18,69,,84.18,percent of total billed charges,All Other,79.3,65,,79.3,percent of total billed charges,All Other,85.4,70,,85.4,percent of total billed charges,All Other,82.96,68,,82.96,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,101.26,80,,101.26,percent of total billed charges,All Other,75.64,83,,75.64,percent of total billed charges,All Other,67.1,83,,,percent of total billed charges,All Other,101.26,80,,101.26,percent of total billed charges,All Other,75.64,83,,75.64,percent of total billed charges,All Other,97.6,80,,97.6,percent of total billed charges,All Other,85.4,70,,85.4,percent of total billed charges,,79.3,65,,79.3,percent of total billed charges,All Other,79.3,65,,79.3,percent of total billed charges,All Other,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,148.19,
SPLIT BLOOD OR PRODUCTS,86985,CPT,,78086985,CDM,300,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,230.75,65,,230.75,percent of total billed charges,All Other,209.45,59,,209.45,percent of total billed charges,All Other,271.58,76.5,,271.58,percent of total billed charges,All Other,244.95,69,,244.95,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,All Other,241.4,68,,241.4,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,195.25,83,,,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,284,80,,284,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,,230.75,65,,230.75,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,308.64,
CULTURE AEROBIC IDENTIFY,87077,CPT,,78087077,CDM,300,RC,,,both,,,94,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.32,,,24.32,Fee Schedule,,21.9,,,21.9,Fee Schedule,,62.31,,,62.31,Fee Schedule,,56.05,,,56.05,Fee Schedule,,52.98,,,52.98,Fee Schedule,,65.8,70,,65.8,percent of total billed charges,All Other,25.45,,,25.45,Fee Schedule,,15,,,15,Other,186% of Medicaid,29.98,,,29.98,Fee Schedule,,58.28,,,58.28,Fee Schedule,,16.97,,,,Fee Schedule,,29.98,,,29.98,Fee Schedule,,58.28,,,58.28,Fee Schedule,,31.92,,,31.92,Fee Schedule,,65.8,70,,65.8,percent of total billed charges,,38.29,,,38.29,Fee Schedule,,32.45,,,32.45,Fee Schedule,,12.12,,,12.12,Fee Schedule,,12.12,,,12.12,Fee Schedule,,12.12,,,12.12,Fee Schedule,,12.12,,,12.12,Fee Schedule,,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,12.36,,,12.36,Other,153% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,11.31,,,11.31,Other,140% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,21.01,,,21.01,Other,250% of Medicaid,26.18,,,26.18,Other,324% of Medicaid,17.37,,,17.37,Other,215% of Medicaid,17.37,,,17.37,Other,215% of Medicaid,10.1,,,10.1,Other,125% of Medicaid,0.01,65.8,
MYCOPLASMA,87109,CPT,,78087109,CDM,300,RC,,,both,,,291,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.32,,,46.32,Fee Schedule,,41.71,,,41.71,Fee Schedule,,111.96,,,111.96,Fee Schedule,,100.72,,,100.72,Fee Schedule,,95.2,,,95.2,Fee Schedule,,203.7,70,,203.7,percent of total billed charges,All Other,48.48,,,48.48,Fee Schedule,,15,,,15,Other,186% of Medicaid,57.1,,,57.1,Fee Schedule,,180.42,,,180.42,Fee Schedule,,32.32,,,,Fee Schedule,,57.1,,,57.1,Fee Schedule,,180.42,,,180.42,Fee Schedule,,60.79,,,60.79,Fee Schedule,,203.7,70,,203.7,percent of total billed charges,,72.93,,,72.93,Fee Schedule,,61.82,,,61.82,Fee Schedule,,23.09,,,23.09,Fee Schedule,,23.09,,,23.09,Fee Schedule,,23.09,,,23.09,Fee Schedule,,23.09,,,23.09,Fee Schedule,,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,12.59,,,12.59,Other,153% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,11.52,,,11.52,Other,140% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,21.4,,,21.4,Other,250% of Medicaid,26.67,,,26.67,Other,324% of Medicaid,17.7,,,17.7,Other,215% of Medicaid,17.7,,,17.7,Other,215% of Medicaid,10.29,,,10.29,Other,125% of Medicaid,0.01,203.7,
OVA AND PARASITES SMEARS,87177,CPT,,78087177,CDM,300,RC,,,both,,,382,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,26.79,,,26.79,Fee Schedule,,24.12,,,24.12,Fee Schedule,,68.61,,,68.61,Fee Schedule,,61.72,,,61.72,Fee Schedule,,58.34,,,58.34,Fee Schedule,,267.4,70,,267.4,percent of total billed charges,All Other,28.04,,,28.04,Fee Schedule,,17,,,17,Other,186% of Medicaid,33.02,,,33.02,Fee Schedule,,236.84,,,236.84,Fee Schedule,,18.69,,,,Fee Schedule,,33.02,,,33.02,Fee Schedule,,236.84,,,236.84,Fee Schedule,,35.16,,,35.16,Fee Schedule,,267.4,70,,267.4,percent of total billed charges,,42.18,,,42.18,Fee Schedule,,35.75,,,35.75,Fee Schedule,,13.35,,,13.35,Fee Schedule,,13.35,,,13.35,Fee Schedule,,13.35,,,13.35,Fee Schedule,,13.35,,,13.35,Fee Schedule,,8.9,,,8.9,Other,100% of Medicaid,8.9,,,8.9,Other,100% of Medicaid,8.9,,,8.9,Other,100% of Medicaid,8.9,,,8.9,Other,100% of Medicaid,20.03,,,20.03,Other,225% of Medicaid,13.62,,,13.62,Other,153% of Medicaid,20.03,,,20.03,Other,225% of Medicaid,12.46,,,12.46,Other,140% of Medicaid,20.03,,,20.03,Other,225% of Medicaid,23.14,,,23.14,Other,250% of Medicaid,28.84,,,28.84,Other,324% of Medicaid,19.14,,,19.14,Other,215% of Medicaid,19.14,,,19.14,Other,215% of Medicaid,11.13,,,11.13,Other,125% of Medicaid,0.01,267.4,
MICROBE SUSCEPT MYCOBACTERI,87190,CPT,,78087190,CDM,300,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,22,,,22,Fee Schedule,,19.81,,,19.81,Fee Schedule,,43.62,,,43.62,Fee Schedule,,39.24,,,39.24,Fee Schedule,,37.09,,,37.09,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,23.03,,,23.03,Fee Schedule,,14,,,14,Other,186% of Medicaid,27.12,,,27.12,Fee Schedule,,45.88,,,45.88,Fee Schedule,,15.35,,,,Fee Schedule,,27.12,,,27.12,Fee Schedule,,45.88,,,45.88,Fee Schedule,,28.87,,,28.87,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,34.64,,,34.64,Fee Schedule,,29.36,,,29.36,Fee Schedule,,10.97,,,10.97,Fee Schedule,,10.97,,,10.97,Fee Schedule,,10.97,,,10.97,Fee Schedule,,10.97,,,10.97,Fee Schedule,,7.31,,,7.31,Other,100% of Medicaid,7.31,,,7.31,Other,100% of Medicaid,7.31,,,7.31,Other,100% of Medicaid,7.31,,,7.31,Other,100% of Medicaid,16.45,,,16.45,Other,225% of Medicaid,11.18,,,11.18,Other,153% of Medicaid,16.45,,,16.45,Other,225% of Medicaid,10.23,,,10.23,Other,140% of Medicaid,16.45,,,16.45,Other,225% of Medicaid,19.01,,,19.01,Other,250% of Medicaid,23.68,,,23.68,Other,324% of Medicaid,15.72,,,15.72,Other,215% of Medicaid,15.72,,,15.72,Other,215% of Medicaid,9.14,,,9.14,Other,125% of Medicaid,0.01,51.8,
VIRUS INOCULATION SHELL VIA,87254,CPT,,78087254,CDM,300,RC,,,both,,,125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,58.88,,,58.88,Fee Schedule,,53.01,,,53.01,Fee Schedule,,150.81,,,150.81,Fee Schedule,,135.67,,,135.67,Fee Schedule,,128.24,,,128.24,Fee Schedule,,87.5,70,,87.5,percent of total billed charges,All Other,61.61,,,61.61,Fee Schedule,,13,,,13,Other,186% of Medicaid,72.57,,,72.57,Fee Schedule,,77.5,,,77.5,Fee Schedule,,41.08,,,,Fee Schedule,,72.57,,,72.57,Fee Schedule,,77.5,,,77.5,Fee Schedule,,77.26,,,77.26,Fee Schedule,,87.5,70,,87.5,percent of total billed charges,,92.7,,,92.7,Fee Schedule,,78.57,,,78.57,Fee Schedule,,29.34,,,29.34,Fee Schedule,,29.34,,,29.34,Fee Schedule,,29.34,,,29.34,Fee Schedule,,29.34,,,29.34,Fee Schedule,,6.83,,,6.83,Other,100% of Medicaid,6.83,,,6.83,Other,100% of Medicaid,6.83,,,6.83,Other,100% of Medicaid,6.83,,,6.83,Other,100% of Medicaid,15.36,,,15.36,Other,225% of Medicaid,10.45,,,10.45,Other,153% of Medicaid,15.36,,,15.36,Other,225% of Medicaid,9.56,,,9.56,Other,140% of Medicaid,15.36,,,15.36,Other,225% of Medicaid,17.75,,,17.75,Other,250% of Medicaid,22.12,,,22.12,Other,324% of Medicaid,14.68,,,14.68,Other,215% of Medicaid,14.68,,,14.68,Other,215% of Medicaid,8.53,,,8.53,Other,125% of Medicaid,0.01,150.81,
LEGION PNEUMOPHILIA AG IF,87278,CPT,,78087278,CDM,300,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.96,,,46.96,Fee Schedule,,42.28,,,42.28,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,49.14,,,49.14,Fee Schedule,,29,,,29,Other,186% of Medicaid,57.88,,,57.88,Fee Schedule,,45.88,,,45.88,Fee Schedule,,32.76,,,,Fee Schedule,,57.88,,,57.88,Fee Schedule,,45.88,,,45.88,Fee Schedule,,61.62,,,61.62,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,73.93,,,73.93,Fee Schedule,,62.66,,,62.66,Fee Schedule,,23.4,,,23.4,Fee Schedule,,23.4,,,23.4,Fee Schedule,,23.4,,,23.4,Fee Schedule,,23.4,,,23.4,Fee Schedule,,15.6,,,15.6,Other,100% of Medicaid,15.6,,,15.6,Other,100% of Medicaid,15.6,,,15.6,Other,100% of Medicaid,15.6,,,15.6,Other,100% of Medicaid,35.1,,,35.1,Other,225% of Medicaid,23.87,,,23.87,Other,153% of Medicaid,35.1,,,35.1,Other,225% of Medicaid,21.84,,,21.84,Other,140% of Medicaid,35.1,,,35.1,Other,225% of Medicaid,40.56,,,40.56,Other,250% of Medicaid,50.54,,,50.54,Other,324% of Medicaid,33.54,,,33.54,Other,215% of Medicaid,33.54,,,33.54,Other,215% of Medicaid,19.5,,,19.5,Other,125% of Medicaid,0.01,73.93,
ASPERGILLUS AG EIA,87305,CPT,,78087305,CDM,300,RC,,,both,,,69,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,15,,,15,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,42.78,,,42.78,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,42.78,,,42.78,Fee Schedule,,47.32,,,47.32,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,67.46,
STREP A AG EIA,87430,CPT,,78087430,CDM,300,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.6,,,50.6,Fee Schedule,,45.56,,,45.56,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,52.95,,,52.95,Fee Schedule,,10,,,10,Other,186% of Medicaid,62.37,,,62.37,Fee Schedule,,45.88,,,45.88,Fee Schedule,,35.3,,,,Fee Schedule,,62.37,,,62.37,Fee Schedule,,45.88,,,45.88,Fee Schedule,,66.4,,,66.4,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,79.66,,,79.66,Fee Schedule,,67.52,,,67.52,Fee Schedule,,25.22,,,25.22,Fee Schedule,,25.22,,,25.22,Fee Schedule,,25.22,,,25.22,Fee Schedule,,25.22,,,25.22,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,79.66,
BARTONELLA DNA AMP PROBE,87471,CPT,,78087471,CDM,300,RC,,,both,,,223,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,81,,,81,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,138.26,,,138.26,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,138.26,,,138.26,Fee Schedule,,138.61,,,138.61,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,270.66,
CYTOMEG DNA QUANT,87497,CPT,,78087497,CDM,300,RC,,,both,,,304,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,128.95,,,128.95,Fee Schedule,,116.1,,,116.1,Fee Schedule,,330.33,,,330.33,Fee Schedule,,297.18,,,297.18,Fee Schedule,,280.9,,,280.9,Fee Schedule,,212.8,70,,212.8,percent of total billed charges,All Other,134.95,,,134.95,Fee Schedule,,54,,,54,Other,186% of Medicaid,158.94,,,158.94,Fee Schedule,,188.48,,,188.48,Fee Schedule,,89.96,,,,Fee Schedule,,158.94,,,158.94,Fee Schedule,,188.48,,,188.48,Fee Schedule,,169.22,,,169.22,Fee Schedule,,212.8,70,,212.8,percent of total billed charges,,203.02,,,203.02,Fee Schedule,,172.07,,,172.07,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,28.85,,,28.85,Other,100% of Medicaid,28.85,,,28.85,Other,100% of Medicaid,28.85,,,28.85,Other,100% of Medicaid,28.85,,,28.85,Other,100% of Medicaid,64.9,,,64.9,Other,225% of Medicaid,44.13,,,44.13,Other,153% of Medicaid,64.9,,,64.9,Other,225% of Medicaid,40.38,,,40.38,Other,140% of Medicaid,64.9,,,64.9,Other,225% of Medicaid,75,,,75,Other,250% of Medicaid,93.46,,,93.46,Other,324% of Medicaid,62.02,,,62.02,Other,215% of Medicaid,62.02,,,62.02,Other,215% of Medicaid,36.06,,,36.06,Other,125% of Medicaid,0.01,330.33,
HEPATITIS C RNA AMP PROBE,87521,CPT,,78087521,CDM,300,RC,,,both,,,586,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,410.2,70,,410.2,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,65,,,65,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,363.32,,,363.32,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,363.32,,,363.32,Fee Schedule,,138.61,,,138.61,Fee Schedule,,410.2,70,,410.2,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,35.09,,,35.09,Other,100% of Medicaid,35.09,,,35.09,Other,100% of Medicaid,35.09,,,35.09,Other,100% of Medicaid,35.09,,,35.09,Other,100% of Medicaid,78.95,,,78.95,Other,225% of Medicaid,53.69,,,53.69,Other,153% of Medicaid,78.95,,,78.95,Other,225% of Medicaid,49.13,,,49.13,Other,140% of Medicaid,78.95,,,78.95,Other,225% of Medicaid,91.23,,,91.23,Other,250% of Medicaid,113.69,,,113.69,Other,324% of Medicaid,75.44,,,75.44,Other,215% of Medicaid,75.44,,,75.44,Other,215% of Medicaid,43.86,,,43.86,Other,125% of Medicaid,0.01,410.2,
HIV-L DNA QUANT,87536,CPT,,78087536,CDM,300,RC,,,both,,,538,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,256.15,,,256.15,Fee Schedule,,230.62,,,230.62,Fee Schedule,,656.23,,,656.23,Fee Schedule,,590.37,,,590.37,Fee Schedule,,558.04,,,558.04,Fee Schedule,,376.6,70,,376.6,percent of total billed charges,All Other,268.07,,,268.07,Fee Schedule,,158,,,158,Other,186% of Medicaid,315.72,,,315.72,Fee Schedule,,333.56,,,333.56,Fee Schedule,,178.71,,,,Fee Schedule,,315.72,,,315.72,Fee Schedule,,333.56,,,333.56,Fee Schedule,,336.15,,,336.15,Fee Schedule,,376.6,70,,376.6,percent of total billed charges,,403.29,,,403.29,Fee Schedule,,341.81,,,341.81,Fee Schedule,,127.65,,,127.65,Fee Schedule,,127.65,,,127.65,Fee Schedule,,127.65,,,127.65,Fee Schedule,,127.65,,,127.65,Fee Schedule,,85.1,,,85.1,Other,100% of Medicaid,85.1,,,85.1,Other,100% of Medicaid,85.1,,,85.1,Other,100% of Medicaid,85.1,,,85.1,Other,100% of Medicaid,191.48,,,191.48,Other,225% of Medicaid,130.2,,,130.2,Other,153% of Medicaid,191.48,,,191.48,Other,225% of Medicaid,119.14,,,119.14,Other,140% of Medicaid,191.48,,,191.48,Other,225% of Medicaid,221.26,,,221.26,Other,250% of Medicaid,275.72,,,275.72,Other,324% of Medicaid,182.97,,,182.97,Other,215% of Medicaid,182.97,,,182.97,Other,215% of Medicaid,106.38,,,106.38,Other,125% of Medicaid,0.01,656.23,
HIV-2 DNA AMP PROBE,87538,CPT,,78087538,CDM,300,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,81,,,81,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,128.96,,,128.96,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,128.96,,,128.96,Fee Schedule,,138.61,,,138.61,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,270.66,
DETECT AGENT NOS DNA AMP,87798,CPT,,78087798,CDM,300,RC,,,both,,,369,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,258.3,70,,258.3,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,228.78,,,228.78,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,228.78,,,228.78,Fee Schedule,,138.61,,,138.61,Fee Schedule,,258.3,70,,258.3,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,270.66,
RSV ASSAY W/OPTIC,87807,CPT,,78087807,CDM,300,RC,,,both,,,69,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.43,,,39.43,Fee Schedule,,35.5,,,35.5,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,All Other,41.27,,,41.27,Fee Schedule,,24,,,24,Other,186% of Medicaid,48.6,,,48.6,Fee Schedule,,42.78,,,42.78,Fee Schedule,,27.51,,,,Fee Schedule,,48.6,,,48.6,Fee Schedule,,42.78,,,42.78,Fee Schedule,,51.75,,,51.75,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,,62.08,,,62.08,Fee Schedule,,52.62,,,52.62,Fee Schedule,,19.65,,,19.65,Fee Schedule,,19.65,,,19.65,Fee Schedule,,19.65,,,19.65,Fee Schedule,,19.65,,,19.65,Fee Schedule,,13.1,,,13.1,Other,100% of Medicaid,13.1,,,13.1,Other,100% of Medicaid,13.1,,,13.1,Other,100% of Medicaid,13.1,,,13.1,Other,100% of Medicaid,29.48,,,29.48,Other,225% of Medicaid,20.04,,,20.04,Other,153% of Medicaid,29.48,,,29.48,Other,225% of Medicaid,18.34,,,18.34,Other,140% of Medicaid,29.48,,,29.48,Other,225% of Medicaid,34.06,,,34.06,Other,250% of Medicaid,42.44,,,42.44,Other,324% of Medicaid,28.17,,,28.17,Other,215% of Medicaid,28.17,,,28.17,Other,215% of Medicaid,16.38,,,16.38,Other,125% of Medicaid,0.01,67.46,
GENOTYPE DNA HIV REVERSE T,87901,CPT,,78087901,CDM,300,RC,,,both,,,888,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,774.92,,,774.92,Fee Schedule,,697.69,,,697.69,Fee Schedule,,1985.29,,,1985.29,Fee Schedule,,1786.04,,,1786.04,Fee Schedule,,1688.22,,,1688.22,Fee Schedule,,621.6,70,,621.6,percent of total billed charges,All Other,810.97,,,810.97,Fee Schedule,,479,,,479,Other,186% of Medicaid,955.14,,,955.14,Fee Schedule,,550.56,,,550.56,Fee Schedule,,540.65,,,,Fee Schedule,,955.14,,,955.14,Fee Schedule,,550.56,,,550.56,Fee Schedule,,1016.93,,,1016.93,Fee Schedule,,621.6,70,,621.6,percent of total billed charges,,1220.06,,,1220.06,Fee Schedule,,1034.08,,,1034.08,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,257.45,,,257.45,Other,100% of Medicaid,257.45,,,257.45,Other,100% of Medicaid,257.45,,,257.45,Other,100% of Medicaid,257.45,,,257.45,Other,100% of Medicaid,579.26,,,579.26,Other,225% of Medicaid,393.9,,,393.9,Other,153% of Medicaid,579.26,,,579.26,Other,225% of Medicaid,360.43,,,360.43,Other,140% of Medicaid,579.26,,,579.26,Other,225% of Medicaid,669.37,,,669.37,Other,250% of Medicaid,834.14,,,834.14,Other,324% of Medicaid,553.52,,,553.52,Other,215% of Medicaid,553.52,,,553.52,Other,215% of Medicaid,321.81,,,321.81,Other,125% of Medicaid,0.01,1985.29,
GENOTYPE DNA HEPATITIS C,87902,CPT,,78087902,CDM,300,RC,,,both,,,1948,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,774.92,,,774.92,Fee Schedule,,697.69,,,697.69,Fee Schedule,,1985.29,,,1985.29,Fee Schedule,,1786.04,,,1786.04,Fee Schedule,,1688.22,,,1688.22,Fee Schedule,,1363.6,70,,1363.6,percent of total billed charges,All Other,810.97,,,810.97,Fee Schedule,,479,,,479,Other,186% of Medicaid,955.14,,,955.14,Fee Schedule,,1207.76,,,1207.76,Fee Schedule,,540.65,,,,Fee Schedule,,955.14,,,955.14,Fee Schedule,,1207.76,,,1207.76,Fee Schedule,,1016.93,,,1016.93,Fee Schedule,,1363.6,70,,1363.6,percent of total billed charges,,1220.06,,,1220.06,Fee Schedule,,1034.08,,,1034.08,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,257.45,,,257.45,Other,100% of Medicaid,257.45,,,257.45,Other,100% of Medicaid,257.45,,,257.45,Other,100% of Medicaid,257.45,,,257.45,Other,100% of Medicaid,579.26,,,579.26,Other,225% of Medicaid,393.9,,,393.9,Other,153% of Medicaid,579.26,,,579.26,Other,225% of Medicaid,360.43,,,360.43,Other,140% of Medicaid,579.26,,,579.26,Other,225% of Medicaid,669.37,,,669.37,Other,250% of Medicaid,834.14,,,834.14,Other,324% of Medicaid,553.52,,,553.52,Other,215% of Medicaid,553.52,,,553.52,Other,215% of Medicaid,321.81,,,321.81,Other,125% of Medicaid,0.01,1985.29,
BILIRUBIN TOTAL TRANSCUT,88720,CPT,TC,85088720,CDM,300,RC,,,both,,,30,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,15.11,,,15.11,Fee Schedule,,13.6,,,13.6,Fee Schedule,,38.69,,,38.69,Fee Schedule,,34.81,,,34.81,Fee Schedule,,32.9,,,32.9,Fee Schedule,,21,70,,21,percent of total billed charges,All Other,15.81,,,15.81,Fee Schedule,,33,,,33,Other,186% of Medicaid,18.62,,,18.62,Fee Schedule,,18.6,,,18.6,Fee Schedule,,10.54,,,,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.6,,,18.6,Fee Schedule,,19.83,,,19.83,Fee Schedule,,21,70,,21,percent of total billed charges,,23.79,,,23.79,Fee Schedule,,20.16,,,20.16,Fee Schedule,,7.53,,,7.53,Fee Schedule,,7.53,,,7.53,Fee Schedule,,7.53,,,7.53,Fee Schedule,,7.53,,,7.53,Fee Schedule,,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,27.38,,,27.38,Other,153% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,25.06,,,25.06,Other,140% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,46.53,,,46.53,Other,250% of Medicaid,57.99,,,57.99,Other,324% of Medicaid,38.48,,,38.48,Other,215% of Medicaid,38.48,,,38.48,Other,215% of Medicaid,22.37,,,22.37,Other,125% of Medicaid,0.01,57.99,
BODY FLUID CELL COUNT,89050,CPT,,78089050,CDM,300,RC,,,both,,,26,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.21,,,14.21,Fee Schedule,,12.79,,,12.79,Fee Schedule,,33.1,,,33.1,Fee Schedule,,29.78,,,29.78,Fee Schedule,,28.15,,,28.15,Fee Schedule,,18.2,70,,18.2,percent of total billed charges,All Other,14.87,,,14.87,Fee Schedule,,5,,,5,Other,186% of Medicaid,17.51,,,17.51,Fee Schedule,,16.12,,,16.12,Fee Schedule,,9.91,,,,Fee Schedule,,17.51,,,17.51,Fee Schedule,,16.12,,,16.12,Fee Schedule,,18.64,,,18.64,Fee Schedule,,18.2,70,,18.2,percent of total billed charges,,22.37,,,22.37,Fee Schedule,,18.96,,,18.96,Fee Schedule,,7.08,,,7.08,Fee Schedule,,7.08,,,7.08,Fee Schedule,,7.08,,,7.08,Fee Schedule,,7.08,,,7.08,Fee Schedule,,2.83,,,2.83,Other,100% of Medicaid,2.83,,,2.83,Other,100% of Medicaid,2.83,,,2.83,Other,100% of Medicaid,2.83,,,2.83,Other,100% of Medicaid,6.36,,,6.36,Other,225% of Medicaid,4.33,,,4.33,Other,153% of Medicaid,6.36,,,6.36,Other,225% of Medicaid,3.96,,,3.96,Other,140% of Medicaid,6.36,,,6.36,Other,225% of Medicaid,7.35,,,7.35,Other,250% of Medicaid,9.16,,,9.16,Other,324% of Medicaid,6.08,,,6.08,Other,215% of Medicaid,6.08,,,6.08,Other,215% of Medicaid,3.54,,,3.54,Other,125% of Medicaid,0.01,33.1,
LEUKOCYTE ASSESSMENT FECAL,89055,CPT,,78089055,CDM,300,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.85,,,12.85,Fee Schedule,,11.57,,,11.57,Fee Schedule,,32.93,,,32.93,Fee Schedule,,29.63,,,29.63,Fee Schedule,,28.01,,,28.01,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,All Other,13.45,,,13.45,Fee Schedule,,6,,,6,Other,186% of Medicaid,15.84,,,15.84,Fee Schedule,,40.3,,,40.3,Fee Schedule,,8.97,,,,Fee Schedule,,15.84,,,15.84,Fee Schedule,,40.3,,,40.3,Fee Schedule,,16.87,,,16.87,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,,20.24,,,20.24,Fee Schedule,,17.15,,,17.15,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,5.25,,,5.25,Other,153% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,4.81,,,4.81,Other,140% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,8.93,,,8.93,Other,250% of Medicaid,11.13,,,11.13,Other,324% of Medicaid,7.38,,,7.38,Other,215% of Medicaid,7.38,,,7.38,Other,215% of Medicaid,4.29,,,4.29,Other,125% of Medicaid,0.01,45.5,
EXAM SYNOVIAL FLUID CRYSTALS,89060,CPT,TC,85089060,CDM,300,RC,,,both,,,80,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,22.06,,,22.06,Fee Schedule,,19.86,,,19.86,Fee Schedule,,55.13,,,55.13,Fee Schedule,,49.6,,,49.6,Fee Schedule,,46.88,,,46.88,Fee Schedule,,56,70,,56,percent of total billed charges,All Other,23.09,,,23.09,Fee Schedule,,11,,,11,Other,186% of Medicaid,27.19,,,27.19,Fee Schedule,,49.6,,,49.6,Fee Schedule,,15.39,,,,Fee Schedule,,27.19,,,27.19,Fee Schedule,,49.6,,,49.6,Fee Schedule,,28.95,,,28.95,Fee Schedule,,56,70,,56,percent of total billed charges,,34.74,,,34.74,Fee Schedule,,29.44,,,29.44,Fee Schedule,,11,,,11,Fee Schedule,,11,,,11,Fee Schedule,,11,,,11,Fee Schedule,,11,,,11,Fee Schedule,,6.06,,,6.06,Other,100% of Medicaid,6.06,,,6.06,Other,100% of Medicaid,6.06,,,6.06,Other,100% of Medicaid,6.06,,,6.06,Other,100% of Medicaid,13.64,,,13.64,Other,225% of Medicaid,9.27,,,9.27,Other,153% of Medicaid,13.64,,,13.64,Other,225% of Medicaid,8.48,,,8.48,Other,140% of Medicaid,13.64,,,13.64,Other,225% of Medicaid,15.76,,,15.76,Other,250% of Medicaid,19.63,,,19.63,Other,324% of Medicaid,13.03,,,13.03,Other,215% of Medicaid,13.03,,,13.03,Other,215% of Medicaid,7.58,,,7.58,Other,125% of Medicaid,0.01,56,
MEAT FIBERS FECES,89160,CPT,,78089160,CDM,300,RC,,,both,,,24,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14.6,,,14.6,Fee Schedule,,13.14,,,13.14,Fee Schedule,,28.44,,,28.44,Fee Schedule,,25.59,,,25.59,Fee Schedule,,24.19,,,24.19,Fee Schedule,,16.8,70,,16.8,percent of total billed charges,All Other,15.28,,,15.28,Fee Schedule,,79,,,79,Other,186% of Medicaid,17.99,,,17.99,Fee Schedule,,14.88,,,14.88,Fee Schedule,,10.19,,,,Fee Schedule,,17.99,,,17.99,Fee Schedule,,14.88,,,14.88,Fee Schedule,,19.16,,,19.16,Fee Schedule,,16.8,70,,16.8,percent of total billed charges,,22.98,,,22.98,Fee Schedule,,19.48,,,19.48,Fee Schedule,,7.28,,,7.28,Fee Schedule,,7.28,,,7.28,Fee Schedule,,7.28,,,7.28,Fee Schedule,,7.28,,,7.28,Fee Schedule,,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,65.16,,,65.16,Other,153% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,59.62,,,59.62,Other,140% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,110.72,,,110.72,Other,250% of Medicaid,137.98,,,137.98,Other,324% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,53.23,,,53.23,Other,125% of Medicaid,0.01,137.98,
PROSTATE CANCER SCREENING PSA,G0103,HCPCS,,78000002,CDM,300,RC,,,both,,,137,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,58.12,,,58.12,Fee Schedule,,52.33,,,52.33,Fee Schedule,,141.88,,,141.88,Fee Schedule,,127.64,,,127.64,Fee Schedule,,120.65,,,120.65,Fee Schedule,,95.9,70,,95.9,percent of total billed charges,All Other,60.83,,,60.83,Fee Schedule,,32,,,32,Other,186% of Medicaid,71.64,,,71.64,Fee Schedule,,84.94,,,84.94,Fee Schedule,,40.55,,,,Fee Schedule,,71.64,,,71.64,Fee Schedule,,84.94,,,84.94,Fee Schedule,,76.27,,,76.27,Fee Schedule,,95.9,70,,95.9,percent of total billed charges,,91.51,,,91.51,Fee Schedule,,77.56,,,77.56,Fee Schedule,,28.97,,,28.97,Fee Schedule,,28.97,,,28.97,Fee Schedule,,28.97,,,28.97,Fee Schedule,,28.97,,,28.97,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,141.88,
CATH CLCT SPEC 1 PT ALL PLACES,P9612,HCPCS,,78000010,CDM,300,RC,,,both,,,60,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.58,,,26.58,Fee Schedule,,23.93,,,23.93,Fee Schedule,,45.9,76.5,,45.9,percent of total billed charges,All Other,41.4,69,,41.4,percent of total billed charges,All Other,39,65,,39,percent of total billed charges,All Other,42,70,,42,percent of total billed charges,All Other,27.81,,,27.81,Fee Schedule,,75,,,75,Other,186% of Medicaid,32.76,,,32.76,Fee Schedule,,37.2,,,37.2,Fee Schedule,,18.54,,,,Fee Schedule,,32.76,,,32.76,Fee Schedule,,37.2,,,37.2,Fee Schedule,,34.88,,,34.88,Fee Schedule,,42,70,,42,percent of total billed charges,,14.22,,,14.22,Fee Schedule,,12.05,,,12.05,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
METABOLIC PANEL IONIZED CA,80047,CPT,QW,78080047,CDM,301,RC,,,both,,,39,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.33,,,41.33,Fee Schedule,,37.21,,,37.21,Fee Schedule,,49.27,,,49.27,Fee Schedule,,44.32,,,44.32,Fee Schedule,,41.89,,,41.89,Fee Schedule,,27.3,70,,27.3,percent of total billed charges,All Other,43.25,,,43.25,Fee Schedule,,14,,,14,Other,186% of Medicaid,50.94,,,50.94,Fee Schedule,,24.18,,,24.18,Fee Schedule,,28.83,,,,Fee Schedule,,50.94,,,50.94,Fee Schedule,,24.18,,,24.18,Fee Schedule,,54.23,,,54.23,Fee Schedule,,27.3,70,,27.3,percent of total billed charges,,65.07,,,65.07,Fee Schedule,,55.15,,,55.15,Fee Schedule,,20.6,,,20.6,Fee Schedule,,20.6,,,20.6,Fee Schedule,,20.6,,,20.6,Fee Schedule,,20.6,,,20.6,Fee Schedule,,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,11.2,,,11.2,Other,153% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,10.25,,,10.25,Other,140% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,19.04,,,19.04,Other,250% of Medicaid,23.72,,,23.72,Other,324% of Medicaid,15.74,,,15.74,Other,215% of Medicaid,15.74,,,15.74,Other,215% of Medicaid,9.15,,,9.15,Other,125% of Medicaid,0.01,65.07,
METABOLIC PANEL TOTAL CA,80048,CPT,,78080048,CDM,301,RC,,,both,,,210,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,25.46,,,25.46,Fee Schedule,,22.93,,,22.93,Fee Schedule,,49.27,,,49.27,Fee Schedule,,44.32,,,44.32,Fee Schedule,,41.89,,,41.89,Fee Schedule,,147,70,,147,percent of total billed charges,All Other,26.65,,,26.65,Fee Schedule,,14,,,14,Other,186% of Medicaid,31.39,,,31.39,Fee Schedule,,130.2,,,130.2,Fee Schedule,,17.77,,,,Fee Schedule,,31.39,,,31.39,Fee Schedule,,130.2,,,130.2,Fee Schedule,,33.42,,,33.42,Fee Schedule,,147,70,,147,percent of total billed charges,,40.09,,,40.09,Fee Schedule,,33.98,,,33.98,Fee Schedule,,12.69,,,12.69,Fee Schedule,,12.69,,,12.69,Fee Schedule,,12.69,,,12.69,Fee Schedule,,12.69,,,12.69,Fee Schedule,,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,11.2,,,11.2,Other,153% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,10.25,,,10.25,Other,140% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,19.04,,,19.04,Other,250% of Medicaid,23.72,,,23.72,Other,324% of Medicaid,15.74,,,15.74,Other,215% of Medicaid,15.74,,,15.74,Other,215% of Medicaid,9.15,,,9.15,Other,125% of Medicaid,0.01,147,
GENERAL HEALTH PANEL,80050,CPT,,78080050,CDM,301,RC,,,both,,,258,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,167.7,65,,167.7,percent of total billed charges,All Other,152.22,59,,152.22,percent of total billed charges,All Other,15.79,,,15.79,Fee Schedule,,15.79,,,15.79,Fee Schedule,,15.79,,,15.79,Fee Schedule,,180.6,70,,180.6,percent of total billed charges,All Other,175.44,68,,175.44,percent of total billed charges,All Other,59,,,59,Other,186% of Medicaid,214.14,80,,214.14,percent of total billed charges,All Other,159.96,83,,159.96,percent of total billed charges,All Other,141.9,83,,,percent of total billed charges,All Other,214.14,80,,214.14,percent of total billed charges,All Other,159.96,83,,159.96,percent of total billed charges,All Other,206.4,80,,206.4,percent of total billed charges,All Other,180.6,70,,180.6,percent of total billed charges,,167.28,,,167.28,Fee Schedule,,141.78,,,141.78,Fee Schedule,,70.92,,,70.92,Fee Schedule,,70.92,,,70.92,Fee Schedule,,70.92,,,70.92,Fee Schedule,,70.92,,,70.92,Fee Schedule,,31.85,,,31.85,Other,100% of Medicaid,31.85,,,31.85,Other,100% of Medicaid,31.85,,,31.85,Other,100% of Medicaid,31.85,,,31.85,Other,100% of Medicaid,71.65,,,71.65,Other,225% of Medicaid,48.72,,,48.72,Other,153% of Medicaid,71.65,,,71.65,Other,225% of Medicaid,44.58,,,44.58,Other,140% of Medicaid,71.65,,,71.65,Other,225% of Medicaid,82.8,,,82.8,Other,250% of Medicaid,103.18,,,103.18,Other,324% of Medicaid,68.47,,,68.47,Other,215% of Medicaid,68.47,,,68.47,Other,215% of Medicaid,39.81,,,39.81,Other,125% of Medicaid,0.01,214.14,
ELECTROLYTE PANEL,80051,CPT,,78080051,CDM,301,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,21.1,,,21.1,Fee Schedule,,19,,,19,Fee Schedule,,41.15,,,41.15,Fee Schedule,,37.02,,,37.02,Fee Schedule,,35,,,35,Fee Schedule,,63,70,,63,percent of total billed charges,All Other,22.08,,,22.08,Fee Schedule,,11,,,11,Other,186% of Medicaid,26.01,,,26.01,Fee Schedule,,55.8,,,55.8,Fee Schedule,,14.72,,,,Fee Schedule,,26.01,,,26.01,Fee Schedule,,55.8,,,55.8,Fee Schedule,,27.69,,,27.69,Fee Schedule,,63,70,,63,percent of total billed charges,,33.22,,,33.22,Fee Schedule,,28.16,,,28.16,Fee Schedule,,10.52,,,10.52,Fee Schedule,,10.52,,,10.52,Fee Schedule,,10.52,,,10.52,Fee Schedule,,10.52,,,10.52,Fee Schedule,,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,9.33,,,9.33,Other,153% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,8.54,,,8.54,Other,140% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,15.86,,,15.86,Other,250% of Medicaid,19.77,,,19.77,Other,324% of Medicaid,13.12,,,13.12,Other,215% of Medicaid,13.12,,,13.12,Other,215% of Medicaid,7.63,,,7.63,Other,125% of Medicaid,0.01,63,
COMPREHEN METABOLIC PANEL,80053,CPT,,78080053,CDM,301,RC,,,both,,,245,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,31.79,,,31.79,Fee Schedule,,28.62,,,28.62,Fee Schedule,,73.71,,,73.71,Fee Schedule,,66.31,,,66.31,Fee Schedule,,62.68,,,62.68,Fee Schedule,,171.5,70,,171.5,percent of total billed charges,All Other,33.26,,,33.26,Fee Schedule,,19,,,19,Other,186% of Medicaid,39.18,,,39.18,Fee Schedule,,151.9,,,151.9,Fee Schedule,,22.18,,,,Fee Schedule,,39.18,,,39.18,Fee Schedule,,151.9,,,151.9,Fee Schedule,,41.71,,,41.71,Fee Schedule,,171.5,70,,171.5,percent of total billed charges,,50.04,,,50.04,Fee Schedule,,42.42,,,42.42,Fee Schedule,,15.84,,,15.84,Fee Schedule,,15.84,,,15.84,Fee Schedule,,15.84,,,15.84,Fee Schedule,,15.84,,,15.84,Fee Schedule,,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,15.45,,,15.45,Other,153% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,14.14,,,14.14,Other,140% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,26.26,,,26.26,Other,250% of Medicaid,32.72,,,32.72,Other,324% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,12.63,,,12.63,Other,125% of Medicaid,0.01,171.5,
LIPID PANEL,80061,CPT,,78080061,CDM,301,RC,,,both,,,227,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,40.3,,,40.3,Fee Schedule,,36.29,,,36.29,Fee Schedule,,103.3,,,103.3,Fee Schedule,,92.93,,,92.93,Fee Schedule,,87.84,,,87.84,Fee Schedule,,158.9,70,,158.9,percent of total billed charges,All Other,42.18,,,42.18,Fee Schedule,,11,,,11,Other,186% of Medicaid,49.68,,,49.68,Fee Schedule,,140.74,,,140.74,Fee Schedule,,28.12,,,,Fee Schedule,,49.68,,,49.68,Fee Schedule,,140.74,,,140.74,Fee Schedule,,52.89,,,52.89,Fee Schedule,,158.9,70,,158.9,percent of total billed charges,,63.46,,,63.46,Fee Schedule,,53.78,,,53.78,Fee Schedule,,20.09,,,20.09,Fee Schedule,,20.09,,,20.09,Fee Schedule,,20.09,,,20.09,Fee Schedule,,20.09,,,20.09,Fee Schedule,,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,9.33,,,9.33,Other,153% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,8.54,,,8.54,Other,140% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,15.86,,,15.86,Other,250% of Medicaid,19.77,,,19.77,Other,324% of Medicaid,13.12,,,13.12,Other,215% of Medicaid,13.12,,,13.12,Other,215% of Medicaid,7.63,,,7.63,Other,125% of Medicaid,0.01,158.9,
RENAL FUNCTION PANEL,80069,CPT,,78080069,CDM,301,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,26.13,,,26.13,Fee Schedule,,23.52,,,23.52,Fee Schedule,,61.81,,,61.81,Fee Schedule,,55.61,,,55.61,Fee Schedule,,52.56,,,52.56,Fee Schedule,,63,70,,63,percent of total billed charges,All Other,27.34,,,27.34,Fee Schedule,,16,,,16,Other,186% of Medicaid,32.2,,,32.2,Fee Schedule,,55.8,,,55.8,Fee Schedule,,18.23,,,,Fee Schedule,,32.2,,,32.2,Fee Schedule,,55.8,,,55.8,Fee Schedule,,34.29,,,34.29,Fee Schedule,,63,70,,63,percent of total billed charges,,41.13,,,41.13,Fee Schedule,,34.86,,,34.86,Fee Schedule,,13.02,,,13.02,Fee Schedule,,13.02,,,13.02,Fee Schedule,,13.02,,,13.02,Fee Schedule,,13.02,,,13.02,Fee Schedule,,8.68,,,8.68,Other,100% of Medicaid,8.68,,,8.68,Other,100% of Medicaid,8.68,,,8.68,Other,100% of Medicaid,8.68,,,8.68,Other,100% of Medicaid,19.53,,,19.53,Other,225% of Medicaid,13.28,,,13.28,Other,153% of Medicaid,19.53,,,19.53,Other,225% of Medicaid,12.15,,,12.15,Other,140% of Medicaid,19.53,,,19.53,Other,225% of Medicaid,22.57,,,22.57,Other,250% of Medicaid,28.12,,,28.12,Other,324% of Medicaid,18.66,,,18.66,Other,215% of Medicaid,18.66,,,18.66,Other,215% of Medicaid,10.85,,,10.85,Other,125% of Medicaid,0.01,63,
ACUTE HEPATITIS PANEL,80074,CPT,,78080074,CDM,301,RC,,,both,,,395,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,143.37,,,143.37,Fee Schedule,,129.08,,,129.08,Fee Schedule,,367.21,,,367.21,Fee Schedule,,330.36,,,330.36,Fee Schedule,,312.27,,,312.27,Fee Schedule,,276.5,70,,276.5,percent of total billed charges,All Other,150.03,,,150.03,Fee Schedule,,59,,,59,Other,186% of Medicaid,176.71,,,176.71,Fee Schedule,,244.9,,,244.9,Fee Schedule,,100.02,,,,Fee Schedule,,176.71,,,176.71,Fee Schedule,,244.9,,,244.9,Fee Schedule,,188.14,,,188.14,Fee Schedule,,276.5,70,,276.5,percent of total billed charges,,225.72,,,225.72,Fee Schedule,,191.31,,,191.31,Fee Schedule,,71.45,,,71.45,Fee Schedule,,71.45,,,71.45,Fee Schedule,,71.45,,,71.45,Fee Schedule,,71.45,,,71.45,Fee Schedule,,31.85,,,31.85,Other,100% of Medicaid,31.85,,,31.85,Other,100% of Medicaid,31.85,,,31.85,Other,100% of Medicaid,31.85,,,31.85,Other,100% of Medicaid,71.65,,,71.65,Other,225% of Medicaid,48.72,,,48.72,Other,153% of Medicaid,71.65,,,71.65,Other,225% of Medicaid,44.58,,,44.58,Other,140% of Medicaid,71.65,,,71.65,Other,225% of Medicaid,82.8,,,82.8,Other,250% of Medicaid,103.18,,,103.18,Other,324% of Medicaid,68.47,,,68.47,Other,215% of Medicaid,68.47,,,68.47,Other,215% of Medicaid,39.81,,,39.81,Other,125% of Medicaid,0.01,367.21,
HEPATIC FUNCTION PANEL,80076,CPT,,78080076,CDM,301,RC,,,both,,,224,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.59,,,24.59,Fee Schedule,,22.14,,,22.14,Fee Schedule,,49.27,,,49.27,Fee Schedule,,44.32,,,44.32,Fee Schedule,,41.89,,,41.89,Fee Schedule,,156.8,70,,156.8,percent of total billed charges,All Other,25.74,,,25.74,Fee Schedule,,14,,,14,Other,186% of Medicaid,30.31,,,30.31,Fee Schedule,,138.88,,,138.88,Fee Schedule,,17.16,,,,Fee Schedule,,30.31,,,30.31,Fee Schedule,,138.88,,,138.88,Fee Schedule,,32.27,,,32.27,Fee Schedule,,156.8,70,,156.8,percent of total billed charges,,38.72,,,38.72,Fee Schedule,,32.82,,,32.82,Fee Schedule,,12.26,,,12.26,Fee Schedule,,12.26,,,12.26,Fee Schedule,,12.26,,,12.26,Fee Schedule,,12.26,,,12.26,Fee Schedule,,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,11.2,,,11.2,Other,153% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,10.25,,,10.25,Other,140% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,19.04,,,19.04,Other,250% of Medicaid,23.72,,,23.72,Other,324% of Medicaid,15.74,,,15.74,Other,215% of Medicaid,15.74,,,15.74,Other,215% of Medicaid,9.15,,,9.15,Other,125% of Medicaid,0.01,156.8,
DRUG ASSAY ADALIMUMAB,80145,CPT,,78080145,CDM,301,RC,,,both,,,122,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,116.1,,,116.1,Fee Schedule,,104.52,,,104.52,Fee Schedule,,30.86,,,30.86,Fee Schedule,,30.86,,,30.86,Fee Schedule,,30.86,,,30.86,Fee Schedule,,85.4,70,,85.4,percent of total billed charges,All Other,121.5,,,121.5,Fee Schedule,,20,,,20,Other,186% of Medicaid,143.09,,,143.09,Fee Schedule,,75.64,,,75.64,Fee Schedule,,81,,,,Fee Schedule,,143.09,,,143.09,Fee Schedule,,75.64,,,75.64,Fee Schedule,,152.35,,,152.35,Fee Schedule,,85.4,70,,85.4,percent of total billed charges,,182.78,,,182.78,Fee Schedule,,154.92,,,154.92,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,182.78,
DRUG ASSAY CAFFEINE,80155,CPT,,78080155,CDM,301,RC,,,both,,,122,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,116.1,,,116.1,Fee Schedule,,104.52,,,104.52,Fee Schedule,,7.72,,,7.72,Fee Schedule,,7.72,,,7.72,Fee Schedule,,7.72,,,7.72,Fee Schedule,,85.4,70,,85.4,percent of total billed charges,All Other,121.5,,,121.5,Fee Schedule,,44,,,44,Other,186% of Medicaid,143.09,,,143.09,Fee Schedule,,75.64,,,75.64,Fee Schedule,,81,,,,Fee Schedule,,143.09,,,143.09,Fee Schedule,,75.64,,,75.64,Fee Schedule,,152.35,,,152.35,Fee Schedule,,85.4,70,,85.4,percent of total billed charges,,182.78,,,182.78,Fee Schedule,,154.92,,,154.92,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,35.91,,,35.91,Other,153% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,32.86,,,32.86,Other,140% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,61.02,,,61.02,Other,250% of Medicaid,76.04,,,76.04,Other,324% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,29.34,,,29.34,Other,125% of Medicaid,0.01,182.78,
ASSAY CARBAMAZEPINE TOTAL,80156,CPT,,78080156,CDM,301,RC,,,both,,,210,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.86,,,43.86,Fee Schedule,,39.48,,,39.48,Fee Schedule,,90.47,,,90.47,Fee Schedule,,81.39,,,81.39,Fee Schedule,,76.94,,,76.94,Fee Schedule,,147,70,,147,percent of total billed charges,All Other,45.9,,,45.9,Fee Schedule,,20,,,20,Other,186% of Medicaid,54.05,,,54.05,Fee Schedule,,130.2,,,130.2,Fee Schedule,,30.6,,,,Fee Schedule,,54.05,,,54.05,Fee Schedule,,130.2,,,130.2,Fee Schedule,,57.55,,,57.55,Fee Schedule,,147,70,,147,percent of total billed charges,,69.05,,,69.05,Fee Schedule,,58.52,,,58.52,Fee Schedule,,21.86,,,21.86,Fee Schedule,,21.86,,,21.86,Fee Schedule,,21.86,,,21.86,Fee Schedule,,21.86,,,21.86,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,147,
ASSAY CARBAMAZEPINE FREE,80157,CPT,,78080157,CDM,301,RC,,,both,,,42,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.88,,,39.88,Fee Schedule,,35.91,,,35.91,Fee Schedule,,102.26,,,102.26,Fee Schedule,,91.99,,,91.99,Fee Schedule,,86.96,,,86.96,Fee Schedule,,29.4,70,,29.4,percent of total billed charges,All Other,41.74,,,41.74,Fee Schedule,,20,,,20,Other,186% of Medicaid,49.16,,,49.16,Fee Schedule,,26.04,,,26.04,Fee Schedule,,27.83,,,,Fee Schedule,,49.16,,,49.16,Fee Schedule,,26.04,,,26.04,Fee Schedule,,52.34,,,52.34,Fee Schedule,,29.4,70,,29.4,percent of total billed charges,,62.79,,,62.79,Fee Schedule,,53.22,,,53.22,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,102.26,
ASSAY OF CYCLOSPORINE,80158,CPT,,78080158,CDM,301,RC,,,both,,,275,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,54.33,,,54.33,Fee Schedule,,48.92,,,48.92,Fee Schedule,,139.19,,,139.19,Fee Schedule,,125.22,,,125.22,Fee Schedule,,118.36,,,118.36,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,All Other,56.86,,,56.86,Fee Schedule,,20,,,20,Other,186% of Medicaid,66.97,,,66.97,Fee Schedule,,170.5,,,170.5,Fee Schedule,,37.91,,,,Fee Schedule,,66.97,,,66.97,Fee Schedule,,170.5,,,170.5,Fee Schedule,,71.3,,,71.3,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,,85.54,,,85.54,Fee Schedule,,72.5,,,72.5,Fee Schedule,,27.08,,,27.08,Fee Schedule,,27.08,,,27.08,Fee Schedule,,27.08,,,27.08,Fee Schedule,,27.08,,,27.08,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,192.5,
DRUG SCREEN QUANT CLOZAPINE,80159,CPT,,78080159,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,60.65,,,60.65,Fee Schedule,,54.61,,,54.61,Fee Schedule,,10.09,,,10.09,Fee Schedule,,10.09,,,10.09,Fee Schedule,,10.09,,,10.09,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,63.47,,,63.47,Fee Schedule,,20,,,20,Other,186% of Medicaid,74.76,,,74.76,Fee Schedule,,62,,,62,Fee Schedule,,42.32,,,,Fee Schedule,,74.76,,,74.76,Fee Schedule,,62,,,62,Fee Schedule,,79.59,,,79.59,Fee Schedule,,70,70,,70,percent of total billed charges,,95.49,,,95.49,Fee Schedule,,80.93,,,80.93,Fee Schedule,,30.23,,,30.23,Fee Schedule,,30.23,,,30.23,Fee Schedule,,30.23,,,30.23,Fee Schedule,,30.23,,,30.23,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,95.49,
ASSAY DIPROPYLACETIC ACID,80164,CPT,,78080164,CDM,301,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,40.76,,,40.76,Fee Schedule,,36.69,,,36.69,Fee Schedule,,104.45,,,104.45,Fee Schedule,,93.97,,,93.97,Fee Schedule,,88.82,,,88.82,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,All Other,42.65,,,42.65,Fee Schedule,,20,,,20,Other,186% of Medicaid,50.23,,,50.23,Fee Schedule,,112.84,,,112.84,Fee Schedule,,28.43,,,,Fee Schedule,,50.23,,,50.23,Fee Schedule,,112.84,,,112.84,Fee Schedule,,53.48,,,53.48,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,,64.17,,,64.17,Fee Schedule,,54.39,,,54.39,Fee Schedule,,20.31,,,20.31,Fee Schedule,,20.31,,,20.31,Fee Schedule,,20.31,,,20.31,Fee Schedule,,20.31,,,20.31,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,127.4,
ASSAY OF ETHOSUXIMIDE,80168,CPT,,78080168,CDM,301,RC,,,both,,,160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.18,,,49.18,Fee Schedule,,44.28,,,44.28,Fee Schedule,,126.04,,,126.04,Fee Schedule,,113.39,,,113.39,Fee Schedule,,107.18,,,107.18,Fee Schedule,,112,70,,112,percent of total billed charges,All Other,51.47,,,51.47,Fee Schedule,,20,,,20,Other,186% of Medicaid,60.62,,,60.62,Fee Schedule,,99.2,,,99.2,Fee Schedule,,34.31,,,,Fee Schedule,,60.62,,,60.62,Fee Schedule,,99.2,,,99.2,Fee Schedule,,64.54,,,64.54,Fee Schedule,,112,70,,112,percent of total billed charges,,77.44,,,77.44,Fee Schedule,,65.63,,,65.63,Fee Schedule,,24.51,,,24.51,Fee Schedule,,24.51,,,24.51,Fee Schedule,,24.51,,,24.51,Fee Schedule,,24.51,,,24.51,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,126.04,
ASSAY OF GENTAMICIN,80170,CPT,,78080170,CDM,301,RC,,,both,,,233,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.3,,,49.3,Fee Schedule,,44.39,,,44.39,Fee Schedule,,126.42,,,126.42,Fee Schedule,,113.74,,,113.74,Fee Schedule,,107.51,,,107.51,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,All Other,51.6,,,51.6,Fee Schedule,,20,,,20,Other,186% of Medicaid,60.77,,,60.77,Fee Schedule,,144.46,,,144.46,Fee Schedule,,34.4,,,,Fee Schedule,,60.77,,,60.77,Fee Schedule,,144.46,,,144.46,Fee Schedule,,64.7,,,64.7,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,,77.63,,,77.63,Fee Schedule,,65.79,,,65.79,Fee Schedule,,24.57,,,24.57,Fee Schedule,,24.57,,,24.57,Fee Schedule,,24.57,,,24.57,Fee Schedule,,24.57,,,24.57,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,163.1,
ASSAY OF HALOPERIDOL,80173,CPT,,78080173,CDM,301,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,47.5,,,47.5,Fee Schedule,,42.76,,,42.76,Fee Schedule,,90.47,,,90.47,Fee Schedule,,81.39,,,81.39,Fee Schedule,,76.94,,,76.94,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,49.71,,,49.71,Fee Schedule,,20,,,20,Other,186% of Medicaid,58.54,,,58.54,Fee Schedule,,129.58,,,129.58,Fee Schedule,,33.14,,,,Fee Schedule,,58.54,,,58.54,Fee Schedule,,129.58,,,129.58,Fee Schedule,,62.33,,,62.33,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,,74.78,,,74.78,Fee Schedule,,63.38,,,63.38,Fee Schedule,,23.67,,,23.67,Fee Schedule,,23.67,,,23.67,Fee Schedule,,23.67,,,23.67,Fee Schedule,,23.67,,,23.67,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,146.3,
DRUG SCREEN QUAN LAMOTRIGINE,80175,CPT,,78080175,CDM,301,RC,,,both,,,31,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.88,,,39.88,Fee Schedule,,35.91,,,35.91,Fee Schedule,,7.24,,,7.24,Fee Schedule,,7.24,,,7.24,Fee Schedule,,7.24,,,7.24,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,All Other,41.74,,,41.74,Fee Schedule,,20,,,20,Other,186% of Medicaid,49.16,,,49.16,Fee Schedule,,19.22,,,19.22,Fee Schedule,,27.83,,,,Fee Schedule,,49.16,,,49.16,Fee Schedule,,19.22,,,19.22,Fee Schedule,,52.34,,,52.34,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,,62.79,,,62.79,Fee Schedule,,53.22,,,53.22,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,62.79,
ASSAY OF LIDOCAINE,80176,CPT,,78080176,CDM,301,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,44.22,,,44.22,Fee Schedule,,39.81,,,39.81,Fee Schedule,,113.27,,,113.27,Fee Schedule,,101.9,,,101.9,Fee Schedule,,96.32,,,96.32,Fee Schedule,,126,70,,126,percent of total billed charges,All Other,46.27,,,46.27,Fee Schedule,,44,,,44,Other,186% of Medicaid,54.5,,,54.5,Fee Schedule,,111.6,,,111.6,Fee Schedule,,30.85,,,,Fee Schedule,,54.5,,,54.5,Fee Schedule,,111.6,,,111.6,Fee Schedule,,58.03,,,58.03,Fee Schedule,,126,70,,126,percent of total billed charges,,69.62,,,69.62,Fee Schedule,,59,,,59,Fee Schedule,,22.04,,,22.04,Fee Schedule,,22.04,,,22.04,Fee Schedule,,22.04,,,22.04,Fee Schedule,,22.04,,,22.04,Fee Schedule,,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,35.91,,,35.91,Other,153% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,32.86,,,32.86,Other,140% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,61.02,,,61.02,Other,250% of Medicaid,76.04,,,76.04,Other,324% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,29.34,,,29.34,Other,125% of Medicaid,0.01,126,
DRUG SCRN QUAN LEVETIRACETAM,80177,CPT,,78080177,CDM,301,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.88,,,39.88,Fee Schedule,,35.91,,,35.91,Fee Schedule,,7.24,,,7.24,Fee Schedule,,7.24,,,7.24,Fee Schedule,,7.24,,,7.24,Fee Schedule,,126,70,,126,percent of total billed charges,All Other,41.74,,,41.74,Fee Schedule,,20,,,20,Other,186% of Medicaid,49.16,,,49.16,Fee Schedule,,111.6,,,111.6,Fee Schedule,,27.83,,,,Fee Schedule,,49.16,,,49.16,Fee Schedule,,111.6,,,111.6,Fee Schedule,,52.34,,,52.34,Fee Schedule,,126,70,,126,percent of total billed charges,,62.79,,,62.79,Fee Schedule,,53.22,,,53.22,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,126,
ASSAY OF LITHIUM,80178,CPT,,78080178,CDM,301,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.9,,,19.9,Fee Schedule,,17.91,,,17.91,Fee Schedule,,50.96,,,50.96,Fee Schedule,,45.85,,,45.85,Fee Schedule,,43.34,,,43.34,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,20.82,,,20.82,Fee Schedule,,12,,,12,Other,186% of Medicaid,24.52,,,24.52,Fee Schedule,,57.66,,,57.66,Fee Schedule,,13.88,,,,Fee Schedule,,24.52,,,24.52,Fee Schedule,,57.66,,,57.66,Fee Schedule,,26.11,,,26.11,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,,31.33,,,31.33,Fee Schedule,,26.55,,,26.55,Fee Schedule,,9.92,,,9.92,Fee Schedule,,9.92,,,9.92,Fee Schedule,,9.92,,,9.92,Fee Schedule,,9.92,,,9.92,Fee Schedule,,6.61,,,6.61,Other,100% of Medicaid,6.61,,,6.61,Other,100% of Medicaid,6.61,,,6.61,Other,100% of Medicaid,6.61,,,6.61,Other,100% of Medicaid,14.87,,,14.87,Other,225% of Medicaid,10.11,,,10.11,Other,153% of Medicaid,14.87,,,14.87,Other,225% of Medicaid,9.25,,,9.25,Other,140% of Medicaid,14.87,,,14.87,Other,225% of Medicaid,17.19,,,17.19,Other,250% of Medicaid,21.42,,,21.42,Other,324% of Medicaid,14.21,,,14.21,Other,215% of Medicaid,14.21,,,14.21,Other,215% of Medicaid,8.26,,,8.26,Other,125% of Medicaid,0.01,65.1,
DRUG SCRN QUAN MYCOPHENOLATE,80180,CPT,,78080180,CDM,301,RC,,,both,,,58,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,54.33,,,54.33,Fee Schedule,,48.92,,,48.92,Fee Schedule,,9.85,,,9.85,Fee Schedule,,9.85,,,9.85,Fee Schedule,,9.85,,,9.85,Fee Schedule,,40.6,70,,40.6,percent of total billed charges,All Other,56.86,,,56.86,Fee Schedule,,20,,,20,Other,186% of Medicaid,66.97,,,66.97,Fee Schedule,,35.96,,,35.96,Fee Schedule,,37.91,,,,Fee Schedule,,66.97,,,66.97,Fee Schedule,,35.96,,,35.96,Fee Schedule,,71.3,,,71.3,Fee Schedule,,40.6,70,,40.6,percent of total billed charges,,85.54,,,85.54,Fee Schedule,,72.5,,,72.5,Fee Schedule,,27.08,,,27.08,Fee Schedule,,27.08,,,27.08,Fee Schedule,,27.08,,,27.08,Fee Schedule,,27.08,,,27.08,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,85.54,
DRUG SCRN QUANT OXCARBAZEPIN,80183,CPT,,78080183,CDM,301,RC,,,both,,,42,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.88,,,39.88,Fee Schedule,,35.91,,,35.91,Fee Schedule,,7.24,,,7.24,Fee Schedule,,7.24,,,7.24,Fee Schedule,,7.24,,,7.24,Fee Schedule,,29.4,70,,29.4,percent of total billed charges,All Other,41.74,,,41.74,Fee Schedule,,20,,,20,Other,186% of Medicaid,49.16,,,49.16,Fee Schedule,,26.04,,,26.04,Fee Schedule,,27.83,,,,Fee Schedule,,49.16,,,49.16,Fee Schedule,,26.04,,,26.04,Fee Schedule,,52.34,,,52.34,Fee Schedule,,29.4,70,,29.4,percent of total billed charges,,62.79,,,62.79,Fee Schedule,,53.22,,,53.22,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,62.79,
ASSAY OF PHENOBARBITAL,80184,CPT,,78080184,CDM,301,RC,,,both,,,174,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.05,,,46.05,Fee Schedule,,41.46,,,41.46,Fee Schedule,,88.34,,,88.34,Fee Schedule,,79.47,,,79.47,Fee Schedule,,75.12,,,75.12,Fee Schedule,,121.8,70,,121.8,percent of total billed charges,All Other,48.2,,,48.2,Fee Schedule,,20,,,20,Other,186% of Medicaid,56.76,,,56.76,Fee Schedule,,107.88,,,107.88,Fee Schedule,,32.13,,,,Fee Schedule,,56.76,,,56.76,Fee Schedule,,107.88,,,107.88,Fee Schedule,,60.44,,,60.44,Fee Schedule,,121.8,70,,121.8,percent of total billed charges,,72.51,,,72.51,Fee Schedule,,61.45,,,61.45,Fee Schedule,,22.95,,,22.95,Fee Schedule,,22.95,,,22.95,Fee Schedule,,22.95,,,22.95,Fee Schedule,,22.95,,,22.95,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,121.8,
ASSAY OF PHENYTOIN FREE,80186,CPT,,78080186,CDM,301,RC,,,both,,,147,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.42,,,41.42,Fee Schedule,,37.29,,,37.29,Fee Schedule,,90.47,,,90.47,Fee Schedule,,81.39,,,81.39,Fee Schedule,,76.94,,,76.94,Fee Schedule,,102.9,70,,102.9,percent of total billed charges,All Other,43.34,,,43.34,Fee Schedule,,20,,,20,Other,186% of Medicaid,51.05,,,51.05,Fee Schedule,,91.14,,,91.14,Fee Schedule,,28.9,,,,Fee Schedule,,51.05,,,51.05,Fee Schedule,,91.14,,,91.14,Fee Schedule,,54.35,,,54.35,Fee Schedule,,102.9,70,,102.9,percent of total billed charges,,65.21,,,65.21,Fee Schedule,,55.27,,,55.27,Fee Schedule,,20.64,,,20.64,Fee Schedule,,20.64,,,20.64,Fee Schedule,,20.64,,,20.64,Fee Schedule,,20.64,,,20.64,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,102.9,
ASSAY OF PRIMIDONE,80188,CPT,,78080188,CDM,301,RC,,,both,,,223,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.94,,,49.94,Fee Schedule,,44.96,,,44.96,Fee Schedule,,127.96,,,127.96,Fee Schedule,,115.12,,,115.12,Fee Schedule,,108.81,,,108.81,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,All Other,52.26,,,52.26,Fee Schedule,,20,,,20,Other,186% of Medicaid,61.55,,,61.55,Fee Schedule,,138.26,,,138.26,Fee Schedule,,34.84,,,,Fee Schedule,,61.55,,,61.55,Fee Schedule,,138.26,,,138.26,Fee Schedule,,65.53,,,65.53,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,,78.62,,,78.62,Fee Schedule,,66.64,,,66.64,Fee Schedule,,24.89,,,24.89,Fee Schedule,,24.89,,,24.89,Fee Schedule,,24.89,,,24.89,Fee Schedule,,24.89,,,24.89,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,156.1,
ASSAY OF PROCAINAMIDE,80190,CPT,,78080190,CDM,301,RC,,,both,,,194,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180.6,,,180.6,Fee Schedule,,162.6,,,162.6,Fee Schedule,,129.16,,,129.16,Fee Schedule,,116.2,,,116.2,Fee Schedule,,109.84,,,109.84,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,All Other,189,,,189,Fee Schedule,,44,,,44,Other,186% of Medicaid,222.6,,,222.6,Fee Schedule,,120.28,,,120.28,Fee Schedule,,126,,,,Fee Schedule,,222.6,,,222.6,Fee Schedule,,120.28,,,120.28,Fee Schedule,,237,,,237,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,,284.34,,,284.34,Fee Schedule,,241,,,241,Fee Schedule,,90,,,90,Fee Schedule,,90,,,90,Fee Schedule,,90,,,90,Fee Schedule,,90,,,90,Fee Schedule,,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,35.91,,,35.91,Other,153% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,32.86,,,32.86,Other,140% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,61.02,,,61.02,Other,250% of Medicaid,76.04,,,76.04,Other,324% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,29.34,,,29.34,Other,125% of Medicaid,0.01,284.34,
ASSAY OF PROCAINAMIDE,80192,CPT,,78080192,CDM,301,RC,,,both,,,194,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.42,,,50.42,Fee Schedule,,45.39,,,45.39,Fee Schedule,,129.16,,,129.16,Fee Schedule,,116.2,,,116.2,Fee Schedule,,109.84,,,109.84,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,All Other,52.76,,,52.76,Fee Schedule,,44,,,44,Other,186% of Medicaid,62.14,,,62.14,Fee Schedule,,120.28,,,120.28,Fee Schedule,,35.18,,,,Fee Schedule,,62.14,,,62.14,Fee Schedule,,120.28,,,120.28,Fee Schedule,,66.16,,,66.16,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,,79.38,,,79.38,Fee Schedule,,67.28,,,67.28,Fee Schedule,,25.13,,,25.13,Fee Schedule,,25.13,,,25.13,Fee Schedule,,25.13,,,25.13,Fee Schedule,,25.13,,,25.13,Fee Schedule,,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,35.91,,,35.91,Other,153% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,32.86,,,32.86,Other,140% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,61.02,,,61.02,Other,250% of Medicaid,76.04,,,76.04,Other,324% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,29.34,,,29.34,Other,125% of Medicaid,0.01,135.8,
ASSAY OF QUINIDINE,80194,CPT,,78080194,CDM,301,RC,,,both,,,174,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.95,,,43.95,Fee Schedule,,39.57,,,39.57,Fee Schedule,,112.56,,,112.56,Fee Schedule,,101.26,,,101.26,Fee Schedule,,95.72,,,95.72,Fee Schedule,,121.8,70,,121.8,percent of total billed charges,All Other,45.99,,,45.99,Fee Schedule,,20,,,20,Other,186% of Medicaid,54.17,,,54.17,Fee Schedule,,107.88,,,107.88,Fee Schedule,,30.66,,,,Fee Schedule,,54.17,,,54.17,Fee Schedule,,107.88,,,107.88,Fee Schedule,,57.67,,,57.67,Fee Schedule,,121.8,70,,121.8,percent of total billed charges,,69.19,,,69.19,Fee Schedule,,58.64,,,58.64,Fee Schedule,,21.9,,,21.9,Fee Schedule,,21.9,,,21.9,Fee Schedule,,21.9,,,21.9,Fee Schedule,,21.9,,,21.9,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,121.8,
ASSAY OF SIROLIMUS,80195,CPT,,78080195,CDM,301,RC,,,both,,,82,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.33,,,41.33,Fee Schedule,,37.21,,,37.21,Fee Schedule,,105.87,,,105.87,Fee Schedule,,95.25,,,95.25,Fee Schedule,,90.03,,,90.03,Fee Schedule,,57.4,70,,57.4,percent of total billed charges,All Other,43.25,,,43.25,Fee Schedule,,20,,,20,Other,186% of Medicaid,50.94,,,50.94,Fee Schedule,,50.84,,,50.84,Fee Schedule,,28.83,,,,Fee Schedule,,50.94,,,50.94,Fee Schedule,,50.84,,,50.84,Fee Schedule,,54.23,,,54.23,Fee Schedule,,57.4,70,,57.4,percent of total billed charges,,65.07,,,65.07,Fee Schedule,,55.15,,,55.15,Fee Schedule,,20.6,,,20.6,Fee Schedule,,20.6,,,20.6,Fee Schedule,,20.6,,,20.6,Fee Schedule,,20.6,,,20.6,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,105.87,
ASSAY OF THEOPHYLLINE,80198,CPT,,78080198,CDM,301,RC,,,both,,,170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,42.56,,,42.56,Fee Schedule,,38.32,,,38.32,Fee Schedule,,109.11,,,109.11,Fee Schedule,,98.16,,,98.16,Fee Schedule,,92.78,,,92.78,Fee Schedule,,119,70,,119,percent of total billed charges,All Other,44.54,,,44.54,Fee Schedule,,15,,,15,Other,186% of Medicaid,52.46,,,52.46,Fee Schedule,,105.4,,,105.4,Fee Schedule,,29.69,,,,Fee Schedule,,52.46,,,52.46,Fee Schedule,,105.4,,,105.4,Fee Schedule,,55.85,,,55.85,Fee Schedule,,119,70,,119,percent of total billed charges,,67.01,,,67.01,Fee Schedule,,56.8,,,56.8,Fee Schedule,,21.21,,,21.21,Fee Schedule,,21.21,,,21.21,Fee Schedule,,21.21,,,21.21,Fee Schedule,,21.21,,,21.21,Fee Schedule,,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,12.36,,,12.36,Other,153% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,11.31,,,11.31,Other,140% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,21.01,,,21.01,Other,250% of Medicaid,26.18,,,26.18,Other,324% of Medicaid,17.37,,,17.37,Other,215% of Medicaid,17.37,,,17.37,Other,215% of Medicaid,10.1,,,10.1,Other,125% of Medicaid,0.01,119,
ASSAY OF TOBRAMYCIN,80200,CPT,,78080200,CDM,301,RC,,,both,,,242,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,48.55,,,48.55,Fee Schedule,,43.71,,,43.71,Fee Schedule,,124.29,,,124.29,Fee Schedule,,111.81,,,111.81,Fee Schedule,,105.69,,,105.69,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,50.81,,,50.81,Fee Schedule,,20,,,20,Other,186% of Medicaid,59.84,,,59.84,Fee Schedule,,150.04,,,150.04,Fee Schedule,,33.87,,,,Fee Schedule,,59.84,,,59.84,Fee Schedule,,150.04,,,150.04,Fee Schedule,,63.71,,,63.71,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,76.44,,,76.44,Fee Schedule,,64.79,,,64.79,Fee Schedule,,24.2,,,24.2,Fee Schedule,,24.2,,,24.2,Fee Schedule,,24.2,,,24.2,Fee Schedule,,24.2,,,24.2,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,169.4,
ASSAY OF TOPIRAMATE,80201,CPT,,78080201,CDM,301,RC,,,both,,,112,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,35.88,,,35.88,Fee Schedule,,32.3,,,32.3,Fee Schedule,,91.95,,,91.95,Fee Schedule,,82.73,,,82.73,Fee Schedule,,78.19,,,78.19,Fee Schedule,,78.4,70,,78.4,percent of total billed charges,All Other,37.55,,,37.55,Fee Schedule,,44,,,44,Other,186% of Medicaid,44.22,,,44.22,Fee Schedule,,69.44,,,69.44,Fee Schedule,,25.03,,,,Fee Schedule,,44.22,,,44.22,Fee Schedule,,69.44,,,69.44,Fee Schedule,,47.08,,,47.08,Fee Schedule,,78.4,70,,78.4,percent of total billed charges,,56.49,,,56.49,Fee Schedule,,47.88,,,47.88,Fee Schedule,,17.88,,,17.88,Fee Schedule,,17.88,,,17.88,Fee Schedule,,17.88,,,17.88,Fee Schedule,,17.88,,,17.88,Fee Schedule,,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,35.91,,,35.91,Other,153% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,32.86,,,32.86,Other,140% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,61.02,,,61.02,Other,250% of Medicaid,76.04,,,76.04,Other,324% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,29.34,,,29.34,Other,125% of Medicaid,0.01,91.95,
ASSAY OF VANCOMYCIN,80202,CPT,,78080202,CDM,301,RC,,,both,,,187,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,40.76,,,40.76,Fee Schedule,,36.69,,,36.69,Fee Schedule,,104.45,,,104.45,Fee Schedule,,93.97,,,93.97,Fee Schedule,,88.82,,,88.82,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,All Other,42.65,,,42.65,Fee Schedule,,20,,,20,Other,186% of Medicaid,50.23,,,50.23,Fee Schedule,,115.94,,,115.94,Fee Schedule,,28.43,,,,Fee Schedule,,50.23,,,50.23,Fee Schedule,,115.94,,,115.94,Fee Schedule,,53.48,,,53.48,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,,64.17,,,64.17,Fee Schedule,,54.39,,,54.39,Fee Schedule,,20.31,,,20.31,Fee Schedule,,20.31,,,20.31,Fee Schedule,,20.31,,,20.31,Fee Schedule,,20.31,,,20.31,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,130.9,
DRUG SCREEN QUANT ZONISAMIDE,80203,CPT,,78080203,CDM,301,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.88,,,39.88,Fee Schedule,,35.91,,,35.91,Fee Schedule,,7.24,,,7.24,Fee Schedule,,7.24,,,7.24,Fee Schedule,,7.24,,,7.24,Fee Schedule,,49,70,,49,percent of total billed charges,All Other,41.74,,,41.74,Fee Schedule,,20,,,20,Other,186% of Medicaid,49.16,,,49.16,Fee Schedule,,43.4,,,43.4,Fee Schedule,,27.83,,,,Fee Schedule,,49.16,,,49.16,Fee Schedule,,43.4,,,43.4,Fee Schedule,,52.34,,,52.34,Fee Schedule,,49,70,,49,percent of total billed charges,,62.79,,,62.79,Fee Schedule,,53.22,,,53.22,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,62.79,
DRUG ASY HYDROXYCHLOROQUINE,80220,CPT,,78080220,CDM,301,RC,,,both,,,59,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,56.11,,,56.11,Fee Schedule,,50.51,,,50.51,Fee Schedule,,18.64,,,18.64,Fee Schedule,,18.64,,,18.64,Fee Schedule,,18.64,,,18.64,Fee Schedule,,41.3,70,,41.3,percent of total billed charges,All Other,58.72,,,58.72,Fee Schedule,,20,,,20,Other,186% of Medicaid,69.15,,,69.15,Fee Schedule,,36.58,,,36.58,Fee Schedule,,39.14,,,,Fee Schedule,,69.15,,,69.15,Fee Schedule,,36.58,,,36.58,Fee Schedule,,73.63,,,73.63,Fee Schedule,,41.3,70,,41.3,percent of total billed charges,,88.34,,,88.34,Fee Schedule,,74.87,,,74.87,Fee Schedule,,27.96,,,27.96,Fee Schedule,,27.96,,,27.96,Fee Schedule,,27.96,,,27.96,Fee Schedule,,27.96,,,27.96,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,88.34,
DRUG ASSAY INFLIXIMAB,80230,CPT,,78080230,CDM,301,RC,,,both,,,122,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,116.1,,,116.1,Fee Schedule,,104.52,,,104.52,Fee Schedule,,7.39,,,7.39,Fee Schedule,,7.39,,,7.39,Fee Schedule,,7.39,,,7.39,Fee Schedule,,85.4,70,,85.4,percent of total billed charges,All Other,121.5,,,121.5,Fee Schedule,,20,,,20,Other,186% of Medicaid,143.09,,,143.09,Fee Schedule,,75.64,,,75.64,Fee Schedule,,81,,,,Fee Schedule,,143.09,,,143.09,Fee Schedule,,75.64,,,75.64,Fee Schedule,,152.35,,,152.35,Fee Schedule,,85.4,70,,85.4,percent of total billed charges,,182.78,,,182.78,Fee Schedule,,154.92,,,154.92,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,182.78,
DRUG ASSAY LACOSAMIDE,80235,CPT,,78080235,CDM,301,RC,,,both,,,87,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,81.6,,,81.6,Fee Schedule,,73.47,,,73.47,Fee Schedule,,21.69,,,21.69,Fee Schedule,,21.69,,,21.69,Fee Schedule,,21.69,,,21.69,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,All Other,85.4,,,85.4,Fee Schedule,,20,,,20,Other,186% of Medicaid,100.58,,,100.58,Fee Schedule,,53.94,,,53.94,Fee Schedule,,56.93,,,,Fee Schedule,,100.58,,,100.58,Fee Schedule,,53.94,,,53.94,Fee Schedule,,107.08,,,107.08,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,,128.48,,,128.48,Fee Schedule,,108.89,,,108.89,Fee Schedule,,40.67,,,40.67,Fee Schedule,,40.67,,,40.67,Fee Schedule,,40.67,,,40.67,Fee Schedule,,40.67,,,40.67,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,128.48,
QUANTITATIVE ASSAY DRUG,80299,CPT,,78080299,CDM,301,RC,,,both,,,343,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,56.11,,,56.11,Fee Schedule,,50.51,,,50.51,Fee Schedule,,105.6,,,105.6,Fee Schedule,,95,,,95,Fee Schedule,,89.8,,,89.8,Fee Schedule,,240.1,70,,240.1,percent of total billed charges,All Other,58.72,,,58.72,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,69.15,,,69.15,Fee Schedule,,212.66,,,212.66,Fee Schedule,,39.14,,,,Fee Schedule,,69.15,,,69.15,Fee Schedule,,212.66,,,212.66,Fee Schedule,,73.63,,,73.63,Fee Schedule,,240.1,70,,240.1,percent of total billed charges,,88.34,,,88.34,Fee Schedule,,74.87,,,74.87,Fee Schedule,,27.96,,,27.96,Fee Schedule,,27.96,,,27.96,Fee Schedule,,27.96,,,27.96,Fee Schedule,,27.96,,,27.96,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,240.1,
DRUG TEST PRSMV DIR OPT OBS,80305,CPT,,78080305,CDM,301,RC,,,both,,,346,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,37.93,,,37.93,Fee Schedule,,34.15,,,34.15,Fee Schedule,,5.98,,,5.98,Fee Schedule,,5.98,,,5.98,Fee Schedule,,5.98,,,5.98,Fee Schedule,,242.2,70,,242.2,percent of total billed charges,All Other,39.69,,,39.69,Fee Schedule,,9,,,9,Other,186% of Medicaid,46.75,,,46.75,Fee Schedule,,214.52,,,214.52,Fee Schedule,,26.46,,,,Fee Schedule,,46.75,,,46.75,Fee Schedule,,214.52,,,214.52,Fee Schedule,,49.77,,,49.77,Fee Schedule,,242.2,70,,242.2,percent of total billed charges,,59.71,,,59.71,Fee Schedule,,50.61,,,50.61,Fee Schedule,,18.9,,,18.9,Fee Schedule,,18.9,,,18.9,Fee Schedule,,18.9,,,18.9,Fee Schedule,,18.9,,,18.9,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,242.2,
DRUG TEST PRSMV INSTRMNT,80306,CPT,,78080306,CDM,301,RC,,,both,,,377,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51.59,,,51.59,Fee Schedule,,46.45,,,46.45,Fee Schedule,,7.98,,,7.98,Fee Schedule,,7.98,,,7.98,Fee Schedule,,7.98,,,7.98,Fee Schedule,,263.9,70,,263.9,percent of total billed charges,All Other,53.99,,,53.99,Fee Schedule,,9,,,9,Other,186% of Medicaid,63.59,,,63.59,Fee Schedule,,233.74,,,233.74,Fee Schedule,,35.99,,,,Fee Schedule,,63.59,,,63.59,Fee Schedule,,233.74,,,233.74,Fee Schedule,,67.7,,,67.7,Fee Schedule,,263.9,70,,263.9,percent of total billed charges,,81.23,,,81.23,Fee Schedule,,68.84,,,68.84,Fee Schedule,,25.71,,,25.71,Fee Schedule,,25.71,,,25.71,Fee Schedule,,25.71,,,25.71,Fee Schedule,,25.71,,,25.71,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,263.9,
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,,38080307,CDM,301,RC,,,both,,,405,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,187.04,,,187.04,Fee Schedule,,168.4,,,168.4,Fee Schedule,,31.92,,,31.92,Fee Schedule,,31.92,,,31.92,Fee Schedule,,31.92,,,31.92,Fee Schedule,,283.5,70,,283.5,percent of total billed charges,All Other,195.74,,,195.74,Fee Schedule,,14,,,14,Other,186% of Medicaid,230.54,,,230.54,Fee Schedule,,251.1,,,251.1,Fee Schedule,,130.49,,,,Fee Schedule,,230.54,,,230.54,Fee Schedule,,251.1,,,251.1,Fee Schedule,,245.45,,,245.45,Fee Schedule,,283.5,70,,283.5,percent of total billed charges,,294.48,,,294.48,Fee Schedule,,249.59,,,249.59,Fee Schedule,,93.21,,,93.21,Fee Schedule,,93.21,,,93.21,Fee Schedule,,93.21,,,93.21,Fee Schedule,,93.21,,,93.21,Fee Schedule,,7.58,,,7.58,Other,100% of Medicaid,7.58,,,7.58,Other,100% of Medicaid,7.58,,,7.58,Other,100% of Medicaid,7.58,,,7.58,Other,100% of Medicaid,17.04,,,17.04,Other,225% of Medicaid,11.59,,,11.59,Other,153% of Medicaid,17.04,,,17.04,Other,225% of Medicaid,10.61,,,10.61,Other,140% of Medicaid,17.04,,,17.04,Other,225% of Medicaid,19.7,,,19.7,Other,250% of Medicaid,24.54,,,24.54,Other,324% of Medicaid,16.29,,,16.29,Other,215% of Medicaid,16.29,,,16.29,Other,215% of Medicaid,9.47,,,9.47,Other,125% of Medicaid,0.01,294.48,
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,,78080307,CDM,301,RC,,,both,,,405,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,187.04,,,187.04,Fee Schedule,,168.4,,,168.4,Fee Schedule,,31.92,,,31.92,Fee Schedule,,31.92,,,31.92,Fee Schedule,,31.92,,,31.92,Fee Schedule,,283.5,70,,283.5,percent of total billed charges,All Other,195.74,,,195.74,Fee Schedule,,14,,,14,Other,186% of Medicaid,230.54,,,230.54,Fee Schedule,,251.1,,,251.1,Fee Schedule,,130.49,,,,Fee Schedule,,230.54,,,230.54,Fee Schedule,,251.1,,,251.1,Fee Schedule,,245.45,,,245.45,Fee Schedule,,283.5,70,,283.5,percent of total billed charges,,294.48,,,294.48,Fee Schedule,,249.59,,,249.59,Fee Schedule,,93.21,,,93.21,Fee Schedule,,93.21,,,93.21,Fee Schedule,,93.21,,,93.21,Fee Schedule,,93.21,,,93.21,Fee Schedule,,7.58,,,7.58,Other,100% of Medicaid,7.58,,,7.58,Other,100% of Medicaid,7.58,,,7.58,Other,100% of Medicaid,7.58,,,7.58,Other,100% of Medicaid,17.04,,,17.04,Other,225% of Medicaid,11.59,,,11.59,Other,153% of Medicaid,17.04,,,17.04,Other,225% of Medicaid,10.61,,,10.61,Other,140% of Medicaid,17.04,,,17.04,Other,225% of Medicaid,19.7,,,19.7,Other,250% of Medicaid,24.54,,,24.54,Other,324% of Medicaid,16.29,,,16.29,Other,215% of Medicaid,16.29,,,16.29,Other,215% of Medicaid,9.47,,,9.47,Other,125% of Medicaid,0.01,294.48,
DRUG SCREEN QUANTALCOHOLS,80320,CPT,,78080320,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,6.12,,,6.12,Fee Schedule,,6.12,,,6.12,Fee Schedule,,6.12,,,6.12,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
ALCOHOLS BIOMARKERS 1OR 2,80321,CPT,,78080321,CDM,301,RC,,,both,,,92,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.8,65,,59.8,percent of total billed charges,All Other,54.28,59,,54.28,percent of total billed charges,All Other,6.12,,,6.12,Fee Schedule,,6.12,,,6.12,Fee Schedule,,6.12,,,6.12,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,All Other,62.56,68,,62.56,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,76.36,80,,76.36,percent of total billed charges,All Other,57.04,83,,57.04,percent of total billed charges,All Other,50.6,83,,,percent of total billed charges,All Other,76.36,80,,76.36,percent of total billed charges,All Other,57.04,83,,57.04,percent of total billed charges,All Other,73.6,80,,73.6,percent of total billed charges,All Other,64.4,70,,64.4,percent of total billed charges,,59.8,65,,59.8,percent of total billed charges,All Other,59.8,65,,59.8,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.36,
ALCOHOLS BIOMARKERS 3/MORE,80322,CPT,,78080322,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,6.73,,,6.73,Fee Schedule,,6.73,,,6.73,Fee Schedule,,6.73,,,6.73,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.81,
ALKALOIDS NOS,80323,CPT,,78080323,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,17,,,17,Fee Schedule,,17,,,17,Fee Schedule,,17,,,17,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
DRUG SCREEN AMPHETAMINES 1/2,80324,CPT,,78080324,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,8.81,,,8.81,Fee Schedule,,8.81,,,8.81,Fee Schedule,,8.81,,,8.81,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
AMPHETAMINES 3OR 4,80325,CPT,,78080325,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,9.69,,,9.69,Fee Schedule,,9.69,,,9.69,Fee Schedule,,9.69,,,9.69,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,88.81,
AMPHETAMINES 5 OR MORE,80326,CPT,,78080326,CDM,301,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.45,65,,86.45,percent of total billed charges,All Other,78.47,59,,78.47,percent of total billed charges,All Other,10.57,,,10.57,Fee Schedule,,10.57,,,10.57,Fee Schedule,,10.57,,,10.57,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,90.44,68,,90.44,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,73.15,83,,,percent of total billed charges,All Other,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,106.4,80,,106.4,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,,86.45,65,,86.45,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,110.39,
ANABOLIC STEROID 1 OR 2,80327,CPT,,78080327,CDM,301,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.45,65,,60.45,percent of total billed charges,All Other,54.87,59,,54.87,percent of total billed charges,All Other,14.62,,,14.62,Fee Schedule,,14.62,,,14.62,Fee Schedule,,14.62,,,14.62,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,63.24,68,,63.24,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,77.19,80,,77.19,percent of total billed charges,All Other,57.66,83,,57.66,percent of total billed charges,All Other,51.15,83,,,percent of total billed charges,All Other,77.19,80,,77.19,percent of total billed charges,All Other,57.66,83,,57.66,percent of total billed charges,All Other,74.4,80,,74.4,percent of total billed charges,All Other,65.1,70,,65.1,percent of total billed charges,,60.45,65,,60.45,percent of total billed charges,All Other,60.45,65,,60.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,77.19,
ANABOLIC STEROID 3 OR MORE,80328,CPT,,78080328,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,16.08,,,16.08,Fee Schedule,,16.08,,,16.08,Fee Schedule,,16.08,,,16.08,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.81,
ANALGESICS NON-OPIOID 1 OR 2 SALICYLATE,80329,CPT,,78080329,CDM,301,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,58.5,65,,58.5,percent of total billed charges,All Other,53.1,59,,53.1,percent of total billed charges,All Other,11.46,,,11.46,Fee Schedule,,11.46,,,11.46,Fee Schedule,,11.46,,,11.46,Fee Schedule,,63,70,,63,percent of total billed charges,All Other,61.2,68,,61.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,74.7,80,,74.7,percent of total billed charges,All Other,55.8,83,,55.8,percent of total billed charges,All Other,49.5,83,,,percent of total billed charges,All Other,74.7,80,,74.7,percent of total billed charges,All Other,55.8,83,,55.8,percent of total billed charges,All Other,72,80,,72,percent of total billed charges,All Other,63,70,,63,percent of total billed charges,,58.5,65,,58.5,percent of total billed charges,All Other,58.5,65,,58.5,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,74.7,
ANALGESICS NON-OPIOID 3-5,80330,CPT,,78080330,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,12.61,,,12.61,Fee Schedule,,12.61,,,12.61,Fee Schedule,,12.61,,,12.61,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.81,
ANALGESICS NON-OPIOID 6/MORE,80331,CPT,,78080331,CDM,301,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.45,65,,86.45,percent of total billed charges,All Other,78.47,59,,78.47,percent of total billed charges,All Other,13.75,,,13.75,Fee Schedule,,13.75,,,13.75,Fee Schedule,,13.75,,,13.75,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,90.44,68,,90.44,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,73.15,83,,,percent of total billed charges,All Other,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,106.4,80,,106.4,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,,86.45,65,,86.45,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.39,
ANTIDEPRESSANTS CLASS 1 OR 2,80332,CPT,,78080332,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,10.14,,,10.14,Fee Schedule,,10.14,,,10.14,Fee Schedule,,10.14,,,10.14,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.38,
ANTIDEPRESSANTS CLASS 3-5,80333,CPT,,78080333,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,11.15,,,11.15,Fee Schedule,,11.15,,,11.15,Fee Schedule,,11.15,,,11.15,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.81,
ANTIDEPRESSANTS CLASS 6/MORE,80334,CPT,,78080334,CDM,301,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.45,65,,86.45,percent of total billed charges,All Other,78.47,59,,78.47,percent of total billed charges,All Other,12.17,,,12.17,Fee Schedule,,12.17,,,12.17,Fee Schedule,,12.17,,,12.17,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,90.44,68,,90.44,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,73.15,83,,,percent of total billed charges,All Other,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,106.4,80,,106.4,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,,86.45,65,,86.45,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.39,
ANTIDEPRESSANT TRICYCLIC 1/2,80335,CPT,,78080335,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,10.14,,,10.14,Fee Schedule,,10.14,,,10.14,Fee Schedule,,10.14,,,10.14,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
ANTIDEPRESSANT TRICYCLIC 3-5,80336,CPT,,78080336,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,11.15,,,11.15,Fee Schedule,,11.15,,,11.15,Fee Schedule,,11.15,,,11.15,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,88.81,
TRICYCLIC & CYCLICALS 6/MORE,80337,CPT,,78080337,CDM,301,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.45,65,,86.45,percent of total billed charges,All Other,78.47,59,,78.47,percent of total billed charges,All Other,12.17,,,12.17,Fee Schedule,,12.17,,,12.17,Fee Schedule,,12.17,,,12.17,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,90.44,68,,90.44,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,73.15,83,,,percent of total billed charges,All Other,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,106.4,80,,106.4,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,,86.45,65,,86.45,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,110.39,
ANTIDEPRESSANT NOT SPECIFIED,80338,CPT,,78080338,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,10.14,,,10.14,Fee Schedule,,10.14,,,10.14,Fee Schedule,,10.14,,,10.14,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.38,
ANTIEPILEPTICS NOS 1-3,80339,CPT,,78080339,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,7.84,,,7.84,Fee Schedule,,7.84,,,7.84,Fee Schedule,,7.84,,,7.84,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.38,
ANTIEPILEPTICS NOS 4-6,80340,CPT,,78080340,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,8.62,,,8.62,Fee Schedule,,8.62,,,8.62,Fee Schedule,,8.62,,,8.62,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.81,
ANTIEPILEPTICS NOS 7/MORE,80341,CPT,,78080341,CDM,301,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.45,65,,86.45,percent of total billed charges,All Other,78.47,59,,78.47,percent of total billed charges,All Other,9.41,,,9.41,Fee Schedule,,9.41,,,9.41,Fee Schedule,,9.41,,,9.41,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,90.44,68,,90.44,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,73.15,83,,,percent of total billed charges,All Other,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,106.4,80,,106.4,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,,86.45,65,,86.45,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.39,
ANTIPSYCHOTICS NOS 1-3,80342,CPT,,78080342,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,8.82,,,8.82,Fee Schedule,,8.82,,,8.82,Fee Schedule,,8.82,,,8.82,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,83,
ANTIPSYCHOTICS NOS 4-6,80343,CPT,,78080343,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,9.7,,,9.7,Fee Schedule,,9.7,,,9.7,Fee Schedule,,9.7,,,9.7,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.81,
ANTIPSYCHOTICS NOS 7/MORE,80344,CPT,,78080344,CDM,301,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.45,65,,86.45,percent of total billed charges,All Other,78.47,59,,78.47,percent of total billed charges,All Other,10.58,,,10.58,Fee Schedule,,10.58,,,10.58,Fee Schedule,,10.58,,,10.58,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,90.44,68,,90.44,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,73.15,83,,,percent of total billed charges,All Other,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,106.4,80,,106.4,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,,86.45,65,,86.45,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.39,
DRUG SCREENING BARBITURATES,80345,CPT,,78080345,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,6.49,,,6.49,Fee Schedule,,6.49,,,6.49,Fee Schedule,,6.49,,,6.49,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
BENZODIAZEPINES1-12,80346,CPT,,78080346,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,10.48,,,10.48,Fee Schedule,,10.48,,,10.48,Fee Schedule,,10.48,,,10.48,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
BENZODIAZEPINES 13 OR MORE,80347,CPT,,78080347,CDM,301,RC,,,both,,,124,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,80.6,65,,80.6,percent of total billed charges,All Other,73.16,59,,73.16,percent of total billed charges,All Other,11.53,,,11.53,Fee Schedule,,11.53,,,11.53,Fee Schedule,,11.53,,,11.53,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,All Other,84.32,68,,84.32,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,102.92,80,,102.92,percent of total billed charges,All Other,76.88,83,,76.88,percent of total billed charges,All Other,68.2,83,,,percent of total billed charges,All Other,102.92,80,,102.92,percent of total billed charges,All Other,76.88,83,,76.88,percent of total billed charges,All Other,99.2,80,,99.2,percent of total billed charges,All Other,86.8,70,,86.8,percent of total billed charges,,80.6,65,,80.6,percent of total billed charges,All Other,80.6,65,,80.6,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,102.92,
DRUG SCREENING BUPRENORPHINE,80348,CPT,,78080348,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
CANNABINOIDS NATURAL,80349,CPT,,78080349,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,13.42,,,13.42,Fee Schedule,,13.42,,,13.42,Fee Schedule,,13.42,,,13.42,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
CANNABINOIDS SYNTHETIC 1-3,80350,CPT,,78080350,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,13.42,,,13.42,Fee Schedule,,13.42,,,13.42,Fee Schedule,,13.42,,,13.42,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,71.38,
CANNABINOIDS SYNTHETIC 4-6,80351,CPT,,78080351,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,14.76,,,14.76,Fee Schedule,,14.76,,,14.76,Fee Schedule,,14.76,,,14.76,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,88.81,
CANNABINOID SYNTHETIC 7/MORE,80352,CPT,,78080352,CDM,301,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.45,65,,86.45,percent of total billed charges,All Other,78.47,59,,78.47,percent of total billed charges,All Other,16.1,,,16.1,Fee Schedule,,16.1,,,16.1,Fee Schedule,,16.1,,,16.1,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,90.44,68,,90.44,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,73.15,83,,,percent of total billed charges,All Other,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,106.4,80,,106.4,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,,86.45,65,,86.45,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,110.39,
DRUG SCREENING COCAINE,80353,CPT,,78080353,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,8.59,,,8.59,Fee Schedule,,8.59,,,8.59,Fee Schedule,,8.59,,,8.59,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
DRUG SCREENING FENTANYL,80354,CPT,,78080354,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
GABAPENTIN NON-BLOOD,80355,CPT,,78080355,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,7.24,,,7.24,Fee Schedule,,7.24,,,7.24,Fee Schedule,,7.24,,,7.24,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.38,
HEROIN METABOLITE,80356,CPT,,78080356,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
KETAMINE AND NORKETAMINE,80357,CPT,,78080357,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,8.33,,,8.33,Fee Schedule,,8.33,,,8.33,Fee Schedule,,8.33,,,8.33,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.38,
DRUG SCREENING METHADONE,80358,CPT,,78080358,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,9.25,,,9.25,Fee Schedule,,9.25,,,9.25,Fee Schedule,,9.25,,,9.25,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
METHYLENEDIOXYAMPHETAMINES,80359,CPT,,78080359,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,8.81,,,8.81,Fee Schedule,,8.81,,,8.81,Fee Schedule,,8.81,,,8.81,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,71.38,
METHYLPHENIDATE,80360,CPT,,78080360,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,8.81,,,8.81,Fee Schedule,,8.81,,,8.81,Fee Schedule,,8.81,,,8.81,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.38,
OPIATES 1 OR MORE,80361,CPT,,78080361,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
OPIOIDS & OPIATE ANALOGS 1/2,80362,CPT,,78080362,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,71.38,
OPIOIDS & OPIATE ANALOGS 3/4,80363,CPT,,78080363,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,12.12,,,12.12,Fee Schedule,,12.12,,,12.12,Fee Schedule,,12.12,,,12.12,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,88.81,
OPIOID &OPIATE ANALOG 5/MORE,80364,CPT,,78080364,CDM,301,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.45,65,,86.45,percent of total billed charges,All Other,78.47,59,,78.47,percent of total billed charges,All Other,13.22,,,13.22,Fee Schedule,,13.22,,,13.22,Fee Schedule,,13.22,,,13.22,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,90.44,68,,90.44,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,73.15,83,,,percent of total billed charges,All Other,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,106.4,80,,106.4,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,,86.45,65,,86.45,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,110.39,
DRUG SCREENING OXYCODONE,80365,CPT,,78080365,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,83,
DRUG SCREENING PREGABALIN,80366,CPT,,78080366,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,7.84,,,7.84,Fee Schedule,,7.84,,,7.84,Fee Schedule,,7.84,,,7.84,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.38,
DRUG SCREENING PROPOXYPHENE,80367,CPT,,78080367,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,9,,,9,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,71.38,
SEDATIVE HYPNOTICS,80368,CPT,,78080368,CDM,301,RC,,,both,,,92,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.8,65,,59.8,percent of total billed charges,All Other,54.28,59,,54.28,percent of total billed charges,All Other,10.48,,,10.48,Fee Schedule,,10.48,,,10.48,Fee Schedule,,10.48,,,10.48,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,All Other,62.56,68,,62.56,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,76.36,80,,76.36,percent of total billed charges,All Other,57.04,83,,57.04,percent of total billed charges,All Other,50.6,83,,,percent of total billed charges,All Other,76.36,80,,76.36,percent of total billed charges,All Other,57.04,83,,57.04,percent of total billed charges,All Other,73.6,80,,73.6,percent of total billed charges,All Other,64.4,70,,64.4,percent of total billed charges,,59.8,65,,59.8,percent of total billed charges,All Other,59.8,65,,59.8,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.36,
SKELETAL MUSCLE RELAXANT 1/2,80369,CPT,,78080369,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65,65,,65,percent of total billed charges,All Other,59,59,,59,percent of total billed charges,All Other,9.99,,,9.99,Fee Schedule,,9.99,,,9.99,Fee Schedule,,9.99,,,9.99,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,68,68,,68,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,55,83,,,percent of total billed charges,All Other,83,80,,83,percent of total billed charges,All Other,62,83,,62,percent of total billed charges,All Other,80,80,,80,percent of total billed charges,All Other,70,70,,70,percent of total billed charges,,65,65,,65,percent of total billed charges,All Other,65,65,,65,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,83,
SKEL MUSC RELAXANT 3 OR MORE,80370,CPT,,78080370,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,10.99,,,10.99,Fee Schedule,,10.99,,,10.99,Fee Schedule,,10.99,,,10.99,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.81,
STIMULANTS SYNTHETIC,80371,CPT,,78080371,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,8.81,,,8.81,Fee Schedule,,8.81,,,8.81,Fee Schedule,,8.81,,,8.81,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.38,
DRUG SCREENING TAPENTADOL,80372,CPT,,78080372,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,11.46,,,11.46,Fee Schedule,,11.46,,,11.46,Fee Schedule,,11.46,,,11.46,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.38,
DRUG SCREENING TRAMADOL,80373,CPT,,78080373,CDM,301,RC,,,both,,,92,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.8,65,,59.8,percent of total billed charges,All Other,54.28,59,,54.28,percent of total billed charges,All Other,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,11.02,,,11.02,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,All Other,62.56,68,,62.56,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,76.36,80,,76.36,percent of total billed charges,All Other,57.04,83,,57.04,percent of total billed charges,All Other,50.6,83,,,percent of total billed charges,All Other,76.36,80,,76.36,percent of total billed charges,All Other,57.04,83,,57.04,percent of total billed charges,All Other,73.6,80,,73.6,percent of total billed charges,All Other,64.4,70,,64.4,percent of total billed charges,,59.8,65,,59.8,percent of total billed charges,All Other,59.8,65,,59.8,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.36,
STEREOISOMER ANALYSIS,80374,CPT,,78080374,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,10.23,,,10.23,Fee Schedule,,10.23,,,10.23,Fee Schedule,,10.23,,,10.23,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,71.38,
DRUG/SUBSTANCE NOS 1-3,80375,CPT,,78080375,CDM,301,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.45,65,,60.45,percent of total billed charges,All Other,54.87,59,,54.87,percent of total billed charges,All Other,10.23,,,10.23,Fee Schedule,,10.23,,,10.23,Fee Schedule,,10.23,,,10.23,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,63.24,68,,63.24,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,77.19,80,,77.19,percent of total billed charges,All Other,57.66,83,,57.66,percent of total billed charges,All Other,51.15,83,,,percent of total billed charges,All Other,77.19,80,,77.19,percent of total billed charges,All Other,57.66,83,,57.66,percent of total billed charges,All Other,74.4,80,,74.4,percent of total billed charges,All Other,65.1,70,,65.1,percent of total billed charges,,60.45,65,,60.45,percent of total billed charges,All Other,60.45,65,,60.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,77.19,
DRUG/SUBSTANCE NOS 4-6,80376,CPT,,78080376,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.55,65,,69.55,percent of total billed charges,All Other,63.13,59,,63.13,percent of total billed charges,All Other,11.25,,,11.25,Fee Schedule,,11.25,,,11.25,Fee Schedule,,11.25,,,11.25,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,72.76,68,,72.76,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,58.85,83,,,percent of total billed charges,All Other,88.81,80,,88.81,percent of total billed charges,All Other,66.34,83,,66.34,percent of total billed charges,All Other,85.6,80,,85.6,percent of total billed charges,All Other,74.9,70,,74.9,percent of total billed charges,,69.55,65,,69.55,percent of total billed charges,All Other,69.55,65,,69.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.81,
DRUG/SUBSTANCE NOS 7/MORE,80377,CPT,,78080377,CDM,301,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,86.45,65,,86.45,percent of total billed charges,All Other,78.47,59,,78.47,percent of total billed charges,All Other,12.28,,,12.28,Fee Schedule,,12.28,,,12.28,Fee Schedule,,12.28,,,12.28,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,90.44,68,,90.44,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,73.15,83,,,percent of total billed charges,All Other,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,106.4,80,,106.4,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,,86.45,65,,86.45,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,110.39,
INSULIN TOLERANCE PANEL,80434,CPT,,78080434,CDM,301,RC,,,both,,,718,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,857.94,,,857.94,Fee Schedule,,772.43,,,772.43,Fee Schedule,,780.08,,,780.08,Fee Schedule,,701.79,,,701.79,Fee Schedule,,663.35,,,663.35,Fee Schedule,,502.6,70,,502.6,percent of total billed charges,All Other,897.84,,,897.84,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1057.46,,,1057.46,Fee Schedule,,445.16,,,445.16,Fee Schedule,,598.56,,,,Fee Schedule,,1057.46,,,1057.46,Fee Schedule,,445.16,,,445.16,Fee Schedule,,1125.87,,,1125.87,Fee Schedule,,502.6,70,,502.6,percent of total billed charges,,1350.77,,,1350.77,Fee Schedule,,1144.86,,,1144.86,Fee Schedule,,427.55,,,427.55,Fee Schedule,,427.55,,,427.55,Fee Schedule,,427.55,,,427.55,Fee Schedule,,427.55,,,427.55,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1350.77,
TRH STIMULATION PANEL,80438,CPT,,78080438,CDM,301,RC,,,both,,,291,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,151.73,,,151.73,Fee Schedule,,136.61,,,136.61,Fee Schedule,,388.64,,,388.64,Fee Schedule,,349.64,,,349.64,Fee Schedule,,330.49,,,330.49,Fee Schedule,,203.7,70,,203.7,percent of total billed charges,All Other,158.79,,,158.79,Fee Schedule,,34,,,34,Other,186% of Medicaid,187.02,,,187.02,Fee Schedule,,180.42,,,180.42,Fee Schedule,,105.86,,,,Fee Schedule,,187.02,,,187.02,Fee Schedule,,180.42,,,180.42,Fee Schedule,,199.12,,,199.12,Fee Schedule,,203.7,70,,203.7,percent of total billed charges,,238.89,,,238.89,Fee Schedule,,202.48,,,202.48,Fee Schedule,,75.62,,,75.62,Fee Schedule,,75.62,,,75.62,Fee Schedule,,75.62,,,75.62,Fee Schedule,,75.62,,,75.62,Fee Schedule,,18.18,,,18.18,Other,100% of Medicaid,18.18,,,18.18,Other,100% of Medicaid,18.18,,,18.18,Other,100% of Medicaid,18.18,,,18.18,Other,100% of Medicaid,40.91,,,40.91,Other,225% of Medicaid,27.82,,,27.82,Other,153% of Medicaid,40.91,,,40.91,Other,225% of Medicaid,25.45,,,25.45,Other,140% of Medicaid,40.91,,,40.91,Other,225% of Medicaid,47.27,,,47.27,Other,250% of Medicaid,58.9,,,58.9,Other,324% of Medicaid,39.09,,,39.09,Other,215% of Medicaid,39.09,,,39.09,Other,215% of Medicaid,22.73,,,22.73,Other,125% of Medicaid,0.01,388.64,
HPA-1 GENOTYPING,81105,CPT,,78081105,CDM,301,RC,,,both,,,386,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,367.88,,,367.88,Fee Schedule,,331.22,,,331.22,Fee Schedule,,295.29,76.5,,295.29,percent of total billed charges,All Other,266.34,69,,266.34,percent of total billed charges,All Other,250.9,65,,250.9,percent of total billed charges,All Other,270.2,70,,270.2,percent of total billed charges,All Other,384.99,,,384.99,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,453.44,,,453.44,Fee Schedule,,239.32,,,239.32,Fee Schedule,,256.66,,,,Fee Schedule,,453.44,,,453.44,Fee Schedule,,239.32,,,239.32,Fee Schedule,,482.77,,,482.77,Fee Schedule,,270.2,70,,270.2,percent of total billed charges,,579.2,,,579.2,Fee Schedule,,490.91,,,490.91,Fee Schedule,,183.33,,,183.33,Fee Schedule,,183.33,,,183.33,Fee Schedule,,183.33,,,183.33,Fee Schedule,,183.33,,,183.33,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,579.2,
IDH1 COMMON VARIANTS,81120,CPT,,78081120,CDM,301,RC,,,both,,,609,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,581.68,,,581.68,Fee Schedule,,523.71,,,523.71,Fee Schedule,,77.3,,,77.3,Fee Schedule,,77.3,,,77.3,Fee Schedule,,77.3,,,77.3,Fee Schedule,,426.3,70,,426.3,percent of total billed charges,All Other,608.74,,,608.74,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,716.96,,,716.96,Fee Schedule,,377.58,,,377.58,Fee Schedule,,405.83,,,,Fee Schedule,,716.96,,,716.96,Fee Schedule,,377.58,,,377.58,Fee Schedule,,763.34,,,763.34,Fee Schedule,,426.3,70,,426.3,percent of total billed charges,,915.82,,,915.82,Fee Schedule,,776.21,,,776.21,Fee Schedule,,289.88,,,289.88,Fee Schedule,,289.88,,,289.88,Fee Schedule,,289.88,,,289.88,Fee Schedule,,289.88,,,289.88,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,915.82,
IDH2 COMMON VARIANTS,81121,CPT,,78081121,CDM,301,RC,,,both,,,933,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,890.33,,,890.33,Fee Schedule,,801.59,,,801.59,Fee Schedule,,713.75,76.5,,713.75,percent of total billed charges,All Other,643.77,69,,643.77,percent of total billed charges,All Other,606.45,65,,606.45,percent of total billed charges,All Other,653.1,70,,653.1,percent of total billed charges,All Other,931.74,,,931.74,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1097.38,,,1097.38,Fee Schedule,,578.46,,,578.46,Fee Schedule,,621.16,,,,Fee Schedule,,1097.38,,,1097.38,Fee Schedule,,578.46,,,578.46,Fee Schedule,,1168.37,,,1168.37,Fee Schedule,,653.1,70,,653.1,percent of total billed charges,,1401.76,,,1401.76,Fee Schedule,,1188.08,,,1188.08,Fee Schedule,,443.69,,,443.69,Fee Schedule,,443.69,,,443.69,Fee Schedule,,443.69,,,443.69,Fee Schedule,,443.69,,,443.69,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1401.76,
BRCA1&2 SEQ & FULL DUP/DEL,81162,CPT,,78081162,CDM,301,RC,,,both,,,8236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,5492.89,,,5492.89,Fee Schedule,,4945.42,,,4945.42,Fee Schedule,,994.34,,,994.34,Fee Schedule,,994.34,,,994.34,Fee Schedule,,994.34,,,994.34,Fee Schedule,,5765.2,70,,5765.2,percent of total billed charges,All Other,5748.37,,,5748.37,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,6770.3,,,6770.3,Fee Schedule,,5106.32,,,5106.32,Fee Schedule,,3832.25,,,,Fee Schedule,,6770.3,,,6770.3,Fee Schedule,,5106.32,,,5106.32,Fee Schedule,,7208.28,,,7208.28,Fee Schedule,,5765.2,70,,5765.2,percent of total billed charges,,8648.17,,,8648.17,Fee Schedule,,7329.85,,,7329.85,Fee Schedule,,2737.32,,,2737.32,Fee Schedule,,2737.32,,,2737.32,Fee Schedule,,2737.32,,,2737.32,Fee Schedule,,2737.32,,,2737.32,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8648.17,
ABL 1 GENE,81170,CPT,,78081170,CDM,301,RC,,,both,,,910,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,903,,,903,Fee Schedule,,813,,,813,Fee Schedule,,131.8,,,131.8,Fee Schedule,,131.8,,,131.8,Fee Schedule,,131.8,,,131.8,Fee Schedule,,637,70,,637,percent of total billed charges,All Other,945,,,945,Fee Schedule,,371,,,371,Other,186% of Medicaid,1113,,,1113,Fee Schedule,,564.2,,,564.2,Fee Schedule,,630,,,,Fee Schedule,,1113,,,1113,Fee Schedule,,564.2,,,564.2,Fee Schedule,,1185,,,1185,Fee Schedule,,637,70,,637,percent of total billed charges,,1421.71,,,1421.71,Fee Schedule,,1204.99,,,1204.99,Fee Schedule,,450,,,450,Fee Schedule,,450,,,450,Fee Schedule,,450,,,450,Fee Schedule,,450,,,450,Fee Schedule,,199.69,,,199.69,Other,100% of Medicaid,199.69,,,199.69,Other,100% of Medicaid,199.69,,,199.69,Other,100% of Medicaid,199.69,,,199.69,Other,100% of Medicaid,449.3,,,449.3,Other,225% of Medicaid,305.52,,,305.52,Other,153% of Medicaid,449.3,,,449.3,Other,225% of Medicaid,279.56,,,279.56,Other,140% of Medicaid,449.3,,,449.3,Other,225% of Medicaid,519.19,,,519.19,Other,250% of Medicaid,646.99,,,646.99,Other,324% of Medicaid,429.33,,,429.33,Other,215% of Medicaid,429.33,,,429.33,Other,215% of Medicaid,249.61,,,249.61,Other,125% of Medicaid,0.01,1421.71,
BCR/ABL1 GENE MAJOR BP,81206,CPT,,78081206,CDM,301,RC,,,both,,,849,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,493.52,,,493.52,Fee Schedule,,444.33,,,444.33,Fee Schedule,,24.24,,,24.24,Fee Schedule,,24.24,,,24.24,Fee Schedule,,24.24,,,24.24,Fee Schedule,,594.3,70,,594.3,percent of total billed charges,All Other,516.47,,,516.47,Fee Schedule,,305,,,305,Other,186% of Medicaid,608.29,,,608.29,Fee Schedule,,526.38,,,526.38,Fee Schedule,,344.32,,,,Fee Schedule,,608.29,,,608.29,Fee Schedule,,526.38,,,526.38,Fee Schedule,,647.64,,,647.64,Fee Schedule,,594.3,70,,594.3,percent of total billed charges,,777.01,,,777.01,Fee Schedule,,658.57,,,658.57,Fee Schedule,,245.94,,,245.94,Fee Schedule,,245.94,,,245.94,Fee Schedule,,245.94,,,245.94,Fee Schedule,,245.94,,,245.94,Fee Schedule,,163.96,,,163.96,Other,100% of Medicaid,163.96,,,163.96,Other,100% of Medicaid,163.96,,,163.96,Other,100% of Medicaid,163.96,,,163.96,Other,100% of Medicaid,368.91,,,368.91,Other,225% of Medicaid,250.86,,,250.86,Other,153% of Medicaid,368.91,,,368.91,Other,225% of Medicaid,229.54,,,229.54,Other,140% of Medicaid,368.91,,,368.91,Other,225% of Medicaid,426.3,,,426.3,Other,250% of Medicaid,531.23,,,531.23,Other,324% of Medicaid,352.51,,,352.51,Other,215% of Medicaid,352.51,,,352.51,Other,215% of Medicaid,204.95,,,204.95,Other,125% of Medicaid,0.01,777.01,
BCR/ABL1 GENE MAJOR BP,81206,CPT,TC,85081206,CDM,301,RC,,,both,,,849,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,493.52,,,493.52,Fee Schedule,,444.33,,,444.33,Fee Schedule,,24.24,,,24.24,Fee Schedule,,24.24,,,24.24,Fee Schedule,,24.24,,,24.24,Fee Schedule,,594.3,70,,594.3,percent of total billed charges,All Other,516.47,,,516.47,Fee Schedule,,305,,,305,Other,186% of Medicaid,608.29,,,608.29,Fee Schedule,,526.38,,,526.38,Fee Schedule,,344.32,,,,Fee Schedule,,608.29,,,608.29,Fee Schedule,,526.38,,,526.38,Fee Schedule,,647.64,,,647.64,Fee Schedule,,594.3,70,,594.3,percent of total billed charges,,777.01,,,777.01,Fee Schedule,,658.57,,,658.57,Fee Schedule,,245.94,,,245.94,Fee Schedule,,245.94,,,245.94,Fee Schedule,,245.94,,,245.94,Fee Schedule,,245.94,,,245.94,Fee Schedule,,163.96,,,163.96,Other,100% of Medicaid,163.96,,,163.96,Other,100% of Medicaid,163.96,,,163.96,Other,100% of Medicaid,163.96,,,163.96,Other,100% of Medicaid,368.91,,,368.91,Other,225% of Medicaid,250.86,,,250.86,Other,153% of Medicaid,368.91,,,368.91,Other,225% of Medicaid,229.54,,,229.54,Other,140% of Medicaid,368.91,,,368.91,Other,225% of Medicaid,426.3,,,426.3,Other,250% of Medicaid,531.23,,,531.23,Other,324% of Medicaid,352.51,,,352.51,Other,215% of Medicaid,352.51,,,352.51,Other,215% of Medicaid,204.95,,,204.95,Other,125% of Medicaid,0.01,777.01,
BCR/ABL1 GENE MINOR BP,81207,CPT,,78081207,CDM,301,RC,,,both,,,750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,435.97,,,435.97,Fee Schedule,,392.52,,,392.52,Fee Schedule,,24.24,,,24.24,Fee Schedule,,24.24,,,24.24,Fee Schedule,,24.24,,,24.24,Fee Schedule,,525,70,,525,percent of total billed charges,All Other,456.25,,,456.25,Fee Schedule,,269,,,269,Other,186% of Medicaid,537.36,,,537.36,Fee Schedule,,465,,,465,Fee Schedule,,304.16,,,,Fee Schedule,,537.36,,,537.36,Fee Schedule,,465,,,465,Fee Schedule,,572.12,,,572.12,Fee Schedule,,525,70,,525,percent of total billed charges,,686.4,,,686.4,Fee Schedule,,581.77,,,581.77,Fee Schedule,,217.26,,,217.26,Fee Schedule,,217.26,,,217.26,Fee Schedule,,217.26,,,217.26,Fee Schedule,,217.26,,,217.26,Fee Schedule,,144.84,,,144.84,Other,100% of Medicaid,144.84,,,144.84,Other,100% of Medicaid,144.84,,,144.84,Other,100% of Medicaid,144.84,,,144.84,Other,100% of Medicaid,325.89,,,325.89,Other,225% of Medicaid,221.61,,,221.61,Other,153% of Medicaid,325.89,,,325.89,Other,225% of Medicaid,202.78,,,202.78,Other,140% of Medicaid,325.89,,,325.89,Other,225% of Medicaid,376.58,,,376.58,Other,250% of Medicaid,469.28,,,469.28,Other,324% of Medicaid,311.41,,,311.41,Other,215% of Medicaid,311.41,,,311.41,Other,215% of Medicaid,181.05,,,181.05,Other,125% of Medicaid,0.01,686.4,
BCR/ABL1 GENE MINOR BP,81207,CPT,TC,85081207,CDM,301,RC,,,both,,,750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,435.97,,,435.97,Fee Schedule,,392.52,,,392.52,Fee Schedule,,24.24,,,24.24,Fee Schedule,,24.24,,,24.24,Fee Schedule,,24.24,,,24.24,Fee Schedule,,525,70,,525,percent of total billed charges,All Other,456.25,,,456.25,Fee Schedule,,269,,,269,Other,186% of Medicaid,537.36,,,537.36,Fee Schedule,,465,,,465,Fee Schedule,,304.16,,,,Fee Schedule,,537.36,,,537.36,Fee Schedule,,465,,,465,Fee Schedule,,572.12,,,572.12,Fee Schedule,,525,70,,525,percent of total billed charges,,686.4,,,686.4,Fee Schedule,,581.77,,,581.77,Fee Schedule,,217.26,,,217.26,Fee Schedule,,217.26,,,217.26,Fee Schedule,,217.26,,,217.26,Fee Schedule,,217.26,,,217.26,Fee Schedule,,144.84,,,144.84,Other,100% of Medicaid,144.84,,,144.84,Other,100% of Medicaid,144.84,,,144.84,Other,100% of Medicaid,144.84,,,144.84,Other,100% of Medicaid,325.89,,,325.89,Other,225% of Medicaid,221.61,,,221.61,Other,153% of Medicaid,325.89,,,325.89,Other,225% of Medicaid,202.78,,,202.78,Other,140% of Medicaid,325.89,,,325.89,Other,225% of Medicaid,376.58,,,376.58,Other,250% of Medicaid,469.28,,,469.28,Other,324% of Medicaid,311.41,,,311.41,Other,215% of Medicaid,311.41,,,311.41,Other,215% of Medicaid,181.05,,,181.05,Other,125% of Medicaid,0.01,686.4,
BRAF GENE,81210,CPT,,78081210,CDM,301,RC,,,both,,,659,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,527.95,,,527.95,Fee Schedule,,475.33,,,475.33,Fee Schedule,,35.94,,,35.94,Fee Schedule,,35.94,,,35.94,Fee Schedule,,35.94,,,35.94,Fee Schedule,,461.3,70,,461.3,percent of total billed charges,All Other,552.51,,,552.51,Fee Schedule,,326,,,326,Other,186% of Medicaid,650.73,,,650.73,Fee Schedule,,408.58,,,408.58,Fee Schedule,,368.34,,,,Fee Schedule,,650.73,,,650.73,Fee Schedule,,408.58,,,408.58,Fee Schedule,,692.83,,,692.83,Fee Schedule,,461.3,70,,461.3,percent of total billed charges,,831.23,,,831.23,Fee Schedule,,704.52,,,704.52,Fee Schedule,,263.1,,,263.1,Fee Schedule,,263.1,,,263.1,Fee Schedule,,263.1,,,263.1,Fee Schedule,,263.1,,,263.1,Fee Schedule,,175.4,,,175.4,Other,100% of Medicaid,175.4,,,175.4,Other,100% of Medicaid,175.4,,,175.4,Other,100% of Medicaid,175.4,,,175.4,Other,100% of Medicaid,394.65,,,394.65,Other,225% of Medicaid,268.36,,,268.36,Other,153% of Medicaid,394.65,,,394.65,Other,225% of Medicaid,245.56,,,245.56,Other,140% of Medicaid,394.65,,,394.65,Other,225% of Medicaid,456.04,,,456.04,Other,250% of Medicaid,568.3,,,568.3,Other,324% of Medicaid,377.11,,,377.11,Other,215% of Medicaid,377.11,,,377.11,Other,215% of Medicaid,219.25,,,219.25,Other,125% of Medicaid,0.01,831.23,
BRAF GENE,81210,CPT,TC,85081210,CDM,301,RC,,,both,,,659,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,527.95,,,527.95,Fee Schedule,,475.33,,,475.33,Fee Schedule,,35.94,,,35.94,Fee Schedule,,35.94,,,35.94,Fee Schedule,,35.94,,,35.94,Fee Schedule,,461.3,70,,461.3,percent of total billed charges,All Other,552.51,,,552.51,Fee Schedule,,326,,,326,Other,186% of Medicaid,650.73,,,650.73,Fee Schedule,,408.58,,,408.58,Fee Schedule,,368.34,,,,Fee Schedule,,650.73,,,650.73,Fee Schedule,,408.58,,,408.58,Fee Schedule,,692.83,,,692.83,Fee Schedule,,461.3,70,,461.3,percent of total billed charges,,831.23,,,831.23,Fee Schedule,,704.52,,,704.52,Fee Schedule,,263.1,,,263.1,Fee Schedule,,263.1,,,263.1,Fee Schedule,,263.1,,,263.1,Fee Schedule,,263.1,,,263.1,Fee Schedule,,175.4,,,175.4,Other,100% of Medicaid,175.4,,,175.4,Other,100% of Medicaid,175.4,,,175.4,Other,100% of Medicaid,175.4,,,175.4,Other,100% of Medicaid,394.65,,,394.65,Other,225% of Medicaid,268.36,,,268.36,Other,153% of Medicaid,394.65,,,394.65,Other,225% of Medicaid,245.56,,,245.56,Other,140% of Medicaid,394.65,,,394.65,Other,225% of Medicaid,456.04,,,456.04,Other,250% of Medicaid,568.3,,,568.3,Other,324% of Medicaid,377.11,,,377.11,Other,215% of Medicaid,377.11,,,377.11,Other,215% of Medicaid,219.25,,,219.25,Other,125% of Medicaid,0.01,831.23,
BRCA1 GENE KNOWN FAM VARIANT,81215,CPT,,78081215,CDM,301,RC,,,both,,,752,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1129.5,,,1129.5,Fee Schedule,,1016.93,,,1016.93,Fee Schedule,,167.2,,,167.2,Fee Schedule,,167.2,,,167.2,Fee Schedule,,167.2,,,167.2,Fee Schedule,,526.4,70,,526.4,percent of total billed charges,All Other,1182.04,,,1182.04,Fee Schedule,,175,,,175,Other,186% of Medicaid,1392.18,,,1392.18,Fee Schedule,,466.24,,,466.24,Fee Schedule,,788.03,,,,Fee Schedule,,1392.18,,,1392.18,Fee Schedule,,466.24,,,466.24,Fee Schedule,,1482.24,,,1482.24,Fee Schedule,,526.4,70,,526.4,percent of total billed charges,,1778.32,,,1778.32,Fee Schedule,,1507.24,,,1507.24,Fee Schedule,,562.88,,,562.88,Fee Schedule,,562.88,,,562.88,Fee Schedule,,562.88,,,562.88,Fee Schedule,,562.88,,,562.88,Fee Schedule,,94.17,,,94.17,Other,100% of Medicaid,94.17,,,94.17,Other,100% of Medicaid,94.17,,,94.17,Other,100% of Medicaid,94.17,,,94.17,Other,100% of Medicaid,211.89,,,211.89,Other,225% of Medicaid,144.08,,,144.08,Other,153% of Medicaid,211.89,,,211.89,Other,225% of Medicaid,131.84,,,131.84,Other,140% of Medicaid,211.89,,,211.89,Other,225% of Medicaid,244.85,,,244.85,Other,250% of Medicaid,305.12,,,305.12,Other,324% of Medicaid,202.47,,,202.47,Other,215% of Medicaid,202.47,,,202.47,Other,215% of Medicaid,117.72,,,117.72,Other,125% of Medicaid,0.01,1778.32,
CFTR GENE COM VARIANTS,81220,CPT,,78081220,CDM,301,RC,,,both,,,1115,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,1675.37,,,1675.37,Fee Schedule,,1508.39,,,1508.39,Fee Schedule,,179.18,,,179.18,Fee Schedule,,179.18,,,179.18,Fee Schedule,,179.18,,,179.18,Fee Schedule,,780.5,70,,780.5,percent of total billed charges,All Other,1753.29,,,1753.29,Fee Schedule,,611,,,611,Other,186% of Medicaid,2064.99,,,2064.99,Fee Schedule,,691.3,,,691.3,Fee Schedule,,1168.86,,,,Fee Schedule,,2064.99,,,2064.99,Fee Schedule,,691.3,,,691.3,Fee Schedule,,2198.57,,,2198.57,Fee Schedule,,780.5,70,,780.5,percent of total billed charges,,2637.75,,,2637.75,Fee Schedule,,2235.65,,,2235.65,Fee Schedule,,834.9,,,834.9,Fee Schedule,,834.9,,,834.9,Fee Schedule,,834.9,,,834.9,Fee Schedule,,834.9,,,834.9,Fee Schedule,,328.25,,,328.25,Other,100% of Medicaid,328.25,,,328.25,Other,100% of Medicaid,328.25,,,328.25,Other,100% of Medicaid,328.25,,,328.25,Other,100% of Medicaid,738.56,,,738.56,Other,225% of Medicaid,502.22,,,502.22,Other,153% of Medicaid,738.56,,,738.56,Other,225% of Medicaid,459.55,,,459.55,Other,140% of Medicaid,738.56,,,738.56,Other,225% of Medicaid,853.45,,,853.45,Other,250% of Medicaid,1063.53,,,1063.53,Other,324% of Medicaid,705.74,,,705.74,Other,215% of Medicaid,705.74,,,705.74,Other,215% of Medicaid,410.31,,,410.31,Other,125% of Medicaid,0.01,2637.75,
CFTR GENE DUP/DELET VARIANTS,81222,CPT,,78081222,CDM,301,RC,,,both,,,1372,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,1309.56,,,1309.56,Fee Schedule,,1179.04,,,1179.04,Fee Schedule,,48.31,,,48.31,Fee Schedule,,48.31,,,48.31,Fee Schedule,,48.31,,,48.31,Fee Schedule,,960.4,70,,960.4,percent of total billed charges,All Other,1370.47,,,1370.47,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1614.11,,,1614.11,Fee Schedule,,850.64,,,850.64,Fee Schedule,,913.65,,,,Fee Schedule,,1614.11,,,1614.11,Fee Schedule,,850.64,,,850.64,Fee Schedule,,1718.53,,,1718.53,Fee Schedule,,960.4,70,,960.4,percent of total billed charges,,2061.81,,,2061.81,Fee Schedule,,1747.51,,,1747.51,Fee Schedule,,652.61,,,652.61,Fee Schedule,,652.61,,,652.61,Fee Schedule,,652.61,,,652.61,Fee Schedule,,652.61,,,652.61,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2061.81,
CFTR GENE FULL SEQUENCE,81223,CPT,,78081223,CDM,301,RC,,,both,,,6520,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,1501.99,,,1501.99,Fee Schedule,,1352.29,,,1352.29,Fee Schedule,,243.71,,,243.71,Fee Schedule,,243.71,,,243.71,Fee Schedule,,243.71,,,243.71,Fee Schedule,,4564,70,,4564,percent of total billed charges,All Other,1571.85,,,1571.85,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1851.29,,,1851.29,Fee Schedule,,4042.4,,,4042.4,Fee Schedule,,1047.9,,,,Fee Schedule,,1851.29,,,1851.29,Fee Schedule,,4042.4,,,4042.4,Fee Schedule,,1971.05,,,1971.05,Fee Schedule,,4564,70,,4564,percent of total billed charges,,2364.78,,,2364.78,Fee Schedule,,2004.29,,,2004.29,Fee Schedule,,748.5,,,748.5,Fee Schedule,,748.5,,,748.5,Fee Schedule,,748.5,,,748.5,Fee Schedule,,748.5,,,748.5,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4564,
CYP2C19 GENE COM VARIANTS,81225,CPT,,78081225,CDM,301,RC,,,both,,,876,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,876.99,,,876.99,Fee Schedule,,789.59,,,789.59,Fee Schedule,,40.48,,,40.48,Fee Schedule,,40.48,,,40.48,Fee Schedule,,40.48,,,40.48,Fee Schedule,,613.2,70,,613.2,percent of total billed charges,All Other,917.78,,,917.78,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1080.95,,,1080.95,Fee Schedule,,543.12,,,543.12,Fee Schedule,,611.86,,,,Fee Schedule,,1080.95,,,1080.95,Fee Schedule,,543.12,,,543.12,Fee Schedule,,1150.87,,,1150.87,Fee Schedule,,613.2,70,,613.2,percent of total billed charges,,1380.77,,,1380.77,Fee Schedule,,1170.28,,,1170.28,Fee Schedule,,437.04,,,437.04,Fee Schedule,,437.04,,,437.04,Fee Schedule,,437.04,,,437.04,Fee Schedule,,437.04,,,437.04,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1380.77,
CYTOGEN M ARRAY COPY NO&SNP,81229,CPT,,78081229,CDM,301,RC,,,both,,,3654,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,3491.6,,,3491.6,Fee Schedule,,3143.6,,,3143.6,Fee Schedule,,14.7,,,14.7,Fee Schedule,,14.7,,,14.7,Fee Schedule,,14.7,,,14.7,Fee Schedule,,2557.8,70,,2557.8,percent of total billed charges,All Other,3654,,,3654,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,4303.6,,,4303.6,Fee Schedule,,2265.48,,,2265.48,Fee Schedule,,2436,,,,Fee Schedule,,4303.6,,,4303.6,Fee Schedule,,2265.48,,,2265.48,Fee Schedule,,4582,,,4582,Fee Schedule,,2557.8,70,,2557.8,percent of total billed charges,,5497.28,,,5497.28,Fee Schedule,,4659.28,,,4659.28,Fee Schedule,,1740,,,1740,Fee Schedule,,1740,,,1740,Fee Schedule,,1740,,,1740,Fee Schedule,,1740,,,1740,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5497.28,
EGFR GENE COM VARIANTS,81235,CPT,TC,85081235,CDM,301,RC,,,both,,,1210,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,976.99,,,976.99,Fee Schedule,,879.61,,,879.61,Fee Schedule,,20.27,,,20.27,Fee Schedule,,20.27,,,20.27,Fee Schedule,,20.27,,,20.27,Fee Schedule,,847,70,,847,percent of total billed charges,All Other,1022.43,,,1022.43,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1204.19,,,1204.19,Fee Schedule,,750.2,,,750.2,Fee Schedule,,681.62,,,,Fee Schedule,,1204.19,,,1204.19,Fee Schedule,,750.2,,,750.2,Fee Schedule,,1282.09,,,1282.09,Fee Schedule,,847,70,,847,percent of total billed charges,,1538.2,,,1538.2,Fee Schedule,,1303.71,,,1303.71,Fee Schedule,,486.87,,,486.87,Fee Schedule,,486.87,,,486.87,Fee Schedule,,486.87,,,486.87,Fee Schedule,,486.87,,,486.87,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1538.2,
F2 GENE,81240,CPT,,78081240,CDM,301,RC,,,both,,,429,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,197.73,,,197.73,Fee Schedule,,178.02,,,178.02,Fee Schedule,,20.27,,,20.27,Fee Schedule,,20.27,,,20.27,Fee Schedule,,20.27,,,20.27,Fee Schedule,,300.3,70,,300.3,percent of total billed charges,All Other,206.92,,,206.92,Fee Schedule,,122,,,122,Other,186% of Medicaid,243.71,,,243.71,Fee Schedule,,265.98,,,265.98,Fee Schedule,,137.95,,,,Fee Schedule,,243.71,,,243.71,Fee Schedule,,265.98,,,265.98,Fee Schedule,,259.48,,,259.48,Fee Schedule,,300.3,70,,300.3,percent of total billed charges,,311.31,,,311.31,Fee Schedule,,263.85,,,263.85,Fee Schedule,,98.54,,,98.54,Fee Schedule,,98.54,,,98.54,Fee Schedule,,98.54,,,98.54,Fee Schedule,,98.54,,,98.54,Fee Schedule,,65.69,,,65.69,Other,100% of Medicaid,65.69,,,65.69,Other,100% of Medicaid,65.69,,,65.69,Other,100% of Medicaid,65.69,,,65.69,Other,100% of Medicaid,147.8,,,147.8,Other,225% of Medicaid,100.51,,,100.51,Other,153% of Medicaid,147.8,,,147.8,Other,225% of Medicaid,91.97,,,91.97,Other,140% of Medicaid,147.8,,,147.8,Other,225% of Medicaid,170.79,,,170.79,Other,250% of Medicaid,212.84,,,212.84,Other,324% of Medicaid,141.23,,,141.23,Other,215% of Medicaid,141.23,,,141.23,Other,215% of Medicaid,82.11,,,82.11,Other,125% of Medicaid,0.01,311.31,
F5 GENE,81241,CPT,,78081241,CDM,301,RC,,,both,,,429,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,220.84,,,220.84,Fee Schedule,,198.83,,,198.83,Fee Schedule,,21.16,,,21.16,Fee Schedule,,21.16,,,21.16,Fee Schedule,,21.16,,,21.16,Fee Schedule,,300.3,70,,300.3,percent of total billed charges,All Other,231.12,,,231.12,Fee Schedule,,136,,,136,Other,186% of Medicaid,272.2,,,272.2,Fee Schedule,,265.98,,,265.98,Fee Schedule,,154.08,,,,Fee Schedule,,272.2,,,272.2,Fee Schedule,,265.98,,,265.98,Fee Schedule,,289.81,,,289.81,Fee Schedule,,300.3,70,,300.3,percent of total billed charges,,347.7,,,347.7,Fee Schedule,,294.7,,,294.7,Fee Schedule,,110.06,,,110.06,Fee Schedule,,110.06,,,110.06,Fee Schedule,,110.06,,,110.06,Fee Schedule,,110.06,,,110.06,Fee Schedule,,73.37,,,73.37,Other,100% of Medicaid,73.37,,,73.37,Other,100% of Medicaid,73.37,,,73.37,Other,100% of Medicaid,73.37,,,73.37,Other,100% of Medicaid,165.08,,,165.08,Other,225% of Medicaid,112.26,,,112.26,Other,153% of Medicaid,165.08,,,165.08,Other,225% of Medicaid,102.72,,,102.72,Other,140% of Medicaid,165.08,,,165.08,Other,225% of Medicaid,190.76,,,190.76,Other,250% of Medicaid,237.72,,,237.72,Other,324% of Medicaid,157.75,,,157.75,Other,215% of Medicaid,157.75,,,157.75,Other,215% of Medicaid,91.71,,,91.71,Other,125% of Medicaid,0.01,347.7,
FMR1 GENE DETECTION,81243,CPT,,78081243,CDM,301,RC,,,both,,,908,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,171.69,,,171.69,Fee Schedule,,154.58,,,154.58,Fee Schedule,,24.41,,,24.41,Fee Schedule,,24.41,,,24.41,Fee Schedule,,24.41,,,24.41,Fee Schedule,,635.6,70,,635.6,percent of total billed charges,All Other,179.68,,,179.68,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,211.62,,,211.62,Fee Schedule,,562.96,,,562.96,Fee Schedule,,119.78,,,,Fee Schedule,,211.62,,,211.62,Fee Schedule,,562.96,,,562.96,Fee Schedule,,225.31,,,225.31,Fee Schedule,,635.6,70,,635.6,percent of total billed charges,,270.31,,,270.31,Fee Schedule,,229.11,,,229.11,Fee Schedule,,85.56,,,85.56,Fee Schedule,,85.56,,,85.56,Fee Schedule,,85.56,,,85.56,Fee Schedule,,85.56,,,85.56,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,635.6,
FMR1 GENE CHARACTERIZATION,81244,CPT,,78081244,CDM,301,RC,,,both,,,518,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,135.12,,,135.12,Fee Schedule,,121.65,,,121.65,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,362.6,70,,362.6,percent of total billed charges,All Other,141.4,,,141.4,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,166.54,,,166.54,Fee Schedule,,321.16,,,321.16,Fee Schedule,,94.27,,,,Fee Schedule,,166.54,,,166.54,Fee Schedule,,321.16,,,321.16,Fee Schedule,,177.32,,,177.32,Fee Schedule,,362.6,70,,362.6,percent of total billed charges,,212.74,,,212.74,Fee Schedule,,180.31,,,180.31,Fee Schedule,,67.34,,,67.34,Fee Schedule,,67.34,,,67.34,Fee Schedule,,67.34,,,67.34,Fee Schedule,,67.34,,,67.34,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,362.6,
FLT3 GENE,81245,CPT,,78181245,CDM,301,RC,,,both,,,611,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,498.19,,,498.19,Fee Schedule,,448.53,,,448.53,Fee Schedule,,31.12,,,31.12,Fee Schedule,,31.12,,,31.12,Fee Schedule,,31.12,,,31.12,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,All Other,521.36,,,521.36,Fee Schedule,,308,,,308,Other,186% of Medicaid,614.04,,,614.04,Fee Schedule,,378.82,,,378.82,Fee Schedule,,347.57,,,,Fee Schedule,,614.04,,,614.04,Fee Schedule,,378.82,,,378.82,Fee Schedule,,653.76,,,653.76,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,,784.36,,,784.36,Fee Schedule,,664.79,,,664.79,Fee Schedule,,248.27,,,248.27,Fee Schedule,,248.27,,,248.27,Fee Schedule,,248.27,,,248.27,Fee Schedule,,248.27,,,248.27,Fee Schedule,,165.51,,,165.51,Other,100% of Medicaid,165.51,,,165.51,Other,100% of Medicaid,165.51,,,165.51,Other,100% of Medicaid,165.51,,,165.51,Other,100% of Medicaid,372.4,,,372.4,Other,225% of Medicaid,253.23,,,253.23,Other,153% of Medicaid,372.4,,,372.4,Other,225% of Medicaid,231.71,,,231.71,Other,140% of Medicaid,372.4,,,372.4,Other,225% of Medicaid,430.33,,,430.33,Other,250% of Medicaid,536.25,,,536.25,Other,324% of Medicaid,355.85,,,355.85,Other,215% of Medicaid,355.85,,,355.85,Other,215% of Medicaid,206.89,,,206.89,Other,125% of Medicaid,0.01,784.36,
FLT3 GENE,81245,CPT,TC,85081245,CDM,301,RC,,,both,,,611,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,498.19,,,498.19,Fee Schedule,,448.53,,,448.53,Fee Schedule,,31.12,,,31.12,Fee Schedule,,31.12,,,31.12,Fee Schedule,,31.12,,,31.12,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,All Other,521.36,,,521.36,Fee Schedule,,308,,,308,Other,186% of Medicaid,614.04,,,614.04,Fee Schedule,,378.82,,,378.82,Fee Schedule,,347.57,,,,Fee Schedule,,614.04,,,614.04,Fee Schedule,,378.82,,,378.82,Fee Schedule,,653.76,,,653.76,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,,784.36,,,784.36,Fee Schedule,,664.79,,,664.79,Fee Schedule,,248.27,,,248.27,Fee Schedule,,248.27,,,248.27,Fee Schedule,,248.27,,,248.27,Fee Schedule,,248.27,,,248.27,Fee Schedule,,165.51,,,165.51,Other,100% of Medicaid,165.51,,,165.51,Other,100% of Medicaid,165.51,,,165.51,Other,100% of Medicaid,165.51,,,165.51,Other,100% of Medicaid,372.4,,,372.4,Other,225% of Medicaid,253.23,,,253.23,Other,153% of Medicaid,372.4,,,372.4,Other,225% of Medicaid,231.71,,,231.71,Other,140% of Medicaid,372.4,,,372.4,Other,225% of Medicaid,430.33,,,430.33,Other,250% of Medicaid,536.25,,,536.25,Other,324% of Medicaid,355.85,,,355.85,Other,215% of Medicaid,355.85,,,355.85,Other,215% of Medicaid,206.89,,,206.89,Other,125% of Medicaid,0.01,784.36,
FLT3 GENE ANALYSIS,81246,CPT,,78081246,CDM,301,RC,,,both,,,212,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,249.83,,,249.83,Fee Schedule,,224.93,,,224.93,Fee Schedule,,31.12,,,31.12,Fee Schedule,,31.12,,,31.12,Fee Schedule,,31.12,,,31.12,Fee Schedule,,148.4,70,,148.4,percent of total billed charges,All Other,261.45,,,261.45,Fee Schedule,,154,,,154,Other,186% of Medicaid,307.93,,,307.93,Fee Schedule,,131.44,,,131.44,Fee Schedule,,174.3,,,,Fee Schedule,,307.93,,,307.93,Fee Schedule,,131.44,,,131.44,Fee Schedule,,327.85,,,327.85,Fee Schedule,,148.4,70,,148.4,percent of total billed charges,,393.34,,,393.34,Fee Schedule,,333.38,,,333.38,Fee Schedule,,124.5,,,124.5,Fee Schedule,,124.5,,,124.5,Fee Schedule,,124.5,,,124.5,Fee Schedule,,124.5,,,124.5,Fee Schedule,,83,,,83,Other,100% of Medicaid,83,,,83,Other,100% of Medicaid,83,,,83,Other,100% of Medicaid,83,,,83,Other,100% of Medicaid,186.75,,,186.75,Other,225% of Medicaid,126.99,,,126.99,Other,153% of Medicaid,186.75,,,186.75,Other,225% of Medicaid,116.2,,,116.2,Other,140% of Medicaid,186.75,,,186.75,Other,225% of Medicaid,215.8,,,215.8,Other,250% of Medicaid,268.92,,,268.92,Other,324% of Medicaid,178.45,,,178.45,Other,215% of Medicaid,178.45,,,178.45,Other,215% of Medicaid,103.75,,,103.75,Other,125% of Medicaid,0.01,393.34,
HFE GENE,81256,CPT,,78081256,CDM,301,RC,,,both,,,1626,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,196.73,,,196.73,Fee Schedule,,177.13,,,177.13,Fee Schedule,,25.42,,,25.42,Fee Schedule,,25.42,,,25.42,Fee Schedule,,25.42,,,25.42,Fee Schedule,,1138.2,70,,1138.2,percent of total billed charges,All Other,205.88,,,205.88,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,242.49,,,242.49,Fee Schedule,,1008.12,,,1008.12,Fee Schedule,,137.26,,,,Fee Schedule,,242.49,,,242.49,Fee Schedule,,1008.12,,,1008.12,Fee Schedule,,258.17,,,258.17,Fee Schedule,,1138.2,70,,1138.2,percent of total billed charges,,309.74,,,309.74,Fee Schedule,,262.53,,,262.53,Fee Schedule,,98.04,,,98.04,Fee Schedule,,98.04,,,98.04,Fee Schedule,,98.04,,,98.04,Fee Schedule,,98.04,,,98.04,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1138.2,
IGH GENE REARRANGE AMP METH,81261,CPT,,78081261,CDM,301,RC,,,both,,,624,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,595.95,,,595.95,Fee Schedule,,536.55,,,536.55,Fee Schedule,,28.82,,,28.82,Fee Schedule,,28.82,,,28.82,Fee Schedule,,28.82,,,28.82,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,All Other,623.67,,,623.67,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,734.54,,,734.54,Fee Schedule,,386.88,,,386.88,Fee Schedule,,415.78,,,,Fee Schedule,,734.54,,,734.54,Fee Schedule,,386.88,,,386.88,Fee Schedule,,782.06,,,782.06,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,,938.28,,,938.28,Fee Schedule,,795.25,,,795.25,Fee Schedule,,296.99,,,296.99,Fee Schedule,,296.99,,,296.99,Fee Schedule,,296.99,,,296.99,Fee Schedule,,296.99,,,296.99,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,938.28,
IGH VARI REGIONAL MUTATION,81263,CPT,TC,85081263,CDM,301,RC,,,both,,,900,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,886.51,,,886.51,Fee Schedule,,798.15,,,798.15,Fee Schedule,,51.44,,,51.44,Fee Schedule,,51.44,,,51.44,Fee Schedule,,51.44,,,51.44,Fee Schedule,,630,70,,630,percent of total billed charges,All Other,927.74,,,927.74,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1092.67,,,1092.67,Fee Schedule,,558,,,558,Fee Schedule,,618.49,,,,Fee Schedule,,1092.67,,,1092.67,Fee Schedule,,558,,,558,Fee Schedule,,1163.35,,,1163.35,Fee Schedule,,630,70,,630,percent of total billed charges,,1395.74,,,1395.74,Fee Schedule,,1182.98,,,1182.98,Fee Schedule,,441.78,,,441.78,Fee Schedule,,441.78,,,441.78,Fee Schedule,,441.78,,,441.78,Fee Schedule,,441.78,,,441.78,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1395.74,
CHIMERISM ANAL NO CELL SELEC,81267,CPT,,78081267,CDM,301,RC,,,both,,,655,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,624.45,,,624.45,Fee Schedule,,562.22,,,562.22,Fee Schedule,,175.69,,,175.69,Fee Schedule,,175.69,,,175.69,Fee Schedule,,175.69,,,175.69,Fee Schedule,,458.5,70,,458.5,percent of total billed charges,All Other,653.5,,,653.5,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,769.68,,,769.68,Fee Schedule,,406.1,,,406.1,Fee Schedule,,435.67,,,,Fee Schedule,,769.68,,,769.68,Fee Schedule,,406.1,,,406.1,Fee Schedule,,819.47,,,819.47,Fee Schedule,,458.5,70,,458.5,percent of total billed charges,,983.16,,,983.16,Fee Schedule,,833.29,,,833.29,Fee Schedule,,311.19,,,311.19,Fee Schedule,,311.19,,,311.19,Fee Schedule,,311.19,,,311.19,Fee Schedule,,311.19,,,311.19,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,983.16,
CHIMERISM ANAL W/CELL SELECT,81268,CPT,,78081268,CDM,301,RC,,,both,,,823,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,784.98,,,784.98,Fee Schedule,,706.74,,,706.74,Fee Schedule,,169.45,,,169.45,Fee Schedule,,169.45,,,169.45,Fee Schedule,,169.45,,,169.45,Fee Schedule,,576.1,70,,576.1,percent of total billed charges,All Other,821.49,,,821.49,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,967.53,,,967.53,Fee Schedule,,510.26,,,510.26,Fee Schedule,,547.66,,,,Fee Schedule,,967.53,,,967.53,Fee Schedule,,510.26,,,510.26,Fee Schedule,,1030.12,,,1030.12,Fee Schedule,,576.1,70,,576.1,percent of total billed charges,,1235.89,,,1235.89,Fee Schedule,,1047.49,,,1047.49,Fee Schedule,,391.19,,,391.19,Fee Schedule,,391.19,,,391.19,Fee Schedule,,391.19,,,391.19,Fee Schedule,,391.19,,,391.19,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1235.89,
HBA1/HBA2 GENE DUP/DEL VRNTS,81269,CPT,,78081269,CDM,301,RC,,,both,,,639,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,609.22,,,609.22,Fee Schedule,,548.5,,,548.5,Fee Schedule,,80.96,,,80.96,Fee Schedule,,80.96,,,80.96,Fee Schedule,,80.96,,,80.96,Fee Schedule,,447.3,70,,447.3,percent of total billed charges,All Other,637.56,,,637.56,Fee Schedule,,358,,,358,Other,186% of Medicaid,750.9,,,750.9,Fee Schedule,,396.18,,,396.18,Fee Schedule,,425.04,,,,Fee Schedule,,750.9,,,750.9,Fee Schedule,,396.18,,,396.18,Fee Schedule,,799.48,,,799.48,Fee Schedule,,447.3,70,,447.3,percent of total billed charges,,959.18,,,959.18,Fee Schedule,,812.96,,,812.96,Fee Schedule,,303.6,,,303.6,Fee Schedule,,303.6,,,303.6,Fee Schedule,,303.6,,,303.6,Fee Schedule,,303.6,,,303.6,Fee Schedule,,192.59,,,192.59,Other,100% of Medicaid,192.59,,,192.59,Other,100% of Medicaid,192.59,,,192.59,Other,100% of Medicaid,192.59,,,192.59,Other,100% of Medicaid,433.32,,,433.32,Other,225% of Medicaid,294.66,,,294.66,Other,153% of Medicaid,433.32,,,433.32,Other,225% of Medicaid,269.62,,,269.62,Other,140% of Medicaid,433.32,,,433.32,Other,225% of Medicaid,500.73,,,500.73,Other,250% of Medicaid,623.98,,,623.98,Other,324% of Medicaid,414.06,,,414.06,Other,215% of Medicaid,414.06,,,414.06,Other,215% of Medicaid,240.73,,,240.73,Other,125% of Medicaid,0.01,959.18,
JAK2 GENE,81270,CPT,,78081270,CDM,301,RC,,,both,,,511,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,275.9,,,275.9,Fee Schedule,,248.4,,,248.4,Fee Schedule,,21.53,,,21.53,Fee Schedule,,21.53,,,21.53,Fee Schedule,,21.53,,,21.53,Fee Schedule,,357.7,70,,357.7,percent of total billed charges,All Other,288.73,,,288.73,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,340.06,,,340.06,Fee Schedule,,316.82,,,316.82,Fee Schedule,,192.49,,,,Fee Schedule,,340.06,,,340.06,Fee Schedule,,316.82,,,316.82,Fee Schedule,,362.06,,,362.06,Fee Schedule,,357.7,70,,357.7,percent of total billed charges,,434.38,,,434.38,Fee Schedule,,368.16,,,368.16,Fee Schedule,,137.49,,,137.49,Fee Schedule,,137.49,,,137.49,Fee Schedule,,137.49,,,137.49,Fee Schedule,,137.49,,,137.49,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,434.38,
JAK2 GENE,81270,CPT,TC,85081270,CDM,301,RC,,,both,,,511,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,275.9,,,275.9,Fee Schedule,,248.4,,,248.4,Fee Schedule,,21.53,,,21.53,Fee Schedule,,21.53,,,21.53,Fee Schedule,,21.53,,,21.53,Fee Schedule,,357.7,70,,357.7,percent of total billed charges,All Other,288.73,,,288.73,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,340.06,,,340.06,Fee Schedule,,316.82,,,316.82,Fee Schedule,,192.49,,,,Fee Schedule,,340.06,,,340.06,Fee Schedule,,316.82,,,316.82,Fee Schedule,,362.06,,,362.06,Fee Schedule,,357.7,70,,357.7,percent of total billed charges,,434.38,,,434.38,Fee Schedule,,368.16,,,368.16,Fee Schedule,,137.49,,,137.49,Fee Schedule,,137.49,,,137.49,Fee Schedule,,137.49,,,137.49,Fee Schedule,,137.49,,,137.49,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,434.38,
KRAS GENE VARIANTS EXON 2,81275,CPT,,78081275,CDM,301,RC,,,both,,,726,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,581.68,,,581.68,Fee Schedule,,523.71,,,523.71,Fee Schedule,,43.32,,,43.32,Fee Schedule,,43.32,,,43.32,Fee Schedule,,43.32,,,43.32,Fee Schedule,,508.2,70,,508.2,percent of total billed charges,All Other,608.74,,,608.74,Fee Schedule,,359,,,359,Other,186% of Medicaid,716.96,,,716.96,Fee Schedule,,450.12,,,450.12,Fee Schedule,,405.83,,,,Fee Schedule,,716.96,,,716.96,Fee Schedule,,450.12,,,450.12,Fee Schedule,,763.34,,,763.34,Fee Schedule,,508.2,70,,508.2,percent of total billed charges,,915.82,,,915.82,Fee Schedule,,776.21,,,776.21,Fee Schedule,,289.88,,,289.88,Fee Schedule,,289.88,,,289.88,Fee Schedule,,289.88,,,289.88,Fee Schedule,,289.88,,,289.88,Fee Schedule,,193.25,,,193.25,Other,100% of Medicaid,193.25,,,193.25,Other,100% of Medicaid,193.25,,,193.25,Other,100% of Medicaid,193.25,,,193.25,Other,100% of Medicaid,434.81,,,434.81,Other,225% of Medicaid,295.67,,,295.67,Other,153% of Medicaid,434.81,,,434.81,Other,225% of Medicaid,270.55,,,270.55,Other,140% of Medicaid,434.81,,,434.81,Other,225% of Medicaid,502.45,,,502.45,Other,250% of Medicaid,626.13,,,626.13,Other,324% of Medicaid,415.49,,,415.49,Other,215% of Medicaid,415.49,,,415.49,Other,215% of Medicaid,241.56,,,241.56,Other,125% of Medicaid,0.01,915.82,
KRAS GENE VARIANTS EXON 2,81275,CPT,TC,85081275,CDM,301,RC,,,both,,,726,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,581.68,,,581.68,Fee Schedule,,523.71,,,523.71,Fee Schedule,,43.32,,,43.32,Fee Schedule,,43.32,,,43.32,Fee Schedule,,43.32,,,43.32,Fee Schedule,,508.2,70,,508.2,percent of total billed charges,All Other,608.74,,,608.74,Fee Schedule,,359,,,359,Other,186% of Medicaid,716.96,,,716.96,Fee Schedule,,450.12,,,450.12,Fee Schedule,,405.83,,,,Fee Schedule,,716.96,,,716.96,Fee Schedule,,450.12,,,450.12,Fee Schedule,,763.34,,,763.34,Fee Schedule,,508.2,70,,508.2,percent of total billed charges,,915.82,,,915.82,Fee Schedule,,776.21,,,776.21,Fee Schedule,,289.88,,,289.88,Fee Schedule,,289.88,,,289.88,Fee Schedule,,289.88,,,289.88,Fee Schedule,,289.88,,,289.88,Fee Schedule,,193.25,,,193.25,Other,100% of Medicaid,193.25,,,193.25,Other,100% of Medicaid,193.25,,,193.25,Other,100% of Medicaid,193.25,,,193.25,Other,100% of Medicaid,434.81,,,434.81,Other,225% of Medicaid,295.67,,,295.67,Other,153% of Medicaid,434.81,,,434.81,Other,225% of Medicaid,270.55,,,270.55,Other,140% of Medicaid,434.81,,,434.81,Other,225% of Medicaid,502.45,,,502.45,Other,250% of Medicaid,626.13,,,626.13,Other,324% of Medicaid,415.49,,,415.49,Other,215% of Medicaid,415.49,,,415.49,Other,215% of Medicaid,241.56,,,241.56,Other,125% of Medicaid,0.01,915.82,
IFNL3 GENE,81283,CPT,,78081283,CDM,301,RC,,,both,,,233,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,220.84,,,220.84,Fee Schedule,,198.83,,,198.83,Fee Schedule,,178.25,76.5,,178.25,percent of total billed charges,All Other,160.77,69,,160.77,percent of total billed charges,All Other,151.45,65,,151.45,percent of total billed charges,All Other,163.1,70,,163.1,percent of total billed charges,All Other,231.12,,,231.12,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,272.2,,,272.2,Fee Schedule,,144.46,,,144.46,Fee Schedule,,154.08,,,,Fee Schedule,,272.2,,,272.2,Fee Schedule,,144.46,,,144.46,Fee Schedule,,289.81,,,289.81,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,,347.7,,,347.7,Fee Schedule,,294.7,,,294.7,Fee Schedule,,110.06,,,110.06,Fee Schedule,,110.06,,,110.06,Fee Schedule,,110.06,,,110.06,Fee Schedule,,110.06,,,110.06,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,347.7,
MGMT GENE PRMTR MTHYLTN ALYS,81287,CPT,,78081287,CDM,301,RC,,,both,,,393,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,375.17,,,375.17,Fee Schedule,,337.77,,,337.77,Fee Schedule,,35.94,,,35.94,Fee Schedule,,35.94,,,35.94,Fee Schedule,,35.94,,,35.94,Fee Schedule,,275.1,70,,275.1,percent of total billed charges,All Other,392.62,,,392.62,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,462.41,,,462.41,Fee Schedule,,243.66,,,243.66,Fee Schedule,,261.74,,,,Fee Schedule,,462.41,,,462.41,Fee Schedule,,243.66,,,243.66,Fee Schedule,,492.33,,,492.33,Fee Schedule,,275.1,70,,275.1,percent of total billed charges,,590.67,,,590.67,Fee Schedule,,500.63,,,500.63,Fee Schedule,,186.96,,,186.96,Fee Schedule,,186.96,,,186.96,Fee Schedule,,186.96,,,186.96,Fee Schedule,,186.96,,,186.96,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,590.67,
MTHFR GENE,81291,CPT,,78081291,CDM,301,RC,,,both,,,132,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,196.67,,,196.67,Fee Schedule,,177.07,,,177.07,Fee Schedule,,24.37,,,24.37,Fee Schedule,,24.37,,,24.37,Fee Schedule,,24.37,,,24.37,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,All Other,205.82,,,205.82,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,242.41,,,242.41,Fee Schedule,,81.84,,,81.84,Fee Schedule,,137.21,,,,Fee Schedule,,242.41,,,242.41,Fee Schedule,,81.84,,,81.84,Fee Schedule,,258.09,,,258.09,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,,309.65,,,309.65,Fee Schedule,,262.45,,,262.45,Fee Schedule,,98.01,,,98.01,Fee Schedule,,98.01,,,98.01,Fee Schedule,,98.01,,,98.01,Fee Schedule,,98.01,,,98.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,309.65,
NPM1 GENE,81310,CPT,,78081310,CDM,301,RC,,,both,,,777,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,742.03,,,742.03,Fee Schedule,,668.07,,,668.07,Fee Schedule,,14.5,,,14.5,Fee Schedule,,14.5,,,14.5,Fee Schedule,,14.5,,,14.5,Fee Schedule,,543.9,70,,543.9,percent of total billed charges,All Other,776.54,,,776.54,Fee Schedule,,459,,,459,Other,186% of Medicaid,914.59,,,914.59,Fee Schedule,,481.74,,,481.74,Fee Schedule,,517.69,,,,Fee Schedule,,914.59,,,914.59,Fee Schedule,,481.74,,,481.74,Fee Schedule,,973.75,,,973.75,Fee Schedule,,543.9,70,,543.9,percent of total billed charges,,1168.27,,,1168.27,Fee Schedule,,990.18,,,990.18,Fee Schedule,,369.78,,,369.78,Fee Schedule,,369.78,,,369.78,Fee Schedule,,369.78,,,369.78,Fee Schedule,,369.78,,,369.78,Fee Schedule,,246.52,,,246.52,Other,100% of Medicaid,246.52,,,246.52,Other,100% of Medicaid,246.52,,,246.52,Other,100% of Medicaid,246.52,,,246.52,Other,100% of Medicaid,554.67,,,554.67,Other,225% of Medicaid,377.18,,,377.18,Other,153% of Medicaid,554.67,,,554.67,Other,225% of Medicaid,345.13,,,345.13,Other,140% of Medicaid,554.67,,,554.67,Other,225% of Medicaid,640.95,,,640.95,Other,250% of Medicaid,798.72,,,798.72,Other,324% of Medicaid,530.02,,,530.02,Other,215% of Medicaid,530.02,,,530.02,Other,215% of Medicaid,308.15,,,308.15,Other,125% of Medicaid,0.01,1168.27,
PML/RARALPHA COM BREAKPOINTS,81315,CPT,,78081315,CDM,301,RC,,,both,,,654,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,624,,,624,Fee Schedule,,561.81,,,561.81,Fee Schedule,,39.53,,,39.53,Fee Schedule,,39.53,,,39.53,Fee Schedule,,39.53,,,39.53,Fee Schedule,,457.8,70,,457.8,percent of total billed charges,All Other,653.03,,,653.03,Fee Schedule,,386,,,386,Other,186% of Medicaid,769.12,,,769.12,Fee Schedule,,405.48,,,405.48,Fee Schedule,,435.35,,,,Fee Schedule,,769.12,,,769.12,Fee Schedule,,405.48,,,405.48,Fee Schedule,,818.87,,,818.87,Fee Schedule,,457.8,70,,457.8,percent of total billed charges,,982.45,,,982.45,Fee Schedule,,832.69,,,832.69,Fee Schedule,,310.97,,,310.97,Fee Schedule,,310.97,,,310.97,Fee Schedule,,310.97,,,310.97,Fee Schedule,,310.97,,,310.97,Fee Schedule,,207.31,,,207.31,Other,100% of Medicaid,207.31,,,207.31,Other,100% of Medicaid,207.31,,,207.31,Other,100% of Medicaid,207.31,,,207.31,Other,100% of Medicaid,466.45,,,466.45,Other,225% of Medicaid,317.18,,,317.18,Other,153% of Medicaid,466.45,,,466.45,Other,225% of Medicaid,290.23,,,290.23,Other,140% of Medicaid,466.45,,,466.45,Other,225% of Medicaid,539.01,,,539.01,Other,250% of Medicaid,671.68,,,671.68,Other,324% of Medicaid,445.72,,,445.72,Other,215% of Medicaid,445.72,,,445.72,Other,215% of Medicaid,259.14,,,259.14,Other,125% of Medicaid,0.01,982.45,
SERPINA1 GENE,81332,CPT,,78081332,CDM,301,RC,,,both,,,244,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,131.39,,,131.39,Fee Schedule,,118.29,,,118.29,Fee Schedule,,25.42,,,25.42,Fee Schedule,,25.42,,,25.42,Fee Schedule,,25.42,,,25.42,Fee Schedule,,170.8,70,,170.8,percent of total billed charges,All Other,137.5,,,137.5,Fee Schedule,,81,,,81,Other,186% of Medicaid,161.94,,,161.94,Fee Schedule,,151.28,,,151.28,Fee Schedule,,91.67,,,,Fee Schedule,,161.94,,,161.94,Fee Schedule,,151.28,,,151.28,Fee Schedule,,172.42,,,172.42,Fee Schedule,,170.8,70,,170.8,percent of total billed charges,,206.86,,,206.86,Fee Schedule,,175.33,,,175.33,Fee Schedule,,65.48,,,65.48,Fee Schedule,,65.48,,,65.48,Fee Schedule,,65.48,,,65.48,Fee Schedule,,65.48,,,65.48,Fee Schedule,,43.65,,,43.65,Other,100% of Medicaid,43.65,,,43.65,Other,100% of Medicaid,43.65,,,43.65,Other,100% of Medicaid,43.65,,,43.65,Other,100% of Medicaid,98.21,,,98.21,Other,225% of Medicaid,66.78,,,66.78,Other,153% of Medicaid,98.21,,,98.21,Other,225% of Medicaid,61.11,,,61.11,Other,140% of Medicaid,98.21,,,98.21,Other,225% of Medicaid,113.49,,,113.49,Other,250% of Medicaid,141.43,,,141.43,Other,324% of Medicaid,93.85,,,93.85,Other,215% of Medicaid,93.85,,,93.85,Other,215% of Medicaid,54.56,,,54.56,Other,125% of Medicaid,0.01,206.86,
TPMT GENE COM VARIANTS,81335,CPT,,78081335,CDM,301,RC,,,both,,,552,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,526.18,,,526.18,Fee Schedule,,473.74,,,473.74,Fee Schedule,,69.92,,,69.92,Fee Schedule,,69.92,,,69.92,Fee Schedule,,69.92,,,69.92,Fee Schedule,,386.4,70,,386.4,percent of total billed charges,All Other,550.65,,,550.65,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,648.55,,,648.55,Fee Schedule,,342.24,,,342.24,Fee Schedule,,367.1,,,,Fee Schedule,,648.55,,,648.55,Fee Schedule,,342.24,,,342.24,Fee Schedule,,690.5,,,690.5,Fee Schedule,,386.4,70,,386.4,percent of total billed charges,,828.43,,,828.43,Fee Schedule,,702.15,,,702.15,Fee Schedule,,262.22,,,262.22,Fee Schedule,,262.22,,,262.22,Fee Schedule,,262.22,,,262.22,Fee Schedule,,262.22,,,262.22,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,828.43,
TRG GENE REARRANGEMENT ANAL,81342,CPT,TC,85081342,CDM,301,RC,,,both,,,1008,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,606.52,,,606.52,Fee Schedule,,546.07,,,546.07,Fee Schedule,,35.91,,,35.91,Fee Schedule,,35.91,,,35.91,Fee Schedule,,35.91,,,35.91,Fee Schedule,,705.6,70,,705.6,percent of total billed charges,All Other,634.73,,,634.73,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,747.57,,,747.57,Fee Schedule,,624.96,,,624.96,Fee Schedule,,423.15,,,,Fee Schedule,,747.57,,,747.57,Fee Schedule,,624.96,,,624.96,Fee Schedule,,795.93,,,795.93,Fee Schedule,,705.6,70,,705.6,percent of total billed charges,,954.92,,,954.92,Fee Schedule,,809.35,,,809.35,Fee Schedule,,302.25,,,302.25,Fee Schedule,,302.25,,,302.25,Fee Schedule,,302.25,,,302.25,Fee Schedule,,302.25,,,302.25,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,954.92,
HBB FULL GENE SEQUENCE,81364,CPT,,78081364,CDM,301,RC,,,both,,,1023,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,976.99,,,976.99,Fee Schedule,,879.61,,,879.61,Fee Schedule,,782.6,76.5,,782.6,percent of total billed charges,All Other,705.87,69,,705.87,percent of total billed charges,All Other,664.95,65,,664.95,percent of total billed charges,All Other,716.1,70,,716.1,percent of total billed charges,All Other,1022.43,,,1022.43,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1204.19,,,1204.19,Fee Schedule,,634.26,,,634.26,Fee Schedule,,681.62,,,,Fee Schedule,,1204.19,,,1204.19,Fee Schedule,,634.26,,,634.26,Fee Schedule,,1282.09,,,1282.09,Fee Schedule,,716.1,70,,716.1,percent of total billed charges,,1538.2,,,1538.2,Fee Schedule,,1303.71,,,1303.71,Fee Schedule,,486.87,,,486.87,Fee Schedule,,486.87,,,486.87,Fee Schedule,,486.87,,,486.87,Fee Schedule,,486.87,,,486.87,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1538.2,
HLA I TYPING COMPLETE LR,81372,CPT,,78081372,CDM,301,RC,,,both,,,2610,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,1214.81,,,1214.81,Fee Schedule,,1093.73,,,1093.73,Fee Schedule,,366.46,,,366.46,Fee Schedule,,366.46,,,366.46,Fee Schedule,,366.46,,,366.46,Fee Schedule,,1827,70,,1827,percent of total billed charges,All Other,1271.31,,,1271.31,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1497.32,,,1497.32,Fee Schedule,,1618.2,,,1618.2,Fee Schedule,,847.54,,,,Fee Schedule,,1497.32,,,1497.32,Fee Schedule,,1618.2,,,1618.2,Fee Schedule,,1594.18,,,1594.18,Fee Schedule,,1827,70,,1827,percent of total billed charges,,1912.63,,,1912.63,Fee Schedule,,1621.07,,,1621.07,Fee Schedule,,605.39,,,605.39,Fee Schedule,,605.39,,,605.39,Fee Schedule,,605.39,,,605.39,Fee Schedule,,605.39,,,605.39,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1912.63,
HLA I TYPING 1 LOCUS LR,81373,CPT,,78081373,CDM,301,RC,,,both,,,534,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,383.56,,,383.56,Fee Schedule,,345.34,,,345.34,Fee Schedule,,124.6,,,124.6,Fee Schedule,,124.6,,,124.6,Fee Schedule,,124.6,,,124.6,Fee Schedule,,373.8,70,,373.8,percent of total billed charges,All Other,401.4,,,401.4,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,472.77,,,472.77,Fee Schedule,,331.08,,,331.08,Fee Schedule,,267.6,,,,Fee Schedule,,472.77,,,472.77,Fee Schedule,,331.08,,,331.08,Fee Schedule,,503.35,,,503.35,Fee Schedule,,373.8,70,,373.8,percent of total billed charges,,603.9,,,603.9,Fee Schedule,,511.84,,,511.84,Fee Schedule,,191.15,,,191.15,Fee Schedule,,191.15,,,191.15,Fee Schedule,,191.15,,,191.15,Fee Schedule,,191.15,,,191.15,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,603.9,
HLA I TYPING 1 ANTIGEN LR,81374,CPT,,78081374,CDM,301,RC,,,both,,,405,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,223.73,,,223.73,Fee Schedule,,201.43,,,201.43,Fee Schedule,,124.6,,,124.6,Fee Schedule,,124.6,,,124.6,Fee Schedule,,124.6,,,124.6,Fee Schedule,,283.5,70,,283.5,percent of total billed charges,All Other,234.14,,,234.14,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,275.76,,,275.76,Fee Schedule,,251.1,,,251.1,Fee Schedule,,156.09,,,,Fee Schedule,,275.76,,,275.76,Fee Schedule,,251.1,,,251.1,Fee Schedule,,293.6,,,293.6,Fee Schedule,,283.5,70,,283.5,percent of total billed charges,,352.25,,,352.25,Fee Schedule,,298.56,,,298.56,Fee Schedule,,111.5,,,111.5,Fee Schedule,,111.5,,,111.5,Fee Schedule,,111.5,,,111.5,Fee Schedule,,111.5,,,111.5,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,352.25,
HLA II TYPING AG EQUIV LR,81375,CPT,,78081375,CDM,301,RC,,,both,,,1047,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,664.43,,,664.43,Fee Schedule,,598.21,,,598.21,Fee Schedule,,128.18,,,128.18,Fee Schedule,,128.18,,,128.18,Fee Schedule,,128.18,,,128.18,Fee Schedule,,732.9,70,,732.9,percent of total billed charges,All Other,695.33,,,695.33,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,818.95,,,818.95,Fee Schedule,,649.14,,,649.14,Fee Schedule,,463.55,,,,Fee Schedule,,818.95,,,818.95,Fee Schedule,,649.14,,,649.14,Fee Schedule,,871.92,,,871.92,Fee Schedule,,732.9,70,,732.9,percent of total billed charges,,1046.09,,,1046.09,Fee Schedule,,886.63,,,886.63,Fee Schedule,,331.11,,,331.11,Fee Schedule,,331.11,,,331.11,Fee Schedule,,331.11,,,331.11,Fee Schedule,,331.11,,,331.11,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1046.09,
HLA II TYPING 1 LOCUS LR,81376,CPT,,78081376,CDM,301,RC,,,both,,,386,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,367.88,,,367.88,Fee Schedule,,331.22,,,331.22,Fee Schedule,,68.66,,,68.66,Fee Schedule,,68.66,,,68.66,Fee Schedule,,68.66,,,68.66,Fee Schedule,,270.2,70,,270.2,percent of total billed charges,All Other,384.99,,,384.99,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,453.44,,,453.44,Fee Schedule,,239.32,,,239.32,Fee Schedule,,256.66,,,,Fee Schedule,,453.44,,,453.44,Fee Schedule,,239.32,,,239.32,Fee Schedule,,482.77,,,482.77,Fee Schedule,,270.2,70,,270.2,percent of total billed charges,,579.2,,,579.2,Fee Schedule,,490.91,,,490.91,Fee Schedule,,183.33,,,183.33,Fee Schedule,,183.33,,,183.33,Fee Schedule,,183.33,,,183.33,Fee Schedule,,183.33,,,183.33,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,579.2,
HLA II TYPE 1 AG EQUIV LR,81377,CPT,,78081377,CDM,301,RC,,,both,,,436,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,285.17,,,285.17,Fee Schedule,,256.75,,,256.75,Fee Schedule,,58.63,,,58.63,Fee Schedule,,58.63,,,58.63,Fee Schedule,,58.63,,,58.63,Fee Schedule,,305.2,70,,305.2,percent of total billed charges,All Other,298.43,,,298.43,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,351.49,,,351.49,Fee Schedule,,270.32,,,270.32,Fee Schedule,,198.95,,,,Fee Schedule,,351.49,,,351.49,Fee Schedule,,270.32,,,270.32,Fee Schedule,,374.22,,,374.22,Fee Schedule,,305.2,70,,305.2,percent of total billed charges,,448.98,,,448.98,Fee Schedule,,380.53,,,380.53,Fee Schedule,,142.11,,,142.11,Fee Schedule,,142.11,,,142.11,Fee Schedule,,142.11,,,142.11,Fee Schedule,,142.11,,,142.11,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,448.98,
HLA I TYPING 1 LOCUS HR,81380,CPT,,78081380,CDM,301,RC,,,both,,,559,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,533.52,,,533.52,Fee Schedule,,480.35,,,480.35,Fee Schedule,,35.98,,,35.98,Fee Schedule,,35.98,,,35.98,Fee Schedule,,35.98,,,35.98,Fee Schedule,,391.3,70,,391.3,percent of total billed charges,All Other,558.34,,,558.34,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,657.6,,,657.6,Fee Schedule,,346.58,,,346.58,Fee Schedule,,372.23,,,,Fee Schedule,,657.6,,,657.6,Fee Schedule,,346.58,,,346.58,Fee Schedule,,700.14,,,700.14,Fee Schedule,,391.3,70,,391.3,percent of total billed charges,,839.99,,,839.99,Fee Schedule,,711.95,,,711.95,Fee Schedule,,265.88,,,265.88,Fee Schedule,,265.88,,,265.88,Fee Schedule,,265.88,,,265.88,Fee Schedule,,265.88,,,265.88,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,839.99,
HLA I TYPING 1 ALLELE HR,81381,CPT,,78081381,CDM,301,RC,,,both,,,659,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,511.4,,,511.4,Fee Schedule,,460.43,,,460.43,Fee Schedule,,124.6,,,124.6,Fee Schedule,,124.6,,,124.6,Fee Schedule,,124.6,,,124.6,Fee Schedule,,461.3,70,,461.3,percent of total billed charges,All Other,535.19,,,535.19,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,630.33,,,630.33,Fee Schedule,,408.58,,,408.58,Fee Schedule,,356.79,,,,Fee Schedule,,630.33,,,630.33,Fee Schedule,,408.58,,,408.58,Fee Schedule,,671.11,,,671.11,Fee Schedule,,461.3,70,,461.3,percent of total billed charges,,805.16,,,805.16,Fee Schedule,,682.42,,,682.42,Fee Schedule,,254.85,,,254.85,Fee Schedule,,254.85,,,254.85,Fee Schedule,,254.85,,,254.85,Fee Schedule,,254.85,,,254.85,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,805.16,
HLA II TYPING 1 LOC HR,81382,CPT,,78081382,CDM,301,RC,,,both,,,391,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,372.28,,,372.28,Fee Schedule,,335.17,,,335.17,Fee Schedule,,25.24,,,25.24,Fee Schedule,,25.24,,,25.24,Fee Schedule,,25.24,,,25.24,Fee Schedule,,273.7,70,,273.7,percent of total billed charges,All Other,389.59,,,389.59,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,458.85,,,458.85,Fee Schedule,,242.42,,,242.42,Fee Schedule,,259.73,,,,Fee Schedule,,458.85,,,458.85,Fee Schedule,,242.42,,,242.42,Fee Schedule,,488.54,,,488.54,Fee Schedule,,273.7,70,,273.7,percent of total billed charges,,586.12,,,586.12,Fee Schedule,,496.78,,,496.78,Fee Schedule,,185.52,,,185.52,Fee Schedule,,185.52,,,185.52,Fee Schedule,,185.52,,,185.52,Fee Schedule,,185.52,,,185.52,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,586.12,
HLA II TYPING 1 ALLELE HR,81383,CPT,,78081383,CDM,301,RC,,,both,,,518,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,328.48,,,328.48,Fee Schedule,,295.74,,,295.74,Fee Schedule,,45.74,,,45.74,Fee Schedule,,45.74,,,45.74,Fee Schedule,,45.74,,,45.74,Fee Schedule,,362.6,70,,362.6,percent of total billed charges,All Other,343.76,,,343.76,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,404.87,,,404.87,Fee Schedule,,321.16,,,321.16,Fee Schedule,,229.17,,,,Fee Schedule,,404.87,,,404.87,Fee Schedule,,321.16,,,321.16,Fee Schedule,,431.06,,,431.06,Fee Schedule,,362.6,70,,362.6,percent of total billed charges,,517.17,,,517.17,Fee Schedule,,438.33,,,438.33,Fee Schedule,,163.7,,,163.7,Fee Schedule,,163.7,,,163.7,Fee Schedule,,163.7,,,163.7,Fee Schedule,,163.7,,,163.7,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,517.17,
MOPATH PROCEDURE LEVEL 1,81400,CPT,,78081400,CDM,301,RC,,,both,,,498,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,192.52,,,192.52,Fee Schedule,,173.33,,,173.33,Fee Schedule,,20.51,,,20.51,Fee Schedule,,20.51,,,20.51,Fee Schedule,,20.51,,,20.51,Fee Schedule,,348.6,70,,348.6,percent of total billed charges,All Other,201.47,,,201.47,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,237.29,,,237.29,Fee Schedule,,308.76,,,308.76,Fee Schedule,,134.32,,,,Fee Schedule,,237.29,,,237.29,Fee Schedule,,308.76,,,308.76,Fee Schedule,,252.64,,,252.64,Fee Schedule,,348.6,70,,348.6,percent of total billed charges,,303.11,,,303.11,Fee Schedule,,256.9,,,256.9,Fee Schedule,,95.94,,,95.94,Fee Schedule,,95.94,,,95.94,Fee Schedule,,95.94,,,95.94,Fee Schedule,,95.94,,,95.94,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,348.6,
MOPATH PROCEDURE LEVEL 2,81401,CPT,,78081401,CDM,301,RC,,,both,,,498,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,412.37,,,412.37,Fee Schedule,,371.27,,,371.27,Fee Schedule,,20.51,,,20.51,Fee Schedule,,20.51,,,20.51,Fee Schedule,,20.51,,,20.51,Fee Schedule,,348.6,70,,348.6,percent of total billed charges,All Other,431.55,,,431.55,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,508.27,,,508.27,Fee Schedule,,308.76,,,308.76,Fee Schedule,,287.7,,,,Fee Schedule,,508.27,,,508.27,Fee Schedule,,308.76,,,308.76,Fee Schedule,,541.15,,,541.15,Fee Schedule,,348.6,70,,348.6,percent of total billed charges,,649.25,,,649.25,Fee Schedule,,550.28,,,550.28,Fee Schedule,,205.5,,,205.5,Fee Schedule,,205.5,,,205.5,Fee Schedule,,205.5,,,205.5,Fee Schedule,,205.5,,,205.5,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,649.25,
MOPATH PROCEDURE LEVEL 4,81403,CPT,,78081403,CDM,301,RC,,,both,,,603,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,557.45,,,557.45,Fee Schedule,,501.89,,,501.89,Fee Schedule,,67.55,,,67.55,Fee Schedule,,67.55,,,67.55,Fee Schedule,,67.55,,,67.55,Fee Schedule,,422.1,70,,422.1,percent of total billed charges,All Other,583.38,,,583.38,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,687.09,,,687.09,Fee Schedule,,373.86,,,373.86,Fee Schedule,,388.92,,,,Fee Schedule,,687.09,,,687.09,Fee Schedule,,373.86,,,373.86,Fee Schedule,,731.54,,,731.54,Fee Schedule,,422.1,70,,422.1,percent of total billed charges,,877.67,,,877.67,Fee Schedule,,743.88,,,743.88,Fee Schedule,,277.8,,,277.8,Fee Schedule,,277.8,,,277.8,Fee Schedule,,277.8,,,277.8,Fee Schedule,,277.8,,,277.8,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,877.67,
MOPATH PROCEDURE LEVEL 5,81404,CPT,,78081404,CDM,301,RC,,,both,,,551,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,827.24,,,827.24,Fee Schedule,,744.79,,,744.79,Fee Schedule,,60.5,,,60.5,Fee Schedule,,60.5,,,60.5,Fee Schedule,,60.5,,,60.5,Fee Schedule,,385.7,70,,385.7,percent of total billed charges,All Other,865.71,,,865.71,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1019.62,,,1019.62,Fee Schedule,,341.62,,,341.62,Fee Schedule,,577.14,,,,Fee Schedule,,1019.62,,,1019.62,Fee Schedule,,341.62,,,341.62,Fee Schedule,,1085.58,,,1085.58,Fee Schedule,,385.7,70,,385.7,percent of total billed charges,,1302.43,,,1302.43,Fee Schedule,,1103.89,,,1103.89,Fee Schedule,,412.25,,,412.25,Fee Schedule,,412.25,,,412.25,Fee Schedule,,412.25,,,412.25,Fee Schedule,,412.25,,,412.25,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1302.43,
MOPATH PROCEDURE LEVEL 6,81405,CPT,,78081405,CDM,301,RC,,,both,,,3201,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,907.06,,,907.06,Fee Schedule,,816.66,,,816.66,Fee Schedule,,87.56,,,87.56,Fee Schedule,,87.56,,,87.56,Fee Schedule,,87.56,,,87.56,Fee Schedule,,2240.7,70,,2240.7,percent of total billed charges,All Other,949.25,,,949.25,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1118.01,,,1118.01,Fee Schedule,,1984.62,,,1984.62,Fee Schedule,,632.84,,,,Fee Schedule,,1118.01,,,1118.01,Fee Schedule,,1984.62,,,1984.62,Fee Schedule,,1190.33,,,1190.33,Fee Schedule,,2240.7,70,,2240.7,percent of total billed charges,,1428.11,,,1428.11,Fee Schedule,,1210.41,,,1210.41,Fee Schedule,,452.03,,,452.03,Fee Schedule,,452.03,,,452.03,Fee Schedule,,452.03,,,452.03,Fee Schedule,,452.03,,,452.03,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2240.7,
MOPATH PROCEDURE LEVEL 7,81406,CPT,,78081406,CDM,301,RC,,,both,,,750,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,851.47,,,851.47,Fee Schedule,,766.6,,,766.6,Fee Schedule,,46.9,,,46.9,Fee Schedule,,46.9,,,46.9,Fee Schedule,,46.9,,,46.9,Fee Schedule,,525,70,,525,percent of total billed charges,All Other,891.07,,,891.07,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,1049.48,,,1049.48,Fee Schedule,,465,,,465,Fee Schedule,,594.05,,,,Fee Schedule,,1049.48,,,1049.48,Fee Schedule,,465,,,465,Fee Schedule,,1117.38,,,1117.38,Fee Schedule,,525,70,,525,percent of total billed charges,,1340.58,,,1340.58,Fee Schedule,,1136.22,,,1136.22,Fee Schedule,,424.32,,,424.32,Fee Schedule,,424.32,,,424.32,Fee Schedule,,424.32,,,424.32,Fee Schedule,,424.32,,,424.32,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1340.58,
MOPATH PROCEDURE LEVEL 9,81408,CPT,,78081408,CDM,301,RC,,,both,,,4917,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,6020,,,6020,Fee Schedule,,5420,,,5420,Fee Schedule,,964.59,,,964.59,Fee Schedule,,964.59,,,964.59,Fee Schedule,,964.59,,,964.59,Fee Schedule,,3441.9,70,,3441.9,percent of total billed charges,All Other,6300,,,6300,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,7420,,,7420,Fee Schedule,,3048.54,,,3048.54,Fee Schedule,,4200,,,,Fee Schedule,,7420,,,7420,Fee Schedule,,3048.54,,,3048.54,Fee Schedule,,7900,,,7900,Fee Schedule,,3441.9,70,,3441.9,percent of total billed charges,,9478.07,,,9478.07,Fee Schedule,,8033.24,,,8033.24,Fee Schedule,,3000,,,3000,Fee Schedule,,3000,,,3000,Fee Schedule,,3000,,,3000,Fee Schedule,,3000,,,3000,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,9478.07,
TARGETED GENOMIC SEQ ANALYS,81445,CPT,,78081445,CDM,301,RC,,,both,,,1884,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,1799.71,,,1799.71,Fee Schedule,,1620.34,,,1620.34,Fee Schedule,,846.27,,,846.27,Fee Schedule,,846.27,,,846.27,Fee Schedule,,846.27,,,846.27,Fee Schedule,,1318.8,70,,1318.8,percent of total billed charges,All Other,1883.42,,,1883.42,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,2218.25,,,2218.25,Fee Schedule,,1168.08,,,1168.08,Fee Schedule,,1255.61,,,,Fee Schedule,,2218.25,,,2218.25,Fee Schedule,,1168.08,,,1168.08,Fee Schedule,,2361.74,,,2361.74,Fee Schedule,,1318.8,70,,1318.8,percent of total billed charges,,2833.52,,,2833.52,Fee Schedule,,2401.58,,,2401.58,Fee Schedule,,896.87,,,896.87,Fee Schedule,,896.87,,,896.87,Fee Schedule,,896.87,,,896.87,Fee Schedule,,896.87,,,896.87,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2833.52,
TARGETED GENOMIC SEQ ANALYS,81450,CPT,,78081450,CDM,301,RC,,,both,,,1596,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,2286.19,,,2286.19,Fee Schedule,,2058.33,,,2058.33,Fee Schedule,,846.27,,,846.27,Fee Schedule,,846.27,,,846.27,Fee Schedule,,846.27,,,846.27,Fee Schedule,,1117.2,70,,1117.2,percent of total billed charges,All Other,2392.52,,,2392.52,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,2817.86,,,2817.86,Fee Schedule,,989.52,,,989.52,Fee Schedule,,1595.01,,,,Fee Schedule,,2817.86,,,2817.86,Fee Schedule,,989.52,,,989.52,Fee Schedule,,3000.14,,,3000.14,Fee Schedule,,1117.2,70,,1117.2,percent of total billed charges,,3599.44,,,3599.44,Fee Schedule,,3050.74,,,3050.74,Fee Schedule,,1139.3,,,1139.3,Fee Schedule,,1139.3,,,1139.3,Fee Schedule,,1139.3,,,1139.3,Fee Schedule,,1139.3,,,1139.3,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3599.44,
TARGETED GENOMIC SEQ ANALYS 51/<GEN,81455,CPT,,78081455,CDM,301,RC,,,both,,,9197,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,8788,,,8788,Fee Schedule,,7912.12,,,7912.12,Fee Schedule,,846.27,,,846.27,Fee Schedule,,846.27,,,846.27,Fee Schedule,,846.27,,,846.27,Fee Schedule,,6437.9,70,,6437.9,percent of total billed charges,All Other,9196.74,,,9196.74,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,10831.72,,,10831.72,Fee Schedule,,5702.14,,,5702.14,Fee Schedule,,6131.16,,,,Fee Schedule,,10831.72,,,10831.72,Fee Schedule,,5702.14,,,5702.14,Fee Schedule,,11532.42,,,11532.42,Fee Schedule,,6437.9,70,,6437.9,percent of total billed charges,,13836.09,,,13836.09,Fee Schedule,,11726.93,,,11726.93,Fee Schedule,,4379.4,,,4379.4,Fee Schedule,,4379.4,,,4379.4,Fee Schedule,,4379.4,,,4379.4,Fee Schedule,,4379.4,,,4379.4,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,13836.09,
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,,78081479,CDM,301,RC,,,both,,,604,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,392.6,65,,392.6,percent of total billed charges,All Other,356.36,59,,356.36,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,422.8,70,,422.8,percent of total billed charges,All Other,410.72,68,,410.72,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,501.32,80,,501.32,percent of total billed charges,All Other,374.48,83,,374.48,percent of total billed charges,All Other,332.2,83,,,percent of total billed charges,All Other,501.32,80,,501.32,percent of total billed charges,All Other,374.48,83,,374.48,percent of total billed charges,All Other,483.2,80,,483.2,percent of total billed charges,All Other,422.8,70,,422.8,percent of total billed charges,,392.6,65,,392.6,percent of total billed charges,All Other,392.6,65,,392.6,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,501.32,
FTL CGEN ABNOR FOUR ANAL,81511,CPT,,78081511,CDM,301,RC,,,both,,,485,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,462.04,,,462.04,Fee Schedule,,415.99,,,415.99,Fee Schedule,,40.56,,,40.56,Fee Schedule,,40.56,,,40.56,Fee Schedule,,40.56,,,40.56,Fee Schedule,,339.5,70,,339.5,percent of total billed charges,All Other,483.53,,,483.53,Fee Schedule,,81,,,81,Other,186% of Medicaid,569.49,,,569.49,Fee Schedule,,300.7,,,300.7,Fee Schedule,,322.35,,,,Fee Schedule,,569.49,,,569.49,Fee Schedule,,300.7,,,300.7,Fee Schedule,,606.33,,,606.33,Fee Schedule,,339.5,70,,339.5,percent of total billed charges,,727.44,,,727.44,Fee Schedule,,616.55,,,616.55,Fee Schedule,,230.25,,,230.25,Fee Schedule,,230.25,,,230.25,Fee Schedule,,230.25,,,230.25,Fee Schedule,,230.25,,,230.25,Fee Schedule,,43.3,,,43.3,Other,100% of Medicaid,43.3,,,43.3,Other,100% of Medicaid,43.3,,,43.3,Other,100% of Medicaid,43.3,,,43.3,Other,100% of Medicaid,97.42,,,97.42,Other,225% of Medicaid,66.25,,,66.25,Other,153% of Medicaid,97.42,,,97.42,Other,225% of Medicaid,60.62,,,60.62,Other,140% of Medicaid,97.42,,,97.42,Other,225% of Medicaid,112.58,,,112.58,Other,250% of Medicaid,140.29,,,140.29,Other,324% of Medicaid,93.09,,,93.09,Other,215% of Medicaid,93.09,,,93.09,Other,215% of Medicaid,54.12,,,54.12,Other,125% of Medicaid,0.01,727.44,
TEST FOR ACETONE/KETONES,82009,CPT,,78082009,CDM,301,RC,,,both,,,97,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,13.61,,,13.61,Fee Schedule,,12.25,,,12.25,Fee Schedule,,34.85,,,34.85,Fee Schedule,,31.35,,,31.35,Fee Schedule,,29.64,,,29.64,Fee Schedule,,67.9,70,,67.9,percent of total billed charges,All Other,14.24,,,14.24,Fee Schedule,,1,,,1,Other,186% of Medicaid,16.77,,,16.77,Fee Schedule,,60.14,,,60.14,Fee Schedule,,9.49,,,,Fee Schedule,,16.77,,,16.77,Fee Schedule,,60.14,,,60.14,Fee Schedule,,17.85,,,17.85,Fee Schedule,,67.9,70,,67.9,percent of total billed charges,,21.42,,,21.42,Fee Schedule,,18.16,,,18.16,Fee Schedule,,6.78,,,6.78,Fee Schedule,,6.78,,,6.78,Fee Schedule,,6.78,,,6.78,Fee Schedule,,6.78,,,6.78,Fee Schedule,,0.51,,,0.51,Other,100% of Medicaid,0.51,,,0.51,Other,100% of Medicaid,0.51,,,0.51,Other,100% of Medicaid,0.51,,,0.51,Other,100% of Medicaid,1.14,,,1.14,Other,225% of Medicaid,0.77,,,0.77,Other,153% of Medicaid,1.14,,,1.14,Other,225% of Medicaid,0.71,,,0.71,Other,140% of Medicaid,1.14,,,1.14,Other,225% of Medicaid,1.31,,,1.31,Other,250% of Medicaid,1.64,,,1.64,Other,324% of Medicaid,1.09,,,1.09,Other,215% of Medicaid,1.09,,,1.09,Other,215% of Medicaid,0.63,,,0.63,Other,125% of Medicaid,0.01,67.9,
ACETONE ASSAY,82010,CPT,,78082010,CDM,301,RC,,,both,,,137,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.59,,,24.59,Fee Schedule,,22.14,,,22.14,Fee Schedule,,63.02,,,63.02,Fee Schedule,,56.7,,,56.7,Fee Schedule,,53.59,,,53.59,Fee Schedule,,95.9,70,,95.9,percent of total billed charges,All Other,25.74,,,25.74,Fee Schedule,,26,,,26,Other,186% of Medicaid,30.31,,,30.31,Fee Schedule,,84.94,,,84.94,Fee Schedule,,17.16,,,,Fee Schedule,,30.31,,,30.31,Fee Schedule,,84.94,,,84.94,Fee Schedule,,32.27,,,32.27,Fee Schedule,,95.9,70,,95.9,percent of total billed charges,,38.72,,,38.72,Fee Schedule,,32.82,,,32.82,Fee Schedule,,12.26,,,12.26,Fee Schedule,,12.26,,,12.26,Fee Schedule,,12.26,,,12.26,Fee Schedule,,12.26,,,12.26,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,95.9,
ACYLCARNITINES QUANT,82017,CPT,,78082017,CDM,301,RC,,,both,,,54,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.78,,,50.78,Fee Schedule,,45.72,,,45.72,Fee Schedule,,111.13,,,111.13,Fee Schedule,,99.98,,,99.98,Fee Schedule,,94.5,,,94.5,Fee Schedule,,37.8,70,,37.8,percent of total billed charges,All Other,53.14,,,53.14,Fee Schedule,,31,,,31,Other,186% of Medicaid,62.59,,,62.59,Fee Schedule,,33.48,,,33.48,Fee Schedule,,35.43,,,,Fee Schedule,,62.59,,,62.59,Fee Schedule,,33.48,,,33.48,Fee Schedule,,66.64,,,66.64,Fee Schedule,,37.8,70,,37.8,percent of total billed charges,,79.95,,,79.95,Fee Schedule,,67.76,,,67.76,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,16.87,,,16.87,Other,100% of Medicaid,16.87,,,16.87,Other,100% of Medicaid,16.87,,,16.87,Other,100% of Medicaid,16.87,,,16.87,Other,100% of Medicaid,37.96,,,37.96,Other,225% of Medicaid,25.81,,,25.81,Other,153% of Medicaid,37.96,,,37.96,Other,225% of Medicaid,23.62,,,23.62,Other,140% of Medicaid,37.96,,,37.96,Other,225% of Medicaid,43.86,,,43.86,Other,250% of Medicaid,54.66,,,54.66,Other,324% of Medicaid,36.27,,,36.27,Other,215% of Medicaid,36.27,,,36.27,Other,215% of Medicaid,21.09,,,21.09,Other,125% of Medicaid,0.01,111.13,
ASSAY OF ACTH,82024,CPT,,78082024,CDM,301,RC,,,both,,,534,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,116.25,,,116.25,Fee Schedule,,104.66,,,104.66,Fee Schedule,,297.84,,,297.84,Fee Schedule,,267.95,,,267.95,Fee Schedule,,253.27,,,253.27,Fee Schedule,,373.8,70,,373.8,percent of total billed charges,All Other,121.65,,,121.65,Fee Schedule,,72,,,72,Other,186% of Medicaid,143.28,,,143.28,Fee Schedule,,331.08,,,331.08,Fee Schedule,,81.1,,,,Fee Schedule,,143.28,,,143.28,Fee Schedule,,331.08,,,331.08,Fee Schedule,,152.55,,,152.55,Fee Schedule,,373.8,70,,373.8,percent of total billed charges,,183.02,,,183.02,Fee Schedule,,155.12,,,155.12,Fee Schedule,,57.93,,,57.93,Fee Schedule,,57.93,,,57.93,Fee Schedule,,57.93,,,57.93,Fee Schedule,,57.93,,,57.93,Fee Schedule,,38.62,,,38.62,Other,100% of Medicaid,38.62,,,38.62,Other,100% of Medicaid,38.62,,,38.62,Other,100% of Medicaid,38.62,,,38.62,Other,100% of Medicaid,86.9,,,86.9,Other,225% of Medicaid,59.09,,,59.09,Other,153% of Medicaid,86.9,,,86.9,Other,225% of Medicaid,54.07,,,54.07,Other,140% of Medicaid,86.9,,,86.9,Other,225% of Medicaid,100.41,,,100.41,Other,250% of Medicaid,125.13,,,125.13,Other,324% of Medicaid,83.03,,,83.03,Other,215% of Medicaid,83.03,,,83.03,Other,215% of Medicaid,48.28,,,48.28,Other,125% of Medicaid,0.01,373.8,
ASSAY OF ADP & AMP,82030,CPT,,78082030,CDM,301,RC,,,both,,,382,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.66,,,77.66,Fee Schedule,,69.92,,,69.92,Fee Schedule,,198.92,,,198.92,Fee Schedule,,178.96,,,178.96,Fee Schedule,,169.16,,,169.16,Fee Schedule,,267.4,70,,267.4,percent of total billed charges,All Other,81.27,,,81.27,Fee Schedule,,58,,,58,Other,186% of Medicaid,95.72,,,95.72,Fee Schedule,,236.84,,,236.84,Fee Schedule,,54.18,,,,Fee Schedule,,95.72,,,95.72,Fee Schedule,,236.84,,,236.84,Fee Schedule,,101.91,,,101.91,Fee Schedule,,267.4,70,,267.4,percent of total billed charges,,122.27,,,122.27,Fee Schedule,,103.63,,,103.63,Fee Schedule,,38.7,,,38.7,Fee Schedule,,38.7,,,38.7,Fee Schedule,,38.7,,,38.7,Fee Schedule,,38.7,,,38.7,Fee Schedule,,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,47.87,,,47.87,Other,153% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,43.8,,,43.8,Other,140% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,81.35,,,81.35,Other,250% of Medicaid,101.38,,,101.38,Other,324% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,39.11,,,39.11,Other,125% of Medicaid,0.01,267.4,
ASSAY OF SERUM ALBUMIN,82040,CPT,,78082040,CDM,301,RC,,,both,,,69,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.9,,,14.9,Fee Schedule,,13.41,,,13.41,Fee Schedule,,38.14,,,38.14,Fee Schedule,,34.31,,,34.31,Fee Schedule,,32.43,,,32.43,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,All Other,15.59,,,15.59,Fee Schedule,,9,,,9,Other,186% of Medicaid,18.36,,,18.36,Fee Schedule,,42.78,,,42.78,Fee Schedule,,10.4,,,,Fee Schedule,,18.36,,,18.36,Fee Schedule,,42.78,,,42.78,Fee Schedule,,19.55,,,19.55,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,,23.46,,,23.46,Fee Schedule,,19.88,,,19.88,Fee Schedule,,7.43,,,7.43,Fee Schedule,,7.43,,,7.43,Fee Schedule,,7.43,,,7.43,Fee Schedule,,7.43,,,7.43,Fee Schedule,,4.95,,,4.95,Other,100% of Medicaid,4.95,,,4.95,Other,100% of Medicaid,4.95,,,4.95,Other,100% of Medicaid,4.95,,,4.95,Other,100% of Medicaid,11.14,,,11.14,Other,225% of Medicaid,7.57,,,7.57,Other,153% of Medicaid,11.14,,,11.14,Other,225% of Medicaid,6.93,,,6.93,Other,140% of Medicaid,11.14,,,11.14,Other,225% of Medicaid,12.87,,,12.87,Other,250% of Medicaid,16.04,,,16.04,Other,324% of Medicaid,10.64,,,10.64,Other,215% of Medicaid,10.64,,,10.64,Other,215% of Medicaid,6.19,,,6.19,Other,125% of Medicaid,0.01,48.3,
ASSAY OF URINE ALBUMIN,82042,CPT,,78082042,CDM,301,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,23.42,,,23.42,Fee Schedule,,21.08,,,21.08,Fee Schedule,,22.19,,,22.19,Fee Schedule,,19.97,,,19.97,Fee Schedule,,18.87,,,18.87,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,All Other,24.51,,,24.51,Fee Schedule,,9,,,9,Other,186% of Medicaid,28.86,,,28.86,Fee Schedule,,40.3,,,40.3,Fee Schedule,,16.34,,,,Fee Schedule,,28.86,,,28.86,Fee Schedule,,40.3,,,40.3,Fee Schedule,,30.73,,,30.73,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,,36.87,,,36.87,Fee Schedule,,31.25,,,31.25,Fee Schedule,,11.67,,,11.67,Fee Schedule,,11.67,,,11.67,Fee Schedule,,11.67,,,11.67,Fee Schedule,,11.67,,,11.67,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,45.5,
MICROALBUMIN QUANTITATIVE,82043,CPT,,78082043,CDM,301,RC,,,both,,,137,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,17.4,,,17.4,Fee Schedule,,15.66,,,15.66,Fee Schedule,,44.61,,,44.61,Fee Schedule,,40.13,,,40.13,Fee Schedule,,37.93,,,37.93,Fee Schedule,,95.9,70,,95.9,percent of total billed charges,All Other,18.21,,,18.21,Fee Schedule,,9,,,9,Other,186% of Medicaid,21.44,,,21.44,Fee Schedule,,84.94,,,84.94,Fee Schedule,,12.14,,,,Fee Schedule,,21.44,,,21.44,Fee Schedule,,84.94,,,84.94,Fee Schedule,,22.83,,,22.83,Fee Schedule,,95.9,70,,95.9,percent of total billed charges,,27.39,,,27.39,Fee Schedule,,23.22,,,23.22,Fee Schedule,,8.67,,,8.67,Fee Schedule,,8.67,,,8.67,Fee Schedule,,8.67,,,8.67,Fee Schedule,,8.67,,,8.67,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,95.9,
ASSAY OF ALDOLASE,82085,CPT,,78082085,CDM,301,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,29.23,,,29.23,Fee Schedule,,26.31,,,26.31,Fee Schedule,,74.86,,,74.86,Fee Schedule,,67.34,,,67.34,Fee Schedule,,63.66,,,63.66,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,All Other,30.59,,,30.59,Fee Schedule,,26,,,26,Other,186% of Medicaid,36.02,,,36.02,Fee Schedule,,79.98,,,79.98,Fee Schedule,,20.39,,,,Fee Schedule,,36.02,,,36.02,Fee Schedule,,79.98,,,79.98,Fee Schedule,,38.35,,,38.35,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,,46.02,,,46.02,Fee Schedule,,39,,,39,Fee Schedule,,14.57,,,14.57,Fee Schedule,,14.57,,,14.57,Fee Schedule,,14.57,,,14.57,Fee Schedule,,14.57,,,14.57,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,90.3,
ASSAY OF ALDOSTERONE,82088,CPT,,78082088,CDM,301,RC,,,both,,,514,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,122.66,,,122.66,Fee Schedule,,110.43,,,110.43,Fee Schedule,,314.28,,,314.28,Fee Schedule,,282.74,,,282.74,Fee Schedule,,267.25,,,267.25,Fee Schedule,,359.8,70,,359.8,percent of total billed charges,All Other,128.36,,,128.36,Fee Schedule,,76,,,76,Other,186% of Medicaid,151.18,,,151.18,Fee Schedule,,318.68,,,318.68,Fee Schedule,,85.58,,,,Fee Schedule,,151.18,,,151.18,Fee Schedule,,318.68,,,318.68,Fee Schedule,,160.96,,,160.96,Fee Schedule,,359.8,70,,359.8,percent of total billed charges,,193.12,,,193.12,Fee Schedule,,163.68,,,163.68,Fee Schedule,,61.13,,,61.13,Fee Schedule,,61.13,,,61.13,Fee Schedule,,61.13,,,61.13,Fee Schedule,,61.13,,,61.13,Fee Schedule,,40.75,,,40.75,Other,100% of Medicaid,40.75,,,40.75,Other,100% of Medicaid,40.75,,,40.75,Other,100% of Medicaid,40.75,,,40.75,Other,100% of Medicaid,91.69,,,91.69,Other,225% of Medicaid,62.35,,,62.35,Other,153% of Medicaid,91.69,,,91.69,Other,225% of Medicaid,57.05,,,57.05,Other,140% of Medicaid,91.69,,,91.69,Other,225% of Medicaid,105.95,,,105.95,Other,250% of Medicaid,132.03,,,132.03,Other,324% of Medicaid,87.61,,,87.61,Other,215% of Medicaid,87.61,,,87.61,Other,215% of Medicaid,50.94,,,50.94,Other,125% of Medicaid,0.01,359.8,
ALPHA-1-ANTITRYPSIN PHENO,82104,CPT,,78082104,CDM,301,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.52,,,43.52,Fee Schedule,,39.19,,,39.19,Fee Schedule,,111.52,,,111.52,Fee Schedule,,100.33,,,100.33,Fee Schedule,,94.83,,,94.83,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,45.55,,,45.55,Fee Schedule,,26,,,26,Other,186% of Medicaid,53.65,,,53.65,Fee Schedule,,119.66,,,119.66,Fee Schedule,,30.37,,,,Fee Schedule,,53.65,,,53.65,Fee Schedule,,119.66,,,119.66,Fee Schedule,,57.12,,,57.12,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,,68.53,,,68.53,Fee Schedule,,58.08,,,58.08,Fee Schedule,,21.69,,,21.69,Fee Schedule,,21.69,,,21.69,Fee Schedule,,21.69,,,21.69,Fee Schedule,,21.69,,,21.69,Fee Schedule,,13.86,,,13.86,Other,100% of Medicaid,13.86,,,13.86,Other,100% of Medicaid,13.86,,,13.86,Other,100% of Medicaid,13.86,,,13.86,Other,100% of Medicaid,31.18,,,31.18,Other,225% of Medicaid,21.2,,,21.2,Other,153% of Medicaid,31.18,,,31.18,Other,225% of Medicaid,19.4,,,19.4,Other,140% of Medicaid,31.18,,,31.18,Other,225% of Medicaid,36.03,,,36.03,Other,250% of Medicaid,44.9,,,44.9,Other,324% of Medicaid,29.79,,,29.79,Other,215% of Medicaid,29.79,,,29.79,Other,215% of Medicaid,17.32,,,17.32,Other,125% of Medicaid,0.01,135.1,
ALPHA-FETOPROTEIN SERUM,82105,CPT,,78082105,CDM,301,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.48,,,50.48,Fee Schedule,,45.45,,,45.45,Fee Schedule,,129.38,,,129.38,Fee Schedule,,116.4,,,116.4,Fee Schedule,,110.02,,,110.02,Fee Schedule,,168,70,,168,percent of total billed charges,All Other,52.83,,,52.83,Fee Schedule,,12,,,12,Other,186% of Medicaid,62.22,,,62.22,Fee Schedule,,148.8,,,148.8,Fee Schedule,,35.22,,,,Fee Schedule,,62.22,,,62.22,Fee Schedule,,148.8,,,148.8,Fee Schedule,,66.24,,,66.24,Fee Schedule,,168,70,,168,percent of total billed charges,,79.47,,,79.47,Fee Schedule,,67.36,,,67.36,Fee Schedule,,25.16,,,25.16,Fee Schedule,,25.16,,,25.16,Fee Schedule,,25.16,,,25.16,Fee Schedule,,25.16,,,25.16,Fee Schedule,,6.57,,,6.57,Other,100% of Medicaid,6.57,,,6.57,Other,100% of Medicaid,6.57,,,6.57,Other,100% of Medicaid,6.57,,,6.57,Other,100% of Medicaid,14.77,,,14.77,Other,225% of Medicaid,10.04,,,10.04,Other,153% of Medicaid,14.77,,,14.77,Other,225% of Medicaid,9.19,,,9.19,Other,140% of Medicaid,14.77,,,14.77,Other,225% of Medicaid,17.07,,,17.07,Other,250% of Medicaid,21.27,,,21.27,Other,324% of Medicaid,14.11,,,14.11,Other,215% of Medicaid,14.11,,,14.11,Other,215% of Medicaid,8.21,,,8.21,Other,125% of Medicaid,0.01,168,
ALPHA-FETOPROTEIN AMNIOTIC,82106,CPT,,78082106,CDM,301,RC,,,both,,,199,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51.17,,,51.17,Fee Schedule,,46.07,,,46.07,Fee Schedule,,129.38,,,129.38,Fee Schedule,,116.4,,,116.4,Fee Schedule,,110.02,,,110.02,Fee Schedule,,139.3,70,,139.3,percent of total billed charges,All Other,53.55,,,53.55,Fee Schedule,,19,,,19,Other,186% of Medicaid,63.07,,,63.07,Fee Schedule,,123.38,,,123.38,Fee Schedule,,35.7,,,,Fee Schedule,,63.07,,,63.07,Fee Schedule,,123.38,,,123.38,Fee Schedule,,67.15,,,67.15,Fee Schedule,,139.3,70,,139.3,percent of total billed charges,,80.56,,,80.56,Fee Schedule,,68.28,,,68.28,Fee Schedule,,25.5,,,25.5,Fee Schedule,,25.5,,,25.5,Fee Schedule,,25.5,,,25.5,Fee Schedule,,25.5,,,25.5,Fee Schedule,,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,15.45,,,15.45,Other,153% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,14.14,,,14.14,Other,140% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,26.26,,,26.26,Other,250% of Medicaid,32.72,,,32.72,Other,324% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,12.63,,,12.63,Other,125% of Medicaid,0.01,139.3,
ALPHA-FETOPROTEIN L3,82107,CPT,,78082107,CDM,301,RC,,,both,,,146,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.87,,,193.87,Fee Schedule,,174.55,,,174.55,Fee Schedule,,485.14,,,485.14,Fee Schedule,,436.45,,,436.45,Fee Schedule,,412.55,,,412.55,Fee Schedule,,102.2,70,,102.2,percent of total billed charges,All Other,202.89,,,202.89,Fee Schedule,,120,,,120,Other,186% of Medicaid,238.96,,,238.96,Fee Schedule,,90.52,,,90.52,Fee Schedule,,135.26,,,,Fee Schedule,,238.96,,,238.96,Fee Schedule,,90.52,,,90.52,Fee Schedule,,254.42,,,254.42,Fee Schedule,,102.2,70,,102.2,percent of total billed charges,,305.24,,,305.24,Fee Schedule,,258.71,,,258.71,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,98.55,,,98.55,Other,153% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,90.17,,,90.17,Other,140% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,167.47,,,167.47,Other,250% of Medicaid,208.69,,,208.69,Other,324% of Medicaid,138.48,,,138.48,Other,215% of Medicaid,138.48,,,138.48,Other,215% of Medicaid,80.51,,,80.51,Other,125% of Medicaid,0.01,485.14,
ASSAY OF ALUMINUM,82108,CPT,,78082108,CDM,301,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,76.69,,,76.69,Fee Schedule,,69.05,,,69.05,Fee Schedule,,196.46,,,196.46,Fee Schedule,,176.74,,,176.74,Fee Schedule,,167.06,,,167.06,Fee Schedule,,168,70,,168,percent of total billed charges,All Other,80.26,,,80.26,Fee Schedule,,47,,,47,Other,186% of Medicaid,94.53,,,94.53,Fee Schedule,,148.8,,,148.8,Fee Schedule,,53.51,,,,Fee Schedule,,94.53,,,94.53,Fee Schedule,,148.8,,,148.8,Fee Schedule,,100.65,,,100.65,Fee Schedule,,168,70,,168,percent of total billed charges,,120.75,,,120.75,Fee Schedule,,102.34,,,102.34,Fee Schedule,,38.22,,,38.22,Fee Schedule,,38.22,,,38.22,Fee Schedule,,38.22,,,38.22,Fee Schedule,,38.22,,,38.22,Fee Schedule,,25.48,,,25.48,Other,100% of Medicaid,25.48,,,25.48,Other,100% of Medicaid,25.48,,,25.48,Other,100% of Medicaid,25.48,,,25.48,Other,100% of Medicaid,57.33,,,57.33,Other,225% of Medicaid,38.98,,,38.98,Other,153% of Medicaid,57.33,,,57.33,Other,225% of Medicaid,35.67,,,35.67,Other,140% of Medicaid,57.33,,,57.33,Other,225% of Medicaid,66.25,,,66.25,Other,250% of Medicaid,82.56,,,82.56,Other,324% of Medicaid,54.78,,,54.78,Other,215% of Medicaid,54.78,,,54.78,Other,215% of Medicaid,31.85,,,31.85,Other,125% of Medicaid,0.01,196.46,
AMINO ACIDS MULT QUAL,82128,CPT,,78082128,CDM,301,RC,,,both,,,167,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,41.75,,,41.75,Fee Schedule,,37.59,,,37.59,Fee Schedule,,83.13,,,83.13,Fee Schedule,,74.79,,,74.79,Fee Schedule,,70.69,,,70.69,Fee Schedule,,116.9,70,,116.9,percent of total billed charges,All Other,43.69,,,43.69,Fee Schedule,,17,,,17,Other,186% of Medicaid,51.46,,,51.46,Fee Schedule,,103.54,,,103.54,Fee Schedule,,29.13,,,,Fee Schedule,,51.46,,,51.46,Fee Schedule,,103.54,,,103.54,Fee Schedule,,54.79,,,54.79,Fee Schedule,,116.9,70,,116.9,percent of total billed charges,,65.73,,,65.73,Fee Schedule,,55.71,,,55.71,Fee Schedule,,20.81,,,20.81,Fee Schedule,,20.81,,,20.81,Fee Schedule,,20.81,,,20.81,Fee Schedule,,20.81,,,20.81,Fee Schedule,,9.29,,,9.29,Other,100% of Medicaid,9.29,,,9.29,Other,100% of Medicaid,9.29,,,9.29,Other,100% of Medicaid,9.29,,,9.29,Other,100% of Medicaid,20.91,,,20.91,Other,225% of Medicaid,14.22,,,14.22,Other,153% of Medicaid,20.91,,,20.91,Other,225% of Medicaid,13.01,,,13.01,Other,140% of Medicaid,20.91,,,20.91,Other,225% of Medicaid,24.16,,,24.16,Other,250% of Medicaid,30.11,,,30.11,Other,324% of Medicaid,19.98,,,19.98,Other,215% of Medicaid,19.98,,,19.98,Other,215% of Medicaid,11.62,,,11.62,Other,125% of Medicaid,0.01,116.9,
AMINO ACIDS SINGLE QUANT,82131,CPT,,78082131,CDM,301,RC,,,both,,,275,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,69.17,,,69.17,Fee Schedule,,62.28,,,62.28,Fee Schedule,,130.1,,,130.1,Fee Schedule,,117.04,,,117.04,Fee Schedule,,110.63,,,110.63,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,All Other,72.39,,,72.39,Fee Schedule,,26,,,26,Other,186% of Medicaid,85.26,,,85.26,Fee Schedule,,170.5,,,170.5,Fee Schedule,,48.26,,,,Fee Schedule,,85.26,,,85.26,Fee Schedule,,170.5,,,170.5,Fee Schedule,,90.77,,,90.77,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,,108.9,,,108.9,Fee Schedule,,92.3,,,92.3,Fee Schedule,,34.47,,,34.47,Fee Schedule,,34.47,,,34.47,Fee Schedule,,34.47,,,34.47,Fee Schedule,,34.47,,,34.47,Fee Schedule,,14.14,,,14.14,Other,100% of Medicaid,14.14,,,14.14,Other,100% of Medicaid,14.14,,,14.14,Other,100% of Medicaid,14.14,,,14.14,Other,100% of Medicaid,31.82,,,31.82,Other,225% of Medicaid,21.63,,,21.63,Other,153% of Medicaid,31.82,,,31.82,Other,225% of Medicaid,19.8,,,19.8,Other,140% of Medicaid,31.82,,,31.82,Other,225% of Medicaid,36.76,,,36.76,Other,250% of Medicaid,45.81,,,45.81,Other,324% of Medicaid,30.4,,,30.4,Other,215% of Medicaid,30.4,,,30.4,Other,215% of Medicaid,17.68,,,17.68,Other,125% of Medicaid,0.01,192.5,
ASSAY AMINOLEVULINIC ACID,82135,CPT,,78082135,CDM,301,RC,,,both,,,218,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.51,,,49.51,Fee Schedule,,44.58,,,44.58,Fee Schedule,,126.92,,,126.92,Fee Schedule,,114.18,,,114.18,Fee Schedule,,107.93,,,107.93,Fee Schedule,,152.6,70,,152.6,percent of total billed charges,All Other,51.82,,,51.82,Fee Schedule,,33,,,33,Other,186% of Medicaid,61.03,,,61.03,Fee Schedule,,135.16,,,135.16,Fee Schedule,,34.55,,,,Fee Schedule,,61.03,,,61.03,Fee Schedule,,135.16,,,135.16,Fee Schedule,,64.98,,,64.98,Fee Schedule,,152.6,70,,152.6,percent of total billed charges,,77.96,,,77.96,Fee Schedule,,66.07,,,66.07,Fee Schedule,,24.68,,,24.68,Fee Schedule,,24.68,,,24.68,Fee Schedule,,24.68,,,24.68,Fee Schedule,,24.68,,,24.68,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,152.6,
AMINO ACIDS QUANT 2-5,82136,CPT,,78082136,CDM,301,RC,,,both,,,511,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.03,,,59.03,Fee Schedule,,53.14,,,53.14,Fee Schedule,,111.13,,,111.13,Fee Schedule,,99.98,,,99.98,Fee Schedule,,94.5,,,94.5,Fee Schedule,,357.7,70,,357.7,percent of total billed charges,All Other,61.77,,,61.77,Fee Schedule,,26,,,26,Other,186% of Medicaid,72.75,,,72.75,Fee Schedule,,316.82,,,316.82,Fee Schedule,,41.18,,,,Fee Schedule,,72.75,,,72.75,Fee Schedule,,316.82,,,316.82,Fee Schedule,,77.46,,,77.46,Fee Schedule,,357.7,70,,357.7,percent of total billed charges,,92.93,,,92.93,Fee Schedule,,78.77,,,78.77,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,14.14,,,14.14,Other,100% of Medicaid,14.14,,,14.14,Other,100% of Medicaid,14.14,,,14.14,Other,100% of Medicaid,14.14,,,14.14,Other,100% of Medicaid,31.82,,,31.82,Other,225% of Medicaid,21.63,,,21.63,Other,153% of Medicaid,31.82,,,31.82,Other,225% of Medicaid,19.8,,,19.8,Other,140% of Medicaid,31.82,,,31.82,Other,225% of Medicaid,36.76,,,36.76,Other,250% of Medicaid,45.81,,,45.81,Other,324% of Medicaid,30.4,,,30.4,Other,215% of Medicaid,30.4,,,30.4,Other,215% of Medicaid,17.68,,,17.68,Other,125% of Medicaid,0.01,357.7,
AMINO ACIDS QUAN 6 OR MORE,82139,CPT,,78082139,CDM,301,RC,,,both,,,1181,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.78,,,50.78,Fee Schedule,,45.72,,,45.72,Fee Schedule,,111.13,,,111.13,Fee Schedule,,99.98,,,99.98,Fee Schedule,,94.5,,,94.5,Fee Schedule,,826.7,70,,826.7,percent of total billed charges,All Other,53.14,,,53.14,Fee Schedule,,26,,,26,Other,186% of Medicaid,62.59,,,62.59,Fee Schedule,,732.22,,,732.22,Fee Schedule,,35.43,,,,Fee Schedule,,62.59,,,62.59,Fee Schedule,,732.22,,,732.22,Fee Schedule,,66.64,,,66.64,Fee Schedule,,826.7,70,,826.7,percent of total billed charges,,79.95,,,79.95,Fee Schedule,,67.76,,,67.76,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,14.14,,,14.14,Other,100% of Medicaid,14.14,,,14.14,Other,100% of Medicaid,14.14,,,14.14,Other,100% of Medicaid,14.14,,,14.14,Other,100% of Medicaid,31.82,,,31.82,Other,225% of Medicaid,21.63,,,21.63,Other,153% of Medicaid,31.82,,,31.82,Other,225% of Medicaid,19.8,,,19.8,Other,140% of Medicaid,31.82,,,31.82,Other,225% of Medicaid,36.76,,,36.76,Other,250% of Medicaid,45.81,,,45.81,Other,324% of Medicaid,30.4,,,30.4,Other,215% of Medicaid,30.4,,,30.4,Other,215% of Medicaid,17.68,,,17.68,Other,125% of Medicaid,0.01,826.7,
ASSAY OF AMMONIA,82140,CPT,,78082140,CDM,301,RC,,,both,,,233,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.86,,,43.86,Fee Schedule,,39.48,,,39.48,Fee Schedule,,112.39,,,112.39,Fee Schedule,,101.11,,,101.11,Fee Schedule,,95.58,,,95.58,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,All Other,45.9,,,45.9,Fee Schedule,,27,,,27,Other,186% of Medicaid,54.05,,,54.05,Fee Schedule,,144.46,,,144.46,Fee Schedule,,30.6,,,,Fee Schedule,,54.05,,,54.05,Fee Schedule,,144.46,,,144.46,Fee Schedule,,57.55,,,57.55,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,,69.05,,,69.05,Fee Schedule,,58.52,,,58.52,Fee Schedule,,21.86,,,21.86,Fee Schedule,,21.86,,,21.86,Fee Schedule,,21.86,,,21.86,Fee Schedule,,21.86,,,21.86,Fee Schedule,,14.57,,,14.57,Other,100% of Medicaid,14.57,,,14.57,Other,100% of Medicaid,14.57,,,14.57,Other,100% of Medicaid,14.57,,,14.57,Other,100% of Medicaid,32.78,,,32.78,Other,225% of Medicaid,22.29,,,22.29,Other,153% of Medicaid,32.78,,,32.78,Other,225% of Medicaid,20.4,,,20.4,Other,140% of Medicaid,32.78,,,32.78,Other,225% of Medicaid,37.88,,,37.88,Other,250% of Medicaid,47.21,,,47.21,Other,324% of Medicaid,31.33,,,31.33,Other,215% of Medicaid,31.33,,,31.33,Other,215% of Medicaid,18.21,,,18.21,Other,125% of Medicaid,0.01,163.1,
ASSAY OF AMYLASE,82150,CPT,,78082150,CDM,301,RC,,,both,,,125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.5,,,19.5,Fee Schedule,,17.56,,,17.56,Fee Schedule,,49.98,,,49.98,Fee Schedule,,44.96,,,44.96,Fee Schedule,,42.5,,,42.5,Fee Schedule,,87.5,70,,87.5,percent of total billed charges,All Other,20.41,,,20.41,Fee Schedule,,9,,,9,Other,186% of Medicaid,24.04,,,24.04,Fee Schedule,,77.5,,,77.5,Fee Schedule,,13.61,,,,Fee Schedule,,24.04,,,24.04,Fee Schedule,,77.5,,,77.5,Fee Schedule,,25.6,,,25.6,Fee Schedule,,87.5,70,,87.5,percent of total billed charges,,30.71,,,30.71,Fee Schedule,,26.03,,,26.03,Fee Schedule,,9.72,,,9.72,Fee Schedule,,9.72,,,9.72,Fee Schedule,,9.72,,,9.72,Fee Schedule,,9.72,,,9.72,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,87.5,
ASSAY OF ANDROSTENEDIONE,82157,CPT,,78082157,CDM,301,RC,,,both,,,446,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,88.13,,,88.13,Fee Schedule,,79.35,,,79.35,Fee Schedule,,225.78,,,225.78,Fee Schedule,,203.12,,,203.12,Fee Schedule,,191.99,,,191.99,Fee Schedule,,312.2,70,,312.2,percent of total billed charges,All Other,92.23,,,92.23,Fee Schedule,,54,,,54,Other,186% of Medicaid,108.63,,,108.63,Fee Schedule,,276.52,,,276.52,Fee Schedule,,61.49,,,,Fee Schedule,,108.63,,,108.63,Fee Schedule,,276.52,,,276.52,Fee Schedule,,115.66,,,115.66,Fee Schedule,,312.2,70,,312.2,percent of total billed charges,,138.76,,,138.76,Fee Schedule,,117.61,,,117.61,Fee Schedule,,43.92,,,43.92,Fee Schedule,,43.92,,,43.92,Fee Schedule,,43.92,,,43.92,Fee Schedule,,43.92,,,43.92,Fee Schedule,,29.28,,,29.28,Other,100% of Medicaid,29.28,,,29.28,Other,100% of Medicaid,29.28,,,29.28,Other,100% of Medicaid,29.28,,,29.28,Other,100% of Medicaid,65.88,,,65.88,Other,225% of Medicaid,44.8,,,44.8,Other,153% of Medicaid,65.88,,,65.88,Other,225% of Medicaid,40.99,,,40.99,Other,140% of Medicaid,65.88,,,65.88,Other,225% of Medicaid,76.13,,,76.13,Other,250% of Medicaid,94.87,,,94.87,Other,324% of Medicaid,62.95,,,62.95,Other,215% of Medicaid,62.95,,,62.95,Other,215% of Medicaid,36.6,,,36.6,Other,125% of Medicaid,0.01,312.2,
ANGIOTENSIN I ENZYME TEST,82164,CPT,,78082164,CDM,301,RC,,,both,,,227,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.95,,,43.95,Fee Schedule,,39.57,,,39.57,Fee Schedule,,112.56,,,112.56,Fee Schedule,,101.26,,,101.26,Fee Schedule,,95.72,,,95.72,Fee Schedule,,158.9,70,,158.9,percent of total billed charges,All Other,45.99,,,45.99,Fee Schedule,,33,,,33,Other,186% of Medicaid,54.17,,,54.17,Fee Schedule,,140.74,,,140.74,Fee Schedule,,30.66,,,,Fee Schedule,,54.17,,,54.17,Fee Schedule,,140.74,,,140.74,Fee Schedule,,57.67,,,57.67,Fee Schedule,,158.9,70,,158.9,percent of total billed charges,,69.19,,,69.19,Fee Schedule,,58.64,,,58.64,Fee Schedule,,21.9,,,21.9,Fee Schedule,,21.9,,,21.9,Fee Schedule,,21.9,,,21.9,Fee Schedule,,21.9,,,21.9,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,158.9,
ASSAY OF APOLIPOPROTEIN,82172,CPT,,78082172,CDM,301,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,63.48,,,63.48,Fee Schedule,,57.15,,,57.15,Fee Schedule,,119.52,,,119.52,Fee Schedule,,107.52,,,107.52,Fee Schedule,,101.63,,,101.63,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,All Other,66.43,,,66.43,Fee Schedule,,30,,,30,Other,186% of Medicaid,78.24,,,78.24,Fee Schedule,,112.84,,,112.84,Fee Schedule,,44.29,,,,Fee Schedule,,78.24,,,78.24,Fee Schedule,,112.84,,,112.84,Fee Schedule,,83.31,,,83.31,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,,99.95,,,99.95,Fee Schedule,,84.71,,,84.71,Fee Schedule,,31.64,,,31.64,Fee Schedule,,31.64,,,31.64,Fee Schedule,,31.64,,,31.64,Fee Schedule,,31.64,,,31.64,Fee Schedule,,16.09,,,16.09,Other,100% of Medicaid,16.09,,,16.09,Other,100% of Medicaid,16.09,,,16.09,Other,100% of Medicaid,16.09,,,16.09,Other,100% of Medicaid,36.2,,,36.2,Other,225% of Medicaid,24.62,,,24.62,Other,153% of Medicaid,36.2,,,36.2,Other,225% of Medicaid,22.53,,,22.53,Other,140% of Medicaid,36.2,,,36.2,Other,225% of Medicaid,41.83,,,41.83,Other,250% of Medicaid,52.13,,,52.13,Other,324% of Medicaid,34.59,,,34.59,Other,215% of Medicaid,34.59,,,34.59,Other,215% of Medicaid,20.11,,,20.11,Other,125% of Medicaid,0.01,127.4,
ASSAY OF ARSENIC,82175,CPT,,78082175,CDM,301,RC,,,both,,,192,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,57.1,,,57.1,Fee Schedule,,51.41,,,51.41,Fee Schedule,,146.32,,,146.32,Fee Schedule,,131.63,,,131.63,Fee Schedule,,124.42,,,124.42,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,All Other,59.76,,,59.76,Fee Schedule,,35,,,35,Other,186% of Medicaid,70.38,,,70.38,Fee Schedule,,119.04,,,119.04,Fee Schedule,,39.84,,,,Fee Schedule,,70.38,,,70.38,Fee Schedule,,119.04,,,119.04,Fee Schedule,,74.93,,,74.93,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,,89.9,,,89.9,Fee Schedule,,76.2,,,76.2,Fee Schedule,,28.46,,,28.46,Fee Schedule,,28.46,,,28.46,Fee Schedule,,28.46,,,28.46,Fee Schedule,,28.46,,,28.46,Fee Schedule,,18.97,,,18.97,Other,100% of Medicaid,18.97,,,18.97,Other,100% of Medicaid,18.97,,,18.97,Other,100% of Medicaid,18.97,,,18.97,Other,100% of Medicaid,42.68,,,42.68,Other,225% of Medicaid,29.02,,,29.02,Other,153% of Medicaid,42.68,,,42.68,Other,225% of Medicaid,26.56,,,26.56,Other,140% of Medicaid,42.68,,,42.68,Other,225% of Medicaid,49.32,,,49.32,Other,250% of Medicaid,61.46,,,61.46,Other,324% of Medicaid,40.79,,,40.79,Other,215% of Medicaid,40.79,,,40.79,Other,215% of Medicaid,23.71,,,23.71,Other,125% of Medicaid,0.01,146.32,
ASSAY OF ASCORBIC ACID,82180,CPT,,78082180,CDM,301,RC,,,both,,,163,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,29.77,,,29.77,Fee Schedule,,26.8,,,26.8,Fee Schedule,,71.02,,,71.02,Fee Schedule,,63.89,,,63.89,Fee Schedule,,60.39,,,60.39,Fee Schedule,,114.1,70,,114.1,percent of total billed charges,All Other,31.15,,,31.15,Fee Schedule,,18,,,18,Other,186% of Medicaid,36.69,,,36.69,Fee Schedule,,101.06,,,101.06,Fee Schedule,,20.77,,,,Fee Schedule,,36.69,,,36.69,Fee Schedule,,101.06,,,101.06,Fee Schedule,,39.07,,,39.07,Fee Schedule,,114.1,70,,114.1,percent of total billed charges,,46.87,,,46.87,Fee Schedule,,39.72,,,39.72,Fee Schedule,,14.84,,,14.84,Fee Schedule,,14.84,,,14.84,Fee Schedule,,14.84,,,14.84,Fee Schedule,,14.84,,,14.84,Fee Schedule,,9.89,,,9.89,Other,100% of Medicaid,9.89,,,9.89,Other,100% of Medicaid,9.89,,,9.89,Other,100% of Medicaid,9.89,,,9.89,Other,100% of Medicaid,22.25,,,22.25,Other,225% of Medicaid,15.13,,,15.13,Other,153% of Medicaid,22.25,,,22.25,Other,225% of Medicaid,13.85,,,13.85,Other,140% of Medicaid,22.25,,,22.25,Other,225% of Medicaid,25.71,,,25.71,Other,250% of Medicaid,32.04,,,32.04,Other,324% of Medicaid,21.26,,,21.26,Other,215% of Medicaid,21.26,,,21.26,Other,215% of Medicaid,12.36,,,12.36,Other,125% of Medicaid,0.01,114.1,
ATOMIC ABSORPTION,82190,CPT,,78082190,CDM,301,RC,,,both,,,63,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.86,,,47.86,Fee Schedule,,43.09,,,43.09,Fee Schedule,,41.98,,,41.98,Fee Schedule,,37.76,,,37.76,Fee Schedule,,35.7,,,35.7,Fee Schedule,,44.1,70,,44.1,percent of total billed charges,All Other,50.09,,,50.09,Fee Schedule,,33,,,33,Other,186% of Medicaid,58.99,,,58.99,Fee Schedule,,39.06,,,39.06,Fee Schedule,,33.39,,,,Fee Schedule,,58.99,,,58.99,Fee Schedule,,39.06,,,39.06,Fee Schedule,,62.81,,,62.81,Fee Schedule,,44.1,70,,44.1,percent of total billed charges,,75.35,,,75.35,Fee Schedule,,63.86,,,63.86,Fee Schedule,,23.85,,,23.85,Fee Schedule,,23.85,,,23.85,Fee Schedule,,23.85,,,23.85,Fee Schedule,,23.85,,,23.85,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,75.35,
ASSAY OF BETA-2 PROTEIN,82232,CPT,,78082232,CDM,301,RC,,,both,,,270,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,48.7,,,48.7,Fee Schedule,,43.85,,,43.85,Fee Schedule,,124.72,,,124.72,Fee Schedule,,112.21,,,112.21,Fee Schedule,,106.06,,,106.06,Fee Schedule,,189,70,,189,percent of total billed charges,All Other,50.97,,,50.97,Fee Schedule,,23,,,23,Other,186% of Medicaid,60.03,,,60.03,Fee Schedule,,167.4,,,167.4,Fee Schedule,,33.98,,,,Fee Schedule,,60.03,,,60.03,Fee Schedule,,167.4,,,167.4,Fee Schedule,,63.91,,,63.91,Fee Schedule,,189,70,,189,percent of total billed charges,,76.68,,,76.68,Fee Schedule,,64.99,,,64.99,Fee Schedule,,24.27,,,24.27,Fee Schedule,,24.27,,,24.27,Fee Schedule,,24.27,,,24.27,Fee Schedule,,24.27,,,24.27,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,189,
BILE ACIDS TOTAL,82239,CPT,,78082239,CDM,301,RC,,,both,,,111,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,51.53,,,51.53,Fee Schedule,,46.4,,,46.4,Fee Schedule,,109.05,,,109.05,Fee Schedule,,98.11,,,98.11,Fee Schedule,,92.73,,,92.73,Fee Schedule,,77.7,70,,77.7,percent of total billed charges,All Other,53.93,,,53.93,Fee Schedule,,25,,,25,Other,186% of Medicaid,63.52,,,63.52,Fee Schedule,,68.82,,,68.82,Fee Schedule,,35.95,,,,Fee Schedule,,63.52,,,63.52,Fee Schedule,,68.82,,,68.82,Fee Schedule,,67.62,,,67.62,Fee Schedule,,77.7,70,,77.7,percent of total billed charges,,81.13,,,81.13,Fee Schedule,,68.76,,,68.76,Fee Schedule,,25.68,,,25.68,Fee Schedule,,25.68,,,25.68,Fee Schedule,,25.68,,,25.68,Fee Schedule,,25.68,,,25.68,Fee Schedule,,13.18,,,13.18,Other,100% of Medicaid,13.18,,,13.18,Other,100% of Medicaid,13.18,,,13.18,Other,100% of Medicaid,13.18,,,13.18,Other,100% of Medicaid,29.66,,,29.66,Other,225% of Medicaid,20.17,,,20.17,Other,153% of Medicaid,29.66,,,29.66,Other,225% of Medicaid,18.45,,,18.45,Other,140% of Medicaid,29.66,,,29.66,Other,225% of Medicaid,34.27,,,34.27,Other,250% of Medicaid,42.7,,,42.7,Other,324% of Medicaid,28.34,,,28.34,Other,215% of Medicaid,28.34,,,28.34,Other,215% of Medicaid,16.48,,,16.48,Other,125% of Medicaid,0.01,109.05,
BILIRUBIN TOTAL,82247,CPT,,78082247,CDM,301,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.11,,,15.11,Fee Schedule,,13.6,,,13.6,Fee Schedule,,38.69,,,38.69,Fee Schedule,,34.81,,,34.81,Fee Schedule,,32.9,,,32.9,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,15.81,,,15.81,Fee Schedule,,9,,,9,Other,186% of Medicaid,18.62,,,18.62,Fee Schedule,,45.88,,,45.88,Fee Schedule,,10.54,,,,Fee Schedule,,18.62,,,18.62,Fee Schedule,,45.88,,,45.88,Fee Schedule,,19.83,,,19.83,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,23.79,,,23.79,Fee Schedule,,20.16,,,20.16,Fee Schedule,,7.53,,,7.53,Fee Schedule,,7.53,,,7.53,Fee Schedule,,7.53,,,7.53,Fee Schedule,,7.53,,,7.53,Fee Schedule,,5.02,,,5.02,Other,100% of Medicaid,5.02,,,5.02,Other,100% of Medicaid,5.02,,,5.02,Other,100% of Medicaid,5.02,,,5.02,Other,100% of Medicaid,11.3,,,11.3,Other,225% of Medicaid,7.68,,,7.68,Other,153% of Medicaid,11.3,,,11.3,Other,225% of Medicaid,7.03,,,7.03,Other,140% of Medicaid,11.3,,,11.3,Other,225% of Medicaid,13.05,,,13.05,Other,250% of Medicaid,16.26,,,16.26,Other,324% of Medicaid,10.79,,,10.79,Other,215% of Medicaid,10.79,,,10.79,Other,215% of Medicaid,6.28,,,6.28,Other,125% of Medicaid,0.01,51.8,
BILIRUBIN DIRECT,82248,CPT,,78082248,CDM,301,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.11,,,15.11,Fee Schedule,,13.6,,,13.6,Fee Schedule,,38.69,,,38.69,Fee Schedule,,34.81,,,34.81,Fee Schedule,,32.9,,,32.9,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,15.81,,,15.81,Fee Schedule,,9,,,9,Other,186% of Medicaid,18.62,,,18.62,Fee Schedule,,45.88,,,45.88,Fee Schedule,,10.54,,,,Fee Schedule,,18.62,,,18.62,Fee Schedule,,45.88,,,45.88,Fee Schedule,,19.83,,,19.83,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,23.79,,,23.79,Fee Schedule,,20.16,,,20.16,Fee Schedule,,7.53,,,7.53,Fee Schedule,,7.53,,,7.53,Fee Schedule,,7.53,,,7.53,Fee Schedule,,7.53,,,7.53,Fee Schedule,,5.02,,,5.02,Other,100% of Medicaid,5.02,,,5.02,Other,100% of Medicaid,5.02,,,5.02,Other,100% of Medicaid,5.02,,,5.02,Other,100% of Medicaid,11.3,,,11.3,Other,225% of Medicaid,7.68,,,7.68,Other,153% of Medicaid,11.3,,,11.3,Other,225% of Medicaid,7.03,,,7.03,Other,140% of Medicaid,11.3,,,11.3,Other,225% of Medicaid,13.05,,,13.05,Other,250% of Medicaid,16.26,,,16.26,Other,324% of Medicaid,10.79,,,10.79,Other,215% of Medicaid,10.79,,,10.79,Other,215% of Medicaid,6.28,,,6.28,Other,125% of Medicaid,0.01,51.8,
ASSAY OF BIOTINIDASE,82261,CPT,,78082261,CDM,301,RC,,,both,,,54,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.78,,,50.78,Fee Schedule,,45.72,,,45.72,Fee Schedule,,111.13,,,111.13,Fee Schedule,,99.98,,,99.98,Fee Schedule,,94.5,,,94.5,Fee Schedule,,37.8,70,,37.8,percent of total billed charges,All Other,53.14,,,53.14,Fee Schedule,,30,,,30,Other,186% of Medicaid,62.59,,,62.59,Fee Schedule,,33.48,,,33.48,Fee Schedule,,35.43,,,,Fee Schedule,,62.59,,,62.59,Fee Schedule,,33.48,,,33.48,Fee Schedule,,66.64,,,66.64,Fee Schedule,,37.8,70,,37.8,percent of total billed charges,,79.95,,,79.95,Fee Schedule,,67.76,,,67.76,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,25.31,,,25.31,Fee Schedule,,16.09,,,16.09,Other,100% of Medicaid,16.09,,,16.09,Other,100% of Medicaid,16.09,,,16.09,Other,100% of Medicaid,16.09,,,16.09,Other,100% of Medicaid,36.2,,,36.2,Other,225% of Medicaid,24.62,,,24.62,Other,153% of Medicaid,36.2,,,36.2,Other,225% of Medicaid,22.53,,,22.53,Other,140% of Medicaid,36.2,,,36.2,Other,225% of Medicaid,41.83,,,41.83,Other,250% of Medicaid,52.13,,,52.13,Other,324% of Medicaid,34.59,,,34.59,Other,215% of Medicaid,34.59,,,34.59,Other,215% of Medicaid,20.11,,,20.11,Other,125% of Medicaid,0.01,111.13,
OCCULT BLOOD FECES,82270,CPT,,78082270,CDM,301,RC,,,both,,,44,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,13.18,,,13.18,Fee Schedule,,11.87,,,11.87,Fee Schedule,,25.1,,,25.1,Fee Schedule,,22.58,,,22.58,Fee Schedule,,21.34,,,21.34,Fee Schedule,,30.8,70,,30.8,percent of total billed charges,All Other,13.8,,,13.8,Fee Schedule,,6,,,6,Other,186% of Medicaid,16.25,,,16.25,Fee Schedule,,27.28,,,27.28,Fee Schedule,,9.2,,,,Fee Schedule,,16.25,,,16.25,Fee Schedule,,27.28,,,27.28,Fee Schedule,,17.3,,,17.3,Fee Schedule,,30.8,70,,30.8,percent of total billed charges,,20.76,,,20.76,Fee Schedule,,17.59,,,17.59,Fee Schedule,,6.57,,,6.57,Fee Schedule,,6.57,,,6.57,Fee Schedule,,6.57,,,6.57,Fee Schedule,,6.57,,,6.57,Fee Schedule,,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,5.25,,,5.25,Other,153% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,4.81,,,4.81,Other,140% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,8.93,,,8.93,Other,250% of Medicaid,11.13,,,11.13,Other,324% of Medicaid,7.38,,,7.38,Other,215% of Medicaid,7.38,,,7.38,Other,215% of Medicaid,4.29,,,4.29,Other,125% of Medicaid,0.01,30.8,
OCCULT BLOOD OTHER SOURCES,82271,CPT,,78082271,CDM,301,RC,,,both,,,53,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,16.01,,,16.01,Fee Schedule,,14.42,,,14.42,Fee Schedule,,25.1,,,25.1,Fee Schedule,,22.58,,,22.58,Fee Schedule,,21.34,,,21.34,Fee Schedule,,37.1,70,,37.1,percent of total billed charges,All Other,16.76,,,16.76,Fee Schedule,,26,,,26,Other,186% of Medicaid,19.74,,,19.74,Fee Schedule,,32.86,,,32.86,Fee Schedule,,11.17,,,,Fee Schedule,,19.74,,,19.74,Fee Schedule,,32.86,,,32.86,Fee Schedule,,21.01,,,21.01,Fee Schedule,,37.1,70,,37.1,percent of total billed charges,,25.21,,,25.21,Fee Schedule,,21.37,,,21.37,Fee Schedule,,7.98,,,7.98,Fee Schedule,,7.98,,,7.98,Fee Schedule,,7.98,,,7.98,Fee Schedule,,7.98,,,7.98,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
OCCULT BLD FECES 1-3 TESTS,82272,CPT,,78082272,CDM,301,RC,,,both,,,37,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.73,,,12.73,Fee Schedule,,11.46,,,11.46,Fee Schedule,,25.1,,,25.1,Fee Schedule,,22.58,,,22.58,Fee Schedule,,21.34,,,21.34,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,All Other,13.32,,,13.32,Fee Schedule,,26,,,26,Other,186% of Medicaid,15.69,,,15.69,Fee Schedule,,22.94,,,22.94,Fee Schedule,,8.88,,,,Fee Schedule,,15.69,,,15.69,Fee Schedule,,22.94,,,22.94,Fee Schedule,,16.71,,,16.71,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,,20.05,,,20.05,Fee Schedule,,16.99,,,16.99,Fee Schedule,,6.35,,,6.35,Fee Schedule,,6.35,,,6.35,Fee Schedule,,6.35,,,6.35,Fee Schedule,,6.35,,,6.35,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
ASSAY OF CADMIUM,82300,CPT,,78082300,CDM,301,RC,,,both,,,213,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,71.16,,,71.16,Fee Schedule,,64.06,,,64.06,Fee Schedule,,113.27,,,113.27,Fee Schedule,,101.9,,,101.9,Fee Schedule,,96.32,,,96.32,Fee Schedule,,149.1,70,,149.1,percent of total billed charges,All Other,74.47,,,74.47,Fee Schedule,,30,,,30,Other,186% of Medicaid,87.7,,,87.7,Fee Schedule,,132.06,,,132.06,Fee Schedule,,49.64,,,,Fee Schedule,,87.7,,,87.7,Fee Schedule,,132.06,,,132.06,Fee Schedule,,93.38,,,93.38,Fee Schedule,,149.1,70,,149.1,percent of total billed charges,,112.03,,,112.03,Fee Schedule,,94.95,,,94.95,Fee Schedule,,35.46,,,35.46,Fee Schedule,,35.46,,,35.46,Fee Schedule,,35.46,,,35.46,Fee Schedule,,35.46,,,35.46,Fee Schedule,,15.96,,,15.96,Other,100% of Medicaid,15.96,,,15.96,Other,100% of Medicaid,15.96,,,15.96,Other,100% of Medicaid,15.96,,,15.96,Other,100% of Medicaid,35.91,,,35.91,Other,225% of Medicaid,24.42,,,24.42,Other,153% of Medicaid,35.91,,,35.91,Other,225% of Medicaid,22.34,,,22.34,Other,140% of Medicaid,35.91,,,35.91,Other,225% of Medicaid,41.49,,,41.49,Other,250% of Medicaid,51.7,,,51.7,Other,324% of Medicaid,34.31,,,34.31,Other,215% of Medicaid,34.31,,,34.31,Other,215% of Medicaid,19.95,,,19.95,Other,125% of Medicaid,0.01,149.1,
VITAMIN D 25 HYDROXY,82306,CPT,,78082306,CDM,301,RC,,,both,,,556,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,89.1,,,89.1,Fee Schedule,,80.22,,,80.22,Fee Schedule,,228.3,,,228.3,Fee Schedule,,205.38,,,205.38,Fee Schedule,,194.14,,,194.14,Fee Schedule,,389.2,70,,389.2,percent of total billed charges,All Other,93.24,,,93.24,Fee Schedule,,55,,,55,Other,186% of Medicaid,109.82,,,109.82,Fee Schedule,,344.72,,,344.72,Fee Schedule,,62.16,,,,Fee Schedule,,109.82,,,109.82,Fee Schedule,,344.72,,,344.72,Fee Schedule,,116.92,,,116.92,Fee Schedule,,389.2,70,,389.2,percent of total billed charges,,140.28,,,140.28,Fee Schedule,,118.89,,,118.89,Fee Schedule,,44.4,,,44.4,Fee Schedule,,44.4,,,44.4,Fee Schedule,,44.4,,,44.4,Fee Schedule,,44.4,,,44.4,Fee Schedule,,29.6,,,29.6,Other,100% of Medicaid,29.6,,,29.6,Other,100% of Medicaid,29.6,,,29.6,Other,100% of Medicaid,29.6,,,29.6,Other,100% of Medicaid,66.6,,,66.6,Other,225% of Medicaid,45.29,,,45.29,Other,153% of Medicaid,66.6,,,66.6,Other,225% of Medicaid,41.44,,,41.44,Other,140% of Medicaid,66.6,,,66.6,Other,225% of Medicaid,76.96,,,76.96,Other,250% of Medicaid,95.9,,,95.9,Other,324% of Medicaid,63.64,,,63.64,Other,215% of Medicaid,63.64,,,63.64,Other,215% of Medicaid,37,,,37,Other,125% of Medicaid,0.01,389.2,
ASSAY OF CALCITONIN,82308,CPT,,78082308,CDM,301,RC,,,both,,,549,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,80.64,,,80.64,Fee Schedule,,72.6,,,72.6,Fee Schedule,,206.54,,,206.54,Fee Schedule,,185.81,,,185.81,Fee Schedule,,175.64,,,175.64,Fee Schedule,,384.3,70,,384.3,percent of total billed charges,All Other,84.39,,,84.39,Fee Schedule,,50,,,50,Other,186% of Medicaid,99.39,,,99.39,Fee Schedule,,340.38,,,340.38,Fee Schedule,,56.26,,,,Fee Schedule,,99.39,,,99.39,Fee Schedule,,340.38,,,340.38,Fee Schedule,,105.82,,,105.82,Fee Schedule,,384.3,70,,384.3,percent of total billed charges,,126.96,,,126.96,Fee Schedule,,107.61,,,107.61,Fee Schedule,,40.19,,,40.19,Fee Schedule,,40.19,,,40.19,Fee Schedule,,40.19,,,40.19,Fee Schedule,,40.19,,,40.19,Fee Schedule,,26.79,,,26.79,Other,100% of Medicaid,26.79,,,26.79,Other,100% of Medicaid,26.79,,,26.79,Other,100% of Medicaid,26.79,,,26.79,Other,100% of Medicaid,60.28,,,60.28,Other,225% of Medicaid,40.99,,,40.99,Other,153% of Medicaid,60.28,,,60.28,Other,225% of Medicaid,37.51,,,37.51,Other,140% of Medicaid,60.28,,,60.28,Other,225% of Medicaid,69.65,,,69.65,Other,250% of Medicaid,86.8,,,86.8,Other,324% of Medicaid,57.6,,,57.6,Other,215% of Medicaid,57.6,,,57.6,Other,215% of Medicaid,33.49,,,33.49,Other,125% of Medicaid,0.01,384.3,
ASSAY OF CALCIUM,82310,CPT,,78082310,CDM,301,RC,,,both,,,234,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.53,,,15.53,Fee Schedule,,13.98,,,13.98,Fee Schedule,,39.78,,,39.78,Fee Schedule,,35.79,,,35.79,Fee Schedule,,33.83,,,33.83,Fee Schedule,,163.8,70,,163.8,percent of total billed charges,All Other,16.25,,,16.25,Fee Schedule,,9,,,9,Other,186% of Medicaid,19.14,,,19.14,Fee Schedule,,145.08,,,145.08,Fee Schedule,,10.84,,,,Fee Schedule,,19.14,,,19.14,Fee Schedule,,145.08,,,145.08,Fee Schedule,,20.38,,,20.38,Fee Schedule,,163.8,70,,163.8,percent of total billed charges,,24.45,,,24.45,Fee Schedule,,20.73,,,20.73,Fee Schedule,,7.74,,,7.74,Fee Schedule,,7.74,,,7.74,Fee Schedule,,7.74,,,7.74,Fee Schedule,,7.74,,,7.74,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,163.8,
ASSAY OF CALCIUM,82330,CPT,,78082330,CDM,301,RC,,,both,,,233,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.18,,,41.18,Fee Schedule,,37.07,,,37.07,Fee Schedule,,53.92,,,53.92,Fee Schedule,,48.51,,,48.51,Fee Schedule,,45.85,,,45.85,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,All Other,43.09,,,43.09,Fee Schedule,,9,,,9,Other,186% of Medicaid,50.75,,,50.75,Fee Schedule,,144.46,,,144.46,Fee Schedule,,28.73,,,,Fee Schedule,,50.75,,,50.75,Fee Schedule,,144.46,,,144.46,Fee Schedule,,54.04,,,54.04,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,,64.83,,,64.83,Fee Schedule,,54.95,,,54.95,Fee Schedule,,20.52,,,20.52,Fee Schedule,,20.52,,,20.52,Fee Schedule,,20.52,,,20.52,Fee Schedule,,20.52,,,20.52,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,163.1,
ASSAY OF CALCIUM IN URINE,82340,CPT,,78082340,CDM,301,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,18.15,,,18.15,Fee Schedule,,16.34,,,16.34,Fee Schedule,,46.53,,,46.53,Fee Schedule,,41.86,,,41.86,Fee Schedule,,39.56,,,39.56,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,18.99,,,18.99,Fee Schedule,,11,,,11,Other,186% of Medicaid,22.37,,,22.37,Fee Schedule,,45.88,,,45.88,Fee Schedule,,12.66,,,,Fee Schedule,,22.37,,,22.37,Fee Schedule,,45.88,,,45.88,Fee Schedule,,23.82,,,23.82,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,28.58,,,28.58,Fee Schedule,,24.22,,,24.22,Fee Schedule,,9.05,,,9.05,Fee Schedule,,9.05,,,9.05,Fee Schedule,,9.05,,,9.05,Fee Schedule,,9.05,,,9.05,Fee Schedule,,6.03,,,6.03,Other,100% of Medicaid,6.03,,,6.03,Other,100% of Medicaid,6.03,,,6.03,Other,100% of Medicaid,6.03,,,6.03,Other,100% of Medicaid,13.57,,,13.57,Other,225% of Medicaid,9.23,,,9.23,Other,153% of Medicaid,13.57,,,13.57,Other,225% of Medicaid,8.44,,,8.44,Other,140% of Medicaid,13.57,,,13.57,Other,225% of Medicaid,15.68,,,15.68,Other,250% of Medicaid,19.54,,,19.54,Other,324% of Medicaid,12.96,,,12.96,Other,215% of Medicaid,12.96,,,12.96,Other,215% of Medicaid,7.54,,,7.54,Other,125% of Medicaid,0.01,51.8,
CALCULUS ANALYSIS QUAL,82355,CPT,,78082355,CDM,301,RC,,,both,,,151,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,34.86,,,34.86,Fee Schedule,,31.38,,,31.38,Fee Schedule,,89.27,,,89.27,Fee Schedule,,80.31,,,80.31,Fee Schedule,,75.91,,,75.91,Fee Schedule,,105.7,70,,105.7,percent of total billed charges,All Other,36.48,,,36.48,Fee Schedule,,22,,,22,Other,186% of Medicaid,42.96,,,42.96,Fee Schedule,,93.62,,,93.62,Fee Schedule,,24.32,,,,Fee Schedule,,42.96,,,42.96,Fee Schedule,,93.62,,,93.62,Fee Schedule,,45.74,,,45.74,Fee Schedule,,105.7,70,,105.7,percent of total billed charges,,54.88,,,54.88,Fee Schedule,,46.51,,,46.51,Fee Schedule,,17.37,,,17.37,Fee Schedule,,17.37,,,17.37,Fee Schedule,,17.37,,,17.37,Fee Schedule,,17.37,,,17.37,Fee Schedule,,11.58,,,11.58,Other,100% of Medicaid,11.58,,,11.58,Other,100% of Medicaid,11.58,,,11.58,Other,100% of Medicaid,11.58,,,11.58,Other,100% of Medicaid,26.06,,,26.06,Other,225% of Medicaid,17.72,,,17.72,Other,153% of Medicaid,26.06,,,26.06,Other,225% of Medicaid,16.21,,,16.21,Other,140% of Medicaid,26.06,,,26.06,Other,225% of Medicaid,30.11,,,30.11,Other,250% of Medicaid,37.52,,,37.52,Other,324% of Medicaid,24.9,,,24.9,Other,215% of Medicaid,24.9,,,24.9,Other,215% of Medicaid,14.48,,,14.48,Other,125% of Medicaid,0.01,105.7,
CALCULUS ASSAY QUANT,82360,CPT,,78082360,CDM,301,RC,,,both,,,138,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.74,,,38.74,Fee Schedule,,34.88,,,34.88,Fee Schedule,,99.3,,,99.3,Fee Schedule,,89.33,,,89.33,Fee Schedule,,84.44,,,84.44,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,All Other,40.54,,,40.54,Fee Schedule,,24,,,24,Other,186% of Medicaid,47.75,,,47.75,Fee Schedule,,85.56,,,85.56,Fee Schedule,,27.03,,,,Fee Schedule,,47.75,,,47.75,Fee Schedule,,85.56,,,85.56,Fee Schedule,,50.84,,,50.84,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,,60.99,,,60.99,Fee Schedule,,51.69,,,51.69,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,12.87,,,12.87,Other,100% of Medicaid,12.87,,,12.87,Other,100% of Medicaid,12.87,,,12.87,Other,100% of Medicaid,12.87,,,12.87,Other,100% of Medicaid,28.96,,,28.96,Other,225% of Medicaid,19.69,,,19.69,Other,153% of Medicaid,28.96,,,28.96,Other,225% of Medicaid,18.02,,,18.02,Other,140% of Medicaid,28.96,,,28.96,Other,225% of Medicaid,33.46,,,33.46,Other,250% of Medicaid,41.7,,,41.7,Other,324% of Medicaid,27.67,,,27.67,Other,215% of Medicaid,27.67,,,27.67,Other,215% of Medicaid,16.09,,,16.09,Other,125% of Medicaid,0.01,99.3,
CALCULUS SPECTROSCOPY,82365,CPT,,78082365,CDM,301,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.83,,,38.83,Fee Schedule,,34.96,,,34.96,Fee Schedule,,99.41,,,99.41,Fee Schedule,,89.43,,,89.43,Fee Schedule,,84.53,,,84.53,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,40.64,,,40.64,Fee Schedule,,23,,,23,Other,186% of Medicaid,47.86,,,47.86,Fee Schedule,,25.42,,,25.42,Fee Schedule,,27.09,,,,Fee Schedule,,47.86,,,47.86,Fee Schedule,,25.42,,,25.42,Fee Schedule,,50.96,,,50.96,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,61.13,,,61.13,Fee Schedule,,51.81,,,51.81,Fee Schedule,,19.35,,,19.35,Fee Schedule,,19.35,,,19.35,Fee Schedule,,19.35,,,19.35,Fee Schedule,,19.35,,,19.35,Fee Schedule,,12.51,,,12.51,Other,100% of Medicaid,12.51,,,12.51,Other,100% of Medicaid,12.51,,,12.51,Other,100% of Medicaid,12.51,,,12.51,Other,100% of Medicaid,28.16,,,28.16,Other,225% of Medicaid,19.15,,,19.15,Other,153% of Medicaid,28.16,,,28.16,Other,225% of Medicaid,17.52,,,17.52,Other,140% of Medicaid,28.16,,,28.16,Other,225% of Medicaid,32.54,,,32.54,Other,250% of Medicaid,40.55,,,40.55,Other,324% of Medicaid,26.9,,,26.9,Other,215% of Medicaid,26.9,,,26.9,Other,215% of Medicaid,15.64,,,15.64,Other,125% of Medicaid,0.01,99.41,
X-RAY ASSAY CALCULUS,82370,CPT,,78082370,CDM,301,RC,,,both,,,114,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.69,,,37.69,Fee Schedule,,33.93,,,33.93,Fee Schedule,,94.75,,,94.75,Fee Schedule,,85.24,,,85.24,Fee Schedule,,80.57,,,80.57,Fee Schedule,,79.8,70,,79.8,percent of total billed charges,All Other,39.44,,,39.44,Fee Schedule,,23,,,23,Other,186% of Medicaid,46.45,,,46.45,Fee Schedule,,70.68,,,70.68,Fee Schedule,,26.29,,,,Fee Schedule,,46.45,,,46.45,Fee Schedule,,70.68,,,70.68,Fee Schedule,,49.45,,,49.45,Fee Schedule,,79.8,70,,79.8,percent of total billed charges,,59.33,,,59.33,Fee Schedule,,50.29,,,50.29,Fee Schedule,,18.78,,,18.78,Fee Schedule,,18.78,,,18.78,Fee Schedule,,18.78,,,18.78,Fee Schedule,,18.78,,,18.78,Fee Schedule,,12.52,,,12.52,Other,100% of Medicaid,12.52,,,12.52,Other,100% of Medicaid,12.52,,,12.52,Other,100% of Medicaid,12.52,,,12.52,Other,100% of Medicaid,28.17,,,28.17,Other,225% of Medicaid,19.16,,,19.16,Other,153% of Medicaid,28.17,,,28.17,Other,225% of Medicaid,17.53,,,17.53,Other,140% of Medicaid,28.17,,,28.17,Other,225% of Medicaid,32.55,,,32.55,Other,250% of Medicaid,40.56,,,40.56,Other,324% of Medicaid,26.92,,,26.92,Other,215% of Medicaid,26.92,,,26.92,Other,215% of Medicaid,15.65,,,15.65,Other,125% of Medicaid,0.01,94.75,
ASSAY C-D TRANSFER MEASURE,82373,CPT,,78082373,CDM,301,RC,,,both,,,108,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,54.36,,,54.36,Fee Schedule,,48.94,,,48.94,Fee Schedule,,139.25,,,139.25,Fee Schedule,,125.27,,,125.27,Fee Schedule,,118.41,,,118.41,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,All Other,56.89,,,56.89,Fee Schedule,,15,,,15,Other,186% of Medicaid,67,,,67,Fee Schedule,,66.96,,,66.96,Fee Schedule,,37.93,,,,Fee Schedule,,67,,,67,Fee Schedule,,66.96,,,66.96,Fee Schedule,,71.34,,,71.34,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,,85.59,,,85.59,Fee Schedule,,72.54,,,72.54,Fee Schedule,,27.09,,,27.09,Fee Schedule,,27.09,,,27.09,Fee Schedule,,27.09,,,27.09,Fee Schedule,,27.09,,,27.09,Fee Schedule,,7.97,,,7.97,Other,100% of Medicaid,7.97,,,7.97,Other,100% of Medicaid,7.97,,,7.97,Other,100% of Medicaid,7.97,,,7.97,Other,100% of Medicaid,17.93,,,17.93,Other,225% of Medicaid,12.19,,,12.19,Other,153% of Medicaid,17.93,,,17.93,Other,225% of Medicaid,11.16,,,11.16,Other,140% of Medicaid,17.93,,,17.93,Other,225% of Medicaid,20.72,,,20.72,Other,250% of Medicaid,25.82,,,25.82,Other,324% of Medicaid,17.13,,,17.13,Other,215% of Medicaid,17.13,,,17.13,Other,215% of Medicaid,9.96,,,9.96,Other,125% of Medicaid,0.01,139.25,
ASSAY BLOOD CARBON DIOXIDE,82374,CPT,,78082374,CDM,301,RC,,,both,,,69,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.69,,,14.69,Fee Schedule,,13.22,,,13.22,Fee Schedule,,37.7,,,37.7,Fee Schedule,,33.92,,,33.92,Fee Schedule,,32.06,,,32.06,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,All Other,15.37,,,15.37,Fee Schedule,,9,,,9,Other,186% of Medicaid,18.1,,,18.1,Fee Schedule,,42.78,,,42.78,Fee Schedule,,10.25,,,,Fee Schedule,,18.1,,,18.1,Fee Schedule,,42.78,,,42.78,Fee Schedule,,19.28,,,19.28,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,,23.13,,,23.13,Fee Schedule,,19.6,,,19.6,Fee Schedule,,7.32,,,7.32,Fee Schedule,,7.32,,,7.32,Fee Schedule,,7.32,,,7.32,Fee Schedule,,7.32,,,7.32,Fee Schedule,,4.88,,,4.88,Other,100% of Medicaid,4.88,,,4.88,Other,100% of Medicaid,4.88,,,4.88,Other,100% of Medicaid,4.88,,,4.88,Other,100% of Medicaid,10.98,,,10.98,Other,225% of Medicaid,7.47,,,7.47,Other,153% of Medicaid,10.98,,,10.98,Other,225% of Medicaid,6.83,,,6.83,Other,140% of Medicaid,10.98,,,10.98,Other,225% of Medicaid,12.69,,,12.69,Other,250% of Medicaid,15.81,,,15.81,Other,324% of Medicaid,10.49,,,10.49,Other,215% of Medicaid,10.49,,,10.49,Other,215% of Medicaid,6.1,,,6.1,Other,125% of Medicaid,0.01,48.3,
ASSAY CARBOXYHB QUANT,82375,CPT,,71082375,CDM,301,RC,,,both,,,160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,37.08,,,37.08,Fee Schedule,,33.39,,,33.39,Fee Schedule,,95.08,,,95.08,Fee Schedule,,85.54,,,85.54,Fee Schedule,,80.85,,,80.85,Fee Schedule,,112,70,,112,percent of total billed charges,All Other,38.81,,,38.81,Fee Schedule,,21,,,21,Other,186% of Medicaid,45.71,,,45.71,Fee Schedule,,99.2,,,99.2,Fee Schedule,,25.87,,,,Fee Schedule,,45.71,,,45.71,Fee Schedule,,99.2,,,99.2,Fee Schedule,,48.66,,,48.66,Fee Schedule,,112,70,,112,percent of total billed charges,,58.38,,,58.38,Fee Schedule,,49.48,,,49.48,Fee Schedule,,18.48,,,18.48,Fee Schedule,,18.48,,,18.48,Fee Schedule,,18.48,,,18.48,Fee Schedule,,18.48,,,18.48,Fee Schedule,,11.11,,,11.11,Other,100% of Medicaid,11.11,,,11.11,Other,100% of Medicaid,11.11,,,11.11,Other,100% of Medicaid,11.11,,,11.11,Other,100% of Medicaid,25,,,25,Other,225% of Medicaid,17,,,17,Other,153% of Medicaid,25,,,25,Other,225% of Medicaid,15.55,,,15.55,Other,140% of Medicaid,25,,,25,Other,225% of Medicaid,28.89,,,28.89,Other,250% of Medicaid,36,,,36,Other,324% of Medicaid,23.89,,,23.89,Other,215% of Medicaid,23.89,,,23.89,Other,215% of Medicaid,13.89,,,13.89,Other,125% of Medicaid,0.01,112,
CARCINOEMBRYONIC ANTIGEN,82378,CPT,,78082378,CDM,301,RC,,,both,,,230,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,57.07,,,57.07,Fee Schedule,,51.38,,,51.38,Fee Schedule,,146.32,,,146.32,Fee Schedule,,131.63,,,131.63,Fee Schedule,,124.42,,,124.42,Fee Schedule,,161,70,,161,percent of total billed charges,All Other,59.72,,,59.72,Fee Schedule,,35,,,35,Other,186% of Medicaid,70.34,,,70.34,Fee Schedule,,142.6,,,142.6,Fee Schedule,,39.82,,,,Fee Schedule,,70.34,,,70.34,Fee Schedule,,142.6,,,142.6,Fee Schedule,,74.89,,,74.89,Fee Schedule,,161,70,,161,percent of total billed charges,,89.85,,,89.85,Fee Schedule,,76.16,,,76.16,Fee Schedule,,28.44,,,28.44,Fee Schedule,,28.44,,,28.44,Fee Schedule,,28.44,,,28.44,Fee Schedule,,28.44,,,28.44,Fee Schedule,,18.96,,,18.96,Other,100% of Medicaid,18.96,,,18.96,Other,100% of Medicaid,18.96,,,18.96,Other,100% of Medicaid,18.96,,,18.96,Other,100% of Medicaid,42.66,,,42.66,Other,225% of Medicaid,29.01,,,29.01,Other,153% of Medicaid,42.66,,,42.66,Other,225% of Medicaid,26.54,,,26.54,Other,140% of Medicaid,42.66,,,42.66,Other,225% of Medicaid,49.3,,,49.3,Other,250% of Medicaid,61.43,,,61.43,Other,324% of Medicaid,40.76,,,40.76,Other,215% of Medicaid,40.76,,,40.76,Other,215% of Medicaid,23.7,,,23.7,Other,125% of Medicaid,0.01,161,
ASSAY OF CAROTENE,82380,CPT,,78082380,CDM,301,RC,,,both,,,117,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,27.75,,,27.75,Fee Schedule,,24.99,,,24.99,Fee Schedule,,71.13,,,71.13,Fee Schedule,,63.99,,,63.99,Fee Schedule,,60.49,,,60.49,Fee Schedule,,81.9,70,,81.9,percent of total billed charges,All Other,29.04,,,29.04,Fee Schedule,,26,,,26,Other,186% of Medicaid,34.21,,,34.21,Fee Schedule,,72.54,,,72.54,Fee Schedule,,19.36,,,,Fee Schedule,,34.21,,,34.21,Fee Schedule,,72.54,,,72.54,Fee Schedule,,36.42,,,36.42,Fee Schedule,,81.9,70,,81.9,percent of total billed charges,,43.69,,,43.69,Fee Schedule,,37.03,,,37.03,Fee Schedule,,13.83,,,13.83,Fee Schedule,,13.83,,,13.83,Fee Schedule,,13.83,,,13.83,Fee Schedule,,13.83,,,13.83,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,81.9,
ASSAY URINE CATECHOLAMINES,82382,CPT,,78082382,CDM,301,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,82.17,,,82.17,Fee Schedule,,73.98,,,73.98,Fee Schedule,,132.07,,,132.07,Fee Schedule,,118.81,,,118.81,Fee Schedule,,112.31,,,112.31,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,86,,,86,Fee Schedule,,35,,,35,Other,186% of Medicaid,101.28,,,101.28,Fee Schedule,,115.32,,,115.32,Fee Schedule,,57.33,,,,Fee Schedule,,101.28,,,101.28,Fee Schedule,,115.32,,,115.32,Fee Schedule,,107.84,,,107.84,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,129.38,,,129.38,Fee Schedule,,109.65,,,109.65,Fee Schedule,,40.95,,,40.95,Fee Schedule,,40.95,,,40.95,Fee Schedule,,40.95,,,40.95,Fee Schedule,,40.95,,,40.95,Fee Schedule,,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,28.43,,,28.43,Other,153% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,26.02,,,26.02,Other,140% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,48.32,,,48.32,Other,250% of Medicaid,60.21,,,60.21,Other,324% of Medicaid,39.96,,,39.96,Other,215% of Medicaid,39.96,,,39.96,Other,215% of Medicaid,23.23,,,23.23,Other,125% of Medicaid,0.01,132.07,
ASSAY BLOOD CATECHOLAMINES,82383,CPT,,78082383,CDM,301,RC,,,both,,,414,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.53,,,87.53,Fee Schedule,,78.81,,,78.81,Fee Schedule,,132.07,,,132.07,Fee Schedule,,118.81,,,118.81,Fee Schedule,,112.31,,,112.31,Fee Schedule,,289.8,70,,289.8,percent of total billed charges,All Other,91.6,,,91.6,Fee Schedule,,35,,,35,Other,186% of Medicaid,107.89,,,107.89,Fee Schedule,,256.68,,,256.68,Fee Schedule,,61.07,,,,Fee Schedule,,107.89,,,107.89,Fee Schedule,,256.68,,,256.68,Fee Schedule,,114.87,,,114.87,Fee Schedule,,289.8,70,,289.8,percent of total billed charges,,137.81,,,137.81,Fee Schedule,,116.8,,,116.8,Fee Schedule,,43.62,,,43.62,Fee Schedule,,43.62,,,43.62,Fee Schedule,,43.62,,,43.62,Fee Schedule,,43.62,,,43.62,Fee Schedule,,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,28.43,,,28.43,Other,153% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,26.02,,,26.02,Other,140% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,48.32,,,48.32,Other,250% of Medicaid,60.21,,,60.21,Other,324% of Medicaid,39.96,,,39.96,Other,215% of Medicaid,39.96,,,39.96,Other,215% of Medicaid,23.23,,,23.23,Other,125% of Medicaid,0.01,289.8,
ASSAY THREE CATECHOLAMINES,82384,CPT,,78082384,CDM,301,RC,,,both,,,284,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,76,,,76,Fee Schedule,,68.43,,,68.43,Fee Schedule,,132.07,,,132.07,Fee Schedule,,118.81,,,118.81,Fee Schedule,,112.31,,,112.31,Fee Schedule,,198.8,70,,198.8,percent of total billed charges,All Other,79.54,,,79.54,Fee Schedule,,35,,,35,Other,186% of Medicaid,93.68,,,93.68,Fee Schedule,,176.08,,,176.08,Fee Schedule,,53.03,,,,Fee Schedule,,93.68,,,93.68,Fee Schedule,,176.08,,,176.08,Fee Schedule,,99.74,,,99.74,Fee Schedule,,198.8,70,,198.8,percent of total billed charges,,119.66,,,119.66,Fee Schedule,,101.42,,,101.42,Fee Schedule,,37.88,,,37.88,Fee Schedule,,37.88,,,37.88,Fee Schedule,,37.88,,,37.88,Fee Schedule,,37.88,,,37.88,Fee Schedule,,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,28.43,,,28.43,Other,153% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,26.02,,,26.02,Other,140% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,48.32,,,48.32,Other,250% of Medicaid,60.21,,,60.21,Other,324% of Medicaid,39.96,,,39.96,Other,215% of Medicaid,39.96,,,39.96,Other,215% of Medicaid,23.23,,,23.23,Other,125% of Medicaid,0.01,198.8,
ASSAY OF CERULOPLASMIN,82390,CPT,,78082390,CDM,301,RC,,,both,,,141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,32.33,,,32.33,Fee Schedule,,29.11,,,29.11,Fee Schedule,,58.09,,,58.09,Fee Schedule,,52.26,,,52.26,Fee Schedule,,49.4,,,49.4,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,All Other,33.83,,,33.83,Fee Schedule,,15,,,15,Other,186% of Medicaid,39.85,,,39.85,Fee Schedule,,87.42,,,87.42,Fee Schedule,,22.55,,,,Fee Schedule,,39.85,,,39.85,Fee Schedule,,87.42,,,87.42,Fee Schedule,,42.42,,,42.42,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,,50.9,,,50.9,Fee Schedule,,43.14,,,43.14,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,8.18,,,8.18,Other,100% of Medicaid,8.18,,,8.18,Other,100% of Medicaid,8.18,,,8.18,Other,100% of Medicaid,8.18,,,8.18,Other,100% of Medicaid,18.41,,,18.41,Other,225% of Medicaid,12.52,,,12.52,Other,153% of Medicaid,18.41,,,18.41,Other,225% of Medicaid,11.45,,,11.45,Other,140% of Medicaid,18.41,,,18.41,Other,225% of Medicaid,21.27,,,21.27,Other,250% of Medicaid,26.51,,,26.51,Other,324% of Medicaid,17.59,,,17.59,Other,215% of Medicaid,17.59,,,17.59,Other,215% of Medicaid,10.23,,,10.23,Other,125% of Medicaid,0.01,98.7,
ASSAY OF CHLORAMPHENICOL,82415,CPT,,78082415,CDM,301,RC,,,both,,,143,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.14,,,38.14,Fee Schedule,,34.34,,,34.34,Fee Schedule,,90.47,,,90.47,Fee Schedule,,81.39,,,81.39,Fee Schedule,,76.94,,,76.94,Fee Schedule,,100.1,70,,100.1,percent of total billed charges,All Other,39.91,,,39.91,Fee Schedule,,44,,,44,Other,186% of Medicaid,47.01,,,47.01,Fee Schedule,,88.66,,,88.66,Fee Schedule,,26.61,,,,Fee Schedule,,47.01,,,47.01,Fee Schedule,,88.66,,,88.66,Fee Schedule,,50.05,,,50.05,Fee Schedule,,100.1,70,,100.1,percent of total billed charges,,60.04,,,60.04,Fee Schedule,,50.89,,,50.89,Fee Schedule,,19.01,,,19.01,Fee Schedule,,19.01,,,19.01,Fee Schedule,,19.01,,,19.01,Fee Schedule,,19.01,,,19.01,Fee Schedule,,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,23.47,,,23.47,Other,100% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,35.91,,,35.91,Other,153% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,32.86,,,32.86,Other,140% of Medicaid,52.81,,,52.81,Other,225% of Medicaid,61.02,,,61.02,Other,250% of Medicaid,76.04,,,76.04,Other,324% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,50.46,,,50.46,Other,215% of Medicaid,29.34,,,29.34,Other,125% of Medicaid,0.01,100.1,
ASSAY OF BLOOD CHLORIDE,82435,CPT,,78082435,CDM,301,RC,,,both,,,55,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,13.85,,,13.85,Fee Schedule,,12.47,,,12.47,Fee Schedule,,35.46,,,35.46,Fee Schedule,,31.9,,,31.9,Fee Schedule,,30.15,,,30.15,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,All Other,14.49,,,14.49,Fee Schedule,,9,,,9,Other,186% of Medicaid,17.07,,,17.07,Fee Schedule,,34.1,,,34.1,Fee Schedule,,9.66,,,,Fee Schedule,,17.07,,,17.07,Fee Schedule,,34.1,,,34.1,Fee Schedule,,18.17,,,18.17,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,,21.8,,,21.8,Fee Schedule,,18.48,,,18.48,Fee Schedule,,6.9,,,6.9,Fee Schedule,,6.9,,,6.9,Fee Schedule,,6.9,,,6.9,Fee Schedule,,6.9,,,6.9,Fee Schedule,,4.6,,,4.6,Other,100% of Medicaid,4.6,,,4.6,Other,100% of Medicaid,4.6,,,4.6,Other,100% of Medicaid,4.6,,,4.6,Other,100% of Medicaid,10.35,,,10.35,Other,225% of Medicaid,7.04,,,7.04,Other,153% of Medicaid,10.35,,,10.35,Other,225% of Medicaid,6.44,,,6.44,Other,140% of Medicaid,10.35,,,10.35,Other,225% of Medicaid,11.96,,,11.96,Other,250% of Medicaid,14.9,,,14.9,Other,324% of Medicaid,9.89,,,9.89,Other,215% of Medicaid,9.89,,,9.89,Other,215% of Medicaid,5.75,,,5.75,Other,125% of Medicaid,0.01,38.5,
ASSAY OF URINE CHLORIDE,82436,CPT,,78082436,CDM,301,RC,,,both,,,90,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,17.31,,,17.31,Fee Schedule,,15.58,,,15.58,Fee Schedule,,18.63,,,18.63,Fee Schedule,,16.76,,,16.76,Fee Schedule,,15.84,,,15.84,Fee Schedule,,63,70,,63,percent of total billed charges,All Other,18.11,,,18.11,Fee Schedule,,9,,,9,Other,186% of Medicaid,21.33,,,21.33,Fee Schedule,,55.8,,,55.8,Fee Schedule,,12.08,,,,Fee Schedule,,21.33,,,21.33,Fee Schedule,,55.8,,,55.8,Fee Schedule,,22.71,,,22.71,Fee Schedule,,63,70,,63,percent of total billed charges,,27.25,,,27.25,Fee Schedule,,23.1,,,23.1,Fee Schedule,,8.63,,,8.63,Fee Schedule,,8.63,,,8.63,Fee Schedule,,8.63,,,8.63,Fee Schedule,,8.63,,,8.63,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,63,
ASSAY OTHER FLUID CHLORIDES,82438,CPT,,78082438,CDM,301,RC,,,both,,,44,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.05,,,15.05,Fee Schedule,,13.55,,,13.55,Fee Schedule,,18.63,,,18.63,Fee Schedule,,16.76,,,16.76,Fee Schedule,,15.84,,,15.84,Fee Schedule,,30.8,70,,30.8,percent of total billed charges,All Other,15.75,,,15.75,Fee Schedule,,9,,,9,Other,186% of Medicaid,18.55,,,18.55,Fee Schedule,,27.28,,,27.28,Fee Schedule,,10.5,,,,Fee Schedule,,18.55,,,18.55,Fee Schedule,,27.28,,,27.28,Fee Schedule,,19.75,,,19.75,Fee Schedule,,30.8,70,,30.8,percent of total billed charges,,23.7,,,23.7,Fee Schedule,,20.08,,,20.08,Fee Schedule,,7.5,,,7.5,Fee Schedule,,7.5,,,7.5,Fee Schedule,,7.5,,,7.5,Fee Schedule,,7.5,,,7.5,Fee Schedule,,5,,,5,Other,100% of Medicaid,5,,,5,Other,100% of Medicaid,5,,,5,Other,100% of Medicaid,5,,,5,Other,100% of Medicaid,11.25,,,11.25,Other,225% of Medicaid,7.65,,,7.65,Other,153% of Medicaid,11.25,,,11.25,Other,225% of Medicaid,7,,,7,Other,140% of Medicaid,11.25,,,11.25,Other,225% of Medicaid,13,,,13,Other,250% of Medicaid,16.2,,,16.2,Other,324% of Medicaid,10.75,,,10.75,Other,215% of Medicaid,10.75,,,10.75,Other,215% of Medicaid,6.25,,,6.25,Other,125% of Medicaid,0.01,30.8,
ASSAY BLD/SERUM CHOLESTEROL,82465,CPT,,78082465,CDM,301,RC,,,both,,,46,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,13.09,,,13.09,Fee Schedule,,11.79,,,11.79,Fee Schedule,,33.59,,,33.59,Fee Schedule,,30.22,,,30.22,Fee Schedule,,28.57,,,28.57,Fee Schedule,,32.2,70,,32.2,percent of total billed charges,All Other,13.7,,,13.7,Fee Schedule,,8,,,8,Other,186% of Medicaid,16.14,,,16.14,Fee Schedule,,28.52,,,28.52,Fee Schedule,,9.14,,,,Fee Schedule,,16.14,,,16.14,Fee Schedule,,28.52,,,28.52,Fee Schedule,,17.18,,,17.18,Fee Schedule,,32.2,70,,32.2,percent of total billed charges,,20.61,,,20.61,Fee Schedule,,17.47,,,17.47,Fee Schedule,,6.53,,,6.53,Fee Schedule,,6.53,,,6.53,Fee Schedule,,6.53,,,6.53,Fee Schedule,,6.53,,,6.53,Fee Schedule,,4.35,,,4.35,Other,100% of Medicaid,4.35,,,4.35,Other,100% of Medicaid,4.35,,,4.35,Other,100% of Medicaid,4.35,,,4.35,Other,100% of Medicaid,9.79,,,9.79,Other,225% of Medicaid,6.66,,,6.66,Other,153% of Medicaid,9.79,,,9.79,Other,225% of Medicaid,6.09,,,6.09,Other,140% of Medicaid,9.79,,,9.79,Other,225% of Medicaid,11.31,,,11.31,Other,250% of Medicaid,14.09,,,14.09,Other,324% of Medicaid,9.35,,,9.35,Other,215% of Medicaid,9.35,,,9.35,Other,215% of Medicaid,5.44,,,5.44,Other,125% of Medicaid,0.01,33.59,
ASSAY SERUM CHOLINESTERASE,82480,CPT,,78082480,CDM,301,RC,,,both,,,108,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,23.69,,,23.69,Fee Schedule,,21.33,,,21.33,Fee Schedule,,60.77,,,60.77,Fee Schedule,,54.67,,,54.67,Fee Schedule,,51.68,,,51.68,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,All Other,24.79,,,24.79,Fee Schedule,,15,,,15,Other,186% of Medicaid,29.2,,,29.2,Fee Schedule,,66.96,,,66.96,Fee Schedule,,16.53,,,,Fee Schedule,,29.2,,,29.2,Fee Schedule,,66.96,,,66.96,Fee Schedule,,31.09,,,31.09,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,,37.3,,,37.3,Fee Schedule,,31.61,,,31.61,Fee Schedule,,11.81,,,11.81,Fee Schedule,,11.81,,,11.81,Fee Schedule,,11.81,,,11.81,Fee Schedule,,11.81,,,11.81,Fee Schedule,,7.87,,,7.87,Other,100% of Medicaid,7.87,,,7.87,Other,100% of Medicaid,7.87,,,7.87,Other,100% of Medicaid,7.87,,,7.87,Other,100% of Medicaid,17.71,,,17.71,Other,225% of Medicaid,12.04,,,12.04,Other,153% of Medicaid,17.71,,,17.71,Other,225% of Medicaid,11.02,,,11.02,Other,140% of Medicaid,17.71,,,17.71,Other,225% of Medicaid,20.46,,,20.46,Other,250% of Medicaid,25.5,,,25.5,Other,324% of Medicaid,16.92,,,16.92,Other,215% of Medicaid,16.92,,,16.92,Other,215% of Medicaid,9.84,,,9.84,Other,125% of Medicaid,0.01,75.6,
ASSAY RBC CHOLINESTERASE,82482,CPT,,78082482,CDM,301,RC,,,both,,,135,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,29.53,,,29.53,Fee Schedule,,26.59,,,26.59,Fee Schedule,,59.24,,,59.24,Fee Schedule,,53.29,,,53.29,Fee Schedule,,50.37,,,50.37,Fee Schedule,,94.5,70,,94.5,percent of total billed charges,All Other,30.9,,,30.9,Fee Schedule,,26,,,26,Other,186% of Medicaid,36.4,,,36.4,Fee Schedule,,83.7,,,83.7,Fee Schedule,,20.6,,,,Fee Schedule,,36.4,,,36.4,Fee Schedule,,83.7,,,83.7,Fee Schedule,,38.75,,,38.75,Fee Schedule,,94.5,70,,94.5,percent of total billed charges,,46.49,,,46.49,Fee Schedule,,39.4,,,39.4,Fee Schedule,,14.72,,,14.72,Fee Schedule,,14.72,,,14.72,Fee Schedule,,14.72,,,14.72,Fee Schedule,,14.72,,,14.72,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,94.5,
ASSAY OF CHROMIUM,82495,CPT,,78082495,CDM,301,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,61.04,,,61.04,Fee Schedule,,54.96,,,54.96,Fee Schedule,,156.4,,,156.4,Fee Schedule,,140.7,,,140.7,Fee Schedule,,133,,,133,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,63.88,,,63.88,Fee Schedule,,38,,,38,Other,186% of Medicaid,75.24,,,75.24,Fee Schedule,,128.96,,,128.96,Fee Schedule,,42.59,,,,Fee Schedule,,75.24,,,75.24,Fee Schedule,,128.96,,,128.96,Fee Schedule,,80.11,,,80.11,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,,96.11,,,96.11,Fee Schedule,,81.46,,,81.46,Fee Schedule,,30.42,,,30.42,Fee Schedule,,30.42,,,30.42,Fee Schedule,,30.42,,,30.42,Fee Schedule,,30.42,,,30.42,Fee Schedule,,20.28,,,20.28,Other,100% of Medicaid,20.28,,,20.28,Other,100% of Medicaid,20.28,,,20.28,Other,100% of Medicaid,20.28,,,20.28,Other,100% of Medicaid,45.63,,,45.63,Other,225% of Medicaid,31.03,,,31.03,Other,153% of Medicaid,45.63,,,45.63,Other,225% of Medicaid,28.39,,,28.39,Other,140% of Medicaid,45.63,,,45.63,Other,225% of Medicaid,52.73,,,52.73,Other,250% of Medicaid,65.71,,,65.71,Other,324% of Medicaid,43.6,,,43.6,Other,215% of Medicaid,43.6,,,43.6,Other,215% of Medicaid,25.35,,,25.35,Other,125% of Medicaid,0.01,156.4,
ASSAY OF CITRATE,82507,CPT,,78082507,CDM,301,RC,,,both,,,237,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,83.68,,,83.68,Fee Schedule,,75.34,,,75.34,Fee Schedule,,214.43,,,214.43,Fee Schedule,,192.91,,,192.91,Fee Schedule,,182.35,,,182.35,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,87.57,,,87.57,Fee Schedule,,48,,,48,Other,186% of Medicaid,103.14,,,103.14,Fee Schedule,,146.94,,,146.94,Fee Schedule,,58.38,,,,Fee Schedule,,103.14,,,103.14,Fee Schedule,,146.94,,,146.94,Fee Schedule,,109.81,,,109.81,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,131.75,,,131.75,Fee Schedule,,111.66,,,111.66,Fee Schedule,,41.7,,,41.7,Fee Schedule,,41.7,,,41.7,Fee Schedule,,41.7,,,41.7,Fee Schedule,,41.7,,,41.7,Fee Schedule,,25.55,,,25.55,Other,100% of Medicaid,25.55,,,25.55,Other,100% of Medicaid,25.55,,,25.55,Other,100% of Medicaid,25.55,,,25.55,Other,100% of Medicaid,57.49,,,57.49,Other,225% of Medicaid,39.1,,,39.1,Other,153% of Medicaid,57.49,,,57.49,Other,225% of Medicaid,35.77,,,35.77,Other,140% of Medicaid,57.49,,,57.49,Other,225% of Medicaid,66.44,,,66.44,Other,250% of Medicaid,82.79,,,82.79,Other,324% of Medicaid,54.94,,,54.94,Other,215% of Medicaid,54.94,,,54.94,Other,215% of Medicaid,31.94,,,31.94,Other,125% of Medicaid,0.01,214.43,
COLLAGEN CROSSLINKS,82523,CPT,,78082523,CDM,301,RC,,,both,,,239,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,56.23,,,56.23,Fee Schedule,,50.62,,,50.62,Fee Schedule,,144.18,,,144.18,Fee Schedule,,129.71,,,129.71,Fee Schedule,,122.6,,,122.6,Fee Schedule,,167.3,70,,167.3,percent of total billed charges,All Other,58.84,,,58.84,Fee Schedule,,35,,,35,Other,186% of Medicaid,69.3,,,69.3,Fee Schedule,,148.18,,,148.18,Fee Schedule,,39.23,,,,Fee Schedule,,69.3,,,69.3,Fee Schedule,,148.18,,,148.18,Fee Schedule,,73.79,,,73.79,Fee Schedule,,167.3,70,,167.3,percent of total billed charges,,88.53,,,88.53,Fee Schedule,,75.03,,,75.03,Fee Schedule,,28.02,,,28.02,Fee Schedule,,28.02,,,28.02,Fee Schedule,,28.02,,,28.02,Fee Schedule,,28.02,,,28.02,Fee Schedule,,18.68,,,18.68,Other,100% of Medicaid,18.68,,,18.68,Other,100% of Medicaid,18.68,,,18.68,Other,100% of Medicaid,18.68,,,18.68,Other,100% of Medicaid,42.03,,,42.03,Other,225% of Medicaid,28.58,,,28.58,Other,153% of Medicaid,42.03,,,42.03,Other,225% of Medicaid,26.15,,,26.15,Other,140% of Medicaid,42.03,,,42.03,Other,225% of Medicaid,48.57,,,48.57,Other,250% of Medicaid,60.52,,,60.52,Other,324% of Medicaid,40.16,,,40.16,Other,215% of Medicaid,40.16,,,40.16,Other,215% of Medicaid,23.35,,,23.35,Other,125% of Medicaid,0.01,167.3,
ASSAY OF COPPER,82525,CPT,,78082525,CDM,301,RC,,,both,,,271,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,37.35,,,37.35,Fee Schedule,,33.63,,,33.63,Fee Schedule,,95.68,,,95.68,Fee Schedule,,86.08,,,86.08,Fee Schedule,,81.36,,,81.36,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,All Other,39.09,,,39.09,Fee Schedule,,23,,,23,Other,186% of Medicaid,46.04,,,46.04,Fee Schedule,,168.02,,,168.02,Fee Schedule,,26.06,,,,Fee Schedule,,46.04,,,46.04,Fee Schedule,,168.02,,,168.02,Fee Schedule,,49.02,,,49.02,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,,58.81,,,58.81,Fee Schedule,,49.85,,,49.85,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,12.41,,,12.41,Other,100% of Medicaid,12.41,,,12.41,Other,100% of Medicaid,12.41,,,12.41,Other,100% of Medicaid,12.41,,,12.41,Other,100% of Medicaid,27.92,,,27.92,Other,225% of Medicaid,18.99,,,18.99,Other,153% of Medicaid,27.92,,,27.92,Other,225% of Medicaid,17.37,,,17.37,Other,140% of Medicaid,27.92,,,27.92,Other,225% of Medicaid,32.27,,,32.27,Other,250% of Medicaid,40.21,,,40.21,Other,324% of Medicaid,26.68,,,26.68,Other,215% of Medicaid,26.68,,,26.68,Other,215% of Medicaid,15.51,,,15.51,Other,125% of Medicaid,0.01,189.7,
CORTISOL FREE,82530,CPT,,78082530,CDM,301,RC,,,both,,,246,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.3,,,50.3,Fee Schedule,,45.28,,,45.28,Fee Schedule,,128.89,,,128.89,Fee Schedule,,115.95,,,115.95,Fee Schedule,,109.6,,,109.6,Fee Schedule,,172.2,70,,172.2,percent of total billed charges,All Other,52.64,,,52.64,Fee Schedule,,31,,,31,Other,186% of Medicaid,61.99,,,61.99,Fee Schedule,,152.52,,,152.52,Fee Schedule,,35.09,,,,Fee Schedule,,61.99,,,61.99,Fee Schedule,,152.52,,,152.52,Fee Schedule,,66,,,66,Fee Schedule,,172.2,70,,172.2,percent of total billed charges,,79.19,,,79.19,Fee Schedule,,67.12,,,67.12,Fee Schedule,,25.07,,,25.07,Fee Schedule,,25.07,,,25.07,Fee Schedule,,25.07,,,25.07,Fee Schedule,,25.07,,,25.07,Fee Schedule,,16.71,,,16.71,Other,100% of Medicaid,16.71,,,16.71,Other,100% of Medicaid,16.71,,,16.71,Other,100% of Medicaid,16.71,,,16.71,Other,100% of Medicaid,37.6,,,37.6,Other,225% of Medicaid,25.57,,,25.57,Other,153% of Medicaid,37.6,,,37.6,Other,225% of Medicaid,23.39,,,23.39,Other,140% of Medicaid,37.6,,,37.6,Other,225% of Medicaid,43.45,,,43.45,Other,250% of Medicaid,54.14,,,54.14,Other,324% of Medicaid,35.93,,,35.93,Other,215% of Medicaid,35.93,,,35.93,Other,215% of Medicaid,20.89,,,20.89,Other,125% of Medicaid,0.01,172.2,
TOTAL CORTISOL,82533,CPT,,78082533,CDM,301,RC,,,both,,,224,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.06,,,49.06,Fee Schedule,,44.17,,,44.17,Fee Schedule,,125.77,,,125.77,Fee Schedule,,113.14,,,113.14,Fee Schedule,,106.95,,,106.95,Fee Schedule,,156.8,70,,156.8,percent of total billed charges,All Other,51.35,,,51.35,Fee Schedule,,30,,,30,Other,186% of Medicaid,60.47,,,60.47,Fee Schedule,,138.88,,,138.88,Fee Schedule,,34.23,,,,Fee Schedule,,60.47,,,60.47,Fee Schedule,,138.88,,,138.88,Fee Schedule,,64.39,,,64.39,Fee Schedule,,156.8,70,,156.8,percent of total billed charges,,77.25,,,77.25,Fee Schedule,,65.47,,,65.47,Fee Schedule,,24.45,,,24.45,Fee Schedule,,24.45,,,24.45,Fee Schedule,,24.45,,,24.45,Fee Schedule,,24.45,,,24.45,Fee Schedule,,16.3,,,16.3,Other,100% of Medicaid,16.3,,,16.3,Other,100% of Medicaid,16.3,,,16.3,Other,100% of Medicaid,16.3,,,16.3,Other,100% of Medicaid,36.68,,,36.68,Other,225% of Medicaid,24.94,,,24.94,Other,153% of Medicaid,36.68,,,36.68,Other,225% of Medicaid,22.82,,,22.82,Other,140% of Medicaid,36.68,,,36.68,Other,225% of Medicaid,42.38,,,42.38,Other,250% of Medicaid,52.81,,,52.81,Other,324% of Medicaid,35.05,,,35.05,Other,215% of Medicaid,35.05,,,35.05,Other,215% of Medicaid,20.38,,,20.38,Other,125% of Medicaid,0.01,156.8,
ASSAY OF CREATINE,82540,CPT,,78082540,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,13.97,,,13.97,Fee Schedule,,12.57,,,12.57,Fee Schedule,,35.73,,,35.73,Fee Schedule,,32.14,,,32.14,Fee Schedule,,30.38,,,30.38,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,14.62,,,14.62,Fee Schedule,,26,,,26,Other,186% of Medicaid,17.21,,,17.21,Fee Schedule,,66.34,,,66.34,Fee Schedule,,9.74,,,,Fee Schedule,,17.21,,,17.21,Fee Schedule,,66.34,,,66.34,Fee Schedule,,18.33,,,18.33,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,,21.99,,,21.99,Fee Schedule,,18.64,,,18.64,Fee Schedule,,6.96,,,6.96,Fee Schedule,,6.96,,,6.96,Fee Schedule,,6.96,,,6.96,Fee Schedule,,6.96,,,6.96,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,74.9,
COLUMN CHROMOTOGRAPHY QUANT,82542,CPT,,78082542,CDM,301,RC,,,both,,,160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,72.51,,,72.51,Fee Schedule,,65.28,,,65.28,Fee Schedule,,139.25,,,139.25,Fee Schedule,,125.27,,,125.27,Fee Schedule,,118.41,,,118.41,Fee Schedule,,112,70,,112,percent of total billed charges,All Other,75.88,,,75.88,Fee Schedule,,33,,,33,Other,186% of Medicaid,89.37,,,89.37,Fee Schedule,,99.2,,,99.2,Fee Schedule,,50.59,,,,Fee Schedule,,89.37,,,89.37,Fee Schedule,,99.2,,,99.2,Fee Schedule,,95.16,,,95.16,Fee Schedule,,112,70,,112,percent of total billed charges,,114.16,,,114.16,Fee Schedule,,96.76,,,96.76,Fee Schedule,,36.14,,,36.14,Fee Schedule,,36.14,,,36.14,Fee Schedule,,36.14,,,36.14,Fee Schedule,,36.14,,,36.14,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,139.25,
ASSAY OF CK (CPK),82550,CPT,,78082550,CDM,301,RC,,,both,,,87,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.6,,,19.6,Fee Schedule,,17.64,,,17.64,Fee Schedule,,50.25,,,50.25,Fee Schedule,,45.21,,,45.21,Fee Schedule,,42.73,,,42.73,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,All Other,20.51,,,20.51,Fee Schedule,,9,,,9,Other,186% of Medicaid,24.15,,,24.15,Fee Schedule,,53.94,,,53.94,Fee Schedule,,13.67,,,,Fee Schedule,,24.15,,,24.15,Fee Schedule,,53.94,,,53.94,Fee Schedule,,25.71,,,25.71,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,,30.85,,,30.85,Fee Schedule,,26.15,,,26.15,Fee Schedule,,9.77,,,9.77,Fee Schedule,,9.77,,,9.77,Fee Schedule,,9.77,,,9.77,Fee Schedule,,9.77,,,9.77,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,60.9,
ASSAY OF CPK IN BLOOD,82552,CPT,,78082552,CDM,301,RC,,,both,,,166,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,40.3,,,40.3,Fee Schedule,,36.29,,,36.29,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,All Other,42.18,,,42.18,Fee Schedule,,18,,,18,Other,186% of Medicaid,49.68,,,49.68,Fee Schedule,,102.92,,,102.92,Fee Schedule,,28.12,,,,Fee Schedule,,49.68,,,49.68,Fee Schedule,,102.92,,,102.92,Fee Schedule,,52.89,,,52.89,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,,63.46,,,63.46,Fee Schedule,,53.78,,,53.78,Fee Schedule,,20.09,,,20.09,Fee Schedule,,20.09,,,20.09,Fee Schedule,,20.09,,,20.09,Fee Schedule,,20.09,,,20.09,Fee Schedule,,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,14.53,,,14.53,Other,153% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,24.68,,,24.68,Other,250% of Medicaid,30.76,,,30.76,Other,324% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,11.87,,,11.87,Other,125% of Medicaid,0.01,116.2,
CREATINE MB FRACTION,82553,CPT,,78082553,CDM,301,RC,,,both,,,244,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.77,,,34.77,Fee Schedule,,31.3,,,31.3,Fee Schedule,,47.46,,,47.46,Fee Schedule,,42.69,,,42.69,Fee Schedule,,40.36,,,40.36,Fee Schedule,,170.8,70,,170.8,percent of total billed charges,All Other,36.38,,,36.38,Fee Schedule,,15,,,15,Other,186% of Medicaid,42.85,,,42.85,Fee Schedule,,151.28,,,151.28,Fee Schedule,,24.26,,,,Fee Schedule,,42.85,,,42.85,Fee Schedule,,151.28,,,151.28,Fee Schedule,,45.62,,,45.62,Fee Schedule,,170.8,70,,170.8,percent of total billed charges,,54.74,,,54.74,Fee Schedule,,46.39,,,46.39,Fee Schedule,,17.33,,,17.33,Fee Schedule,,17.33,,,17.33,Fee Schedule,,17.33,,,17.33,Fee Schedule,,17.33,,,17.33,Fee Schedule,,8.13,,,8.13,Other,100% of Medicaid,8.13,,,8.13,Other,100% of Medicaid,8.13,,,8.13,Other,100% of Medicaid,8.13,,,8.13,Other,100% of Medicaid,18.29,,,18.29,Other,225% of Medicaid,12.44,,,12.44,Other,153% of Medicaid,18.29,,,18.29,Other,225% of Medicaid,11.38,,,11.38,Other,140% of Medicaid,18.29,,,18.29,Other,225% of Medicaid,21.14,,,21.14,Other,250% of Medicaid,26.34,,,26.34,Other,324% of Medicaid,17.48,,,17.48,Other,215% of Medicaid,17.48,,,17.48,Other,215% of Medicaid,10.16,,,10.16,Other,125% of Medicaid,0.01,170.8,
ASSAY OF CREATININE,82565,CPT,,78082565,CDM,301,RC,,,both,,,99,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.41,,,15.41,Fee Schedule,,13.88,,,13.88,Fee Schedule,,39.57,,,39.57,Fee Schedule,,35.59,,,35.59,Fee Schedule,,33.65,,,33.65,Fee Schedule,,69.3,70,,69.3,percent of total billed charges,All Other,16.13,,,16.13,Fee Schedule,,9,,,9,Other,186% of Medicaid,19,,,19,Fee Schedule,,61.38,,,61.38,Fee Schedule,,10.75,,,,Fee Schedule,,19,,,19,Fee Schedule,,61.38,,,61.38,Fee Schedule,,20.22,,,20.22,Fee Schedule,,69.3,70,,69.3,percent of total billed charges,,24.26,,,24.26,Fee Schedule,,20.57,,,20.57,Fee Schedule,,7.68,,,7.68,Fee Schedule,,7.68,,,7.68,Fee Schedule,,7.68,,,7.68,Fee Schedule,,7.68,,,7.68,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,69.3,
ASSAY OF URINE CREATININE,82570,CPT,,78082570,CDM,301,RC,,,both,,,78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.59,,,15.59,Fee Schedule,,14.04,,,14.04,Fee Schedule,,39.89,,,39.89,Fee Schedule,,35.89,,,35.89,Fee Schedule,,33.92,,,33.92,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,All Other,16.32,,,16.32,Fee Schedule,,9,,,9,Other,186% of Medicaid,19.22,,,19.22,Fee Schedule,,48.36,,,48.36,Fee Schedule,,10.88,,,,Fee Schedule,,19.22,,,19.22,Fee Schedule,,48.36,,,48.36,Fee Schedule,,20.46,,,20.46,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,,24.55,,,24.55,Fee Schedule,,20.81,,,20.81,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,54.6,
CREATININE CLEARANCE TEST,82575,CPT,,78082575,CDM,301,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,28.47,,,28.47,Fee Schedule,,25.64,,,25.64,Fee Schedule,,72.88,,,72.88,Fee Schedule,,65.57,,,65.57,Fee Schedule,,61.98,,,61.98,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,All Other,29.8,,,29.8,Fee Schedule,,11,,,11,Other,186% of Medicaid,35.1,,,35.1,Fee Schedule,,79.98,,,79.98,Fee Schedule,,19.87,,,,Fee Schedule,,35.1,,,35.1,Fee Schedule,,79.98,,,79.98,Fee Schedule,,37.37,,,37.37,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,,44.83,,,44.83,Fee Schedule,,38,,,38,Fee Schedule,,14.19,,,14.19,Fee Schedule,,14.19,,,14.19,Fee Schedule,,14.19,,,14.19,Fee Schedule,,14.19,,,14.19,Fee Schedule,,5.89,,,5.89,Other,100% of Medicaid,5.89,,,5.89,Other,100% of Medicaid,5.89,,,5.89,Other,100% of Medicaid,5.89,,,5.89,Other,100% of Medicaid,13.25,,,13.25,Other,225% of Medicaid,9.01,,,9.01,Other,153% of Medicaid,13.25,,,13.25,Other,225% of Medicaid,8.24,,,8.24,Other,140% of Medicaid,13.25,,,13.25,Other,225% of Medicaid,15.31,,,15.31,Other,250% of Medicaid,19.08,,,19.08,Other,324% of Medicaid,12.66,,,12.66,Other,215% of Medicaid,12.66,,,12.66,Other,215% of Medicaid,7.36,,,7.36,Other,125% of Medicaid,0.01,90.3,
ASSAY OF CRYOFIBRINOGEN,82585,CPT,,78082585,CDM,301,RC,,,both,,,277,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.56,,,42.56,Fee Schedule,,38.32,,,38.32,Fee Schedule,,40.22,,,40.22,Fee Schedule,,36.19,,,36.19,Fee Schedule,,34.2,,,34.2,Fee Schedule,,193.9,70,,193.9,percent of total billed charges,All Other,44.54,,,44.54,Fee Schedule,,33,,,33,Other,186% of Medicaid,52.46,,,52.46,Fee Schedule,,171.74,,,171.74,Fee Schedule,,29.69,,,,Fee Schedule,,52.46,,,52.46,Fee Schedule,,171.74,,,171.74,Fee Schedule,,55.85,,,55.85,Fee Schedule,,193.9,70,,193.9,percent of total billed charges,,67.01,,,67.01,Fee Schedule,,56.8,,,56.8,Fee Schedule,,21.21,,,21.21,Fee Schedule,,21.21,,,21.21,Fee Schedule,,21.21,,,21.21,Fee Schedule,,21.21,,,21.21,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,193.9,
ASSAY OF CRYOGLOBULIN,82595,CPT,,78082595,CDM,301,RC,,,both,,,124,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.47,,,19.47,Fee Schedule,,17.53,,,17.53,Fee Schedule,,49.92,,,49.92,Fee Schedule,,44.91,,,44.91,Fee Schedule,,42.45,,,42.45,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,All Other,20.38,,,20.38,Fee Schedule,,10,,,10,Other,186% of Medicaid,24,,,24,Fee Schedule,,76.88,,,76.88,Fee Schedule,,13.59,,,,Fee Schedule,,24,,,24,Fee Schedule,,76.88,,,76.88,Fee Schedule,,25.56,,,25.56,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,,30.66,,,30.66,Fee Schedule,,25.99,,,25.99,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,5.53,,,5.53,Other,100% of Medicaid,5.53,,,5.53,Other,100% of Medicaid,5.53,,,5.53,Other,100% of Medicaid,5.53,,,5.53,Other,100% of Medicaid,12.45,,,12.45,Other,225% of Medicaid,8.47,,,8.47,Other,153% of Medicaid,12.45,,,12.45,Other,225% of Medicaid,7.75,,,7.75,Other,140% of Medicaid,12.45,,,12.45,Other,225% of Medicaid,14.39,,,14.39,Other,250% of Medicaid,17.93,,,17.93,Other,324% of Medicaid,11.9,,,11.9,Other,215% of Medicaid,11.9,,,11.9,Other,215% of Medicaid,6.92,,,6.92,Other,125% of Medicaid,0.01,86.8,
ASSAY OF CYANIDE,82600,CPT,,78082600,CDM,301,RC,,,both,,,194,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,58.39,,,58.39,Fee Schedule,,52.57,,,52.57,Fee Schedule,,149.6,,,149.6,Fee Schedule,,134.59,,,134.59,Fee Schedule,,127.22,,,127.22,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,All Other,61.11,,,61.11,Fee Schedule,,47,,,47,Other,186% of Medicaid,71.97,,,71.97,Fee Schedule,,120.28,,,120.28,Fee Schedule,,40.74,,,,Fee Schedule,,71.97,,,71.97,Fee Schedule,,120.28,,,120.28,Fee Schedule,,76.63,,,76.63,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,,91.94,,,91.94,Fee Schedule,,77.92,,,77.92,Fee Schedule,,29.1,,,29.1,Fee Schedule,,29.1,,,29.1,Fee Schedule,,29.1,,,29.1,Fee Schedule,,29.1,,,29.1,Fee Schedule,,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,38.73,,,38.73,Other,153% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,35.44,,,35.44,Other,140% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,65.82,,,65.82,Other,250% of Medicaid,82.02,,,82.02,Other,324% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,31.64,,,31.64,Other,125% of Medicaid,0.01,149.6,
VITAMIN B-12,82607,CPT,,78082607,CDM,301,RC,,,both,,,227,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,45.39,,,45.39,Fee Schedule,,40.87,,,40.87,Fee Schedule,,116.23,,,116.23,Fee Schedule,,104.57,,,104.57,Fee Schedule,,98.84,,,98.84,Fee Schedule,,158.9,70,,158.9,percent of total billed charges,All Other,47.5,,,47.5,Fee Schedule,,23,,,23,Other,186% of Medicaid,55.95,,,55.95,Fee Schedule,,140.74,,,140.74,Fee Schedule,,31.67,,,,Fee Schedule,,55.95,,,55.95,Fee Schedule,,140.74,,,140.74,Fee Schedule,,59.57,,,59.57,Fee Schedule,,158.9,70,,158.9,percent of total billed charges,,71.46,,,71.46,Fee Schedule,,60.57,,,60.57,Fee Schedule,,22.62,,,22.62,Fee Schedule,,22.62,,,22.62,Fee Schedule,,22.62,,,22.62,Fee Schedule,,22.62,,,22.62,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,158.9,
B-12 BINDING CAPACITY,82608,CPT,,78082608,CDM,301,RC,,,both,,,201,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.1,,,43.1,Fee Schedule,,38.81,,,38.81,Fee Schedule,,110.42,,,110.42,Fee Schedule,,99.34,,,99.34,Fee Schedule,,93.9,,,93.9,Fee Schedule,,140.7,70,,140.7,percent of total billed charges,All Other,45.11,,,45.11,Fee Schedule,,27,,,27,Other,186% of Medicaid,53.13,,,53.13,Fee Schedule,,124.62,,,124.62,Fee Schedule,,30.07,,,,Fee Schedule,,53.13,,,53.13,Fee Schedule,,124.62,,,124.62,Fee Schedule,,56.56,,,56.56,Fee Schedule,,140.7,70,,140.7,percent of total billed charges,,67.86,,,67.86,Fee Schedule,,57.52,,,57.52,Fee Schedule,,21.48,,,21.48,Fee Schedule,,21.48,,,21.48,Fee Schedule,,21.48,,,21.48,Fee Schedule,,21.48,,,21.48,Fee Schedule,,14.32,,,14.32,Other,100% of Medicaid,14.32,,,14.32,Other,100% of Medicaid,14.32,,,14.32,Other,100% of Medicaid,14.32,,,14.32,Other,100% of Medicaid,32.22,,,32.22,Other,225% of Medicaid,21.91,,,21.91,Other,153% of Medicaid,32.22,,,32.22,Other,225% of Medicaid,20.05,,,20.05,Other,140% of Medicaid,32.22,,,32.22,Other,225% of Medicaid,37.23,,,37.23,Other,250% of Medicaid,46.4,,,46.4,Other,324% of Medicaid,30.79,,,30.79,Other,215% of Medicaid,30.79,,,30.79,Other,215% of Medicaid,17.9,,,17.9,Other,125% of Medicaid,0.01,140.7,
CYSTATIN C,82610,CPT,,78082610,CDM,301,RC,,,both,,,71,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,55.75,,,55.75,Fee Schedule,,50.19,,,50.19,Fee Schedule,,87.57,,,87.57,Fee Schedule,,78.78,,,78.78,Fee Schedule,,74.47,,,74.47,Fee Schedule,,49.7,70,,49.7,percent of total billed charges,All Other,58.34,,,58.34,Fee Schedule,,33,,,33,Other,186% of Medicaid,68.71,,,68.71,Fee Schedule,,44.02,,,44.02,Fee Schedule,,38.89,,,,Fee Schedule,,68.71,,,68.71,Fee Schedule,,44.02,,,44.02,Fee Schedule,,73.15,,,73.15,Fee Schedule,,49.7,70,,49.7,percent of total billed charges,,87.77,,,87.77,Fee Schedule,,74.39,,,74.39,Fee Schedule,,27.78,,,27.78,Fee Schedule,,27.78,,,27.78,Fee Schedule,,27.78,,,27.78,Fee Schedule,,27.78,,,27.78,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,87.77,
TEST FOR URINE CYSTINES,82615,CPT,,78082615,CDM,301,RC,,,both,,,78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.75,,,28.75,Fee Schedule,,25.88,,,25.88,Fee Schedule,,62.91,,,62.91,Fee Schedule,,56.6,,,56.6,Fee Schedule,,53.5,,,53.5,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,All Other,30.08,,,30.08,Fee Schedule,,13,,,13,Other,186% of Medicaid,35.43,,,35.43,Fee Schedule,,48.36,,,48.36,Fee Schedule,,20.06,,,,Fee Schedule,,35.43,,,35.43,Fee Schedule,,48.36,,,48.36,Fee Schedule,,37.72,,,37.72,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,,45.26,,,45.26,Fee Schedule,,38.36,,,38.36,Fee Schedule,,14.33,,,14.33,Fee Schedule,,14.33,,,14.33,Fee Schedule,,14.33,,,14.33,Fee Schedule,,14.33,,,14.33,Fee Schedule,,7.07,,,7.07,Other,100% of Medicaid,7.07,,,7.07,Other,100% of Medicaid,7.07,,,7.07,Other,100% of Medicaid,7.07,,,7.07,Other,100% of Medicaid,15.91,,,15.91,Other,225% of Medicaid,10.82,,,10.82,Other,153% of Medicaid,15.91,,,15.91,Other,225% of Medicaid,9.9,,,9.9,Other,140% of Medicaid,15.91,,,15.91,Other,225% of Medicaid,18.38,,,18.38,Other,250% of Medicaid,22.91,,,22.91,Other,324% of Medicaid,15.2,,,15.2,Other,215% of Medicaid,15.2,,,15.2,Other,215% of Medicaid,8.84,,,8.84,Other,125% of Medicaid,0.01,62.91,
DHEA,82626,CPT,,78082626,CDM,301,RC,,,both,,,384,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,76.06,,,76.06,Fee Schedule,,68.48,,,68.48,Fee Schedule,,194.87,,,194.87,Fee Schedule,,175.31,,,175.31,Fee Schedule,,165.71,,,165.71,Fee Schedule,,268.8,70,,268.8,percent of total billed charges,All Other,79.6,,,79.6,Fee Schedule,,45,,,45,Other,186% of Medicaid,93.75,,,93.75,Fee Schedule,,238.08,,,238.08,Fee Schedule,,53.07,,,,Fee Schedule,,93.75,,,93.75,Fee Schedule,,238.08,,,238.08,Fee Schedule,,99.82,,,99.82,Fee Schedule,,268.8,70,,268.8,percent of total billed charges,,119.76,,,119.76,Fee Schedule,,101.5,,,101.5,Fee Schedule,,37.91,,,37.91,Fee Schedule,,37.91,,,37.91,Fee Schedule,,37.91,,,37.91,Fee Schedule,,37.91,,,37.91,Fee Schedule,,24.06,,,24.06,Other,100% of Medicaid,24.06,,,24.06,Other,100% of Medicaid,24.06,,,24.06,Other,100% of Medicaid,24.06,,,24.06,Other,100% of Medicaid,54.13,,,54.13,Other,225% of Medicaid,36.81,,,36.81,Other,153% of Medicaid,54.13,,,54.13,Other,225% of Medicaid,33.68,,,33.68,Other,140% of Medicaid,54.13,,,54.13,Other,225% of Medicaid,62.55,,,62.55,Other,250% of Medicaid,77.95,,,77.95,Other,324% of Medicaid,51.73,,,51.73,Other,215% of Medicaid,51.73,,,51.73,Other,215% of Medicaid,30.07,,,30.07,Other,125% of Medicaid,0.01,268.8,
DHEA-S,82627,CPT,,78082627,CDM,301,RC,,,both,,,384,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,66.91,,,66.91,Fee Schedule,,60.24,,,60.24,Fee Schedule,,171.47,,,171.47,Fee Schedule,,154.26,,,154.26,Fee Schedule,,145.81,,,145.81,Fee Schedule,,268.8,70,,268.8,percent of total billed charges,All Other,70.02,,,70.02,Fee Schedule,,41,,,41,Other,186% of Medicaid,82.47,,,82.47,Fee Schedule,,238.08,,,238.08,Fee Schedule,,46.68,,,,Fee Schedule,,82.47,,,82.47,Fee Schedule,,238.08,,,238.08,Fee Schedule,,87.81,,,87.81,Fee Schedule,,268.8,70,,268.8,percent of total billed charges,,105.35,,,105.35,Fee Schedule,,89.29,,,89.29,Fee Schedule,,33.35,,,33.35,Fee Schedule,,33.35,,,33.35,Fee Schedule,,33.35,,,33.35,Fee Schedule,,33.35,,,33.35,Fee Schedule,,22.23,,,22.23,Other,100% of Medicaid,22.23,,,22.23,Other,100% of Medicaid,22.23,,,22.23,Other,100% of Medicaid,22.23,,,22.23,Other,100% of Medicaid,50.02,,,50.02,Other,225% of Medicaid,34.01,,,34.01,Other,153% of Medicaid,50.02,,,50.02,Other,225% of Medicaid,31.12,,,31.12,Other,140% of Medicaid,50.02,,,50.02,Other,225% of Medicaid,57.8,,,57.8,Other,250% of Medicaid,72.03,,,72.03,Other,324% of Medicaid,47.79,,,47.79,Other,215% of Medicaid,47.79,,,47.79,Other,215% of Medicaid,27.79,,,27.79,Other,125% of Medicaid,0.01,268.8,
DESOXYCORTICOSTERONE,82633,CPT,,78082633,CDM,301,RC,,,both,,,98,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,93.25,,,93.25,Fee Schedule,,83.96,,,83.96,Fee Schedule,,238.87,,,238.87,Fee Schedule,,214.9,,,214.9,Fee Schedule,,203.13,,,203.13,Fee Schedule,,68.6,70,,68.6,percent of total billed charges,All Other,97.59,,,97.59,Fee Schedule,,76,,,76,Other,186% of Medicaid,114.94,,,114.94,Fee Schedule,,60.76,,,60.76,Fee Schedule,,65.06,,,,Fee Schedule,,114.94,,,114.94,Fee Schedule,,60.76,,,60.76,Fee Schedule,,122.37,,,122.37,Fee Schedule,,68.6,70,,68.6,percent of total billed charges,,146.82,,,146.82,Fee Schedule,,124.43,,,124.43,Fee Schedule,,46.47,,,46.47,Fee Schedule,,46.47,,,46.47,Fee Schedule,,46.47,,,46.47,Fee Schedule,,46.47,,,46.47,Fee Schedule,,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,62.76,,,62.76,Other,153% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,57.43,,,57.43,Other,140% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,106.65,,,106.65,Other,250% of Medicaid,132.9,,,132.9,Other,324% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,51.27,,,51.27,Other,125% of Medicaid,0.01,238.87,
DEOXYCORTISOL,82634,CPT,,78082634,CDM,301,RC,,,both,,,429,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,88.13,,,88.13,Fee Schedule,,79.35,,,79.35,Fee Schedule,,225.78,,,225.78,Fee Schedule,,203.12,,,203.12,Fee Schedule,,191.99,,,191.99,Fee Schedule,,300.3,70,,300.3,percent of total billed charges,All Other,92.23,,,92.23,Fee Schedule,,28,,,28,Other,186% of Medicaid,108.63,,,108.63,Fee Schedule,,265.98,,,265.98,Fee Schedule,,61.49,,,,Fee Schedule,,108.63,,,108.63,Fee Schedule,,265.98,,,265.98,Fee Schedule,,115.66,,,115.66,Fee Schedule,,300.3,70,,300.3,percent of total billed charges,,138.76,,,138.76,Fee Schedule,,117.61,,,117.61,Fee Schedule,,43.92,,,43.92,Fee Schedule,,43.92,,,43.92,Fee Schedule,,43.92,,,43.92,Fee Schedule,,43.92,,,43.92,Fee Schedule,,15.15,,,15.15,Other,100% of Medicaid,15.15,,,15.15,Other,100% of Medicaid,15.15,,,15.15,Other,100% of Medicaid,15.15,,,15.15,Other,100% of Medicaid,34.09,,,34.09,Other,225% of Medicaid,23.18,,,23.18,Other,153% of Medicaid,34.09,,,34.09,Other,225% of Medicaid,21.21,,,21.21,Other,140% of Medicaid,34.09,,,34.09,Other,225% of Medicaid,39.39,,,39.39,Other,250% of Medicaid,49.09,,,49.09,Other,324% of Medicaid,32.57,,,32.57,Other,215% of Medicaid,32.57,,,32.57,Other,215% of Medicaid,18.94,,,18.94,Other,125% of Medicaid,0.01,300.3,
ASSAY OF DIBUCAINE NUMBER,82638,CPT,,78082638,CDM,301,RC,,,both,,,139,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.87,,,36.87,Fee Schedule,,33.2,,,33.2,Fee Schedule,,94.42,,,94.42,Fee Schedule,,84.94,,,84.94,Fee Schedule,,80.29,,,80.29,Fee Schedule,,97.3,70,,97.3,percent of total billed charges,All Other,38.59,,,38.59,Fee Schedule,,33,,,33,Other,186% of Medicaid,45.45,,,45.45,Fee Schedule,,86.18,,,86.18,Fee Schedule,,25.73,,,,Fee Schedule,,45.45,,,45.45,Fee Schedule,,86.18,,,86.18,Fee Schedule,,48.39,,,48.39,Fee Schedule,,97.3,70,,97.3,percent of total billed charges,,58.05,,,58.05,Fee Schedule,,49.2,,,49.2,Fee Schedule,,18.38,,,18.38,Fee Schedule,,18.38,,,18.38,Fee Schedule,,18.38,,,18.38,Fee Schedule,,18.38,,,18.38,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,97.3,
DIHYDROTESTOSTERONE,82642,CPT,,78082642,CDM,301,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,88.13,,,88.13,Fee Schedule,,79.35,,,79.35,Fee Schedule,,32.53,,,32.53,Fee Schedule,,32.53,,,32.53,Fee Schedule,,32.53,,,32.53,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,92.23,,,92.23,Fee Schedule,,58,,,58,Other,186% of Medicaid,108.63,,,108.63,Fee Schedule,,57.66,,,57.66,Fee Schedule,,61.49,,,,Fee Schedule,,108.63,,,108.63,Fee Schedule,,57.66,,,57.66,Fee Schedule,,115.66,,,115.66,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,,138.76,,,138.76,Fee Schedule,,117.61,,,117.61,Fee Schedule,,43.92,,,43.92,Fee Schedule,,43.92,,,43.92,Fee Schedule,,43.92,,,43.92,Fee Schedule,,43.92,,,43.92,Fee Schedule,,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,47.87,,,47.87,Other,153% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,43.8,,,43.8,Other,140% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,81.35,,,81.35,Other,250% of Medicaid,101.38,,,101.38,Other,324% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,39.11,,,39.11,Other,125% of Medicaid,0.01,138.76,
VIT D 1 25-DIHYDROXY,82652,CPT,,78082652,CDM,301,RC,,,both,,,760,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,115.89,,,115.89,Fee Schedule,,104.34,,,104.34,Fee Schedule,,296.91,,,296.91,Fee Schedule,,267.11,,,267.11,Fee Schedule,,252.48,,,252.48,Fee Schedule,,532,70,,532,percent of total billed charges,All Other,121.28,,,121.28,Fee Schedule,,73,,,73,Other,186% of Medicaid,142.84,,,142.84,Fee Schedule,,471.2,,,471.2,Fee Schedule,,80.85,,,,Fee Schedule,,142.84,,,142.84,Fee Schedule,,471.2,,,471.2,Fee Schedule,,152.08,,,152.08,Fee Schedule,,532,70,,532,percent of total billed charges,,182.45,,,182.45,Fee Schedule,,154.64,,,154.64,Fee Schedule,,57.75,,,57.75,Fee Schedule,,57.75,,,57.75,Fee Schedule,,57.75,,,57.75,Fee Schedule,,57.75,,,57.75,Fee Schedule,,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,59.9,,,59.9,Other,153% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,54.81,,,54.81,Other,140% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,101.8,,,101.8,Other,250% of Medicaid,126.86,,,126.86,Other,324% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,48.94,,,48.94,Other,125% of Medicaid,0.01,532,
PANCREATIC ELASTASE FECAL,82656,CPT,,78082656,CDM,301,RC,,,both,,,67,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.71,,,34.71,Fee Schedule,,31.25,,,31.25,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,46.9,70,,46.9,percent of total billed charges,All Other,36.32,,,36.32,Fee Schedule,,10,,,10,Other,186% of Medicaid,42.78,,,42.78,Fee Schedule,,41.54,,,41.54,Fee Schedule,,24.21,,,,Fee Schedule,,42.78,,,42.78,Fee Schedule,,41.54,,,41.54,Fee Schedule,,45.54,,,45.54,Fee Schedule,,46.9,70,,46.9,percent of total billed charges,,54.64,,,54.64,Fee Schedule,,46.31,,,46.31,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,67.46,
ASSAY OF ERYTHROPOIETIN,82668,CPT,,78082668,CDM,301,RC,,,both,,,312,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,56.56,,,56.56,Fee Schedule,,50.92,,,50.92,Fee Schedule,,145,,,145,Fee Schedule,,130.45,,,130.45,Fee Schedule,,123.3,,,123.3,Fee Schedule,,218.4,70,,218.4,percent of total billed charges,All Other,59.19,,,59.19,Fee Schedule,,32,,,32,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,193.44,,,193.44,Fee Schedule,,39.46,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,193.44,,,193.44,Fee Schedule,,74.22,,,74.22,Fee Schedule,,218.4,70,,218.4,percent of total billed charges,,89.05,,,89.05,Fee Schedule,,75.47,,,75.47,Fee Schedule,,28.19,,,28.19,Fee Schedule,,28.19,,,28.19,Fee Schedule,,28.19,,,28.19,Fee Schedule,,28.19,,,28.19,Fee Schedule,,17.23,,,17.23,Other,100% of Medicaid,17.23,,,17.23,Other,100% of Medicaid,17.23,,,17.23,Other,100% of Medicaid,17.23,,,17.23,Other,100% of Medicaid,38.77,,,38.77,Other,225% of Medicaid,26.36,,,26.36,Other,153% of Medicaid,38.77,,,38.77,Other,225% of Medicaid,24.12,,,24.12,Other,140% of Medicaid,38.77,,,38.77,Other,225% of Medicaid,44.8,,,44.8,Other,250% of Medicaid,55.83,,,55.83,Other,324% of Medicaid,37.05,,,37.05,Other,215% of Medicaid,37.05,,,37.05,Other,215% of Medicaid,21.54,,,21.54,Other,125% of Medicaid,0.01,218.4,
ASSAY OF ESTRADIOL,82670,CPT,,78082670,CDM,301,RC,,,both,,,373,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,84.1,,,84.1,Fee Schedule,,75.72,,,75.72,Fee Schedule,,215.47,,,215.47,Fee Schedule,,193.85,,,193.85,Fee Schedule,,183.23,,,183.23,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,88.01,,,88.01,Fee Schedule,,52,,,52,Other,186% of Medicaid,103.66,,,103.66,Fee Schedule,,231.26,,,231.26,Fee Schedule,,58.67,,,,Fee Schedule,,103.66,,,103.66,Fee Schedule,,231.26,,,231.26,Fee Schedule,,110.36,,,110.36,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,132.41,,,132.41,Fee Schedule,,112.22,,,112.22,Fee Schedule,,41.91,,,41.91,Fee Schedule,,41.91,,,41.91,Fee Schedule,,41.91,,,41.91,Fee Schedule,,41.91,,,41.91,Fee Schedule,,27.94,,,27.94,Other,100% of Medicaid,27.94,,,27.94,Other,100% of Medicaid,27.94,,,27.94,Other,100% of Medicaid,27.94,,,27.94,Other,100% of Medicaid,62.87,,,62.87,Other,225% of Medicaid,42.75,,,42.75,Other,153% of Medicaid,62.87,,,62.87,Other,225% of Medicaid,39.12,,,39.12,Other,140% of Medicaid,62.87,,,62.87,Other,225% of Medicaid,72.64,,,72.64,Other,250% of Medicaid,90.53,,,90.53,Other,324% of Medicaid,60.07,,,60.07,Other,215% of Medicaid,60.07,,,60.07,Other,215% of Medicaid,34.93,,,34.93,Other,125% of Medicaid,0.01,261.1,
ASSAY OF ESTROGENS,82671,CPT,,78082671,CDM,301,RC,,,both,,,504,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,97.22,,,97.22,Fee Schedule,,87.53,,,87.53,Fee Schedule,,249.07,,,249.07,Fee Schedule,,224.07,,,224.07,Fee Schedule,,211.8,,,211.8,Fee Schedule,,352.8,70,,352.8,percent of total billed charges,All Other,101.75,,,101.75,Fee Schedule,,76,,,76,Other,186% of Medicaid,119.83,,,119.83,Fee Schedule,,312.48,,,312.48,Fee Schedule,,67.83,,,,Fee Schedule,,119.83,,,119.83,Fee Schedule,,312.48,,,312.48,Fee Schedule,,127.59,,,127.59,Fee Schedule,,352.8,70,,352.8,percent of total billed charges,,153.07,,,153.07,Fee Schedule,,129.74,,,129.74,Fee Schedule,,48.45,,,48.45,Fee Schedule,,48.45,,,48.45,Fee Schedule,,48.45,,,48.45,Fee Schedule,,48.45,,,48.45,Fee Schedule,,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,62.76,,,62.76,Other,153% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,57.43,,,57.43,Other,140% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,106.65,,,106.65,Other,250% of Medicaid,132.9,,,132.9,Other,324% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,51.27,,,51.27,Other,125% of Medicaid,0.01,352.8,
ASSAY OF ESTROGEN,82672,CPT,,78082672,CDM,301,RC,,,both,,,352,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,65.32,,,65.32,Fee Schedule,,58.81,,,58.81,Fee Schedule,,167.3,,,167.3,Fee Schedule,,150.51,,,150.51,Fee Schedule,,142.27,,,142.27,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,All Other,68.36,,,68.36,Fee Schedule,,40,,,40,Other,186% of Medicaid,80.51,,,80.51,Fee Schedule,,218.24,,,218.24,Fee Schedule,,45.57,,,,Fee Schedule,,80.51,,,80.51,Fee Schedule,,218.24,,,218.24,Fee Schedule,,85.72,,,85.72,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,,102.84,,,102.84,Fee Schedule,,87.16,,,87.16,Fee Schedule,,32.55,,,32.55,Fee Schedule,,32.55,,,32.55,Fee Schedule,,32.55,,,32.55,Fee Schedule,,32.55,,,32.55,Fee Schedule,,21.7,,,21.7,Other,100% of Medicaid,21.7,,,21.7,Other,100% of Medicaid,21.7,,,21.7,Other,100% of Medicaid,21.7,,,21.7,Other,100% of Medicaid,48.83,,,48.83,Other,225% of Medicaid,33.2,,,33.2,Other,153% of Medicaid,48.83,,,48.83,Other,225% of Medicaid,30.38,,,30.38,Other,140% of Medicaid,48.83,,,48.83,Other,225% of Medicaid,56.42,,,56.42,Other,250% of Medicaid,70.31,,,70.31,Other,324% of Medicaid,46.66,,,46.66,Other,215% of Medicaid,46.66,,,46.66,Other,215% of Medicaid,27.13,,,27.13,Other,125% of Medicaid,0.01,246.4,
ASSAY OF ESTRIOL,82677,CPT,,78082677,CDM,301,RC,,,both,,,213,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,72.78,,,72.78,Fee Schedule,,65.53,,,65.53,Fee Schedule,,186.48,,,186.48,Fee Schedule,,167.77,,,167.77,Fee Schedule,,158.58,,,158.58,Fee Schedule,,149.1,70,,149.1,percent of total billed charges,All Other,76.17,,,76.17,Fee Schedule,,33,,,33,Other,186% of Medicaid,89.71,,,89.71,Fee Schedule,,132.06,,,132.06,Fee Schedule,,50.78,,,,Fee Schedule,,89.71,,,89.71,Fee Schedule,,132.06,,,132.06,Fee Schedule,,95.51,,,95.51,Fee Schedule,,149.1,70,,149.1,percent of total billed charges,,114.59,,,114.59,Fee Schedule,,97.12,,,97.12,Fee Schedule,,36.27,,,36.27,Fee Schedule,,36.27,,,36.27,Fee Schedule,,36.27,,,36.27,Fee Schedule,,36.27,,,36.27,Fee Schedule,,17.68,,,17.68,Other,100% of Medicaid,17.68,,,17.68,Other,100% of Medicaid,17.68,,,17.68,Other,100% of Medicaid,17.68,,,17.68,Other,100% of Medicaid,39.77,,,39.77,Other,225% of Medicaid,27.04,,,27.04,Other,153% of Medicaid,39.77,,,39.77,Other,225% of Medicaid,24.75,,,24.75,Other,140% of Medicaid,39.77,,,39.77,Other,225% of Medicaid,45.96,,,45.96,Other,250% of Medicaid,57.27,,,57.27,Other,324% of Medicaid,38,,,38,Other,215% of Medicaid,38,,,38,Other,215% of Medicaid,22.09,,,22.09,Other,125% of Medicaid,0.01,186.48,
ASSAY OF ESTRONE,82679,CPT,,78082679,CDM,301,RC,,,both,,,280,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,75.1,,,75.1,Fee Schedule,,67.61,,,67.61,Fee Schedule,,192.46,,,192.46,Fee Schedule,,173.14,,,173.14,Fee Schedule,,163.66,,,163.66,Fee Schedule,,196,70,,196,percent of total billed charges,All Other,78.59,,,78.59,Fee Schedule,,46,,,46,Other,186% of Medicaid,92.56,,,92.56,Fee Schedule,,173.6,,,173.6,Fee Schedule,,52.4,,,,Fee Schedule,,92.56,,,92.56,Fee Schedule,,173.6,,,173.6,Fee Schedule,,98.55,,,98.55,Fee Schedule,,196,70,,196,percent of total billed charges,,118.24,,,118.24,Fee Schedule,,100.21,,,100.21,Fee Schedule,,37.43,,,37.43,Fee Schedule,,37.43,,,37.43,Fee Schedule,,37.43,,,37.43,Fee Schedule,,37.43,,,37.43,Fee Schedule,,24.95,,,24.95,Other,100% of Medicaid,24.95,,,24.95,Other,100% of Medicaid,24.95,,,24.95,Other,100% of Medicaid,24.95,,,24.95,Other,100% of Medicaid,56.14,,,56.14,Other,225% of Medicaid,38.17,,,38.17,Other,153% of Medicaid,56.14,,,56.14,Other,225% of Medicaid,34.93,,,34.93,Other,140% of Medicaid,56.14,,,56.14,Other,225% of Medicaid,64.87,,,64.87,Other,250% of Medicaid,80.84,,,80.84,Other,324% of Medicaid,53.64,,,53.64,Other,215% of Medicaid,53.64,,,53.64,Other,215% of Medicaid,31.19,,,31.19,Other,125% of Medicaid,0.01,196,
ASSAY OF ETHYLENE GLYCOL,82693,CPT,,78082693,CDM,301,RC,,,both,,,210,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,44.85,,,44.85,Fee Schedule,,40.38,,,40.38,Fee Schedule,,114.86,,,114.86,Fee Schedule,,103.33,,,103.33,Fee Schedule,,97.67,,,97.67,Fee Schedule,,147,70,,147,percent of total billed charges,All Other,46.94,,,46.94,Fee Schedule,,47,,,47,Other,186% of Medicaid,55.28,,,55.28,Fee Schedule,,130.2,,,130.2,Fee Schedule,,31.29,,,,Fee Schedule,,55.28,,,55.28,Fee Schedule,,130.2,,,130.2,Fee Schedule,,58.86,,,58.86,Fee Schedule,,147,70,,147,percent of total billed charges,,70.61,,,70.61,Fee Schedule,,59.85,,,59.85,Fee Schedule,,22.35,,,22.35,Fee Schedule,,22.35,,,22.35,Fee Schedule,,22.35,,,22.35,Fee Schedule,,22.35,,,22.35,Fee Schedule,,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,38.73,,,38.73,Other,153% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,35.44,,,35.44,Other,140% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,65.82,,,65.82,Other,250% of Medicaid,82.02,,,82.02,Other,324% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,31.64,,,31.64,Other,125% of Medicaid,0.01,147,
FATS/LIPIDS FECES QUAL,82705,CPT,,78082705,CDM,301,RC,,,both,,,87,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.35,,,15.35,Fee Schedule,,13.82,,,13.82,Fee Schedule,,39.24,,,39.24,Fee Schedule,,35.3,,,35.3,Fee Schedule,,33.37,,,33.37,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,All Other,16.07,,,16.07,Fee Schedule,,9,,,9,Other,186% of Medicaid,18.92,,,18.92,Fee Schedule,,53.94,,,53.94,Fee Schedule,,10.71,,,,Fee Schedule,,18.92,,,18.92,Fee Schedule,,53.94,,,53.94,Fee Schedule,,20.15,,,20.15,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,,24.17,,,24.17,Fee Schedule,,20.48,,,20.48,Fee Schedule,,7.65,,,7.65,Fee Schedule,,7.65,,,7.65,Fee Schedule,,7.65,,,7.65,Fee Schedule,,7.65,,,7.65,Fee Schedule,,5.1,,,5.1,Other,100% of Medicaid,5.1,,,5.1,Other,100% of Medicaid,5.1,,,5.1,Other,100% of Medicaid,5.1,,,5.1,Other,100% of Medicaid,11.48,,,11.48,Other,225% of Medicaid,7.8,,,7.8,Other,153% of Medicaid,11.48,,,11.48,Other,225% of Medicaid,7.14,,,7.14,Other,140% of Medicaid,11.48,,,11.48,Other,225% of Medicaid,13.26,,,13.26,Other,250% of Medicaid,16.52,,,16.52,Other,324% of Medicaid,10.97,,,10.97,Other,215% of Medicaid,10.97,,,10.97,Other,215% of Medicaid,6.38,,,6.38,Other,125% of Medicaid,0.01,60.9,
FATS/LIPIDS FECES QUANT,82710,CPT,,78082710,CDM,301,RC,,,both,,,239,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.57,,,50.57,Fee Schedule,,45.53,,,45.53,Fee Schedule,,129.55,,,129.55,Fee Schedule,,116.55,,,116.55,Fee Schedule,,110.16,,,110.16,Fee Schedule,,167.3,70,,167.3,percent of total billed charges,All Other,52.92,,,52.92,Fee Schedule,,31,,,31,Other,186% of Medicaid,62.33,,,62.33,Fee Schedule,,148.18,,,148.18,Fee Schedule,,35.28,,,,Fee Schedule,,62.33,,,62.33,Fee Schedule,,148.18,,,148.18,Fee Schedule,,66.36,,,66.36,Fee Schedule,,167.3,70,,167.3,percent of total billed charges,,79.62,,,79.62,Fee Schedule,,67.48,,,67.48,Fee Schedule,,25.2,,,25.2,Fee Schedule,,25.2,,,25.2,Fee Schedule,,25.2,,,25.2,Fee Schedule,,25.2,,,25.2,Fee Schedule,,16.8,,,16.8,Other,100% of Medicaid,16.8,,,16.8,Other,100% of Medicaid,16.8,,,16.8,Other,100% of Medicaid,16.8,,,16.8,Other,100% of Medicaid,37.8,,,37.8,Other,225% of Medicaid,25.7,,,25.7,Other,153% of Medicaid,37.8,,,37.8,Other,225% of Medicaid,23.52,,,23.52,Other,140% of Medicaid,37.8,,,37.8,Other,225% of Medicaid,43.68,,,43.68,Other,250% of Medicaid,54.43,,,54.43,Other,324% of Medicaid,36.12,,,36.12,Other,215% of Medicaid,36.12,,,36.12,Other,215% of Medicaid,21,,,21,Other,125% of Medicaid,0.01,167.3,
Fatty Acids Nonesterified,82725,CPT,,78082725,CDM,301,RC,,,both,,,350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,56.5,,,56.5,Fee Schedule,,50.87,,,50.87,Fee Schedule,,102.7,,,102.7,Fee Schedule,,92.39,,,92.39,Fee Schedule,,87.33,,,87.33,Fee Schedule,,245,70,,245,percent of total billed charges,All Other,59.13,,,59.13,Fee Schedule,,33,,,33,Other,186% of Medicaid,69.64,,,69.64,Fee Schedule,,217,,,217,Fee Schedule,,39.42,,,,Fee Schedule,,69.64,,,69.64,Fee Schedule,,217,,,217,Fee Schedule,,74.14,,,74.14,Fee Schedule,,245,70,,245,percent of total billed charges,,88.95,,,88.95,Fee Schedule,,75.39,,,75.39,Fee Schedule,,28.16,,,28.16,Fee Schedule,,28.16,,,28.16,Fee Schedule,,28.16,,,28.16,Fee Schedule,,28.16,,,28.16,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,245,
LONG CHAIN FATTY ACIDS,82726,CPT,,78082726,CDM,301,RC,,,both,,,63,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,59.45,,,59.45,Fee Schedule,,53.52,,,53.52,Fee Schedule,,139.25,,,139.25,Fee Schedule,,125.27,,,125.27,Fee Schedule,,118.41,,,118.41,Fee Schedule,,44.1,70,,44.1,percent of total billed charges,All Other,62.21,,,62.21,Fee Schedule,,37,,,37,Other,186% of Medicaid,73.27,,,73.27,Fee Schedule,,39.06,,,39.06,Fee Schedule,,41.48,,,,Fee Schedule,,73.27,,,73.27,Fee Schedule,,39.06,,,39.06,Fee Schedule,,78.01,,,78.01,Fee Schedule,,44.1,70,,44.1,percent of total billed charges,,93.6,,,93.6,Fee Schedule,,79.33,,,79.33,Fee Schedule,,29.63,,,29.63,Fee Schedule,,29.63,,,29.63,Fee Schedule,,29.63,,,29.63,Fee Schedule,,29.63,,,29.63,Fee Schedule,,19.75,,,19.75,Other,100% of Medicaid,19.75,,,19.75,Other,100% of Medicaid,19.75,,,19.75,Other,100% of Medicaid,19.75,,,19.75,Other,100% of Medicaid,44.44,,,44.44,Other,225% of Medicaid,30.22,,,30.22,Other,153% of Medicaid,44.44,,,44.44,Other,225% of Medicaid,27.65,,,27.65,Other,140% of Medicaid,44.44,,,44.44,Other,225% of Medicaid,51.35,,,51.35,Other,250% of Medicaid,63.99,,,63.99,Other,324% of Medicaid,42.46,,,42.46,Other,215% of Medicaid,42.46,,,42.46,Other,215% of Medicaid,24.69,,,24.69,Other,125% of Medicaid,0.01,139.25,
ASSAY OF FERRITIN,82728,CPT,,78082728,CDM,301,RC,,,both,,,196,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.03,,,41.03,Fee Schedule,,36.94,,,36.94,Fee Schedule,,105.05,,,105.05,Fee Schedule,,94.51,,,94.51,Fee Schedule,,89.33,,,89.33,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,All Other,42.93,,,42.93,Fee Schedule,,25,,,25,Other,186% of Medicaid,50.57,,,50.57,Fee Schedule,,121.52,,,121.52,Fee Schedule,,28.62,,,,Fee Schedule,,50.57,,,50.57,Fee Schedule,,121.52,,,121.52,Fee Schedule,,53.84,,,53.84,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,,64.59,,,64.59,Fee Schedule,,54.75,,,54.75,Fee Schedule,,20.45,,,20.45,Fee Schedule,,20.45,,,20.45,Fee Schedule,,20.45,,,20.45,Fee Schedule,,20.45,,,20.45,Fee Schedule,,13.63,,,13.63,Other,100% of Medicaid,13.63,,,13.63,Other,100% of Medicaid,13.63,,,13.63,Other,100% of Medicaid,13.63,,,13.63,Other,100% of Medicaid,30.67,,,30.67,Other,225% of Medicaid,20.85,,,20.85,Other,153% of Medicaid,30.67,,,30.67,Other,225% of Medicaid,19.08,,,19.08,Other,140% of Medicaid,30.67,,,30.67,Other,225% of Medicaid,35.44,,,35.44,Other,250% of Medicaid,44.16,,,44.16,Other,324% of Medicaid,29.3,,,29.3,Other,215% of Medicaid,29.3,,,29.3,Other,215% of Medicaid,17.04,,,17.04,Other,125% of Medicaid,0.01,137.2,
ASSAY OF FETAL FIBRONECTIN,82731,CPT,,78082731,CDM,301,RC,,,both,,,204,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,193.87,,,193.87,Fee Schedule,,174.55,,,174.55,Fee Schedule,,485.14,,,485.14,Fee Schedule,,436.45,,,436.45,Fee Schedule,,412.55,,,412.55,Fee Schedule,,142.8,70,,142.8,percent of total billed charges,All Other,202.89,,,202.89,Fee Schedule,,120,,,120,Other,186% of Medicaid,238.96,,,238.96,Fee Schedule,,126.48,,,126.48,Fee Schedule,,135.26,,,,Fee Schedule,,238.96,,,238.96,Fee Schedule,,126.48,,,126.48,Fee Schedule,,254.42,,,254.42,Fee Schedule,,142.8,70,,142.8,percent of total billed charges,,305.24,,,305.24,Fee Schedule,,258.71,,,258.71,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,98.55,,,98.55,Other,153% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,90.17,,,90.17,Other,140% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,167.47,,,167.47,Other,250% of Medicaid,208.69,,,208.69,Other,324% of Medicaid,138.48,,,138.48,Other,215% of Medicaid,138.48,,,138.48,Other,215% of Medicaid,80.51,,,80.51,Other,125% of Medicaid,0.01,485.14,
BLOOD FOLIC ACID SERUM,82746,CPT,,78082746,CDM,301,RC,,,both,,,197,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,44.25,,,44.25,Fee Schedule,,39.84,,,39.84,Fee Schedule,,113.38,,,113.38,Fee Schedule,,102,,,102,Fee Schedule,,96.42,,,96.42,Fee Schedule,,137.9,70,,137.9,percent of total billed charges,All Other,46.31,,,46.31,Fee Schedule,,23,,,23,Other,186% of Medicaid,54.54,,,54.54,Fee Schedule,,122.14,,,122.14,Fee Schedule,,30.87,,,,Fee Schedule,,54.54,,,54.54,Fee Schedule,,122.14,,,122.14,Fee Schedule,,58.07,,,58.07,Fee Schedule,,137.9,70,,137.9,percent of total billed charges,,69.66,,,69.66,Fee Schedule,,59.04,,,59.04,Fee Schedule,,22.05,,,22.05,Fee Schedule,,22.05,,,22.05,Fee Schedule,,22.05,,,22.05,Fee Schedule,,22.05,,,22.05,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,137.9,
ASSAY OF FOLIC ACID RBC,82747,CPT,,78082747,CDM,301,RC,,,both,,,298,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.13,,,53.13,Fee Schedule,,47.83,,,47.83,Fee Schedule,,89.76,,,89.76,Fee Schedule,,80.75,,,80.75,Fee Schedule,,76.33,,,76.33,Fee Schedule,,208.6,70,,208.6,percent of total billed charges,All Other,55.6,,,55.6,Fee Schedule,,23,,,23,Other,186% of Medicaid,65.48,,,65.48,Fee Schedule,,184.76,,,184.76,Fee Schedule,,37.07,,,,Fee Schedule,,65.48,,,65.48,Fee Schedule,,184.76,,,184.76,Fee Schedule,,69.72,,,69.72,Fee Schedule,,208.6,70,,208.6,percent of total billed charges,,83.64,,,83.64,Fee Schedule,,70.89,,,70.89,Fee Schedule,,26.48,,,26.48,Fee Schedule,,26.48,,,26.48,Fee Schedule,,26.48,,,26.48,Fee Schedule,,26.48,,,26.48,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,208.6,
ASSAY OF SEMEN FRUCTOSE,82757,CPT,,78082757,CDM,301,RC,,,both,,,37,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.19,,,52.19,Fee Schedule,,46.99,,,46.99,Fee Schedule,,133.77,,,133.77,Fee Schedule,,120.34,,,120.34,Fee Schedule,,113.75,,,113.75,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,All Other,54.62,,,54.62,Fee Schedule,,33,,,33,Other,186% of Medicaid,64.33,,,64.33,Fee Schedule,,22.94,,,22.94,Fee Schedule,,36.41,,,,Fee Schedule,,64.33,,,64.33,Fee Schedule,,22.94,,,22.94,Fee Schedule,,68.49,,,68.49,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,,82.17,,,82.17,Fee Schedule,,69.65,,,69.65,Fee Schedule,,26.01,,,26.01,Fee Schedule,,26.01,,,26.01,Fee Schedule,,26.01,,,26.01,Fee Schedule,,26.01,,,26.01,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,133.77,
ASSAY GALACTOSE TRANSFERASE,82775,CPT,,78082775,CDM,301,RC,,,both,,,68,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,63.42,,,63.42,Fee Schedule,,57.1,,,57.1,Fee Schedule,,162.43,,,162.43,Fee Schedule,,146.13,,,146.13,Fee Schedule,,138.12,,,138.12,Fee Schedule,,47.6,70,,47.6,percent of total billed charges,All Other,66.37,,,66.37,Fee Schedule,,39,,,39,Other,186% of Medicaid,78.17,,,78.17,Fee Schedule,,42.16,,,42.16,Fee Schedule,,44.25,,,,Fee Schedule,,78.17,,,78.17,Fee Schedule,,42.16,,,42.16,Fee Schedule,,83.23,,,83.23,Fee Schedule,,47.6,70,,47.6,percent of total billed charges,,99.85,,,99.85,Fee Schedule,,84.63,,,84.63,Fee Schedule,,31.61,,,31.61,Fee Schedule,,31.61,,,31.61,Fee Schedule,,31.61,,,31.61,Fee Schedule,,31.61,,,31.61,Fee Schedule,,21.07,,,21.07,Other,100% of Medicaid,21.07,,,21.07,Other,100% of Medicaid,21.07,,,21.07,Other,100% of Medicaid,21.07,,,21.07,Other,100% of Medicaid,47.41,,,47.41,Other,225% of Medicaid,32.24,,,32.24,Other,153% of Medicaid,47.41,,,47.41,Other,225% of Medicaid,29.5,,,29.5,Other,140% of Medicaid,47.41,,,47.41,Other,225% of Medicaid,54.78,,,54.78,Other,250% of Medicaid,68.27,,,68.27,Other,324% of Medicaid,45.3,,,45.3,Other,215% of Medicaid,45.3,,,45.3,Other,215% of Medicaid,26.34,,,26.34,Other,125% of Medicaid,0.01,162.43,
GALECTIN-3,82777,CPT,,78082777,CDM,301,RC,,,both,,,140,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,133.19,,,133.19,Fee Schedule,,119.92,,,119.92,Fee Schedule,,7.12,,,7.12,Fee Schedule,,7.12,,,7.12,Fee Schedule,,7.12,,,7.12,Fee Schedule,,98,70,,98,percent of total billed charges,All Other,139.39,,,139.39,Fee Schedule,,73,,,73,Other,186% of Medicaid,164.17,,,164.17,Fee Schedule,,86.8,,,86.8,Fee Schedule,,92.93,,,,Fee Schedule,,164.17,,,164.17,Fee Schedule,,86.8,,,86.8,Fee Schedule,,174.79,,,174.79,Fee Schedule,,98,70,,98,percent of total billed charges,,209.7,,,209.7,Fee Schedule,,177.74,,,177.74,Fee Schedule,,66.38,,,66.38,Fee Schedule,,66.38,,,66.38,Fee Schedule,,66.38,,,66.38,Fee Schedule,,66.38,,,66.38,Fee Schedule,,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,59.9,,,59.9,Other,153% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,54.81,,,54.81,Other,140% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,101.8,,,101.8,Other,250% of Medicaid,126.86,,,126.86,Other,324% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,48.94,,,48.94,Other,125% of Medicaid,0.01,209.7,
ASSAY OF IGE,82785,CPT,TC,85082785,CDM,301,RC,,,both,,,237,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.54,,,49.54,Fee Schedule,,44.61,,,44.61,Fee Schedule,,127.03,,,127.03,Fee Schedule,,114.28,,,114.28,Fee Schedule,,108.02,,,108.02,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,51.85,,,51.85,Fee Schedule,,23,,,23,Other,186% of Medicaid,61.07,,,61.07,Fee Schedule,,146.94,,,146.94,Fee Schedule,,34.57,,,,Fee Schedule,,61.07,,,61.07,Fee Schedule,,146.94,,,146.94,Fee Schedule,,65.02,,,65.02,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,78,,,78,Fee Schedule,,66.11,,,66.11,Fee Schedule,,24.69,,,24.69,Fee Schedule,,24.69,,,24.69,Fee Schedule,,24.69,,,24.69,Fee Schedule,,24.69,,,24.69,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,165.9,
BLOOD GASES CALCULATED O2,82803,CPT,,71082803,CDM,301,RC,,,both,,,377,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,78.47,,,78.47,Fee Schedule,,70.65,,,70.65,Fee Schedule,,149.17,,,149.17,Fee Schedule,,134.19,,,134.19,Fee Schedule,,126.85,,,126.85,Fee Schedule,,263.9,70,,263.9,percent of total billed charges,All Other,82.12,,,82.12,Fee Schedule,,30,,,30,Other,186% of Medicaid,96.72,,,96.72,Fee Schedule,,233.74,,,233.74,Fee Schedule,,54.75,,,,Fee Schedule,,96.72,,,96.72,Fee Schedule,,233.74,,,233.74,Fee Schedule,,102.98,,,102.98,Fee Schedule,,263.9,70,,263.9,percent of total billed charges,,123.55,,,123.55,Fee Schedule,,104.71,,,104.71,Fee Schedule,,39.11,,,39.11,Fee Schedule,,39.11,,,39.11,Fee Schedule,,39.11,,,39.11,Fee Schedule,,39.11,,,39.11,Fee Schedule,,16.36,,,16.36,Other,100% of Medicaid,16.36,,,16.36,Other,100% of Medicaid,16.36,,,16.36,Other,100% of Medicaid,16.36,,,16.36,Other,100% of Medicaid,36.81,,,36.81,Other,225% of Medicaid,25.03,,,25.03,Other,153% of Medicaid,36.81,,,36.81,Other,225% of Medicaid,22.91,,,22.91,Other,140% of Medicaid,36.81,,,36.81,Other,225% of Medicaid,42.54,,,42.54,Other,250% of Medicaid,53.01,,,53.01,Other,324% of Medicaid,35.18,,,35.18,Other,215% of Medicaid,35.18,,,35.18,Other,215% of Medicaid,20.45,,,20.45,Other,125% of Medicaid,0.01,263.9,
BLOOD GAS MIXED WO O2 SAT,82803,CPT,,78082803,CDM,301,RC,,,both,,,377,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,78.47,,,78.47,Fee Schedule,,70.65,,,70.65,Fee Schedule,,149.17,,,149.17,Fee Schedule,,134.19,,,134.19,Fee Schedule,,126.85,,,126.85,Fee Schedule,,263.9,70,,263.9,percent of total billed charges,All Other,82.12,,,82.12,Fee Schedule,,30,,,30,Other,186% of Medicaid,96.72,,,96.72,Fee Schedule,,233.74,,,233.74,Fee Schedule,,54.75,,,,Fee Schedule,,96.72,,,96.72,Fee Schedule,,233.74,,,233.74,Fee Schedule,,102.98,,,102.98,Fee Schedule,,263.9,70,,263.9,percent of total billed charges,,123.55,,,123.55,Fee Schedule,,104.71,,,104.71,Fee Schedule,,39.11,,,39.11,Fee Schedule,,39.11,,,39.11,Fee Schedule,,39.11,,,39.11,Fee Schedule,,39.11,,,39.11,Fee Schedule,,16.36,,,16.36,Other,100% of Medicaid,16.36,,,16.36,Other,100% of Medicaid,16.36,,,16.36,Other,100% of Medicaid,16.36,,,16.36,Other,100% of Medicaid,36.81,,,36.81,Other,225% of Medicaid,25.03,,,25.03,Other,153% of Medicaid,36.81,,,36.81,Other,225% of Medicaid,22.91,,,22.91,Other,140% of Medicaid,36.81,,,36.81,Other,225% of Medicaid,42.54,,,42.54,Other,250% of Medicaid,53.01,,,53.01,Other,324% of Medicaid,35.18,,,35.18,Other,215% of Medicaid,35.18,,,35.18,Other,215% of Medicaid,20.45,,,20.45,Other,125% of Medicaid,0.01,263.9,
BLOOD GASES W/O2 SATURATION,82805,CPT,,71082805,CDM,301,RC,,,both,,,294,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,237.1,,,237.1,Fee Schedule,,213.47,,,213.47,Fee Schedule,,218.87,,,218.87,Fee Schedule,,196.9,,,196.9,Fee Schedule,,186.12,,,186.12,Fee Schedule,,205.8,70,,205.8,percent of total billed charges,All Other,248.13,,,248.13,Fee Schedule,,45,,,45,Other,186% of Medicaid,292.24,,,292.24,Fee Schedule,,182.28,,,182.28,Fee Schedule,,165.42,,,,Fee Schedule,,292.24,,,292.24,Fee Schedule,,182.28,,,182.28,Fee Schedule,,311.14,,,311.14,Fee Schedule,,205.8,70,,205.8,percent of total billed charges,,373.29,,,373.29,Fee Schedule,,316.39,,,316.39,Fee Schedule,,118.16,,,118.16,Fee Schedule,,118.16,,,118.16,Fee Schedule,,118.16,,,118.16,Fee Schedule,,118.16,,,118.16,Fee Schedule,,24.13,,,24.13,Other,100% of Medicaid,24.13,,,24.13,Other,100% of Medicaid,24.13,,,24.13,Other,100% of Medicaid,24.13,,,24.13,Other,100% of Medicaid,54.29,,,54.29,Other,225% of Medicaid,36.92,,,36.92,Other,153% of Medicaid,54.29,,,54.29,Other,225% of Medicaid,33.78,,,33.78,Other,140% of Medicaid,54.29,,,54.29,Other,225% of Medicaid,62.74,,,62.74,Other,250% of Medicaid,78.18,,,78.18,Other,324% of Medicaid,51.88,,,51.88,Other,215% of Medicaid,51.88,,,51.88,Other,215% of Medicaid,30.16,,,30.16,Other,125% of Medicaid,0.01,373.29,
BLOOD GASES W/O2 SATURATION,82805,CPT,,78082805,CDM,301,RC,,,both,,,294,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,237.1,,,237.1,Fee Schedule,,213.47,,,213.47,Fee Schedule,,218.87,,,218.87,Fee Schedule,,196.9,,,196.9,Fee Schedule,,186.12,,,186.12,Fee Schedule,,205.8,70,,205.8,percent of total billed charges,All Other,248.13,,,248.13,Fee Schedule,,45,,,45,Other,186% of Medicaid,292.24,,,292.24,Fee Schedule,,182.28,,,182.28,Fee Schedule,,165.42,,,,Fee Schedule,,292.24,,,292.24,Fee Schedule,,182.28,,,182.28,Fee Schedule,,311.14,,,311.14,Fee Schedule,,205.8,70,,205.8,percent of total billed charges,,373.29,,,373.29,Fee Schedule,,316.39,,,316.39,Fee Schedule,,118.16,,,118.16,Fee Schedule,,118.16,,,118.16,Fee Schedule,,118.16,,,118.16,Fee Schedule,,118.16,,,118.16,Fee Schedule,,24.13,,,24.13,Other,100% of Medicaid,24.13,,,24.13,Other,100% of Medicaid,24.13,,,24.13,Other,100% of Medicaid,24.13,,,24.13,Other,100% of Medicaid,54.29,,,54.29,Other,225% of Medicaid,36.92,,,36.92,Other,153% of Medicaid,54.29,,,54.29,Other,225% of Medicaid,33.78,,,33.78,Other,140% of Medicaid,54.29,,,54.29,Other,225% of Medicaid,62.74,,,62.74,Other,250% of Medicaid,78.18,,,78.18,Other,324% of Medicaid,51.88,,,51.88,Other,215% of Medicaid,51.88,,,51.88,Other,215% of Medicaid,30.16,,,30.16,Other,125% of Medicaid,0.01,373.29,
GASTRIC ANALY W/PH EA SPEC,82930,CPT,,78082930,CDM,301,RC,,,both,,,92,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.2,,,20.2,Fee Schedule,,18.18,,,18.18,Fee Schedule,,42.03,,,42.03,Fee Schedule,,37.81,,,37.81,Fee Schedule,,35.74,,,35.74,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,All Other,21.14,,,21.14,Fee Schedule,,26,,,26,Other,186% of Medicaid,24.89,,,24.89,Fee Schedule,,57.04,,,57.04,Fee Schedule,,14.09,,,,Fee Schedule,,24.89,,,24.89,Fee Schedule,,57.04,,,57.04,Fee Schedule,,26.5,,,26.5,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,,31.8,,,31.8,Fee Schedule,,26.95,,,26.95,Fee Schedule,,10.07,,,10.07,Fee Schedule,,10.07,,,10.07,Fee Schedule,,10.07,,,10.07,Fee Schedule,,10.07,,,10.07,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,64.4,
ASSAY OF GASTRIN,82941,CPT,,78082941,CDM,301,RC,,,both,,,207,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.07,,,53.07,Fee Schedule,,47.78,,,47.78,Fee Schedule,,136.01,,,136.01,Fee Schedule,,122.36,,,122.36,Fee Schedule,,115.66,,,115.66,Fee Schedule,,144.9,70,,144.9,percent of total billed charges,All Other,55.53,,,55.53,Fee Schedule,,33,,,33,Other,186% of Medicaid,65.41,,,65.41,Fee Schedule,,128.34,,,128.34,Fee Schedule,,37.02,,,,Fee Schedule,,65.41,,,65.41,Fee Schedule,,128.34,,,128.34,Fee Schedule,,69.64,,,69.64,Fee Schedule,,144.9,70,,144.9,percent of total billed charges,,83.55,,,83.55,Fee Schedule,,70.81,,,70.81,Fee Schedule,,26.45,,,26.45,Fee Schedule,,26.45,,,26.45,Fee Schedule,,26.45,,,26.45,Fee Schedule,,26.45,,,26.45,Fee Schedule,,17.63,,,17.63,Other,100% of Medicaid,17.63,,,17.63,Other,100% of Medicaid,17.63,,,17.63,Other,100% of Medicaid,17.63,,,17.63,Other,100% of Medicaid,39.67,,,39.67,Other,225% of Medicaid,26.97,,,26.97,Other,153% of Medicaid,39.67,,,39.67,Other,225% of Medicaid,24.68,,,24.68,Other,140% of Medicaid,39.67,,,39.67,Other,225% of Medicaid,45.84,,,45.84,Other,250% of Medicaid,57.12,,,57.12,Other,324% of Medicaid,37.9,,,37.9,Other,215% of Medicaid,37.9,,,37.9,Other,215% of Medicaid,22.04,,,22.04,Other,125% of Medicaid,0.01,144.9,
ASSAY OF GLUCAGON,82943,CPT,,78082943,CDM,301,RC,,,both,,,264,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.01,,,43.01,Fee Schedule,,38.73,,,38.73,Fee Schedule,,110.2,,,110.2,Fee Schedule,,99.14,,,99.14,Fee Schedule,,93.71,,,93.71,Fee Schedule,,184.8,70,,184.8,percent of total billed charges,All Other,45.01,,,45.01,Fee Schedule,,27,,,27,Other,186% of Medicaid,53.02,,,53.02,Fee Schedule,,163.68,,,163.68,Fee Schedule,,30.01,,,,Fee Schedule,,53.02,,,53.02,Fee Schedule,,163.68,,,163.68,Fee Schedule,,56.45,,,56.45,Fee Schedule,,184.8,70,,184.8,percent of total billed charges,,67.72,,,67.72,Fee Schedule,,57.4,,,57.4,Fee Schedule,,21.44,,,21.44,Fee Schedule,,21.44,,,21.44,Fee Schedule,,21.44,,,21.44,Fee Schedule,,21.44,,,21.44,Fee Schedule,,14.29,,,14.29,Other,100% of Medicaid,14.29,,,14.29,Other,100% of Medicaid,14.29,,,14.29,Other,100% of Medicaid,14.29,,,14.29,Other,100% of Medicaid,32.15,,,32.15,Other,225% of Medicaid,21.86,,,21.86,Other,153% of Medicaid,32.15,,,32.15,Other,225% of Medicaid,20.01,,,20.01,Other,140% of Medicaid,32.15,,,32.15,Other,225% of Medicaid,37.15,,,37.15,Other,250% of Medicaid,46.3,,,46.3,Other,324% of Medicaid,30.72,,,30.72,Other,215% of Medicaid,30.72,,,30.72,Other,215% of Medicaid,17.86,,,17.86,Other,125% of Medicaid,0.01,184.8,
GLUCOSE OTHER FLUID,82945,CPT,,78082945,CDM,301,RC,,,both,,,55,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,11.83,,,11.83,Fee Schedule,,10.65,,,10.65,Fee Schedule,,30.25,,,30.25,Fee Schedule,,27.21,,,27.21,Fee Schedule,,25.72,,,25.72,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,All Other,12.38,,,12.38,Fee Schedule,,7,,,7,Other,186% of Medicaid,14.58,,,14.58,Fee Schedule,,34.1,,,34.1,Fee Schedule,,8.25,,,,Fee Schedule,,14.58,,,14.58,Fee Schedule,,34.1,,,34.1,Fee Schedule,,15.52,,,15.52,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,,18.62,,,18.62,Fee Schedule,,15.79,,,15.79,Fee Schedule,,5.9,,,5.9,Fee Schedule,,5.9,,,5.9,Fee Schedule,,5.9,,,5.9,Fee Schedule,,5.9,,,5.9,Fee Schedule,,3.93,,,3.93,Other,100% of Medicaid,3.93,,,3.93,Other,100% of Medicaid,3.93,,,3.93,Other,100% of Medicaid,3.93,,,3.93,Other,100% of Medicaid,8.84,,,8.84,Other,225% of Medicaid,6.01,,,6.01,Other,153% of Medicaid,8.84,,,8.84,Other,225% of Medicaid,5.5,,,5.5,Other,140% of Medicaid,8.84,,,8.84,Other,225% of Medicaid,10.22,,,10.22,Other,250% of Medicaid,12.73,,,12.73,Other,324% of Medicaid,8.45,,,8.45,Other,215% of Medicaid,8.45,,,8.45,Other,215% of Medicaid,4.91,,,4.91,Other,125% of Medicaid,0.01,38.5,
ASSAY GLUCOSE BLOOD QUANT,82947,CPT,,78082947,CDM,301,RC,,,both,,,84,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,11.83,,,11.83,Fee Schedule,,10.65,,,10.65,Fee Schedule,,30.25,,,30.25,Fee Schedule,,27.21,,,27.21,Fee Schedule,,25.72,,,25.72,Fee Schedule,,58.8,70,,58.8,percent of total billed charges,All Other,12.38,,,12.38,Fee Schedule,,7,,,7,Other,186% of Medicaid,14.58,,,14.58,Fee Schedule,,52.08,,,52.08,Fee Schedule,,8.25,,,,Fee Schedule,,14.58,,,14.58,Fee Schedule,,52.08,,,52.08,Fee Schedule,,15.52,,,15.52,Fee Schedule,,58.8,70,,58.8,percent of total billed charges,,18.62,,,18.62,Fee Schedule,,15.79,,,15.79,Fee Schedule,,5.9,,,5.9,Fee Schedule,,5.9,,,5.9,Fee Schedule,,5.9,,,5.9,Fee Schedule,,5.9,,,5.9,Fee Schedule,,3.93,,,3.93,Other,100% of Medicaid,3.93,,,3.93,Other,100% of Medicaid,3.93,,,3.93,Other,100% of Medicaid,3.93,,,3.93,Other,100% of Medicaid,8.84,,,8.84,Other,225% of Medicaid,6.01,,,6.01,Other,153% of Medicaid,8.84,,,8.84,Other,225% of Medicaid,5.5,,,5.5,Other,140% of Medicaid,8.84,,,8.84,Other,225% of Medicaid,10.22,,,10.22,Other,250% of Medicaid,12.73,,,12.73,Other,324% of Medicaid,8.45,,,8.45,Other,215% of Medicaid,8.45,,,8.45,Other,215% of Medicaid,4.91,,,4.91,Other,125% of Medicaid,0.01,58.8,
GLUCOSE TEST,82950,CPT,,78082950,CDM,301,RC,,,both,,,94,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.3,,,14.3,Fee Schedule,,12.87,,,12.87,Fee Schedule,,36.61,,,36.61,Fee Schedule,,32.93,,,32.93,Fee Schedule,,31.13,,,31.13,Fee Schedule,,65.8,70,,65.8,percent of total billed charges,All Other,14.96,,,14.96,Fee Schedule,,9,,,9,Other,186% of Medicaid,17.62,,,17.62,Fee Schedule,,58.28,,,58.28,Fee Schedule,,9.98,,,,Fee Schedule,,17.62,,,17.62,Fee Schedule,,58.28,,,58.28,Fee Schedule,,18.76,,,18.76,Fee Schedule,,65.8,70,,65.8,percent of total billed charges,,22.51,,,22.51,Fee Schedule,,19.08,,,19.08,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,4.75,,,4.75,Other,100% of Medicaid,4.75,,,4.75,Other,100% of Medicaid,4.75,,,4.75,Other,100% of Medicaid,4.75,,,4.75,Other,100% of Medicaid,10.69,,,10.69,Other,225% of Medicaid,7.27,,,7.27,Other,153% of Medicaid,10.69,,,10.69,Other,225% of Medicaid,6.65,,,6.65,Other,140% of Medicaid,10.69,,,10.69,Other,225% of Medicaid,12.35,,,12.35,Other,250% of Medicaid,15.39,,,15.39,Other,324% of Medicaid,10.21,,,10.21,Other,215% of Medicaid,10.21,,,10.21,Other,215% of Medicaid,5.94,,,5.94,Other,125% of Medicaid,0.01,65.8,
GLUCOSE TOLERANCE TEST (GTT),82951,CPT,,78082951,CDM,301,RC,,,both,,,220,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.74,,,38.74,Fee Schedule,,34.88,,,34.88,Fee Schedule,,99.3,,,99.3,Fee Schedule,,89.33,,,89.33,Fee Schedule,,84.44,,,84.44,Fee Schedule,,154,70,,154,percent of total billed charges,All Other,40.54,,,40.54,Fee Schedule,,13,,,13,Other,186% of Medicaid,47.75,,,47.75,Fee Schedule,,136.4,,,136.4,Fee Schedule,,27.03,,,,Fee Schedule,,47.75,,,47.75,Fee Schedule,,136.4,,,136.4,Fee Schedule,,50.84,,,50.84,Fee Schedule,,154,70,,154,percent of total billed charges,,60.99,,,60.99,Fee Schedule,,51.69,,,51.69,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,6.91,,,6.91,Other,100% of Medicaid,6.91,,,6.91,Other,100% of Medicaid,6.91,,,6.91,Other,100% of Medicaid,6.91,,,6.91,Other,100% of Medicaid,15.54,,,15.54,Other,225% of Medicaid,10.57,,,10.57,Other,153% of Medicaid,15.54,,,15.54,Other,225% of Medicaid,9.67,,,9.67,Other,140% of Medicaid,15.54,,,15.54,Other,225% of Medicaid,17.96,,,17.96,Other,250% of Medicaid,22.38,,,22.38,Other,324% of Medicaid,14.85,,,14.85,Other,215% of Medicaid,14.85,,,14.85,Other,215% of Medicaid,8.64,,,8.64,Other,125% of Medicaid,0.01,154,
GTT-ADDED SAMPLES,82952,CPT,,78082952,CDM,301,RC,,,both,,,78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,11.8,,,11.8,Fee Schedule,,10.62,,,10.62,Fee Schedule,,22.19,,,22.19,Fee Schedule,,19.97,,,19.97,Fee Schedule,,18.87,,,18.87,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,All Other,12.35,,,12.35,Fee Schedule,,3,,,3,Other,186% of Medicaid,14.54,,,14.54,Fee Schedule,,48.36,,,48.36,Fee Schedule,,8.23,,,,Fee Schedule,,14.54,,,14.54,Fee Schedule,,48.36,,,48.36,Fee Schedule,,15.48,,,15.48,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,,18.58,,,18.58,Fee Schedule,,15.75,,,15.75,Fee Schedule,,5.88,,,5.88,Fee Schedule,,5.88,,,5.88,Fee Schedule,,5.88,,,5.88,Fee Schedule,,5.88,,,5.88,Fee Schedule,,1.41,,,1.41,Other,100% of Medicaid,1.41,,,1.41,Other,100% of Medicaid,1.41,,,1.41,Other,100% of Medicaid,1.41,,,1.41,Other,100% of Medicaid,3.18,,,3.18,Other,225% of Medicaid,2.16,,,2.16,Other,153% of Medicaid,3.18,,,3.18,Other,225% of Medicaid,1.98,,,1.98,Other,140% of Medicaid,3.18,,,3.18,Other,225% of Medicaid,3.68,,,3.68,Other,250% of Medicaid,4.58,,,4.58,Other,324% of Medicaid,3.04,,,3.04,Other,215% of Medicaid,3.04,,,3.04,Other,215% of Medicaid,1.77,,,1.77,Other,125% of Medicaid,0.01,54.6,
ASSAY OF G6PD ENZYME,82955,CPT,,78082955,CDM,301,RC,,,both,,,143,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,29.2,,,29.2,Fee Schedule,,26.29,,,26.29,Fee Schedule,,74.8,,,74.8,Fee Schedule,,67.29,,,67.29,Fee Schedule,,63.61,,,63.61,Fee Schedule,,100.1,70,,100.1,percent of total billed charges,All Other,30.56,,,30.56,Fee Schedule,,18,,,18,Other,186% of Medicaid,35.99,,,35.99,Fee Schedule,,88.66,,,88.66,Fee Schedule,,20.37,,,,Fee Schedule,,35.99,,,35.99,Fee Schedule,,88.66,,,88.66,Fee Schedule,,38.32,,,38.32,Fee Schedule,,100.1,70,,100.1,percent of total billed charges,,45.97,,,45.97,Fee Schedule,,38.96,,,38.96,Fee Schedule,,14.55,,,14.55,Fee Schedule,,14.55,,,14.55,Fee Schedule,,14.55,,,14.55,Fee Schedule,,14.55,,,14.55,Fee Schedule,,9.7,,,9.7,Other,100% of Medicaid,9.7,,,9.7,Other,100% of Medicaid,9.7,,,9.7,Other,100% of Medicaid,9.7,,,9.7,Other,100% of Medicaid,21.83,,,21.83,Other,225% of Medicaid,14.84,,,14.84,Other,153% of Medicaid,21.83,,,21.83,Other,225% of Medicaid,13.58,,,13.58,Other,140% of Medicaid,21.83,,,21.83,Other,225% of Medicaid,25.22,,,25.22,Other,250% of Medicaid,31.43,,,31.43,Other,324% of Medicaid,20.86,,,20.86,Other,215% of Medicaid,20.86,,,20.86,Other,215% of Medicaid,12.13,,,12.13,Other,125% of Medicaid,0.01,100.1,
TEST FOR G6PD ENZYME,82960,CPT,,78082960,CDM,301,RC,,,both,,,155,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,18.21,,,18.21,Fee Schedule,,16.4,,,16.4,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,All Other,19.06,,,19.06,Fee Schedule,,6,,,6,Other,186% of Medicaid,22.45,,,22.45,Fee Schedule,,96.1,,,96.1,Fee Schedule,,12.71,,,,Fee Schedule,,22.45,,,22.45,Fee Schedule,,96.1,,,96.1,Fee Schedule,,23.9,,,23.9,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,,28.67,,,28.67,Fee Schedule,,24.3,,,24.3,Fee Schedule,,9.08,,,9.08,Fee Schedule,,9.08,,,9.08,Fee Schedule,,9.08,,,9.08,Fee Schedule,,9.08,,,9.08,Fee Schedule,,3.03,,,3.03,Other,100% of Medicaid,3.03,,,3.03,Other,100% of Medicaid,3.03,,,3.03,Other,100% of Medicaid,3.03,,,3.03,Other,100% of Medicaid,6.82,,,6.82,Other,225% of Medicaid,4.64,,,4.64,Other,153% of Medicaid,6.82,,,6.82,Other,225% of Medicaid,4.24,,,4.24,Other,140% of Medicaid,6.82,,,6.82,Other,225% of Medicaid,7.88,,,7.88,Other,250% of Medicaid,9.82,,,9.82,Other,324% of Medicaid,6.51,,,6.51,Other,215% of Medicaid,6.51,,,6.51,Other,215% of Medicaid,3.79,,,3.79,Other,125% of Medicaid,0.01,108.5,
GLUCOSE BLOOD TEST,82962,CPT,,78082962,CDM,301,RC,,,both,,,31,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,9.87,,,9.87,Fee Schedule,,8.89,,,8.89,Fee Schedule,,16.77,,,16.77,Fee Schedule,,15.09,,,15.09,Fee Schedule,,14.26,,,14.26,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,All Other,10.33,,,10.33,Fee Schedule,,26,,,26,Other,186% of Medicaid,12.17,,,12.17,Fee Schedule,,19.22,,,19.22,Fee Schedule,,6.89,,,,Fee Schedule,,12.17,,,12.17,Fee Schedule,,19.22,,,19.22,Fee Schedule,,12.96,,,12.96,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,,15.54,,,15.54,Fee Schedule,,13.17,,,13.17,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
ASSAY OF GGT,82977,CPT,,78082977,CDM,301,RC,,,both,,,87,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,21.67,,,21.67,Fee Schedule,,19.51,,,19.51,Fee Schedule,,55.51,,,55.51,Fee Schedule,,49.94,,,49.94,Fee Schedule,,47.21,,,47.21,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,All Other,22.68,,,22.68,Fee Schedule,,9,,,9,Other,186% of Medicaid,26.71,,,26.71,Fee Schedule,,53.94,,,53.94,Fee Schedule,,15.12,,,,Fee Schedule,,26.71,,,26.71,Fee Schedule,,53.94,,,53.94,Fee Schedule,,28.44,,,28.44,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,,34.12,,,34.12,Fee Schedule,,28.92,,,28.92,Fee Schedule,,10.8,,,10.8,Fee Schedule,,10.8,,,10.8,Fee Schedule,,10.8,,,10.8,Fee Schedule,,10.8,,,10.8,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,60.9,
GLUTATHIONE,82978,CPT,,78082978,CDM,301,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.5,,,46.5,Fee Schedule,,41.87,,,41.87,Fee Schedule,,109.93,,,109.93,Fee Schedule,,98.9,,,98.9,Fee Schedule,,93.48,,,93.48,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,48.67,,,48.67,Fee Schedule,,33,,,33,Other,186% of Medicaid,57.32,,,57.32,Fee Schedule,,53.32,,,53.32,Fee Schedule,,32.45,,,,Fee Schedule,,57.32,,,57.32,Fee Schedule,,53.32,,,53.32,Fee Schedule,,61.03,,,61.03,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,,73.22,,,73.22,Fee Schedule,,62.06,,,62.06,Fee Schedule,,23.18,,,23.18,Fee Schedule,,23.18,,,23.18,Fee Schedule,,23.18,,,23.18,Fee Schedule,,23.18,,,23.18,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,109.93,
ASSAY RBC GLUTATHIONE,82979,CPT,,78082979,CDM,301,RC,,,both,,,213,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.41,,,28.41,Fee Schedule,,25.58,,,25.58,Fee Schedule,,53.1,,,53.1,Fee Schedule,,47.77,,,47.77,Fee Schedule,,45.16,,,45.16,Fee Schedule,,149.1,70,,149.1,percent of total billed charges,All Other,29.74,,,29.74,Fee Schedule,,26,,,26,Other,186% of Medicaid,35.02,,,35.02,Fee Schedule,,132.06,,,132.06,Fee Schedule,,19.82,,,,Fee Schedule,,35.02,,,35.02,Fee Schedule,,132.06,,,132.06,Fee Schedule,,37.29,,,37.29,Fee Schedule,,149.1,70,,149.1,percent of total billed charges,,44.74,,,44.74,Fee Schedule,,37.92,,,37.92,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,149.1,
GLYCATED PROTEIN,82985,CPT,,78082985,CDM,301,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.45,,,50.45,Fee Schedule,,45.42,,,45.42,Fee Schedule,,116.23,,,116.23,Fee Schedule,,104.57,,,104.57,Fee Schedule,,98.84,,,98.84,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,All Other,52.79,,,52.79,Fee Schedule,,20,,,20,Other,186% of Medicaid,62.18,,,62.18,Fee Schedule,,79.98,,,79.98,Fee Schedule,,35.2,,,,Fee Schedule,,62.18,,,62.18,Fee Schedule,,79.98,,,79.98,Fee Schedule,,66.2,,,66.2,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,,79.43,,,79.43,Fee Schedule,,67.32,,,67.32,Fee Schedule,,25.14,,,25.14,Fee Schedule,,25.14,,,25.14,Fee Schedule,,25.14,,,25.14,Fee Schedule,,25.14,,,25.14,Fee Schedule,,10.75,,,10.75,Other,100% of Medicaid,10.75,,,10.75,Other,100% of Medicaid,10.75,,,10.75,Other,100% of Medicaid,10.75,,,10.75,Other,100% of Medicaid,24.18,,,24.18,Other,225% of Medicaid,16.44,,,16.44,Other,153% of Medicaid,24.18,,,24.18,Other,225% of Medicaid,15.04,,,15.04,Other,140% of Medicaid,24.18,,,24.18,Other,225% of Medicaid,27.94,,,27.94,Other,250% of Medicaid,34.82,,,34.82,Other,324% of Medicaid,23.1,,,23.1,Other,215% of Medicaid,23.1,,,23.1,Other,215% of Medicaid,13.43,,,13.43,Other,125% of Medicaid,0.01,116.23,
GONADOTROPIN (FSH),83001,CPT,,78083001,CDM,301,RC,,,both,,,263,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,55.93,,,55.93,Fee Schedule,,50.35,,,50.35,Fee Schedule,,143.3,,,143.3,Fee Schedule,,128.92,,,128.92,Fee Schedule,,121.86,,,121.86,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,58.53,,,58.53,Fee Schedule,,35,,,35,Other,186% of Medicaid,68.93,,,68.93,Fee Schedule,,163.06,,,163.06,Fee Schedule,,39.02,,,,Fee Schedule,,68.93,,,68.93,Fee Schedule,,163.06,,,163.06,Fee Schedule,,73.39,,,73.39,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,,88.05,,,88.05,Fee Schedule,,74.63,,,74.63,Fee Schedule,,27.87,,,27.87,Fee Schedule,,27.87,,,27.87,Fee Schedule,,27.87,,,27.87,Fee Schedule,,27.87,,,27.87,Fee Schedule,,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,18.58,,,18.58,Other,100% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,28.43,,,28.43,Other,153% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,26.01,,,26.01,Other,140% of Medicaid,41.81,,,41.81,Other,225% of Medicaid,48.31,,,48.31,Other,250% of Medicaid,60.2,,,60.2,Other,324% of Medicaid,39.95,,,39.95,Other,215% of Medicaid,39.95,,,39.95,Other,215% of Medicaid,23.23,,,23.23,Other,125% of Medicaid,0.01,184.1,
GONADOTROPIN (LH),83002,CPT,,78083002,CDM,301,RC,,,both,,,271,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,55.75,,,55.75,Fee Schedule,,50.19,,,50.19,Fee Schedule,,142.81,,,142.81,Fee Schedule,,128.48,,,128.48,Fee Schedule,,121.44,,,121.44,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,All Other,58.34,,,58.34,Fee Schedule,,34,,,34,Other,186% of Medicaid,68.71,,,68.71,Fee Schedule,,168.02,,,168.02,Fee Schedule,,38.89,,,,Fee Schedule,,68.71,,,68.71,Fee Schedule,,168.02,,,168.02,Fee Schedule,,73.15,,,73.15,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,,87.77,,,87.77,Fee Schedule,,74.39,,,74.39,Fee Schedule,,27.78,,,27.78,Fee Schedule,,27.78,,,27.78,Fee Schedule,,27.78,,,27.78,Fee Schedule,,27.78,,,27.78,Fee Schedule,,18.52,,,18.52,Other,100% of Medicaid,18.52,,,18.52,Other,100% of Medicaid,18.52,,,18.52,Other,100% of Medicaid,18.52,,,18.52,Other,100% of Medicaid,41.67,,,41.67,Other,225% of Medicaid,28.34,,,28.34,Other,153% of Medicaid,41.67,,,41.67,Other,225% of Medicaid,25.93,,,25.93,Other,140% of Medicaid,41.67,,,41.67,Other,225% of Medicaid,48.15,,,48.15,Other,250% of Medicaid,60,,,60,Other,324% of Medicaid,39.82,,,39.82,Other,215% of Medicaid,39.82,,,39.82,Other,215% of Medicaid,23.15,,,23.15,Other,125% of Medicaid,0.01,189.7,
ASSAY GROWTH HORMONE (HGH),83003,CPT,,78083003,CDM,301,RC,,,both,,,196,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.18,,,50.18,Fee Schedule,,45.18,,,45.18,Fee Schedule,,128.62,,,128.62,Fee Schedule,,115.71,,,115.71,Fee Schedule,,109.37,,,109.37,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,All Other,52.51,,,52.51,Fee Schedule,,31,,,31,Other,186% of Medicaid,61.85,,,61.85,Fee Schedule,,121.52,,,121.52,Fee Schedule,,35.01,,,,Fee Schedule,,61.85,,,61.85,Fee Schedule,,121.52,,,121.52,Fee Schedule,,65.85,,,65.85,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,,79,,,79,Fee Schedule,,66.96,,,66.96,Fee Schedule,,25.01,,,25.01,Fee Schedule,,25.01,,,25.01,Fee Schedule,,25.01,,,25.01,Fee Schedule,,25.01,,,25.01,Fee Schedule,,16.67,,,16.67,Other,100% of Medicaid,16.67,,,16.67,Other,100% of Medicaid,16.67,,,16.67,Other,100% of Medicaid,16.67,,,16.67,Other,100% of Medicaid,37.51,,,37.51,Other,225% of Medicaid,25.51,,,25.51,Other,153% of Medicaid,37.51,,,37.51,Other,225% of Medicaid,23.34,,,23.34,Other,140% of Medicaid,37.51,,,37.51,Other,225% of Medicaid,43.34,,,43.34,Other,250% of Medicaid,54.01,,,54.01,Other,324% of Medicaid,35.84,,,35.84,Other,215% of Medicaid,35.84,,,35.84,Other,215% of Medicaid,20.84,,,20.84,Other,125% of Medicaid,0.01,137.2,
ASSAY OF HAPTOGLOBIN QUANT,83010,CPT,,78083010,CDM,301,RC,,,both,,,203,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,37.87,,,37.87,Fee Schedule,,34.09,,,34.09,Fee Schedule,,97,,,97,Fee Schedule,,87.26,,,87.26,Fee Schedule,,82.48,,,82.48,Fee Schedule,,142.1,70,,142.1,percent of total billed charges,All Other,39.63,,,39.63,Fee Schedule,,23,,,23,Other,186% of Medicaid,46.67,,,46.67,Fee Schedule,,125.86,,,125.86,Fee Schedule,,26.42,,,,Fee Schedule,,46.67,,,46.67,Fee Schedule,,125.86,,,125.86,Fee Schedule,,49.69,,,49.69,Fee Schedule,,142.1,70,,142.1,percent of total billed charges,,59.62,,,59.62,Fee Schedule,,50.53,,,50.53,Fee Schedule,,18.87,,,18.87,Fee Schedule,,18.87,,,18.87,Fee Schedule,,18.87,,,18.87,Fee Schedule,,18.87,,,18.87,Fee Schedule,,12.58,,,12.58,Other,100% of Medicaid,12.58,,,12.58,Other,100% of Medicaid,12.58,,,12.58,Other,100% of Medicaid,12.58,,,12.58,Other,100% of Medicaid,28.31,,,28.31,Other,225% of Medicaid,19.25,,,19.25,Other,153% of Medicaid,28.31,,,28.31,Other,225% of Medicaid,17.61,,,17.61,Other,140% of Medicaid,28.31,,,28.31,Other,225% of Medicaid,32.71,,,32.71,Other,250% of Medicaid,40.76,,,40.76,Other,324% of Medicaid,27.05,,,27.05,Other,215% of Medicaid,27.05,,,27.05,Other,215% of Medicaid,15.73,,,15.73,Other,125% of Medicaid,0.01,142.1,
H PYLORI (C-13) BREATH TEST,83013,CPT,,78083013,CDM,301,RC,,,both,,,449,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,202.75,,,202.75,Fee Schedule,,182.55,,,182.55,Fee Schedule,,519.45,,,519.45,Fee Schedule,,467.31,,,467.31,Fee Schedule,,441.72,,,441.72,Fee Schedule,,314.3,70,,314.3,percent of total billed charges,All Other,212.18,,,212.18,Fee Schedule,,125,,,125,Other,186% of Medicaid,249.91,,,249.91,Fee Schedule,,278.38,,,278.38,Fee Schedule,,141.46,,,,Fee Schedule,,249.91,,,249.91,Fee Schedule,,278.38,,,278.38,Fee Schedule,,266.07,,,266.07,Fee Schedule,,314.3,70,,314.3,percent of total billed charges,,319.22,,,319.22,Fee Schedule,,270.56,,,270.56,Fee Schedule,,101.04,,,101.04,Fee Schedule,,101.04,,,101.04,Fee Schedule,,101.04,,,101.04,Fee Schedule,,101.04,,,101.04,Fee Schedule,,67.36,,,67.36,Other,100% of Medicaid,67.36,,,67.36,Other,100% of Medicaid,67.36,,,67.36,Other,100% of Medicaid,67.36,,,67.36,Other,100% of Medicaid,151.56,,,151.56,Other,225% of Medicaid,103.06,,,103.06,Other,153% of Medicaid,151.56,,,151.56,Other,225% of Medicaid,94.3,,,94.3,Other,140% of Medicaid,151.56,,,151.56,Other,225% of Medicaid,175.14,,,175.14,Other,250% of Medicaid,218.25,,,218.25,Other,324% of Medicaid,144.82,,,144.82,Other,215% of Medicaid,144.82,,,144.82,Other,215% of Medicaid,84.2,,,84.2,Other,125% of Medicaid,0.01,519.45,
HEAVY METAL SCREEN,83015,CPT,,78083015,CDM,301,RC,,,both,,,299,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.03,,,63.03,Fee Schedule,,56.75,,,56.75,Fee Schedule,,145.22,,,145.22,Fee Schedule,,130.65,,,130.65,Fee Schedule,,123.49,,,123.49,Fee Schedule,,209.3,70,,209.3,percent of total billed charges,All Other,65.96,,,65.96,Fee Schedule,,39,,,39,Other,186% of Medicaid,77.69,,,77.69,Fee Schedule,,185.38,,,185.38,Fee Schedule,,43.97,,,,Fee Schedule,,77.69,,,77.69,Fee Schedule,,185.38,,,185.38,Fee Schedule,,82.71,,,82.71,Fee Schedule,,209.3,70,,209.3,percent of total billed charges,,99.24,,,99.24,Fee Schedule,,84.11,,,84.11,Fee Schedule,,31.41,,,31.41,Fee Schedule,,31.41,,,31.41,Fee Schedule,,31.41,,,31.41,Fee Schedule,,31.41,,,31.41,Fee Schedule,,20.94,,,20.94,Other,100% of Medicaid,20.94,,,20.94,Other,100% of Medicaid,20.94,,,20.94,Other,100% of Medicaid,20.94,,,20.94,Other,100% of Medicaid,47.12,,,47.12,Other,225% of Medicaid,32.04,,,32.04,Other,153% of Medicaid,47.12,,,47.12,Other,225% of Medicaid,29.32,,,29.32,Other,140% of Medicaid,47.12,,,47.12,Other,225% of Medicaid,54.44,,,54.44,Other,250% of Medicaid,67.85,,,67.85,Other,324% of Medicaid,45.02,,,45.02,Other,215% of Medicaid,45.02,,,45.02,Other,215% of Medicaid,26.18,,,26.18,Other,125% of Medicaid,0.01,209.3,
QUANTITATIVE SCREEN METALS,83018,CPT,,78083018,CDM,301,RC,,,both,,,254,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,66.1,,,66.1,Fee Schedule,,59.51,,,59.51,Fee Schedule,,169.39,,,169.39,Fee Schedule,,152.39,,,152.39,Fee Schedule,,144.04,,,144.04,Fee Schedule,,177.8,70,,177.8,percent of total billed charges,All Other,69.17,,,69.17,Fee Schedule,,47,,,47,Other,186% of Medicaid,81.47,,,81.47,Fee Schedule,,157.48,,,157.48,Fee Schedule,,46.12,,,,Fee Schedule,,81.47,,,81.47,Fee Schedule,,157.48,,,157.48,Fee Schedule,,86.74,,,86.74,Fee Schedule,,177.8,70,,177.8,percent of total billed charges,,104.07,,,104.07,Fee Schedule,,88.21,,,88.21,Fee Schedule,,32.94,,,32.94,Fee Schedule,,32.94,,,32.94,Fee Schedule,,32.94,,,32.94,Fee Schedule,,32.94,,,32.94,Fee Schedule,,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,38.73,,,38.73,Other,153% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,35.44,,,35.44,Other,140% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,65.82,,,65.82,Other,250% of Medicaid,82.02,,,82.02,Other,324% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,31.64,,,31.64,Other,125% of Medicaid,0.01,177.8,
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,,78083020,CDM,301,RC,,,both,,,83,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.74,,,38.74,Fee Schedule,,34.88,,,34.88,Fee Schedule,,99.3,,,99.3,Fee Schedule,,89.33,,,89.33,Fee Schedule,,84.44,,,84.44,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,All Other,40.54,,,40.54,Fee Schedule,,24,,,24,Other,186% of Medicaid,47.75,,,47.75,Fee Schedule,,51.46,,,51.46,Fee Schedule,,27.03,,,,Fee Schedule,,47.75,,,47.75,Fee Schedule,,51.46,,,51.46,Fee Schedule,,50.84,,,50.84,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,,60.99,,,60.99,Fee Schedule,,51.69,,,51.69,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,12.87,,,12.87,Other,100% of Medicaid,12.87,,,12.87,Other,100% of Medicaid,12.87,,,12.87,Other,100% of Medicaid,12.87,,,12.87,Other,100% of Medicaid,28.96,,,28.96,Other,225% of Medicaid,19.69,,,19.69,Other,153% of Medicaid,28.96,,,28.96,Other,225% of Medicaid,18.02,,,18.02,Other,140% of Medicaid,28.96,,,28.96,Other,225% of Medicaid,33.46,,,33.46,Other,250% of Medicaid,41.7,,,41.7,Other,324% of Medicaid,27.67,,,27.67,Other,215% of Medicaid,27.67,,,27.67,Other,215% of Medicaid,16.09,,,16.09,Other,125% of Medicaid,0.01,99.3,
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,,78083021,CDM,301,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,54.36,,,54.36,Fee Schedule,,48.94,,,48.94,Fee Schedule,,139.25,,,139.25,Fee Schedule,,125.27,,,125.27,Fee Schedule,,118.41,,,118.41,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,56.89,,,56.89,Fee Schedule,,34,,,34,Other,186% of Medicaid,67,,,67,Fee Schedule,,115.32,,,115.32,Fee Schedule,,37.93,,,,Fee Schedule,,67,,,67,Fee Schedule,,115.32,,,115.32,Fee Schedule,,71.34,,,71.34,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,85.59,,,85.59,Fee Schedule,,72.54,,,72.54,Fee Schedule,,27.09,,,27.09,Fee Schedule,,27.09,,,27.09,Fee Schedule,,27.09,,,27.09,Fee Schedule,,27.09,,,27.09,Fee Schedule,,18.06,,,18.06,Other,100% of Medicaid,18.06,,,18.06,Other,100% of Medicaid,18.06,,,18.06,Other,100% of Medicaid,18.06,,,18.06,Other,100% of Medicaid,40.64,,,40.64,Other,225% of Medicaid,27.63,,,27.63,Other,153% of Medicaid,40.64,,,40.64,Other,225% of Medicaid,25.28,,,25.28,Other,140% of Medicaid,40.64,,,40.64,Other,225% of Medicaid,46.96,,,46.96,Other,250% of Medicaid,58.51,,,58.51,Other,324% of Medicaid,38.83,,,38.83,Other,215% of Medicaid,38.83,,,38.83,Other,215% of Medicaid,22.58,,,22.58,Other,125% of Medicaid,0.01,139.25,
FETAL HEMOGLOBIN CHEMICAL,83030,CPT,,78083030,CDM,301,RC,,,both,,,79,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,32.33,,,32.33,Fee Schedule,,29.11,,,29.11,Fee Schedule,,26.91,,,26.91,Fee Schedule,,24.21,,,24.21,Fee Schedule,,22.88,,,22.88,Fee Schedule,,55.3,70,,55.3,percent of total billed charges,All Other,33.83,,,33.83,Fee Schedule,,7,,,7,Other,186% of Medicaid,39.85,,,39.85,Fee Schedule,,48.98,,,48.98,Fee Schedule,,22.55,,,,Fee Schedule,,39.85,,,39.85,Fee Schedule,,48.98,,,48.98,Fee Schedule,,42.42,,,42.42,Fee Schedule,,55.3,70,,55.3,percent of total billed charges,,50.9,,,50.9,Fee Schedule,,43.14,,,43.14,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.79,,,5.79,Other,153% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.3,,,5.3,Other,140% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,9.85,,,9.85,Other,250% of Medicaid,12.27,,,12.27,Other,324% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,4.73,,,4.73,Other,125% of Medicaid,0.01,55.3,
FETAL HEMOGLOBIN ASSAY QUAL,83033,CPT,,78083033,CDM,301,RC,,,both,,,92,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,24.08,,,24.08,Fee Schedule,,21.68,,,21.68,Fee Schedule,,26.91,,,26.91,Fee Schedule,,24.21,,,24.21,Fee Schedule,,22.88,,,22.88,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,All Other,25.2,,,25.2,Fee Schedule,,26,,,26,Other,186% of Medicaid,29.68,,,29.68,Fee Schedule,,57.04,,,57.04,Fee Schedule,,16.8,,,,Fee Schedule,,29.68,,,29.68,Fee Schedule,,57.04,,,57.04,Fee Schedule,,31.6,,,31.6,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,,37.91,,,37.91,Fee Schedule,,32.13,,,32.13,Fee Schedule,,12,,,12,Fee Schedule,,12,,,12,Fee Schedule,,12,,,12,Fee Schedule,,12,,,12,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,64.4,
GLYCOSYLATED HEMOGLOBIN TEST,83036,CPT,,78083036,CDM,301,RC,,,both,,,138,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,29.23,,,29.23,Fee Schedule,,26.31,,,26.31,Fee Schedule,,74.86,,,74.86,Fee Schedule,,67.34,,,67.34,Fee Schedule,,63.66,,,63.66,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,All Other,30.59,,,30.59,Fee Schedule,,18,,,18,Other,186% of Medicaid,36.02,,,36.02,Fee Schedule,,85.56,,,85.56,Fee Schedule,,20.39,,,,Fee Schedule,,36.02,,,36.02,Fee Schedule,,85.56,,,85.56,Fee Schedule,,38.35,,,38.35,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,,46.02,,,46.02,Fee Schedule,,39,,,39,Fee Schedule,,14.57,,,14.57,Fee Schedule,,14.57,,,14.57,Fee Schedule,,14.57,,,14.57,Fee Schedule,,14.57,,,14.57,Fee Schedule,,9.71,,,9.71,Other,100% of Medicaid,9.71,,,9.71,Other,100% of Medicaid,9.71,,,9.71,Other,100% of Medicaid,9.71,,,9.71,Other,100% of Medicaid,21.85,,,21.85,Other,225% of Medicaid,14.86,,,14.86,Other,153% of Medicaid,21.85,,,21.85,Other,225% of Medicaid,13.59,,,13.59,Other,140% of Medicaid,21.85,,,21.85,Other,225% of Medicaid,25.25,,,25.25,Other,250% of Medicaid,31.46,,,31.46,Other,324% of Medicaid,20.88,,,20.88,Other,215% of Medicaid,20.88,,,20.88,Other,215% of Medicaid,12.14,,,12.14,Other,125% of Medicaid,0.01,96.6,
BLOOD METHEMOGLOBIN ASSAY,83050,CPT,,71083050,CDM,301,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.68,,,24.68,Fee Schedule,,22.22,,,22.22,Fee Schedule,,26.91,,,26.91,Fee Schedule,,24.21,,,24.21,Fee Schedule,,22.88,,,22.88,Fee Schedule,,126,70,,126,percent of total billed charges,All Other,25.83,,,25.83,Fee Schedule,,7,,,7,Other,186% of Medicaid,30.42,,,30.42,Fee Schedule,,111.6,,,111.6,Fee Schedule,,17.22,,,,Fee Schedule,,30.42,,,30.42,Fee Schedule,,111.6,,,111.6,Fee Schedule,,32.39,,,32.39,Fee Schedule,,126,70,,126,percent of total billed charges,,38.86,,,38.86,Fee Schedule,,32.94,,,32.94,Fee Schedule,,12.3,,,12.3,Fee Schedule,,12.3,,,12.3,Fee Schedule,,12.3,,,12.3,Fee Schedule,,12.3,,,12.3,Fee Schedule,,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.79,,,5.79,Other,153% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.3,,,5.3,Other,140% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,9.85,,,9.85,Other,250% of Medicaid,12.27,,,12.27,Other,324% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,4.73,,,4.73,Other,125% of Medicaid,0.01,126,
BLOOD METHEMOGLOBIN ASSAY,83050,CPT,,78083050,CDM,301,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.68,,,24.68,Fee Schedule,,22.22,,,22.22,Fee Schedule,,26.91,,,26.91,Fee Schedule,,24.21,,,24.21,Fee Schedule,,22.88,,,22.88,Fee Schedule,,126,70,,126,percent of total billed charges,All Other,25.83,,,25.83,Fee Schedule,,7,,,7,Other,186% of Medicaid,30.42,,,30.42,Fee Schedule,,111.6,,,111.6,Fee Schedule,,17.22,,,,Fee Schedule,,30.42,,,30.42,Fee Schedule,,111.6,,,111.6,Fee Schedule,,32.39,,,32.39,Fee Schedule,,126,70,,126,percent of total billed charges,,38.86,,,38.86,Fee Schedule,,32.94,,,32.94,Fee Schedule,,12.3,,,12.3,Fee Schedule,,12.3,,,12.3,Fee Schedule,,12.3,,,12.3,Fee Schedule,,12.3,,,12.3,Fee Schedule,,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.79,,,5.79,Other,153% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.3,,,5.3,Other,140% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,9.85,,,9.85,Other,250% of Medicaid,12.27,,,12.27,Other,324% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,4.73,,,4.73,Other,125% of Medicaid,0.01,126,
ASSAY OF PLASMA HEMOGLOBIN,83051,CPT,,78083051,CDM,301,RC,,,both,,,125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,22,,,22,Fee Schedule,,19.81,,,19.81,Fee Schedule,,26.91,,,26.91,Fee Schedule,,24.21,,,24.21,Fee Schedule,,22.88,,,22.88,Fee Schedule,,87.5,70,,87.5,percent of total billed charges,All Other,23.03,,,23.03,Fee Schedule,,7,,,7,Other,186% of Medicaid,27.12,,,27.12,Fee Schedule,,77.5,,,77.5,Fee Schedule,,15.35,,,,Fee Schedule,,27.12,,,27.12,Fee Schedule,,77.5,,,77.5,Fee Schedule,,28.87,,,28.87,Fee Schedule,,87.5,70,,87.5,percent of total billed charges,,34.64,,,34.64,Fee Schedule,,29.36,,,29.36,Fee Schedule,,10.97,,,10.97,Fee Schedule,,10.97,,,10.97,Fee Schedule,,10.97,,,10.97,Fee Schedule,,10.97,,,10.97,Fee Schedule,,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.79,,,5.79,Other,153% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.3,,,5.3,Other,140% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,9.85,,,9.85,Other,250% of Medicaid,12.27,,,12.27,Other,324% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,4.73,,,4.73,Other,125% of Medicaid,0.01,87.5,
HEMOGLOBIN STABILITY SCREEN,83068,CPT,,78083068,CDM,301,RC,,,both,,,31,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,28.5,,,28.5,Fee Schedule,,25.66,,,25.66,Fee Schedule,,26.91,,,26.91,Fee Schedule,,24.21,,,24.21,Fee Schedule,,22.88,,,22.88,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,All Other,29.83,,,29.83,Fee Schedule,,26,,,26,Other,186% of Medicaid,35.13,,,35.13,Fee Schedule,,19.22,,,19.22,Fee Schedule,,19.89,,,,Fee Schedule,,35.13,,,35.13,Fee Schedule,,19.22,,,19.22,Fee Schedule,,37.41,,,37.41,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,,44.88,,,44.88,Fee Schedule,,38.04,,,38.04,Fee Schedule,,14.21,,,14.21,Fee Schedule,,14.21,,,14.21,Fee Schedule,,14.21,,,14.21,Fee Schedule,,14.21,,,14.21,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.88,
ASSAY OF URINE HEMOGLOBIN,83069,CPT,,78083069,CDM,301,RC,,,both,,,30,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,11.89,,,11.89,Fee Schedule,,10.7,,,10.7,Fee Schedule,,26.91,,,26.91,Fee Schedule,,24.21,,,24.21,Fee Schedule,,22.88,,,22.88,Fee Schedule,,21,70,,21,percent of total billed charges,All Other,12.44,,,12.44,Fee Schedule,,26,,,26,Other,186% of Medicaid,14.65,,,14.65,Fee Schedule,,18.6,,,18.6,Fee Schedule,,8.3,,,,Fee Schedule,,14.65,,,14.65,Fee Schedule,,18.6,,,18.6,Fee Schedule,,15.6,,,15.6,Fee Schedule,,21,70,,21,percent of total billed charges,,18.72,,,18.72,Fee Schedule,,15.87,,,15.87,Fee Schedule,,5.93,,,5.93,Fee Schedule,,5.93,,,5.93,Fee Schedule,,5.93,,,5.93,Fee Schedule,,5.93,,,5.93,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
ASSAY OF HEMOSIDERIN QUAL,83070,CPT,,78083070,CDM,301,RC,,,both,,,87,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14.3,,,14.3,Fee Schedule,,12.87,,,12.87,Fee Schedule,,36.61,,,36.61,Fee Schedule,,32.93,,,32.93,Fee Schedule,,31.13,,,31.13,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,All Other,14.96,,,14.96,Fee Schedule,,26,,,26,Other,186% of Medicaid,17.62,,,17.62,Fee Schedule,,53.94,,,53.94,Fee Schedule,,9.98,,,,Fee Schedule,,17.62,,,17.62,Fee Schedule,,53.94,,,53.94,Fee Schedule,,18.76,,,18.76,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,,22.51,,,22.51,Fee Schedule,,19.08,,,19.08,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,60.9,
ASSAY OF HISTAMINE,83088,CPT,,78083088,CDM,301,RC,,,both,,,582,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,88.89,,,88.89,Fee Schedule,,80.03,,,80.03,Fee Schedule,,227.75,,,227.75,Fee Schedule,,204.89,,,204.89,Fee Schedule,,193.67,,,193.67,Fee Schedule,,407.4,70,,407.4,percent of total billed charges,All Other,93.02,,,93.02,Fee Schedule,,73,,,73,Other,186% of Medicaid,109.56,,,109.56,Fee Schedule,,360.84,,,360.84,Fee Schedule,,62.01,,,,Fee Schedule,,109.56,,,109.56,Fee Schedule,,360.84,,,360.84,Fee Schedule,,116.64,,,116.64,Fee Schedule,,407.4,70,,407.4,percent of total billed charges,,139.94,,,139.94,Fee Schedule,,118.61,,,118.61,Fee Schedule,,44.3,,,44.3,Fee Schedule,,44.3,,,44.3,Fee Schedule,,44.3,,,44.3,Fee Schedule,,44.3,,,44.3,Fee Schedule,,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,59.9,,,59.9,Other,153% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,54.81,,,54.81,Other,140% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,101.8,,,101.8,Other,250% of Medicaid,126.86,,,126.86,Other,324% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,48.94,,,48.94,Other,125% of Medicaid,0.01,407.4,
ASSAY OF FOR HVA,83150,CPT,,78083150,CDM,301,RC,,,both,,,184,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,67.45,,,67.45,Fee Schedule,,60.73,,,60.73,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,128.8,70,,128.8,percent of total billed charges,All Other,70.59,,,70.59,Fee Schedule,,12,,,12,Other,186% of Medicaid,83.14,,,83.14,Fee Schedule,,114.08,,,114.08,Fee Schedule,,47.06,,,,Fee Schedule,,83.14,,,83.14,Fee Schedule,,114.08,,,114.08,Fee Schedule,,88.52,,,88.52,Fee Schedule,,128.8,70,,128.8,percent of total billed charges,,106.2,,,106.2,Fee Schedule,,90.01,,,90.01,Fee Schedule,,33.62,,,33.62,Fee Schedule,,33.62,,,33.62,Fee Schedule,,33.62,,,33.62,Fee Schedule,,33.62,,,33.62,Fee Schedule,,6.31,,,6.31,Other,100% of Medicaid,6.31,,,6.31,Other,100% of Medicaid,6.31,,,6.31,Other,100% of Medicaid,6.31,,,6.31,Other,100% of Medicaid,14.2,,,14.2,Other,225% of Medicaid,9.66,,,9.66,Other,153% of Medicaid,14.2,,,14.2,Other,225% of Medicaid,8.84,,,8.84,Other,140% of Medicaid,14.2,,,14.2,Other,225% of Medicaid,16.41,,,16.41,Other,250% of Medicaid,20.45,,,20.45,Other,324% of Medicaid,13.57,,,13.57,Other,215% of Medicaid,13.57,,,13.57,Other,215% of Medicaid,7.89,,,7.89,Other,125% of Medicaid,0.01,128.8,
ASSAY OF CORTICOSTEROIDS,83491,CPT,,78083491,CDM,301,RC,,,both,,,226,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,53.88,,,53.88,Fee Schedule,,48.51,,,48.51,Fee Schedule,,135.08,,,135.08,Fee Schedule,,121.52,,,121.52,Fee Schedule,,114.87,,,114.87,Fee Schedule,,158.2,70,,158.2,percent of total billed charges,All Other,56.39,,,56.39,Fee Schedule,,58,,,58,Other,186% of Medicaid,66.41,,,66.41,Fee Schedule,,140.12,,,140.12,Fee Schedule,,37.59,,,,Fee Schedule,,66.41,,,66.41,Fee Schedule,,140.12,,,140.12,Fee Schedule,,70.71,,,70.71,Fee Schedule,,158.2,70,,158.2,percent of total billed charges,,84.83,,,84.83,Fee Schedule,,71.9,,,71.9,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,47.87,,,47.87,Other,153% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,43.8,,,43.8,Other,140% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,81.35,,,81.35,Other,250% of Medicaid,101.38,,,101.38,Other,324% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,39.11,,,39.11,Other,125% of Medicaid,0.01,158.2,
ASSAY OF 5-HIAA,83497,CPT,,78083497,CDM,301,RC,,,both,,,171,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.83,,,38.83,Fee Schedule,,34.96,,,34.96,Fee Schedule,,99.41,,,99.41,Fee Schedule,,89.43,,,89.43,Fee Schedule,,84.53,,,84.53,Fee Schedule,,119.7,70,,119.7,percent of total billed charges,All Other,40.64,,,40.64,Fee Schedule,,24,,,24,Other,186% of Medicaid,47.86,,,47.86,Fee Schedule,,106.02,,,106.02,Fee Schedule,,27.09,,,,Fee Schedule,,47.86,,,47.86,Fee Schedule,,106.02,,,106.02,Fee Schedule,,50.96,,,50.96,Fee Schedule,,119.7,70,,119.7,percent of total billed charges,,61.13,,,61.13,Fee Schedule,,51.81,,,51.81,Fee Schedule,,19.35,,,19.35,Fee Schedule,,19.35,,,19.35,Fee Schedule,,19.35,,,19.35,Fee Schedule,,19.35,,,19.35,Fee Schedule,,12.9,,,12.9,Other,100% of Medicaid,12.9,,,12.9,Other,100% of Medicaid,12.9,,,12.9,Other,100% of Medicaid,12.9,,,12.9,Other,100% of Medicaid,29.03,,,29.03,Other,225% of Medicaid,19.74,,,19.74,Other,153% of Medicaid,29.03,,,29.03,Other,225% of Medicaid,18.06,,,18.06,Other,140% of Medicaid,29.03,,,29.03,Other,225% of Medicaid,33.54,,,33.54,Other,250% of Medicaid,41.8,,,41.8,Other,324% of Medicaid,27.74,,,27.74,Other,215% of Medicaid,27.74,,,27.74,Other,215% of Medicaid,16.13,,,16.13,Other,125% of Medicaid,0.01,119.7,
ASSAY OF PROGESTERONE,83498,CPT,,78083498,CDM,301,RC,,,both,,,298,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,81.78,,,81.78,Fee Schedule,,73.63,,,73.63,Fee Schedule,,209.5,,,209.5,Fee Schedule,,188.47,,,188.47,Fee Schedule,,178.15,,,178.15,Fee Schedule,,208.6,70,,208.6,percent of total billed charges,All Other,85.59,,,85.59,Fee Schedule,,51,,,51,Other,186% of Medicaid,100.8,,,100.8,Fee Schedule,,184.76,,,184.76,Fee Schedule,,57.06,,,,Fee Schedule,,100.8,,,100.8,Fee Schedule,,184.76,,,184.76,Fee Schedule,,107.32,,,107.32,Fee Schedule,,208.6,70,,208.6,percent of total billed charges,,128.76,,,128.76,Fee Schedule,,109.13,,,109.13,Fee Schedule,,40.76,,,40.76,Fee Schedule,,40.76,,,40.76,Fee Schedule,,40.76,,,40.76,Fee Schedule,,40.76,,,40.76,Fee Schedule,,27.17,,,27.17,Other,100% of Medicaid,27.17,,,27.17,Other,100% of Medicaid,27.17,,,27.17,Other,100% of Medicaid,27.17,,,27.17,Other,100% of Medicaid,61.13,,,61.13,Other,225% of Medicaid,41.57,,,41.57,Other,153% of Medicaid,61.13,,,61.13,Other,225% of Medicaid,38.04,,,38.04,Other,140% of Medicaid,61.13,,,61.13,Other,225% of Medicaid,70.64,,,70.64,Other,250% of Medicaid,88.03,,,88.03,Other,324% of Medicaid,58.42,,,58.42,Other,215% of Medicaid,58.42,,,58.42,Other,215% of Medicaid,33.96,,,33.96,Other,125% of Medicaid,0.01,209.5,
ASSAY FREE HYDROXYPROLINE,83500,CPT,,78083500,CDM,301,RC,,,both,,,293,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.18,,,68.18,Fee Schedule,,61.38,,,61.38,Fee Schedule,,174.65,,,174.65,Fee Schedule,,157.12,,,157.12,Fee Schedule,,148.51,,,148.51,Fee Schedule,,205.1,70,,205.1,percent of total billed charges,All Other,71.35,,,71.35,Fee Schedule,,42,,,42,Other,186% of Medicaid,84.03,,,84.03,Fee Schedule,,181.66,,,181.66,Fee Schedule,,47.57,,,,Fee Schedule,,84.03,,,84.03,Fee Schedule,,181.66,,,181.66,Fee Schedule,,89.47,,,89.47,Fee Schedule,,205.1,70,,205.1,percent of total billed charges,,107.34,,,107.34,Fee Schedule,,90.98,,,90.98,Fee Schedule,,33.98,,,33.98,Fee Schedule,,33.98,,,33.98,Fee Schedule,,33.98,,,33.98,Fee Schedule,,33.98,,,33.98,Fee Schedule,,22.65,,,22.65,Other,100% of Medicaid,22.65,,,22.65,Other,100% of Medicaid,22.65,,,22.65,Other,100% of Medicaid,22.65,,,22.65,Other,100% of Medicaid,50.96,,,50.96,Other,225% of Medicaid,34.65,,,34.65,Other,153% of Medicaid,50.96,,,50.96,Other,225% of Medicaid,31.71,,,31.71,Other,140% of Medicaid,50.96,,,50.96,Other,225% of Medicaid,58.89,,,58.89,Other,250% of Medicaid,73.39,,,73.39,Other,324% of Medicaid,48.7,,,48.7,Other,215% of Medicaid,48.7,,,48.7,Other,215% of Medicaid,28.31,,,28.31,Other,125% of Medicaid,0.01,205.1,
IMMUNOASSAY NONANTIBODY,83516,CPT,,78083516,CDM,301,RC,,,both,,,132,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.71,,,34.71,Fee Schedule,,31.25,,,31.25,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,All Other,36.32,,,36.32,Fee Schedule,,33,,,33,Other,186% of Medicaid,42.78,,,42.78,Fee Schedule,,81.84,,,81.84,Fee Schedule,,24.21,,,,Fee Schedule,,42.78,,,42.78,Fee Schedule,,81.84,,,81.84,Fee Schedule,,45.54,,,45.54,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,,54.64,,,54.64,Fee Schedule,,46.31,,,46.31,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,92.4,
RIA NONANTIBODY,83519,CPT,,78083519,CDM,301,RC,,,both,,,343,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,55.38,,,55.38,Fee Schedule,,49.86,,,49.86,Fee Schedule,,104.17,,,104.17,Fee Schedule,,93.72,,,93.72,Fee Schedule,,88.59,,,88.59,Fee Schedule,,240.1,70,,240.1,percent of total billed charges,All Other,57.96,,,57.96,Fee Schedule,,33,,,33,Other,186% of Medicaid,68.26,,,68.26,Fee Schedule,,212.66,,,212.66,Fee Schedule,,38.64,,,,Fee Schedule,,68.26,,,68.26,Fee Schedule,,212.66,,,212.66,Fee Schedule,,72.68,,,72.68,Fee Schedule,,240.1,70,,240.1,percent of total billed charges,,87.2,,,87.2,Fee Schedule,,73.91,,,73.91,Fee Schedule,,27.6,,,27.6,Fee Schedule,,27.6,,,27.6,Fee Schedule,,27.6,,,27.6,Fee Schedule,,27.6,,,27.6,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,240.1,
ASSAY OF INSULIN,83525,CPT,,78083525,CDM,301,RC,,,both,,,168,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.4,,,34.4,Fee Schedule,,30.98,,,30.98,Fee Schedule,,88.17,,,88.17,Fee Schedule,,79.32,,,79.32,Fee Schedule,,74.98,,,74.98,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,All Other,36,,,36,Fee Schedule,,21,,,21,Other,186% of Medicaid,42.41,,,42.41,Fee Schedule,,104.16,,,104.16,Fee Schedule,,24,,,,Fee Schedule,,42.41,,,42.41,Fee Schedule,,104.16,,,104.16,Fee Schedule,,45.15,,,45.15,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,,54.17,,,54.17,Fee Schedule,,45.91,,,45.91,Fee Schedule,,17.15,,,17.15,Fee Schedule,,17.15,,,17.15,Fee Schedule,,17.15,,,17.15,Fee Schedule,,17.15,,,17.15,Fee Schedule,,11.43,,,11.43,Other,100% of Medicaid,11.43,,,11.43,Other,100% of Medicaid,11.43,,,11.43,Other,100% of Medicaid,11.43,,,11.43,Other,100% of Medicaid,25.72,,,25.72,Other,225% of Medicaid,17.49,,,17.49,Other,153% of Medicaid,25.72,,,25.72,Other,225% of Medicaid,16,,,16,Other,140% of Medicaid,25.72,,,25.72,Other,225% of Medicaid,29.72,,,29.72,Other,250% of Medicaid,37.03,,,37.03,Other,324% of Medicaid,24.57,,,24.57,Other,215% of Medicaid,24.57,,,24.57,Other,215% of Medicaid,14.29,,,14.29,Other,125% of Medicaid,0.01,117.6,
ASSAY OF IRON,83540,CPT,,78083540,CDM,301,RC,,,both,,,82,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.47,,,19.47,Fee Schedule,,17.53,,,17.53,Fee Schedule,,49.98,,,49.98,Fee Schedule,,44.96,,,44.96,Fee Schedule,,42.5,,,42.5,Fee Schedule,,57.4,70,,57.4,percent of total billed charges,All Other,20.38,,,20.38,Fee Schedule,,9,,,9,Other,186% of Medicaid,24,,,24,Fee Schedule,,50.84,,,50.84,Fee Schedule,,13.59,,,,Fee Schedule,,24,,,24,Fee Schedule,,50.84,,,50.84,Fee Schedule,,25.56,,,25.56,Fee Schedule,,57.4,70,,57.4,percent of total billed charges,,30.66,,,30.66,Fee Schedule,,25.99,,,25.99,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,57.4,
IRON BINDING TEST,83550,CPT,,78083550,CDM,301,RC,,,both,,,91,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,26.31,,,26.31,Fee Schedule,,23.69,,,23.69,Fee Schedule,,67.4,,,67.4,Fee Schedule,,60.64,,,60.64,Fee Schedule,,57.32,,,57.32,Fee Schedule,,63.7,70,,63.7,percent of total billed charges,All Other,27.53,,,27.53,Fee Schedule,,9,,,9,Other,186% of Medicaid,32.43,,,32.43,Fee Schedule,,56.42,,,56.42,Fee Schedule,,18.35,,,,Fee Schedule,,32.43,,,32.43,Fee Schedule,,56.42,,,56.42,Fee Schedule,,34.52,,,34.52,Fee Schedule,,63.7,70,,63.7,percent of total billed charges,,41.42,,,41.42,Fee Schedule,,35.11,,,35.11,Fee Schedule,,13.11,,,13.11,Fee Schedule,,13.11,,,13.11,Fee Schedule,,13.11,,,13.11,Fee Schedule,,13.11,,,13.11,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,67.4,
ASSAY OF IDH ENZYME,83570,CPT,,78083570,CDM,301,RC,,,both,,,50,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.64,,,26.64,Fee Schedule,,23.98,,,23.98,Fee Schedule,,68.23,,,68.23,Fee Schedule,,61.38,,,61.38,Fee Schedule,,58.02,,,58.02,Fee Schedule,,35,70,,35,percent of total billed charges,All Other,27.88,,,27.88,Fee Schedule,,26,,,26,Other,186% of Medicaid,32.83,,,32.83,Fee Schedule,,31,,,31,Fee Schedule,,18.59,,,,Fee Schedule,,32.83,,,32.83,Fee Schedule,,31,,,31,Fee Schedule,,34.96,,,34.96,Fee Schedule,,35,70,,35,percent of total billed charges,,41.94,,,41.94,Fee Schedule,,35.55,,,35.55,Fee Schedule,,13.28,,,13.28,Fee Schedule,,13.28,,,13.28,Fee Schedule,,13.28,,,13.28,Fee Schedule,,13.28,,,13.28,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,68.23,
ASSAY OF KETOGENIC STEROIDS,83582,CPT,,78083582,CDM,301,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.56,,,46.56,Fee Schedule,,41.92,,,41.92,Fee Schedule,,109.27,,,109.27,Fee Schedule,,98.3,,,98.3,Fee Schedule,,92.92,,,92.92,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,48.73,,,48.73,Fee Schedule,,58,,,58,Other,186% of Medicaid,57.39,,,57.39,Fee Schedule,,115.32,,,115.32,Fee Schedule,,32.49,,,,Fee Schedule,,57.39,,,57.39,Fee Schedule,,115.32,,,115.32,Fee Schedule,,61.11,,,61.11,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,73.31,,,73.31,Fee Schedule,,62.14,,,62.14,Fee Schedule,,23.21,,,23.21,Fee Schedule,,23.21,,,23.21,Fee Schedule,,23.21,,,23.21,Fee Schedule,,23.21,,,23.21,Fee Schedule,,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,47.87,,,47.87,Other,153% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,43.8,,,43.8,Other,140% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,81.35,,,81.35,Other,250% of Medicaid,101.38,,,101.38,Other,324% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,39.11,,,39.11,Other,125% of Medicaid,0.01,130.2,
ASSAY 17- KETOSTEROIDS,83586,CPT,,78083586,CDM,301,RC,,,both,,,155,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.53,,,38.53,Fee Schedule,,34.69,,,34.69,Fee Schedule,,71.79,,,71.79,Fee Schedule,,64.58,,,64.58,Fee Schedule,,61.05,,,61.05,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,All Other,40.32,,,40.32,Fee Schedule,,18,,,18,Other,186% of Medicaid,47.49,,,47.49,Fee Schedule,,96.1,,,96.1,Fee Schedule,,26.88,,,,Fee Schedule,,47.49,,,47.49,Fee Schedule,,96.1,,,96.1,Fee Schedule,,50.56,,,50.56,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,,60.66,,,60.66,Fee Schedule,,51.41,,,51.41,Fee Schedule,,19.2,,,19.2,Fee Schedule,,19.2,,,19.2,Fee Schedule,,19.2,,,19.2,Fee Schedule,,19.2,,,19.2,Fee Schedule,,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,14.53,,,14.53,Other,153% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,24.68,,,24.68,Other,250% of Medicaid,30.76,,,30.76,Other,324% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,11.87,,,11.87,Other,125% of Medicaid,0.01,108.5,
FRACTIONATION KETOSTEROIDS,83593,CPT,,78083593,CDM,301,RC,,,both,,,147,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,85.79,,,85.79,Fee Schedule,,77.24,,,77.24,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,102.9,70,,102.9,percent of total billed charges,All Other,89.78,,,89.78,Fee Schedule,,22,,,22,Other,186% of Medicaid,105.74,,,105.74,Fee Schedule,,91.14,,,91.14,Fee Schedule,,59.85,,,,Fee Schedule,,105.74,,,105.74,Fee Schedule,,91.14,,,91.14,Fee Schedule,,112.58,,,112.58,Fee Schedule,,102.9,70,,102.9,percent of total billed charges,,135.06,,,135.06,Fee Schedule,,114.47,,,114.47,Fee Schedule,,42.75,,,42.75,Fee Schedule,,42.75,,,42.75,Fee Schedule,,42.75,,,42.75,Fee Schedule,,42.75,,,42.75,Fee Schedule,,11.56,,,11.56,Other,100% of Medicaid,11.56,,,11.56,Other,100% of Medicaid,11.56,,,11.56,Other,100% of Medicaid,11.56,,,11.56,Other,100% of Medicaid,26.02,,,26.02,Other,225% of Medicaid,17.69,,,17.69,Other,153% of Medicaid,26.02,,,26.02,Other,225% of Medicaid,16.19,,,16.19,Other,140% of Medicaid,26.02,,,26.02,Other,225% of Medicaid,30.07,,,30.07,Other,250% of Medicaid,37.47,,,37.47,Other,324% of Medicaid,24.86,,,24.86,Other,215% of Medicaid,24.86,,,24.86,Other,215% of Medicaid,14.46,,,14.46,Other,125% of Medicaid,0.01,135.06,
LACTATE (LD) (LDH) ENZYME,83615,CPT,,78083615,CDM,301,RC,,,both,,,87,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,18.18,,,18.18,Fee Schedule,,16.37,,,16.37,Fee Schedule,,46.58,,,46.58,Fee Schedule,,41.91,,,41.91,Fee Schedule,,39.61,,,39.61,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,All Other,19.03,,,19.03,Fee Schedule,,9,,,9,Other,186% of Medicaid,22.41,,,22.41,Fee Schedule,,53.94,,,53.94,Fee Schedule,,12.68,,,,Fee Schedule,,22.41,,,22.41,Fee Schedule,,53.94,,,53.94,Fee Schedule,,23.86,,,23.86,Fee Schedule,,60.9,70,,60.9,percent of total billed charges,,28.62,,,28.62,Fee Schedule,,24.26,,,24.26,Fee Schedule,,9.06,,,9.06,Fee Schedule,,9.06,,,9.06,Fee Schedule,,9.06,,,9.06,Fee Schedule,,9.06,,,9.06,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,60.9,
ASSAY OF LDH ENZYMES,83625,CPT,,78083625,CDM,301,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.5,,,38.5,Fee Schedule,,34.66,,,34.66,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,126,70,,126,percent of total billed charges,All Other,40.29,,,40.29,Fee Schedule,,18,,,18,Other,186% of Medicaid,47.45,,,47.45,Fee Schedule,,111.6,,,111.6,Fee Schedule,,26.86,,,,Fee Schedule,,47.45,,,47.45,Fee Schedule,,111.6,,,111.6,Fee Schedule,,50.52,,,50.52,Fee Schedule,,126,70,,126,percent of total billed charges,,60.61,,,60.61,Fee Schedule,,51.37,,,51.37,Fee Schedule,,19.19,,,19.19,Fee Schedule,,19.19,,,19.19,Fee Schedule,,19.19,,,19.19,Fee Schedule,,19.19,,,19.19,Fee Schedule,,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,14.53,,,14.53,Other,153% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,24.68,,,24.68,Other,250% of Medicaid,30.76,,,30.76,Other,324% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,11.87,,,11.87,Other,125% of Medicaid,0.01,126,
"LACTOFERRIN, FECAL, QUANT",83631,CPT,,78083631,CDM,301,RC,,,both,,,154,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,59.09,,,59.09,Fee Schedule,,53.2,,,53.2,Fee Schedule,,151.36,,,151.36,Fee Schedule,,136.17,,,136.17,Fee Schedule,,128.71,,,128.71,Fee Schedule,,107.8,70,,107.8,percent of total billed charges,All Other,61.83,,,61.83,Fee Schedule,,21,,,21,Other,186% of Medicaid,72.83,,,72.83,Fee Schedule,,95.48,,,95.48,Fee Schedule,,41.22,,,,Fee Schedule,,72.83,,,72.83,Fee Schedule,,95.48,,,95.48,Fee Schedule,,77.54,,,77.54,Fee Schedule,,107.8,70,,107.8,percent of total billed charges,,93.03,,,93.03,Fee Schedule,,78.85,,,78.85,Fee Schedule,,29.45,,,29.45,Fee Schedule,,29.45,,,29.45,Fee Schedule,,29.45,,,29.45,Fee Schedule,,29.45,,,29.45,Fee Schedule,,11.39,,,11.39,Other,100% of Medicaid,11.39,,,11.39,Other,100% of Medicaid,11.39,,,11.39,Other,100% of Medicaid,11.39,,,11.39,Other,100% of Medicaid,25.63,,,25.63,Other,225% of Medicaid,17.43,,,17.43,Other,153% of Medicaid,25.63,,,25.63,Other,225% of Medicaid,15.95,,,15.95,Other,140% of Medicaid,25.63,,,25.63,Other,225% of Medicaid,29.62,,,29.62,Other,250% of Medicaid,36.91,,,36.91,Other,324% of Medicaid,24.49,,,24.49,Other,215% of Medicaid,24.49,,,24.49,Other,215% of Medicaid,14.24,,,14.24,Other,125% of Medicaid,0.01,151.36,
PLACENTAL LACTOGEN,83632,CPT,,78083632,CDM,301,RC,,,both,,,202,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.86,,,60.86,Fee Schedule,,54.8,,,54.8,Fee Schedule,,155.91,,,155.91,Fee Schedule,,140.26,,,140.26,Fee Schedule,,132.58,,,132.58,Fee Schedule,,141.4,70,,141.4,percent of total billed charges,All Other,63.69,,,63.69,Fee Schedule,,33,,,33,Other,186% of Medicaid,75.02,,,75.02,Fee Schedule,,125.24,,,125.24,Fee Schedule,,42.46,,,,Fee Schedule,,75.02,,,75.02,Fee Schedule,,125.24,,,125.24,Fee Schedule,,79.87,,,79.87,Fee Schedule,,141.4,70,,141.4,percent of total billed charges,,95.82,,,95.82,Fee Schedule,,81.22,,,81.22,Fee Schedule,,30.33,,,30.33,Fee Schedule,,30.33,,,30.33,Fee Schedule,,30.33,,,30.33,Fee Schedule,,30.33,,,30.33,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,155.91,
ASSAY OF LEAD,83655,CPT,,78083655,CDM,301,RC,,,both,,,160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.45,,,36.45,Fee Schedule,,32.82,,,32.82,Fee Schedule,,93.32,,,93.32,Fee Schedule,,83.96,,,83.96,Fee Schedule,,79.36,,,79.36,Fee Schedule,,112,70,,112,percent of total billed charges,All Other,38.15,,,38.15,Fee Schedule,,23,,,23,Other,186% of Medicaid,44.93,,,44.93,Fee Schedule,,99.2,,,99.2,Fee Schedule,,25.43,,,,Fee Schedule,,44.93,,,44.93,Fee Schedule,,99.2,,,99.2,Fee Schedule,,47.83,,,47.83,Fee Schedule,,112,70,,112,percent of total billed charges,,57.39,,,57.39,Fee Schedule,,48.64,,,48.64,Fee Schedule,,18.17,,,18.17,Fee Schedule,,18.17,,,18.17,Fee Schedule,,18.17,,,18.17,Fee Schedule,,18.17,,,18.17,Fee Schedule,,12.11,,,12.11,Other,100% of Medicaid,12.11,,,12.11,Other,100% of Medicaid,12.11,,,12.11,Other,100% of Medicaid,12.11,,,12.11,Other,100% of Medicaid,27.25,,,27.25,Other,225% of Medicaid,18.53,,,18.53,Other,153% of Medicaid,27.25,,,27.25,Other,225% of Medicaid,16.95,,,16.95,Other,140% of Medicaid,27.25,,,27.25,Other,225% of Medicaid,31.49,,,31.49,Other,250% of Medicaid,39.24,,,39.24,Other,324% of Medicaid,26.04,,,26.04,Other,215% of Medicaid,26.04,,,26.04,Other,215% of Medicaid,15.14,,,15.14,Other,125% of Medicaid,0.01,112,
L/S RATIO FETAL LUNG,83661,CPT,,78083661,CDM,301,RC,,,both,,,328,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,66.19,,,66.19,Fee Schedule,,59.59,,,59.59,Fee Schedule,,169.55,,,169.55,Fee Schedule,,152.53,,,152.53,Fee Schedule,,144.18,,,144.18,Fee Schedule,,229.6,70,,229.6,percent of total billed charges,All Other,69.27,,,69.27,Fee Schedule,,41,,,41,Other,186% of Medicaid,81.58,,,81.58,Fee Schedule,,203.36,,,203.36,Fee Schedule,,46.18,,,,Fee Schedule,,81.58,,,81.58,Fee Schedule,,203.36,,,203.36,Fee Schedule,,86.86,,,86.86,Fee Schedule,,229.6,70,,229.6,percent of total billed charges,,104.21,,,104.21,Fee Schedule,,88.33,,,88.33,Fee Schedule,,32.99,,,32.99,Fee Schedule,,32.99,,,32.99,Fee Schedule,,32.99,,,32.99,Fee Schedule,,32.99,,,32.99,Fee Schedule,,21.99,,,21.99,Other,100% of Medicaid,21.99,,,21.99,Other,100% of Medicaid,21.99,,,21.99,Other,100% of Medicaid,21.99,,,21.99,Other,100% of Medicaid,49.48,,,49.48,Other,225% of Medicaid,33.64,,,33.64,Other,153% of Medicaid,49.48,,,49.48,Other,225% of Medicaid,30.79,,,30.79,Other,140% of Medicaid,49.48,,,49.48,Other,225% of Medicaid,57.17,,,57.17,Other,250% of Medicaid,71.25,,,71.25,Other,324% of Medicaid,47.28,,,47.28,Other,215% of Medicaid,47.28,,,47.28,Other,215% of Medicaid,27.49,,,27.49,Other,125% of Medicaid,0.01,229.6,
ASSAY OF LAP ENZYME,83670,CPT,,78083670,CDM,301,RC,,,both,,,92,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.53,,,29.53,Fee Schedule,,26.59,,,26.59,Fee Schedule,,55.18,,,55.18,Fee Schedule,,49.65,,,49.65,Fee Schedule,,46.93,,,46.93,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,All Other,30.9,,,30.9,Fee Schedule,,26,,,26,Other,186% of Medicaid,36.4,,,36.4,Fee Schedule,,57.04,,,57.04,Fee Schedule,,20.6,,,,Fee Schedule,,36.4,,,36.4,Fee Schedule,,57.04,,,57.04,Fee Schedule,,38.75,,,38.75,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,,46.49,,,46.49,Fee Schedule,,39.4,,,39.4,Fee Schedule,,14.72,,,14.72,Fee Schedule,,14.72,,,14.72,Fee Schedule,,14.72,,,14.72,Fee Schedule,,14.72,,,14.72,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,64.4,
ASSAY OF LIPASE,83690,CPT,,78083690,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,20.74,,,20.74,Fee Schedule,,18.67,,,18.67,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,21.7,,,21.7,Fee Schedule,,11,,,11,Other,186% of Medicaid,25.56,,,25.56,Fee Schedule,,62,,,62,Fee Schedule,,14.47,,,,Fee Schedule,,25.56,,,25.56,Fee Schedule,,62,,,62,Fee Schedule,,27.22,,,27.22,Fee Schedule,,70,70,,70,percent of total billed charges,,32.65,,,32.65,Fee Schedule,,27.67,,,27.67,Fee Schedule,,10.34,,,10.34,Fee Schedule,,10.34,,,10.34,Fee Schedule,,10.34,,,10.34,Fee Schedule,,10.34,,,10.34,Fee Schedule,,5.81,,,5.81,Other,100% of Medicaid,5.81,,,5.81,Other,100% of Medicaid,5.81,,,5.81,Other,100% of Medicaid,5.81,,,5.81,Other,100% of Medicaid,13.07,,,13.07,Other,225% of Medicaid,8.89,,,8.89,Other,153% of Medicaid,13.07,,,13.07,Other,225% of Medicaid,8.13,,,8.13,Other,140% of Medicaid,13.07,,,13.07,Other,225% of Medicaid,15.1,,,15.1,Other,250% of Medicaid,18.82,,,18.82,Other,324% of Medicaid,12.49,,,12.49,Other,215% of Medicaid,12.49,,,12.49,Other,215% of Medicaid,7.26,,,7.26,Other,125% of Medicaid,0.01,70,
ASSAY OF LIPOPROTEIN(A),83695,CPT,,78083695,CDM,301,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.1,,,43.1,Fee Schedule,,38.81,,,38.81,Fee Schedule,,99.85,,,99.85,Fee Schedule,,89.82,,,89.82,Fee Schedule,,84.91,,,84.91,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,All Other,45.11,,,45.11,Fee Schedule,,33,,,33,Other,186% of Medicaid,53.13,,,53.13,Fee Schedule,,67.58,,,67.58,Fee Schedule,,30.07,,,,Fee Schedule,,53.13,,,53.13,Fee Schedule,,67.58,,,67.58,Fee Schedule,,56.56,,,56.56,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,,67.86,,,67.86,Fee Schedule,,57.52,,,57.52,Fee Schedule,,21.48,,,21.48,Fee Schedule,,21.48,,,21.48,Fee Schedule,,21.48,,,21.48,Fee Schedule,,21.48,,,21.48,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,99.85,
LIPOPRO BLD ELECTROPHORETIC,83700,CPT,,78083700,CDM,301,RC,,,both,,,137,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,33.89,,,33.89,Fee Schedule,,30.51,,,30.51,Fee Schedule,,86.8,,,86.8,Fee Schedule,,78.09,,,78.09,Fee Schedule,,73.81,,,73.81,Fee Schedule,,95.9,70,,95.9,percent of total billed charges,All Other,35.47,,,35.47,Fee Schedule,,33,,,33,Other,186% of Medicaid,41.77,,,41.77,Fee Schedule,,84.94,,,84.94,Fee Schedule,,23.65,,,,Fee Schedule,,41.77,,,41.77,Fee Schedule,,84.94,,,84.94,Fee Schedule,,44.48,,,44.48,Fee Schedule,,95.9,70,,95.9,percent of total billed charges,,53.36,,,53.36,Fee Schedule,,45.23,,,45.23,Fee Schedule,,16.89,,,16.89,Fee Schedule,,16.89,,,16.89,Fee Schedule,,16.89,,,16.89,Fee Schedule,,16.89,,,16.89,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,95.9,
LIPOPROTEIN BLD BY NMR,83704,CPT,,78083704,CDM,301,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,102.91,,,102.91,Fee Schedule,,92.65,,,92.65,Fee Schedule,,156.78,,,156.78,Fee Schedule,,141.05,,,141.05,Fee Schedule,,133.32,,,133.32,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,107.7,,,107.7,Fee Schedule,,73,,,73,Other,186% of Medicaid,126.84,,,126.84,Fee Schedule,,119.66,,,119.66,Fee Schedule,,71.8,,,,Fee Schedule,,126.84,,,126.84,Fee Schedule,,119.66,,,119.66,Fee Schedule,,135.05,,,135.05,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,,162.03,,,162.03,Fee Schedule,,137.33,,,137.33,Fee Schedule,,51.29,,,51.29,Fee Schedule,,51.29,,,51.29,Fee Schedule,,51.29,,,51.29,Fee Schedule,,51.29,,,51.29,Fee Schedule,,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,59.9,,,59.9,Other,153% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,54.81,,,54.81,Other,140% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,101.8,,,101.8,Other,250% of Medicaid,126.86,,,126.86,Other,324% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,48.94,,,48.94,Other,125% of Medicaid,0.01,162.03,
ASSAY OF LIPOPROTEIN,83718,CPT,,78083718,CDM,301,RC,,,both,,,92,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.65,,,24.65,Fee Schedule,,22.19,,,22.19,Fee Schedule,,63.13,,,63.13,Fee Schedule,,56.79,,,56.79,Fee Schedule,,53.68,,,53.68,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,All Other,25.8,,,25.8,Fee Schedule,,9,,,9,Other,186% of Medicaid,30.38,,,30.38,Fee Schedule,,57.04,,,57.04,Fee Schedule,,17.2,,,,Fee Schedule,,30.38,,,30.38,Fee Schedule,,57.04,,,57.04,Fee Schedule,,32.35,,,32.35,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,,38.81,,,38.81,Fee Schedule,,32.9,,,32.9,Fee Schedule,,12.29,,,12.29,Fee Schedule,,12.29,,,12.29,Fee Schedule,,12.29,,,12.29,Fee Schedule,,12.29,,,12.29,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,64.4,
ASSAY OF BLOOD LIPOPROTEIN,83721,CPT,,78083721,CDM,301,RC,,,both,,,264,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,31.61,,,31.61,Fee Schedule,,28.46,,,28.46,Fee Schedule,,73.54,,,73.54,Fee Schedule,,66.16,,,66.16,Fee Schedule,,62.54,,,62.54,Fee Schedule,,184.8,70,,184.8,percent of total billed charges,All Other,33.08,,,33.08,Fee Schedule,,26,,,26,Other,186% of Medicaid,38.96,,,38.96,Fee Schedule,,163.68,,,163.68,Fee Schedule,,22.05,,,,Fee Schedule,,38.96,,,38.96,Fee Schedule,,163.68,,,163.68,Fee Schedule,,41.48,,,41.48,Fee Schedule,,184.8,70,,184.8,percent of total billed charges,,49.76,,,49.76,Fee Schedule,,42.17,,,42.17,Fee Schedule,,15.75,,,15.75,Fee Schedule,,15.75,,,15.75,Fee Schedule,,15.75,,,15.75,Fee Schedule,,15.75,,,15.75,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,184.8,
ASSAY OF MAGNESIUM,83735,CPT,,78083735,CDM,301,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,20.17,,,20.17,Fee Schedule,,18.16,,,18.16,Fee Schedule,,51.68,,,51.68,Fee Schedule,,46.49,,,46.49,Fee Schedule,,43.94,,,43.94,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,21.11,,,21.11,Fee Schedule,,9,,,9,Other,186% of Medicaid,24.86,,,24.86,Fee Schedule,,73.78,,,73.78,Fee Schedule,,14.07,,,,Fee Schedule,,24.86,,,24.86,Fee Schedule,,73.78,,,73.78,Fee Schedule,,26.47,,,26.47,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,,31.75,,,31.75,Fee Schedule,,26.91,,,26.91,Fee Schedule,,10.05,,,10.05,Fee Schedule,,10.05,,,10.05,Fee Schedule,,10.05,,,10.05,Fee Schedule,,10.05,,,10.05,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,83.3,
ASSAY OF MANGANESE,83785,CPT,,78083785,CDM,301,RC,,,both,,,205,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,80.22,,,80.22,Fee Schedule,,72.22,,,72.22,Fee Schedule,,189.66,,,189.66,Fee Schedule,,170.63,,,170.63,Fee Schedule,,161.28,,,161.28,Fee Schedule,,143.5,70,,143.5,percent of total billed charges,All Other,83.95,,,83.95,Fee Schedule,,50,,,50,Other,186% of Medicaid,98.87,,,98.87,Fee Schedule,,127.1,,,127.1,Fee Schedule,,55.97,,,,Fee Schedule,,98.87,,,98.87,Fee Schedule,,127.1,,,127.1,Fee Schedule,,105.27,,,105.27,Fee Schedule,,143.5,70,,143.5,percent of total billed charges,,126.3,,,126.3,Fee Schedule,,107.04,,,107.04,Fee Schedule,,39.98,,,39.98,Fee Schedule,,39.98,,,39.98,Fee Schedule,,39.98,,,39.98,Fee Schedule,,39.98,,,39.98,Fee Schedule,,26.65,,,26.65,Other,100% of Medicaid,26.65,,,26.65,Other,100% of Medicaid,26.65,,,26.65,Other,100% of Medicaid,26.65,,,26.65,Other,100% of Medicaid,59.96,,,59.96,Other,225% of Medicaid,40.77,,,40.77,Other,153% of Medicaid,59.96,,,59.96,Other,225% of Medicaid,37.31,,,37.31,Other,140% of Medicaid,59.96,,,59.96,Other,225% of Medicaid,69.29,,,69.29,Other,250% of Medicaid,86.35,,,86.35,Other,324% of Medicaid,57.3,,,57.3,Other,215% of Medicaid,57.3,,,57.3,Other,215% of Medicaid,33.31,,,33.31,Other,125% of Medicaid,0.01,189.66,
QUAN MASS SPECT EA SPECIM,83789,CPT,,78083789,CDM,301,RC,,,both,,,116,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,72.57,,,72.57,Fee Schedule,,65.34,,,65.34,Fee Schedule,,139.25,,,139.25,Fee Schedule,,125.27,,,125.27,Fee Schedule,,118.41,,,118.41,Fee Schedule,,81.2,70,,81.2,percent of total billed charges,All Other,75.95,,,75.95,Fee Schedule,,33,,,33,Other,186% of Medicaid,89.45,,,89.45,Fee Schedule,,71.92,,,71.92,Fee Schedule,,50.63,,,,Fee Schedule,,89.45,,,89.45,Fee Schedule,,71.92,,,71.92,Fee Schedule,,95.23,,,95.23,Fee Schedule,,81.2,70,,81.2,percent of total billed charges,,114.26,,,114.26,Fee Schedule,,96.84,,,96.84,Fee Schedule,,36.17,,,36.17,Fee Schedule,,36.17,,,36.17,Fee Schedule,,36.17,,,36.17,Fee Schedule,,36.17,,,36.17,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,139.25,
ASSAY OF MERCURY,83825,CPT,,78083825,CDM,301,RC,,,both,,,241,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,48.94,,,48.94,Fee Schedule,,44.06,,,44.06,Fee Schedule,,125.38,,,125.38,Fee Schedule,,112.8,,,112.8,Fee Schedule,,106.62,,,106.62,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,All Other,51.22,,,51.22,Fee Schedule,,30,,,30,Other,186% of Medicaid,60.32,,,60.32,Fee Schedule,,149.42,,,149.42,Fee Schedule,,34.15,,,,Fee Schedule,,60.32,,,60.32,Fee Schedule,,149.42,,,149.42,Fee Schedule,,64.23,,,64.23,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,,77.06,,,77.06,Fee Schedule,,65.31,,,65.31,Fee Schedule,,24.39,,,24.39,Fee Schedule,,24.39,,,24.39,Fee Schedule,,24.39,,,24.39,Fee Schedule,,24.39,,,24.39,Fee Schedule,,16.26,,,16.26,Other,100% of Medicaid,16.26,,,16.26,Other,100% of Medicaid,16.26,,,16.26,Other,100% of Medicaid,16.26,,,16.26,Other,100% of Medicaid,36.59,,,36.59,Other,225% of Medicaid,24.88,,,24.88,Other,153% of Medicaid,36.59,,,36.59,Other,225% of Medicaid,22.76,,,22.76,Other,140% of Medicaid,36.59,,,36.59,Other,225% of Medicaid,42.28,,,42.28,Other,250% of Medicaid,52.68,,,52.68,Other,324% of Medicaid,34.96,,,34.96,Other,215% of Medicaid,34.96,,,34.96,Other,215% of Medicaid,20.33,,,20.33,Other,125% of Medicaid,0.01,168.7,
ASSAY OF METANEPHRINES,83835,CPT,,78083835,CDM,301,RC,,,both,,,395,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.99,,,50.99,Fee Schedule,,45.91,,,45.91,Fee Schedule,,130.64,,,130.64,Fee Schedule,,117.53,,,117.53,Fee Schedule,,111.09,,,111.09,Fee Schedule,,276.5,70,,276.5,percent of total billed charges,All Other,53.36,,,53.36,Fee Schedule,,32,,,32,Other,186% of Medicaid,62.85,,,62.85,Fee Schedule,,244.9,,,244.9,Fee Schedule,,35.57,,,,Fee Schedule,,62.85,,,62.85,Fee Schedule,,244.9,,,244.9,Fee Schedule,,66.91,,,66.91,Fee Schedule,,276.5,70,,276.5,percent of total billed charges,,80.28,,,80.28,Fee Schedule,,68.04,,,68.04,Fee Schedule,,25.41,,,25.41,Fee Schedule,,25.41,,,25.41,Fee Schedule,,25.41,,,25.41,Fee Schedule,,25.41,,,25.41,Fee Schedule,,16.94,,,16.94,Other,100% of Medicaid,16.94,,,16.94,Other,100% of Medicaid,16.94,,,16.94,Other,100% of Medicaid,16.94,,,16.94,Other,100% of Medicaid,38.12,,,38.12,Other,225% of Medicaid,25.92,,,25.92,Other,153% of Medicaid,38.12,,,38.12,Other,225% of Medicaid,23.72,,,23.72,Other,140% of Medicaid,38.12,,,38.12,Other,225% of Medicaid,44.04,,,44.04,Other,250% of Medicaid,54.89,,,54.89,Other,324% of Medicaid,36.42,,,36.42,Other,215% of Medicaid,36.42,,,36.42,Other,215% of Medicaid,21.18,,,21.18,Other,125% of Medicaid,0.01,276.5,
ASSAY OF METHEMALBUMIN,83857,CPT,,78083857,CDM,301,RC,,,both,,,55,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.33,,,32.33,Fee Schedule,,29.11,,,29.11,Fee Schedule,,66.64,,,66.64,Fee Schedule,,59.95,,,59.95,Fee Schedule,,56.67,,,56.67,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,All Other,33.83,,,33.83,Fee Schedule,,26,,,26,Other,186% of Medicaid,39.85,,,39.85,Fee Schedule,,34.1,,,34.1,Fee Schedule,,22.55,,,,Fee Schedule,,39.85,,,39.85,Fee Schedule,,34.1,,,34.1,Fee Schedule,,42.42,,,42.42,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,,50.9,,,50.9,Fee Schedule,,43.14,,,43.14,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,66.64,
MUCOPOLYSACCHARIDES,83864,CPT,,78083864,CDM,301,RC,,,both,,,313,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,85.79,,,85.79,Fee Schedule,,77.24,,,77.24,Fee Schedule,,123.52,,,123.52,Fee Schedule,,111.12,,,111.12,Fee Schedule,,105.04,,,105.04,Fee Schedule,,219.1,70,,219.1,percent of total billed charges,All Other,89.78,,,89.78,Fee Schedule,,38,,,38,Other,186% of Medicaid,105.74,,,105.74,Fee Schedule,,194.06,,,194.06,Fee Schedule,,59.85,,,,Fee Schedule,,105.74,,,105.74,Fee Schedule,,194.06,,,194.06,Fee Schedule,,112.58,,,112.58,Fee Schedule,,219.1,70,,219.1,percent of total billed charges,,135.06,,,135.06,Fee Schedule,,114.47,,,114.47,Fee Schedule,,42.75,,,42.75,Fee Schedule,,42.75,,,42.75,Fee Schedule,,42.75,,,42.75,Fee Schedule,,42.75,,,42.75,Fee Schedule,,20.35,,,20.35,Other,100% of Medicaid,20.35,,,20.35,Other,100% of Medicaid,20.35,,,20.35,Other,100% of Medicaid,20.35,,,20.35,Other,100% of Medicaid,45.79,,,45.79,Other,225% of Medicaid,31.14,,,31.14,Other,153% of Medicaid,45.79,,,45.79,Other,225% of Medicaid,28.49,,,28.49,Other,140% of Medicaid,45.79,,,45.79,Other,225% of Medicaid,52.91,,,52.91,Other,250% of Medicaid,65.94,,,65.94,Other,324% of Medicaid,43.76,,,43.76,Other,215% of Medicaid,43.76,,,43.76,Other,215% of Medicaid,25.44,,,25.44,Other,125% of Medicaid,0.01,219.1,
ASSAY SYNOVIAL FLUID MUCIN,83872,CPT,,78083872,CDM,301,RC,,,both,,,47,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17.64,,,17.64,Fee Schedule,,15.88,,,15.88,Fee Schedule,,33.1,,,33.1,Fee Schedule,,29.78,,,29.78,Fee Schedule,,28.15,,,28.15,Fee Schedule,,32.9,70,,32.9,percent of total billed charges,All Other,18.46,,,18.46,Fee Schedule,,26,,,26,Other,186% of Medicaid,21.74,,,21.74,Fee Schedule,,29.14,,,29.14,Fee Schedule,,12.31,,,,Fee Schedule,,21.74,,,21.74,Fee Schedule,,29.14,,,29.14,Fee Schedule,,23.15,,,23.15,Fee Schedule,,32.9,70,,32.9,percent of total billed charges,,27.77,,,27.77,Fee Schedule,,23.54,,,23.54,Fee Schedule,,8.79,,,8.79,Fee Schedule,,8.79,,,8.79,Fee Schedule,,8.79,,,8.79,Fee Schedule,,8.79,,,8.79,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
ASSAY OF CSF PROTEIN,83873,CPT,,78083873,CDM,301,RC,,,both,,,334,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,51.77,,,51.77,Fee Schedule,,46.61,,,46.61,Fee Schedule,,132.67,,,132.67,Fee Schedule,,119.36,,,119.36,Fee Schedule,,112.82,,,112.82,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,All Other,54.18,,,54.18,Fee Schedule,,33,,,33,Other,186% of Medicaid,63.81,,,63.81,Fee Schedule,,207.08,,,207.08,Fee Schedule,,36.12,,,,Fee Schedule,,63.81,,,63.81,Fee Schedule,,207.08,,,207.08,Fee Schedule,,67.94,,,67.94,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,,81.51,,,81.51,Fee Schedule,,69.09,,,69.09,Fee Schedule,,25.8,,,25.8,Fee Schedule,,25.8,,,25.8,Fee Schedule,,25.8,,,25.8,Fee Schedule,,25.8,,,25.8,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,233.8,
ASSAY OF MYOGLOBIN,83874,CPT,,78083874,CDM,301,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.89,,,38.89,Fee Schedule,,35.01,,,35.01,Fee Schedule,,91.84,,,91.84,Fee Schedule,,82.63,,,82.63,Fee Schedule,,78.1,,,78.1,Fee Schedule,,168,70,,168,percent of total billed charges,All Other,40.7,,,40.7,Fee Schedule,,33,,,33,Other,186% of Medicaid,47.93,,,47.93,Fee Schedule,,148.8,,,148.8,Fee Schedule,,27.13,,,,Fee Schedule,,47.93,,,47.93,Fee Schedule,,148.8,,,148.8,Fee Schedule,,51.03,,,51.03,Fee Schedule,,168,70,,168,percent of total billed charges,,61.23,,,61.23,Fee Schedule,,51.89,,,51.89,Fee Schedule,,19.38,,,19.38,Fee Schedule,,19.38,,,19.38,Fee Schedule,,19.38,,,19.38,Fee Schedule,,19.38,,,19.38,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,168,
NATRIURETIC PEPTIDE,83880,CPT,,78083880,CDM,301,RC,,,both,,,230,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,118.17,,,118.17,Fee Schedule,,106.39,,,106.39,Fee Schedule,,261.78,,,261.78,Fee Schedule,,235.51,,,235.51,Fee Schedule,,222.61,,,222.61,Fee Schedule,,161,70,,161,percent of total billed charges,All Other,123.67,,,123.67,Fee Schedule,,64,,,64,Other,186% of Medicaid,145.65,,,145.65,Fee Schedule,,142.6,,,142.6,Fee Schedule,,82.45,,,,Fee Schedule,,145.65,,,145.65,Fee Schedule,,142.6,,,142.6,Fee Schedule,,155.08,,,155.08,Fee Schedule,,161,70,,161,percent of total billed charges,,186.05,,,186.05,Fee Schedule,,157.69,,,157.69,Fee Schedule,,58.89,,,58.89,Fee Schedule,,58.89,,,58.89,Fee Schedule,,58.89,,,58.89,Fee Schedule,,58.89,,,58.89,Fee Schedule,,34.41,,,34.41,Other,100% of Medicaid,34.41,,,34.41,Other,100% of Medicaid,34.41,,,34.41,Other,100% of Medicaid,34.41,,,34.41,Other,100% of Medicaid,77.42,,,77.42,Other,225% of Medicaid,52.65,,,52.65,Other,153% of Medicaid,77.42,,,77.42,Other,225% of Medicaid,48.17,,,48.17,Other,140% of Medicaid,77.42,,,77.42,Other,225% of Medicaid,89.47,,,89.47,Other,250% of Medicaid,111.49,,,111.49,Other,324% of Medicaid,73.98,,,73.98,Other,215% of Medicaid,73.98,,,73.98,Other,215% of Medicaid,43.01,,,43.01,Other,125% of Medicaid,0.01,261.78,
ASSAY NEPHELOMETRY NOT SPEC,83883,CPT,,78083883,CDM,301,RC,,,both,,,222,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,40.94,,,40.94,Fee Schedule,,36.86,,,36.86,Fee Schedule,,87.57,,,87.57,Fee Schedule,,78.78,,,78.78,Fee Schedule,,74.47,,,74.47,Fee Schedule,,155.4,70,,155.4,percent of total billed charges,All Other,42.84,,,42.84,Fee Schedule,,32,,,32,Other,186% of Medicaid,50.46,,,50.46,Fee Schedule,,137.64,,,137.64,Fee Schedule,,28.56,,,,Fee Schedule,,50.46,,,50.46,Fee Schedule,,137.64,,,137.64,Fee Schedule,,53.72,,,53.72,Fee Schedule,,155.4,70,,155.4,percent of total billed charges,,64.45,,,64.45,Fee Schedule,,54.63,,,54.63,Fee Schedule,,20.4,,,20.4,Fee Schedule,,20.4,,,20.4,Fee Schedule,,20.4,,,20.4,Fee Schedule,,20.4,,,20.4,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,155.4,
ASSAY OF NICKEL,83885,CPT,,78083885,CDM,301,RC,,,both,,,196,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,73.78,,,73.78,Fee Schedule,,66.42,,,66.42,Fee Schedule,,157.93,,,157.93,Fee Schedule,,142.08,,,142.08,Fee Schedule,,134.3,,,134.3,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,All Other,77.21,,,77.21,Fee Schedule,,47,,,47,Other,186% of Medicaid,90.93,,,90.93,Fee Schedule,,121.52,,,121.52,Fee Schedule,,51.47,,,,Fee Schedule,,90.93,,,90.93,Fee Schedule,,121.52,,,121.52,Fee Schedule,,96.81,,,96.81,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,,116.15,,,116.15,Fee Schedule,,98.45,,,98.45,Fee Schedule,,36.77,,,36.77,Fee Schedule,,36.77,,,36.77,Fee Schedule,,36.77,,,36.77,Fee Schedule,,36.77,,,36.77,Fee Schedule,,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,38.73,,,38.73,Other,153% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,35.44,,,35.44,Other,140% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,65.82,,,65.82,Other,250% of Medicaid,82.02,,,82.02,Other,324% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,31.64,,,31.64,Other,125% of Medicaid,0.01,157.93,
ASSAY OF NUCLEOTIDASE,83915,CPT,,78083915,CDM,301,RC,,,both,,,144,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,33.56,,,33.56,Fee Schedule,,30.22,,,30.22,Fee Schedule,,86.04,,,86.04,Fee Schedule,,77.4,,,77.4,Fee Schedule,,73.16,,,73.16,Fee Schedule,,100.8,70,,100.8,percent of total billed charges,All Other,35.12,,,35.12,Fee Schedule,,33,,,33,Other,186% of Medicaid,41.37,,,41.37,Fee Schedule,,89.28,,,89.28,Fee Schedule,,23.42,,,,Fee Schedule,,41.37,,,41.37,Fee Schedule,,89.28,,,89.28,Fee Schedule,,44.04,,,44.04,Fee Schedule,,100.8,70,,100.8,percent of total billed charges,,52.84,,,52.84,Fee Schedule,,44.79,,,44.79,Fee Schedule,,16.73,,,16.73,Fee Schedule,,16.73,,,16.73,Fee Schedule,,16.73,,,16.73,Fee Schedule,,16.73,,,16.73,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,100.8,
OLIGOCLONAL BANDS,83916,CPT,,78083916,CDM,301,RC,,,both,,,319,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,82.44,,,82.44,Fee Schedule,,74.23,,,74.23,Fee Schedule,,155.08,,,155.08,Fee Schedule,,139.52,,,139.52,Fee Schedule,,131.88,,,131.88,Fee Schedule,,223.3,70,,223.3,percent of total billed charges,All Other,86.28,,,86.28,Fee Schedule,,73,,,73,Other,186% of Medicaid,101.62,,,101.62,Fee Schedule,,197.78,,,197.78,Fee Schedule,,57.52,,,,Fee Schedule,,101.62,,,101.62,Fee Schedule,,197.78,,,197.78,Fee Schedule,,108.19,,,108.19,Fee Schedule,,223.3,70,,223.3,percent of total billed charges,,129.8,,,129.8,Fee Schedule,,110.02,,,110.02,Fee Schedule,,41.09,,,41.09,Fee Schedule,,41.09,,,41.09,Fee Schedule,,41.09,,,41.09,Fee Schedule,,41.09,,,41.09,Fee Schedule,,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,59.9,,,59.9,Other,153% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,54.81,,,54.81,Other,140% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,101.8,,,101.8,Other,250% of Medicaid,126.86,,,126.86,Other,324% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,48.94,,,48.94,Other,125% of Medicaid,0.01,223.3,
QUANTIT ORGANIC ACIDS EA SPECIM,83918,CPT,,78083918,CDM,301,RC,,,both,,,99,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,71.04,,,71.04,Fee Schedule,,63.96,,,63.96,Fee Schedule,,126.92,,,126.92,Fee Schedule,,114.18,,,114.18,Fee Schedule,,107.93,,,107.93,Fee Schedule,,69.3,70,,69.3,percent of total billed charges,All Other,74.34,,,74.34,Fee Schedule,,43,,,43,Other,186% of Medicaid,87.56,,,87.56,Fee Schedule,,61.38,,,61.38,Fee Schedule,,49.56,,,,Fee Schedule,,87.56,,,87.56,Fee Schedule,,61.38,,,61.38,Fee Schedule,,93.22,,,93.22,Fee Schedule,,69.3,70,,69.3,percent of total billed charges,,111.84,,,111.84,Fee Schedule,,94.79,,,94.79,Fee Schedule,,35.4,,,35.4,Fee Schedule,,35.4,,,35.4,Fee Schedule,,35.4,,,35.4,Fee Schedule,,35.4,,,35.4,Fee Schedule,,22.98,,,22.98,Other,100% of Medicaid,22.98,,,22.98,Other,100% of Medicaid,22.98,,,22.98,Other,100% of Medicaid,22.98,,,22.98,Other,100% of Medicaid,51.7,,,51.7,Other,225% of Medicaid,35.16,,,35.16,Other,153% of Medicaid,51.7,,,51.7,Other,225% of Medicaid,32.17,,,32.17,Other,140% of Medicaid,51.7,,,51.7,Other,225% of Medicaid,59.74,,,59.74,Other,250% of Medicaid,74.45,,,74.45,Other,324% of Medicaid,49.4,,,49.4,Other,215% of Medicaid,49.4,,,49.4,Other,215% of Medicaid,28.72,,,28.72,Other,125% of Medicaid,0.01,126.92,
ORGANIC ACIDS EA SPEC QUAL,83919,CPT,,78083919,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,49.51,,,49.51,Fee Schedule,,44.58,,,44.58,Fee Schedule,,126.92,,,126.92,Fee Schedule,,114.18,,,114.18,Fee Schedule,,107.93,,,107.93,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,51.82,,,51.82,Fee Schedule,,31,,,31,Other,186% of Medicaid,61.03,,,61.03,Fee Schedule,,66.34,,,66.34,Fee Schedule,,34.55,,,,Fee Schedule,,61.03,,,61.03,Fee Schedule,,66.34,,,66.34,Fee Schedule,,64.98,,,64.98,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,,77.96,,,77.96,Fee Schedule,,66.07,,,66.07,Fee Schedule,,24.68,,,24.68,Fee Schedule,,24.68,,,24.68,Fee Schedule,,24.68,,,24.68,Fee Schedule,,24.68,,,24.68,Fee Schedule,,16.45,,,16.45,Other,100% of Medicaid,16.45,,,16.45,Other,100% of Medicaid,16.45,,,16.45,Other,100% of Medicaid,16.45,,,16.45,Other,100% of Medicaid,37.01,,,37.01,Other,225% of Medicaid,25.17,,,25.17,Other,153% of Medicaid,37.01,,,37.01,Other,225% of Medicaid,23.03,,,23.03,Other,140% of Medicaid,37.01,,,37.01,Other,225% of Medicaid,42.77,,,42.77,Other,250% of Medicaid,53.3,,,53.3,Other,324% of Medicaid,35.37,,,35.37,Other,215% of Medicaid,35.37,,,35.37,Other,215% of Medicaid,20.56,,,20.56,Other,125% of Medicaid,0.01,126.92,
ORGANIC ACID SINGLE QUANT,83921,CPT,,78083921,CDM,301,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,63.84,,,63.84,Fee Schedule,,57.48,,,57.48,Fee Schedule,,126.92,,,126.92,Fee Schedule,,114.18,,,114.18,Fee Schedule,,107.93,,,107.93,Fee Schedule,,109.9,70,,109.9,percent of total billed charges,All Other,66.81,,,66.81,Fee Schedule,,39,,,39,Other,186% of Medicaid,78.69,,,78.69,Fee Schedule,,97.34,,,97.34,Fee Schedule,,44.54,,,,Fee Schedule,,78.69,,,78.69,Fee Schedule,,97.34,,,97.34,Fee Schedule,,83.78,,,83.78,Fee Schedule,,109.9,70,,109.9,percent of total billed charges,,100.51,,,100.51,Fee Schedule,,85.19,,,85.19,Fee Schedule,,31.82,,,31.82,Fee Schedule,,31.82,,,31.82,Fee Schedule,,31.82,,,31.82,Fee Schedule,,31.82,,,31.82,Fee Schedule,,21.21,,,21.21,Other,100% of Medicaid,21.21,,,21.21,Other,100% of Medicaid,21.21,,,21.21,Other,100% of Medicaid,21.21,,,21.21,Other,100% of Medicaid,47.72,,,47.72,Other,225% of Medicaid,32.45,,,32.45,Other,153% of Medicaid,47.72,,,47.72,Other,225% of Medicaid,29.69,,,29.69,Other,140% of Medicaid,47.72,,,47.72,Other,225% of Medicaid,55.15,,,55.15,Other,250% of Medicaid,68.72,,,68.72,Other,324% of Medicaid,45.6,,,45.6,Other,215% of Medicaid,45.6,,,45.6,Other,215% of Medicaid,26.51,,,26.51,Other,125% of Medicaid,0.01,126.92,
ASSAY OF BLOOD OSMOLALITY,83930,CPT,,78083930,CDM,301,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.9,,,19.9,Fee Schedule,,17.91,,,17.91,Fee Schedule,,50.96,,,50.96,Fee Schedule,,45.85,,,45.85,Fee Schedule,,43.34,,,43.34,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,All Other,20.82,,,20.82,Fee Schedule,,11,,,11,Other,186% of Medicaid,24.52,,,24.52,Fee Schedule,,79.98,,,79.98,Fee Schedule,,13.88,,,,Fee Schedule,,24.52,,,24.52,Fee Schedule,,79.98,,,79.98,Fee Schedule,,26.11,,,26.11,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,,31.33,,,31.33,Fee Schedule,,26.55,,,26.55,Fee Schedule,,9.92,,,9.92,Fee Schedule,,9.92,,,9.92,Fee Schedule,,9.92,,,9.92,Fee Schedule,,9.92,,,9.92,Fee Schedule,,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,9.33,,,9.33,Other,153% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,8.54,,,8.54,Other,140% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,15.86,,,15.86,Other,250% of Medicaid,19.77,,,19.77,Other,324% of Medicaid,13.12,,,13.12,Other,215% of Medicaid,13.12,,,13.12,Other,215% of Medicaid,7.63,,,7.63,Other,125% of Medicaid,0.01,90.3,
OSMOLALITY URINE,83935,CPT,,78083935,CDM,301,RC,,,both,,,42,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,20.53,,,20.53,Fee Schedule,,18.48,,,18.48,Fee Schedule,,52.55,,,52.55,Fee Schedule,,47.28,,,47.28,Fee Schedule,,44.69,,,44.69,Fee Schedule,,29.4,70,,29.4,percent of total billed charges,All Other,21.48,,,21.48,Fee Schedule,,11,,,11,Other,186% of Medicaid,25.3,,,25.3,Fee Schedule,,26.04,,,26.04,Fee Schedule,,14.32,,,,Fee Schedule,,25.3,,,25.3,Fee Schedule,,26.04,,,26.04,Fee Schedule,,26.94,,,26.94,Fee Schedule,,29.4,70,,29.4,percent of total billed charges,,32.32,,,32.32,Fee Schedule,,27.39,,,27.39,Fee Schedule,,10.23,,,10.23,Fee Schedule,,10.23,,,10.23,Fee Schedule,,10.23,,,10.23,Fee Schedule,,10.23,,,10.23,Fee Schedule,,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,6.1,,,6.1,Other,100% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,9.33,,,9.33,Other,153% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,8.54,,,8.54,Other,140% of Medicaid,13.73,,,13.73,Other,225% of Medicaid,15.86,,,15.86,Other,250% of Medicaid,19.77,,,19.77,Other,324% of Medicaid,13.12,,,13.12,Other,215% of Medicaid,13.12,,,13.12,Other,215% of Medicaid,7.63,,,7.63,Other,125% of Medicaid,0.01,52.55,
OSTEOCALCIN,83937,CPT,,78083937,CDM,301,RC,,,both,,,177,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,89.85,,,89.85,Fee Schedule,,80.89,,,80.89,Fee Schedule,,230.21,,,230.21,Fee Schedule,,207.11,,,207.11,Fee Schedule,,195.77,,,195.77,Fee Schedule,,123.9,70,,123.9,percent of total billed charges,All Other,94.03,,,94.03,Fee Schedule,,76,,,76,Other,186% of Medicaid,110.74,,,110.74,Fee Schedule,,109.74,,,109.74,Fee Schedule,,62.69,,,,Fee Schedule,,110.74,,,110.74,Fee Schedule,,109.74,,,109.74,Fee Schedule,,117.91,,,117.91,Fee Schedule,,123.9,70,,123.9,percent of total billed charges,,141.46,,,141.46,Fee Schedule,,119.9,,,119.9,Fee Schedule,,44.78,,,44.78,Fee Schedule,,44.78,,,44.78,Fee Schedule,,44.78,,,44.78,Fee Schedule,,44.78,,,44.78,Fee Schedule,,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,62.76,,,62.76,Other,153% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,57.43,,,57.43,Other,140% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,106.65,,,106.65,Other,250% of Medicaid,132.9,,,132.9,Other,324% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,51.27,,,51.27,Other,125% of Medicaid,0.01,230.21,
ASSAY OF OXALATE,83945,CPT,,78083945,CDM,301,RC,,,both,,,174,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.49,,,43.49,Fee Schedule,,39.16,,,39.16,Fee Schedule,,85.32,,,85.32,Fee Schedule,,76.76,,,76.76,Fee Schedule,,72.56,,,72.56,Fee Schedule,,121.8,70,,121.8,percent of total billed charges,All Other,45.52,,,45.52,Fee Schedule,,22,,,22,Other,186% of Medicaid,53.61,,,53.61,Fee Schedule,,107.88,,,107.88,Fee Schedule,,30.35,,,,Fee Schedule,,53.61,,,53.61,Fee Schedule,,107.88,,,107.88,Fee Schedule,,57.08,,,57.08,Fee Schedule,,121.8,70,,121.8,percent of total billed charges,,68.48,,,68.48,Fee Schedule,,58.04,,,58.04,Fee Schedule,,21.68,,,21.68,Fee Schedule,,21.68,,,21.68,Fee Schedule,,21.68,,,21.68,Fee Schedule,,21.68,,,21.68,Fee Schedule,,12.02,,,12.02,Other,100% of Medicaid,12.02,,,12.02,Other,100% of Medicaid,12.02,,,12.02,Other,100% of Medicaid,12.02,,,12.02,Other,100% of Medicaid,27.04,,,27.04,Other,225% of Medicaid,18.39,,,18.39,Other,153% of Medicaid,27.04,,,27.04,Other,225% of Medicaid,16.83,,,16.83,Other,140% of Medicaid,27.04,,,27.04,Other,225% of Medicaid,31.25,,,31.25,Other,250% of Medicaid,38.94,,,38.94,Other,324% of Medicaid,25.84,,,25.84,Other,215% of Medicaid,25.84,,,25.84,Other,215% of Medicaid,15.02,,,15.02,Other,125% of Medicaid,0.01,121.8,
ONCOPROTEIN HER-2/NEU,83950,CPT,,78083950,CDM,301,RC,,,both,,,383,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.87,,,193.87,Fee Schedule,,174.55,,,174.55,Fee Schedule,,485.14,,,485.14,Fee Schedule,,436.45,,,436.45,Fee Schedule,,412.55,,,412.55,Fee Schedule,,268.1,70,,268.1,percent of total billed charges,All Other,202.89,,,202.89,Fee Schedule,,120,,,120,Other,186% of Medicaid,238.96,,,238.96,Fee Schedule,,237.46,,,237.46,Fee Schedule,,135.26,,,,Fee Schedule,,238.96,,,238.96,Fee Schedule,,237.46,,,237.46,Fee Schedule,,254.42,,,254.42,Fee Schedule,,268.1,70,,268.1,percent of total billed charges,,305.24,,,305.24,Fee Schedule,,258.71,,,258.71,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,98.55,,,98.55,Other,153% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,90.17,,,90.17,Other,140% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,167.47,,,167.47,Other,250% of Medicaid,208.69,,,208.69,Other,324% of Medicaid,138.48,,,138.48,Other,215% of Medicaid,138.48,,,138.48,Other,215% of Medicaid,80.51,,,80.51,Other,125% of Medicaid,0.01,485.14,
ONCOPROTEIN DCP,83951,CPT,,78083951,CDM,301,RC,,,both,,,146,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,193.87,,,193.87,Fee Schedule,,174.55,,,174.55,Fee Schedule,,485.14,,,485.14,Fee Schedule,,436.45,,,436.45,Fee Schedule,,412.55,,,412.55,Fee Schedule,,102.2,70,,102.2,percent of total billed charges,All Other,202.89,,,202.89,Fee Schedule,,120,,,120,Other,186% of Medicaid,238.96,,,238.96,Fee Schedule,,90.52,,,90.52,Fee Schedule,,135.26,,,,Fee Schedule,,238.96,,,238.96,Fee Schedule,,90.52,,,90.52,Fee Schedule,,254.42,,,254.42,Fee Schedule,,102.2,70,,102.2,percent of total billed charges,,305.24,,,305.24,Fee Schedule,,258.71,,,258.71,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,96.62,,,96.62,Fee Schedule,,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,64.41,,,64.41,Other,100% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,98.55,,,98.55,Other,153% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,90.17,,,90.17,Other,140% of Medicaid,144.92,,,144.92,Other,225% of Medicaid,167.47,,,167.47,Other,250% of Medicaid,208.69,,,208.69,Other,324% of Medicaid,138.48,,,138.48,Other,215% of Medicaid,138.48,,,138.48,Other,215% of Medicaid,80.51,,,80.51,Other,125% of Medicaid,0.01,485.14,
ASSAY PH BODY FLUID NOS,83986,CPT,,78083986,CDM,301,RC,,,both,,,36,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,10.78,,,10.78,Fee Schedule,,9.7,,,9.7,Fee Schedule,,25.81,,,25.81,Fee Schedule,,23.22,,,23.22,Fee Schedule,,21.95,,,21.95,Fee Schedule,,25.2,70,,25.2,percent of total billed charges,All Other,11.28,,,11.28,Fee Schedule,,26,,,26,Other,186% of Medicaid,13.28,,,13.28,Fee Schedule,,22.32,,,22.32,Fee Schedule,,7.52,,,,Fee Schedule,,13.28,,,13.28,Fee Schedule,,22.32,,,22.32,Fee Schedule,,14.14,,,14.14,Fee Schedule,,25.2,70,,25.2,percent of total billed charges,,16.97,,,16.97,Fee Schedule,,14.38,,,14.38,Fee Schedule,,5.37,,,5.37,Fee Schedule,,5.37,,,5.37,Fee Schedule,,5.37,,,5.37,Fee Schedule,,5.37,,,5.37,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
ASSAY FOR PHENCYCLIDINE,83992,CPT,,78083992,CDM,301,RC,,,both,,,168,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,109.2,65,,109.2,percent of total billed charges,All Other,99.12,59,,99.12,percent of total billed charges,All Other,113.33,,,113.33,Fee Schedule,,101.95,,,101.95,Fee Schedule,,96.37,,,96.37,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,All Other,114.24,68,,114.24,percent of total billed charges,All Other,47,,,47,Other,186% of Medicaid,139.44,80,,139.44,percent of total billed charges,All Other,104.16,83,,104.16,percent of total billed charges,All Other,92.4,83,,,percent of total billed charges,All Other,139.44,80,,139.44,percent of total billed charges,All Other,104.16,83,,104.16,percent of total billed charges,All Other,134.4,80,,134.4,percent of total billed charges,All Other,117.6,70,,117.6,percent of total billed charges,,109.2,65,,109.2,percent of total billed charges,All Other,109.2,65,,109.2,percent of total billed charges,All Other,64.97,,,64.97,Fee Schedule,,64.97,,,64.97,Fee Schedule,,64.97,,,64.97,Fee Schedule,,64.97,,,64.97,Fee Schedule,,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,38.73,,,38.73,Other,153% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,35.44,,,35.44,Other,140% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,65.82,,,65.82,Other,250% of Medicaid,82.02,,,82.02,Other,324% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,31.64,,,31.64,Other,125% of Medicaid,0.01,139.44,
ASSAY FOR CALPROTECTIN FECAL,83993,CPT,,78083993,CDM,301,RC,,,both,,,125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,59.09,,,59.09,Fee Schedule,,53.2,,,53.2,Fee Schedule,,151.36,,,151.36,Fee Schedule,,136.17,,,136.17,Fee Schedule,,128.71,,,128.71,Fee Schedule,,87.5,70,,87.5,percent of total billed charges,All Other,61.83,,,61.83,Fee Schedule,,21,,,21,Other,186% of Medicaid,72.83,,,72.83,Fee Schedule,,77.5,,,77.5,Fee Schedule,,41.22,,,,Fee Schedule,,72.83,,,72.83,Fee Schedule,,77.5,,,77.5,Fee Schedule,,77.54,,,77.54,Fee Schedule,,87.5,70,,87.5,percent of total billed charges,,93.03,,,93.03,Fee Schedule,,78.85,,,78.85,Fee Schedule,,29.45,,,29.45,Fee Schedule,,29.45,,,29.45,Fee Schedule,,29.45,,,29.45,Fee Schedule,,29.45,,,29.45,Fee Schedule,,11.39,,,11.39,Other,100% of Medicaid,11.39,,,11.39,Other,100% of Medicaid,11.39,,,11.39,Other,100% of Medicaid,11.39,,,11.39,Other,100% of Medicaid,25.63,,,25.63,Other,225% of Medicaid,17.43,,,17.43,Other,153% of Medicaid,25.63,,,25.63,Other,225% of Medicaid,15.95,,,15.95,Other,140% of Medicaid,25.63,,,25.63,Other,225% of Medicaid,29.62,,,29.62,Other,250% of Medicaid,36.91,,,36.91,Other,324% of Medicaid,24.49,,,24.49,Other,215% of Medicaid,24.49,,,24.49,Other,215% of Medicaid,14.24,,,14.24,Other,125% of Medicaid,0.01,151.36,
ASSAY OF BLOOD PKU,84030,CPT,,78084030,CDM,301,RC,,,both,,,203,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,16.56,,,16.56,Fee Schedule,,14.91,,,14.91,Fee Schedule,,42.42,,,42.42,Fee Schedule,,38.16,,,38.16,Fee Schedule,,36.07,,,36.07,Fee Schedule,,142.1,70,,142.1,percent of total billed charges,All Other,17.33,,,17.33,Fee Schedule,,10,,,10,Other,186% of Medicaid,20.41,,,20.41,Fee Schedule,,125.86,,,125.86,Fee Schedule,,11.55,,,,Fee Schedule,,20.41,,,20.41,Fee Schedule,,125.86,,,125.86,Fee Schedule,,21.73,,,21.73,Fee Schedule,,142.1,70,,142.1,percent of total billed charges,,26.06,,,26.06,Fee Schedule,,22.09,,,22.09,Fee Schedule,,8.25,,,8.25,Fee Schedule,,8.25,,,8.25,Fee Schedule,,8.25,,,8.25,Fee Schedule,,8.25,,,8.25,Fee Schedule,,5.5,,,5.5,Other,100% of Medicaid,5.5,,,5.5,Other,100% of Medicaid,5.5,,,5.5,Other,100% of Medicaid,5.5,,,5.5,Other,100% of Medicaid,12.38,,,12.38,Other,225% of Medicaid,8.42,,,8.42,Other,153% of Medicaid,12.38,,,12.38,Other,225% of Medicaid,7.7,,,7.7,Other,140% of Medicaid,12.38,,,12.38,Other,225% of Medicaid,14.3,,,14.3,Other,250% of Medicaid,17.82,,,17.82,Other,324% of Medicaid,11.83,,,11.83,Other,215% of Medicaid,11.83,,,11.83,Other,215% of Medicaid,6.88,,,6.88,Other,125% of Medicaid,0.01,142.1,
ASSAY ACID PHOSPHATASE,84060,CPT,,78084060,CDM,301,RC,,,both,,,91,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23,,,23,Fee Schedule,,20.7,,,20.7,Fee Schedule,,56.94,,,56.94,Fee Schedule,,51.22,,,51.22,Fee Schedule,,48.42,,,48.42,Fee Schedule,,63.7,70,,63.7,percent of total billed charges,All Other,24.07,,,24.07,Fee Schedule,,9,,,9,Other,186% of Medicaid,28.34,,,28.34,Fee Schedule,,56.42,,,56.42,Fee Schedule,,16.04,,,,Fee Schedule,,28.34,,,28.34,Fee Schedule,,56.42,,,56.42,Fee Schedule,,30.18,,,30.18,Fee Schedule,,63.7,70,,63.7,percent of total billed charges,,36.21,,,36.21,Fee Schedule,,30.69,,,30.69,Fee Schedule,,11.46,,,11.46,Fee Schedule,,11.46,,,11.46,Fee Schedule,,11.46,,,11.46,Fee Schedule,,11.46,,,11.46,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,63.7,
ASSAY PROSTATE PHOSPHATASE,84066,CPT,,78084066,CDM,301,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,29.08,,,29.08,Fee Schedule,,26.18,,,26.18,Fee Schedule,,74.47,,,74.47,Fee Schedule,,67,,,67,Fee Schedule,,63.33,,,63.33,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,30.43,,,30.43,Fee Schedule,,18,,,18,Other,186% of Medicaid,35.84,,,35.84,Fee Schedule,,82.46,,,82.46,Fee Schedule,,20.29,,,,Fee Schedule,,35.84,,,35.84,Fee Schedule,,82.46,,,82.46,Fee Schedule,,38.16,,,38.16,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,,45.78,,,45.78,Fee Schedule,,38.8,,,38.8,Fee Schedule,,14.49,,,14.49,Fee Schedule,,14.49,,,14.49,Fee Schedule,,14.49,,,14.49,Fee Schedule,,14.49,,,14.49,Fee Schedule,,9.66,,,9.66,Other,100% of Medicaid,9.66,,,9.66,Other,100% of Medicaid,9.66,,,9.66,Other,100% of Medicaid,9.66,,,9.66,Other,100% of Medicaid,21.74,,,21.74,Other,225% of Medicaid,14.78,,,14.78,Other,153% of Medicaid,21.74,,,21.74,Other,225% of Medicaid,13.52,,,13.52,Other,140% of Medicaid,21.74,,,21.74,Other,225% of Medicaid,25.12,,,25.12,Other,250% of Medicaid,31.3,,,31.3,Other,324% of Medicaid,20.77,,,20.77,Other,215% of Medicaid,20.77,,,20.77,Other,215% of Medicaid,12.08,,,12.08,Other,125% of Medicaid,0.01,93.1,
ASSAY ALKALINE PHOSPHATASE,84075,CPT,,78084075,CDM,301,RC,,,both,,,89,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.59,,,15.59,Fee Schedule,,14.04,,,14.04,Fee Schedule,,39.89,,,39.89,Fee Schedule,,35.89,,,35.89,Fee Schedule,,33.92,,,33.92,Fee Schedule,,62.3,70,,62.3,percent of total billed charges,All Other,16.32,,,16.32,Fee Schedule,,9,,,9,Other,186% of Medicaid,19.22,,,19.22,Fee Schedule,,55.18,,,55.18,Fee Schedule,,10.88,,,,Fee Schedule,,19.22,,,19.22,Fee Schedule,,55.18,,,55.18,Fee Schedule,,20.46,,,20.46,Fee Schedule,,62.3,70,,62.3,percent of total billed charges,,24.55,,,24.55,Fee Schedule,,20.81,,,20.81,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,62.3,
ASSAY ALKALINE PHOSPHATASES,84080,CPT,,78084080,CDM,301,RC,,,both,,,95,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,44.49,,,44.49,Fee Schedule,,40.05,,,40.05,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,66.5,70,,66.5,percent of total billed charges,All Other,46.56,,,46.56,Fee Schedule,,19,,,19,Other,186% of Medicaid,54.83,,,54.83,Fee Schedule,,58.9,,,58.9,Fee Schedule,,31.04,,,,Fee Schedule,,54.83,,,54.83,Fee Schedule,,58.9,,,58.9,Fee Schedule,,58.38,,,58.38,Fee Schedule,,66.5,70,,66.5,percent of total billed charges,,70.04,,,70.04,Fee Schedule,,59.37,,,59.37,Fee Schedule,,22.17,,,22.17,Fee Schedule,,22.17,,,22.17,Fee Schedule,,22.17,,,22.17,Fee Schedule,,22.17,,,22.17,Fee Schedule,,10.01,,,10.01,Other,100% of Medicaid,10.01,,,10.01,Other,100% of Medicaid,10.01,,,10.01,Other,100% of Medicaid,10.01,,,10.01,Other,100% of Medicaid,22.52,,,22.52,Other,225% of Medicaid,15.31,,,15.31,Other,153% of Medicaid,22.52,,,22.52,Other,225% of Medicaid,14.01,,,14.01,Other,140% of Medicaid,22.52,,,22.52,Other,225% of Medicaid,26.02,,,26.02,Other,250% of Medicaid,32.43,,,32.43,Other,324% of Medicaid,21.52,,,21.52,Other,215% of Medicaid,21.52,,,21.52,Other,215% of Medicaid,12.51,,,12.51,Other,125% of Medicaid,0.01,70.04,
AMNIOTIC FLUID ENZYME TEST,84081,CPT,,78084081,CDM,301,RC,,,both,,,170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,49.73,,,49.73,Fee Schedule,,44.77,,,44.77,Fee Schedule,,127.41,,,127.41,Fee Schedule,,114.62,,,114.62,Fee Schedule,,108.35,,,108.35,Fee Schedule,,119,70,,119,percent of total billed charges,All Other,52.04,,,52.04,Fee Schedule,,15,,,15,Other,186% of Medicaid,61.29,,,61.29,Fee Schedule,,105.4,,,105.4,Fee Schedule,,34.69,,,,Fee Schedule,,61.29,,,61.29,Fee Schedule,,105.4,,,105.4,Fee Schedule,,65.25,,,65.25,Fee Schedule,,119,70,,119,percent of total billed charges,,78.29,,,78.29,Fee Schedule,,66.35,,,66.35,Fee Schedule,,24.78,,,24.78,Fee Schedule,,24.78,,,24.78,Fee Schedule,,24.78,,,24.78,Fee Schedule,,24.78,,,24.78,Fee Schedule,,8.05,,,8.05,Other,100% of Medicaid,8.05,,,8.05,Other,100% of Medicaid,8.05,,,8.05,Other,100% of Medicaid,8.05,,,8.05,Other,100% of Medicaid,18.11,,,18.11,Other,225% of Medicaid,12.32,,,12.32,Other,153% of Medicaid,18.11,,,18.11,Other,225% of Medicaid,11.27,,,11.27,Other,140% of Medicaid,18.11,,,18.11,Other,225% of Medicaid,20.93,,,20.93,Other,250% of Medicaid,26.08,,,26.08,Other,324% of Medicaid,17.31,,,17.31,Other,215% of Medicaid,17.31,,,17.31,Other,215% of Medicaid,10.06,,,10.06,Other,125% of Medicaid,0.01,127.41,
ASSAY OF PHOSPHORUS,84100,CPT,,78084100,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.27,,,14.27,Fee Schedule,,12.85,,,12.85,Fee Schedule,,36.55,,,36.55,Fee Schedule,,32.88,,,32.88,Fee Schedule,,31.08,,,31.08,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,14.93,,,14.93,Fee Schedule,,9,,,9,Other,186% of Medicaid,17.59,,,17.59,Fee Schedule,,62,,,62,Fee Schedule,,9.95,,,,Fee Schedule,,17.59,,,17.59,Fee Schedule,,62,,,62,Fee Schedule,,18.72,,,18.72,Fee Schedule,,70,70,,70,percent of total billed charges,,22.46,,,22.46,Fee Schedule,,19.04,,,19.04,Fee Schedule,,7.11,,,7.11,Fee Schedule,,7.11,,,7.11,Fee Schedule,,7.11,,,7.11,Fee Schedule,,7.11,,,7.11,Fee Schedule,,4.74,,,4.74,Other,100% of Medicaid,4.74,,,4.74,Other,100% of Medicaid,4.74,,,4.74,Other,100% of Medicaid,4.74,,,4.74,Other,100% of Medicaid,10.67,,,10.67,Other,225% of Medicaid,7.25,,,7.25,Other,153% of Medicaid,10.67,,,10.67,Other,225% of Medicaid,6.64,,,6.64,Other,140% of Medicaid,10.67,,,10.67,Other,225% of Medicaid,12.32,,,12.32,Other,250% of Medicaid,15.36,,,15.36,Other,324% of Medicaid,10.19,,,10.19,Other,215% of Medicaid,10.19,,,10.19,Other,215% of Medicaid,5.93,,,5.93,Other,125% of Medicaid,0.01,70,
ASSAY OF URINE PHOSPHORUS,84105,CPT,,78084105,CDM,301,RC,,,both,,,72,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,17.4,,,17.4,Fee Schedule,,15.66,,,15.66,Fee Schedule,,39.89,,,39.89,Fee Schedule,,35.89,,,35.89,Fee Schedule,,33.92,,,33.92,Fee Schedule,,50.4,70,,50.4,percent of total billed charges,All Other,18.21,,,18.21,Fee Schedule,,9,,,9,Other,186% of Medicaid,21.44,,,21.44,Fee Schedule,,44.64,,,44.64,Fee Schedule,,12.14,,,,Fee Schedule,,21.44,,,21.44,Fee Schedule,,44.64,,,44.64,Fee Schedule,,22.83,,,22.83,Fee Schedule,,50.4,70,,50.4,percent of total billed charges,,27.39,,,27.39,Fee Schedule,,23.22,,,23.22,Fee Schedule,,8.67,,,8.67,Fee Schedule,,8.67,,,8.67,Fee Schedule,,8.67,,,8.67,Fee Schedule,,8.67,,,8.67,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,50.4,
ASSAY OF PORPHOBILINOGEN,84110,CPT,,78084110,CDM,301,RC,,,both,,,138,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,25.4,,,25.4,Fee Schedule,,22.87,,,22.87,Fee Schedule,,65.1,,,65.1,Fee Schedule,,58.57,,,58.57,Fee Schedule,,55.36,,,55.36,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,All Other,26.59,,,26.59,Fee Schedule,,16,,,16,Other,186% of Medicaid,31.31,,,31.31,Fee Schedule,,85.56,,,85.56,Fee Schedule,,17.72,,,,Fee Schedule,,31.31,,,31.31,Fee Schedule,,85.56,,,85.56,Fee Schedule,,33.34,,,33.34,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,,40,,,40,Fee Schedule,,33.9,,,33.9,Fee Schedule,,12.66,,,12.66,Fee Schedule,,12.66,,,12.66,Fee Schedule,,12.66,,,12.66,Fee Schedule,,12.66,,,12.66,Fee Schedule,,8.44,,,8.44,Other,100% of Medicaid,8.44,,,8.44,Other,100% of Medicaid,8.44,,,8.44,Other,100% of Medicaid,8.44,,,8.44,Other,100% of Medicaid,18.99,,,18.99,Other,225% of Medicaid,12.91,,,12.91,Other,153% of Medicaid,18.99,,,18.99,Other,225% of Medicaid,11.82,,,11.82,Other,140% of Medicaid,18.99,,,18.99,Other,225% of Medicaid,21.94,,,21.94,Other,250% of Medicaid,27.35,,,27.35,Other,324% of Medicaid,18.15,,,18.15,Other,215% of Medicaid,18.15,,,18.15,Other,215% of Medicaid,10.55,,,10.55,Other,125% of Medicaid,0.01,96.6,
ASSAY OF URINE PORPHYRINS,84120,CPT,,78084120,CDM,301,RC,,,both,,,243,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,44.28,,,44.28,Fee Schedule,,39.86,,,39.86,Fee Schedule,,97.43,,,97.43,Fee Schedule,,87.66,,,87.66,Fee Schedule,,82.85,,,82.85,Fee Schedule,,170.1,70,,170.1,percent of total billed charges,All Other,46.34,,,46.34,Fee Schedule,,27,,,27,Other,186% of Medicaid,54.57,,,54.57,Fee Schedule,,150.66,,,150.66,Fee Schedule,,30.89,,,,Fee Schedule,,54.57,,,54.57,Fee Schedule,,150.66,,,150.66,Fee Schedule,,58.1,,,58.1,Fee Schedule,,170.1,70,,170.1,percent of total billed charges,,69.71,,,69.71,Fee Schedule,,59.08,,,59.08,Fee Schedule,,22.07,,,22.07,Fee Schedule,,22.07,,,22.07,Fee Schedule,,22.07,,,22.07,Fee Schedule,,22.07,,,22.07,Fee Schedule,,14.71,,,14.71,Other,100% of Medicaid,14.71,,,14.71,Other,100% of Medicaid,14.71,,,14.71,Other,100% of Medicaid,14.71,,,14.71,Other,100% of Medicaid,33.1,,,33.1,Other,225% of Medicaid,22.51,,,22.51,Other,153% of Medicaid,33.1,,,33.1,Other,225% of Medicaid,20.59,,,20.59,Other,140% of Medicaid,33.1,,,33.1,Other,225% of Medicaid,38.25,,,38.25,Other,250% of Medicaid,47.66,,,47.66,Other,324% of Medicaid,31.63,,,31.63,Other,215% of Medicaid,31.63,,,31.63,Other,215% of Medicaid,18.39,,,18.39,Other,125% of Medicaid,0.01,170.1,
ASSAY OF FECES PORPHYRINS,84126,CPT,,78084126,CDM,301,RC,,,both,,,306,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117.72,,,117.72,Fee Schedule,,105.99,,,105.99,Fee Schedule,,196.46,,,196.46,Fee Schedule,,176.74,,,176.74,Fee Schedule,,167.06,,,167.06,Fee Schedule,,214.2,70,,214.2,percent of total billed charges,All Other,123.2,,,123.2,Fee Schedule,,73,,,73,Other,186% of Medicaid,145.1,,,145.1,Fee Schedule,,189.72,,,189.72,Fee Schedule,,82.13,,,,Fee Schedule,,145.1,,,145.1,Fee Schedule,,189.72,,,189.72,Fee Schedule,,154.48,,,154.48,Fee Schedule,,214.2,70,,214.2,percent of total billed charges,,185.34,,,185.34,Fee Schedule,,157.09,,,157.09,Fee Schedule,,58.67,,,58.67,Fee Schedule,,58.67,,,58.67,Fee Schedule,,58.67,,,58.67,Fee Schedule,,58.67,,,58.67,Fee Schedule,,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,59.9,,,59.9,Other,153% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,54.81,,,54.81,Other,140% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,101.8,,,101.8,Other,250% of Medicaid,126.86,,,126.86,Other,324% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,48.94,,,48.94,Other,125% of Medicaid,0.01,214.2,
ASSAY OF SERUM POTASSIUM,84132,CPT,,78084132,CDM,301,RC,,,both,,,82,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.33,,,14.33,Fee Schedule,,12.9,,,12.9,Fee Schedule,,35.46,,,35.46,Fee Schedule,,31.9,,,31.9,Fee Schedule,,30.15,,,30.15,Fee Schedule,,57.4,70,,57.4,percent of total billed charges,All Other,14.99,,,14.99,Fee Schedule,,9,,,9,Other,186% of Medicaid,17.66,,,17.66,Fee Schedule,,50.84,,,50.84,Fee Schedule,,10,,,,Fee Schedule,,17.66,,,17.66,Fee Schedule,,50.84,,,50.84,Fee Schedule,,18.8,,,18.8,Fee Schedule,,57.4,70,,57.4,percent of total billed charges,,22.56,,,22.56,Fee Schedule,,19.12,,,19.12,Fee Schedule,,7.14,,,7.14,Fee Schedule,,7.14,,,7.14,Fee Schedule,,7.14,,,7.14,Fee Schedule,,7.14,,,7.14,Fee Schedule,,4.76,,,4.76,Other,100% of Medicaid,4.76,,,4.76,Other,100% of Medicaid,4.76,,,4.76,Other,100% of Medicaid,4.76,,,4.76,Other,100% of Medicaid,10.71,,,10.71,Other,225% of Medicaid,7.28,,,7.28,Other,153% of Medicaid,10.71,,,10.71,Other,225% of Medicaid,6.66,,,6.66,Other,140% of Medicaid,10.71,,,10.71,Other,225% of Medicaid,12.38,,,12.38,Other,250% of Medicaid,15.42,,,15.42,Other,324% of Medicaid,10.23,,,10.23,Other,215% of Medicaid,10.23,,,10.23,Other,215% of Medicaid,5.95,,,5.95,Other,125% of Medicaid,0.01,57.4,
ASSAY OF URINE POTASSIUM,84133,CPT,,78084133,CDM,301,RC,,,both,,,68,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.24,,,14.24,Fee Schedule,,12.82,,,12.82,Fee Schedule,,33.15,,,33.15,Fee Schedule,,29.83,,,29.83,Fee Schedule,,28.19,,,28.19,Fee Schedule,,47.6,70,,47.6,percent of total billed charges,All Other,14.9,,,14.9,Fee Schedule,,9,,,9,Other,186% of Medicaid,17.55,,,17.55,Fee Schedule,,42.16,,,42.16,Fee Schedule,,9.93,,,,Fee Schedule,,17.55,,,17.55,Fee Schedule,,42.16,,,42.16,Fee Schedule,,18.68,,,18.68,Fee Schedule,,47.6,70,,47.6,percent of total billed charges,,22.42,,,22.42,Fee Schedule,,19,,,19,Fee Schedule,,7.1,,,7.1,Fee Schedule,,7.1,,,7.1,Fee Schedule,,7.1,,,7.1,Fee Schedule,,7.1,,,7.1,Fee Schedule,,4.73,,,4.73,Other,100% of Medicaid,4.73,,,4.73,Other,100% of Medicaid,4.73,,,4.73,Other,100% of Medicaid,4.73,,,4.73,Other,100% of Medicaid,10.64,,,10.64,Other,225% of Medicaid,7.24,,,7.24,Other,153% of Medicaid,10.64,,,10.64,Other,225% of Medicaid,6.62,,,6.62,Other,140% of Medicaid,10.64,,,10.64,Other,225% of Medicaid,12.3,,,12.3,Other,250% of Medicaid,15.33,,,15.33,Other,324% of Medicaid,10.17,,,10.17,Other,215% of Medicaid,10.17,,,10.17,Other,215% of Medicaid,5.91,,,5.91,Other,125% of Medicaid,0.01,47.6,
ASSAY OF PREALBUMIN,84134,CPT,,78084134,CDM,301,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.92,,,43.92,Fee Schedule,,39.54,,,39.54,Fee Schedule,,43.07,,,43.07,Fee Schedule,,38.75,,,38.75,Fee Schedule,,36.63,,,36.63,Fee Schedule,,168,70,,168,percent of total billed charges,All Other,45.96,,,45.96,Fee Schedule,,14,,,14,Other,186% of Medicaid,54.13,,,54.13,Fee Schedule,,148.8,,,148.8,Fee Schedule,,30.64,,,,Fee Schedule,,54.13,,,54.13,Fee Schedule,,148.8,,,148.8,Fee Schedule,,57.63,,,57.63,Fee Schedule,,168,70,,168,percent of total billed charges,,69.14,,,69.14,Fee Schedule,,58.6,,,58.6,Fee Schedule,,21.89,,,21.89,Fee Schedule,,21.89,,,21.89,Fee Schedule,,21.89,,,21.89,Fee Schedule,,21.89,,,21.89,Fee Schedule,,7.39,,,7.39,Other,100% of Medicaid,7.39,,,7.39,Other,100% of Medicaid,7.39,,,7.39,Other,100% of Medicaid,7.39,,,7.39,Other,100% of Medicaid,16.63,,,16.63,Other,225% of Medicaid,11.31,,,11.31,Other,153% of Medicaid,16.63,,,16.63,Other,225% of Medicaid,10.35,,,10.35,Other,140% of Medicaid,16.63,,,16.63,Other,225% of Medicaid,19.22,,,19.22,Other,250% of Medicaid,23.95,,,23.95,Other,324% of Medicaid,15.9,,,15.9,Other,215% of Medicaid,15.9,,,15.9,Other,215% of Medicaid,9.24,,,9.24,Other,125% of Medicaid,0.01,168,
ASSAY OF PREGNANEDIOL,84135,CPT,,78084135,CDM,301,RC,,,both,,,251,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,64.02,,,64.02,Fee Schedule,,57.64,,,57.64,Fee Schedule,,147.52,,,147.52,Fee Schedule,,132.72,,,132.72,Fee Schedule,,125.45,,,125.45,Fee Schedule,,175.7,70,,175.7,percent of total billed charges,All Other,67,,,67,Fee Schedule,,58,,,58,Other,186% of Medicaid,78.91,,,78.91,Fee Schedule,,155.62,,,155.62,Fee Schedule,,44.67,,,,Fee Schedule,,78.91,,,78.91,Fee Schedule,,155.62,,,155.62,Fee Schedule,,84.02,,,84.02,Fee Schedule,,175.7,70,,175.7,percent of total billed charges,,100.8,,,100.8,Fee Schedule,,85.43,,,85.43,Fee Schedule,,31.91,,,31.91,Fee Schedule,,31.91,,,31.91,Fee Schedule,,31.91,,,31.91,Fee Schedule,,31.91,,,31.91,Fee Schedule,,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,47.87,,,47.87,Other,153% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,43.8,,,43.8,Other,140% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,81.35,,,81.35,Other,250% of Medicaid,101.38,,,101.38,Other,324% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,39.11,,,39.11,Other,125% of Medicaid,0.01,175.7,
ASSAY OF PREGNANETRIOL,84138,CPT,,78084138,CDM,301,RC,,,both,,,251,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.36,,,63.36,Fee Schedule,,57.05,,,57.05,Fee Schedule,,146.04,,,146.04,Fee Schedule,,131.38,,,131.38,Fee Schedule,,124.19,,,124.19,Fee Schedule,,175.7,70,,175.7,percent of total billed charges,All Other,66.31,,,66.31,Fee Schedule,,58,,,58,Other,186% of Medicaid,78.1,,,78.1,Fee Schedule,,155.62,,,155.62,Fee Schedule,,44.21,,,,Fee Schedule,,78.1,,,78.1,Fee Schedule,,155.62,,,155.62,Fee Schedule,,83.15,,,83.15,Fee Schedule,,175.7,70,,175.7,percent of total billed charges,,99.76,,,99.76,Fee Schedule,,84.55,,,84.55,Fee Schedule,,31.58,,,31.58,Fee Schedule,,31.58,,,31.58,Fee Schedule,,31.58,,,31.58,Fee Schedule,,31.58,,,31.58,Fee Schedule,,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,47.87,,,47.87,Other,153% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,43.8,,,43.8,Other,140% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,81.35,,,81.35,Other,250% of Medicaid,101.38,,,101.38,Other,324% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,39.11,,,39.11,Other,125% of Medicaid,0.01,175.7,
PREGNENOLONE,84140,CPT,,78084140,CDM,301,RC,,,both,,,124,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,62.22,,,62.22,Fee Schedule,,56.02,,,56.02,Fee Schedule,,159.47,,,159.47,Fee Schedule,,143.46,,,143.46,Fee Schedule,,135.61,,,135.61,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,All Other,65.11,,,65.11,Fee Schedule,,38,,,38,Other,186% of Medicaid,76.69,,,76.69,Fee Schedule,,76.88,,,76.88,Fee Schedule,,43.41,,,,Fee Schedule,,76.69,,,76.69,Fee Schedule,,76.88,,,76.88,Fee Schedule,,81.65,,,81.65,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,,97.96,,,97.96,Fee Schedule,,83.02,,,83.02,Fee Schedule,,31.01,,,31.01,Fee Schedule,,31.01,,,31.01,Fee Schedule,,31.01,,,31.01,Fee Schedule,,31.01,,,31.01,Fee Schedule,,20.67,,,20.67,Other,100% of Medicaid,20.67,,,20.67,Other,100% of Medicaid,20.67,,,20.67,Other,100% of Medicaid,20.67,,,20.67,Other,100% of Medicaid,46.51,,,46.51,Other,225% of Medicaid,31.63,,,31.63,Other,153% of Medicaid,46.51,,,46.51,Other,225% of Medicaid,28.94,,,28.94,Other,140% of Medicaid,46.51,,,46.51,Other,225% of Medicaid,53.74,,,53.74,Other,250% of Medicaid,66.97,,,66.97,Other,324% of Medicaid,44.44,,,44.44,Other,215% of Medicaid,44.44,,,44.44,Other,215% of Medicaid,25.84,,,25.84,Other,125% of Medicaid,0.01,159.47,
ASSAY OF 17-HYDROXYPREGNENO,84143,CPT,,78084143,CDM,301,RC,,,both,,,73,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,68.66,,,68.66,Fee Schedule,,61.82,,,61.82,Fee Schedule,,176.02,,,176.02,Fee Schedule,,158.35,,,158.35,Fee Schedule,,149.68,,,149.68,Fee Schedule,,51.1,70,,51.1,percent of total billed charges,All Other,71.85,,,71.85,Fee Schedule,,42,,,42,Other,186% of Medicaid,84.63,,,84.63,Fee Schedule,,45.26,,,45.26,Fee Schedule,,47.9,,,,Fee Schedule,,84.63,,,84.63,Fee Schedule,,45.26,,,45.26,Fee Schedule,,90.1,,,90.1,Fee Schedule,,51.1,70,,51.1,percent of total billed charges,,108.1,,,108.1,Fee Schedule,,91.62,,,91.62,Fee Schedule,,34.22,,,34.22,Fee Schedule,,34.22,,,34.22,Fee Schedule,,34.22,,,34.22,Fee Schedule,,34.22,,,34.22,Fee Schedule,,22.81,,,22.81,Other,100% of Medicaid,22.81,,,22.81,Other,100% of Medicaid,22.81,,,22.81,Other,100% of Medicaid,22.81,,,22.81,Other,100% of Medicaid,51.32,,,51.32,Other,225% of Medicaid,34.9,,,34.9,Other,153% of Medicaid,51.32,,,51.32,Other,225% of Medicaid,31.93,,,31.93,Other,140% of Medicaid,51.32,,,51.32,Other,225% of Medicaid,59.31,,,59.31,Other,250% of Medicaid,73.9,,,73.9,Other,324% of Medicaid,49.04,,,49.04,Other,215% of Medicaid,49.04,,,49.04,Other,215% of Medicaid,28.51,,,28.51,Other,125% of Medicaid,0.01,176.02,
ASSAY OF PROGESTERONE,84144,CPT,,78084144,CDM,301,RC,,,both,,,266,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,62.79,,,62.79,Fee Schedule,,56.53,,,56.53,Fee Schedule,,160.89,,,160.89,Fee Schedule,,144.74,,,144.74,Fee Schedule,,136.82,,,136.82,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,All Other,65.71,,,65.71,Fee Schedule,,39,,,39,Other,186% of Medicaid,77.39,,,77.39,Fee Schedule,,164.92,,,164.92,Fee Schedule,,43.81,,,,Fee Schedule,,77.39,,,77.39,Fee Schedule,,164.92,,,164.92,Fee Schedule,,82.4,,,82.4,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,,98.86,,,98.86,Fee Schedule,,83.79,,,83.79,Fee Schedule,,31.29,,,31.29,Fee Schedule,,31.29,,,31.29,Fee Schedule,,31.29,,,31.29,Fee Schedule,,31.29,,,31.29,Fee Schedule,,20.86,,,20.86,Other,100% of Medicaid,20.86,,,20.86,Other,100% of Medicaid,20.86,,,20.86,Other,100% of Medicaid,20.86,,,20.86,Other,100% of Medicaid,46.94,,,46.94,Other,225% of Medicaid,31.92,,,31.92,Other,153% of Medicaid,46.94,,,46.94,Other,225% of Medicaid,29.2,,,29.2,Other,140% of Medicaid,46.94,,,46.94,Other,225% of Medicaid,54.24,,,54.24,Other,250% of Medicaid,67.59,,,67.59,Other,324% of Medicaid,44.85,,,44.85,Other,215% of Medicaid,44.85,,,44.85,Other,215% of Medicaid,26.08,,,26.08,Other,125% of Medicaid,0.01,186.2,
PROCALCITONIN (PCT),84145,CPT,,78084145,CDM,301,RC,,,both,,,172,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,81.93,,,81.93,Fee Schedule,,73.77,,,73.77,Fee Schedule,,206.54,,,206.54,Fee Schedule,,185.81,,,185.81,Fee Schedule,,175.64,,,175.64,Fee Schedule,,120.4,70,,120.4,percent of total billed charges,All Other,85.74,,,85.74,Fee Schedule,,58,,,58,Other,186% of Medicaid,100.99,,,100.99,Fee Schedule,,106.64,,,106.64,Fee Schedule,,57.16,,,,Fee Schedule,,100.99,,,100.99,Fee Schedule,,106.64,,,106.64,Fee Schedule,,107.52,,,107.52,Fee Schedule,,120.4,70,,120.4,percent of total billed charges,,129,,,129,Fee Schedule,,109.33,,,109.33,Fee Schedule,,40.83,,,40.83,Fee Schedule,,40.83,,,40.83,Fee Schedule,,40.83,,,40.83,Fee Schedule,,40.83,,,40.83,Fee Schedule,,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,47.87,,,47.87,Other,153% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,43.8,,,43.8,Other,140% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,81.35,,,81.35,Other,250% of Medicaid,101.38,,,101.38,Other,324% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,39.11,,,39.11,Other,125% of Medicaid,0.01,206.54,
ASSAY OF PROLACTIN,84146,CPT,,78084146,CDM,301,RC,,,both,,,260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,58.33,,,58.33,Fee Schedule,,52.52,,,52.52,Fee Schedule,,149.44,,,149.44,Fee Schedule,,134.44,,,134.44,Fee Schedule,,127.08,,,127.08,Fee Schedule,,182,70,,182,percent of total billed charges,All Other,61.05,,,61.05,Fee Schedule,,36,,,36,Other,186% of Medicaid,71.9,,,71.9,Fee Schedule,,161.2,,,161.2,Fee Schedule,,40.7,,,,Fee Schedule,,71.9,,,71.9,Fee Schedule,,161.2,,,161.2,Fee Schedule,,76.55,,,76.55,Fee Schedule,,182,70,,182,percent of total billed charges,,91.84,,,91.84,Fee Schedule,,77.84,,,77.84,Fee Schedule,,29.07,,,29.07,Fee Schedule,,29.07,,,29.07,Fee Schedule,,29.07,,,29.07,Fee Schedule,,29.07,,,29.07,Fee Schedule,,19.38,,,19.38,Other,100% of Medicaid,19.38,,,19.38,Other,100% of Medicaid,19.38,,,19.38,Other,100% of Medicaid,19.38,,,19.38,Other,100% of Medicaid,43.61,,,43.61,Other,225% of Medicaid,29.65,,,29.65,Other,153% of Medicaid,43.61,,,43.61,Other,225% of Medicaid,27.13,,,27.13,Other,140% of Medicaid,43.61,,,43.61,Other,225% of Medicaid,50.39,,,50.39,Other,250% of Medicaid,62.79,,,62.79,Other,324% of Medicaid,41.67,,,41.67,Other,215% of Medicaid,41.67,,,41.67,Other,215% of Medicaid,24.23,,,24.23,Other,125% of Medicaid,0.01,182,
PSA TOTAL,84153,CPT,,78084153,CDM,301,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,55.35,,,55.35,Fee Schedule,,49.84,,,49.84,Fee Schedule,,141.88,,,141.88,Fee Schedule,,127.64,,,127.64,Fee Schedule,,120.65,,,120.65,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,57.93,,,57.93,Fee Schedule,,34,,,34,Other,186% of Medicaid,68.23,,,68.23,Fee Schedule,,73.78,,,73.78,Fee Schedule,,38.62,,,,Fee Schedule,,68.23,,,68.23,Fee Schedule,,73.78,,,73.78,Fee Schedule,,72.64,,,72.64,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,,87.15,,,87.15,Fee Schedule,,73.87,,,73.87,Fee Schedule,,27.59,,,27.59,Fee Schedule,,27.59,,,27.59,Fee Schedule,,27.59,,,27.59,Fee Schedule,,27.59,,,27.59,Fee Schedule,,18.39,,,18.39,Other,100% of Medicaid,18.39,,,18.39,Other,100% of Medicaid,18.39,,,18.39,Other,100% of Medicaid,18.39,,,18.39,Other,100% of Medicaid,41.38,,,41.38,Other,225% of Medicaid,28.14,,,28.14,Other,153% of Medicaid,41.38,,,41.38,Other,225% of Medicaid,25.75,,,25.75,Other,140% of Medicaid,41.38,,,41.38,Other,225% of Medicaid,47.81,,,47.81,Other,250% of Medicaid,59.58,,,59.58,Other,324% of Medicaid,39.54,,,39.54,Other,215% of Medicaid,39.54,,,39.54,Other,215% of Medicaid,22.99,,,22.99,Other,125% of Medicaid,0.01,141.88,
ASSAY OF PSA FREE,84154,CPT,,78084154,CDM,301,RC,,,both,,,275,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,55.35,,,55.35,Fee Schedule,,49.84,,,49.84,Fee Schedule,,141.88,,,141.88,Fee Schedule,,127.64,,,127.64,Fee Schedule,,120.65,,,120.65,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,All Other,57.93,,,57.93,Fee Schedule,,34,,,34,Other,186% of Medicaid,68.23,,,68.23,Fee Schedule,,170.5,,,170.5,Fee Schedule,,38.62,,,,Fee Schedule,,68.23,,,68.23,Fee Schedule,,170.5,,,170.5,Fee Schedule,,72.64,,,72.64,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,,87.15,,,87.15,Fee Schedule,,73.87,,,73.87,Fee Schedule,,27.59,,,27.59,Fee Schedule,,27.59,,,27.59,Fee Schedule,,27.59,,,27.59,Fee Schedule,,27.59,,,27.59,Fee Schedule,,18.39,,,18.39,Other,100% of Medicaid,18.39,,,18.39,Other,100% of Medicaid,18.39,,,18.39,Other,100% of Medicaid,18.39,,,18.39,Other,100% of Medicaid,41.38,,,41.38,Other,225% of Medicaid,28.14,,,28.14,Other,153% of Medicaid,41.38,,,41.38,Other,225% of Medicaid,25.75,,,25.75,Other,140% of Medicaid,41.38,,,41.38,Other,225% of Medicaid,47.81,,,47.81,Other,250% of Medicaid,59.58,,,59.58,Other,324% of Medicaid,39.54,,,39.54,Other,215% of Medicaid,39.54,,,39.54,Other,215% of Medicaid,22.99,,,22.99,Other,125% of Medicaid,0.01,192.5,
ASSAY OF PROTEIN SERUM,84155,CPT,,78084155,CDM,301,RC,,,both,,,94,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,11.05,,,11.05,Fee Schedule,,9.95,,,9.95,Fee Schedule,,28.28,,,28.28,Fee Schedule,,25.44,,,25.44,Fee Schedule,,24.05,,,24.05,Fee Schedule,,65.8,70,,65.8,percent of total billed charges,All Other,11.56,,,11.56,Fee Schedule,,7,,,7,Other,186% of Medicaid,13.62,,,13.62,Fee Schedule,,58.28,,,58.28,Fee Schedule,,7.71,,,,Fee Schedule,,13.62,,,13.62,Fee Schedule,,58.28,,,58.28,Fee Schedule,,14.5,,,14.5,Fee Schedule,,65.8,70,,65.8,percent of total billed charges,,17.39,,,17.39,Fee Schedule,,14.74,,,14.74,Fee Schedule,,5.51,,,5.51,Fee Schedule,,5.51,,,5.51,Fee Schedule,,5.51,,,5.51,Fee Schedule,,5.51,,,5.51,Fee Schedule,,3.67,,,3.67,Other,100% of Medicaid,3.67,,,3.67,Other,100% of Medicaid,3.67,,,3.67,Other,100% of Medicaid,3.67,,,3.67,Other,100% of Medicaid,8.26,,,8.26,Other,225% of Medicaid,5.62,,,5.62,Other,153% of Medicaid,8.26,,,8.26,Other,225% of Medicaid,5.14,,,5.14,Other,140% of Medicaid,8.26,,,8.26,Other,225% of Medicaid,9.54,,,9.54,Other,250% of Medicaid,11.89,,,11.89,Other,324% of Medicaid,7.89,,,7.89,Other,215% of Medicaid,7.89,,,7.89,Other,215% of Medicaid,4.59,,,4.59,Other,125% of Medicaid,0.01,65.8,
ASSAY OF PROTEIN URINE,84156,CPT,,78084156,CDM,301,RC,,,both,,,94,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,11.05,,,11.05,Fee Schedule,,9.95,,,9.95,Fee Schedule,,28.28,,,28.28,Fee Schedule,,25.44,,,25.44,Fee Schedule,,24.05,,,24.05,Fee Schedule,,65.8,70,,65.8,percent of total billed charges,All Other,11.56,,,11.56,Fee Schedule,,7,,,7,Other,186% of Medicaid,13.62,,,13.62,Fee Schedule,,58.28,,,58.28,Fee Schedule,,7.71,,,,Fee Schedule,,13.62,,,13.62,Fee Schedule,,58.28,,,58.28,Fee Schedule,,14.5,,,14.5,Fee Schedule,,65.8,70,,65.8,percent of total billed charges,,17.39,,,17.39,Fee Schedule,,14.74,,,14.74,Fee Schedule,,5.51,,,5.51,Fee Schedule,,5.51,,,5.51,Fee Schedule,,5.51,,,5.51,Fee Schedule,,5.51,,,5.51,Fee Schedule,,3.67,,,3.67,Other,100% of Medicaid,3.67,,,3.67,Other,100% of Medicaid,3.67,,,3.67,Other,100% of Medicaid,3.67,,,3.67,Other,100% of Medicaid,8.26,,,8.26,Other,225% of Medicaid,5.62,,,5.62,Other,153% of Medicaid,8.26,,,8.26,Other,225% of Medicaid,5.14,,,5.14,Other,140% of Medicaid,8.26,,,8.26,Other,225% of Medicaid,9.54,,,9.54,Other,250% of Medicaid,11.89,,,11.89,Other,324% of Medicaid,7.89,,,7.89,Other,215% of Medicaid,7.89,,,7.89,Other,215% of Medicaid,4.59,,,4.59,Other,125% of Medicaid,0.01,65.8,
PROTEIN E-PHORESIS SERUM,84165,CPT,,78084165,CDM,301,RC,,,both,,,241,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,32.33,,,32.33,Fee Schedule,,29.11,,,29.11,Fee Schedule,,82.86,,,82.86,Fee Schedule,,74.54,,,74.54,Fee Schedule,,70.46,,,70.46,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,All Other,33.83,,,33.83,Fee Schedule,,15,,,15,Other,186% of Medicaid,39.85,,,39.85,Fee Schedule,,149.42,,,149.42,Fee Schedule,,22.55,,,,Fee Schedule,,39.85,,,39.85,Fee Schedule,,149.42,,,149.42,Fee Schedule,,42.42,,,42.42,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,,50.9,,,50.9,Fee Schedule,,43.14,,,43.14,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,12.36,,,12.36,Other,153% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,11.31,,,11.31,Other,140% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,21.01,,,21.01,Other,250% of Medicaid,26.18,,,26.18,Other,324% of Medicaid,17.37,,,17.37,Other,215% of Medicaid,17.37,,,17.37,Other,215% of Medicaid,10.1,,,10.1,Other,125% of Medicaid,0.01,168.7,
PROTEIN E-PHORESIS/URINE/CSF,84166,CPT,,78084166,CDM,301,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.67,,,53.67,Fee Schedule,,48.32,,,48.32,Fee Schedule,,137.49,,,137.49,Fee Schedule,,123.69,,,123.69,Fee Schedule,,116.92,,,116.92,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,56.16,,,56.16,Fee Schedule,,21,,,21,Other,186% of Medicaid,66.15,,,66.15,Fee Schedule,,119.66,,,119.66,Fee Schedule,,37.44,,,,Fee Schedule,,66.15,,,66.15,Fee Schedule,,119.66,,,119.66,Fee Schedule,,70.43,,,70.43,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,,84.5,,,84.5,Fee Schedule,,71.62,,,71.62,Fee Schedule,,26.75,,,26.75,Fee Schedule,,26.75,,,26.75,Fee Schedule,,26.75,,,26.75,Fee Schedule,,26.75,,,26.75,Fee Schedule,,11.36,,,11.36,Other,100% of Medicaid,11.36,,,11.36,Other,100% of Medicaid,11.36,,,11.36,Other,100% of Medicaid,11.36,,,11.36,Other,100% of Medicaid,25.57,,,25.57,Other,225% of Medicaid,17.38,,,17.38,Other,153% of Medicaid,25.57,,,25.57,Other,225% of Medicaid,15.91,,,15.91,Other,140% of Medicaid,25.57,,,25.57,Other,225% of Medicaid,29.54,,,29.54,Other,250% of Medicaid,36.81,,,36.81,Other,324% of Medicaid,24.43,,,24.43,Other,215% of Medicaid,24.43,,,24.43,Other,215% of Medicaid,14.2,,,14.2,Other,125% of Medicaid,0.01,137.49,
WESTERN BLOT TEST,84181,CPT,,78084181,CDM,301,RC,,,both,,,245,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,51.26,,,51.26,Fee Schedule,,46.15,,,46.15,Fee Schedule,,102.8,,,102.8,Fee Schedule,,92.49,,,92.49,Fee Schedule,,87.42,,,87.42,Fee Schedule,,171.5,70,,171.5,percent of total billed charges,All Other,53.64,,,53.64,Fee Schedule,,32,,,32,Other,186% of Medicaid,63.18,,,63.18,Fee Schedule,,151.9,,,151.9,Fee Schedule,,35.76,,,,Fee Schedule,,63.18,,,63.18,Fee Schedule,,151.9,,,151.9,Fee Schedule,,67.27,,,67.27,Fee Schedule,,171.5,70,,171.5,percent of total billed charges,,80.71,,,80.71,Fee Schedule,,68.4,,,68.4,Fee Schedule,,25.55,,,25.55,Fee Schedule,,25.55,,,25.55,Fee Schedule,,25.55,,,25.55,Fee Schedule,,25.55,,,25.55,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,171.5,
PROTEIN WESTERN BLOT TEST,84182,CPT,,78084182,CDM,301,RC,,,both,,,742,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,87.92,,,87.92,Fee Schedule,,79.16,,,79.16,Fee Schedule,,138.81,,,138.81,Fee Schedule,,124.88,,,124.88,Fee Schedule,,118.04,,,118.04,Fee Schedule,,519.4,70,,519.4,percent of total billed charges,All Other,92.01,,,92.01,Fee Schedule,,80,,,80,Other,186% of Medicaid,108.37,,,108.37,Fee Schedule,,460.04,,,460.04,Fee Schedule,,61.34,,,,Fee Schedule,,108.37,,,108.37,Fee Schedule,,460.04,,,460.04,Fee Schedule,,115.38,,,115.38,Fee Schedule,,519.4,70,,519.4,percent of total billed charges,,138.43,,,138.43,Fee Schedule,,117.33,,,117.33,Fee Schedule,,43.82,,,43.82,Fee Schedule,,43.82,,,43.82,Fee Schedule,,43.82,,,43.82,Fee Schedule,,43.82,,,43.82,Fee Schedule,,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,65.47,,,65.47,Other,153% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,59.91,,,59.91,Other,140% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,111.26,,,111.26,Other,250% of Medicaid,138.64,,,138.64,Other,324% of Medicaid,92,,,92,Other,215% of Medicaid,92,,,92,Other,215% of Medicaid,53.49,,,53.49,Other,125% of Medicaid,0.01,519.4,
ASSAY RBC PROTOPORPHYRIN,84202,CPT,,78084202,CDM,301,RC,,,both,,,141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.19,,,43.19,Fee Schedule,,38.89,,,38.89,Fee Schedule,,76.06,,,76.06,Fee Schedule,,68.43,,,68.43,Fee Schedule,,64.68,,,64.68,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,All Other,45.2,,,45.2,Fee Schedule,,17,,,17,Other,186% of Medicaid,53.24,,,53.24,Fee Schedule,,87.42,,,87.42,Fee Schedule,,30.14,,,,Fee Schedule,,53.24,,,53.24,Fee Schedule,,87.42,,,87.42,Fee Schedule,,56.68,,,56.68,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,,68.01,,,68.01,Fee Schedule,,57.64,,,57.64,Fee Schedule,,21.53,,,21.53,Fee Schedule,,21.53,,,21.53,Fee Schedule,,21.53,,,21.53,Fee Schedule,,21.53,,,21.53,Fee Schedule,,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,13.91,,,13.91,Other,153% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,12.73,,,12.73,Other,140% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,23.63,,,23.63,Other,250% of Medicaid,29.45,,,29.45,Other,324% of Medicaid,19.54,,,19.54,Other,215% of Medicaid,19.54,,,19.54,Other,215% of Medicaid,11.36,,,11.36,Other,125% of Medicaid,0.01,98.7,
ASSAY OF VITAMIN B-6,84207,CPT,,78084207,CDM,301,RC,,,both,,,192,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,84.58,,,84.58,Fee Schedule,,76.15,,,76.15,Fee Schedule,,216.68,,,216.68,Fee Schedule,,194.93,,,194.93,Fee Schedule,,184.26,,,184.26,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,All Other,88.52,,,88.52,Fee Schedule,,52,,,52,Other,186% of Medicaid,104.25,,,104.25,Fee Schedule,,119.04,,,119.04,Fee Schedule,,59.01,,,,Fee Schedule,,104.25,,,104.25,Fee Schedule,,119.04,,,119.04,Fee Schedule,,111,,,111,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,,133.17,,,133.17,Fee Schedule,,112.87,,,112.87,Fee Schedule,,42.15,,,42.15,Fee Schedule,,42.15,,,42.15,Fee Schedule,,42.15,,,42.15,Fee Schedule,,42.15,,,42.15,Fee Schedule,,28.1,,,28.1,Other,100% of Medicaid,28.1,,,28.1,Other,100% of Medicaid,28.1,,,28.1,Other,100% of Medicaid,28.1,,,28.1,Other,100% of Medicaid,63.23,,,63.23,Other,225% of Medicaid,42.99,,,42.99,Other,153% of Medicaid,63.23,,,63.23,Other,225% of Medicaid,39.34,,,39.34,Other,140% of Medicaid,63.23,,,63.23,Other,225% of Medicaid,73.06,,,73.06,Other,250% of Medicaid,91.04,,,91.04,Other,324% of Medicaid,60.42,,,60.42,Other,215% of Medicaid,60.42,,,60.42,Other,215% of Medicaid,35.13,,,35.13,Other,125% of Medicaid,0.01,216.68,
ASSAY OF PYRUVATE,84210,CPT,,78084210,CDM,301,RC,,,both,,,66,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.58,,,43.58,Fee Schedule,,39.24,,,39.24,Fee Schedule,,83.68,,,83.68,Fee Schedule,,75.28,,,75.28,Fee Schedule,,71.16,,,71.16,Fee Schedule,,46.2,70,,46.2,percent of total billed charges,All Other,45.61,,,45.61,Fee Schedule,,33,,,33,Other,186% of Medicaid,53.72,,,53.72,Fee Schedule,,40.92,,,40.92,Fee Schedule,,30.41,,,,Fee Schedule,,53.72,,,53.72,Fee Schedule,,40.92,,,40.92,Fee Schedule,,57.2,,,57.2,Fee Schedule,,46.2,70,,46.2,percent of total billed charges,,68.62,,,68.62,Fee Schedule,,58.16,,,58.16,Fee Schedule,,21.72,,,21.72,Fee Schedule,,21.72,,,21.72,Fee Schedule,,21.72,,,21.72,Fee Schedule,,21.72,,,21.72,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,83.68,
ASSAY OF PYRUVATE KINASE,84220,CPT,,78084220,CDM,301,RC,,,both,,,31,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,28.41,,,28.41,Fee Schedule,,25.58,,,25.58,Fee Schedule,,72.77,,,72.77,Fee Schedule,,65.47,,,65.47,Fee Schedule,,61.88,,,61.88,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,All Other,29.74,,,29.74,Fee Schedule,,18,,,18,Other,186% of Medicaid,35.02,,,35.02,Fee Schedule,,19.22,,,19.22,Fee Schedule,,19.82,,,,Fee Schedule,,35.02,,,35.02,Fee Schedule,,19.22,,,19.22,Fee Schedule,,37.29,,,37.29,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,,44.74,,,44.74,Fee Schedule,,37.92,,,37.92,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,9.44,,,9.44,Other,100% of Medicaid,9.44,,,9.44,Other,100% of Medicaid,9.44,,,9.44,Other,100% of Medicaid,9.44,,,9.44,Other,100% of Medicaid,21.24,,,21.24,Other,225% of Medicaid,14.44,,,14.44,Other,153% of Medicaid,21.24,,,21.24,Other,225% of Medicaid,13.22,,,13.22,Other,140% of Medicaid,21.24,,,21.24,Other,225% of Medicaid,24.54,,,24.54,Other,250% of Medicaid,30.59,,,30.59,Other,324% of Medicaid,20.3,,,20.3,Other,215% of Medicaid,20.3,,,20.3,Other,215% of Medicaid,11.8,,,11.8,Other,125% of Medicaid,0.01,72.77,
ASSAY OF ESTROGEN,84233,CPT,,78084233,CDM,301,RC,,,both,,,486,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,264.52,,,264.52,Fee Schedule,,238.15,,,238.15,Fee Schedule,,485.14,,,485.14,Fee Schedule,,436.45,,,436.45,Fee Schedule,,412.55,,,412.55,Fee Schedule,,340.2,70,,340.2,percent of total billed charges,All Other,276.82,,,276.82,Fee Schedule,,70,,,70,Other,186% of Medicaid,326.03,,,326.03,Fee Schedule,,301.32,,,301.32,Fee Schedule,,184.55,,,,Fee Schedule,,326.03,,,326.03,Fee Schedule,,301.32,,,301.32,Fee Schedule,,347.13,,,347.13,Fee Schedule,,340.2,70,,340.2,percent of total billed charges,,416.47,,,416.47,Fee Schedule,,352.98,,,352.98,Fee Schedule,,131.82,,,131.82,Fee Schedule,,131.82,,,131.82,Fee Schedule,,131.82,,,131.82,Fee Schedule,,131.82,,,131.82,Fee Schedule,,37.88,,,37.88,Other,100% of Medicaid,37.88,,,37.88,Other,100% of Medicaid,37.88,,,37.88,Other,100% of Medicaid,37.88,,,37.88,Other,100% of Medicaid,85.22,,,85.22,Other,225% of Medicaid,57.95,,,57.95,Other,153% of Medicaid,85.22,,,85.22,Other,225% of Medicaid,53.03,,,53.03,Other,140% of Medicaid,85.22,,,85.22,Other,225% of Medicaid,98.48,,,98.48,Other,250% of Medicaid,122.72,,,122.72,Other,324% of Medicaid,81.43,,,81.43,Other,215% of Medicaid,81.43,,,81.43,Other,215% of Medicaid,47.34,,,47.34,Other,125% of Medicaid,0.01,485.14,
ASSAY OF PROGESTERONE,84234,CPT,,78084234,CDM,301,RC,,,both,,,440,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.29,,,195.29,Fee Schedule,,175.82,,,175.82,Fee Schedule,,500.27,,,500.27,Fee Schedule,,450.06,,,450.06,Fee Schedule,,425.41,,,425.41,Fee Schedule,,308,70,,308,percent of total billed charges,All Other,204.37,,,204.37,Fee Schedule,,46,,,46,Other,186% of Medicaid,240.7,,,240.7,Fee Schedule,,272.8,,,272.8,Fee Schedule,,136.25,,,,Fee Schedule,,240.7,,,240.7,Fee Schedule,,272.8,,,272.8,Fee Schedule,,256.28,,,256.28,Fee Schedule,,308,70,,308,percent of total billed charges,,307.47,,,307.47,Fee Schedule,,260.6,,,260.6,Fee Schedule,,97.32,,,97.32,Fee Schedule,,97.32,,,97.32,Fee Schedule,,97.32,,,97.32,Fee Schedule,,97.32,,,97.32,Fee Schedule,,24.69,,,24.69,Other,100% of Medicaid,24.69,,,24.69,Other,100% of Medicaid,24.69,,,24.69,Other,100% of Medicaid,24.69,,,24.69,Other,100% of Medicaid,55.56,,,55.56,Other,225% of Medicaid,37.78,,,37.78,Other,153% of Medicaid,55.56,,,55.56,Other,225% of Medicaid,34.57,,,34.57,Other,140% of Medicaid,55.56,,,55.56,Other,225% of Medicaid,64.21,,,64.21,Other,250% of Medicaid,80.01,,,80.01,Other,324% of Medicaid,53.09,,,53.09,Other,215% of Medicaid,53.09,,,53.09,Other,215% of Medicaid,30.87,,,30.87,Other,125% of Medicaid,0.01,500.27,
ASSAY OF ENDOCRINE HORMONE,84235,CPT,,78084235,CDM,301,RC,,,both,,,311,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,214.4,,,214.4,Fee Schedule,,193.03,,,193.03,Fee Schedule,,403.6,,,403.6,Fee Schedule,,363.09,,,363.09,Fee Schedule,,343.21,,,343.21,Fee Schedule,,217.7,70,,217.7,percent of total billed charges,All Other,224.37,,,224.37,Fee Schedule,,76,,,76,Other,186% of Medicaid,264.26,,,264.26,Fee Schedule,,192.82,,,192.82,Fee Schedule,,149.58,,,,Fee Schedule,,264.26,,,264.26,Fee Schedule,,192.82,,,192.82,Fee Schedule,,281.36,,,281.36,Fee Schedule,,217.7,70,,217.7,percent of total billed charges,,337.56,,,337.56,Fee Schedule,,286.1,,,286.1,Fee Schedule,,106.85,,,106.85,Fee Schedule,,106.85,,,106.85,Fee Schedule,,106.85,,,106.85,Fee Schedule,,106.85,,,106.85,Fee Schedule,,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,62.76,,,62.76,Other,153% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,57.43,,,57.43,Other,140% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,106.65,,,106.65,Other,250% of Medicaid,132.9,,,132.9,Other,324% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,51.27,,,51.27,Other,125% of Medicaid,0.01,403.6,
ASSAY NONENDOCRINE RECEPTOR,84238,CPT,,78084238,CDM,301,RC,,,both,,,416,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,110.08,,,110.08,Fee Schedule,,99.1,,,99.1,Fee Schedule,,282,,,282,Fee Schedule,,253.7,,,253.7,Fee Schedule,,239.8,,,239.8,Fee Schedule,,291.2,70,,291.2,percent of total billed charges,All Other,115.2,,,115.2,Fee Schedule,,73,,,73,Other,186% of Medicaid,135.67,,,135.67,Fee Schedule,,257.92,,,257.92,Fee Schedule,,76.8,,,,Fee Schedule,,135.67,,,135.67,Fee Schedule,,257.92,,,257.92,Fee Schedule,,144.45,,,144.45,Fee Schedule,,291.2,70,,291.2,percent of total billed charges,,173.31,,,173.31,Fee Schedule,,146.89,,,146.89,Fee Schedule,,54.86,,,54.86,Fee Schedule,,54.86,,,54.86,Fee Schedule,,54.86,,,54.86,Fee Schedule,,54.86,,,54.86,Fee Schedule,,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,39.15,,,39.15,Other,100% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,59.9,,,59.9,Other,153% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,54.81,,,54.81,Other,140% of Medicaid,88.1,,,88.1,Other,225% of Medicaid,101.8,,,101.8,Other,250% of Medicaid,126.86,,,126.86,Other,324% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,84.18,,,84.18,Other,215% of Medicaid,48.94,,,48.94,Other,125% of Medicaid,0.01,291.2,
ASSAY OF RENIN,84244,CPT,,78084244,CDM,301,RC,,,both,,,279,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,66.19,,,66.19,Fee Schedule,,59.59,,,59.59,Fee Schedule,,169.61,,,169.61,Fee Schedule,,152.58,,,152.58,Fee Schedule,,144.23,,,144.23,Fee Schedule,,195.3,70,,195.3,percent of total billed charges,All Other,69.27,,,69.27,Fee Schedule,,58,,,58,Other,186% of Medicaid,81.58,,,81.58,Fee Schedule,,172.98,,,172.98,Fee Schedule,,46.18,,,,Fee Schedule,,81.58,,,81.58,Fee Schedule,,172.98,,,172.98,Fee Schedule,,86.86,,,86.86,Fee Schedule,,195.3,70,,195.3,percent of total billed charges,,104.21,,,104.21,Fee Schedule,,88.33,,,88.33,Fee Schedule,,32.99,,,32.99,Fee Schedule,,32.99,,,32.99,Fee Schedule,,32.99,,,32.99,Fee Schedule,,32.99,,,32.99,Fee Schedule,,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,47.87,,,47.87,Other,153% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,43.8,,,43.8,Other,140% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,81.35,,,81.35,Other,250% of Medicaid,101.38,,,101.38,Other,324% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,39.11,,,39.11,Other,125% of Medicaid,0.01,195.3,
ASSAY OF VITAMIN B-2,84252,CPT,,78084252,CDM,301,RC,,,both,,,179,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,60.92,,,60.92,Fee Schedule,,54.85,,,54.85,Fee Schedule,,156.07,,,156.07,Fee Schedule,,140.41,,,140.41,Fee Schedule,,132.72,,,132.72,Fee Schedule,,125.3,70,,125.3,percent of total billed charges,All Other,63.76,,,63.76,Fee Schedule,,33,,,33,Other,186% of Medicaid,75.09,,,75.09,Fee Schedule,,110.98,,,110.98,Fee Schedule,,42.5,,,,Fee Schedule,,75.09,,,75.09,Fee Schedule,,110.98,,,110.98,Fee Schedule,,79.95,,,79.95,Fee Schedule,,125.3,70,,125.3,percent of total billed charges,,95.92,,,95.92,Fee Schedule,,81.3,,,81.3,Fee Schedule,,30.36,,,30.36,Fee Schedule,,30.36,,,30.36,Fee Schedule,,30.36,,,30.36,Fee Schedule,,30.36,,,30.36,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,156.07,
ASSAY OF SELENIUM,84255,CPT,,78084255,CDM,301,RC,,,both,,,260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,76.85,,,76.85,Fee Schedule,,69.19,,,69.19,Fee Schedule,,196.9,,,196.9,Fee Schedule,,177.13,,,177.13,Fee Schedule,,167.43,,,167.43,Fee Schedule,,182,70,,182,percent of total billed charges,All Other,80.42,,,80.42,Fee Schedule,,47,,,47,Other,186% of Medicaid,94.72,,,94.72,Fee Schedule,,161.2,,,161.2,Fee Schedule,,53.61,,,,Fee Schedule,,94.72,,,94.72,Fee Schedule,,161.2,,,161.2,Fee Schedule,,100.84,,,100.84,Fee Schedule,,182,70,,182,percent of total billed charges,,120.99,,,120.99,Fee Schedule,,102.54,,,102.54,Fee Schedule,,38.3,,,38.3,Fee Schedule,,38.3,,,38.3,Fee Schedule,,38.3,,,38.3,Fee Schedule,,38.3,,,38.3,Fee Schedule,,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,38.73,,,38.73,Other,153% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,35.44,,,35.44,Other,140% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,65.82,,,65.82,Other,250% of Medicaid,82.02,,,82.02,Other,324% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,31.64,,,31.64,Other,125% of Medicaid,0.01,196.9,
ASSAY OF SEROTONIN,84260,CPT,,78084260,CDM,301,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,93.25,,,93.25,Fee Schedule,,83.96,,,83.96,Fee Schedule,,132.07,,,132.07,Fee Schedule,,118.81,,,118.81,Fee Schedule,,112.31,,,112.31,Fee Schedule,,73.5,70,,73.5,percent of total billed charges,All Other,97.59,,,97.59,Fee Schedule,,76,,,76,Other,186% of Medicaid,114.94,,,114.94,Fee Schedule,,65.1,,,65.1,Fee Schedule,,65.06,,,,Fee Schedule,,114.94,,,114.94,Fee Schedule,,65.1,,,65.1,Fee Schedule,,122.37,,,122.37,Fee Schedule,,73.5,70,,73.5,percent of total billed charges,,146.82,,,146.82,Fee Schedule,,124.43,,,124.43,Fee Schedule,,46.47,,,46.47,Fee Schedule,,46.47,,,46.47,Fee Schedule,,46.47,,,46.47,Fee Schedule,,46.47,,,46.47,Fee Schedule,,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,62.76,,,62.76,Other,153% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,57.43,,,57.43,Other,140% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,106.65,,,106.65,Other,250% of Medicaid,132.9,,,132.9,Other,324% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,51.27,,,51.27,Other,125% of Medicaid,0.01,146.82,
ASSAY OF SIALIC ACID,84275,CPT,,78084275,CDM,301,RC,,,both,,,176,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.45,,,40.45,Fee Schedule,,36.42,,,36.42,Fee Schedule,,103.63,,,103.63,Fee Schedule,,93.23,,,93.23,Fee Schedule,,88.12,,,88.12,Fee Schedule,,123.2,70,,123.2,percent of total billed charges,All Other,42.34,,,42.34,Fee Schedule,,25,,,25,Other,186% of Medicaid,49.86,,,49.86,Fee Schedule,,109.12,,,109.12,Fee Schedule,,28.22,,,,Fee Schedule,,49.86,,,49.86,Fee Schedule,,109.12,,,109.12,Fee Schedule,,53.09,,,53.09,Fee Schedule,,123.2,70,,123.2,percent of total billed charges,,63.69,,,63.69,Fee Schedule,,53.98,,,53.98,Fee Schedule,,20.16,,,20.16,Fee Schedule,,20.16,,,20.16,Fee Schedule,,20.16,,,20.16,Fee Schedule,,20.16,,,20.16,Fee Schedule,,13.44,,,13.44,Other,100% of Medicaid,13.44,,,13.44,Other,100% of Medicaid,13.44,,,13.44,Other,100% of Medicaid,13.44,,,13.44,Other,100% of Medicaid,30.24,,,30.24,Other,225% of Medicaid,20.56,,,20.56,Other,153% of Medicaid,30.24,,,30.24,Other,225% of Medicaid,18.82,,,18.82,Other,140% of Medicaid,30.24,,,30.24,Other,225% of Medicaid,34.94,,,34.94,Other,250% of Medicaid,43.55,,,43.55,Other,324% of Medicaid,28.9,,,28.9,Other,215% of Medicaid,28.9,,,28.9,Other,215% of Medicaid,16.8,,,16.8,Other,125% of Medicaid,0.01,123.2,
ASSAY OF SERUM SODIUM,84295,CPT,,78084295,CDM,301,RC,,,both,,,72,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.48,,,14.48,Fee Schedule,,13.04,,,13.04,Fee Schedule,,37.1,,,37.1,Fee Schedule,,33.38,,,33.38,Fee Schedule,,31.55,,,31.55,Fee Schedule,,50.4,70,,50.4,percent of total billed charges,All Other,15.15,,,15.15,Fee Schedule,,9,,,9,Other,186% of Medicaid,17.85,,,17.85,Fee Schedule,,44.64,,,44.64,Fee Schedule,,10.1,,,,Fee Schedule,,17.85,,,17.85,Fee Schedule,,44.64,,,44.64,Fee Schedule,,19,,,19,Fee Schedule,,50.4,70,,50.4,percent of total billed charges,,22.79,,,22.79,Fee Schedule,,19.32,,,19.32,Fee Schedule,,7.22,,,7.22,Fee Schedule,,7.22,,,7.22,Fee Schedule,,7.22,,,7.22,Fee Schedule,,7.22,,,7.22,Fee Schedule,,4.81,,,4.81,Other,100% of Medicaid,4.81,,,4.81,Other,100% of Medicaid,4.81,,,4.81,Other,100% of Medicaid,4.81,,,4.81,Other,100% of Medicaid,10.82,,,10.82,Other,225% of Medicaid,7.36,,,7.36,Other,153% of Medicaid,10.82,,,10.82,Other,225% of Medicaid,6.73,,,6.73,Other,140% of Medicaid,10.82,,,10.82,Other,225% of Medicaid,12.51,,,12.51,Other,250% of Medicaid,15.58,,,15.58,Other,324% of Medicaid,10.34,,,10.34,Other,215% of Medicaid,10.34,,,10.34,Other,215% of Medicaid,6.01,,,6.01,Other,125% of Medicaid,0.01,50.4,
ASSAY OF URINE SODIUM,84300,CPT,,78084300,CDM,301,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.23,,,15.23,Fee Schedule,,13.71,,,13.71,Fee Schedule,,37.54,,,37.54,Fee Schedule,,33.77,,,33.77,Fee Schedule,,31.92,,,31.92,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,All Other,15.94,,,15.94,Fee Schedule,,9,,,9,Other,186% of Medicaid,18.77,,,18.77,Fee Schedule,,40.3,,,40.3,Fee Schedule,,10.63,,,,Fee Schedule,,18.77,,,18.77,Fee Schedule,,40.3,,,40.3,Fee Schedule,,19.99,,,19.99,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,,23.98,,,23.98,Fee Schedule,,20.32,,,20.32,Fee Schedule,,7.59,,,7.59,Fee Schedule,,7.59,,,7.59,Fee Schedule,,7.59,,,7.59,Fee Schedule,,7.59,,,7.59,Fee Schedule,,5.03,,,5.03,Other,100% of Medicaid,5.03,,,5.03,Other,100% of Medicaid,5.03,,,5.03,Other,100% of Medicaid,5.03,,,5.03,Other,100% of Medicaid,11.32,,,11.32,Other,225% of Medicaid,7.7,,,7.7,Other,153% of Medicaid,11.32,,,11.32,Other,225% of Medicaid,7.04,,,7.04,Other,140% of Medicaid,11.32,,,11.32,Other,225% of Medicaid,13.08,,,13.08,Other,250% of Medicaid,16.3,,,16.3,Other,324% of Medicaid,10.81,,,10.81,Other,215% of Medicaid,10.81,,,10.81,Other,215% of Medicaid,6.29,,,6.29,Other,125% of Medicaid,0.01,45.5,
SODIUM OTHER  SOURCE,84302,CPT,,78084302,CDM,301,RC,,,both,,,29,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.63,,,14.63,Fee Schedule,,13.17,,,13.17,Fee Schedule,,37.54,,,37.54,Fee Schedule,,33.77,,,33.77,Fee Schedule,,31.92,,,31.92,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,All Other,15.31,,,15.31,Fee Schedule,,9,,,9,Other,186% of Medicaid,18.03,,,18.03,Fee Schedule,,17.98,,,17.98,Fee Schedule,,10.21,,,,Fee Schedule,,18.03,,,18.03,Fee Schedule,,17.98,,,17.98,Fee Schedule,,19.2,,,19.2,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,,23.03,,,23.03,Fee Schedule,,19.52,,,19.52,Fee Schedule,,7.29,,,7.29,Fee Schedule,,7.29,,,7.29,Fee Schedule,,7.29,,,7.29,Fee Schedule,,7.29,,,7.29,Fee Schedule,,4.86,,,4.86,Other,100% of Medicaid,4.86,,,4.86,Other,100% of Medicaid,4.86,,,4.86,Other,100% of Medicaid,4.86,,,4.86,Other,100% of Medicaid,10.94,,,10.94,Other,225% of Medicaid,7.44,,,7.44,Other,153% of Medicaid,10.94,,,10.94,Other,225% of Medicaid,6.8,,,6.8,Other,140% of Medicaid,10.94,,,10.94,Other,225% of Medicaid,12.64,,,12.64,Other,250% of Medicaid,15.75,,,15.75,Other,324% of Medicaid,10.45,,,10.45,Other,215% of Medicaid,10.45,,,10.45,Other,215% of Medicaid,6.08,,,6.08,Other,125% of Medicaid,0.01,37.54,
ASSAY OF SOMATOMEDIN,84305,CPT,,78084305,CDM,301,RC,,,both,,,254,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,63.99,,,63.99,Fee Schedule,,57.61,,,57.61,Fee Schedule,,163.96,,,163.96,Fee Schedule,,147.51,,,147.51,Fee Schedule,,139.43,,,139.43,Fee Schedule,,177.8,70,,177.8,percent of total billed charges,All Other,66.97,,,66.97,Fee Schedule,,39,,,39,Other,186% of Medicaid,78.87,,,78.87,Fee Schedule,,157.48,,,157.48,Fee Schedule,,44.65,,,,Fee Schedule,,78.87,,,78.87,Fee Schedule,,157.48,,,157.48,Fee Schedule,,83.98,,,83.98,Fee Schedule,,177.8,70,,177.8,percent of total billed charges,,100.75,,,100.75,Fee Schedule,,85.39,,,85.39,Fee Schedule,,31.89,,,31.89,Fee Schedule,,31.89,,,31.89,Fee Schedule,,31.89,,,31.89,Fee Schedule,,31.89,,,31.89,Fee Schedule,,20.71,,,20.71,Other,100% of Medicaid,20.71,,,20.71,Other,100% of Medicaid,20.71,,,20.71,Other,100% of Medicaid,20.71,,,20.71,Other,100% of Medicaid,46.59,,,46.59,Other,225% of Medicaid,31.68,,,31.68,Other,153% of Medicaid,46.59,,,46.59,Other,225% of Medicaid,28.99,,,28.99,Other,140% of Medicaid,46.59,,,46.59,Other,225% of Medicaid,53.83,,,53.83,Other,250% of Medicaid,67.08,,,67.08,Other,324% of Medicaid,44.52,,,44.52,Other,215% of Medicaid,44.52,,,44.52,Other,215% of Medicaid,25.88,,,25.88,Other,125% of Medicaid,0.01,177.8,
SPECTROPHOTOMETRY,84311,CPT,,78084311,CDM,301,RC,,,both,,,134,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.38,,,24.38,Fee Schedule,,21.95,,,21.95,Fee Schedule,,53.87,,,53.87,Fee Schedule,,48.46,,,48.46,Fee Schedule,,45.81,,,45.81,Fee Schedule,,93.8,70,,93.8,percent of total billed charges,All Other,25.52,,,25.52,Fee Schedule,,26,,,26,Other,186% of Medicaid,30.05,,,30.05,Fee Schedule,,83.08,,,83.08,Fee Schedule,,17.01,,,,Fee Schedule,,30.05,,,30.05,Fee Schedule,,83.08,,,83.08,Fee Schedule,,32,,,32,Fee Schedule,,93.8,70,,93.8,percent of total billed charges,,38.39,,,38.39,Fee Schedule,,32.53,,,32.53,Fee Schedule,,12.15,,,12.15,Fee Schedule,,12.15,,,12.15,Fee Schedule,,12.15,,,12.15,Fee Schedule,,12.15,,,12.15,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,93.8,
BODY FLUID SPECIFIC GRAVITY,84315,CPT,,78084315,CDM,301,RC,,,both,,,54,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,9.87,,,9.87,Fee Schedule,,8.89,,,8.89,Fee Schedule,,19.34,,,19.34,Fee Schedule,,17.4,,,17.4,Fee Schedule,,16.45,,,16.45,Fee Schedule,,37.8,70,,37.8,percent of total billed charges,All Other,10.33,,,10.33,Fee Schedule,,26,,,26,Other,186% of Medicaid,12.17,,,12.17,Fee Schedule,,33.48,,,33.48,Fee Schedule,,6.89,,,,Fee Schedule,,12.17,,,12.17,Fee Schedule,,33.48,,,33.48,Fee Schedule,,12.96,,,12.96,Fee Schedule,,37.8,70,,37.8,percent of total billed charges,,15.54,,,15.54,Fee Schedule,,13.17,,,13.17,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,4.92,,,4.92,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
SUGARS SINGLE QUAL,84376,CPT,,78084376,CDM,301,RC,,,both,,,24,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,16.56,,,16.56,Fee Schedule,,14.91,,,14.91,Fee Schedule,,42.42,,,42.42,Fee Schedule,,38.16,,,38.16,Fee Schedule,,36.07,,,36.07,Fee Schedule,,16.8,70,,16.8,percent of total billed charges,All Other,17.33,,,17.33,Fee Schedule,,9,,,9,Other,186% of Medicaid,20.41,,,20.41,Fee Schedule,,14.88,,,14.88,Fee Schedule,,11.55,,,,Fee Schedule,,20.41,,,20.41,Fee Schedule,,14.88,,,14.88,Fee Schedule,,21.73,,,21.73,Fee Schedule,,16.8,70,,16.8,percent of total billed charges,,26.06,,,26.06,Fee Schedule,,22.09,,,22.09,Fee Schedule,,8.25,,,8.25,Fee Schedule,,8.25,,,8.25,Fee Schedule,,8.25,,,8.25,Fee Schedule,,8.25,,,8.25,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,42.42,
SUGARS MULTI QUAL EA SPECIMEN,84377,CPT,,78084377,CDM,301,RC,,,both,,,32,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,16.56,,,16.56,Fee Schedule,,14.91,,,14.91,Fee Schedule,,42.42,,,42.42,Fee Schedule,,38.16,,,38.16,Fee Schedule,,36.07,,,36.07,Fee Schedule,,22.4,70,,22.4,percent of total billed charges,All Other,17.33,,,17.33,Fee Schedule,,10,,,10,Other,186% of Medicaid,20.41,,,20.41,Fee Schedule,,19.84,,,19.84,Fee Schedule,,11.55,,,,Fee Schedule,,20.41,,,20.41,Fee Schedule,,19.84,,,19.84,Fee Schedule,,21.73,,,21.73,Fee Schedule,,22.4,70,,22.4,percent of total billed charges,,26.06,,,26.06,Fee Schedule,,22.09,,,22.09,Fee Schedule,,8.25,,,8.25,Fee Schedule,,8.25,,,8.25,Fee Schedule,,8.25,,,8.25,Fee Schedule,,8.25,,,8.25,Fee Schedule,,5.5,,,5.5,Other,100% of Medicaid,5.5,,,5.5,Other,100% of Medicaid,5.5,,,5.5,Other,100% of Medicaid,5.5,,,5.5,Other,100% of Medicaid,12.38,,,12.38,Other,225% of Medicaid,8.42,,,8.42,Other,153% of Medicaid,12.38,,,12.38,Other,225% of Medicaid,7.7,,,7.7,Other,140% of Medicaid,12.38,,,12.38,Other,225% of Medicaid,14.3,,,14.3,Other,250% of Medicaid,17.82,,,17.82,Other,324% of Medicaid,11.83,,,11.83,Other,215% of Medicaid,11.83,,,11.83,Other,215% of Medicaid,6.88,,,6.88,Other,125% of Medicaid,0.01,42.42,
SUGARS; SINGLE QUAN EA SPECIMEN,84378,CPT,,78084378,CDM,301,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.71,,,34.71,Fee Schedule,,31.25,,,31.25,Fee Schedule,,88.89,,,88.89,Fee Schedule,,79.96,,,79.96,Fee Schedule,,75.59,,,75.59,Fee Schedule,,49,70,,49,percent of total billed charges,All Other,36.32,,,36.32,Fee Schedule,,21,,,21,Other,186% of Medicaid,42.78,,,42.78,Fee Schedule,,43.4,,,43.4,Fee Schedule,,24.21,,,,Fee Schedule,,42.78,,,42.78,Fee Schedule,,43.4,,,43.4,Fee Schedule,,45.54,,,45.54,Fee Schedule,,49,70,,49,percent of total billed charges,,54.64,,,54.64,Fee Schedule,,46.31,,,46.31,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,11.53,,,11.53,Other,100% of Medicaid,11.53,,,11.53,Other,100% of Medicaid,11.53,,,11.53,Other,100% of Medicaid,11.53,,,11.53,Other,100% of Medicaid,25.94,,,25.94,Other,225% of Medicaid,17.64,,,17.64,Other,153% of Medicaid,25.94,,,25.94,Other,225% of Medicaid,16.14,,,16.14,Other,140% of Medicaid,25.94,,,25.94,Other,225% of Medicaid,29.98,,,29.98,Other,250% of Medicaid,37.36,,,37.36,Other,324% of Medicaid,24.79,,,24.79,Other,215% of Medicaid,24.79,,,24.79,Other,215% of Medicaid,14.41,,,14.41,Other,125% of Medicaid,0.01,88.89,
URINE SULFATE,84392,CPT,,78084392,CDM,301,RC,,,both,,,29,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,16.52,,,16.52,Fee Schedule,,14.88,,,14.88,Fee Schedule,,36.61,,,36.61,Fee Schedule,,32.93,,,32.93,Fee Schedule,,31.13,,,31.13,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,All Other,17.29,,,17.29,Fee Schedule,,32,,,32,Other,186% of Medicaid,20.37,,,20.37,Fee Schedule,,17.98,,,17.98,Fee Schedule,,11.53,,,,Fee Schedule,,20.37,,,20.37,Fee Schedule,,17.98,,,17.98,Fee Schedule,,21.69,,,21.69,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,,26.02,,,26.02,Fee Schedule,,22.05,,,22.05,Fee Schedule,,8.24,,,8.24,Fee Schedule,,8.24,,,8.24,Fee Schedule,,8.24,,,8.24,Fee Schedule,,8.24,,,8.24,Fee Schedule,,17.41,,,17.41,Other,100% of Medicaid,17.41,,,17.41,Other,100% of Medicaid,17.41,,,17.41,Other,100% of Medicaid,17.41,,,17.41,Other,100% of Medicaid,39.16,,,39.16,Other,225% of Medicaid,26.63,,,26.63,Other,153% of Medicaid,39.16,,,39.16,Other,225% of Medicaid,24.37,,,24.37,Other,140% of Medicaid,39.16,,,39.16,Other,225% of Medicaid,45.25,,,45.25,Other,250% of Medicaid,56.39,,,56.39,Other,324% of Medicaid,37.42,,,37.42,Other,215% of Medicaid,37.42,,,37.42,Other,215% of Medicaid,21.76,,,21.76,Other,125% of Medicaid,0.01,56.39,
ASSAY OF TESTOSTERONE,84402,CPT,,78084402,CDM,301,RC,,,both,,,525,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,76.66,,,76.66,Fee Schedule,,69.02,,,69.02,Fee Schedule,,196.4,,,196.4,Fee Schedule,,176.69,,,176.69,Fee Schedule,,167.01,,,167.01,Fee Schedule,,367.5,70,,367.5,percent of total billed charges,All Other,80.23,,,80.23,Fee Schedule,,47,,,47,Other,186% of Medicaid,94.49,,,94.49,Fee Schedule,,325.5,,,325.5,Fee Schedule,,53.49,,,,Fee Schedule,,94.49,,,94.49,Fee Schedule,,325.5,,,325.5,Fee Schedule,,100.61,,,100.61,Fee Schedule,,367.5,70,,367.5,percent of total billed charges,,120.7,,,120.7,Fee Schedule,,102.3,,,102.3,Fee Schedule,,38.21,,,38.21,Fee Schedule,,38.21,,,38.21,Fee Schedule,,38.21,,,38.21,Fee Schedule,,38.21,,,38.21,Fee Schedule,,25.47,,,25.47,Other,100% of Medicaid,25.47,,,25.47,Other,100% of Medicaid,25.47,,,25.47,Other,100% of Medicaid,25.47,,,25.47,Other,100% of Medicaid,57.31,,,57.31,Other,225% of Medicaid,38.97,,,38.97,Other,153% of Medicaid,57.31,,,57.31,Other,225% of Medicaid,35.66,,,35.66,Other,140% of Medicaid,57.31,,,57.31,Other,225% of Medicaid,66.22,,,66.22,Other,250% of Medicaid,82.52,,,82.52,Other,324% of Medicaid,54.76,,,54.76,Other,215% of Medicaid,54.76,,,54.76,Other,215% of Medicaid,31.84,,,31.84,Other,125% of Medicaid,0.01,367.5,
ASSAY OF TOTAL TESTOSTERONE,84403,CPT,,78084403,CDM,301,RC,,,both,,,329,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,77.69,,,77.69,Fee Schedule,,69.95,,,69.95,Fee Schedule,,199.09,,,199.09,Fee Schedule,,179.11,,,179.11,Fee Schedule,,169.3,,,169.3,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,81.3,,,81.3,Fee Schedule,,48,,,48,Other,186% of Medicaid,95.76,,,95.76,Fee Schedule,,203.98,,,203.98,Fee Schedule,,54.2,,,,Fee Schedule,,95.76,,,95.76,Fee Schedule,,203.98,,,203.98,Fee Schedule,,101.95,,,101.95,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,,122.31,,,122.31,Fee Schedule,,103.67,,,103.67,Fee Schedule,,38.72,,,38.72,Fee Schedule,,38.72,,,38.72,Fee Schedule,,38.72,,,38.72,Fee Schedule,,38.72,,,38.72,Fee Schedule,,25.81,,,25.81,Other,100% of Medicaid,25.81,,,25.81,Other,100% of Medicaid,25.81,,,25.81,Other,100% of Medicaid,25.81,,,25.81,Other,100% of Medicaid,58.07,,,58.07,Other,225% of Medicaid,39.49,,,39.49,Other,153% of Medicaid,58.07,,,58.07,Other,225% of Medicaid,36.13,,,36.13,Other,140% of Medicaid,58.07,,,58.07,Other,225% of Medicaid,67.11,,,67.11,Other,250% of Medicaid,83.62,,,83.62,Other,324% of Medicaid,55.49,,,55.49,Other,215% of Medicaid,55.49,,,55.49,Other,215% of Medicaid,32.26,,,32.26,Other,125% of Medicaid,0.01,230.3,
ASSAY OF VITAMIN B-1,84425,CPT,,78084425,CDM,301,RC,,,both,,,192,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,63.9,,,63.9,Fee Schedule,,57.53,,,57.53,Fee Schedule,,163.74,,,163.74,Fee Schedule,,147.31,,,147.31,Fee Schedule,,139.24,,,139.24,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,All Other,66.87,,,66.87,Fee Schedule,,28,,,28,Other,186% of Medicaid,78.76,,,78.76,Fee Schedule,,119.04,,,119.04,Fee Schedule,,44.58,,,,Fee Schedule,,78.76,,,78.76,Fee Schedule,,119.04,,,119.04,Fee Schedule,,83.86,,,83.86,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,,100.61,,,100.61,Fee Schedule,,85.27,,,85.27,Fee Schedule,,31.85,,,31.85,Fee Schedule,,31.85,,,31.85,Fee Schedule,,31.85,,,31.85,Fee Schedule,,31.85,,,31.85,Fee Schedule,,15.15,,,15.15,Other,100% of Medicaid,15.15,,,15.15,Other,100% of Medicaid,15.15,,,15.15,Other,100% of Medicaid,15.15,,,15.15,Other,100% of Medicaid,34.09,,,34.09,Other,225% of Medicaid,23.18,,,23.18,Other,153% of Medicaid,34.09,,,34.09,Other,225% of Medicaid,21.21,,,21.21,Other,140% of Medicaid,34.09,,,34.09,Other,225% of Medicaid,39.39,,,39.39,Other,250% of Medicaid,49.09,,,49.09,Other,324% of Medicaid,32.57,,,32.57,Other,215% of Medicaid,32.57,,,32.57,Other,215% of Medicaid,18.94,,,18.94,Other,125% of Medicaid,0.01,163.74,
ASSAY OF THIOCYANATE,84430,CPT,,78084430,CDM,301,RC,,,both,,,170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.01,,,35.01,Fee Schedule,,31.52,,,31.52,Fee Schedule,,89.76,,,89.76,Fee Schedule,,80.75,,,80.75,Fee Schedule,,76.33,,,76.33,Fee Schedule,,119,70,,119,percent of total billed charges,All Other,36.63,,,36.63,Fee Schedule,,47,,,47,Other,186% of Medicaid,43.15,,,43.15,Fee Schedule,,105.4,,,105.4,Fee Schedule,,24.42,,,,Fee Schedule,,43.15,,,43.15,Fee Schedule,,105.4,,,105.4,Fee Schedule,,45.94,,,45.94,Fee Schedule,,119,70,,119,percent of total billed charges,,55.11,,,55.11,Fee Schedule,,46.71,,,46.71,Fee Schedule,,17.45,,,17.45,Fee Schedule,,17.45,,,17.45,Fee Schedule,,17.45,,,17.45,Fee Schedule,,17.45,,,17.45,Fee Schedule,,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,25.31,,,25.31,Other,100% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,38.73,,,38.73,Other,153% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,35.44,,,35.44,Other,140% of Medicaid,56.96,,,56.96,Other,225% of Medicaid,65.82,,,65.82,Other,250% of Medicaid,82.02,,,82.02,Other,324% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,54.43,,,54.43,Other,215% of Medicaid,31.64,,,31.64,Other,125% of Medicaid,0.01,119,
THYROGLOBULIN,84432,CPT,,78084432,CDM,301,RC,,,both,,,45,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,48.34,,,48.34,Fee Schedule,,43.52,,,43.52,Fee Schedule,,123.9,,,123.9,Fee Schedule,,111.47,,,111.47,Fee Schedule,,105.36,,,105.36,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,All Other,50.59,,,50.59,Fee Schedule,,58,,,58,Other,186% of Medicaid,59.58,,,59.58,Fee Schedule,,27.9,,,27.9,Fee Schedule,,33.73,,,,Fee Schedule,,59.58,,,59.58,Fee Schedule,,27.9,,,27.9,Fee Schedule,,63.44,,,63.44,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,,76.11,,,76.11,Fee Schedule,,64.51,,,64.51,Fee Schedule,,24.09,,,24.09,Fee Schedule,,24.09,,,24.09,Fee Schedule,,24.09,,,24.09,Fee Schedule,,24.09,,,24.09,Fee Schedule,,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,31.29,,,31.29,Other,100% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,47.87,,,47.87,Other,153% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,43.8,,,43.8,Other,140% of Medicaid,70.4,,,70.4,Other,225% of Medicaid,81.35,,,81.35,Other,250% of Medicaid,101.38,,,101.38,Other,324% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,67.27,,,67.27,Other,215% of Medicaid,39.11,,,39.11,Other,125% of Medicaid,0.01,123.9,
ASSAY OF TOTAL THYROXINE,84436,CPT,,78084436,CDM,301,RC,,,both,,,99,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,20.68,,,20.68,Fee Schedule,,18.62,,,18.62,Fee Schedule,,52.99,,,52.99,Fee Schedule,,47.67,,,47.67,Fee Schedule,,45.06,,,45.06,Fee Schedule,,69.3,70,,69.3,percent of total billed charges,All Other,21.64,,,21.64,Fee Schedule,,11,,,11,Other,186% of Medicaid,25.49,,,25.49,Fee Schedule,,61.38,,,61.38,Fee Schedule,,14.43,,,,Fee Schedule,,25.49,,,25.49,Fee Schedule,,61.38,,,61.38,Fee Schedule,,27.14,,,27.14,Fee Schedule,,69.3,70,,69.3,percent of total billed charges,,32.56,,,32.56,Fee Schedule,,27.59,,,27.59,Fee Schedule,,10.31,,,10.31,Fee Schedule,,10.31,,,10.31,Fee Schedule,,10.31,,,10.31,Fee Schedule,,10.31,,,10.31,Fee Schedule,,5.76,,,5.76,Other,100% of Medicaid,5.76,,,5.76,Other,100% of Medicaid,5.76,,,5.76,Other,100% of Medicaid,5.76,,,5.76,Other,100% of Medicaid,12.95,,,12.95,Other,225% of Medicaid,8.81,,,8.81,Other,153% of Medicaid,12.95,,,12.95,Other,225% of Medicaid,8.06,,,8.06,Other,140% of Medicaid,12.95,,,12.95,Other,225% of Medicaid,14.97,,,14.97,Other,250% of Medicaid,18.65,,,18.65,Other,324% of Medicaid,12.38,,,12.38,Other,215% of Medicaid,12.38,,,12.38,Other,215% of Medicaid,7.2,,,7.2,Other,125% of Medicaid,0.01,69.3,
ASSAY OF FREE THYROXINE,84439,CPT,,78084439,CDM,301,RC,,,both,,,235,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,27.15,,,27.15,Fee Schedule,,24.44,,,24.44,Fee Schedule,,69.54,,,69.54,Fee Schedule,,62.56,,,62.56,Fee Schedule,,59.14,,,59.14,Fee Schedule,,164.5,70,,164.5,percent of total billed charges,All Other,28.41,,,28.41,Fee Schedule,,17,,,17,Other,186% of Medicaid,33.46,,,33.46,Fee Schedule,,145.7,,,145.7,Fee Schedule,,18.94,,,,Fee Schedule,,33.46,,,33.46,Fee Schedule,,145.7,,,145.7,Fee Schedule,,35.63,,,35.63,Fee Schedule,,164.5,70,,164.5,percent of total billed charges,,42.75,,,42.75,Fee Schedule,,36.23,,,36.23,Fee Schedule,,13.53,,,13.53,Fee Schedule,,13.53,,,13.53,Fee Schedule,,13.53,,,13.53,Fee Schedule,,13.53,,,13.53,Fee Schedule,,9,,,9,Other,100% of Medicaid,9,,,9,Other,100% of Medicaid,9,,,9,Other,100% of Medicaid,9,,,9,Other,100% of Medicaid,20.25,,,20.25,Other,225% of Medicaid,13.77,,,13.77,Other,153% of Medicaid,20.25,,,20.25,Other,225% of Medicaid,12.6,,,12.6,Other,140% of Medicaid,20.25,,,20.25,Other,225% of Medicaid,23.4,,,23.4,Other,250% of Medicaid,29.16,,,29.16,Other,324% of Medicaid,19.35,,,19.35,Other,215% of Medicaid,19.35,,,19.35,Other,215% of Medicaid,11.25,,,11.25,Other,125% of Medicaid,0.01,164.5,
ASSAY OF THYROID ACTIVITY,84442,CPT,,78084442,CDM,301,RC,,,both,,,237,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,44.49,,,44.49,Fee Schedule,,40.05,,,40.05,Fee Schedule,,114.09,,,114.09,Fee Schedule,,102.64,,,102.64,Fee Schedule,,97.02,,,97.02,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,46.56,,,46.56,Fee Schedule,,17,,,17,Other,186% of Medicaid,54.83,,,54.83,Fee Schedule,,146.94,,,146.94,Fee Schedule,,31.04,,,,Fee Schedule,,54.83,,,54.83,Fee Schedule,,146.94,,,146.94,Fee Schedule,,58.38,,,58.38,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,70.04,,,70.04,Fee Schedule,,59.37,,,59.37,Fee Schedule,,22.17,,,22.17,Fee Schedule,,22.17,,,22.17,Fee Schedule,,22.17,,,22.17,Fee Schedule,,22.17,,,22.17,Fee Schedule,,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,13.91,,,13.91,Other,153% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,12.73,,,12.73,Other,140% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,23.63,,,23.63,Other,250% of Medicaid,29.45,,,29.45,Other,324% of Medicaid,19.54,,,19.54,Other,215% of Medicaid,19.54,,,19.54,Other,215% of Medicaid,11.36,,,11.36,Other,125% of Medicaid,0.01,165.9,
ASSAY THYROID STIM HORMONE,84443,CPT,,78084443,CDM,301,RC,,,both,,,210,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.57,,,50.57,Fee Schedule,,45.53,,,45.53,Fee Schedule,,129.55,,,129.55,Fee Schedule,,116.55,,,116.55,Fee Schedule,,110.16,,,110.16,Fee Schedule,,147,70,,147,percent of total billed charges,All Other,52.92,,,52.92,Fee Schedule,,17,,,17,Other,186% of Medicaid,62.33,,,62.33,Fee Schedule,,130.2,,,130.2,Fee Schedule,,35.28,,,,Fee Schedule,,62.33,,,62.33,Fee Schedule,,130.2,,,130.2,Fee Schedule,,66.36,,,66.36,Fee Schedule,,147,70,,147,percent of total billed charges,,79.62,,,79.62,Fee Schedule,,67.48,,,67.48,Fee Schedule,,25.2,,,25.2,Fee Schedule,,25.2,,,25.2,Fee Schedule,,25.2,,,25.2,Fee Schedule,,25.2,,,25.2,Fee Schedule,,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,13.91,,,13.91,Other,153% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,12.73,,,12.73,Other,140% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,23.63,,,23.63,Other,250% of Medicaid,29.45,,,29.45,Other,324% of Medicaid,19.54,,,19.54,Other,215% of Medicaid,19.54,,,19.54,Other,215% of Medicaid,11.36,,,11.36,Other,125% of Medicaid,0.01,147,
ASSAY OF TSI,84445,CPT,,78084445,CDM,301,RC,,,both,,,323,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,153.09,,,153.09,Fee Schedule,,137.83,,,137.83,Fee Schedule,,392.15,,,392.15,Fee Schedule,,352.79,,,352.79,Fee Schedule,,333.47,,,333.47,Fee Schedule,,226.1,70,,226.1,percent of total billed charges,All Other,160.21,,,160.21,Fee Schedule,,76,,,76,Other,186% of Medicaid,188.69,,,188.69,Fee Schedule,,200.26,,,200.26,Fee Schedule,,106.81,,,,Fee Schedule,,188.69,,,188.69,Fee Schedule,,200.26,,,200.26,Fee Schedule,,200.9,,,200.9,Fee Schedule,,226.1,70,,226.1,percent of total billed charges,,241.03,,,241.03,Fee Schedule,,204.29,,,204.29,Fee Schedule,,76.29,,,76.29,Fee Schedule,,76.29,,,76.29,Fee Schedule,,76.29,,,76.29,Fee Schedule,,76.29,,,76.29,Fee Schedule,,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,62.76,,,62.76,Other,153% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,57.43,,,57.43,Other,140% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,106.65,,,106.65,Other,250% of Medicaid,132.9,,,132.9,Other,324% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,51.27,,,51.27,Other,125% of Medicaid,0.01,392.15,
ASSAY OF VITAMIN E,84446,CPT,,78084446,CDM,301,RC,,,both,,,192,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,42.68,,,42.68,Fee Schedule,,38.43,,,38.43,Fee Schedule,,109.33,,,109.33,Fee Schedule,,98.35,,,98.35,Fee Schedule,,92.97,,,92.97,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,All Other,44.67,,,44.67,Fee Schedule,,26,,,26,Other,186% of Medicaid,52.61,,,52.61,Fee Schedule,,119.04,,,119.04,Fee Schedule,,29.78,,,,Fee Schedule,,52.61,,,52.61,Fee Schedule,,119.04,,,119.04,Fee Schedule,,56.01,,,56.01,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,,67.2,,,67.2,Fee Schedule,,56.96,,,56.96,Fee Schedule,,21.27,,,21.27,Fee Schedule,,21.27,,,21.27,Fee Schedule,,21.27,,,21.27,Fee Schedule,,21.27,,,21.27,Fee Schedule,,14.18,,,14.18,Other,100% of Medicaid,14.18,,,14.18,Other,100% of Medicaid,14.18,,,14.18,Other,100% of Medicaid,14.18,,,14.18,Other,100% of Medicaid,31.91,,,31.91,Other,225% of Medicaid,21.7,,,21.7,Other,153% of Medicaid,31.91,,,31.91,Other,225% of Medicaid,19.85,,,19.85,Other,140% of Medicaid,31.91,,,31.91,Other,225% of Medicaid,36.87,,,36.87,Other,250% of Medicaid,45.94,,,45.94,Other,324% of Medicaid,30.49,,,30.49,Other,215% of Medicaid,30.49,,,30.49,Other,215% of Medicaid,17.73,,,17.73,Other,125% of Medicaid,0.01,134.4,
TRANSCORTIN,84449,CPT,,78084449,CDM,301,RC,,,both,,,108,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.18,,,54.18,Fee Schedule,,48.78,,,48.78,Fee Schedule,,138.81,,,138.81,Fee Schedule,,124.88,,,124.88,Fee Schedule,,118.04,,,118.04,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,All Other,56.7,,,56.7,Fee Schedule,,33,,,33,Other,186% of Medicaid,66.78,,,66.78,Fee Schedule,,66.96,,,66.96,Fee Schedule,,37.8,,,,Fee Schedule,,66.78,,,66.78,Fee Schedule,,66.96,,,66.96,Fee Schedule,,71.1,,,71.1,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,,85.3,,,85.3,Fee Schedule,,72.3,,,72.3,Fee Schedule,,27,,,27,Fee Schedule,,27,,,27,Fee Schedule,,27,,,27,Fee Schedule,,27,,,27,Fee Schedule,,18,,,18,Other,100% of Medicaid,18,,,18,Other,100% of Medicaid,18,,,18,Other,100% of Medicaid,18,,,18,Other,100% of Medicaid,40.5,,,40.5,Other,225% of Medicaid,27.54,,,27.54,Other,153% of Medicaid,40.5,,,40.5,Other,225% of Medicaid,25.2,,,25.2,Other,140% of Medicaid,40.5,,,40.5,Other,225% of Medicaid,46.8,,,46.8,Other,250% of Medicaid,58.32,,,58.32,Other,324% of Medicaid,38.7,,,38.7,Other,215% of Medicaid,38.7,,,38.7,Other,215% of Medicaid,22.5,,,22.5,Other,125% of Medicaid,0.01,138.81,
TRANSFERASE (AST) (SGOT),84450,CPT,,78084450,CDM,301,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.59,,,15.59,Fee Schedule,,14.04,,,14.04,Fee Schedule,,39.89,,,39.89,Fee Schedule,,35.89,,,35.89,Fee Schedule,,33.92,,,33.92,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,16.32,,,16.32,Fee Schedule,,9,,,9,Other,186% of Medicaid,19.22,,,19.22,Fee Schedule,,62,,,62,Fee Schedule,,10.88,,,,Fee Schedule,,19.22,,,19.22,Fee Schedule,,62,,,62,Fee Schedule,,20.46,,,20.46,Fee Schedule,,70,70,,70,percent of total billed charges,,24.55,,,24.55,Fee Schedule,,20.81,,,20.81,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,70,
ALANINE AMINO (ALT) (SGPT),84460,CPT,,78084460,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.95,,,15.95,Fee Schedule,,14.36,,,14.36,Fee Schedule,,40.77,,,40.77,Fee Schedule,,36.68,,,36.68,Fee Schedule,,34.67,,,34.67,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,16.7,,,16.7,Fee Schedule,,9,,,9,Other,186% of Medicaid,19.66,,,19.66,Fee Schedule,,66.34,,,66.34,Fee Schedule,,11.13,,,,Fee Schedule,,19.66,,,19.66,Fee Schedule,,66.34,,,66.34,Fee Schedule,,20.94,,,20.94,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,,25.12,,,25.12,Fee Schedule,,21.29,,,21.29,Fee Schedule,,7.95,,,7.95,Fee Schedule,,7.95,,,7.95,Fee Schedule,,7.95,,,7.95,Fee Schedule,,7.95,,,7.95,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,74.9,
ASSAY OF TRANSFERRIN,84466,CPT,,78084466,CDM,301,RC,,,both,,,142,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.41,,,38.41,Fee Schedule,,34.58,,,34.58,Fee Schedule,,98.48,,,98.48,Fee Schedule,,88.59,,,88.59,Fee Schedule,,83.74,,,83.74,Fee Schedule,,99.4,70,,99.4,percent of total billed charges,All Other,40.19,,,40.19,Fee Schedule,,23,,,23,Other,186% of Medicaid,47.34,,,47.34,Fee Schedule,,88.04,,,88.04,Fee Schedule,,26.8,,,,Fee Schedule,,47.34,,,47.34,Fee Schedule,,88.04,,,88.04,Fee Schedule,,50.4,,,50.4,Fee Schedule,,99.4,70,,99.4,percent of total billed charges,,60.47,,,60.47,Fee Schedule,,51.25,,,51.25,Fee Schedule,,19.14,,,19.14,Fee Schedule,,19.14,,,19.14,Fee Schedule,,19.14,,,19.14,Fee Schedule,,19.14,,,19.14,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,99.4,
ASSAY OF TRIGLYCERIDES,84478,CPT,,78084478,CDM,301,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,17.28,,,17.28,Fee Schedule,,15.56,,,15.56,Fee Schedule,,44.39,,,44.39,Fee Schedule,,39.93,,,39.93,Fee Schedule,,37.75,,,37.75,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,18.08,,,18.08,Fee Schedule,,9,,,9,Other,186% of Medicaid,21.3,,,21.3,Fee Schedule,,66.34,,,66.34,Fee Schedule,,12.05,,,,Fee Schedule,,21.3,,,21.3,Fee Schedule,,66.34,,,66.34,Fee Schedule,,22.67,,,22.67,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,,27.2,,,27.2,Fee Schedule,,23.06,,,23.06,Fee Schedule,,8.61,,,8.61,Fee Schedule,,8.61,,,8.61,Fee Schedule,,8.61,,,8.61,Fee Schedule,,8.61,,,8.61,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,74.9,
ASSAY OF THYROID (T3 OR T4),84479,CPT,,78084479,CDM,301,RC,,,both,,,235,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.47,,,19.47,Fee Schedule,,17.53,,,17.53,Fee Schedule,,49.92,,,49.92,Fee Schedule,,44.91,,,44.91,Fee Schedule,,42.45,,,42.45,Fee Schedule,,164.5,70,,164.5,percent of total billed charges,All Other,20.38,,,20.38,Fee Schedule,,6,,,6,Other,186% of Medicaid,24,,,24,Fee Schedule,,145.7,,,145.7,Fee Schedule,,13.59,,,,Fee Schedule,,24,,,24,Fee Schedule,,145.7,,,145.7,Fee Schedule,,25.56,,,25.56,Fee Schedule,,164.5,70,,164.5,percent of total billed charges,,30.66,,,30.66,Fee Schedule,,25.99,,,25.99,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,3.33,,,3.33,Other,100% of Medicaid,3.33,,,3.33,Other,100% of Medicaid,3.33,,,3.33,Other,100% of Medicaid,3.33,,,3.33,Other,100% of Medicaid,7.5,,,7.5,Other,225% of Medicaid,5.1,,,5.1,Other,153% of Medicaid,7.5,,,7.5,Other,225% of Medicaid,4.67,,,4.67,Other,140% of Medicaid,7.5,,,7.5,Other,225% of Medicaid,8.67,,,8.67,Other,250% of Medicaid,10.8,,,10.8,Other,324% of Medicaid,7.17,,,7.17,Other,215% of Medicaid,7.17,,,7.17,Other,215% of Medicaid,4.17,,,4.17,Other,125% of Medicaid,0.01,164.5,
ASSAY TRIIODOTHYRONINE (T3),84480,CPT,,78084480,CDM,301,RC,,,both,,,173,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,42.68,,,42.68,Fee Schedule,,38.43,,,38.43,Fee Schedule,,109.33,,,109.33,Fee Schedule,,98.35,,,98.35,Fee Schedule,,92.97,,,92.97,Fee Schedule,,121.1,70,,121.1,percent of total billed charges,All Other,44.67,,,44.67,Fee Schedule,,11,,,11,Other,186% of Medicaid,52.61,,,52.61,Fee Schedule,,107.26,,,107.26,Fee Schedule,,29.78,,,,Fee Schedule,,52.61,,,52.61,Fee Schedule,,107.26,,,107.26,Fee Schedule,,56.01,,,56.01,Fee Schedule,,121.1,70,,121.1,percent of total billed charges,,67.2,,,67.2,Fee Schedule,,56.96,,,56.96,Fee Schedule,,21.27,,,21.27,Fee Schedule,,21.27,,,21.27,Fee Schedule,,21.27,,,21.27,Fee Schedule,,21.27,,,21.27,Fee Schedule,,5.76,,,5.76,Other,100% of Medicaid,5.76,,,5.76,Other,100% of Medicaid,5.76,,,5.76,Other,100% of Medicaid,5.76,,,5.76,Other,100% of Medicaid,12.95,,,12.95,Other,225% of Medicaid,8.81,,,8.81,Other,153% of Medicaid,12.95,,,12.95,Other,225% of Medicaid,8.06,,,8.06,Other,140% of Medicaid,12.95,,,12.95,Other,225% of Medicaid,14.97,,,14.97,Other,250% of Medicaid,18.65,,,18.65,Other,324% of Medicaid,12.38,,,12.38,Other,215% of Medicaid,12.38,,,12.38,Other,215% of Medicaid,7.2,,,7.2,Other,125% of Medicaid,0.01,121.1,
FREE ASSAY (FT-3),84481,CPT,,78084481,CDM,301,RC,,,both,,,532,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.99,,,50.99,Fee Schedule,,45.91,,,45.91,Fee Schedule,,130.64,,,130.64,Fee Schedule,,117.53,,,117.53,Fee Schedule,,111.09,,,111.09,Fee Schedule,,372.4,70,,372.4,percent of total billed charges,All Other,53.36,,,53.36,Fee Schedule,,17,,,17,Other,186% of Medicaid,62.85,,,62.85,Fee Schedule,,329.84,,,329.84,Fee Schedule,,35.57,,,,Fee Schedule,,62.85,,,62.85,Fee Schedule,,329.84,,,329.84,Fee Schedule,,66.91,,,66.91,Fee Schedule,,372.4,70,,372.4,percent of total billed charges,,80.28,,,80.28,Fee Schedule,,68.04,,,68.04,Fee Schedule,,25.41,,,25.41,Fee Schedule,,25.41,,,25.41,Fee Schedule,,25.41,,,25.41,Fee Schedule,,25.41,,,25.41,Fee Schedule,,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,13.91,,,13.91,Other,153% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,12.73,,,12.73,Other,140% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,23.63,,,23.63,Other,250% of Medicaid,29.45,,,29.45,Other,324% of Medicaid,19.54,,,19.54,Other,215% of Medicaid,19.54,,,19.54,Other,215% of Medicaid,11.36,,,11.36,Other,125% of Medicaid,0.01,372.4,
T3 REVERSE,84482,CPT,,78084482,CDM,301,RC,,,both,,,377,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,47.44,,,47.44,Fee Schedule,,42.71,,,42.71,Fee Schedule,,59.35,,,59.35,Fee Schedule,,53.39,,,53.39,Fee Schedule,,50.47,,,50.47,Fee Schedule,,263.9,70,,263.9,percent of total billed charges,All Other,49.64,,,49.64,Fee Schedule,,11,,,11,Other,186% of Medicaid,58.47,,,58.47,Fee Schedule,,233.74,,,233.74,Fee Schedule,,33.1,,,,Fee Schedule,,58.47,,,58.47,Fee Schedule,,233.74,,,233.74,Fee Schedule,,62.25,,,62.25,Fee Schedule,,263.9,70,,263.9,percent of total billed charges,,74.69,,,74.69,Fee Schedule,,63.3,,,63.3,Fee Schedule,,23.64,,,23.64,Fee Schedule,,23.64,,,23.64,Fee Schedule,,23.64,,,23.64,Fee Schedule,,23.64,,,23.64,Fee Schedule,,5.76,,,5.76,Other,100% of Medicaid,5.76,,,5.76,Other,100% of Medicaid,5.76,,,5.76,Other,100% of Medicaid,5.76,,,5.76,Other,100% of Medicaid,12.95,,,12.95,Other,225% of Medicaid,8.81,,,8.81,Other,153% of Medicaid,12.95,,,12.95,Other,225% of Medicaid,8.06,,,8.06,Other,140% of Medicaid,12.95,,,12.95,Other,225% of Medicaid,14.97,,,14.97,Other,250% of Medicaid,18.65,,,18.65,Other,324% of Medicaid,12.38,,,12.38,Other,215% of Medicaid,12.38,,,12.38,Other,215% of Medicaid,7.2,,,7.2,Other,125% of Medicaid,0.01,263.9,
ASSAY OF TROPONIN QUANT,84484,CPT,,78084484,CDM,301,RC,,,both,,,281,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,37.53,,,37.53,Fee Schedule,,33.79,,,33.79,Fee Schedule,,47.46,,,47.46,Fee Schedule,,42.69,,,42.69,Fee Schedule,,40.36,,,40.36,Fee Schedule,,196.7,70,,196.7,percent of total billed charges,All Other,39.28,,,39.28,Fee Schedule,,15,,,15,Other,186% of Medicaid,46.26,,,46.26,Fee Schedule,,174.22,,,174.22,Fee Schedule,,26.19,,,,Fee Schedule,,46.26,,,46.26,Fee Schedule,,174.22,,,174.22,Fee Schedule,,49.26,,,49.26,Fee Schedule,,196.7,70,,196.7,percent of total billed charges,,59.1,,,59.1,Fee Schedule,,50.09,,,50.09,Fee Schedule,,18.71,,,18.71,Fee Schedule,,18.71,,,18.71,Fee Schedule,,18.71,,,18.71,Fee Schedule,,18.71,,,18.71,Fee Schedule,,8.13,,,8.13,Other,100% of Medicaid,8.13,,,8.13,Other,100% of Medicaid,8.13,,,8.13,Other,100% of Medicaid,8.13,,,8.13,Other,100% of Medicaid,18.29,,,18.29,Other,225% of Medicaid,12.44,,,12.44,Other,153% of Medicaid,18.29,,,18.29,Other,225% of Medicaid,11.38,,,11.38,Other,140% of Medicaid,18.29,,,18.29,Other,225% of Medicaid,21.14,,,21.14,Other,250% of Medicaid,26.34,,,26.34,Other,324% of Medicaid,17.48,,,17.48,Other,215% of Medicaid,17.48,,,17.48,Other,215% of Medicaid,10.16,,,10.16,Other,125% of Medicaid,0.01,196.7,
ASSAY OF TYROSINE,84510,CPT,,78084510,CDM,301,RC,,,both,,,34,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,32,,,32,Fee Schedule,,28.81,,,28.81,Fee Schedule,,80.23,,,80.23,Fee Schedule,,72.18,,,72.18,Fee Schedule,,68.22,,,68.22,Fee Schedule,,23.8,70,,23.8,percent of total billed charges,All Other,33.48,,,33.48,Fee Schedule,,20,,,20,Other,186% of Medicaid,39.44,,,39.44,Fee Schedule,,21.08,,,21.08,Fee Schedule,,22.32,,,,Fee Schedule,,39.44,,,39.44,Fee Schedule,,21.08,,,21.08,Fee Schedule,,41.99,,,41.99,Fee Schedule,,23.8,70,,23.8,percent of total billed charges,,50.38,,,50.38,Fee Schedule,,42.7,,,42.7,Fee Schedule,,15.95,,,15.95,Fee Schedule,,15.95,,,15.95,Fee Schedule,,15.95,,,15.95,Fee Schedule,,15.95,,,15.95,Fee Schedule,,10.63,,,10.63,Other,100% of Medicaid,10.63,,,10.63,Other,100% of Medicaid,10.63,,,10.63,Other,100% of Medicaid,10.63,,,10.63,Other,100% of Medicaid,23.92,,,23.92,Other,225% of Medicaid,16.26,,,16.26,Other,153% of Medicaid,23.92,,,23.92,Other,225% of Medicaid,14.88,,,14.88,Other,140% of Medicaid,23.92,,,23.92,Other,225% of Medicaid,27.64,,,27.64,Other,250% of Medicaid,34.44,,,34.44,Other,324% of Medicaid,22.85,,,22.85,Other,215% of Medicaid,22.85,,,22.85,Other,215% of Medicaid,13.29,,,13.29,Other,125% of Medicaid,0.01,80.23,
ASSAY OF UREA NITROGEN,84520,CPT,,78084520,CDM,301,RC,,,both,,,84,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,11.89,,,11.89,Fee Schedule,,10.7,,,10.7,Fee Schedule,,30.47,,,30.47,Fee Schedule,,27.41,,,27.41,Fee Schedule,,25.91,,,25.91,Fee Schedule,,58.8,70,,58.8,percent of total billed charges,All Other,12.44,,,12.44,Fee Schedule,,7,,,7,Other,186% of Medicaid,14.65,,,14.65,Fee Schedule,,52.08,,,52.08,Fee Schedule,,8.3,,,,Fee Schedule,,14.65,,,14.65,Fee Schedule,,52.08,,,52.08,Fee Schedule,,15.6,,,15.6,Fee Schedule,,58.8,70,,58.8,percent of total billed charges,,18.72,,,18.72,Fee Schedule,,15.87,,,15.87,Fee Schedule,,5.93,,,5.93,Fee Schedule,,5.93,,,5.93,Fee Schedule,,5.93,,,5.93,Fee Schedule,,5.93,,,5.93,Fee Schedule,,3.95,,,3.95,Other,100% of Medicaid,3.95,,,3.95,Other,100% of Medicaid,3.95,,,3.95,Other,100% of Medicaid,3.95,,,3.95,Other,100% of Medicaid,8.89,,,8.89,Other,225% of Medicaid,6.04,,,6.04,Other,153% of Medicaid,8.89,,,8.89,Other,225% of Medicaid,5.53,,,5.53,Other,140% of Medicaid,8.89,,,8.89,Other,225% of Medicaid,10.27,,,10.27,Other,250% of Medicaid,12.8,,,12.8,Other,324% of Medicaid,8.49,,,8.49,Other,215% of Medicaid,8.49,,,8.49,Other,215% of Medicaid,4.94,,,4.94,Other,125% of Medicaid,0.01,58.8,
ASSAY OF URINE/UREA-N,84540,CPT,,78084540,CDM,301,RC,,,both,,,84,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,16.74,,,16.74,Fee Schedule,,15.07,,,15.07,Fee Schedule,,36.61,,,36.61,Fee Schedule,,32.93,,,32.93,Fee Schedule,,31.13,,,31.13,Fee Schedule,,58.8,70,,58.8,percent of total billed charges,All Other,17.51,,,17.51,Fee Schedule,,9,,,9,Other,186% of Medicaid,20.63,,,20.63,Fee Schedule,,52.08,,,52.08,Fee Schedule,,11.68,,,,Fee Schedule,,20.63,,,20.63,Fee Schedule,,52.08,,,52.08,Fee Schedule,,21.96,,,21.96,Fee Schedule,,58.8,70,,58.8,percent of total billed charges,,26.35,,,26.35,Fee Schedule,,22.33,,,22.33,Fee Schedule,,8.34,,,8.34,Fee Schedule,,8.34,,,8.34,Fee Schedule,,8.34,,,8.34,Fee Schedule,,8.34,,,8.34,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,58.8,
UREA-N CLEARANCE TEST,84545,CPT,,78084545,CDM,301,RC,,,both,,,117,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,21.67,,,21.67,Fee Schedule,,19.51,,,19.51,Fee Schedule,,50.91,,,50.91,Fee Schedule,,45.8,,,45.8,Fee Schedule,,43.29,,,43.29,Fee Schedule,,81.9,70,,81.9,percent of total billed charges,All Other,22.68,,,22.68,Fee Schedule,,26,,,26,Other,186% of Medicaid,26.71,,,26.71,Fee Schedule,,72.54,,,72.54,Fee Schedule,,15.12,,,,Fee Schedule,,26.71,,,26.71,Fee Schedule,,72.54,,,72.54,Fee Schedule,,28.44,,,28.44,Fee Schedule,,81.9,70,,81.9,percent of total billed charges,,34.12,,,34.12,Fee Schedule,,28.92,,,28.92,Fee Schedule,,10.8,,,10.8,Fee Schedule,,10.8,,,10.8,Fee Schedule,,10.8,,,10.8,Fee Schedule,,10.8,,,10.8,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,81.9,
ASSAY OF BLOOD/URIC ACID,84550,CPT,,78084550,CDM,301,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,13.61,,,13.61,Fee Schedule,,12.25,,,12.25,Fee Schedule,,34.85,,,34.85,Fee Schedule,,31.35,,,31.35,Fee Schedule,,29.64,,,29.64,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,14.24,,,14.24,Fee Schedule,,8,,,8,Other,186% of Medicaid,16.77,,,16.77,Fee Schedule,,57.66,,,57.66,Fee Schedule,,9.49,,,,Fee Schedule,,16.77,,,16.77,Fee Schedule,,57.66,,,57.66,Fee Schedule,,17.85,,,17.85,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,,21.42,,,21.42,Fee Schedule,,18.16,,,18.16,Fee Schedule,,6.78,,,6.78,Fee Schedule,,6.78,,,6.78,Fee Schedule,,6.78,,,6.78,Fee Schedule,,6.78,,,6.78,Fee Schedule,,4.52,,,4.52,Other,100% of Medicaid,4.52,,,4.52,Other,100% of Medicaid,4.52,,,4.52,Other,100% of Medicaid,4.52,,,4.52,Other,100% of Medicaid,10.17,,,10.17,Other,225% of Medicaid,6.92,,,6.92,Other,153% of Medicaid,10.17,,,10.17,Other,225% of Medicaid,6.33,,,6.33,Other,140% of Medicaid,10.17,,,10.17,Other,225% of Medicaid,11.75,,,11.75,Other,250% of Medicaid,14.64,,,14.64,Other,324% of Medicaid,9.72,,,9.72,Other,215% of Medicaid,9.72,,,9.72,Other,215% of Medicaid,5.65,,,5.65,Other,125% of Medicaid,0.01,65.1,
ASSAY OF URINE/URIC ACID,84560,CPT,,78084560,CDM,301,RC,,,both,,,92,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.29,,,15.29,Fee Schedule,,13.77,,,13.77,Fee Schedule,,36.61,,,36.61,Fee Schedule,,32.93,,,32.93,Fee Schedule,,31.13,,,31.13,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,All Other,16,,,16,Fee Schedule,,9,,,9,Other,186% of Medicaid,18.85,,,18.85,Fee Schedule,,57.04,,,57.04,Fee Schedule,,10.67,,,,Fee Schedule,,18.85,,,18.85,Fee Schedule,,57.04,,,57.04,Fee Schedule,,20.07,,,20.07,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,,24.07,,,24.07,Fee Schedule,,20.4,,,20.4,Fee Schedule,,7.62,,,7.62,Fee Schedule,,7.62,,,7.62,Fee Schedule,,7.62,,,7.62,Fee Schedule,,7.62,,,7.62,Fee Schedule,,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,5.08,,,5.08,Other,100% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.77,,,7.77,Other,153% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,7.11,,,7.11,Other,140% of Medicaid,11.43,,,11.43,Other,225% of Medicaid,13.21,,,13.21,Other,250% of Medicaid,16.46,,,16.46,Other,324% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,10.92,,,10.92,Other,215% of Medicaid,6.35,,,6.35,Other,125% of Medicaid,0.01,64.4,
ASSAY OF FECES/UROBILINOGEN,84577,CPT,,78084577,CDM,301,RC,,,both,,,77,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,50.57,,,50.57,Fee Schedule,,45.53,,,45.53,Fee Schedule,,96.23,,,96.23,Fee Schedule,,86.57,,,86.57,Fee Schedule,,81.83,,,81.83,Fee Schedule,,53.9,70,,53.9,percent of total billed charges,All Other,52.92,,,52.92,Fee Schedule,,33,,,33,Other,186% of Medicaid,62.33,,,62.33,Fee Schedule,,47.74,,,47.74,Fee Schedule,,35.28,,,,Fee Schedule,,62.33,,,62.33,Fee Schedule,,47.74,,,47.74,Fee Schedule,,66.36,,,66.36,Fee Schedule,,53.9,70,,53.9,percent of total billed charges,,79.62,,,79.62,Fee Schedule,,67.48,,,67.48,Fee Schedule,,25.2,,,25.2,Fee Schedule,,25.2,,,25.2,Fee Schedule,,25.2,,,25.2,Fee Schedule,,25.2,,,25.2,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,96.23,
TEST URINE UROBILINOGEN,84578,CPT,,78084578,CDM,301,RC,,,both,,,20,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,13.45,,,13.45,Fee Schedule,,12.11,,,12.11,Fee Schedule,,25.04,,,25.04,Fee Schedule,,22.53,,,22.53,Fee Schedule,,21.3,,,21.3,Fee Schedule,,14,70,,14,percent of total billed charges,All Other,14.08,,,14.08,Fee Schedule,,26,,,26,Other,186% of Medicaid,16.58,,,16.58,Fee Schedule,,12.4,,,12.4,Fee Schedule,,9.39,,,,Fee Schedule,,16.58,,,16.58,Fee Schedule,,12.4,,,12.4,Fee Schedule,,17.66,,,17.66,Fee Schedule,,14,70,,14,percent of total billed charges,,21.18,,,21.18,Fee Schedule,,17.95,,,17.95,Fee Schedule,,6.71,,,6.71,Fee Schedule,,6.71,,,6.71,Fee Schedule,,6.71,,,6.71,Fee Schedule,,6.71,,,6.71,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
ASSAY OF URINE UROBILINOGEN,84583,CPT,,78084583,CDM,301,RC,,,both,,,37,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.21,,,18.21,Fee Schedule,,16.4,,,16.4,Fee Schedule,,33.7,,,33.7,Fee Schedule,,30.32,,,30.32,Fee Schedule,,28.66,,,28.66,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,All Other,19.06,,,19.06,Fee Schedule,,26,,,26,Other,186% of Medicaid,22.45,,,22.45,Fee Schedule,,22.94,,,22.94,Fee Schedule,,12.71,,,,Fee Schedule,,22.45,,,22.45,Fee Schedule,,22.94,,,22.94,Fee Schedule,,23.9,,,23.9,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,,28.67,,,28.67,Fee Schedule,,24.3,,,24.3,Fee Schedule,,9.08,,,9.08,Fee Schedule,,9.08,,,9.08,Fee Schedule,,9.08,,,9.08,Fee Schedule,,9.08,,,9.08,Fee Schedule,,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,13.76,,,13.76,Other,100% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,21.05,,,21.05,Other,153% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,19.26,,,19.26,Other,140% of Medicaid,30.96,,,30.96,Other,225% of Medicaid,35.78,,,35.78,Other,250% of Medicaid,44.58,,,44.58,Other,324% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,29.58,,,29.58,Other,215% of Medicaid,17.2,,,17.2,Other,125% of Medicaid,0.01,44.58,
ASSAY OF URINE VMA,84585,CPT,,78084585,CDM,301,RC,,,both,,,164,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.66,,,46.66,Fee Schedule,,42.01,,,42.01,Fee Schedule,,119.57,,,119.57,Fee Schedule,,107.57,,,107.57,Fee Schedule,,101.68,,,101.68,Fee Schedule,,114.8,70,,114.8,percent of total billed charges,All Other,48.83,,,48.83,Fee Schedule,,29,,,29,Other,186% of Medicaid,57.51,,,57.51,Fee Schedule,,101.68,,,101.68,Fee Schedule,,32.55,,,,Fee Schedule,,57.51,,,57.51,Fee Schedule,,101.68,,,101.68,Fee Schedule,,61.23,,,61.23,Fee Schedule,,114.8,70,,114.8,percent of total billed charges,,73.46,,,73.46,Fee Schedule,,62.26,,,62.26,Fee Schedule,,23.25,,,23.25,Fee Schedule,,23.25,,,23.25,Fee Schedule,,23.25,,,23.25,Fee Schedule,,23.25,,,23.25,Fee Schedule,,15.5,,,15.5,Other,100% of Medicaid,15.5,,,15.5,Other,100% of Medicaid,15.5,,,15.5,Other,100% of Medicaid,15.5,,,15.5,Other,100% of Medicaid,34.88,,,34.88,Other,225% of Medicaid,23.72,,,23.72,Other,153% of Medicaid,34.88,,,34.88,Other,225% of Medicaid,21.7,,,21.7,Other,140% of Medicaid,34.88,,,34.88,Other,225% of Medicaid,40.3,,,40.3,Other,250% of Medicaid,50.22,,,50.22,Other,324% of Medicaid,33.33,,,33.33,Other,215% of Medicaid,33.33,,,33.33,Other,215% of Medicaid,19.38,,,19.38,Other,125% of Medicaid,0.01,119.57,
ASSAY OF VIP,84586,CPT,,78084586,CDM,301,RC,,,both,,,584,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,106.34,,,106.34,Fee Schedule,,95.74,,,95.74,Fee Schedule,,272.47,,,272.47,Fee Schedule,,245.12,,,245.12,Fee Schedule,,231.7,,,231.7,Fee Schedule,,408.8,70,,408.8,percent of total billed charges,All Other,111.29,,,111.29,Fee Schedule,,76,,,76,Other,186% of Medicaid,131.07,,,131.07,Fee Schedule,,362.08,,,362.08,Fee Schedule,,74.19,,,,Fee Schedule,,131.07,,,131.07,Fee Schedule,,362.08,,,362.08,Fee Schedule,,139.55,,,139.55,Fee Schedule,,408.8,70,,408.8,percent of total billed charges,,167.43,,,167.43,Fee Schedule,,141.91,,,141.91,Fee Schedule,,53,,,53,Fee Schedule,,53,,,53,Fee Schedule,,53,,,53,Fee Schedule,,53,,,53,Fee Schedule,,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,41.02,,,41.02,Other,100% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,62.76,,,62.76,Other,153% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,57.43,,,57.43,Other,140% of Medicaid,92.29,,,92.29,Other,225% of Medicaid,106.65,,,106.65,Other,250% of Medicaid,132.9,,,132.9,Other,324% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,88.19,,,88.19,Other,215% of Medicaid,51.27,,,51.27,Other,125% of Medicaid,0.01,408.8,
ASSAY OF VASOPRESSIN,84588,CPT,,78084588,CDM,301,RC,,,both,,,641,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,102.16,,,102.16,Fee Schedule,,91.98,,,91.98,Fee Schedule,,261.78,,,261.78,Fee Schedule,,235.51,,,235.51,Fee Schedule,,222.61,,,222.61,Fee Schedule,,448.7,70,,448.7,percent of total billed charges,All Other,106.91,,,106.91,Fee Schedule,,63,,,63,Other,186% of Medicaid,125.92,,,125.92,Fee Schedule,,397.42,,,397.42,Fee Schedule,,71.27,,,,Fee Schedule,,125.92,,,125.92,Fee Schedule,,397.42,,,397.42,Fee Schedule,,134.06,,,134.06,Fee Schedule,,448.7,70,,448.7,percent of total billed charges,,160.84,,,160.84,Fee Schedule,,136.32,,,136.32,Fee Schedule,,50.91,,,50.91,Fee Schedule,,50.91,,,50.91,Fee Schedule,,50.91,,,50.91,Fee Schedule,,50.91,,,50.91,Fee Schedule,,33.94,,,33.94,Other,100% of Medicaid,33.94,,,33.94,Other,100% of Medicaid,33.94,,,33.94,Other,100% of Medicaid,33.94,,,33.94,Other,100% of Medicaid,76.37,,,76.37,Other,225% of Medicaid,51.93,,,51.93,Other,153% of Medicaid,76.37,,,76.37,Other,225% of Medicaid,47.52,,,47.52,Other,140% of Medicaid,76.37,,,76.37,Other,225% of Medicaid,88.24,,,88.24,Other,250% of Medicaid,109.97,,,109.97,Other,324% of Medicaid,72.97,,,72.97,Other,215% of Medicaid,72.97,,,72.97,Other,215% of Medicaid,42.43,,,42.43,Other,125% of Medicaid,0.01,448.7,
ASSAY OF VITAMIN A,84590,CPT,,78084590,CDM,301,RC,,,both,,,233,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.95,,,34.95,Fee Schedule,,31.46,,,31.46,Fee Schedule,,89.43,,,89.43,Fee Schedule,,80.46,,,80.46,Fee Schedule,,76.05,,,76.05,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,All Other,36.57,,,36.57,Fee Schedule,,22,,,22,Other,186% of Medicaid,43.07,,,43.07,Fee Schedule,,144.46,,,144.46,Fee Schedule,,24.38,,,,Fee Schedule,,43.07,,,43.07,Fee Schedule,,144.46,,,144.46,Fee Schedule,,45.86,,,45.86,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,,55.02,,,55.02,Fee Schedule,,46.63,,,46.63,Fee Schedule,,17.42,,,17.42,Fee Schedule,,17.42,,,17.42,Fee Schedule,,17.42,,,17.42,Fee Schedule,,17.42,,,17.42,Fee Schedule,,11.61,,,11.61,Other,100% of Medicaid,11.61,,,11.61,Other,100% of Medicaid,11.61,,,11.61,Other,100% of Medicaid,11.61,,,11.61,Other,100% of Medicaid,26.12,,,26.12,Other,225% of Medicaid,17.76,,,17.76,Other,153% of Medicaid,26.12,,,26.12,Other,225% of Medicaid,16.25,,,16.25,Other,140% of Medicaid,26.12,,,26.12,Other,225% of Medicaid,30.19,,,30.19,Other,250% of Medicaid,37.62,,,37.62,Other,324% of Medicaid,24.96,,,24.96,Other,215% of Medicaid,24.96,,,24.96,Other,215% of Medicaid,14.51,,,14.51,Other,125% of Medicaid,0.01,163.1,
ASSAY OF NOS VITAMIN,84591,CPT,,78084591,CDM,301,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,51.35,,,51.35,Fee Schedule,,46.23,,,46.23,Fee Schedule,,89.43,,,89.43,Fee Schedule,,80.46,,,80.46,Fee Schedule,,76.05,,,76.05,Fee Schedule,,49,70,,49,percent of total billed charges,All Other,53.74,,,53.74,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,63.29,,,63.29,Fee Schedule,,43.4,,,43.4,Fee Schedule,,35.83,,,,Fee Schedule,,63.29,,,63.29,Fee Schedule,,43.4,,,43.4,Fee Schedule,,67.39,,,67.39,Fee Schedule,,49,70,,49,percent of total billed charges,,80.85,,,80.85,Fee Schedule,,68.52,,,68.52,Fee Schedule,,25.59,,,25.59,Fee Schedule,,25.59,,,25.59,Fee Schedule,,25.59,,,25.59,Fee Schedule,,25.59,,,25.59,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,89.43,
ASSAY OF VITAMIN K,84597,CPT,,78084597,CDM,301,RC,,,both,,,192,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.3,,,41.3,Fee Schedule,,37.18,,,37.18,Fee Schedule,,105.71,,,105.71,Fee Schedule,,95.1,,,95.1,Fee Schedule,,89.89,,,89.89,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,All Other,43.22,,,43.22,Fee Schedule,,26,,,26,Other,186% of Medicaid,50.9,,,50.9,Fee Schedule,,119.04,,,119.04,Fee Schedule,,28.81,,,,Fee Schedule,,50.9,,,50.9,Fee Schedule,,119.04,,,119.04,Fee Schedule,,54.19,,,54.19,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,,65.02,,,65.02,Fee Schedule,,55.11,,,55.11,Fee Schedule,,20.58,,,20.58,Fee Schedule,,20.58,,,20.58,Fee Schedule,,20.58,,,20.58,Fee Schedule,,20.58,,,20.58,Fee Schedule,,13.72,,,13.72,Other,100% of Medicaid,13.72,,,13.72,Other,100% of Medicaid,13.72,,,13.72,Other,100% of Medicaid,13.72,,,13.72,Other,100% of Medicaid,30.87,,,30.87,Other,225% of Medicaid,20.99,,,20.99,Other,153% of Medicaid,30.87,,,30.87,Other,225% of Medicaid,19.21,,,19.21,Other,140% of Medicaid,30.87,,,30.87,Other,225% of Medicaid,35.67,,,35.67,Other,250% of Medicaid,44.45,,,44.45,Other,324% of Medicaid,29.5,,,29.5,Other,215% of Medicaid,29.5,,,29.5,Other,215% of Medicaid,17.15,,,17.15,Other,125% of Medicaid,0.01,134.4,
ASSAY OF VOLATILES,84600,CPT,,78084600,CDM,301,RC,,,both,,,161,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51.5,,,51.5,Fee Schedule,,46.37,,,46.37,Fee Schedule,,115.35,,,115.35,Fee Schedule,,103.78,,,103.78,Fee Schedule,,98.09,,,98.09,Fee Schedule,,112.7,70,,112.7,percent of total billed charges,All Other,53.9,,,53.9,Fee Schedule,,33,,,33,Other,186% of Medicaid,63.48,,,63.48,Fee Schedule,,99.82,,,99.82,Fee Schedule,,35.93,,,,Fee Schedule,,63.48,,,63.48,Fee Schedule,,99.82,,,99.82,Fee Schedule,,67.58,,,67.58,Fee Schedule,,112.7,70,,112.7,percent of total billed charges,,81.08,,,81.08,Fee Schedule,,68.72,,,68.72,Fee Schedule,,25.67,,,25.67,Fee Schedule,,25.67,,,25.67,Fee Schedule,,25.67,,,25.67,Fee Schedule,,25.67,,,25.67,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,115.35,
XYLOSE TOLERANCE TEST,84620,CPT,,78084620,CDM,301,RC,,,both,,,165,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.86,,,38.86,Fee Schedule,,34.99,,,34.99,Fee Schedule,,85.32,,,85.32,Fee Schedule,,76.76,,,76.76,Fee Schedule,,72.56,,,72.56,Fee Schedule,,115.5,70,,115.5,percent of total billed charges,All Other,40.67,,,40.67,Fee Schedule,,24,,,24,Other,186% of Medicaid,47.9,,,47.9,Fee Schedule,,102.3,,,102.3,Fee Schedule,,27.11,,,,Fee Schedule,,47.9,,,47.9,Fee Schedule,,102.3,,,102.3,Fee Schedule,,50.99,,,50.99,Fee Schedule,,115.5,70,,115.5,percent of total billed charges,,61.18,,,61.18,Fee Schedule,,51.85,,,51.85,Fee Schedule,,19.37,,,19.37,Fee Schedule,,19.37,,,19.37,Fee Schedule,,19.37,,,19.37,Fee Schedule,,19.37,,,19.37,Fee Schedule,,12.91,,,12.91,Other,100% of Medicaid,12.91,,,12.91,Other,100% of Medicaid,12.91,,,12.91,Other,100% of Medicaid,12.91,,,12.91,Other,100% of Medicaid,29.05,,,29.05,Other,225% of Medicaid,19.75,,,19.75,Other,153% of Medicaid,29.05,,,29.05,Other,225% of Medicaid,18.07,,,18.07,Other,140% of Medicaid,29.05,,,29.05,Other,225% of Medicaid,33.57,,,33.57,Other,250% of Medicaid,41.83,,,41.83,Other,324% of Medicaid,27.76,,,27.76,Other,215% of Medicaid,27.76,,,27.76,Other,215% of Medicaid,16.14,,,16.14,Other,125% of Medicaid,0.01,115.5,
ASSAY OF ZINC,84630,CPT,,78084630,CDM,301,RC,,,both,,,192,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.28,,,34.28,Fee Schedule,,30.87,,,30.87,Fee Schedule,,56.77,,,56.77,Fee Schedule,,51.07,,,51.07,Fee Schedule,,48.28,,,48.28,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,All Other,35.88,,,35.88,Fee Schedule,,15,,,15,Other,186% of Medicaid,42.26,,,42.26,Fee Schedule,,119.04,,,119.04,Fee Schedule,,23.92,,,,Fee Schedule,,42.26,,,42.26,Fee Schedule,,119.04,,,119.04,Fee Schedule,,44.99,,,44.99,Fee Schedule,,134.4,70,,134.4,percent of total billed charges,,53.98,,,53.98,Fee Schedule,,45.75,,,45.75,Fee Schedule,,17.09,,,17.09,Fee Schedule,,17.09,,,17.09,Fee Schedule,,17.09,,,17.09,Fee Schedule,,17.09,,,17.09,Fee Schedule,,7.98,,,7.98,Other,100% of Medicaid,7.98,,,7.98,Other,100% of Medicaid,7.98,,,7.98,Other,100% of Medicaid,7.98,,,7.98,Other,100% of Medicaid,17.95,,,17.95,Other,225% of Medicaid,12.21,,,12.21,Other,153% of Medicaid,17.95,,,17.95,Other,225% of Medicaid,11.17,,,11.17,Other,140% of Medicaid,17.95,,,17.95,Other,225% of Medicaid,20.75,,,20.75,Other,250% of Medicaid,25.85,,,25.85,Other,324% of Medicaid,17.15,,,17.15,Other,215% of Medicaid,17.15,,,17.15,Other,215% of Medicaid,9.97,,,9.97,Other,125% of Medicaid,0.01,134.4,
ASSAY OF C-PEPTIDE,84681,CPT,,78084681,CDM,301,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,62.64,,,62.64,Fee Schedule,,56.4,,,56.4,Fee Schedule,,160.45,,,160.45,Fee Schedule,,144.35,,,144.35,Fee Schedule,,136.44,,,136.44,Fee Schedule,,168,70,,168,percent of total billed charges,All Other,65.55,,,65.55,Fee Schedule,,39,,,39,Other,186% of Medicaid,77.21,,,77.21,Fee Schedule,,148.8,,,148.8,Fee Schedule,,43.7,,,,Fee Schedule,,77.21,,,77.21,Fee Schedule,,148.8,,,148.8,Fee Schedule,,82.2,,,82.2,Fee Schedule,,168,70,,168,percent of total billed charges,,98.62,,,98.62,Fee Schedule,,83.59,,,83.59,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,31.84,,,31.84,Other,153% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,29.13,,,29.13,Other,140% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,54.11,,,54.11,Other,250% of Medicaid,67.42,,,67.42,Other,324% of Medicaid,44.74,,,44.74,Other,215% of Medicaid,44.74,,,44.74,Other,215% of Medicaid,26.01,,,26.01,Other,125% of Medicaid,0.01,168,
CHORIONIC GONADOTROPIN TEST,84702,CPT,,77084702,CDM,301,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,45.3,,,45.3,Fee Schedule,,40.79,,,40.79,Fee Schedule,,116.12,,,116.12,Fee Schedule,,104.47,,,104.47,Fee Schedule,,98.75,,,98.75,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,All Other,47.41,,,47.41,Fee Schedule,,23,,,23,Other,186% of Medicaid,55.84,,,55.84,Fee Schedule,,67.58,,,67.58,Fee Schedule,,31.61,,,,Fee Schedule,,55.84,,,55.84,Fee Schedule,,67.58,,,67.58,Fee Schedule,,59.45,,,59.45,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,,71.32,,,71.32,Fee Schedule,,60.45,,,60.45,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,12.49,,,12.49,Other,100% of Medicaid,12.49,,,12.49,Other,100% of Medicaid,12.49,,,12.49,Other,100% of Medicaid,12.49,,,12.49,Other,100% of Medicaid,28.11,,,28.11,Other,225% of Medicaid,19.12,,,19.12,Other,153% of Medicaid,28.11,,,28.11,Other,225% of Medicaid,17.49,,,17.49,Other,140% of Medicaid,28.11,,,28.11,Other,225% of Medicaid,32.48,,,32.48,Other,250% of Medicaid,40.48,,,40.48,Other,324% of Medicaid,26.86,,,26.86,Other,215% of Medicaid,26.86,,,26.86,Other,215% of Medicaid,15.62,,,15.62,Other,125% of Medicaid,0.01,116.12,
CHORIONIC GONADOTROPIN TEST,84702,CPT,,78084702,CDM,301,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,45.3,,,45.3,Fee Schedule,,40.79,,,40.79,Fee Schedule,,116.12,,,116.12,Fee Schedule,,104.47,,,104.47,Fee Schedule,,98.75,,,98.75,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,All Other,47.41,,,47.41,Fee Schedule,,23,,,23,Other,186% of Medicaid,55.84,,,55.84,Fee Schedule,,67.58,,,67.58,Fee Schedule,,31.61,,,,Fee Schedule,,55.84,,,55.84,Fee Schedule,,67.58,,,67.58,Fee Schedule,,59.45,,,59.45,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,,71.32,,,71.32,Fee Schedule,,60.45,,,60.45,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,12.49,,,12.49,Other,100% of Medicaid,12.49,,,12.49,Other,100% of Medicaid,12.49,,,12.49,Other,100% of Medicaid,12.49,,,12.49,Other,100% of Medicaid,28.11,,,28.11,Other,225% of Medicaid,19.12,,,19.12,Other,153% of Medicaid,28.11,,,28.11,Other,225% of Medicaid,17.49,,,17.49,Other,140% of Medicaid,28.11,,,28.11,Other,225% of Medicaid,32.48,,,32.48,Other,250% of Medicaid,40.48,,,40.48,Other,324% of Medicaid,26.86,,,26.86,Other,215% of Medicaid,26.86,,,26.86,Other,215% of Medicaid,15.62,,,15.62,Other,125% of Medicaid,0.01,116.12,
CHORIONIC GONADOTROPIN ASSAY,84703,CPT,,78084703,CDM,301,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,22.64,,,22.64,Fee Schedule,,20.38,,,20.38,Fee Schedule,,57.92,,,57.92,Fee Schedule,,52.11,,,52.11,Fee Schedule,,49.26,,,49.26,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,All Other,23.69,,,23.69,Fee Schedule,,4,,,4,Other,186% of Medicaid,27.9,,,27.9,Fee Schedule,,67.58,,,67.58,Fee Schedule,,15.79,,,,Fee Schedule,,27.9,,,27.9,Fee Schedule,,67.58,,,67.58,Fee Schedule,,29.7,,,29.7,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,,35.64,,,35.64,Fee Schedule,,30.2,,,30.2,Fee Schedule,,11.28,,,11.28,Fee Schedule,,11.28,,,11.28,Fee Schedule,,11.28,,,11.28,Fee Schedule,,11.28,,,11.28,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,76.3,
DRUG TEST DEF 1-7 CLASSES,G0480,HCPCS,,78000013,CDM,301,RC,,,both,,,504,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,344.43,,,344.43,Fee Schedule,,310.11,,,310.11,Fee Schedule,,57.22,,,57.22,Fee Schedule,,57.22,,,57.22,Fee Schedule,,57.22,,,57.22,Fee Schedule,,352.8,70,,352.8,percent of total billed charges,All Other,360.45,,,360.45,Fee Schedule,,28,,,28,Other,186% of Medicaid,424.54,,,424.54,Fee Schedule,,312.48,,,312.48,Fee Schedule,,240.3,,,,Fee Schedule,,424.54,,,424.54,Fee Schedule,,312.48,,,312.48,Fee Schedule,,452,,,452,Fee Schedule,,352.8,70,,352.8,percent of total billed charges,,542.29,,,542.29,Fee Schedule,,459.62,,,459.62,Fee Schedule,,171.65,,,171.65,Fee Schedule,,171.65,,,171.65,Fee Schedule,,171.65,,,171.65,Fee Schedule,,171.65,,,171.65,Fee Schedule,,15.15,,,15.15,Other,100% of Medicaid,15.15,,,15.15,Other,100% of Medicaid,15.15,,,15.15,Other,100% of Medicaid,15.15,,,15.15,Other,100% of Medicaid,34.09,,,34.09,Other,225% of Medicaid,23.18,,,23.18,Other,153% of Medicaid,34.09,,,34.09,Other,225% of Medicaid,21.21,,,21.21,Other,140% of Medicaid,34.09,,,34.09,Other,225% of Medicaid,39.39,,,39.39,Other,250% of Medicaid,49.09,,,49.09,Other,324% of Medicaid,32.57,,,32.57,Other,215% of Medicaid,32.57,,,32.57,Other,215% of Medicaid,18.94,,,18.94,Other,125% of Medicaid,0.01,542.29,
ALLERGEN SPECIFIC IGG,86001,CPT,,78086001,CDM,302,RC,,,both,,,26,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,23.54,,,23.54,Fee Schedule,,21.19,,,21.19,Fee Schedule,,38.47,,,38.47,Fee Schedule,,34.61,,,34.61,Fee Schedule,,32.71,,,32.71,Fee Schedule,,18.2,70,,18.2,percent of total billed charges,All Other,24.63,,,24.63,Fee Schedule,,32,,,32,Other,186% of Medicaid,29.01,,,29.01,Fee Schedule,,16.12,,,16.12,Fee Schedule,,16.42,,,,Fee Schedule,,29.01,,,29.01,Fee Schedule,,16.12,,,16.12,Fee Schedule,,30.89,,,30.89,Fee Schedule,,18.2,70,,18.2,percent of total billed charges,,37.06,,,37.06,Fee Schedule,,31.41,,,31.41,Fee Schedule,,11.73,,,11.73,Fee Schedule,,11.73,,,11.73,Fee Schedule,,11.73,,,11.73,Fee Schedule,,11.73,,,11.73,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,56.14,
ALLERGEN SPECIFIC IGE,86003,CPT,,78086003,CDM,302,RC,,,both,,,45,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.71,,,15.71,Fee Schedule,,14.15,,,14.15,Fee Schedule,,38.47,,,38.47,Fee Schedule,,34.61,,,34.61,Fee Schedule,,32.71,,,32.71,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,All Other,16.44,,,16.44,Fee Schedule,,7,,,7,Other,186% of Medicaid,19.37,,,19.37,Fee Schedule,,27.9,,,27.9,Fee Schedule,,10.96,,,,Fee Schedule,,19.37,,,19.37,Fee Schedule,,27.9,,,27.9,Fee Schedule,,20.62,,,20.62,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,,24.74,,,24.74,Fee Schedule,,20.97,,,20.97,Fee Schedule,,7.83,,,7.83,Fee Schedule,,7.83,,,7.83,Fee Schedule,,7.83,,,7.83,Fee Schedule,,7.83,,,7.83,Fee Schedule,,3.69,,,3.69,Other,100% of Medicaid,3.69,,,3.69,Other,100% of Medicaid,3.69,,,3.69,Other,100% of Medicaid,3.69,,,3.69,Other,100% of Medicaid,8.29,,,8.29,Other,225% of Medicaid,5.64,,,5.64,Other,153% of Medicaid,8.29,,,8.29,Other,225% of Medicaid,5.16,,,5.16,Other,140% of Medicaid,8.29,,,8.29,Other,225% of Medicaid,9.58,,,9.58,Other,250% of Medicaid,11.94,,,11.94,Other,324% of Medicaid,7.93,,,7.93,Other,215% of Medicaid,7.93,,,7.93,Other,215% of Medicaid,4.61,,,4.61,Other,125% of Medicaid,0.01,38.47,
ALLERG SP IGE; QUAN OR SEMIQUAN,86003,CPT,TC,85086003,CDM,302,RC,,,both,,,45,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.71,,,15.71,Fee Schedule,,14.15,,,14.15,Fee Schedule,,38.47,,,38.47,Fee Schedule,,34.61,,,34.61,Fee Schedule,,32.71,,,32.71,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,All Other,16.44,,,16.44,Fee Schedule,,7,,,7,Other,186% of Medicaid,19.37,,,19.37,Fee Schedule,,27.9,,,27.9,Fee Schedule,,10.96,,,,Fee Schedule,,19.37,,,19.37,Fee Schedule,,27.9,,,27.9,Fee Schedule,,20.62,,,20.62,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,,24.74,,,24.74,Fee Schedule,,20.97,,,20.97,Fee Schedule,,7.83,,,7.83,Fee Schedule,,7.83,,,7.83,Fee Schedule,,7.83,,,7.83,Fee Schedule,,7.83,,,7.83,Fee Schedule,,3.69,,,3.69,Other,100% of Medicaid,3.69,,,3.69,Other,100% of Medicaid,3.69,,,3.69,Other,100% of Medicaid,3.69,,,3.69,Other,100% of Medicaid,8.29,,,8.29,Other,225% of Medicaid,5.64,,,5.64,Other,153% of Medicaid,8.29,,,8.29,Other,225% of Medicaid,5.16,,,5.16,Other,140% of Medicaid,8.29,,,8.29,Other,225% of Medicaid,9.58,,,9.58,Other,250% of Medicaid,11.94,,,11.94,Other,324% of Medicaid,7.93,,,7.93,Other,215% of Medicaid,7.93,,,7.93,Other,215% of Medicaid,4.61,,,4.61,Other,125% of Medicaid,0.01,38.47,
ALLERGEN SPECIFIC IGE,86005,CPT,,78086005,CDM,302,RC,,,both,,,47,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,23.99,,,23.99,Fee Schedule,,21.6,,,21.6,Fee Schedule,,61.49,,,61.49,Fee Schedule,,55.31,,,55.31,Fee Schedule,,52.29,,,52.29,Fee Schedule,,32.9,70,,32.9,percent of total billed charges,All Other,25.11,,,25.11,Fee Schedule,,32,,,32,Other,186% of Medicaid,29.57,,,29.57,Fee Schedule,,29.14,,,29.14,Fee Schedule,,16.74,,,,Fee Schedule,,29.57,,,29.57,Fee Schedule,,29.14,,,29.14,Fee Schedule,,31.48,,,31.48,Fee Schedule,,32.9,70,,32.9,percent of total billed charges,,37.77,,,37.77,Fee Schedule,,32.01,,,32.01,Fee Schedule,,11.96,,,11.96,Fee Schedule,,11.96,,,11.96,Fee Schedule,,11.96,,,11.96,Fee Schedule,,11.96,,,11.96,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,61.49,
ALLG SPEC IGE RECOMB EA,86008,CPT,,78086008,CDM,302,RC,,,both,,,57,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.97,,,53.97,Fee Schedule,,48.59,,,48.59,Fee Schedule,,8.86,,,8.86,Fee Schedule,,8.86,,,8.86,Fee Schedule,,8.86,,,8.86,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,All Other,56.48,,,56.48,Fee Schedule,,7,,,7,Other,186% of Medicaid,66.52,,,66.52,Fee Schedule,,35.34,,,35.34,Fee Schedule,,37.65,,,,Fee Schedule,,66.52,,,66.52,Fee Schedule,,35.34,,,35.34,Fee Schedule,,70.82,,,70.82,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,,84.97,,,84.97,Fee Schedule,,72.02,,,72.02,Fee Schedule,,26.9,,,26.9,Fee Schedule,,26.9,,,26.9,Fee Schedule,,26.9,,,26.9,Fee Schedule,,26.9,,,26.9,Fee Schedule,,3.69,,,3.69,Other,100% of Medicaid,3.69,,,3.69,Other,100% of Medicaid,3.69,,,3.69,Other,100% of Medicaid,3.69,,,3.69,Other,100% of Medicaid,8.29,,,8.29,Other,225% of Medicaid,5.64,,,5.64,Other,153% of Medicaid,8.29,,,8.29,Other,225% of Medicaid,5.16,,,5.16,Other,140% of Medicaid,8.29,,,8.29,Other,225% of Medicaid,9.58,,,9.58,Other,250% of Medicaid,11.94,,,11.94,Other,324% of Medicaid,7.93,,,7.93,Other,215% of Medicaid,7.93,,,7.93,Other,215% of Medicaid,4.61,,,4.61,Other,125% of Medicaid,0.01,84.97,
ACTINANTIBODY EACH,86015,CPT,,78086015,CDM,302,RC,,,both,,,37,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.27,,,36.27,Fee Schedule,,32.66,,,32.66,Fee Schedule,,11.53,,,11.53,Fee Schedule,,11.53,,,11.53,Fee Schedule,,11.53,,,11.53,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,All Other,37.96,,,37.96,Fee Schedule,,13,,,13,Other,186% of Medicaid,44.71,,,44.71,Fee Schedule,,22.94,,,22.94,Fee Schedule,,25.31,,,,Fee Schedule,,44.71,,,44.71,Fee Schedule,,22.94,,,22.94,Fee Schedule,,47.6,,,47.6,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,,54.64,,,54.64,Fee Schedule,,46.31,,,46.31,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,6.98,,,6.98,Other,100% of Medicaid,6.98,,,6.98,Other,100% of Medicaid,6.98,,,6.98,Other,100% of Medicaid,6.98,,,6.98,Other,100% of Medicaid,15.7,,,15.7,Other,225% of Medicaid,10.68,,,10.68,Other,153% of Medicaid,15.7,,,15.7,Other,225% of Medicaid,9.77,,,9.77,Other,140% of Medicaid,15.7,,,15.7,Other,225% of Medicaid,18.15,,,18.15,Other,250% of Medicaid,22.61,,,22.61,Other,324% of Medicaid,15.01,,,15.01,Other,215% of Medicaid,15.01,,,15.01,Other,215% of Medicaid,8.72,,,8.72,Other,125% of Medicaid,0.01,54.64,
WBC ANTIBODY IDENTIFICATION,86021,CPT,,78086021,CDM,302,RC,,,both,,,342,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,45.3,,,45.3,Fee Schedule,,40.79,,,40.79,Fee Schedule,,116.12,,,116.12,Fee Schedule,,104.47,,,104.47,Fee Schedule,,98.75,,,98.75,Fee Schedule,,239.4,70,,239.4,percent of total billed charges,All Other,47.41,,,47.41,Fee Schedule,,32,,,32,Other,186% of Medicaid,55.84,,,55.84,Fee Schedule,,212.04,,,212.04,Fee Schedule,,31.61,,,,Fee Schedule,,55.84,,,55.84,Fee Schedule,,212.04,,,212.04,Fee Schedule,,59.45,,,59.45,Fee Schedule,,239.4,70,,239.4,percent of total billed charges,,71.32,,,71.32,Fee Schedule,,60.45,,,60.45,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,239.4,
PLATELET ANTIBODIES,86022,CPT,,78086022,CDM,302,RC,,,both,,,409,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,55.29,,,55.29,Fee Schedule,,49.78,,,49.78,Fee Schedule,,141.66,,,141.66,Fee Schedule,,127.44,,,127.44,Fee Schedule,,120.46,,,120.46,Fee Schedule,,286.3,70,,286.3,percent of total billed charges,All Other,57.87,,,57.87,Fee Schedule,,32,,,32,Other,186% of Medicaid,68.15,,,68.15,Fee Schedule,,253.58,,,253.58,Fee Schedule,,38.58,,,,Fee Schedule,,68.15,,,68.15,Fee Schedule,,253.58,,,253.58,Fee Schedule,,72.56,,,72.56,Fee Schedule,,286.3,70,,286.3,percent of total billed charges,,87.06,,,87.06,Fee Schedule,,73.79,,,73.79,Fee Schedule,,27.56,,,27.56,Fee Schedule,,27.56,,,27.56,Fee Schedule,,27.56,,,27.56,Fee Schedule,,27.56,,,27.56,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,286.3,
IMMUNOGLOBULIN ASSAY,86023,CPT,,78086023,CDM,302,RC,,,both,,,40,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,37.5,,,37.5,Fee Schedule,,33.77,,,33.77,Fee Schedule,,96.06,,,96.06,Fee Schedule,,86.42,,,86.42,Fee Schedule,,81.69,,,81.69,Fee Schedule,,28,70,,28,percent of total billed charges,All Other,39.25,,,39.25,Fee Schedule,,32,,,32,Other,186% of Medicaid,46.23,,,46.23,Fee Schedule,,24.8,,,24.8,Fee Schedule,,26.17,,,,Fee Schedule,,46.23,,,46.23,Fee Schedule,,24.8,,,24.8,Fee Schedule,,49.22,,,49.22,Fee Schedule,,28,70,,28,percent of total billed charges,,59.05,,,59.05,Fee Schedule,,50.05,,,50.05,Fee Schedule,,18.69,,,18.69,Fee Schedule,,18.69,,,18.69,Fee Schedule,,18.69,,,18.69,Fee Schedule,,18.69,,,18.69,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,96.06,
ANCA SCREEN EACH ANTIBODY,86036,CPT,,78086036,CDM,302,RC,,,both,,,39,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.27,,,36.27,Fee Schedule,,32.66,,,32.66,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,27.3,70,,27.3,percent of total billed charges,All Other,37.96,,,37.96,Fee Schedule,,14,,,14,Other,186% of Medicaid,44.71,,,44.71,Fee Schedule,,24.18,,,24.18,Fee Schedule,,25.31,,,,Fee Schedule,,44.71,,,44.71,Fee Schedule,,24.18,,,24.18,Fee Schedule,,47.6,,,47.6,Fee Schedule,,27.3,70,,27.3,percent of total billed charges,,57.11,,,57.11,Fee Schedule,,48.4,,,48.4,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,11.17,,,11.17,Other,153% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,10.22,,,10.22,Other,140% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,18.99,,,18.99,Other,250% of Medicaid,23.66,,,23.66,Other,324% of Medicaid,15.7,,,15.7,Other,215% of Medicaid,15.7,,,15.7,Other,215% of Medicaid,9.13,,,9.13,Other,125% of Medicaid,0.01,57.11,
ANCA TITER EACH ANTIBODY,86037,CPT,,78086037,CDM,302,RC,,,both,,,28,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.27,,,36.27,Fee Schedule,,32.66,,,32.66,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,19.6,70,,19.6,percent of total billed charges,All Other,37.96,,,37.96,Fee Schedule,,14,,,14,Other,186% of Medicaid,44.71,,,44.71,Fee Schedule,,17.36,,,17.36,Fee Schedule,,25.31,,,,Fee Schedule,,44.71,,,44.71,Fee Schedule,,17.36,,,17.36,Fee Schedule,,47.6,,,47.6,Fee Schedule,,19.6,70,,19.6,percent of total billed charges,,57.11,,,57.11,Fee Schedule,,48.4,,,48.4,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,11.17,,,11.17,Other,153% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,10.22,,,10.22,Other,140% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,18.99,,,18.99,Other,250% of Medicaid,23.66,,,23.66,Other,324% of Medicaid,15.7,,,15.7,Other,215% of Medicaid,15.7,,,15.7,Other,215% of Medicaid,9.13,,,9.13,Other,125% of Medicaid,0.01,57.11,
ANTINUCLEAR ANTIBODIES,86038,CPT,,78086038,CDM,302,RC,,,both,,,218,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.39,,,36.39,Fee Schedule,,32.76,,,32.76,Fee Schedule,,93.21,,,93.21,Fee Schedule,,83.86,,,83.86,Fee Schedule,,79.27,,,79.27,Fee Schedule,,152.6,70,,152.6,percent of total billed charges,All Other,38.08,,,38.08,Fee Schedule,,10,,,10,Other,186% of Medicaid,44.85,,,44.85,Fee Schedule,,135.16,,,135.16,Fee Schedule,,25.39,,,,Fee Schedule,,44.85,,,44.85,Fee Schedule,,135.16,,,135.16,Fee Schedule,,47.76,,,47.76,Fee Schedule,,152.6,70,,152.6,percent of total billed charges,,57.29,,,57.29,Fee Schedule,,48.56,,,48.56,Fee Schedule,,18.14,,,18.14,Fee Schedule,,18.14,,,18.14,Fee Schedule,,18.14,,,18.14,Fee Schedule,,18.14,,,18.14,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,152.6,
ANTINUCLEAR ANTIBODIES (ANA),86039,CPT,,78086039,CDM,302,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,33.59,,,33.59,Fee Schedule,,30.24,,,30.24,Fee Schedule,,86.09,,,86.09,Fee Schedule,,77.45,,,77.45,Fee Schedule,,73.21,,,73.21,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,35.15,,,35.15,Fee Schedule,,10,,,10,Other,186% of Medicaid,41.4,,,41.4,Fee Schedule,,115.32,,,115.32,Fee Schedule,,23.44,,,,Fee Schedule,,41.4,,,41.4,Fee Schedule,,115.32,,,115.32,Fee Schedule,,44.08,,,44.08,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,52.89,,,52.89,Fee Schedule,,44.83,,,44.83,Fee Schedule,,16.74,,,16.74,Fee Schedule,,16.74,,,16.74,Fee Schedule,,16.74,,,16.74,Fee Schedule,,16.74,,,16.74,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,130.2,
AQUAPORIN-4 ANTB ELISA,86051,CPT,,78086051,CDM,302,RC,,,both,,,37,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.71,,,34.71,Fee Schedule,,31.25,,,31.25,Fee Schedule,,11.53,,,11.53,Fee Schedule,,11.53,,,11.53,Fee Schedule,,11.53,,,11.53,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,All Other,36.32,,,36.32,Fee Schedule,,13,,,13,Other,186% of Medicaid,42.78,,,42.78,Fee Schedule,,22.94,,,22.94,Fee Schedule,,24.21,,,,Fee Schedule,,42.78,,,42.78,Fee Schedule,,22.94,,,22.94,Fee Schedule,,45.54,,,45.54,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,,54.64,,,54.64,Fee Schedule,,46.31,,,46.31,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,6.98,,,6.98,Other,100% of Medicaid,6.98,,,6.98,Other,100% of Medicaid,6.98,,,6.98,Other,100% of Medicaid,6.98,,,6.98,Other,100% of Medicaid,15.7,,,15.7,Other,225% of Medicaid,10.68,,,10.68,Other,153% of Medicaid,15.7,,,15.7,Other,225% of Medicaid,9.77,,,9.77,Other,140% of Medicaid,15.7,,,15.7,Other,225% of Medicaid,18.15,,,18.15,Other,250% of Medicaid,22.61,,,22.61,Other,324% of Medicaid,15.01,,,15.01,Other,215% of Medicaid,15.01,,,15.01,Other,215% of Medicaid,8.72,,,8.72,Other,125% of Medicaid,0.01,54.64,
AQUAPORIN-4 ANTB CBA EACH,86052,CPT,,78086052,CDM,302,RC,,,both,,,35,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.27,,,36.27,Fee Schedule,,32.66,,,32.66,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,24.5,70,,24.5,percent of total billed charges,All Other,37.96,,,37.96,Fee Schedule,,14,,,14,Other,186% of Medicaid,44.71,,,44.71,Fee Schedule,,21.7,,,21.7,Fee Schedule,,25.31,,,,Fee Schedule,,44.71,,,44.71,Fee Schedule,,21.7,,,21.7,Fee Schedule,,47.6,,,47.6,Fee Schedule,,24.5,70,,24.5,percent of total billed charges,,57.11,,,57.11,Fee Schedule,,48.4,,,48.4,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,11.17,,,11.17,Other,153% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,10.22,,,10.22,Other,140% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,18.99,,,18.99,Other,250% of Medicaid,23.66,,,23.66,Other,324% of Medicaid,15.7,,,15.7,Other,215% of Medicaid,15.7,,,15.7,Other,215% of Medicaid,9.13,,,9.13,Other,125% of Medicaid,0.01,57.11,
AQAPRN-4 ANTB FLO CYTMTRY EA,86053,CPT,,78086053,CDM,302,RC,,,both,,,77,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,113.57,,,113.57,Fee Schedule,,102.25,,,102.25,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,53.9,70,,53.9,percent of total billed charges,All Other,118.85,,,118.85,Fee Schedule,,14,,,14,Other,186% of Medicaid,139.98,,,139.98,Fee Schedule,,47.74,,,47.74,Fee Schedule,,79.23,,,,Fee Schedule,,139.98,,,139.98,Fee Schedule,,47.74,,,47.74,Fee Schedule,,149.03,,,149.03,Fee Schedule,,53.9,70,,53.9,percent of total billed charges,,57.11,,,57.11,Fee Schedule,,48.4,,,48.4,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,11.17,,,11.17,Other,153% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,10.22,,,10.22,Other,140% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,18.99,,,18.99,Other,250% of Medicaid,23.66,,,23.66,Other,324% of Medicaid,15.7,,,15.7,Other,215% of Medicaid,15.7,,,15.7,Other,215% of Medicaid,9.13,,,9.13,Other,125% of Medicaid,0.01,149.03,
ANTISTREPTOLYSIN O TITER,86060,CPT,,78086060,CDM,302,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,21.97,,,21.97,Fee Schedule,,19.78,,,19.78,Fee Schedule,,56.28,,,56.28,Fee Schedule,,50.63,,,50.63,Fee Schedule,,47.86,,,47.86,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,23,,,23,Fee Schedule,,10,,,10,Other,186% of Medicaid,27.08,,,27.08,Fee Schedule,,66.34,,,66.34,Fee Schedule,,15.33,,,,Fee Schedule,,27.08,,,27.08,Fee Schedule,,66.34,,,66.34,Fee Schedule,,28.84,,,28.84,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,,34.59,,,34.59,Fee Schedule,,29.32,,,29.32,Fee Schedule,,10.95,,,10.95,Fee Schedule,,10.95,,,10.95,Fee Schedule,,10.95,,,10.95,Fee Schedule,,10.95,,,10.95,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,74.9,
ANTISTREPTOLYSIN O SCREEN,86063,CPT,,78086063,CDM,302,RC,,,both,,,138,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,17.37,,,17.37,Fee Schedule,,15.64,,,15.64,Fee Schedule,,39.51,,,39.51,Fee Schedule,,35.55,,,35.55,Fee Schedule,,33.6,,,33.6,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,All Other,18.18,,,18.18,Fee Schedule,,7,,,7,Other,186% of Medicaid,21.41,,,21.41,Fee Schedule,,85.56,,,85.56,Fee Schedule,,12.12,,,,Fee Schedule,,21.41,,,21.41,Fee Schedule,,85.56,,,85.56,Fee Schedule,,22.79,,,22.79,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,,27.34,,,27.34,Fee Schedule,,23.18,,,23.18,Fee Schedule,,8.66,,,8.66,Fee Schedule,,8.66,,,8.66,Fee Schedule,,8.66,,,8.66,Fee Schedule,,8.66,,,8.66,Fee Schedule,,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.79,,,5.79,Other,153% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.3,,,5.3,Other,140% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,9.85,,,9.85,Other,250% of Medicaid,12.27,,,12.27,Other,324% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,4.73,,,4.73,Other,125% of Medicaid,0.01,96.6,
C-REACTIVE PROTEIN,86140,CPT,,78086140,CDM,302,RC,,,both,,,83,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.59,,,15.59,Fee Schedule,,14.04,,,14.04,Fee Schedule,,39.89,,,39.89,Fee Schedule,,35.89,,,35.89,Fee Schedule,,33.92,,,33.92,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,All Other,16.32,,,16.32,Fee Schedule,,8,,,8,Other,186% of Medicaid,19.22,,,19.22,Fee Schedule,,51.46,,,51.46,Fee Schedule,,10.88,,,,Fee Schedule,,19.22,,,19.22,Fee Schedule,,51.46,,,51.46,Fee Schedule,,20.46,,,20.46,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,,24.55,,,24.55,Fee Schedule,,20.81,,,20.81,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,4.14,,,4.14,Other,100% of Medicaid,4.14,,,4.14,Other,100% of Medicaid,4.14,,,4.14,Other,100% of Medicaid,4.14,,,4.14,Other,100% of Medicaid,9.32,,,9.32,Other,225% of Medicaid,6.34,,,6.34,Other,153% of Medicaid,9.32,,,9.32,Other,225% of Medicaid,5.8,,,5.8,Other,140% of Medicaid,9.32,,,9.32,Other,225% of Medicaid,10.77,,,10.77,Other,250% of Medicaid,13.42,,,13.42,Other,324% of Medicaid,8.9,,,8.9,Other,215% of Medicaid,8.9,,,8.9,Other,215% of Medicaid,5.18,,,5.18,Other,125% of Medicaid,0.01,58.1,
C-REACTIVE PROTEIN HS,86141,CPT,,78086141,CDM,302,RC,,,both,,,84,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.98,,,38.98,Fee Schedule,,35.09,,,35.09,Fee Schedule,,99.85,,,99.85,Fee Schedule,,89.82,,,89.82,Fee Schedule,,84.91,,,84.91,Fee Schedule,,58.8,70,,58.8,percent of total billed charges,All Other,40.79,,,40.79,Fee Schedule,,19,,,19,Other,186% of Medicaid,48.04,,,48.04,Fee Schedule,,52.08,,,52.08,Fee Schedule,,27.2,,,,Fee Schedule,,48.04,,,48.04,Fee Schedule,,52.08,,,52.08,Fee Schedule,,51.15,,,51.15,Fee Schedule,,58.8,70,,58.8,percent of total billed charges,,61.37,,,61.37,Fee Schedule,,52.02,,,52.02,Fee Schedule,,19.43,,,19.43,Fee Schedule,,19.43,,,19.43,Fee Schedule,,19.43,,,19.43,Fee Schedule,,19.43,,,19.43,Fee Schedule,,10.35,,,10.35,Other,100% of Medicaid,10.35,,,10.35,Other,100% of Medicaid,10.35,,,10.35,Other,100% of Medicaid,10.35,,,10.35,Other,100% of Medicaid,23.29,,,23.29,Other,225% of Medicaid,15.84,,,15.84,Other,153% of Medicaid,23.29,,,23.29,Other,225% of Medicaid,14.49,,,14.49,Other,140% of Medicaid,23.29,,,23.29,Other,225% of Medicaid,26.92,,,26.92,Other,250% of Medicaid,33.54,,,33.54,Other,324% of Medicaid,22.26,,,22.26,Other,215% of Medicaid,22.26,,,22.26,Other,215% of Medicaid,12.94,,,12.94,Other,125% of Medicaid,0.01,99.85,
PHOSPHOLIPID ANTIBODY,86148,CPT,,78086148,CDM,302,RC,,,both,,,260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,48.37,,,48.37,Fee Schedule,,43.55,,,43.55,Fee Schedule,,123.9,,,123.9,Fee Schedule,,111.47,,,111.47,Fee Schedule,,105.36,,,105.36,Fee Schedule,,182,70,,182,percent of total billed charges,All Other,50.62,,,50.62,Fee Schedule,,15,,,15,Other,186% of Medicaid,59.62,,,59.62,Fee Schedule,,161.2,,,161.2,Fee Schedule,,33.75,,,,Fee Schedule,,59.62,,,59.62,Fee Schedule,,161.2,,,161.2,Fee Schedule,,63.48,,,63.48,Fee Schedule,,182,70,,182,percent of total billed charges,,76.16,,,76.16,Fee Schedule,,64.55,,,64.55,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,12.08,,,12.08,Other,153% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,11.06,,,11.06,Other,140% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,20.54,,,20.54,Other,250% of Medicaid,25.59,,,25.59,Other,324% of Medicaid,16.98,,,16.98,Other,215% of Medicaid,16.98,,,16.98,Other,215% of Medicaid,9.87,,,9.87,Other,125% of Medicaid,0.01,182,
COLD AGGLUTININ TITER,86157,CPT,,78086157,CDM,302,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.26,,,24.26,Fee Schedule,,21.84,,,21.84,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,25.39,,,25.39,Fee Schedule,,10,,,10,Other,186% of Medicaid,29.9,,,29.9,Fee Schedule,,66.34,,,66.34,Fee Schedule,,16.93,,,,Fee Schedule,,29.9,,,29.9,Fee Schedule,,66.34,,,66.34,Fee Schedule,,31.84,,,31.84,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,,38.2,,,38.2,Fee Schedule,,32.37,,,32.37,Fee Schedule,,12.09,,,12.09,Fee Schedule,,12.09,,,12.09,Fee Schedule,,12.09,,,12.09,Fee Schedule,,12.09,,,12.09,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,74.9,
COMPLEMENT ANTIGEN,86160,CPT,,78086160,CDM,302,RC,,,both,,,175,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.12,,,36.12,Fee Schedule,,32.52,,,32.52,Fee Schedule,,92.56,,,92.56,Fee Schedule,,83.27,,,83.27,Fee Schedule,,78.71,,,78.71,Fee Schedule,,122.5,70,,122.5,percent of total billed charges,All Other,37.8,,,37.8,Fee Schedule,,20,,,20,Other,186% of Medicaid,44.52,,,44.52,Fee Schedule,,108.5,,,108.5,Fee Schedule,,25.2,,,,Fee Schedule,,44.52,,,44.52,Fee Schedule,,108.5,,,108.5,Fee Schedule,,47.4,,,47.4,Fee Schedule,,122.5,70,,122.5,percent of total billed charges,,56.87,,,56.87,Fee Schedule,,48.2,,,48.2,Fee Schedule,,18,,,18,Fee Schedule,,18,,,18,Fee Schedule,,18,,,18,Fee Schedule,,18,,,18,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,122.5,
COMPLEMENT/FUNCTION ACTIVITY,86161,CPT,,78086161,CDM,302,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.12,,,36.12,Fee Schedule,,32.52,,,32.52,Fee Schedule,,92.56,,,92.56,Fee Schedule,,83.27,,,83.27,Fee Schedule,,78.71,,,78.71,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,All Other,37.8,,,37.8,Fee Schedule,,22,,,22,Other,186% of Medicaid,44.52,,,44.52,Fee Schedule,,112.84,,,112.84,Fee Schedule,,25.2,,,,Fee Schedule,,44.52,,,44.52,Fee Schedule,,112.84,,,112.84,Fee Schedule,,47.4,,,47.4,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,,56.87,,,56.87,Fee Schedule,,48.2,,,48.2,Fee Schedule,,18,,,18,Fee Schedule,,18,,,18,Fee Schedule,,18,,,18,Fee Schedule,,18,,,18,Fee Schedule,,12,,,12,Other,100% of Medicaid,12,,,12,Other,100% of Medicaid,12,,,12,Other,100% of Medicaid,12,,,12,Other,100% of Medicaid,27,,,27,Other,225% of Medicaid,18.36,,,18.36,Other,153% of Medicaid,27,,,27,Other,225% of Medicaid,16.8,,,16.8,Other,140% of Medicaid,27,,,27,Other,225% of Medicaid,31.2,,,31.2,Other,250% of Medicaid,38.88,,,38.88,Other,324% of Medicaid,25.8,,,25.8,Other,215% of Medicaid,25.8,,,25.8,Other,215% of Medicaid,15,,,15,Other,125% of Medicaid,0.01,127.4,
COMPLEMENT TOTAL (CH50),86162,CPT,,78086162,CDM,302,RC,,,both,,,343,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,61.16,,,61.16,Fee Schedule,,55.07,,,55.07,Fee Schedule,,156.67,,,156.67,Fee Schedule,,140.95,,,140.95,Fee Schedule,,133.23,,,133.23,Fee Schedule,,240.1,70,,240.1,percent of total billed charges,All Other,64.01,,,64.01,Fee Schedule,,36,,,36,Other,186% of Medicaid,75.39,,,75.39,Fee Schedule,,212.66,,,212.66,Fee Schedule,,42.67,,,,Fee Schedule,,75.39,,,75.39,Fee Schedule,,212.66,,,212.66,Fee Schedule,,80.26,,,80.26,Fee Schedule,,240.1,70,,240.1,percent of total billed charges,,96.3,,,96.3,Fee Schedule,,81.62,,,81.62,Fee Schedule,,30.48,,,30.48,Fee Schedule,,30.48,,,30.48,Fee Schedule,,30.48,,,30.48,Fee Schedule,,30.48,,,30.48,Fee Schedule,,19.58,,,19.58,Other,100% of Medicaid,19.58,,,19.58,Other,100% of Medicaid,19.58,,,19.58,Other,100% of Medicaid,19.58,,,19.58,Other,100% of Medicaid,44.06,,,44.06,Other,225% of Medicaid,29.96,,,29.96,Other,153% of Medicaid,44.06,,,44.06,Other,225% of Medicaid,27.42,,,27.42,Other,140% of Medicaid,44.06,,,44.06,Other,225% of Medicaid,50.92,,,50.92,Other,250% of Medicaid,63.45,,,63.45,Other,324% of Medicaid,42.11,,,42.11,Other,215% of Medicaid,42.11,,,42.11,Other,215% of Medicaid,24.48,,,24.48,Other,125% of Medicaid,0.01,240.1,
CCP ANTIBODY,86200,CPT,,78086200,CDM,302,RC,,,both,,,84,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.98,,,38.98,Fee Schedule,,35.09,,,35.09,Fee Schedule,,99.85,,,99.85,Fee Schedule,,89.82,,,89.82,Fee Schedule,,84.91,,,84.91,Fee Schedule,,58.8,70,,58.8,percent of total billed charges,All Other,40.79,,,40.79,Fee Schedule,,32,,,32,Other,186% of Medicaid,48.04,,,48.04,Fee Schedule,,52.08,,,52.08,Fee Schedule,,27.2,,,,Fee Schedule,,48.04,,,48.04,Fee Schedule,,52.08,,,52.08,Fee Schedule,,51.15,,,51.15,Fee Schedule,,58.8,70,,58.8,percent of total billed charges,,61.37,,,61.37,Fee Schedule,,52.02,,,52.02,Fee Schedule,,19.43,,,19.43,Fee Schedule,,19.43,,,19.43,Fee Schedule,,19.43,,,19.43,Fee Schedule,,19.43,,,19.43,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,99.85,
DNA ANTIBODY,86215,CPT,,78086215,CDM,302,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.88,,,39.88,Fee Schedule,,35.91,,,35.91,Fee Schedule,,102.2,,,102.2,Fee Schedule,,91.94,,,91.94,Fee Schedule,,86.91,,,86.91,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,All Other,41.74,,,41.74,Fee Schedule,,10,,,10,Other,186% of Medicaid,49.16,,,49.16,Fee Schedule,,112.84,,,112.84,Fee Schedule,,27.83,,,,Fee Schedule,,49.16,,,49.16,Fee Schedule,,112.84,,,112.84,Fee Schedule,,52.34,,,52.34,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,,62.79,,,62.79,Fee Schedule,,53.22,,,53.22,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,127.4,
DNA AB; NATIVE OR DS,86225,CPT,,78086225,CDM,302,RC,,,both,,,185,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.36,,,41.36,Fee Schedule,,37.24,,,37.24,Fee Schedule,,105.93,,,105.93,Fee Schedule,,95.3,,,95.3,Fee Schedule,,90.08,,,90.08,Fee Schedule,,129.5,70,,129.5,percent of total billed charges,All Other,43.28,,,43.28,Fee Schedule,,10,,,10,Other,186% of Medicaid,50.98,,,50.98,Fee Schedule,,114.7,,,114.7,Fee Schedule,,28.85,,,,Fee Schedule,,50.98,,,50.98,Fee Schedule,,114.7,,,114.7,Fee Schedule,,54.27,,,54.27,Fee Schedule,,129.5,70,,129.5,percent of total billed charges,,65.11,,,65.11,Fee Schedule,,55.19,,,55.19,Fee Schedule,,20.61,,,20.61,Fee Schedule,,20.61,,,20.61,Fee Schedule,,20.61,,,20.61,Fee Schedule,,20.61,,,20.61,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,129.5,
DNA ANTIBODY SINGLE STRAND,86226,CPT,,78086226,CDM,302,RC,,,both,,,225,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.45,,,36.45,Fee Schedule,,32.82,,,32.82,Fee Schedule,,93.38,,,93.38,Fee Schedule,,84.01,,,84.01,Fee Schedule,,79.41,,,79.41,Fee Schedule,,157.5,70,,157.5,percent of total billed charges,All Other,38.15,,,38.15,Fee Schedule,,32,,,32,Other,186% of Medicaid,44.93,,,44.93,Fee Schedule,,139.5,,,139.5,Fee Schedule,,25.43,,,,Fee Schedule,,44.93,,,44.93,Fee Schedule,,139.5,,,139.5,Fee Schedule,,47.83,,,47.83,Fee Schedule,,157.5,70,,157.5,percent of total billed charges,,57.39,,,57.39,Fee Schedule,,48.64,,,48.64,Fee Schedule,,18.17,,,18.17,Fee Schedule,,18.17,,,18.17,Fee Schedule,,18.17,,,18.17,Fee Schedule,,18.17,,,18.17,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,157.5,
EMA EACH IG CLASS,86231,CPT,,78086231,CDM,302,RC,,,both,,,39,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.39,,,36.39,Fee Schedule,,32.76,,,32.76,Fee Schedule,,12.09,,,12.09,Fee Schedule,,12.09,,,12.09,Fee Schedule,,12.09,,,12.09,Fee Schedule,,27.3,70,,27.3,percent of total billed charges,All Other,38.08,,,38.08,Fee Schedule,,14,,,14,Other,186% of Medicaid,44.85,,,44.85,Fee Schedule,,24.18,,,24.18,Fee Schedule,,25.39,,,,Fee Schedule,,44.85,,,44.85,Fee Schedule,,24.18,,,24.18,Fee Schedule,,47.76,,,47.76,Fee Schedule,,27.3,70,,27.3,percent of total billed charges,,57.29,,,57.29,Fee Schedule,,48.56,,,48.56,Fee Schedule,,18.14,,,18.14,Fee Schedule,,18.14,,,18.14,Fee Schedule,,18.14,,,18.14,Fee Schedule,,18.14,,,18.14,Fee Schedule,,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,7.32,,,7.32,Other,100% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,11.2,,,11.2,Other,153% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,10.25,,,10.25,Other,140% of Medicaid,16.48,,,16.48,Other,225% of Medicaid,19.04,,,19.04,Other,250% of Medicaid,23.72,,,23.72,Other,324% of Medicaid,15.74,,,15.74,Other,215% of Medicaid,15.74,,,15.74,Other,215% of Medicaid,9.15,,,9.15,Other,125% of Medicaid,0.01,57.29,
DGP ANTIBODY EACH IG CLASS,86258,CPT,,78086258,CDM,302,RC,,,both,,,37,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.27,,,36.27,Fee Schedule,,32.66,,,32.66,Fee Schedule,,11.53,,,11.53,Fee Schedule,,11.53,,,11.53,Fee Schedule,,11.53,,,11.53,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,All Other,37.96,,,37.96,Fee Schedule,,13,,,13,Other,186% of Medicaid,44.71,,,44.71,Fee Schedule,,22.94,,,22.94,Fee Schedule,,25.31,,,,Fee Schedule,,44.71,,,44.71,Fee Schedule,,22.94,,,22.94,Fee Schedule,,47.6,,,47.6,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,,54.64,,,54.64,Fee Schedule,,46.31,,,46.31,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,6.98,,,6.98,Other,100% of Medicaid,6.98,,,6.98,Other,100% of Medicaid,6.98,,,6.98,Other,100% of Medicaid,6.98,,,6.98,Other,100% of Medicaid,15.7,,,15.7,Other,225% of Medicaid,10.68,,,10.68,Other,153% of Medicaid,15.7,,,15.7,Other,225% of Medicaid,9.77,,,9.77,Other,140% of Medicaid,15.7,,,15.7,Other,225% of Medicaid,18.15,,,18.15,Other,250% of Medicaid,22.61,,,22.61,Other,324% of Medicaid,15.01,,,15.01,Other,215% of Medicaid,15.01,,,15.01,Other,215% of Medicaid,8.72,,,8.72,Other,125% of Medicaid,0.01,54.64,
IMMUNOASSAY TUMOR CA 15-3,86300,CPT,,78086300,CDM,302,RC,,,both,,,134,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,62.64,,,62.64,Fee Schedule,,56.4,,,56.4,Fee Schedule,,160.51,,,160.51,Fee Schedule,,144.4,,,144.4,Fee Schedule,,136.49,,,136.49,Fee Schedule,,93.8,70,,93.8,percent of total billed charges,All Other,65.55,,,65.55,Fee Schedule,,39,,,39,Other,186% of Medicaid,77.21,,,77.21,Fee Schedule,,83.08,,,83.08,Fee Schedule,,43.7,,,,Fee Schedule,,77.21,,,77.21,Fee Schedule,,83.08,,,83.08,Fee Schedule,,82.2,,,82.2,Fee Schedule,,93.8,70,,93.8,percent of total billed charges,,98.62,,,98.62,Fee Schedule,,83.59,,,83.59,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,31.84,,,31.84,Other,153% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,29.13,,,29.13,Other,140% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,54.11,,,54.11,Other,250% of Medicaid,67.42,,,67.42,Other,324% of Medicaid,44.74,,,44.74,Other,215% of Medicaid,44.74,,,44.74,Other,215% of Medicaid,26.01,,,26.01,Other,125% of Medicaid,0.01,160.51,
IMMUNOASSAY TUMOR CA 19-9,86301,CPT,,78086301,CDM,302,RC,,,both,,,173,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,62.64,,,62.64,Fee Schedule,,56.4,,,56.4,Fee Schedule,,160.51,,,160.51,Fee Schedule,,144.4,,,144.4,Fee Schedule,,136.49,,,136.49,Fee Schedule,,121.1,70,,121.1,percent of total billed charges,All Other,65.55,,,65.55,Fee Schedule,,39,,,39,Other,186% of Medicaid,77.21,,,77.21,Fee Schedule,,107.26,,,107.26,Fee Schedule,,43.7,,,,Fee Schedule,,77.21,,,77.21,Fee Schedule,,107.26,,,107.26,Fee Schedule,,82.2,,,82.2,Fee Schedule,,121.1,70,,121.1,percent of total billed charges,,98.62,,,98.62,Fee Schedule,,83.59,,,83.59,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,31.84,,,31.84,Other,153% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,29.13,,,29.13,Other,140% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,54.11,,,54.11,Other,250% of Medicaid,67.42,,,67.42,Other,324% of Medicaid,44.74,,,44.74,Other,215% of Medicaid,44.74,,,44.74,Other,215% of Medicaid,26.01,,,26.01,Other,125% of Medicaid,0.01,160.51,
IMMUNOASSAY TUMOR CA 125,86304,CPT,,78086304,CDM,302,RC,,,both,,,260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,62.64,,,62.64,Fee Schedule,,56.4,,,56.4,Fee Schedule,,160.51,,,160.51,Fee Schedule,,144.4,,,144.4,Fee Schedule,,136.49,,,136.49,Fee Schedule,,182,70,,182,percent of total billed charges,All Other,65.55,,,65.55,Fee Schedule,,39,,,39,Other,186% of Medicaid,77.21,,,77.21,Fee Schedule,,161.2,,,161.2,Fee Schedule,,43.7,,,,Fee Schedule,,77.21,,,77.21,Fee Schedule,,161.2,,,161.2,Fee Schedule,,82.2,,,82.2,Fee Schedule,,182,70,,182,percent of total billed charges,,98.62,,,98.62,Fee Schedule,,83.59,,,83.59,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,31.84,,,31.84,Other,153% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,29.13,,,29.13,Other,140% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,54.11,,,54.11,Other,250% of Medicaid,67.42,,,67.42,Other,324% of Medicaid,44.74,,,44.74,Other,215% of Medicaid,44.74,,,44.74,Other,215% of Medicaid,26.01,,,26.01,Other,125% of Medicaid,0.01,182,
HUMAN EPIDIDYMIS PROTEIN 4,86305,CPT,,78086305,CDM,302,RC,,,both,,,124,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,62.64,,,62.64,Fee Schedule,,56.4,,,56.4,Fee Schedule,,160.51,,,160.51,Fee Schedule,,144.4,,,144.4,Fee Schedule,,136.49,,,136.49,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,All Other,65.55,,,65.55,Fee Schedule,,39,,,39,Other,186% of Medicaid,77.21,,,77.21,Fee Schedule,,76.88,,,76.88,Fee Schedule,,43.7,,,,Fee Schedule,,77.21,,,77.21,Fee Schedule,,76.88,,,76.88,Fee Schedule,,82.2,,,82.2,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,,98.62,,,98.62,Fee Schedule,,83.59,,,83.59,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,20.81,,,20.81,Other,100% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,31.84,,,31.84,Other,153% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,29.13,,,29.13,Other,140% of Medicaid,46.82,,,46.82,Other,225% of Medicaid,54.11,,,54.11,Other,250% of Medicaid,67.42,,,67.42,Other,324% of Medicaid,44.74,,,44.74,Other,215% of Medicaid,44.74,,,44.74,Other,215% of Medicaid,26.01,,,26.01,Other,125% of Medicaid,0.01,160.51,
HETEROPHILE ANTIBODIES,86308,CPT,,78086308,CDM,302,RC,,,both,,,118,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.59,,,15.59,Fee Schedule,,14.04,,,14.04,Fee Schedule,,39.89,,,39.89,Fee Schedule,,35.89,,,35.89,Fee Schedule,,33.92,,,33.92,Fee Schedule,,82.6,70,,82.6,percent of total billed charges,All Other,16.32,,,16.32,Fee Schedule,,9,,,9,Other,186% of Medicaid,19.22,,,19.22,Fee Schedule,,73.16,,,73.16,Fee Schedule,,10.88,,,,Fee Schedule,,19.22,,,19.22,Fee Schedule,,73.16,,,73.16,Fee Schedule,,20.46,,,20.46,Fee Schedule,,82.6,70,,82.6,percent of total billed charges,,24.55,,,24.55,Fee Schedule,,20.81,,,20.81,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,4.78,,,4.78,Other,100% of Medicaid,4.78,,,4.78,Other,100% of Medicaid,4.78,,,4.78,Other,100% of Medicaid,4.78,,,4.78,Other,100% of Medicaid,10.75,,,10.75,Other,225% of Medicaid,7.31,,,7.31,Other,153% of Medicaid,10.75,,,10.75,Other,225% of Medicaid,6.69,,,6.69,Other,140% of Medicaid,10.75,,,10.75,Other,225% of Medicaid,12.42,,,12.42,Other,250% of Medicaid,15.48,,,15.48,Other,324% of Medicaid,10.27,,,10.27,Other,215% of Medicaid,10.27,,,10.27,Other,215% of Medicaid,5.97,,,5.97,Other,125% of Medicaid,0.01,82.6,
HETEROPHILE ANTIBODIES,86309,CPT,,78086309,CDM,302,RC,,,both,,,102,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.47,,,19.47,Fee Schedule,,17.53,,,17.53,Fee Schedule,,49.92,,,49.92,Fee Schedule,,44.91,,,44.91,Fee Schedule,,42.45,,,42.45,Fee Schedule,,71.4,70,,71.4,percent of total billed charges,All Other,20.38,,,20.38,Fee Schedule,,12,,,12,Other,186% of Medicaid,24,,,24,Fee Schedule,,63.24,,,63.24,Fee Schedule,,13.59,,,,Fee Schedule,,24,,,24,Fee Schedule,,63.24,,,63.24,Fee Schedule,,25.56,,,25.56,Fee Schedule,,71.4,70,,71.4,percent of total billed charges,,30.66,,,30.66,Fee Schedule,,25.99,,,25.99,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,6.47,,,6.47,Other,100% of Medicaid,6.47,,,6.47,Other,100% of Medicaid,6.47,,,6.47,Other,100% of Medicaid,6.47,,,6.47,Other,100% of Medicaid,14.56,,,14.56,Other,225% of Medicaid,9.9,,,9.9,Other,153% of Medicaid,14.56,,,14.56,Other,225% of Medicaid,9.06,,,9.06,Other,140% of Medicaid,14.56,,,14.56,Other,225% of Medicaid,16.82,,,16.82,Other,250% of Medicaid,20.96,,,20.96,Other,324% of Medicaid,13.91,,,13.91,Other,215% of Medicaid,13.91,,,13.91,Other,215% of Medicaid,8.09,,,8.09,Other,125% of Medicaid,0.01,71.4,
IMMUNOASSAY TUMOR OTHER,86316,CPT,,78086316,CDM,302,RC,,,both,,,381,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,62.64,,,62.64,Fee Schedule,,56.4,,,56.4,Fee Schedule,,160.51,,,160.51,Fee Schedule,,144.4,,,144.4,Fee Schedule,,136.49,,,136.49,Fee Schedule,,266.7,70,,266.7,percent of total billed charges,All Other,65.55,,,65.55,Fee Schedule,,32,,,32,Other,186% of Medicaid,77.21,,,77.21,Fee Schedule,,236.22,,,236.22,Fee Schedule,,43.7,,,,Fee Schedule,,77.21,,,77.21,Fee Schedule,,236.22,,,236.22,Fee Schedule,,82.2,,,82.2,Fee Schedule,,266.7,70,,266.7,percent of total billed charges,,98.62,,,98.62,Fee Schedule,,83.59,,,83.59,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,31.22,,,31.22,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,266.7,
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,,78086317,CDM,302,RC,,,both,,,141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,45.12,,,45.12,Fee Schedule,,40.62,,,40.62,Fee Schedule,,115.63,,,115.63,Fee Schedule,,104.02,,,104.02,Fee Schedule,,98.33,,,98.33,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,All Other,47.22,,,47.22,Fee Schedule,,32,,,32,Other,186% of Medicaid,55.61,,,55.61,Fee Schedule,,87.42,,,87.42,Fee Schedule,,31.48,,,,Fee Schedule,,55.61,,,55.61,Fee Schedule,,87.42,,,87.42,Fee Schedule,,59.21,,,59.21,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,,71.04,,,71.04,Fee Schedule,,60.21,,,60.21,Fee Schedule,,22.49,,,22.49,Fee Schedule,,22.49,,,22.49,Fee Schedule,,22.49,,,22.49,Fee Schedule,,22.49,,,22.49,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,115.63,
IMMUNOASSAY INFECTIOUS AGENT,86318,CPT,,78086318,CDM,302,RC,,,both,,,132,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.45,,,54.45,Fee Schedule,,49.02,,,49.02,Fee Schedule,,99.85,,,99.85,Fee Schedule,,89.82,,,89.82,Fee Schedule,,84.91,,,84.91,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,All Other,56.98,,,56.98,Fee Schedule,,7,,,7,Other,186% of Medicaid,67.11,,,67.11,Fee Schedule,,81.84,,,81.84,Fee Schedule,,37.99,,,,Fee Schedule,,67.11,,,67.11,Fee Schedule,,81.84,,,81.84,Fee Schedule,,71.46,,,71.46,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,,85.73,,,85.73,Fee Schedule,,72.66,,,72.66,Fee Schedule,,27.14,,,27.14,Fee Schedule,,27.14,,,27.14,Fee Schedule,,27.14,,,27.14,Fee Schedule,,27.14,,,27.14,Fee Schedule,,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.79,,,5.79,Other,153% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.3,,,5.3,Other,140% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,9.85,,,9.85,Other,250% of Medicaid,12.27,,,12.27,Other,324% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,4.73,,,4.73,Other,125% of Medicaid,0.01,99.85,
SERUM IMMUNOELECTROPHORESIS,86320,CPT,,78086320,CDM,302,RC,,,both,,,320,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,90.06,,,90.06,Fee Schedule,,81.08,,,81.08,Fee Schedule,,172.84,,,172.84,Fee Schedule,,155.49,,,155.49,Fee Schedule,,146.98,,,146.98,Fee Schedule,,224,70,,224,percent of total billed charges,All Other,94.25,,,94.25,Fee Schedule,,52,,,52,Other,186% of Medicaid,111,,,111,Fee Schedule,,198.4,,,198.4,Fee Schedule,,62.83,,,,Fee Schedule,,111,,,111,Fee Schedule,,198.4,,,198.4,Fee Schedule,,118.18,,,118.18,Fee Schedule,,224,70,,224,percent of total billed charges,,141.79,,,141.79,Fee Schedule,,120.18,,,120.18,Fee Schedule,,44.88,,,44.88,Fee Schedule,,44.88,,,44.88,Fee Schedule,,44.88,,,44.88,Fee Schedule,,44.88,,,44.88,Fee Schedule,,27.69,,,27.69,Other,100% of Medicaid,27.69,,,27.69,Other,100% of Medicaid,27.69,,,27.69,Other,100% of Medicaid,27.69,,,27.69,Other,100% of Medicaid,62.31,,,62.31,Other,225% of Medicaid,42.37,,,42.37,Other,153% of Medicaid,62.31,,,62.31,Other,225% of Medicaid,38.77,,,38.77,Other,140% of Medicaid,62.31,,,62.31,Other,225% of Medicaid,72,,,72,Other,250% of Medicaid,89.73,,,89.73,Other,324% of Medicaid,59.54,,,59.54,Other,215% of Medicaid,59.54,,,59.54,Other,215% of Medicaid,34.62,,,34.62,Other,125% of Medicaid,0.01,224,
IMMUNOELECTROPHORESIS ASSAY,86327,CPT,,78086327,CDM,302,RC,,,both,,,365,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,90.06,,,90.06,Fee Schedule,,81.08,,,81.08,Fee Schedule,,174.98,,,174.98,Fee Schedule,,157.41,,,157.41,Fee Schedule,,148.79,,,148.79,Fee Schedule,,255.5,70,,255.5,percent of total billed charges,All Other,94.25,,,94.25,Fee Schedule,,80,,,80,Other,186% of Medicaid,111,,,111,Fee Schedule,,226.3,,,226.3,Fee Schedule,,62.83,,,,Fee Schedule,,111,,,111,Fee Schedule,,226.3,,,226.3,Fee Schedule,,118.18,,,118.18,Fee Schedule,,255.5,70,,255.5,percent of total billed charges,,141.79,,,141.79,Fee Schedule,,120.18,,,120.18,Fee Schedule,,44.88,,,44.88,Fee Schedule,,44.88,,,44.88,Fee Schedule,,44.88,,,44.88,Fee Schedule,,44.88,,,44.88,Fee Schedule,,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,65.47,,,65.47,Other,153% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,59.91,,,59.91,Other,140% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,111.26,,,111.26,Other,250% of Medicaid,138.64,,,138.64,Other,324% of Medicaid,92,,,92,Other,215% of Medicaid,92,,,92,Other,215% of Medicaid,53.49,,,53.49,Other,125% of Medicaid,0.01,255.5,
IA NFCT AB SARSCOV2 COVID19,86328,CPT,,78086328,CDM,302,RC,,,both,,,158,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,136.29,,,136.29,Fee Schedule,,122.71,,,122.71,Fee Schedule,,18.09,,,18.09,Fee Schedule,,18.09,,,18.09,Fee Schedule,,18.09,,,18.09,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,All Other,142.63,,,142.63,Fee Schedule,,50,,,50,Other,186% of Medicaid,167.99,,,167.99,Fee Schedule,,97.96,,,97.96,Fee Schedule,,95.09,,,,Fee Schedule,,167.99,,,167.99,Fee Schedule,,97.96,,,97.96,Fee Schedule,,178.86,,,178.86,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,,214.58,,,214.58,Fee Schedule,,181.87,,,181.87,Fee Schedule,,67.92,,,67.92,Fee Schedule,,67.92,,,67.92,Fee Schedule,,67.92,,,67.92,Fee Schedule,,67.92,,,67.92,Fee Schedule,,27.14,,,27.14,Other,100% of Medicaid,27.14,,,27.14,Other,100% of Medicaid,27.14,,,27.14,Other,100% of Medicaid,27.14,,,27.14,Other,100% of Medicaid,61.07,,,61.07,Other,225% of Medicaid,41.52,,,41.52,Other,153% of Medicaid,61.07,,,61.07,Other,225% of Medicaid,38,,,38,Other,140% of Medicaid,61.07,,,61.07,Other,225% of Medicaid,70.56,,,70.56,Other,250% of Medicaid,87.93,,,87.93,Other,324% of Medicaid,58.35,,,58.35,Other,215% of Medicaid,58.35,,,58.35,Other,215% of Medicaid,33.93,,,33.93,Other,125% of Medicaid,0.01,214.58,
IMMUNODIFFUSION,86329,CPT,,78086329,CDM,302,RC,,,both,,,147,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,42.29,,,42.29,Fee Schedule,,38.08,,,38.08,Fee Schedule,,108.34,,,108.34,Fee Schedule,,97.47,,,97.47,Fee Schedule,,92.13,,,92.13,Fee Schedule,,102.9,70,,102.9,percent of total billed charges,All Other,44.26,,,44.26,Fee Schedule,,23,,,23,Other,186% of Medicaid,52.13,,,52.13,Fee Schedule,,91.14,,,91.14,Fee Schedule,,29.51,,,,Fee Schedule,,52.13,,,52.13,Fee Schedule,,91.14,,,91.14,Fee Schedule,,55.5,,,55.5,Fee Schedule,,102.9,70,,102.9,percent of total billed charges,,66.58,,,66.58,Fee Schedule,,56.43,,,56.43,Fee Schedule,,21.08,,,21.08,Fee Schedule,,21.08,,,21.08,Fee Schedule,,21.08,,,21.08,Fee Schedule,,21.08,,,21.08,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,108.34,
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,,78086331,CDM,302,RC,,,both,,,147,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,92.39,,,92.39,Fee Schedule,,83.12,,,83.12,Fee Schedule,,78.57,,,78.57,Fee Schedule,,102.9,70,,102.9,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,32,,,32,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,91.14,,,91.14,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,91.14,,,91.14,Fee Schedule,,47.32,,,47.32,Fee Schedule,,102.9,70,,102.9,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,102.9,
IMMUNE COMPLEX ASSAY,86332,CPT,,78086332,CDM,302,RC,,,both,,,196,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,73.35,,,73.35,Fee Schedule,,66.04,,,66.04,Fee Schedule,,187.96,,,187.96,Fee Schedule,,169.1,,,169.1,Fee Schedule,,159.84,,,159.84,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,All Other,76.77,,,76.77,Fee Schedule,,32,,,32,Other,186% of Medicaid,90.41,,,90.41,Fee Schedule,,121.52,,,121.52,Fee Schedule,,51.18,,,,Fee Schedule,,90.41,,,90.41,Fee Schedule,,121.52,,,121.52,Fee Schedule,,96.26,,,96.26,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,,115.49,,,115.49,Fee Schedule,,97.89,,,97.89,Fee Schedule,,36.56,,,36.56,Fee Schedule,,36.56,,,36.56,Fee Schedule,,36.56,,,36.56,Fee Schedule,,36.56,,,36.56,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,187.96,
SERUM IMMUNOFIXATION ELECTROPH,86334,CPT,,78086334,CDM,302,RC,,,both,,,175,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,67.24,,,67.24,Fee Schedule,,60.54,,,60.54,Fee Schedule,,172.29,,,172.29,Fee Schedule,,155,,,155,Fee Schedule,,146.51,,,146.51,Fee Schedule,,122.5,70,,122.5,percent of total billed charges,All Other,70.37,,,70.37,Fee Schedule,,42,,,42,Other,186% of Medicaid,82.88,,,82.88,Fee Schedule,,108.5,,,108.5,Fee Schedule,,46.91,,,,Fee Schedule,,82.88,,,82.88,Fee Schedule,,108.5,,,108.5,Fee Schedule,,88.24,,,88.24,Fee Schedule,,122.5,70,,122.5,percent of total billed charges,,105.87,,,105.87,Fee Schedule,,89.73,,,89.73,Fee Schedule,,33.51,,,33.51,Fee Schedule,,33.51,,,33.51,Fee Schedule,,33.51,,,33.51,Fee Schedule,,33.51,,,33.51,Fee Schedule,,22.34,,,22.34,Other,100% of Medicaid,22.34,,,22.34,Other,100% of Medicaid,22.34,,,22.34,Other,100% of Medicaid,22.34,,,22.34,Other,100% of Medicaid,50.27,,,50.27,Other,225% of Medicaid,34.18,,,34.18,Other,153% of Medicaid,50.27,,,50.27,Other,225% of Medicaid,31.28,,,31.28,Other,140% of Medicaid,50.27,,,50.27,Other,225% of Medicaid,58.08,,,58.08,Other,250% of Medicaid,72.38,,,72.38,Other,324% of Medicaid,48.03,,,48.03,Other,215% of Medicaid,48.03,,,48.03,Other,215% of Medicaid,27.93,,,27.93,Other,125% of Medicaid,0.01,172.29,
INHIBIN A,86336,CPT,,78086336,CDM,302,RC,,,both,,,112,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.93,,,46.93,Fee Schedule,,42.25,,,42.25,Fee Schedule,,120.18,,,120.18,Fee Schedule,,108.11,,,108.11,Fee Schedule,,102.19,,,102.19,Fee Schedule,,78.4,70,,78.4,percent of total billed charges,All Other,49.11,,,49.11,Fee Schedule,,12,,,12,Other,186% of Medicaid,57.84,,,57.84,Fee Schedule,,69.44,,,69.44,Fee Schedule,,32.74,,,,Fee Schedule,,57.84,,,57.84,Fee Schedule,,69.44,,,69.44,Fee Schedule,,61.58,,,61.58,Fee Schedule,,78.4,70,,78.4,percent of total billed charges,,73.88,,,73.88,Fee Schedule,,62.62,,,62.62,Fee Schedule,,23.39,,,23.39,Fee Schedule,,23.39,,,23.39,Fee Schedule,,23.39,,,23.39,Fee Schedule,,23.39,,,23.39,Fee Schedule,,6.57,,,6.57,Other,100% of Medicaid,6.57,,,6.57,Other,100% of Medicaid,6.57,,,6.57,Other,100% of Medicaid,6.57,,,6.57,Other,100% of Medicaid,14.77,,,14.77,Other,225% of Medicaid,10.04,,,10.04,Other,153% of Medicaid,14.77,,,14.77,Other,225% of Medicaid,9.19,,,9.19,Other,140% of Medicaid,14.77,,,14.77,Other,225% of Medicaid,17.07,,,17.07,Other,250% of Medicaid,21.27,,,21.27,Other,324% of Medicaid,14.11,,,14.11,Other,215% of Medicaid,14.11,,,14.11,Other,215% of Medicaid,8.21,,,8.21,Other,125% of Medicaid,0.01,120.18,
INSULIN ANTIBODIES,86337,CPT,,78086337,CDM,302,RC,,,both,,,320,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,64.44,,,64.44,Fee Schedule,,58.02,,,58.02,Fee Schedule,,165.11,,,165.11,Fee Schedule,,148.54,,,148.54,Fee Schedule,,140.41,,,140.41,Fee Schedule,,224,70,,224,percent of total billed charges,All Other,67.44,,,67.44,Fee Schedule,,23,,,23,Other,186% of Medicaid,79.43,,,79.43,Fee Schedule,,198.4,,,198.4,Fee Schedule,,44.96,,,,Fee Schedule,,79.43,,,79.43,Fee Schedule,,198.4,,,198.4,Fee Schedule,,84.57,,,84.57,Fee Schedule,,224,70,,224,percent of total billed charges,,101.46,,,101.46,Fee Schedule,,86,,,86,Fee Schedule,,32.12,,,32.12,Fee Schedule,,32.12,,,32.12,Fee Schedule,,32.12,,,32.12,Fee Schedule,,32.12,,,32.12,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,224,
INTRINSIC FACTOR ANTIBODY,86340,CPT,,78086340,CDM,302,RC,,,both,,,266,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,45.39,,,45.39,Fee Schedule,,40.87,,,40.87,Fee Schedule,,116.23,,,116.23,Fee Schedule,,104.57,,,104.57,Fee Schedule,,98.84,,,98.84,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,All Other,47.5,,,47.5,Fee Schedule,,21,,,21,Other,186% of Medicaid,55.95,,,55.95,Fee Schedule,,164.92,,,164.92,Fee Schedule,,31.67,,,,Fee Schedule,,55.95,,,55.95,Fee Schedule,,164.92,,,164.92,Fee Schedule,,59.57,,,59.57,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,,71.46,,,71.46,Fee Schedule,,60.57,,,60.57,Fee Schedule,,22.62,,,22.62,Fee Schedule,,22.62,,,22.62,Fee Schedule,,22.62,,,22.62,Fee Schedule,,22.62,,,22.62,Fee Schedule,,11.47,,,11.47,Other,100% of Medicaid,11.47,,,11.47,Other,100% of Medicaid,11.47,,,11.47,Other,100% of Medicaid,11.47,,,11.47,Other,100% of Medicaid,25.82,,,25.82,Other,225% of Medicaid,17.55,,,17.55,Other,153% of Medicaid,25.82,,,25.82,Other,225% of Medicaid,16.06,,,16.06,Other,140% of Medicaid,25.82,,,25.82,Other,225% of Medicaid,29.83,,,29.83,Other,250% of Medicaid,37.17,,,37.17,Other,324% of Medicaid,24.67,,,24.67,Other,215% of Medicaid,24.67,,,24.67,Other,215% of Medicaid,14.34,,,14.34,Other,125% of Medicaid,0.01,186.2,
ISLET CELL ANTIBODY,86341,CPT,,78086341,CDM,302,RC,,,both,,,314,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,70.95,,,70.95,Fee Schedule,,63.87,,,63.87,Fee Schedule,,152.62,,,152.62,Fee Schedule,,137.3,,,137.3,Fee Schedule,,129.78,,,129.78,Fee Schedule,,219.8,70,,219.8,percent of total billed charges,All Other,74.25,,,74.25,Fee Schedule,,23,,,23,Other,186% of Medicaid,87.44,,,87.44,Fee Schedule,,194.68,,,194.68,Fee Schedule,,49.5,,,,Fee Schedule,,87.44,,,87.44,Fee Schedule,,194.68,,,194.68,Fee Schedule,,93.1,,,93.1,Fee Schedule,,219.8,70,,219.8,percent of total billed charges,,111.7,,,111.7,Fee Schedule,,94.67,,,94.67,Fee Schedule,,35.36,,,35.36,Fee Schedule,,35.36,,,35.36,Fee Schedule,,35.36,,,35.36,Fee Schedule,,35.36,,,35.36,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,219.8,
LHR TEST,86343,CPT,,78086343,CDM,302,RC,,,both,,,38,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.5,,,37.5,Fee Schedule,,33.77,,,33.77,Fee Schedule,,49.48,,,49.48,Fee Schedule,,44.52,,,44.52,Fee Schedule,,42.08,,,42.08,Fee Schedule,,26.6,70,,26.6,percent of total billed charges,All Other,39.25,,,39.25,Fee Schedule,,32,,,32,Other,186% of Medicaid,46.23,,,46.23,Fee Schedule,,23.56,,,23.56,Fee Schedule,,26.17,,,,Fee Schedule,,46.23,,,46.23,Fee Schedule,,23.56,,,23.56,Fee Schedule,,49.22,,,49.22,Fee Schedule,,26.6,70,,26.6,percent of total billed charges,,59.05,,,59.05,Fee Schedule,,50.05,,,50.05,Fee Schedule,,18.69,,,18.69,Fee Schedule,,18.69,,,18.69,Fee Schedule,,18.69,,,18.69,Fee Schedule,,18.69,,,18.69,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,59.05,
CELL FUNCTION ASSAY W/STIM,86352,CPT,,78086352,CDM,302,RC,,,both,,,429,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,408.94,,,408.94,Fee Schedule,,368.18,,,368.18,Fee Schedule,,1047.72,,,1047.72,Fee Schedule,,942.57,,,942.57,Fee Schedule,,890.95,,,890.95,Fee Schedule,,300.3,70,,300.3,percent of total billed charges,All Other,427.96,,,427.96,Fee Schedule,,80,,,80,Other,186% of Medicaid,504.04,,,504.04,Fee Schedule,,265.98,,,265.98,Fee Schedule,,285.31,,,,Fee Schedule,,504.04,,,504.04,Fee Schedule,,265.98,,,265.98,Fee Schedule,,536.65,,,536.65,Fee Schedule,,300.3,70,,300.3,percent of total billed charges,,643.85,,,643.85,Fee Schedule,,545.7,,,545.7,Fee Schedule,,203.79,,,203.79,Fee Schedule,,203.79,,,203.79,Fee Schedule,,203.79,,,203.79,Fee Schedule,,203.79,,,203.79,Fee Schedule,,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,65.47,,,65.47,Other,153% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,59.91,,,59.91,Other,140% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,111.26,,,111.26,Other,250% of Medicaid,138.64,,,138.64,Other,324% of Medicaid,92,,,92,Other,215% of Medicaid,92,,,92,Other,215% of Medicaid,53.49,,,53.49,Other,125% of Medicaid,0.01,1047.72,
LYMPHOCYTE TRANSFORMATION,86353,CPT,,78086353,CDM,302,RC,,,both,,,156,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,147.58,,,147.58,Fee Schedule,,132.87,,,132.87,Fee Schedule,,378.07,,,378.07,Fee Schedule,,340.12,,,340.12,Fee Schedule,,321.49,,,321.49,Fee Schedule,,109.2,70,,109.2,percent of total billed charges,All Other,154.44,,,154.44,Fee Schedule,,80,,,80,Other,186% of Medicaid,181.9,,,181.9,Fee Schedule,,96.72,,,96.72,Fee Schedule,,102.96,,,,Fee Schedule,,181.9,,,181.9,Fee Schedule,,96.72,,,96.72,Fee Schedule,,193.67,,,193.67,Fee Schedule,,109.2,70,,109.2,percent of total billed charges,,232.35,,,232.35,Fee Schedule,,196.93,,,196.93,Fee Schedule,,73.55,,,73.55,Fee Schedule,,73.55,,,73.55,Fee Schedule,,73.55,,,73.55,Fee Schedule,,73.55,,,73.55,Fee Schedule,,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,65.47,,,65.47,Other,153% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,59.91,,,59.91,Other,140% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,111.26,,,111.26,Other,250% of Medicaid,138.64,,,138.64,Other,324% of Medicaid,92,,,92,Other,215% of Medicaid,92,,,92,Other,215% of Medicaid,53.49,,,53.49,Other,125% of Medicaid,0.01,378.07,
B CELLS TOTAL COUNT,86355,CPT,,78086355,CDM,302,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,113.57,,,113.57,Fee Schedule,,102.25,,,102.25,Fee Schedule,,290.88,,,290.88,Fee Schedule,,261.68,,,261.68,Fee Schedule,,247.35,,,247.35,Fee Schedule,,168,70,,168,percent of total billed charges,All Other,118.85,,,118.85,Fee Schedule,,44,,,44,Other,186% of Medicaid,139.98,,,139.98,Fee Schedule,,148.8,,,148.8,Fee Schedule,,79.23,,,,Fee Schedule,,139.98,,,139.98,Fee Schedule,,148.8,,,148.8,Fee Schedule,,149.03,,,149.03,Fee Schedule,,168,70,,168,percent of total billed charges,,178.8,,,178.8,Fee Schedule,,151.55,,,151.55,Fee Schedule,,56.6,,,56.6,Fee Schedule,,56.6,,,56.6,Fee Schedule,,56.6,,,56.6,Fee Schedule,,56.6,,,56.6,Fee Schedule,,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,35.8,,,35.8,Other,153% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,32.76,,,32.76,Other,140% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,60.84,,,60.84,Other,250% of Medicaid,75.82,,,75.82,Other,324% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,29.25,,,29.25,Other,125% of Medicaid,0.01,290.88,
MONONUCLEAR CELL ANTIGEN,86356,CPT,,78086356,CDM,302,RC,,,both,,,172,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,80.61,,,80.61,Fee Schedule,,72.57,,,72.57,Fee Schedule,,206.43,,,206.43,Fee Schedule,,185.71,,,185.71,Fee Schedule,,175.54,,,175.54,Fee Schedule,,120.4,70,,120.4,percent of total billed charges,All Other,84.36,,,84.36,Fee Schedule,,80,,,80,Other,186% of Medicaid,99.35,,,99.35,Fee Schedule,,106.64,,,106.64,Fee Schedule,,56.24,,,,Fee Schedule,,99.35,,,99.35,Fee Schedule,,106.64,,,106.64,Fee Schedule,,105.78,,,105.78,Fee Schedule,,120.4,70,,120.4,percent of total billed charges,,126.91,,,126.91,Fee Schedule,,107.57,,,107.57,Fee Schedule,,40.17,,,40.17,Fee Schedule,,40.17,,,40.17,Fee Schedule,,40.17,,,40.17,Fee Schedule,,40.17,,,40.17,Fee Schedule,,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,65.47,,,65.47,Other,153% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,59.91,,,59.91,Other,140% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,111.26,,,111.26,Other,250% of Medicaid,138.64,,,138.64,Other,324% of Medicaid,92,,,92,Other,215% of Medicaid,92,,,92,Other,215% of Medicaid,53.49,,,53.49,Other,125% of Medicaid,0.01,206.43,
NK CELLS TOTAL COUNT,86357,CPT,,78086357,CDM,302,RC,,,both,,,198,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,113.57,,,113.57,Fee Schedule,,102.25,,,102.25,Fee Schedule,,290.88,,,290.88,Fee Schedule,,261.68,,,261.68,Fee Schedule,,247.35,,,247.35,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,All Other,118.85,,,118.85,Fee Schedule,,44,,,44,Other,186% of Medicaid,139.98,,,139.98,Fee Schedule,,122.76,,,122.76,Fee Schedule,,79.23,,,,Fee Schedule,,139.98,,,139.98,Fee Schedule,,122.76,,,122.76,Fee Schedule,,149.03,,,149.03,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,,178.8,,,178.8,Fee Schedule,,151.55,,,151.55,Fee Schedule,,56.6,,,56.6,Fee Schedule,,56.6,,,56.6,Fee Schedule,,56.6,,,56.6,Fee Schedule,,56.6,,,56.6,Fee Schedule,,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,35.8,,,35.8,Other,153% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,32.76,,,32.76,Other,140% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,60.84,,,60.84,Other,250% of Medicaid,75.82,,,75.82,Other,324% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,29.25,,,29.25,Other,125% of Medicaid,0.01,290.88,
T CELLS TOTAL COUNT,86359,CPT,,78086359,CDM,302,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,113.57,,,113.57,Fee Schedule,,102.25,,,102.25,Fee Schedule,,290.88,,,290.88,Fee Schedule,,261.68,,,261.68,Fee Schedule,,247.35,,,247.35,Fee Schedule,,168,70,,168,percent of total billed charges,All Other,118.85,,,118.85,Fee Schedule,,44,,,44,Other,186% of Medicaid,139.98,,,139.98,Fee Schedule,,148.8,,,148.8,Fee Schedule,,79.23,,,,Fee Schedule,,139.98,,,139.98,Fee Schedule,,148.8,,,148.8,Fee Schedule,,149.03,,,149.03,Fee Schedule,,168,70,,168,percent of total billed charges,,178.8,,,178.8,Fee Schedule,,151.55,,,151.55,Fee Schedule,,56.6,,,56.6,Fee Schedule,,56.6,,,56.6,Fee Schedule,,56.6,,,56.6,Fee Schedule,,56.6,,,56.6,Fee Schedule,,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,35.8,,,35.8,Other,153% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,32.76,,,32.76,Other,140% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,60.84,,,60.84,Other,250% of Medicaid,75.82,,,75.82,Other,324% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,29.25,,,29.25,Other,125% of Medicaid,0.01,290.88,
T CELL ABSOLUTE COUNT/RATIO,86360,CPT,,78086360,CDM,302,RC,,,both,,,365,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,141.41,,,141.41,Fee Schedule,,127.32,,,127.32,Fee Schedule,,362.34,,,362.34,Fee Schedule,,325.97,,,325.97,Fee Schedule,,308.12,,,308.12,Fee Schedule,,255.5,70,,255.5,percent of total billed charges,All Other,147.99,,,147.99,Fee Schedule,,87,,,87,Other,186% of Medicaid,174.3,,,174.3,Fee Schedule,,226.3,,,226.3,Fee Schedule,,98.66,,,,Fee Schedule,,174.3,,,174.3,Fee Schedule,,226.3,,,226.3,Fee Schedule,,185.57,,,185.57,Fee Schedule,,255.5,70,,255.5,percent of total billed charges,,222.64,,,222.64,Fee Schedule,,188.7,,,188.7,Fee Schedule,,70.47,,,70.47,Fee Schedule,,70.47,,,70.47,Fee Schedule,,70.47,,,70.47,Fee Schedule,,70.47,,,70.47,Fee Schedule,,46.98,,,46.98,Other,100% of Medicaid,46.98,,,46.98,Other,100% of Medicaid,46.98,,,46.98,Other,100% of Medicaid,46.98,,,46.98,Other,100% of Medicaid,105.71,,,105.71,Other,225% of Medicaid,71.88,,,71.88,Other,153% of Medicaid,105.71,,,105.71,Other,225% of Medicaid,65.77,,,65.77,Other,140% of Medicaid,105.71,,,105.71,Other,225% of Medicaid,122.15,,,122.15,Other,250% of Medicaid,152.22,,,152.22,Other,324% of Medicaid,101.01,,,101.01,Other,215% of Medicaid,101.01,,,101.01,Other,215% of Medicaid,58.73,,,58.73,Other,125% of Medicaid,0.01,362.34,
T CELL ABSOLUTE COUNT,86361,CPT,,78086361,CDM,302,RC,,,both,,,160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,80.61,,,80.61,Fee Schedule,,72.57,,,72.57,Fee Schedule,,206.43,,,206.43,Fee Schedule,,185.71,,,185.71,Fee Schedule,,175.54,,,175.54,Fee Schedule,,112,70,,112,percent of total billed charges,All Other,84.36,,,84.36,Fee Schedule,,44,,,44,Other,186% of Medicaid,99.35,,,99.35,Fee Schedule,,99.2,,,99.2,Fee Schedule,,56.24,,,,Fee Schedule,,99.35,,,99.35,Fee Schedule,,99.2,,,99.2,Fee Schedule,,105.78,,,105.78,Fee Schedule,,112,70,,112,percent of total billed charges,,126.91,,,126.91,Fee Schedule,,107.57,,,107.57,Fee Schedule,,40.17,,,40.17,Fee Schedule,,40.17,,,40.17,Fee Schedule,,40.17,,,40.17,Fee Schedule,,40.17,,,40.17,Fee Schedule,,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,35.8,,,35.8,Other,153% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,32.76,,,32.76,Other,140% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,60.84,,,60.84,Other,250% of Medicaid,75.82,,,75.82,Other,324% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,29.25,,,29.25,Other,125% of Medicaid,0.01,206.43,
MOG-IGG1 ANTB CBA EACH,86362,CPT,,78086362,CDM,302,RC,,,both,,,39,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.27,,,36.27,Fee Schedule,,32.66,,,32.66,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,27.3,70,,27.3,percent of total billed charges,All Other,37.96,,,37.96,Fee Schedule,,32,,,32,Other,186% of Medicaid,44.71,,,44.71,Fee Schedule,,24.18,,,24.18,Fee Schedule,,25.31,,,,Fee Schedule,,44.71,,,44.71,Fee Schedule,,24.18,,,24.18,Fee Schedule,,47.6,,,47.6,Fee Schedule,,27.3,70,,27.3,percent of total billed charges,,57.11,,,57.11,Fee Schedule,,48.4,,,48.4,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,57.11,
MOG-IGG1 ANTB FLO CYTMTRY EA,86363,CPT,,78086363,CDM,302,RC,,,both,,,77,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,113.57,,,113.57,Fee Schedule,,102.25,,,102.25,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,12.05,,,12.05,Fee Schedule,,53.9,70,,53.9,percent of total billed charges,All Other,118.85,,,118.85,Fee Schedule,,14,,,14,Other,186% of Medicaid,139.98,,,139.98,Fee Schedule,,47.74,,,47.74,Fee Schedule,,79.23,,,,Fee Schedule,,139.98,,,139.98,Fee Schedule,,47.74,,,47.74,Fee Schedule,,149.03,,,149.03,Fee Schedule,,53.9,70,,53.9,percent of total billed charges,,57.11,,,57.11,Fee Schedule,,48.4,,,48.4,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,7.3,,,7.3,Other,100% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,11.17,,,11.17,Other,153% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,10.22,,,10.22,Other,140% of Medicaid,16.43,,,16.43,Other,225% of Medicaid,18.99,,,18.99,Other,250% of Medicaid,23.66,,,23.66,Other,324% of Medicaid,15.7,,,15.7,Other,215% of Medicaid,15.7,,,15.7,Other,215% of Medicaid,9.13,,,9.13,Other,125% of Medicaid,0.01,149.03,
STEM CELLS TOTAL COUNT,86367,CPT,,78086367,CDM,302,RC,,,both,,,246,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,234.12,,,234.12,Fee Schedule,,210.78,,,210.78,Fee Schedule,,290.88,,,290.88,Fee Schedule,,261.68,,,261.68,Fee Schedule,,247.35,,,247.35,Fee Schedule,,172.2,70,,172.2,percent of total billed charges,All Other,245.01,,,245.01,Fee Schedule,,44,,,44,Other,186% of Medicaid,288.56,,,288.56,Fee Schedule,,152.52,,,152.52,Fee Schedule,,163.34,,,,Fee Schedule,,288.56,,,288.56,Fee Schedule,,152.52,,,152.52,Fee Schedule,,307.23,,,307.23,Fee Schedule,,172.2,70,,172.2,percent of total billed charges,,368.6,,,368.6,Fee Schedule,,312.41,,,312.41,Fee Schedule,,116.67,,,116.67,Fee Schedule,,116.67,,,116.67,Fee Schedule,,116.67,,,116.67,Fee Schedule,,116.67,,,116.67,Fee Schedule,,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,35.8,,,35.8,Other,153% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,32.76,,,32.76,Other,140% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,60.84,,,60.84,Other,250% of Medicaid,75.82,,,75.82,Other,324% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,29.25,,,29.25,Other,125% of Medicaid,0.01,368.6,
MICROSOMAL ATIBODY,86376,CPT,,78086376,CDM,302,RC,,,both,,,155,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.8,,,43.8,Fee Schedule,,39.43,,,39.43,Fee Schedule,,112.23,,,112.23,Fee Schedule,,100.97,,,100.97,Fee Schedule,,95.44,,,95.44,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,All Other,45.83,,,45.83,Fee Schedule,,27,,,27,Other,186% of Medicaid,53.98,,,53.98,Fee Schedule,,96.1,,,96.1,Fee Schedule,,30.56,,,,Fee Schedule,,53.98,,,53.98,Fee Schedule,,96.1,,,96.1,Fee Schedule,,57.47,,,57.47,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,,68.95,,,68.95,Fee Schedule,,58.44,,,58.44,Fee Schedule,,21.83,,,21.83,Fee Schedule,,21.83,,,21.83,Fee Schedule,,21.83,,,21.83,Fee Schedule,,21.83,,,21.83,Fee Schedule,,14.55,,,14.55,Other,100% of Medicaid,14.55,,,14.55,Other,100% of Medicaid,14.55,,,14.55,Other,100% of Medicaid,14.55,,,14.55,Other,100% of Medicaid,32.74,,,32.74,Other,225% of Medicaid,22.26,,,22.26,Other,153% of Medicaid,32.74,,,32.74,Other,225% of Medicaid,20.37,,,20.37,Other,140% of Medicaid,32.74,,,32.74,Other,225% of Medicaid,37.83,,,37.83,Other,250% of Medicaid,47.14,,,47.14,Other,324% of Medicaid,31.28,,,31.28,Other,215% of Medicaid,31.28,,,31.28,Other,215% of Medicaid,18.19,,,18.19,Other,125% of Medicaid,0.01,112.23,
MIGRATION INHIBITORY FACTOR,86378,CPT,,78086378,CDM,302,RC,,,both,,,138,34.8,,,34.8,Other,150% of Medicare + 9.63% HCRA Surcharge,21.16,,,21.16,Other,Non Covered Service,89.7,65,,89.7,percent of total billed charges,All Other,81.42,59,,81.42,percent of total billed charges,All Other,6.3,,,6.3,Fee Schedule,,6.3,,,6.3,Fee Schedule,,6.3,,,6.3,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,All Other,93.84,68,,93.84,percent of total billed charges,All Other,80,,,80,Other,186% of Medicaid,114.54,80,,114.54,percent of total billed charges,All Other,85.56,83,,85.56,percent of total billed charges,All Other,75.9,83,,,percent of total billed charges,All Other,114.54,80,,114.54,percent of total billed charges,All Other,85.56,83,,85.56,percent of total billed charges,All Other,110.4,80,,110.4,percent of total billed charges,All Other,96.6,70,,96.6,percent of total billed charges,,89.7,65,,89.7,percent of total billed charges,All Other,89.7,65,,89.7,percent of total billed charges,All Other,69,,,69,Fee Schedule,,69,,,69,Fee Schedule,,69,,,69,Fee Schedule,,69,,,69,Fee Schedule,,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,42.79,,,42.79,Other,100% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,65.47,,,65.47,Other,153% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,59.91,,,59.91,Other,140% of Medicaid,96.28,,,96.28,Other,225% of Medicaid,111.26,,,111.26,Other,250% of Medicaid,138.64,,,138.64,Other,324% of Medicaid,92,,,92,Other,215% of Medicaid,92,,,92,Other,215% of Medicaid,53.49,,,53.49,Other,125% of Medicaid,6.3,138.64,
NEUTRALIZATION TEST VIRAL,86382,CPT,,78086382,CDM,302,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.9,,,50.9,Fee Schedule,,45.83,,,45.83,Fee Schedule,,130.42,,,130.42,Fee Schedule,,117.33,,,117.33,Fee Schedule,,110.91,,,110.91,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,53.27,,,53.27,Fee Schedule,,9,,,9,Other,186% of Medicaid,62.74,,,62.74,Fee Schedule,,115.32,,,115.32,Fee Schedule,,35.51,,,,Fee Schedule,,62.74,,,62.74,Fee Schedule,,115.32,,,115.32,Fee Schedule,,66.79,,,66.79,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,80.14,,,80.14,Fee Schedule,,67.92,,,67.92,Fee Schedule,,25.37,,,25.37,Fee Schedule,,25.37,,,25.37,Fee Schedule,,25.37,,,25.37,Fee Schedule,,25.37,,,25.37,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,130.42,
PARTICLE AGGLUTINATION TEST,86403,CPT,,78086403,CDM,302,RC,,,both,,,194,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.74,,,34.74,Fee Schedule,,31.27,,,31.27,Fee Schedule,,78.58,,,78.58,Fee Schedule,,70.7,,,70.7,Fee Schedule,,66.82,,,66.82,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,All Other,36.35,,,36.35,Fee Schedule,,7,,,7,Other,186% of Medicaid,42.81,,,42.81,Fee Schedule,,120.28,,,120.28,Fee Schedule,,24.23,,,,Fee Schedule,,42.81,,,42.81,Fee Schedule,,120.28,,,120.28,Fee Schedule,,45.58,,,45.58,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,,54.69,,,54.69,Fee Schedule,,46.35,,,46.35,Fee Schedule,,17.31,,,17.31,Fee Schedule,,17.31,,,17.31,Fee Schedule,,17.31,,,17.31,Fee Schedule,,17.31,,,17.31,Fee Schedule,,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.79,,,5.79,Other,153% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.3,,,5.3,Other,140% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,9.85,,,9.85,Other,250% of Medicaid,12.27,,,12.27,Other,324% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,4.73,,,4.73,Other,125% of Medicaid,0.01,135.8,
PARTICLE AGGLUT ANTBDY TITR,86406,CPT,,78086406,CDM,302,RC,,,both,,,34,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,32.03,,,32.03,Fee Schedule,,28.83,,,28.83,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,23.8,70,,23.8,percent of total billed charges,All Other,33.52,,,33.52,Fee Schedule,,32,,,32,Other,186% of Medicaid,39.47,,,39.47,Fee Schedule,,21.08,,,21.08,Fee Schedule,,22.34,,,,Fee Schedule,,39.47,,,39.47,Fee Schedule,,21.08,,,21.08,Fee Schedule,,42.03,,,42.03,Fee Schedule,,23.8,70,,23.8,percent of total billed charges,,50.42,,,50.42,Fee Schedule,,42.74,,,42.74,Fee Schedule,,15.96,,,15.96,Fee Schedule,,15.96,,,15.96,Fee Schedule,,15.96,,,15.96,Fee Schedule,,15.96,,,15.96,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,56.14,
RHEUMATOID FACTOR TEST,86430,CPT,,78086430,CDM,302,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,18.48,,,18.48,Fee Schedule,,16.64,,,16.64,Fee Schedule,,43.73,,,43.73,Fee Schedule,,39.34,,,39.34,Fee Schedule,,37.19,,,37.19,Fee Schedule,,49,70,,49,percent of total billed charges,All Other,19.34,,,19.34,Fee Schedule,,9,,,9,Other,186% of Medicaid,22.78,,,22.78,Fee Schedule,,43.4,,,43.4,Fee Schedule,,12.89,,,,Fee Schedule,,22.78,,,22.78,Fee Schedule,,43.4,,,43.4,Fee Schedule,,24.25,,,24.25,Fee Schedule,,49,70,,49,percent of total billed charges,,29.1,,,29.1,Fee Schedule,,24.66,,,24.66,Fee Schedule,,9.21,,,9.21,Fee Schedule,,9.21,,,9.21,Fee Schedule,,9.21,,,9.21,Fee Schedule,,9.21,,,9.21,Fee Schedule,,4.93,,,4.93,Other,100% of Medicaid,4.93,,,4.93,Other,100% of Medicaid,4.93,,,4.93,Other,100% of Medicaid,4.93,,,4.93,Other,100% of Medicaid,11.09,,,11.09,Other,225% of Medicaid,7.54,,,7.54,Other,153% of Medicaid,11.09,,,11.09,Other,225% of Medicaid,6.9,,,6.9,Other,140% of Medicaid,11.09,,,11.09,Other,225% of Medicaid,12.81,,,12.81,Other,250% of Medicaid,15.97,,,15.97,Other,324% of Medicaid,10.6,,,10.6,Other,215% of Medicaid,10.6,,,10.6,Other,215% of Medicaid,6.16,,,6.16,Other,125% of Medicaid,0.01,49,
RHEUMATOID FACTOR QUANT,86431,CPT,,78086431,CDM,302,RC,,,both,,,108,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,17.07,,,17.07,Fee Schedule,,15.37,,,15.37,Fee Schedule,,43.73,,,43.73,Fee Schedule,,39.34,,,39.34,Fee Schedule,,37.19,,,37.19,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,All Other,17.86,,,17.86,Fee Schedule,,10,,,10,Other,186% of Medicaid,21.04,,,21.04,Fee Schedule,,66.96,,,66.96,Fee Schedule,,11.91,,,,Fee Schedule,,21.04,,,21.04,Fee Schedule,,66.96,,,66.96,Fee Schedule,,22.4,,,22.4,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,,26.87,,,26.87,Fee Schedule,,22.77,,,22.77,Fee Schedule,,8.51,,,8.51,Fee Schedule,,8.51,,,8.51,Fee Schedule,,8.51,,,8.51,Fee Schedule,,8.51,,,8.51,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,75.6,
TB TEST CELL IMMUN MEASURE,86480,CPT,,78086480,CDM,302,RC,,,both,,,393,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,186.56,,,186.56,Fee Schedule,,167.97,,,167.97,Fee Schedule,,477.97,,,477.97,Fee Schedule,,429.99,,,429.99,Fee Schedule,,406.45,,,406.45,Fee Schedule,,275.1,70,,275.1,percent of total billed charges,All Other,195.24,,,195.24,Fee Schedule,,94,,,94,Other,186% of Medicaid,229.95,,,229.95,Fee Schedule,,243.66,,,243.66,Fee Schedule,,130.16,,,,Fee Schedule,,229.95,,,229.95,Fee Schedule,,243.66,,,243.66,Fee Schedule,,244.82,,,244.82,Fee Schedule,,275.1,70,,275.1,percent of total billed charges,,293.73,,,293.73,Fee Schedule,,248.95,,,248.95,Fee Schedule,,92.97,,,92.97,Fee Schedule,,92.97,,,92.97,Fee Schedule,,92.97,,,92.97,Fee Schedule,,92.97,,,92.97,Fee Schedule,,50.5,,,50.5,Other,100% of Medicaid,50.5,,,50.5,Other,100% of Medicaid,50.5,,,50.5,Other,100% of Medicaid,50.5,,,50.5,Other,100% of Medicaid,113.63,,,113.63,Other,225% of Medicaid,77.27,,,77.27,Other,153% of Medicaid,113.63,,,113.63,Other,225% of Medicaid,70.7,,,70.7,Other,140% of Medicaid,113.63,,,113.63,Other,225% of Medicaid,131.3,,,131.3,Other,250% of Medicaid,163.62,,,163.62,Other,324% of Medicaid,108.58,,,108.58,Other,215% of Medicaid,108.58,,,108.58,Other,215% of Medicaid,63.13,,,63.13,Other,125% of Medicaid,0.01,477.97,
SKIN TEST; TB ID,86580,CPT,,40086580,CDM,302,RC,,,both,,,58,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,33.95,,,33.95,Fee Schedule,,30.57,,,30.57,Fee Schedule,,52.44,,,52.44,Fee Schedule,,47.18,,,47.18,Fee Schedule,,44.6,,,44.6,Fee Schedule,,40.6,70,,40.6,percent of total billed charges,All Other,35.53,,,35.53,Fee Schedule,,32,,,32,Other,186% of Medicaid,41.85,,,41.85,Fee Schedule,,35.96,,,35.96,Fee Schedule,,23.69,,,,Fee Schedule,,41.85,,,41.85,Fee Schedule,,35.96,,,35.96,Fee Schedule,,44.56,,,44.56,Fee Schedule,,40.6,70,,40.6,percent of total billed charges,,50.84,,,50.84,Fee Schedule,,43.09,,,43.09,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,17.33,56.14,
SYPHILIS TEST NON-TREP QUAL,86592,CPT,,78086592,CDM,302,RC,,,both,,,68,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.85,,,12.85,Fee Schedule,,11.57,,,11.57,Fee Schedule,,32.93,,,32.93,Fee Schedule,,29.63,,,29.63,Fee Schedule,,28.01,,,28.01,Fee Schedule,,47.6,70,,47.6,percent of total billed charges,All Other,13.45,,,13.45,Fee Schedule,,6,,,6,Other,186% of Medicaid,15.84,,,15.84,Fee Schedule,,42.16,,,42.16,Fee Schedule,,8.97,,,,Fee Schedule,,15.84,,,15.84,Fee Schedule,,42.16,,,42.16,Fee Schedule,,16.87,,,16.87,Fee Schedule,,47.6,70,,47.6,percent of total billed charges,,20.24,,,20.24,Fee Schedule,,17.15,,,17.15,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,3.3,,,3.3,Other,100% of Medicaid,3.3,,,3.3,Other,100% of Medicaid,3.3,,,3.3,Other,100% of Medicaid,3.3,,,3.3,Other,100% of Medicaid,7.43,,,7.43,Other,225% of Medicaid,5.05,,,5.05,Other,153% of Medicaid,7.43,,,7.43,Other,225% of Medicaid,4.62,,,4.62,Other,140% of Medicaid,7.43,,,7.43,Other,225% of Medicaid,8.59,,,8.59,Other,250% of Medicaid,10.7,,,10.7,Other,324% of Medicaid,7.1,,,7.1,Other,215% of Medicaid,7.1,,,7.1,Other,215% of Medicaid,4.13,,,4.13,Other,125% of Medicaid,0.01,47.6,
SYPHILIS TEST NON-TREP QUANT,86593,CPT,,78086593,CDM,302,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,13.24,,,13.24,Fee Schedule,,11.92,,,11.92,Fee Schedule,,33.92,,,33.92,Fee Schedule,,30.52,,,30.52,Fee Schedule,,28.85,,,28.85,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,13.86,,,13.86,Fee Schedule,,7,,,7,Other,186% of Medicaid,16.32,,,16.32,Fee Schedule,,57.66,,,57.66,Fee Schedule,,9.24,,,,Fee Schedule,,16.32,,,16.32,Fee Schedule,,57.66,,,57.66,Fee Schedule,,17.38,,,17.38,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,,20.85,,,20.85,Fee Schedule,,17.67,,,17.67,Fee Schedule,,6.6,,,6.6,Fee Schedule,,6.6,,,6.6,Fee Schedule,,6.6,,,6.6,Fee Schedule,,6.6,,,6.6,Fee Schedule,,3.74,,,3.74,Other,100% of Medicaid,3.74,,,3.74,Other,100% of Medicaid,3.74,,,3.74,Other,100% of Medicaid,3.74,,,3.74,Other,100% of Medicaid,8.41,,,8.41,Other,225% of Medicaid,5.72,,,5.72,Other,153% of Medicaid,8.41,,,8.41,Other,225% of Medicaid,5.23,,,5.23,Other,140% of Medicaid,8.41,,,8.41,Other,225% of Medicaid,9.72,,,9.72,Other,250% of Medicaid,12.11,,,12.11,Other,324% of Medicaid,8.03,,,8.03,Other,215% of Medicaid,8.03,,,8.03,Other,215% of Medicaid,4.67,,,4.67,Other,125% of Medicaid,0.01,65.1,
VOLTAGE-GTD CA CHNL ANTB EA,86596,CPT,,78086596,CDM,302,RC,,,both,,,59,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.27,,,36.27,Fee Schedule,,32.66,,,32.66,Fee Schedule,,18.4,,,18.4,Fee Schedule,,18.4,,,18.4,Fee Schedule,,18.4,,,18.4,Fee Schedule,,41.3,70,,41.3,percent of total billed charges,All Other,37.96,,,37.96,Fee Schedule,,21,,,21,Other,186% of Medicaid,44.71,,,44.71,Fee Schedule,,36.58,,,36.58,Fee Schedule,,25.31,,,,Fee Schedule,,44.71,,,44.71,Fee Schedule,,36.58,,,36.58,Fee Schedule,,47.6,,,47.6,Fee Schedule,,41.3,70,,41.3,percent of total billed charges,,87.2,,,87.2,Fee Schedule,,73.91,,,73.91,Fee Schedule,,27.6,,,27.6,Fee Schedule,,27.6,,,27.6,Fee Schedule,,27.6,,,27.6,Fee Schedule,,27.6,,,27.6,Fee Schedule,,11.15,,,11.15,Other,100% of Medicaid,11.15,,,11.15,Other,100% of Medicaid,11.15,,,11.15,Other,100% of Medicaid,11.15,,,11.15,Other,100% of Medicaid,25.09,,,25.09,Other,225% of Medicaid,17.06,,,17.06,Other,153% of Medicaid,25.09,,,25.09,Other,225% of Medicaid,15.61,,,15.61,Other,140% of Medicaid,25.09,,,25.09,Other,225% of Medicaid,28.99,,,28.99,Other,250% of Medicaid,36.13,,,36.13,Other,324% of Medicaid,23.97,,,23.97,Other,215% of Medicaid,23.97,,,23.97,Other,215% of Medicaid,13.94,,,13.94,Other,125% of Medicaid,0.01,87.2,
ANTIOMYCES ANTIBODY,86602,CPT,,78086602,CDM,302,RC,,,both,,,34,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,30.64,,,30.64,Fee Schedule,,27.59,,,27.59,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,23.8,70,,23.8,percent of total billed charges,All Other,32.07,,,32.07,Fee Schedule,,15,,,15,Other,186% of Medicaid,37.77,,,37.77,Fee Schedule,,21.08,,,21.08,Fee Schedule,,21.38,,,,Fee Schedule,,37.77,,,37.77,Fee Schedule,,21.08,,,21.08,Fee Schedule,,40.21,,,40.21,Fee Schedule,,23.8,70,,23.8,percent of total billed charges,,48.24,,,48.24,Fee Schedule,,40.89,,,40.89,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,48.24,
ASPERGILLUS ANTIBODY,86606,CPT,,78086606,CDM,302,RC,,,both,,,201,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,45.3,,,45.3,Fee Schedule,,40.79,,,40.79,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,140.7,70,,140.7,percent of total billed charges,All Other,47.41,,,47.41,Fee Schedule,,15,,,15,Other,186% of Medicaid,55.84,,,55.84,Fee Schedule,,124.62,,,124.62,Fee Schedule,,31.61,,,,Fee Schedule,,55.84,,,55.84,Fee Schedule,,124.62,,,124.62,Fee Schedule,,59.45,,,59.45,Fee Schedule,,140.7,70,,140.7,percent of total billed charges,,71.32,,,71.32,Fee Schedule,,60.45,,,60.45,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,22.58,,,22.58,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,140.7,
BACTERIUM ANTIBODY,86609,CPT,,78086609,CDM,302,RC,,,both,,,77,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.77,,,38.77,Fee Schedule,,34.9,,,34.9,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,53.9,70,,53.9,percent of total billed charges,All Other,40.57,,,40.57,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,47.78,,,47.78,Fee Schedule,,47.74,,,47.74,Fee Schedule,,27.05,,,,Fee Schedule,,47.78,,,47.78,Fee Schedule,,47.74,,,47.74,Fee Schedule,,50.88,,,50.88,Fee Schedule,,53.9,70,,53.9,percent of total billed charges,,61.04,,,61.04,Fee Schedule,,51.73,,,51.73,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,61.04,
BARTONELLA ANTIBODY,86611,CPT,,78086611,CDM,302,RC,,,both,,,37,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,30.64,,,30.64,Fee Schedule,,27.59,,,27.59,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,All Other,32.07,,,32.07,Fee Schedule,,15,,,15,Other,186% of Medicaid,37.77,,,37.77,Fee Schedule,,22.94,,,22.94,Fee Schedule,,21.38,,,,Fee Schedule,,37.77,,,37.77,Fee Schedule,,22.94,,,22.94,Fee Schedule,,40.21,,,40.21,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,,48.24,,,48.24,Fee Schedule,,40.89,,,40.89,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,48.24,
BLASTOMYCES ANTIBODY,86612,CPT,,78086612,CDM,302,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.83,,,38.83,Fee Schedule,,34.96,,,34.96,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,40.64,,,40.64,Fee Schedule,,15,,,15,Other,186% of Medicaid,47.86,,,47.86,Fee Schedule,,25.42,,,25.42,Fee Schedule,,27.09,,,,Fee Schedule,,47.86,,,47.86,Fee Schedule,,25.42,,,25.42,Fee Schedule,,50.96,,,50.96,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,61.13,,,61.13,Fee Schedule,,51.81,,,51.81,Fee Schedule,,19.35,,,19.35,Fee Schedule,,19.35,,,19.35,Fee Schedule,,19.35,,,19.35,Fee Schedule,,19.35,,,19.35,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,61.13,
BORDETELLA ANTIBODY,86615,CPT,,78086615,CDM,302,RC,,,both,,,225,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.7,,,39.7,Fee Schedule,,35.74,,,35.74,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,157.5,70,,157.5,percent of total billed charges,All Other,41.55,,,41.55,Fee Schedule,,15,,,15,Other,186% of Medicaid,48.93,,,48.93,Fee Schedule,,139.5,,,139.5,Fee Schedule,,27.7,,,,Fee Schedule,,48.93,,,48.93,Fee Schedule,,139.5,,,139.5,Fee Schedule,,52.1,,,52.1,Fee Schedule,,157.5,70,,157.5,percent of total billed charges,,62.51,,,62.51,Fee Schedule,,52.98,,,52.98,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,157.5,
LYME DISEASE ANTIBODY,86618,CPT,,78086618,CDM,302,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,51.26,,,51.26,Fee Schedule,,46.15,,,46.15,Fee Schedule,,131.36,,,131.36,Fee Schedule,,118.17,,,118.17,Fee Schedule,,111.7,,,111.7,Fee Schedule,,73.5,70,,73.5,percent of total billed charges,All Other,53.64,,,53.64,Fee Schedule,,32,,,32,Other,186% of Medicaid,63.18,,,63.18,Fee Schedule,,65.1,,,65.1,Fee Schedule,,35.76,,,,Fee Schedule,,63.18,,,63.18,Fee Schedule,,65.1,,,65.1,Fee Schedule,,67.27,,,67.27,Fee Schedule,,73.5,70,,73.5,percent of total billed charges,,80.71,,,80.71,Fee Schedule,,68.4,,,68.4,Fee Schedule,,25.55,,,25.55,Fee Schedule,,25.55,,,25.55,Fee Schedule,,25.55,,,25.55,Fee Schedule,,25.55,,,25.55,Fee Schedule,,17.03,,,17.03,Other,100% of Medicaid,17.03,,,17.03,Other,100% of Medicaid,17.03,,,17.03,Other,100% of Medicaid,17.03,,,17.03,Other,100% of Medicaid,38.32,,,38.32,Other,225% of Medicaid,26.06,,,26.06,Other,153% of Medicaid,38.32,,,38.32,Other,225% of Medicaid,23.84,,,23.84,Other,140% of Medicaid,38.32,,,38.32,Other,225% of Medicaid,44.28,,,44.28,Other,250% of Medicaid,55.18,,,55.18,Other,324% of Medicaid,36.61,,,36.61,Other,215% of Medicaid,36.61,,,36.61,Other,215% of Medicaid,21.29,,,21.29,Other,125% of Medicaid,0.01,131.36,
CAMPYLOBACTER ANTIBODY,86625,CPT,,78086625,CDM,302,RC,,,both,,,215,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,39.49,,,39.49,Fee Schedule,,35.56,,,35.56,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,150.5,70,,150.5,percent of total billed charges,All Other,41.33,,,41.33,Fee Schedule,,15,,,15,Other,186% of Medicaid,48.68,,,48.68,Fee Schedule,,133.3,,,133.3,Fee Schedule,,27.55,,,,Fee Schedule,,48.68,,,48.68,Fee Schedule,,133.3,,,133.3,Fee Schedule,,51.82,,,51.82,Fee Schedule,,150.5,70,,150.5,percent of total billed charges,,62.18,,,62.18,Fee Schedule,,52.7,,,52.7,Fee Schedule,,19.68,,,19.68,Fee Schedule,,19.68,,,19.68,Fee Schedule,,19.68,,,19.68,Fee Schedule,,19.68,,,19.68,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,150.5,
CANDIDA ANTIBODY,86628,CPT,,78086628,CDM,302,RC,,,both,,,69,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.15,,,36.15,Fee Schedule,,32.55,,,32.55,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,All Other,37.83,,,37.83,Fee Schedule,,32,,,32,Other,186% of Medicaid,44.56,,,44.56,Fee Schedule,,42.78,,,42.78,Fee Schedule,,25.22,,,,Fee Schedule,,44.56,,,44.56,Fee Schedule,,42.78,,,42.78,Fee Schedule,,47.44,,,47.44,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,,56.92,,,56.92,Fee Schedule,,48.24,,,48.24,Fee Schedule,,18.02,,,18.02,Fee Schedule,,18.02,,,18.02,Fee Schedule,,18.02,,,18.02,Fee Schedule,,18.02,,,18.02,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,56.92,
CHLAMYDIA ANTIBODY,86631,CPT,,78086631,CDM,302,RC,,,both,,,257,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,35.58,,,35.58,Fee Schedule,,32.03,,,32.03,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,179.9,70,,179.9,percent of total billed charges,All Other,37.23,,,37.23,Fee Schedule,,15,,,15,Other,186% of Medicaid,43.85,,,43.85,Fee Schedule,,159.34,,,159.34,Fee Schedule,,24.82,,,,Fee Schedule,,43.85,,,43.85,Fee Schedule,,159.34,,,159.34,Fee Schedule,,46.69,,,46.69,Fee Schedule,,179.9,70,,179.9,percent of total billed charges,,56.02,,,56.02,Fee Schedule,,47.48,,,47.48,Fee Schedule,,17.73,,,17.73,Fee Schedule,,17.73,,,17.73,Fee Schedule,,17.73,,,17.73,Fee Schedule,,17.73,,,17.73,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,179.9,
CHLAMYDIA IGM ANTIBODY,86632,CPT,,78086632,CDM,302,RC,,,both,,,257,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.17,,,38.17,Fee Schedule,,34.36,,,34.36,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,179.9,70,,179.9,percent of total billed charges,All Other,39.94,,,39.94,Fee Schedule,,15,,,15,Other,186% of Medicaid,47.04,,,47.04,Fee Schedule,,159.34,,,159.34,Fee Schedule,,26.63,,,,Fee Schedule,,47.04,,,47.04,Fee Schedule,,159.34,,,159.34,Fee Schedule,,50.09,,,50.09,Fee Schedule,,179.9,70,,179.9,percent of total billed charges,,60.09,,,60.09,Fee Schedule,,50.93,,,50.93,Fee Schedule,,19.02,,,19.02,Fee Schedule,,19.02,,,19.02,Fee Schedule,,19.02,,,19.02,Fee Schedule,,19.02,,,19.02,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,179.9,
COCCIDIOIDES ANTIBODY,86635,CPT,,78086635,CDM,302,RC,,,both,,,212,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.52,,,34.52,Fee Schedule,,31.08,,,31.08,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,148.4,70,,148.4,percent of total billed charges,All Other,36.13,,,36.13,Fee Schedule,,15,,,15,Other,186% of Medicaid,42.55,,,42.55,Fee Schedule,,131.44,,,131.44,Fee Schedule,,24.09,,,,Fee Schedule,,42.55,,,42.55,Fee Schedule,,131.44,,,131.44,Fee Schedule,,45.31,,,45.31,Fee Schedule,,148.4,70,,148.4,percent of total billed charges,,54.36,,,54.36,Fee Schedule,,46.07,,,46.07,Fee Schedule,,17.21,,,17.21,Fee Schedule,,17.21,,,17.21,Fee Schedule,,17.21,,,17.21,Fee Schedule,,17.21,,,17.21,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,148.4,
Q FEVER ANTIBODY,86638,CPT,,78086638,CDM,302,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.48,,,36.48,Fee Schedule,,32.85,,,32.85,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,38.18,,,38.18,Fee Schedule,,15,,,15,Other,186% of Medicaid,44.97,,,44.97,Fee Schedule,,57.66,,,57.66,Fee Schedule,,25.45,,,,Fee Schedule,,44.97,,,44.97,Fee Schedule,,57.66,,,57.66,Fee Schedule,,47.87,,,47.87,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,,57.44,,,57.44,Fee Schedule,,48.68,,,48.68,Fee Schedule,,18.18,,,18.18,Fee Schedule,,18.18,,,18.18,Fee Schedule,,18.18,,,18.18,Fee Schedule,,18.18,,,18.18,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,65.1,
CRYPTOCOCCUS ANTIBODY,86641,CPT,,78086641,CDM,302,RC,,,both,,,116,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,43.37,,,43.37,Fee Schedule,,39.05,,,39.05,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,81.2,70,,81.2,percent of total billed charges,All Other,45.39,,,45.39,Fee Schedule,,15,,,15,Other,186% of Medicaid,53.46,,,53.46,Fee Schedule,,71.92,,,71.92,Fee Schedule,,30.26,,,,Fee Schedule,,53.46,,,53.46,Fee Schedule,,71.92,,,71.92,Fee Schedule,,56.92,,,56.92,Fee Schedule,,81.2,70,,81.2,percent of total billed charges,,68.29,,,68.29,Fee Schedule,,57.88,,,57.88,Fee Schedule,,21.62,,,21.62,Fee Schedule,,21.62,,,21.62,Fee Schedule,,21.62,,,21.62,Fee Schedule,,21.62,,,21.62,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,81.2,
CMV ANTIBODY,86644,CPT,,78086644,CDM,302,RC,,,both,,,206,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.31,,,43.31,Fee Schedule,,39,,,39,Fee Schedule,,110.97,,,110.97,Fee Schedule,,99.83,,,99.83,Fee Schedule,,94.37,,,94.37,Fee Schedule,,144.2,70,,144.2,percent of total billed charges,All Other,45.33,,,45.33,Fee Schedule,,27,,,27,Other,186% of Medicaid,53.39,,,53.39,Fee Schedule,,127.72,,,127.72,Fee Schedule,,30.22,,,,Fee Schedule,,53.39,,,53.39,Fee Schedule,,127.72,,,127.72,Fee Schedule,,56.84,,,56.84,Fee Schedule,,144.2,70,,144.2,percent of total billed charges,,68.19,,,68.19,Fee Schedule,,57.8,,,57.8,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,22.02,,,22.02,Other,153% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,20.15,,,20.15,Other,140% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,37.41,,,37.41,Other,250% of Medicaid,46.62,,,46.62,Other,324% of Medicaid,30.94,,,30.94,Other,215% of Medicaid,30.94,,,30.94,Other,215% of Medicaid,17.99,,,17.99,Other,125% of Medicaid,0.01,144.2,
CMV ANTIBODY IGM,86645,CPT,,78086645,CDM,302,RC,,,both,,,197,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.72,,,50.72,Fee Schedule,,45.66,,,45.66,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,137.9,70,,137.9,percent of total billed charges,All Other,53.08,,,53.08,Fee Schedule,,15,,,15,Other,186% of Medicaid,62.51,,,62.51,Fee Schedule,,122.14,,,122.14,Fee Schedule,,35.39,,,,Fee Schedule,,62.51,,,62.51,Fee Schedule,,122.14,,,122.14,Fee Schedule,,66.56,,,66.56,Fee Schedule,,137.9,70,,137.9,percent of total billed charges,,79.85,,,79.85,Fee Schedule,,67.68,,,67.68,Fee Schedule,,25.28,,,25.28,Fee Schedule,,25.28,,,25.28,Fee Schedule,,25.28,,,25.28,Fee Schedule,,25.28,,,25.28,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,137.9,
ENCEPHALITIS ANTIBODY,86651,CPT,,78086651,CDM,302,RC,,,both,,,83,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.7,,,39.7,Fee Schedule,,35.74,,,35.74,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,All Other,41.55,,,41.55,Fee Schedule,,15,,,15,Other,186% of Medicaid,48.93,,,48.93,Fee Schedule,,51.46,,,51.46,Fee Schedule,,27.7,,,,Fee Schedule,,48.93,,,48.93,Fee Schedule,,51.46,,,51.46,Fee Schedule,,52.1,,,52.1,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,,62.51,,,62.51,Fee Schedule,,52.98,,,52.98,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,62.51,
ENCEPHALITIS ANTIBODY,86653,CPT,,78086653,CDM,302,RC,,,both,,,83,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.7,,,39.7,Fee Schedule,,35.74,,,35.74,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,All Other,41.55,,,41.55,Fee Schedule,,15,,,15,Other,186% of Medicaid,48.93,,,48.93,Fee Schedule,,51.46,,,51.46,Fee Schedule,,27.7,,,,Fee Schedule,,48.93,,,48.93,Fee Schedule,,51.46,,,51.46,Fee Schedule,,52.1,,,52.1,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,,62.51,,,62.51,Fee Schedule,,52.98,,,52.98,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,62.51,
AB; ENCEPHALITIS W EQUINE,86654,CPT,,78086654,CDM,302,RC,,,both,,,37,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.7,,,39.7,Fee Schedule,,35.74,,,35.74,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,All Other,41.55,,,41.55,Fee Schedule,,15,,,15,Other,186% of Medicaid,48.93,,,48.93,Fee Schedule,,22.94,,,22.94,Fee Schedule,,27.7,,,,Fee Schedule,,48.93,,,48.93,Fee Schedule,,22.94,,,22.94,Fee Schedule,,52.1,,,52.1,Fee Schedule,,25.9,70,,25.9,percent of total billed charges,,62.51,,,62.51,Fee Schedule,,52.98,,,52.98,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,62.51,
ENTEROVIRUS ANTIBODY,86658,CPT,,78086658,CDM,302,RC,,,both,,,83,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.22,,,39.22,Fee Schedule,,35.31,,,35.31,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,All Other,41.04,,,41.04,Fee Schedule,,15,,,15,Other,186% of Medicaid,48.34,,,48.34,Fee Schedule,,51.46,,,51.46,Fee Schedule,,27.36,,,,Fee Schedule,,48.34,,,48.34,Fee Schedule,,51.46,,,51.46,Fee Schedule,,51.47,,,51.47,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,,61.75,,,61.75,Fee Schedule,,52.34,,,52.34,Fee Schedule,,19.55,,,19.55,Fee Schedule,,19.55,,,19.55,Fee Schedule,,19.55,,,19.55,Fee Schedule,,19.55,,,19.55,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,61.75,
EPSTEIN-BARR ANTIBODY,86663,CPT,,78086663,CDM,302,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.49,,,39.49,Fee Schedule,,35.56,,,35.56,Fee Schedule,,101.16,,,101.16,Fee Schedule,,91.01,,,91.01,Fee Schedule,,86.02,,,86.02,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,41.33,,,41.33,Fee Schedule,,24,,,24,Other,186% of Medicaid,48.68,,,48.68,Fee Schedule,,53.32,,,53.32,Fee Schedule,,27.55,,,,Fee Schedule,,48.68,,,48.68,Fee Schedule,,53.32,,,53.32,Fee Schedule,,51.82,,,51.82,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,,62.18,,,62.18,Fee Schedule,,52.7,,,52.7,Fee Schedule,,19.68,,,19.68,Fee Schedule,,19.68,,,19.68,Fee Schedule,,19.68,,,19.68,Fee Schedule,,19.68,,,19.68,Fee Schedule,,13.12,,,13.12,Other,100% of Medicaid,13.12,,,13.12,Other,100% of Medicaid,13.12,,,13.12,Other,100% of Medicaid,13.12,,,13.12,Other,100% of Medicaid,29.52,,,29.52,Other,225% of Medicaid,20.07,,,20.07,Other,153% of Medicaid,29.52,,,29.52,Other,225% of Medicaid,18.37,,,18.37,Other,140% of Medicaid,29.52,,,29.52,Other,225% of Medicaid,34.11,,,34.11,Other,250% of Medicaid,42.51,,,42.51,Other,324% of Medicaid,28.21,,,28.21,Other,215% of Medicaid,28.21,,,28.21,Other,215% of Medicaid,16.4,,,16.4,Other,125% of Medicaid,0.01,101.16,
EPSTEIN-BARR ANTIBODY,86664,CPT,,78086664,CDM,302,RC,,,both,,,99,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.02,,,46.02,Fee Schedule,,41.44,,,41.44,Fee Schedule,,117.98,,,117.98,Fee Schedule,,106.14,,,106.14,Fee Schedule,,100.33,,,100.33,Fee Schedule,,69.3,70,,69.3,percent of total billed charges,All Other,48.16,,,48.16,Fee Schedule,,28,,,28,Other,186% of Medicaid,56.73,,,56.73,Fee Schedule,,61.38,,,61.38,Fee Schedule,,32.11,,,,Fee Schedule,,56.73,,,56.73,Fee Schedule,,61.38,,,61.38,Fee Schedule,,60.4,,,60.4,Fee Schedule,,69.3,70,,69.3,percent of total billed charges,,72.46,,,72.46,Fee Schedule,,61.41,,,61.41,Fee Schedule,,22.94,,,22.94,Fee Schedule,,22.94,,,22.94,Fee Schedule,,22.94,,,22.94,Fee Schedule,,22.94,,,22.94,Fee Schedule,,15.29,,,15.29,Other,100% of Medicaid,15.29,,,15.29,Other,100% of Medicaid,15.29,,,15.29,Other,100% of Medicaid,15.29,,,15.29,Other,100% of Medicaid,34.4,,,34.4,Other,225% of Medicaid,23.39,,,23.39,Other,153% of Medicaid,34.4,,,34.4,Other,225% of Medicaid,21.41,,,21.41,Other,140% of Medicaid,34.4,,,34.4,Other,225% of Medicaid,39.75,,,39.75,Other,250% of Medicaid,49.54,,,49.54,Other,324% of Medicaid,32.87,,,32.87,Other,215% of Medicaid,32.87,,,32.87,Other,215% of Medicaid,19.11,,,19.11,Other,125% of Medicaid,0.01,117.98,
EPSTEIN-BARR ANTIBODY,86665,CPT,,78086665,CDM,302,RC,,,both,,,117,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,54.6,,,54.6,Fee Schedule,,49.16,,,49.16,Fee Schedule,,139.9,,,139.9,Fee Schedule,,125.86,,,125.86,Fee Schedule,,118.97,,,118.97,Fee Schedule,,81.9,70,,81.9,percent of total billed charges,All Other,57.14,,,57.14,Fee Schedule,,34,,,34,Other,186% of Medicaid,67.3,,,67.3,Fee Schedule,,72.54,,,72.54,Fee Schedule,,38.09,,,,Fee Schedule,,67.3,,,67.3,Fee Schedule,,72.54,,,72.54,Fee Schedule,,71.65,,,71.65,Fee Schedule,,81.9,70,,81.9,percent of total billed charges,,85.97,,,85.97,Fee Schedule,,72.86,,,72.86,Fee Schedule,,27.21,,,27.21,Fee Schedule,,27.21,,,27.21,Fee Schedule,,27.21,,,27.21,Fee Schedule,,27.21,,,27.21,Fee Schedule,,18.14,,,18.14,Other,100% of Medicaid,18.14,,,18.14,Other,100% of Medicaid,18.14,,,18.14,Other,100% of Medicaid,18.14,,,18.14,Other,100% of Medicaid,40.82,,,40.82,Other,225% of Medicaid,27.75,,,27.75,Other,153% of Medicaid,40.82,,,40.82,Other,225% of Medicaid,25.4,,,25.4,Other,140% of Medicaid,40.82,,,40.82,Other,225% of Medicaid,47.16,,,47.16,Other,250% of Medicaid,58.77,,,58.77,Other,324% of Medicaid,39,,,39,Other,215% of Medicaid,39,,,39,Other,215% of Medicaid,22.68,,,22.68,Other,125% of Medicaid,0.01,139.9,
FRANCISELLA TULARENSIS,86668,CPT,,78086668,CDM,302,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,42.62,,,42.62,Fee Schedule,,38.37,,,38.37,Fee Schedule,,80.23,,,80.23,Fee Schedule,,72.18,,,72.18,Fee Schedule,,68.22,,,68.22,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,All Other,44.6,,,44.6,Fee Schedule,,22,,,22,Other,186% of Medicaid,52.53,,,52.53,Fee Schedule,,67.58,,,67.58,Fee Schedule,,29.74,,,,Fee Schedule,,52.53,,,52.53,Fee Schedule,,67.58,,,67.58,Fee Schedule,,55.93,,,55.93,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,,67.1,,,67.1,Fee Schedule,,56.88,,,56.88,Fee Schedule,,21.24,,,21.24,Fee Schedule,,21.24,,,21.24,Fee Schedule,,21.24,,,21.24,Fee Schedule,,21.24,,,21.24,Fee Schedule,,11.62,,,11.62,Other,100% of Medicaid,11.62,,,11.62,Other,100% of Medicaid,11.62,,,11.62,Other,100% of Medicaid,11.62,,,11.62,Other,100% of Medicaid,26.13,,,26.13,Other,225% of Medicaid,17.77,,,17.77,Other,153% of Medicaid,26.13,,,26.13,Other,225% of Medicaid,16.26,,,16.26,Other,140% of Medicaid,26.13,,,26.13,Other,225% of Medicaid,30.2,,,30.2,Other,250% of Medicaid,37.63,,,37.63,Other,324% of Medicaid,24.97,,,24.97,Other,215% of Medicaid,24.97,,,24.97,Other,215% of Medicaid,14.52,,,14.52,Other,125% of Medicaid,0.01,80.23,
FUNGUS ANTIBODY,86671,CPT,,78086671,CDM,302,RC,,,both,,,132,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.87,,,36.87,Fee Schedule,,33.2,,,33.2,Fee Schedule,,39.18,,,39.18,Fee Schedule,,35.25,,,35.25,Fee Schedule,,33.32,,,33.32,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,All Other,38.59,,,38.59,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,45.45,,,45.45,Fee Schedule,,81.84,,,81.84,Fee Schedule,,25.73,,,,Fee Schedule,,45.45,,,45.45,Fee Schedule,,81.84,,,81.84,Fee Schedule,,48.39,,,48.39,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,,58.05,,,58.05,Fee Schedule,,49.2,,,49.2,Fee Schedule,,18.38,,,18.38,Fee Schedule,,18.38,,,18.38,Fee Schedule,,18.38,,,18.38,Fee Schedule,,18.38,,,18.38,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,92.4,
GIARDIA LAMBLIA ANTIBODY,86674,CPT,,78086674,CDM,302,RC,,,both,,,271,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.31,,,44.31,Fee Schedule,,39.89,,,39.89,Fee Schedule,,113.55,,,113.55,Fee Schedule,,102.15,,,102.15,Fee Schedule,,96.56,,,96.56,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,All Other,46.37,,,46.37,Fee Schedule,,27,,,27,Other,186% of Medicaid,54.61,,,54.61,Fee Schedule,,168.02,,,168.02,Fee Schedule,,30.91,,,,Fee Schedule,,54.61,,,54.61,Fee Schedule,,168.02,,,168.02,Fee Schedule,,58.14,,,58.14,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,,69.76,,,69.76,Fee Schedule,,59.12,,,59.12,Fee Schedule,,22.08,,,22.08,Fee Schedule,,22.08,,,22.08,Fee Schedule,,22.08,,,22.08,Fee Schedule,,22.08,,,22.08,Fee Schedule,,14.72,,,14.72,Other,100% of Medicaid,14.72,,,14.72,Other,100% of Medicaid,14.72,,,14.72,Other,100% of Medicaid,14.72,,,14.72,Other,100% of Medicaid,33.12,,,33.12,Other,225% of Medicaid,22.52,,,22.52,Other,153% of Medicaid,33.12,,,33.12,Other,225% of Medicaid,20.61,,,20.61,Other,140% of Medicaid,33.12,,,33.12,Other,225% of Medicaid,38.27,,,38.27,Other,250% of Medicaid,47.69,,,47.69,Other,324% of Medicaid,31.65,,,31.65,Other,215% of Medicaid,31.65,,,31.65,Other,215% of Medicaid,18.4,,,18.4,Other,125% of Medicaid,0.01,189.7,
HELMINTH ANTIBODY,86682,CPT,,78086682,CDM,302,RC,,,both,,,312,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.16,,,39.16,Fee Schedule,,35.26,,,35.26,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,218.4,70,,218.4,percent of total billed charges,All Other,40.98,,,40.98,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,48.27,,,48.27,Fee Schedule,,193.44,,,193.44,Fee Schedule,,27.32,,,,Fee Schedule,,48.27,,,48.27,Fee Schedule,,193.44,,,193.44,Fee Schedule,,51.39,,,51.39,Fee Schedule,,218.4,70,,218.4,percent of total billed charges,,61.65,,,61.65,Fee Schedule,,52.26,,,52.26,Fee Schedule,,19.52,,,19.52,Fee Schedule,,19.52,,,19.52,Fee Schedule,,19.52,,,19.52,Fee Schedule,,19.52,,,19.52,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,218.4,
HEMOPHILUS INFLUENZA ANTIBDY,86684,CPT,,78086684,CDM,302,RC,,,both,,,51,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,47.68,,,47.68,Fee Schedule,,42.93,,,42.93,Fee Schedule,,122.2,,,122.2,Fee Schedule,,109.94,,,109.94,Fee Schedule,,103.92,,,103.92,Fee Schedule,,35.7,70,,35.7,percent of total billed charges,All Other,49.9,,,49.9,Fee Schedule,,29,,,29,Other,186% of Medicaid,58.77,,,58.77,Fee Schedule,,31.62,,,31.62,Fee Schedule,,33.26,,,,Fee Schedule,,58.77,,,58.77,Fee Schedule,,31.62,,,31.62,Fee Schedule,,62.57,,,62.57,Fee Schedule,,35.7,70,,35.7,percent of total billed charges,,75.07,,,75.07,Fee Schedule,,63.62,,,63.62,Fee Schedule,,23.76,,,23.76,Fee Schedule,,23.76,,,23.76,Fee Schedule,,23.76,,,23.76,Fee Schedule,,23.76,,,23.76,Fee Schedule,,15.84,,,15.84,Other,100% of Medicaid,15.84,,,15.84,Other,100% of Medicaid,15.84,,,15.84,Other,100% of Medicaid,15.84,,,15.84,Other,100% of Medicaid,35.64,,,35.64,Other,225% of Medicaid,24.24,,,24.24,Other,153% of Medicaid,35.64,,,35.64,Other,225% of Medicaid,22.18,,,22.18,Other,140% of Medicaid,35.64,,,35.64,Other,225% of Medicaid,41.18,,,41.18,Other,250% of Medicaid,51.32,,,51.32,Other,324% of Medicaid,34.06,,,34.06,Other,215% of Medicaid,34.06,,,34.06,Other,215% of Medicaid,19.8,,,19.8,Other,125% of Medicaid,0.01,122.2,
HTLV-I ANTIBODY,86687,CPT,,78086687,CDM,302,RC,,,both,,,126,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.36,,,27.36,Fee Schedule,,24.63,,,24.63,Fee Schedule,,64.72,,,64.72,Fee Schedule,,58.22,,,58.22,Fee Schedule,,55.03,,,55.03,Fee Schedule,,88.2,70,,88.2,percent of total billed charges,All Other,28.63,,,28.63,Fee Schedule,,17,,,17,Other,186% of Medicaid,33.72,,,33.72,Fee Schedule,,78.12,,,78.12,Fee Schedule,,19.09,,,,Fee Schedule,,33.72,,,33.72,Fee Schedule,,78.12,,,78.12,Fee Schedule,,35.91,,,35.91,Fee Schedule,,88.2,70,,88.2,percent of total billed charges,,43.08,,,43.08,Fee Schedule,,36.51,,,36.51,Fee Schedule,,13.64,,,13.64,Fee Schedule,,13.64,,,13.64,Fee Schedule,,13.64,,,13.64,Fee Schedule,,13.64,,,13.64,Fee Schedule,,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,9.09,,,9.09,Other,100% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,13.91,,,13.91,Other,153% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,12.73,,,12.73,Other,140% of Medicaid,20.45,,,20.45,Other,225% of Medicaid,23.63,,,23.63,Other,250% of Medicaid,29.45,,,29.45,Other,324% of Medicaid,19.54,,,19.54,Other,215% of Medicaid,19.54,,,19.54,Other,215% of Medicaid,11.36,,,11.36,Other,125% of Medicaid,0.01,88.2,
HTLV OR HIV ANTIBODY WB,86689,CPT,,78086689,CDM,302,RC,,,both,,,116,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,58.24,,,58.24,Fee Schedule,,52.44,,,52.44,Fee Schedule,,149.22,,,149.22,Fee Schedule,,134.24,,,134.24,Fee Schedule,,126.89,,,126.89,Fee Schedule,,81.2,70,,81.2,percent of total billed charges,All Other,60.95,,,60.95,Fee Schedule,,36,,,36,Other,186% of Medicaid,71.79,,,71.79,Fee Schedule,,71.92,,,71.92,Fee Schedule,,40.64,,,,Fee Schedule,,71.79,,,71.79,Fee Schedule,,71.92,,,71.92,Fee Schedule,,76.43,,,76.43,Fee Schedule,,81.2,70,,81.2,percent of total billed charges,,91.7,,,91.7,Fee Schedule,,77.72,,,77.72,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,19.35,,,19.35,Other,100% of Medicaid,19.35,,,19.35,Other,100% of Medicaid,19.35,,,19.35,Other,100% of Medicaid,19.35,,,19.35,Other,100% of Medicaid,43.54,,,43.54,Other,225% of Medicaid,29.61,,,29.61,Other,153% of Medicaid,43.54,,,43.54,Other,225% of Medicaid,27.09,,,27.09,Other,140% of Medicaid,43.54,,,43.54,Other,225% of Medicaid,50.31,,,50.31,Other,250% of Medicaid,62.69,,,62.69,Other,324% of Medicaid,41.6,,,41.6,Other,215% of Medicaid,41.6,,,41.6,Other,215% of Medicaid,24.19,,,24.19,Other,125% of Medicaid,0.01,149.22,
HEPATITIS DELTA AGENT,86692,CPT,,78086692,CDM,302,RC,,,both,,,166,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,51.65,,,51.65,Fee Schedule,,46.5,,,46.5,Fee Schedule,,132.34,,,132.34,Fee Schedule,,119.06,,,119.06,Fee Schedule,,112.54,,,112.54,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,All Other,54.05,,,54.05,Fee Schedule,,32,,,32,Other,186% of Medicaid,63.66,,,63.66,Fee Schedule,,102.92,,,102.92,Fee Schedule,,36.04,,,,Fee Schedule,,63.66,,,63.66,Fee Schedule,,102.92,,,102.92,Fee Schedule,,67.78,,,67.78,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,,81.32,,,81.32,Fee Schedule,,68.93,,,68.93,Fee Schedule,,25.74,,,25.74,Fee Schedule,,25.74,,,25.74,Fee Schedule,,25.74,,,25.74,Fee Schedule,,25.74,,,25.74,Fee Schedule,,17.16,,,17.16,Other,100% of Medicaid,17.16,,,17.16,Other,100% of Medicaid,17.16,,,17.16,Other,100% of Medicaid,17.16,,,17.16,Other,100% of Medicaid,38.61,,,38.61,Other,225% of Medicaid,26.25,,,26.25,Other,153% of Medicaid,38.61,,,38.61,Other,225% of Medicaid,24.02,,,24.02,Other,140% of Medicaid,38.61,,,38.61,Other,225% of Medicaid,44.62,,,44.62,Other,250% of Medicaid,55.6,,,55.6,Other,324% of Medicaid,36.89,,,36.89,Other,215% of Medicaid,36.89,,,36.89,Other,215% of Medicaid,21.45,,,21.45,Other,125% of Medicaid,0.01,132.34,
HERPES SIMPLEX TEST,86694,CPT,,78086694,CDM,302,RC,,,both,,,271,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.31,,,43.31,Fee Schedule,,39,,,39,Fee Schedule,,110.97,,,110.97,Fee Schedule,,99.83,,,99.83,Fee Schedule,,94.37,,,94.37,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,All Other,45.33,,,45.33,Fee Schedule,,32,,,32,Other,186% of Medicaid,53.39,,,53.39,Fee Schedule,,168.02,,,168.02,Fee Schedule,,30.22,,,,Fee Schedule,,53.39,,,53.39,Fee Schedule,,168.02,,,168.02,Fee Schedule,,56.84,,,56.84,Fee Schedule,,189.7,70,,189.7,percent of total billed charges,,68.19,,,68.19,Fee Schedule,,57.8,,,57.8,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,189.7,
HISTOPLASMA,86698,CPT,,78086698,CDM,302,RC,,,both,,,266,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.51,,,41.51,Fee Schedule,,37.37,,,37.37,Fee Schedule,,86.58,,,86.58,Fee Schedule,,77.89,,,77.89,Fee Schedule,,73.63,,,73.63,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,All Other,43.44,,,43.44,Fee Schedule,,23,,,23,Other,186% of Medicaid,51.16,,,51.16,Fee Schedule,,164.92,,,164.92,Fee Schedule,,28.96,,,,Fee Schedule,,51.16,,,51.16,Fee Schedule,,164.92,,,164.92,Fee Schedule,,54.47,,,54.47,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,,65.35,,,65.35,Fee Schedule,,55.39,,,55.39,Fee Schedule,,20.69,,,20.69,Fee Schedule,,20.69,,,20.69,Fee Schedule,,20.69,,,20.69,Fee Schedule,,20.69,,,20.69,Fee Schedule,,12.53,,,12.53,Other,100% of Medicaid,12.53,,,12.53,Other,100% of Medicaid,12.53,,,12.53,Other,100% of Medicaid,12.53,,,12.53,Other,100% of Medicaid,28.2,,,28.2,Other,225% of Medicaid,19.18,,,19.18,Other,153% of Medicaid,28.2,,,28.2,Other,225% of Medicaid,17.55,,,17.55,Other,140% of Medicaid,28.2,,,28.2,Other,225% of Medicaid,32.59,,,32.59,Other,250% of Medicaid,40.61,,,40.61,Other,324% of Medicaid,26.95,,,26.95,Other,215% of Medicaid,26.95,,,26.95,Other,215% of Medicaid,15.67,,,15.67,Other,125% of Medicaid,0.01,186.2,
AB; HIV-2,86702,CPT,,78086702,CDM,302,RC,,,both,,,88,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,40.7,,,40.7,Fee Schedule,,36.64,,,36.64,Fee Schedule,,104.28,,,104.28,Fee Schedule,,93.82,,,93.82,Fee Schedule,,88.68,,,88.68,Fee Schedule,,61.6,70,,61.6,percent of total billed charges,All Other,42.59,,,42.59,Fee Schedule,,25,,,25,Other,186% of Medicaid,50.16,,,50.16,Fee Schedule,,54.56,,,54.56,Fee Schedule,,28.39,,,,Fee Schedule,,50.16,,,50.16,Fee Schedule,,54.56,,,54.56,Fee Schedule,,53.4,,,53.4,Fee Schedule,,61.6,70,,61.6,percent of total billed charges,,64.07,,,64.07,Fee Schedule,,54.3,,,54.3,Fee Schedule,,20.28,,,20.28,Fee Schedule,,20.28,,,20.28,Fee Schedule,,20.28,,,20.28,Fee Schedule,,20.28,,,20.28,Fee Schedule,,13.52,,,13.52,Other,100% of Medicaid,13.52,,,13.52,Other,100% of Medicaid,13.52,,,13.52,Other,100% of Medicaid,13.52,,,13.52,Other,100% of Medicaid,30.42,,,30.42,Other,225% of Medicaid,20.69,,,20.69,Other,153% of Medicaid,30.42,,,30.42,Other,225% of Medicaid,18.93,,,18.93,Other,140% of Medicaid,30.42,,,30.42,Other,225% of Medicaid,35.15,,,35.15,Other,250% of Medicaid,43.8,,,43.8,Other,324% of Medicaid,29.07,,,29.07,Other,215% of Medicaid,29.07,,,29.07,Other,215% of Medicaid,16.9,,,16.9,Other,125% of Medicaid,0.01,104.28,
HIV-1/HIV-2 SINGLE ASSAY,86703,CPT,,78086703,CDM,302,RC,,,both,,,89,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.27,,,41.27,Fee Schedule,,37.15,,,37.15,Fee Schedule,,105.76,,,105.76,Fee Schedule,,95.15,,,95.15,Fee Schedule,,89.94,,,89.94,Fee Schedule,,62.3,70,,62.3,percent of total billed charges,All Other,43.19,,,43.19,Fee Schedule,,26,,,26,Other,186% of Medicaid,50.86,,,50.86,Fee Schedule,,55.18,,,55.18,Fee Schedule,,28.79,,,,Fee Schedule,,50.86,,,50.86,Fee Schedule,,55.18,,,55.18,Fee Schedule,,54.15,,,54.15,Fee Schedule,,62.3,70,,62.3,percent of total billed charges,,64.97,,,64.97,Fee Schedule,,55.07,,,55.07,Fee Schedule,,20.57,,,20.57,Fee Schedule,,20.57,,,20.57,Fee Schedule,,20.57,,,20.57,Fee Schedule,,20.57,,,20.57,Fee Schedule,,13.71,,,13.71,Other,100% of Medicaid,13.71,,,13.71,Other,100% of Medicaid,13.71,,,13.71,Other,100% of Medicaid,13.71,,,13.71,Other,100% of Medicaid,30.85,,,30.85,Other,225% of Medicaid,20.98,,,20.98,Other,153% of Medicaid,30.85,,,30.85,Other,225% of Medicaid,19.19,,,19.19,Other,140% of Medicaid,30.85,,,30.85,Other,225% of Medicaid,35.65,,,35.65,Other,250% of Medicaid,44.42,,,44.42,Other,324% of Medicaid,29.48,,,29.48,Other,215% of Medicaid,29.48,,,29.48,Other,215% of Medicaid,17.14,,,17.14,Other,125% of Medicaid,0.01,105.76,
HEP B CORE ANTIBODY TOTAL,86704,CPT,,78086704,CDM,302,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.27,,,36.27,Fee Schedule,,32.66,,,32.66,Fee Schedule,,92.94,,,92.94,Fee Schedule,,83.61,,,83.61,Fee Schedule,,79.03,,,79.03,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,37.96,,,37.96,Fee Schedule,,19,,,19,Other,186% of Medicaid,44.71,,,44.71,Fee Schedule,,115.32,,,115.32,Fee Schedule,,25.31,,,,Fee Schedule,,44.71,,,44.71,Fee Schedule,,115.32,,,115.32,Fee Schedule,,47.6,,,47.6,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,57.11,,,57.11,Fee Schedule,,48.4,,,48.4,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,18.08,,,18.08,Fee Schedule,,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,15.61,,,15.61,Other,153% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,14.28,,,14.28,Other,140% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,26.52,,,26.52,Other,250% of Medicaid,33.05,,,33.05,Other,324% of Medicaid,21.93,,,21.93,Other,215% of Medicaid,21.93,,,21.93,Other,215% of Medicaid,12.75,,,12.75,Other,125% of Medicaid,0.01,130.2,
HEP B CORE ANTIBODY IGM,86705,CPT,,78086705,CDM,302,RC,,,both,,,206,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,35.43,,,35.43,Fee Schedule,,31.9,,,31.9,Fee Schedule,,90.75,,,90.75,Fee Schedule,,81.64,,,81.64,Fee Schedule,,77.17,,,77.17,Fee Schedule,,144.2,70,,144.2,percent of total billed charges,All Other,37.08,,,37.08,Fee Schedule,,19,,,19,Other,186% of Medicaid,43.67,,,43.67,Fee Schedule,,127.72,,,127.72,Fee Schedule,,24.72,,,,Fee Schedule,,43.67,,,43.67,Fee Schedule,,127.72,,,127.72,Fee Schedule,,46.49,,,46.49,Fee Schedule,,144.2,70,,144.2,percent of total billed charges,,55.78,,,55.78,Fee Schedule,,47.28,,,47.28,Fee Schedule,,17.66,,,17.66,Fee Schedule,,17.66,,,17.66,Fee Schedule,,17.66,,,17.66,Fee Schedule,,17.66,,,17.66,Fee Schedule,,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,15.61,,,15.61,Other,153% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,14.28,,,14.28,Other,140% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,26.52,,,26.52,Other,250% of Medicaid,33.05,,,33.05,Other,324% of Medicaid,21.93,,,21.93,Other,215% of Medicaid,21.93,,,21.93,Other,215% of Medicaid,12.75,,,12.75,Other,125% of Medicaid,0.01,144.2,
HEP B SURFACE ANTIBODY,86706,CPT,,78086706,CDM,302,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,32.33,,,32.33,Fee Schedule,,29.11,,,29.11,Fee Schedule,,82.86,,,82.86,Fee Schedule,,74.54,,,74.54,Fee Schedule,,70.46,,,70.46,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,All Other,33.83,,,33.83,Fee Schedule,,19,,,19,Other,186% of Medicaid,39.85,,,39.85,Fee Schedule,,112.84,,,112.84,Fee Schedule,,22.55,,,,Fee Schedule,,39.85,,,39.85,Fee Schedule,,112.84,,,112.84,Fee Schedule,,42.42,,,42.42,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,,50.9,,,50.9,Fee Schedule,,43.14,,,43.14,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,15.61,,,15.61,Other,153% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,14.28,,,14.28,Other,140% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,26.52,,,26.52,Other,250% of Medicaid,33.05,,,33.05,Other,324% of Medicaid,21.93,,,21.93,Other,215% of Medicaid,21.93,,,21.93,Other,215% of Medicaid,12.75,,,12.75,Other,125% of Medicaid,0.01,127.4,
HEP BE ANTIBODY,86707,CPT,,78086707,CDM,302,RC,,,both,,,174,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.83,,,34.83,Fee Schedule,,31.35,,,31.35,Fee Schedule,,89.21,,,89.21,Fee Schedule,,80.26,,,80.26,Fee Schedule,,75.86,,,75.86,Fee Schedule,,121.8,70,,121.8,percent of total billed charges,All Other,36.45,,,36.45,Fee Schedule,,19,,,19,Other,186% of Medicaid,42.92,,,42.92,Fee Schedule,,107.88,,,107.88,Fee Schedule,,24.3,,,,Fee Schedule,,42.92,,,42.92,Fee Schedule,,107.88,,,107.88,Fee Schedule,,45.7,,,45.7,Fee Schedule,,121.8,70,,121.8,percent of total billed charges,,54.83,,,54.83,Fee Schedule,,46.47,,,46.47,Fee Schedule,,17.36,,,17.36,Fee Schedule,,17.36,,,17.36,Fee Schedule,,17.36,,,17.36,Fee Schedule,,17.36,,,17.36,Fee Schedule,,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,15.61,,,15.61,Other,153% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,14.28,,,14.28,Other,140% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,26.52,,,26.52,Other,250% of Medicaid,33.05,,,33.05,Other,324% of Medicaid,21.93,,,21.93,Other,215% of Medicaid,21.93,,,21.93,Other,215% of Medicaid,12.75,,,12.75,Other,125% of Medicaid,0.01,121.8,
HEP A ANTIBODY TOTAL,86708,CPT,,78086708,CDM,302,RC,,,both,,,168,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,37.29,,,37.29,Fee Schedule,,33.58,,,33.58,Fee Schedule,,95.52,,,95.52,Fee Schedule,,85.93,,,85.93,Fee Schedule,,81.22,,,81.22,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,All Other,39.03,,,39.03,Fee Schedule,,19,,,19,Other,186% of Medicaid,45.97,,,45.97,Fee Schedule,,104.16,,,104.16,Fee Schedule,,26.02,,,,Fee Schedule,,45.97,,,45.97,Fee Schedule,,104.16,,,104.16,Fee Schedule,,48.94,,,48.94,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,,58.72,,,58.72,Fee Schedule,,49.77,,,49.77,Fee Schedule,,18.59,,,18.59,Fee Schedule,,18.59,,,18.59,Fee Schedule,,18.59,,,18.59,Fee Schedule,,18.59,,,18.59,Fee Schedule,,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,15.45,,,15.45,Other,153% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,14.14,,,14.14,Other,140% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,26.26,,,26.26,Other,250% of Medicaid,32.72,,,32.72,Other,324% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,12.63,,,12.63,Other,125% of Medicaid,0.01,117.6,
HEP A ANTIBODY IGM,86709,CPT,,78086709,CDM,302,RC,,,both,,,185,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,33.89,,,33.89,Fee Schedule,,30.51,,,30.51,Fee Schedule,,86.8,,,86.8,Fee Schedule,,78.09,,,78.09,Fee Schedule,,73.81,,,73.81,Fee Schedule,,129.5,70,,129.5,percent of total billed charges,All Other,35.47,,,35.47,Fee Schedule,,19,,,19,Other,186% of Medicaid,41.77,,,41.77,Fee Schedule,,114.7,,,114.7,Fee Schedule,,23.65,,,,Fee Schedule,,41.77,,,41.77,Fee Schedule,,114.7,,,114.7,Fee Schedule,,44.48,,,44.48,Fee Schedule,,129.5,70,,129.5,percent of total billed charges,,53.36,,,53.36,Fee Schedule,,45.23,,,45.23,Fee Schedule,,16.89,,,16.89,Fee Schedule,,16.89,,,16.89,Fee Schedule,,16.89,,,16.89,Fee Schedule,,16.89,,,16.89,Fee Schedule,,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,15.45,,,15.45,Other,153% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,14.14,,,14.14,Other,140% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,26.26,,,26.26,Other,250% of Medicaid,32.72,,,32.72,Other,324% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,12.63,,,12.63,Other,125% of Medicaid,0.01,129.5,
INFLUENZA VIRUS ANTIBODY,86710,CPT,,78086710,CDM,302,RC,,,both,,,254,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,40.79,,,40.79,Fee Schedule,,36.72,,,36.72,Fee Schedule,,104.56,,,104.56,Fee Schedule,,94.06,,,94.06,Fee Schedule,,88.91,,,88.91,Fee Schedule,,177.8,70,,177.8,percent of total billed charges,All Other,42.68,,,42.68,Fee Schedule,,25,,,25,Other,186% of Medicaid,50.27,,,50.27,Fee Schedule,,157.48,,,157.48,Fee Schedule,,28.46,,,,Fee Schedule,,50.27,,,50.27,Fee Schedule,,157.48,,,157.48,Fee Schedule,,53.52,,,53.52,Fee Schedule,,177.8,70,,177.8,percent of total billed charges,,64.21,,,64.21,Fee Schedule,,54.43,,,54.43,Fee Schedule,,20.33,,,20.33,Fee Schedule,,20.33,,,20.33,Fee Schedule,,20.33,,,20.33,Fee Schedule,,20.33,,,20.33,Fee Schedule,,13.55,,,13.55,Other,100% of Medicaid,13.55,,,13.55,Other,100% of Medicaid,13.55,,,13.55,Other,100% of Medicaid,13.55,,,13.55,Other,100% of Medicaid,30.49,,,30.49,Other,225% of Medicaid,20.73,,,20.73,Other,153% of Medicaid,30.49,,,30.49,Other,225% of Medicaid,18.97,,,18.97,Other,140% of Medicaid,30.49,,,30.49,Other,225% of Medicaid,35.23,,,35.23,Other,250% of Medicaid,43.9,,,43.9,Other,324% of Medicaid,29.13,,,29.13,Other,215% of Medicaid,29.13,,,29.13,Other,215% of Medicaid,16.94,,,16.94,Other,125% of Medicaid,0.01,177.8,
JOHN CUNNINGHAM ANTIBODY,86711,CPT,,78086711,CDM,302,RC,,,both,,,54,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.84,,,50.84,Fee Schedule,,45.77,,,45.77,Fee Schedule,,7.92,,,7.92,Fee Schedule,,7.92,,,7.92,Fee Schedule,,7.92,,,7.92,Fee Schedule,,37.8,70,,37.8,percent of total billed charges,All Other,53.2,,,53.2,Fee Schedule,,32,,,32,Other,186% of Medicaid,62.66,,,62.66,Fee Schedule,,33.48,,,33.48,Fee Schedule,,35.47,,,,Fee Schedule,,62.66,,,62.66,Fee Schedule,,33.48,,,33.48,Fee Schedule,,66.72,,,66.72,Fee Schedule,,37.8,70,,37.8,percent of total billed charges,,80.04,,,80.04,Fee Schedule,,67.84,,,67.84,Fee Schedule,,25.34,,,25.34,Fee Schedule,,25.34,,,25.34,Fee Schedule,,25.34,,,25.34,Fee Schedule,,25.34,,,25.34,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,80.04,
LEGIONELLA ANTIBODY,86713,CPT,,78086713,CDM,302,RC,,,both,,,275,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.05,,,46.05,Fee Schedule,,41.46,,,41.46,Fee Schedule,,117.98,,,117.98,Fee Schedule,,106.14,,,106.14,Fee Schedule,,100.33,,,100.33,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,All Other,48.2,,,48.2,Fee Schedule,,28,,,28,Other,186% of Medicaid,56.76,,,56.76,Fee Schedule,,170.5,,,170.5,Fee Schedule,,32.13,,,,Fee Schedule,,56.76,,,56.76,Fee Schedule,,170.5,,,170.5,Fee Schedule,,60.44,,,60.44,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,,72.51,,,72.51,Fee Schedule,,61.45,,,61.45,Fee Schedule,,22.95,,,22.95,Fee Schedule,,22.95,,,22.95,Fee Schedule,,22.95,,,22.95,Fee Schedule,,22.95,,,22.95,Fee Schedule,,15.3,,,15.3,Other,100% of Medicaid,15.3,,,15.3,Other,100% of Medicaid,15.3,,,15.3,Other,100% of Medicaid,15.3,,,15.3,Other,100% of Medicaid,34.43,,,34.43,Other,225% of Medicaid,23.41,,,23.41,Other,153% of Medicaid,34.43,,,34.43,Other,225% of Medicaid,21.42,,,21.42,Other,140% of Medicaid,34.43,,,34.43,Other,225% of Medicaid,39.78,,,39.78,Other,250% of Medicaid,49.57,,,49.57,Other,324% of Medicaid,32.9,,,32.9,Other,215% of Medicaid,32.9,,,32.9,Other,215% of Medicaid,19.13,,,19.13,Other,125% of Medicaid,0.01,192.5,
LEPTOSPIRA ANTIBODY,86720,CPT,,78086720,CDM,302,RC,,,both,,,252,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,48.76,,,48.76,Fee Schedule,,43.9,,,43.9,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,176.4,70,,176.4,percent of total billed charges,All Other,51.03,,,51.03,Fee Schedule,,15,,,15,Other,186% of Medicaid,60.1,,,60.1,Fee Schedule,,156.24,,,156.24,Fee Schedule,,34.02,,,,Fee Schedule,,60.1,,,60.1,Fee Schedule,,156.24,,,156.24,Fee Schedule,,63.99,,,63.99,Fee Schedule,,176.4,70,,176.4,percent of total billed charges,,76.77,,,76.77,Fee Schedule,,65.07,,,65.07,Fee Schedule,,24.3,,,24.3,Fee Schedule,,24.3,,,24.3,Fee Schedule,,24.3,,,24.3,Fee Schedule,,24.3,,,24.3,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,176.4,
AB LCM,86727,CPT,,78086727,CDM,302,RC,,,both,,,42,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.74,,,38.74,Fee Schedule,,34.88,,,34.88,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,29.4,70,,29.4,percent of total billed charges,All Other,40.54,,,40.54,Fee Schedule,,15,,,15,Other,186% of Medicaid,47.75,,,47.75,Fee Schedule,,26.04,,,26.04,Fee Schedule,,27.03,,,,Fee Schedule,,47.75,,,47.75,Fee Schedule,,26.04,,,26.04,Fee Schedule,,50.84,,,50.84,Fee Schedule,,29.4,70,,29.4,percent of total billed charges,,60.99,,,60.99,Fee Schedule,,51.69,,,51.69,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,60.99,
MYCOPLASMA ANTIBODY,86738,CPT,,78086738,CDM,302,RC,,,both,,,204,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.85,,,39.85,Fee Schedule,,35.88,,,35.88,Fee Schedule,,102.15,,,102.15,Fee Schedule,,91.9,,,91.9,Fee Schedule,,86.86,,,86.86,Fee Schedule,,142.8,70,,142.8,percent of total billed charges,All Other,41.71,,,41.71,Fee Schedule,,25,,,25,Other,186% of Medicaid,49.12,,,49.12,Fee Schedule,,126.48,,,126.48,Fee Schedule,,27.8,,,,Fee Schedule,,49.12,,,49.12,Fee Schedule,,126.48,,,126.48,Fee Schedule,,52.3,,,52.3,Fee Schedule,,142.8,70,,142.8,percent of total billed charges,,62.74,,,62.74,Fee Schedule,,53.18,,,53.18,Fee Schedule,,19.86,,,19.86,Fee Schedule,,19.86,,,19.86,Fee Schedule,,19.86,,,19.86,Fee Schedule,,19.86,,,19.86,Fee Schedule,,13.24,,,13.24,Other,100% of Medicaid,13.24,,,13.24,Other,100% of Medicaid,13.24,,,13.24,Other,100% of Medicaid,13.24,,,13.24,Other,100% of Medicaid,29.79,,,29.79,Other,225% of Medicaid,20.26,,,20.26,Other,153% of Medicaid,29.79,,,29.79,Other,225% of Medicaid,18.54,,,18.54,Other,140% of Medicaid,29.79,,,29.79,Other,225% of Medicaid,34.42,,,34.42,Other,250% of Medicaid,42.9,,,42.9,Other,324% of Medicaid,28.47,,,28.47,Other,215% of Medicaid,28.47,,,28.47,Other,215% of Medicaid,16.55,,,16.55,Other,125% of Medicaid,0.01,142.8,
PARVOVIRUS ANTIBODY,86747,CPT,,78086747,CDM,302,RC,,,both,,,170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,45.24,,,45.24,Fee Schedule,,40.73,,,40.73,Fee Schedule,,115.96,,,115.96,Fee Schedule,,104.32,,,104.32,Fee Schedule,,98.61,,,98.61,Fee Schedule,,119,70,,119,percent of total billed charges,All Other,47.34,,,47.34,Fee Schedule,,28,,,28,Other,186% of Medicaid,55.76,,,55.76,Fee Schedule,,105.4,,,105.4,Fee Schedule,,31.56,,,,Fee Schedule,,55.76,,,55.76,Fee Schedule,,105.4,,,105.4,Fee Schedule,,59.37,,,59.37,Fee Schedule,,119,70,,119,percent of total billed charges,,71.23,,,71.23,Fee Schedule,,60.37,,,60.37,Fee Schedule,,22.55,,,22.55,Fee Schedule,,22.55,,,22.55,Fee Schedule,,22.55,,,22.55,Fee Schedule,,22.55,,,22.55,Fee Schedule,,15.03,,,15.03,Other,100% of Medicaid,15.03,,,15.03,Other,100% of Medicaid,15.03,,,15.03,Other,100% of Medicaid,15.03,,,15.03,Other,100% of Medicaid,33.82,,,33.82,Other,225% of Medicaid,23,,,23,Other,153% of Medicaid,33.82,,,33.82,Other,225% of Medicaid,21.04,,,21.04,Other,140% of Medicaid,33.82,,,33.82,Other,225% of Medicaid,39.08,,,39.08,Other,250% of Medicaid,48.7,,,48.7,Other,324% of Medicaid,32.31,,,32.31,Other,215% of Medicaid,32.31,,,32.31,Other,215% of Medicaid,18.79,,,18.79,Other,125% of Medicaid,0.01,119,
RESPIRATORY VIRUS ANTIBODY,86756,CPT,,78086756,CDM,302,RC,,,both,,,173,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.83,,,47.83,Fee Schedule,,43.06,,,43.06,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,121.1,70,,121.1,percent of total billed charges,All Other,50.05,,,50.05,Fee Schedule,,15,,,15,Other,186% of Medicaid,58.95,,,58.95,Fee Schedule,,107.26,,,107.26,Fee Schedule,,33.37,,,,Fee Schedule,,58.95,,,58.95,Fee Schedule,,107.26,,,107.26,Fee Schedule,,62.77,,,62.77,Fee Schedule,,121.1,70,,121.1,percent of total billed charges,,75.3,,,75.3,Fee Schedule,,63.82,,,63.82,Fee Schedule,,23.84,,,23.84,Fee Schedule,,23.84,,,23.84,Fee Schedule,,23.84,,,23.84,Fee Schedule,,23.84,,,23.84,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,121.1,
RICKETTSIA ANTIBODY,86757,CPT,,78086757,CDM,302,RC,,,both,,,272,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,58.24,,,58.24,Fee Schedule,,52.44,,,52.44,Fee Schedule,,149.22,,,149.22,Fee Schedule,,134.24,,,134.24,Fee Schedule,,126.89,,,126.89,Fee Schedule,,190.4,70,,190.4,percent of total billed charges,All Other,60.95,,,60.95,Fee Schedule,,36,,,36,Other,186% of Medicaid,71.79,,,71.79,Fee Schedule,,168.64,,,168.64,Fee Schedule,,40.64,,,,Fee Schedule,,71.79,,,71.79,Fee Schedule,,168.64,,,168.64,Fee Schedule,,76.43,,,76.43,Fee Schedule,,190.4,70,,190.4,percent of total billed charges,,91.7,,,91.7,Fee Schedule,,77.72,,,77.72,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,19.35,,,19.35,Other,100% of Medicaid,19.35,,,19.35,Other,100% of Medicaid,19.35,,,19.35,Other,100% of Medicaid,19.35,,,19.35,Other,100% of Medicaid,43.54,,,43.54,Other,225% of Medicaid,29.61,,,29.61,Other,153% of Medicaid,43.54,,,43.54,Other,225% of Medicaid,27.09,,,27.09,Other,140% of Medicaid,43.54,,,43.54,Other,225% of Medicaid,50.31,,,50.31,Other,250% of Medicaid,62.69,,,62.69,Other,324% of Medicaid,41.6,,,41.6,Other,215% of Medicaid,41.6,,,41.6,Other,215% of Medicaid,24.19,,,24.19,Other,125% of Medicaid,0.01,190.4,
ROTAVIRUS ANTIBODY,86759,CPT,,78086759,CDM,302,RC,,,both,,,219,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.87,,,54.87,Fee Schedule,,49.4,,,49.4,Fee Schedule,,101.71,,,101.71,Fee Schedule,,91.5,,,91.5,Fee Schedule,,86.49,,,86.49,Fee Schedule,,153.3,70,,153.3,percent of total billed charges,All Other,57.42,,,57.42,Fee Schedule,,27,,,27,Other,186% of Medicaid,67.63,,,67.63,Fee Schedule,,135.78,,,135.78,Fee Schedule,,38.28,,,,Fee Schedule,,67.63,,,67.63,Fee Schedule,,135.78,,,135.78,Fee Schedule,,72.01,,,72.01,Fee Schedule,,153.3,70,,153.3,percent of total billed charges,,86.39,,,86.39,Fee Schedule,,73.22,,,73.22,Fee Schedule,,27.35,,,27.35,Fee Schedule,,27.35,,,27.35,Fee Schedule,,27.35,,,27.35,Fee Schedule,,27.35,,,27.35,Fee Schedule,,14.73,,,14.73,Other,100% of Medicaid,14.73,,,14.73,Other,100% of Medicaid,14.73,,,14.73,Other,100% of Medicaid,14.73,,,14.73,Other,100% of Medicaid,33.13,,,33.13,Other,225% of Medicaid,22.53,,,22.53,Other,153% of Medicaid,33.13,,,33.13,Other,225% of Medicaid,20.62,,,20.62,Other,140% of Medicaid,33.13,,,33.13,Other,225% of Medicaid,38.29,,,38.29,Other,250% of Medicaid,47.71,,,47.71,Other,324% of Medicaid,31.66,,,31.66,Other,215% of Medicaid,31.66,,,31.66,Other,215% of Medicaid,18.41,,,18.41,Other,125% of Medicaid,0.01,153.3,
RUBELLA ANTIBODY,86762,CPT,,78086762,CDM,302,RC,,,both,,,132,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.31,,,43.31,Fee Schedule,,39,,,39,Fee Schedule,,110.97,,,110.97,Fee Schedule,,99.83,,,99.83,Fee Schedule,,94.37,,,94.37,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,All Other,45.33,,,45.33,Fee Schedule,,27,,,27,Other,186% of Medicaid,53.39,,,53.39,Fee Schedule,,81.84,,,81.84,Fee Schedule,,30.22,,,,Fee Schedule,,53.39,,,53.39,Fee Schedule,,81.84,,,81.84,Fee Schedule,,56.84,,,56.84,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,,68.19,,,68.19,Fee Schedule,,57.8,,,57.8,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,22.02,,,22.02,Other,153% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,20.15,,,20.15,Other,140% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,37.41,,,37.41,Other,250% of Medicaid,46.62,,,46.62,Other,324% of Medicaid,30.94,,,30.94,Other,215% of Medicaid,30.94,,,30.94,Other,215% of Medicaid,17.99,,,17.99,Other,125% of Medicaid,0.01,110.97,
RUBEOLA ANTIBODY,86765,CPT,,78086765,CDM,302,RC,,,both,,,132,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.77,,,38.77,Fee Schedule,,34.9,,,34.9,Fee Schedule,,99.35,,,99.35,Fee Schedule,,89.38,,,89.38,Fee Schedule,,84.49,,,84.49,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,All Other,40.57,,,40.57,Fee Schedule,,24,,,24,Other,186% of Medicaid,47.78,,,47.78,Fee Schedule,,81.84,,,81.84,Fee Schedule,,27.05,,,,Fee Schedule,,47.78,,,47.78,Fee Schedule,,81.84,,,81.84,Fee Schedule,,50.88,,,50.88,Fee Schedule,,92.4,70,,92.4,percent of total billed charges,,61.04,,,61.04,Fee Schedule,,51.73,,,51.73,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,12.88,,,12.88,Other,100% of Medicaid,12.88,,,12.88,Other,100% of Medicaid,12.88,,,12.88,Other,100% of Medicaid,12.88,,,12.88,Other,100% of Medicaid,28.98,,,28.98,Other,225% of Medicaid,19.71,,,19.71,Other,153% of Medicaid,28.98,,,28.98,Other,225% of Medicaid,18.03,,,18.03,Other,140% of Medicaid,28.98,,,28.98,Other,225% of Medicaid,33.49,,,33.49,Other,250% of Medicaid,41.73,,,41.73,Other,324% of Medicaid,27.69,,,27.69,Other,215% of Medicaid,27.69,,,27.69,Other,215% of Medicaid,16.1,,,16.1,Other,125% of Medicaid,0.01,99.35,
SALMONELLA ANTIBODY,86768,CPT,,78086768,CDM,302,RC,,,both,,,42,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.7,,,39.7,Fee Schedule,,35.74,,,35.74,Fee Schedule,,63.07,,,63.07,Fee Schedule,,56.74,,,56.74,Fee Schedule,,53.64,,,53.64,Fee Schedule,,29.4,70,,29.4,percent of total billed charges,All Other,41.55,,,41.55,Fee Schedule,,17,,,17,Other,186% of Medicaid,48.93,,,48.93,Fee Schedule,,26.04,,,26.04,Fee Schedule,,27.7,,,,Fee Schedule,,48.93,,,48.93,Fee Schedule,,26.04,,,26.04,Fee Schedule,,52.1,,,52.1,Fee Schedule,,29.4,70,,29.4,percent of total billed charges,,62.51,,,62.51,Fee Schedule,,52.98,,,52.98,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,19.79,,,19.79,Fee Schedule,,9.14,,,9.14,Other,100% of Medicaid,9.14,,,9.14,Other,100% of Medicaid,9.14,,,9.14,Other,100% of Medicaid,9.14,,,9.14,Other,100% of Medicaid,20.57,,,20.57,Other,225% of Medicaid,13.98,,,13.98,Other,153% of Medicaid,20.57,,,20.57,Other,225% of Medicaid,12.8,,,12.8,Other,140% of Medicaid,20.57,,,20.57,Other,225% of Medicaid,23.77,,,23.77,Other,250% of Medicaid,29.62,,,29.62,Other,324% of Medicaid,19.65,,,19.65,Other,215% of Medicaid,19.65,,,19.65,Other,215% of Medicaid,11.43,,,11.43,Other,125% of Medicaid,0.01,63.07,
SARS-COV-2 COVID-19 ANTIBODY,86769,CPT,,78086769,CDM,302,RC,,,both,,,170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,126.81,,,126.81,Fee Schedule,,114.17,,,114.17,Fee Schedule,,19.38,,,19.38,Fee Schedule,,19.38,,,19.38,Fee Schedule,,19.38,,,19.38,Fee Schedule,,119,70,,119,percent of total billed charges,All Other,132.71,,,132.71,Fee Schedule,,47,,,47,Other,186% of Medicaid,156.3,,,156.3,Fee Schedule,,105.4,,,105.4,Fee Schedule,,88.47,,,,Fee Schedule,,156.3,,,156.3,Fee Schedule,,105.4,,,105.4,Fee Schedule,,166.41,,,166.41,Fee Schedule,,119,70,,119,percent of total billed charges,,199.66,,,199.66,Fee Schedule,,169.22,,,169.22,Fee Schedule,,63.2,,,63.2,Fee Schedule,,63.2,,,63.2,Fee Schedule,,63.2,,,63.2,Fee Schedule,,63.2,,,63.2,Fee Schedule,,25.28,,,25.28,Other,100% of Medicaid,25.28,,,25.28,Other,100% of Medicaid,25.28,,,25.28,Other,100% of Medicaid,25.28,,,25.28,Other,100% of Medicaid,56.88,,,56.88,Other,225% of Medicaid,38.68,,,38.68,Other,153% of Medicaid,56.88,,,56.88,Other,225% of Medicaid,35.39,,,35.39,Other,140% of Medicaid,56.88,,,56.88,Other,225% of Medicaid,65.73,,,65.73,Other,250% of Medicaid,81.91,,,81.91,Other,324% of Medicaid,54.35,,,54.35,Other,215% of Medicaid,54.35,,,54.35,Other,215% of Medicaid,31.6,,,31.6,Other,125% of Medicaid,0.01,199.66,
TETANUS ANTIBODY,86774,CPT,,78086774,CDM,302,RC,,,both,,,247,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,44.55,,,44.55,Fee Schedule,,40.11,,,40.11,Fee Schedule,,114.09,,,114.09,Fee Schedule,,102.64,,,102.64,Fee Schedule,,97.02,,,97.02,Fee Schedule,,172.9,70,,172.9,percent of total billed charges,All Other,46.62,,,46.62,Fee Schedule,,32,,,32,Other,186% of Medicaid,54.91,,,54.91,Fee Schedule,,153.14,,,153.14,Fee Schedule,,31.08,,,,Fee Schedule,,54.91,,,54.91,Fee Schedule,,153.14,,,153.14,Fee Schedule,,58.46,,,58.46,Fee Schedule,,172.9,70,,172.9,percent of total billed charges,,70.14,,,70.14,Fee Schedule,,59.45,,,59.45,Fee Schedule,,22.2,,,22.2,Fee Schedule,,22.2,,,22.2,Fee Schedule,,22.2,,,22.2,Fee Schedule,,22.2,,,22.2,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,172.9,
TOXOPLASMA ANTIBODY IGM,86778,CPT,,78086778,CDM,302,RC,,,both,,,324,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.37,,,43.37,Fee Schedule,,39.05,,,39.05,Fee Schedule,,98.48,,,98.48,Fee Schedule,,88.59,,,88.59,Fee Schedule,,83.74,,,83.74,Fee Schedule,,226.8,70,,226.8,percent of total billed charges,All Other,45.39,,,45.39,Fee Schedule,,27,,,27,Other,186% of Medicaid,53.46,,,53.46,Fee Schedule,,200.88,,,200.88,Fee Schedule,,30.26,,,,Fee Schedule,,53.46,,,53.46,Fee Schedule,,200.88,,,200.88,Fee Schedule,,56.92,,,56.92,Fee Schedule,,226.8,70,,226.8,percent of total billed charges,,68.29,,,68.29,Fee Schedule,,57.88,,,57.88,Fee Schedule,,21.62,,,21.62,Fee Schedule,,21.62,,,21.62,Fee Schedule,,21.62,,,21.62,Fee Schedule,,21.62,,,21.62,Fee Schedule,,14.26,,,14.26,Other,100% of Medicaid,14.26,,,14.26,Other,100% of Medicaid,14.26,,,14.26,Other,100% of Medicaid,14.26,,,14.26,Other,100% of Medicaid,32.09,,,32.09,Other,225% of Medicaid,21.82,,,21.82,Other,153% of Medicaid,32.09,,,32.09,Other,225% of Medicaid,19.97,,,19.97,Other,140% of Medicaid,32.09,,,32.09,Other,225% of Medicaid,37.08,,,37.08,Other,250% of Medicaid,46.21,,,46.21,Other,324% of Medicaid,30.66,,,30.66,Other,215% of Medicaid,30.66,,,30.66,Other,215% of Medicaid,17.83,,,17.83,Other,125% of Medicaid,0.01,226.8,
TREPONEMA PALLIDUM,86780,CPT,,78086780,CDM,302,RC,,,both,,,218,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.85,,,39.85,Fee Schedule,,35.88,,,35.88,Fee Schedule,,102.09,,,102.09,Fee Schedule,,91.85,,,91.85,Fee Schedule,,86.82,,,86.82,Fee Schedule,,152.6,70,,152.6,percent of total billed charges,All Other,41.71,,,41.71,Fee Schedule,,24,,,24,Other,186% of Medicaid,49.12,,,49.12,Fee Schedule,,135.16,,,135.16,Fee Schedule,,27.8,,,,Fee Schedule,,49.12,,,49.12,Fee Schedule,,135.16,,,135.16,Fee Schedule,,52.3,,,52.3,Fee Schedule,,152.6,70,,152.6,percent of total billed charges,,62.74,,,62.74,Fee Schedule,,53.18,,,53.18,Fee Schedule,,19.86,,,19.86,Fee Schedule,,19.86,,,19.86,Fee Schedule,,19.86,,,19.86,Fee Schedule,,19.86,,,19.86,Fee Schedule,,12.76,,,12.76,Other,100% of Medicaid,12.76,,,12.76,Other,100% of Medicaid,12.76,,,12.76,Other,100% of Medicaid,12.76,,,12.76,Other,100% of Medicaid,28.7,,,28.7,Other,225% of Medicaid,19.52,,,19.52,Other,153% of Medicaid,28.7,,,28.7,Other,225% of Medicaid,17.86,,,17.86,Other,140% of Medicaid,28.7,,,28.7,Other,225% of Medicaid,33.17,,,33.17,Other,250% of Medicaid,41.33,,,41.33,Other,324% of Medicaid,27.43,,,27.43,Other,215% of Medicaid,27.43,,,27.43,Other,215% of Medicaid,15.95,,,15.95,Other,125% of Medicaid,0.01,152.6,
VARICELLA-ZOSTER ANTIBODY,86787,CPT,,78086787,CDM,302,RC,,,both,,,224,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.77,,,38.77,Fee Schedule,,34.9,,,34.9,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,156.8,70,,156.8,percent of total billed charges,All Other,40.57,,,40.57,Fee Schedule,,15,,,15,Other,186% of Medicaid,47.78,,,47.78,Fee Schedule,,138.88,,,138.88,Fee Schedule,,27.05,,,,Fee Schedule,,47.78,,,47.78,Fee Schedule,,138.88,,,138.88,Fee Schedule,,50.88,,,50.88,Fee Schedule,,156.8,70,,156.8,percent of total billed charges,,61.04,,,61.04,Fee Schedule,,51.73,,,51.73,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,156.8,
WEST NILE VIRUS AB IGM,86788,CPT,,78086788,CDM,302,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,50.72,,,50.72,Fee Schedule,,45.66,,,45.66,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,53.08,,,53.08,Fee Schedule,,15,,,15,Other,186% of Medicaid,62.51,,,62.51,Fee Schedule,,25.42,,,25.42,Fee Schedule,,35.39,,,,Fee Schedule,,62.51,,,62.51,Fee Schedule,,25.42,,,25.42,Fee Schedule,,66.56,,,66.56,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,79.85,,,79.85,Fee Schedule,,67.68,,,67.68,Fee Schedule,,25.28,,,25.28,Fee Schedule,,25.28,,,25.28,Fee Schedule,,25.28,,,25.28,Fee Schedule,,25.28,,,25.28,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,79.85,
WEST NILE VIRUS ANTIBODY,86789,CPT,,78086789,CDM,302,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.31,,,43.31,Fee Schedule,,39,,,39,Fee Schedule,,110.97,,,110.97,Fee Schedule,,99.83,,,99.83,Fee Schedule,,94.37,,,94.37,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,45.33,,,45.33,Fee Schedule,,27,,,27,Other,186% of Medicaid,53.39,,,53.39,Fee Schedule,,66.34,,,66.34,Fee Schedule,,30.22,,,,Fee Schedule,,53.39,,,53.39,Fee Schedule,,66.34,,,66.34,Fee Schedule,,56.84,,,56.84,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,,68.19,,,68.19,Fee Schedule,,57.8,,,57.8,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,21.59,,,21.59,Fee Schedule,,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,14.39,,,14.39,Other,100% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,22.02,,,22.02,Other,153% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,20.15,,,20.15,Other,140% of Medicaid,32.38,,,32.38,Other,225% of Medicaid,37.41,,,37.41,Other,250% of Medicaid,46.62,,,46.62,Other,324% of Medicaid,30.94,,,30.94,Other,215% of Medicaid,30.94,,,30.94,Other,215% of Medicaid,17.99,,,17.99,Other,125% of Medicaid,0.01,110.97,
VIRUS ANTIBODY NOS,86790,CPT,,78086790,CDM,302,RC,,,both,,,168,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.77,,,38.77,Fee Schedule,,34.9,,,34.9,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,All Other,40.57,,,40.57,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,47.78,,,47.78,Fee Schedule,,104.16,,,104.16,Fee Schedule,,27.05,,,,Fee Schedule,,47.78,,,47.78,Fee Schedule,,104.16,,,104.16,Fee Schedule,,50.88,,,50.88,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,,61.04,,,61.04,Fee Schedule,,51.73,,,51.73,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,19.32,,,19.32,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,117.6,
THYROGLOBULIN ANTIBODY,86800,CPT,,78086800,CDM,302,RC,,,both,,,268,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,47.89,,,47.89,Fee Schedule,,43.12,,,43.12,Fee Schedule,,122.64,,,122.64,Fee Schedule,,110.33,,,110.33,Fee Schedule,,104.29,,,104.29,Fee Schedule,,187.6,70,,187.6,percent of total billed charges,All Other,50.12,,,50.12,Fee Schedule,,25,,,25,Other,186% of Medicaid,59.03,,,59.03,Fee Schedule,,166.16,,,166.16,Fee Schedule,,33.41,,,,Fee Schedule,,59.03,,,59.03,Fee Schedule,,166.16,,,166.16,Fee Schedule,,62.84,,,62.84,Fee Schedule,,187.6,70,,187.6,percent of total billed charges,,75.4,,,75.4,Fee Schedule,,63.9,,,63.9,Fee Schedule,,23.87,,,23.87,Fee Schedule,,23.87,,,23.87,Fee Schedule,,23.87,,,23.87,Fee Schedule,,23.87,,,23.87,Fee Schedule,,13.48,,,13.48,Other,100% of Medicaid,13.48,,,13.48,Other,100% of Medicaid,13.48,,,13.48,Other,100% of Medicaid,13.48,,,13.48,Other,100% of Medicaid,30.34,,,30.34,Other,225% of Medicaid,20.63,,,20.63,Other,153% of Medicaid,30.34,,,30.34,Other,225% of Medicaid,18.88,,,18.88,Other,140% of Medicaid,30.34,,,30.34,Other,225% of Medicaid,35.06,,,35.06,Other,250% of Medicaid,43.69,,,43.69,Other,324% of Medicaid,28.99,,,28.99,Other,215% of Medicaid,28.99,,,28.99,Other,215% of Medicaid,16.85,,,16.85,Other,125% of Medicaid,0.01,187.6,
HEPATITIS C AB TEST,86803,CPT,,78086803,CDM,302,RC,,,both,,,284,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,42.95,,,42.95,Fee Schedule,,38.67,,,38.67,Fee Schedule,,110.04,,,110.04,Fee Schedule,,98.99,,,98.99,Fee Schedule,,93.57,,,93.57,Fee Schedule,,198.8,70,,198.8,percent of total billed charges,All Other,44.95,,,44.95,Fee Schedule,,19,,,19,Other,186% of Medicaid,52.94,,,52.94,Fee Schedule,,176.08,,,176.08,Fee Schedule,,29.97,,,,Fee Schedule,,52.94,,,52.94,Fee Schedule,,176.08,,,176.08,Fee Schedule,,56.37,,,56.37,Fee Schedule,,198.8,70,,198.8,percent of total billed charges,,67.63,,,67.63,Fee Schedule,,57.32,,,57.32,Fee Schedule,,21.41,,,21.41,Fee Schedule,,21.41,,,21.41,Fee Schedule,,21.41,,,21.41,Fee Schedule,,21.41,,,21.41,Fee Schedule,,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,15.45,,,15.45,Other,153% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,14.14,,,14.14,Other,140% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,26.26,,,26.26,Other,250% of Medicaid,32.72,,,32.72,Other,324% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,12.63,,,12.63,Other,125% of Medicaid,0.01,198.8,
HEP C AB TEST CONFIRM,86804,CPT,,78086804,CDM,302,RC,,,both,,,312,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.62,,,46.62,Fee Schedule,,41.98,,,41.98,Fee Schedule,,119.46,,,119.46,Fee Schedule,,107.47,,,107.47,Fee Schedule,,101.59,,,101.59,Fee Schedule,,218.4,70,,218.4,percent of total billed charges,All Other,48.79,,,48.79,Fee Schedule,,29,,,29,Other,186% of Medicaid,57.47,,,57.47,Fee Schedule,,193.44,,,193.44,Fee Schedule,,32.53,,,,Fee Schedule,,57.47,,,57.47,Fee Schedule,,193.44,,,193.44,Fee Schedule,,61.19,,,61.19,Fee Schedule,,218.4,70,,218.4,percent of total billed charges,,73.41,,,73.41,Fee Schedule,,62.22,,,62.22,Fee Schedule,,23.24,,,23.24,Fee Schedule,,23.24,,,23.24,Fee Schedule,,23.24,,,23.24,Fee Schedule,,23.24,,,23.24,Fee Schedule,,15.49,,,15.49,Other,100% of Medicaid,15.49,,,15.49,Other,100% of Medicaid,15.49,,,15.49,Other,100% of Medicaid,15.49,,,15.49,Other,100% of Medicaid,34.85,,,34.85,Other,225% of Medicaid,23.7,,,23.7,Other,153% of Medicaid,34.85,,,34.85,Other,225% of Medicaid,21.69,,,21.69,Other,140% of Medicaid,34.85,,,34.85,Other,225% of Medicaid,40.27,,,40.27,Other,250% of Medicaid,50.19,,,50.19,Other,324% of Medicaid,33.3,,,33.3,Other,215% of Medicaid,33.3,,,33.3,Other,215% of Medicaid,19.36,,,19.36,Other,125% of Medicaid,0.01,218.4,
HLA TYPING A B PR C,86812,CPT,,78086812,CDM,302,RC,,,both,,,293,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,77.69,,,77.69,Fee Schedule,,69.95,,,69.95,Fee Schedule,,199.03,,,199.03,Fee Schedule,,179.06,,,179.06,Fee Schedule,,169.25,,,169.25,Fee Schedule,,205.1,70,,205.1,percent of total billed charges,All Other,81.3,,,81.3,Fee Schedule,,86,,,86,Other,186% of Medicaid,95.76,,,95.76,Fee Schedule,,181.66,,,181.66,Fee Schedule,,54.2,,,,Fee Schedule,,95.76,,,95.76,Fee Schedule,,181.66,,,181.66,Fee Schedule,,101.95,,,101.95,Fee Schedule,,205.1,70,,205.1,percent of total billed charges,,122.31,,,122.31,Fee Schedule,,103.67,,,103.67,Fee Schedule,,38.72,,,38.72,Fee Schedule,,38.72,,,38.72,Fee Schedule,,38.72,,,38.72,Fee Schedule,,38.72,,,38.72,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,0.01,205.1,
HLA TYPING A B OR C,86813,CPT,,77086813,CDM,302,RC,,,both,,,343,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,174.58,,,174.58,Fee Schedule,,157.18,,,157.18,Fee Schedule,,447.22,,,447.22,Fee Schedule,,402.34,,,402.34,Fee Schedule,,380.3,,,380.3,Fee Schedule,,240.1,70,,240.1,percent of total billed charges,All Other,182.7,,,182.7,Fee Schedule,,86,,,86,Other,186% of Medicaid,215.18,,,215.18,Fee Schedule,,212.66,,,212.66,Fee Schedule,,121.8,,,,Fee Schedule,,215.18,,,215.18,Fee Schedule,,212.66,,,212.66,Fee Schedule,,229.1,,,229.1,Fee Schedule,,240.1,70,,240.1,percent of total billed charges,,274.86,,,274.86,Fee Schedule,,232.96,,,232.96,Fee Schedule,,87,,,87,Fee Schedule,,87,,,87,Fee Schedule,,87,,,87,Fee Schedule,,87,,,87,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,0.01,447.22,
HLA TYPING A B OR C,86813,CPT,,78086813,CDM,302,RC,,,both,,,343,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,174.58,,,174.58,Fee Schedule,,157.18,,,157.18,Fee Schedule,,447.22,,,447.22,Fee Schedule,,402.34,,,402.34,Fee Schedule,,380.3,,,380.3,Fee Schedule,,240.1,70,,240.1,percent of total billed charges,All Other,182.7,,,182.7,Fee Schedule,,86,,,86,Other,186% of Medicaid,215.18,,,215.18,Fee Schedule,,212.66,,,212.66,Fee Schedule,,121.8,,,,Fee Schedule,,215.18,,,215.18,Fee Schedule,,212.66,,,212.66,Fee Schedule,,229.1,,,229.1,Fee Schedule,,240.1,70,,240.1,percent of total billed charges,,274.86,,,274.86,Fee Schedule,,232.96,,,232.96,Fee Schedule,,87,,,87,Fee Schedule,,87,,,87,Fee Schedule,,87,,,87,Fee Schedule,,87,,,87,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,0.01,447.22,
HLA TYPING DR/DQ,86817,CPT,,78086817,CDM,302,RC,,,both,,,382,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,319.48,,,319.48,Fee Schedule,,287.64,,,287.64,Fee Schedule,,496.54,,,496.54,Fee Schedule,,446.71,,,446.71,Fee Schedule,,422.24,,,422.24,Fee Schedule,,267.4,70,,267.4,percent of total billed charges,All Other,334.34,,,334.34,Fee Schedule,,86,,,86,Other,186% of Medicaid,393.78,,,393.78,Fee Schedule,,236.84,,,236.84,Fee Schedule,,222.89,,,,Fee Schedule,,393.78,,,393.78,Fee Schedule,,236.84,,,236.84,Fee Schedule,,419.25,,,419.25,Fee Schedule,,267.4,70,,267.4,percent of total billed charges,,503,,,503,Fee Schedule,,426.32,,,426.32,Fee Schedule,,159.21,,,159.21,Fee Schedule,,159.21,,,159.21,Fee Schedule,,159.21,,,159.21,Fee Schedule,,159.21,,,159.21,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,0.01,503,
HLA X-MATH NON-CYTOTOXIC,86825,CPT,,78086825,CDM,302,RC,,,both,,,346,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,329.56,,,329.56,Fee Schedule,,296.72,,,296.72,Fee Schedule,,619.4,,,619.4,Fee Schedule,,557.24,,,557.24,Fee Schedule,,526.72,,,526.72,Fee Schedule,,242.2,70,,242.2,percent of total billed charges,All Other,344.89,,,344.89,Fee Schedule,,86,,,86,Other,186% of Medicaid,406.21,,,406.21,Fee Schedule,,214.52,,,214.52,Fee Schedule,,229.93,,,,Fee Schedule,,406.21,,,406.21,Fee Schedule,,214.52,,,214.52,Fee Schedule,,432.49,,,432.49,Fee Schedule,,242.2,70,,242.2,percent of total billed charges,,518.88,,,518.88,Fee Schedule,,439.78,,,439.78,Fee Schedule,,164.24,,,164.24,Fee Schedule,,164.24,,,164.24,Fee Schedule,,164.24,,,164.24,Fee Schedule,,164.24,,,164.24,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,0.01,619.4,
HLA X-MATH NONCYTOTOXIC ADDL,86826,CPT,,78086826,CDM,302,RC,,,both,,,116,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,109.96,,,109.96,Fee Schedule,,99,,,99,Fee Schedule,,206.43,,,206.43,Fee Schedule,,185.71,,,185.71,Fee Schedule,,175.54,,,175.54,Fee Schedule,,81.2,70,,81.2,percent of total billed charges,All Other,115.07,,,115.07,Fee Schedule,,86,,,86,Other,186% of Medicaid,135.53,,,135.53,Fee Schedule,,71.92,,,71.92,Fee Schedule,,76.71,,,,Fee Schedule,,135.53,,,135.53,Fee Schedule,,71.92,,,71.92,Fee Schedule,,144.29,,,144.29,Fee Schedule,,81.2,70,,81.2,percent of total billed charges,,173.12,,,173.12,Fee Schedule,,146.73,,,146.73,Fee Schedule,,54.8,,,54.8,Fee Schedule,,54.8,,,54.8,Fee Schedule,,54.8,,,54.8,Fee Schedule,,54.8,,,54.8,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,0.01,206.43,
HLA CLASS I&II ANTIBODY QUAL,86828,CPT,,78086828,CDM,302,RC,,,both,,,203,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,193.21,,,193.21,Fee Schedule,,173.95,,,173.95,Fee Schedule,,21.76,,,21.76,Fee Schedule,,21.76,,,21.76,Fee Schedule,,21.76,,,21.76,Fee Schedule,,142.1,70,,142.1,percent of total billed charges,All Other,202.2,,,202.2,Fee Schedule,,86,,,86,Other,186% of Medicaid,238.14,,,238.14,Fee Schedule,,125.86,,,125.86,Fee Schedule,,134.8,,,,Fee Schedule,,238.14,,,238.14,Fee Schedule,,125.86,,,125.86,Fee Schedule,,253.55,,,253.55,Fee Schedule,,142.1,70,,142.1,percent of total billed charges,,304.2,,,304.2,Fee Schedule,,257.83,,,257.83,Fee Schedule,,96.29,,,96.29,Fee Schedule,,96.29,,,96.29,Fee Schedule,,96.29,,,96.29,Fee Schedule,,96.29,,,96.29,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,0.01,304.2,
HLA CLASS I HIGH DEFIN QUAL,86832,CPT,,78086832,CDM,302,RC,,,both,,,1021,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,974.49,,,974.49,Fee Schedule,,877.36,,,877.36,Fee Schedule,,69.76,,,69.76,Fee Schedule,,69.76,,,69.76,Fee Schedule,,69.76,,,69.76,Fee Schedule,,714.7,70,,714.7,percent of total billed charges,All Other,1019.81,,,1019.81,Fee Schedule,,86,,,86,Other,186% of Medicaid,1201.11,,,1201.11,Fee Schedule,,633.02,,,633.02,Fee Schedule,,679.88,,,,Fee Schedule,,1201.11,,,1201.11,Fee Schedule,,633.02,,,633.02,Fee Schedule,,1278.81,,,1278.81,Fee Schedule,,714.7,70,,714.7,percent of total billed charges,,1534.26,,,1534.26,Fee Schedule,,1300.38,,,1300.38,Fee Schedule,,485.63,,,485.63,Fee Schedule,,485.63,,,485.63,Fee Schedule,,485.63,,,485.63,Fee Schedule,,485.63,,,485.63,Fee Schedule,,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,64.75,,,64.75,Other,140% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,120.26,,,120.26,Other,250% of Medicaid,149.86,,,149.86,Other,324% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,0.01,1534.26,
HLA CLASS II HIGH DEFIN QUAL,86833,CPT,,78086833,CDM,302,RC,,,both,,,1027,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,980.66,,,980.66,Fee Schedule,,882.92,,,882.92,Fee Schedule,,63.42,,,63.42,Fee Schedule,,63.42,,,63.42,Fee Schedule,,63.42,,,63.42,Fee Schedule,,718.9,70,,718.9,percent of total billed charges,All Other,1026.27,,,1026.27,Fee Schedule,,86,,,86,Other,186% of Medicaid,1208.72,,,1208.72,Fee Schedule,,636.74,,,636.74,Fee Schedule,,684.18,,,,Fee Schedule,,1208.72,,,1208.72,Fee Schedule,,636.74,,,636.74,Fee Schedule,,1286.91,,,1286.91,Fee Schedule,,718.9,70,,718.9,percent of total billed charges,,1543.98,,,1543.98,Fee Schedule,,1308.62,,,1308.62,Fee Schedule,,488.7,,,488.7,Fee Schedule,,488.7,,,488.7,Fee Schedule,,488.7,,,488.7,Fee Schedule,,488.7,,,488.7,Fee Schedule,,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,64.75,,,64.75,Other,140% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,120.26,,,120.26,Other,250% of Medicaid,149.86,,,149.86,Other,324% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,0.01,1543.98,
PROTHROMBIN ABS,86849,CPT,,78086849,CDM,302,RC,,,both,,,609,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,395.85,65,,395.85,percent of total billed charges,All Other,359.31,59,,359.31,percent of total billed charges,All Other,7.5,,,7.5,Fee Schedule,,7.5,,,7.5,Fee Schedule,,7.5,,,7.5,Fee Schedule,,426.3,70,,426.3,percent of total billed charges,All Other,414.12,68,,414.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,505.47,80,,505.47,percent of total billed charges,All Other,377.58,83,,377.58,percent of total billed charges,All Other,334.95,83,,,percent of total billed charges,All Other,505.47,80,,505.47,percent of total billed charges,All Other,377.58,83,,377.58,percent of total billed charges,All Other,487.2,80,,487.2,percent of total billed charges,All Other,426.3,70,,426.3,percent of total billed charges,,395.85,65,,395.85,percent of total billed charges,All Other,395.85,65,,395.85,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,505.47,
RBC ANTIBODY ELUTION,86860,CPT,,77086860,CDM,302,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,230.75,65,,230.75,percent of total billed charges,All Other,209.45,59,,209.45,percent of total billed charges,All Other,8.44,,,8.44,Fee Schedule,,8.44,,,8.44,Fee Schedule,,8.44,,,8.44,Fee Schedule,,248.5,70,,248.5,percent of total billed charges,All Other,241.4,68,,241.4,percent of total billed charges,All Other,22,,,22,Other,186% of Medicaid,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,195.25,83,,,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,284,80,,284,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,,230.75,65,,230.75,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,11.82,,,11.82,Other,100% of Medicaid,11.82,,,11.82,Other,100% of Medicaid,11.82,,,11.82,Other,100% of Medicaid,11.82,,,11.82,Other,100% of Medicaid,26.59,,,26.59,Other,225% of Medicaid,18.08,,,18.08,Other,153% of Medicaid,26.59,,,26.59,Other,225% of Medicaid,16.54,,,16.54,Other,140% of Medicaid,26.59,,,26.59,Other,225% of Medicaid,30.72,,,30.72,Other,250% of Medicaid,38.29,,,38.29,Other,324% of Medicaid,25.41,,,25.41,Other,215% of Medicaid,25.41,,,25.41,Other,215% of Medicaid,14.77,,,14.77,Other,125% of Medicaid,8.44,308.64,
RBC ANTIBODY ELUTION,86860,CPT,,78086860,CDM,302,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,230.75,65,,230.75,percent of total billed charges,All Other,209.45,59,,209.45,percent of total billed charges,All Other,8.44,,,8.44,Fee Schedule,,8.44,,,8.44,Fee Schedule,,8.44,,,8.44,Fee Schedule,,248.5,70,,248.5,percent of total billed charges,All Other,241.4,68,,241.4,percent of total billed charges,All Other,22,,,22,Other,186% of Medicaid,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,195.25,83,,,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,284,80,,284,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,,230.75,65,,230.75,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,11.82,,,11.82,Other,100% of Medicaid,11.82,,,11.82,Other,100% of Medicaid,11.82,,,11.82,Other,100% of Medicaid,11.82,,,11.82,Other,100% of Medicaid,26.59,,,26.59,Other,225% of Medicaid,18.08,,,18.08,Other,153% of Medicaid,26.59,,,26.59,Other,225% of Medicaid,16.54,,,16.54,Other,140% of Medicaid,26.59,,,26.59,Other,225% of Medicaid,30.72,,,30.72,Other,250% of Medicaid,38.29,,,38.29,Other,324% of Medicaid,25.41,,,25.41,Other,215% of Medicaid,25.41,,,25.41,Other,215% of Medicaid,14.77,,,14.77,Other,125% of Medicaid,8.44,308.64,
RBC ANTIBODY IDENTIFICATION,86870,CPT,,77086870,CDM,302,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,475.15,65,,475.15,percent of total billed charges,All Other,431.29,59,,431.29,percent of total billed charges,All Other,11.57,,,11.57,Fee Schedule,,11.57,,,11.57,Fee Schedule,,11.57,,,11.57,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,497.08,68,,497.08,percent of total billed charges,All Other,26,,,26,Other,186% of Medicaid,606.73,80,,606.73,percent of total billed charges,All Other,453.22,83,,453.22,percent of total billed charges,All Other,402.05,83,,,percent of total billed charges,All Other,606.73,80,,606.73,percent of total billed charges,All Other,453.22,83,,453.22,percent of total billed charges,All Other,584.8,80,,584.8,percent of total billed charges,All Other,511.7,70,,511.7,percent of total billed charges,,475.15,65,,475.15,percent of total billed charges,All Other,475.15,65,,475.15,percent of total billed charges,All Other,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,14.24,,,14.24,Other,100% of Medicaid,14.24,,,14.24,Other,100% of Medicaid,14.24,,,14.24,Other,100% of Medicaid,14.24,,,14.24,Other,100% of Medicaid,32.04,,,32.04,Other,225% of Medicaid,21.79,,,21.79,Other,153% of Medicaid,32.04,,,32.04,Other,225% of Medicaid,19.94,,,19.94,Other,140% of Medicaid,32.04,,,32.04,Other,225% of Medicaid,37.03,,,37.03,Other,250% of Medicaid,46.14,,,46.14,Other,324% of Medicaid,30.62,,,30.62,Other,215% of Medicaid,30.62,,,30.62,Other,215% of Medicaid,17.8,,,17.8,Other,125% of Medicaid,11.57,649.53,
RBC ANTIBODY IDENTIFICATION,86870,CPT,,78086870,CDM,302,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,475.15,65,,475.15,percent of total billed charges,All Other,431.29,59,,431.29,percent of total billed charges,All Other,11.57,,,11.57,Fee Schedule,,11.57,,,11.57,Fee Schedule,,11.57,,,11.57,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,497.08,68,,497.08,percent of total billed charges,All Other,26,,,26,Other,186% of Medicaid,606.73,80,,606.73,percent of total billed charges,All Other,453.22,83,,453.22,percent of total billed charges,All Other,402.05,83,,,percent of total billed charges,All Other,606.73,80,,606.73,percent of total billed charges,All Other,453.22,83,,453.22,percent of total billed charges,All Other,584.8,80,,584.8,percent of total billed charges,All Other,511.7,70,,511.7,percent of total billed charges,,475.15,65,,475.15,percent of total billed charges,All Other,475.15,65,,475.15,percent of total billed charges,All Other,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,14.24,,,14.24,Other,100% of Medicaid,14.24,,,14.24,Other,100% of Medicaid,14.24,,,14.24,Other,100% of Medicaid,14.24,,,14.24,Other,100% of Medicaid,32.04,,,32.04,Other,225% of Medicaid,21.79,,,21.79,Other,153% of Medicaid,32.04,,,32.04,Other,225% of Medicaid,19.94,,,19.94,Other,140% of Medicaid,32.04,,,32.04,Other,225% of Medicaid,37.03,,,37.03,Other,250% of Medicaid,46.14,,,46.14,Other,324% of Medicaid,30.62,,,30.62,Other,215% of Medicaid,30.62,,,30.62,Other,215% of Medicaid,17.8,,,17.8,Other,125% of Medicaid,11.57,649.53,
COOMBS TEST DIRECT,86880,CPT,,77086880,CDM,302,RC,,,both,,,131,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Fee Schedule,,16.22,,,16.22,Fee Schedule,,14.61,,,14.61,Fee Schedule,,41.43,,,41.43,Fee Schedule,,37.27,,,37.27,Fee Schedule,,35.23,,,35.23,Fee Schedule,,91.7,70,,91.7,percent of total billed charges,All Other,16.98,,,16.98,Fee Schedule,,9,,,9,Other,186% of Medicaid,20,,,20,Fee Schedule,,81.22,,,81.22,Fee Schedule,,11.32,,,,Fee Schedule,,20,,,20,Fee Schedule,,81.22,,,81.22,Fee Schedule,,21.29,,,21.29,Fee Schedule,,91.7,70,,91.7,percent of total billed charges,,25.54,,,25.54,Fee Schedule,,21.65,,,21.65,Fee Schedule,,8.09,,,8.09,Fee Schedule,,8.09,,,8.09,Fee Schedule,,8.09,,,8.09,Fee Schedule,,8.09,,,8.09,Fee Schedule,,4.74,,,4.74,Other,100% of Medicaid,4.74,,,4.74,Other,100% of Medicaid,4.74,,,4.74,Other,100% of Medicaid,4.74,,,4.74,Other,100% of Medicaid,10.66,,,10.66,Other,225% of Medicaid,7.25,,,7.25,Other,153% of Medicaid,10.66,,,10.66,Other,225% of Medicaid,6.63,,,6.63,Other,140% of Medicaid,10.66,,,10.66,Other,225% of Medicaid,12.32,,,12.32,Other,250% of Medicaid,15.35,,,15.35,Other,324% of Medicaid,10.18,,,10.18,Other,215% of Medicaid,10.18,,,10.18,Other,215% of Medicaid,5.92,,,5.92,Other,125% of Medicaid,4.74,110.53,
COOMBS TEST DIRECT,86880,CPT,,78086880,CDM,302,RC,,,both,,,131,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Fee Schedule,,16.22,,,16.22,Fee Schedule,,14.61,,,14.61,Fee Schedule,,41.43,,,41.43,Fee Schedule,,37.27,,,37.27,Fee Schedule,,35.23,,,35.23,Fee Schedule,,91.7,70,,91.7,percent of total billed charges,All Other,16.98,,,16.98,Fee Schedule,,9,,,9,Other,186% of Medicaid,20,,,20,Fee Schedule,,81.22,,,81.22,Fee Schedule,,11.32,,,,Fee Schedule,,20,,,20,Fee Schedule,,81.22,,,81.22,Fee Schedule,,21.29,,,21.29,Fee Schedule,,91.7,70,,91.7,percent of total billed charges,,25.54,,,25.54,Fee Schedule,,21.65,,,21.65,Fee Schedule,,8.09,,,8.09,Fee Schedule,,8.09,,,8.09,Fee Schedule,,8.09,,,8.09,Fee Schedule,,8.09,,,8.09,Fee Schedule,,4.74,,,4.74,Other,100% of Medicaid,4.74,,,4.74,Other,100% of Medicaid,4.74,,,4.74,Other,100% of Medicaid,4.74,,,4.74,Other,100% of Medicaid,10.66,,,10.66,Other,225% of Medicaid,7.25,,,7.25,Other,153% of Medicaid,10.66,,,10.66,Other,225% of Medicaid,6.63,,,6.63,Other,140% of Medicaid,10.66,,,10.66,Other,225% of Medicaid,12.32,,,12.32,Other,250% of Medicaid,15.35,,,15.35,Other,324% of Medicaid,10.18,,,10.18,Other,215% of Medicaid,10.18,,,10.18,Other,215% of Medicaid,5.92,,,5.92,Other,125% of Medicaid,4.74,110.53,
COOMBS TEST INDIRECT QUAL,86885,CPT,,78086885,CDM,302,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Fee Schedule,,17.22,,,17.22,Fee Schedule,,15.5,,,15.5,Fee Schedule,,44.17,,,44.17,Fee Schedule,,39.74,,,39.74,Fee Schedule,,37.56,,,37.56,Fee Schedule,,248.5,70,,248.5,percent of total billed charges,All Other,18.02,,,18.02,Fee Schedule,,86,,,86,Other,186% of Medicaid,21.22,,,21.22,Fee Schedule,,220.1,,,220.1,Fee Schedule,,12.01,,,,Fee Schedule,,21.22,,,21.22,Fee Schedule,,220.1,,,220.1,Fee Schedule,,22.59,,,22.59,Fee Schedule,,248.5,70,,248.5,percent of total billed charges,,27.11,,,27.11,Fee Schedule,,22.98,,,22.98,Fee Schedule,,8.58,,,8.58,Fee Schedule,,8.58,,,8.58,Fee Schedule,,8.58,,,8.58,Fee Schedule,,8.58,,,8.58,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,8.58,308.64,
BLOOD TYPE ANTIGEN DONOR EA,86902,CPT,,77086902,CDM,302,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Fee Schedule,,19.11,,,19.11,Fee Schedule,,17.21,,,17.21,Fee Schedule,,29.48,,,29.48,Fee Schedule,,26.52,,,26.52,Fee Schedule,,25.07,,,25.07,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,20,,,20,Fee Schedule,,86,,,86,Other,186% of Medicaid,23.56,,,23.56,Fee Schedule,,453.22,,,453.22,Fee Schedule,,13.34,,,,Fee Schedule,,23.56,,,23.56,Fee Schedule,,453.22,,,453.22,Fee Schedule,,25.08,,,25.08,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,30.09,,,30.09,Fee Schedule,,25.51,,,25.51,Fee Schedule,,9.53,,,9.53,Fee Schedule,,9.53,,,9.53,Fee Schedule,,9.53,,,9.53,Fee Schedule,,9.53,,,9.53,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,9.53,649.53,
BLOOD TYPE ANTIGEN DONOR EA,86902,CPT,,78086902,CDM,302,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Fee Schedule,,19.11,,,19.11,Fee Schedule,,17.21,,,17.21,Fee Schedule,,29.48,,,29.48,Fee Schedule,,26.52,,,26.52,Fee Schedule,,25.07,,,25.07,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,20,,,20,Fee Schedule,,86,,,86,Other,186% of Medicaid,23.56,,,23.56,Fee Schedule,,453.22,,,453.22,Fee Schedule,,13.34,,,,Fee Schedule,,23.56,,,23.56,Fee Schedule,,453.22,,,453.22,Fee Schedule,,25.08,,,25.08,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,30.09,,,30.09,Fee Schedule,,25.51,,,25.51,Fee Schedule,,9.53,,,9.53,Fee Schedule,,9.53,,,9.53,Fee Schedule,,9.53,,,9.53,Fee Schedule,,9.53,,,9.53,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,9.53,649.53,
BLOOD TYPING RBC ANTIGENS,86905,CPT,,78086905,CDM,302,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Fee Schedule,,11.53,,,11.53,Fee Schedule,,10.38,,,10.38,Fee Schedule,,29.48,,,29.48,Fee Schedule,,26.52,,,26.52,Fee Schedule,,25.07,,,25.07,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,12.06,,,12.06,Fee Schedule,,7,,,7,Other,186% of Medicaid,14.21,,,14.21,Fee Schedule,,453.22,,,453.22,Fee Schedule,,8.04,,,,Fee Schedule,,14.21,,,14.21,Fee Schedule,,453.22,,,453.22,Fee Schedule,,15.13,,,15.13,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,18.15,,,18.15,Fee Schedule,,15.38,,,15.38,Fee Schedule,,5.75,,,5.75,Fee Schedule,,5.75,,,5.75,Fee Schedule,,5.75,,,5.75,Fee Schedule,,5.75,,,5.75,Fee Schedule,,3.83,,,3.83,Other,100% of Medicaid,3.83,,,3.83,Other,100% of Medicaid,3.83,,,3.83,Other,100% of Medicaid,3.83,,,3.83,Other,100% of Medicaid,8.62,,,8.62,Other,225% of Medicaid,5.86,,,5.86,Other,153% of Medicaid,8.62,,,8.62,Other,225% of Medicaid,5.36,,,5.36,Other,140% of Medicaid,8.62,,,8.62,Other,225% of Medicaid,9.96,,,9.96,Other,250% of Medicaid,12.41,,,12.41,Other,324% of Medicaid,8.23,,,8.23,Other,215% of Medicaid,8.23,,,8.23,Other,215% of Medicaid,4.79,,,4.79,Other,125% of Medicaid,3.83,649.53,
BLD TYPING SEROLOGIC RH PHNT,86906,CPT,,78086906,CDM,302,RC,,,both,,,133,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Fee Schedule,,23.33,,,23.33,Fee Schedule,,21,,,21,Fee Schedule,,59.79,,,59.79,Fee Schedule,,53.79,,,53.79,Fee Schedule,,50.84,,,50.84,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,24.41,,,24.41,Fee Schedule,,86,,,86,Other,186% of Medicaid,28.75,,,28.75,Fee Schedule,,82.46,,,82.46,Fee Schedule,,16.28,,,,Fee Schedule,,28.75,,,28.75,Fee Schedule,,82.46,,,82.46,Fee Schedule,,30.61,,,30.61,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,,36.73,,,36.73,Fee Schedule,,31.13,,,31.13,Fee Schedule,,11.63,,,11.63,Fee Schedule,,11.63,,,11.63,Fee Schedule,,11.63,,,11.63,Fee Schedule,,11.63,,,11.63,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,11.63,149.87,
COMPATIBILITY TEST ANTIGLOB,86922,CPT,,77086922,CDM,302,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,230.75,65,,230.75,percent of total billed charges,All Other,209.45,59,,209.45,percent of total billed charges,All Other,10.08,,,10.08,Fee Schedule,,10.08,,,10.08,Fee Schedule,,10.08,,,10.08,Fee Schedule,,248.5,70,,248.5,percent of total billed charges,All Other,241.4,68,,241.4,percent of total billed charges,All Other,86,,,86,Other,186% of Medicaid,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,195.25,83,,,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,284,80,,284,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,,230.75,65,,230.75,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,64.75,,,64.75,Other,140% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,120.26,,,120.26,Other,250% of Medicaid,149.86,,,149.86,Other,324% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,10.08,308.64,
COMPATIBILITY TEST ANTIGLOB,86922,CPT,,78086922,CDM,302,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,230.75,65,,230.75,percent of total billed charges,All Other,209.45,59,,209.45,percent of total billed charges,All Other,10.08,,,10.08,Fee Schedule,,10.08,,,10.08,Fee Schedule,,10.08,,,10.08,Fee Schedule,,248.5,70,,248.5,percent of total billed charges,All Other,241.4,68,,241.4,percent of total billed charges,All Other,86,,,86,Other,186% of Medicaid,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,195.25,83,,,percent of total billed charges,All Other,294.65,80,,294.65,percent of total billed charges,All Other,220.1,83,,220.1,percent of total billed charges,All Other,284,80,,284,percent of total billed charges,All Other,248.5,70,,248.5,percent of total billed charges,,230.75,65,,230.75,percent of total billed charges,All Other,230.75,65,,230.75,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,64.75,,,64.75,Other,140% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,120.26,,,120.26,Other,250% of Medicaid,149.86,,,149.86,Other,324% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,10.08,308.64,
BLOOD PRODUCT/IRRADIATION,86945,CPT,,78086945,CDM,302,RC,,,both,,,78,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,50.7,65,,50.7,percent of total billed charges,All Other,46.02,59,,46.02,percent of total billed charges,All Other,7.9,,,7.9,Fee Schedule,,7.9,,,7.9,Fee Schedule,,7.9,,,7.9,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,All Other,53.04,68,,53.04,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,64.74,80,,64.74,percent of total billed charges,All Other,48.36,83,,48.36,percent of total billed charges,All Other,42.9,83,,,percent of total billed charges,All Other,64.74,80,,64.74,percent of total billed charges,All Other,48.36,83,,48.36,percent of total billed charges,All Other,62.4,80,,62.4,percent of total billed charges,All Other,54.6,70,,54.6,percent of total billed charges,,50.7,65,,50.7,percent of total billed charges,All Other,50.7,65,,50.7,percent of total billed charges,All Other,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,7.9,148.19,
RBC PRETX INCUBATJ W/CHEMICL,86970,CPT,,78086970,CDM,302,RC,,,both,,,133,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,86.45,65,,86.45,percent of total billed charges,All Other,78.47,59,,78.47,percent of total billed charges,All Other,101.75,76.5,,101.75,percent of total billed charges,All Other,91.77,69,,91.77,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,All Other,90.44,68,,90.44,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,73.15,83,,,percent of total billed charges,All Other,110.39,80,,110.39,percent of total billed charges,All Other,82.46,83,,82.46,percent of total billed charges,All Other,106.4,80,,106.4,percent of total billed charges,All Other,93.1,70,,93.1,percent of total billed charges,,86.45,65,,86.45,percent of total billed charges,All Other,86.45,65,,86.45,percent of total billed charges,All Other,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,148.19,
RBC PRETREATMENT,86971,CPT,,78086971,CDM,302,RC,,,both,,,731,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,475.15,65,,475.15,percent of total billed charges,All Other,431.29,59,,431.29,percent of total billed charges,All Other,559.22,76.5,,559.22,percent of total billed charges,All Other,504.39,69,,504.39,percent of total billed charges,All Other,475.15,65,,475.15,percent of total billed charges,All Other,511.7,70,,511.7,percent of total billed charges,All Other,497.08,68,,497.08,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,606.73,80,,606.73,percent of total billed charges,All Other,453.22,83,,453.22,percent of total billed charges,All Other,402.05,83,,,percent of total billed charges,All Other,606.73,80,,606.73,percent of total billed charges,All Other,453.22,83,,453.22,percent of total billed charges,All Other,584.8,80,,584.8,percent of total billed charges,All Other,511.7,70,,511.7,percent of total billed charges,,475.15,65,,475.15,percent of total billed charges,All Other,475.15,65,,475.15,percent of total billed charges,All Other,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,606.73,
RBC SERUM PRETX INCUBJ DRUGS,86975,CPT,,78086975,CDM,302,RC,,,both,,,1054,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,685.1,65,,685.1,percent of total billed charges,All Other,621.86,59,,621.86,percent of total billed charges,All Other,806.31,76.5,,806.31,percent of total billed charges,All Other,727.26,69,,727.26,percent of total billed charges,All Other,685.1,65,,685.1,percent of total billed charges,All Other,737.8,70,,737.8,percent of total billed charges,All Other,716.72,68,,716.72,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,874.82,80,,874.82,percent of total billed charges,All Other,653.48,83,,653.48,percent of total billed charges,All Other,579.7,83,,,percent of total billed charges,All Other,874.82,80,,874.82,percent of total billed charges,All Other,653.48,83,,653.48,percent of total billed charges,All Other,843.2,80,,843.2,percent of total billed charges,All Other,737.8,70,,737.8,percent of total billed charges,,685.1,65,,685.1,percent of total billed charges,All Other,685.1,65,,685.1,percent of total billed charges,All Other,163.55,,,163.55,Fee Schedule,,163.55,,,163.55,Fee Schedule,,163.55,,,163.55,Fee Schedule,,163.55,,,163.55,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,874.82,
RBC SERUM PRETX INCUBJ/INHIB,86977,CPT,,78086977,CDM,302,RC,,,both,,,579,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,376.35,65,,376.35,percent of total billed charges,All Other,341.61,59,,341.61,percent of total billed charges,All Other,442.94,76.5,,442.94,percent of total billed charges,All Other,399.51,69,,399.51,percent of total billed charges,All Other,376.35,65,,376.35,percent of total billed charges,All Other,405.3,70,,405.3,percent of total billed charges,All Other,393.72,68,,393.72,percent of total billed charges,All Other,85,,,85,Other,186% of Medicaid,480.57,80,,480.57,percent of total billed charges,All Other,358.98,83,,358.98,percent of total billed charges,All Other,318.45,83,,,percent of total billed charges,All Other,480.57,80,,480.57,percent of total billed charges,All Other,358.98,83,,358.98,percent of total billed charges,All Other,463.2,80,,463.2,percent of total billed charges,All Other,405.3,70,,405.3,percent of total billed charges,,376.35,65,,376.35,percent of total billed charges,All Other,376.35,65,,376.35,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,45.74,,,45.74,Other,100% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,69.98,,,69.98,Other,153% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,64.03,,,64.03,Other,140% of Medicaid,102.91,,,102.91,Other,225% of Medicaid,118.92,,,118.92,Other,250% of Medicaid,148.19,,,148.19,Other,324% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,98.34,,,98.34,Other,215% of Medicaid,57.17,,,57.17,Other,125% of Medicaid,45.74,480.57,
TRANSFUSION PROCEDURE,86999,CPT,,78086999,CDM,302,RC,,,both,,,86,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,55.9,65,,55.9,percent of total billed charges,All Other,50.74,59,,50.74,percent of total billed charges,All Other,65.79,76.5,,65.79,percent of total billed charges,All Other,59.34,69,,59.34,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,All Other,58.48,68,,58.48,percent of total billed charges,All Other,86,,,86,Other,186% of Medicaid,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,47.3,83,,,percent of total billed charges,All Other,71.38,80,,71.38,percent of total billed charges,All Other,53.32,83,,53.32,percent of total billed charges,All Other,68.8,80,,68.8,percent of total billed charges,All Other,60.2,70,,60.2,percent of total billed charges,,55.9,65,,55.9,percent of total billed charges,All Other,55.9,65,,55.9,percent of total billed charges,All Other,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,32.72,149.87,
BLEEDING TIME TEST,85002,CPT,,78085002,CDM,305,RC,,,both,,,47,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14.51,,,14.51,Fee Schedule,,13.06,,,13.06,Fee Schedule,,34.69,,,34.69,Fee Schedule,,31.21,,,31.21,Fee Schedule,,29.5,,,29.5,Fee Schedule,,32.9,70,,32.9,percent of total billed charges,All Other,15.18,,,15.18,Fee Schedule,,6,,,6,Other,186% of Medicaid,17.88,,,17.88,Fee Schedule,,29.14,,,29.14,Fee Schedule,,10.12,,,,Fee Schedule,,17.88,,,17.88,Fee Schedule,,29.14,,,29.14,Fee Schedule,,19.04,,,19.04,Fee Schedule,,32.9,70,,32.9,percent of total billed charges,,22.84,,,22.84,Fee Schedule,,19.36,,,19.36,Fee Schedule,,7.23,,,7.23,Fee Schedule,,7.23,,,7.23,Fee Schedule,,7.23,,,7.23,Fee Schedule,,7.23,,,7.23,Fee Schedule,,3.03,,,3.03,Other,100% of Medicaid,3.03,,,3.03,Other,100% of Medicaid,3.03,,,3.03,Other,100% of Medicaid,3.03,,,3.03,Other,100% of Medicaid,6.82,,,6.82,Other,225% of Medicaid,4.64,,,4.64,Other,153% of Medicaid,6.82,,,6.82,Other,225% of Medicaid,4.24,,,4.24,Other,140% of Medicaid,6.82,,,6.82,Other,225% of Medicaid,7.88,,,7.88,Other,250% of Medicaid,9.82,,,9.82,Other,324% of Medicaid,6.51,,,6.51,Other,215% of Medicaid,6.51,,,6.51,Other,215% of Medicaid,3.79,,,3.79,Other,125% of Medicaid,0.01,34.69,
AUTOMATED DIFF WBC COUNT,85004,CPT,,78085004,CDM,305,RC,,,both,,,33,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.47,,,19.47,Fee Schedule,,17.53,,,17.53,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,23.1,70,,23.1,percent of total billed charges,All Other,20.38,,,20.38,Fee Schedule,,6,,,6,Other,186% of Medicaid,24,,,24,Fee Schedule,,20.46,,,20.46,Fee Schedule,,13.59,,,,Fee Schedule,,24,,,24,Fee Schedule,,20.46,,,20.46,Fee Schedule,,25.56,,,25.56,Fee Schedule,,23.1,70,,23.1,percent of total billed charges,,30.66,,,30.66,Fee Schedule,,25.99,,,25.99,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,4.9,,,4.9,Other,153% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,4.48,,,4.48,Other,140% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,8.32,,,8.32,Other,250% of Medicaid,10.37,,,10.37,Other,324% of Medicaid,6.88,,,6.88,Other,215% of Medicaid,6.88,,,6.88,Other,215% of Medicaid,4,,,4,Other,125% of Medicaid,0.01,44.83,
BL SMEAR W/DIFF WBC COUNT,85007,CPT,,78085007,CDM,305,RC,,,both,,,40,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,11.44,,,11.44,Fee Schedule,,10.3,,,10.3,Fee Schedule,,26.52,,,26.52,Fee Schedule,,23.86,,,23.86,Fee Schedule,,22.55,,,22.55,Fee Schedule,,28,70,,28,percent of total billed charges,All Other,11.97,,,11.97,Fee Schedule,,3,,,3,Other,186% of Medicaid,14.1,,,14.1,Fee Schedule,,24.8,,,24.8,Fee Schedule,,7.98,,,,Fee Schedule,,14.1,,,14.1,Fee Schedule,,24.8,,,24.8,Fee Schedule,,15.01,,,15.01,Fee Schedule,,28,70,,28,percent of total billed charges,,18.01,,,18.01,Fee Schedule,,15.26,,,15.26,Fee Schedule,,5.7,,,5.7,Fee Schedule,,5.7,,,5.7,Fee Schedule,,5.7,,,5.7,Fee Schedule,,5.7,,,5.7,Fee Schedule,,1.44,,,1.44,Other,100% of Medicaid,1.44,,,1.44,Other,100% of Medicaid,1.44,,,1.44,Other,100% of Medicaid,1.44,,,1.44,Other,100% of Medicaid,3.25,,,3.25,Other,225% of Medicaid,2.21,,,2.21,Other,153% of Medicaid,3.25,,,3.25,Other,225% of Medicaid,2.02,,,2.02,Other,140% of Medicaid,3.25,,,3.25,Other,225% of Medicaid,3.76,,,3.76,Other,250% of Medicaid,4.68,,,4.68,Other,324% of Medicaid,3.11,,,3.11,Other,215% of Medicaid,3.11,,,3.11,Other,215% of Medicaid,1.81,,,1.81,Other,125% of Medicaid,0.01,28,
BL SMEAR W/O DIFF WBC COUNT,85008,CPT,,78085008,CDM,305,RC,,,both,,,38,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,10.32,,,10.32,Fee Schedule,,9.3,,,9.3,Fee Schedule,,26.52,,,26.52,Fee Schedule,,23.86,,,23.86,Fee Schedule,,22.55,,,22.55,Fee Schedule,,26.6,70,,26.6,percent of total billed charges,All Other,10.8,,,10.8,Fee Schedule,,33,,,33,Other,186% of Medicaid,12.73,,,12.73,Fee Schedule,,23.56,,,23.56,Fee Schedule,,7.2,,,,Fee Schedule,,12.73,,,12.73,Fee Schedule,,23.56,,,23.56,Fee Schedule,,13.55,,,13.55,Fee Schedule,,26.6,70,,26.6,percent of total billed charges,,16.25,,,16.25,Fee Schedule,,13.78,,,13.78,Fee Schedule,,5.15,,,5.15,Fee Schedule,,5.15,,,5.15,Fee Schedule,,5.15,,,5.15,Fee Schedule,,5.15,,,5.15,Fee Schedule,,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,27.38,,,27.38,Other,153% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,25.06,,,25.06,Other,140% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,46.53,,,46.53,Other,250% of Medicaid,57.99,,,57.99,Other,324% of Medicaid,38.48,,,38.48,Other,215% of Medicaid,38.48,,,38.48,Other,215% of Medicaid,22.37,,,22.37,Other,125% of Medicaid,0.01,57.99,
HEMOGLOBIN,85018,CPT,,78085018,CDM,305,RC,,,both,,,83,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,7.13,,,7.13,Fee Schedule,,6.42,,,6.42,Fee Schedule,,18.25,,,18.25,Fee Schedule,,16.42,,,16.42,Fee Schedule,,15.52,,,15.52,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,All Other,7.47,,,7.47,Fee Schedule,,4,,,4,Other,186% of Medicaid,8.79,,,8.79,Fee Schedule,,51.46,,,51.46,Fee Schedule,,4.98,,,,Fee Schedule,,8.79,,,8.79,Fee Schedule,,51.46,,,51.46,Fee Schedule,,9.36,,,9.36,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,,11.23,,,11.23,Fee Schedule,,9.52,,,9.52,Fee Schedule,,3.56,,,3.56,Fee Schedule,,3.56,,,3.56,Fee Schedule,,3.56,,,3.56,Fee Schedule,,3.56,,,3.56,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,58.1,
COMPLETE CBC W/AUTO DIFF WBC,85025,CPT,,78085025,CDM,305,RC,,,both,,,124,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,23.39,,,23.39,Fee Schedule,,21.06,,,21.06,Fee Schedule,,59.95,,,59.95,Fee Schedule,,53.93,,,53.93,Fee Schedule,,50.98,,,50.98,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,All Other,24.48,,,24.48,Fee Schedule,,6,,,6,Other,186% of Medicaid,28.83,,,28.83,Fee Schedule,,76.88,,,76.88,Fee Schedule,,16.32,,,,Fee Schedule,,28.83,,,28.83,Fee Schedule,,76.88,,,76.88,Fee Schedule,,30.69,,,30.69,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,,36.82,,,36.82,Fee Schedule,,31.21,,,31.21,Fee Schedule,,11.66,,,11.66,Fee Schedule,,11.66,,,11.66,Fee Schedule,,11.66,,,11.66,Fee Schedule,,11.66,,,11.66,Fee Schedule,,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,4.9,,,4.9,Other,153% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,4.48,,,4.48,Other,140% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,8.32,,,8.32,Other,250% of Medicaid,10.37,,,10.37,Other,324% of Medicaid,6.88,,,6.88,Other,215% of Medicaid,6.88,,,6.88,Other,215% of Medicaid,4,,,4,Other,125% of Medicaid,0.01,86.8,
COMPLETE CBC AUTOMATED,85027,CPT,,78085027,CDM,305,RC,,,both,,,100,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.47,,,19.47,Fee Schedule,,17.53,,,17.53,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,70,70,,70,percent of total billed charges,All Other,20.38,,,20.38,Fee Schedule,,6,,,6,Other,186% of Medicaid,24,,,24,Fee Schedule,,62,,,62,Fee Schedule,,13.59,,,,Fee Schedule,,24,,,24,Fee Schedule,,62,,,62,Fee Schedule,,25.56,,,25.56,Fee Schedule,,70,70,,70,percent of total billed charges,,30.66,,,30.66,Fee Schedule,,25.99,,,25.99,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,9.71,,,9.71,Fee Schedule,,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,4.9,,,4.9,Other,153% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,4.48,,,4.48,Other,140% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,8.32,,,8.32,Other,250% of Medicaid,10.37,,,10.37,Other,324% of Medicaid,6.88,,,6.88,Other,215% of Medicaid,6.88,,,6.88,Other,215% of Medicaid,4,,,4,Other,125% of Medicaid,0.01,70,
MANUAL CELL COUNT EACH,85032,CPT,,78085032,CDM,305,RC,,,both,,,38,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12.97,,,12.97,Fee Schedule,,11.68,,,11.68,Fee Schedule,,33.15,,,33.15,Fee Schedule,,29.83,,,29.83,Fee Schedule,,28.19,,,28.19,Fee Schedule,,26.6,70,,26.6,percent of total billed charges,All Other,13.58,,,13.58,Fee Schedule,,4,,,4,Other,186% of Medicaid,15.99,,,15.99,Fee Schedule,,23.56,,,23.56,Fee Schedule,,9.05,,,,Fee Schedule,,15.99,,,15.99,Fee Schedule,,23.56,,,23.56,Fee Schedule,,17.02,,,17.02,Fee Schedule,,26.6,70,,26.6,percent of total billed charges,,20.43,,,20.43,Fee Schedule,,17.31,,,17.31,Fee Schedule,,6.47,,,6.47,Fee Schedule,,6.47,,,6.47,Fee Schedule,,6.47,,,6.47,Fee Schedule,,6.47,,,6.47,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,33.15,
AUTOMATED RBC COUNT,85041,CPT,,78085041,CDM,305,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,9.09,,,9.09,Fee Schedule,,8.18,,,8.18,Fee Schedule,,23.24,,,23.24,Fee Schedule,,20.9,,,20.9,Fee Schedule,,19.76,,,19.76,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,9.51,,,9.51,Fee Schedule,,6,,,6,Other,186% of Medicaid,11.2,,,11.2,Fee Schedule,,25.42,,,25.42,Fee Schedule,,6.34,,,,Fee Schedule,,11.2,,,11.2,Fee Schedule,,25.42,,,25.42,Fee Schedule,,11.93,,,11.93,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,14.31,,,14.31,Fee Schedule,,12.13,,,12.13,Fee Schedule,,4.53,,,4.53,Fee Schedule,,4.53,,,4.53,Fee Schedule,,4.53,,,4.53,Fee Schedule,,4.53,,,4.53,Fee Schedule,,3.02,,,3.02,Other,100% of Medicaid,3.02,,,3.02,Other,100% of Medicaid,3.02,,,3.02,Other,100% of Medicaid,3.02,,,3.02,Other,100% of Medicaid,6.8,,,6.8,Other,225% of Medicaid,4.62,,,4.62,Other,153% of Medicaid,6.8,,,6.8,Other,225% of Medicaid,4.23,,,4.23,Other,140% of Medicaid,6.8,,,6.8,Other,225% of Medicaid,7.85,,,7.85,Other,250% of Medicaid,9.78,,,9.78,Other,324% of Medicaid,6.49,,,6.49,Other,215% of Medicaid,6.49,,,6.49,Other,215% of Medicaid,3.78,,,3.78,Other,125% of Medicaid,0.01,28.7,
MANUAL RETICULOCYTE COUNT,85044,CPT,,78085044,CDM,305,RC,,,both,,,77,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12.97,,,12.97,Fee Schedule,,11.68,,,11.68,Fee Schedule,,33.15,,,33.15,Fee Schedule,,29.83,,,29.83,Fee Schedule,,28.19,,,28.19,Fee Schedule,,53.9,70,,53.9,percent of total billed charges,All Other,13.58,,,13.58,Fee Schedule,,3,,,3,Other,186% of Medicaid,15.99,,,15.99,Fee Schedule,,47.74,,,47.74,Fee Schedule,,9.05,,,,Fee Schedule,,15.99,,,15.99,Fee Schedule,,47.74,,,47.74,Fee Schedule,,17.02,,,17.02,Fee Schedule,,53.9,70,,53.9,percent of total billed charges,,20.43,,,20.43,Fee Schedule,,17.31,,,17.31,Fee Schedule,,6.47,,,6.47,Fee Schedule,,6.47,,,6.47,Fee Schedule,,6.47,,,6.47,Fee Schedule,,6.47,,,6.47,Fee Schedule,,1.44,,,1.44,Other,100% of Medicaid,1.44,,,1.44,Other,100% of Medicaid,1.44,,,1.44,Other,100% of Medicaid,1.44,,,1.44,Other,100% of Medicaid,3.25,,,3.25,Other,225% of Medicaid,2.21,,,2.21,Other,153% of Medicaid,3.25,,,3.25,Other,225% of Medicaid,2.02,,,2.02,Other,140% of Medicaid,3.25,,,3.25,Other,225% of Medicaid,3.76,,,3.76,Other,250% of Medicaid,4.68,,,4.68,Other,324% of Medicaid,3.11,,,3.11,Other,215% of Medicaid,3.11,,,3.11,Other,215% of Medicaid,1.81,,,1.81,Other,125% of Medicaid,0.01,53.9,
AUTOMATED RETICULOCYTE COUNT,85045,CPT,,78085045,CDM,305,RC,,,both,,,55,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.01,,,12.01,Fee Schedule,,10.81,,,10.81,Fee Schedule,,30.85,,,30.85,Fee Schedule,,27.76,,,27.76,Fee Schedule,,26.24,,,26.24,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,All Other,12.57,,,12.57,Fee Schedule,,6,,,6,Other,186% of Medicaid,14.8,,,14.8,Fee Schedule,,34.1,,,34.1,Fee Schedule,,8.38,,,,Fee Schedule,,14.8,,,14.8,Fee Schedule,,34.1,,,34.1,Fee Schedule,,15.76,,,15.76,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,,18.91,,,18.91,Fee Schedule,,16.03,,,16.03,Fee Schedule,,5.99,,,5.99,Fee Schedule,,5.99,,,5.99,Fee Schedule,,5.99,,,5.99,Fee Schedule,,5.99,,,5.99,Fee Schedule,,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,3.2,,,3.2,Other,100% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,4.9,,,4.9,Other,153% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,4.48,,,4.48,Other,140% of Medicaid,7.2,,,7.2,Other,225% of Medicaid,8.32,,,8.32,Other,250% of Medicaid,10.37,,,10.37,Other,324% of Medicaid,6.88,,,6.88,Other,215% of Medicaid,6.88,,,6.88,Other,215% of Medicaid,4,,,4,Other,125% of Medicaid,0.01,38.5,
AUTOMATED LEUKOCYTE COUNT,85048,CPT,,78085048,CDM,305,RC,,,both,,,57,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,7.65,,,7.65,Fee Schedule,,6.88,,,6.88,Fee Schedule,,19.56,,,19.56,Fee Schedule,,17.6,,,17.6,Fee Schedule,,16.64,,,16.64,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,All Other,8,,,8,Fee Schedule,,5,,,5,Other,186% of Medicaid,9.42,,,9.42,Fee Schedule,,35.34,,,35.34,Fee Schedule,,5.33,,,,Fee Schedule,,9.42,,,9.42,Fee Schedule,,35.34,,,35.34,Fee Schedule,,10.03,,,10.03,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,,12.04,,,12.04,Fee Schedule,,10.2,,,10.2,Fee Schedule,,3.81,,,3.81,Fee Schedule,,3.81,,,3.81,Fee Schedule,,3.81,,,3.81,Fee Schedule,,3.81,,,3.81,Fee Schedule,,2.54,,,2.54,Other,100% of Medicaid,2.54,,,2.54,Other,100% of Medicaid,2.54,,,2.54,Other,100% of Medicaid,2.54,,,2.54,Other,100% of Medicaid,5.72,,,5.72,Other,225% of Medicaid,3.89,,,3.89,Other,153% of Medicaid,5.72,,,5.72,Other,225% of Medicaid,3.56,,,3.56,Other,140% of Medicaid,5.72,,,5.72,Other,225% of Medicaid,6.6,,,6.6,Other,250% of Medicaid,8.23,,,8.23,Other,324% of Medicaid,5.46,,,5.46,Other,215% of Medicaid,5.46,,,5.46,Other,215% of Medicaid,3.18,,,3.18,Other,125% of Medicaid,0.01,39.9,
RETICULATED PLATELET ASSAY,85055,CPT,,78085055,CDM,305,RC,,,both,,,114,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,107.58,,,107.58,Fee Schedule,,96.86,,,96.86,Fee Schedule,,206.43,,,206.43,Fee Schedule,,185.71,,,185.71,Fee Schedule,,175.54,,,175.54,Fee Schedule,,79.8,70,,79.8,percent of total billed charges,All Other,112.58,,,112.58,Fee Schedule,,44,,,44,Other,186% of Medicaid,132.6,,,132.6,Fee Schedule,,70.68,,,70.68,Fee Schedule,,75.05,,,,Fee Schedule,,132.6,,,132.6,Fee Schedule,,70.68,,,70.68,Fee Schedule,,141.17,,,141.17,Fee Schedule,,79.8,70,,79.8,percent of total billed charges,,169.37,,,169.37,Fee Schedule,,143.55,,,143.55,Fee Schedule,,53.61,,,53.61,Fee Schedule,,53.61,,,53.61,Fee Schedule,,53.61,,,53.61,Fee Schedule,,53.61,,,53.61,Fee Schedule,,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,35.8,,,35.8,Other,153% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,32.76,,,32.76,Other,140% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,60.84,,,60.84,Other,250% of Medicaid,75.82,,,75.82,Other,324% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,29.25,,,29.25,Other,125% of Medicaid,0.01,206.43,
PERIPHERAL BLD SMEAR,85060,CPT,TC,85085060,CDM,305,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,74.14,,,74.14,Fee Schedule,,66.75,,,66.75,Fee Schedule,,143.03,,,143.03,Fee Schedule,,128.67,,,128.67,Fee Schedule,,121.63,,,121.63,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,77.58,,,77.58,Fee Schedule,,38,,,38,Other,186% of Medicaid,91.38,,,91.38,Fee Schedule,,73.78,,,73.78,Fee Schedule,,51.72,,,,Fee Schedule,,91.38,,,91.38,Fee Schedule,,73.78,,,73.78,Fee Schedule,,97.29,,,97.29,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,37.89,,,37.89,Fee Schedule,,37.89,,,37.89,Fee Schedule,,37.89,,,37.89,Fee Schedule,,37.89,,,37.89,Fee Schedule,,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,31.25,,,31.25,Other,153% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,28.59,,,28.59,Other,140% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,53.1,,,53.1,Other,250% of Medicaid,66.17,,,66.17,Other,324% of Medicaid,43.91,,,43.91,Other,215% of Medicaid,43.91,,,43.91,Other,215% of Medicaid,25.53,,,25.53,Other,125% of Medicaid,0.01,143.03,
BM SMR INTERP,85097,CPT,TC,85085097,CDM,305,RC,,,both,,,1749,1553.82,,,1553.82,Other,150% of Medicare + 9.63% HCRA Surcharge,944.89,,,944.89,Other,Medicare OPPS,148.93,,,148.93,Fee Schedule,,134.09,,,134.09,Fee Schedule,,560.28,,,560.28,Fee Schedule,,504.04,,,504.04,Fee Schedule,,476.44,,,476.44,Fee Schedule,,1224.3,70,,1224.3,percent of total billed charges,All Other,155.86,,,155.86,Fee Schedule,,38,,,38,Other,186% of Medicaid,183.57,,,183.57,Fee Schedule,,1084.38,,,1084.38,Fee Schedule,,103.91,,,,Fee Schedule,,183.57,,,183.57,Fee Schedule,,1084.38,,,1084.38,Fee Schedule,,195.45,,,195.45,Fee Schedule,,1224.3,70,,1224.3,percent of total billed charges,,229.6,,,229.6,Fee Schedule,,194.6,,,194.6,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,31.25,,,31.25,Other,153% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,28.59,,,28.59,Other,140% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,53.1,,,53.1,Other,250% of Medicaid,66.17,,,66.17,Other,324% of Medicaid,43.91,,,43.91,Other,215% of Medicaid,43.91,,,43.91,Other,215% of Medicaid,25.53,,,25.53,Other,125% of Medicaid,20.42,1553.82,
CHROMOGENIC SUBSTRATE ASSAY,85130,CPT,,78085130,CDM,305,RC,,,both,,,44,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,35.79,,,35.79,Fee Schedule,,32.22,,,32.22,Fee Schedule,,58.96,,,58.96,Fee Schedule,,53.05,,,53.05,Fee Schedule,,50.14,,,50.14,Fee Schedule,,30.8,70,,30.8,percent of total billed charges,All Other,37.45,,,37.45,Fee Schedule,,33,,,33,Other,186% of Medicaid,44.11,,,44.11,Fee Schedule,,27.28,,,27.28,Fee Schedule,,24.97,,,,Fee Schedule,,44.11,,,44.11,Fee Schedule,,27.28,,,27.28,Fee Schedule,,46.97,,,46.97,Fee Schedule,,30.8,70,,30.8,percent of total billed charges,,56.35,,,56.35,Fee Schedule,,47.76,,,47.76,Fee Schedule,,17.84,,,17.84,Fee Schedule,,17.84,,,17.84,Fee Schedule,,17.84,,,17.84,Fee Schedule,,17.84,,,17.84,Fee Schedule,,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,27.38,,,27.38,Other,153% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,25.06,,,25.06,Other,140% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,46.53,,,46.53,Other,250% of Medicaid,57.99,,,57.99,Other,324% of Medicaid,38.48,,,38.48,Other,215% of Medicaid,38.48,,,38.48,Other,215% of Medicaid,22.37,,,22.37,Other,125% of Medicaid,0.01,58.96,
BLOOD CLOT RETRACTION,85170,CPT,,78085170,CDM,305,RC,,,both,,,34,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,49.06,,,49.06,Fee Schedule,,44.17,,,44.17,Fee Schedule,,27.89,,,27.89,Fee Schedule,,25.09,,,25.09,Fee Schedule,,23.72,,,23.72,Fee Schedule,,23.8,70,,23.8,percent of total billed charges,All Other,51.35,,,51.35,Fee Schedule,,37,,,37,Other,186% of Medicaid,60.47,,,60.47,Fee Schedule,,21.08,,,21.08,Fee Schedule,,34.23,,,,Fee Schedule,,60.47,,,60.47,Fee Schedule,,21.08,,,21.08,Fee Schedule,,64.39,,,64.39,Fee Schedule,,23.8,70,,23.8,percent of total billed charges,,77.25,,,77.25,Fee Schedule,,65.47,,,65.47,Fee Schedule,,24.45,,,24.45,Fee Schedule,,24.45,,,24.45,Fee Schedule,,24.45,,,24.45,Fee Schedule,,24.45,,,24.45,Fee Schedule,,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,30.62,,,30.62,Other,153% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,28.02,,,28.02,Other,140% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,52.04,,,52.04,Other,250% of Medicaid,64.84,,,64.84,Other,324% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,25.02,,,25.02,Other,125% of Medicaid,0.01,77.25,
BLOOD CLOT FACTOR II TEST,85210,CPT,,78085210,CDM,305,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.07,,,39.07,Fee Schedule,,35.18,,,35.18,Fee Schedule,,100.12,,,100.12,Fee Schedule,,90.07,,,90.07,Fee Schedule,,85.14,,,85.14,Fee Schedule,,105,70,,105,percent of total billed charges,All Other,40.89,,,40.89,Fee Schedule,,24,,,24,Other,186% of Medicaid,48.16,,,48.16,Fee Schedule,,93,,,93,Fee Schedule,,27.26,,,,Fee Schedule,,48.16,,,48.16,Fee Schedule,,93,,,93,Fee Schedule,,51.27,,,51.27,Fee Schedule,,105,70,,105,percent of total billed charges,,61.51,,,61.51,Fee Schedule,,52.14,,,52.14,Fee Schedule,,19.47,,,19.47,Fee Schedule,,19.47,,,19.47,Fee Schedule,,19.47,,,19.47,Fee Schedule,,19.47,,,19.47,Fee Schedule,,12.98,,,12.98,Other,100% of Medicaid,12.98,,,12.98,Other,100% of Medicaid,12.98,,,12.98,Other,100% of Medicaid,12.98,,,12.98,Other,100% of Medicaid,29.21,,,29.21,Other,225% of Medicaid,19.86,,,19.86,Other,153% of Medicaid,29.21,,,29.21,Other,225% of Medicaid,18.17,,,18.17,Other,140% of Medicaid,29.21,,,29.21,Other,225% of Medicaid,33.75,,,33.75,Other,250% of Medicaid,42.06,,,42.06,Other,324% of Medicaid,27.91,,,27.91,Other,215% of Medicaid,27.91,,,27.91,Other,215% of Medicaid,16.23,,,16.23,Other,125% of Medicaid,0.01,105,
BLOOD CLOT FACTOR V TEST,85220,CPT,,78085220,CDM,305,RC,,,both,,,558,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.13,,,53.13,Fee Schedule,,47.83,,,47.83,Fee Schedule,,136.07,,,136.07,Fee Schedule,,122.41,,,122.41,Fee Schedule,,115.71,,,115.71,Fee Schedule,,390.6,70,,390.6,percent of total billed charges,All Other,55.6,,,55.6,Fee Schedule,,33,,,33,Other,186% of Medicaid,65.48,,,65.48,Fee Schedule,,345.96,,,345.96,Fee Schedule,,37.07,,,,Fee Schedule,,65.48,,,65.48,Fee Schedule,,345.96,,,345.96,Fee Schedule,,69.72,,,69.72,Fee Schedule,,390.6,70,,390.6,percent of total billed charges,,83.64,,,83.64,Fee Schedule,,70.89,,,70.89,Fee Schedule,,26.48,,,26.48,Fee Schedule,,26.48,,,26.48,Fee Schedule,,26.48,,,26.48,Fee Schedule,,26.48,,,26.48,Fee Schedule,,17.65,,,17.65,Other,100% of Medicaid,17.65,,,17.65,Other,100% of Medicaid,17.65,,,17.65,Other,100% of Medicaid,17.65,,,17.65,Other,100% of Medicaid,39.71,,,39.71,Other,225% of Medicaid,27,,,27,Other,153% of Medicaid,39.71,,,39.71,Other,225% of Medicaid,24.71,,,24.71,Other,140% of Medicaid,39.71,,,39.71,Other,225% of Medicaid,45.89,,,45.89,Other,250% of Medicaid,57.19,,,57.19,Other,324% of Medicaid,37.95,,,37.95,Other,215% of Medicaid,37.95,,,37.95,Other,215% of Medicaid,22.06,,,22.06,Other,125% of Medicaid,0.01,390.6,
BLOOD CLOT FACTOR VII TEST,85230,CPT,,78085230,CDM,305,RC,,,both,,,521,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.88,,,53.88,Fee Schedule,,48.51,,,48.51,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,364.7,70,,364.7,percent of total billed charges,All Other,56.39,,,56.39,Fee Schedule,,33,,,33,Other,186% of Medicaid,66.41,,,66.41,Fee Schedule,,323.02,,,323.02,Fee Schedule,,37.59,,,,Fee Schedule,,66.41,,,66.41,Fee Schedule,,323.02,,,323.02,Fee Schedule,,70.71,,,70.71,Fee Schedule,,364.7,70,,364.7,percent of total billed charges,,84.83,,,84.83,Fee Schedule,,71.9,,,71.9,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,40.28,,,40.28,Other,225% of Medicaid,27.39,,,27.39,Other,153% of Medicaid,40.28,,,40.28,Other,225% of Medicaid,25.06,,,25.06,Other,140% of Medicaid,40.28,,,40.28,Other,225% of Medicaid,46.54,,,46.54,Other,250% of Medicaid,58,,,58,Other,324% of Medicaid,38.49,,,38.49,Other,215% of Medicaid,38.49,,,38.49,Other,215% of Medicaid,22.38,,,22.38,Other,125% of Medicaid,0.01,364.7,
BLOOD CLOT FACTOR VIII TEST,85240,CPT,,78085240,CDM,305,RC,,,both,,,762,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.88,,,53.88,Fee Schedule,,48.51,,,48.51,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,533.4,70,,533.4,percent of total billed charges,All Other,56.39,,,56.39,Fee Schedule,,18,,,18,Other,186% of Medicaid,66.41,,,66.41,Fee Schedule,,472.44,,,472.44,Fee Schedule,,37.59,,,,Fee Schedule,,66.41,,,66.41,Fee Schedule,,472.44,,,472.44,Fee Schedule,,70.71,,,70.71,Fee Schedule,,533.4,70,,533.4,percent of total billed charges,,84.83,,,84.83,Fee Schedule,,71.9,,,71.9,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,14.53,,,14.53,Other,153% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,24.68,,,24.68,Other,250% of Medicaid,30.76,,,30.76,Other,324% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,11.87,,,11.87,Other,125% of Medicaid,0.01,533.4,
BLOOD CLOT FACTOR VIII TEST,85244,CPT,,78085244,CDM,305,RC,,,both,,,653,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,61.46,,,61.46,Fee Schedule,,55.34,,,55.34,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,457.1,70,,457.1,percent of total billed charges,All Other,64.32,,,64.32,Fee Schedule,,18,,,18,Other,186% of Medicaid,75.76,,,75.76,Fee Schedule,,404.86,,,404.86,Fee Schedule,,42.88,,,,Fee Schedule,,75.76,,,75.76,Fee Schedule,,404.86,,,404.86,Fee Schedule,,80.66,,,80.66,Fee Schedule,,457.1,70,,457.1,percent of total billed charges,,96.77,,,96.77,Fee Schedule,,82.02,,,82.02,Fee Schedule,,30.63,,,30.63,Fee Schedule,,30.63,,,30.63,Fee Schedule,,30.63,,,30.63,Fee Schedule,,30.63,,,30.63,Fee Schedule,,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,14.53,,,14.53,Other,153% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,24.68,,,24.68,Other,250% of Medicaid,30.76,,,30.76,Other,324% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,11.87,,,11.87,Other,125% of Medicaid,0.01,457.1,
CLOTTING FACTOR VIII RISTOCETI,85245,CPT,,78085245,CDM,305,RC,,,both,,,140,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,69.05,,,69.05,Fee Schedule,,62.17,,,62.17,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,98,70,,98,percent of total billed charges,All Other,72.26,,,72.26,Fee Schedule,,18,,,18,Other,186% of Medicaid,85.11,,,85.11,Fee Schedule,,86.8,,,86.8,Fee Schedule,,48.17,,,,Fee Schedule,,85.11,,,85.11,Fee Schedule,,86.8,,,86.8,Fee Schedule,,90.61,,,90.61,Fee Schedule,,98,70,,98,percent of total billed charges,,108.71,,,108.71,Fee Schedule,,92.14,,,92.14,Fee Schedule,,34.41,,,34.41,Fee Schedule,,34.41,,,34.41,Fee Schedule,,34.41,,,34.41,Fee Schedule,,34.41,,,34.41,Fee Schedule,,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,14.53,,,14.53,Other,153% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,24.68,,,24.68,Other,250% of Medicaid,30.76,,,30.76,Other,324% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,11.87,,,11.87,Other,125% of Medicaid,0.01,108.71,
BLOOD CLOT FACTOR VIII TEST,85246,CPT,,78085246,CDM,305,RC,,,both,,,762,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,69.05,,,69.05,Fee Schedule,,62.17,,,62.17,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,533.4,70,,533.4,percent of total billed charges,All Other,72.26,,,72.26,Fee Schedule,,18,,,18,Other,186% of Medicaid,85.11,,,85.11,Fee Schedule,,472.44,,,472.44,Fee Schedule,,48.17,,,,Fee Schedule,,85.11,,,85.11,Fee Schedule,,472.44,,,472.44,Fee Schedule,,90.61,,,90.61,Fee Schedule,,533.4,70,,533.4,percent of total billed charges,,108.71,,,108.71,Fee Schedule,,92.14,,,92.14,Fee Schedule,,34.41,,,34.41,Fee Schedule,,34.41,,,34.41,Fee Schedule,,34.41,,,34.41,Fee Schedule,,34.41,,,34.41,Fee Schedule,,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,14.53,,,14.53,Other,153% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,24.68,,,24.68,Other,250% of Medicaid,30.76,,,30.76,Other,324% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,11.87,,,11.87,Other,125% of Medicaid,0.01,533.4,
BLOOD CLOT FACTOR VIII TEST,85247,CPT,,78085247,CDM,305,RC,,,both,,,653,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,69.05,,,69.05,Fee Schedule,,62.17,,,62.17,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,457.1,70,,457.1,percent of total billed charges,All Other,72.26,,,72.26,Fee Schedule,,22,,,22,Other,186% of Medicaid,85.11,,,85.11,Fee Schedule,,404.86,,,404.86,Fee Schedule,,48.17,,,,Fee Schedule,,85.11,,,85.11,Fee Schedule,,404.86,,,404.86,Fee Schedule,,90.61,,,90.61,Fee Schedule,,457.1,70,,457.1,percent of total billed charges,,108.71,,,108.71,Fee Schedule,,92.14,,,92.14,Fee Schedule,,34.41,,,34.41,Fee Schedule,,34.41,,,34.41,Fee Schedule,,34.41,,,34.41,Fee Schedule,,34.41,,,34.41,Fee Schedule,,11.89,,,11.89,Other,100% of Medicaid,11.89,,,11.89,Other,100% of Medicaid,11.89,,,11.89,Other,100% of Medicaid,11.89,,,11.89,Other,100% of Medicaid,26.75,,,26.75,Other,225% of Medicaid,18.19,,,18.19,Other,153% of Medicaid,26.75,,,26.75,Other,225% of Medicaid,16.64,,,16.64,Other,140% of Medicaid,26.75,,,26.75,Other,225% of Medicaid,30.91,,,30.91,Other,250% of Medicaid,38.52,,,38.52,Other,324% of Medicaid,25.56,,,25.56,Other,215% of Medicaid,25.56,,,25.56,Other,215% of Medicaid,14.86,,,14.86,Other,125% of Medicaid,0.01,457.1,
BLOOD CLOT FACTOR IX TEST,85250,CPT,,78085250,CDM,305,RC,,,both,,,435,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,57.31,,,57.31,Fee Schedule,,51.6,,,51.6,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,304.5,70,,304.5,percent of total billed charges,All Other,59.98,,,59.98,Fee Schedule,,35,,,35,Other,186% of Medicaid,70.64,,,70.64,Fee Schedule,,269.7,,,269.7,Fee Schedule,,39.98,,,,Fee Schedule,,70.64,,,70.64,Fee Schedule,,269.7,,,269.7,Fee Schedule,,75.21,,,75.21,Fee Schedule,,304.5,70,,304.5,percent of total billed charges,,90.23,,,90.23,Fee Schedule,,76.48,,,76.48,Fee Schedule,,28.56,,,28.56,Fee Schedule,,28.56,,,28.56,Fee Schedule,,28.56,,,28.56,Fee Schedule,,28.56,,,28.56,Fee Schedule,,19.04,,,19.04,Other,100% of Medicaid,19.04,,,19.04,Other,100% of Medicaid,19.04,,,19.04,Other,100% of Medicaid,19.04,,,19.04,Other,100% of Medicaid,42.84,,,42.84,Other,225% of Medicaid,29.13,,,29.13,Other,153% of Medicaid,42.84,,,42.84,Other,225% of Medicaid,26.66,,,26.66,Other,140% of Medicaid,42.84,,,42.84,Other,225% of Medicaid,49.5,,,49.5,Other,250% of Medicaid,61.69,,,61.69,Other,324% of Medicaid,40.94,,,40.94,Other,215% of Medicaid,40.94,,,40.94,Other,215% of Medicaid,23.8,,,23.8,Other,125% of Medicaid,0.01,304.5,
BLOOD CLOT FACTOR X TEST,85260,CPT,,78085260,CDM,305,RC,,,both,,,446,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.88,,,53.88,Fee Schedule,,48.51,,,48.51,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,312.2,70,,312.2,percent of total billed charges,All Other,56.39,,,56.39,Fee Schedule,,33,,,33,Other,186% of Medicaid,66.41,,,66.41,Fee Schedule,,276.52,,,276.52,Fee Schedule,,37.59,,,,Fee Schedule,,66.41,,,66.41,Fee Schedule,,276.52,,,276.52,Fee Schedule,,70.71,,,70.71,Fee Schedule,,312.2,70,,312.2,percent of total billed charges,,84.83,,,84.83,Fee Schedule,,71.9,,,71.9,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,40.28,,,40.28,Other,225% of Medicaid,27.39,,,27.39,Other,153% of Medicaid,40.28,,,40.28,Other,225% of Medicaid,25.06,,,25.06,Other,140% of Medicaid,40.28,,,40.28,Other,225% of Medicaid,46.54,,,46.54,Other,250% of Medicaid,58,,,58,Other,324% of Medicaid,38.49,,,38.49,Other,215% of Medicaid,38.49,,,38.49,Other,215% of Medicaid,22.38,,,22.38,Other,125% of Medicaid,0.01,312.2,
BLOOD CLOT FACTOR XI TEST,85270,CPT,,78085270,CDM,305,RC,,,both,,,454,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.88,,,53.88,Fee Schedule,,48.51,,,48.51,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,317.8,70,,317.8,percent of total billed charges,All Other,56.39,,,56.39,Fee Schedule,,33,,,33,Other,186% of Medicaid,66.41,,,66.41,Fee Schedule,,281.48,,,281.48,Fee Schedule,,37.59,,,,Fee Schedule,,66.41,,,66.41,Fee Schedule,,281.48,,,281.48,Fee Schedule,,70.71,,,70.71,Fee Schedule,,317.8,70,,317.8,percent of total billed charges,,84.83,,,84.83,Fee Schedule,,71.9,,,71.9,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,26.85,,,26.85,Fee Schedule,,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,40.28,,,40.28,Other,225% of Medicaid,27.39,,,27.39,Other,153% of Medicaid,40.28,,,40.28,Other,225% of Medicaid,25.06,,,25.06,Other,140% of Medicaid,40.28,,,40.28,Other,225% of Medicaid,46.54,,,46.54,Other,250% of Medicaid,58,,,58,Other,324% of Medicaid,38.49,,,38.49,Other,215% of Medicaid,38.49,,,38.49,Other,215% of Medicaid,22.38,,,22.38,Other,125% of Medicaid,0.01,317.8,
BLOOD CLOT FACTOR XII TEST,85280,CPT,,78085280,CDM,305,RC,,,both,,,416,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,58.24,,,58.24,Fee Schedule,,52.44,,,52.44,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,291.2,70,,291.2,percent of total billed charges,All Other,60.95,,,60.95,Fee Schedule,,36,,,36,Other,186% of Medicaid,71.79,,,71.79,Fee Schedule,,257.92,,,257.92,Fee Schedule,,40.64,,,,Fee Schedule,,71.79,,,71.79,Fee Schedule,,257.92,,,257.92,Fee Schedule,,76.43,,,76.43,Fee Schedule,,291.2,70,,291.2,percent of total billed charges,,91.7,,,91.7,Fee Schedule,,77.72,,,77.72,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,29.03,,,29.03,Fee Schedule,,19.35,,,19.35,Other,100% of Medicaid,19.35,,,19.35,Other,100% of Medicaid,19.35,,,19.35,Other,100% of Medicaid,19.35,,,19.35,Other,100% of Medicaid,43.54,,,43.54,Other,225% of Medicaid,29.61,,,29.61,Other,153% of Medicaid,43.54,,,43.54,Other,225% of Medicaid,27.09,,,27.09,Other,140% of Medicaid,43.54,,,43.54,Other,225% of Medicaid,50.31,,,50.31,Other,250% of Medicaid,62.69,,,62.69,Other,324% of Medicaid,41.6,,,41.6,Other,215% of Medicaid,41.6,,,41.6,Other,215% of Medicaid,24.19,,,24.19,Other,125% of Medicaid,0.01,291.2,
BLOOD CLOT FACTOR XIII TEST,85290,CPT,,78085290,CDM,305,RC,,,both,,,416,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.18,,,49.18,Fee Schedule,,44.28,,,44.28,Fee Schedule,,56.77,,,56.77,Fee Schedule,,51.07,,,51.07,Fee Schedule,,48.28,,,48.28,Fee Schedule,,291.2,70,,291.2,percent of total billed charges,All Other,51.47,,,51.47,Fee Schedule,,15,,,15,Other,186% of Medicaid,60.62,,,60.62,Fee Schedule,,257.92,,,257.92,Fee Schedule,,34.31,,,,Fee Schedule,,60.62,,,60.62,Fee Schedule,,257.92,,,257.92,Fee Schedule,,64.54,,,64.54,Fee Schedule,,291.2,70,,291.2,percent of total billed charges,,77.44,,,77.44,Fee Schedule,,65.63,,,65.63,Fee Schedule,,24.51,,,24.51,Fee Schedule,,24.51,,,24.51,Fee Schedule,,24.51,,,24.51,Fee Schedule,,24.51,,,24.51,Fee Schedule,,8.01,,,8.01,Other,100% of Medicaid,8.01,,,8.01,Other,100% of Medicaid,8.01,,,8.01,Other,100% of Medicaid,8.01,,,8.01,Other,100% of Medicaid,18.02,,,18.02,Other,225% of Medicaid,12.25,,,12.25,Other,153% of Medicaid,18.02,,,18.02,Other,225% of Medicaid,11.21,,,11.21,Other,140% of Medicaid,18.02,,,18.02,Other,225% of Medicaid,20.82,,,20.82,Other,250% of Medicaid,25.95,,,25.95,Other,324% of Medicaid,17.22,,,17.22,Other,215% of Medicaid,17.22,,,17.22,Other,215% of Medicaid,10.01,,,10.01,Other,125% of Medicaid,0.01,291.2,
CLOTTING; FACTOR XIII SCREEN SOLUBLE,85291,CPT,,78085291,CDM,305,RC,,,both,,,416,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.42,,,27.42,Fee Schedule,,24.69,,,24.69,Fee Schedule,,56.77,,,56.77,Fee Schedule,,51.07,,,51.07,Fee Schedule,,48.28,,,48.28,Fee Schedule,,291.2,70,,291.2,percent of total billed charges,All Other,28.7,,,28.7,Fee Schedule,,13,,,13,Other,186% of Medicaid,33.8,,,33.8,Fee Schedule,,257.92,,,257.92,Fee Schedule,,19.13,,,,Fee Schedule,,33.8,,,33.8,Fee Schedule,,257.92,,,257.92,Fee Schedule,,35.98,,,35.98,Fee Schedule,,291.2,70,,291.2,percent of total billed charges,,43.17,,,43.17,Fee Schedule,,36.59,,,36.59,Fee Schedule,,13.67,,,13.67,Fee Schedule,,13.67,,,13.67,Fee Schedule,,13.67,,,13.67,Fee Schedule,,13.67,,,13.67,Fee Schedule,,7.17,,,7.17,Other,100% of Medicaid,7.17,,,7.17,Other,100% of Medicaid,7.17,,,7.17,Other,100% of Medicaid,7.17,,,7.17,Other,100% of Medicaid,16.13,,,16.13,Other,225% of Medicaid,10.97,,,10.97,Other,153% of Medicaid,16.13,,,16.13,Other,225% of Medicaid,10.04,,,10.04,Other,140% of Medicaid,16.13,,,16.13,Other,225% of Medicaid,18.64,,,18.64,Other,250% of Medicaid,23.23,,,23.23,Other,324% of Medicaid,15.42,,,15.42,Other,215% of Medicaid,15.42,,,15.42,Other,215% of Medicaid,8.96,,,8.96,Other,125% of Medicaid,0.01,291.2,
ANTITHROMBIN III TEST,85300,CPT,,78085300,CDM,305,RC,,,both,,,409,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,35.67,,,35.67,Fee Schedule,,32.11,,,32.11,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,286.3,70,,286.3,percent of total billed charges,All Other,37.33,,,37.33,Fee Schedule,,18,,,18,Other,186% of Medicaid,43.96,,,43.96,Fee Schedule,,253.58,,,253.58,Fee Schedule,,24.89,,,,Fee Schedule,,43.96,,,43.96,Fee Schedule,,253.58,,,253.58,Fee Schedule,,46.81,,,46.81,Fee Schedule,,286.3,70,,286.3,percent of total billed charges,,56.16,,,56.16,Fee Schedule,,47.6,,,47.6,Fee Schedule,,17.78,,,17.78,Fee Schedule,,17.78,,,17.78,Fee Schedule,,17.78,,,17.78,Fee Schedule,,17.78,,,17.78,Fee Schedule,,9.52,,,9.52,Other,100% of Medicaid,9.52,,,9.52,Other,100% of Medicaid,9.52,,,9.52,Other,100% of Medicaid,9.52,,,9.52,Other,100% of Medicaid,21.43,,,21.43,Other,225% of Medicaid,14.57,,,14.57,Other,153% of Medicaid,21.43,,,21.43,Other,225% of Medicaid,13.33,,,13.33,Other,140% of Medicaid,21.43,,,21.43,Other,225% of Medicaid,24.76,,,24.76,Other,250% of Medicaid,30.86,,,30.86,Other,324% of Medicaid,20.48,,,20.48,Other,215% of Medicaid,20.48,,,20.48,Other,215% of Medicaid,11.91,,,11.91,Other,125% of Medicaid,0.01,286.3,
ANTITHROMBIN III TEST,85301,CPT,,78085301,CDM,305,RC,,,both,,,409,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,32.54,,,32.54,Fee Schedule,,29.3,,,29.3,Fee Schedule,,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,70.88,,,70.88,Fee Schedule,,286.3,70,,286.3,percent of total billed charges,All Other,34.05,,,34.05,Fee Schedule,,20,,,20,Other,186% of Medicaid,40.11,,,40.11,Fee Schedule,,253.58,,,253.58,Fee Schedule,,22.7,,,,Fee Schedule,,40.11,,,40.11,Fee Schedule,,253.58,,,253.58,Fee Schedule,,42.7,,,42.7,Fee Schedule,,286.3,70,,286.3,percent of total billed charges,,51.23,,,51.23,Fee Schedule,,43.42,,,43.42,Fee Schedule,,16.22,,,16.22,Fee Schedule,,16.22,,,16.22,Fee Schedule,,16.22,,,16.22,Fee Schedule,,16.22,,,16.22,Fee Schedule,,10.81,,,10.81,Other,100% of Medicaid,10.81,,,10.81,Other,100% of Medicaid,10.81,,,10.81,Other,100% of Medicaid,10.81,,,10.81,Other,100% of Medicaid,24.32,,,24.32,Other,225% of Medicaid,16.54,,,16.54,Other,153% of Medicaid,24.32,,,24.32,Other,225% of Medicaid,15.13,,,15.13,Other,140% of Medicaid,24.32,,,24.32,Other,225% of Medicaid,28.11,,,28.11,Other,250% of Medicaid,35.02,,,35.02,Other,324% of Medicaid,23.24,,,23.24,Other,215% of Medicaid,23.24,,,23.24,Other,215% of Medicaid,13.51,,,13.51,Other,125% of Medicaid,0.01,286.3,
BLOOD CLOT INHIBITOR ANTIGEN,85302,CPT,,78085302,CDM,305,RC,,,both,,,454,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.15,,,36.15,Fee Schedule,,32.55,,,32.55,Fee Schedule,,92.72,,,92.72,Fee Schedule,,83.42,,,83.42,Fee Schedule,,78.85,,,78.85,Fee Schedule,,317.8,70,,317.8,percent of total billed charges,All Other,37.83,,,37.83,Fee Schedule,,22,,,22,Other,186% of Medicaid,44.56,,,44.56,Fee Schedule,,281.48,,,281.48,Fee Schedule,,25.22,,,,Fee Schedule,,44.56,,,44.56,Fee Schedule,,281.48,,,281.48,Fee Schedule,,47.44,,,47.44,Fee Schedule,,317.8,70,,317.8,percent of total billed charges,,56.92,,,56.92,Fee Schedule,,48.24,,,48.24,Fee Schedule,,18.02,,,18.02,Fee Schedule,,18.02,,,18.02,Fee Schedule,,18.02,,,18.02,Fee Schedule,,18.02,,,18.02,Fee Schedule,,12.01,,,12.01,Other,100% of Medicaid,12.01,,,12.01,Other,100% of Medicaid,12.01,,,12.01,Other,100% of Medicaid,12.01,,,12.01,Other,100% of Medicaid,27.02,,,27.02,Other,225% of Medicaid,18.38,,,18.38,Other,153% of Medicaid,27.02,,,27.02,Other,225% of Medicaid,16.81,,,16.81,Other,140% of Medicaid,27.02,,,27.02,Other,225% of Medicaid,31.23,,,31.23,Other,250% of Medicaid,38.91,,,38.91,Other,324% of Medicaid,25.82,,,25.82,Other,215% of Medicaid,25.82,,,25.82,Other,215% of Medicaid,15.01,,,15.01,Other,125% of Medicaid,0.01,317.8,
BLOOD CLOT INHIBITOR TEST,85303,CPT,,78085303,CDM,305,RC,,,both,,,301,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.66,,,41.66,Fee Schedule,,37.51,,,37.51,Fee Schedule,,106.64,,,106.64,Fee Schedule,,95.94,,,95.94,Fee Schedule,,90.68,,,90.68,Fee Schedule,,210.7,70,,210.7,percent of total billed charges,All Other,43.6,,,43.6,Fee Schedule,,26,,,26,Other,186% of Medicaid,51.35,,,51.35,Fee Schedule,,186.62,,,186.62,Fee Schedule,,29.06,,,,Fee Schedule,,51.35,,,51.35,Fee Schedule,,186.62,,,186.62,Fee Schedule,,54.67,,,54.67,Fee Schedule,,210.7,70,,210.7,percent of total billed charges,,65.59,,,65.59,Fee Schedule,,55.59,,,55.59,Fee Schedule,,20.76,,,20.76,Fee Schedule,,20.76,,,20.76,Fee Schedule,,20.76,,,20.76,Fee Schedule,,20.76,,,20.76,Fee Schedule,,13.84,,,13.84,Other,100% of Medicaid,13.84,,,13.84,Other,100% of Medicaid,13.84,,,13.84,Other,100% of Medicaid,13.84,,,13.84,Other,100% of Medicaid,31.14,,,31.14,Other,225% of Medicaid,21.18,,,21.18,Other,153% of Medicaid,31.14,,,31.14,Other,225% of Medicaid,19.38,,,19.38,Other,140% of Medicaid,31.14,,,31.14,Other,225% of Medicaid,35.98,,,35.98,Other,250% of Medicaid,44.84,,,44.84,Other,324% of Medicaid,29.76,,,29.76,Other,215% of Medicaid,29.76,,,29.76,Other,215% of Medicaid,17.3,,,17.3,Other,125% of Medicaid,0.01,210.7,
CLOTTING INHIBITOR; PROTEIN S TOTAL,85305,CPT,,78085305,CDM,305,RC,,,both,,,454,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.95,,,34.95,Fee Schedule,,31.46,,,31.46,Fee Schedule,,89.43,,,89.43,Fee Schedule,,80.46,,,80.46,Fee Schedule,,76.05,,,76.05,Fee Schedule,,317.8,70,,317.8,percent of total billed charges,All Other,36.57,,,36.57,Fee Schedule,,22,,,22,Other,186% of Medicaid,43.07,,,43.07,Fee Schedule,,281.48,,,281.48,Fee Schedule,,24.38,,,,Fee Schedule,,43.07,,,43.07,Fee Schedule,,281.48,,,281.48,Fee Schedule,,45.86,,,45.86,Fee Schedule,,317.8,70,,317.8,percent of total billed charges,,55.02,,,55.02,Fee Schedule,,46.63,,,46.63,Fee Schedule,,17.42,,,17.42,Fee Schedule,,17.42,,,17.42,Fee Schedule,,17.42,,,17.42,Fee Schedule,,17.42,,,17.42,Fee Schedule,,11.61,,,11.61,Other,100% of Medicaid,11.61,,,11.61,Other,100% of Medicaid,11.61,,,11.61,Other,100% of Medicaid,11.61,,,11.61,Other,100% of Medicaid,26.12,,,26.12,Other,225% of Medicaid,17.76,,,17.76,Other,153% of Medicaid,26.12,,,26.12,Other,225% of Medicaid,16.25,,,16.25,Other,140% of Medicaid,26.12,,,26.12,Other,225% of Medicaid,30.19,,,30.19,Other,250% of Medicaid,37.62,,,37.62,Other,324% of Medicaid,24.96,,,24.96,Other,215% of Medicaid,24.96,,,24.96,Other,215% of Medicaid,14.51,,,14.51,Other,125% of Medicaid,0.01,317.8,
BLOOD CLOT INHIBITOR TEST,85306,CPT,,78085306,CDM,305,RC,,,both,,,301,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.11,,,46.11,Fee Schedule,,41.52,,,41.52,Fee Schedule,,110.2,,,110.2,Fee Schedule,,99.14,,,99.14,Fee Schedule,,93.71,,,93.71,Fee Schedule,,210.7,70,,210.7,percent of total billed charges,All Other,48.26,,,48.26,Fee Schedule,,28,,,28,Other,186% of Medicaid,56.84,,,56.84,Fee Schedule,,186.62,,,186.62,Fee Schedule,,32.17,,,,Fee Schedule,,56.84,,,56.84,Fee Schedule,,186.62,,,186.62,Fee Schedule,,60.51,,,60.51,Fee Schedule,,210.7,70,,210.7,percent of total billed charges,,72.6,,,72.6,Fee Schedule,,61.53,,,61.53,Fee Schedule,,22.98,,,22.98,Fee Schedule,,22.98,,,22.98,Fee Schedule,,22.98,,,22.98,Fee Schedule,,22.98,,,22.98,Fee Schedule,,15.32,,,15.32,Other,100% of Medicaid,15.32,,,15.32,Other,100% of Medicaid,15.32,,,15.32,Other,100% of Medicaid,15.32,,,15.32,Other,100% of Medicaid,34.47,,,34.47,Other,225% of Medicaid,23.44,,,23.44,Other,153% of Medicaid,34.47,,,34.47,Other,225% of Medicaid,21.45,,,21.45,Other,140% of Medicaid,34.47,,,34.47,Other,225% of Medicaid,39.83,,,39.83,Other,250% of Medicaid,49.64,,,49.64,Other,324% of Medicaid,32.94,,,32.94,Other,215% of Medicaid,32.94,,,32.94,Other,215% of Medicaid,19.15,,,19.15,Other,125% of Medicaid,0.01,210.7,
ASSAY ACTIVATED PROTEIN C,85307,CPT,,78085307,CDM,305,RC,,,both,,,86,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,46.11,,,46.11,Fee Schedule,,41.52,,,41.52,Fee Schedule,,110.2,,,110.2,Fee Schedule,,99.14,,,99.14,Fee Schedule,,93.71,,,93.71,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,All Other,48.26,,,48.26,Fee Schedule,,28,,,28,Other,186% of Medicaid,56.84,,,56.84,Fee Schedule,,53.32,,,53.32,Fee Schedule,,32.17,,,,Fee Schedule,,56.84,,,56.84,Fee Schedule,,53.32,,,53.32,Fee Schedule,,60.51,,,60.51,Fee Schedule,,60.2,70,,60.2,percent of total billed charges,,72.6,,,72.6,Fee Schedule,,61.53,,,61.53,Fee Schedule,,22.98,,,22.98,Fee Schedule,,22.98,,,22.98,Fee Schedule,,22.98,,,22.98,Fee Schedule,,22.98,,,22.98,Fee Schedule,,14.88,,,14.88,Other,100% of Medicaid,14.88,,,14.88,Other,100% of Medicaid,14.88,,,14.88,Other,100% of Medicaid,14.88,,,14.88,Other,100% of Medicaid,33.47,,,33.47,Other,225% of Medicaid,22.76,,,22.76,Other,153% of Medicaid,33.47,,,33.47,Other,225% of Medicaid,20.83,,,20.83,Other,140% of Medicaid,33.47,,,33.47,Other,225% of Medicaid,38.68,,,38.68,Other,250% of Medicaid,48.2,,,48.2,Other,324% of Medicaid,31.99,,,31.99,Other,215% of Medicaid,31.99,,,31.99,Other,215% of Medicaid,18.6,,,18.6,Other,125% of Medicaid,0.01,110.2,
FACTOR INHIBITOR TEST,85335,CPT,,78085335,CDM,305,RC,,,both,,,486,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,38.74,,,38.74,Fee Schedule,,34.88,,,34.88,Fee Schedule,,85.32,,,85.32,Fee Schedule,,76.76,,,76.76,Fee Schedule,,72.56,,,72.56,Fee Schedule,,340.2,70,,340.2,percent of total billed charges,All Other,40.54,,,40.54,Fee Schedule,,24,,,24,Other,186% of Medicaid,47.75,,,47.75,Fee Schedule,,301.32,,,301.32,Fee Schedule,,27.03,,,,Fee Schedule,,47.75,,,47.75,Fee Schedule,,301.32,,,301.32,Fee Schedule,,50.84,,,50.84,Fee Schedule,,340.2,70,,340.2,percent of total billed charges,,60.99,,,60.99,Fee Schedule,,51.69,,,51.69,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,19.31,,,19.31,Fee Schedule,,12.87,,,12.87,Other,100% of Medicaid,12.87,,,12.87,Other,100% of Medicaid,12.87,,,12.87,Other,100% of Medicaid,12.87,,,12.87,Other,100% of Medicaid,28.96,,,28.96,Other,225% of Medicaid,19.69,,,19.69,Other,153% of Medicaid,28.96,,,28.96,Other,225% of Medicaid,18.02,,,18.02,Other,140% of Medicaid,28.96,,,28.96,Other,225% of Medicaid,33.46,,,33.46,Other,250% of Medicaid,41.7,,,41.7,Other,324% of Medicaid,27.67,,,27.67,Other,215% of Medicaid,27.67,,,27.67,Other,215% of Medicaid,16.09,,,16.09,Other,125% of Medicaid,0.01,340.2,
THROMBOMODULIN,85337,CPT,,78085337,CDM,305,RC,,,both,,,248,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51.98,,,51.98,Fee Schedule,,46.8,,,46.8,Fee Schedule,,80.39,,,80.39,Fee Schedule,,72.32,,,72.32,Fee Schedule,,68.36,,,68.36,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,All Other,54.4,,,54.4,Fee Schedule,,26,,,26,Other,186% of Medicaid,64.07,,,64.07,Fee Schedule,,153.76,,,153.76,Fee Schedule,,36.27,,,,Fee Schedule,,64.07,,,64.07,Fee Schedule,,153.76,,,153.76,Fee Schedule,,68.22,,,68.22,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,,81.84,,,81.84,Fee Schedule,,69.37,,,69.37,Fee Schedule,,25.91,,,25.91,Fee Schedule,,25.91,,,25.91,Fee Schedule,,25.91,,,25.91,Fee Schedule,,25.91,,,25.91,Fee Schedule,,13.82,,,13.82,Other,100% of Medicaid,13.82,,,13.82,Other,100% of Medicaid,13.82,,,13.82,Other,100% of Medicaid,13.82,,,13.82,Other,100% of Medicaid,31.09,,,31.09,Other,225% of Medicaid,21.14,,,21.14,Other,153% of Medicaid,31.09,,,31.09,Other,225% of Medicaid,19.34,,,19.34,Other,140% of Medicaid,31.09,,,31.09,Other,225% of Medicaid,35.92,,,35.92,Other,250% of Medicaid,44.77,,,44.77,Other,324% of Medicaid,29.71,,,29.71,Other,215% of Medicaid,29.71,,,29.71,Other,215% of Medicaid,17.27,,,17.27,Other,125% of Medicaid,0.01,173.6,
COAGULATION TIME,85345,CPT,,78085345,CDM,305,RC,,,both,,,61,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14.12,,,14.12,Fee Schedule,,12.71,,,12.71,Fee Schedule,,33.15,,,33.15,Fee Schedule,,29.83,,,29.83,Fee Schedule,,28.19,,,28.19,Fee Schedule,,42.7,70,,42.7,percent of total billed charges,All Other,14.77,,,14.77,Fee Schedule,,37,,,37,Other,186% of Medicaid,17.4,,,17.4,Fee Schedule,,37.82,,,37.82,Fee Schedule,,9.85,,,,Fee Schedule,,17.4,,,17.4,Fee Schedule,,37.82,,,37.82,Fee Schedule,,18.53,,,18.53,Fee Schedule,,42.7,70,,42.7,percent of total billed charges,,22.23,,,22.23,Fee Schedule,,18.84,,,18.84,Fee Schedule,,7.04,,,7.04,Fee Schedule,,7.04,,,7.04,Fee Schedule,,7.04,,,7.04,Fee Schedule,,7.04,,,7.04,Fee Schedule,,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,30.62,,,30.62,Other,153% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,28.02,,,28.02,Other,140% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,52.04,,,52.04,Other,250% of Medicaid,64.84,,,64.84,Other,324% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,25.02,,,25.02,Other,125% of Medicaid,0.01,64.84,
COAGULATION TIME ACTIVATED,85347,CPT,,78085347,CDM,305,RC,,,both,,,24,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.88,,,12.88,Fee Schedule,,11.6,,,11.6,Fee Schedule,,32.83,,,32.83,Fee Schedule,,29.53,,,29.53,Fee Schedule,,27.91,,,27.91,Fee Schedule,,16.8,70,,16.8,percent of total billed charges,All Other,13.48,,,13.48,Fee Schedule,,8,,,8,Other,186% of Medicaid,15.88,,,15.88,Fee Schedule,,14.88,,,14.88,Fee Schedule,,8.99,,,,Fee Schedule,,15.88,,,15.88,Fee Schedule,,14.88,,,14.88,Fee Schedule,,16.91,,,16.91,Fee Schedule,,16.8,70,,16.8,percent of total billed charges,,20.28,,,20.28,Fee Schedule,,17.19,,,17.19,Fee Schedule,,6.42,,,6.42,Fee Schedule,,6.42,,,6.42,Fee Schedule,,6.42,,,6.42,Fee Schedule,,6.42,,,6.42,Fee Schedule,,4.28,,,4.28,Other,100% of Medicaid,4.28,,,4.28,Other,100% of Medicaid,4.28,,,4.28,Other,100% of Medicaid,4.28,,,4.28,Other,100% of Medicaid,9.63,,,9.63,Other,225% of Medicaid,6.55,,,6.55,Other,153% of Medicaid,9.63,,,9.63,Other,225% of Medicaid,5.99,,,5.99,Other,140% of Medicaid,9.63,,,9.63,Other,225% of Medicaid,11.13,,,11.13,Other,250% of Medicaid,13.87,,,13.87,Other,324% of Medicaid,9.2,,,9.2,Other,215% of Medicaid,9.2,,,9.2,Other,215% of Medicaid,5.35,,,5.35,Other,125% of Medicaid,0.01,32.83,
EUGLOBULIN LYSIS,85360,CPT,,78085360,CDM,305,RC,,,both,,,50,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.31,,,25.31,Fee Schedule,,22.79,,,22.79,Fee Schedule,,47.4,,,47.4,Fee Schedule,,42.64,,,42.64,Fee Schedule,,40.31,,,40.31,Fee Schedule,,35,70,,35,percent of total billed charges,All Other,26.49,,,26.49,Fee Schedule,,12,,,12,Other,186% of Medicaid,31.2,,,31.2,Fee Schedule,,31,,,31,Fee Schedule,,17.66,,,,Fee Schedule,,31.2,,,31.2,Fee Schedule,,31,,,31,Fee Schedule,,33.22,,,33.22,Fee Schedule,,35,70,,35,percent of total billed charges,,39.86,,,39.86,Fee Schedule,,33.78,,,33.78,Fee Schedule,,12.62,,,12.62,Fee Schedule,,12.62,,,12.62,Fee Schedule,,12.62,,,12.62,Fee Schedule,,12.62,,,12.62,Fee Schedule,,6.67,,,6.67,Other,100% of Medicaid,6.67,,,6.67,Other,100% of Medicaid,6.67,,,6.67,Other,100% of Medicaid,6.67,,,6.67,Other,100% of Medicaid,15,,,15,Other,225% of Medicaid,10.2,,,10.2,Other,153% of Medicaid,15,,,15,Other,225% of Medicaid,9.33,,,9.33,Other,140% of Medicaid,15,,,15,Other,225% of Medicaid,17.33,,,17.33,Other,250% of Medicaid,21.6,,,21.6,Other,324% of Medicaid,14.33,,,14.33,Other,215% of Medicaid,14.33,,,14.33,Other,215% of Medicaid,8.33,,,8.33,Other,125% of Medicaid,0.01,47.4,
FIBRIN DEGRADATION PRODUCTS,85362,CPT,,78085362,CDM,305,RC,,,both,,,155,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,20.74,,,20.74,Fee Schedule,,18.67,,,18.67,Fee Schedule,,53.1,,,53.1,Fee Schedule,,47.77,,,47.77,Fee Schedule,,45.16,,,45.16,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,All Other,21.7,,,21.7,Fee Schedule,,13,,,13,Other,186% of Medicaid,25.56,,,25.56,Fee Schedule,,96.1,,,96.1,Fee Schedule,,14.47,,,,Fee Schedule,,25.56,,,25.56,Fee Schedule,,96.1,,,96.1,Fee Schedule,,27.22,,,27.22,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,,32.65,,,32.65,Fee Schedule,,27.67,,,27.67,Fee Schedule,,10.34,,,10.34,Fee Schedule,,10.34,,,10.34,Fee Schedule,,10.34,,,10.34,Fee Schedule,,10.34,,,10.34,Fee Schedule,,6.89,,,6.89,Other,100% of Medicaid,6.89,,,6.89,Other,100% of Medicaid,6.89,,,6.89,Other,100% of Medicaid,6.89,,,6.89,Other,100% of Medicaid,15.5,,,15.5,Other,225% of Medicaid,10.54,,,10.54,Other,153% of Medicaid,15.5,,,15.5,Other,225% of Medicaid,9.65,,,9.65,Other,140% of Medicaid,15.5,,,15.5,Other,225% of Medicaid,17.91,,,17.91,Other,250% of Medicaid,22.32,,,22.32,Other,324% of Medicaid,14.81,,,14.81,Other,215% of Medicaid,14.81,,,14.81,Other,215% of Medicaid,8.61,,,8.61,Other,125% of Medicaid,0.01,108.5,
FIBRIN DEGRADE SEMIQUANT,85378,CPT,,78085378,CDM,305,RC,,,both,,,155,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.26,,,29.26,Fee Schedule,,26.34,,,26.34,Fee Schedule,,54.96,,,54.96,Fee Schedule,,49.45,,,49.45,Fee Schedule,,46.74,,,46.74,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,All Other,30.62,,,30.62,Fee Schedule,,18,,,18,Other,186% of Medicaid,36.06,,,36.06,Fee Schedule,,96.1,,,96.1,Fee Schedule,,20.41,,,,Fee Schedule,,36.06,,,36.06,Fee Schedule,,96.1,,,96.1,Fee Schedule,,38.39,,,38.39,Fee Schedule,,108.5,70,,108.5,percent of total billed charges,,46.06,,,46.06,Fee Schedule,,39.04,,,39.04,Fee Schedule,,14.58,,,14.58,Fee Schedule,,14.58,,,14.58,Fee Schedule,,14.58,,,14.58,Fee Schedule,,14.58,,,14.58,Fee Schedule,,9.72,,,9.72,Other,100% of Medicaid,9.72,,,9.72,Other,100% of Medicaid,9.72,,,9.72,Other,100% of Medicaid,9.72,,,9.72,Other,100% of Medicaid,21.87,,,21.87,Other,225% of Medicaid,14.87,,,14.87,Other,153% of Medicaid,21.87,,,21.87,Other,225% of Medicaid,13.61,,,13.61,Other,140% of Medicaid,21.87,,,21.87,Other,225% of Medicaid,25.27,,,25.27,Other,250% of Medicaid,31.49,,,31.49,Other,324% of Medicaid,20.9,,,20.9,Other,215% of Medicaid,20.9,,,20.9,Other,215% of Medicaid,12.15,,,12.15,Other,125% of Medicaid,0.01,108.5,
FIBRIN DEGRADATION QUANT,85379,CPT,,78085379,CDM,305,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,30.64,,,30.64,Fee Schedule,,27.59,,,27.59,Fee Schedule,,62.53,,,62.53,Fee Schedule,,56.25,,,56.25,Fee Schedule,,53.17,,,53.17,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,All Other,32.07,,,32.07,Fee Schedule,,19,,,19,Other,186% of Medicaid,37.77,,,37.77,Fee Schedule,,112.84,,,112.84,Fee Schedule,,21.38,,,,Fee Schedule,,37.77,,,37.77,Fee Schedule,,112.84,,,112.84,Fee Schedule,,40.21,,,40.21,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,,48.24,,,48.24,Fee Schedule,,40.89,,,40.89,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,15.27,,,15.27,Fee Schedule,,10.18,,,10.18,Other,100% of Medicaid,10.18,,,10.18,Other,100% of Medicaid,10.18,,,10.18,Other,100% of Medicaid,10.18,,,10.18,Other,100% of Medicaid,22.91,,,22.91,Other,225% of Medicaid,15.58,,,15.58,Other,153% of Medicaid,22.91,,,22.91,Other,225% of Medicaid,14.25,,,14.25,Other,140% of Medicaid,22.91,,,22.91,Other,225% of Medicaid,26.47,,,26.47,Other,250% of Medicaid,32.98,,,32.98,Other,324% of Medicaid,21.89,,,21.89,Other,215% of Medicaid,21.89,,,21.89,Other,215% of Medicaid,12.73,,,12.73,Other,125% of Medicaid,0.01,127.4,
FIBRINOGEN,85384,CPT,,78085384,CDM,305,RC,,,both,,,118,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,29.26,,,29.26,Fee Schedule,,26.34,,,26.34,Fee Schedule,,65.49,,,65.49,Fee Schedule,,58.91,,,58.91,Fee Schedule,,55.69,,,55.69,Fee Schedule,,82.6,70,,82.6,percent of total billed charges,All Other,30.62,,,30.62,Fee Schedule,,13,,,13,Other,186% of Medicaid,36.06,,,36.06,Fee Schedule,,73.16,,,73.16,Fee Schedule,,20.41,,,,Fee Schedule,,36.06,,,36.06,Fee Schedule,,73.16,,,73.16,Fee Schedule,,38.39,,,38.39,Fee Schedule,,82.6,70,,82.6,percent of total billed charges,,46.06,,,46.06,Fee Schedule,,39.04,,,39.04,Fee Schedule,,14.58,,,14.58,Fee Schedule,,14.58,,,14.58,Fee Schedule,,14.58,,,14.58,Fee Schedule,,14.58,,,14.58,Fee Schedule,,6.97,,,6.97,Other,100% of Medicaid,6.97,,,6.97,Other,100% of Medicaid,6.97,,,6.97,Other,100% of Medicaid,6.97,,,6.97,Other,100% of Medicaid,15.68,,,15.68,Other,225% of Medicaid,10.66,,,10.66,Other,153% of Medicaid,15.68,,,15.68,Other,225% of Medicaid,9.76,,,9.76,Other,140% of Medicaid,15.68,,,15.68,Other,225% of Medicaid,18.12,,,18.12,Other,250% of Medicaid,22.58,,,22.58,Other,324% of Medicaid,14.98,,,14.98,Other,215% of Medicaid,14.98,,,14.98,Other,215% of Medicaid,8.71,,,8.71,Other,125% of Medicaid,0.01,82.6,
FIBRINOGEN,85385,CPT,,78085385,CDM,305,RC,,,both,,,110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.52,,,43.52,Fee Schedule,,39.19,,,39.19,Fee Schedule,,65.49,,,65.49,Fee Schedule,,58.91,,,58.91,Fee Schedule,,55.69,,,55.69,Fee Schedule,,77,70,,77,percent of total billed charges,All Other,45.55,,,45.55,Fee Schedule,,13,,,13,Other,186% of Medicaid,53.65,,,53.65,Fee Schedule,,68.2,,,68.2,Fee Schedule,,30.37,,,,Fee Schedule,,53.65,,,53.65,Fee Schedule,,68.2,,,68.2,Fee Schedule,,57.12,,,57.12,Fee Schedule,,77,70,,77,percent of total billed charges,,68.53,,,68.53,Fee Schedule,,58.08,,,58.08,Fee Schedule,,21.69,,,21.69,Fee Schedule,,21.69,,,21.69,Fee Schedule,,21.69,,,21.69,Fee Schedule,,21.69,,,21.69,Fee Schedule,,6.97,,,6.97,Other,100% of Medicaid,6.97,,,6.97,Other,100% of Medicaid,6.97,,,6.97,Other,100% of Medicaid,6.97,,,6.97,Other,100% of Medicaid,15.68,,,15.68,Other,225% of Medicaid,10.66,,,10.66,Other,153% of Medicaid,15.68,,,15.68,Other,225% of Medicaid,9.76,,,9.76,Other,140% of Medicaid,15.68,,,15.68,Other,225% of Medicaid,18.12,,,18.12,Other,250% of Medicaid,22.58,,,22.58,Other,324% of Medicaid,14.98,,,14.98,Other,215% of Medicaid,14.98,,,14.98,Other,215% of Medicaid,8.71,,,8.71,Other,125% of Medicaid,0.01,77,
FIBRINOLYSINS SCREEN,85390,CPT,,78085390,CDM,305,RC,,,both,,,33,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,46.59,,,46.59,Fee Schedule,,41.95,,,41.95,Fee Schedule,,39.84,,,39.84,Fee Schedule,,35.84,,,35.84,Fee Schedule,,33.88,,,33.88,Fee Schedule,,23.1,70,,23.1,percent of total billed charges,All Other,48.76,,,48.76,Fee Schedule,,37,,,37,Other,186% of Medicaid,57.43,,,57.43,Fee Schedule,,20.46,,,20.46,Fee Schedule,,32.51,,,,Fee Schedule,,57.43,,,57.43,Fee Schedule,,20.46,,,20.46,Fee Schedule,,61.15,,,61.15,Fee Schedule,,23.1,70,,23.1,percent of total billed charges,,73.36,,,73.36,Fee Schedule,,62.18,,,62.18,Fee Schedule,,23.22,,,23.22,Fee Schedule,,23.22,,,23.22,Fee Schedule,,23.22,,,23.22,Fee Schedule,,23.22,,,23.22,Fee Schedule,,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,30.62,,,30.62,Other,153% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,28.02,,,28.02,Other,140% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,52.04,,,52.04,Other,250% of Medicaid,64.84,,,64.84,Other,324% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,25.02,,,25.02,Other,125% of Medicaid,0.01,73.36,
CLOTTING ASSAY WHOLE BLOOD,85396,CPT,,78085396,CDM,305,RC,,,both,,,29,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.26,,,60.26,Fee Schedule,,54.25,,,54.25,Fee Schedule,,117.87,,,117.87,Fee Schedule,,106.04,,,106.04,Fee Schedule,,100.24,,,100.24,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,All Other,63.06,,,63.06,Fee Schedule,,84,,,84,Other,186% of Medicaid,74.27,,,74.27,Fee Schedule,,17.98,,,17.98,Fee Schedule,,42.04,,,,Fee Schedule,,74.27,,,74.27,Fee Schedule,,17.98,,,17.98,Fee Schedule,,79.08,,,79.08,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,,93.48,,,93.48,Fee Schedule,,79.23,,,79.23,Fee Schedule,,31.4,,,31.4,Fee Schedule,,31.4,,,31.4,Fee Schedule,,31.4,,,31.4,Fee Schedule,,31.4,,,31.4,Fee Schedule,,45.11,,,45.11,Other,100% of Medicaid,45.11,,,45.11,Other,100% of Medicaid,45.11,,,45.11,Other,100% of Medicaid,45.11,,,45.11,Other,100% of Medicaid,101.5,,,101.5,Other,225% of Medicaid,69.02,,,69.02,Other,153% of Medicaid,101.5,,,101.5,Other,225% of Medicaid,63.16,,,63.16,Other,140% of Medicaid,101.5,,,101.5,Other,225% of Medicaid,117.29,,,117.29,Other,250% of Medicaid,146.16,,,146.16,Other,324% of Medicaid,96.99,,,96.99,Other,215% of Medicaid,96.99,,,96.99,Other,215% of Medicaid,56.39,,,56.39,Other,125% of Medicaid,0.01,146.16,
CLOTTING FUNCT ACTIVITY,85397,CPT,,78085397,CDM,305,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,92.89,,,92.89,Fee Schedule,,83.63,,,83.63,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,97.21,,,97.21,Fee Schedule,,18,,,18,Other,186% of Medicaid,114.49,,,114.49,Fee Schedule,,74.4,,,74.4,Fee Schedule,,64.81,,,,Fee Schedule,,114.49,,,114.49,Fee Schedule,,74.4,,,74.4,Fee Schedule,,121.9,,,121.9,Fee Schedule,,84,70,,84,percent of total billed charges,,146.25,,,146.25,Fee Schedule,,123.95,,,123.95,Fee Schedule,,46.29,,,46.29,Fee Schedule,,46.29,,,46.29,Fee Schedule,,46.29,,,46.29,Fee Schedule,,46.29,,,46.29,Fee Schedule,,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,14.53,,,14.53,Other,153% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,24.68,,,24.68,Other,250% of Medicaid,30.76,,,30.76,Other,324% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,11.87,,,11.87,Other,125% of Medicaid,0.01,146.25,
FIBRINOLYTIC ANTIPLASMIN,85410,CPT,,78085410,CDM,305,RC,,,both,,,45,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,23.21,,,23.21,Fee Schedule,,20.89,,,20.89,Fee Schedule,,59.51,,,59.51,Fee Schedule,,53.54,,,53.54,Fee Schedule,,50.61,,,50.61,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,All Other,24.29,,,24.29,Fee Schedule,,37,,,37,Other,186% of Medicaid,28.6,,,28.6,Fee Schedule,,27.9,,,27.9,Fee Schedule,,16.19,,,,Fee Schedule,,28.6,,,28.6,Fee Schedule,,27.9,,,27.9,Fee Schedule,,30.45,,,30.45,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,,36.54,,,36.54,Fee Schedule,,30.97,,,30.97,Fee Schedule,,11.57,,,11.57,Fee Schedule,,11.57,,,11.57,Fee Schedule,,11.57,,,11.57,Fee Schedule,,11.57,,,11.57,Fee Schedule,,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,30.62,,,30.62,Other,153% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,28.02,,,28.02,Other,140% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,52.04,,,52.04,Other,250% of Medicaid,64.84,,,64.84,Other,324% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,25.02,,,25.02,Other,125% of Medicaid,0.01,64.84,
FIBRINOLYTIC PLASMINOGEN,85415,CPT,,78085415,CDM,305,RC,,,both,,,55,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,51.74,,,51.74,Fee Schedule,,46.58,,,46.58,Fee Schedule,,64.66,,,64.66,Fee Schedule,,58.17,,,58.17,Fee Schedule,,54.99,,,54.99,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,All Other,54.15,,,54.15,Fee Schedule,,37,,,37,Other,186% of Medicaid,63.77,,,63.77,Fee Schedule,,34.1,,,34.1,Fee Schedule,,36.1,,,,Fee Schedule,,63.77,,,63.77,Fee Schedule,,34.1,,,34.1,Fee Schedule,,67.9,,,67.9,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,,81.46,,,81.46,Fee Schedule,,69.05,,,69.05,Fee Schedule,,25.79,,,25.79,Fee Schedule,,25.79,,,25.79,Fee Schedule,,25.79,,,25.79,Fee Schedule,,25.79,,,25.79,Fee Schedule,,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,30.62,,,30.62,Other,153% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,28.02,,,28.02,Other,140% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,52.04,,,52.04,Other,250% of Medicaid,64.84,,,64.84,Other,324% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,25.02,,,25.02,Other,125% of Medicaid,0.01,81.46,
FIBRINOLYTIC PLASMINOGEN,85420,CPT,,78085420,CDM,305,RC,,,both,,,152,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,19.66,,,19.66,Fee Schedule,,17.7,,,17.7,Fee Schedule,,48,,,48,Fee Schedule,,43.19,,,43.19,Fee Schedule,,40.82,,,40.82,Fee Schedule,,106.4,70,,106.4,percent of total billed charges,All Other,20.57,,,20.57,Fee Schedule,,37,,,37,Other,186% of Medicaid,24.23,,,24.23,Fee Schedule,,94.24,,,94.24,Fee Schedule,,13.71,,,,Fee Schedule,,24.23,,,24.23,Fee Schedule,,94.24,,,94.24,Fee Schedule,,25.79,,,25.79,Fee Schedule,,106.4,70,,106.4,percent of total billed charges,,30.95,,,30.95,Fee Schedule,,26.23,,,26.23,Fee Schedule,,9.8,,,9.8,Fee Schedule,,9.8,,,9.8,Fee Schedule,,9.8,,,9.8,Fee Schedule,,9.8,,,9.8,Fee Schedule,,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,30.62,,,30.62,Other,153% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,28.02,,,28.02,Other,140% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,52.04,,,52.04,Other,250% of Medicaid,64.84,,,64.84,Other,324% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,25.02,,,25.02,Other,125% of Medicaid,0.01,106.4,
HEMOGLOBIN FETAL,85460,CPT,,78085460,CDM,305,RC,,,both,,,26,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,23.27,,,23.27,Fee Schedule,,20.95,,,20.95,Fee Schedule,,59.68,,,59.68,Fee Schedule,,53.69,,,53.69,Fee Schedule,,50.75,,,50.75,Fee Schedule,,18.2,70,,18.2,percent of total billed charges,All Other,24.35,,,24.35,Fee Schedule,,14,,,14,Other,186% of Medicaid,28.68,,,28.68,Fee Schedule,,16.12,,,16.12,Fee Schedule,,16.23,,,,Fee Schedule,,28.68,,,28.68,Fee Schedule,,16.12,,,16.12,Fee Schedule,,30.53,,,30.53,Fee Schedule,,18.2,70,,18.2,percent of total billed charges,,36.63,,,36.63,Fee Schedule,,31.05,,,31.05,Fee Schedule,,11.6,,,11.6,Fee Schedule,,11.6,,,11.6,Fee Schedule,,11.6,,,11.6,Fee Schedule,,11.6,,,11.6,Fee Schedule,,7.73,,,7.73,Other,100% of Medicaid,7.73,,,7.73,Other,100% of Medicaid,7.73,,,7.73,Other,100% of Medicaid,7.73,,,7.73,Other,100% of Medicaid,17.39,,,17.39,Other,225% of Medicaid,11.83,,,11.83,Other,153% of Medicaid,17.39,,,17.39,Other,225% of Medicaid,10.82,,,10.82,Other,140% of Medicaid,17.39,,,17.39,Other,225% of Medicaid,20.1,,,20.1,Other,250% of Medicaid,25.05,,,25.05,Other,324% of Medicaid,16.62,,,16.62,Other,215% of Medicaid,16.62,,,16.62,Other,215% of Medicaid,9.66,,,9.66,Other,125% of Medicaid,0.01,59.68,
HEMOGLOBIN FETAL,85461,CPT,,77085461,CDM,305,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,28.17,,,28.17,Fee Schedule,,25.37,,,25.37,Fee Schedule,,51.18,,,51.18,Fee Schedule,,46.05,,,46.05,Fee Schedule,,43.52,,,43.52,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,29.48,,,29.48,Fee Schedule,,17,,,17,Other,186% of Medicaid,34.73,,,34.73,Fee Schedule,,57.66,,,57.66,Fee Schedule,,19.66,,,,Fee Schedule,,34.73,,,34.73,Fee Schedule,,57.66,,,57.66,Fee Schedule,,36.97,,,36.97,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,,44.36,,,44.36,Fee Schedule,,37.6,,,37.6,Fee Schedule,,14.04,,,14.04,Fee Schedule,,14.04,,,14.04,Fee Schedule,,14.04,,,14.04,Fee Schedule,,14.04,,,14.04,Fee Schedule,,9.36,,,9.36,Other,100% of Medicaid,9.36,,,9.36,Other,100% of Medicaid,9.36,,,9.36,Other,100% of Medicaid,9.36,,,9.36,Other,100% of Medicaid,21.06,,,21.06,Other,225% of Medicaid,14.32,,,14.32,Other,153% of Medicaid,21.06,,,21.06,Other,225% of Medicaid,13.1,,,13.1,Other,140% of Medicaid,21.06,,,21.06,Other,225% of Medicaid,24.34,,,24.34,Other,250% of Medicaid,30.33,,,30.33,Other,324% of Medicaid,20.12,,,20.12,Other,215% of Medicaid,20.12,,,20.12,Other,215% of Medicaid,11.7,,,11.7,Other,125% of Medicaid,0.01,65.1,
HEMOGLOBIN FETAL,85461,CPT,,78085461,CDM,305,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,28.17,,,28.17,Fee Schedule,,25.37,,,25.37,Fee Schedule,,51.18,,,51.18,Fee Schedule,,46.05,,,46.05,Fee Schedule,,43.52,,,43.52,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,29.48,,,29.48,Fee Schedule,,17,,,17,Other,186% of Medicaid,34.73,,,34.73,Fee Schedule,,57.66,,,57.66,Fee Schedule,,19.66,,,,Fee Schedule,,34.73,,,34.73,Fee Schedule,,57.66,,,57.66,Fee Schedule,,36.97,,,36.97,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,,44.36,,,44.36,Fee Schedule,,37.6,,,37.6,Fee Schedule,,14.04,,,14.04,Fee Schedule,,14.04,,,14.04,Fee Schedule,,14.04,,,14.04,Fee Schedule,,14.04,,,14.04,Fee Schedule,,9.36,,,9.36,Other,100% of Medicaid,9.36,,,9.36,Other,100% of Medicaid,9.36,,,9.36,Other,100% of Medicaid,9.36,,,9.36,Other,100% of Medicaid,21.06,,,21.06,Other,225% of Medicaid,14.32,,,14.32,Other,153% of Medicaid,21.06,,,21.06,Other,225% of Medicaid,13.1,,,13.1,Other,140% of Medicaid,21.06,,,21.06,Other,225% of Medicaid,24.34,,,24.34,Other,250% of Medicaid,30.33,,,30.33,Other,324% of Medicaid,20.12,,,20.12,Other,215% of Medicaid,20.12,,,20.12,Other,215% of Medicaid,11.7,,,11.7,Other,125% of Medicaid,0.01,65.1,
HEMOLYSIN,85475,CPT,,78085475,CDM,305,RC,,,both,,,52,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.7,,,26.7,Fee Schedule,,24.04,,,24.04,Fee Schedule,,68.39,,,68.39,Fee Schedule,,61.53,,,61.53,Fee Schedule,,58.16,,,58.16,Fee Schedule,,36.4,70,,36.4,percent of total billed charges,All Other,27.94,,,27.94,Fee Schedule,,16,,,16,Other,186% of Medicaid,32.91,,,32.91,Fee Schedule,,32.24,,,32.24,Fee Schedule,,18.63,,,,Fee Schedule,,32.91,,,32.91,Fee Schedule,,32.24,,,32.24,Fee Schedule,,35.04,,,35.04,Fee Schedule,,36.4,70,,36.4,percent of total billed charges,,42.04,,,42.04,Fee Schedule,,35.63,,,35.63,Fee Schedule,,13.31,,,13.31,Fee Schedule,,13.31,,,13.31,Fee Schedule,,13.31,,,13.31,Fee Schedule,,13.31,,,13.31,Fee Schedule,,8.87,,,8.87,Other,100% of Medicaid,8.87,,,8.87,Other,100% of Medicaid,8.87,,,8.87,Other,100% of Medicaid,8.87,,,8.87,Other,100% of Medicaid,19.96,,,19.96,Other,225% of Medicaid,13.57,,,13.57,Other,153% of Medicaid,19.96,,,19.96,Other,225% of Medicaid,12.42,,,12.42,Other,140% of Medicaid,19.96,,,19.96,Other,225% of Medicaid,23.06,,,23.06,Other,250% of Medicaid,28.74,,,28.74,Other,324% of Medicaid,19.07,,,19.07,Other,215% of Medicaid,19.07,,,19.07,Other,215% of Medicaid,11.09,,,11.09,Other,125% of Medicaid,0.01,68.39,
HEPARIN ASSAY,85520,CPT,,78085520,CDM,305,RC,,,both,,,255,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.4,,,39.4,Fee Schedule,,35.47,,,35.47,Fee Schedule,,101,,,101,Fee Schedule,,90.86,,,90.86,Fee Schedule,,85.88,,,85.88,Fee Schedule,,178.5,70,,178.5,percent of total billed charges,All Other,41.23,,,41.23,Fee Schedule,,24,,,24,Other,186% of Medicaid,48.56,,,48.56,Fee Schedule,,158.1,,,158.1,Fee Schedule,,27.49,,,,Fee Schedule,,48.56,,,48.56,Fee Schedule,,158.1,,,158.1,Fee Schedule,,51.71,,,51.71,Fee Schedule,,178.5,70,,178.5,percent of total billed charges,,62.03,,,62.03,Fee Schedule,,52.58,,,52.58,Fee Schedule,,19.64,,,19.64,Fee Schedule,,19.64,,,19.64,Fee Schedule,,19.64,,,19.64,Fee Schedule,,19.64,,,19.64,Fee Schedule,,13.09,,,13.09,Other,100% of Medicaid,13.09,,,13.09,Other,100% of Medicaid,13.09,,,13.09,Other,100% of Medicaid,13.09,,,13.09,Other,100% of Medicaid,29.45,,,29.45,Other,225% of Medicaid,20.03,,,20.03,Other,153% of Medicaid,29.45,,,29.45,Other,225% of Medicaid,18.33,,,18.33,Other,140% of Medicaid,29.45,,,29.45,Other,225% of Medicaid,34.03,,,34.03,Other,250% of Medicaid,42.41,,,42.41,Other,324% of Medicaid,28.14,,,28.14,Other,215% of Medicaid,28.14,,,28.14,Other,215% of Medicaid,16.36,,,16.36,Other,125% of Medicaid,0.01,178.5,
WBC ALKALINE PHOSPHATASE,85540,CPT,,78085540,CDM,305,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.89,,,25.89,Fee Schedule,,23.31,,,23.31,Fee Schedule,,66.36,,,66.36,Fee Schedule,,59.7,,,59.7,Fee Schedule,,56.43,,,56.43,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,All Other,27.09,,,27.09,Fee Schedule,,16,,,16,Other,186% of Medicaid,31.91,,,31.91,Fee Schedule,,79.98,,,79.98,Fee Schedule,,18.06,,,,Fee Schedule,,31.91,,,31.91,Fee Schedule,,79.98,,,79.98,Fee Schedule,,33.97,,,33.97,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,,40.76,,,40.76,Fee Schedule,,34.54,,,34.54,Fee Schedule,,12.9,,,12.9,Fee Schedule,,12.9,,,12.9,Fee Schedule,,12.9,,,12.9,Fee Schedule,,12.9,,,12.9,Fee Schedule,,8.6,,,8.6,Other,100% of Medicaid,8.6,,,8.6,Other,100% of Medicaid,8.6,,,8.6,Other,100% of Medicaid,8.6,,,8.6,Other,100% of Medicaid,19.35,,,19.35,Other,225% of Medicaid,13.16,,,13.16,Other,153% of Medicaid,19.35,,,19.35,Other,225% of Medicaid,12.04,,,12.04,Other,140% of Medicaid,19.35,,,19.35,Other,225% of Medicaid,22.36,,,22.36,Other,250% of Medicaid,27.86,,,27.86,Other,324% of Medicaid,18.49,,,18.49,Other,215% of Medicaid,18.49,,,18.49,Other,215% of Medicaid,10.75,,,10.75,Other,125% of Medicaid,0.01,90.3,
MURAMIDASE,85549,CPT,,78085549,CDM,305,RC,,,both,,,292,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,56.44,,,56.44,Fee Schedule,,50.81,,,50.81,Fee Schedule,,144.67,,,144.67,Fee Schedule,,130.15,,,130.15,Fee Schedule,,123.02,,,123.02,Fee Schedule,,204.4,70,,204.4,percent of total billed charges,All Other,59.06,,,59.06,Fee Schedule,,35,,,35,Other,186% of Medicaid,69.56,,,69.56,Fee Schedule,,181.04,,,181.04,Fee Schedule,,39.38,,,,Fee Schedule,,69.56,,,69.56,Fee Schedule,,181.04,,,181.04,Fee Schedule,,74.06,,,74.06,Fee Schedule,,204.4,70,,204.4,percent of total billed charges,,88.86,,,88.86,Fee Schedule,,75.31,,,75.31,Fee Schedule,,28.13,,,28.13,Fee Schedule,,28.13,,,28.13,Fee Schedule,,28.13,,,28.13,Fee Schedule,,28.13,,,28.13,Fee Schedule,,18.75,,,18.75,Other,100% of Medicaid,18.75,,,18.75,Other,100% of Medicaid,18.75,,,18.75,Other,100% of Medicaid,18.75,,,18.75,Other,100% of Medicaid,42.19,,,42.19,Other,225% of Medicaid,28.69,,,28.69,Other,153% of Medicaid,42.19,,,42.19,Other,225% of Medicaid,26.25,,,26.25,Other,140% of Medicaid,42.19,,,42.19,Other,225% of Medicaid,48.75,,,48.75,Other,250% of Medicaid,60.75,,,60.75,Other,324% of Medicaid,40.31,,,40.31,Other,215% of Medicaid,40.31,,,40.31,Other,215% of Medicaid,23.44,,,23.44,Other,125% of Medicaid,0.01,204.4,
RBC OSMOTIC FRAGILITY,85555,CPT,,78085555,CDM,305,RC,,,both,,,50,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,22.48,,,22.48,Fee Schedule,,20.24,,,20.24,Fee Schedule,,51.57,,,51.57,Fee Schedule,,46.39,,,46.39,Fee Schedule,,43.85,,,43.85,Fee Schedule,,35,70,,35,percent of total billed charges,All Other,23.53,,,23.53,Fee Schedule,,14,,,14,Other,186% of Medicaid,27.71,,,27.71,Fee Schedule,,31,,,31,Fee Schedule,,15.69,,,,Fee Schedule,,27.71,,,27.71,Fee Schedule,,31,,,31,Fee Schedule,,29.51,,,29.51,Fee Schedule,,35,70,,35,percent of total billed charges,,35.4,,,35.4,Fee Schedule,,30,,,30,Fee Schedule,,11.21,,,11.21,Fee Schedule,,11.21,,,11.21,Fee Schedule,,11.21,,,11.21,Fee Schedule,,11.21,,,11.21,Fee Schedule,,7.47,,,7.47,Other,100% of Medicaid,7.47,,,7.47,Other,100% of Medicaid,7.47,,,7.47,Other,100% of Medicaid,7.47,,,7.47,Other,100% of Medicaid,16.81,,,16.81,Other,225% of Medicaid,11.43,,,11.43,Other,153% of Medicaid,16.81,,,16.81,Other,225% of Medicaid,10.46,,,10.46,Other,140% of Medicaid,16.81,,,16.81,Other,225% of Medicaid,19.42,,,19.42,Other,250% of Medicaid,24.2,,,24.2,Other,324% of Medicaid,16.06,,,16.06,Other,215% of Medicaid,16.06,,,16.06,Other,215% of Medicaid,9.34,,,9.34,Other,125% of Medicaid,0.01,51.57,
RBC OSMOTIC FRAGILITY,85557,CPT,,78085557,CDM,305,RC,,,both,,,82,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.21,,,40.21,Fee Schedule,,36.21,,,36.21,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,57.4,70,,57.4,percent of total billed charges,All Other,42.08,,,42.08,Fee Schedule,,18,,,18,Other,186% of Medicaid,49.57,,,49.57,Fee Schedule,,50.84,,,50.84,Fee Schedule,,28.06,,,,Fee Schedule,,49.57,,,49.57,Fee Schedule,,50.84,,,50.84,Fee Schedule,,52.77,,,52.77,Fee Schedule,,57.4,70,,57.4,percent of total billed charges,,63.31,,,63.31,Fee Schedule,,53.66,,,53.66,Fee Schedule,,20.04,,,20.04,Fee Schedule,,20.04,,,20.04,Fee Schedule,,20.04,,,20.04,Fee Schedule,,20.04,,,20.04,Fee Schedule,,9.52,,,9.52,Other,100% of Medicaid,9.52,,,9.52,Other,100% of Medicaid,9.52,,,9.52,Other,100% of Medicaid,9.52,,,9.52,Other,100% of Medicaid,21.43,,,21.43,Other,225% of Medicaid,14.57,,,14.57,Other,153% of Medicaid,21.43,,,21.43,Other,225% of Medicaid,13.33,,,13.33,Other,140% of Medicaid,21.43,,,21.43,Other,225% of Medicaid,24.76,,,24.76,Other,250% of Medicaid,30.86,,,30.86,Other,324% of Medicaid,20.48,,,20.48,Other,215% of Medicaid,20.48,,,20.48,Other,215% of Medicaid,11.91,,,11.91,Other,125% of Medicaid,0.01,67.46,
BLOOD PLATELET AGGREGATION,85576,CPT,,78085576,CDM,305,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,74.98,,,74.98,Fee Schedule,,67.51,,,67.51,Fee Schedule,,165.66,,,165.66,Fee Schedule,,149.03,,,149.03,Fee Schedule,,140.87,,,140.87,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,All Other,78.47,,,78.47,Fee Schedule,,20,,,20,Other,186% of Medicaid,92.42,,,92.42,Fee Schedule,,79.98,,,79.98,Fee Schedule,,52.31,,,,Fee Schedule,,92.42,,,92.42,Fee Schedule,,79.98,,,79.98,Fee Schedule,,98.39,,,98.39,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,,118.05,,,118.05,Fee Schedule,,100.05,,,100.05,Fee Schedule,,37.37,,,37.37,Fee Schedule,,37.37,,,37.37,Fee Schedule,,37.37,,,37.37,Fee Schedule,,37.37,,,37.37,Fee Schedule,,10.82,,,10.82,Other,100% of Medicaid,10.82,,,10.82,Other,100% of Medicaid,10.82,,,10.82,Other,100% of Medicaid,10.82,,,10.82,Other,100% of Medicaid,24.34,,,24.34,Other,225% of Medicaid,16.55,,,16.55,Other,153% of Medicaid,24.34,,,24.34,Other,225% of Medicaid,15.14,,,15.14,Other,140% of Medicaid,24.34,,,24.34,Other,225% of Medicaid,28.12,,,28.12,Other,250% of Medicaid,35.05,,,35.05,Other,324% of Medicaid,23.26,,,23.26,Other,215% of Medicaid,23.26,,,23.26,Other,215% of Medicaid,13.52,,,13.52,Other,125% of Medicaid,0.01,165.66,
PLT AGGREGATION (IN VITRO) EA AGENT,85576,CPT,TC,85085576,CDM,305,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,74.98,,,74.98,Fee Schedule,,67.51,,,67.51,Fee Schedule,,165.66,,,165.66,Fee Schedule,,149.03,,,149.03,Fee Schedule,,140.87,,,140.87,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,All Other,78.47,,,78.47,Fee Schedule,,20,,,20,Other,186% of Medicaid,92.42,,,92.42,Fee Schedule,,79.98,,,79.98,Fee Schedule,,52.31,,,,Fee Schedule,,92.42,,,92.42,Fee Schedule,,79.98,,,79.98,Fee Schedule,,98.39,,,98.39,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,,118.05,,,118.05,Fee Schedule,,100.05,,,100.05,Fee Schedule,,37.37,,,37.37,Fee Schedule,,37.37,,,37.37,Fee Schedule,,37.37,,,37.37,Fee Schedule,,37.37,,,37.37,Fee Schedule,,10.82,,,10.82,Other,100% of Medicaid,10.82,,,10.82,Other,100% of Medicaid,10.82,,,10.82,Other,100% of Medicaid,10.82,,,10.82,Other,100% of Medicaid,24.34,,,24.34,Other,225% of Medicaid,16.55,,,16.55,Other,153% of Medicaid,24.34,,,24.34,Other,225% of Medicaid,15.14,,,15.14,Other,140% of Medicaid,24.34,,,24.34,Other,225% of Medicaid,28.12,,,28.12,Other,250% of Medicaid,35.05,,,35.05,Other,324% of Medicaid,23.26,,,23.26,Other,215% of Medicaid,23.26,,,23.26,Other,215% of Medicaid,13.52,,,13.52,Other,125% of Medicaid,0.01,165.66,
HEXAGNAL PHOSPH PLTLT NEUTRL,85598,CPT,,78085598,CDM,305,RC,,,both,,,88,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,54.12,,,54.12,Fee Schedule,,48.73,,,48.73,Fee Schedule,,104.12,,,104.12,Fee Schedule,,93.67,,,93.67,Fee Schedule,,88.54,,,88.54,Fee Schedule,,61.6,70,,61.6,percent of total billed charges,All Other,56.64,,,56.64,Fee Schedule,,37,,,37,Other,186% of Medicaid,66.71,,,66.71,Fee Schedule,,54.56,,,54.56,Fee Schedule,,37.76,,,,Fee Schedule,,66.71,,,66.71,Fee Schedule,,54.56,,,54.56,Fee Schedule,,71.02,,,71.02,Fee Schedule,,61.6,70,,61.6,percent of total billed charges,,85.21,,,85.21,Fee Schedule,,72.22,,,72.22,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,20.01,,,20.01,Other,100% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,30.62,,,30.62,Other,153% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,28.02,,,28.02,Other,140% of Medicaid,45.03,,,45.03,Other,225% of Medicaid,52.04,,,52.04,Other,250% of Medicaid,64.84,,,64.84,Other,324% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,43.03,,,43.03,Other,215% of Medicaid,25.02,,,25.02,Other,125% of Medicaid,0.01,104.12,
PROTHROMBIN TIME,85610,CPT,,30085610,CDM,305,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.91,,,12.91,Fee Schedule,,11.63,,,11.63,Fee Schedule,,30.3,,,30.3,Fee Schedule,,27.26,,,27.26,Fee Schedule,,25.77,,,25.77,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,13.51,,,13.51,Fee Schedule,,7,,,7,Other,186% of Medicaid,15.92,,,15.92,Fee Schedule,,25.42,,,25.42,Fee Schedule,,9.01,,,,Fee Schedule,,15.92,,,15.92,Fee Schedule,,25.42,,,25.42,Fee Schedule,,16.95,,,16.95,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,20.33,,,20.33,Fee Schedule,,17.23,,,17.23,Fee Schedule,,6.44,,,6.44,Fee Schedule,,6.44,,,6.44,Fee Schedule,,6.44,,,6.44,Fee Schedule,,6.44,,,6.44,Fee Schedule,,3.95,,,3.95,Other,100% of Medicaid,3.95,,,3.95,Other,100% of Medicaid,3.95,,,3.95,Other,100% of Medicaid,3.95,,,3.95,Other,100% of Medicaid,8.89,,,8.89,Other,225% of Medicaid,6.04,,,6.04,Other,153% of Medicaid,8.89,,,8.89,Other,225% of Medicaid,5.53,,,5.53,Other,140% of Medicaid,8.89,,,8.89,Other,225% of Medicaid,10.27,,,10.27,Other,250% of Medicaid,12.8,,,12.8,Other,324% of Medicaid,8.49,,,8.49,Other,215% of Medicaid,8.49,,,8.49,Other,215% of Medicaid,4.94,,,4.94,Other,125% of Medicaid,0.01,30.3,
PROTHROMBIN TIME,85610,CPT,,78085610,CDM,305,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.91,,,12.91,Fee Schedule,,11.63,,,11.63,Fee Schedule,,30.3,,,30.3,Fee Schedule,,27.26,,,27.26,Fee Schedule,,25.77,,,25.77,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,13.51,,,13.51,Fee Schedule,,7,,,7,Other,186% of Medicaid,15.92,,,15.92,Fee Schedule,,25.42,,,25.42,Fee Schedule,,9.01,,,,Fee Schedule,,15.92,,,15.92,Fee Schedule,,25.42,,,25.42,Fee Schedule,,16.95,,,16.95,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,20.33,,,20.33,Fee Schedule,,17.23,,,17.23,Fee Schedule,,6.44,,,6.44,Fee Schedule,,6.44,,,6.44,Fee Schedule,,6.44,,,6.44,Fee Schedule,,6.44,,,6.44,Fee Schedule,,3.95,,,3.95,Other,100% of Medicaid,3.95,,,3.95,Other,100% of Medicaid,3.95,,,3.95,Other,100% of Medicaid,3.95,,,3.95,Other,100% of Medicaid,8.89,,,8.89,Other,225% of Medicaid,6.04,,,6.04,Other,153% of Medicaid,8.89,,,8.89,Other,225% of Medicaid,5.53,,,5.53,Other,140% of Medicaid,8.89,,,8.89,Other,225% of Medicaid,10.27,,,10.27,Other,250% of Medicaid,12.8,,,12.8,Other,324% of Medicaid,8.49,,,8.49,Other,215% of Medicaid,8.49,,,8.49,Other,215% of Medicaid,4.94,,,4.94,Other,125% of Medicaid,0.01,30.3,
RUSSELL VIPER VENOM DILUTED,85613,CPT,,78085613,CDM,305,RC,,,both,,,224,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,28.84,,,28.84,Fee Schedule,,25.96,,,25.96,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,156.8,70,,156.8,percent of total billed charges,All Other,30.18,,,30.18,Fee Schedule,,15,,,15,Other,186% of Medicaid,35.54,,,35.54,Fee Schedule,,138.88,,,138.88,Fee Schedule,,20.12,,,,Fee Schedule,,35.54,,,35.54,Fee Schedule,,138.88,,,138.88,Fee Schedule,,37.84,,,37.84,Fee Schedule,,156.8,70,,156.8,percent of total billed charges,,45.4,,,45.4,Fee Schedule,,38.48,,,38.48,Fee Schedule,,14.37,,,14.37,Fee Schedule,,14.37,,,14.37,Fee Schedule,,14.37,,,14.37,Fee Schedule,,14.37,,,14.37,Fee Schedule,,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,7.9,,,7.9,Other,100% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,12.08,,,12.08,Other,153% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,11.06,,,11.06,Other,140% of Medicaid,17.77,,,17.77,Other,225% of Medicaid,20.54,,,20.54,Other,250% of Medicaid,25.59,,,25.59,Other,324% of Medicaid,16.98,,,16.98,Other,215% of Medicaid,16.98,,,16.98,Other,215% of Medicaid,9.87,,,9.87,Other,125% of Medicaid,0.01,156.8,
REPTILASE TEST,85635,CPT,,78085635,CDM,305,RC,,,both,,,32,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,29.65,,,29.65,Fee Schedule,,26.69,,,26.69,Fee Schedule,,75.95,,,75.95,Fee Schedule,,68.33,,,68.33,Fee Schedule,,64.59,,,64.59,Fee Schedule,,22.4,70,,22.4,percent of total billed charges,All Other,31.03,,,31.03,Fee Schedule,,16,,,16,Other,186% of Medicaid,36.54,,,36.54,Fee Schedule,,19.84,,,19.84,Fee Schedule,,20.69,,,,Fee Schedule,,36.54,,,36.54,Fee Schedule,,19.84,,,19.84,Fee Schedule,,38.91,,,38.91,Fee Schedule,,22.4,70,,22.4,percent of total billed charges,,46.68,,,46.68,Fee Schedule,,39.56,,,39.56,Fee Schedule,,14.78,,,14.78,Fee Schedule,,14.78,,,14.78,Fee Schedule,,14.78,,,14.78,Fee Schedule,,14.78,,,14.78,Fee Schedule,,8.56,,,8.56,Other,100% of Medicaid,8.56,,,8.56,Other,100% of Medicaid,8.56,,,8.56,Other,100% of Medicaid,8.56,,,8.56,Other,100% of Medicaid,19.27,,,19.27,Other,225% of Medicaid,13.1,,,13.1,Other,153% of Medicaid,19.27,,,19.27,Other,225% of Medicaid,11.99,,,11.99,Other,140% of Medicaid,19.27,,,19.27,Other,225% of Medicaid,22.27,,,22.27,Other,250% of Medicaid,27.75,,,27.75,Other,324% of Medicaid,18.41,,,18.41,Other,215% of Medicaid,18.41,,,18.41,Other,215% of Medicaid,10.71,,,10.71,Other,125% of Medicaid,0.01,75.95,
RBC SED RATE NONAUTOMATED,85651,CPT,,78085651,CDM,305,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.85,,,12.85,Fee Schedule,,11.57,,,11.57,Fee Schedule,,27.4,,,27.4,Fee Schedule,,24.65,,,24.65,Fee Schedule,,23.3,,,23.3,Fee Schedule,,49,70,,49,percent of total billed charges,All Other,13.45,,,13.45,Fee Schedule,,4,,,4,Other,186% of Medicaid,15.84,,,15.84,Fee Schedule,,43.4,,,43.4,Fee Schedule,,8.97,,,,Fee Schedule,,15.84,,,15.84,Fee Schedule,,43.4,,,43.4,Fee Schedule,,16.87,,,16.87,Fee Schedule,,49,70,,49,percent of total billed charges,,20.24,,,20.24,Fee Schedule,,17.15,,,17.15,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,49,
AUTOM ERYTHROCYTE SED RATE,85652,CPT,,78085652,CDM,305,RC,,,both,,,16,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,8.13,,,8.13,Fee Schedule,,7.32,,,7.32,Fee Schedule,,20.82,,,20.82,Fee Schedule,,18.73,,,18.73,Fee Schedule,,17.71,,,17.71,Fee Schedule,,11.2,70,,11.2,percent of total billed charges,All Other,8.51,,,8.51,Fee Schedule,,4,,,4,Other,186% of Medicaid,10.02,,,10.02,Fee Schedule,,9.92,,,9.92,Fee Schedule,,5.67,,,,Fee Schedule,,10.02,,,10.02,Fee Schedule,,9.92,,,9.92,Fee Schedule,,10.67,,,10.67,Fee Schedule,,11.2,70,,11.2,percent of total billed charges,,12.8,,,12.8,Fee Schedule,,10.84,,,10.84,Fee Schedule,,4.05,,,4.05,Fee Schedule,,4.05,,,4.05,Fee Schedule,,4.05,,,4.05,Fee Schedule,,4.05,,,4.05,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,20.82,
RBC SICKLE CELL TEST,85660,CPT,,78085660,CDM,305,RC,,,both,,,80,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,16.59,,,16.59,Fee Schedule,,14.93,,,14.93,Fee Schedule,,31.51,,,31.51,Fee Schedule,,28.35,,,28.35,Fee Schedule,,26.8,,,26.8,Fee Schedule,,56,70,,56,percent of total billed charges,All Other,17.36,,,17.36,Fee Schedule,,33,,,33,Other,186% of Medicaid,20.44,,,20.44,Fee Schedule,,49.6,,,49.6,Fee Schedule,,11.57,,,,Fee Schedule,,20.44,,,20.44,Fee Schedule,,49.6,,,49.6,Fee Schedule,,21.76,,,21.76,Fee Schedule,,56,70,,56,percent of total billed charges,,26.11,,,26.11,Fee Schedule,,22.13,,,22.13,Fee Schedule,,8.27,,,8.27,Fee Schedule,,8.27,,,8.27,Fee Schedule,,8.27,,,8.27,Fee Schedule,,8.27,,,8.27,Fee Schedule,,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,17.9,,,17.9,Other,100% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,27.38,,,27.38,Other,153% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,25.06,,,25.06,Other,140% of Medicaid,40.27,,,40.27,Other,225% of Medicaid,46.53,,,46.53,Other,250% of Medicaid,57.99,,,57.99,Other,324% of Medicaid,38.48,,,38.48,Other,215% of Medicaid,38.48,,,38.48,Other,215% of Medicaid,22.37,,,22.37,Other,125% of Medicaid,0.01,57.99,
THROMBIN TIME PLASMA,85670,CPT,,78085670,CDM,305,RC,,,both,,,108,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,17.37,,,17.37,Fee Schedule,,15.64,,,15.64,Fee Schedule,,44.55,,,44.55,Fee Schedule,,40.08,,,40.08,Fee Schedule,,37.89,,,37.89,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,All Other,18.18,,,18.18,Fee Schedule,,10,,,10,Other,186% of Medicaid,21.41,,,21.41,Fee Schedule,,66.96,,,66.96,Fee Schedule,,12.12,,,,Fee Schedule,,21.41,,,21.41,Fee Schedule,,66.96,,,66.96,Fee Schedule,,22.79,,,22.79,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,,27.34,,,27.34,Fee Schedule,,23.18,,,23.18,Fee Schedule,,8.66,,,8.66,Fee Schedule,,8.66,,,8.66,Fee Schedule,,8.66,,,8.66,Fee Schedule,,8.66,,,8.66,Fee Schedule,,5.35,,,5.35,Other,100% of Medicaid,5.35,,,5.35,Other,100% of Medicaid,5.35,,,5.35,Other,100% of Medicaid,5.35,,,5.35,Other,100% of Medicaid,12.04,,,12.04,Other,225% of Medicaid,8.19,,,8.19,Other,153% of Medicaid,12.04,,,12.04,Other,225% of Medicaid,7.49,,,7.49,Other,140% of Medicaid,12.04,,,12.04,Other,225% of Medicaid,13.92,,,13.92,Other,250% of Medicaid,17.34,,,17.34,Other,324% of Medicaid,11.51,,,11.51,Other,215% of Medicaid,11.51,,,11.51,Other,215% of Medicaid,6.69,,,6.69,Other,125% of Medicaid,0.01,75.6,
THROMBOPLASTIN INHIBITION,85705,CPT,,78085705,CDM,305,RC,,,both,,,270,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.99,,,28.99,Fee Schedule,,26.1,,,26.1,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,189,70,,189,percent of total billed charges,All Other,30.33,,,30.33,Fee Schedule,,14,,,14,Other,186% of Medicaid,35.73,,,35.73,Fee Schedule,,167.4,,,167.4,Fee Schedule,,20.22,,,,Fee Schedule,,35.73,,,35.73,Fee Schedule,,167.4,,,167.4,Fee Schedule,,38.04,,,38.04,Fee Schedule,,189,70,,189,percent of total billed charges,,45.64,,,45.64,Fee Schedule,,38.68,,,38.68,Fee Schedule,,14.45,,,14.45,Fee Schedule,,14.45,,,14.45,Fee Schedule,,14.45,,,14.45,Fee Schedule,,14.45,,,14.45,Fee Schedule,,7.69,,,7.69,Other,100% of Medicaid,7.69,,,7.69,Other,100% of Medicaid,7.69,,,7.69,Other,100% of Medicaid,7.69,,,7.69,Other,100% of Medicaid,17.29,,,17.29,Other,225% of Medicaid,11.76,,,11.76,Other,153% of Medicaid,17.29,,,17.29,Other,225% of Medicaid,10.76,,,10.76,Other,140% of Medicaid,17.29,,,17.29,Other,225% of Medicaid,19.98,,,19.98,Other,250% of Medicaid,24.9,,,24.9,Other,324% of Medicaid,16.53,,,16.53,Other,215% of Medicaid,16.53,,,16.53,Other,215% of Medicaid,9.61,,,9.61,Other,125% of Medicaid,0.01,189,
BLOOD VISCOSITY EXAMINATION,85810,CPT,,78085810,CDM,305,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,35.13,,,35.13,Fee Schedule,,31.63,,,31.63,Fee Schedule,,90.04,,,90.04,Fee Schedule,,81,,,81,Fee Schedule,,76.56,,,76.56,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,36.76,,,36.76,Fee Schedule,,22,,,22,Other,186% of Medicaid,43.3,,,43.3,Fee Schedule,,115.32,,,115.32,Fee Schedule,,24.51,,,,Fee Schedule,,43.3,,,43.3,Fee Schedule,,115.32,,,115.32,Fee Schedule,,46.1,,,46.1,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,55.3,,,55.3,Fee Schedule,,46.87,,,46.87,Fee Schedule,,17.51,,,17.51,Fee Schedule,,17.51,,,17.51,Fee Schedule,,17.51,,,17.51,Fee Schedule,,17.51,,,17.51,Fee Schedule,,11.67,,,11.67,Other,100% of Medicaid,11.67,,,11.67,Other,100% of Medicaid,11.67,,,11.67,Other,100% of Medicaid,11.67,,,11.67,Other,100% of Medicaid,26.26,,,26.26,Other,225% of Medicaid,17.86,,,17.86,Other,153% of Medicaid,26.26,,,26.26,Other,225% of Medicaid,16.34,,,16.34,Other,140% of Medicaid,26.26,,,26.26,Other,225% of Medicaid,30.34,,,30.34,Other,250% of Medicaid,37.81,,,37.81,Other,324% of Medicaid,25.09,,,25.09,Other,215% of Medicaid,25.09,,,25.09,Other,215% of Medicaid,14.59,,,14.59,Other,125% of Medicaid,0.01,130.2,
SPLECIMEN CONCENTRATION,87015,CPT,,78087015,CDM,306,RC,,,both,,,227,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,20.11,,,20.11,Fee Schedule,,18.1,,,18.1,Fee Schedule,,51.51,,,51.51,Fee Schedule,,46.34,,,46.34,Fee Schedule,,43.8,,,43.8,Fee Schedule,,158.9,70,,158.9,percent of total billed charges,All Other,21.04,,,21.04,Fee Schedule,,6,,,6,Other,186% of Medicaid,24.78,,,24.78,Fee Schedule,,140.74,,,140.74,Fee Schedule,,14.03,,,,Fee Schedule,,24.78,,,24.78,Fee Schedule,,140.74,,,140.74,Fee Schedule,,26.39,,,26.39,Fee Schedule,,158.9,70,,158.9,percent of total billed charges,,31.66,,,31.66,Fee Schedule,,26.83,,,26.83,Fee Schedule,,10.02,,,10.02,Fee Schedule,,10.02,,,10.02,Fee Schedule,,10.02,,,10.02,Fee Schedule,,10.02,,,10.02,Fee Schedule,,3.28,,,3.28,Other,100% of Medicaid,3.28,,,3.28,Other,100% of Medicaid,3.28,,,3.28,Other,100% of Medicaid,3.28,,,3.28,Other,100% of Medicaid,7.39,,,7.39,Other,225% of Medicaid,5.02,,,5.02,Other,153% of Medicaid,7.39,,,7.39,Other,225% of Medicaid,4.6,,,4.6,Other,140% of Medicaid,7.39,,,7.39,Other,225% of Medicaid,8.53,,,8.53,Other,250% of Medicaid,10.64,,,10.64,Other,324% of Medicaid,7.06,,,7.06,Other,215% of Medicaid,7.06,,,7.06,Other,215% of Medicaid,4.1,,,4.1,Other,125% of Medicaid,0.01,158.9,
BLOOD CULTURE FOR BACTERIA,87040,CPT,,78087040,CDM,306,RC,,,both,,,166,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,31.06,,,31.06,Fee Schedule,,27.97,,,27.97,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,All Other,32.51,,,32.51,Fee Schedule,,15,,,15,Other,186% of Medicaid,38.29,,,38.29,Fee Schedule,,102.92,,,102.92,Fee Schedule,,21.67,,,,Fee Schedule,,38.29,,,38.29,Fee Schedule,,102.92,,,102.92,Fee Schedule,,40.76,,,40.76,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,,48.91,,,48.91,Fee Schedule,,41.45,,,41.45,Fee Schedule,,15.48,,,15.48,Fee Schedule,,15.48,,,15.48,Fee Schedule,,15.48,,,15.48,Fee Schedule,,15.48,,,15.48,Fee Schedule,,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,12.59,,,12.59,Other,153% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,11.52,,,11.52,Other,140% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,21.4,,,21.4,Other,250% of Medicaid,26.67,,,26.67,Other,324% of Medicaid,17.7,,,17.7,Other,215% of Medicaid,17.7,,,17.7,Other,215% of Medicaid,10.29,,,10.29,Other,125% of Medicaid,0.01,116.2,
FECES CULTURE BACTERIA,87045,CPT,,78087045,CDM,306,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,28.41,,,28.41,Fee Schedule,,25.58,,,25.58,Fee Schedule,,72.77,,,72.77,Fee Schedule,,65.47,,,65.47,Fee Schedule,,61.88,,,61.88,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,29.74,,,29.74,Fee Schedule,,15,,,15,Other,186% of Medicaid,35.02,,,35.02,Fee Schedule,,119.66,,,119.66,Fee Schedule,,19.82,,,,Fee Schedule,,35.02,,,35.02,Fee Schedule,,119.66,,,119.66,Fee Schedule,,37.29,,,37.29,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,,44.74,,,44.74,Fee Schedule,,37.92,,,37.92,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,12.59,,,12.59,Other,153% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,11.52,,,11.52,Other,140% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,21.4,,,21.4,Other,250% of Medicaid,26.67,,,26.67,Other,324% of Medicaid,17.7,,,17.7,Other,215% of Medicaid,17.7,,,17.7,Other,215% of Medicaid,10.29,,,10.29,Other,125% of Medicaid,0.01,135.1,
STOOL CULTR BACTERIA EACH,87046,CPT,,78087046,CDM,306,RC,,,both,,,68,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,28.41,,,28.41,Fee Schedule,,25.58,,,25.58,Fee Schedule,,72.77,,,72.77,Fee Schedule,,65.47,,,65.47,Fee Schedule,,61.88,,,61.88,Fee Schedule,,47.6,70,,47.6,percent of total billed charges,All Other,29.74,,,29.74,Fee Schedule,,6,,,6,Other,186% of Medicaid,35.02,,,35.02,Fee Schedule,,42.16,,,42.16,Fee Schedule,,19.82,,,,Fee Schedule,,35.02,,,35.02,Fee Schedule,,42.16,,,42.16,Fee Schedule,,37.29,,,37.29,Fee Schedule,,47.6,70,,47.6,percent of total billed charges,,44.74,,,44.74,Fee Schedule,,37.92,,,37.92,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,14.16,,,14.16,Fee Schedule,,2.98,,,2.98,Other,100% of Medicaid,2.98,,,2.98,Other,100% of Medicaid,2.98,,,2.98,Other,100% of Medicaid,2.98,,,2.98,Other,100% of Medicaid,6.7,,,6.7,Other,225% of Medicaid,4.56,,,4.56,Other,153% of Medicaid,6.7,,,6.7,Other,225% of Medicaid,4.17,,,4.17,Other,140% of Medicaid,6.7,,,6.7,Other,225% of Medicaid,7.75,,,7.75,Other,250% of Medicaid,9.65,,,9.65,Other,324% of Medicaid,6.41,,,6.41,Other,215% of Medicaid,6.41,,,6.41,Other,215% of Medicaid,3.72,,,3.72,Other,125% of Medicaid,0.01,72.77,
CULTURE BACTERIA OTHER,87070,CPT,,78087070,CDM,306,RC,,,both,,,216,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,25.95,,,25.95,Fee Schedule,,23.36,,,23.36,Fee Schedule,,66.42,,,66.42,Fee Schedule,,59.75,,,59.75,Fee Schedule,,56.48,,,56.48,Fee Schedule,,151.2,70,,151.2,percent of total billed charges,All Other,27.15,,,27.15,Fee Schedule,,15,,,15,Other,186% of Medicaid,31.98,,,31.98,Fee Schedule,,133.92,,,133.92,Fee Schedule,,18.1,,,,Fee Schedule,,31.98,,,31.98,Fee Schedule,,133.92,,,133.92,Fee Schedule,,34.05,,,34.05,Fee Schedule,,151.2,70,,151.2,percent of total billed charges,,40.85,,,40.85,Fee Schedule,,34.62,,,34.62,Fee Schedule,,12.93,,,12.93,Fee Schedule,,12.93,,,12.93,Fee Schedule,,12.93,,,12.93,Fee Schedule,,12.93,,,12.93,Fee Schedule,,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,12.59,,,12.59,Other,153% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,11.52,,,11.52,Other,140% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,21.4,,,21.4,Other,250% of Medicaid,26.67,,,26.67,Other,324% of Medicaid,17.7,,,17.7,Other,215% of Medicaid,17.7,,,17.7,Other,215% of Medicaid,10.29,,,10.29,Other,125% of Medicaid,0.01,151.2,
CULTURE AEROBIC QUANT OTHER,87071,CPT,,78087071,CDM,306,RC,,,both,,,32,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,29.77,,,29.77,Fee Schedule,,26.8,,,26.8,Fee Schedule,,72.77,,,72.77,Fee Schedule,,65.47,,,65.47,Fee Schedule,,61.88,,,61.88,Fee Schedule,,22.4,70,,22.4,percent of total billed charges,All Other,31.15,,,31.15,Fee Schedule,,31,,,31,Other,186% of Medicaid,36.69,,,36.69,Fee Schedule,,19.84,,,19.84,Fee Schedule,,20.77,,,,Fee Schedule,,36.69,,,36.69,Fee Schedule,,19.84,,,19.84,Fee Schedule,,39.07,,,39.07,Fee Schedule,,22.4,70,,22.4,percent of total billed charges,,46.87,,,46.87,Fee Schedule,,39.72,,,39.72,Fee Schedule,,14.84,,,14.84,Fee Schedule,,14.84,,,14.84,Fee Schedule,,14.84,,,14.84,Fee Schedule,,14.84,,,14.84,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,72.77,
CULTR BACTERIA EXCEPT BLOOD,87075,CPT,,78087075,CDM,306,RC,,,both,,,210,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,28.5,,,28.5,Fee Schedule,,25.66,,,25.66,Fee Schedule,,72.94,,,72.94,Fee Schedule,,65.62,,,65.62,Fee Schedule,,62.02,,,62.02,Fee Schedule,,147,70,,147,percent of total billed charges,All Other,29.83,,,29.83,Fee Schedule,,18,,,18,Other,186% of Medicaid,35.13,,,35.13,Fee Schedule,,130.2,,,130.2,Fee Schedule,,19.89,,,,Fee Schedule,,35.13,,,35.13,Fee Schedule,,130.2,,,130.2,Fee Schedule,,37.41,,,37.41,Fee Schedule,,147,70,,147,percent of total billed charges,,44.88,,,44.88,Fee Schedule,,38.04,,,38.04,Fee Schedule,,14.21,,,14.21,Fee Schedule,,14.21,,,14.21,Fee Schedule,,14.21,,,14.21,Fee Schedule,,14.21,,,14.21,Fee Schedule,,9.47,,,9.47,Other,100% of Medicaid,9.47,,,9.47,Other,100% of Medicaid,9.47,,,9.47,Other,100% of Medicaid,9.47,,,9.47,Other,100% of Medicaid,21.31,,,21.31,Other,225% of Medicaid,14.49,,,14.49,Other,153% of Medicaid,21.31,,,21.31,Other,225% of Medicaid,13.26,,,13.26,Other,140% of Medicaid,21.31,,,21.31,Other,225% of Medicaid,24.62,,,24.62,Other,250% of Medicaid,30.68,,,30.68,Other,324% of Medicaid,20.36,,,20.36,Other,215% of Medicaid,20.36,,,20.36,Other,215% of Medicaid,11.84,,,11.84,Other,125% of Medicaid,0.01,147,
CULTURE ANAEROBE IDENT EACH,87076,CPT,,78087076,CDM,306,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.32,,,24.32,Fee Schedule,,21.9,,,21.9,Fee Schedule,,62.31,,,62.31,Fee Schedule,,56.05,,,56.05,Fee Schedule,,52.98,,,52.98,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,All Other,25.45,,,25.45,Fee Schedule,,15,,,15,Other,186% of Medicaid,29.98,,,29.98,Fee Schedule,,40.3,,,40.3,Fee Schedule,,16.97,,,,Fee Schedule,,29.98,,,29.98,Fee Schedule,,40.3,,,40.3,Fee Schedule,,31.92,,,31.92,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,,38.29,,,38.29,Fee Schedule,,32.45,,,32.45,Fee Schedule,,12.12,,,12.12,Fee Schedule,,12.12,,,12.12,Fee Schedule,,12.12,,,12.12,Fee Schedule,,12.12,,,12.12,Fee Schedule,,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,12.36,,,12.36,Other,153% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,11.31,,,11.31,Other,140% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,21.01,,,21.01,Other,250% of Medicaid,26.18,,,26.18,Other,324% of Medicaid,17.37,,,17.37,Other,215% of Medicaid,17.37,,,17.37,Other,215% of Medicaid,10.1,,,10.1,Other,125% of Medicaid,0.01,62.31,
CULTURE SCREEN ONLY,87081,CPT,,78087081,CDM,306,RC,,,both,,,171,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.96,,,19.96,Fee Schedule,,17.97,,,17.97,Fee Schedule,,51.13,,,51.13,Fee Schedule,,46,,,46,Fee Schedule,,43.48,,,43.48,Fee Schedule,,119.7,70,,119.7,percent of total billed charges,All Other,20.88,,,20.88,Fee Schedule,,10,,,10,Other,186% of Medicaid,24.6,,,24.6,Fee Schedule,,106.02,,,106.02,Fee Schedule,,13.92,,,,Fee Schedule,,24.6,,,24.6,Fee Schedule,,106.02,,,106.02,Fee Schedule,,26.19,,,26.19,Fee Schedule,,119.7,70,,119.7,percent of total billed charges,,31.42,,,31.42,Fee Schedule,,26.63,,,26.63,Fee Schedule,,9.95,,,9.95,Fee Schedule,,9.95,,,9.95,Fee Schedule,,9.95,,,9.95,Fee Schedule,,9.95,,,9.95,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,119.7,
URINE CULTURE/COLONY COUNT,87086,CPT,,78087086,CDM,306,RC,,,both,,,128,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.29,,,24.29,Fee Schedule,,21.87,,,21.87,Fee Schedule,,62.25,,,62.25,Fee Schedule,,56,,,56,Fee Schedule,,52.94,,,52.94,Fee Schedule,,89.6,70,,89.6,percent of total billed charges,All Other,25.42,,,25.42,Fee Schedule,,15,,,15,Other,186% of Medicaid,29.94,,,29.94,Fee Schedule,,79.36,,,79.36,Fee Schedule,,16.95,,,,Fee Schedule,,29.94,,,29.94,Fee Schedule,,79.36,,,79.36,Fee Schedule,,31.88,,,31.88,Fee Schedule,,89.6,70,,89.6,percent of total billed charges,,38.24,,,38.24,Fee Schedule,,32.41,,,32.41,Fee Schedule,,12.11,,,12.11,Fee Schedule,,12.11,,,12.11,Fee Schedule,,12.11,,,12.11,Fee Schedule,,12.11,,,12.11,Fee Schedule,,8.07,,,8.07,Other,100% of Medicaid,8.07,,,8.07,Other,100% of Medicaid,8.07,,,8.07,Other,100% of Medicaid,8.07,,,8.07,Other,100% of Medicaid,18.16,,,18.16,Other,225% of Medicaid,12.35,,,12.35,Other,153% of Medicaid,18.16,,,18.16,Other,225% of Medicaid,11.3,,,11.3,Other,140% of Medicaid,18.16,,,18.16,Other,225% of Medicaid,20.98,,,20.98,Other,250% of Medicaid,26.15,,,26.15,Other,324% of Medicaid,17.35,,,17.35,Other,215% of Medicaid,17.35,,,17.35,Other,215% of Medicaid,10.09,,,10.09,Other,125% of Medicaid,0.01,89.6,
URINE BACTERIA CULTURE,87088,CPT,,78087088,CDM,306,RC,,,both,,,166,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,24.35,,,24.35,Fee Schedule,,21.92,,,21.92,Fee Schedule,,62.47,,,62.47,Fee Schedule,,56.2,,,56.2,Fee Schedule,,53.12,,,53.12,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,All Other,25.48,,,25.48,Fee Schedule,,15,,,15,Other,186% of Medicaid,30.01,,,30.01,Fee Schedule,,102.92,,,102.92,Fee Schedule,,16.99,,,,Fee Schedule,,30.01,,,30.01,Fee Schedule,,102.92,,,102.92,Fee Schedule,,31.96,,,31.96,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,,38.34,,,38.34,Fee Schedule,,32.49,,,32.49,Fee Schedule,,12.14,,,12.14,Fee Schedule,,12.14,,,12.14,Fee Schedule,,12.14,,,12.14,Fee Schedule,,12.14,,,12.14,Fee Schedule,,8.09,,,8.09,Other,100% of Medicaid,8.09,,,8.09,Other,100% of Medicaid,8.09,,,8.09,Other,100% of Medicaid,8.09,,,8.09,Other,100% of Medicaid,18.2,,,18.2,Other,225% of Medicaid,12.38,,,12.38,Other,153% of Medicaid,18.2,,,18.2,Other,225% of Medicaid,11.33,,,11.33,Other,140% of Medicaid,18.2,,,18.2,Other,225% of Medicaid,21.03,,,21.03,Other,250% of Medicaid,26.21,,,26.21,Other,324% of Medicaid,17.39,,,17.39,Other,215% of Medicaid,17.39,,,17.39,Other,215% of Medicaid,10.11,,,10.11,Other,125% of Medicaid,0.01,116.2,
SKIN FUNGI CULTURE,87101,CPT,,78087101,CDM,306,RC,,,both,,,138,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,23.21,,,23.21,Fee Schedule,,20.89,,,20.89,Fee Schedule,,59.51,,,59.51,Fee Schedule,,53.54,,,53.54,Fee Schedule,,50.61,,,50.61,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,All Other,24.29,,,24.29,Fee Schedule,,14,,,14,Other,186% of Medicaid,28.6,,,28.6,Fee Schedule,,85.56,,,85.56,Fee Schedule,,16.19,,,,Fee Schedule,,28.6,,,28.6,Fee Schedule,,85.56,,,85.56,Fee Schedule,,30.45,,,30.45,Fee Schedule,,96.6,70,,96.6,percent of total billed charges,,36.54,,,36.54,Fee Schedule,,30.97,,,30.97,Fee Schedule,,11.57,,,11.57,Fee Schedule,,11.57,,,11.57,Fee Schedule,,11.57,,,11.57,Fee Schedule,,11.57,,,11.57,Fee Schedule,,7.71,,,7.71,Other,100% of Medicaid,7.71,,,7.71,Other,100% of Medicaid,7.71,,,7.71,Other,100% of Medicaid,7.71,,,7.71,Other,100% of Medicaid,17.35,,,17.35,Other,225% of Medicaid,11.8,,,11.8,Other,153% of Medicaid,17.35,,,17.35,Other,225% of Medicaid,10.79,,,10.79,Other,140% of Medicaid,17.35,,,17.35,Other,225% of Medicaid,20.05,,,20.05,Other,250% of Medicaid,24.98,,,24.98,Other,324% of Medicaid,16.58,,,16.58,Other,215% of Medicaid,16.58,,,16.58,Other,215% of Medicaid,9.64,,,9.64,Other,125% of Medicaid,0.01,96.6,
FUNGUS ISOLATION CULTURE,87102,CPT,,78087102,CDM,306,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,25.31,,,25.31,Fee Schedule,,22.79,,,22.79,Fee Schedule,,64.83,,,64.83,Fee Schedule,,58.32,,,58.32,Fee Schedule,,55.13,,,55.13,Fee Schedule,,73.5,70,,73.5,percent of total billed charges,All Other,26.49,,,26.49,Fee Schedule,,16,,,16,Other,186% of Medicaid,31.2,,,31.2,Fee Schedule,,65.1,,,65.1,Fee Schedule,,17.66,,,,Fee Schedule,,31.2,,,31.2,Fee Schedule,,65.1,,,65.1,Fee Schedule,,33.22,,,33.22,Fee Schedule,,73.5,70,,73.5,percent of total billed charges,,39.86,,,39.86,Fee Schedule,,33.78,,,33.78,Fee Schedule,,12.62,,,12.62,Fee Schedule,,12.62,,,12.62,Fee Schedule,,12.62,,,12.62,Fee Schedule,,12.62,,,12.62,Fee Schedule,,8.41,,,8.41,Other,100% of Medicaid,8.41,,,8.41,Other,100% of Medicaid,8.41,,,8.41,Other,100% of Medicaid,8.41,,,8.41,Other,100% of Medicaid,18.92,,,18.92,Other,225% of Medicaid,12.87,,,12.87,Other,153% of Medicaid,18.92,,,18.92,Other,225% of Medicaid,11.77,,,11.77,Other,140% of Medicaid,18.92,,,18.92,Other,225% of Medicaid,21.87,,,21.87,Other,250% of Medicaid,27.25,,,27.25,Other,324% of Medicaid,18.08,,,18.08,Other,215% of Medicaid,18.08,,,18.08,Other,215% of Medicaid,10.51,,,10.51,Other,125% of Medicaid,0.01,73.5,
BLOOD FUNGUS CULTURE,87103,CPT,,78087103,CDM,306,RC,,,both,,,66,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,61.58,,,61.58,Fee Schedule,,55.45,,,55.45,Fee Schedule,,69.54,,,69.54,Fee Schedule,,62.56,,,62.56,Fee Schedule,,59.14,,,59.14,Fee Schedule,,46.2,70,,46.2,percent of total billed charges,All Other,64.45,,,64.45,Fee Schedule,,21,,,21,Other,186% of Medicaid,75.91,,,75.91,Fee Schedule,,40.92,,,40.92,Fee Schedule,,42.97,,,,Fee Schedule,,75.91,,,75.91,Fee Schedule,,40.92,,,40.92,Fee Schedule,,80.82,,,80.82,Fee Schedule,,46.2,70,,46.2,percent of total billed charges,,96.96,,,96.96,Fee Schedule,,82.18,,,82.18,Fee Schedule,,30.69,,,30.69,Fee Schedule,,30.69,,,30.69,Fee Schedule,,30.69,,,30.69,Fee Schedule,,30.69,,,30.69,Fee Schedule,,11.48,,,11.48,Other,100% of Medicaid,11.48,,,11.48,Other,100% of Medicaid,11.48,,,11.48,Other,100% of Medicaid,11.48,,,11.48,Other,100% of Medicaid,25.84,,,25.84,Other,225% of Medicaid,17.57,,,17.57,Other,153% of Medicaid,25.84,,,25.84,Other,225% of Medicaid,16.08,,,16.08,Other,140% of Medicaid,25.84,,,25.84,Other,225% of Medicaid,29.86,,,29.86,Other,250% of Medicaid,37.21,,,37.21,Other,324% of Medicaid,24.69,,,24.69,Other,215% of Medicaid,24.69,,,24.69,Other,215% of Medicaid,14.35,,,14.35,Other,125% of Medicaid,0.01,96.96,
FUNGI IDENTIFICATION YEAST,87106,CPT,,78087106,CDM,306,RC,,,both,,,137,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,31.06,,,31.06,Fee Schedule,,27.97,,,27.97,Fee Schedule,,79.62,,,79.62,Fee Schedule,,71.63,,,71.63,Fee Schedule,,67.71,,,67.71,Fee Schedule,,95.9,70,,95.9,percent of total billed charges,All Other,32.51,,,32.51,Fee Schedule,,18,,,18,Other,186% of Medicaid,38.29,,,38.29,Fee Schedule,,84.94,,,84.94,Fee Schedule,,21.67,,,,Fee Schedule,,38.29,,,38.29,Fee Schedule,,84.94,,,84.94,Fee Schedule,,40.76,,,40.76,Fee Schedule,,95.9,70,,95.9,percent of total billed charges,,48.91,,,48.91,Fee Schedule,,41.45,,,41.45,Fee Schedule,,15.48,,,15.48,Fee Schedule,,15.48,,,15.48,Fee Schedule,,15.48,,,15.48,Fee Schedule,,15.48,,,15.48,Fee Schedule,,9.8,,,9.8,Other,100% of Medicaid,9.8,,,9.8,Other,100% of Medicaid,9.8,,,9.8,Other,100% of Medicaid,9.8,,,9.8,Other,100% of Medicaid,22.04,,,22.04,Other,225% of Medicaid,14.99,,,14.99,Other,153% of Medicaid,22.04,,,22.04,Other,225% of Medicaid,13.72,,,13.72,Other,140% of Medicaid,22.04,,,22.04,Other,225% of Medicaid,25.47,,,25.47,Other,250% of Medicaid,31.74,,,31.74,Other,324% of Medicaid,21.06,,,21.06,Other,215% of Medicaid,21.06,,,21.06,Other,215% of Medicaid,12.25,,,12.25,Other,125% of Medicaid,0.01,95.9,
FUNGI IDENTIFICATION MOLD,87107,CPT,,78087107,CDM,306,RC,,,both,,,213,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,31.06,,,31.06,Fee Schedule,,27.97,,,27.97,Fee Schedule,,79.62,,,79.62,Fee Schedule,,71.63,,,71.63,Fee Schedule,,67.71,,,67.71,Fee Schedule,,149.1,70,,149.1,percent of total billed charges,All Other,32.51,,,32.51,Fee Schedule,,18,,,18,Other,186% of Medicaid,38.29,,,38.29,Fee Schedule,,132.06,,,132.06,Fee Schedule,,21.67,,,,Fee Schedule,,38.29,,,38.29,Fee Schedule,,132.06,,,132.06,Fee Schedule,,40.76,,,40.76,Fee Schedule,,149.1,70,,149.1,percent of total billed charges,,48.91,,,48.91,Fee Schedule,,41.45,,,41.45,Fee Schedule,,15.48,,,15.48,Fee Schedule,,15.48,,,15.48,Fee Schedule,,15.48,,,15.48,Fee Schedule,,15.48,,,15.48,Fee Schedule,,9.8,,,9.8,Other,100% of Medicaid,9.8,,,9.8,Other,100% of Medicaid,9.8,,,9.8,Other,100% of Medicaid,9.8,,,9.8,Other,100% of Medicaid,22.04,,,22.04,Other,225% of Medicaid,14.99,,,14.99,Other,153% of Medicaid,22.04,,,22.04,Other,225% of Medicaid,13.72,,,13.72,Other,140% of Medicaid,22.04,,,22.04,Other,225% of Medicaid,25.47,,,25.47,Other,250% of Medicaid,31.74,,,31.74,Other,324% of Medicaid,21.06,,,21.06,Other,215% of Medicaid,21.06,,,21.06,Other,215% of Medicaid,12.25,,,12.25,Other,125% of Medicaid,0.01,149.1,
CHLAMYHDIA CULTURE,87110,CPT,,78087110,CDM,306,RC,,,both,,,281,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,59,,,59,Fee Schedule,,53.12,,,53.12,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,196.7,70,,196.7,percent of total billed charges,All Other,61.74,,,61.74,Fee Schedule,,15,,,15,Other,186% of Medicaid,72.72,,,72.72,Fee Schedule,,174.22,,,174.22,Fee Schedule,,41.16,,,,Fee Schedule,,72.72,,,72.72,Fee Schedule,,174.22,,,174.22,Fee Schedule,,77.42,,,77.42,Fee Schedule,,196.7,70,,196.7,percent of total billed charges,,92.89,,,92.89,Fee Schedule,,78.73,,,78.73,Fee Schedule,,29.4,,,29.4,Fee Schedule,,29.4,,,29.4,Fee Schedule,,29.4,,,29.4,Fee Schedule,,29.4,,,29.4,Fee Schedule,,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,8.23,,,8.23,Other,100% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,12.59,,,12.59,Other,153% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,11.52,,,11.52,Other,140% of Medicaid,18.52,,,18.52,Other,225% of Medicaid,21.4,,,21.4,Other,250% of Medicaid,26.67,,,26.67,Other,324% of Medicaid,17.7,,,17.7,Other,215% of Medicaid,17.7,,,17.7,Other,215% of Medicaid,10.29,,,10.29,Other,125% of Medicaid,0.01,196.7,
MYCOBACTERIA CULTURE,87116,CPT,,78087116,CDM,306,RC,,,both,,,164,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,32.51,,,32.51,Fee Schedule,,29.27,,,29.27,Fee Schedule,,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,70.88,,,70.88,Fee Schedule,,114.8,70,,114.8,percent of total billed charges,All Other,34.02,,,34.02,Fee Schedule,,20,,,20,Other,186% of Medicaid,40.07,,,40.07,Fee Schedule,,101.68,,,101.68,Fee Schedule,,22.68,,,,Fee Schedule,,40.07,,,40.07,Fee Schedule,,101.68,,,101.68,Fee Schedule,,42.66,,,42.66,Fee Schedule,,114.8,70,,114.8,percent of total billed charges,,51.18,,,51.18,Fee Schedule,,43.38,,,43.38,Fee Schedule,,16.2,,,16.2,Fee Schedule,,16.2,,,16.2,Fee Schedule,,16.2,,,16.2,Fee Schedule,,16.2,,,16.2,Fee Schedule,,10.8,,,10.8,Other,100% of Medicaid,10.8,,,10.8,Other,100% of Medicaid,10.8,,,10.8,Other,100% of Medicaid,10.8,,,10.8,Other,100% of Medicaid,24.3,,,24.3,Other,225% of Medicaid,16.52,,,16.52,Other,153% of Medicaid,24.3,,,24.3,Other,225% of Medicaid,15.12,,,15.12,Other,140% of Medicaid,24.3,,,24.3,Other,225% of Medicaid,28.08,,,28.08,Other,250% of Medicaid,34.99,,,34.99,Other,324% of Medicaid,23.22,,,23.22,Other,215% of Medicaid,23.22,,,23.22,Other,215% of Medicaid,13.5,,,13.5,Other,125% of Medicaid,0.01,114.8,
MYCOBACTERIC IDENTIFICATION,87118,CPT,,78087118,CDM,306,RC,,,both,,,71,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.98,,,43.98,Fee Schedule,,39.59,,,39.59,Fee Schedule,,84.39,,,84.39,Fee Schedule,,75.92,,,75.92,Fee Schedule,,71.76,,,71.76,Fee Schedule,,49.7,70,,49.7,percent of total billed charges,All Other,46.02,,,46.02,Fee Schedule,,27,,,27,Other,186% of Medicaid,54.2,,,54.2,Fee Schedule,,44.02,,,44.02,Fee Schedule,,30.68,,,,Fee Schedule,,54.2,,,54.2,Fee Schedule,,44.02,,,44.02,Fee Schedule,,57.71,,,57.71,Fee Schedule,,49.7,70,,49.7,percent of total billed charges,,69.24,,,69.24,Fee Schedule,,58.68,,,58.68,Fee Schedule,,21.92,,,21.92,Fee Schedule,,21.92,,,21.92,Fee Schedule,,21.92,,,21.92,Fee Schedule,,21.92,,,21.92,Fee Schedule,,14.61,,,14.61,Other,100% of Medicaid,14.61,,,14.61,Other,100% of Medicaid,14.61,,,14.61,Other,100% of Medicaid,14.61,,,14.61,Other,100% of Medicaid,32.87,,,32.87,Other,225% of Medicaid,22.35,,,22.35,Other,153% of Medicaid,32.87,,,32.87,Other,225% of Medicaid,20.45,,,20.45,Other,140% of Medicaid,32.87,,,32.87,Other,225% of Medicaid,37.99,,,37.99,Other,250% of Medicaid,47.34,,,47.34,Other,324% of Medicaid,31.41,,,31.41,Other,215% of Medicaid,31.41,,,31.41,Other,215% of Medicaid,18.26,,,18.26,Other,125% of Medicaid,0.01,84.39,
CULTURE IMMUNOFLUORESC,87140,CPT,,78087140,CDM,306,RC,,,both,,,44,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,16.77,,,16.77,Fee Schedule,,15.09,,,15.09,Fee Schedule,,42.96,,,42.96,Fee Schedule,,38.65,,,38.65,Fee Schedule,,36.53,,,36.53,Fee Schedule,,30.8,70,,30.8,percent of total billed charges,All Other,17.55,,,17.55,Fee Schedule,,31,,,31,Other,186% of Medicaid,20.66,,,20.66,Fee Schedule,,27.28,,,27.28,Fee Schedule,,11.7,,,,Fee Schedule,,20.66,,,20.66,Fee Schedule,,27.28,,,27.28,Fee Schedule,,22,,,22,Fee Schedule,,30.8,70,,30.8,percent of total billed charges,,26.4,,,26.4,Fee Schedule,,22.37,,,22.37,Fee Schedule,,8.36,,,8.36,Fee Schedule,,8.36,,,8.36,Fee Schedule,,8.36,,,8.36,Fee Schedule,,8.36,,,8.36,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,53.74,
CULTURE TYPLE IMMUNOLOGIC,87147,CPT,,78087147,CDM,306,RC,,,both,,,66,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,15.59,,,15.59,Fee Schedule,,14.04,,,14.04,Fee Schedule,,39.89,,,39.89,Fee Schedule,,35.89,,,35.89,Fee Schedule,,33.92,,,33.92,Fee Schedule,,46.2,70,,46.2,percent of total billed charges,All Other,16.32,,,16.32,Fee Schedule,,31,,,31,Other,186% of Medicaid,19.22,,,19.22,Fee Schedule,,40.92,,,40.92,Fee Schedule,,10.88,,,,Fee Schedule,,19.22,,,19.22,Fee Schedule,,40.92,,,40.92,Fee Schedule,,20.46,,,20.46,Fee Schedule,,46.2,70,,46.2,percent of total billed charges,,24.55,,,24.55,Fee Schedule,,20.81,,,20.81,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,53.74,
DNA.RNA DIRECT PROBE,87149,CPT,,78087149,CDM,306,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,60.35,,,60.35,Fee Schedule,,54.34,,,54.34,Fee Schedule,,154.65,,,154.65,Fee Schedule,,139.12,,,139.12,Fee Schedule,,131.51,,,131.51,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,All Other,63.16,,,63.16,Fee Schedule,,31,,,31,Other,186% of Medicaid,74.39,,,74.39,Fee Schedule,,79.98,,,79.98,Fee Schedule,,42.11,,,,Fee Schedule,,74.39,,,74.39,Fee Schedule,,79.98,,,79.98,Fee Schedule,,79.2,,,79.2,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,,95.02,,,95.02,Fee Schedule,,80.53,,,80.53,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,154.65,
DNA/RNA SEQUENCING,87153,CPT,,78087153,CDM,306,RC,,,both,,,876,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,347.23,,,347.23,Fee Schedule,,312.63,,,312.63,Fee Schedule,,889.57,,,889.57,Fee Schedule,,800.29,,,800.29,Fee Schedule,,756.46,,,756.46,Fee Schedule,,613.2,70,,613.2,percent of total billed charges,All Other,363.38,,,363.38,Fee Schedule,,108,,,108,Other,186% of Medicaid,427.99,,,427.99,Fee Schedule,,543.12,,,543.12,Fee Schedule,,242.26,,,,Fee Schedule,,427.99,,,427.99,Fee Schedule,,543.12,,,543.12,Fee Schedule,,455.67,,,455.67,Fee Schedule,,613.2,70,,613.2,percent of total billed charges,,546.7,,,546.7,Fee Schedule,,463.36,,,463.36,Fee Schedule,,173.04,,,173.04,Fee Schedule,,173.04,,,173.04,Fee Schedule,,173.04,,,173.04,Fee Schedule,,173.04,,,173.04,Fee Schedule,,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,88.46,,,88.46,Other,153% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,80.94,,,80.94,Other,140% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,150.32,,,150.32,Other,250% of Medicaid,187.33,,,187.33,Other,324% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,72.27,,,72.27,Other,125% of Medicaid,0.01,889.57,
CULTURE TYPING ADDED METHOD,87158,CPT,,78087158,CDM,306,RC,,,both,,,33,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,23.3,,,23.3,Fee Schedule,,20.98,,,20.98,Fee Schedule,,40.33,,,40.33,Fee Schedule,,36.28,,,36.28,Fee Schedule,,34.3,,,34.3,Fee Schedule,,23.1,70,,23.1,percent of total billed charges,All Other,24.38,,,24.38,Fee Schedule,,31,,,31,Other,186% of Medicaid,28.72,,,28.72,Fee Schedule,,20.46,,,20.46,Fee Schedule,,16.25,,,,Fee Schedule,,28.72,,,28.72,Fee Schedule,,20.46,,,20.46,Fee Schedule,,30.57,,,30.57,Fee Schedule,,23.1,70,,23.1,percent of total billed charges,,36.68,,,36.68,Fee Schedule,,31.09,,,31.09,Fee Schedule,,11.61,,,11.61,Fee Schedule,,11.61,,,11.61,Fee Schedule,,11.61,,,11.61,Fee Schedule,,11.61,,,11.61,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,53.74,
DARK FIELD EXAMINATION,87164,CPT,,78087164,CDM,306,RC,,,both,,,71,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,32.33,,,32.33,Fee Schedule,,29.11,,,29.11,Fee Schedule,,82.86,,,82.86,Fee Schedule,,74.54,,,74.54,Fee Schedule,,70.46,,,70.46,Fee Schedule,,49.7,70,,49.7,percent of total billed charges,All Other,33.83,,,33.83,Fee Schedule,,15,,,15,Other,186% of Medicaid,39.85,,,39.85,Fee Schedule,,44.02,,,44.02,Fee Schedule,,22.55,,,,Fee Schedule,,39.85,,,39.85,Fee Schedule,,44.02,,,44.02,Fee Schedule,,42.42,,,42.42,Fee Schedule,,49.7,70,,49.7,percent of total billed charges,,50.9,,,50.9,Fee Schedule,,43.14,,,43.14,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,16.11,,,16.11,Fee Schedule,,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,8.08,,,8.08,Other,100% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,12.36,,,12.36,Other,153% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,11.31,,,11.31,Other,140% of Medicaid,18.18,,,18.18,Other,225% of Medicaid,21.01,,,21.01,Other,250% of Medicaid,26.18,,,26.18,Other,324% of Medicaid,17.37,,,17.37,Other,215% of Medicaid,17.37,,,17.37,Other,215% of Medicaid,10.1,,,10.1,Other,125% of Medicaid,0.01,82.86,
MACROSCOPIC EXAM ARTHROPOD,87168,CPT,,78087168,CDM,306,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.85,,,12.85,Fee Schedule,,11.57,,,11.57,Fee Schedule,,32.93,,,32.93,Fee Schedule,,29.63,,,29.63,Fee Schedule,,28.01,,,28.01,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,All Other,13.45,,,13.45,Fee Schedule,,31,,,31,Other,186% of Medicaid,15.84,,,15.84,Fee Schedule,,67.58,,,67.58,Fee Schedule,,8.97,,,,Fee Schedule,,15.84,,,15.84,Fee Schedule,,67.58,,,67.58,Fee Schedule,,16.87,,,16.87,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,,20.24,,,20.24,Fee Schedule,,17.15,,,17.15,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,76.3,
MACROSCOPIC EXAM PARASITE,87169,CPT,,78087169,CDM,306,RC,,,both,,,196,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12.97,,,12.97,Fee Schedule,,11.68,,,11.68,Fee Schedule,,32.93,,,32.93,Fee Schedule,,29.63,,,29.63,Fee Schedule,,28.01,,,28.01,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,All Other,13.58,,,13.58,Fee Schedule,,4,,,4,Other,186% of Medicaid,15.99,,,15.99,Fee Schedule,,121.52,,,121.52,Fee Schedule,,9.05,,,,Fee Schedule,,15.99,,,15.99,Fee Schedule,,121.52,,,121.52,Fee Schedule,,17.02,,,17.02,Fee Schedule,,137.2,70,,137.2,percent of total billed charges,,20.43,,,20.43,Fee Schedule,,17.31,,,17.31,Fee Schedule,,6.47,,,6.47,Fee Schedule,,6.47,,,6.47,Fee Schedule,,6.47,,,6.47,Fee Schedule,,6.47,,,6.47,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,137.2,
PINWORM EXAM,87172,CPT,,78087172,CDM,306,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.85,,,12.85,Fee Schedule,,11.57,,,11.57,Fee Schedule,,32.93,,,32.93,Fee Schedule,,29.63,,,29.63,Fee Schedule,,28.01,,,28.01,Fee Schedule,,49,70,,49,percent of total billed charges,All Other,13.45,,,13.45,Fee Schedule,,4,,,4,Other,186% of Medicaid,15.84,,,15.84,Fee Schedule,,43.4,,,43.4,Fee Schedule,,8.97,,,,Fee Schedule,,15.84,,,15.84,Fee Schedule,,43.4,,,43.4,Fee Schedule,,16.87,,,16.87,Fee Schedule,,49,70,,49,percent of total billed charges,,20.24,,,20.24,Fee Schedule,,17.15,,,17.15,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,49,
TISSUE HOMOGENIZATION CULTR,87176,CPT,,78087176,CDM,306,RC,,,both,,,26,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,17.7,,,17.7,Fee Schedule,,15.93,,,15.93,Fee Schedule,,45.37,,,45.37,Fee Schedule,,40.82,,,40.82,Fee Schedule,,38.58,,,38.58,Fee Schedule,,18.2,70,,18.2,percent of total billed charges,All Other,18.52,,,18.52,Fee Schedule,,31,,,31,Other,186% of Medicaid,21.81,,,21.81,Fee Schedule,,16.12,,,16.12,Fee Schedule,,12.35,,,,Fee Schedule,,21.81,,,21.81,Fee Schedule,,16.12,,,16.12,Fee Schedule,,23.23,,,23.23,Fee Schedule,,18.2,70,,18.2,percent of total billed charges,,27.87,,,27.87,Fee Schedule,,23.62,,,23.62,Fee Schedule,,8.82,,,8.82,Fee Schedule,,8.82,,,8.82,Fee Schedule,,8.82,,,8.82,Fee Schedule,,8.82,,,8.82,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,53.74,
MICROBE SUSCEPTIBLE DIFUSE,87181,CPT,,78087181,CDM,306,RC,,,both,,,30,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.3,,,14.3,Fee Schedule,,12.87,,,12.87,Fee Schedule,,36.61,,,36.61,Fee Schedule,,32.93,,,32.93,Fee Schedule,,31.13,,,31.13,Fee Schedule,,21,70,,21,percent of total billed charges,All Other,14.96,,,14.96,Fee Schedule,,8,,,8,Other,186% of Medicaid,17.62,,,17.62,Fee Schedule,,18.6,,,18.6,Fee Schedule,,9.98,,,,Fee Schedule,,17.62,,,17.62,Fee Schedule,,18.6,,,18.6,Fee Schedule,,18.76,,,18.76,Fee Schedule,,21,70,,21,percent of total billed charges,,22.51,,,22.51,Fee Schedule,,19.08,,,19.08,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,4.55,,,4.55,Other,100% of Medicaid,4.55,,,4.55,Other,100% of Medicaid,4.55,,,4.55,Other,100% of Medicaid,4.55,,,4.55,Other,100% of Medicaid,10.23,,,10.23,Other,225% of Medicaid,6.95,,,6.95,Other,153% of Medicaid,10.23,,,10.23,Other,225% of Medicaid,6.36,,,6.36,Other,140% of Medicaid,10.23,,,10.23,Other,225% of Medicaid,11.82,,,11.82,Other,250% of Medicaid,14.73,,,14.73,Other,324% of Medicaid,9.77,,,9.77,Other,215% of Medicaid,9.77,,,9.77,Other,215% of Medicaid,5.68,,,5.68,Other,125% of Medicaid,0.01,36.61,
MICROBE SUSCEPLTIBLE DISK,87184,CPT,,78087184,CDM,306,RC,,,both,,,60,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,22.51,,,22.51,Fee Schedule,,20.27,,,20.27,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,42,70,,42,percent of total billed charges,All Other,23.56,,,23.56,Fee Schedule,,12,,,12,Other,186% of Medicaid,27.75,,,27.75,Fee Schedule,,37.2,,,37.2,Fee Schedule,,15.71,,,,Fee Schedule,,27.75,,,27.75,Fee Schedule,,37.2,,,37.2,Fee Schedule,,29.55,,,29.55,Fee Schedule,,42,70,,42,percent of total billed charges,,35.45,,,35.45,Fee Schedule,,30.04,,,30.04,Fee Schedule,,11.22,,,11.22,Fee Schedule,,11.22,,,11.22,Fee Schedule,,11.22,,,11.22,Fee Schedule,,11.22,,,11.22,Fee Schedule,,6.66,,,6.66,Other,100% of Medicaid,6.66,,,6.66,Other,100% of Medicaid,6.66,,,6.66,Other,100% of Medicaid,6.66,,,6.66,Other,100% of Medicaid,14.98,,,14.98,Other,225% of Medicaid,10.18,,,10.18,Other,153% of Medicaid,14.98,,,14.98,Other,225% of Medicaid,9.32,,,9.32,Other,140% of Medicaid,14.98,,,14.98,Other,225% of Medicaid,17.31,,,17.31,Other,250% of Medicaid,21.57,,,21.57,Other,324% of Medicaid,14.31,,,14.31,Other,215% of Medicaid,14.31,,,14.31,Other,215% of Medicaid,8.32,,,8.32,Other,125% of Medicaid,0.01,44.83,
MICROBE SUSCEPTIBLE ENZYME,87185,CPT,,78087185,CDM,306,RC,,,both,,,30,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,14.3,,,14.3,Fee Schedule,,12.87,,,12.87,Fee Schedule,,36.61,,,36.61,Fee Schedule,,32.93,,,32.93,Fee Schedule,,31.13,,,31.13,Fee Schedule,,21,70,,21,percent of total billed charges,All Other,14.96,,,14.96,Fee Schedule,,8,,,8,Other,186% of Medicaid,17.62,,,17.62,Fee Schedule,,18.6,,,18.6,Fee Schedule,,9.98,,,,Fee Schedule,,17.62,,,17.62,Fee Schedule,,18.6,,,18.6,Fee Schedule,,18.76,,,18.76,Fee Schedule,,21,70,,21,percent of total billed charges,,22.51,,,22.51,Fee Schedule,,19.08,,,19.08,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,7.13,,,7.13,Fee Schedule,,4.55,,,4.55,Other,100% of Medicaid,4.55,,,4.55,Other,100% of Medicaid,4.55,,,4.55,Other,100% of Medicaid,4.55,,,4.55,Other,100% of Medicaid,10.23,,,10.23,Other,225% of Medicaid,6.95,,,6.95,Other,153% of Medicaid,10.23,,,10.23,Other,225% of Medicaid,6.36,,,6.36,Other,140% of Medicaid,10.23,,,10.23,Other,225% of Medicaid,11.82,,,11.82,Other,250% of Medicaid,14.73,,,14.73,Other,324% of Medicaid,9.77,,,9.77,Other,215% of Medicaid,9.77,,,9.77,Other,215% of Medicaid,5.68,,,5.68,Other,125% of Medicaid,0.01,36.61,
MICROBE SUSCEPTIBLE,87186,CPT,,78087186,CDM,306,RC,,,both,,,166,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,26.04,,,26.04,Fee Schedule,,23.44,,,23.44,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,All Other,27.25,,,27.25,Fee Schedule,,12,,,12,Other,186% of Medicaid,32.09,,,32.09,Fee Schedule,,102.92,,,102.92,Fee Schedule,,18.17,,,,Fee Schedule,,32.09,,,32.09,Fee Schedule,,102.92,,,102.92,Fee Schedule,,34.17,,,34.17,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,,40.99,,,40.99,Fee Schedule,,34.74,,,34.74,Fee Schedule,,12.98,,,12.98,Fee Schedule,,12.98,,,12.98,Fee Schedule,,12.98,,,12.98,Fee Schedule,,12.98,,,12.98,Fee Schedule,,6.66,,,6.66,Other,100% of Medicaid,6.66,,,6.66,Other,100% of Medicaid,6.66,,,6.66,Other,100% of Medicaid,6.66,,,6.66,Other,100% of Medicaid,14.98,,,14.98,Other,225% of Medicaid,10.18,,,10.18,Other,153% of Medicaid,14.98,,,14.98,Other,225% of Medicaid,9.32,,,9.32,Other,140% of Medicaid,14.98,,,14.98,Other,225% of Medicaid,17.31,,,17.31,Other,250% of Medicaid,21.57,,,21.57,Other,324% of Medicaid,14.31,,,14.31,Other,215% of Medicaid,14.31,,,14.31,Other,215% of Medicaid,8.32,,,8.32,Other,125% of Medicaid,0.01,116.2,
SENSITIVITY - MACROBROTH EA AGNT,87188,CPT,,79087188,CDM,306,RC,,,both,,,34,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,19.99,,,19.99,Fee Schedule,,17.99,,,17.99,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,23.8,70,,23.8,percent of total billed charges,All Other,20.92,,,20.92,Fee Schedule,,8,,,8,Other,186% of Medicaid,24.63,,,24.63,Fee Schedule,,21.08,,,21.08,Fee Schedule,,13.94,,,,Fee Schedule,,24.63,,,24.63,Fee Schedule,,21.08,,,21.08,Fee Schedule,,26.23,,,26.23,Fee Schedule,,23.8,70,,23.8,percent of total billed charges,,31.47,,,31.47,Fee Schedule,,26.67,,,26.67,Fee Schedule,,9.96,,,9.96,Fee Schedule,,9.96,,,9.96,Fee Schedule,,9.96,,,9.96,Fee Schedule,,9.96,,,9.96,Fee Schedule,,4.55,,,4.55,Other,100% of Medicaid,4.55,,,4.55,Other,100% of Medicaid,4.55,,,4.55,Other,100% of Medicaid,4.55,,,4.55,Other,100% of Medicaid,10.23,,,10.23,Other,225% of Medicaid,6.95,,,6.95,Other,153% of Medicaid,10.23,,,10.23,Other,225% of Medicaid,6.36,,,6.36,Other,140% of Medicaid,10.23,,,10.23,Other,225% of Medicaid,11.82,,,11.82,Other,250% of Medicaid,14.73,,,14.73,Other,324% of Medicaid,9.77,,,9.77,Other,215% of Medicaid,9.77,,,9.77,Other,215% of Medicaid,5.68,,,5.68,Other,125% of Medicaid,0.01,44.83,
SMEAR GRAM STAIN,87205,CPT,,78087205,CDM,306,RC,,,both,,,72,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.85,,,12.85,Fee Schedule,,11.57,,,11.57,Fee Schedule,,32.93,,,32.93,Fee Schedule,,29.63,,,29.63,Fee Schedule,,28.01,,,28.01,Fee Schedule,,50.4,70,,50.4,percent of total billed charges,All Other,13.45,,,13.45,Fee Schedule,,6,,,6,Other,186% of Medicaid,15.84,,,15.84,Fee Schedule,,44.64,,,44.64,Fee Schedule,,8.97,,,,Fee Schedule,,15.84,,,15.84,Fee Schedule,,44.64,,,44.64,Fee Schedule,,16.87,,,16.87,Fee Schedule,,50.4,70,,50.4,percent of total billed charges,,20.24,,,20.24,Fee Schedule,,17.15,,,17.15,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,5.25,,,5.25,Other,153% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,4.81,,,4.81,Other,140% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,8.93,,,8.93,Other,250% of Medicaid,11.13,,,11.13,Other,324% of Medicaid,7.38,,,7.38,Other,215% of Medicaid,7.38,,,7.38,Other,215% of Medicaid,4.29,,,4.29,Other,125% of Medicaid,0.01,50.4,
SMEAR FLUJORESCENT/ACID STAI,87206,CPT,,78087206,CDM,306,RC,,,both,,,92,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,16.22,,,16.22,Fee Schedule,,14.61,,,14.61,Fee Schedule,,41.43,,,41.43,Fee Schedule,,37.27,,,37.27,Fee Schedule,,35.23,,,35.23,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,All Other,16.98,,,16.98,Fee Schedule,,10,,,10,Other,186% of Medicaid,20,,,20,Fee Schedule,,57.04,,,57.04,Fee Schedule,,11.32,,,,Fee Schedule,,20,,,20,Fee Schedule,,57.04,,,57.04,Fee Schedule,,21.29,,,21.29,Fee Schedule,,64.4,70,,64.4,percent of total billed charges,,25.54,,,25.54,Fee Schedule,,21.65,,,21.65,Fee Schedule,,8.09,,,8.09,Fee Schedule,,8.09,,,8.09,Fee Schedule,,8.09,,,8.09,Fee Schedule,,8.09,,,8.09,Fee Schedule,,5.39,,,5.39,Other,100% of Medicaid,5.39,,,5.39,Other,100% of Medicaid,5.39,,,5.39,Other,100% of Medicaid,5.39,,,5.39,Other,100% of Medicaid,12.13,,,12.13,Other,225% of Medicaid,8.25,,,8.25,Other,153% of Medicaid,12.13,,,12.13,Other,225% of Medicaid,7.55,,,7.55,Other,140% of Medicaid,12.13,,,12.13,Other,225% of Medicaid,14.01,,,14.01,Other,250% of Medicaid,17.46,,,17.46,Other,324% of Medicaid,11.59,,,11.59,Other,215% of Medicaid,11.59,,,11.59,Other,215% of Medicaid,6.74,,,6.74,Other,125% of Medicaid,0.01,64.4,
SMEAR SPECIAL STAIN,87207,CPT,,78087207,CDM,306,RC,,,both,,,107,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,18.03,,,18.03,Fee Schedule,,16.23,,,16.23,Fee Schedule,,46.25,,,46.25,Fee Schedule,,41.61,,,41.61,Fee Schedule,,39.33,,,39.33,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,All Other,18.87,,,18.87,Fee Schedule,,11,,,11,Other,186% of Medicaid,22.22,,,22.22,Fee Schedule,,66.34,,,66.34,Fee Schedule,,12.58,,,,Fee Schedule,,22.22,,,22.22,Fee Schedule,,66.34,,,66.34,Fee Schedule,,23.66,,,23.66,Fee Schedule,,74.9,70,,74.9,percent of total billed charges,,28.39,,,28.39,Fee Schedule,,24.06,,,24.06,Fee Schedule,,8.99,,,8.99,Fee Schedule,,8.99,,,8.99,Fee Schedule,,8.99,,,8.99,Fee Schedule,,8.99,,,8.99,Fee Schedule,,5.99,,,5.99,Other,100% of Medicaid,5.99,,,5.99,Other,100% of Medicaid,5.99,,,5.99,Other,100% of Medicaid,5.99,,,5.99,Other,100% of Medicaid,13.48,,,13.48,Other,225% of Medicaid,9.16,,,9.16,Other,153% of Medicaid,13.48,,,13.48,Other,225% of Medicaid,8.39,,,8.39,Other,140% of Medicaid,13.48,,,13.48,Other,225% of Medicaid,15.57,,,15.57,Other,250% of Medicaid,19.41,,,19.41,Other,324% of Medicaid,12.88,,,12.88,Other,215% of Medicaid,12.88,,,12.88,Other,215% of Medicaid,7.49,,,7.49,Other,125% of Medicaid,0.01,74.9,
SMEAR COMPLEX STAIN,87209,CPT,,78087209,CDM,306,RC,,,both,,,116,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,54.12,,,54.12,Fee Schedule,,48.73,,,48.73,Fee Schedule,,138.59,,,138.59,Fee Schedule,,124.68,,,124.68,Fee Schedule,,117.85,,,117.85,Fee Schedule,,81.2,70,,81.2,percent of total billed charges,All Other,56.64,,,56.64,Fee Schedule,,11,,,11,Other,186% of Medicaid,66.71,,,66.71,Fee Schedule,,71.92,,,71.92,Fee Schedule,,37.76,,,,Fee Schedule,,66.71,,,66.71,Fee Schedule,,71.92,,,71.92,Fee Schedule,,71.02,,,71.02,Fee Schedule,,81.2,70,,81.2,percent of total billed charges,,85.21,,,85.21,Fee Schedule,,72.22,,,72.22,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,5.91,,,5.91,Other,100% of Medicaid,5.91,,,5.91,Other,100% of Medicaid,5.91,,,5.91,Other,100% of Medicaid,5.91,,,5.91,Other,100% of Medicaid,13.29,,,13.29,Other,225% of Medicaid,9.04,,,9.04,Other,153% of Medicaid,13.29,,,13.29,Other,225% of Medicaid,8.27,,,8.27,Other,140% of Medicaid,13.29,,,13.29,Other,225% of Medicaid,15.36,,,15.36,Other,250% of Medicaid,19.14,,,19.14,Other,324% of Medicaid,12.7,,,12.7,Other,215% of Medicaid,12.7,,,12.7,Other,215% of Medicaid,7.39,,,7.39,Other,125% of Medicaid,0.01,138.59,
SMEAR WET MOUNT SALINE/INK,87210,CPT,,78087210,CDM,306,RC,,,both,,,142,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,17.52,,,17.52,Fee Schedule,,15.77,,,15.77,Fee Schedule,,32.93,,,32.93,Fee Schedule,,29.63,,,29.63,Fee Schedule,,28.01,,,28.01,Fee Schedule,,99.4,70,,99.4,percent of total billed charges,All Other,18.33,,,18.33,Fee Schedule,,6,,,6,Other,186% of Medicaid,21.59,,,21.59,Fee Schedule,,88.04,,,88.04,Fee Schedule,,12.22,,,,Fee Schedule,,21.59,,,21.59,Fee Schedule,,88.04,,,88.04,Fee Schedule,,22.99,,,22.99,Fee Schedule,,99.4,70,,99.4,percent of total billed charges,,27.58,,,27.58,Fee Schedule,,23.38,,,23.38,Fee Schedule,,8.73,,,8.73,Fee Schedule,,8.73,,,8.73,Fee Schedule,,8.73,,,8.73,Fee Schedule,,8.73,,,8.73,Fee Schedule,,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,3.43,,,3.43,Other,100% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,5.25,,,5.25,Other,153% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,4.81,,,4.81,Other,140% of Medicaid,7.73,,,7.73,Other,225% of Medicaid,8.93,,,8.93,Other,250% of Medicaid,11.13,,,11.13,Other,324% of Medicaid,7.38,,,7.38,Other,215% of Medicaid,7.38,,,7.38,Other,215% of Medicaid,4.29,,,4.29,Other,125% of Medicaid,0.01,99.4,
TISSUE EXAM FOR FUNGI,87220,CPT,,78087220,CDM,306,RC,,,both,,,144,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,12.85,,,12.85,Fee Schedule,,11.57,,,11.57,Fee Schedule,,32.93,,,32.93,Fee Schedule,,29.63,,,29.63,Fee Schedule,,28.01,,,28.01,Fee Schedule,,100.8,70,,100.8,percent of total billed charges,All Other,13.45,,,13.45,Fee Schedule,,31,,,31,Other,186% of Medicaid,15.84,,,15.84,Fee Schedule,,89.28,,,89.28,Fee Schedule,,8.97,,,,Fee Schedule,,15.84,,,15.84,Fee Schedule,,89.28,,,89.28,Fee Schedule,,16.87,,,16.87,Fee Schedule,,100.8,70,,100.8,percent of total billed charges,,20.24,,,20.24,Fee Schedule,,17.15,,,17.15,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,6.41,,,6.41,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,100.8,
ASSAY TOXIN OR ANTITOXIN,87230,CPT,,78087230,CDM,306,RC,,,both,,,89,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.42,,,59.42,Fee Schedule,,53.5,,,53.5,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,62.3,70,,62.3,percent of total billed charges,All Other,62.18,,,62.18,Fee Schedule,,18,,,18,Other,186% of Medicaid,73.24,,,73.24,Fee Schedule,,55.18,,,55.18,Fee Schedule,,41.45,,,,Fee Schedule,,73.24,,,73.24,Fee Schedule,,55.18,,,55.18,Fee Schedule,,77.97,,,77.97,Fee Schedule,,62.3,70,,62.3,percent of total billed charges,,93.55,,,93.55,Fee Schedule,,79.29,,,79.29,Fee Schedule,,29.61,,,29.61,Fee Schedule,,29.61,,,29.61,Fee Schedule,,29.61,,,29.61,Fee Schedule,,29.61,,,29.61,Fee Schedule,,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,14.53,,,14.53,Other,153% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,24.68,,,24.68,Other,250% of Medicaid,30.76,,,30.76,Other,324% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,11.87,,,11.87,Other,125% of Medicaid,0.01,93.55,
VIRUS INOCULATION TISSUE,87250,CPT,,78087250,CDM,306,RC,,,both,,,236,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,58.88,,,58.88,Fee Schedule,,53.01,,,53.01,Fee Schedule,,150.81,,,150.81,Fee Schedule,,135.67,,,135.67,Fee Schedule,,128.24,,,128.24,Fee Schedule,,165.2,70,,165.2,percent of total billed charges,All Other,61.61,,,61.61,Fee Schedule,,36,,,36,Other,186% of Medicaid,72.57,,,72.57,Fee Schedule,,146.32,,,146.32,Fee Schedule,,41.08,,,,Fee Schedule,,72.57,,,72.57,Fee Schedule,,146.32,,,146.32,Fee Schedule,,77.26,,,77.26,Fee Schedule,,165.2,70,,165.2,percent of total billed charges,,92.7,,,92.7,Fee Schedule,,78.57,,,78.57,Fee Schedule,,29.34,,,29.34,Fee Schedule,,29.34,,,29.34,Fee Schedule,,29.34,,,29.34,Fee Schedule,,29.34,,,29.34,Fee Schedule,,19.56,,,19.56,Other,100% of Medicaid,19.56,,,19.56,Other,100% of Medicaid,19.56,,,19.56,Other,100% of Medicaid,19.56,,,19.56,Other,100% of Medicaid,44.01,,,44.01,Other,225% of Medicaid,29.93,,,29.93,Other,153% of Medicaid,44.01,,,44.01,Other,225% of Medicaid,27.38,,,27.38,Other,140% of Medicaid,44.01,,,44.01,Other,225% of Medicaid,50.86,,,50.86,Other,250% of Medicaid,63.37,,,63.37,Other,324% of Medicaid,42.05,,,42.05,Other,215% of Medicaid,42.05,,,42.05,Other,215% of Medicaid,24.45,,,24.45,Other,125% of Medicaid,0.01,165.2,
VIRUS ISOLATE; TISSUE CULT INOC,87252,CPT,,78087252,CDM,306,RC,,,both,,,275,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,78.47,,,78.47,Fee Schedule,,70.65,,,70.65,Fee Schedule,,201.01,,,201.01,Fee Schedule,,180.83,,,180.83,Fee Schedule,,170.93,,,170.93,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,All Other,82.12,,,82.12,Fee Schedule,,48,,,48,Other,186% of Medicaid,96.72,,,96.72,Fee Schedule,,170.5,,,170.5,Fee Schedule,,54.75,,,,Fee Schedule,,96.72,,,96.72,Fee Schedule,,170.5,,,170.5,Fee Schedule,,102.98,,,102.98,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,,123.55,,,123.55,Fee Schedule,,104.71,,,104.71,Fee Schedule,,39.11,,,39.11,Fee Schedule,,39.11,,,39.11,Fee Schedule,,39.11,,,39.11,Fee Schedule,,39.11,,,39.11,Fee Schedule,,26.07,,,26.07,Other,100% of Medicaid,26.07,,,26.07,Other,100% of Medicaid,26.07,,,26.07,Other,100% of Medicaid,26.07,,,26.07,Other,100% of Medicaid,58.66,,,58.66,Other,225% of Medicaid,39.89,,,39.89,Other,153% of Medicaid,58.66,,,58.66,Other,225% of Medicaid,36.5,,,36.5,Other,140% of Medicaid,58.66,,,58.66,Other,225% of Medicaid,67.78,,,67.78,Other,250% of Medicaid,84.47,,,84.47,Other,324% of Medicaid,56.05,,,56.05,Other,215% of Medicaid,56.05,,,56.05,Other,215% of Medicaid,32.59,,,32.59,Other,125% of Medicaid,0.01,201.01,
VIRUS INOCULATE TISSUE ADDL,87253,CPT,,78087253,CDM,306,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,60.8,,,60.8,Fee Schedule,,54.74,,,54.74,Fee Schedule,,155.74,,,155.74,Fee Schedule,,140.11,,,140.11,Fee Schedule,,132.44,,,132.44,Fee Schedule,,109.9,70,,109.9,percent of total billed charges,All Other,63.63,,,63.63,Fee Schedule,,38,,,38,Other,186% of Medicaid,74.94,,,74.94,Fee Schedule,,97.34,,,97.34,Fee Schedule,,42.42,,,,Fee Schedule,,74.94,,,74.94,Fee Schedule,,97.34,,,97.34,Fee Schedule,,79.79,,,79.79,Fee Schedule,,109.9,70,,109.9,percent of total billed charges,,95.73,,,95.73,Fee Schedule,,81.14,,,81.14,Fee Schedule,,30.3,,,30.3,Fee Schedule,,30.3,,,30.3,Fee Schedule,,30.3,,,30.3,Fee Schedule,,30.3,,,30.3,Fee Schedule,,20.2,,,20.2,Other,100% of Medicaid,20.2,,,20.2,Other,100% of Medicaid,20.2,,,20.2,Other,100% of Medicaid,20.2,,,20.2,Other,100% of Medicaid,45.45,,,45.45,Other,225% of Medicaid,30.91,,,30.91,Other,153% of Medicaid,45.45,,,45.45,Other,225% of Medicaid,28.28,,,28.28,Other,140% of Medicaid,45.45,,,45.45,Other,225% of Medicaid,52.52,,,52.52,Other,250% of Medicaid,65.45,,,65.45,Other,324% of Medicaid,43.43,,,43.43,Other,215% of Medicaid,43.43,,,43.43,Other,215% of Medicaid,25.25,,,25.25,Other,125% of Medicaid,0.01,155.74,
GENET VIRUS ISOLATE HSV,87255,CPT,,78087255,CDM,306,RC,,,both,,,217,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,101.92,,,101.92,Fee Schedule,,91.76,,,91.76,Fee Schedule,,261.18,,,261.18,Fee Schedule,,234.96,,,234.96,Fee Schedule,,222.1,,,222.1,Fee Schedule,,151.9,70,,151.9,percent of total billed charges,All Other,106.66,,,106.66,Fee Schedule,,13,,,13,Other,186% of Medicaid,125.62,,,125.62,Fee Schedule,,134.54,,,134.54,Fee Schedule,,71.11,,,,Fee Schedule,,125.62,,,125.62,Fee Schedule,,134.54,,,134.54,Fee Schedule,,133.75,,,133.75,Fee Schedule,,151.9,70,,151.9,percent of total billed charges,,160.46,,,160.46,Fee Schedule,,136,,,136,Fee Schedule,,50.79,,,50.79,Fee Schedule,,50.79,,,50.79,Fee Schedule,,50.79,,,50.79,Fee Schedule,,50.79,,,50.79,Fee Schedule,,6.83,,,6.83,Other,100% of Medicaid,6.83,,,6.83,Other,100% of Medicaid,6.83,,,6.83,Other,100% of Medicaid,6.83,,,6.83,Other,100% of Medicaid,15.36,,,15.36,Other,225% of Medicaid,10.45,,,10.45,Other,153% of Medicaid,15.36,,,15.36,Other,225% of Medicaid,9.56,,,9.56,Other,140% of Medicaid,15.36,,,15.36,Other,225% of Medicaid,17.75,,,17.75,Other,250% of Medicaid,22.12,,,22.12,Other,324% of Medicaid,14.68,,,14.68,Other,215% of Medicaid,14.68,,,14.68,Other,215% of Medicaid,8.53,,,8.53,Other,125% of Medicaid,0.01,261.18,
ADENOVIRUS AG BY IF,87260,CPT,,78087260,CDM,306,RC,,,both,,,48,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.43,,,43.43,Fee Schedule,,39.11,,,39.11,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,33.6,70,,33.6,percent of total billed charges,All Other,45.45,,,45.45,Fee Schedule,,15,,,15,Other,186% of Medicaid,53.54,,,53.54,Fee Schedule,,29.76,,,29.76,Fee Schedule,,30.3,,,,Fee Schedule,,53.54,,,53.54,Fee Schedule,,29.76,,,29.76,Fee Schedule,,57,,,57,Fee Schedule,,33.6,70,,33.6,percent of total billed charges,,68.38,,,68.38,Fee Schedule,,57.96,,,57.96,Fee Schedule,,21.65,,,21.65,Fee Schedule,,21.65,,,21.65,Fee Schedule,,21.65,,,21.65,Fee Schedule,,21.65,,,21.65,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,68.38,
PERTUSSIS AG IF,87265,CPT,,78087265,CDM,306,RC,,,both,,,411,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,287.7,70,,287.7,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,15,,,15,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,254.82,,,254.82,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,254.82,,,254.82,Fee Schedule,,47.32,,,47.32,Fee Schedule,,287.7,70,,287.7,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,287.7,
CHLAMYDIA T AG BY DFA,87270,CPT,,78087270,CDM,306,RC,,,both,,,62,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,43.4,70,,43.4,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,15,,,15,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,38.44,,,38.44,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,38.44,,,38.44,Fee Schedule,,47.32,,,47.32,Fee Schedule,,43.4,70,,43.4,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,67.46,
INFLUENZA B AG BY IF,87275,CPT,,78087275,CDM,306,RC,,,both,,,67,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.87,,,36.87,Fee Schedule,,33.2,,,33.2,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,46.9,70,,46.9,percent of total billed charges,All Other,38.59,,,38.59,Fee Schedule,,23,,,23,Other,186% of Medicaid,45.45,,,45.45,Fee Schedule,,41.54,,,41.54,Fee Schedule,,25.73,,,,Fee Schedule,,45.45,,,45.45,Fee Schedule,,41.54,,,41.54,Fee Schedule,,48.39,,,48.39,Fee Schedule,,46.9,70,,46.9,percent of total billed charges,,58.05,,,58.05,Fee Schedule,,49.2,,,49.2,Fee Schedule,,18.38,,,18.38,Fee Schedule,,18.38,,,18.38,Fee Schedule,,18.38,,,18.38,Fee Schedule,,18.38,,,18.38,Fee Schedule,,12.25,,,12.25,Other,100% of Medicaid,12.25,,,12.25,Other,100% of Medicaid,12.25,,,12.25,Other,100% of Medicaid,12.25,,,12.25,Other,100% of Medicaid,27.56,,,27.56,Other,225% of Medicaid,18.74,,,18.74,Other,153% of Medicaid,27.56,,,27.56,Other,225% of Medicaid,17.15,,,17.15,Other,140% of Medicaid,27.56,,,27.56,Other,225% of Medicaid,31.85,,,31.85,Other,250% of Medicaid,39.69,,,39.69,Other,324% of Medicaid,26.34,,,26.34,Other,215% of Medicaid,26.34,,,26.34,Other,215% of Medicaid,15.31,,,15.31,Other,125% of Medicaid,0.01,67.46,
INFLUENZA A AG BY DFA,87276,CPT,,78087276,CDM,306,RC,,,both,,,67,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,48.37,,,48.37,Fee Schedule,,43.55,,,43.55,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,46.9,70,,46.9,percent of total billed charges,All Other,50.62,,,50.62,Fee Schedule,,27,,,27,Other,186% of Medicaid,59.62,,,59.62,Fee Schedule,,41.54,,,41.54,Fee Schedule,,33.75,,,,Fee Schedule,,59.62,,,59.62,Fee Schedule,,41.54,,,41.54,Fee Schedule,,63.48,,,63.48,Fee Schedule,,46.9,70,,46.9,percent of total billed charges,,76.16,,,76.16,Fee Schedule,,64.55,,,64.55,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,14.65,,,14.65,Other,100% of Medicaid,14.65,,,14.65,Other,100% of Medicaid,14.65,,,14.65,Other,100% of Medicaid,14.65,,,14.65,Other,100% of Medicaid,32.95,,,32.95,Other,225% of Medicaid,22.41,,,22.41,Other,153% of Medicaid,32.95,,,32.95,Other,225% of Medicaid,20.5,,,20.5,Other,140% of Medicaid,32.95,,,32.95,Other,225% of Medicaid,38.08,,,38.08,Other,250% of Medicaid,47.45,,,47.45,Other,324% of Medicaid,31.49,,,31.49,Other,215% of Medicaid,31.49,,,31.49,Other,215% of Medicaid,18.31,,,18.31,Other,125% of Medicaid,0.01,76.16,
PARAINFLUENZA AG BY DFA,87279,CPT,,78087279,CDM,306,RC,,,both,,,56,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.45,,,49.45,Fee Schedule,,44.53,,,44.53,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,39.2,70,,39.2,percent of total billed charges,All Other,51.75,,,51.75,Fee Schedule,,15,,,15,Other,186% of Medicaid,60.96,,,60.96,Fee Schedule,,34.72,,,34.72,Fee Schedule,,34.5,,,,Fee Schedule,,60.96,,,60.96,Fee Schedule,,34.72,,,34.72,Fee Schedule,,64.9,,,64.9,Fee Schedule,,39.2,70,,39.2,percent of total billed charges,,77.86,,,77.86,Fee Schedule,,65.99,,,65.99,Fee Schedule,,24.65,,,24.65,Fee Schedule,,24.65,,,24.65,Fee Schedule,,24.65,,,24.65,Fee Schedule,,24.65,,,24.65,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,77.86,
RSV AG BY IF,87280,CPT,,78087280,CDM,306,RC,,,both,,,55,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,40.39,,,40.39,Fee Schedule,,36.37,,,36.37,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,All Other,42.27,,,42.27,Fee Schedule,,15,,,15,Other,186% of Medicaid,49.79,,,49.79,Fee Schedule,,34.1,,,34.1,Fee Schedule,,28.18,,,,Fee Schedule,,49.79,,,49.79,Fee Schedule,,34.1,,,34.1,Fee Schedule,,53.01,,,53.01,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,,63.6,,,63.6,Fee Schedule,,53.9,,,53.9,Fee Schedule,,20.13,,,20.13,Fee Schedule,,20.13,,,20.13,Fee Schedule,,20.13,,,20.13,Fee Schedule,,20.13,,,20.13,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,67.46,
PNEUMOCYSTIS CARINII AG IF,87281,CPT,,78087281,CDM,306,RC,,,both,,,430,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,301,70,,301,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,15,,,15,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,266.6,,,266.6,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,266.6,,,266.6,Fee Schedule,,47.32,,,47.32,Fee Schedule,,301,70,,301,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,301,
VARICELLA ZOSTER AG IF,87290,CPT,,78087290,CDM,306,RC,,,both,,,44,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,40.39,,,40.39,Fee Schedule,,36.37,,,36.37,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,30.8,70,,30.8,percent of total billed charges,All Other,42.27,,,42.27,Fee Schedule,,15,,,15,Other,186% of Medicaid,49.79,,,49.79,Fee Schedule,,27.28,,,27.28,Fee Schedule,,28.18,,,,Fee Schedule,,49.79,,,49.79,Fee Schedule,,27.28,,,27.28,Fee Schedule,,53.01,,,53.01,Fee Schedule,,30.8,70,,30.8,percent of total billed charges,,63.6,,,63.6,Fee Schedule,,53.9,,,53.9,Fee Schedule,,20.13,,,20.13,Fee Schedule,,20.13,,,20.13,Fee Schedule,,20.13,,,20.13,Fee Schedule,,20.13,,,20.13,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,67.46,
INFECTIOUS AGENT ANTIGEN DETEC,87299,CPT,,78087299,CDM,306,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,48.46,,,48.46,Fee Schedule,,43.63,,,43.63,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,50.72,,,50.72,Fee Schedule,,30,,,30,Other,186% of Medicaid,59.73,,,59.73,Fee Schedule,,45.88,,,45.88,Fee Schedule,,33.81,,,,Fee Schedule,,59.73,,,59.73,Fee Schedule,,45.88,,,45.88,Fee Schedule,,63.6,,,63.6,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,76.3,,,76.3,Fee Schedule,,64.67,,,64.67,Fee Schedule,,24.15,,,24.15,Fee Schedule,,24.15,,,24.15,Fee Schedule,,24.15,,,24.15,Fee Schedule,,24.15,,,24.15,Fee Schedule,,16.1,,,16.1,Other,100% of Medicaid,16.1,,,16.1,Other,100% of Medicaid,16.1,,,16.1,Other,100% of Medicaid,16.1,,,16.1,Other,100% of Medicaid,36.23,,,36.23,Other,225% of Medicaid,24.63,,,24.63,Other,153% of Medicaid,36.23,,,36.23,Other,225% of Medicaid,22.54,,,22.54,Other,140% of Medicaid,36.23,,,36.23,Other,225% of Medicaid,41.86,,,41.86,Other,250% of Medicaid,52.16,,,52.16,Other,324% of Medicaid,34.62,,,34.62,Other,215% of Medicaid,34.62,,,34.62,Other,215% of Medicaid,20.13,,,20.13,Other,125% of Medicaid,0.01,76.3,
CLOSTRIDIUM AG EIA,87324,CPT,,78087324,CDM,306,RC,,,both,,,302,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,211.4,70,,211.4,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,18,,,18,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,187.24,,,187.24,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,187.24,,,187.24,Fee Schedule,,47.32,,,47.32,Fee Schedule,,211.4,70,,211.4,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,9.49,,,9.49,Other,100% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,14.53,,,14.53,Other,153% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,13.29,,,13.29,Other,140% of Medicaid,21.36,,,21.36,Other,225% of Medicaid,24.68,,,24.68,Other,250% of Medicaid,30.76,,,30.76,Other,324% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,20.41,,,20.41,Other,215% of Medicaid,11.87,,,11.87,Other,125% of Medicaid,0.01,211.4,
CRYPTOCOCCUS NEOFORM AG EIA,87327,CPT,,78087327,CDM,306,RC,,,both,,,78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40.39,,,40.39,Fee Schedule,,36.37,,,36.37,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,All Other,42.27,,,42.27,Fee Schedule,,15,,,15,Other,186% of Medicaid,49.79,,,49.79,Fee Schedule,,48.36,,,48.36,Fee Schedule,,28.18,,,,Fee Schedule,,49.79,,,49.79,Fee Schedule,,48.36,,,48.36,Fee Schedule,,53.01,,,53.01,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,,63.6,,,63.6,Fee Schedule,,53.9,,,53.9,Fee Schedule,,20.13,,,20.13,Fee Schedule,,20.13,,,20.13,Fee Schedule,,20.13,,,20.13,Fee Schedule,,20.13,,,20.13,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,67.46,
CRYPTOSPORIDIUM AG EIA,87328,CPT,,78087328,CDM,306,RC,,,both,,,69,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.6,,,41.6,Fee Schedule,,37.45,,,37.45,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,All Other,43.53,,,43.53,Fee Schedule,,26,,,26,Other,186% of Medicaid,51.27,,,51.27,Fee Schedule,,42.78,,,42.78,Fee Schedule,,29.02,,,,Fee Schedule,,51.27,,,51.27,Fee Schedule,,42.78,,,42.78,Fee Schedule,,54.59,,,54.59,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,,65.49,,,65.49,Fee Schedule,,55.51,,,55.51,Fee Schedule,,20.73,,,20.73,Fee Schedule,,20.73,,,20.73,Fee Schedule,,20.73,,,20.73,Fee Schedule,,20.73,,,20.73,Fee Schedule,,13.82,,,13.82,Other,100% of Medicaid,13.82,,,13.82,Other,100% of Medicaid,13.82,,,13.82,Other,100% of Medicaid,13.82,,,13.82,Other,100% of Medicaid,31.1,,,31.1,Other,225% of Medicaid,21.14,,,21.14,Other,153% of Medicaid,31.1,,,31.1,Other,225% of Medicaid,19.35,,,19.35,Other,140% of Medicaid,31.1,,,31.1,Other,225% of Medicaid,35.93,,,35.93,Other,250% of Medicaid,44.78,,,44.78,Other,324% of Medicaid,29.71,,,29.71,Other,215% of Medicaid,29.71,,,29.71,Other,215% of Medicaid,17.28,,,17.28,Other,125% of Medicaid,0.01,67.46,
ENTAMOEB HIST GROUP AG EIA,87337,CPT,,78087337,CDM,306,RC,,,both,,,60,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,42,70,,42,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,15,,,15,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,37.2,,,37.2,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,37.2,,,37.2,Fee Schedule,,47.32,,,47.32,Fee Schedule,,42,70,,42,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,67.46,
HPYLORI STOOL EIA,87338,CPT,,78087338,CDM,306,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,43.28,,,43.28,Fee Schedule,,38.97,,,38.97,Fee Schedule,,110.92,,,110.92,Fee Schedule,,99.78,,,99.78,Fee Schedule,,94.32,,,94.32,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,45.3,,,45.3,Fee Schedule,,15,,,15,Other,186% of Medicaid,53.35,,,53.35,Fee Schedule,,57.66,,,57.66,Fee Schedule,,30.2,,,,Fee Schedule,,53.35,,,53.35,Fee Schedule,,57.66,,,57.66,Fee Schedule,,56.8,,,56.8,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,,68.15,,,68.15,Fee Schedule,,57.76,,,57.76,Fee Schedule,,21.57,,,21.57,Fee Schedule,,21.57,,,21.57,Fee Schedule,,21.57,,,21.57,Fee Schedule,,21.57,,,21.57,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,110.92,
HEPATITIS B SURFACE AG EIA,87340,CPT,,78087340,CDM,306,RC,,,both,,,139,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,31.09,,,31.09,Fee Schedule,,27.99,,,27.99,Fee Schedule,,79.62,,,79.62,Fee Schedule,,71.63,,,71.63,Fee Schedule,,67.71,,,67.71,Fee Schedule,,97.3,70,,97.3,percent of total billed charges,All Other,32.54,,,32.54,Fee Schedule,,19,,,19,Other,186% of Medicaid,38.32,,,38.32,Fee Schedule,,86.18,,,86.18,Fee Schedule,,21.69,,,,Fee Schedule,,38.32,,,38.32,Fee Schedule,,86.18,,,86.18,Fee Schedule,,40.8,,,40.8,Fee Schedule,,97.3,70,,97.3,percent of total billed charges,,48.95,,,48.95,Fee Schedule,,41.49,,,41.49,Fee Schedule,,15.5,,,15.5,Fee Schedule,,15.5,,,15.5,Fee Schedule,,15.5,,,15.5,Fee Schedule,,15.5,,,15.5,Fee Schedule,,10.33,,,10.33,Other,100% of Medicaid,10.33,,,10.33,Other,100% of Medicaid,10.33,,,10.33,Other,100% of Medicaid,10.33,,,10.33,Other,100% of Medicaid,23.24,,,23.24,Other,225% of Medicaid,15.8,,,15.8,Other,153% of Medicaid,23.24,,,23.24,Other,225% of Medicaid,14.46,,,14.46,Other,140% of Medicaid,23.24,,,23.24,Other,225% of Medicaid,26.86,,,26.86,Other,250% of Medicaid,33.47,,,33.47,Other,324% of Medicaid,22.21,,,22.21,Other,215% of Medicaid,22.21,,,22.21,Other,215% of Medicaid,12.91,,,12.91,Other,125% of Medicaid,0.01,97.3,
HEPATITIS B SURFACE AG IA,87341,CPT,,78087341,CDM,306,RC,,,both,,,33,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,31.09,,,31.09,Fee Schedule,,27.99,,,27.99,Fee Schedule,,79.62,,,79.62,Fee Schedule,,71.63,,,71.63,Fee Schedule,,67.71,,,67.71,Fee Schedule,,23.1,70,,23.1,percent of total billed charges,All Other,32.54,,,32.54,Fee Schedule,,19,,,19,Other,186% of Medicaid,38.32,,,38.32,Fee Schedule,,20.46,,,20.46,Fee Schedule,,21.69,,,,Fee Schedule,,38.32,,,38.32,Fee Schedule,,20.46,,,20.46,Fee Schedule,,40.8,,,40.8,Fee Schedule,,23.1,70,,23.1,percent of total billed charges,,48.95,,,48.95,Fee Schedule,,41.49,,,41.49,Fee Schedule,,15.5,,,15.5,Fee Schedule,,15.5,,,15.5,Fee Schedule,,15.5,,,15.5,Fee Schedule,,15.5,,,15.5,Fee Schedule,,10.33,,,10.33,Other,100% of Medicaid,10.33,,,10.33,Other,100% of Medicaid,10.33,,,10.33,Other,100% of Medicaid,10.33,,,10.33,Other,100% of Medicaid,23.24,,,23.24,Other,225% of Medicaid,15.8,,,15.8,Other,153% of Medicaid,23.24,,,23.24,Other,225% of Medicaid,14.46,,,14.46,Other,140% of Medicaid,23.24,,,23.24,Other,225% of Medicaid,26.86,,,26.86,Other,250% of Medicaid,33.47,,,33.47,Other,324% of Medicaid,22.21,,,22.21,Other,215% of Medicaid,22.21,,,22.21,Other,215% of Medicaid,12.91,,,12.91,Other,125% of Medicaid,0.01,79.62,
HEPATITIS BE AG EIA,87350,CPT,,78087350,CDM,306,RC,,,both,,,168,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,34.71,,,34.71,Fee Schedule,,31.25,,,31.25,Fee Schedule,,88.89,,,88.89,Fee Schedule,,79.96,,,79.96,Fee Schedule,,75.59,,,75.59,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,All Other,36.32,,,36.32,Fee Schedule,,19,,,19,Other,186% of Medicaid,42.78,,,42.78,Fee Schedule,,104.16,,,104.16,Fee Schedule,,24.21,,,,Fee Schedule,,42.78,,,42.78,Fee Schedule,,104.16,,,104.16,Fee Schedule,,45.54,,,45.54,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,,54.64,,,54.64,Fee Schedule,,46.31,,,46.31,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,17.3,,,17.3,Fee Schedule,,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,10.2,,,10.2,Other,100% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,15.61,,,15.61,Other,153% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,14.28,,,14.28,Other,140% of Medicaid,22.95,,,22.95,Other,225% of Medicaid,26.52,,,26.52,Other,250% of Medicaid,33.05,,,33.05,Other,324% of Medicaid,21.93,,,21.93,Other,215% of Medicaid,21.93,,,21.93,Other,215% of Medicaid,12.75,,,12.75,Other,125% of Medicaid,0.01,117.6,
HISTOPLASMA CAPSUL AG EIA,87385,CPT,,78087385,CDM,306,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,39.88,,,39.88,Fee Schedule,,35.91,,,35.91,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,49,70,,49,percent of total billed charges,All Other,41.74,,,41.74,Fee Schedule,,23,,,23,Other,186% of Medicaid,49.16,,,49.16,Fee Schedule,,43.4,,,43.4,Fee Schedule,,27.83,,,,Fee Schedule,,49.16,,,49.16,Fee Schedule,,43.4,,,43.4,Fee Schedule,,52.34,,,52.34,Fee Schedule,,49,70,,49,percent of total billed charges,,62.79,,,62.79,Fee Schedule,,53.22,,,53.22,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,19.88,,,19.88,Fee Schedule,,12.53,,,12.53,Other,100% of Medicaid,12.53,,,12.53,Other,100% of Medicaid,12.53,,,12.53,Other,100% of Medicaid,12.53,,,12.53,Other,100% of Medicaid,28.2,,,28.2,Other,225% of Medicaid,19.18,,,19.18,Other,153% of Medicaid,28.2,,,28.2,Other,225% of Medicaid,17.55,,,17.55,Other,140% of Medicaid,28.2,,,28.2,Other,225% of Medicaid,32.59,,,32.59,Other,250% of Medicaid,40.61,,,40.61,Other,324% of Medicaid,26.95,,,26.95,Other,215% of Medicaid,26.95,,,26.95,Other,215% of Medicaid,15.67,,,15.67,Other,125% of Medicaid,0.01,67.46,
HIV-1 AG W/HIV-1 & HIV-2 AB,87389,CPT,,78087389,CDM,306,RC,,,both,,,136,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,72.48,,,72.48,Fee Schedule,,65.26,,,65.26,Fee Schedule,,13.65,,,13.65,Fee Schedule,,13.65,,,13.65,Fee Schedule,,13.65,,,13.65,Fee Schedule,,95.2,70,,95.2,percent of total billed charges,All Other,75.85,,,75.85,Fee Schedule,,35,,,35,Other,186% of Medicaid,89.34,,,89.34,Fee Schedule,,84.32,,,84.32,Fee Schedule,,50.57,,,,Fee Schedule,,89.34,,,89.34,Fee Schedule,,84.32,,,84.32,Fee Schedule,,95.12,,,95.12,Fee Schedule,,95.2,70,,95.2,percent of total billed charges,,114.12,,,114.12,Fee Schedule,,96.72,,,96.72,Fee Schedule,,36.12,,,36.12,Fee Schedule,,36.12,,,36.12,Fee Schedule,,36.12,,,36.12,Fee Schedule,,36.12,,,36.12,Fee Schedule,,18.67,,,18.67,Other,100% of Medicaid,18.67,,,18.67,Other,100% of Medicaid,18.67,,,18.67,Other,100% of Medicaid,18.67,,,18.67,Other,100% of Medicaid,42.02,,,42.02,Other,225% of Medicaid,28.57,,,28.57,Other,153% of Medicaid,42.02,,,42.02,Other,225% of Medicaid,26.14,,,26.14,Other,140% of Medicaid,42.02,,,42.02,Other,225% of Medicaid,48.55,,,48.55,Other,250% of Medicaid,60.51,,,60.51,Other,324% of Medicaid,40.15,,,40.15,Other,215% of Medicaid,40.15,,,40.15,Other,215% of Medicaid,23.34,,,23.34,Other,125% of Medicaid,0.01,114.12,
INFLUENZA A/B AG EIA,87400,CPT,,78087400,CDM,306,RC,,,both,,,167,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,42.53,,,42.53,Fee Schedule,,38.29,,,38.29,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,116.9,70,,116.9,percent of total billed charges,All Other,44.51,,,44.51,Fee Schedule,,31,,,31,Other,186% of Medicaid,52.42,,,52.42,Fee Schedule,,103.54,,,103.54,Fee Schedule,,29.67,,,,Fee Schedule,,52.42,,,52.42,Fee Schedule,,103.54,,,103.54,Fee Schedule,,55.81,,,55.81,Fee Schedule,,116.9,70,,116.9,percent of total billed charges,,66.96,,,66.96,Fee Schedule,,56.75,,,56.75,Fee Schedule,,21.2,,,21.2,Fee Schedule,,21.2,,,21.2,Fee Schedule,,21.2,,,21.2,Fee Schedule,,21.2,,,21.2,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,116.9,
RESP SYNCYTIAL VIRUS AG IA,87420,CPT,,78087420,CDM,306,RC,,,both,,,45,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,41.87,,,41.87,Fee Schedule,,37.7,,,37.7,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,All Other,43.82,,,43.82,Fee Schedule,,15,,,15,Other,186% of Medicaid,51.61,,,51.61,Fee Schedule,,27.9,,,27.9,Fee Schedule,,29.21,,,,Fee Schedule,,51.61,,,51.61,Fee Schedule,,27.9,,,27.9,Fee Schedule,,54.94,,,54.94,Fee Schedule,,31.5,70,,31.5,percent of total billed charges,,65.92,,,65.92,Fee Schedule,,55.87,,,55.87,Fee Schedule,,20.87,,,20.87,Fee Schedule,,20.87,,,20.87,Fee Schedule,,20.87,,,20.87,Fee Schedule,,20.87,,,20.87,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,67.46,
SHIGA-LIKE TOXIN AG EIA,87427,CPT,,78087427,CDM,306,RC,,,both,,,70,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,49,70,,49,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,22,,,22,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,43.4,,,43.4,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,43.4,,,43.4,Fee Schedule,,47.32,,,47.32,Fee Schedule,,49,70,,49,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,11.98,,,11.98,Other,100% of Medicaid,11.98,,,11.98,Other,100% of Medicaid,11.98,,,11.98,Other,100% of Medicaid,11.98,,,11.98,Other,100% of Medicaid,26.96,,,26.96,Other,225% of Medicaid,18.33,,,18.33,Other,153% of Medicaid,26.96,,,26.96,Other,225% of Medicaid,16.77,,,16.77,Other,140% of Medicaid,26.96,,,26.96,Other,225% of Medicaid,31.15,,,31.15,Other,250% of Medicaid,38.82,,,38.82,Other,324% of Medicaid,25.76,,,25.76,Other,215% of Medicaid,25.76,,,25.76,Other,215% of Medicaid,14.98,,,14.98,Other,125% of Medicaid,0.01,67.46,
AG DETECT NOS EIA MULT,87449,CPT,,78087449,CDM,306,RC,,,both,,,367,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,256.9,70,,256.9,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,10,,,10,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,227.54,,,227.54,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,227.54,,,227.54,Fee Schedule,,47.32,,,47.32,Fee Schedule,,256.9,70,,256.9,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,5.25,,,5.25,Other,100% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,8.04,,,8.04,Other,153% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,7.35,,,7.35,Other,140% of Medicaid,11.82,,,11.82,Other,225% of Medicaid,13.66,,,13.66,Other,250% of Medicaid,17.02,,,17.02,Other,324% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,11.29,,,11.29,Other,215% of Medicaid,6.57,,,6.57,Other,125% of Medicaid,0.01,256.9,
ANAPLSMA PHGCYTOPHLM AMP PRB,87468,CPT,,78087468,CDM,306,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,56.61,76.5,,56.61,percent of total billed charges,All Other,51.06,69,,51.06,percent of total billed charges,All Other,48.1,65,,48.1,percent of total billed charges,All Other,51.8,70,,51.8,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,45.88,,,45.88,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,45.88,,,45.88,Fee Schedule,,138.61,,,138.61,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,48.1,65,,48.1,percent of total billed charges,All Other,48.1,65,,48.1,percent of total billed charges,All Other,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.69,,,48.69,Other,225% of Medicaid,33.11,,,33.11,Other,153% of Medicaid,48.69,,,48.69,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.69,,,48.69,Other,225% of Medicaid,56.26,,,56.26,Other,250% of Medicaid,70.11,,,70.11,Other,324% of Medicaid,46.53,,,46.53,Other,215% of Medicaid,46.53,,,46.53,Other,215% of Medicaid,27.05,,,27.05,Other,125% of Medicaid,0.01,138.61,
CANDIDA DNA DIR PROBE,87480,CPT,,78087480,CDM,306,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,60.35,,,60.35,Fee Schedule,,54.34,,,54.34,Fee Schedule,,154.65,,,154.65,Fee Schedule,,139.12,,,139.12,Fee Schedule,,131.51,,,131.51,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,All Other,63.16,,,63.16,Fee Schedule,,26,,,26,Other,186% of Medicaid,74.39,,,74.39,Fee Schedule,,40.3,,,40.3,Fee Schedule,,42.11,,,,Fee Schedule,,74.39,,,74.39,Fee Schedule,,40.3,,,40.3,Fee Schedule,,79.2,,,79.2,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,,95.02,,,95.02,Fee Schedule,,80.53,,,80.53,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,14.09,,,14.09,Other,100% of Medicaid,14.09,,,14.09,Other,100% of Medicaid,14.09,,,14.09,Other,100% of Medicaid,14.09,,,14.09,Other,100% of Medicaid,31.7,,,31.7,Other,225% of Medicaid,21.56,,,21.56,Other,153% of Medicaid,31.7,,,31.7,Other,225% of Medicaid,19.73,,,19.73,Other,140% of Medicaid,31.7,,,31.7,Other,225% of Medicaid,36.63,,,36.63,Other,250% of Medicaid,45.65,,,45.65,Other,324% of Medicaid,30.29,,,30.29,Other,215% of Medicaid,30.29,,,30.29,Other,215% of Medicaid,17.61,,,17.61,Other,125% of Medicaid,0.01,154.65,
CANDIDA DNA AMP PROBE,87481,CPT,,78087481,CDM,306,RC,,,both,,,112,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,78.4,70,,78.4,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,39,,,39,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,69.44,,,69.44,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,69.44,,,69.44,Fee Schedule,,138.61,,,138.61,Fee Schedule,,78.4,70,,78.4,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.05,,,21.05,Other,100% of Medicaid,21.05,,,21.05,Other,100% of Medicaid,21.05,,,21.05,Other,100% of Medicaid,21.05,,,21.05,Other,100% of Medicaid,47.36,,,47.36,Other,225% of Medicaid,32.21,,,32.21,Other,153% of Medicaid,47.36,,,47.36,Other,225% of Medicaid,29.47,,,29.47,Other,140% of Medicaid,47.36,,,47.36,Other,225% of Medicaid,54.73,,,54.73,Other,250% of Medicaid,68.2,,,68.2,Other,324% of Medicaid,45.26,,,45.26,Other,215% of Medicaid,45.26,,,45.26,Other,215% of Medicaid,26.31,,,26.31,Other,125% of Medicaid,0.01,270.66,
CNS DNA AMP PROBE TYPE 12-25,87483,CPT,,78087483,CDM,306,RC,,,both,,,1314,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,1254.51,,,1254.51,Fee Schedule,,1129.47,,,1129.47,Fee Schedule,,228.69,,,228.69,Fee Schedule,,228.69,,,228.69,Fee Schedule,,228.69,,,228.69,Fee Schedule,,919.8,70,,919.8,percent of total billed charges,All Other,1312.86,,,1312.86,Fee Schedule,,108,,,108,Other,186% of Medicaid,1546.25,,,1546.25,Fee Schedule,,814.68,,,814.68,Fee Schedule,,875.24,,,,Fee Schedule,,1546.25,,,1546.25,Fee Schedule,,814.68,,,814.68,Fee Schedule,,1646.28,,,1646.28,Fee Schedule,,919.8,70,,919.8,percent of total billed charges,,1975.14,,,1975.14,Fee Schedule,,1674.05,,,1674.05,Fee Schedule,,625.17,,,625.17,Fee Schedule,,625.17,,,625.17,Fee Schedule,,625.17,,,625.17,Fee Schedule,,625.17,,,625.17,Fee Schedule,,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,88.46,,,88.46,Other,153% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,80.94,,,80.94,Other,140% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,150.32,,,150.32,Other,250% of Medicaid,187.33,,,187.33,Other,324% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,72.27,,,72.27,Other,125% of Medicaid,0.01,1975.14,
EHRLICHA CHAFFEENSIS AMP PRB,87484,CPT,,78087484,CDM,306,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,56.61,76.5,,56.61,percent of total billed charges,All Other,51.06,69,,51.06,percent of total billed charges,All Other,48.1,65,,48.1,percent of total billed charges,All Other,51.8,70,,51.8,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,45.88,,,45.88,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,45.88,,,45.88,Fee Schedule,,138.61,,,138.61,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,48.1,65,,48.1,percent of total billed charges,All Other,48.1,65,,48.1,percent of total billed charges,All Other,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.69,,,48.69,Other,225% of Medicaid,33.11,,,33.11,Other,153% of Medicaid,48.69,,,48.69,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.69,,,48.69,Other,225% of Medicaid,56.26,,,56.26,Other,250% of Medicaid,70.11,,,70.11,Other,324% of Medicaid,46.53,,,46.53,Other,215% of Medicaid,46.53,,,46.53,Other,215% of Medicaid,27.05,,,27.05,Other,125% of Medicaid,0.01,138.61,
CHYLMD PNEUM DNA AMP PROBE,87486,CPT,,78087486,CDM,306,RC,,,both,,,223,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,138.26,,,138.26,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,138.26,,,138.26,Fee Schedule,,138.61,,,138.61,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,270.66,
CHYLMD TRACH DNA DIR PROBE,87490,CPT,,78087490,CDM,306,RC,,,both,,,223,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.48,,,68.48,Fee Schedule,,61.65,,,61.65,Fee Schedule,,154.65,,,154.65,Fee Schedule,,139.12,,,139.12,Fee Schedule,,131.51,,,131.51,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,All Other,71.66,,,71.66,Fee Schedule,,15,,,15,Other,186% of Medicaid,84.4,,,84.4,Fee Schedule,,138.26,,,138.26,Fee Schedule,,47.78,,,,Fee Schedule,,84.4,,,84.4,Fee Schedule,,138.26,,,138.26,Fee Schedule,,89.86,,,89.86,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,,107.81,,,107.81,Fee Schedule,,91.38,,,91.38,Fee Schedule,,34.13,,,34.13,Fee Schedule,,34.13,,,34.13,Fee Schedule,,34.13,,,34.13,Fee Schedule,,34.13,,,34.13,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,156.1,
CHYLMD TRACH DNA AMP PROBE,87491,CPT,,78087491,CDM,306,RC,,,both,,,260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,182,70,,182,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,161.2,,,161.2,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,161.2,,,161.2,Fee Schedule,,138.61,,,138.61,Fee Schedule,,182,70,,182,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,270.66,
C DIFF AMPLIFIED PROBE,87493,CPT,,78087493,CDM,306,RC,,,both,,,223,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,112.18,,,112.18,Fee Schedule,,101,,,101,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,All Other,117.4,,,117.4,Fee Schedule,,81,,,81,Other,186% of Medicaid,138.27,,,138.27,Fee Schedule,,138.26,,,138.26,Fee Schedule,,78.27,,,,Fee Schedule,,138.27,,,138.27,Fee Schedule,,138.26,,,138.26,Fee Schedule,,147.22,,,147.22,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,,176.62,,,176.62,Fee Schedule,,149.7,,,149.7,Fee Schedule,,55.91,,,55.91,Fee Schedule,,55.91,,,55.91,Fee Schedule,,55.91,,,55.91,Fee Schedule,,55.91,,,55.91,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,270.66,
CYTOMEG DNA AMP PROBE,87496,CPT,,78087496,CDM,306,RC,,,both,,,957,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,669.9,70,,669.9,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,44,,,44,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,593.34,,,593.34,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,593.34,,,593.34,Fee Schedule,,138.61,,,138.61,Fee Schedule,,669.9,70,,669.9,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,23.62,,,23.62,Other,100% of Medicaid,23.62,,,23.62,Other,100% of Medicaid,23.62,,,23.62,Other,100% of Medicaid,23.62,,,23.62,Other,100% of Medicaid,53.15,,,53.15,Other,225% of Medicaid,36.14,,,36.14,Other,153% of Medicaid,53.15,,,53.15,Other,225% of Medicaid,33.07,,,33.07,Other,140% of Medicaid,53.15,,,53.15,Other,225% of Medicaid,61.42,,,61.42,Other,250% of Medicaid,76.54,,,76.54,Other,324% of Medicaid,50.79,,,50.79,Other,215% of Medicaid,50.79,,,50.79,Other,215% of Medicaid,29.53,,,29.53,Other,125% of Medicaid,0.01,669.9,
ENTEROVIRUS DNA AMP PROBE,87498,CPT,,78087498,CDM,306,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,128.96,,,128.96,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,128.96,,,128.96,Fee Schedule,,138.61,,,138.61,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,270.66,
INFLUENZA DNA AMP PROB 1+,87501,CPT,,78087501,CDM,306,RC,,,both,,,304,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,154.44,,,154.44,Fee Schedule,,139.05,,,139.05,Fee Schedule,,395.77,,,395.77,Fee Schedule,,356.04,,,356.04,Fee Schedule,,336.55,,,336.55,Fee Schedule,,212.8,70,,212.8,percent of total billed charges,All Other,161.63,,,161.63,Fee Schedule,,95,,,95,Other,186% of Medicaid,190.36,,,190.36,Fee Schedule,,188.48,,,188.48,Fee Schedule,,107.75,,,,Fee Schedule,,190.36,,,190.36,Fee Schedule,,188.48,,,188.48,Fee Schedule,,202.67,,,202.67,Fee Schedule,,212.8,70,,212.8,percent of total billed charges,,243.16,,,243.16,Fee Schedule,,206.09,,,206.09,Fee Schedule,,76.97,,,76.97,Fee Schedule,,76.97,,,76.97,Fee Schedule,,76.97,,,76.97,Fee Schedule,,76.97,,,76.97,Fee Schedule,,51.31,,,51.31,Other,100% of Medicaid,51.31,,,51.31,Other,100% of Medicaid,51.31,,,51.31,Other,100% of Medicaid,51.31,,,51.31,Other,100% of Medicaid,115.45,,,115.45,Other,225% of Medicaid,78.5,,,78.5,Other,153% of Medicaid,115.45,,,115.45,Other,225% of Medicaid,71.83,,,71.83,Other,140% of Medicaid,115.45,,,115.45,Other,225% of Medicaid,133.41,,,133.41,Other,250% of Medicaid,166.24,,,166.24,Other,324% of Medicaid,110.32,,,110.32,Other,215% of Medicaid,110.32,,,110.32,Other,215% of Medicaid,64.14,,,64.14,Other,125% of Medicaid,0.01,395.77,
INFLUENZA DNA AMP PROBE,87502,CPT,,78087502,CDM,306,RC,,,both,,,658,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,288.36,,,288.36,Fee Schedule,,259.62,,,259.62,Fee Schedule,,656.23,,,656.23,Fee Schedule,,590.37,,,590.37,Fee Schedule,,558.04,,,558.04,Fee Schedule,,460.6,70,,460.6,percent of total billed charges,All Other,301.77,,,301.77,Fee Schedule,,100,,,100,Other,186% of Medicaid,355.42,,,355.42,Fee Schedule,,407.96,,,407.96,Fee Schedule,,201.18,,,,Fee Schedule,,355.42,,,355.42,Fee Schedule,,407.96,,,407.96,Fee Schedule,,378.41,,,378.41,Fee Schedule,,460.6,70,,460.6,percent of total billed charges,,454,,,454,Fee Schedule,,384.79,,,384.79,Fee Schedule,,143.7,,,143.7,Fee Schedule,,143.7,,,143.7,Fee Schedule,,143.7,,,143.7,Fee Schedule,,143.7,,,143.7,Fee Schedule,,53.98,,,53.98,Other,100% of Medicaid,53.98,,,53.98,Other,100% of Medicaid,53.98,,,53.98,Other,100% of Medicaid,53.98,,,53.98,Other,100% of Medicaid,121.47,,,121.47,Other,225% of Medicaid,82.6,,,82.6,Other,153% of Medicaid,121.47,,,121.47,Other,225% of Medicaid,75.58,,,75.58,Other,140% of Medicaid,121.47,,,121.47,Other,225% of Medicaid,140.36,,,140.36,Other,250% of Medicaid,174.91,,,174.91,Other,324% of Medicaid,116.07,,,116.07,Other,215% of Medicaid,116.07,,,116.07,Other,215% of Medicaid,67.48,,,67.48,Other,125% of Medicaid,0.01,656.23,
INFLUENZA DNA AMP PROB >2 TYPES,87503,CPT,,78087503,CDM,306,RC,,,both,,,124,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,87.95,,,87.95,Fee Schedule,,79.19,,,79.19,Fee Schedule,,160.13,,,160.13,Fee Schedule,,144.05,,,144.05,Fee Schedule,,136.17,,,136.17,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,All Other,92.04,,,92.04,Fee Schedule,,40,,,40,Other,186% of Medicaid,108.41,,,108.41,Fee Schedule,,76.88,,,76.88,Fee Schedule,,61.36,,,,Fee Schedule,,108.41,,,108.41,Fee Schedule,,76.88,,,76.88,Fee Schedule,,115.42,,,115.42,Fee Schedule,,86.8,70,,86.8,percent of total billed charges,,138.47,,,138.47,Fee Schedule,,117.37,,,117.37,Fee Schedule,,43.83,,,43.83,Fee Schedule,,43.83,,,43.83,Fee Schedule,,43.83,,,43.83,Fee Schedule,,43.83,,,43.83,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,160.13,
IADNA-DNA/RNA PROBE TQ 12-25,87507,CPT,,78087507,CDM,306,RC,,,both,,,3862,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,1254.51,,,1254.51,Fee Schedule,,1129.47,,,1129.47,Fee Schedule,,226.87,,,226.87,Fee Schedule,,226.87,,,226.87,Fee Schedule,,226.87,,,226.87,Fee Schedule,,2703.4,70,,2703.4,percent of total billed charges,All Other,1312.86,,,1312.86,Fee Schedule,,108,,,108,Other,186% of Medicaid,1546.25,,,1546.25,Fee Schedule,,2394.44,,,2394.44,Fee Schedule,,875.24,,,,Fee Schedule,,1546.25,,,1546.25,Fee Schedule,,2394.44,,,2394.44,Fee Schedule,,1646.28,,,1646.28,Fee Schedule,,2703.4,70,,2703.4,percent of total billed charges,,1975.14,,,1975.14,Fee Schedule,,1674.05,,,1674.05,Fee Schedule,,625.17,,,625.17,Fee Schedule,,625.17,,,625.17,Fee Schedule,,625.17,,,625.17,Fee Schedule,,625.17,,,625.17,Fee Schedule,,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,88.46,,,88.46,Other,153% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,80.94,,,80.94,Other,140% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,150.32,,,150.32,Other,250% of Medicaid,187.33,,,187.33,Other,324% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,72.27,,,72.27,Other,125% of Medicaid,0.01,2703.4,
GARDNER VAG DNA DIR PROBE,87510,CPT,,78087510,CDM,306,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,60.35,,,60.35,Fee Schedule,,54.34,,,54.34,Fee Schedule,,154.65,,,154.65,Fee Schedule,,139.12,,,139.12,Fee Schedule,,131.51,,,131.51,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,All Other,63.16,,,63.16,Fee Schedule,,26,,,26,Other,186% of Medicaid,74.39,,,74.39,Fee Schedule,,40.3,,,40.3,Fee Schedule,,42.11,,,,Fee Schedule,,74.39,,,74.39,Fee Schedule,,40.3,,,40.3,Fee Schedule,,79.2,,,79.2,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,,95.02,,,95.02,Fee Schedule,,80.53,,,80.53,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,14.09,,,14.09,Other,100% of Medicaid,14.09,,,14.09,Other,100% of Medicaid,14.09,,,14.09,Other,100% of Medicaid,14.09,,,14.09,Other,100% of Medicaid,31.7,,,31.7,Other,225% of Medicaid,21.56,,,21.56,Other,153% of Medicaid,31.7,,,31.7,Other,225% of Medicaid,19.73,,,19.73,Other,140% of Medicaid,31.7,,,31.7,Other,225% of Medicaid,36.63,,,36.63,Other,250% of Medicaid,45.65,,,45.65,Other,324% of Medicaid,30.29,,,30.29,Other,215% of Medicaid,30.29,,,30.29,Other,215% of Medicaid,17.61,,,17.61,Other,125% of Medicaid,0.01,154.65,
GARDNER VAG DNA QUANT,87512,CPT,,78087512,CDM,306,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,125.7,,,125.7,Fee Schedule,,113.17,,,113.17,Fee Schedule,,321.95,,,321.95,Fee Schedule,,289.64,,,289.64,Fee Schedule,,273.78,,,273.78,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,131.54,,,131.54,Fee Schedule,,81,,,81,Other,186% of Medicaid,154.93,,,154.93,Fee Schedule,,82.46,,,82.46,Fee Schedule,,87.7,,,,Fee Schedule,,154.93,,,154.93,Fee Schedule,,82.46,,,82.46,Fee Schedule,,164.95,,,164.95,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,,197.9,,,197.9,Fee Schedule,,167.73,,,167.73,Fee Schedule,,62.64,,,62.64,Fee Schedule,,62.64,,,62.64,Fee Schedule,,62.64,,,62.64,Fee Schedule,,62.64,,,62.64,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,321.95,
HEPATITIS B DNA DIR PROBE,87515,CPT,,78087515,CDM,306,RC,,,both,,,356,70.45,,,70.45,Other,150% of Medicare + 9.63% HCRA Surcharge,42.84,,,42.84,Other,Non Covered Service,231.4,65,,231.4,percent of total billed charges,All Other,210.04,59,,210.04,percent of total billed charges,All Other,9.57,,,9.57,Fee Schedule,,9.57,,,9.57,Fee Schedule,,9.57,,,9.57,Fee Schedule,,249.2,70,,249.2,percent of total billed charges,All Other,242.08,68,,242.08,percent of total billed charges,All Other,81,,,81,Other,186% of Medicaid,295.48,80,,295.48,percent of total billed charges,All Other,220.72,83,,220.72,percent of total billed charges,All Other,195.8,83,,,percent of total billed charges,All Other,295.48,80,,295.48,percent of total billed charges,All Other,220.72,83,,220.72,percent of total billed charges,All Other,284.8,80,,284.8,percent of total billed charges,All Other,249.2,70,,249.2,percent of total billed charges,,231.4,65,,231.4,percent of total billed charges,All Other,231.4,65,,231.4,percent of total billed charges,All Other,178,,,178,Fee Schedule,,178,,,178,Fee Schedule,,178,,,178,Fee Schedule,,178,,,178,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,9.57,295.48,
HEPATITIS B DNA AMP PROBE,87516,CPT,,78087516,CDM,306,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,159.6,70,,159.6,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,141.36,,,141.36,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,141.36,,,141.36,Fee Schedule,,138.61,,,138.61,Fee Schedule,,159.6,70,,159.6,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,270.66,
HEPATITIS B DNA QUANT,87517,CPT,,78087517,CDM,306,RC,,,both,,,403,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,128.95,,,128.95,Fee Schedule,,116.1,,,116.1,Fee Schedule,,330.33,,,330.33,Fee Schedule,,297.18,,,297.18,Fee Schedule,,280.9,,,280.9,Fee Schedule,,282.1,70,,282.1,percent of total billed charges,All Other,134.95,,,134.95,Fee Schedule,,81,,,81,Other,186% of Medicaid,158.94,,,158.94,Fee Schedule,,249.86,,,249.86,Fee Schedule,,89.96,,,,Fee Schedule,,158.94,,,158.94,Fee Schedule,,249.86,,,249.86,Fee Schedule,,169.22,,,169.22,Fee Schedule,,282.1,70,,282.1,percent of total billed charges,,203.02,,,203.02,Fee Schedule,,172.07,,,172.07,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,330.33,
HSV DNA AMP PROBE,87529,CPT,,78087529,CDM,306,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,174.3,70,,174.3,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,60,,,60,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,154.38,,,154.38,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,154.38,,,154.38,Fee Schedule,,138.61,,,138.61,Fee Schedule,,174.3,70,,174.3,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,32.47,,,32.47,Other,100% of Medicaid,32.47,,,32.47,Other,100% of Medicaid,32.47,,,32.47,Other,100% of Medicaid,32.47,,,32.47,Other,100% of Medicaid,73.06,,,73.06,Other,225% of Medicaid,49.68,,,49.68,Other,153% of Medicaid,73.06,,,73.06,Other,225% of Medicaid,45.46,,,45.46,Other,140% of Medicaid,73.06,,,73.06,Other,225% of Medicaid,84.43,,,84.43,Other,250% of Medicaid,105.21,,,105.21,Other,324% of Medicaid,69.81,,,69.81,Other,215% of Medicaid,69.81,,,69.81,Other,215% of Medicaid,40.59,,,40.59,Other,125% of Medicaid,0.01,270.66,
HSV DNA QUANT,87530,CPT,,78087530,CDM,306,RC,,,both,,,136,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,128.95,,,128.95,Fee Schedule,,116.1,,,116.1,Fee Schedule,,330.33,,,330.33,Fee Schedule,,297.18,,,297.18,Fee Schedule,,280.9,,,280.9,Fee Schedule,,95.2,70,,95.2,percent of total billed charges,All Other,134.95,,,134.95,Fee Schedule,,81,,,81,Other,186% of Medicaid,158.94,,,158.94,Fee Schedule,,84.32,,,84.32,Fee Schedule,,89.96,,,,Fee Schedule,,158.94,,,158.94,Fee Schedule,,84.32,,,84.32,Fee Schedule,,169.22,,,169.22,Fee Schedule,,95.2,70,,95.2,percent of total billed charges,,203.02,,,203.02,Fee Schedule,,172.07,,,172.07,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,330.33,
HHV-6 DNA AMP PROBE,87532,CPT,,78087532,CDM,306,RC,,,both,,,223,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,81,,,81,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,138.26,,,138.26,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,138.26,,,138.26,Fee Schedule,,138.61,,,138.61,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,270.66,
HHV-6 DNA QUANT,87533,CPT,,78087533,CDM,306,RC,,,both,,,133,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,125.7,,,125.7,Fee Schedule,,113.17,,,113.17,Fee Schedule,,321.95,,,321.95,Fee Schedule,,289.64,,,289.64,Fee Schedule,,273.78,,,273.78,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,All Other,131.54,,,131.54,Fee Schedule,,81,,,81,Other,186% of Medicaid,154.93,,,154.93,Fee Schedule,,82.46,,,82.46,Fee Schedule,,87.7,,,,Fee Schedule,,154.93,,,154.93,Fee Schedule,,82.46,,,82.46,Fee Schedule,,164.95,,,164.95,Fee Schedule,,93.1,70,,93.1,percent of total billed charges,,197.9,,,197.9,Fee Schedule,,167.73,,,167.73,Fee Schedule,,62.64,,,62.64,Fee Schedule,,62.64,,,62.64,Fee Schedule,,62.64,,,62.64,Fee Schedule,,62.64,,,62.64,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,321.95,
HIV-L DNA AMP PROBE,87535,CPT,,78087535,CDM,306,RC,,,both,,,223,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,138.26,,,138.26,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,138.26,,,138.26,Fee Schedule,,138.61,,,138.61,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,270.66,
LEGION PNEUMO DNA AMP PROB,87541,CPT,,78087541,CDM,306,RC,,,both,,,112,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,78.4,70,,78.4,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,81,,,81,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,69.44,,,69.44,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,69.44,,,69.44,Fee Schedule,,138.61,,,138.61,Fee Schedule,,78.4,70,,78.4,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,270.66,
M. TUBERCULO DNA AMP PROBE,87556,CPT,,78087556,CDM,306,RC,,,both,,,223,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,125.46,,,125.46,Fee Schedule,,112.95,,,112.95,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,All Other,131.29,,,131.29,Fee Schedule,,78,,,78,Other,186% of Medicaid,154.63,,,154.63,Fee Schedule,,138.26,,,138.26,Fee Schedule,,87.53,,,,Fee Schedule,,154.63,,,154.63,Fee Schedule,,138.26,,,138.26,Fee Schedule,,164.64,,,164.64,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,,197.52,,,197.52,Fee Schedule,,167.41,,,167.41,Fee Schedule,,62.52,,,62.52,Fee Schedule,,62.52,,,62.52,Fee Schedule,,62.52,,,62.52,Fee Schedule,,62.52,,,62.52,Fee Schedule,,41.68,,,41.68,Other,100% of Medicaid,41.68,,,41.68,Other,100% of Medicaid,41.68,,,41.68,Other,100% of Medicaid,41.68,,,41.68,Other,100% of Medicaid,93.78,,,93.78,Other,225% of Medicaid,63.77,,,63.77,Other,153% of Medicaid,93.78,,,93.78,Other,225% of Medicaid,58.35,,,58.35,Other,140% of Medicaid,93.78,,,93.78,Other,225% of Medicaid,108.37,,,108.37,Other,250% of Medicaid,135.04,,,135.04,Other,324% of Medicaid,89.61,,,89.61,Other,215% of Medicaid,89.61,,,89.61,Other,215% of Medicaid,52.1,,,52.1,Other,125% of Medicaid,0.01,270.66,
MYCOPLASMA AMPLIF NA PROBE,87581,CPT,,78087581,CDM,306,RC,,,both,,,170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,119,70,,119,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,105.4,,,105.4,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,105.4,,,105.4,Fee Schedule,,138.61,,,138.61,Fee Schedule,,119,70,,119,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,270.66,
N.GONORRHOEAE DNA DIR PROB,87590,CPT,,78087590,CDM,306,RC,,,both,,,217,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,80.91,,,80.91,Fee Schedule,,72.84,,,72.84,Fee Schedule,,154.65,,,154.65,Fee Schedule,,139.12,,,139.12,Fee Schedule,,131.51,,,131.51,Fee Schedule,,151.9,70,,151.9,percent of total billed charges,All Other,84.67,,,84.67,Fee Schedule,,15,,,15,Other,186% of Medicaid,99.72,,,99.72,Fee Schedule,,134.54,,,134.54,Fee Schedule,,56.45,,,,Fee Schedule,,99.72,,,99.72,Fee Schedule,,134.54,,,134.54,Fee Schedule,,106.18,,,106.18,Fee Schedule,,151.9,70,,151.9,percent of total billed charges,,127.39,,,127.39,Fee Schedule,,107.97,,,107.97,Fee Schedule,,40.32,,,40.32,Fee Schedule,,40.32,,,40.32,Fee Schedule,,40.32,,,40.32,Fee Schedule,,40.32,,,40.32,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,154.65,
N.GONORRHOEAE DNA AMP PROB,87591,CPT,,78087591,CDM,306,RC,,,both,,,223,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,138.26,,,138.26,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,138.26,,,138.26,Fee Schedule,,138.61,,,138.61,Fee Schedule,,156.1,70,,156.1,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,270.66,
ORTHOPOXVIRUS AMP PRB,87593,CPT,,78087593,CDM,306,RC,,,both,,,170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,130.05,76.5,,130.05,percent of total billed charges,All Other,117.3,69,,117.3,percent of total billed charges,All Other,110.5,65,,110.5,percent of total billed charges,All Other,119,70,,119,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,96,,,96,Other,186% of Medicaid,0.01,,,0.01,Fee Schedule,,105.4,,,105.4,Fee Schedule,,0.01,,,,Fee Schedule,,0.01,,,0.01,Fee Schedule,,105.4,,,105.4,Fee Schedule,,0.01,,,0.01,Fee Schedule,,119,70,,119,percent of total billed charges,,110.5,65,,110.5,percent of total billed charges,All Other,110.5,65,,110.5,percent of total billed charges,All Other,76.76,,,76.76,Fee Schedule,,76.76,,,76.76,Fee Schedule,,76.76,,,76.76,Fee Schedule,,76.76,,,76.76,Fee Schedule,,51.82,,,51.82,Other,100% of Medicaid,51.82,,,51.82,Other,100% of Medicaid,51.82,,,51.82,Other,100% of Medicaid,51.82,,,51.82,Other,100% of Medicaid,116.6,,,116.6,Other,225% of Medicaid,79.29,,,79.29,Other,153% of Medicaid,116.6,,,116.6,Other,225% of Medicaid,72.55,,,72.55,Other,140% of Medicaid,116.6,,,116.6,Other,225% of Medicaid,134.74,,,134.74,Other,250% of Medicaid,167.91,,,167.91,Other,324% of Medicaid,111.42,,,111.42,Other,215% of Medicaid,111.42,,,111.42,Other,215% of Medicaid,64.78,,,64.78,Other,125% of Medicaid,0.01,167.91,
HPV HIGH-RISK TYPES,87624,CPT,,78087624,CDM,306,RC,,,both,,,167,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,19.1,,,19.1,Fee Schedule,,19.1,,,19.1,Fee Schedule,,19.1,,,19.1,Fee Schedule,,116.9,70,,116.9,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,52,,,52,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,103.54,,,103.54,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,103.54,,,103.54,Fee Schedule,,138.61,,,138.61,Fee Schedule,,116.9,70,,116.9,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,28.13,,,28.13,Other,100% of Medicaid,28.13,,,28.13,Other,100% of Medicaid,28.13,,,28.13,Other,100% of Medicaid,28.13,,,28.13,Other,100% of Medicaid,63.29,,,63.29,Other,225% of Medicaid,43.04,,,43.04,Other,153% of Medicaid,63.29,,,63.29,Other,225% of Medicaid,39.38,,,39.38,Other,140% of Medicaid,63.29,,,63.29,Other,225% of Medicaid,73.13,,,73.13,Other,250% of Medicaid,91.14,,,91.14,Other,324% of Medicaid,60.48,,,60.48,Other,215% of Medicaid,60.48,,,60.48,Other,215% of Medicaid,35.16,,,35.16,Other,125% of Medicaid,0.01,166.29,
HPV HIGH-RISK TYPES,87624,CPT,,78187624,CDM,306,RC,,,both,,,167,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,19.1,,,19.1,Fee Schedule,,19.1,,,19.1,Fee Schedule,,19.1,,,19.1,Fee Schedule,,116.9,70,,116.9,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,52,,,52,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,103.54,,,103.54,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,103.54,,,103.54,Fee Schedule,,138.61,,,138.61,Fee Schedule,,116.9,70,,116.9,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,28.13,,,28.13,Other,100% of Medicaid,28.13,,,28.13,Other,100% of Medicaid,28.13,,,28.13,Other,100% of Medicaid,28.13,,,28.13,Other,100% of Medicaid,63.29,,,63.29,Other,225% of Medicaid,43.04,,,43.04,Other,153% of Medicaid,63.29,,,63.29,Other,225% of Medicaid,39.38,,,39.38,Other,140% of Medicaid,63.29,,,63.29,Other,225% of Medicaid,73.13,,,73.13,Other,250% of Medicaid,91.14,,,91.14,Other,324% of Medicaid,60.48,,,60.48,Other,215% of Medicaid,60.48,,,60.48,Other,215% of Medicaid,35.16,,,35.16,Other,125% of Medicaid,0.01,166.29,
HPV TYPES 16&18 ONLY,87625,CPT,,78087625,CDM,306,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,122.06,,,122.06,Fee Schedule,,109.89,,,109.89,Fee Schedule,,19.1,,,19.1,Fee Schedule,,19.1,,,19.1,Fee Schedule,,19.1,,,19.1,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,All Other,127.73,,,127.73,Fee Schedule,,52,,,52,Other,186% of Medicaid,150.44,,,150.44,Fee Schedule,,79.98,,,79.98,Fee Schedule,,85.16,,,,Fee Schedule,,150.44,,,150.44,Fee Schedule,,79.98,,,79.98,Fee Schedule,,160.17,,,160.17,Fee Schedule,,90.3,70,,90.3,percent of total billed charges,,192.17,,,192.17,Fee Schedule,,162.87,,,162.87,Fee Schedule,,60.83,,,60.83,Fee Schedule,,60.83,,,60.83,Fee Schedule,,60.83,,,60.83,Fee Schedule,,60.83,,,60.83,Fee Schedule,,28.13,,,28.13,Other,100% of Medicaid,28.13,,,28.13,Other,100% of Medicaid,28.13,,,28.13,Other,100% of Medicaid,28.13,,,28.13,Other,100% of Medicaid,63.29,,,63.29,Other,225% of Medicaid,43.04,,,43.04,Other,153% of Medicaid,63.29,,,63.29,Other,225% of Medicaid,39.38,,,39.38,Other,140% of Medicaid,63.29,,,63.29,Other,225% of Medicaid,73.13,,,73.13,Other,250% of Medicaid,91.14,,,91.14,Other,324% of Medicaid,60.48,,,60.48,Other,215% of Medicaid,60.48,,,60.48,Other,215% of Medicaid,35.16,,,35.16,Other,125% of Medicaid,0.01,192.17,
RESP VIRUS 12-25 TARGETS,87633,CPT,,78087633,CDM,306,RC,,,both,,,835,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,1254.51,,,1254.51,Fee Schedule,,1129.47,,,1129.47,Fee Schedule,,229.16,,,229.16,Fee Schedule,,229.16,,,229.16,Fee Schedule,,229.16,,,229.16,Fee Schedule,,584.5,70,,584.5,percent of total billed charges,All Other,1312.86,,,1312.86,Fee Schedule,,108,,,108,Other,186% of Medicaid,1546.25,,,1546.25,Fee Schedule,,517.7,,,517.7,Fee Schedule,,875.24,,,,Fee Schedule,,1546.25,,,1546.25,Fee Schedule,,517.7,,,517.7,Fee Schedule,,1646.28,,,1646.28,Fee Schedule,,584.5,70,,584.5,percent of total billed charges,,1975.14,,,1975.14,Fee Schedule,,1674.05,,,1674.05,Fee Schedule,,625.17,,,625.17,Fee Schedule,,625.17,,,625.17,Fee Schedule,,625.17,,,625.17,Fee Schedule,,625.17,,,625.17,Fee Schedule,,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,88.46,,,88.46,Other,153% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,80.94,,,80.94,Other,140% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,150.32,,,150.32,Other,250% of Medicaid,187.33,,,187.33,Other,324% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,72.27,,,72.27,Other,125% of Medicaid,0.01,1975.14,
SARS-COV-2 COVID-19 AMP PRB,87635,CPT,,78087635,CDM,306,RC,,,both,,,170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,154.44,,,154.44,Fee Schedule,,139.05,,,139.05,Fee Schedule,,61.57,,,61.57,Fee Schedule,,61.57,,,61.57,Fee Schedule,,61.57,,,61.57,Fee Schedule,,119,70,,119,percent of total billed charges,All Other,161.63,,,161.63,Fee Schedule,,57,,,57,Other,186% of Medicaid,190.36,,,190.36,Fee Schedule,,105.4,,,105.4,Fee Schedule,,107.75,,,,Fee Schedule,,190.36,,,190.36,Fee Schedule,,105.4,,,105.4,Fee Schedule,,202.67,,,202.67,Fee Schedule,,119,70,,119,percent of total billed charges,,243.16,,,243.16,Fee Schedule,,206.09,,,206.09,Fee Schedule,,76.97,,,76.97,Fee Schedule,,76.97,,,76.97,Fee Schedule,,76.97,,,76.97,Fee Schedule,,76.97,,,76.97,Fee Schedule,,30.79,,,30.79,Other,100% of Medicaid,30.79,,,30.79,Other,100% of Medicaid,30.79,,,30.79,Other,100% of Medicaid,30.79,,,30.79,Other,100% of Medicaid,69.28,,,69.28,Other,225% of Medicaid,47.11,,,47.11,Other,153% of Medicaid,69.28,,,69.28,Other,225% of Medicaid,43.11,,,43.11,Other,140% of Medicaid,69.28,,,69.28,Other,225% of Medicaid,80.05,,,80.05,Other,250% of Medicaid,99.76,,,99.76,Other,324% of Medicaid,66.2,,,66.2,Other,215% of Medicaid,66.2,,,66.2,Other,215% of Medicaid,38.49,,,38.49,Other,125% of Medicaid,0.01,243.16,
SARSCOV2 & INF A&B AMP PRB,87636,CPT,,78087636,CDM,306,RC,,,both,,,287,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,142.63,,,142.63,Fee Schedule,,142.63,,,142.63,Fee Schedule,,142.63,,,142.63,Fee Schedule,,142.63,,,142.63,Fee Schedule,,142.63,,,142.63,Fee Schedule,,200.9,70,,200.9,percent of total billed charges,All Other,449.28,,,449.28,Fee Schedule,,159,,,159,Other,186% of Medicaid,529.16,,,529.16,Fee Schedule,,177.94,,,177.94,Fee Schedule,,299.52,,,,Fee Schedule,,529.16,,,529.16,Fee Schedule,,177.94,,,177.94,Fee Schedule,,563.39,,,563.39,Fee Schedule,,200.9,70,,200.9,percent of total billed charges,,675.93,,,675.93,Fee Schedule,,572.89,,,572.89,Fee Schedule,,213.9,,,213.9,Fee Schedule,,213.9,,,213.9,Fee Schedule,,213.9,,,213.9,Fee Schedule,,213.9,,,213.9,Fee Schedule,,85.59,,,85.59,Other,100% of Medicaid,85.59,,,85.59,Other,100% of Medicaid,85.59,,,85.59,Other,100% of Medicaid,85.59,,,85.59,Other,100% of Medicaid,192.58,,,192.58,Other,225% of Medicaid,130.95,,,130.95,Other,153% of Medicaid,192.58,,,192.58,Other,225% of Medicaid,119.83,,,119.83,Other,140% of Medicaid,192.58,,,192.58,Other,225% of Medicaid,222.53,,,222.53,Other,250% of Medicaid,277.31,,,277.31,Other,324% of Medicaid,184.02,,,184.02,Other,215% of Medicaid,184.02,,,184.02,Other,215% of Medicaid,106.99,,,106.99,Other,125% of Medicaid,0.01,675.93,
SARSCOV2&INF A&B&RSV AMP PRB,87637,CPT,,78087637,CDM,306,RC,,,both,,,287,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,429.32,,,429.32,Fee Schedule,,386.53,,,386.53,Fee Schedule,,142.63,,,142.63,Fee Schedule,,142.63,,,142.63,Fee Schedule,,142.63,,,142.63,Fee Schedule,,200.9,70,,200.9,percent of total billed charges,All Other,449.28,,,449.28,Fee Schedule,,159,,,159,Other,186% of Medicaid,529.16,,,529.16,Fee Schedule,,177.94,,,177.94,Fee Schedule,,299.52,,,,Fee Schedule,,529.16,,,529.16,Fee Schedule,,177.94,,,177.94,Fee Schedule,,563.39,,,563.39,Fee Schedule,,200.9,70,,200.9,percent of total billed charges,,675.93,,,675.93,Fee Schedule,,572.89,,,572.89,Fee Schedule,,213.9,,,213.9,Fee Schedule,,213.9,,,213.9,Fee Schedule,,213.9,,,213.9,Fee Schedule,,213.9,,,213.9,Fee Schedule,,85.59,,,85.59,Other,100% of Medicaid,85.59,,,85.59,Other,100% of Medicaid,85.59,,,85.59,Other,100% of Medicaid,85.59,,,85.59,Other,100% of Medicaid,192.58,,,192.58,Other,225% of Medicaid,130.95,,,130.95,Other,153% of Medicaid,192.58,,,192.58,Other,225% of Medicaid,119.83,,,119.83,Other,140% of Medicaid,192.58,,,192.58,Other,225% of Medicaid,222.53,,,222.53,Other,250% of Medicaid,277.31,,,277.31,Other,324% of Medicaid,184.02,,,184.02,Other,215% of Medicaid,184.02,,,184.02,Other,215% of Medicaid,106.99,,,106.99,Other,125% of Medicaid,0.01,675.93,
STREP B DNA AMP PROBE,87653,CPT,,78087653,CDM,306,RC,,,both,,,94,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,65.8,70,,65.8,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,58.28,,,58.28,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,58.28,,,58.28,Fee Schedule,,138.61,,,138.61,Fee Schedule,,65.8,70,,65.8,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,270.66,
TRICHOMONAS VAGIN DIR PROBE,87660,CPT,,78087660,CDM,306,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,60.35,,,60.35,Fee Schedule,,54.34,,,54.34,Fee Schedule,,154.65,,,154.65,Fee Schedule,,139.12,,,139.12,Fee Schedule,,131.51,,,131.51,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,All Other,63.16,,,63.16,Fee Schedule,,26,,,26,Other,186% of Medicaid,74.39,,,74.39,Fee Schedule,,40.3,,,40.3,Fee Schedule,,42.11,,,,Fee Schedule,,74.39,,,74.39,Fee Schedule,,40.3,,,40.3,Fee Schedule,,79.2,,,79.2,Fee Schedule,,45.5,70,,45.5,percent of total billed charges,,95.02,,,95.02,Fee Schedule,,80.53,,,80.53,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,30.08,,,30.08,Fee Schedule,,14.09,,,14.09,Other,100% of Medicaid,14.09,,,14.09,Other,100% of Medicaid,14.09,,,14.09,Other,100% of Medicaid,14.09,,,14.09,Other,100% of Medicaid,31.7,,,31.7,Other,225% of Medicaid,21.56,,,21.56,Other,153% of Medicaid,31.7,,,31.7,Other,225% of Medicaid,19.73,,,19.73,Other,140% of Medicaid,31.7,,,31.7,Other,225% of Medicaid,36.63,,,36.63,Other,250% of Medicaid,45.65,,,45.65,Other,324% of Medicaid,30.29,,,30.29,Other,215% of Medicaid,30.29,,,30.29,Other,215% of Medicaid,17.61,,,17.61,Other,125% of Medicaid,0.01,154.65,
TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,,78087661,CDM,306,RC,,,both,,,79,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,19.15,,,19.15,Fee Schedule,,19.15,,,19.15,Fee Schedule,,19.15,,,19.15,Fee Schedule,,55.3,70,,55.3,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,48.98,,,48.98,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,48.98,,,48.98,Fee Schedule,,138.61,,,138.61,Fee Schedule,,55.3,70,,55.3,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,166.29,
DETECT AGENT NOS DNA DIR,87797,CPT,,78087797,CDM,306,RC,,,both,,,160,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,90.39,,,90.39,Fee Schedule,,81.38,,,81.38,Fee Schedule,,154.65,,,154.65,Fee Schedule,,139.12,,,139.12,Fee Schedule,,131.51,,,131.51,Fee Schedule,,112,70,,112,percent of total billed charges,All Other,94.59,,,94.59,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,111.41,,,111.41,Fee Schedule,,99.2,,,99.2,Fee Schedule,,63.06,,,,Fee Schedule,,111.41,,,111.41,Fee Schedule,,99.2,,,99.2,Fee Schedule,,118.62,,,118.62,Fee Schedule,,112,70,,112,percent of total billed charges,,142.31,,,142.31,Fee Schedule,,120.62,,,120.62,Fee Schedule,,45.05,,,45.05,Fee Schedule,,45.05,,,45.05,Fee Schedule,,45.05,,,45.05,Fee Schedule,,45.05,,,45.05,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,154.65,
DETECT AGENT NOS DNA QUANT,87799,CPT,,78087799,CDM,306,RC,,,both,,,430,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,128.95,,,128.95,Fee Schedule,,116.1,,,116.1,Fee Schedule,,330.33,,,330.33,Fee Schedule,,297.18,,,297.18,Fee Schedule,,280.9,,,280.9,Fee Schedule,,301,70,,301,percent of total billed charges,All Other,134.95,,,134.95,Fee Schedule,,81,,,81,Other,186% of Medicaid,158.94,,,158.94,Fee Schedule,,266.6,,,266.6,Fee Schedule,,89.96,,,,Fee Schedule,,158.94,,,158.94,Fee Schedule,,266.6,,,266.6,Fee Schedule,,169.22,,,169.22,Fee Schedule,,301,70,,301,percent of total billed charges,,203.02,,,203.02,Fee Schedule,,172.07,,,172.07,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,0.01,330.33,
DIR NA PROBE MULTI ORGANISMS,87800,CPT,,78087800,CDM,306,RC,,,both,,,238,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,131.45,,,131.45,Fee Schedule,,118.35,,,118.35,Fee Schedule,,309.29,,,309.29,Fee Schedule,,278.25,,,278.25,Fee Schedule,,263.01,,,263.01,Fee Schedule,,166.6,70,,166.6,percent of total billed charges,All Other,137.56,,,137.56,Fee Schedule,,52,,,52,Other,186% of Medicaid,162.02,,,162.02,Fee Schedule,,147.56,,,147.56,Fee Schedule,,91.71,,,,Fee Schedule,,162.02,,,162.02,Fee Schedule,,147.56,,,147.56,Fee Schedule,,172.5,,,172.5,Fee Schedule,,166.6,70,,166.6,percent of total billed charges,,206.95,,,206.95,Fee Schedule,,175.41,,,175.41,Fee Schedule,,65.51,,,65.51,Fee Schedule,,65.51,,,65.51,Fee Schedule,,65.51,,,65.51,Fee Schedule,,65.51,,,65.51,Fee Schedule,,28.19,,,28.19,Other,100% of Medicaid,28.19,,,28.19,Other,100% of Medicaid,28.19,,,28.19,Other,100% of Medicaid,28.19,,,28.19,Other,100% of Medicaid,63.43,,,63.43,Other,225% of Medicaid,43.13,,,43.13,Other,153% of Medicaid,63.43,,,63.43,Other,225% of Medicaid,39.46,,,39.46,Other,140% of Medicaid,63.43,,,63.43,Other,225% of Medicaid,73.29,,,73.29,Other,250% of Medicaid,91.33,,,91.33,Other,324% of Medicaid,60.61,,,60.61,Other,215% of Medicaid,60.61,,,60.61,Other,215% of Medicaid,35.24,,,35.24,Other,125% of Medicaid,0.01,309.29,
DETECT AGNT MULT DNA AMPLI,87801,CPT,,78087801,CDM,306,RC,,,both,,,414,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,211.3,,,211.3,Fee Schedule,,190.24,,,190.24,Fee Schedule,,541.31,,,541.31,Fee Schedule,,486.99,,,486.99,Fee Schedule,,460.31,,,460.31,Fee Schedule,,289.8,70,,289.8,percent of total billed charges,All Other,221.13,,,221.13,Fee Schedule,,75,,,75,Other,186% of Medicaid,260.44,,,260.44,Fee Schedule,,256.68,,,256.68,Fee Schedule,,147.42,,,,Fee Schedule,,260.44,,,260.44,Fee Schedule,,256.68,,,256.68,Fee Schedule,,277.29,,,277.29,Fee Schedule,,289.8,70,,289.8,percent of total billed charges,,332.68,,,332.68,Fee Schedule,,281.97,,,281.97,Fee Schedule,,105.3,,,105.3,Fee Schedule,,105.3,,,105.3,Fee Schedule,,105.3,,,105.3,Fee Schedule,,105.3,,,105.3,Fee Schedule,,40.4,,,40.4,Other,100% of Medicaid,40.4,,,40.4,Other,100% of Medicaid,40.4,,,40.4,Other,100% of Medicaid,40.4,,,40.4,Other,100% of Medicaid,90.9,,,90.9,Other,225% of Medicaid,61.81,,,61.81,Other,153% of Medicaid,90.9,,,90.9,Other,225% of Medicaid,56.56,,,56.56,Other,140% of Medicaid,90.9,,,90.9,Other,225% of Medicaid,105.04,,,105.04,Other,250% of Medicaid,130.9,,,130.9,Other,324% of Medicaid,86.86,,,86.86,Other,215% of Medicaid,86.86,,,86.86,Other,215% of Medicaid,50.5,,,50.5,Other,125% of Medicaid,0.01,541.31,
STREP B IA W DO,87802,CPT,,78087802,CDM,306,RC,,,both,,,69,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,38.32,,,38.32,Fee Schedule,,34.5,,,34.5,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,All Other,40.1,,,40.1,Fee Schedule,,31,,,31,Other,186% of Medicaid,47.23,,,47.23,Fee Schedule,,42.78,,,42.78,Fee Schedule,,26.73,,,,Fee Schedule,,47.23,,,47.23,Fee Schedule,,42.78,,,42.78,Fee Schedule,,50.28,,,50.28,Fee Schedule,,48.3,70,,48.3,percent of total billed charges,,60.33,,,60.33,Fee Schedule,,51.13,,,51.13,Fee Schedule,,19.1,,,19.1,Fee Schedule,,19.1,,,19.1,Fee Schedule,,19.1,,,19.1,Fee Schedule,,19.1,,,19.1,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,67.46,
INFLUENZA ASSAY W/OPTIC,87804,CPT,,78087804,CDM,306,RC,,,both,,,233,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.82,,,49.82,Fee Schedule,,44.85,,,44.85,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,All Other,52.13,,,52.13,Fee Schedule,,27,,,27,Other,186% of Medicaid,61.4,,,61.4,Fee Schedule,,144.46,,,144.46,Fee Schedule,,34.76,,,,Fee Schedule,,61.4,,,61.4,Fee Schedule,,144.46,,,144.46,Fee Schedule,,65.37,,,65.37,Fee Schedule,,163.1,70,,163.1,percent of total billed charges,,78.43,,,78.43,Fee Schedule,,66.48,,,66.48,Fee Schedule,,24.83,,,24.83,Fee Schedule,,24.83,,,24.83,Fee Schedule,,24.83,,,24.83,Fee Schedule,,24.83,,,24.83,Fee Schedule,,14.65,,,14.65,Other,100% of Medicaid,14.65,,,14.65,Other,100% of Medicaid,14.65,,,14.65,Other,100% of Medicaid,14.65,,,14.65,Other,100% of Medicaid,32.95,,,32.95,Other,225% of Medicaid,22.41,,,22.41,Other,153% of Medicaid,32.95,,,32.95,Other,225% of Medicaid,20.5,,,20.5,Other,140% of Medicaid,32.95,,,32.95,Other,225% of Medicaid,38.08,,,38.08,Other,250% of Medicaid,47.45,,,47.45,Other,324% of Medicaid,31.49,,,31.49,Other,215% of Medicaid,31.49,,,31.49,Other,215% of Medicaid,18.31,,,18.31,Other,125% of Medicaid,0.01,163.1,
STREP A ASSAY W/OPTIC,87880,CPT,,78087880,CDM,306,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.76,,,49.76,Fee Schedule,,44.8,,,44.8,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,52.07,,,52.07,Fee Schedule,,7,,,7,Other,186% of Medicaid,61.33,,,61.33,Fee Schedule,,45.88,,,45.88,Fee Schedule,,34.71,,,,Fee Schedule,,61.33,,,61.33,Fee Schedule,,45.88,,,45.88,Fee Schedule,,65.29,,,65.29,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,78.34,,,78.34,Fee Schedule,,66.39,,,66.39,Fee Schedule,,24.8,,,24.8,Fee Schedule,,24.8,,,24.8,Fee Schedule,,24.8,,,24.8,Fee Schedule,,24.8,,,24.8,Fee Schedule,,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,3.79,,,3.79,Other,100% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.79,,,5.79,Other,153% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,5.3,,,5.3,Other,140% of Medicaid,8.52,,,8.52,Other,225% of Medicaid,9.85,,,9.85,Other,250% of Medicaid,12.27,,,12.27,Other,324% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,8.14,,,8.14,Other,215% of Medicaid,4.73,,,4.73,Other,125% of Medicaid,0.01,78.34,
PHENOTYPE INFECT AGENT DRUG,87900,CPT,,78087900,CDM,306,RC,,,both,,,924,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,392.35,,,392.35,Fee Schedule,,353.25,,,353.25,Fee Schedule,,1005.14,,,1005.14,Fee Schedule,,904.26,,,904.26,Fee Schedule,,854.74,,,854.74,Fee Schedule,,646.8,70,,646.8,percent of total billed charges,All Other,410.6,,,410.6,Fee Schedule,,150,,,150,Other,186% of Medicaid,483.6,,,483.6,Fee Schedule,,572.88,,,572.88,Fee Schedule,,273.74,,,,Fee Schedule,,483.6,,,483.6,Fee Schedule,,572.88,,,572.88,Fee Schedule,,514.88,,,514.88,Fee Schedule,,646.8,70,,646.8,percent of total billed charges,,617.73,,,617.73,Fee Schedule,,523.57,,,523.57,Fee Schedule,,195.53,,,195.53,Fee Schedule,,195.53,,,195.53,Fee Schedule,,195.53,,,195.53,Fee Schedule,,195.53,,,195.53,Fee Schedule,,80.8,,,80.8,Other,100% of Medicaid,80.8,,,80.8,Other,100% of Medicaid,80.8,,,80.8,Other,100% of Medicaid,80.8,,,80.8,Other,100% of Medicaid,181.8,,,181.8,Other,225% of Medicaid,123.62,,,123.62,Other,153% of Medicaid,181.8,,,181.8,Other,225% of Medicaid,113.12,,,113.12,Other,140% of Medicaid,181.8,,,181.8,Other,225% of Medicaid,210.08,,,210.08,Other,250% of Medicaid,261.79,,,261.79,Other,324% of Medicaid,173.72,,,173.72,Other,215% of Medicaid,173.72,,,173.72,Other,215% of Medicaid,101,,,101,Other,125% of Medicaid,0.01,1005.14,
GENOTYPE DNA/RNA HIV,87906,CPT,,78087906,CDM,306,RC,,,both,,,407,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,387.48,,,387.48,Fee Schedule,,348.86,,,348.86,Fee Schedule,,992.65,,,992.65,Fee Schedule,,893.02,,,893.02,Fee Schedule,,844.11,,,844.11,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,405.5,,,405.5,Fee Schedule,,239,,,239,Other,186% of Medicaid,477.59,,,477.59,Fee Schedule,,252.34,,,252.34,Fee Schedule,,270.33,,,,Fee Schedule,,477.59,,,477.59,Fee Schedule,,252.34,,,252.34,Fee Schedule,,508.48,,,508.48,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,610.06,,,610.06,Fee Schedule,,517.06,,,517.06,Fee Schedule,,193.1,,,193.1,Fee Schedule,,193.1,,,193.1,Fee Schedule,,193.1,,,193.1,Fee Schedule,,193.1,,,193.1,Fee Schedule,,128.73,,,128.73,Other,100% of Medicaid,128.73,,,128.73,Other,100% of Medicaid,128.73,,,128.73,Other,100% of Medicaid,128.73,,,128.73,Other,100% of Medicaid,289.64,,,289.64,Other,225% of Medicaid,196.96,,,196.96,Other,153% of Medicaid,289.64,,,289.64,Other,225% of Medicaid,180.22,,,180.22,Other,140% of Medicaid,289.64,,,289.64,Other,225% of Medicaid,334.7,,,334.7,Other,250% of Medicaid,417.09,,,417.09,Other,324% of Medicaid,276.77,,,276.77,Other,215% of Medicaid,276.77,,,276.77,Other,215% of Medicaid,160.91,,,160.91,Other,125% of Medicaid,0.01,992.65,
GENOTYPE CYTOMEGALOVIRUS,87910,CPT,,78087910,CDM,306,RC,,,both,,,812,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,774.92,,,774.92,Fee Schedule,,697.69,,,697.69,Fee Schedule,,141.55,,,141.55,Fee Schedule,,141.55,,,141.55,Fee Schedule,,141.55,,,141.55,Fee Schedule,,568.4,70,,568.4,percent of total billed charges,All Other,810.97,,,810.97,Fee Schedule,,108,,,108,Other,186% of Medicaid,955.14,,,955.14,Fee Schedule,,503.44,,,503.44,Fee Schedule,,540.65,,,,Fee Schedule,,955.14,,,955.14,Fee Schedule,,503.44,,,503.44,Fee Schedule,,1016.93,,,1016.93,Fee Schedule,,568.4,70,,568.4,percent of total billed charges,,1220.06,,,1220.06,Fee Schedule,,1034.08,,,1034.08,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,88.46,,,88.46,Other,153% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,80.94,,,80.94,Other,140% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,150.32,,,150.32,Other,250% of Medicaid,187.33,,,187.33,Other,324% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,72.27,,,72.27,Other,125% of Medicaid,0.01,1220.06,
GENOTYPE DNA HEPATITIS B,87912,CPT,,78087912,CDM,306,RC,,,both,,,812,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,774.92,,,774.92,Fee Schedule,,697.69,,,697.69,Fee Schedule,,141.55,,,141.55,Fee Schedule,,141.55,,,141.55,Fee Schedule,,141.55,,,141.55,Fee Schedule,,568.4,70,,568.4,percent of total billed charges,All Other,810.97,,,810.97,Fee Schedule,,108,,,108,Other,186% of Medicaid,955.14,,,955.14,Fee Schedule,,503.44,,,503.44,Fee Schedule,,540.65,,,,Fee Schedule,,955.14,,,955.14,Fee Schedule,,503.44,,,503.44,Fee Schedule,,1016.93,,,1016.93,Fee Schedule,,568.4,70,,568.4,percent of total billed charges,,1220.06,,,1220.06,Fee Schedule,,1034.08,,,1034.08,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,386.18,,,386.18,Fee Schedule,,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,57.82,,,57.82,Other,100% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,88.46,,,88.46,Other,153% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,80.94,,,80.94,Other,140% of Medicaid,130.09,,,130.09,Other,225% of Medicaid,150.32,,,150.32,Other,250% of Medicaid,187.33,,,187.33,Other,324% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,124.31,,,124.31,Other,215% of Medicaid,72.27,,,72.27,Other,125% of Medicaid,0.01,1220.06,
TROFILE(R),87999,CPT,,78087999,CDM,306,RC,,,both,,,9740,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6331,65,,6331,percent of total billed charges,All Other,5746.6,59,,5746.6,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,6818,70,,6818,percent of total billed charges,All Other,6623.2,68,,6623.2,percent of total billed charges,All Other,31,,,31,Other,186% of Medicaid,8084.2,80,,8084.2,percent of total billed charges,All Other,6038.8,83,,6038.8,percent of total billed charges,All Other,5357,83,,,percent of total billed charges,All Other,8084.2,80,,8084.2,percent of total billed charges,All Other,6038.8,83,,6038.8,percent of total billed charges,All Other,7792,80,,7792,percent of total billed charges,All Other,6818,70,,6818,percent of total billed charges,,6331,65,,6331,percent of total billed charges,All Other,6331,65,,6331,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,8084.2,
CDC 2019 COVID DIAGNOSTIC PANEL,U0001,HCPCS,,78000015,CDM,306,RC,,,both,,,158,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,108.12,,,108.12,Fee Schedule,,97.34,,,97.34,Fee Schedule,,17.33,,,17.33,Fee Schedule,,17.33,,,17.33,Fee Schedule,,17.33,,,17.33,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,All Other,113.15,,,113.15,Fee Schedule,,31,,,31,Other,186% of Medicaid,133.26,,,133.26,Fee Schedule,,97.96,,,97.96,Fee Schedule,,75.43,,,,Fee Schedule,,133.26,,,133.26,Fee Schedule,,97.96,,,97.96,Fee Schedule,,141.88,,,141.88,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,,170.23,,,170.23,Fee Schedule,,144.28,,,144.28,Fee Schedule,,53.88,,,53.88,Fee Schedule,,53.88,,,53.88,Fee Schedule,,53.88,,,53.88,Fee Schedule,,53.88,,,53.88,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,0.01,170.23,
COVID-19 LAB TEST NON-CDC,U0002,HCPCS,,78000014,CDM,306,RC,,,both,,,158,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,154.44,,,154.44,Fee Schedule,,139.05,,,139.05,Fee Schedule,,61.57,,,61.57,Fee Schedule,,61.57,,,61.57,Fee Schedule,,61.57,,,61.57,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,All Other,161.63,,,161.63,Fee Schedule,,57,,,57,Other,186% of Medicaid,190.36,,,190.36,Fee Schedule,,97.96,,,97.96,Fee Schedule,,107.75,,,,Fee Schedule,,190.36,,,190.36,Fee Schedule,,97.96,,,97.96,Fee Schedule,,202.67,,,202.67,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,,243.16,,,243.16,Fee Schedule,,206.09,,,206.09,Fee Schedule,,76.97,,,76.97,Fee Schedule,,76.97,,,76.97,Fee Schedule,,76.97,,,76.97,Fee Schedule,,76.97,,,76.97,Fee Schedule,,30.79,,,30.79,Other,100% of Medicaid,30.79,,,30.79,Other,100% of Medicaid,30.79,,,30.79,Other,100% of Medicaid,30.79,,,30.79,Other,100% of Medicaid,69.28,,,69.28,Other,225% of Medicaid,47.11,,,47.11,Other,153% of Medicaid,69.28,,,69.28,Other,225% of Medicaid,43.11,,,43.11,Other,140% of Medicaid,69.28,,,69.28,Other,225% of Medicaid,80.05,,,80.05,Other,250% of Medicaid,99.76,,,99.76,Other,324% of Medicaid,66.2,,,66.2,Other,215% of Medicaid,66.2,,,66.2,Other,215% of Medicaid,38.49,,,38.49,Other,125% of Medicaid,0.01,243.16,
SARS-COV-2-COVID-19 AMP PRB HIGH TECH,U0003,HCPCS,,78000016,CDM,306,RC,,,both,,,161,123.33,,,123.33,Other,150% of Medicare + 9.63% HCRA Surcharge,75,,,75,Fee Schedule,,104.65,65,,104.65,percent of total billed charges,All Other,94.99,59,,94.99,percent of total billed charges,All Other,100,,,100,Fee Schedule,,100,,,100,Fee Schedule,,100,,,100,Fee Schedule,,112.7,70,,112.7,percent of total billed charges,All Other,109.48,68,,109.48,percent of total billed charges,All Other,81,,,81,Other,186% of Medicaid,133.63,80,,133.63,percent of total billed charges,All Other,99.82,83,,99.82,percent of total billed charges,All Other,88.55,83,,,percent of total billed charges,All Other,133.63,80,,133.63,percent of total billed charges,All Other,99.82,83,,99.82,percent of total billed charges,All Other,128.8,80,,128.8,percent of total billed charges,All Other,112.7,70,,112.7,percent of total billed charges,,355.43,,,355.43,Fee Schedule,,301.25,,,301.25,Fee Schedule,,80.5,,,80.5,Fee Schedule,,80.5,,,80.5,Fee Schedule,,80.5,,,80.5,Fee Schedule,,80.5,,,80.5,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,43.62,355.43,
COV-19 TEST NON-CDC HGH THRU,U0004,HCPCS,,78000018,CDM,306,RC,,,both,,,161,123.33,,,123.33,Other,150% of Medicare + 9.63% HCRA Surcharge,75,,,75,Fee Schedule,,104.65,65,,104.65,percent of total billed charges,All Other,94.99,59,,94.99,percent of total billed charges,All Other,100,,,100,Fee Schedule,,100,,,100,Fee Schedule,,100,,,100,Fee Schedule,,112.7,70,,112.7,percent of total billed charges,All Other,109.48,68,,109.48,percent of total billed charges,All Other,81,,,81,Other,186% of Medicaid,133.63,80,,133.63,percent of total billed charges,All Other,99.82,83,,99.82,percent of total billed charges,All Other,88.55,83,,,percent of total billed charges,All Other,133.63,80,,133.63,percent of total billed charges,All Other,99.82,83,,99.82,percent of total billed charges,All Other,128.8,80,,128.8,percent of total billed charges,All Other,112.7,70,,112.7,percent of total billed charges,,355.43,,,355.43,Fee Schedule,,301.25,,,301.25,Fee Schedule,,80.5,,,80.5,Fee Schedule,,80.5,,,80.5,Fee Schedule,,80.5,,,80.5,Fee Schedule,,80.5,,,80.5,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.41,,,113.41,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,93.78,,,93.78,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,43.62,355.43,
COV-19 AMP PRB HGH THRUPUT WITHIN 2 DAYS,U0005,HCPCS,,78000017,CDM,306,RC,,,both,,,75,123.33,,,123.33,Other,150% of Medicare + 9.63% HCRA Surcharge,75,,,75,Fee Schedule,,48.75,65,,48.75,percent of total billed charges,All Other,44.25,59,,44.25,percent of total billed charges,All Other,25,,,25,Fee Schedule,,25,,,25,Fee Schedule,,25,,,25,Fee Schedule,,52.5,70,,52.5,percent of total billed charges,All Other,51,68,,51,percent of total billed charges,All Other,31,,,31,Other,186% of Medicaid,62.25,80,,62.25,percent of total billed charges,All Other,46.5,83,,46.5,percent of total billed charges,All Other,41.25,83,,,percent of total billed charges,All Other,62.25,80,,62.25,percent of total billed charges,All Other,46.5,83,,46.5,percent of total billed charges,All Other,60,80,,60,percent of total billed charges,All Other,52.5,70,,52.5,percent of total billed charges,,118.48,,,118.48,Fee Schedule,,100.42,,,100.42,Fee Schedule,,37.5,,,37.5,Fee Schedule,,37.5,,,37.5,Fee Schedule,,37.5,,,37.5,Fee Schedule,,37.5,,,37.5,Fee Schedule,,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,16.59,,,16.59,Other,100% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,25.38,,,25.38,Other,153% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,23.22,,,23.22,Other,140% of Medicaid,37.32,,,37.32,Other,225% of Medicaid,43.13,,,43.13,Other,250% of Medicaid,53.74,,,53.74,Other,324% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,35.66,,,35.66,Other,215% of Medicaid,20.73,,,20.73,Other,125% of Medicaid,16.59,123.33,
URINALYSIS NONAUTO W/SCOPE,81000,CPT,,78081000,CDM,307,RC,,,both,,,29,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,12.1,,,12.1,Fee Schedule,,10.89,,,10.89,Fee Schedule,,24.39,,,24.39,Fee Schedule,,21.94,,,21.94,Fee Schedule,,20.74,,,20.74,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,All Other,12.66,,,12.66,Fee Schedule,,7,,,7,Other,186% of Medicaid,14.91,,,14.91,Fee Schedule,,17.98,,,17.98,Fee Schedule,,8.44,,,,Fee Schedule,,14.91,,,14.91,Fee Schedule,,17.98,,,17.98,Fee Schedule,,15.88,,,15.88,Fee Schedule,,20.3,70,,20.3,percent of total billed charges,,19.05,,,19.05,Fee Schedule,,16.15,,,16.15,Fee Schedule,,6.03,,,6.03,Fee Schedule,,6.03,,,6.03,Fee Schedule,,6.03,,,6.03,Fee Schedule,,6.03,,,6.03,Fee Schedule,,4,,,4,Other,100% of Medicaid,4,,,4,Other,100% of Medicaid,4,,,4,Other,100% of Medicaid,4,,,4,Other,100% of Medicaid,9,,,9,Other,225% of Medicaid,6.12,,,6.12,Other,153% of Medicaid,9,,,9,Other,225% of Medicaid,5.6,,,5.6,Other,140% of Medicaid,9,,,9,Other,225% of Medicaid,10.4,,,10.4,Other,250% of Medicaid,12.96,,,12.96,Other,324% of Medicaid,8.6,,,8.6,Other,215% of Medicaid,8.6,,,8.6,Other,215% of Medicaid,5,,,5,Other,125% of Medicaid,0.01,24.39,
URINALYSIS AUTO W/SCOPE,81001,CPT,,78081001,CDM,307,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,9.54,,,9.54,Fee Schedule,,8.59,,,8.59,Fee Schedule,,24.39,,,24.39,Fee Schedule,,21.94,,,21.94,Fee Schedule,,20.74,,,20.74,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,9.99,,,9.99,Fee Schedule,,6,,,6,Other,186% of Medicaid,11.76,,,11.76,Fee Schedule,,45.88,,,45.88,Fee Schedule,,6.66,,,,Fee Schedule,,11.76,,,11.76,Fee Schedule,,45.88,,,45.88,Fee Schedule,,12.52,,,12.52,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,15.02,,,15.02,Fee Schedule,,12.73,,,12.73,Fee Schedule,,4.76,,,4.76,Fee Schedule,,4.76,,,4.76,Fee Schedule,,4.76,,,4.76,Fee Schedule,,4.76,,,4.76,Fee Schedule,,3.17,,,3.17,Other,100% of Medicaid,3.17,,,3.17,Other,100% of Medicaid,3.17,,,3.17,Other,100% of Medicaid,3.17,,,3.17,Other,100% of Medicaid,7.13,,,7.13,Other,225% of Medicaid,4.85,,,4.85,Other,153% of Medicaid,7.13,,,7.13,Other,225% of Medicaid,4.44,,,4.44,Other,140% of Medicaid,7.13,,,7.13,Other,225% of Medicaid,8.24,,,8.24,Other,250% of Medicaid,10.27,,,10.27,Other,324% of Medicaid,6.82,,,6.82,Other,215% of Medicaid,6.82,,,6.82,Other,215% of Medicaid,3.96,,,3.96,Other,125% of Medicaid,0.01,51.8,
URINALYSIS NONAUTO W/O SCOPE,81002,CPT,,30081002,CDM,307,RC,,,both,,,35,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,10.47,,,10.47,Fee Schedule,,9.43,,,9.43,Fee Schedule,,19.73,,,19.73,Fee Schedule,,17.75,,,17.75,Fee Schedule,,16.78,,,16.78,Fee Schedule,,24.5,70,,24.5,percent of total billed charges,All Other,10.96,,,10.96,Fee Schedule,,4,,,4,Other,186% of Medicaid,12.91,,,12.91,Fee Schedule,,21.7,,,21.7,Fee Schedule,,7.31,,,,Fee Schedule,,12.91,,,12.91,Fee Schedule,,21.7,,,21.7,Fee Schedule,,13.75,,,13.75,Fee Schedule,,24.5,70,,24.5,percent of total billed charges,,16.49,,,16.49,Fee Schedule,,13.98,,,13.98,Fee Schedule,,5.22,,,5.22,Fee Schedule,,5.22,,,5.22,Fee Schedule,,5.22,,,5.22,Fee Schedule,,5.22,,,5.22,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,24.5,
URINALYSIS NONAUTO W/O SCOPE,81002,CPT,,78081002,CDM,307,RC,,,both,,,35,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,10.47,,,10.47,Fee Schedule,,9.43,,,9.43,Fee Schedule,,19.73,,,19.73,Fee Schedule,,17.75,,,17.75,Fee Schedule,,16.78,,,16.78,Fee Schedule,,24.5,70,,24.5,percent of total billed charges,All Other,10.96,,,10.96,Fee Schedule,,4,,,4,Other,186% of Medicaid,12.91,,,12.91,Fee Schedule,,21.7,,,21.7,Fee Schedule,,7.31,,,,Fee Schedule,,12.91,,,12.91,Fee Schedule,,21.7,,,21.7,Fee Schedule,,13.75,,,13.75,Fee Schedule,,24.5,70,,24.5,percent of total billed charges,,16.49,,,16.49,Fee Schedule,,13.98,,,13.98,Fee Schedule,,5.22,,,5.22,Fee Schedule,,5.22,,,5.22,Fee Schedule,,5.22,,,5.22,Fee Schedule,,5.22,,,5.22,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,24.5,
URINALYSIS NONAUTO W/O SCOPE,81002,CPT,,82081002,CDM,307,RC,,,both,,,35,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,10.47,,,10.47,Fee Schedule,,9.43,,,9.43,Fee Schedule,,19.73,,,19.73,Fee Schedule,,17.75,,,17.75,Fee Schedule,,16.78,,,16.78,Fee Schedule,,24.5,70,,24.5,percent of total billed charges,All Other,10.96,,,10.96,Fee Schedule,,4,,,4,Other,186% of Medicaid,12.91,,,12.91,Fee Schedule,,21.7,,,21.7,Fee Schedule,,7.31,,,,Fee Schedule,,12.91,,,12.91,Fee Schedule,,21.7,,,21.7,Fee Schedule,,13.75,,,13.75,Fee Schedule,,24.5,70,,24.5,percent of total billed charges,,16.49,,,16.49,Fee Schedule,,13.98,,,13.98,Fee Schedule,,5.22,,,5.22,Fee Schedule,,5.22,,,5.22,Fee Schedule,,5.22,,,5.22,Fee Schedule,,5.22,,,5.22,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,24.5,
URINALYSIS AUTO W/O SCOPE,81003,CPT,,30081003,CDM,307,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,6.77,,,6.77,Fee Schedule,,6.1,,,6.1,Fee Schedule,,17.32,,,17.32,Fee Schedule,,15.58,,,15.58,Fee Schedule,,14.73,,,14.73,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,7.09,,,7.09,Fee Schedule,,4,,,4,Other,186% of Medicaid,8.35,,,8.35,Fee Schedule,,25.42,,,25.42,Fee Schedule,,4.73,,,,Fee Schedule,,8.35,,,8.35,Fee Schedule,,25.42,,,25.42,Fee Schedule,,8.89,,,8.89,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,10.66,,,10.66,Fee Schedule,,9.04,,,9.04,Fee Schedule,,3.38,,,3.38,Fee Schedule,,3.38,,,3.38,Fee Schedule,,3.38,,,3.38,Fee Schedule,,3.38,,,3.38,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,28.7,
URINALYSIS AUTO W/O SCOPE,81003,CPT,,82081003,CDM,307,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,6.77,,,6.77,Fee Schedule,,6.1,,,6.1,Fee Schedule,,17.32,,,17.32,Fee Schedule,,15.58,,,15.58,Fee Schedule,,14.73,,,14.73,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,7.09,,,7.09,Fee Schedule,,4,,,4,Other,186% of Medicaid,8.35,,,8.35,Fee Schedule,,25.42,,,25.42,Fee Schedule,,4.73,,,,Fee Schedule,,8.35,,,8.35,Fee Schedule,,25.42,,,25.42,Fee Schedule,,8.89,,,8.89,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,10.66,,,10.66,Fee Schedule,,9.04,,,9.04,Fee Schedule,,3.38,,,3.38,Fee Schedule,,3.38,,,3.38,Fee Schedule,,3.38,,,3.38,Fee Schedule,,3.38,,,3.38,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,28.7,
URINALYSIS,81005,CPT,,78081005,CDM,307,RC,,,both,,,32,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6.53,,,6.53,Fee Schedule,,5.88,,,5.88,Fee Schedule,,16.71,,,16.71,Fee Schedule,,15.04,,,15.04,Fee Schedule,,14.21,,,14.21,Fee Schedule,,22.4,70,,22.4,percent of total billed charges,All Other,6.84,,,6.84,Fee Schedule,,32,,,32,Other,186% of Medicaid,8.05,,,8.05,Fee Schedule,,19.84,,,19.84,Fee Schedule,,4.56,,,,Fee Schedule,,8.05,,,8.05,Fee Schedule,,19.84,,,19.84,Fee Schedule,,8.57,,,8.57,Fee Schedule,,22.4,70,,22.4,percent of total billed charges,,10.28,,,10.28,Fee Schedule,,8.72,,,8.72,Fee Schedule,,3.26,,,3.26,Fee Schedule,,3.26,,,3.26,Fee Schedule,,3.26,,,3.26,Fee Schedule,,3.26,,,3.26,Fee Schedule,,17.41,,,17.41,Other,100% of Medicaid,17.41,,,17.41,Other,100% of Medicaid,17.41,,,17.41,Other,100% of Medicaid,17.41,,,17.41,Other,100% of Medicaid,39.16,,,39.16,Other,225% of Medicaid,26.63,,,26.63,Other,153% of Medicaid,39.16,,,39.16,Other,225% of Medicaid,24.37,,,24.37,Other,140% of Medicaid,39.16,,,39.16,Other,225% of Medicaid,45.25,,,45.25,Other,250% of Medicaid,56.39,,,56.39,Other,324% of Medicaid,37.42,,,37.42,Other,215% of Medicaid,37.42,,,37.42,Other,215% of Medicaid,21.76,,,21.76,Other,125% of Medicaid,0.01,56.39,
MICROSCOPIC EXAM OF URINE,81015,CPT,,78081015,CDM,307,RC,,,both,,,68,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,9.18,,,9.18,Fee Schedule,,8.27,,,8.27,Fee Schedule,,23.45,,,23.45,Fee Schedule,,21.1,,,21.1,Fee Schedule,,19.94,,,19.94,Fee Schedule,,47.6,70,,47.6,percent of total billed charges,All Other,9.61,,,9.61,Fee Schedule,,4,,,4,Other,186% of Medicaid,11.32,,,11.32,Fee Schedule,,42.16,,,42.16,Fee Schedule,,6.41,,,,Fee Schedule,,11.32,,,11.32,Fee Schedule,,42.16,,,42.16,Fee Schedule,,12.05,,,12.05,Fee Schedule,,47.6,70,,47.6,percent of total billed charges,,14.45,,,14.45,Fee Schedule,,12.25,,,12.25,Fee Schedule,,4.58,,,4.58,Fee Schedule,,4.58,,,4.58,Fee Schedule,,4.58,,,4.58,Fee Schedule,,4.58,,,4.58,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,47.6,
URINE PREGNANCY TEST,81025,CPT,,30081025,CDM,307,RC,,,both,,,57,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,25.92,,,25.92,Fee Schedule,,23.33,,,23.33,Fee Schedule,,48.77,,,48.77,Fee Schedule,,43.88,,,43.88,Fee Schedule,,41.47,,,41.47,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,All Other,27.12,,,27.12,Fee Schedule,,4,,,4,Other,186% of Medicaid,31.94,,,31.94,Fee Schedule,,35.34,,,35.34,Fee Schedule,,18.08,,,,Fee Schedule,,31.94,,,31.94,Fee Schedule,,35.34,,,35.34,Fee Schedule,,34.01,,,34.01,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,,40.8,,,40.8,Fee Schedule,,34.58,,,34.58,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,48.77,
URINE PREGNANCY VISUAL COLOR,81025,CPT,,34081025,CDM,307,RC,,,both,,,57,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,25.92,,,25.92,Fee Schedule,,23.33,,,23.33,Fee Schedule,,48.77,,,48.77,Fee Schedule,,43.88,,,43.88,Fee Schedule,,41.47,,,41.47,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,All Other,27.12,,,27.12,Fee Schedule,,4,,,4,Other,186% of Medicaid,31.94,,,31.94,Fee Schedule,,35.34,,,35.34,Fee Schedule,,18.08,,,,Fee Schedule,,31.94,,,31.94,Fee Schedule,,35.34,,,35.34,Fee Schedule,,34.01,,,34.01,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,,40.8,,,40.8,Fee Schedule,,34.58,,,34.58,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,48.77,
URINE PREGNANCY TEST,81025,CPT,,82081025,CDM,307,RC,,,both,,,57,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,25.92,,,25.92,Fee Schedule,,23.33,,,23.33,Fee Schedule,,48.77,,,48.77,Fee Schedule,,43.88,,,43.88,Fee Schedule,,41.47,,,41.47,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,All Other,27.12,,,27.12,Fee Schedule,,4,,,4,Other,186% of Medicaid,31.94,,,31.94,Fee Schedule,,35.34,,,35.34,Fee Schedule,,18.08,,,,Fee Schedule,,31.94,,,31.94,Fee Schedule,,35.34,,,35.34,Fee Schedule,,34.01,,,34.01,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,,40.8,,,40.8,Fee Schedule,,34.58,,,34.58,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,2.02,,,2.02,Other,100% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,3.09,,,3.09,Other,153% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,2.83,,,2.83,Other,140% of Medicaid,4.55,,,4.55,Other,225% of Medicaid,5.25,,,5.25,Other,250% of Medicaid,6.54,,,6.54,Other,324% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,4.34,,,4.34,Other,215% of Medicaid,2.53,,,2.53,Other,125% of Medicaid,0.01,48.77,
URINALYSIS VOLUME MEASURE,81050,CPT,,78081050,CDM,307,RC,,,both,,,12,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,10.96,,,10.96,Fee Schedule,,9.86,,,9.86,Fee Schedule,,23.13,,,23.13,Fee Schedule,,20.8,,,20.8,Fee Schedule,,19.67,,,19.67,Fee Schedule,,8.4,70,,8.4,percent of total billed charges,All Other,11.47,,,11.47,Fee Schedule,,32,,,32,Other,186% of Medicaid,13.5,,,13.5,Fee Schedule,,7.44,,,7.44,Fee Schedule,,7.64,,,,Fee Schedule,,13.5,,,13.5,Fee Schedule,,7.44,,,7.44,Fee Schedule,,14.38,,,14.38,Fee Schedule,,8.4,70,,8.4,percent of total billed charges,,17.25,,,17.25,Fee Schedule,,14.62,,,14.62,Fee Schedule,,5.46,,,5.46,Fee Schedule,,5.46,,,5.46,Fee Schedule,,5.46,,,5.46,Fee Schedule,,5.46,,,5.46,Fee Schedule,,17.41,,,17.41,Other,100% of Medicaid,17.41,,,17.41,Other,100% of Medicaid,17.41,,,17.41,Other,100% of Medicaid,17.41,,,17.41,Other,100% of Medicaid,39.16,,,39.16,Other,225% of Medicaid,26.63,,,26.63,Other,153% of Medicaid,39.16,,,39.16,Other,225% of Medicaid,24.37,,,24.37,Other,140% of Medicaid,39.16,,,39.16,Other,225% of Medicaid,45.25,,,45.25,Other,250% of Medicaid,56.39,,,56.39,Other,324% of Medicaid,37.42,,,37.42,Other,215% of Medicaid,37.42,,,37.42,Other,215% of Medicaid,21.76,,,21.76,Other,125% of Medicaid,0.01,56.39,
ROUTINE VENIPUNCTURE,36415,CPT,,26036415,CDM,309,RC,,,both,,,21,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,16.44,,,16.44,Fee Schedule,,14.79,,,14.79,Fee Schedule,,13.98,,,13.98,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,All Other,27.81,,,27.81,Fee Schedule,,75,,,75,Other,186% of Medicaid,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,18.54,,,,Fee Schedule,,32.76,,,32.76,Fee Schedule,,13.02,,,13.02,Fee Schedule,,34.88,,,34.88,Fee Schedule,,14.7,70,,14.7,percent of total billed charges,,14.22,,,14.22,Fee Schedule,,12.05,,,12.05,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,4.5,,,4.5,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
DRUG ASSAY VEDOLIZUMAB,80280,CPT,,78080280,CDM,309,RC,,,both,,,260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.1,,,116.1,Fee Schedule,,104.52,,,104.52,Fee Schedule,,30.86,,,30.86,Fee Schedule,,30.86,,,30.86,Fee Schedule,,30.86,,,30.86,Fee Schedule,,182,70,,182,percent of total billed charges,All Other,121.5,,,121.5,Fee Schedule,,20,,,20,Other,186% of Medicaid,143.09,,,143.09,Fee Schedule,,161.2,,,161.2,Fee Schedule,,81,,,,Fee Schedule,,143.09,,,143.09,Fee Schedule,,161.2,,,161.2,Fee Schedule,,152.35,,,152.35,Fee Schedule,,182,70,,182,percent of total billed charges,,182.78,,,182.78,Fee Schedule,,154.92,,,154.92,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,57.86,,,57.86,Fee Schedule,,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,10.61,,,10.61,Other,100% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,16.23,,,16.23,Other,153% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,14.85,,,14.85,Other,140% of Medicaid,23.86,,,23.86,Other,225% of Medicaid,27.57,,,27.57,Other,250% of Medicaid,34.36,,,34.36,Other,324% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,22.8,,,22.8,Other,215% of Medicaid,13.26,,,13.26,Other,125% of Medicaid,0.01,182.78,
ASSAY OF CATHEPSIN-D,82387,CPT,,78082387,CDM,309,RC,,,both,,,1042,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.36,,,54.36,Fee Schedule,,48.94,,,48.94,Fee Schedule,,132.07,,,132.07,Fee Schedule,,118.81,,,118.81,Fee Schedule,,112.31,,,112.31,Fee Schedule,,729.4,70,,729.4,percent of total billed charges,All Other,56.89,,,56.89,Fee Schedule,,33,,,33,Other,186% of Medicaid,67,,,67,Fee Schedule,,646.04,,,646.04,Fee Schedule,,37.93,,,,Fee Schedule,,67,,,67,Fee Schedule,,646.04,,,646.04,Fee Schedule,,71.34,,,71.34,Fee Schedule,,729.4,70,,729.4,percent of total billed charges,,85.59,,,85.59,Fee Schedule,,72.54,,,72.54,Fee Schedule,,27.09,,,27.09,Fee Schedule,,27.09,,,27.09,Fee Schedule,,27.09,,,27.09,Fee Schedule,,27.09,,,27.09,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,729.4,
CHEMILUMINESCENT ASSAY,82397,CPT,,78082397,CDM,309,RC,,,both,,,260,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,42.5,,,42.5,Fee Schedule,,38.27,,,38.27,Fee Schedule,,82.42,,,82.42,Fee Schedule,,74.15,,,74.15,Fee Schedule,,70.09,,,70.09,Fee Schedule,,182,70,,182,percent of total billed charges,All Other,44.48,,,44.48,Fee Schedule,,33,,,33,Other,186% of Medicaid,52.39,,,52.39,Fee Schedule,,161.2,,,161.2,Fee Schedule,,29.65,,,,Fee Schedule,,52.39,,,52.39,Fee Schedule,,161.2,,,161.2,Fee Schedule,,55.77,,,55.77,Fee Schedule,,182,70,,182,percent of total billed charges,,66.92,,,66.92,Fee Schedule,,56.71,,,56.71,Fee Schedule,,21.18,,,21.18,Fee Schedule,,21.18,,,21.18,Fee Schedule,,21.18,,,21.18,Fee Schedule,,21.18,,,21.18,Fee Schedule,,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,17.61,,,17.61,Other,100% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,26.94,,,26.94,Other,153% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,24.65,,,24.65,Other,140% of Medicaid,39.61,,,39.61,Other,225% of Medicaid,45.77,,,45.77,Other,250% of Medicaid,57.04,,,57.04,Other,324% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,37.85,,,37.85,Other,215% of Medicaid,22.01,,,22.01,Other,125% of Medicaid,0.01,182,
ASSAY OF IGE,82785,CPT,,78082785,CDM,309,RC,,,both,,,237,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,49.54,,,49.54,Fee Schedule,,44.61,,,44.61,Fee Schedule,,127.03,,,127.03,Fee Schedule,,114.28,,,114.28,Fee Schedule,,108.02,,,108.02,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,51.85,,,51.85,Fee Schedule,,23,,,23,Other,186% of Medicaid,61.07,,,61.07,Fee Schedule,,146.94,,,146.94,Fee Schedule,,34.57,,,,Fee Schedule,,61.07,,,61.07,Fee Schedule,,146.94,,,146.94,Fee Schedule,,65.02,,,65.02,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,78,,,78,Fee Schedule,,66.11,,,66.11,Fee Schedule,,24.69,,,24.69,Fee Schedule,,24.69,,,24.69,Fee Schedule,,24.69,,,24.69,Fee Schedule,,24.69,,,24.69,Fee Schedule,,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,12.63,,,12.63,Other,100% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,19.32,,,19.32,Other,153% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,28.41,,,28.41,Other,225% of Medicaid,32.83,,,32.83,Other,250% of Medicaid,40.91,,,40.91,Other,324% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,27.14,,,27.14,Other,215% of Medicaid,15.78,,,15.78,Other,125% of Medicaid,0.01,165.9,
ASSAY OF HOMOCYSTINE,83090,CPT,,78083090,CDM,309,RC,,,both,,,1113,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,53.94,,,53.94,Fee Schedule,,48.56,,,48.56,Fee Schedule,,130.1,,,130.1,Fee Schedule,,117.04,,,117.04,Fee Schedule,,110.63,,,110.63,Fee Schedule,,779.1,70,,779.1,percent of total billed charges,All Other,56.45,,,56.45,Fee Schedule,,33,,,33,Other,186% of Medicaid,66.48,,,66.48,Fee Schedule,,690.06,,,690.06,Fee Schedule,,37.63,,,,Fee Schedule,,66.48,,,66.48,Fee Schedule,,690.06,,,690.06,Fee Schedule,,70.78,,,70.78,Fee Schedule,,779.1,70,,779.1,percent of total billed charges,,84.92,,,84.92,Fee Schedule,,71.98,,,71.98,Fee Schedule,,26.88,,,26.88,Fee Schedule,,26.88,,,26.88,Fee Schedule,,26.88,,,26.88,Fee Schedule,,26.88,,,26.88,Fee Schedule,,17.92,,,17.92,Other,100% of Medicaid,17.92,,,17.92,Other,100% of Medicaid,17.92,,,17.92,Other,100% of Medicaid,17.92,,,17.92,Other,100% of Medicaid,40.32,,,40.32,Other,225% of Medicaid,27.42,,,27.42,Other,153% of Medicaid,40.32,,,40.32,Other,225% of Medicaid,25.09,,,25.09,Other,140% of Medicaid,40.32,,,40.32,Other,225% of Medicaid,46.59,,,46.59,Other,250% of Medicaid,58.06,,,58.06,Other,324% of Medicaid,38.53,,,38.53,Other,215% of Medicaid,38.53,,,38.53,Other,215% of Medicaid,22.4,,,22.4,Other,125% of Medicaid,0.01,779.1,
COMPLEMENT FIXATION EACH,86171,CPT,,78086171,CDM,309,RC,,,both,,,350,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.13,,,30.13,Fee Schedule,,27.13,,,27.13,Fee Schedule,,77.27,,,77.27,Fee Schedule,,69.51,,,69.51,Fee Schedule,,65.71,,,65.71,Fee Schedule,,245,70,,245,percent of total billed charges,All Other,31.53,,,31.53,Fee Schedule,,32,,,32,Other,186% of Medicaid,37.14,,,37.14,Fee Schedule,,217,,,217,Fee Schedule,,21.02,,,,Fee Schedule,,37.14,,,37.14,Fee Schedule,,217,,,217,Fee Schedule,,39.54,,,39.54,Fee Schedule,,245,70,,245,percent of total billed charges,,47.44,,,47.44,Fee Schedule,,40.21,,,40.21,Fee Schedule,,15.02,,,15.02,Fee Schedule,,15.02,,,15.02,Fee Schedule,,15.02,,,15.02,Fee Schedule,,15.02,,,15.02,Fee Schedule,,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,245,
IMMUNOASSAY TUMOR QUAL,86294,CPT,,78086294,CDM,309,RC,,,both,,,166,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.97,,,76.97,Fee Schedule,,69.29,,,69.29,Fee Schedule,,126.04,,,126.04,Fee Schedule,,113.39,,,113.39,Fee Schedule,,107.18,,,107.18,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,All Other,80.55,,,80.55,Fee Schedule,,15,,,15,Other,186% of Medicaid,94.86,,,94.86,Fee Schedule,,102.92,,,102.92,Fee Schedule,,53.7,,,,Fee Schedule,,94.86,,,94.86,Fee Schedule,,102.92,,,102.92,Fee Schedule,,101,,,101,Fee Schedule,,116.2,70,,116.2,percent of total billed charges,,121.18,,,121.18,Fee Schedule,,102.71,,,102.71,Fee Schedule,,38.36,,,38.36,Fee Schedule,,38.36,,,38.36,Fee Schedule,,38.36,,,38.36,Fee Schedule,,38.36,,,38.36,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,126.04,
OTHER IMMUNOELECTROPHORESIS,86325,CPT,,78086325,CDM,309,RC,,,both,,,327,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,69.62,,,69.62,Fee Schedule,,62.68,,,62.68,Fee Schedule,,172.4,,,172.4,Fee Schedule,,155.1,,,155.1,Fee Schedule,,146.6,,,146.6,Fee Schedule,,228.9,70,,228.9,percent of total billed charges,All Other,72.86,,,72.86,Fee Schedule,,43,,,43,Other,186% of Medicaid,85.81,,,85.81,Fee Schedule,,202.74,,,202.74,Fee Schedule,,48.57,,,,Fee Schedule,,85.81,,,85.81,Fee Schedule,,202.74,,,202.74,Fee Schedule,,91.36,,,91.36,Fee Schedule,,228.9,70,,228.9,percent of total billed charges,,109.61,,,109.61,Fee Schedule,,92.9,,,92.9,Fee Schedule,,34.7,,,34.7,Fee Schedule,,34.7,,,34.7,Fee Schedule,,34.7,,,34.7,Fee Schedule,,34.7,,,34.7,Fee Schedule,,23.13,,,23.13,Other,100% of Medicaid,23.13,,,23.13,Other,100% of Medicaid,23.13,,,23.13,Other,100% of Medicaid,23.13,,,23.13,Other,100% of Medicaid,52.04,,,52.04,Other,225% of Medicaid,35.39,,,35.39,Other,153% of Medicaid,52.04,,,52.04,Other,225% of Medicaid,32.38,,,32.38,Other,140% of Medicaid,52.04,,,52.04,Other,225% of Medicaid,60.14,,,60.14,Other,250% of Medicaid,74.94,,,74.94,Other,324% of Medicaid,49.73,,,49.73,Other,215% of Medicaid,49.73,,,49.73,Other,215% of Medicaid,28.91,,,28.91,Other,125% of Medicaid,0.01,228.9,
TRICHINELLA ANTIBODY,86784,CPT,,78086784,CDM,309,RC,,,both,,,284,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.81,,,37.81,Fee Schedule,,34.04,,,34.04,Fee Schedule,,44.83,,,44.83,Fee Schedule,,40.33,,,40.33,Fee Schedule,,38.12,,,38.12,Fee Schedule,,198.8,70,,198.8,percent of total billed charges,All Other,39.56,,,39.56,Fee Schedule,,15,,,15,Other,186% of Medicaid,46.6,,,46.6,Fee Schedule,,176.08,,,176.08,Fee Schedule,,26.38,,,,Fee Schedule,,46.6,,,46.6,Fee Schedule,,176.08,,,176.08,Fee Schedule,,49.61,,,49.61,Fee Schedule,,198.8,70,,198.8,percent of total billed charges,,59.52,,,59.52,Fee Schedule,,50.45,,,50.45,Fee Schedule,,18.84,,,18.84,Fee Schedule,,18.84,,,18.84,Fee Schedule,,18.84,,,18.84,Fee Schedule,,18.84,,,18.84,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,198.8,
COOMBS TEST INDIRECT TITER,86886,CPT,,78086886,CDM,309,RC,,,both,,,355,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Fee Schedule,,15.59,,,15.59,Fee Schedule,,14.04,,,14.04,Fee Schedule,,39.89,,,39.89,Fee Schedule,,35.89,,,35.89,Fee Schedule,,33.92,,,33.92,Fee Schedule,,248.5,70,,248.5,percent of total billed charges,All Other,16.32,,,16.32,Fee Schedule,,86,,,86,Other,186% of Medicaid,19.22,,,19.22,Fee Schedule,,220.1,,,220.1,Fee Schedule,,10.88,,,,Fee Schedule,,19.22,,,19.22,Fee Schedule,,220.1,,,220.1,Fee Schedule,,20.46,,,20.46,Fee Schedule,,248.5,70,,248.5,percent of total billed charges,,24.55,,,24.55,Fee Schedule,,20.81,,,20.81,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,7.77,,,7.77,Fee Schedule,,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,46.26,,,46.26,Other,100% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,64.76,,,64.76,Other,140% of Medicaid,104.08,,,104.08,Other,225% of Medicaid,120.27,,,120.27,Other,250% of Medicaid,149.87,,,149.87,Other,324% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,99.45,,,99.45,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,7.77,308.64,
BLOOD TYPING ABO,86900,CPT,,78086900,CDM,309,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Fee Schedule,,9,,,9,Fee Schedule,,8.1,,,8.1,Fee Schedule,,23.02,,,23.02,Fee Schedule,,20.71,,,20.71,Fee Schedule,,19.57,,,19.57,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,9.42,,,9.42,Fee Schedule,,6,,,6,Other,186% of Medicaid,11.09,,,11.09,Fee Schedule,,163.06,,,163.06,Fee Schedule,,6.28,,,,Fee Schedule,,11.09,,,11.09,Fee Schedule,,163.06,,,163.06,Fee Schedule,,11.81,,,11.81,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,,14.17,,,14.17,Fee Schedule,,12.01,,,12.01,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,4.49,,,4.49,Fee Schedule,,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,2.99,,,2.99,Other,100% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,4.57,,,4.57,Other,153% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,4.19,,,4.19,Other,140% of Medicaid,6.73,,,6.73,Other,225% of Medicaid,7.77,,,7.77,Other,250% of Medicaid,9.69,,,9.69,Other,324% of Medicaid,6.43,,,6.43,Other,215% of Medicaid,6.43,,,6.43,Other,215% of Medicaid,3.74,,,3.74,Other,125% of Medicaid,2.99,230.83,
COMPATIBILITY TEST ELECTRIC,86923,CPT,,78086923,CDM,309,RC,,,both,,,579,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,376.35,65,,376.35,percent of total billed charges,All Other,341.61,59,,341.61,percent of total billed charges,All Other,7.49,,,7.49,Fee Schedule,,7.49,,,7.49,Fee Schedule,,7.49,,,7.49,Fee Schedule,,405.3,70,,405.3,percent of total billed charges,All Other,393.72,68,,393.72,percent of total billed charges,All Other,86,,,86,Other,186% of Medicaid,480.57,80,,480.57,percent of total billed charges,All Other,358.98,83,,358.98,percent of total billed charges,All Other,318.45,83,,,percent of total billed charges,All Other,480.57,80,,480.57,percent of total billed charges,All Other,358.98,83,,358.98,percent of total billed charges,All Other,463.2,80,,463.2,percent of total billed charges,All Other,405.3,70,,405.3,percent of total billed charges,,376.35,65,,376.35,percent of total billed charges,All Other,376.35,65,,376.35,percent of total billed charges,All Other,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,46.25,,,46.25,Other,100% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,70.77,,,70.77,Other,153% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,64.75,,,64.75,Other,140% of Medicaid,104.07,,,104.07,Other,225% of Medicaid,120.26,,,120.26,Other,250% of Medicaid,149.86,,,149.86,Other,324% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,99.44,,,99.44,Other,215% of Medicaid,57.82,,,57.82,Other,125% of Medicaid,7.49,480.57,
HEMOLYSINS/AGGLUTININS AUTO,86940,CPT,,78086940,CDM,309,RC,,,both,,,63,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,26.4,,,26.4,Fee Schedule,,23.77,,,23.77,Fee Schedule,,63.24,,,63.24,Fee Schedule,,56.89,,,56.89,Fee Schedule,,53.78,,,53.78,Fee Schedule,,44.1,70,,44.1,percent of total billed charges,All Other,27.63,,,27.63,Fee Schedule,,13,,,13,Other,186% of Medicaid,32.54,,,32.54,Fee Schedule,,39.06,,,39.06,Fee Schedule,,18.42,,,,Fee Schedule,,32.54,,,32.54,Fee Schedule,,39.06,,,39.06,Fee Schedule,,34.64,,,34.64,Fee Schedule,,44.1,70,,44.1,percent of total billed charges,,41.56,,,41.56,Fee Schedule,,35.23,,,35.23,Fee Schedule,,13.16,,,13.16,Fee Schedule,,13.16,,,13.16,Fee Schedule,,13.16,,,13.16,Fee Schedule,,13.16,,,13.16,Fee Schedule,,7.21,,,7.21,Other,100% of Medicaid,7.21,,,7.21,Other,100% of Medicaid,7.21,,,7.21,Other,100% of Medicaid,7.21,,,7.21,Other,100% of Medicaid,16.23,,,16.23,Other,225% of Medicaid,11.03,,,11.03,Other,153% of Medicaid,16.23,,,16.23,Other,225% of Medicaid,10.1,,,10.1,Other,140% of Medicaid,16.23,,,16.23,Other,225% of Medicaid,18.75,,,18.75,Other,250% of Medicaid,23.36,,,23.36,Other,324% of Medicaid,15.5,,,15.5,Other,215% of Medicaid,15.5,,,15.5,Other,215% of Medicaid,9.01,,,9.01,Other,125% of Medicaid,0.01,63.24,
GIARDIA AG EIA,87329,CPT,,78087329,CDM,309,RC,,,both,,,173,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,121.1,70,,121.1,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,22,,,22,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,107.26,,,107.26,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,107.26,,,107.26,Fee Schedule,,47.32,,,47.32,Fee Schedule,,121.1,70,,121.1,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,11.98,,,11.98,Other,100% of Medicaid,11.98,,,11.98,Other,100% of Medicaid,11.98,,,11.98,Other,100% of Medicaid,11.98,,,11.98,Other,100% of Medicaid,26.96,,,26.96,Other,225% of Medicaid,18.33,,,18.33,Other,153% of Medicaid,26.96,,,26.96,Other,225% of Medicaid,16.77,,,16.77,Other,140% of Medicaid,26.96,,,26.96,Other,225% of Medicaid,31.15,,,31.15,Other,250% of Medicaid,38.82,,,38.82,Other,324% of Medicaid,25.76,,,25.76,Other,215% of Medicaid,25.76,,,25.76,Other,215% of Medicaid,14.98,,,14.98,Other,125% of Medicaid,0.01,121.1,
ROTAVIRUS AG EIA,87425,CPT,,78087425,CDM,309,RC,,,both,,,83,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,36.06,,,36.06,Fee Schedule,,32.47,,,32.47,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,All Other,37.74,,,37.74,Fee Schedule,,22,,,22,Other,186% of Medicaid,44.45,,,44.45,Fee Schedule,,51.46,,,51.46,Fee Schedule,,25.16,,,,Fee Schedule,,44.45,,,44.45,Fee Schedule,,51.46,,,51.46,Fee Schedule,,47.32,,,47.32,Fee Schedule,,58.1,70,,58.1,percent of total billed charges,,56.77,,,56.77,Fee Schedule,,48.12,,,48.12,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,17.97,,,17.97,Fee Schedule,,11.98,,,11.98,Other,100% of Medicaid,11.98,,,11.98,Other,100% of Medicaid,11.98,,,11.98,Other,100% of Medicaid,11.98,,,11.98,Other,100% of Medicaid,26.96,,,26.96,Other,225% of Medicaid,18.33,,,18.33,Other,153% of Medicaid,26.96,,,26.96,Other,225% of Medicaid,16.77,,,16.77,Other,140% of Medicaid,26.96,,,26.96,Other,225% of Medicaid,31.15,,,31.15,Other,250% of Medicaid,38.82,,,38.82,Other,324% of Medicaid,25.76,,,25.76,Other,215% of Medicaid,25.76,,,25.76,Other,215% of Medicaid,14.98,,,14.98,Other,125% of Medicaid,0.01,67.46,
LYME DIS DNA AMP PROBE,87476,CPT,,78087476,CDM,309,RC,,,both,,,961,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,105.62,,,105.62,Fee Schedule,,95.09,,,95.09,Fee Schedule,,270.66,,,270.66,Fee Schedule,,243.49,,,243.49,Fee Schedule,,230.16,,,230.16,Fee Schedule,,672.7,70,,672.7,percent of total billed charges,All Other,110.53,,,110.53,Fee Schedule,,40,,,40,Other,186% of Medicaid,130.18,,,130.18,Fee Schedule,,595.82,,,595.82,Fee Schedule,,73.69,,,,Fee Schedule,,130.18,,,130.18,Fee Schedule,,595.82,,,595.82,Fee Schedule,,138.61,,,138.61,Fee Schedule,,672.7,70,,672.7,percent of total billed charges,,166.29,,,166.29,Fee Schedule,,140.94,,,140.94,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,52.64,,,52.64,Fee Schedule,,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,21.64,,,21.64,Other,100% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,33.12,,,33.12,Other,153% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,30.3,,,30.3,Other,140% of Medicaid,48.7,,,48.7,Other,225% of Medicaid,56.28,,,56.28,Other,250% of Medicaid,70.13,,,70.13,Other,324% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,46.54,,,46.54,Other,215% of Medicaid,27.06,,,27.06,Other,125% of Medicaid,0.01,672.7,
HEPATITIS C RNA QUANT,87522,CPT,,78087522,CDM,309,RC,,,both,,,529,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,128.95,,,128.95,Fee Schedule,,116.1,,,116.1,Fee Schedule,,330.33,,,330.33,Fee Schedule,,297.18,,,297.18,Fee Schedule,,280.9,,,280.9,Fee Schedule,,370.3,70,,370.3,percent of total billed charges,All Other,134.95,,,134.95,Fee Schedule,,80,,,80,Other,186% of Medicaid,158.94,,,158.94,Fee Schedule,,327.98,,,327.98,Fee Schedule,,89.96,,,,Fee Schedule,,158.94,,,158.94,Fee Schedule,,327.98,,,327.98,Fee Schedule,,169.22,,,169.22,Fee Schedule,,370.3,70,,370.3,percent of total billed charges,,203.02,,,203.02,Fee Schedule,,172.07,,,172.07,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,64.26,,,64.26,Fee Schedule,,42.84,,,42.84,Other,100% of Medicaid,42.84,,,42.84,Other,100% of Medicaid,42.84,,,42.84,Other,100% of Medicaid,42.84,,,42.84,Other,100% of Medicaid,96.39,,,96.39,Other,225% of Medicaid,65.55,,,65.55,Other,153% of Medicaid,96.39,,,96.39,Other,225% of Medicaid,59.98,,,59.98,Other,140% of Medicaid,96.39,,,96.39,Other,225% of Medicaid,111.38,,,111.38,Other,250% of Medicaid,138.8,,,138.8,Other,324% of Medicaid,92.11,,,92.11,Other,215% of Medicaid,92.11,,,92.11,Other,215% of Medicaid,53.55,,,53.55,Other,125% of Medicaid,0.01,370.3,
AGENT NOS ASSAY W/OPTIC,87899,CPT,,78087899,CDM,309,RC,,,both,,,108,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,48.37,,,48.37,Fee Schedule,,43.55,,,43.55,Fee Schedule,,67.46,,,67.46,Fee Schedule,,60.69,,,60.69,Fee Schedule,,57.36,,,57.36,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,All Other,50.62,,,50.62,Fee Schedule,,15,,,15,Other,186% of Medicaid,59.62,,,59.62,Fee Schedule,,66.96,,,66.96,Fee Schedule,,33.75,,,,Fee Schedule,,59.62,,,59.62,Fee Schedule,,66.96,,,66.96,Fee Schedule,,63.48,,,63.48,Fee Schedule,,75.6,70,,75.6,percent of total billed charges,,76.16,,,76.16,Fee Schedule,,64.55,,,64.55,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,24.11,,,24.11,Fee Schedule,,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,8.11,,,8.11,Other,100% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,12.41,,,12.41,Other,153% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,11.35,,,11.35,Other,140% of Medicaid,18.25,,,18.25,Other,225% of Medicaid,21.09,,,21.09,Other,250% of Medicaid,26.28,,,26.28,Other,324% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,17.44,,,17.44,Other,215% of Medicaid,10.14,,,10.14,Other,125% of Medicaid,0.01,76.16,
BODY FLUID CELL COUNT,89051,CPT,,78089051,CDM,309,RC,,,both,,,74,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,16.86,,,16.86,Fee Schedule,,15.18,,,15.18,Fee Schedule,,33.1,,,33.1,Fee Schedule,,29.78,,,29.78,Fee Schedule,,28.15,,,28.15,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,All Other,17.64,,,17.64,Fee Schedule,,5,,,5,Other,186% of Medicaid,20.78,,,20.78,Fee Schedule,,45.88,,,45.88,Fee Schedule,,11.76,,,,Fee Schedule,,20.78,,,20.78,Fee Schedule,,45.88,,,45.88,Fee Schedule,,22.12,,,22.12,Fee Schedule,,51.8,70,,51.8,percent of total billed charges,,26.54,,,26.54,Fee Schedule,,22.49,,,22.49,Fee Schedule,,8.4,,,8.4,Fee Schedule,,8.4,,,8.4,Fee Schedule,,8.4,,,8.4,Fee Schedule,,8.4,,,8.4,Fee Schedule,,2.83,,,2.83,Other,100% of Medicaid,2.83,,,2.83,Other,100% of Medicaid,2.83,,,2.83,Other,100% of Medicaid,2.83,,,2.83,Other,100% of Medicaid,6.36,,,6.36,Other,225% of Medicaid,4.33,,,4.33,Other,153% of Medicaid,6.36,,,6.36,Other,225% of Medicaid,3.96,,,3.96,Other,140% of Medicaid,6.36,,,6.36,Other,225% of Medicaid,7.35,,,7.35,Other,250% of Medicaid,9.16,,,9.16,Other,324% of Medicaid,6.08,,,6.08,Other,215% of Medicaid,6.08,,,6.08,Other,215% of Medicaid,3.54,,,3.54,Other,125% of Medicaid,0.01,51.8,
EXAM SYNOVIAL FLUID CRYSTALS,89060,CPT,,78089060,CDM,309,RC,,,both,,,80,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,22.06,,,22.06,Fee Schedule,,19.86,,,19.86,Fee Schedule,,55.13,,,55.13,Fee Schedule,,49.6,,,49.6,Fee Schedule,,46.88,,,46.88,Fee Schedule,,56,70,,56,percent of total billed charges,All Other,23.09,,,23.09,Fee Schedule,,11,,,11,Other,186% of Medicaid,27.19,,,27.19,Fee Schedule,,49.6,,,49.6,Fee Schedule,,15.39,,,,Fee Schedule,,27.19,,,27.19,Fee Schedule,,49.6,,,49.6,Fee Schedule,,28.95,,,28.95,Fee Schedule,,56,70,,56,percent of total billed charges,,34.74,,,34.74,Fee Schedule,,29.44,,,29.44,Fee Schedule,,11,,,11,Fee Schedule,,11,,,11,Fee Schedule,,11,,,11,Fee Schedule,,11,,,11,Fee Schedule,,6.06,,,6.06,Other,100% of Medicaid,6.06,,,6.06,Other,100% of Medicaid,6.06,,,6.06,Other,100% of Medicaid,6.06,,,6.06,Other,100% of Medicaid,13.64,,,13.64,Other,225% of Medicaid,9.27,,,9.27,Other,153% of Medicaid,13.64,,,13.64,Other,225% of Medicaid,8.48,,,8.48,Other,140% of Medicaid,13.64,,,13.64,Other,225% of Medicaid,15.76,,,15.76,Other,250% of Medicaid,19.63,,,19.63,Other,324% of Medicaid,13.03,,,13.03,Other,215% of Medicaid,13.03,,,13.03,Other,215% of Medicaid,7.58,,,7.58,Other,125% of Medicaid,0.01,56,
SPECIMEN FAT STAIN,89125,CPT,,78089125,CDM,309,RC,,,both,,,31,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17.7,,,17.7,Fee Schedule,,15.93,,,15.93,Fee Schedule,,33.32,,,33.32,Fee Schedule,,29.97,,,29.97,Fee Schedule,,28.33,,,28.33,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,All Other,18.52,,,18.52,Fee Schedule,,79,,,79,Other,186% of Medicaid,21.81,,,21.81,Fee Schedule,,19.22,,,19.22,Fee Schedule,,12.35,,,,Fee Schedule,,21.81,,,21.81,Fee Schedule,,19.22,,,19.22,Fee Schedule,,23.23,,,23.23,Fee Schedule,,21.7,70,,21.7,percent of total billed charges,,27.87,,,27.87,Fee Schedule,,23.62,,,23.62,Fee Schedule,,8.82,,,8.82,Fee Schedule,,8.82,,,8.82,Fee Schedule,,8.82,,,8.82,Fee Schedule,,8.82,,,8.82,Fee Schedule,,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,65.16,,,65.16,Other,153% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,59.62,,,59.62,Other,140% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,110.72,,,110.72,Other,250% of Medicaid,137.98,,,137.98,Other,324% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,53.23,,,53.23,Other,125% of Medicaid,0.01,137.98,
NASAL SMEAR FOR EOSINOPHILS,89190,CPT,,78089190,CDM,309,RC,,,both,,,61,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,17.43,,,17.43,Fee Schedule,,15.69,,,15.69,Fee Schedule,,36.61,,,36.61,Fee Schedule,,32.93,,,32.93,Fee Schedule,,31.13,,,31.13,Fee Schedule,,42.7,70,,42.7,percent of total billed charges,All Other,18.24,,,18.24,Fee Schedule,,9,,,9,Other,186% of Medicaid,21.48,,,21.48,Fee Schedule,,37.82,,,37.82,Fee Schedule,,12.16,,,,Fee Schedule,,21.48,,,21.48,Fee Schedule,,37.82,,,37.82,Fee Schedule,,22.87,,,22.87,Fee Schedule,,42.7,70,,42.7,percent of total billed charges,,27.44,,,27.44,Fee Schedule,,23.26,,,23.26,Fee Schedule,,8.69,,,8.69,Fee Schedule,,8.69,,,8.69,Fee Schedule,,8.69,,,8.69,Fee Schedule,,8.69,,,8.69,Fee Schedule,,4.75,,,4.75,Other,100% of Medicaid,4.75,,,4.75,Other,100% of Medicaid,4.75,,,4.75,Other,100% of Medicaid,4.75,,,4.75,Other,100% of Medicaid,10.68,,,10.68,Other,225% of Medicaid,7.26,,,7.26,Other,153% of Medicaid,10.68,,,10.68,Other,225% of Medicaid,6.65,,,6.65,Other,140% of Medicaid,10.68,,,10.68,Other,225% of Medicaid,12.34,,,12.34,Other,250% of Medicaid,15.38,,,15.38,Other,324% of Medicaid,10.21,,,10.21,Other,215% of Medicaid,10.21,,,10.21,Other,215% of Medicaid,5.93,,,5.93,Other,125% of Medicaid,0.01,42.7,
COLLECT SWEAT FOR TEST,89230,CPT,,78089230,CDM,309,RC,,,both,,,161,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,9.96,,,9.96,Fee Schedule,,8.97,,,8.97,Fee Schedule,,21.54,,,21.54,Fee Schedule,,19.37,,,19.37,Fee Schedule,,18.31,,,18.31,Fee Schedule,,112.7,70,,112.7,percent of total billed charges,All Other,10.43,,,10.43,Fee Schedule,,12,,,12,Other,186% of Medicaid,12.28,,,12.28,Fee Schedule,,99.82,,,99.82,Fee Schedule,,6.95,,,,Fee Schedule,,12.28,,,12.28,Fee Schedule,,99.82,,,99.82,Fee Schedule,,13.07,,,13.07,Fee Schedule,,112.7,70,,112.7,percent of total billed charges,,11.48,,,11.48,Fee Schedule,,9.73,,,9.73,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,6.44,,,6.44,Other,100% of Medicaid,6.44,,,6.44,Other,100% of Medicaid,6.44,,,6.44,Other,100% of Medicaid,6.44,,,6.44,Other,100% of Medicaid,14.5,,,14.5,Other,225% of Medicaid,9.86,,,9.86,Other,153% of Medicaid,14.5,,,14.5,Other,225% of Medicaid,9.02,,,9.02,Other,140% of Medicaid,14.5,,,14.5,Other,225% of Medicaid,16.75,,,16.75,Other,250% of Medicaid,20.88,,,20.88,Other,324% of Medicaid,13.85,,,13.85,Other,215% of Medicaid,13.85,,,13.85,Other,215% of Medicaid,8.05,,,8.05,Other,125% of Medicaid,6.44,112.7,
SEMEN; PRESENCE & MOTILITY,89300,CPT,,78089300,CDM,309,RC,,,both,,,174,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,29.62,,,29.62,Fee Schedule,,26.67,,,26.67,Fee Schedule,,68.77,,,68.77,Fee Schedule,,61.87,,,61.87,Fee Schedule,,58.48,,,58.48,Fee Schedule,,121.8,70,,121.8,percent of total billed charges,All Other,31,,,31,Fee Schedule,,79,,,79,Other,186% of Medicaid,36.51,,,36.51,Fee Schedule,,107.88,,,107.88,Fee Schedule,,20.66,,,,Fee Schedule,,36.51,,,36.51,Fee Schedule,,107.88,,,107.88,Fee Schedule,,38.87,,,38.87,Fee Schedule,,121.8,70,,121.8,percent of total billed charges,,46.63,,,46.63,Fee Schedule,,39.52,,,39.52,Fee Schedule,,14.76,,,14.76,Fee Schedule,,14.76,,,14.76,Fee Schedule,,14.76,,,14.76,Fee Schedule,,14.76,,,14.76,Fee Schedule,,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,65.16,,,65.16,Other,153% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,59.62,,,59.62,Other,140% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,110.72,,,110.72,Other,250% of Medicaid,137.98,,,137.98,Other,324% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,53.23,,,53.23,Other,125% of Medicaid,0.01,137.98,
SEMEN; MOTILITY & COUNT,89310,CPT,,78089310,CDM,309,RC,,,both,,,123,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,25.92,,,25.92,Fee Schedule,,23.33,,,23.33,Fee Schedule,,66.36,,,66.36,Fee Schedule,,59.7,,,59.7,Fee Schedule,,56.43,,,56.43,Fee Schedule,,86.1,70,,86.1,percent of total billed charges,All Other,27.12,,,27.12,Fee Schedule,,79,,,79,Other,186% of Medicaid,31.94,,,31.94,Fee Schedule,,76.26,,,76.26,Fee Schedule,,18.08,,,,Fee Schedule,,31.94,,,31.94,Fee Schedule,,76.26,,,76.26,Fee Schedule,,34.01,,,34.01,Fee Schedule,,86.1,70,,86.1,percent of total billed charges,,40.8,,,40.8,Fee Schedule,,34.58,,,34.58,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,12.92,,,12.92,Fee Schedule,,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,65.16,,,65.16,Other,153% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,59.62,,,59.62,Other,140% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,110.72,,,110.72,Other,250% of Medicaid,137.98,,,137.98,Other,324% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,53.23,,,53.23,Other,125% of Medicaid,0.01,137.98,
SEMEN ANALYSIS VOL/COUNT/MOT,89320,CPT,,78089320,CDM,309,RC,,,both,,,225,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.05,,,37.05,Fee Schedule,,33.36,,,33.36,Fee Schedule,,92.94,,,92.94,Fee Schedule,,83.61,,,83.61,Fee Schedule,,79.03,,,79.03,Fee Schedule,,157.5,70,,157.5,percent of total billed charges,All Other,38.78,,,38.78,Fee Schedule,,79,,,79,Other,186% of Medicaid,45.67,,,45.67,Fee Schedule,,139.5,,,139.5,Fee Schedule,,25.85,,,,Fee Schedule,,45.67,,,45.67,Fee Schedule,,139.5,,,139.5,Fee Schedule,,48.62,,,48.62,Fee Schedule,,157.5,70,,157.5,percent of total billed charges,,58.34,,,58.34,Fee Schedule,,49.44,,,49.44,Fee Schedule,,18.47,,,18.47,Fee Schedule,,18.47,,,18.47,Fee Schedule,,18.47,,,18.47,Fee Schedule,,18.47,,,18.47,Fee Schedule,,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,65.16,,,65.16,Other,153% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,59.62,,,59.62,Other,140% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,110.72,,,110.72,Other,250% of Medicaid,137.98,,,137.98,Other,324% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,53.23,,,53.23,Other,125% of Medicaid,0.01,157.5,
SPECIMEN HANDLING PT-LAB,99001,CPT,,78099001,CDM,309,RC,,,both,,,57,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,37.05,65,,37.05,percent of total billed charges,All Other,33.63,59,,33.63,percent of total billed charges,All Other,5.68,,,5.68,Fee Schedule,,5.68,,,5.68,Fee Schedule,,5.68,,,5.68,Fee Schedule,,39.9,70,,39.9,percent of total billed charges,All Other,38.76,68,,38.76,percent of total billed charges,All Other,75,,,75,Other,186% of Medicaid,47.31,80,,47.31,percent of total billed charges,All Other,35.34,83,,35.34,percent of total billed charges,All Other,31.35,83,,,percent of total billed charges,All Other,47.31,80,,47.31,percent of total billed charges,All Other,35.34,83,,35.34,percent of total billed charges,All Other,45.6,80,,45.6,percent of total billed charges,All Other,39.9,70,,39.9,percent of total billed charges,,37.05,65,,37.05,percent of total billed charges,All Other,37.05,65,,37.05,percent of total billed charges,All Other,9.21,,,9.21,Fee Schedule,,9.21,,,9.21,Fee Schedule,,9.21,,,9.21,Fee Schedule,,9.21,,,9.21,Fee Schedule,,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
TRAVL 1 WAY NEC LAB SPEC TRIP,P9604,HCPCS,,78000009,CDM,309,RC,,,both,,,47,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,30.55,65,,30.55,percent of total billed charges,All Other,27.73,59,,27.73,percent of total billed charges,All Other,3,,,3,Fee Schedule,,3,,,3,Fee Schedule,,3,,,3,Fee Schedule,,32.9,70,,32.9,percent of total billed charges,All Other,31.96,68,,31.96,percent of total billed charges,All Other,18,,,18,Other,186% of Medicaid,39.01,80,,39.01,percent of total billed charges,All Other,29.14,83,,29.14,percent of total billed charges,All Other,25.85,83,,,percent of total billed charges,All Other,39.01,80,,39.01,percent of total billed charges,All Other,29.14,83,,29.14,percent of total billed charges,All Other,37.6,80,,37.6,percent of total billed charges,All Other,32.9,70,,32.9,percent of total billed charges,,30.55,65,,30.55,percent of total billed charges,All Other,30.55,65,,30.55,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,9.44,,,9.44,Other,100% of Medicaid,9.44,,,9.44,Other,100% of Medicaid,9.44,,,9.44,Other,100% of Medicaid,9.44,,,9.44,Other,100% of Medicaid,21.25,,,21.25,Other,225% of Medicaid,14.45,,,14.45,Other,153% of Medicaid,21.25,,,21.25,Other,225% of Medicaid,13.22,,,13.22,Other,140% of Medicaid,21.25,,,21.25,Other,225% of Medicaid,24.55,,,24.55,Other,250% of Medicaid,30.6,,,30.6,Other,324% of Medicaid,20.3,,,20.3,Other,215% of Medicaid,20.3,,,20.3,Other,215% of Medicaid,11.8,,,11.8,Other,125% of Medicaid,0.01,39.01,
PATH CLIN CONSLT SF 5-20,80503,CPT,,78080503,CDM,310,RC,,,both,,,194,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,68.63,,,68.63,Fee Schedule,,61.79,,,61.79,Fee Schedule,,24.78,,,24.78,Fee Schedule,,24.78,,,24.78,Fee Schedule,,24.78,,,24.78,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,All Other,71.82,,,71.82,Fee Schedule,,30,,,30,Other,186% of Medicaid,84.59,,,84.59,Fee Schedule,,120.28,,,120.28,Fee Schedule,,47.88,,,,Fee Schedule,,84.59,,,84.59,Fee Schedule,,120.28,,,120.28,Fee Schedule,,90.06,,,90.06,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,,106.6,,,106.6,Fee Schedule,,90.35,,,90.35,Fee Schedule,,76.13,,,76.13,Fee Schedule,,76.13,,,76.13,Fee Schedule,,76.13,,,76.13,Fee Schedule,,76.13,,,76.13,Fee Schedule,,16.15,,,16.15,Other,100% of Medicaid,16.15,,,16.15,Other,100% of Medicaid,16.15,,,16.15,Other,100% of Medicaid,16.15,,,16.15,Other,100% of Medicaid,36.34,,,36.34,Other,225% of Medicaid,24.71,,,24.71,Other,153% of Medicaid,36.34,,,36.34,Other,225% of Medicaid,22.61,,,22.61,Other,140% of Medicaid,36.34,,,36.34,Other,225% of Medicaid,41.99,,,41.99,Other,250% of Medicaid,52.33,,,52.33,Other,324% of Medicaid,34.72,,,34.72,Other,215% of Medicaid,34.72,,,34.72,Other,215% of Medicaid,20.19,,,20.19,Other,125% of Medicaid,16.15,135.8,
MOPATH PROCEDURE LEVEL 8,81407,CPT,,78081407,CDM,310,RC,,,both,,,2666,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,2547.27,,,2547.27,Fee Schedule,,2293.39,,,2293.39,Fee Schedule,,846.27,,,846.27,Fee Schedule,,846.27,,,846.27,Fee Schedule,,846.27,,,846.27,Fee Schedule,,1866.2,70,,1866.2,percent of total billed charges,All Other,2665.75,,,2665.75,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,3139.66,,,3139.66,Fee Schedule,,1652.92,,,1652.92,Fee Schedule,,1777.17,,,,Fee Schedule,,3139.66,,,3139.66,Fee Schedule,,1652.92,,,1652.92,Fee Schedule,,3342.77,,,3342.77,Fee Schedule,,1866.2,70,,1866.2,percent of total billed charges,,4010.5,,,4010.5,Fee Schedule,,3399.15,,,3399.15,Fee Schedule,,1269.41,,,1269.41,Fee Schedule,,1269.41,,,1269.41,Fee Schedule,,1269.41,,,1269.41,Fee Schedule,,1269.41,,,1269.41,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4010.5,
FETAL CHRMOML ANEUPLOIDY,81420,CPT,,78081420,CDM,310,RC,,,both,,,2392,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,2284.74,,,2284.74,Fee Schedule,,2057.03,,,2057.03,Fee Schedule,,700,,,700,Fee Schedule,,700,,,700,Fee Schedule,,700,,,700,Fee Schedule,,1674.4,70,,1674.4,percent of total billed charges,All Other,2391.01,,,2391.01,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,2816.08,,,2816.08,Fee Schedule,,1483.04,,,1483.04,Fee Schedule,,1594.01,,,,Fee Schedule,,2816.08,,,2816.08,Fee Schedule,,1483.04,,,1483.04,Fee Schedule,,2998.25,,,2998.25,Fee Schedule,,1674.4,70,,1674.4,percent of total billed charges,,3597.16,,,3597.16,Fee Schedule,,3048.82,,,3048.82,Fee Schedule,,1138.58,,,1138.58,Fee Schedule,,1138.58,,,1138.58,Fee Schedule,,1138.58,,,1138.58,Fee Schedule,,1138.58,,,1138.58,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3597.16,
NOONAN SPECTRUM DISORDERS,81442,CPT,,78081442,CDM,310,RC,,,both,,,4818,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,6452.24,,,6452.24,Fee Schedule,,5809.16,,,5809.16,Fee Schedule,,1071.8,,,1071.8,Fee Schedule,,1071.8,,,1071.8,Fee Schedule,,1071.8,,,1071.8,Fee Schedule,,3372.6,70,,3372.6,percent of total billed charges,All Other,6752.34,,,6752.34,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,7952.76,,,7952.76,Fee Schedule,,2987.16,,,2987.16,Fee Schedule,,4501.56,,,,Fee Schedule,,7952.76,,,7952.76,Fee Schedule,,2987.16,,,2987.16,Fee Schedule,,8467.22,,,8467.22,Fee Schedule,,3372.6,70,,3372.6,percent of total billed charges,,10158.6,,,10158.6,Fee Schedule,,8610.03,,,8610.03,Fee Schedule,,3215.4,,,3215.4,Fee Schedule,,3215.4,,,3215.4,Fee Schedule,,3215.4,,,3215.4,Fee Schedule,,3215.4,,,3215.4,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,10158.6,
TARGETED GENOMIC SEQ ANALYS,81450,CPT,TC,85181450,CDM,310,RC,,,both,,,1596,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,2286.19,,,2286.19,Fee Schedule,,2058.33,,,2058.33,Fee Schedule,,846.27,,,846.27,Fee Schedule,,846.27,,,846.27,Fee Schedule,,846.27,,,846.27,Fee Schedule,,1117.2,70,,1117.2,percent of total billed charges,All Other,2392.52,,,2392.52,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,2817.86,,,2817.86,Fee Schedule,,989.52,,,989.52,Fee Schedule,,1595.01,,,,Fee Schedule,,2817.86,,,2817.86,Fee Schedule,,989.52,,,989.52,Fee Schedule,,3000.14,,,3000.14,Fee Schedule,,1117.2,70,,1117.2,percent of total billed charges,,3599.44,,,3599.44,Fee Schedule,,3050.74,,,3050.74,Fee Schedule,,1139.3,,,1139.3,Fee Schedule,,1139.3,,,1139.3,Fee Schedule,,1139.3,,,1139.3,Fee Schedule,,1139.3,,,1139.3,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3599.44,
ONC BRST MRNA 70 CNT 31 GENE,81523,CPT,,78081523,CDM,310,RC,,,both,,,12200,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,11657.73,,,11657.73,Fee Schedule,,10495.83,,,10495.83,Fee Schedule,,3873,,,3873,Fee Schedule,,3873,,,3873,Fee Schedule,,3873,,,3873,Fee Schedule,,8540,70,,8540,percent of total billed charges,All Other,12199.95,,,12199.95,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,14368.83,,,14368.83,Fee Schedule,,7564,,,7564,Fee Schedule,,8133.3,,,,Fee Schedule,,14368.83,,,14368.83,Fee Schedule,,7564,,,7564,Fee Schedule,,15298.35,,,15298.35,Fee Schedule,,8540,70,,8540,percent of total billed charges,,18354.28,,,18354.28,Fee Schedule,,15556.37,,,15556.37,Fee Schedule,,5809.5,,,5809.5,Fee Schedule,,5809.5,,,5809.5,Fee Schedule,,5809.5,,,5809.5,Fee Schedule,,5809.5,,,5809.5,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,18354.28,
NFCT DS CHRNC HCV 6 ASSAYS,81596,CPT,,78081596,CDM,310,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,217.29,,,217.29,Fee Schedule,,195.63,,,195.63,Fee Schedule,,72.19,,,72.19,Fee Schedule,,72.19,,,72.19,Fee Schedule,,72.19,,,72.19,Fee Schedule,,159.6,70,,159.6,percent of total billed charges,All Other,227.4,,,227.4,Fee Schedule,,108,,,108,Other,186% of Medicaid,267.82,,,267.82,Fee Schedule,,141.36,,,141.36,Fee Schedule,,151.6,,,,Fee Schedule,,267.82,,,267.82,Fee Schedule,,141.36,,,141.36,Fee Schedule,,285.15,,,285.15,Fee Schedule,,159.6,70,,159.6,percent of total billed charges,,342.11,,,342.11,Fee Schedule,,289.96,,,289.96,Fee Schedule,,108.29,,,108.29,Fee Schedule,,108.29,,,108.29,Fee Schedule,,108.29,,,108.29,Fee Schedule,,108.29,,,108.29,Fee Schedule,,58.33,,,58.33,Other,100% of Medicaid,58.33,,,58.33,Other,100% of Medicaid,58.33,,,58.33,Other,100% of Medicaid,58.33,,,58.33,Other,100% of Medicaid,131.24,,,131.24,Other,225% of Medicaid,89.24,,,89.24,Other,153% of Medicaid,131.24,,,131.24,Other,225% of Medicaid,81.66,,,81.66,Other,140% of Medicaid,131.24,,,131.24,Other,225% of Medicaid,151.65,,,151.65,Other,250% of Medicaid,188.98,,,188.98,Other,324% of Medicaid,125.4,,,125.4,Other,215% of Medicaid,125.4,,,125.4,Other,215% of Medicaid,72.91,,,72.91,Other,125% of Medicaid,0.01,342.11,
BONE MARROW INTERPRETATION,85097,CPT,,78085097,CDM,310,RC,,,both,,,1749,1553.82,,,1553.82,Other,150% of Medicare + 9.63% HCRA Surcharge,944.89,,,944.89,Other,Medicare OPPS,148.93,,,148.93,Fee Schedule,,134.09,,,134.09,Fee Schedule,,560.28,,,560.28,Fee Schedule,,504.04,,,504.04,Fee Schedule,,476.44,,,476.44,Fee Schedule,,1224.3,70,,1224.3,percent of total billed charges,All Other,155.86,,,155.86,Fee Schedule,,38,,,38,Other,186% of Medicaid,183.57,,,183.57,Fee Schedule,,1084.38,,,1084.38,Fee Schedule,,103.91,,,,Fee Schedule,,183.57,,,183.57,Fee Schedule,,1084.38,,,1084.38,Fee Schedule,,195.45,,,195.45,Fee Schedule,,1224.3,70,,1224.3,percent of total billed charges,,229.6,,,229.6,Fee Schedule,,194.6,,,194.6,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,20.42,,,20.42,Other,100% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,31.25,,,31.25,Other,153% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,28.59,,,28.59,Other,140% of Medicaid,45.95,,,45.95,Other,225% of Medicaid,53.1,,,53.1,Other,250% of Medicaid,66.17,,,66.17,Other,324% of Medicaid,43.91,,,43.91,Other,215% of Medicaid,43.91,,,43.91,Other,215% of Medicaid,25.53,,,25.53,Other,125% of Medicaid,20.42,1553.82,
CYTP URNE 3-5 PROBES EA SPEC,88120,CPT,,78088120,CDM,310,RC,,,both,,,2695,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,1712.99,,,1712.99,Fee Schedule,,1542.26,,,1542.26,Fee Schedule,,2829.54,,,2829.54,Fee Schedule,,2545.56,,,2545.56,Fee Schedule,,2406.14,,,2406.14,Fee Schedule,,1886.5,70,,1886.5,percent of total billed charges,All Other,1792.67,,,1792.67,Fee Schedule,,334,,,334,Other,186% of Medicaid,2111.36,,,2111.36,Fee Schedule,,1670.9,,,1670.9,Fee Schedule,,1195.11,,,,Fee Schedule,,2111.36,,,2111.36,Fee Schedule,,1670.9,,,1670.9,Fee Schedule,,2247.95,,,2247.95,Fee Schedule,,1886.5,70,,1886.5,percent of total billed charges,,2712.56,,,2712.56,Fee Schedule,,2299.06,,,2299.06,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,403.6,,,403.6,Other,225% of Medicaid,274.45,,,274.45,Other,153% of Medicaid,403.6,,,403.6,Other,225% of Medicaid,251.13,,,251.13,Other,140% of Medicaid,403.6,,,403.6,Other,225% of Medicaid,466.38,,,466.38,Other,250% of Medicaid,581.18,,,581.18,Other,324% of Medicaid,385.66,,,385.66,Other,215% of Medicaid,385.66,,,385.66,Other,215% of Medicaid,224.22,,,224.22,Other,125% of Medicaid,179.38,2829.54,
CYTOPATH C/V AUTO FLUID REDO,88175,CPT,,78088175,CDM,310,RC,,,both,,,159,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,80.1,,,80.1,Fee Schedule,,72.11,,,72.11,Fee Schedule,,192.13,,,192.13,Fee Schedule,,172.85,,,172.85,Fee Schedule,,163.38,,,163.38,Fee Schedule,,111.3,70,,111.3,percent of total billed charges,All Other,83.82,,,83.82,Fee Schedule,,49,,,49,Other,186% of Medicaid,98.72,,,98.72,Fee Schedule,,98.58,,,98.58,Fee Schedule,,55.88,,,,Fee Schedule,,98.72,,,98.72,Fee Schedule,,98.58,,,98.58,Fee Schedule,,105.11,,,105.11,Fee Schedule,,111.3,70,,111.3,percent of total billed charges,,126.11,,,126.11,Fee Schedule,,106.88,,,106.88,Fee Schedule,,39.92,,,39.92,Fee Schedule,,39.92,,,39.92,Fee Schedule,,39.92,,,39.92,Fee Schedule,,39.92,,,39.92,Fee Schedule,,26.61,,,26.61,Other,100% of Medicaid,26.61,,,26.61,Other,100% of Medicaid,26.61,,,26.61,Other,100% of Medicaid,26.61,,,26.61,Other,100% of Medicaid,59.87,,,59.87,Other,225% of Medicaid,40.71,,,40.71,Other,153% of Medicaid,59.87,,,59.87,Other,225% of Medicaid,37.25,,,37.25,Other,140% of Medicaid,59.87,,,59.87,Other,225% of Medicaid,69.19,,,69.19,Other,250% of Medicaid,86.22,,,86.22,Other,324% of Medicaid,57.21,,,57.21,Other,215% of Medicaid,57.21,,,57.21,Other,215% of Medicaid,33.26,,,33.26,Other,125% of Medicaid,0.01,192.13,
TISSUE CULTURE PLACENTA,88235,CPT,,78088235,CDM,310,RC,,,both,,,961,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,452.4,,,452.4,Fee Schedule,,407.31,,,407.31,Fee Schedule,,198.32,,,198.32,Fee Schedule,,178.42,,,178.42,Fee Schedule,,168.65,,,168.65,Fee Schedule,,672.7,70,,672.7,percent of total billed charges,All Other,473.45,,,473.45,Fee Schedule,,248,,,248,Other,186% of Medicaid,557.61,,,557.61,Fee Schedule,,595.82,,,595.82,Fee Schedule,,315.63,,,,Fee Schedule,,557.61,,,557.61,Fee Schedule,,595.82,,,595.82,Fee Schedule,,593.69,,,593.69,Fee Schedule,,672.7,70,,672.7,percent of total billed charges,,712.28,,,712.28,Fee Schedule,,603.7,,,603.7,Fee Schedule,,225.45,,,225.45,Fee Schedule,,225.45,,,225.45,Fee Schedule,,225.45,,,225.45,Fee Schedule,,225.45,,,225.45,Fee Schedule,,133.23,,,133.23,Other,100% of Medicaid,133.23,,,133.23,Other,100% of Medicaid,133.23,,,133.23,Other,100% of Medicaid,133.23,,,133.23,Other,100% of Medicaid,299.77,,,299.77,Other,225% of Medicaid,203.84,,,203.84,Other,153% of Medicaid,299.77,,,299.77,Other,225% of Medicaid,186.52,,,186.52,Other,140% of Medicaid,299.77,,,299.77,Other,225% of Medicaid,346.4,,,346.4,Other,250% of Medicaid,431.66,,,431.66,Other,324% of Medicaid,286.44,,,286.44,Other,215% of Medicaid,286.44,,,286.44,Other,215% of Medicaid,166.54,,,166.54,Other,125% of Medicaid,0.01,712.28,
CHROMOSOME ANALYSIS 20-25,88264,CPT,,78088264,CDM,310,RC,,,both,,,1316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,435.28,,,435.28,Fee Schedule,,391.89,,,391.89,Fee Schedule,,961.19,,,961.19,Fee Schedule,,864.72,,,864.72,Fee Schedule,,817.36,,,817.36,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,All Other,455.52,,,455.52,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,536.5,,,536.5,Fee Schedule,,815.92,,,815.92,Fee Schedule,,303.68,,,,Fee Schedule,,536.5,,,536.5,Fee Schedule,,815.92,,,815.92,Fee Schedule,,571.21,,,571.21,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,,685.31,,,685.31,Fee Schedule,,580.84,,,580.84,Fee Schedule,,216.92,,,216.92,Fee Schedule,,216.92,,,216.92,Fee Schedule,,216.92,,,216.92,Fee Schedule,,216.92,,,216.92,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,961.19,
CHROMOSOME ANALYS PLACENTA,88267,CPT,,78088267,CDM,310,RC,,,both,,,1316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,567.6,,,567.6,Fee Schedule,,511.02,,,511.02,Fee Schedule,,1386.33,,,1386.33,Fee Schedule,,1247.19,,,1247.19,Fee Schedule,,1178.89,,,1178.89,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,All Other,594,,,594,Fee Schedule,,169,,,169,Other,186% of Medicaid,699.59,,,699.59,Fee Schedule,,815.92,,,815.92,Fee Schedule,,396,,,,Fee Schedule,,699.59,,,699.59,Fee Schedule,,815.92,,,815.92,Fee Schedule,,744.85,,,744.85,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,,893.64,,,893.64,Fee Schedule,,757.41,,,757.41,Fee Schedule,,282.86,,,282.86,Fee Schedule,,282.86,,,282.86,Fee Schedule,,282.86,,,282.86,Fee Schedule,,282.86,,,282.86,Fee Schedule,,90.9,,,90.9,Other,100% of Medicaid,90.9,,,90.9,Other,100% of Medicaid,90.9,,,90.9,Other,100% of Medicaid,90.9,,,90.9,Other,100% of Medicaid,204.53,,,204.53,Other,225% of Medicaid,139.08,,,139.08,Other,153% of Medicaid,204.53,,,204.53,Other,225% of Medicaid,127.26,,,127.26,Other,140% of Medicaid,204.53,,,204.53,Other,225% of Medicaid,236.34,,,236.34,Other,250% of Medicaid,294.52,,,294.52,Other,324% of Medicaid,195.44,,,195.44,Other,215% of Medicaid,195.44,,,195.44,Other,215% of Medicaid,113.63,,,113.63,Other,125% of Medicaid,0.01,1386.33,
CHROMOSOME KARYOTYPE STUDY,88280,CPT,,78088280,CDM,310,RC,,,both,,,206,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,100.74,,,100.74,Fee Schedule,,90.7,,,90.7,Fee Schedule,,193.55,,,193.55,Fee Schedule,,174.13,,,174.13,Fee Schedule,,164.59,,,164.59,Fee Schedule,,144.2,70,,144.2,percent of total billed charges,All Other,105.43,,,105.43,Fee Schedule,,19,,,19,Other,186% of Medicaid,124.17,,,124.17,Fee Schedule,,127.72,,,127.72,Fee Schedule,,70.29,,,,Fee Schedule,,124.17,,,124.17,Fee Schedule,,127.72,,,127.72,Fee Schedule,,132.21,,,132.21,Fee Schedule,,144.2,70,,144.2,percent of total billed charges,,158.62,,,158.62,Fee Schedule,,134.44,,,134.44,Fee Schedule,,50.21,,,50.21,Fee Schedule,,50.21,,,50.21,Fee Schedule,,50.21,,,50.21,Fee Schedule,,50.21,,,50.21,Fee Schedule,,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,15.45,,,15.45,Other,153% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,14.14,,,14.14,Other,140% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,26.26,,,26.26,Other,250% of Medicaid,32.72,,,32.72,Other,324% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,12.63,,,12.63,Other,125% of Medicaid,0.01,193.55,
SURG PATH LEVEL-I GROSS ONLY,88300,CPT,TC,85088300,CDM,310,RC,,,both,,,123,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,39.4,,,39.4,Fee Schedule,,35.47,,,35.47,Fee Schedule,,157.17,,,157.17,Fee Schedule,,141.39,,,141.39,Fee Schedule,,133.65,,,133.65,Fee Schedule,,86.1,70,,86.1,percent of total billed charges,All Other,41.23,,,41.23,Fee Schedule,,101,,,101,Other,186% of Medicaid,48.56,,,48.56,Fee Schedule,,76.26,,,76.26,Fee Schedule,,27.49,,,,Fee Schedule,,48.56,,,48.56,Fee Schedule,,76.26,,,76.26,Fee Schedule,,51.71,,,51.71,Fee Schedule,,86.1,70,,86.1,percent of total billed charges,,52.48,,,52.48,Fee Schedule,,44.48,,,44.48,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,82.95,,,82.95,Other,153% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,75.91,,,75.91,Other,140% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,140.97,,,140.97,Other,250% of Medicaid,175.67,,,175.67,Other,324% of Medicaid,116.57,,,116.57,Other,215% of Medicaid,116.57,,,116.57,Other,215% of Medicaid,67.77,,,67.77,Other,125% of Medicaid,27.49,175.67,
SURG PATH LVL 2,88302,CPT,TC,85088302,CDM,310,RC,,,both,,,478,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,87.38,,,87.38,Fee Schedule,,78.67,,,78.67,Fee Schedule,,328.47,,,328.47,Fee Schedule,,295.5,,,295.5,Fee Schedule,,279.32,,,279.32,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,All Other,91.44,,,91.44,Fee Schedule,,36,,,36,Other,186% of Medicaid,107.7,,,107.7,Fee Schedule,,296.36,,,296.36,Fee Schedule,,60.96,,,,Fee Schedule,,107.7,,,107.7,Fee Schedule,,296.36,,,296.36,Fee Schedule,,114.67,,,114.67,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,19.5,,,19.5,Other,100% of Medicaid,19.5,,,19.5,Other,100% of Medicaid,19.5,,,19.5,Other,100% of Medicaid,19.5,,,19.5,Other,100% of Medicaid,43.88,,,43.88,Other,225% of Medicaid,29.84,,,29.84,Other,153% of Medicaid,43.88,,,43.88,Other,225% of Medicaid,27.3,,,27.3,Other,140% of Medicaid,43.88,,,43.88,Other,225% of Medicaid,50.71,,,50.71,Other,250% of Medicaid,63.19,,,63.19,Other,324% of Medicaid,41.93,,,41.93,Other,215% of Medicaid,41.93,,,41.93,Other,215% of Medicaid,24.38,,,24.38,Other,125% of Medicaid,19.5,334.6,
TISSUE EXAM BY PATHOLOGIST LVL 3,88304,CPT,TC,85088304,CDM,310,RC,,,both,,,478,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,104.81,,,104.81,Fee Schedule,,94.36,,,94.36,Fee Schedule,,361.79,,,361.79,Fee Schedule,,325.48,,,325.48,Fee Schedule,,307.65,,,307.65,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,All Other,109.68,,,109.68,Fee Schedule,,48,,,48,Other,186% of Medicaid,129.18,,,129.18,Fee Schedule,,296.36,,,296.36,Fee Schedule,,73.12,,,,Fee Schedule,,129.18,,,129.18,Fee Schedule,,296.36,,,296.36,Fee Schedule,,137.54,,,137.54,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,25.58,,,25.58,Other,100% of Medicaid,25.58,,,25.58,Other,100% of Medicaid,25.58,,,25.58,Other,100% of Medicaid,25.58,,,25.58,Other,100% of Medicaid,57.56,,,57.56,Other,225% of Medicaid,39.14,,,39.14,Other,153% of Medicaid,57.56,,,57.56,Other,225% of Medicaid,35.82,,,35.82,Other,140% of Medicaid,57.56,,,57.56,Other,225% of Medicaid,66.52,,,66.52,Other,250% of Medicaid,82.89,,,82.89,Other,324% of Medicaid,55,,,55,Other,215% of Medicaid,55,,,55,Other,215% of Medicaid,31.98,,,31.98,Other,125% of Medicaid,25.58,361.79,
TISSUE EXAM BY PATHOLOGIST LVL 4,88305,CPT,TC,85088305,CDM,310,RC,,,both,,,478,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,116.79,,,116.79,Fee Schedule,,105.15,,,105.15,Fee Schedule,,487.88,,,487.88,Fee Schedule,,438.92,,,438.92,Fee Schedule,,414.88,,,414.88,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,All Other,122.22,,,122.22,Fee Schedule,,81,,,81,Other,186% of Medicaid,143.95,,,143.95,Fee Schedule,,296.36,,,296.36,Fee Schedule,,81.48,,,,Fee Schedule,,143.95,,,143.95,Fee Schedule,,296.36,,,296.36,Fee Schedule,,153.26,,,153.26,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,,164,,,164,Fee Schedule,,139,,,139,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.42,,,113.42,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.79,,,93.79,Other,215% of Medicaid,93.79,,,93.79,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,43.62,487.88,
TISSUE EXAM BY PATHOLOGIST LVL 5,88307,CPT,TC,85088307,CDM,310,RC,,,both,,,1051,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,684.11,,,684.11,Fee Schedule,,615.93,,,615.93,Fee Schedule,,1028.05,,,1028.05,Fee Schedule,,924.87,,,924.87,Fee Schedule,,874.22,,,874.22,Fee Schedule,,735.7,70,,735.7,percent of total billed charges,All Other,715.93,,,715.93,Fee Schedule,,328,,,328,Other,186% of Medicaid,843.21,,,843.21,Fee Schedule,,651.62,,,651.62,Fee Schedule,,477.29,,,,Fee Schedule,,843.21,,,843.21,Fee Schedule,,651.62,,,651.62,Fee Schedule,,897.76,,,897.76,Fee Schedule,,735.7,70,,735.7,percent of total billed charges,,987.28,,,987.28,Fee Schedule,,836.78,,,836.78,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,176.15,,,176.15,Other,100% of Medicaid,176.15,,,176.15,Other,100% of Medicaid,176.15,,,176.15,Other,100% of Medicaid,176.15,,,176.15,Other,100% of Medicaid,396.35,,,396.35,Other,225% of Medicaid,269.52,,,269.52,Other,153% of Medicaid,396.35,,,396.35,Other,225% of Medicaid,246.62,,,246.62,Other,140% of Medicaid,396.35,,,396.35,Other,225% of Medicaid,458,,,458,Other,250% of Medicaid,570.74,,,570.74,Other,324% of Medicaid,378.73,,,378.73,Other,215% of Medicaid,378.73,,,378.73,Other,215% of Medicaid,220.19,,,220.19,Other,125% of Medicaid,176.15,1028.05,
TISSUE EXAM BY PATHOLOGIST LVL 6,88309,CPT,TC,85088309,CDM,310,RC,,,both,,,1859,1553.82,,,1553.82,Other,150% of Medicare + 9.63% HCRA Surcharge,944.89,,,944.89,Other,Medicare OPPS,959.92,,,959.92,Fee Schedule,,864.25,,,864.25,Fee Schedule,,1428.03,,,1428.03,Fee Schedule,,1284.71,,,1284.71,Fee Schedule,,1214.35,,,1214.35,Fee Schedule,,1301.3,70,,1301.3,percent of total billed charges,All Other,1004.57,,,1004.57,Fee Schedule,,498,,,498,Other,186% of Medicaid,1183.16,,,1183.16,Fee Schedule,,1152.58,,,1152.58,Fee Schedule,,669.71,,,,Fee Schedule,,1183.16,,,1183.16,Fee Schedule,,1152.58,,,1152.58,Fee Schedule,,1259.69,,,1259.69,Fee Schedule,,1301.3,70,,1301.3,percent of total billed charges,,1407.12,,,1407.12,Fee Schedule,,1192.62,,,1192.62,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,267.64,,,267.64,Other,100% of Medicaid,267.64,,,267.64,Other,100% of Medicaid,267.64,,,267.64,Other,100% of Medicaid,267.64,,,267.64,Other,100% of Medicaid,602.19,,,602.19,Other,225% of Medicaid,409.49,,,409.49,Other,153% of Medicaid,602.19,,,602.19,Other,225% of Medicaid,374.7,,,374.7,Other,140% of Medicaid,602.19,,,602.19,Other,225% of Medicaid,695.86,,,695.86,Other,250% of Medicaid,867.15,,,867.15,Other,324% of Medicaid,575.43,,,575.43,Other,215% of Medicaid,575.43,,,575.43,Other,215% of Medicaid,334.55,,,334.55,Other,125% of Medicaid,267.64,1553.82,
DECALCIFICATION,88311,CPT,TC,85088311,CDM,310,RC,,,both,,,171,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.5,,,28.5,Fee Schedule,,25.66,,,25.66,Fee Schedule,,47.68,,,47.68,Fee Schedule,,42.89,,,42.89,Fee Schedule,,40.54,,,40.54,Fee Schedule,,119.7,70,,119.7,percent of total billed charges,All Other,29.83,,,29.83,Fee Schedule,,101,,,101,Other,186% of Medicaid,35.13,,,35.13,Fee Schedule,,106.02,,,106.02,Fee Schedule,,19.89,,,,Fee Schedule,,35.13,,,35.13,Fee Schedule,,106.02,,,106.02,Fee Schedule,,37.41,,,37.41,Fee Schedule,,119.7,70,,119.7,percent of total billed charges,,41,,,41,Fee Schedule,,34.75,,,34.75,Fee Schedule,,13.53,,,13.53,Fee Schedule,,13.53,,,13.53,Fee Schedule,,13.53,,,13.53,Fee Schedule,,13.53,,,13.53,Fee Schedule,,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,82.95,,,82.95,Other,153% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,75.91,,,75.91,Other,140% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,140.97,,,140.97,Other,250% of Medicaid,175.67,,,175.67,Other,324% of Medicaid,116.57,,,116.57,Other,215% of Medicaid,116.57,,,116.57,Other,215% of Medicaid,67.77,,,67.77,Other,125% of Medicaid,0.01,175.67,
SPECIAL STAINS GROUP 1,88312,CPT,TC,85088312,CDM,310,RC,,,both,,,435,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,284.66,,,284.66,Fee Schedule,,256.28,,,256.28,Fee Schedule,,564.06,,,564.06,Fee Schedule,,507.44,,,507.44,Fee Schedule,,479.65,,,479.65,Fee Schedule,,304.5,70,,304.5,percent of total billed charges,All Other,297.9,,,297.9,Fee Schedule,,25,,,25,Other,186% of Medicaid,350.85,,,350.85,Fee Schedule,,269.7,,,269.7,Fee Schedule,,198.6,,,,Fee Schedule,,350.85,,,350.85,Fee Schedule,,269.7,,,269.7,Fee Schedule,,373.55,,,373.55,Fee Schedule,,304.5,70,,304.5,percent of total billed charges,,418.2,,,418.2,Fee Schedule,,354.45,,,354.45,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,13.31,,,13.31,Other,100% of Medicaid,13.31,,,13.31,Other,100% of Medicaid,13.31,,,13.31,Other,100% of Medicaid,13.31,,,13.31,Other,100% of Medicaid,29.95,,,29.95,Other,225% of Medicaid,20.37,,,20.37,Other,153% of Medicaid,29.95,,,29.95,Other,225% of Medicaid,18.64,,,18.64,Other,140% of Medicaid,29.95,,,29.95,Other,225% of Medicaid,34.61,,,34.61,Other,250% of Medicaid,43.13,,,43.13,Other,324% of Medicaid,28.62,,,28.62,Other,215% of Medicaid,28.62,,,28.62,Other,215% of Medicaid,16.64,,,16.64,Other,125% of Medicaid,13.31,564.06,
SPECIAL STAINS GROUP 2,88313,CPT,TC,85088313,CDM,310,RC,,,both,,,361,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,233.43,,,233.43,Fee Schedule,,210.16,,,210.16,Fee Schedule,,464.1,,,464.1,Fee Schedule,,417.52,,,417.52,Fee Schedule,,394.66,,,394.66,Fee Schedule,,252.7,70,,252.7,percent of total billed charges,All Other,244.28,,,244.28,Fee Schedule,,19,,,19,Other,186% of Medicaid,287.71,,,287.71,Fee Schedule,,223.82,,,223.82,Fee Schedule,,162.86,,,,Fee Schedule,,287.71,,,287.71,Fee Schedule,,223.82,,,223.82,Fee Schedule,,306.32,,,306.32,Fee Schedule,,252.7,70,,252.7,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,9.98,,,9.98,Other,100% of Medicaid,9.98,,,9.98,Other,100% of Medicaid,9.98,,,9.98,Other,100% of Medicaid,9.98,,,9.98,Other,100% of Medicaid,22.45,,,22.45,Other,225% of Medicaid,15.27,,,15.27,Other,153% of Medicaid,22.45,,,22.45,Other,225% of Medicaid,13.97,,,13.97,Other,140% of Medicaid,22.45,,,22.45,Other,225% of Medicaid,25.94,,,25.94,Other,250% of Medicaid,32.33,,,32.33,Other,324% of Medicaid,21.45,,,21.45,Other,215% of Medicaid,21.45,,,21.45,Other,215% of Medicaid,12.47,,,12.47,Other,125% of Medicaid,9.98,464.1,
REF CONSULT PREP ELSEWHERE,88321,CPT,TC,85088321,CDM,310,RC,,,both,,,210,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,257.63,,,257.63,Fee Schedule,,231.95,,,231.95,Fee Schedule,,567.18,,,567.18,Fee Schedule,,510.26,,,510.26,Fee Schedule,,482.31,,,482.31,Fee Schedule,,147,70,,147,percent of total billed charges,All Other,269.61,,,269.61,Fee Schedule,,117,,,117,Other,186% of Medicaid,317.54,,,317.54,Fee Schedule,,130.2,,,130.2,Fee Schedule,,179.74,,,,Fee Schedule,,317.54,,,317.54,Fee Schedule,,130.2,,,130.2,Fee Schedule,,338.08,,,338.08,Fee Schedule,,147,70,,147,percent of total billed charges,,398.52,,,398.52,Fee Schedule,,337.77,,,337.77,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,44.07,567.18,
REF CONSULT W SLIDE PREP,88323,CPT,TC,85088323,CDM,310,RC,,,both,,,386,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,97.16,,,97.16,Fee Schedule,,87.48,,,87.48,Fee Schedule,,411.77,,,411.77,Fee Schedule,,370.44,,,370.44,Fee Schedule,,350.15,,,350.15,Fee Schedule,,270.2,70,,270.2,percent of total billed charges,All Other,101.68,,,101.68,Fee Schedule,,117,,,117,Other,186% of Medicaid,119.76,,,119.76,Fee Schedule,,239.32,,,239.32,Fee Schedule,,67.79,,,,Fee Schedule,,119.76,,,119.76,Fee Schedule,,239.32,,,239.32,Fee Schedule,,127.51,,,127.51,Fee Schedule,,270.2,70,,270.2,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,59.54,411.77,
COMPREHENSIVE REVIEW OF DATA,88325,CPT,,78088325,CDM,310,RC,,,both,,,579,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,412.37,,,412.37,Fee Schedule,,371.27,,,371.27,Fee Schedule,,1291.91,,,1291.91,Fee Schedule,,1162.25,,,1162.25,Fee Schedule,,1098.6,,,1098.6,Fee Schedule,,405.3,70,,405.3,percent of total billed charges,All Other,431.55,,,431.55,Fee Schedule,,117,,,117,Other,186% of Medicaid,508.27,,,508.27,Fee Schedule,,358.98,,,358.98,Fee Schedule,,287.7,,,,Fee Schedule,,508.27,,,508.27,Fee Schedule,,358.98,,,358.98,Fee Schedule,,541.15,,,541.15,Fee Schedule,,405.3,70,,405.3,percent of total billed charges,,642.88,,,642.88,Fee Schedule,,544.88,,,544.88,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,63.06,1291.91,
PATH CONSULT DURING SURGERY,88329,CPT,,85088329,CDM,310,RC,,,both,,,411,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,108.96,,,108.96,Fee Schedule,,98.1,,,98.1,Fee Schedule,,336.03,,,336.03,Fee Schedule,,302.31,,,302.31,Fee Schedule,,285.75,,,285.75,Fee Schedule,,287.7,70,,287.7,percent of total billed charges,All Other,114.03,,,114.03,Fee Schedule,,117,,,117,Other,186% of Medicaid,134.3,,,134.3,Fee Schedule,,254.82,,,254.82,Fee Schedule,,76.02,,,,Fee Schedule,,134.3,,,134.3,Fee Schedule,,254.82,,,254.82,Fee Schedule,,142.99,,,142.99,Fee Schedule,,287.7,70,,287.7,percent of total billed charges,,168.92,,,168.92,Fee Schedule,,143.17,,,143.17,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,50.15,336.03,
SP CONSULT; 1ST TB W FS SGL SP,88331,CPT,TC,85088331,CDM,310,RC,,,both,,,581,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,135.33,,,135.33,Fee Schedule,,121.84,,,121.84,Fee Schedule,,223.8,,,223.8,Fee Schedule,,201.34,,,201.34,Fee Schedule,,190.31,,,190.31,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,All Other,141.62,,,141.62,Fee Schedule,,117,,,117,Other,186% of Medicaid,166.8,,,166.8,Fee Schedule,,360.22,,,360.22,Fee Schedule,,94.42,,,,Fee Schedule,,166.8,,,166.8,Fee Schedule,,360.22,,,360.22,Fee Schedule,,177.59,,,177.59,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,,196.8,,,196.8,Fee Schedule,,166.8,,,166.8,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,63.06,406.7,
PATH CONSULT INTRAOP ADDL,88332,CPT,TC,85088332,CDM,310,RC,,,both,,,158,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.9,,,81.9,Fee Schedule,,73.74,,,73.74,Fee Schedule,,78.64,,,78.64,Fee Schedule,,70.75,,,70.75,Fee Schedule,,66.87,,,66.87,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,All Other,85.71,,,85.71,Fee Schedule,,117,,,117,Other,186% of Medicaid,100.95,,,100.95,Fee Schedule,,97.96,,,97.96,Fee Schedule,,57.14,,,,Fee Schedule,,100.95,,,100.95,Fee Schedule,,97.96,,,97.96,Fee Schedule,,107.48,,,107.48,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,34.65,,,34.65,Fee Schedule,,34.65,,,34.65,Fee Schedule,,34.65,,,34.65,Fee Schedule,,34.65,,,34.65,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,0.01,204.32,
INTRAOP CYTO PATH CONSULT 1,88333,CPT,TC,85088333,CDM,310,RC,,,both,,,1834,1553.82,,,1553.82,Other,150% of Medicare + 9.63% HCRA Surcharge,944.89,,,944.89,Other,Medicare OPPS,104.81,,,104.81,Fee Schedule,,94.36,,,94.36,Fee Schedule,,245.18,,,245.18,Fee Schedule,,220.57,,,220.57,Fee Schedule,,208.49,,,208.49,Fee Schedule,,1283.8,70,,1283.8,percent of total billed charges,All Other,109.68,,,109.68,Fee Schedule,,117,,,117,Other,186% of Medicaid,129.18,,,129.18,Fee Schedule,,1137.08,,,1137.08,Fee Schedule,,73.12,,,,Fee Schedule,,129.18,,,129.18,Fee Schedule,,1137.08,,,1137.08,Fee Schedule,,137.54,,,137.54,Fee Schedule,,1283.8,70,,1283.8,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,63.06,1553.82,
INTRAOP CYTO PATH CONSULT 2,88334,CPT,TC,85088334,CDM,310,RC,,,both,,,184,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.21,,,63.21,Fee Schedule,,56.91,,,56.91,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,128.8,70,,128.8,percent of total billed charges,All Other,66.15,,,66.15,Fee Schedule,,117,,,117,Other,186% of Medicaid,77.91,,,77.91,Fee Schedule,,114.08,,,114.08,Fee Schedule,,44.1,,,,Fee Schedule,,77.91,,,77.91,Fee Schedule,,114.08,,,114.08,Fee Schedule,,82.95,,,82.95,Fee Schedule,,128.8,70,,128.8,percent of total billed charges,,91.84,,,91.84,Fee Schedule,,77.84,,,77.84,Fee Schedule,,27.06,,,27.06,Fee Schedule,,27.06,,,27.06,Fee Schedule,,27.06,,,27.06,Fee Schedule,,27.06,,,27.06,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,0.01,204.32,
IMMUNOHISTO ANTIBODY SLIDE,88341,CPT,,78088341,CDM,310,RC,,,both,,,357,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.2,,,208.2,Fee Schedule,,187.45,,,187.45,Fee Schedule,,18.31,,,18.31,Fee Schedule,,18.31,,,18.31,Fee Schedule,,18.31,,,18.31,Fee Schedule,,249.9,70,,249.9,percent of total billed charges,All Other,217.89,,,217.89,Fee Schedule,,48,,,48,Other,186% of Medicaid,256.62,,,256.62,Fee Schedule,,221.34,,,221.34,Fee Schedule,,145.26,,,,Fee Schedule,,256.62,,,256.62,Fee Schedule,,221.34,,,221.34,Fee Schedule,,273.22,,,273.22,Fee Schedule,,249.9,70,,249.9,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,96.9,,,96.9,Fee Schedule,,96.9,,,96.9,Fee Schedule,,96.9,,,96.9,Fee Schedule,,96.9,,,96.9,Fee Schedule,,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,39.2,,,39.2,Other,153% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,35.87,,,35.87,Other,140% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,66.62,,,66.62,Other,250% of Medicaid,83.02,,,83.02,Other,324% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,32.03,,,32.03,Other,125% of Medicaid,0.01,291.92,
IMMUNOHISTO ANTIBODY SLIDE,88341,CPT,TC,85088341,CDM,310,RC,,,both,,,357,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,208.2,,,208.2,Fee Schedule,,187.45,,,187.45,Fee Schedule,,18.31,,,18.31,Fee Schedule,,18.31,,,18.31,Fee Schedule,,18.31,,,18.31,Fee Schedule,,249.9,70,,249.9,percent of total billed charges,All Other,217.89,,,217.89,Fee Schedule,,48,,,48,Other,186% of Medicaid,256.62,,,256.62,Fee Schedule,,221.34,,,221.34,Fee Schedule,,145.26,,,,Fee Schedule,,256.62,,,256.62,Fee Schedule,,221.34,,,221.34,Fee Schedule,,273.22,,,273.22,Fee Schedule,,249.9,70,,249.9,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,96.9,,,96.9,Fee Schedule,,96.9,,,96.9,Fee Schedule,,96.9,,,96.9,Fee Schedule,,96.9,,,96.9,Fee Schedule,,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,39.2,,,39.2,Other,153% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,35.87,,,35.87,Other,140% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,66.62,,,66.62,Other,250% of Medicaid,83.02,,,83.02,Other,324% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,32.03,,,32.03,Other,125% of Medicaid,0.01,291.92,
IMMUNOHISTO ANTIBODY SLIDE,88342,CPT,TC,85088342,CDM,310,RC,,,both,,,747,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,236.71,,,236.71,Fee Schedule,,213.11,,,213.11,Fee Schedule,,440.32,,,440.32,Fee Schedule,,396.13,,,396.13,Fee Schedule,,374.43,,,374.43,Fee Schedule,,522.9,70,,522.9,percent of total billed charges,All Other,247.72,,,247.72,Fee Schedule,,48,,,48,Other,186% of Medicaid,291.75,,,291.75,Fee Schedule,,463.14,,,463.14,Fee Schedule,,165.14,,,,Fee Schedule,,291.75,,,291.75,Fee Schedule,,463.14,,,463.14,Fee Schedule,,310.63,,,310.63,Fee Schedule,,522.9,70,,522.9,percent of total billed charges,,321.44,,,321.44,Fee Schedule,,272.44,,,272.44,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,39.2,,,39.2,Other,153% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,35.87,,,35.87,Other,140% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,66.62,,,66.62,Other,250% of Medicaid,83.02,,,83.02,Other,324% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,32.03,,,32.03,Other,125% of Medicaid,25.62,522.9,
IMMUNOHISTO ANTIBODY SLIDE,88344,CPT,,78088344,CDM,310,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,444.91,,,444.91,Fee Schedule,,400.57,,,400.57,Fee Schedule,,30.75,,,30.75,Fee Schedule,,30.75,,,30.75,Fee Schedule,,30.75,,,30.75,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,465.6,,,465.6,Fee Schedule,,48,,,48,Other,186% of Medicaid,548.38,,,548.38,Fee Schedule,,453.22,,,453.22,Fee Schedule,,310.4,,,,Fee Schedule,,548.38,,,548.38,Fee Schedule,,453.22,,,453.22,Fee Schedule,,583.85,,,583.85,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,639.6,,,639.6,Fee Schedule,,542.1,,,542.1,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,39.2,,,39.2,Other,153% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,35.87,,,35.87,Other,140% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,66.62,,,66.62,Other,250% of Medicaid,83.02,,,83.02,Other,324% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,32.03,,,32.03,Other,125% of Medicaid,25.62,649.53,
IMMUNOHISTO ANTIBODY SLIDE,88344,CPT,TC,85088344,CDM,310,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,444.91,,,444.91,Fee Schedule,,400.57,,,400.57,Fee Schedule,,30.75,,,30.75,Fee Schedule,,30.75,,,30.75,Fee Schedule,,30.75,,,30.75,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,465.6,,,465.6,Fee Schedule,,48,,,48,Other,186% of Medicaid,548.38,,,548.38,Fee Schedule,,453.22,,,453.22,Fee Schedule,,310.4,,,,Fee Schedule,,548.38,,,548.38,Fee Schedule,,453.22,,,453.22,Fee Schedule,,583.85,,,583.85,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,639.6,,,639.6,Fee Schedule,,542.1,,,542.1,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,39.2,,,39.2,Other,153% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,35.87,,,35.87,Other,140% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,66.62,,,66.62,Other,250% of Medicaid,83.02,,,83.02,Other,324% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,32.03,,,32.03,Other,125% of Medicaid,25.62,649.53,
IMMUNOFLUORESCENT STUDY,88346,CPT,,78088346,CDM,310,RC,,,both,,,731,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,377.48,,,377.48,Fee Schedule,,339.86,,,339.86,Fee Schedule,,426.02,,,426.02,Fee Schedule,,383.26,,,383.26,Fee Schedule,,362.27,,,362.27,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,395.04,,,395.04,Fee Schedule,,36,,,36,Other,186% of Medicaid,465.27,,,465.27,Fee Schedule,,453.22,,,453.22,Fee Schedule,,263.36,,,,Fee Schedule,,465.27,,,465.27,Fee Schedule,,453.22,,,453.22,Fee Schedule,,495.37,,,495.37,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,567.44,,,567.44,Fee Schedule,,480.94,,,480.94,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,19.44,,,19.44,Other,100% of Medicaid,19.44,,,19.44,Other,100% of Medicaid,19.44,,,19.44,Other,100% of Medicaid,19.44,,,19.44,Other,100% of Medicaid,43.75,,,43.75,Other,225% of Medicaid,29.75,,,29.75,Other,153% of Medicaid,43.75,,,43.75,Other,225% of Medicaid,27.22,,,27.22,Other,140% of Medicaid,43.75,,,43.75,Other,225% of Medicaid,50.55,,,50.55,Other,250% of Medicaid,62.99,,,62.99,Other,324% of Medicaid,41.8,,,41.8,Other,215% of Medicaid,41.8,,,41.8,Other,215% of Medicaid,24.3,,,24.3,Other,125% of Medicaid,19.44,567.44,
IMMUNOFLUOR ANTB 1ST STAIN,88346,CPT,TC,85088346,CDM,310,RC,,,both,,,731,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,377.48,,,377.48,Fee Schedule,,339.86,,,339.86,Fee Schedule,,426.02,,,426.02,Fee Schedule,,383.26,,,383.26,Fee Schedule,,362.27,,,362.27,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,395.04,,,395.04,Fee Schedule,,36,,,36,Other,186% of Medicaid,465.27,,,465.27,Fee Schedule,,453.22,,,453.22,Fee Schedule,,263.36,,,,Fee Schedule,,465.27,,,465.27,Fee Schedule,,453.22,,,453.22,Fee Schedule,,495.37,,,495.37,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,567.44,,,567.44,Fee Schedule,,480.94,,,480.94,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,19.44,,,19.44,Other,100% of Medicaid,19.44,,,19.44,Other,100% of Medicaid,19.44,,,19.44,Other,100% of Medicaid,19.44,,,19.44,Other,100% of Medicaid,43.75,,,43.75,Other,225% of Medicaid,29.75,,,29.75,Other,153% of Medicaid,43.75,,,43.75,Other,225% of Medicaid,27.22,,,27.22,Other,140% of Medicaid,43.75,,,43.75,Other,225% of Medicaid,50.55,,,50.55,Other,250% of Medicaid,62.99,,,62.99,Other,324% of Medicaid,41.8,,,41.8,Other,215% of Medicaid,41.8,,,41.8,Other,215% of Medicaid,24.3,,,24.3,Other,125% of Medicaid,19.44,567.44,
ELECTRON MICROSCOPY,88348,CPT,,78088348,CDM,310,RC,,,both,,,2218,1553.82,,,1553.82,Other,150% of Medicare + 9.63% HCRA Surcharge,944.89,,,944.89,Other,Medicare OPPS,1342.25,,,1342.25,Fee Schedule,,1208.47,,,1208.47,Fee Schedule,,4257.8,,,4257.8,Fee Schedule,,3830.46,,,3830.46,Fee Schedule,,3620.68,,,3620.68,Fee Schedule,,1552.6,70,,1552.6,percent of total billed charges,All Other,1404.68,,,1404.68,Fee Schedule,,136,,,136,Other,186% of Medicaid,1654.4,,,1654.4,Fee Schedule,,1375.16,,,1375.16,Fee Schedule,,936.45,,,,Fee Schedule,,1654.4,,,1654.4,Fee Schedule,,1375.16,,,1375.16,Fee Schedule,,1761.42,,,1761.42,Fee Schedule,,1552.6,70,,1552.6,percent of total billed charges,,1828.6,,,1828.6,Fee Schedule,,1549.85,,,1549.85,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,112.23,,,112.23,Other,153% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,102.7,,,102.7,Other,140% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,190.72,,,190.72,Other,250% of Medicaid,237.67,,,237.67,Other,324% of Medicaid,157.71,,,157.71,Other,215% of Medicaid,157.71,,,157.71,Other,215% of Medicaid,91.69,,,91.69,Other,125% of Medicaid,73.36,4257.8,
ELECTRON MICROSCOPY,88348,CPT,TC,85088348,CDM,310,RC,,,both,,,2218,1553.82,,,1553.82,Other,150% of Medicare + 9.63% HCRA Surcharge,944.89,,,944.89,Other,Medicare OPPS,1342.25,,,1342.25,Fee Schedule,,1208.47,,,1208.47,Fee Schedule,,4257.8,,,4257.8,Fee Schedule,,3830.46,,,3830.46,Fee Schedule,,3620.68,,,3620.68,Fee Schedule,,1552.6,70,,1552.6,percent of total billed charges,All Other,1404.68,,,1404.68,Fee Schedule,,136,,,136,Other,186% of Medicaid,1654.4,,,1654.4,Fee Schedule,,1375.16,,,1375.16,Fee Schedule,,936.45,,,,Fee Schedule,,1654.4,,,1654.4,Fee Schedule,,1375.16,,,1375.16,Fee Schedule,,1761.42,,,1761.42,Fee Schedule,,1552.6,70,,1552.6,percent of total billed charges,,1828.6,,,1828.6,Fee Schedule,,1549.85,,,1549.85,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,112.23,,,112.23,Other,153% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,102.7,,,102.7,Other,140% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,190.72,,,190.72,Other,250% of Medicaid,237.67,,,237.67,Other,324% of Medicaid,157.71,,,157.71,Other,215% of Medicaid,157.71,,,157.71,Other,215% of Medicaid,91.69,,,91.69,Other,125% of Medicaid,73.36,4257.8,
IMMUNOFLUOR ANTB ADDL STAIN,88350,CPT,,78088350,CDM,310,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,281.4,,,281.4,Fee Schedule,,253.36,,,253.36,Fee Schedule,,40.4,,,40.4,Fee Schedule,,40.4,,,40.4,Fee Schedule,,40.4,,,40.4,Fee Schedule,,168,70,,168,percent of total billed charges,All Other,294.49,,,294.49,Fee Schedule,,31,,,31,Other,186% of Medicaid,346.85,,,346.85,Fee Schedule,,148.8,,,148.8,Fee Schedule,,196.33,,,,Fee Schedule,,346.85,,,346.85,Fee Schedule,,148.8,,,148.8,Fee Schedule,,369.29,,,369.29,Fee Schedule,,168,70,,168,percent of total billed charges,,431.32,,,431.32,Fee Schedule,,365.57,,,365.57,Fee Schedule,,95.82,,,95.82,Fee Schedule,,95.82,,,95.82,Fee Schedule,,95.82,,,95.82,Fee Schedule,,95.82,,,95.82,Fee Schedule,,16.41,,,16.41,Other,100% of Medicaid,16.41,,,16.41,Other,100% of Medicaid,16.41,,,16.41,Other,100% of Medicaid,16.41,,,16.41,Other,100% of Medicaid,36.93,,,36.93,Other,225% of Medicaid,25.11,,,25.11,Other,153% of Medicaid,36.93,,,36.93,Other,225% of Medicaid,22.98,,,22.98,Other,140% of Medicaid,36.93,,,36.93,Other,225% of Medicaid,42.67,,,42.67,Other,250% of Medicaid,53.18,,,53.18,Other,324% of Medicaid,35.29,,,35.29,Other,215% of Medicaid,35.29,,,35.29,Other,215% of Medicaid,20.52,,,20.52,Other,125% of Medicaid,0.01,431.32,
IMMUNOFLUOR ANTB ADDL STAIN,88350,CPT,TC,85088350,CDM,310,RC,,,both,,,240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,281.4,,,281.4,Fee Schedule,,253.36,,,253.36,Fee Schedule,,40.4,,,40.4,Fee Schedule,,40.4,,,40.4,Fee Schedule,,40.4,,,40.4,Fee Schedule,,168,70,,168,percent of total billed charges,All Other,294.49,,,294.49,Fee Schedule,,31,,,31,Other,186% of Medicaid,346.85,,,346.85,Fee Schedule,,148.8,,,148.8,Fee Schedule,,196.33,,,,Fee Schedule,,346.85,,,346.85,Fee Schedule,,148.8,,,148.8,Fee Schedule,,369.29,,,369.29,Fee Schedule,,168,70,,168,percent of total billed charges,,431.32,,,431.32,Fee Schedule,,365.57,,,365.57,Fee Schedule,,95.82,,,95.82,Fee Schedule,,95.82,,,95.82,Fee Schedule,,95.82,,,95.82,Fee Schedule,,95.82,,,95.82,Fee Schedule,,16.41,,,16.41,Other,100% of Medicaid,16.41,,,16.41,Other,100% of Medicaid,16.41,,,16.41,Other,100% of Medicaid,16.41,,,16.41,Other,100% of Medicaid,36.93,,,36.93,Other,225% of Medicaid,25.11,,,25.11,Other,153% of Medicaid,36.93,,,36.93,Other,225% of Medicaid,22.98,,,22.98,Other,140% of Medicaid,36.93,,,36.93,Other,225% of Medicaid,42.67,,,42.67,Other,250% of Medicaid,53.18,,,53.18,Other,324% of Medicaid,35.29,,,35.29,Other,215% of Medicaid,35.29,,,35.29,Other,215% of Medicaid,20.52,,,20.52,Other,125% of Medicaid,0.01,431.32,
TUMOR IMMUNOHISTOCHEM/MANUAL,88360,CPT,,78088360,CDM,310,RC,,,both,,,682,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,262.86,,,262.86,Fee Schedule,,236.66,,,236.66,Fee Schedule,,497.42,,,497.42,Fee Schedule,,447.5,,,447.5,Fee Schedule,,422.99,,,422.99,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,All Other,275.09,,,275.09,Fee Schedule,,48,,,48,Other,186% of Medicaid,323.99,,,323.99,Fee Schedule,,422.84,,,422.84,Fee Schedule,,183.39,,,,Fee Schedule,,323.99,,,323.99,Fee Schedule,,422.84,,,422.84,Fee Schedule,,344.95,,,344.95,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,,383.76,,,383.76,Fee Schedule,,325.26,,,325.26,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,39.2,,,39.2,Other,153% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,35.87,,,35.87,Other,140% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,66.62,,,66.62,Other,250% of Medicaid,83.02,,,83.02,Other,324% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,32.03,,,32.03,Other,125% of Medicaid,25.62,497.42,
TUMOR IMMUNOHISTOCHEM/MANUAL,88360,CPT,TC,85088360,CDM,310,RC,,,both,,,682,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,262.86,,,262.86,Fee Schedule,,236.66,,,236.66,Fee Schedule,,497.42,,,497.42,Fee Schedule,,447.5,,,447.5,Fee Schedule,,422.99,,,422.99,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,All Other,275.09,,,275.09,Fee Schedule,,48,,,48,Other,186% of Medicaid,323.99,,,323.99,Fee Schedule,,422.84,,,422.84,Fee Schedule,,183.39,,,,Fee Schedule,,323.99,,,323.99,Fee Schedule,,422.84,,,422.84,Fee Schedule,,344.95,,,344.95,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,,383.76,,,383.76,Fee Schedule,,325.26,,,325.26,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,39.2,,,39.2,Other,153% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,35.87,,,35.87,Other,140% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,66.62,,,66.62,Other,250% of Medicaid,83.02,,,83.02,Other,324% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,32.03,,,32.03,Other,125% of Medicaid,25.62,497.42,
TUMOR IMMUNOHISTOCHEM/COMPUT,88361,CPT,,78088361,CDM,310,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,253.05,,,253.05,Fee Schedule,,227.83,,,227.83,Fee Schedule,,671.14,,,671.14,Fee Schedule,,603.78,,,603.78,Fee Schedule,,570.71,,,570.71,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,264.82,,,264.82,Fee Schedule,,48,,,48,Other,186% of Medicaid,311.9,,,311.9,Fee Schedule,,453.22,,,453.22,Fee Schedule,,176.55,,,,Fee Schedule,,311.9,,,311.9,Fee Schedule,,453.22,,,453.22,Fee Schedule,,332.08,,,332.08,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,372.28,,,372.28,Fee Schedule,,315.53,,,315.53,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,39.2,,,39.2,Other,153% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,35.87,,,35.87,Other,140% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,66.62,,,66.62,Other,250% of Medicaid,83.02,,,83.02,Other,324% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,32.03,,,32.03,Other,125% of Medicaid,25.62,671.14,
TUMOR IMMUNOHISTOCHEM/COMPUT,88361,CPT,TC,85088361,CDM,310,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,253.05,,,253.05,Fee Schedule,,227.83,,,227.83,Fee Schedule,,671.14,,,671.14,Fee Schedule,,603.78,,,603.78,Fee Schedule,,570.71,,,570.71,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,264.82,,,264.82,Fee Schedule,,48,,,48,Other,186% of Medicaid,311.9,,,311.9,Fee Schedule,,453.22,,,453.22,Fee Schedule,,176.55,,,,Fee Schedule,,311.9,,,311.9,Fee Schedule,,453.22,,,453.22,Fee Schedule,,332.08,,,332.08,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,372.28,,,372.28,Fee Schedule,,315.53,,,315.53,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,39.2,,,39.2,Other,153% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,35.87,,,35.87,Other,140% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,66.62,,,66.62,Other,250% of Medicaid,83.02,,,83.02,Other,324% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,32.03,,,32.03,Other,125% of Medicaid,25.62,671.14,
INSITU HYBRIDIZATION (FISH),88364,CPT,TC,85088364,CDM,310,RC,,,both,,,1683,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,329.35,,,329.35,Fee Schedule,,296.53,,,296.53,Fee Schedule,,28.03,,,28.03,Fee Schedule,,28.03,,,28.03,Fee Schedule,,28.03,,,28.03,Fee Schedule,,1178.1,70,,1178.1,percent of total billed charges,All Other,344.67,,,344.67,Fee Schedule,,334,,,334,Other,186% of Medicaid,405.95,,,405.95,Fee Schedule,,1043.46,,,1043.46,Fee Schedule,,229.78,,,,Fee Schedule,,405.95,,,405.95,Fee Schedule,,1043.46,,,1043.46,Fee Schedule,,432.21,,,432.21,Fee Schedule,,1178.1,70,,1178.1,percent of total billed charges,,501.84,,,501.84,Fee Schedule,,425.34,,,425.34,Fee Schedule,,156.45,,,156.45,Fee Schedule,,156.45,,,156.45,Fee Schedule,,156.45,,,156.45,Fee Schedule,,156.45,,,156.45,Fee Schedule,,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,274.45,,,274.45,Other,153% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,251.13,,,251.13,Other,140% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,466.39,,,466.39,Other,250% of Medicaid,581.19,,,581.19,Other,324% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,224.23,,,224.23,Other,125% of Medicaid,0.01,1178.1,
INSITU HYBRIDIZATION (FISH),88365,CPT,,78088365,CDM,310,RC,,,both,,,666,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,445.06,,,445.06,Fee Schedule,,400.7,,,400.7,Fee Schedule,,759.2,,,759.2,Fee Schedule,,683,,,683,Fee Schedule,,645.6,,,645.6,Fee Schedule,,466.2,70,,466.2,percent of total billed charges,All Other,465.76,,,465.76,Fee Schedule,,334,,,334,Other,186% of Medicaid,548.56,,,548.56,Fee Schedule,,412.92,,,412.92,Fee Schedule,,310.51,,,,Fee Schedule,,548.56,,,548.56,Fee Schedule,,412.92,,,412.92,Fee Schedule,,584.05,,,584.05,Fee Schedule,,466.2,70,,466.2,percent of total billed charges,,659.28,,,659.28,Fee Schedule,,558.78,,,558.78,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,274.45,,,274.45,Other,153% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,251.13,,,251.13,Other,140% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,466.39,,,466.39,Other,250% of Medicaid,581.19,,,581.19,Other,324% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,224.23,,,224.23,Other,125% of Medicaid,179.38,759.2,
INSITU HYBRIDIZATION (FISH),88365,CPT,TC,85088365,CDM,310,RC,,,both,,,666,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,445.06,,,445.06,Fee Schedule,,400.7,,,400.7,Fee Schedule,,759.2,,,759.2,Fee Schedule,,683,,,683,Fee Schedule,,645.6,,,645.6,Fee Schedule,,466.2,70,,466.2,percent of total billed charges,All Other,465.76,,,465.76,Fee Schedule,,334,,,334,Other,186% of Medicaid,548.56,,,548.56,Fee Schedule,,412.92,,,412.92,Fee Schedule,,310.51,,,,Fee Schedule,,548.56,,,548.56,Fee Schedule,,412.92,,,412.92,Fee Schedule,,584.05,,,584.05,Fee Schedule,,466.2,70,,466.2,percent of total billed charges,,659.28,,,659.28,Fee Schedule,,558.78,,,558.78,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,274.45,,,274.45,Other,153% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,251.13,,,251.13,Other,140% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,466.39,,,466.39,Other,250% of Medicaid,581.19,,,581.19,Other,324% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,224.23,,,224.23,Other,125% of Medicaid,179.38,759.2,
INSITU HYBRIDIZATION AUTO,88367,CPT,,78088367,CDM,310,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,260.7,,,260.7,Fee Schedule,,234.71,,,234.71,Fee Schedule,,1368.3,,,1368.3,Fee Schedule,,1230.97,,,1230.97,Fee Schedule,,1163.56,,,1163.56,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,272.82,,,272.82,Fee Schedule,,334,,,334,Other,186% of Medicaid,321.32,,,321.32,Fee Schedule,,453.22,,,453.22,Fee Schedule,,181.88,,,,Fee Schedule,,321.32,,,321.32,Fee Schedule,,453.22,,,453.22,Fee Schedule,,342.11,,,342.11,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,385.4,,,385.4,Fee Schedule,,326.65,,,326.65,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,274.45,,,274.45,Other,153% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,251.13,,,251.13,Other,140% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,466.39,,,466.39,Other,250% of Medicaid,581.19,,,581.19,Other,324% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,224.23,,,224.23,Other,125% of Medicaid,179.38,1368.3,
INSITU HYBRIDIZATION MANUAL,88368,CPT,TC,85088368,CDM,310,RC,,,both,,,1015,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,351.33,,,351.33,Fee Schedule,,316.31,,,316.31,Fee Schedule,,1104.22,,,1104.22,Fee Schedule,,993.4,,,993.4,Fee Schedule,,938.99,,,938.99,Fee Schedule,,710.5,70,,710.5,percent of total billed charges,All Other,367.67,,,367.67,Fee Schedule,,334,,,334,Other,186% of Medicaid,433.03,,,433.03,Fee Schedule,,629.3,,,629.3,Fee Schedule,,245.11,,,,Fee Schedule,,433.03,,,433.03,Fee Schedule,,629.3,,,629.3,Fee Schedule,,461.04,,,461.04,Fee Schedule,,710.5,70,,710.5,percent of total billed charges,,459.2,,,459.2,Fee Schedule,,389.2,,,389.2,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,274.45,,,274.45,Other,153% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,251.13,,,251.13,Other,140% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,466.39,,,466.39,Other,250% of Medicaid,581.19,,,581.19,Other,324% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,224.23,,,224.23,Other,125% of Medicaid,179.38,1104.22,
PROTEIN ANALYSIS W/PROBE,88372,CPT,,78088372,CDM,310,RC,,,both,,,145,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,78.92,,,78.92,Fee Schedule,,71.06,,,71.06,Fee Schedule,,175.41,,,175.41,Fee Schedule,,157.81,,,157.81,Fee Schedule,,149.17,,,149.17,Fee Schedule,,101.5,70,,101.5,percent of total billed charges,All Other,82.59,,,82.59,Fee Schedule,,135,,,135,Other,186% of Medicaid,97.28,,,97.28,Fee Schedule,,89.9,,,89.9,Fee Schedule,,55.06,,,,Fee Schedule,,97.28,,,97.28,Fee Schedule,,89.9,,,89.9,Fee Schedule,,103.57,,,103.57,Fee Schedule,,101.5,70,,101.5,percent of total billed charges,,124.26,,,124.26,Fee Schedule,,105.32,,,105.32,Fee Schedule,,39.33,,,39.33,Fee Schedule,,39.33,,,39.33,Fee Schedule,,39.33,,,39.33,Fee Schedule,,39.33,,,39.33,Fee Schedule,,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,111.42,,,111.42,Other,153% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,101.95,,,101.95,Other,140% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,189.34,,,189.34,Other,250% of Medicaid,235.95,,,235.95,Other,324% of Medicaid,156.57,,,156.57,Other,215% of Medicaid,156.57,,,156.57,Other,215% of Medicaid,91.03,,,91.03,Other,125% of Medicaid,0.01,235.95,
M/PHMTRC ALYS ISHQUANT/SEMIQ CPTR EACH,88374,CPT,,78088374,CDM,310,RC,,,both,,,579,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,807.91,,,807.91,Fee Schedule,,727.39,,,727.39,Fee Schedule,,63.79,,,63.79,Fee Schedule,,63.79,,,63.79,Fee Schedule,,63.79,,,63.79,Fee Schedule,,405.3,70,,405.3,percent of total billed charges,All Other,845.49,,,845.49,Fee Schedule,,334,,,334,Other,186% of Medicaid,995.8,,,995.8,Fee Schedule,,358.98,,,358.98,Fee Schedule,,563.66,,,,Fee Schedule,,995.8,,,995.8,Fee Schedule,,358.98,,,358.98,Fee Schedule,,1060.22,,,1060.22,Fee Schedule,,405.3,70,,405.3,percent of total billed charges,,1367.76,,,1367.76,Fee Schedule,,1159.26,,,1159.26,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,274.45,,,274.45,Other,153% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,251.13,,,251.13,Other,140% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,466.39,,,466.39,Other,250% of Medicaid,581.19,,,581.19,Other,324% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,224.23,,,224.23,Other,125% of Medicaid,63.79,1367.76,
M/PHMTRC ALYS ISHQUANT/SEMIQ,88377,CPT,,78088377,CDM,310,RC,,,both,,,1621,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,1091.64,,,1091.64,Fee Schedule,,982.84,,,982.84,Fee Schedule,,59.35,,,59.35,Fee Schedule,,59.35,,,59.35,Fee Schedule,,59.35,,,59.35,Fee Schedule,,1134.7,70,,1134.7,percent of total billed charges,All Other,1142.41,,,1142.41,Fee Schedule,,334,,,334,Other,186% of Medicaid,1345.51,,,1345.51,Fee Schedule,,1005.02,,,1005.02,Fee Schedule,,761.61,,,,Fee Schedule,,1345.51,,,1345.51,Fee Schedule,,1005.02,,,1005.02,Fee Schedule,,1432.55,,,1432.55,Fee Schedule,,1134.7,70,,1134.7,percent of total billed charges,,1649.84,,,1649.84,Fee Schedule,,1398.34,,,1398.34,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,274.45,,,274.45,Other,153% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,251.13,,,251.13,Other,140% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,466.39,,,466.39,Other,250% of Medicaid,581.19,,,581.19,Other,324% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,224.23,,,224.23,Other,125% of Medicaid,59.35,1649.84,
M/PHMTRC ALYS ISHQUANT/SEMIQ,88377,CPT,TC,85088377,CDM,310,RC,,,both,,,1621,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,1091.64,,,1091.64,Fee Schedule,,982.84,,,982.84,Fee Schedule,,59.35,,,59.35,Fee Schedule,,59.35,,,59.35,Fee Schedule,,59.35,,,59.35,Fee Schedule,,1134.7,70,,1134.7,percent of total billed charges,All Other,1142.41,,,1142.41,Fee Schedule,,334,,,334,Other,186% of Medicaid,1345.51,,,1345.51,Fee Schedule,,1005.02,,,1005.02,Fee Schedule,,761.61,,,,Fee Schedule,,1345.51,,,1345.51,Fee Schedule,,1005.02,,,1005.02,Fee Schedule,,1432.55,,,1432.55,Fee Schedule,,1134.7,70,,1134.7,percent of total billed charges,,1649.84,,,1649.84,Fee Schedule,,1398.34,,,1398.34,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,179.38,,,179.38,Other,100% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,274.45,,,274.45,Other,153% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,251.13,,,251.13,Other,140% of Medicaid,403.61,,,403.61,Other,225% of Medicaid,466.39,,,466.39,Other,250% of Medicaid,581.19,,,581.19,Other,324% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,385.67,,,385.67,Other,215% of Medicaid,224.23,,,224.23,Other,125% of Medicaid,59.35,1649.84,
MICRODISSECTION LASER,88380,CPT,,78088380,CDM,310,RC,,,both,,,663,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,241.4,,,241.4,Fee Schedule,,217.34,,,217.34,Fee Schedule,,718.7,,,718.7,Fee Schedule,,646.57,,,646.57,Fee Schedule,,611.16,,,611.16,Fee Schedule,,464.1,70,,464.1,percent of total billed charges,All Other,252.63,,,252.63,Fee Schedule,,136,,,136,Other,186% of Medicaid,297.54,,,297.54,Fee Schedule,,411.06,,,411.06,Fee Schedule,,168.42,,,,Fee Schedule,,297.54,,,297.54,Fee Schedule,,411.06,,,411.06,Fee Schedule,,316.79,,,316.79,Fee Schedule,,464.1,70,,464.1,percent of total billed charges,,354.24,,,354.24,Fee Schedule,,300.24,,,300.24,Fee Schedule,,120.18,,,120.18,Fee Schedule,,120.18,,,120.18,Fee Schedule,,120.18,,,120.18,Fee Schedule,,120.18,,,120.18,Fee Schedule,,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,112.23,,,112.23,Other,153% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,102.7,,,102.7,Other,140% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,190.72,,,190.72,Other,250% of Medicaid,237.67,,,237.67,Other,324% of Medicaid,157.71,,,157.71,Other,215% of Medicaid,157.71,,,157.71,Other,215% of Medicaid,91.69,,,91.69,Other,125% of Medicaid,0.01,718.7,
MICRODISSECTION MANUAL,88381,CPT,,78088381,CDM,310,RC,,,both,,,72,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,584.93,,,584.93,Fee Schedule,,526.63,,,526.63,Fee Schedule,,916.2,,,916.2,Fee Schedule,,824.25,,,824.25,Fee Schedule,,779.11,,,779.11,Fee Schedule,,50.4,70,,50.4,percent of total billed charges,All Other,612.14,,,612.14,Fee Schedule,,101,,,101,Other,186% of Medicaid,720.96,,,720.96,Fee Schedule,,44.64,,,44.64,Fee Schedule,,408.09,,,,Fee Schedule,,720.96,,,720.96,Fee Schedule,,44.64,,,44.64,Fee Schedule,,767.6,,,767.6,Fee Schedule,,50.4,70,,50.4,percent of total billed charges,,900.36,,,900.36,Fee Schedule,,763.11,,,763.11,Fee Schedule,,235.49,,,235.49,Fee Schedule,,235.49,,,235.49,Fee Schedule,,235.49,,,235.49,Fee Schedule,,235.49,,,235.49,Fee Schedule,,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,82.95,,,82.95,Other,153% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,75.91,,,75.91,Other,140% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,140.97,,,140.97,Other,250% of Medicaid,175.67,,,175.67,Other,324% of Medicaid,116.57,,,116.57,Other,215% of Medicaid,116.57,,,116.57,Other,215% of Medicaid,67.77,,,67.77,Other,125% of Medicaid,0.01,916.2,
"PROSTATE BIOPSY, ANY MTHD",G0416,HCPCS,TC,85000001,CDM,310,RC,,,both,,,2649,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,665.12,,,665.12,Fee Schedule,,598.4,,,598.4,Fee Schedule,,2891.19,,,2891.19,Fee Schedule,,2601.02,,,2601.02,Fee Schedule,,2458.57,,,2458.57,Fee Schedule,,1854.3,70,,1854.3,percent of total billed charges,All Other,790.22,,,790.22,Fee Schedule,,136,,,136,Other,186% of Medicaid,929.91,,,929.91,Fee Schedule,,1642.38,,,1642.38,Fee Schedule,,437.85,,,,Fee Schedule,,929.91,,,929.91,Fee Schedule,,1642.38,,,1642.38,Fee Schedule,,823.58,,,823.58,Fee Schedule,,1854.3,70,,1854.3,percent of total billed charges,,857.72,,,857.72,Fee Schedule,,726.97,,,726.97,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,73.36,,,73.36,Other,100% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,112.23,,,112.23,Other,153% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,102.7,,,102.7,Other,140% of Medicaid,165.05,,,165.05,Other,225% of Medicaid,190.72,,,190.72,Other,250% of Medicaid,237.67,,,237.67,Other,324% of Medicaid,157.71,,,157.71,Other,215% of Medicaid,157.71,,,157.71,Other,215% of Medicaid,91.69,,,91.69,Other,125% of Medicaid,73.36,2891.19,
CYTOPATH FL NONGYN SMEARS,88104,CPT,,78088104,CDM,311,RC,,,both,,,270,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,160.55,,,160.55,Fee Schedule,,144.55,,,144.55,Fee Schedule,,264.25,,,264.25,Fee Schedule,,237.72,,,237.72,Fee Schedule,,224.71,,,224.71,Fee Schedule,,189,70,,189,percent of total billed charges,All Other,168.02,,,168.02,Fee Schedule,,36,,,36,Other,186% of Medicaid,197.89,,,197.89,Fee Schedule,,167.4,,,167.4,Fee Schedule,,112.01,,,,Fee Schedule,,197.89,,,197.89,Fee Schedule,,167.4,,,167.4,Fee Schedule,,210.69,,,210.69,Fee Schedule,,189,70,,189,percent of total billed charges,,193.52,,,193.52,Fee Schedule,,164.02,,,164.02,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,264.25,
CYTOPATH FL NONGYN SMEARS,88104,CPT,TC,85088104,CDM,311,RC,,,both,,,270,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,160.55,,,160.55,Fee Schedule,,144.55,,,144.55,Fee Schedule,,264.25,,,264.25,Fee Schedule,,237.72,,,237.72,Fee Schedule,,224.71,,,224.71,Fee Schedule,,189,70,,189,percent of total billed charges,All Other,168.02,,,168.02,Fee Schedule,,36,,,36,Other,186% of Medicaid,197.89,,,197.89,Fee Schedule,,167.4,,,167.4,Fee Schedule,,112.01,,,,Fee Schedule,,197.89,,,197.89,Fee Schedule,,167.4,,,167.4,Fee Schedule,,210.69,,,210.69,Fee Schedule,,189,70,,189,percent of total billed charges,,193.52,,,193.52,Fee Schedule,,164.02,,,164.02,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,264.25,
CYTOPATH FL NONGYN FILTER,88106,CPT,,78088106,CDM,311,RC,,,both,,,284,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,173.65,,,173.65,Fee Schedule,,156.34,,,156.34,Fee Schedule,,368.91,,,368.91,Fee Schedule,,331.89,,,331.89,Fee Schedule,,313.71,,,313.71,Fee Schedule,,198.8,70,,198.8,percent of total billed charges,All Other,181.72,,,181.72,Fee Schedule,,36,,,36,Other,186% of Medicaid,214.03,,,214.03,Fee Schedule,,176.08,,,176.08,Fee Schedule,,121.15,,,,Fee Schedule,,214.03,,,214.03,Fee Schedule,,176.08,,,176.08,Fee Schedule,,227.88,,,227.88,Fee Schedule,,198.8,70,,198.8,percent of total billed charges,,232.88,,,232.88,Fee Schedule,,197.38,,,197.38,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,368.91,
CYHTOPATH CONCENTRATE TECH,88108,CPT,,78088108,CDM,311,RC,,,both,,,300,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,153.87,,,153.87,Fee Schedule,,138.54,,,138.54,Fee Schedule,,338.01,,,338.01,Fee Schedule,,304.08,,,304.08,Fee Schedule,,287.43,,,287.43,Fee Schedule,,210,70,,210,percent of total billed charges,All Other,161.03,,,161.03,Fee Schedule,,36,,,36,Other,186% of Medicaid,189.66,,,189.66,Fee Schedule,,186,,,186,Fee Schedule,,107.35,,,,Fee Schedule,,189.66,,,189.66,Fee Schedule,,186,,,186,Fee Schedule,,201.92,,,201.92,Fee Schedule,,210,70,,210,percent of total billed charges,,203.36,,,203.36,Fee Schedule,,172.36,,,172.36,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,338.01,
CP CONCENTR TECH SMEAR,88108,CPT,TC,85088108,CDM,311,RC,,,both,,,300,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,153.87,,,153.87,Fee Schedule,,138.54,,,138.54,Fee Schedule,,338.01,,,338.01,Fee Schedule,,304.08,,,304.08,Fee Schedule,,287.43,,,287.43,Fee Schedule,,210,70,,210,percent of total billed charges,All Other,161.03,,,161.03,Fee Schedule,,36,,,36,Other,186% of Medicaid,189.66,,,189.66,Fee Schedule,,186,,,186,Fee Schedule,,107.35,,,,Fee Schedule,,189.66,,,189.66,Fee Schedule,,186,,,186,Fee Schedule,,201.92,,,201.92,Fee Schedule,,210,70,,210,percent of total billed charges,,203.36,,,203.36,Fee Schedule,,172.36,,,172.36,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,338.01,
CYTOPATH CELL ENHANCE TECH,88112,CPT,,78088112,CDM,311,RC,,,both,,,250,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,135.33,,,135.33,Fee Schedule,,121.84,,,121.84,Fee Schedule,,323.7,,,323.7,Fee Schedule,,291.22,,,291.22,Fee Schedule,,275.27,,,275.27,Fee Schedule,,175,70,,175,percent of total billed charges,All Other,141.62,,,141.62,Fee Schedule,,54,,,54,Other,186% of Medicaid,166.8,,,166.8,Fee Schedule,,155,,,155,Fee Schedule,,94.42,,,,Fee Schedule,,166.8,,,166.8,Fee Schedule,,155,,,155,Fee Schedule,,177.59,,,177.59,Fee Schedule,,175,70,,175,percent of total billed charges,,188.6,,,188.6,Fee Schedule,,159.85,,,159.85,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,29.11,,,29.11,Other,100% of Medicaid,29.11,,,29.11,Other,100% of Medicaid,29.11,,,29.11,Other,100% of Medicaid,29.11,,,29.11,Other,100% of Medicaid,65.49,,,65.49,Other,225% of Medicaid,44.54,,,44.54,Other,153% of Medicaid,65.49,,,65.49,Other,225% of Medicaid,40.75,,,40.75,Other,140% of Medicaid,65.49,,,65.49,Other,225% of Medicaid,75.68,,,75.68,Other,250% of Medicaid,94.31,,,94.31,Other,324% of Medicaid,62.58,,,62.58,Other,215% of Medicaid,62.58,,,62.58,Other,215% of Medicaid,36.39,,,36.39,Other,125% of Medicaid,29.11,323.7,
CYTOPATH CELL ENHANCE TECH,88112,CPT,TC,85088112,CDM,311,RC,,,both,,,250,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,135.33,,,135.33,Fee Schedule,,121.84,,,121.84,Fee Schedule,,323.7,,,323.7,Fee Schedule,,291.22,,,291.22,Fee Schedule,,275.27,,,275.27,Fee Schedule,,175,70,,175,percent of total billed charges,All Other,141.62,,,141.62,Fee Schedule,,54,,,54,Other,186% of Medicaid,166.8,,,166.8,Fee Schedule,,155,,,155,Fee Schedule,,94.42,,,,Fee Schedule,,166.8,,,166.8,Fee Schedule,,155,,,155,Fee Schedule,,177.59,,,177.59,Fee Schedule,,175,70,,175,percent of total billed charges,,188.6,,,188.6,Fee Schedule,,159.85,,,159.85,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,29.11,,,29.11,Other,100% of Medicaid,29.11,,,29.11,Other,100% of Medicaid,29.11,,,29.11,Other,100% of Medicaid,29.11,,,29.11,Other,100% of Medicaid,65.49,,,65.49,Other,225% of Medicaid,44.54,,,44.54,Other,153% of Medicaid,65.49,,,65.49,Other,225% of Medicaid,40.75,,,40.75,Other,140% of Medicaid,65.49,,,65.49,Other,225% of Medicaid,75.68,,,75.68,Other,250% of Medicaid,94.31,,,94.31,Other,324% of Medicaid,62.58,,,62.58,Other,215% of Medicaid,62.58,,,62.58,Other,215% of Medicaid,36.39,,,36.39,Other,125% of Medicaid,29.11,323.7,
SEX CHROMATIN IDENTIFICATION,88130,CPT,,78088130,CDM,311,RC,,,both,,,91,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.12,,,54.12,Fee Schedule,,48.73,,,48.73,Fee Schedule,,116.07,,,116.07,Fee Schedule,,104.42,,,104.42,Fee Schedule,,98.7,,,98.7,Fee Schedule,,63.7,70,,63.7,percent of total billed charges,All Other,56.64,,,56.64,Fee Schedule,,79,,,79,Other,186% of Medicaid,66.71,,,66.71,Fee Schedule,,56.42,,,56.42,Fee Schedule,,37.76,,,,Fee Schedule,,66.71,,,66.71,Fee Schedule,,56.42,,,56.42,Fee Schedule,,71.02,,,71.02,Fee Schedule,,63.7,70,,63.7,percent of total billed charges,,85.21,,,85.21,Fee Schedule,,72.22,,,72.22,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,26.97,,,26.97,Fee Schedule,,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,42.59,,,42.59,Other,100% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,65.16,,,65.16,Other,153% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,59.62,,,59.62,Other,140% of Medicaid,95.82,,,95.82,Other,225% of Medicaid,110.72,,,110.72,Other,250% of Medicaid,137.98,,,137.98,Other,324% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,91.56,,,91.56,Other,215% of Medicaid,53.23,,,53.23,Other,125% of Medicaid,0.01,137.98,
CYTOPATH C/V INTERPRET,88141,CPT,,78088141,CDM,311,RC,,,both,,,143,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.12,,,77.12,Fee Schedule,,69.43,,,69.43,Fee Schedule,,184.73,,,184.73,Fee Schedule,,166.19,,,166.19,Fee Schedule,,157.09,,,157.09,Fee Schedule,,100.1,70,,100.1,percent of total billed charges,All Other,80.7,,,80.7,Fee Schedule,,16,,,16,Other,186% of Medicaid,95.05,,,95.05,Fee Schedule,,88.66,,,88.66,Fee Schedule,,53.8,,,,Fee Schedule,,95.05,,,95.05,Fee Schedule,,88.66,,,88.66,Fee Schedule,,101.2,,,101.2,Fee Schedule,,100.1,70,,100.1,percent of total billed charges,,106.6,,,106.6,Fee Schedule,,90.35,,,90.35,Fee Schedule,,39.53,,,39.53,Fee Schedule,,39.53,,,39.53,Fee Schedule,,39.53,,,39.53,Fee Schedule,,39.53,,,39.53,Fee Schedule,,8.38,,,8.38,Other,100% of Medicaid,8.38,,,8.38,Other,100% of Medicaid,8.38,,,8.38,Other,100% of Medicaid,8.38,,,8.38,Other,100% of Medicaid,18.86,,,18.86,Other,225% of Medicaid,12.83,,,12.83,Other,153% of Medicaid,18.86,,,18.86,Other,225% of Medicaid,11.74,,,11.74,Other,140% of Medicaid,18.86,,,18.86,Other,225% of Medicaid,21.8,,,21.8,Other,250% of Medicaid,27.16,,,27.16,Other,324% of Medicaid,18.02,,,18.02,Other,215% of Medicaid,18.02,,,18.02,Other,215% of Medicaid,10.48,,,10.48,Other,125% of Medicaid,0.01,184.73,
CYTOPATH C/V THIN LAYER,88142,CPT,,78088142,CDM,311,RC,,,both,,,141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,60.98,,,60.98,Fee Schedule,,54.9,,,54.9,Fee Schedule,,156.23,,,156.23,Fee Schedule,,140.55,,,140.55,Fee Schedule,,132.86,,,132.86,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,All Other,63.82,,,63.82,Fee Schedule,,38,,,38,Other,186% of Medicaid,75.16,,,75.16,Fee Schedule,,87.42,,,87.42,Fee Schedule,,42.55,,,,Fee Schedule,,75.16,,,75.16,Fee Schedule,,87.42,,,87.42,Fee Schedule,,80.03,,,80.03,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,,96.01,,,96.01,Fee Schedule,,81.38,,,81.38,Fee Schedule,,30.39,,,30.39,Fee Schedule,,30.39,,,30.39,Fee Schedule,,30.39,,,30.39,Fee Schedule,,30.39,,,30.39,Fee Schedule,,20.26,,,20.26,Other,100% of Medicaid,20.26,,,20.26,Other,100% of Medicaid,20.26,,,20.26,Other,100% of Medicaid,20.26,,,20.26,Other,100% of Medicaid,45.59,,,45.59,Other,225% of Medicaid,31,,,31,Other,153% of Medicaid,45.59,,,45.59,Other,225% of Medicaid,28.36,,,28.36,Other,140% of Medicaid,45.59,,,45.59,Other,225% of Medicaid,52.68,,,52.68,Other,250% of Medicaid,65.64,,,65.64,Other,324% of Medicaid,43.56,,,43.56,Other,215% of Medicaid,43.56,,,43.56,Other,215% of Medicaid,25.33,,,25.33,Other,125% of Medicaid,0.01,156.23,
CYTOPATH C/V REDO,88153,CPT,,78088153,CDM,311,RC,,,both,,,66,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,72.33,,,72.33,Fee Schedule,,65.12,,,65.12,Fee Schedule,,81.49,,,81.49,Fee Schedule,,73.31,,,73.31,Fee Schedule,,69.29,,,69.29,Fee Schedule,,46.2,70,,46.2,percent of total billed charges,All Other,75.69,,,75.69,Fee Schedule,,29,,,29,Other,186% of Medicaid,89.15,,,89.15,Fee Schedule,,40.92,,,40.92,Fee Schedule,,50.46,,,,Fee Schedule,,89.15,,,89.15,Fee Schedule,,40.92,,,40.92,Fee Schedule,,94.92,,,94.92,Fee Schedule,,46.2,70,,46.2,percent of total billed charges,,113.88,,,113.88,Fee Schedule,,96.52,,,96.52,Fee Schedule,,36.05,,,36.05,Fee Schedule,,36.05,,,36.05,Fee Schedule,,36.05,,,36.05,Fee Schedule,,36.05,,,36.05,Fee Schedule,,15.57,,,15.57,Other,100% of Medicaid,15.57,,,15.57,Other,100% of Medicaid,15.57,,,15.57,Other,100% of Medicaid,15.57,,,15.57,Other,100% of Medicaid,35.04,,,35.04,Other,225% of Medicaid,23.83,,,23.83,Other,153% of Medicaid,35.04,,,35.04,Other,225% of Medicaid,21.8,,,21.8,Other,140% of Medicaid,35.04,,,35.04,Other,225% of Medicaid,40.49,,,40.49,Other,250% of Medicaid,50.46,,,50.46,Other,324% of Medicaid,33.48,,,33.48,Other,215% of Medicaid,33.48,,,33.48,Other,215% of Medicaid,19.47,,,19.47,Other,125% of Medicaid,0.01,113.88,
CYTOPATH C/V INDEX ADD-ON,88155,CPT,,78088155,CDM,311,RC,,,both,,,80,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,44.1,,,44.1,Fee Schedule,,39.7,,,39.7,Fee Schedule,,46.25,,,46.25,Fee Schedule,,41.61,,,41.61,Fee Schedule,,39.33,,,39.33,Fee Schedule,,56,70,,56,percent of total billed charges,All Other,46.15,,,46.15,Fee Schedule,,65,,,65,Other,186% of Medicaid,54.35,,,54.35,Fee Schedule,,49.6,,,49.6,Fee Schedule,,30.77,,,,Fee Schedule,,54.35,,,54.35,Fee Schedule,,49.6,,,49.6,Fee Schedule,,57.87,,,57.87,Fee Schedule,,56,70,,56,percent of total billed charges,,69.43,,,69.43,Fee Schedule,,58.84,,,58.84,Fee Schedule,,21.98,,,21.98,Fee Schedule,,21.98,,,21.98,Fee Schedule,,21.98,,,21.98,Fee Schedule,,21.98,,,21.98,Fee Schedule,,34.77,,,34.77,Other,100% of Medicaid,34.77,,,34.77,Other,100% of Medicaid,34.77,,,34.77,Other,100% of Medicaid,34.77,,,34.77,Other,100% of Medicaid,78.24,,,78.24,Other,225% of Medicaid,53.2,,,53.2,Other,153% of Medicaid,78.24,,,78.24,Other,225% of Medicaid,48.68,,,48.68,Other,140% of Medicaid,78.24,,,78.24,Other,225% of Medicaid,90.41,,,90.41,Other,250% of Medicaid,112.67,,,112.67,Other,324% of Medicaid,74.76,,,74.76,Other,215% of Medicaid,74.76,,,74.76,Other,215% of Medicaid,43.47,,,43.47,Other,125% of Medicaid,0.01,112.67,
CP SMR OTHR; SCRN & INT,88160,CPT,TC,85088160,CDM,311,RC,,,both,,,258,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,180.18,,,180.18,Fee Schedule,,162.22,,,162.22,Fee Schedule,,209.5,,,209.5,Fee Schedule,,188.47,,,188.47,Fee Schedule,,178.15,,,178.15,Fee Schedule,,180.6,70,,180.6,percent of total billed charges,All Other,188.56,,,188.56,Fee Schedule,,36,,,36,Other,186% of Medicaid,222.08,,,222.08,Fee Schedule,,159.96,,,159.96,Fee Schedule,,125.71,,,,Fee Schedule,,222.08,,,222.08,Fee Schedule,,159.96,,,159.96,Fee Schedule,,236.45,,,236.45,Fee Schedule,,180.6,70,,180.6,percent of total billed charges,,223.04,,,223.04,Fee Schedule,,189.04,,,189.04,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,236.45,
CYTOPATH SMEAR OTHER SOURCE,88161,CPT,,78088161,CDM,311,RC,,,both,,,258,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,186.71,,,186.71,Fee Schedule,,168.1,,,168.1,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,180.6,70,,180.6,percent of total billed charges,All Other,195.39,,,195.39,Fee Schedule,,36,,,36,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,,159.96,,,159.96,Fee Schedule,,130.26,,,,Fee Schedule,,230.13,,,230.13,Fee Schedule,,159.96,,,159.96,Fee Schedule,,245.02,,,245.02,Fee Schedule,,180.6,70,,180.6,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,245.02,
CYTOPATH SMEAR OTHER SOURCE,88161,CPT,TC,85088161,CDM,311,RC,,,both,,,258,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,186.71,,,186.71,Fee Schedule,,168.1,,,168.1,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,180.6,70,,180.6,percent of total billed charges,All Other,195.39,,,195.39,Fee Schedule,,36,,,36,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,,159.96,,,159.96,Fee Schedule,,130.26,,,,Fee Schedule,,230.13,,,230.13,Fee Schedule,,159.96,,,159.96,Fee Schedule,,245.02,,,245.02,Fee Schedule,,180.6,70,,180.6,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,245.02,
CP SMR OTHR; > 5 SLIDES,88162,CPT,TC,85088162,CDM,311,RC,,,both,,,329,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,297,,,297,Fee Schedule,,267.4,,,267.4,Fee Schedule,,288.03,,,288.03,Fee Schedule,,259.12,,,259.12,Fee Schedule,,244.93,,,244.93,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,310.81,,,310.81,Fee Schedule,,36,,,36,Other,186% of Medicaid,366.07,,,366.07,Fee Schedule,,203.98,,,203.98,Fee Schedule,,207.21,,,,Fee Schedule,,366.07,,,366.07,Fee Schedule,,203.98,,,203.98,Fee Schedule,,389.75,,,389.75,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,,360.8,,,360.8,Fee Schedule,,305.8,,,305.8,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,389.75,
CYTOPATH TBS C/V MANUAL,88164,CPT,,78088164,CDM,311,RC,,,both,,,76,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,53.46,,,53.46,Fee Schedule,,48.13,,,48.13,Fee Schedule,,81.49,,,81.49,Fee Schedule,,73.31,,,73.31,Fee Schedule,,69.29,,,69.29,Fee Schedule,,53.2,70,,53.2,percent of total billed charges,All Other,55.94,,,55.94,Fee Schedule,,28,,,28,Other,186% of Medicaid,65.89,,,65.89,Fee Schedule,,47.12,,,47.12,Fee Schedule,,37.3,,,,Fee Schedule,,65.89,,,65.89,Fee Schedule,,47.12,,,47.12,Fee Schedule,,70.15,,,70.15,Fee Schedule,,53.2,70,,53.2,percent of total billed charges,,75.45,,,75.45,Fee Schedule,,63.94,,,63.94,Fee Schedule,,22.68,,,22.68,Fee Schedule,,22.68,,,22.68,Fee Schedule,,22.68,,,22.68,Fee Schedule,,22.68,,,22.68,Fee Schedule,,14.8,,,14.8,Other,100% of Medicaid,14.8,,,14.8,Other,100% of Medicaid,14.8,,,14.8,Other,100% of Medicaid,14.8,,,14.8,Other,100% of Medicaid,33.29,,,33.29,Other,225% of Medicaid,22.64,,,22.64,Other,153% of Medicaid,33.29,,,33.29,Other,225% of Medicaid,20.72,,,20.72,Other,140% of Medicaid,33.29,,,33.29,Other,225% of Medicaid,38.47,,,38.47,Other,250% of Medicaid,47.94,,,47.94,Other,324% of Medicaid,31.81,,,31.81,Other,215% of Medicaid,31.81,,,31.81,Other,215% of Medicaid,18.5,,,18.5,Other,125% of Medicaid,0.01,81.49,
CYTP DX EVAL FNA LST EA SITE,88172,CPT,,78088172,CDM,311,RC,,,both,,,682,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,71.01,,,71.01,Fee Schedule,,63.93,,,63.93,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,All Other,74.31,,,74.31,Fee Schedule,,145,,,145,Other,186% of Medicaid,87.52,,,87.52,Fee Schedule,,422.84,,,422.84,Fee Schedule,,49.54,,,,Fee Schedule,,87.52,,,87.52,Fee Schedule,,422.84,,,422.84,Fee Schedule,,93.18,,,93.18,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,,93.48,,,93.48,Fee Schedule,,79.23,,,79.23,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,77.8,,,77.8,Other,100% of Medicaid,77.8,,,77.8,Other,100% of Medicaid,77.8,,,77.8,Other,100% of Medicaid,77.8,,,77.8,Other,100% of Medicaid,175.05,,,175.05,Other,225% of Medicaid,119.03,,,119.03,Other,153% of Medicaid,175.05,,,175.05,Other,225% of Medicaid,108.92,,,108.92,Other,140% of Medicaid,175.05,,,175.05,Other,225% of Medicaid,202.28,,,202.28,Other,250% of Medicaid,252.07,,,252.07,Other,324% of Medicaid,167.27,,,167.27,Other,215% of Medicaid,167.27,,,167.27,Other,215% of Medicaid,97.25,,,97.25,Other,125% of Medicaid,49.54,477.4,
CYTP DX EVAL FNA 1ST EA SITE,88172,CPT,TC,85088172,CDM,311,RC,,,both,,,682,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,71.01,,,71.01,Fee Schedule,,63.93,,,63.93,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,All Other,74.31,,,74.31,Fee Schedule,,145,,,145,Other,186% of Medicaid,87.52,,,87.52,Fee Schedule,,422.84,,,422.84,Fee Schedule,,49.54,,,,Fee Schedule,,87.52,,,87.52,Fee Schedule,,422.84,,,422.84,Fee Schedule,,93.18,,,93.18,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,,93.48,,,93.48,Fee Schedule,,79.23,,,79.23,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,77.8,,,77.8,Other,100% of Medicaid,77.8,,,77.8,Other,100% of Medicaid,77.8,,,77.8,Other,100% of Medicaid,77.8,,,77.8,Other,100% of Medicaid,175.05,,,175.05,Other,225% of Medicaid,119.03,,,119.03,Other,153% of Medicaid,175.05,,,175.05,Other,225% of Medicaid,108.92,,,108.92,Other,140% of Medicaid,175.05,,,175.05,Other,225% of Medicaid,202.28,,,202.28,Other,250% of Medicaid,252.07,,,252.07,Other,324% of Medicaid,167.27,,,167.27,Other,215% of Medicaid,167.27,,,167.27,Other,215% of Medicaid,97.25,,,97.25,Other,125% of Medicaid,49.54,477.4,
CYTOPATH EVAL FNA REPORT,88173,CPT,,78088173,CDM,311,RC,,,both,,,540,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,327.52,,,327.52,Fee Schedule,,294.88,,,294.88,Fee Schedule,,485.53,,,485.53,Fee Schedule,,436.8,,,436.8,Fee Schedule,,412.88,,,412.88,Fee Schedule,,378,70,,378,percent of total billed charges,All Other,342.75,,,342.75,Fee Schedule,,36,,,36,Other,186% of Medicaid,403.69,,,403.69,Fee Schedule,,334.8,,,334.8,Fee Schedule,,228.5,,,,Fee Schedule,,403.69,,,403.69,Fee Schedule,,334.8,,,334.8,Fee Schedule,,429.8,,,429.8,Fee Schedule,,378,70,,378,percent of total billed charges,,423.12,,,423.12,Fee Schedule,,358.62,,,358.62,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,485.53,
EVAL OF FNA; INT & REP,88173,CPT,TC,85088173,CDM,311,RC,,,both,,,540,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,327.52,,,327.52,Fee Schedule,,294.88,,,294.88,Fee Schedule,,485.53,,,485.53,Fee Schedule,,436.8,,,436.8,Fee Schedule,,412.88,,,412.88,Fee Schedule,,378,70,,378,percent of total billed charges,All Other,342.75,,,342.75,Fee Schedule,,36,,,36,Other,186% of Medicaid,403.69,,,403.69,Fee Schedule,,334.8,,,334.8,Fee Schedule,,228.5,,,,Fee Schedule,,403.69,,,403.69,Fee Schedule,,334.8,,,334.8,Fee Schedule,,429.8,,,429.8,Fee Schedule,,378,70,,378,percent of total billed charges,,423.12,,,423.12,Fee Schedule,,358.62,,,358.62,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,485.53,
CYTP FNA EVAL EA ADDL,88177,CPT,,78088177,CDM,311,RC,,,both,,,91,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.24,,,27.24,Fee Schedule,,24.53,,,24.53,Fee Schedule,,45.32,,,45.32,Fee Schedule,,40.77,,,40.77,Fee Schedule,,38.54,,,38.54,Fee Schedule,,63.7,70,,63.7,percent of total billed charges,All Other,28.51,,,28.51,Fee Schedule,,135,,,135,Other,186% of Medicaid,33.58,,,33.58,Fee Schedule,,56.42,,,56.42,Fee Schedule,,19.01,,,,Fee Schedule,,33.58,,,33.58,Fee Schedule,,56.42,,,56.42,Fee Schedule,,35.75,,,35.75,Fee Schedule,,63.7,70,,63.7,percent of total billed charges,,34.44,,,34.44,Fee Schedule,,29.19,,,29.19,Fee Schedule,,10.83,,,10.83,Fee Schedule,,10.83,,,10.83,Fee Schedule,,10.83,,,10.83,Fee Schedule,,10.83,,,10.83,Fee Schedule,,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,111.42,,,111.42,Other,153% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,101.95,,,101.95,Other,140% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,189.34,,,189.34,Other,250% of Medicaid,235.95,,,235.95,Other,324% of Medicaid,156.57,,,156.57,Other,215% of Medicaid,156.57,,,156.57,Other,215% of Medicaid,91.03,,,91.03,Other,125% of Medicaid,0.01,235.95,
CYTP FNA EVAL EA ADDL,88177,CPT,TC,85088177,CDM,311,RC,,,both,,,91,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,27.24,,,27.24,Fee Schedule,,24.53,,,24.53,Fee Schedule,,45.32,,,45.32,Fee Schedule,,40.77,,,40.77,Fee Schedule,,38.54,,,38.54,Fee Schedule,,63.7,70,,63.7,percent of total billed charges,All Other,28.51,,,28.51,Fee Schedule,,135,,,135,Other,186% of Medicaid,33.58,,,33.58,Fee Schedule,,56.42,,,56.42,Fee Schedule,,19.01,,,,Fee Schedule,,33.58,,,33.58,Fee Schedule,,56.42,,,56.42,Fee Schedule,,35.75,,,35.75,Fee Schedule,,63.7,70,,63.7,percent of total billed charges,,34.44,,,34.44,Fee Schedule,,29.19,,,29.19,Fee Schedule,,10.83,,,10.83,Fee Schedule,,10.83,,,10.83,Fee Schedule,,10.83,,,10.83,Fee Schedule,,10.83,,,10.83,Fee Schedule,,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,111.42,,,111.42,Other,153% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,101.95,,,101.95,Other,140% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,189.34,,,189.34,Other,250% of Medicaid,235.95,,,235.95,Other,324% of Medicaid,156.57,,,156.57,Other,215% of Medicaid,156.57,,,156.57,Other,215% of Medicaid,91.03,,,91.03,Other,125% of Medicaid,0.01,235.95,
CELL MARKER STUDY,88182,CPT,,78088182,CDM,311,RC,,,both,,,481,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,425.95,,,425.95,Fee Schedule,,383.49,,,383.49,Fee Schedule,,485.75,,,485.75,Fee Schedule,,437,,,437,Fee Schedule,,413.06,,,413.06,Fee Schedule,,336.7,70,,336.7,percent of total billed charges,All Other,445.76,,,445.76,Fee Schedule,,135,,,135,Other,186% of Medicaid,525,,,525,Fee Schedule,,298.22,,,298.22,Fee Schedule,,297.17,,,,Fee Schedule,,525,,,525,Fee Schedule,,298.22,,,298.22,Fee Schedule,,558.96,,,558.96,Fee Schedule,,336.7,70,,336.7,percent of total billed charges,,524.8,,,524.8,Fee Schedule,,444.8,,,444.8,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,72.82,,,72.82,Other,100% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,111.42,,,111.42,Other,153% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,101.95,,,101.95,Other,140% of Medicaid,163.85,,,163.85,Other,225% of Medicaid,189.34,,,189.34,Other,250% of Medicaid,235.95,,,235.95,Other,324% of Medicaid,156.57,,,156.57,Other,215% of Medicaid,156.57,,,156.57,Other,215% of Medicaid,91.03,,,91.03,Other,125% of Medicaid,59.54,558.96,
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,,78088184,CDM,311,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,255.4,,,255.4,Fee Schedule,,229.94,,,229.94,Fee Schedule,,587.84,,,587.84,Fee Schedule,,528.84,,,528.84,Fee Schedule,,499.88,,,499.88,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,267.28,,,267.28,Fee Schedule,,44,,,44,Other,186% of Medicaid,314.79,,,314.79,Fee Schedule,,453.22,,,453.22,Fee Schedule,,178.19,,,,Fee Schedule,,314.79,,,314.79,Fee Schedule,,453.22,,,453.22,Fee Schedule,,335.16,,,335.16,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,35.8,,,35.8,Other,153% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,32.76,,,32.76,Other,140% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,60.84,,,60.84,Other,250% of Medicaid,75.82,,,75.82,Other,324% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,29.25,,,29.25,Other,125% of Medicaid,23.4,649.53,
FLOW CYTOMETRY TC 1ST MARKER,88184,CPT,TC,85088184,CDM,311,RC,,,both,,,731,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,255.4,,,255.4,Fee Schedule,,229.94,,,229.94,Fee Schedule,,587.84,,,587.84,Fee Schedule,,528.84,,,528.84,Fee Schedule,,499.88,,,499.88,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,All Other,267.28,,,267.28,Fee Schedule,,44,,,44,Other,186% of Medicaid,314.79,,,314.79,Fee Schedule,,453.22,,,453.22,Fee Schedule,,178.19,,,,Fee Schedule,,314.79,,,314.79,Fee Schedule,,453.22,,,453.22,Fee Schedule,,335.16,,,335.16,Fee Schedule,,511.7,70,,511.7,percent of total billed charges,,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,23.4,,,23.4,Other,100% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,35.8,,,35.8,Other,153% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,32.76,,,32.76,Other,140% of Medicaid,52.65,,,52.65,Other,225% of Medicaid,60.84,,,60.84,Other,250% of Medicaid,75.82,,,75.82,Other,324% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,50.31,,,50.31,Other,215% of Medicaid,29.25,,,29.25,Other,125% of Medicaid,23.4,649.53,
FLOWCYTOMETRY/TC ADD-ON,88185,CPT,,78088185,CDM,311,RC,,,both,,,270,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.39,,,77.39,Fee Schedule,,69.67,,,69.67,Fee Schedule,,352.25,,,352.25,Fee Schedule,,316.9,,,316.9,Fee Schedule,,299.54,,,299.54,Fee Schedule,,189,70,,189,percent of total billed charges,All Other,80.99,,,80.99,Fee Schedule,,29,,,29,Other,186% of Medicaid,95.38,,,95.38,Fee Schedule,,167.4,,,167.4,Fee Schedule,,53.99,,,,Fee Schedule,,95.38,,,95.38,Fee Schedule,,167.4,,,167.4,Fee Schedule,,101.55,,,101.55,Fee Schedule,,189,70,,189,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,33.57,,,33.57,Fee Schedule,,33.57,,,33.57,Fee Schedule,,33.57,,,33.57,Fee Schedule,,33.57,,,33.57,Fee Schedule,,15.6,,,15.6,Other,100% of Medicaid,15.6,,,15.6,Other,100% of Medicaid,15.6,,,15.6,Other,100% of Medicaid,15.6,,,15.6,Other,100% of Medicaid,35.11,,,35.11,Other,225% of Medicaid,23.87,,,23.87,Other,153% of Medicaid,35.11,,,35.11,Other,225% of Medicaid,21.85,,,21.85,Other,140% of Medicaid,35.11,,,35.11,Other,225% of Medicaid,40.57,,,40.57,Other,250% of Medicaid,50.56,,,50.56,Other,324% of Medicaid,33.55,,,33.55,Other,215% of Medicaid,33.55,,,33.55,Other,215% of Medicaid,19.51,,,19.51,Other,125% of Medicaid,0.01,352.25,
FLOW CYTOMETRY EA ADDTL MARKER,88185,CPT,TC,85088185,CDM,311,RC,,,both,,,270,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.39,,,77.39,Fee Schedule,,69.67,,,69.67,Fee Schedule,,352.25,,,352.25,Fee Schedule,,316.9,,,316.9,Fee Schedule,,299.54,,,299.54,Fee Schedule,,189,70,,189,percent of total billed charges,All Other,80.99,,,80.99,Fee Schedule,,29,,,29,Other,186% of Medicaid,95.38,,,95.38,Fee Schedule,,167.4,,,167.4,Fee Schedule,,53.99,,,,Fee Schedule,,95.38,,,95.38,Fee Schedule,,167.4,,,167.4,Fee Schedule,,101.55,,,101.55,Fee Schedule,,189,70,,189,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,33.57,,,33.57,Fee Schedule,,33.57,,,33.57,Fee Schedule,,33.57,,,33.57,Fee Schedule,,33.57,,,33.57,Fee Schedule,,15.6,,,15.6,Other,100% of Medicaid,15.6,,,15.6,Other,100% of Medicaid,15.6,,,15.6,Other,100% of Medicaid,15.6,,,15.6,Other,100% of Medicaid,35.11,,,35.11,Other,225% of Medicaid,23.87,,,23.87,Other,153% of Medicaid,35.11,,,35.11,Other,225% of Medicaid,21.85,,,21.85,Other,140% of Medicaid,35.11,,,35.11,Other,225% of Medicaid,40.57,,,40.57,Other,250% of Medicaid,50.56,,,50.56,Other,324% of Medicaid,33.55,,,33.55,Other,215% of Medicaid,33.55,,,33.55,Other,215% of Medicaid,19.51,,,19.51,Other,125% of Medicaid,0.01,352.25,
FLOWCYTOMETRY/READ 2-8,88187,CPT,,78088187,CDM,311,RC,,,both,,,338,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.56,,,110.56,Fee Schedule,,99.54,,,99.54,Fee Schedule,,416.64,,,416.64,Fee Schedule,,374.83,,,374.83,Fee Schedule,,354.3,,,354.3,Fee Schedule,,236.6,70,,236.6,percent of total billed charges,All Other,115.7,,,115.7,Fee Schedule,,38,,,38,Other,186% of Medicaid,136.27,,,136.27,Fee Schedule,,209.56,,,209.56,Fee Schedule,,77.13,,,,Fee Schedule,,136.27,,,136.27,Fee Schedule,,209.56,,,209.56,Fee Schedule,,145.08,,,145.08,Fee Schedule,,236.6,70,,236.6,percent of total billed charges,,170.56,,,170.56,Fee Schedule,,144.56,,,144.56,Fee Schedule,,59.01,,,59.01,Fee Schedule,,59.01,,,59.01,Fee Schedule,,59.01,,,59.01,Fee Schedule,,59.01,,,59.01,Fee Schedule,,20.2,,,20.2,Other,100% of Medicaid,20.2,,,20.2,Other,100% of Medicaid,20.2,,,20.2,Other,100% of Medicaid,20.2,,,20.2,Other,100% of Medicaid,45.45,,,45.45,Other,225% of Medicaid,30.91,,,30.91,Other,153% of Medicaid,45.45,,,45.45,Other,225% of Medicaid,28.28,,,28.28,Other,140% of Medicaid,45.45,,,45.45,Other,225% of Medicaid,52.52,,,52.52,Other,250% of Medicaid,65.45,,,65.45,Other,324% of Medicaid,43.43,,,43.43,Other,215% of Medicaid,43.43,,,43.43,Other,215% of Medicaid,25.25,,,25.25,Other,125% of Medicaid,0.01,416.64,
FLOW CYTOMETRY INTERP 2-8 MARKERS,88187,CPT,TC,85088187,CDM,311,RC,,,both,,,338,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.56,,,110.56,Fee Schedule,,99.54,,,99.54,Fee Schedule,,416.64,,,416.64,Fee Schedule,,374.83,,,374.83,Fee Schedule,,354.3,,,354.3,Fee Schedule,,236.6,70,,236.6,percent of total billed charges,All Other,115.7,,,115.7,Fee Schedule,,38,,,38,Other,186% of Medicaid,136.27,,,136.27,Fee Schedule,,209.56,,,209.56,Fee Schedule,,77.13,,,,Fee Schedule,,136.27,,,136.27,Fee Schedule,,209.56,,,209.56,Fee Schedule,,145.08,,,145.08,Fee Schedule,,236.6,70,,236.6,percent of total billed charges,,170.56,,,170.56,Fee Schedule,,144.56,,,144.56,Fee Schedule,,59.01,,,59.01,Fee Schedule,,59.01,,,59.01,Fee Schedule,,59.01,,,59.01,Fee Schedule,,59.01,,,59.01,Fee Schedule,,20.2,,,20.2,Other,100% of Medicaid,20.2,,,20.2,Other,100% of Medicaid,20.2,,,20.2,Other,100% of Medicaid,20.2,,,20.2,Other,100% of Medicaid,45.45,,,45.45,Other,225% of Medicaid,30.91,,,30.91,Other,153% of Medicaid,45.45,,,45.45,Other,225% of Medicaid,28.28,,,28.28,Other,140% of Medicaid,45.45,,,45.45,Other,225% of Medicaid,52.52,,,52.52,Other,250% of Medicaid,65.45,,,65.45,Other,324% of Medicaid,43.43,,,43.43,Other,215% of Medicaid,43.43,,,43.43,Other,215% of Medicaid,25.25,,,25.25,Other,125% of Medicaid,0.01,416.64,
FLOWCYTOMETRY/READ 9-15,88188,CPT,,78088188,CDM,311,RC,,,both,,,417,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,191.17,,,191.17,Fee Schedule,,172.11,,,172.11,Fee Schedule,,517.04,,,517.04,Fee Schedule,,465.15,,,465.15,Fee Schedule,,439.67,,,439.67,Fee Schedule,,291.9,70,,291.9,percent of total billed charges,All Other,200.06,,,200.06,Fee Schedule,,47,,,47,Other,186% of Medicaid,235.62,,,235.62,Fee Schedule,,258.54,,,258.54,Fee Schedule,,133.37,,,,Fee Schedule,,235.62,,,235.62,Fee Schedule,,258.54,,,258.54,Fee Schedule,,250.86,,,250.86,Fee Schedule,,291.9,70,,291.9,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,99.06,,,99.06,Fee Schedule,,99.06,,,99.06,Fee Schedule,,99.06,,,99.06,Fee Schedule,,99.06,,,99.06,Fee Schedule,,25.25,,,25.25,Other,100% of Medicaid,25.25,,,25.25,Other,100% of Medicaid,25.25,,,25.25,Other,100% of Medicaid,25.25,,,25.25,Other,100% of Medicaid,56.81,,,56.81,Other,225% of Medicaid,38.63,,,38.63,Other,153% of Medicaid,56.81,,,56.81,Other,225% of Medicaid,35.35,,,35.35,Other,140% of Medicaid,56.81,,,56.81,Other,225% of Medicaid,65.65,,,65.65,Other,250% of Medicaid,81.81,,,81.81,Other,324% of Medicaid,54.29,,,54.29,Other,215% of Medicaid,54.29,,,54.29,Other,215% of Medicaid,31.56,,,31.56,Other,125% of Medicaid,0.01,517.04,
FLOW CYTOMETRY INTERP 16&> MAR,88189,CPT,,78088189,CDM,311,RC,,,both,,,189,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,258.29,,,258.29,Fee Schedule,,232.55,,,232.55,Fee Schedule,,629.98,,,629.98,Fee Schedule,,566.75,,,566.75,Fee Schedule,,535.71,,,535.71,Fee Schedule,,132.3,70,,132.3,percent of total billed charges,All Other,270.3,,,270.3,Fee Schedule,,56,,,56,Other,186% of Medicaid,318.36,,,318.36,Fee Schedule,,117.18,,,117.18,Fee Schedule,,180.2,,,,Fee Schedule,,318.36,,,318.36,Fee Schedule,,117.18,,,117.18,Fee Schedule,,338.95,,,338.95,Fee Schedule,,132.3,70,,132.3,percent of total billed charges,,400.16,,,400.16,Fee Schedule,,339.16,,,339.16,Fee Schedule,,133.17,,,133.17,Fee Schedule,,133.17,,,133.17,Fee Schedule,,133.17,,,133.17,Fee Schedule,,133.17,,,133.17,Fee Schedule,,30.3,,,30.3,Other,100% of Medicaid,30.3,,,30.3,Other,100% of Medicaid,30.3,,,30.3,Other,100% of Medicaid,30.3,,,30.3,Other,100% of Medicaid,68.18,,,68.18,Other,225% of Medicaid,46.36,,,46.36,Other,153% of Medicaid,68.18,,,68.18,Other,225% of Medicaid,42.42,,,42.42,Other,140% of Medicaid,68.18,,,68.18,Other,225% of Medicaid,78.78,,,78.78,Other,250% of Medicaid,98.17,,,98.17,Other,324% of Medicaid,65.15,,,65.15,Other,215% of Medicaid,65.15,,,65.15,Other,215% of Medicaid,37.88,,,37.88,Other,125% of Medicaid,0.01,629.98,
TISSUE CULTURE LYMPHOCYTE,88230,CPT,,78088230,CDM,311,RC,,,both,,,601,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,350.63,,,350.63,Fee Schedule,,315.69,,,315.69,Fee Schedule,,158.43,,,158.43,Fee Schedule,,142.53,,,142.53,Fee Schedule,,134.72,,,134.72,Fee Schedule,,420.7,70,,420.7,percent of total billed charges,All Other,366.94,,,366.94,Fee Schedule,,75,,,75,Other,186% of Medicaid,432.18,,,432.18,Fee Schedule,,372.62,,,372.62,Fee Schedule,,244.63,,,,Fee Schedule,,432.18,,,432.18,Fee Schedule,,372.62,,,372.62,Fee Schedule,,460.14,,,460.14,Fee Schedule,,420.7,70,,420.7,percent of total billed charges,,552.05,,,552.05,Fee Schedule,,467.9,,,467.9,Fee Schedule,,174.74,,,174.74,Fee Schedule,,174.74,,,174.74,Fee Schedule,,174.74,,,174.74,Fee Schedule,,174.74,,,174.74,Fee Schedule,,40.4,,,40.4,Other,100% of Medicaid,40.4,,,40.4,Other,100% of Medicaid,40.4,,,40.4,Other,100% of Medicaid,40.4,,,40.4,Other,100% of Medicaid,90.9,,,90.9,Other,225% of Medicaid,61.81,,,61.81,Other,153% of Medicaid,90.9,,,90.9,Other,225% of Medicaid,56.56,,,56.56,Other,140% of Medicaid,90.9,,,90.9,Other,225% of Medicaid,105.04,,,105.04,Other,250% of Medicaid,130.9,,,130.9,Other,324% of Medicaid,86.86,,,86.86,Other,215% of Medicaid,86.86,,,86.86,Other,215% of Medicaid,50.5,,,50.5,Other,125% of Medicaid,0.01,552.05,
TISSUE CULTURE SKIN/BIOPSY,88233,CPT,,78088233,CDM,311,RC,,,both,,,865,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,423.6,,,423.6,Fee Schedule,,381.38,,,381.38,Fee Schedule,,198.32,,,198.32,Fee Schedule,,178.42,,,178.42,Fee Schedule,,168.65,,,168.65,Fee Schedule,,605.5,70,,605.5,percent of total billed charges,All Other,443.3,,,443.3,Fee Schedule,,248,,,248,Other,186% of Medicaid,522.11,,,522.11,Fee Schedule,,536.3,,,536.3,Fee Schedule,,295.53,,,,Fee Schedule,,522.11,,,522.11,Fee Schedule,,536.3,,,536.3,Fee Schedule,,555.88,,,555.88,Fee Schedule,,605.5,70,,605.5,percent of total billed charges,,666.92,,,666.92,Fee Schedule,,565.26,,,565.26,Fee Schedule,,211.1,,,211.1,Fee Schedule,,211.1,,,211.1,Fee Schedule,,211.1,,,211.1,Fee Schedule,,211.1,,,211.1,Fee Schedule,,133.23,,,133.23,Other,100% of Medicaid,133.23,,,133.23,Other,100% of Medicaid,133.23,,,133.23,Other,100% of Medicaid,133.23,,,133.23,Other,100% of Medicaid,299.77,,,299.77,Other,225% of Medicaid,203.84,,,203.84,Other,153% of Medicaid,299.77,,,299.77,Other,225% of Medicaid,186.52,,,186.52,Other,140% of Medicaid,299.77,,,299.77,Other,225% of Medicaid,346.4,,,346.4,Other,250% of Medicaid,431.66,,,431.66,Other,324% of Medicaid,286.44,,,286.44,Other,215% of Medicaid,286.44,,,286.44,Other,215% of Medicaid,166.54,,,166.54,Other,125% of Medicaid,0.01,666.92,
TISSSUE CULTURE BONE MARROW,88237,CPT,,78088237,CDM,311,RC,,,both,,,798,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,432.69,,,432.69,Fee Schedule,,389.56,,,389.56,Fee Schedule,,198.32,,,198.32,Fee Schedule,,178.42,,,178.42,Fee Schedule,,168.65,,,168.65,Fee Schedule,,558.6,70,,558.6,percent of total billed charges,All Other,452.81,,,452.81,Fee Schedule,,188,,,188,Other,186% of Medicaid,533.31,,,533.31,Fee Schedule,,494.76,,,494.76,Fee Schedule,,301.88,,,,Fee Schedule,,533.31,,,533.31,Fee Schedule,,494.76,,,494.76,Fee Schedule,,567.81,,,567.81,Fee Schedule,,558.6,70,,558.6,percent of total billed charges,,681.24,,,681.24,Fee Schedule,,577.39,,,577.39,Fee Schedule,,215.63,,,215.63,Fee Schedule,,215.63,,,215.63,Fee Schedule,,215.63,,,215.63,Fee Schedule,,215.63,,,215.63,Fee Schedule,,101.03,,,101.03,Other,100% of Medicaid,101.03,,,101.03,Other,100% of Medicaid,101.03,,,101.03,Other,100% of Medicaid,101.03,,,101.03,Other,100% of Medicaid,227.32,,,227.32,Other,225% of Medicaid,154.58,,,154.58,Other,153% of Medicaid,227.32,,,227.32,Other,225% of Medicaid,141.44,,,141.44,Other,140% of Medicaid,227.32,,,227.32,Other,225% of Medicaid,262.68,,,262.68,Other,250% of Medicaid,327.34,,,327.34,Other,324% of Medicaid,217.22,,,217.22,Other,215% of Medicaid,217.22,,,217.22,Other,215% of Medicaid,126.29,,,126.29,Other,125% of Medicaid,0.01,681.24,
TISSUE CULTURE; BM BLD CELLS,88237,CPT,TC,85088237,CDM,311,RC,,,both,,,798,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,432.69,,,432.69,Fee Schedule,,389.56,,,389.56,Fee Schedule,,198.32,,,198.32,Fee Schedule,,178.42,,,178.42,Fee Schedule,,168.65,,,168.65,Fee Schedule,,558.6,70,,558.6,percent of total billed charges,All Other,452.81,,,452.81,Fee Schedule,,188,,,188,Other,186% of Medicaid,533.31,,,533.31,Fee Schedule,,494.76,,,494.76,Fee Schedule,,301.88,,,,Fee Schedule,,533.31,,,533.31,Fee Schedule,,494.76,,,494.76,Fee Schedule,,567.81,,,567.81,Fee Schedule,,558.6,70,,558.6,percent of total billed charges,,681.24,,,681.24,Fee Schedule,,577.39,,,577.39,Fee Schedule,,215.63,,,215.63,Fee Schedule,,215.63,,,215.63,Fee Schedule,,215.63,,,215.63,Fee Schedule,,215.63,,,215.63,Fee Schedule,,101.03,,,101.03,Other,100% of Medicaid,101.03,,,101.03,Other,100% of Medicaid,101.03,,,101.03,Other,100% of Medicaid,101.03,,,101.03,Other,100% of Medicaid,227.32,,,227.32,Other,225% of Medicaid,154.58,,,154.58,Other,153% of Medicaid,227.32,,,227.32,Other,225% of Medicaid,141.44,,,141.44,Other,140% of Medicaid,227.32,,,227.32,Other,225% of Medicaid,262.68,,,262.68,Other,250% of Medicaid,327.34,,,327.34,Other,324% of Medicaid,217.22,,,217.22,Other,215% of Medicaid,217.22,,,217.22,Other,215% of Medicaid,126.29,,,126.29,Other,125% of Medicaid,0.01,681.24,
TISSUE CULTURE TUMOR,88239,CPT,,78088239,CDM,311,RC,,,both,,,762,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,444.04,,,444.04,Fee Schedule,,399.78,,,399.78,Fee Schedule,,158.43,,,158.43,Fee Schedule,,142.53,,,142.53,Fee Schedule,,134.72,,,134.72,Fee Schedule,,533.4,70,,533.4,percent of total billed charges,All Other,464.69,,,464.69,Fee Schedule,,248,,,248,Other,186% of Medicaid,547.3,,,547.3,Fee Schedule,,472.44,,,472.44,Fee Schedule,,309.79,,,,Fee Schedule,,547.3,,,547.3,Fee Schedule,,472.44,,,472.44,Fee Schedule,,582.7,,,582.7,Fee Schedule,,533.4,70,,533.4,percent of total billed charges,,699.1,,,699.1,Fee Schedule,,592.53,,,592.53,Fee Schedule,,221.28,,,221.28,Fee Schedule,,221.28,,,221.28,Fee Schedule,,221.28,,,221.28,Fee Schedule,,221.28,,,221.28,Fee Schedule,,133.23,,,133.23,Other,100% of Medicaid,133.23,,,133.23,Other,100% of Medicaid,133.23,,,133.23,Other,100% of Medicaid,133.23,,,133.23,Other,100% of Medicaid,299.77,,,299.77,Other,225% of Medicaid,203.84,,,203.84,Other,153% of Medicaid,299.77,,,299.77,Other,225% of Medicaid,186.52,,,186.52,Other,140% of Medicaid,299.77,,,299.77,Other,225% of Medicaid,346.4,,,346.4,Other,250% of Medicaid,431.66,,,431.66,Other,324% of Medicaid,286.44,,,286.44,Other,215% of Medicaid,286.44,,,286.44,Other,215% of Medicaid,166.54,,,166.54,Other,125% of Medicaid,0.01,699.1,
CHROMOSOME ANALYSIS 45,88263,CPT,,78088263,CDM,311,RC,,,both,,,474,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,452.37,,,452.37,Fee Schedule,,407.29,,,407.29,Fee Schedule,,1158.91,,,1158.91,Fee Schedule,,1042.6,,,1042.6,Fee Schedule,,985.5,,,985.5,Fee Schedule,,331.8,70,,331.8,percent of total billed charges,All Other,473.41,,,473.41,Fee Schedule,,188,,,188,Other,186% of Medicaid,557.58,,,557.58,Fee Schedule,,293.88,,,293.88,Fee Schedule,,315.61,,,,Fee Schedule,,557.58,,,557.58,Fee Schedule,,293.88,,,293.88,Fee Schedule,,593.65,,,593.65,Fee Schedule,,331.8,70,,331.8,percent of total billed charges,,712.23,,,712.23,Fee Schedule,,603.66,,,603.66,Fee Schedule,,225.44,,,225.44,Fee Schedule,,225.44,,,225.44,Fee Schedule,,225.44,,,225.44,Fee Schedule,,225.44,,,225.44,Fee Schedule,,101,,,101,Other,100% of Medicaid,101,,,101,Other,100% of Medicaid,101,,,101,Other,100% of Medicaid,101,,,101,Other,100% of Medicaid,227.25,,,227.25,Other,225% of Medicaid,154.53,,,154.53,Other,153% of Medicaid,227.25,,,227.25,Other,225% of Medicaid,141.4,,,141.4,Other,140% of Medicaid,227.25,,,227.25,Other,225% of Medicaid,262.6,,,262.6,Other,250% of Medicaid,327.24,,,327.24,Other,324% of Medicaid,217.15,,,217.15,Other,215% of Medicaid,217.15,,,217.15,Other,215% of Medicaid,126.25,,,126.25,Other,125% of Medicaid,0.01,1158.91,
CHROM ANALY; 20-25 CELLS,88264,CPT,TC,85088264,CDM,311,RC,,,both,,,1316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,435.28,,,435.28,Fee Schedule,,391.89,,,391.89,Fee Schedule,,961.19,,,961.19,Fee Schedule,,864.72,,,864.72,Fee Schedule,,817.36,,,817.36,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,All Other,455.52,,,455.52,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,536.5,,,536.5,Fee Schedule,,815.92,,,815.92,Fee Schedule,,303.68,,,,Fee Schedule,,536.5,,,536.5,Fee Schedule,,815.92,,,815.92,Fee Schedule,,571.21,,,571.21,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,,685.31,,,685.31,Fee Schedule,,580.84,,,580.84,Fee Schedule,,216.92,,,216.92,Fee Schedule,,216.92,,,216.92,Fee Schedule,,216.92,,,216.92,Fee Schedule,,216.92,,,216.92,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,961.19,
CHROM ANALY SITU AF CELLS FROM,88269,CPT,,78088269,CDM,311,RC,,,both,,,856,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,522.72,,,522.72,Fee Schedule,,470.62,,,470.62,Fee Schedule,,934.67,,,934.67,Fee Schedule,,840.86,,,840.86,Fee Schedule,,794.81,,,794.81,Fee Schedule,,599.2,70,,599.2,percent of total billed charges,All Other,547.03,,,547.03,Fee Schedule,,141,,,141,Other,186% of Medicaid,644.28,,,644.28,Fee Schedule,,530.72,,,530.72,Fee Schedule,,364.69,,,,Fee Schedule,,644.28,,,644.28,Fee Schedule,,530.72,,,530.72,Fee Schedule,,685.96,,,685.96,Fee Schedule,,599.2,70,,599.2,percent of total billed charges,,822.98,,,822.98,Fee Schedule,,697.53,,,697.53,Fee Schedule,,260.49,,,260.49,Fee Schedule,,260.49,,,260.49,Fee Schedule,,260.49,,,260.49,Fee Schedule,,260.49,,,260.49,Fee Schedule,,75.75,,,75.75,Other,100% of Medicaid,75.75,,,75.75,Other,100% of Medicaid,75.75,,,75.75,Other,100% of Medicaid,75.75,,,75.75,Other,100% of Medicaid,170.44,,,170.44,Other,225% of Medicaid,115.9,,,115.9,Other,153% of Medicaid,170.44,,,170.44,Other,225% of Medicaid,106.05,,,106.05,Other,140% of Medicaid,170.44,,,170.44,Other,225% of Medicaid,196.95,,,196.95,Other,250% of Medicaid,245.43,,,245.43,Other,324% of Medicaid,162.86,,,162.86,Other,215% of Medicaid,162.86,,,162.86,Other,215% of Medicaid,94.69,,,94.69,Other,125% of Medicaid,0.01,934.67,
CYTOGENETICS DNA PROBE,88271,CPT,,78088271,CDM,311,RC,,,both,,,1019,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,64.47,,,64.47,Fee Schedule,,58.05,,,58.05,Fee Schedule,,139.58,,,139.58,Fee Schedule,,125.57,,,125.57,Fee Schedule,,118.69,,,118.69,Fee Schedule,,713.3,70,,713.3,percent of total billed charges,All Other,67.47,,,67.47,Fee Schedule,,40,,,40,Other,186% of Medicaid,79.47,,,79.47,Fee Schedule,,631.78,,,631.78,Fee Schedule,,44.98,,,,Fee Schedule,,79.47,,,79.47,Fee Schedule,,631.78,,,631.78,Fee Schedule,,84.61,,,84.61,Fee Schedule,,713.3,70,,713.3,percent of total billed charges,,101.51,,,101.51,Fee Schedule,,86.04,,,86.04,Fee Schedule,,32.13,,,32.13,Fee Schedule,,32.13,,,32.13,Fee Schedule,,32.13,,,32.13,Fee Schedule,,32.13,,,32.13,Fee Schedule,,21.42,,,21.42,Other,100% of Medicaid,21.42,,,21.42,Other,100% of Medicaid,21.42,,,21.42,Other,100% of Medicaid,21.42,,,21.42,Other,100% of Medicaid,48.2,,,48.2,Other,225% of Medicaid,32.77,,,32.77,Other,153% of Medicaid,48.2,,,48.2,Other,225% of Medicaid,29.99,,,29.99,Other,140% of Medicaid,48.2,,,48.2,Other,225% of Medicaid,55.69,,,55.69,Other,250% of Medicaid,69.4,,,69.4,Other,324% of Medicaid,46.05,,,46.05,Other,215% of Medicaid,46.05,,,46.05,Other,215% of Medicaid,26.78,,,26.78,Other,125% of Medicaid,0.01,713.3,
CYTOGENETICS 10-30,88273,CPT,,78088273,CDM,311,RC,,,both,,,170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,104.78,,,104.78,Fee Schedule,,94.34,,,94.34,Fee Schedule,,223.2,,,223.2,Fee Schedule,,200.8,,,200.8,Fee Schedule,,189.8,,,189.8,Fee Schedule,,119,70,,119,percent of total billed charges,All Other,109.65,,,109.65,Fee Schedule,,65,,,65,Other,186% of Medicaid,129.15,,,129.15,Fee Schedule,,105.4,,,105.4,Fee Schedule,,73.1,,,,Fee Schedule,,129.15,,,129.15,Fee Schedule,,105.4,,,105.4,Fee Schedule,,137.5,,,137.5,Fee Schedule,,119,70,,119,percent of total billed charges,,164.97,,,164.97,Fee Schedule,,139.82,,,139.82,Fee Schedule,,52.22,,,52.22,Fee Schedule,,52.22,,,52.22,Fee Schedule,,52.22,,,52.22,Fee Schedule,,52.22,,,52.22,Fee Schedule,,34.81,,,34.81,Other,100% of Medicaid,34.81,,,34.81,Other,100% of Medicaid,34.81,,,34.81,Other,100% of Medicaid,34.81,,,34.81,Other,100% of Medicaid,78.32,,,78.32,Other,225% of Medicaid,53.26,,,53.26,Other,153% of Medicaid,78.32,,,78.32,Other,225% of Medicaid,48.73,,,48.73,Other,140% of Medicaid,78.32,,,78.32,Other,225% of Medicaid,90.51,,,90.51,Other,250% of Medicaid,112.78,,,112.78,Other,324% of Medicaid,74.84,,,74.84,Other,215% of Medicaid,74.84,,,74.84,Other,215% of Medicaid,43.51,,,43.51,Other,125% of Medicaid,0.01,223.2,
CYTOGENETICS 100-300,88275,CPT,,78088275,CDM,311,RC,,,both,,,239,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,154.08,,,154.08,Fee Schedule,,138.72,,,138.72,Fee Schedule,,309.67,,,309.67,Fee Schedule,,278.59,,,278.59,Fee Schedule,,263.34,,,263.34,Fee Schedule,,167.3,70,,167.3,percent of total billed charges,All Other,161.25,,,161.25,Fee Schedule,,95,,,95,Other,186% of Medicaid,189.91,,,189.91,Fee Schedule,,148.18,,,148.18,Fee Schedule,,107.5,,,,Fee Schedule,,189.91,,,189.91,Fee Schedule,,148.18,,,148.18,Fee Schedule,,202.2,,,202.2,Fee Schedule,,167.3,70,,167.3,percent of total billed charges,,242.59,,,242.59,Fee Schedule,,205.61,,,205.61,Fee Schedule,,76.79,,,76.79,Fee Schedule,,76.79,,,76.79,Fee Schedule,,76.79,,,76.79,Fee Schedule,,76.79,,,76.79,Fee Schedule,,51.19,,,51.19,Other,100% of Medicaid,51.19,,,51.19,Other,100% of Medicaid,51.19,,,51.19,Other,100% of Medicaid,51.19,,,51.19,Other,100% of Medicaid,115.18,,,115.18,Other,225% of Medicaid,78.32,,,78.32,Other,153% of Medicaid,115.18,,,115.18,Other,225% of Medicaid,71.67,,,71.67,Other,140% of Medicaid,115.18,,,115.18,Other,225% of Medicaid,133.09,,,133.09,Other,250% of Medicaid,165.86,,,165.86,Other,324% of Medicaid,110.06,,,110.06,Other,215% of Medicaid,110.06,,,110.06,Other,215% of Medicaid,63.99,,,63.99,Other,125% of Medicaid,0.01,309.67,
CHROM ANALY; ADDTL KARYOT EA STUDY,88280,CPT,TC,85088280,CDM,311,RC,,,both,,,206,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,100.74,,,100.74,Fee Schedule,,90.7,,,90.7,Fee Schedule,,193.55,,,193.55,Fee Schedule,,174.13,,,174.13,Fee Schedule,,164.59,,,164.59,Fee Schedule,,144.2,70,,144.2,percent of total billed charges,All Other,105.43,,,105.43,Fee Schedule,,19,,,19,Other,186% of Medicaid,124.17,,,124.17,Fee Schedule,,127.72,,,127.72,Fee Schedule,,70.29,,,,Fee Schedule,,124.17,,,124.17,Fee Schedule,,127.72,,,127.72,Fee Schedule,,132.21,,,132.21,Fee Schedule,,144.2,70,,144.2,percent of total billed charges,,158.62,,,158.62,Fee Schedule,,134.44,,,134.44,Fee Schedule,,50.21,,,50.21,Fee Schedule,,50.21,,,50.21,Fee Schedule,,50.21,,,50.21,Fee Schedule,,50.21,,,50.21,Fee Schedule,,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,10.1,,,10.1,Other,100% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,15.45,,,15.45,Other,153% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,14.14,,,14.14,Other,140% of Medicaid,22.73,,,22.73,Other,225% of Medicaid,26.26,,,26.26,Other,250% of Medicaid,32.72,,,32.72,Other,324% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,21.72,,,21.72,Other,215% of Medicaid,12.63,,,12.63,Other,125% of Medicaid,0.01,193.55,
CHROMOSOME BANDING STUD,88283,CPT,,78088283,CDM,311,RC,,,both,,,217,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,206.49,,,206.49,Fee Schedule,,185.91,,,185.91,Fee Schedule,,403.27,,,403.27,Fee Schedule,,362.8,,,362.8,Fee Schedule,,342.93,,,342.93,Fee Schedule,,151.9,70,,151.9,percent of total billed charges,All Other,216.09,,,216.09,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,254.51,,,254.51,Fee Schedule,,134.54,,,134.54,Fee Schedule,,144.06,,,,Fee Schedule,,254.51,,,254.51,Fee Schedule,,134.54,,,134.54,Fee Schedule,,270.97,,,270.97,Fee Schedule,,151.9,70,,151.9,percent of total billed charges,,325.1,,,325.1,Fee Schedule,,275.54,,,275.54,Fee Schedule,,102.9,,,102.9,Fee Schedule,,102.9,,,102.9,Fee Schedule,,102.9,,,102.9,Fee Schedule,,102.9,,,102.9,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,403.27,
CHROM ANALY ADDTL CELL COUNTS,88285,CPT,,78088285,CDM,311,RC,,,both,,,114,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,81,,,81,Fee Schedule,,72.93,,,72.93,Fee Schedule,,146.54,,,146.54,Fee Schedule,,131.83,,,131.83,Fee Schedule,,124.61,,,124.61,Fee Schedule,,79.8,70,,79.8,percent of total billed charges,All Other,84.77,,,84.77,Fee Schedule,,9,,,9,Other,186% of Medicaid,99.84,,,99.84,Fee Schedule,,70.68,,,70.68,Fee Schedule,,56.51,,,,Fee Schedule,,99.84,,,99.84,Fee Schedule,,70.68,,,70.68,Fee Schedule,,106.29,,,106.29,Fee Schedule,,79.8,70,,79.8,percent of total billed charges,,127.53,,,127.53,Fee Schedule,,108.09,,,108.09,Fee Schedule,,40.37,,,40.37,Fee Schedule,,40.37,,,40.37,Fee Schedule,,40.37,,,40.37,Fee Schedule,,40.37,,,40.37,Fee Schedule,,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,5.05,,,5.05,Other,100% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.73,,,7.73,Other,153% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,11.36,,,11.36,Other,225% of Medicaid,13.13,,,13.13,Other,250% of Medicaid,16.36,,,16.36,Other,324% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,10.86,,,10.86,Other,215% of Medicaid,6.31,,,6.31,Other,125% of Medicaid,0.01,146.54,
CHROMOSOME ANALY ADDTL HI RES,88289,CPT,,78088289,CDM,311,RC,,,both,,,205,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,103.63,,,103.63,Fee Schedule,,93.31,,,93.31,Fee Schedule,,265.56,,,265.56,Fee Schedule,,238.91,,,238.91,Fee Schedule,,225.82,,,225.82,Fee Schedule,,143.5,70,,143.5,percent of total billed charges,All Other,108.45,,,108.45,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,127.74,,,127.74,Fee Schedule,,127.1,,,127.1,Fee Schedule,,72.3,,,,Fee Schedule,,127.74,,,127.74,Fee Schedule,,127.1,,,127.1,Fee Schedule,,136,,,136,Fee Schedule,,143.5,70,,143.5,percent of total billed charges,,163.16,,,163.16,Fee Schedule,,138.29,,,138.29,Fee Schedule,,51.65,,,51.65,Fee Schedule,,51.65,,,51.65,Fee Schedule,,51.65,,,51.65,Fee Schedule,,51.65,,,51.65,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,265.56,
TISSUE EXAM BY PATHOLOGIST,88305,CPT,,78088305,CDM,312,RC,,,both,,,478,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,116.79,,,116.79,Fee Schedule,,105.15,,,105.15,Fee Schedule,,487.88,,,487.88,Fee Schedule,,438.92,,,438.92,Fee Schedule,,414.88,,,414.88,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,All Other,122.22,,,122.22,Fee Schedule,,81,,,81,Other,186% of Medicaid,143.95,,,143.95,Fee Schedule,,296.36,,,296.36,Fee Schedule,,81.48,,,,Fee Schedule,,143.95,,,143.95,Fee Schedule,,296.36,,,296.36,Fee Schedule,,153.26,,,153.26,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,,164,,,164,Fee Schedule,,139,,,139,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,43.62,,,43.62,Other,100% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,66.74,,,66.74,Other,153% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,61.07,,,61.07,Other,140% of Medicaid,98.15,,,98.15,Other,225% of Medicaid,113.42,,,113.42,Other,250% of Medicaid,141.33,,,141.33,Other,324% of Medicaid,93.79,,,93.79,Other,215% of Medicaid,93.79,,,93.79,Other,215% of Medicaid,54.53,,,54.53,Other,125% of Medicaid,43.62,487.88,
DECALCIFY TISSUE,88311,CPT,,78088311,CDM,312,RC,,,both,,,171,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,28.5,,,28.5,Fee Schedule,,25.66,,,25.66,Fee Schedule,,47.68,,,47.68,Fee Schedule,,42.89,,,42.89,Fee Schedule,,40.54,,,40.54,Fee Schedule,,119.7,70,,119.7,percent of total billed charges,All Other,29.83,,,29.83,Fee Schedule,,101,,,101,Other,186% of Medicaid,35.13,,,35.13,Fee Schedule,,106.02,,,106.02,Fee Schedule,,19.89,,,,Fee Schedule,,35.13,,,35.13,Fee Schedule,,106.02,,,106.02,Fee Schedule,,37.41,,,37.41,Fee Schedule,,119.7,70,,119.7,percent of total billed charges,,41,,,41,Fee Schedule,,34.75,,,34.75,Fee Schedule,,13.53,,,13.53,Fee Schedule,,13.53,,,13.53,Fee Schedule,,13.53,,,13.53,Fee Schedule,,13.53,,,13.53,Fee Schedule,,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,82.95,,,82.95,Other,153% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,75.91,,,75.91,Other,140% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,140.97,,,140.97,Other,250% of Medicaid,175.67,,,175.67,Other,324% of Medicaid,116.57,,,116.57,Other,215% of Medicaid,116.57,,,116.57,Other,215% of Medicaid,67.77,,,67.77,Other,125% of Medicaid,0.01,175.67,
SPECIAL STAINS GROUP 2,88313,CPT,,78088313,CDM,312,RC,,,both,,,361,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,233.43,,,233.43,Fee Schedule,,210.16,,,210.16,Fee Schedule,,464.1,,,464.1,Fee Schedule,,417.52,,,417.52,Fee Schedule,,394.66,,,394.66,Fee Schedule,,252.7,70,,252.7,percent of total billed charges,All Other,244.28,,,244.28,Fee Schedule,,19,,,19,Other,186% of Medicaid,287.71,,,287.71,Fee Schedule,,223.82,,,223.82,Fee Schedule,,162.86,,,,Fee Schedule,,287.71,,,287.71,Fee Schedule,,223.82,,,223.82,Fee Schedule,,306.32,,,306.32,Fee Schedule,,252.7,70,,252.7,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,9.98,,,9.98,Other,100% of Medicaid,9.98,,,9.98,Other,100% of Medicaid,9.98,,,9.98,Other,100% of Medicaid,9.98,,,9.98,Other,100% of Medicaid,22.45,,,22.45,Other,225% of Medicaid,15.27,,,15.27,Other,153% of Medicaid,22.45,,,22.45,Other,225% of Medicaid,13.97,,,13.97,Other,140% of Medicaid,22.45,,,22.45,Other,225% of Medicaid,25.94,,,25.94,Other,250% of Medicaid,32.33,,,32.33,Other,324% of Medicaid,21.45,,,21.45,Other,215% of Medicaid,21.45,,,21.45,Other,215% of Medicaid,12.47,,,12.47,Other,125% of Medicaid,9.98,464.1,
PATH CONSULT INTROP,88329,CPT,,78088329,CDM,312,RC,,,both,,,411,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,108.96,,,108.96,Fee Schedule,,98.1,,,98.1,Fee Schedule,,336.03,,,336.03,Fee Schedule,,302.31,,,302.31,Fee Schedule,,285.75,,,285.75,Fee Schedule,,287.7,70,,287.7,percent of total billed charges,All Other,114.03,,,114.03,Fee Schedule,,117,,,117,Other,186% of Medicaid,134.3,,,134.3,Fee Schedule,,254.82,,,254.82,Fee Schedule,,76.02,,,,Fee Schedule,,134.3,,,134.3,Fee Schedule,,254.82,,,254.82,Fee Schedule,,142.99,,,142.99,Fee Schedule,,287.7,70,,287.7,percent of total billed charges,,168.92,,,168.92,Fee Schedule,,143.17,,,143.17,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,50.15,336.03,
PATH CONSULT INTRAOP ADDL,88332,CPT,,78088332,CDM,312,RC,,,both,,,158,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,81.9,,,81.9,Fee Schedule,,73.74,,,73.74,Fee Schedule,,78.64,,,78.64,Fee Schedule,,70.75,,,70.75,Fee Schedule,,66.87,,,66.87,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,All Other,85.71,,,85.71,Fee Schedule,,117,,,117,Other,186% of Medicaid,100.95,,,100.95,Fee Schedule,,97.96,,,97.96,Fee Schedule,,57.14,,,,Fee Schedule,,100.95,,,100.95,Fee Schedule,,97.96,,,97.96,Fee Schedule,,107.48,,,107.48,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,34.65,,,34.65,Fee Schedule,,34.65,,,34.65,Fee Schedule,,34.65,,,34.65,Fee Schedule,,34.65,,,34.65,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,0.01,204.32,
IMMUNOHISTOCHEMISTRY,88342,CPT,,78088342,CDM,312,RC,,,both,,,747,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,236.71,,,236.71,Fee Schedule,,213.11,,,213.11,Fee Schedule,,440.32,,,440.32,Fee Schedule,,396.13,,,396.13,Fee Schedule,,374.43,,,374.43,Fee Schedule,,522.9,70,,522.9,percent of total billed charges,All Other,247.72,,,247.72,Fee Schedule,,48,,,48,Other,186% of Medicaid,291.75,,,291.75,Fee Schedule,,463.14,,,463.14,Fee Schedule,,165.14,,,,Fee Schedule,,291.75,,,291.75,Fee Schedule,,463.14,,,463.14,Fee Schedule,,310.63,,,310.63,Fee Schedule,,522.9,70,,522.9,percent of total billed charges,,321.44,,,321.44,Fee Schedule,,272.44,,,272.44,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,25.62,,,25.62,Other,100% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,39.2,,,39.2,Other,153% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,35.87,,,35.87,Other,140% of Medicaid,57.65,,,57.65,Other,225% of Medicaid,66.62,,,66.62,Other,250% of Medicaid,83.02,,,83.02,Other,324% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,55.09,,,55.09,Other,215% of Medicaid,32.03,,,32.03,Other,125% of Medicaid,25.62,522.9,
CYTOPATH SMEAR OTHER SOURCE,88160,CPT,,78088160,CDM,319,RC,,,both,,,258,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,180.18,,,180.18,Fee Schedule,,162.22,,,162.22,Fee Schedule,,209.5,,,209.5,Fee Schedule,,188.47,,,188.47,Fee Schedule,,178.15,,,178.15,Fee Schedule,,180.6,70,,180.6,percent of total billed charges,All Other,188.56,,,188.56,Fee Schedule,,36,,,36,Other,186% of Medicaid,222.08,,,222.08,Fee Schedule,,159.96,,,159.96,Fee Schedule,,125.71,,,,Fee Schedule,,222.08,,,222.08,Fee Schedule,,159.96,,,159.96,Fee Schedule,,236.45,,,236.45,Fee Schedule,,180.6,70,,180.6,percent of total billed charges,,223.04,,,223.04,Fee Schedule,,189.04,,,189.04,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,19.31,,,19.31,Other,100% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,29.55,,,29.55,Other,153% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,27.04,,,27.04,Other,140% of Medicaid,43.45,,,43.45,Other,225% of Medicaid,50.21,,,50.21,Other,250% of Medicaid,62.57,,,62.57,Other,324% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,41.52,,,41.52,Other,215% of Medicaid,24.14,,,24.14,Other,125% of Medicaid,19.31,236.45,
CHROMOSOME ANALYSIS 20-25,88245,CPT,,78088245,CDM,319,RC,,,both,,,1316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,521.24,,,521.24,Fee Schedule,,469.29,,,469.29,Fee Schedule,,600.88,,,600.88,Fee Schedule,,540.57,,,540.57,Fee Schedule,,510.97,,,510.97,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,All Other,545.49,,,545.49,Fee Schedule,,169,,,169,Other,186% of Medicaid,642.46,,,642.46,Fee Schedule,,815.92,,,815.92,Fee Schedule,,363.66,,,,Fee Schedule,,642.46,,,642.46,Fee Schedule,,815.92,,,815.92,Fee Schedule,,684.02,,,684.02,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,,820.66,,,820.66,Fee Schedule,,695.56,,,695.56,Fee Schedule,,259.76,,,259.76,Fee Schedule,,259.76,,,259.76,Fee Schedule,,259.76,,,259.76,Fee Schedule,,259.76,,,259.76,Fee Schedule,,90.9,,,90.9,Other,100% of Medicaid,90.9,,,90.9,Other,100% of Medicaid,90.9,,,90.9,Other,100% of Medicaid,90.9,,,90.9,Other,100% of Medicaid,204.53,,,204.53,Other,225% of Medicaid,139.08,,,139.08,Other,153% of Medicaid,204.53,,,204.53,Other,225% of Medicaid,127.26,,,127.26,Other,140% of Medicaid,204.53,,,204.53,Other,225% of Medicaid,236.34,,,236.34,Other,250% of Medicaid,294.52,,,294.52,Other,324% of Medicaid,195.44,,,195.44,Other,215% of Medicaid,195.44,,,195.44,Other,215% of Medicaid,113.63,,,113.63,Other,125% of Medicaid,0.01,921.2,
CHROMOSOME ANALYSIS 50-100,88248,CPT,,78088248,CDM,319,RC,,,both,,,1316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,521.24,,,521.24,Fee Schedule,,469.29,,,469.29,Fee Schedule,,1335.48,,,1335.48,Fee Schedule,,1201.44,,,1201.44,Fee Schedule,,1135.64,,,1135.64,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,All Other,545.49,,,545.49,Fee Schedule,,188,,,188,Other,186% of Medicaid,642.46,,,642.46,Fee Schedule,,815.92,,,815.92,Fee Schedule,,363.66,,,,Fee Schedule,,642.46,,,642.46,Fee Schedule,,815.92,,,815.92,Fee Schedule,,684.02,,,684.02,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,,820.66,,,820.66,Fee Schedule,,695.56,,,695.56,Fee Schedule,,259.76,,,259.76,Fee Schedule,,259.76,,,259.76,Fee Schedule,,259.76,,,259.76,Fee Schedule,,259.76,,,259.76,Fee Schedule,,101,,,101,Other,100% of Medicaid,101,,,101,Other,100% of Medicaid,101,,,101,Other,100% of Medicaid,101,,,101,Other,100% of Medicaid,227.25,,,227.25,Other,225% of Medicaid,154.53,,,154.53,Other,153% of Medicaid,227.25,,,227.25,Other,225% of Medicaid,141.4,,,141.4,Other,140% of Medicaid,227.25,,,227.25,Other,225% of Medicaid,262.6,,,262.6,Other,250% of Medicaid,327.24,,,327.24,Other,324% of Medicaid,217.15,,,217.15,Other,215% of Medicaid,217.15,,,217.15,Other,215% of Medicaid,126.25,,,126.25,Other,125% of Medicaid,0.01,1335.48,
CHROMOSOME ANALYSIS 15-20,88262,CPT,,78088262,CDM,319,RC,,,both,,,1316,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,,377.72,,,377.72,Fee Schedule,,340.08,,,340.08,Fee Schedule,,961.19,,,961.19,Fee Schedule,,864.72,,,864.72,Fee Schedule,,817.36,,,817.36,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,All Other,395.29,,,395.29,Fee Schedule,,188,,,188,Other,186% of Medicaid,465.57,,,465.57,Fee Schedule,,815.92,,,815.92,Fee Schedule,,263.53,,,,Fee Schedule,,465.57,,,465.57,Fee Schedule,,815.92,,,815.92,Fee Schedule,,495.69,,,495.69,Fee Schedule,,921.2,70,,921.2,percent of total billed charges,,594.7,,,594.7,Fee Schedule,,504.05,,,504.05,Fee Schedule,,188.24,,,188.24,Fee Schedule,,188.24,,,188.24,Fee Schedule,,188.24,,,188.24,Fee Schedule,,188.24,,,188.24,Fee Schedule,,101,,,101,Other,100% of Medicaid,101,,,101,Other,100% of Medicaid,101,,,101,Other,100% of Medicaid,101,,,101,Other,100% of Medicaid,227.25,,,227.25,Other,225% of Medicaid,154.53,,,154.53,Other,153% of Medicaid,227.25,,,227.25,Other,225% of Medicaid,141.4,,,141.4,Other,140% of Medicaid,227.25,,,227.25,Other,225% of Medicaid,262.6,,,262.6,Other,250% of Medicaid,327.24,,,327.24,Other,324% of Medicaid,217.15,,,217.15,Other,215% of Medicaid,217.15,,,217.15,Other,215% of Medicaid,126.25,,,126.25,Other,125% of Medicaid,0.01,961.19,
SURGICAL PATH GROSS,88300,CPT,,78088300,CDM,319,RC,,,both,,,123,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,39.4,,,39.4,Fee Schedule,,35.47,,,35.47,Fee Schedule,,157.17,,,157.17,Fee Schedule,,141.39,,,141.39,Fee Schedule,,133.65,,,133.65,Fee Schedule,,86.1,70,,86.1,percent of total billed charges,All Other,41.23,,,41.23,Fee Schedule,,101,,,101,Other,186% of Medicaid,48.56,,,48.56,Fee Schedule,,76.26,,,76.26,Fee Schedule,,27.49,,,,Fee Schedule,,48.56,,,48.56,Fee Schedule,,76.26,,,76.26,Fee Schedule,,51.71,,,51.71,Fee Schedule,,86.1,70,,86.1,percent of total billed charges,,52.48,,,52.48,Fee Schedule,,44.48,,,44.48,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,54.22,,,54.22,Other,100% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,82.95,,,82.95,Other,153% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,75.91,,,75.91,Other,140% of Medicaid,121.99,,,121.99,Other,225% of Medicaid,140.97,,,140.97,Other,250% of Medicaid,175.67,,,175.67,Other,324% of Medicaid,116.57,,,116.57,Other,215% of Medicaid,116.57,,,116.57,Other,215% of Medicaid,67.77,,,67.77,Other,125% of Medicaid,27.49,175.67,
TISSUE EXAM BY PATHOLOGIST,88302,CPT,,78088302,CDM,319,RC,,,both,,,478,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,87.38,,,87.38,Fee Schedule,,78.67,,,78.67,Fee Schedule,,328.47,,,328.47,Fee Schedule,,295.5,,,295.5,Fee Schedule,,279.32,,,279.32,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,All Other,91.44,,,91.44,Fee Schedule,,36,,,36,Other,186% of Medicaid,107.7,,,107.7,Fee Schedule,,296.36,,,296.36,Fee Schedule,,60.96,,,,Fee Schedule,,107.7,,,107.7,Fee Schedule,,296.36,,,296.36,Fee Schedule,,114.67,,,114.67,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,34.49,,,34.49,Fee Schedule,,19.5,,,19.5,Other,100% of Medicaid,19.5,,,19.5,Other,100% of Medicaid,19.5,,,19.5,Other,100% of Medicaid,19.5,,,19.5,Other,100% of Medicaid,43.88,,,43.88,Other,225% of Medicaid,29.84,,,29.84,Other,153% of Medicaid,43.88,,,43.88,Other,225% of Medicaid,27.3,,,27.3,Other,140% of Medicaid,43.88,,,43.88,Other,225% of Medicaid,50.71,,,50.71,Other,250% of Medicaid,63.19,,,63.19,Other,324% of Medicaid,41.93,,,41.93,Other,215% of Medicaid,41.93,,,41.93,Other,215% of Medicaid,24.38,,,24.38,Other,125% of Medicaid,19.5,334.6,
TISSUE EXAM BY PATHOLOGIST,88304,CPT,,78088304,CDM,319,RC,,,both,,,478,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,104.81,,,104.81,Fee Schedule,,94.36,,,94.36,Fee Schedule,,361.79,,,361.79,Fee Schedule,,325.48,,,325.48,Fee Schedule,,307.65,,,307.65,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,All Other,109.68,,,109.68,Fee Schedule,,48,,,48,Other,186% of Medicaid,129.18,,,129.18,Fee Schedule,,296.36,,,296.36,Fee Schedule,,73.12,,,,Fee Schedule,,129.18,,,129.18,Fee Schedule,,296.36,,,296.36,Fee Schedule,,137.54,,,137.54,Fee Schedule,,334.6,70,,334.6,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,25.58,,,25.58,Other,100% of Medicaid,25.58,,,25.58,Other,100% of Medicaid,25.58,,,25.58,Other,100% of Medicaid,25.58,,,25.58,Other,100% of Medicaid,57.56,,,57.56,Other,225% of Medicaid,39.14,,,39.14,Other,153% of Medicaid,57.56,,,57.56,Other,225% of Medicaid,35.82,,,35.82,Other,140% of Medicaid,57.56,,,57.56,Other,225% of Medicaid,66.52,,,66.52,Other,250% of Medicaid,82.89,,,82.89,Other,324% of Medicaid,55,,,55,Other,215% of Medicaid,55,,,55,Other,215% of Medicaid,31.98,,,31.98,Other,125% of Medicaid,25.58,361.79,
TISSUE EXAM BY PATHOLOGIST,88307,CPT,,78088307,CDM,319,RC,,,both,,,1051,649.53,,,649.53,Other,150% of Medicare + 9.63% HCRA Surcharge,394.98,,,394.98,Other,Medicare OPPS,684.11,,,684.11,Fee Schedule,,615.93,,,615.93,Fee Schedule,,1028.05,,,1028.05,Fee Schedule,,924.87,,,924.87,Fee Schedule,,874.22,,,874.22,Fee Schedule,,735.7,70,,735.7,percent of total billed charges,All Other,715.93,,,715.93,Fee Schedule,,328,,,328,Other,186% of Medicaid,843.21,,,843.21,Fee Schedule,,651.62,,,651.62,Fee Schedule,,477.29,,,,Fee Schedule,,843.21,,,843.21,Fee Schedule,,651.62,,,651.62,Fee Schedule,,897.76,,,897.76,Fee Schedule,,735.7,70,,735.7,percent of total billed charges,,987.28,,,987.28,Fee Schedule,,836.78,,,836.78,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,425.12,,,425.12,Fee Schedule,,176.15,,,176.15,Other,100% of Medicaid,176.15,,,176.15,Other,100% of Medicaid,176.15,,,176.15,Other,100% of Medicaid,176.15,,,176.15,Other,100% of Medicaid,396.35,,,396.35,Other,225% of Medicaid,269.52,,,269.52,Other,153% of Medicaid,396.35,,,396.35,Other,225% of Medicaid,246.62,,,246.62,Other,140% of Medicaid,396.35,,,396.35,Other,225% of Medicaid,458,,,458,Other,250% of Medicaid,570.74,,,570.74,Other,324% of Medicaid,378.73,,,378.73,Other,215% of Medicaid,378.73,,,378.73,Other,215% of Medicaid,220.19,,,220.19,Other,125% of Medicaid,176.15,1028.05,
TISSUE EXAM BY PATHOLOGIST,88309,CPT,,78088309,CDM,319,RC,,,both,,,1859,1553.82,,,1553.82,Other,150% of Medicare + 9.63% HCRA Surcharge,944.89,,,944.89,Other,Medicare OPPS,959.92,,,959.92,Fee Schedule,,864.25,,,864.25,Fee Schedule,,1428.03,,,1428.03,Fee Schedule,,1284.71,,,1284.71,Fee Schedule,,1214.35,,,1214.35,Fee Schedule,,1301.3,70,,1301.3,percent of total billed charges,All Other,1004.57,,,1004.57,Fee Schedule,,498,,,498,Other,186% of Medicaid,1183.16,,,1183.16,Fee Schedule,,1152.58,,,1152.58,Fee Schedule,,669.71,,,,Fee Schedule,,1183.16,,,1183.16,Fee Schedule,,1152.58,,,1152.58,Fee Schedule,,1259.69,,,1259.69,Fee Schedule,,1301.3,70,,1301.3,percent of total billed charges,,1407.12,,,1407.12,Fee Schedule,,1192.62,,,1192.62,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,267.64,,,267.64,Other,100% of Medicaid,267.64,,,267.64,Other,100% of Medicaid,267.64,,,267.64,Other,100% of Medicaid,267.64,,,267.64,Other,100% of Medicaid,602.19,,,602.19,Other,225% of Medicaid,409.49,,,409.49,Other,153% of Medicaid,602.19,,,602.19,Other,225% of Medicaid,374.7,,,374.7,Other,140% of Medicaid,602.19,,,602.19,Other,225% of Medicaid,695.86,,,695.86,Other,250% of Medicaid,867.15,,,867.15,Other,324% of Medicaid,575.43,,,575.43,Other,215% of Medicaid,575.43,,,575.43,Other,215% of Medicaid,334.55,,,334.55,Other,125% of Medicaid,267.64,1553.82,
SPECIAL STAINS GROUP 1,88312,CPT,,78088312,CDM,319,RC,,,both,,,435,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,284.66,,,284.66,Fee Schedule,,256.28,,,256.28,Fee Schedule,,564.06,,,564.06,Fee Schedule,,507.44,,,507.44,Fee Schedule,,479.65,,,479.65,Fee Schedule,,304.5,70,,304.5,percent of total billed charges,All Other,297.9,,,297.9,Fee Schedule,,25,,,25,Other,186% of Medicaid,350.85,,,350.85,Fee Schedule,,269.7,,,269.7,Fee Schedule,,198.6,,,,Fee Schedule,,350.85,,,350.85,Fee Schedule,,269.7,,,269.7,Fee Schedule,,373.55,,,373.55,Fee Schedule,,304.5,70,,304.5,percent of total billed charges,,418.2,,,418.2,Fee Schedule,,354.45,,,354.45,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,13.31,,,13.31,Other,100% of Medicaid,13.31,,,13.31,Other,100% of Medicaid,13.31,,,13.31,Other,100% of Medicaid,13.31,,,13.31,Other,100% of Medicaid,29.95,,,29.95,Other,225% of Medicaid,20.37,,,20.37,Other,153% of Medicaid,29.95,,,29.95,Other,225% of Medicaid,18.64,,,18.64,Other,140% of Medicaid,29.95,,,29.95,Other,225% of Medicaid,34.61,,,34.61,Other,250% of Medicaid,43.13,,,43.13,Other,324% of Medicaid,28.62,,,28.62,Other,215% of Medicaid,28.62,,,28.62,Other,215% of Medicaid,16.64,,,16.64,Other,125% of Medicaid,13.31,564.06,
ENZYME HISTOCHEMISTRY,88319,CPT,,78088319,CDM,319,RC,,,both,,,1749,1553.82,,,1553.82,Other,150% of Medicare + 9.63% HCRA Surcharge,944.89,,,944.89,Other,Medicare OPPS,362.22,,,362.22,Fee Schedule,,326.12,,,326.12,Fee Schedule,,840.08,,,840.08,Fee Schedule,,755.77,,,755.77,Fee Schedule,,714.38,,,714.38,Fee Schedule,,1224.3,70,,1224.3,percent of total billed charges,All Other,379.07,,,379.07,Fee Schedule,,66,,,66,Other,186% of Medicaid,446.46,,,446.46,Fee Schedule,,1084.38,,,1084.38,Fee Schedule,,252.71,,,,Fee Schedule,,446.46,,,446.46,Fee Schedule,,1084.38,,,1084.38,Fee Schedule,,475.34,,,475.34,Fee Schedule,,1224.3,70,,1224.3,percent of total billed charges,,546.12,,,546.12,Fee Schedule,,462.87,,,462.87,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,35.54,,,35.54,Other,100% of Medicaid,35.54,,,35.54,Other,100% of Medicaid,35.54,,,35.54,Other,100% of Medicaid,35.54,,,35.54,Other,100% of Medicaid,79.97,,,79.97,Other,225% of Medicaid,54.38,,,54.38,Other,153% of Medicaid,79.97,,,79.97,Other,225% of Medicaid,49.76,,,49.76,Other,140% of Medicaid,79.97,,,79.97,Other,225% of Medicaid,92.41,,,92.41,Other,250% of Medicaid,115.16,,,115.16,Other,324% of Medicaid,76.42,,,76.42,Other,215% of Medicaid,76.42,,,76.42,Other,215% of Medicaid,44.43,,,44.43,Other,125% of Medicaid,35.54,1553.82,
MICROSLIDE CONSULTATION,88321,CPT,,78088321,CDM,319,RC,,,both,,,210,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,257.63,,,257.63,Fee Schedule,,231.95,,,231.95,Fee Schedule,,567.18,,,567.18,Fee Schedule,,510.26,,,510.26,Fee Schedule,,482.31,,,482.31,Fee Schedule,,147,70,,147,percent of total billed charges,All Other,269.61,,,269.61,Fee Schedule,,117,,,117,Other,186% of Medicaid,317.54,,,317.54,Fee Schedule,,130.2,,,130.2,Fee Schedule,,179.74,,,,Fee Schedule,,317.54,,,317.54,Fee Schedule,,130.2,,,130.2,Fee Schedule,,338.08,,,338.08,Fee Schedule,,147,70,,147,percent of total billed charges,,398.52,,,398.52,Fee Schedule,,337.77,,,337.77,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,50.15,,,50.15,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,44.07,567.18,
MICROSLIDE CONSULTATION,88323,CPT,,78088323,CDM,319,RC,,,both,,,386,97.92,,,97.92,Other,150% of Medicare + 9.63% HCRA Surcharge,59.54,,,59.54,Other,Medicare OPPS,97.16,,,97.16,Fee Schedule,,87.48,,,87.48,Fee Schedule,,411.77,,,411.77,Fee Schedule,,370.44,,,370.44,Fee Schedule,,350.15,,,350.15,Fee Schedule,,270.2,70,,270.2,percent of total billed charges,All Other,101.68,,,101.68,Fee Schedule,,117,,,117,Other,186% of Medicaid,119.76,,,119.76,Fee Schedule,,239.32,,,239.32,Fee Schedule,,67.79,,,,Fee Schedule,,119.76,,,119.76,Fee Schedule,,239.32,,,239.32,Fee Schedule,,127.51,,,127.51,Fee Schedule,,270.2,70,,270.2,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,74.21,,,74.21,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,59.54,411.77,
PATH CONSULT INTRAOP 1 BLOC,88331,CPT,,78088331,CDM,319,RC,,,both,,,581,308.64,,,308.64,Other,150% of Medicare + 9.63% HCRA Surcharge,187.69,,,187.69,Other,Medicare OPPS,135.33,,,135.33,Fee Schedule,,121.84,,,121.84,Fee Schedule,,223.8,,,223.8,Fee Schedule,,201.34,,,201.34,Fee Schedule,,190.31,,,190.31,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,All Other,141.62,,,141.62,Fee Schedule,,117,,,117,Other,186% of Medicaid,166.8,,,166.8,Fee Schedule,,360.22,,,360.22,Fee Schedule,,94.42,,,,Fee Schedule,,166.8,,,166.8,Fee Schedule,,360.22,,,360.22,Fee Schedule,,177.59,,,177.59,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,,196.8,,,196.8,Fee Schedule,,166.8,,,166.8,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,215.25,,,215.25,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,63.06,406.7,
INTRAOP CYTO PATH CONSULT 1,88333,CPT,,78088333,CDM,319,RC,,,both,,,1834,1553.82,,,1553.82,Other,150% of Medicare + 9.63% HCRA Surcharge,944.89,,,944.89,Other,Medicare OPPS,104.81,,,104.81,Fee Schedule,,94.36,,,94.36,Fee Schedule,,245.18,,,245.18,Fee Schedule,,220.57,,,220.57,Fee Schedule,,208.49,,,208.49,Fee Schedule,,1283.8,70,,1283.8,percent of total billed charges,All Other,109.68,,,109.68,Fee Schedule,,117,,,117,Other,186% of Medicaid,129.18,,,129.18,Fee Schedule,,1137.08,,,1137.08,Fee Schedule,,73.12,,,,Fee Schedule,,129.18,,,129.18,Fee Schedule,,1137.08,,,1137.08,Fee Schedule,,137.54,,,137.54,Fee Schedule,,1283.8,70,,1283.8,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,942.3,,,942.3,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,63.06,1553.82,
INTRAOP CYTO PATH CONSULT 2,88334,CPT,,78088334,CDM,319,RC,,,both,,,184,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,63.21,,,63.21,Fee Schedule,,56.91,,,56.91,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,128.8,70,,128.8,percent of total billed charges,All Other,66.15,,,66.15,Fee Schedule,,117,,,117,Other,186% of Medicaid,77.91,,,77.91,Fee Schedule,,114.08,,,114.08,Fee Schedule,,44.1,,,,Fee Schedule,,77.91,,,77.91,Fee Schedule,,114.08,,,114.08,Fee Schedule,,82.95,,,82.95,Fee Schedule,,128.8,70,,128.8,percent of total billed charges,,91.84,,,91.84,Fee Schedule,,77.84,,,77.84,Fee Schedule,,27.06,,,27.06,Fee Schedule,,27.06,,,27.06,Fee Schedule,,27.06,,,27.06,Fee Schedule,,27.06,,,27.06,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,0.01,204.32,
SINUS TRACT INJ; DX,20501,CPT,,46020501,CDM,320,RC,,,both,,,146,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.04,,,120.04,Fee Schedule,,108,,,108,Fee Schedule,,111.69,76.5,,111.69,percent of total billed charges,All Other,100.74,69,,100.74,percent of total billed charges,All Other,94.9,65,,94.9,percent of total billed charges,All Other,102.2,70,,102.2,percent of total billed charges,All Other,142.62,,,142.62,Fee Schedule,,967,,,967,Other,186% of Medicaid,167.83,,,167.83,Fee Schedule,,90.52,,,90.52,Fee Schedule,,79.02,,,,Fee Schedule,,167.83,,,167.83,Fee Schedule,,90.52,,,90.52,Fee Schedule,,148.64,,,148.64,Fee Schedule,,102.2,70,,102.2,percent of total billed charges,,178.76,,,178.76,Fee Schedule,,151.51,,,151.51,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,1683.75,
SINUS TRACT INJ; DX,20501,CPT,,47020501,CDM,320,RC,,,both,,,146,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,120.04,,,120.04,Fee Schedule,,108,,,108,Fee Schedule,,111.69,76.5,,111.69,percent of total billed charges,All Other,100.74,69,,100.74,percent of total billed charges,All Other,94.9,65,,94.9,percent of total billed charges,All Other,102.2,70,,102.2,percent of total billed charges,All Other,142.62,,,142.62,Fee Schedule,,967,,,967,Other,186% of Medicaid,167.83,,,167.83,Fee Schedule,,90.52,,,90.52,Fee Schedule,,79.02,,,,Fee Schedule,,167.83,,,167.83,Fee Schedule,,90.52,,,90.52,Fee Schedule,,148.64,,,148.64,Fee Schedule,,102.2,70,,102.2,percent of total billed charges,,178.76,,,178.76,Fee Schedule,,151.51,,,151.51,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,1683.75,
INSERT PLEURAL CATH,32550,CPT,,47032550,CDM,320,RC,,,both,,,11690,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,677.78,,,677.78,Fee Schedule,,609.79,,,609.79,Fee Schedule,,8942.85,76.5,,8942.85,percent of total billed charges,All Other,8066.1,69,,8066.1,percent of total billed charges,All Other,7598.5,65,,7598.5,percent of total billed charges,All Other,8183,70,,8183,percent of total billed charges,All Other,805.26,,,805.26,Fee Schedule,,1196,,,1196,Other,186% of Medicaid,947.62,,,947.62,Fee Schedule,,7247.8,,,7247.8,Fee Schedule,,446.19,,,,Fee Schedule,,947.62,,,947.62,Fee Schedule,,7247.8,,,7247.8,Fee Schedule,,839.26,,,839.26,Fee Schedule,,8183,70,,8183,percent of total billed charges,,982.36,,,982.36,Fee Schedule,,832.61,,,832.61,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,0.01,8942.85,
INTRVASC US NONCORONARY 1ST,37252,CPT,,47437230,CDM,320,RC,,,both,,,1082,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,293.89,,,293.89,Fee Schedule,,264.41,,,264.41,Fee Schedule,,827.73,76.5,,827.73,percent of total billed charges,All Other,746.58,69,,746.58,percent of total billed charges,All Other,703.3,65,,703.3,percent of total billed charges,All Other,757.4,70,,757.4,percent of total billed charges,All Other,349.17,,,349.17,Fee Schedule,,3002,,,3002,Other,186% of Medicaid,410.9,,,410.9,Fee Schedule,,670.84,,,670.84,Fee Schedule,,193.47,,,,Fee Schedule,,410.9,,,410.9,Fee Schedule,,670.84,,,670.84,Fee Schedule,,363.91,,,363.91,Fee Schedule,,757.4,70,,757.4,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,1614.07,,,1614.07,Other,100% of Medicaid,1614.07,,,1614.07,Other,100% of Medicaid,1614.07,,,1614.07,Other,100% of Medicaid,1614.07,,,1614.07,Other,100% of Medicaid,3631.66,,,3631.66,Other,225% of Medicaid,2469.53,,,2469.53,Other,153% of Medicaid,3631.66,,,3631.66,Other,225% of Medicaid,2259.7,,,2259.7,Other,140% of Medicaid,3631.66,,,3631.66,Other,225% of Medicaid,4196.58,,,4196.58,Other,250% of Medicaid,5229.58,,,5229.58,Other,324% of Medicaid,3470.25,,,3470.25,Other,215% of Medicaid,3470.25,,,3470.25,Other,215% of Medicaid,2017.59,,,2017.59,Other,125% of Medicaid,0.01,5229.58,
INTRVASC US NONCORONARY ADDL,37253,CPT,,47437231,CDM,320,RC,,,both,,,993,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,233.57,,,233.57,Fee Schedule,,210.14,,,210.14,Fee Schedule,,759.65,76.5,,759.65,percent of total billed charges,All Other,685.17,69,,685.17,percent of total billed charges,All Other,645.45,65,,645.45,percent of total billed charges,All Other,695.1,70,,695.1,percent of total billed charges,All Other,277.5,,,277.5,Fee Schedule,,3002,,,3002,Other,186% of Medicaid,326.56,,,326.56,Fee Schedule,,615.66,,,615.66,Fee Schedule,,153.76,,,,Fee Schedule,,326.56,,,326.56,Fee Schedule,,615.66,,,615.66,Fee Schedule,,289.22,,,289.22,Fee Schedule,,695.1,70,,695.1,percent of total billed charges,,336.2,,,336.2,Fee Schedule,,284.95,,,284.95,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,1614.07,,,1614.07,Other,100% of Medicaid,1614.07,,,1614.07,Other,100% of Medicaid,1614.07,,,1614.07,Other,100% of Medicaid,1614.07,,,1614.07,Other,100% of Medicaid,3631.66,,,3631.66,Other,225% of Medicaid,2469.53,,,2469.53,Other,153% of Medicaid,3631.66,,,3631.66,Other,225% of Medicaid,2259.7,,,2259.7,Other,140% of Medicaid,3631.66,,,3631.66,Other,225% of Medicaid,4196.58,,,4196.58,Other,250% of Medicaid,5229.58,,,5229.58,Other,324% of Medicaid,3470.25,,,3470.25,Other,215% of Medicaid,3470.25,,,3470.25,Other,215% of Medicaid,2017.59,,,2017.59,Other,125% of Medicaid,0.01,5229.58,
XR EYE DETECT FOREIGN BODY,70030,CPT,TCLT,42170030,CDM,320,RC,,,both,,,241,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,104.64,,,104.64,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,168.7,
XR EYE DETECT FOREIGN BODY,70030,CPT,TCRT,42270030,CDM,320,RC,,,both,,,241,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,104.64,,,104.64,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,168.7,
XR EYE DETECT FOREIGN BODY BILAT,70030,CPT,TC50,42370030,CDM,320,RC,,,both,,,362,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,224.44,,,224.44,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,224.44,,,224.44,Fee Schedule,,104.64,,,104.64,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,253.4,
XR EYE DETECT FOREIGN BODY FY MOD,70030,CPT,FYLT,42770030,CDM,320,RC,,,both,,,241,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,104.64,,,104.64,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,168.7,
XR EYE DETECT FOREIGN BODY FY MOD,70030,CPT,FYRT,42870030,CDM,320,RC,,,both,,,241,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,104.64,,,104.64,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,168.7,
XR EYE DETECT FOREIGN BODY BILAT FY MOD,70030,CPT,FY50,42970030,CDM,320,RC,,,both,,,362,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,224.44,,,224.44,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,224.44,,,224.44,Fee Schedule,,104.64,,,104.64,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,253.4,
XR EYE DETECT FOREIGN BODY LT W/ FY MOD,70030,CPT,FYLT,43170030,CDM,320,RC,,,both,,,241,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,104.64,,,104.64,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,168.7,
XR EYE DETECT FOREIGN BODY RT W/ FY MOD,70030,CPT,FYRT,43270030,CDM,320,RC,,,both,,,241,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,149.42,,,149.42,Fee Schedule,,104.64,,,104.64,Fee Schedule,,168.7,70,,168.7,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,168.7,
XR EYE DETECT FOREIGN BODY BILAT W/ FY,70030,CPT,FY50,43370030,CDM,320,RC,,,both,,,362,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,224.44,,,224.44,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,224.44,,,224.44,Fee Schedule,,104.64,,,104.64,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,253.4,
XR EXAM OF JAW <4 VIEWS,70100,CPT,TC,42070100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,130.39,,,130.39,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,169.06,
XR EXAM OF JAW <4 VIEWS W/ FY MOD,70100,CPT,FY,42670100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,130.39,,,130.39,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,169.06,
XR MANDIBLE BI 4 VIEWS MINU,70110,CPT,TC,42070110,CDM,320,RC,,,both,,,510,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,192.84,,,192.84,Fee Schedule,,173.49,,,173.49,Fee Schedule,,163.99,,,163.99,Fee Schedule,,357,70,,357,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,316.2,,,316.2,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,316.2,,,316.2,Fee Schedule,,137.54,,,137.54,Fee Schedule,,357,70,,357,percent of total billed charges,,157.44,,,157.44,Fee Schedule,,133.44,,,133.44,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,357,
XR MANDIBLE BI 4 VIEWS MINU W/ FY MOD,70110,CPT,FY,42670110,CDM,320,RC,,,both,,,510,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,192.84,,,192.84,Fee Schedule,,173.49,,,173.49,Fee Schedule,,163.99,,,163.99,Fee Schedule,,357,70,,357,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,316.2,,,316.2,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,316.2,,,316.2,Fee Schedule,,137.54,,,137.54,Fee Schedule,,357,70,,357,percent of total billed charges,,157.44,,,157.44,Fee Schedule,,133.44,,,133.44,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,357,
XR EXAM OF JAW 4+ VIEWS W/ FY MOD,70110,CPT,FY,43070110,CDM,320,RC,,,both,,,510,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,192.84,,,192.84,Fee Schedule,,173.49,,,173.49,Fee Schedule,,163.99,,,163.99,Fee Schedule,,357,70,,357,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,316.2,,,316.2,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,316.2,,,316.2,Fee Schedule,,137.54,,,137.54,Fee Schedule,,357,70,,357,percent of total billed charges,,157.44,,,157.44,Fee Schedule,,133.44,,,133.44,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,357,
XR EXAM OF MASTOIDS 3+ VIEW,70130,CPT,TC,42070130,CDM,320,RC,,,both,,,653,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,159.6,,,159.6,Fee Schedule,,143.59,,,143.59,Fee Schedule,,278.49,,,278.49,Fee Schedule,,250.54,,,250.54,Fee Schedule,,236.82,,,236.82,Fee Schedule,,457.1,70,,457.1,percent of total billed charges,All Other,189.61,,,189.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,223.13,,,223.13,Fee Schedule,,404.86,,,404.86,Fee Schedule,,105.06,,,,Fee Schedule,,223.13,,,223.13,Fee Schedule,,404.86,,,404.86,Fee Schedule,,197.62,,,197.62,Fee Schedule,,457.1,70,,457.1,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,457.1,
XR EXAM OF MASTOIDS 3+ VIEW W/ FY MOD,70130,CPT,FY,42670130,CDM,320,RC,,,both,,,653,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,159.6,,,159.6,Fee Schedule,,143.59,,,143.59,Fee Schedule,,278.49,,,278.49,Fee Schedule,,250.54,,,250.54,Fee Schedule,,236.82,,,236.82,Fee Schedule,,457.1,70,,457.1,percent of total billed charges,All Other,189.61,,,189.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,223.13,,,223.13,Fee Schedule,,404.86,,,404.86,Fee Schedule,,105.06,,,,Fee Schedule,,223.13,,,223.13,Fee Schedule,,404.86,,,404.86,Fee Schedule,,197.62,,,197.62,Fee Schedule,,457.1,70,,457.1,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,457.1,
XR EXAM OF MASTOIDS 3+ VIEW W/ FY MOD,70130,CPT,FY,43070130,CDM,320,RC,,,both,,,653,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,159.6,,,159.6,Fee Schedule,,143.59,,,143.59,Fee Schedule,,278.49,,,278.49,Fee Schedule,,250.54,,,250.54,Fee Schedule,,236.82,,,236.82,Fee Schedule,,457.1,70,,457.1,percent of total billed charges,All Other,189.61,,,189.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,223.13,,,223.13,Fee Schedule,,404.86,,,404.86,Fee Schedule,,105.06,,,,Fee Schedule,,223.13,,,223.13,Fee Schedule,,404.86,,,404.86,Fee Schedule,,197.62,,,197.62,Fee Schedule,,457.1,70,,457.1,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,457.1,
XR  OF FACIAL BONES <3 VIEW,70140,CPT,TC,42070140,CDM,320,RC,,,both,,,198,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,78.73,,,78.73,Fee Schedule,,70.83,,,70.83,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,All Other,93.54,,,93.54,Fee Schedule,,67,,,67,Other,186% of Medicaid,110.07,,,110.07,Fee Schedule,,122.76,,,122.76,Fee Schedule,,51.83,,,,Fee Schedule,,110.07,,,110.07,Fee Schedule,,122.76,,,122.76,Fee Schedule,,97.49,,,97.49,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,,109.88,,,109.88,Fee Schedule,,93.13,,,93.13,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR  OF FACIAL BONES <3 VIEW W/ FY MOD,70140,CPT,FY,42670140,CDM,320,RC,,,both,,,198,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,78.73,,,78.73,Fee Schedule,,70.83,,,70.83,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,All Other,93.54,,,93.54,Fee Schedule,,67,,,67,Other,186% of Medicaid,110.07,,,110.07,Fee Schedule,,122.76,,,122.76,Fee Schedule,,51.83,,,,Fee Schedule,,110.07,,,110.07,Fee Schedule,,122.76,,,122.76,Fee Schedule,,97.49,,,97.49,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,,109.88,,,109.88,Fee Schedule,,93.13,,,93.13,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR  OF FACIAL BONES < 3 VIEWS W/ FY MOD,70140,CPT,FY,43070140,CDM,320,RC,,,both,,,198,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,78.73,,,78.73,Fee Schedule,,70.83,,,70.83,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,All Other,93.54,,,93.54,Fee Schedule,,67,,,67,Other,186% of Medicaid,110.07,,,110.07,Fee Schedule,,122.76,,,122.76,Fee Schedule,,51.83,,,,Fee Schedule,,110.07,,,110.07,Fee Schedule,,122.76,,,122.76,Fee Schedule,,97.49,,,97.49,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,,109.88,,,109.88,Fee Schedule,,93.13,,,93.13,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR EXAM OF FACIAL BONES 3+ VIEWS,70150,CPT,TC,42070150,CDM,320,RC,,,both,,,248,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,121.48,,,121.48,Fee Schedule,,109.29,,,109.29,Fee Schedule,,211.86,,,211.86,Fee Schedule,,190.59,,,190.59,Fee Schedule,,180.16,,,180.16,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,All Other,144.32,,,144.32,Fee Schedule,,67,,,67,Other,186% of Medicaid,169.84,,,169.84,Fee Schedule,,153.76,,,153.76,Fee Schedule,,79.97,,,,Fee Schedule,,169.84,,,169.84,Fee Schedule,,153.76,,,153.76,Fee Schedule,,150.42,,,150.42,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,,172.2,,,172.2,Fee Schedule,,145.95,,,145.95,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,211.86,
XR EXAM OF FACIAL BONES 3+ VIEWS W/ FY,70150,CPT,FY,42670150,CDM,320,RC,,,both,,,248,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,121.48,,,121.48,Fee Schedule,,109.29,,,109.29,Fee Schedule,,211.86,,,211.86,Fee Schedule,,190.59,,,190.59,Fee Schedule,,180.16,,,180.16,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,All Other,144.32,,,144.32,Fee Schedule,,67,,,67,Other,186% of Medicaid,169.84,,,169.84,Fee Schedule,,153.76,,,153.76,Fee Schedule,,79.97,,,,Fee Schedule,,169.84,,,169.84,Fee Schedule,,153.76,,,153.76,Fee Schedule,,150.42,,,150.42,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,,172.2,,,172.2,Fee Schedule,,145.95,,,145.95,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,211.86,
XR EXAM OF FACIAL BONES 3+ VIEWS W/ FY,70150,CPT,FY,43070150,CDM,320,RC,,,both,,,248,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,121.48,,,121.48,Fee Schedule,,109.29,,,109.29,Fee Schedule,,211.86,,,211.86,Fee Schedule,,190.59,,,190.59,Fee Schedule,,180.16,,,180.16,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,All Other,144.32,,,144.32,Fee Schedule,,67,,,67,Other,186% of Medicaid,169.84,,,169.84,Fee Schedule,,153.76,,,153.76,Fee Schedule,,79.97,,,,Fee Schedule,,169.84,,,169.84,Fee Schedule,,153.76,,,153.76,Fee Schedule,,150.42,,,150.42,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,,172.2,,,172.2,Fee Schedule,,145.95,,,145.95,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,211.86,
XR NASAL BONES 3 VIEWS,70160,CPT,TC,42070160,CDM,320,RC,,,both,,,470,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,329,70,,329,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,291.4,,,291.4,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,291.4,,,291.4,Fee Schedule,,127.51,,,127.51,Fee Schedule,,329,70,,329,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,329,
XR NASAL BONES 3 VIEWS W/ FY MOD,70160,CPT,FY,42670160,CDM,320,RC,,,both,,,470,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,329,70,,329,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,291.4,,,291.4,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,291.4,,,291.4,Fee Schedule,,127.51,,,127.51,Fee Schedule,,329,70,,329,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,329,
XR NASAL BONES 3 VIEWS W/ FY MOD,70160,CPT,FY,43070160,CDM,320,RC,,,both,,,470,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,329,70,,329,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,291.4,,,291.4,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,291.4,,,291.4,Fee Schedule,,127.51,,,127.51,Fee Schedule,,329,70,,329,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,329,
XR EYE SOCKETS 4+ VIEWS,70200,CPT,TC,42070200,CDM,320,RC,,,both,,,248,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,120.33,,,120.33,Fee Schedule,,108.26,,,108.26,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,All Other,142.96,,,142.96,Fee Schedule,,67,,,67,Other,186% of Medicaid,168.23,,,168.23,Fee Schedule,,153.76,,,153.76,Fee Schedule,,79.21,,,,Fee Schedule,,168.23,,,168.23,Fee Schedule,,153.76,,,153.76,Fee Schedule,,148.99,,,148.99,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,,172.2,,,172.2,Fee Schedule,,145.95,,,145.95,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,214.27,
XR EYE SOCKETS 4+ VIEWS W/ FY MOD,70200,CPT,FY,42670200,CDM,320,RC,,,both,,,248,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,120.33,,,120.33,Fee Schedule,,108.26,,,108.26,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,All Other,142.96,,,142.96,Fee Schedule,,67,,,67,Other,186% of Medicaid,168.23,,,168.23,Fee Schedule,,153.76,,,153.76,Fee Schedule,,79.21,,,,Fee Schedule,,168.23,,,168.23,Fee Schedule,,153.76,,,153.76,Fee Schedule,,148.99,,,148.99,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,,172.2,,,172.2,Fee Schedule,,145.95,,,145.95,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,214.27,
XR EYE SOCKETS 4+ VIEWS W/ FY MOD,70200,CPT,FY,43070200,CDM,320,RC,,,both,,,248,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,120.33,,,120.33,Fee Schedule,,108.26,,,108.26,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,All Other,142.96,,,142.96,Fee Schedule,,67,,,67,Other,186% of Medicaid,168.23,,,168.23,Fee Schedule,,153.76,,,153.76,Fee Schedule,,79.21,,,,Fee Schedule,,168.23,,,168.23,Fee Schedule,,153.76,,,153.76,Fee Schedule,,148.99,,,148.99,Fee Schedule,,173.6,70,,173.6,percent of total billed charges,,172.2,,,172.2,Fee Schedule,,145.95,,,145.95,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,214.27,
XR EXAM OF SINUSES <3 VIEWS,70210,CPT,TC,42070210,CDM,320,RC,,,both,,,282,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,157.17,,,157.17,Fee Schedule,,141.39,,,141.39,Fee Schedule,,133.65,,,133.65,Fee Schedule,,197.4,70,,197.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,174.84,,,174.84,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,174.84,,,174.84,Fee Schedule,,103.21,,,103.21,Fee Schedule,,197.4,70,,197.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,197.4,
XR EXAM OF SINUSES <3 VIEWS W/ FY MOD,70210,CPT,FY,42670210,CDM,320,RC,,,both,,,282,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,157.17,,,157.17,Fee Schedule,,141.39,,,141.39,Fee Schedule,,133.65,,,133.65,Fee Schedule,,197.4,70,,197.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,174.84,,,174.84,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,174.84,,,174.84,Fee Schedule,,103.21,,,103.21,Fee Schedule,,197.4,70,,197.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,197.4,
XR EXAM OF SINUSES <3 VIEWS W/ FY MOD,70210,CPT,FY,43070210,CDM,320,RC,,,both,,,282,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,157.17,,,157.17,Fee Schedule,,141.39,,,141.39,Fee Schedule,,133.65,,,133.65,Fee Schedule,,197.4,70,,197.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,174.84,,,174.84,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,174.84,,,174.84,Fee Schedule,,103.21,,,103.21,Fee Schedule,,197.4,70,,197.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,197.4,
XR PARANASAL SINUSES 3 VIEW,70220,CPT,TC,42070220,CDM,320,RC,,,both,,,601,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,94.9,,,94.9,Fee Schedule,,85.38,,,85.38,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,420.7,70,,420.7,percent of total billed charges,All Other,112.75,,,112.75,Fee Schedule,,67,,,67,Other,186% of Medicaid,132.69,,,132.69,Fee Schedule,,372.62,,,372.62,Fee Schedule,,62.48,,,,Fee Schedule,,132.69,,,132.69,Fee Schedule,,372.62,,,372.62,Fee Schedule,,117.51,,,117.51,Fee Schedule,,420.7,70,,420.7,percent of total billed charges,,134.48,,,134.48,Fee Schedule,,113.98,,,113.98,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,420.7,
XR PARANASAL SINUSES 3 VIEW W/ FY MOD,70220,CPT,FY,42670220,CDM,320,RC,,,both,,,601,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,94.9,,,94.9,Fee Schedule,,85.38,,,85.38,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,420.7,70,,420.7,percent of total billed charges,All Other,112.75,,,112.75,Fee Schedule,,67,,,67,Other,186% of Medicaid,132.69,,,132.69,Fee Schedule,,372.62,,,372.62,Fee Schedule,,62.48,,,,Fee Schedule,,132.69,,,132.69,Fee Schedule,,372.62,,,372.62,Fee Schedule,,117.51,,,117.51,Fee Schedule,,420.7,70,,420.7,percent of total billed charges,,134.48,,,134.48,Fee Schedule,,113.98,,,113.98,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,420.7,
XR EXAM OF SINUSES 3+ VIEWS W/ FY MOD,70220,CPT,FY,43070220,CDM,320,RC,,,both,,,601,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,94.9,,,94.9,Fee Schedule,,85.38,,,85.38,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,420.7,70,,420.7,percent of total billed charges,All Other,112.75,,,112.75,Fee Schedule,,67,,,67,Other,186% of Medicaid,132.69,,,132.69,Fee Schedule,,372.62,,,372.62,Fee Schedule,,62.48,,,,Fee Schedule,,132.69,,,132.69,Fee Schedule,,372.62,,,372.62,Fee Schedule,,117.51,,,117.51,Fee Schedule,,420.7,70,,420.7,percent of total billed charges,,134.48,,,134.48,Fee Schedule,,113.98,,,113.98,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,420.7,
XR SELLA TURCICA,70240,CPT,TC,42070240,CDM,320,RC,,,both,,,472,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,330.4,70,,330.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,292.64,,,292.64,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,292.64,,,292.64,Fee Schedule,,103.21,,,103.21,Fee Schedule,,330.4,70,,330.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,330.4,
XR SELLA TURCICA W/ FY MOD,70240,CPT,FY,42670240,CDM,320,RC,,,both,,,472,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,330.4,70,,330.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,292.64,,,292.64,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,292.64,,,292.64,Fee Schedule,,103.21,,,103.21,Fee Schedule,,330.4,70,,330.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,330.4,
XR SELLA TURCICA W/ FY MOD,70240,CPT,FY,43070240,CDM,320,RC,,,both,,,472,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,330.4,70,,330.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,292.64,,,292.64,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,292.64,,,292.64,Fee Schedule,,103.21,,,103.21,Fee Schedule,,330.4,70,,330.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,330.4,
XR SKULL COMPLETE,70250,CPT,TC,42070250,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,96.05,,,96.05,Fee Schedule,,86.42,,,86.42,Fee Schedule,,176.18,,,176.18,Fee Schedule,,158.5,,,158.5,Fee Schedule,,149.82,,,149.82,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,114.12,,,114.12,Fee Schedule,,67,,,67,Other,186% of Medicaid,134.29,,,134.29,Fee Schedule,,150.04,,,150.04,Fee Schedule,,63.23,,,,Fee Schedule,,134.29,,,134.29,Fee Schedule,,150.04,,,150.04,Fee Schedule,,118.93,,,118.93,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,132.84,,,132.84,Fee Schedule,,112.59,,,112.59,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR SKULL COMPLETE W/ FY MOD,70250,CPT,FY,42670250,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,96.05,,,96.05,Fee Schedule,,86.42,,,86.42,Fee Schedule,,176.18,,,176.18,Fee Schedule,,158.5,,,158.5,Fee Schedule,,149.82,,,149.82,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,114.12,,,114.12,Fee Schedule,,67,,,67,Other,186% of Medicaid,134.29,,,134.29,Fee Schedule,,150.04,,,150.04,Fee Schedule,,63.23,,,,Fee Schedule,,134.29,,,134.29,Fee Schedule,,150.04,,,150.04,Fee Schedule,,118.93,,,118.93,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,132.84,,,132.84,Fee Schedule,,112.59,,,112.59,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR SKULL COMPLETE W/ FY MOD,70250,CPT,FY,43070250,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,96.05,,,96.05,Fee Schedule,,86.42,,,86.42,Fee Schedule,,176.18,,,176.18,Fee Schedule,,158.5,,,158.5,Fee Schedule,,149.82,,,149.82,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,114.12,,,114.12,Fee Schedule,,67,,,67,Other,186% of Medicaid,134.29,,,134.29,Fee Schedule,,150.04,,,150.04,Fee Schedule,,63.23,,,,Fee Schedule,,134.29,,,134.29,Fee Schedule,,150.04,,,150.04,Fee Schedule,,118.93,,,118.93,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,132.84,,,132.84,Fee Schedule,,112.59,,,112.59,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR SKULL COMPLETE MIN 4 VIE,70260,CPT,TC,42070260,CDM,320,RC,,,both,,,330,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,108.78,,,108.78,Fee Schedule,,97.87,,,97.87,Fee Schedule,,216.62,,,216.62,Fee Schedule,,194.88,,,194.88,Fee Schedule,,184.21,,,184.21,Fee Schedule,,231,70,,231,percent of total billed charges,All Other,129.24,,,129.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,152.09,,,152.09,Fee Schedule,,204.6,,,204.6,Fee Schedule,,71.61,,,,Fee Schedule,,152.09,,,152.09,Fee Schedule,,204.6,,,204.6,Fee Schedule,,134.7,,,134.7,Fee Schedule,,231,70,,231,percent of total billed charges,,154.16,,,154.16,Fee Schedule,,130.66,,,130.66,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,231,
XR SKULL COMPLETE MIN 4 VIE W/ FY MOD,70260,CPT,FY,42670260,CDM,320,RC,,,both,,,330,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,108.78,,,108.78,Fee Schedule,,97.87,,,97.87,Fee Schedule,,216.62,,,216.62,Fee Schedule,,194.88,,,194.88,Fee Schedule,,184.21,,,184.21,Fee Schedule,,231,70,,231,percent of total billed charges,All Other,129.24,,,129.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,152.09,,,152.09,Fee Schedule,,204.6,,,204.6,Fee Schedule,,71.61,,,,Fee Schedule,,152.09,,,152.09,Fee Schedule,,204.6,,,204.6,Fee Schedule,,134.7,,,134.7,Fee Schedule,,231,70,,231,percent of total billed charges,,154.16,,,154.16,Fee Schedule,,130.66,,,130.66,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,231,
XR SKULL COMPLETE MIN 4 VIE W/ FY MOD,70260,CPT,FY,43070260,CDM,320,RC,,,both,,,330,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,108.78,,,108.78,Fee Schedule,,97.87,,,97.87,Fee Schedule,,216.62,,,216.62,Fee Schedule,,194.88,,,194.88,Fee Schedule,,184.21,,,184.21,Fee Schedule,,231,70,,231,percent of total billed charges,All Other,129.24,,,129.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,152.09,,,152.09,Fee Schedule,,204.6,,,204.6,Fee Schedule,,71.61,,,,Fee Schedule,,152.09,,,152.09,Fee Schedule,,204.6,,,204.6,Fee Schedule,,134.7,,,134.7,Fee Schedule,,231,70,,231,percent of total billed charges,,154.16,,,154.16,Fee Schedule,,130.66,,,130.66,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,231,
TMJ JOINT - UNILATERAL,70328,CPT,TC,42070328,CDM,320,RC,,,both,,,649,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,454.3,70,,454.3,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,402.38,,,402.38,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,402.38,,,402.38,Fee Schedule,,111.79,,,111.79,Fee Schedule,,454.3,70,,454.3,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,454.3,
TMJ JOINT - UNILATERAL W/ FY MOD,70328,CPT,FY,42670328,CDM,320,RC,,,both,,,649,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,454.3,70,,454.3,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,402.38,,,402.38,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,402.38,,,402.38,Fee Schedule,,111.79,,,111.79,Fee Schedule,,454.3,70,,454.3,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,454.3,
TMJ JOINT - UNILATERAL W/ FY MOD,70328,CPT,FY,43070328,CDM,320,RC,,,both,,,649,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,454.3,70,,454.3,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,402.38,,,402.38,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,402.38,,,402.38,Fee Schedule,,111.79,,,111.79,Fee Schedule,,454.3,70,,454.3,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,454.3,
XR TM JOINT BILATERAL,70330,CPT,TC,42070330,CDM,320,RC,,,both,,,288,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,144.57,,,144.57,Fee Schedule,,130.07,,,130.07,Fee Schedule,,254.71,,,254.71,Fee Schedule,,229.15,,,229.15,Fee Schedule,,216.6,,,216.6,Fee Schedule,,201.6,70,,201.6,percent of total billed charges,All Other,171.76,,,171.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,202.13,,,202.13,Fee Schedule,,178.56,,,178.56,Fee Schedule,,95.17,,,,Fee Schedule,,202.13,,,202.13,Fee Schedule,,178.56,,,178.56,Fee Schedule,,179.01,,,179.01,Fee Schedule,,201.6,70,,201.6,percent of total billed charges,,206.64,,,206.64,Fee Schedule,,175.14,,,175.14,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,254.71,
XR TM JOINT BILATERAL W/ FY MOD,70330,CPT,FY,42670330,CDM,320,RC,,,both,,,288,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,144.57,,,144.57,Fee Schedule,,130.07,,,130.07,Fee Schedule,,254.71,,,254.71,Fee Schedule,,229.15,,,229.15,Fee Schedule,,216.6,,,216.6,Fee Schedule,,201.6,70,,201.6,percent of total billed charges,All Other,171.76,,,171.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,202.13,,,202.13,Fee Schedule,,178.56,,,178.56,Fee Schedule,,95.17,,,,Fee Schedule,,202.13,,,202.13,Fee Schedule,,178.56,,,178.56,Fee Schedule,,179.01,,,179.01,Fee Schedule,,201.6,70,,201.6,percent of total billed charges,,206.64,,,206.64,Fee Schedule,,175.14,,,175.14,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,254.71,
XR NECK SOFT TISSUES,70360,CPT,TC,42070360,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,78.73,,,78.73,Fee Schedule,,70.83,,,70.83,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,93.54,,,93.54,Fee Schedule,,67,,,67,Other,186% of Medicaid,110.07,,,110.07,Fee Schedule,,143.22,,,143.22,Fee Schedule,,51.83,,,,Fee Schedule,,110.07,,,110.07,Fee Schedule,,143.22,,,143.22,Fee Schedule,,97.49,,,97.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR NECK SOFT TISSUES W/ FY MOD,70360,CPT,FY,42670360,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,78.73,,,78.73,Fee Schedule,,70.83,,,70.83,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,93.54,,,93.54,Fee Schedule,,67,,,67,Other,186% of Medicaid,110.07,,,110.07,Fee Schedule,,143.22,,,143.22,Fee Schedule,,51.83,,,,Fee Schedule,,110.07,,,110.07,Fee Schedule,,143.22,,,143.22,Fee Schedule,,97.49,,,97.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR TM JOINT BILATERAL W/ FY MOD,70360,CPT,FY,43070360,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,78.73,,,78.73,Fee Schedule,,70.83,,,70.83,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,93.54,,,93.54,Fee Schedule,,67,,,67,Other,186% of Medicaid,110.07,,,110.07,Fee Schedule,,143.22,,,143.22,Fee Schedule,,51.83,,,,Fee Schedule,,110.07,,,110.07,Fee Schedule,,143.22,,,143.22,Fee Schedule,,97.49,,,97.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
SALIVARY GLAND CALCULUS,70380,CPT,TC,42070380,CDM,320,RC,,,both,,,624,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,386.88,,,386.88,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,386.88,,,386.88,Fee Schedule,,127.51,,,127.51,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,436.8,
SALIVARY GLAND CALCULUS W/ FY MOD,70380,CPT,FY,42670380,CDM,320,RC,,,both,,,624,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,386.88,,,386.88,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,386.88,,,386.88,Fee Schedule,,127.51,,,127.51,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,436.8,
SALIVARY GLAND CALCULUS W/ FY MOD,70380,CPT,FY,43070380,CDM,320,RC,,,both,,,624,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,386.88,,,386.88,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,386.88,,,386.88,Fee Schedule,,127.51,,,127.51,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,436.8,
SIALOGRAM,70390,CPT,TC,42070390,CDM,320,RC,,,both,,,894,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,339.83,,,339.83,Fee Schedule,,305.74,,,305.74,Fee Schedule,,580.72,,,580.72,Fee Schedule,,522.43,,,522.43,Fee Schedule,,493.82,,,493.82,Fee Schedule,,625.8,70,,625.8,percent of total billed charges,All Other,403.75,,,403.75,Fee Schedule,,406,,,406,Other,186% of Medicaid,475.12,,,475.12,Fee Schedule,,554.28,,,554.28,Fee Schedule,,223.71,,,,Fee Schedule,,475.12,,,475.12,Fee Schedule,,554.28,,,554.28,Fee Schedule,,420.79,,,420.79,Fee Schedule,,625.8,70,,625.8,percent of total billed charges,,503.48,,,503.48,Fee Schedule,,426.73,,,426.73,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,706.37,
SIALOGRAM W/ FY MOD,70390,CPT,FY,42670390,CDM,320,RC,,,both,,,894,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,339.83,,,339.83,Fee Schedule,,305.74,,,305.74,Fee Schedule,,580.72,,,580.72,Fee Schedule,,522.43,,,522.43,Fee Schedule,,493.82,,,493.82,Fee Schedule,,625.8,70,,625.8,percent of total billed charges,All Other,403.75,,,403.75,Fee Schedule,,406,,,406,Other,186% of Medicaid,475.12,,,475.12,Fee Schedule,,554.28,,,554.28,Fee Schedule,,223.71,,,,Fee Schedule,,475.12,,,475.12,Fee Schedule,,554.28,,,554.28,Fee Schedule,,420.79,,,420.79,Fee Schedule,,625.8,70,,625.8,percent of total billed charges,,503.48,,,503.48,Fee Schedule,,426.73,,,426.73,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,706.37,
SIALOGRAM,70390,CPT,TC,47070390,CDM,320,RC,,,both,,,894,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,339.83,,,339.83,Fee Schedule,,305.74,,,305.74,Fee Schedule,,580.72,,,580.72,Fee Schedule,,522.43,,,522.43,Fee Schedule,,493.82,,,493.82,Fee Schedule,,625.8,70,,625.8,percent of total billed charges,All Other,403.75,,,403.75,Fee Schedule,,406,,,406,Other,186% of Medicaid,475.12,,,475.12,Fee Schedule,,554.28,,,554.28,Fee Schedule,,223.71,,,,Fee Schedule,,475.12,,,475.12,Fee Schedule,,554.28,,,554.28,Fee Schedule,,420.79,,,420.79,Fee Schedule,,625.8,70,,625.8,percent of total billed charges,,503.48,,,503.48,Fee Schedule,,426.73,,,426.73,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,706.37,
XR RIBS 2 VIEWS LEFT,71100,CPT,TCLT,42171100,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,152.4,,,152.4,Fee Schedule,,137.1,,,137.1,Fee Schedule,,129.59,,,129.59,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,113.21,,,113.21,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 2 VIEWS RIGHT,71100,CPT,TCRT,42271100,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,152.4,,,152.4,Fee Schedule,,137.1,,,137.1,Fee Schedule,,129.59,,,129.59,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,113.21,,,113.21,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 2 VIEWS LEFT FY MOD,71100,CPT,FYLT,42771100,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,152.4,,,152.4,Fee Schedule,,137.1,,,137.1,Fee Schedule,,129.59,,,129.59,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,113.21,,,113.21,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 2 VIEWS RIGHT FY MOD,71100,CPT,FYRT,42871100,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,152.4,,,152.4,Fee Schedule,,137.1,,,137.1,Fee Schedule,,129.59,,,129.59,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,113.21,,,113.21,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 2 VIEWS LEFT W/ FY MOD,71100,CPT,FYLT,43171100,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,152.4,,,152.4,Fee Schedule,,137.1,,,137.1,Fee Schedule,,129.59,,,129.59,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,113.21,,,113.21,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 2 VIEWS RIGHT W/ FY MOD,71100,CPT,FYRT,43271100,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,152.4,,,152.4,Fee Schedule,,137.1,,,137.1,Fee Schedule,,129.59,,,129.59,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,270.94,,,270.94,Fee Schedule,,113.21,,,113.21,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 3 VIEWS + CXR LT,71101,CPT,TCLT,42171101,CDM,320,RC,,,both,,,437,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,185.72,,,185.72,Fee Schedule,,167.08,,,167.08,Fee Schedule,,157.93,,,157.93,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,127.51,,,127.51,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 3 VIEWS + CXR RT,71101,CPT,TCRT,42271101,CDM,320,RC,,,both,,,437,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,185.72,,,185.72,Fee Schedule,,167.08,,,167.08,Fee Schedule,,157.93,,,157.93,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,127.51,,,127.51,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 3 VIEWS + CXR LT FY MOD,71101,CPT,FYLT,42771101,CDM,320,RC,,,both,,,437,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,185.72,,,185.72,Fee Schedule,,167.08,,,167.08,Fee Schedule,,157.93,,,157.93,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,127.51,,,127.51,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 3 VIEWS + CXR RT FY MOD,71101,CPT,FYRT,42871101,CDM,320,RC,,,both,,,437,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,185.72,,,185.72,Fee Schedule,,167.08,,,167.08,Fee Schedule,,157.93,,,157.93,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,127.51,,,127.51,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 3 VIEWS + CXR LT W/ FY MOD,71101,CPT,FYLT,43171101,CDM,320,RC,,,both,,,437,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,185.72,,,185.72,Fee Schedule,,167.08,,,167.08,Fee Schedule,,157.93,,,157.93,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,127.51,,,127.51,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS 3 VIEWS + CXR RT W/ FY MOD,71101,CPT,FYRT,43271101,CDM,320,RC,,,both,,,437,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,185.72,,,185.72,Fee Schedule,,167.08,,,167.08,Fee Schedule,,157.93,,,157.93,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,67,,,67,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,270.94,,,270.94,Fee Schedule,,127.51,,,127.51,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR RIBS BILATERAL,71110,CPT,TC,42071110,CDM,320,RC,,,both,,,513,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,359.1,70,,359.1,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,318.06,,,318.06,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,318.06,,,318.06,Fee Schedule,,130.39,,,130.39,Fee Schedule,,359.1,70,,359.1,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,359.1,
XR RIBS BILATERAL W/ FY MOD,71110,CPT,FY,42671110,CDM,320,RC,,,both,,,513,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,359.1,70,,359.1,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,318.06,,,318.06,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,318.06,,,318.06,Fee Schedule,,130.39,,,130.39,Fee Schedule,,359.1,70,,359.1,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,359.1,
XR RIBS BILATERAL W/ FY MOD,71110,CPT,FY,43071110,CDM,320,RC,,,both,,,513,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,359.1,70,,359.1,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,318.06,,,318.06,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,318.06,,,318.06,Fee Schedule,,130.39,,,130.39,Fee Schedule,,359.1,70,,359.1,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,359.1,
XR RIBS BILATERAL 4 VIEWS A,71111,CPT,TC,42071111,CDM,320,RC,,,both,,,548,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,129.55,,,129.55,Fee Schedule,,116.55,,,116.55,Fee Schedule,,261.83,,,261.83,Fee Schedule,,235.56,,,235.56,Fee Schedule,,222.65,,,222.65,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,All Other,153.91,,,153.91,Fee Schedule,,67,,,67,Other,186% of Medicaid,181.12,,,181.12,Fee Schedule,,339.76,,,339.76,Fee Schedule,,85.28,,,,Fee Schedule,,181.12,,,181.12,Fee Schedule,,339.76,,,339.76,Fee Schedule,,160.41,,,160.41,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,,183.68,,,183.68,Fee Schedule,,155.68,,,155.68,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,383.6,
XR RIBS BILATERAL 4 VIEWS A W/ FY MOD,71111,CPT,FY,42671111,CDM,320,RC,,,both,,,548,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,129.55,,,129.55,Fee Schedule,,116.55,,,116.55,Fee Schedule,,261.83,,,261.83,Fee Schedule,,235.56,,,235.56,Fee Schedule,,222.65,,,222.65,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,All Other,153.91,,,153.91,Fee Schedule,,67,,,67,Other,186% of Medicaid,181.12,,,181.12,Fee Schedule,,339.76,,,339.76,Fee Schedule,,85.28,,,,Fee Schedule,,181.12,,,181.12,Fee Schedule,,339.76,,,339.76,Fee Schedule,,160.41,,,160.41,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,,183.68,,,183.68,Fee Schedule,,155.68,,,155.68,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,383.6,
XR RIBS BILATERAL 4 VIEWS A W/FY MOD,71111,CPT,FY,43071111,CDM,320,RC,,,both,,,548,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,129.55,,,129.55,Fee Schedule,,116.55,,,116.55,Fee Schedule,,261.83,,,261.83,Fee Schedule,,235.56,,,235.56,Fee Schedule,,222.65,,,222.65,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,All Other,153.91,,,153.91,Fee Schedule,,67,,,67,Other,186% of Medicaid,181.12,,,181.12,Fee Schedule,,339.76,,,339.76,Fee Schedule,,85.28,,,,Fee Schedule,,181.12,,,181.12,Fee Schedule,,339.76,,,339.76,Fee Schedule,,160.41,,,160.41,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,,183.68,,,183.68,Fee Schedule,,155.68,,,155.68,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,383.6,
XR OF STERNUM 2 VIEWS,71120,CPT,TC,42071120,CDM,320,RC,,,both,,,548,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,157.17,,,157.17,Fee Schedule,,141.39,,,141.39,Fee Schedule,,133.65,,,133.65,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,339.76,,,339.76,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,339.76,,,339.76,Fee Schedule,,104.64,,,104.64,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,383.6,
XR OF STERNUM 2 VIEWS W/ FY MOD,71120,CPT,FY,42671120,CDM,320,RC,,,both,,,548,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,157.17,,,157.17,Fee Schedule,,141.39,,,141.39,Fee Schedule,,133.65,,,133.65,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,339.76,,,339.76,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,339.76,,,339.76,Fee Schedule,,104.64,,,104.64,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,383.6,
XR OF STERNUM 2 VIEWS W/ FY MOD,71120,CPT,FY,43071120,CDM,320,RC,,,both,,,548,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,157.17,,,157.17,Fee Schedule,,141.39,,,141.39,Fee Schedule,,133.65,,,133.65,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,339.76,,,339.76,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,339.76,,,339.76,Fee Schedule,,104.64,,,104.64,Fee Schedule,,383.6,70,,383.6,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,383.6,
XR EXAM OF BREASTBONE 3+ VI W/ FY MOD,71130,CPT,FY,43071130,CDM,320,RC,,,both,,,520,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,107.6,,,107.6,Fee Schedule,,96.81,,,96.81,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,364,70,,364,percent of total billed charges,All Other,127.84,,,127.84,Fee Schedule,,67,,,67,Other,186% of Medicaid,150.44,,,150.44,Fee Schedule,,322.4,,,322.4,Fee Schedule,,70.83,,,,Fee Schedule,,150.44,,,150.44,Fee Schedule,,322.4,,,322.4,Fee Schedule,,133.23,,,133.23,Fee Schedule,,364,70,,364,percent of total billed charges,,152.52,,,152.52,Fee Schedule,,129.27,,,129.27,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,364,
XR SPINE 1 VIEW,72020,CPT,TC,42072020,CDM,320,RC,,,both,,,433,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,57.93,,,57.93,Fee Schedule,,52.12,,,52.12,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,All Other,68.83,,,68.83,Fee Schedule,,67,,,67,Other,186% of Medicaid,80.99,,,80.99,Fee Schedule,,268.46,,,268.46,Fee Schedule,,38.14,,,,Fee Schedule,,80.99,,,80.99,Fee Schedule,,268.46,,,268.46,Fee Schedule,,71.73,,,71.73,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,,82,,,82,Fee Schedule,,69.5,,,69.5,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,303.1,
XR SPINE 1 VIEW W/ FY MOD,72020,CPT,FY,42672020,CDM,320,RC,,,both,,,433,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,57.93,,,57.93,Fee Schedule,,52.12,,,52.12,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,All Other,68.83,,,68.83,Fee Schedule,,67,,,67,Other,186% of Medicaid,80.99,,,80.99,Fee Schedule,,268.46,,,268.46,Fee Schedule,,38.14,,,,Fee Schedule,,80.99,,,80.99,Fee Schedule,,268.46,,,268.46,Fee Schedule,,71.73,,,71.73,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,,82,,,82,Fee Schedule,,69.5,,,69.5,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,303.1,
XR SPINE 1 VIEW W/ FY MOD,72020,CPT,FY,43072020,CDM,320,RC,,,both,,,433,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,57.93,,,57.93,Fee Schedule,,52.12,,,52.12,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,All Other,68.83,,,68.83,Fee Schedule,,67,,,67,Other,186% of Medicaid,80.99,,,80.99,Fee Schedule,,268.46,,,268.46,Fee Schedule,,38.14,,,,Fee Schedule,,80.99,,,80.99,Fee Schedule,,268.46,,,268.46,Fee Schedule,,71.73,,,71.73,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,,82,,,82,Fee Schedule,,69.5,,,69.5,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,303.1,
XR CERVICAL SPINE 2-3 VIEWS,72040,CPT,TC,42072040,CDM,320,RC,,,both,,,481,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,192.84,,,192.84,Fee Schedule,,173.49,,,173.49,Fee Schedule,,163.99,,,163.99,Fee Schedule,,336.7,70,,336.7,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,298.22,,,298.22,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,298.22,,,298.22,Fee Schedule,,124.66,,,124.66,Fee Schedule,,336.7,70,,336.7,percent of total billed charges,,141.04,,,141.04,Fee Schedule,,119.54,,,119.54,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,336.7,
XR CERVICAL SPINE 2-3 VIEWS W/ FY MOD,72040,CPT,FY,42672040,CDM,320,RC,,,both,,,481,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,192.84,,,192.84,Fee Schedule,,173.49,,,173.49,Fee Schedule,,163.99,,,163.99,Fee Schedule,,336.7,70,,336.7,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,298.22,,,298.22,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,298.22,,,298.22,Fee Schedule,,124.66,,,124.66,Fee Schedule,,336.7,70,,336.7,percent of total billed charges,,141.04,,,141.04,Fee Schedule,,119.54,,,119.54,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,336.7,
XR CERVICAL SPINE 2-3 VIEWS W/ FY MOD,72040,CPT,FY,43072040,CDM,320,RC,,,both,,,481,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,192.84,,,192.84,Fee Schedule,,173.49,,,173.49,Fee Schedule,,163.99,,,163.99,Fee Schedule,,336.7,70,,336.7,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,298.22,,,298.22,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,298.22,,,298.22,Fee Schedule,,124.66,,,124.66,Fee Schedule,,336.7,70,,336.7,percent of total billed charges,,141.04,,,141.04,Fee Schedule,,119.54,,,119.54,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,336.7,
XR CERVICAL SPINE 4 VIEWS,72050,CPT,TC,42072050,CDM,320,RC,,,both,,,525,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,142.27,,,142.27,Fee Schedule,,128,,,128,Fee Schedule,,261.83,,,261.83,Fee Schedule,,235.56,,,235.56,Fee Schedule,,222.65,,,222.65,Fee Schedule,,367.5,70,,367.5,percent of total billed charges,All Other,169.03,,,169.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,198.92,,,198.92,Fee Schedule,,325.5,,,325.5,Fee Schedule,,93.66,,,,Fee Schedule,,198.92,,,198.92,Fee Schedule,,325.5,,,325.5,Fee Schedule,,176.17,,,176.17,Fee Schedule,,367.5,70,,367.5,percent of total billed charges,,196.8,,,196.8,Fee Schedule,,166.8,,,166.8,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,367.5,
XR CERVICAL SPINE 4 VIEWS W/ FY MOD,72050,CPT,FY,42672050,CDM,320,RC,,,both,,,525,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,142.27,,,142.27,Fee Schedule,,128,,,128,Fee Schedule,,261.83,,,261.83,Fee Schedule,,235.56,,,235.56,Fee Schedule,,222.65,,,222.65,Fee Schedule,,367.5,70,,367.5,percent of total billed charges,All Other,169.03,,,169.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,198.92,,,198.92,Fee Schedule,,325.5,,,325.5,Fee Schedule,,93.66,,,,Fee Schedule,,198.92,,,198.92,Fee Schedule,,325.5,,,325.5,Fee Schedule,,176.17,,,176.17,Fee Schedule,,367.5,70,,367.5,percent of total billed charges,,196.8,,,196.8,Fee Schedule,,166.8,,,166.8,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,367.5,
XR CERVICAL SPINE 4 VIEWS W/ FY MOD,72050,CPT,FY,43072050,CDM,320,RC,,,both,,,525,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,142.27,,,142.27,Fee Schedule,,128,,,128,Fee Schedule,,261.83,,,261.83,Fee Schedule,,235.56,,,235.56,Fee Schedule,,222.65,,,222.65,Fee Schedule,,367.5,70,,367.5,percent of total billed charges,All Other,169.03,,,169.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,198.92,,,198.92,Fee Schedule,,325.5,,,325.5,Fee Schedule,,93.66,,,,Fee Schedule,,198.92,,,198.92,Fee Schedule,,325.5,,,325.5,Fee Schedule,,176.17,,,176.17,Fee Schedule,,367.5,70,,367.5,percent of total billed charges,,196.8,,,196.8,Fee Schedule,,166.8,,,166.8,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,367.5,
XR CERVICAL SPINE COMP,72052,CPT,TC,42072052,CDM,320,RC,,,both,,,624,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,167.7,,,167.7,Fee Schedule,,150.88,,,150.88,Fee Schedule,,345.13,,,345.13,Fee Schedule,,310.49,,,310.49,Fee Schedule,,293.49,,,293.49,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,All Other,199.24,,,199.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,234.46,,,234.46,Fee Schedule,,386.88,,,386.88,Fee Schedule,,110.4,,,,Fee Schedule,,234.46,,,234.46,Fee Schedule,,386.88,,,386.88,Fee Schedule,,207.65,,,207.65,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,436.8,
XR CERVICAL SPINE COMP W/ FY MOD,72052,CPT,FY,42672052,CDM,320,RC,,,both,,,624,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,167.7,,,167.7,Fee Schedule,,150.88,,,150.88,Fee Schedule,,345.13,,,345.13,Fee Schedule,,310.49,,,310.49,Fee Schedule,,293.49,,,293.49,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,All Other,199.24,,,199.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,234.46,,,234.46,Fee Schedule,,386.88,,,386.88,Fee Schedule,,110.4,,,,Fee Schedule,,234.46,,,234.46,Fee Schedule,,386.88,,,386.88,Fee Schedule,,207.65,,,207.65,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,436.8,
XR CERVICAL SPINE COMP W/ FY MOD,72052,CPT,FY,43072052,CDM,320,RC,,,both,,,624,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,167.7,,,167.7,Fee Schedule,,150.88,,,150.88,Fee Schedule,,345.13,,,345.13,Fee Schedule,,310.49,,,310.49,Fee Schedule,,293.49,,,293.49,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,All Other,199.24,,,199.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,234.46,,,234.46,Fee Schedule,,386.88,,,386.88,Fee Schedule,,110.4,,,,Fee Schedule,,234.46,,,234.46,Fee Schedule,,386.88,,,386.88,Fee Schedule,,207.65,,,207.65,Fee Schedule,,436.8,70,,436.8,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,436.8,
XR THORACIC SPINE 2 VIEWS,72070,CPT,TC,42072070,CDM,320,RC,,,both,,,587,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,81.03,,,81.03,Fee Schedule,,72.9,,,72.9,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,410.9,70,,410.9,percent of total billed charges,All Other,96.27,,,96.27,Fee Schedule,,67,,,67,Other,186% of Medicaid,113.28,,,113.28,Fee Schedule,,363.94,,,363.94,Fee Schedule,,53.34,,,,Fee Schedule,,113.28,,,113.28,Fee Schedule,,363.94,,,363.94,Fee Schedule,,100.33,,,100.33,Fee Schedule,,410.9,70,,410.9,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,410.9,
XR THORACIC SPINE 2 VIEWS W/ FY MOD,72070,CPT,FY,42672070,CDM,320,RC,,,both,,,587,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,81.03,,,81.03,Fee Schedule,,72.9,,,72.9,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,410.9,70,,410.9,percent of total billed charges,All Other,96.27,,,96.27,Fee Schedule,,67,,,67,Other,186% of Medicaid,113.28,,,113.28,Fee Schedule,,363.94,,,363.94,Fee Schedule,,53.34,,,,Fee Schedule,,113.28,,,113.28,Fee Schedule,,363.94,,,363.94,Fee Schedule,,100.33,,,100.33,Fee Schedule,,410.9,70,,410.9,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,410.9,
XR THORACIC SPINE 2 VIEWS W/ FY MOD,72070,CPT,FY,43072070,CDM,320,RC,,,both,,,587,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,81.03,,,81.03,Fee Schedule,,72.9,,,72.9,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,410.9,70,,410.9,percent of total billed charges,All Other,96.27,,,96.27,Fee Schedule,,67,,,67,Other,186% of Medicaid,113.28,,,113.28,Fee Schedule,,363.94,,,363.94,Fee Schedule,,53.34,,,,Fee Schedule,,113.28,,,113.28,Fee Schedule,,363.94,,,363.94,Fee Schedule,,100.33,,,100.33,Fee Schedule,,410.9,70,,410.9,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,410.9,
XR THORACIC SPINE 3 VIEWS,72072,CPT,TC,42072072,CDM,320,RC,,,both,,,550,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,190.48,,,190.48,Fee Schedule,,171.37,,,171.37,Fee Schedule,,161.98,,,161.98,Fee Schedule,,385,70,,385,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,341,,,341,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,341,,,341,Fee Schedule,,124.66,,,124.66,Fee Schedule,,385,70,,385,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,385,
XR THORACIC SPINE 3 VIEWS W/ FY MOD,72072,CPT,FY,42672072,CDM,320,RC,,,both,,,550,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,190.48,,,190.48,Fee Schedule,,171.37,,,171.37,Fee Schedule,,161.98,,,161.98,Fee Schedule,,385,70,,385,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,341,,,341,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,341,,,341,Fee Schedule,,124.66,,,124.66,Fee Schedule,,385,70,,385,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,385,
XR THORACIC SPINE 3 VIEWS W/ FY MOD,72072,CPT,FY,43072072,CDM,320,RC,,,both,,,550,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,190.48,,,190.48,Fee Schedule,,171.37,,,171.37,Fee Schedule,,161.98,,,161.98,Fee Schedule,,385,70,,385,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,341,,,341,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,341,,,341,Fee Schedule,,124.66,,,124.66,Fee Schedule,,385,70,,385,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,385,
XR EXAM OF THORACIC SPINE 4+ VIEWS,72074,CPT,TC,42072074,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,238.05,,,238.05,Fee Schedule,,214.16,,,214.16,Fee Schedule,,202.43,,,202.43,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,150.04,,,150.04,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,150.04,,,150.04,Fee Schedule,,141.84,,,141.84,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,160.72,,,160.72,Fee Schedule,,136.22,,,136.22,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,238.05,
XR EXAM OF THORACIC SPINE 4+ VIEWS W/ FY,72074,CPT,FY,42672074,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,238.05,,,238.05,Fee Schedule,,214.16,,,214.16,Fee Schedule,,202.43,,,202.43,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,150.04,,,150.04,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,150.04,,,150.04,Fee Schedule,,141.84,,,141.84,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,160.72,,,160.72,Fee Schedule,,136.22,,,136.22,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,238.05,
XR EXAM OF THORACIC SPINE 4+ VIEWS W/ FY,72074,CPT,FY,43072074,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,238.05,,,238.05,Fee Schedule,,214.16,,,214.16,Fee Schedule,,202.43,,,202.43,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,150.04,,,150.04,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,150.04,,,150.04,Fee Schedule,,141.84,,,141.84,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,160.72,,,160.72,Fee Schedule,,136.22,,,136.22,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,238.05,
XR THORACOLUMBAR 2 VIEWS,72080,CPT,TC,42072080,CDM,320,RC,,,both,,,362,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,176.18,,,176.18,Fee Schedule,,158.5,,,158.5,Fee Schedule,,149.82,,,149.82,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,224.44,,,224.44,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,224.44,,,224.44,Fee Schedule,,106.06,,,106.06,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,253.4,
XR THORACOLUMBAR 2 VIEWS W/ FY MOD,72080,CPT,FY,42672080,CDM,320,RC,,,both,,,362,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,176.18,,,176.18,Fee Schedule,,158.5,,,158.5,Fee Schedule,,149.82,,,149.82,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,224.44,,,224.44,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,224.44,,,224.44,Fee Schedule,,106.06,,,106.06,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,253.4,
XR THORACOLUMBAR 2 VIEWS W/ FY MOD,72080,CPT,FY,43072080,CDM,320,RC,,,both,,,362,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,176.18,,,176.18,Fee Schedule,,158.5,,,158.5,Fee Schedule,,149.82,,,149.82,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,224.44,,,224.44,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,224.44,,,224.44,Fee Schedule,,106.06,,,106.06,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,253.4,
X-RAY EXAM ENTIRE SPI 1 VW,72081,CPT,TC,42072081,CDM,320,RC,,,both,,,204,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,24.57,,,24.57,Fee Schedule,,24.57,,,24.57,Fee Schedule,,24.57,,,24.57,Fee Schedule,,142.8,70,,142.8,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,126.48,,,126.48,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,126.48,,,126.48,Fee Schedule,,130.39,,,130.39,Fee Schedule,,142.8,70,,142.8,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,24.57,164.2,
X-RAY EXAM ENTIRE SPI 1 VW W/ FY MOD,72081,CPT,FY,42672081,CDM,320,RC,,,both,,,204,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,24.57,,,24.57,Fee Schedule,,24.57,,,24.57,Fee Schedule,,24.57,,,24.57,Fee Schedule,,142.8,70,,142.8,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,126.48,,,126.48,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,126.48,,,126.48,Fee Schedule,,130.39,,,130.39,Fee Schedule,,142.8,70,,142.8,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,24.57,164.2,
X-RAY EXAM ENTIRE SPI 1 VW W/ FY MOD,72081,CPT,FY,43072081,CDM,320,RC,,,both,,,204,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,24.57,,,24.57,Fee Schedule,,24.57,,,24.57,Fee Schedule,,24.57,,,24.57,Fee Schedule,,142.8,70,,142.8,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,126.48,,,126.48,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,126.48,,,126.48,Fee Schedule,,130.39,,,130.39,Fee Schedule,,142.8,70,,142.8,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,24.57,164.2,
X-RAY EXAM ENTIRE SPI 2/3 VW,72082,CPT,TC,42072082,CDM,320,RC,,,both,,,351,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,191.94,,,191.94,Fee Schedule,,172.69,,,172.69,Fee Schedule,,44.99,,,44.99,Fee Schedule,,44.99,,,44.99,Fee Schedule,,44.99,,,44.99,Fee Schedule,,245.7,70,,245.7,percent of total billed charges,All Other,228.04,,,228.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,268.36,,,268.36,Fee Schedule,,217.62,,,217.62,Fee Schedule,,126.36,,,,Fee Schedule,,268.36,,,268.36,Fee Schedule,,217.62,,,217.62,Fee Schedule,,237.67,,,237.67,Fee Schedule,,245.7,70,,245.7,percent of total billed charges,,270.6,,,270.6,Fee Schedule,,229.35,,,229.35,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,270.6,
X-RAY EXAM ENTIRE SPI 2/3 VW W/ FY MOD,72082,CPT,FY,42672082,CDM,320,RC,,,both,,,351,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,191.94,,,191.94,Fee Schedule,,172.69,,,172.69,Fee Schedule,,44.99,,,44.99,Fee Schedule,,44.99,,,44.99,Fee Schedule,,44.99,,,44.99,Fee Schedule,,245.7,70,,245.7,percent of total billed charges,All Other,228.04,,,228.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,268.36,,,268.36,Fee Schedule,,217.62,,,217.62,Fee Schedule,,126.36,,,,Fee Schedule,,268.36,,,268.36,Fee Schedule,,217.62,,,217.62,Fee Schedule,,237.67,,,237.67,Fee Schedule,,245.7,70,,245.7,percent of total billed charges,,270.6,,,270.6,Fee Schedule,,229.35,,,229.35,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,270.6,
X-RAY EXAM ENTIRE SPI 2/3 VW W/ FY MOD,72082,CPT,FY,43072082,CDM,320,RC,,,both,,,351,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,191.94,,,191.94,Fee Schedule,,172.69,,,172.69,Fee Schedule,,44.99,,,44.99,Fee Schedule,,44.99,,,44.99,Fee Schedule,,44.99,,,44.99,Fee Schedule,,245.7,70,,245.7,percent of total billed charges,All Other,228.04,,,228.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,268.36,,,268.36,Fee Schedule,,217.62,,,217.62,Fee Schedule,,126.36,,,,Fee Schedule,,268.36,,,268.36,Fee Schedule,,217.62,,,217.62,Fee Schedule,,237.67,,,237.67,Fee Schedule,,245.7,70,,245.7,percent of total billed charges,,270.6,,,270.6,Fee Schedule,,229.35,,,229.35,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,270.6,
X-RAY EXAM ENTIRE SPI 4/5 VW,72083,CPT,TC,42072083,CDM,320,RC,,,both,,,638,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,217.37,,,217.37,Fee Schedule,,195.56,,,195.56,Fee Schedule,,55.38,,,55.38,Fee Schedule,,55.38,,,55.38,Fee Schedule,,55.38,,,55.38,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,258.25,,,258.25,Fee Schedule,,67,,,67,Other,186% of Medicaid,303.9,,,303.9,Fee Schedule,,395.56,,,395.56,Fee Schedule,,143.09,,,,Fee Schedule,,303.9,,,303.9,Fee Schedule,,395.56,,,395.56,Fee Schedule,,269.15,,,269.15,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,,301.76,,,301.76,Fee Schedule,,255.76,,,255.76,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,446.6,
X-RAY EXAM ENTIRE SPI 4/5 VW W/ FY MOD,72083,CPT,FY,42672083,CDM,320,RC,,,both,,,638,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,217.37,,,217.37,Fee Schedule,,195.56,,,195.56,Fee Schedule,,55.38,,,55.38,Fee Schedule,,55.38,,,55.38,Fee Schedule,,55.38,,,55.38,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,258.25,,,258.25,Fee Schedule,,67,,,67,Other,186% of Medicaid,303.9,,,303.9,Fee Schedule,,395.56,,,395.56,Fee Schedule,,143.09,,,,Fee Schedule,,303.9,,,303.9,Fee Schedule,,395.56,,,395.56,Fee Schedule,,269.15,,,269.15,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,,301.76,,,301.76,Fee Schedule,,255.76,,,255.76,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,446.6,
X-RAY EXAM ENTIRE SPI 4/5 VW W/ FY MOD,72083,CPT,FY,43072083,CDM,320,RC,,,both,,,638,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,217.37,,,217.37,Fee Schedule,,195.56,,,195.56,Fee Schedule,,55.38,,,55.38,Fee Schedule,,55.38,,,55.38,Fee Schedule,,55.38,,,55.38,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,258.25,,,258.25,Fee Schedule,,67,,,67,Other,186% of Medicaid,303.9,,,303.9,Fee Schedule,,395.56,,,395.56,Fee Schedule,,143.09,,,,Fee Schedule,,303.9,,,303.9,Fee Schedule,,395.56,,,395.56,Fee Schedule,,269.15,,,269.15,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,,301.76,,,301.76,Fee Schedule,,255.76,,,255.76,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,446.6,
X-RAY EXAM ENTIRE SPI 6/> VW,72084,CPT,TC,42072084,CDM,320,RC,,,both,,,638,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,274.15,,,274.15,Fee Schedule,,246.65,,,246.65,Fee Schedule,,64.37,,,64.37,Fee Schedule,,64.37,,,64.37,Fee Schedule,,64.37,,,64.37,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,325.71,,,325.71,Fee Schedule,,67,,,67,Other,186% of Medicaid,383.29,,,383.29,Fee Schedule,,395.56,,,395.56,Fee Schedule,,180.47,,,,Fee Schedule,,383.29,,,383.29,Fee Schedule,,395.56,,,395.56,Fee Schedule,,339.46,,,339.46,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,,385.4,,,385.4,Fee Schedule,,326.65,,,326.65,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,446.6,
X-RAY EXAM ENTIRE SPI 6/> VW W/ FY MOD,72084,CPT,FY,42672084,CDM,320,RC,,,both,,,638,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,274.15,,,274.15,Fee Schedule,,246.65,,,246.65,Fee Schedule,,64.37,,,64.37,Fee Schedule,,64.37,,,64.37,Fee Schedule,,64.37,,,64.37,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,325.71,,,325.71,Fee Schedule,,67,,,67,Other,186% of Medicaid,383.29,,,383.29,Fee Schedule,,395.56,,,395.56,Fee Schedule,,180.47,,,,Fee Schedule,,383.29,,,383.29,Fee Schedule,,395.56,,,395.56,Fee Schedule,,339.46,,,339.46,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,,385.4,,,385.4,Fee Schedule,,326.65,,,326.65,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,446.6,
X-RAY EXAM ENTIRE SPI 6/> VW W/ FY MOD,72084,CPT,FY,43072084,CDM,320,RC,,,both,,,638,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,274.15,,,274.15,Fee Schedule,,246.65,,,246.65,Fee Schedule,,64.37,,,64.37,Fee Schedule,,64.37,,,64.37,Fee Schedule,,64.37,,,64.37,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,325.71,,,325.71,Fee Schedule,,67,,,67,Other,186% of Medicaid,383.29,,,383.29,Fee Schedule,,395.56,,,395.56,Fee Schedule,,180.47,,,,Fee Schedule,,383.29,,,383.29,Fee Schedule,,395.56,,,395.56,Fee Schedule,,339.46,,,339.46,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,,385.4,,,385.4,Fee Schedule,,326.65,,,326.65,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,446.6,
XRLUMBAR SPINE 2 VIEWS,72100,CPT,TC,42072100,CDM,320,RC,,,both,,,494,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,101.82,,,101.82,Fee Schedule,,91.61,,,91.61,Fee Schedule,,204.73,,,204.73,Fee Schedule,,184.18,,,184.18,Fee Schedule,,174.1,,,174.1,Fee Schedule,,345.8,70,,345.8,percent of total billed charges,All Other,120.98,,,120.98,Fee Schedule,,67,,,67,Other,186% of Medicaid,142.36,,,142.36,Fee Schedule,,306.28,,,306.28,Fee Schedule,,67.03,,,,Fee Schedule,,142.36,,,142.36,Fee Schedule,,306.28,,,306.28,Fee Schedule,,126.08,,,126.08,Fee Schedule,,345.8,70,,345.8,percent of total billed charges,,142.68,,,142.68,Fee Schedule,,120.93,,,120.93,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,345.8,
XRLUMBAR SPINE 2 VIEWS W/ FY MOD,72100,CPT,FY,42672100,CDM,320,RC,,,both,,,494,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,101.82,,,101.82,Fee Schedule,,91.61,,,91.61,Fee Schedule,,204.73,,,204.73,Fee Schedule,,184.18,,,184.18,Fee Schedule,,174.1,,,174.1,Fee Schedule,,345.8,70,,345.8,percent of total billed charges,All Other,120.98,,,120.98,Fee Schedule,,67,,,67,Other,186% of Medicaid,142.36,,,142.36,Fee Schedule,,306.28,,,306.28,Fee Schedule,,67.03,,,,Fee Schedule,,142.36,,,142.36,Fee Schedule,,306.28,,,306.28,Fee Schedule,,126.08,,,126.08,Fee Schedule,,345.8,70,,345.8,percent of total billed charges,,142.68,,,142.68,Fee Schedule,,120.93,,,120.93,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,345.8,
XR LUMBAR SPINE 2 VIEWS W/ FY MOD,72100,CPT,FY,43072100,CDM,320,RC,,,both,,,494,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,101.82,,,101.82,Fee Schedule,,91.61,,,91.61,Fee Schedule,,204.73,,,204.73,Fee Schedule,,184.18,,,184.18,Fee Schedule,,174.1,,,174.1,Fee Schedule,,345.8,70,,345.8,percent of total billed charges,All Other,120.98,,,120.98,Fee Schedule,,67,,,67,Other,186% of Medicaid,142.36,,,142.36,Fee Schedule,,306.28,,,306.28,Fee Schedule,,67.03,,,,Fee Schedule,,142.36,,,142.36,Fee Schedule,,306.28,,,306.28,Fee Schedule,,126.08,,,126.08,Fee Schedule,,345.8,70,,345.8,percent of total billed charges,,142.68,,,142.68,Fee Schedule,,120.93,,,120.93,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,345.8,
XR LUMBAR SPINE COMPLETE,72110,CPT,TC,42072110,CDM,320,RC,,,both,,,695,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,137.65,,,137.65,Fee Schedule,,123.84,,,123.84,Fee Schedule,,280.9,,,280.9,Fee Schedule,,252.71,,,252.71,Fee Schedule,,238.87,,,238.87,Fee Schedule,,486.5,70,,486.5,percent of total billed charges,All Other,163.54,,,163.54,Fee Schedule,,67,,,67,Other,186% of Medicaid,192.45,,,192.45,Fee Schedule,,430.9,,,430.9,Fee Schedule,,90.62,,,,Fee Schedule,,192.45,,,192.45,Fee Schedule,,430.9,,,430.9,Fee Schedule,,170.44,,,170.44,Fee Schedule,,486.5,70,,486.5,percent of total billed charges,,190.24,,,190.24,Fee Schedule,,161.24,,,161.24,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,486.5,
XR LUMBAR SPINE COMPLETE W/FY MOD,72110,CPT,FY,42672110,CDM,320,RC,,,both,,,695,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,137.65,,,137.65,Fee Schedule,,123.84,,,123.84,Fee Schedule,,280.9,,,280.9,Fee Schedule,,252.71,,,252.71,Fee Schedule,,238.87,,,238.87,Fee Schedule,,486.5,70,,486.5,percent of total billed charges,All Other,163.54,,,163.54,Fee Schedule,,67,,,67,Other,186% of Medicaid,192.45,,,192.45,Fee Schedule,,430.9,,,430.9,Fee Schedule,,90.62,,,,Fee Schedule,,192.45,,,192.45,Fee Schedule,,430.9,,,430.9,Fee Schedule,,170.44,,,170.44,Fee Schedule,,486.5,70,,486.5,percent of total billed charges,,190.24,,,190.24,Fee Schedule,,161.24,,,161.24,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,486.5,
XR LUMBAR SPINE COMPLETE W/ FY MOD,72110,CPT,FY,43072110,CDM,320,RC,,,both,,,695,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,137.65,,,137.65,Fee Schedule,,123.84,,,123.84,Fee Schedule,,280.9,,,280.9,Fee Schedule,,252.71,,,252.71,Fee Schedule,,238.87,,,238.87,Fee Schedule,,486.5,70,,486.5,percent of total billed charges,All Other,163.54,,,163.54,Fee Schedule,,67,,,67,Other,186% of Medicaid,192.45,,,192.45,Fee Schedule,,430.9,,,430.9,Fee Schedule,,90.62,,,,Fee Schedule,,192.45,,,192.45,Fee Schedule,,430.9,,,430.9,Fee Schedule,,170.44,,,170.44,Fee Schedule,,486.5,70,,486.5,percent of total billed charges,,190.24,,,190.24,Fee Schedule,,161.24,,,161.24,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,486.5,
XR LUMBAR SPINE COMP W FLEX,72114,CPT,TC,42072114,CDM,320,RC,,,both,,,867,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,392.75,,,392.75,Fee Schedule,,353.33,,,353.33,Fee Schedule,,333.98,,,333.98,Fee Schedule,,606.9,70,,606.9,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,537.54,,,537.54,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,537.54,,,537.54,Fee Schedule,,201.92,,,201.92,Fee Schedule,,606.9,70,,606.9,percent of total billed charges,,232.88,,,232.88,Fee Schedule,,197.38,,,197.38,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,606.9,
XR LUMBAR SPINE COMP W FLEX W/ FY MOD,72114,CPT,FY,42672114,CDM,320,RC,,,both,,,867,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,392.75,,,392.75,Fee Schedule,,353.33,,,353.33,Fee Schedule,,333.98,,,333.98,Fee Schedule,,606.9,70,,606.9,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,537.54,,,537.54,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,537.54,,,537.54,Fee Schedule,,201.92,,,201.92,Fee Schedule,,606.9,70,,606.9,percent of total billed charges,,232.88,,,232.88,Fee Schedule,,197.38,,,197.38,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,606.9,
XR LUMBAR SPINE COMP W FLEX W/ FY MOD,72114,CPT,FY,43072114,CDM,320,RC,,,both,,,867,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,392.75,,,392.75,Fee Schedule,,353.33,,,353.33,Fee Schedule,,333.98,,,333.98,Fee Schedule,,606.9,70,,606.9,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,537.54,,,537.54,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,537.54,,,537.54,Fee Schedule,,201.92,,,201.92,Fee Schedule,,606.9,70,,606.9,percent of total billed charges,,232.88,,,232.88,Fee Schedule,,197.38,,,197.38,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,606.9,
XR EXAM OF LOWER SPINE,72120,CPT,TC,42072120,CDM,320,RC,,,both,,,706,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,104.15,,,104.15,Fee Schedule,,93.71,,,93.71,Fee Schedule,,280.9,,,280.9,Fee Schedule,,252.71,,,252.71,Fee Schedule,,238.87,,,238.87,Fee Schedule,,494.2,70,,494.2,percent of total billed charges,All Other,123.74,,,123.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,145.62,,,145.62,Fee Schedule,,437.72,,,437.72,Fee Schedule,,68.57,,,,Fee Schedule,,145.62,,,145.62,Fee Schedule,,437.72,,,437.72,Fee Schedule,,128.97,,,128.97,Fee Schedule,,494.2,70,,494.2,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,494.2,
XR EXAM OF LOWER SPINE W/ FY MOD,72120,CPT,FY,42672120,CDM,320,RC,,,both,,,706,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,104.15,,,104.15,Fee Schedule,,93.71,,,93.71,Fee Schedule,,280.9,,,280.9,Fee Schedule,,252.71,,,252.71,Fee Schedule,,238.87,,,238.87,Fee Schedule,,494.2,70,,494.2,percent of total billed charges,All Other,123.74,,,123.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,145.62,,,145.62,Fee Schedule,,437.72,,,437.72,Fee Schedule,,68.57,,,,Fee Schedule,,145.62,,,145.62,Fee Schedule,,437.72,,,437.72,Fee Schedule,,128.97,,,128.97,Fee Schedule,,494.2,70,,494.2,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,494.2,
XR EXAM OF LOWER SPINE W/ FY MOD,72120,CPT,FY,43072120,CDM,320,RC,,,both,,,706,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,104.15,,,104.15,Fee Schedule,,93.71,,,93.71,Fee Schedule,,280.9,,,280.9,Fee Schedule,,252.71,,,252.71,Fee Schedule,,238.87,,,238.87,Fee Schedule,,494.2,70,,494.2,percent of total billed charges,All Other,123.74,,,123.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,145.62,,,145.62,Fee Schedule,,437.72,,,437.72,Fee Schedule,,68.57,,,,Fee Schedule,,145.62,,,145.62,Fee Schedule,,437.72,,,437.72,Fee Schedule,,128.97,,,128.97,Fee Schedule,,494.2,70,,494.2,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,494.2,
XR PELVIS 1 VIEW,72170,CPT,TC,42072170,CDM,320,RC,,,both,,,392,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,68.33,,,68.33,Fee Schedule,,61.48,,,61.48,Fee Schedule,,126.2,,,126.2,Fee Schedule,,113.54,,,113.54,Fee Schedule,,107.32,,,107.32,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,81.18,,,81.18,Fee Schedule,,67,,,67,Other,186% of Medicaid,95.53,,,95.53,Fee Schedule,,243.04,,,243.04,Fee Schedule,,44.98,,,,Fee Schedule,,95.53,,,95.53,Fee Schedule,,243.04,,,243.04,Fee Schedule,,84.61,,,84.61,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,95.12,,,95.12,Fee Schedule,,80.62,,,80.62,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,274.4,
XR PELVIS 1 VIEW W/ FY MOD,72170,CPT,FY,42672170,CDM,320,RC,,,both,,,392,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,68.33,,,68.33,Fee Schedule,,61.48,,,61.48,Fee Schedule,,126.2,,,126.2,Fee Schedule,,113.54,,,113.54,Fee Schedule,,107.32,,,107.32,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,81.18,,,81.18,Fee Schedule,,67,,,67,Other,186% of Medicaid,95.53,,,95.53,Fee Schedule,,243.04,,,243.04,Fee Schedule,,44.98,,,,Fee Schedule,,95.53,,,95.53,Fee Schedule,,243.04,,,243.04,Fee Schedule,,84.61,,,84.61,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,95.12,,,95.12,Fee Schedule,,80.62,,,80.62,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,274.4,
XR PELVIS 1 VIEW W/ FY MOD,72170,CPT,FY,43072170,CDM,320,RC,,,both,,,392,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,68.33,,,68.33,Fee Schedule,,61.48,,,61.48,Fee Schedule,,126.2,,,126.2,Fee Schedule,,113.54,,,113.54,Fee Schedule,,107.32,,,107.32,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,81.18,,,81.18,Fee Schedule,,67,,,67,Other,186% of Medicaid,95.53,,,95.53,Fee Schedule,,243.04,,,243.04,Fee Schedule,,44.98,,,,Fee Schedule,,95.53,,,95.53,Fee Schedule,,243.04,,,243.04,Fee Schedule,,84.61,,,84.61,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,95.12,,,95.12,Fee Schedule,,80.62,,,80.62,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,274.4,
XR EXAM OF PELVIS 3+ VIEWS,72190,CPT,TC,42072190,CDM,320,RC,,,both,,,605,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,216.62,,,216.62,Fee Schedule,,194.88,,,194.88,Fee Schedule,,184.21,,,184.21,Fee Schedule,,423.5,70,,423.5,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,375.1,,,375.1,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,375.1,,,375.1,Fee Schedule,,130.39,,,130.39,Fee Schedule,,423.5,70,,423.5,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,423.5,
XR EXAM OF PELVIS 3+ VIEWS W/ FY MOD,72190,CPT,FY,42672190,CDM,320,RC,,,both,,,605,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,216.62,,,216.62,Fee Schedule,,194.88,,,194.88,Fee Schedule,,184.21,,,184.21,Fee Schedule,,423.5,70,,423.5,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,375.1,,,375.1,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,375.1,,,375.1,Fee Schedule,,130.39,,,130.39,Fee Schedule,,423.5,70,,423.5,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,423.5,
XR EXAM OF PELVIS 3+ VIEWS W/ FY MOD,72190,CPT,FY,43072190,CDM,320,RC,,,both,,,605,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,216.62,,,216.62,Fee Schedule,,194.88,,,194.88,Fee Schedule,,184.21,,,184.21,Fee Schedule,,423.5,70,,423.5,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,375.1,,,375.1,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,375.1,,,375.1,Fee Schedule,,130.39,,,130.39,Fee Schedule,,423.5,70,,423.5,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,423.5,
XR SACROILIAC JTS 1 OR 2 VI,72200,CPT,TC,42072200,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,87.98,,,87.98,Fee Schedule,,79.15,,,79.15,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,104.53,,,104.53,Fee Schedule,,67,,,67,Other,186% of Medicaid,123.01,,,123.01,Fee Schedule,,150.04,,,150.04,Fee Schedule,,57.92,,,,Fee Schedule,,123.01,,,123.01,Fee Schedule,,150.04,,,150.04,Fee Schedule,,108.94,,,108.94,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR SACROILIAC JTS 1 OR 2 VI W/ FY MOD,72200,CPT,FY,42672200,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,87.98,,,87.98,Fee Schedule,,79.15,,,79.15,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,104.53,,,104.53,Fee Schedule,,67,,,67,Other,186% of Medicaid,123.01,,,123.01,Fee Schedule,,150.04,,,150.04,Fee Schedule,,57.92,,,,Fee Schedule,,123.01,,,123.01,Fee Schedule,,150.04,,,150.04,Fee Schedule,,108.94,,,108.94,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR SACROILIAC JTS 1 OR 2 VI W/ FY MOD,72200,CPT,FY,43072200,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,87.98,,,87.98,Fee Schedule,,79.15,,,79.15,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,104.53,,,104.53,Fee Schedule,,67,,,67,Other,186% of Medicaid,123.01,,,123.01,Fee Schedule,,150.04,,,150.04,Fee Schedule,,57.92,,,,Fee Schedule,,123.01,,,123.01,Fee Schedule,,150.04,,,150.04,Fee Schedule,,108.94,,,108.94,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR SACROILIAC JOINTS 3 VIEW,72202,CPT,TC,42072202,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,99.53,,,99.53,Fee Schedule,,89.54,,,89.54,Fee Schedule,,178.59,,,178.59,Fee Schedule,,160.67,,,160.67,Fee Schedule,,151.87,,,151.87,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,118.25,,,118.25,Fee Schedule,,67,,,67,Other,186% of Medicaid,139.15,,,139.15,Fee Schedule,,150.04,,,150.04,Fee Schedule,,65.52,,,,Fee Schedule,,139.15,,,139.15,Fee Schedule,,150.04,,,150.04,Fee Schedule,,123.24,,,123.24,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR SACROILIAC JOINTS 3 VIEW W/ FY MOD,72202,CPT,FY,42672202,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,99.53,,,99.53,Fee Schedule,,89.54,,,89.54,Fee Schedule,,178.59,,,178.59,Fee Schedule,,160.67,,,160.67,Fee Schedule,,151.87,,,151.87,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,118.25,,,118.25,Fee Schedule,,67,,,67,Other,186% of Medicaid,139.15,,,139.15,Fee Schedule,,150.04,,,150.04,Fee Schedule,,65.52,,,,Fee Schedule,,139.15,,,139.15,Fee Schedule,,150.04,,,150.04,Fee Schedule,,123.24,,,123.24,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR SACROILIAC JOINTS 3 VIEW W/ FY MOD,72202,CPT,FY,43072202,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,99.53,,,99.53,Fee Schedule,,89.54,,,89.54,Fee Schedule,,178.59,,,178.59,Fee Schedule,,160.67,,,160.67,Fee Schedule,,151.87,,,151.87,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,118.25,,,118.25,Fee Schedule,,67,,,67,Other,186% of Medicaid,139.15,,,139.15,Fee Schedule,,150.04,,,150.04,Fee Schedule,,65.52,,,,Fee Schedule,,139.15,,,139.15,Fee Schedule,,150.04,,,150.04,Fee Schedule,,123.24,,,123.24,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR SACRUM & COCCYX 2 VIEWS,72220,CPT,TC,42072220,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,270.94,,,270.94,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,270.94,,,270.94,Fee Schedule,,104.64,,,104.64,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR SACRUM & COCCYX 2 VIEWS W/ FY MOD,72220,CPT,FY,42672220,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,270.94,,,270.94,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,270.94,,,270.94,Fee Schedule,,104.64,,,104.64,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
XR SACRUM & COCCYX 2 VIEWS W/ FY MOD,72220,CPT,FY,43072220,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,270.94,,,270.94,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,270.94,,,270.94,Fee Schedule,,104.64,,,104.64,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,305.9,
MYELOGRAM CERVICAL,72240,CPT,TC,42072240,CDM,320,RC,,,both,,,1939,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,239.31,,,239.31,Fee Schedule,,215.31,,,215.31,Fee Schedule,,699.69,,,699.69,Fee Schedule,,629.46,,,629.46,Fee Schedule,,594.99,,,594.99,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,All Other,284.33,,,284.33,Fee Schedule,,928,,,928,Other,186% of Medicaid,334.59,,,334.59,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,157.54,,,,Fee Schedule,,334.59,,,334.59,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,296.33,,,296.33,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,,354.24,,,354.24,Fee Schedule,,300.24,,,300.24,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,157.54,1617.07,
MYELOGRAM CERVICAL W/ FY MOD,72240,CPT,FY,42672240,CDM,320,RC,,,both,,,1939,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,239.31,,,239.31,Fee Schedule,,215.31,,,215.31,Fee Schedule,,699.69,,,699.69,Fee Schedule,,629.46,,,629.46,Fee Schedule,,594.99,,,594.99,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,All Other,284.33,,,284.33,Fee Schedule,,928,,,928,Other,186% of Medicaid,334.59,,,334.59,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,157.54,,,,Fee Schedule,,334.59,,,334.59,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,296.33,,,296.33,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,,354.24,,,354.24,Fee Schedule,,300.24,,,300.24,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,157.54,1617.07,
MYELOGRAM CERVICAL,72240,CPT,TC,47072240,CDM,320,RC,,,both,,,1939,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,239.31,,,239.31,Fee Schedule,,215.31,,,215.31,Fee Schedule,,699.69,,,699.69,Fee Schedule,,629.46,,,629.46,Fee Schedule,,594.99,,,594.99,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,All Other,284.33,,,284.33,Fee Schedule,,928,,,928,Other,186% of Medicaid,334.59,,,334.59,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,157.54,,,,Fee Schedule,,334.59,,,334.59,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,296.33,,,296.33,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,,354.24,,,354.24,Fee Schedule,,300.24,,,300.24,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,157.54,1617.07,
MYELOGRAM THORACIC,72255,CPT,TC,42072255,CDM,320,RC,,,both,,,1939,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,225.44,,,225.44,Fee Schedule,,202.82,,,202.82,Fee Schedule,,642.58,,,642.58,Fee Schedule,,578.09,,,578.09,Fee Schedule,,546.43,,,546.43,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,All Other,267.84,,,267.84,Fee Schedule,,928,,,928,Other,186% of Medicaid,315.19,,,315.19,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,148.41,,,,Fee Schedule,,315.19,,,315.19,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,279.15,,,279.15,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,,360.8,,,360.8,Fee Schedule,,305.8,,,305.8,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,148.41,1617.07,
MYELOGRAM THORACIC W/ FY MOD,72255,CPT,FY,42672255,CDM,320,RC,,,both,,,1939,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,225.44,,,225.44,Fee Schedule,,202.82,,,202.82,Fee Schedule,,642.58,,,642.58,Fee Schedule,,578.09,,,578.09,Fee Schedule,,546.43,,,546.43,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,All Other,267.84,,,267.84,Fee Schedule,,928,,,928,Other,186% of Medicaid,315.19,,,315.19,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,148.41,,,,Fee Schedule,,315.19,,,315.19,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,279.15,,,279.15,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,,360.8,,,360.8,Fee Schedule,,305.8,,,305.8,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,148.41,1617.07,
MYELOGRAM THORACIC W/ FY MOD,72255,CPT,FY,43072255,CDM,320,RC,,,both,,,1939,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,225.44,,,225.44,Fee Schedule,,202.82,,,202.82,Fee Schedule,,642.58,,,642.58,Fee Schedule,,578.09,,,578.09,Fee Schedule,,546.43,,,546.43,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,All Other,267.84,,,267.84,Fee Schedule,,928,,,928,Other,186% of Medicaid,315.19,,,315.19,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,148.41,,,,Fee Schedule,,315.19,,,315.19,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,279.15,,,279.15,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,,360.8,,,360.8,Fee Schedule,,305.8,,,305.8,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,148.41,1617.07,
MYELOGRAM THORACIC,72255,CPT,TC,47072255,CDM,320,RC,,,both,,,1939,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,225.44,,,225.44,Fee Schedule,,202.82,,,202.82,Fee Schedule,,642.58,,,642.58,Fee Schedule,,578.09,,,578.09,Fee Schedule,,546.43,,,546.43,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,All Other,267.84,,,267.84,Fee Schedule,,928,,,928,Other,186% of Medicaid,315.19,,,315.19,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,148.41,,,,Fee Schedule,,315.19,,,315.19,Fee Schedule,,1202.18,,,1202.18,Fee Schedule,,279.15,,,279.15,Fee Schedule,,1357.3,70,,1357.3,percent of total billed charges,,360.8,,,360.8,Fee Schedule,,305.8,,,305.8,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,148.41,1617.07,
MYELOGRAM LUMBOSACRAL,72265,CPT,TC,42072265,CDM,320,RC,,,both,,,2536,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,241.61,,,241.61,Fee Schedule,,217.37,,,217.37,Fee Schedule,,680.67,,,680.67,Fee Schedule,,612.36,,,612.36,Fee Schedule,,578.82,,,578.82,Fee Schedule,,1775.2,70,,1775.2,percent of total billed charges,All Other,287.05,,,287.05,Fee Schedule,,928,,,928,Other,186% of Medicaid,337.8,,,337.8,Fee Schedule,,1572.32,,,1572.32,Fee Schedule,,159.05,,,,Fee Schedule,,337.8,,,337.8,Fee Schedule,,1572.32,,,1572.32,Fee Schedule,,299.17,,,299.17,Fee Schedule,,1775.2,70,,1775.2,percent of total billed charges,,346.04,,,346.04,Fee Schedule,,293.29,,,293.29,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,159.05,1775.2,
MYELOGRAM LUMBOSACRAL W/ FY MOD,72265,CPT,FY,42672265,CDM,320,RC,,,both,,,2536,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,241.61,,,241.61,Fee Schedule,,217.37,,,217.37,Fee Schedule,,680.67,,,680.67,Fee Schedule,,612.36,,,612.36,Fee Schedule,,578.82,,,578.82,Fee Schedule,,1775.2,70,,1775.2,percent of total billed charges,All Other,287.05,,,287.05,Fee Schedule,,928,,,928,Other,186% of Medicaid,337.8,,,337.8,Fee Schedule,,1572.32,,,1572.32,Fee Schedule,,159.05,,,,Fee Schedule,,337.8,,,337.8,Fee Schedule,,1572.32,,,1572.32,Fee Schedule,,299.17,,,299.17,Fee Schedule,,1775.2,70,,1775.2,percent of total billed charges,,346.04,,,346.04,Fee Schedule,,293.29,,,293.29,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,159.05,1775.2,
MYELOGRAM LUMBOSACRAL,72265,CPT,,47072265,CDM,320,RC,,,both,,,2536,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,241.61,,,241.61,Fee Schedule,,217.37,,,217.37,Fee Schedule,,680.67,,,680.67,Fee Schedule,,612.36,,,612.36,Fee Schedule,,578.82,,,578.82,Fee Schedule,,1775.2,70,,1775.2,percent of total billed charges,All Other,287.05,,,287.05,Fee Schedule,,928,,,928,Other,186% of Medicaid,337.8,,,337.8,Fee Schedule,,1572.32,,,1572.32,Fee Schedule,,159.05,,,,Fee Schedule,,337.8,,,337.8,Fee Schedule,,1572.32,,,1572.32,Fee Schedule,,299.17,,,299.17,Fee Schedule,,1775.2,70,,1775.2,percent of total billed charges,,346.04,,,346.04,Fee Schedule,,293.29,,,293.29,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,159.05,1775.2,
CONTRAST X-RAY SPINE 2+ REGIONS,72270,CPT,,47072270,CDM,320,RC,,,both,,,1840,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,306.3,,,306.3,Fee Schedule,,275.58,,,275.58,Fee Schedule,,1047.12,,,1047.12,Fee Schedule,,942.02,,,942.02,Fee Schedule,,890.43,,,890.43,Fee Schedule,,1288,70,,1288,percent of total billed charges,All Other,363.92,,,363.92,Fee Schedule,,928,,,928,Other,186% of Medicaid,428.25,,,428.25,Fee Schedule,,1140.8,,,1140.8,Fee Schedule,,201.64,,,,Fee Schedule,,428.25,,,428.25,Fee Schedule,,1140.8,,,1140.8,Fee Schedule,,379.28,,,379.28,Fee Schedule,,1288,70,,1288,percent of total billed charges,,498.56,,,498.56,Fee Schedule,,422.56,,,422.56,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,201.64,1617.07,
X-RAY C/T SPINE DISK,72285,CPT,TC,42072285,CDM,320,RC,,,both,,,4047,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS,267.03,,,267.03,Fee Schedule,,240.25,,,240.25,Fee Schedule,,628.28,,,628.28,Fee Schedule,,565.22,,,565.22,Fee Schedule,,534.27,,,534.27,Fee Schedule,,2832.9,70,,2832.9,percent of total billed charges,All Other,317.26,,,317.26,Fee Schedule,,928,,,928,Other,186% of Medicaid,373.35,,,373.35,Fee Schedule,,2509.14,,,2509.14,Fee Schedule,,175.79,,,,Fee Schedule,,373.35,,,373.35,Fee Schedule,,2509.14,,,2509.14,Fee Schedule,,330.65,,,330.65,Fee Schedule,,2832.9,70,,2832.9,percent of total billed charges,,350.96,,,350.96,Fee Schedule,,297.46,,,297.46,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,175.79,3488.94,
X-RAY C/T SPINE DISK W/ FY MOD,72285,CPT,FY,42672285,CDM,320,RC,,,both,,,4047,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS,267.03,,,267.03,Fee Schedule,,240.25,,,240.25,Fee Schedule,,628.28,,,628.28,Fee Schedule,,565.22,,,565.22,Fee Schedule,,534.27,,,534.27,Fee Schedule,,2832.9,70,,2832.9,percent of total billed charges,All Other,317.26,,,317.26,Fee Schedule,,928,,,928,Other,186% of Medicaid,373.35,,,373.35,Fee Schedule,,2509.14,,,2509.14,Fee Schedule,,175.79,,,,Fee Schedule,,373.35,,,373.35,Fee Schedule,,2509.14,,,2509.14,Fee Schedule,,330.65,,,330.65,Fee Schedule,,2832.9,70,,2832.9,percent of total billed charges,,350.96,,,350.96,Fee Schedule,,297.46,,,297.46,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,175.79,3488.94,
X-RAY C/T SPINE DISK W/ FY MOD,72285,CPT,FY,43072285,CDM,320,RC,,,both,,,4047,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS,267.03,,,267.03,Fee Schedule,,240.25,,,240.25,Fee Schedule,,628.28,,,628.28,Fee Schedule,,565.22,,,565.22,Fee Schedule,,534.27,,,534.27,Fee Schedule,,2832.9,70,,2832.9,percent of total billed charges,All Other,317.26,,,317.26,Fee Schedule,,928,,,928,Other,186% of Medicaid,373.35,,,373.35,Fee Schedule,,2509.14,,,2509.14,Fee Schedule,,175.79,,,,Fee Schedule,,373.35,,,373.35,Fee Schedule,,2509.14,,,2509.14,Fee Schedule,,330.65,,,330.65,Fee Schedule,,2832.9,70,,2832.9,percent of total billed charges,,350.96,,,350.96,Fee Schedule,,297.46,,,297.46,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,175.79,3488.94,
X-RAY C/T SPINE DISK,72285,CPT,,47072285,CDM,320,RC,,,both,,,4047,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS,267.03,,,267.03,Fee Schedule,,240.25,,,240.25,Fee Schedule,,628.28,,,628.28,Fee Schedule,,565.22,,,565.22,Fee Schedule,,534.27,,,534.27,Fee Schedule,,2832.9,70,,2832.9,percent of total billed charges,All Other,317.26,,,317.26,Fee Schedule,,928,,,928,Other,186% of Medicaid,373.35,,,373.35,Fee Schedule,,2509.14,,,2509.14,Fee Schedule,,175.79,,,,Fee Schedule,,373.35,,,373.35,Fee Schedule,,2509.14,,,2509.14,Fee Schedule,,330.65,,,330.65,Fee Schedule,,2832.9,70,,2832.9,percent of total billed charges,,350.96,,,350.96,Fee Schedule,,297.46,,,297.46,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,175.79,3488.94,
XR OF LOWER SPINE DISK,72295,CPT,TC,42072295,CDM,320,RC,,,both,,,6489,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS,250.86,,,250.86,Fee Schedule,,225.7,,,225.7,Fee Schedule,,618.8,,,618.8,Fee Schedule,,556.7,,,556.7,Fee Schedule,,526.21,,,526.21,Fee Schedule,,4542.3,70,,4542.3,percent of total billed charges,All Other,298.05,,,298.05,Fee Schedule,,928,,,928,Other,186% of Medicaid,350.73,,,350.73,Fee Schedule,,4023.18,,,4023.18,Fee Schedule,,165.14,,,,Fee Schedule,,350.73,,,350.73,Fee Schedule,,4023.18,,,4023.18,Fee Schedule,,310.63,,,310.63,Fee Schedule,,4542.3,70,,4542.3,percent of total billed charges,,355.88,,,355.88,Fee Schedule,,301.63,,,301.63,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,165.14,4542.3,
XR OF LOWER SPINE DISK W/ FY MOD,72295,CPT,FY,42672295,CDM,320,RC,,,both,,,6489,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS,250.86,,,250.86,Fee Schedule,,225.7,,,225.7,Fee Schedule,,618.8,,,618.8,Fee Schedule,,556.7,,,556.7,Fee Schedule,,526.21,,,526.21,Fee Schedule,,4542.3,70,,4542.3,percent of total billed charges,All Other,298.05,,,298.05,Fee Schedule,,928,,,928,Other,186% of Medicaid,350.73,,,350.73,Fee Schedule,,4023.18,,,4023.18,Fee Schedule,,165.14,,,,Fee Schedule,,350.73,,,350.73,Fee Schedule,,4023.18,,,4023.18,Fee Schedule,,310.63,,,310.63,Fee Schedule,,4542.3,70,,4542.3,percent of total billed charges,,355.88,,,355.88,Fee Schedule,,301.63,,,301.63,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,165.14,4542.3,
X-RAY OF LOWER SPINE DISK,72295,CPT,,47072295,CDM,320,RC,,,both,,,6489,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS,250.86,,,250.86,Fee Schedule,,225.7,,,225.7,Fee Schedule,,618.8,,,618.8,Fee Schedule,,556.7,,,556.7,Fee Schedule,,526.21,,,526.21,Fee Schedule,,4542.3,70,,4542.3,percent of total billed charges,All Other,298.05,,,298.05,Fee Schedule,,928,,,928,Other,186% of Medicaid,350.73,,,350.73,Fee Schedule,,4023.18,,,4023.18,Fee Schedule,,165.14,,,,Fee Schedule,,350.73,,,350.73,Fee Schedule,,4023.18,,,4023.18,Fee Schedule,,310.63,,,310.63,Fee Schedule,,4542.3,70,,4542.3,percent of total billed charges,,355.88,,,355.88,Fee Schedule,,301.63,,,301.63,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,2750.96,,,2750.96,Fee Schedule,,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,499.1,,,499.1,Other,100% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,763.62,,,763.62,Other,153% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,698.74,,,698.74,Other,140% of Medicaid,1122.97,,,1122.97,Other,225% of Medicaid,1297.65,,,1297.65,Other,250% of Medicaid,1617.07,,,1617.07,Other,324% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,1073.06,,,1073.06,Other,215% of Medicaid,623.87,,,623.87,Other,125% of Medicaid,165.14,4542.3,
XR CLAVICLE LEFT,73000,CPT,TCLT,42173000,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,106.06,,,106.06,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR CLAVICLE RIGHT,73000,CPT,TCRT,42273000,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,106.06,,,106.06,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR CLAVICLE BILAT,73000,CPT,TC50,42373000,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,347.2,,,347.2,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,347.2,,,347.2,Fee Schedule,,106.06,,,106.06,Fee Schedule,,392,70,,392,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR CLAVICLE LEFT FY MOD,73000,CPT,FYLT,42773000,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,106.06,,,106.06,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR CLAVICLE RIGHT FY MOD,73000,CPT,FYRT,42873000,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,106.06,,,106.06,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR CLAVICLE BILAT FY MOD,73000,CPT,FY50,42973000,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,347.2,,,347.2,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,347.2,,,347.2,Fee Schedule,,106.06,,,106.06,Fee Schedule,,392,70,,392,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR CLAVICLE LEFT W/ FY MOD,73000,CPT,FYLT,43173000,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,106.06,,,106.06,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR CLAVICLE RIGHT W/ FY MOD,73000,CPT,FYRT,43273000,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,231.26,,,231.26,Fee Schedule,,106.06,,,106.06,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR CLAVICLE BILAT W/ FY MOD,73000,CPT,FY50,43373000,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,347.2,,,347.2,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,347.2,,,347.2,Fee Schedule,,106.06,,,106.06,Fee Schedule,,392,70,,392,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR SCAPULA LEFT,73010,CPT,TCLT,42173010,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,53.3,,,53.3,Fee Schedule,,47.96,,,47.96,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,63.33,,,63.33,Fee Schedule,,67,,,67,Other,186% of Medicaid,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,35.09,,,,Fee Schedule,,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,66,,,66,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,35.09,198.66,
XR SCAPULA RIGHT,73010,CPT,TCRT,42273010,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,53.3,,,53.3,Fee Schedule,,47.96,,,47.96,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,63.33,,,63.33,Fee Schedule,,67,,,67,Other,186% of Medicaid,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,35.09,,,,Fee Schedule,,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,66,,,66,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,35.09,198.66,
XR OF SCAPULA BILAT,73010,CPT,TC50,42373010,CDM,320,RC,,,both,,,363,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,53.3,,,53.3,Fee Schedule,,47.96,,,47.96,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,All Other,63.33,,,63.33,Fee Schedule,,67,,,67,Other,186% of Medicaid,74.53,,,74.53,Fee Schedule,,225.06,,,225.06,Fee Schedule,,35.09,,,,Fee Schedule,,74.53,,,74.53,Fee Schedule,,225.06,,,225.06,Fee Schedule,,66,,,66,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,35.09,254.1,
XR SCAPULA LEFT FY MOD,73010,CPT,FYLT,42773010,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,53.3,,,53.3,Fee Schedule,,47.96,,,47.96,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,63.33,,,63.33,Fee Schedule,,67,,,67,Other,186% of Medicaid,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,35.09,,,,Fee Schedule,,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,66,,,66,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,35.09,198.66,
XR SCAPULA RIGHT FY MOD,73010,CPT,FYRT,42873010,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,53.3,,,53.3,Fee Schedule,,47.96,,,47.96,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,63.33,,,63.33,Fee Schedule,,67,,,67,Other,186% of Medicaid,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,35.09,,,,Fee Schedule,,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,66,,,66,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,35.09,198.66,
XR OF SCAPULA BILAT FY MOD,73010,CPT,FY50,42973010,CDM,320,RC,,,both,,,363,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,53.3,,,53.3,Fee Schedule,,47.96,,,47.96,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,All Other,63.33,,,63.33,Fee Schedule,,67,,,67,Other,186% of Medicaid,74.53,,,74.53,Fee Schedule,,225.06,,,225.06,Fee Schedule,,35.09,,,,Fee Schedule,,74.53,,,74.53,Fee Schedule,,225.06,,,225.06,Fee Schedule,,66,,,66,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,35.09,254.1,
XR SCAPULA LEFT W/ FY MOD,73010,CPT,FYLT,43173010,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,53.3,,,53.3,Fee Schedule,,47.96,,,47.96,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,63.33,,,63.33,Fee Schedule,,67,,,67,Other,186% of Medicaid,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,35.09,,,,Fee Schedule,,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,66,,,66,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,35.09,198.66,
XR SCAPULA RIGHT W/ FY MOD,73010,CPT,FYRT,43273010,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,53.3,,,53.3,Fee Schedule,,47.96,,,47.96,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,63.33,,,63.33,Fee Schedule,,67,,,67,Other,186% of Medicaid,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,35.09,,,,Fee Schedule,,74.53,,,74.53,Fee Schedule,,150.04,,,150.04,Fee Schedule,,66,,,66,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,35.09,198.66,
XR OF SCAPULA BILAT W/ FY MOD,73010,CPT,FY50,43373010,CDM,320,RC,,,both,,,363,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,53.3,,,53.3,Fee Schedule,,47.96,,,47.96,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,All Other,63.33,,,63.33,Fee Schedule,,67,,,67,Other,186% of Medicaid,74.53,,,74.53,Fee Schedule,,225.06,,,225.06,Fee Schedule,,35.09,,,,Fee Schedule,,74.53,,,74.53,Fee Schedule,,225.06,,,225.06,Fee Schedule,,66,,,66,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,35.09,254.1,
XR EXAM OF SHOULDER 1 VIEW,73020,CPT,TC,42073020,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,49.86,,,49.86,Fee Schedule,,44.86,,,44.86,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,59.24,,,59.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,32.82,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,61.74,,,61.74,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.82,164.2,
XR SHOULDER 1 V LT,73020,CPT,TCLT,42173020,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,49.86,,,49.86,Fee Schedule,,44.86,,,44.86,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,59.24,,,59.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,32.82,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,61.74,,,61.74,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.82,164.2,
XR SHOULDER 1 V RT,73020,CPT,TCRT,42273020,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,49.86,,,49.86,Fee Schedule,,44.86,,,44.86,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,59.24,,,59.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,32.82,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,61.74,,,61.74,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.82,164.2,
XR SHOULDER 1 VBILAT,73020,CPT,TC50,42373020,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,49.86,,,49.86,Fee Schedule,,44.86,,,44.86,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,59.24,,,59.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,215.14,,,215.14,Fee Schedule,,32.82,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,215.14,,,215.14,Fee Schedule,,61.74,,,61.74,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.82,242.9,
XR EXAM OF SHOULDER 1 VIEW W/ FY MOD,73020,CPT,FY,42673020,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,49.86,,,49.86,Fee Schedule,,44.86,,,44.86,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,59.24,,,59.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,32.82,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,61.74,,,61.74,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.82,164.2,
XR SHOULDER 1 V LT FY MOD,73020,CPT,FYLT,42773020,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,49.86,,,49.86,Fee Schedule,,44.86,,,44.86,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,59.24,,,59.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,32.82,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,61.74,,,61.74,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.82,164.2,
XR SHOULDER 1 V RT FY MOD,73020,CPT,FYRT,42873020,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,49.86,,,49.86,Fee Schedule,,44.86,,,44.86,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,59.24,,,59.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,32.82,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,61.74,,,61.74,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.82,164.2,
XR SHOULDER 1 VBILAT FY MOD,73020,CPT,FY50,42973020,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,49.86,,,49.86,Fee Schedule,,44.86,,,44.86,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,59.24,,,59.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,215.14,,,215.14,Fee Schedule,,32.82,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,215.14,,,215.14,Fee Schedule,,61.74,,,61.74,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.82,242.9,
XR SHOULDER 1 V LT W/ FY MOD,73020,CPT,FYLT,43173020,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,49.86,,,49.86,Fee Schedule,,44.86,,,44.86,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,59.24,,,59.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,32.82,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,61.74,,,61.74,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.82,164.2,
XR SHOULDER 1 V RT W/ FY MOD,73020,CPT,FYRT,43273020,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,49.86,,,49.86,Fee Schedule,,44.86,,,44.86,Fee Schedule,,114.31,,,114.31,Fee Schedule,,102.84,,,102.84,Fee Schedule,,97.21,,,97.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,59.24,,,59.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,32.82,,,,Fee Schedule,,69.71,,,69.71,Fee Schedule,,143.22,,,143.22,Fee Schedule,,61.74,,,61.74,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.82,164.2,
XR SHOULDER 2 VIEWS OR MO LT,73030,CPT,TCLT,42173030,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,111.79,,,111.79,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR SHOULDER 2 VIEWS OR MO RT,73030,CPT,TCRT,42273030,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,111.79,,,111.79,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR SHOULDER 2 VIEWS BILAT,73030,CPT,TC50,42373030,CDM,320,RC,,,both,,,611,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,378.82,,,378.82,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,378.82,,,378.82,Fee Schedule,,111.79,,,111.79,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,427.7,
XR SHOULDER 2 VIEWS OR MO LT FY MOD,73030,CPT,FYLT,42773030,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,111.79,,,111.79,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR SHOULDER 2 VIEWS OR MO RT FY MOD,73030,CPT,FYRT,42873030,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,111.79,,,111.79,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR SHOULDER 2 VIEWS BILAT FY MOD,73030,CPT,FY50,42973030,CDM,320,RC,,,both,,,611,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,378.82,,,378.82,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,378.82,,,378.82,Fee Schedule,,111.79,,,111.79,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,427.7,
XR SHOULDER 2+ VIEWS LT W/ FY MOD,73030,CPT,FYLT,43173030,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,111.79,,,111.79,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR SHOULDER 2+ VIEWS RT W/ FY MOD,73030,CPT,FYRT,43273030,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,252.34,,,252.34,Fee Schedule,,111.79,,,111.79,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR SHOULDER 2+ VIEWS BILAT W/ FY MOD,73030,CPT,FY50,43373030,CDM,320,RC,,,both,,,611,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,147.63,,,147.63,Fee Schedule,,132.81,,,132.81,Fee Schedule,,125.54,,,125.54,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,378.82,,,378.82,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,378.82,,,378.82,Fee Schedule,,111.79,,,111.79,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,427.7,
ACJ BILATERAL W/WO WEIGHTS,73050,CPT,TC,42073050,CDM,320,RC,,,both,,,606,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,69.48,,,69.48,Fee Schedule,,62.51,,,62.51,Fee Schedule,,192.84,,,192.84,Fee Schedule,,173.49,,,173.49,Fee Schedule,,163.99,,,163.99,Fee Schedule,,424.2,70,,424.2,percent of total billed charges,All Other,82.55,,,82.55,Fee Schedule,,67,,,67,Other,186% of Medicaid,97.14,,,97.14,Fee Schedule,,375.72,,,375.72,Fee Schedule,,45.74,,,,Fee Schedule,,97.14,,,97.14,Fee Schedule,,375.72,,,375.72,Fee Schedule,,86.03,,,86.03,Fee Schedule,,424.2,70,,424.2,percent of total billed charges,,95.12,,,95.12,Fee Schedule,,80.62,,,80.62,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,424.2,
ACJ BILATERAL W/WO WEIGHTS W/ FY MOD,73050,CPT,FY,42673050,CDM,320,RC,,,both,,,606,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,69.48,,,69.48,Fee Schedule,,62.51,,,62.51,Fee Schedule,,192.84,,,192.84,Fee Schedule,,173.49,,,173.49,Fee Schedule,,163.99,,,163.99,Fee Schedule,,424.2,70,,424.2,percent of total billed charges,All Other,82.55,,,82.55,Fee Schedule,,67,,,67,Other,186% of Medicaid,97.14,,,97.14,Fee Schedule,,375.72,,,375.72,Fee Schedule,,45.74,,,,Fee Schedule,,97.14,,,97.14,Fee Schedule,,375.72,,,375.72,Fee Schedule,,86.03,,,86.03,Fee Schedule,,424.2,70,,424.2,percent of total billed charges,,95.12,,,95.12,Fee Schedule,,80.62,,,80.62,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,424.2,
ACJ BILATERAL W/WO WEIGHTS W/ FY MOD,73050,CPT,FY,43073050,CDM,320,RC,,,both,,,606,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,69.48,,,69.48,Fee Schedule,,62.51,,,62.51,Fee Schedule,,192.84,,,192.84,Fee Schedule,,173.49,,,173.49,Fee Schedule,,163.99,,,163.99,Fee Schedule,,424.2,70,,424.2,percent of total billed charges,All Other,82.55,,,82.55,Fee Schedule,,67,,,67,Other,186% of Medicaid,97.14,,,97.14,Fee Schedule,,375.72,,,375.72,Fee Schedule,,45.74,,,,Fee Schedule,,97.14,,,97.14,Fee Schedule,,375.72,,,375.72,Fee Schedule,,86.03,,,86.03,Fee Schedule,,424.2,70,,424.2,percent of total billed charges,,95.12,,,95.12,Fee Schedule,,80.62,,,80.62,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,424.2,
XR HUMERUS LEFT,73060,CPT,TCLT,42173060,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,104.64,,,104.64,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR HUMERUS RIGHT,73060,CPT,TCRT,42273060,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,104.64,,,104.64,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR HUMERUS 2 VIEW BILAT,73060,CPT,TC50,42373060,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,347.2,,,347.2,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,347.2,,,347.2,Fee Schedule,,104.64,,,104.64,Fee Schedule,,392,70,,392,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR HUMERUS LEFT FY MOD,73060,CPT,FYLT,42773060,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,104.64,,,104.64,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR HUMERUS RIGHT FY MOD,73060,CPT,FYRT,42873060,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,104.64,,,104.64,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR HUMERUS 2 VIEW BILAT FY MOD,73060,CPT,FY50,42973060,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,347.2,,,347.2,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,347.2,,,347.2,Fee Schedule,,104.64,,,104.64,Fee Schedule,,392,70,,392,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR HUMERUS LEFT W/ FY MOD,73060,CPT,FYLT,43173060,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,104.64,,,104.64,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR HUMERUS RIGHT W/ FY MOD,73060,CPT,FYRT,43273060,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,231.26,,,231.26,Fee Schedule,,104.64,,,104.64,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR HUMERUS 2 VIEW BILAT W/ FY MOD,73060,CPT,FY50,43373060,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,84.5,,,84.5,Fee Schedule,,76.03,,,76.03,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,100.4,,,100.4,Fee Schedule,,67,,,67,Other,186% of Medicaid,118.15,,,118.15,Fee Schedule,,347.2,,,347.2,Fee Schedule,,55.63,,,,Fee Schedule,,118.15,,,118.15,Fee Schedule,,347.2,,,347.2,Fee Schedule,,104.64,,,104.64,Fee Schedule,,392,70,,392,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR EXAM OF ELBOW 2 VIEWS,73070,CPT,TC,42073070,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ELBOW 2 VIEW LEFT,73070,CPT,TCLT,42173070,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ELBOW 2 VIEW RIGHT,73070,CPT,TCRT,42273070,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ELBOW 2 V BILAT,73070,CPT,TC50,42373070,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,215.14,,,215.14,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,215.14,,,215.14,Fee Schedule,,91.76,,,91.76,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR EXAM OF ELBOW 2 VIEWS W/ FY MOD,73070,CPT,FY,42673070,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ELBOW 2 VIEW LEFT FY MOD,73070,CPT,FYLT,42773070,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ELBOW 2 VIEW RIGHT FY MOD,73070,CPT,FYRT,42873070,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ELBOW 2 V BILAT FY MOD,73070,CPT,FY50,42973070,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,215.14,,,215.14,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,215.14,,,215.14,Fee Schedule,,91.76,,,91.76,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR ELBOW 2 VIEW LEFT W/ FY MOD,73070,CPT,FYLT,43173070,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ELBOW 2 VIEW RIGHT W/ FY MOD,73070,CPT,FYRT,43273070,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,145.27,,,145.27,Fee Schedule,,130.69,,,130.69,Fee Schedule,,123.54,,,123.54,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ELBOW 3 VIEWS LT,73080,CPT,TCLT,42173080,CDM,320,RC,,,both,,,392,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,106.06,,,106.06,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,274.4,
XR ELBOW 3 VIEWS RT,73080,CPT,TCRT,42273080,CDM,320,RC,,,both,,,392,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,106.06,,,106.06,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,274.4,
XR ELBOW 3 VIEWS  BILAT,73080,CPT,TC50,42373080,CDM,320,RC,,,both,,,588,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,411.6,70,,411.6,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,364.56,,,364.56,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,364.56,,,364.56,Fee Schedule,,106.06,,,106.06,Fee Schedule,,411.6,70,,411.6,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,411.6,
XR ELBOW 3 VIEWS LT FY MOD,73080,CPT,FYLT,42773080,CDM,320,RC,,,both,,,392,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,106.06,,,106.06,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,274.4,
XR ELBOW 3 VIEWS RT FY MOD,73080,CPT,FYRT,42873080,CDM,320,RC,,,both,,,392,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,106.06,,,106.06,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,274.4,
XR ELBOW 3 VIEWS  BILAT FY MOD,73080,CPT,FY50,42973080,CDM,320,RC,,,both,,,588,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,411.6,70,,411.6,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,364.56,,,364.56,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,364.56,,,364.56,Fee Schedule,,106.06,,,106.06,Fee Schedule,,411.6,70,,411.6,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,411.6,
XR ELBOW 3 VIEWS LT W/ FY MOD,73080,CPT,FYLT,43173080,CDM,320,RC,,,both,,,392,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,106.06,,,106.06,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,274.4,
XR ELBOW 3 VIEWS RT W/ FY MOD,73080,CPT,FYRT,43273080,CDM,320,RC,,,both,,,392,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,243.04,,,243.04,Fee Schedule,,106.06,,,106.06,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,274.4,
XR ELBOW 3 VIEWS  BILAT W/ FY MOD,73080,CPT,FY50,43373080,CDM,320,RC,,,both,,,588,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,411.6,70,,411.6,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,364.56,,,364.56,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,364.56,,,364.56,Fee Schedule,,106.06,,,106.06,Fee Schedule,,411.6,70,,411.6,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,411.6,
XR ARTHROGRAM ELBOW LT,73085,CPT,TCLT,42173085,CDM,320,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,258.96,,,258.96,Fee Schedule,,232.99,,,232.99,Fee Schedule,,495.06,,,495.06,Fee Schedule,,445.38,,,445.38,Fee Schedule,,420.98,,,420.98,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,307.67,,,307.67,Fee Schedule,,406,,,406,Other,186% of Medicaid,362.06,,,362.06,Fee Schedule,,743.38,,,743.38,Fee Schedule,,170.48,,,,Fee Schedule,,362.06,,,362.06,Fee Schedule,,743.38,,,743.38,Fee Schedule,,320.66,,,320.66,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,170.48,839.3,
XR ARTHROGRAM ELBOW RT,73085,CPT,TCRT,42273085,CDM,320,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,258.96,,,258.96,Fee Schedule,,232.99,,,232.99,Fee Schedule,,495.06,,,495.06,Fee Schedule,,445.38,,,445.38,Fee Schedule,,420.98,,,420.98,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,307.67,,,307.67,Fee Schedule,,406,,,406,Other,186% of Medicaid,362.06,,,362.06,Fee Schedule,,743.38,,,743.38,Fee Schedule,,170.48,,,,Fee Schedule,,362.06,,,362.06,Fee Schedule,,743.38,,,743.38,Fee Schedule,,320.66,,,320.66,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,170.48,839.3,
XR ARTHROGRAM ELBOW BILAT,73085,CPT,TC50,42373085,CDM,320,RC,,,both,,,1799,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,258.96,,,258.96,Fee Schedule,,232.99,,,232.99,Fee Schedule,,495.06,,,495.06,Fee Schedule,,445.38,,,445.38,Fee Schedule,,420.98,,,420.98,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,All Other,307.67,,,307.67,Fee Schedule,,406,,,406,Other,186% of Medicaid,362.06,,,362.06,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,170.48,,,,Fee Schedule,,362.06,,,362.06,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,320.66,,,320.66,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,170.48,1259.3,
XR ARTHROGRAM ELBOW LT FY MOD,73085,CPT,FYLT,42773085,CDM,320,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,258.96,,,258.96,Fee Schedule,,232.99,,,232.99,Fee Schedule,,495.06,,,495.06,Fee Schedule,,445.38,,,445.38,Fee Schedule,,420.98,,,420.98,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,307.67,,,307.67,Fee Schedule,,406,,,406,Other,186% of Medicaid,362.06,,,362.06,Fee Schedule,,743.38,,,743.38,Fee Schedule,,170.48,,,,Fee Schedule,,362.06,,,362.06,Fee Schedule,,743.38,,,743.38,Fee Schedule,,320.66,,,320.66,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,170.48,839.3,
XR ARTHROGRAM ELBOW RT FY MOD,73085,CPT,FYRT,42873085,CDM,320,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,258.96,,,258.96,Fee Schedule,,232.99,,,232.99,Fee Schedule,,495.06,,,495.06,Fee Schedule,,445.38,,,445.38,Fee Schedule,,420.98,,,420.98,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,307.67,,,307.67,Fee Schedule,,406,,,406,Other,186% of Medicaid,362.06,,,362.06,Fee Schedule,,743.38,,,743.38,Fee Schedule,,170.48,,,,Fee Schedule,,362.06,,,362.06,Fee Schedule,,743.38,,,743.38,Fee Schedule,,320.66,,,320.66,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,170.48,839.3,
XR ARTHROGRAM ELBOW BILAT FY MOD,73085,CPT,FY50,42973085,CDM,320,RC,,,both,,,1799,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,258.96,,,258.96,Fee Schedule,,232.99,,,232.99,Fee Schedule,,495.06,,,495.06,Fee Schedule,,445.38,,,445.38,Fee Schedule,,420.98,,,420.98,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,All Other,307.67,,,307.67,Fee Schedule,,406,,,406,Other,186% of Medicaid,362.06,,,362.06,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,170.48,,,,Fee Schedule,,362.06,,,362.06,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,320.66,,,320.66,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,170.48,1259.3,
XR FOREARM LT,73090,CPT,TCLT,42173090,CDM,320,RC,,,both,,,334,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,93.18,,,93.18,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,233.8,
XR FOREARM RT,73090,CPT,TCRT,42273090,CDM,320,RC,,,both,,,334,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,93.18,,,93.18,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,233.8,
XR FOREARM BILAT,73090,CPT,TC50,42373090,CDM,320,RC,,,both,,,501,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,350.7,70,,350.7,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,310.62,,,310.62,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,310.62,,,310.62,Fee Schedule,,93.18,,,93.18,Fee Schedule,,350.7,70,,350.7,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,350.7,
XR FOREARM LT FY MOD,73090,CPT,FYLT,42773090,CDM,320,RC,,,both,,,334,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,93.18,,,93.18,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,233.8,
XR FOREARM RT FY MOD,73090,CPT,FYRT,42873090,CDM,320,RC,,,both,,,334,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,93.18,,,93.18,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,233.8,
XR FOREARM BILAT FY MOD,73090,CPT,FY50,42973090,CDM,320,RC,,,both,,,501,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,350.7,70,,350.7,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,310.62,,,310.62,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,310.62,,,310.62,Fee Schedule,,93.18,,,93.18,Fee Schedule,,350.7,70,,350.7,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,350.7,
XR FOREARM LT W/ FY MOD,73090,CPT,FYLT,43173090,CDM,320,RC,,,both,,,334,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,93.18,,,93.18,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,233.8,
XR FOREARM RT W/ FY MOD,73090,CPT,FYRT,43273090,CDM,320,RC,,,both,,,334,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,207.08,,,207.08,Fee Schedule,,93.18,,,93.18,Fee Schedule,,233.8,70,,233.8,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,233.8,
XR FOREARM BILAT W/ FY MOD,73090,CPT,FY50,43373090,CDM,320,RC,,,both,,,501,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,350.7,70,,350.7,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,310.62,,,310.62,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,310.62,,,310.62,Fee Schedule,,93.18,,,93.18,Fee Schedule,,350.7,70,,350.7,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,350.7,
XR UPPER EXT CHILD 2 V LT,73092,CPT,TCLT,42173092,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,159.52,,,159.52,Fee Schedule,,143.51,,,143.51,Fee Schedule,,135.65,,,135.65,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,103.21,,,103.21,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR UPPER EXT CHILD 2 V RT,73092,CPT,TCRT,42273092,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,159.52,,,159.52,Fee Schedule,,143.51,,,143.51,Fee Schedule,,135.65,,,135.65,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,103.21,,,103.21,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR UPPER EXT CHILD BILAT,73092,CPT,TC50,42373092,CDM,320,RC,,,both,,,363,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,159.52,,,159.52,Fee Schedule,,143.51,,,143.51,Fee Schedule,,135.65,,,135.65,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,225.06,,,225.06,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,225.06,,,225.06,Fee Schedule,,103.21,,,103.21,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,254.1,
XR UPPER EXT CHILD 2 V LT FY MOD,73092,CPT,FYLT,42773092,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,159.52,,,159.52,Fee Schedule,,143.51,,,143.51,Fee Schedule,,135.65,,,135.65,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,103.21,,,103.21,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR UPPER EXT CHILD 2 V RT FY MOD,73092,CPT,FYRT,42873092,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,159.52,,,159.52,Fee Schedule,,143.51,,,143.51,Fee Schedule,,135.65,,,135.65,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,103.21,,,103.21,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR UPPER EXT CHILD BILAT FY MOD,73092,CPT,FY50,42973092,CDM,320,RC,,,both,,,363,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,159.52,,,159.52,Fee Schedule,,143.51,,,143.51,Fee Schedule,,135.65,,,135.65,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,225.06,,,225.06,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,225.06,,,225.06,Fee Schedule,,103.21,,,103.21,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,254.1,
XR UPPER EXT CHILD 2 V LT W/ FY MOD,73092,CPT,FYLT,43173092,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,159.52,,,159.52,Fee Schedule,,143.51,,,143.51,Fee Schedule,,135.65,,,135.65,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,103.21,,,103.21,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR UPPER EXT CHILD 2 V RT W/ FY MOD,73092,CPT,FYRT,43273092,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,159.52,,,159.52,Fee Schedule,,143.51,,,143.51,Fee Schedule,,135.65,,,135.65,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,150.04,,,150.04,Fee Schedule,,103.21,,,103.21,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR UPPER EXT CHILD BILAT W/ FY MOD,73092,CPT,FY50,43373092,CDM,320,RC,,,both,,,363,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,159.52,,,159.52,Fee Schedule,,143.51,,,143.51,Fee Schedule,,135.65,,,135.65,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,225.06,,,225.06,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,225.06,,,225.06,Fee Schedule,,103.21,,,103.21,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,254.1,
XR EXAM OF WRIST 2 VIEWS,73100,CPT,TC,42073100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,111.79,,,111.79,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR WRIST 2 VIEWS LT,73100,CPT,TCLT,42173100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,111.79,,,111.79,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR WRIST 2 VIEWS RT,73100,CPT,TCRT,42273100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,111.79,,,111.79,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR WRIST 2 VIEWS BILAT,73100,CPT,TC50,42373100,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,215.14,,,215.14,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,215.14,,,215.14,Fee Schedule,,111.79,,,111.79,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR EXAM OF WRIST 2 VIEWS W/ FY MOD,73100,CPT,FY,42673100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,111.79,,,111.79,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR WRIST 2 VIEWS LT FYMOD,73100,CPT,FYLT,42773100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,111.79,,,111.79,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR WRIST 2 VIEWS RT FY MOD,73100,CPT,FYRT,42873100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,111.79,,,111.79,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR WRIST 2 VIEWS BILAT FY MOD,73100,CPT,FY50,42973100,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,215.14,,,215.14,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,215.14,,,215.14,Fee Schedule,,111.79,,,111.79,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR EXAM OF WRIST 2 VIEWS W/ FY MOD,73100,CPT,FY,43073100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,111.79,,,111.79,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR WRIST 2 VIEWS LT W/ FY MOD,73100,CPT,FYLT,43173100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,111.79,,,111.79,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR WRIST 2 VIEWS RT W/ FY MOD,73100,CPT,FYRT,43273100,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,143.22,,,143.22,Fee Schedule,,111.79,,,111.79,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR WRIST 2 VIEWS BILAT W/ FY MOD,73100,CPT,FY50,43373100,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,154.76,,,154.76,Fee Schedule,,139.22,,,139.22,Fee Schedule,,131.6,,,131.6,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,215.14,,,215.14,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,215.14,,,215.14,Fee Schedule,,111.79,,,111.79,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR WRIST 3+ VIEWS LT,73110,CPT,TCLT,42173110,CDM,320,RC,,,both,,,330,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,231,70,,231,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,141.84,,,141.84,Fee Schedule,,231,70,,231,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,231,
XR WRIST 3+ VIEWS RT,73110,CPT,TCRT,42273110,CDM,320,RC,,,both,,,330,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,231,70,,231,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,141.84,,,141.84,Fee Schedule,,231,70,,231,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,231,
XR WRIST 3+ V BILAT,73110,CPT,TC50,42373110,CDM,320,RC,,,both,,,495,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,346.5,70,,346.5,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,306.9,,,306.9,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,306.9,,,306.9,Fee Schedule,,141.84,,,141.84,Fee Schedule,,346.5,70,,346.5,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,346.5,
XR WRIST 3+ VIEWS LT FY MOD,73110,CPT,FYLT,42773110,CDM,320,RC,,,both,,,330,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,231,70,,231,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,141.84,,,141.84,Fee Schedule,,231,70,,231,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,231,
XR WRIST 3+ VIEWS RT FY MOD,73110,CPT,FYRT,42873110,CDM,320,RC,,,both,,,330,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,231,70,,231,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,141.84,,,141.84,Fee Schedule,,231,70,,231,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,231,
XR WRIST 3+ V BILAT FY MOD,73110,CPT,FY50,42973110,CDM,320,RC,,,both,,,495,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,346.5,70,,346.5,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,306.9,,,306.9,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,306.9,,,306.9,Fee Schedule,,141.84,,,141.84,Fee Schedule,,346.5,70,,346.5,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,346.5,
XR WRIST 3+ VIEWS LT W/ FY MOD,73110,CPT,FYLT,43173110,CDM,320,RC,,,both,,,330,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,231,70,,231,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,141.84,,,141.84,Fee Schedule,,231,70,,231,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,231,
XR WRIST 3+ VIEWS RT W/ FY MOD,73110,CPT,FYRT,43273110,CDM,320,RC,,,both,,,330,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,231,70,,231,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,204.6,,,204.6,Fee Schedule,,141.84,,,141.84,Fee Schedule,,231,70,,231,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,231,
XR WRIST 3+ V BILAT W/ FY MOD,73110,CPT,FY50,43373110,CDM,320,RC,,,both,,,495,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,114.55,,,114.55,Fee Schedule,,103.06,,,103.06,Fee Schedule,,195.25,,,195.25,Fee Schedule,,175.66,,,175.66,Fee Schedule,,166.04,,,166.04,Fee Schedule,,346.5,70,,346.5,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,67,,,67,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,306.9,,,306.9,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,306.9,,,306.9,Fee Schedule,,141.84,,,141.84,Fee Schedule,,346.5,70,,346.5,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,346.5,
XR HAND 2 VIEWS LT,73120,CPT,TCLT,42173120,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,82.21,,,82.21,Fee Schedule,,73.96,,,73.96,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,97.67,,,97.67,Fee Schedule,,67,,,67,Other,186% of Medicaid,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.12,,,,Fee Schedule,,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,101.79,,,101.79,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR HAND 2 VIEWS RT,73120,CPT,TCRT,42273120,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,82.21,,,82.21,Fee Schedule,,73.96,,,73.96,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,97.67,,,97.67,Fee Schedule,,67,,,67,Other,186% of Medicaid,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.12,,,,Fee Schedule,,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,101.79,,,101.79,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR HAND 2 VIEWS BILAT,73120,CPT,TC50,42373120,CDM,320,RC,,,both,,,363,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,82.21,,,82.21,Fee Schedule,,73.96,,,73.96,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,All Other,97.67,,,97.67,Fee Schedule,,67,,,67,Other,186% of Medicaid,114.93,,,114.93,Fee Schedule,,225.06,,,225.06,Fee Schedule,,54.12,,,,Fee Schedule,,114.93,,,114.93,Fee Schedule,,225.06,,,225.06,Fee Schedule,,101.79,,,101.79,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,254.1,
XR HAND 2 VIEWS LT FY MOD,73120,CPT,FYLT,42773120,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,82.21,,,82.21,Fee Schedule,,73.96,,,73.96,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,97.67,,,97.67,Fee Schedule,,67,,,67,Other,186% of Medicaid,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.12,,,,Fee Schedule,,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,101.79,,,101.79,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR HAND 2 VIEWS RT FY MOD,73120,CPT,FYRT,42873120,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,82.21,,,82.21,Fee Schedule,,73.96,,,73.96,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,97.67,,,97.67,Fee Schedule,,67,,,67,Other,186% of Medicaid,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.12,,,,Fee Schedule,,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,101.79,,,101.79,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR HAND 2 VIEWS BILAT FY MOD,73120,CPT,FY50,42973120,CDM,320,RC,,,both,,,363,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,82.21,,,82.21,Fee Schedule,,73.96,,,73.96,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,All Other,97.67,,,97.67,Fee Schedule,,67,,,67,Other,186% of Medicaid,114.93,,,114.93,Fee Schedule,,225.06,,,225.06,Fee Schedule,,54.12,,,,Fee Schedule,,114.93,,,114.93,Fee Schedule,,225.06,,,225.06,Fee Schedule,,101.79,,,101.79,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,254.1,
XR HAND 2 VIEWS LT W/ FY MOD,73120,CPT,FYLT,43173120,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,82.21,,,82.21,Fee Schedule,,73.96,,,73.96,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,97.67,,,97.67,Fee Schedule,,67,,,67,Other,186% of Medicaid,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.12,,,,Fee Schedule,,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,101.79,,,101.79,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR HAND 2 VIEWS RT W/ FY MOD,73120,CPT,FYRT,43273120,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,82.21,,,82.21,Fee Schedule,,73.96,,,73.96,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,97.67,,,97.67,Fee Schedule,,67,,,67,Other,186% of Medicaid,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,54.12,,,,Fee Schedule,,114.93,,,114.93,Fee Schedule,,150.04,,,150.04,Fee Schedule,,101.79,,,101.79,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR HAND 2 VIEWS BILAT W/ FY MOD,73120,CPT,FY50,43373120,CDM,320,RC,,,both,,,363,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,82.21,,,82.21,Fee Schedule,,73.96,,,73.96,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,All Other,97.67,,,97.67,Fee Schedule,,67,,,67,Other,186% of Medicaid,114.93,,,114.93,Fee Schedule,,225.06,,,225.06,Fee Schedule,,54.12,,,,Fee Schedule,,114.93,,,114.93,Fee Schedule,,225.06,,,225.06,Fee Schedule,,101.79,,,101.79,Fee Schedule,,254.1,70,,254.1,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,254.1,
XR HAND 3+ VIEWS LT,73130,CPT,TCLT,42173130,CDM,320,RC,,,both,,,352,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,124.66,,,124.66,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,246.4,
XR HAND 3+ VIEWS RT,73130,CPT,TCRT,42273130,CDM,320,RC,,,both,,,352,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,124.66,,,124.66,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,246.4,
XR HAND 3+ VIEWS BILAT,73130,CPT,TC50,42373130,CDM,320,RC,,,both,,,528,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,369.6,70,,369.6,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,327.36,,,327.36,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,327.36,,,327.36,Fee Schedule,,124.66,,,124.66,Fee Schedule,,369.6,70,,369.6,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,369.6,
XR HAND 3+ VIEWS LT FY MOD,73130,CPT,FYLT,42773130,CDM,320,RC,,,both,,,352,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,124.66,,,124.66,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,246.4,
XR HAND 3+ VIEWS RT FY MOD,73130,CPT,FYRT,42873130,CDM,320,RC,,,both,,,352,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,124.66,,,124.66,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,246.4,
XR HAND 3+ VIEWS BILAT FY MOD,73130,CPT,FY50,42973130,CDM,320,RC,,,both,,,528,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,369.6,70,,369.6,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,327.36,,,327.36,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,327.36,,,327.36,Fee Schedule,,124.66,,,124.66,Fee Schedule,,369.6,70,,369.6,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,369.6,
XR HAND 3+ VIEWS LT W/ FY MOD,73130,CPT,FYLT,43173130,CDM,320,RC,,,both,,,352,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,124.66,,,124.66,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,246.4,
XR HAND 3+ VIEWS RT W/ FY MOD,73130,CPT,FYRT,43273130,CDM,320,RC,,,both,,,352,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,218.24,,,218.24,Fee Schedule,,124.66,,,124.66,Fee Schedule,,246.4,70,,246.4,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,246.4,
XR HAND 3+ VIEWS BILAT W/ FY MOD,73130,CPT,FY50,43373130,CDM,320,RC,,,both,,,528,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,100.68,,,100.68,Fee Schedule,,90.58,,,90.58,Fee Schedule,,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,369.6,70,,369.6,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,67,,,67,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,327.36,,,327.36,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,327.36,,,327.36,Fee Schedule,,124.66,,,124.66,Fee Schedule,,369.6,70,,369.6,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,369.6,
XR FINGER 2+ VIEWS LT,73140,CPT,TCLT,42173140,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,109.93,,,109.93,Fee Schedule,,98.9,,,98.9,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,130.6,,,130.6,Fee Schedule,,67,,,67,Other,186% of Medicaid,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,72.37,,,,Fee Schedule,,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,136.12,,,136.12,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,150.88,,,150.88,Fee Schedule,,127.88,,,127.88,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,173.83,
XR FINGER 2+ VIEWS RT,73140,CPT,TCRT,42273140,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,109.93,,,109.93,Fee Schedule,,98.9,,,98.9,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,130.6,,,130.6,Fee Schedule,,67,,,67,Other,186% of Medicaid,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,72.37,,,,Fee Schedule,,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,136.12,,,136.12,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,150.88,,,150.88,Fee Schedule,,127.88,,,127.88,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,173.83,
XR FINGER 2+ VIEWS BILAT,73140,CPT,TC50,42373140,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,109.93,,,109.93,Fee Schedule,,98.9,,,98.9,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,130.6,,,130.6,Fee Schedule,,67,,,67,Other,186% of Medicaid,153.69,,,153.69,Fee Schedule,,215.14,,,215.14,Fee Schedule,,72.37,,,,Fee Schedule,,153.69,,,153.69,Fee Schedule,,215.14,,,215.14,Fee Schedule,,136.12,,,136.12,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,150.88,,,150.88,Fee Schedule,,127.88,,,127.88,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR FINGER 2+ VIEWS LT FY MOD,73140,CPT,FYLT,42773140,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,109.93,,,109.93,Fee Schedule,,98.9,,,98.9,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,130.6,,,130.6,Fee Schedule,,67,,,67,Other,186% of Medicaid,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,72.37,,,,Fee Schedule,,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,136.12,,,136.12,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,150.88,,,150.88,Fee Schedule,,127.88,,,127.88,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,173.83,
XR FINGER 2+ VIEWS RT FY MOD,73140,CPT,FYRT,42873140,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,109.93,,,109.93,Fee Schedule,,98.9,,,98.9,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,130.6,,,130.6,Fee Schedule,,67,,,67,Other,186% of Medicaid,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,72.37,,,,Fee Schedule,,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,136.12,,,136.12,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,150.88,,,150.88,Fee Schedule,,127.88,,,127.88,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,173.83,
XR FINGER 2+ VIEWS BILAT FY MOD,73140,CPT,FY50,42973140,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,109.93,,,109.93,Fee Schedule,,98.9,,,98.9,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,130.6,,,130.6,Fee Schedule,,67,,,67,Other,186% of Medicaid,153.69,,,153.69,Fee Schedule,,215.14,,,215.14,Fee Schedule,,72.37,,,,Fee Schedule,,153.69,,,153.69,Fee Schedule,,215.14,,,215.14,Fee Schedule,,136.12,,,136.12,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,150.88,,,150.88,Fee Schedule,,127.88,,,127.88,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR FINGER 2+ VIEWS LT W/ FY MOD,73140,CPT,FYLT,43173140,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,109.93,,,109.93,Fee Schedule,,98.9,,,98.9,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,130.6,,,130.6,Fee Schedule,,67,,,67,Other,186% of Medicaid,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,72.37,,,,Fee Schedule,,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,136.12,,,136.12,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,150.88,,,150.88,Fee Schedule,,127.88,,,127.88,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,173.83,
X-RAY EXAM HIP UNI 1 VIEW LT,73501,CPT,TCLT,42173501,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,103.21,,,103.21,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,114.8,,,114.8,Fee Schedule,,97.3,,,97.3,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,20.07,165.9,
X-RAY EXAM HIP UNI 1 VIEW RT,73501,CPT,TCRT,42273501,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,103.21,,,103.21,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,114.8,,,114.8,Fee Schedule,,97.3,,,97.3,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,20.07,165.9,
X-RAY EXAM HIP UNI 1 VIEW LT FY MOD,73501,CPT,FYLT,42773501,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,103.21,,,103.21,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,114.8,,,114.8,Fee Schedule,,97.3,,,97.3,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,20.07,165.9,
X-RAY EXAM HIP UNI 1 VIEW RT FY MOD,73501,CPT,FYRT,42873501,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,103.21,,,103.21,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,114.8,,,114.8,Fee Schedule,,97.3,,,97.3,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,20.07,165.9,
X-RAY EXAM HIP UNI 1 VIEW LT W/ FY MOD,73501,CPT,FYLT,43173501,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,103.21,,,103.21,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,114.8,,,114.8,Fee Schedule,,97.3,,,97.3,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,20.07,165.9,
X-RAY EXAM HIP UNI 1 VIEW RT W/ FY MOD,73501,CPT,FYRT,43273501,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,20.07,,,20.07,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,146.94,,,146.94,Fee Schedule,,103.21,,,103.21,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,114.8,,,114.8,Fee Schedule,,97.3,,,97.3,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,20.07,165.9,
X-RAY EXAM HIP UNI 2-3 VIEWS LT,73502,CPT,TCLT,42173502,CDM,320,RC,,,both,,,268,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,128.4,,,128.4,Fee Schedule,,115.52,,,115.52,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,187.6,70,,187.6,percent of total billed charges,All Other,152.55,,,152.55,Fee Schedule,,67,,,67,Other,186% of Medicaid,179.52,,,179.52,Fee Schedule,,166.16,,,166.16,Fee Schedule,,84.53,,,,Fee Schedule,,179.52,,,179.52,Fee Schedule,,166.16,,,166.16,Fee Schedule,,158.99,,,158.99,Fee Schedule,,187.6,70,,187.6,percent of total billed charges,,177.12,,,177.12,Fee Schedule,,150.12,,,150.12,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,29.42,187.6,
X-RAY EXAM HIP UNI 2-3 VIEWS RT,73502,CPT,TCRT,42273502,CDM,320,RC,,,both,,,268,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,128.4,,,128.4,Fee Schedule,,115.52,,,115.52,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,187.6,70,,187.6,percent of total billed charges,All Other,152.55,,,152.55,Fee Schedule,,67,,,67,Other,186% of Medicaid,179.52,,,179.52,Fee Schedule,,166.16,,,166.16,Fee Schedule,,84.53,,,,Fee Schedule,,179.52,,,179.52,Fee Schedule,,166.16,,,166.16,Fee Schedule,,158.99,,,158.99,Fee Schedule,,187.6,70,,187.6,percent of total billed charges,,177.12,,,177.12,Fee Schedule,,150.12,,,150.12,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,29.42,187.6,
X-RAY EXAM HIP UNI 2-3 VIEWS LT FY MOD,73502,CPT,FYLT,42773502,CDM,320,RC,,,both,,,268,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,128.4,,,128.4,Fee Schedule,,115.52,,,115.52,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,187.6,70,,187.6,percent of total billed charges,All Other,152.55,,,152.55,Fee Schedule,,67,,,67,Other,186% of Medicaid,179.52,,,179.52,Fee Schedule,,166.16,,,166.16,Fee Schedule,,84.53,,,,Fee Schedule,,179.52,,,179.52,Fee Schedule,,166.16,,,166.16,Fee Schedule,,158.99,,,158.99,Fee Schedule,,187.6,70,,187.6,percent of total billed charges,,177.12,,,177.12,Fee Schedule,,150.12,,,150.12,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,29.42,187.6,
X-RAY EXAM HIP UNI 2-3 VIEWS RT FY MOD,73502,CPT,FYRT,42873502,CDM,320,RC,,,both,,,268,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,128.4,,,128.4,Fee Schedule,,115.52,,,115.52,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,187.6,70,,187.6,percent of total billed charges,All Other,152.55,,,152.55,Fee Schedule,,67,,,67,Other,186% of Medicaid,179.52,,,179.52,Fee Schedule,,166.16,,,166.16,Fee Schedule,,84.53,,,,Fee Schedule,,179.52,,,179.52,Fee Schedule,,166.16,,,166.16,Fee Schedule,,158.99,,,158.99,Fee Schedule,,187.6,70,,187.6,percent of total billed charges,,177.12,,,177.12,Fee Schedule,,150.12,,,150.12,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,29.42,187.6,
X-RAY EXAM HIP UNI 2-3 VIEWS LT W/ FY,73502,CPT,FYLT,43173502,CDM,320,RC,,,both,,,250,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,128.4,,,128.4,Fee Schedule,,115.52,,,115.52,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,175,70,,175,percent of total billed charges,All Other,152.55,,,152.55,Fee Schedule,,67,,,67,Other,186% of Medicaid,179.52,,,179.52,Fee Schedule,,155,,,155,Fee Schedule,,84.53,,,,Fee Schedule,,179.52,,,179.52,Fee Schedule,,155,,,155,Fee Schedule,,158.99,,,158.99,Fee Schedule,,175,70,,175,percent of total billed charges,,177.12,,,177.12,Fee Schedule,,150.12,,,150.12,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,29.42,179.52,
X-RAY EXAM HIP UNI 2-3 VIEWS RT W/ FY,73502,CPT,FYRT,43273502,CDM,320,RC,,,both,,,250,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,128.4,,,128.4,Fee Schedule,,115.52,,,115.52,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,29.42,,,29.42,Fee Schedule,,175,70,,175,percent of total billed charges,All Other,152.55,,,152.55,Fee Schedule,,67,,,67,Other,186% of Medicaid,179.52,,,179.52,Fee Schedule,,155,,,155,Fee Schedule,,84.53,,,,Fee Schedule,,179.52,,,179.52,Fee Schedule,,155,,,155,Fee Schedule,,158.99,,,158.99,Fee Schedule,,175,70,,175,percent of total billed charges,,177.12,,,177.12,Fee Schedule,,150.12,,,150.12,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,29.42,179.52,
X-RAY EXAM HIP UNI 4/> VIEWS LT,73503,CPT,TCLT,42173503,CDM,320,RC,,,both,,,336,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,201.92,,,201.92,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,,224.68,,,224.68,Fee Schedule,,190.43,,,190.43,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,235.2,
X-RAY EXAM HIP UNI 4/> VIEWS RT,73503,CPT,TCRT,42273503,CDM,320,RC,,,both,,,336,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,201.92,,,201.92,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,,224.68,,,224.68,Fee Schedule,,190.43,,,190.43,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,235.2,
X-RAY EXAM HIP UNI 4/> VIEWS LT FY MOD,73503,CPT,FYLT,42773503,CDM,320,RC,,,both,,,336,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,201.92,,,201.92,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,,224.68,,,224.68,Fee Schedule,,190.43,,,190.43,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,235.2,
X-RAY EXAM HIP UNI 4/> VIEWS RT FY MOD,73503,CPT,FYRT,42873503,CDM,320,RC,,,both,,,336,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,201.92,,,201.92,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,,224.68,,,224.68,Fee Schedule,,190.43,,,190.43,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,235.2,
X-RAY EXAM HIP UNI 4/> VIEWS LT W/ FY,73503,CPT,FYLT,43173503,CDM,320,RC,,,both,,,336,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,201.92,,,201.92,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,,224.68,,,224.68,Fee Schedule,,190.43,,,190.43,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,235.2,
X-RAY EXAM HIP UNI 4/> VIEWS RT W/ FY,73503,CPT,FYRT,43273503,CDM,320,RC,,,both,,,336,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,36.34,,,36.34,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,208.32,,,208.32,Fee Schedule,,201.92,,,201.92,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,,224.68,,,224.68,Fee Schedule,,190.43,,,190.43,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,235.2,
X-RAY EXAM HIPS BI 2 VIEWS,73521,CPT,TC,42073521,CDM,320,RC,,,both,,,392,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,106.45,,,106.45,Fee Schedule,,95.77,,,95.77,Fee Schedule,,25.61,,,25.61,Fee Schedule,,25.61,,,25.61,Fee Schedule,,25.61,,,25.61,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,126.47,,,126.47,Fee Schedule,,67,,,67,Other,186% of Medicaid,148.83,,,148.83,Fee Schedule,,243.04,,,243.04,Fee Schedule,,70.08,,,,Fee Schedule,,148.83,,,148.83,Fee Schedule,,243.04,,,243.04,Fee Schedule,,131.81,,,131.81,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,149.24,,,149.24,Fee Schedule,,126.49,,,126.49,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,25.61,274.4,
X-RAY EXAM HIPS BI 2 VIEWS W/ FY MOD,73521,CPT,FY,42673521,CDM,320,RC,,,both,,,392,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,106.45,,,106.45,Fee Schedule,,95.77,,,95.77,Fee Schedule,,25.61,,,25.61,Fee Schedule,,25.61,,,25.61,Fee Schedule,,25.61,,,25.61,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,126.47,,,126.47,Fee Schedule,,67,,,67,Other,186% of Medicaid,148.83,,,148.83,Fee Schedule,,243.04,,,243.04,Fee Schedule,,70.08,,,,Fee Schedule,,148.83,,,148.83,Fee Schedule,,243.04,,,243.04,Fee Schedule,,131.81,,,131.81,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,149.24,,,149.24,Fee Schedule,,126.49,,,126.49,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,25.61,274.4,
X-RAY EXAM HIPS BI 2 VIEWS W/ FY MOD,73521,CPT,FY,43073521,CDM,320,RC,,,both,,,392,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,106.45,,,106.45,Fee Schedule,,95.77,,,95.77,Fee Schedule,,25.61,,,25.61,Fee Schedule,,25.61,,,25.61,Fee Schedule,,25.61,,,25.61,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,All Other,126.47,,,126.47,Fee Schedule,,67,,,67,Other,186% of Medicaid,148.83,,,148.83,Fee Schedule,,243.04,,,243.04,Fee Schedule,,70.08,,,,Fee Schedule,,148.83,,,148.83,Fee Schedule,,243.04,,,243.04,Fee Schedule,,131.81,,,131.81,Fee Schedule,,274.4,70,,274.4,percent of total billed charges,,149.24,,,149.24,Fee Schedule,,126.49,,,126.49,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,25.61,274.4,
X-RAY EXAM HIPS BI 3-4 VIEWS,73522,CPT,TC,42073522,CDM,320,RC,,,both,,,336,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,138.8,,,138.8,Fee Schedule,,124.87,,,124.87,Fee Schedule,,32.88,,,32.88,Fee Schedule,,32.88,,,32.88,Fee Schedule,,32.88,,,32.88,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,164.9,,,164.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,194.05,,,194.05,Fee Schedule,,208.32,,,208.32,Fee Schedule,,91.37,,,,Fee Schedule,,194.05,,,194.05,Fee Schedule,,208.32,,,208.32,Fee Schedule,,171.86,,,171.86,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,,193.52,,,193.52,Fee Schedule,,164.02,,,164.02,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.88,235.2,
X-RAY EXAM HIPS BI 3-4 VIEWS W/ FY MOD,73522,CPT,FY,42673522,CDM,320,RC,,,both,,,336,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,138.8,,,138.8,Fee Schedule,,124.87,,,124.87,Fee Schedule,,32.88,,,32.88,Fee Schedule,,32.88,,,32.88,Fee Schedule,,32.88,,,32.88,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,164.9,,,164.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,194.05,,,194.05,Fee Schedule,,208.32,,,208.32,Fee Schedule,,91.37,,,,Fee Schedule,,194.05,,,194.05,Fee Schedule,,208.32,,,208.32,Fee Schedule,,171.86,,,171.86,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,,193.52,,,193.52,Fee Schedule,,164.02,,,164.02,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.88,235.2,
X-RAY EXAM HIPS BI 3-4 VIEWS W/ FY MOD,73522,CPT,FY,43073522,CDM,320,RC,,,both,,,336,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,138.8,,,138.8,Fee Schedule,,124.87,,,124.87,Fee Schedule,,32.88,,,32.88,Fee Schedule,,32.88,,,32.88,Fee Schedule,,32.88,,,32.88,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,164.9,,,164.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,194.05,,,194.05,Fee Schedule,,208.32,,,208.32,Fee Schedule,,91.37,,,,Fee Schedule,,194.05,,,194.05,Fee Schedule,,208.32,,,208.32,Fee Schedule,,171.86,,,171.86,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,,193.52,,,193.52,Fee Schedule,,164.02,,,164.02,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,32.88,235.2,
X-RAY EXAM HIPS BI 5/> VIEWS,73523,CPT,TC,42073523,CDM,320,RC,,,both,,,638,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,39.46,,,39.46,Fee Schedule,,39.46,,,39.46,Fee Schedule,,39.46,,,39.46,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,395.56,,,395.56,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,395.56,,,395.56,Fee Schedule,,201.92,,,201.92,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,446.6,
X-RAY EXAM HIPS BI 5/> VIEWS W/ FY MOD,73523,CPT,FY,42673523,CDM,320,RC,,,both,,,638,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,39.46,,,39.46,Fee Schedule,,39.46,,,39.46,Fee Schedule,,39.46,,,39.46,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,395.56,,,395.56,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,395.56,,,395.56,Fee Schedule,,201.92,,,201.92,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,446.6,
X-RAY EXAM HIPS BI 5/> VIEWS W/ FY MOD,73523,CPT,FY,43073523,CDM,320,RC,,,both,,,638,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,39.46,,,39.46,Fee Schedule,,39.46,,,39.46,Fee Schedule,,39.46,,,39.46,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,67,,,67,Other,186% of Medicaid,228,,,228,Fee Schedule,,395.56,,,395.56,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,395.56,,,395.56,Fee Schedule,,201.92,,,201.92,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,446.6,
X-RAY EXAM OF FEMUR 1 LT,73551,CPT,TCLT,42173551,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,91.76,,,91.76,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,19.04,165.9,
X-RAY EXAM OF FEMUR 1 RT,73551,CPT,TCRT,42273551,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,91.76,,,91.76,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,19.04,165.9,
X-RAY EXAM OF FEMUR 1 BILATERAL,73551,CPT,TC50,42373551,CDM,320,RC,,,both,,,356,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,249.2,70,,249.2,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,220.72,,,220.72,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,220.72,,,220.72,Fee Schedule,,91.76,,,91.76,Fee Schedule,,249.2,70,,249.2,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,19.04,249.2,
X-RAY EXAM OF FEMUR 1 LT FY MOD,73551,CPT,FYLT,42773551,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,91.76,,,91.76,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,19.04,165.9,
X-RAY EXAM OF FEMUR 1 RT FY MOD,73551,CPT,FYRT,42873551,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,91.76,,,91.76,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,19.04,165.9,
X-RAY EXAM OF FEMUR 1 BILATERAL FY MOD,73551,CPT,FY50,42973551,CDM,320,RC,,,both,,,356,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,249.2,70,,249.2,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,220.72,,,220.72,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,220.72,,,220.72,Fee Schedule,,91.76,,,91.76,Fee Schedule,,249.2,70,,249.2,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,19.04,249.2,
X-RAY EXAM OF FEMUR 1 LT W/ FY MOD,73551,CPT,FYLT,43173551,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,91.76,,,91.76,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,19.04,165.9,
X-RAY EXAM OF FEMUR 1 RT W/ FY MOD,73551,CPT,FYRT,43273551,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,19.04,,,19.04,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,146.94,,,146.94,Fee Schedule,,91.76,,,91.76,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,19.04,165.9,
X-RAY EXAM OF FEMUR 2/> LT,73552,CPT,TCLT,42173552,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,93.75,,,93.75,Fee Schedule,,84.35,,,84.35,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,111.39,,,111.39,Fee Schedule,,67,,,67,Other,186% of Medicaid,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,61.72,,,,Fee Schedule,,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,116.09,,,116.09,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,22.84,165.9,
X-RAY EXAM OF FEMUR 2/> RT,73552,CPT,TCRT,42273552,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,93.75,,,93.75,Fee Schedule,,84.35,,,84.35,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,111.39,,,111.39,Fee Schedule,,67,,,67,Other,186% of Medicaid,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,61.72,,,,Fee Schedule,,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,116.09,,,116.09,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,22.84,165.9,
X-RAY EXAM OF FEMUR 2/> BILAT,73552,CPT,TC50,42373552,CDM,320,RC,,,both,,,356,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,93.75,,,93.75,Fee Schedule,,84.35,,,84.35,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,249.2,70,,249.2,percent of total billed charges,All Other,111.39,,,111.39,Fee Schedule,,67,,,67,Other,186% of Medicaid,131.08,,,131.08,Fee Schedule,,220.72,,,220.72,Fee Schedule,,61.72,,,,Fee Schedule,,131.08,,,131.08,Fee Schedule,,220.72,,,220.72,Fee Schedule,,116.09,,,116.09,Fee Schedule,,249.2,70,,249.2,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,22.84,249.2,
X-RAY EXAM OF FEMUR 2/> LT FY MOD,73552,CPT,FYLT,42773552,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,93.75,,,93.75,Fee Schedule,,84.35,,,84.35,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,111.39,,,111.39,Fee Schedule,,67,,,67,Other,186% of Medicaid,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,61.72,,,,Fee Schedule,,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,116.09,,,116.09,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,22.84,165.9,
X-RAY EXAM OF FEMUR 2/> RT FY MOD,73552,CPT,FYRT,42873552,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,93.75,,,93.75,Fee Schedule,,84.35,,,84.35,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,111.39,,,111.39,Fee Schedule,,67,,,67,Other,186% of Medicaid,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,61.72,,,,Fee Schedule,,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,116.09,,,116.09,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,22.84,165.9,
X-RAY EXAM OF FEMUR 2/> BILAT FY MOD,73552,CPT,FY50,42973552,CDM,320,RC,,,both,,,356,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,93.75,,,93.75,Fee Schedule,,84.35,,,84.35,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,249.2,70,,249.2,percent of total billed charges,All Other,111.39,,,111.39,Fee Schedule,,67,,,67,Other,186% of Medicaid,131.08,,,131.08,Fee Schedule,,220.72,,,220.72,Fee Schedule,,61.72,,,,Fee Schedule,,131.08,,,131.08,Fee Schedule,,220.72,,,220.72,Fee Schedule,,116.09,,,116.09,Fee Schedule,,249.2,70,,249.2,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,22.84,249.2,
X-RAY EXAM OF FEMUR 2/> LT W/ FY MOD,73552,CPT,FYLT,43173552,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,93.75,,,93.75,Fee Schedule,,84.35,,,84.35,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,111.39,,,111.39,Fee Schedule,,67,,,67,Other,186% of Medicaid,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,61.72,,,,Fee Schedule,,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,116.09,,,116.09,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,22.84,165.9,
X-RAY EXAM OF FEMUR 2/> RT W/ FY MOD,73552,CPT,FYRT,43273552,CDM,320,RC,,,both,,,237,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,93.75,,,93.75,Fee Schedule,,84.35,,,84.35,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,22.84,,,22.84,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,All Other,111.39,,,111.39,Fee Schedule,,67,,,67,Other,186% of Medicaid,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,61.72,,,,Fee Schedule,,131.08,,,131.08,Fee Schedule,,146.94,,,146.94,Fee Schedule,,116.09,,,116.09,Fee Schedule,,165.9,70,,165.9,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,22.84,165.9,
XR EXAM OF KNEE 1 OR 2 VIEW,73560,CPT,TC,42073560,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,113.21,,,113.21,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR KNEE 1 OR 2 VIEWS LT,73560,CPT,TCLT,42173560,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,113.21,,,113.21,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR KNEE 1 OR 2 VIEWS RT,73560,CPT,TCRT,42273560,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,113.21,,,113.21,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR KNEE 1 OR 2 VIEWS BILAT,73560,CPT,TC50,42373560,CDM,320,RC,,,both,,,611,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,378.82,,,378.82,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,378.82,,,378.82,Fee Schedule,,113.21,,,113.21,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,427.7,
XR EXAM OF KNEE 1 OR 2 VIEW W/ FY MOD,73560,CPT,FY,42673560,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,113.21,,,113.21,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR KNEE 1 OR 2 VIEWS LT FY MOD,73560,CPT,FYLT,42773560,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,113.21,,,113.21,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR KNEE 1 OR 2 VIEWS RT FY MOD,73560,CPT,FYRT,42873560,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,113.21,,,113.21,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR KNEE 1 OR 2 VIEWS BILAT FY MOD,73560,CPT,FY50,42973560,CDM,320,RC,,,both,,,611,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,378.82,,,378.82,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,378.82,,,378.82,Fee Schedule,,113.21,,,113.21,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,427.7,
XR KNEE 1 OR 2 VIEW W/ FY MOD,73560,CPT,FY,43073560,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,113.21,,,113.21,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR KNEE 1 OR 2 VIEWS LT W/ FY MOD,73560,CPT,FYLT,43173560,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,113.21,,,113.21,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR KNEE 1 OR 2 VIEWS RT W/ FY MOD,73560,CPT,FYRT,43273560,CDM,320,RC,,,both,,,407,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,252.34,,,252.34,Fee Schedule,,113.21,,,113.21,Fee Schedule,,284.9,70,,284.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,284.9,
XR KNEE 1 OR 2 VIEWS BILAT W/ FY MOD,73560,CPT,FY50,43373560,CDM,320,RC,,,both,,,611,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,378.82,,,378.82,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,378.82,,,378.82,Fee Schedule,,113.21,,,113.21,Fee Schedule,,427.7,70,,427.7,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,427.7,
XR KNEE 3 VIEWS LT,73562,CPT,TCLT,42173562,CDM,320,RC,,,both,,,445,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,137.54,,,137.54,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 3 VIEWS RT,73562,CPT,TCRT,42273562,CDM,320,RC,,,both,,,445,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,137.54,,,137.54,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 3 VIEWS BILAT,73562,CPT,TC50,42373562,CDM,320,RC,,,both,,,668,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,137.54,,,137.54,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,467.6,
XR KNEE 3 VIEWS LT FY MOD,73562,CPT,FYLT,42773562,CDM,320,RC,,,both,,,445,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,137.54,,,137.54,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 3 VIEWS RT FY MOD,73562,CPT,FYRT,42873562,CDM,320,RC,,,both,,,445,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,137.54,,,137.54,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 3 VIEWS BILAT FY MOD,73562,CPT,FY50,42973562,CDM,320,RC,,,both,,,668,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,137.54,,,137.54,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,467.6,
XR KNEE 3 VIEWS LT W/ FY MOD,73562,CPT,FYLT,43173562,CDM,320,RC,,,both,,,445,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,137.54,,,137.54,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 3 VIEWS RT W/ FY MOD,73562,CPT,FYRT,43273562,CDM,320,RC,,,both,,,445,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,137.54,,,137.54,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 3 VIEWS BILAT W/ FY MOD,73562,CPT,FY50,43373562,CDM,320,RC,,,both,,,668,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,137.54,,,137.54,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,467.6,
XR KNEE 4+ VIEWS LT,73564,CPT,TCLT,42173564,CDM,320,RC,,,both,,,445,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,126.1,,,126.1,Fee Schedule,,113.45,,,113.45,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,149.82,,,149.82,Fee Schedule,,67,,,67,Other,186% of Medicaid,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,83.01,,,,Fee Schedule,,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,156.14,,,156.14,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 4+ VIEWS RT,73564,CPT,TCRT,42273564,CDM,320,RC,,,both,,,445,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,126.1,,,126.1,Fee Schedule,,113.45,,,113.45,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,149.82,,,149.82,Fee Schedule,,67,,,67,Other,186% of Medicaid,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,83.01,,,,Fee Schedule,,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,156.14,,,156.14,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 4+ VIEWS BILAT,73564,CPT,TC50,42373564,CDM,320,RC,,,both,,,668,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,126.1,,,126.1,Fee Schedule,,113.45,,,113.45,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,All Other,149.82,,,149.82,Fee Schedule,,67,,,67,Other,186% of Medicaid,176.3,,,176.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,83.01,,,,Fee Schedule,,176.3,,,176.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,156.14,,,156.14,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,467.6,
XR KNEE 4+ VIEWS LT FY MOD,73564,CPT,FYLT,42773564,CDM,320,RC,,,both,,,445,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,126.1,,,126.1,Fee Schedule,,113.45,,,113.45,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,149.82,,,149.82,Fee Schedule,,67,,,67,Other,186% of Medicaid,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,83.01,,,,Fee Schedule,,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,156.14,,,156.14,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 4+ VIEWS RT FY MOD,73564,CPT,FYRT,42873564,CDM,320,RC,,,both,,,445,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,126.1,,,126.1,Fee Schedule,,113.45,,,113.45,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,149.82,,,149.82,Fee Schedule,,67,,,67,Other,186% of Medicaid,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,83.01,,,,Fee Schedule,,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,156.14,,,156.14,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 4+ VIEWS BILAT FY MOD,73564,CPT,FY50,42973564,CDM,320,RC,,,both,,,668,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,126.1,,,126.1,Fee Schedule,,113.45,,,113.45,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,All Other,149.82,,,149.82,Fee Schedule,,67,,,67,Other,186% of Medicaid,176.3,,,176.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,83.01,,,,Fee Schedule,,176.3,,,176.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,156.14,,,156.14,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,467.6,
XR KNEE 4+ VIEWS LT W/ FY MOD,73564,CPT,FYLT,43173564,CDM,320,RC,,,both,,,445,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,126.1,,,126.1,Fee Schedule,,113.45,,,113.45,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,149.82,,,149.82,Fee Schedule,,67,,,67,Other,186% of Medicaid,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,83.01,,,,Fee Schedule,,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,156.14,,,156.14,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 4+ VIEWS RT W/FY MOD,73564,CPT,FYRT,43273564,CDM,320,RC,,,both,,,445,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,126.1,,,126.1,Fee Schedule,,113.45,,,113.45,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,All Other,149.82,,,149.82,Fee Schedule,,67,,,67,Other,186% of Medicaid,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,83.01,,,,Fee Schedule,,176.3,,,176.3,Fee Schedule,,275.9,,,275.9,Fee Schedule,,156.14,,,156.14,Fee Schedule,,311.5,70,,311.5,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,311.5,
XR KNEE 4+ VIEWS BILAT W/ FY MOD,73564,CPT,FY50,43373564,CDM,320,RC,,,both,,,668,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,126.1,,,126.1,Fee Schedule,,113.45,,,113.45,Fee Schedule,,214.27,,,214.27,Fee Schedule,,192.76,,,192.76,Fee Schedule,,182.21,,,182.21,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,All Other,149.82,,,149.82,Fee Schedule,,67,,,67,Other,186% of Medicaid,176.3,,,176.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,83.01,,,,Fee Schedule,,176.3,,,176.3,Fee Schedule,,414.16,,,414.16,Fee Schedule,,156.14,,,156.14,Fee Schedule,,467.6,70,,467.6,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,467.6,
XR BOTH KNEES STANDING AP,73565,CPT,TC,42073565,CDM,320,RC,,,both,,,566,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,171.41,,,171.41,Fee Schedule,,154.21,,,154.21,Fee Schedule,,145.76,,,145.76,Fee Schedule,,396.2,70,,396.2,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,350.92,,,350.92,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,350.92,,,350.92,Fee Schedule,,137.54,,,137.54,Fee Schedule,,396.2,70,,396.2,percent of total billed charges,,157.44,,,157.44,Fee Schedule,,133.44,,,133.44,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,396.2,
XR BOTH KNEES STANDING AP W/ FY MOD,73565,CPT,FY,42673565,CDM,320,RC,,,both,,,566,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,171.41,,,171.41,Fee Schedule,,154.21,,,154.21,Fee Schedule,,145.76,,,145.76,Fee Schedule,,396.2,70,,396.2,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,350.92,,,350.92,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,350.92,,,350.92,Fee Schedule,,137.54,,,137.54,Fee Schedule,,396.2,70,,396.2,percent of total billed charges,,157.44,,,157.44,Fee Schedule,,133.44,,,133.44,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,396.2,
XR BOTH KNEES STANDING AP W/ FY MOD,73565,CPT,FY,43073565,CDM,320,RC,,,both,,,566,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,111.08,,,111.08,Fee Schedule,,99.93,,,99.93,Fee Schedule,,171.41,,,171.41,Fee Schedule,,154.21,,,154.21,Fee Schedule,,145.76,,,145.76,Fee Schedule,,396.2,70,,396.2,percent of total billed charges,All Other,131.97,,,131.97,Fee Schedule,,67,,,67,Other,186% of Medicaid,155.3,,,155.3,Fee Schedule,,350.92,,,350.92,Fee Schedule,,73.12,,,,Fee Schedule,,155.3,,,155.3,Fee Schedule,,350.92,,,350.92,Fee Schedule,,137.54,,,137.54,Fee Schedule,,396.2,70,,396.2,percent of total billed charges,,157.44,,,157.44,Fee Schedule,,133.44,,,133.44,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,396.2,
XR EXAM OF LOWER LEG 2 VIEW,73590,CPT,TC,42073590,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,103.21,,,103.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR TIBIA/FIBULA 2 VIEWS LT,73590,CPT,TCLT,42173590,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,103.21,,,103.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR TIBIA/FIBULA 2 VIEWS RT,73590,CPT,TCRT,42273590,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,103.21,,,103.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR TIBIA/FIBULA 2 VIEWS BIL,73590,CPT,TC50,42373590,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,347.2,,,347.2,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,347.2,,,347.2,Fee Schedule,,103.21,,,103.21,Fee Schedule,,392,70,,392,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR EXAM OF LOWER LEG 2 VIEW W/ FY MOD,73590,CPT,FY,42673590,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,103.21,,,103.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR TIBIA/FIBULA 2 VIEWS LT FY MOD,73590,CPT,FYLT,42773590,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,103.21,,,103.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR TIBIA/FIBULA 2 VIEWS RT FY MOD,73590,CPT,FYRT,42873590,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,103.21,,,103.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR TIBIA/FIBULA 2 VIEWS BIL FY MOD,73590,CPT,FY50,42973590,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,347.2,,,347.2,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,347.2,,,347.2,Fee Schedule,,103.21,,,103.21,Fee Schedule,,392,70,,392,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR TIBIA/FIBULA 2 VIEWS LT W/ FY MOD,73590,CPT,FYLT,43173590,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,103.21,,,103.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR TIBIA/FIBULA 2 VIEWS RT W/ FY MOD,73590,CPT,FYRT,43273590,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,231.26,,,231.26,Fee Schedule,,103.21,,,103.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR TIBIA/FIBULA 2 VIEWS BIL W/ FY MOD,73590,CPT,FY50,43373590,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,347.2,,,347.2,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,347.2,,,347.2,Fee Schedule,,103.21,,,103.21,Fee Schedule,,392,70,,392,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR EXAM OF LEG INFANT 2 VIE,73592,CPT,TC,42073592,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,103.21,,,103.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR LEG INFANT 2 VIEWS LT,73592,CPT,TCLT,42173592,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,103.21,,,103.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR LEG INFANT 2 VIEWS RT,73592,CPT,TCRT,42273592,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,103.21,,,103.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR LEG INFANT 2 VIEWS BILAT,73592,CPT,TC50,42373592,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,215.14,,,215.14,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,215.14,,,215.14,Fee Schedule,,103.21,,,103.21,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR EXAM OF LEG INFANT 2 VIE W/ FY MOD,73592,CPT,FY,42673592,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,103.21,,,103.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR LEG INFANT 2 VIEWS LT FY MOD,73592,CPT,FYLT,42773592,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,103.21,,,103.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR LEG INFANT 2 VIEWS RT FY MOD,73592,CPT,FYRT,42873592,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,103.21,,,103.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR LEG INFANT 2 VIEWS BILAT FY MOD,73592,CPT,FY50,42973592,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,215.14,,,215.14,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,215.14,,,215.14,Fee Schedule,,103.21,,,103.21,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR EXAM OF LEG INFANT 2 VIEWS W/ FY MOD,73592,CPT,FY,43073592,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,83.35,,,83.35,Fee Schedule,,74.99,,,74.99,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,99.03,,,99.03,Fee Schedule,,67,,,67,Other,186% of Medicaid,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,54.87,,,,Fee Schedule,,116.54,,,116.54,Fee Schedule,,143.22,,,143.22,Fee Schedule,,103.21,,,103.21,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR EXAM OF ANKLE 2 VIEWS,73600,CPT,TC,42073600,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,106.06,,,106.06,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ANKLE 2 VIEWS LT,73600,CPT,TCLT,42173600,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,106.06,,,106.06,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ANKLE 2 VIEWS RT,73600,CPT,TCRT,42273600,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,106.06,,,106.06,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ANKLE 2 V BILAT,73600,CPT,TC50,42373600,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,215.14,,,215.14,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,215.14,,,215.14,Fee Schedule,,106.06,,,106.06,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR EXAM OF ANKLE 2 VIEWS W/ FY MOD,73600,CPT,FY,42673600,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,106.06,,,106.06,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ANKLE 2 VIEWS LT FY MOD,73600,CPT,FYLT,42773600,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,106.06,,,106.06,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ANKLE 2 VIEWS RT FY MOD,73600,CPT,FYRT,42873600,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,106.06,,,106.06,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ANKLE 2 V BILAT FY MOD,73600,CPT,FY50,42973600,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,215.14,,,215.14,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,215.14,,,215.14,Fee Schedule,,106.06,,,106.06,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR ANKLE 2 VIEWS LT W/ FY MOD,73600,CPT,FYLT,43173600,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,106.06,,,106.06,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ANKLE 2 VIEWS RT W/ FY MOD,73600,CPT,FYRT,43273600,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,143.22,,,143.22,Fee Schedule,,106.06,,,106.06,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR ANKLE 2 V BILAT W/ FY MOD,73600,CPT,FY50,43373600,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,142.86,,,142.86,Fee Schedule,,128.53,,,128.53,Fee Schedule,,121.49,,,121.49,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,67,,,67,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,215.14,,,215.14,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,215.14,,,215.14,Fee Schedule,,106.06,,,106.06,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR ANKLE 3+ VIEWS LT,73610,CPT,TCLT,42173610,CDM,320,RC,,,both,,,348,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,67,,,67,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,121.82,,,121.82,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,243.6,
XR ANKLE 3+ VIEWS RT,73610,CPT,TCRT,42273610,CDM,320,RC,,,both,,,348,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,67,,,67,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,121.82,,,121.82,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,243.6,
XR ANKLE 3+ VIEWS BILAT,73610,CPT,TC50,42373610,CDM,320,RC,,,both,,,522,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,365.4,70,,365.4,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,67,,,67,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,323.64,,,323.64,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,323.64,,,323.64,Fee Schedule,,121.82,,,121.82,Fee Schedule,,365.4,70,,365.4,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,365.4,
XR ANKLE 3+ VIEWS LT FY MOD,73610,CPT,FYLT,42773610,CDM,320,RC,,,both,,,348,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,67,,,67,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,121.82,,,121.82,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,243.6,
XR ANKLE 3+ VIEWS RT FY MOD,73610,CPT,FYRT,42873610,CDM,320,RC,,,both,,,348,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,67,,,67,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,121.82,,,121.82,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,243.6,
XR ANKLE 3+ VIEWS BILAT FY MOD,73610,CPT,FY50,42973610,CDM,320,RC,,,both,,,522,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,365.4,70,,365.4,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,67,,,67,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,323.64,,,323.64,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,323.64,,,323.64,Fee Schedule,,121.82,,,121.82,Fee Schedule,,365.4,70,,365.4,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,365.4,
XR ANKLE 3+ VIEWS LT W/ FY MOD,73610,CPT,FYLT,43173610,CDM,320,RC,,,both,,,348,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,67,,,67,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,121.82,,,121.82,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,243.6,
XR ANKLE 3+ VIEWS RT W/ FY MOD,73610,CPT,FYRT,43273610,CDM,320,RC,,,both,,,348,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,67,,,67,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,215.76,,,215.76,Fee Schedule,,121.82,,,121.82,Fee Schedule,,243.6,70,,243.6,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,243.6,
XR ANKLE 3+ VIEWS BILAT W/ FY MOD,73610,CPT,FY50,43373610,CDM,320,RC,,,both,,,522,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,169.06,,,169.06,Fee Schedule,,152.09,,,152.09,Fee Schedule,,143.76,,,143.76,Fee Schedule,,365.4,70,,365.4,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,67,,,67,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,323.64,,,323.64,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,323.64,,,323.64,Fee Schedule,,121.82,,,121.82,Fee Schedule,,365.4,70,,365.4,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,365.4,
XR EXAM OF FOOT; 2 VIEWS,73620,CPT,TC,42073620,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR FOOT 2 VIEWS LT,73620,CPT,TCLT,42173620,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR FOOT 2 VIEWS RT,73620,CPT,TCRT,42273620,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR FOOT 2 V BILAT,73620,CPT,TC50,42373620,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,215.14,,,215.14,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,215.14,,,215.14,Fee Schedule,,91.76,,,91.76,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR EXAM OF FOOT 2 VIEWS W/ FY MOD,73620,CPT,FY,42673620,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR FOOT 2 VIEWS LT FY MOD,73620,CPT,FYLT,42773620,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR FOOT 2 VIEWS RT FY MOD,73620,CPT,FYRT,42873620,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR FOOT 2 V BILAT FY MOD,73620,CPT,FY50,42973620,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,215.14,,,215.14,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,215.14,,,215.14,Fee Schedule,,91.76,,,91.76,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR FOOT 2 VIEWS LT W/ FY MOD,73620,CPT,FYLT,43173620,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR FOOT 2 VIEWS RT W/ FY MOD,73620,CPT,FYRT,43273620,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,143.22,,,143.22,Fee Schedule,,91.76,,,91.76,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR FOOT 2 V BILAT W/ FY MOD,73620,CPT,FY50,43373620,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,67,,,67,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,215.14,,,215.14,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,215.14,,,215.14,Fee Schedule,,91.76,,,91.76,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR EXAM OF FOOT; 3+ VIEWS,73630,CPT,TC,42073630,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,113.21,,,113.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR FOOT 3+ VIEWS LT,73630,CPT,TCLT,42173630,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,113.21,,,113.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR FOOT 3+ VIEWS RT,73630,CPT,TCRT,42273630,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,113.21,,,113.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR FOOT 3+ VIEWS BILAT,73630,CPT,TC50,42373630,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,347.2,,,347.2,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,347.2,,,347.2,Fee Schedule,,113.21,,,113.21,Fee Schedule,,392,70,,392,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR EXAM OF FOOT 3+ VIEWS W/ FY MOD,73630,CPT,FY,42673630,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,113.21,,,113.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR FOOT 3+ VIEWS LT FY MOD,73630,CPT,FYLT,42773630,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,113.21,,,113.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR FOOT 3+ VIEWS RT FY MOD,73630,CPT,FYRT,42873630,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,113.21,,,113.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR FOOT 3+ VIEWS BILAT FY MOD,73630,CPT,FY50,42973630,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,347.2,,,347.2,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,347.2,,,347.2,Fee Schedule,,113.21,,,113.21,Fee Schedule,,392,70,,392,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR FOOT 3+ VIEWS LT W/ FY MOD,73630,CPT,FYLT,43173630,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,113.21,,,113.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR FOOT 3+ VIEWS RT W/ FY MOD,73630,CPT,FYRT,43273630,CDM,320,RC,,,both,,,373,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,231.26,,,231.26,Fee Schedule,,113.21,,,113.21,Fee Schedule,,261.1,70,,261.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,261.1,
XR FOOT 3+ VIEWS BILAT W/ FY MOD,73630,CPT,FY50,43373630,CDM,320,RC,,,both,,,560,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,164.29,,,164.29,Fee Schedule,,147.8,,,147.8,Fee Schedule,,139.71,,,139.71,Fee Schedule,,392,70,,392,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,67,,,67,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,347.2,,,347.2,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,347.2,,,347.2,Fee Schedule,,113.21,,,113.21,Fee Schedule,,392,70,,392,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,392,
XR HEEL 2+ VIEWS LT,73650,CPT,TCLT,42173650,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,90.34,,,90.34,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR HEEL 2+ VIEWS RT,73650,CPT,TCRT,42273650,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,90.34,,,90.34,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR HEEL 2+ VIEWS BILAT,73650,CPT,TC50,42373650,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,215.14,,,215.14,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,215.14,,,215.14,Fee Schedule,,90.34,,,90.34,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR HEEL 2+ VIEWS LT FY MOD,73650,CPT,FYLT,42773650,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,90.34,,,90.34,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR HEEL 2+ VIEWS RT FY MOD,73650,CPT,FYRT,42873650,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,90.34,,,90.34,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR HEEL 2+ VIEWS BILAT FY MOD,73650,CPT,FY50,42973650,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,215.14,,,215.14,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,215.14,,,215.14,Fee Schedule,,90.34,,,90.34,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR HEEL 2+ VIEWS LT W/ FY MOD,73650,CPT,FYLT,43173650,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,90.34,,,90.34,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR HEEL 2+ VIEWS RT W/ FY MOD,73650,CPT,FYRT,43273650,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,90.34,,,90.34,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR HEEL 2+ VIEWS BILAT W/ FY MOD,73650,CPT,FY50,43373650,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,140.51,,,140.51,Fee Schedule,,126.41,,,126.41,Fee Schedule,,119.48,,,119.48,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,215.14,,,215.14,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,215.14,,,215.14,Fee Schedule,,90.34,,,90.34,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR TOE(S) 2+ VIEWS LT,73660,CPT,TCLT,42173660,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,79.88,,,79.88,Fee Schedule,,71.86,,,71.86,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,94.9,,,94.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,52.58,,,,Fee Schedule,,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,98.91,,,98.91,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR TOE(S) 2+ VIEWS RT,73660,CPT,TCRT,42273660,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,79.88,,,79.88,Fee Schedule,,71.86,,,71.86,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,94.9,,,94.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,52.58,,,,Fee Schedule,,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,98.91,,,98.91,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR TOE(S) 2+ VIEWS  BILAT,73660,CPT,TC50,42373660,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,79.88,,,79.88,Fee Schedule,,71.86,,,71.86,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,94.9,,,94.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,111.68,,,111.68,Fee Schedule,,215.14,,,215.14,Fee Schedule,,52.58,,,,Fee Schedule,,111.68,,,111.68,Fee Schedule,,215.14,,,215.14,Fee Schedule,,98.91,,,98.91,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR TOE(S) 2+ VIEWS LT FY MOD,73660,CPT,FYLT,42773660,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,79.88,,,79.88,Fee Schedule,,71.86,,,71.86,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,94.9,,,94.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,52.58,,,,Fee Schedule,,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,98.91,,,98.91,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR TOE(S) 2+ VIEWS RT FY MOD,73660,CPT,FYRT,42873660,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,79.88,,,79.88,Fee Schedule,,71.86,,,71.86,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,94.9,,,94.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,52.58,,,,Fee Schedule,,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,98.91,,,98.91,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR TOE(S) 2+ VIEWS  BILAT FY MOD,73660,CPT,FY50,42973660,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,79.88,,,79.88,Fee Schedule,,71.86,,,71.86,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,94.9,,,94.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,111.68,,,111.68,Fee Schedule,,215.14,,,215.14,Fee Schedule,,52.58,,,,Fee Schedule,,111.68,,,111.68,Fee Schedule,,215.14,,,215.14,Fee Schedule,,98.91,,,98.91,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
XR TOE(S) 2+ VIEWS LT W/ FY MOD,73660,CPT,FYLT,43173660,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,79.88,,,79.88,Fee Schedule,,71.86,,,71.86,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,94.9,,,94.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,52.58,,,,Fee Schedule,,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,98.91,,,98.91,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR TOE(S) 2+ VIEWS RT W/ FY MOD,73660,CPT,FYRT,43273660,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,79.88,,,79.88,Fee Schedule,,71.86,,,71.86,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,94.9,,,94.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,52.58,,,,Fee Schedule,,111.68,,,111.68,Fee Schedule,,143.22,,,143.22,Fee Schedule,,98.91,,,98.91,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
XR TOE(S) 2+ VIEWS  BILAT W/ FY MOD,73660,CPT,FY50,43373660,CDM,320,RC,,,both,,,347,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,79.88,,,79.88,Fee Schedule,,71.86,,,71.86,Fee Schedule,,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,All Other,94.9,,,94.9,Fee Schedule,,67,,,67,Other,186% of Medicaid,111.68,,,111.68,Fee Schedule,,215.14,,,215.14,Fee Schedule,,52.58,,,,Fee Schedule,,111.68,,,111.68,Fee Schedule,,215.14,,,215.14,Fee Schedule,,98.91,,,98.91,Fee Schedule,,242.9,70,,242.9,percent of total billed charges,,111.52,,,111.52,Fee Schedule,,94.52,,,94.52,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,242.9,
X-RAY EXAM ABDOMEN 1 VIEW,74018,CPT,TC,42074018,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,17.12,,,17.12,Fee Schedule,,17.12,,,17.12,Fee Schedule,,17.12,,,17.12,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,270.94,,,270.94,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,270.94,,,270.94,Fee Schedule,,93.18,,,93.18,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,17.12,305.9,
X-RAY EXAM ABDOMEN 1 VIEW W/ FY MOD,74018,CPT,FY,42674018,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,17.12,,,17.12,Fee Schedule,,17.12,,,17.12,Fee Schedule,,17.12,,,17.12,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,270.94,,,270.94,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,270.94,,,270.94,Fee Schedule,,93.18,,,93.18,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,17.12,305.9,
X-RAY EXAM ABDOMEN 1 VIEW W/ FY MOD,74018,CPT,FY,43074018,CDM,320,RC,,,both,,,437,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,75.25,,,75.25,Fee Schedule,,67.7,,,67.7,Fee Schedule,,17.12,,,17.12,Fee Schedule,,17.12,,,17.12,Fee Schedule,,17.12,,,17.12,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,89.41,,,89.41,Fee Schedule,,67,,,67,Other,186% of Medicaid,105.21,,,105.21,Fee Schedule,,270.94,,,270.94,Fee Schedule,,49.54,,,,Fee Schedule,,105.21,,,105.21,Fee Schedule,,270.94,,,270.94,Fee Schedule,,93.18,,,93.18,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,17.12,305.9,
X-RAY EXAM ABDOMEN 2 VIEWS,74019,CPT,TC,42074019,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,20.47,,,20.47,Fee Schedule,,20.47,,,20.47,Fee Schedule,,20.47,,,20.47,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,150.04,,,150.04,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,150.04,,,150.04,Fee Schedule,,111.79,,,111.79,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,20.47,198.66,
X-RAY EXAM ABDOMEN 2 VIEWS W/ FY MOD,74019,CPT,FY,42674019,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,20.47,,,20.47,Fee Schedule,,20.47,,,20.47,Fee Schedule,,20.47,,,20.47,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,150.04,,,150.04,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,150.04,,,150.04,Fee Schedule,,111.79,,,111.79,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,20.47,198.66,
X-RAY EXAM ABDOMEN 2 VIEWS W/ FY MOD,74019,CPT,FY,43074019,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,90.28,,,90.28,Fee Schedule,,81.22,,,81.22,Fee Schedule,,20.47,,,20.47,Fee Schedule,,20.47,,,20.47,Fee Schedule,,20.47,,,20.47,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,107.26,,,107.26,Fee Schedule,,67,,,67,Other,186% of Medicaid,126.22,,,126.22,Fee Schedule,,150.04,,,150.04,Fee Schedule,,59.43,,,,Fee Schedule,,126.22,,,126.22,Fee Schedule,,150.04,,,150.04,Fee Schedule,,111.79,,,111.79,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,20.47,198.66,
X-RAY ABDOMEN 3+ VIEWS,74021,CPT,,42074021,CDM,320,RC,,,both,,,408,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,23.83,,,23.83,Fee Schedule,,23.83,,,23.83,Fee Schedule,,23.83,,,23.83,Fee Schedule,,285.6,70,,285.6,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,252.96,,,252.96,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,252.96,,,252.96,Fee Schedule,,130.39,,,130.39,Fee Schedule,,285.6,70,,285.6,percent of total billed charges,,149.24,,,149.24,Fee Schedule,,126.49,,,126.49,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,23.83,285.6,
X-RAY ABDOMEN 3+ VIEWS W FY MOD,74021,CPT,FY,42674021,CDM,320,RC,,,both,,,408,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,23.83,,,23.83,Fee Schedule,,23.83,,,23.83,Fee Schedule,,23.83,,,23.83,Fee Schedule,,285.6,70,,285.6,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,252.96,,,252.96,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,252.96,,,252.96,Fee Schedule,,130.39,,,130.39,Fee Schedule,,285.6,70,,285.6,percent of total billed charges,,149.24,,,149.24,Fee Schedule,,126.49,,,126.49,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,23.83,285.6,
X-RAY ABDOMEN 3+ VIEWS W/ FY MOD,74021,CPT,FY,43074021,CDM,320,RC,,,both,,,408,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,23.83,,,23.83,Fee Schedule,,23.83,,,23.83,Fee Schedule,,23.83,,,23.83,Fee Schedule,,285.6,70,,285.6,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,67,,,67,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,252.96,,,252.96,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,252.96,,,252.96,Fee Schedule,,130.39,,,130.39,Fee Schedule,,285.6,70,,285.6,percent of total billed charges,,149.24,,,149.24,Fee Schedule,,126.49,,,126.49,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,23.83,285.6,
XR PHARYNX/CERVICAL ESOPH,74210,CPT,TC,42074210,CDM,320,RC,,,both,,,494,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,233.54,,,233.54,Fee Schedule,,210.11,,,210.11,Fee Schedule,,428.43,,,428.43,Fee Schedule,,385.43,,,385.43,Fee Schedule,,364.32,,,364.32,Fee Schedule,,345.8,70,,345.8,percent of total billed charges,All Other,277.47,,,277.47,Fee Schedule,,67,,,67,Other,186% of Medicaid,326.52,,,326.52,Fee Schedule,,306.28,,,306.28,Fee Schedule,,153.74,,,,Fee Schedule,,326.52,,,326.52,Fee Schedule,,306.28,,,306.28,Fee Schedule,,289.18,,,289.18,Fee Schedule,,345.8,70,,345.8,percent of total billed charges,,350.96,,,350.96,Fee Schedule,,297.46,,,297.46,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,428.43,
XR PHARYNX/CERVICAL ESOPH W/ FY MOD,74210,CPT,FY,42674210,CDM,320,RC,,,both,,,494,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,233.54,,,233.54,Fee Schedule,,210.11,,,210.11,Fee Schedule,,428.43,,,428.43,Fee Schedule,,385.43,,,385.43,Fee Schedule,,364.32,,,364.32,Fee Schedule,,345.8,70,,345.8,percent of total billed charges,All Other,277.47,,,277.47,Fee Schedule,,67,,,67,Other,186% of Medicaid,326.52,,,326.52,Fee Schedule,,306.28,,,306.28,Fee Schedule,,153.74,,,,Fee Schedule,,326.52,,,326.52,Fee Schedule,,306.28,,,306.28,Fee Schedule,,289.18,,,289.18,Fee Schedule,,345.8,70,,345.8,percent of total billed charges,,350.96,,,350.96,Fee Schedule,,297.46,,,297.46,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,428.43,
XR ESOPHAGUS,74220,CPT,TC,42074220,CDM,320,RC,,,both,,,864,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,240.46,,,240.46,Fee Schedule,,216.34,,,216.34,Fee Schedule,,473.64,,,473.64,Fee Schedule,,426.1,,,426.1,Fee Schedule,,402.76,,,402.76,Fee Schedule,,604.8,70,,604.8,percent of total billed charges,All Other,285.69,,,285.69,Fee Schedule,,67,,,67,Other,186% of Medicaid,336.19,,,336.19,Fee Schedule,,535.68,,,535.68,Fee Schedule,,158.3,,,,Fee Schedule,,336.19,,,336.19,Fee Schedule,,535.68,,,535.68,Fee Schedule,,297.75,,,297.75,Fee Schedule,,604.8,70,,604.8,percent of total billed charges,,354.24,,,354.24,Fee Schedule,,300.24,,,300.24,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,604.8,
XR ESOPHAGUS W/ FY MOD,74220,CPT,FY,42674220,CDM,320,RC,,,both,,,864,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,240.46,,,240.46,Fee Schedule,,216.34,,,216.34,Fee Schedule,,473.64,,,473.64,Fee Schedule,,426.1,,,426.1,Fee Schedule,,402.76,,,402.76,Fee Schedule,,604.8,70,,604.8,percent of total billed charges,All Other,285.69,,,285.69,Fee Schedule,,67,,,67,Other,186% of Medicaid,336.19,,,336.19,Fee Schedule,,535.68,,,535.68,Fee Schedule,,158.3,,,,Fee Schedule,,336.19,,,336.19,Fee Schedule,,535.68,,,535.68,Fee Schedule,,297.75,,,297.75,Fee Schedule,,604.8,70,,604.8,percent of total billed charges,,354.24,,,354.24,Fee Schedule,,300.24,,,300.24,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,604.8,
X-RAY XM ESOPHAGUS 2CNTRST,74221,CPT,,42074221,CDM,320,RC,,,both,,,626,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,267.03,,,267.03,Fee Schedule,,240.25,,,240.25,Fee Schedule,,72.9,,,72.9,Fee Schedule,,72.9,,,72.9,Fee Schedule,,72.9,,,72.9,Fee Schedule,,438.2,70,,438.2,percent of total billed charges,All Other,317.26,,,317.26,Fee Schedule,,406,,,406,Other,186% of Medicaid,373.35,,,373.35,Fee Schedule,,388.12,,,388.12,Fee Schedule,,175.79,,,,Fee Schedule,,373.35,,,373.35,Fee Schedule,,388.12,,,388.12,Fee Schedule,,330.65,,,330.65,Fee Schedule,,438.2,70,,438.2,percent of total billed charges,,393.6,,,393.6,Fee Schedule,,333.6,,,333.6,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,72.9,706.37,
SWALLOWING FUNCTION W/CINE -VI,74230,CPT,TC,42074230,CDM,320,RC,,,both,,,953,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,345.6,,,345.6,Fee Schedule,,310.94,,,310.94,Fee Schedule,,459.33,,,459.33,Fee Schedule,,413.23,,,413.23,Fee Schedule,,390.6,,,390.6,Fee Schedule,,667.1,70,,667.1,percent of total billed charges,All Other,410.61,,,410.61,Fee Schedule,,406,,,406,Other,186% of Medicaid,483.2,,,483.2,Fee Schedule,,590.86,,,590.86,Fee Schedule,,227.51,,,,Fee Schedule,,483.2,,,483.2,Fee Schedule,,590.86,,,590.86,Fee Schedule,,427.94,,,427.94,Fee Schedule,,667.1,70,,667.1,percent of total billed charges,,514.96,,,514.96,Fee Schedule,,436.46,,,436.46,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,706.37,
SWALLOWING FUNCTION W/CINE -VI W/ FY MOD,74230,CPT,FY,42674230,CDM,320,RC,,,both,,,953,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,345.6,,,345.6,Fee Schedule,,310.94,,,310.94,Fee Schedule,,459.33,,,459.33,Fee Schedule,,413.23,,,413.23,Fee Schedule,,390.6,,,390.6,Fee Schedule,,667.1,70,,667.1,percent of total billed charges,All Other,410.61,,,410.61,Fee Schedule,,406,,,406,Other,186% of Medicaid,483.2,,,483.2,Fee Schedule,,590.86,,,590.86,Fee Schedule,,227.51,,,,Fee Schedule,,483.2,,,483.2,Fee Schedule,,590.86,,,590.86,Fee Schedule,,427.94,,,427.94,Fee Schedule,,667.1,70,,667.1,percent of total billed charges,,514.96,,,514.96,Fee Schedule,,436.46,,,436.46,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,706.37,
XR UPPER GI TRACT WO KUB,74240,CPT,TC,42074240,CDM,320,RC,,,both,,,915,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,294.76,,,294.76,Fee Schedule,,265.19,,,265.19,Fee Schedule,,545.04,,,545.04,Fee Schedule,,490.34,,,490.34,Fee Schedule,,463.48,,,463.48,Fee Schedule,,640.5,70,,640.5,percent of total billed charges,All Other,350.2,,,350.2,Fee Schedule,,406,,,406,Other,186% of Medicaid,412.1,,,412.1,Fee Schedule,,567.3,,,567.3,Fee Schedule,,194.04,,,,Fee Schedule,,412.1,,,412.1,Fee Schedule,,567.3,,,567.3,Fee Schedule,,364.98,,,364.98,Fee Schedule,,640.5,70,,640.5,percent of total billed charges,,432.96,,,432.96,Fee Schedule,,366.96,,,366.96,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,194.04,706.37,
XR UPPER GI TRACT WO KUB W/ FY MOD,74240,CPT,FY,42674240,CDM,320,RC,,,both,,,915,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,294.76,,,294.76,Fee Schedule,,265.19,,,265.19,Fee Schedule,,545.04,,,545.04,Fee Schedule,,490.34,,,490.34,Fee Schedule,,463.48,,,463.48,Fee Schedule,,640.5,70,,640.5,percent of total billed charges,All Other,350.2,,,350.2,Fee Schedule,,406,,,406,Other,186% of Medicaid,412.1,,,412.1,Fee Schedule,,567.3,,,567.3,Fee Schedule,,194.04,,,,Fee Schedule,,412.1,,,412.1,Fee Schedule,,567.3,,,567.3,Fee Schedule,,364.98,,,364.98,Fee Schedule,,640.5,70,,640.5,percent of total billed charges,,432.96,,,432.96,Fee Schedule,,366.96,,,366.96,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,194.04,706.37,
XR UPPER GI W/AIR WO KUB,74246,CPT,TC,42074246,CDM,320,RC,,,both,,,763,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,336.35,,,336.35,Fee Schedule,,302.61,,,302.61,Fee Schedule,,606.91,,,606.91,Fee Schedule,,546,,,546,Fee Schedule,,516.1,,,516.1,Fee Schedule,,534.1,70,,534.1,percent of total billed charges,All Other,399.62,,,399.62,Fee Schedule,,406,,,406,Other,186% of Medicaid,470.26,,,470.26,Fee Schedule,,473.06,,,473.06,Fee Schedule,,221.42,,,,Fee Schedule,,470.26,,,470.26,Fee Schedule,,473.06,,,473.06,Fee Schedule,,416.49,,,416.49,Fee Schedule,,534.1,70,,534.1,percent of total billed charges,,498.56,,,498.56,Fee Schedule,,422.56,,,422.56,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,706.37,
XR UPPER GI W/AIR WO KUB W/ FY MOD,74246,CPT,FY,42674246,CDM,320,RC,,,both,,,763,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,336.35,,,336.35,Fee Schedule,,302.61,,,302.61,Fee Schedule,,606.91,,,606.91,Fee Schedule,,546,,,546,Fee Schedule,,516.1,,,516.1,Fee Schedule,,534.1,70,,534.1,percent of total billed charges,All Other,399.62,,,399.62,Fee Schedule,,406,,,406,Other,186% of Medicaid,470.26,,,470.26,Fee Schedule,,473.06,,,473.06,Fee Schedule,,221.42,,,,Fee Schedule,,470.26,,,470.26,Fee Schedule,,473.06,,,473.06,Fee Schedule,,416.49,,,416.49,Fee Schedule,,534.1,70,,534.1,percent of total billed charges,,498.56,,,498.56,Fee Schedule,,422.56,,,422.56,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,706.37,
X-RAY SM INT F-THRU STD,74248,CPT,,42074248,CDM,320,RC,,,both,,,135,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,172.29,,,172.29,Fee Schedule,,155.01,,,155.01,Fee Schedule,,46.62,,,46.62,Fee Schedule,,46.62,,,46.62,Fee Schedule,,46.62,,,46.62,Fee Schedule,,94.5,70,,94.5,percent of total billed charges,All Other,204.7,,,204.7,Fee Schedule,,406,,,406,Other,186% of Medicaid,240.88,,,240.88,Fee Schedule,,83.7,,,83.7,Fee Schedule,,113.42,,,,Fee Schedule,,240.88,,,240.88,Fee Schedule,,83.7,,,83.7,Fee Schedule,,213.34,,,213.34,Fee Schedule,,94.5,70,,94.5,percent of total billed charges,,254.2,,,254.2,Fee Schedule,,215.45,,,215.45,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,0.01,706.37,
XR SMALL BOWEL,74250,CPT,TC,42074250,CDM,320,RC,,,both,,,792,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,291.31,,,291.31,Fee Schedule,,262.09,,,262.09,Fee Schedule,,585.48,,,585.48,Fee Schedule,,526.72,,,526.72,Fee Schedule,,497.87,,,497.87,Fee Schedule,,554.4,70,,554.4,percent of total billed charges,All Other,346.1,,,346.1,Fee Schedule,,406,,,406,Other,186% of Medicaid,407.29,,,407.29,Fee Schedule,,491.04,,,491.04,Fee Schedule,,191.77,,,,Fee Schedule,,407.29,,,407.29,Fee Schedule,,491.04,,,491.04,Fee Schedule,,360.71,,,360.71,Fee Schedule,,554.4,70,,554.4,percent of total billed charges,,429.68,,,429.68,Fee Schedule,,364.18,,,364.18,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,191.77,706.37,
XR SMALL BOWEL W/ FY MOD,74250,CPT,FY,42674250,CDM,320,RC,,,both,,,792,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,291.31,,,291.31,Fee Schedule,,262.09,,,262.09,Fee Schedule,,585.48,,,585.48,Fee Schedule,,526.72,,,526.72,Fee Schedule,,497.87,,,497.87,Fee Schedule,,554.4,70,,554.4,percent of total billed charges,All Other,346.1,,,346.1,Fee Schedule,,406,,,406,Other,186% of Medicaid,407.29,,,407.29,Fee Schedule,,491.04,,,491.04,Fee Schedule,,191.77,,,,Fee Schedule,,407.29,,,407.29,Fee Schedule,,491.04,,,491.04,Fee Schedule,,360.71,,,360.71,Fee Schedule,,554.4,70,,554.4,percent of total billed charges,,429.68,,,429.68,Fee Schedule,,364.18,,,364.18,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,191.77,706.37,
XR SML BOWEL VIA ENTEROCLYS,74251,CPT,TC,42074251,CDM,320,RC,,,both,,,3420,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.22,,,618.22,Fee Schedule,,556.21,,,556.21,Fee Schedule,,992.26,,,992.26,Fee Schedule,,892.68,,,892.68,Fee Schedule,,843.79,,,843.79,Fee Schedule,,2394,70,,2394,percent of total billed charges,All Other,734.5,,,734.5,Fee Schedule,,406,,,406,Other,186% of Medicaid,864.35,,,864.35,Fee Schedule,,2120.4,,,2120.4,Fee Schedule,,406.98,,,,Fee Schedule,,864.35,,,864.35,Fee Schedule,,2120.4,,,2120.4,Fee Schedule,,765.51,,,765.51,Fee Schedule,,2394,70,,2394,percent of total billed charges,,1618.68,,,1618.68,Fee Schedule,,1371.93,,,1371.93,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,2394,
XR SML BOWEL VIA ENTEROCLYS W/ FY MOD,74251,CPT,FY,42674251,CDM,320,RC,,,both,,,3420,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.22,,,618.22,Fee Schedule,,556.21,,,556.21,Fee Schedule,,992.26,,,992.26,Fee Schedule,,892.68,,,892.68,Fee Schedule,,843.79,,,843.79,Fee Schedule,,2394,70,,2394,percent of total billed charges,All Other,734.5,,,734.5,Fee Schedule,,406,,,406,Other,186% of Medicaid,864.35,,,864.35,Fee Schedule,,2120.4,,,2120.4,Fee Schedule,,406.98,,,,Fee Schedule,,864.35,,,864.35,Fee Schedule,,2120.4,,,2120.4,Fee Schedule,,765.51,,,765.51,Fee Schedule,,2394,70,,2394,percent of total billed charges,,1618.68,,,1618.68,Fee Schedule,,1371.93,,,1371.93,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,2394,
XR COLON W CONTRAST,74270,CPT,TC,42074270,CDM,320,RC,,,both,,,1022,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,364.07,,,364.07,Fee Schedule,,327.55,,,327.55,Fee Schedule,,609.27,,,609.27,Fee Schedule,,548.12,,,548.12,Fee Schedule,,518.1,,,518.1,Fee Schedule,,715.4,70,,715.4,percent of total billed charges,All Other,432.55,,,432.55,Fee Schedule,,406,,,406,Other,186% of Medicaid,509.02,,,509.02,Fee Schedule,,633.64,,,633.64,Fee Schedule,,239.67,,,,Fee Schedule,,509.02,,,509.02,Fee Schedule,,633.64,,,633.64,Fee Schedule,,450.81,,,450.81,Fee Schedule,,715.4,70,,715.4,percent of total billed charges,,536.28,,,536.28,Fee Schedule,,454.53,,,454.53,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,715.4,
XR COLON W CONTRAST W/ FY MOD,74270,CPT,FY,42674270,CDM,320,RC,,,both,,,1022,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,364.07,,,364.07,Fee Schedule,,327.55,,,327.55,Fee Schedule,,609.27,,,609.27,Fee Schedule,,548.12,,,548.12,Fee Schedule,,518.1,,,518.1,Fee Schedule,,715.4,70,,715.4,percent of total billed charges,All Other,432.55,,,432.55,Fee Schedule,,406,,,406,Other,186% of Medicaid,509.02,,,509.02,Fee Schedule,,633.64,,,633.64,Fee Schedule,,239.67,,,,Fee Schedule,,509.02,,,509.02,Fee Schedule,,633.64,,,633.64,Fee Schedule,,450.81,,,450.81,Fee Schedule,,715.4,70,,715.4,percent of total billed charges,,536.28,,,536.28,Fee Schedule,,454.53,,,454.53,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,715.4,
THERAP BE/AIR FOR OBSTRUCT,74283,CPT,TC,42074283,CDM,320,RC,,,both,,,934,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,541.98,,,541.98,Fee Schedule,,487.61,,,487.61,Fee Schedule,,606.91,,,606.91,Fee Schedule,,546,,,546,Fee Schedule,,516.1,,,516.1,Fee Schedule,,653.8,70,,653.8,percent of total billed charges,All Other,643.92,,,643.92,Fee Schedule,,406,,,406,Other,186% of Medicaid,757.75,,,757.75,Fee Schedule,,579.08,,,579.08,Fee Schedule,,356.79,,,,Fee Schedule,,757.75,,,757.75,Fee Schedule,,579.08,,,579.08,Fee Schedule,,671.11,,,671.11,Fee Schedule,,653.8,70,,653.8,percent of total billed charges,,795.4,,,795.4,Fee Schedule,,674.15,,,674.15,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,795.4,
THERAP BE/AIR FOR OBSTRUCT W/ FY MOD,74283,CPT,FY,42674283,CDM,320,RC,,,both,,,934,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,541.98,,,541.98,Fee Schedule,,487.61,,,487.61,Fee Schedule,,606.91,,,606.91,Fee Schedule,,546,,,546,Fee Schedule,,516.1,,,516.1,Fee Schedule,,653.8,70,,653.8,percent of total billed charges,All Other,643.92,,,643.92,Fee Schedule,,406,,,406,Other,186% of Medicaid,757.75,,,757.75,Fee Schedule,,579.08,,,579.08,Fee Schedule,,356.79,,,,Fee Schedule,,757.75,,,757.75,Fee Schedule,,579.08,,,579.08,Fee Schedule,,671.11,,,671.11,Fee Schedule,,653.8,70,,653.8,percent of total billed charges,,795.4,,,795.4,Fee Schedule,,674.15,,,674.15,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,795.4,
THERAP BE/AIR FOR OBSTRUCT W/ FY MOD,74283,CPT,FY,43074283,CDM,320,RC,,,both,,,934,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,541.98,,,541.98,Fee Schedule,,487.61,,,487.61,Fee Schedule,,606.91,,,606.91,Fee Schedule,,546,,,546,Fee Schedule,,516.1,,,516.1,Fee Schedule,,653.8,70,,653.8,percent of total billed charges,All Other,643.92,,,643.92,Fee Schedule,,406,,,406,Other,186% of Medicaid,757.75,,,757.75,Fee Schedule,,579.08,,,579.08,Fee Schedule,,356.79,,,,Fee Schedule,,757.75,,,757.75,Fee Schedule,,579.08,,,579.08,Fee Schedule,,671.11,,,671.11,Fee Schedule,,653.8,70,,653.8,percent of total billed charges,,795.4,,,795.4,Fee Schedule,,674.15,,,674.15,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,795.4,
ORAL GALLBLADDER STUDY,74290,CPT,TC,42074290,CDM,320,RC,,,both,,,615,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,242.79,,,242.79,Fee Schedule,,218.44,,,218.44,Fee Schedule,,371.32,,,371.32,Fee Schedule,,334.06,,,334.06,Fee Schedule,,315.76,,,315.76,Fee Schedule,,430.5,70,,430.5,percent of total billed charges,All Other,288.46,,,288.46,Fee Schedule,,406,,,406,Other,186% of Medicaid,339.45,,,339.45,Fee Schedule,,381.3,,,381.3,Fee Schedule,,159.83,,,,Fee Schedule,,339.45,,,339.45,Fee Schedule,,381.3,,,381.3,Fee Schedule,,300.63,,,300.63,Fee Schedule,,430.5,70,,430.5,percent of total billed charges,,360.8,,,360.8,Fee Schedule,,305.8,,,305.8,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,159.83,706.37,
ORAL GALLBLADDER STUDY W/ FY MOD,74290,CPT,FY,42674290,CDM,320,RC,,,both,,,615,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,242.79,,,242.79,Fee Schedule,,218.44,,,218.44,Fee Schedule,,371.32,,,371.32,Fee Schedule,,334.06,,,334.06,Fee Schedule,,315.76,,,315.76,Fee Schedule,,430.5,70,,430.5,percent of total billed charges,All Other,288.46,,,288.46,Fee Schedule,,406,,,406,Other,186% of Medicaid,339.45,,,339.45,Fee Schedule,,381.3,,,381.3,Fee Schedule,,159.83,,,,Fee Schedule,,339.45,,,339.45,Fee Schedule,,381.3,,,381.3,Fee Schedule,,300.63,,,300.63,Fee Schedule,,430.5,70,,430.5,percent of total billed charges,,360.8,,,360.8,Fee Schedule,,305.8,,,305.8,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,159.83,706.37,
CHOLANGIOGRAM INTRAOP,74300,CPT,TC,42074300,CDM,320,RC,,,both,,,1428,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,928.2,65,,928.2,percent of total billed charges,All Other,842.52,59,,842.52,percent of total billed charges,All Other,33.47,,,33.47,Fee Schedule,,33.47,,,33.47,Fee Schedule,,33.47,,,33.47,Fee Schedule,,999.6,70,,999.6,percent of total billed charges,All Other,971.04,68,,971.04,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,1142.4,80,,1142.4,percent of total billed charges,All Other,1185.24,83,,1185.24,percent of total billed charges,All Other,1185.24,83,,,percent of total billed charges,All Other,1142.4,80,,1142.4,percent of total billed charges,All Other,1185.24,83,,1185.24,percent of total billed charges,All Other,1142.4,80,,1142.4,percent of total billed charges,All Other,999.6,70,,999.6,percent of total billed charges,,928.2,65,,928.2,percent of total billed charges,All Other,928.2,65,,928.2,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1185.24,
CHOLANGIOGRAM INTRAOP W/ FY MOD,74300,CPT,FY,42674300,CDM,320,RC,,,both,,,1428,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,928.2,65,,928.2,percent of total billed charges,All Other,842.52,59,,842.52,percent of total billed charges,All Other,33.47,,,33.47,Fee Schedule,,33.47,,,33.47,Fee Schedule,,33.47,,,33.47,Fee Schedule,,999.6,70,,999.6,percent of total billed charges,All Other,971.04,68,,971.04,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,1142.4,80,,1142.4,percent of total billed charges,All Other,1185.24,83,,1185.24,percent of total billed charges,All Other,1185.24,83,,,percent of total billed charges,All Other,1142.4,80,,1142.4,percent of total billed charges,All Other,1185.24,83,,1185.24,percent of total billed charges,All Other,1142.4,80,,1142.4,percent of total billed charges,All Other,999.6,70,,999.6,percent of total billed charges,,928.2,65,,928.2,percent of total billed charges,All Other,928.2,65,,928.2,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1185.24,
CHOLANGIOGRAM INTRAOP,74300,CPT,TC,47074300,CDM,320,RC,,,both,,,1428,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,928.2,65,,928.2,percent of total billed charges,All Other,842.52,59,,842.52,percent of total billed charges,All Other,33.47,,,33.47,Fee Schedule,,33.47,,,33.47,Fee Schedule,,33.47,,,33.47,Fee Schedule,,999.6,70,,999.6,percent of total billed charges,All Other,971.04,68,,971.04,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,1142.4,80,,1142.4,percent of total billed charges,All Other,1185.24,83,,1185.24,percent of total billed charges,All Other,1185.24,83,,,percent of total billed charges,All Other,1142.4,80,,1142.4,percent of total billed charges,All Other,1185.24,83,,1185.24,percent of total billed charges,All Other,1142.4,80,,1142.4,percent of total billed charges,All Other,999.6,70,,999.6,percent of total billed charges,,928.2,65,,928.2,percent of total billed charges,All Other,928.2,65,,928.2,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1185.24,
ENDO CATH - BILE DUCTS,74328,CPT,TC,42074328,CDM,320,RC,,,both,,,638,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,414.7,65,,414.7,percent of total billed charges,All Other,376.42,59,,376.42,percent of total billed charges,All Other,81.44,,,81.44,Fee Schedule,,81.44,,,81.44,Fee Schedule,,81.44,,,81.44,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,433.84,68,,433.84,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,510.4,80,,510.4,percent of total billed charges,All Other,529.54,83,,529.54,percent of total billed charges,All Other,529.54,83,,,percent of total billed charges,All Other,510.4,80,,510.4,percent of total billed charges,All Other,529.54,83,,529.54,percent of total billed charges,All Other,510.4,80,,510.4,percent of total billed charges,All Other,446.6,70,,446.6,percent of total billed charges,,414.7,65,,414.7,percent of total billed charges,All Other,414.7,65,,414.7,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
ENDO CATH - BILE DUCTS W/ FY MOD,74328,CPT,FY,42674328,CDM,320,RC,,,both,,,638,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,414.7,65,,414.7,percent of total billed charges,All Other,376.42,59,,376.42,percent of total billed charges,All Other,81.44,,,81.44,Fee Schedule,,81.44,,,81.44,Fee Schedule,,81.44,,,81.44,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,433.84,68,,433.84,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,510.4,80,,510.4,percent of total billed charges,All Other,529.54,83,,529.54,percent of total billed charges,All Other,529.54,83,,,percent of total billed charges,All Other,510.4,80,,510.4,percent of total billed charges,All Other,529.54,83,,529.54,percent of total billed charges,All Other,510.4,80,,510.4,percent of total billed charges,All Other,446.6,70,,446.6,percent of total billed charges,,414.7,65,,414.7,percent of total billed charges,All Other,414.7,65,,414.7,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
ENDO CATH - BILE DUCTS W/ FY MOD,74328,CPT,FY,43074328,CDM,320,RC,,,both,,,638,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,414.7,65,,414.7,percent of total billed charges,All Other,376.42,59,,376.42,percent of total billed charges,All Other,81.44,,,81.44,Fee Schedule,,81.44,,,81.44,Fee Schedule,,81.44,,,81.44,Fee Schedule,,446.6,70,,446.6,percent of total billed charges,All Other,433.84,68,,433.84,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,510.4,80,,510.4,percent of total billed charges,All Other,529.54,83,,529.54,percent of total billed charges,All Other,529.54,83,,,percent of total billed charges,All Other,510.4,80,,510.4,percent of total billed charges,All Other,529.54,83,,529.54,percent of total billed charges,All Other,510.4,80,,510.4,percent of total billed charges,All Other,446.6,70,,446.6,percent of total billed charges,,414.7,65,,414.7,percent of total billed charges,All Other,414.7,65,,414.7,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
ENDO CATH - PANCR DUCT,74329,CPT,TC,42074329,CDM,320,RC,,,both,,,749,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,486.85,65,,486.85,percent of total billed charges,All Other,441.91,59,,441.91,percent of total billed charges,All Other,65.22,,,65.22,Fee Schedule,,65.22,,,65.22,Fee Schedule,,65.22,,,65.22,Fee Schedule,,524.3,70,,524.3,percent of total billed charges,All Other,509.32,68,,509.32,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,599.2,80,,599.2,percent of total billed charges,All Other,621.67,83,,621.67,percent of total billed charges,All Other,621.67,83,,,percent of total billed charges,All Other,599.2,80,,599.2,percent of total billed charges,All Other,621.67,83,,621.67,percent of total billed charges,All Other,599.2,80,,599.2,percent of total billed charges,All Other,524.3,70,,524.3,percent of total billed charges,,486.85,65,,486.85,percent of total billed charges,All Other,486.85,65,,486.85,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
ENDO CATH - PANCR DUCT W/ FY MOD,74329,CPT,FY,42674329,CDM,320,RC,,,both,,,749,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,486.85,65,,486.85,percent of total billed charges,All Other,441.91,59,,441.91,percent of total billed charges,All Other,65.22,,,65.22,Fee Schedule,,65.22,,,65.22,Fee Schedule,,65.22,,,65.22,Fee Schedule,,524.3,70,,524.3,percent of total billed charges,All Other,509.32,68,,509.32,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,599.2,80,,599.2,percent of total billed charges,All Other,621.67,83,,621.67,percent of total billed charges,All Other,621.67,83,,,percent of total billed charges,All Other,599.2,80,,599.2,percent of total billed charges,All Other,621.67,83,,621.67,percent of total billed charges,All Other,599.2,80,,599.2,percent of total billed charges,All Other,524.3,70,,524.3,percent of total billed charges,,486.85,65,,486.85,percent of total billed charges,All Other,486.85,65,,486.85,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
ENDO CATH - PANCR DUCT W/ FY MOD,74329,CPT,FY,43074329,CDM,320,RC,,,both,,,749,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,486.85,65,,486.85,percent of total billed charges,All Other,441.91,59,,441.91,percent of total billed charges,All Other,65.22,,,65.22,Fee Schedule,,65.22,,,65.22,Fee Schedule,,65.22,,,65.22,Fee Schedule,,524.3,70,,524.3,percent of total billed charges,All Other,509.32,68,,509.32,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,599.2,80,,599.2,percent of total billed charges,All Other,621.67,83,,621.67,percent of total billed charges,All Other,621.67,83,,,percent of total billed charges,All Other,599.2,80,,599.2,percent of total billed charges,All Other,621.67,83,,621.67,percent of total billed charges,All Other,599.2,80,,599.2,percent of total billed charges,All Other,524.3,70,,524.3,percent of total billed charges,,486.85,65,,486.85,percent of total billed charges,All Other,486.85,65,,486.85,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
ENDO CATH BIL & PANCR - ERCP,74330,CPT,TC,42074330,CDM,320,RC,,,both,,,2170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1410.5,65,,1410.5,percent of total billed charges,All Other,1280.3,59,,1280.3,percent of total billed charges,All Other,121.13,,,121.13,Fee Schedule,,121.13,,,121.13,Fee Schedule,,121.13,,,121.13,Fee Schedule,,1519,70,,1519,percent of total billed charges,All Other,1475.6,68,,1475.6,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,1736,80,,1736,percent of total billed charges,All Other,1801.1,83,,1801.1,percent of total billed charges,All Other,1801.1,83,,,percent of total billed charges,All Other,1736,80,,1736,percent of total billed charges,All Other,1801.1,83,,1801.1,percent of total billed charges,All Other,1736,80,,1736,percent of total billed charges,All Other,1519,70,,1519,percent of total billed charges,,1410.5,65,,1410.5,percent of total billed charges,All Other,1410.5,65,,1410.5,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1801.1,
ENDO CATH BIL & PANCR - ERCP W/ FY MOD,74330,CPT,FY,42674330,CDM,320,RC,,,both,,,2170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1410.5,65,,1410.5,percent of total billed charges,All Other,1280.3,59,,1280.3,percent of total billed charges,All Other,121.13,,,121.13,Fee Schedule,,121.13,,,121.13,Fee Schedule,,121.13,,,121.13,Fee Schedule,,1519,70,,1519,percent of total billed charges,All Other,1475.6,68,,1475.6,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,1736,80,,1736,percent of total billed charges,All Other,1801.1,83,,1801.1,percent of total billed charges,All Other,1801.1,83,,,percent of total billed charges,All Other,1736,80,,1736,percent of total billed charges,All Other,1801.1,83,,1801.1,percent of total billed charges,All Other,1736,80,,1736,percent of total billed charges,All Other,1519,70,,1519,percent of total billed charges,,1410.5,65,,1410.5,percent of total billed charges,All Other,1410.5,65,,1410.5,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1801.1,
ENDO CATH BIL & PANCR - ERCP W/ FY MOD,74330,CPT,FY,43074330,CDM,320,RC,,,both,,,2170,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1410.5,65,,1410.5,percent of total billed charges,All Other,1280.3,59,,1280.3,percent of total billed charges,All Other,121.13,,,121.13,Fee Schedule,,121.13,,,121.13,Fee Schedule,,121.13,,,121.13,Fee Schedule,,1519,70,,1519,percent of total billed charges,All Other,1475.6,68,,1475.6,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,1736,80,,1736,percent of total billed charges,All Other,1801.1,83,,1801.1,percent of total billed charges,All Other,1801.1,83,,,percent of total billed charges,All Other,1736,80,,1736,percent of total billed charges,All Other,1801.1,83,,1801.1,percent of total billed charges,All Other,1736,80,,1736,percent of total billed charges,All Other,1519,70,,1519,percent of total billed charges,,1410.5,65,,1410.5,percent of total billed charges,All Other,1410.5,65,,1410.5,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1801.1,
DILATE FOR STRICTURE/OBSTR,74360,CPT,TC,42074360,CDM,320,RC,,,both,,,816,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,530.4,65,,530.4,percent of total billed charges,All Other,481.44,59,,481.44,percent of total billed charges,All Other,87.31,,,87.31,Fee Schedule,,87.31,,,87.31,Fee Schedule,,87.31,,,87.31,Fee Schedule,,571.2,70,,571.2,percent of total billed charges,All Other,554.88,68,,554.88,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,652.8,80,,652.8,percent of total billed charges,All Other,505.92,83,,505.92,percent of total billed charges,All Other,448.8,83,,,percent of total billed charges,All Other,652.8,80,,652.8,percent of total billed charges,All Other,505.92,83,,505.92,percent of total billed charges,All Other,652.8,80,,652.8,percent of total billed charges,All Other,571.2,70,,571.2,percent of total billed charges,,530.4,65,,530.4,percent of total billed charges,All Other,530.4,65,,530.4,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
DILATE FOR STRICTURE/OBSTR W/ FY MOD,74360,CPT,FY,42674360,CDM,320,RC,,,both,,,816,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,530.4,65,,530.4,percent of total billed charges,All Other,481.44,59,,481.44,percent of total billed charges,All Other,87.31,,,87.31,Fee Schedule,,87.31,,,87.31,Fee Schedule,,87.31,,,87.31,Fee Schedule,,571.2,70,,571.2,percent of total billed charges,All Other,554.88,68,,554.88,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,652.8,80,,652.8,percent of total billed charges,All Other,505.92,83,,505.92,percent of total billed charges,All Other,448.8,83,,,percent of total billed charges,All Other,652.8,80,,652.8,percent of total billed charges,All Other,505.92,83,,505.92,percent of total billed charges,All Other,652.8,80,,652.8,percent of total billed charges,All Other,571.2,70,,571.2,percent of total billed charges,,530.4,65,,530.4,percent of total billed charges,All Other,530.4,65,,530.4,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
PTHD BILE DUCT STRICTURE,74363,CPT,TC,47074363,CDM,320,RC,,,both,,,194,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,126.1,65,,126.1,percent of total billed charges,All Other,114.46,59,,114.46,percent of total billed charges,All Other,77.65,,,77.65,Fee Schedule,,77.65,,,77.65,Fee Schedule,,77.65,,,77.65,Fee Schedule,,135.8,70,,135.8,percent of total billed charges,All Other,131.92,68,,131.92,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,155.2,80,,155.2,percent of total billed charges,All Other,161.02,83,,161.02,percent of total billed charges,All Other,161.02,83,,,percent of total billed charges,All Other,155.2,80,,155.2,percent of total billed charges,All Other,161.02,83,,161.02,percent of total billed charges,All Other,155.2,80,,155.2,percent of total billed charges,All Other,135.8,70,,135.8,percent of total billed charges,,126.1,65,,126.1,percent of total billed charges,All Other,126.1,65,,126.1,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
IVP W/WO TOMOGRAPHY/KUB,74400,CPT,TC,42074400,CDM,320,RC,,,both,,,997,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,388.51,,,388.51,Fee Schedule,,349.54,,,349.54,Fee Schedule,,616.39,,,616.39,Fee Schedule,,554.53,,,554.53,Fee Schedule,,524.16,,,524.16,Fee Schedule,,697.9,70,,697.9,percent of total billed charges,All Other,461.58,,,461.58,Fee Schedule,,406,,,406,Other,186% of Medicaid,543.18,,,543.18,Fee Schedule,,618.14,,,618.14,Fee Schedule,,255.76,,,,Fee Schedule,,543.18,,,543.18,Fee Schedule,,618.14,,,618.14,Fee Schedule,,481.07,,,481.07,Fee Schedule,,697.9,70,,697.9,percent of total billed charges,,565.8,,,565.8,Fee Schedule,,479.55,,,479.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,706.37,
IVP W/WO TOMOGRAPHY/KUB W/ FY MOD,74400,CPT,FY,42674400,CDM,320,RC,,,both,,,997,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,388.51,,,388.51,Fee Schedule,,349.54,,,349.54,Fee Schedule,,616.39,,,616.39,Fee Schedule,,554.53,,,554.53,Fee Schedule,,524.16,,,524.16,Fee Schedule,,697.9,70,,697.9,percent of total billed charges,All Other,461.58,,,461.58,Fee Schedule,,406,,,406,Other,186% of Medicaid,543.18,,,543.18,Fee Schedule,,618.14,,,618.14,Fee Schedule,,255.76,,,,Fee Schedule,,543.18,,,543.18,Fee Schedule,,618.14,,,618.14,Fee Schedule,,481.07,,,481.07,Fee Schedule,,697.9,70,,697.9,percent of total billed charges,,565.8,,,565.8,Fee Schedule,,479.55,,,479.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,706.37,
IVP W TOMOGRAPHY,74415,CPT,TC,42074415,CDM,320,RC,,,both,,,1023,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,445.1,,,445.1,Fee Schedule,,400.45,,,400.45,Fee Schedule,,787.75,,,787.75,Fee Schedule,,708.69,,,708.69,Fee Schedule,,669.88,,,669.88,Fee Schedule,,716.1,70,,716.1,percent of total billed charges,All Other,528.82,,,528.82,Fee Schedule,,406,,,406,Other,186% of Medicaid,622.3,,,622.3,Fee Schedule,,634.26,,,634.26,Fee Schedule,,293.01,,,,Fee Schedule,,622.3,,,622.3,Fee Schedule,,634.26,,,634.26,Fee Schedule,,551.14,,,551.14,Fee Schedule,,716.1,70,,716.1,percent of total billed charges,,662.56,,,662.56,Fee Schedule,,561.56,,,561.56,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,787.75,
IVP W TOMOGRAPHY W/ FY MOD,74415,CPT,FY,42674415,CDM,320,RC,,,both,,,1023,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,445.1,,,445.1,Fee Schedule,,400.45,,,400.45,Fee Schedule,,787.75,,,787.75,Fee Schedule,,708.69,,,708.69,Fee Schedule,,669.88,,,669.88,Fee Schedule,,716.1,70,,716.1,percent of total billed charges,All Other,528.82,,,528.82,Fee Schedule,,406,,,406,Other,186% of Medicaid,622.3,,,622.3,Fee Schedule,,634.26,,,634.26,Fee Schedule,,293.01,,,,Fee Schedule,,622.3,,,622.3,Fee Schedule,,634.26,,,634.26,Fee Schedule,,551.14,,,551.14,Fee Schedule,,716.1,70,,716.1,percent of total billed charges,,662.56,,,662.56,Fee Schedule,,561.56,,,561.56,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,787.75,
RETROGRADE PYELOGRAM,74420,CPT,TC,42074420,CDM,320,RC,,,both,,,1142,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,187.32,,,187.32,Fee Schedule,,168.53,,,168.53,Fee Schedule,,1232.67,,,1232.67,Fee Schedule,,1108.95,,,1108.95,Fee Schedule,,1048.22,,,1048.22,Fee Schedule,,799.4,70,,799.4,percent of total billed charges,All Other,222.55,,,222.55,Fee Schedule,,406,,,406,Other,186% of Medicaid,261.89,,,261.89,Fee Schedule,,708.04,,,708.04,Fee Schedule,,123.31,,,,Fee Schedule,,261.89,,,261.89,Fee Schedule,,708.04,,,708.04,Fee Schedule,,231.94,,,231.94,Fee Schedule,,799.4,70,,799.4,percent of total billed charges,,257.48,,,257.48,Fee Schedule,,218.23,,,218.23,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,123.31,1232.67,
RETROGRADE PYELOGRAM W/ FY MOD,74420,CPT,FY,42674420,CDM,320,RC,,,both,,,1142,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,187.32,,,187.32,Fee Schedule,,168.53,,,168.53,Fee Schedule,,1232.67,,,1232.67,Fee Schedule,,1108.95,,,1108.95,Fee Schedule,,1048.22,,,1048.22,Fee Schedule,,799.4,70,,799.4,percent of total billed charges,All Other,222.55,,,222.55,Fee Schedule,,406,,,406,Other,186% of Medicaid,261.89,,,261.89,Fee Schedule,,708.04,,,708.04,Fee Schedule,,123.31,,,,Fee Schedule,,261.89,,,261.89,Fee Schedule,,708.04,,,708.04,Fee Schedule,,231.94,,,231.94,Fee Schedule,,799.4,70,,799.4,percent of total billed charges,,257.48,,,257.48,Fee Schedule,,218.23,,,218.23,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,123.31,1232.67,
XR URINARY TRACT W CONTRAST,74425,CPT,TC,42074425,CDM,320,RC,,,both,,,1137,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,389.5,,,389.5,Fee Schedule,,350.43,,,350.43,Fee Schedule,,1232.67,,,1232.67,Fee Schedule,,1108.95,,,1108.95,Fee Schedule,,1048.22,,,1048.22,Fee Schedule,,795.9,70,,795.9,percent of total billed charges,All Other,462.76,,,462.76,Fee Schedule,,406,,,406,Other,186% of Medicaid,544.57,,,544.57,Fee Schedule,,704.94,,,704.94,Fee Schedule,,256.41,,,,Fee Schedule,,544.57,,,544.57,Fee Schedule,,704.94,,,704.94,Fee Schedule,,482.3,,,482.3,Fee Schedule,,795.9,70,,795.9,percent of total billed charges,,567.44,,,567.44,Fee Schedule,,480.94,,,480.94,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1232.67,
XR URINARY TRACT W CONTRAST W/ FY MOD,74425,CPT,FY,42674425,CDM,320,RC,,,both,,,1062,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,389.5,,,389.5,Fee Schedule,,350.43,,,350.43,Fee Schedule,,1232.67,,,1232.67,Fee Schedule,,1108.95,,,1108.95,Fee Schedule,,1048.22,,,1048.22,Fee Schedule,,743.4,70,,743.4,percent of total billed charges,All Other,462.76,,,462.76,Fee Schedule,,406,,,406,Other,186% of Medicaid,544.57,,,544.57,Fee Schedule,,658.44,,,658.44,Fee Schedule,,256.41,,,,Fee Schedule,,544.57,,,544.57,Fee Schedule,,658.44,,,658.44,Fee Schedule,,482.3,,,482.3,Fee Schedule,,743.4,70,,743.4,percent of total billed charges,,567.44,,,567.44,Fee Schedule,,480.94,,,480.94,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1232.67,
CONTRST X-RAY URINARY TRACT,74425,CPT,TC,47074425,CDM,320,RC,,,both,,,1137,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,389.5,,,389.5,Fee Schedule,,350.43,,,350.43,Fee Schedule,,1232.67,,,1232.67,Fee Schedule,,1108.95,,,1108.95,Fee Schedule,,1048.22,,,1048.22,Fee Schedule,,795.9,70,,795.9,percent of total billed charges,All Other,462.76,,,462.76,Fee Schedule,,406,,,406,Other,186% of Medicaid,544.57,,,544.57,Fee Schedule,,704.94,,,704.94,Fee Schedule,,256.41,,,,Fee Schedule,,544.57,,,544.57,Fee Schedule,,704.94,,,704.94,Fee Schedule,,482.3,,,482.3,Fee Schedule,,795.9,70,,795.9,percent of total billed charges,,567.44,,,567.44,Fee Schedule,,480.94,,,480.94,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1232.67,
XR BLADDER 3+ VIEWS W CONTR,74430,CPT,TC,42074430,CDM,320,RC,,,both,,,838,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,318.94,,,318.94,Fee Schedule,,286.93,,,286.93,Fee Schedule,,271.21,,,271.21,Fee Schedule,,586.6,70,,586.6,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,406,,,406,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,519.56,,,519.56,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,519.56,,,519.56,Fee Schedule,,113.21,,,113.21,Fee Schedule,,586.6,70,,586.6,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,60.19,706.37,
XR BLADDER 3+ VIEWS W CONTR W/ FY MOD,74430,CPT,FY,42674430,CDM,320,RC,,,both,,,838,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,318.94,,,318.94,Fee Schedule,,286.93,,,286.93,Fee Schedule,,271.21,,,271.21,Fee Schedule,,586.6,70,,586.6,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,406,,,406,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,519.56,,,519.56,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,519.56,,,519.56,Fee Schedule,,113.21,,,113.21,Fee Schedule,,586.6,70,,586.6,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,60.19,706.37,
URETHROGRAM RETROGRADE,74450,CPT,TC,42074450,CDM,320,RC,,,both,,,1235,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,802.75,65,,802.75,percent of total billed charges,All Other,728.65,59,,728.65,percent of total billed charges,All Other,1232.67,,,1232.67,Fee Schedule,,1108.95,,,1108.95,Fee Schedule,,1048.22,,,1048.22,Fee Schedule,,864.5,70,,864.5,percent of total billed charges,All Other,839.8,68,,839.8,percent of total billed charges,All Other,406,,,406,Other,186% of Medicaid,988,80,,988,percent of total billed charges,All Other,1025.05,83,,1025.05,percent of total billed charges,All Other,1025.05,83,,,percent of total billed charges,All Other,988,80,,988,percent of total billed charges,All Other,1025.05,83,,1025.05,percent of total billed charges,All Other,988,80,,988,percent of total billed charges,All Other,864.5,70,,864.5,percent of total billed charges,,802.75,65,,802.75,percent of total billed charges,All Other,802.75,65,,802.75,percent of total billed charges,All Other,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1232.67,
URETHROGRAM RETROGRADE W/ FY MOD,74450,CPT,FY,42674450,CDM,320,RC,,,both,,,1235,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,802.75,65,,802.75,percent of total billed charges,All Other,728.65,59,,728.65,percent of total billed charges,All Other,1232.67,,,1232.67,Fee Schedule,,1108.95,,,1108.95,Fee Schedule,,1048.22,,,1048.22,Fee Schedule,,864.5,70,,864.5,percent of total billed charges,All Other,839.8,68,,839.8,percent of total billed charges,All Other,406,,,406,Other,186% of Medicaid,988,80,,988,percent of total billed charges,All Other,1025.05,83,,1025.05,percent of total billed charges,All Other,1025.05,83,,,percent of total billed charges,All Other,988,80,,988,percent of total billed charges,All Other,1025.05,83,,1025.05,percent of total billed charges,All Other,988,80,,988,percent of total billed charges,All Other,864.5,70,,864.5,percent of total billed charges,,802.75,65,,802.75,percent of total billed charges,All Other,802.75,65,,802.75,percent of total billed charges,All Other,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1232.67,
DILATION URETERS/URETHRA/NEPHR,74485,CPT,TC,42074485,CDM,320,RC,,,both,,,5267,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,280.91,,,280.91,Fee Schedule,,252.73,,,252.73,Fee Schedule,,587.84,,,587.84,Fee Schedule,,528.84,,,528.84,Fee Schedule,,499.88,,,499.88,Fee Schedule,,3686.9,70,,3686.9,percent of total billed charges,All Other,333.75,,,333.75,Fee Schedule,,558,,,558,Other,186% of Medicaid,392.75,,,392.75,Fee Schedule,,3265.54,,,3265.54,Fee Schedule,,184.93,,,,Fee Schedule,,392.75,,,392.75,Fee Schedule,,3265.54,,,3265.54,Fee Schedule,,347.84,,,347.84,Fee Schedule,,3686.9,70,,3686.9,percent of total billed charges,,401.8,,,401.8,Fee Schedule,,340.55,,,340.55,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,184.93,3686.9,
DILATION URETERS/URETHRA/NEPHR W/ FY MOD,74485,CPT,FY,42674485,CDM,320,RC,,,both,,,5267,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,280.91,,,280.91,Fee Schedule,,252.73,,,252.73,Fee Schedule,,587.84,,,587.84,Fee Schedule,,528.84,,,528.84,Fee Schedule,,499.88,,,499.88,Fee Schedule,,3686.9,70,,3686.9,percent of total billed charges,All Other,333.75,,,333.75,Fee Schedule,,558,,,558,Other,186% of Medicaid,392.75,,,392.75,Fee Schedule,,3265.54,,,3265.54,Fee Schedule,,184.93,,,,Fee Schedule,,392.75,,,392.75,Fee Schedule,,3265.54,,,3265.54,Fee Schedule,,347.84,,,347.84,Fee Schedule,,3686.9,70,,3686.9,percent of total billed charges,,401.8,,,401.8,Fee Schedule,,340.55,,,340.55,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,184.93,3686.9,
DILATE URETERS/URETHRA/NEPHROSTOMY,74485,CPT,,47074485,CDM,320,RC,,,both,,,5267,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,280.91,,,280.91,Fee Schedule,,252.73,,,252.73,Fee Schedule,,587.84,,,587.84,Fee Schedule,,528.84,,,528.84,Fee Schedule,,499.88,,,499.88,Fee Schedule,,3686.9,70,,3686.9,percent of total billed charges,All Other,333.75,,,333.75,Fee Schedule,,558,,,558,Other,186% of Medicaid,392.75,,,392.75,Fee Schedule,,3265.54,,,3265.54,Fee Schedule,,184.93,,,,Fee Schedule,,392.75,,,392.75,Fee Schedule,,3265.54,,,3265.54,Fee Schedule,,347.84,,,347.84,Fee Schedule,,3686.9,70,,3686.9,percent of total billed charges,,401.8,,,401.8,Fee Schedule,,340.55,,,340.55,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,2834.48,,,2834.48,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,184.93,3686.9,
HYSTEROSALPINGOGRAM,74740,CPT,TC,42074740,CDM,320,RC,,,both,,,1169,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,262.41,,,262.41,Fee Schedule,,236.09,,,236.09,Fee Schedule,,426.02,,,426.02,Fee Schedule,,383.26,,,383.26,Fee Schedule,,362.27,,,362.27,Fee Schedule,,818.3,70,,818.3,percent of total billed charges,All Other,311.77,,,311.77,Fee Schedule,,406,,,406,Other,186% of Medicaid,366.88,,,366.88,Fee Schedule,,724.78,,,724.78,Fee Schedule,,172.75,,,,Fee Schedule,,366.88,,,366.88,Fee Schedule,,724.78,,,724.78,Fee Schedule,,324.93,,,324.93,Fee Schedule,,818.3,70,,818.3,percent of total billed charges,,393.6,,,393.6,Fee Schedule,,333.6,,,333.6,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,172.75,818.3,
HYSTEROSALPINGOGRAM W/ FY MOD,74740,CPT,FY,42674740,CDM,320,RC,,,both,,,1169,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,262.41,,,262.41,Fee Schedule,,236.09,,,236.09,Fee Schedule,,426.02,,,426.02,Fee Schedule,,383.26,,,383.26,Fee Schedule,,362.27,,,362.27,Fee Schedule,,818.3,70,,818.3,percent of total billed charges,All Other,311.77,,,311.77,Fee Schedule,,406,,,406,Other,186% of Medicaid,366.88,,,366.88,Fee Schedule,,724.78,,,724.78,Fee Schedule,,172.75,,,,Fee Schedule,,366.88,,,366.88,Fee Schedule,,724.78,,,724.78,Fee Schedule,,324.93,,,324.93,Fee Schedule,,818.3,70,,818.3,percent of total billed charges,,393.6,,,393.6,Fee Schedule,,333.6,,,333.6,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,172.75,818.3,
ANGIOGRAPHY PELVIC,75736,CPT,TC,47075736,CDM,320,RC,,,both,,,11570,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,320.53,,,320.53,Fee Schedule,,288.38,,,288.38,Fee Schedule,,1223.19,,,1223.19,Fee Schedule,,1100.43,,,1100.43,Fee Schedule,,1040.16,,,1040.16,Fee Schedule,,8099,70,,8099,percent of total billed charges,All Other,380.82,,,380.82,Fee Schedule,,1434,,,1434,Other,186% of Medicaid,448.14,,,448.14,Fee Schedule,,7173.4,,,7173.4,Fee Schedule,,211.01,,,,Fee Schedule,,448.14,,,448.14,Fee Schedule,,7173.4,,,7173.4,Fee Schedule,,396.9,,,396.9,Fee Schedule,,8099,70,,8099,percent of total billed charges,,436.24,,,436.24,Fee Schedule,,369.74,,,369.74,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1179.92,,,1179.92,Other,153% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1079.67,,,1079.67,Other,140% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,2005.1,,,2005.1,Other,250% of Medicaid,2498.66,,,2498.66,Other,324% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,963.99,,,963.99,Other,125% of Medicaid,211.01,9930.15,
ANGIOGRAPHY EACH ADD VESSEL,75774,CPT,TC,47075774,CDM,320,RC,,,both,,,3889,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,176.92,,,176.92,Fee Schedule,,159.17,,,159.17,Fee Schedule,,989.96,,,989.96,Fee Schedule,,890.6,,,890.6,Fee Schedule,,841.83,,,841.83,Fee Schedule,,2722.3,70,,2722.3,percent of total billed charges,All Other,210.19,,,210.19,Fee Schedule,,1434,,,1434,Other,186% of Medicaid,247.35,,,247.35,Fee Schedule,,2411.18,,,2411.18,Fee Schedule,,116.47,,,,Fee Schedule,,247.35,,,247.35,Fee Schedule,,2411.18,,,2411.18,Fee Schedule,,219.07,,,219.07,Fee Schedule,,2722.3,70,,2722.3,percent of total billed charges,,252.56,,,252.56,Fee Schedule,,214.06,,,214.06,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1179.92,,,1179.92,Other,153% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1079.67,,,1079.67,Other,140% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,2005.1,,,2005.1,Other,250% of Medicaid,2498.66,,,2498.66,Other,324% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,963.99,,,963.99,Other,125% of Medicaid,0.01,2722.3,
SHUNTOGRAM,75809,CPT,TC,42075809,CDM,320,RC,,,both,,,667,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,205.82,,,205.82,Fee Schedule,,185.17,,,185.17,Fee Schedule,,521.2,,,521.2,Fee Schedule,,468.89,,,468.89,Fee Schedule,,443.21,,,443.21,Fee Schedule,,466.9,70,,466.9,percent of total billed charges,All Other,244.53,,,244.53,Fee Schedule,,406,,,406,Other,186% of Medicaid,287.76,,,287.76,Fee Schedule,,413.54,,,413.54,Fee Schedule,,135.49,,,,Fee Schedule,,287.76,,,287.76,Fee Schedule,,413.54,,,413.54,Fee Schedule,,254.85,,,254.85,Fee Schedule,,466.9,70,,466.9,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,120.81,706.37,
SHUNTOGRAM W/ FY MOD,75809,CPT,FY,42675809,CDM,320,RC,,,both,,,667,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,205.82,,,205.82,Fee Schedule,,185.17,,,185.17,Fee Schedule,,521.2,,,521.2,Fee Schedule,,468.89,,,468.89,Fee Schedule,,443.21,,,443.21,Fee Schedule,,466.9,70,,466.9,percent of total billed charges,All Other,244.53,,,244.53,Fee Schedule,,406,,,406,Other,186% of Medicaid,287.76,,,287.76,Fee Schedule,,413.54,,,413.54,Fee Schedule,,135.49,,,,Fee Schedule,,287.76,,,287.76,Fee Schedule,,413.54,,,413.54,Fee Schedule,,254.85,,,254.85,Fee Schedule,,466.9,70,,466.9,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,120.81,706.37,
SHUNTOGRAM W/ FY MOD,75809,CPT,FY,43075809,CDM,320,RC,,,both,,,667,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,205.82,,,205.82,Fee Schedule,,185.17,,,185.17,Fee Schedule,,521.2,,,521.2,Fee Schedule,,468.89,,,468.89,Fee Schedule,,443.21,,,443.21,Fee Schedule,,466.9,70,,466.9,percent of total billed charges,All Other,244.53,,,244.53,Fee Schedule,,406,,,406,Other,186% of Medicaid,287.76,,,287.76,Fee Schedule,,413.54,,,413.54,Fee Schedule,,135.49,,,,Fee Schedule,,287.76,,,287.76,Fee Schedule,,413.54,,,413.54,Fee Schedule,,254.85,,,254.85,Fee Schedule,,466.9,70,,466.9,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,120.81,706.37,
SHUNTOGRAM,75809,CPT,TC,47075809,CDM,320,RC,,,both,,,667,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,205.82,,,205.82,Fee Schedule,,185.17,,,185.17,Fee Schedule,,521.2,,,521.2,Fee Schedule,,468.89,,,468.89,Fee Schedule,,443.21,,,443.21,Fee Schedule,,466.9,70,,466.9,percent of total billed charges,All Other,244.53,,,244.53,Fee Schedule,,406,,,406,Other,186% of Medicaid,287.76,,,287.76,Fee Schedule,,413.54,,,413.54,Fee Schedule,,135.49,,,,Fee Schedule,,287.76,,,287.76,Fee Schedule,,413.54,,,413.54,Fee Schedule,,254.85,,,254.85,Fee Schedule,,466.9,70,,466.9,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,120.81,706.37,
VENOGRAM EXTREMITY UNIL,75820,CPT,TC,42075820,CDM,320,RC,,,both,,,3649,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,205.82,,,205.82,Fee Schedule,,185.17,,,185.17,Fee Schedule,,635.46,,,635.46,Fee Schedule,,571.68,,,571.68,Fee Schedule,,540.37,,,540.37,Fee Schedule,,2554.3,70,,2554.3,percent of total billed charges,All Other,244.53,,,244.53,Fee Schedule,,503,,,503,Other,186% of Medicaid,287.76,,,287.76,Fee Schedule,,2262.38,,,2262.38,Fee Schedule,,135.49,,,,Fee Schedule,,287.76,,,287.76,Fee Schedule,,2262.38,,,2262.38,Fee Schedule,,254.85,,,254.85,Fee Schedule,,2554.3,70,,2554.3,percent of total billed charges,,300.12,,,300.12,Fee Schedule,,254.37,,,254.37,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,135.49,2893.99,
VENOGRAM EXTREMITY UNIL W/ FY MOD,75820,CPT,FY,42675820,CDM,320,RC,,,both,,,3649,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,205.82,,,205.82,Fee Schedule,,185.17,,,185.17,Fee Schedule,,635.46,,,635.46,Fee Schedule,,571.68,,,571.68,Fee Schedule,,540.37,,,540.37,Fee Schedule,,2554.3,70,,2554.3,percent of total billed charges,All Other,244.53,,,244.53,Fee Schedule,,503,,,503,Other,186% of Medicaid,287.76,,,287.76,Fee Schedule,,2262.38,,,2262.38,Fee Schedule,,135.49,,,,Fee Schedule,,287.76,,,287.76,Fee Schedule,,2262.38,,,2262.38,Fee Schedule,,254.85,,,254.85,Fee Schedule,,2554.3,70,,2554.3,percent of total billed charges,,300.12,,,300.12,Fee Schedule,,254.37,,,254.37,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,135.49,2893.99,
UNILATERAL VENOGRAM,75820,CPT,TC,47075820,CDM,320,RC,,,both,,,3649,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,205.82,,,205.82,Fee Schedule,,185.17,,,185.17,Fee Schedule,,635.46,,,635.46,Fee Schedule,,571.68,,,571.68,Fee Schedule,,540.37,,,540.37,Fee Schedule,,2554.3,70,,2554.3,percent of total billed charges,All Other,244.53,,,244.53,Fee Schedule,,503,,,503,Other,186% of Medicaid,287.76,,,287.76,Fee Schedule,,2262.38,,,2262.38,Fee Schedule,,135.49,,,,Fee Schedule,,287.76,,,287.76,Fee Schedule,,2262.38,,,2262.38,Fee Schedule,,254.85,,,254.85,Fee Schedule,,2554.3,70,,2554.3,percent of total billed charges,,300.12,,,300.12,Fee Schedule,,254.37,,,254.37,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,135.49,2893.99,
UNILATERAL VENOGRAM,75820,CPT,TC,49075820,CDM,320,RC,,,both,,,3649,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,205.82,,,205.82,Fee Schedule,,185.17,,,185.17,Fee Schedule,,635.46,,,635.46,Fee Schedule,,571.68,,,571.68,Fee Schedule,,540.37,,,540.37,Fee Schedule,,2554.3,70,,2554.3,percent of total billed charges,All Other,244.53,,,244.53,Fee Schedule,,503,,,503,Other,186% of Medicaid,287.76,,,287.76,Fee Schedule,,2262.38,,,2262.38,Fee Schedule,,135.49,,,,Fee Schedule,,287.76,,,287.76,Fee Schedule,,2262.38,,,2262.38,Fee Schedule,,254.85,,,254.85,Fee Schedule,,2554.3,70,,2554.3,percent of total billed charges,,300.12,,,300.12,Fee Schedule,,254.37,,,254.37,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,135.49,2893.99,
VENOGRAPHY EXTREMITY; BILATERAL,75822,CPT,TC,42075822,CDM,320,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,227.77,,,227.77,Fee Schedule,,204.92,,,204.92,Fee Schedule,,711.58,,,711.58,Fee Schedule,,640.16,,,640.16,Fee Schedule,,605.1,,,605.1,Fee Schedule,,2345,70,,2345,percent of total billed charges,All Other,270.61,,,270.61,Fee Schedule,,503,,,503,Other,186% of Medicaid,318.44,,,318.44,Fee Schedule,,2077,,,2077,Fee Schedule,,149.94,,,,Fee Schedule,,318.44,,,318.44,Fee Schedule,,2077,,,2077,Fee Schedule,,282.03,,,282.03,Fee Schedule,,2345,70,,2345,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,149.94,2893.99,
VENOGRAPHY EXTREMITY BILATERAL FY MOD,75822,CPT,FY,42675822,CDM,320,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,227.77,,,227.77,Fee Schedule,,204.92,,,204.92,Fee Schedule,,711.58,,,711.58,Fee Schedule,,640.16,,,640.16,Fee Schedule,,605.1,,,605.1,Fee Schedule,,2345,70,,2345,percent of total billed charges,All Other,270.61,,,270.61,Fee Schedule,,503,,,503,Other,186% of Medicaid,318.44,,,318.44,Fee Schedule,,2077,,,2077,Fee Schedule,,149.94,,,,Fee Schedule,,318.44,,,318.44,Fee Schedule,,2077,,,2077,Fee Schedule,,282.03,,,282.03,Fee Schedule,,2345,70,,2345,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,149.94,2893.99,
VENOGRAPHY EXTREMITY BIL W/ FY MOD,75822,CPT,FY,43075822,CDM,320,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,227.77,,,227.77,Fee Schedule,,204.92,,,204.92,Fee Schedule,,711.58,,,711.58,Fee Schedule,,640.16,,,640.16,Fee Schedule,,605.1,,,605.1,Fee Schedule,,2345,70,,2345,percent of total billed charges,All Other,270.61,,,270.61,Fee Schedule,,503,,,503,Other,186% of Medicaid,318.44,,,318.44,Fee Schedule,,2077,,,2077,Fee Schedule,,149.94,,,,Fee Schedule,,318.44,,,318.44,Fee Schedule,,2077,,,2077,Fee Schedule,,282.03,,,282.03,Fee Schedule,,2345,70,,2345,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,149.94,2893.99,
VENOGRAPHY EXTREMITY; BILATERA,75822,CPT,TC,47075822,CDM,320,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,227.77,,,227.77,Fee Schedule,,204.92,,,204.92,Fee Schedule,,711.58,,,711.58,Fee Schedule,,640.16,,,640.16,Fee Schedule,,605.1,,,605.1,Fee Schedule,,2345,70,,2345,percent of total billed charges,All Other,270.61,,,270.61,Fee Schedule,,503,,,503,Other,186% of Medicaid,318.44,,,318.44,Fee Schedule,,2077,,,2077,Fee Schedule,,149.94,,,,Fee Schedule,,318.44,,,318.44,Fee Schedule,,2077,,,2077,Fee Schedule,,282.03,,,282.03,Fee Schedule,,2345,70,,2345,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,149.94,2893.99,
VENOGRAPHY W SERIALOGRAPHY,75827,CPT,TC,42075827,CDM,320,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,228.91,,,228.91,Fee Schedule,,205.95,,,205.95,Fee Schedule,,1073.26,,,1073.26,Fee Schedule,,965.54,,,965.54,Fee Schedule,,912.66,,,912.66,Fee Schedule,,2345,70,,2345,percent of total billed charges,All Other,271.97,,,271.97,Fee Schedule,,503,,,503,Other,186% of Medicaid,320.05,,,320.05,Fee Schedule,,2077,,,2077,Fee Schedule,,150.7,,,,Fee Schedule,,320.05,,,320.05,Fee Schedule,,2077,,,2077,Fee Schedule,,283.45,,,283.45,Fee Schedule,,2345,70,,2345,percent of total billed charges,,329.64,,,329.64,Fee Schedule,,279.39,,,279.39,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,150.7,2893.99,
VENOGRAPHY W SERIALOGRAPHY FY MOD,75827,CPT,FY,42675827,CDM,320,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,228.91,,,228.91,Fee Schedule,,205.95,,,205.95,Fee Schedule,,1073.26,,,1073.26,Fee Schedule,,965.54,,,965.54,Fee Schedule,,912.66,,,912.66,Fee Schedule,,2345,70,,2345,percent of total billed charges,All Other,271.97,,,271.97,Fee Schedule,,503,,,503,Other,186% of Medicaid,320.05,,,320.05,Fee Schedule,,2077,,,2077,Fee Schedule,,150.7,,,,Fee Schedule,,320.05,,,320.05,Fee Schedule,,2077,,,2077,Fee Schedule,,283.45,,,283.45,Fee Schedule,,2345,70,,2345,percent of total billed charges,,329.64,,,329.64,Fee Schedule,,279.39,,,279.39,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,150.7,2893.99,
SUPERIOR VENA CAVAGRAM,75827,CPT,TC,47075827,CDM,320,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,228.91,,,228.91,Fee Schedule,,205.95,,,205.95,Fee Schedule,,1073.26,,,1073.26,Fee Schedule,,965.54,,,965.54,Fee Schedule,,912.66,,,912.66,Fee Schedule,,2345,70,,2345,percent of total billed charges,All Other,271.97,,,271.97,Fee Schedule,,503,,,503,Other,186% of Medicaid,320.05,,,320.05,Fee Schedule,,2077,,,2077,Fee Schedule,,150.7,,,,Fee Schedule,,320.05,,,320.05,Fee Schedule,,2077,,,2077,Fee Schedule,,283.45,,,283.45,Fee Schedule,,2345,70,,2345,percent of total billed charges,,329.64,,,329.64,Fee Schedule,,279.39,,,279.39,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,1008.82,,,1008.82,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,150.7,2893.99,
UNIL SELCTV RENAL VENOGRAM,75831,CPT,,47075831,CDM,320,RC,,,both,,,8040,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,238.32,,,238.32,Fee Schedule,,214.42,,,214.42,Fee Schedule,,1075.67,,,1075.67,Fee Schedule,,967.71,,,967.71,Fee Schedule,,914.71,,,914.71,Fee Schedule,,5628,70,,5628,percent of total billed charges,All Other,283.15,,,283.15,Fee Schedule,,558,,,558,Other,186% of Medicaid,333.21,,,333.21,Fee Schedule,,4984.8,,,4984.8,Fee Schedule,,156.89,,,,Fee Schedule,,333.21,,,333.21,Fee Schedule,,4984.8,,,4984.8,Fee Schedule,,295.1,,,295.1,Fee Schedule,,5628,70,,5628,percent of total billed charges,,334.56,,,334.56,Fee Schedule,,283.56,,,283.56,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,156.89,5759.82,
UNIL SELCTV ADRENAL VENOGRAM,75840,CPT,TC,47075840,CDM,320,RC,,,both,,,7864,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,260.27,,,260.27,Fee Schedule,,234.16,,,234.16,Fee Schedule,,1054.24,,,1054.24,Fee Schedule,,948.43,,,948.43,Fee Schedule,,896.49,,,896.49,Fee Schedule,,5504.8,70,,5504.8,percent of total billed charges,All Other,309.23,,,309.23,Fee Schedule,,558,,,558,Other,186% of Medicaid,363.89,,,363.89,Fee Schedule,,4875.68,,,4875.68,Fee Schedule,,171.34,,,,Fee Schedule,,363.89,,,363.89,Fee Schedule,,4875.68,,,4875.68,Fee Schedule,,322.28,,,322.28,Fee Schedule,,5504.8,70,,5504.8,percent of total billed charges,,367.36,,,367.36,Fee Schedule,,311.36,,,311.36,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,171.34,5759.82,
BILAT SELCTV ADRENAL VENOGRAM,75842,CPT,TC,47075842,CDM,320,RC,,,both,,,11570,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,307.64,,,307.64,Fee Schedule,,276.78,,,276.78,Fee Schedule,,1182.75,,,1182.75,Fee Schedule,,1064.04,,,1064.04,Fee Schedule,,1005.77,,,1005.77,Fee Schedule,,8099,70,,8099,percent of total billed charges,All Other,365.51,,,365.51,Fee Schedule,,1434,,,1434,Other,186% of Medicaid,430.12,,,430.12,Fee Schedule,,7173.4,,,7173.4,Fee Schedule,,202.52,,,,Fee Schedule,,430.12,,,430.12,Fee Schedule,,7173.4,,,7173.4,Fee Schedule,,380.94,,,380.94,Fee Schedule,,8099,70,,8099,percent of total billed charges,,428.04,,,428.04,Fee Schedule,,362.79,,,362.79,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1179.92,,,1179.92,Other,153% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1079.67,,,1079.67,Other,140% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,2005.1,,,2005.1,Other,250% of Medicaid,2498.66,,,2498.66,Other,324% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,963.99,,,963.99,Other,125% of Medicaid,202.52,9930.15,
SINUS OR JUGL CATH VENOGRAM,75860,CPT,,47075860,CDM,320,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,253.35,,,253.35,Fee Schedule,,227.94,,,227.94,Fee Schedule,,1087.56,,,1087.56,Fee Schedule,,978.41,,,978.41,Fee Schedule,,924.82,,,924.82,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,All Other,301,,,301,Fee Schedule,,558,,,558,Other,186% of Medicaid,354.21,,,354.21,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,166.78,,,,Fee Schedule,,354.21,,,354.21,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,313.71,,,313.71,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,,357.52,,,357.52,Fee Schedule,,303.02,,,303.02,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,166.78,5759.82,
SINUS OR JUGL CATH VENOGRAM,75860,CPT,,49075860,CDM,320,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,253.35,,,253.35,Fee Schedule,,227.94,,,227.94,Fee Schedule,,1087.56,,,1087.56,Fee Schedule,,978.41,,,978.41,Fee Schedule,,924.82,,,924.82,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,All Other,301,,,301,Fee Schedule,,558,,,558,Other,186% of Medicaid,354.21,,,354.21,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,166.78,,,,Fee Schedule,,354.21,,,354.21,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,313.71,,,313.71,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,,357.52,,,357.52,Fee Schedule,,303.02,,,303.02,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,166.78,5759.82,
SUPERIOR SAGITTAL SINUS VENOGRAM,75870,CPT,TC,45075870,CDM,320,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,339.99,,,339.99,Fee Schedule,,305.88,,,305.88,Fee Schedule,,1078.03,,,1078.03,Fee Schedule,,969.83,,,969.83,Fee Schedule,,916.72,,,916.72,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,All Other,403.94,,,403.94,Fee Schedule,,503,,,503,Other,186% of Medicaid,475.35,,,475.35,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,223.82,,,,Fee Schedule,,475.35,,,475.35,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,420.99,,,420.99,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,,503.48,,,503.48,Fee Schedule,,426.73,,,426.73,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,223.82,5759.82,
VENUS SAMPLING,75893,CPT,TC,47075893,CDM,320,RC,,,both,,,11570,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,277.59,,,277.59,Fee Schedule,,249.75,,,249.75,Fee Schedule,,1068.49,,,1068.49,Fee Schedule,,961.25,,,961.25,Fee Schedule,,908.61,,,908.61,Fee Schedule,,8099,70,,8099,percent of total billed charges,All Other,329.81,,,329.81,Fee Schedule,,1434,,,1434,Other,186% of Medicaid,388.11,,,388.11,Fee Schedule,,7173.4,,,7173.4,Fee Schedule,,182.74,,,,Fee Schedule,,388.11,,,388.11,Fee Schedule,,7173.4,,,7173.4,Fee Schedule,,343.73,,,343.73,Fee Schedule,,8099,70,,8099,percent of total billed charges,,383.76,,,383.76,Fee Schedule,,325.26,,,325.26,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1179.92,,,1179.92,Other,153% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1079.67,,,1079.67,Other,140% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,2005.1,,,2005.1,Other,250% of Medicaid,2498.66,,,2498.66,Other,324% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,963.99,,,963.99,Other,125% of Medicaid,182.74,9930.15,
TRANSCATH THERAPY FOLLOW UP,75898,CPT,TC,47075898,CDM,320,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,4359.55,65,,4359.55,percent of total billed charges,All Other,3957.13,59,,3957.13,percent of total billed charges,All Other,530.74,,,530.74,Fee Schedule,,477.47,,,477.47,Fee Schedule,,451.32,,,451.32,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,All Other,4560.76,68,,4560.76,percent of total billed charges,All Other,503,,,503,Other,186% of Medicaid,5365.6,80,,5365.6,percent of total billed charges,All Other,5566.81,83,,5566.81,percent of total billed charges,All Other,5566.81,83,,,percent of total billed charges,All Other,5365.6,80,,5365.6,percent of total billed charges,All Other,5566.81,83,,5566.81,percent of total billed charges,All Other,5365.6,80,,5365.6,percent of total billed charges,All Other,4694.9,70,,4694.9,percent of total billed charges,,4359.55,65,,4359.55,percent of total billed charges,All Other,4359.55,65,,4359.55,percent of total billed charges,All Other,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,270.64,,,270.64,Other,100% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,414.08,,,414.08,Other,153% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,378.9,,,378.9,Other,140% of Medicaid,608.94,,,608.94,Other,225% of Medicaid,703.67,,,703.67,Other,250% of Medicaid,876.88,,,876.88,Other,324% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,581.88,,,581.88,Other,215% of Medicaid,338.3,,,338.3,Other,125% of Medicaid,270.64,5759.82,
REM OBSTRUCTN FROM CVD,75901,CPT,TC,47075901,CDM,320,RC,,,both,,,1171,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,711.98,,,711.98,Fee Schedule,,640.56,,,640.56,Fee Schedule,,1004.26,,,1004.26,Fee Schedule,,903.47,,,903.47,Fee Schedule,,853.99,,,853.99,Fee Schedule,,819.7,70,,819.7,percent of total billed charges,All Other,845.89,,,845.89,Fee Schedule,,558,,,558,Other,186% of Medicaid,995.43,,,995.43,Fee Schedule,,726.02,,,726.02,Fee Schedule,,468.7,,,,Fee Schedule,,995.43,,,995.43,Fee Schedule,,726.02,,,726.02,Fee Schedule,,881.6,,,881.6,Fee Schedule,,819.7,70,,819.7,percent of total billed charges,,1066,,,1066,Fee Schedule,,903.5,,,903.5,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1066,
REMOVE CVD LUMEN OBSTRUCT,75902,CPT,TC,42075902,CDM,320,RC,,,both,,,406,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,242.79,,,242.79,Fee Schedule,,218.44,,,218.44,Fee Schedule,,404.64,,,404.64,Fee Schedule,,364.03,,,364.03,Fee Schedule,,344.09,,,344.09,Fee Schedule,,284.2,70,,284.2,percent of total billed charges,All Other,288.46,,,288.46,Fee Schedule,,558,,,558,Other,186% of Medicaid,339.45,,,339.45,Fee Schedule,,251.72,,,251.72,Fee Schedule,,159.83,,,,Fee Schedule,,339.45,,,339.45,Fee Schedule,,251.72,,,251.72,Fee Schedule,,300.63,,,300.63,Fee Schedule,,284.2,70,,284.2,percent of total billed charges,,370.64,,,370.64,Fee Schedule,,314.14,,,314.14,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
REMOVE CVD LUMEN OBSTRUCT FY MOD,75902,CPT,FY,42675902,CDM,320,RC,,,both,,,406,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,242.79,,,242.79,Fee Schedule,,218.44,,,218.44,Fee Schedule,,404.64,,,404.64,Fee Schedule,,364.03,,,364.03,Fee Schedule,,344.09,,,344.09,Fee Schedule,,284.2,70,,284.2,percent of total billed charges,All Other,288.46,,,288.46,Fee Schedule,,558,,,558,Other,186% of Medicaid,339.45,,,339.45,Fee Schedule,,251.72,,,251.72,Fee Schedule,,159.83,,,,Fee Schedule,,339.45,,,339.45,Fee Schedule,,251.72,,,251.72,Fee Schedule,,300.63,,,300.63,Fee Schedule,,284.2,70,,284.2,percent of total billed charges,,370.64,,,370.64,Fee Schedule,,314.14,,,314.14,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
REM CVD LUMEN OBSTR,75902,CPT,,47075902,CDM,320,RC,,,both,,,406,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,242.79,,,242.79,Fee Schedule,,218.44,,,218.44,Fee Schedule,,404.64,,,404.64,Fee Schedule,,364.03,,,364.03,Fee Schedule,,344.09,,,344.09,Fee Schedule,,284.2,70,,284.2,percent of total billed charges,All Other,288.46,,,288.46,Fee Schedule,,558,,,558,Other,186% of Medicaid,339.45,,,339.45,Fee Schedule,,251.72,,,251.72,Fee Schedule,,159.83,,,,Fee Schedule,,339.45,,,339.45,Fee Schedule,,251.72,,,251.72,Fee Schedule,,300.63,,,300.63,Fee Schedule,,284.2,70,,284.2,percent of total billed charges,,370.64,,,370.64,Fee Schedule,,314.14,,,314.14,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
XR CONTROL CATHETER CHANGE,75984,CPT,TC,42075984,CDM,320,RC,,,both,,,590,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.19,,,201.19,Fee Schedule,,181.01,,,181.01,Fee Schedule,,556.93,,,556.93,Fee Schedule,,501.04,,,501.04,Fee Schedule,,473.6,,,473.6,Fee Schedule,,413,70,,413,percent of total billed charges,All Other,239.04,,,239.04,Fee Schedule,,558,,,558,Other,186% of Medicaid,281.29,,,281.29,Fee Schedule,,365.8,,,365.8,Fee Schedule,,132.45,,,,Fee Schedule,,281.29,,,281.29,Fee Schedule,,365.8,,,365.8,Fee Schedule,,249.13,,,249.13,Fee Schedule,,413,70,,413,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
XR CONTROL CATHETER CHANGE FY MOD,75984,CPT,FY,42675984,CDM,320,RC,,,both,,,590,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.19,,,201.19,Fee Schedule,,181.01,,,181.01,Fee Schedule,,556.93,,,556.93,Fee Schedule,,501.04,,,501.04,Fee Schedule,,473.6,,,473.6,Fee Schedule,,413,70,,413,percent of total billed charges,All Other,239.04,,,239.04,Fee Schedule,,558,,,558,Other,186% of Medicaid,281.29,,,281.29,Fee Schedule,,365.8,,,365.8,Fee Schedule,,132.45,,,,Fee Schedule,,281.29,,,281.29,Fee Schedule,,365.8,,,365.8,Fee Schedule,,249.13,,,249.13,Fee Schedule,,413,70,,413,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
XRAY CONTROL CATHETER CHANGE,75984,CPT,TC,46075984,CDM,320,RC,,,both,,,590,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.19,,,201.19,Fee Schedule,,181.01,,,181.01,Fee Schedule,,556.93,,,556.93,Fee Schedule,,501.04,,,501.04,Fee Schedule,,473.6,,,473.6,Fee Schedule,,413,70,,413,percent of total billed charges,All Other,239.04,,,239.04,Fee Schedule,,558,,,558,Other,186% of Medicaid,281.29,,,281.29,Fee Schedule,,365.8,,,365.8,Fee Schedule,,132.45,,,,Fee Schedule,,281.29,,,281.29,Fee Schedule,,365.8,,,365.8,Fee Schedule,,249.13,,,249.13,Fee Schedule,,413,70,,413,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
XRAY CONTROL CATHETER CHANGE,75984,CPT,TC,47075984,CDM,320,RC,,,both,,,590,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,201.19,,,201.19,Fee Schedule,,181.01,,,181.01,Fee Schedule,,556.93,,,556.93,Fee Schedule,,501.04,,,501.04,Fee Schedule,,473.6,,,473.6,Fee Schedule,,413,70,,413,percent of total billed charges,All Other,239.04,,,239.04,Fee Schedule,,558,,,558,Other,186% of Medicaid,281.29,,,281.29,Fee Schedule,,365.8,,,365.8,Fee Schedule,,132.45,,,,Fee Schedule,,281.29,,,281.29,Fee Schedule,,365.8,,,365.8,Fee Schedule,,249.13,,,249.13,Fee Schedule,,413,70,,413,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
DRAINAGE CATH UNDER XR,75989,CPT,TC,47075989,CDM,320,RC,,,both,,,2125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.72,,,197.72,Fee Schedule,,177.88,,,177.88,Fee Schedule,,542.63,,,542.63,Fee Schedule,,488.17,,,488.17,Fee Schedule,,461.43,,,461.43,Fee Schedule,,1487.5,70,,1487.5,percent of total billed charges,All Other,234.9,,,234.9,Fee Schedule,,558,,,558,Other,186% of Medicaid,276.43,,,276.43,Fee Schedule,,1317.5,,,1317.5,Fee Schedule,,130.16,,,,Fee Schedule,,276.43,,,276.43,Fee Schedule,,1317.5,,,1317.5,Fee Schedule,,244.82,,,244.82,Fee Schedule,,1487.5,70,,1487.5,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1487.5,
FLUOROSCOPE EXAM =< 1 HR,76000,CPT,TC,42076000,CDM,320,RC,,,both,,,527,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,97.2,,,97.2,Fee Schedule,,87.45,,,87.45,Fee Schedule,,485.53,,,485.53,Fee Schedule,,436.8,,,436.8,Fee Schedule,,412.88,,,412.88,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,All Other,115.48,,,115.48,Fee Schedule,,406,,,406,Other,186% of Medicaid,135.9,,,135.9,Fee Schedule,,326.74,,,326.74,Fee Schedule,,63.99,,,,Fee Schedule,,135.9,,,135.9,Fee Schedule,,326.74,,,326.74,Fee Schedule,,120.36,,,120.36,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,,136.12,,,136.12,Fee Schedule,,115.37,,,115.37,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,63.99,706.37,
FLUOROSCOPE EXAM =< 1 HR FY MOD,76000,CPT,FY,42676000,CDM,320,RC,,,both,,,527,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,97.2,,,97.2,Fee Schedule,,87.45,,,87.45,Fee Schedule,,485.53,,,485.53,Fee Schedule,,436.8,,,436.8,Fee Schedule,,412.88,,,412.88,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,All Other,115.48,,,115.48,Fee Schedule,,406,,,406,Other,186% of Medicaid,135.9,,,135.9,Fee Schedule,,326.74,,,326.74,Fee Schedule,,63.99,,,,Fee Schedule,,135.9,,,135.9,Fee Schedule,,326.74,,,326.74,Fee Schedule,,120.36,,,120.36,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,,136.12,,,136.12,Fee Schedule,,115.37,,,115.37,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,63.99,706.37,
FLUOROSCOPE EXAM =< 1 HR W/ FY MOD,76000,CPT,FY,43076000,CDM,320,RC,,,both,,,527,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,97.2,,,97.2,Fee Schedule,,87.45,,,87.45,Fee Schedule,,485.53,,,485.53,Fee Schedule,,436.8,,,436.8,Fee Schedule,,412.88,,,412.88,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,All Other,115.48,,,115.48,Fee Schedule,,406,,,406,Other,186% of Medicaid,135.9,,,135.9,Fee Schedule,,326.74,,,326.74,Fee Schedule,,63.99,,,,Fee Schedule,,135.9,,,135.9,Fee Schedule,,326.74,,,326.74,Fee Schedule,,120.36,,,120.36,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,,136.12,,,136.12,Fee Schedule,,115.37,,,115.37,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,63.99,706.37,
FLUOROSCOPE EXAM =< 1 HR,76000,CPT,,47076000,CDM,320,RC,,,both,,,527,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,97.2,,,97.2,Fee Schedule,,87.45,,,87.45,Fee Schedule,,485.53,,,485.53,Fee Schedule,,436.8,,,436.8,Fee Schedule,,412.88,,,412.88,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,All Other,115.48,,,115.48,Fee Schedule,,406,,,406,Other,186% of Medicaid,135.9,,,135.9,Fee Schedule,,326.74,,,326.74,Fee Schedule,,63.99,,,,Fee Schedule,,135.9,,,135.9,Fee Schedule,,326.74,,,326.74,Fee Schedule,,120.36,,,120.36,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,,136.12,,,136.12,Fee Schedule,,115.37,,,115.37,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,63.99,706.37,
FLUOROSCOPE EXAM EXTENSIVE 1+ FY MOD,76001,CPT,FY,42676001,CDM,320,RC,,,both,,,825,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,536.25,65,,536.25,percent of total billed charges,All Other,486.75,59,,486.75,percent of total billed charges,All Other,97.09,,,97.09,Fee Schedule,,97.09,,,97.09,Fee Schedule,,97.09,,,97.09,Fee Schedule,,577.5,70,,577.5,percent of total billed charges,All Other,561,68,,561,percent of total billed charges,All Other,406,,,406,Other,186% of Medicaid,660,80,,660,percent of total billed charges,All Other,511.5,83,,511.5,percent of total billed charges,All Other,453.75,83,,,percent of total billed charges,All Other,660,80,,660,percent of total billed charges,All Other,511.5,83,,511.5,percent of total billed charges,All Other,660,80,,660,percent of total billed charges,All Other,577.5,70,,577.5,percent of total billed charges,,536.25,65,,536.25,percent of total billed charges,All Other,536.25,65,,536.25,percent of total billed charges,All Other,412.5,,,412.5,Fee Schedule,,412.5,,,412.5,Fee Schedule,,412.5,,,412.5,Fee Schedule,,412.5,,,412.5,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,0.01,706.37,
NOSE TO RECTUM FOR FB CHILD,76010,CPT,TC,42076010,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,130.97,,,130.97,Fee Schedule,,117.83,,,117.83,Fee Schedule,,111.37,,,111.37,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,90.34,,,90.34,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
NOSE TO RECTUM FOR FB CHILD FY MOD,76010,CPT,FY,42676010,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,130.97,,,130.97,Fee Schedule,,117.83,,,117.83,Fee Schedule,,111.37,,,111.37,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,90.34,,,90.34,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
NOSE TO RECTUM FOR FB CHILD W/ FY MOD,76010,CPT,FY,43076010,CDM,320,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,72.96,,,72.96,Fee Schedule,,65.64,,,65.64,Fee Schedule,,130.97,,,130.97,Fee Schedule,,117.83,,,117.83,Fee Schedule,,111.37,,,111.37,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,67,,,67,Other,186% of Medicaid,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,143.22,,,143.22,Fee Schedule,,90.34,,,90.34,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,164.2,
ABSCESS FISTULA/SINUS TRACT ST,76080,CPT,TC,42076080,CDM,320,RC,,,both,,,1134,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,122.62,,,122.62,Fee Schedule,,110.32,,,110.32,Fee Schedule,,249.94,,,249.94,Fee Schedule,,224.86,,,224.86,Fee Schedule,,212.54,,,212.54,Fee Schedule,,793.8,70,,793.8,percent of total billed charges,All Other,145.69,,,145.69,Fee Schedule,,406,,,406,Other,186% of Medicaid,171.44,,,171.44,Fee Schedule,,703.08,,,703.08,Fee Schedule,,80.72,,,,Fee Schedule,,171.44,,,171.44,Fee Schedule,,703.08,,,703.08,Fee Schedule,,151.84,,,151.84,Fee Schedule,,793.8,70,,793.8,percent of total billed charges,,175.48,,,175.48,Fee Schedule,,148.73,,,148.73,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,80.72,996.88,
ABSCESS FISTULA/SINUS TRACT ST FY MOD,76080,CPT,FY,42676080,CDM,320,RC,,,both,,,1134,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,122.62,,,122.62,Fee Schedule,,110.32,,,110.32,Fee Schedule,,249.94,,,249.94,Fee Schedule,,224.86,,,224.86,Fee Schedule,,212.54,,,212.54,Fee Schedule,,793.8,70,,793.8,percent of total billed charges,All Other,145.69,,,145.69,Fee Schedule,,406,,,406,Other,186% of Medicaid,171.44,,,171.44,Fee Schedule,,703.08,,,703.08,Fee Schedule,,80.72,,,,Fee Schedule,,171.44,,,171.44,Fee Schedule,,703.08,,,703.08,Fee Schedule,,151.84,,,151.84,Fee Schedule,,793.8,70,,793.8,percent of total billed charges,,175.48,,,175.48,Fee Schedule,,148.73,,,148.73,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,80.72,996.88,
ABSCESS FISTULA/SINUS TRACT ST,76080,CPT,TC,46076080,CDM,320,RC,,,both,,,1134,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,122.62,,,122.62,Fee Schedule,,110.32,,,110.32,Fee Schedule,,249.94,,,249.94,Fee Schedule,,224.86,,,224.86,Fee Schedule,,212.54,,,212.54,Fee Schedule,,793.8,70,,793.8,percent of total billed charges,All Other,145.69,,,145.69,Fee Schedule,,406,,,406,Other,186% of Medicaid,171.44,,,171.44,Fee Schedule,,703.08,,,703.08,Fee Schedule,,80.72,,,,Fee Schedule,,171.44,,,171.44,Fee Schedule,,703.08,,,703.08,Fee Schedule,,151.84,,,151.84,Fee Schedule,,793.8,70,,793.8,percent of total billed charges,,175.48,,,175.48,Fee Schedule,,148.73,,,148.73,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,80.72,996.88,
XR SURGICAL SPECIMEN RT,76098,CPT,RT,42176098,CDM,320,RC,,,both,,,1844,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,96.05,,,96.05,Fee Schedule,,86.42,,,86.42,Fee Schedule,,78.64,,,78.64,Fee Schedule,,70.75,,,70.75,Fee Schedule,,66.87,,,66.87,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,All Other,114.12,,,114.12,Fee Schedule,,406,,,406,Other,186% of Medicaid,134.29,,,134.29,Fee Schedule,,1143.28,,,1143.28,Fee Schedule,,63.23,,,,Fee Schedule,,134.29,,,134.29,Fee Schedule,,1143.28,,,1143.28,Fee Schedule,,118.93,,,118.93,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,63.23,1290.8,
XR SURGICAL SPECIMEN LT,76098,CPT,,42276098,CDM,320,RC,,,both,,,1844,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,96.05,,,96.05,Fee Schedule,,86.42,,,86.42,Fee Schedule,,78.64,,,78.64,Fee Schedule,,70.75,,,70.75,Fee Schedule,,66.87,,,66.87,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,All Other,114.12,,,114.12,Fee Schedule,,406,,,406,Other,186% of Medicaid,134.29,,,134.29,Fee Schedule,,1143.28,,,1143.28,Fee Schedule,,63.23,,,,Fee Schedule,,134.29,,,134.29,Fee Schedule,,1143.28,,,1143.28,Fee Schedule,,118.93,,,118.93,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,63.23,1290.8,
X-RAY BREAST SPECIMEN,76098,CPT,TC,54076098,CDM,320,RC,,,both,,,1844,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,96.05,,,96.05,Fee Schedule,,86.42,,,86.42,Fee Schedule,,78.64,,,78.64,Fee Schedule,,70.75,,,70.75,Fee Schedule,,66.87,,,66.87,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,All Other,114.12,,,114.12,Fee Schedule,,406,,,406,Other,186% of Medicaid,134.29,,,134.29,Fee Schedule,,1143.28,,,1143.28,Fee Schedule,,63.23,,,,Fee Schedule,,134.29,,,134.29,Fee Schedule,,1143.28,,,1143.28,Fee Schedule,,118.93,,,118.93,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,63.23,1290.8,
XR SURGICAL SPECIMEN LT,76098,CPT,TCLT,54176098,CDM,320,RC,,,both,,,1844,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,96.05,,,96.05,Fee Schedule,,86.42,,,86.42,Fee Schedule,,78.64,,,78.64,Fee Schedule,,70.75,,,70.75,Fee Schedule,,66.87,,,66.87,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,All Other,114.12,,,114.12,Fee Schedule,,406,,,406,Other,186% of Medicaid,134.29,,,134.29,Fee Schedule,,1143.28,,,1143.28,Fee Schedule,,63.23,,,,Fee Schedule,,134.29,,,134.29,Fee Schedule,,1143.28,,,1143.28,Fee Schedule,,118.93,,,118.93,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,63.23,1290.8,
XR SURGICAL SPECIMEN RT,76098,CPT,TCRT,54276098,CDM,320,RC,,,both,,,1844,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,96.05,,,96.05,Fee Schedule,,86.42,,,86.42,Fee Schedule,,78.64,,,78.64,Fee Schedule,,70.75,,,70.75,Fee Schedule,,66.87,,,66.87,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,All Other,114.12,,,114.12,Fee Schedule,,406,,,406,Other,186% of Medicaid,134.29,,,134.29,Fee Schedule,,1143.28,,,1143.28,Fee Schedule,,63.23,,,,Fee Schedule,,134.29,,,134.29,Fee Schedule,,1143.28,,,1143.28,Fee Schedule,,118.93,,,118.93,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,63.23,1290.8,
TOMOGRAM,76100,CPT,TC,42076100,CDM,320,RC,,,both,,,816,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,215.04,,,215.04,Fee Schedule,,193.47,,,193.47,Fee Schedule,,530.74,,,530.74,Fee Schedule,,477.47,,,477.47,Fee Schedule,,451.32,,,451.32,Fee Schedule,,571.2,70,,571.2,percent of total billed charges,All Other,255.48,,,255.48,Fee Schedule,,67,,,67,Other,186% of Medicaid,300.65,,,300.65,Fee Schedule,,505.92,,,505.92,Fee Schedule,,141.56,,,,Fee Schedule,,300.65,,,300.65,Fee Schedule,,505.92,,,505.92,Fee Schedule,,266.27,,,266.27,Fee Schedule,,571.2,70,,571.2,percent of total billed charges,,305.04,,,305.04,Fee Schedule,,258.54,,,258.54,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,571.2,
TOMOGRAM FY MOD,76100,CPT,FY,42676100,CDM,320,RC,,,both,,,816,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,215.04,,,215.04,Fee Schedule,,193.47,,,193.47,Fee Schedule,,530.74,,,530.74,Fee Schedule,,477.47,,,477.47,Fee Schedule,,451.32,,,451.32,Fee Schedule,,571.2,70,,571.2,percent of total billed charges,All Other,255.48,,,255.48,Fee Schedule,,67,,,67,Other,186% of Medicaid,300.65,,,300.65,Fee Schedule,,505.92,,,505.92,Fee Schedule,,141.56,,,,Fee Schedule,,300.65,,,300.65,Fee Schedule,,505.92,,,505.92,Fee Schedule,,266.27,,,266.27,Fee Schedule,,571.2,70,,571.2,percent of total billed charges,,305.04,,,305.04,Fee Schedule,,258.54,,,258.54,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,571.2,
CINE/VIDEO X-RAYS,76120,CPT,,42076120,CDM,320,RC,,,both,,,399,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,343.28,,,343.28,Fee Schedule,,308.84,,,308.84,Fee Schedule,,407,,,407,Fee Schedule,,366.15,,,366.15,Fee Schedule,,346.1,,,346.1,Fee Schedule,,279.3,70,,279.3,percent of total billed charges,All Other,407.84,,,407.84,Fee Schedule,,67,,,67,Other,186% of Medicaid,479.94,,,479.94,Fee Schedule,,247.38,,,247.38,Fee Schedule,,225.98,,,,Fee Schedule,,479.94,,,479.94,Fee Schedule,,247.38,,,247.38,Fee Schedule,,425.06,,,425.06,Fee Schedule,,279.3,70,,279.3,percent of total billed charges,,477.24,,,477.24,Fee Schedule,,404.49,,,404.49,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,479.94,
CINE/VIDEO X-RAYS,76120,CPT,,49176120,CDM,320,RC,,,both,,,399,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,343.28,,,343.28,Fee Schedule,,308.84,,,308.84,Fee Schedule,,407,,,407,Fee Schedule,,366.15,,,366.15,Fee Schedule,,346.1,,,346.1,Fee Schedule,,279.3,70,,279.3,percent of total billed charges,All Other,407.84,,,407.84,Fee Schedule,,67,,,67,Other,186% of Medicaid,479.94,,,479.94,Fee Schedule,,247.38,,,247.38,Fee Schedule,,225.98,,,,Fee Schedule,,479.94,,,479.94,Fee Schedule,,247.38,,,247.38,Fee Schedule,,425.06,,,425.06,Fee Schedule,,279.3,70,,279.3,percent of total billed charges,,477.24,,,477.24,Fee Schedule,,404.49,,,404.49,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,479.94,
FLUOROSCOPIC GUIDANCE FOR CV,77001,CPT,TC,42077001,CDM,320,RC,,,both,,,581,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.91,,,280.91,Fee Schedule,,252.73,,,252.73,Fee Schedule,,668.72,,,668.72,Fee Schedule,,601.61,,,601.61,Fee Schedule,,568.66,,,568.66,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,All Other,333.75,,,333.75,Fee Schedule,,558,,,558,Other,186% of Medicaid,392.75,,,392.75,Fee Schedule,,360.22,,,360.22,Fee Schedule,,184.93,,,,Fee Schedule,,392.75,,,392.75,Fee Schedule,,360.22,,,360.22,Fee Schedule,,347.84,,,347.84,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,,416.56,,,416.56,Fee Schedule,,353.06,,,353.06,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
FLUOROSCOPIC GUIDANCE FOR CV FY MOD,77001,CPT,FY,42677001,CDM,320,RC,,,both,,,581,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.91,,,280.91,Fee Schedule,,252.73,,,252.73,Fee Schedule,,668.72,,,668.72,Fee Schedule,,601.61,,,601.61,Fee Schedule,,568.66,,,568.66,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,All Other,333.75,,,333.75,Fee Schedule,,558,,,558,Other,186% of Medicaid,392.75,,,392.75,Fee Schedule,,360.22,,,360.22,Fee Schedule,,184.93,,,,Fee Schedule,,392.75,,,392.75,Fee Schedule,,360.22,,,360.22,Fee Schedule,,347.84,,,347.84,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,,416.56,,,416.56,Fee Schedule,,353.06,,,353.06,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
FLUOROSCOPIC GUIDANCE FOR CV W/ FY MOD,77001,CPT,FY,43077001,CDM,320,RC,,,both,,,581,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.91,,,280.91,Fee Schedule,,252.73,,,252.73,Fee Schedule,,668.72,,,668.72,Fee Schedule,,601.61,,,601.61,Fee Schedule,,568.66,,,568.66,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,All Other,333.75,,,333.75,Fee Schedule,,558,,,558,Other,186% of Medicaid,392.75,,,392.75,Fee Schedule,,360.22,,,360.22,Fee Schedule,,184.93,,,,Fee Schedule,,392.75,,,392.75,Fee Schedule,,360.22,,,360.22,Fee Schedule,,347.84,,,347.84,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,,416.56,,,416.56,Fee Schedule,,353.06,,,353.06,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
FLUOROGUIDE FOR VEIN DEVICE,77001,CPT,,47077001,CDM,320,RC,,,both,,,581,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,280.91,,,280.91,Fee Schedule,,252.73,,,252.73,Fee Schedule,,668.72,,,668.72,Fee Schedule,,601.61,,,601.61,Fee Schedule,,568.66,,,568.66,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,All Other,333.75,,,333.75,Fee Schedule,,558,,,558,Other,186% of Medicaid,392.75,,,392.75,Fee Schedule,,360.22,,,360.22,Fee Schedule,,184.93,,,,Fee Schedule,,392.75,,,392.75,Fee Schedule,,360.22,,,360.22,Fee Schedule,,347.84,,,347.84,Fee Schedule,,406.7,70,,406.7,percent of total billed charges,,416.56,,,416.56,Fee Schedule,,353.06,,,353.06,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
NEEDLE LOCALIZATION BY XR,77002,CPT,TC,42077002,CDM,320,RC,,,both,,,577,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,310.93,,,310.93,Fee Schedule,,279.74,,,279.74,Fee Schedule,,338.01,,,338.01,Fee Schedule,,304.08,,,304.08,Fee Schedule,,287.43,,,287.43,Fee Schedule,,403.9,70,,403.9,percent of total billed charges,All Other,369.41,,,369.41,Fee Schedule,,558,,,558,Other,186% of Medicaid,434.72,,,434.72,Fee Schedule,,357.74,,,357.74,Fee Schedule,,204.69,,,,Fee Schedule,,434.72,,,434.72,Fee Schedule,,357.74,,,357.74,Fee Schedule,,385.01,,,385.01,Fee Schedule,,403.9,70,,403.9,percent of total billed charges,,441.16,,,441.16,Fee Schedule,,373.91,,,373.91,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
NEEDLE LOCALIZATION BY XR FY MOD,77002,CPT,FY,42677002,CDM,320,RC,,,both,,,577,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,310.93,,,310.93,Fee Schedule,,279.74,,,279.74,Fee Schedule,,338.01,,,338.01,Fee Schedule,,304.08,,,304.08,Fee Schedule,,287.43,,,287.43,Fee Schedule,,403.9,70,,403.9,percent of total billed charges,All Other,369.41,,,369.41,Fee Schedule,,558,,,558,Other,186% of Medicaid,434.72,,,434.72,Fee Schedule,,357.74,,,357.74,Fee Schedule,,204.69,,,,Fee Schedule,,434.72,,,434.72,Fee Schedule,,357.74,,,357.74,Fee Schedule,,385.01,,,385.01,Fee Schedule,,403.9,70,,403.9,percent of total billed charges,,441.16,,,441.16,Fee Schedule,,373.91,,,373.91,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
NEEDLE LOCALIZATION BY XR W/ FY MOD,77002,CPT,FY,43077002,CDM,320,RC,,,both,,,577,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,310.93,,,310.93,Fee Schedule,,279.74,,,279.74,Fee Schedule,,338.01,,,338.01,Fee Schedule,,304.08,,,304.08,Fee Schedule,,287.43,,,287.43,Fee Schedule,,403.9,70,,403.9,percent of total billed charges,All Other,369.41,,,369.41,Fee Schedule,,558,,,558,Other,186% of Medicaid,434.72,,,434.72,Fee Schedule,,357.74,,,357.74,Fee Schedule,,204.69,,,,Fee Schedule,,434.72,,,434.72,Fee Schedule,,357.74,,,357.74,Fee Schedule,,385.01,,,385.01,Fee Schedule,,403.9,70,,403.9,percent of total billed charges,,441.16,,,441.16,Fee Schedule,,373.91,,,373.91,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
NEEDLE LOCALIZATION BY XRAY,77002,CPT,,47077002,CDM,320,RC,,,both,,,577,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,310.93,,,310.93,Fee Schedule,,279.74,,,279.74,Fee Schedule,,338.01,,,338.01,Fee Schedule,,304.08,,,304.08,Fee Schedule,,287.43,,,287.43,Fee Schedule,,403.9,70,,403.9,percent of total billed charges,All Other,369.41,,,369.41,Fee Schedule,,558,,,558,Other,186% of Medicaid,434.72,,,434.72,Fee Schedule,,357.74,,,357.74,Fee Schedule,,204.69,,,,Fee Schedule,,434.72,,,434.72,Fee Schedule,,357.74,,,357.74,Fee Schedule,,385.01,,,385.01,Fee Schedule,,403.9,70,,403.9,percent of total billed charges,,441.16,,,441.16,Fee Schedule,,373.91,,,373.91,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
FLUOROGUIDE FOR SPINE INJECT,77003,CPT,TC,42077003,CDM,320,RC,,,both,,,618,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,267.03,,,267.03,Fee Schedule,,240.25,,,240.25,Fee Schedule,,230.93,,,230.93,Fee Schedule,,207.75,,,207.75,Fee Schedule,,196.37,,,196.37,Fee Schedule,,432.6,70,,432.6,percent of total billed charges,All Other,317.26,,,317.26,Fee Schedule,,558,,,558,Other,186% of Medicaid,373.35,,,373.35,Fee Schedule,,383.16,,,383.16,Fee Schedule,,175.79,,,,Fee Schedule,,373.35,,,373.35,Fee Schedule,,383.16,,,383.16,Fee Schedule,,330.65,,,330.65,Fee Schedule,,432.6,70,,432.6,percent of total billed charges,,378.84,,,378.84,Fee Schedule,,321.09,,,321.09,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
FLUOROGUIDE FOR SPINE INJECT FY MOD,77003,CPT,FY,42677003,CDM,320,RC,,,both,,,618,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,267.03,,,267.03,Fee Schedule,,240.25,,,240.25,Fee Schedule,,230.93,,,230.93,Fee Schedule,,207.75,,,207.75,Fee Schedule,,196.37,,,196.37,Fee Schedule,,432.6,70,,432.6,percent of total billed charges,All Other,317.26,,,317.26,Fee Schedule,,558,,,558,Other,186% of Medicaid,373.35,,,373.35,Fee Schedule,,383.16,,,383.16,Fee Schedule,,175.79,,,,Fee Schedule,,373.35,,,373.35,Fee Schedule,,383.16,,,383.16,Fee Schedule,,330.65,,,330.65,Fee Schedule,,432.6,70,,432.6,percent of total billed charges,,378.84,,,378.84,Fee Schedule,,321.09,,,321.09,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
FLUOROGUIDE FOR SPINE INJECT,77003,CPT,,47077003,CDM,320,RC,,,both,,,618,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,267.03,,,267.03,Fee Schedule,,240.25,,,240.25,Fee Schedule,,230.93,,,230.93,Fee Schedule,,207.75,,,207.75,Fee Schedule,,196.37,,,196.37,Fee Schedule,,432.6,70,,432.6,percent of total billed charges,All Other,317.26,,,317.26,Fee Schedule,,558,,,558,Other,186% of Medicaid,373.35,,,373.35,Fee Schedule,,383.16,,,383.16,Fee Schedule,,175.79,,,,Fee Schedule,,373.35,,,373.35,Fee Schedule,,383.16,,,383.16,Fee Schedule,,330.65,,,330.65,Fee Schedule,,432.6,70,,432.6,percent of total billed charges,,378.84,,,378.84,Fee Schedule,,321.09,,,321.09,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,971.61,
X-RAY OF MAMMARY DUCT,77053,CPT,TC,54077053,CDM,320,RC,,,both,,,894,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,128.4,,,128.4,Fee Schedule,,115.52,,,115.52,Fee Schedule,,352.25,,,352.25,Fee Schedule,,316.9,,,316.9,Fee Schedule,,299.54,,,299.54,Fee Schedule,,625.8,70,,625.8,percent of total billed charges,All Other,152.55,,,152.55,Fee Schedule,,406,,,406,Other,186% of Medicaid,179.52,,,179.52,Fee Schedule,,554.28,,,554.28,Fee Schedule,,84.53,,,,Fee Schedule,,179.52,,,179.52,Fee Schedule,,554.28,,,554.28,Fee Schedule,,158.99,,,158.99,Fee Schedule,,625.8,70,,625.8,percent of total billed charges,,177.12,,,177.12,Fee Schedule,,150.12,,,150.12,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,84.53,706.37,
X-RAY OF MAMMARY DUCTS,77054,CPT,TC,54077054,CDM,320,RC,,,both,,,1120,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,167.7,,,167.7,Fee Schedule,,150.88,,,150.88,Fee Schedule,,485.53,,,485.53,Fee Schedule,,436.8,,,436.8,Fee Schedule,,412.88,,,412.88,Fee Schedule,,784,70,,784,percent of total billed charges,All Other,199.24,,,199.24,Fee Schedule,,406,,,406,Other,186% of Medicaid,234.46,,,234.46,Fee Schedule,,694.4,,,694.4,Fee Schedule,,110.4,,,,Fee Schedule,,234.46,,,234.46,Fee Schedule,,694.4,,,694.4,Fee Schedule,,207.65,,,207.65,Fee Schedule,,784,70,,784,percent of total billed charges,,232.88,,,232.88,Fee Schedule,,197.38,,,197.38,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,110.4,784,
XR FOR BONE AGE,77072,CPT,TC,42077072,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,59.08,,,59.08,Fee Schedule,,53.15,,,53.15,Fee Schedule,,100.06,,,100.06,Fee Schedule,,90.02,,,90.02,Fee Schedule,,85.09,,,85.09,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,70.19,,,70.19,Fee Schedule,,67,,,67,Other,186% of Medicaid,82.6,,,82.6,Fee Schedule,,150.04,,,150.04,Fee Schedule,,38.89,,,,Fee Schedule,,82.6,,,82.6,Fee Schedule,,150.04,,,150.04,Fee Schedule,,73.15,,,73.15,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,83.64,,,83.64,Fee Schedule,,70.89,,,70.89,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR FOR BONE AGE FY MOD,77072,CPT,FY,42677072,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,59.08,,,59.08,Fee Schedule,,53.15,,,53.15,Fee Schedule,,100.06,,,100.06,Fee Schedule,,90.02,,,90.02,Fee Schedule,,85.09,,,85.09,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,70.19,,,70.19,Fee Schedule,,67,,,67,Other,186% of Medicaid,82.6,,,82.6,Fee Schedule,,150.04,,,150.04,Fee Schedule,,38.89,,,,Fee Schedule,,82.6,,,82.6,Fee Schedule,,150.04,,,150.04,Fee Schedule,,73.15,,,73.15,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,83.64,,,83.64,Fee Schedule,,70.89,,,70.89,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR FOR BONE AGE W/ FY MOD,77072,CPT,FY,43077072,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,59.08,,,59.08,Fee Schedule,,53.15,,,53.15,Fee Schedule,,100.06,,,100.06,Fee Schedule,,90.02,,,90.02,Fee Schedule,,85.09,,,85.09,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,70.19,,,70.19,Fee Schedule,,67,,,67,Other,186% of Medicaid,82.6,,,82.6,Fee Schedule,,150.04,,,150.04,Fee Schedule,,38.89,,,,Fee Schedule,,82.6,,,82.6,Fee Schedule,,150.04,,,150.04,Fee Schedule,,73.15,,,73.15,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,83.64,,,83.64,Fee Schedule,,70.89,,,70.89,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
X-RAYS BONE LENGTH STUDIES,77073,CPT,TC,46077073,CDM,320,RC,,,both,,,242,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,112.22,,,112.22,Fee Schedule,,100.97,,,100.97,Fee Schedule,,171.41,,,171.41,Fee Schedule,,154.21,,,154.21,Fee Schedule,,145.76,,,145.76,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,All Other,133.33,,,133.33,Fee Schedule,,67,,,67,Other,186% of Medicaid,156.9,,,156.9,Fee Schedule,,150.04,,,150.04,Fee Schedule,,73.88,,,,Fee Schedule,,156.9,,,156.9,Fee Schedule,,150.04,,,150.04,Fee Schedule,,138.96,,,138.96,Fee Schedule,,169.4,70,,169.4,percent of total billed charges,,157.44,,,157.44,Fee Schedule,,133.44,,,133.44,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,198.66,
XR BONE SURVEY LIMITED,77074,CPT,TC,42077074,CDM,320,RC,,,both,,,331,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,154.97,,,154.97,Fee Schedule,,139.42,,,139.42,Fee Schedule,,333.24,,,333.24,Fee Schedule,,299.79,,,299.79,Fee Schedule,,283.37,,,283.37,Fee Schedule,,231.7,70,,231.7,percent of total billed charges,All Other,184.12,,,184.12,Fee Schedule,,67,,,67,Other,186% of Medicaid,216.67,,,216.67,Fee Schedule,,205.22,,,205.22,Fee Schedule,,102.02,,,,Fee Schedule,,216.67,,,216.67,Fee Schedule,,205.22,,,205.22,Fee Schedule,,191.89,,,191.89,Fee Schedule,,231.7,70,,231.7,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,333.24,
XR BONE SURVEY LIMITED FY MOD,77074,CPT,FY,42677074,CDM,320,RC,,,both,,,331,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,154.97,,,154.97,Fee Schedule,,139.42,,,139.42,Fee Schedule,,333.24,,,333.24,Fee Schedule,,299.79,,,299.79,Fee Schedule,,283.37,,,283.37,Fee Schedule,,231.7,70,,231.7,percent of total billed charges,All Other,184.12,,,184.12,Fee Schedule,,67,,,67,Other,186% of Medicaid,216.67,,,216.67,Fee Schedule,,205.22,,,205.22,Fee Schedule,,102.02,,,,Fee Schedule,,216.67,,,216.67,Fee Schedule,,205.22,,,205.22,Fee Schedule,,191.89,,,191.89,Fee Schedule,,231.7,70,,231.7,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,333.24,
XR BONE SURVEY LIMITED W/ FY MOD,77074,CPT,FY,43077074,CDM,320,RC,,,both,,,331,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,154.97,,,154.97,Fee Schedule,,139.42,,,139.42,Fee Schedule,,333.24,,,333.24,Fee Schedule,,299.79,,,299.79,Fee Schedule,,283.37,,,283.37,Fee Schedule,,231.7,70,,231.7,percent of total billed charges,All Other,184.12,,,184.12,Fee Schedule,,67,,,67,Other,186% of Medicaid,216.67,,,216.67,Fee Schedule,,205.22,,,205.22,Fee Schedule,,102.02,,,,Fee Schedule,,216.67,,,216.67,Fee Schedule,,205.22,,,205.22,Fee Schedule,,191.89,,,191.89,Fee Schedule,,231.7,70,,231.7,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,333.24,
XR BONE SURVEY COMPLETE,77075,CPT,TC,42077075,CDM,320,RC,,,both,,,534,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,255.65,,,255.65,Fee Schedule,,230,,,230,Fee Schedule,,530.74,,,530.74,Fee Schedule,,477.47,,,477.47,Fee Schedule,,451.32,,,451.32,Fee Schedule,,373.8,70,,373.8,percent of total billed charges,All Other,303.73,,,303.73,Fee Schedule,,406,,,406,Other,186% of Medicaid,357.42,,,357.42,Fee Schedule,,331.08,,,331.08,Fee Schedule,,168.29,,,,Fee Schedule,,357.42,,,357.42,Fee Schedule,,331.08,,,331.08,Fee Schedule,,316.55,,,316.55,Fee Schedule,,373.8,70,,373.8,percent of total billed charges,,359.16,,,359.16,Fee Schedule,,304.41,,,304.41,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,120.81,706.37,
XR BONE SURVEY COMPLETE FY MOD,77075,CPT,FY,42677075,CDM,320,RC,,,both,,,534,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,255.65,,,255.65,Fee Schedule,,230,,,230,Fee Schedule,,530.74,,,530.74,Fee Schedule,,477.47,,,477.47,Fee Schedule,,451.32,,,451.32,Fee Schedule,,373.8,70,,373.8,percent of total billed charges,All Other,303.73,,,303.73,Fee Schedule,,406,,,406,Other,186% of Medicaid,357.42,,,357.42,Fee Schedule,,331.08,,,331.08,Fee Schedule,,168.29,,,,Fee Schedule,,357.42,,,357.42,Fee Schedule,,331.08,,,331.08,Fee Schedule,,316.55,,,316.55,Fee Schedule,,373.8,70,,373.8,percent of total billed charges,,359.16,,,359.16,Fee Schedule,,304.41,,,304.41,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,120.81,706.37,
XR BONE SURVEY COMPLETE W/ FY MOD,77075,CPT,FY,43077075,CDM,320,RC,,,both,,,534,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,255.65,,,255.65,Fee Schedule,,230,,,230,Fee Schedule,,530.74,,,530.74,Fee Schedule,,477.47,,,477.47,Fee Schedule,,451.32,,,451.32,Fee Schedule,,373.8,70,,373.8,percent of total billed charges,All Other,303.73,,,303.73,Fee Schedule,,406,,,406,Other,186% of Medicaid,357.42,,,357.42,Fee Schedule,,331.08,,,331.08,Fee Schedule,,168.29,,,,Fee Schedule,,357.42,,,357.42,Fee Schedule,,331.08,,,331.08,Fee Schedule,,316.55,,,316.55,Fee Schedule,,373.8,70,,373.8,percent of total billed charges,,359.16,,,359.16,Fee Schedule,,304.41,,,304.41,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,120.81,706.37,
XR BONE SURVEY INFANT,77076,CPT,TC,42077076,CDM,320,RC,,,both,,,510,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,257.98,,,257.98,Fee Schedule,,232.1,,,232.1,Fee Schedule,,466.51,,,466.51,Fee Schedule,,419.69,,,419.69,Fee Schedule,,396.71,,,396.71,Fee Schedule,,357,70,,357,percent of total billed charges,All Other,306.5,,,306.5,Fee Schedule,,67,,,67,Other,186% of Medicaid,360.68,,,360.68,Fee Schedule,,316.2,,,316.2,Fee Schedule,,169.83,,,,Fee Schedule,,360.68,,,360.68,Fee Schedule,,316.2,,,316.2,Fee Schedule,,319.44,,,319.44,Fee Schedule,,357,70,,357,percent of total billed charges,,362.44,,,362.44,Fee Schedule,,307.19,,,307.19,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,466.51,
XR BONE SURVEY INFANT FY MOD,77076,CPT,FY,42677076,CDM,320,RC,,,both,,,510,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,257.98,,,257.98,Fee Schedule,,232.1,,,232.1,Fee Schedule,,466.51,,,466.51,Fee Schedule,,419.69,,,419.69,Fee Schedule,,396.71,,,396.71,Fee Schedule,,357,70,,357,percent of total billed charges,All Other,306.5,,,306.5,Fee Schedule,,67,,,67,Other,186% of Medicaid,360.68,,,360.68,Fee Schedule,,316.2,,,316.2,Fee Schedule,,169.83,,,,Fee Schedule,,360.68,,,360.68,Fee Schedule,,316.2,,,316.2,Fee Schedule,,319.44,,,319.44,Fee Schedule,,357,70,,357,percent of total billed charges,,362.44,,,362.44,Fee Schedule,,307.19,,,307.19,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,466.51,
XR BONE SURVEY INFANT W/ FY MOD,77076,CPT,FY,43077076,CDM,320,RC,,,both,,,510,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,257.98,,,257.98,Fee Schedule,,232.1,,,232.1,Fee Schedule,,466.51,,,466.51,Fee Schedule,,419.69,,,419.69,Fee Schedule,,396.71,,,396.71,Fee Schedule,,357,70,,357,percent of total billed charges,All Other,306.5,,,306.5,Fee Schedule,,67,,,67,Other,186% of Medicaid,360.68,,,360.68,Fee Schedule,,316.2,,,316.2,Fee Schedule,,169.83,,,,Fee Schedule,,360.68,,,360.68,Fee Schedule,,316.2,,,316.2,Fee Schedule,,319.44,,,319.44,Fee Schedule,,357,70,,357,percent of total billed charges,,362.44,,,362.44,Fee Schedule,,307.19,,,307.19,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,466.51,
BONE DENSITY STUDY DEXA W/ FY MOD,77080,CPT,FY,43077080,CDM,320,RC,,,both,,,683,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,608.17,,,608.17,Fee Schedule,,547.13,,,547.13,Fee Schedule,,517.17,,,517.17,Fee Schedule,,478.1,70,,478.1,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,267,,,267,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,423.46,,,423.46,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,423.46,,,423.46,Fee Schedule,,127.51,,,127.51,Fee Schedule,,478.1,70,,478.1,percent of total billed charges,,134.48,,,134.48,Fee Schedule,,113.98,,,113.98,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,143.28,,,143.28,Other,100% of Medicaid,143.28,,,143.28,Other,100% of Medicaid,143.28,,,143.28,Other,100% of Medicaid,143.28,,,143.28,Other,100% of Medicaid,322.39,,,322.39,Other,225% of Medicaid,219.22,,,219.22,Other,153% of Medicaid,322.39,,,322.39,Other,225% of Medicaid,200.6,,,200.6,Other,140% of Medicaid,322.39,,,322.39,Other,225% of Medicaid,372.53,,,372.53,Other,250% of Medicaid,464.24,,,464.24,Other,324% of Medicaid,308.06,,,308.06,Other,215% of Medicaid,308.06,,,308.06,Other,215% of Medicaid,179.1,,,179.1,Other,125% of Medicaid,67.79,608.17,
BONE DENSITY STUDY DEXA,77080,CPT,TC,54077080,CDM,320,RC,,,both,,,683,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,102.97,,,102.97,Fee Schedule,,92.64,,,92.64,Fee Schedule,,608.17,,,608.17,Fee Schedule,,547.13,,,547.13,Fee Schedule,,517.17,,,517.17,Fee Schedule,,478.1,70,,478.1,percent of total billed charges,All Other,122.34,,,122.34,Fee Schedule,,267,,,267,Other,186% of Medicaid,143.97,,,143.97,Fee Schedule,,423.46,,,423.46,Fee Schedule,,67.79,,,,Fee Schedule,,143.97,,,143.97,Fee Schedule,,423.46,,,423.46,Fee Schedule,,127.51,,,127.51,Fee Schedule,,478.1,70,,478.1,percent of total billed charges,,134.48,,,134.48,Fee Schedule,,113.98,,,113.98,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,143.28,,,143.28,Other,100% of Medicaid,143.28,,,143.28,Other,100% of Medicaid,143.28,,,143.28,Other,100% of Medicaid,143.28,,,143.28,Other,100% of Medicaid,322.39,,,322.39,Other,225% of Medicaid,219.22,,,219.22,Other,153% of Medicaid,322.39,,,322.39,Other,225% of Medicaid,200.6,,,200.6,Other,140% of Medicaid,322.39,,,322.39,Other,225% of Medicaid,372.53,,,372.53,Other,250% of Medicaid,464.24,,,464.24,Other,324% of Medicaid,308.06,,,308.06,Other,215% of Medicaid,308.06,,,308.06,Other,215% of Medicaid,179.1,,,179.1,Other,125% of Medicaid,67.79,608.17,
BONE DENSITY PERIPHERAL,77081,CPT,TC,54077081,CDM,320,RC,,,both,,,1041,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,77.58,,,77.58,Fee Schedule,,69.8,,,69.8,Fee Schedule,,133.38,,,133.38,Fee Schedule,,120,,,120,Fee Schedule,,113.42,,,113.42,Fee Schedule,,728.7,70,,728.7,percent of total billed charges,All Other,92.17,,,92.17,Fee Schedule,,267,,,267,Other,186% of Medicaid,108.47,,,108.47,Fee Schedule,,645.42,,,645.42,Fee Schedule,,51.07,,,,Fee Schedule,,108.47,,,108.47,Fee Schedule,,645.42,,,645.42,Fee Schedule,,96.06,,,96.06,Fee Schedule,,728.7,70,,728.7,percent of total billed charges,,103.32,,,103.32,Fee Schedule,,87.57,,,87.57,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,143.28,,,143.28,Other,100% of Medicaid,143.28,,,143.28,Other,100% of Medicaid,143.28,,,143.28,Other,100% of Medicaid,143.28,,,143.28,Other,100% of Medicaid,322.39,,,322.39,Other,225% of Medicaid,219.22,,,219.22,Other,153% of Medicaid,322.39,,,322.39,Other,225% of Medicaid,200.6,,,200.6,Other,140% of Medicaid,322.39,,,322.39,Other,225% of Medicaid,372.53,,,372.53,Other,250% of Medicaid,464.24,,,464.24,Other,324% of Medicaid,308.06,,,308.06,Other,215% of Medicaid,308.06,,,308.06,Other,215% of Medicaid,179.1,,,179.1,Other,125% of Medicaid,51.07,728.7,
TMJ JOINT ARTHROGRAPHY,70332,CPT,TC,42070332,CDM,322,RC,,,both,,,527,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,198.86,,,198.86,Fee Schedule,,178.92,,,178.92,Fee Schedule,,402.23,,,402.23,Fee Schedule,,361.86,,,361.86,Fee Schedule,,342.04,,,342.04,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,All Other,236.27,,,236.27,Fee Schedule,,406,,,406,Other,186% of Medicaid,278.04,,,278.04,Fee Schedule,,326.74,,,326.74,Fee Schedule,,130.91,,,,Fee Schedule,,278.04,,,278.04,Fee Schedule,,326.74,,,326.74,Fee Schedule,,246.24,,,246.24,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,130.91,706.37,
TMJ JOINT ARTHROGRAPHY W/ FY MOD,70332,CPT,FY,42670332,CDM,322,RC,,,both,,,527,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,198.86,,,198.86,Fee Schedule,,178.92,,,178.92,Fee Schedule,,402.23,,,402.23,Fee Schedule,,361.86,,,361.86,Fee Schedule,,342.04,,,342.04,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,All Other,236.27,,,236.27,Fee Schedule,,406,,,406,Other,186% of Medicaid,278.04,,,278.04,Fee Schedule,,326.74,,,326.74,Fee Schedule,,130.91,,,,Fee Schedule,,278.04,,,278.04,Fee Schedule,,326.74,,,326.74,Fee Schedule,,246.24,,,246.24,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,130.91,706.37,
TMJ JOINT ARTHROGRAPHY W/ FY MOD,70332,CPT,FY,43070332,CDM,322,RC,,,both,,,527,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,198.86,,,198.86,Fee Schedule,,178.92,,,178.92,Fee Schedule,,402.23,,,402.23,Fee Schedule,,361.86,,,361.86,Fee Schedule,,342.04,,,342.04,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,All Other,236.27,,,236.27,Fee Schedule,,406,,,406,Other,186% of Medicaid,278.04,,,278.04,Fee Schedule,,326.74,,,326.74,Fee Schedule,,130.91,,,,Fee Schedule,,278.04,,,278.04,Fee Schedule,,326.74,,,326.74,Fee Schedule,,246.24,,,246.24,Fee Schedule,,368.9,70,,368.9,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,130.91,706.37,
XR SHOULDER ARTHROGRAM LT,73040,CPT,TCLT,42173040,CDM,322,RC,,,both,,,1307,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,365.22,,,365.22,Fee Schedule,,328.59,,,328.59,Fee Schedule,,566.41,,,566.41,Fee Schedule,,509.56,,,509.56,Fee Schedule,,481.66,,,481.66,Fee Schedule,,914.9,70,,914.9,percent of total billed charges,All Other,433.92,,,433.92,Fee Schedule,,406,,,406,Other,186% of Medicaid,510.63,,,510.63,Fee Schedule,,810.34,,,810.34,Fee Schedule,,240.43,,,,Fee Schedule,,510.63,,,510.63,Fee Schedule,,810.34,,,810.34,Fee Schedule,,452.24,,,452.24,Fee Schedule,,914.9,70,,914.9,percent of total billed charges,,521.52,,,521.52,Fee Schedule,,442.02,,,442.02,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,914.9,
XR SHOULDER ARTHROGRAM RT,73040,CPT,TCRT,42273040,CDM,322,RC,,,both,,,1307,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,365.22,,,365.22,Fee Schedule,,328.59,,,328.59,Fee Schedule,,566.41,,,566.41,Fee Schedule,,509.56,,,509.56,Fee Schedule,,481.66,,,481.66,Fee Schedule,,914.9,70,,914.9,percent of total billed charges,All Other,433.92,,,433.92,Fee Schedule,,406,,,406,Other,186% of Medicaid,510.63,,,510.63,Fee Schedule,,810.34,,,810.34,Fee Schedule,,240.43,,,,Fee Schedule,,510.63,,,510.63,Fee Schedule,,810.34,,,810.34,Fee Schedule,,452.24,,,452.24,Fee Schedule,,914.9,70,,914.9,percent of total billed charges,,521.52,,,521.52,Fee Schedule,,442.02,,,442.02,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,914.9,
XR SHOULDER ARTHROGRAM BILAT,73040,CPT,TC50,42373040,CDM,322,RC,,,both,,,1961,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,365.22,,,365.22,Fee Schedule,,328.59,,,328.59,Fee Schedule,,566.41,,,566.41,Fee Schedule,,509.56,,,509.56,Fee Schedule,,481.66,,,481.66,Fee Schedule,,1372.7,70,,1372.7,percent of total billed charges,All Other,433.92,,,433.92,Fee Schedule,,406,,,406,Other,186% of Medicaid,510.63,,,510.63,Fee Schedule,,1215.82,,,1215.82,Fee Schedule,,240.43,,,,Fee Schedule,,510.63,,,510.63,Fee Schedule,,1215.82,,,1215.82,Fee Schedule,,452.24,,,452.24,Fee Schedule,,1372.7,70,,1372.7,percent of total billed charges,,521.52,,,521.52,Fee Schedule,,442.02,,,442.02,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1372.7,
XR SHOULDER ARTHROGRAM LT FY MOD,73040,CPT,FYLT,42773040,CDM,322,RC,,,both,,,1307,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,365.22,,,365.22,Fee Schedule,,328.59,,,328.59,Fee Schedule,,566.41,,,566.41,Fee Schedule,,509.56,,,509.56,Fee Schedule,,481.66,,,481.66,Fee Schedule,,914.9,70,,914.9,percent of total billed charges,All Other,433.92,,,433.92,Fee Schedule,,406,,,406,Other,186% of Medicaid,510.63,,,510.63,Fee Schedule,,810.34,,,810.34,Fee Schedule,,240.43,,,,Fee Schedule,,510.63,,,510.63,Fee Schedule,,810.34,,,810.34,Fee Schedule,,452.24,,,452.24,Fee Schedule,,914.9,70,,914.9,percent of total billed charges,,521.52,,,521.52,Fee Schedule,,442.02,,,442.02,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,914.9,
XR SHOULDER ARTHROGRAM RT FY MOD,73040,CPT,FYRT,42873040,CDM,322,RC,,,both,,,1307,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,365.22,,,365.22,Fee Schedule,,328.59,,,328.59,Fee Schedule,,566.41,,,566.41,Fee Schedule,,509.56,,,509.56,Fee Schedule,,481.66,,,481.66,Fee Schedule,,914.9,70,,914.9,percent of total billed charges,All Other,433.92,,,433.92,Fee Schedule,,406,,,406,Other,186% of Medicaid,510.63,,,510.63,Fee Schedule,,810.34,,,810.34,Fee Schedule,,240.43,,,,Fee Schedule,,510.63,,,510.63,Fee Schedule,,810.34,,,810.34,Fee Schedule,,452.24,,,452.24,Fee Schedule,,914.9,70,,914.9,percent of total billed charges,,521.52,,,521.52,Fee Schedule,,442.02,,,442.02,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,914.9,
XR SHOULDER ARTHROGRAM BILAT FY MOD,73040,CPT,FY50,42973040,CDM,322,RC,,,both,,,1961,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,365.22,,,365.22,Fee Schedule,,328.59,,,328.59,Fee Schedule,,566.41,,,566.41,Fee Schedule,,509.56,,,509.56,Fee Schedule,,481.66,,,481.66,Fee Schedule,,1372.7,70,,1372.7,percent of total billed charges,All Other,433.92,,,433.92,Fee Schedule,,406,,,406,Other,186% of Medicaid,510.63,,,510.63,Fee Schedule,,1215.82,,,1215.82,Fee Schedule,,240.43,,,,Fee Schedule,,510.63,,,510.63,Fee Schedule,,1215.82,,,1215.82,Fee Schedule,,452.24,,,452.24,Fee Schedule,,1372.7,70,,1372.7,percent of total billed charges,,521.52,,,521.52,Fee Schedule,,442.02,,,442.02,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1372.7,
XR ARTHROGRAM WRIST LT,73115,CPT,TCLT,42173115,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,375.62,,,375.62,Fee Schedule,,337.94,,,337.94,Fee Schedule,,571.18,,,571.18,Fee Schedule,,513.85,,,513.85,Fee Schedule,,485.71,,,485.71,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,446.27,,,446.27,Fee Schedule,,406,,,406,Other,186% of Medicaid,525.17,,,525.17,Fee Schedule,,743.38,,,743.38,Fee Schedule,,247.28,,,,Fee Schedule,,525.17,,,525.17,Fee Schedule,,743.38,,,743.38,Fee Schedule,,465.11,,,465.11,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,544.48,,,544.48,Fee Schedule,,461.48,,,461.48,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,839.3,
XR ARTHROGRAM WRIST RT,73115,CPT,TCRT,42273115,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,375.62,,,375.62,Fee Schedule,,337.94,,,337.94,Fee Schedule,,571.18,,,571.18,Fee Schedule,,513.85,,,513.85,Fee Schedule,,485.71,,,485.71,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,446.27,,,446.27,Fee Schedule,,406,,,406,Other,186% of Medicaid,525.17,,,525.17,Fee Schedule,,743.38,,,743.38,Fee Schedule,,247.28,,,,Fee Schedule,,525.17,,,525.17,Fee Schedule,,743.38,,,743.38,Fee Schedule,,465.11,,,465.11,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,544.48,,,544.48,Fee Schedule,,461.48,,,461.48,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,839.3,
XR ARTHROGRAM WRIST BILAT,73115,CPT,TC50,42373115,CDM,322,RC,,,both,,,1799,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,375.62,,,375.62,Fee Schedule,,337.94,,,337.94,Fee Schedule,,571.18,,,571.18,Fee Schedule,,513.85,,,513.85,Fee Schedule,,485.71,,,485.71,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,All Other,446.27,,,446.27,Fee Schedule,,406,,,406,Other,186% of Medicaid,525.17,,,525.17,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,247.28,,,,Fee Schedule,,525.17,,,525.17,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,465.11,,,465.11,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,,544.48,,,544.48,Fee Schedule,,461.48,,,461.48,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1259.3,
XR ARTHROGRAM WRIST LT FY MOD,73115,CPT,FYLT,42773115,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,375.62,,,375.62,Fee Schedule,,337.94,,,337.94,Fee Schedule,,571.18,,,571.18,Fee Schedule,,513.85,,,513.85,Fee Schedule,,485.71,,,485.71,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,446.27,,,446.27,Fee Schedule,,406,,,406,Other,186% of Medicaid,525.17,,,525.17,Fee Schedule,,743.38,,,743.38,Fee Schedule,,247.28,,,,Fee Schedule,,525.17,,,525.17,Fee Schedule,,743.38,,,743.38,Fee Schedule,,465.11,,,465.11,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,544.48,,,544.48,Fee Schedule,,461.48,,,461.48,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,839.3,
XR ARTHROGRAM WRIST RT FY MOD,73115,CPT,FYRT,42873115,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,375.62,,,375.62,Fee Schedule,,337.94,,,337.94,Fee Schedule,,571.18,,,571.18,Fee Schedule,,513.85,,,513.85,Fee Schedule,,485.71,,,485.71,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,446.27,,,446.27,Fee Schedule,,406,,,406,Other,186% of Medicaid,525.17,,,525.17,Fee Schedule,,743.38,,,743.38,Fee Schedule,,247.28,,,,Fee Schedule,,525.17,,,525.17,Fee Schedule,,743.38,,,743.38,Fee Schedule,,465.11,,,465.11,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,544.48,,,544.48,Fee Schedule,,461.48,,,461.48,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,839.3,
XR ARTHROGRAM WRIST BILAT FY MOD,73115,CPT,FY50,42973115,CDM,322,RC,,,both,,,1799,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,375.62,,,375.62,Fee Schedule,,337.94,,,337.94,Fee Schedule,,571.18,,,571.18,Fee Schedule,,513.85,,,513.85,Fee Schedule,,485.71,,,485.71,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,All Other,446.27,,,446.27,Fee Schedule,,406,,,406,Other,186% of Medicaid,525.17,,,525.17,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,247.28,,,,Fee Schedule,,525.17,,,525.17,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,465.11,,,465.11,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,,544.48,,,544.48,Fee Schedule,,461.48,,,461.48,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1259.3,
XR ARTHROGRAM HIP LT,73525,CPT,TCLT,42173525,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,350.23,,,350.23,Fee Schedule,,315.1,,,315.1,Fee Schedule,,509.31,,,509.31,Fee Schedule,,458.19,,,458.19,Fee Schedule,,433.1,,,433.1,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,416.1,,,416.1,Fee Schedule,,406,,,406,Other,186% of Medicaid,489.66,,,489.66,Fee Schedule,,743.38,,,743.38,Fee Schedule,,230.56,,,,Fee Schedule,,489.66,,,489.66,Fee Schedule,,743.38,,,743.38,Fee Schedule,,433.67,,,433.67,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,526.44,,,526.44,Fee Schedule,,446.19,,,446.19,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,839.3,
XR ARTHROGRAM HIP RT,73525,CPT,TCRT,42273525,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,350.23,,,350.23,Fee Schedule,,315.1,,,315.1,Fee Schedule,,509.31,,,509.31,Fee Schedule,,458.19,,,458.19,Fee Schedule,,433.1,,,433.1,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,416.1,,,416.1,Fee Schedule,,406,,,406,Other,186% of Medicaid,489.66,,,489.66,Fee Schedule,,743.38,,,743.38,Fee Schedule,,230.56,,,,Fee Schedule,,489.66,,,489.66,Fee Schedule,,743.38,,,743.38,Fee Schedule,,433.67,,,433.67,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,526.44,,,526.44,Fee Schedule,,446.19,,,446.19,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,839.3,
XR ARTHROGRAM HIP BILAT,73525,CPT,TC50,42373525,CDM,322,RC,,,both,,,1799,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,350.23,,,350.23,Fee Schedule,,315.1,,,315.1,Fee Schedule,,509.31,,,509.31,Fee Schedule,,458.19,,,458.19,Fee Schedule,,433.1,,,433.1,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,All Other,416.1,,,416.1,Fee Schedule,,406,,,406,Other,186% of Medicaid,489.66,,,489.66,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,230.56,,,,Fee Schedule,,489.66,,,489.66,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,433.67,,,433.67,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,,526.44,,,526.44,Fee Schedule,,446.19,,,446.19,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1259.3,
XR ARTHROGRAM HIP LT FY MOD,73525,CPT,FYLT,42773525,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,350.23,,,350.23,Fee Schedule,,315.1,,,315.1,Fee Schedule,,509.31,,,509.31,Fee Schedule,,458.19,,,458.19,Fee Schedule,,433.1,,,433.1,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,416.1,,,416.1,Fee Schedule,,406,,,406,Other,186% of Medicaid,489.66,,,489.66,Fee Schedule,,743.38,,,743.38,Fee Schedule,,230.56,,,,Fee Schedule,,489.66,,,489.66,Fee Schedule,,743.38,,,743.38,Fee Schedule,,433.67,,,433.67,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,526.44,,,526.44,Fee Schedule,,446.19,,,446.19,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,839.3,
XR ARTHROGRAM HIP RT FY MOD,73525,CPT,FYRT,42873525,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,350.23,,,350.23,Fee Schedule,,315.1,,,315.1,Fee Schedule,,509.31,,,509.31,Fee Schedule,,458.19,,,458.19,Fee Schedule,,433.1,,,433.1,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,416.1,,,416.1,Fee Schedule,,406,,,406,Other,186% of Medicaid,489.66,,,489.66,Fee Schedule,,743.38,,,743.38,Fee Schedule,,230.56,,,,Fee Schedule,,489.66,,,489.66,Fee Schedule,,743.38,,,743.38,Fee Schedule,,433.67,,,433.67,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,526.44,,,526.44,Fee Schedule,,446.19,,,446.19,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,839.3,
XR ARTHROGRAM HIP BILAT FY MOD,73525,CPT,FY50,42973525,CDM,322,RC,,,both,,,1799,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,350.23,,,350.23,Fee Schedule,,315.1,,,315.1,Fee Schedule,,509.31,,,509.31,Fee Schedule,,458.19,,,458.19,Fee Schedule,,433.1,,,433.1,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,All Other,416.1,,,416.1,Fee Schedule,,406,,,406,Other,186% of Medicaid,489.66,,,489.66,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,230.56,,,,Fee Schedule,,489.66,,,489.66,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,433.67,,,433.67,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,,526.44,,,526.44,Fee Schedule,,446.19,,,446.19,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,218.02,1259.3,
ARTHROGRAM KNEE LT,73580,CPT,TCLT,42173580,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,278.58,,,278.58,Fee Schedule,,250.64,,,250.64,Fee Schedule,,723.47,,,723.47,Fee Schedule,,650.86,,,650.86,Fee Schedule,,615.21,,,615.21,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,330.98,,,330.98,Fee Schedule,,406,,,406,Other,186% of Medicaid,389.49,,,389.49,Fee Schedule,,743.38,,,743.38,Fee Schedule,,183.39,,,,Fee Schedule,,389.49,,,389.49,Fee Schedule,,743.38,,,743.38,Fee Schedule,,344.95,,,344.95,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,183.39,839.3,
ARTHROGRAM KNEE RT,73580,CPT,TCRT,42273580,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,278.58,,,278.58,Fee Schedule,,250.64,,,250.64,Fee Schedule,,723.47,,,723.47,Fee Schedule,,650.86,,,650.86,Fee Schedule,,615.21,,,615.21,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,330.98,,,330.98,Fee Schedule,,406,,,406,Other,186% of Medicaid,389.49,,,389.49,Fee Schedule,,743.38,,,743.38,Fee Schedule,,183.39,,,,Fee Schedule,,389.49,,,389.49,Fee Schedule,,743.38,,,743.38,Fee Schedule,,344.95,,,344.95,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,183.39,839.3,
ARTHROGRAM KNEE BILAT,73580,CPT,TC50,42373580,CDM,322,RC,,,both,,,1799,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,278.58,,,278.58,Fee Schedule,,250.64,,,250.64,Fee Schedule,,723.47,,,723.47,Fee Schedule,,650.86,,,650.86,Fee Schedule,,615.21,,,615.21,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,All Other,330.98,,,330.98,Fee Schedule,,406,,,406,Other,186% of Medicaid,389.49,,,389.49,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,183.39,,,,Fee Schedule,,389.49,,,389.49,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,344.95,,,344.95,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,183.39,1259.3,
ARTHROGRAM KNEE LT FY MOD,73580,CPT,FYLT,42773580,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,278.58,,,278.58,Fee Schedule,,250.64,,,250.64,Fee Schedule,,723.47,,,723.47,Fee Schedule,,650.86,,,650.86,Fee Schedule,,615.21,,,615.21,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,330.98,,,330.98,Fee Schedule,,406,,,406,Other,186% of Medicaid,389.49,,,389.49,Fee Schedule,,743.38,,,743.38,Fee Schedule,,183.39,,,,Fee Schedule,,389.49,,,389.49,Fee Schedule,,743.38,,,743.38,Fee Schedule,,344.95,,,344.95,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,183.39,839.3,
ARTHROGRAM KNEE RT FY MOD,73580,CPT,FYRT,42873580,CDM,322,RC,,,both,,,1199,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,278.58,,,278.58,Fee Schedule,,250.64,,,250.64,Fee Schedule,,723.47,,,723.47,Fee Schedule,,650.86,,,650.86,Fee Schedule,,615.21,,,615.21,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,All Other,330.98,,,330.98,Fee Schedule,,406,,,406,Other,186% of Medicaid,389.49,,,389.49,Fee Schedule,,743.38,,,743.38,Fee Schedule,,183.39,,,,Fee Schedule,,389.49,,,389.49,Fee Schedule,,743.38,,,743.38,Fee Schedule,,344.95,,,344.95,Fee Schedule,,839.3,70,,839.3,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,183.39,839.3,
ARTHROGRAM KNEE BILAT FY MOD,73580,CPT,FY50,42973580,CDM,322,RC,,,both,,,1799,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,278.58,,,278.58,Fee Schedule,,250.64,,,250.64,Fee Schedule,,723.47,,,723.47,Fee Schedule,,650.86,,,650.86,Fee Schedule,,615.21,,,615.21,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,All Other,330.98,,,330.98,Fee Schedule,,406,,,406,Other,186% of Medicaid,389.49,,,389.49,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,183.39,,,,Fee Schedule,,389.49,,,389.49,Fee Schedule,,1115.38,,,1115.38,Fee Schedule,,344.95,,,344.95,Fee Schedule,,1259.3,70,,1259.3,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,183.39,1259.3,
THORACIC AORTOGRAM W SERIALOGR,75605,CPT,TC,47075605,CDM,323,RC,,,both,,,11570,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,237.18,,,237.18,Fee Schedule,,213.38,,,213.38,Fee Schedule,,1104.22,,,1104.22,Fee Schedule,,993.4,,,993.4,Fee Schedule,,938.99,,,938.99,Fee Schedule,,8099,70,,8099,percent of total billed charges,All Other,281.79,,,281.79,Fee Schedule,,1434,,,1434,Other,186% of Medicaid,331.6,,,331.6,Fee Schedule,,7173.4,,,7173.4,Fee Schedule,,156.14,,,,Fee Schedule,,331.6,,,331.6,Fee Schedule,,7173.4,,,7173.4,Fee Schedule,,293.68,,,293.68,Fee Schedule,,8099,70,,8099,percent of total billed charges,,334.56,,,334.56,Fee Schedule,,283.56,,,283.56,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1179.92,,,1179.92,Other,153% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1079.67,,,1079.67,Other,140% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,2005.1,,,2005.1,Other,250% of Medicaid,2498.66,,,2498.66,Other,324% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,963.99,,,963.99,Other,125% of Medicaid,156.14,9930.15,
ABDOMINAL ARTERIOGRAPHY,75625,CPT,TC,47075625,CDM,323,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,208.12,,,208.12,Fee Schedule,,187.24,,,187.24,Fee Schedule,,1106.58,,,1106.58,Fee Schedule,,995.51,,,995.51,Fee Schedule,,940.99,,,940.99,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,All Other,247.26,,,247.26,Fee Schedule,,558,,,558,Other,186% of Medicaid,290.97,,,290.97,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,137,,,,Fee Schedule,,290.97,,,290.97,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,257.7,,,257.7,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,137,5759.82,
ABDOMINAL ARTERIOGRAPHY,75625,CPT,TC,49075625,CDM,323,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,208.12,,,208.12,Fee Schedule,,187.24,,,187.24,Fee Schedule,,1106.58,,,1106.58,Fee Schedule,,995.51,,,995.51,Fee Schedule,,940.99,,,940.99,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,All Other,247.26,,,247.26,Fee Schedule,,558,,,558,Other,186% of Medicaid,290.97,,,290.97,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,137,,,,Fee Schedule,,290.97,,,290.97,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,257.7,,,257.7,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,137,5759.82,
ABDOMINAL AORTOGRAM W RUN,75630,CPT,TC,47075630,CDM,323,RC,,,both,,,9613,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,224.45,,,224.45,Fee Schedule,,201.93,,,201.93,Fee Schedule,,1132.77,,,1132.77,Fee Schedule,,1019.08,,,1019.08,Fee Schedule,,963.27,,,963.27,Fee Schedule,,6729.1,70,,6729.1,percent of total billed charges,All Other,266.66,,,266.66,Fee Schedule,,558,,,558,Other,186% of Medicaid,313.81,,,313.81,Fee Schedule,,5960.06,,,5960.06,Fee Schedule,,147.76,,,,Fee Schedule,,313.81,,,313.81,Fee Schedule,,5960.06,,,5960.06,Fee Schedule,,277.92,,,277.92,Fee Schedule,,6729.1,70,,6729.1,percent of total billed charges,,319.8,,,319.8,Fee Schedule,,271.05,,,271.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,147.76,6729.1,
EXTREMITY ANGIO - UNIL,75710,CPT,TC,42075710,CDM,323,RC,,,both,,,9172,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,239.47,,,239.47,Fee Schedule,,215.45,,,215.45,Fee Schedule,,1244.62,,,1244.62,Fee Schedule,,1119.7,,,1119.7,Fee Schedule,,1058.38,,,1058.38,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,All Other,284.52,,,284.52,Fee Schedule,,558,,,558,Other,186% of Medicaid,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,157.65,,,,Fee Schedule,,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,296.53,,,296.53,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,157.65,6420.4,
EXTREMITY ANGIO - UNIL W/ FY MOD,75710,CPT,FY,42675710,CDM,323,RC,,,both,,,9172,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,239.47,,,239.47,Fee Schedule,,215.45,,,215.45,Fee Schedule,,1244.62,,,1244.62,Fee Schedule,,1119.7,,,1119.7,Fee Schedule,,1058.38,,,1058.38,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,All Other,284.52,,,284.52,Fee Schedule,,558,,,558,Other,186% of Medicaid,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,157.65,,,,Fee Schedule,,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,296.53,,,296.53,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,157.65,6420.4,
EXTREMITY ANGIO UNI,75710,CPT,TC,47075710,CDM,323,RC,,,both,,,9172,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,239.47,,,239.47,Fee Schedule,,215.45,,,215.45,Fee Schedule,,1244.62,,,1244.62,Fee Schedule,,1119.7,,,1119.7,Fee Schedule,,1058.38,,,1058.38,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,All Other,284.52,,,284.52,Fee Schedule,,558,,,558,Other,186% of Medicaid,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,157.65,,,,Fee Schedule,,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,296.53,,,296.53,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,157.65,6420.4,
EXTREMITY ANGIO UNI LT,75710,CPT,TCLT,47175710,CDM,323,RC,,,both,,,9172,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,239.47,,,239.47,Fee Schedule,,215.45,,,215.45,Fee Schedule,,1244.62,,,1244.62,Fee Schedule,,1119.7,,,1119.7,Fee Schedule,,1058.38,,,1058.38,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,All Other,284.52,,,284.52,Fee Schedule,,558,,,558,Other,186% of Medicaid,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,157.65,,,,Fee Schedule,,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,296.53,,,296.53,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,157.65,6420.4,
EXTREMITY ANGIO UNI RT,75710,CPT,TCRT,47275710,CDM,323,RC,,,both,,,9172,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,239.47,,,239.47,Fee Schedule,,215.45,,,215.45,Fee Schedule,,1244.62,,,1244.62,Fee Schedule,,1119.7,,,1119.7,Fee Schedule,,1058.38,,,1058.38,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,All Other,284.52,,,284.52,Fee Schedule,,558,,,558,Other,186% of Medicaid,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,157.65,,,,Fee Schedule,,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,296.53,,,296.53,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,157.65,6420.4,
EXTREMITY ANGIO UNI LT 59 MOD,75710,CPT,TC59,47475710,CDM,323,RC,,,both,,,9172,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,239.47,,,239.47,Fee Schedule,,215.45,,,215.45,Fee Schedule,,1244.62,,,1244.62,Fee Schedule,,1119.7,,,1119.7,Fee Schedule,,1058.38,,,1058.38,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,All Other,284.52,,,284.52,Fee Schedule,,558,,,558,Other,186% of Medicaid,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,157.65,,,,Fee Schedule,,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,296.53,,,296.53,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,157.65,6420.4,
EXTREMITY ANGIO UNI RT 59 MOD,75710,CPT,TC59,47575710,CDM,323,RC,,,both,,,9172,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,239.47,,,239.47,Fee Schedule,,215.45,,,215.45,Fee Schedule,,1244.62,,,1244.62,Fee Schedule,,1119.7,,,1119.7,Fee Schedule,,1058.38,,,1058.38,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,All Other,284.52,,,284.52,Fee Schedule,,558,,,558,Other,186% of Medicaid,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,157.65,,,,Fee Schedule,,334.81,,,334.81,Fee Schedule,,5686.64,,,5686.64,Fee Schedule,,296.53,,,296.53,Fee Schedule,,6420.4,70,,6420.4,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,157.65,6420.4,
EXTREMITY ANGIO BILAT,75716,CPT,TC,47075716,CDM,323,RC,,,both,,,10286,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,249.87,,,249.87,Fee Schedule,,224.81,,,224.81,Fee Schedule,,1432.8,,,1432.8,Fee Schedule,,1289,,,1289,Fee Schedule,,1218.4,,,1218.4,Fee Schedule,,7200.2,70,,7200.2,percent of total billed charges,All Other,296.87,,,296.87,Fee Schedule,,558,,,558,Other,186% of Medicaid,349.35,,,349.35,Fee Schedule,,6377.32,,,6377.32,Fee Schedule,,164.49,,,,Fee Schedule,,349.35,,,349.35,Fee Schedule,,6377.32,,,6377.32,Fee Schedule,,309.4,,,309.4,Fee Schedule,,7200.2,70,,7200.2,percent of total billed charges,,352.6,,,352.6,Fee Schedule,,298.85,,,298.85,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,164.49,7200.2,
EXTREMITY ANGIO BILAT 59 MOD,75716,CPT,TC59,47175716,CDM,323,RC,,,both,,,10286,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,249.87,,,249.87,Fee Schedule,,224.81,,,224.81,Fee Schedule,,1432.8,,,1432.8,Fee Schedule,,1289,,,1289,Fee Schedule,,1218.4,,,1218.4,Fee Schedule,,7200.2,70,,7200.2,percent of total billed charges,All Other,296.87,,,296.87,Fee Schedule,,558,,,558,Other,186% of Medicaid,349.35,,,349.35,Fee Schedule,,6377.32,,,6377.32,Fee Schedule,,164.49,,,,Fee Schedule,,349.35,,,349.35,Fee Schedule,,6377.32,,,6377.32,Fee Schedule,,309.4,,,309.4,Fee Schedule,,7200.2,70,,7200.2,percent of total billed charges,,352.6,,,352.6,Fee Schedule,,298.85,,,298.85,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,164.49,7200.2,
EXTREMITY ANGIO BILAT,75716,CPT,TC,49075716,CDM,323,RC,,,both,,,10286,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,249.87,,,249.87,Fee Schedule,,224.81,,,224.81,Fee Schedule,,1432.8,,,1432.8,Fee Schedule,,1289,,,1289,Fee Schedule,,1218.4,,,1218.4,Fee Schedule,,7200.2,70,,7200.2,percent of total billed charges,All Other,296.87,,,296.87,Fee Schedule,,558,,,558,Other,186% of Medicaid,349.35,,,349.35,Fee Schedule,,6377.32,,,6377.32,Fee Schedule,,164.49,,,,Fee Schedule,,349.35,,,349.35,Fee Schedule,,6377.32,,,6377.32,Fee Schedule,,309.4,,,309.4,Fee Schedule,,7200.2,70,,7200.2,percent of total billed charges,,352.6,,,352.6,Fee Schedule,,298.85,,,298.85,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,164.49,7200.2,
VISCERAL ANGIOGRAPHY,75726,CPT,TC,47075726,CDM,323,RC,,,both,,,11570,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,269.52,,,269.52,Fee Schedule,,242.49,,,242.49,Fee Schedule,,1225.55,,,1225.55,Fee Schedule,,1102.55,,,1102.55,Fee Schedule,,1042.16,,,1042.16,Fee Schedule,,8099,70,,8099,percent of total billed charges,All Other,320.22,,,320.22,Fee Schedule,,1434,,,1434,Other,186% of Medicaid,376.83,,,376.83,Fee Schedule,,7173.4,,,7173.4,Fee Schedule,,177.43,,,,Fee Schedule,,376.83,,,376.83,Fee Schedule,,7173.4,,,7173.4,Fee Schedule,,333.74,,,333.74,Fee Schedule,,8099,70,,8099,percent of total billed charges,,380.48,,,380.48,Fee Schedule,,322.48,,,322.48,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,7353.9,,,7353.9,Fee Schedule,,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1179.92,,,1179.92,Other,153% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1079.67,,,1079.67,Other,140% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,2005.1,,,2005.1,Other,250% of Medicaid,2498.66,,,2498.66,Other,324% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,963.99,,,963.99,Other,125% of Medicaid,177.43,9930.15,
ADRENAL ANGIOGR UNIL,75731,CPT,TC,47075731,CDM,323,RC,,,both,,,8073,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,347.1,,,347.1,Fee Schedule,,312.28,,,312.28,Fee Schedule,,1244.62,,,1244.62,Fee Schedule,,1119.7,,,1119.7,Fee Schedule,,1058.38,,,1058.38,Fee Schedule,,5651.1,70,,5651.1,percent of total billed charges,All Other,412.39,,,412.39,Fee Schedule,,558,,,558,Other,186% of Medicaid,485.29,,,485.29,Fee Schedule,,5005.26,,,5005.26,Fee Schedule,,228.5,,,,Fee Schedule,,485.29,,,485.29,Fee Schedule,,5005.26,,,5005.26,Fee Schedule,,429.8,,,429.8,Fee Schedule,,5651.1,70,,5651.1,percent of total billed charges,,475.6,,,475.6,Fee Schedule,,403.1,,,403.1,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,2609.81,,,2609.81,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,228.5,5759.82,
ADRENAL ANGIOGR BILAT,75733,CPT,TC,47075733,CDM,323,RC,,,both,,,7864,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,390.01,,,390.01,Fee Schedule,,350.89,,,350.89,Fee Schedule,,1428.03,,,1428.03,Fee Schedule,,1284.71,,,1284.71,Fee Schedule,,1214.35,,,1214.35,Fee Schedule,,5504.8,70,,5504.8,percent of total billed charges,All Other,463.37,,,463.37,Fee Schedule,,558,,,558,Other,186% of Medicaid,545.28,,,545.28,Fee Schedule,,4875.68,,,4875.68,Fee Schedule,,256.75,,,,Fee Schedule,,545.28,,,545.28,Fee Schedule,,4875.68,,,4875.68,Fee Schedule,,482.93,,,482.93,Fee Schedule,,5504.8,70,,5504.8,percent of total billed charges,,524.8,,,524.8,Fee Schedule,,444.8,,,444.8,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,256.75,5759.82,
PULMONARY UNI SELECTIVE ANGI,75741,CPT,TC,47075741,CDM,323,RC,,,both,,,7864,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,245.25,,,245.25,Fee Schedule,,220.65,,,220.65,Fee Schedule,,1078.03,,,1078.03,Fee Schedule,,969.83,,,969.83,Fee Schedule,,916.72,,,916.72,Fee Schedule,,5504.8,70,,5504.8,percent of total billed charges,All Other,291.38,,,291.38,Fee Schedule,,558,,,558,Other,186% of Medicaid,342.88,,,342.88,Fee Schedule,,4875.68,,,4875.68,Fee Schedule,,161.45,,,,Fee Schedule,,342.88,,,342.88,Fee Schedule,,4875.68,,,4875.68,Fee Schedule,,303.68,,,303.68,Fee Schedule,,5504.8,70,,5504.8,percent of total billed charges,,347.68,,,347.68,Fee Schedule,,294.68,,,294.68,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,161.45,5759.82,
PULMONARY BILAT SELECTIVE ANGI,75743,CPT,TC,47075743,CDM,323,RC,,,both,,,7864,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,249.87,,,249.87,Fee Schedule,,224.81,,,224.81,Fee Schedule,,1137.54,,,1137.54,Fee Schedule,,1023.37,,,1023.37,Fee Schedule,,967.32,,,967.32,Fee Schedule,,5504.8,70,,5504.8,percent of total billed charges,All Other,296.87,,,296.87,Fee Schedule,,558,,,558,Other,186% of Medicaid,349.35,,,349.35,Fee Schedule,,4875.68,,,4875.68,Fee Schedule,,164.49,,,,Fee Schedule,,349.35,,,349.35,Fee Schedule,,4875.68,,,4875.68,Fee Schedule,,309.4,,,309.4,Fee Schedule,,5504.8,70,,5504.8,percent of total billed charges,,354.24,,,354.24,Fee Schedule,,300.24,,,300.24,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,164.49,5759.82,
X-RAY EXAM CHEST 1 VIEW,71045,CPT,TC,42071045,CDM,324,RC,,,both,,,310,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,60.26,,,60.26,Fee Schedule,,54.21,,,54.21,Fee Schedule,,10.16,,,10.16,Fee Schedule,,10.16,,,10.16,Fee Schedule,,10.16,,,10.16,Fee Schedule,,217,70,,217,percent of total billed charges,All Other,71.59,,,71.59,Fee Schedule,,67,,,67,Other,186% of Medicaid,84.25,,,84.25,Fee Schedule,,192.2,,,192.2,Fee Schedule,,39.67,,,,Fee Schedule,,84.25,,,84.25,Fee Schedule,,192.2,,,192.2,Fee Schedule,,74.62,,,74.62,Fee Schedule,,217,70,,217,percent of total billed charges,,83.64,,,83.64,Fee Schedule,,70.89,,,70.89,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,10.16,217,
X-RAY EXAM CHEST 1 VIEW W/ FY MOD,71045,CPT,FY,42671045,CDM,324,RC,,,both,,,310,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,60.26,,,60.26,Fee Schedule,,54.21,,,54.21,Fee Schedule,,10.16,,,10.16,Fee Schedule,,10.16,,,10.16,Fee Schedule,,10.16,,,10.16,Fee Schedule,,217,70,,217,percent of total billed charges,All Other,71.59,,,71.59,Fee Schedule,,67,,,67,Other,186% of Medicaid,84.25,,,84.25,Fee Schedule,,192.2,,,192.2,Fee Schedule,,39.67,,,,Fee Schedule,,84.25,,,84.25,Fee Schedule,,192.2,,,192.2,Fee Schedule,,74.62,,,74.62,Fee Schedule,,217,70,,217,percent of total billed charges,,83.64,,,83.64,Fee Schedule,,70.89,,,70.89,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,10.16,217,
X-RAY EXAM CHEST 2 VIEWS,71046,CPT,TC,42071046,CDM,324,RC,,,both,,,369,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,81.03,,,81.03,Fee Schedule,,72.9,,,72.9,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,258.3,70,,258.3,percent of total billed charges,All Other,96.27,,,96.27,Fee Schedule,,67,,,67,Other,186% of Medicaid,113.28,,,113.28,Fee Schedule,,228.78,,,228.78,Fee Schedule,,53.34,,,,Fee Schedule,,113.28,,,113.28,Fee Schedule,,228.78,,,228.78,Fee Schedule,,100.33,,,100.33,Fee Schedule,,258.3,70,,258.3,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,18.62,258.3,
X-RAY EXAM CHEST 2 VIEWS W/ FY MOD,71046,CPT,FY,42671046,CDM,324,RC,,,both,,,369,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,81.03,,,81.03,Fee Schedule,,72.9,,,72.9,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,258.3,70,,258.3,percent of total billed charges,All Other,96.27,,,96.27,Fee Schedule,,67,,,67,Other,186% of Medicaid,113.28,,,113.28,Fee Schedule,,228.78,,,228.78,Fee Schedule,,53.34,,,,Fee Schedule,,113.28,,,113.28,Fee Schedule,,228.78,,,228.78,Fee Schedule,,100.33,,,100.33,Fee Schedule,,258.3,70,,258.3,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,18.62,258.3,
X-RAY EXAM CHEST 2 VIEWS W/ FY MOD,71046,CPT,FY,43071046,CDM,324,RC,,,both,,,369,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,81.03,,,81.03,Fee Schedule,,72.9,,,72.9,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,258.3,70,,258.3,percent of total billed charges,All Other,96.27,,,96.27,Fee Schedule,,67,,,67,Other,186% of Medicaid,113.28,,,113.28,Fee Schedule,,228.78,,,228.78,Fee Schedule,,53.34,,,,Fee Schedule,,113.28,,,113.28,Fee Schedule,,228.78,,,228.78,Fee Schedule,,100.33,,,100.33,Fee Schedule,,258.3,70,,258.3,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,18.62,258.3,
X-RAY EXAM CHEST 2 VIEWS W/ FY MOD,71046,CPT,FY,43071046FY,CDM,324,RC,,,both,,,369,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,81.03,,,81.03,Fee Schedule,,72.9,,,72.9,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,18.62,,,18.62,Fee Schedule,,258.3,70,,258.3,percent of total billed charges,All Other,96.27,,,96.27,Fee Schedule,,67,,,67,Other,186% of Medicaid,113.28,,,113.28,Fee Schedule,,228.78,,,228.78,Fee Schedule,,53.34,,,,Fee Schedule,,113.28,,,113.28,Fee Schedule,,228.78,,,228.78,Fee Schedule,,100.33,,,100.33,Fee Schedule,,258.3,70,,258.3,percent of total billed charges,,113.16,,,113.16,Fee Schedule,,95.91,,,95.91,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,18.62,258.3,
X-RAY EXAM CHEST 3 VIEWS,71047,CPT,TC,42071047,CDM,324,RC,,,both,,,338,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,101.82,,,101.82,Fee Schedule,,91.61,,,91.61,Fee Schedule,,23.7,,,23.7,Fee Schedule,,23.7,,,23.7,Fee Schedule,,23.7,,,23.7,Fee Schedule,,236.6,70,,236.6,percent of total billed charges,All Other,120.98,,,120.98,Fee Schedule,,67,,,67,Other,186% of Medicaid,142.36,,,142.36,Fee Schedule,,209.56,,,209.56,Fee Schedule,,67.03,,,,Fee Schedule,,142.36,,,142.36,Fee Schedule,,209.56,,,209.56,Fee Schedule,,126.08,,,126.08,Fee Schedule,,236.6,70,,236.6,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,23.7,236.6,
X-RAY EXAM CHEST 3 VIEWS W/ FY MOD,71047,CPT,FY,42671047,CDM,324,RC,,,both,,,338,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,101.82,,,101.82,Fee Schedule,,91.61,,,91.61,Fee Schedule,,23.7,,,23.7,Fee Schedule,,23.7,,,23.7,Fee Schedule,,23.7,,,23.7,Fee Schedule,,236.6,70,,236.6,percent of total billed charges,All Other,120.98,,,120.98,Fee Schedule,,67,,,67,Other,186% of Medicaid,142.36,,,142.36,Fee Schedule,,209.56,,,209.56,Fee Schedule,,67.03,,,,Fee Schedule,,142.36,,,142.36,Fee Schedule,,209.56,,,209.56,Fee Schedule,,126.08,,,126.08,Fee Schedule,,236.6,70,,236.6,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,23.7,236.6,
X-RAY EXAM CHEST 4+ VIEWS,71048,CPT,TC,42071048,CDM,324,RC,,,both,,,460,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,108.78,,,108.78,Fee Schedule,,97.87,,,97.87,Fee Schedule,,24.38,,,24.38,Fee Schedule,,24.38,,,24.38,Fee Schedule,,24.38,,,24.38,Fee Schedule,,322,70,,322,percent of total billed charges,All Other,129.24,,,129.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,152.09,,,152.09,Fee Schedule,,285.2,,,285.2,Fee Schedule,,71.61,,,,Fee Schedule,,152.09,,,152.09,Fee Schedule,,285.2,,,285.2,Fee Schedule,,134.7,,,134.7,Fee Schedule,,322,70,,322,percent of total billed charges,,154.16,,,154.16,Fee Schedule,,130.66,,,130.66,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,24.38,322,
X-RAY EXAM CHEST 4+ VIEWS W/ FY MOD,71048,CPT,FY,42671048,CDM,324,RC,,,both,,,460,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,108.78,,,108.78,Fee Schedule,,97.87,,,97.87,Fee Schedule,,24.38,,,24.38,Fee Schedule,,24.38,,,24.38,Fee Schedule,,24.38,,,24.38,Fee Schedule,,322,70,,322,percent of total billed charges,All Other,129.24,,,129.24,Fee Schedule,,67,,,67,Other,186% of Medicaid,152.09,,,152.09,Fee Schedule,,285.2,,,285.2,Fee Schedule,,71.61,,,,Fee Schedule,,152.09,,,152.09,Fee Schedule,,285.2,,,285.2,Fee Schedule,,134.7,,,134.7,Fee Schedule,,322,70,,322,percent of total billed charges,,154.16,,,154.16,Fee Schedule,,130.66,,,130.66,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,24.38,322,
XR EXAM OF BREASTBONE 3+ VI,71130,CPT,TC,42071130,CDM,324,RC,,,both,,,520,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,107.6,,,107.6,Fee Schedule,,96.81,,,96.81,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,364,70,,364,percent of total billed charges,All Other,127.84,,,127.84,Fee Schedule,,67,,,67,Other,186% of Medicaid,150.44,,,150.44,Fee Schedule,,322.4,,,322.4,Fee Schedule,,70.83,,,,Fee Schedule,,150.44,,,150.44,Fee Schedule,,322.4,,,322.4,Fee Schedule,,133.23,,,133.23,Fee Schedule,,364,70,,364,percent of total billed charges,,152.52,,,152.52,Fee Schedule,,129.27,,,129.27,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,364,
XR EXAM OF BREASTBONE 3+ VI W/ FY MOD,71130,CPT,FY,42671130,CDM,324,RC,,,both,,,520,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,107.6,,,107.6,Fee Schedule,,96.81,,,96.81,Fee Schedule,,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,364,70,,364,percent of total billed charges,All Other,127.84,,,127.84,Fee Schedule,,67,,,67,Other,186% of Medicaid,150.44,,,150.44,Fee Schedule,,322.4,,,322.4,Fee Schedule,,70.83,,,,Fee Schedule,,150.44,,,150.44,Fee Schedule,,322.4,,,322.4,Fee Schedule,,133.23,,,133.23,Fee Schedule,,364,70,,364,percent of total billed charges,,152.52,,,152.52,Fee Schedule,,129.27,,,129.27,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,364,
XR FINGER 2+ VIEWS RT W/ FY MOD,73140,CPT,FYRT,43273140,CDM,329,RC,,,both,,,231,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,109.93,,,109.93,Fee Schedule,,98.9,,,98.9,Fee Schedule,,173.83,,,173.83,Fee Schedule,,156.38,,,156.38,Fee Schedule,,147.82,,,147.82,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,All Other,130.6,,,130.6,Fee Schedule,,67,,,67,Other,186% of Medicaid,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,72.37,,,,Fee Schedule,,153.69,,,153.69,Fee Schedule,,143.22,,,143.22,Fee Schedule,,136.12,,,136.12,Fee Schedule,,161.7,70,,161.7,percent of total billed charges,,150.88,,,150.88,Fee Schedule,,127.88,,,127.88,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,36.12,,,36.12,Other,100% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,55.26,,,55.26,Other,153% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,50.56,,,50.56,Other,140% of Medicaid,81.26,,,81.26,Other,225% of Medicaid,93.91,,,93.91,Other,250% of Medicaid,117.02,,,117.02,Other,324% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,77.65,,,77.65,Other,215% of Medicaid,45.15,,,45.15,Other,125% of Medicaid,36.12,173.83,
XR COLON W AIR & BARIUM,74280,CPT,TC,42074280,CDM,329,RC,,,both,,,1452,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,557.17,,,557.17,Fee Schedule,,501.27,,,501.27,Fee Schedule,,994.73,,,994.73,Fee Schedule,,894.89,,,894.89,Fee Schedule,,845.88,,,845.88,Fee Schedule,,1016.4,70,,1016.4,percent of total billed charges,All Other,661.96,,,661.96,Fee Schedule,,406,,,406,Other,186% of Medicaid,778.98,,,778.98,Fee Schedule,,900.24,,,900.24,Fee Schedule,,366.79,,,,Fee Schedule,,778.98,,,778.98,Fee Schedule,,900.24,,,900.24,Fee Schedule,,689.91,,,689.91,Fee Schedule,,1016.4,70,,1016.4,percent of total billed charges,,826.56,,,826.56,Fee Schedule,,700.56,,,700.56,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,1016.4,
XR COLON W AIR & BARIUM W/ FY MOD,74280,CPT,FY,42674280,CDM,329,RC,,,both,,,1452,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,557.17,,,557.17,Fee Schedule,,501.27,,,501.27,Fee Schedule,,994.73,,,994.73,Fee Schedule,,894.89,,,894.89,Fee Schedule,,845.88,,,845.88,Fee Schedule,,1016.4,70,,1016.4,percent of total billed charges,All Other,661.96,,,661.96,Fee Schedule,,406,,,406,Other,186% of Medicaid,778.98,,,778.98,Fee Schedule,,900.24,,,900.24,Fee Schedule,,366.79,,,,Fee Schedule,,778.98,,,778.98,Fee Schedule,,900.24,,,900.24,Fee Schedule,,689.91,,,689.91,Fee Schedule,,1016.4,70,,1016.4,percent of total billed charges,,826.56,,,826.56,Fee Schedule,,700.56,,,700.56,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,201.9,1016.4,
CAVOGRAM INFERIOR,75825,CPT,TC,47075825,CDM,329,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,213.89,,,213.89,Fee Schedule,,192.43,,,192.43,Fee Schedule,,1051.83,,,1051.83,Fee Schedule,,946.26,,,946.26,Fee Schedule,,894.44,,,894.44,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,All Other,254.12,,,254.12,Fee Schedule,,558,,,558,Other,186% of Medicaid,299.04,,,299.04,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,140.81,,,,Fee Schedule,,299.04,,,299.04,Fee Schedule,,4158.34,,,4158.34,Fee Schedule,,264.85,,,264.85,Fee Schedule,,4694.9,70,,4694.9,percent of total billed charges,,303.4,,,303.4,Fee Schedule,,257.15,,,257.15,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,4434.05,,,4434.05,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,140.81,5759.82,
ARTERIAL EMBOLIZATION,75894,CPT,TC,47075894,CDM,329,RC,,,both,,,2144,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1393.6,65,,1393.6,percent of total billed charges,All Other,1264.96,59,,1264.96,percent of total billed charges,All Other,914.17,,,914.17,Fee Schedule,,914.17,,,914.17,Fee Schedule,,914.17,,,914.17,Fee Schedule,,1500.8,70,,1500.8,percent of total billed charges,All Other,1457.92,68,,1457.92,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,1715.2,80,,1715.2,percent of total billed charges,All Other,1779.52,83,,1779.52,percent of total billed charges,All Other,1779.52,83,,,percent of total billed charges,All Other,1715.2,80,,1715.2,percent of total billed charges,All Other,1779.52,83,,1779.52,percent of total billed charges,All Other,1715.2,80,,1715.2,percent of total billed charges,All Other,1500.8,70,,1500.8,percent of total billed charges,,1393.6,65,,1393.6,percent of total billed charges,All Other,1393.6,65,,1393.6,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1779.52,
CHEMO ADMIN NON HORMONAL SC/IM,96401,CPT,,34096401,CDM,331,RC,,,both,,,201,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,140.7,70,,140.7,percent of total billed charges,All Other,136.68,68,,136.68,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,160.8,80,,160.8,percent of total billed charges,All Other,166.83,83,,166.83,percent of total billed charges,All Other,166.83,83,,,percent of total billed charges,All Other,160.8,80,,160.8,percent of total billed charges,All Other,166.83,83,,166.83,percent of total billed charges,All Other,160.8,80,,160.8,percent of total billed charges,All Other,140.7,70,,140.7,percent of total billed charges,,369,,,369,Fee Schedule,,312.75,,,312.75,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO ADMIN NON HORMONAL SC/IM,96401,CPT,,75096401,CDM,331,RC,,,both,,,201,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,140.7,70,,140.7,percent of total billed charges,All Other,136.68,68,,136.68,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,160.8,80,,160.8,percent of total billed charges,All Other,166.83,83,,166.83,percent of total billed charges,All Other,166.83,83,,,percent of total billed charges,All Other,160.8,80,,160.8,percent of total billed charges,All Other,166.83,83,,166.83,percent of total billed charges,All Other,160.8,80,,160.8,percent of total billed charges,All Other,140.7,70,,140.7,percent of total billed charges,,369,,,369,Fee Schedule,,312.75,,,312.75,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO ANTI-NEOPL SQ/IM,96401,CPT,,82096401,CDM,331,RC,,,both,,,201,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,140.7,70,,140.7,percent of total billed charges,All Other,136.68,68,,136.68,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,160.8,80,,160.8,percent of total billed charges,All Other,166.83,83,,166.83,percent of total billed charges,All Other,166.83,83,,,percent of total billed charges,All Other,160.8,80,,160.8,percent of total billed charges,All Other,166.83,83,,166.83,percent of total billed charges,All Other,160.8,80,,160.8,percent of total billed charges,All Other,140.7,70,,140.7,percent of total billed charges,,369,,,369,Fee Schedule,,312.75,,,312.75,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO SUBQ/IM HORMONAL,96402,CPT,,34096402,CDM,331,RC,,,both,,,187,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,130.9,70,,130.9,percent of total billed charges,All Other,127.16,68,,127.16,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,149.6,80,,149.6,percent of total billed charges,All Other,155.21,83,,155.21,percent of total billed charges,All Other,155.21,83,,,percent of total billed charges,All Other,149.6,80,,149.6,percent of total billed charges,All Other,155.21,83,,155.21,percent of total billed charges,All Other,149.6,80,,149.6,percent of total billed charges,All Other,130.9,70,,130.9,percent of total billed charges,,160.72,,,160.72,Fee Schedule,,136.22,,,136.22,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO SUBQ/IM HORMONAL,96402,CPT,,75096402,CDM,331,RC,,,both,,,187,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,130.9,70,,130.9,percent of total billed charges,All Other,127.16,68,,127.16,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,149.6,80,,149.6,percent of total billed charges,All Other,155.21,83,,155.21,percent of total billed charges,All Other,155.21,83,,,percent of total billed charges,All Other,149.6,80,,149.6,percent of total billed charges,All Other,155.21,83,,155.21,percent of total billed charges,All Other,149.6,80,,149.6,percent of total billed charges,All Other,130.9,70,,130.9,percent of total billed charges,,160.72,,,160.72,Fee Schedule,,136.22,,,136.22,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO HORMON ANTINEOPL SQ/IM,96402,CPT,,82096402,CDM,331,RC,,,both,,,187,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,130.9,70,,130.9,percent of total billed charges,All Other,127.16,68,,127.16,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,149.6,80,,149.6,percent of total billed charges,All Other,155.21,83,,155.21,percent of total billed charges,All Other,155.21,83,,,percent of total billed charges,All Other,149.6,80,,149.6,percent of total billed charges,All Other,155.21,83,,155.21,percent of total billed charges,All Other,149.6,80,,149.6,percent of total billed charges,All Other,130.9,70,,130.9,percent of total billed charges,,160.72,,,160.72,Fee Schedule,,136.22,,,136.22,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO IV PUSH SNGL DRUG INITIA,96409,CPT,,34096409,CDM,331,RC,,,both,,,1106,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,774.2,70,,774.2,percent of total billed charges,All Other,752.08,68,,752.08,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,917.98,83,,,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,774.2,70,,774.2,percent of total billed charges,,511.68,,,511.68,Fee Schedule,,433.68,,,433.68,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO IV PUSH SNGL DRUG INITIA,96409,CPT,,75096409,CDM,331,RC,,,both,,,1106,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,774.2,70,,774.2,percent of total billed charges,All Other,752.08,68,,752.08,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,917.98,83,,,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,774.2,70,,774.2,percent of total billed charges,,511.68,,,511.68,Fee Schedule,,433.68,,,433.68,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO IV PUSH SNGL DRUG,96409,CPT,,82096409,CDM,331,RC,,,both,,,1106,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,774.2,70,,774.2,percent of total billed charges,All Other,752.08,68,,752.08,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,917.98,83,,,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,774.2,70,,774.2,percent of total billed charges,,511.68,,,511.68,Fee Schedule,,433.68,,,433.68,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO IV PUSH TECHNIQUE EA ADL,96411,CPT,,34096411,CDM,331,RC,,,both,,,1352,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,946.4,70,,946.4,percent of total billed charges,All Other,919.36,68,,919.36,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,1081.6,80,,1081.6,percent of total billed charges,All Other,1122.16,83,,1122.16,percent of total billed charges,All Other,1122.16,83,,,percent of total billed charges,All Other,1081.6,80,,1081.6,percent of total billed charges,All Other,1122.16,83,,1122.16,percent of total billed charges,All Other,1081.6,80,,1081.6,percent of total billed charges,All Other,946.4,70,,946.4,percent of total billed charges,,278.8,,,278.8,Fee Schedule,,236.3,,,236.3,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO IV PUSH TECHNIQUE EA ADL,96411,CPT,,75096411,CDM,331,RC,,,both,,,1352,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,946.4,70,,946.4,percent of total billed charges,All Other,919.36,68,,919.36,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,1081.6,80,,1081.6,percent of total billed charges,All Other,1122.16,83,,1122.16,percent of total billed charges,All Other,1122.16,83,,,percent of total billed charges,All Other,1081.6,80,,1081.6,percent of total billed charges,All Other,1122.16,83,,1122.16,percent of total billed charges,All Other,1081.6,80,,1081.6,percent of total billed charges,All Other,946.4,70,,946.4,percent of total billed charges,,278.8,,,278.8,Fee Schedule,,236.3,,,236.3,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO IV PUSH ADDL DRUG,96411,CPT,,82096411,CDM,331,RC,,,both,,,1352,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,946.4,70,,946.4,percent of total billed charges,All Other,919.36,68,,919.36,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,1081.6,80,,1081.6,percent of total billed charges,All Other,1122.16,83,,1122.16,percent of total billed charges,All Other,1122.16,83,,,percent of total billed charges,All Other,1081.6,80,,1081.6,percent of total billed charges,All Other,1122.16,83,,1122.16,percent of total billed charges,All Other,1081.6,80,,1081.6,percent of total billed charges,All Other,946.4,70,,946.4,percent of total billed charges,,278.8,,,278.8,Fee Schedule,,236.3,,,236.3,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,1143,
CHEMO CNS (INTRATHECAL) W LP,96450,CPT,,42096450,CDM,331,RC,,,both,,,932,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,652.4,70,,652.4,percent of total billed charges,All Other,633.76,68,,633.76,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,745.6,80,,745.6,percent of total billed charges,All Other,773.56,83,,773.56,percent of total billed charges,All Other,773.56,83,,,percent of total billed charges,All Other,745.6,80,,745.6,percent of total billed charges,All Other,773.56,83,,773.56,percent of total billed charges,All Other,745.6,80,,745.6,percent of total billed charges,All Other,652.4,70,,652.4,percent of total billed charges,,367.36,,,367.36,Fee Schedule,,311.36,,,311.36,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,311.36,1936.53,
CHEMO CNS (INTRATHECAL) W LP FY MOD,96450,CPT,,42696450,CDM,331,RC,,,both,,,932,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,652.4,70,,652.4,percent of total billed charges,All Other,633.76,68,,633.76,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,745.6,80,,745.6,percent of total billed charges,All Other,773.56,83,,773.56,percent of total billed charges,All Other,773.56,83,,,percent of total billed charges,All Other,745.6,80,,745.6,percent of total billed charges,All Other,773.56,83,,773.56,percent of total billed charges,All Other,745.6,80,,745.6,percent of total billed charges,All Other,652.4,70,,652.4,percent of total billed charges,,367.36,,,367.36,Fee Schedule,,311.36,,,311.36,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,311.36,1936.53,
CHEMO IV INFUSION UP TO 1 HR,96413,CPT,,34096413,CDM,335,RC,,,both,,,1118,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,782.6,70,,782.6,percent of total billed charges,All Other,760.24,68,,760.24,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,894.4,80,,894.4,percent of total billed charges,All Other,927.94,83,,927.94,percent of total billed charges,All Other,927.94,83,,,percent of total billed charges,All Other,894.4,80,,894.4,percent of total billed charges,All Other,927.94,83,,927.94,percent of total billed charges,All Other,894.4,80,,894.4,percent of total billed charges,All Other,782.6,70,,782.6,percent of total billed charges,,664.2,,,664.2,Fee Schedule,,562.95,,,562.95,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,228.51,1143,
CHEMO IV INFUSION UP TO 1 HR,96413,CPT,,75096413,CDM,335,RC,,,both,,,1118,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,782.6,70,,782.6,percent of total billed charges,All Other,760.24,68,,760.24,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,894.4,80,,894.4,percent of total billed charges,All Other,927.94,83,,927.94,percent of total billed charges,All Other,927.94,83,,,percent of total billed charges,All Other,894.4,80,,894.4,percent of total billed charges,All Other,927.94,83,,927.94,percent of total billed charges,All Other,894.4,80,,894.4,percent of total billed charges,All Other,782.6,70,,782.6,percent of total billed charges,,664.2,,,664.2,Fee Schedule,,562.95,,,562.95,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,228.51,1143,
CHEMO IV INFUSION UP TO 1 HOUR,96413,CPT,,82096413,CDM,335,RC,,,both,,,1118,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,782.6,70,,782.6,percent of total billed charges,All Other,760.24,68,,760.24,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,894.4,80,,894.4,percent of total billed charges,All Other,927.94,83,,927.94,percent of total billed charges,All Other,927.94,83,,,percent of total billed charges,All Other,894.4,80,,894.4,percent of total billed charges,All Other,927.94,83,,927.94,percent of total billed charges,All Other,894.4,80,,894.4,percent of total billed charges,All Other,782.6,70,,782.6,percent of total billed charges,,664.2,,,664.2,Fee Schedule,,562.95,,,562.95,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,228.51,1143,
CHEMO ADMIN INF EA ADDL HR,96415,CPT,,34096415,CDM,335,RC,,,both,,,1106,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,774.2,70,,774.2,percent of total billed charges,All Other,752.08,68,,752.08,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,917.98,83,,,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,774.2,70,,774.2,percent of total billed charges,,141.04,,,141.04,Fee Schedule,,119.54,,,119.54,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,77.41,1936.53,
CHEMO ADMIN INF EA ADDL HR,96415,CPT,,75096415,CDM,335,RC,,,both,,,1106,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,774.2,70,,774.2,percent of total billed charges,All Other,752.08,68,,752.08,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,917.98,83,,,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,774.2,70,,774.2,percent of total billed charges,,141.04,,,141.04,Fee Schedule,,119.54,,,119.54,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,77.41,1936.53,
CHEMO ADMIN INF EA ADDL HR,96415,CPT,,82096415,CDM,335,RC,,,both,,,1106,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,774.2,70,,774.2,percent of total billed charges,All Other,752.08,68,,752.08,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,917.98,83,,,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,774.2,70,,774.2,percent of total billed charges,,141.04,,,141.04,Fee Schedule,,119.54,,,119.54,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,77.41,1936.53,
CHEMO INITIATION IV PROLONGPMP,96416,CPT,,34096416,CDM,335,RC,,,both,,,1027,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,718.9,70,,718.9,percent of total billed charges,All Other,698.36,68,,698.36,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,821.6,80,,821.6,percent of total billed charges,All Other,852.41,83,,852.41,percent of total billed charges,All Other,852.41,83,,,percent of total billed charges,All Other,821.6,80,,821.6,percent of total billed charges,All Other,852.41,83,,852.41,percent of total billed charges,All Other,821.6,80,,821.6,percent of total billed charges,All Other,718.9,70,,718.9,percent of total billed charges,,651.08,,,651.08,Fee Schedule,,551.83,,,551.83,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,372.15,1936.53,
CHEMO INITIATION IV PROLONGPMP,96416,CPT,,75096416,CDM,335,RC,,,both,,,1027,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,718.9,70,,718.9,percent of total billed charges,All Other,698.36,68,,698.36,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,821.6,80,,821.6,percent of total billed charges,All Other,852.41,83,,852.41,percent of total billed charges,All Other,852.41,83,,,percent of total billed charges,All Other,821.6,80,,821.6,percent of total billed charges,All Other,852.41,83,,852.41,percent of total billed charges,All Other,821.6,80,,821.6,percent of total billed charges,All Other,718.9,70,,718.9,percent of total billed charges,,651.08,,,651.08,Fee Schedule,,551.83,,,551.83,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,372.15,1936.53,
CHEMO PROLONG 8+HRS INFUSE W/PUMP,96416,CPT,,82096416,CDM,335,RC,,,both,,,1027,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,718.9,70,,718.9,percent of total billed charges,All Other,698.36,68,,698.36,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,821.6,80,,821.6,percent of total billed charges,All Other,852.41,83,,852.41,percent of total billed charges,All Other,852.41,83,,,percent of total billed charges,All Other,821.6,80,,821.6,percent of total billed charges,All Other,852.41,83,,852.41,percent of total billed charges,All Other,821.6,80,,821.6,percent of total billed charges,All Other,718.9,70,,718.9,percent of total billed charges,,651.08,,,651.08,Fee Schedule,,551.83,,,551.83,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,372.15,1936.53,
CHEMO IVPB SEQUENTIAL UP TO 1,96417,CPT,,34096417,CDM,335,RC,,,both,,,1106,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,774.2,70,,774.2,percent of total billed charges,All Other,752.08,68,,752.08,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,917.98,83,,,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,774.2,70,,774.2,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,77.41,1143,
CHEMO IVPB SEQUENTIAL UP TO 1,96417,CPT,,75096417,CDM,335,RC,,,both,,,1106,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,774.2,70,,774.2,percent of total billed charges,All Other,752.08,68,,752.08,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,917.98,83,,,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,774.2,70,,774.2,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,77.41,1143,
CHEMO IV INFUS EACH ADDL SEQ =<1 HR,96417,CPT,,82096417,CDM,335,RC,,,both,,,1106,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,774.2,70,,774.2,percent of total billed charges,All Other,752.08,68,,752.08,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,917.98,83,,,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,917.98,83,,917.98,percent of total billed charges,All Other,884.8,80,,884.8,percent of total billed charges,All Other,774.2,70,,774.2,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,77.41,1143,
CHEMO IA; INFUSION; > 8 HRS,96425,CPT,,75096425,CDM,335,RC,,,both,,,878,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,598,,,598,Case Rate,Chemotherapy Per Visit,538,,,538,Case Rate,Chemotherapy Per Visit,1143,,,1143,Case Rate,Chemotherapy Per Visit,1029,,,1029,Case Rate,Chemotherapy Per Visit,972,,,972,Case Rate,Chemotherapy Per Visit,614.6,70,,614.6,percent of total billed charges,All Other,597.04,68,,597.04,percent of total billed charges,All Other,1112,,,1112,Other,186% of Medicaid,702.4,80,,702.4,percent of total billed charges,All Other,728.74,83,,728.74,percent of total billed charges,All Other,728.74,83,,,percent of total billed charges,All Other,702.4,80,,702.4,percent of total billed charges,All Other,728.74,83,,728.74,percent of total billed charges,All Other,702.4,80,,702.4,percent of total billed charges,All Other,614.6,70,,614.6,percent of total billed charges,,859.36,,,859.36,Fee Schedule,,728.36,,,728.36,Fee Schedule,,953,,,953,Case Rate,Chemotherapy Per Visit,858,,,858,Case Rate,Chemotherapy Per Visit,953,,,953,Case Rate,Chemotherapy Per Visit,810,,,810,Case Rate,Chemotherapy Per Visit,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,372.15,1936.53,
THYROID UPTAKE MEASUREMENT,78012,CPT,TC,50078012,CDM,341,RC,,,both,,,876,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,251.21,,,251.21,Fee Schedule,,226.01,,,226.01,Fee Schedule,,72.2,,,72.2,Fee Schedule,,72.2,,,72.2,Fee Schedule,,72.2,,,72.2,Fee Schedule,,613.2,70,,613.2,percent of total billed charges,All Other,298.46,,,298.46,Fee Schedule,,538,,,538,Other,186% of Medicaid,351.23,,,351.23,Fee Schedule,,543.12,,,543.12,Fee Schedule,,165.38,,,,Fee Schedule,,351.23,,,351.23,Fee Schedule,,543.12,,,543.12,Fee Schedule,,311.06,,,311.06,Fee Schedule,,613.2,70,,613.2,percent of total billed charges,,349.32,,,349.32,Fee Schedule,,296.07,,,296.07,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,72.2,937.43,
THYROID IMAGING W/BLOOD FLOW ONLY,78013,CPT,TC,50078013,CDM,341,RC,,,both,,,1365,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,535.57,,,535.57,Fee Schedule,,481.84,,,481.84,Fee Schedule,,175.68,,,175.68,Fee Schedule,,175.68,,,175.68,Fee Schedule,,175.68,,,175.68,Fee Schedule,,955.5,70,,955.5,percent of total billed charges,All Other,636.3,,,636.3,Fee Schedule,,538,,,538,Other,186% of Medicaid,748.79,,,748.79,Fee Schedule,,846.3,,,846.3,Fee Schedule,,352.57,,,,Fee Schedule,,748.79,,,748.79,Fee Schedule,,846.3,,,846.3,Fee Schedule,,663.17,,,663.17,Fee Schedule,,955.5,70,,955.5,percent of total billed charges,,818.36,,,818.36,Fee Schedule,,693.61,,,693.61,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,175.68,955.5,
THYROID IMAGING W/BLOOD FLOW AND UPTAKE,78014,CPT,TC,50078014,CDM,341,RC,,,both,,,2000,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,676.5,,,676.5,Fee Schedule,,608.64,,,608.64,Fee Schedule,,219.34,,,219.34,Fee Schedule,,219.34,,,219.34,Fee Schedule,,219.34,,,219.34,Fee Schedule,,1400,70,,1400,percent of total billed charges,All Other,803.75,,,803.75,Fee Schedule,,538,,,538,Other,186% of Medicaid,945.83,,,945.83,Fee Schedule,,1240,,,1240,Fee Schedule,,445.35,,,,Fee Schedule,,945.83,,,945.83,Fee Schedule,,1240,,,1240,Fee Schedule,,837.68,,,837.68,Fee Schedule,,1400,70,,1400,percent of total billed charges,,993.84,,,993.84,Fee Schedule,,842.34,,,842.34,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,219.34,1400,
THYROID METS; WHOLE BODY,78018,CPT,TC,50078018,CDM,341,RC,,,both,,,2150,976.7,,,976.7,Other,150% of Medicare + 9.63% HCRA Surcharge,593.94,,,593.94,Other,Medicare OPPS,853.42,,,853.42,Fee Schedule,,767.81,,,767.81,Fee Schedule,,1939.65,,,1939.65,Fee Schedule,,1744.97,,,1744.97,Fee Schedule,,1649.41,,,1649.41,Fee Schedule,,1505,70,,1505,percent of total billed charges,All Other,1013.94,,,1013.94,Fee Schedule,,538,,,538,Other,186% of Medicaid,1193.18,,,1193.18,Fee Schedule,,1333,,,1333,Fee Schedule,,561.81,,,,Fee Schedule,,1193.18,,,1193.18,Fee Schedule,,1333,,,1333,Fee Schedule,,1056.74,,,1056.74,Fee Schedule,,1505,70,,1505,percent of total billed charges,,1264.44,,,1264.44,Fee Schedule,,1071.69,,,1071.69,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1939.65,
PARATHYROID NUCLEAR IMAGING,78070,CPT,TC,50078070,CDM,341,RC,,,both,,,2412,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,806.08,,,806.08,Fee Schedule,,725.22,,,725.22,Fee Schedule,,878.33,,,878.33,Fee Schedule,,790.18,,,790.18,Fee Schedule,,746.9,,,746.9,Fee Schedule,,1688.4,70,,1688.4,percent of total billed charges,All Other,957.7,,,957.7,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1127,,,1127,Fee Schedule,,1495.44,,,1495.44,Fee Schedule,,530.65,,,,Fee Schedule,,1127,,,1127,Fee Schedule,,1495.44,,,1495.44,Fee Schedule,,998.13,,,998.13,Fee Schedule,,1688.4,70,,1688.4,percent of total billed charges,,1179.16,,,1179.16,Fee Schedule,,999.41,,,999.41,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,453.21,2017.29,
PARATHYRD PLANAR W/WO SUBTRJ,78071,CPT,TC,50078071,CDM,341,RC,,,both,,,2578,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,920.44,,,920.44,Fee Schedule,,828.11,,,828.11,Fee Schedule,,295.66,,,295.66,Fee Schedule,,295.66,,,295.66,Fee Schedule,,295.66,,,295.66,Fee Schedule,,1804.6,70,,1804.6,percent of total billed charges,All Other,1093.57,,,1093.57,Fee Schedule,,538,,,538,Other,186% of Medicaid,1286.89,,,1286.89,Fee Schedule,,1598.36,,,1598.36,Fee Schedule,,605.93,,,,Fee Schedule,,1286.89,,,1286.89,Fee Schedule,,1598.36,,,1598.36,Fee Schedule,,1139.73,,,1139.73,Fee Schedule,,1804.6,70,,1804.6,percent of total billed charges,,1354.64,,,1354.64,Fee Schedule,,1148.14,,,1148.14,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1804.6,
BONE MARROW IMAGING LIMITED,78102,CPT,TC,50078102,CDM,341,RC,,,both,,,1238,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,472.02,,,472.02,Fee Schedule,,424.67,,,424.67,Fee Schedule,,978.29,,,978.29,Fee Schedule,,880.1,,,880.1,Fee Schedule,,831.9,,,831.9,Fee Schedule,,866.6,70,,866.6,percent of total billed charges,All Other,560.81,,,560.81,Fee Schedule,,538,,,538,Other,186% of Medicaid,659.95,,,659.95,Fee Schedule,,767.56,,,767.56,Fee Schedule,,310.74,,,,Fee Schedule,,659.95,,,659.95,Fee Schedule,,767.56,,,767.56,Fee Schedule,,584.48,,,584.48,Fee Schedule,,866.6,70,,866.6,percent of total billed charges,,680.6,,,680.6,Fee Schedule,,576.85,,,576.85,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,978.29,
BM IMAGING; MULTIPLE AREAS,78103,CPT,TC,50078103,CDM,341,RC,,,both,,,1458,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,491.67,,,491.67,Fee Schedule,,442.35,,,442.35,Fee Schedule,,1282.87,,,1282.87,Fee Schedule,,1154.11,,,1154.11,Fee Schedule,,1090.91,,,1090.91,Fee Schedule,,1020.6,70,,1020.6,percent of total billed charges,All Other,584.15,,,584.15,Fee Schedule,,538,,,538,Other,186% of Medicaid,687.42,,,687.42,Fee Schedule,,903.96,,,903.96,Fee Schedule,,323.67,,,,Fee Schedule,,687.42,,,687.42,Fee Schedule,,903.96,,,903.96,Fee Schedule,,608.81,,,608.81,Fee Schedule,,1020.6,70,,1020.6,percent of total billed charges,,736.36,,,736.36,Fee Schedule,,624.11,,,624.11,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1282.87,
RED CELL SEQUESTRATION,78140,CPT,TC,50078140,CDM,341,RC,,,both,,,1739,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,296.61,,,296.61,Fee Schedule,,266.85,,,266.85,Fee Schedule,,761.77,,,761.77,Fee Schedule,,685.32,,,685.32,Fee Schedule,,647.79,,,647.79,Fee Schedule,,1217.3,70,,1217.3,percent of total billed charges,All Other,352.39,,,352.39,Fee Schedule,,538,,,538,Other,186% of Medicaid,414.69,,,414.69,Fee Schedule,,1078.18,,,1078.18,Fee Schedule,,195.26,,,,Fee Schedule,,414.69,,,414.69,Fee Schedule,,1078.18,,,1078.18,Fee Schedule,,367.27,,,367.27,Fee Schedule,,1217.3,70,,1217.3,percent of total billed charges,,419.84,,,419.84,Fee Schedule,,355.84,,,355.84,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,195.26,1217.3,
LYMPH NODE IMAGING,78195,CPT,TC,50078195,CDM,341,RC,,,both,,,2568,976.7,,,976.7,Other,150% of Medicare + 9.63% HCRA Surcharge,593.94,,,593.94,Other,Medicare OPPS,933.33,,,933.33,Fee Schedule,,839.7,,,839.7,Fee Schedule,,1801.6,,,1801.6,Fee Schedule,,1620.79,,,1620.79,Fee Schedule,,1532.02,,,1532.02,Fee Schedule,,1797.6,70,,1797.6,percent of total billed charges,All Other,1108.88,,,1108.88,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1304.91,,,1304.91,Fee Schedule,,1592.16,,,1592.16,Fee Schedule,,614.42,,,,Fee Schedule,,1304.91,,,1304.91,Fee Schedule,,1592.16,,,1592.16,Fee Schedule,,1155.69,,,1155.69,Fee Schedule,,1797.6,70,,1797.6,percent of total billed charges,,1374.32,,,1374.32,Fee Schedule,,1164.82,,,1164.82,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,593.94,2017.29,
LIVER & SPLEEN STATIC ONLY,78215,CPT,TC,50078215,CDM,341,RC,,,both,,,1343,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,554.04,,,554.04,Fee Schedule,,498.46,,,498.46,Fee Schedule,,1175.79,,,1175.79,Fee Schedule,,1057.78,,,1057.78,Fee Schedule,,999.85,,,999.85,Fee Schedule,,940.1,70,,940.1,percent of total billed charges,All Other,658.25,,,658.25,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,774.61,,,774.61,Fee Schedule,,832.66,,,832.66,Fee Schedule,,364.73,,,,Fee Schedule,,774.61,,,774.61,Fee Schedule,,832.66,,,832.66,Fee Schedule,,686.04,,,686.04,Fee Schedule,,940.1,70,,940.1,percent of total billed charges,,801.96,,,801.96,Fee Schedule,,679.71,,,679.71,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,364.73,2017.29,
HEPATOBILIARY SYSTEM IMAGING,78226,CPT,TC,50078226,CDM,341,RC,,,both,,,2718,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,910.04,,,910.04,Fee Schedule,,818.75,,,818.75,Fee Schedule,,282.47,,,282.47,Fee Schedule,,282.47,,,282.47,Fee Schedule,,282.47,,,282.47,Fee Schedule,,1902.6,70,,1902.6,percent of total billed charges,All Other,1081.21,,,1081.21,Fee Schedule,,538,,,538,Other,186% of Medicaid,1272.35,,,1272.35,Fee Schedule,,1685.16,,,1685.16,Fee Schedule,,599.09,,,,Fee Schedule,,1272.35,,,1272.35,Fee Schedule,,1685.16,,,1685.16,Fee Schedule,,1126.86,,,1126.86,Fee Schedule,,1902.6,70,,1902.6,percent of total billed charges,,1341.52,,,1341.52,Fee Schedule,,1137.02,,,1137.02,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,282.47,1902.6,
HEPATOBIL SYST IMAGE W/DRUG,78227,CPT,TC,50078227,CDM,341,RC,,,both,,,3731,976.7,,,976.7,Other,150% of Medicare + 9.63% HCRA Surcharge,593.94,,,593.94,Other,Medicare OPPS,1237.34,,,1237.34,Fee Schedule,,1113.22,,,1113.22,Fee Schedule,,387.38,,,387.38,Fee Schedule,,387.38,,,387.38,Fee Schedule,,387.38,,,387.38,Fee Schedule,,2611.7,70,,2611.7,percent of total billed charges,All Other,1470.07,,,1470.07,Fee Schedule,,538,,,538,Other,186% of Medicaid,1729.94,,,1729.94,Fee Schedule,,2313.22,,,2313.22,Fee Schedule,,814.55,,,,Fee Schedule,,1729.94,,,1729.94,Fee Schedule,,2313.22,,,2313.22,Fee Schedule,,1532.13,,,1532.13,Fee Schedule,,2611.7,70,,2611.7,percent of total billed charges,,1826.96,,,1826.96,Fee Schedule,,1548.46,,,1548.46,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,2611.7,
GASTRIC REFLUX SCAN,78262,CPT,TC,50078262,CDM,341,RC,,,both,,,1658,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,675.51,,,675.51,Fee Schedule,,607.75,,,607.75,Fee Schedule,,1487.49,,,1487.49,Fee Schedule,,1338.2,,,1338.2,Fee Schedule,,1264.91,,,1264.91,Fee Schedule,,1160.6,70,,1160.6,percent of total billed charges,All Other,802.57,,,802.57,Fee Schedule,,538,,,538,Other,186% of Medicaid,944.45,,,944.45,Fee Schedule,,1027.96,,,1027.96,Fee Schedule,,444.7,,,,Fee Schedule,,944.45,,,944.45,Fee Schedule,,1027.96,,,1027.96,Fee Schedule,,836.45,,,836.45,Fee Schedule,,1160.6,70,,1160.6,percent of total billed charges,,982.36,,,982.36,Fee Schedule,,832.61,,,832.61,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1487.49,
GASTRIC EMPTYING STUDY,78264,CPT,TC,50078264,CDM,341,RC,,,both,,,2746,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,921.75,,,921.75,Fee Schedule,,829.29,,,829.29,Fee Schedule,,1675.51,,,1675.51,Fee Schedule,,1507.35,,,1507.35,Fee Schedule,,1424.8,,,1424.8,Fee Schedule,,1922.2,70,,1922.2,percent of total billed charges,All Other,1095.12,,,1095.12,Fee Schedule,,538,,,538,Other,186% of Medicaid,1288.72,,,1288.72,Fee Schedule,,1702.52,,,1702.52,Fee Schedule,,606.8,,,,Fee Schedule,,1288.72,,,1288.72,Fee Schedule,,1702.52,,,1702.52,Fee Schedule,,1141.35,,,1141.35,Fee Schedule,,1922.2,70,,1922.2,percent of total billed charges,,1354.64,,,1354.64,Fee Schedule,,1148.14,,,1148.14,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1922.2,
ACUTE GI BLOOD LOSS IMAGING,78278,CPT,TC,50078278,CDM,341,RC,,,both,,,2767,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,947.17,,,947.17,Fee Schedule,,852.16,,,852.16,Fee Schedule,,1675.4,,,1675.4,Fee Schedule,,1507.25,,,1507.25,Fee Schedule,,1424.7,,,1424.7,Fee Schedule,,1936.9,70,,1936.9,percent of total billed charges,All Other,1125.33,,,1125.33,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1324.26,,,1324.26,Fee Schedule,,1715.54,,,1715.54,Fee Schedule,,623.53,,,,Fee Schedule,,1324.26,,,1324.26,Fee Schedule,,1715.54,,,1715.54,Fee Schedule,,1172.83,,,1172.83,Fee Schedule,,1936.9,70,,1936.9,percent of total billed charges,,1392.36,,,1392.36,Fee Schedule,,1180.11,,,1180.11,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,453.21,2017.29,
MECKELS DIVERTICULUM,78290,CPT,TC,50078290,CDM,341,RC,,,both,,,2524,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,934.48,,,934.48,Fee Schedule,,840.74,,,840.74,Fee Schedule,,1677.87,,,1677.87,Fee Schedule,,1509.47,,,1509.47,Fee Schedule,,1426.8,,,1426.8,Fee Schedule,,1766.8,70,,1766.8,percent of total billed charges,All Other,1110.24,,,1110.24,Fee Schedule,,538,,,538,Other,186% of Medicaid,1306.51,,,1306.51,Fee Schedule,,1564.88,,,1564.88,Fee Schedule,,615.17,,,,Fee Schedule,,1306.51,,,1306.51,Fee Schedule,,1564.88,,,1564.88,Fee Schedule,,1157.11,,,1157.11,Fee Schedule,,1766.8,70,,1766.8,percent of total billed charges,,1375.96,,,1375.96,Fee Schedule,,1166.21,,,1166.21,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1766.8,
PERITON-VENOUS SHUNT PATENCY,78291,CPT,,50078291,CDM,341,RC,,,both,,,1758,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,697.46,,,697.46,Fee Schedule,,627.5,,,627.5,Fee Schedule,,1466.12,,,1466.12,Fee Schedule,,1318.97,,,1318.97,Fee Schedule,,1246.74,,,1246.74,Fee Schedule,,1230.6,70,,1230.6,percent of total billed charges,All Other,828.65,,,828.65,Fee Schedule,,538,,,538,Other,186% of Medicaid,975.13,,,975.13,Fee Schedule,,1089.96,,,1089.96,Fee Schedule,,459.14,,,,Fee Schedule,,975.13,,,975.13,Fee Schedule,,1089.96,,,1089.96,Fee Schedule,,863.63,,,863.63,Fee Schedule,,1230.6,70,,1230.6,percent of total billed charges,,1015.16,,,1015.16,Fee Schedule,,860.41,,,860.41,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1466.12,
BONE AND OR JT IMAGING LIMITED,78300,CPT,TC,50078300,CDM,341,RC,,,both,,,1304,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,617.42,,,617.42,Fee Schedule,,555.49,,,555.49,Fee Schedule,,1018.73,,,1018.73,Fee Schedule,,916.49,,,916.49,Fee Schedule,,866.29,,,866.29,Fee Schedule,,912.8,70,,912.8,percent of total billed charges,All Other,733.55,,,733.55,Fee Schedule,,538,,,538,Other,186% of Medicaid,863.23,,,863.23,Fee Schedule,,808.48,,,808.48,Fee Schedule,,406.46,,,,Fee Schedule,,863.23,,,863.23,Fee Schedule,,808.48,,,808.48,Fee Schedule,,764.52,,,764.52,Fee Schedule,,912.8,70,,912.8,percent of total billed charges,,916.76,,,916.76,Fee Schedule,,777.01,,,777.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1018.73,
BONE/JOINT MULTI AREAS,78305,CPT,TC,50078305,CDM,341,RC,,,both,,,1509,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,733.13,,,733.13,Fee Schedule,,659.58,,,659.58,Fee Schedule,,1344.74,,,1344.74,Fee Schedule,,1209.77,,,1209.77,Fee Schedule,,1143.52,,,1143.52,Fee Schedule,,1056.3,70,,1056.3,percent of total billed charges,All Other,871.02,,,871.02,Fee Schedule,,538,,,538,Other,186% of Medicaid,1025,,,1025,Fee Schedule,,935.58,,,935.58,Fee Schedule,,482.62,,,,Fee Schedule,,1025,,,1025,Fee Schedule,,935.58,,,935.58,Fee Schedule,,907.79,,,907.79,Fee Schedule,,1056.3,70,,1056.3,percent of total billed charges,,1090.6,,,1090.6,Fee Schedule,,924.35,,,924.35,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1344.74,
BONE SCAN WHOLE BODY,78306,CPT,TC,50078306,CDM,341,RC,,,both,,,1934,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,797.82,,,797.82,Fee Schedule,,717.79,,,717.79,Fee Schedule,,1478.01,,,1478.01,Fee Schedule,,1329.67,,,1329.67,Fee Schedule,,1256.85,,,1256.85,Fee Schedule,,1353.8,70,,1353.8,percent of total billed charges,All Other,947.88,,,947.88,Fee Schedule,,538,,,538,Other,186% of Medicaid,1115.45,,,1115.45,Fee Schedule,,1199.08,,,1199.08,Fee Schedule,,525.21,,,,Fee Schedule,,1115.45,,,1115.45,Fee Schedule,,1199.08,,,1199.08,Fee Schedule,,987.9,,,987.9,Fee Schedule,,1353.8,70,,1353.8,percent of total billed charges,,1182.44,,,1182.44,Fee Schedule,,1002.19,,,1002.19,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1478.01,
THREE PHASE BONE SCAN,78315,CPT,TC,50078315,CDM,341,RC,,,both,,,2733,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,935.63,,,935.63,Fee Schedule,,841.77,,,841.77,Fee Schedule,,1713.49,,,1713.49,Fee Schedule,,1541.51,,,1541.51,Fee Schedule,,1457.09,,,1457.09,Fee Schedule,,1913.1,70,,1913.1,percent of total billed charges,All Other,1111.61,,,1111.61,Fee Schedule,,538,,,538,Other,186% of Medicaid,1308.12,,,1308.12,Fee Schedule,,1694.46,,,1694.46,Fee Schedule,,615.93,,,,Fee Schedule,,1308.12,,,1308.12,Fee Schedule,,1694.46,,,1694.46,Fee Schedule,,1158.54,,,1158.54,Fee Schedule,,1913.1,70,,1913.1,percent of total billed charges,,1375.96,,,1375.96,Fee Schedule,,1166.21,,,1166.21,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1913.1,
HT MUSCLE IMAGE SPECT SING,78451,CPT,TC,50078451,CDM,341,RC,,,both,,,3860,2565.89,,,2565.89,Other,150% of Medicare + 9.63% HCRA Surcharge,1560.33,,,1560.33,Other,Medicare OPPS,867.3,,,867.3,Fee Schedule,,780.3,,,780.3,Fee Schedule,,1927.7,,,1927.7,Fee Schedule,,1734.23,,,1734.23,Fee Schedule,,1639.25,,,1639.25,Fee Schedule,,2702,70,,2702,percent of total billed charges,All Other,1030.43,,,1030.43,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1212.58,,,1212.58,Fee Schedule,,2393.2,,,2393.2,Fee Schedule,,570.95,,,,Fee Schedule,,1212.58,,,1212.58,Fee Schedule,,2393.2,,,2393.2,Fee Schedule,,1073.93,,,1073.93,Fee Schedule,,2702,70,,2702,percent of total billed charges,,1267.72,,,1267.72,Fee Schedule,,1074.47,,,1074.47,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,570.95,2702,
HT MUSCLE IMAGE SPECT MULT,78452,CPT,TC,50078452,CDM,341,RC,,,both,,,4216,2565.89,,,2565.89,Other,150% of Medicare + 9.63% HCRA Surcharge,1560.33,,,1560.33,Other,Medicare OPPS,1245.57,,,1245.57,Fee Schedule,,1120.62,,,1120.62,Fee Schedule,,2801.1,,,2801.1,Fee Schedule,,2519.97,,,2519.97,Fee Schedule,,2381.96,,,2381.96,Fee Schedule,,2951.2,70,,2951.2,percent of total billed charges,All Other,1479.84,,,1479.84,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1741.45,,,1741.45,Fee Schedule,,2613.92,,,2613.92,Fee Schedule,,819.97,,,,Fee Schedule,,1741.45,,,1741.45,Fee Schedule,,2613.92,,,2613.92,Fee Schedule,,1542.32,,,1542.32,Fee Schedule,,2951.2,70,,2951.2,percent of total billed charges,,1831.88,,,1831.88,Fee Schedule,,1552.63,,,1552.63,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,622.62,2951.2,
HT MUSCLE IMAGE PLANAR SING,78453,CPT,TC,50078453,CDM,341,RC,,,both,,,3310,2565.89,,,2565.89,Other,150% of Medicare + 9.63% HCRA Surcharge,1560.33,,,1560.33,Other,Medicare OPPS,770.26,,,770.26,Fee Schedule,,692.99,,,692.99,Fee Schedule,,1715.95,,,1715.95,Fee Schedule,,1543.73,,,1543.73,Fee Schedule,,1459.19,,,1459.19,Fee Schedule,,2317,70,,2317,percent of total billed charges,All Other,915.13,,,915.13,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1076.91,,,1076.91,Fee Schedule,,2052.2,,,2052.2,Fee Schedule,,507.07,,,,Fee Schedule,,1076.91,,,1076.91,Fee Schedule,,2052.2,,,2052.2,Fee Schedule,,953.77,,,953.77,Fee Schedule,,2317,70,,2317,percent of total billed charges,,1144.72,,,1144.72,Fee Schedule,,970.22,,,970.22,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,507.07,2565.89,
HT MUSC IMAGE PLANAR MULT,78454,CPT,TC,50078454,CDM,341,RC,,,both,,,2989,2565.89,,,2565.89,Other,150% of Medicare + 9.63% HCRA Surcharge,1560.33,,,1560.33,Other,Medicare OPPS,1165.69,,,1165.69,Fee Schedule,,1048.76,,,1048.76,Fee Schedule,,2515.59,,,2515.59,Fee Schedule,,2263.12,,,2263.12,Fee Schedule,,2139.17,,,2139.17,Fee Schedule,,2092.3,70,,2092.3,percent of total billed charges,All Other,1384.94,,,1384.94,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1629.77,,,1629.77,Fee Schedule,,1853.18,,,1853.18,Fee Schedule,,767.38,,,,Fee Schedule,,1629.77,,,1629.77,Fee Schedule,,1853.18,,,1853.18,Fee Schedule,,1443.41,,,1443.41,Fee Schedule,,2092.3,70,,2092.3,percent of total billed charges,,1707.24,,,1707.24,Fee Schedule,,1446.99,,,1446.99,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,622.62,2565.89,
MI PLANAR QUAL/QUAN,78466,CPT,TC,50078466,CDM,341,RC,,,both,,,1268,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,469.73,,,469.73,Fee Schedule,,422.61,,,422.61,Fee Schedule,,1021.14,,,1021.14,Fee Schedule,,918.66,,,918.66,Fee Schedule,,868.34,,,868.34,Fee Schedule,,887.6,70,,887.6,percent of total billed charges,All Other,558.08,,,558.08,Fee Schedule,,538,,,538,Other,186% of Medicaid,656.74,,,656.74,Fee Schedule,,786.16,,,786.16,Fee Schedule,,309.23,,,,Fee Schedule,,656.74,,,656.74,Fee Schedule,,786.16,,,786.16,Fee Schedule,,581.64,,,581.64,Fee Schedule,,887.6,70,,887.6,percent of total billed charges,,742.92,,,742.92,Fee Schedule,,629.67,,,629.67,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1021.14,
MUGA SGL W WM AND EF,78472,CPT,TC,50078472,CDM,341,RC,,,both,,,1669,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,573.69,,,573.69,Fee Schedule,,516.14,,,516.14,Fee Schedule,,1420.91,,,1420.91,Fee Schedule,,1278.3,,,1278.3,Fee Schedule,,1208.29,,,1208.29,Fee Schedule,,1168.3,70,,1168.3,percent of total billed charges,All Other,681.59,,,681.59,Fee Schedule,,538,,,538,Other,186% of Medicaid,802.09,,,802.09,Fee Schedule,,1034.78,,,1034.78,Fee Schedule,,377.66,,,,Fee Schedule,,802.09,,,802.09,Fee Schedule,,1034.78,,,1034.78,Fee Schedule,,710.37,,,710.37,Fee Schedule,,1168.3,70,,1168.3,percent of total billed charges,,839.68,,,839.68,Fee Schedule,,711.68,,,711.68,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1420.91,
MUGA; MULTI W WM & EF,78473,CPT,TC,50078473,CDM,341,RC,,,both,,,1724,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,697.46,,,697.46,Fee Schedule,,627.5,,,627.5,Fee Schedule,,1811.14,,,1811.14,Fee Schedule,,1629.37,,,1629.37,Fee Schedule,,1540.13,,,1540.13,Fee Schedule,,1206.8,70,,1206.8,percent of total billed charges,All Other,828.65,,,828.65,Fee Schedule,,538,,,538,Other,186% of Medicaid,975.13,,,975.13,Fee Schedule,,1068.88,,,1068.88,Fee Schedule,,459.14,,,,Fee Schedule,,975.13,,,975.13,Fee Schedule,,1068.88,,,1068.88,Fee Schedule,,863.63,,,863.63,Fee Schedule,,1206.8,70,,1206.8,percent of total billed charges,,1016.8,,,1016.8,Fee Schedule,,861.8,,,861.8,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1811.14,
LUNG VENTILATION IMAGING,78579,CPT,TC,50078579,CDM,341,RC,,,both,,,1285,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,520.38,,,520.38,Fee Schedule,,468.18,,,468.18,Fee Schedule,,156.38,,,156.38,Fee Schedule,,156.38,,,156.38,Fee Schedule,,156.38,,,156.38,Fee Schedule,,899.5,70,,899.5,percent of total billed charges,All Other,618.26,,,618.26,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,727.56,,,727.56,Fee Schedule,,796.7,,,796.7,Fee Schedule,,342.57,,,,Fee Schedule,,727.56,,,727.56,Fee Schedule,,796.7,,,796.7,Fee Schedule,,644.36,,,644.36,Fee Schedule,,899.5,70,,899.5,percent of total billed charges,,759.32,,,759.32,Fee Schedule,,643.57,,,643.57,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,156.38,2017.29,
PULMONARY PERFUSION IMAGING,78580,CPT,TC,50078580,CDM,341,RC,,,both,,,1872,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,633.76,,,633.76,Fee Schedule,,570.18,,,570.18,Fee Schedule,,1235.3,,,1235.3,Fee Schedule,,1111.32,,,1111.32,Fee Schedule,,1050.46,,,1050.46,Fee Schedule,,1310.4,70,,1310.4,percent of total billed charges,All Other,752.96,,,752.96,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,886.07,,,886.07,Fee Schedule,,1160.64,,,1160.64,Fee Schedule,,417.21,,,,Fee Schedule,,886.07,,,886.07,Fee Schedule,,1160.64,,,1160.64,Fee Schedule,,784.75,,,784.75,Fee Schedule,,1310.4,70,,1310.4,percent of total billed charges,,929.88,,,929.88,Fee Schedule,,788.13,,,788.13,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,417.21,2017.29,
LUNG VENTILAT&PERFUS IMAGING,78582,CPT,TC,50078582,CDM,341,RC,,,both,,,2603,976.7,,,976.7,Other,150% of Medicare + 9.63% HCRA Surcharge,593.94,,,593.94,Other,Medicare OPPS,882.32,,,882.32,Fee Schedule,,793.81,,,793.81,Fee Schedule,,270.41,,,270.41,Fee Schedule,,270.41,,,270.41,Fee Schedule,,270.41,,,270.41,Fee Schedule,,1822.1,70,,1822.1,percent of total billed charges,All Other,1048.28,,,1048.28,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1233.59,,,1233.59,Fee Schedule,,1613.86,,,1613.86,Fee Schedule,,580.84,,,,Fee Schedule,,1233.59,,,1233.59,Fee Schedule,,1613.86,,,1613.86,Fee Schedule,,1092.53,,,1092.53,Fee Schedule,,1822.1,70,,1822.1,percent of total billed charges,,1302.16,,,1302.16,Fee Schedule,,1103.66,,,1103.66,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,270.41,2017.29,
LUNG PERFUSION DIFFERENTIAL,78597,CPT,,50078597,CDM,341,RC,,,both,,,1412,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,522.68,,,522.68,Fee Schedule,,470.25,,,470.25,Fee Schedule,,160.95,,,160.95,Fee Schedule,,160.95,,,160.95,Fee Schedule,,160.95,,,160.95,Fee Schedule,,988.4,70,,988.4,percent of total billed charges,All Other,620.99,,,620.99,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,730.77,,,730.77,Fee Schedule,,875.44,,,875.44,Fee Schedule,,344.09,,,,Fee Schedule,,730.77,,,730.77,Fee Schedule,,875.44,,,875.44,Fee Schedule,,647.21,,,647.21,Fee Schedule,,988.4,70,,988.4,percent of total billed charges,,774.08,,,774.08,Fee Schedule,,656.08,,,656.08,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,160.95,2017.29,
LUNG PERF&VENTILAT DIFERENTL QUANT,78598,CPT,TC,50078598,CDM,341,RC,,,both,,,2093,976.7,,,976.7,Other,150% of Medicare + 9.63% HCRA Surcharge,593.94,,,593.94,Other,Medicare OPPS,823.4,,,823.4,Fee Schedule,,740.8,,,740.8,Fee Schedule,,253.15,,,253.15,Fee Schedule,,253.15,,,253.15,Fee Schedule,,253.15,,,253.15,Fee Schedule,,1465.1,70,,1465.1,percent of total billed charges,All Other,978.27,,,978.27,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1151.22,,,1151.22,Fee Schedule,,1297.66,,,1297.66,Fee Schedule,,542.05,,,,Fee Schedule,,1151.22,,,1151.22,Fee Schedule,,1297.66,,,1297.66,Fee Schedule,,1019.57,,,1019.57,Fee Schedule,,1465.1,70,,1465.1,percent of total billed charges,,1220.16,,,1220.16,Fee Schedule,,1034.16,,,1034.16,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,253.15,2017.29,
CISTERNOGRAPHY,78630,CPT,TC,50078630,CDM,341,RC,,,both,,,2806,976.7,,,976.7,Other,150% of Medicare + 9.63% HCRA Surcharge,593.94,,,593.94,Other,Medicare OPPS,959.9,,,959.9,Fee Schedule,,863.61,,,863.61,Fee Schedule,,2120.49,,,2120.49,Fee Schedule,,1907.66,,,1907.66,Fee Schedule,,1803.19,,,1803.19,Fee Schedule,,1964.2,70,,1964.2,percent of total billed charges,All Other,1140.45,,,1140.45,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1342.06,,,1342.06,Fee Schedule,,1739.72,,,1739.72,Fee Schedule,,631.91,,,,Fee Schedule,,1342.06,,,1342.06,Fee Schedule,,1739.72,,,1739.72,Fee Schedule,,1188.59,,,1188.59,Fee Schedule,,1964.2,70,,1964.2,percent of total billed charges,,1413.68,,,1413.68,Fee Schedule,,1198.18,,,1198.18,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,593.94,2120.49,
CSF SHUNT EVALUATION,78645,CPT,TC,50078645,CDM,341,RC,,,both,,,2346,976.7,,,976.7,Other,150% of Medicare + 9.63% HCRA Surcharge,593.94,,,593.94,Other,Medicare OPPS,934.48,,,934.48,Fee Schedule,,840.74,,,840.74,Fee Schedule,,1684.99,,,1684.99,Fee Schedule,,1515.88,,,1515.88,Fee Schedule,,1432.86,,,1432.86,Fee Schedule,,1642.2,70,,1642.2,percent of total billed charges,All Other,1110.24,,,1110.24,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1306.51,,,1306.51,Fee Schedule,,1454.52,,,1454.52,Fee Schedule,,615.17,,,,Fee Schedule,,1306.51,,,1306.51,Fee Schedule,,1454.52,,,1454.52,Fee Schedule,,1157.11,,,1157.11,Fee Schedule,,1642.2,70,,1642.2,percent of total billed charges,,1372.68,,,1372.68,Fee Schedule,,1163.43,,,1163.43,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,593.94,2017.29,
CSF LEAKAGE IMAGING,78650,CPT,TC,50078650,CDM,341,RC,,,both,,,2989,2565.89,,,2565.89,Other,150% of Medicare + 9.63% HCRA Surcharge,1560.33,,,1560.33,Other,Medicare OPPS,776.19,,,776.19,Fee Schedule,,698.33,,,698.33,Fee Schedule,,2096.65,,,2096.65,Fee Schedule,,1886.22,,,1886.22,Fee Schedule,,1782.92,,,1782.92,Fee Schedule,,2092.3,70,,2092.3,percent of total billed charges,All Other,922.18,,,922.18,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1085.21,,,1085.21,Fee Schedule,,1853.18,,,1853.18,Fee Schedule,,510.97,,,,Fee Schedule,,1085.21,,,1085.21,Fee Schedule,,1853.18,,,1853.18,Fee Schedule,,961.11,,,961.11,Fee Schedule,,2092.3,70,,2092.3,percent of total billed charges,,1169.32,,,1169.32,Fee Schedule,,991.07,,,991.07,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,510.97,2565.89,
KIDNEY FLOW AND FUNCTION IMAGE,78707,CPT,TC,50078707,CDM,341,RC,,,both,,,1578,976.7,,,976.7,Other,150% of Medicare + 9.63% HCRA Surcharge,593.94,,,593.94,Other,Medicare OPPS,595.64,,,595.64,Fee Schedule,,535.89,,,535.89,Fee Schedule,,1337.61,,,1337.61,Fee Schedule,,1203.36,,,1203.36,Fee Schedule,,1137.46,,,1137.46,Fee Schedule,,1104.6,70,,1104.6,percent of total billed charges,All Other,707.67,,,707.67,Fee Schedule,,538,,,538,Other,186% of Medicaid,832.77,,,832.77,Fee Schedule,,978.36,,,978.36,Fee Schedule,,392.11,,,,Fee Schedule,,832.77,,,832.77,Fee Schedule,,978.36,,,978.36,Fee Schedule,,737.54,,,737.54,Fee Schedule,,1104.6,70,,1104.6,percent of total billed charges,,865.92,,,865.92,Fee Schedule,,733.92,,,733.92,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1337.61,
RENAL FLOW SINGLE W PHARM INT,78708,CPT,TC,50078708,CDM,341,RC,,,both,,,2068,976.7,,,976.7,Other,150% of Medicare + 9.63% HCRA Surcharge,593.94,,,593.94,Other,Medicare OPPS,416.74,,,416.74,Fee Schedule,,374.94,,,374.94,Fee Schedule,,849.78,,,849.78,Fee Schedule,,764.5,,,764.5,Fee Schedule,,722.63,,,722.63,Fee Schedule,,1447.6,70,,1447.6,percent of total billed charges,All Other,495.13,,,495.13,Fee Schedule,,538,,,538,Other,186% of Medicaid,582.65,,,582.65,Fee Schedule,,1282.16,,,1282.16,Fee Schedule,,274.34,,,,Fee Schedule,,582.65,,,582.65,Fee Schedule,,1282.16,,,1282.16,Fee Schedule,,516.03,,,516.03,Fee Schedule,,1447.6,70,,1447.6,percent of total billed charges,,577.28,,,577.28,Fee Schedule,,489.28,,,489.28,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,274.34,1447.6,
RENAL FLOW MULT W PHARM INTER,78709,CPT,TC,50078709,CDM,341,RC,,,both,,,2348,976.7,,,976.7,Other,150% of Medicare + 9.63% HCRA Surcharge,593.94,,,593.94,Other,Medicare OPPS,949.5,,,949.5,Fee Schedule,,854.26,,,854.26,Fee Schedule,,2082.4,,,2082.4,Fee Schedule,,1873.4,,,1873.4,Fee Schedule,,1770.8,,,1770.8,Fee Schedule,,1643.6,70,,1643.6,percent of total billed charges,All Other,1128.09,,,1128.09,Fee Schedule,,538,,,538,Other,186% of Medicaid,1327.52,,,1327.52,Fee Schedule,,1455.76,,,1455.76,Fee Schedule,,625.07,,,,Fee Schedule,,1327.52,,,1327.52,Fee Schedule,,1455.76,,,1455.76,Fee Schedule,,1175.72,,,1175.72,Fee Schedule,,1643.6,70,,1643.6,percent of total billed charges,,1398.92,,,1398.92,Fee Schedule,,1185.67,,,1185.67,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,755.17,,,755.17,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,2082.4,
TESTICULAR IMAGING W/FLOW,78761,CPT,TC,50078761,CDM,341,RC,,,both,,,1406,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,567.92,,,567.92,Fee Schedule,,510.95,,,510.95,Fee Schedule,,1240.07,,,1240.07,Fee Schedule,,1115.61,,,1115.61,Fee Schedule,,1054.51,,,1054.51,Fee Schedule,,984.2,70,,984.2,percent of total billed charges,All Other,674.73,,,674.73,Fee Schedule,,538,,,538,Other,186% of Medicaid,794.01,,,794.01,Fee Schedule,,871.72,,,871.72,Fee Schedule,,373.86,,,,Fee Schedule,,794.01,,,794.01,Fee Schedule,,871.72,,,871.72,Fee Schedule,,703.22,,,703.22,Fee Schedule,,984.2,70,,984.2,percent of total billed charges,,823.28,,,823.28,Fee Schedule,,697.78,,,697.78,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,289.33,,,289.33,Other,100% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,442.67,,,442.67,Other,153% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,405.06,,,405.06,Other,140% of Medicaid,650.99,,,650.99,Other,225% of Medicaid,752.26,,,752.26,Other,250% of Medicaid,937.43,,,937.43,Other,324% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,622.06,,,622.06,Other,215% of Medicaid,361.66,,,361.66,Other,125% of Medicaid,289.33,1240.07,
LIMITED TUMOR LOCALIZ/RP DISTR,78800,CPT,TC,50078800,CDM,341,RC,,,both,,,2180,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,700.78,,,700.78,Fee Schedule,,630.48,,,630.48,Fee Schedule,,1083.01,,,1083.01,Fee Schedule,,974.32,,,974.32,Fee Schedule,,920.96,,,920.96,Fee Schedule,,1526,70,,1526,percent of total billed charges,All Other,832.59,,,832.59,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,979.77,,,979.77,Fee Schedule,,1351.6,,,1351.6,Fee Schedule,,461.33,,,,Fee Schedule,,979.77,,,979.77,Fee Schedule,,1351.6,,,1351.6,Fee Schedule,,867.74,,,867.74,Fee Schedule,,1526,70,,1526,percent of total billed charges,,1029.92,,,1029.92,Fee Schedule,,872.92,,,872.92,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,453.21,2017.29,
TUMOR LOCALIZ; MULTI AREAS,78801,CPT,TC,50078801,CDM,341,RC,,,both,,,1972,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,748.15,,,748.15,Fee Schedule,,673.1,,,673.1,Fee Schedule,,1497.03,,,1497.03,Fee Schedule,,1346.78,,,1346.78,Fee Schedule,,1273.02,,,1273.02,Fee Schedule,,1380.4,70,,1380.4,percent of total billed charges,All Other,888.87,,,888.87,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1046,,,1046,Fee Schedule,,1222.64,,,1222.64,Fee Schedule,,492.51,,,,Fee Schedule,,1046,,,1046,Fee Schedule,,1222.64,,,1222.64,Fee Schedule,,926.39,,,926.39,Fee Schedule,,1380.4,70,,1380.4,percent of total billed charges,,1115.2,,,1115.2,Fee Schedule,,945.2,,,945.2,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,453.21,2017.29,
TUMOR LOCALIZ; MULTI AREAS,78801,CPT,TC,54078801,CDM,341,RC,,,both,,,1972,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,748.15,,,748.15,Fee Schedule,,673.1,,,673.1,Fee Schedule,,1497.03,,,1497.03,Fee Schedule,,1346.78,,,1346.78,Fee Schedule,,1273.02,,,1273.02,Fee Schedule,,1380.4,70,,1380.4,percent of total billed charges,All Other,888.87,,,888.87,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1046,,,1046,Fee Schedule,,1222.64,,,1222.64,Fee Schedule,,492.51,,,,Fee Schedule,,1046,,,1046,Fee Schedule,,1222.64,,,1222.64,Fee Schedule,,926.39,,,926.39,Fee Schedule,,1380.4,70,,1380.4,percent of total billed charges,,1115.2,,,1115.2,Fee Schedule,,945.2,,,945.2,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,589.01,,,589.01,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,453.21,2017.29,
TUMOR IMAGING WB SGL DAY,78802,CPT,TC,50078802,CDM,341,RC,,,both,,,2989,2565.89,,,2565.89,Other,150% of Medicare + 9.63% HCRA Surcharge,1560.33,,,1560.33,Other,Medicare OPPS,849.78,,,849.78,Fee Schedule,,764.54,,,764.54,Fee Schedule,,1994.34,,,1994.34,Fee Schedule,,1794.17,,,1794.17,Fee Schedule,,1695.91,,,1695.91,Fee Schedule,,2092.3,70,,2092.3,percent of total billed charges,All Other,1009.62,,,1009.62,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1188.1,,,1188.1,Fee Schedule,,1853.18,,,1853.18,Fee Schedule,,559.42,,,,Fee Schedule,,1188.1,,,1188.1,Fee Schedule,,1853.18,,,1853.18,Fee Schedule,,1052.24,,,1052.24,Fee Schedule,,2092.3,70,,2092.3,percent of total billed charges,,1261.16,,,1261.16,Fee Schedule,,1068.91,,,1068.91,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,559.42,2565.89,
TUMOR LOCALIZ; SPECT (3D),78803,CPT,TC,50078803,CDM,341,RC,,,both,,,2989,2565.89,,,2565.89,Other,150% of Medicare + 9.63% HCRA Surcharge,1560.33,,,1560.33,Other,Medicare OPPS,1033.66,,,1033.66,Fee Schedule,,929.97,,,929.97,Fee Schedule,,2089.52,,,2089.52,Fee Schedule,,1879.81,,,1879.81,Fee Schedule,,1776.86,,,1776.86,Fee Schedule,,2092.3,70,,2092.3,percent of total billed charges,All Other,1228.07,,,1228.07,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,1445.17,,,1445.17,Fee Schedule,,1853.18,,,1853.18,Fee Schedule,,680.46,,,,Fee Schedule,,1445.17,,,1445.17,Fee Schedule,,1853.18,,,1853.18,Fee Schedule,,1279.92,,,1279.92,Fee Schedule,,2092.3,70,,2092.3,percent of total billed charges,,1539.96,,,1539.96,Fee Schedule,,1305.21,,,1305.21,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,622.62,2565.89,
TUMOR IMAGING WB 2+ DAYS,78804,CPT,TC,50078804,CDM,341,RC,,,both,,,4429,2565.89,,,2565.89,Other,150% of Medicare + 9.63% HCRA Surcharge,1560.33,,,1560.33,Other,Medicare OPPS,1873.04,,,1873.04,Fee Schedule,,1685.15,,,1685.15,Fee Schedule,,3700.7,,,3700.7,Fee Schedule,,3329.28,,,3329.28,Fee Schedule,,3146.94,,,3146.94,Fee Schedule,,3100.3,70,,3100.3,percent of total billed charges,All Other,2225.34,,,2225.34,Fee Schedule,,1158,,,1158,Other,186% of Medicaid,2618.73,,,2618.73,Fee Schedule,,2745.98,,,2745.98,Fee Schedule,,1233.04,,,,Fee Schedule,,2618.73,,,2618.73,Fee Schedule,,2745.98,,,2745.98,Fee Schedule,,2319.28,,,2319.28,Fee Schedule,,3100.3,70,,3100.3,percent of total billed charges,,2806.04,,,2806.04,Fee Schedule,,2378.29,,,2378.29,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,2035.5,,,2035.5,Fee Schedule,,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,622.62,,,622.62,Other,100% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,952.61,,,952.61,Other,153% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,871.67,,,871.67,Other,140% of Medicaid,1400.89,,,1400.89,Other,225% of Medicaid,1618.81,,,1618.81,Other,250% of Medicaid,2017.29,,,2017.29,Other,324% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,1338.63,,,1338.63,Other,215% of Medicaid,778.27,,,778.27,Other,125% of Medicaid,622.62,3700.7,
THYROID RADIATION THERAPY,79005,CPT,TC,50079005,CDM,342,RC,,,both,,,1657,449.56,,,449.56,Other,150% of Medicare + 9.63% HCRA Surcharge,273.38,,,273.38,Other,Medicare OPPS,178.26,,,178.26,Fee Schedule,,160.38,,,160.38,Fee Schedule,,383.22,,,383.22,Fee Schedule,,344.75,,,344.75,Fee Schedule,,325.87,,,325.87,Fee Schedule,,1159.9,70,,1159.9,percent of total billed charges,All Other,211.79,,,211.79,Fee Schedule,,611,,,611,Other,186% of Medicaid,249.22,,,249.22,Fee Schedule,,1027.34,,,1027.34,Fee Schedule,,117.35,,,,Fee Schedule,,249.22,,,249.22,Fee Schedule,,1027.34,,,1027.34,Fee Schedule,,220.73,,,220.73,Fee Schedule,,1159.9,70,,1159.9,percent of total billed charges,,247.64,,,247.64,Fee Schedule,,209.89,,,209.89,Fee Schedule,,379.84,,,379.84,Fee Schedule,,379.84,,,379.84,Fee Schedule,,379.84,,,379.84,Fee Schedule,,379.84,,,379.84,Fee Schedule,,328.35,,,328.35,Other,100% of Medicaid,328.35,,,328.35,Other,100% of Medicaid,328.35,,,328.35,Other,100% of Medicaid,328.35,,,328.35,Other,100% of Medicaid,738.79,,,738.79,Other,225% of Medicaid,502.38,,,502.38,Other,153% of Medicaid,738.79,,,738.79,Other,225% of Medicaid,459.69,,,459.69,Other,140% of Medicaid,738.79,,,738.79,Other,225% of Medicaid,853.72,,,853.72,Other,250% of Medicaid,1063.86,,,1063.86,Other,324% of Medicaid,705.96,,,705.96,Other,215% of Medicaid,705.96,,,705.96,Other,215% of Medicaid,410.44,,,410.44,Other,125% of Medicaid,117.35,1159.9,
RADIOPH RX BY IV ADMIN,79101,CPT,TC,50079101,CDM,342,RC,,,both,,,5012,449.56,,,449.56,Other,150% of Medicare + 9.63% HCRA Surcharge,273.38,,,273.38,Other,Medicare OPPS,186.33,,,186.33,Fee Schedule,,167.64,,,167.64,Fee Schedule,,416.53,,,416.53,Fee Schedule,,374.73,,,374.73,Fee Schedule,,354.21,,,354.21,Fee Schedule,,3508.4,70,,3508.4,percent of total billed charges,All Other,221.37,,,221.37,Fee Schedule,,611,,,611,Other,186% of Medicaid,260.51,,,260.51,Fee Schedule,,3107.44,,,3107.44,Fee Schedule,,122.66,,,,Fee Schedule,,260.51,,,260.51,Fee Schedule,,3107.44,,,3107.44,Fee Schedule,,230.72,,,230.72,Fee Schedule,,3508.4,70,,3508.4,percent of total billed charges,,257.48,,,257.48,Fee Schedule,,218.23,,,218.23,Fee Schedule,,379.84,,,379.84,Fee Schedule,,379.84,,,379.84,Fee Schedule,,379.84,,,379.84,Fee Schedule,,379.84,,,379.84,Fee Schedule,,328.35,,,328.35,Other,100% of Medicaid,328.35,,,328.35,Other,100% of Medicaid,328.35,,,328.35,Other,100% of Medicaid,328.35,,,328.35,Other,100% of Medicaid,738.79,,,738.79,Other,225% of Medicaid,502.38,,,502.38,Other,153% of Medicaid,738.79,,,738.79,Other,225% of Medicaid,459.69,,,459.69,Other,140% of Medicaid,738.79,,,738.79,Other,225% of Medicaid,853.72,,,853.72,Other,250% of Medicaid,1063.86,,,1063.86,Other,324% of Medicaid,705.96,,,705.96,Other,215% of Medicaid,705.96,,,705.96,Other,215% of Medicaid,410.44,,,410.44,Other,125% of Medicaid,122.66,3508.4,
RPHARM MONOCLONAL AB THERAPY,79403,CPT,TC,50079403,CDM,342,RC,,,both,,,1425,449.56,,,449.56,Other,150% of Medicare + 9.63% HCRA Surcharge,273.38,,,273.38,Other,Medicare OPPS,350.74,,,350.74,Fee Schedule,,315.56,,,315.56,Fee Schedule,,645.16,,,645.16,Fee Schedule,,580.41,,,580.41,Fee Schedule,,548.62,,,548.62,Fee Schedule,,997.5,70,,997.5,percent of total billed charges,All Other,416.71,,,416.71,Fee Schedule,,611,,,611,Other,186% of Medicaid,490.38,,,490.38,Fee Schedule,,883.5,,,883.5,Fee Schedule,,230.9,,,,Fee Schedule,,490.38,,,490.38,Fee Schedule,,883.5,,,883.5,Fee Schedule,,434.3,,,434.3,Fee Schedule,,997.5,70,,997.5,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,379.84,,,379.84,Fee Schedule,,379.84,,,379.84,Fee Schedule,,379.84,,,379.84,Fee Schedule,,379.84,,,379.84,Fee Schedule,,328.35,,,328.35,Other,100% of Medicaid,328.35,,,328.35,Other,100% of Medicaid,328.35,,,328.35,Other,100% of Medicaid,328.35,,,328.35,Other,100% of Medicaid,738.79,,,738.79,Other,225% of Medicaid,502.38,,,502.38,Other,153% of Medicaid,738.79,,,738.79,Other,225% of Medicaid,459.69,,,459.69,Other,140% of Medicaid,738.79,,,738.79,Other,225% of Medicaid,853.72,,,853.72,Other,250% of Medicaid,1063.86,,,1063.86,Other,324% of Medicaid,705.96,,,705.96,Other,215% of Medicaid,705.96,,,705.96,Other,215% of Medicaid,410.44,,,410.44,Other,125% of Medicaid,230.9,1063.86,
RADIOPHARMACEUTICAL DIAGNOSTIC,A4641,HCPCS,,50000001,CDM,343,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,250,,,250,Fee Schedule,,250,,,250,Fee Schedule,,250,,,250,Fee Schedule,,0.01,70,,0.01,percent of total billed charges,All Other,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,250,
TC99M SESTAMIBI PER DOSE,A9500,HCPCS,,50000002,CDM,343,RC,,,both,,,108,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,36.72,34,,36.72,percent of total billed charges,Radiopharmaceutical,36.72,34,,36.72,percent of total billed charges,Radiopharmaceutical,36.72,34,,36.72,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,66.96,34,,66.96,percent of total billed charges,Radiopharmaceutical,66.96,34,,66.96,percent of total billed charges,Radiopharmaceutical,66.96,34,,,percent of total billed charges,Radiopharmaceutical,66.96,34,,66.96,percent of total billed charges,Radiopharmaceutical,66.96,34,,66.96,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,75.6,70,,75.6,percent of total billed charges,,38.88,36,,38.88,percent of total billed charges,Radiopharmaceutical,38.88,36,,38.88,percent of total billed charges,Radiopharmaceutical,37.8,35,,37.8,percent of total billed charges,Radiopharmaceutical,37.8,35,,37.8,percent of total billed charges,Radiopharmaceutical,37.8,35,,37.8,percent of total billed charges,Radiopharmaceutical,37.8,35,,37.8,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,75.6,
TC99M TETROFOSMIN,A9502,HCPCS,,50000003,CDM,343,RC,,,both,,,216,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,73.44,34,,73.44,percent of total billed charges,Radiopharmaceutical,73.44,34,,73.44,percent of total billed charges,Radiopharmaceutical,73.44,34,,73.44,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,133.92,34,,133.92,percent of total billed charges,Radiopharmaceutical,133.92,34,,133.92,percent of total billed charges,Radiopharmaceutical,133.92,34,,,percent of total billed charges,Radiopharmaceutical,133.92,34,,133.92,percent of total billed charges,Radiopharmaceutical,133.92,34,,133.92,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,151.2,70,,151.2,percent of total billed charges,,77.76,36,,77.76,percent of total billed charges,Radiopharmaceutical,77.76,36,,77.76,percent of total billed charges,Radiopharmaceutical,75.6,35,,75.6,percent of total billed charges,Radiopharmaceutical,75.6,35,,75.6,percent of total billed charges,Radiopharmaceutical,75.6,35,,75.6,percent of total billed charges,Radiopharmaceutical,75.6,35,,75.6,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,151.2,
TC99M MEDRONATE UP TO 30 MCI,A9503,HCPCS,,50000004,CDM,343,RC,,,both,,,45.78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.57,34,,15.57,percent of total billed charges,Radiopharmaceutical,15.57,34,,15.57,percent of total billed charges,Radiopharmaceutical,15.57,34,,15.57,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,28.38,34,,28.38,percent of total billed charges,Radiopharmaceutical,28.38,34,,28.38,percent of total billed charges,Radiopharmaceutical,28.38,34,,,percent of total billed charges,Radiopharmaceutical,28.38,34,,28.38,percent of total billed charges,Radiopharmaceutical,28.38,34,,28.38,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,32.05,70,,32.05,percent of total billed charges,,16.48,36,,16.48,percent of total billed charges,Radiopharmaceutical,16.48,36,,16.48,percent of total billed charges,Radiopharmaceutical,16.02,35,,16.02,percent of total billed charges,Radiopharmaceutical,16.02,35,,16.02,percent of total billed charges,Radiopharmaceutical,16.02,35,,16.02,percent of total billed charges,Radiopharmaceutical,16.02,35,,16.02,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.05,
TL201 THALLIUM PER 1 MCI,A9505,HCPCS,,50000005,CDM,343,RC,,,both,,,45.78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.57,34,,15.57,percent of total billed charges,Radiopharmaceutical,15.57,34,,15.57,percent of total billed charges,Radiopharmaceutical,15.57,34,,15.57,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,28.38,34,,28.38,percent of total billed charges,Radiopharmaceutical,28.38,34,,28.38,percent of total billed charges,Radiopharmaceutical,28.38,34,,,percent of total billed charges,Radiopharmaceutical,28.38,34,,28.38,percent of total billed charges,Radiopharmaceutical,28.38,34,,28.38,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,32.05,70,,32.05,percent of total billed charges,,16.48,36,,16.48,percent of total billed charges,Radiopharmaceutical,16.48,36,,16.48,percent of total billed charges,Radiopharmaceutical,16.02,35,,16.02,percent of total billed charges,Radiopharmaceutical,16.02,35,,16.02,percent of total billed charges,Radiopharmaceutical,16.02,35,,16.02,percent of total billed charges,Radiopharmaceutical,16.02,35,,16.02,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,32.05,
IN111 CAPROMAB =< 10 MCI,A9507,HCPCS,,50000006,CDM,343,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,3193.12,,,3193.12,Fee Schedule,,3193.12,,,3193.12,Fee Schedule,,3193.12,,,3193.12,Fee Schedule,,0.01,70,,0.01,percent of total billed charges,All Other,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,34,,,percent of total billed charges,Radiopharmaceutical,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3193.12,
TC99M DISOFENIN =< 15MCI,A9510,HCPCS,,50000007,CDM,343,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,42.84,,,42.84,Fee Schedule,,42.84,,,42.84,Fee Schedule,,42.84,,,42.84,Fee Schedule,,76.3,70,,76.3,percent of total billed charges,All Other,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,67.58,34,,67.58,percent of total billed charges,Radiopharmaceutical,0.01,34,,,percent of total billed charges,Radiopharmaceutical,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,67.58,34,,67.58,percent of total billed charges,Radiopharmaceutical,87.2,80,,87.2,percent of total billed charges,All Other,76.3,70,,76.3,percent of total billed charges,,70.85,65,,70.85,percent of total billed charges,All Other,70.85,65,,70.85,percent of total billed charges,All Other,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,87.2,
TC99M PERTECHNETATE PER 1 MCI,A9512,HCPCS,,50000008,CDM,343,RC,,,both,,,1.09,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.37,34,,0.37,percent of total billed charges,Radiopharmaceutical,0.37,34,,0.37,percent of total billed charges,Radiopharmaceutical,0.37,34,,0.37,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.68,34,,0.68,percent of total billed charges,Radiopharmaceutical,0.68,34,,0.68,percent of total billed charges,Radiopharmaceutical,0.68,34,,,percent of total billed charges,Radiopharmaceutical,0.68,34,,0.68,percent of total billed charges,Radiopharmaceutical,0.68,34,,0.68,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.76,70,,0.76,percent of total billed charges,,0.39,36,,0.39,percent of total billed charges,Radiopharmaceutical,0.39,36,,0.39,percent of total billed charges,Radiopharmaceutical,0.38,35,,0.38,percent of total billed charges,Radiopharmaceutical,0.38,35,,0.38,percent of total billed charges,Radiopharmaceutical,0.38,35,,0.38,percent of total billed charges,Radiopharmaceutical,0.38,35,,0.38,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,0.76,
IODINE I-123 SOD IODIDE PER 100 MCI,A9516,HCPCS,,50000009,CDM,343,RC,,,both,,,78,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,26.52,34,,26.52,percent of total billed charges,Radiopharmaceutical,26.52,34,,26.52,percent of total billed charges,Radiopharmaceutical,26.52,34,,26.52,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,48.36,34,,48.36,percent of total billed charges,Radiopharmaceutical,48.36,34,,48.36,percent of total billed charges,Radiopharmaceutical,48.36,34,,,percent of total billed charges,Radiopharmaceutical,48.36,34,,48.36,percent of total billed charges,Radiopharmaceutical,48.36,34,,48.36,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,54.6,70,,54.6,percent of total billed charges,,28.08,36,,28.08,percent of total billed charges,Radiopharmaceutical,28.08,36,,28.08,percent of total billed charges,Radiopharmaceutical,27.3,35,,27.3,percent of total billed charges,Radiopharmaceutical,27.3,35,,27.3,percent of total billed charges,Radiopharmaceutical,27.3,35,,27.3,percent of total billed charges,Radiopharmaceutical,27.3,35,,27.3,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,54.6,
TC99M EXAMETAZIME UP TO 25 MCI,A9521,HCPCS,,50000011,CDM,343,RC,,,both,,,4210,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1431.4,34,,1431.4,percent of total billed charges,Radiopharmaceutical,1431.4,34,,1431.4,percent of total billed charges,Radiopharmaceutical,1431.4,34,,1431.4,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,2610.2,34,,2610.2,percent of total billed charges,Radiopharmaceutical,2610.2,34,,2610.2,percent of total billed charges,Radiopharmaceutical,2610.2,34,,,percent of total billed charges,Radiopharmaceutical,2610.2,34,,2610.2,percent of total billed charges,Radiopharmaceutical,2610.2,34,,2610.2,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,2947,70,,2947,percent of total billed charges,,1515.6,36,,1515.6,percent of total billed charges,Radiopharmaceutical,1515.6,36,,1515.6,percent of total billed charges,Radiopharmaceutical,1473.5,35,,1473.5,percent of total billed charges,Radiopharmaceutical,1473.5,35,,1473.5,percent of total billed charges,Radiopharmaceutical,1473.5,35,,1473.5,percent of total billed charges,Radiopharmaceutical,1473.5,35,,1473.5,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2947,
TC99M MEBROFENIN UP TO 15 MCI,A9537,HCPCS,,50000012,CDM,343,RC,,,both,,,109,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,37.06,34,,37.06,percent of total billed charges,Radiopharmaceutical,37.06,34,,37.06,percent of total billed charges,Radiopharmaceutical,37.06,34,,37.06,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,67.58,34,,67.58,percent of total billed charges,Radiopharmaceutical,67.58,34,,67.58,percent of total billed charges,Radiopharmaceutical,67.58,34,,,percent of total billed charges,Radiopharmaceutical,67.58,34,,67.58,percent of total billed charges,Radiopharmaceutical,67.58,34,,67.58,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,76.3,70,,76.3,percent of total billed charges,,39.24,36,,39.24,percent of total billed charges,Radiopharmaceutical,39.24,36,,39.24,percent of total billed charges,Radiopharmaceutical,38.15,35,,38.15,percent of total billed charges,Radiopharmaceutical,38.15,35,,38.15,percent of total billed charges,Radiopharmaceutical,38.15,35,,38.15,percent of total billed charges,Radiopharmaceutical,38.15,35,,38.15,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,76.3,
TC99M PYROPHOSPHATE UP TO 25 M,A9538,HCPCS,,50000013,CDM,343,RC,,,both,,,65,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,22.1,34,,22.1,percent of total billed charges,Radiopharmaceutical,22.1,34,,22.1,percent of total billed charges,Radiopharmaceutical,22.1,34,,22.1,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,40.3,34,,40.3,percent of total billed charges,Radiopharmaceutical,40.3,34,,40.3,percent of total billed charges,Radiopharmaceutical,40.3,34,,,percent of total billed charges,Radiopharmaceutical,40.3,34,,40.3,percent of total billed charges,Radiopharmaceutical,40.3,34,,40.3,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,45.5,70,,45.5,percent of total billed charges,,23.4,36,,23.4,percent of total billed charges,Radiopharmaceutical,23.4,36,,23.4,percent of total billed charges,Radiopharmaceutical,22.75,35,,22.75,percent of total billed charges,Radiopharmaceutical,22.75,35,,22.75,percent of total billed charges,Radiopharmaceutical,22.75,35,,22.75,percent of total billed charges,Radiopharmaceutical,22.75,35,,22.75,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,45.5,
TC99M PENTETATE UP TO 25 MCI,A9539,HCPCS,,50000014,CDM,343,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84.66,34,,84.66,percent of total billed charges,Radiopharmaceutical,84.66,34,,84.66,percent of total billed charges,Radiopharmaceutical,84.66,34,,84.66,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,154.38,34,,154.38,percent of total billed charges,Radiopharmaceutical,154.38,34,,154.38,percent of total billed charges,Radiopharmaceutical,154.38,34,,,percent of total billed charges,Radiopharmaceutical,154.38,34,,154.38,percent of total billed charges,Radiopharmaceutical,154.38,34,,154.38,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,174.3,70,,174.3,percent of total billed charges,,89.64,36,,89.64,percent of total billed charges,Radiopharmaceutical,89.64,36,,89.64,percent of total billed charges,Radiopharmaceutical,87.15,35,,87.15,percent of total billed charges,Radiopharmaceutical,87.15,35,,87.15,percent of total billed charges,Radiopharmaceutical,87.15,35,,87.15,percent of total billed charges,Radiopharmaceutical,87.15,35,,87.15,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.3,
TC99M MAA UP TO 10 MCI,A9540,HCPCS,,50000015,CDM,343,RC,,,both,,,313,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,106.42,34,,106.42,percent of total billed charges,Radiopharmaceutical,106.42,34,,106.42,percent of total billed charges,Radiopharmaceutical,106.42,34,,106.42,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,194.06,34,,194.06,percent of total billed charges,Radiopharmaceutical,194.06,34,,194.06,percent of total billed charges,Radiopharmaceutical,194.06,34,,,percent of total billed charges,Radiopharmaceutical,194.06,34,,194.06,percent of total billed charges,Radiopharmaceutical,194.06,34,,194.06,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,219.1,70,,219.1,percent of total billed charges,,112.68,36,,112.68,percent of total billed charges,Radiopharmaceutical,112.68,36,,112.68,percent of total billed charges,Radiopharmaceutical,109.55,35,,109.55,percent of total billed charges,Radiopharmaceutical,109.55,35,,109.55,percent of total billed charges,Radiopharmaceutical,109.55,35,,109.55,percent of total billed charges,Radiopharmaceutical,109.55,35,,109.55,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,219.1,
TC99M SULFUR COLLOID UP TO 20,A9541,HCPCS,,50000016,CDM,343,RC,,,both,,,215,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,73.1,34,,73.1,percent of total billed charges,Radiopharmaceutical,73.1,34,,73.1,percent of total billed charges,Radiopharmaceutical,73.1,34,,73.1,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,133.3,34,,133.3,percent of total billed charges,Radiopharmaceutical,133.3,34,,133.3,percent of total billed charges,Radiopharmaceutical,133.3,34,,,percent of total billed charges,Radiopharmaceutical,133.3,34,,133.3,percent of total billed charges,Radiopharmaceutical,133.3,34,,133.3,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,150.5,70,,150.5,percent of total billed charges,,77.4,36,,77.4,percent of total billed charges,Radiopharmaceutical,77.4,36,,77.4,percent of total billed charges,Radiopharmaceutical,75.25,35,,75.25,percent of total billed charges,Radiopharmaceutical,75.25,35,,75.25,percent of total billed charges,Radiopharmaceutical,75.25,35,,75.25,percent of total billed charges,Radiopharmaceutical,75.25,35,,75.25,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,150.5,
IN111 OXYQUINOLINE PER 0.5 MCI,A9547,HCPCS,,50000017,CDM,343,RC,,,both,,,4039,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1373.26,34,,1373.26,percent of total billed charges,Radiopharmaceutical,1373.26,34,,1373.26,percent of total billed charges,Radiopharmaceutical,1373.26,34,,1373.26,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,2504.18,34,,2504.18,percent of total billed charges,Radiopharmaceutical,2504.18,34,,2504.18,percent of total billed charges,Radiopharmaceutical,2504.18,34,,,percent of total billed charges,Radiopharmaceutical,2504.18,34,,2504.18,percent of total billed charges,Radiopharmaceutical,2504.18,34,,2504.18,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,2827.3,70,,2827.3,percent of total billed charges,,1454.04,36,,1454.04,percent of total billed charges,Radiopharmaceutical,1454.04,36,,1454.04,percent of total billed charges,Radiopharmaceutical,1413.65,35,,1413.65,percent of total billed charges,Radiopharmaceutical,1413.65,35,,1413.65,percent of total billed charges,Radiopharmaceutical,1413.65,35,,1413.65,percent of total billed charges,Radiopharmaceutical,1413.65,35,,1413.65,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2827.3,
IN111 PENTETATE PER 0.5 MCI,A9548,HCPCS,,50000018,CDM,343,RC,,,both,,,3935,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1337.9,34,,1337.9,percent of total billed charges,Radiopharmaceutical,1337.9,34,,1337.9,percent of total billed charges,Radiopharmaceutical,1337.9,34,,1337.9,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,2439.7,34,,2439.7,percent of total billed charges,Radiopharmaceutical,2439.7,34,,2439.7,percent of total billed charges,Radiopharmaceutical,2439.7,34,,,percent of total billed charges,Radiopharmaceutical,2439.7,34,,2439.7,percent of total billed charges,Radiopharmaceutical,2439.7,34,,2439.7,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,2754.5,70,,2754.5,percent of total billed charges,,1416.6,36,,1416.6,percent of total billed charges,Radiopharmaceutical,1416.6,36,,1416.6,percent of total billed charges,Radiopharmaceutical,1377.25,35,,1377.25,percent of total billed charges,Radiopharmaceutical,1377.25,35,,1377.25,percent of total billed charges,Radiopharmaceutical,1377.25,35,,1377.25,percent of total billed charges,Radiopharmaceutical,1377.25,35,,1377.25,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2754.5,
GA67 GALLIUM PER 1 MCI,A9556,HCPCS,,50000019,CDM,343,RC,,,both,,,115,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,39.1,34,,39.1,percent of total billed charges,Radiopharmaceutical,39.1,34,,39.1,percent of total billed charges,Radiopharmaceutical,39.1,34,,39.1,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,71.3,34,,71.3,percent of total billed charges,Radiopharmaceutical,71.3,34,,71.3,percent of total billed charges,Radiopharmaceutical,71.3,34,,,percent of total billed charges,Radiopharmaceutical,71.3,34,,71.3,percent of total billed charges,Radiopharmaceutical,71.3,34,,71.3,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,80.5,70,,80.5,percent of total billed charges,,41.4,36,,41.4,percent of total billed charges,Radiopharmaceutical,41.4,36,,41.4,percent of total billed charges,Radiopharmaceutical,40.25,35,,40.25,percent of total billed charges,Radiopharmaceutical,40.25,35,,40.25,percent of total billed charges,Radiopharmaceutical,40.25,35,,40.25,percent of total billed charges,Radiopharmaceutical,40.25,35,,40.25,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,80.5,
TC99M BICISATE UP TO 25 MCI,A9557,HCPCS,,50000020,CDM,343,RC,,,both,,,3262,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,379.53,,,379.53,Fee Schedule,,379.53,,,379.53,Fee Schedule,,379.53,,,379.53,Fee Schedule,,2283.4,70,,2283.4,percent of total billed charges,All Other,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,2022.44,34,,2022.44,percent of total billed charges,Radiopharmaceutical,0.01,34,,,percent of total billed charges,Radiopharmaceutical,0.01,34,,0.01,percent of total billed charges,Radiopharmaceutical,2022.44,34,,2022.44,percent of total billed charges,Radiopharmaceutical,2609.6,80,,2609.6,percent of total billed charges,All Other,2283.4,70,,2283.4,percent of total billed charges,,2120.3,65,,2120.3,percent of total billed charges,All Other,2120.3,65,,2120.3,percent of total billed charges,All Other,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2609.6,
TC99M LABELED RBC UP TO 30 MCI,A9560,HCPCS,,50000021,CDM,343,RC,,,both,,,273,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,92.82,34,,92.82,percent of total billed charges,Radiopharmaceutical,92.82,34,,92.82,percent of total billed charges,Radiopharmaceutical,92.82,34,,92.82,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,169.26,34,,169.26,percent of total billed charges,Radiopharmaceutical,169.26,34,,169.26,percent of total billed charges,Radiopharmaceutical,169.26,34,,,percent of total billed charges,Radiopharmaceutical,169.26,34,,169.26,percent of total billed charges,Radiopharmaceutical,169.26,34,,169.26,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,191.1,70,,191.1,percent of total billed charges,,98.28,36,,98.28,percent of total billed charges,Radiopharmaceutical,98.28,36,,98.28,percent of total billed charges,Radiopharmaceutical,95.55,35,,95.55,percent of total billed charges,Radiopharmaceutical,95.55,35,,95.55,percent of total billed charges,Radiopharmaceutical,95.55,35,,95.55,percent of total billed charges,Radiopharmaceutical,95.55,35,,95.55,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,191.1,
TC99M MERTIATIDE UP TO 15 MCI,A9562,HCPCS,,50000022,CDM,343,RC,,,both,,,803,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,273.02,34,,273.02,percent of total billed charges,Radiopharmaceutical,273.02,34,,273.02,percent of total billed charges,Radiopharmaceutical,273.02,34,,273.02,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,497.86,34,,497.86,percent of total billed charges,Radiopharmaceutical,497.86,34,,497.86,percent of total billed charges,Radiopharmaceutical,497.86,34,,,percent of total billed charges,Radiopharmaceutical,497.86,34,,497.86,percent of total billed charges,Radiopharmaceutical,497.86,34,,497.86,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,562.1,70,,562.1,percent of total billed charges,,289.08,36,,289.08,percent of total billed charges,Radiopharmaceutical,289.08,36,,289.08,percent of total billed charges,Radiopharmaceutical,281.05,35,,281.05,percent of total billed charges,Radiopharmaceutical,281.05,35,,281.05,percent of total billed charges,Radiopharmaceutical,281.05,35,,281.05,percent of total billed charges,Radiopharmaceutical,281.05,35,,281.05,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,562.1,
TECHNETIUM TC-99M AEROSOL,A9567,HCPCS,,50000026,CDM,343,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,84.66,34,,84.66,percent of total billed charges,Radiopharmaceutical,84.66,34,,84.66,percent of total billed charges,Radiopharmaceutical,84.66,34,,84.66,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,154.38,34,,154.38,percent of total billed charges,Radiopharmaceutical,154.38,34,,154.38,percent of total billed charges,Radiopharmaceutical,154.38,34,,,percent of total billed charges,Radiopharmaceutical,154.38,34,,154.38,percent of total billed charges,Radiopharmaceutical,154.38,34,,154.38,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,174.3,70,,174.3,percent of total billed charges,,89.64,36,,89.64,percent of total billed charges,Radiopharmaceutical,89.64,36,,89.64,percent of total billed charges,Radiopharmaceutical,87.15,35,,87.15,percent of total billed charges,Radiopharmaceutical,87.15,35,,87.15,percent of total billed charges,Radiopharmaceutical,87.15,35,,87.15,percent of total billed charges,Radiopharmaceutical,87.15,35,,87.15,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,174.3,
INDIUM IN-111 AUTO WBC,A9570,HCPCS,,50000023,CDM,343,RC,,,both,,,4141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1407.94,34,,1407.94,percent of total billed charges,Radiopharmaceutical,1407.94,34,,1407.94,percent of total billed charges,Radiopharmaceutical,1407.94,34,,1407.94,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,2567.42,34,,2567.42,percent of total billed charges,Radiopharmaceutical,2567.42,34,,2567.42,percent of total billed charges,Radiopharmaceutical,2567.42,34,,,percent of total billed charges,Radiopharmaceutical,2567.42,34,,2567.42,percent of total billed charges,Radiopharmaceutical,2567.42,34,,2567.42,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,2898.7,70,,2898.7,percent of total billed charges,,1490.76,36,,1490.76,percent of total billed charges,Radiopharmaceutical,1490.76,36,,1490.76,percent of total billed charges,Radiopharmaceutical,1449.35,35,,1449.35,percent of total billed charges,Radiopharmaceutical,1449.35,35,,1449.35,percent of total billed charges,Radiopharmaceutical,1449.35,35,,1449.35,percent of total billed charges,Radiopharmaceutical,1449.35,35,,1449.35,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2898.7,
INDIUM IN-111 PENTETREOTIDE UP,A9572,HCPCS,,50000024,CDM,343,RC,,,both,,,7693,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2615.62,34,,2615.62,percent of total billed charges,Radiopharmaceutical,2615.62,34,,2615.62,percent of total billed charges,Radiopharmaceutical,2615.62,34,,2615.62,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,4769.66,34,,4769.66,percent of total billed charges,Radiopharmaceutical,4769.66,34,,4769.66,percent of total billed charges,Radiopharmaceutical,4769.66,34,,,percent of total billed charges,Radiopharmaceutical,4769.66,34,,4769.66,percent of total billed charges,Radiopharmaceutical,4769.66,34,,4769.66,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,5385.1,70,,5385.1,percent of total billed charges,,2769.48,36,,2769.48,percent of total billed charges,Radiopharmaceutical,2769.48,36,,2769.48,percent of total billed charges,Radiopharmaceutical,2692.55,35,,2692.55,percent of total billed charges,Radiopharmaceutical,2692.55,35,,2692.55,percent of total billed charges,Radiopharmaceutical,2692.55,35,,2692.55,percent of total billed charges,Radiopharmaceutical,2692.55,35,,2692.55,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5385.1,
I131 IODIDE CAP RX PER 1 MCI,A9517,HCPCS,,50000010,CDM,344,RC,,,both,,,231,35.09,,,35.09,Other,150% of Medicare + 9.63% HCRA Surcharge,21.34,,,21.34,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,78.54,34,,78.54,percent of total billed charges,Radiopharmaceutical,78.54,34,,78.54,percent of total billed charges,Radiopharmaceutical,78.54,34,,78.54,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,0.01,35,,0.01,percent of total billed charges,Radiopharmaceutical,627,,,627,Other,Non Covered Service,143.22,34,,143.22,percent of total billed charges,Radiopharmaceutical,143.22,34,,143.22,percent of total billed charges,Radiopharmaceutical,143.22,34,,,percent of total billed charges,Radiopharmaceutical,143.22,34,,143.22,percent of total billed charges,Radiopharmaceutical,143.22,34,,143.22,percent of total billed charges,Radiopharmaceutical,0.01,,,0.01,Other,Non Covered Service,161.7,70,,161.7,percent of total billed charges,,83.16,36,,83.16,percent of total billed charges,Radiopharmaceutical,83.16,36,,83.16,percent of total billed charges,Radiopharmaceutical,80.85,35,,80.85,percent of total billed charges,Radiopharmaceutical,80.85,35,,80.85,percent of total billed charges,Radiopharmaceutical,80.85,35,,80.85,percent of total billed charges,Radiopharmaceutical,80.85,35,,80.85,percent of total billed charges,Radiopharmaceutical,336.95,,,336.95,Other,100% of Medicaid,336.95,,,336.95,Other,100% of Medicaid,336.95,,,336.95,Other,100% of Medicaid,336.95,,,336.95,Other,100% of Medicaid,758.13,,,758.13,Other,225% of Medicaid,515.53,,,515.53,Other,153% of Medicaid,758.13,,,758.13,Other,225% of Medicaid,471.73,,,471.73,Other,140% of Medicaid,758.13,,,758.13,Other,225% of Medicaid,876.07,,,876.07,Other,250% of Medicaid,1091.71,,,1091.71,Other,324% of Medicaid,724.44,,,724.44,Other,215% of Medicaid,724.44,,,724.44,Other,215% of Medicaid,421.19,,,421.19,Other,125% of Medicaid,0.01,1091.71,
CT SOFT TISSUE NECK WO CONTRAST,70490,CPT,TC,46070490,CDM,350,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,324.81,,,324.81,Fee Schedule,,292.22,,,292.22,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,385.9,,,385.9,Fee Schedule,,471,,,471,Other,186% of Medicaid,454.12,,,454.12,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,213.82,,,,Fee Schedule,,454.12,,,454.12,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,402.19,,,402.19,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,467.4,,,467.4,Fee Schedule,,396.15,,,396.15,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT ANGIOGRAPHY HEAD,70496,CPT,TC,46070496,CDM,350,RC,,,both,,,2326,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.57,,,618.57,Fee Schedule,,556.52,,,556.52,Fee Schedule,,2372.51,,,2372.51,Fee Schedule,,2134.39,,,2134.39,Fee Schedule,,2017.5,,,2017.5,Fee Schedule,,1628.2,70,,1628.2,percent of total billed charges,All Other,734.92,,,734.92,Fee Schedule,,594,,,594,Other,186% of Medicaid,864.84,,,864.84,Fee Schedule,,1442.12,,,1442.12,Fee Schedule,,407.21,,,,Fee Schedule,,864.84,,,864.84,Fee Schedule,,1442.12,,,1442.12,Fee Schedule,,765.94,,,765.94,Fee Schedule,,1628.2,70,,1628.2,percent of total billed charges,,1003.68,,,1003.68,Fee Schedule,,850.68,,,850.68,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2372.51,
CT ANGIOGRAPHY NECK,70498,CPT,TC,46070498,CDM,350,RC,,,both,,,2326,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.57,,,618.57,Fee Schedule,,556.52,,,556.52,Fee Schedule,,2372.51,,,2372.51,Fee Schedule,,2134.39,,,2134.39,Fee Schedule,,2017.5,,,2017.5,Fee Schedule,,1628.2,70,,1628.2,percent of total billed charges,All Other,734.92,,,734.92,Fee Schedule,,594,,,594,Other,186% of Medicaid,864.84,,,864.84,Fee Schedule,,1442.12,,,1442.12,Fee Schedule,,407.21,,,,Fee Schedule,,864.84,,,864.84,Fee Schedule,,1442.12,,,1442.12,Fee Schedule,,765.94,,,765.94,Fee Schedule,,1628.2,70,,1628.2,percent of total billed charges,,1002.04,,,1002.04,Fee Schedule,,849.29,,,849.29,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2372.51,
CT ANGIO CHEST W CONTRAST,71275,CPT,TC,46071275,CDM,350,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.57,,,618.57,Fee Schedule,,556.52,,,556.52,Fee Schedule,,2370.1,,,2370.1,Fee Schedule,,2132.23,,,2132.23,Fee Schedule,,2015.45,,,2015.45,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,734.92,,,734.92,Fee Schedule,,594,,,594,Other,186% of Medicaid,864.84,,,864.84,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,407.21,,,,Fee Schedule,,864.84,,,864.84,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,765.94,,,765.94,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,1016.8,,,1016.8,Fee Schedule,,861.8,,,861.8,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2370.1,
CT ANGIO PELVIS W CONTRAST,72191,CPT,TC,46072191,CDM,350,RC,,,both,,,2895,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,617.27,,,617.27,Fee Schedule,,555.35,,,555.35,Fee Schedule,,2370.1,,,2370.1,Fee Schedule,,2132.23,,,2132.23,Fee Schedule,,2015.45,,,2015.45,Fee Schedule,,2026.5,70,,2026.5,percent of total billed charges,All Other,733.37,,,733.37,Fee Schedule,,594,,,594,Other,186% of Medicaid,863.01,,,863.01,Fee Schedule,,1794.9,,,1794.9,Fee Schedule,,406.35,,,,Fee Schedule,,863.01,,,863.01,Fee Schedule,,1794.9,,,1794.9,Fee Schedule,,764.33,,,764.33,Fee Schedule,,2026.5,70,,2026.5,percent of total billed charges,,1156.2,,,1156.2,Fee Schedule,,979.95,,,979.95,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2370.1,
CT L EXT W AND WO CONTRAST,73702,CPT,TC,46073702,CDM,350,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,498.25,,,498.25,Fee Schedule,,448.27,,,448.27,Fee Schedule,,2279.68,,,2279.68,Fee Schedule,,2050.88,,,2050.88,Fee Schedule,,1938.56,,,1938.56,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,591.96,,,591.96,Fee Schedule,,561,,,561,Other,186% of Medicaid,696.61,,,696.61,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,328,,,,Fee Schedule,,696.61,,,696.61,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,616.95,,,616.95,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,715.04,,,715.04,Fee Schedule,,606.04,,,606.04,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2279.68,
CT ANGIOGRAPHY L EXT W AND WO CONTRAST,73706,CPT,TC,46073706,CDM,350,RC,,,both,,,2309,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.57,,,618.57,Fee Schedule,,556.52,,,556.52,Fee Schedule,,2370.1,,,2370.1,Fee Schedule,,2132.23,,,2132.23,Fee Schedule,,2015.45,,,2015.45,Fee Schedule,,1616.3,70,,1616.3,percent of total billed charges,All Other,734.92,,,734.92,Fee Schedule,,594,,,594,Other,186% of Medicaid,864.84,,,864.84,Fee Schedule,,1431.58,,,1431.58,Fee Schedule,,407.21,,,,Fee Schedule,,864.84,,,864.84,Fee Schedule,,1431.58,,,1431.58,Fee Schedule,,765.94,,,765.94,Fee Schedule,,1616.3,70,,1616.3,percent of total billed charges,,1226.72,,,1226.72,Fee Schedule,,1039.72,,,1039.72,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2370.1,
CT ANGIO L EXT W AND WO CONTRAST LT,73706,CPT,TCLT,46173706,CDM,350,RC,,,both,,,2309,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.57,,,618.57,Fee Schedule,,556.52,,,556.52,Fee Schedule,,2370.1,,,2370.1,Fee Schedule,,2132.23,,,2132.23,Fee Schedule,,2015.45,,,2015.45,Fee Schedule,,1616.3,70,,1616.3,percent of total billed charges,All Other,734.92,,,734.92,Fee Schedule,,594,,,594,Other,186% of Medicaid,864.84,,,864.84,Fee Schedule,,1431.58,,,1431.58,Fee Schedule,,407.21,,,,Fee Schedule,,864.84,,,864.84,Fee Schedule,,1431.58,,,1431.58,Fee Schedule,,765.94,,,765.94,Fee Schedule,,1616.3,70,,1616.3,percent of total billed charges,,1226.72,,,1226.72,Fee Schedule,,1039.72,,,1039.72,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2370.1,
CT ANGIO L EXT W AND WO CONTRAST RT,73706,CPT,TCRT,46273706,CDM,350,RC,,,both,,,2309,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.57,,,618.57,Fee Schedule,,556.52,,,556.52,Fee Schedule,,2370.1,,,2370.1,Fee Schedule,,2132.23,,,2132.23,Fee Schedule,,2015.45,,,2015.45,Fee Schedule,,1616.3,70,,1616.3,percent of total billed charges,All Other,734.92,,,734.92,Fee Schedule,,594,,,594,Other,186% of Medicaid,864.84,,,864.84,Fee Schedule,,1431.58,,,1431.58,Fee Schedule,,407.21,,,,Fee Schedule,,864.84,,,864.84,Fee Schedule,,1431.58,,,1431.58,Fee Schedule,,765.94,,,765.94,Fee Schedule,,1616.3,70,,1616.3,percent of total billed charges,,1226.72,,,1226.72,Fee Schedule,,1039.72,,,1039.72,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2370.1,
CT ANGIO L EXT W AND WO CONTRAST BILAT,73706,CPT,TC50,46373706,CDM,350,RC,,,both,,,3464,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.57,,,618.57,Fee Schedule,,556.52,,,556.52,Fee Schedule,,2370.1,,,2370.1,Fee Schedule,,2132.23,,,2132.23,Fee Schedule,,2015.45,,,2015.45,Fee Schedule,,2424.8,70,,2424.8,percent of total billed charges,All Other,734.92,,,734.92,Fee Schedule,,594,,,594,Other,186% of Medicaid,864.84,,,864.84,Fee Schedule,,2147.68,,,2147.68,Fee Schedule,,407.21,,,,Fee Schedule,,864.84,,,864.84,Fee Schedule,,2147.68,,,2147.68,Fee Schedule,,765.94,,,765.94,Fee Schedule,,2424.8,70,,2424.8,percent of total billed charges,,1226.72,,,1226.72,Fee Schedule,,1039.72,,,1039.72,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2424.8,
CT ABDOMEN W AND WO CONTRAST,74170,CPT,TC,46074170,CDM,350,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.41,,,618.41,Fee Schedule,,556.38,,,556.38,Fee Schedule,,2341.55,,,2341.55,Fee Schedule,,2106.54,,,2106.54,Fee Schedule,,1991.17,,,1991.17,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,734.73,,,734.73,Fee Schedule,,561,,,561,Other,186% of Medicaid,864.62,,,864.62,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,407.11,,,,Fee Schedule,,864.62,,,864.62,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,765.75,,,765.75,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,1038.12,,,1038.12,Fee Schedule,,879.87,,,879.87,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2341.55,
CT CALCIUM SCORING,75571,CPT,TC,46075571,CDM,350,RC,,,both,,,608,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,261.42,,,261.42,Fee Schedule,,235.2,,,235.2,Fee Schedule,,326.11,,,326.11,Fee Schedule,,293.38,,,293.38,Fee Schedule,,277.32,,,277.32,Fee Schedule,,425.6,70,,425.6,percent of total billed charges,All Other,310.59,,,310.59,Fee Schedule,,471,,,471,Other,186% of Medicaid,365.5,,,365.5,Fee Schedule,,376.96,,,376.96,Fee Schedule,,172.1,,,,Fee Schedule,,365.5,,,365.5,Fee Schedule,,376.96,,,376.96,Fee Schedule,,323.7,,,323.7,Fee Schedule,,425.6,70,,425.6,percent of total billed charges,,367.36,,,367.36,Fee Schedule,,311.36,,,311.36,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,99.85,821.17,
CT HRT W 3D IMAGE,75572,CPT,TC,46075572,CDM,350,RC,,,both,,,1601,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,528.46,,,528.46,Fee Schedule,,475.44,,,475.44,Fee Schedule,,1465.9,,,1465.9,Fee Schedule,,1318.78,,,1318.78,Fee Schedule,,1246.55,,,1246.55,Fee Schedule,,1120.7,70,,1120.7,percent of total billed charges,All Other,627.85,,,627.85,Fee Schedule,,561,,,561,Other,186% of Medicaid,738.84,,,738.84,Fee Schedule,,992.62,,,992.62,Fee Schedule,,347.89,,,,Fee Schedule,,738.84,,,738.84,Fee Schedule,,992.62,,,992.62,Fee Schedule,,654.36,,,654.36,Fee Schedule,,1120.7,70,,1120.7,percent of total billed charges,,752.76,,,752.76,Fee Schedule,,638.01,,,638.01,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1465.9,
CT HRT W 3D IMAGE CONGEN,75573,CPT,TC,46075573,CDM,350,RC,,,both,,,2007,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.73,,,618.73,Fee Schedule,,556.67,,,556.67,Fee Schedule,,1799.03,,,1799.03,Fee Schedule,,1618.47,,,1618.47,Fee Schedule,,1529.83,,,1529.83,Fee Schedule,,1404.9,70,,1404.9,percent of total billed charges,All Other,735.11,,,735.11,Fee Schedule,,561,,,561,Other,186% of Medicaid,865.06,,,865.06,Fee Schedule,,1244.34,,,1244.34,Fee Schedule,,407.32,,,,Fee Schedule,,865.06,,,865.06,Fee Schedule,,1244.34,,,1244.34,Fee Schedule,,766.14,,,766.14,Fee Schedule,,1404.9,70,,1404.9,percent of total billed charges,,964.32,,,964.32,Fee Schedule,,817.32,,,817.32,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1799.03,
CT ANGIO HRT W 3D IMAGE,75574,CPT,TC,46075574,CDM,350,RC,,,both,,,2679,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,617.42,,,617.42,Fee Schedule,,555.49,,,555.49,Fee Schedule,,1799.03,,,1799.03,Fee Schedule,,1618.47,,,1618.47,Fee Schedule,,1529.83,,,1529.83,Fee Schedule,,1875.3,70,,1875.3,percent of total billed charges,All Other,733.55,,,733.55,Fee Schedule,,594,,,594,Other,186% of Medicaid,863.23,,,863.23,Fee Schedule,,1660.98,,,1660.98,Fee Schedule,,406.46,,,,Fee Schedule,,863.23,,,863.23,Fee Schedule,,1660.98,,,1660.98,Fee Schedule,,764.52,,,764.52,Fee Schedule,,1875.3,70,,1875.3,percent of total billed charges,,1100.44,,,1100.44,Fee Schedule,,932.69,,,932.69,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,1875.3,
CT ANGIO AORTA W CONTRAST,75635,CPT,TC,46075635,CDM,350,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.57,,,618.57,Fee Schedule,,556.52,,,556.52,Fee Schedule,,2370.21,,,2370.21,Fee Schedule,,2132.32,,,2132.32,Fee Schedule,,2015.54,,,2015.54,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,734.92,,,734.92,Fee Schedule,,594,,,594,Other,186% of Medicaid,864.84,,,864.84,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,407.21,,,,Fee Schedule,,864.84,,,864.84,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,765.94,,,765.94,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,1546.52,,,1546.52,Fee Schedule,,1310.77,,,1310.77,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2370.21,
RADIOLOGIC GUIDANCE FOR PROCED,75989,CPT,TC,46075989,CDM,350,RC,,,both,,,2125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.72,,,197.72,Fee Schedule,,177.88,,,177.88,Fee Schedule,,542.63,,,542.63,Fee Schedule,,488.17,,,488.17,Fee Schedule,,461.43,,,461.43,Fee Schedule,,1487.5,70,,1487.5,percent of total billed charges,All Other,234.9,,,234.9,Fee Schedule,,558,,,558,Other,186% of Medicaid,276.43,,,276.43,Fee Schedule,,1317.5,,,1317.5,Fee Schedule,,130.16,,,,Fee Schedule,,276.43,,,276.43,Fee Schedule,,1317.5,,,1317.5,Fee Schedule,,244.82,,,244.82,Fee Schedule,,1487.5,70,,1487.5,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1487.5,
3D RENDER W/INTRP POSTPROCES,76376,CPT,,48076376,CDM,350,RC,,,both,,,67,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,54.45,,,54.45,Fee Schedule,,48.99,,,48.99,Fee Schedule,,433.19,,,433.19,Fee Schedule,,389.72,,,389.72,Fee Schedule,,368.37,,,368.37,Fee Schedule,,46.9,70,,46.9,percent of total billed charges,All Other,64.7,,,64.7,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,76.13,,,76.13,Fee Schedule,,41.54,,,41.54,Fee Schedule,,35.85,,,,Fee Schedule,,76.13,,,76.13,Fee Schedule,,41.54,,,41.54,Fee Schedule,,67.43,,,67.43,Fee Schedule,,46.9,70,,46.9,percent of total billed charges,,65.6,,,65.6,Fee Schedule,,55.6,,,55.6,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,433.19,
3D RENDERING W/INTRP POSTPROCESS,76377,CPT,,47076377,CDM,350,RC,,,both,,,315,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,141.29,,,141.29,Fee Schedule,,127.11,,,127.11,Fee Schedule,,380.81,,,380.81,Fee Schedule,,342.59,,,342.59,Fee Schedule,,323.82,,,323.82,Fee Schedule,,220.5,70,,220.5,percent of total billed charges,All Other,167.86,,,167.86,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,197.53,,,197.53,Fee Schedule,,195.3,,,195.3,Fee Schedule,,93.01,,,,Fee Schedule,,197.53,,,197.53,Fee Schedule,,195.3,,,195.3,Fee Schedule,,174.95,,,174.95,Fee Schedule,,220.5,70,,220.5,percent of total billed charges,,167.28,,,167.28,Fee Schedule,,141.78,,,141.78,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,380.81,
3D RENDERING W/INTRP POSTPROCESS,76377,CPT,,48076377,CDM,350,RC,,,both,,,315,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,141.29,,,141.29,Fee Schedule,,127.11,,,127.11,Fee Schedule,,380.81,,,380.81,Fee Schedule,,342.59,,,342.59,Fee Schedule,,323.82,,,323.82,Fee Schedule,,220.5,70,,220.5,percent of total billed charges,All Other,167.86,,,167.86,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,197.53,,,197.53,Fee Schedule,,195.3,,,195.3,Fee Schedule,,93.01,,,,Fee Schedule,,197.53,,,197.53,Fee Schedule,,195.3,,,195.3,Fee Schedule,,174.95,,,174.95,Fee Schedule,,220.5,70,,220.5,percent of total billed charges,,167.28,,,167.28,Fee Schedule,,141.78,,,141.78,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,380.81,
CT LIMITED OR FOLLOW-UP STUDY,76380,CPT,,46076380,CDM,350,RC,,,both,,,270,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,305.16,,,305.16,Fee Schedule,,274.54,,,274.54,Fee Schedule,,794.87,,,794.87,Fee Schedule,,715.1,,,715.1,Fee Schedule,,675.93,,,675.93,Fee Schedule,,189,70,,189,percent of total billed charges,All Other,362.55,,,362.55,Fee Schedule,,471,,,471,Other,186% of Medicaid,426.64,,,426.64,Fee Schedule,,167.4,,,167.4,Fee Schedule,,200.89,,,,Fee Schedule,,426.64,,,426.64,Fee Schedule,,167.4,,,167.4,Fee Schedule,,377.86,,,377.86,Fee Schedule,,189,70,,189,percent of total billed charges,,451,,,451,Fee Schedule,,382.25,,,382.25,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,99.85,821.17,
CT GUIDED STEREOTACTIC,77011,CPT,TC,46077011,CDM,350,RC,,,both,,,2262,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,557.01,,,557.01,Fee Schedule,,501.13,,,501.13,Fee Schedule,,2962.6,,,2962.6,Fee Schedule,,2665.26,,,2665.26,Fee Schedule,,2519.29,,,2519.29,Fee Schedule,,1583.4,70,,1583.4,percent of total billed charges,All Other,661.77,,,661.77,Fee Schedule,,313,,,313,Other,186% of Medicaid,778.76,,,778.76,Fee Schedule,,1402.44,,,1402.44,Fee Schedule,,366.68,,,,Fee Schedule,,778.76,,,778.76,Fee Schedule,,1402.44,,,1402.44,Fee Schedule,,689.71,,,689.71,Fee Schedule,,1583.4,70,,1583.4,percent of total billed charges,,811.8,,,811.8,Fee Schedule,,688.05,,,688.05,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,257.51,,,257.51,Other,153% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,235.63,,,235.63,Other,140% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,437.59,,,437.59,Other,250% of Medicaid,545.31,,,545.31,Other,324% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,210.38,,,210.38,Other,125% of Medicaid,0.01,2962.6,
CT GUIDANCE FOR NEEDLE PLACEME,77012,CPT,TC,46077012,CDM,350,RC,,,both,,,2477,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,245.09,,,245.09,Fee Schedule,,220.5,,,220.5,Fee Schedule,,747.25,,,747.25,Fee Schedule,,672.25,,,672.25,Fee Schedule,,635.44,,,635.44,Fee Schedule,,1733.9,70,,1733.9,percent of total billed charges,All Other,291.19,,,291.19,Fee Schedule,,313,,,313,Other,186% of Medicaid,342.66,,,342.66,Fee Schedule,,1535.74,,,1535.74,Fee Schedule,,161.34,,,,Fee Schedule,,342.66,,,342.66,Fee Schedule,,1535.74,,,1535.74,Fee Schedule,,303.48,,,303.48,Fee Schedule,,1733.9,70,,1733.9,percent of total billed charges,,357.52,,,357.52,Fee Schedule,,303.02,,,303.02,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,257.51,,,257.51,Other,153% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,235.63,,,235.63,Other,140% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,437.59,,,437.59,Other,250% of Medicaid,545.31,,,545.31,Other,324% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,210.38,,,210.38,Other,125% of Medicaid,0.01,1733.9,
CT SCAN FOR NEEDLE BIOPSY LT,77012,CPT,TCLT,46177012,CDM,350,RC,,,both,,,2477,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,245.09,,,245.09,Fee Schedule,,220.5,,,220.5,Fee Schedule,,747.25,,,747.25,Fee Schedule,,672.25,,,672.25,Fee Schedule,,635.44,,,635.44,Fee Schedule,,1733.9,70,,1733.9,percent of total billed charges,All Other,291.19,,,291.19,Fee Schedule,,313,,,313,Other,186% of Medicaid,342.66,,,342.66,Fee Schedule,,1535.74,,,1535.74,Fee Schedule,,161.34,,,,Fee Schedule,,342.66,,,342.66,Fee Schedule,,1535.74,,,1535.74,Fee Schedule,,303.48,,,303.48,Fee Schedule,,1733.9,70,,1733.9,percent of total billed charges,,357.52,,,357.52,Fee Schedule,,303.02,,,303.02,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,257.51,,,257.51,Other,153% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,235.63,,,235.63,Other,140% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,437.59,,,437.59,Other,250% of Medicaid,545.31,,,545.31,Other,324% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,210.38,,,210.38,Other,125% of Medicaid,0.01,1733.9,
CT SCAN FOR NEEDLE BIOPSY RT,77012,CPT,TCRT,46277012,CDM,350,RC,,,both,,,2477,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,245.09,,,245.09,Fee Schedule,,220.5,,,220.5,Fee Schedule,,747.25,,,747.25,Fee Schedule,,672.25,,,672.25,Fee Schedule,,635.44,,,635.44,Fee Schedule,,1733.9,70,,1733.9,percent of total billed charges,All Other,291.19,,,291.19,Fee Schedule,,313,,,313,Other,186% of Medicaid,342.66,,,342.66,Fee Schedule,,1535.74,,,1535.74,Fee Schedule,,161.34,,,,Fee Schedule,,342.66,,,342.66,Fee Schedule,,1535.74,,,1535.74,Fee Schedule,,303.48,,,303.48,Fee Schedule,,1733.9,70,,1733.9,percent of total billed charges,,357.52,,,357.52,Fee Schedule,,303.02,,,303.02,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,257.51,,,257.51,Other,153% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,235.63,,,235.63,Other,140% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,437.59,,,437.59,Other,250% of Medicaid,545.31,,,545.31,Other,324% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,210.38,,,210.38,Other,125% of Medicaid,0.01,1733.9,
CT GUIDANCE FOR ABLATION,77013,CPT,TC,46077013,CDM,350,RC,,,both,,,2125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1381.25,65,,1381.25,percent of total billed charges,All Other,1253.75,59,,1253.75,percent of total billed charges,All Other,342.07,,,342.07,Fee Schedule,,342.07,,,342.07,Fee Schedule,,342.07,,,342.07,Fee Schedule,,1487.5,70,,1487.5,percent of total billed charges,All Other,1445,68,,1445,percent of total billed charges,All Other,313,,,313,Other,186% of Medicaid,1700,80,,1700,percent of total billed charges,All Other,1763.75,83,,1763.75,percent of total billed charges,All Other,1763.75,83,,,percent of total billed charges,All Other,1700,80,,1700,percent of total billed charges,All Other,1763.75,83,,1763.75,percent of total billed charges,All Other,1700,80,,1700,percent of total billed charges,All Other,1487.5,70,,1487.5,percent of total billed charges,,1381.25,65,,1381.25,percent of total billed charges,All Other,1381.25,65,,1381.25,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,257.51,,,257.51,Other,153% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,235.63,,,235.63,Other,140% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,437.59,,,437.59,Other,250% of Medicaid,545.31,,,545.31,Other,324% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,210.38,,,210.38,Other,125% of Medicaid,0.01,1763.75,
CT SCAN FOR THERAPY GUIDE,77014,CPT,TC,46077014,CDM,350,RC,,,both,,,1239,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,261.26,,,261.26,Fee Schedule,,235.05,,,235.05,Fee Schedule,,1047.12,,,1047.12,Fee Schedule,,942.02,,,942.02,Fee Schedule,,890.43,,,890.43,Fee Schedule,,867.3,70,,867.3,percent of total billed charges,All Other,310.4,,,310.4,Fee Schedule,,313,,,313,Other,186% of Medicaid,365.27,,,365.27,Fee Schedule,,768.18,,,768.18,Fee Schedule,,171.99,,,,Fee Schedule,,365.27,,,365.27,Fee Schedule,,768.18,,,768.18,Fee Schedule,,323.51,,,323.51,Fee Schedule,,867.3,70,,867.3,percent of total billed charges,,372.28,,,372.28,Fee Schedule,,315.53,,,315.53,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,168.3,,,168.3,Other,100% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,257.51,,,257.51,Other,153% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,235.63,,,235.63,Other,140% of Medicaid,378.68,,,378.68,Other,225% of Medicaid,437.59,,,437.59,Other,250% of Medicaid,545.31,,,545.31,Other,324% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,361.85,,,361.85,Other,215% of Medicaid,210.38,,,210.38,Other,125% of Medicaid,0.01,1047.12,
CT HEAD BRAIN WO CONTRAST,70450,CPT,TC,46070450,CDM,351,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,239.31,,,239.31,Fee Schedule,,215.31,,,215.31,Fee Schedule,,1087.56,,,1087.56,Fee Schedule,,978.41,,,978.41,Fee Schedule,,924.82,,,924.82,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,284.33,,,284.33,Fee Schedule,,561,,,561,Other,186% of Medicaid,334.59,,,334.59,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,157.54,,,,Fee Schedule,,334.59,,,334.59,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,296.33,,,296.33,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,120.81,1493.8,
CT HEAD BRAIN W CONTRAST,70460,CPT,TC,46070460,CDM,351,RC,,,both,,,2559,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,343.28,,,343.28,Fee Schedule,,308.84,,,308.84,Fee Schedule,,1408.8,,,1408.8,Fee Schedule,,1267.4,,,1267.4,Fee Schedule,,1197.99,,,1197.99,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,407.84,,,407.84,Fee Schedule,,561,,,561,Other,186% of Medicaid,479.94,,,479.94,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,225.98,,,,Fee Schedule,,479.94,,,479.94,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,425.06,,,425.06,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,493.64,,,493.64,Fee Schedule,,418.39,,,418.39,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1791.3,
CT HEAD BRAIN W AND WO CONTRAST,70470,CPT,TC,46070470,CDM,351,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,410.46,,,410.46,Fee Schedule,,369.28,,,369.28,Fee Schedule,,1734.75,,,1734.75,Fee Schedule,,1560.64,,,1560.64,Fee Schedule,,1475.17,,,1475.17,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,487.66,,,487.66,Fee Schedule,,561,,,561,Other,186% of Medicaid,573.87,,,573.87,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,270.21,,,,Fee Schedule,,573.87,,,573.87,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,508.25,,,508.25,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,592.04,,,592.04,Fee Schedule,,501.79,,,501.79,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2209.2,
CT ORBITS WO CONTRAST,70480,CPT,TC,46070480,CDM,351,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,356.16,,,356.16,Fee Schedule,,320.44,,,320.44,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,423.15,,,423.15,Fee Schedule,,471,,,471,Other,186% of Medicaid,497.96,,,497.96,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,234.47,,,,Fee Schedule,,497.96,,,497.96,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,441.02,,,441.02,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,510.04,,,510.04,Fee Schedule,,432.29,,,432.29,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT ORBITS W CONTRAST,70481,CPT,TC,46070481,CDM,351,RC,,,both,,,2559,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,458.98,,,458.98,Fee Schedule,,412.94,,,412.94,Fee Schedule,,2086.95,,,2086.95,Fee Schedule,,1877.49,,,1877.49,Fee Schedule,,1774.67,,,1774.67,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,545.31,,,545.31,Fee Schedule,,561,,,561,Other,186% of Medicaid,641.7,,,641.7,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,302.15,,,,Fee Schedule,,641.7,,,641.7,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,568.33,,,568.33,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,662.56,,,662.56,Fee Schedule,,561.56,,,561.56,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2086.95,
CT ORBITS W CONTRAST W 59 MOD,70481,CPT,59,46170481,CDM,351,RC,,,both,,,2559,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,458.98,,,458.98,Fee Schedule,,412.94,,,412.94,Fee Schedule,,2086.95,,,2086.95,Fee Schedule,,1877.49,,,1877.49,Fee Schedule,,1774.67,,,1774.67,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,545.31,,,545.31,Fee Schedule,,561,,,561,Other,186% of Medicaid,641.7,,,641.7,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,302.15,,,,Fee Schedule,,641.7,,,641.7,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,568.33,,,568.33,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,662.56,,,662.56,Fee Schedule,,561.56,,,561.56,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2086.95,
CT ORBITS W AND WO CONTRAST,70482,CPT,TC,46070482,CDM,351,RC,,,both,,,2084,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,544.47,,,544.47,Fee Schedule,,489.85,,,489.85,Fee Schedule,,2341.55,,,2341.55,Fee Schedule,,2106.54,,,2106.54,Fee Schedule,,1991.17,,,1991.17,Fee Schedule,,1458.8,70,,1458.8,percent of total billed charges,All Other,646.88,,,646.88,Fee Schedule,,561,,,561,Other,186% of Medicaid,761.23,,,761.23,Fee Schedule,,1292.08,,,1292.08,Fee Schedule,,358.43,,,,Fee Schedule,,761.23,,,761.23,Fee Schedule,,1292.08,,,1292.08,Fee Schedule,,674.19,,,674.19,Fee Schedule,,1458.8,70,,1458.8,percent of total billed charges,,790.48,,,790.48,Fee Schedule,,669.98,,,669.98,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2341.55,
CT MAXILLOFACIAL WO CONTRAST,70486,CPT,TC,46070486,CDM,351,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,316.7,,,316.7,Fee Schedule,,284.93,,,284.93,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,376.27,,,376.27,Fee Schedule,,471,,,471,Other,186% of Medicaid,442.79,,,442.79,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,208.49,,,,Fee Schedule,,442.79,,,442.79,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,392.16,,,392.16,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,452.64,,,452.64,Fee Schedule,,383.64,,,383.64,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT MAXILLOFACIAL W CONTRAST,70487,CPT,TC,46070487,CDM,351,RC,,,both,,,2559,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,358.46,,,358.46,Fee Schedule,,322.5,,,322.5,Fee Schedule,,1768.07,,,1768.07,Fee Schedule,,1590.62,,,1590.62,Fee Schedule,,1503.5,,,1503.5,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,425.88,,,425.88,Fee Schedule,,561,,,561,Other,186% of Medicaid,501.17,,,501.17,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,235.98,,,,Fee Schedule,,501.17,,,501.17,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,443.86,,,443.86,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,514.96,,,514.96,Fee Schedule,,436.46,,,436.46,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1791.3,
CT MAXILLOFACIAL W AND WO CONTRAST,70488,CPT,TC,46070488,CDM,351,RC,,,both,,,2163,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,449.73,,,449.73,Fee Schedule,,404.61,,,404.61,Fee Schedule,,2205.92,,,2205.92,Fee Schedule,,1984.52,,,1984.52,Fee Schedule,,1875.84,,,1875.84,Fee Schedule,,1514.1,70,,1514.1,percent of total billed charges,All Other,534.31,,,534.31,Fee Schedule,,561,,,561,Other,186% of Medicaid,628.77,,,628.77,Fee Schedule,,1341.06,,,1341.06,Fee Schedule,,296.06,,,,Fee Schedule,,628.77,,,628.77,Fee Schedule,,1341.06,,,1341.06,Fee Schedule,,556.87,,,556.87,Fee Schedule,,1514.1,70,,1514.1,percent of total billed charges,,652.72,,,652.72,Fee Schedule,,553.22,,,553.22,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2205.92,
CT NECK SOFT TISSUE W CONTRAST,70491,CPT,TC,46070491,CDM,351,RC,,,both,,,2559,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,431.26,,,431.26,Fee Schedule,,388,,,388,Fee Schedule,,1696.72,,,1696.72,Fee Schedule,,1526.43,,,1526.43,Fee Schedule,,1442.83,,,1442.83,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,512.37,,,512.37,Fee Schedule,,561,,,561,Other,186% of Medicaid,602.95,,,602.95,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,283.9,,,,Fee Schedule,,602.95,,,602.95,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,534,,,534,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,623.2,,,623.2,Fee Schedule,,528.2,,,528.2,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1791.3,
CT NECK SOFT TISSUE W AND WO CONTRAST,70492,CPT,TC,46070492,CDM,351,RC,,,both,,,2085,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,524.82,,,524.82,Fee Schedule,,472.17,,,472.17,Fee Schedule,,2125.03,,,2125.03,Fee Schedule,,1911.76,,,1911.76,Fee Schedule,,1807.05,,,1807.05,Fee Schedule,,1459.5,70,,1459.5,percent of total billed charges,All Other,623.53,,,623.53,Fee Schedule,,561,,,561,Other,186% of Medicaid,733.76,,,733.76,Fee Schedule,,1292.7,,,1292.7,Fee Schedule,,345.49,,,,Fee Schedule,,733.76,,,733.76,Fee Schedule,,1292.7,,,1292.7,Fee Schedule,,649.85,,,649.85,Fee Schedule,,1459.5,70,,1459.5,percent of total billed charges,,760.96,,,760.96,Fee Schedule,,644.96,,,644.96,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2125.03,
CT CHEST WO CONTRAST,71250,CPT,TC,46071250,CDM,352,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,297.08,,,297.08,Fee Schedule,,267.28,,,267.28,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,352.96,,,352.96,Fee Schedule,,471,,,471,Other,186% of Medicaid,415.36,,,415.36,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,195.57,,,,Fee Schedule,,415.36,,,415.36,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,367.86,,,367.86,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT CHEST W CONTRAST,71260,CPT,TC,46071260,CDM,352,RC,,,both,,,2134,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,404.68,,,404.68,Fee Schedule,,364.09,,,364.09,Fee Schedule,,1751.41,,,1751.41,Fee Schedule,,1575.63,,,1575.63,Fee Schedule,,1489.34,,,1489.34,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,480.8,,,480.8,Fee Schedule,,561,,,561,Other,186% of Medicaid,565.8,,,565.8,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,266.41,,,,Fee Schedule,,565.8,,,565.8,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,501.1,,,501.1,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,580.56,,,580.56,Fee Schedule,,492.06,,,492.06,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1751.41,
CT CHEST W AND WO CONTRAST,71270,CPT,TC,46071270,CDM,352,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,495.95,,,495.95,Fee Schedule,,446.2,,,446.2,Fee Schedule,,2203.56,,,2203.56,Fee Schedule,,1982.4,,,1982.4,Fee Schedule,,1873.83,,,1873.83,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,589.23,,,589.23,Fee Schedule,,561,,,561,Other,186% of Medicaid,693.4,,,693.4,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,326.49,,,,Fee Schedule,,693.4,,,693.4,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,614.11,,,614.11,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,718.32,,,718.32,Fee Schedule,,608.82,,,608.82,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2209.2,
CT THORAX LUNG CANCER SCR C-,71271,CPT,,46071271,CDM,352,RC,,,both,,,1329,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,313.42,,,313.42,Fee Schedule,,281.98,,,281.98,Fee Schedule,,96,,,96,Fee Schedule,,96,,,96,Fee Schedule,,96,,,96,Fee Schedule,,930.3,70,,930.3,percent of total billed charges,All Other,372.37,,,372.37,Fee Schedule,,471,,,471,Other,186% of Medicaid,438.2,,,438.2,Fee Schedule,,823.98,,,823.98,Fee Schedule,,206.33,,,,Fee Schedule,,438.2,,,438.2,Fee Schedule,,823.98,,,823.98,Fee Schedule,,388.09,,,388.09,Fee Schedule,,930.3,70,,930.3,percent of total billed charges,,447.72,,,447.72,Fee Schedule,,379.47,,,379.47,Fee Schedule,,129.44,,,129.44,Fee Schedule,,129.44,,,129.44,Fee Schedule,,129.44,,,129.44,Fee Schedule,,129.44,,,129.44,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,96,930.3,
CT CERV SPINE WO CONTRAST,72125,CPT,TC,46072125,CDM,352,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,300.53,,,300.53,Fee Schedule,,270.38,,,270.38,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,357.06,,,357.06,Fee Schedule,,471,,,471,Other,186% of Medicaid,420.18,,,420.18,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,197.84,,,,Fee Schedule,,420.18,,,420.18,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,372.13,,,372.13,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,429.68,,,429.68,Fee Schedule,,364.18,,,364.18,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT CERV SPINE W CONTRAST,72126,CPT,TC,46072126,CDM,352,RC,,,both,,,2559,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,402.39,,,402.39,Fee Schedule,,362.02,,,362.02,Fee Schedule,,1756.18,,,1756.18,Fee Schedule,,1579.92,,,1579.92,Fee Schedule,,1493.39,,,1493.39,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,478.07,,,478.07,Fee Schedule,,561,,,561,Other,186% of Medicaid,562.58,,,562.58,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,264.89,,,,Fee Schedule,,562.58,,,562.58,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,498.25,,,498.25,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,578.92,,,578.92,Fee Schedule,,490.67,,,490.67,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,264.89,1791.3,
CT CERV SPINE W AND WO CONTRAST,72127,CPT,TC,46072127,CDM,352,RC,,,both,,,2895,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,497.1,,,497.1,Fee Schedule,,447.23,,,447.23,Fee Schedule,,2201.15,,,2201.15,Fee Schedule,,1980.23,,,1980.23,Fee Schedule,,1871.78,,,1871.78,Fee Schedule,,2026.5,70,,2026.5,percent of total billed charges,All Other,590.6,,,590.6,Fee Schedule,,561,,,561,Other,186% of Medicaid,695,,,695,Fee Schedule,,1794.9,,,1794.9,Fee Schedule,,327.24,,,,Fee Schedule,,695,,,695,Fee Schedule,,1794.9,,,1794.9,Fee Schedule,,615.53,,,615.53,Fee Schedule,,2026.5,70,,2026.5,percent of total billed charges,,718.32,,,718.32,Fee Schedule,,608.82,,,608.82,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2201.15,
CT T SPINE WO CONTRAST,72128,CPT,TC,46072128,CDM,352,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,299.38,,,299.38,Fee Schedule,,269.35,,,269.35,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,355.69,,,355.69,Fee Schedule,,471,,,471,Other,186% of Medicaid,418.57,,,418.57,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,197.09,,,,Fee Schedule,,418.57,,,418.57,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,370.71,,,370.71,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,428.04,,,428.04,Fee Schedule,,362.79,,,362.79,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT T SPINE W CONTRAST,72129,CPT,TC,46072129,CDM,352,RC,,,both,,,2559,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,405.83,,,405.83,Fee Schedule,,365.12,,,365.12,Fee Schedule,,1758.59,,,1758.59,Fee Schedule,,1582.09,,,1582.09,Fee Schedule,,1495.44,,,1495.44,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,482.16,,,482.16,Fee Schedule,,561,,,561,Other,186% of Medicaid,567.4,,,567.4,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,267.16,,,,Fee Schedule,,567.4,,,567.4,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,502.52,,,502.52,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,583.84,,,583.84,Fee Schedule,,494.84,,,494.84,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1791.3,
CT T SPINE W AND WO CONTRAST,72130,CPT,TC,46072130,CDM,352,RC,,,both,,,2895,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,500.57,,,500.57,Fee Schedule,,450.36,,,450.36,Fee Schedule,,2203.56,,,2203.56,Fee Schedule,,1982.4,,,1982.4,Fee Schedule,,1873.83,,,1873.83,Fee Schedule,,2026.5,70,,2026.5,percent of total billed charges,All Other,594.73,,,594.73,Fee Schedule,,561,,,561,Other,186% of Medicaid,699.86,,,699.86,Fee Schedule,,1794.9,,,1794.9,Fee Schedule,,329.53,,,,Fee Schedule,,699.86,,,699.86,Fee Schedule,,1794.9,,,1794.9,Fee Schedule,,619.83,,,619.83,Fee Schedule,,2026.5,70,,2026.5,percent of total billed charges,,723.24,,,723.24,Fee Schedule,,612.99,,,612.99,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2203.56,
CT L SPINE WO CONTRAST,72131,CPT,TC,46072131,CDM,352,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,297.08,,,297.08,Fee Schedule,,267.28,,,267.28,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,352.96,,,352.96,Fee Schedule,,471,,,471,Other,186% of Medicaid,415.36,,,415.36,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,195.57,,,,Fee Schedule,,415.36,,,415.36,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,367.86,,,367.86,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,426.4,,,426.4,Fee Schedule,,361.4,,,361.4,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT L SPINE W CONTRAST,72132,CPT,TC,46072132,CDM,352,RC,,,both,,,2559,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,403.54,,,403.54,Fee Schedule,,363.06,,,363.06,Fee Schedule,,1753.82,,,1753.82,Fee Schedule,,1577.8,,,1577.8,Fee Schedule,,1491.39,,,1491.39,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,479.44,,,479.44,Fee Schedule,,561,,,561,Other,186% of Medicaid,564.19,,,564.19,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,265.65,,,,Fee Schedule,,564.19,,,564.19,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,499.68,,,499.68,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,578.92,,,578.92,Fee Schedule,,490.67,,,490.67,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,265.65,1791.3,
CT L SPINE W AND WO CONTRAST,72133,CPT,TC,46072133,CDM,352,RC,,,both,,,2895,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,498.25,,,498.25,Fee Schedule,,448.27,,,448.27,Fee Schedule,,2201.15,,,2201.15,Fee Schedule,,1980.23,,,1980.23,Fee Schedule,,1871.78,,,1871.78,Fee Schedule,,2026.5,70,,2026.5,percent of total billed charges,All Other,591.96,,,591.96,Fee Schedule,,561,,,561,Other,186% of Medicaid,696.61,,,696.61,Fee Schedule,,1794.9,,,1794.9,Fee Schedule,,328,,,,Fee Schedule,,696.61,,,696.61,Fee Schedule,,1794.9,,,1794.9,Fee Schedule,,616.95,,,616.95,Fee Schedule,,2026.5,70,,2026.5,percent of total billed charges,,716.68,,,716.68,Fee Schedule,,607.43,,,607.43,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2201.15,
CT PELVIS WO CONTRAST,72192,CPT,TC,46072192,CDM,352,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,295.9,,,295.9,Fee Schedule,,266.22,,,266.22,Fee Schedule,,1330.27,,,1330.27,Fee Schedule,,1196.76,,,1196.76,Fee Schedule,,1131.22,,,1131.22,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,351.56,,,351.56,Fee Schedule,,471,,,471,Other,186% of Medicaid,413.71,,,413.71,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,194.8,,,,Fee Schedule,,413.71,,,413.71,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,366.4,,,366.4,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT PELVIS W CONTRAST,72193,CPT,TC,46072193,CDM,352,RC,,,both,,,2559,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.41,,,618.41,Fee Schedule,,556.38,,,556.38,Fee Schedule,,1663.4,,,1663.4,Fee Schedule,,1496.45,,,1496.45,Fee Schedule,,1414.5,,,1414.5,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,734.73,,,734.73,Fee Schedule,,561,,,561,Other,186% of Medicaid,864.62,,,864.62,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,407.11,,,,Fee Schedule,,864.62,,,864.62,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,765.75,,,765.75,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,924.96,,,924.96,Fee Schedule,,783.96,,,783.96,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1791.3,
CT PELVIS W AND WO CONTRAST,72194,CPT,TC,46072194,CDM,352,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.41,,,618.41,Fee Schedule,,556.38,,,556.38,Fee Schedule,,2224.93,,,2224.93,Fee Schedule,,2001.63,,,2001.63,Fee Schedule,,1892.01,,,1892.01,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,734.73,,,734.73,Fee Schedule,,561,,,561,Other,186% of Medicaid,864.62,,,864.62,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,407.11,,,,Fee Schedule,,864.62,,,864.62,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,765.75,,,765.75,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,1033.2,,,1033.2,Fee Schedule,,875.7,,,875.7,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2224.93,
CT U EXT WO CONTRAST LT,73200,CPT,TCLT,46173200,CDM,352,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,369.85,,,369.85,Fee Schedule,,332.75,,,332.75,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,439.41,,,439.41,Fee Schedule,,471,,,471,Other,186% of Medicaid,517.09,,,517.09,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,243.47,,,,Fee Schedule,,517.09,,,517.09,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,457.96,,,457.96,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,601.88,,,601.88,Fee Schedule,,510.13,,,510.13,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT U EXT WO CONTRAST RT,73200,CPT,TCRT,46273200,CDM,352,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,369.85,,,369.85,Fee Schedule,,332.75,,,332.75,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,439.41,,,439.41,Fee Schedule,,471,,,471,Other,186% of Medicaid,517.09,,,517.09,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,243.47,,,,Fee Schedule,,517.09,,,517.09,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,457.96,,,457.96,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,601.88,,,601.88,Fee Schedule,,510.13,,,510.13,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT U EXT W CONTRAST LT,73201,CPT,TCLT,46173201,CDM,352,RC,,,both,,,2559,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,526,,,526,Fee Schedule,,473.23,,,473.23,Fee Schedule,,1699.07,,,1699.07,Fee Schedule,,1528.55,,,1528.55,Fee Schedule,,1444.83,,,1444.83,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,624.93,,,624.93,Fee Schedule,,561,,,561,Other,186% of Medicaid,735.41,,,735.41,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,346.27,,,,Fee Schedule,,735.41,,,735.41,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,651.32,,,651.32,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,765.88,,,765.88,Fee Schedule,,649.13,,,649.13,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,301.44,1791.3,
CT U EXT W CONTRAST RT,73201,CPT,TCRT,46273201,CDM,352,RC,,,both,,,2559,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,526,,,526,Fee Schedule,,473.23,,,473.23,Fee Schedule,,1699.07,,,1699.07,Fee Schedule,,1528.55,,,1528.55,Fee Schedule,,1444.83,,,1444.83,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,624.93,,,624.93,Fee Schedule,,561,,,561,Other,186% of Medicaid,735.41,,,735.41,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,346.27,,,,Fee Schedule,,735.41,,,735.41,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,651.32,,,651.32,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,765.88,,,765.88,Fee Schedule,,649.13,,,649.13,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,301.44,1791.3,
CT U EXT W AND WO CONTRAST LT,73202,CPT,TCLT,46173202,CDM,352,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.41,,,618.41,Fee Schedule,,556.38,,,556.38,Fee Schedule,,2267.79,,,2267.79,Fee Schedule,,2040.18,,,2040.18,Fee Schedule,,1928.45,,,1928.45,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,734.73,,,734.73,Fee Schedule,,561,,,561,Other,186% of Medicaid,864.62,,,864.62,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,407.11,,,,Fee Schedule,,864.62,,,864.62,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,765.75,,,765.75,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,1011.88,,,1011.88,Fee Schedule,,857.63,,,857.63,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2267.79,
CT U EXT W AND WO CONTRAST RT,73202,CPT,TCRT,46273202,CDM,352,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.41,,,618.41,Fee Schedule,,556.38,,,556.38,Fee Schedule,,2267.79,,,2267.79,Fee Schedule,,2040.18,,,2040.18,Fee Schedule,,1928.45,,,1928.45,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,734.73,,,734.73,Fee Schedule,,561,,,561,Other,186% of Medicaid,864.62,,,864.62,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,407.11,,,,Fee Schedule,,864.62,,,864.62,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,765.75,,,765.75,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,1011.88,,,1011.88,Fee Schedule,,857.63,,,857.63,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2267.79,
CT ANGIO U EXT W AND WO CONTRAST,73206,CPT,TC,46073206,CDM,352,RC,,,both,,,3301,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,617.27,,,617.27,Fee Schedule,,555.35,,,555.35,Fee Schedule,,2370.1,,,2370.1,Fee Schedule,,2132.23,,,2132.23,Fee Schedule,,2015.45,,,2015.45,Fee Schedule,,2310.7,70,,2310.7,percent of total billed charges,All Other,733.37,,,733.37,Fee Schedule,,594,,,594,Other,186% of Medicaid,863.01,,,863.01,Fee Schedule,,2046.62,,,2046.62,Fee Schedule,,406.35,,,,Fee Schedule,,863.01,,,863.01,Fee Schedule,,2046.62,,,2046.62,Fee Schedule,,764.33,,,764.33,Fee Schedule,,2310.7,70,,2310.7,percent of total billed charges,,1116.84,,,1116.84,Fee Schedule,,946.59,,,946.59,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2370.1,
CT ANGIO U EXT W AND WO CONTRAST LT,73206,CPT,TCLT,46173206,CDM,352,RC,,,both,,,3301,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,617.27,,,617.27,Fee Schedule,,555.35,,,555.35,Fee Schedule,,2370.1,,,2370.1,Fee Schedule,,2132.23,,,2132.23,Fee Schedule,,2015.45,,,2015.45,Fee Schedule,,2310.7,70,,2310.7,percent of total billed charges,All Other,733.37,,,733.37,Fee Schedule,,594,,,594,Other,186% of Medicaid,863.01,,,863.01,Fee Schedule,,2046.62,,,2046.62,Fee Schedule,,406.35,,,,Fee Schedule,,863.01,,,863.01,Fee Schedule,,2046.62,,,2046.62,Fee Schedule,,764.33,,,764.33,Fee Schedule,,2310.7,70,,2310.7,percent of total billed charges,,1116.84,,,1116.84,Fee Schedule,,946.59,,,946.59,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2370.1,
CT ANGIO U EXT W AND WO CONTRAST RT,73206,CPT,TCRT,46273206,CDM,352,RC,,,both,,,3301,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,617.27,,,617.27,Fee Schedule,,555.35,,,555.35,Fee Schedule,,2370.1,,,2370.1,Fee Schedule,,2132.23,,,2132.23,Fee Schedule,,2015.45,,,2015.45,Fee Schedule,,2310.7,70,,2310.7,percent of total billed charges,All Other,733.37,,,733.37,Fee Schedule,,594,,,594,Other,186% of Medicaid,863.01,,,863.01,Fee Schedule,,2046.62,,,2046.62,Fee Schedule,,406.35,,,,Fee Schedule,,863.01,,,863.01,Fee Schedule,,2046.62,,,2046.62,Fee Schedule,,764.33,,,764.33,Fee Schedule,,2310.7,70,,2310.7,percent of total billed charges,,1116.84,,,1116.84,Fee Schedule,,946.59,,,946.59,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2370.1,
CT ANGIO U EXT W AND WO CONTRAST BILAT,73206,CPT,TC50,46373206,CDM,352,RC,,,both,,,4952,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,617.27,,,617.27,Fee Schedule,,555.35,,,555.35,Fee Schedule,,2370.1,,,2370.1,Fee Schedule,,2132.23,,,2132.23,Fee Schedule,,2015.45,,,2015.45,Fee Schedule,,3466.4,70,,3466.4,percent of total billed charges,All Other,733.37,,,733.37,Fee Schedule,,594,,,594,Other,186% of Medicaid,863.01,,,863.01,Fee Schedule,,3070.24,,,3070.24,Fee Schedule,,406.35,,,,Fee Schedule,,863.01,,,863.01,Fee Schedule,,3070.24,,,3070.24,Fee Schedule,,764.33,,,764.33,Fee Schedule,,3466.4,70,,3466.4,percent of total billed charges,,1116.84,,,1116.84,Fee Schedule,,946.59,,,946.59,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,3466.4,
CT L EXT WO CONTRAST LT,73700,CPT,TCLT,46173700,CDM,352,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,298.23,,,298.23,Fee Schedule,,268.32,,,268.32,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,354.33,,,354.33,Fee Schedule,,471,,,471,Other,186% of Medicaid,416.97,,,416.97,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,196.33,,,,Fee Schedule,,416.97,,,416.97,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,369.29,,,369.29,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,426.4,,,426.4,Fee Schedule,,361.4,,,361.4,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT L EXT WO CONTRAST RT,73700,CPT,TCRT,46273700,CDM,352,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,298.23,,,298.23,Fee Schedule,,268.32,,,268.32,Fee Schedule,,1358.82,,,1358.82,Fee Schedule,,1222.44,,,1222.44,Fee Schedule,,1155.49,,,1155.49,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,354.33,,,354.33,Fee Schedule,,471,,,471,Other,186% of Medicaid,416.97,,,416.97,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,196.33,,,,Fee Schedule,,416.97,,,416.97,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,369.29,,,369.29,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,426.4,,,426.4,Fee Schedule,,361.4,,,361.4,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT L EXT W CONTRAST LT,73701,CPT,TCLT,46173701,CDM,352,RC,,,both,,,2559,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,404.68,,,404.68,Fee Schedule,,364.09,,,364.09,Fee Schedule,,1718.14,,,1718.14,Fee Schedule,,1545.7,,,1545.7,Fee Schedule,,1461.05,,,1461.05,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,480.8,,,480.8,Fee Schedule,,561,,,561,Other,186% of Medicaid,565.8,,,565.8,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,266.41,,,,Fee Schedule,,565.8,,,565.8,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,501.1,,,501.1,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,582.2,,,582.2,Fee Schedule,,493.45,,,493.45,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1791.3,
CT L EXT W CONTRAST RT,73701,CPT,TCRT,46273701,CDM,352,RC,,,both,,,2559,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,404.68,,,404.68,Fee Schedule,,364.09,,,364.09,Fee Schedule,,1718.14,,,1718.14,Fee Schedule,,1545.7,,,1545.7,Fee Schedule,,1461.05,,,1461.05,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,480.8,,,480.8,Fee Schedule,,561,,,561,Other,186% of Medicaid,565.8,,,565.8,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,266.41,,,,Fee Schedule,,565.8,,,565.8,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,501.1,,,501.1,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,582.2,,,582.2,Fee Schedule,,493.45,,,493.45,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1791.3,
CT L EXT W AND WO CONTRAST LT,73702,CPT,TCLT,46173702,CDM,352,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,498.25,,,498.25,Fee Schedule,,448.27,,,448.27,Fee Schedule,,2279.68,,,2279.68,Fee Schedule,,2050.88,,,2050.88,Fee Schedule,,1938.56,,,1938.56,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,591.96,,,591.96,Fee Schedule,,561,,,561,Other,186% of Medicaid,696.61,,,696.61,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,328,,,,Fee Schedule,,696.61,,,696.61,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,616.95,,,616.95,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,715.04,,,715.04,Fee Schedule,,606.04,,,606.04,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2279.68,
CT L EXT W AND WO CONTRAST RT,73702,CPT,TCRT,46273702,CDM,352,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,498.25,,,498.25,Fee Schedule,,448.27,,,448.27,Fee Schedule,,2279.68,,,2279.68,Fee Schedule,,2050.88,,,2050.88,Fee Schedule,,1938.56,,,1938.56,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,591.96,,,591.96,Fee Schedule,,561,,,561,Other,186% of Medicaid,696.61,,,696.61,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,328,,,,Fee Schedule,,696.61,,,696.61,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,616.95,,,616.95,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,715.04,,,715.04,Fee Schedule,,606.04,,,606.04,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,2279.68,
CT ABDOMEN WO CONTRAST,74150,CPT,TC,46074150,CDM,352,RC,,,both,,,2134,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,292.46,,,292.46,Fee Schedule,,263.12,,,263.12,Fee Schedule,,1320.73,,,1320.73,Fee Schedule,,1188.18,,,1188.18,Fee Schedule,,1123.11,,,1123.11,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,347.47,,,347.47,Fee Schedule,,471,,,471,Other,186% of Medicaid,408.89,,,408.89,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,192.53,,,,Fee Schedule,,408.89,,,408.89,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,362.14,,,362.14,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,419.84,,,419.84,Fee Schedule,,355.84,,,355.84,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,253.45,,,253.45,Other,100% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,387.77,,,387.77,Other,153% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,354.82,,,354.82,Other,140% of Medicaid,570.25,,,570.25,Other,225% of Medicaid,658.96,,,658.96,Other,250% of Medicaid,821.17,,,821.17,Other,324% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,544.91,,,544.91,Other,215% of Medicaid,316.81,,,316.81,Other,125% of Medicaid,120.81,1493.8,
CT ABDOMEN W CONTRAST,74160,CPT,TC,46074160,CDM,352,RC,,,both,,,2559,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,618.41,,,618.41,Fee Schedule,,556.38,,,556.38,Fee Schedule,,1903.7,,,1903.7,Fee Schedule,,1712.63,,,1712.63,Fee Schedule,,1618.84,,,1618.84,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,734.73,,,734.73,Fee Schedule,,561,,,561,Other,186% of Medicaid,864.62,,,864.62,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,407.11,,,,Fee Schedule,,864.62,,,864.62,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,765.75,,,765.75,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,921.68,,,921.68,Fee Schedule,,781.18,,,781.18,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,201.9,1903.7,
CT ANGIO ABD PELVIS W AND WO CONTRAST,74174,CPT,TC,46074174,CDM,352,RC,,,both,,,2623,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,998.82,,,998.82,Fee Schedule,,898.63,,,898.63,Fee Schedule,,246.54,,,246.54,Fee Schedule,,246.54,,,246.54,Fee Schedule,,246.54,,,246.54,Fee Schedule,,1836.1,70,,1836.1,percent of total billed charges,All Other,1186.69,,,1186.69,Fee Schedule,,594,,,594,Other,186% of Medicaid,1396.47,,,1396.47,Fee Schedule,,1626.26,,,1626.26,Fee Schedule,,657.53,,,,Fee Schedule,,1396.47,,,1396.47,Fee Schedule,,1626.26,,,1626.26,Fee Schedule,,1236.78,,,1236.78,Fee Schedule,,1836.1,70,,1836.1,percent of total billed charges,,1453.04,,,1453.04,Fee Schedule,,1231.54,,,1231.54,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,246.54,1836.1,
CT ANGIO ABD W AND WO CONTRAST,74175,CPT,TC,46074175,CDM,352,RC,,,both,,,3156,332.01,,,332.01,Other,150% of Medicare + 9.63% HCRA Surcharge,201.9,,,201.9,Other,Medicare OPPS,617.27,,,617.27,Fee Schedule,,555.35,,,555.35,Fee Schedule,,2372.51,,,2372.51,Fee Schedule,,2134.39,,,2134.39,Fee Schedule,,2017.5,,,2017.5,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,733.37,,,733.37,Fee Schedule,,594,,,594,Other,186% of Medicaid,863.01,,,863.01,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,406.35,,,,Fee Schedule,,863.01,,,863.01,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,764.33,,,764.33,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,1154.56,,,1154.56,Fee Schedule,,978.56,,,978.56,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,291.55,,,291.55,Fee Schedule,,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,201.9,2372.51,
CT ABDOMEN PELVIS WO CONTRAST,74176,CPT,TC,46074176,CDM,352,RC,,,both,,,2134,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,368.86,,,368.86,Fee Schedule,,331.86,,,331.86,Fee Schedule,,923.38,,,923.38,Fee Schedule,,830.71,,,830.71,Fee Schedule,,785.21,,,785.21,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,All Other,438.24,,,438.24,Fee Schedule,,561,,,561,Other,186% of Medicaid,515.71,,,515.71,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,242.82,,,,Fee Schedule,,515.71,,,515.71,Fee Schedule,,1323.08,,,1323.08,Fee Schedule,,456.74,,,456.74,Fee Schedule,,1493.8,70,,1493.8,percent of total billed charges,,526.44,,,526.44,Fee Schedule,,446.19,,,446.19,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,242.82,1493.8,
CT ABDOMEN PELVIS W CONTRAST,74177,CPT,TC,46074177,CDM,352,RC,,,both,,,2559,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,784.77,,,784.77,Fee Schedule,,706.05,,,706.05,Fee Schedule,,1760.94,,,1760.94,Fee Schedule,,1584.21,,,1584.21,Fee Schedule,,1497.44,,,1497.44,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,All Other,932.38,,,932.38,Fee Schedule,,561,,,561,Other,186% of Medicaid,1097.2,,,1097.2,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,516.62,,,,Fee Schedule,,1097.2,,,1097.2,Fee Schedule,,1586.58,,,1586.58,Fee Schedule,,971.74,,,971.74,Fee Schedule,,1791.3,70,,1791.3,percent of total billed charges,,1157.84,,,1157.84,Fee Schedule,,981.34,,,981.34,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,301.44,1791.3,
CT ABDOMEN PELVIS W AND WO CONTRAST,74178,CPT,TC,46074178,CDM,352,RC,,,both,,,3156,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,886.6,,,886.6,Fee Schedule,,797.66,,,797.66,Fee Schedule,,2327.25,,,2327.25,Fee Schedule,,2093.67,,,2093.67,Fee Schedule,,1979.01,,,1979.01,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,All Other,1053.35,,,1053.35,Fee Schedule,,561,,,561,Other,186% of Medicaid,1239.57,,,1239.57,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,583.65,,,,Fee Schedule,,1239.57,,,1239.57,Fee Schedule,,1956.72,,,1956.72,Fee Schedule,,1097.82,,,1097.82,Fee Schedule,,2209.2,70,,2209.2,percent of total billed charges,,1305.44,,,1305.44,Fee Schedule,,1106.44,,,1106.44,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,301.44,,,301.44,Other,100% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,461.21,,,461.21,Other,153% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,422.02,,,422.02,Other,140% of Medicaid,678.25,,,678.25,Other,225% of Medicaid,783.76,,,783.76,Other,250% of Medicaid,976.68,,,976.68,Other,324% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,648.11,,,648.11,Other,215% of Medicaid,376.81,,,376.81,Other,125% of Medicaid,301.44,2327.25,
TRLUML PERIP ATHRC ILIAC ART,0238T,HCPCS,,47000007,CDM,360,RC,,,both,,,38665,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",27065.5,70,,27065.5,percent of total billed charges,All Other,26292.2,,,26292.2,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,30932,,,30932,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",30932,,,30932,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,30932,,,30932,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",27065.5,70,,27065.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,31686.15,
PERCUT LAMOT/LAM LUMBAR (MILD),0275T,HCPCS,,47000001,CDM,360,RC,,,both,,,14928,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10449.6,70,,10449.6,percent of total billed charges,All Other,10151.04,,,10151.04,Other,ASC Grouper table,5525.15,,,5525.15,Other,186% of Medicaid,11942.4,,,11942.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11942.4,,,11942.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,11942.4,,,11942.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10449.6,70,,10449.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4544.88,,,4544.88,Other,153% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4158.71,,,4158.71,Other,140% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,7723.33,,,7723.33,Other,250% of Medicaid,9624.45,,,9624.45,Other,324% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,3713.14,,,3713.14,Other,125% of Medicaid,2970.51,12927.47,
INSJ/RPLCMT ICDS SS ELTRD,0571T,HCPCS,,49000013,CDM,360,RC,,,both,,,104697,59449.04,,,59449.04,Other,150% of Medicare + 9.63% HCRA Surcharge,36151.32,,,36151.32,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",73287.9,70,,73287.9,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,23174,,,23174,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,83757.6,,,83757.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",73287.9,70,,73287.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13740,,,13740,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12977,,,12977,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12459.14,,,12459.14,Other,100% of Medicaid,12459.14,,,12459.14,Other,100% of Medicaid,12459.14,,,12459.14,Other,100% of Medicaid,12459.14,,,12459.14,Other,100% of Medicaid,28033.06,,,28033.06,Other,225% of Medicaid,19062.48,,,19062.48,Other,153% of Medicaid,28033.06,,,28033.06,Other,225% of Medicaid,17442.79,,,17442.79,Other,140% of Medicaid,28033.06,,,28033.06,Other,225% of Medicaid,32393.76,,,32393.76,Other,250% of Medicaid,40367.61,,,40367.61,Other,324% of Medicaid,26787.15,,,26787.15,Other,215% of Medicaid,26787.15,,,26787.15,Other,215% of Medicaid,15573.92,,,15573.92,Other,125% of Medicaid,3343,83757.6,
INSERTION SS DFB ELECTRODE,0572T,HCPCS,,49000014,CDM,360,RC,,,both,,,24784,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",17348.8,70,,17348.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4045.63,,,4045.63,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,19827.2,,,19827.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",17348.8,70,,17348.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,3327.86,,,3327.86,Other,153% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,3045.1,,,3045.1,Other,140% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,5655.18,,,5655.18,Other,250% of Medicaid,7047.22,,,7047.22,Other,324% of Medicaid,4676.4,,,4676.4,Other,215% of Medicaid,4676.4,,,4676.4,Other,215% of Medicaid,2718.84,,,2718.84,Other,125% of Medicaid,2175.07,19827.2,
REMOVAL SS DFB ELECTRODE,0573T,HCPCS,,49000015,CDM,360,RC,,,both,,,9678,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6774.6,70,,6774.6,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4045.63,,,4045.63,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,7742.4,,,7742.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6774.6,70,,6774.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,3327.86,,,3327.86,Other,153% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,3045.1,,,3045.1,Other,140% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,5655.18,,,5655.18,Other,250% of Medicaid,7047.22,,,7047.22,Other,324% of Medicaid,4676.4,,,4676.4,Other,215% of Medicaid,4676.4,,,4676.4,Other,215% of Medicaid,2718.84,,,2718.84,Other,125% of Medicaid,2175.07,9473,
REPOS PREV SS IMPL DFB ELTRD,0574T,HCPCS,,49000016,CDM,360,RC,,,both,,,9678,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6774.6,70,,6774.6,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4045.63,,,4045.63,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,7742.4,,,7742.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6774.6,70,,6774.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,3327.86,,,3327.86,Other,153% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,3045.1,,,3045.1,Other,140% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,5655.18,,,5655.18,Other,250% of Medicaid,7047.22,,,7047.22,Other,324% of Medicaid,4676.4,,,4676.4,Other,215% of Medicaid,4676.4,,,4676.4,Other,215% of Medicaid,2718.84,,,2718.84,Other,125% of Medicaid,2175.07,9473,
RMVL SS IMPL DFB PG ONLY,0580T,HCPCS,,49000021,CDM,360,RC,,,both,,,9678,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6774.6,70,,6774.6,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4045.63,,,4045.63,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,7742.4,,,7742.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6774.6,70,,6774.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,2175.07,,,2175.07,Other,100% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,3327.86,,,3327.86,Other,153% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,3045.1,,,3045.1,Other,140% of Medicaid,4893.91,,,4893.91,Other,225% of Medicaid,5655.18,,,5655.18,Other,250% of Medicaid,7047.22,,,7047.22,Other,324% of Medicaid,4676.4,,,4676.4,Other,215% of Medicaid,4676.4,,,4676.4,Other,215% of Medicaid,2718.84,,,2718.84,Other,125% of Medicaid,2175.07,9473,
FNA BX W/US GDN 1ST LES,10005,CPT,,44010005,CDM,360,RC,,,both,,,2621,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1834.7,70,,1834.7,percent of total billed charges,All Other,1782.28,,,1782.28,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,2096.8,,,2096.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2096.8,,,2096.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2096.8,,,2096.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1834.7,70,,1834.7,percent of total billed charges,,355.88,,,355.88,Fee Schedule,,301.63,,,301.63,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,301.63,7216,
FNA BX W/US GDN 1ST LES/ INCOMPLETE,10005,CPT,73,44410005,CDM,360,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1023.4,70,,1023.4,percent of total billed charges,All Other,994.16,,,994.16,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1023.4,70,,1023.4,percent of total billed charges,,355.88,,,355.88,Fee Schedule,,301.63,,,301.63,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,301.63,7216,
FNA BX W/US GDN EA ADDL,10006,CPT,,44010006,CDM,360,RC,,,both,,,1310,517.02,39.4668,,517.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",917,70,,917,percent of total billed charges,All Other,890.8,,,890.8,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,1048,,,1048,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1048,,,1048,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1048,,,1048,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",917,70,,917,percent of total billed charges,,242.72,,,242.72,Fee Schedule,,205.72,,,205.72,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,0.01,7216,
FNA BX W/FLUOR GDN 1ST LES,10007,CPT,,44010007,CDM,360,RC,,,both,,,2449,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1714.3,70,,1714.3,percent of total billed charges,All Other,1665.32,,,1665.32,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,1959.2,,,1959.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1959.2,,,1959.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1959.2,,,1959.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1714.3,70,,1714.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,557.64,7216,
FNA BX W/FLUOR GDN EA ADDL,10008,CPT,,44010008,CDM,360,RC,,,both,,,1202,474.39,39.4668,,474.39,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",841.4,70,,841.4,percent of total billed charges,All Other,817.36,,,817.36,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,961.6,,,961.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",961.6,,,961.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,961.6,,,961.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",841.4,70,,841.4,percent of total billed charges,,275.52,,,275.52,Fee Schedule,,233.52,,,233.52,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,0.01,7216,
FNA BX W/CT GDN 1ST LES,10009,CPT,,44010009,CDM,360,RC,,,both,,,2449,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1714.3,70,,1714.3,percent of total billed charges,All Other,1665.32,,,1665.32,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,1959.2,,,1959.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1959.2,,,1959.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1959.2,,,1959.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1714.3,70,,1714.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,557.64,7216,
FNA BX W/CT GDN EA ADDL,10010,CPT,,44010010,CDM,360,RC,,,both,,,1224,483.07,39.4668,,483.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",856.8,70,,856.8,percent of total billed charges,All Other,832.32,,,832.32,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,979.2,,,979.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",979.2,,,979.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,979.2,,,979.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",856.8,70,,856.8,percent of total billed charges,,382.12,,,382.12,Fee Schedule,,323.87,,,323.87,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,0.01,7216,
FNA W/O IMAGE,10021,CPT,,42010021,CDM,360,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",588.7,70,,588.7,percent of total billed charges,All Other,571.88,,,571.88,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,672.8,,,672.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,262.4,,,262.4,Fee Schedule,,222.4,,,222.4,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,222.4,7216,
FNA W/O IMAGE W/ FY MOD,10021,CPT,,42610021,CDM,360,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",588.7,70,,588.7,percent of total billed charges,All Other,571.88,,,571.88,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,672.8,,,672.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,262.4,,,262.4,Fee Schedule,,222.4,,,222.4,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,222.4,7216,
FNA W/O IMAGE,10021,CPT,,47010021,CDM,360,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",588.7,70,,588.7,percent of total billed charges,All Other,571.88,,,571.88,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,672.8,,,672.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,262.4,,,262.4,Fee Schedule,,222.4,,,222.4,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,222.4,7216,
PUNCTURE DRAINAGE OF LESION,10160,CPT,,46010160,CDM,360,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",588.7,70,,588.7,percent of total billed charges,All Other,571.88,,,571.88,Other,ASC Grouper table,732.77,,,732.77,Other,186% of Medicaid,672.8,,,672.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,457.56,,,457.56,Fee Schedule,,387.81,,,387.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,387.81,7216,
SHAVE LES S/N/H/F/G; 0.5CM/<,11305,CPT,,30011305,CDM,360,RC,,,both,,,656,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",459.2,70,,459.2,percent of total billed charges,All Other,446.08,,,446.08,Other,ASC Grouper table,732.77,,,732.77,Other,186% of Medicaid,524.8,,,524.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",524.8,,,524.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,524.8,,,524.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",459.2,70,,459.2,percent of total billed charges,,183.68,,,183.68,Fee Schedule,,155.68,,,155.68,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,155.68,7216,
INSERT DRUG IMPLANT,11981,CPT,,26011981,CDM,360,RC,,,both,,,727,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",508.9,70,,508.9,percent of total billed charges,All Other,494.36,,,494.36,Other,ASC Grouper table,732.77,,,732.77,Other,186% of Medicaid,581.6,,,581.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",581.6,,,581.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,581.6,,,581.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",508.9,70,,508.9,percent of total billed charges,,306.68,,,306.68,Fee Schedule,,259.93,,,259.93,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,140.37,7216,
REMOVE W INS DRUG IMPLANT,11983,CPT,,26011983,CDM,360,RC,,,both,,,2379,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1665.3,70,,1665.3,percent of total billed charges,All Other,1617.72,,,1617.72,Other,ASC Grouper table,732.77,,,732.77,Other,186% of Medicaid,1903.2,,,1903.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1903.2,,,1903.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1903.2,,,1903.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1665.3,70,,1665.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,393.96,7216,
MAMMARY DUCT INJ,19030,CPT,,54019030,CDM,360,RC,,,both,,,403,159.05,39.4668,,159.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",282.1,70,,282.1,percent of total billed charges,All Other,274.04,,,274.04,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,322.4,,,322.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",322.4,,,322.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,322.4,,,322.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",282.1,70,,282.1,percent of total billed charges,,360.8,,,360.8,Fee Schedule,,305.8,,,305.8,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
PLACE PO BREAST CATH FOR RAD,19296,CPT,,44019296,CDM,360,RC,,,both,,,19821,17034.04,,,17034.04,Other,150% of Medicare + 9.63% HCRA Surcharge,10358.5,,,10358.5,Other,Medicare OPPS,7938,,,7938,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7144,,,7144,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3860.87,,,3860.87,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9196,,,9196,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",13874.7,70,,13874.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2075.74,,,2075.74,Other,100% of Medicaid,2075.74,,,2075.74,Other,100% of Medicaid,2075.74,,,2075.74,Other,100% of Medicaid,2075.74,,,2075.74,Other,100% of Medicaid,4670.41,,,4670.41,Other,225% of Medicaid,3175.88,,,3175.88,Other,153% of Medicaid,4670.41,,,4670.41,Other,225% of Medicaid,2906.03,,,2906.03,Other,140% of Medicaid,4670.41,,,4670.41,Other,225% of Medicaid,5396.92,,,5396.92,Other,250% of Medicaid,6725.39,,,6725.39,Other,324% of Medicaid,4462.84,,,4462.84,Other,215% of Medicaid,4462.84,,,4462.84,Other,215% of Medicaid,2594.67,,,2594.67,Other,125% of Medicaid,2075.74,17034.04,
MUSCLE BIOPSY PERCUT,20206,CPT,,30020206,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,273.88,,,273.88,Fee Schedule,,232.13,,,232.13,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,232.13,7216,
MUSCLE BIOPSY PERCUT,20206,CPT,,46020206,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,273.88,,,273.88,Fee Schedule,,232.13,,,232.13,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,232.13,7216,
BIOPSY BONE TROCAR NDL SPRFCL,20220,CPT,,46020220,CDM,360,RC,,,both,,,3426,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2329.68,,,2329.68,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,2740.8,,,2740.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2740.8,,,2740.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2398.2,70,,2398.2,percent of total billed charges,,416.56,,,416.56,Fee Schedule,,353.06,,,353.06,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,353.06,7216,
BIOPSY BONE DEEP,20225,CPT,,46020225,CDM,360,RC,,,both,,,6428,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4371.04,,,4371.04,Other,ASC Grouper table,1972.73,,,1972.73,Other,186% of Medicaid,5142.4,,,5142.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5142.4,,,5142.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4499.6,70,,4499.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1622.73,,,1622.73,Other,153% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1484.85,,,1484.85,Other,140% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,2757.58,,,2757.58,Other,250% of Medicaid,3436.37,,,3436.37,Other,324% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,1325.76,,,1325.76,Other,125% of Medicaid,1060.61,7216,
DRAIN/INJECT SM JNT/BURSA,20600,CPT,,46020600,CDM,360,RC,,,both,,,1017,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",711.9,70,,711.9,percent of total billed charges,All Other,691.56,,,691.56,Other,ASC Grouper table,685.34,,,685.34,Other,186% of Medicaid,813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,813.6,,,813.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",711.9,70,,711.9,percent of total billed charges,,172.2,,,172.2,Fee Schedule,,145.95,,,145.95,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,145.95,7216,
DRAIN/INJ INTERM JNT/BURSA,20605,CPT,,46020605,CDM,360,RC,,,both,,,1017,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",711.9,70,,711.9,percent of total billed charges,All Other,691.56,,,691.56,Other,ASC Grouper table,685.34,,,685.34,Other,186% of Medicaid,813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,813.6,,,813.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",711.9,70,,711.9,percent of total billed charges,,178.76,,,178.76,Fee Schedule,,151.51,,,151.51,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,151.51,7216,
ARTHROCENTESIS MAJOR JOINT,20610,CPT,,46020610,CDM,360,RC,,,both,,,1017,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",711.9,70,,711.9,percent of total billed charges,All Other,691.56,,,691.56,Other,ASC Grouper table,685.34,,,685.34,Other,186% of Medicaid,813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,813.6,,,813.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",711.9,70,,711.9,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,184.87,7216,
PERQ VERTEBRAL AUGMENTATION,22513,CPT,,47022513,CDM,360,RC,,,both,,,23950,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS,4827,,,4827,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4344,,,4344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,5525.15,,,5525.15,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,19160,,,19160,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16765,70,,16765,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4544.88,,,4544.88,Other,153% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4158.71,,,4158.71,Other,140% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,7723.33,,,7723.33,Other,250% of Medicaid,9624.45,,,9624.45,Other,324% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,3713.14,,,3713.14,Other,125% of Medicaid,2970.51,19160,
PERQ VERTEBRAL AUGMENTATION,22514,CPT,,47022514,CDM,360,RC,,,both,,,23950,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS,4827,,,4827,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4344,,,4344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,5525.15,,,5525.15,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,19160,,,19160,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16765,70,,16765,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4544.88,,,4544.88,Other,153% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4158.71,,,4158.71,Other,140% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,7723.33,,,7723.33,Other,250% of Medicaid,9624.45,,,9624.45,Other,324% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,3713.14,,,3713.14,Other,125% of Medicaid,2970.51,19160,
PERQ VERTEBRAL AUGMENTATION,22515,CPT,,47022515,CDM,360,RC,,,both,,,864,340.99,39.4668,,340.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",604.8,70,,604.8,percent of total billed charges,All Other,587.52,,,587.52,Other,ASC Grouper table,5525.15,,,5525.15,Other,186% of Medicaid,691.2,,,691.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",691.2,,,691.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,691.2,,,691.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",604.8,70,,604.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4544.88,,,4544.88,Other,153% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4158.71,,,4158.71,Other,140% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,7723.33,,,7723.33,Other,250% of Medicaid,9624.45,,,9624.45,Other,324% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,3713.14,,,3713.14,Other,125% of Medicaid,0.01,9624.45,
BIOPSY SOFT TISSUE PELVIS,27040,CPT,,46027040,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,1972.73,,,1972.73,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1622.73,,,1622.73,Other,153% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1484.85,,,1484.85,Other,140% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,2757.58,,,2757.58,Other,250% of Medicaid,3436.37,,,3436.37,Other,324% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,1325.76,,,1325.76,Other,125% of Medicaid,1060.61,7216,
ST BX; HIP/PELVIS; DEEP,27041,CPT,,46027041,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,1972.73,,,1972.73,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1622.73,,,1622.73,Other,153% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1484.85,,,1484.85,Other,140% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,2757.58,,,2757.58,Other,250% of Medicaid,3436.37,,,3436.37,Other,324% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,1325.76,,,1325.76,Other,125% of Medicaid,1060.61,7216,
CT GUIDED BIOPSY KNEE,27323,CPT,,46027323,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,1972.73,,,1972.73,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1622.73,,,1622.73,Other,153% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1484.85,,,1484.85,Other,140% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,2757.58,,,2757.58,Other,250% of Medicaid,3436.37,,,3436.37,Other,324% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,1325.76,,,1325.76,Other,125% of Medicaid,1060.61,7216,
KNEE ARTHROGRAPHY INJ,27369,CPT,,42027369,CDM,360,RC,,,both,,,213,84.06,39.4668,,84.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",149.1,70,,149.1,percent of total billed charges,All Other,144.84,,,144.84,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,170.4,,,170.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",170.4,,,170.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,170.4,,,170.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",149.1,70,,149.1,percent of total billed charges,,191.88,,,191.88,Fee Schedule,,162.63,,,162.63,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
KNEE ARTHROGRAPHY INJ W/ FY MOD,27369,CPT,,42627369,CDM,360,RC,,,both,,,213,84.06,39.4668,,84.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",149.1,70,,149.1,percent of total billed charges,All Other,144.84,,,144.84,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,170.4,,,170.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",170.4,,,170.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,170.4,,,170.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",149.1,70,,149.1,percent of total billed charges,,191.88,,,191.88,Fee Schedule,,162.63,,,162.63,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
KNEE ARTHROGRAPHY INJ,27369,CPT,,46027369,CDM,360,RC,,,both,,,213,84.06,39.4668,,84.06,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",149.1,70,,149.1,percent of total billed charges,All Other,144.84,,,144.84,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,170.4,,,170.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",170.4,,,170.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,170.4,,,170.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",149.1,70,,149.1,percent of total billed charges,,191.88,,,191.88,Fee Schedule,,162.63,,,162.63,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
MANIPULATE KNEE JNT UNDER ANESTH,27570,CPT,,47027570,CDM,360,RC,,,both,,,4340,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2951.2,,,2951.2,Other,ASC Grouper table,1730.05,,,1730.05,Other,186% of Medicaid,3472,,,3472,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3472,,,3472,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3038,70,,3038,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,930.13,7216,
EXCISION OF LESION LEG,27618,CPT,,46027618,CDM,360,RC,,,both,,,5898,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4010.64,,,4010.64,Other,ASC Grouper table,1972.73,,,1972.73,Other,186% of Medicaid,4718.4,,,4718.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4718.4,,,4718.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4128.6,70,,4128.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1622.73,,,1622.73,Other,153% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1484.85,,,1484.85,Other,140% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,2757.58,,,2757.58,Other,250% of Medicaid,3436.37,,,3436.37,Other,324% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,1325.76,,,1325.76,Other,125% of Medicaid,1060.61,7216,
TENOTOMY OP FLEXOR; TOE SINGLE,28232,CPT,,73028232,CDM,360,RC,,,both,,,4778,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3344.6,70,,3344.6,percent of total billed charges,All Other,3249.04,,,3249.04,Other,ASC Grouper table,2890.82,,,2890.82,Other,186% of Medicaid,3822.4,,,3822.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3822.4,,,3822.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3822.4,,,3822.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3344.6,70,,3344.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1554.2,,,1554.2,Other,100% of Medicaid,1554.2,,,1554.2,Other,100% of Medicaid,1554.2,,,1554.2,Other,100% of Medicaid,1554.2,,,1554.2,Other,100% of Medicaid,3496.96,,,3496.96,Other,225% of Medicaid,2377.93,,,2377.93,Other,153% of Medicaid,3496.96,,,3496.96,Other,225% of Medicaid,2175.89,,,2175.89,Other,140% of Medicaid,3496.96,,,3496.96,Other,225% of Medicaid,4040.93,,,4040.93,Other,250% of Medicaid,5035.62,,,5035.62,Other,324% of Medicaid,3341.54,,,3341.54,Other,215% of Medicaid,3341.54,,,3341.54,Other,215% of Medicaid,1942.76,,,1942.76,Other,125% of Medicaid,1554.2,7216,
"drainge abscess/hemat,nasal, inter appr",30000,CPT,,82030000,CDM,360,RC,,,both,,,1037,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",725.9,70,,725.9,percent of total billed charges,All Other,705.16,,,705.16,Other,ASC Grouper table,422.72,,,422.72,Other,186% of Medicaid,829.6,,,829.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",829.6,,,829.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,829.6,,,829.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",725.9,70,,725.9,percent of total billed charges,,583.84,,,583.84,Fee Schedule,,494.84,,,494.84,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,227.27,7216,
INTUBATION ET EMERGENT,31500,CPT,,82031500,CDM,360,RC,,,both,,,903,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",632.1,70,,632.1,percent of total billed charges,All Other,614.04,,,614.04,Other,ASC Grouper table,1147.53,,,1147.53,Other,186% of Medicaid,722.4,,,722.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",722.4,,,722.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,722.4,,,722.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",632.1,70,,632.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",616.95,,,616.95,Other,100% of Medicaid,616.95,,,616.95,Other,100% of Medicaid,616.95,,,616.95,Other,100% of Medicaid,616.95,,,616.95,Other,100% of Medicaid,1388.14,,,1388.14,Other,225% of Medicaid,943.93,,,943.93,Other,153% of Medicaid,1388.14,,,1388.14,Other,225% of Medicaid,863.73,,,863.73,Other,140% of Medicaid,1388.14,,,1388.14,Other,225% of Medicaid,1604.07,,,1604.07,Other,250% of Medicaid,1998.92,,,1998.92,Other,324% of Medicaid,1326.44,,,1326.44,Other,215% of Medicaid,1326.44,,,1326.44,Other,215% of Medicaid,771.19,,,771.19,Other,125% of Medicaid,268.41,7216,
EXPLORE REPAIR CHEST,32110,CPT,,30032110,CDM,360,RC,,,both,,,6852,2704.27,39.4668,,2704.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4796.4,70,,4796.4,percent of total billed charges,All Other,4659.36,,,4659.36,Other,ASC Grouper table,3589.7,,,3589.7,Other,186% of Medicaid,5481.6,,,5481.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5481.6,,,5481.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5481.6,,,5481.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4796.4,70,,4796.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1929.95,,,1929.95,Other,100% of Medicaid,1929.95,,,1929.95,Other,100% of Medicaid,1929.95,,,1929.95,Other,100% of Medicaid,1929.95,,,1929.95,Other,100% of Medicaid,4342.38,,,4342.38,Other,225% of Medicaid,2952.82,,,2952.82,Other,153% of Medicaid,4342.38,,,4342.38,Other,225% of Medicaid,2701.93,,,2701.93,Other,140% of Medicaid,4342.38,,,4342.38,Other,225% of Medicaid,5017.87,,,5017.87,Other,250% of Medicaid,6253.03,,,6253.03,Other,324% of Medicaid,4149.39,,,4149.39,Other,215% of Medicaid,4149.39,,,4149.39,Other,215% of Medicaid,2412.44,,,2412.44,Other,125% of Medicaid,0.01,7266,
THORACOTOMY W CARD MASSAGE,32160,CPT,,30032160,CDM,360,RC,,,both,,,3056,1206.11,39.4668,,1206.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2139.2,70,,2139.2,percent of total billed charges,All Other,2078.08,,,2078.08,Other,ASC Grouper table,3589.7,,,3589.7,Other,186% of Medicaid,2444.8,,,2444.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2444.8,,,2444.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2444.8,,,2444.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2139.2,70,,2139.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1929.95,,,1929.95,Other,100% of Medicaid,1929.95,,,1929.95,Other,100% of Medicaid,1929.95,,,1929.95,Other,100% of Medicaid,1929.95,,,1929.95,Other,100% of Medicaid,4342.38,,,4342.38,Other,225% of Medicaid,2952.82,,,2952.82,Other,153% of Medicaid,4342.38,,,4342.38,Other,225% of Medicaid,2701.93,,,2701.93,Other,140% of Medicaid,4342.38,,,4342.38,Other,225% of Medicaid,5017.87,,,5017.87,Other,250% of Medicaid,6253.03,,,6253.03,Other,324% of Medicaid,4149.39,,,4149.39,Other,215% of Medicaid,4149.39,,,4149.39,Other,215% of Medicaid,2412.44,,,2412.44,Other,125% of Medicaid,0.01,7266,
BIOPSY PLEURA PERC NEEDLE,32400,CPT,,46032400,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
CORE NDL BX LNG/MED PERQ,32408,CPT,,44032408,CDM,360,RC,,,both,,,4606,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3132.08,,,3132.08,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,3684.8,,,3684.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3684.8,,,3684.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3684.8,,,3684.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3224.2,70,,3224.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
CORE NDL BX LNG/MED PERQ,32408,CPT,,46032408,CDM,360,RC,,,both,,,4606,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3132.08,,,3132.08,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,3684.8,,,3684.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3684.8,,,3684.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3684.8,,,3684.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3224.2,70,,3224.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
INSERTION OF CHEST TUBE,32551,CPT,,47032551,CDM,360,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2345,70,,2345,percent of total billed charges,All Other,2278,,,2278,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2680,,,2680,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2680,,,2680,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2680,,,2680,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2345,70,,2345,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ASPIRATE PLEURA W IMAGING,32555,CPT,,42032555,CDM,360,RC,,,both,,,2118,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1482.6,70,,1482.6,percent of total billed charges,All Other,1440.24,,,1440.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1694.4,,,1694.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1482.6,70,,1482.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ASPIRATE PLEURA W IMAGING W/ FY MOD,32555,CPT,,42632555,CDM,360,RC,,,both,,,2118,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1482.6,70,,1482.6,percent of total billed charges,All Other,1440.24,,,1440.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1694.4,,,1694.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1482.6,70,,1482.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ASPIRATE PLEURA W IMAGING,32555,CPT,,44032555,CDM,360,RC,,,both,,,2118,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1482.6,70,,1482.6,percent of total billed charges,All Other,1440.24,,,1440.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1694.4,,,1694.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1482.6,70,,1482.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
INCOMPLETE THORACENTESIS,32555,CPT,73,44432555,CDM,360,RC,,,both,,,1695,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1186.5,70,,1186.5,percent of total billed charges,All Other,1152.6,,,1152.6,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1356,,,1356,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1356,,,1356,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1356,,,1356,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1186.5,70,,1186.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ASPIRATE PLEURA W IMAGING,32555,CPT,,46032555,CDM,360,RC,,,both,,,2118,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1482.6,70,,1482.6,percent of total billed charges,All Other,1440.24,,,1440.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1694.4,,,1694.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1482.6,70,,1482.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ASPIRATE PLEURA W IMAGING LT,32555,CPT,LT,46132555,CDM,360,RC,,,both,,,2118,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1482.6,70,,1482.6,percent of total billed charges,All Other,1440.24,,,1440.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1694.4,,,1694.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1482.6,70,,1482.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ASPIRATE PLEURA W IMAGING RT,32555,CPT,RT,46232555,CDM,360,RC,,,both,,,2118,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1482.6,70,,1482.6,percent of total billed charges,All Other,1440.24,,,1440.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1694.4,,,1694.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1482.6,70,,1482.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ASPIRATE PLEURA W IMAGING BILAT,32555,CPT,50,46332555,CDM,360,RC,,,both,,,3177,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2223.9,70,,2223.9,percent of total billed charges,All Other,2160.36,,,2160.36,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2541.6,,,2541.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2541.6,,,2541.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2541.6,,,2541.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2223.9,70,,2223.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ASPIRATE PLEURA W IMAGING,32555,CPT,,47032555,CDM,360,RC,,,both,,,2118,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1482.6,70,,1482.6,percent of total billed charges,All Other,1440.24,,,1440.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1694.4,,,1694.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1482.6,70,,1482.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ASPIRATE PLEURA W IMAGING,32555,CPT,,82032555,CDM,360,RC,,,both,,,2118,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1482.6,70,,1482.6,percent of total billed charges,All Other,1440.24,,,1440.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1694.4,,,1694.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1694.4,,,1694.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1482.6,70,,1482.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
INSERT CATH PLEURA W/ IMAGE,32557,CPT,,47032557,CDM,360,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2345,70,,2345,percent of total billed charges,All Other,2278,,,2278,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2680,,,2680,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2680,,,2680,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2680,,,2680,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2345,70,,2345,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
CHEMICAL PLEURODESIS,32560,CPT,,46032560,CDM,360,RC,,,both,,,1815,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1270.5,70,,1270.5,percent of total billed charges,All Other,1234.2,,,1234.2,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1452,,,1452,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1452,,,1452,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1452,,,1452,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1270.5,70,,1270.5,percent of total billed charges,,370.64,,,370.64,Fee Schedule,,314.14,,,314.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,314.14,7216,
CT GUIDED PERC RF ABLATE PUL T,32998,CPT,,46032998,CDM,360,RC,,,both,,,18449,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",12914.3,70,,12914.3,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4046.39,,,4046.39,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,14759.2,,,14759.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12914.3,70,,12914.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2175.48,,,2175.48,Other,100% of Medicaid,2175.48,,,2175.48,Other,100% of Medicaid,2175.48,,,2175.48,Other,100% of Medicaid,2175.48,,,2175.48,Other,100% of Medicaid,4894.83,,,4894.83,Other,225% of Medicaid,3328.48,,,3328.48,Other,153% of Medicaid,4894.83,,,4894.83,Other,225% of Medicaid,3045.67,,,3045.67,Other,140% of Medicaid,4894.83,,,4894.83,Other,225% of Medicaid,5656.24,,,5656.24,Other,250% of Medicaid,7048.55,,,7048.55,Other,324% of Medicaid,4677.28,,,4677.28,Other,215% of Medicaid,4677.28,,,4677.28,Other,215% of Medicaid,2719.35,,,2719.35,Other,125% of Medicaid,2175.48,14759.2,
INSERT HEART PM ATRIAL,33206,CPT,,49033206,CDM,360,RC,,,both,,,23249,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",16274.3,70,,16274.3,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,18599.2,,,18599.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16274.3,70,,16274.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3343,19295.74,
INSERT HEART PM VENTRICULAR,33207,CPT,,47033207,CDM,360,RC,,,both,,,23249,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",16274.3,70,,16274.3,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,18599.2,,,18599.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16274.3,70,,16274.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3343,19295.74,
INSERT HEART PM VENTRICULAR,33207,CPT,,49033207,CDM,360,RC,,,both,,,23249,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",16274.3,70,,16274.3,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,18599.2,,,18599.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16274.3,70,,16274.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3343,19295.74,
DDD PACER INSERTION,33208,CPT,,47033208,CDM,360,RC,,,both,,,26727,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",18708.9,70,,18708.9,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,21381.6,,,21381.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",18708.9,70,,18708.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6628,,,6628,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6260,,,6260,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3343,21381.6,
INSRT HEART PM ATRIAL & VENT,33208,CPT,,49033208,CDM,360,RC,,,both,,,26727,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",18708.9,70,,18708.9,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,21381.6,,,21381.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",18708.9,70,,18708.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6628,,,6628,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6260,,,6260,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3343,21381.6,
INS/REPL PG ONLY; SGL CHAMBER,33212,CPT,,47033212,CDM,360,RC,,,both,,,18374,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12861.8,70,,12861.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3126,18609.83,
INSERT PULSE GEN SNGL LEAD,33212,CPT,,49033212,CDM,360,RC,,,both,,,18374,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12861.8,70,,12861.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3126,18609.83,
INSERTION OR REPLC OF PACE DC,33213,CPT,,47033213,CDM,360,RC,,,both,,,23249,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16274.3,70,,16274.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3126,19295.74,
INSERT PULSE GEN DUAL LEADS,33213,CPT,,49033213,CDM,360,RC,,,both,,,23249,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16274.3,70,,16274.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3126,19295.74,
UPGRADE IMPL PACEMKR; SC TO DC,33214,CPT,,49033214,CDM,360,RC,,,both,,,24061,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",16842.7,70,,16842.7,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,19248.8,,,19248.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16842.7,70,,16842.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6628,,,6628,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6260,,,6260,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3343,19295.74,
REPOSITION PACING-DEFIB LEAD,33215,CPT,,49033215,CDM,360,RC,,,both,,,6712,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4698.4,70,,4698.4,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5369.6,,,5369.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4698.4,70,,4698.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,9473,
INSERT 1 ELECTRODE PM-DEFIB,33216,CPT,,47033216,CDM,360,RC,,,both,,,18374,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",12861.8,70,,12861.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,14699.2,,,14699.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12861.8,70,,12861.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,15351.79,
INSERT 1 ELECTRODE PM-DEFIB,33216,CPT,,49033216,CDM,360,RC,,,both,,,18374,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",12861.8,70,,12861.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,14699.2,,,14699.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12861.8,70,,12861.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,15351.79,
INSERT 2 ELECTRODE PM-DEFIB,33217,CPT,,49033217,CDM,360,RC,,,both,,,18374,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",12861.8,70,,12861.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,14699.2,,,14699.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12861.8,70,,12861.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,15351.79,
REPAIR LEAD PACE-DEFIB ONE,33218,CPT,,47033218,CDM,360,RC,,,both,,,7544,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5280.8,70,,5280.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,6035.2,,,6035.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5280.8,70,,5280.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,9473,
REPAIR LEAD PACE-DEFIB ONE,33218,CPT,,49033218,CDM,360,RC,,,both,,,7544,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5280.8,70,,5280.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,6035.2,,,6035.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5280.8,70,,5280.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,9473,
REPAIR LEAD PACE-DEFIB DUAL,33220,CPT,,49033220,CDM,360,RC,,,both,,,7544,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5280.8,70,,5280.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,6035.2,,,6035.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5280.8,70,,5280.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,9473,
INSERT PULSE GEN MULT LEADS,33221,CPT,,49033221,CDM,360,RC,,,both,,,58236,35210.01,,,35210.01,Other,150% of Medicare + 9.63% HCRA Surcharge,21411.42,,,21411.42,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,46588.8,,,46588.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",40765.2,70,,40765.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3126,46588.8,
PACER POCKET REVISION,33222,CPT,,49033222,CDM,360,RC,,,both,,,4696,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3193.28,,,3193.28,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,3756.8,,,3756.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3756.8,,,3756.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3287.2,70,,3287.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2003.89,7902.43,
REVISE POCKET FOR DEFIB,33223,CPT,,47033223,CDM,360,RC,,,both,,,5004,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3402.72,,,3402.72,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,4003.2,,,4003.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4003.2,,,4003.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3502.8,70,,3502.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2003.89,7902.43,
REVISE POCKET FOR DEFIB,33223,CPT,,49033223,CDM,360,RC,,,both,,,5004,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3402.72,,,3402.72,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,4003.2,,,4003.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4003.2,,,4003.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3502.8,70,,3502.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2003.89,7902.43,
INSERT PACING LEAD & CONNECT,33224,CPT,,49033224,CDM,360,RC,,,both,,,38162,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",26713.4,70,,26713.4,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,30529.6,,,30529.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",26713.4,70,,26713.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6628,,,6628,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6260,,,6260,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3126,30529.6,
LV PACING LEAD ADD-ON,33225,CPT,,47033225,CDM,360,RC,,,both,,,40754,16084.3,39.4668,,16084.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",28527.8,70,,28527.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,32603.2,,,32603.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",28527.8,70,,28527.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6628,,,6628,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6260,,,6260,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,0.01,32603.2,
L VENTRIC PACING LEAD ADD-ON,33225,CPT,,49033225,CDM,360,RC,,,both,,,40754,16084.3,39.4668,,16084.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",28527.8,70,,28527.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,32603.2,,,32603.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",28527.8,70,,28527.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6628,,,6628,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7364,,,7364,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6260,,,6260,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,0.01,32603.2,
REPOSITION L VENTRIC LEAD,33226,CPT,,49033226,CDM,360,RC,,,both,,,6712,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4698.4,70,,4698.4,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3946.5,,,3946.5,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5369.6,,,5369.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4698.4,70,,4698.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,3246.31,,,3246.31,Other,153% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,2970.48,,,2970.48,Other,140% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,5516.61,,,5516.61,Other,250% of Medicaid,6874.55,,,6874.55,Other,324% of Medicaid,4561.81,,,4561.81,Other,215% of Medicaid,4561.81,,,4561.81,Other,215% of Medicaid,2652.22,,,2652.22,Other,125% of Medicaid,2121.77,9473,
REMOVE&REPLACE PM GEN SINGL,33227,CPT,,47033227,CDM,360,RC,,,both,,,30257,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,24205.6,,,24205.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",21179.9,70,,21179.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3126,24205.6,
REMOVE&REPLACE PM GEN SINGL,33227,CPT,,49033227,CDM,360,RC,,,both,,,30257,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,24205.6,,,24205.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",21179.9,70,,21179.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3126,24205.6,
REMV&REPLC PM GEN DUAL LEAD,33228,CPT,,47033228,CDM,360,RC,,,both,,,33159,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,26527.2,,,26527.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",23211.3,70,,23211.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3126,26527.2,
REMV&REPLC PM GEN DUAL LEAD,33228,CPT,,49033228,CDM,360,RC,,,both,,,33159,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,26527.2,,,26527.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",23211.3,70,,23211.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,3126,26527.2,
INSRT PULSE GEN W/DUAL LEADS,33230,CPT,,49033230,CDM,360,RC,,,both,,,73662,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,25102.49,,,25102.49,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,58929.6,,,58929.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",51563.4,70,,51563.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13740,,,13740,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12977,,,12977,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,20648.82,,,20648.82,Other,153% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,18894.34,,,18894.34,Other,140% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,35089.5,,,35089.5,Other,250% of Medicaid,43726.91,,,43726.91,Other,324% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,16869.95,,,16869.95,Other,125% of Medicaid,3126,58929.6,
INSRT PULSE GEN W/MULT LEADS,33231,CPT,,49033231,CDM,360,RC,,,both,,,104697,59449.04,,,59449.04,Other,150% of Medicare + 9.63% HCRA Surcharge,36151.32,,,36151.32,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,25102.49,,,25102.49,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,83757.6,,,83757.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",73287.9,70,,73287.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13740,,,13740,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12977,,,12977,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,20648.82,,,20648.82,Other,153% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,18894.34,,,18894.34,Other,140% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,35089.5,,,35089.5,Other,250% of Medicaid,43726.91,,,43726.91,Other,324% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,16869.95,,,16869.95,Other,125% of Medicaid,3126,83757.6,
REMOVAL OF PERM PACEMAKER GNRT,33233,CPT,,47033233,CDM,360,RC,,,both,,,21018,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",14292.24,,,14292.24,Other,ASC Grouper table,3946.5,,,3946.5,Other,186% of Medicaid,16814.4,,,16814.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16814.4,,,16814.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",14712.6,70,,14712.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,3246.31,,,3246.31,Other,153% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,2970.48,,,2970.48,Other,140% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,5516.61,,,5516.61,Other,250% of Medicaid,6874.55,,,6874.55,Other,324% of Medicaid,4561.81,,,4561.81,Other,215% of Medicaid,4561.81,,,4561.81,Other,215% of Medicaid,2652.22,,,2652.22,Other,125% of Medicaid,2121.77,16814.4,
REMOVAL OF PM GENERATOR,33233,CPT,,49033233,CDM,360,RC,,,both,,,21018,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",14292.24,,,14292.24,Other,ASC Grouper table,3946.5,,,3946.5,Other,186% of Medicaid,16814.4,,,16814.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16814.4,,,16814.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",14712.6,70,,14712.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,3246.31,,,3246.31,Other,153% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,2970.48,,,2970.48,Other,140% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,5516.61,,,5516.61,Other,250% of Medicaid,6874.55,,,6874.55,Other,324% of Medicaid,4561.81,,,4561.81,Other,215% of Medicaid,4561.81,,,4561.81,Other,215% of Medicaid,2652.22,,,2652.22,Other,125% of Medicaid,2121.77,16814.4,
REMOVE 1-PACER LEAD ONLY,33234,CPT,,49033234,CDM,360,RC,,,both,,,7544,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5280.8,70,,5280.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,6035.2,,,6035.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5280.8,70,,5280.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,9473,
REMOVE 2-PACER LEAD ONLY,33235,CPT,,49033235,CDM,360,RC,,,both,,,7544,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5280.8,70,,5280.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,6035.2,,,6035.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5280.8,70,,5280.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,9473,
INSRT PULSE GEN W/SINGL LEAD,33240,CPT,,47033240,CDM,360,RC,,,both,,,51361,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,25102.49,,,25102.49,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,41088.8,,,41088.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",35952.7,70,,35952.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13740,,,13740,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12977,,,12977,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,20648.82,,,20648.82,Other,153% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,18894.34,,,18894.34,Other,140% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,35089.5,,,35089.5,Other,250% of Medicaid,43726.91,,,43726.91,Other,324% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,16869.95,,,16869.95,Other,125% of Medicaid,3343,43726.91,
INSRT PULSE GEN W/SINGL LEAD,33240,CPT,,49033240,CDM,360,RC,,,both,,,51361,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,25102.49,,,25102.49,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,41088.8,,,41088.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",35952.7,70,,35952.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13740,,,13740,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12977,,,12977,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,20648.82,,,20648.82,Other,153% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,18894.34,,,18894.34,Other,140% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,35089.5,,,35089.5,Other,250% of Medicaid,43726.91,,,43726.91,Other,324% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,16869.95,,,16869.95,Other,125% of Medicaid,3343,43726.91,
REMOVE PULSE GENERATOR,33241,CPT,,49033241,CDM,360,RC,,,both,,,7544,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3946.5,,,3946.5,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,6035.2,,,6035.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5280.8,70,,5280.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,2121.77,,,2121.77,Other,100% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,3246.31,,,3246.31,Other,153% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,2970.48,,,2970.48,Other,140% of Medicaid,4773.99,,,4773.99,Other,225% of Medicaid,5516.61,,,5516.61,Other,250% of Medicaid,6874.55,,,6874.55,Other,324% of Medicaid,4561.81,,,4561.81,Other,215% of Medicaid,4561.81,,,4561.81,Other,215% of Medicaid,2652.22,,,2652.22,Other,125% of Medicaid,2121.77,9473,
REM SC/DC ICD LEAD; TV EXTRACT,33244,CPT,,49033244,CDM,360,RC,,,both,,,7544,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5280.8,70,,5280.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,6035.2,,,6035.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5280.8,70,,5280.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,9473,
NSERT PACE-DEFIB W/LEAD,33249,CPT,,49033249,CDM,360,RC,,,both,,,72199,59449.04,,,59449.04,Other,150% of Medicare + 9.63% HCRA Surcharge,36151.32,,,36151.32,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",50539.3,70,,50539.3,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,25102.49,,,25102.49,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,57759.2,,,57759.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",50539.3,70,,50539.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13740,,,13740,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12977,,,12977,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,20648.82,,,20648.82,Other,153% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,18894.34,,,18894.34,Other,140% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,35089.5,,,35089.5,Other,250% of Medicaid,43726.91,,,43726.91,Other,324% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,16869.95,,,16869.95,Other,125% of Medicaid,3343,59449.04,
REMV&REPLC CVD GEN SING LEAD,33262,CPT,,49033262,CDM,360,RC,,,both,,,51361,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,25102.49,,,25102.49,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,41088.8,,,41088.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",35952.7,70,,35952.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13740,,,13740,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12977,,,12977,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,20648.82,,,20648.82,Other,153% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,18894.34,,,18894.34,Other,140% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,35089.5,,,35089.5,Other,250% of Medicaid,43726.91,,,43726.91,Other,324% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,16869.95,,,16869.95,Other,125% of Medicaid,3126,43726.91,
REMV&REPLC CVD GEN DUAL LEAD,33263,CPT,,49033263,CDM,360,RC,,,both,,,51361,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,25102.49,,,25102.49,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,41088.8,,,41088.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",35952.7,70,,35952.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13740,,,13740,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12977,,,12977,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,20648.82,,,20648.82,Other,153% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,18894.34,,,18894.34,Other,140% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,35089.5,,,35089.5,Other,250% of Medicaid,43726.91,,,43726.91,Other,324% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,16869.95,,,16869.95,Other,125% of Medicaid,3126,43726.91,
REMV&REPLC CVD GEN MULT LEAD,33264,CPT,,49033264,CDM,360,RC,,,both,,,72199,59449.04,,,59449.04,Other,150% of Medicare + 9.63% HCRA Surcharge,36151.32,,,36151.32,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,25102.49,,,25102.49,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,57759.2,,,57759.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",50539.3,70,,50539.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13740,,,13740,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12977,,,12977,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,13495.96,,,13495.96,Other,100% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,20648.82,,,20648.82,Other,153% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,18894.34,,,18894.34,Other,140% of Medicaid,30365.91,,,30365.91,Other,225% of Medicaid,35089.5,,,35089.5,Other,250% of Medicaid,43726.91,,,43726.91,Other,324% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,29016.31,,,29016.31,Other,215% of Medicaid,16869.95,,,16869.95,Other,125% of Medicaid,3126,59449.04,
INSJ SUBQ CAR RHYTHM MNTR,33285,CPT,,49033285,CDM,360,RC,,,both,,,18374,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",12494.32,,,12494.32,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,14699.2,,,14699.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",14699.2,,,14699.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,14699.2,,,14699.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12861.8,70,,12861.8,percent of total billed charges,,423.12,,,423.12,Fee Schedule,,358.62,,,358.62,Fee Schedule,,6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,358.62,18609.83,
INSJ SUBQ CAR RHYTHM MNTR,33285,CPT,,82033285,CDM,360,RC,,,both,,,18374,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",12494.32,,,12494.32,Other,ASC Grouper table,10683.42,,,10683.42,Other,186% of Medicaid,14699.2,,,14699.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",14699.2,,,14699.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,14699.2,,,14699.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12861.8,70,,12861.8,percent of total billed charges,,423.12,,,423.12,Fee Schedule,,358.62,,,358.62,Fee Schedule,,6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,5743.77,,,5743.77,Other,100% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8787.97,,,8787.97,Other,153% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,8041.28,,,8041.28,Other,140% of Medicaid,12923.49,,,12923.49,Other,225% of Medicaid,14933.81,,,14933.81,Other,250% of Medicaid,18609.83,,,18609.83,Other,324% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,12349.11,,,12349.11,Other,215% of Medicaid,7179.72,,,7179.72,Other,125% of Medicaid,358.62,18609.83,
REMOVE ILR,33286,CPT,,49033286,CDM,360,RC,,,both,,,2885,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1961.8,,,1961.8,Other,ASC Grouper table,4536.58,,,4536.58,Other,186% of Medicaid,2308,,,2308,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2308,,,2308,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2308,,,2308,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2019.5,70,,2019.5,percent of total billed charges,,418.2,,,418.2,Fee Schedule,,354.45,,,354.45,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,354.45,7902.43,
INS IAB ASSIST DEVICE THRU FEM ART OPEN,33970,CPT,,49033970,CDM,360,RC,,,both,,,1358,535.96,39.4668,,535.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",950.6,70,,950.6,percent of total billed charges,All Other,923.44,,,923.44,Other,ASC Grouper table,3935.36,,,3935.36,Other,186% of Medicaid,1086.4,,,1086.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1086.4,,,1086.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1086.4,,,1086.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",950.6,70,,950.6,percent of total billed charges,,1702.32,,,1702.32,Fee Schedule,,1442.82,,,1442.82,Fee Schedule,,4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,3237.15,,,3237.15,Other,153% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,2962.1,,,2962.1,Other,140% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,5501.04,,,5501.04,Other,250% of Medicaid,6855.14,,,6855.14,Other,324% of Medicaid,4548.94,,,4548.94,Other,215% of Medicaid,4548.94,,,4548.94,Other,215% of Medicaid,2644.73,,,2644.73,Other,125% of Medicaid,0.01,7216,
AORTIC CIRCULATION ASSIST,33971,CPT,,49033971,CDM,360,RC,,,both,,,2709,1069.16,39.4668,,1069.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1896.3,70,,1896.3,percent of total billed charges,All Other,1842.12,,,1842.12,Other,ASC Grouper table,3935.36,,,3935.36,Other,186% of Medicaid,2167.2,,,2167.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2167.2,,,2167.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2167.2,,,2167.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1896.3,70,,1896.3,percent of total billed charges,,3416.12,,,3416.12,Fee Schedule,,2895.37,,,2895.37,Fee Schedule,,4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,3237.15,,,3237.15,Other,153% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,2962.1,,,2962.1,Other,140% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,5501.04,,,5501.04,Other,250% of Medicaid,6855.14,,,6855.14,Other,324% of Medicaid,4548.94,,,4548.94,Other,215% of Medicaid,4548.94,,,4548.94,Other,215% of Medicaid,2644.73,,,2644.73,Other,125% of Medicaid,0.01,7216,
INSERT IAB ASSIST DEVICE THRU ASC AORTA,33973,CPT,,49033973,CDM,360,RC,,,both,,,1968,776.71,39.4668,,776.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1377.6,70,,1377.6,percent of total billed charges,All Other,1338.24,,,1338.24,Other,ASC Grouper table,3935.36,,,3935.36,Other,186% of Medicaid,1574.4,,,1574.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1574.4,,,1574.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1574.4,,,1574.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1377.6,70,,1377.6,percent of total billed charges,,2412.44,,,2412.44,Fee Schedule,,2044.69,,,2044.69,Fee Schedule,,4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,3237.15,,,3237.15,Other,153% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,2962.1,,,2962.1,Other,140% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,5501.04,,,5501.04,Other,250% of Medicaid,6855.14,,,6855.14,Other,324% of Medicaid,4548.94,,,4548.94,Other,215% of Medicaid,4548.94,,,4548.94,Other,215% of Medicaid,2644.73,,,2644.73,Other,125% of Medicaid,0.01,7216,
UNLISTED CARDIAC SURGERY,33999,CPT,,49033999,CDM,360,RC,,,both,,,2045,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,1431.5,70,,1431.5,percent of total billed charges,All Other,1390.6,,,1390.6,Other,ASC Grouper table,3935.36,,,3935.36,Other,186% of Medicaid,1636,,,1636,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1636,,,1636,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1636,,,1636,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1431.5,70,,1431.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,2115.78,,,2115.78,Other,100% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,3237.15,,,3237.15,Other,153% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,2962.1,,,2962.1,Other,140% of Medicaid,4760.51,,,4760.51,Other,225% of Medicaid,5501.04,,,5501.04,Other,250% of Medicaid,6855.14,,,6855.14,Other,324% of Medicaid,4548.94,,,4548.94,Other,215% of Medicaid,4548.94,,,4548.94,Other,215% of Medicaid,2644.73,,,2644.73,Other,125% of Medicaid,0.01,7216,
INJ PERC EXTR ANEURYSM,36002,CPT,,47036002,CDM,360,RC,,,both,,,1304,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",912.8,70,,912.8,percent of total billed charges,All Other,886.72,,,886.72,Other,ASC Grouper table,728.13,,,728.13,Other,186% of Medicaid,1043.2,,,1043.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1043.2,,,1043.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1043.2,,,1043.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",912.8,70,,912.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",391.47,,,391.47,Other,100% of Medicaid,391.47,,,391.47,Other,100% of Medicaid,391.47,,,391.47,Other,100% of Medicaid,391.47,,,391.47,Other,100% of Medicaid,880.81,,,880.81,Other,225% of Medicaid,598.95,,,598.95,Other,153% of Medicaid,880.81,,,880.81,Other,225% of Medicaid,548.06,,,548.06,Other,140% of Medicaid,880.81,,,880.81,Other,225% of Medicaid,1017.82,,,1017.82,Other,250% of Medicaid,1268.36,,,1268.36,Other,324% of Medicaid,841.66,,,841.66,Other,215% of Medicaid,841.66,,,841.66,Other,215% of Medicaid,489.34,,,489.34,Other,125% of Medicaid,391.47,7216,
EX VEIN NEEDLE/INTRACATH UNI,36005,CPT,,47036005,CDM,360,RC,,,both,,,2233,881.29,39.4668,,881.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1563.1,70,,1563.1,percent of total billed charges,All Other,1518.44,,,1518.44,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,1786.4,,,1786.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1786.4,,,1786.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1786.4,,,1786.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1563.1,70,,1563.1,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
EX VEIN NEEDLE/INTRACATH UNI,36005,CPT,,49036005,CDM,360,RC,,,both,,,2233,881.29,39.4668,,881.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1563.1,70,,1563.1,percent of total billed charges,All Other,1518.44,,,1518.44,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,1786.4,,,1786.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1786.4,,,1786.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1786.4,,,1786.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1563.1,70,,1563.1,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
SUP OR INFER VENA CAVA CATH,36010,CPT,,47036010,CDM,360,RC,,,both,,,800,315.73,39.4668,,315.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",560,70,,560,percent of total billed charges,All Other,544,,,544,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,640,,,640,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",640,,,640,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,640,,,640,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",560,70,,560,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
CATH INTRO/1ST ORDER VEIN,36011,CPT,,47036011,CDM,360,RC,,,both,,,1020,402.56,39.4668,,402.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",714,70,,714,percent of total billed charges,All Other,693.6,,,693.6,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,816,,,816,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",816,,,816,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,816,,,816,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",714,70,,714,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
SELECTIVE CATH VEIN; 2ND ORDER FAMILY,36012,CPT,,47036012,CDM,360,RC,,,both,,,696,274.69,39.4668,,274.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",487.2,70,,487.2,percent of total billed charges,All Other,473.28,,,473.28,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,556.8,,,556.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",556.8,,,556.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,556.8,,,556.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",487.2,70,,487.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
NS CATH - RETROGR BRACHIAL ARTERY,36120,CPT,,47036120,CDM,360,RC,,,both,,,363,143.26,39.4668,,143.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",254.1,70,,254.1,percent of total billed charges,All Other,246.84,,,246.84,Other,ASC Grouper table,305.79,,,305.79,Other,186% of Medicaid,290.4,,,290.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",290.4,,,290.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,290.4,,,290.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",254.1,70,,254.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",164.4,,,164.4,Other,100% of Medicaid,164.4,,,164.4,Other,100% of Medicaid,164.4,,,164.4,Other,100% of Medicaid,164.4,,,164.4,Other,100% of Medicaid,369.91,,,369.91,Other,225% of Medicaid,251.54,,,251.54,Other,153% of Medicaid,369.91,,,369.91,Other,225% of Medicaid,230.16,,,230.16,Other,140% of Medicaid,369.91,,,369.91,Other,225% of Medicaid,427.45,,,427.45,Other,250% of Medicaid,532.67,,,532.67,Other,324% of Medicaid,353.47,,,353.47,Other,215% of Medicaid,353.47,,,353.47,Other,215% of Medicaid,205.5,,,205.5,Other,125% of Medicaid,0.01,7216,
EX ARTERY NEEDLE/INTRACATH UN,36140,CPT,,47036140,CDM,360,RC,,,both,,,769,303.5,39.4668,,303.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",538.3,70,,538.3,percent of total billed charges,All Other,522.92,,,522.92,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,615.2,,,615.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",615.2,,,615.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,615.2,,,615.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",538.3,70,,538.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
EX ARTERY NEEDLE/INTRACATH UN,36140,CPT,,49036140,CDM,360,RC,,,both,,,769,303.5,39.4668,,303.5,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",538.3,70,,538.3,percent of total billed charges,All Other,522.92,,,522.92,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,615.2,,,615.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",615.2,,,615.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,615.2,,,615.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",538.3,70,,538.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
NONSELECT CATH - TRANSLUMBAR AORTA,36160,CPT,,46036160,CDM,360,RC,,,both,,,533,210.36,39.4668,,210.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",373.1,70,,373.1,percent of total billed charges,All Other,362.44,,,362.44,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,426.4,,,426.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",426.4,,,426.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,426.4,,,426.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",373.1,70,,373.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
NONSELECT CATH - TRANSLUMBAR AORTA,36160,CPT,,47036160,CDM,360,RC,,,both,,,533,210.36,39.4668,,210.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",373.1,70,,373.1,percent of total billed charges,All Other,362.44,,,362.44,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,426.4,,,426.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",426.4,,,426.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,426.4,,,426.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",373.1,70,,373.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
AORTA CATHETER FEMBRACAX,36200,CPT,,47036200,CDM,360,RC,,,both,,,1146,452.29,39.4668,,452.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",802.2,70,,802.2,percent of total billed charges,All Other,779.28,,,779.28,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,916.8,,,916.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",916.8,,,916.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,916.8,,,916.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",802.2,70,,802.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
AORTA CATHETER FEMBRACAX,36200,CPT,,49036200,CDM,360,RC,,,both,,,1146,452.29,39.4668,,452.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",802.2,70,,802.2,percent of total billed charges,All Other,779.28,,,779.28,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,916.8,,,916.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",916.8,,,916.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,916.8,,,916.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",802.2,70,,802.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
SELECT CATH ART - BRACH-CEPH; 1ST ORDER,36215,CPT,,47036215,CDM,360,RC,,,both,,,1698,670.15,39.4668,,670.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1188.6,70,,1188.6,percent of total billed charges,All Other,1154.64,,,1154.64,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,1358.4,,,1358.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1358.4,,,1358.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1358.4,,,1358.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1188.6,70,,1188.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
SELECT CATH ART - BRACH-CEPH; 2ND ORDER,36216,CPT,,47036216,CDM,360,RC,,,both,,,1757,693.43,39.4668,,693.43,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1229.9,70,,1229.9,percent of total billed charges,All Other,1194.76,,,1194.76,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,1405.6,,,1405.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1405.6,,,1405.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1405.6,,,1405.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1229.9,70,,1229.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
LEFT CAROTID 1ST 2ND & 3RD,36217,CPT,,47036217,CDM,360,RC,,,both,,,2114,834.33,39.4668,,834.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1479.8,70,,1479.8,percent of total billed charges,All Other,1437.52,,,1437.52,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,1691.2,,,1691.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1691.2,,,1691.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1691.2,,,1691.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1479.8,70,,1479.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
SELECT CATH ART - BRACH-CEPH; EA ADDTL,36218,CPT,,47036218,CDM,360,RC,,,both,,,210,82.88,39.4668,,82.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",147,70,,147,percent of total billed charges,All Other,142.8,,,142.8,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,168,,,168,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",168,,,168,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,168,,,168,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",147,70,,147,percent of total billed charges,,246,,,246,Fee Schedule,,208.5,,,208.5,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
PLACE CATH THORACIC AORTA,36221,CPT,,47036221,CDM,360,RC,,,both,,,9535,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6674.5,70,,6674.5,percent of total billed charges,All Other,6483.8,,,6483.8,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7628,,,7628,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7628,,,7628,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7628,,,7628,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6674.5,70,,6674.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7628,
PLACE CATH THORACIC AORTA LT,36221,CPT,LT,47136221,CDM,360,RC,,,both,,,9535,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6674.5,70,,6674.5,percent of total billed charges,All Other,6483.8,,,6483.8,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7628,,,7628,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7628,,,7628,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7628,,,7628,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6674.5,70,,6674.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7628,
PLACE CATH THORACIC AORTA RT,36221,CPT,RT,47236221,CDM,360,RC,,,both,,,9535,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6674.5,70,,6674.5,percent of total billed charges,All Other,6483.8,,,6483.8,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7628,,,7628,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7628,,,7628,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7628,,,7628,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6674.5,70,,6674.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7628,
PLACE CATH THORACIC AORTA BILAT,36221,CPT,50,47336221,CDM,360,RC,,,both,,,14303,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10012.1,70,,10012.1,percent of total billed charges,All Other,9726.04,,,9726.04,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,11442.4,,,11442.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11442.4,,,11442.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,11442.4,,,11442.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10012.1,70,,10012.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,11442.4,
PLACE CATH CAROTID/INOM ART,36222,CPT,,47036222,CDM,360,RC,,,both,,,8748,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6123.6,70,,6123.6,percent of total billed charges,All Other,5948.64,,,5948.64,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6998.4,,,6998.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6123.6,70,,6123.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7216,
PLACE CATH CAROTID/INOM ART LT,36222,CPT,LT,47136222,CDM,360,RC,,,both,,,8748,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6123.6,70,,6123.6,percent of total billed charges,All Other,5948.64,,,5948.64,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6998.4,,,6998.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6123.6,70,,6123.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7216,
PLACE CATH CAROTID/INOM ART RT,36222,CPT,RT,47236222,CDM,360,RC,,,both,,,8748,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6123.6,70,,6123.6,percent of total billed charges,All Other,5948.64,,,5948.64,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6998.4,,,6998.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6123.6,70,,6123.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7216,
PLACE CATH CAROTID/INOM ART BILAT,36222,CPT,50,47336222,CDM,360,RC,,,both,,,13122,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",9185.4,70,,9185.4,percent of total billed charges,All Other,8922.96,,,8922.96,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,10497.6,,,10497.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10497.6,,,10497.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,10497.6,,,10497.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9185.4,70,,9185.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,10497.6,
PLACE CATH CAROTID/INOM ART,36223,CPT,,47036223,CDM,360,RC,,,both,,,11570,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8099,70,,8099,percent of total billed charges,All Other,7867.6,,,7867.6,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,9256,,,9256,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9256,,,9256,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,9256,,,9256,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8099,70,,8099,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,9930.15,
PLACE CATH CAROTID/INOM ART LT,36223,CPT,LT,47136223,CDM,360,RC,,,both,,,11570,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8099,70,,8099,percent of total billed charges,All Other,7867.6,,,7867.6,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,9256,,,9256,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9256,,,9256,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,9256,,,9256,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8099,70,,8099,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,9930.15,
PLACE CATH CAROTID/INOM ART RT,36223,CPT,RT,47236223,CDM,360,RC,,,both,,,11570,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8099,70,,8099,percent of total billed charges,All Other,7867.6,,,7867.6,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,9256,,,9256,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9256,,,9256,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,9256,,,9256,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8099,70,,8099,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,9930.15,
PLACE CATH CAROTID/INOM ART BILAT,36223,CPT,50,47336223,CDM,360,RC,,,both,,,17355,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",12148.5,70,,12148.5,percent of total billed charges,All Other,11801.4,,,11801.4,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,13884,,,13884,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",13884,,,13884,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,13884,,,13884,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12148.5,70,,12148.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,13884,
PLACE CATH CAROTID ART,36224,CPT,,47036224,CDM,360,RC,,,both,,,14383,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10068.1,70,,10068.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,11506.4,,,11506.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10068.1,70,,10068.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,11506.4,
PLACE CATH CAROTID ART LT,36224,CPT,LT,47136224,CDM,360,RC,,,both,,,14383,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10068.1,70,,10068.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,11506.4,,,11506.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10068.1,70,,10068.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,11506.4,
PLACE CATH CAROTID ART RT,36224,CPT,RT,47236224,CDM,360,RC,,,both,,,14383,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10068.1,70,,10068.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,11506.4,,,11506.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10068.1,70,,10068.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,11506.4,
PLACE CATH CAROTID ART BILAT,36224,CPT,50,47336224,CDM,360,RC,,,both,,,21575,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",15102.5,70,,15102.5,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,17260,,,17260,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",15102.5,70,,15102.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,17260,
PLACE CATH SUBCLAVIAN ART,36225,CPT,,47036225,CDM,360,RC,,,both,,,8748,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6123.6,70,,6123.6,percent of total billed charges,All Other,5948.64,,,5948.64,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6998.4,,,6998.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6123.6,70,,6123.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7216,
PLACE CATH SUBCLAVIAN ART LT,36225,CPT,LT,47136225,CDM,360,RC,,,both,,,8748,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6123.6,70,,6123.6,percent of total billed charges,All Other,5948.64,,,5948.64,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6998.4,,,6998.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6123.6,70,,6123.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7216,
PLACE CATH SUBCLAVIAN ART RT,36225,CPT,RT,47236225,CDM,360,RC,,,both,,,8748,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6123.6,70,,6123.6,percent of total billed charges,All Other,5948.64,,,5948.64,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6998.4,,,6998.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6998.4,,,6998.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6123.6,70,,6123.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7216,
PLACE CATH SUBCLAVIAN ART BILAT,36225,CPT,50,47336225,CDM,360,RC,,,both,,,13122,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",9185.4,70,,9185.4,percent of total billed charges,All Other,8922.96,,,8922.96,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,10497.6,,,10497.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10497.6,,,10497.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,10497.6,,,10497.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9185.4,70,,9185.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,10497.6,
PLACE CATH VERTEBRAL ART,36226,CPT,,47036226,CDM,360,RC,,,both,,,14383,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10068.1,70,,10068.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,11506.4,,,11506.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10068.1,70,,10068.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,11506.4,
PLACE CATH VERTEBRAL ART LT,36226,CPT,LT,47136226,CDM,360,RC,,,both,,,14383,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10068.1,70,,10068.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,11506.4,,,11506.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10068.1,70,,10068.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,11506.4,
PLACE CATH VERTEBRAL ART RT,36226,CPT,RT,47236226,CDM,360,RC,,,both,,,14383,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10068.1,70,,10068.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,11506.4,,,11506.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10068.1,70,,10068.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,11506.4,
PLACE CATH VERTEBRAL ART BILAT,36226,CPT,50,47336226,CDM,360,RC,,,both,,,21575,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",15102.5,70,,15102.5,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,17260,,,17260,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",15102.5,70,,15102.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,17260,
PLACE CATH XTRNL CAROTID,36227,CPT,,47036227,CDM,360,RC,,,both,,,430,169.71,39.4668,,169.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",301,70,,301,percent of total billed charges,All Other,292.4,,,292.4,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,344,,,344,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",344,,,344,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,344,,,344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",301,70,,301,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,0.01,7216,
PLACE CATH XTRNL CAROTID LT,36227,CPT,LT,47136227,CDM,360,RC,,,both,,,430,169.71,39.4668,,169.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",301,70,,301,percent of total billed charges,All Other,292.4,,,292.4,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,344,,,344,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",344,,,344,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,344,,,344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",301,70,,301,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,0.01,7216,
PLACE CATH XTRNL CAROTID RT,36227,CPT,RT,47236227,CDM,360,RC,,,both,,,430,169.71,39.4668,,169.71,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",301,70,,301,percent of total billed charges,All Other,292.4,,,292.4,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,344,,,344,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",344,,,344,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,344,,,344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",301,70,,301,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,0.01,7216,
PLACE CATH XTRNL CAROTID BILAT,36227,CPT,50,47336227,CDM,360,RC,,,both,,,645,254.56,39.4668,,254.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",451.5,70,,451.5,percent of total billed charges,All Other,438.6,,,438.6,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,516,,,516,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",516,,,516,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,516,,,516,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",451.5,70,,451.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,0.01,7216,
PLACE CATH INTRACRANIAL ART,36228,CPT,,47036228,CDM,360,RC,,,both,,,643,253.77,39.4668,,253.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",450.1,70,,450.1,percent of total billed charges,All Other,437.24,,,437.24,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,514.4,,,514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",514.4,,,514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,514.4,,,514.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",450.1,70,,450.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,0.01,7216,
PLACE CATH INTRACRANIAL ART LT,36228,CPT,LT,47136228,CDM,360,RC,,,both,,,643,253.77,39.4668,,253.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",450.1,70,,450.1,percent of total billed charges,All Other,437.24,,,437.24,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,514.4,,,514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",514.4,,,514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,514.4,,,514.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",450.1,70,,450.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,0.01,7216,
PLACE CATH INTRACRANIAL ART RT,36228,CPT,RT,47236228,CDM,360,RC,,,both,,,643,253.77,39.4668,,253.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",450.1,70,,450.1,percent of total billed charges,All Other,437.24,,,437.24,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,514.4,,,514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",514.4,,,514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,514.4,,,514.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",450.1,70,,450.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,0.01,7216,
PLACE CATH INTRACRANIAL ART BILAT,36228,CPT,50,47336228,CDM,360,RC,,,both,,,965,380.85,39.4668,,380.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",675.5,70,,675.5,percent of total billed charges,All Other,656.2,,,656.2,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,772,,,772,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",772,,,772,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,772,,,772,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",675.5,70,,675.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,0.01,7216,
OTHER ABD AORTA VASC FAM 1ST,36245,CPT,,47036245,CDM,360,RC,,,both,,,1489,587.66,39.4668,,587.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1042.3,70,,1042.3,percent of total billed charges,All Other,1012.52,,,1012.52,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,1191.2,,,1191.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1191.2,,,1191.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1191.2,,,1191.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1042.3,70,,1042.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
OAAV 1ST & 2ND,36246,CPT,,47036246,CDM,360,RC,,,both,,,2057,811.83,39.4668,,811.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1439.9,70,,1439.9,percent of total billed charges,All Other,1398.76,,,1398.76,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,1645.6,,,1645.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1645.6,,,1645.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1645.6,,,1645.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1439.9,70,,1439.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
OAAV 1ST & 2ND,36246,CPT,,49036246,CDM,360,RC,,,both,,,2057,811.83,39.4668,,811.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1439.9,70,,1439.9,percent of total billed charges,All Other,1398.76,,,1398.76,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,1645.6,,,1645.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1645.6,,,1645.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1645.6,,,1645.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1439.9,70,,1439.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
COM FEM CONTRA 1ST 2ND & 3RD,36247,CPT,,47036247,CDM,360,RC,,,both,,,2250,888,39.4668,,888,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1575,70,,1575,percent of total billed charges,All Other,1530,,,1530,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,1800,,,1800,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1800,,,1800,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1800,,,1800,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1575,70,,1575,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
SMA EA ADD 2ND & 3RD VESL,36248,CPT,,47036248,CDM,360,RC,,,both,,,1053,415.59,39.4668,,415.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",737.1,70,,737.1,percent of total billed charges,All Other,716.04,,,716.04,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,842.4,,,842.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",842.4,,,842.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,842.4,,,842.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",737.1,70,,737.1,percent of total billed charges,,229.6,,,229.6,Fee Schedule,,194.6,,,194.6,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
INS CATH REN ART 1ST UNILAT,36251,CPT,,47036251,CDM,360,RC,,,both,,,8781,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5971.08,,,5971.08,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7024.8,,,7024.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7024.8,,,7024.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7024.8,,,7024.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6146.7,70,,6146.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7216,
INS CATH REN ART 1ST BILAT,36252,CPT,,47036252,CDM,360,RC,,,both,,,8781,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5971.08,,,5971.08,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7024.8,,,7024.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7024.8,,,7024.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7024.8,,,7024.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6146.7,70,,6146.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7216,
INS CATH REN ART 1ST BILAT,36252,CPT,,49036252,CDM,360,RC,,,both,,,8781,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5971.08,,,5971.08,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,7024.8,,,7024.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7024.8,,,7024.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7024.8,,,7024.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6146.7,70,,6146.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7216,
INS CATH REN ART 2ND+ BILAT,36254,CPT,,49036254,CDM,360,RC,,,both,,,8749,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5949.32,,,5949.32,Other,ASC Grouper table,1729.13,,,1729.13,Other,186% of Medicaid,6999.2,,,6999.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6999.2,,,6999.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6999.2,,,6999.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6124.3,70,,6124.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,929.64,,,929.64,Other,100% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1422.35,,,1422.35,Other,153% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,1301.49,,,1301.49,Other,140% of Medicaid,2091.69,,,2091.69,Other,225% of Medicaid,2417.06,,,2417.06,Other,250% of Medicaid,3012.03,,,3012.03,Other,324% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1998.72,,,1998.72,Other,215% of Medicaid,1162.05,,,1162.05,Other,125% of Medicaid,929.64,7216,
VENOUS SELECTIVE ORGAN BLOOD SAMPLING,36500,CPT,,47036500,CDM,360,RC,,,both,,,706,278.64,39.4668,,278.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",494.2,70,,494.2,percent of total billed charges,All Other,480.08,,,480.08,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,564.8,,,564.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",564.8,,,564.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,564.8,,,564.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",494.2,70,,494.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
INS NON-TUNNEL CV CATH 5 YRS/>,36556,CPT,,42036556,CDM,360,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4560.76,,,4560.76,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4694.9,70,,4694.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,7216,
INS NON-TUNNEL CV CATH 5 YRS W/ FY MOD,36556,CPT,,42636556,CDM,360,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4560.76,,,4560.76,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4694.9,70,,4694.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,7216,
INS NON TUN CV CATH >5 YR,36556,CPT,,47036556,CDM,360,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4560.76,,,4560.76,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4694.9,70,,4694.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,7216,
INSERT TUNNELED CV CATH,36558,CPT,,47036558,CDM,360,RC,,,both,,,7234,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4919.12,,,4919.12,Other,ASC Grouper table,2489.81,,,2489.81,Other,186% of Medicaid,5787.2,,,5787.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5787.2,,,5787.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5063.8,70,,5063.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,2048.07,,,2048.07,Other,153% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,1874.05,,,1874.05,Other,140% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,3480.39,,,3480.39,Other,250% of Medicaid,4337.1,,,4337.1,Other,324% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,1673.26,,,1673.26,Other,125% of Medicaid,1338.61,7216,
INS TUNNELED CV CATH W SQ PORT,36560,CPT,,42036560,CDM,360,RC,,,both,,,8952,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2489.81,,,2489.81,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6266.4,70,,6266.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,2048.07,,,2048.07,Other,153% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,1874.05,,,1874.05,Other,140% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,3480.39,,,3480.39,Other,250% of Medicaid,4337.1,,,4337.1,Other,324% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,1673.26,,,1673.26,Other,125% of Medicaid,1338.61,9473,
INS TUNNELED CV CATH W SQ PORT W/ FY MOD,36560,CPT,,42636560,CDM,360,RC,,,both,,,8952,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2489.81,,,2489.81,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6266.4,70,,6266.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,2048.07,,,2048.07,Other,153% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,1874.05,,,1874.05,Other,140% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,3480.39,,,3480.39,Other,250% of Medicaid,4337.1,,,4337.1,Other,324% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,1673.26,,,1673.26,Other,125% of Medicaid,1338.61,9473,
PORT PLACEMENT >5,36561,CPT,,47036561,CDM,360,RC,,,both,,,8873,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2489.81,,,2489.81,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6211.1,70,,6211.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,2048.07,,,2048.07,Other,153% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,1874.05,,,1874.05,Other,140% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,3480.39,,,3480.39,Other,250% of Medicaid,4337.1,,,4337.1,Other,324% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,1673.26,,,1673.26,Other,125% of Medicaid,1338.61,9473,
INSERT PICC CATH >5 YRS O,36569,CPT,,47036569,CDM,360,RC,,,both,,,4042,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2748.56,,,2748.56,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,3233.6,,,3233.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3233.6,,,3233.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2829.4,70,,2829.4,percent of total billed charges,,449.36,,,449.36,Fee Schedule,,380.86,,,380.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,7216,
INSERT PICC UNSUCCESSFUL,36569,CPT,74,47336569,CDM,360,RC,,,both,,,3235,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2199.8,,,2199.8,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,2588,,,2588,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2588,,,2588,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2264.5,70,,2264.5,percent of total billed charges,,449.36,,,449.36,Fee Schedule,,380.86,,,380.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,7216,
INSJ PICC RS&I 5 YR+,36573,CPT,,47036573,CDM,360,RC,,,both,,,7992,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5434.56,,,5434.56,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,6393.6,,,6393.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6393.6,,,6393.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6393.6,,,6393.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5594.4,70,,5594.4,percent of total billed charges,,403.44,,,403.44,Fee Schedule,,341.94,,,341.94,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,7216,
INSERT PICC UNSUCCESSFUL,36573,CPT,74,47336573,CDM,360,RC,,,both,,,6394,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4347.92,,,4347.92,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,5115.2,,,5115.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5115.2,,,5115.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5115.2,,,5115.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4475.8,70,,4475.8,percent of total billed charges,,403.44,,,403.44,Fee Schedule,,341.94,,,341.94,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,7216,
REPAIR CVA CATHETER,36575,CPT,,47036575,CDM,360,RC,,,both,,,1989,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1352.52,,,1352.52,Other,ASC Grouper table,1556.39,,,1556.39,Other,186% of Medicaid,1591.2,,,1591.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1591.2,,,1591.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1392.3,70,,1392.3,percent of total billed charges,,162.36,,,162.36,Fee Schedule,,137.61,,,137.61,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,137.61,7216,
PORT REMOVAL,36578,CPT,,47036578,CDM,360,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4560.76,,,4560.76,Other,ASC Grouper table,1556.39,,,1556.39,Other,186% of Medicaid,5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4694.9,70,,4694.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,836.77,7216,
REPLACE TUNNELED CV CATH,36581,CPT,,47036581,CDM,360,RC,,,both,,,7234,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4919.12,,,4919.12,Other,ASC Grouper table,2489.81,,,2489.81,Other,186% of Medicaid,5787.2,,,5787.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5787.2,,,5787.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5063.8,70,,5063.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,2048.07,,,2048.07,Other,153% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,1874.05,,,1874.05,Other,140% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,3480.39,,,3480.39,Other,250% of Medicaid,4337.1,,,4337.1,Other,324% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,1673.26,,,1673.26,Other,125% of Medicaid,1338.61,7216,
REPLACE PICC CATH,36584,CPT,,42036584,CDM,360,RC,,,both,,,3500,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2380,,,2380,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,2800,,,2800,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2800,,,2800,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2450,70,,2450,percent of total billed charges,,280.44,,,280.44,Fee Schedule,,237.69,,,237.69,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,237.69,7216,
REPLACE PICC CATH W/ FY MOD,36584,CPT,,42636584,CDM,360,RC,,,both,,,3500,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2380,,,2380,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,2800,,,2800,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2800,,,2800,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2450,70,,2450,percent of total billed charges,,280.44,,,280.44,Fee Schedule,,237.69,,,237.69,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,237.69,7216,
REPLACE PICC CATH,36584,CPT,,47036584,CDM,360,RC,,,both,,,3500,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2380,,,2380,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,2800,,,2800,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2800,,,2800,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2450,70,,2450,percent of total billed charges,,280.44,,,280.44,Fee Schedule,,237.69,,,237.69,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,237.69,7216,
REMOVAL TUNNELED CV CATH,36589,CPT,,47036589,CDM,360,RC,,,both,,,2408,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1637.44,,,1637.44,Other,ASC Grouper table,1556.39,,,1556.39,Other,186% of Medicaid,1926.4,,,1926.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1926.4,,,1926.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1685.6,70,,1685.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,690.31,7216,
REM TUNNELED CVAD W PORT/PUMP,36590,CPT,,30036590,CDM,360,RC,,,both,,,4327,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2942.36,,,2942.36,Other,ASC Grouper table,1556.39,,,1556.39,Other,186% of Medicaid,3461.6,,,3461.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3461.6,,,3461.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3028.9,70,,3028.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,836.77,7216,
REM TUNNELED CVAD W PORT/PUMP,36590,CPT,,47036590,CDM,360,RC,,,both,,,4327,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2942.36,,,2942.36,Other,ASC Grouper table,1556.39,,,1556.39,Other,186% of Medicaid,3461.6,,,3461.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3461.6,,,3461.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3028.9,70,,3028.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,836.77,7216,
DECLOT VASCULAR DEVICE,36593,CPT,,47036593,CDM,360,RC,,,both,,,896,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",627.2,70,,627.2,percent of total billed charges,All Other,609.28,,,609.28,Other,ASC Grouper table,643.88,,,643.88,Other,186% of Medicaid,716.8,,,716.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",716.8,,,716.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,716.8,,,716.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",627.2,70,,627.2,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",346.17,,,346.17,Other,100% of Medicaid,346.17,,,346.17,Other,100% of Medicaid,346.17,,,346.17,Other,100% of Medicaid,346.17,,,346.17,Other,100% of Medicaid,778.89,,,778.89,Other,225% of Medicaid,529.65,,,529.65,Other,153% of Medicaid,778.89,,,778.89,Other,225% of Medicaid,484.64,,,484.64,Other,140% of Medicaid,778.89,,,778.89,Other,225% of Medicaid,900.05,,,900.05,Other,250% of Medicaid,1121.61,,,1121.61,Other,324% of Medicaid,744.28,,,744.28,Other,215% of Medicaid,744.28,,,744.28,Other,215% of Medicaid,432.72,,,432.72,Other,125% of Medicaid,134.83,7216,
DECLOT VASCULAR DEVICE,36593,CPT,,82036593,CDM,360,RC,,,both,,,896,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",627.2,70,,627.2,percent of total billed charges,All Other,609.28,,,609.28,Other,ASC Grouper table,643.88,,,643.88,Other,186% of Medicaid,716.8,,,716.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",716.8,,,716.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,716.8,,,716.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",627.2,70,,627.2,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",346.17,,,346.17,Other,100% of Medicaid,346.17,,,346.17,Other,100% of Medicaid,346.17,,,346.17,Other,100% of Medicaid,346.17,,,346.17,Other,100% of Medicaid,778.89,,,778.89,Other,225% of Medicaid,529.65,,,529.65,Other,153% of Medicaid,778.89,,,778.89,Other,225% of Medicaid,484.64,,,484.64,Other,140% of Medicaid,778.89,,,778.89,Other,225% of Medicaid,900.05,,,900.05,Other,250% of Medicaid,1121.61,,,1121.61,Other,324% of Medicaid,744.28,,,744.28,Other,215% of Medicaid,744.28,,,744.28,Other,215% of Medicaid,432.72,,,432.72,Other,125% of Medicaid,134.83,7216,
SA MECH REM OBSTR CVAD,36595,CPT,,47036595,CDM,360,RC,,,both,,,8098,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5668.6,70,,5668.6,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1556.39,,,1556.39,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,6478.4,,,6478.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5668.6,70,,5668.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,836.77,9473,
MECH REM OF CVA LUMEN OBSTRUCT,36596,CPT,,47036596,CDM,360,RC,,,both,,,3708,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2595.6,70,,2595.6,percent of total billed charges,All Other,2521.44,,,2521.44,Other,ASC Grouper table,1556.39,,,1556.39,Other,186% of Medicaid,2966.4,,,2966.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2966.4,,,2966.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2966.4,,,2966.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2595.6,70,,2595.6,percent of total billed charges,,211.56,,,211.56,Fee Schedule,,179.31,,,179.31,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,179.31,7216,
REPOSIT CVC W FLUORO,36597,CPT,,47036597,CDM,360,RC,,,both,,,3709,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2596.3,70,,2596.3,percent of total billed charges,All Other,2522.12,,,2522.12,Other,ASC Grouper table,1556.39,,,1556.39,Other,186% of Medicaid,2967.2,,,2967.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2967.2,,,2967.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2967.2,,,2967.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2596.3,70,,2596.3,percent of total billed charges,,285.36,,,285.36,Fee Schedule,,241.86,,,241.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,241.86,7216,
CVA CHECK W/CONT AND FLUORO,36598,CPT,,47036598,CDM,360,RC,,,both,,,794,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",555.8,70,,555.8,percent of total billed charges,All Other,539.92,,,539.92,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,635.2,,,635.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",635.2,,,635.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,635.2,,,635.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",555.8,70,,555.8,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,147.34,7216,
ARTERIAL CATH - SAMPLE/MONITOR,36620,CPT,,47036620,CDM,360,RC,,,both,,,299,118.01,39.4668,,118.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",209.3,70,,209.3,percent of total billed charges,All Other,203.32,,,203.32,Other,ASC Grouper table,515.68,,,515.68,Other,186% of Medicaid,239.2,,,239.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",239.2,,,239.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,239.2,,,239.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",209.3,70,,209.3,percent of total billed charges,,211.56,,,211.56,Fee Schedule,,179.31,,,179.31,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,7216,
REVISE AV FISTULA - GRAFT,36832,CPT,,47036832,CDM,360,RC,,,both,,,30403,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4389.18,,,4389.18,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5743,,,5743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",21282.1,70,,21282.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2359.78,,,2359.78,Other,100% of Medicaid,2359.78,,,2359.78,Other,100% of Medicaid,2359.78,,,2359.78,Other,100% of Medicaid,2359.78,,,2359.78,Other,100% of Medicaid,5309.5,,,5309.5,Other,225% of Medicaid,3610.46,,,3610.46,Other,153% of Medicaid,5309.5,,,5309.5,Other,225% of Medicaid,3303.69,,,3303.69,Other,140% of Medicaid,5309.5,,,5309.5,Other,225% of Medicaid,6135.42,,,6135.42,Other,250% of Medicaid,7645.67,,,7645.67,Other,324% of Medicaid,5073.52,,,5073.52,Other,215% of Medicaid,5073.52,,,5073.52,Other,215% of Medicaid,2949.72,,,2949.72,Other,125% of Medicaid,2359.78,21282.1,
INTRO CATH DIALYSIS CIRCUIT,36901,CPT,,47036901,CDM,360,RC,,,both,,,3721,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2530.28,,,2530.28,Other,ASC Grouper table,786.61,,,786.61,Other,186% of Medicaid,2976.8,,,2976.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2976.8,,,2976.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2976.8,,,2976.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2604.7,70,,2604.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,647.05,,,647.05,Other,153% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,592.08,,,592.08,Other,140% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,1099.57,,,1099.57,Other,250% of Medicaid,1370.23,,,1370.23,Other,324% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,528.64,,,528.64,Other,125% of Medicaid,422.91,7216,
INTRO CATH DIALYSIS CIRCUIT,36902,CPT,,47036902,CDM,360,RC,,,both,,,26229,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,20983.2,,,20983.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",18360.3,70,,18360.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,20983.2,
INTRO CATH DIALYSIS CIRCUIT,36903,CPT,,47036903,CDM,360,RC,,,both,,,53013,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,42410.4,,,42410.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",37109.1,70,,37109.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,42410.4,
THRMBC/NFS DIALYSIS CIRCUIT,36904,CPT,,47036904,CDM,360,RC,,,both,,,24513,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS,4827,,,4827,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4344,,,4344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,19610.4,,,19610.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",17159.1,70,,17159.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,19610.4,
THRMBC/NFS DIALYSIS CIRCUIT,36905,CPT,,47036905,CDM,360,RC,,,both,,,48636,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,38908.8,,,38908.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",34045.2,70,,34045.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,2475.91,38908.8,
THRMBC/NFS DIALYSIS CIRCUIT,36906,CPT,,47036906,CDM,360,RC,,,both,,,80352,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,64281.6,,,64281.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",56246.4,70,,56246.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",8589,,,8589,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7730,,,7730,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",8589,,,8589,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7301,,,7301,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,64281.6,
BALO ANGIOP CTR DIALYSIS SEG,36907,CPT,,47036907,CDM,360,RC,,,both,,,700,276.27,39.4668,,276.27,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",476,,,476,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,560,,,560,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",560,,,560,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,560,,,560,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",490,70,,490,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,0.01,8021.96,
STENT PLMT CTR DIALYSIS SEG,36908,CPT,,47036908,CDM,360,RC,,,both,,,900,355.2,39.4668,,355.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",612,,,612,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,720,,,720,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",720,,,720,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,720,,,720,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",630,70,,630,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,0.01,8021.96,
DIALYSIS CIRCUIT EMBOLJ,36909,CPT,,47036909,CDM,360,RC,,,both,,,998,393.88,39.4668,,393.88,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",678.64,,,678.64,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,798.4,,,798.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",798.4,,,798.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,798.4,,,798.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",698.6,70,,698.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,0.01,8021.97,
PRIM ART MECH THROMBECTOMY,37184,CPT,,47037184,CDM,360,RC,,,both,,,23894,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,7938,,,7938,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7144,,,7144,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",16725.8,70,,16725.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,19115.2,,,19115.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16725.8,70,,16725.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,2475.91,31686.15,
PRIM ART M-THROMBECT ADD-ON,37185,CPT,,47037185,CDM,360,RC,,,both,,,12221,4823.24,39.4668,,4823.24,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8554.7,70,,8554.7,percent of total billed charges,All Other,8310.28,,,8310.28,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,9776.8,,,9776.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9776.8,,,9776.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,9776.8,,,9776.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8554.7,70,,8554.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,0.01,9776.8,
SEC ART M-THROMBECT ADD-ON,37186,CPT,,47037186,CDM,360,RC,,,both,,,12092,4772.33,39.4668,,4772.33,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8464.4,70,,8464.4,percent of total billed charges,All Other,8222.56,,,8222.56,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,9673.6,,,9673.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9673.6,,,9673.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,9673.6,,,9673.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8464.4,70,,8464.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,0.01,9673.6,
VENOUS MECH THROMBECTOMY,37187,CPT,,47037187,CDM,360,RC,,,both,,,23894,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,7938,,,7938,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7144,,,7144,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",16725.8,70,,16725.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,19115.2,,,19115.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16725.8,70,,16725.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,19879.22,
VENOUS M-THROMBECTOMY ADD-ON,37188,CPT,,47037188,CDM,360,RC,,,both,,,12221,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,7938,,,7938,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7144,,,7144,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8554.7,70,,8554.7,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9776.8,,,9776.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8554.7,70,,8554.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,9776.8,
INS ENDOVAS VENA CAVA FILTR,37191,CPT,,47037191,CDM,360,RC,,,both,,,15182,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10627.4,70,,10627.4,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12145.6,,,12145.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10627.4,70,,10627.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,12145.6,
REDO ENDOVAS VENA CAVA FILTR,37192,CPT,,47037192,CDM,360,RC,,,both,,,8937,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6255.9,70,,6255.9,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,7149.6,,,7149.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6255.9,70,,6255.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,9473,
REM ENDOVAS VENA CAVA FILTER,37193,CPT,,47037193,CDM,360,RC,,,both,,,9563,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6694.1,70,,6694.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,7650.4,,,7650.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6694.1,70,,6694.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,9473,
REMOVE INTRAVAS FOREIGN BODY,37197,CPT,,47037197,CDM,360,RC,,,both,,,10036,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7025.2,70,,7025.2,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,8028.8,,,8028.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7025.2,70,,7025.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,9473,
THROMBOLYTIC ART THERAPY,37211,CPT,,47037211,CDM,360,RC,,,both,,,11570,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8099,70,,8099,percent of total billed charges,All Other,7867.6,,,7867.6,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,9256,,,9256,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9256,,,9256,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,9256,,,9256,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8099,70,,8099,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2053,9930.15,
THROMBOLYTIC VENOUS THERAPY,37212,CPT,,47037212,CDM,360,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4694.9,70,,4694.9,percent of total billed charges,All Other,4560.76,,,4560.76,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5365.6,,,5365.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4694.9,70,,4694.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2053,7216,
THROMBLYTIC ART/VEN THERAPY,37213,CPT,,47037213,CDM,360,RC,,,both,,,6913,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4839.1,70,,4839.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5530.4,,,5530.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4839.1,70,,4839.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,9473,
CESSJ THERAPY CATH REMOVAL,37214,CPT,,47037214,CDM,360,RC,,,both,,,6913,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4839.1,70,,4839.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5530.4,,,5530.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4839.1,70,,4839.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,9473,
ILIAC REVASC,37220,CPT,,47037220,CDM,360,RC,,,both,,,18493,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,14794.4,,,14794.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12945.1,70,,12945.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,2475.91,14794.4,
ILIAC REVASC BILAT,37220,CPT,50,47337220,CDM,360,RC,,,both,,,27740,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,22192,,,22192,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",19418,70,,19418,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,2475.91,22192,
ILIAC REVASC STENT,37221,CPT,,47037221,CDM,360,RC,,,both,,,39788,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,31830.4,,,31830.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",27851.6,70,,27851.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,31830.4,
ILIAC REVASC STENT BILAT,37221,CPT,50,47337221,CDM,360,RC,,,both,,,59682,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,47745.6,,,47745.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",41777.4,70,,41777.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,47745.6,
ILIAC REVASC ADD-ON,37222,CPT,,47037222,CDM,360,RC,,,both,,,17283,6821.05,39.4668,,6821.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",11752.44,,,11752.44,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,13826.4,,,13826.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",13826.4,,,13826.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,13826.4,,,13826.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12098.1,70,,12098.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,0.01,13826.4,
ILIAC REVASC W/STENT ADD-ON,37223,CPT,,47037223,CDM,360,RC,,,both,,,18493,7298.6,39.4668,,7298.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",12575.24,,,12575.24,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,14794.4,,,14794.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",14794.4,,,14794.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,14794.4,,,14794.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12945.1,70,,12945.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,0.01,14794.4,
PTA FEMORAL POP ART EA VESSEL,37224,CPT,,47037224,CDM,360,RC,,,both,,,18493,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,14794.4,,,14794.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12945.1,70,,12945.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,2475.91,14794.4,
FEM/POPL REVAS W/ATHER,37225,CPT,,47037225,CDM,360,RC,,,both,,,39788,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,31830.4,,,31830.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",27851.6,70,,27851.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,31830.4,
FEM/POPL REVASC W/STENT,37226,CPT,,47037226,CDM,360,RC,,,both,,,39788,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,31830.4,,,31830.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",27851.6,70,,27851.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,31830.4,
FEM/POPL REVASC STNT & ATHER,37227,CPT,,47037227,CDM,360,RC,,,both,,,67088,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,53670.4,,,53670.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",46961.6,70,,46961.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",8589,,,8589,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7730,,,7730,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",8589,,,8589,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7301,,,7301,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,53670.4,
TIB/PER REVASC W/TLA,37228,CPT,,47037228,CDM,360,RC,,,both,,,23894,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,19115.2,,,19115.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",16725.8,70,,16725.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,2475.91,19879.22,
TIB/PER REVASC W/ATHER,37229,CPT,,47037229,CDM,360,RC,,,both,,,39788,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,31830.4,,,31830.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",27851.6,70,,27851.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,31830.4,
TIB/PER REVASC W/STENT,37230,CPT,,47037230,CDM,360,RC,,,both,,,38665,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,30932,,,30932,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",27065.5,70,,27065.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,31686.15,
TIB/PER REVASC STENT & ATHER,37231,CPT,,47037231,CDM,360,RC,,,both,,,57522,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,46017.6,,,46017.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",40265.4,70,,40265.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",8589,,,8589,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7730,,,7730,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",8589,,,8589,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7301,,,7301,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,46017.6,
TIB/PER REVASC ADD-ON,37232,CPT,,47037232,CDM,360,RC,,,both,,,18493,7298.6,39.4668,,7298.6,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",12575.24,,,12575.24,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,14794.4,,,14794.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",14794.4,,,14794.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,14794.4,,,14794.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12945.1,70,,12945.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,0.01,14794.4,
TIB/PER REVAS W/ATHER ADD ON,37233,CPT,,47037233,CDM,360,RC,,,both,,,37185,14675.73,39.4668,,14675.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",25285.8,,,25285.8,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,29748,,,29748,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",29748,,,29748,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,29748,,,29748,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",26029.5,70,,26029.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,0.01,29748,
REVSC OPN/PRQ TIB/PERO STENT,37234,CPT,,47037234,CDM,360,RC,,,both,,,15857,6258.25,39.4668,,6258.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",10782.76,,,10782.76,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,12685.6,,,12685.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12685.6,,,12685.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12685.6,,,12685.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11099.9,70,,11099.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,0.01,12685.6,
TIB/PER REVSC STNT & ATHER ADD,37235,CPT,,47037235,CDM,360,RC,,,both,,,15857,6258.25,39.4668,,6258.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",10782.76,,,10782.76,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,12685.6,,,12685.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12685.6,,,12685.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12685.6,,,12685.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11099.9,70,,11099.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,0.01,12685.6,
OPEN/PERQ PLACE STENT 1ST,37236,CPT,,47037236,CDM,360,RC,,,both,,,37733,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,30186.4,,,30186.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",26413.1,70,,26413.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,30186.4,
OPEN/PERQ PLACE STENT EA ADD,37237,CPT,,47037237,CDM,360,RC,,,both,,,16742,6607.53,39.4668,,6607.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",11719.4,70,,11719.4,percent of total billed charges,All Other,11384.56,,,11384.56,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,13393.6,,,13393.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",13393.6,,,13393.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,13393.6,,,13393.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11719.4,70,,11719.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,0.01,13393.6,
OPEN/PERQ PLACE STENT SAME,37238,CPT,,47037238,CDM,360,RC,,,both,,,34617,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,27693.6,,,27693.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",24231.9,70,,24231.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,27693.6,
OPEN/PERQ PLACE STENT EA ADD,37239,CPT,,47037239,CDM,360,RC,,,both,,,16742,6607.53,39.4668,,6607.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",11719.4,70,,11719.4,percent of total billed charges,All Other,11384.56,,,11384.56,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,13393.6,,,13393.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",13393.6,,,13393.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,13393.6,,,13393.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11719.4,70,,11719.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,0.01,13393.6,
VASC EMBOLIZE/OCCLUDE VENOUS,37241,CPT,,47037241,CDM,360,RC,,,both,,,35914,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,28731.2,,,28731.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",25139.8,70,,25139.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,28731.2,
VASC EMBOLIZE/OCCLUDE ARTERY,37242,CPT,,47037242,CDM,360,RC,,,both,,,36585,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,29268,,,29268,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",25609.5,70,,25609.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,31686.15,
VASC EMBOLIZE/OCCLUDE ORGAN,37243,CPT,,47037243,CDM,360,RC,,,both,,,33564,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,26851.2,,,26851.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",23494.8,70,,23494.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,26851.2,
VASC EMBOLIZE/OCCLUDE BLEED,37244,CPT,,47037244,CDM,360,RC,,,both,,,33564,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,26851.2,,,26851.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",23494.8,70,,23494.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,26851.2,
TRLUML BALO ANGIOP 1ST ART,37246,CPT,,47037246,CDM,360,RC,,,both,,,22489,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",15742.3,70,,15742.3,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,17991.2,,,17991.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",15742.3,70,,15742.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,17991.2,
TRLUML BALO ANGIOP ADDL ART,37247,CPT,,47037247,CDM,360,RC,,,both,,,849,335.07,39.4668,,335.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",594.3,70,,594.3,percent of total billed charges,All Other,577.32,,,577.32,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,679.2,,,679.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",679.2,,,679.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,679.2,,,679.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",594.3,70,,594.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,0.01,8021.96,
TRLUML BALO ANGIOP 1ST VEIN,37248,CPT,,47037248,CDM,360,RC,,,both,,,22489,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,17991.2,,,17991.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",15742.3,70,,15742.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,17991.2,
TRLUML BALO ANGIOP ADDL VEIN,37249,CPT,,47037249,CDM,360,RC,,,both,,,723,285.34,39.4668,,285.34,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",491.64,,,491.64,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,578.4,,,578.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",578.4,,,578.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,578.4,,,578.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",506.1,70,,506.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,0.01,8021.96,
LIGATION/BAND ANGIOACCESS AV FISTULA,37607,CPT,,47037607,CDM,360,RC,,,both,,,8728,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4418.02,,,4418.02,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6109.6,70,,6109.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2375.28,,,2375.28,Other,100% of Medicaid,2375.28,,,2375.28,Other,100% of Medicaid,2375.28,,,2375.28,Other,100% of Medicaid,2375.28,,,2375.28,Other,100% of Medicaid,5344.38,,,5344.38,Other,225% of Medicaid,3634.18,,,3634.18,Other,153% of Medicaid,5344.38,,,5344.38,Other,225% of Medicaid,3325.39,,,3325.39,Other,140% of Medicaid,5344.38,,,5344.38,Other,225% of Medicaid,6175.73,,,6175.73,Other,250% of Medicaid,7695.91,,,7695.91,Other,324% of Medicaid,5106.85,,,5106.85,Other,215% of Medicaid,5106.85,,,5106.85,Other,215% of Medicaid,2969.1,,,2969.1,Other,125% of Medicaid,2375.28,9473,
BONE MARROW ASPIRATION,38220,CPT,,46038220,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2363.9,70,,2363.9,percent of total billed charges,All Other,2296.36,,,2296.36,Other,ASC Grouper table,1037.21,,,1037.21,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,326.36,,,326.36,Fee Schedule,,276.61,,,276.61,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.69,,,1254.69,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.69,,,1254.69,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.69,,,1254.69,Other,225% of Medicaid,1449.86,,,1449.86,Other,250% of Medicaid,1806.75,,,1806.75,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,276.61,7216,
BONE MARROW BIOPSY,38221,CPT,,46038221,CDM,360,RC,,,both,,,3926,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2669.68,,,2669.68,Other,ASC Grouper table,1037.21,,,1037.21,Other,186% of Medicaid,3140.8,,,3140.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3140.8,,,3140.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3140.8,,,3140.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2748.2,70,,2748.2,percent of total billed charges,,339.48,,,339.48,Fee Schedule,,287.73,,,287.73,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.69,,,1254.69,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.69,,,1254.69,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.69,,,1254.69,Other,225% of Medicaid,1449.86,,,1449.86,Other,250% of Medicaid,1806.75,,,1806.75,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,287.73,7216,
BIOPSY LYMPH NODE NEEDLE,38505,CPT,,44038505,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,2241.52,,,2241.52,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,410,,,410,Fee Schedule,,347.5,,,347.5,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1843.83,,,1843.83,Other,153% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1687.16,,,1687.16,Other,140% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,3133.3,,,3133.3,Other,250% of Medicaid,3904.58,,,3904.58,Other,324% of Medicaid,2591,,,2591,Other,215% of Medicaid,2591,,,2591,Other,215% of Medicaid,1506.39,,,1506.39,Other,125% of Medicaid,347.5,7216,
BIOPSY LYMPH NODE NEEDLE,38505,CPT,,46038505,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,2241.52,,,2241.52,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,410,,,410,Fee Schedule,,347.5,,,347.5,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1843.83,,,1843.83,Other,153% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1687.16,,,1687.16,Other,140% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,3133.3,,,3133.3,Other,250% of Medicaid,3904.58,,,3904.58,Other,324% of Medicaid,2591,,,2591,Other,215% of Medicaid,2591,,,2591,Other,215% of Medicaid,1506.39,,,1506.39,Other,125% of Medicaid,347.5,7216,
SENTINEL NODE INJECTION,38792,CPT,,44038792,CDM,360,RC,,,both,,,1401,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",980.7,70,,980.7,percent of total billed charges,All Other,952.68,,,952.68,Other,ASC Grouper table,765.51,,,765.51,Other,186% of Medicaid,1120.8,,,1120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1120.8,,,1120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1120.8,,,1120.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",980.7,70,,980.7,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",411.56,,,411.56,Other,100% of Medicaid,411.56,,,411.56,Other,100% of Medicaid,411.56,,,411.56,Other,100% of Medicaid,411.56,,,411.56,Other,100% of Medicaid,926.02,,,926.02,Other,225% of Medicaid,629.69,,,629.69,Other,153% of Medicaid,926.02,,,926.02,Other,225% of Medicaid,576.19,,,576.19,Other,140% of Medicaid,926.02,,,926.02,Other,225% of Medicaid,1070.06,,,1070.06,Other,250% of Medicaid,1333.46,,,1333.46,Other,324% of Medicaid,884.86,,,884.86,Other,215% of Medicaid,884.86,,,884.86,Other,215% of Medicaid,514.45,,,514.45,Other,125% of Medicaid,134.83,7216,
IDENTIFY SENTINEL NODE,38792,CPT,,50038792,CDM,360,RC,,,both,,,1401,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",980.7,70,,980.7,percent of total billed charges,All Other,952.68,,,952.68,Other,ASC Grouper table,765.51,,,765.51,Other,186% of Medicaid,1120.8,,,1120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1120.8,,,1120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1120.8,,,1120.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",980.7,70,,980.7,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",411.56,,,411.56,Other,100% of Medicaid,411.56,,,411.56,Other,100% of Medicaid,411.56,,,411.56,Other,100% of Medicaid,411.56,,,411.56,Other,100% of Medicaid,926.02,,,926.02,Other,225% of Medicaid,629.69,,,629.69,Other,153% of Medicaid,926.02,,,926.02,Other,225% of Medicaid,576.19,,,576.19,Other,140% of Medicaid,926.02,,,926.02,Other,225% of Medicaid,1070.06,,,1070.06,Other,250% of Medicaid,1333.46,,,1333.46,Other,324% of Medicaid,884.86,,,884.86,Other,215% of Medicaid,884.86,,,884.86,Other,215% of Medicaid,514.45,,,514.45,Other,125% of Medicaid,134.83,7216,
IDENTIFY SENTINEL NODE,38792,CPT,,50138792,CDM,360,RC,,,both,,,1401,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",980.7,70,,980.7,percent of total billed charges,All Other,952.68,,,952.68,Other,ASC Grouper table,765.51,,,765.51,Other,186% of Medicaid,1120.8,,,1120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1120.8,,,1120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1120.8,,,1120.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",980.7,70,,980.7,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",411.56,,,411.56,Other,100% of Medicaid,411.56,,,411.56,Other,100% of Medicaid,411.56,,,411.56,Other,100% of Medicaid,411.56,,,411.56,Other,100% of Medicaid,926.02,,,926.02,Other,225% of Medicaid,629.69,,,629.69,Other,153% of Medicaid,926.02,,,926.02,Other,225% of Medicaid,576.19,,,576.19,Other,140% of Medicaid,926.02,,,926.02,Other,225% of Medicaid,1070.06,,,1070.06,Other,250% of Medicaid,1333.46,,,1333.46,Other,324% of Medicaid,884.86,,,884.86,Other,215% of Medicaid,884.86,,,884.86,Other,215% of Medicaid,514.45,,,514.45,Other,125% of Medicaid,134.83,7216,
BIOPSY SALIVARY GLAND; NEEDLE,42400,CPT,,47042400,CDM,360,RC,,,both,,,2405,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1683.5,70,,1683.5,percent of total billed charges,All Other,1635.4,,,1635.4,Other,ASC Grouper table,428.26,,,428.26,Other,186% of Medicaid,1924,,,1924,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1924,,,1924,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1924,,,1924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1683.5,70,,1683.5,percent of total billed charges,,254.2,,,254.2,Fee Schedule,,215.45,,,215.45,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,352.28,,,352.28,Other,153% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,322.35,,,322.35,Other,140% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,598.64,,,598.64,Other,250% of Medicaid,746,,,746,Other,324% of Medicaid,495.03,,,495.03,Other,215% of Medicaid,495.03,,,495.03,Other,215% of Medicaid,287.81,,,287.81,Other,125% of Medicaid,215.45,7216,
INJ FOR SIALOGRAPHY,42550,CPT,,42042550,CDM,360,RC,,,both,,,246,97.09,39.4668,,97.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",172.2,70,,172.2,percent of total billed charges,All Other,167.28,,,167.28,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,196.8,,,196.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",196.8,,,196.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,196.8,,,196.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",172.2,70,,172.2,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJ FOR SIALOGRAPHY W/ FY MOD,42550,CPT,,42642550,CDM,360,RC,,,both,,,246,97.09,39.4668,,97.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",172.2,70,,172.2,percent of total billed charges,All Other,167.28,,,167.28,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,196.8,,,196.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",196.8,,,196.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,196.8,,,196.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",172.2,70,,172.2,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJ FOR SIALOGRAPHY,42550,CPT,,47042550,CDM,360,RC,,,both,,,246,97.09,39.4668,,97.09,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",172.2,70,,172.2,percent of total billed charges,All Other,167.28,,,167.28,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,196.8,,,196.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",196.8,,,196.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,196.8,,,196.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",172.2,70,,172.2,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
UGI W BX. SGL/MULTIPLE,43239,CPT,,30043239,CDM,360,RC,,,both,,,2490,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1693.2,,,1693.2,Other,ASC Grouper table,1530.53,,,1530.53,Other,186% of Medicaid,1992,,,1992,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1992,,,1992,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1743,70,,1743,percent of total billed charges,,3387,,,3387,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2879,,,2879,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1258.98,,,1258.98,Other,153% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1152.01,,,1152.01,Other,140% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,2139.45,,,2139.45,Other,250% of Medicaid,2666.08,,,2666.08,Other,324% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1028.58,,,1028.58,Other,125% of Medicaid,822.86,7216,
RPLC GTUBE NO REVJ TRC,43762,CPT,,34043762,CDM,360,RC,,,both,,,1648,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1120.64,,,1120.64,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,1318.4,,,1318.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1318.4,,,1318.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1318.4,,,1318.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1153.6,70,,1153.6,percent of total billed charges,,178.76,,,178.76,Fee Schedule,,151.51,,,151.51,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,151.51,7216,
RPLC GTUBE REVJ GSTRST TRC,43763,CPT,,34043763,CDM,360,RC,,,both,,,1592,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1082.56,,,1082.56,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,1273.6,,,1273.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1273.6,,,1273.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1273.6,,,1273.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1114.4,70,,1114.4,percent of total billed charges,,410,,,410,Fee Schedule,,347.5,,,347.5,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,271.58,7216,
BIOPSY OF LIVER NEEDLE PERC,47000,CPT,,46047000,CDM,360,RC,,,both,,,3495,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2376.6,,,2376.6,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2796,,,2796,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2796,,,2796,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2446.5,70,,2446.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ABLATION LIVER TUMORS PERCUT R,47382,CPT,,46047382,CDM,360,RC,,,both,,,18449,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",12914.3,70,,12914.3,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3989.05,,,3989.05,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,14759.2,,,14759.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12914.3,70,,12914.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2144.65,,,2144.65,Other,100% of Medicaid,2144.65,,,2144.65,Other,100% of Medicaid,2144.65,,,2144.65,Other,100% of Medicaid,2144.65,,,2144.65,Other,100% of Medicaid,4825.46,,,4825.46,Other,225% of Medicaid,3281.31,,,3281.31,Other,153% of Medicaid,4825.46,,,4825.46,Other,225% of Medicaid,3002.51,,,3002.51,Other,140% of Medicaid,4825.46,,,4825.46,Other,225% of Medicaid,5576.08,,,5576.08,Other,250% of Medicaid,6948.66,,,6948.66,Other,324% of Medicaid,4610.99,,,4610.99,Other,215% of Medicaid,4610.99,,,4610.99,Other,215% of Medicaid,2680.81,,,2680.81,Other,125% of Medicaid,2144.65,14759.2,
PERCUTANEOUS CHOLECYSTOSTOMY,47490,CPT,,44047490,CDM,360,RC,,,both,,,12073,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8451.1,70,,8451.1,percent of total billed charges,All Other,8209.64,,,8209.64,Other,ASC Grouper table,2588.58,,,2588.58,Other,186% of Medicaid,9658.4,,,9658.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9658.4,,,9658.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,9658.4,,,9658.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8451.1,70,,8451.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,2129.32,,,2129.32,Other,153% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,1948.39,,,1948.39,Other,140% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,3618.44,,,3618.44,Other,250% of Medicaid,4509.14,,,4509.14,Other,324% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,1739.64,,,1739.64,Other,125% of Medicaid,1391.71,9658.4,
PERCUTANEOUS CHOLECYSTOSTOMY,47490,CPT,,46047490,CDM,360,RC,,,both,,,12073,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8451.1,70,,8451.1,percent of total billed charges,All Other,8209.64,,,8209.64,Other,ASC Grouper table,2588.58,,,2588.58,Other,186% of Medicaid,9658.4,,,9658.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9658.4,,,9658.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,9658.4,,,9658.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8451.1,70,,8451.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,2129.32,,,2129.32,Other,153% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,1948.39,,,1948.39,Other,140% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,3618.44,,,3618.44,Other,250% of Medicaid,4509.14,,,4509.14,Other,324% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,1739.64,,,1739.64,Other,125% of Medicaid,1391.71,9658.4,
INJECTION FOR CHOLANGIOGRAM,47531,CPT,,42047531,CDM,360,RC,,,both,,,7974,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5422.32,,,5422.32,Other,ASC Grouper table,786.61,,,786.61,Other,186% of Medicaid,6379.2,,,6379.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6379.2,,,6379.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6379.2,,,6379.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5581.8,70,,5581.8,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,647.05,,,647.05,Other,153% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,592.08,,,592.08,Other,140% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,1099.57,,,1099.57,Other,250% of Medicaid,1370.23,,,1370.23,Other,324% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,528.64,,,528.64,Other,125% of Medicaid,282.17,7216,
INJECTION FOR CHOLANGIOGRAM W/ FY MOD,47531,CPT,,42647531,CDM,360,RC,,,both,,,7974,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5422.32,,,5422.32,Other,ASC Grouper table,786.61,,,786.61,Other,186% of Medicaid,6379.2,,,6379.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6379.2,,,6379.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6379.2,,,6379.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5581.8,70,,5581.8,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,647.05,,,647.05,Other,153% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,592.08,,,592.08,Other,140% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,1099.57,,,1099.57,Other,250% of Medicaid,1370.23,,,1370.23,Other,324% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,528.64,,,528.64,Other,125% of Medicaid,282.17,7216,
INJECTION FOR CHOLANGIOGRAM W/ FY MOD,47531,CPT,FY,43047531,CDM,360,RC,,,both,,,7974,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5422.32,,,5422.32,Other,ASC Grouper table,786.61,,,786.61,Other,186% of Medicaid,6379.2,,,6379.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6379.2,,,6379.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6379.2,,,6379.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5581.8,70,,5581.8,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,647.05,,,647.05,Other,153% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,592.08,,,592.08,Other,140% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,1099.57,,,1099.57,Other,250% of Medicaid,1370.23,,,1370.23,Other,324% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,528.64,,,528.64,Other,125% of Medicaid,282.17,7216,
INJECTION FOR CHOLANGIOGRAM,47531,CPT,,47047531,CDM,360,RC,,,both,,,7974,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5422.32,,,5422.32,Other,ASC Grouper table,786.61,,,786.61,Other,186% of Medicaid,6379.2,,,6379.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6379.2,,,6379.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6379.2,,,6379.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5581.8,70,,5581.8,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,647.05,,,647.05,Other,153% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,592.08,,,592.08,Other,140% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,1099.57,,,1099.57,Other,250% of Medicaid,1370.23,,,1370.23,Other,324% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,528.64,,,528.64,Other,125% of Medicaid,282.17,7216,
INJECTION FOR CHOLANGIOGRAM,47532,CPT,,47047532,CDM,360,RC,,,both,,,8239,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5602.52,,,5602.52,Other,ASC Grouper table,786.61,,,786.61,Other,186% of Medicaid,6591.2,,,6591.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6591.2,,,6591.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6591.2,,,6591.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5767.3,70,,5767.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,422.91,,,422.91,Other,100% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,647.05,,,647.05,Other,153% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,592.08,,,592.08,Other,140% of Medicaid,951.55,,,951.55,Other,225% of Medicaid,1099.57,,,1099.57,Other,250% of Medicaid,1370.23,,,1370.23,Other,324% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,909.26,,,909.26,Other,215% of Medicaid,528.64,,,528.64,Other,125% of Medicaid,422.91,7216,
PLMT BILIARY DRAINAGE CATH,47533,CPT,,46047533,CDM,360,RC,,,both,,,8980,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6106.4,,,6106.4,Other,ASC Grouper table,2588.58,,,2588.58,Other,186% of Medicaid,7184,,,7184,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7184,,,7184,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7184,,,7184,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6286,70,,6286,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,2129.32,,,2129.32,Other,153% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,1948.39,,,1948.39,Other,140% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,3618.44,,,3618.44,Other,250% of Medicaid,4509.14,,,4509.14,Other,324% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,1739.64,,,1739.64,Other,125% of Medicaid,1391.71,7216,
PLMT BILIARY DRAINAGE CATH,47533,CPT,,47047533,CDM,360,RC,,,both,,,8980,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6106.4,,,6106.4,Other,ASC Grouper table,2588.58,,,2588.58,Other,186% of Medicaid,7184,,,7184,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7184,,,7184,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7184,,,7184,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6286,70,,6286,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,2129.32,,,2129.32,Other,153% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,1948.39,,,1948.39,Other,140% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,3618.44,,,3618.44,Other,250% of Medicaid,4509.14,,,4509.14,Other,324% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,1739.64,,,1739.64,Other,125% of Medicaid,1391.71,7216,
PLMT BILIARY DRAINAGE CATH,47534,CPT,,47047534,CDM,360,RC,,,both,,,8239,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5602.52,,,5602.52,Other,ASC Grouper table,2588.58,,,2588.58,Other,186% of Medicaid,6591.2,,,6591.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6591.2,,,6591.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6591.2,,,6591.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5767.3,70,,5767.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,2129.32,,,2129.32,Other,153% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,1948.39,,,1948.39,Other,140% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,3618.44,,,3618.44,Other,250% of Medicaid,4509.14,,,4509.14,Other,324% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,1739.64,,,1739.64,Other,125% of Medicaid,1391.71,7216,
CONVERSION EXT BIL DRG CATH,47535,CPT,,47047535,CDM,360,RC,,,both,,,8239,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5602.52,,,5602.52,Other,ASC Grouper table,2588.58,,,2588.58,Other,186% of Medicaid,6591.2,,,6591.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6591.2,,,6591.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6591.2,,,6591.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5767.3,70,,5767.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,2129.32,,,2129.32,Other,153% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,1948.39,,,1948.39,Other,140% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,3618.44,,,3618.44,Other,250% of Medicaid,4509.14,,,4509.14,Other,324% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,1739.64,,,1739.64,Other,125% of Medicaid,1391.71,7216,
EXCHANGE BILIARY DRG CATH,47536,CPT,,47047536,CDM,360,RC,,,both,,,8239,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5602.52,,,5602.52,Other,ASC Grouper table,2588.58,,,2588.58,Other,186% of Medicaid,6591.2,,,6591.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6591.2,,,6591.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6591.2,,,6591.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5767.3,70,,5767.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,2129.32,,,2129.32,Other,153% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,1948.39,,,1948.39,Other,140% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,3618.44,,,3618.44,Other,250% of Medicaid,4509.14,,,4509.14,Other,324% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,1739.64,,,1739.64,Other,125% of Medicaid,1391.71,7216,
REMOVAL BILIARY DRG CATH,47537,CPT,,47047537,CDM,360,RC,,,both,,,1921,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1306.28,,,1306.28,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,1536.8,,,1536.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1536.8,,,1536.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1536.8,,,1536.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1344.7,70,,1344.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,553.78,7216,
PERQ PLMT BILE DUCT STENT,47538,CPT,,47047538,CDM,360,RC,,,both,,,15583,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2588.58,,,2588.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12466.4,,,12466.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10908.1,70,,10908.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,2129.32,,,2129.32,Other,153% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,1948.39,,,1948.39,Other,140% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,3618.44,,,3618.44,Other,250% of Medicaid,4509.14,,,4509.14,Other,324% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,1739.64,,,1739.64,Other,125% of Medicaid,1391.71,12466.4,
PERQ PLMT BILE DUCT STENT,47539,CPT,,47047539,CDM,360,RC,,,both,,,15583,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2588.58,,,2588.58,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12466.4,,,12466.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10908.1,70,,10908.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,1391.71,,,1391.71,Other,100% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,2129.32,,,2129.32,Other,153% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,1948.39,,,1948.39,Other,140% of Medicaid,3131.35,,,3131.35,Other,225% of Medicaid,3618.44,,,3618.44,Other,250% of Medicaid,4509.14,,,4509.14,Other,324% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,2992.17,,,2992.17,Other,215% of Medicaid,1739.64,,,1739.64,Other,125% of Medicaid,1391.71,12466.4,
PERQ PLMT BILE DUCT STENT,47540,CPT,,47047540,CDM,360,RC,,,both,,,15583,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3989.05,,,3989.05,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12466.4,,,12466.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10908.1,70,,10908.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2144.65,,,2144.65,Other,100% of Medicaid,2144.65,,,2144.65,Other,100% of Medicaid,2144.65,,,2144.65,Other,100% of Medicaid,2144.65,,,2144.65,Other,100% of Medicaid,4825.46,,,4825.46,Other,225% of Medicaid,3281.31,,,3281.31,Other,153% of Medicaid,4825.46,,,4825.46,Other,225% of Medicaid,3002.51,,,3002.51,Other,140% of Medicaid,4825.46,,,4825.46,Other,225% of Medicaid,5576.08,,,5576.08,Other,250% of Medicaid,6948.66,,,6948.66,Other,324% of Medicaid,4610.99,,,4610.99,Other,215% of Medicaid,4610.99,,,4610.99,Other,215% of Medicaid,2680.81,,,2680.81,Other,125% of Medicaid,2144.65,12466.4,
REMOVAL DUCT GLBLDR CALCULI,47544,CPT,,47047544,CDM,360,RC,,,both,,,862,340.2,39.4668,,340.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",603.4,70,,603.4,percent of total billed charges,All Other,586.16,,,586.16,Other,ASC Grouper table,3989.05,,,3989.05,Other,186% of Medicaid,689.6,,,689.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",689.6,,,689.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,689.6,,,689.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",603.4,70,,603.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2144.65,,,2144.65,Other,100% of Medicaid,2144.65,,,2144.65,Other,100% of Medicaid,2144.65,,,2144.65,Other,100% of Medicaid,2144.65,,,2144.65,Other,100% of Medicaid,4825.46,,,4825.46,Other,225% of Medicaid,3281.31,,,3281.31,Other,153% of Medicaid,4825.46,,,4825.46,Other,225% of Medicaid,3002.51,,,3002.51,Other,140% of Medicaid,4825.46,,,4825.46,Other,225% of Medicaid,5576.08,,,5576.08,Other,250% of Medicaid,6948.66,,,6948.66,Other,324% of Medicaid,4610.99,,,4610.99,Other,215% of Medicaid,4610.99,,,4610.99,Other,215% of Medicaid,2680.81,,,2680.81,Other,125% of Medicaid,0.01,7216,
PERC DIL BILIARY STRICTURE WO,47555,CPT,,47047555,CDM,360,RC,,,both,,,9229,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2563.55,,,2563.55,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6460.3,70,,6460.3,percent of total billed charges,,3387,,,3387,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2879,,,2879,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1378.25,,,1378.25,Other,100% of Medicaid,1378.25,,,1378.25,Other,100% of Medicaid,1378.25,,,1378.25,Other,100% of Medicaid,1378.25,,,1378.25,Other,100% of Medicaid,3101.07,,,3101.07,Other,225% of Medicaid,2108.73,,,2108.73,Other,153% of Medicaid,3101.07,,,3101.07,Other,225% of Medicaid,1929.55,,,1929.55,Other,140% of Medicaid,3101.07,,,3101.07,Other,225% of Medicaid,3583.46,,,3583.46,Other,250% of Medicaid,4465.54,,,4465.54,Other,324% of Medicaid,2963.24,,,2963.24,Other,215% of Medicaid,2963.24,,,2963.24,Other,215% of Medicaid,1722.82,,,1722.82,Other,125% of Medicaid,1378.25,9473,
PERC DIL BILIARY STRICTURE W S,47556,CPT,,47047556,CDM,360,RC,,,both,,,11733,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2563.55,,,2563.55,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9196,,,9196,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8213.1,70,,8213.1,percent of total billed charges,,3387,,,3387,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2879,,,2879,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1378.25,,,1378.25,Other,100% of Medicaid,1378.25,,,1378.25,Other,100% of Medicaid,1378.25,,,1378.25,Other,100% of Medicaid,1378.25,,,1378.25,Other,100% of Medicaid,3101.07,,,3101.07,Other,225% of Medicaid,2108.73,,,2108.73,Other,153% of Medicaid,3101.07,,,3101.07,Other,225% of Medicaid,1929.55,,,1929.55,Other,140% of Medicaid,3101.07,,,3101.07,Other,225% of Medicaid,3583.46,,,3583.46,Other,250% of Medicaid,4465.54,,,4465.54,Other,324% of Medicaid,2963.24,,,2963.24,Other,215% of Medicaid,2963.24,,,2963.24,Other,215% of Medicaid,1722.82,,,1722.82,Other,125% of Medicaid,1378.25,18600.85,
BIOPSY OF PANCREAS PERCUT,48102,CPT,,46048102,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ABD PARACENTESIS W/IMAGING,49083,CPT,,44049083,CDM,360,RC,,,both,,,1893,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1287.24,,,1287.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1514.4,,,1514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1514.4,,,1514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1514.4,,,1514.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1325.1,70,,1325.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
INCOMPLETE PARACENTESIS,49083,CPT,73,44449083,CDM,360,RC,,,both,,,1515,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1030.2,,,1030.2,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1212,,,1212,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1212,,,1212,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1212,,,1212,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1060.5,70,,1060.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ABD PARACENTESIS W/IMAGING,49083,CPT,,46049083,CDM,360,RC,,,both,,,1893,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1287.24,,,1287.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1514.4,,,1514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1514.4,,,1514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1514.4,,,1514.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1325.1,70,,1325.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ABD PARACENTESIS W/IMAGING,49083,CPT,,47049083,CDM,360,RC,,,both,,,1893,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1287.24,,,1287.24,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1514.4,,,1514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1514.4,,,1514.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1514.4,,,1514.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1325.1,70,,1325.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
BIOPSY ABDOMINAL RETROPERITONE,49180,CPT,,44049180,CDM,360,RC,,,both,,,3462,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2354.16,,,2354.16,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2769.6,,,2769.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2769.6,,,2769.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2423.4,70,,2423.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
BIOPSY ABDOMINAL RETROPERITONE,49180,CPT,,46049180,CDM,360,RC,,,both,,,3462,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2354.16,,,2354.16,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2769.6,,,2769.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2769.6,,,2769.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2423.4,70,,2423.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
SCLEROTX FLUID COLLECTION,49185,CPT,,46049185,CDM,360,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2363.9,70,,2363.9,percent of total billed charges,All Other,2296.36,,,2296.36,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
EXC ABD TUM 5 CM OR LESS,49203,CPT,,46049203,CDM,360,RC,,,both,,,4374,1726.28,39.4668,,1726.28,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3061.8,70,,3061.8,percent of total billed charges,All Other,2974.32,,,2974.32,Other,ASC Grouper table,3204.55,,,3204.55,Other,186% of Medicaid,3499.2,,,3499.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3499.2,,,3499.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3499.2,,,3499.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3061.8,70,,3061.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1722.87,,,1722.87,Other,100% of Medicaid,1722.87,,,1722.87,Other,100% of Medicaid,1722.87,,,1722.87,Other,100% of Medicaid,1722.87,,,1722.87,Other,100% of Medicaid,3876.47,,,3876.47,Other,225% of Medicaid,2636,,,2636,Other,153% of Medicaid,3876.47,,,3876.47,Other,225% of Medicaid,2412.02,,,2412.02,Other,140% of Medicaid,3876.47,,,3876.47,Other,225% of Medicaid,4479.47,,,4479.47,Other,250% of Medicaid,5582.11,,,5582.11,Other,324% of Medicaid,3704.18,,,3704.18,Other,215% of Medicaid,3704.18,,,3704.18,Other,215% of Medicaid,2153.59,,,2153.59,Other,125% of Medicaid,0.01,7216,
EXC ABD TUM OVER 5 CM,49204,CPT,,46049204,CDM,360,RC,,,both,,,5567,2197.12,39.4668,,2197.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3896.9,70,,3896.9,percent of total billed charges,All Other,3785.56,,,3785.56,Other,ASC Grouper table,3204.55,,,3204.55,Other,186% of Medicaid,4453.6,,,4453.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4453.6,,,4453.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4453.6,,,4453.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3896.9,70,,3896.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1722.87,,,1722.87,Other,100% of Medicaid,1722.87,,,1722.87,Other,100% of Medicaid,1722.87,,,1722.87,Other,100% of Medicaid,1722.87,,,1722.87,Other,100% of Medicaid,3876.47,,,3876.47,Other,225% of Medicaid,2636,,,2636,Other,153% of Medicaid,3876.47,,,3876.47,Other,225% of Medicaid,2412.02,,,2412.02,Other,140% of Medicaid,3876.47,,,3876.47,Other,225% of Medicaid,4479.47,,,4479.47,Other,250% of Medicaid,5582.11,,,5582.11,Other,324% of Medicaid,3704.18,,,3704.18,Other,215% of Medicaid,3704.18,,,3704.18,Other,215% of Medicaid,2153.59,,,2153.59,Other,125% of Medicaid,0.01,7216,
EXC ABD TUM OVER 10 CM,49205,CPT,,46049205,CDM,360,RC,,,both,,,6377,2516.8,39.4668,,2516.8,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4463.9,70,,4463.9,percent of total billed charges,All Other,4336.36,,,4336.36,Other,ASC Grouper table,3204.55,,,3204.55,Other,186% of Medicaid,5101.6,,,5101.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5101.6,,,5101.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5101.6,,,5101.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4463.9,70,,4463.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1722.87,,,1722.87,Other,100% of Medicaid,1722.87,,,1722.87,Other,100% of Medicaid,1722.87,,,1722.87,Other,100% of Medicaid,1722.87,,,1722.87,Other,100% of Medicaid,3876.47,,,3876.47,Other,225% of Medicaid,2636,,,2636,Other,153% of Medicaid,3876.47,,,3876.47,Other,225% of Medicaid,2412.02,,,2412.02,Other,140% of Medicaid,3876.47,,,3876.47,Other,225% of Medicaid,4479.47,,,4479.47,Other,250% of Medicaid,5582.11,,,5582.11,Other,324% of Medicaid,3704.18,,,3704.18,Other,215% of Medicaid,3704.18,,,3704.18,Other,215% of Medicaid,2153.59,,,2153.59,Other,125% of Medicaid,0.01,7216,
INJ AIR/CONTRAST INTO PERITONEAL CAVITY,49400,CPT,,47049400,CDM,360,RC,,,both,,,1234,487.02,39.4668,,487.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",863.8,70,,863.8,percent of total billed charges,All Other,839.12,,,839.12,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,987.2,,,987.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",987.2,,,987.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,987.2,,,987.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",863.8,70,,863.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
CT GUIDED CATHETER EXCHANGE,49423,CPT,,46049423,CDM,360,RC,,,both,,,5324,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3726.8,70,,3726.8,percent of total billed charges,All Other,3620.32,,,3620.32,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,4259.2,,,4259.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4259.2,,,4259.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4259.2,,,4259.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3726.8,70,,3726.8,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,282.17,7216,
EXCHANGE PREVIOUS DRAINAGE CATH,49423,CPT,,47049423,CDM,360,RC,,,both,,,5324,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3726.8,70,,3726.8,percent of total billed charges,All Other,3620.32,,,3620.32,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,4259.2,,,4259.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4259.2,,,4259.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4259.2,,,4259.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3726.8,70,,3726.8,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,282.17,7216,
INJ TO EVAL PERITONEAL-VENOUS,49427,CPT,,42049427,CDM,360,RC,,,both,,,177,69.86,39.4668,,69.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",123.9,70,,123.9,percent of total billed charges,All Other,120.36,,,120.36,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,141.6,,,141.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",141.6,,,141.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,141.6,,,141.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",123.9,70,,123.9,percent of total billed charges,,185.32,,,185.32,Fee Schedule,,157.07,,,157.07,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJ TO EVAL PERITONEAL-VENOUS W/ FY MOD,49427,CPT,,42649427,CDM,360,RC,,,both,,,177,69.86,39.4668,,69.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",123.9,70,,123.9,percent of total billed charges,All Other,120.36,,,120.36,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,141.6,,,141.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",141.6,,,141.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,141.6,,,141.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",123.9,70,,123.9,percent of total billed charges,,185.32,,,185.32,Fee Schedule,,157.07,,,157.07,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJ TO EVAL PERITONEAL-VENOUS,49427,CPT,,50049427,CDM,360,RC,,,both,,,177,69.86,39.4668,,69.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",123.9,70,,123.9,percent of total billed charges,All Other,120.36,,,120.36,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,141.6,,,141.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",141.6,,,141.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,141.6,,,141.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",123.9,70,,123.9,percent of total billed charges,,185.32,,,185.32,Fee Schedule,,157.07,,,157.07,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
PLACE GASTROSTOMY TUBE PERC,49440,CPT,,47049440,CDM,360,RC,,,both,,,3921,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2666.28,,,2666.28,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,3136.8,,,3136.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3136.8,,,3136.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3136.8,,,3136.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2744.7,70,,2744.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,553.78,7216,
PLACE DUOD/JEJ TUBE PERC,49441,CPT,,47049441,CDM,360,RC,,,both,,,8731,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5937.08,,,5937.08,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,6984.8,,,6984.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6984.8,,,6984.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6984.8,,,6984.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6111.7,70,,6111.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,553.78,7216,
CHANGE G-TUBE TO G-J PERC,49446,CPT,,47049446,CDM,360,RC,,,both,,,4275,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2907,,,2907,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,3420,,,3420,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3420,,,3420,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3420,,,3420,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2992.5,70,,2992.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,553.78,7216,
REPLACE G C TUBE PERC,49450,CPT,,30049450,CDM,360,RC,,,both,,,2408,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1637.44,,,1637.44,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,1926.4,,,1926.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1926.4,,,1926.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1926.4,,,1926.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1685.6,70,,1685.6,percent of total billed charges,,309.96,,,309.96,Fee Schedule,,262.71,,,262.71,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,262.71,7216,
REPLACE G C TUBE PERC,49450,CPT,,34049450,CDM,360,RC,,,both,,,2408,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1637.44,,,1637.44,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,1926.4,,,1926.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1926.4,,,1926.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1926.4,,,1926.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1685.6,70,,1685.6,percent of total billed charges,,309.96,,,309.96,Fee Schedule,,262.71,,,262.71,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,262.71,7216,
REPLACE G C TUBE PERC,49450,CPT,,47049450,CDM,360,RC,,,both,,,2408,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1637.44,,,1637.44,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,1926.4,,,1926.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1926.4,,,1926.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1926.4,,,1926.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1685.6,70,,1685.6,percent of total billed charges,,309.96,,,309.96,Fee Schedule,,262.71,,,262.71,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,262.71,7216,
REPLACE G-J TUBE PERC,49452,CPT,,47049452,CDM,360,RC,,,both,,,2720,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1849.6,,,1849.6,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,2176,,,2176,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2176,,,2176,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2176,,,2176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1904,70,,1904,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,553.78,7216,
FLUORO EXAM OF G/COLON TUBE,49465,CPT,,42049465,CDM,360,RC,,,both,,,701,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",490.7,70,,490.7,percent of total billed charges,All Other,476.68,,,476.68,Other,ASC Grouper table,622.9,,,622.9,Other,186% of Medicaid,560.8,,,560.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",560.8,,,560.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,560.8,,,560.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",490.7,70,,490.7,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,512.38,,,512.38,Other,153% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,468.85,,,468.85,Other,140% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,870.71,,,870.71,Other,250% of Medicaid,1085.04,,,1085.04,Other,324% of Medicaid,720.01,,,720.01,Other,215% of Medicaid,720.01,,,720.01,Other,215% of Medicaid,418.61,,,418.61,Other,125% of Medicaid,122.32,7216,
FLUORO EXAM OF G/COLON TUBE W/ FY MOD,49465,CPT,,42649465,CDM,360,RC,,,both,,,655,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",458.5,70,,458.5,percent of total billed charges,All Other,445.4,,,445.4,Other,ASC Grouper table,622.9,,,622.9,Other,186% of Medicaid,524,,,524,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",524,,,524,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,524,,,524,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.5,70,,458.5,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,512.38,,,512.38,Other,153% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,468.85,,,468.85,Other,140% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,870.71,,,870.71,Other,250% of Medicaid,1085.04,,,1085.04,Other,324% of Medicaid,720.01,,,720.01,Other,215% of Medicaid,720.01,,,720.01,Other,215% of Medicaid,418.61,,,418.61,Other,125% of Medicaid,122.32,7216,
FLUORO EXAM OF G/COLON TUBE W/ FY MOD,49465,CPT,FY,43049465,CDM,360,RC,,,both,,,655,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",458.5,70,,458.5,percent of total billed charges,All Other,445.4,,,445.4,Other,ASC Grouper table,622.9,,,622.9,Other,186% of Medicaid,524,,,524,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",524,,,524,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,524,,,524,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.5,70,,458.5,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,512.38,,,512.38,Other,153% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,468.85,,,468.85,Other,140% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,870.71,,,870.71,Other,250% of Medicaid,1085.04,,,1085.04,Other,324% of Medicaid,720.01,,,720.01,Other,215% of Medicaid,720.01,,,720.01,Other,215% of Medicaid,418.61,,,418.61,Other,125% of Medicaid,122.32,7216,
FLUORO EXAM OF G/COLON TUBE,49465,CPT,,47049465,CDM,360,RC,,,both,,,655,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",458.5,70,,458.5,percent of total billed charges,All Other,445.4,,,445.4,Other,ASC Grouper table,622.9,,,622.9,Other,186% of Medicaid,524,,,524,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",524,,,524,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,524,,,524,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.5,70,,458.5,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,334.89,,,334.89,Other,100% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,512.38,,,512.38,Other,153% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,468.85,,,468.85,Other,140% of Medicaid,753.5,,,753.5,Other,225% of Medicaid,870.71,,,870.71,Other,250% of Medicaid,1085.04,,,1085.04,Other,324% of Medicaid,720.01,,,720.01,Other,215% of Medicaid,720.01,,,720.01,Other,215% of Medicaid,418.61,,,418.61,Other,125% of Medicaid,122.32,7216,
RENAL BIOPSY PERCUTANEOUS,50200,CPT,,44050200,CDM,360,RC,,,both,,,3462,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2354.16,,,2354.16,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,2769.6,,,2769.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2769.6,,,2769.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2423.4,70,,2423.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
BIOPSY OF KIDNEY PERCUT,50200,CPT,,46050200,CDM,360,RC,,,both,,,3462,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2354.16,,,2354.16,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,2769.6,,,2769.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2769.6,,,2769.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2423.4,70,,2423.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
CHANGE URETER STENT PERCUT,50382,CPT,,47050382,CDM,360,RC,,,both,,,7524,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5266.8,70,,5266.8,percent of total billed charges,All Other,5116.32,,,5116.32,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,6019.2,,,6019.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6019.2,,,6019.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6019.2,,,6019.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5266.8,70,,5266.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
REMOVE URETER STENT PERCUT,50384,CPT,,47050384,CDM,360,RC,,,both,,,4460,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3122,70,,3122,percent of total billed charges,All Other,3032.8,,,3032.8,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,3568,,,3568,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3568,,,3568,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3568,,,3568,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3122,70,,3122,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
CHANGE EXT/INT URETER STENT,50387,CPT,,47050387,CDM,360,RC,,,both,,,4738,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3316.6,70,,3316.6,percent of total billed charges,All Other,3221.84,,,3221.84,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,3790.4,,,3790.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3790.4,,,3790.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3790.4,,,3790.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3316.6,70,,3316.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
CHANGE EXT/INT URETER STENT BILATERAL,50387,CPT,50,47350387,CDM,360,RC,,,both,,,7107,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4974.9,70,,4974.9,percent of total billed charges,All Other,4832.76,,,4832.76,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,5685.6,,,5685.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5685.6,,,5685.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5685.6,,,5685.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4974.9,70,,4974.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
REMOVAL RENAL TUBE W/FLUORO,50389,CPT,,47050389,CDM,360,RC,,,both,,,2009,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1406.3,70,,1406.3,percent of total billed charges,All Other,1366.12,,,1366.12,Other,ASC Grouper table,903.1,,,903.1,Other,186% of Medicaid,1607.2,,,1607.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1607.2,,,1607.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1607.2,,,1607.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1406.3,70,,1406.3,percent of total billed charges,,252.56,,,252.56,Fee Schedule,,214.06,,,214.06,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,742.87,,,742.87,Other,153% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,679.75,,,679.75,Other,140% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,1262.39,,,1262.39,Other,250% of Medicaid,1573.13,,,1573.13,Other,324% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,606.92,,,606.92,Other,125% of Medicaid,214.06,7216,
ASP A/O INJ RENAL CYST PERCUT,50390,CPT,,46050390,CDM,360,RC,,,both,,,3462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2354.16,,,2354.16,Other,ASC Grouper table,903.1,,,903.1,Other,186% of Medicaid,2769.6,,,2769.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2769.6,,,2769.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2423.4,70,,2423.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,742.87,,,742.87,Other,153% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,679.75,,,679.75,Other,140% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,1262.39,,,1262.39,Other,250% of Medicaid,1573.13,,,1573.13,Other,324% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,606.92,,,606.92,Other,125% of Medicaid,485.54,7216,
NJX PX NFROSGRM &/URTRGRM,50430,CPT,,47050430,CDM,360,RC,,,both,,,2166,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1472.88,,,1472.88,Other,ASC Grouper table,903.1,,,903.1,Other,186% of Medicaid,1732.8,,,1732.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1732.8,,,1732.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1732.8,,,1732.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1516.2,70,,1516.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,742.87,,,742.87,Other,153% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,679.75,,,679.75,Other,140% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,1262.39,,,1262.39,Other,250% of Medicaid,1573.13,,,1573.13,Other,324% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,606.92,,,606.92,Other,125% of Medicaid,485.54,7216,
NJX PX NFROSGRM &/URTRGRM,50431,CPT,,42050431,CDM,360,RC,,,both,,,2318,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1576.24,,,1576.24,Other,ASC Grouper table,903.1,,,903.1,Other,186% of Medicaid,1854.4,,,1854.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1854.4,,,1854.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1854.4,,,1854.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1622.6,70,,1622.6,percent of total billed charges,,309.96,,,309.96,Fee Schedule,,262.71,,,262.71,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,742.87,,,742.87,Other,153% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,679.75,,,679.75,Other,140% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,1262.39,,,1262.39,Other,250% of Medicaid,1573.13,,,1573.13,Other,324% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,606.92,,,606.92,Other,125% of Medicaid,262.71,7216,
NJX PX NFROSGRM &/URTRGRM W/ FY MOD,50431,CPT,,42650431,CDM,360,RC,,,both,,,2318,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1576.24,,,1576.24,Other,ASC Grouper table,903.1,,,903.1,Other,186% of Medicaid,1854.4,,,1854.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1854.4,,,1854.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1854.4,,,1854.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1622.6,70,,1622.6,percent of total billed charges,,309.96,,,309.96,Fee Schedule,,262.71,,,262.71,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,742.87,,,742.87,Other,153% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,679.75,,,679.75,Other,140% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,1262.39,,,1262.39,Other,250% of Medicaid,1573.13,,,1573.13,Other,324% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,606.92,,,606.92,Other,125% of Medicaid,262.71,7216,
NJX PX NFROSGRM &/URTRGRM,50431,CPT,,47050431,CDM,360,RC,,,both,,,2318,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1576.24,,,1576.24,Other,ASC Grouper table,903.1,,,903.1,Other,186% of Medicaid,1854.4,,,1854.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1854.4,,,1854.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1854.4,,,1854.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1622.6,70,,1622.6,percent of total billed charges,,309.96,,,309.96,Fee Schedule,,262.71,,,262.71,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,742.87,,,742.87,Other,153% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,679.75,,,679.75,Other,140% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,1262.39,,,1262.39,Other,250% of Medicaid,1573.13,,,1573.13,Other,324% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,606.92,,,606.92,Other,125% of Medicaid,262.71,7216,
PLMT NEPHROSTOMY CATHETER,50432,CPT,,46050432,CDM,360,RC,,,both,,,6214,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4225.52,,,4225.52,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,4971.2,,,4971.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4971.2,,,4971.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4971.2,,,4971.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4349.8,70,,4349.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
PLMT NEPHROSTOMY CATHETER,50432,CPT,50,46350432,CDM,360,RC,,,both,,,9321,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6338.28,,,6338.28,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,7456.8,,,7456.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7456.8,,,7456.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7456.8,,,7456.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6524.7,70,,6524.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7456.8,
PLMT NEPHROSTOMY CATHETER,50432,CPT,,47050432,CDM,360,RC,,,both,,,6214,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4225.52,,,4225.52,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,4971.2,,,4971.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4971.2,,,4971.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4971.2,,,4971.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4349.8,70,,4349.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
PLMT NEPHROSTOMY CATHETER,50432,CPT,50,47350432,CDM,360,RC,,,both,,,9321,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6338.28,,,6338.28,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,7456.8,,,7456.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7456.8,,,7456.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7456.8,,,7456.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6524.7,70,,6524.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7456.8,
PLMT NEPHROURETERAL CATHETER,50433,CPT,,46050433,CDM,360,RC,,,both,,,7216,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4906.88,,,4906.88,Other,ASC Grouper table,2585.92,,,2585.92,Other,186% of Medicaid,5772.8,,,5772.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5772.8,,,5772.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5772.8,,,5772.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5051.2,70,,5051.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,2127.13,,,2127.13,Other,153% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,1946.39,,,1946.39,Other,140% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,3614.73,,,3614.73,Other,250% of Medicaid,4504.5,,,4504.5,Other,324% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,1737.85,,,1737.85,Other,125% of Medicaid,1390.28,7216,
PLMT NEPHROURETERAL CATHETER,50433,CPT,,47050433,CDM,360,RC,,,both,,,7216,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4906.88,,,4906.88,Other,ASC Grouper table,2585.92,,,2585.92,Other,186% of Medicaid,5772.8,,,5772.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5772.8,,,5772.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5772.8,,,5772.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5051.2,70,,5051.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,2127.13,,,2127.13,Other,153% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,1946.39,,,1946.39,Other,140% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,3614.73,,,3614.73,Other,250% of Medicaid,4504.5,,,4504.5,Other,324% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,1737.85,,,1737.85,Other,125% of Medicaid,1390.28,7216,
CONVERT NEPHROSTOMY CATHETER,50434,CPT,,46050434,CDM,360,RC,,,both,,,4176,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2839.68,,,2839.68,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,3340.8,,,3340.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3340.8,,,3340.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3340.8,,,3340.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2923.2,70,,2923.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
CONVERT NEPHROSTOMY CATHETER,50434,CPT,,47050434,CDM,360,RC,,,both,,,4176,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2839.68,,,2839.68,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,3340.8,,,3340.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3340.8,,,3340.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3340.8,,,3340.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2923.2,70,,2923.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
EXCHANGE NEPHROSTOMY CATH,50435,CPT,,46050435,CDM,360,RC,,,both,,,4176,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2839.68,,,2839.68,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,3340.8,,,3340.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3340.8,,,3340.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3340.8,,,3340.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2923.2,70,,2923.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
EXCHANGE NEPHROSTOMY CATH,50435,CPT,,47050435,CDM,360,RC,,,both,,,4176,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2839.68,,,2839.68,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,3340.8,,,3340.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3340.8,,,3340.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3340.8,,,3340.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2923.2,70,,2923.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
EXCHANGE NEPHROSTOMY CATH BILATERAL,50435,CPT,50,47350435,CDM,360,RC,,,both,,,6264,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4259.52,,,4259.52,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,5011.2,,,5011.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5011.2,,,5011.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5011.2,,,5011.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4384.8,70,,4384.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
CREATE PASSAGE TO KIDNEY,50437,CPT,,46050437,CDM,360,RC,,,both,,,8589,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5840.52,,,5840.52,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,6871.2,,,6871.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6871.2,,,6871.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6871.2,,,6871.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6012.3,70,,6012.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
CREATE PASSAGE TO KIDNEY BILATERAL,50437,CPT,50,46350395,CDM,360,RC,,,both,,,12884,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",8761.12,,,8761.12,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,10307.2,,,10307.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10307.2,,,10307.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,10307.2,,,10307.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9018.8,70,,9018.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,10307.2,
CREATE PASSAGE TO KIDNEY,50437,CPT,,47050437,CDM,360,RC,,,both,,,8589,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",5840.52,,,5840.52,Other,ASC Grouper table,2010.85,,,2010.85,Other,186% of Medicaid,6871.2,,,6871.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6871.2,,,6871.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6871.2,,,6871.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6012.3,70,,6012.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,1081.1,,,1081.1,Other,100% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1654.08,,,1654.08,Other,153% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,1513.54,,,1513.54,Other,140% of Medicaid,2432.48,,,2432.48,Other,225% of Medicaid,2810.86,,,2810.86,Other,250% of Medicaid,3502.77,,,3502.77,Other,324% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,2324.37,,,2324.37,Other,215% of Medicaid,1351.38,,,1351.38,Other,125% of Medicaid,1081.1,7216,
PERC RF ABLATE 1+ RENAL TUMOR,50592,CPT,,46050592,CDM,360,RC,,,both,,,15948,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6125,,,6125,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5513,,,5513,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5206,,,5206,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",11163.6,70,,11163.6,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,2585.92,,,2585.92,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12758.4,,,12758.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11163.6,70,,11163.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,2127.13,,,2127.13,Other,153% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,1946.39,,,1946.39,Other,140% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,3614.73,,,3614.73,Other,250% of Medicaid,4504.5,,,4504.5,Other,324% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,1737.85,,,1737.85,Other,125% of Medicaid,1390.28,12758.4,
ENDOLUMINAL BX URTR RNL PLVS,50606,CPT,,46050606,CDM,360,RC,,,both,,,657,259.3,39.4668,,259.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",459.9,70,,459.9,percent of total billed charges,All Other,446.76,,,446.76,Other,ASC Grouper table,3435.38,,,3435.38,Other,186% of Medicaid,525.6,,,525.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",525.6,,,525.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,525.6,,,525.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",459.9,70,,459.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1846.98,,,1846.98,Other,100% of Medicaid,1846.98,,,1846.98,Other,100% of Medicaid,1846.98,,,1846.98,Other,100% of Medicaid,1846.98,,,1846.98,Other,100% of Medicaid,4155.7,,,4155.7,Other,225% of Medicaid,2825.87,,,2825.87,Other,153% of Medicaid,4155.7,,,4155.7,Other,225% of Medicaid,2585.77,,,2585.77,Other,140% of Medicaid,4155.7,,,4155.7,Other,225% of Medicaid,4802.14,,,4802.14,Other,250% of Medicaid,5984.2,,,5984.2,Other,324% of Medicaid,3971,,,3971,Other,215% of Medicaid,3971,,,3971,Other,215% of Medicaid,2308.72,,,2308.72,Other,125% of Medicaid,0.01,7216,
ENDOLUMINAL BX URTR RNL PLVS,50606,CPT,,47050606,CDM,360,RC,,,both,,,657,259.3,39.4668,,259.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",459.9,70,,459.9,percent of total billed charges,All Other,446.76,,,446.76,Other,ASC Grouper table,3435.38,,,3435.38,Other,186% of Medicaid,525.6,,,525.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",525.6,,,525.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,525.6,,,525.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",459.9,70,,459.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1846.98,,,1846.98,Other,100% of Medicaid,1846.98,,,1846.98,Other,100% of Medicaid,1846.98,,,1846.98,Other,100% of Medicaid,1846.98,,,1846.98,Other,100% of Medicaid,4155.7,,,4155.7,Other,225% of Medicaid,2825.87,,,2825.87,Other,153% of Medicaid,4155.7,,,4155.7,Other,225% of Medicaid,2585.77,,,2585.77,Other,140% of Medicaid,4155.7,,,4155.7,Other,225% of Medicaid,4802.14,,,4802.14,Other,250% of Medicaid,5984.2,,,5984.2,Other,324% of Medicaid,3971,,,3971,Other,215% of Medicaid,3971,,,3971,Other,215% of Medicaid,2308.72,,,2308.72,Other,125% of Medicaid,0.01,7216,
INJ FOR URETEROGRAM THRU INDWELLING CATH,50684,CPT,,47050684,CDM,360,RC,,,both,,,198,78.14,39.4668,,78.14,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",138.6,70,,138.6,percent of total billed charges,All Other,134.64,,,134.64,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,158.4,,,158.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",158.4,,,158.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,158.4,,,158.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",138.6,70,,138.6,percent of total billed charges,,239.44,,,239.44,Fee Schedule,,202.94,,,202.94,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
PLMT URETERAL STENT PRQ,50693,CPT,,46050693,CDM,360,RC,,,both,,,9252,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2585.92,,,2585.92,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,7401.6,,,7401.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6476.4,70,,6476.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,2127.13,,,2127.13,Other,153% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,1946.39,,,1946.39,Other,140% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,3614.73,,,3614.73,Other,250% of Medicaid,4504.5,,,4504.5,Other,324% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,1737.85,,,1737.85,Other,125% of Medicaid,1390.28,9473,
PLMT URETERAL STENT PRQ,50693,CPT,,47050693,CDM,360,RC,,,both,,,9252,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2585.92,,,2585.92,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,7401.6,,,7401.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6476.4,70,,6476.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,2127.13,,,2127.13,Other,153% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,1946.39,,,1946.39,Other,140% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,3614.73,,,3614.73,Other,250% of Medicaid,4504.5,,,4504.5,Other,324% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,1737.85,,,1737.85,Other,125% of Medicaid,1390.28,9473,
PLMT URETERAL STENT PRQ,50694,CPT,,46050694,CDM,360,RC,,,both,,,9252,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2585.92,,,2585.92,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,7401.6,,,7401.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6476.4,70,,6476.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,2127.13,,,2127.13,Other,153% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,1946.39,,,1946.39,Other,140% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,3614.73,,,3614.73,Other,250% of Medicaid,4504.5,,,4504.5,Other,324% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,1737.85,,,1737.85,Other,125% of Medicaid,1390.28,9473,
PLMT URETERAL STENT PRQ,50694,CPT,,47050694,CDM,360,RC,,,both,,,9252,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2585.92,,,2585.92,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,7401.6,,,7401.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6476.4,70,,6476.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,2127.13,,,2127.13,Other,153% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,1946.39,,,1946.39,Other,140% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,3614.73,,,3614.73,Other,250% of Medicaid,4504.5,,,4504.5,Other,324% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,1737.85,,,1737.85,Other,125% of Medicaid,1390.28,9473,
PLMT URETERAL STENT PRQ,50695,CPT,,46050695,CDM,360,RC,,,both,,,8488,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2585.92,,,2585.92,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,6790.4,,,6790.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5941.6,70,,5941.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,2127.13,,,2127.13,Other,153% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,1946.39,,,1946.39,Other,140% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,3614.73,,,3614.73,Other,250% of Medicaid,4504.5,,,4504.5,Other,324% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,1737.85,,,1737.85,Other,125% of Medicaid,1390.28,9473,
PLMT URETERAL STENT PRQ,50695,CPT,,47050695,CDM,360,RC,,,both,,,8488,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2585.92,,,2585.92,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,6790.4,,,6790.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5941.6,70,,5941.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,1390.28,,,1390.28,Other,100% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,2127.13,,,2127.13,Other,153% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,1946.39,,,1946.39,Other,140% of Medicaid,3128.13,,,3128.13,Other,225% of Medicaid,3614.73,,,3614.73,Other,250% of Medicaid,4504.5,,,4504.5,Other,324% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,2989.1,,,2989.1,Other,215% of Medicaid,1737.85,,,1737.85,Other,125% of Medicaid,1390.28,9473,
CYSTO W DIL OF URETHRAL STRICT,52281,CPT,,42052281,CDM,360,RC,,,both,,,5732,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3897.76,,,3897.76,Other,ASC Grouper table,2876.39,,,2876.39,Other,186% of Medicaid,4585.6,,,4585.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4585.6,,,4585.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4012.4,70,,4012.4,percent of total billed charges,,3387,,,3387,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2879,,,2879,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1546.44,,,1546.44,Other,100% of Medicaid,1546.44,,,1546.44,Other,100% of Medicaid,1546.44,,,1546.44,Other,100% of Medicaid,1546.44,,,1546.44,Other,100% of Medicaid,3479.5,,,3479.5,Other,225% of Medicaid,2366.06,,,2366.06,Other,153% of Medicaid,3479.5,,,3479.5,Other,225% of Medicaid,2165.02,,,2165.02,Other,140% of Medicaid,3479.5,,,3479.5,Other,225% of Medicaid,4020.76,,,4020.76,Other,250% of Medicaid,5010.48,,,5010.48,Other,324% of Medicaid,3324.86,,,3324.86,Other,215% of Medicaid,3324.86,,,3324.86,Other,215% of Medicaid,1933.06,,,1933.06,Other,125% of Medicaid,1546.44,7216,
CYSTO W DIL OF URETHRAL STRICT W/ FY MOD,52281,CPT,,42652281,CDM,360,RC,,,both,,,5732,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3897.76,,,3897.76,Other,ASC Grouper table,2876.39,,,2876.39,Other,186% of Medicaid,4585.6,,,4585.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4585.6,,,4585.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4012.4,70,,4012.4,percent of total billed charges,,3387,,,3387,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2879,,,2879,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1546.44,,,1546.44,Other,100% of Medicaid,1546.44,,,1546.44,Other,100% of Medicaid,1546.44,,,1546.44,Other,100% of Medicaid,1546.44,,,1546.44,Other,100% of Medicaid,3479.5,,,3479.5,Other,225% of Medicaid,2366.06,,,2366.06,Other,153% of Medicaid,3479.5,,,3479.5,Other,225% of Medicaid,2165.02,,,2165.02,Other,140% of Medicaid,3479.5,,,3479.5,Other,225% of Medicaid,4020.76,,,4020.76,Other,250% of Medicaid,5010.48,,,5010.48,Other,324% of Medicaid,3324.86,,,3324.86,Other,215% of Medicaid,3324.86,,,3324.86,Other,215% of Medicaid,1933.06,,,1933.06,Other,125% of Medicaid,1546.44,7216,
CYSTOSCOPY IMPLANT STENT,52282,CPT,,47052282,CDM,360,RC,,,both,,,10227,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,1857.16,,,1857.16,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9196,,,9196,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7158.9,70,,7158.9,percent of total billed charges,,3387,,,3387,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2879,,,2879,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",998.48,,,998.48,Other,100% of Medicaid,998.48,,,998.48,Other,100% of Medicaid,998.48,,,998.48,Other,100% of Medicaid,998.48,,,998.48,Other,100% of Medicaid,2246.57,,,2246.57,Other,225% of Medicaid,1527.67,,,1527.67,Other,153% of Medicaid,2246.57,,,2246.57,Other,225% of Medicaid,1397.87,,,1397.87,Other,140% of Medicaid,2246.57,,,2246.57,Other,225% of Medicaid,2596.04,,,2596.04,Other,250% of Medicaid,3235.06,,,3235.06,Other,324% of Medicaid,2146.72,,,2146.72,Other,215% of Medicaid,2146.72,,,2146.72,Other,215% of Medicaid,1248.09,,,1248.09,Other,125% of Medicaid,998.48,10243,
INSERT IUD,58300,CPT,,26058300,CDM,360,RC,,,both,,,554,218.65,39.4668,,218.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",387.8,70,,387.8,percent of total billed charges,All Other,376.72,,,376.72,Other,ASC Grouper table,239.93,,,239.93,Other,186% of Medicaid,443.2,,,443.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",443.2,,,443.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,443.2,,,443.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",387.8,70,,387.8,percent of total billed charges,,244.36,,,244.36,Fee Schedule,,207.11,,,207.11,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",128.99,,,128.99,Other,100% of Medicaid,128.99,,,128.99,Other,100% of Medicaid,128.99,,,128.99,Other,100% of Medicaid,128.99,,,128.99,Other,100% of Medicaid,290.23,,,290.23,Other,225% of Medicaid,197.36,,,197.36,Other,153% of Medicaid,290.23,,,290.23,Other,225% of Medicaid,180.59,,,180.59,Other,140% of Medicaid,290.23,,,290.23,Other,225% of Medicaid,335.38,,,335.38,Other,250% of Medicaid,417.94,,,417.94,Other,324% of Medicaid,277.33,,,277.33,Other,215% of Medicaid,277.33,,,277.33,Other,215% of Medicaid,161.24,,,161.24,Other,125% of Medicaid,0.01,7216,
DRAINAGE OF OVARIAN CYST(S) AB,58805,CPT,,44058805,CDM,360,RC,,,both,,,10374,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7261.8,70,,7261.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,2505.72,,,2505.72,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,8299.2,,,8299.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7261.8,70,,7261.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1347.16,,,1347.16,Other,100% of Medicaid,1347.16,,,1347.16,Other,100% of Medicaid,1347.16,,,1347.16,Other,100% of Medicaid,1347.16,,,1347.16,Other,100% of Medicaid,3031.12,,,3031.12,Other,225% of Medicaid,2061.16,,,2061.16,Other,153% of Medicaid,3031.12,,,3031.12,Other,225% of Medicaid,1886.03,,,1886.03,Other,140% of Medicaid,3031.12,,,3031.12,Other,225% of Medicaid,3502.62,,,3502.62,Other,250% of Medicaid,4364.81,,,4364.81,Other,324% of Medicaid,2896.4,,,2896.4,Other,215% of Medicaid,2896.4,,,2896.4,Other,215% of Medicaid,1683.95,,,1683.95,Other,125% of Medicaid,1347.16,9473,
EPISIOTOMY OR VAGINAL REPAIR,59300,CPT,,26059300,CDM,360,RC,,,both,,,6366,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4456.2,70,,4456.2,percent of total billed charges,All Other,4328.88,,,4328.88,Other,ASC Grouper table,1901.99,,,1901.99,Other,186% of Medicaid,5092.8,,,5092.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5092.8,,,5092.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5092.8,,,5092.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4456.2,70,,4456.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1022.58,,,1022.58,Other,100% of Medicaid,1022.58,,,1022.58,Other,100% of Medicaid,1022.58,,,1022.58,Other,100% of Medicaid,1022.58,,,1022.58,Other,100% of Medicaid,2300.8,,,2300.8,Other,225% of Medicaid,1564.54,,,1564.54,Other,153% of Medicaid,2300.8,,,2300.8,Other,225% of Medicaid,1431.61,,,1431.61,Other,140% of Medicaid,2300.8,,,2300.8,Other,225% of Medicaid,2658.7,,,2658.7,Other,250% of Medicaid,3313.15,,,3313.15,Other,324% of Medicaid,2198.54,,,2198.54,Other,215% of Medicaid,2198.54,,,2198.54,Other,215% of Medicaid,1278.22,,,1278.22,Other,125% of Medicaid,1022.58,7216,
EXT CEPHALIC VERSION,59412,CPT,,26059412,CDM,360,RC,,,both,,,6366,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4456.2,70,,4456.2,percent of total billed charges,All Other,4328.88,,,4328.88,Other,ASC Grouper table,1453.16,,,1453.16,Other,186% of Medicaid,5092.8,,,5092.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5092.8,,,5092.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5092.8,,,5092.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4456.2,70,,4456.2,percent of total billed charges,,496.92,,,496.92,Fee Schedule,,421.17,,,421.17,Fee Schedule,,4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",781.27,,,781.27,Other,100% of Medicaid,781.27,,,781.27,Other,100% of Medicaid,781.27,,,781.27,Other,100% of Medicaid,781.27,,,781.27,Other,100% of Medicaid,1757.85,,,1757.85,Other,225% of Medicaid,1195.34,,,1195.34,Other,153% of Medicaid,1757.85,,,1757.85,Other,225% of Medicaid,1093.77,,,1093.77,Other,140% of Medicaid,1757.85,,,1757.85,Other,225% of Medicaid,2031.3,,,2031.3,Other,250% of Medicaid,2531.31,,,2531.31,Other,324% of Medicaid,1679.73,,,1679.73,Other,215% of Medicaid,1679.73,,,1679.73,Other,215% of Medicaid,976.58,,,976.58,Other,125% of Medicaid,421.17,7216,
BIOPSY THYROID PERC NEEDLE,60100,CPT,,46060100,CDM,360,RC,,,both,,,1601,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1120.7,70,,1120.7,percent of total billed charges,All Other,1088.68,,,1088.68,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,1280.8,,,1280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1280.8,,,1280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1280.8,,,1280.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1120.7,70,,1120.7,percent of total billed charges,,367.36,,,367.36,Fee Schedule,,311.36,,,311.36,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,311.36,7216,
ASPIR/INJ THYROID CYST,60300,CPT,,44060300,CDM,360,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",994.16,,,994.16,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1023.4,70,,1023.4,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,198.77,7216,
BURR HOLES,61154,CPT,,30061154,CDM,360,RC,,,both,,,5490,2166.73,39.4668,,2166.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3843,70,,3843,percent of total billed charges,All Other,3733.2,,,3733.2,Other,ASC Grouper table,4159.36,,,4159.36,Other,186% of Medicaid,4392,,,4392,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4392,,,4392,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4392,,,4392,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3843,70,,3843,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2236.21,,,2236.21,Other,100% of Medicaid,2236.21,,,2236.21,Other,100% of Medicaid,2236.21,,,2236.21,Other,100% of Medicaid,2236.21,,,2236.21,Other,100% of Medicaid,5031.48,,,5031.48,Other,225% of Medicaid,3421.41,,,3421.41,Other,153% of Medicaid,5031.48,,,5031.48,Other,225% of Medicaid,3130.7,,,3130.7,Other,140% of Medicaid,5031.48,,,5031.48,Other,225% of Medicaid,5814.16,,,5814.16,Other,250% of Medicaid,7245.33,,,7245.33,Other,324% of Medicaid,4807.86,,,4807.86,Other,215% of Medicaid,4807.86,,,4807.86,Other,215% of Medicaid,2795.27,,,2795.27,Other,125% of Medicaid,0.01,7245.33,
TC EMBOLIZ HEMOST TUMOR NOT CN,61626,CPT,,47061626,CDM,360,RC,,,both,,,30955,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,5459,,,5459,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",21668.5,70,,21668.5,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4555.05,,,4555.05,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,24764,,,24764,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",21668.5,70,,21668.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2448.95,,,2448.95,Other,100% of Medicaid,2448.95,,,2448.95,Other,100% of Medicaid,2448.95,,,2448.95,Other,100% of Medicaid,2448.95,,,2448.95,Other,100% of Medicaid,5510.14,,,5510.14,Other,225% of Medicaid,3746.89,,,3746.89,Other,153% of Medicaid,5510.14,,,5510.14,Other,225% of Medicaid,3428.53,,,3428.53,Other,140% of Medicaid,5510.14,,,5510.14,Other,225% of Medicaid,6367.27,,,6367.27,Other,250% of Medicaid,7934.6,,,7934.6,Other,324% of Medicaid,5265.24,,,5265.24,Other,215% of Medicaid,5265.24,,,5265.24,Other,215% of Medicaid,3061.19,,,3061.19,Other,125% of Medicaid,2448.95,24764,
EVASC PRLNG ADMN RX AGNT 1ST,61650,CPT,,47061650,CDM,360,RC,,,both,,,2293,904.97,39.4668,,904.97,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1559.24,,,1559.24,Other,ASC Grouper table,4062.81,,,4062.81,Other,186% of Medicaid,1834.4,,,1834.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1834.4,,,1834.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1834.4,,,1834.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1605.1,70,,1605.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2184.31,,,2184.31,Other,100% of Medicaid,2184.31,,,2184.31,Other,100% of Medicaid,2184.31,,,2184.31,Other,100% of Medicaid,2184.31,,,2184.31,Other,100% of Medicaid,4914.69,,,4914.69,Other,225% of Medicaid,3341.99,,,3341.99,Other,153% of Medicaid,4914.69,,,4914.69,Other,225% of Medicaid,3058.03,,,3058.03,Other,140% of Medicaid,4914.69,,,4914.69,Other,225% of Medicaid,5679.19,,,5679.19,Other,250% of Medicaid,7077.15,,,7077.15,Other,324% of Medicaid,4696.26,,,4696.26,Other,215% of Medicaid,4696.26,,,4696.26,Other,215% of Medicaid,2730.38,,,2730.38,Other,125% of Medicaid,0.01,7266,
EVASC PRLNG ADMN RX AGNT ADD,61651,CPT,,47061651,CDM,360,RC,,,both,,,978,385.99,39.4668,,385.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",684.6,70,,684.6,percent of total billed charges,All Other,665.04,,,665.04,Other,ASC Grouper table,4062.81,,,4062.81,Other,186% of Medicaid,782.4,,,782.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",782.4,,,782.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,782.4,,,782.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",684.6,70,,684.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2184.31,,,2184.31,Other,100% of Medicaid,2184.31,,,2184.31,Other,100% of Medicaid,2184.31,,,2184.31,Other,100% of Medicaid,2184.31,,,2184.31,Other,100% of Medicaid,4914.69,,,4914.69,Other,225% of Medicaid,3341.99,,,3341.99,Other,153% of Medicaid,4914.69,,,4914.69,Other,225% of Medicaid,3058.03,,,3058.03,Other,140% of Medicaid,4914.69,,,4914.69,Other,225% of Medicaid,5679.19,,,5679.19,Other,250% of Medicaid,7077.15,,,7077.15,Other,324% of Medicaid,4696.26,,,4696.26,Other,215% of Medicaid,4696.26,,,4696.26,Other,215% of Medicaid,2730.38,,,2730.38,Other,125% of Medicaid,0.01,7266,
LUMBAR PUNC MYELOGRAM,62284,CPT,,47062284,CDM,360,RC,,,both,,,844,333.1,39.4668,,333.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",590.8,70,,590.8,percent of total billed charges,All Other,573.92,,,573.92,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,675.2,,,675.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",675.2,,,675.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,675.2,,,675.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",590.8,70,,590.8,percent of total billed charges,,406.72,,,406.72,Fee Schedule,,344.72,,,344.72,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
CT GUIDED DISK ASPIRATION,62287,CPT,,46062287,CDM,360,RC,,,both,,,12158,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS,4827,,,4827,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4344,,,4344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5305,,,5305,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4775,,,4775,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4509,,,4509,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,5525.15,,,5525.15,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9196,,,9196,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8510.6,70,,8510.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4544.88,,,4544.88,Other,153% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4158.71,,,4158.71,Other,140% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,7723.33,,,7723.33,Other,250% of Medicaid,9624.45,,,9624.45,Other,324% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,3713.14,,,3713.14,Other,125% of Medicaid,2121.65,10243,
INJECT FOR SPINE DISK XR LU,62290,CPT,,42062290,CDM,360,RC,,,both,,,652,257.32,39.4668,,257.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",456.4,70,,456.4,percent of total billed charges,All Other,443.36,,,443.36,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,521.6,,,521.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",521.6,,,521.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,521.6,,,521.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",456.4,70,,456.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECT FOR SPINE DISK XR LU W/ FY MOD,62290,CPT,,42662290,CDM,360,RC,,,both,,,652,257.32,39.4668,,257.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",456.4,70,,456.4,percent of total billed charges,All Other,443.36,,,443.36,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,521.6,,,521.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",521.6,,,521.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,521.6,,,521.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",456.4,70,,456.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
MYELOGRAPHY LUMBAR INJECTION,62302,CPT,,42062302,CDM,360,RC,,,both,,,2329,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1630.3,70,,1630.3,percent of total billed charges,All Other,1583.72,,,1583.72,Other,ASC Grouper table,1185,,,1185,Other,186% of Medicaid,1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1863.2,,,1863.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1630.3,70,,1630.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,974.76,,,974.76,Other,153% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,891.93,,,891.93,Other,140% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,1656.45,,,1656.45,Other,250% of Medicaid,2064.19,,,2064.19,Other,324% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,796.37,,,796.37,Other,125% of Medicaid,637.1,7216,
MYELOGRAPHY LUMBAR INJECTION W/ FY MOD,62302,CPT,,42662302,CDM,360,RC,,,both,,,2329,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1630.3,70,,1630.3,percent of total billed charges,All Other,1583.72,,,1583.72,Other,ASC Grouper table,1185,,,1185,Other,186% of Medicaid,1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1863.2,,,1863.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1630.3,70,,1630.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,974.76,,,974.76,Other,153% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,891.93,,,891.93,Other,140% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,1656.45,,,1656.45,Other,250% of Medicaid,2064.19,,,2064.19,Other,324% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,796.37,,,796.37,Other,125% of Medicaid,637.1,7216,
MYELOGRAPHY LUMBAR INJECTION,62303,CPT,,42062303,CDM,360,RC,,,both,,,2329,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1630.3,70,,1630.3,percent of total billed charges,All Other,1583.72,,,1583.72,Other,ASC Grouper table,1185,,,1185,Other,186% of Medicaid,1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1863.2,,,1863.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1630.3,70,,1630.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,974.76,,,974.76,Other,153% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,891.93,,,891.93,Other,140% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,1656.45,,,1656.45,Other,250% of Medicaid,2064.19,,,2064.19,Other,324% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,796.37,,,796.37,Other,125% of Medicaid,637.1,7216,
MYELOGRAPHY LUMBAR INJECTION W/ FY MOD,62303,CPT,,42662303,CDM,360,RC,,,both,,,2329,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1630.3,70,,1630.3,percent of total billed charges,All Other,1583.72,,,1583.72,Other,ASC Grouper table,1185,,,1185,Other,186% of Medicaid,1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1863.2,,,1863.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1630.3,70,,1630.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,974.76,,,974.76,Other,153% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,891.93,,,891.93,Other,140% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,1656.45,,,1656.45,Other,250% of Medicaid,2064.19,,,2064.19,Other,324% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,796.37,,,796.37,Other,125% of Medicaid,637.1,7216,
MYELOGRAPHY LUMBAR INJECTION,62304,CPT,,42062304,CDM,360,RC,,,both,,,2329,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1630.3,70,,1630.3,percent of total billed charges,All Other,1583.72,,,1583.72,Other,ASC Grouper table,1185,,,1185,Other,186% of Medicaid,1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1863.2,,,1863.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1630.3,70,,1630.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,974.76,,,974.76,Other,153% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,891.93,,,891.93,Other,140% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,1656.45,,,1656.45,Other,250% of Medicaid,2064.19,,,2064.19,Other,324% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,796.37,,,796.37,Other,125% of Medicaid,637.1,7216,
MYELOGRAPHY LUMBAR INJECTION W/ FY MOD,62304,CPT,,42662304,CDM,360,RC,,,both,,,2329,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1630.3,70,,1630.3,percent of total billed charges,All Other,1583.72,,,1583.72,Other,ASC Grouper table,1185,,,1185,Other,186% of Medicaid,1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1863.2,,,1863.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1630.3,70,,1630.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,974.76,,,974.76,Other,153% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,891.93,,,891.93,Other,140% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,1656.45,,,1656.45,Other,250% of Medicaid,2064.19,,,2064.19,Other,324% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,796.37,,,796.37,Other,125% of Medicaid,637.1,7216,
MYELOGRAPHY LUMBAR INJECTION,62305,CPT,,42062305,CDM,360,RC,,,both,,,2329,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1630.3,70,,1630.3,percent of total billed charges,All Other,1583.72,,,1583.72,Other,ASC Grouper table,1185,,,1185,Other,186% of Medicaid,1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1863.2,,,1863.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1630.3,70,,1630.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,974.76,,,974.76,Other,153% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,891.93,,,891.93,Other,140% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,1656.45,,,1656.45,Other,250% of Medicaid,2064.19,,,2064.19,Other,324% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,796.37,,,796.37,Other,125% of Medicaid,637.1,7216,
MYELOGRAPHY LUMBAR INJECTION W/ FY MOD,62305,CPT,,42662305,CDM,360,RC,,,both,,,2329,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1630.3,70,,1630.3,percent of total billed charges,All Other,1583.72,,,1583.72,Other,ASC Grouper table,1185,,,1185,Other,186% of Medicaid,1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1863.2,,,1863.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1863.2,,,1863.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1630.3,70,,1630.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,637.1,,,637.1,Other,100% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,974.76,,,974.76,Other,153% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,891.93,,,891.93,Other,140% of Medicaid,1433.46,,,1433.46,Other,225% of Medicaid,1656.45,,,1656.45,Other,250% of Medicaid,2064.19,,,2064.19,Other,324% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,1369.76,,,1369.76,Other,215% of Medicaid,796.37,,,796.37,Other,125% of Medicaid,637.1,7216,
INJ ANESTH GREATER OCCIPITAL NERVE,64405,CPT,,30064405,CDM,360,RC,,,both,,,1164,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",814.8,70,,814.8,percent of total billed charges,All Other,791.52,,,791.52,Other,ASC Grouper table,965.78,,,965.78,Other,186% of Medicaid,931.2,,,931.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",931.2,,,931.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,931.2,,,931.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",814.8,70,,814.8,percent of total billed charges,,255.84,,,255.84,Fee Schedule,,216.84,,,216.84,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,794.43,,,794.43,Other,153% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,726.93,,,726.93,Other,140% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,1350.01,,,1350.01,Other,250% of Medicaid,1682.32,,,1682.32,Other,324% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,649.04,,,649.04,Other,125% of Medicaid,216.84,7216,
INJ ANESTH GREATER OCCIPITAL NERVE,64405,CPT,,47064405,CDM,360,RC,,,both,,,1164,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",814.8,70,,814.8,percent of total billed charges,All Other,791.52,,,791.52,Other,ASC Grouper table,965.78,,,965.78,Other,186% of Medicaid,931.2,,,931.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",931.2,,,931.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,931.2,,,931.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",814.8,70,,814.8,percent of total billed charges,,255.84,,,255.84,Fee Schedule,,216.84,,,216.84,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,794.43,,,794.43,Other,153% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,726.93,,,726.93,Other,140% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,1350.01,,,1350.01,Other,250% of Medicaid,1682.32,,,1682.32,Other,324% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,649.04,,,649.04,Other,125% of Medicaid,216.84,7216,
INJ FORAMEN EPIDURAL C/T,64479,CPT,,47064479,CDM,360,RC,,,both,,,2231,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1517.08,,,1517.08,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1784.8,,,1784.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1784.8,,,1784.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1561.7,70,,1561.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,600.01,7216,
INJ FORAMEN EPIDURAL C/T ADD-ON,64480,CPT,,47064480,CDM,360,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",783.36,,,783.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,921.6,,,921.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",921.6,,,921.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",806.4,70,,806.4,percent of total billed charges,,293.56,,,293.56,Fee Schedule,,248.81,,,248.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,7216,
INJ ANES TRANS EPI LUM X 1,64483,CPT,,47064483,CDM,360,RC,,,both,,,2477,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1684.36,,,1684.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1733.9,70,,1733.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,600.01,7216,
INJ FORAMEN EPIDURAL L/S ADD-ON,64484,CPT,,47064484,CDM,360,RC,,,both,,,1152,454.66,39.4668,,454.66,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",783.36,,,783.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,921.6,,,921.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",921.6,,,921.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",806.4,70,,806.4,percent of total billed charges,,247.64,,,247.64,Fee Schedule,,209.89,,,209.89,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,7216,
INJ ANES FACET JT C/T X1,64490,CPT,,47064490,CDM,360,RC,,,both,,,2477,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1684.36,,,1684.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1981.6,,,1981.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1733.9,70,,1733.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,600.01,7216,
INJ ANES FACET JT C/T ADDL,64491,CPT,,47064491,CDM,360,RC,,,both,,,871,343.76,39.4668,,343.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",592.28,,,592.28,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,696.8,,,696.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",696.8,,,696.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,696.8,,,696.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",609.7,70,,609.7,percent of total billed charges,,285.36,,,285.36,Fee Schedule,,241.86,,,241.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,7216,
INJ PARAVERT F JNT C/T 3 LEV,64492,CPT,,47064492,CDM,360,RC,,,both,,,871,343.76,39.4668,,343.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",592.28,,,592.28,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,696.8,,,696.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",696.8,,,696.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,696.8,,,696.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",609.7,70,,609.7,percent of total billed charges,,288.64,,,288.64,Fee Schedule,,244.64,,,244.64,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,7216,
INJ FACET JNT-LMBR/SACRL,64493,CPT,,42064493,CDM,360,RC,,,both,,,2477,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1684.36,,,1684.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1981.6,,,1981.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1733.9,70,,1733.9,percent of total billed charges,,431.32,,,431.32,Fee Schedule,,365.57,,,365.57,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,365.57,7216,
INJ FACET JNT-LMBR/SACRL W/ FY MOD,64493,CPT,,42664493,CDM,360,RC,,,both,,,2477,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1684.36,,,1684.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1981.6,,,1981.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1733.9,70,,1733.9,percent of total billed charges,,431.32,,,431.32,Fee Schedule,,365.57,,,365.57,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,365.57,7216,
INJ FACET JNT-LMBR/SACRL W/ FY MOD,64493,CPT,FY,43064493,CDM,360,RC,,,both,,,2477,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1684.36,,,1684.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1981.6,,,1981.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1733.9,70,,1733.9,percent of total billed charges,,431.32,,,431.32,Fee Schedule,,365.57,,,365.57,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,365.57,7216,
INJ FACET JNT-LMBR/SACRL,64493,CPT,,47064493,CDM,360,RC,,,both,,,2477,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1684.36,,,1684.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1981.6,,,1981.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1981.6,,,1981.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1733.9,70,,1733.9,percent of total billed charges,,431.32,,,431.32,Fee Schedule,,365.57,,,365.57,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,365.57,7216,
INJ ANES FACET JT L/S ADDL,64494,CPT,,42064494,CDM,360,RC,,,both,,,918,362.31,39.4668,,362.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",642.6,70,,642.6,percent of total billed charges,All Other,624.24,,,624.24,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,734.4,,,734.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",734.4,,,734.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,734.4,,,734.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",642.6,70,,642.6,percent of total billed charges,,246,,,246,Fee Schedule,,208.5,,,208.5,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,7216,
INJ ANES FACET JT L/S ADDL W/ FY MOD,64494,CPT,,42664494,CDM,360,RC,,,both,,,918,362.31,39.4668,,362.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",642.6,70,,642.6,percent of total billed charges,All Other,624.24,,,624.24,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,734.4,,,734.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",734.4,,,734.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,734.4,,,734.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",642.6,70,,642.6,percent of total billed charges,,246,,,246,Fee Schedule,,208.5,,,208.5,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,7216,
INJ ANES FACET JT L/S ADDL W/ FY MOD,64494,CPT,FY,43064494,CDM,360,RC,,,both,,,918,362.31,39.4668,,362.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",642.6,70,,642.6,percent of total billed charges,All Other,624.24,,,624.24,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,734.4,,,734.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",734.4,,,734.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,734.4,,,734.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",642.6,70,,642.6,percent of total billed charges,,246,,,246,Fee Schedule,,208.5,,,208.5,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,7216,
INJ ANES FACET JT L/S ADDL,64494,CPT,,47064494,CDM,360,RC,,,both,,,918,362.31,39.4668,,362.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",642.6,70,,642.6,percent of total billed charges,All Other,624.24,,,624.24,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,734.4,,,734.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",734.4,,,734.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,734.4,,,734.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",642.6,70,,642.6,percent of total billed charges,,246,,,246,Fee Schedule,,208.5,,,208.5,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,7216,
XR LUMBOSACRAL FACET BLOC,64495,CPT,,47064495,CDM,360,RC,,,both,,,871,343.76,39.4668,,343.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",609.7,70,,609.7,percent of total billed charges,All Other,592.28,,,592.28,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,696.8,,,696.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",696.8,,,696.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,696.8,,,696.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",609.7,70,,609.7,percent of total billed charges,,249.28,,,249.28,Fee Schedule,,211.28,,,211.28,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,7216,
INJ ANESTH; LUMB/THOR (SYMPATHETIC),64520,CPT,,49064520,CDM,360,RC,,,both,,,3427,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2330.36,,,2330.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,2741.6,,,2741.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2741.6,,,2741.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2398.9,70,,2398.9,percent of total billed charges,,405.08,,,405.08,Fee Schedule,,343.33,,,343.33,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,343.33,7216,
PERITONEOGRAM AFTER INJECTION,74190,CPT,,47074190,CDM,360,RC,,,both,,,2943,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,0.01,,,0.01,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",0.01,,,0.01,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,2060.1,70,,2060.1,percent of total billed charges,All Other,2001.24,68,,2001.24,percent of total billed charges,All Other,406,,,406,Other,186% of Medicaid,2354.4,,,2354.4,Other,ASC Grouper table,2442.69,83,,2442.69,percent of total billed charges,All Other,2442.69,83,,,percent of total billed charges,All Other,2354.4,,,2354.4,Other,ASC Grouper table,2442.69,83,,2442.69,percent of total billed charges,All Other,2354.4,,,2354.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2060.1,70,,2060.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,0.01,3933,
THROMBOLYSIS CORONARY IV,92977,CPT,,30092977,CDM,360,RC,,,both,,,769,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",538.3,70,,538.3,percent of total billed charges,All Other,522.92,,,522.92,Other,ASC Grouper table,1111.71,,,1111.71,Other,186% of Medicaid,615.2,,,615.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",615.2,,,615.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,615.2,,,615.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",538.3,70,,538.3,percent of total billed charges,,250.92,,,250.92,Fee Schedule,,212.67,,,212.67,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,212.67,7216,
PERC DRUG-EL COR STENT SING,C9600,HCPCS,,49000009,CDM,360,RC,,,both,,,32135,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",22494.5,70,,22494.5,percent of total billed charges,All Other,21851.8,,,21851.8,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,25708,,,25708,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",25708,,,25708,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,25708,,,25708,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",22494.5,70,,22494.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,25708,
PERC DRUG-EL COR STENT BRAN,C9601,HCPCS,,49000026,CDM,360,RC,,,both,,,16067,6341.13,39.4668,,6341.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",11246.9,70,,11246.9,percent of total billed charges,All Other,10925.56,,,10925.56,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,12853.6,,,12853.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12853.6,,,12853.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12853.6,,,12853.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11246.9,70,,11246.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,12853.6,
PERC D-E COR STENT ATHER S,C9602,HCPCS,,49000010,CDM,360,RC,,,both,,,51696,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",36187.2,70,,36187.2,percent of total billed charges,All Other,35153.28,,,35153.28,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,41356.8,,,41356.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",41356.8,,,41356.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,41356.8,,,41356.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",36187.2,70,,36187.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,41356.8,
PERC D-E COR STENT ATHER BR,C9603,HCPCS,,49000027,CDM,360,RC,,,both,,,25848,10201.38,39.4668,,10201.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",18093.6,70,,18093.6,percent of total billed charges,All Other,17576.64,,,17576.64,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,20678.4,,,20678.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",20678.4,,,20678.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,20678.4,,,20678.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",18093.6,70,,18093.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,20678.4,
PERC D-E COR REVASC T CABG S,C9604,HCPCS,,49000011,CDM,360,RC,,,both,,,32135,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",22494.5,70,,22494.5,percent of total billed charges,All Other,21851.8,,,21851.8,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,25708,,,25708,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",25708,,,25708,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,25708,,,25708,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",22494.5,70,,22494.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,25708,
PERC D-E COR REVASC T CABG B,C9605,HCPCS,,49000028,CDM,360,RC,,,both,,,16067,6341.13,39.4668,,6341.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",11246.9,70,,11246.9,percent of total billed charges,All Other,10925.56,,,10925.56,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,12853.6,,,12853.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12853.6,,,12853.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12853.6,,,12853.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11246.9,70,,11246.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,12853.6,
PERC D-E COR REVASC W AMI S,C9606,HCPCS,,49000029,CDM,360,RC,,,both,,,16067,6341.13,39.4668,,6341.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",11246.9,70,,11246.9,percent of total billed charges,All Other,10925.56,,,10925.56,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,12853.6,,,12853.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12853.6,,,12853.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12853.6,,,12853.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11246.9,70,,11246.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,12853.6,
PERC D-E COR REVASC CHRO SIN,C9607,HCPCS,,49000012,CDM,360,RC,,,both,,,51696,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",36187.2,70,,36187.2,percent of total billed charges,All Other,35153.28,,,35153.28,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,41356.8,,,41356.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",41356.8,,,41356.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,41356.8,,,41356.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",36187.2,70,,36187.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,41356.8,
PERC D-E COR REVASC CHRO ADD,C9608,HCPCS,,49000030,CDM,360,RC,,,both,,,25848,10201.38,39.4668,,10201.38,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",18093.6,70,,18093.6,percent of total billed charges,All Other,17576.64,,,17576.64,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,20678.4,,,20678.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",20678.4,,,20678.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,20678.4,,,20678.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",18093.6,70,,18093.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,20678.4,
REVASC INTRAVASC LITHOTRIPSY,C9764,HCPCS,,47000012,CDM,360,RC,,,both,,,33365,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",23355.5,70,,23355.5,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,3853.11,,,3853.11,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,26692,,,26692,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",23355.5,70,,23355.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,2071.56,,,2071.56,Other,100% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,3169.49,,,3169.49,Other,153% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,2900.19,,,2900.19,Other,140% of Medicaid,4661.02,,,4661.02,Other,225% of Medicaid,5386.06,,,5386.06,Other,250% of Medicaid,6711.86,,,6711.86,Other,324% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,4453.86,,,4453.86,Other,215% of Medicaid,2589.45,,,2589.45,Other,125% of Medicaid,2071.56,26692,
REVASC INTRA LITHOTRIP-STENT,C9765,HCPCS,,47000013,CDM,360,RC,,,both,,,53991,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",37793.7,70,,37793.7,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,43192.8,,,43192.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",37793.7,70,,37793.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,2475.91,43192.8,
REVASC INTRA LITHOTRIP-ATHER,C9766,HCPCS,,47000014,CDM,360,RC,,,both,,,53991,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,4827,,,4827,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4344,,,4344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",37793.7,70,,37793.7,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,43192.8,,,43192.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",37793.7,70,,37793.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,2475.91,43192.8,
REVASC LITHOTRIP-STENT-ATHER,C9767,HCPCS,,47000015,CDM,360,RC,,,both,,,53991,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,4827,,,4827,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4344,,,4344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",37793.7,70,,37793.7,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,43192.8,,,43192.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",37793.7,70,,37793.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,43192.8,
REVASC LITHOTRIP TIBI/PERONE,C9772,HCPCS,,47000016,CDM,360,RC,,,both,,,33365,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.2,,,4605.2,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,26692,,,26692,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",23355.5,70,,23355.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,2475.91,,,2475.91,Other,100% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,3466.28,,,3466.28,Other,140% of Medicaid,5570.8,,,5570.8,Other,225% of Medicaid,6437.37,,,6437.37,Other,250% of Medicaid,8021.96,,,8021.96,Other,324% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,5323.21,,,5323.21,Other,215% of Medicaid,3094.89,,,3094.89,Other,125% of Medicaid,2475.91,26692,
REVASC LITHOTR-STENT TIB/PER,C9773,HCPCS,,47000017,CDM,360,RC,,,both,,,53991,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,43192.8,,,43192.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",37793.7,70,,37793.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,43192.8,
REVASC LITHOTR-ATHER TIB/PER,C9774,HCPCS,,47000018,CDM,360,RC,,,both,,,53991,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,43192.8,,,43192.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",37793.7,70,,37793.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,43192.8,
REVASC LITH-STEN-ATH TIB/PER,C9775,HCPCS,,47000019,CDM,360,RC,,,both,,,53991,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4820,,,4820,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,4605.21,,,4605.21,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,43192.8,,,43192.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",37793.7,70,,37793.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6261,,,6261,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6956,,,6956,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5913,,,5913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,2475.92,,,2475.92,Other,100% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3788.15,,,3788.15,Other,153% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,3466.29,,,3466.29,Other,140% of Medicaid,5570.82,,,5570.82,Other,225% of Medicaid,6437.39,,,6437.39,Other,250% of Medicaid,8021.97,,,8021.97,Other,324% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,5323.22,,,5323.22,Other,215% of Medicaid,3094.9,,,3094.9,Other,125% of Medicaid,2475.92,43192.8,
OCCLUSIVE DEVICE PLACEMENT,G0269,HCPCS,,47000002,CDM,360,RC,,,both,,,232,91.56,39.4668,,91.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,162.4,70,,162.4,percent of total billed charges,All Other,157.76,,,157.76,Other,ASC Grouper table,0.01,,,0.01,Other,186% of Medicaid,185.6,,,185.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",185.6,,,185.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,185.6,,,185.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",162.4,70,,162.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7216,
GUIDE CATHET FLUID DRAINAGE,10030,CPT,,44010030,CDM,361,RC,,,both,,,3578,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2504.6,70,,2504.6,percent of total billed charges,All Other,2433.04,,,2433.04,Other,ASC Grouper table,1206.77,,,1206.77,Other,186% of Medicaid,2862.4,,,2862.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2862.4,,,2862.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2862.4,,,2862.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2504.6,70,,2504.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,992.66,,,992.66,Other,153% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,908.32,,,908.32,Other,140% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,1686.88,,,1686.88,Other,250% of Medicaid,2102.11,,,2102.11,Other,324% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,811,,,811,Other,125% of Medicaid,648.8,7216,
GUIDE CATHET FLUID DRAINAGE,10030,CPT,,46010030,CDM,361,RC,,,both,,,3578,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2504.6,70,,2504.6,percent of total billed charges,All Other,2433.04,,,2433.04,Other,ASC Grouper table,1206.77,,,1206.77,Other,186% of Medicaid,2862.4,,,2862.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2862.4,,,2862.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2862.4,,,2862.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2504.6,70,,2504.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,992.66,,,992.66,Other,153% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,908.32,,,908.32,Other,140% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,1686.88,,,1686.88,Other,250% of Medicaid,2102.11,,,2102.11,Other,324% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,811,,,811,Other,125% of Medicaid,648.8,7216,
I&D ABSC; SMPL OR SGL,10060,CPT,,47010060,CDM,361,RC,,,both,,,587,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",410.9,70,,410.9,percent of total billed charges,All Other,399.16,,,399.16,Other,ASC Grouper table,732.77,,,732.77,Other,186% of Medicaid,469.6,,,469.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",469.6,,,469.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,469.6,,,469.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",410.9,70,,410.9,percent of total billed charges,,505.12,,,505.12,Fee Schedule,,428.12,,,428.12,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,219.99,7216,
I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,,82010060,CDM,361,RC,,,both,,,587,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",410.9,70,,410.9,percent of total billed charges,All Other,399.16,,,399.16,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,469.6,,,469.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",469.6,,,469.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,469.6,,,469.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",410.9,70,,410.9,percent of total billed charges,,505.12,,,505.12,Fee Schedule,,428.12,,,428.12,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,219.99,7216,
I&D HEMATOMA/FLUID,10140,CPT,,47010140,CDM,361,RC,,,both,,,4951,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3465.7,70,,3465.7,percent of total billed charges,All Other,3366.68,,,3366.68,Other,ASC Grouper table,1206.77,,,1206.77,Other,186% of Medicaid,3960.8,,,3960.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3960.8,,,3960.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3960.8,,,3960.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3465.7,70,,3465.7,percent of total billed charges,,569.08,,,569.08,Fee Schedule,,482.33,,,482.33,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,992.66,,,992.66,Other,153% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,908.32,,,908.32,Other,140% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,1686.88,,,1686.88,Other,250% of Medicaid,2102.11,,,2102.11,Other,324% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,811,,,811,Other,125% of Medicaid,482.33,7216,
PUNCT ASP - ABSC HEMAT CYST,10160,CPT,,44010160,CDM,361,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",588.7,70,,588.7,percent of total billed charges,All Other,571.88,,,571.88,Other,ASC Grouper table,732.77,,,732.77,Other,186% of Medicaid,672.8,,,672.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,457.56,,,457.56,Fee Schedule,,387.81,,,387.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,387.81,7216,
RECONST NAIL BED W GRFT,11762,CPT,,30011762,CDM,361,RC,,,both,,,5004,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3502.8,70,,3502.8,percent of total billed charges,All Other,3402.72,,,3402.72,Other,ASC Grouper table,2241.52,,,2241.52,Other,186% of Medicaid,4003.2,,,4003.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4003.2,,,4003.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4003.2,,,4003.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3502.8,70,,3502.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1843.83,,,1843.83,Other,153% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1687.16,,,1687.16,Other,140% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,3133.3,,,3133.3,Other,250% of Medicaid,3904.58,,,3904.58,Other,324% of Medicaid,2591,,,2591,Other,215% of Medicaid,2591,,,2591,Other,215% of Medicaid,1506.39,,,1506.39,Other,125% of Medicaid,1205.12,7216,
BREAST CYST ASPIRATE,19000,CPT,,54019000,CDM,361,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1023.4,70,,1023.4,percent of total billed charges,All Other,994.16,,,994.16,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1023.4,70,,1023.4,percent of total billed charges,,205,,,205,Fee Schedule,,173.75,,,173.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,173.75,7216,
DRAIN BREAST LESION ADD-ON,19001,CPT,,42019001,CDM,361,RC,,,both,,,514,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",359.8,70,,359.8,percent of total billed charges,All Other,349.52,,,349.52,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,411.2,,,411.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",411.2,,,411.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,411.2,,,411.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",359.8,70,,359.8,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,0.01,7216,
DRAIN BREAST LESION ADD-ON W/ FY MOD,19001,CPT,,42619001,CDM,361,RC,,,both,,,514,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",359.8,70,,359.8,percent of total billed charges,All Other,349.52,,,349.52,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,411.2,,,411.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",411.2,,,411.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,411.2,,,411.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",359.8,70,,359.8,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,0.01,7216,
BX BREAST 1ST LESION STRTCTC,19081,CPT,,54019081,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
BX BREAST 1ST LESION STRTCTC LT,19081,CPT,LT,54119081,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
BX BREAST 1ST LESION STRTCTC RT,19081,CPT,RT,54219081,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
BX BREAST 1ST LESION STRTCTC BILAT,19081,CPT,50,54319081,CDM,361,RC,,,both,,,5066,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3444.88,,,3444.88,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,4052.8,,,4052.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4052.8,,,4052.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4052.8,,,4052.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3546.2,70,,3546.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
INCOMPLETE BX BREAST 1ST LESION STRTCTC,19081,CPT,73,54419081,CDM,361,RC,,,both,,,2702,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1837.36,,,1837.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2161.6,,,2161.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1891.4,70,,1891.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
INCOMPLETE BX BREAST 1ST LESION STRTCTC,19081,CPT,74,54519081,CDM,361,RC,,,both,,,2702,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1837.36,,,1837.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2161.6,,,2161.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1891.4,70,,1891.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
BX BREAST ADD LESION STRTCTC,19082,CPT,,54019082,CDM,361,RC,,,both,,,272,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",190.4,70,,190.4,percent of total billed charges,All Other,184.96,,,184.96,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,217.6,,,217.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",217.6,,,217.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,217.6,,,217.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",190.4,70,,190.4,percent of total billed charges,,396.88,,,396.88,Fee Schedule,,336.38,,,336.38,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
BX BREAST ADD LESION STRTCTC LT,19082,CPT,LT,54119082,CDM,361,RC,,,both,,,272,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",190.4,70,,190.4,percent of total billed charges,All Other,184.96,,,184.96,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,217.6,,,217.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",217.6,,,217.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,217.6,,,217.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",190.4,70,,190.4,percent of total billed charges,,396.88,,,396.88,Fee Schedule,,336.38,,,336.38,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
BX BREAST ADD LESION STRTCTC RT,19082,CPT,RT,54219082,CDM,361,RC,,,both,,,272,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",190.4,70,,190.4,percent of total billed charges,All Other,184.96,,,184.96,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,217.6,,,217.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",217.6,,,217.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,217.6,,,217.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",190.4,70,,190.4,percent of total billed charges,,396.88,,,396.88,Fee Schedule,,336.38,,,336.38,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
INCOMPLETE BX BREAST ADD LESION STRTCTC,19082,CPT,73,54419082,CDM,361,RC,,,both,,,218,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",152.6,70,,152.6,percent of total billed charges,All Other,148.24,,,148.24,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,174.4,,,174.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",174.4,,,174.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,174.4,,,174.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",152.6,70,,152.6,percent of total billed charges,,396.88,,,396.88,Fee Schedule,,336.38,,,336.38,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
BX BREAST 1ST LESION US IMAG,19083,CPT,,44019083,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
BX BREAST 1ST LESION US IMAG,19083,CPT,,54019083,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
BX BREAST 1ST LESION US IMAG LT,19083,CPT,LT,54119083,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
BX BREAST 1ST LESION US IMAG RT,19083,CPT,RT,54219083,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
BX BREAST 1ST LESION US IMAG BILAT,19083,CPT,50,54319083,CDM,361,RC,,,both,,,5066,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3444.88,,,3444.88,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,4052.8,,,4052.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4052.8,,,4052.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4052.8,,,4052.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3546.2,70,,3546.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
INCOMPLETE BX BREAST 1ST LESION US IMAG,19083,CPT,73,54419083,CDM,361,RC,,,both,,,2702,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1837.36,,,1837.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2161.6,,,2161.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1891.4,70,,1891.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
INCOMPLETE BX BREAST 1ST LESION US IMAG,19083,CPT,74,54519083,CDM,361,RC,,,both,,,2702,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1837.36,,,1837.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2161.6,,,2161.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1891.4,70,,1891.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
BX BREAST ADD LESION US IMAG,19084,CPT,,44019084,CDM,361,RC,,,both,,,273,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",191.1,70,,191.1,percent of total billed charges,All Other,185.64,,,185.64,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,218.4,,,218.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",218.4,,,218.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,218.4,,,218.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",191.1,70,,191.1,percent of total billed charges,,369,,,369,Fee Schedule,,312.75,,,312.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
BX BREAST ADD LESION US IMAG,19084,CPT,,54019084,CDM,361,RC,,,both,,,273,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",191.1,70,,191.1,percent of total billed charges,All Other,185.64,,,185.64,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,218.4,,,218.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",218.4,,,218.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,218.4,,,218.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",191.1,70,,191.1,percent of total billed charges,,369,,,369,Fee Schedule,,312.75,,,312.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
BX BREAST ADD LESION US IMAG LT,19084,CPT,LT,54119084,CDM,361,RC,,,both,,,273,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",191.1,70,,191.1,percent of total billed charges,All Other,185.64,,,185.64,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,218.4,,,218.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",218.4,,,218.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,218.4,,,218.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",191.1,70,,191.1,percent of total billed charges,,369,,,369,Fee Schedule,,312.75,,,312.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
BX BREAST ADD LESION US IMAG RT,19084,CPT,RT,54219084,CDM,361,RC,,,both,,,273,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",191.1,70,,191.1,percent of total billed charges,All Other,185.64,,,185.64,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,218.4,,,218.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",218.4,,,218.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,218.4,,,218.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",191.1,70,,191.1,percent of total billed charges,,369,,,369,Fee Schedule,,312.75,,,312.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
INCOMPLETE BX BREAST ADD LESION US IMAG,19084,CPT,73,54419084,CDM,361,RC,,,both,,,219,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",153.3,70,,153.3,percent of total billed charges,All Other,148.92,,,148.92,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,175.2,,,175.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",175.2,,,175.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,175.2,,,175.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",153.3,70,,153.3,percent of total billed charges,,369,,,369,Fee Schedule,,312.75,,,312.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
BX BREAST 1ST LESION MR IMAG,19085,CPT,,54019085,CDM,361,RC,,,both,,,4409,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,3527.2,,,3527.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3086.3,70,,3086.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,9473,
BX BREAST ADD LESION MR IMAG,19086,CPT,,54019086,CDM,361,RC,,,both,,,1763,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1234.1,70,,1234.1,percent of total billed charges,All Other,1198.84,,,1198.84,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,1410.4,,,1410.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1410.4,,,1410.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1410.4,,,1410.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1234.1,70,,1234.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
PERQ DEVICE BREAST 1ST IMAG,19281,CPT,,54019281,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2363.9,70,,2363.9,percent of total billed charges,All Other,2296.36,,,2296.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
PERQ DEVICE BREAST 1ST IMAG LT,19281,CPT,LT,54119281,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2363.9,70,,2363.9,percent of total billed charges,All Other,2296.36,,,2296.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
PERQ DEVICE BREAST 1ST IMAG RT,19281,CPT,RT,54219281,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2363.9,70,,2363.9,percent of total billed charges,All Other,2296.36,,,2296.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
PERQ DEVICE BREAST 1ST IMAG BILAT,19281,CPT,50,54319281,CDM,361,RC,,,both,,,5066,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3546.2,70,,3546.2,percent of total billed charges,All Other,3444.88,,,3444.88,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,4052.8,,,4052.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4052.8,,,4052.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4052.8,,,4052.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3546.2,70,,3546.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
INCOMPLETE PERQ DEVICE BREAST 1ST IMAG,19281,CPT,73,54419281,CDM,361,RC,,,both,,,2702,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1891.4,70,,1891.4,percent of total billed charges,All Other,1837.36,,,1837.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2161.6,,,2161.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1891.4,70,,1891.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
INCOMPLETE PERQ DEVICE BREAST 1ST IMAG,19281,CPT,74,54519281,CDM,361,RC,,,both,,,2702,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1891.4,70,,1891.4,percent of total billed charges,All Other,1837.36,,,1837.36,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2161.6,,,2161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2161.6,,,2161.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1891.4,70,,1891.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,1501.64,7216,
PERQ DEVICE BREAST EA IMAG,19282,CPT,,54019282,CDM,361,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",105,70,,105,percent of total billed charges,All Other,102,,,102,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,120,,,120,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",120,,,120,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,120,,,120,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",105,70,,105,percent of total billed charges,,237.8,,,237.8,Fee Schedule,,201.55,,,201.55,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
PERQ DEVICE BREAST EA IMAG LT,19282,CPT,LT,54119282,CDM,361,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",105,70,,105,percent of total billed charges,All Other,102,,,102,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,120,,,120,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",120,,,120,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,120,,,120,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",105,70,,105,percent of total billed charges,,237.8,,,237.8,Fee Schedule,,201.55,,,201.55,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
PERQ DEVICE BREAST EA IMAG RT,19282,CPT,RT,54219282,CDM,361,RC,,,both,,,150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",105,70,,105,percent of total billed charges,All Other,102,,,102,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,120,,,120,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",120,,,120,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,120,,,120,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",105,70,,105,percent of total billed charges,,237.8,,,237.8,Fee Schedule,,201.55,,,201.55,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
INCOMPLETE PERQ DEVICE BREAST EA IMAG,19282,CPT,73,54419282,CDM,361,RC,,,both,,,120,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",84,70,,84,percent of total billed charges,All Other,81.6,,,81.6,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,96,,,96,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",96,,,96,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,96,,,96,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",84,70,,84,percent of total billed charges,,237.8,,,237.8,Fee Schedule,,201.55,,,201.55,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
PERQ DEV BREAST 1ST STRTCTC,19283,CPT,,54019283,CDM,361,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1023.4,70,,1023.4,percent of total billed charges,All Other,994.16,,,994.16,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1023.4,70,,1023.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,773.13,7216,
PERQ DEV BREAST 1ST STRTCTC LT,19283,CPT,LT,54119283,CDM,361,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1023.4,70,,1023.4,percent of total billed charges,All Other,994.16,,,994.16,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1023.4,70,,1023.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,773.13,7216,
PERQ DEV BREAST 1ST STRTCTC RT,19283,CPT,RT,54219283,CDM,361,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1023.4,70,,1023.4,percent of total billed charges,All Other,994.16,,,994.16,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1023.4,70,,1023.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,773.13,7216,
PERQ DEV BREAST 1ST STRTCTC BILAT,19283,CPT,50,54319283,CDM,361,RC,,,both,,,2193,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1535.1,70,,1535.1,percent of total billed charges,All Other,1491.24,,,1491.24,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,1754.4,,,1754.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1754.4,,,1754.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1754.4,,,1754.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1535.1,70,,1535.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,773.13,7216,
INCOMPLETE PERQ DEV BREAST 1ST STRTCTC,19283,CPT,73,54419283,CDM,361,RC,,,both,,,1170,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",819,70,,819,percent of total billed charges,All Other,795.6,,,795.6,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,936,,,936,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",936,,,936,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,936,,,936,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",819,70,,819,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,773.13,7216,
INCOMPLETE PERQ DEV BREAST 1ST STRTCTC,19283,CPT,74,54519283,CDM,361,RC,,,both,,,1170,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",819,70,,819,percent of total billed charges,All Other,795.6,,,795.6,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,936,,,936,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",936,,,936,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,936,,,936,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",819,70,,819,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,773.13,7216,
PERQ DEV BREAST ADD STRTCTC,19284,CPT,,54019284,CDM,361,RC,,,both,,,151,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",105.7,70,,105.7,percent of total billed charges,All Other,102.68,,,102.68,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,120.8,,,120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",120.8,,,120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,120.8,,,120.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",105.7,70,,105.7,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
PERQ DEV BREAST ADD STRTCTC LT,19284,CPT,LT,54119284,CDM,361,RC,,,both,,,151,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",105.7,70,,105.7,percent of total billed charges,All Other,102.68,,,102.68,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,120.8,,,120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",120.8,,,120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,120.8,,,120.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",105.7,70,,105.7,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
PERQ DEV BREAST ADD STRTCTC RT,19284,CPT,RT,54219284,CDM,361,RC,,,both,,,151,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",105.7,70,,105.7,percent of total billed charges,All Other,102.68,,,102.68,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,120.8,,,120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",120.8,,,120.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,120.8,,,120.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",105.7,70,,105.7,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
INCOMPLETE PERQ DEV BREAST ADD STRTCTC,19284,CPT,73,54419284,CDM,361,RC,,,both,,,122,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",85.4,70,,85.4,percent of total billed charges,All Other,82.96,,,82.96,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,97.6,,,97.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",97.6,,,97.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,97.6,,,97.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",85.4,70,,85.4,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
PERQ DEV BREAST 1ST US IMAG,19285,CPT,,54019285,CDM,361,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1023.4,70,,1023.4,percent of total billed charges,All Other,994.16,,,994.16,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1023.4,70,,1023.4,percent of total billed charges,,406.72,,,406.72,Fee Schedule,,344.72,,,344.72,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,344.72,7216,
PERQ DEV BREAST 1ST US IMAG LT,19285,CPT,LT,54119285,CDM,361,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1023.4,70,,1023.4,percent of total billed charges,All Other,994.16,,,994.16,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1023.4,70,,1023.4,percent of total billed charges,,406.72,,,406.72,Fee Schedule,,344.72,,,344.72,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,344.72,7216,
PERQ DEV BREAST 1ST US IMAG RT,19285,CPT,RT,54219285,CDM,361,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1023.4,70,,1023.4,percent of total billed charges,All Other,994.16,,,994.16,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1023.4,70,,1023.4,percent of total billed charges,,406.72,,,406.72,Fee Schedule,,344.72,,,344.72,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,344.72,7216,
PERQ DEV BREAST 1ST US IMAG BLIAT,19285,CPT,50,54319285,CDM,361,RC,,,both,,,2193,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1535.1,70,,1535.1,percent of total billed charges,All Other,1491.24,,,1491.24,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,1754.4,,,1754.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1754.4,,,1754.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1754.4,,,1754.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1535.1,70,,1535.1,percent of total billed charges,,406.72,,,406.72,Fee Schedule,,344.72,,,344.72,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,344.72,7216,
INCOMPLETE PERQ DEV BREAST 1ST US IMAG,19285,CPT,73,54419285,CDM,361,RC,,,both,,,1171,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",819.7,70,,819.7,percent of total billed charges,All Other,796.28,,,796.28,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,936.8,,,936.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",936.8,,,936.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,936.8,,,936.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",819.7,70,,819.7,percent of total billed charges,,406.72,,,406.72,Fee Schedule,,344.72,,,344.72,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,344.72,7216,
INCOMPLETE PERQ DEV BREAST 1ST US IMAG,19285,CPT,74,54519285,CDM,361,RC,,,both,,,1171,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",819.7,70,,819.7,percent of total billed charges,All Other,796.28,,,796.28,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,936.8,,,936.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",936.8,,,936.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,936.8,,,936.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",819.7,70,,819.7,percent of total billed charges,,406.72,,,406.72,Fee Schedule,,344.72,,,344.72,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,344.72,7216,
PERQ DEV BREAST ADD US IMAG,19286,CPT,,54019286,CDM,361,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",90.3,70,,90.3,percent of total billed charges,All Other,87.72,,,87.72,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,103.2,,,103.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",103.2,,,103.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,103.2,,,103.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",90.3,70,,90.3,percent of total billed charges,,205,,,205,Fee Schedule,,173.75,,,173.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
PERQ DEV BREAST ADD US IMAG LT,19286,CPT,LT,54119286,CDM,361,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",90.3,70,,90.3,percent of total billed charges,All Other,87.72,,,87.72,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,103.2,,,103.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",103.2,,,103.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,103.2,,,103.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",90.3,70,,90.3,percent of total billed charges,,205,,,205,Fee Schedule,,173.75,,,173.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
PERQ DEV BREAST ADD US IMAG RT,19286,CPT,RT,54219286,CDM,361,RC,,,both,,,129,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",90.3,70,,90.3,percent of total billed charges,All Other,87.72,,,87.72,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,103.2,,,103.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",103.2,,,103.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,103.2,,,103.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",90.3,70,,90.3,percent of total billed charges,,205,,,205,Fee Schedule,,173.75,,,173.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
INCOMPLETE PERQ DEV BREAST ADD US IMAG,19286,CPT,73,54419286,CDM,361,RC,,,both,,,104,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",72.8,70,,72.8,percent of total billed charges,All Other,70.72,,,70.72,Other,ASC Grouper table,2793.05,,,2793.05,Other,186% of Medicaid,83.2,,,83.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",83.2,,,83.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,83.2,,,83.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",72.8,70,,72.8,percent of total billed charges,,205,,,205,Fee Schedule,,173.75,,,173.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,1501.64,,,1501.64,Other,100% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2297.51,,,2297.51,Other,153% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,2102.3,,,2102.3,Other,140% of Medicaid,3378.69,,,3378.69,Other,225% of Medicaid,3904.26,,,3904.26,Other,250% of Medicaid,4865.31,,,4865.31,Other,324% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,3228.53,,,3228.53,Other,215% of Medicaid,1877.05,,,1877.05,Other,125% of Medicaid,0.01,7216,
MUSCLE BX; PERC NDL,20206,CPT,,44020206,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,273.88,,,273.88,Fee Schedule,,232.13,,,232.13,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,232.13,7216,
INJ TENDON SHEATH/LIGAMENT,20550,CPT,,47020550,CDM,361,RC,,,both,,,950,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",665,70,,665,percent of total billed charges,All Other,646,,,646,Other,ASC Grouper table,685.34,,,685.34,Other,186% of Medicaid,760,,,760,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",760,,,760,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,760,,,760,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",665,70,,665,percent of total billed charges,,188.6,,,188.6,Fee Schedule,,159.85,,,159.85,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,159.85,7216,
INJECT TRIGGER POINTS 3/>,20553,CPT,,82020553,CDM,361,RC,,,both,,,807,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",564.9,70,,564.9,percent of total billed charges,All Other,548.76,,,548.76,Other,ASC Grouper table,685,,,685,Other,186% of Medicaid,645.6,,,645.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",645.6,,,645.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,645.6,,,645.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",564.9,70,,564.9,percent of total billed charges,,206.64,,,206.64,Fee Schedule,,175.14,,,175.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,175.14,7216,
DRAIN/INJ INTER JOINT/BURSA W/US,20606,CPT,,44020606,CDM,361,RC,,,both,,,1452,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1016.4,70,,1016.4,percent of total billed charges,All Other,987.36,,,987.36,Other,ASC Grouper table,1079.29,,,1079.29,Other,186% of Medicaid,1161.6,,,1161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1161.6,,,1161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1161.6,,,1161.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1016.4,70,,1016.4,percent of total billed charges,,249.28,,,249.28,Fee Schedule,,211.28,,,211.28,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",580.26,,,580.26,Other,100% of Medicaid,580.26,,,580.26,Other,100% of Medicaid,580.26,,,580.26,Other,100% of Medicaid,580.26,,,580.26,Other,100% of Medicaid,1305.59,,,1305.59,Other,225% of Medicaid,887.8,,,887.8,Other,153% of Medicaid,1305.59,,,1305.59,Other,225% of Medicaid,812.37,,,812.37,Other,140% of Medicaid,1305.59,,,1305.59,Other,225% of Medicaid,1508.68,,,1508.68,Other,250% of Medicaid,1880.05,,,1880.05,Other,324% of Medicaid,1247.57,,,1247.57,Other,215% of Medicaid,1247.57,,,1247.57,Other,215% of Medicaid,725.33,,,725.33,Other,125% of Medicaid,211.28,7216,
ASPIRATE/INJECT MAJOR JOINT,20610,CPT,,42020610,CDM,361,RC,,,both,,,1017,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",711.9,70,,711.9,percent of total billed charges,All Other,691.56,,,691.56,Other,ASC Grouper table,685.34,,,685.34,Other,186% of Medicaid,813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,813.6,,,813.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",711.9,70,,711.9,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,184.87,7216,
ASPIRATE/INJECT MAJOR JOINT W/ FY MOD,20610,CPT,,42620610,CDM,361,RC,,,both,,,1017,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",711.9,70,,711.9,percent of total billed charges,All Other,691.56,,,691.56,Other,ASC Grouper table,685.34,,,685.34,Other,186% of Medicaid,813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,813.6,,,813.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",711.9,70,,711.9,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,184.87,7216,
ASPIRATE/INJECT MAJOR JOINT,20610,CPT,,47020610,CDM,361,RC,,,both,,,1017,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",711.9,70,,711.9,percent of total billed charges,All Other,691.56,,,691.56,Other,ASC Grouper table,685.34,,,685.34,Other,186% of Medicaid,813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,813.6,,,813.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",711.9,70,,711.9,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,184.87,7216,
ASPIRATE/INJECT MAJOR JOINT,20610,CPT,,82020610,CDM,361,RC,,,both,,,1017,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",711.9,70,,711.9,percent of total billed charges,All Other,691.56,,,691.56,Other,ASC Grouper table,685,,,685,Other,186% of Medicaid,813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",813.6,,,813.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,813.6,,,813.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",711.9,70,,711.9,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,184.87,7216,
DRAIN/INJ MAJOR JOINT/BURSA W/US,20611,CPT,,44020611,CDM,361,RC,,,both,,,991,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",693.7,70,,693.7,percent of total billed charges,All Other,673.88,,,673.88,Other,ASC Grouper table,1079.29,,,1079.29,Other,186% of Medicaid,792.8,,,792.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",792.8,,,792.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,792.8,,,792.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",693.7,70,,693.7,percent of total billed charges,,285.36,,,285.36,Fee Schedule,,241.86,,,241.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",580.26,,,580.26,Other,100% of Medicaid,580.26,,,580.26,Other,100% of Medicaid,580.26,,,580.26,Other,100% of Medicaid,580.26,,,580.26,Other,100% of Medicaid,1305.59,,,1305.59,Other,225% of Medicaid,887.8,,,887.8,Other,153% of Medicaid,1305.59,,,1305.59,Other,225% of Medicaid,812.37,,,812.37,Other,140% of Medicaid,1305.59,,,1305.59,Other,225% of Medicaid,1508.68,,,1508.68,Other,250% of Medicaid,1880.05,,,1880.05,Other,324% of Medicaid,1247.57,,,1247.57,Other,215% of Medicaid,1247.57,,,1247.57,Other,215% of Medicaid,725.33,,,725.33,Other,125% of Medicaid,241.86,7216,
I&D DEEP ABSC SFT TISS NK/THOR,21501,CPT,,44021501,CDM,361,RC,,,both,,,5816,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3954.88,,,3954.88,Other,ASC Grouper table,3164.19,,,3164.19,Other,186% of Medicaid,4652.8,,,4652.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4652.8,,,4652.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4071.2,70,,4071.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1701.18,,,1701.18,Other,100% of Medicaid,1701.18,,,1701.18,Other,100% of Medicaid,1701.18,,,1701.18,Other,100% of Medicaid,1701.18,,,1701.18,Other,100% of Medicaid,3827.65,,,3827.65,Other,225% of Medicaid,2602.81,,,2602.81,Other,153% of Medicaid,3827.65,,,3827.65,Other,225% of Medicaid,2381.65,,,2381.65,Other,140% of Medicaid,3827.65,,,3827.65,Other,225% of Medicaid,4423.07,,,4423.07,Other,250% of Medicaid,5511.82,,,5511.82,Other,324% of Medicaid,3657.54,,,3657.54,Other,215% of Medicaid,3657.54,,,3657.54,Other,215% of Medicaid,2126.47,,,2126.47,Other,125% of Medicaid,1701.18,7216,
SFT TISS BX - NECK/THORAX,21550,CPT,,44021550,CDM,361,RC,,,both,,,4819,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3373.3,70,,3373.3,percent of total billed charges,All Other,3276.92,,,3276.92,Other,ASC Grouper table,3164.19,,,3164.19,Other,186% of Medicaid,3855.2,,,3855.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3855.2,,,3855.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3855.2,,,3855.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3373.3,70,,3373.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1701.18,,,1701.18,Other,100% of Medicaid,1701.18,,,1701.18,Other,100% of Medicaid,1701.18,,,1701.18,Other,100% of Medicaid,1701.18,,,1701.18,Other,100% of Medicaid,3827.65,,,3827.65,Other,225% of Medicaid,2602.81,,,2602.81,Other,153% of Medicaid,3827.65,,,3827.65,Other,225% of Medicaid,2381.65,,,2381.65,Other,140% of Medicaid,3827.65,,,3827.65,Other,225% of Medicaid,4423.07,,,4423.07,Other,250% of Medicaid,5511.82,,,5511.82,Other,324% of Medicaid,3657.54,,,3657.54,Other,215% of Medicaid,3657.54,,,3657.54,Other,215% of Medicaid,2126.47,,,2126.47,Other,125% of Medicaid,1701.18,7216,
INJECTION FOR SHOULDER XR,23350,CPT,,42023350,CDM,361,RC,,,both,,,371,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",259.7,70,,259.7,percent of total billed charges,All Other,252.28,,,252.28,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,296.8,,,296.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",296.8,,,296.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,296.8,,,296.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",259.7,70,,259.7,percent of total billed charges,,239.44,,,239.44,Fee Schedule,,202.94,,,202.94,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR SHOULDER XR W/ FY MOD,23350,CPT,,42623350,CDM,361,RC,,,both,,,371,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",259.7,70,,259.7,percent of total billed charges,All Other,252.28,,,252.28,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,296.8,,,296.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",296.8,,,296.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,296.8,,,296.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",259.7,70,,259.7,percent of total billed charges,,239.44,,,239.44,Fee Schedule,,202.94,,,202.94,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR SHOULDER X-RAY,23350,CPT,,46023350,CDM,361,RC,,,both,,,371,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",259.7,70,,259.7,percent of total billed charges,All Other,252.28,,,252.28,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,296.8,,,296.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",296.8,,,296.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,296.8,,,296.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",259.7,70,,259.7,percent of total billed charges,,239.44,,,239.44,Fee Schedule,,202.94,,,202.94,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR ELBOW XR,24220,CPT,,42024220,CDM,361,RC,,,both,,,351,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",245.7,70,,245.7,percent of total billed charges,All Other,238.68,,,238.68,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,280.8,,,280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",280.8,,,280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,280.8,,,280.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",245.7,70,,245.7,percent of total billed charges,,318.16,,,318.16,Fee Schedule,,269.66,,,269.66,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR ELBOW XR W/ FY MOD,24220,CPT,,42624220,CDM,361,RC,,,both,,,351,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",245.7,70,,245.7,percent of total billed charges,All Other,238.68,,,238.68,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,280.8,,,280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",280.8,,,280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,280.8,,,280.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",245.7,70,,245.7,percent of total billed charges,,318.16,,,318.16,Fee Schedule,,269.66,,,269.66,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR WRIST XR,25246,CPT,,42025246,CDM,361,RC,,,both,,,386,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",270.2,70,,270.2,percent of total billed charges,All Other,262.48,,,262.48,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,308.8,,,308.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",308.8,,,308.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,308.8,,,308.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",270.2,70,,270.2,percent of total billed charges,,349.32,,,349.32,Fee Schedule,,296.07,,,296.07,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR WRIST XR W/ FY MOD,25246,CPT,,42625246,CDM,361,RC,,,both,,,386,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",270.2,70,,270.2,percent of total billed charges,All Other,262.48,,,262.48,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,308.8,,,308.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",308.8,,,308.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,308.8,,,308.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",270.2,70,,270.2,percent of total billed charges,,349.32,,,349.32,Fee Schedule,,296.07,,,296.07,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR HIP XR,27093,CPT,,42027093,CDM,361,RC,,,both,,,389,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",272.3,70,,272.3,percent of total billed charges,All Other,264.52,,,264.52,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,311.2,,,311.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",311.2,,,311.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,311.2,,,311.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",272.3,70,,272.3,percent of total billed charges,,324.72,,,324.72,Fee Schedule,,275.22,,,275.22,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR HIP XR W/ FY MOD,27093,CPT,,42627093,CDM,361,RC,,,both,,,389,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",272.3,70,,272.3,percent of total billed charges,All Other,264.52,,,264.52,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,311.2,,,311.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",311.2,,,311.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,311.2,,,311.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",272.3,70,,272.3,percent of total billed charges,,324.72,,,324.72,Fee Schedule,,275.22,,,275.22,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECT SACROILIAC JOINT,27096,CPT,,46027096,CDM,361,RC,,,both,,,338,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",229.84,,,229.84,Other,ASC Grouper table,830,,,830,Other,186% of Medicaid,270.4,,,270.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",270.4,,,270.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,270.4,,,270.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",236.6,70,,236.6,percent of total billed charges,,395.24,,,395.24,Fee Schedule,,334.99,,,334.99,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",446.24,,,446.24,Other,100% of Medicaid,446.24,,,446.24,Other,100% of Medicaid,446.24,,,446.24,Other,100% of Medicaid,446.24,,,446.24,Other,100% of Medicaid,1004.03,,,1004.03,Other,225% of Medicaid,682.74,,,682.74,Other,153% of Medicaid,1004.03,,,1004.03,Other,225% of Medicaid,624.73,,,624.73,Other,140% of Medicaid,1004.03,,,1004.03,Other,225% of Medicaid,1160.22,,,1160.22,Other,250% of Medicaid,1445.81,,,1445.81,Other,324% of Medicaid,959.41,,,959.41,Other,215% of Medicaid,959.41,,,959.41,Other,215% of Medicaid,557.8,,,557.8,Other,125% of Medicaid,0.01,7216,
INJECT SACROILIAC JOINT,27096,CPT,,47027096,CDM,361,RC,,,both,,,338,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",229.84,,,229.84,Other,ASC Grouper table,830,,,830,Other,186% of Medicaid,270.4,,,270.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",270.4,,,270.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,270.4,,,270.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",236.6,70,,236.6,percent of total billed charges,,395.24,,,395.24,Fee Schedule,,334.99,,,334.99,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",446.24,,,446.24,Other,100% of Medicaid,446.24,,,446.24,Other,100% of Medicaid,446.24,,,446.24,Other,100% of Medicaid,446.24,,,446.24,Other,100% of Medicaid,1004.03,,,1004.03,Other,225% of Medicaid,682.74,,,682.74,Other,153% of Medicaid,1004.03,,,1004.03,Other,225% of Medicaid,624.73,,,624.73,Other,140% of Medicaid,1004.03,,,1004.03,Other,225% of Medicaid,1160.22,,,1160.22,Other,250% of Medicaid,1445.81,,,1445.81,Other,324% of Medicaid,959.41,,,959.41,Other,215% of Medicaid,959.41,,,959.41,Other,215% of Medicaid,557.8,,,557.8,Other,125% of Medicaid,0.01,7216,
TENOTOMY OP FLEXOR; FT SGL/MULTI,28230,CPT,,73028230,CDM,361,RC,,,both,,,5245,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3671.5,70,,3671.5,percent of total billed charges,All Other,3566.6,,,3566.6,Other,ASC Grouper table,2890.82,,,2890.82,Other,186% of Medicaid,4196,,,4196,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4196,,,4196,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4196,,,4196,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3671.5,70,,3671.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1554.2,,,1554.2,Other,100% of Medicaid,1554.2,,,1554.2,Other,100% of Medicaid,1554.2,,,1554.2,Other,100% of Medicaid,1554.2,,,1554.2,Other,100% of Medicaid,3496.96,,,3496.96,Other,225% of Medicaid,2377.93,,,2377.93,Other,153% of Medicaid,3496.96,,,3496.96,Other,225% of Medicaid,2175.89,,,2175.89,Other,140% of Medicaid,3496.96,,,3496.96,Other,225% of Medicaid,4040.93,,,4040.93,Other,250% of Medicaid,5035.62,,,5035.62,Other,324% of Medicaid,3341.54,,,3341.54,Other,215% of Medicaid,3341.54,,,3341.54,Other,215% of Medicaid,1942.76,,,1942.76,Other,125% of Medicaid,1554.2,7216,
ASPIRATE PLEURA WO IMAGING,32554,CPT,,34032554,CDM,361,RC,,,both,,,1729,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1210.3,70,,1210.3,percent of total billed charges,All Other,1175.72,,,1175.72,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,1383.2,,,1383.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1383.2,,,1383.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1383.2,,,1383.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1210.3,70,,1210.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
INSERT CATH PLEURA W/ IMAGE,32557,CPT,,44032557,CDM,361,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2345,70,,2345,percent of total billed charges,All Other,2278,,,2278,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2680,,,2680,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2680,,,2680,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2680,,,2680,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2345,70,,2345,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
INSERT CATH PLEURA W/ IMAGE,32557,CPT,,46032557,CDM,361,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2345,70,,2345,percent of total billed charges,All Other,2278,,,2278,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2680,,,2680,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2680,,,2680,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2680,,,2680,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2345,70,,2345,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
INS TUNNELED CV/2 CATH W/O P,36565,CPT,,42036565,CDM,361,RC,,,both,,,10036,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2489.81,,,2489.81,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7025.2,70,,7025.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,2048.07,,,2048.07,Other,153% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,1874.05,,,1874.05,Other,140% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,3480.39,,,3480.39,Other,250% of Medicaid,4337.1,,,4337.1,Other,324% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,1673.26,,,1673.26,Other,125% of Medicaid,1338.61,9473,
INS TUNNELED CV/2 CATH W/O P W/ FY MOD,36565,CPT,,42636565,CDM,361,RC,,,both,,,10036,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,2489.81,,,2489.81,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7025.2,70,,7025.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,1338.61,,,1338.61,Other,100% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,2048.07,,,2048.07,Other,153% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,1874.05,,,1874.05,Other,140% of Medicaid,3011.87,,,3011.87,Other,225% of Medicaid,3480.39,,,3480.39,Other,250% of Medicaid,4337.1,,,4337.1,Other,324% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,2878.01,,,2878.01,Other,215% of Medicaid,1673.26,,,1673.26,Other,125% of Medicaid,1338.61,9473,
INSERT PICC CATH >5 YRS O,36569,CPT,,34036569,CDM,361,RC,,,both,,,4042,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2748.56,,,2748.56,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,3233.6,,,3233.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3233.6,,,3233.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2829.4,70,,2829.4,percent of total billed charges,,449.36,,,449.36,Fee Schedule,,380.86,,,380.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,7216,
INS PICC AGE 5 YRS >,36569,CPT,,82036569,CDM,361,RC,,,both,,,4042,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2748.56,,,2748.56,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,3233.6,,,3233.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3233.6,,,3233.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2829.4,70,,2829.4,percent of total billed charges,,449.36,,,449.36,Fee Schedule,,380.86,,,380.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,7216,
INS PERIPH CV/PORT >5 YRS,36571,CPT,,42036571,CDM,361,RC,,,both,,,8373,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5861.1,70,,5861.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,9473,
INS PERIPH CV/PORT >5 YRS W/ FY MOD,36571,CPT,,42636571,CDM,361,RC,,,both,,,8373,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3907,,,3907,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,5266,,,5266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5861.1,70,,5861.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,9473,
REPOSITION CV CATHETER,36597,CPT,,42036597,CDM,361,RC,,,both,,,3709,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2596.3,70,,2596.3,percent of total billed charges,All Other,2522.12,,,2522.12,Other,ASC Grouper table,1556.39,,,1556.39,Other,186% of Medicaid,2967.2,,,2967.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2967.2,,,2967.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2967.2,,,2967.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2596.3,70,,2596.3,percent of total billed charges,,285.36,,,285.36,Fee Schedule,,241.86,,,241.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,241.86,7216,
REPOSITION CV CATHETER W/ FY MOD,36597,CPT,,42636597,CDM,361,RC,,,both,,,3709,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2596.3,70,,2596.3,percent of total billed charges,All Other,2522.12,,,2522.12,Other,ASC Grouper table,1556.39,,,1556.39,Other,186% of Medicaid,2967.2,,,2967.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2967.2,,,2967.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2967.2,,,2967.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2596.3,70,,2596.3,percent of total billed charges,,285.36,,,285.36,Fee Schedule,,241.86,,,241.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,241.86,7216,
INJ W/FLUOR EVAL CV DEVICE W/ FY MOD,36598,CPT,,42636598,CDM,361,RC,,,both,,,794,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",555.8,70,,555.8,percent of total billed charges,All Other,539.92,,,539.92,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,635.2,,,635.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",635.2,,,635.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,635.2,,,635.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",555.8,70,,555.8,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,147.34,7216,
NEEDLE BIOPSY OF LIVER,47000,CPT,,42047000,CDM,361,RC,,,both,,,3495,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2376.6,,,2376.6,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2796,,,2796,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2796,,,2796,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2446.5,70,,2446.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
NEEDLE BIOPSY OF LIVER W/ FY MOD,47000,CPT,,42647000,CDM,361,RC,,,both,,,3495,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2376.6,,,2376.6,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2796,,,2796,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2796,,,2796,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2446.5,70,,2446.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
NEEDLE BIOPSY OF LIVER,47000,CPT,,44047000,CDM,361,RC,,,both,,,3495,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2376.6,,,2376.6,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,2796,,,2796,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2796,,,2796,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2446.5,70,,2446.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
IMAGE CATH FLUID COLXN VISC,49405,CPT,,44049405,CDM,361,RC,,,both,,,5062,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3543.4,70,,3543.4,percent of total billed charges,All Other,3442.16,,,3442.16,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,4049.6,,,4049.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4049.6,,,4049.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4049.6,,,4049.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3543.4,70,,3543.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
IMAGE CATH FLUID COLXN VISC,49405,CPT,,46049405,CDM,361,RC,,,both,,,5062,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3543.4,70,,3543.4,percent of total billed charges,All Other,3442.16,,,3442.16,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,4049.6,,,4049.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4049.6,,,4049.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4049.6,,,4049.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3543.4,70,,3543.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
IMAGE CATH FLUID PERI/RETRO,49406,CPT,,42049406,CDM,361,RC,,,both,,,5417,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3791.9,70,,3791.9,percent of total billed charges,All Other,3683.56,,,3683.56,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,4333.6,,,4333.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4333.6,,,4333.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4333.6,,,4333.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3791.9,70,,3791.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
IMAGE CATH FLUID PERI/RETRO W/ FY MOD,49406,CPT,,42649406,CDM,361,RC,,,both,,,5417,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3791.9,70,,3791.9,percent of total billed charges,All Other,3683.56,,,3683.56,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,4333.6,,,4333.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4333.6,,,4333.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4333.6,,,4333.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3791.9,70,,3791.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
IMAGE CATH FLUID PERI/RETRO,49406,CPT,,44049406,CDM,361,RC,,,both,,,5417,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3791.9,70,,3791.9,percent of total billed charges,All Other,3683.56,,,3683.56,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,4333.6,,,4333.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4333.6,,,4333.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4333.6,,,4333.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3791.9,70,,3791.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
IMAGE CATH FLUID PERI/RETRO,49406,CPT,,46049406,CDM,361,RC,,,both,,,5417,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3791.9,70,,3791.9,percent of total billed charges,All Other,3683.56,,,3683.56,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,4333.6,,,4333.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4333.6,,,4333.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,4333.6,,,4333.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3791.9,70,,3791.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
IMAGE CATH FLUID TRNS/VGNL,49407,CPT,,44049407,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2363.9,70,,2363.9,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,9473,
IMAGE CATH FLUID TRNS/VGNL,49407,CPT,,46049407,CDM,361,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,3473,,,3473,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3126,,,3126,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2363.9,70,,2363.9,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,1196.3,,,1196.3,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,9473,
ASSESS CYST CONTRAST INJECT,49424,CPT,,42049424,CDM,361,RC,,,both,,,241,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",168.7,70,,168.7,percent of total billed charges,All Other,163.88,,,163.88,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,192.8,,,192.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",192.8,,,192.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,192.8,,,192.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",168.7,70,,168.7,percent of total billed charges,,180.4,,,180.4,Fee Schedule,,152.9,,,152.9,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
ASSESS CYST CONTRAST INJECT W/ FY MOD,49424,CPT,,42649424,CDM,361,RC,,,both,,,241,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",168.7,70,,168.7,percent of total billed charges,All Other,163.88,,,163.88,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,192.8,,,192.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",192.8,,,192.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,192.8,,,192.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",168.7,70,,168.7,percent of total billed charges,,180.4,,,180.4,Fee Schedule,,152.9,,,152.9,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
REPLACE DUOD JEJ TUBE PERC,49451,CPT,,47049451,CDM,361,RC,,,both,,,4863,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3306.84,,,3306.84,Other,ASC Grouper table,1030.03,,,1030.03,Other,186% of Medicaid,3890.4,,,3890.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3890.4,,,3890.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3890.4,,,3890.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3404.1,70,,3404.1,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,360.01,7216,
INJECTION FOR URETER XR,50690,CPT,,42050690,CDM,361,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",28.7,70,,28.7,percent of total billed charges,All Other,27.88,,,27.88,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,32.8,,,32.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",32.8,,,32.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,32.8,,,32.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",28.7,70,,28.7,percent of total billed charges,,331.28,,,331.28,Fee Schedule,,280.78,,,280.78,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR URETER XR W/ FY MOD,50690,CPT,,42650690,CDM,361,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",28.7,70,,28.7,percent of total billed charges,All Other,27.88,,,27.88,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,32.8,,,32.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",32.8,,,32.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,32.8,,,32.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",28.7,70,,28.7,percent of total billed charges,,331.28,,,331.28,Fee Schedule,,280.78,,,280.78,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR BLADDER XR,51600,CPT,,42051600,CDM,361,RC,,,both,,,254,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",177.8,70,,177.8,percent of total billed charges,All Other,172.72,,,172.72,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,203.2,,,203.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",203.2,,,203.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,203.2,,,203.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",177.8,70,,177.8,percent of total billed charges,,209.92,,,209.92,Fee Schedule,,177.92,,,177.92,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
INJECTION FOR BLADDER XR W/ FY MOD,51600,CPT,,42651600,CDM,361,RC,,,both,,,254,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",177.8,70,,177.8,percent of total billed charges,All Other,172.72,,,172.72,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,203.2,,,203.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",203.2,,,203.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,203.2,,,203.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",177.8,70,,177.8,percent of total billed charges,,209.92,,,209.92,Fee Schedule,,177.92,,,177.92,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
CHANGE OF BLADDER TUBE,51705,CPT,,42051705,CDM,361,RC,,,both,,,776,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",543.2,70,,543.2,percent of total billed charges,All Other,527.68,,,527.68,Other,ASC Grouper table,847.47,,,847.47,Other,186% of Medicaid,620.8,,,620.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",620.8,,,620.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,620.8,,,620.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",543.2,70,,543.2,percent of total billed charges,,246,,,246,Fee Schedule,,208.5,,,208.5,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,697.11,,,697.11,Other,153% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,637.88,,,637.88,Other,140% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,1184.63,,,1184.63,Other,250% of Medicaid,1476.23,,,1476.23,Other,324% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,569.53,,,569.53,Other,125% of Medicaid,208.5,7216,
CHANGE OF BLADDER TUBE W/ FY MOD,51705,CPT,,42651705,CDM,361,RC,,,both,,,776,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",543.2,70,,543.2,percent of total billed charges,All Other,527.68,,,527.68,Other,ASC Grouper table,847.47,,,847.47,Other,186% of Medicaid,620.8,,,620.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",620.8,,,620.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,620.8,,,620.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",543.2,70,,543.2,percent of total billed charges,,246,,,246,Fee Schedule,,208.5,,,208.5,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,697.11,,,697.11,Other,153% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,637.88,,,637.88,Other,140% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,1184.63,,,1184.63,Other,250% of Medicaid,1476.23,,,1476.23,Other,324% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,569.53,,,569.53,Other,125% of Medicaid,208.5,7216,
HYSTEROSON INJECTION,58340,CPT,,42058340,CDM,361,RC,,,both,,,346,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",242.2,70,,242.2,percent of total billed charges,All Other,235.28,,,235.28,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,276.8,,,276.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",276.8,,,276.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,276.8,,,276.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",242.2,70,,242.2,percent of total billed charges,,272.24,,,272.24,Fee Schedule,,230.74,,,230.74,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
HYSTEROSON INJECTION,58340,CPT,52,42158340,CDM,361,RC,,,both,,,277,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",193.9,70,,193.9,percent of total billed charges,All Other,188.36,,,188.36,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,221.6,,,221.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",221.6,,,221.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,221.6,,,221.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",193.9,70,,193.9,percent of total billed charges,,272.24,,,272.24,Fee Schedule,,230.74,,,230.74,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
HYSTEROSON INJECTION W/ FY MOD,58340,CPT,,42658340,CDM,361,RC,,,both,,,346,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",242.2,70,,242.2,percent of total billed charges,All Other,235.28,,,235.28,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,276.8,,,276.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",276.8,,,276.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,276.8,,,276.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",242.2,70,,242.2,percent of total billed charges,,272.24,,,272.24,Fee Schedule,,230.74,,,230.74,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
HYSTEROSON INJECTION,58340,CPT,,44058340,CDM,361,RC,,,both,,,346,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",242.2,70,,242.2,percent of total billed charges,All Other,235.28,,,235.28,Other,ASC Grouper table,966.6,,,966.6,Other,186% of Medicaid,276.8,,,276.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",276.8,,,276.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,276.8,,,276.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",242.2,70,,242.2,percent of total billed charges,,272.24,,,272.24,Fee Schedule,,230.74,,,230.74,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,0.01,7216,
BIOPSY THYROID PERC CORE NEEDL,60100,CPT,,42060100,CDM,361,RC,,,both,,,1601,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1120.7,70,,1120.7,percent of total billed charges,All Other,1088.68,,,1088.68,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,1280.8,,,1280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1280.8,,,1280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1280.8,,,1280.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1120.7,70,,1120.7,percent of total billed charges,,367.36,,,367.36,Fee Schedule,,311.36,,,311.36,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,311.36,7216,
BIOPSY THYROID PERC CORE NEEDL W/ FY MOD,60100,CPT,,42660100,CDM,361,RC,,,both,,,1601,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1120.7,70,,1120.7,percent of total billed charges,All Other,1088.68,,,1088.68,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,1280.8,,,1280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1280.8,,,1280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1280.8,,,1280.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1120.7,70,,1120.7,percent of total billed charges,,367.36,,,367.36,Fee Schedule,,311.36,,,311.36,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,311.36,7216,
BIOPSY THYROID PERC CORE NEEDL,60100,CPT,,44060100,CDM,361,RC,,,both,,,1601,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1120.7,70,,1120.7,percent of total billed charges,All Other,1088.68,,,1088.68,Other,ASC Grouper table,1037.22,,,1037.22,Other,186% of Medicaid,1280.8,,,1280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1280.8,,,1280.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1280.8,,,1280.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1120.7,70,,1120.7,percent of total billed charges,,367.36,,,367.36,Fee Schedule,,311.36,,,311.36,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,311.36,7216,
INTERDISCAL PERQ ASPIR DX,62267,CPT,,46062267,CDM,361,RC,,,both,,,3395,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2308.6,,,2308.6,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,2716,,,2716,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2716,,,2716,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2716,,,2716,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2376.5,70,,2376.5,percent of total billed charges,,738,,,738,Fee Schedule,,625.5,,,625.5,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,600.01,7216,
INTERDISCAL PERQ ASPIR DX,62267,CPT,,47062267,CDM,361,RC,,,both,,,3395,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2308.6,,,2308.6,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,2716,,,2716,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2716,,,2716,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2716,,,2716,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2376.5,70,,2376.5,percent of total billed charges,,738,,,738,Fee Schedule,,625.5,,,625.5,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,600.01,7216,
LUMBAR PUNCTURE,62270,CPT,,34062270,CDM,361,RC,,,both,,,1479,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1005.72,,,1005.72,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1035.3,70,,1035.3,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,252.98,7216,
LUMBAR PUNCTURE INCOMPLETE AFTER ANES,62270,CPT,74,34162270,CDM,361,RC,,,both,,,1184,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",805.12,,,805.12,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,947.2,,,947.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",947.2,,,947.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",828.8,70,,828.8,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,252.98,7216,
LUMBAR PUNCTURE INCOMPLETE BEFORE ANES,62270,CPT,73,34262270,CDM,361,RC,,,both,,,1184,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",805.12,,,805.12,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,947.2,,,947.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",947.2,,,947.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",828.8,70,,828.8,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,252.98,7216,
LUMBAR PUNCTURE,62270,CPT,,42062270,CDM,361,RC,,,both,,,1479,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1005.72,,,1005.72,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1035.3,70,,1035.3,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,252.98,7216,
LUMBAR PUNCTURE W/ FY MOD,62270,CPT,,42662270,CDM,361,RC,,,both,,,1479,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1005.72,,,1005.72,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1035.3,70,,1035.3,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,252.98,7216,
LUMBAR PUNCTURE W/ FY MOD,62270,CPT,FY,43062270,CDM,361,RC,,,both,,,1479,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1005.72,,,1005.72,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1035.3,70,,1035.3,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,252.98,7216,
LUMBAR PUNCTURE,62270,CPT,,47062270,CDM,361,RC,,,both,,,1479,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1005.72,,,1005.72,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1035.3,70,,1035.3,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,252.98,7216,
LUMBAR PUNCTURE INCOMPLETE AFTER ANES,62270,CPT,74,47162270,CDM,361,RC,,,both,,,1184,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",805.12,,,805.12,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,947.2,,,947.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",947.2,,,947.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",828.8,70,,828.8,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,252.98,7216,
LUMBAR PUNCTURE,62270,CPT,,82062270,CDM,361,RC,,,both,,,1479,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1005.72,,,1005.72,Other,ASC Grouper table,1116,,,1116,Other,186% of Medicaid,1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1035.3,70,,1035.3,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,252.98,7216,
DRAIN CEREBRO SPINAL FLUID,62272,CPT,,42062272,CDM,361,RC,,,both,,,1452,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",987.36,,,987.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1161.6,,,1161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1161.6,,,1161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1016.4,70,,1016.4,percent of total billed charges,,431.32,,,431.32,Fee Schedule,,365.57,,,365.57,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,365.57,7216,
DRAIN CEREBRO SPINAL FLUID W/ FY MOD,62272,CPT,,42662272,CDM,361,RC,,,both,,,1452,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",987.36,,,987.36,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,1161.6,,,1161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1161.6,,,1161.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1016.4,70,,1016.4,percent of total billed charges,,431.32,,,431.32,Fee Schedule,,365.57,,,365.57,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,365.57,7216,
INJ EPIDURAL BLOOD OR CLOT PATCH,62273,CPT,,34062273,CDM,361,RC,,,both,,,2701,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1836.68,,,1836.68,Other,ASC Grouper table,1116.02,,,1116.02,Other,186% of Medicaid,2160.8,,,2160.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2160.8,,,2160.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1890.7,70,,1890.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,600.01,7216,
INJ EPIDURAL BLOOD OR CLOT PATCH,62273,CPT,,82062273,CDM,361,RC,,,both,,,2701,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1836.68,,,1836.68,Other,ASC Grouper table,1116,,,1116,Other,186% of Medicaid,2160.8,,,2160.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2160.8,,,2160.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1890.7,70,,1890.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,600.01,7216,
LAMINOTOMY SINGLE CERVICAL,63040,CPT,,42063040,CDM,361,RC,,,both,,,15553,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS,4827,,,4827,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4344,,,4344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10887.1,70,,10887.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,5525.15,,,5525.15,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12442.4,,,12442.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10887.1,70,,10887.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4544.88,,,4544.88,Other,153% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4158.71,,,4158.71,Other,140% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,7723.33,,,7723.33,Other,250% of Medicaid,9624.45,,,9624.45,Other,324% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,3713.14,,,3713.14,Other,125% of Medicaid,2970.51,12927.47,
LAMINOTOMY SINGLE CERVICAL W/ FY MOD,63040,CPT,,42663040,CDM,361,RC,,,both,,,15553,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS,4827,,,4827,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4344,,,4344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10887.1,70,,10887.1,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,5525.15,,,5525.15,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12442.4,,,12442.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10887.1,70,,10887.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4544.88,,,4544.88,Other,153% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4158.71,,,4158.71,Other,140% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,7723.33,,,7723.33,Other,250% of Medicaid,9624.45,,,9624.45,Other,324% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,3713.14,,,3713.14,Other,125% of Medicaid,2970.51,12927.47,
LAMINOTOMY SINGLE LUMBAR,63042,CPT,,42063042,CDM,361,RC,,,both,,,15553,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS,4827,,,4827,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4344,,,4344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,5525.15,,,5525.15,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12442.4,,,12442.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10887.1,70,,10887.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4544.88,,,4544.88,Other,153% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4158.71,,,4158.71,Other,140% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,7723.33,,,7723.33,Other,250% of Medicaid,9624.45,,,9624.45,Other,324% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,3713.14,,,3713.14,Other,125% of Medicaid,2970.51,12927.47,
LAMINOTOMY SINGLE LUMBAR W/ FY MOD,63042,CPT,,42663042,CDM,361,RC,,,both,,,15553,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS,4827,,,4827,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4344,,,4344,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,5525.15,,,5525.15,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12442.4,,,12442.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10887.1,70,,10887.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,2970.51,,,2970.51,Other,100% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4544.88,,,4544.88,Other,153% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,4158.71,,,4158.71,Other,140% of Medicaid,6683.65,,,6683.65,Other,225% of Medicaid,7723.33,,,7723.33,Other,250% of Medicaid,9624.45,,,9624.45,Other,324% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,6386.6,,,6386.6,Other,215% of Medicaid,3713.14,,,3713.14,Other,125% of Medicaid,2970.51,12927.47,
INJ ANESTH GREATER OCCIPITAL NERVE,64405,CPT,,82064405,CDM,361,RC,,,both,,,1164,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",814.8,70,,814.8,percent of total billed charges,All Other,791.52,,,791.52,Other,ASC Grouper table,966,,,966,Other,186% of Medicaid,931.2,,,931.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",931.2,,,931.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,931.2,,,931.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",814.8,70,,814.8,percent of total billed charges,,255.84,,,255.84,Fee Schedule,,216.84,,,216.84,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,794.43,,,794.43,Other,153% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,726.93,,,726.93,Other,140% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,1350.01,,,1350.01,Other,250% of Medicaid,1682.32,,,1682.32,Other,324% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,649.04,,,649.04,Other,125% of Medicaid,216.84,7216,
INJ ANESTH OTHR PERIPHERA,64450,CPT,,73064450,CDM,361,RC,,,both,,,1479,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1035.3,70,,1035.3,percent of total billed charges,All Other,1005.72,,,1005.72,Other,ASC Grouper table,965.78,,,965.78,Other,186% of Medicaid,1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1183.2,,,1183.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1035.3,70,,1035.3,percent of total billed charges,,203.36,,,203.36,Fee Schedule,,172.36,,,172.36,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,794.43,,,794.43,Other,153% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,726.93,,,726.93,Other,140% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,1350.01,,,1350.01,Other,250% of Medicaid,1682.32,,,1682.32,Other,324% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,649.04,,,649.04,Other,125% of Medicaid,172.36,7216,
INJ ANESTH OTHR PERIPHERA,64450,CPT,,82064450,CDM,361,RC,,,both,,,1479,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1035.3,70,,1035.3,percent of total billed charges,All Other,1005.72,,,1005.72,Other,ASC Grouper table,965.78,,,965.78,Other,186% of Medicaid,1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1183.2,,,1183.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1183.2,,,1183.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1035.3,70,,1035.3,percent of total billed charges,,203.36,,,203.36,Fee Schedule,,172.36,,,172.36,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,794.43,,,794.43,Other,153% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,726.93,,,726.93,Other,140% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,1350.01,,,1350.01,Other,250% of Medicaid,1682.32,,,1682.32,Other,324% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,649.04,,,649.04,Other,125% of Medicaid,172.36,7216,
DESTROY CERV/THOR FACET JNT,64633,CPT,,47064633,CDM,361,RC,,,both,,,4047,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2751.96,,,2751.96,Other,ASC Grouper table,1119.51,,,1119.51,Other,186% of Medicaid,3237.6,,,3237.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3237.6,,,3237.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3237.6,,,3237.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2832.9,70,,2832.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,920.88,,,920.88,Other,153% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,842.64,,,842.64,Other,140% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,1564.9,,,1564.9,Other,250% of Medicaid,1950.11,,,1950.11,Other,324% of Medicaid,1294.05,,,1294.05,Other,215% of Medicaid,1294.05,,,1294.05,Other,215% of Medicaid,752.36,,,752.36,Other,125% of Medicaid,601.89,7216,
DESTROY CERV/THOR FACET JNT ADDL,64634,CPT,,47064634,CDM,361,RC,,,both,,,721,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",490.28,,,490.28,Other,ASC Grouper table,965.78,,,965.78,Other,186% of Medicaid,576.8,,,576.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",576.8,,,576.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,576.8,,,576.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",504.7,70,,504.7,percent of total billed charges,,321.44,,,321.44,Fee Schedule,,272.44,,,272.44,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,794.43,,,794.43,Other,153% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,726.93,,,726.93,Other,140% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,1350.01,,,1350.01,Other,250% of Medicaid,1682.32,,,1682.32,Other,324% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,649.04,,,649.04,Other,125% of Medicaid,0.01,7216,
DESTROY LUMB/SAC FACET JNT,64635,CPT,,47064635,CDM,361,RC,,,both,,,4047,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2751.96,,,2751.96,Other,ASC Grouper table,1119.51,,,1119.51,Other,186% of Medicaid,3237.6,,,3237.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3237.6,,,3237.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3237.6,,,3237.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2832.9,70,,2832.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,920.88,,,920.88,Other,153% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,842.64,,,842.64,Other,140% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,1564.9,,,1564.9,Other,250% of Medicaid,1950.11,,,1950.11,Other,324% of Medicaid,1294.05,,,1294.05,Other,215% of Medicaid,1294.05,,,1294.05,Other,215% of Medicaid,752.36,,,752.36,Other,125% of Medicaid,601.89,7216,
DESTROY LUMB/SAC FACET JNT ADDL,64636,CPT,,47064636,CDM,361,RC,,,both,,,2232,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1517.76,,,1517.76,Other,ASC Grouper table,1119.51,,,1119.51,Other,186% of Medicaid,1785.6,,,1785.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1785.6,,,1785.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1785.6,,,1785.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1562.4,70,,1562.4,percent of total billed charges,,283.72,,,283.72,Fee Schedule,,240.47,,,240.47,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,920.88,,,920.88,Other,153% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,842.64,,,842.64,Other,140% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,1564.9,,,1564.9,Other,250% of Medicaid,1950.11,,,1950.11,Other,324% of Medicaid,1294.05,,,1294.05,Other,215% of Medicaid,1294.05,,,1294.05,Other,215% of Medicaid,752.36,,,752.36,Other,125% of Medicaid,0.01,7216,
UNLISTED PROCEDURE NERVOUS,64999,CPT,,42064999,CDM,361,RC,,,both,,,873,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,611.1,70,,611.1,percent of total billed charges,All Other,593.64,,,593.64,Other,ASC Grouper table,724.42,,,724.42,Other,186% of Medicaid,698.4,,,698.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",698.4,,,698.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,698.4,,,698.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",611.1,70,,611.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",389.48,,,389.48,Other,100% of Medicaid,389.48,,,389.48,Other,100% of Medicaid,389.48,,,389.48,Other,100% of Medicaid,389.48,,,389.48,Other,100% of Medicaid,876.32,,,876.32,Other,225% of Medicaid,595.9,,,595.9,Other,153% of Medicaid,876.32,,,876.32,Other,225% of Medicaid,545.27,,,545.27,Other,140% of Medicaid,876.32,,,876.32,Other,225% of Medicaid,1012.64,,,1012.64,Other,250% of Medicaid,1261.9,,,1261.9,Other,324% of Medicaid,837.37,,,837.37,Other,215% of Medicaid,837.37,,,837.37,Other,215% of Medicaid,486.84,,,486.84,Other,125% of Medicaid,0.01,7216,
UNLISTED PROCEDURE NERVOUS W/ FY MOD,64999,CPT,,42664999,CDM,361,RC,,,both,,,873,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,611.1,70,,611.1,percent of total billed charges,All Other,593.64,,,593.64,Other,ASC Grouper table,724.42,,,724.42,Other,186% of Medicaid,698.4,,,698.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",698.4,,,698.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,698.4,,,698.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",611.1,70,,611.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",389.48,,,389.48,Other,100% of Medicaid,389.48,,,389.48,Other,100% of Medicaid,389.48,,,389.48,Other,100% of Medicaid,389.48,,,389.48,Other,100% of Medicaid,876.32,,,876.32,Other,225% of Medicaid,595.9,,,595.9,Other,153% of Medicaid,876.32,,,876.32,Other,225% of Medicaid,545.27,,,545.27,Other,140% of Medicaid,876.32,,,876.32,Other,225% of Medicaid,1012.64,,,1012.64,Other,250% of Medicaid,1261.9,,,1261.9,Other,324% of Medicaid,837.37,,,837.37,Other,215% of Medicaid,837.37,,,837.37,Other,215% of Medicaid,486.84,,,486.84,Other,125% of Medicaid,0.01,7216,
LOW COST SKIN SUBSTITUTE APP,C5271,HCPCS,,73000010,CDM,361,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",916.3,70,,916.3,percent of total billed charges,All Other,890.12,,,890.12,Other,ASC Grouper table,2593.2,,,2593.2,Other,186% of Medicaid,1047.2,,,1047.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1047.2,,,1047.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1047.2,,,1047.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",916.3,70,,916.3,percent of total billed charges,,850.85,65,,850.85,percent of total billed charges,All Other,850.85,65,,850.85,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,690.13,7216,
LOW COST SKIN SUBSTITUTE APP,C5272,HCPCS,,73000011,CDM,361,RC,,,both,,,353,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",247.1,70,,247.1,percent of total billed charges,All Other,240.04,,,240.04,Other,ASC Grouper table,2238.09,,,2238.09,Other,186% of Medicaid,282.4,,,282.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",282.4,,,282.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,282.4,,,282.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",247.1,70,,247.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,1841.01,,,1841.01,Other,153% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,1684.59,,,1684.59,Other,140% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,3128.52,,,3128.52,Other,250% of Medicaid,3898.62,,,3898.62,Other,324% of Medicaid,2587.05,,,2587.05,Other,215% of Medicaid,2587.05,,,2587.05,Other,215% of Medicaid,1504.1,,,1504.1,Other,125% of Medicaid,0.01,7216,
LOW COST SKIN SUBSTITUTE APP,C5273,HCPCS,,73000012,CDM,361,RC,,,both,,,3886,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2720.2,70,,2720.2,percent of total billed charges,All Other,2642.48,,,2642.48,Other,ASC Grouper table,2593.2,,,2593.2,Other,186% of Medicaid,3108.8,,,3108.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3108.8,,,3108.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2720.2,70,,2720.2,percent of total billed charges,,2525.9,65,,2525.9,percent of total billed charges,All Other,2525.9,65,,2525.9,percent of total billed charges,All Other,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,1394.2,7216,
LOW COST SKIN SUBSTITUTE APP,C5274,HCPCS,,73000013,CDM,361,RC,,,both,,,961,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",672.7,70,,672.7,percent of total billed charges,All Other,653.48,,,653.48,Other,ASC Grouper table,2238.09,,,2238.09,Other,186% of Medicaid,768.8,,,768.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",768.8,,,768.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,768.8,,,768.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.7,70,,672.7,percent of total billed charges,,624.65,65,,624.65,percent of total billed charges,All Other,624.65,65,,624.65,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,1841.01,,,1841.01,Other,153% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,1684.59,,,1684.59,Other,140% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,3128.52,,,3128.52,Other,250% of Medicaid,3898.62,,,3898.62,Other,324% of Medicaid,2587.05,,,2587.05,Other,215% of Medicaid,2587.05,,,2587.05,Other,215% of Medicaid,1504.1,,,1504.1,Other,125% of Medicaid,0.01,7216,
LOW COST SKIN SUBSTITUTE APP,C5275,HCPCS,,73000014,CDM,361,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",916.3,70,,916.3,percent of total billed charges,All Other,890.12,,,890.12,Other,ASC Grouper table,2593.2,,,2593.2,Other,186% of Medicaid,1047.2,,,1047.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1047.2,,,1047.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1047.2,,,1047.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",916.3,70,,916.3,percent of total billed charges,,850.85,65,,850.85,percent of total billed charges,All Other,850.85,65,,850.85,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,690.13,7216,
LOW COST SKIN SUBSTITUTE APP,C5276,HCPCS,,73000015,CDM,361,RC,,,both,,,353,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",247.1,70,,247.1,percent of total billed charges,All Other,240.04,,,240.04,Other,ASC Grouper table,2238.09,,,2238.09,Other,186% of Medicaid,282.4,,,282.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",282.4,,,282.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,282.4,,,282.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",247.1,70,,247.1,percent of total billed charges,,229.45,65,,229.45,percent of total billed charges,All Other,229.45,65,,229.45,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,1841.01,,,1841.01,Other,153% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,1684.59,,,1684.59,Other,140% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,3128.52,,,3128.52,Other,250% of Medicaid,3898.62,,,3898.62,Other,324% of Medicaid,2587.05,,,2587.05,Other,215% of Medicaid,2587.05,,,2587.05,Other,215% of Medicaid,1504.1,,,1504.1,Other,125% of Medicaid,0.01,7216,
LOW COST SKIN SUBSTITUTE APP,C5277,HCPCS,,73000016,CDM,361,RC,,,both,,,1465,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1025.5,70,,1025.5,percent of total billed charges,All Other,996.2,,,996.2,Other,ASC Grouper table,2593.2,,,2593.2,Other,186% of Medicaid,1172,,,1172,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1172,,,1172,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1172,,,1172,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1025.5,70,,1025.5,percent of total billed charges,,952.25,65,,952.25,percent of total billed charges,All Other,952.25,65,,952.25,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,690.13,7216,
LOW COST SKIN SUBSTITUTE APP,C5278,HCPCS,,73000017,CDM,361,RC,,,both,,,961,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",672.7,70,,672.7,percent of total billed charges,All Other,653.48,,,653.48,Other,ASC Grouper table,2238.09,,,2238.09,Other,186% of Medicaid,768.8,,,768.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",768.8,,,768.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,768.8,,,768.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.7,70,,672.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,1203.28,,,1203.28,Other,100% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,1841.01,,,1841.01,Other,153% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,1684.59,,,1684.59,Other,140% of Medicaid,2707.37,,,2707.37,Other,225% of Medicaid,3128.52,,,3128.52,Other,250% of Medicaid,3898.62,,,3898.62,Other,324% of Medicaid,2587.05,,,2587.05,Other,215% of Medicaid,2587.05,,,2587.05,Other,215% of Medicaid,1504.1,,,1504.1,Other,125% of Medicaid,0.01,7216,
MOD SED SAME PHYS/QHP 5/>YR FIRST 15 MIN,99152,CPT,,35099152,CDM,370,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED SAME PHYS/QHP 5/>YR FIRST 15 MIN,99152,CPT,,49099152,CDM,370,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED SAME PHYS/QHP EA ADDL 15 MIN,99153,CPT,,35099153,CDM,370,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED SAME PHYS/QHP EA ADDL 15 MIN,99153,CPT,,49099153,CDM,370,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED SAME PHYS/QHP 5/>YR FIRST 15 MIN,99152,CPT,,44099152,CDM,371,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED SAME PHYS/QHP 5/>YR FIRST 15 MIN,99152,CPT,,46099152,CDM,371,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED SAME PHYS/QHP 5/>YR FIRST 15 MIN,99152,CPT,,47099152,CDM,371,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED SAME PHYS/QHP EA ADDL 15 MIN,99153,CPT,,44099153,CDM,371,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED SAME PHYS/QHP EA ADDL 15 MIN,99153,CPT,,46099153,CDM,371,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED SAME PHYS/QHP EA ADDL 15 MIN,99153,CPT,,47099153,CDM,371,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
COVID-19 CONVALESCENT PLASMA,C9507,HCPCS,,77000025,CDM,390,RC,,,both,,,2252,805.99,,,805.99,Other,150% of Medicare + 9.63% HCRA Surcharge,490.13,,,490.13,Other,Medicare OPPS,1576.4,70,,1576.4,percent of total billed charges,Blood Products,1576.4,70,,1576.4,percent of total billed charges,Blood Products,1576.4,70,,1576.4,percent of total billed charges,Blood Products,1576.4,70,,1576.4,percent of total billed charges,Blood Products,1576.4,70,,1576.4,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,1508.84,67,,1508.84,percent of total billed charges,Blood Products,1576.4,70,"If Charge > 500, then 70 percent",1576.4,percent of total billed charges,Blood Products,1508.84,67,,1508.84,percent of total billed charges,Blood Products,1508.84,67,,1508.84,percent of total billed charges,Blood Products,1508.84,67,,,percent of total billed charges,Blood Products,1508.84,67,,1508.84,percent of total billed charges,Blood Products,1508.84,67,,1508.84,percent of total billed charges,Blood Products,1576.4,70,,1576.4,percent of total billed charges,Blood Products,1576.4,70,,1576.4,percent of total billed charges,Blood Products,1576.4,70,,1576.4,percent of total billed charges,Blood Products,1576.4,70,,1576.4,percent of total billed charges,Blood Products,1508.84,67,,1508.84,percent of total billed charges,Blood Products,1508.84,67,,1508.84,percent of total billed charges,Blood Products,1508.84,67,,1508.84,percent of total billed charges,Blood Products,1508.84,67,,1508.84,percent of total billed charges,Blood Products,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,1576.4,70,"If Charge > 2,000, then 70 percent",1576.4,percent of total billed charges,Blood Products,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1576.4,
CRYOPRECIPITATE EA UNIT,P9012,HCPCS,,77000003,CDM,390,RC,,,both,,,918,98.45,,,98.45,Other,150% of Medicare + 9.63% HCRA Surcharge,59.87,,,59.87,Other,Medicare OPPS,642.6,70,,642.6,percent of total billed charges,Blood Products,642.6,70,,642.6,percent of total billed charges,Blood Products,642.6,70,,642.6,percent of total billed charges,Blood Products,642.6,70,,642.6,percent of total billed charges,Blood Products,642.6,70,,642.6,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,615.06,67,,615.06,percent of total billed charges,Blood Products,642.6,70,"If Charge > 500, then 70 percent",642.6,percent of total billed charges,Blood Products,615.06,67,,615.06,percent of total billed charges,Blood Products,615.06,67,,615.06,percent of total billed charges,Blood Products,615.06,67,,,percent of total billed charges,Blood Products,615.06,67,,615.06,percent of total billed charges,Blood Products,615.06,67,,615.06,percent of total billed charges,Blood Products,642.6,70,,642.6,percent of total billed charges,Blood Products,642.6,70,,642.6,percent of total billed charges,Blood Products,642.6,70,,642.6,percent of total billed charges,Blood Products,642.6,70,,642.6,percent of total billed charges,Blood Products,615.06,67,,615.06,percent of total billed charges,Blood Products,615.06,67,,615.06,percent of total billed charges,Blood Products,615.06,67,,615.06,percent of total billed charges,Blood Products,615.06,67,,615.06,percent of total billed charges,Blood Products,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,853.84,,,853.84,Other,153% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,781.29,,,781.29,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,1450.97,,,1450.97,Other,250% of Medicaid,1808.13,,,1808.13,Other,324% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,697.58,,,697.58,Other,125% of Medicaid,0.01,1808.13,
LEUKOCYTE POOR BLOOD EA UNIT,P9016,HCPCS,,77000004,CDM,390,RC,,,both,,,540,297.35,,,297.35,Other,150% of Medicare + 9.63% HCRA Surcharge,180.82,,,180.82,Other,Medicare OPPS,378,70,,378,percent of total billed charges,Blood Products,378,70,,378,percent of total billed charges,Blood Products,378,70,,378,percent of total billed charges,Blood Products,378,70,,378,percent of total billed charges,Blood Products,378,70,,378,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,361.8,67,,361.8,percent of total billed charges,Blood Products,378,70,"If Charge > 500, then 70 percent",378,percent of total billed charges,Blood Products,361.8,67,,361.8,percent of total billed charges,Blood Products,361.8,67,,361.8,percent of total billed charges,Blood Products,361.8,67,,,percent of total billed charges,Blood Products,361.8,67,,361.8,percent of total billed charges,Blood Products,361.8,67,,361.8,percent of total billed charges,Blood Products,378,70,,378,percent of total billed charges,Blood Products,378,70,,378,percent of total billed charges,Blood Products,378,70,,378,percent of total billed charges,Blood Products,378,70,,378,percent of total billed charges,Blood Products,361.8,67,,361.8,percent of total billed charges,Blood Products,361.8,67,,361.8,percent of total billed charges,Blood Products,361.8,67,,361.8,percent of total billed charges,Blood Products,361.8,67,,361.8,percent of total billed charges,Blood Products,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,1023.42,,,1023.42,Other,225% of Medicaid,695.93,,,695.93,Other,153% of Medicaid,1023.42,,,1023.42,Other,225% of Medicaid,636.79,,,636.79,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,1182.62,,,1182.62,Other,250% of Medicaid,1473.72,,,1473.72,Other,324% of Medicaid,977.93,,,977.93,Other,215% of Medicaid,977.93,,,977.93,Other,215% of Medicaid,568.57,,,568.57,Other,125% of Medicaid,0.01,1473.72,
WASHED RED BLOOD CELLS EA UNIT,P9022,HCPCS,,77000008,CDM,390,RC,,,both,,,792,653.04,,,653.04,Other,150% of Medicare + 9.63% HCRA Surcharge,397.12,,,397.12,Other,Medicare OPPS,554.4,70,,554.4,percent of total billed charges,Blood Products,554.4,70,,554.4,percent of total billed charges,Blood Products,554.4,70,,554.4,percent of total billed charges,Blood Products,554.4,70,,554.4,percent of total billed charges,Blood Products,554.4,70,,554.4,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,530.64,67,,530.64,percent of total billed charges,Blood Products,554.4,70,"If Charge > 500, then 70 percent",554.4,percent of total billed charges,Blood Products,530.64,67,,530.64,percent of total billed charges,Blood Products,530.64,67,,530.64,percent of total billed charges,Blood Products,530.64,67,,,percent of total billed charges,Blood Products,530.64,67,,530.64,percent of total billed charges,Blood Products,530.64,67,,530.64,percent of total billed charges,Blood Products,554.4,70,,554.4,percent of total billed charges,Blood Products,554.4,70,,554.4,percent of total billed charges,Blood Products,554.4,70,,554.4,percent of total billed charges,Blood Products,554.4,70,,554.4,percent of total billed charges,Blood Products,530.64,67,,530.64,percent of total billed charges,Blood Products,530.64,67,,530.64,percent of total billed charges,Blood Products,530.64,67,,530.64,percent of total billed charges,Blood Products,530.64,67,,530.64,percent of total billed charges,Blood Products,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,853.84,,,853.84,Other,153% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,781.29,,,781.29,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,1450.97,,,1450.97,Other,250% of Medicaid,1808.13,,,1808.13,Other,324% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,697.58,,,697.58,Other,125% of Medicaid,0.01,1808.13,
PLATELETS PHERESIS LR EA UNIT,P9035,HCPCS,,77000011,CDM,390,RC,,,both,,,1317,776.72,,,776.72,Other,150% of Medicare + 9.63% HCRA Surcharge,472.33,,,472.33,Other,Medicare OPPS,921.9,70,,921.9,percent of total billed charges,Blood Products,921.9,70,,921.9,percent of total billed charges,Blood Products,921.9,70,,921.9,percent of total billed charges,Blood Products,921.9,70,,921.9,percent of total billed charges,Blood Products,921.9,70,,921.9,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,882.39,67,,882.39,percent of total billed charges,Blood Products,921.9,70,"If Charge > 500, then 70 percent",921.9,percent of total billed charges,Blood Products,882.39,67,,882.39,percent of total billed charges,Blood Products,882.39,67,,882.39,percent of total billed charges,Blood Products,882.39,67,,,percent of total billed charges,Blood Products,882.39,67,,882.39,percent of total billed charges,Blood Products,882.39,67,,882.39,percent of total billed charges,Blood Products,921.9,70,,921.9,percent of total billed charges,Blood Products,921.9,70,,921.9,percent of total billed charges,Blood Products,921.9,70,,921.9,percent of total billed charges,Blood Products,921.9,70,,921.9,percent of total billed charges,Blood Products,882.39,67,,882.39,percent of total billed charges,Blood Products,882.39,67,,882.39,percent of total billed charges,Blood Products,882.39,67,,882.39,percent of total billed charges,Blood Products,882.39,67,,882.39,percent of total billed charges,Blood Products,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,853.84,,,853.84,Other,153% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,781.29,,,781.29,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,1450.97,,,1450.97,Other,250% of Medicaid,1808.13,,,1808.13,Other,324% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,697.58,,,697.58,Other,125% of Medicaid,0.01,1808.13,
PLATLTS PHERES LEUKOCYTES RDUC,P9035,HCPCS,,78000006,CDM,390,RC,,,both,,,921.9,776.72,,,776.72,Other,150% of Medicare + 9.63% HCRA Surcharge,472.33,,,472.33,Other,Medicare OPPS,645.33,70,,645.33,percent of total billed charges,Blood Products,645.33,70,,645.33,percent of total billed charges,Blood Products,645.33,70,,645.33,percent of total billed charges,Blood Products,645.33,70,,645.33,percent of total billed charges,Blood Products,645.33,70,,645.33,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,617.67,67,,617.67,percent of total billed charges,Blood Products,645.33,70,"If Charge > 500, then 70 percent",645.33,percent of total billed charges,Blood Products,617.67,67,,617.67,percent of total billed charges,Blood Products,617.67,67,,617.67,percent of total billed charges,Blood Products,617.67,67,,,percent of total billed charges,Blood Products,617.67,67,,617.67,percent of total billed charges,Blood Products,617.67,67,,617.67,percent of total billed charges,Blood Products,645.33,70,,645.33,percent of total billed charges,Blood Products,645.33,70,,645.33,percent of total billed charges,Blood Products,645.33,70,,645.33,percent of total billed charges,Blood Products,645.33,70,,645.33,percent of total billed charges,Blood Products,617.67,67,,617.67,percent of total billed charges,Blood Products,617.67,67,,617.67,percent of total billed charges,Blood Products,617.67,67,,617.67,percent of total billed charges,Blood Products,617.67,67,,617.67,percent of total billed charges,Blood Products,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,853.84,,,853.84,Other,153% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,781.29,,,781.29,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,1450.97,,,1450.97,Other,250% of Medicaid,1808.13,,,1808.13,Other,324% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,697.58,,,697.58,Other,125% of Medicaid,0.01,1808.13,
PLATELETS PHERESIS LR IRRAD EA UNIT,P9037,HCPCS,,77000013,CDM,390,RC,,,both,,,1409,1105.86,,,1105.86,Other,150% of Medicare + 9.63% HCRA Surcharge,672.48,,,672.48,Other,Medicare OPPS,986.3,70,,986.3,percent of total billed charges,Blood Products,986.3,70,,986.3,percent of total billed charges,Blood Products,986.3,70,,986.3,percent of total billed charges,Blood Products,986.3,70,,986.3,percent of total billed charges,Blood Products,986.3,70,,986.3,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,944.03,67,,944.03,percent of total billed charges,Blood Products,986.3,70,"If Charge > 500, then 70 percent",986.3,percent of total billed charges,Blood Products,944.03,67,,944.03,percent of total billed charges,Blood Products,944.03,67,,944.03,percent of total billed charges,Blood Products,944.03,67,,,percent of total billed charges,Blood Products,944.03,67,,944.03,percent of total billed charges,Blood Products,944.03,67,,944.03,percent of total billed charges,Blood Products,986.3,70,,986.3,percent of total billed charges,Blood Products,986.3,70,,986.3,percent of total billed charges,Blood Products,986.3,70,,986.3,percent of total billed charges,Blood Products,986.3,70,,986.3,percent of total billed charges,Blood Products,944.03,67,,944.03,percent of total billed charges,Blood Products,944.03,67,,944.03,percent of total billed charges,Blood Products,944.03,67,,944.03,percent of total billed charges,Blood Products,944.03,67,,944.03,percent of total billed charges,Blood Products,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,853.84,,,853.84,Other,153% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,781.29,,,781.29,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,1450.97,,,1450.97,Other,250% of Medicaid,1808.13,,,1808.13,Other,324% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,697.58,,,697.58,Other,125% of Medicaid,0.01,1808.13,
RBC IRRADIATED EACH UNIT,P9038,HCPCS,,77000014,CDM,390,RC,,,both,,,822,356.39,,,356.39,Other,150% of Medicare + 9.63% HCRA Surcharge,216.72,,,216.72,Other,Medicare OPPS,575.4,70,,575.4,percent of total billed charges,Blood Products,575.4,70,,575.4,percent of total billed charges,Blood Products,575.4,70,,575.4,percent of total billed charges,Blood Products,575.4,70,,575.4,percent of total billed charges,Blood Products,575.4,70,,575.4,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,550.74,67,,550.74,percent of total billed charges,Blood Products,575.4,70,"If Charge > 500, then 70 percent",575.4,percent of total billed charges,Blood Products,550.74,67,,550.74,percent of total billed charges,Blood Products,550.74,67,,550.74,percent of total billed charges,Blood Products,550.74,67,,,percent of total billed charges,Blood Products,550.74,67,,550.74,percent of total billed charges,Blood Products,550.74,67,,550.74,percent of total billed charges,Blood Products,575.4,70,,575.4,percent of total billed charges,Blood Products,575.4,70,,575.4,percent of total billed charges,Blood Products,575.4,70,,575.4,percent of total billed charges,Blood Products,575.4,70,,575.4,percent of total billed charges,Blood Products,550.74,67,,550.74,percent of total billed charges,Blood Products,550.74,67,,550.74,percent of total billed charges,Blood Products,550.74,67,,550.74,percent of total billed charges,Blood Products,550.74,67,,550.74,percent of total billed charges,Blood Products,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,1023.42,,,1023.42,Other,225% of Medicaid,695.93,,,695.93,Other,153% of Medicaid,1023.42,,,1023.42,Other,225% of Medicaid,636.79,,,636.79,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,1182.62,,,1182.62,Other,250% of Medicaid,1473.72,,,1473.72,Other,324% of Medicaid,977.93,,,977.93,Other,215% of Medicaid,977.93,,,977.93,Other,215% of Medicaid,568.57,,,568.57,Other,125% of Medicaid,0.01,1473.72,
RBC LR IRRADIATED EACH UNIT,P9040,HCPCS,,77000015,CDM,390,RC,,,both,,,638,415.19,,,415.19,Other,150% of Medicare + 9.63% HCRA Surcharge,252.48,,,252.48,Other,Medicare OPPS,446.6,70,,446.6,percent of total billed charges,Blood Products,446.6,70,,446.6,percent of total billed charges,Blood Products,446.6,70,,446.6,percent of total billed charges,Blood Products,446.6,70,,446.6,percent of total billed charges,Blood Products,446.6,70,,446.6,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,427.46,67,,427.46,percent of total billed charges,Blood Products,446.6,70,"If Charge > 500, then 70 percent",446.6,percent of total billed charges,Blood Products,427.46,67,,427.46,percent of total billed charges,Blood Products,427.46,67,,427.46,percent of total billed charges,Blood Products,427.46,67,,,percent of total billed charges,Blood Products,427.46,67,,427.46,percent of total billed charges,Blood Products,427.46,67,,427.46,percent of total billed charges,Blood Products,446.6,70,,446.6,percent of total billed charges,Blood Products,446.6,70,,446.6,percent of total billed charges,Blood Products,446.6,70,,446.6,percent of total billed charges,Blood Products,446.6,70,,446.6,percent of total billed charges,Blood Products,427.46,67,,427.46,percent of total billed charges,Blood Products,427.46,67,,427.46,percent of total billed charges,Blood Products,427.46,67,,427.46,percent of total billed charges,Blood Products,427.46,67,,427.46,percent of total billed charges,Blood Products,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,1023.42,,,1023.42,Other,225% of Medicaid,695.93,,,695.93,Other,153% of Medicaid,1023.42,,,1023.42,Other,225% of Medicaid,636.79,,,636.79,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,1182.62,,,1182.62,Other,250% of Medicaid,1473.72,,,1473.72,Other,324% of Medicaid,977.93,,,977.93,Other,215% of Medicaid,977.93,,,977.93,Other,215% of Medicaid,568.57,,,568.57,Other,125% of Medicaid,0.01,1473.72,
GRANULOCYTES PHERESIS UNIT,P9050,HCPCS,,78000021,CDM,390,RC,,,both,,,4954,1955.19,39.4668,,1955.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3467.8,70,,3467.8,percent of total billed charges,Blood Products,3467.8,70,,3467.8,percent of total billed charges,Blood Products,3467.8,70,,3467.8,percent of total billed charges,Blood Products,3467.8,70,,3467.8,percent of total billed charges,Blood Products,3467.8,70,,3467.8,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,3319.18,67,,3319.18,percent of total billed charges,Blood Products,3467.8,70,"If Charge > 500, then 70 percent",3467.8,percent of total billed charges,Blood Products,3319.18,67,,3319.18,percent of total billed charges,Blood Products,3319.18,67,,3319.18,percent of total billed charges,Blood Products,3319.18,67,,,percent of total billed charges,Blood Products,3319.18,67,,3319.18,percent of total billed charges,Blood Products,3319.18,67,,3319.18,percent of total billed charges,Blood Products,3467.8,70,,3467.8,percent of total billed charges,Blood Products,3467.8,70,,3467.8,percent of total billed charges,Blood Products,3467.8,70,,3467.8,percent of total billed charges,Blood Products,3467.8,70,,3467.8,percent of total billed charges,Blood Products,3319.18,67,,3319.18,percent of total billed charges,Blood Products,3319.18,67,,3319.18,percent of total billed charges,Blood Products,3319.18,67,,3319.18,percent of total billed charges,Blood Products,3319.18,67,,3319.18,percent of total billed charges,Blood Products,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,853.84,,,853.84,Other,153% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,781.29,,,781.29,Other,140% of Medicaid,3467.8,70,"If Charge > 2,000, then 70 percent",3467.8,percent of total billed charges,Blood Products,1450.97,,,1450.97,Other,250% of Medicaid,1808.13,,,1808.13,Other,324% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,697.58,,,697.58,Other,125% of Medicaid,0.01,3467.8,
FFP 8-24 HRS OF COLLECT EA UNIT,P9059,HCPCS,,77000020,CDM,390,RC,,,both,,,174,119.34,,,119.34,Other,150% of Medicare + 9.63% HCRA Surcharge,72.57,,,72.57,Other,Medicare OPPS,121.8,70,,121.8,percent of total billed charges,Blood Products,121.8,70,,121.8,percent of total billed charges,Blood Products,121.8,70,,121.8,percent of total billed charges,Blood Products,121.8,70,,121.8,percent of total billed charges,Blood Products,121.8,70,,121.8,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,116.58,67,,116.58,percent of total billed charges,Blood Products,0.01,70,"If Charge > 500, then 70 percent",0.01,percent of total billed charges,Blood Products,116.58,67,,116.58,percent of total billed charges,Blood Products,116.58,67,,116.58,percent of total billed charges,Blood Products,116.58,67,,,percent of total billed charges,Blood Products,116.58,67,,116.58,percent of total billed charges,Blood Products,116.58,67,,116.58,percent of total billed charges,Blood Products,121.8,70,,121.8,percent of total billed charges,Blood Products,121.8,70,,121.8,percent of total billed charges,Blood Products,121.8,70,,121.8,percent of total billed charges,Blood Products,121.8,70,,121.8,percent of total billed charges,Blood Products,116.58,67,,116.58,percent of total billed charges,Blood Products,116.58,67,,116.58,percent of total billed charges,Blood Products,116.58,67,,116.58,percent of total billed charges,Blood Products,116.58,67,,116.58,percent of total billed charges,Blood Products,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,1023.42,,,1023.42,Other,225% of Medicaid,695.93,,,695.93,Other,153% of Medicaid,1023.42,,,1023.42,Other,225% of Medicaid,636.79,,,636.79,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,1182.62,,,1182.62,Other,250% of Medicaid,1473.72,,,1473.72,Other,324% of Medicaid,977.93,,,977.93,Other,215% of Medicaid,977.93,,,977.93,Other,215% of Medicaid,568.57,,,568.57,Other,125% of Medicaid,0.01,1473.72,
PLATELETS PHERESIS PATH REDU,P9073,HCPCS,,78000022,CDM,390,RC,,,both,,,1789,906.55,,,906.55,Other,150% of Medicare + 9.63% HCRA Surcharge,551.28,,,551.28,Other,Medicare OPPS,1252.3,70,,1252.3,percent of total billed charges,Blood Products,1252.3,70,,1252.3,percent of total billed charges,Blood Products,1252.3,70,,1252.3,percent of total billed charges,Blood Products,1252.3,70,,1252.3,percent of total billed charges,Blood Products,1252.3,70,,1252.3,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,1198.63,67,,1198.63,percent of total billed charges,Blood Products,1252.3,70,"If Charge > 500, then 70 percent",1252.3,percent of total billed charges,Blood Products,1198.63,67,,1198.63,percent of total billed charges,Blood Products,1198.63,67,,1198.63,percent of total billed charges,Blood Products,1198.63,67,,,percent of total billed charges,Blood Products,1198.63,67,,1198.63,percent of total billed charges,Blood Products,1198.63,67,,1198.63,percent of total billed charges,Blood Products,1252.3,70,,1252.3,percent of total billed charges,Blood Products,1252.3,70,,1252.3,percent of total billed charges,Blood Products,1252.3,70,,1252.3,percent of total billed charges,Blood Products,1252.3,70,,1252.3,percent of total billed charges,Blood Products,1198.63,67,,1198.63,percent of total billed charges,Blood Products,1198.63,67,,1198.63,percent of total billed charges,Blood Products,1198.63,67,,1198.63,percent of total billed charges,Blood Products,1198.63,67,,1198.63,percent of total billed charges,Blood Products,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,558.07,,,558.07,Other,100% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,853.84,,,853.84,Other,153% of Medicaid,1255.65,,,1255.65,Other,225% of Medicaid,781.29,,,781.29,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,1450.97,,,1450.97,Other,250% of Medicaid,1808.13,,,1808.13,Other,324% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,1199.84,,,1199.84,Other,215% of Medicaid,697.58,,,697.58,Other,125% of Medicaid,0.01,1808.13,
TRANSFUSION BLOOD OR BLOOD COMPONENTS,36430,CPT,,26036430,CDM,391,RC,,,both,,,1109,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS,720.85,70,,720.85,percent of total billed charges,Blood Products,654.31,70,,654.31,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,"If Charge > 500, then 70 percent",776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,784.43,
BLOOD TRANSFUSION SERVICE,36430,CPT,,30036430,CDM,391,RC,,,both,,,1109,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS,720.85,70,,720.85,percent of total billed charges,Blood Products,654.31,70,,654.31,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,"If Charge > 500, then 70 percent",776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,784.43,
BLOOD TRANSFUSION SERVICE,36430,CPT,59,30136430,CDM,391,RC,,,both,,,1109,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS,720.85,70,,720.85,percent of total billed charges,Blood Products,654.31,70,,654.31,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,"If Charge > 500, then 70 percent",776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,784.43,
BLOOD TRANSFUSION SERVICE,36430,CPT,XU,30236430,CDM,391,RC,,,both,,,1109,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS,720.85,70,,720.85,percent of total billed charges,Blood Products,654.31,70,,654.31,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,"If Charge > 500, then 70 percent",776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,784.43,
TRANSFUSION BLOOD OR BLOOD COMPONENTS,36430,CPT,,34036430,CDM,391,RC,,,both,,,1109,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS,720.85,70,,720.85,percent of total billed charges,Blood Products,654.31,70,,654.31,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,"If Charge > 500, then 70 percent",776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,784.43,
TRANSFUSION BLOOD SERVICE,36430,CPT,,75036430,CDM,391,RC,,,both,,,1109,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS,720.85,70,,720.85,percent of total billed charges,Blood Products,654.31,70,,654.31,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,"If Charge > 500, then 70 percent",776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,784.43,
BLOOD TRANSFUSION SERVICE,36430,CPT,,82036430,CDM,391,RC,,,both,,,1109,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS,720.85,70,,720.85,percent of total billed charges,Blood Products,654.31,70,,654.31,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,0.01,,,0.01,Other,Non Covered Service,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,"If Charge > 500, then 70 percent",776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,776.3,70,,776.3,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,743.03,67,,743.03,percent of total billed charges,Blood Products,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,70,"If Charge > 2,000, then 70 percent",0.01,percent of total billed charges,Blood Products,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,784.43,
DX MAMMO INCL CAD UNI LT,77065,CPT,TCLT,54177065,CDM,401,RC,,,both,,,836,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,302.86,,,302.86,Fee Schedule,,272.48,,,272.48,Fee Schedule,,72.65,,,72.65,Fee Schedule,,72.65,,,72.65,Fee Schedule,,72.65,,,72.65,Fee Schedule,,585.2,70,,585.2,percent of total billed charges,All Other,359.82,,,359.82,Fee Schedule,,202,,,202,Other,186% of Medicaid,423.43,,,423.43,Fee Schedule,,518.32,,,518.32,Fee Schedule,,199.37,,,,Fee Schedule,,423.43,,,423.43,Fee Schedule,,518.32,,,518.32,Fee Schedule,,375.01,,,375.01,Fee Schedule,,585.2,70,,585.2,percent of total billed charges,,429.68,,,429.68,Fee Schedule,,364.18,,,364.18,Fee Schedule,,151.28,,,151.28,Fee Schedule,,151.28,,,151.28,Fee Schedule,,151.28,,,151.28,Fee Schedule,,151.28,,,151.28,Fee Schedule,,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,166.07,,,166.07,Other,153% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,151.96,,,151.96,Other,140% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,282.21,,,282.21,Other,250% of Medicaid,351.68,,,351.68,Other,324% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,135.68,,,135.68,Other,125% of Medicaid,0.01,585.2,
DX MAMMO INCL CAD UNI RT,77065,CPT,TCRT,54277065,CDM,401,RC,,,both,,,836,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,302.86,,,302.86,Fee Schedule,,272.48,,,272.48,Fee Schedule,,72.65,,,72.65,Fee Schedule,,72.65,,,72.65,Fee Schedule,,72.65,,,72.65,Fee Schedule,,585.2,70,,585.2,percent of total billed charges,All Other,359.82,,,359.82,Fee Schedule,,202,,,202,Other,186% of Medicaid,423.43,,,423.43,Fee Schedule,,518.32,,,518.32,Fee Schedule,,199.37,,,,Fee Schedule,,423.43,,,423.43,Fee Schedule,,518.32,,,518.32,Fee Schedule,,375.01,,,375.01,Fee Schedule,,585.2,70,,585.2,percent of total billed charges,,429.68,,,429.68,Fee Schedule,,364.18,,,364.18,Fee Schedule,,151.28,,,151.28,Fee Schedule,,151.28,,,151.28,Fee Schedule,,151.28,,,151.28,Fee Schedule,,151.28,,,151.28,Fee Schedule,,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,166.07,,,166.07,Other,153% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,151.96,,,151.96,Other,140% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,282.21,,,282.21,Other,250% of Medicaid,351.68,,,351.68,Other,324% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,135.68,,,135.68,Other,125% of Medicaid,0.01,585.2,
DX MAMMO AFTER SCREENING INCL CAD UNI,77065,CPT,TCGG,54377065,CDM,401,RC,,,both,,,836,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,302.86,,,302.86,Fee Schedule,,272.48,,,272.48,Fee Schedule,,72.65,,,72.65,Fee Schedule,,72.65,,,72.65,Fee Schedule,,72.65,,,72.65,Fee Schedule,,585.2,70,,585.2,percent of total billed charges,All Other,359.82,,,359.82,Fee Schedule,,202,,,202,Other,186% of Medicaid,423.43,,,423.43,Fee Schedule,,518.32,,,518.32,Fee Schedule,,199.37,,,,Fee Schedule,,423.43,,,423.43,Fee Schedule,,518.32,,,518.32,Fee Schedule,,375.01,,,375.01,Fee Schedule,,585.2,70,,585.2,percent of total billed charges,,429.68,,,429.68,Fee Schedule,,364.18,,,364.18,Fee Schedule,,151.28,,,151.28,Fee Schedule,,151.28,,,151.28,Fee Schedule,,151.28,,,151.28,Fee Schedule,,151.28,,,151.28,Fee Schedule,,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,166.07,,,166.07,Other,153% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,151.96,,,151.96,Other,140% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,282.21,,,282.21,Other,250% of Medicaid,351.68,,,351.68,Other,324% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,135.68,,,135.68,Other,125% of Medicaid,0.01,585.2,
DX MAMMO INCL CAD BI,77066,CPT,TC,54077066,CDM,401,RC,,,both,,,1070,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,388.51,,,388.51,Fee Schedule,,349.54,,,349.54,Fee Schedule,,92.79,,,92.79,Fee Schedule,,92.79,,,92.79,Fee Schedule,,92.79,,,92.79,Fee Schedule,,749,70,,749,percent of total billed charges,All Other,461.58,,,461.58,Fee Schedule,,202,,,202,Other,186% of Medicaid,543.18,,,543.18,Fee Schedule,,663.4,,,663.4,Fee Schedule,,255.76,,,,Fee Schedule,,543.18,,,543.18,Fee Schedule,,663.4,,,663.4,Fee Schedule,,481.07,,,481.07,Fee Schedule,,749,70,,749,percent of total billed charges,,547.76,,,547.76,Fee Schedule,,464.26,,,464.26,Fee Schedule,,192.86,,,192.86,Fee Schedule,,192.86,,,192.86,Fee Schedule,,192.86,,,192.86,Fee Schedule,,192.86,,,192.86,Fee Schedule,,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,166.07,,,166.07,Other,153% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,151.96,,,151.96,Other,140% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,282.21,,,282.21,Other,250% of Medicaid,351.68,,,351.68,Other,324% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,135.68,,,135.68,Other,125% of Medicaid,0.01,749,
DX MAMMO AFTER SCREENING INCL CAD BI,77066,CPT,TCGG,54377066,CDM,401,RC,,,both,,,1070,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,388.51,,,388.51,Fee Schedule,,349.54,,,349.54,Fee Schedule,,92.79,,,92.79,Fee Schedule,,92.79,,,92.79,Fee Schedule,,92.79,,,92.79,Fee Schedule,,749,70,,749,percent of total billed charges,All Other,461.58,,,461.58,Fee Schedule,,202,,,202,Other,186% of Medicaid,543.18,,,543.18,Fee Schedule,,663.4,,,663.4,Fee Schedule,,255.76,,,,Fee Schedule,,543.18,,,543.18,Fee Schedule,,663.4,,,663.4,Fee Schedule,,481.07,,,481.07,Fee Schedule,,749,70,,749,percent of total billed charges,,547.76,,,547.76,Fee Schedule,,464.26,,,464.26,Fee Schedule,,192.86,,,192.86,Fee Schedule,,192.86,,,192.86,Fee Schedule,,192.86,,,192.86,Fee Schedule,,192.86,,,192.86,Fee Schedule,,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,166.07,,,166.07,Other,153% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,151.96,,,151.96,Other,140% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,282.21,,,282.21,Other,250% of Medicaid,351.68,,,351.68,Other,324% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,135.68,,,135.68,Other,125% of Medicaid,0.01,749,
DRAINAGE CATH UNDER XR,75989,CPT,TC,44075989,CDM,402,RC,,,both,,,2125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,197.72,,,197.72,Fee Schedule,,177.88,,,177.88,Fee Schedule,,542.63,,,542.63,Fee Schedule,,488.17,,,488.17,Fee Schedule,,461.43,,,461.43,Fee Schedule,,1487.5,70,,1487.5,percent of total billed charges,All Other,234.9,,,234.9,Fee Schedule,,558,,,558,Other,186% of Medicaid,276.43,,,276.43,Fee Schedule,,1317.5,,,1317.5,Fee Schedule,,130.16,,,,Fee Schedule,,276.43,,,276.43,Fee Schedule,,1317.5,,,1317.5,Fee Schedule,,244.82,,,244.82,Fee Schedule,,1487.5,70,,1487.5,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,1487.5,
US NEONATAL HEAD,76506,CPT,TC,44076506,CDM,402,RC,,,both,,,676,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,285.51,,,285.51,Fee Schedule,,256.87,,,256.87,Fee Schedule,,437.96,,,437.96,Fee Schedule,,394.01,,,394.01,Fee Schedule,,372.43,,,372.43,Fee Schedule,,473.2,70,,473.2,percent of total billed charges,All Other,339.21,,,339.21,Fee Schedule,,240,,,240,Other,186% of Medicaid,399.17,,,399.17,Fee Schedule,,419.12,,,419.12,Fee Schedule,,187.95,,,,Fee Schedule,,399.17,,,399.17,Fee Schedule,,419.12,,,419.12,Fee Schedule,,353.53,,,353.53,Fee Schedule,,473.2,70,,473.2,percent of total billed charges,,419.84,,,419.84,Fee Schedule,,355.84,,,355.84,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,473.2,
US EXAM OF HEAD AND NECK,76536,CPT,TC,44076536,CDM,402,RC,,,both,,,807,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,291.31,,,291.31,Fee Schedule,,262.09,,,262.09,Fee Schedule,,637.82,,,637.82,Fee Schedule,,573.8,,,573.8,Fee Schedule,,542.38,,,542.38,Fee Schedule,,564.9,70,,564.9,percent of total billed charges,All Other,346.1,,,346.1,Fee Schedule,,240,,,240,Other,186% of Medicaid,407.29,,,407.29,Fee Schedule,,500.34,,,500.34,Fee Schedule,,191.77,,,,Fee Schedule,,407.29,,,407.29,Fee Schedule,,500.34,,,500.34,Fee Schedule,,360.71,,,360.71,Fee Schedule,,564.9,70,,564.9,percent of total billed charges,,419.84,,,419.84,Fee Schedule,,355.84,,,355.84,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,637.82,
US EXAM CHEST,76604,CPT,TC,44076604,CDM,402,RC,,,both,,,550,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,105.3,,,105.3,Fee Schedule,,94.74,,,94.74,Fee Schedule,,428.43,,,428.43,Fee Schedule,,385.43,,,385.43,Fee Schedule,,364.32,,,364.32,Fee Schedule,,385,70,,385,percent of total billed charges,All Other,125.11,,,125.11,Fee Schedule,,240,,,240,Other,186% of Medicaid,147.22,,,147.22,Fee Schedule,,341,,,341,Fee Schedule,,69.32,,,,Fee Schedule,,147.22,,,147.22,Fee Schedule,,341,,,341,Fee Schedule,,130.39,,,130.39,Fee Schedule,,385,70,,385,percent of total billed charges,,150.88,,,150.88,Fee Schedule,,127.88,,,127.88,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,69.32,428.43,
US BREAST COMPLETE LT,76641,CPT,TCLT,44176641,CDM,402,RC,,,both,,,634,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,236.99,,,236.99,Fee Schedule,,213.21,,,213.21,Fee Schedule,,74.78,,,74.78,Fee Schedule,,74.78,,,74.78,Fee Schedule,,74.78,,,74.78,Fee Schedule,,443.8,70,,443.8,percent of total billed charges,All Other,281.56,,,281.56,Fee Schedule,,240,,,240,Other,186% of Medicaid,331.33,,,331.33,Fee Schedule,,393.08,,,393.08,Fee Schedule,,156.01,,,,Fee Schedule,,331.33,,,331.33,Fee Schedule,,393.08,,,393.08,Fee Schedule,,293.45,,,293.45,Fee Schedule,,443.8,70,,443.8,percent of total billed charges,,339.48,,,339.48,Fee Schedule,,287.73,,,287.73,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,74.78,443.8,
US BREAST COMPLETE RT,76641,CPT,TCRT,44276641,CDM,402,RC,,,both,,,634,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,236.99,,,236.99,Fee Schedule,,213.21,,,213.21,Fee Schedule,,74.78,,,74.78,Fee Schedule,,74.78,,,74.78,Fee Schedule,,74.78,,,74.78,Fee Schedule,,443.8,70,,443.8,percent of total billed charges,All Other,281.56,,,281.56,Fee Schedule,,240,,,240,Other,186% of Medicaid,331.33,,,331.33,Fee Schedule,,393.08,,,393.08,Fee Schedule,,156.01,,,,Fee Schedule,,331.33,,,331.33,Fee Schedule,,393.08,,,393.08,Fee Schedule,,293.45,,,293.45,Fee Schedule,,443.8,70,,443.8,percent of total billed charges,,339.48,,,339.48,Fee Schedule,,287.73,,,287.73,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,74.78,443.8,
US BREAST COMPLETE BILATERAL,76641,CPT,TC50,44376641,CDM,402,RC,,,both,,,951,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,236.99,,,236.99,Fee Schedule,,213.21,,,213.21,Fee Schedule,,74.78,,,74.78,Fee Schedule,,74.78,,,74.78,Fee Schedule,,74.78,,,74.78,Fee Schedule,,665.7,70,,665.7,percent of total billed charges,All Other,281.56,,,281.56,Fee Schedule,,240,,,240,Other,186% of Medicaid,331.33,,,331.33,Fee Schedule,,589.62,,,589.62,Fee Schedule,,156.01,,,,Fee Schedule,,331.33,,,331.33,Fee Schedule,,589.62,,,589.62,Fee Schedule,,293.45,,,293.45,Fee Schedule,,665.7,70,,665.7,percent of total billed charges,,339.48,,,339.48,Fee Schedule,,287.73,,,287.73,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,74.78,665.7,
US BREAST LIMITED LT,76642,CPT,TCLT,44176642,CDM,402,RC,,,both,,,415,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,183.87,,,183.87,Fee Schedule,,165.43,,,165.43,Fee Schedule,,57.01,,,57.01,Fee Schedule,,57.01,,,57.01,Fee Schedule,,57.01,,,57.01,Fee Schedule,,290.5,70,,290.5,percent of total billed charges,All Other,218.46,,,218.46,Fee Schedule,,240,,,240,Other,186% of Medicaid,257.07,,,257.07,Fee Schedule,,257.3,,,257.3,Fee Schedule,,121.04,,,,Fee Schedule,,257.07,,,257.07,Fee Schedule,,257.3,,,257.3,Fee Schedule,,227.68,,,227.68,Fee Schedule,,290.5,70,,290.5,percent of total billed charges,,259.12,,,259.12,Fee Schedule,,219.62,,,219.62,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,57.01,418.39,
US BREAST LIMITED RT,76642,CPT,TCRT,44276642,CDM,402,RC,,,both,,,415,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,183.87,,,183.87,Fee Schedule,,165.43,,,165.43,Fee Schedule,,57.01,,,57.01,Fee Schedule,,57.01,,,57.01,Fee Schedule,,57.01,,,57.01,Fee Schedule,,290.5,70,,290.5,percent of total billed charges,All Other,218.46,,,218.46,Fee Schedule,,240,,,240,Other,186% of Medicaid,257.07,,,257.07,Fee Schedule,,257.3,,,257.3,Fee Schedule,,121.04,,,,Fee Schedule,,257.07,,,257.07,Fee Schedule,,257.3,,,257.3,Fee Schedule,,227.68,,,227.68,Fee Schedule,,290.5,70,,290.5,percent of total billed charges,,259.12,,,259.12,Fee Schedule,,219.62,,,219.62,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,57.01,418.39,
US BREAST LIMITED BILATERAL,76642,CPT,TC50,44376642,CDM,402,RC,,,both,,,623,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,183.87,,,183.87,Fee Schedule,,165.43,,,165.43,Fee Schedule,,57.01,,,57.01,Fee Schedule,,57.01,,,57.01,Fee Schedule,,57.01,,,57.01,Fee Schedule,,436.1,70,,436.1,percent of total billed charges,All Other,218.46,,,218.46,Fee Schedule,,240,,,240,Other,186% of Medicaid,257.07,,,257.07,Fee Schedule,,386.26,,,386.26,Fee Schedule,,121.04,,,,Fee Schedule,,257.07,,,257.07,Fee Schedule,,386.26,,,386.26,Fee Schedule,,227.68,,,227.68,Fee Schedule,,436.1,70,,436.1,percent of total billed charges,,259.12,,,259.12,Fee Schedule,,219.62,,,219.62,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,57.01,436.1,
US ABDOMEN COMPLETE,76700,CPT,TC,44076700,CDM,402,RC,,,both,,,1165,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,272.97,,,272.97,Fee Schedule,,245.59,,,245.59,Fee Schedule,,673.49,,,673.49,Fee Schedule,,605.9,,,605.9,Fee Schedule,,572.71,,,572.71,Fee Schedule,,815.5,70,,815.5,percent of total billed charges,All Other,324.31,,,324.31,Fee Schedule,,996,,,996,Other,186% of Medicaid,381.64,,,381.64,Fee Schedule,,722.3,,,722.3,Fee Schedule,,179.7,,,,Fee Schedule,,381.64,,,381.64,Fee Schedule,,722.3,,,722.3,Fee Schedule,,338,,,338,Fee Schedule,,815.5,70,,815.5,percent of total billed charges,,391.96,,,391.96,Fee Schedule,,332.21,,,332.21,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,120.81,1734.3,
US ABDOMEN LIMITED,76705,CPT,TC,44076705,CDM,402,RC,,,both,,,982,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,206.97,,,206.97,Fee Schedule,,186.21,,,186.21,Fee Schedule,,547.4,,,547.4,Fee Schedule,,492.46,,,492.46,Fee Schedule,,465.49,,,465.49,Fee Schedule,,687.4,70,,687.4,percent of total billed charges,All Other,245.9,,,245.9,Fee Schedule,,240,,,240,Other,186% of Medicaid,289.36,,,289.36,Fee Schedule,,608.84,,,608.84,Fee Schedule,,136.25,,,,Fee Schedule,,289.36,,,289.36,Fee Schedule,,608.84,,,608.84,Fee Schedule,,256.28,,,256.28,Fee Schedule,,687.4,70,,687.4,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,687.4,
US ABDL AORTA SCREEN AAA,76706,CPT,TC,44076706,CDM,402,RC,,,both,,,657,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,280.91,,,280.91,Fee Schedule,,252.73,,,252.73,Fee Schedule,,64.79,,,64.79,Fee Schedule,,64.79,,,64.79,Fee Schedule,,64.79,,,64.79,Fee Schedule,,459.9,70,,459.9,percent of total billed charges,All Other,333.75,,,333.75,Fee Schedule,,240,,,240,Other,186% of Medicaid,392.75,,,392.75,Fee Schedule,,407.34,,,407.34,Fee Schedule,,184.93,,,,Fee Schedule,,392.75,,,392.75,Fee Schedule,,407.34,,,407.34,Fee Schedule,,347.84,,,347.84,Fee Schedule,,459.9,70,,459.9,percent of total billed charges,,398.52,,,398.52,Fee Schedule,,337.77,,,337.77,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,64.79,459.9,
US RETROPERITONEAL COMPL,76770,CPT,TC,44076770,CDM,402,RC,,,both,,,1039,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,255.49,,,255.49,Fee Schedule,,229.86,,,229.86,Fee Schedule,,673.49,,,673.49,Fee Schedule,,605.9,,,605.9,Fee Schedule,,572.71,,,572.71,Fee Schedule,,727.3,70,,727.3,percent of total billed charges,All Other,303.54,,,303.54,Fee Schedule,,996,,,996,Other,186% of Medicaid,357.2,,,357.2,Fee Schedule,,644.18,,,644.18,Fee Schedule,,168.19,,,,Fee Schedule,,357.2,,,357.2,Fee Schedule,,644.18,,,644.18,Fee Schedule,,316.36,,,316.36,Fee Schedule,,727.3,70,,727.3,percent of total billed charges,,365.72,,,365.72,Fee Schedule,,309.97,,,309.97,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,120.81,1734.3,
US RETROPERITONEAL LTD,76775,CPT,TC,44076775,CDM,402,RC,,,both,,,1406,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,113.37,,,113.37,Fee Schedule,,102,,,102,Fee Schedule,,580.72,,,580.72,Fee Schedule,,522.43,,,522.43,Fee Schedule,,493.82,,,493.82,Fee Schedule,,984.2,70,,984.2,percent of total billed charges,All Other,134.7,,,134.7,Fee Schedule,,240,,,240,Other,186% of Medicaid,158.51,,,158.51,Fee Schedule,,871.72,,,871.72,Fee Schedule,,74.63,,,,Fee Schedule,,158.51,,,158.51,Fee Schedule,,871.72,,,871.72,Fee Schedule,,140.38,,,140.38,Fee Schedule,,984.2,70,,984.2,percent of total billed charges,,149.24,,,149.24,Fee Schedule,,126.49,,,126.49,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,74.63,984.2,
US SPINAL CANAL W CONTENTS,76800,CPT,TC,44076800,CDM,402,RC,,,both,,,816,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,369.85,,,369.85,Fee Schedule,,332.75,,,332.75,Fee Schedule,,552.16,,,552.16,Fee Schedule,,496.75,,,496.75,Fee Schedule,,469.54,,,469.54,Fee Schedule,,571.2,70,,571.2,percent of total billed charges,All Other,439.41,,,439.41,Fee Schedule,,240,,,240,Other,186% of Medicaid,517.09,,,517.09,Fee Schedule,,505.92,,,505.92,Fee Schedule,,243.47,,,,Fee Schedule,,517.09,,,517.09,Fee Schedule,,505.92,,,505.92,Fee Schedule,,457.96,,,457.96,Fee Schedule,,571.2,70,,571.2,percent of total billed charges,,431.32,,,431.32,Fee Schedule,,365.57,,,365.57,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,571.2,
US 1ST TRIMESTER,76801,CPT,TC,44076801,CDM,402,RC,,,both,,,658,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,246.24,,,246.24,Fee Schedule,,221.54,,,221.54,Fee Schedule,,573.59,,,573.59,Fee Schedule,,516.02,,,516.02,Fee Schedule,,487.76,,,487.76,Fee Schedule,,460.6,70,,460.6,percent of total billed charges,All Other,292.55,,,292.55,Fee Schedule,,209,,,209,Other,186% of Medicaid,344.27,,,344.27,Fee Schedule,,407.96,,,407.96,Fee Schedule,,162.1,,,,Fee Schedule,,344.27,,,344.27,Fee Schedule,,407.96,,,407.96,Fee Schedule,,304.9,,,304.9,Fee Schedule,,460.6,70,,460.6,percent of total billed charges,,349.32,,,349.32,Fee Schedule,,296.07,,,296.07,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,573.59,
US 1ST TRIM EA ADD GEST,76802,CPT,TC,44076802,CDM,402,RC,,,both,,,319,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,72.8,,,72.8,Fee Schedule,,65.49,,,65.49,Fee Schedule,,204.73,,,204.73,Fee Schedule,,184.18,,,184.18,Fee Schedule,,174.1,,,174.1,Fee Schedule,,223.3,70,,223.3,percent of total billed charges,All Other,86.49,,,86.49,Fee Schedule,,209,,,209,Other,186% of Medicaid,101.78,,,101.78,Fee Schedule,,197.78,,,197.78,Fee Schedule,,47.92,,,,Fee Schedule,,101.78,,,101.78,Fee Schedule,,197.78,,,197.78,Fee Schedule,,90.14,,,90.14,Fee Schedule,,223.3,70,,223.3,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,0.01,364.84,
US 2ND OR 3RD TRIMESTER,76805,CPT,TC,44076805,CDM,402,RC,,,both,,,826,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,308.79,,,308.79,Fee Schedule,,277.82,,,277.82,Fee Schedule,,673.49,,,673.49,Fee Schedule,,605.9,,,605.9,Fee Schedule,,572.71,,,572.71,Fee Schedule,,578.2,70,,578.2,percent of total billed charges,All Other,366.87,,,366.87,Fee Schedule,,209,,,209,Other,186% of Medicaid,431.73,,,431.73,Fee Schedule,,512.12,,,512.12,Fee Schedule,,203.28,,,,Fee Schedule,,431.73,,,431.73,Fee Schedule,,512.12,,,512.12,Fee Schedule,,382.36,,,382.36,Fee Schedule,,578.2,70,,578.2,percent of total billed charges,,434.6,,,434.6,Fee Schedule,,368.35,,,368.35,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,673.49,
US 2ND 3RD TRIMESTER ADDL GEST,76810,CPT,TC,44076810,CDM,402,RC,,,both,,,457,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,143.42,,,143.42,Fee Schedule,,129.04,,,129.04,Fee Schedule,,349.9,,,349.9,Fee Schedule,,314.78,,,314.78,Fee Schedule,,297.54,,,297.54,Fee Schedule,,319.9,70,,319.9,percent of total billed charges,All Other,170.4,,,170.4,Fee Schedule,,209,,,209,Other,186% of Medicaid,200.52,,,200.52,Fee Schedule,,283.34,,,283.34,Fee Schedule,,94.42,,,,Fee Schedule,,200.52,,,200.52,Fee Schedule,,283.34,,,283.34,Fee Schedule,,177.59,,,177.59,Fee Schedule,,319.9,70,,319.9,percent of total billed charges,,205,,,205,Fee Schedule,,173.75,,,173.75,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,0.01,364.84,
US DETAILED SNGL FETUS,76811,CPT,TC,44076811,CDM,402,RC,,,both,,,714,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,306.65,,,306.65,Fee Schedule,,275.89,,,275.89,Fee Schedule,,702.04,,,702.04,Fee Schedule,,631.58,,,631.58,Fee Schedule,,596.99,,,596.99,Fee Schedule,,499.8,70,,499.8,percent of total billed charges,All Other,364.33,,,364.33,Fee Schedule,,209,,,209,Other,186% of Medicaid,428.74,,,428.74,Fee Schedule,,442.68,,,442.68,Fee Schedule,,201.87,,,,Fee Schedule,,428.74,,,428.74,Fee Schedule,,442.68,,,442.68,Fee Schedule,,379.71,,,379.71,Fee Schedule,,499.8,70,,499.8,percent of total billed charges,,410,,,410,Fee Schedule,,347.5,,,347.5,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,702.04,
US OB DETAILED ADDL FETUS,76812,CPT,TC,44076812,CDM,402,RC,,,both,,,871,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,374.63,,,374.63,Fee Schedule,,337.05,,,337.05,Fee Schedule,,437.96,,,437.96,Fee Schedule,,394.01,,,394.01,Fee Schedule,,372.43,,,372.43,Fee Schedule,,609.7,70,,609.7,percent of total billed charges,All Other,445.1,,,445.1,Fee Schedule,,209,,,209,Other,186% of Medicaid,523.78,,,523.78,Fee Schedule,,540.02,,,540.02,Fee Schedule,,246.62,,,,Fee Schedule,,523.78,,,523.78,Fee Schedule,,540.02,,,540.02,Fee Schedule,,463.89,,,463.89,Fee Schedule,,609.7,70,,609.7,percent of total billed charges,,533,,,533,Fee Schedule,,451.75,,,451.75,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,0.01,609.7,
US OB LIMITED 1 OR > GEST,76815,CPT,TC,44076815,CDM,402,RC,,,both,,,466,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,175.77,,,175.77,Fee Schedule,,158.14,,,158.14,Fee Schedule,,421.3,,,421.3,Fee Schedule,,379.02,,,379.02,Fee Schedule,,358.26,,,358.26,Fee Schedule,,326.2,70,,326.2,percent of total billed charges,All Other,208.83,,,208.83,Fee Schedule,,209,,,209,Other,186% of Medicaid,245.75,,,245.75,Fee Schedule,,288.92,,,288.92,Fee Schedule,,115.71,,,,Fee Schedule,,245.75,,,245.75,Fee Schedule,,288.92,,,288.92,Fee Schedule,,217.65,,,217.65,Fee Schedule,,326.2,70,,326.2,percent of total billed charges,,249.28,,,249.28,Fee Schedule,,211.28,,,211.28,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,421.3,
US REPEAT PREGNANCY EXAM,76816,CPT,TC,44076816,CDM,402,RC,,,both,,,646,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,242.79,,,242.79,Fee Schedule,,218.44,,,218.44,Fee Schedule,,435.55,,,435.55,Fee Schedule,,391.84,,,391.84,Fee Schedule,,370.38,,,370.38,Fee Schedule,,452.2,70,,452.2,percent of total billed charges,All Other,288.46,,,288.46,Fee Schedule,,209,,,209,Other,186% of Medicaid,339.45,,,339.45,Fee Schedule,,400.52,,,400.52,Fee Schedule,,159.83,,,,Fee Schedule,,339.45,,,339.45,Fee Schedule,,400.52,,,400.52,Fee Schedule,,300.63,,,300.63,Fee Schedule,,452.2,70,,452.2,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,452.2,
US REPEAT PREGNANCY EXAM W MOD,76816,CPT,TC59,44176816,CDM,402,RC,,,both,,,646,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,242.79,,,242.79,Fee Schedule,,218.44,,,218.44,Fee Schedule,,435.55,,,435.55,Fee Schedule,,391.84,,,391.84,Fee Schedule,,370.38,,,370.38,Fee Schedule,,452.2,70,,452.2,percent of total billed charges,All Other,288.46,,,288.46,Fee Schedule,,209,,,209,Other,186% of Medicaid,339.45,,,339.45,Fee Schedule,,400.52,,,400.52,Fee Schedule,,159.83,,,,Fee Schedule,,339.45,,,339.45,Fee Schedule,,400.52,,,400.52,Fee Schedule,,300.63,,,300.63,Fee Schedule,,452.2,70,,452.2,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,452.2,
US PREGNANCY TRANSVAGINAL,76817,CPT,TC,44076817,CDM,402,RC,,,both,,,590,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,198.86,,,198.86,Fee Schedule,,178.92,,,178.92,Fee Schedule,,435.55,,,435.55,Fee Schedule,,391.84,,,391.84,Fee Schedule,,370.38,,,370.38,Fee Schedule,,413,70,,413,percent of total billed charges,All Other,236.27,,,236.27,Fee Schedule,,209,,,209,Other,186% of Medicaid,278.04,,,278.04,Fee Schedule,,365.8,,,365.8,Fee Schedule,,130.91,,,,Fee Schedule,,278.04,,,278.04,Fee Schedule,,365.8,,,365.8,Fee Schedule,,246.24,,,246.24,Fee Schedule,,413,70,,413,percent of total billed charges,,282.08,,,282.08,Fee Schedule,,239.08,,,239.08,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,435.55,
US FETAL BIOPHYSICAL PROFILE,76819,CPT,TC,44076819,CDM,402,RC,,,both,,,855,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,172.48,,,172.48,Fee Schedule,,155.18,,,155.18,Fee Schedule,,378.45,,,378.45,Fee Schedule,,340.47,,,340.47,Fee Schedule,,321.82,,,321.82,Fee Schedule,,598.5,70,,598.5,percent of total billed charges,All Other,204.93,,,204.93,Fee Schedule,,209,,,209,Other,186% of Medicaid,241.15,,,241.15,Fee Schedule,,530.1,,,530.1,Fee Schedule,,113.55,,,,Fee Schedule,,241.15,,,241.15,Fee Schedule,,530.1,,,530.1,Fee Schedule,,213.58,,,213.58,Fee Schedule,,598.5,70,,598.5,percent of total billed charges,,229.6,,,229.6,Fee Schedule,,194.6,,,194.6,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,598.5,
US FETAL BIOPHYSICAL PROFILE W MOD,76819,CPT,TC59,44176819,CDM,402,RC,,,both,,,855,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,172.48,,,172.48,Fee Schedule,,155.18,,,155.18,Fee Schedule,,378.45,,,378.45,Fee Schedule,,340.47,,,340.47,Fee Schedule,,321.82,,,321.82,Fee Schedule,,598.5,70,,598.5,percent of total billed charges,All Other,204.93,,,204.93,Fee Schedule,,209,,,209,Other,186% of Medicaid,241.15,,,241.15,Fee Schedule,,530.1,,,530.1,Fee Schedule,,113.55,,,,Fee Schedule,,241.15,,,241.15,Fee Schedule,,530.1,,,530.1,Fee Schedule,,213.58,,,213.58,Fee Schedule,,598.5,70,,598.5,percent of total billed charges,,229.6,,,229.6,Fee Schedule,,194.6,,,194.6,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,598.5,
FETAL UMBILICAL ARTERY ECHO,76820,CPT,TC,44076820,CDM,402,RC,,,both,,,273,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,74.1,,,74.1,Fee Schedule,,66.67,,,66.67,Fee Schedule,,157.17,,,157.17,Fee Schedule,,141.39,,,141.39,Fee Schedule,,133.65,,,133.65,Fee Schedule,,191.1,70,,191.1,percent of total billed charges,All Other,88.04,,,88.04,Fee Schedule,,209,,,209,Other,186% of Medicaid,103.61,,,103.61,Fee Schedule,,169.26,,,169.26,Fee Schedule,,48.78,,,,Fee Schedule,,103.61,,,103.61,Fee Schedule,,169.26,,,169.26,Fee Schedule,,91.76,,,91.76,Fee Schedule,,191.1,70,,191.1,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,48.78,364.84,
FETAL MIDDLE CEREB ART ECHO,76821,CPT,TC,44076821,CDM,402,RC,,,both,,,437,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,194.24,,,194.24,Fee Schedule,,174.75,,,174.75,Fee Schedule,,435.55,,,435.55,Fee Schedule,,391.84,,,391.84,Fee Schedule,,370.38,,,370.38,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,All Other,230.77,,,230.77,Fee Schedule,,209,,,209,Other,186% of Medicaid,271.57,,,271.57,Fee Schedule,,270.94,,,270.94,Fee Schedule,,127.87,,,,Fee Schedule,,271.57,,,271.57,Fee Schedule,,270.94,,,270.94,Fee Schedule,,240.52,,,240.52,Fee Schedule,,305.9,70,,305.9,percent of total billed charges,,272.24,,,272.24,Fee Schedule,,230.74,,,230.74,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,435.55,
US TRANSVAGINAL NON OB,76830,CPT,TC,44076830,CDM,402,RC,,,both,,,953,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,301.87,,,301.87,Fee Schedule,,271.59,,,271.59,Fee Schedule,,640.17,,,640.17,Fee Schedule,,575.92,,,575.92,Fee Schedule,,544.38,,,544.38,Fee Schedule,,667.1,70,,667.1,percent of total billed charges,All Other,358.65,,,358.65,Fee Schedule,,240,,,240,Other,186% of Medicaid,422.05,,,422.05,Fee Schedule,,590.86,,,590.86,Fee Schedule,,198.72,,,,Fee Schedule,,422.05,,,422.05,Fee Schedule,,590.86,,,590.86,Fee Schedule,,373.79,,,373.79,Fee Schedule,,667.1,70,,667.1,percent of total billed charges,,431.32,,,431.32,Fee Schedule,,365.57,,,365.57,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,667.1,
SALINE INFUSED SONOHYSTEROGRAM,76831,CPT,TC,44076831,CDM,402,RC,,,both,,,682,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,285.51,,,285.51,Fee Schedule,,256.87,,,256.87,Fee Schedule,,633.05,,,633.05,Fee Schedule,,569.51,,,569.51,Fee Schedule,,538.32,,,538.32,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,All Other,339.21,,,339.21,Fee Schedule,,996,,,996,Other,186% of Medicaid,399.17,,,399.17,Fee Schedule,,422.84,,,422.84,Fee Schedule,,187.95,,,,Fee Schedule,,399.17,,,399.17,Fee Schedule,,422.84,,,422.84,Fee Schedule,,353.53,,,353.53,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,,406.72,,,406.72,Fee Schedule,,344.72,,,344.72,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,187.95,1734.3,
US PELVIC COMPLETE,76856,CPT,TC,44076856,CDM,402,RC,,,both,,,809,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,254.34,,,254.34,Fee Schedule,,228.83,,,228.83,Fee Schedule,,637.82,,,637.82,Fee Schedule,,573.8,,,573.8,Fee Schedule,,542.38,,,542.38,Fee Schedule,,566.3,70,,566.3,percent of total billed charges,All Other,302.18,,,302.18,Fee Schedule,,996,,,996,Other,186% of Medicaid,355.6,,,355.6,Fee Schedule,,501.58,,,501.58,Fee Schedule,,167.43,,,,Fee Schedule,,355.6,,,355.6,Fee Schedule,,501.58,,,501.58,Fee Schedule,,314.93,,,314.93,Fee Schedule,,566.3,70,,566.3,percent of total billed charges,,362.44,,,362.44,Fee Schedule,,307.19,,,307.19,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,120.81,1734.3,
US PELVIS NON OB LIMITED,76857,CPT,TC,44076857,CDM,402,RC,,,both,,,609,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,91.43,,,91.43,Fee Schedule,,82.25,,,82.25,Fee Schedule,,435.55,,,435.55,Fee Schedule,,391.84,,,391.84,Fee Schedule,,370.38,,,370.38,Fee Schedule,,426.3,70,,426.3,percent of total billed charges,All Other,108.62,,,108.62,Fee Schedule,,240,,,240,Other,186% of Medicaid,127.82,,,127.82,Fee Schedule,,377.58,,,377.58,Fee Schedule,,60.19,,,,Fee Schedule,,127.82,,,127.82,Fee Schedule,,377.58,,,377.58,Fee Schedule,,113.21,,,113.21,Fee Schedule,,426.3,70,,426.3,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,60.19,435.55,
US TESTICULAR EXAM,76870,CPT,TC,44076870,CDM,402,RC,,,both,,,874,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,243.94,,,243.94,Fee Schedule,,219.47,,,219.47,Fee Schedule,,647.35,,,647.35,Fee Schedule,,582.38,,,582.38,Fee Schedule,,550.49,,,550.49,Fee Schedule,,611.8,70,,611.8,percent of total billed charges,All Other,289.82,,,289.82,Fee Schedule,,240,,,240,Other,186% of Medicaid,341.06,,,341.06,Fee Schedule,,541.88,,,541.88,Fee Schedule,,160.59,,,,Fee Schedule,,341.06,,,341.06,Fee Schedule,,541.88,,,541.88,Fee Schedule,,302.06,,,302.06,Fee Schedule,,611.8,70,,611.8,percent of total billed charges,,349.32,,,349.32,Fee Schedule,,296.07,,,296.07,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,647.35,
US PROSTATE VOLUME FOR BT,76873,CPT,TC,44076873,CDM,402,RC,,,both,,,846,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,348.06,,,348.06,Fee Schedule,,313.15,,,313.15,Fee Schedule,,673.49,,,673.49,Fee Schedule,,605.9,,,605.9,Fee Schedule,,572.71,,,572.71,Fee Schedule,,592.2,70,,592.2,percent of total billed charges,All Other,413.53,,,413.53,Fee Schedule,,996,,,996,Other,186% of Medicaid,486.63,,,486.63,Fee Schedule,,524.52,,,524.52,Fee Schedule,,229.13,,,,Fee Schedule,,486.63,,,486.63,Fee Schedule,,524.52,,,524.52,Fee Schedule,,430.98,,,430.98,Fee Schedule,,592.2,70,,592.2,percent of total billed charges,,483.8,,,483.8,Fee Schedule,,410.05,,,410.05,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,120.81,1734.3,
US EXTREM NON-VASC COMPL,76881,CPT,TC,44076881,CDM,402,RC,,,both,,,665,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,38.28,,,38.28,Fee Schedule,,34.44,,,34.44,Fee Schedule,,604.5,,,604.5,Fee Schedule,,543.83,,,543.83,Fee Schedule,,514.04,,,514.04,Fee Schedule,,465.5,70,,465.5,percent of total billed charges,All Other,45.48,,,45.48,Fee Schedule,,240,,,240,Other,186% of Medicaid,53.52,,,53.52,Fee Schedule,,412.3,,,412.3,Fee Schedule,,25.2,,,,Fee Schedule,,53.52,,,53.52,Fee Schedule,,412.3,,,412.3,Fee Schedule,,47.4,,,47.4,Fee Schedule,,465.5,70,,465.5,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,25.2,604.5,
US XTR NON-VASC LMTD,76882,CPT,TC,44076882,CDM,402,RC,,,both,,,275,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,107.6,,,107.6,Fee Schedule,,96.81,,,96.81,Fee Schedule,,71.51,,,71.51,Fee Schedule,,64.34,,,64.34,Fee Schedule,,60.81,,,60.81,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,All Other,127.84,,,127.84,Fee Schedule,,240,,,240,Other,186% of Medicaid,150.44,,,150.44,Fee Schedule,,170.5,,,170.5,Fee Schedule,,70.83,,,,Fee Schedule,,150.44,,,150.44,Fee Schedule,,170.5,,,170.5,Fee Schedule,,133.23,,,133.23,Fee Schedule,,192.5,70,,192.5,percent of total billed charges,,162.36,,,162.36,Fee Schedule,,137.61,,,137.61,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,60.81,418.39,
US XTR NON-VASC LMTD BILATERAL,76882,CPT,TC50,44376882,CDM,402,RC,,,both,,,413,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,107.6,,,107.6,Fee Schedule,,96.81,,,96.81,Fee Schedule,,71.51,,,71.51,Fee Schedule,,64.34,,,64.34,Fee Schedule,,60.81,,,60.81,Fee Schedule,,289.1,70,,289.1,percent of total billed charges,All Other,127.84,,,127.84,Fee Schedule,,240,,,240,Other,186% of Medicaid,150.44,,,150.44,Fee Schedule,,256.06,,,256.06,Fee Schedule,,70.83,,,,Fee Schedule,,150.44,,,150.44,Fee Schedule,,256.06,,,256.06,Fee Schedule,,133.23,,,133.23,Fee Schedule,,289.1,70,,289.1,percent of total billed charges,,162.36,,,162.36,Fee Schedule,,137.61,,,137.61,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,60.81,418.39,
US PEDIATRIC HIPS,76885,CPT,TC,44076885,CDM,402,RC,,,both,,,842,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,306.5,,,306.5,Fee Schedule,,275.75,,,275.75,Fee Schedule,,437.96,,,437.96,Fee Schedule,,394.01,,,394.01,Fee Schedule,,372.43,,,372.43,Fee Schedule,,589.4,70,,589.4,percent of total billed charges,All Other,364.14,,,364.14,Fee Schedule,,240,,,240,Other,186% of Medicaid,428.52,,,428.52,Fee Schedule,,522.04,,,522.04,Fee Schedule,,201.77,,,,Fee Schedule,,428.52,,,428.52,Fee Schedule,,522.04,,,522.04,Fee Schedule,,379.52,,,379.52,Fee Schedule,,589.4,70,,589.4,percent of total billed charges,,506.76,,,506.76,Fee Schedule,,429.51,,,429.51,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,99.85,589.4,
US GUIDED PSEUDOANEURYSM,76936,CPT,TC,44076936,CDM,402,RC,,,both,,,1559,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,583.93,,,583.93,Fee Schedule,,525.35,,,525.35,Fee Schedule,,747.25,,,747.25,Fee Schedule,,672.25,,,672.25,Fee Schedule,,635.44,,,635.44,Fee Schedule,,1091.3,70,,1091.3,percent of total billed charges,All Other,693.76,,,693.76,Fee Schedule,,558,,,558,Other,186% of Medicaid,816.4,,,816.4,Fee Schedule,,966.58,,,966.58,Fee Schedule,,384.41,,,,Fee Schedule,,816.4,,,816.4,Fee Schedule,,966.58,,,966.58,Fee Schedule,,723.05,,,723.05,Fee Schedule,,1091.3,70,,1091.3,percent of total billed charges,,829.84,,,829.84,Fee Schedule,,703.34,,,703.34,Fee Schedule,,404.96,,,404.96,Fee Schedule,,404.96,,,404.96,Fee Schedule,,404.96,,,404.96,Fee Schedule,,404.96,,,404.96,Fee Schedule,,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,299.88,1091.3,
US GUIDANCE VASCULAR ACCESS,76937,CPT,TC,30076937,CDM,402,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,339,,,339,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,115.32,,,115.32,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,115.32,,,115.32,Fee Schedule,,106.06,,,106.06,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,278.63,,,278.63,Other,153% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,254.95,,,254.95,Other,140% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,473.49,,,473.49,Other,250% of Medicaid,590.04,,,590.04,Other,324% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,227.64,,,227.64,Other,125% of Medicaid,0.01,590.04,
US GUIDANCE VASCULAR ACCESS,76937,CPT,TC,44076937,CDM,402,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,339,,,339,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,115.32,,,115.32,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,115.32,,,115.32,Fee Schedule,,106.06,,,106.06,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,278.63,,,278.63,Other,153% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,254.95,,,254.95,Other,140% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,473.49,,,473.49,Other,250% of Medicaid,590.04,,,590.04,Other,324% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,227.64,,,227.64,Other,125% of Medicaid,0.01,590.04,
US GUIDE VASCULAR ACCESS,76937,CPT,TC,47076937,CDM,402,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,339,,,339,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,115.32,,,115.32,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,115.32,,,115.32,Fee Schedule,,106.06,,,106.06,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,278.63,,,278.63,Other,153% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,254.95,,,254.95,Other,140% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,473.49,,,473.49,Other,250% of Medicaid,590.04,,,590.04,Other,324% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,227.64,,,227.64,Other,125% of Medicaid,0.01,590.04,
US GUIDE VASCULAR ACCESS 59 MOD,76937,CPT,TC59,47176937,CDM,402,RC,,,both,,,186,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,85.65,,,85.65,Fee Schedule,,77.06,,,77.06,Fee Schedule,,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,All Other,101.76,,,101.76,Fee Schedule,,339,,,339,Other,186% of Medicaid,119.75,,,119.75,Fee Schedule,,115.32,,,115.32,Fee Schedule,,56.39,,,,Fee Schedule,,119.75,,,119.75,Fee Schedule,,115.32,,,115.32,Fee Schedule,,106.06,,,106.06,Fee Schedule,,130.2,70,,130.2,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,278.63,,,278.63,Other,153% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,254.95,,,254.95,Other,140% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,473.49,,,473.49,Other,250% of Medicaid,590.04,,,590.04,Other,324% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,227.64,,,227.64,Other,125% of Medicaid,0.01,590.04,
US GUIDED NEEDLE PLACEMEN,76942,CPT,TC,30076942,CDM,402,RC,,,both,,,1201,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,1151.79,,,1151.79,Fee Schedule,,1036.19,,,1036.19,Fee Schedule,,979.44,,,979.44,Fee Schedule,,840.7,70,,840.7,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,339,,,339,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,744.62,,,744.62,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,744.62,,,744.62,Fee Schedule,,121.82,,,121.82,Fee Schedule,,840.7,70,,840.7,percent of total billed charges,,134.48,,,134.48,Fee Schedule,,113.98,,,113.98,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,278.63,,,278.63,Other,153% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,254.95,,,254.95,Other,140% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,473.49,,,473.49,Other,250% of Medicaid,590.04,,,590.04,Other,324% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,227.64,,,227.64,Other,125% of Medicaid,0.01,1151.79,
US GUIDED NEEDLE PLACEMEN,76942,CPT,TC,44076942,CDM,402,RC,,,both,,,1201,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,1151.79,,,1151.79,Fee Schedule,,1036.19,,,1036.19,Fee Schedule,,979.44,,,979.44,Fee Schedule,,840.7,70,,840.7,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,339,,,339,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,744.62,,,744.62,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,744.62,,,744.62,Fee Schedule,,121.82,,,121.82,Fee Schedule,,840.7,70,,840.7,percent of total billed charges,,134.48,,,134.48,Fee Schedule,,113.98,,,113.98,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,278.63,,,278.63,Other,153% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,254.95,,,254.95,Other,140% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,473.49,,,473.49,Other,250% of Medicaid,590.04,,,590.04,Other,324% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,227.64,,,227.64,Other,125% of Medicaid,0.01,1151.79,
US GUIDED NEEDLE PLACEMENT,76942,CPT,TC,47076942,CDM,402,RC,,,both,,,1201,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,98.38,,,98.38,Fee Schedule,,88.51,,,88.51,Fee Schedule,,1151.79,,,1151.79,Fee Schedule,,1036.19,,,1036.19,Fee Schedule,,979.44,,,979.44,Fee Schedule,,840.7,70,,840.7,percent of total billed charges,All Other,116.88,,,116.88,Fee Schedule,,339,,,339,Other,186% of Medicaid,137.55,,,137.55,Fee Schedule,,744.62,,,744.62,Fee Schedule,,64.76,,,,Fee Schedule,,137.55,,,137.55,Fee Schedule,,744.62,,,744.62,Fee Schedule,,121.82,,,121.82,Fee Schedule,,840.7,70,,840.7,percent of total billed charges,,134.48,,,134.48,Fee Schedule,,113.98,,,113.98,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,278.63,,,278.63,Other,153% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,254.95,,,254.95,Other,140% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,473.49,,,473.49,Other,250% of Medicaid,590.04,,,590.04,Other,324% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,227.64,,,227.64,Other,125% of Medicaid,0.01,1151.79,
US GUIDED AMNIOCENTESIS,76946,CPT,TC,44076946,CDM,402,RC,,,both,,,1207,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,53.3,,,53.3,Fee Schedule,,47.96,,,47.96,Fee Schedule,,135.74,,,135.74,Fee Schedule,,122.12,,,122.12,Fee Schedule,,115.43,,,115.43,Fee Schedule,,844.9,70,,844.9,percent of total billed charges,All Other,63.33,,,63.33,Fee Schedule,,339,,,339,Other,186% of Medicaid,74.53,,,74.53,Fee Schedule,,748.34,,,748.34,Fee Schedule,,35.09,,,,Fee Schedule,,74.53,,,74.53,Fee Schedule,,748.34,,,748.34,Fee Schedule,,66,,,66,Fee Schedule,,844.9,70,,844.9,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,278.63,,,278.63,Other,153% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,254.95,,,254.95,Other,140% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,473.49,,,473.49,Other,250% of Medicaid,590.04,,,590.04,Other,324% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,227.64,,,227.64,Other,125% of Medicaid,0.01,844.9,
US INTERSTITIAL RE APPLIC,76965,CPT,TC,44076965,CDM,402,RC,,,both,,,1150,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,96.05,,,96.05,Fee Schedule,,86.42,,,86.42,Fee Schedule,,352.25,,,352.25,Fee Schedule,,316.9,,,316.9,Fee Schedule,,299.54,,,299.54,Fee Schedule,,805,70,,805,percent of total billed charges,All Other,114.12,,,114.12,Fee Schedule,,339,,,339,Other,186% of Medicaid,134.29,,,134.29,Fee Schedule,,713,,,713,Fee Schedule,,63.23,,,,Fee Schedule,,134.29,,,134.29,Fee Schedule,,713,,,713,Fee Schedule,,118.93,,,118.93,Fee Schedule,,805,70,,805,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,278.63,,,278.63,Other,153% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,254.95,,,254.95,Other,140% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,473.49,,,473.49,Other,250% of Medicaid,590.04,,,590.04,Other,324% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,227.64,,,227.64,Other,125% of Medicaid,0.01,805,
US GUIDE INTRAOP,76998,CPT,TC,44076998,CDM,402,RC,,,both,,,1325,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,861.25,65,,861.25,percent of total billed charges,All Other,781.75,59,,781.75,percent of total billed charges,All Other,70.21,,,70.21,Fee Schedule,,70.21,,,70.21,Fee Schedule,,70.21,,,70.21,Fee Schedule,,927.5,70,,927.5,percent of total billed charges,All Other,901,68,,901,percent of total billed charges,All Other,339,,,339,Other,186% of Medicaid,1060,80,,1060,percent of total billed charges,All Other,1099.75,83,,1099.75,percent of total billed charges,All Other,1099.75,83,,,percent of total billed charges,All Other,1060,80,,1060,percent of total billed charges,All Other,1099.75,83,,1099.75,percent of total billed charges,All Other,1060,80,,1060,percent of total billed charges,All Other,927.5,70,,927.5,percent of total billed charges,,861.25,65,,861.25,percent of total billed charges,All Other,861.25,65,,861.25,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,182.11,,,182.11,Other,100% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,278.63,,,278.63,Other,153% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,254.95,,,254.95,Other,140% of Medicaid,409.75,,,409.75,Other,225% of Medicaid,473.49,,,473.49,Other,250% of Medicaid,590.04,,,590.04,Other,324% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,391.54,,,391.54,Other,215% of Medicaid,227.64,,,227.64,Other,125% of Medicaid,0.01,1099.75,
US PROCEDURE UNSPEC,76999,CPT,TC,44076999,CDM,402,RC,,,both,,,273,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,177.45,65,,177.45,percent of total billed charges,All Other,161.07,59,,161.07,percent of total billed charges,All Other,66,,,66,Fee Schedule,,66,,,66,Fee Schedule,,66,,,66,Fee Schedule,,191.1,70,,191.1,percent of total billed charges,All Other,185.64,68,,185.64,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,218.4,80,,218.4,percent of total billed charges,All Other,169.26,83,,169.26,percent of total billed charges,All Other,150.15,83,,,percent of total billed charges,All Other,218.4,80,,218.4,percent of total billed charges,All Other,169.26,83,,169.26,percent of total billed charges,All Other,218.4,80,,218.4,percent of total billed charges,All Other,191.1,70,,191.1,percent of total billed charges,,177.45,65,,177.45,percent of total billed charges,All Other,177.45,65,,177.45,percent of total billed charges,All Other,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,127.7,,,127.7,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,66,418.39,
SCR MAMMO BI INCL CAD,77067,CPT,TC,54077067,CDM,403,RC,,,both,,,882,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,320.18,,,320.18,Fee Schedule,,288.06,,,288.06,Fee Schedule,,76.73,,,76.73,Fee Schedule,,76.73,,,76.73,Fee Schedule,,76.73,,,76.73,Fee Schedule,,617.4,70,,617.4,percent of total billed charges,All Other,380.4,,,380.4,Fee Schedule,,202,,,202,Other,186% of Medicaid,447.65,,,447.65,Fee Schedule,,546.84,,,546.84,Fee Schedule,,210.78,,,,Fee Schedule,,447.65,,,447.65,Fee Schedule,,546.84,,,546.84,Fee Schedule,,396.46,,,396.46,Fee Schedule,,617.4,70,,617.4,percent of total billed charges,,452.64,,,452.64,Fee Schedule,,383.64,,,383.64,Fee Schedule,,159.95,,,159.95,Fee Schedule,,159.95,,,159.95,Fee Schedule,,159.95,,,159.95,Fee Schedule,,159.95,,,159.95,Fee Schedule,,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,166.07,,,166.07,Other,153% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,151.96,,,151.96,Other,140% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,282.21,,,282.21,Other,250% of Medicaid,351.68,,,351.68,Other,324% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,135.68,,,135.68,Other,125% of Medicaid,0.01,617.4,
SCREENING MAMMO DIGITAL UNILATERAL,G0202,HCPCS,52LT,54100006,CDM,403,RC,,,both,,,641,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,416.65,65,,416.65,percent of total billed charges,All Other,378.19,59,,378.19,percent of total billed charges,All Other,79.9,,,79.9,Fee Schedule,,79.9,,,79.9,Fee Schedule,,79.9,,,79.9,Fee Schedule,,448.7,70,,448.7,percent of total billed charges,All Other,435.88,68,,435.88,percent of total billed charges,All Other,202,,,202,Other,186% of Medicaid,512.8,80,,512.8,percent of total billed charges,All Other,397.42,83,,397.42,percent of total billed charges,All Other,352.55,83,,,percent of total billed charges,All Other,512.8,80,,512.8,percent of total billed charges,All Other,397.42,83,,397.42,percent of total billed charges,All Other,512.8,80,,512.8,percent of total billed charges,All Other,448.7,70,,448.7,percent of total billed charges,,416.65,65,,416.65,percent of total billed charges,All Other,416.65,65,,416.65,percent of total billed charges,All Other,320.5,,,320.5,Fee Schedule,,320.5,,,320.5,Fee Schedule,,320.5,,,320.5,Fee Schedule,,320.5,,,320.5,Fee Schedule,,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,166.07,,,166.07,Other,153% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,151.96,,,151.96,Other,140% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,282.21,,,282.21,Other,250% of Medicaid,351.68,,,351.68,Other,324% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,135.68,,,135.68,Other,125% of Medicaid,0.01,512.8,
SCREENING MAMMO DIGITAL UNILATERAL,G0202,HCPCS,52RT,54200006,CDM,403,RC,,,both,,,641,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,416.65,65,,416.65,percent of total billed charges,All Other,378.19,59,,378.19,percent of total billed charges,All Other,79.9,,,79.9,Fee Schedule,,79.9,,,79.9,Fee Schedule,,79.9,,,79.9,Fee Schedule,,448.7,70,,448.7,percent of total billed charges,All Other,435.88,68,,435.88,percent of total billed charges,All Other,202,,,202,Other,186% of Medicaid,512.8,80,,512.8,percent of total billed charges,All Other,397.42,83,,397.42,percent of total billed charges,All Other,352.55,83,,,percent of total billed charges,All Other,512.8,80,,512.8,percent of total billed charges,All Other,397.42,83,,397.42,percent of total billed charges,All Other,512.8,80,,512.8,percent of total billed charges,All Other,448.7,70,,448.7,percent of total billed charges,,416.65,65,,416.65,percent of total billed charges,All Other,416.65,65,,416.65,percent of total billed charges,All Other,320.5,,,320.5,Fee Schedule,,320.5,,,320.5,Fee Schedule,,320.5,,,320.5,Fee Schedule,,320.5,,,320.5,Fee Schedule,,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,108.54,,,108.54,Other,100% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,166.07,,,166.07,Other,153% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,151.96,,,151.96,Other,140% of Medicaid,244.22,,,244.22,Other,225% of Medicaid,282.21,,,282.21,Other,250% of Medicaid,351.68,,,351.68,Other,324% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,233.37,,,233.37,Other,215% of Medicaid,135.68,,,135.68,Other,125% of Medicaid,0.01,512.8,
INTUBATION ENDOTRACHEAL,31500,CPT,,71031500,CDM,410,RC,,,both,,,903,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,586.95,65,,586.95,percent of total billed charges,All Other,532.77,59,,532.77,percent of total billed charges,All Other,690.8,76.5,,690.8,percent of total billed charges,All Other,623.07,69,,623.07,percent of total billed charges,All Other,586.95,65,,586.95,percent of total billed charges,All Other,632.1,70,,632.1,percent of total billed charges,All Other,558.72,,,558.72,Fee Schedule,,893,,,893,Other,186% of Medicaid,657.49,,,657.49,Fee Schedule,,559.86,,,559.86,Fee Schedule,,309.58,,,,Fee Schedule,,657.49,,,657.49,Fee Schedule,,559.86,,,559.86,Fee Schedule,,722.4,80,,722.4,percent of total billed charges,All Other,632.1,70,,632.1,percent of total billed charges,,680.6,,,680.6,Fee Schedule,,576.85,,,576.85,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,734.95,,,734.95,Other,153% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,672.5,,,672.5,Other,140% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,1248.94,,,1248.94,Other,250% of Medicaid,1556.37,,,1556.37,Other,324% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,600.45,,,600.45,Other,125% of Medicaid,122,1556.37,
WITHDRAWAL OF ARTERIAL BLOOD,36600,CPT,,71036600,CDM,410,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,170.95,65,,170.95,percent of total billed charges,All Other,155.17,59,,155.17,percent of total billed charges,All Other,201.2,76.5,,201.2,percent of total billed charges,All Other,181.47,69,,181.47,percent of total billed charges,All Other,170.95,65,,170.95,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,All Other,58.4,,,58.4,Fee Schedule,,63,,,63,Other,186% of Medicaid,68.73,,,68.73,Fee Schedule,,163.06,,,163.06,Fee Schedule,,32.36,,,,Fee Schedule,,68.73,,,68.73,Fee Schedule,,163.06,,,163.06,Fee Schedule,,210.4,80,,210.4,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,,75.44,,,75.44,Fee Schedule,,63.94,,,63.94,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,32.36,230.83,
ARTERIAL PUNCTURE,36600,CPT,,78036600,CDM,410,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,170.95,65,,170.95,percent of total billed charges,All Other,155.17,59,,155.17,percent of total billed charges,All Other,201.2,76.5,,201.2,percent of total billed charges,All Other,181.47,69,,181.47,percent of total billed charges,All Other,170.95,65,,170.95,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,All Other,58.4,,,58.4,Fee Schedule,,63,,,63,Other,186% of Medicaid,68.73,,,68.73,Fee Schedule,,163.06,,,163.06,Fee Schedule,,32.36,,,,Fee Schedule,,68.73,,,68.73,Fee Schedule,,163.06,,,163.06,Fee Schedule,,210.4,80,,210.4,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,,75.44,,,75.44,Fee Schedule,,63.94,,,63.94,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,32.36,230.83,
HEART/LUNG RESUSCITATION CPR,92950,CPT,,71092950,CDM,410,RC,,,both,,,903,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,586.95,65,,586.95,percent of total billed charges,All Other,532.77,59,,532.77,percent of total billed charges,All Other,690.8,76.5,,690.8,percent of total billed charges,All Other,623.07,69,,623.07,percent of total billed charges,All Other,586.95,65,,586.95,percent of total billed charges,All Other,632.1,70,,632.1,percent of total billed charges,All Other,720.86,,,720.86,Fee Schedule,,893,,,893,Other,186% of Medicaid,848.29,,,848.29,Fee Schedule,,559.86,,,559.86,Fee Schedule,,399.42,,,,Fee Schedule,,848.29,,,848.29,Fee Schedule,,559.86,,,559.86,Fee Schedule,,722.4,80,,722.4,percent of total billed charges,All Other,632.1,70,,632.1,percent of total billed charges,,883.96,,,883.96,Fee Schedule,,749.21,,,749.21,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,734.95,,,734.95,Other,153% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,672.5,,,672.5,Other,140% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,1248.94,,,1248.94,Other,250% of Medicaid,1556.37,,,1556.37,Other,324% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,600.45,,,600.45,Other,125% of Medicaid,122,1556.37,
VENT MGMT INPAT INIT DAY,94002,CPT,,71094002,CDM,410,RC,,,both,,,1255,1132.39,,,1132.39,Other,150% of Medicare + 9.63% HCRA Surcharge,688.61,,,688.61,Other,Medicare OPPS,815.75,65,,815.75,percent of total billed charges,All Other,740.45,59,,740.45,percent of total billed charges,All Other,960.08,76.5,,960.08,percent of total billed charges,All Other,865.95,69,,865.95,percent of total billed charges,All Other,815.75,65,,815.75,percent of total billed charges,All Other,878.5,70,,878.5,percent of total billed charges,All Other,359.03,,,359.03,Fee Schedule,,303,,,303,Other,186% of Medicaid,422.5,,,422.5,Fee Schedule,,778.1,,,778.1,Fee Schedule,,198.93,,,,Fee Schedule,,422.5,,,422.5,Fee Schedule,,778.1,,,778.1,Fee Schedule,,1004,80,,1004,percent of total billed charges,All Other,878.5,70,,878.5,percent of total billed charges,,442.8,,,442.8,Fee Schedule,,375.3,,,375.3,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,162.64,,,162.64,Other,100% of Medicaid,162.64,,,162.64,Other,100% of Medicaid,162.64,,,162.64,Other,100% of Medicaid,162.64,,,162.64,Other,100% of Medicaid,365.94,,,365.94,Other,225% of Medicaid,248.84,,,248.84,Other,153% of Medicaid,365.94,,,365.94,Other,225% of Medicaid,227.7,,,227.7,Other,140% of Medicaid,365.94,,,365.94,Other,225% of Medicaid,422.87,,,422.87,Other,250% of Medicaid,526.96,,,526.96,Other,324% of Medicaid,349.68,,,349.68,Other,215% of Medicaid,349.68,,,349.68,Other,215% of Medicaid,203.3,,,203.3,Other,125% of Medicaid,122,1132.39,
VENT MGMT INPAT SUBQ DAY,94003,CPT,,71094003,CDM,410,RC,,,both,,,1255,1132.39,,,1132.39,Other,150% of Medicare + 9.63% HCRA Surcharge,688.61,,,688.61,Other,Medicare OPPS,815.75,65,,815.75,percent of total billed charges,All Other,740.45,59,,740.45,percent of total billed charges,All Other,960.08,76.5,,960.08,percent of total billed charges,All Other,865.95,69,,865.95,percent of total billed charges,All Other,815.75,65,,815.75,percent of total billed charges,All Other,878.5,70,,878.5,percent of total billed charges,All Other,252.79,,,252.79,Fee Schedule,,303,,,303,Other,186% of Medicaid,297.48,,,297.48,Fee Schedule,,778.1,,,778.1,Fee Schedule,,140.07,,,,Fee Schedule,,297.48,,,297.48,Fee Schedule,,778.1,,,778.1,Fee Schedule,,1004,80,,1004,percent of total billed charges,All Other,878.5,70,,878.5,percent of total billed charges,,311.6,,,311.6,Fee Schedule,,264.1,,,264.1,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,162.64,,,162.64,Other,100% of Medicaid,162.64,,,162.64,Other,100% of Medicaid,162.64,,,162.64,Other,100% of Medicaid,162.64,,,162.64,Other,100% of Medicaid,365.94,,,365.94,Other,225% of Medicaid,248.84,,,248.84,Other,153% of Medicaid,365.94,,,365.94,Other,225% of Medicaid,227.7,,,227.7,Other,140% of Medicaid,365.94,,,365.94,Other,225% of Medicaid,422.87,,,422.87,Other,250% of Medicaid,526.96,,,526.96,Other,324% of Medicaid,349.68,,,349.68,Other,215% of Medicaid,349.68,,,349.68,Other,215% of Medicaid,203.3,,,203.3,Other,125% of Medicaid,122,1132.39,
AIRWAY INHALATION TREATMENT,94640,CPT,,30094640,CDM,410,RC,,,both,,,433,385.42,,,385.42,Other,150% of Medicare + 9.63% HCRA Surcharge,234.37,,,234.37,Other,Medicare OPPS,281.45,65,,281.45,percent of total billed charges,All Other,255.47,59,,255.47,percent of total billed charges,All Other,111.96,,,111.96,Fee Schedule,,100.72,,,100.72,Fee Schedule,,95.2,,,95.2,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,All Other,33.12,,,33.12,Fee Schedule,,127,,,127,Other,186% of Medicaid,38.98,,,38.98,Fee Schedule,,268.46,,,268.46,Fee Schedule,,18.35,,,,Fee Schedule,,38.98,,,38.98,Fee Schedule,,268.46,,,268.46,Fee Schedule,,346.4,80,,346.4,percent of total billed charges,All Other,303.1,70,,303.1,percent of total billed charges,,54.12,,,54.12,Fee Schedule,,45.87,,,45.87,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,18.35,385.42,
AIRWAY INHALATION TREATMENT SU,94640,CPT,76,30194640,CDM,410,RC,,,both,,,433,385.42,,,385.42,Other,150% of Medicare + 9.63% HCRA Surcharge,234.37,,,234.37,Other,Medicare OPPS,281.45,65,,281.45,percent of total billed charges,All Other,255.47,59,,255.47,percent of total billed charges,All Other,111.96,,,111.96,Fee Schedule,,100.72,,,100.72,Fee Schedule,,95.2,,,95.2,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,All Other,33.12,,,33.12,Fee Schedule,,127,,,127,Other,186% of Medicaid,38.98,,,38.98,Fee Schedule,,268.46,,,268.46,Fee Schedule,,18.35,,,,Fee Schedule,,38.98,,,38.98,Fee Schedule,,268.46,,,268.46,Fee Schedule,,346.4,80,,346.4,percent of total billed charges,All Other,303.1,70,,303.1,percent of total billed charges,,54.12,,,54.12,Fee Schedule,,45.87,,,45.87,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,18.35,385.42,
AIRWAY INHALATION TREATMENT,94640,CPT,,71094640,CDM,410,RC,,,both,,,433,385.42,,,385.42,Other,150% of Medicare + 9.63% HCRA Surcharge,234.37,,,234.37,Other,Medicare OPPS,281.45,65,,281.45,percent of total billed charges,All Other,255.47,59,,255.47,percent of total billed charges,All Other,111.96,,,111.96,Fee Schedule,,100.72,,,100.72,Fee Schedule,,95.2,,,95.2,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,All Other,33.12,,,33.12,Fee Schedule,,127,,,127,Other,186% of Medicaid,38.98,,,38.98,Fee Schedule,,268.46,,,268.46,Fee Schedule,,18.35,,,,Fee Schedule,,38.98,,,38.98,Fee Schedule,,268.46,,,268.46,Fee Schedule,,346.4,80,,346.4,percent of total billed charges,All Other,303.1,70,,303.1,percent of total billed charges,,54.12,,,54.12,Fee Schedule,,45.87,,,45.87,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,18.35,385.42,
AIRWAY INHAL TX SUBSEQUENT,94640,CPT,76,71194640,CDM,410,RC,,,both,,,433,385.42,,,385.42,Other,150% of Medicare + 9.63% HCRA Surcharge,234.37,,,234.37,Other,Medicare OPPS,281.45,65,,281.45,percent of total billed charges,All Other,255.47,59,,255.47,percent of total billed charges,All Other,111.96,,,111.96,Fee Schedule,,100.72,,,100.72,Fee Schedule,,95.2,,,95.2,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,All Other,33.12,,,33.12,Fee Schedule,,127,,,127,Other,186% of Medicaid,38.98,,,38.98,Fee Schedule,,268.46,,,268.46,Fee Schedule,,18.35,,,,Fee Schedule,,38.98,,,38.98,Fee Schedule,,268.46,,,268.46,Fee Schedule,,346.4,80,,346.4,percent of total billed charges,All Other,303.1,70,,303.1,percent of total billed charges,,54.12,,,54.12,Fee Schedule,,45.87,,,45.87,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,18.35,385.42,
CONT BRONCH TX 1ST HOUR,94644,CPT,,30094644,CDM,410,RC,,,both,,,336,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,218.4,65,,218.4,percent of total billed charges,All Other,198.24,59,,198.24,percent of total billed charges,All Other,280.9,,,280.9,Fee Schedule,,252.71,,,252.71,Fee Schedule,,238.87,,,238.87,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,246.08,,,246.08,Fee Schedule,,127,,,127,Other,186% of Medicaid,289.59,,,289.59,Fee Schedule,,208.32,,,208.32,Fee Schedule,,136.35,,,,Fee Schedule,,289.59,,,289.59,Fee Schedule,,208.32,,,208.32,Fee Schedule,,268.8,80,,268.8,percent of total billed charges,All Other,235.2,70,,235.2,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,68.45,298.48,
CONT BRONCH TX 1ST HOUR,94644,CPT,,71094644,CDM,410,RC,,,both,,,336,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,218.4,65,,218.4,percent of total billed charges,All Other,198.24,59,,198.24,percent of total billed charges,All Other,280.9,,,280.9,Fee Schedule,,252.71,,,252.71,Fee Schedule,,238.87,,,238.87,Fee Schedule,,235.2,70,,235.2,percent of total billed charges,All Other,246.08,,,246.08,Fee Schedule,,127,,,127,Other,186% of Medicaid,289.59,,,289.59,Fee Schedule,,208.32,,,208.32,Fee Schedule,,136.35,,,,Fee Schedule,,289.59,,,289.59,Fee Schedule,,208.32,,,208.32,Fee Schedule,,268.8,80,,268.8,percent of total billed charges,All Other,235.2,70,,235.2,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,68.45,298.48,
CONT BRONCH TX EACH ADDL HOUR,94645,CPT,,30094645,CDM,410,RC,,,both,,,314,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204.1,65,,204.1,percent of total billed charges,All Other,185.26,59,,185.26,percent of total billed charges,All Other,102.42,,,102.42,Fee Schedule,,92.14,,,92.14,Fee Schedule,,87.1,,,87.1,Fee Schedule,,219.8,70,,219.8,percent of total billed charges,All Other,67.46,,,67.46,Fee Schedule,,127,,,127,Other,186% of Medicaid,79.39,,,79.39,Fee Schedule,,194.68,,,194.68,Fee Schedule,,37.38,,,,Fee Schedule,,79.39,,,79.39,Fee Schedule,,194.68,,,194.68,Fee Schedule,,251.2,80,,251.2,percent of total billed charges,All Other,219.8,70,,219.8,percent of total billed charges,,77.08,,,77.08,Fee Schedule,,65.33,,,65.33,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,251.2,
CONT BRONCH TX EACH ADDL HOUR,94645,CPT,,71094645,CDM,410,RC,,,both,,,314,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,204.1,65,,204.1,percent of total billed charges,All Other,185.26,59,,185.26,percent of total billed charges,All Other,102.42,,,102.42,Fee Schedule,,92.14,,,92.14,Fee Schedule,,87.1,,,87.1,Fee Schedule,,219.8,70,,219.8,percent of total billed charges,All Other,67.46,,,67.46,Fee Schedule,,127,,,127,Other,186% of Medicaid,79.39,,,79.39,Fee Schedule,,194.68,,,194.68,Fee Schedule,,37.38,,,,Fee Schedule,,79.39,,,79.39,Fee Schedule,,194.68,,,194.68,Fee Schedule,,251.2,80,,251.2,percent of total billed charges,All Other,219.8,70,,219.8,percent of total billed charges,,77.08,,,77.08,Fee Schedule,,65.33,,,65.33,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,251.2,
POS AIRWAY PRESSURE CPAP,94660,CPT,,71094660,CDM,410,RC,,,both,,,535,385.42,,,385.42,Other,150% of Medicare + 9.63% HCRA Surcharge,234.37,,,234.37,Other,Medicare OPPS,347.75,65,,347.75,percent of total billed charges,All Other,315.65,59,,315.65,percent of total billed charges,All Other,409.28,76.5,,409.28,percent of total billed charges,All Other,369.15,69,,369.15,percent of total billed charges,All Other,347.75,65,,347.75,percent of total billed charges,All Other,374.5,70,,374.5,percent of total billed charges,All Other,146.52,,,146.52,Fee Schedule,,303,,,303,Other,186% of Medicaid,172.42,,,172.42,Fee Schedule,,331.7,,,331.7,Fee Schedule,,81.19,,,,Fee Schedule,,172.42,,,172.42,Fee Schedule,,331.7,,,331.7,Fee Schedule,,428,80,,428,percent of total billed charges,All Other,374.5,70,,374.5,percent of total billed charges,,182.04,,,182.04,Fee Schedule,,154.29,,,154.29,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,162.65,,,162.65,Other,100% of Medicaid,162.65,,,162.65,Other,100% of Medicaid,162.65,,,162.65,Other,100% of Medicaid,162.65,,,162.65,Other,100% of Medicaid,365.95,,,365.95,Other,225% of Medicaid,248.85,,,248.85,Other,153% of Medicaid,365.95,,,365.95,Other,225% of Medicaid,227.7,,,227.7,Other,140% of Medicaid,365.95,,,365.95,Other,225% of Medicaid,422.88,,,422.88,Other,250% of Medicaid,526.97,,,526.97,Other,324% of Medicaid,349.69,,,349.69,Other,215% of Medicaid,349.69,,,349.69,Other,215% of Medicaid,203.31,,,203.31,Other,125% of Medicaid,81.19,526.97,
EVALUATE PT USE OF INHALER,94664,CPT,,30094664,CDM,410,RC,,,both,,,433,385.42,,,385.42,Other,150% of Medicare + 9.63% HCRA Surcharge,234.37,,,234.37,Other,Medicare OPPS,281.45,65,,281.45,percent of total billed charges,All Other,255.47,59,,255.47,percent of total billed charges,All Other,111.96,,,111.96,Fee Schedule,,100.72,,,100.72,Fee Schedule,,95.2,,,95.2,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,All Other,74.51,,,74.51,Fee Schedule,,127,,,127,Other,186% of Medicaid,87.68,,,87.68,Fee Schedule,,268.46,,,268.46,Fee Schedule,,41.29,,,,Fee Schedule,,87.68,,,87.68,Fee Schedule,,268.46,,,268.46,Fee Schedule,,346.4,80,,346.4,percent of total billed charges,All Other,303.1,70,,303.1,percent of total billed charges,,82,,,82,Fee Schedule,,69.5,,,69.5,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,41.29,385.42,
EVALUATE PT USE OF INHALER,94664,CPT,,71094664,CDM,410,RC,,,both,,,433,385.42,,,385.42,Other,150% of Medicare + 9.63% HCRA Surcharge,234.37,,,234.37,Other,Medicare OPPS,281.45,65,,281.45,percent of total billed charges,All Other,255.47,59,,255.47,percent of total billed charges,All Other,111.96,,,111.96,Fee Schedule,,100.72,,,100.72,Fee Schedule,,95.2,,,95.2,Fee Schedule,,303.1,70,,303.1,percent of total billed charges,All Other,74.51,,,74.51,Fee Schedule,,127,,,127,Other,186% of Medicaid,87.68,,,87.68,Fee Schedule,,268.46,,,268.46,Fee Schedule,,41.29,,,,Fee Schedule,,87.68,,,87.68,Fee Schedule,,268.46,,,268.46,Fee Schedule,,346.4,80,,346.4,percent of total billed charges,All Other,303.1,70,,303.1,percent of total billed charges,,82,,,82,Fee Schedule,,69.5,,,69.5,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,41.29,385.42,
CHEST WALL MANIPULATION INITIA,94667,CPT,,71094667,CDM,410,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,170.95,65,,170.95,percent of total billed charges,All Other,155.17,59,,155.17,percent of total billed charges,All Other,157.17,,,157.17,Fee Schedule,,141.39,,,141.39,Fee Schedule,,133.65,,,133.65,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,103.35,,,103.35,Fee Schedule,,127,,,127,Other,186% of Medicaid,121.62,,,121.62,Fee Schedule,,163.06,,,163.06,Fee Schedule,,57.27,,,,Fee Schedule,,121.62,,,121.62,Fee Schedule,,163.06,,,163.06,Fee Schedule,,210.4,80,,210.4,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,,109.88,,,109.88,Fee Schedule,,93.13,,,93.13,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,57.27,230.83,
CHEST WALL MANIP SUBSEQUENT,94668,CPT,,71094668,CDM,410,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,170.95,65,,170.95,percent of total billed charges,All Other,155.17,59,,155.17,percent of total billed charges,All Other,152.4,,,152.4,Fee Schedule,,137.1,,,137.1,Fee Schedule,,129.59,,,129.59,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,162.55,,,162.55,Fee Schedule,,127,,,127,Other,186% of Medicaid,191.29,,,191.29,Fee Schedule,,163.06,,,163.06,Fee Schedule,,90.07,,,,Fee Schedule,,191.29,,,191.29,Fee Schedule,,163.06,,,163.06,Fee Schedule,,210.4,80,,210.4,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,,170.56,,,170.56,Fee Schedule,,144.56,,,144.56,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,68.45,230.83,
MECHANICAL CHEST WALL OSCILL,94669,CPT,,71094669,CDM,410,RC,,,both,,,1284,385.42,,,385.42,Other,150% of Medicare + 9.63% HCRA Surcharge,234.37,,,234.37,Other,Medicare OPPS,834.6,65,,834.6,percent of total billed charges,All Other,757.56,59,,757.56,percent of total billed charges,All Other,982.26,76.5,,982.26,percent of total billed charges,All Other,885.96,69,,885.96,percent of total billed charges,All Other,834.6,65,,834.6,percent of total billed charges,All Other,898.8,70,,898.8,percent of total billed charges,All Other,85.5,,,85.5,Fee Schedule,,127,,,127,Other,186% of Medicaid,100.62,,,100.62,Fee Schedule,,796.08,,,796.08,Fee Schedule,,47.38,,,,Fee Schedule,,100.62,,,100.62,Fee Schedule,,796.08,,,796.08,Fee Schedule,,1027.2,80,,1027.2,percent of total billed charges,All Other,898.8,70,,898.8,percent of total billed charges,,90.2,,,90.2,Fee Schedule,,76.45,,,76.45,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,47.38,1027.2,
HIGH FLOW OXYGEN THERAPY,94799,CPT,,71000005,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP CRITICAL CARE TRANSFER,94799,CPT,,71000006,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP CODE BLUE,94799,CPT,,71000007,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP LABOR AND DELIVERY,94799,CPT,,71000008,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP RAPID RESPONSE,94799,CPT,,71000009,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP VENT PATIENT TRANSPORT,94799,CPT,,71000010,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP NIF ASSESMENT,94799,CPT,,71000011,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP ARTERIAL BLOOD DRAW,94799,CPT,,71000012,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP SPECIAL CARE,94799,CPT,,71000013,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP ADDITIONAL BLOOD DRAW,94799,CPT,,71000014,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP SPECIAL CARE,94799,CPT,,71000015,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP VENT MANAGEMENT,94799,CPT,,71000016,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP RT ASSIST,94799,CPT,,71000017,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP INTUBATION,94799,CPT,,71000018,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP TRACH TUBE,94799,CPT,,71000019,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP PATIENT EDUCATION,94799,CPT,,71000020,CDM,410,RC,,,both,,,0.01,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,282.26,
RESP MS THERAPY/15 MIN,G0237,HCPCS,,71000022,CDM,410,RC,,,both,,,127,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,39.46,,,39.46,Fee Schedule,,35.5,,,35.5,Fee Schedule,,67.99,,,67.99,Fee Schedule,,61.2,,,61.2,Fee Schedule,,57.81,,,57.81,Fee Schedule,,88.9,70,,88.9,percent of total billed charges,All Other,46.88,,,46.88,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,55.17,,,55.17,Fee Schedule,,25.98,,,25.98,Fee Schedule,,25.98,,,,Fee Schedule,,55.17,,,55.17,Fee Schedule,,25.98,,,25.98,Fee Schedule,,48.86,,,48.86,Fee Schedule,,88.9,70,,88.9,percent of total billed charges,,49.2,,,49.2,Fee Schedule,,41.7,,,41.7,Fee Schedule,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.9,
RESP FCN THERAPY/15 MIN,G0238,HCPCS,,71000023,CDM,410,RC,,,both,,,127,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,35.98,,,35.98,Fee Schedule,,32.37,,,32.37,Fee Schedule,,72.47,,,72.47,Fee Schedule,,65.24,,,65.24,Fee Schedule,,61.62,,,61.62,Fee Schedule,,88.9,70,,88.9,percent of total billed charges,All Other,42.75,,,42.75,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,50.31,,,50.31,Fee Schedule,,23.69,,,23.69,Fee Schedule,,23.69,,,,Fee Schedule,,50.31,,,50.31,Fee Schedule,,23.69,,,23.69,Fee Schedule,,44.56,,,44.56,Fee Schedule,,88.9,70,,88.9,percent of total billed charges,,49.2,,,49.2,Fee Schedule,,41.7,,,41.7,Fee Schedule,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.9,
RESP FCN/ STRENG 2/> INDIV,G0239,HCPCS,,71000024,CDM,410,RC,,,both,,,127,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,45.23,,,45.23,Fee Schedule,,40.7,,,40.7,Fee Schedule,,79.3,,,79.3,Fee Schedule,,71.38,,,71.38,Fee Schedule,,67.42,,,67.42,Fee Schedule,,88.9,70,,88.9,percent of total billed charges,All Other,53.74,,,53.74,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,63.24,,,63.24,Fee Schedule,,29.78,,,29.78,Fee Schedule,,29.78,,,,Fee Schedule,,63.24,,,63.24,Fee Schedule,,29.78,,,29.78,Fee Schedule,,56.01,,,56.01,Fee Schedule,,88.9,70,,88.9,percent of total billed charges,,62.32,,,62.32,Fee Schedule,,52.82,,,52.82,Fee Schedule,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,88.9,
FBC HBO PER 30 MIN,G0277,HCPCS,,74000001,CDM,413,RC,,,both,,,968,250.74,,,250.74,Other,150% of Medicare + 9.63% HCRA Surcharge,152.48,,,152.48,Other,Medicare OPPS,2377,,,2377,Case Rate,Hyperbaric Therapy Per Visit,2139,,,2139,Case Rate,Hyperbaric Therapy Per Visit,740.52,76.5,,740.52,percent of total billed charges,All Other,667.92,69,,667.92,percent of total billed charges,All Other,629.2,65,,629.2,percent of total billed charges,All Other,677.6,70,,677.6,percent of total billed charges,All Other,658.24,68,,658.24,percent of total billed charges,All Other,1084,,,1084,Other,186% of Medicaid,774.4,80,,774.4,percent of total billed charges,All Other,803.44,83,,803.44,percent of total billed charges,All Other,803.44,83,,,percent of total billed charges,All Other,774.4,80,,774.4,percent of total billed charges,All Other,803.44,83,,803.44,percent of total billed charges,All Other,774.4,80,,774.4,percent of total billed charges,All Other,677.6,70,,677.6,percent of total billed charges,,1841,,,1841,Case Rate,Hyperbaric Therapy Per Visit,1565,,,1565,Case Rate,Hyperbaric Therapy Per Visit,1056,,,1056,Case Rate,Hyperbaric Therapy Per Visit,951,,,951,Case Rate,Hyperbaric Therapy Per Visit,1056,,,1056,Case Rate,Hyperbaric Therapy Per Visit,898,,,898,Case Rate,Hyperbaric Therapy Per Visit,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,891.54,,,891.54,Other,153% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,815.79,,,815.79,Other,140% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,1515.03,,,1515.03,Other,250% of Medicaid,1887.96,,,1887.96,Other,324% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,728.38,,,728.38,Other,125% of Medicaid,152.48,2377,
STRAPPING OF SHOULDER,29240,CPT,GP,62029240,CDM,420,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,38.91,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,38.91,590.87,
STRAPPING OF SHOULDER,29240,CPT,GP,64129240,CDM,420,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,38.91,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,38.91,590.87,
STRAPPING OF ELBOW OR WRIST,29260,CPT,GP,62029260,CDM,420,RC,,,both,,,563,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,41.31,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,41.31,590.87,
STRAPPING OF ELBOW OR WRIST,29260,CPT,GP,64129260,CDM,420,RC,,,both,,,563,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,41.31,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,41.31,590.87,
STRAPPING OF KNEE,29530,CPT,GP,62029530,CDM,420,RC,,,both,,,491,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,375.62,76.5,,375.62,percent of total billed charges,All Other,338.79,69,,338.79,percent of total billed charges,All Other,319.15,65,,319.15,percent of total billed charges,All Other,343.7,70,,343.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,407.53,83,,407.53,percent of total billed charges,Therapy,38.91,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,407.53,83,,407.53,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,343.7,70,,343.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,38.91,590.87,
STRAPPING OF KNEE,29530,CPT,GP,64029530,CDM,420,RC,,,both,,,491,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,375.62,76.5,,375.62,percent of total billed charges,All Other,338.79,69,,338.79,percent of total billed charges,All Other,319.15,65,,319.15,percent of total billed charges,All Other,343.7,70,,343.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,407.53,83,,407.53,percent of total billed charges,Therapy,38.91,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,407.53,83,,407.53,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,343.7,70,,343.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,38.91,590.87,
STRAPPING OF ANKLE AND/OR FT,29540,CPT,GP,62029540,CDM,420,RC,,,both,,,491,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,375.62,76.5,,375.62,percent of total billed charges,All Other,338.79,69,,338.79,percent of total billed charges,All Other,319.15,65,,319.15,percent of total billed charges,All Other,343.7,70,,343.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,407.53,83,,407.53,percent of total billed charges,Therapy,37.51,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,407.53,83,,407.53,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,343.7,70,,343.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,37.51,590.87,
STRAPPING OF ANKLE AND/OR FT,29540,CPT,GP,64029540,CDM,420,RC,,,both,,,491,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,375.62,76.5,,375.62,percent of total billed charges,All Other,338.79,69,,338.79,percent of total billed charges,All Other,319.15,65,,319.15,percent of total billed charges,All Other,343.7,70,,343.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,407.53,83,,407.53,percent of total billed charges,Therapy,37.51,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,407.53,83,,407.53,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,343.7,70,,343.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,37.51,590.87,
CANALITH REPOSITIONING PROC,95992,CPT,GP,62095992,CDM,420,RC,,,both,,,177,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,266.11,,,266.11,Fee Schedule,,239.4,,,239.4,Fee Schedule,,226.29,,,226.29,Fee Schedule,,123.9,70,,123.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,146.91,83,,146.91,percent of total billed charges,Therapy,77.85,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,146.91,83,,146.91,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,123.9,70,,123.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
CANALITH REPOSITIONING PROC,95992,CPT,GP,64095992,CDM,420,RC,,,both,,,177,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,266.11,,,266.11,Fee Schedule,,239.4,,,239.4,Fee Schedule,,226.29,,,226.29,Fee Schedule,,123.9,70,,123.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,146.91,83,,146.91,percent of total billed charges,Therapy,77.85,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,146.91,83,,146.91,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,123.9,70,,123.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
HOT OR COLD PACKS THERAPY,97010,CPT,GP,62097010,CDM,420,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,3.82,,,3.82,Fee Schedule,,3.82,,,3.82,Fee Schedule,,3.82,,,3.82,Fee Schedule,,67.2,70,,67.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,52.8,55,,,percent of total billed charges,Default if not in Fee Schedule,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,67.2,70,,67.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
HOT OR COLD PACKS THERAPY,97010,CPT,GP,64197010,CDM,420,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,3.82,,,3.82,Fee Schedule,,3.82,,,3.82,Fee Schedule,,3.82,,,3.82,Fee Schedule,,67.2,70,,67.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,52.8,55,,,percent of total billed charges,Default if not in Fee Schedule,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,67.2,70,,67.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
MECHANICAL TRACTION THERAPY 1+ AREAS,97012,CPT,GP,62097012,CDM,420,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,96.56,,,96.56,Fee Schedule,,86.87,,,86.87,Fee Schedule,,82.11,,,82.11,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,31.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,83.3,70,,83.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
PARAFFIN BATH THERAPY,97018,CPT,GP,62097018,CDM,420,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,64.17,,,64.17,Fee Schedule,,57.73,,,57.73,Fee Schedule,,54.57,,,54.57,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,12.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,83.3,70,,83.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
INFRARED THERAPY 1+ AREAS,97026,CPT,GP,62097026,CDM,420,RC,,,both,,,27,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,35.62,,,35.62,Fee Schedule,,32.05,,,32.05,Fee Schedule,,30.29,,,30.29,Fee Schedule,,18.9,70,,18.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,22.41,83,,22.41,percent of total billed charges,Therapy,15.08,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,22.41,83,,22.41,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,18.9,70,,18.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
ELECTRICAL STIMULATION 15,97032,CPT,GP,62097032,CDM,420,RC,,,both,,,118,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,113.22,,,113.22,Fee Schedule,,101.85,,,101.85,Fee Schedule,,96.28,,,96.28,Fee Schedule,,82.6,70,,82.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,97.94,83,,97.94,percent of total billed charges,Therapy,31.77,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,97.94,83,,97.94,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,82.6,70,,82.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
ELECTRICAL STIMULATION 15,97032,CPT,GP,64197032,CDM,420,RC,,,both,,,118,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,113.22,,,113.22,Fee Schedule,,101.85,,,101.85,Fee Schedule,,96.28,,,96.28,Fee Schedule,,82.6,70,,82.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,97.94,83,,97.94,percent of total billed charges,Therapy,31.77,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,97.94,83,,97.94,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,82.6,70,,82.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
IONTOPHORESIS,97033,CPT,GP,62097033,CDM,420,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,186.59,,,186.59,Fee Schedule,,167.87,,,167.87,Fee Schedule,,158.67,,,158.67,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,151.06,83,,151.06,percent of total billed charges,Therapy,43.16,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,151.06,83,,151.06,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,127.4,70,,127.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
PT-IONTOPHORESIS,97033,CPT,GP,64197033,CDM,420,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,186.59,,,186.59,Fee Schedule,,167.87,,,167.87,Fee Schedule,,158.67,,,158.67,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,151.06,83,,151.06,percent of total billed charges,Therapy,43.16,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,151.06,83,,151.06,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,127.4,70,,127.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
ULTRASOUND 15 MINUTES,97035,CPT,GP,62097035,CDM,420,RC,,,both,,,127,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,74.47,,,74.47,Fee Schedule,,67,,,67,Fee Schedule,,63.33,,,63.33,Fee Schedule,,88.9,70,,88.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,105.41,83,,105.41,percent of total billed charges,Therapy,31.19,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,105.41,83,,105.41,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,88.9,70,,88.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
ULTRASOUND 15 MINUTES,97035,CPT,GP,64197035,CDM,420,RC,,,both,,,127,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,74.47,,,74.47,Fee Schedule,,67,,,67,Fee Schedule,,63.33,,,63.33,Fee Schedule,,88.9,70,,88.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,105.41,83,,105.41,percent of total billed charges,Therapy,31.19,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,105.41,83,,105.41,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,88.9,70,,88.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
THERAPEUTIC EXERCISE 15 MIN,97110,CPT,GP,62097110,CDM,420,RC,,,both,,,187,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,188.02,,,188.02,Fee Schedule,,169.15,,,169.15,Fee Schedule,,159.88,,,159.88,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,130.9,70,,130.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-THERAPEUTIC EXERCISE 15 MIN,97110,CPT,GPGT,62297110,CDM,420,RC,,,both,,,187,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,188.02,,,188.02,Fee Schedule,,169.15,,,169.15,Fee Schedule,,159.88,,,159.88,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,130.9,70,,130.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THERAPEUTIC EXERCISE 15 MIN,97110,CPT,GP,64197110,CDM,420,RC,,,both,,,187,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,188.02,,,188.02,Fee Schedule,,169.15,,,169.15,Fee Schedule,,159.88,,,159.88,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,130.9,70,,130.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-THERAPEUTIC EXERCISE 15 MIN,97110,CPT,GPGT,64397110,CDM,420,RC,,,both,,,187,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,188.02,,,188.02,Fee Schedule,,169.15,,,169.15,Fee Schedule,,159.88,,,159.88,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,130.9,70,,130.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
NEUROMUSC REEDUCATION 15 MIN,97112,CPT,GP,62097112,CDM,420,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,197.55,,,197.55,Fee Schedule,,177.73,,,177.73,Fee Schedule,,167.99,,,167.99,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,74.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,145.6,70,,145.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-NEUROMUSC REEDUCATION 15 MIN,97112,CPT,GPGT,62297112,CDM,420,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,197.55,,,197.55,Fee Schedule,,177.73,,,177.73,Fee Schedule,,167.99,,,167.99,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,74.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,145.6,70,,145.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
NEUROMUSC REEDUCATION 15 MIN,97112,CPT,GP,64197112,CDM,420,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,197.55,,,197.55,Fee Schedule,,177.73,,,177.73,Fee Schedule,,167.99,,,167.99,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,74.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,145.6,70,,145.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-NEUROMUSC REEDUCATION 15 MIN,97112,CPT,GPGT,64397112,CDM,420,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,197.55,,,197.55,Fee Schedule,,177.73,,,177.73,Fee Schedule,,167.99,,,167.99,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,74.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,145.6,70,,145.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
GAIT TRAINING THERAPY,97116,CPT,GP,62097116,CDM,420,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,166.37,,,166.37,Fee Schedule,,149.67,,,149.67,Fee Schedule,,141.48,,,141.48,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
TH-GAIT TRAINING THERAPY,97116,CPT,GPGT,62297116,CDM,420,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,166.37,,,166.37,Fee Schedule,,149.67,,,149.67,Fee Schedule,,141.48,,,141.48,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
GAIT TRAINING THERAPY,97116,CPT,GP,64097116,CDM,420,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,166.37,,,166.37,Fee Schedule,,149.67,,,149.67,Fee Schedule,,141.48,,,141.48,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
TH-GAIT TRAINING THERAPY,97116,CPT,GPGT,64297116,CDM,420,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,166.37,,,166.37,Fee Schedule,,149.67,,,149.67,Fee Schedule,,141.48,,,141.48,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
MASSAGE THERAPY,97124,CPT,GP,62097124,CDM,420,RC,,,both,,,145,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,154.21,,,154.21,Fee Schedule,,138.73,,,138.73,Fee Schedule,,131.13,,,131.13,Fee Schedule,,101.5,70,,101.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,120.35,83,,120.35,percent of total billed charges,Therapy,67.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,120.35,83,,120.35,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,101.5,70,,101.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
MASSAGE THERAPY,97124,CPT,GP,64197124,CDM,420,RC,,,both,,,145,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,154.21,,,154.21,Fee Schedule,,138.73,,,138.73,Fee Schedule,,131.13,,,131.13,Fee Schedule,,101.5,70,,101.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,120.35,83,,120.35,percent of total billed charges,Therapy,67.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,120.35,83,,120.35,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,101.5,70,,101.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
MANUAL THERAPY,97140,CPT,GP,62097140,CDM,420,RC,,,both,,,198,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,176.95,,,176.95,Fee Schedule,,159.19,,,159.19,Fee Schedule,,150.47,,,150.47,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,164.34,83,,164.34,percent of total billed charges,Therapy,59.93,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,164.34,83,,164.34,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,138.6,70,,138.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
MANUAL THERAPY,97140,CPT,GP,64197140,CDM,420,RC,,,both,,,198,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,176.95,,,176.95,Fee Schedule,,159.19,,,159.19,Fee Schedule,,150.47,,,150.47,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,164.34,83,,164.34,percent of total billed charges,Therapy,59.93,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,164.34,83,,164.34,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,138.6,70,,138.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THERAPEUTIC REHAB GROUP,97150,CPT,GP,62097150,CDM,420,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,121.88,,,121.88,Fee Schedule,,109.64,,,109.64,Fee Schedule,,103.64,,,103.64,Fee Schedule,,67.2,70,,67.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,39.98,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,67.2,70,,67.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THERAPEUTIC REHAB GROUP,97150,CPT,GP,64197150,CDM,420,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,121.88,,,121.88,Fee Schedule,,109.64,,,109.64,Fee Schedule,,103.64,,,103.64,Fee Schedule,,67.2,70,,67.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,39.98,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,67.2,70,,67.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THERAPEUTIC ACTIVITY 15 MIN,97530,CPT,GP,62097530,CDM,420,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.47,,,207.47,Fee Schedule,,186.65,,,186.65,Fee Schedule,,176.43,,,176.43,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,81.96,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-THERAPEUTIC ACTIVITY 15 MIN,97530,CPT,GPGT,62297530,CDM,420,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.47,,,207.47,Fee Schedule,,186.65,,,186.65,Fee Schedule,,176.43,,,176.43,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,81.96,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THERAPEUTIC ACTIVITY 15 MIN,97530,CPT,GP,64197530,CDM,420,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.47,,,207.47,Fee Schedule,,186.65,,,186.65,Fee Schedule,,176.43,,,176.43,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,81.96,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-THERAPEUTIC ACTIVITY 15 MIN,97530,CPT,GPGT,64397530,CDM,420,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.47,,,207.47,Fee Schedule,,186.65,,,186.65,Fee Schedule,,176.43,,,176.43,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,81.96,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
SENSORY INTEGRATE TECH 15MIN,97533,CPT,GP,62097533,CDM,420,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,174.15,,,174.15,Fee Schedule,,156.68,,,156.68,Fee Schedule,,148.09,,,148.09,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,140.34,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
SENSORY INTEGRATE TECH 15MIN,97533,CPT,GP,64197533,CDM,420,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,174.15,,,174.15,Fee Schedule,,156.68,,,156.68,Fee Schedule,,148.09,,,148.09,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,140.34,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
SELF CARE MNGMENT TRAINING,97535,CPT,GP,62097535,CDM,420,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.03,,,207.03,Fee Schedule,,186.26,,,186.26,Fee Schedule,,176.05,,,176.05,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,72.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,135.1,70,,135.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
TH-SELF CARE MNGMENT TRAINING,97535,CPT,GPGT,62297535,CDM,420,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.03,,,207.03,Fee Schedule,,186.26,,,186.26,Fee Schedule,,176.05,,,176.05,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,72.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,135.1,70,,135.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
SELF CARE MNGMENT TRAINING,97535,CPT,GP,64197535,CDM,420,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.03,,,207.03,Fee Schedule,,186.26,,,186.26,Fee Schedule,,176.05,,,176.05,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,72.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,135.1,70,,135.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
TH-SELF CARE MNGMENT TRAINING,97535,CPT,GPGT,64397535,CDM,420,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.03,,,207.03,Fee Schedule,,186.26,,,186.26,Fee Schedule,,176.05,,,176.05,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,72.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,135.1,70,,135.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
COMMUNITY/WORK REINTEGRATION EA 15 MIN,97537,CPT,GP,62097537,CDM,420,RC,,,both,,,141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,178.48,,,178.48,Fee Schedule,,160.57,,,160.57,Fee Schedule,,151.78,,,151.78,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,117.03,83,,117.03,percent of total billed charges,Therapy,70.37,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,117.03,83,,117.03,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,98.7,70,,98.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
COMMUNITY/WORK REINTEGRATION EA 15 MIN,97537,CPT,GP,64197537,CDM,420,RC,,,both,,,141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,178.48,,,178.48,Fee Schedule,,160.57,,,160.57,Fee Schedule,,151.78,,,151.78,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,117.03,83,,117.03,percent of total billed charges,Therapy,70.37,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,117.03,83,,117.03,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,98.7,70,,98.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
WHEELCHAIR MNGMENT TRAINING,97542,CPT,GP,62097542,CDM,420,RC,,,both,,,190,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,180.89,,,180.89,Fee Schedule,,162.74,,,162.74,Fee Schedule,,153.83,,,153.83,Fee Schedule,,133,70,,133,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,157.7,83,,157.7,percent of total billed charges,Therapy,70.37,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,157.7,83,,157.7,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,133,70,,133,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
WHEELCHAIR MNGMENT TRAINING,97542,CPT,GP,64197542,CDM,420,RC,,,both,,,190,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,180.89,,,180.89,Fee Schedule,,162.74,,,162.74,Fee Schedule,,153.83,,,153.83,Fee Schedule,,133,70,,133,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,157.7,83,,157.7,percent of total billed charges,Therapy,70.37,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,157.7,83,,157.7,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,133,70,,133,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
SLCTV WND DEBRIDEM 20 CM OR <,97597,CPT,GP,62097597,CDM,420,RC,,,both,,,573,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,438.35,76.5,,438.35,percent of total billed charges,All Other,395.37,69,,395.37,percent of total billed charges,All Other,372.45,65,,372.45,percent of total billed charges,All Other,256,,,256,Case Rate,,219,,,219,Case Rate,Therapy Visit,717,,,717,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,475.59,83,,475.59,percent of total billed charges,Therapy,77.34,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,475.59,83,,475.59,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,401.1,70,,401.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,589.47,,,589.47,Other,153% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,539.38,,,539.38,Other,140% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,1001.71,,,1001.71,Other,250% of Medicaid,1248.29,,,1248.29,Other,324% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,481.59,,,481.59,Other,125% of Medicaid,77.34,1248.29,
SLCTV WND DEBRIDEM 20 CM OR <,97597,CPT,GP,64197597,CDM,420,RC,,,both,,,573,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,438.35,76.5,,438.35,percent of total billed charges,All Other,395.37,69,,395.37,percent of total billed charges,All Other,372.45,65,,372.45,percent of total billed charges,All Other,256,,,256,Case Rate,,219,,,219,Case Rate,Therapy Visit,717,,,717,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,475.59,83,,475.59,percent of total billed charges,Therapy,77.34,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,475.59,83,,475.59,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,401.1,70,,401.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,589.47,,,589.47,Other,153% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,539.38,,,539.38,Other,140% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,1001.71,,,1001.71,Other,250% of Medicaid,1248.29,,,1248.29,Other,324% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,481.59,,,481.59,Other,125% of Medicaid,77.34,1248.29,
ELECTRICAL STIMULATION EA 15 MINS,G0283,HCPCS,GP,62000001,CDM,420,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,80.5,,,80.5,Fee Schedule,,72.42,,,72.42,Fee Schedule,,68.46,,,68.46,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,26,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,83.3,70,,83.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
ELECTRICAL STIMULATION EA 15 MINS,G0283,HCPCS,GP,64000002,CDM,420,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,80.5,,,80.5,Fee Schedule,,72.42,,,72.42,Fee Schedule,,68.46,,,68.46,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,26,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,83.3,70,,83.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
PT EVAL LOW COMPLEX 20 MIN,97161,CPT,GP,62097161,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
TH-PT EVAL LOW COMPLEX 20 MIN,97161,CPT,GPGT,62297161,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
PT EVAL LOW COMPLEX 20 MIN,97161,CPT,GP,64097161,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
TH-PT EVAL LOW COMPLEX 20 MIN,97161,CPT,GPGT,64297161,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
PT EVAL MOD COMPLEX 30 MIN,97162,CPT,GP,62097162,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
ARC SCREEN PT,97162,CPT,GP,62197162,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
TH-PT EVAL MOD COMPLEX 30 MIN,97162,CPT,GPGT,62297162,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
PT EVAL MOD COMPLEX 30 MIN,97162,CPT,GP,64097162,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
ARC SCREEN PT SAUG,97162,CPT,GP,64197162,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
TH-PT EVAL MOD COMPLEX 30 MIN,97162,CPT,GPGT,64297162,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
PT EVAL HIGH COMPLEX 45 MIN,97163,CPT,GP,62097163,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
TH-PT EVAL HIGH COMPLEX 45 MIN,97163,CPT,GPGT,62297163,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
PT EVAL HIGH COMPLEX 45 MIN,97163,CPT,GP,64097163,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
TH-PT EVAL HIGH COMPLEX 45 MIN,97163,CPT,GPGT,64297163,CDM,424,RC,,,both,,,468,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,76.19,,,76.19,Fee Schedule,,327.6,70,,327.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,223.02,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,388.44,83,,388.44,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,327.6,70,,327.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,388.44,
PT RE-EVAL EST PLAN CARE,97164,CPT,GP,62097164,CDM,424,RC,,,both,,,266,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,52.16,,,52.16,Fee Schedule,,52.16,,,52.16,Fee Schedule,,52.16,,,52.16,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,220.78,83,,220.78,percent of total billed charges,Therapy,155.32,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,220.78,83,,220.78,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,186.2,70,,186.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,368,
PT RE-EVAL EST PLAN CARE,97164,CPT,GP,64097164,CDM,424,RC,,,both,,,266,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,52.16,,,52.16,Fee Schedule,,52.16,,,52.16,Fee Schedule,,52.16,,,52.16,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,206,,,206,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,220.78,83,,220.78,percent of total billed charges,Therapy,155.32,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,220.78,83,,220.78,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,186.2,70,,186.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,110.65,,,110.65,Other,100% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,169.29,,,169.29,Other,153% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,154.91,,,154.91,Other,140% of Medicaid,248.96,,,248.96,Other,225% of Medicaid,287.69,,,287.69,Other,250% of Medicaid,358.5,,,358.5,Other,324% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,237.89,,,237.89,Other,215% of Medicaid,138.31,,,138.31,Other,125% of Medicaid,0.01,368,
APPLY LONG ARM SPLINT,29105,CPT,GO,63029105,CDM,430,RC,,,both,,,544,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,416.16,76.5,,416.16,percent of total billed charges,All Other,375.36,69,,375.36,percent of total billed charges,All Other,353.6,65,,353.6,percent of total billed charges,All Other,380.8,70,,380.8,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,451.52,83,,451.52,percent of total billed charges,Therapy,93.56,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,451.52,83,,451.52,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,380.8,70,,380.8,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,93.56,590.87,
APPLY LONG ARM SPLINT,29105,CPT,GO,63129105,CDM,430,RC,,,both,,,544,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,416.16,76.5,,416.16,percent of total billed charges,All Other,375.36,69,,375.36,percent of total billed charges,All Other,353.6,65,,353.6,percent of total billed charges,All Other,380.8,70,,380.8,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,451.52,83,,451.52,percent of total billed charges,Therapy,93.56,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,451.52,83,,451.52,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,380.8,70,,380.8,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,93.56,590.87,
APPLY LONG ARM SPLINT,29105,CPT,GO,64029105,CDM,430,RC,,,both,,,544,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,416.16,76.5,,416.16,percent of total billed charges,All Other,375.36,69,,375.36,percent of total billed charges,All Other,353.6,65,,353.6,percent of total billed charges,All Other,380.8,70,,380.8,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,451.52,83,,451.52,percent of total billed charges,Therapy,93.56,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,451.52,83,,451.52,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,380.8,70,,380.8,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,93.56,590.87,
APPLY SHORT ARM SPLINT; STATIC,29125,CPT,GO,63029125,CDM,430,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,91.73,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,91.73,590.87,
APPLY FOREARM SPLINT,29125,CPT,GO,63129125,CDM,430,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,91.73,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,91.73,590.87,
APPLY FOREARM SPLINT,29125,CPT,GO,64029125,CDM,430,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,91.73,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,91.73,590.87,
APPLY FOREARM SPLINT DYNAMIC,29126,CPT,GO,63029126,CDM,430,RC,,,both,,,452,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,345.78,76.5,,345.78,percent of total billed charges,All Other,311.88,69,,311.88,percent of total billed charges,All Other,293.8,65,,293.8,percent of total billed charges,All Other,256,,,256,Case Rate,,219,,,219,Case Rate,Therapy Visit,552,,,552,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,375.16,83,,375.16,percent of total billed charges,Therapy,111.64,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,375.16,83,,375.16,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,316.4,70,,316.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,296.56,,,296.56,Other,100% of Medicaid,296.56,,,296.56,Other,100% of Medicaid,296.56,,,296.56,Other,100% of Medicaid,296.56,,,296.56,Other,100% of Medicaid,667.27,,,667.27,Other,225% of Medicaid,453.74,,,453.74,Other,153% of Medicaid,667.27,,,667.27,Other,225% of Medicaid,415.19,,,415.19,Other,140% of Medicaid,667.27,,,667.27,Other,225% of Medicaid,771.07,,,771.07,Other,250% of Medicaid,960.87,,,960.87,Other,324% of Medicaid,637.61,,,637.61,Other,215% of Medicaid,637.61,,,637.61,Other,215% of Medicaid,370.7,,,370.7,Other,125% of Medicaid,111.64,960.87,
APPLY FOREARM SPLINT DYNAMIC,29126,CPT,GO,64029126,CDM,430,RC,,,both,,,452,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,345.78,76.5,,345.78,percent of total billed charges,All Other,311.88,69,,311.88,percent of total billed charges,All Other,293.8,65,,293.8,percent of total billed charges,All Other,256,,,256,Case Rate,,219,,,219,Case Rate,Therapy Visit,552,,,552,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,375.16,83,,375.16,percent of total billed charges,Therapy,111.64,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,375.16,83,,375.16,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,316.4,70,,316.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,296.56,,,296.56,Other,100% of Medicaid,296.56,,,296.56,Other,100% of Medicaid,296.56,,,296.56,Other,100% of Medicaid,296.56,,,296.56,Other,100% of Medicaid,667.27,,,667.27,Other,225% of Medicaid,453.74,,,453.74,Other,153% of Medicaid,667.27,,,667.27,Other,225% of Medicaid,415.19,,,415.19,Other,140% of Medicaid,667.27,,,667.27,Other,225% of Medicaid,771.07,,,771.07,Other,250% of Medicaid,960.87,,,960.87,Other,324% of Medicaid,637.61,,,637.61,Other,215% of Medicaid,637.61,,,637.61,Other,215% of Medicaid,370.7,,,370.7,Other,125% of Medicaid,111.64,960.87,
APPLICATION OF FINGER SPLINT,29130,CPT,GO,63029130,CDM,430,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,65.12,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,65.12,590.87,
APPLICATION OF FINGER SPLINT,29130,CPT,GO,64029130,CDM,430,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,65.12,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,65.12,590.87,
APPL OF FNGER SPLNT DYNAMIC,29131,CPT,GO,63029131,CDM,430,RC,,,both,,,452,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,345.78,76.5,,345.78,percent of total billed charges,All Other,311.88,69,,311.88,percent of total billed charges,All Other,293.8,65,,293.8,percent of total billed charges,All Other,316.4,70,,316.4,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,375.16,83,,375.16,percent of total billed charges,Therapy,77.83,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,375.16,83,,375.16,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,316.4,70,,316.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,67.21,590.87,
APPL OF FNGER SPLNT DYNAMIC,29131,CPT,GO,64029131,CDM,430,RC,,,both,,,452,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,345.78,76.5,,345.78,percent of total billed charges,All Other,311.88,69,,311.88,percent of total billed charges,All Other,293.8,65,,293.8,percent of total billed charges,All Other,316.4,70,,316.4,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,375.16,83,,375.16,percent of total billed charges,Therapy,77.83,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,375.16,83,,375.16,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,316.4,70,,316.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,67.21,590.87,
STRAPPING OF SHOULDER,29240,CPT,GO,63029240,CDM,430,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,38.91,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,38.91,590.87,
STRAPPING OF SHOULDER,29240,CPT,GO,64029240,CDM,430,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,38.91,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,38.91,590.87,
STRAPPING OF ELBOW OR WRIST,29260,CPT,GO,63029260,CDM,430,RC,,,both,,,563,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,41.31,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,41.31,590.87,
STRAPPING OF ELBOW OR WRIST,29260,CPT,GO,64029260,CDM,430,RC,,,both,,,563,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,41.31,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,41.31,590.87,
STRAPPING OF HAND OR FINGER,29280,CPT,GO,63029280,CDM,430,RC,,,both,,,563,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,44.58,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,44.58,590.87,
STRAPPING OF HAND OR FINGER,29280,CPT,GO,64029280,CDM,430,RC,,,both,,,563,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,430.7,76.5,,430.7,percent of total billed charges,All Other,388.47,69,,388.47,percent of total billed charges,All Other,365.95,65,,365.95,percent of total billed charges,All Other,394.1,70,,394.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,339,,,339,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,44.58,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,467.29,83,,467.29,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,394.1,70,,394.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,44.58,590.87,
HOT OR COLD PACKS THERAPY,97010,CPT,GO,63097010,CDM,430,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,3.82,,,3.82,Fee Schedule,,3.82,,,3.82,Fee Schedule,,3.82,,,3.82,Fee Schedule,,67.2,70,,67.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,52.8,55,,,percent of total billed charges,Default if not in Fee Schedule,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,67.2,70,,67.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
HOT OR COLD PACKS THERAPY,97010,CPT,GO,64097010,CDM,430,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,3.82,,,3.82,Fee Schedule,,3.82,,,3.82,Fee Schedule,,3.82,,,3.82,Fee Schedule,,67.2,70,,67.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,52.8,55,,,percent of total billed charges,Default if not in Fee Schedule,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,67.2,70,,67.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
PARAFFIN BATH THERAPY,97018,CPT,GO,63097018,CDM,430,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,64.17,,,64.17,Fee Schedule,,57.73,,,57.73,Fee Schedule,,54.57,,,54.57,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,12.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,83.3,70,,83.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
PARAFFIN BATH THERAPY,97018,CPT,GO,64097018,CDM,430,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,64.17,,,64.17,Fee Schedule,,57.73,,,57.73,Fee Schedule,,54.57,,,54.57,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,12.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,83.3,70,,83.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
ELECT STIM;MANUAL;EACH 15,97032,CPT,GO,63097032,CDM,430,RC,,,both,,,118,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,113.22,,,113.22,Fee Schedule,,101.85,,,101.85,Fee Schedule,,96.28,,,96.28,Fee Schedule,,82.6,70,,82.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,97.94,83,,97.94,percent of total billed charges,Therapy,31.77,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,97.94,83,,97.94,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,82.6,70,,82.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
ELECT STIM;MANUAL;EACH 15,97032,CPT,GO,64097032,CDM,430,RC,,,both,,,118,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,113.22,,,113.22,Fee Schedule,,101.85,,,101.85,Fee Schedule,,96.28,,,96.28,Fee Schedule,,82.6,70,,82.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,97.94,83,,97.94,percent of total billed charges,Therapy,31.77,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,97.94,83,,97.94,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,82.6,70,,82.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
IONTOPHORESIS,97033,CPT,GO,63097033,CDM,430,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,186.59,,,186.59,Fee Schedule,,167.87,,,167.87,Fee Schedule,,158.67,,,158.67,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,151.06,83,,151.06,percent of total billed charges,Therapy,43.16,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,151.06,83,,151.06,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,127.4,70,,127.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
OT-IONTOPHORESIS,97033,CPT,GO,64097033,CDM,430,RC,,,both,,,182,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,186.59,,,186.59,Fee Schedule,,167.87,,,167.87,Fee Schedule,,158.67,,,158.67,Fee Schedule,,127.4,70,,127.4,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,151.06,83,,151.06,percent of total billed charges,Therapy,43.16,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,151.06,83,,151.06,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,127.4,70,,127.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
CONTRAST BATH THERAPY,97034,CPT,GO,63097034,CDM,430,RC,,,both,,,82,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,105.44,,,105.44,Fee Schedule,,94.85,,,94.85,Fee Schedule,,89.66,,,89.66,Fee Schedule,,57.4,70,,57.4,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,68.06,83,,68.06,percent of total billed charges,Therapy,31.19,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,68.06,83,,68.06,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,57.4,70,,57.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
CONTRAST BATH THERAPY,97034,CPT,GO,64097034,CDM,430,RC,,,both,,,82,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,105.44,,,105.44,Fee Schedule,,94.85,,,94.85,Fee Schedule,,89.66,,,89.66,Fee Schedule,,57.4,70,,57.4,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,68.06,83,,68.06,percent of total billed charges,Therapy,31.19,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,68.06,83,,68.06,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,57.4,70,,57.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
ULTRASOUND THERAPY,97035,CPT,GO,63097035,CDM,430,RC,,,both,,,127,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,74.47,,,74.47,Fee Schedule,,67,,,67,Fee Schedule,,63.33,,,63.33,Fee Schedule,,88.9,70,,88.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,105.41,83,,105.41,percent of total billed charges,Therapy,31.19,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,105.41,83,,105.41,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,88.9,70,,88.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
ULTRASOUND THERAPY,97035,CPT,GO,64097035,CDM,430,RC,,,both,,,127,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,74.47,,,74.47,Fee Schedule,,67,,,67,Fee Schedule,,63.33,,,63.33,Fee Schedule,,88.9,70,,88.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,105.41,83,,105.41,percent of total billed charges,Therapy,31.19,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,105.41,83,,105.41,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,88.9,70,,88.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
FLUIDOTHERAPY,97039,CPT,GO,63097139,CDM,430,RC,,,both,,,111,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,84.92,76.5,,84.92,percent of total billed charges,All Other,76.59,69,,76.59,percent of total billed charges,All Other,72.15,65,,72.15,percent of total billed charges,All Other,256,,,256,Case Rate,,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,92.13,83,,92.13,percent of total billed charges,Therapy,61.05,55,,,percent of total billed charges,Default if not in Fee Schedule,257,,,257,Case Rate,Therapy Visit,92.13,83,,92.13,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,77.7,70,,77.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
FLUIDOTHERAPY,97039,CPT,GO,64097139,CDM,430,RC,,,both,,,111,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,84.92,76.5,,84.92,percent of total billed charges,All Other,76.59,69,,76.59,percent of total billed charges,All Other,72.15,65,,72.15,percent of total billed charges,All Other,256,,,256,Case Rate,,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,92.13,83,,92.13,percent of total billed charges,Therapy,61.05,55,,,percent of total billed charges,Default if not in Fee Schedule,257,,,257,Case Rate,Therapy Visit,92.13,83,,92.13,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,77.7,70,,77.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
THERAPEUTIC EXERCISES,97110,CPT,GO,63097110,CDM,430,RC,,,both,,,187,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,188.02,,,188.02,Fee Schedule,,169.15,,,169.15,Fee Schedule,,159.88,,,159.88,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,130.9,70,,130.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-THERAPEUTIC EXERCISES,97110,CPT,GOGT,63297110,CDM,430,RC,,,both,,,187,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,188.02,,,188.02,Fee Schedule,,169.15,,,169.15,Fee Schedule,,159.88,,,159.88,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,130.9,70,,130.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THERAPEUTIC EXERCISES,97110,CPT,GO,64097110,CDM,430,RC,,,both,,,187,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,188.02,,,188.02,Fee Schedule,,169.15,,,169.15,Fee Schedule,,159.88,,,159.88,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,130.9,70,,130.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-THERAPEUTIC EXERCISES,97110,CPT,GOGT,64297110,CDM,430,RC,,,both,,,187,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,188.02,,,188.02,Fee Schedule,,169.15,,,169.15,Fee Schedule,,159.88,,,159.88,Fee Schedule,,130.9,70,,130.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,65.18,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,155.21,83,,155.21,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,130.9,70,,130.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
NEUROMUSCULAR REEDUCATION,97112,CPT,GO,63097112,CDM,430,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,197.55,,,197.55,Fee Schedule,,177.73,,,177.73,Fee Schedule,,167.99,,,167.99,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,74.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,145.6,70,,145.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-NEUROMUSCULAR REEDUCATION,97112,CPT,GOGT,63297112,CDM,430,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,197.55,,,197.55,Fee Schedule,,177.73,,,177.73,Fee Schedule,,167.99,,,167.99,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,74.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,145.6,70,,145.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
NEUROMUSCULAR REEDUCATION,97112,CPT,GO,64097112,CDM,430,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,197.55,,,197.55,Fee Schedule,,177.73,,,177.73,Fee Schedule,,167.99,,,167.99,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,74.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,145.6,70,,145.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-NEUROMUSCULAR REEDUCATION,97112,CPT,GOGT,64297112,CDM,430,RC,,,both,,,208,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,197.55,,,197.55,Fee Schedule,,177.73,,,177.73,Fee Schedule,,167.99,,,167.99,Fee Schedule,,145.6,70,,145.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,74.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,172.64,83,,172.64,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,145.6,70,,145.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
MASSAGE THERAPY,97124,CPT,GO,63097124,CDM,430,RC,,,both,,,145,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,154.21,,,154.21,Fee Schedule,,138.73,,,138.73,Fee Schedule,,131.13,,,131.13,Fee Schedule,,101.5,70,,101.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,120.35,83,,120.35,percent of total billed charges,Therapy,67.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,120.35,83,,120.35,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,101.5,70,,101.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
MASSAGE THERAPY,97124,CPT,GO,64097124,CDM,430,RC,,,both,,,145,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,154.21,,,154.21,Fee Schedule,,138.73,,,138.73,Fee Schedule,,131.13,,,131.13,Fee Schedule,,101.5,70,,101.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,120.35,83,,120.35,percent of total billed charges,Therapy,67.87,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,120.35,83,,120.35,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,101.5,70,,101.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
MANUAL THERAPY,97140,CPT,GO,63097140,CDM,430,RC,,,both,,,198,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,176.95,,,176.95,Fee Schedule,,159.19,,,159.19,Fee Schedule,,150.47,,,150.47,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,164.34,83,,164.34,percent of total billed charges,Therapy,59.93,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,164.34,83,,164.34,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,138.6,70,,138.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
MANUAL THERAPY,97140,CPT,GO,64097140,CDM,430,RC,,,both,,,198,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,176.95,,,176.95,Fee Schedule,,159.19,,,159.19,Fee Schedule,,150.47,,,150.47,Fee Schedule,,138.6,70,,138.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,164.34,83,,164.34,percent of total billed charges,Therapy,59.93,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,164.34,83,,164.34,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,138.6,70,,138.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THERAPEUTIC REHAB GROUP,97150,CPT,GO,63097150,CDM,430,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,121.88,,,121.88,Fee Schedule,,109.64,,,109.64,Fee Schedule,,103.64,,,103.64,Fee Schedule,,67.2,70,,67.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,39.98,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,67.2,70,,67.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THERAPEUTIC REHAB GROUP,97150,CPT,GO,64097150,CDM,430,RC,,,both,,,96,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,121.88,,,121.88,Fee Schedule,,109.64,,,109.64,Fee Schedule,,103.64,,,103.64,Fee Schedule,,67.2,70,,67.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,39.98,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,79.68,83,,79.68,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,67.2,70,,67.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THERAPEUTIC ACTIVITIES,97530,CPT,GO,63097530,CDM,430,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.47,,,207.47,Fee Schedule,,186.65,,,186.65,Fee Schedule,,176.43,,,176.43,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,81.96,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-THERAPEUTIC ACTIVITIES,97530,CPT,GOGT,63297530,CDM,430,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.47,,,207.47,Fee Schedule,,186.65,,,186.65,Fee Schedule,,176.43,,,176.43,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,81.96,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THERAPEUTIC ACTIVITIES,97530,CPT,GO,64097530,CDM,430,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.47,,,207.47,Fee Schedule,,186.65,,,186.65,Fee Schedule,,176.43,,,176.43,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,81.96,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
TH-THERAPEUTIC ACTIVITIES,97530,CPT,GOGT,64297530,CDM,430,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.47,,,207.47,Fee Schedule,,186.65,,,186.65,Fee Schedule,,176.43,,,176.43,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,81.96,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
SELF CARE MNGMENT TRAINING,97535,CPT,GO,63097535,CDM,430,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.03,,,207.03,Fee Schedule,,186.26,,,186.26,Fee Schedule,,176.05,,,176.05,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,72.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,135.1,70,,135.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
TH-SELF CARE MNGMENT TRAINING,97535,CPT,GOGT,63297535,CDM,430,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.03,,,207.03,Fee Schedule,,186.26,,,186.26,Fee Schedule,,176.05,,,176.05,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,72.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,135.1,70,,135.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
SELF CARE MNGMENT TRAINING,97535,CPT,GO,64097535,CDM,430,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.03,,,207.03,Fee Schedule,,186.26,,,186.26,Fee Schedule,,176.05,,,176.05,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,72.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,135.1,70,,135.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
TH-SELF CARE MNGMENT TRAINING,97535,CPT,GOGT,64297535,CDM,430,RC,,,both,,,193,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,207.03,,,207.03,Fee Schedule,,186.26,,,186.26,Fee Schedule,,176.05,,,176.05,Fee Schedule,,135.1,70,,135.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,72.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,160.19,83,,160.19,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,135.1,70,,135.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
COMMUNITY/WORK REINTEGRATION EA 15 MIN,97537,CPT,GO,63097537,CDM,430,RC,,,both,,,141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,178.48,,,178.48,Fee Schedule,,160.57,,,160.57,Fee Schedule,,151.78,,,151.78,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,117.03,83,,117.03,percent of total billed charges,Therapy,70.37,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,117.03,83,,117.03,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,98.7,70,,98.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
COMMUNITY/WORK REINTEGRATION EA 15 MIN,97537,CPT,GO,64097537,CDM,430,RC,,,both,,,141,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,178.48,,,178.48,Fee Schedule,,160.57,,,160.57,Fee Schedule,,151.78,,,151.78,Fee Schedule,,98.7,70,,98.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,117.03,83,,117.03,percent of total billed charges,Therapy,70.37,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,117.03,83,,117.03,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,98.7,70,,98.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
WHEELCHAIR MGT TRAINING 15MIN,97542,CPT,GO,63097542,CDM,430,RC,,,both,,,190,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,180.89,,,180.89,Fee Schedule,,162.74,,,162.74,Fee Schedule,,153.83,,,153.83,Fee Schedule,,133,70,,133,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,157.7,83,,157.7,percent of total billed charges,Therapy,70.37,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,157.7,83,,157.7,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,133,70,,133,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
WHEELCHAIR MGT TRAINING 15MIN,97542,CPT,GO,64097542,CDM,430,RC,,,both,,,190,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,180.89,,,180.89,Fee Schedule,,162.74,,,162.74,Fee Schedule,,153.83,,,153.83,Fee Schedule,,133,70,,133,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,157.7,83,,157.7,percent of total billed charges,Therapy,70.37,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,157.7,83,,157.7,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,133,70,,133,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
SLCTV WND DEBRIDEM 20 CM OR <,97597,CPT,GO,63097597,CDM,430,RC,,,both,,,573,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,438.35,76.5,,438.35,percent of total billed charges,All Other,395.37,69,,395.37,percent of total billed charges,All Other,372.45,65,,372.45,percent of total billed charges,All Other,256,,,256,Case Rate,,219,,,219,Case Rate,Therapy Visit,717,,,717,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,475.59,83,,475.59,percent of total billed charges,Therapy,77.34,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,475.59,83,,475.59,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,401.1,70,,401.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,589.47,,,589.47,Other,153% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,539.38,,,539.38,Other,140% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,1001.71,,,1001.71,Other,250% of Medicaid,1248.29,,,1248.29,Other,324% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,481.59,,,481.59,Other,125% of Medicaid,77.34,1248.29,
SLCTV WND DEBRIDEM 20 CM OR <,97597,CPT,GO,64097597,CDM,430,RC,,,both,,,573,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,438.35,76.5,,438.35,percent of total billed charges,All Other,395.37,69,,395.37,percent of total billed charges,All Other,372.45,65,,372.45,percent of total billed charges,All Other,256,,,256,Case Rate,,219,,,219,Case Rate,Therapy Visit,717,,,717,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,475.59,83,,475.59,percent of total billed charges,Therapy,77.34,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,475.59,83,,475.59,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,401.1,70,,401.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,589.47,,,589.47,Other,153% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,539.38,,,539.38,Other,140% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,1001.71,,,1001.71,Other,250% of Medicaid,1248.29,,,1248.29,Other,324% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,481.59,,,481.59,Other,125% of Medicaid,77.34,1248.29,
ORTHOTIC MGMT AND TRAINING,97760,CPT,GO,63097760,CDM,430,RC,,,both,,,201,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,226.32,,,226.32,Fee Schedule,,203.61,,,203.61,Fee Schedule,,192.46,,,192.46,Fee Schedule,,140.7,70,,140.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,166.83,83,,166.83,percent of total billed charges,Therapy,106.81,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,166.83,83,,166.83,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,140.7,70,,140.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
ORTHOTIC MGMT AND TRAINING,97760,CPT,GO,64097760,CDM,430,RC,,,both,,,201,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,226.32,,,226.32,Fee Schedule,,203.61,,,203.61,Fee Schedule,,192.46,,,192.46,Fee Schedule,,140.7,70,,140.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,166.83,83,,166.83,percent of total billed charges,Therapy,106.81,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,166.83,83,,166.83,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,140.7,70,,140.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
ELECTRICAL STIMULATION EA 15 MINS,G0283,HCPCS,GO,63000001,CDM,430,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,80.5,,,80.5,Fee Schedule,,72.42,,,72.42,Fee Schedule,,68.46,,,68.46,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,26,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,83.3,70,,83.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
ELECTRICAL STIMULATION EA 15 MINS,G0283,HCPCS,GO,64000001,CDM,430,RC,,,both,,,119,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,80.5,,,80.5,Fee Schedule,,72.42,,,72.42,Fee Schedule,,68.46,,,68.46,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,53,,,53,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,26,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,98.77,83,,98.77,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,83.3,70,,83.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,28.29,,,28.29,Other,100% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,43.29,,,43.29,Other,153% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,39.61,,,39.61,Other,140% of Medicaid,63.66,,,63.66,Other,225% of Medicaid,73.57,,,73.57,Other,250% of Medicaid,91.68,,,91.68,Other,324% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,60.83,,,60.83,Other,215% of Medicaid,35.37,,,35.37,Other,125% of Medicaid,0.01,368,
SENSORY INTEGRATE TECH 15MIN,97533,CPT,GO,63097533,CDM,431,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,174.15,,,174.15,Fee Schedule,,156.68,,,156.68,Fee Schedule,,148.09,,,148.09,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,140.34,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
SENSORY INTEGRATE TECH 15MIN,97533,CPT,GO,64097533,CDM,431,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,174.15,,,174.15,Fee Schedule,,156.68,,,156.68,Fee Schedule,,148.09,,,148.09,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,140.34,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
OT EVAL LOW COMPLEX 30 MIN,97165,CPT,GO,63097165,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
TH-OT EVAL LOW COMPLEX 30 MIN,97165,CPT,GOGT,63297165,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
OT EVAL LOW COMPLEX 30 MIN,97165,CPT,GO,64097165,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
TH-OT EVAL LOW COMPLEX 30 MIN,97165,CPT,GOGT,64297165,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
OT EVAL MOD COMPLEX 45 MIN,97166,CPT,GO,63097166,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
ARC SCREEN OT,97166,CPT,GO,63197166,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
TH-OT EVAL MOD COMPLEX 45 MIN,97166,CPT,GOGT,63297166,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
OT EVAL MOD COMPLEX 45 MIN,97166,CPT,GO,64097166,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
ARC SCREEN OT SAUG,97166,CPT,GO,64197166,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
TH-OT EVAL MOD COMPLEX 45 MIN,97166,CPT,GOGT,64297166,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
OT EVAL HIGH COMPLEX 60 MIN,97167,CPT,GO,63097167,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
TH-OT EVAL HIGH COMPLEX 60 MIN,97167,CPT,GOGT,63297167,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
OT EVAL HIGH COMPLEX 60 MIN,97167,CPT,GO,64097167,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
TH-OT EVAL HIGH COMPLEX 60 MIN,97167,CPT,GOGT,64297167,CDM,434,RC,,,both,,,475,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,73.77,,,73.77,Fee Schedule,,332.5,70,,332.5,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,225.29,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,394.25,83,,394.25,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,332.5,70,,332.5,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,394.25,
OT RE-EVAL EST PLAN CARE,97168,CPT,GO,63097168,CDM,434,RC,,,both,,,266,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,48.77,,,48.77,Fee Schedule,,48.77,,,48.77,Fee Schedule,,48.77,,,48.77,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,220.78,83,,220.78,percent of total billed charges,Therapy,156.09,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,220.78,83,,220.78,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,186.2,70,,186.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,378.77,
OT RE-EVAL EST PLAN CARE,97168,CPT,GO,64097168,CDM,434,RC,,,both,,,266,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,48.77,,,48.77,Fee Schedule,,48.77,,,48.77,Fee Schedule,,48.77,,,48.77,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,217,,,217,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,220.78,83,,220.78,percent of total billed charges,Therapy,156.09,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,220.78,83,,220.78,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,186.2,70,,186.2,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,116.9,,,116.9,Other,100% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,178.86,,,178.86,Other,153% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,163.66,,,163.66,Other,140% of Medicaid,263.03,,,263.03,Other,225% of Medicaid,303.95,,,303.95,Other,250% of Medicaid,378.77,,,378.77,Other,324% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,251.34,,,251.34,Other,215% of Medicaid,146.13,,,146.13,Other,125% of Medicaid,0.01,378.77,
TREATMENT SPEECH DISORDER,92507,CPT,GN,65092507,CDM,440,RC,,,both,,,539,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,521.42,,,521.42,Fee Schedule,,469.09,,,469.09,Fee Schedule,,443.4,,,443.4,Fee Schedule,,377.3,70,,377.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,200,,,200,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,447.37,83,,447.37,percent of total billed charges,Therapy,169.13,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,447.37,83,,447.37,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,377.3,70,,377.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,521.42,
DYSPHAGIA TREATMENT,92526,CPT,GN,65092526,CDM,440,RC,,,both,,,623,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,602.96,,,602.96,Fee Schedule,,542.45,,,542.45,Fee Schedule,,512.74,,,512.74,Fee Schedule,,436.1,70,,436.1,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,517.09,83,,517.09,percent of total billed charges,Therapy,187.97,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,517.09,83,,517.09,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,436.1,70,,436.1,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,602.96,
TRAINING SPEECH GEN DEVICE,92609,CPT,GN,65092609,CDM,440,RC,,,both,,,707,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,748.46,,,748.46,Fee Schedule,,673.34,,,673.34,Fee Schedule,,636.46,,,636.46,Fee Schedule,,494.9,70,,494.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,586.81,83,,586.81,percent of total billed charges,Therapy,230.01,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,586.81,83,,586.81,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,494.9,70,,494.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,748.46,
THER IVNTJ 1ST 15 MIN,97129,CPT,GN,65097129,CDM,440,RC,,,both,,,158,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,22.08,,,22.08,Fee Schedule,,22.08,,,22.08,Fee Schedule,,22.08,,,22.08,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,131.14,83,,131.14,percent of total billed charges,Therapy,48.24,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,131.14,83,,131.14,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,110.6,70,,110.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
THER IVNTJ EA ADDL 15MIN,97130,CPT,GN,65097130,CDM,440,RC,,,both,,,158,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,21.13,,,21.13,Fee Schedule,,21.13,,,21.13,Fee Schedule,,21.13,,,21.13,Fee Schedule,,110.6,70,,110.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,131.14,83,,131.14,percent of total billed charges,Therapy,46.05,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,131.14,83,,131.14,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,110.6,70,,110.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
SENSORY INTEGRATE TECH 15MIN,97533,CPT,GN,65097533,CDM,440,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,174.15,,,174.15,Fee Schedule,,156.68,,,156.68,Fee Schedule,,148.09,,,148.09,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,123,,,123,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,140.34,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,173.47,83,,173.47,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,146.3,70,,146.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,66.22,,,66.22,Other,100% of Medicaid,149,,,149,Other,225% of Medicaid,101.32,,,101.32,Other,153% of Medicaid,149,,,149,Other,225% of Medicaid,92.71,,,92.71,Other,140% of Medicaid,149,,,149,Other,225% of Medicaid,172.17,,,172.17,Other,250% of Medicaid,214.56,,,214.56,Other,324% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,142.38,,,142.38,Other,215% of Medicaid,82.78,,,82.78,Other,125% of Medicaid,0.01,368,
EVALUATION OF SPEECH FLUENCY,92521,CPT,GN,65092521,CDM,444,RC,,,both,,,337,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,109.85,,,109.85,Fee Schedule,,109.85,,,109.85,Fee Schedule,,109.85,,,109.85,Fee Schedule,,235.9,70,,235.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,200,,,200,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,279.71,83,,279.71,percent of total billed charges,Therapy,294.88,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,279.71,83,,279.71,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,235.9,70,,235.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,368,
EVALUATE SPEECH PRODUCTION,92522,CPT,GN,65092522,CDM,444,RC,,,both,,,297,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,88.43,,,88.43,Fee Schedule,,88.43,,,88.43,Fee Schedule,,88.43,,,88.43,Fee Schedule,,207.9,70,,207.9,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,200,,,200,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,246.51,83,,246.51,percent of total billed charges,Therapy,246.88,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,246.51,83,,246.51,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,207.9,70,,207.9,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,368,
SPEECH SOUND LANG COMPREHEN,92523,CPT,GN,65092523,CDM,444,RC,,,both,,,660,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,190.46,,,190.46,Fee Schedule,,190.46,,,190.46,Fee Schedule,,190.46,,,190.46,Fee Schedule,,462,70,,462,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,200,,,200,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,547.8,83,,547.8,percent of total billed charges,Therapy,505.47,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,547.8,83,,547.8,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,462,70,,462,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,547.8,
BEHAVRAL QUALIT ANALYS VOICE,92524,CPT,GN,65092524,CDM,444,RC,,,both,,,308,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,84.68,,,84.68,Fee Schedule,,84.68,,,84.68,Fee Schedule,,84.68,,,84.68,Fee Schedule,,215.6,70,,215.6,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,200,,,200,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,255.64,83,,255.64,percent of total billed charges,Therapy,243.08,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,255.64,83,,255.64,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,215.6,70,,215.6,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,368,
EVAL TO USE/FIT VOICE PROSTH,92597,CPT,,65092597,CDM,444,RC,,,both,,,249,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,632.56,,,632.56,Fee Schedule,,569.07,,,569.07,Fee Schedule,,537.9,,,537.9,Fee Schedule,,174.3,70,,174.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,200,,,200,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,206.67,83,,206.67,percent of total billed charges,Therapy,160.27,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,206.67,83,,206.67,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,174.3,70,,174.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,632.56,
EVAL FOR SPEECH DEVICE RX 1HR,92607,CPT,,65092607,CDM,444,RC,,,both,,,441,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,1157.49,,,1157.49,Fee Schedule,,1041.31,,,1041.31,Fee Schedule,,984.29,,,984.29,Fee Schedule,,308.7,70,,308.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,200,,,200,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,366.03,83,,366.03,percent of total billed charges,Therapy,275.84,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,366.03,83,,366.03,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,308.7,70,,308.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,1157.49,
EX FOR SPEECH DEVICE RX EA ADDL 30 MIN,92608,CPT,,65092608,CDM,444,RC,,,both,,,179,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,337.13,,,337.13,Fee Schedule,,303.29,,,303.29,Fee Schedule,,286.68,,,286.68,Fee Schedule,,125.3,70,,125.3,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,200,,,200,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,148.57,83,,148.57,percent of total billed charges,Therapy,108.38,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,148.57,83,,148.57,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,125.3,70,,125.3,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,368,
INDIRECT SWALLOW ASSESSMENT,92610,CPT,GN,65092610,CDM,444,RC,,,both,,,702,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,680.84,,,680.84,Fee Schedule,,612.5,,,612.5,Fee Schedule,,578.96,,,578.96,Fee Schedule,,491.4,70,,491.4,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,200,,,200,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,582.66,83,,582.66,percent of total billed charges,Therapy,154.79,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,582.66,83,,582.66,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,491.4,70,,491.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,680.84,
MOTION FLUOROSCOPY/SWALLOW,92611,CPT,GN,65092611,CDM,444,RC,,,both,,,762,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,738.7,,,738.7,Fee Schedule,,664.56,,,664.56,Fee Schedule,,628.17,,,628.17,Fee Schedule,,533.4,70,,533.4,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,406,,,406,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,632.46,83,,632.46,percent of total billed charges,Therapy,205.15,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,632.46,83,,632.46,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,533.4,70,,533.4,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,218.02,,,218.02,Other,100% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,333.56,,,333.56,Other,153% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,305.22,,,305.22,Other,140% of Medicaid,490.54,,,490.54,Other,225% of Medicaid,566.84,,,566.84,Other,250% of Medicaid,706.37,,,706.37,Other,324% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,468.73,,,468.73,Other,215% of Medicaid,272.52,,,272.52,Other,125% of Medicaid,0.01,738.7,
APHASIA ASSESMENT PER HR,96105,CPT,GN,65096105,CDM,444,RC,,,both,,,590,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,673.33,,,673.33,Fee Schedule,,605.75,,,605.75,Fee Schedule,,572.57,,,572.57,Fee Schedule,,413,70,,413,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,247,,,247,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,489.7,83,,489.7,percent of total billed charges,Therapy,212.58,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,489.7,83,,489.7,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,413,70,,413,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,673.33,
COGNITIVE TEST BY HC PRO,96125,CPT,GN,65096125,CDM,444,RC,,,both,,,281,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Case Rate,Therapy Visit,162,,,162,Case Rate,Therapy Visit,585.32,,,585.32,Fee Schedule,,526.57,,,526.57,Fee Schedule,,497.73,,,497.73,Fee Schedule,,196.7,70,,196.7,percent of total billed charges,All Other,219,,,219,Case Rate,Therapy Visit,247,,,247,Other,186% of Medicaid,257,,,257,Case Rate,Therapy Visit,233.23,83,,233.23,percent of total billed charges,Therapy,227.14,,,,Fee Schedule,,257,,,257,Case Rate,Therapy Visit,233.23,83,,233.23,percent of total billed charges,Therapy,368,,,368,Case Rate,Therapy Visit,196.7,70,,196.7,percent of total billed charges,,259,,,259,Case Rate,Therapy Visit,220,,,220,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,138,,,138,Case Rate,Therapy Visit,154,,,154,Case Rate,Therapy Visit,131,,,131,Case Rate,Therapy Visit,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,585.32,
CLEAR EYELID GLAND W HEAT,0207T,HCPCS,,30000001,CDM,450,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,153,,,153,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.1,70,,184.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,82.31,,,82.31,Other,100% of Medicaid,82.31,,,82.31,Other,100% of Medicaid,82.31,,,82.31,Other,100% of Medicaid,82.31,,,82.31,Other,100% of Medicaid,185.19,,,185.19,Other,225% of Medicaid,125.93,,,125.93,Other,153% of Medicaid,185.19,,,185.19,Other,225% of Medicaid,115.23,,,115.23,Other,140% of Medicaid,185.19,,,185.19,Other,225% of Medicaid,214,,,214,Other,250% of Medicaid,266.67,,,266.67,Other,324% of Medicaid,176.96,,,176.96,Other,215% of Medicaid,176.96,,,176.96,Other,215% of Medicaid,102.88,,,102.88,Other,125% of Medicaid,0.01,266.67,
NJX PARAVERT W US CER THOR,0213T,HCPCS,,30000002,CDM,450,RC,,,both,,,2478,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,864,,,864,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1734.6,70,,1734.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,710.84,,,710.84,Other,153% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,650.44,,,650.44,Other,140% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,1207.97,,,1207.97,Other,250% of Medicaid,1505.31,,,1505.31,Other,324% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,580.75,,,580.75,Other,125% of Medicaid,0.01,1734.6,
NJX PARAVERT W/US CER/THOR,0214T,HCPCS,,30000003,CDM,450,RC,,,both,,,872,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,864,,,864,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,610.4,70,,610.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,710.84,,,710.84,Other,153% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,650.44,,,650.44,Other,140% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,1207.97,,,1207.97,Other,250% of Medicaid,1505.31,,,1505.31,Other,324% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,580.75,,,580.75,Other,125% of Medicaid,0.01,1505.31,
NJX PARAVERT W/US CER/THOR,0215T,HCPCS,,30000004,CDM,450,RC,,,both,,,872,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,864,,,864,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,610.4,70,,610.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,710.84,,,710.84,Other,153% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,650.44,,,650.44,Other,140% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,1207.97,,,1207.97,Other,250% of Medicaid,1505.31,,,1505.31,Other,324% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,580.75,,,580.75,Other,125% of Medicaid,0.01,1505.31,
NJX PARAVERT W/US LUMB/SAC,0216T,HCPCS,,30000005,CDM,450,RC,,,both,,,2478,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,864,,,864,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1734.6,70,,1734.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,710.84,,,710.84,Other,153% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,650.44,,,650.44,Other,140% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,1207.97,,,1207.97,Other,250% of Medicaid,1505.31,,,1505.31,Other,324% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,580.75,,,580.75,Other,125% of Medicaid,0.01,1734.6,
NJX PARAVERT W US LUMB SAC,0217T,HCPCS,,30000006,CDM,450,RC,,,both,,,872,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,864,,,864,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,610.4,70,,610.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,710.84,,,710.84,Other,153% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,650.44,,,650.44,Other,140% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,1207.97,,,1207.97,Other,250% of Medicaid,1505.31,,,1505.31,Other,324% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,580.75,,,580.75,Other,125% of Medicaid,0.01,1505.31,
NJX PARAVERT W/US LUMB/SAC,0218T,HCPCS,,30000007,CDM,450,RC,,,both,,,872,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,864,,,864,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,610.4,70,,610.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,464.6,,,464.6,Other,100% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,710.84,,,710.84,Other,153% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,650.44,,,650.44,Other,140% of Medicaid,1045.36,,,1045.36,Other,225% of Medicaid,1207.97,,,1207.97,Other,250% of Medicaid,1505.31,,,1505.31,Other,324% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,998.9,,,998.9,Other,215% of Medicaid,580.75,,,580.75,Other,125% of Medicaid,0.01,1505.31,
NJX PLATELET PLASMA,0232T,HCPCS,,30000008,CDM,450,RC,,,both,,,851,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,846,,,846,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,595.7,70,,595.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,454.85,,,454.85,Other,100% of Medicaid,1023.41,,,1023.41,Other,225% of Medicaid,695.92,,,695.92,Other,153% of Medicaid,1023.41,,,1023.41,Other,225% of Medicaid,636.79,,,636.79,Other,140% of Medicaid,1023.41,,,1023.41,Other,225% of Medicaid,1182.61,,,1182.61,Other,250% of Medicaid,1473.71,,,1473.71,Other,324% of Medicaid,977.93,,,977.93,Other,215% of Medicaid,977.93,,,977.93,Other,215% of Medicaid,568.56,,,568.56,Other,125% of Medicaid,0.01,1473.71,
FNA W O IMAGE,10021,CPT,,30010021,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,1037,,,1037,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,0.01,1806.76,
I&D ABSCESS SIMPLE/SINGL,10060,CPT,,30010060,CDM,450,RC,,,both,,,587,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,399.16,68,,399.16,percent of total billed charges,All Other,733,,,733,Other,186% of Medicaid,469.6,80,,469.6,percent of total billed charges,All Other,487.21,,,487.21,Other,Non Covered Service,487.21,,,,Other,Non Covered Service,469.6,80,,469.6,percent of total billed charges,All Other,487.21,,,487.21,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.9,70,,410.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,1276.45,
I AND D ABSCESS COMP MULTIPLE,10061,CPT,,30010061,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,733,,,733,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,1276.45,
DRAINAGE OF PILONIDAL CYST,10080,CPT,,30010080,CDM,450,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,994.16,68,,994.16,percent of total billed charges,All Other,733,,,733,Other,186% of Medicaid,1169.6,80,,1169.6,percent of total billed charges,All Other,1213.46,,,1213.46,Other,Non Covered Service,1213.46,,,,Other,Non Covered Service,1169.6,80,,1169.6,percent of total billed charges,All Other,1213.46,,,1213.46,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1023.4,70,,1023.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,1276.45,
I&D PILONID CYST; CPLX,10081,CPT,,30010081,CDM,450,RC,,,both,,,3098,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1207,,,1207,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2168.6,70,,2168.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,992.66,,,992.66,Other,153% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,908.32,,,908.32,Other,140% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,1686.88,,,1686.88,Other,250% of Medicaid,2102.11,,,2102.11,Other,324% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,811,,,811,Other,125% of Medicaid,0.01,2168.6,
REMOVE FB SKIN SUBCU SIMPLE,10120,CPT,,30010120,CDM,450,RC,,,both,,,1041,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,707.88,68,,707.88,percent of total billed charges,All Other,733,,,733,Other,186% of Medicaid,832.8,80,,832.8,percent of total billed charges,All Other,864.03,,,864.03,Other,Non Covered Service,864.03,,,,Other,Non Covered Service,832.8,80,,832.8,percent of total billed charges,All Other,864.03,,,864.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,728.7,70,,728.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,1276.45,
INC & REM FB SQ; COMPL,10121,CPT,,30010121,CDM,450,RC,,,both,,,4422,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3006.96,68,,3006.96,percent of total billed charges,All Other,2242,,,2242,Other,186% of Medicaid,3537.6,80,,3537.6,percent of total billed charges,All Other,3670.26,,,3670.26,Other,Non Covered Service,3670.26,,,,Other,Non Covered Service,3537.6,80,,3537.6,percent of total billed charges,All Other,3670.26,,,3670.26,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3095.4,70,,3095.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1843.83,,,1843.83,Other,153% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1687.16,,,1687.16,Other,140% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,3133.3,,,3133.3,Other,250% of Medicaid,3904.58,,,3904.58,Other,324% of Medicaid,2591,,,2591,Other,215% of Medicaid,2591,,,2591,Other,215% of Medicaid,1506.39,,,1506.39,Other,125% of Medicaid,0.01,3904.58,
DRAINAGE OF HEMATOMA/FLUID,10140,CPT,,30010140,CDM,450,RC,,,both,,,4951,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3366.68,68,,3366.68,percent of total billed charges,All Other,1207,,,1207,Other,186% of Medicaid,3960.8,80,,3960.8,percent of total billed charges,All Other,4109.33,,,4109.33,Other,Non Covered Service,4109.33,,,,Other,Non Covered Service,3960.8,80,,3960.8,percent of total billed charges,All Other,4109.33,,,4109.33,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3465.7,70,,3465.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,992.66,,,992.66,Other,153% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,908.32,,,908.32,Other,140% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,1686.88,,,1686.88,Other,250% of Medicaid,2102.11,,,2102.11,Other,324% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,811,,,811,Other,125% of Medicaid,0.01,4109.33,
ASPIRATION ABSCESS HEMA C,10160,CPT,,30010160,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,733,,,733,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,1276.45,
I&D CPLX POSTOP WND INF,10180,CPT,,30010180,CDM,450,RC,,,both,,,5816,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3954.88,68,,3954.88,percent of total billed charges,All Other,2493,,,2493,Other,186% of Medicaid,4652.8,80,,4652.8,percent of total billed charges,All Other,4827.28,,,4827.28,Other,Non Covered Service,4827.28,,,,Other,Non Covered Service,4652.8,80,,4652.8,percent of total billed charges,All Other,4827.28,,,4827.28,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4071.2,70,,4071.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,0.01,5134.61,
DEBR EXZ/INF SKIN; 10% BS,11000,CPT,,30011000,CDM,450,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,890.12,68,,890.12,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,1086.47,,,,Other,Non Covered Service,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,916.3,70,,916.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
DEBRIDE SKIN AT FX SITE,11010,CPT,,30011010,CDM,450,RC,,,both,,,1528,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1039.04,68,,1039.04,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,1222.4,80,,1222.4,percent of total billed charges,All Other,1268.24,,,1268.24,Other,Non Covered Service,1268.24,,,,Other,Non Covered Service,1222.4,80,,1222.4,percent of total billed charges,All Other,1268.24,,,1268.24,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1069.6,70,,1069.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
DEB SKIN BONE AT FX SITE,11012,CPT,,30011012,CDM,450,RC,,,both,,,7946,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5403.28,68,,5403.28,percent of total billed charges,All Other,2493,,,2493,Other,186% of Medicaid,6356.8,80,,6356.8,percent of total billed charges,All Other,6595.18,,,6595.18,Other,Non Covered Service,6595.18,,,,Other,Non Covered Service,6356.8,80,,6356.8,percent of total billed charges,All Other,6595.18,,,6595.18,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5562.2,70,,5562.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,0.01,6595.18,
DEB SUBQ TISSUE 20 SQ CM <,11042,CPT,,30011042,CDM,450,RC,,,both,,,1041,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,707.88,68,,707.88,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,832.8,80,,832.8,percent of total billed charges,All Other,864.03,,,864.03,Other,Non Covered Service,864.03,,,,Other,Non Covered Service,832.8,80,,832.8,percent of total billed charges,All Other,864.03,,,864.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,728.7,70,,728.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
DEB MUSC/FASCIA 20 SQ CM/<,11043,CPT,,30011043,CDM,450,RC,,,both,,,1402,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,953.36,68,,953.36,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,1121.6,80,,1121.6,percent of total billed charges,All Other,1163.66,,,1163.66,Other,Non Covered Service,1163.66,,,,Other,Non Covered Service,1121.6,80,,1121.6,percent of total billed charges,All Other,1163.66,,,1163.66,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,981.4,70,,981.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
PARE BENIGN LES; SGL,11055,CPT,,30011055,CDM,450,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,733,,,733,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,285.6,70,,285.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,1276.45,
REM SKIN TAGS 1 TO 15,11200,CPT,,30011200,CDM,450,RC,,,both,,,439,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,298.52,68,,298.52,percent of total billed charges,All Other,733,,,733,Other,186% of Medicaid,351.2,80,,351.2,percent of total billed charges,All Other,364.37,,,364.37,Other,Non Covered Service,364.37,,,,Other,Non Covered Service,351.2,80,,351.2,percent of total billed charges,All Other,364.37,,,364.37,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,307.3,70,,307.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,1276.45,
EXC TR-EXT B9+MARG 0.5CM/<,11400,CPT,,30011400,CDM,450,RC,,,both,,,1732,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1240,,,1240,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1212.4,70,,1212.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
EXC BENIGN LESION < 0.5C,11420,CPT,,30011420,CDM,450,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2242,,,2242,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2363.9,70,,2363.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1843.83,,,1843.83,Other,153% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1687.16,,,1687.16,Other,140% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,3133.3,,,3133.3,Other,250% of Medicaid,3904.58,,,3904.58,Other,324% of Medicaid,2591,,,2591,Other,215% of Medicaid,2591,,,2591,Other,215% of Medicaid,1506.39,,,1506.39,Other,125% of Medicaid,0.01,3904.58,
EXC BLES S/N/EX G; 0.6-1.0CM,11421,CPT,,30011421,CDM,450,RC,,,both,,,3395,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2308.6,68,,2308.6,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,2716,80,,2716,percent of total billed charges,All Other,2817.85,,,2817.85,Other,Non Covered Service,2817.85,,,,Other,Non Covered Service,2716,80,,2716,percent of total billed charges,All Other,2817.85,,,2817.85,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2376.5,70,,2376.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2817.85,
EXC HIDRAD AXIL; S/I REP,11450,CPT,,30011450,CDM,450,RC,,,both,,,7424,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3621,,,3621,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5196.8,70,,5196.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1947.01,,,1947.01,Other,100% of Medicaid,1947.01,,,1947.01,Other,100% of Medicaid,1947.01,,,1947.01,Other,100% of Medicaid,1947.01,,,1947.01,Other,100% of Medicaid,4380.77,,,4380.77,Other,225% of Medicaid,2978.92,,,2978.92,Other,153% of Medicaid,4380.77,,,4380.77,Other,225% of Medicaid,2725.81,,,2725.81,Other,140% of Medicaid,4380.77,,,4380.77,Other,225% of Medicaid,5062.22,,,5062.22,Other,250% of Medicaid,6308.31,,,6308.31,Other,324% of Medicaid,4186.07,,,4186.07,Other,215% of Medicaid,4186.07,,,4186.07,Other,215% of Medicaid,2433.76,,,2433.76,Other,125% of Medicaid,0.01,6308.31,
TRIM ND NAILS,11719,CPT,,30011719,CDM,450,RC,,,both,,,186,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,126.48,68,,126.48,percent of total billed charges,All Other,353,,,353,Other,186% of Medicaid,148.8,80,,148.8,percent of total billed charges,All Other,154.38,,,154.38,Other,Non Covered Service,154.38,,,,Other,Non Covered Service,148.8,80,,148.8,percent of total billed charges,All Other,154.38,,,154.38,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,130.2,70,,130.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,290.55,,,290.55,Other,153% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,265.86,,,265.86,Other,140% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,493.74,,,493.74,Other,250% of Medicaid,615.28,,,615.28,Other,324% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,237.38,,,237.38,Other,125% of Medicaid,0.01,615.28,
REMOVAL OF NAIL PLATE,11730,CPT,,30011730,CDM,450,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,277.44,68,,277.44,percent of total billed charges,All Other,353,,,353,Other,186% of Medicaid,326.4,80,,326.4,percent of total billed charges,All Other,338.64,,,338.64,Other,Non Covered Service,338.64,,,,Other,Non Covered Service,326.4,80,,326.4,percent of total billed charges,All Other,338.64,,,338.64,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,285.6,70,,285.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,290.55,,,290.55,Other,153% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,265.86,,,265.86,Other,140% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,493.74,,,493.74,Other,250% of Medicaid,615.28,,,615.28,Other,324% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,237.38,,,237.38,Other,125% of Medicaid,0.01,615.28,
REMOVE NAIL PLATE ADD-ON,11732,CPT,,30011732,CDM,450,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,353,,,353,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,210,70,,210,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,290.55,,,290.55,Other,153% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,265.86,,,265.86,Other,140% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,493.74,,,493.74,Other,250% of Medicaid,615.28,,,615.28,Other,324% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,237.38,,,237.38,Other,125% of Medicaid,0.01,615.28,
DRAIN BLOOD FROM UNDER NAIL,11740,CPT,,30011740,CDM,450,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,178.84,68,,178.84,percent of total billed charges,All Other,353,,,353,Other,186% of Medicaid,210.4,80,,210.4,percent of total billed charges,All Other,218.29,,,218.29,Other,Non Covered Service,218.29,,,,Other,Non Covered Service,210.4,80,,210.4,percent of total billed charges,All Other,218.29,,,218.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.1,70,,184.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,290.55,,,290.55,Other,153% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,265.86,,,265.86,Other,140% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,493.74,,,493.74,Other,250% of Medicaid,615.28,,,615.28,Other,324% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,237.38,,,237.38,Other,125% of Medicaid,0.01,615.28,
REMOVAL OF NAIL BED,11750,CPT,,30011750,CDM,450,RC,,,both,,,1876,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1275.68,68,,1275.68,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,1500.8,80,,1500.8,percent of total billed charges,All Other,1557.08,,,1557.08,Other,Non Covered Service,1557.08,,,,Other,Non Covered Service,1500.8,80,,1500.8,percent of total billed charges,All Other,1557.08,,,1557.08,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1313.2,70,,1313.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
BIOPSY NAIL UNIT,11755,CPT,,30011755,CDM,450,RC,,,both,,,1661,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1240,,,1240,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1162.7,70,,1162.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REPAIR NAIL BED,11760,CPT,,30011760,CDM,450,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,890.12,68,,890.12,percent of total billed charges,All Other,353,,,353,Other,186% of Medicaid,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,1086.47,,,,Other,Non Covered Service,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,916.3,70,,916.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,290.55,,,290.55,Other,153% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,265.86,,,265.86,Other,140% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,493.74,,,493.74,Other,250% of Medicaid,615.28,,,615.28,Other,324% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,237.38,,,237.38,Other,125% of Medicaid,0.01,1134.89,
WEDGE EXC NAIL FOLD,11765,CPT,,30011765,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,353,,,353,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,290.55,,,290.55,Other,153% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,265.86,,,265.86,Other,140% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,493.74,,,493.74,Other,250% of Medicaid,615.28,,,615.28,Other,324% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,237.38,,,237.38,Other,125% of Medicaid,0.01,720.54,
REM IMPL CONTRACEP CAPS,11976,CPT,,30011976,CDM,450,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1240,,,1240,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1023.4,70,,1023.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REPAIR SKIN 2.5CM OR LESS,12001,CPT,,30012001,CDM,450,RC,,,both,,,509,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,346.12,68,,346.12,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,422.47,,,,Other,Non Covered Service,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,356.3,70,,356.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
REPAIR SKIN 2.6CM TO 7.5C,12002,CPT,,30012002,CDM,450,RC,,,both,,,509,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,346.12,68,,346.12,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,422.47,,,,Other,Non Covered Service,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,356.3,70,,356.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
REPAIR SKIN 7.6CM TO 12.5,12004,CPT,,30012004,CDM,450,RC,,,both,,,509,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,346.12,68,,346.12,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,422.47,,,,Other,Non Covered Service,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,356.3,70,,356.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
REPAIR SKIN 12.6-20.0 CM,12005,CPT,,30012005,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
REPAIR SKIN 20.1CM TO 30,12006,CPT,,30012006,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
SREP S/N/A/G/TR/E; > 30CM,12007,CPT,,30012007,CDM,450,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,277.44,68,,277.44,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,326.4,80,,326.4,percent of total billed charges,All Other,338.64,,,338.64,Other,Non Covered Service,338.64,,,,Other,Non Covered Service,326.4,80,,326.4,percent of total billed charges,All Other,338.64,,,338.64,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,285.6,70,,285.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
REPAIR SKIN 2.5CM OR LESS,12011,CPT,,30012011,CDM,450,RC,,,both,,,600,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,408,68,,408,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,480,80,,480,percent of total billed charges,All Other,498,,,498,Other,Non Covered Service,498,,,,Other,Non Covered Service,480,80,,480,percent of total billed charges,All Other,498,,,498,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,420,70,,420,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
REPAIR SKIN 2.6CM TO 5.0C,12013,CPT,,30012013,CDM,450,RC,,,both,,,698,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,474.64,68,,474.64,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,558.4,80,,558.4,percent of total billed charges,All Other,579.34,,,579.34,Other,Non Covered Service,579.34,,,,Other,Non Covered Service,558.4,80,,558.4,percent of total billed charges,All Other,579.34,,,579.34,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,488.6,70,,488.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
REPAIR SKIN 5.1CM TO 7.5C,12014,CPT,,30012014,CDM,450,RC,,,both,,,509,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,346.12,68,,346.12,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,422.47,,,,Other,Non Covered Service,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,356.3,70,,356.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
REPAIR SKIN F E E N L 7.6-12,12015,CPT,,30012015,CDM,450,RC,,,both,,,509,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,346.12,68,,346.12,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,422.47,,,,Other,Non Covered Service,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,356.3,70,,356.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
SREP F E N L MM 12.6-20C,12016,CPT,,30012016,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
REPAIR SKIN F E E N L 20.1-3,12017,CPT,,30012017,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
REPAIR SKIN F E E N L OVER 3,12018,CPT,,30012018,CDM,450,RC,,,both,,,437,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,297.16,68,,297.16,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,349.6,80,,349.6,percent of total billed charges,All Other,362.71,,,362.71,Other,Non Covered Service,362.71,,,,Other,Non Covered Service,349.6,80,,349.6,percent of total billed charges,All Other,362.71,,,362.71,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,305.9,70,,305.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
TX S WND DEHICS SMPL,12020,CPT,,30012020,CDM,450,RC,,,both,,,1653,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1124.04,68,,1124.04,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,1322.4,80,,1322.4,percent of total billed charges,All Other,1371.99,,,1371.99,Other,Non Covered Service,1371.99,,,,Other,Non Covered Service,1322.4,80,,1322.4,percent of total billed charges,All Other,1371.99,,,1371.99,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1157.1,70,,1157.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
CLOSURE OF SPLIT WOUND,12021,CPT,,30012021,CDM,450,RC,,,both,,,1125,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,765,68,,765,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,900,80,,900,percent of total billed charges,All Other,933.75,,,933.75,Other,Non Covered Service,933.75,,,,Other,Non Covered Service,900,80,,900,percent of total billed charges,All Other,933.75,,,933.75,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,787.5,70,,787.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
REPAIR INTER SKIN 2.5 OR,12031,CPT,,30012031,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
REPAIR INTER SKIN 2.6 TO 7.0,12032,CPT,,30012032,CDM,450,RC,,,both,,,1204,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,818.72,68,,818.72,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,963.2,80,,963.2,percent of total billed charges,All Other,999.32,,,999.32,Other,Non Covered Service,999.32,,,,Other,Non Covered Service,963.2,80,,963.2,percent of total billed charges,All Other,999.32,,,999.32,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,842.8,70,,842.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
REPAIR INTER SKIN 7.6-12.0,12034,CPT,,30012034,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
INT REP S/A/EX 12.6-20.OC,12035,CPT,,30012035,CDM,450,RC,,,both,,,1048,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,712.64,68,,712.64,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,838.4,80,,838.4,percent of total billed charges,All Other,869.84,,,869.84,Other,Non Covered Service,869.84,,,,Other,Non Covered Service,838.4,80,,838.4,percent of total billed charges,All Other,869.84,,,869.84,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,733.6,70,,733.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
REPAIR INTER SKIN 20.1 - 30,12036,CPT,,30012036,CDM,450,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,890.12,68,,890.12,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,1086.47,,,,Other,Non Covered Service,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,916.3,70,,916.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
REPAIR INTER SKIN OVER 30,12037,CPT,,30012037,CDM,450,RC,,,both,,,3886,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1352,,,1352,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2720.2,70,,2720.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,3295.3,
CLOSURE WOUND 2.5 CM OR LESS,12041,CPT,,30012041,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
CLOSURE WOUND 2.6 CM TO 7.0,12042,CPT,,30012042,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
CLOSURE WOUND 7.6CM TO 12,12044,CPT,,30012044,CDM,450,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,890.12,68,,890.12,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,1086.47,,,,Other,Non Covered Service,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,916.3,70,,916.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
CLOSURE WOUND 12.6 CM - 20.0,12045,CPT,,30012045,CDM,450,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,890.12,68,,890.12,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,1086.47,,,,Other,Non Covered Service,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,916.3,70,,916.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
CLOSURE WOUND 20.1CM TO 30,12046,CPT,,30012046,CDM,450,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1352,,,1352,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,916.3,70,,916.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
CLOSURE WOUND OVER 30.0 C,12047,CPT,,30012047,CDM,450,RC,,,both,,,3886,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1352,,,1352,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2720.2,70,,2720.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,3295.3,
REPAIR INTER 2.5CM OR LESS,12051,CPT,,30012051,CDM,450,RC,,,both,,,1204,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,818.72,68,,818.72,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,963.2,80,,963.2,percent of total billed charges,All Other,999.32,,,999.32,Other,Non Covered Service,999.32,,,,Other,Non Covered Service,963.2,80,,963.2,percent of total billed charges,All Other,999.32,,,999.32,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,842.8,70,,842.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
REPAIR INTER 2.6 - 5 CM,12052,CPT,,30012052,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
REPAIR INTER 5 1 TO 7.5 CM,12053,CPT,,30012053,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
CLS WND F E E N L 7.6-12,12054,CPT,,30012054,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,571.88,68,,571.88,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,698.03,,,,Other,Non Covered Service,672.8,80,,672.8,percent of total billed charges,All Other,698.03,,,698.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
CLS WND F E E N L 12.6-20,12055,CPT,,30012055,CDM,450,RC,,,both,,,2356,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1602.08,68,,1602.08,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,1884.8,80,,1884.8,percent of total billed charges,All Other,1955.48,,,1955.48,Other,Non Covered Service,1955.48,,,,Other,Non Covered Service,1884.8,80,,1884.8,percent of total billed charges,All Other,1955.48,,,1955.48,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1649.2,70,,1649.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
CLS WND F E E N L 20.1-30,12056,CPT,,30012056,CDM,450,RC,,,both,,,3200,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2176,68,,2176,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,2560,80,,2560,percent of total billed charges,All Other,2656,,,2656,Other,Non Covered Service,2656,,,,Other,Non Covered Service,2560,80,,2560,percent of total billed charges,All Other,2656,,,2656,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2240,70,,2240,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2656,
CLS WND F E E N L OVER 30,12057,CPT,,30012057,CDM,450,RC,,,both,,,1033,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1352,,,1352,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,723.1,70,,723.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
REPAIR COMPLEX TRUNK 1.1,13100,CPT,,30013100,CDM,450,RC,,,both,,,1517,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1240,,,1240,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1061.9,70,,1061.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REPAIR COMPLEX TRUNK 2.6 - 7,13101,CPT,,30013101,CDM,450,RC,,,both,,,1517,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031.56,68,,1031.56,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,1213.6,80,,1213.6,percent of total billed charges,All Other,1259.11,,,1259.11,Other,Non Covered Service,1259.11,,,,Other,Non Covered Service,1213.6,80,,1213.6,percent of total billed charges,All Other,1259.11,,,1259.11,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1061.9,70,,1061.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REPAIR CMPLX EA ADDL 5CM,13102,CPT,,30013102,CDM,450,RC,,,both,,,1517,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031.56,68,,1031.56,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,1213.6,80,,1213.6,percent of total billed charges,All Other,1259.11,,,1259.11,Other,Non Covered Service,1259.11,,,,Other,Non Covered Service,1213.6,80,,1213.6,percent of total billed charges,All Other,1259.11,,,1259.11,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1061.9,70,,1061.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REP CPLX S A L 1.1CM - 2,13120,CPT,,30013120,CDM,450,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,890.12,68,,890.12,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,1086.47,,,,Other,Non Covered Service,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,916.3,70,,916.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
COMPLEX SKIN REPAIR 2.6-7.0,13121,CPT,,30013121,CDM,450,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,890.12,68,,890.12,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,1086.47,,,,Other,Non Covered Service,1047.2,80,,1047.2,percent of total billed charges,All Other,1086.47,,,1086.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,916.3,70,,916.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REP CPLX S A L EA ADL 5C,13122,CPT,,30013122,CDM,450,RC,,,both,,,509,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,346.12,68,,346.12,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,422.47,,,,Other,Non Covered Service,407.2,80,,407.2,percent of total billed charges,All Other,422.47,,,422.47,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,356.3,70,,356.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REP CPLX F C EXT 1.1CM - 2.5,13131,CPT,,30013131,CDM,450,RC,,,both,,,1204,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,818.72,68,,818.72,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,963.2,80,,963.2,percent of total billed charges,All Other,999.32,,,999.32,Other,Non Covered Service,999.32,,,,Other,Non Covered Service,963.2,80,,963.2,percent of total billed charges,All Other,999.32,,,999.32,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,842.8,70,,842.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
COMPLEX REPAIR 2.6 - 7.5 CM,13132,CPT,,30013132,CDM,450,RC,,,both,,,1769,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1202.92,68,,1202.92,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,1415.2,80,,1415.2,percent of total billed charges,All Other,1468.27,,,1468.27,Other,Non Covered Service,1468.27,,,,Other,Non Covered Service,1415.2,80,,1415.2,percent of total billed charges,All Other,1468.27,,,1468.27,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1238.3,70,,1238.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REP CPLX F C EXT EA AD 5C,13133,CPT,,30013133,CDM,450,RC,,,both,,,1125,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,765,68,,765,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,900,80,,900,percent of total billed charges,All Other,933.75,,,933.75,Other,Non Covered Service,933.75,,,,Other,Non Covered Service,900,80,,900,percent of total billed charges,All Other,933.75,,,933.75,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,787.5,70,,787.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REP CPLX E N E L 1.1CM-2.5,13151,CPT,,30013151,CDM,450,RC,,,both,,,1769,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1202.92,68,,1202.92,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,1415.2,80,,1415.2,percent of total billed charges,All Other,1468.27,,,1468.27,Other,Non Covered Service,1468.27,,,,Other,Non Covered Service,1415.2,80,,1415.2,percent of total billed charges,All Other,1468.27,,,1468.27,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1238.3,70,,1238.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REP CPLX E N E L 2.6CM - 7,13152,CPT,,30013152,CDM,450,RC,,,both,,,1624,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1104.32,68,,1104.32,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,1299.2,80,,1299.2,percent of total billed charges,All Other,1347.92,,,1347.92,Other,Non Covered Service,1347.92,,,,Other,Non Covered Service,1299.2,80,,1299.2,percent of total billed charges,All Other,1347.92,,,1347.92,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1136.8,70,,1136.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
REP CPLX E N E L EA AD 5C,13153,CPT,,30013153,CDM,450,RC,,,both,,,1033,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,702.44,68,,702.44,percent of total billed charges,All Other,2242,,,2242,Other,186% of Medicaid,826.4,80,,826.4,percent of total billed charges,All Other,857.39,,,857.39,Other,Non Covered Service,857.39,,,,Other,Non Covered Service,826.4,80,,826.4,percent of total billed charges,All Other,857.39,,,857.39,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,723.1,70,,723.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,1205.12,,,1205.12,Other,100% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1843.83,,,1843.83,Other,153% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,1687.16,,,1687.16,Other,140% of Medicaid,2711.51,,,2711.51,Other,225% of Medicaid,3133.3,,,3133.3,Other,250% of Medicaid,3904.58,,,3904.58,Other,324% of Medicaid,2591,,,2591,Other,215% of Medicaid,2591,,,2591,Other,215% of Medicaid,1506.39,,,1506.39,Other,125% of Medicaid,0.01,3904.58,
PINCH GRFT SM; DEFECT TO 2CM,15050,CPT,,30015050,CDM,450,RC,,,both,,,1710,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1240,,,1240,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1197,70,,1197,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2160.86,
FIRST DEGREE BURN LOCAL TREAT,16000,CPT,,30016000,CDM,450,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,277.44,68,,277.44,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,326.4,80,,326.4,percent of total billed charges,All Other,338.64,,,338.64,Other,Non Covered Service,338.64,,,,Other,Non Covered Service,326.4,80,,326.4,percent of total billed charges,All Other,338.64,,,338.64,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,285.6,70,,285.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
DRESS DEBRID P THICK BURN S,16020,CPT,,30016020,CDM,450,RC,,,both,,,573,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,389.64,68,,389.64,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,458.4,80,,458.4,percent of total billed charges,All Other,475.59,,,475.59,Other,Non Covered Service,475.59,,,,Other,Non Covered Service,458.4,80,,458.4,percent of total billed charges,All Other,475.59,,,475.59,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,401.1,70,,401.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
DRESS DEBRID P THICK BURN M,16025,CPT,,30016025,CDM,450,RC,,,both,,,535,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,363.8,68,,363.8,percent of total billed charges,All Other,957,,,957,Other,186% of Medicaid,428,80,,428,percent of total billed charges,All Other,444.05,,,444.05,Other,Non Covered Service,444.05,,,,Other,Non Covered Service,428,80,,428,percent of total billed charges,All Other,444.05,,,444.05,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,374.5,70,,374.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,0.01,1667.69,
DRESS DEBRID P THICK BURN L,16030,CPT,,30016030,CDM,450,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1352,,,1352,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,588.7,70,,588.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,2355.44,
DESTRUCT B9 LESION 1-14,17110,CPT,,30017110,CDM,450,RC,,,both,,,1205,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,733,,,733,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,843.5,70,,843.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,1276.45,
CHEM CAUT GRANULATION TISS,17250,CPT,,30017250,CDM,450,RC,,,both,,,697,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,473.96,68,,473.96,percent of total billed charges,All Other,733,,,733,Other,186% of Medicaid,557.6,80,,557.6,percent of total billed charges,All Other,578.51,,,578.51,Other,Non Covered Service,578.51,,,,Other,Non Covered Service,557.6,80,,557.6,percent of total billed charges,All Other,578.51,,,578.51,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,487.9,70,,487.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,1276.45,
EXPLORE PENETRATING WOUND NECK,20100,CPT,,30020100,CDM,450,RC,,,both,,,2200,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2493,,,2493,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1540,70,,1540,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,0.01,4341.8,
EXPL P WND ABD FLANK,20102,CPT,,30020102,CDM,450,RC,,,both,,,7270,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4943.6,68,,4943.6,percent of total billed charges,All Other,2493,,,2493,Other,186% of Medicaid,5816,80,,5816,percent of total billed charges,All Other,6034.1,,,6034.1,Other,Non Covered Service,6034.1,,,,Other,Non Covered Service,5816,80,,5816,percent of total billed charges,All Other,6034.1,,,6034.1,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5089,70,,5089,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,0.01,6034.1,
EXPL PENETRATING WOUND EX,20103,CPT,,30020103,CDM,450,RC,,,both,,,4627,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3146.36,68,,3146.36,percent of total billed charges,All Other,1352,,,1352,Other,186% of Medicaid,3701.6,80,,3701.6,percent of total billed charges,All Other,3840.41,,,3840.41,Other,Non Covered Service,3840.41,,,,Other,Non Covered Service,3701.6,80,,3701.6,percent of total billed charges,All Other,3840.41,,,3840.41,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3238.9,70,,3238.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,3840.41,
INJECTION OF SINUS TRACT,20500,CPT,,30020500,CDM,450,RC,,,both,,,3126,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2256,,,2256,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2188.2,70,,2188.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,1855.93,,,1855.93,Other,153% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,1698.24,,,1698.24,Other,140% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,3153.87,,,3153.87,Other,250% of Medicaid,3930.21,,,3930.21,Other,324% of Medicaid,2608.01,,,2608.01,Other,215% of Medicaid,2608.01,,,2608.01,Other,215% of Medicaid,1516.29,,,1516.29,Other,125% of Medicaid,0.01,3930.21,
REMOVE FB MUSCLE TENDN SI,20520,CPT,,30020520,CDM,450,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2296.36,68,,2296.36,percent of total billed charges,All Other,1973,,,1973,Other,186% of Medicaid,2701.6,80,,2701.6,percent of total billed charges,All Other,2802.91,,,2802.91,Other,Non Covered Service,2802.91,,,,Other,Non Covered Service,2701.6,80,,2701.6,percent of total billed charges,All Other,2802.91,,,2802.91,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2363.9,70,,2363.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1622.73,,,1622.73,Other,153% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1484.85,,,1484.85,Other,140% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,2757.58,,,2757.58,Other,250% of Medicaid,3436.37,,,3436.37,Other,324% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,1325.76,,,1325.76,Other,125% of Medicaid,0.01,3436.37,
INJ TENDON SHEATH/LIGAMENT,20550,CPT,,30020550,CDM,450,RC,,,both,,,950,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,685,,,685,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,665,70,,665,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,0.01,1193.81,
INJ TENDON ORIGIN/INSERT,20551,CPT,,30020551,CDM,450,RC,,,both,,,771,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,685,,,685,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,539.7,70,,539.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,0.01,1193.81,
INJ TRIGGER POINT 1/2 MUSCL,20552,CPT,,30020552,CDM,450,RC,,,both,,,842,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,572.56,68,,572.56,percent of total billed charges,All Other,685,,,685,Other,186% of Medicaid,673.6,80,,673.6,percent of total billed charges,All Other,698.86,,,698.86,Other,Non Covered Service,698.86,,,,Other,Non Covered Service,673.6,80,,673.6,percent of total billed charges,All Other,698.86,,,698.86,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,589.4,70,,589.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,0.01,1193.81,
ASPIRATE INJ SMALL JOINT,20600,CPT,,30020600,CDM,450,RC,,,both,,,1017,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,685,,,685,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,711.9,70,,711.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,0.01,1193.81,
ASPIRATE INJ MED JOINT,20605,CPT,,30020605,CDM,450,RC,,,both,,,1017,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,685,,,685,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,711.9,70,,711.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,0.01,1193.81,
ASPIRATE INJ LARGE JOINT,20610,CPT,,30020610,CDM,450,RC,,,both,,,1017,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,685,,,685,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,711.9,70,,711.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,0.01,1193.81,
ASPIRATE/INJ GANGLION CYST,20612,CPT,,30020612,CDM,450,RC,,,both,,,1280,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,870.4,68,,870.4,percent of total billed charges,All Other,685,,,685,Other,186% of Medicaid,1024,80,,1024,percent of total billed charges,All Other,1062.4,,,1062.4,Other,Non Covered Service,1062.4,,,,Other,Non Covered Service,1024,80,,1024,percent of total billed charges,All Other,1062.4,,,1062.4,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,896,70,,896,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,0.01,1193.81,
APPLICATION OF PELVIS BRACE,20662,CPT,,30020662,CDM,450,RC,,,both,,,7494,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3028,,,3028,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5245.8,70,,5245.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1627.85,,,1627.85,Other,100% of Medicaid,1627.85,,,1627.85,Other,100% of Medicaid,1627.85,,,1627.85,Other,100% of Medicaid,1627.85,,,1627.85,Other,100% of Medicaid,3662.66,,,3662.66,Other,225% of Medicaid,2490.61,,,2490.61,Other,153% of Medicaid,3662.66,,,3662.66,Other,225% of Medicaid,2278.99,,,2278.99,Other,140% of Medicaid,3662.66,,,3662.66,Other,225% of Medicaid,4232.41,,,4232.41,Other,250% of Medicaid,5274.24,,,5274.24,Other,324% of Medicaid,3499.88,,,3499.88,Other,215% of Medicaid,3499.88,,,3499.88,Other,215% of Medicaid,2034.81,,,2034.81,Other,125% of Medicaid,0.01,5274.24,
APPLICATION OF HALO REMOVAL FE,20663,CPT,,30020663,CDM,450,RC,,,both,,,7494,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3028,,,3028,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5245.8,70,,5245.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1627.85,,,1627.85,Other,100% of Medicaid,1627.85,,,1627.85,Other,100% of Medicaid,1627.85,,,1627.85,Other,100% of Medicaid,1627.85,,,1627.85,Other,100% of Medicaid,3662.66,,,3662.66,Other,225% of Medicaid,2490.61,,,2490.61,Other,153% of Medicaid,3662.66,,,3662.66,Other,225% of Medicaid,2278.99,,,2278.99,Other,140% of Medicaid,3662.66,,,3662.66,Other,225% of Medicaid,4232.41,,,4232.41,Other,250% of Medicaid,5274.24,,,5274.24,Other,324% of Medicaid,3499.88,,,3499.88,Other,215% of Medicaid,3499.88,,,3499.88,Other,215% of Medicaid,2034.81,,,2034.81,Other,125% of Medicaid,0.01,5849,
REMOVAL OF SUPPORT IMPLANT,20670,CPT,,30020670,CDM,450,RC,,,both,,,4904,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3334.72,68,,3334.72,percent of total billed charges,All Other,3028,,,3028,Other,186% of Medicaid,3923.2,80,,3923.2,percent of total billed charges,All Other,4070.32,,,4070.32,Other,Non Covered Service,4070.32,,,,Other,Non Covered Service,3923.2,80,,3923.2,percent of total billed charges,All Other,4070.32,,,4070.32,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3432.8,70,,3432.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1627.85,,,1627.85,Other,100% of Medicaid,1627.85,,,1627.85,Other,100% of Medicaid,1627.85,,,1627.85,Other,100% of Medicaid,1627.85,,,1627.85,Other,100% of Medicaid,3662.66,,,3662.66,Other,225% of Medicaid,2490.61,,,2490.61,Other,153% of Medicaid,3662.66,,,3662.66,Other,225% of Medicaid,2278.99,,,2278.99,Other,140% of Medicaid,3662.66,,,3662.66,Other,225% of Medicaid,4232.41,,,4232.41,Other,250% of Medicaid,5274.24,,,5274.24,Other,324% of Medicaid,3499.88,,,3499.88,Other,215% of Medicaid,3499.88,,,3499.88,Other,215% of Medicaid,2034.81,,,2034.81,Other,125% of Medicaid,0.01,5274.24,
CL TX OF NASAL BONE FX W,21315,CPT,,30021315,CDM,450,RC,,,both,,,6166,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4192.88,68,,4192.88,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,4932.8,80,,4932.8,percent of total billed charges,All Other,5117.78,,,5117.78,Other,Non Covered Service,5117.78,,,,Other,Non Covered Service,4932.8,80,,4932.8,percent of total billed charges,All Other,5117.78,,,5117.78,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4316.2,70,,4316.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,5117.78,
CL TX OF NASAL BONE FX; W STAB,21320,CPT,,30021320,CDM,450,RC,,,both,,,6405,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4355.4,68,,4355.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,5124,80,,5124,percent of total billed charges,All Other,5316.15,,,5316.15,Other,Non Covered Service,5316.15,,,,Other,Non Covered Service,5124,80,,5124,percent of total billed charges,All Other,5316.15,,,5316.15,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4483.5,70,,4483.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,5817.88,
CL TX NASAL SEPTAL FX,21337,CPT,,30021337,CDM,450,RC,,,both,,,9130,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031,,,1031,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6391,70,,6391,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,6391,
CL TS TMJ DISLOCATION IN,21480,CPT,,30021480,CDM,450,RC,,,both,,,467,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,317.56,68,,317.56,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,373.6,80,,373.6,percent of total billed charges,All Other,387.61,,,387.61,Other,Non Covered Service,387.61,,,,Other,Non Covered Service,373.6,80,,373.6,percent of total billed charges,All Other,387.61,,,387.61,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,326.9,70,,326.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
REM FB SHOULDER; SQ,23330,CPT,,30023330,CDM,450,RC,,,both,,,3395,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1973,,,1973,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2376.5,70,,2376.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1622.73,,,1622.73,Other,153% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1484.85,,,1484.85,Other,140% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,2757.58,,,2757.58,Other,250% of Medicaid,3436.37,,,3436.37,Other,324% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,1325.76,,,1325.76,Other,125% of Medicaid,0.01,3436.37,
CL TX CLAVICULAR FX WO M,23500,CPT,,30023500,CDM,450,RC,,,both,,,467,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031,,,1031,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,326.9,70,,326.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX ACLAV DISLOC W MANI,23545,CPT,,30023545,CDM,450,RC,,,both,,,1798,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1222.64,68,,1222.64,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,1438.4,80,,1438.4,percent of total billed charges,All Other,1492.34,,,1492.34,Other,Non Covered Service,1492.34,,,,Other,Non Covered Service,1438.4,80,,1438.4,percent of total billed charges,All Other,1492.34,,,1492.34,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1258.6,70,,1258.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX PROX HUMERAL FX W,23605,CPT,,30023605,CDM,450,RC,,,both,,,7272,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4944.96,68,,4944.96,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,5817.6,80,,5817.6,percent of total billed charges,All Other,6035.76,,,6035.76,Other,Non Covered Service,6035.76,,,,Other,Non Covered Service,5817.6,80,,5817.6,percent of total billed charges,All Other,6035.76,,,6035.76,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5090.4,70,,5090.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,6035.76,
CL TX GR TUBEROSITY FX; W MANIP,23625,CPT,,30023625,CDM,450,RC,,,both,,,3953,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2688.04,68,,2688.04,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,3162.4,80,,3162.4,percent of total billed charges,All Other,3280.99,,,3280.99,Other,Non Covered Service,3280.99,,,,Other,Non Covered Service,3162.4,80,,3162.4,percent of total billed charges,All Other,3280.99,,,3280.99,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2767.1,70,,2767.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,3280.99,
CL TX SHLDR DISL W MANI; WO AN,23650,CPT,,30023650,CDM,450,RC,,,both,,,603,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.04,68,,410.04,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,500.49,,,,Other,Non Covered Service,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,422.1,70,,422.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX SHLDR DISL W MANIP; W AN,23655,CPT,,30023655,CDM,450,RC,,,both,,,5919,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4024.92,68,,4024.92,percent of total billed charges,All Other,1730,,,1730,Other,186% of Medicaid,4735.2,80,,4735.2,percent of total billed charges,All Other,4912.77,,,4912.77,Other,Non Covered Service,4912.77,,,,Other,Non Covered Service,4735.2,80,,4735.2,percent of total billed charges,All Other,4912.77,,,4912.77,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4143.3,70,,4143.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,4912.77,
CL TX SHLDR DISLOC & FX GT; W MAN,23665,CPT,,30023665,CDM,450,RC,,,both,,,3304,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2246.72,68,,2246.72,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2643.2,80,,2643.2,percent of total billed charges,All Other,2742.32,,,2742.32,Other,Non Covered Service,2742.32,,,,Other,Non Covered Service,2643.2,80,,2643.2,percent of total billed charges,All Other,2742.32,,,2742.32,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2312.8,70,,2312.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CL TX SHDR DISLOC W NK FX,23675,CPT,,30023675,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
INCISION & DRAINAGE ARM/ELBOW,23931,CPT,,30023931,CDM,450,RC,,,both,,,5674,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1973,,,1973,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3971.8,70,,3971.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1622.73,,,1622.73,Other,153% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1484.85,,,1484.85,Other,140% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,2757.58,,,2757.58,Other,250% of Medicaid,3436.37,,,3436.37,Other,324% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,1325.76,,,1325.76,Other,125% of Medicaid,0.01,3971.8,
CLOSED TX HUMERUS FX W MA,24505,CPT,,30024505,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CL TX SC TX HUMERUS SHFT,24535,CPT,,30024535,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CL TX EC HUMEROUS FX W MA,24565,CPT,,30024565,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CL TX C HUMERUS FX W MANI,24577,CPT,,30024577,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
TX CL ELBOW DISLOC WO ANE,24600,CPT,,30024600,CDM,450,RC,,,both,,,603,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.04,68,,410.04,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,500.49,,,,Other,Non Covered Service,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,422.1,70,,422.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
TX CL ELBOW DISLOC W ANES,24605,CPT,,30024605,CDM,450,RC,,,both,,,5531,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3761.08,68,,3761.08,percent of total billed charges,All Other,1730,,,1730,Other,186% of Medicaid,4424.8,80,,4424.8,percent of total billed charges,All Other,4590.73,,,4590.73,Other,Non Covered Service,4590.73,,,,Other,Non Covered Service,4424.8,80,,4424.8,percent of total billed charges,All Other,4590.73,,,4590.73,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3871.7,70,,3871.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,4590.73,
CL TX MONTEGGIA ELB FX W MANIP,24620,CPT,,30024620,CDM,450,RC,,,both,,,5382,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3659.76,68,,3659.76,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,4305.6,80,,4305.6,percent of total billed charges,All Other,4467.06,,,4467.06,Other,Non Covered Service,4467.06,,,,Other,Non Covered Service,4305.6,80,,4305.6,percent of total billed charges,All Other,4467.06,,,4467.06,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3767.4,70,,3767.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,4467.06,
CL TX NURSEMAID ELBOW W M,24640,CPT,,30024640,CDM,450,RC,,,both,,,603,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.04,68,,410.04,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,500.49,,,,Other,Non Covered Service,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,422.1,70,,422.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX RADIAL HD/NECK FX; W MANIP,24655,CPT,,30024655,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CLOSED TX ULNAR FRACTURE PROXIMAL END W,24675,CPT,,30024675,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CL TX RADIAL SHAFT FX WO,25500,CPT,,30025500,CDM,450,RC,,,both,,,563,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031,,,1031,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,394.1,70,,394.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX RADIAL SHFT FX W MA,25505,CPT,,30025505,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
GALEAZZI FX/DISLOC,25520,CPT,,300025520,CDM,450,RC,,,both,,,5210,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3542.8,68,,3542.8,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,4168,80,,4168,percent of total billed charges,All Other,4324.3,,,4324.3,Other,Non Covered Service,4324.3,,,,Other,Non Covered Service,4168,80,,4168,percent of total billed charges,All Other,4324.3,,,4324.3,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3647,70,,3647,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,4324.3,
GALEAZZI FX/DISLOC,25520,CPT,,30025520,CDM,450,RC,,,both,,,5210,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3542.8,68,,3542.8,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,4168,80,,4168,percent of total billed charges,All Other,4324.3,,,4324.3,Other,Non Covered Service,4324.3,,,,Other,Non Covered Service,4168,80,,4168,percent of total billed charges,All Other,4324.3,,,4324.3,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3647,70,,3647,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,4324.3,
CL TX ULNAR SHFT FX W MANIP,25535,CPT,,30025535,CDM,450,RC,,,both,,,714,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,485.52,68,,485.52,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,571.2,80,,571.2,percent of total billed charges,All Other,592.62,,,592.62,Other,Non Covered Service,592.62,,,,Other,Non Covered Service,571.2,80,,571.2,percent of total billed charges,All Other,592.62,,,592.62,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,499.8,70,,499.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX RADIAL AND ULNAR SHFT,25560,CPT,,30025560,CDM,450,RC,,,both,,,603,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031,,,1031,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,422.1,70,,422.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX RADIAL AND ULNA FX W,25565,CPT,,30025565,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
TREAT FRACTURE RADIUS ULNA W,25600,CPT,,30025600,CDM,450,RC,,,both,,,554,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031,,,1031,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,387.8,70,,387.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
TREAT FRACTURE RADIUS ULNA,25605,CPT,,30025605,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CK TX CARPL SCAPHOID FX W,25624,CPT,,30025624,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CLTX CARPL BONE FX W MNP EA BONE,25635,CPT,,30025635,CDM,450,RC,,,both,,,7839,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5330.52,68,,5330.52,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,6271.2,80,,6271.2,percent of total billed charges,All Other,6506.37,,,6506.37,Other,Non Covered Service,6506.37,,,,Other,Non Covered Service,6271.2,80,,6271.2,percent of total billed charges,All Other,6506.37,,,6506.37,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5487.3,70,,5487.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,6506.37,
CLTX RDCRPL/INTERCARPL DISLC 1+ BONES,25660,CPT,,30025660,CDM,450,RC,,,both,,,758,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031,,,1031,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,530.6,70,,530.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
TREAT WRIST DISLOCATION,25675,CPT,,30025675,CDM,450,RC,,,both,,,692,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,470.56,68,,470.56,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,553.6,80,,553.6,percent of total billed charges,All Other,574.36,,,574.36,Other,Non Covered Service,574.36,,,,Other,Non Covered Service,553.6,80,,553.6,percent of total billed charges,All Other,574.36,,,574.36,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,484.4,70,,484.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX LUNATE DISLOC W MANIP,25690,CPT,,30025690,CDM,450,RC,,,both,,,5340,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3631.2,68,,3631.2,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,4272,80,,4272,percent of total billed charges,All Other,4432.2,,,4432.2,Other,Non Covered Service,4432.2,,,,Other,Non Covered Service,4272,80,,4272,percent of total billed charges,All Other,4432.2,,,4432.2,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3738,70,,3738,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,4432.2,
I AND D FINGER ABSCESS SIMPLE,26010,CPT,,30026010,CDM,450,RC,,,both,,,570,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,387.6,68,,387.6,percent of total billed charges,All Other,733,,,733,Other,186% of Medicaid,456,80,,456,percent of total billed charges,All Other,473.1,,,473.1,Other,Non Covered Service,473.1,,,,Other,Non Covered Service,456,80,,456,percent of total billed charges,All Other,473.1,,,473.1,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,399,70,,399,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,1276.45,
I AND D FINGER ABSCESS COMPLI,26011,CPT,,30026011,CDM,450,RC,,,both,,,4245,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2886.6,68,,2886.6,percent of total billed charges,All Other,1207,,,1207,Other,186% of Medicaid,3396,80,,3396,percent of total billed charges,All Other,3523.35,,,3523.35,Other,Non Covered Service,3523.35,,,,Other,Non Covered Service,3396,80,,3396,percent of total billed charges,All Other,3523.35,,,3523.35,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2971.5,70,,2971.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,992.66,,,992.66,Other,153% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,908.32,,,908.32,Other,140% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,1686.88,,,1686.88,Other,250% of Medicaid,2102.11,,,2102.11,Other,324% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,811,,,811,Other,125% of Medicaid,0.01,3523.35,
PARTIAL EXC BONE DISTAL,26236,CPT,,30026236,CDM,450,RC,,,both,,,5598,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2289,,,2289,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3918.6,70,,3918.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,1883.15,,,1883.15,Other,153% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,1723.14,,,1723.14,Other,140% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,3200.12,,,3200.12,Other,250% of Medicaid,3987.84,,,3987.84,Other,324% of Medicaid,2646.25,,,2646.25,Other,215% of Medicaid,2646.25,,,2646.25,Other,215% of Medicaid,1538.52,,,1538.52,Other,125% of Medicaid,0.01,3987.84,
REP ET HAND WO FG EA T,26410,CPT,,30026410,CDM,450,RC,,,both,,,5990,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4073.2,68,,4073.2,percent of total billed charges,All Other,2289,,,2289,Other,186% of Medicaid,4792,80,,4792,percent of total billed charges,All Other,4971.7,,,4971.7,Other,Non Covered Service,4971.7,,,,Other,Non Covered Service,4792,80,,4792,percent of total billed charges,All Other,4971.7,,,4971.7,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4193,70,,4193,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,1883.15,,,1883.15,Other,153% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,1723.14,,,1723.14,Other,140% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,3200.12,,,3200.12,Other,250% of Medicaid,3987.84,,,3987.84,Other,324% of Medicaid,2646.25,,,2646.25,Other,215% of Medicaid,2646.25,,,2646.25,Other,215% of Medicaid,1538.52,,,1538.52,Other,125% of Medicaid,0.01,4971.7,
REPAIR FINGER TENDON,26418,CPT,,30026418,CDM,450,RC,,,both,,,4665,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3172.2,68,,3172.2,percent of total billed charges,All Other,2289,,,2289,Other,186% of Medicaid,3732,80,,3732,percent of total billed charges,All Other,3871.95,,,3871.95,Other,Non Covered Service,3871.95,,,,Other,Non Covered Service,3732,80,,3732,percent of total billed charges,All Other,3871.95,,,3871.95,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3265.5,70,,3265.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,1883.15,,,1883.15,Other,153% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,1723.14,,,1723.14,Other,140% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,3200.12,,,3200.12,Other,250% of Medicaid,3987.84,,,3987.84,Other,324% of Medicaid,2646.25,,,2646.25,Other,215% of Medicaid,2646.25,,,2646.25,Other,215% of Medicaid,1538.52,,,1538.52,Other,125% of Medicaid,0.01,3987.84,
CL TX MC FX SGL; W MANIP,26605,CPT,,30026605,CDM,450,RC,,,both,,,617,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,419.56,68,,419.56,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,493.6,80,,493.6,percent of total billed charges,All Other,512.11,,,512.11,Other,Non Covered Service,512.11,,,,Other,Non Covered Service,493.6,80,,493.6,percent of total billed charges,All Other,512.11,,,512.11,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,431.9,70,,431.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX CMC DISLOC THUMB W,26641,CPT,,30026641,CDM,450,RC,,,both,,,563,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,382.84,68,,382.84,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,450.4,80,,450.4,percent of total billed charges,All Other,467.29,,,467.29,Other,Non Covered Service,467.29,,,,Other,Non Covered Service,450.4,80,,450.4,percent of total billed charges,All Other,467.29,,,467.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,394.1,70,,394.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX CMC DISL W M EA,26670,CPT,,30026670,CDM,450,RC,,,both,,,858,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031,,,1031,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,600.6,70,,600.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX MCP DISLOC SGL W,26700,CPT,,30026700,CDM,450,RC,,,both,,,603,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.04,68,,410.04,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,500.49,,,,Other,Non Covered Service,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,422.1,70,,422.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX MCP DISLOC W MANIP & ANESTH,26705,CPT,,30026705,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1730,,,1730,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,3013.64,
CL TX PHALANG SHFT FX W,26725,CPT,,30026725,CDM,450,RC,,,both,,,603,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.04,68,,410.04,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,500.49,,,,Other,Non Covered Service,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,422.1,70,,422.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX ARTFX MCP IP JNT W,26742,CPT,,30026742,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CL TX D PLAL FX FGRR THMB,26755,CPT,,30026755,CDM,450,RC,,,both,,,563,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,382.84,68,,382.84,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,450.4,80,,450.4,percent of total billed charges,All Other,467.29,,,467.29,Other,Non Covered Service,467.29,,,,Other,Non Covered Service,450.4,80,,450.4,percent of total billed charges,All Other,467.29,,,467.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,394.1,70,,394.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
OPEN TX DISTAL PHALANG FRACT EA,26765,CPT,,30026765,CDM,450,RC,,,both,,,8210,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5582.8,68,,5582.8,percent of total billed charges,All Other,5092,,,5092,Other,186% of Medicaid,6568,80,,6568,percent of total billed charges,All Other,6814.3,,,6814.3,Other,Non Covered Service,6814.3,,,,Other,Non Covered Service,6568,80,,6568,percent of total billed charges,All Other,6814.3,,,6814.3,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5747,70,,5747,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2737.73,,,2737.73,Other,100% of Medicaid,2737.73,,,2737.73,Other,100% of Medicaid,2737.73,,,2737.73,Other,100% of Medicaid,2737.73,,,2737.73,Other,100% of Medicaid,6159.88,,,6159.88,Other,225% of Medicaid,4188.72,,,4188.72,Other,153% of Medicaid,6159.88,,,6159.88,Other,225% of Medicaid,3832.82,,,3832.82,Other,140% of Medicaid,6159.88,,,6159.88,Other,225% of Medicaid,7118.09,,,7118.09,Other,250% of Medicaid,8870.23,,,8870.23,Other,324% of Medicaid,5886.11,,,5886.11,Other,215% of Medicaid,5886.11,,,5886.11,Other,215% of Medicaid,3422.16,,,3422.16,Other,125% of Medicaid,0.01,8870.23,
CL TX IP JNT D W MANIP ; WO AN,26770,CPT,,30026770,CDM,450,RC,,,both,,,603,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.04,68,,410.04,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,500.49,,,,Other,Non Covered Service,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,422.1,70,,422.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX IP JT D W MANIP; W ANEST,26775,CPT,,30026775,CDM,450,RC,,,both,,,5431,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3693.08,68,,3693.08,percent of total billed charges,All Other,1730,,,1730,Other,186% of Medicaid,4344.8,80,,4344.8,percent of total billed charges,All Other,4507.73,,,4507.73,Other,Non Covered Service,4507.73,,,,Other,Non Covered Service,4344.8,80,,4344.8,percent of total billed charges,All Other,4507.73,,,4507.73,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3801.7,70,,3801.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,4507.73,
AMPUTATE FING/TH SGL; W DIR CL,26951,CPT,,30026951,CDM,450,RC,,,both,,,6701,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4556.68,68,,4556.68,percent of total billed charges,All Other,2289,,,2289,Other,186% of Medicaid,5360.8,80,,5360.8,percent of total billed charges,All Other,5561.83,,,5561.83,Other,Non Covered Service,5561.83,,,,Other,Non Covered Service,5360.8,80,,5360.8,percent of total billed charges,All Other,5561.83,,,5561.83,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4690.7,70,,4690.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,1230.82,,,1230.82,Other,100% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,1883.15,,,1883.15,Other,153% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,1723.14,,,1723.14,Other,140% of Medicaid,2769.33,,,2769.33,Other,225% of Medicaid,3200.12,,,3200.12,Other,250% of Medicaid,3987.84,,,3987.84,Other,324% of Medicaid,2646.25,,,2646.25,Other,215% of Medicaid,2646.25,,,2646.25,Other,215% of Medicaid,1538.52,,,1538.52,Other,125% of Medicaid,0.01,5849,
AMPUTATE FING/TH SGL; W LOC AD,26952,CPT,,30026952,CDM,450,RC,,,both,,,6701,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4556.68,68,,4556.68,percent of total billed charges,All Other,3655,,,3655,Other,186% of Medicaid,5360.8,80,,5360.8,percent of total billed charges,All Other,5561.83,,,5561.83,Other,Non Covered Service,5561.83,,,,Other,Non Covered Service,5360.8,80,,5360.8,percent of total billed charges,All Other,5561.83,,,5561.83,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4690.7,70,,4690.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1964.82,,,1964.82,Other,100% of Medicaid,1964.82,,,1964.82,Other,100% of Medicaid,1964.82,,,1964.82,Other,100% of Medicaid,1964.82,,,1964.82,Other,100% of Medicaid,4420.84,,,4420.84,Other,225% of Medicaid,3006.17,,,3006.17,Other,153% of Medicaid,4420.84,,,4420.84,Other,225% of Medicaid,2750.75,,,2750.75,Other,140% of Medicaid,4420.84,,,4420.84,Other,225% of Medicaid,5108.53,,,5108.53,Other,250% of Medicaid,6366.02,,,6366.02,Other,324% of Medicaid,4224.36,,,4224.36,Other,215% of Medicaid,4224.36,,,4224.36,Other,215% of Medicaid,2456.02,,,2456.02,Other,125% of Medicaid,0.01,6366.02,
CL TX TRAUMA HIP DISLC WO,27250,CPT,,30027250,CDM,450,RC,,,both,,,554,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,376.72,68,,376.72,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,443.2,80,,443.2,percent of total billed charges,All Other,459.82,,,459.82,Other,Non Covered Service,459.82,,,,Other,Non Covered Service,443.2,80,,443.2,percent of total billed charges,All Other,459.82,,,459.82,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,387.8,70,,387.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX TRAUMA HIP DISLC W,27252,CPT,,30027252,CDM,450,RC,,,both,,,5075,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3451,68,,3451,percent of total billed charges,All Other,1730,,,1730,Other,186% of Medicaid,4060,80,,4060,percent of total billed charges,All Other,4212.25,,,4212.25,Other,Non Covered Service,4212.25,,,,Other,Non Covered Service,4060,80,,4060,percent of total billed charges,All Other,4212.25,,,4212.25,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3552.5,70,,3552.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,4212.25,
TX SPONTAN HIP DISLOC W A,27257,CPT,,30027257,CDM,450,RC,,,both,,,5531,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1730,,,1730,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3871.7,70,,3871.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,3871.7,
CL TX POST HIP DISLOC WO,27265,CPT,,30027265,CDM,450,RC,,,both,,,603,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.04,68,,410.04,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,500.49,,,,Other,Non Covered Service,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,422.1,70,,422.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX POSTOP HIP DISLOC W,27266,CPT,,30027266,CDM,450,RC,,,both,,,5075,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3451,68,,3451,percent of total billed charges,All Other,1730,,,1730,Other,186% of Medicaid,4060,80,,4060,percent of total billed charges,All Other,4212.25,,,4212.25,Other,Non Covered Service,4212.25,,,,Other,Non Covered Service,4060,80,,4060,percent of total billed charges,All Other,4212.25,,,4212.25,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3552.5,70,,3552.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,4212.25,
CLOSED REDUCTION OF FEMUR,27502,CPT,,30027502,CDM,450,RC,,,both,,,7272,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4944.96,68,,4944.96,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,5817.6,80,,5817.6,percent of total billed charges,All Other,6035.76,,,6035.76,Other,Non Covered Service,6035.76,,,,Other,Non Covered Service,5817.6,80,,5817.6,percent of total billed charges,All Other,6035.76,,,6035.76,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5090.4,70,,5090.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,6035.76,
CL TX PROX TIBIAL FX W SK TRACTION,27532,CPT,,30027532,CDM,450,RC,,,both,,,6701,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4556.68,68,,4556.68,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,5360.8,80,,5360.8,percent of total billed charges,All Other,5561.83,,,5561.83,Other,Non Covered Service,5561.83,,,,Other,Non Covered Service,5360.8,80,,5360.8,percent of total billed charges,All Other,5561.83,,,5561.83,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4690.7,70,,4690.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,5849,
CL TX KNEE DISL WO ANEST,27550,CPT,,30027550,CDM,450,RC,,,both,,,563,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,382.84,68,,382.84,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,450.4,80,,450.4,percent of total billed charges,All Other,467.29,,,467.29,Other,Non Covered Service,467.29,,,,Other,Non Covered Service,450.4,80,,450.4,percent of total billed charges,All Other,467.29,,,467.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,394.1,70,,394.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX KNEE DISL W ANESTH,27552,CPT,,30027552,CDM,450,RC,,,both,,,5075,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3451,68,,3451,percent of total billed charges,All Other,1730,,,1730,Other,186% of Medicaid,4060,80,,4060,percent of total billed charges,All Other,4212.25,,,4212.25,Other,Non Covered Service,4212.25,,,,Other,Non Covered Service,4060,80,,4060,percent of total billed charges,All Other,4212.25,,,4212.25,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3552.5,70,,3552.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,4212.25,
CL TX PATELLAR DISLC WO A,27560,CPT,,30027560,CDM,450,RC,,,both,,,603,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,410.04,68,,410.04,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,500.49,,,,Other,Non Covered Service,482.4,80,,482.4,percent of total billed charges,All Other,500.49,,,500.49,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,422.1,70,,422.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX PATELLAR DISLOCATE,27562,CPT,,30027562,CDM,450,RC,,,both,,,5075,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3451,68,,3451,percent of total billed charges,All Other,1730,,,1730,Other,186% of Medicaid,4060,80,,4060,percent of total billed charges,All Other,4212.25,,,4212.25,Other,Non Covered Service,4212.25,,,,Other,Non Covered Service,4060,80,,4060,percent of total billed charges,All Other,4212.25,,,4212.25,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3552.5,70,,3552.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,4212.25,
CL TX TIB SHFT FX WO MANI,27750,CPT,,30027750,CDM,450,RC,,,both,,,517,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,351.56,68,,351.56,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,413.6,80,,413.6,percent of total billed charges,All Other,429.11,,,429.11,Other,Non Covered Service,429.11,,,,Other,Non Covered Service,413.6,80,,413.6,percent of total billed charges,All Other,429.11,,,429.11,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,361.9,70,,361.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX TIB SHFT FX W MANIP,27752,CPT,,30027752,CDM,450,RC,,,both,,,7272,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4944.96,68,,4944.96,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,5817.6,80,,5817.6,percent of total billed charges,All Other,6035.76,,,6035.76,Other,Non Covered Service,6035.76,,,,Other,Non Covered Service,5817.6,80,,5817.6,percent of total billed charges,All Other,6035.76,,,6035.76,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5090.4,70,,5090.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,6035.76,
CLTX MED ANKLE FX W MNPJ,27762,CPT,,30027762,CDM,450,RC,,,both,,,6796,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4621.28,68,,4621.28,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,5436.8,80,,5436.8,percent of total billed charges,All Other,5640.68,,,5640.68,Other,Non Covered Service,5640.68,,,,Other,Non Covered Service,5436.8,80,,5436.8,percent of total billed charges,All Other,5640.68,,,5640.68,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4757.2,70,,4757.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,5640.68,
CLTX POST ANKLE FX W/MNPJ,27768,CPT,,30027768,CDM,450,RC,,,both,,,9625,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6545,68,,6545,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,7700,80,,7700,percent of total billed charges,All Other,7988.75,,,7988.75,Other,Non Covered Service,7988.75,,,,Other,Non Covered Service,7700,80,,7700,percent of total billed charges,All Other,7988.75,,,7988.75,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6737.5,70,,6737.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,7988.75,
CL TX PROX FIB/SHAFT FX W MANIP,27781,CPT,,30027781,CDM,450,RC,,,both,,,8929,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6071.72,68,,6071.72,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,7143.2,80,,7143.2,percent of total billed charges,All Other,7411.07,,,7411.07,Other,Non Covered Service,7411.07,,,,Other,Non Covered Service,7143.2,80,,7143.2,percent of total billed charges,All Other,7411.07,,,7411.07,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6250.3,70,,6250.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,7411.07,
CT TX DISTL FIB FX W MANI,27788,CPT,,30027788,CDM,450,RC,,,both,,,563,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,382.84,68,,382.84,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,450.4,80,,450.4,percent of total billed charges,All Other,467.29,,,467.29,Other,Non Covered Service,467.29,,,,Other,Non Covered Service,450.4,80,,450.4,percent of total billed charges,All Other,467.29,,,467.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,394.1,70,,394.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CLD TRMT ANKLE FRACTURE M,27810,CPT,,30027810,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CL TX TRIMALL ANKLE FX WO,27816,CPT,,30027816,CDM,450,RC,,,both,,,517,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031,,,1031,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,361.9,70,,361.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CLOSED REDUCTION ANKLE FRACTUR,27818,CPT,,30027818,CDM,450,RC,,,both,,,3230,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2196.4,68,,2196.4,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,2680.9,,,,Other,Non Covered Service,2584,80,,2584,percent of total billed charges,All Other,2680.9,,,2680.9,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2261,70,,2261,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,2904.24,
CL TX WB DSTL TIB FX W MA,27825,CPT,,30027825,CDM,450,RC,,,both,,,7408,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5037.44,68,,5037.44,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,5926.4,80,,5926.4,percent of total billed charges,All Other,6148.64,,,6148.64,Other,Non Covered Service,6148.64,,,,Other,Non Covered Service,5926.4,80,,5926.4,percent of total billed charges,All Other,6148.64,,,6148.64,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5185.6,70,,5185.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,6148.64,
CL TX ANKLE DISLOCATION; WO ANES,27840,CPT,,30027840,CDM,450,RC,,,both,,,493,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,335.24,68,,335.24,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,394.4,80,,394.4,percent of total billed charges,All Other,409.19,,,409.19,Other,Non Covered Service,409.19,,,,Other,Non Covered Service,394.4,80,,394.4,percent of total billed charges,All Other,409.19,,,409.19,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,345.1,70,,345.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX ANKLE DISLOC W ANES,27842,CPT,,30027842,CDM,450,RC,,,both,,,5531,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3761.08,68,,3761.08,percent of total billed charges,All Other,1730,,,1730,Other,186% of Medicaid,4424.8,80,,4424.8,percent of total billed charges,All Other,4590.73,,,4590.73,Other,Non Covered Service,4590.73,,,,Other,Non Covered Service,4424.8,80,,4424.8,percent of total billed charges,All Other,4590.73,,,4590.73,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3871.7,70,,3871.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,4590.73,
LEG OR ANKLE SURGERY PROCEDURE,27899,CPT,,30027899,CDM,450,RC,,,both,,,517,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,351.56,68,,351.56,percent of total billed charges,All Other,785,,,785,Other,186% of Medicaid,413.6,80,,413.6,percent of total billed charges,All Other,429.11,,,429.11,Other,Non Covered Service,429.11,,,,Other,Non Covered Service,413.6,80,,413.6,percent of total billed charges,All Other,429.11,,,429.11,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,361.9,70,,361.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,422.14,,,422.14,Other,100% of Medicaid,422.14,,,422.14,Other,100% of Medicaid,422.14,,,422.14,Other,100% of Medicaid,422.14,,,422.14,Other,100% of Medicaid,949.81,,,949.81,Other,225% of Medicaid,645.87,,,645.87,Other,153% of Medicaid,949.81,,,949.81,Other,225% of Medicaid,590.99,,,590.99,Other,140% of Medicaid,949.81,,,949.81,Other,225% of Medicaid,1097.55,,,1097.55,Other,250% of Medicaid,1367.72,,,1367.72,Other,324% of Medicaid,907.59,,,907.59,Other,215% of Medicaid,907.59,,,907.59,Other,215% of Medicaid,527.67,,,527.67,Other,125% of Medicaid,0.01,1367.72,
EXC FOOT/TOE TUM SC < 1.5 CM,28043,CPT,,30028043,CDM,450,RC,,,both,,,4678,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1973,,,1973,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3274.6,70,,3274.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1622.73,,,1622.73,Other,153% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1484.85,,,1484.85,Other,140% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,2757.58,,,2757.58,Other,250% of Medicaid,3436.37,,,3436.37,Other,324% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,1325.76,,,1325.76,Other,125% of Medicaid,0.01,3436.37,
REM FOREIGN BODY FOOT SQ,28190,CPT,,30028190,CDM,450,RC,,,both,,,3020,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2053.6,68,,2053.6,percent of total billed charges,All Other,1240,,,1240,Other,186% of Medicaid,2416,80,,2416,percent of total billed charges,All Other,2506.6,,,2506.6,Other,Non Covered Service,2506.6,,,,Other,Non Covered Service,2416,80,,2416,percent of total billed charges,All Other,2506.6,,,2506.6,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2114,70,,2114,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,2506.6,
REM DEEP FB OF FOOT,28192,CPT,,30028192,CDM,450,RC,,,both,,,6117,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1973,,,1973,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4281.9,70,,4281.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,1060.61,,,1060.61,Other,100% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1622.73,,,1622.73,Other,153% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,1484.85,,,1484.85,Other,140% of Medicaid,2386.37,,,2386.37,Other,225% of Medicaid,2757.58,,,2757.58,Other,250% of Medicaid,3436.37,,,3436.37,Other,324% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,2280.31,,,2280.31,Other,215% of Medicaid,1325.76,,,1325.76,Other,125% of Medicaid,0.01,4281.9,
CL TX CALCANEAL FX W MANIP,28405,CPT,,30028405,CDM,450,RC,,,both,,,1678,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1141.04,68,,1141.04,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,1342.4,80,,1342.4,percent of total billed charges,All Other,1392.74,,,1392.74,Other,Non Covered Service,1392.74,,,,Other,Non Covered Service,1342.4,80,,1342.4,percent of total billed charges,All Other,1392.74,,,1392.74,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1174.6,70,,1174.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
TREATMENT OF ANKLE FRACTURE,28435,CPT,,30028435,CDM,450,RC,,,both,,,4304,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2926.72,68,,2926.72,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,3443.2,80,,3443.2,percent of total billed charges,All Other,3572.32,,,3572.32,Other,Non Covered Service,3572.32,,,,Other,Non Covered Service,3443.2,80,,3443.2,percent of total billed charges,All Other,3572.32,,,3572.32,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3012.8,70,,3012.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,3572.32,
CL TX METATARSAL FX; W MANIP,28475,CPT,,30028475,CDM,450,RC,,,both,,,576,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,391.68,68,,391.68,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,460.8,80,,460.8,percent of total billed charges,All Other,478.08,,,478.08,Other,Non Covered Service,478.08,,,,Other,Non Covered Service,460.8,80,,460.8,percent of total billed charges,All Other,478.08,,,478.08,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,403.2,70,,403.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX FX GT PHALANX(S); WO MANIP,28490,CPT,,30028490,CDM,450,RC,,,both,,,714,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031,,,1031,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,499.8,70,,499.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX FX GT PHALANX S W,28495,CPT,,30028495,CDM,450,RC,,,both,,,517,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,351.56,68,,351.56,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,413.6,80,,413.6,percent of total billed charges,All Other,429.11,,,429.11,Other,Non Covered Service,429.11,,,,Other,Non Covered Service,413.6,80,,413.6,percent of total billed charges,All Other,429.11,,,429.11,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,361.9,70,,361.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX FX PHALANX PHALANG,28515,CPT,,30028515,CDM,450,RC,,,both,,,517,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,351.56,68,,351.56,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,413.6,80,,413.6,percent of total billed charges,All Other,429.11,,,429.11,Other,Non Covered Service,429.11,,,,Other,Non Covered Service,413.6,80,,413.6,percent of total billed charges,All Other,429.11,,,429.11,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,361.9,70,,361.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX TALOTARSAL JOINT DIS WO ANEST,28570,CPT,,30028570,CDM,450,RC,,,both,,,923,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1031,,,1031,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,646.1,70,,646.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX TALOTARSAL JOINT DISL W,28575,CPT,,30028575,CDM,450,RC,,,both,,,6701,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1730,,,1730,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4690.7,70,,4690.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,930.13,,,930.13,Other,100% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1423.11,,,1423.11,Other,153% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,1302.19,,,1302.19,Other,140% of Medicaid,2092.8,,,2092.8,Other,225% of Medicaid,2418.35,,,2418.35,Other,250% of Medicaid,3013.64,,,3013.64,Other,324% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1999.79,,,1999.79,Other,215% of Medicaid,1162.67,,,1162.67,Other,125% of Medicaid,0.01,5849,
CLOSED REDUCTION TOE,28630,CPT,,30028630,CDM,450,RC,,,both,,,554,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,376.72,68,,376.72,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,443.2,80,,443.2,percent of total billed charges,All Other,459.82,,,459.82,Other,Non Covered Service,459.82,,,,Other,Non Covered Service,443.2,80,,443.2,percent of total billed charges,All Other,459.82,,,459.82,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,387.8,70,,387.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
CL TX IP JOINT DSL WO AN,28660,CPT,,30028660,CDM,450,RC,,,both,,,517,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,351.56,68,,351.56,percent of total billed charges,All Other,1031,,,1031,Other,186% of Medicaid,413.6,80,,413.6,percent of total billed charges,All Other,429.11,,,429.11,Other,Non Covered Service,429.11,,,,Other,Non Covered Service,413.6,80,,413.6,percent of total billed charges,All Other,429.11,,,429.11,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,361.9,70,,361.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,554.35,,,554.35,Other,100% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,848.16,,,848.16,Other,153% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,776.09,,,776.09,Other,140% of Medicaid,1247.29,,,1247.29,Other,225% of Medicaid,1441.31,,,1441.31,Other,250% of Medicaid,1796.1,,,1796.1,Other,324% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,1191.85,,,1191.85,Other,215% of Medicaid,692.94,,,692.94,Other,125% of Medicaid,0.01,1796.1,
APPLICATION OF BODY CAST,29000,CPT,,30029000,CDM,450,RC,,,both,,,541,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,680,,,680,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378.7,70,,378.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
APPLY FIGURE EIGHT CAST,29049,CPT,,30029049,CDM,450,RC,,,both,,,541,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,680,,,680,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378.7,70,,378.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
APPLY LONG ARM CAST,29065,CPT,,30029065,CDM,450,RC,,,both,,,750,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,510,68,,510,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,600,80,,600,percent of total billed charges,All Other,622.5,,,622.5,Other,Non Covered Service,622.5,,,,Other,Non Covered Service,600,80,,600,percent of total billed charges,All Other,622.5,,,622.5,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,525,70,,525,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,0.01,798.69,
APPLY SHORT ARM CAST,29075,CPT,,30029075,CDM,450,RC,,,both,,,907,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,616.76,68,,616.76,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,725.6,80,,725.6,percent of total billed charges,All Other,752.81,,,752.81,Other,Non Covered Service,752.81,,,,Other,Non Covered Service,725.6,80,,725.6,percent of total billed charges,All Other,752.81,,,752.81,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,634.9,70,,634.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,0.01,798.69,
APPLY GAUNTLET CAST,29085,CPT,,30029085,CDM,450,RC,,,both,,,382,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,459,,,459,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,267.4,70,,267.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,0.01,798.69,
APPLY LONG ARM SPLINT,29105,CPT,,30029105,CDM,450,RC,,,both,,,544,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,380.8,70,,380.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
APPLY FOREARM SPLINT,29125,CPT,,30029125,CDM,450,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,394.1,70,,394.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
APPLICATION OF FINGER SPLINT,29130,CPT,,30029130,CDM,450,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,394.1,70,,394.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
STRAPPING OF SHOULDER,29240,CPT,,30029240,CDM,450,RC,,,both,,,563,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,394.1,70,,394.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
STRAPPING OF ELBOW OR WRIST,29260,CPT,,30029260,CDM,450,RC,,,both,,,563,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,394.1,70,,394.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
STRAPPING OF HAND OR FINGER,29280,CPT,,30029280,CDM,450,RC,,,both,,,563,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,394.1,70,,394.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
APPLICATION OF LONG LEG CAST,29345,CPT,,30029345,CDM,450,RC,,,both,,,831,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,565.08,68,,565.08,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,664.8,80,,664.8,percent of total billed charges,All Other,689.73,,,689.73,Other,Non Covered Service,689.73,,,,Other,Non Covered Service,664.8,80,,664.8,percent of total billed charges,All Other,689.73,,,689.73,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,581.7,70,,581.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,0.01,798.69,
APPLICATION OF LONG LEG CAST,29355,CPT,,30029355,CDM,450,RC,,,both,,,831,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,680,,,680,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,581.7,70,,581.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
APPLY LONG LEG CAST BRACE,29358,CPT,,30029358,CDM,450,RC,,,both,,,831,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,459,,,459,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,581.7,70,,581.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,0.01,798.69,
APPLICATION OF LONG LEG CYLIND,29365,CPT,,30029365,CDM,450,RC,,,both,,,831,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,459,,,459,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,581.7,70,,581.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,0.01,798.69,
APPLY SHORT LEG CAST,29405,CPT,,30029405,CDM,450,RC,,,both,,,794,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,459,,,459,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,555.8,70,,555.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,0.01,798.69,
APPLY SHORT LEG CAST PTB,29435,CPT,,30029435,CDM,450,RC,,,both,,,831,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,680,,,680,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,581.7,70,,581.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
ADDITION OF WALKER TO CAST,29440,CPT,,30029440,CDM,450,RC,,,both,,,367,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,680,,,680,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,256.9,70,,256.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
APPLICATION OF CLUBFOOF LEG CA,29450,CPT,,30029450,CDM,450,RC,,,both,,,367,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,249.56,68,,249.56,percent of total billed charges,All Other,680,,,680,Other,186% of Medicaid,293.6,80,,293.6,percent of total billed charges,All Other,304.61,,,304.61,Other,Non Covered Service,304.61,,,,Other,Non Covered Service,293.6,80,,293.6,percent of total billed charges,All Other,304.61,,,304.61,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,256.9,70,,256.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
APPLICATION LONG LEG SPLINT,29505,CPT,,30029505,CDM,450,RC,,,both,,,427,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,298.9,70,,298.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
APPLICATION LOWER LEG SPLINT,29515,CPT,,30029515,CDM,450,RC,,,both,,,427,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,298.9,70,,298.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
STRAPPING OF HIP,29520,CPT,,30029520,CDM,450,RC,,,both,,,367,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,256.9,70,,256.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
STRAPPING OF KNEE,29530,CPT,,30029530,CDM,450,RC,,,both,,,491,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,343.7,70,,343.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
STRAPPING OF ANKLE,29540,CPT,,30029540,CDM,450,RC,,,both,,,491,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,343.7,70,,343.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
STRAPPING OF TOES,29550,CPT,,30029550,CDM,450,RC,,,both,,,427,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,298.9,70,,298.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
UNNA BOOT,29580,CPT,,30029580,CDM,450,RC,,,both,,,427,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,459,,,459,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,298.9,70,,298.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,0.01,798.69,
APPLY MULTLAY COMPRS LWR LEG,29581,CPT,,30029581,CDM,450,RC,,,both,,,393,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,459,,,459,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368,,,368,Case Rate,,275.1,70,,275.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,0.01,798.69,
APPLY MULTLAY COMPRS UPR LEG,29582,CPT,,30029582,CDM,450,RC,,,both,,,421,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294.7,70,,294.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
REMOVAL REVISION OF CAST,29700,CPT,,30029700,CDM,450,RC,,,both,,,541,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,680,,,680,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378.7,70,,378.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
REMOVAL REVISION FULL ARM LEG,29705,CPT,,30029705,CDM,450,RC,,,both,,,541,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,367.88,68,,367.88,percent of total billed charges,All Other,680,,,680,Other,186% of Medicaid,432.8,80,,432.8,percent of total billed charges,All Other,449.03,,,449.03,Other,Non Covered Service,449.03,,,,Other,Non Covered Service,432.8,80,,432.8,percent of total billed charges,All Other,449.03,,,449.03,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378.7,70,,378.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
REMOVAL REVISION OF CAST,29710,CPT,,30029710,CDM,450,RC,,,both,,,831,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,680,,,680,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,581.7,70,,581.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
WINDOWING OF CAST,29730,CPT,,30029730,CDM,450,RC,,,both,,,367,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,680,,,680,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,256.9,70,,256.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
WEDGING OF CAST,29740,CPT,,30029740,CDM,450,RC,,,both,,,541,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,680,,,680,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378.7,70,,378.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
WEDGING OF CLUBFOOT CAST,29750,CPT,,30029750,CDM,450,RC,,,both,,,541,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,680,,,680,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,378.7,70,,378.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,0.01,1184.3,
CASTING OR STRAPPING PROCEDURE,29799,CPT,,30029799,CDM,450,RC,,,both,,,427,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,339,,,339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,298.9,70,,298.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,182.37,,,182.37,Other,100% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,279.02,,,279.02,Other,153% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,255.32,,,255.32,Other,140% of Medicaid,410.33,,,410.33,Other,225% of Medicaid,474.16,,,474.16,Other,250% of Medicaid,590.87,,,590.87,Other,324% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,392.09,,,392.09,Other,215% of Medicaid,227.96,,,227.96,Other,125% of Medicaid,0.01,590.87,
I AND D ABSCESS OF NASAL SEPT,30020,CPT,,30030020,CDM,450,RC,,,both,,,1160,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,788.8,68,,788.8,percent of total billed charges,All Other,2256,,,2256,Other,186% of Medicaid,928,80,,928,percent of total billed charges,All Other,962.8,,,962.8,Other,Non Covered Service,962.8,,,,Other,Non Covered Service,928,80,,928,percent of total billed charges,All Other,962.8,,,962.8,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,812,70,,812,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,1855.93,,,1855.93,Other,153% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,1698.24,,,1698.24,Other,140% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,3153.87,,,3153.87,Other,250% of Medicaid,3930.21,,,3930.21,Other,324% of Medicaid,2608.01,,,2608.01,Other,215% of Medicaid,2608.01,,,2608.01,Other,215% of Medicaid,1516.29,,,1516.29,Other,125% of Medicaid,0.01,3930.21,
REMOVE FOREIGN BODY NOSE,30300,CPT,,30030300,CDM,450,RC,,,both,,,271,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.28,68,,184.28,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,216.8,80,,216.8,percent of total billed charges,All Other,224.93,,,224.93,Other,Non Covered Service,224.93,,,,Other,Non Covered Service,216.8,80,,216.8,percent of total billed charges,All Other,224.93,,,224.93,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.7,70,,189.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
CONTROL NASAL HEMOR ANT S,30901,CPT,,30030901,CDM,450,RC,,,both,,,433,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294.44,68,,294.44,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,346.4,80,,346.4,percent of total billed charges,All Other,359.39,,,359.39,Other,Non Covered Service,359.39,,,,Other,Non Covered Service,346.4,80,,346.4,percent of total billed charges,All Other,359.39,,,359.39,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,303.1,70,,303.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
CONTROL NASAL HEMOR ANT C,30903,CPT,,30030903,CDM,450,RC,,,both,,,433,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,423,,,423,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,303.1,70,,303.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
POSTERIOR PACKING NOSE SI,30905,CPT,,30030905,CDM,450,RC,,,both,,,433,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,294.44,68,,294.44,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,346.4,80,,346.4,percent of total billed charges,All Other,359.39,,,359.39,Other,Non Covered Service,359.39,,,,Other,Non Covered Service,346.4,80,,346.4,percent of total billed charges,All Other,359.39,,,359.39,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,303.1,70,,303.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
CTRL POST EPISTAX SQ,30906,CPT,,30030906,CDM,450,RC,,,both,,,469,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,318.92,68,,318.92,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,375.2,80,,375.2,percent of total billed charges,All Other,389.27,,,389.27,Other,Non Covered Service,389.27,,,,Other,Non Covered Service,375.2,80,,375.2,percent of total billed charges,All Other,389.27,,,389.27,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,328.3,70,,328.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
INTUBATION ENDOTRACHEAL,31500,CPT,,30031500,CDM,450,RC,,,both,,,903,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,893,,,893,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,632.1,70,,632.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,734.95,,,734.95,Other,153% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,672.5,,,672.5,Other,140% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,1248.94,,,1248.94,Other,250% of Medicaid,1556.37,,,1556.37,Other,324% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,600.45,,,600.45,Other,125% of Medicaid,0.01,1556.37,
CHANGE OF WINDPIPE AIRWAY,31502,CPT,,30031502,CDM,450,RC,,,both,,,491,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,219,,,219,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,343.7,70,,343.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,117.92,,,117.92,Other,100% of Medicaid,117.92,,,117.92,Other,100% of Medicaid,117.92,,,117.92,Other,100% of Medicaid,117.92,,,117.92,Other,100% of Medicaid,265.31,,,265.31,Other,225% of Medicaid,180.41,,,180.41,Other,153% of Medicaid,265.31,,,265.31,Other,225% of Medicaid,165.08,,,165.08,Other,140% of Medicaid,265.31,,,265.31,Other,225% of Medicaid,306.59,,,306.59,Other,250% of Medicaid,382.05,,,382.05,Other,324% of Medicaid,253.52,,,253.52,Other,215% of Medicaid,253.52,,,253.52,Other,215% of Medicaid,147.4,,,147.4,Other,125% of Medicaid,0.01,441.38,
LARYNGOSCOPY IND; DIAGNOSTIC,31505,CPT,,30031505,CDM,450,RC,,,both,,,523,357.93,,,357.93,Other,150% of Medicare + 9.63% HCRA Surcharge,217.66,,,217.66,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,355.64,68,,355.64,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,418.4,80,,418.4,percent of total billed charges,All Other,434.09,,,434.09,Other,Non Covered Service,434.09,,,,Other,Non Covered Service,418.4,80,,418.4,percent of total billed charges,All Other,434.09,,,434.09,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,366.1,70,,366.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
LARYNGOSCOPY W REMOVE FB,31511,CPT,,30031511,CDM,450,RC,,,both,,,657,357.93,,,357.93,Other,150% of Medicare + 9.63% HCRA Surcharge,217.66,,,217.66,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,423,,,423,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,459.9,70,,459.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
DX LARYNGOSCOPY EXCL NB,31525,CPT,,30031525,CDM,450,RC,,,both,,,5126,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3485.68,68,,3485.68,percent of total billed charges,All Other,831,,,831,Other,186% of Medicaid,4100.8,80,,4100.8,percent of total billed charges,All Other,4254.58,,,4254.58,Other,Non Covered Service,4254.58,,,,Other,Non Covered Service,4100.8,80,,4100.8,percent of total billed charges,All Other,4254.58,,,4254.58,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3588.2,70,,3588.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,446.91,,,446.91,Other,100% of Medicaid,446.91,,,446.91,Other,100% of Medicaid,446.91,,,446.91,Other,100% of Medicaid,446.91,,,446.91,Other,100% of Medicaid,1005.55,,,1005.55,Other,225% of Medicaid,683.77,,,683.77,Other,153% of Medicaid,1005.55,,,1005.55,Other,225% of Medicaid,625.67,,,625.67,Other,140% of Medicaid,1005.55,,,1005.55,Other,225% of Medicaid,1161.96,,,1161.96,Other,250% of Medicaid,1447.99,,,1447.99,Other,324% of Medicaid,960.85,,,960.85,Other,215% of Medicaid,960.85,,,960.85,Other,215% of Medicaid,558.64,,,558.64,Other,125% of Medicaid,0.01,4254.58,
LARYNGOSCOPY W FB REMOVAL,31530,CPT,,30031530,CDM,450,RC,,,both,,,7157,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4866.76,68,,4866.76,percent of total billed charges,All Other,831,,,831,Other,186% of Medicaid,5725.6,80,,5725.6,percent of total billed charges,All Other,5940.31,,,5940.31,Other,Non Covered Service,5940.31,,,,Other,Non Covered Service,5725.6,80,,5725.6,percent of total billed charges,All Other,5940.31,,,5940.31,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5009.9,70,,5009.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,446.91,,,446.91,Other,100% of Medicaid,446.91,,,446.91,Other,100% of Medicaid,446.91,,,446.91,Other,100% of Medicaid,446.91,,,446.91,Other,100% of Medicaid,1005.55,,,1005.55,Other,225% of Medicaid,683.77,,,683.77,Other,153% of Medicaid,1005.55,,,1005.55,Other,225% of Medicaid,625.67,,,625.67,Other,140% of Medicaid,1005.55,,,1005.55,Other,225% of Medicaid,1161.96,,,1161.96,Other,250% of Medicaid,1447.99,,,1447.99,Other,324% of Medicaid,960.85,,,960.85,Other,215% of Medicaid,960.85,,,960.85,Other,215% of Medicaid,558.64,,,558.64,Other,125% of Medicaid,0.01,5940.31,
LARYNGOSCOPY FLEX; DIAGNOSTIC,31575,CPT,,30031575,CDM,450,RC,,,both,,,614,357.93,,,357.93,Other,150% of Medicare + 9.63% HCRA Surcharge,217.66,,,217.66,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,417.52,68,,417.52,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,491.2,80,,491.2,percent of total billed charges,All Other,509.62,,,509.62,Other,Non Covered Service,509.62,,,,Other,Non Covered Service,491.2,80,,491.2,percent of total billed charges,All Other,509.62,,,509.62,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,429.8,70,,429.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
TRACHEOSTOMY TRANSTRACHE,31603,CPT,,30031603,CDM,450,RC,,,both,,,3126,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3493,,,3493,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2188.2,70,,2188.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1878.16,,,1878.16,Other,100% of Medicaid,1878.16,,,1878.16,Other,100% of Medicaid,1878.16,,,1878.16,Other,100% of Medicaid,1878.16,,,1878.16,Other,100% of Medicaid,4225.87,,,4225.87,Other,225% of Medicaid,2873.59,,,2873.59,Other,153% of Medicaid,4225.87,,,4225.87,Other,225% of Medicaid,2629.43,,,2629.43,Other,140% of Medicaid,4225.87,,,4225.87,Other,225% of Medicaid,4883.23,,,4883.23,Other,250% of Medicaid,6085.25,,,6085.25,Other,324% of Medicaid,4038.05,,,4038.05,Other,215% of Medicaid,4038.05,,,4038.05,Other,215% of Medicaid,2347.71,,,2347.71,Other,125% of Medicaid,0.01,6085.25,
TRACHEOSTOMY CRICOTHYROI,31605,CPT,,30031605,CDM,450,RC,,,both,,,2583,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3493,,,3493,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1808.1,70,,1808.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1878.16,,,1878.16,Other,100% of Medicaid,1878.16,,,1878.16,Other,100% of Medicaid,1878.16,,,1878.16,Other,100% of Medicaid,1878.16,,,1878.16,Other,100% of Medicaid,4225.87,,,4225.87,Other,225% of Medicaid,2873.59,,,2873.59,Other,153% of Medicaid,4225.87,,,4225.87,Other,225% of Medicaid,2629.43,,,2629.43,Other,140% of Medicaid,4225.87,,,4225.87,Other,225% of Medicaid,4883.23,,,4883.23,Other,250% of Medicaid,6085.25,,,6085.25,Other,324% of Medicaid,4038.05,,,4038.05,Other,215% of Medicaid,4038.05,,,4038.05,Other,215% of Medicaid,2347.71,,,2347.71,Other,125% of Medicaid,0.01,6085.25,
TRACHEOBRONCH THRU OLD INCISION,31615,CPT,,30031615,CDM,450,RC,,,both,,,1998,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2135,,,2135,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1398.6,70,,1398.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1147.75,,,1147.75,Other,100% of Medicaid,1147.75,,,1147.75,Other,100% of Medicaid,1147.75,,,1147.75,Other,100% of Medicaid,1147.75,,,1147.75,Other,100% of Medicaid,2582.44,,,2582.44,Other,225% of Medicaid,1756.06,,,1756.06,Other,153% of Medicaid,2582.44,,,2582.44,Other,225% of Medicaid,1606.85,,,1606.85,Other,140% of Medicaid,2582.44,,,2582.44,Other,225% of Medicaid,2984.15,,,2984.15,Other,250% of Medicaid,3718.71,,,3718.71,Other,324% of Medicaid,2467.66,,,2467.66,Other,215% of Medicaid,2467.66,,,2467.66,Other,215% of Medicaid,1434.69,,,1434.69,Other,125% of Medicaid,0.01,3718.71,
CORE NDL BX LNG/MED PERQ,32408,CPT,,30032408,CDM,450,RC,,,both,,,4606,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1196,,,1196,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3224.2,70,,3224.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,0.01,3224.2,
INSERTION CHEST TUBE,32551,CPT,,30032551,CDM,450,RC,,,both,,,3350,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2278,68,,2278,percent of total billed charges,All Other,1196,,,1196,Other,186% of Medicaid,2680,80,,2680,percent of total billed charges,All Other,2780.5,,,2780.5,Other,Non Covered Service,2780.5,,,,Other,Non Covered Service,2680,80,,2680,percent of total billed charges,All Other,2780.5,,,2780.5,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2345,70,,2345,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,0.01,2893.99,
REMOVE LUNG CATHETER,32552,CPT,,30032552,CDM,450,RC,,,both,,,1304,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1196,,,1196,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,912.8,70,,912.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,0.01,2083.89,
ASPIRATE PLEURA WO IMAGING,32554,CPT,,30032554,CDM,450,RC,,,both,,,1729,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1175.72,68,,1175.72,percent of total billed charges,All Other,1196,,,1196,Other,186% of Medicaid,1383.2,80,,1383.2,percent of total billed charges,All Other,1435.07,,,1435.07,Other,Non Covered Service,1435.07,,,,Other,Non Covered Service,1383.2,80,,1383.2,percent of total billed charges,All Other,1435.07,,,1435.07,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1210.3,70,,1210.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,0.01,2083.89,
ASPIRATE PLEURA W IMAGING,32555,CPT,,30032555,CDM,450,RC,,,both,,,2118,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1440.24,68,,1440.24,percent of total billed charges,All Other,1196,,,1196,Other,186% of Medicaid,1694.4,80,,1694.4,percent of total billed charges,All Other,1757.94,,,1757.94,Other,Non Covered Service,1757.94,,,,Other,Non Covered Service,1694.4,80,,1694.4,percent of total billed charges,All Other,1757.94,,,1757.94,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1482.6,70,,1482.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,0.01,2083.89,
LYSE CHEST FIBRIN SUBQ DAY,32562,CPT,,30032562,CDM,450,RC,,,both,,,1815,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1196,,,1196,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1270.5,70,,1270.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,0.01,2083.89,
INSRT TEMP VENOUS PACEMAK,33210,CPT,,30033210,CDM,450,RC,,,both,,,18374,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4537,,,4537,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,12861.8,70,,12861.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,0.01,15351.79,
REPAIR BLOOD VESSEL DIRECT; UPR EXTREM,35206,CPT,,30035206,CDM,450,RC,,,both,,,11616,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7898.88,68,,7898.88,percent of total billed charges,All Other,4418,,,4418,Other,186% of Medicaid,9292.8,80,,9292.8,percent of total billed charges,All Other,9641.28,,,9641.28,Other,Non Covered Service,9641.28,,,,Other,Non Covered Service,9292.8,80,,9292.8,percent of total billed charges,All Other,9641.28,,,9641.28,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8131.2,70,,8131.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2375.28,,,2375.28,Other,100% of Medicaid,2375.28,,,2375.28,Other,100% of Medicaid,2375.28,,,2375.28,Other,100% of Medicaid,2375.28,,,2375.28,Other,100% of Medicaid,5344.38,,,5344.38,Other,225% of Medicaid,3634.18,,,3634.18,Other,153% of Medicaid,5344.38,,,5344.38,Other,225% of Medicaid,3325.39,,,3325.39,Other,140% of Medicaid,5344.38,,,5344.38,Other,225% of Medicaid,6175.73,,,6175.73,Other,250% of Medicaid,7695.91,,,7695.91,Other,324% of Medicaid,5106.85,,,5106.85,Other,215% of Medicaid,5106.85,,,5106.85,Other,215% of Medicaid,2969.1,,,2969.1,Other,125% of Medicaid,0.01,9641.28,
REPAIR BLD VESSEL DIRECT; LWR EXTREM,35226,CPT,,30035226,CDM,450,RC,,,both,,,2302,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1565.36,68,,1565.36,percent of total billed charges,All Other,4418,,,4418,Other,186% of Medicaid,1841.6,80,,1841.6,percent of total billed charges,All Other,1910.66,,,1910.66,Other,Non Covered Service,1910.66,,,,Other,Non Covered Service,1841.6,80,,1841.6,percent of total billed charges,All Other,1910.66,,,1910.66,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1611.4,70,,1611.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2375.28,,,2375.28,Other,100% of Medicaid,2375.28,,,2375.28,Other,100% of Medicaid,2375.28,,,2375.28,Other,100% of Medicaid,2375.28,,,2375.28,Other,100% of Medicaid,5344.38,,,5344.38,Other,225% of Medicaid,3634.18,,,3634.18,Other,153% of Medicaid,5344.38,,,5344.38,Other,225% of Medicaid,3325.39,,,3325.39,Other,140% of Medicaid,5344.38,,,5344.38,Other,225% of Medicaid,6175.73,,,6175.73,Other,250% of Medicaid,7695.91,,,7695.91,Other,324% of Medicaid,5106.85,,,5106.85,Other,215% of Medicaid,5106.85,,,5106.85,Other,215% of Medicaid,2969.1,,,2969.1,Other,125% of Medicaid,0.01,7695.91,
BLD DRAW < 3 YRS FEM JUGUL,36400,CPT,,30036400,CDM,450,RC,,,both,,,85,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,267,,,267,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,59.5,70,,59.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,143.8,,,143.8,Other,100% of Medicaid,143.8,,,143.8,Other,100% of Medicaid,143.8,,,143.8,Other,100% of Medicaid,143.8,,,143.8,Other,100% of Medicaid,323.55,,,323.55,Other,225% of Medicaid,220.01,,,220.01,Other,153% of Medicaid,323.55,,,323.55,Other,225% of Medicaid,201.32,,,201.32,Other,140% of Medicaid,323.55,,,323.55,Other,225% of Medicaid,373.88,,,373.88,Other,250% of Medicaid,465.91,,,465.91,Other,324% of Medicaid,309.17,,,309.17,Other,215% of Medicaid,309.17,,,309.17,Other,215% of Medicaid,179.75,,,179.75,Other,125% of Medicaid,0.01,465.91,
BLOOD DRAW < 3 YEARS SCALP,36405,CPT,,30036405,CDM,450,RC,,,both,,,12,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,267,,,267,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,8.4,70,,8.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,143.8,,,143.8,Other,100% of Medicaid,143.8,,,143.8,Other,100% of Medicaid,143.8,,,143.8,Other,100% of Medicaid,143.8,,,143.8,Other,100% of Medicaid,323.55,,,323.55,Other,225% of Medicaid,220.01,,,220.01,Other,153% of Medicaid,323.55,,,323.55,Other,225% of Medicaid,201.32,,,201.32,Other,140% of Medicaid,323.55,,,323.55,Other,225% of Medicaid,373.88,,,373.88,Other,250% of Medicaid,465.91,,,465.91,Other,324% of Medicaid,309.17,,,309.17,Other,215% of Medicaid,309.17,,,309.17,Other,215% of Medicaid,179.75,,,179.75,Other,125% of Medicaid,0.01,465.91,
BLD DRAW < 3 YRS OTHER VEIN,36406,CPT,,30036406,CDM,450,RC,,,both,,,45,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,267,,,267,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,31.5,70,,31.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,143.8,,,143.8,Other,100% of Medicaid,143.8,,,143.8,Other,100% of Medicaid,143.8,,,143.8,Other,100% of Medicaid,143.8,,,143.8,Other,100% of Medicaid,323.55,,,323.55,Other,225% of Medicaid,220.01,,,220.01,Other,153% of Medicaid,323.55,,,323.55,Other,225% of Medicaid,201.32,,,201.32,Other,140% of Medicaid,323.55,,,323.55,Other,225% of Medicaid,373.88,,,373.88,Other,250% of Medicaid,465.91,,,465.91,Other,324% of Medicaid,309.17,,,309.17,Other,215% of Medicaid,309.17,,,309.17,Other,215% of Medicaid,179.75,,,179.75,Other,125% of Medicaid,0.01,465.91,
NON-ROUTINE BLD DRAW >3 YRS,36410,CPT,,30036410,CDM,450,RC,,,both,,,130,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,,,63,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,91,70,,91,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,109.55,
CAPILLARY BLOOD DRAW,36416,CPT,,30036416,CDM,450,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,75,,,75,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,28.7,70,,28.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,40.28,,,40.28,Other,100% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,61.63,,,61.63,Other,153% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,56.39,,,56.39,Other,140% of Medicaid,90.63,,,90.63,Other,225% of Medicaid,104.73,,,104.73,Other,250% of Medicaid,130.51,,,130.51,Other,324% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,86.61,,,86.61,Other,215% of Medicaid,50.35,,,50.35,Other,125% of Medicaid,0.01,130.51,
VEIN ACCESS CUTDOWN > 1 YR,36425,CPT,,30036425,CDM,450,RC,,,both,,,851,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,255,,,255,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,595.7,70,,595.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,136.84,,,136.84,Other,100% of Medicaid,136.84,,,136.84,Other,100% of Medicaid,136.84,,,136.84,Other,100% of Medicaid,136.84,,,136.84,Other,100% of Medicaid,307.9,,,307.9,Other,225% of Medicaid,209.37,,,209.37,Other,153% of Medicaid,307.9,,,307.9,Other,225% of Medicaid,191.58,,,191.58,Other,140% of Medicaid,307.9,,,307.9,Other,225% of Medicaid,355.79,,,355.79,Other,250% of Medicaid,443.37,,,443.37,Other,324% of Medicaid,294.21,,,294.21,Other,215% of Medicaid,294.21,,,294.21,Other,215% of Medicaid,171.05,,,171.05,Other,125% of Medicaid,0.01,719.99,
INSERT CATHETER VEIN,36481,CPT,,30036481,CDM,450,RC,,,both,,,2087,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,516,,,516,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1460.9,70,,1460.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,277.25,,,277.25,Other,100% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,424.19,,,424.19,Other,153% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,388.15,,,388.15,Other,140% of Medicaid,623.81,,,623.81,Other,225% of Medicaid,720.85,,,720.85,Other,250% of Medicaid,898.28,,,898.28,Other,324% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,596.08,,,596.08,Other,215% of Medicaid,346.56,,,346.56,Other,125% of Medicaid,0.01,1460.9,
INSERT NON TUNNEL CV CATH,36556,CPT,,30036556,CDM,450,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4560.76,68,,4560.76,percent of total billed charges,All Other,586,,,586,Other,186% of Medicaid,5365.6,80,,5365.6,percent of total billed charges,All Other,5566.81,,,5566.81,Other,Non Covered Service,5566.81,,,,Other,Non Covered Service,5365.6,80,,5365.6,percent of total billed charges,All Other,5566.81,,,5566.81,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4694.9,70,,4694.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,0.01,5759.82,
INS PICC AGE 5 YRS >,36569,CPT,,30036569,CDM,450,RC,,,both,,,4042,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2748.56,68,,2748.56,percent of total billed charges,All Other,372,,,372,Other,186% of Medicaid,3233.6,80,,3233.6,percent of total billed charges,All Other,3354.86,,,3354.86,Other,Non Covered Service,3354.86,,,,Other,Non Covered Service,3233.6,80,,3233.6,percent of total billed charges,All Other,3354.86,,,3354.86,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2829.4,70,,2829.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,199.74,,,199.74,Other,100% of Medicaid,199.74,,,199.74,Other,100% of Medicaid,199.74,,,199.74,Other,100% of Medicaid,199.74,,,199.74,Other,100% of Medicaid,449.42,,,449.42,Other,225% of Medicaid,305.6,,,305.6,Other,153% of Medicaid,449.42,,,449.42,Other,225% of Medicaid,279.64,,,279.64,Other,140% of Medicaid,449.42,,,449.42,Other,225% of Medicaid,519.33,,,519.33,Other,250% of Medicaid,647.16,,,647.16,Other,324% of Medicaid,429.44,,,429.44,Other,215% of Medicaid,429.44,,,429.44,Other,215% of Medicaid,249.68,,,249.68,Other,125% of Medicaid,0.01,3354.86,
REPAIR CVA CATHETER,36575,CPT,,30036575,CDM,450,RC,,,both,,,1989,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1352.52,68,,1352.52,percent of total billed charges,All Other,1556,,,1556,Other,186% of Medicaid,1591.2,80,,1591.2,percent of total billed charges,All Other,1650.87,,,1650.87,Other,Non Covered Service,1650.87,,,,Other,Non Covered Service,1591.2,80,,1591.2,percent of total billed charges,All Other,1650.87,,,1650.87,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1392.3,70,,1392.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,836.77,,,836.77,Other,100% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1280.26,,,1280.26,Other,153% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,1171.48,,,1171.48,Other,140% of Medicaid,1882.73,,,1882.73,Other,225% of Medicaid,2175.6,,,2175.6,Other,250% of Medicaid,2711.13,,,2711.13,Other,324% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1799.05,,,1799.05,Other,215% of Medicaid,1045.96,,,1045.96,Other,125% of Medicaid,0.01,2711.13,
DECLOT VASCULAR DEVICE,36593,CPT,,30036593,CDM,450,RC,,,both,,,896,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,609.28,68,,609.28,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,716.8,80,,716.8,percent of total billed charges,All Other,743.68,,,743.68,Other,Non Covered Service,743.68,,,,Other,Non Covered Service,716.8,80,,716.8,percent of total billed charges,All Other,743.68,,,743.68,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,627.2,70,,627.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,743.68,
ARTERIAL PUNCTURE,36600,CPT,,30036600,CDM,450,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,63,,,63,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.1,70,,184.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,230.83,
INSERT ARTERIAL CATHETER,36620,CPT,,30036620,CDM,450,RC,,,both,,,299,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,306,,,306,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,209.3,70,,209.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,164.4,,,164.4,Other,100% of Medicaid,164.4,,,164.4,Other,100% of Medicaid,164.4,,,164.4,Other,100% of Medicaid,164.4,,,164.4,Other,100% of Medicaid,369.91,,,369.91,Other,225% of Medicaid,251.54,,,251.54,Other,153% of Medicaid,369.91,,,369.91,Other,225% of Medicaid,230.16,,,230.16,Other,140% of Medicaid,369.91,,,369.91,Other,225% of Medicaid,427.45,,,427.45,Other,250% of Medicaid,532.67,,,532.67,Other,324% of Medicaid,353.47,,,353.47,Other,215% of Medicaid,353.47,,,353.47,Other,215% of Medicaid,205.5,,,205.5,Other,125% of Medicaid,0.01,532.67,
PLACE NEEDLE INTRAOSSEOUS,36680,CPT,,30036680,CDM,450,RC,,,both,,,851,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,578.68,68,,578.68,percent of total billed charges,All Other,685,,,685,Other,186% of Medicaid,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,706.33,,,,Other,Non Covered Service,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,595.7,70,,595.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,368.46,,,368.46,Other,100% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,563.74,,,563.74,Other,153% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,515.84,,,515.84,Other,140% of Medicaid,829.04,,,829.04,Other,225% of Medicaid,958,,,958,Other,250% of Medicaid,1193.81,,,1193.81,Other,324% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,792.19,,,792.19,Other,215% of Medicaid,460.58,,,460.58,Other,125% of Medicaid,0.01,1193.81,
LIGATE/DIVIDE/EXCISE VEIN 1 LEG,37785,CPT,,30037785,CDM,450,RC,,,both,,,7721,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4156,,,4156,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5404.7,70,,5404.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2234.47,,,2234.47,Other,100% of Medicaid,2234.47,,,2234.47,Other,100% of Medicaid,2234.47,,,2234.47,Other,100% of Medicaid,2234.47,,,2234.47,Other,100% of Medicaid,5027.56,,,5027.56,Other,225% of Medicaid,3418.74,,,3418.74,Other,153% of Medicaid,5027.56,,,5027.56,Other,225% of Medicaid,3128.26,,,3128.26,Other,140% of Medicaid,5027.56,,,5027.56,Other,225% of Medicaid,5809.63,,,5809.63,Other,250% of Medicaid,7239.69,,,7239.69,Other,324% of Medicaid,4804.12,,,4804.12,Other,215% of Medicaid,4804.12,,,4804.12,Other,215% of Medicaid,2793.09,,,2793.09,Other,125% of Medicaid,0.01,7239.69,
BONE MARROW BIOPSY,38221,CPT,,30038221,CDM,450,RC,,,both,,,3926,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,791,,,791,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2748.2,70,,2748.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,650.55,,,650.55,Other,153% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,595.27,,,595.27,Other,140% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,1105.51,,,1105.51,Other,250% of Medicaid,1377.63,,,1377.63,Other,324% of Medicaid,914.17,,,914.17,Other,215% of Medicaid,914.17,,,914.17,Other,215% of Medicaid,531.49,,,531.49,Other,125% of Medicaid,0.01,2929.69,
REPAIR LIP FT VERMILION ONLY,40650,CPT,,30040650,CDM,450,RC,,,both,,,1515,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,423,,,423,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1060.5,70,,1060.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,1060.5,
REM EMBEDDED FB MOUTH VESTIB; SIMPLE,40804,CPT,,30040804,CDM,450,RC,,,both,,,1860,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428,,,428,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1302,70,,1302,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,352.28,,,352.28,Other,153% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,322.35,,,322.35,Other,140% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,598.64,,,598.64,Other,250% of Medicaid,746,,,746,Other,324% of Medicaid,495.03,,,495.03,Other,215% of Medicaid,495.03,,,495.03,Other,215% of Medicaid,287.81,,,287.81,Other,125% of Medicaid,0.01,1638.03,
CL LACERATION MOUTH VESTIB 2.5CM,40830,CPT,,30040830,CDM,450,RC,,,both,,,1263,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,858.84,68,,858.84,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,1010.4,80,,1010.4,percent of total billed charges,All Other,1048.29,,,1048.29,Other,Non Covered Service,1048.29,,,,Other,Non Covered Service,1010.4,80,,1010.4,percent of total billed charges,All Other,1048.29,,,1048.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,884.1,70,,884.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,1048.29,
CL LACERATION MOUTH VESTIB >2.5CM,40831,CPT,,30040831,CDM,450,RC,,,both,,,1998,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1358.64,68,,1358.64,percent of total billed charges,All Other,428,,,428,Other,186% of Medicaid,1598.4,80,,1598.4,percent of total billed charges,All Other,1658.34,,,1658.34,Other,Non Covered Service,1658.34,,,,Other,Non Covered Service,1598.4,80,,1598.4,percent of total billed charges,All Other,1658.34,,,1658.34,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1398.6,70,,1398.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,352.28,,,352.28,Other,153% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,322.35,,,322.35,Other,140% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,598.64,,,598.64,Other,250% of Medicaid,746,,,746,Other,324% of Medicaid,495.03,,,495.03,Other,215% of Medicaid,495.03,,,495.03,Other,215% of Medicaid,287.81,,,287.81,Other,125% of Medicaid,0.01,1658.34,
EO I&D ABSC/CYS FOM; SUBMAND,41017,CPT,,30041017,CDM,450,RC,,,both,,,7746,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5267.28,68,,5267.28,percent of total billed charges,All Other,829,,,829,Other,186% of Medicaid,6196.8,80,,6196.8,percent of total billed charges,All Other,6429.18,,,6429.18,Other,Non Covered Service,6429.18,,,,Other,Non Covered Service,6196.8,80,,6196.8,percent of total billed charges,All Other,6429.18,,,6429.18,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5422.2,70,,5422.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,445.74,,,445.74,Other,100% of Medicaid,445.74,,,445.74,Other,100% of Medicaid,445.74,,,445.74,Other,100% of Medicaid,445.74,,,445.74,Other,100% of Medicaid,1002.91,,,1002.91,Other,225% of Medicaid,681.98,,,681.98,Other,153% of Medicaid,1002.91,,,1002.91,Other,225% of Medicaid,624.03,,,624.03,Other,140% of Medicaid,1002.91,,,1002.91,Other,225% of Medicaid,1158.92,,,1158.92,Other,250% of Medicaid,1444.19,,,1444.19,Other,324% of Medicaid,958.34,,,958.34,Other,215% of Medicaid,958.34,,,958.34,Other,215% of Medicaid,557.17,,,557.17,Other,125% of Medicaid,0.01,6429.18,
REP LACERAT 2.5CM < FLR M,41250,CPT,,30041250,CDM,450,RC,,,both,,,851,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,578.68,68,,578.68,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,706.33,,,,Other,Non Covered Service,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,595.7,70,,595.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
REP LACERAT FLR MOUTH>2.5,41252,CPT,,30041252,CDM,450,RC,,,both,,,2583,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1756.44,68,,1756.44,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,2066.4,80,,2066.4,percent of total billed charges,All Other,2143.89,,,2143.89,Other,Non Covered Service,2143.89,,,,Other,Non Covered Service,2066.4,80,,2066.4,percent of total billed charges,All Other,2143.89,,,2143.89,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1808.1,70,,1808.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,2143.89,
DR ABSC CYST HEMATOM DE,41800,CPT,,30041800,CDM,450,RC,,,both,,,570,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,387.6,68,,387.6,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,456,80,,456,percent of total billed charges,All Other,473.1,,,473.1,Other,Non Covered Service,473.1,,,,Other,Non Covered Service,456,80,,456,percent of total billed charges,All Other,473.1,,,473.1,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,399,70,,399,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
REM EMB FB FROM DENTOALV SFT TISSUE,41805,CPT,,30041805,CDM,450,RC,,,both,,,4870,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,428,,,428,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3409,70,,3409,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,230.25,,,230.25,Other,100% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,352.28,,,352.28,Other,153% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,322.35,,,322.35,Other,140% of Medicaid,518.06,,,518.06,Other,225% of Medicaid,598.64,,,598.64,Other,250% of Medicaid,746,,,746,Other,324% of Medicaid,495.03,,,495.03,Other,215% of Medicaid,495.03,,,495.03,Other,215% of Medicaid,287.81,,,287.81,Other,125% of Medicaid,0.01,3409,
DRAINAGE OF ABSCESS OF PA,42000,CPT,,30042000,CDM,450,RC,,,both,,,1160,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,788.8,68,,788.8,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,928,80,,928,percent of total billed charges,All Other,962.8,,,962.8,Other,Non Covered Service,962.8,,,,Other,Non Covered Service,928,80,,928,percent of total billed charges,All Other,962.8,,,962.8,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,812,70,,812,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,962.8,
I AND D TONSIL ABSCESS,42700,CPT,,30042700,CDM,450,RC,,,both,,,1160,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,788.8,68,,788.8,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,928,80,,928,percent of total billed charges,All Other,962.8,,,962.8,Other,Non Covered Service,962.8,,,,Other,Non Covered Service,928,80,,928,percent of total billed charges,All Other,962.8,,,962.8,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,812,70,,812,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,962.8,
REMOVE FOREIGN BODY PHARYNX,42809,CPT,,30042809,CDM,450,RC,,,both,,,851,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,578.68,68,,578.68,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,706.33,,,,Other,Non Covered Service,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,595.7,70,,595.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,736.35,
SUTURE PHARYNX FOR WOUND OR INJURY,42900,CPT,,30042900,CDM,450,RC,,,both,,,4533,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2256,,,2256,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3173.1,70,,3173.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,1855.93,,,1855.93,Other,153% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,1698.24,,,1698.24,Other,140% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,3153.87,,,3153.87,Other,250% of Medicaid,3930.21,,,3930.21,Other,324% of Medicaid,2608.01,,,2608.01,Other,215% of Medicaid,2608.01,,,2608.01,Other,215% of Medicaid,1516.29,,,1516.29,Other,125% of Medicaid,0.01,3930.21,
ESOPHAGUS ENDOSCOPY,43200,CPT,,30043200,CDM,450,RC,,,both,,,2900,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1531,,,1531,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2030,70,,2030,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1258.98,,,1258.98,Other,153% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1152.01,,,1152.01,Other,140% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,2139.45,,,2139.45,Other,250% of Medicaid,2666.08,,,2666.08,Other,324% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1028.58,,,1028.58,Other,125% of Medicaid,0.01,2666.08,
ESOPHAGOSCOPY W FB REMOVAL,43215,CPT,,30043215,CDM,450,RC,,,both,,,3921,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1531,,,1531,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2744.7,70,,2744.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1258.98,,,1258.98,Other,153% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1152.01,,,1152.01,Other,140% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,2139.45,,,2139.45,Other,250% of Medicaid,2666.08,,,2666.08,Other,324% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1028.58,,,1028.58,Other,125% of Medicaid,0.01,3438.42,
UGI DIAGNOSTIC,43235,CPT,,30043235,CDM,450,RC,,,both,,,2900,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1972,68,,1972,percent of total billed charges,All Other,1531,,,1531,Other,186% of Medicaid,2320,80,,2320,percent of total billed charges,All Other,2407,,,2407,Other,Non Covered Service,2407,,,,Other,Non Covered Service,2320,80,,2320,percent of total billed charges,All Other,2407,,,2407,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2030,70,,2030,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1258.98,,,1258.98,Other,153% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1152.01,,,1152.01,Other,140% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,2139.45,,,2139.45,Other,250% of Medicaid,2666.08,,,2666.08,Other,324% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1028.58,,,1028.58,Other,125% of Medicaid,0.01,2666.08,
GASTROSTOMY TUBE PLACEMENT,43246,CPT,,30043246,CDM,450,RC,,,both,,,3921,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1531,,,1531,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2744.7,70,,2744.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1258.98,,,1258.98,Other,153% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1152.01,,,1152.01,Other,140% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,2139.45,,,2139.45,Other,250% of Medicaid,2666.08,,,2666.08,Other,324% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1028.58,,,1028.58,Other,125% of Medicaid,0.01,3438.42,
UGI W REMOVAL OF FOREIGN BODY,43247,CPT,,30043247,CDM,450,RC,,,both,,,3382,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2299.76,68,,2299.76,percent of total billed charges,All Other,1531,,,1531,Other,186% of Medicaid,2705.6,80,,2705.6,percent of total billed charges,All Other,2807.06,,,2807.06,Other,Non Covered Service,2807.06,,,,Other,Non Covered Service,2705.6,80,,2705.6,percent of total billed charges,All Other,2807.06,,,2807.06,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2367.4,70,,2367.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1258.98,,,1258.98,Other,153% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1152.01,,,1152.01,Other,140% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,2139.45,,,2139.45,Other,250% of Medicaid,2666.08,,,2666.08,Other,324% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1028.58,,,1028.58,Other,125% of Medicaid,0.01,2807.06,
NASAL /OROGASTRIC W/TUBE PLMT,43752,CPT,,30043752,CDM,450,RC,,,both,,,851,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,578.68,68,,578.68,percent of total billed charges,All Other,1030,,,1030,Other,186% of Medicaid,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,706.33,,,,Other,Non Covered Service,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,595.7,70,,595.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,0.01,1794.25,
NG TUBE ASPIRATION/LAVAGE,43753,CPT,,30043753,CDM,450,RC,,,both,,,632,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,429.76,68,,429.76,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,505.6,80,,505.6,percent of total billed charges,All Other,524.56,,,524.56,Other,Non Covered Service,524.56,,,,Other,Non Covered Service,505.6,80,,505.6,percent of total billed charges,All Other,524.56,,,524.56,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,442.4,70,,442.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,567.18,
RPLC GTUBE NO REVJ TRC,43762,CPT,,30043762,CDM,450,RC,,,both,,,1648,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1120.64,68,,1120.64,percent of total billed charges,All Other,1030,,,1030,Other,186% of Medicaid,1318.4,80,,1318.4,percent of total billed charges,All Other,1367.84,,,1367.84,Other,Non Covered Service,1367.84,,,,Other,Non Covered Service,1318.4,80,,1318.4,percent of total billed charges,All Other,1367.84,,,1367.84,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1153.6,70,,1153.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,0.01,1794.25,
RPLC GTUBE REVJ GSTRST TRC,43763,CPT,,30043763,CDM,450,RC,,,both,,,1592,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1030,,,1030,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1114.4,70,,1114.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,0.01,1794.25,
PLACE GASTROSTOMY TUBE,43830,CPT,,30043830,CDM,450,RC,,,both,,,5442,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3157,,,3157,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3809.4,70,,3809.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1697.31,,,1697.31,Other,100% of Medicaid,1697.31,,,1697.31,Other,100% of Medicaid,1697.31,,,1697.31,Other,100% of Medicaid,1697.31,,,1697.31,Other,100% of Medicaid,3818.95,,,3818.95,Other,225% of Medicaid,2596.89,,,2596.89,Other,153% of Medicaid,3818.95,,,3818.95,Other,225% of Medicaid,2376.24,,,2376.24,Other,140% of Medicaid,3818.95,,,3818.95,Other,225% of Medicaid,4413.01,,,4413.01,Other,250% of Medicaid,5499.29,,,5499.29,Other,324% of Medicaid,3649.22,,,3649.22,Other,215% of Medicaid,3649.22,,,3649.22,Other,215% of Medicaid,2121.64,,,2121.64,Other,125% of Medicaid,0.01,5499.29,
NG TUBE INSERTION,44500,CPT,,30044500,CDM,450,RC,,,both,,,2409,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1030,,,1030,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1686.3,70,,1686.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,0.01,1794.25,
SIGMOIDOSCOPY FLEX W REM FB,45332,CPT,,30045332,CDM,450,RC,,,both,,,2439,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1478,,,1478,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1707.3,70,,1707.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,794.73,,,794.73,Other,100% of Medicaid,794.73,,,794.73,Other,100% of Medicaid,794.73,,,794.73,Other,100% of Medicaid,794.73,,,794.73,Other,100% of Medicaid,1788.15,,,1788.15,Other,225% of Medicaid,1215.94,,,1215.94,Other,153% of Medicaid,1788.15,,,1788.15,Other,225% of Medicaid,1112.63,,,1112.63,Other,140% of Medicaid,1788.15,,,1788.15,Other,225% of Medicaid,2066.3,,,2066.3,Other,250% of Medicaid,2574.93,,,2574.93,Other,324% of Medicaid,1708.67,,,1708.67,Other,215% of Medicaid,1708.67,,,1708.67,Other,215% of Medicaid,993.42,,,993.42,Other,125% of Medicaid,0.01,2574.93,
SIGMOIDOSC W BLEED CONTROL,45334,CPT,,30045334,CDM,450,RC,,,both,,,3099,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1478,,,1478,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2169.3,70,,2169.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,794.73,,,794.73,Other,100% of Medicaid,794.73,,,794.73,Other,100% of Medicaid,794.73,,,794.73,Other,100% of Medicaid,794.73,,,794.73,Other,100% of Medicaid,1788.15,,,1788.15,Other,225% of Medicaid,1215.94,,,1215.94,Other,153% of Medicaid,1788.15,,,1788.15,Other,225% of Medicaid,1112.63,,,1112.63,Other,140% of Medicaid,1788.15,,,1788.15,Other,225% of Medicaid,2066.3,,,2066.3,Other,250% of Medicaid,2574.93,,,2574.93,Other,324% of Medicaid,1708.67,,,1708.67,Other,215% of Medicaid,1708.67,,,1708.67,Other,215% of Medicaid,993.42,,,993.42,Other,125% of Medicaid,0.01,2574.93,
REDUCTION OF PROCIDENTIA,45900,CPT,,30045900,CDM,450,RC,,,both,,,1963,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1334.84,68,,1334.84,percent of total billed charges,All Other,2000,,,2000,Other,186% of Medicaid,1570.4,80,,1570.4,percent of total billed charges,All Other,1629.29,,,1629.29,Other,Non Covered Service,1629.29,,,,Other,Non Covered Service,1570.4,80,,1570.4,percent of total billed charges,All Other,1629.29,,,1629.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1374.1,70,,1374.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1645.02,,,1645.02,Other,153% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1505.24,,,1505.24,Other,140% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,2795.45,,,2795.45,Other,250% of Medicaid,3483.57,,,3483.57,Other,324% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,1343.97,,,1343.97,Other,125% of Medicaid,0.01,3483.57,
REMOVE FECAL IMPACTION OR FB,45915,CPT,,30045915,CDM,450,RC,,,both,,,5394,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3667.92,68,,3667.92,percent of total billed charges,All Other,2000,,,2000,Other,186% of Medicaid,4315.2,80,,4315.2,percent of total billed charges,All Other,4477.02,,,4477.02,Other,Non Covered Service,4477.02,,,,Other,Non Covered Service,4315.2,80,,4315.2,percent of total billed charges,All Other,4477.02,,,4477.02,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3775.8,70,,3775.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1645.02,,,1645.02,Other,153% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1505.24,,,1505.24,Other,140% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,2795.45,,,2795.45,Other,250% of Medicaid,3483.57,,,3483.57,Other,324% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,1343.97,,,1343.97,Other,125% of Medicaid,0.01,4477.02,
I AND D PERIRECTAL OR ISCHIA,46040,CPT,,30046040,CDM,450,RC,,,both,,,9261,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6297.48,68,,6297.48,percent of total billed charges,All Other,2000,,,2000,Other,186% of Medicaid,7408.8,80,,7408.8,percent of total billed charges,All Other,7686.63,,,7686.63,Other,Non Covered Service,7686.63,,,,Other,Non Covered Service,7408.8,80,,7408.8,percent of total billed charges,All Other,7686.63,,,7686.63,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,6482.7,70,,6482.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1645.02,,,1645.02,Other,153% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1505.24,,,1505.24,Other,140% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,2795.45,,,2795.45,Other,250% of Medicaid,3483.57,,,3483.57,Other,324% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,1343.97,,,1343.97,Other,125% of Medicaid,0.01,7686.63,
I AND D RECTAL ABSCESS,46045,CPT,,30046045,CDM,450,RC,,,both,,,8500,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5780,68,,5780,percent of total billed charges,All Other,2732,,,2732,Other,186% of Medicaid,6800,80,,6800,percent of total billed charges,All Other,7055,,,7055,Other,Non Covered Service,7055,,,,Other,Non Covered Service,6800,80,,6800,percent of total billed charges,All Other,7055,,,7055,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5950,70,,5950,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1469.05,,,1469.05,Other,100% of Medicaid,1469.05,,,1469.05,Other,100% of Medicaid,1469.05,,,1469.05,Other,100% of Medicaid,1469.05,,,1469.05,Other,100% of Medicaid,3305.35,,,3305.35,Other,225% of Medicaid,2247.64,,,2247.64,Other,153% of Medicaid,3305.35,,,3305.35,Other,225% of Medicaid,2056.66,,,2056.66,Other,140% of Medicaid,3305.35,,,3305.35,Other,225% of Medicaid,3819.52,,,3819.52,Other,250% of Medicaid,4759.71,,,4759.71,Other,324% of Medicaid,3158.45,,,3158.45,Other,215% of Medicaid,3158.45,,,3158.45,Other,215% of Medicaid,1836.31,,,1836.31,Other,125% of Medicaid,0.01,7055,
I AND D PERIANAL ABSCESS,46050,CPT,,30046050,CDM,450,RC,,,both,,,5731,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3897.08,68,,3897.08,percent of total billed charges,All Other,2000,,,2000,Other,186% of Medicaid,4584.8,80,,4584.8,percent of total billed charges,All Other,4756.73,,,4756.73,Other,Non Covered Service,4756.73,,,,Other,Non Covered Service,4584.8,80,,4584.8,percent of total billed charges,All Other,4756.73,,,4756.73,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4011.7,70,,4011.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1645.02,,,1645.02,Other,153% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1505.24,,,1505.24,Other,140% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,2795.45,,,2795.45,Other,250% of Medicaid,3483.57,,,3483.57,Other,324% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,1343.97,,,1343.97,Other,125% of Medicaid,0.01,4756.73,
I AND D THROMB HEMORRHOID EXT,46083,CPT,,30046083,CDM,450,RC,,,both,,,1378,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,937.04,68,,937.04,percent of total billed charges,All Other,2000,,,2000,Other,186% of Medicaid,1102.4,80,,1102.4,percent of total billed charges,All Other,1143.74,,,1143.74,Other,Non Covered Service,1143.74,,,,Other,Non Covered Service,1102.4,80,,1102.4,percent of total billed charges,All Other,1143.74,,,1143.74,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,964.6,70,,964.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1645.02,,,1645.02,Other,153% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1505.24,,,1505.24,Other,140% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,2795.45,,,2795.45,Other,250% of Medicaid,3483.57,,,3483.57,Other,324% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,1343.97,,,1343.97,Other,125% of Medicaid,0.01,3483.57,
REMOVE ANAL FIST SUBQ,46270,CPT,,30046270,CDM,450,RC,,,both,,,7901,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2732,,,2732,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5530.7,70,,5530.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1469.05,,,1469.05,Other,100% of Medicaid,1469.05,,,1469.05,Other,100% of Medicaid,1469.05,,,1469.05,Other,100% of Medicaid,1469.05,,,1469.05,Other,100% of Medicaid,3305.35,,,3305.35,Other,225% of Medicaid,2247.64,,,2247.64,Other,153% of Medicaid,3305.35,,,3305.35,Other,225% of Medicaid,2056.66,,,2056.66,Other,140% of Medicaid,3305.35,,,3305.35,Other,225% of Medicaid,3819.52,,,3819.52,Other,250% of Medicaid,4759.71,,,4759.71,Other,324% of Medicaid,3158.45,,,3158.45,Other,215% of Medicaid,3158.45,,,3158.45,Other,215% of Medicaid,1836.31,,,1836.31,Other,125% of Medicaid,0.01,5530.7,
REMOVAL OF HEMORRHOID CLOT,46320,CPT,,30046320,CDM,450,RC,,,both,,,5391,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2000,,,2000,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3773.7,70,,3773.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,1075.17,,,1075.17,Other,100% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1645.02,,,1645.02,Other,153% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,1505.24,,,1505.24,Other,140% of Medicaid,2419.14,,,2419.14,Other,225% of Medicaid,2795.45,,,2795.45,Other,250% of Medicaid,3483.57,,,3483.57,Other,324% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,2311.63,,,2311.63,Other,215% of Medicaid,1343.97,,,1343.97,Other,125% of Medicaid,0.01,3773.7,
DIAGNOSTIC ANOSCOPY,46600,CPT,,30046600,CDM,450,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,178.84,68,,178.84,percent of total billed charges,All Other,1030,,,1030,Other,186% of Medicaid,210.4,80,,210.4,percent of total billed charges,All Other,218.29,,,218.29,Other,Non Covered Service,218.29,,,,Other,Non Covered Service,210.4,80,,210.4,percent of total billed charges,All Other,218.29,,,218.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.1,70,,184.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,0.01,1794.25,
REMOVE FOREIGN BODY RECTUMQ,46608,CPT,,30046608,CDM,450,RC,,,both,,,3099,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1478,,,1478,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2169.3,70,,2169.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,794.73,,,794.73,Other,100% of Medicaid,794.73,,,794.73,Other,100% of Medicaid,794.73,,,794.73,Other,100% of Medicaid,794.73,,,794.73,Other,100% of Medicaid,1788.15,,,1788.15,Other,225% of Medicaid,1215.94,,,1215.94,Other,153% of Medicaid,1788.15,,,1788.15,Other,225% of Medicaid,1112.63,,,1112.63,Other,140% of Medicaid,1788.15,,,1788.15,Other,225% of Medicaid,2066.3,,,2066.3,Other,250% of Medicaid,2574.93,,,2574.93,Other,324% of Medicaid,1708.67,,,1708.67,Other,215% of Medicaid,1708.67,,,1708.67,Other,215% of Medicaid,993.42,,,993.42,Other,125% of Medicaid,0.01,2574.93,
ABD PARACENTESIS,49082,CPT,,30049082,CDM,450,RC,,,both,,,1860,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1264.8,68,,1264.8,percent of total billed charges,All Other,1196,,,1196,Other,186% of Medicaid,1488,80,,1488,percent of total billed charges,All Other,1543.8,,,1543.8,Other,Non Covered Service,1543.8,,,,Other,Non Covered Service,1488,80,,1488,percent of total billed charges,All Other,1543.8,,,1543.8,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1302,70,,1302,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,0.01,2083.89,
ABD PARACENTESIS W/IMAGING,49083,CPT,,30049083,CDM,450,RC,,,both,,,1893,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1287.24,68,,1287.24,percent of total billed charges,All Other,1196,,,1196,Other,186% of Medicaid,1514.4,80,,1514.4,percent of total billed charges,All Other,1571.19,,,1571.19,Other,Non Covered Service,1571.19,,,,Other,Non Covered Service,1514.4,80,,1514.4,percent of total billed charges,All Other,1571.19,,,1571.19,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1325.1,70,,1325.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,0.01,2083.89,
REPLACE DUOD JEJ TUBE PERC,49451,CPT,,30049451,CDM,450,RC,,,both,,,4863,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3306.84,68,,3306.84,percent of total billed charges,All Other,784,,,784,Other,186% of Medicaid,3890.4,80,,3890.4,percent of total billed charges,All Other,4036.29,,,4036.29,Other,Non Covered Service,4036.29,,,,Other,Non Covered Service,3890.4,80,,3890.4,percent of total billed charges,All Other,4036.29,,,4036.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3404.1,70,,3404.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,645.06,,,645.06,Other,153% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,590.25,,,590.25,Other,140% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,1096.18,,,1096.18,Other,250% of Medicaid,1366.01,,,1366.01,Other,324% of Medicaid,906.45,,,906.45,Other,215% of Medicaid,906.45,,,906.45,Other,215% of Medicaid,527.01,,,527.01,Other,125% of Medicaid,0.01,4036.29,
PRP I HERN INIT REDUC > 5,49505,CPT,,30049505,CDM,450,RC,,,both,,,10788,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3639,,,3639,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,7551.6,70,,7551.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1956.45,,,1956.45,Other,100% of Medicaid,1956.45,,,1956.45,Other,100% of Medicaid,1956.45,,,1956.45,Other,100% of Medicaid,1956.45,,,1956.45,Other,100% of Medicaid,4402.01,,,4402.01,Other,225% of Medicaid,2993.37,,,2993.37,Other,153% of Medicaid,4402.01,,,4402.01,Other,225% of Medicaid,2739.03,,,2739.03,Other,140% of Medicaid,4402.01,,,4402.01,Other,225% of Medicaid,5086.77,,,5086.77,Other,250% of Medicaid,6338.9,,,6338.9,Other,324% of Medicaid,4206.37,,,4206.37,Other,215% of Medicaid,4206.37,,,4206.37,Other,215% of Medicaid,2445.56,,,2445.56,Other,125% of Medicaid,0.01,7551.6,
ASPIR BLADDER SUPRAPUB CA,51102,CPT,,30051102,CDM,450,RC,,,both,,,6552,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2501,,,2501,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4586.4,70,,4586.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1344.88,,,1344.88,Other,100% of Medicaid,1344.88,,,1344.88,Other,100% of Medicaid,1344.88,,,1344.88,Other,100% of Medicaid,1344.88,,,1344.88,Other,100% of Medicaid,3025.99,,,3025.99,Other,225% of Medicaid,2057.67,,,2057.67,Other,153% of Medicaid,3025.99,,,3025.99,Other,225% of Medicaid,1882.84,,,1882.84,Other,140% of Medicaid,3025.99,,,3025.99,Other,225% of Medicaid,3496.7,,,3496.7,Other,250% of Medicaid,4357.42,,,4357.42,Other,324% of Medicaid,2891.5,,,2891.5,Other,215% of Medicaid,2891.5,,,2891.5,Other,215% of Medicaid,1681.1,,,1681.1,Other,125% of Medicaid,0.01,4586.4,
IRRIGATION OF BLADDER,51700,CPT,,30051700,CDM,450,RC,,,both,,,776,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,527.68,68,,527.68,percent of total billed charges,All Other,847,,,847,Other,186% of Medicaid,620.8,80,,620.8,percent of total billed charges,All Other,644.08,,,644.08,Other,Non Covered Service,644.08,,,,Other,Non Covered Service,620.8,80,,620.8,percent of total billed charges,All Other,644.08,,,644.08,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,543.2,70,,543.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,697.11,,,697.11,Other,153% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,637.88,,,637.88,Other,140% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,1184.63,,,1184.63,Other,250% of Medicaid,1476.23,,,1476.23,Other,324% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,569.53,,,569.53,Other,125% of Medicaid,0.01,1476.23,
INSERT STRAIGHT CATHETER,51701,CPT,,30051701,CDM,450,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,178.84,68,,178.84,percent of total billed charges,All Other,614,,,614,Other,186% of Medicaid,210.4,80,,210.4,percent of total billed charges,All Other,218.29,,,218.29,Other,Non Covered Service,218.29,,,,Other,Non Covered Service,210.4,80,,210.4,percent of total billed charges,All Other,218.29,,,218.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.1,70,,184.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,0.01,1070.21,
INSERT FOLEY CATH SIMPLE,51702,CPT,,30051702,CDM,450,RC,,,both,,,271,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.28,68,,184.28,percent of total billed charges,All Other,614,,,614,Other,186% of Medicaid,216.8,80,,216.8,percent of total billed charges,All Other,224.93,,,224.93,Other,Non Covered Service,224.93,,,,Other,Non Covered Service,216.8,80,,216.8,percent of total billed charges,All Other,224.93,,,224.93,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.7,70,,189.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,0.01,1070.21,
INSERT FOLEY CATH SIMPLE,51702,CPT,59,30151702,CDM,450,RC,,,both,,,271,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.28,68,,184.28,percent of total billed charges,All Other,614,,,614,Other,186% of Medicaid,216.8,80,,216.8,percent of total billed charges,All Other,224.93,,,224.93,Other,Non Covered Service,224.93,,,,Other,Non Covered Service,216.8,80,,216.8,percent of total billed charges,All Other,224.93,,,224.93,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.7,70,,189.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,0.01,1070.21,
INSERT FOLEY CATH SIMPLE,51702,CPT,XU,30251702,CDM,450,RC,,,both,,,271,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.28,68,,184.28,percent of total billed charges,All Other,614,,,614,Other,186% of Medicaid,216.8,80,,216.8,percent of total billed charges,All Other,224.93,,,224.93,Other,Non Covered Service,224.93,,,,Other,Non Covered Service,216.8,80,,216.8,percent of total billed charges,All Other,224.93,,,224.93,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.7,70,,189.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,0.01,1070.21,
INSERT BLADDER CATH COMPL,51703,CPT,,30051703,CDM,450,RC,,,both,,,424,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,288.32,68,,288.32,percent of total billed charges,All Other,847,,,847,Other,186% of Medicaid,339.2,80,,339.2,percent of total billed charges,All Other,351.92,,,351.92,Other,Non Covered Service,351.92,,,,Other,Non Covered Service,339.2,80,,339.2,percent of total billed charges,All Other,351.92,,,351.92,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,296.8,70,,296.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,697.11,,,697.11,Other,153% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,637.88,,,637.88,Other,140% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,1184.63,,,1184.63,Other,250% of Medicaid,1476.23,,,1476.23,Other,324% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,569.53,,,569.53,Other,125% of Medicaid,0.01,1476.23,
CYSTOSTOMY TUBE CHANGE,51705,CPT,,30051705,CDM,450,RC,,,both,,,776,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,527.68,68,,527.68,percent of total billed charges,All Other,614,,,614,Other,186% of Medicaid,620.8,80,,620.8,percent of total billed charges,All Other,644.08,,,644.08,Other,Non Covered Service,644.08,,,,Other,Non Covered Service,620.8,80,,620.8,percent of total billed charges,All Other,644.08,,,644.08,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,543.2,70,,543.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,0.01,1070.21,
CHANGE OF CYSTOSTOMY TUBE COMPLICATED,51710,CPT,,30051710,CDM,450,RC,,,both,,,1932,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,666,,,666,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1352.4,70,,1352.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,358.13,,,358.13,Other,100% of Medicaid,358.13,,,358.13,Other,100% of Medicaid,358.13,,,358.13,Other,100% of Medicaid,358.13,,,358.13,Other,100% of Medicaid,805.79,,,805.79,Other,225% of Medicaid,547.94,,,547.94,Other,153% of Medicaid,805.79,,,805.79,Other,225% of Medicaid,501.38,,,501.38,Other,140% of Medicaid,805.79,,,805.79,Other,225% of Medicaid,931.14,,,931.14,Other,250% of Medicaid,1160.34,,,1160.34,Other,324% of Medicaid,769.98,,,769.98,Other,215% of Medicaid,769.98,,,769.98,Other,215% of Medicaid,447.66,,,447.66,Other,125% of Medicaid,0.01,1352.4,
US PV RESIDUAL URINE,51798,CPT,,30051798,CDM,450,RC,,,both,,,258,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,175.44,68,,175.44,percent of total billed charges,All Other,614,,,614,Other,186% of Medicaid,206.4,80,,206.4,percent of total billed charges,All Other,214.14,,,214.14,Other,Non Covered Service,214.14,,,,Other,Non Covered Service,206.4,80,,206.4,percent of total billed charges,All Other,214.14,,,214.14,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,180.6,70,,180.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,0.01,1070.21,
CYSTOURETHROSCOPY,52281,CPT,,30052281,CDM,450,RC,,,both,,,5732,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2501,,,2501,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4012.4,70,,4012.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1344.88,,,1344.88,Other,100% of Medicaid,1344.88,,,1344.88,Other,100% of Medicaid,1344.88,,,1344.88,Other,100% of Medicaid,1344.88,,,1344.88,Other,100% of Medicaid,3025.99,,,3025.99,Other,225% of Medicaid,2057.67,,,2057.67,Other,153% of Medicaid,3025.99,,,3025.99,Other,225% of Medicaid,1882.84,,,1882.84,Other,140% of Medicaid,3025.99,,,3025.99,Other,225% of Medicaid,3496.7,,,3496.7,Other,250% of Medicaid,4357.42,,,4357.42,Other,324% of Medicaid,2891.5,,,2891.5,Other,215% of Medicaid,2891.5,,,2891.5,Other,215% of Medicaid,1681.1,,,1681.1,Other,125% of Medicaid,0.01,4357.42,
DILATE URETHRA STRICTURE,53600,CPT,,30053600,CDM,450,RC,,,both,,,675,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,459,68,,459,percent of total billed charges,All Other,847,,,847,Other,186% of Medicaid,540,80,,540,percent of total billed charges,All Other,560.25,,,560.25,Other,Non Covered Service,560.25,,,,Other,Non Covered Service,540,80,,540,percent of total billed charges,All Other,560.25,,,560.25,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,472.5,70,,472.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,697.11,,,697.11,Other,153% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,637.88,,,637.88,Other,140% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,1184.63,,,1184.63,Other,250% of Medicaid,1476.23,,,1476.23,Other,324% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,569.53,,,569.53,Other,125% of Medicaid,0.01,1476.23,
IRRIGATE CORPORA CAVERNOSA FOR PRIAPISM,54220,CPT,,30054220,CDM,450,RC,,,both,,,658,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,447.44,68,,447.44,percent of total billed charges,All Other,847,,,847,Other,186% of Medicaid,526.4,80,,526.4,percent of total billed charges,All Other,546.14,,,546.14,Other,Non Covered Service,546.14,,,,Other,Non Covered Service,526.4,80,,526.4,percent of total billed charges,All Other,546.14,,,546.14,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,460.6,70,,460.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,697.11,,,697.11,Other,153% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,637.88,,,637.88,Other,140% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,1184.63,,,1184.63,Other,250% of Medicaid,1476.23,,,1476.23,Other,324% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,569.53,,,569.53,Other,125% of Medicaid,0.01,1476.23,
INJ CORPORA CAVERNOSA W P,54235,CPT,,30054235,CDM,450,RC,,,both,,,1143,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,777.24,68,,777.24,percent of total billed charges,All Other,847,,,847,Other,186% of Medicaid,914.4,80,,914.4,percent of total billed charges,All Other,948.69,,,948.69,Other,Non Covered Service,948.69,,,,Other,Non Covered Service,914.4,80,,914.4,percent of total billed charges,All Other,948.69,,,948.69,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,800.1,70,,800.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,697.11,,,697.11,Other,153% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,637.88,,,637.88,Other,140% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,1184.63,,,1184.63,Other,250% of Medicaid,1476.23,,,1476.23,Other,324% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,569.53,,,569.53,Other,125% of Medicaid,0.01,1476.23,
FORESKIN MANIPULATION,54450,CPT,,30054450,CDM,450,RC,,,both,,,881,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,599.08,68,,599.08,percent of total billed charges,All Other,903,,,903,Other,186% of Medicaid,704.8,80,,704.8,percent of total billed charges,All Other,731.23,,,731.23,Other,Non Covered Service,731.23,,,,Other,Non Covered Service,704.8,80,,704.8,percent of total billed charges,All Other,731.23,,,731.23,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,616.7,70,,616.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,742.87,,,742.87,Other,153% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,679.75,,,679.75,Other,140% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,1262.39,,,1262.39,Other,250% of Medicaid,1573.13,,,1573.13,Other,324% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,606.92,,,606.92,Other,125% of Medicaid,0.01,1573.13,
I & D EPIDIDYMIS TESTIS/SCROTA,54700,CPT,,30054700,CDM,450,RC,,,both,,,6949,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2347,,,2347,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4864.3,70,,4864.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1261.72,,,1261.72,Other,100% of Medicaid,1261.72,,,1261.72,Other,100% of Medicaid,1261.72,,,1261.72,Other,100% of Medicaid,1261.72,,,1261.72,Other,100% of Medicaid,2838.87,,,2838.87,Other,225% of Medicaid,1930.43,,,1930.43,Other,153% of Medicaid,2838.87,,,2838.87,Other,225% of Medicaid,1766.41,,,1766.41,Other,140% of Medicaid,2838.87,,,2838.87,Other,225% of Medicaid,3280.47,,,3280.47,Other,250% of Medicaid,4087.98,,,4087.98,Other,324% of Medicaid,2712.7,,,2712.7,Other,215% of Medicaid,2712.7,,,2712.7,Other,215% of Medicaid,1577.15,,,1577.15,Other,125% of Medicaid,0.01,4864.3,
DRAINAGE OF SCROTAL WALL,55100,CPT,,30055100,CDM,450,RC,,,both,,,4543,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3089.24,68,,3089.24,percent of total billed charges,All Other,2347,,,2347,Other,186% of Medicaid,3634.4,80,,3634.4,percent of total billed charges,All Other,3770.69,,,3770.69,Other,Non Covered Service,3770.69,,,,Other,Non Covered Service,3634.4,80,,3634.4,percent of total billed charges,All Other,3770.69,,,3770.69,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3180.1,70,,3180.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1261.72,,,1261.72,Other,100% of Medicaid,1261.72,,,1261.72,Other,100% of Medicaid,1261.72,,,1261.72,Other,100% of Medicaid,1261.72,,,1261.72,Other,100% of Medicaid,2838.87,,,2838.87,Other,225% of Medicaid,1930.43,,,1930.43,Other,153% of Medicaid,2838.87,,,2838.87,Other,225% of Medicaid,1766.41,,,1766.41,Other,140% of Medicaid,2838.87,,,2838.87,Other,225% of Medicaid,3280.47,,,3280.47,Other,250% of Medicaid,4087.98,,,4087.98,Other,324% of Medicaid,2712.7,,,2712.7,Other,215% of Medicaid,2712.7,,,2712.7,Other,215% of Medicaid,1577.15,,,1577.15,Other,125% of Medicaid,0.01,4087.98,
I AND D OF VULVA OR PERINEA,56405,CPT,,30056405,CDM,450,RC,,,both,,,659,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,448.12,68,,448.12,percent of total billed charges,All Other,445,,,445,Other,186% of Medicaid,527.2,80,,527.2,percent of total billed charges,All Other,546.97,,,546.97,Other,Non Covered Service,546.97,,,,Other,Non Covered Service,527.2,80,,527.2,percent of total billed charges,All Other,546.97,,,546.97,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,461.3,70,,461.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,239.18,,,239.18,Other,100% of Medicaid,239.18,,,239.18,Other,100% of Medicaid,239.18,,,239.18,Other,100% of Medicaid,239.18,,,239.18,Other,100% of Medicaid,538.15,,,538.15,Other,225% of Medicaid,365.94,,,365.94,Other,153% of Medicaid,538.15,,,538.15,Other,225% of Medicaid,334.85,,,334.85,Other,140% of Medicaid,538.15,,,538.15,Other,225% of Medicaid,621.86,,,621.86,Other,250% of Medicaid,774.93,,,774.93,Other,324% of Medicaid,514.23,,,514.23,Other,215% of Medicaid,514.23,,,514.23,Other,215% of Medicaid,298.97,,,298.97,Other,125% of Medicaid,0.01,774.93,
I AND D BARTHOLIN GLAND ABSCE,56420,CPT,,30056420,CDM,450,RC,,,both,,,623,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,423.64,68,,423.64,percent of total billed charges,All Other,445,,,445,Other,186% of Medicaid,498.4,80,,498.4,percent of total billed charges,All Other,517.09,,,517.09,Other,Non Covered Service,517.09,,,,Other,Non Covered Service,498.4,80,,498.4,percent of total billed charges,All Other,517.09,,,517.09,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,436.1,70,,436.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,239.18,,,239.18,Other,100% of Medicaid,239.18,,,239.18,Other,100% of Medicaid,239.18,,,239.18,Other,100% of Medicaid,239.18,,,239.18,Other,100% of Medicaid,538.15,,,538.15,Other,225% of Medicaid,365.94,,,365.94,Other,153% of Medicaid,538.15,,,538.15,Other,225% of Medicaid,334.85,,,334.85,Other,140% of Medicaid,538.15,,,538.15,Other,225% of Medicaid,621.86,,,621.86,Other,250% of Medicaid,774.93,,,774.93,Other,324% of Medicaid,514.23,,,514.23,Other,215% of Medicaid,514.23,,,514.23,Other,215% of Medicaid,298.97,,,298.97,Other,125% of Medicaid,0.01,774.93,
EXCISE BARTHOLIN'S GLAND OR CY,56740,CPT,,30056740,CDM,450,RC,,,both,,,6383,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2339,,,2339,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4468.1,70,,4468.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1257.31,,,1257.31,Other,100% of Medicaid,1257.31,,,1257.31,Other,100% of Medicaid,1257.31,,,1257.31,Other,100% of Medicaid,1257.31,,,1257.31,Other,100% of Medicaid,2828.94,,,2828.94,Other,225% of Medicaid,1923.68,,,1923.68,Other,153% of Medicaid,2828.94,,,2828.94,Other,225% of Medicaid,1760.23,,,1760.23,Other,140% of Medicaid,2828.94,,,2828.94,Other,225% of Medicaid,3268.99,,,3268.99,Other,250% of Medicaid,4073.67,,,4073.67,Other,324% of Medicaid,2703.21,,,2703.21,Other,215% of Medicaid,2703.21,,,2703.21,Other,215% of Medicaid,1571.63,,,1571.63,Other,125% of Medicaid,0.01,5649.37,
INS PACK FOR NON-OB VAG HEMORRHAGE,57180,CPT,,30057180,CDM,450,RC,,,both,,,554,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,376.72,68,,376.72,percent of total billed charges,All Other,1132,,,1132,Other,186% of Medicaid,443.2,80,,443.2,percent of total billed charges,All Other,459.82,,,459.82,Other,Non Covered Service,459.82,,,,Other,Non Covered Service,443.2,80,,443.2,percent of total billed charges,All Other,459.82,,,459.82,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,387.8,70,,387.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,608.53,,,608.53,Other,100% of Medicaid,608.53,,,608.53,Other,100% of Medicaid,608.53,,,608.53,Other,100% of Medicaid,608.53,,,608.53,Other,100% of Medicaid,1369.18,,,1369.18,Other,225% of Medicaid,931.04,,,931.04,Other,153% of Medicaid,1369.18,,,1369.18,Other,225% of Medicaid,851.94,,,851.94,Other,140% of Medicaid,1369.18,,,1369.18,Other,225% of Medicaid,1582.17,,,1582.17,Other,250% of Medicaid,1971.62,,,1971.62,Other,324% of Medicaid,1308.33,,,1308.33,Other,215% of Medicaid,1308.33,,,1308.33,Other,215% of Medicaid,760.66,,,760.66,Other,125% of Medicaid,0.01,1971.62,
REMOVE IUD,58301,CPT,,30058301,CDM,450,RC,,,both,,,659,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,448.12,68,,448.12,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,527.2,80,,527.2,percent of total billed charges,All Other,546.97,,,546.97,Other,Non Covered Service,546.97,,,,Other,Non Covered Service,527.2,80,,527.2,percent of total billed charges,All Other,546.97,,,546.97,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,461.3,70,,461.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,128.99,,,128.99,Other,100% of Medicaid,128.99,,,128.99,Other,100% of Medicaid,128.99,,,128.99,Other,100% of Medicaid,128.99,,,128.99,Other,100% of Medicaid,290.23,,,290.23,Other,225% of Medicaid,197.36,,,197.36,Other,153% of Medicaid,290.23,,,290.23,Other,225% of Medicaid,180.59,,,180.59,Other,140% of Medicaid,290.23,,,290.23,Other,225% of Medicaid,335.38,,,335.38,Other,250% of Medicaid,417.94,,,417.94,Other,324% of Medicaid,277.33,,,277.33,Other,215% of Medicaid,277.33,,,277.33,Other,215% of Medicaid,161.24,,,161.24,Other,125% of Medicaid,0.01,579.7,
REMOVE FOREIGN BOBY VAGINA,58999,CPT,,30058999,CDM,450,RC,,,both,,,402,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,879,,,879,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,281.4,70,,281.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,472.52,,,472.52,Other,100% of Medicaid,472.52,,,472.52,Other,100% of Medicaid,472.52,,,472.52,Other,100% of Medicaid,472.52,,,472.52,Other,100% of Medicaid,1063.18,,,1063.18,Other,225% of Medicaid,722.96,,,722.96,Other,153% of Medicaid,1063.18,,,1063.18,Other,225% of Medicaid,661.53,,,661.53,Other,140% of Medicaid,1063.18,,,1063.18,Other,225% of Medicaid,1228.56,,,1228.56,Other,250% of Medicaid,1530.98,,,1530.98,Other,324% of Medicaid,1015.93,,,1015.93,Other,215% of Medicaid,1015.93,,,1015.93,Other,215% of Medicaid,590.65,,,590.65,Other,125% of Medicaid,0.01,1530.98,
EPISIOTOMY OR VAGINAL REPAIR,59300,CPT,,30059300,CDM,450,RC,,,both,,,6366,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1595,,,1595,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4456.2,70,,4456.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,857.63,,,857.63,Other,100% of Medicaid,857.63,,,857.63,Other,100% of Medicaid,857.63,,,857.63,Other,100% of Medicaid,857.63,,,857.63,Other,100% of Medicaid,1929.68,,,1929.68,Other,225% of Medicaid,1312.18,,,1312.18,Other,153% of Medicaid,1929.68,,,1929.68,Other,225% of Medicaid,1200.69,,,1200.69,Other,140% of Medicaid,1929.68,,,1929.68,Other,225% of Medicaid,2229.85,,,2229.85,Other,250% of Medicaid,2778.74,,,2778.74,Other,324% of Medicaid,1843.91,,,1843.91,Other,215% of Medicaid,1843.91,,,1843.91,Other,215% of Medicaid,1072.04,,,1072.04,Other,125% of Medicaid,0.01,5649.37,
VAGINAL DELIVERY,59409,CPT,,30059409,CDM,450,RC,,,both,,,7217,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3499,,,3499,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5051.9,70,,5051.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1881.45,,,1881.45,Other,100% of Medicaid,1881.45,,,1881.45,Other,100% of Medicaid,1881.45,,,1881.45,Other,100% of Medicaid,1881.45,,,1881.45,Other,100% of Medicaid,4233.26,,,4233.26,Other,225% of Medicaid,2878.61,,,2878.61,Other,153% of Medicaid,4233.26,,,4233.26,Other,225% of Medicaid,2634.03,,,2634.03,Other,140% of Medicaid,4233.26,,,4233.26,Other,225% of Medicaid,4891.76,,,4891.76,Other,250% of Medicaid,6095.89,,,6095.89,Other,324% of Medicaid,4045.11,,,4045.11,Other,215% of Medicaid,4045.11,,,4045.11,Other,215% of Medicaid,2351.81,,,2351.81,Other,125% of Medicaid,0.01,6095.89,
DELIVERY OF PLACENTA,59414,CPT,,30059414,CDM,450,RC,,,both,,,6744,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1902,,,1902,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4720.8,70,,4720.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1022.58,,,1022.58,Other,100% of Medicaid,1022.58,,,1022.58,Other,100% of Medicaid,1022.58,,,1022.58,Other,100% of Medicaid,1022.58,,,1022.58,Other,100% of Medicaid,2300.8,,,2300.8,Other,225% of Medicaid,1564.54,,,1564.54,Other,153% of Medicaid,2300.8,,,2300.8,Other,225% of Medicaid,1431.61,,,1431.61,Other,140% of Medicaid,2300.8,,,2300.8,Other,225% of Medicaid,2658.7,,,2658.7,Other,250% of Medicaid,3313.15,,,3313.15,Other,324% of Medicaid,2198.54,,,2198.54,Other,215% of Medicaid,2198.54,,,2198.54,Other,215% of Medicaid,1278.22,,,1278.22,Other,125% of Medicaid,0.01,5649.37,
SURG TX INCOMPL ABORTION,59812,CPT,,30059812,CDM,450,RC,,,both,,,7311,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1456,,,1456,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5117.7,70,,5117.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,782.57,,,782.57,Other,100% of Medicaid,782.57,,,782.57,Other,100% of Medicaid,782.57,,,782.57,Other,100% of Medicaid,782.57,,,782.57,Other,100% of Medicaid,1760.79,,,1760.79,Other,225% of Medicaid,1197.34,,,1197.34,Other,153% of Medicaid,1760.79,,,1760.79,Other,225% of Medicaid,1095.6,,,1095.6,Other,140% of Medicaid,1760.79,,,1760.79,Other,225% of Medicaid,2034.69,,,2034.69,Other,250% of Medicaid,2535.54,,,2535.54,Other,324% of Medicaid,1682.53,,,1682.53,Other,215% of Medicaid,1682.53,,,1682.53,Other,215% of Medicaid,978.22,,,978.22,Other,125% of Medicaid,0.01,5649.37,
LUMBAR PUNCTURE,62270,CPT,,30062270,CDM,450,RC,,,both,,,1479,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1005.72,68,,1005.72,percent of total billed charges,All Other,1116,,,1116,Other,186% of Medicaid,1183.2,80,,1183.2,percent of total billed charges,All Other,1227.57,,,1227.57,Other,Non Covered Service,1227.57,,,,Other,Non Covered Service,1183.2,80,,1183.2,percent of total billed charges,All Other,1227.57,,,1227.57,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1035.3,70,,1035.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,1944.03,
INJECT EPIDURAL PATCH,62273,CPT,,30062273,CDM,450,RC,,,both,,,2701,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1836.68,68,,1836.68,percent of total billed charges,All Other,1116,,,1116,Other,186% of Medicaid,2160.8,80,,2160.8,percent of total billed charges,All Other,2241.83,,,2241.83,Other,Non Covered Service,2241.83,,,,Other,Non Covered Service,2160.8,80,,2160.8,percent of total billed charges,All Other,2241.83,,,2241.83,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1890.7,70,,1890.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,0.01,2241.83,
INJ ANESTH ; TRIGEMINAL NERVE,64400,CPT,,30064400,CDM,450,RC,,,both,,,963,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,654.84,68,,654.84,percent of total billed charges,All Other,966,,,966,Other,186% of Medicaid,770.4,80,,770.4,percent of total billed charges,All Other,799.29,,,799.29,Other,Non Covered Service,799.29,,,,Other,Non Covered Service,770.4,80,,770.4,percent of total billed charges,All Other,799.29,,,799.29,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,674.1,70,,674.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,794.43,,,794.43,Other,153% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,726.93,,,726.93,Other,140% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,1350.01,,,1350.01,Other,250% of Medicaid,1682.32,,,1682.32,Other,324% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,649.04,,,649.04,Other,125% of Medicaid,0.01,1682.32,
INJ ANES AGENT ILIOINGUIN,64425,CPT,,30064425,CDM,450,RC,,,both,,,1452,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,966,,,966,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1016.4,70,,1016.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,519.24,,,519.24,Other,100% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,794.43,,,794.43,Other,153% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,726.93,,,726.93,Other,140% of Medicaid,1168.28,,,1168.28,Other,225% of Medicaid,1350.01,,,1350.01,Other,250% of Medicaid,1682.32,,,1682.32,Other,324% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,1116.36,,,1116.36,Other,215% of Medicaid,649.04,,,649.04,Other,125% of Medicaid,0.01,1682.32,
INJECTION AA&/STRD FEMORAL NERVE,64447,CPT,,30064447,CDM,450,RC,,,both,,,2169,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1120,,,1120,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1518.3,70,,1518.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,601.89,,,601.89,Other,100% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,920.88,,,920.88,Other,153% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,842.64,,,842.64,Other,140% of Medicaid,1354.24,,,1354.24,Other,225% of Medicaid,1564.9,,,1564.9,Other,250% of Medicaid,1950.11,,,1950.11,Other,324% of Medicaid,1294.05,,,1294.05,Other,215% of Medicaid,1294.05,,,1294.05,Other,215% of Medicaid,752.36,,,752.36,Other,125% of Medicaid,0.01,1950.11,
INJ ANESTH OTHR PERIPHERA,64450,CPT,,30064450,CDM,450,RC,,,both,,,1479,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1005.72,68,,1005.72,percent of total billed charges,All Other,724,,,724,Other,186% of Medicaid,1183.2,80,,1183.2,percent of total billed charges,All Other,1227.57,,,1227.57,Other,Non Covered Service,1227.57,,,,Other,Non Covered Service,1183.2,80,,1183.2,percent of total billed charges,All Other,1227.57,,,1227.57,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1035.3,70,,1035.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,389.48,,,389.48,Other,100% of Medicaid,389.48,,,389.48,Other,100% of Medicaid,389.48,,,389.48,Other,100% of Medicaid,389.48,,,389.48,Other,100% of Medicaid,876.32,,,876.32,Other,225% of Medicaid,595.9,,,595.9,Other,153% of Medicaid,876.32,,,876.32,Other,225% of Medicaid,545.27,,,545.27,Other,140% of Medicaid,876.32,,,876.32,Other,225% of Medicaid,1012.64,,,1012.64,Other,250% of Medicaid,1261.9,,,1261.9,Other,324% of Medicaid,837.37,,,837.37,Other,215% of Medicaid,837.37,,,837.37,Other,215% of Medicaid,486.84,,,486.84,Other,125% of Medicaid,0.01,1261.9,
REMOVE FB EYE CONJUNCT SU,65205,CPT,,30065205,CDM,450,RC,,,both,,,318,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,216.24,68,,216.24,percent of total billed charges,All Other,352,,,352,Other,186% of Medicaid,254.4,80,,254.4,percent of total billed charges,All Other,263.94,,,263.94,Other,Non Covered Service,263.94,,,,Other,Non Covered Service,254.4,80,,254.4,percent of total billed charges,All Other,263.94,,,263.94,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,222.6,70,,222.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,289.14,,,289.14,Other,153% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,264.58,,,264.58,Other,140% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,491.35,,,491.35,Other,250% of Medicaid,612.3,,,612.3,Other,324% of Medicaid,406.31,,,406.31,Other,215% of Medicaid,406.31,,,406.31,Other,215% of Medicaid,236.23,,,236.23,Other,125% of Medicaid,0.01,612.3,
REMOVE FB EYE CONJUCT EMB,65210,CPT,,30065210,CDM,450,RC,,,both,,,851,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,578.68,68,,578.68,percent of total billed charges,All Other,352,,,352,Other,186% of Medicaid,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,706.33,,,,Other,Non Covered Service,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,595.7,70,,595.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,289.14,,,289.14,Other,153% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,264.58,,,264.58,Other,140% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,491.35,,,491.35,Other,250% of Medicaid,612.3,,,612.3,Other,324% of Medicaid,406.31,,,406.31,Other,215% of Medicaid,406.31,,,406.31,Other,215% of Medicaid,236.23,,,236.23,Other,125% of Medicaid,0.01,719.99,
REMOVE FB CORNEAL W O SLI,65220,CPT,,30065220,CDM,450,RC,,,both,,,851,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,578.68,68,,578.68,percent of total billed charges,All Other,352,,,352,Other,186% of Medicaid,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,706.33,,,,Other,Non Covered Service,680.8,80,,680.8,percent of total billed charges,All Other,706.33,,,706.33,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,595.7,70,,595.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,289.14,,,289.14,Other,153% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,264.58,,,264.58,Other,140% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,491.35,,,491.35,Other,250% of Medicaid,612.3,,,612.3,Other,324% of Medicaid,406.31,,,406.31,Other,215% of Medicaid,406.31,,,406.31,Other,215% of Medicaid,236.23,,,236.23,Other,125% of Medicaid,0.01,719.99,
REMOVE FB EYE CORNEAL W S,65222,CPT,,30065222,CDM,450,RC,,,both,,,371,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,252.28,68,,252.28,percent of total billed charges,All Other,352,,,352,Other,186% of Medicaid,296.8,80,,296.8,percent of total billed charges,All Other,307.93,,,307.93,Other,Non Covered Service,307.93,,,,Other,Non Covered Service,296.8,80,,296.8,percent of total billed charges,All Other,307.93,,,307.93,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,259.7,70,,259.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,188.98,,,188.98,Other,100% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,289.14,,,289.14,Other,153% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,264.58,,,264.58,Other,140% of Medicaid,425.21,,,425.21,Other,225% of Medicaid,491.35,,,491.35,Other,250% of Medicaid,612.3,,,612.3,Other,324% of Medicaid,406.31,,,406.31,Other,215% of Medicaid,406.31,,,406.31,Other,215% of Medicaid,236.23,,,236.23,Other,125% of Medicaid,0.01,612.3,
DRAINAGE EXT EAR SIMPLE,69000,CPT,,30069000,CDM,450,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,994.16,68,,994.16,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,1169.6,80,,1169.6,percent of total billed charges,All Other,1213.46,,,1213.46,Other,Non Covered Service,1213.46,,,,Other,Non Covered Service,1169.6,80,,1169.6,percent of total billed charges,All Other,1213.46,,,1213.46,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1023.4,70,,1023.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,1271.37,
DRAIN EXTERNAL EAR COMPLETE,69005,CPT,,30069005,CDM,450,RC,,,both,,,6590,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2256,,,2256,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4613,70,,4613,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,1213.03,,,1213.03,Other,100% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,1855.93,,,1855.93,Other,153% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,1698.24,,,1698.24,Other,140% of Medicaid,2729.31,,,2729.31,Other,225% of Medicaid,3153.87,,,3153.87,Other,250% of Medicaid,3930.21,,,3930.21,Other,324% of Medicaid,2608.01,,,2608.01,Other,215% of Medicaid,2608.01,,,2608.01,Other,215% of Medicaid,1516.29,,,1516.29,Other,125% of Medicaid,0.01,4613,
DRAIN EXT AUDITORY CANAL ABSC,69020,CPT,,30069020,CDM,450,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,994.16,68,,994.16,percent of total billed charges,All Other,423,,,423,Other,186% of Medicaid,1169.6,80,,1169.6,percent of total billed charges,All Other,1213.46,,,1213.46,Other,Non Covered Service,1213.46,,,,Other,Non Covered Service,1169.6,80,,1169.6,percent of total billed charges,All Other,1213.46,,,1213.46,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1023.4,70,,1023.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,227.27,,,227.27,Other,100% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,347.72,,,347.72,Other,153% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,318.18,,,318.18,Other,140% of Medicaid,511.36,,,511.36,Other,225% of Medicaid,590.9,,,590.9,Other,250% of Medicaid,736.35,,,736.35,Other,324% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,488.63,,,488.63,Other,215% of Medicaid,284.09,,,284.09,Other,125% of Medicaid,0.01,1271.37,
CLEAR OUTER EAR CANAL,69200,CPT,,30069200,CDM,450,RC,,,both,,,271,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,184.28,68,,184.28,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,216.8,80,,216.8,percent of total billed charges,All Other,224.93,,,224.93,Other,Non Covered Service,224.93,,,,Other,Non Covered Service,216.8,80,,216.8,percent of total billed charges,All Other,224.93,,,224.93,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,189.7,70,,189.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,230.83,
REMOVE IMPACTED EAR WAX UNI,69209,CPT,,30069209,CDM,450,RC,,,both,,,250,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,170,68,,170,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,200,80,,200,percent of total billed charges,All Other,207.5,,,207.5,Other,Non Covered Service,207.5,,,,Other,Non Covered Service,200,80,,200,percent of total billed charges,All Other,207.5,,,207.5,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,175,70,,175,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,207.5,
REMOVAL IMPACTED CERUMEN,69210,CPT,,30069210,CDM,450,RC,,,both,,,258,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,175.44,68,,175.44,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,206.4,80,,206.4,percent of total billed charges,All Other,214.14,,,214.14,Other,Non Covered Service,214.14,,,,Other,Non Covered Service,206.4,80,,206.4,percent of total billed charges,All Other,214.14,,,214.14,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,180.6,70,,180.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.14,
US EXAM OF HEAD AND NECK,76536,CPT,TC,30076536,CDM,450,RC,,,both,,,807,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,240,,,240,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,564.9,70,,564.9,percent of total billed charges,,419.84,,,419.84,Fee Schedule,,355.84,,,355.84,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,0.01,564.9,
US ABDOMEN LIMITED,76705,CPT,TC,30076705,CDM,450,RC,,,both,,,982,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,240,,,240,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,687.4,70,,687.4,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,0.01,687.4,
US RETROPERITONEAL LTD,76775,CPT,TC,30076775,CDM,450,RC,,,both,,,1339,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,240,,,240,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,937.3,70,,937.3,percent of total billed charges,,149.24,,,149.24,Fee Schedule,,126.49,,,126.49,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,0.01,937.3,
US OB LIMITED 1 OR > GEST,76815,CPT,TC,30076815,CDM,450,RC,,,both,,,443,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,209,,,209,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,310.1,70,,310.1,percent of total billed charges,,249.28,,,249.28,Fee Schedule,,211.28,,,211.28,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,0.01,364.84,
US PELVIS NON OB LIMITED,76857,CPT,TC,30076857,CDM,450,RC,,,both,,,580,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,240,,,240,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,406,70,,406,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,0.01,418.39,
US XTR NON-VASC LMTD,76882,CPT,TC,30076882,CDM,450,RC,,,both,,,275,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,240,,,240,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,192.5,70,,192.5,percent of total billed charges,,162.36,,,162.36,Fee Schedule,,137.61,,,137.61,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,0.01,418.39,
SKIN TEST; TB ID,86580,CPT,,30086580,CDM,450,RC,,,both,,,58,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,32,,,32,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,40.6,70,,40.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,56.14,
SKIN TEST; TB ID,86580,CPT,,82086580,CDM,450,RC,,,both,,,58,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,32,,,32,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,40.6,70,,40.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,17.33,,,17.33,Other,100% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,26.51,,,26.51,Other,153% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,24.26,,,24.26,Other,140% of Medicaid,38.99,,,38.99,Other,225% of Medicaid,45.05,,,45.05,Other,250% of Medicaid,56.14,,,56.14,Other,324% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,37.26,,,37.26,Other,215% of Medicaid,21.66,,,21.66,Other,125% of Medicaid,0.01,56.14,
EYE WASHING,92499,CPT,,30092499,CDM,450,RC,,,both,,,231,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,153,,,153,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,161.7,70,,161.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,82.31,,,82.31,Other,100% of Medicaid,82.31,,,82.31,Other,100% of Medicaid,82.31,,,82.31,Other,100% of Medicaid,82.31,,,82.31,Other,100% of Medicaid,185.19,,,185.19,Other,225% of Medicaid,125.93,,,125.93,Other,153% of Medicaid,185.19,,,185.19,Other,225% of Medicaid,115.23,,,115.23,Other,140% of Medicaid,185.19,,,185.19,Other,225% of Medicaid,214,,,214,Other,250% of Medicaid,266.67,,,266.67,Other,324% of Medicaid,176.96,,,176.96,Other,215% of Medicaid,176.96,,,176.96,Other,215% of Medicaid,102.88,,,102.88,Other,125% of Medicaid,0.01,266.67,
HEART LUNG RESUSCITATION CPR,92950,CPT,,30092950,CDM,450,RC,,,both,,,903,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,893,,,893,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,632.1,70,,632.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,734.95,,,734.95,Other,153% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,672.5,,,672.5,Other,140% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,1248.94,,,1248.94,Other,250% of Medicaid,1556.37,,,1556.37,Other,324% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,600.45,,,600.45,Other,125% of Medicaid,0.01,1556.37,
HEART LUNG RESUSCITATION CPR,92950,CPT,,82092950,CDM,450,RC,,,both,,,903,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,893,,,893,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,632.1,70,,632.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,734.95,,,734.95,Other,153% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,672.5,,,672.5,Other,140% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,1248.94,,,1248.94,Other,250% of Medicaid,1556.37,,,1556.37,Other,324% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,600.45,,,600.45,Other,125% of Medicaid,0.01,1556.37,
TEMPORARY EXTERNAL PACING,92953,CPT,,30092953,CDM,450,RC,,,both,,,1325,1176.05,,,1176.05,Other,150% of Medicare + 9.63% HCRA Surcharge,715.16,,,715.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,830,,,830,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,927.5,70,,927.5,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,682.58,,,682.58,Other,153% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,624.58,,,624.58,Other,140% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,1159.94,,,1159.94,Other,250% of Medicaid,1445.47,,,1445.47,Other,324% of Medicaid,959.18,,,959.18,Other,215% of Medicaid,959.18,,,959.18,Other,215% of Medicaid,557.66,,,557.66,Other,125% of Medicaid,0.01,1445.47,
CARDIOVERSION,92960,CPT,,30092960,CDM,450,RC,,,both,,,2056,1176.05,,,1176.05,Other,150% of Medicare + 9.63% HCRA Surcharge,715.16,,,715.16,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1398.08,68,,1398.08,percent of total billed charges,All Other,830,,,830,Other,186% of Medicaid,1644.8,80,,1644.8,percent of total billed charges,All Other,1706.48,,,1706.48,Other,Non Covered Service,1706.48,,,,Other,Non Covered Service,1644.8,80,,1644.8,percent of total billed charges,All Other,1706.48,,,1706.48,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1439.2,70,,1439.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,682.58,,,682.58,Other,153% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,624.58,,,624.58,Other,140% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,1159.94,,,1159.94,Other,250% of Medicaid,1445.47,,,1445.47,Other,324% of Medicaid,959.18,,,959.18,Other,215% of Medicaid,959.18,,,959.18,Other,215% of Medicaid,557.66,,,557.66,Other,125% of Medicaid,0.01,1706.48,
TTE F-UP OR LMTD,93308,CPT,TC,30093308,CDM,450,RC,,,both,,,993,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Fee Schedule,,511,,,511,Other,186% of Medicaid,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,794.4,80,,794.4,percent of total billed charges,All Other,695.1,70,,695.1,percent of total billed charges,,362.44,,,362.44,Fee Schedule,,307.19,,,307.19,Fee Schedule,,1000,,,1000,Case Rate,,900,,,900,Case Rate,,1000,,,1000,Case Rate,,851,,,851,Case Rate,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,1000,
SPIROMETRY VITAL CAPACITY,94010,CPT,,30094010,CDM,450,RC,,,both,,,671,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,127,,,127,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,469.7,70,,469.7,percent of total billed charges,,90.2,,,90.2,Fee Schedule,,76.45,,,76.45,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,667,
HYDRATION IV INFUSION INIT,96360,CPT,,30096360,CDM,450,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,326.2,70,,326.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
HYDRATION IV INFUSION INIT,96360,CPT,59,30196360,CDM,450,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,326.2,70,,326.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
HYDRATION IV INFUSION INIT,96360,CPT,XU,30296360,CDM,450,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,326.2,70,,326.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
HYDRATION IV INFUSION INIT,96360,CPT,XS,30396360,CDM,450,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,326.2,70,,326.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
IV HYDRATION EACH ADD ON,96361,CPT,,30096361,CDM,450,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1112,,,1112,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,0.01,1936.53,
IV HYDRATION EACH ADD ON,96361,CPT,59,30196361,CDM,450,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1112,,,1112,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,0.01,1936.53,
IV HYDRATION EACH ADD ON,96361,CPT,XU,30296361,CDM,450,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1112,,,1112,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,0.01,1936.53,
INFUSION THERAPY 1 HOUR,96365,CPT,,30096365,CDM,450,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,499.1,70,,499.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
INFUSION THERAPY 1 HOUR,96365,CPT,59,30196365,CDM,450,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,499.1,70,,499.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
INFUSION THERAPY 1 HOUR,96365,CPT,XU,30296365,CDM,450,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,499.1,70,,499.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
INFUSION THERAPY 1 HOUR,96365,CPT,XS,30396365,CDM,450,RC,,,both,,,713,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,499.1,70,,499.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
INFUSION THERAPY ADDL HR,96366,CPT,,30096366,CDM,450,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1112,,,1112,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,0.01,1936.53,
INFUSION THERAPY ADDL HR,96366,CPT,59,30196366,CDM,450,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1112,,,1112,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,0.01,1936.53,
INFUSION THERAPY ADDL HR,96366,CPT,XU,30296366,CDM,450,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1112,,,1112,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,0.01,1936.53,
TX/PROPH/DR ADDL SEQ IV I,96367,CPT,,30096367,CDM,450,RC,,,both,,,458,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,320.6,70,,320.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
TX/PROPH/DR ADDL SEQ IV I,96367,CPT,59,30196367,CDM,450,RC,,,both,,,458,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,320.6,70,,320.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
TX/PROPH/DR ADDL SEQ IV I,96367,CPT,XU,30296367,CDM,450,RC,,,both,,,458,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,320.6,70,,320.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
THER DIAG CONCURRENT INF,96368,CPT,,30096368,CDM,450,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
THER DIAG CONCURRENT INF,96368,CPT,59,30196368,CDM,450,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
THER DIAG CONCURRENT INF,96368,CPT,XU,30296368,CDM,450,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
SC THER INFUSION UP TO 1 HR,96369,CPT,,30096369,CDM,450,RC,,,both,,,611,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,427.7,70,,427.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
SC THER INFUSION ADDL HR,96370,CPT,,30096370,CDM,450,RC,,,both,,,192,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1112,,,1112,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,134.4,70,,134.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,0.01,1936.53,
SC THER INFUSION RESET PUMP,96371,CPT,,30096371,CDM,450,RC,,,both,,,153,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,425,,,425,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,107.1,70,,107.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,740.38,
THER/PROPH/DIAG INJ SC/IM,96372,CPT,,30096372,CDM,450,RC,,,both,,,460,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,322,
THER/PROPH/DIAG INJ SC/IM,96372,CPT,59,30196372,CDM,450,RC,,,both,,,460,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,322,
THER/PROPH/DIAG INJ SC/IM,96372,CPT,XU,30296372,CDM,450,RC,,,both,,,460,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,322,
INJECT ARTERIAL THERAPEUT,96373,CPT,,30096373,CDM,450,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,326.2,70,,326.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,387.31,
IV PUSH INITIAL,96374,CPT,,30096374,CDM,450,RC,,,both,,,483,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,338.1,70,,338.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,387.31,
IV PUSH INITIAL,96374,CPT,59,30196374,CDM,450,RC,,,both,,,483,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,338.1,70,,338.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,387.31,
IV PUSH INITIAL,96374,CPT,XU,30296374,CDM,450,RC,,,both,,,483,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,338.1,70,,338.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,387.31,
IV PUSH INITIAL,96374,CPT,XS,30396374,CDM,450,RC,,,both,,,483,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,338.1,70,,338.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,387.31,
TX/PRO/DX/ INJ NEW DRUG A,96375,CPT,,30096375,CDM,450,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,322,
TX/PRO/DX/ INJ NEW DRUG A,96375,CPT,59,30196375,CDM,450,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,322,
TX/PRO/DX/ INJ NEW DRUG A,96375,CPT,XU,30296375,CDM,450,RC,,,both,,,460,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,322,
TX/PRO/DX INJ SAME DRUG ADDON,96376,CPT,,30096376,CDM,450,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,322,
TX/PRO/DX INJ SAME DRUG ADDON,96376,CPT,59,30196376,CDM,450,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,322,
TX/PRO/DX INJ SAME DRUG ADDON,96376,CPT,XU,30296376,CDM,450,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,322,
IRRIG DRUG DELIVERY DEVICE,96523,CPT,,30096523,CDM,450,RC,,,both,,,243,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,72,,,72,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,170.1,70,,170.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,170.1,
DEBRIDEMENT SKIN PARTIAL,97597,CPT,,30097597,CDM,450,RC,,,both,,,573,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,389.64,68,,389.64,percent of total billed charges,All Other,717,,,717,Other,186% of Medicaid,458.4,80,,458.4,percent of total billed charges,All Other,475.59,,,475.59,Other,Non Covered Service,475.59,,,,Other,Non Covered Service,458.4,80,,458.4,percent of total billed charges,All Other,475.59,,,475.59,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,401.1,70,,401.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,589.47,,,589.47,Other,153% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,539.38,,,539.38,Other,140% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,1001.71,,,1001.71,Other,250% of Medicaid,1248.29,,,1248.29,Other,324% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,481.59,,,481.59,Other,125% of Medicaid,0.01,1248.29,
DEBRIDEMENT SKIN FULL THI,97598,CPT,,30097598,CDM,450,RC,,,both,,,573,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,2144,,,2144,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,401.1,70,,401.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1152.93,,,1152.93,Other,100% of Medicaid,1152.93,,,1152.93,Other,100% of Medicaid,1152.93,,,1152.93,Other,100% of Medicaid,1152.93,,,1152.93,Other,100% of Medicaid,2594.08,,,2594.08,Other,225% of Medicaid,1763.98,,,1763.98,Other,153% of Medicaid,2594.08,,,2594.08,Other,225% of Medicaid,1614.1,,,1614.1,Other,140% of Medicaid,2594.08,,,2594.08,Other,225% of Medicaid,2997.61,,,2997.61,Other,250% of Medicaid,3735.48,,,3735.48,Other,324% of Medicaid,2478.79,,,2478.79,Other,215% of Medicaid,2478.79,,,2478.79,Other,215% of Medicaid,1441.16,,,1441.16,Other,125% of Medicaid,0.01,3735.48,
MOD SED SAME PHYS/QHP <5 YRS,99151,CPT,,30099151,CDM,450,RC,,,both,,,574,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,401.8,70,,401.8,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,401.8,
MOD SED SAME PHYS/QHP 5/>YR FIRST 15 MIN,99152,CPT,,30099152,CDM,450,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED SAME PHYS/QHP EA ADDL 15 MIN,99153,CPT,,30099153,CDM,450,RC,,,both,,,157,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,109.9,70,,109.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,109.9,
MOD SED OTH PHYS/QHP <5 YRS,99155,CPT,,30099155,CDM,450,RC,,,both,,,173,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,121.1,70,,121.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.1,
MOD SED OTH PHYS/QHP 5/>YRS,99156,CPT,,30099156,CDM,450,RC,,,both,,,173,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,121.1,70,,121.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.1,
MOD SED OTHER PHYS/QHP EA,99157,CPT,,30099157,CDM,450,RC,,,both,,,173,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,121.1,70,,121.1,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,121.1,
MMH ED VISIT LEVEL 1,99281,CPT,,30000056,CDM,450,RC,,,both,,,1240,160.43,,,160.43,Other,150% of Medicare + 9.63% HCRA Surcharge,97.56,,,97.56,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,843.2,68,,843.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,992,80,,992,percent of total billed charges,All Other,1029.2,,,1029.2,Case Rate,ED Per Visit,1029.2,,,,Case Rate,ED Per Visit,992,80,,992,percent of total billed charges,All Other,1029.2,,,1029.2,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,868,70,,868,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2018,
MMH ED VISIT LEVEL 1 W/MOD,99281,CPT,25,30000063,CDM,450,RC,,,both,,,1240,160.43,,,160.43,Other,150% of Medicare + 9.63% HCRA Surcharge,97.56,,,97.56,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,843.2,68,,843.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,992,80,,992,percent of total billed charges,All Other,1029.2,,,1029.2,Case Rate,ED Per Visit,1029.2,,,,Case Rate,ED Per Visit,992,80,,992,percent of total billed charges,All Other,1029.2,,,1029.2,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,868,70,,868,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2018,
ED VISIT LEVEL 1 W/MOD,99281,CPT,25,30000074,CDM,450,RC,,,both,,,2191,160.43,,,160.43,Other,150% of Medicare + 9.63% HCRA Surcharge,97.56,,,97.56,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,1489.88,68,,1489.88,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1752.8,80,,1752.8,percent of total billed charges,All Other,1818.53,,,1818.53,Case Rate,ED Per Visit,1818.53,,,,Case Rate,ED Per Visit,1752.8,80,,1752.8,percent of total billed charges,All Other,1818.53,,,1818.53,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,1533.7,70,,1533.7,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2018,
TH-ED VISIT LEVEL 1,99281,CPT,GT,30000080,CDM,450,RC,,,both,,,2191,160.43,,,160.43,Other,150% of Medicare + 9.63% HCRA Surcharge,97.56,,,97.56,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,1489.88,68,,1489.88,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1752.8,80,,1752.8,percent of total billed charges,All Other,1818.53,,,1818.53,Case Rate,ED Per Visit,1818.53,,,,Case Rate,ED Per Visit,1752.8,80,,1752.8,percent of total billed charges,All Other,1818.53,,,1818.53,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,1533.7,70,,1533.7,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2018,
ED VISIT LEVEL 1,99281,CPT,,30099281,CDM,450,RC,,,both,,,2191,160.43,,,160.43,Other,150% of Medicare + 9.63% HCRA Surcharge,97.56,,,97.56,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,1489.88,68,,1489.88,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1752.8,80,,1752.8,percent of total billed charges,All Other,1818.53,,,1818.53,Case Rate,ED Per Visit,1818.53,,,,Case Rate,ED Per Visit,1752.8,80,,1752.8,percent of total billed charges,All Other,1818.53,,,1818.53,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,1533.7,70,,1533.7,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2018,
MMH ED VISIT LEVEL 2 W/MOD,99282,CPT,25,30000064,CDM,450,RC,,,both,,,1661,295.54,,,295.54,Other,150% of Medicare + 9.63% HCRA Surcharge,179.72,,,179.72,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,1129.48,68,,1129.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1328.8,80,,1328.8,percent of total billed charges,All Other,1378.63,,,1378.63,Case Rate,ED Per Visit,1378.63,,,,Case Rate,ED Per Visit,1328.8,80,,1328.8,percent of total billed charges,All Other,1378.63,,,1378.63,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,1162.7,70,,1162.7,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2018,
ED VISIT LEVEL 2 W/MOD,99282,CPT,25,30000075,CDM,450,RC,,,both,,,3649,295.54,,,295.54,Other,150% of Medicare + 9.63% HCRA Surcharge,179.72,,,179.72,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,2481.32,68,,2481.32,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,2919.2,80,,2919.2,percent of total billed charges,All Other,3028.67,,,3028.67,Case Rate,ED Per Visit,3028.67,,,,Case Rate,ED Per Visit,2919.2,80,,2919.2,percent of total billed charges,All Other,3028.67,,,3028.67,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,2554.3,70,,2554.3,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3028.67,
ED VISIT LEVEL 2,99282,CPT,,30099282,CDM,450,RC,,,both,,,3649,295.54,,,295.54,Other,150% of Medicare + 9.63% HCRA Surcharge,179.72,,,179.72,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,2481.32,68,,2481.32,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,2919.2,80,,2919.2,percent of total billed charges,All Other,3028.67,,,3028.67,Case Rate,ED Per Visit,3028.67,,,,Case Rate,ED Per Visit,2919.2,80,,2919.2,percent of total billed charges,All Other,3028.67,,,3028.67,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,2554.3,70,,2554.3,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3028.67,
MMH ED VISIT LEVEL 3 W/MOD,99283,CPT,25,30000065,CDM,450,RC,,,both,,,2600,515.58,,,515.58,Other,150% of Medicare + 9.63% HCRA Surcharge,313.52,,,313.52,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,1768,68,,1768,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,2080,80,,2080,percent of total billed charges,All Other,2158,,,2158,Case Rate,ED Per Visit,2158,,,,Case Rate,ED Per Visit,2080,80,,2080,percent of total billed charges,All Other,2158,,,2158,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,1820,70,,1820,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2158,
ED VISIT LEVEL 3 W/MOD,99283,CPT,25,30000076,CDM,450,RC,,,both,,,4816,515.58,,,515.58,Other,150% of Medicare + 9.63% HCRA Surcharge,313.52,,,313.52,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,3274.88,68,,3274.88,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,3852.8,80,,3852.8,percent of total billed charges,All Other,3997.28,,,3997.28,Case Rate,ED Per Visit,3997.28,,,,Case Rate,ED Per Visit,3852.8,80,,3852.8,percent of total billed charges,All Other,3997.28,,,3997.28,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,3371.2,70,,3371.2,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3997.28,
ED VISIT LEVEL 3,99283,CPT,,30099283,CDM,450,RC,,,both,,,4816,515.58,,,515.58,Other,150% of Medicare + 9.63% HCRA Surcharge,313.52,,,313.52,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,3274.88,68,,3274.88,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,3852.8,80,,3852.8,percent of total billed charges,All Other,3997.28,,,3997.28,Case Rate,ED Per Visit,3997.28,,,,Case Rate,ED Per Visit,3852.8,80,,3852.8,percent of total billed charges,All Other,3997.28,,,3997.28,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,3371.2,70,,3371.2,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3997.28,
MMH ED VISIT LEVEL 4 W/MOD,99284,CPT,25,30000066,CDM,450,RC,,,both,,,3200,800.34,,,800.34,Other,150% of Medicare + 9.63% HCRA Surcharge,486.69,,,486.69,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,2176,68,,2176,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,2560,80,,2560,percent of total billed charges,All Other,2656,,,2656,Case Rate,ED Per Visit,2656,,,,Case Rate,ED Per Visit,2560,80,,2560,percent of total billed charges,All Other,2656,,,2656,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,2240,70,,2240,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2656,
ED VISIT LEVEL 4 W/MOD,99284,CPT,25,30000077,CDM,450,RC,,,both,,,6275,800.34,,,800.34,Other,150% of Medicare + 9.63% HCRA Surcharge,486.69,,,486.69,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,4267,68,,4267,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,5020,80,,5020,percent of total billed charges,All Other,5208.25,,,5208.25,Case Rate,ED Per Visit,5208.25,,,,Case Rate,ED Per Visit,5020,80,,5020,percent of total billed charges,All Other,5208.25,,,5208.25,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,4392.5,70,,4392.5,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5208.25,
TH-ED VISIT LEVEL 4,99284,CPT,GT,30000083,CDM,450,RC,,,both,,,6275,800.34,,,800.34,Other,150% of Medicare + 9.63% HCRA Surcharge,486.69,,,486.69,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,4267,68,,4267,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,5020,80,,5020,percent of total billed charges,All Other,5208.25,,,5208.25,Case Rate,ED Per Visit,5208.25,,,,Case Rate,ED Per Visit,5020,80,,5020,percent of total billed charges,All Other,5208.25,,,5208.25,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,4392.5,70,,4392.5,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5208.25,
ED VISIT LEVEL 4,99284,CPT,,30099284,CDM,450,RC,,,both,,,6275,800.34,,,800.34,Other,150% of Medicare + 9.63% HCRA Surcharge,486.69,,,486.69,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,4267,68,,4267,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,5020,80,,5020,percent of total billed charges,All Other,5208.25,,,5208.25,Case Rate,ED Per Visit,5208.25,,,,Case Rate,ED Per Visit,5020,80,,5020,percent of total billed charges,All Other,5208.25,,,5208.25,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,4392.5,70,,4392.5,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5208.25,
MMH ED VISIT LEVEL 5 W/MOD,99285,CPT,25,30000067,CDM,450,RC,,,both,,,4000,1160.67,,,1160.67,Other,150% of Medicare + 9.63% HCRA Surcharge,705.81,,,705.81,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,2720,68,,2720,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,3200,80,,3200,percent of total billed charges,All Other,3320,,,3320,Case Rate,ED Per Visit,3320,,,,Case Rate,ED Per Visit,3200,80,,3200,percent of total billed charges,All Other,3320,,,3320,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,2800,70,,2800,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3320,
ED VISIT LEVEL 5 W/MOD,99285,CPT,25,30000078,CDM,450,RC,,,both,,,7880,1160.67,,,1160.67,Other,150% of Medicare + 9.63% HCRA Surcharge,705.81,,,705.81,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,5358.4,68,,5358.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,6304,80,,6304,percent of total billed charges,All Other,6540.4,,,6540.4,Case Rate,ED Per Visit,6540.4,,,,Case Rate,ED Per Visit,6304,80,,6304,percent of total billed charges,All Other,6540.4,,,6540.4,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,5516,70,,5516,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6540.4,
ED VISIT LEVEL 5,99285,CPT,,30099285,CDM,450,RC,,,both,,,7880,1160.67,,,1160.67,Other,150% of Medicare + 9.63% HCRA Surcharge,705.81,,,705.81,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,5358.4,68,,5358.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,6304,80,,6304,percent of total billed charges,All Other,6540.4,,,6540.4,Case Rate,ED Per Visit,6540.4,,,,Case Rate,ED Per Visit,6304,80,,6304,percent of total billed charges,All Other,6540.4,,,6540.4,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,5516,70,,5516,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,6540.4,
MMH CRITICAL CARE FIRST HOUR W/MOD,99291,CPT,25,30000068,CDM,450,RC,,,both,,,5815,1603.49,,,1603.49,Other,150% of Medicare + 9.63% HCRA Surcharge,975.09,,,975.09,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,3954.2,68,,3954.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,4652,80,,4652,percent of total billed charges,All Other,4826.45,,,4826.45,Case Rate,ED Per Visit,4826.45,,,,Case Rate,ED Per Visit,4652,80,,4652,percent of total billed charges,All Other,4826.45,,,4826.45,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,4070.5,70,,4070.5,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4826.45,
CRITICAL CARE FIRST HOUR,99291,CPT,,30099291,CDM,450,RC,,,both,,,6127,1603.49,,,1603.49,Other,150% of Medicare + 9.63% HCRA Surcharge,975.09,,,975.09,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,4166.36,68,,4166.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,4901.6,80,,4901.6,percent of total billed charges,All Other,5085.41,,,5085.41,Case Rate,ED Per Visit,5085.41,,,,Case Rate,ED Per Visit,4901.6,80,,4901.6,percent of total billed charges,All Other,5085.41,,,5085.41,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,4288.9,70,,4288.9,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5085.41,
CRITICAL CARE FIRST HOUR W/MOD,99291,CPT,25,30499291,CDM,450,RC,,,both,,,6127,1603.49,,,1603.49,Other,150% of Medicare + 9.63% HCRA Surcharge,975.09,,,975.09,Other,Medicare OPPS,1648,,,1648,Case Rate,ED Per Visit,1483,,,1483,Case Rate,ED Per Visit,1857,,,1857,Case Rate,ED Per Visit,1671,,,1671,Case Rate,ED Per Visit,1578,,,1578,Case Rate,ED Per Visit,1278,,,1278,Case Rate,ED Per Visit,4166.36,68,,4166.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,4901.6,80,,4901.6,percent of total billed charges,All Other,5085.41,,,5085.41,Case Rate,ED Per Visit,5085.41,,,,Case Rate,ED Per Visit,4901.6,80,,4901.6,percent of total billed charges,All Other,5085.41,,,5085.41,Case Rate,ED Per Visit,2018,,,2018,Case Rate,ED Per Visit,4288.9,70,,4288.9,percent of total billed charges,,1461,,,1461,Case Rate,ED Per Visit,1242,,,1242,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1316,,,1316,Case Rate,ED Per Visit,1464,,,1464,Case Rate,ED Per Visit,1244,,,1244,Case Rate,ED Per Visit,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5085.41,
MMH CRITICAL CARE EA ADDL 30 W/MOD,99292,CPT,25,30000069,CDM,450,RC,,,both,,,1240,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,843.2,68,,843.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,992,80,,992,percent of total billed charges,All Other,1029.2,,,1029.2,Other,Non Covered Service,1029.2,,,,Other,Non Covered Service,992,80,,992,percent of total billed charges,All Other,1029.2,,,1029.2,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,868,70,,868,percent of total billed charges,,259,,,259,Case Rate,,220,,,220,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1029.2,
CRITICAL CARE EA ADDL 30,99292,CPT,,30099292,CDM,450,RC,,,both,,,1806,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1228.08,68,,1228.08,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1444.8,80,,1444.8,percent of total billed charges,All Other,1498.98,,,1498.98,Other,Non Covered Service,1498.98,,,,Other,Non Covered Service,1444.8,80,,1444.8,percent of total billed charges,All Other,1498.98,,,1498.98,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1264.2,70,,1264.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1498.98,
PREVENTIVE COUNSELING INDIV; 15 MIN,99401,CPT,,30099401,CDM,450,RC,,,both,,,269,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,188.3,70,,188.3,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,188.3,
IV INFUS TX DX INIT PROLNG RQR,C8957,HCPCS,,30000009,CDM,450,RC,,,both,,,977,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1112,,,1112,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,683.9,70,,683.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,0.01,1936.53,
TELEHEALTH FACILITY FEE NEURO,Q3014,HCPCS,GT,30000018,CDM,450,RC,,,both,,,161,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,112.7,70,,112.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.7,
TELEHEALTH FACILITY FEE PSYCH,Q3014,HCPCS,GT,30000023,CDM,450,RC,,,both,,,161,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,112.7,70,,112.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,112.7,
BREATHING CAPACITY TEST,94010,CPT,,71094010,CDM,460,RC,,,both,,,671,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,436.15,65,,436.15,percent of total billed charges,All Other,395.89,59,,395.89,percent of total billed charges,All Other,188.07,,,188.07,Fee Schedule,,169.2,,,169.2,Fee Schedule,,159.93,,,159.93,Fee Schedule,,469.7,70,,469.7,percent of total billed charges,All Other,79.82,,,79.82,Fee Schedule,,127,,,127,Other,186% of Medicaid,93.93,,,93.93,Fee Schedule,,416.02,,,416.02,Fee Schedule,,44.23,,,,Fee Schedule,,93.93,,,93.93,Fee Schedule,,416.02,,,416.02,Fee Schedule,,536.8,80,,536.8,percent of total billed charges,All Other,469.7,70,,469.7,percent of total billed charges,,90.2,,,90.2,Fee Schedule,,76.45,,,76.45,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,44.23,667,
EVALUATION OF WHEEZING,94060,CPT,,71094060,CDM,460,RC,,,both,,,1017,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,661.05,65,,661.05,percent of total billed charges,All Other,600.03,59,,600.03,percent of total billed charges,All Other,323.7,,,323.7,Fee Schedule,,291.22,,,291.22,Fee Schedule,,275.27,,,275.27,Fee Schedule,,711.9,70,,711.9,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,433,,,433,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,630.54,,,630.54,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,630.54,,,630.54,Fee Schedule,,813.6,80,,813.6,percent of total billed charges,All Other,711.9,70,,711.9,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,356.29,,,356.29,Other,153% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,326.01,,,326.01,Other,140% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,605.45,,,605.45,Other,250% of Medicaid,754.49,,,754.49,Other,324% of Medicaid,500.66,,,500.66,Other,215% of Medicaid,500.66,,,500.66,Other,215% of Medicaid,291.08,,,291.08,Other,125% of Medicaid,66.28,813.6,
EVALUATION OF WHEEZING W/MOD,94060,CPT,59,71194060,CDM,460,RC,,,both,,,1017,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,661.05,65,,661.05,percent of total billed charges,All Other,600.03,59,,600.03,percent of total billed charges,All Other,323.7,,,323.7,Fee Schedule,,291.22,,,291.22,Fee Schedule,,275.27,,,275.27,Fee Schedule,,711.9,70,,711.9,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,433,,,433,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,630.54,,,630.54,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,630.54,,,630.54,Fee Schedule,,813.6,80,,813.6,percent of total billed charges,All Other,711.9,70,,711.9,percent of total billed charges,,139.4,,,139.4,Fee Schedule,,118.15,,,118.15,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,356.29,,,356.29,Other,153% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,326.01,,,326.01,Other,140% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,605.45,,,605.45,Other,250% of Medicaid,754.49,,,754.49,Other,324% of Medicaid,500.66,,,500.66,Other,215% of Medicaid,500.66,,,500.66,Other,215% of Medicaid,291.08,,,291.08,Other,125% of Medicaid,66.28,813.6,
VITAL CAPACITY TEST,94150,CPT,,30094150,CDM,460,RC,,,both,,,329,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,21.09,,,21.09,Fee Schedule,,21.09,,,21.09,Fee Schedule,,21.09,,,21.09,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,223.72,68,,223.72,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,263.2,80,,263.2,percent of total billed charges,All Other,203.98,62,,203.98,percent of total billed charges,Lab & Radiology,180.95,55,,,percent of total billed charges,Default if not in Fee Schedule,263.2,80,,263.2,percent of total billed charges,All Other,203.98,62,,203.98,percent of total billed charges,Lab & Radiology,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,21.09,667,
VITAL CAPACITY TEST,94150,CPT,,71094150,CDM,460,RC,,,both,,,329,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,21.09,,,21.09,Fee Schedule,,21.09,,,21.09,Fee Schedule,,21.09,,,21.09,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,223.72,68,,223.72,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,263.2,80,,263.2,percent of total billed charges,All Other,203.98,62,,203.98,percent of total billed charges,Lab & Radiology,180.95,55,,,percent of total billed charges,Default if not in Fee Schedule,263.2,80,,263.2,percent of total billed charges,All Other,203.98,62,,203.98,percent of total billed charges,Lab & Radiology,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,21.09,667,
RESP FLOW VOLUME LOOP,94375,CPT,,71094375,CDM,460,RC,,,both,,,639,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,415.35,65,,415.35,percent of total billed charges,All Other,377.01,59,,377.01,percent of total billed charges,All Other,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,447.3,70,,447.3,percent of total billed charges,All Other,103.13,,,103.13,Fee Schedule,,433,,,433,Other,186% of Medicaid,121.36,,,121.36,Fee Schedule,,396.18,,,396.18,Fee Schedule,,57.14,,,,Fee Schedule,,121.36,,,121.36,Fee Schedule,,396.18,,,396.18,Fee Schedule,,511.2,80,,511.2,percent of total billed charges,All Other,447.3,70,,447.3,percent of total billed charges,,116.44,,,116.44,Fee Schedule,,98.69,,,98.69,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,356.29,,,356.29,Other,153% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,326.01,,,326.01,Other,140% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,605.45,,,605.45,Other,250% of Medicaid,754.49,,,754.49,Other,324% of Medicaid,500.66,,,500.66,Other,215% of Medicaid,500.66,,,500.66,Other,215% of Medicaid,291.08,,,291.08,Other,125% of Medicaid,57.14,754.49,
EXERCISE TEST FOR BRONCHOSPASM,94617,CPT,,71094617,CDM,460,RC,,,both,,,723,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,186.35,,,186.35,Fee Schedule,,168.03,,,168.03,Fee Schedule,,59.52,,,59.52,Fee Schedule,,59.52,,,59.52,Fee Schedule,,59.52,,,59.52,Fee Schedule,,506.1,70,,506.1,percent of total billed charges,All Other,491.64,68,,491.64,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,578.4,80,,578.4,percent of total billed charges,All Other,600.09,83,,600.09,percent of total billed charges,All Other,600.09,83,,,percent of total billed charges,All Other,578.4,80,,578.4,percent of total billed charges,All Other,600.09,83,,600.09,percent of total billed charges,All Other,249.52,,,249.52,Fee Schedule,,506.1,70,,506.1,percent of total billed charges,,272.24,,,272.24,Fee Schedule,,230.74,,,230.74,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,59.52,667,
PULMONARY STRESS TESTING,94618,CPT,,71094618,CDM,460,RC,,,both,,,298,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,193.7,65,,193.7,percent of total billed charges,All Other,175.82,59,,175.82,percent of total billed charges,All Other,10.88,,,10.88,Fee Schedule,,10.88,,,10.88,Fee Schedule,,10.88,,,10.88,Fee Schedule,,208.6,70,,208.6,percent of total billed charges,All Other,50.98,,,50.98,Fee Schedule,,127,,,127,Other,186% of Medicaid,59.99,,,59.99,Fee Schedule,,184.76,,,184.76,Fee Schedule,,28.25,,,,Fee Schedule,,59.99,,,59.99,Fee Schedule,,184.76,,,184.76,Fee Schedule,,238.4,80,,238.4,percent of total billed charges,All Other,208.6,70,,208.6,percent of total billed charges,,54.12,,,54.12,Fee Schedule,,45.87,,,45.87,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,10.88,667,
PULM STRESS TEST/COMPLEX,94621,CPT,,71094621,CDM,460,RC,,,both,,,3266,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,2122.9,65,,2122.9,percent of total billed charges,All Other,1926.94,59,,1926.94,percent of total billed charges,All Other,659.24,,,659.24,Fee Schedule,,593.08,,,593.08,Fee Schedule,,560.6,,,560.6,Fee Schedule,,2286.2,70,,2286.2,percent of total billed charges,All Other,364.33,,,364.33,Fee Schedule,,433,,,433,Other,186% of Medicaid,428.74,,,428.74,Fee Schedule,,2024.92,,,2024.92,Fee Schedule,,201.87,,,,Fee Schedule,,428.74,,,428.74,Fee Schedule,,2024.92,,,2024.92,Fee Schedule,,2612.8,80,,2612.8,percent of total billed charges,All Other,2286.2,70,,2286.2,percent of total billed charges,,419.84,,,419.84,Fee Schedule,,355.84,,,355.84,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,356.29,,,356.29,Other,153% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,326.01,,,326.01,Other,140% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,605.45,,,605.45,Other,250% of Medicaid,754.49,,,754.49,Other,324% of Medicaid,500.66,,,500.66,Other,215% of Medicaid,500.66,,,500.66,Other,215% of Medicaid,291.08,,,291.08,Other,125% of Medicaid,201.87,2612.8,
PULM FUNCT TST PLETHYSMOGRAP,94726,CPT,,71094726,CDM,460,RC,,,both,,,632,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,410.8,65,,410.8,percent of total billed charges,All Other,372.88,59,,372.88,percent of total billed charges,All Other,41.15,,,41.15,Fee Schedule,,41.15,,,41.15,Fee Schedule,,41.15,,,41.15,Fee Schedule,,442.4,70,,442.4,percent of total billed charges,All Other,182.94,,,182.94,Fee Schedule,,433,,,433,Other,186% of Medicaid,215.28,,,215.28,Fee Schedule,,391.84,,,391.84,Fee Schedule,,101.37,,,,Fee Schedule,,215.28,,,215.28,Fee Schedule,,391.84,,,391.84,Fee Schedule,,505.6,80,,505.6,percent of total billed charges,All Other,442.4,70,,442.4,percent of total billed charges,,206.64,,,206.64,Fee Schedule,,175.14,,,175.14,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,232.87,,,232.87,Other,100% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,356.29,,,356.29,Other,153% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,326.01,,,326.01,Other,140% of Medicaid,523.95,,,523.95,Other,225% of Medicaid,605.45,,,605.45,Other,250% of Medicaid,754.49,,,754.49,Other,324% of Medicaid,500.66,,,500.66,Other,215% of Medicaid,500.66,,,500.66,Other,215% of Medicaid,291.08,,,291.08,Other,125% of Medicaid,41.15,754.49,
PFT BY LUNG VOLUME/GAS,94727,CPT,,71094727,CDM,460,RC,,,both,,,329,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,30.61,,,30.61,Fee Schedule,,30.61,,,30.61,Fee Schedule,,30.61,,,30.61,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,136.1,,,136.1,Fee Schedule,,127,,,127,Other,186% of Medicaid,160.16,,,160.16,Fee Schedule,,203.98,,,203.98,Fee Schedule,,75.41,,,,Fee Schedule,,160.16,,,160.16,Fee Schedule,,203.98,,,203.98,Fee Schedule,,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,154.16,,,154.16,Fee Schedule,,130.66,,,130.66,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,30.61,667,
CO/MEMBRANE DIFFUSE CAPACITY,94729,CPT,,71094729,CDM,460,RC,,,both,,,301,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,195.65,65,,195.65,percent of total billed charges,All Other,177.59,59,,177.59,percent of total billed charges,All Other,43.87,,,43.87,Fee Schedule,,43.87,,,43.87,Fee Schedule,,43.87,,,43.87,Fee Schedule,,210.7,70,,210.7,percent of total billed charges,All Other,197.84,,,197.84,Fee Schedule,,127,,,127,Other,186% of Medicaid,232.81,,,232.81,Fee Schedule,,186.62,,,186.62,Fee Schedule,,109.62,,,,Fee Schedule,,232.81,,,232.81,Fee Schedule,,186.62,,,186.62,Fee Schedule,,240.8,80,,240.8,percent of total billed charges,All Other,210.7,70,,210.7,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,0.01,667,
PULSE OX FOR O2 SAT,94760,CPT,,30094760,CDM,460,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,135.85,65,,135.85,percent of total billed charges,All Other,123.31,59,,123.31,percent of total billed charges,All Other,19.13,,,19.13,Fee Schedule,,17.21,,,17.21,Fee Schedule,,16.26,,,16.26,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,11.18,,,11.18,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,13.16,,,13.16,Fee Schedule,,129.58,,,129.58,Fee Schedule,,6.2,,,,Fee Schedule,,13.16,,,13.16,Fee Schedule,,129.58,,,129.58,Fee Schedule,,167.2,80,,167.2,percent of total billed charges,All Other,146.3,70,,146.3,percent of total billed charges,,11.48,,,11.48,Fee Schedule,,9.73,,,9.73,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667,
MEASURE BLOOD OXYGEN LEVEL SINGLE,94760,CPT,,71094760,CDM,460,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,135.85,65,,135.85,percent of total billed charges,All Other,123.31,59,,123.31,percent of total billed charges,All Other,19.13,,,19.13,Fee Schedule,,17.21,,,17.21,Fee Schedule,,16.26,,,16.26,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,11.18,,,11.18,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,13.16,,,13.16,Fee Schedule,,129.58,,,129.58,Fee Schedule,,6.2,,,,Fee Schedule,,13.16,,,13.16,Fee Schedule,,129.58,,,129.58,Fee Schedule,,167.2,80,,167.2,percent of total billed charges,All Other,146.3,70,,146.3,percent of total billed charges,,11.48,,,11.48,Fee Schedule,,9.73,,,9.73,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667,
MEASURE BLOOD OXYGEN LEVEL SINGLE 59 MOD,94760,CPT,59,71194760,CDM,460,RC,,,both,,,209,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,135.85,65,,135.85,percent of total billed charges,All Other,123.31,59,,123.31,percent of total billed charges,All Other,19.13,,,19.13,Fee Schedule,,17.21,,,17.21,Fee Schedule,,16.26,,,16.26,Fee Schedule,,146.3,70,,146.3,percent of total billed charges,All Other,11.18,,,11.18,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,13.16,,,13.16,Fee Schedule,,129.58,,,129.58,Fee Schedule,,6.2,,,,Fee Schedule,,13.16,,,13.16,Fee Schedule,,129.58,,,129.58,Fee Schedule,,167.2,80,,167.2,percent of total billed charges,All Other,146.3,70,,146.3,percent of total billed charges,,11.48,,,11.48,Fee Schedule,,9.73,,,9.73,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667,
PULSE OX FOR O2 SAT MULT,94761,CPT,,30094761,CDM,460,RC,,,both,,,528,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,343.2,65,,343.2,percent of total billed charges,All Other,311.52,59,,311.52,percent of total billed charges,All Other,31.02,,,31.02,Fee Schedule,,27.9,,,27.9,Fee Schedule,,26.38,,,26.38,Fee Schedule,,369.6,70,,369.6,percent of total billed charges,All Other,16.68,,,16.68,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,19.62,,,19.62,Fee Schedule,,327.36,,,327.36,Fee Schedule,,9.24,,,,Fee Schedule,,19.62,,,19.62,Fee Schedule,,327.36,,,327.36,Fee Schedule,,422.4,80,,422.4,percent of total billed charges,All Other,369.6,70,,369.6,percent of total billed charges,,16.4,,,16.4,Fee Schedule,,13.9,,,13.9,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667,
MEASURE BLOOD OXYGEN LEVEL MULTI,94761,CPT,,71094761,CDM,460,RC,,,both,,,528,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,343.2,65,,343.2,percent of total billed charges,All Other,311.52,59,,311.52,percent of total billed charges,All Other,31.02,,,31.02,Fee Schedule,,27.9,,,27.9,Fee Schedule,,26.38,,,26.38,Fee Schedule,,369.6,70,,369.6,percent of total billed charges,All Other,16.68,,,16.68,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,19.62,,,19.62,Fee Schedule,,327.36,,,327.36,Fee Schedule,,9.24,,,,Fee Schedule,,19.62,,,19.62,Fee Schedule,,327.36,,,327.36,Fee Schedule,,422.4,80,,422.4,percent of total billed charges,All Other,369.6,70,,369.6,percent of total billed charges,,16.4,,,16.4,Fee Schedule,,13.9,,,13.9,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667,
MEASURE BLOOD OXYGEN LEVEL MULTI 59 MOD,94761,CPT,59,71194761,CDM,460,RC,,,both,,,528,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,343.2,65,,343.2,percent of total billed charges,All Other,311.52,59,,311.52,percent of total billed charges,All Other,31.02,,,31.02,Fee Schedule,,27.9,,,27.9,Fee Schedule,,26.38,,,26.38,Fee Schedule,,369.6,70,,369.6,percent of total billed charges,All Other,16.68,,,16.68,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,19.62,,,19.62,Fee Schedule,,327.36,,,327.36,Fee Schedule,,9.24,,,,Fee Schedule,,19.62,,,19.62,Fee Schedule,,327.36,,,327.36,Fee Schedule,,422.4,80,,422.4,percent of total billed charges,All Other,369.6,70,,369.6,percent of total billed charges,,16.4,,,16.4,Fee Schedule,,13.9,,,13.9,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,667,
CONTINUOUS PULSE OX,94762,CPT,,30094762,CDM,460,RC,,,both,,,337,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,81.36,,,81.36,Fee Schedule,,73.36,,,73.36,Fee Schedule,,133.58,,,133.58,Fee Schedule,,120.25,,,120.25,Fee Schedule,,113.59,,,113.59,Fee Schedule,,235.9,70,,235.9,percent of total billed charges,All Other,229.16,68,,229.16,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,269.6,80,,269.6,percent of total billed charges,All Other,279.71,83,,279.71,percent of total billed charges,All Other,279.71,83,,,percent of total billed charges,All Other,269.6,80,,269.6,percent of total billed charges,All Other,279.71,83,,279.71,percent of total billed charges,All Other,108.94,,,108.94,Fee Schedule,,235.9,70,,235.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,68.45,667,
MEASURE BLOOD O2 LEVEL CONTINU,94762,CPT,,71094762,CDM,460,RC,,,both,,,337,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,81.36,,,81.36,Fee Schedule,,73.36,,,73.36,Fee Schedule,,133.58,,,133.58,Fee Schedule,,120.25,,,120.25,Fee Schedule,,113.59,,,113.59,Fee Schedule,,235.9,70,,235.9,percent of total billed charges,All Other,229.16,68,,229.16,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,269.6,80,,269.6,percent of total billed charges,All Other,279.71,83,,279.71,percent of total billed charges,All Other,279.71,83,,,percent of total billed charges,All Other,269.6,80,,269.6,percent of total billed charges,All Other,279.71,83,,279.71,percent of total billed charges,All Other,108.94,,,108.94,Fee Schedule,,235.9,70,,235.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,68.45,667,
MEASURE BLOOD O2 LEVEL CONTINU 59 MOD,94762,CPT,59,71194762,CDM,460,RC,,,both,,,337,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,81.36,,,81.36,Fee Schedule,,73.36,,,73.36,Fee Schedule,,133.58,,,133.58,Fee Schedule,,120.25,,,120.25,Fee Schedule,,113.59,,,113.59,Fee Schedule,,235.9,70,,235.9,percent of total billed charges,All Other,229.16,68,,229.16,percent of total billed charges,All Other,127,,,127,Other,186% of Medicaid,269.6,80,,269.6,percent of total billed charges,All Other,279.71,83,,279.71,percent of total billed charges,All Other,279.71,83,,,percent of total billed charges,All Other,269.6,80,,269.6,percent of total billed charges,All Other,279.71,83,,279.71,percent of total billed charges,All Other,108.94,,,108.94,Fee Schedule,,235.9,70,,235.9,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,68.45,,,68.45,Other,100% of Medicaid,154,,,154,Other,225% of Medicaid,104.72,,,104.72,Other,153% of Medicaid,154,,,154,Other,225% of Medicaid,95.82,,,95.82,Other,140% of Medicaid,154,,,154,Other,225% of Medicaid,177.96,,,177.96,Other,250% of Medicaid,221.76,,,221.76,Other,324% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,147.16,,,147.16,Other,215% of Medicaid,85.56,,,85.56,Other,125% of Medicaid,68.45,667,
CALORIC VSTBLR TEST W/REC,92537,CPT,,66092537,CDM,470,RC,,,both,,,821,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,533.65,65,,533.65,percent of total billed charges,All Other,484.39,59,,484.39,percent of total billed charges,All Other,8.5,,,8.5,Fee Schedule,,8.5,,,8.5,Fee Schedule,,8.5,,,8.5,Fee Schedule,,574.7,70,,574.7,percent of total billed charges,All Other,38.62,,,38.62,Fee Schedule,,221,,,221,Other,186% of Medicaid,45.45,,,45.45,Fee Schedule,,509.02,,,509.02,Fee Schedule,,21.4,,,,Fee Schedule,,45.45,,,45.45,Fee Schedule,,509.02,,,509.02,Fee Schedule,,656.8,80,,656.8,percent of total billed charges,All Other,574.7,70,,574.7,percent of total billed charges,,49.2,,,49.2,Fee Schedule,,41.7,,,41.7,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,182.08,,,182.08,Other,153% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,166.6,,,166.6,Other,140% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,309.41,,,309.41,Other,250% of Medicaid,385.57,,,385.57,Other,324% of Medicaid,255.86,,,255.86,Other,215% of Medicaid,255.86,,,255.86,Other,215% of Medicaid,148.75,,,148.75,Other,125% of Medicaid,8.5,656.8,
CALORIC VSTBLR TEST W/REC,92538,CPT,,66092538,CDM,470,RC,,,both,,,821,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,533.65,65,,533.65,percent of total billed charges,All Other,484.39,59,,484.39,percent of total billed charges,All Other,4.76,,,4.76,Fee Schedule,,4.76,,,4.76,Fee Schedule,,4.76,,,4.76,Fee Schedule,,574.7,70,,574.7,percent of total billed charges,All Other,27.67,,,27.67,Fee Schedule,,221,,,221,Other,186% of Medicaid,32.56,,,32.56,Fee Schedule,,509.02,,,509.02,Fee Schedule,,15.33,,,,Fee Schedule,,32.56,,,32.56,Fee Schedule,,509.02,,,509.02,Fee Schedule,,656.8,80,,656.8,percent of total billed charges,All Other,574.7,70,,574.7,percent of total billed charges,,32.8,,,32.8,Fee Schedule,,27.8,,,27.8,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,182.08,,,182.08,Other,153% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,166.6,,,166.6,Other,140% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,309.41,,,309.41,Other,250% of Medicaid,385.57,,,385.57,Other,324% of Medicaid,255.86,,,255.86,Other,215% of Medicaid,255.86,,,255.86,Other,215% of Medicaid,148.75,,,148.75,Other,125% of Medicaid,4.76,656.8,
BASIC VESTIBULAR EVALUATION,92540,CPT,,66092540,CDM,470,RC,,,both,,,472,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,306.8,65,,306.8,percent of total billed charges,All Other,278.48,59,,278.48,percent of total billed charges,All Other,130.97,,,130.97,Fee Schedule,,117.83,,,117.83,Fee Schedule,,111.37,,,111.37,Fee Schedule,,330.4,70,,330.4,percent of total billed charges,All Other,127.84,,,127.84,Fee Schedule,,221,,,221,Other,186% of Medicaid,150.44,,,150.44,Fee Schedule,,292.64,,,292.64,Fee Schedule,,70.83,,,,Fee Schedule,,150.44,,,150.44,Fee Schedule,,292.64,,,292.64,Fee Schedule,,377.6,80,,377.6,percent of total billed charges,All Other,330.4,70,,330.4,percent of total billed charges,,162.36,,,162.36,Fee Schedule,,137.61,,,137.61,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,182.08,,,182.08,Other,153% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,166.6,,,166.6,Other,140% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,309.41,,,309.41,Other,250% of Medicaid,385.57,,,385.57,Other,324% of Medicaid,255.86,,,255.86,Other,215% of Medicaid,255.86,,,255.86,Other,215% of Medicaid,148.75,,,148.75,Other,125% of Medicaid,70.83,385.57,
SCREENING PURE TONE AIR ONLY,92551,CPT,,66092551,CDM,470,RC,,,both,,,135,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,11.9,,,11.9,Fee Schedule,,11.9,,,11.9,Fee Schedule,,11.9,,,11.9,Fee Schedule,,94.5,70,,94.5,percent of total billed charges,All Other,91.8,68,,91.8,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,108,80,,108,percent of total billed charges,All Other,83.7,62,,83.7,percent of total billed charges,Lab & Radiology,74.25,55,,,percent of total billed charges,Default if not in Fee Schedule,108,80,,108,percent of total billed charges,All Other,83.7,62,,83.7,percent of total billed charges,Lab & Radiology,368,,,368,Case Rate,,94.5,70,,94.5,percent of total billed charges,,55.76,,,55.76,Fee Schedule,,47.26,,,47.26,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,382,
STENGER PURE TONE,92565,CPT,,66092565,CDM,470,RC,,,both,,,362,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,235.3,65,,235.3,percent of total billed charges,All Other,213.58,59,,213.58,percent of total billed charges,All Other,90.53,,,90.53,Fee Schedule,,81.44,,,81.44,Fee Schedule,,76.98,,,76.98,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,86.68,,,86.68,Fee Schedule,,138,,,138,Other,186% of Medicaid,102,,,102,Fee Schedule,,224.44,,,224.44,Fee Schedule,,48.03,,,,Fee Schedule,,102,,,102,Fee Schedule,,224.44,,,224.44,Fee Schedule,,289.6,80,,289.6,percent of total billed charges,All Other,253.4,70,,253.4,percent of total billed charges,,91.84,,,91.84,Fee Schedule,,77.84,,,77.84,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,48.03,382,
FILTERED SPEECH TEST,92571,CPT,,66092571,CDM,470,RC,,,both,,,362,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,235.3,65,,235.3,percent of total billed charges,All Other,213.58,59,,213.58,percent of total billed charges,All Other,133.58,,,133.58,Fee Schedule,,120.25,,,120.25,Fee Schedule,,113.59,,,113.59,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,246.16,68,,246.16,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,289.6,80,,289.6,percent of total billed charges,All Other,300.46,83,,300.46,percent of total billed charges,All Other,300.46,83,,,percent of total billed charges,All Other,289.6,80,,289.6,percent of total billed charges,All Other,300.46,83,,300.46,percent of total billed charges,All Other,133.23,,,133.23,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,300.46,
ELECTROCOCHLEOGRAPHY,92584,CPT,,66092584,CDM,470,RC,,,both,,,441,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,286.65,65,,286.65,percent of total billed charges,All Other,260.19,59,,260.19,percent of total billed charges,All Other,466.51,,,466.51,Fee Schedule,,419.69,,,419.69,Fee Schedule,,396.71,,,396.71,Fee Schedule,,308.7,70,,308.7,percent of total billed charges,All Other,449.04,,,449.04,Fee Schedule,,132,,,132,Other,186% of Medicaid,528.42,,,528.42,Fee Schedule,,273.42,,,273.42,Fee Schedule,,248.81,,,,Fee Schedule,,528.42,,,528.42,Fee Schedule,,273.42,,,273.42,Fee Schedule,,352.8,80,,352.8,percent of total billed charges,All Other,308.7,70,,308.7,percent of total billed charges,,557.6,,,557.6,Fee Schedule,,472.6,,,472.6,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,71.1,557.6,
EVOKED AUDITORY TEST LIMITED,92587,CPT,,66092587,CDM,470,RC,,,both,,,759,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,493.35,65,,493.35,percent of total billed charges,All Other,447.81,59,,447.81,percent of total billed charges,All Other,209.5,,,209.5,Fee Schedule,,188.47,,,188.47,Fee Schedule,,178.15,,,178.15,Fee Schedule,,531.3,70,,531.3,percent of total billed charges,All Other,15.31,,,15.31,Fee Schedule,,132,,,132,Other,186% of Medicaid,18.02,,,18.02,Fee Schedule,,470.58,,,470.58,Fee Schedule,,8.48,,,,Fee Schedule,,18.02,,,18.02,Fee Schedule,,470.58,,,470.58,Fee Schedule,,607.2,80,,607.2,percent of total billed charges,All Other,531.3,70,,531.3,percent of total billed charges,,19.68,,,19.68,Fee Schedule,,16.68,,,16.68,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,8.48,607.2,
EVOKED AUDITORY TST COMPLETE,92588,CPT,,66092588,CDM,470,RC,,,both,,,697,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,453.05,65,,453.05,percent of total billed charges,All Other,411.23,59,,411.23,percent of total billed charges,All Other,333.24,,,333.24,Fee Schedule,,299.79,,,299.79,Fee Schedule,,283.37,,,283.37,Fee Schedule,,487.9,70,,487.9,percent of total billed charges,All Other,20.81,,,20.81,Fee Schedule,,132,,,132,Other,186% of Medicaid,24.49,,,24.49,Fee Schedule,,432.14,,,432.14,Fee Schedule,,11.53,,,,Fee Schedule,,24.49,,,24.49,Fee Schedule,,432.14,,,432.14,Fee Schedule,,557.6,80,,557.6,percent of total billed charges,All Other,487.9,70,,487.9,percent of total billed charges,,26.24,,,26.24,Fee Schedule,,22.24,,,22.24,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,11.53,567.18,
HEARING AID CHECK ONE EAR,92592,CPT,,66092592,CDM,470,RC,,,both,,,91,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,59.15,65,,59.15,percent of total billed charges,All Other,53.69,59,,53.69,percent of total billed charges,All Other,69.62,76.5,,69.62,percent of total billed charges,All Other,62.79,69,,62.79,percent of total billed charges,All Other,59.15,65,,59.15,percent of total billed charges,All Other,63.7,70,,63.7,percent of total billed charges,All Other,61.88,68,,61.88,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,72.8,80,,72.8,percent of total billed charges,All Other,75.53,83,,75.53,percent of total billed charges,All Other,75.53,83,,,percent of total billed charges,All Other,72.8,80,,72.8,percent of total billed charges,All Other,75.53,83,,75.53,percent of total billed charges,All Other,72.8,80,,72.8,percent of total billed charges,All Other,63.7,70,,63.7,percent of total billed charges,,59.15,65,,59.15,percent of total billed charges,All Other,59.15,65,,59.15,percent of total billed charges,All Other,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,382,
HEARING AID CHECK BOTH,92593,CPT,,66092593,CDM,470,RC,,,both,,,180,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,117,65,,117,percent of total billed charges,All Other,106.2,59,,106.2,percent of total billed charges,All Other,137.7,76.5,,137.7,percent of total billed charges,All Other,124.2,69,,124.2,percent of total billed charges,All Other,117,65,,117,percent of total billed charges,All Other,126,70,,126,percent of total billed charges,All Other,122.4,68,,122.4,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,144,80,,144,percent of total billed charges,All Other,149.4,83,,149.4,percent of total billed charges,All Other,149.4,83,,,percent of total billed charges,All Other,144,80,,144,percent of total billed charges,All Other,149.4,83,,149.4,percent of total billed charges,All Other,144,80,,144,percent of total billed charges,All Other,126,70,,126,percent of total billed charges,,117,65,,117,percent of total billed charges,All Other,117,65,,117,percent of total billed charges,All Other,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,382,
ELECTRO HEARING AID TEST ONE,92594,CPT,,66092594,CDM,470,RC,,,both,,,118,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,76.7,65,,76.7,percent of total billed charges,All Other,69.62,59,,69.62,percent of total billed charges,All Other,90.27,76.5,,90.27,percent of total billed charges,All Other,81.42,69,,81.42,percent of total billed charges,All Other,76.7,65,,76.7,percent of total billed charges,All Other,82.6,70,,82.6,percent of total billed charges,All Other,80.24,68,,80.24,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,94.4,80,,94.4,percent of total billed charges,All Other,97.94,83,,97.94,percent of total billed charges,All Other,97.94,83,,,percent of total billed charges,All Other,94.4,80,,94.4,percent of total billed charges,All Other,97.94,83,,97.94,percent of total billed charges,All Other,94.4,80,,94.4,percent of total billed charges,All Other,82.6,70,,82.6,percent of total billed charges,,76.7,65,,76.7,percent of total billed charges,All Other,76.7,65,,76.7,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,240.07,
ELECTRO HEARING AID TEST BOTH,92595,CPT,,66092595,CDM,470,RC,,,both,,,205,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,133.25,65,,133.25,percent of total billed charges,All Other,120.95,59,,120.95,percent of total billed charges,All Other,156.83,76.5,,156.83,percent of total billed charges,All Other,141.45,69,,141.45,percent of total billed charges,All Other,133.25,65,,133.25,percent of total billed charges,All Other,143.5,70,,143.5,percent of total billed charges,All Other,139.4,68,,139.4,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,164,80,,164,percent of total billed charges,All Other,170.15,83,,170.15,percent of total billed charges,All Other,170.15,83,,,percent of total billed charges,All Other,164,80,,164,percent of total billed charges,All Other,170.15,83,,170.15,percent of total billed charges,All Other,164,80,,164,percent of total billed charges,All Other,143.5,70,,143.5,percent of total billed charges,,133.25,65,,133.25,percent of total billed charges,All Other,133.25,65,,133.25,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,240.07,
HEARING AID REPAIR,V5014,HCPCS,,66000135,CDM,470,RC,,,both,,,0.01,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,0.01,65,,0.01,percent of total billed charges,All Other,0.01,59,,0.01,percent of total billed charges,All Other,0.01,76.5,,0.01,percent of total billed charges,All Other,0.01,69,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,All Other,0.01,68,,0.01,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,83,,,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,83,,0.01,percent of total billed charges,All Other,0.01,80,,0.01,percent of total billed charges,All Other,0.01,70,,0.01,percent of total billed charges,,0.01,65,,0.01,percent of total billed charges,All Other,0.01,65,,0.01,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,240.07,
DISPENSING FEE BINAURAL,V5160,HCPCS,,66000009,CDM,470,RC,,,both,,,1603,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1041.95,65,,1041.95,percent of total billed charges,All Other,945.77,59,,945.77,percent of total billed charges,All Other,1226.3,76.5,,1226.3,percent of total billed charges,All Other,1106.07,69,,1106.07,percent of total billed charges,All Other,1041.95,65,,1041.95,percent of total billed charges,All Other,1122.1,70,,1122.1,percent of total billed charges,All Other,1090.04,68,,1090.04,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,1282.4,80,,1282.4,percent of total billed charges,All Other,1330.49,83,,1330.49,percent of total billed charges,All Other,1330.49,83,,,percent of total billed charges,All Other,1282.4,80,,1282.4,percent of total billed charges,All Other,1330.49,83,,1330.49,percent of total billed charges,All Other,1282.4,80,,1282.4,percent of total billed charges,All Other,1122.1,70,,1122.1,percent of total billed charges,,1041.95,65,,1041.95,percent of total billed charges,All Other,1041.95,65,,1041.95,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,1330.49,
DISPENSING FEE BINAURAL WITH IMPRESSION,V5160,HCPCS,,66000146,CDM,470,RC,,,both,,,1603,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1041.95,65,,1041.95,percent of total billed charges,All Other,945.77,59,,945.77,percent of total billed charges,All Other,1226.3,76.5,,1226.3,percent of total billed charges,All Other,1106.07,69,,1106.07,percent of total billed charges,All Other,1041.95,65,,1041.95,percent of total billed charges,All Other,1122.1,70,,1122.1,percent of total billed charges,All Other,1090.04,68,,1090.04,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,1282.4,80,,1282.4,percent of total billed charges,All Other,1330.49,83,,1330.49,percent of total billed charges,All Other,1330.49,83,,,percent of total billed charges,All Other,1282.4,80,,1282.4,percent of total billed charges,All Other,1330.49,83,,1330.49,percent of total billed charges,All Other,1282.4,80,,1282.4,percent of total billed charges,All Other,1122.1,70,,1122.1,percent of total billed charges,,1041.95,65,,1041.95,percent of total billed charges,All Other,1041.95,65,,1041.95,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,1330.49,
DISPENSING FEE CROS,V5200,HCPCS,,66000141,CDM,470,RC,,,both,,,1542,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1002.3,65,,1002.3,percent of total billed charges,All Other,909.78,59,,909.78,percent of total billed charges,All Other,1179.63,76.5,,1179.63,percent of total billed charges,All Other,1063.98,69,,1063.98,percent of total billed charges,All Other,1002.3,65,,1002.3,percent of total billed charges,All Other,1079.4,70,,1079.4,percent of total billed charges,All Other,1048.56,68,,1048.56,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,1233.6,80,,1233.6,percent of total billed charges,All Other,1279.86,83,,1279.86,percent of total billed charges,All Other,1279.86,83,,,percent of total billed charges,All Other,1233.6,80,,1233.6,percent of total billed charges,All Other,1279.86,83,,1279.86,percent of total billed charges,All Other,1233.6,80,,1233.6,percent of total billed charges,All Other,1079.4,70,,1079.4,percent of total billed charges,,1002.3,65,,1002.3,percent of total billed charges,All Other,1002.3,65,,1002.3,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,1279.86,
DISPENSING FEE CROS WITH IMPRESSION,V5200,HCPCS,,66000147,CDM,470,RC,,,both,,,1542,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1002.3,65,,1002.3,percent of total billed charges,All Other,909.78,59,,909.78,percent of total billed charges,All Other,1179.63,76.5,,1179.63,percent of total billed charges,All Other,1063.98,69,,1063.98,percent of total billed charges,All Other,1002.3,65,,1002.3,percent of total billed charges,All Other,1079.4,70,,1079.4,percent of total billed charges,All Other,1048.56,68,,1048.56,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,1233.6,80,,1233.6,percent of total billed charges,All Other,1279.86,83,,1279.86,percent of total billed charges,All Other,1279.86,83,,,percent of total billed charges,All Other,1233.6,80,,1233.6,percent of total billed charges,All Other,1279.86,83,,1279.86,percent of total billed charges,All Other,1233.6,80,,1233.6,percent of total billed charges,All Other,1079.4,70,,1079.4,percent of total billed charges,,1002.3,65,,1002.3,percent of total billed charges,All Other,1002.3,65,,1002.3,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,1279.86,
DISPENSING FEE BICROS,V5240,HCPCS,,66000140,CDM,470,RC,,,both,,,1470,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,955.5,65,,955.5,percent of total billed charges,All Other,867.3,59,,867.3,percent of total billed charges,All Other,1124.55,76.5,,1124.55,percent of total billed charges,All Other,1014.3,69,,1014.3,percent of total billed charges,All Other,955.5,65,,955.5,percent of total billed charges,All Other,1029,70,,1029,percent of total billed charges,All Other,999.6,68,,999.6,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,1176,80,,1176,percent of total billed charges,All Other,1220.1,83,,1220.1,percent of total billed charges,All Other,1220.1,83,,,percent of total billed charges,All Other,1176,80,,1176,percent of total billed charges,All Other,1220.1,83,,1220.1,percent of total billed charges,All Other,1176,80,,1176,percent of total billed charges,All Other,1029,70,,1029,percent of total billed charges,,955.5,65,,955.5,percent of total billed charges,All Other,955.5,65,,955.5,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,1220.1,
DISPENSING FEE BICROS WITH IMPRESSION,V5240,HCPCS,,66000145,CDM,470,RC,,,both,,,1470,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,955.5,65,,955.5,percent of total billed charges,All Other,867.3,59,,867.3,percent of total billed charges,All Other,1124.55,76.5,,1124.55,percent of total billed charges,All Other,1014.3,69,,1014.3,percent of total billed charges,All Other,955.5,65,,955.5,percent of total billed charges,All Other,1029,70,,1029,percent of total billed charges,All Other,999.6,68,,999.6,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,1176,80,,1176,percent of total billed charges,All Other,1220.1,83,,1220.1,percent of total billed charges,All Other,1220.1,83,,,percent of total billed charges,All Other,1176,80,,1176,percent of total billed charges,All Other,1220.1,83,,1220.1,percent of total billed charges,All Other,1176,80,,1176,percent of total billed charges,All Other,1029,70,,1029,percent of total billed charges,,955.5,65,,955.5,percent of total billed charges,All Other,955.5,65,,955.5,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,1220.1,
DISPENSING FEE MONAURAL,V5241,HCPCS,,66000010,CDM,470,RC,,,both,,,1542,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1002.3,65,,1002.3,percent of total billed charges,All Other,909.78,59,,909.78,percent of total billed charges,All Other,1179.63,76.5,,1179.63,percent of total billed charges,All Other,1063.98,69,,1063.98,percent of total billed charges,All Other,1002.3,65,,1002.3,percent of total billed charges,All Other,1079.4,70,,1079.4,percent of total billed charges,All Other,1048.56,68,,1048.56,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,1233.6,80,,1233.6,percent of total billed charges,All Other,1279.86,83,,1279.86,percent of total billed charges,All Other,1279.86,83,,,percent of total billed charges,All Other,1233.6,80,,1233.6,percent of total billed charges,All Other,1279.86,83,,1279.86,percent of total billed charges,All Other,1233.6,80,,1233.6,percent of total billed charges,All Other,1079.4,70,,1079.4,percent of total billed charges,,1002.3,65,,1002.3,percent of total billed charges,All Other,1002.3,65,,1002.3,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,1279.86,
DISPENSING FEE MONAURAL WITH IMPRESSION,V5241,HCPCS,,66000148,CDM,470,RC,,,both,,,1542,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1002.3,65,,1002.3,percent of total billed charges,All Other,909.78,59,,909.78,percent of total billed charges,All Other,1179.63,76.5,,1179.63,percent of total billed charges,All Other,1063.98,69,,1063.98,percent of total billed charges,All Other,1002.3,65,,1002.3,percent of total billed charges,All Other,1079.4,70,,1079.4,percent of total billed charges,All Other,1048.56,68,,1048.56,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,1233.6,80,,1233.6,percent of total billed charges,All Other,1279.86,83,,1279.86,percent of total billed charges,All Other,1279.86,83,,,percent of total billed charges,All Other,1233.6,80,,1233.6,percent of total billed charges,All Other,1279.86,83,,1279.86,percent of total billed charges,All Other,1233.6,80,,1233.6,percent of total billed charges,All Other,1079.4,70,,1079.4,percent of total billed charges,,1002.3,65,,1002.3,percent of total billed charges,All Other,1002.3,65,,1002.3,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,1279.86,
HEARING SERVICE,V5299,HCPCS,,66000134,CDM,470,RC,,,both,,,40,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26,65,,26,percent of total billed charges,All Other,23.6,59,,23.6,percent of total billed charges,All Other,30.6,76.5,,30.6,percent of total billed charges,All Other,27.6,69,,27.6,percent of total billed charges,All Other,26,65,,26,percent of total billed charges,All Other,28,70,,28,percent of total billed charges,All Other,27.2,68,,27.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,32,80,,32,percent of total billed charges,All Other,33.2,83,,33.2,percent of total billed charges,All Other,33.2,83,,,percent of total billed charges,All Other,32,80,,32,percent of total billed charges,All Other,33.2,83,,33.2,percent of total billed charges,All Other,32,80,,32,percent of total billed charges,All Other,28,70,,28,percent of total billed charges,,26,65,,26,percent of total billed charges,All Other,26,65,,26,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,33.2,
REPAIR/MOD AUGMENTATION COMMUN,V5336,HCPCS,,66000119,CDM,470,RC,,,both,,,179,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,116.35,65,,116.35,percent of total billed charges,All Other,105.61,59,,105.61,percent of total billed charges,All Other,136.94,76.5,,136.94,percent of total billed charges,All Other,123.51,69,,123.51,percent of total billed charges,All Other,116.35,65,,116.35,percent of total billed charges,All Other,125.3,70,,125.3,percent of total billed charges,All Other,121.72,68,,121.72,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,143.2,80,,143.2,percent of total billed charges,All Other,148.57,83,,148.57,percent of total billed charges,All Other,148.57,83,,,percent of total billed charges,All Other,143.2,80,,143.2,percent of total billed charges,All Other,148.57,83,,148.57,percent of total billed charges,All Other,143.2,80,,143.2,percent of total billed charges,All Other,125.3,70,,125.3,percent of total billed charges,,116.35,65,,116.35,percent of total billed charges,All Other,116.35,65,,116.35,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,148.57,
SPEECH/HEARING THERAPY INDIV,92507,CPT,,66092507,CDM,471,RC,,,both,,,539,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180,,,180,Fee Schedule,,162,,,162,Fee Schedule,,521.42,,,521.42,Fee Schedule,,469.09,,,469.09,Fee Schedule,,443.4,,,443.4,Fee Schedule,,377.3,70,,377.3,percent of total billed charges,All Other,0.01,,,0.01,Case Rate,,200,,,200,Other,186% of Medicaid,180,,,180,Case Rate,,169.13,,,169.13,Case Rate,,169.13,,,,Case Rate,,180,,,180,Case Rate,,169.13,,,169.13,Case Rate,,368,,,368,Case Rate,,377.3,70,,377.3,percent of total billed charges,,370.64,,,370.64,Fee Schedule,,314.14,,,314.14,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,521.42,
SPONTANEOUS NYSTAGMUS GAZE & FIX,92541,CPT,,66092541,CDM,471,RC,,,both,,,697,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,453.05,65,,453.05,percent of total billed charges,All Other,411.23,59,,411.23,percent of total billed charges,All Other,176.18,,,176.18,Fee Schedule,,158.5,,,158.5,Fee Schedule,,149.82,,,149.82,Fee Schedule,,487.9,70,,487.9,percent of total billed charges,All Other,18.04,,,18.04,Fee Schedule,,138,,,138,Other,186% of Medicaid,21.23,,,21.23,Fee Schedule,,432.14,,,432.14,Fee Schedule,,10,,,,Fee Schedule,,21.23,,,21.23,Fee Schedule,,432.14,,,432.14,Fee Schedule,,557.6,80,,557.6,percent of total billed charges,All Other,487.9,70,,487.9,percent of total billed charges,,22.96,,,22.96,Fee Schedule,,19.46,,,19.46,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,10,557.6,
POSITIONAL NYSTAGMUS MIN 4 POS,92542,CPT,,66092542,CDM,471,RC,,,both,,,697,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,453.05,65,,453.05,percent of total billed charges,All Other,411.23,59,,411.23,percent of total billed charges,All Other,197.61,,,197.61,Fee Schedule,,177.78,,,177.78,Fee Schedule,,168.04,,,168.04,Fee Schedule,,487.9,70,,487.9,percent of total billed charges,All Other,18.04,,,18.04,Fee Schedule,,138,,,138,Other,186% of Medicaid,21.23,,,21.23,Fee Schedule,,432.14,,,432.14,Fee Schedule,,10,,,,Fee Schedule,,21.23,,,21.23,Fee Schedule,,432.14,,,432.14,Fee Schedule,,557.6,80,,557.6,percent of total billed charges,All Other,487.9,70,,487.9,percent of total billed charges,,21.32,,,21.32,Fee Schedule,,18.07,,,18.07,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,10,557.6,
OPTOKINETIC NYSTAGMUS W RECORD,92544,CPT,,66092544,CDM,471,RC,,,both,,,697,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,453.05,65,,453.05,percent of total billed charges,All Other,411.23,59,,411.23,percent of total billed charges,All Other,166.65,,,166.65,Fee Schedule,,149.92,,,149.92,Fee Schedule,,141.71,,,141.71,Fee Schedule,,487.9,70,,487.9,percent of total billed charges,All Other,15.31,,,15.31,Fee Schedule,,138,,,138,Other,186% of Medicaid,18.02,,,18.02,Fee Schedule,,432.14,,,432.14,Fee Schedule,,8.48,,,,Fee Schedule,,18.02,,,18.02,Fee Schedule,,432.14,,,432.14,Fee Schedule,,557.6,80,,557.6,percent of total billed charges,All Other,487.9,70,,487.9,percent of total billed charges,,18.04,,,18.04,Fee Schedule,,15.29,,,15.29,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,8.48,557.6,
OSCILLATING TRACKING W RECORD,92545,CPT,,66092545,CDM,471,RC,,,both,,,697,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,453.05,65,,453.05,percent of total billed charges,All Other,411.23,59,,411.23,percent of total billed charges,All Other,159.52,,,159.52,Fee Schedule,,143.51,,,143.51,Fee Schedule,,135.65,,,135.65,Fee Schedule,,487.9,70,,487.9,percent of total billed charges,All Other,15.31,,,15.31,Fee Schedule,,138,,,138,Other,186% of Medicaid,18.02,,,18.02,Fee Schedule,,432.14,,,432.14,Fee Schedule,,8.48,,,,Fee Schedule,,18.02,,,18.02,Fee Schedule,,432.14,,,432.14,Fee Schedule,,557.6,80,,557.6,percent of total billed charges,All Other,487.9,70,,487.9,percent of total billed charges,,18.04,,,18.04,Fee Schedule,,15.29,,,15.29,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,8.48,567.18,
USE VERTICAL ELECTRODES,92547,CPT,,66092547,CDM,471,RC,,,both,,,697,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,453.05,65,,453.05,percent of total billed charges,All Other,411.23,59,,411.23,percent of total billed charges,All Other,35.78,,,35.78,Fee Schedule,,32.19,,,32.19,Fee Schedule,,30.43,,,30.43,Fee Schedule,,487.9,70,,487.9,percent of total billed charges,All Other,43.93,,,43.93,Fee Schedule,,221,,,221,Other,186% of Medicaid,51.69,,,51.69,Fee Schedule,,432.14,,,432.14,Fee Schedule,,24.34,,,,Fee Schedule,,51.69,,,51.69,Fee Schedule,,432.14,,,432.14,Fee Schedule,,557.6,80,,557.6,percent of total billed charges,All Other,487.9,70,,487.9,percent of total billed charges,,50.84,,,50.84,Fee Schedule,,43.09,,,43.09,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,119,,,119,Other,100% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,182.08,,,182.08,Other,153% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,166.6,,,166.6,Other,140% of Medicaid,267.76,,,267.76,Other,225% of Medicaid,309.41,,,309.41,Other,250% of Medicaid,385.57,,,385.57,Other,324% of Medicaid,255.86,,,255.86,Other,215% of Medicaid,255.86,,,255.86,Other,215% of Medicaid,148.75,,,148.75,Other,125% of Medicaid,0.01,557.6,
TYMPANOMETRY & REFLEX THRESH,92550,CPT,,66092550,CDM,471,RC,,,both,,,329,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,130.42,,,130.42,Fee Schedule,,117.33,,,117.33,Fee Schedule,,110.91,,,110.91,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,86.83,,,86.83,Fee Schedule,,132,,,132,Other,186% of Medicaid,102.18,,,102.18,Fee Schedule,,203.98,,,203.98,Fee Schedule,,48.11,,,,Fee Schedule,,102.18,,,102.18,Fee Schedule,,203.98,,,203.98,Fee Schedule,,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,108.24,,,108.24,Fee Schedule,,91.74,,,91.74,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,48.11,382,
PTA; AIR ONLY,92552,CPT,,66092552,CDM,471,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,170.95,65,,170.95,percent of total billed charges,All Other,155.17,59,,155.17,percent of total billed charges,All Other,178.59,,,178.59,Fee Schedule,,160.67,,,160.67,Fee Schedule,,151.87,,,151.87,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,156.68,,,156.68,Fee Schedule,,138,,,138,Other,186% of Medicaid,184.38,,,184.38,Fee Schedule,,163.06,,,163.06,Fee Schedule,,86.81,,,,Fee Schedule,,184.38,,,184.38,Fee Schedule,,163.06,,,163.06,Fee Schedule,,210.4,80,,210.4,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,,162.36,,,162.36,Fee Schedule,,137.61,,,137.61,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,74.1,382,
PTA; AIR AND BONE,92553,CPT,,66092553,CDM,471,RC,,,both,,,329,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,226.16,,,226.16,Fee Schedule,,203.46,,,203.46,Fee Schedule,,192.32,,,192.32,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,189.61,,,189.61,Fee Schedule,,132,,,132,Other,186% of Medicaid,223.13,,,223.13,Fee Schedule,,203.98,,,203.98,Fee Schedule,,105.06,,,,Fee Schedule,,223.13,,,223.13,Fee Schedule,,203.98,,,203.98,Fee Schedule,,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,196.8,,,196.8,Fee Schedule,,166.8,,,166.8,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,71.1,382,
SPEECH AUDIOM THRESHOLD,92555,CPT,,66092555,CDM,471,RC,,,both,,,170,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,110.5,65,,110.5,percent of total billed charges,All Other,100.3,59,,100.3,percent of total billed charges,All Other,130.97,,,130.97,Fee Schedule,,117.83,,,117.83,Fee Schedule,,111.37,,,111.37,Fee Schedule,,119,70,,119,percent of total billed charges,All Other,119.61,,,119.61,Fee Schedule,,138,,,138,Other,186% of Medicaid,140.76,,,140.76,Fee Schedule,,105.4,,,105.4,Fee Schedule,,66.28,,,,Fee Schedule,,140.76,,,140.76,Fee Schedule,,105.4,,,105.4,Fee Schedule,,136,80,,136,percent of total billed charges,All Other,119,70,,119,percent of total billed charges,,123,,,123,Fee Schedule,,104.25,,,104.25,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,66.28,382,
SA THRESHOLD; W SR,92556,CPT,,66092556,CDM,471,RC,,,both,,,185,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,120.25,65,,120.25,percent of total billed charges,All Other,109.15,59,,109.15,percent of total billed charges,All Other,202.38,,,202.38,Fee Schedule,,182.06,,,182.06,Fee Schedule,,172.09,,,172.09,Fee Schedule,,129.5,70,,129.5,percent of total billed charges,All Other,185.48,,,185.48,Fee Schedule,,138,,,138,Other,186% of Medicaid,218.27,,,218.27,Fee Schedule,,114.7,,,114.7,Fee Schedule,,102.77,,,,Fee Schedule,,218.27,,,218.27,Fee Schedule,,114.7,,,114.7,Fee Schedule,,148,80,,148,percent of total billed charges,All Other,129.5,70,,129.5,percent of total billed charges,,193.52,,,193.52,Fee Schedule,,164.02,,,164.02,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,67.21,382,
CAE W SR,92557,CPT,,66092557,CDM,471,RC,,,both,,,378,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,245.7,65,,245.7,percent of total billed charges,All Other,223.02,59,,223.02,percent of total billed charges,All Other,258,,,258,Fee Schedule,,232.1,,,232.1,Fee Schedule,,219.39,,,219.39,Fee Schedule,,264.6,70,,264.6,percent of total billed charges,All Other,124.96,,,124.96,Fee Schedule,,132,,,132,Other,186% of Medicaid,147.05,,,147.05,Fee Schedule,,234.36,,,234.36,Fee Schedule,,69.24,,,,Fee Schedule,,147.05,,,147.05,Fee Schedule,,234.36,,,234.36,Fee Schedule,,302.4,80,,302.4,percent of total billed charges,All Other,264.6,70,,264.6,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,69.24,382,
TONE DECAY TEST,92563,CPT,,66092563,CDM,471,RC,,,both,,,362,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,235.3,65,,235.3,percent of total billed charges,All Other,213.58,59,,213.58,percent of total billed charges,All Other,165.26,,,165.26,Fee Schedule,,148.77,,,148.77,Fee Schedule,,140.52,,,140.52,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,246.16,68,,246.16,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,289.6,80,,289.6,percent of total billed charges,All Other,300.46,83,,300.46,percent of total billed charges,All Other,300.46,83,,,percent of total billed charges,All Other,289.6,80,,289.6,percent of total billed charges,All Other,300.46,83,,300.46,percent of total billed charges,All Other,148.99,,,148.99,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,,154.16,,,154.16,Fee Schedule,,130.66,,,130.66,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,300.46,
TYMPANOMETRY,92567,CPT,,66092567,CDM,471,RC,,,both,,,185,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,120.25,65,,120.25,percent of total billed charges,All Other,109.15,59,,109.15,percent of total billed charges,All Other,98.69,,,98.69,Fee Schedule,,88.79,,,88.79,Fee Schedule,,83.93,,,83.93,Fee Schedule,,129.5,70,,129.5,percent of total billed charges,All Other,42.64,,,42.64,Fee Schedule,,138,,,138,Other,186% of Medicaid,50.18,,,50.18,Fee Schedule,,114.7,,,114.7,Fee Schedule,,23.63,,,,Fee Schedule,,50.18,,,50.18,Fee Schedule,,114.7,,,114.7,Fee Schedule,,148,80,,148,percent of total billed charges,All Other,129.5,70,,129.5,percent of total billed charges,,50.84,,,50.84,Fee Schedule,,43.09,,,43.09,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,23.63,382,
ACOUSTIC REFL THRESHOLD TST,92568,CPT,,66092568,CDM,471,RC,,,both,,,362,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,235.3,65,,235.3,percent of total billed charges,All Other,213.58,59,,213.58,percent of total billed charges,All Other,104.39,,,104.39,Fee Schedule,,93.92,,,93.92,Fee Schedule,,88.77,,,88.77,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,58.44,,,58.44,Fee Schedule,,138,,,138,Other,186% of Medicaid,68.77,,,68.77,Fee Schedule,,224.44,,,224.44,Fee Schedule,,32.38,,,,Fee Schedule,,68.77,,,68.77,Fee Schedule,,224.44,,,224.44,Fee Schedule,,289.6,80,,289.6,percent of total billed charges,All Other,253.4,70,,253.4,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,32.38,382,
ACOUSTIC IMMITTANCE TESTING,92570,CPT,,66092570,CDM,471,RC,,,both,,,362,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,235.3,65,,235.3,percent of total billed charges,All Other,213.58,59,,213.58,percent of total billed charges,All Other,200.62,,,200.62,Fee Schedule,,180.49,,,180.49,Fee Schedule,,170.6,,,170.6,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,114.34,,,114.34,Fee Schedule,,132,,,132,Other,186% of Medicaid,134.56,,,134.56,Fee Schedule,,224.44,,,224.44,Fee Schedule,,63.36,,,,Fee Schedule,,134.56,,,134.56,Fee Schedule,,224.44,,,224.44,Fee Schedule,,289.6,80,,289.6,percent of total billed charges,All Other,253.4,70,,253.4,percent of total billed charges,,142.68,,,142.68,Fee Schedule,,120.93,,,120.93,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,63.36,382,
STAGGERED SPONDAIC WORD TEST,92572,CPT,,66092572,CDM,471,RC,,,both,,,329,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,210.48,,,210.48,Fee Schedule,,189.48,,,189.48,Fee Schedule,,178.97,,,178.97,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,223.72,68,,223.72,percent of total billed charges,All Other,132,,,132,Other,186% of Medicaid,263.2,80,,263.2,percent of total billed charges,All Other,273.07,83,,273.07,percent of total billed charges,All Other,273.07,83,,,percent of total billed charges,All Other,263.2,80,,263.2,percent of total billed charges,All Other,273.07,83,,273.07,percent of total billed charges,All Other,229.1,,,229.1,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,,198.44,,,198.44,Fee Schedule,,168.19,,,168.19,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,0.01,282.26,
VRA,92579,CPT,,66092579,CDM,471,RC,,,both,,,394,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,256.1,65,,256.1,percent of total billed charges,All Other,232.46,59,,232.46,percent of total billed charges,All Other,275.21,,,275.21,Fee Schedule,,247.58,,,247.58,Fee Schedule,,234.03,,,234.03,Fee Schedule,,275.8,70,,275.8,percent of total billed charges,All Other,144.82,,,144.82,Fee Schedule,,132,,,132,Other,186% of Medicaid,170.42,,,170.42,Fee Schedule,,244.28,,,244.28,Fee Schedule,,80.24,,,,Fee Schedule,,170.42,,,170.42,Fee Schedule,,244.28,,,244.28,Fee Schedule,,315.2,80,,315.2,percent of total billed charges,All Other,275.8,70,,275.8,percent of total billed charges,,182.04,,,182.04,Fee Schedule,,154.29,,,154.29,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,71.1,382,
CONDITIONING PLAY AUDIOMETRY,92582,CPT,,66092582,CDM,471,RC,,,both,,,394,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,256.1,65,,256.1,percent of total billed charges,All Other,232.46,59,,232.46,percent of total billed charges,All Other,359.43,,,359.43,Fee Schedule,,323.36,,,323.36,Fee Schedule,,305.65,,,305.65,Fee Schedule,,275.8,70,,275.8,percent of total billed charges,All Other,357.06,,,357.06,Fee Schedule,,132,,,132,Other,186% of Medicaid,420.18,,,420.18,Fee Schedule,,244.28,,,244.28,Fee Schedule,,197.84,,,,Fee Schedule,,420.18,,,420.18,Fee Schedule,,244.28,,,244.28,Fee Schedule,,315.2,80,,315.2,percent of total billed charges,All Other,275.8,70,,275.8,percent of total billed charges,,373.92,,,373.92,Fee Schedule,,316.92,,,316.92,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,71.1,420.18,
SELECT PICTURE AUDIOMETRY,92583,CPT,,66092583,CDM,471,RC,,,both,,,362,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,235.3,65,,235.3,percent of total billed charges,All Other,213.58,59,,213.58,percent of total billed charges,All Other,237.63,,,237.63,Fee Schedule,,213.91,,,213.91,Fee Schedule,,202.05,,,202.05,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,246.16,68,,246.16,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,289.6,80,,289.6,percent of total billed charges,All Other,300.46,83,,300.46,percent of total billed charges,All Other,300.46,83,,,percent of total billed charges,All Other,289.6,80,,289.6,percent of total billed charges,All Other,300.46,83,,300.46,percent of total billed charges,All Other,244.82,,,244.82,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,,244.36,,,244.36,Fee Schedule,,207.11,,,207.11,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,300.46,
EAR PROTECTOR EVAL,92596,CPT,,66092596,CDM,471,RC,,,both,,,78,72.47,,,72.47,Other,150% of Medicare + 9.63% HCRA Surcharge,44.07,,,44.07,Other,Medicare OPPS,50.7,65,,50.7,percent of total billed charges,All Other,46.02,59,,46.02,percent of total billed charges,All Other,59.67,76.5,,59.67,percent of total billed charges,All Other,53.82,69,,53.82,percent of total billed charges,All Other,50.7,65,,50.7,percent of total billed charges,All Other,54.6,70,,54.6,percent of total billed charges,All Other,53.04,68,,53.04,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,62.4,80,,62.4,percent of total billed charges,All Other,64.74,83,,64.74,percent of total billed charges,All Other,64.74,83,,,percent of total billed charges,All Other,62.4,80,,62.4,percent of total billed charges,All Other,64.74,83,,64.74,percent of total billed charges,All Other,330.65,,,330.65,Fee Schedule,,54.6,70,,54.6,percent of total billed charges,,331.28,,,331.28,Fee Schedule,,280.78,,,280.78,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,331.28,
CENTRAL AUDITORY FCN INIT 60 MIN,92620,CPT,,66092620,CDM,471,RC,,,both,,,406,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,263.9,65,,263.9,percent of total billed charges,All Other,239.54,59,,239.54,percent of total billed charges,All Other,515.28,,,515.28,Fee Schedule,,463.57,,,463.57,Fee Schedule,,438.18,,,438.18,Fee Schedule,,284.2,70,,284.2,percent of total billed charges,All Other,311.01,,,311.01,Fee Schedule,,200,,,200,Other,186% of Medicaid,365.99,,,365.99,Fee Schedule,,251.72,,,251.72,Fee Schedule,,172.33,,,,Fee Schedule,,365.99,,,365.99,Fee Schedule,,251.72,,,251.72,Fee Schedule,,324.8,80,,324.8,percent of total billed charges,All Other,284.2,70,,284.2,percent of total billed charges,,387.04,,,387.04,Fee Schedule,,328.04,,,328.04,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,107.52,515.28,
AUDITORY FUNCTION + 15 MIN,92621,CPT,,66092621,CDM,471,RC,,,both,,,93,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,60.45,65,,60.45,percent of total billed charges,All Other,54.87,59,,54.87,percent of total billed charges,All Other,118.48,,,118.48,Fee Schedule,,106.59,,,106.59,Fee Schedule,,100.75,,,100.75,Fee Schedule,,65.1,70,,65.1,percent of total billed charges,All Other,73.07,,,73.07,Fee Schedule,,200,,,200,Other,186% of Medicaid,85.99,,,85.99,Fee Schedule,,57.66,,,57.66,Fee Schedule,,40.49,,,,Fee Schedule,,85.99,,,85.99,Fee Schedule,,57.66,,,57.66,Fee Schedule,,74.4,80,,74.4,percent of total billed charges,All Other,65.1,70,,65.1,percent of total billed charges,,90.2,,,90.2,Fee Schedule,,76.45,,,76.45,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,382,
TINNITUS ASSESSMENT,92625,CPT,,66092625,CDM,471,RC,,,both,,,329,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,374.86,,,374.86,Fee Schedule,,337.45,,,337.45,Fee Schedule,,318.74,,,318.74,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,223.72,68,,223.72,percent of total billed charges,All Other,132,,,132,Other,186% of Medicaid,263.2,80,,263.2,percent of total billed charges,All Other,273.07,83,,273.07,percent of total billed charges,All Other,273.07,83,,,percent of total billed charges,All Other,263.2,80,,263.2,percent of total billed charges,All Other,273.07,83,,273.07,percent of total billed charges,All Other,249.4,,,249.4,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,0.01,374.86,
EVAL AUD REHAB STATUS,92626,CPT,,66092626,CDM,471,RC,,,both,,,441,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,286.65,65,,286.65,percent of total billed charges,All Other,260.19,59,,260.19,percent of total billed charges,All Other,529.04,,,529.04,Fee Schedule,,475.94,,,475.94,Fee Schedule,,449.88,,,449.88,Fee Schedule,,308.7,70,,308.7,percent of total billed charges,All Other,292.36,,,292.36,Fee Schedule,,200,,,200,Other,186% of Medicaid,344.04,,,344.04,Fee Schedule,,273.42,,,273.42,Fee Schedule,,161.99,,,,Fee Schedule,,344.04,,,344.04,Fee Schedule,,273.42,,,273.42,Fee Schedule,,352.8,80,,352.8,percent of total billed charges,All Other,308.7,70,,308.7,percent of total billed charges,,359.16,,,359.16,Fee Schedule,,304.41,,,304.41,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,107.52,529.04,
EVAL AUD STATUS REHAB EA ADDL 15 MIN,92627,CPT,,66092627,CDM,471,RC,,,both,,,111,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,58.19,,,58.19,Fee Schedule,,52.35,,,52.35,Fee Schedule,,128.89,,,128.89,Fee Schedule,,115.95,,,115.95,Fee Schedule,,109.6,,,109.6,Fee Schedule,,77.7,70,,77.7,percent of total billed charges,All Other,69.13,,,69.13,Fee Schedule,,200,,,200,Other,186% of Medicaid,81.35,,,81.35,Fee Schedule,,68.82,,,68.82,Fee Schedule,,38.3,,,,Fee Schedule,,81.35,,,81.35,Fee Schedule,,68.82,,,68.82,Fee Schedule,,368,,,368,Case Rate,,77.7,70,,77.7,percent of total billed charges,,85.28,,,85.28,Fee Schedule,,72.28,,,72.28,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,107.52,,,107.52,Other,100% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,164.51,,,164.51,Other,153% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,150.53,,,150.53,Other,140% of Medicaid,241.92,,,241.92,Other,225% of Medicaid,279.56,,,279.56,Other,250% of Medicaid,348.37,,,348.37,Other,324% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,231.17,,,231.17,Other,215% of Medicaid,134.4,,,134.4,Other,125% of Medicaid,0.01,382,
AEP HEARING STATUS DETER I&R,92651,CPT,,66092651,CDM,471,RC,,,both,,,457,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,297.05,65,,297.05,percent of total billed charges,All Other,269.63,59,,269.63,percent of total billed charges,All Other,86.57,,,86.57,Fee Schedule,,86.57,,,86.57,Fee Schedule,,86.57,,,86.57,Fee Schedule,,319.9,70,,319.9,percent of total billed charges,All Other,333.97,,,333.97,Fee Schedule,,132,,,132,Other,186% of Medicaid,393.02,,,393.02,Fee Schedule,,283.34,,,283.34,Fee Schedule,,185.05,,,,Fee Schedule,,393.02,,,393.02,Fee Schedule,,283.34,,,283.34,Fee Schedule,,365.6,80,,365.6,percent of total billed charges,All Other,319.9,70,,319.9,percent of total billed charges,,428.04,,,428.04,Fee Schedule,,362.79,,,362.79,Fee Schedule,,382,,,382,Case Rate,,343,,,343,Case Rate,,382,,,382,Case Rate,,324,,,324,Case Rate,,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,71.1,,,71.1,Other,100% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,108.78,,,108.78,Other,153% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,99.54,,,99.54,Other,140% of Medicaid,159.98,,,159.98,Other,225% of Medicaid,184.86,,,184.86,Other,250% of Medicaid,230.37,,,230.37,Other,324% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,152.87,,,152.87,Other,215% of Medicaid,88.88,,,88.88,Other,125% of Medicaid,71.1,567.18,
ASSESSMENT FOR HEARING AID,V5010,HCPCS,,66000002,CDM,471,RC,,,both,,,239,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,155.35,65,,155.35,percent of total billed charges,All Other,141.01,59,,141.01,percent of total billed charges,All Other,182.84,76.5,,182.84,percent of total billed charges,All Other,164.91,69,,164.91,percent of total billed charges,All Other,155.35,65,,155.35,percent of total billed charges,All Other,167.3,70,,167.3,percent of total billed charges,All Other,162.52,68,,162.52,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,191.2,80,,191.2,percent of total billed charges,All Other,198.37,83,,198.37,percent of total billed charges,All Other,198.37,83,,,percent of total billed charges,All Other,191.2,80,,191.2,percent of total billed charges,All Other,198.37,83,,198.37,percent of total billed charges,All Other,191.2,80,,191.2,percent of total billed charges,All Other,167.3,70,,167.3,percent of total billed charges,,155.35,65,,155.35,percent of total billed charges,All Other,155.35,65,,155.35,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,240.07,
CONFORMITY EVALUATION,V5020,HCPCS,,66000008,CDM,471,RC,,,both,,,220,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,143,65,,143,percent of total billed charges,All Other,129.8,59,,129.8,percent of total billed charges,All Other,168.3,76.5,,168.3,percent of total billed charges,All Other,151.8,69,,151.8,percent of total billed charges,All Other,143,65,,143,percent of total billed charges,All Other,154,70,,154,percent of total billed charges,All Other,149.6,68,,149.6,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,176,80,,176,percent of total billed charges,All Other,182.6,83,,182.6,percent of total billed charges,All Other,182.6,83,,,percent of total billed charges,All Other,176,80,,176,percent of total billed charges,All Other,182.6,83,,182.6,percent of total billed charges,All Other,176,80,,176,percent of total billed charges,All Other,154,70,,154,percent of total billed charges,,143,65,,143,percent of total billed charges,All Other,143,65,,143,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,240.07,
HEARING AID FITTING/CHECKING,V5011,HCPCS,,66000003,CDM,472,RC,,,both,,,1166,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,757.9,65,,757.9,percent of total billed charges,All Other,687.94,59,,687.94,percent of total billed charges,All Other,891.99,76.5,,891.99,percent of total billed charges,All Other,804.54,69,,804.54,percent of total billed charges,All Other,757.9,65,,757.9,percent of total billed charges,All Other,816.2,70,,816.2,percent of total billed charges,All Other,792.88,68,,792.88,percent of total billed charges,All Other,138,,,138,Other,186% of Medicaid,932.8,80,,932.8,percent of total billed charges,All Other,967.78,83,,967.78,percent of total billed charges,All Other,967.78,83,,,percent of total billed charges,All Other,932.8,80,,932.8,percent of total billed charges,All Other,967.78,83,,967.78,percent of total billed charges,All Other,932.8,80,,932.8,percent of total billed charges,All Other,816.2,70,,816.2,percent of total billed charges,,757.9,65,,757.9,percent of total billed charges,All Other,757.9,65,,757.9,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,74.1,,,74.1,Other,100% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,113.37,,,113.37,Other,153% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,103.74,,,103.74,Other,140% of Medicaid,166.72,,,166.72,Other,225% of Medicaid,192.65,,,192.65,Other,250% of Medicaid,240.07,,,240.07,Other,324% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,159.31,,,159.31,Other,215% of Medicaid,92.62,,,92.62,Other,125% of Medicaid,0.01,967.78,
PRGRMG DEV EVAL ICDS SS IP,0575T,HCPCS,,49000017,CDM,480,RC,,,both,,,119,68.14,,,68.14,Other,150% of Medicare + 9.63% HCRA Surcharge,41.44,,,41.44,Other,Medicare OPPS,77.35,65,,77.35,percent of total billed charges,All Other,70.21,59,,70.21,percent of total billed charges,All Other,23.74,,,23.74,Fee Schedule,,23.74,,,23.74,Fee Schedule,,23.74,,,23.74,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,80.92,68,,80.92,percent of total billed charges,All Other,142,,,142,Other,186% of Medicaid,95.2,80,,95.2,percent of total billed charges,All Other,98.77,83,,98.77,percent of total billed charges,All Other,98.77,83,,,percent of total billed charges,All Other,95.2,80,,95.2,percent of total billed charges,All Other,98.77,83,,98.77,percent of total billed charges,All Other,95.2,,,95.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",83.3,70,,83.3,percent of total billed charges,,77.35,65,,77.35,percent of total billed charges,All Other,77.35,65,,77.35,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,116.5,,,116.5,Other,153% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,106.6,,,106.6,Other,140% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,197.97,,,197.97,Other,250% of Medicaid,246.7,,,246.7,Other,324% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,95.18,,,95.18,Other,125% of Medicaid,23.74,3227,
INTERROG DEV EVAL ICDS SS IP,0576T,HCPCS,,49000018,CDM,480,RC,,,both,,,119,68.14,,,68.14,Other,150% of Medicare + 9.63% HCRA Surcharge,41.44,,,41.44,Other,Medicare OPPS,77.35,65,,77.35,percent of total billed charges,All Other,70.21,59,,70.21,percent of total billed charges,All Other,23.35,,,23.35,Fee Schedule,,23.35,,,23.35,Fee Schedule,,23.35,,,23.35,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,80.92,68,,80.92,percent of total billed charges,All Other,142,,,142,Other,186% of Medicaid,95.2,80,,95.2,percent of total billed charges,All Other,98.77,83,,98.77,percent of total billed charges,All Other,98.77,83,,,percent of total billed charges,All Other,95.2,80,,95.2,percent of total billed charges,All Other,98.77,83,,98.77,percent of total billed charges,All Other,95.2,,,95.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",83.3,70,,83.3,percent of total billed charges,,77.35,65,,77.35,percent of total billed charges,All Other,77.35,65,,77.35,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,116.5,,,116.5,Other,153% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,106.6,,,106.6,Other,140% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,197.97,,,197.97,Other,250% of Medicaid,246.7,,,246.7,Other,324% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,95.18,,,95.18,Other,125% of Medicaid,23.35,3227,
EPHYS EVAL ICDS SS,0577T,HCPCS,,49000019,CDM,480,RC,,,both,,,3234,2150.59,,,2150.59,Other,150% of Medicare + 9.63% HCRA Surcharge,1307.78,,,1307.78,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2263.8,70,,2263.8,percent of total billed charges,All Other,2199.12,,,2199.12,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,2587.2,,,2587.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2587.2,,,2587.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2587.2,,,2587.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2263.8,70,,2263.8,percent of total billed charges,,2102.1,65,,2102.1,percent of total billed charges,All Other,2102.1,65,,2102.1,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,449.69,7216,
REM INTERROG DEV ICDS TECH,0579T,HCPCS,,49000020,CDM,480,RC,,,both,,,119,68.14,,,68.14,Other,150% of Medicare + 9.63% HCRA Surcharge,41.44,,,41.44,Other,Medicare OPPS,77.35,65,,77.35,percent of total billed charges,All Other,70.21,59,,70.21,percent of total billed charges,All Other,25.51,,,25.51,Fee Schedule,,25.51,,,25.51,Fee Schedule,,25.51,,,25.51,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,80.92,68,,80.92,percent of total billed charges,All Other,142,,,142,Other,186% of Medicaid,95.2,80,,95.2,percent of total billed charges,All Other,98.77,83,,98.77,percent of total billed charges,All Other,98.77,83,,,percent of total billed charges,All Other,95.2,80,,95.2,percent of total billed charges,All Other,98.77,83,,98.77,percent of total billed charges,All Other,95.2,,,95.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",83.3,70,,83.3,percent of total billed charges,,77.35,65,,77.35,percent of total billed charges,All Other,77.35,65,,77.35,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,116.5,,,116.5,Other,153% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,106.6,,,106.6,Other,140% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,197.97,,,197.97,Other,250% of Medicaid,246.7,,,246.7,Other,324% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,95.18,,,95.18,Other,125% of Medicaid,25.51,3227,
N-INVAS EST C FFR SW ALY CTA,75580,CPT,,46075580,CDM,480,RC,,,both,,,2989,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS,3013.94,,,3013.94,Fee Schedule,,2711.6,,,2711.6,Fee Schedule,,2286.59,76.5,,2286.59,percent of total billed charges,All Other,2062.41,69,,2062.41,percent of total billed charges,All Other,1942.85,65,,1942.85,percent of total billed charges,All Other,2092.3,70,,2092.3,percent of total billed charges,All Other,3580.83,,,3580.83,Fee Schedule,,594,,,594,Other,186% of Medicaid,4213.85,,,4213.85,Fee Schedule,,1984.1,,,1984.1,Fee Schedule,,1984.1,,,,Fee Schedule,,4213.85,,,4213.85,Fee Schedule,,1984.1,,,1984.1,Fee Schedule,,2391.2,,,2391.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2092.3,70,,2092.3,percent of total billed charges,,1942.85,65,,1942.85,percent of total billed charges,All Other,1942.85,65,,1942.85,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,319.38,,,319.38,Other,100% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,488.66,,,488.66,Other,153% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,447.14,,,447.14,Other,140% of Medicaid,718.61,,,718.61,Other,225% of Medicaid,830.39,,,830.39,Other,250% of Medicaid,1034.8,,,1034.8,Other,324% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,686.67,,,686.67,Other,215% of Medicaid,399.23,,,399.23,Other,125% of Medicaid,319.38,4213.85,
PRQ CARDIAC ANGIOPLAST 1 ART,92920,CPT,,49092920,CDM,480,RC,,,both,,,16218,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7266,,,7266,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6539,,,6539,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",6176,,,6176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",11352.6,70,,11352.6,percent of total billed charges,All Other,11028.24,,,11028.24,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,12974.4,,,12974.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12974.4,,,12974.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12974.4,,,12974.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11352.6,70,,11352.6,percent of total billed charges,,2546.92,,,2546.92,Fee Schedule,,2158.67,,,2158.67,Fee Schedule,,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,2158.67,12974.4,
PRQ CARDIAC ANGIO ADDL ART,92921,CPT,,49000022,CDM,480,RC,,,both,,,8110,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,5677,70,,5677,percent of total billed charges,All Other,5514.8,,,5514.8,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,6488,,,6488,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",6488,,,6488,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,6488,,,6488,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5677,70,,5677,percent of total billed charges,,5271.5,65,,5271.5,percent of total billed charges,All Other,5271.5,65,,5271.5,percent of total billed charges,All Other,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,7216,
PRQ CARD STENT W/ANGIO 1 VSL,92928,CPT,,49092928,CDM,480,RC,,,both,,,32438,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",22706.6,70,,22706.6,percent of total billed charges,All Other,22057.84,,,22057.84,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,25950.4,,,25950.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",25950.4,,,25950.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,25950.4,,,25950.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",22706.6,70,,22706.6,percent of total billed charges,,2833.92,,,2833.92,Fee Schedule,,2401.92,,,2401.92,Fee Schedule,,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,2209.39,25950.4,
PRQ CARD STENT W/ANGIO ADDL,92929,CPT,,49000023,CDM,480,RC,,,both,,,16219,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,11353.3,70,,11353.3,percent of total billed charges,All Other,11028.92,,,11028.92,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,12975.2,,,12975.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12975.2,,,12975.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12975.2,,,12975.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11353.3,70,,11353.3,percent of total billed charges,,10542.35,65,,10542.35,percent of total billed charges,All Other,10542.35,65,,10542.35,percent of total billed charges,All Other,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,12975.2,
PRQ REVASC BYP GRAFT 1 VSL,92937,CPT,,49092937,CDM,480,RC,,,both,,,32438,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",22706.6,70,,22706.6,percent of total billed charges,All Other,22057.84,,,22057.84,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,25950.4,,,25950.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",25950.4,,,25950.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,25950.4,,,25950.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",22706.6,70,,22706.6,percent of total billed charges,,2830.64,,,2830.64,Fee Schedule,,2399.14,,,2399.14,Fee Schedule,,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,2209.39,25950.4,
PRQ REVASC BYP GRAFT ADDL,92938,CPT,,49000024,CDM,480,RC,,,both,,,16219,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,11353.3,70,,11353.3,percent of total billed charges,All Other,11028.92,,,11028.92,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,12975.2,,,12975.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12975.2,,,12975.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12975.2,,,12975.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11353.3,70,,11353.3,percent of total billed charges,,10542.35,65,,10542.35,percent of total billed charges,All Other,10542.35,65,,10542.35,percent of total billed charges,All Other,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,12975.2,
PRQ CARD REVASC MI 1 VSL,92941,CPT,,49092941,CDM,480,RC,,,both,,,2458,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1720.6,70,,1720.6,percent of total billed charges,All Other,1671.44,,,1671.44,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,1966.4,,,1966.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1966.4,,,1966.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1966.4,,,1966.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1720.6,70,,1720.6,percent of total billed charges,,3184.88,,,3184.88,Fee Schedule,,2699.38,,,2699.38,Fee Schedule,,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,8517,
PRQ CARD REVASC CHRONIC 1VSL,92943,CPT,,49092943,CDM,480,RC,,,both,,,32438,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",22706.6,70,,22706.6,percent of total billed charges,All Other,22057.84,,,22057.84,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,25950.4,,,25950.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",25950.4,,,25950.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,25950.4,,,25950.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",22706.6,70,,22706.6,percent of total billed charges,,3184.88,,,3184.88,Fee Schedule,,2699.38,,,2699.38,Fee Schedule,,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,2209.39,25950.4,
PRQ CARD REVASC CHRONIC ADDL,92944,CPT,,49000025,CDM,480,RC,,,both,,,16219,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,11353.3,70,,11353.3,percent of total billed charges,All Other,11028.92,,,11028.92,Other,ASC Grouper table,4109.46,,,4109.46,Other,186% of Medicaid,12975.2,,,12975.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12975.2,,,12975.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12975.2,,,12975.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11353.3,70,,11353.3,percent of total billed charges,,10542.35,65,,10542.35,percent of total billed charges,All Other,10542.35,65,,10542.35,percent of total billed charges,All Other,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,12975.2,
CARDIOVERSION ELECTRIC EXT,92960,CPT,,48092960,CDM,480,RC,,,both,,,2056,1176.05,,,1176.05,Other,150% of Medicare + 9.63% HCRA Surcharge,715.16,,,715.16,Other,Medicare OPPS,330.52,,,330.52,Fee Schedule,,298.03,,,298.03,Fee Schedule,,1593.04,,,1593.04,Fee Schedule,,1433.15,,,1433.15,Fee Schedule,,1354.66,,,1354.66,Fee Schedule,,1439.2,70,,1439.2,percent of total billed charges,All Other,1398.08,68,,1398.08,percent of total billed charges,All Other,830,,,830,Other,186% of Medicaid,1644.8,80,,1644.8,percent of total billed charges,All Other,1706.48,83,,1706.48,percent of total billed charges,All Other,1706.48,83,,,percent of total billed charges,All Other,1644.8,80,,1644.8,percent of total billed charges,All Other,1706.48,83,,1706.48,percent of total billed charges,All Other,1644.8,,,1644.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1439.2,70,,1439.2,percent of total billed charges,,518.24,,,518.24,Fee Schedule,,439.24,,,439.24,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,682.58,,,682.58,Other,153% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,624.58,,,624.58,Other,140% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,1159.94,,,1159.94,Other,250% of Medicaid,1445.47,,,1445.47,Other,324% of Medicaid,959.18,,,959.18,Other,215% of Medicaid,959.18,,,959.18,Other,215% of Medicaid,557.66,,,557.66,Other,125% of Medicaid,298.03,3227,
CARDIOVERSION ELECTRIC EXT,92960,CPT,,49092960,CDM,480,RC,,,both,,,2056,1176.05,,,1176.05,Other,150% of Medicare + 9.63% HCRA Surcharge,715.16,,,715.16,Other,Medicare OPPS,330.52,,,330.52,Fee Schedule,,298.03,,,298.03,Fee Schedule,,1593.04,,,1593.04,Fee Schedule,,1433.15,,,1433.15,Fee Schedule,,1354.66,,,1354.66,Fee Schedule,,1439.2,70,,1439.2,percent of total billed charges,All Other,1398.08,68,,1398.08,percent of total billed charges,All Other,830,,,830,Other,186% of Medicaid,1644.8,80,,1644.8,percent of total billed charges,All Other,1706.48,83,,1706.48,percent of total billed charges,All Other,1706.48,83,,,percent of total billed charges,All Other,1644.8,80,,1644.8,percent of total billed charges,All Other,1706.48,83,,1706.48,percent of total billed charges,All Other,1644.8,,,1644.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1439.2,70,,1439.2,percent of total billed charges,,518.24,,,518.24,Fee Schedule,,439.24,,,439.24,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,682.58,,,682.58,Other,153% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,624.58,,,624.58,Other,140% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,1159.94,,,1159.94,Other,250% of Medicaid,1445.47,,,1445.47,Other,324% of Medicaid,959.18,,,959.18,Other,215% of Medicaid,959.18,,,959.18,Other,215% of Medicaid,557.66,,,557.66,Other,125% of Medicaid,298.03,3227,
CARDIOVERSION ELECTIVE; INT,92961,CPT,,49092961,CDM,480,RC,,,both,,,1572,1176.05,,,1176.05,Other,150% of Medicare + 9.63% HCRA Surcharge,715.16,,,715.16,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1100.4,70,,1100.4,percent of total billed charges,All Other,1068.96,,,1068.96,Other,ASC Grouper table,829.8,,,829.8,Other,186% of Medicaid,1257.6,,,1257.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1257.6,,,1257.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1257.6,,,1257.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1100.4,70,,1100.4,percent of total billed charges,,1182.44,,,1182.44,Fee Schedule,,1002.19,,,1002.19,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,446.13,,,446.13,Other,100% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,682.58,,,682.58,Other,153% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,624.58,,,624.58,Other,140% of Medicaid,1003.8,,,1003.8,Other,225% of Medicaid,1159.94,,,1159.94,Other,250% of Medicaid,1445.47,,,1445.47,Other,324% of Medicaid,959.18,,,959.18,Other,215% of Medicaid,959.18,,,959.18,Other,215% of Medicaid,557.66,,,557.66,Other,125% of Medicaid,446.13,7216,
PRGRMG EVAL IMPLANTABLE DFB,93282,CPT,,49093282,CDM,480,RC,,,both,,,119,68.14,,,68.14,Other,150% of Medicare + 9.63% HCRA Surcharge,41.44,,,41.44,Other,Medicare OPPS,125.17,,,125.17,Fee Schedule,,112.86,,,112.86,Fee Schedule,,147.13,,,147.13,Fee Schedule,,132.45,,,132.45,Fee Schedule,,125.1,,,125.1,Fee Schedule,,83.3,70,,83.3,percent of total billed charges,All Other,80.92,68,,80.92,percent of total billed charges,All Other,142,,,142,Other,186% of Medicaid,95.2,80,,95.2,percent of total billed charges,All Other,98.77,83,,98.77,percent of total billed charges,All Other,98.77,83,,,percent of total billed charges,All Other,95.2,80,,95.2,percent of total billed charges,All Other,98.77,83,,98.77,percent of total billed charges,All Other,95.2,,,95.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",83.3,70,,83.3,percent of total billed charges,,200.08,,,200.08,Fee Schedule,,169.58,,,169.58,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,116.5,,,116.5,Other,153% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,106.6,,,106.6,Other,140% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,197.97,,,197.97,Other,250% of Medicaid,246.7,,,246.7,Other,324% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,95.18,,,95.18,Other,125% of Medicaid,41.44,3227,
CARDIOVERTER DEFIB SYSTEM,93284,CPT,,30093284,CDM,480,RC,,,both,,,168,68.14,,,68.14,Other,150% of Medicare + 9.63% HCRA Surcharge,41.44,,,41.44,Other,Medicare OPPS,146.53,,,146.53,Fee Schedule,,132.12,,,132.12,Fee Schedule,,192.41,,,192.41,Fee Schedule,,173.2,,,173.2,Fee Schedule,,163.6,,,163.6,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,All Other,114.24,68,,114.24,percent of total billed charges,All Other,142,,,142,Other,186% of Medicaid,134.4,80,,134.4,percent of total billed charges,All Other,139.44,83,,139.44,percent of total billed charges,All Other,139.44,83,,,percent of total billed charges,All Other,134.4,80,,134.4,percent of total billed charges,All Other,139.44,83,,139.44,percent of total billed charges,All Other,134.4,,,134.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",117.6,70,,117.6,percent of total billed charges,,232.88,,,232.88,Fee Schedule,,197.38,,,197.38,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,116.5,,,116.5,Other,153% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,106.6,,,106.6,Other,140% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,197.97,,,197.97,Other,250% of Medicaid,246.7,,,246.7,Other,324% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,95.18,,,95.18,Other,125% of Medicaid,41.44,3227,
INTERROGATION DEVICE EVAL,93288,CPT,,30093288,CDM,480,RC,,,both,,,168,68.14,,,68.14,Other,150% of Medicare + 9.63% HCRA Surcharge,41.44,,,41.44,Other,Medicare OPPS,115.55,,,115.55,Fee Schedule,,104.19,,,104.19,Fee Schedule,,121.44,,,121.44,Fee Schedule,,109.25,,,109.25,Fee Schedule,,103.27,,,103.27,Fee Schedule,,117.6,70,,117.6,percent of total billed charges,All Other,114.24,68,,114.24,percent of total billed charges,All Other,142,,,142,Other,186% of Medicaid,134.4,80,,134.4,percent of total billed charges,All Other,139.44,83,,139.44,percent of total billed charges,All Other,139.44,83,,,percent of total billed charges,All Other,134.4,80,,134.4,percent of total billed charges,All Other,139.44,83,,139.44,percent of total billed charges,All Other,134.4,,,134.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",117.6,70,,117.6,percent of total billed charges,,183.68,,,183.68,Fee Schedule,,155.68,,,155.68,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,116.5,,,116.5,Other,153% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,106.6,,,106.6,Other,140% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,197.97,,,197.97,Other,250% of Medicaid,246.7,,,246.7,Other,324% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,95.18,,,95.18,Other,125% of Medicaid,41.44,3227,
TTE F-UP OR LMTD,93308,CPT,,48093308,CDM,480,RC,,,both,,,993,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,238.57,,,238.57,Fee Schedule,,215.11,,,215.11,Fee Schedule,,547.4,,,547.4,Fee Schedule,,492.46,,,492.46,Fee Schedule,,465.49,,,465.49,Fee Schedule,,695.1,70,,695.1,percent of total billed charges,All Other,675.24,68,,675.24,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,794.4,80,,794.4,percent of total billed charges,All Other,824.19,83,,824.19,percent of total billed charges,All Other,824.19,83,,,percent of total billed charges,All Other,794.4,80,,794.4,percent of total billed charges,All Other,824.19,83,,824.19,percent of total billed charges,All Other,794.4,,,794.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",695.1,70,,695.1,percent of total billed charges,,362.44,,,362.44,Fee Schedule,,307.19,,,307.19,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,215.11,3227,
DOPPLER COLOR FLOW,93325,CPT,,49093325,CDM,480,RC,,,both,,,17,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.17,,,65.17,Fee Schedule,,58.76,,,58.76,Fee Schedule,,223.8,,,223.8,Fee Schedule,,201.34,,,201.34,Fee Schedule,,190.31,,,190.31,Fee Schedule,,11.9,70,,11.9,percent of total billed charges,All Other,11.56,68,,11.56,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,13.6,80,,13.6,percent of total billed charges,All Other,14.11,83,,14.11,percent of total billed charges,All Other,14.11,83,,,percent of total billed charges,All Other,13.6,80,,13.6,percent of total billed charges,All Other,14.11,83,,14.11,percent of total billed charges,All Other,13.6,,,13.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11.9,70,,11.9,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,0.01,3227,
BUNDLE OF HIS RECORDING,93600,CPT,,49093600,CDM,480,RC,,,both,,,15156,13495.09,,,13495.09,Other,150% of Medicare + 9.63% HCRA Surcharge,8206.44,,,8206.44,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12124.8,,,12124.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10609.2,70,,10609.2,percent of total billed charges,,9851.4,65,,9851.4,percent of total billed charges,All Other,9851.4,65,,9851.4,percent of total billed charges,All Other,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,449.69,13495.09,
INTRA-ATRIAL RECORDING,93602,CPT,,49093602,CDM,480,RC,,,both,,,15156,13495.09,,,13495.09,Other,150% of Medicare + 9.63% HCRA Surcharge,8206.44,,,8206.44,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",10306.08,,,10306.08,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,12124.8,,,12124.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12124.8,,,12124.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12124.8,,,12124.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",10609.2,70,,10609.2,percent of total billed charges,,9851.4,65,,9851.4,percent of total billed charges,All Other,9851.4,65,,9851.4,percent of total billed charges,All Other,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,449.69,13495.09,
RIGHT VENTRICULAR RECORDING,93603,CPT,,49093603,CDM,480,RC,,,both,,,2922,2150.59,,,2150.59,Other,150% of Medicare + 9.63% HCRA Surcharge,1307.78,,,1307.78,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1986.96,,,1986.96,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,2337.6,,,2337.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2337.6,,,2337.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,2337.6,,,2337.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2045.4,70,,2045.4,percent of total billed charges,,1899.3,65,,1899.3,percent of total billed charges,All Other,1899.3,65,,1899.3,percent of total billed charges,All Other,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,449.69,10243,
ARRHYTHMIA INDUCTION,93618,CPT,,49093618,CDM,480,RC,,,both,,,2922,2150.59,,,2150.59,Other,150% of Medicare + 9.63% HCRA Surcharge,1307.78,,,1307.78,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,2337.6,,,2337.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2045.4,70,,2045.4,percent of total billed charges,,1899.3,65,,1899.3,percent of total billed charges,All Other,1899.3,65,,1899.3,percent of total billed charges,All Other,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,449.69,10243,
COMP EP EVAL WO A INDUCTION,93619,CPT,,49093619,CDM,480,RC,,,both,,,15819,13495.09,,,13495.09,Other,150% of Medicare + 9.63% HCRA Surcharge,8206.44,,,8206.44,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12655.2,,,12655.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11073.3,70,,11073.3,percent of total billed charges,,10282.35,65,,10282.35,percent of total billed charges,All Other,10282.35,65,,10282.35,percent of total billed charges,All Other,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,449.69,13495.09,
COMP EP EVAL W INDUCTION,93620,CPT,,49093620,CDM,480,RC,,,both,,,15819,13495.09,,,13495.09,Other,150% of Medicare + 9.63% HCRA Surcharge,8206.44,,,8206.44,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,12655.2,,,12655.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11073.3,70,,11073.3,percent of total billed charges,,10282.35,65,,10282.35,percent of total billed charges,All Other,10282.35,65,,10282.35,percent of total billed charges,All Other,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,449.69,13495.09,
COMP EP EVAL W RA RECORDING,93621,CPT,,49093621,CDM,480,RC,,,both,,,432,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",302.4,70,,302.4,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,345.6,,,345.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",302.4,70,,302.4,percent of total billed charges,,280.8,65,,280.8,percent of total billed charges,All Other,280.8,65,,280.8,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,0.01,9473,
COMP EP EVAL W LV RECORDING,93622,CPT,,49093622,CDM,480,RC,,,both,,,639,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",447.3,70,,447.3,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,511.2,,,511.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",447.3,70,,447.3,percent of total billed charges,,415.35,65,,415.35,percent of total billed charges,All Other,415.35,65,,415.35,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,0.01,9473,
STIM & PACING S/P IV DRUGS,93623,CPT,,49093623,CDM,480,RC,,,both,,,587,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",410.9,70,,410.9,percent of total billed charges,All Other,399.16,,,399.16,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,469.6,,,469.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",469.6,,,469.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,469.6,,,469.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",410.9,70,,410.9,percent of total billed charges,,381.55,65,,381.55,percent of total billed charges,All Other,381.55,65,,381.55,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,0.01,7216,
EP F-UP STUDY W PACING,93624,CPT,,49093624,CDM,480,RC,,,both,,,15819,13495.09,,,13495.09,Other,150% of Medicare + 9.63% HCRA Surcharge,8206.44,,,8206.44,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",10756.92,,,10756.92,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,12655.2,,,12655.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12655.2,,,12655.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,12655.2,,,12655.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",11073.3,70,,11073.3,percent of total billed charges,,10282.35,65,,10282.35,percent of total billed charges,All Other,10282.35,65,,10282.35,percent of total billed charges,All Other,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,449.69,13495.09,
EP EVAL CD LEADS; INIT/REPLACEMENT,93640,CPT,,49093640,CDM,480,RC,,,both,,,724,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,579.2,,,579.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",506.8,70,,506.8,percent of total billed charges,,470.6,65,,470.6,percent of total billed charges,All Other,470.6,65,,470.6,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,0.01,10243,
EP EVAL CD; W GENERATOR TEST,93641,CPT,,49093641,CDM,480,RC,,,both,,,1220,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,976,,,976,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",854,70,,854,percent of total billed charges,,793,65,,793,percent of total billed charges,All Other,793,65,,793,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,0.01,10243,
EP EVAL CD; W PACING,93642,CPT,,49093642,CDM,480,RC,,,both,,,2922,2150.59,,,2150.59,Other,150% of Medicare + 9.63% HCRA Surcharge,1307.78,,,1307.78,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",10243,,,10243,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,836.42,,,836.42,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,2337.6,,,2337.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2045.4,70,,2045.4,percent of total billed charges,,398.52,,,398.52,Fee Schedule,,337.77,,,337.77,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,449.69,,,449.69,Other,100% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,688.02,,,688.02,Other,153% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,629.56,,,629.56,Other,140% of Medicaid,1011.79,,,1011.79,Other,225% of Medicaid,1169.18,,,1169.18,Other,250% of Medicaid,1456.98,,,1456.98,Other,324% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,966.83,,,966.83,Other,215% of Medicaid,562.11,,,562.11,Other,125% of Medicaid,337.77,10243,
TILT TABLE EVALUATION,93660,CPT,,48093660,CDM,480,RC,,,both,,,2227,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,234.44,,,234.44,Fee Schedule,,211.39,,,211.39,Fee Schedule,,461.74,,,461.74,Fee Schedule,,415.4,,,415.4,Fee Schedule,,392.65,,,392.65,Fee Schedule,,1558.9,70,,1558.9,percent of total billed charges,All Other,1514.36,68,,1514.36,percent of total billed charges,All Other,269,,,269,Other,186% of Medicaid,1781.6,80,,1781.6,percent of total billed charges,All Other,1848.41,83,,1848.41,percent of total billed charges,All Other,1848.41,83,,,percent of total billed charges,All Other,1781.6,80,,1781.6,percent of total billed charges,All Other,1848.41,83,,1848.41,percent of total billed charges,All Other,1781.6,,,1781.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1558.9,70,,1558.9,percent of total billed charges,,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,221.52,,,221.52,Other,153% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,202.7,,,202.7,Other,140% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,376.44,,,376.44,Other,250% of Medicaid,469.11,,,469.11,Other,324% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,180.98,,,180.98,Other,125% of Medicaid,144.79,3227,
EA ANTITACHY PACEMAKER SYS,93724,CPT,,49093724,CDM,480,RC,,,both,,,887,539.74,,,539.74,Other,150% of Medicare + 9.63% HCRA Surcharge,328.22,,,328.22,Other,Medicare OPPS,148.65,,,148.65,Fee Schedule,,134.04,,,134.04,Fee Schedule,,307.75,,,307.75,Fee Schedule,,277.04,,,277.04,Fee Schedule,,261.68,,,261.68,Fee Schedule,,620.9,70,,620.9,percent of total billed charges,All Other,603.16,68,,603.16,percent of total billed charges,All Other,142,,,142,Other,186% of Medicaid,709.6,80,,709.6,percent of total billed charges,All Other,736.21,83,,736.21,percent of total billed charges,All Other,736.21,83,,,percent of total billed charges,All Other,709.6,80,,709.6,percent of total billed charges,All Other,736.21,83,,736.21,percent of total billed charges,All Other,709.6,,,709.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",620.9,70,,620.9,percent of total billed charges,,226.32,,,226.32,Fee Schedule,,191.82,,,191.82,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,116.5,,,116.5,Other,153% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,106.6,,,106.6,Other,140% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,197.97,,,197.97,Other,250% of Medicaid,246.7,,,246.7,Other,324% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,95.18,,,95.18,Other,125% of Medicaid,76.14,3227,
CARDIOVASCULAR SERVICE UNLISTED,93799,CPT,,48093799,CDM,480,RC,,,both,,,329,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,223.72,68,,223.72,percent of total billed charges,All Other,78,,,78,Other,186% of Medicaid,263.2,80,,263.2,percent of total billed charges,All Other,273.07,83,,273.07,percent of total billed charges,All Other,273.07,83,,,percent of total billed charges,All Other,263.2,80,,263.2,percent of total billed charges,All Other,273.07,83,,273.07,percent of total billed charges,All Other,263.2,,,263.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",230.3,70,,230.3,percent of total billed charges,,213.85,65,,213.85,percent of total billed charges,All Other,213.85,65,,213.85,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,64.34,,,64.34,Other,153% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,58.87,,,58.87,Other,140% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,109.34,,,109.34,Other,250% of Medicaid,136.25,,,136.25,Other,324% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,52.57,,,52.57,Other,125% of Medicaid,0.01,3227,
CARDIOVASCULAR SERVICE UNLISTED,93799,CPT,,49093799,CDM,480,RC,,,both,,,329,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,223.72,68,,223.72,percent of total billed charges,All Other,78,,,78,Other,186% of Medicaid,263.2,80,,263.2,percent of total billed charges,All Other,273.07,83,,273.07,percent of total billed charges,All Other,273.07,83,,,percent of total billed charges,All Other,263.2,80,,263.2,percent of total billed charges,All Other,273.07,83,,273.07,percent of total billed charges,All Other,263.2,,,263.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",230.3,70,,230.3,percent of total billed charges,,213.85,65,,213.85,percent of total billed charges,All Other,213.85,65,,213.85,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,64.34,,,64.34,Other,153% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,58.87,,,58.87,Other,140% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,109.34,,,109.34,Other,250% of Medicaid,136.25,,,136.25,Other,324% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,52.57,,,52.57,Other,125% of Medicaid,0.01,3227,
INSERT ELECTRD/PM CATH SNGL,33210,CPT,,49033210,CDM,481,RC,,,both,,,18374,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",12861.8,70,,12861.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4537,,,4537,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,14699.2,,,14699.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12861.8,70,,12861.8,percent of total billed charges,,780.64,,,780.64,Fee Schedule,,661.64,,,661.64,Fee Schedule,,6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,661.64,15351.79,
INSERT CARD ELECTRODES DUAL,33211,CPT,,49033211,CDM,481,RC,,,both,,,18374,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS,3969,,,3969,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3572,,,3572,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",12861.8,70,,12861.8,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,4537,,,4537,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,14699.2,,,14699.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",12861.8,70,,12861.8,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5698,,,5698,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6331,,,6331,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5381,,,5381,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,2439.02,,,2439.02,Other,100% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3731.7,,,3731.7,Other,153% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,3414.63,,,3414.63,Other,140% of Medicaid,5487.8,,,5487.8,Other,225% of Medicaid,6341.45,,,6341.45,Other,250% of Medicaid,7902.43,,,7902.43,Other,324% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,5243.89,,,5243.89,Other,215% of Medicaid,3048.78,,,3048.78,Other,125% of Medicaid,2439.02,15351.79,
IMPL PRESSURE SENSOR W/ANGIO,33289,CPT,,49000003,CDM,481,RC,,,both,,,61460,52519.99,,,52519.99,Other,150% of Medicare + 9.63% HCRA Surcharge,31937.73,,,31937.73,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",8517,,,8517,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7665,,,7665,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7239,,,7239,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",43022,70,,43022,percent of total billed charges,All Other,6152,,,6152,Other,ASC Grouper table,23174,,,23174,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,49168,,,49168,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",43022,70,,43022,percent of total billed charges,,1612.12,,,1612.12,Fee Schedule,,1366.37,,,1366.37,Fee Schedule,,15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",13740,,,13740,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",15267,,,15267,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12977,,,12977,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",12459.14,,,12459.14,Other,100% of Medicaid,12459.14,,,12459.14,Other,100% of Medicaid,12459.14,,,12459.14,Other,100% of Medicaid,12459.14,,,12459.14,Other,100% of Medicaid,28033.06,,,28033.06,Other,225% of Medicaid,19062.48,,,19062.48,Other,153% of Medicaid,28033.06,,,28033.06,Other,225% of Medicaid,17442.79,,,17442.79,Other,140% of Medicaid,28033.06,,,28033.06,Other,225% of Medicaid,32393.76,,,32393.76,Other,250% of Medicaid,40367.61,,,40367.61,Other,324% of Medicaid,26787.15,,,26787.15,Other,215% of Medicaid,26787.15,,,26787.15,Other,215% of Medicaid,15573.92,,,15573.92,Other,125% of Medicaid,1366.37,52519.99,
INS IA PERC BALLOON,33967,CPT,,49033967,CDM,481,RC,,,both,,,1075,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",752.5,70,,752.5,percent of total billed charges,All Other,731,,,731,Other,ASC Grouper table,9762.81,,,9762.81,Other,186% of Medicaid,860,,,860,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",860,,,860,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,860,,,860,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",752.5,70,,752.5,percent of total billed charges,,1244.76,,,1244.76,Fee Schedule,,1055.01,,,1055.01,Fee Schedule,,8589,,,8589,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7730,,,7730,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",8589,,,8589,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7301,,,7301,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5248.82,,,5248.82,Other,100% of Medicaid,5248.82,,,5248.82,Other,100% of Medicaid,5248.82,,,5248.82,Other,100% of Medicaid,5248.82,,,5248.82,Other,100% of Medicaid,11809.85,,,11809.85,Other,225% of Medicaid,8030.7,,,8030.7,Other,153% of Medicaid,11809.85,,,11809.85,Other,225% of Medicaid,7348.35,,,7348.35,Other,140% of Medicaid,11809.85,,,11809.85,Other,225% of Medicaid,13646.94,,,13646.94,Other,250% of Medicaid,17006.19,,,17006.19,Other,324% of Medicaid,11284.97,,,11284.97,Other,215% of Medicaid,11284.97,,,11284.97,Other,215% of Medicaid,6561.03,,,6561.03,Other,125% of Medicaid,0.01,17006.19,
REM IAB ASSIST DEVICE PERCUTANEOUS,33968,CPT,,49033968,CDM,481,RC,,,both,,,128,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",89.6,70,,89.6,percent of total billed charges,All Other,87.04,,,87.04,Other,ASC Grouper table,3496.8,,,3496.8,Other,186% of Medicaid,102.4,,,102.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",102.4,,,102.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,102.4,,,102.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",89.6,70,,89.6,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,8589,,,8589,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7730,,,7730,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",8589,,,8589,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",7301,,,7301,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1880,,,1880,Other,100% of Medicaid,1880,,,1880,Other,100% of Medicaid,1880,,,1880,Other,100% of Medicaid,1880,,,1880,Other,100% of Medicaid,4230,,,4230,Other,225% of Medicaid,2876.4,,,2876.4,Other,153% of Medicaid,4230,,,4230,Other,225% of Medicaid,2632,,,2632,Other,140% of Medicaid,4230,,,4230,Other,225% of Medicaid,4888,,,4888,Other,250% of Medicaid,6091.19,,,6091.19,Other,324% of Medicaid,4042,,,4042,Other,215% of Medicaid,4042,,,4042,Other,215% of Medicaid,2350,,,2350,Other,125% of Medicaid,0.01,8589,
CPR,92950,CPT,,49092950,CDM,481,RC,,,both,,,903,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,586.95,65,,586.95,percent of total billed charges,All Other,532.77,59,,532.77,percent of total billed charges,All Other,690.8,76.5,,690.8,percent of total billed charges,All Other,623.07,69,,623.07,percent of total billed charges,All Other,586.95,65,,586.95,percent of total billed charges,All Other,632.1,70,,632.1,percent of total billed charges,All Other,614.04,68,,614.04,percent of total billed charges,All Other,893,,,893,Other,186% of Medicaid,722.4,80,,722.4,percent of total billed charges,All Other,749.49,83,,749.49,percent of total billed charges,All Other,749.49,83,,,percent of total billed charges,All Other,722.4,80,,722.4,percent of total billed charges,All Other,749.49,83,,749.49,percent of total billed charges,All Other,722.4,,,722.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",632.1,70,,632.1,percent of total billed charges,,883.96,,,883.96,Fee Schedule,,749.21,,,749.21,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,480.36,,,480.36,Other,100% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,734.95,,,734.95,Other,153% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,672.5,,,672.5,Other,140% of Medicaid,1080.81,,,1080.81,Other,225% of Medicaid,1248.94,,,1248.94,Other,250% of Medicaid,1556.37,,,1556.37,Other,324% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,1032.77,,,1032.77,Other,215% of Medicaid,600.45,,,600.45,Other,125% of Medicaid,344.91,3227,
PERC CORON THROMBECTOMY,92973,CPT,,49092973,CDM,481,RC,,,both,,,11972,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,7781.8,65,,7781.8,percent of total billed charges,All Other,7063.48,59,,7063.48,percent of total billed charges,All Other,9158.58,76.5,,9158.58,percent of total billed charges,All Other,8260.68,69,,8260.68,percent of total billed charges,All Other,7781.8,65,,7781.8,percent of total billed charges,All Other,8380.4,70,,8380.4,percent of total billed charges,All Other,8140.96,68,,8140.96,percent of total billed charges,All Other,4109,,,4109,Other,186% of Medicaid,9577.6,80,,9577.6,percent of total billed charges,All Other,9936.76,83,,9936.76,percent of total billed charges,All Other,9936.76,83,,,percent of total billed charges,All Other,9577.6,80,,9577.6,percent of total billed charges,All Other,9936.76,83,,9936.76,percent of total billed charges,All Other,9577.6,,,9577.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8380.4,70,,8380.4,percent of total billed charges,,849.52,,,849.52,Fee Schedule,,720.02,,,720.02,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,2209.39,,,2209.39,Other,100% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3380.36,,,3380.36,Other,153% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,3093.14,,,3093.14,Other,140% of Medicaid,4971.12,,,4971.12,Other,225% of Medicaid,5744.41,,,5744.41,Other,250% of Medicaid,7158.42,,,7158.42,Other,324% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,4750.18,,,4750.18,Other,215% of Medicaid,2761.73,,,2761.73,Other,125% of Medicaid,0.01,9936.76,
CATH - CORON IV BRACHYTX,92974,CPT,,49092974,CDM,481,RC,,,both,,,4788,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,3112.2,65,,3112.2,percent of total billed charges,All Other,2824.92,59,,2824.92,percent of total billed charges,All Other,3662.82,76.5,,3662.82,percent of total billed charges,All Other,3303.72,69,,3303.72,percent of total billed charges,All Other,3112.2,65,,3112.2,percent of total billed charges,All Other,3351.6,70,,3351.6,percent of total billed charges,All Other,3255.84,68,,3255.84,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,3830.4,80,,3830.4,percent of total billed charges,All Other,3974.04,83,,3974.04,percent of total billed charges,All Other,3974.04,83,,,percent of total billed charges,All Other,3830.4,80,,3830.4,percent of total billed charges,All Other,3974.04,83,,3974.04,percent of total billed charges,All Other,3830.4,,,3830.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3351.6,70,,3351.6,percent of total billed charges,,775.72,,,775.72,Fee Schedule,,657.47,,,657.47,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3974.04,
THROMBOLYSIS; IC INFUSION,92975,CPT,,49092975,CDM,481,RC,,,both,,,1481,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1036.7,70,,1036.7,percent of total billed charges,All Other,1007.08,,,1007.08,Other,ASC Grouper table,1434.42,,,1434.42,Other,186% of Medicaid,1184.8,,,1184.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1184.8,,,1184.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,1184.8,,,1184.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1036.7,70,,1036.7,percent of total billed charges,,1810.56,,,1810.56,Fee Schedule,,1534.56,,,1534.56,Fee Schedule,,4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1179.92,,,1179.92,Other,153% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1079.67,,,1079.67,Other,140% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,2005.1,,,2005.1,Other,250% of Medicaid,2498.66,,,2498.66,Other,324% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,963.99,,,963.99,Other,125% of Medicaid,0.01,7216,
THROMBOLYSIS CORON; IV INFUS,92977,CPT,,49092977,CDM,481,RC,,,both,,,769,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",538.3,70,,538.3,percent of total billed charges,All Other,522.92,,,522.92,Other,ASC Grouper table,1111.71,,,1111.71,Other,186% of Medicaid,615.2,,,615.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",615.2,,,615.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,615.2,,,615.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",538.3,70,,538.3,percent of total billed charges,,250.92,,,250.92,Fee Schedule,,212.67,,,212.67,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,597.69,,,597.69,Other,100% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,914.47,,,914.47,Other,153% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,836.77,,,836.77,Other,140% of Medicaid,1344.81,,,1344.81,Other,225% of Medicaid,1554.01,,,1554.01,Other,250% of Medicaid,1936.53,,,1936.53,Other,324% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,1285.04,,,1285.04,Other,215% of Medicaid,747.12,,,747.12,Other,125% of Medicaid,212.67,7216,
IV US CORONARY V; INITIAL,92978,CPT,,49092978,CDM,481,RC,,,both,,,349,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",189.25,,,189.25,Fee Schedule,,189.25,,,189.25,Fee Schedule,,189.25,,,189.25,Fee Schedule,,244.3,70,,244.3,percent of total billed charges,All Other,237.32,,,237.32,Other,ASC Grouper table,557.78,,,557.78,Other,186% of Medicaid,279.2,,,279.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",279.2,,,279.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,279.2,,,279.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",244.3,70,,244.3,percent of total billed charges,,226.85,65,,226.85,percent of total billed charges,All Other,226.85,65,,226.85,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,7216,
IV US CORONARY V; EA ADDTL,92979,CPT,,49092979,CDM,481,RC,,,both,,,281,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",96.47,,,96.47,Fee Schedule,,96.47,,,96.47,Fee Schedule,,96.47,,,96.47,Fee Schedule,,196.7,70,,196.7,percent of total billed charges,All Other,191.08,,,191.08,Other,ASC Grouper table,557.78,,,557.78,Other,186% of Medicaid,224.8,,,224.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",224.8,,,224.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,224.8,,,224.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",196.7,70,,196.7,percent of total billed charges,,182.65,65,,182.65,percent of total billed charges,All Other,182.65,65,,182.65,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,419.83,,,419.83,Other,140% of Medicaid,674.73,,,674.73,Other,225% of Medicaid,779.69,,,779.69,Other,250% of Medicaid,971.61,,,971.61,Other,324% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,644.74,,,644.74,Other,215% of Medicaid,374.85,,,374.85,Other,125% of Medicaid,0.01,7216,
RIGHT HEART CATH,93451,CPT,,49093451,CDM,481,RC,,,both,,,12354,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",8400.72,,,8400.72,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,9883.2,,,9883.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9883.2,,,9883.2,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,9883.2,,,9883.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8647.8,70,,8647.8,percent of total billed charges,,3801.52,,,3801.52,Fee Schedule,,3222.02,,,3222.02,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,9883.2,
LEFT HRT CATH W/VENTRCLGRPHY,93452,CPT,,49093452,CDM,481,RC,,,both,,,12354,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9883.2,,,9883.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8647.8,70,,8647.8,percent of total billed charges,,3448.92,,,3448.92,Fee Schedule,,2923.17,,,2923.17,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,9883.2,
R&L HRT CATH W/VENTRICLGRPHY,93453,CPT,,49093453,CDM,481,RC,,,both,,,11335,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9068,,,9068,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7934.5,70,,7934.5,percent of total billed charges,,4300.08,,,4300.08,Fee Schedule,,3644.58,,,3644.58,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,9473,
CORONARY ARTERY ANGIO S&I,93454,CPT,,49093454,CDM,481,RC,,,both,,,12354,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9883.2,,,9883.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8647.8,70,,8647.8,percent of total billed charges,,3445.64,,,3445.64,Fee Schedule,,2920.39,,,2920.39,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,9883.2,
CORONARY ART/GRFT ANGIO S&I,93455,CPT,,49093455,CDM,481,RC,,,both,,,12354,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9883.2,,,9883.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8647.8,70,,8647.8,percent of total billed charges,,3773.64,,,3773.64,Fee Schedule,,3198.39,,,3198.39,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,9883.2,
R HRT CORONARY ARTERY ANGIO,93456,CPT,,49093456,CDM,481,RC,,,both,,,12354,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9883.2,,,9883.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8647.8,70,,8647.8,percent of total billed charges,,4219.72,,,4219.72,Fee Schedule,,3576.47,,,3576.47,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,9883.2,
R HRT ART/GRFT ANGIO,93457,CPT,,49093457,CDM,481,RC,,,both,,,11335,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9068,,,9068,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7934.5,70,,7934.5,percent of total billed charges,,4547.72,,,4547.72,Fee Schedule,,3854.47,,,3854.47,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,9473,
L HRT ARTERY/VENTRICLE ANGIO,93458,CPT,,49093458,CDM,481,RC,,,both,,,13219,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,10575.2,,,10575.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9253.3,70,,9253.3,percent of total billed charges,,3854,,,3854,Fee Schedule,,3266.5,,,3266.5,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,10575.2,
L HRT ART/GRFT ANGIO,93459,CPT,,49093459,CDM,481,RC,,,both,,,11335,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9068,,,9068,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7934.5,70,,7934.5,percent of total billed charges,,4060.64,,,4060.64,Fee Schedule,,3441.64,,,3441.64,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,9473,
R&L HRT ART/VENTRICLE ANGIO,93460,CPT,,49093460,CDM,481,RC,,,both,,,12354,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9883.2,,,9883.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",8647.8,70,,8647.8,percent of total billed charges,,4498.52,,,4498.52,Fee Schedule,,3812.77,,,3812.77,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,9883.2,
R&L HRT ART/GRAFT/VENTRICLE ANGIO,93461,CPT,,49093461,CDM,481,RC,,,both,,,11335,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS,5954,,,5954,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",5359,,,5359,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",7617,,,7617,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",6152,,,6152,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9473,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7237,,,7237,Other,ASC Grouper table,9473,,,9473,Other,ASC Grouper table,9068,,,9068,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7934.5,70,,7934.5,percent of total billed charges,,4954.44,,,4954.44,Fee Schedule,,4199.19,,,4199.19,Fee Schedule,,6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6232,,,6232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",6924,,,6924,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",5885,,,5885,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,9473,
L HRT CATH TRNSPTL PUNCTURE,93462,CPT,,49093462,CDM,481,RC,,,both,,,11335,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",7707.8,,,7707.8,Other,ASC Grouper table,2774.94,,,2774.94,Other,186% of Medicaid,9068,,,9068,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",9068,,,9068,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,9068,,,9068,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7934.5,70,,7934.5,percent of total billed charges,,1011.88,,,1011.88,Fee Schedule,,857.63,,,857.63,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1491.9,,,1491.9,Other,100% of Medicaid,1491.9,,,1491.9,Other,100% of Medicaid,1491.9,,,1491.9,Other,100% of Medicaid,1491.9,,,1491.9,Other,100% of Medicaid,3356.78,,,3356.78,Other,225% of Medicaid,2282.61,,,2282.61,Other,153% of Medicaid,3356.78,,,3356.78,Other,225% of Medicaid,2088.67,,,2088.67,Other,140% of Medicaid,3356.78,,,3356.78,Other,225% of Medicaid,3878.95,,,3878.95,Other,250% of Medicaid,4833.77,,,4833.77,Other,324% of Medicaid,3207.59,,,3207.59,Other,215% of Medicaid,3207.59,,,3207.59,Other,215% of Medicaid,1864.88,,,1864.88,Other,125% of Medicaid,0.01,9068,
INS SWAN GANZ BEDSIDE,93503,CPT,,49093503,CDM,481,RC,,,both,,,4788,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3351.6,70,,3351.6,percent of total billed charges,All Other,3255.84,,,3255.84,Other,ASC Grouper table,586.35,,,586.35,Other,186% of Medicaid,3830.4,,,3830.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3830.4,,,3830.4,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,3830.4,,,3830.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3351.6,70,,3351.6,percent of total billed charges,,423.12,,,423.12,Fee Schedule,,358.62,,,358.62,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,315.24,,,315.24,Other,100% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,482.32,,,482.32,Other,153% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,441.34,,,441.34,Other,140% of Medicaid,709.29,,,709.29,Other,225% of Medicaid,819.63,,,819.63,Other,250% of Medicaid,1021.38,,,1021.38,Other,324% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,677.77,,,677.77,Other,215% of Medicaid,394.05,,,394.05,Other,125% of Medicaid,315.24,7216,
ENDOMYOCARDIAL BX,93505,CPT,,49093505,CDM,481,RC,,,both,,,6707,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4694.9,70,,4694.9,percent of total billed charges,All Other,4560.76,,,4560.76,Other,ASC Grouper table,3170.4,,,3170.4,Other,186% of Medicaid,5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5365.6,,,5365.6,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,5365.6,,,5365.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4694.9,70,,4694.9,percent of total billed charges,,2176.28,,,2176.28,Fee Schedule,,1844.53,,,1844.53,Fee Schedule,,4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,1704.51,,,1704.51,Other,100% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2607.91,,,2607.91,Other,153% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,2386.32,,,2386.32,Other,140% of Medicaid,3835.16,,,3835.16,Other,225% of Medicaid,4431.74,,,4431.74,Other,250% of Medicaid,5522.63,,,5522.63,Other,324% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,3664.71,,,3664.71,Other,215% of Medicaid,2130.64,,,2130.64,Other,125% of Medicaid,1704.51,7216,
INJECT CONGENITAL CARD CATH,93563,CPT,,49093563,CDM,481,RC,,,both,,,211,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14237,,,14237,Case Rate,Cardiac Cath Lab Per Case,12813,,,12813,Case Rate,Cardiac Cath Lab Per Case,3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",143.48,68,,143.48,percent of total billed charges,All Other,725,,,725,Other,186% of Medicaid,168.8,80,,168.8,percent of total billed charges,All Other,175.13,83,,175.13,percent of total billed charges,All Other,175.13,83,,,percent of total billed charges,All Other,168.8,80,,168.8,percent of total billed charges,All Other,175.13,83,,175.13,percent of total billed charges,All Other,168.8,,,168.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",147.7,70,,147.7,percent of total billed charges,,278.8,,,278.8,Fee Schedule,,236.3,,,236.3,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,596.52,,,596.52,Other,153% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,545.84,,,545.84,Other,140% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,1013.7,,,1013.7,Other,250% of Medicaid,1263.23,,,1263.23,Other,324% of Medicaid,838.25,,,838.25,Other,215% of Medicaid,838.25,,,838.25,Other,215% of Medicaid,487.36,,,487.36,Other,125% of Medicaid,0.01,14237,
INJECT L VENTR/ATRIAL ANGIO,93565,CPT,,49093565,CDM,481,RC,,,both,,,163,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14237,,,14237,Case Rate,Cardiac Cath Lab Per Case,12813,,,12813,Case Rate,Cardiac Cath Lab Per Case,3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",110.84,68,,110.84,percent of total billed charges,All Other,725,,,725,Other,186% of Medicaid,130.4,80,,130.4,percent of total billed charges,All Other,135.29,83,,135.29,percent of total billed charges,All Other,135.29,83,,,percent of total billed charges,All Other,130.4,80,,130.4,percent of total billed charges,All Other,135.29,83,,135.29,percent of total billed charges,All Other,130.4,,,130.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",114.1,70,,114.1,percent of total billed charges,,223.04,,,223.04,Fee Schedule,,189.04,,,189.04,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,596.52,,,596.52,Other,153% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,545.84,,,545.84,Other,140% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,1013.7,,,1013.7,Other,250% of Medicaid,1263.23,,,1263.23,Other,324% of Medicaid,838.25,,,838.25,Other,215% of Medicaid,838.25,,,838.25,Other,215% of Medicaid,487.36,,,487.36,Other,125% of Medicaid,0.01,14237,
INJECT R VENTR/ATRIAL ANGIO,93566,CPT,,49093566,CDM,481,RC,,,both,,,161,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14237,,,14237,Case Rate,Cardiac Cath Lab Per Case,12813,,,12813,Case Rate,Cardiac Cath Lab Per Case,3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",109.48,68,,109.48,percent of total billed charges,All Other,725,,,725,Other,186% of Medicaid,128.8,80,,128.8,percent of total billed charges,All Other,133.63,83,,133.63,percent of total billed charges,All Other,133.63,83,,,percent of total billed charges,All Other,128.8,80,,128.8,percent of total billed charges,All Other,133.63,83,,133.63,percent of total billed charges,All Other,128.8,,,128.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",112.7,70,,112.7,percent of total billed charges,,221.4,,,221.4,Fee Schedule,,187.65,,,187.65,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,596.52,,,596.52,Other,153% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,545.84,,,545.84,Other,140% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,1013.7,,,1013.7,Other,250% of Medicaid,1263.23,,,1263.23,Other,324% of Medicaid,838.25,,,838.25,Other,215% of Medicaid,838.25,,,838.25,Other,215% of Medicaid,487.36,,,487.36,Other,125% of Medicaid,0.01,14237,
INJECT SUPRVLV AORTOGRAPHY,93567,CPT,,49093567,CDM,481,RC,,,both,,,198,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14237,,,14237,Case Rate,Cardiac Cath Lab Per Case,12813,,,12813,Case Rate,Cardiac Cath Lab Per Case,3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",134.64,68,,134.64,percent of total billed charges,All Other,725,,,725,Other,186% of Medicaid,158.4,80,,158.4,percent of total billed charges,All Other,164.34,83,,164.34,percent of total billed charges,All Other,164.34,83,,,percent of total billed charges,All Other,158.4,80,,158.4,percent of total billed charges,All Other,164.34,83,,164.34,percent of total billed charges,All Other,158.4,,,158.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",138.6,70,,138.6,percent of total billed charges,,250.92,,,250.92,Fee Schedule,,212.67,,,212.67,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,596.52,,,596.52,Other,153% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,545.84,,,545.84,Other,140% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,1013.7,,,1013.7,Other,250% of Medicaid,1263.23,,,1263.23,Other,324% of Medicaid,838.25,,,838.25,Other,215% of Medicaid,838.25,,,838.25,Other,215% of Medicaid,487.36,,,487.36,Other,125% of Medicaid,0.01,14237,
INJECT PULM ART HRT CATH,93568,CPT,,49093568,CDM,481,RC,,,both,,,159,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,14237,,,14237,Case Rate,Cardiac Cath Lab Per Case,12813,,,12813,Case Rate,Cardiac Cath Lab Per Case,3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",108.12,68,,108.12,percent of total billed charges,All Other,725,,,725,Other,186% of Medicaid,127.2,80,,127.2,percent of total billed charges,All Other,131.97,83,,131.97,percent of total billed charges,All Other,131.97,83,,,percent of total billed charges,All Other,127.2,80,,127.2,percent of total billed charges,All Other,131.97,83,,131.97,percent of total billed charges,All Other,127.2,,,127.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",111.3,70,,111.3,percent of total billed charges,,229.6,,,229.6,Fee Schedule,,194.6,,,194.6,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,389.88,,,389.88,Other,100% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,596.52,,,596.52,Other,153% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,545.84,,,545.84,Other,140% of Medicaid,877.24,,,877.24,Other,225% of Medicaid,1013.7,,,1013.7,Other,250% of Medicaid,1263.23,,,1263.23,Other,324% of Medicaid,838.25,,,838.25,Other,215% of Medicaid,838.25,,,838.25,Other,215% of Medicaid,487.36,,,487.36,Other,125% of Medicaid,0.01,14237,
IV DOPPLER; INITIAL VESSEL,93571,CPT,,49093571,CDM,481,RC,,,both,,,349,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,226.85,65,,226.85,percent of total billed charges,All Other,205.91,59,,205.91,percent of total billed charges,All Other,266.99,76.5,,266.99,percent of total billed charges,All Other,240.81,69,,240.81,percent of total billed charges,All Other,226.85,65,,226.85,percent of total billed charges,All Other,244.3,70,,244.3,percent of total billed charges,All Other,237.32,68,,237.32,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,279.2,80,,279.2,percent of total billed charges,All Other,289.67,83,,289.67,percent of total billed charges,All Other,289.67,83,,,percent of total billed charges,All Other,279.2,80,,279.2,percent of total billed charges,All Other,289.67,83,,289.67,percent of total billed charges,All Other,279.2,,,279.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",244.3,70,,244.3,percent of total billed charges,,226.85,65,,226.85,percent of total billed charges,All Other,226.85,65,,226.85,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,0.01,3227,
IV DOPPLER; EA ADDTL VESSEL,93572,CPT,,49093572,CDM,481,RC,,,both,,,278,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,180.7,65,,180.7,percent of total billed charges,All Other,164.02,59,,164.02,percent of total billed charges,All Other,212.67,76.5,,212.67,percent of total billed charges,All Other,191.82,69,,191.82,percent of total billed charges,All Other,180.7,65,,180.7,percent of total billed charges,All Other,194.6,70,,194.6,percent of total billed charges,All Other,189.04,68,,189.04,percent of total billed charges,All Other,558,,,558,Other,186% of Medicaid,222.4,80,,222.4,percent of total billed charges,All Other,230.74,83,,230.74,percent of total billed charges,All Other,230.74,83,,,percent of total billed charges,All Other,222.4,80,,222.4,percent of total billed charges,All Other,230.74,83,,230.74,percent of total billed charges,All Other,222.4,,,222.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",194.6,70,,194.6,percent of total billed charges,,180.7,65,,180.7,percent of total billed charges,All Other,180.7,65,,180.7,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,299.88,,,299.88,Other,100% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,458.82,,,458.82,Other,153% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,419.84,,,419.84,Other,140% of Medicaid,674.74,,,674.74,Other,225% of Medicaid,779.7,,,779.7,Other,250% of Medicaid,971.62,,,971.62,Other,324% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,644.75,,,644.75,Other,215% of Medicaid,374.86,,,374.86,Other,125% of Medicaid,0.01,3227,
ILIAC ART ANGIO CARDIAC CATH,G0278,HCPCS,,49000002,CDM,481,RC,,,both,,,51,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",78.25,,,78.25,Fee Schedule,,70.44,,,70.44,Fee Schedule,,66.54,,,66.54,Fee Schedule,,35.7,70,,35.7,percent of total billed charges,All Other,34.68,,,34.68,Other,ASC Grouper table,1434.42,,,1434.42,Other,186% of Medicaid,40.8,,,40.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",40.8,,,40.8,Other,ASC Grouper table,7216,,,7216,Other,ASC Grouper table,40.8,,,40.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",35.7,70,,35.7,percent of total billed charges,,67.24,,,67.24,Fee Schedule,,56.99,,,56.99,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,771.19,,,771.19,Other,100% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1179.92,,,1179.92,Other,153% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,1079.67,,,1079.67,Other,140% of Medicaid,1735.18,,,1735.18,Other,225% of Medicaid,2005.1,,,2005.1,Other,250% of Medicaid,2498.66,,,2498.66,Other,324% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,1658.06,,,1658.06,Other,215% of Medicaid,963.99,,,963.99,Other,125% of Medicaid,0.01,7216,
STRESS TEST TRACING ONLY,93017,CPT,,48093017,CDM,482,RC,,,both,,,969,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,121.04,,,121.04,Fee Schedule,,109.14,,,109.14,Fee Schedule,,378.45,,,378.45,Fee Schedule,,340.47,,,340.47,Fee Schedule,,321.82,,,321.82,Fee Schedule,,678.3,70,,678.3,percent of total billed charges,All Other,658.92,68,,658.92,percent of total billed charges,All Other,269,,,269,Other,186% of Medicaid,775.2,80,,775.2,percent of total billed charges,All Other,804.27,83,,804.27,percent of total billed charges,All Other,804.27,83,,804.27,percent of total billed charges,All Other,775.2,80,,775.2,percent of total billed charges,All Other,804.27,83,,804.27,percent of total billed charges,All Other,775.2,80,,775.2,percent of total billed charges,All Other,678.3,70,,678.3,percent of total billed charges,,170.56,,,170.56,Fee Schedule,,144.56,,,144.56,Fee Schedule,,526,,,526,Case Rate,,473,,,473,Case Rate,,526,,,526,Case Rate,,447,,,447,Case Rate,,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,221.52,,,221.52,Other,153% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,202.7,,,202.7,Other,140% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,376.44,,,376.44,Other,250% of Medicaid,469.11,,,469.11,Other,324% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,180.98,,,180.98,Other,125% of Medicaid,109.14,804.27,
FETAL CARDIOVASC 2-D US,76825,CPT,,48076825,CDM,483,RC,,,both,,,2308,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,637.07,,,637.07,Fee Schedule,,573.17,,,573.17,Fee Schedule,,954.29,,,954.29,Fee Schedule,,858.51,,,858.51,Fee Schedule,,811.49,,,811.49,Fee Schedule,,1615.6,70,,1615.6,percent of total billed charges,All Other,756.9,,,756.9,Fee Schedule,,209,,,209,Other,186% of Medicaid,890.71,,,890.71,Fee Schedule,,419.39,,,419.39,Fee Schedule,,419.39,,,,Fee Schedule,,890.71,,,890.71,Fee Schedule,,419.39,,,419.39,Fee Schedule,,788.85,,,788.85,Fee Schedule,,1615.6,70,,1615.6,percent of total billed charges,,915.12,,,915.12,Fee Schedule,,775.62,,,775.62,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,770.53,,,770.53,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,112.6,1615.6,
COMPL FETAL DOPPLER ECHOCARGIOGRAM,76827,CPT,TC,48076827,CDM,483,RC,,,both,,,249,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,148.05,,,148.05,Fee Schedule,,133.2,,,133.2,Fee Schedule,,269.01,,,269.01,Fee Schedule,,242.01,,,242.01,Fee Schedule,,228.76,,,228.76,Fee Schedule,,174.3,70,,174.3,percent of total billed charges,All Other,175.89,,,175.89,Fee Schedule,,209,,,209,Other,186% of Medicaid,206.99,,,206.99,Fee Schedule,,97.46,,,97.46,Fee Schedule,,97.46,,,,Fee Schedule,,206.99,,,206.99,Fee Schedule,,97.46,,,97.46,Fee Schedule,,183.32,,,183.32,Fee Schedule,,174.3,70,,174.3,percent of total billed charges,,213.2,,,213.2,Fee Schedule,,180.7,,,180.7,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,179.33,,,179.33,Fee Schedule,,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,112.6,,,112.6,Other,100% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,172.28,,,172.28,Other,153% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,157.65,,,157.65,Other,140% of Medicaid,253.36,,,253.36,Other,225% of Medicaid,292.77,,,292.77,Other,250% of Medicaid,364.84,,,364.84,Other,324% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,242.1,,,242.1,Other,215% of Medicaid,140.76,,,140.76,Other,125% of Medicaid,97.46,364.84,
TTE CONG ABN COMPLETE,93303,CPT,,48093303,CDM,483,RC,,,both,,,3125,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,511.15,,,511.15,Fee Schedule,,460.9,,,460.9,Fee Schedule,,1009.03,,,1009.03,Fee Schedule,,907.76,,,907.76,Fee Schedule,,858.05,,,858.05,Fee Schedule,,2187.5,70,,2187.5,percent of total billed charges,All Other,2125,68,,2125,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,2500,80,,2500,percent of total billed charges,All Other,2593.75,83,,2593.75,percent of total billed charges,All Other,2593.75,83,,2593.75,percent of total billed charges,All Other,2500,80,,2500,percent of total billed charges,All Other,2593.75,83,,2593.75,percent of total billed charges,All Other,2500,80,,2500,percent of total billed charges,All Other,2187.5,70,,2187.5,percent of total billed charges,,798.68,,,798.68,Fee Schedule,,676.93,,,676.93,Fee Schedule,,1000,,,1000,Case Rate,,900,,,900,Case Rate,,1000,,,1000,Case Rate,,851,,,851,Case Rate,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,274.81,2593.75,
TTE CONG ABN LIMITED/F-UP,93304,CPT,,48093304,CDM,483,RC,,,both,,,3125,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,385.98,,,385.98,Fee Schedule,,348.03,,,348.03,Fee Schedule,,673.49,,,673.49,Fee Schedule,,605.9,,,605.9,Fee Schedule,,572.71,,,572.71,Fee Schedule,,2187.5,70,,2187.5,percent of total billed charges,All Other,2125,68,,2125,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,2500,80,,2500,percent of total billed charges,All Other,2593.75,83,,2593.75,percent of total billed charges,All Other,2593.75,83,,2593.75,percent of total billed charges,All Other,2500,80,,2500,percent of total billed charges,All Other,2593.75,83,,2593.75,percent of total billed charges,All Other,2500,80,,2500,percent of total billed charges,All Other,2187.5,70,,2187.5,percent of total billed charges,,598.6,,,598.6,Fee Schedule,,507.35,,,507.35,Fee Schedule,,1000,,,1000,Case Rate,,900,,,900,Case Rate,,1000,,,1000,Case Rate,,851,,,851,Case Rate,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,274.81,2593.75,
TTE W/DOPPLER COMPLETE,93306,CPT,,48093306,CDM,483,RC,,,both,,,2181,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,413.91,,,413.91,Fee Schedule,,373.22,,,373.22,Fee Schedule,,1156.55,,,1156.55,Fee Schedule,,1040.48,,,1040.48,Fee Schedule,,983.49,,,983.49,Fee Schedule,,1526.7,70,,1526.7,percent of total billed charges,All Other,1483.08,68,,1483.08,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,1744.8,80,,1744.8,percent of total billed charges,All Other,1810.23,83,,1810.23,percent of total billed charges,All Other,1810.23,83,,1810.23,percent of total billed charges,All Other,1744.8,80,,1744.8,percent of total billed charges,All Other,1810.23,83,,1810.23,percent of total billed charges,All Other,1744.8,80,,1744.8,percent of total billed charges,All Other,1526.7,70,,1526.7,percent of total billed charges,,637.96,,,637.96,Fee Schedule,,540.71,,,540.71,Fee Schedule,,1000,,,1000,Case Rate,,900,,,900,Case Rate,,1000,,,1000,Case Rate,,851,,,851,Case Rate,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,274.81,1810.23,
TTE W/O DOPPLER COMPLETE,93307,CPT,,48093307,CDM,483,RC,,,both,,,1511,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,301.58,,,301.58,Fee Schedule,,271.93,,,271.93,Fee Schedule,,669.75,,,669.75,Fee Schedule,,602.9,,,602.9,Fee Schedule,,569.48,,,569.48,Fee Schedule,,1057.7,70,,1057.7,percent of total billed charges,All Other,1027.48,68,,1027.48,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,1208.8,80,,1208.8,percent of total billed charges,All Other,1254.13,83,,1254.13,percent of total billed charges,All Other,1254.13,83,,1254.13,percent of total billed charges,All Other,1208.8,80,,1208.8,percent of total billed charges,All Other,1254.13,83,,1254.13,percent of total billed charges,All Other,403.81,,,403.81,Fee Schedule,,1057.7,70,,1057.7,percent of total billed charges,,469.04,,,469.04,Fee Schedule,,397.54,,,397.54,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,1254.13,
TEE,93312,CPT,,48093312,CDM,483,RC,,,both,,,3048,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,422.47,,,422.47,Fee Schedule,,380.94,,,380.94,Fee Schedule,,1497.03,,,1497.03,Fee Schedule,,1346.78,,,1346.78,Fee Schedule,,1273.02,,,1273.02,Fee Schedule,,2133.6,70,,2133.6,percent of total billed charges,All Other,2072.64,68,,2072.64,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,2438.4,80,,2438.4,percent of total billed charges,All Other,2529.84,83,,2529.84,percent of total billed charges,All Other,2529.84,83,,2529.84,percent of total billed charges,All Other,2438.4,80,,2438.4,percent of total billed charges,All Other,2529.84,83,,2529.84,percent of total billed charges,All Other,2438.4,80,,2438.4,percent of total billed charges,All Other,2133.6,70,,2133.6,percent of total billed charges,,656,,,656,Fee Schedule,,556,,,556,Fee Schedule,,1000,,,1000,Case Rate,,900,,,900,Case Rate,,1000,,,1000,Case Rate,,851,,,851,Case Rate,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,274.81,2529.84,
DOPPLER ECHO COMPLETE,93320,CPT,,48093320,CDM,483,RC,,,both,,,144,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,107,,,107,Fee Schedule,,96.48,,,96.48,Fee Schedule,,302.33,,,302.33,Fee Schedule,,271.99,,,271.99,Fee Schedule,,257.09,,,257.09,Fee Schedule,,100.8,70,,100.8,percent of total billed charges,All Other,97.92,68,,97.92,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,115.2,80,,115.2,percent of total billed charges,All Other,119.52,83,,119.52,percent of total billed charges,All Other,119.52,83,,119.52,percent of total billed charges,All Other,115.2,80,,115.2,percent of total billed charges,All Other,119.52,83,,119.52,percent of total billed charges,All Other,115.2,80,,115.2,percent of total billed charges,All Other,100.8,70,,100.8,percent of total billed charges,,165.64,,,165.64,Fee Schedule,,140.39,,,140.39,Fee Schedule,,1000,,,1000,Case Rate,,900,,,900,Case Rate,,1000,,,1000,Case Rate,,851,,,851,Case Rate,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,1000,
DOPPLER ECHO LIMITED/ F-UP,93321,CPT,,48093321,CDM,483,RC,,,both,,,55,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,57.7,,,57.7,Fee Schedule,,52.03,,,52.03,Fee Schedule,,150.04,,,150.04,Fee Schedule,,134.98,,,134.98,Fee Schedule,,127.59,,,127.59,Fee Schedule,,38.5,70,,38.5,percent of total billed charges,All Other,37.4,68,,37.4,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,44,80,,44,percent of total billed charges,All Other,45.65,83,,45.65,percent of total billed charges,All Other,45.65,83,,45.65,percent of total billed charges,All Other,44,80,,44,percent of total billed charges,All Other,45.65,83,,45.65,percent of total billed charges,All Other,44,80,,44,percent of total billed charges,All Other,38.5,70,,38.5,percent of total billed charges,,90.2,,,90.2,Fee Schedule,,76.45,,,76.45,Fee Schedule,,1000,,,1000,Case Rate,,900,,,900,Case Rate,,1000,,,1000,Case Rate,,851,,,851,Case Rate,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,1000,
DOPPLER COLOR FLOW ADD-ON,93325,CPT,,48093325,CDM,483,RC,,,both,,,17,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,65.17,,,65.17,Fee Schedule,,58.76,,,58.76,Fee Schedule,,223.8,,,223.8,Fee Schedule,,201.34,,,201.34,Fee Schedule,,190.31,,,190.31,Fee Schedule,,11.9,70,,11.9,percent of total billed charges,All Other,11.56,68,,11.56,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,13.6,80,,13.6,percent of total billed charges,All Other,14.11,83,,14.11,percent of total billed charges,All Other,14.11,83,,14.11,percent of total billed charges,All Other,13.6,80,,13.6,percent of total billed charges,All Other,14.11,83,,14.11,percent of total billed charges,All Other,87.26,,,87.26,Fee Schedule,,11.9,70,,11.9,percent of total billed charges,,101.68,,,101.68,Fee Schedule,,86.18,,,86.18,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,0.01,418.39,
ECHO STRESS RE TIME TC,93350,CPT,,48093350,CDM,483,RC,,,both,,,2181,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,378.51,,,378.51,Fee Schedule,,341.3,,,341.3,Fee Schedule,,893.72,,,893.72,Fee Schedule,,804.52,,,804.52,Fee Schedule,,759.92,,,759.92,Fee Schedule,,1526.7,70,,1526.7,percent of total billed charges,All Other,1483.08,68,,1483.08,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,1744.8,80,,1744.8,percent of total billed charges,All Other,1810.23,83,,1810.23,percent of total billed charges,All Other,1810.23,83,,1810.23,percent of total billed charges,All Other,1744.8,80,,1744.8,percent of total billed charges,All Other,1810.23,83,,1810.23,percent of total billed charges,All Other,506.82,,,506.82,Fee Schedule,,1526.7,70,,1526.7,percent of total billed charges,,588.76,,,588.76,Fee Schedule,,499.01,,,499.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,1810.23,
STRESS TTE COMPLETE,93351,CPT,,48093351,CDM,483,RC,,,both,,,3344,996.88,,,996.88,Other,150% of Medicare + 9.63% HCRA Surcharge,606.21,,,606.21,Other,Medicare OPPS,485.66,,,485.66,Fee Schedule,,437.92,,,437.92,Fee Schedule,,1092.49,,,1092.49,Fee Schedule,,982.84,,,982.84,Fee Schedule,,929.02,,,929.02,Fee Schedule,,2340.8,70,,2340.8,percent of total billed charges,All Other,2273.92,68,,2273.92,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,2675.2,80,,2675.2,percent of total billed charges,All Other,2775.52,83,,2775.52,percent of total billed charges,All Other,2775.52,83,,2775.52,percent of total billed charges,All Other,2675.2,80,,2675.2,percent of total billed charges,All Other,2775.52,83,,2775.52,percent of total billed charges,All Other,2675.2,80,,2675.2,percent of total billed charges,All Other,2340.8,70,,2340.8,percent of total billed charges,,744.56,,,744.56,Fee Schedule,,631.06,,,631.06,Fee Schedule,,1000,,,1000,Case Rate,,900,,,900,Case Rate,,1000,,,1000,Case Rate,,851,,,851,Case Rate,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,274.81,2775.52,
ADMIN ECG CONTRAST AGENT,93352,CPT,,48093352,CDM,483,RC,,,both,,,210,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,110.33,,,110.33,Fee Schedule,,99.48,,,99.48,Fee Schedule,,234.5,,,234.5,Fee Schedule,,211.1,,,211.1,Fee Schedule,,199.39,,,199.39,Fee Schedule,,147,70,,147,percent of total billed charges,All Other,142.8,68,,142.8,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,168,80,,168,percent of total billed charges,All Other,174.3,83,,174.3,percent of total billed charges,All Other,174.3,83,,174.3,percent of total billed charges,All Other,168,80,,168,percent of total billed charges,All Other,174.3,83,,174.3,percent of total billed charges,All Other,147.73,,,147.73,Fee Schedule,,147,70,,147,percent of total billed charges,,162.36,,,162.36,Fee Schedule,,137.61,,,137.61,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,890.39,
MYOCRD STRAIN IMG SPCKL TRCK,93356,CPT,,48093356,CDM,483,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,35.25,,,35.25,Fee Schedule,,31.79,,,31.79,Fee Schedule,,39.13,,,39.13,Fee Schedule,,39.13,,,39.13,Fee Schedule,,39.13,,,39.13,Fee Schedule,,210,70,,210,percent of total billed charges,All Other,45.29,,,45.29,Fee Schedule,,511,,,511,Other,186% of Medicaid,53.3,,,53.3,Fee Schedule,,186,,,186,Fee Schedule,,25.1,,,,Fee Schedule,,53.3,,,53.3,Fee Schedule,,186,,,186,Fee Schedule,,240,80,,240,percent of total billed charges,All Other,210,70,,210,percent of total billed charges,,57.4,,,57.4,Fee Schedule,,48.65,,,48.65,Fee Schedule,,1000,,,1000,Case Rate,,900,,,900,Case Rate,,1000,,,1000,Case Rate,,851,,,851,Case Rate,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,1000,
2D TTE W OR W/O FOL W/CON FU,C8924,HCPCS,,48000001,CDM,483,RC,,,both,,,2768,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,1799.2,65,,1799.2,percent of total billed charges,All Other,1633.12,59,,1633.12,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,1937.6,70,,1937.6,percent of total billed charges,All Other,1882.24,68,,1882.24,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,2214.4,80,,2214.4,percent of total billed charges,All Other,2297.44,62,,2297.44,percent of total billed charges,Lab & Radiology,1522.4,55,,,percent of total billed charges,Default if not in Fee Schedule,2214.4,80,,2214.4,percent of total billed charges,All Other,2297.44,62,,2297.44,percent of total billed charges,Lab & Radiology,2214.4,80,,2214.4,percent of total billed charges,All Other,1937.6,70,,1937.6,percent of total billed charges,,1799.2,65,,1799.2,percent of total billed charges,All Other,1799.2,65,,1799.2,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,2297.44,
2D TEE W OR W/O FOL W/CON IN,C8925,HCPCS,,48000002,CDM,483,RC,,,both,,,4962,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,3225.3,65,,3225.3,percent of total billed charges,All Other,2927.58,59,,2927.58,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,3473.4,70,,3473.4,percent of total billed charges,All Other,3374.16,68,,3374.16,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,3969.6,80,,3969.6,percent of total billed charges,All Other,4118.46,62,,4118.46,percent of total billed charges,Lab & Radiology,2729.1,55,,,percent of total billed charges,Default if not in Fee Schedule,3969.6,80,,3969.6,percent of total billed charges,All Other,4118.46,62,,4118.46,percent of total billed charges,Lab & Radiology,3969.6,80,,3969.6,percent of total billed charges,All Other,3473.4,70,,3473.4,percent of total billed charges,,3225.3,65,,3225.3,percent of total billed charges,All Other,3225.3,65,,3225.3,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,4118.46,
TTE W OR W/O FOL W/CON DOPPLER,C8929,HCPCS,,48000003,CDM,483,RC,,,both,,,4962,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,3225.3,65,,3225.3,percent of total billed charges,All Other,2927.58,59,,2927.58,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,3473.4,70,,3473.4,percent of total billed charges,All Other,3374.16,68,,3374.16,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,3969.6,80,,3969.6,percent of total billed charges,All Other,4118.46,83,,4118.46,percent of total billed charges,All Other,4118.46,83,,,percent of total billed charges,All Other,3969.6,80,,3969.6,percent of total billed charges,All Other,4118.46,83,,4118.46,percent of total billed charges,All Other,3969.6,80,,3969.6,percent of total billed charges,All Other,3473.4,70,,3473.4,percent of total billed charges,,3225.3,65,,3225.3,percent of total billed charges,All Other,3225.3,65,,3225.3,percent of total billed charges,All Other,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,4118.46,
TTE W OR W/O CONTR CONT ECG,C8930,HCPCS,,48000004,CDM,483,RC,,,both,,,4962,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,3225.3,65,,3225.3,percent of total billed charges,All Other,2927.58,59,,2927.58,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,3473.4,70,,3473.4,percent of total billed charges,All Other,3374.16,68,,3374.16,percent of total billed charges,All Other,511,,,511,Other,186% of Medicaid,3969.6,80,,3969.6,percent of total billed charges,All Other,4118.46,62,,4118.46,percent of total billed charges,Lab & Radiology,2729.1,55,,,percent of total billed charges,Default if not in Fee Schedule,3969.6,80,,3969.6,percent of total billed charges,All Other,4118.46,62,,4118.46,percent of total billed charges,Lab & Radiology,3969.6,80,,3969.6,percent of total billed charges,All Other,3473.4,70,,3473.4,percent of total billed charges,,3225.3,65,,3225.3,percent of total billed charges,All Other,3225.3,65,,3225.3,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,274.81,,,274.81,Other,100% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,420.46,,,420.46,Other,153% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,384.73,,,384.73,Other,140% of Medicaid,618.32,,,618.32,Other,225% of Medicaid,714.51,,,714.51,Other,250% of Medicaid,890.39,,,890.39,Other,324% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,590.84,,,590.84,Other,215% of Medicaid,343.51,,,343.51,Other,125% of Medicaid,0.01,4118.46,
E&M LOW LEVEL,99211,CPT,,82099211,CDM,510,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,159.6,70,,159.6,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,All Other,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
PHONE E/M PHYS/QHP 5 TO 10MIN,99441,CPT,,70099441,CDM,510,RC,,,both,,,41,16.18,39.4668,,16.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.65,65,,26.65,percent of total billed charges,All Other,24.19,59,,24.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,28.7,70,,28.7,percent of total billed charges,All Other,27.88,68,,27.88,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,32.8,80,,32.8,percent of total billed charges,All Other,34.03,83,,34.03,percent of total billed charges,All Other,34.03,83,,,percent of total billed charges,All Other,32.8,80,,32.8,percent of total billed charges,All Other,34.03,83,,34.03,percent of total billed charges,All Other,32.8,80,,32.8,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,,170.56,,,170.56,Fee Schedule,,144.56,,,144.56,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,All Other,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.56,
PHONE E/M PHYS/QHP 5 TO 10MIN,99441,CPT,,83099441,CDM,510,RC,,,both,,,41,16.18,39.4668,,16.18,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,26.65,65,,26.65,percent of total billed charges,All Other,24.19,59,,24.19,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,28.7,70,,28.7,percent of total billed charges,All Other,27.88,68,,27.88,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,32.8,80,,32.8,percent of total billed charges,All Other,34.03,83,,34.03,percent of total billed charges,All Other,34.03,83,,,percent of total billed charges,All Other,32.8,80,,32.8,percent of total billed charges,All Other,34.03,83,,34.03,percent of total billed charges,All Other,32.8,80,,32.8,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,,170.56,,,170.56,Fee Schedule,,144.56,,,144.56,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,All Other,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,170.56,
PHONE E/M PHYS/QHP 11 TO 20MIN,99442,CPT,,70099442,CDM,510,RC,,,both,,,76,29.99,39.4668,,29.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,49.4,65,,49.4,percent of total billed charges,All Other,44.84,59,,44.84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,53.2,70,,53.2,percent of total billed charges,All Other,51.68,68,,51.68,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,60.8,80,,60.8,percent of total billed charges,All Other,63.08,83,,63.08,percent of total billed charges,All Other,63.08,83,,,percent of total billed charges,All Other,60.8,80,,60.8,percent of total billed charges,All Other,63.08,83,,63.08,percent of total billed charges,All Other,60.8,80,,60.8,percent of total billed charges,All Other,53.2,70,,53.2,percent of total billed charges,,318.16,,,318.16,Fee Schedule,,269.66,,,269.66,Fee Schedule,,53.2,70,,53.2,percent of total billed charges,All Other,53.2,70,,53.2,percent of total billed charges,All Other,53.2,70,,53.2,percent of total billed charges,All Other,53.2,70,,53.2,percent of total billed charges,All Other,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,318.16,
PHONE E/M PHYS/QHP 11 TO 20MIN,99442,CPT,,83099442,CDM,510,RC,,,both,,,76,29.99,39.4668,,29.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,49.4,65,,49.4,percent of total billed charges,All Other,44.84,59,,44.84,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,53.2,70,,53.2,percent of total billed charges,All Other,51.68,68,,51.68,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,60.8,80,,60.8,percent of total billed charges,All Other,63.08,83,,63.08,percent of total billed charges,All Other,63.08,83,,,percent of total billed charges,All Other,60.8,80,,60.8,percent of total billed charges,All Other,63.08,83,,63.08,percent of total billed charges,All Other,60.8,80,,60.8,percent of total billed charges,All Other,53.2,70,,53.2,percent of total billed charges,,318.16,,,318.16,Fee Schedule,,269.66,,,269.66,Fee Schedule,,53.2,70,,53.2,percent of total billed charges,All Other,53.2,70,,53.2,percent of total billed charges,All Other,53.2,70,,53.2,percent of total billed charges,All Other,53.2,70,,53.2,percent of total billed charges,All Other,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,318.16,
PHONE E/M PHYS/QHP 21 TO 30MIN,99443,CPT,,70099443,CDM,510,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78,65,,78,percent of total billed charges,All Other,70.8,59,,70.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,81.6,68,,81.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,99.6,83,,,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,,469.04,,,469.04,Fee Schedule,,397.54,,,397.54,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,469.04,
PHONE E/M PHYS/QHP 21 TO 30MIN,99443,CPT,,83099443,CDM,510,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78,65,,78,percent of total billed charges,All Other,70.8,59,,70.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,84,70,,84,percent of total billed charges,All Other,81.6,68,,81.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,99.6,83,,,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,,469.04,,,469.04,Fee Schedule,,397.54,,,397.54,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,469.04,
GROUND MILEAGE PER STATUTE MILE,A0425,HCPCS,,41000002,CDM,540,RC,,,both,,,32,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.8,65,,20.8,percent of total billed charges,All Other,18.88,59,,18.88,percent of total billed charges,All Other,19.84,76.5,,19.84,percent of total billed charges,All Other,22.08,69,,22.08,percent of total billed charges,All Other,20.8,65,,20.8,percent of total billed charges,All Other,22.4,70,,22.4,percent of total billed charges,All Other,21.76,68,,21.76,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,25.6,80,,25.6,percent of total billed charges,All Other,26.56,83,,26.56,percent of total billed charges,All Other,26.56,83,,,percent of total billed charges,All Other,25.6,80,,25.6,percent of total billed charges,All Other,26.56,83,,26.56,percent of total billed charges,All Other,25.6,80,,25.6,percent of total billed charges,All Other,22.4,70,,22.4,percent of total billed charges,,20.8,65,,20.8,percent of total billed charges,All Other,20.8,65,,20.8,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,26.56,
ALS 1 NON-EMERGENCY,A0426,HCPCS,,41000003,CDM,540,RC,,,both,,,1145,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,744.25,65,,744.25,percent of total billed charges,All Other,675.55,59,,675.55,percent of total billed charges,All Other,709.9,76.5,,709.9,percent of total billed charges,All Other,790.05,69,,790.05,percent of total billed charges,All Other,744.25,65,,744.25,percent of total billed charges,All Other,801.5,70,,801.5,percent of total billed charges,All Other,778.6,68,,778.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,916,80,,916,percent of total billed charges,All Other,950.35,83,,950.35,percent of total billed charges,All Other,950.35,83,,,percent of total billed charges,All Other,916,80,,916,percent of total billed charges,All Other,950.35,83,,950.35,percent of total billed charges,All Other,916,80,,916,percent of total billed charges,All Other,801.5,70,,801.5,percent of total billed charges,,744.25,65,,744.25,percent of total billed charges,All Other,744.25,65,,744.25,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,950.35,
ALS1-EMERGENCY,A0427,HCPCS,,41000004,CDM,540,RC,,,both,,,1897,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1233.05,65,,1233.05,percent of total billed charges,All Other,1119.23,59,,1119.23,percent of total billed charges,All Other,1176.14,76.5,,1176.14,percent of total billed charges,All Other,1308.93,69,,1308.93,percent of total billed charges,All Other,1233.05,65,,1233.05,percent of total billed charges,All Other,1327.9,70,,1327.9,percent of total billed charges,All Other,1289.96,68,,1289.96,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,1517.6,80,,1517.6,percent of total billed charges,All Other,1574.51,83,,1574.51,percent of total billed charges,All Other,1574.51,83,,,percent of total billed charges,All Other,1517.6,80,,1517.6,percent of total billed charges,All Other,1574.51,83,,1574.51,percent of total billed charges,All Other,1517.6,80,,1517.6,percent of total billed charges,All Other,1327.9,70,,1327.9,percent of total billed charges,,1233.05,65,,1233.05,percent of total billed charges,All Other,1233.05,65,,1233.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1574.51,
BLS - NON-EMERGENT,A0428,HCPCS,,41000005,CDM,540,RC,,,both,,,999,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,649.35,65,,649.35,percent of total billed charges,All Other,589.41,59,,589.41,percent of total billed charges,All Other,619.38,76.5,,619.38,percent of total billed charges,All Other,689.31,69,,689.31,percent of total billed charges,All Other,649.35,65,,649.35,percent of total billed charges,All Other,699.3,70,,699.3,percent of total billed charges,All Other,679.32,68,,679.32,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,799.2,80,,799.2,percent of total billed charges,All Other,829.17,83,,829.17,percent of total billed charges,All Other,829.17,83,,,percent of total billed charges,All Other,799.2,80,,799.2,percent of total billed charges,All Other,829.17,83,,829.17,percent of total billed charges,All Other,799.2,80,,799.2,percent of total billed charges,All Other,699.3,70,,699.3,percent of total billed charges,,649.35,65,,649.35,percent of total billed charges,All Other,649.35,65,,649.35,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,829.17,
BLS - EMERGENCY,A0429,HCPCS,,41000006,CDM,540,RC,,,both,,,1598,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1038.7,65,,1038.7,percent of total billed charges,All Other,942.82,59,,942.82,percent of total billed charges,All Other,990.76,76.5,,990.76,percent of total billed charges,All Other,1102.62,69,,1102.62,percent of total billed charges,All Other,1038.7,65,,1038.7,percent of total billed charges,All Other,1118.6,70,,1118.6,percent of total billed charges,All Other,1086.64,68,,1086.64,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,1278.4,80,,1278.4,percent of total billed charges,All Other,1326.34,83,,1326.34,percent of total billed charges,All Other,1326.34,83,,,percent of total billed charges,All Other,1278.4,80,,1278.4,percent of total billed charges,All Other,1326.34,83,,1326.34,percent of total billed charges,All Other,1278.4,80,,1278.4,percent of total billed charges,All Other,1118.6,70,,1118.6,percent of total billed charges,,1038.7,65,,1038.7,percent of total billed charges,All Other,1038.7,65,,1038.7,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1326.34,
PARAMED INTERCEPT RURAL,A0432,HCPCS,,41000007,CDM,540,RC,,,both,,,1747,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1135.55,65,,1135.55,percent of total billed charges,All Other,1030.73,59,,1030.73,percent of total billed charges,All Other,1083.14,76.5,,1083.14,percent of total billed charges,All Other,1205.43,69,,1205.43,percent of total billed charges,All Other,1135.55,65,,1135.55,percent of total billed charges,All Other,1222.9,70,,1222.9,percent of total billed charges,All Other,1187.96,68,,1187.96,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,1397.6,80,,1397.6,percent of total billed charges,All Other,1450.01,83,,1450.01,percent of total billed charges,All Other,1450.01,83,,,percent of total billed charges,All Other,1397.6,80,,1397.6,percent of total billed charges,All Other,1450.01,83,,1450.01,percent of total billed charges,All Other,1397.6,80,,1397.6,percent of total billed charges,All Other,1222.9,70,,1222.9,percent of total billed charges,,1135.55,65,,1135.55,percent of total billed charges,All Other,1135.55,65,,1135.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1450.01,
ALS 2,A0433,HCPCS,,41000008,CDM,540,RC,,,both,,,2515,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1634.75,65,,1634.75,percent of total billed charges,All Other,1483.85,59,,1483.85,percent of total billed charges,All Other,1559.3,76.5,,1559.3,percent of total billed charges,All Other,1735.35,69,,1735.35,percent of total billed charges,All Other,1634.75,65,,1634.75,percent of total billed charges,All Other,1760.5,70,,1760.5,percent of total billed charges,All Other,1710.2,68,,1710.2,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,2012,80,,2012,percent of total billed charges,All Other,2087.45,83,,2087.45,percent of total billed charges,All Other,2087.45,83,,,percent of total billed charges,All Other,2012,80,,2012,percent of total billed charges,All Other,2087.45,83,,2087.45,percent of total billed charges,All Other,2012,80,,2012,percent of total billed charges,All Other,1760.5,70,,1760.5,percent of total billed charges,,1634.75,65,,1634.75,percent of total billed charges,All Other,1634.75,65,,1634.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2087.45,
SPECIALTY CARE TRANSPORT,A0434,HCPCS,,41000009,CDM,540,RC,,,both,,,2973,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,1932.45,65,,1932.45,percent of total billed charges,All Other,1754.07,59,,1754.07,percent of total billed charges,All Other,1843.26,76.5,,1843.26,percent of total billed charges,All Other,2051.37,69,,2051.37,percent of total billed charges,All Other,1932.45,65,,1932.45,percent of total billed charges,All Other,2081.1,70,,2081.1,percent of total billed charges,All Other,2021.64,68,,2021.64,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,2378.4,80,,2378.4,percent of total billed charges,All Other,2467.59,83,,2467.59,percent of total billed charges,All Other,2467.59,83,,,percent of total billed charges,All Other,2378.4,80,,2378.4,percent of total billed charges,All Other,2467.59,83,,2467.59,percent of total billed charges,All Other,2378.4,80,,2378.4,percent of total billed charges,All Other,2081.1,70,,2081.1,percent of total billed charges,,1932.45,65,,1932.45,percent of total billed charges,All Other,1932.45,65,,1932.45,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,2467.59,
AMB RESPOND AND TREAT; NO TRANSPORT,A0998,HCPCS,GY,41000010,CDM,540,RC,,,both,,,161,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.65,65,,104.65,percent of total billed charges,All Other,94.99,59,,94.99,percent of total billed charges,All Other,99.82,76.5,,99.82,percent of total billed charges,All Other,111.09,69,,111.09,percent of total billed charges,All Other,104.65,65,,104.65,percent of total billed charges,All Other,112.7,70,,112.7,percent of total billed charges,All Other,109.48,68,,109.48,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,128.8,80,,128.8,percent of total billed charges,All Other,133.63,83,,133.63,percent of total billed charges,All Other,133.63,83,,,percent of total billed charges,All Other,128.8,80,,128.8,percent of total billed charges,All Other,133.63,83,,133.63,percent of total billed charges,All Other,128.8,80,,128.8,percent of total billed charges,All Other,112.7,70,,112.7,percent of total billed charges,,104.65,65,,104.65,percent of total billed charges,All Other,104.65,65,,104.65,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.63,
ALS/BLS O2 & SUPPLIES,A0422,HCPCS,,41000001,CDM,544,RC,,,both,,,29,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,18.85,65,,18.85,percent of total billed charges,All Other,17.11,59,,17.11,percent of total billed charges,All Other,17.98,76.5,,17.98,percent of total billed charges,All Other,20.01,69,,20.01,percent of total billed charges,All Other,18.85,65,,18.85,percent of total billed charges,All Other,20.3,70,,20.3,percent of total billed charges,All Other,19.72,68,,19.72,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,23.2,80,,23.2,percent of total billed charges,All Other,24.07,83,,24.07,percent of total billed charges,All Other,24.07,83,,,percent of total billed charges,All Other,23.2,80,,23.2,percent of total billed charges,All Other,24.07,83,,24.07,percent of total billed charges,All Other,23.2,80,,23.2,percent of total billed charges,All Other,20.3,70,,20.3,percent of total billed charges,,18.85,65,,18.85,percent of total billed charges,All Other,18.85,65,,18.85,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,24.07,
MRI TEMPOROMANDIBULAR JOINT,70336,CPT,TC,45070336,CDM,610,RC,,,both,,,2847,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,702.73,,,702.73,Fee Schedule,,632.23,,,632.23,Fee Schedule,,2401.06,,,2401.06,Fee Schedule,,2160.08,,,2160.08,Fee Schedule,,2041.78,,,2041.78,Fee Schedule,,1992.9,70,,1992.9,percent of total billed charges,All Other,834.9,,,834.9,Fee Schedule,,683,,,683,Other,186% of Medicaid,982.49,,,982.49,Fee Schedule,,1765.14,,,1765.14,Fee Schedule,,462.61,,,,Fee Schedule,,982.49,,,982.49,Fee Schedule,,1765.14,,,1765.14,Fee Schedule,,870.15,,,870.15,Fee Schedule,,1992.9,70,,1992.9,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2401.06,
MRI ORBIT FACE NECK WO CONTRAST,70540,CPT,TC,45070540,CDM,610,RC,,,both,,,2660,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,588.36,,,588.36,Fee Schedule,,529.34,,,529.34,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,1862,70,,1862,percent of total billed charges,All Other,699.03,,,699.03,Fee Schedule,,683,,,683,Other,186% of Medicaid,822.6,,,822.6,Fee Schedule,,1649.2,,,1649.2,Fee Schedule,,387.32,,,,Fee Schedule,,822.6,,,822.6,Fee Schedule,,1649.2,,,1649.2,Fee Schedule,,728.54,,,728.54,Fee Schedule,,1862,70,,1862,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI ORBIT FACE NECK W CONTRAST,70542,CPT,TC,45070542,CDM,610,RC,,,both,,,3504,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,694.81,,,694.81,Fee Schedule,,625.11,,,625.11,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2452.8,70,,2452.8,percent of total billed charges,All Other,825.5,,,825.5,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,971.43,,,971.43,Fee Schedule,,2172.48,,,2172.48,Fee Schedule,,457.4,,,,Fee Schedule,,971.43,,,971.43,Fee Schedule,,2172.48,,,2172.48,Fee Schedule,,860.35,,,860.35,Fee Schedule,,2452.8,70,,2452.8,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3060.14,
MRI ORBIT FACE NECK  W WO CONT,70543,CPT,TC,45070543,CDM,610,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,860.02,,,860.02,Fee Schedule,,773.75,,,773.75,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,1021.78,,,1021.78,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1202.42,,,1202.42,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,566.16,,,,Fee Schedule,,1202.42,,,1202.42,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,1064.92,,,1064.92,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRA NECK W CONTRAST,70548,CPT,TC,45070548,CDM,610,RC,,,both,,,2873,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,634.75,,,634.75,Fee Schedule,,571.07,,,571.07,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2011.1,70,,2011.1,percent of total billed charges,All Other,754.13,,,754.13,Fee Schedule,,871,,,871,Other,186% of Medicaid,887.45,,,887.45,Fee Schedule,,1781.26,,,1781.26,Fee Schedule,,417.86,,,,Fee Schedule,,887.45,,,887.45,Fee Schedule,,1781.26,,,1781.26,Fee Schedule,,785.97,,,785.97,Fee Schedule,,2011.1,70,,2011.1,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,417.86,3060.14,
MRI CHEST WO CONTRAST,71550,CPT,TC,45071550,CDM,610,RC,,,both,,,3409,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,824.2,,,824.2,Fee Schedule,,741.52,,,741.52,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2386.3,70,,2386.3,percent of total billed charges,All Other,979.22,,,979.22,Fee Schedule,,683,,,683,Other,186% of Medicaid,1152.33,,,1152.33,Fee Schedule,,2113.58,,,2113.58,Fee Schedule,,542.58,,,,Fee Schedule,,1152.33,,,1152.33,Fee Schedule,,2113.58,,,2113.58,Fee Schedule,,1020.56,,,1020.56,Fee Schedule,,2386.3,70,,2386.3,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI CHEST W CONTRAST,71551,CPT,TC,45071551,CDM,610,RC,,,both,,,3215,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,1051.81,,,1051.81,Fee Schedule,,946.3,,,946.3,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2250.5,70,,2250.5,percent of total billed charges,All Other,1249.64,,,1249.64,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1470.55,,,1470.55,Fee Schedule,,1993.3,,,1993.3,Fee Schedule,,692.41,,,,Fee Schedule,,1470.55,,,1470.55,Fee Schedule,,1993.3,,,1993.3,Fee Schedule,,1415.17,,,1415.17,Fee Schedule,,2250.5,70,,2250.5,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,550.44,3060.14,
MRI CHEST W AND WO CONTRAST,71552,CPT,TC,45071552,CDM,610,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,1293.42,,,1293.42,Fee Schedule,,1163.67,,,1163.67,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,1536.69,,,1536.69,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1808.35,,,1808.35,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,851.47,,,,Fee Schedule,,1808.35,,,1808.35,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,1601.57,,,1601.57,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI PELVIS WO CONTRAST,72195,CPT,TC,45072195,CDM,610,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,579.11,,,579.11,Fee Schedule,,521.02,,,521.02,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,688.04,,,688.04,Fee Schedule,,683,,,683,Other,186% of Medicaid,809.67,,,809.67,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,381.23,,,,Fee Schedule,,809.67,,,809.67,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,717.08,,,717.08,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI PELVIS W CONTRAST,72196,CPT,TC,45072196,CDM,610,RC,,,both,,,2712,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,677.49,,,677.49,Fee Schedule,,609.53,,,609.53,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,1898.4,70,,1898.4,percent of total billed charges,All Other,804.92,,,804.92,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,947.21,,,947.21,Fee Schedule,,1681.44,,,1681.44,Fee Schedule,,446,,,,Fee Schedule,,947.21,,,947.21,Fee Schedule,,1681.44,,,1681.44,Fee Schedule,,838.9,,,838.9,Fee Schedule,,1898.4,70,,1898.4,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3060.14,
MRI PELVIS W AND WO CONTRAST,72197,CPT,TC,45072197,CDM,610,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,845,,,845,Fee Schedule,,760.23,,,760.23,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,1003.93,,,1003.93,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1181.41,,,1181.41,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,556.27,,,,Fee Schedule,,1181.41,,,1181.41,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,1046.32,,,1046.32,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI U EXT WO CONTRAST LT,73218,CPT,TCLT,45173218,CDM,610,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,824.2,,,824.2,Fee Schedule,,741.52,,,741.52,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,979.22,,,979.22,Fee Schedule,,683,,,683,Other,186% of Medicaid,1152.33,,,1152.33,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,542.58,,,,Fee Schedule,,1152.33,,,1152.33,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,1020.56,,,1020.56,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI U EXT WO CONTRAST RT,73218,CPT,TCRT,45273218,CDM,610,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,824.2,,,824.2,Fee Schedule,,741.52,,,741.52,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,979.22,,,979.22,Fee Schedule,,683,,,683,Other,186% of Medicaid,1152.33,,,1152.33,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,542.58,,,,Fee Schedule,,1152.33,,,1152.33,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,1020.56,,,1020.56,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI U EXT NOT JOINT W CONTRAST LT,73219,CPT,TCLT,45173219,CDM,610,RC,,,both,,,3095,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,918.94,,,918.94,Fee Schedule,,826.76,,,826.76,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2166.5,70,,2166.5,percent of total billed charges,All Other,1091.79,,,1091.79,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1284.79,,,1284.79,Fee Schedule,,1918.9,,,1918.9,Fee Schedule,,604.95,,,,Fee Schedule,,1284.79,,,1284.79,Fee Schedule,,1918.9,,,1918.9,Fee Schedule,,1137.88,,,1137.88,Fee Schedule,,2166.5,70,,2166.5,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3060.14,
MRI U EXT NOT JOINT W CONTRAST RT,73219,CPT,TCRT,45273219,CDM,610,RC,,,both,,,3095,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,918.94,,,918.94,Fee Schedule,,826.76,,,826.76,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2166.5,70,,2166.5,percent of total billed charges,All Other,1091.79,,,1091.79,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1284.79,,,1284.79,Fee Schedule,,1918.9,,,1918.9,Fee Schedule,,604.95,,,,Fee Schedule,,1284.79,,,1284.79,Fee Schedule,,1918.9,,,1918.9,Fee Schedule,,1137.88,,,1137.88,Fee Schedule,,2166.5,70,,2166.5,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3060.14,
MRI U EXT W AND WO CONTRAST LT,73220,CPT,TCLT,45173220,CDM,610,RC,,,both,,,3910,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,1113.02,,,1113.02,Fee Schedule,,1001.37,,,1001.37,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2737,70,,2737,percent of total billed charges,All Other,1322.37,,,1322.37,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1556.14,,,1556.14,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,732.71,,,,Fee Schedule,,1556.14,,,1556.14,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,1378.19,,,1378.19,Fee Schedule,,2737,70,,2737,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI U EXT W AND WO CONTRAST RT,73220,CPT,TCRT,45273220,CDM,610,RC,,,both,,,3910,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,1113.02,,,1113.02,Fee Schedule,,1001.37,,,1001.37,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2737,70,,2737,percent of total billed charges,All Other,1322.37,,,1322.37,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1556.14,,,1556.14,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,732.71,,,,Fee Schedule,,1556.14,,,1556.14,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,1378.19,,,1378.19,Fee Schedule,,2737,70,,2737,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI JOINT U EXT WO CONTRAST LT,73221,CPT,TCLT,45173221,CDM,610,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,502.87,,,502.87,Fee Schedule,,452.43,,,452.43,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,597.46,,,597.46,Fee Schedule,,683,,,683,Other,186% of Medicaid,703.07,,,703.07,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,331.04,,,,Fee Schedule,,703.07,,,703.07,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,622.68,,,622.68,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI JOINT U EXT WO CONTRAST RT,73221,CPT,TCRT,45273221,CDM,610,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,502.87,,,502.87,Fee Schedule,,452.43,,,452.43,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,597.46,,,597.46,Fee Schedule,,683,,,683,Other,186% of Medicaid,703.07,,,703.07,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,331.04,,,,Fee Schedule,,703.07,,,703.07,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,622.68,,,622.68,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI JOINT U EXT W CONTRAST LT,73222,CPT,TCLT,45173222,CDM,610,RC,,,both,,,3186,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,853.1,,,853.1,Fee Schedule,,767.52,,,767.52,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2230.2,70,,2230.2,percent of total billed charges,All Other,1013.56,,,1013.56,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1192.74,,,1192.74,Fee Schedule,,1975.32,,,1975.32,Fee Schedule,,561.6,,,,Fee Schedule,,1192.74,,,1192.74,Fee Schedule,,1975.32,,,1975.32,Fee Schedule,,1056.35,,,1056.35,Fee Schedule,,2230.2,70,,2230.2,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,550.44,3060.14,
MRI JOINT U EXT W CONTRAST RT,73222,CPT,TCRT,45273222,CDM,610,RC,,,both,,,3186,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,853.1,,,853.1,Fee Schedule,,767.52,,,767.52,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2230.2,70,,2230.2,percent of total billed charges,All Other,1013.56,,,1013.56,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1192.74,,,1192.74,Fee Schedule,,1975.32,,,1975.32,Fee Schedule,,561.6,,,,Fee Schedule,,1192.74,,,1192.74,Fee Schedule,,1975.32,,,1975.32,Fee Schedule,,1056.35,,,1056.35,Fee Schedule,,2230.2,70,,2230.2,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,550.44,3060.14,
MRI JOINT U EXT W AND WO CONTRAST LT,73223,CPT,TCLT,45173223,CDM,610,RC,,,both,,,3910,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,1031.01,,,1031.01,Fee Schedule,,927.58,,,927.58,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2737,70,,2737,percent of total billed charges,All Other,1224.93,,,1224.93,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1441.47,,,1441.47,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,678.72,,,,Fee Schedule,,1441.47,,,1441.47,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,1276.64,,,1276.64,Fee Schedule,,2737,70,,2737,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI JOINT U EXT W AND WO CONTRAST RT,73223,CPT,TCRT,45273223,CDM,610,RC,,,both,,,3910,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,1031.01,,,1031.01,Fee Schedule,,927.58,,,927.58,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2737,70,,2737,percent of total billed charges,All Other,1224.93,,,1224.93,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1441.47,,,1441.47,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,678.72,,,,Fee Schedule,,1441.47,,,1441.47,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,1276.64,,,1276.64,Fee Schedule,,2737,70,,2737,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI L EXT WO CONTRAST LT,73718,CPT,TCLT,45173718,CDM,610,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,577.96,,,577.96,Fee Schedule,,519.99,,,519.99,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,686.67,,,686.67,Fee Schedule,,683,,,683,Other,186% of Medicaid,808.06,,,808.06,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,380.48,,,,Fee Schedule,,808.06,,,808.06,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,715.66,,,715.66,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI L EXT WO CONTRAST RT,73718,CPT,TCRT,45273718,CDM,610,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,577.96,,,577.96,Fee Schedule,,519.99,,,519.99,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,686.67,,,686.67,Fee Schedule,,683,,,683,Other,186% of Medicaid,808.06,,,808.06,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,380.48,,,,Fee Schedule,,808.06,,,808.06,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,715.66,,,715.66,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI L EXT W CONTRAST LT,73719,CPT,TCLT,45173719,CDM,610,RC,,,both,,,2712,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,676.34,,,676.34,Fee Schedule,,608.5,,,608.5,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,1898.4,70,,1898.4,percent of total billed charges,All Other,803.56,,,803.56,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,945.61,,,945.61,Fee Schedule,,1681.44,,,1681.44,Fee Schedule,,445.24,,,,Fee Schedule,,945.61,,,945.61,Fee Schedule,,1681.44,,,1681.44,Fee Schedule,,837.48,,,837.48,Fee Schedule,,1898.4,70,,1898.4,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3060.14,
MRI L EXT W CONTRAST RT,73719,CPT,TCRT,45273719,CDM,610,RC,,,both,,,2712,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,676.34,,,676.34,Fee Schedule,,608.5,,,608.5,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,1898.4,70,,1898.4,percent of total billed charges,All Other,803.56,,,803.56,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,945.61,,,945.61,Fee Schedule,,1681.44,,,1681.44,Fee Schedule,,445.24,,,,Fee Schedule,,945.61,,,945.61,Fee Schedule,,1681.44,,,1681.44,Fee Schedule,,837.48,,,837.48,Fee Schedule,,1898.4,70,,1898.4,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3060.14,
MRI FEMUR W AND WO CONTRAST LT,73720,CPT,TCLT,45173720,CDM,610,RC,,,both,,,3910,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,854.25,,,854.25,Fee Schedule,,768.56,,,768.56,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2737,70,,2737,percent of total billed charges,All Other,1014.92,,,1014.92,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1194.34,,,1194.34,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,562.36,,,,Fee Schedule,,1194.34,,,1194.34,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,1057.77,,,1057.77,Fee Schedule,,2737,70,,2737,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI FEMUR W AND WO CONTRAST RT,73720,CPT,TCRT,45273720,CDM,610,RC,,,both,,,3910,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,854.25,,,854.25,Fee Schedule,,768.56,,,768.56,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2737,70,,2737,percent of total billed charges,All Other,1014.92,,,1014.92,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1194.34,,,1194.34,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,562.36,,,,Fee Schedule,,1194.34,,,1194.34,Fee Schedule,,2424.2,,,2424.2,Fee Schedule,,1057.77,,,1057.77,Fee Schedule,,2737,70,,2737,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI JOINT L EXT WO CONTRAST LT,73721,CPT,TCLT,45173721,CDM,610,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,501.72,,,501.72,Fee Schedule,,451.39,,,451.39,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,596.09,,,596.09,Fee Schedule,,683,,,683,Other,186% of Medicaid,701.47,,,701.47,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,330.29,,,,Fee Schedule,,701.47,,,701.47,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,621.26,,,621.26,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI JOINT L EXT WO CONTRAST RT,73721,CPT,TCRT,45273721,CDM,610,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,501.72,,,501.72,Fee Schedule,,451.39,,,451.39,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,596.09,,,596.09,Fee Schedule,,683,,,683,Other,186% of Medicaid,701.47,,,701.47,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,330.29,,,,Fee Schedule,,701.47,,,701.47,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,621.26,,,621.26,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI JOINT L EXT W CONTRAST LT,73722,CPT,TCLT,45173722,CDM,610,RC,,,both,,,3128,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,855.4,,,855.4,Fee Schedule,,769.59,,,769.59,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2189.6,70,,2189.6,percent of total billed charges,All Other,1016.29,,,1016.29,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1195.95,,,1195.95,Fee Schedule,,1939.36,,,1939.36,Fee Schedule,,563.12,,,,Fee Schedule,,1195.95,,,1195.95,Fee Schedule,,1939.36,,,1939.36,Fee Schedule,,1059.19,,,1059.19,Fee Schedule,,2189.6,70,,2189.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,550.44,3060.14,
MRI JOINT L EXT W CONTRAST RT,73722,CPT,TCRT,45273722,CDM,610,RC,,,both,,,3128,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,855.4,,,855.4,Fee Schedule,,769.59,,,769.59,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2189.6,70,,2189.6,percent of total billed charges,All Other,1016.29,,,1016.29,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1195.95,,,1195.95,Fee Schedule,,1939.36,,,1939.36,Fee Schedule,,563.12,,,,Fee Schedule,,1195.95,,,1195.95,Fee Schedule,,1939.36,,,1939.36,Fee Schedule,,1059.19,,,1059.19,Fee Schedule,,2189.6,70,,2189.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,550.44,3060.14,
MRI JOINT L EXT W AND WO CONTRAST LT,73723,CPT,TCLT,45173723,CDM,610,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,1026.38,,,1026.38,Fee Schedule,,923.42,,,923.42,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,1219.43,,,1219.43,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1435.01,,,1435.01,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,675.68,,,,Fee Schedule,,1435.01,,,1435.01,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,1270.91,,,1270.91,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI JOINT L EXT W AND WO CONTRAST RT,73723,CPT,TCRT,45273723,CDM,610,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,1026.38,,,1026.38,Fee Schedule,,923.42,,,923.42,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,1219.43,,,1219.43,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1435.01,,,1435.01,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,675.68,,,,Fee Schedule,,1435.01,,,1435.01,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,1270.91,,,1270.91,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI ABDOMEN WO CONTRAST,74181,CPT,TC,45074181,CDM,610,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,461.27,,,461.27,Fee Schedule,,415,,,415,Fee Schedule,,2401.06,,,2401.06,Fee Schedule,,2160.08,,,2160.08,Fee Schedule,,2041.78,,,2041.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,548.03,,,548.03,Fee Schedule,,683,,,683,Other,186% of Medicaid,644.92,,,644.92,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,303.66,,,,Fee Schedule,,644.92,,,644.92,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,571.17,,,571.17,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2401.06,
MRI ABDOMEN W CONTRAST,74182,CPT,TC,45074182,CDM,610,RC,,,both,,,2992,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,798.81,,,798.81,Fee Schedule,,718.68,,,718.68,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2094.4,70,,2094.4,percent of total billed charges,All Other,949.05,,,949.05,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1116.83,,,1116.83,Fee Schedule,,1855.04,,,1855.04,Fee Schedule,,525.86,,,,Fee Schedule,,1116.83,,,1116.83,Fee Schedule,,1855.04,,,1855.04,Fee Schedule,,989.12,,,989.12,Fee Schedule,,2094.4,70,,2094.4,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3060.14,
MRI ABDOMEN W AND WO CONTRAST,74183,CPT,TC,45074183,CDM,610,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,849.62,,,849.62,Fee Schedule,,764.4,,,764.4,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,1009.43,,,1009.43,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1187.88,,,1187.88,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,559.31,,,,Fee Schedule,,1187.88,,,1187.88,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,1052.04,,,1052.04,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
CARDIAC MRI MORPH & FUNCTION W/O CONT,75557,CPT,,45075557,CDM,610,RC,,,both,,,737,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,614.94,,,614.94,Fee Schedule,,553.25,,,553.25,Fee Schedule,,2313,,,2313,Fee Schedule,,2080.85,,,2080.85,Fee Schedule,,1966.89,,,1966.89,Fee Schedule,,515.9,70,,515.9,percent of total billed charges,All Other,730.6,,,730.6,Fee Schedule,,683,,,683,Other,186% of Medicaid,859.75,,,859.75,Fee Schedule,,456.94,,,456.94,Fee Schedule,,404.82,,,,Fee Schedule,,859.75,,,859.75,Fee Schedule,,456.94,,,456.94,Fee Schedule,,761.44,,,761.44,Fee Schedule,,515.9,70,,515.9,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2313,
CARDIAC MRI W/WO CONTRAST & FURTHER SEQ,75561,CPT,,45075561,CDM,610,RC,,,both,,,1161,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,878.49,,,878.49,Fee Schedule,,790.37,,,790.37,Fee Schedule,,3336.17,,,3336.17,Fee Schedule,,3001.33,,,3001.33,Fee Schedule,,2836.96,,,2836.96,Fee Schedule,,812.7,70,,812.7,percent of total billed charges,All Other,1043.73,,,1043.73,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1228.24,,,1228.24,Fee Schedule,,719.82,,,719.82,Fee Schedule,,578.32,,,,Fee Schedule,,1228.24,,,1228.24,Fee Schedule,,719.82,,,719.82,Fee Schedule,,1087.79,,,1087.79,Fee Schedule,,812.7,70,,812.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3336.17,
MRI CARD W STRESS IMG & DYE,75563,CPT,TC,45075563,CDM,610,RC,,,both,,,2926,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS,1033.3,,,1033.3,Fee Schedule,,929.65,,,929.65,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2048.2,70,,2048.2,percent of total billed charges,All Other,1227.66,,,1227.66,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1444.68,,,1444.68,Fee Schedule,,1814.12,,,1814.12,Fee Schedule,,680.23,,,,Fee Schedule,,1444.68,,,1444.68,Fee Schedule,,1814.12,,,1814.12,Fee Schedule,,1279.48,,,1279.48,Fee Schedule,,2048.2,70,,2048.2,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,1089.31,,,1089.31,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,550.44,3738.35,
CARD MRI VEL FLW MAP ADD-ON,75565,CPT,TC,45075565,CDM,610,RC,,,both,,,2354,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,121.32,,,121.32,Fee Schedule,,109.15,,,109.15,Fee Schedule,,433.19,,,433.19,Fee Schedule,,389.72,,,389.72,Fee Schedule,,368.37,,,368.37,Fee Schedule,,1647.8,70,,1647.8,percent of total billed charges,All Other,144.13,,,144.13,Fee Schedule,,683,,,683,Other,186% of Medicaid,169.61,,,169.61,Fee Schedule,,1459.48,,,1459.48,Fee Schedule,,79.86,,,,Fee Schedule,,169.61,,,169.61,Fee Schedule,,1459.48,,,1459.48,Fee Schedule,,162.98,,,162.98,Fee Schedule,,1647.8,70,,1647.8,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,0.01,1772,
MAGNETIC RESONANCE SPECTROSCOPY,76390,CPT,TC,45076390,CDM,610,RC,,,both,,,3215,164.2,,,164.2,Other,150% of Medicare + 9.63% HCRA Surcharge,99.85,,,99.85,Other,Medicare OPPS,2089.75,65,,2089.75,percent of total billed charges,All Other,1896.85,59,,1896.85,percent of total billed charges,All Other,376.84,,,376.84,Fee Schedule,,376.84,,,376.84,Fee Schedule,,376.84,,,376.84,Fee Schedule,,2250.5,70,,2250.5,percent of total billed charges,All Other,2186.2,68,,2186.2,percent of total billed charges,All Other,683,,,683,Other,186% of Medicaid,2572,80,,2572,percent of total billed charges,All Other,1993.3,62,,1993.3,percent of total billed charges,Lab & Radiology,1768.25,55,,,percent of total billed charges,Default if not in Fee Schedule,2572,80,,2572,percent of total billed charges,All Other,1993.3,62,,1993.3,percent of total billed charges,Lab & Radiology,2572,80,,2572,percent of total billed charges,All Other,2250.5,70,,2250.5,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,576.27,,,576.27,Fee Schedule,,576.27,,,576.27,Fee Schedule,,576.27,,,576.27,Fee Schedule,,576.27,,,576.27,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,99.85,2572,
MRI BREAST W AND WO CONTRAST LT,C8905,HCPCS,TCLT,45000005,CDM,610,RC,,,both,,,3440,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,2236,65,,2236,percent of total billed charges,All Other,2029.6,59,,2029.6,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,2408,70,,2408,percent of total billed charges,All Other,2339.2,68,,2339.2,percent of total billed charges,All Other,1024,,,1024,Other,186% of Medicaid,2752,80,,2752,percent of total billed charges,All Other,2132.8,62,,2132.8,percent of total billed charges,Lab & Radiology,1892,55,,,percent of total billed charges,Default if not in Fee Schedule,2752,80,,2752,percent of total billed charges,All Other,2132.8,62,,2132.8,percent of total billed charges,Lab & Radiology,2752,80,,2752,percent of total billed charges,All Other,2408,70,,2408,percent of total billed charges,,2236,65,,2236,percent of total billed charges,All Other,2236,65,,2236,percent of total billed charges,All Other,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,0.01,2752,
MRI BREAST W AND WO CONTRAST RT,C8905,HCPCS,TCRT,45000006,CDM,610,RC,,,both,,,3440,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,2236,65,,2236,percent of total billed charges,All Other,2029.6,59,,2029.6,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,2408,70,,2408,percent of total billed charges,All Other,2339.2,68,,2339.2,percent of total billed charges,All Other,1024,,,1024,Other,186% of Medicaid,2752,80,,2752,percent of total billed charges,All Other,2132.8,62,,2132.8,percent of total billed charges,Lab & Radiology,1892,55,,,percent of total billed charges,Default if not in Fee Schedule,2752,80,,2752,percent of total billed charges,All Other,2132.8,62,,2132.8,percent of total billed charges,Lab & Radiology,2752,80,,2752,percent of total billed charges,All Other,2408,70,,2408,percent of total billed charges,,2236,65,,2236,percent of total billed charges,All Other,2236,65,,2236,percent of total billed charges,All Other,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,0.01,2752,
MRI BREAST W AND WO CONTRAST BILAT,C8908,HCPCS,TC,45000007,CDM,610,RC,,,both,,,5159,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,3353.35,65,,3353.35,percent of total billed charges,All Other,3043.81,59,,3043.81,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,3611.3,70,,3611.3,percent of total billed charges,All Other,3508.12,68,,3508.12,percent of total billed charges,All Other,1024,,,1024,Other,186% of Medicaid,4127.2,80,,4127.2,percent of total billed charges,All Other,3198.58,62,,3198.58,percent of total billed charges,Lab & Radiology,2837.45,55,,,percent of total billed charges,Default if not in Fee Schedule,4127.2,80,,4127.2,percent of total billed charges,All Other,3198.58,62,,3198.58,percent of total billed charges,Lab & Radiology,4127.2,80,,4127.2,percent of total billed charges,All Other,3611.3,70,,3611.3,percent of total billed charges,,3353.35,65,,3353.35,percent of total billed charges,All Other,3353.35,65,,3353.35,percent of total billed charges,All Other,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,0.01,4127.2,
MRI BRAIN W O CONTRAST,70551,CPT,TC,45070551,CDM,611,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,458.98,,,458.98,Fee Schedule,,412.94,,,412.94,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,545.31,,,545.31,Fee Schedule,,683,,,683,Other,186% of Medicaid,641.7,,,641.7,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,302.15,,,,Fee Schedule,,641.7,,,641.7,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,568.33,,,568.33,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2403.42,
MRI BRAIN W CONTRAST,70552,CPT,TC,45070552,CDM,611,RC,,,both,,,3410,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,675.2,,,675.2,Fee Schedule,,607.46,,,607.46,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2387,70,,2387,percent of total billed charges,All Other,802.19,,,802.19,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,944,,,944,Fee Schedule,,2114.2,,,2114.2,Fee Schedule,,444.49,,,,Fee Schedule,,944,,,944,Fee Schedule,,2114.2,,,2114.2,Fee Schedule,,836.06,,,836.06,Fee Schedule,,2387,70,,2387,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3060.14,
MRI BRAIN W AND WO CONTRAST,70553,CPT,TC,45070553,CDM,611,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,764.13,,,764.13,Fee Schedule,,687.48,,,687.48,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,907.86,,,907.86,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1068.35,,,1068.35,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,503.03,,,,Fee Schedule,,1068.35,,,1068.35,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,946.18,,,946.18,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI BRAIN W/WO CONTRAST W/PITUITARY MOD,70553,CPT,TC59,45170553,CDM,611,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,764.13,,,764.13,Fee Schedule,,687.48,,,687.48,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,907.86,,,907.86,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1068.35,,,1068.35,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,503.03,,,,Fee Schedule,,1068.35,,,1068.35,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,946.18,,,946.18,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI BRAIN W/WO CONTRAST W/IACS MOD,70553,CPT,TC59,45270553,CDM,611,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,764.13,,,764.13,Fee Schedule,,687.48,,,687.48,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,907.86,,,907.86,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1068.35,,,1068.35,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,503.03,,,,Fee Schedule,,1068.35,,,1068.35,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,946.18,,,946.18,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI C SPINE WO CONTRAST,72141,CPT,TC,45072141,CDM,612,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,439.33,,,439.33,Fee Schedule,,395.26,,,395.26,Fee Schedule,,2401.06,,,2401.06,Fee Schedule,,2160.08,,,2160.08,Fee Schedule,,2041.78,,,2041.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,521.96,,,521.96,Fee Schedule,,683,,,683,Other,186% of Medicaid,614.23,,,614.23,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,289.21,,,,Fee Schedule,,614.23,,,614.23,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,543.99,,,543.99,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2401.06,
MRI C SPINE W CONTRAST,72142,CPT,TC,45072142,CDM,612,RC,,,both,,,3348,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,691.37,,,691.37,Fee Schedule,,622.02,,,622.02,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2343.6,70,,2343.6,percent of total billed charges,All Other,821.41,,,821.41,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,966.62,,,966.62,Fee Schedule,,2075.76,,,2075.76,Fee Schedule,,455.13,,,,Fee Schedule,,966.62,,,966.62,Fee Schedule,,2075.76,,,2075.76,Fee Schedule,,856.08,,,856.08,Fee Schedule,,2343.6,70,,2343.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3060.14,
MRI T SPINE WO CONTRAST,72146,CPT,TC,45072146,CDM,612,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,438.18,,,438.18,Fee Schedule,,394.22,,,394.22,Fee Schedule,,2401.06,,,2401.06,Fee Schedule,,2160.08,,,2160.08,Fee Schedule,,2041.78,,,2041.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,520.59,,,520.59,Fee Schedule,,683,,,683,Other,186% of Medicaid,612.63,,,612.63,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,288.46,,,,Fee Schedule,,612.63,,,612.63,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,542.57,,,542.57,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2401.06,
MRI SPINE THORACIC W CONTRAST,72147,CPT,TC,45072147,CDM,612,RC,,,both,,,3791,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,684.41,,,684.41,Fee Schedule,,615.76,,,615.76,Fee Schedule,,3029.23,,,3029.23,Fee Schedule,,2725.21,,,2725.21,Fee Schedule,,2575.95,,,2575.95,Fee Schedule,,2653.7,70,,2653.7,percent of total billed charges,All Other,813.14,,,813.14,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,956.89,,,956.89,Fee Schedule,,2350.42,,,2350.42,Fee Schedule,,450.56,,,,Fee Schedule,,956.89,,,956.89,Fee Schedule,,2350.42,,,2350.42,Fee Schedule,,847.47,,,847.47,Fee Schedule,,2653.7,70,,2653.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3029.23,
MRI L SPINE WO CONTRAST,72148,CPT,TC,45072148,CDM,612,RC,,,both,,,2898,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,440.51,,,440.51,Fee Schedule,,396.32,,,396.32,Fee Schedule,,2401.06,,,2401.06,Fee Schedule,,2160.08,,,2160.08,Fee Schedule,,2041.78,,,2041.78,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,All Other,523.36,,,523.36,Fee Schedule,,683,,,683,Other,186% of Medicaid,615.88,,,615.88,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,289.99,,,,Fee Schedule,,615.88,,,615.88,Fee Schedule,,1796.76,,,1796.76,Fee Schedule,,545.46,,,545.46,Fee Schedule,,2028.6,70,,2028.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,367.47,,,367.47,Other,100% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,562.22,,,562.22,Other,153% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,514.45,,,514.45,Other,140% of Medicaid,826.8,,,826.8,Other,225% of Medicaid,955.41,,,955.41,Other,250% of Medicaid,1190.59,,,1190.59,Other,324% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,790.05,,,790.05,Other,215% of Medicaid,459.33,,,459.33,Other,125% of Medicaid,269.26,2401.06,
MRI L SPINE W CONTRAST,72149,CPT,TC,45072149,CDM,612,RC,,,both,,,3648,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,675.2,,,675.2,Fee Schedule,,607.46,,,607.46,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,2553.6,70,,2553.6,percent of total billed charges,All Other,802.19,,,802.19,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,944,,,944,Fee Schedule,,2261.76,,,2261.76,Fee Schedule,,444.49,,,,Fee Schedule,,944,,,944,Fee Schedule,,2261.76,,,2261.76,Fee Schedule,,836.06,,,836.06,Fee Schedule,,2553.6,70,,2553.6,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3060.14,
MRI C SPINE W AND WO CONTRAST,72156,CPT,TC,45072156,CDM,612,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,768.76,,,768.76,Fee Schedule,,691.64,,,691.64,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,913.35,,,913.35,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1074.82,,,1074.82,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,506.08,,,,Fee Schedule,,1074.82,,,1074.82,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,951.91,,,951.91,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI T SPINE W AND WO CONTRAST,72157,CPT,TC,45072157,CDM,612,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,771.05,,,771.05,Fee Schedule,,693.71,,,693.71,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,916.08,,,916.08,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1078.03,,,1078.03,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,507.59,,,,Fee Schedule,,1078.03,,,1078.03,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,954.75,,,954.75,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRI L SPINE W AND WO CONTRAST,72158,CPT,TC,45072158,CDM,612,RC,,,both,,,4261,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,766.46,,,766.46,Fee Schedule,,689.57,,,689.57,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,All Other,910.62,,,910.62,Fee Schedule,,1024,,,1024,Other,186% of Medicaid,1071.6,,,1071.6,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,504.57,,,,Fee Schedule,,1071.6,,,1071.6,Fee Schedule,,2641.82,,,2641.82,Fee Schedule,,949.07,,,949.07,Fee Schedule,,2982.7,70,,2982.7,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,550.44,,,550.44,Other,100% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,842.17,,,842.17,Other,153% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,770.61,,,770.61,Other,140% of Medicaid,1238.48,,,1238.48,Other,225% of Medicaid,1431.13,,,1431.13,Other,250% of Medicaid,1783.41,,,1783.41,Other,324% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,1183.44,,,1183.44,Other,215% of Medicaid,688.04,,,688.04,Other,125% of Medicaid,422.59,3738.35,
MRA HEAD WO CONTRAST,70544,CPT,TC,45070544,CDM,615,RC,,,both,,,2947,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,574.68,,,574.68,Fee Schedule,,517.03,,,517.03,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2062.9,70,,2062.9,percent of total billed charges,All Other,682.77,,,682.77,Fee Schedule,,871,,,871,Other,186% of Medicaid,803.47,,,803.47,Fee Schedule,,1827.14,,,1827.14,Fee Schedule,,378.32,,,,Fee Schedule,,803.47,,,803.47,Fee Schedule,,1827.14,,,1827.14,Fee Schedule,,711.59,,,711.59,Fee Schedule,,2062.9,70,,2062.9,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,269.26,2403.42,
MRA HEAD W CONTRAST,70545,CPT,TC,45070545,CDM,615,RC,,,both,,,2816,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,616.28,,,616.28,Fee Schedule,,554.46,,,554.46,Fee Schedule,,3060.14,,,3060.14,Fee Schedule,,2753.01,,,2753.01,Fee Schedule,,2602.24,,,2602.24,Fee Schedule,,1971.2,70,,1971.2,percent of total billed charges,All Other,732.19,,,732.19,Fee Schedule,,871,,,871,Other,186% of Medicaid,861.63,,,861.63,Fee Schedule,,1745.92,,,1745.92,Fee Schedule,,405.7,,,,Fee Schedule,,861.63,,,861.63,Fee Schedule,,1745.92,,,1745.92,Fee Schedule,,763.1,,,763.1,Fee Schedule,,1971.2,70,,1971.2,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,405.7,3060.14,
MRA HEAD W AND WO CONTRAST,70546,CPT,TC,45070546,CDM,615,RC,,,both,,,4144,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,937.6,,,937.6,Fee Schedule,,843.55,,,843.55,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,2900.8,70,,2900.8,percent of total billed charges,All Other,1113.96,,,1113.96,Fee Schedule,,871,,,871,Other,186% of Medicaid,1310.88,,,1310.88,Fee Schedule,,2569.28,,,2569.28,Fee Schedule,,617.23,,,,Fee Schedule,,1310.88,,,1310.88,Fee Schedule,,2569.28,,,2569.28,Fee Schedule,,1160.98,,,1160.98,Fee Schedule,,2900.8,70,,2900.8,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,422.59,3738.35,
MRA NECK WO CONTRAST,70547,CPT,TC,45070547,CDM,615,RC,,,both,,,2963,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,575.83,,,575.83,Fee Schedule,,518.06,,,518.06,Fee Schedule,,2403.42,,,2403.42,Fee Schedule,,2162.2,,,2162.2,Fee Schedule,,2043.78,,,2043.78,Fee Schedule,,2074.1,70,,2074.1,percent of total billed charges,All Other,684.13,,,684.13,Fee Schedule,,871,,,871,Other,186% of Medicaid,805.07,,,805.07,Fee Schedule,,1837.06,,,1837.06,Fee Schedule,,379.07,,,,Fee Schedule,,805.07,,,805.07,Fee Schedule,,1837.06,,,1837.06,Fee Schedule,,713.01,,,713.01,Fee Schedule,,2074.1,70,,2074.1,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,269.26,2403.42,
MRA NECK W AND WO CONTRAST,70549,CPT,TC,45070549,CDM,615,RC,,,both,,,4547,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,941.05,,,941.05,Fee Schedule,,846.65,,,846.65,Fee Schedule,,3738.35,,,3738.35,Fee Schedule,,3363.15,,,3363.15,Fee Schedule,,3178.96,,,3178.96,Fee Schedule,,3182.9,70,,3182.9,percent of total billed charges,All Other,1118.05,,,1118.05,Fee Schedule,,871,,,871,Other,186% of Medicaid,1315.7,,,1315.7,Fee Schedule,,2819.14,,,2819.14,Fee Schedule,,619.5,,,,Fee Schedule,,1315.7,,,1315.7,Fee Schedule,,2819.14,,,2819.14,Fee Schedule,,1165.25,,,1165.25,Fee Schedule,,3182.9,70,,3182.9,percent of total billed charges,,1772,,,1772,Case Rate,,1506,,,1506,Case Rate,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,422.59,3738.35,
MRA L EXT W AND WO CONTRAST LT,C8914,HCPCS,TCLT,45000011,CDM,616,RC,,,both,,,3440,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,2236,65,,2236,percent of total billed charges,All Other,2029.6,59,,2029.6,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,2408,70,,2408,percent of total billed charges,All Other,2339.2,68,,2339.2,percent of total billed charges,All Other,871,,,871,Other,186% of Medicaid,2752,80,,2752,percent of total billed charges,All Other,2132.8,62,,2132.8,percent of total billed charges,Lab & Radiology,1892,55,,,percent of total billed charges,Default if not in Fee Schedule,2752,80,,2752,percent of total billed charges,All Other,2132.8,62,,2132.8,percent of total billed charges,Lab & Radiology,2752,80,,2752,percent of total billed charges,All Other,2408,70,,2408,percent of total billed charges,,2236,65,,2236,percent of total billed charges,All Other,2236,65,,2236,percent of total billed charges,All Other,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,0.01,2752,
MRA L EXT W AND WO CONTRAST RT,C8914,HCPCS,TCRT,45000012,CDM,616,RC,,,both,,,3440,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,2236,65,,2236,percent of total billed charges,All Other,2029.6,59,,2029.6,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,2408,70,,2408,percent of total billed charges,All Other,2339.2,68,,2339.2,percent of total billed charges,All Other,871,,,871,Other,186% of Medicaid,2752,80,,2752,percent of total billed charges,All Other,2132.8,62,,2132.8,percent of total billed charges,Lab & Radiology,1892,55,,,percent of total billed charges,Default if not in Fee Schedule,2752,80,,2752,percent of total billed charges,All Other,2132.8,62,,2132.8,percent of total billed charges,Lab & Radiology,2752,80,,2752,percent of total billed charges,All Other,2408,70,,2408,percent of total billed charges,,2236,65,,2236,percent of total billed charges,All Other,2236,65,,2236,percent of total billed charges,All Other,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,0.01,2752,
MRA ABD W CONTRAST,C8900,HCPCS,TC,45000002,CDM,618,RC,,,both,,,1815,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,1179.75,65,,1179.75,percent of total billed charges,All Other,1070.85,59,,1070.85,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,1270.5,70,,1270.5,percent of total billed charges,All Other,1234.2,68,,1234.2,percent of total billed charges,All Other,871,,,871,Other,186% of Medicaid,1452,80,,1452,percent of total billed charges,All Other,1125.3,62,,1125.3,percent of total billed charges,Lab & Radiology,998.25,55,,,percent of total billed charges,Default if not in Fee Schedule,1452,80,,1452,percent of total billed charges,All Other,1125.3,62,,1125.3,percent of total billed charges,Lab & Radiology,1452,80,,1452,percent of total billed charges,All Other,1270.5,70,,1270.5,percent of total billed charges,,1179.75,65,,1179.75,percent of total billed charges,All Other,1179.75,65,,1179.75,percent of total billed charges,All Other,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,0.01,1517.86,
MRA ABD WO CONTRAST,C8901,HCPCS,,45000003,CDM,618,RC,,,both,,,1332,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,865.8,65,,865.8,percent of total billed charges,All Other,785.88,59,,785.88,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,932.4,70,,932.4,percent of total billed charges,All Other,905.76,68,,905.76,percent of total billed charges,All Other,871,,,871,Other,186% of Medicaid,1065.6,80,,1065.6,percent of total billed charges,All Other,825.84,62,,825.84,percent of total billed charges,Lab & Radiology,732.6,55,,,percent of total billed charges,Default if not in Fee Schedule,1065.6,80,,1065.6,percent of total billed charges,All Other,825.84,62,,825.84,percent of total billed charges,Lab & Radiology,1065.6,80,,1065.6,percent of total billed charges,All Other,932.4,70,,932.4,percent of total billed charges,,865.8,65,,865.8,percent of total billed charges,All Other,865.8,65,,865.8,percent of total billed charges,All Other,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,0.01,1517.86,
MRA ABD W AND WO CONTRAST,C8902,HCPCS,,45000004,CDM,618,RC,,,both,,,3751,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,2438.15,65,,2438.15,percent of total billed charges,All Other,2213.09,59,,2213.09,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,2625.7,70,,2625.7,percent of total billed charges,All Other,2550.68,68,,2550.68,percent of total billed charges,All Other,871,,,871,Other,186% of Medicaid,3000.8,80,,3000.8,percent of total billed charges,All Other,2325.62,62,,2325.62,percent of total billed charges,Lab & Radiology,2063.05,55,,,percent of total billed charges,Default if not in Fee Schedule,3000.8,80,,3000.8,percent of total billed charges,All Other,2325.62,62,,2325.62,percent of total billed charges,Lab & Radiology,3000.8,80,,3000.8,percent of total billed charges,All Other,2625.7,70,,2625.7,percent of total billed charges,,2438.15,65,,2438.15,percent of total billed charges,All Other,2438.15,65,,2438.15,percent of total billed charges,All Other,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,0.01,3000.8,
MRA CHEST W CONTRAST,C8909,HCPCS,,45000008,CDM,618,RC,,,both,,,1815,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,1179.75,65,,1179.75,percent of total billed charges,All Other,1070.85,59,,1070.85,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,1270.5,70,,1270.5,percent of total billed charges,All Other,1234.2,68,,1234.2,percent of total billed charges,All Other,871,,,871,Other,186% of Medicaid,1452,80,,1452,percent of total billed charges,All Other,1125.3,62,,1125.3,percent of total billed charges,Lab & Radiology,998.25,55,,,percent of total billed charges,Default if not in Fee Schedule,1452,80,,1452,percent of total billed charges,All Other,1125.3,62,,1125.3,percent of total billed charges,Lab & Radiology,1452,80,,1452,percent of total billed charges,All Other,1270.5,70,,1270.5,percent of total billed charges,,1179.75,65,,1179.75,percent of total billed charges,All Other,1179.75,65,,1179.75,percent of total billed charges,All Other,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,0.01,1517.86,
MRA CHEST WO CONTRAST,C8910,HCPCS,,45000009,CDM,618,RC,,,both,,,1553,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,1009.45,65,,1009.45,percent of total billed charges,All Other,916.27,59,,916.27,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,1087.1,70,,1087.1,percent of total billed charges,All Other,1056.04,68,,1056.04,percent of total billed charges,All Other,871,,,871,Other,186% of Medicaid,1242.4,80,,1242.4,percent of total billed charges,All Other,962.86,62,,962.86,percent of total billed charges,Lab & Radiology,854.15,55,,,percent of total billed charges,Default if not in Fee Schedule,1242.4,80,,1242.4,percent of total billed charges,All Other,962.86,62,,962.86,percent of total billed charges,Lab & Radiology,1242.4,80,,1242.4,percent of total billed charges,All Other,1087.1,70,,1087.1,percent of total billed charges,,1009.45,65,,1009.45,percent of total billed charges,All Other,1009.45,65,,1009.45,percent of total billed charges,All Other,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,0.01,1517.86,
MRA CHEST W AND WO CONTRAST,C8911,HCPCS,,45000010,CDM,618,RC,,,both,,,3751,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,2438.15,65,,2438.15,percent of total billed charges,All Other,2213.09,59,,2213.09,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,2625.7,70,,2625.7,percent of total billed charges,All Other,2550.68,68,,2550.68,percent of total billed charges,All Other,871,,,871,Other,186% of Medicaid,3000.8,80,,3000.8,percent of total billed charges,All Other,2325.62,62,,2325.62,percent of total billed charges,Lab & Radiology,2063.05,55,,,percent of total billed charges,Default if not in Fee Schedule,3000.8,80,,3000.8,percent of total billed charges,All Other,2325.62,62,,2325.62,percent of total billed charges,Lab & Radiology,3000.8,80,,3000.8,percent of total billed charges,All Other,2625.7,70,,2625.7,percent of total billed charges,,2438.15,65,,2438.15,percent of total billed charges,All Other,2438.15,65,,2438.15,percent of total billed charges,All Other,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,0.01,3000.8,
"MRA W/O CONT, PELVIS",C8919,HCPCS,,45000015,CDM,618,RC,,,both,,,1165,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,757.25,65,,757.25,percent of total billed charges,All Other,687.35,59,,687.35,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,815.5,70,,815.5,percent of total billed charges,All Other,792.2,68,,792.2,percent of total billed charges,All Other,871,,,871,Other,186% of Medicaid,932,80,,932,percent of total billed charges,All Other,722.3,62,,722.3,percent of total billed charges,Lab & Radiology,640.75,55,,,percent of total billed charges,Default if not in Fee Schedule,932,80,,932,percent of total billed charges,All Other,722.3,62,,722.3,percent of total billed charges,Lab & Radiology,932,80,,932,percent of total billed charges,All Other,815.5,70,,815.5,percent of total billed charges,,757.25,65,,757.25,percent of total billed charges,All Other,757.25,65,,757.25,percent of total billed charges,All Other,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,372.86,,,372.86,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,0.01,1517.86,
MRA PELVIS W AND WO CONTRAST,C8920,HCPCS,TC,45000013,CDM,618,RC,,,both,,,3441,694.93,,,694.93,Other,150% of Medicare + 9.63% HCRA Surcharge,422.59,,,422.59,Other,Medicare OPPS,2236.65,65,,2236.65,percent of total billed charges,All Other,2030.19,59,,2030.19,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,2408.7,70,,2408.7,percent of total billed charges,All Other,2339.88,68,,2339.88,percent of total billed charges,All Other,871,,,871,Other,186% of Medicaid,2752.8,80,,2752.8,percent of total billed charges,All Other,2133.42,62,,2133.42,percent of total billed charges,Lab & Radiology,1892.55,55,,,percent of total billed charges,Default if not in Fee Schedule,2752.8,80,,2752.8,percent of total billed charges,All Other,2133.42,62,,2133.42,percent of total billed charges,Lab & Radiology,2752.8,80,,2752.8,percent of total billed charges,All Other,2408.7,70,,2408.7,percent of total billed charges,,2236.65,65,,2236.65,percent of total billed charges,All Other,2236.65,65,,2236.65,percent of total billed charges,All Other,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,610.96,,,610.96,Fee Schedule,,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,468.47,,,468.47,Other,100% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,716.77,,,716.77,Other,153% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,655.86,,,655.86,Other,140% of Medicaid,1054.07,,,1054.07,Other,225% of Medicaid,1218.03,,,1218.03,Other,250% of Medicaid,1517.86,,,1517.86,Other,324% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,1007.22,,,1007.22,Other,215% of Medicaid,585.59,,,585.59,Other,125% of Medicaid,0.01,2752.8,
ACETADOTE 200 MG/ML,J0132,HCPCS,,80000012,CDM,636,RC,55150025930,NDC,both,4,ML,68.9,6.95,,,6.95,Other,150% of Medicare + 9.63% HCRA Surcharge,4.22,,,4.22,Fee Schedule,Average Sale Price (ASP) x 6,24.11,35,,24.11,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,23.42,34,,23.42,percent of total billed charges,Drugs,23.42,34,,23.42,percent of total billed charges,Drugs,23.42,34,,23.42,percent of total billed charges,Drugs,23.42,34,,23.42,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,27.56,40,,27.56,percent of total billed charges,Drugs,48.23,70,,48.23,percent of total billed charges,All Other,24.8,36,,24.8,percent of total billed charges,Drugs,24.8,36,,24.8,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,24.11,35,,24.11,percent of total billed charges,Drugs,22.97,,,22.97,Other,Drug Cost,22.97,,,22.97,Other,Drug Cost,22.97,,,22.97,Other,Drug Cost,22.97,,,22.97,Other,Drug Cost,22.97,,,22.97,Other,Drug Cost,22.97,,,22.97,Other,Drug Cost,51.67,,,51.67,Other,225% of Medicaid,32.15,,,32.15,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.76,,,6.76,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",49.37,,,49.37,Other,215% Medicaid APG methodology,49.37,,,49.37,Other,215% Medicaid APG methodology,28.71,,,28.71,Other,125% Medicaid APG methodology,0.01,51.67,
ACETAMINOPHEN 1000MG/100ML INJ,J0136,HCPCS,,80000013,CDM,636,RC,143938610,NDC,both,10,ML,9.51,0.55,,,0.55,Other,150% of Medicare + 9.63% HCRA Surcharge,0.34,,,0.34,Fee Schedule,Average Sale Price (ASP) x 6,3.33,35,,3.33,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,3.23,34,,3.23,percent of total billed charges,Drugs,3.23,34,,3.23,percent of total billed charges,Drugs,3.23,34,,3.23,percent of total billed charges,Drugs,3.23,34,,3.23,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,3.81,40,,3.81,percent of total billed charges,Drugs,6.66,70,,6.66,percent of total billed charges,All Other,3.42,36,,3.42,percent of total billed charges,Drugs,3.42,36,,3.42,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,3.33,35,,3.33,percent of total billed charges,Drugs,3.17,,,3.17,Other,Drug Cost,3.17,,,3.17,Other,Drug Cost,3.17,,,3.17,Other,Drug Cost,3.17,,,3.17,Other,Drug Cost,3.17,,,3.17,Other,Drug Cost,3.17,,,3.17,Other,Drug Cost,7.13,,,7.13,Other,225% of Medicaid,4.44,,,4.44,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.54,,,0.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6.82,,,6.82,Other,215% Medicaid APG methodology,6.82,,,6.82,Other,215% Medicaid APG methodology,3.96,,,3.96,Other,125% Medicaid APG methodology,0.01,7.13,
ACETAZOLAMID SODIUM INJ 500 MG,J1120,HCPCS,,80000024,CDM,636,RC,39822019001,NDC,both,1,EA,31.95,277.44,,,277.44,Other,150% of Medicare + 9.63% HCRA Surcharge,168.71,,,168.71,Fee Schedule,Average Sale Price (ASP) x 6,11.18,35,,11.18,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,10.86,34,,10.86,percent of total billed charges,Drugs,10.86,34,,10.86,percent of total billed charges,Drugs,10.86,34,,10.86,percent of total billed charges,Drugs,10.86,34,,10.86,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,12.78,40,,12.78,percent of total billed charges,Drugs,22.37,70,,22.37,percent of total billed charges,All Other,11.5,36,,11.5,percent of total billed charges,Drugs,11.5,36,,11.5,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,11.18,35,,11.18,percent of total billed charges,Drugs,10.65,,,10.65,Other,Drug Cost,10.65,,,10.65,Other,Drug Cost,10.65,,,10.65,Other,Drug Cost,10.65,,,10.65,Other,Drug Cost,10.65,,,10.65,Other,Drug Cost,10.65,,,10.65,Other,Drug Cost,23.96,,,23.96,Other,225% of Medicaid,14.91,,,14.91,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,269.94,,,269.94,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",22.9,,,22.9,Other,215% Medicaid APG methodology,22.9,,,22.9,Other,215% Medicaid APG methodology,13.31,,,13.31,Other,125% Medicaid APG methodology,0.01,277.44,
ACYCLOVIR INJ 50 MG/ML 10 ML,J0133,HCPCS,,80000047,CDM,636,RC,55150015410,NDC,both,10,ML,5.01,0.55,,,0.55,Other,150% of Medicare + 9.63% HCRA Surcharge,0.34,,,0.34,Fee Schedule,Average Sale Price (ASP) x 6,1.75,35,,1.75,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,1.7,34,,1.7,percent of total billed charges,Drugs,1.7,34,,1.7,percent of total billed charges,Drugs,1.7,34,,1.7,percent of total billed charges,Drugs,1.7,34,,1.7,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,2,40,,2,percent of total billed charges,Drugs,3.51,70,,3.51,percent of total billed charges,All Other,1.8,36,,1.8,percent of total billed charges,Drugs,1.8,36,,1.8,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,1.75,35,,1.75,percent of total billed charges,Drugs,1.67,,,1.67,Other,Drug Cost,1.67,,,1.67,Other,Drug Cost,1.67,,,1.67,Other,Drug Cost,1.67,,,1.67,Other,Drug Cost,1.67,,,1.67,Other,Drug Cost,1.67,,,1.67,Other,Drug Cost,3.76,,,3.76,Other,225% of Medicaid,2.34,,,2.34,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.54,,,0.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.59,,,3.59,Other,215% Medicaid APG methodology,3.59,,,3.59,Other,215% Medicaid APG methodology,2.09,,,2.09,Other,125% Medicaid APG methodology,0.01,3.76,
ADENOSINE 3MG/ML 2ML INJ,J0153,HCPCS,,80000048,CDM,636,RC,63323065102,NDC,both,10,ML,17.31,5.93,,,5.93,Other,150% of Medicare + 9.63% HCRA Surcharge,3.61,,,3.61,Fee Schedule,Average Sale Price (ASP) x 6,6.06,35,,6.06,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,5.89,34,,5.89,percent of total billed charges,Drugs,5.89,34,,5.89,percent of total billed charges,Drugs,5.89,34,,5.89,percent of total billed charges,Drugs,5.89,34,,5.89,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,6.92,40,,6.92,percent of total billed charges,Drugs,12.12,70,,12.12,percent of total billed charges,All Other,6.23,36,,6.23,percent of total billed charges,Drugs,6.23,36,,6.23,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,6.06,35,,6.06,percent of total billed charges,Drugs,5.77,,,5.77,Other,Drug Cost,5.77,,,5.77,Other,Drug Cost,5.77,,,5.77,Other,Drug Cost,5.77,,,5.77,Other,Drug Cost,5.77,,,5.77,Other,Drug Cost,5.77,,,5.77,Other,Drug Cost,12.98,,,12.98,Other,225% of Medicaid,8.08,,,8.08,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,5.77,,,5.77,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",12.41,,,12.41,Other,215% Medicaid APG methodology,12.41,,,12.41,Other,215% Medicaid APG methodology,7.21,,,7.21,Other,125% Medicaid APG methodology,0.01,12.98,
ADRENALIN EPINEPHRINE INJ 0.1 MG 10 ML,J0171,HCPCS,,80000050,CDM,636,RC,76329331801,NDC,both,10,ML,17.34,7.38,,,7.38,Other,150% of Medicare + 9.63% HCRA Surcharge,4.49,,,4.49,Fee Schedule,Average Sale Price (ASP) x 6,6.07,35,,6.07,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,5.9,34,,5.9,percent of total billed charges,Drugs,5.9,34,,5.9,percent of total billed charges,Drugs,5.9,34,,5.9,percent of total billed charges,Drugs,5.9,34,,5.9,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,6.94,40,,6.94,percent of total billed charges,Drugs,12.14,70,,12.14,percent of total billed charges,All Other,6.24,36,,6.24,percent of total billed charges,Drugs,6.24,36,,6.24,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,6.07,35,,6.07,percent of total billed charges,Drugs,5.78,,,5.78,Other,Drug Cost,5.78,,,5.78,Other,Drug Cost,5.78,,,5.78,Other,Drug Cost,5.78,,,5.78,Other,Drug Cost,5.78,,,5.78,Other,Drug Cost,5.78,,,5.78,Other,Drug Cost,13.01,,,13.01,Other,225% of Medicaid,8.09,,,8.09,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.18,,,7.18,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",12.43,,,12.43,Other,215% Medicaid APG methodology,12.43,,,12.43,Other,215% Medicaid APG methodology,7.23,,,7.23,Other,125% Medicaid APG methodology,0.01,13.01,
EPINEPHRINE INJ 1 MG/ML 1ML,J0171,HCPCS,,80000051,CDM,636,RC,42023015925,NDC,both,25,ML,1.22,7.38,,,7.38,Other,150% of Medicare + 9.63% HCRA Surcharge,4.49,,,4.49,Fee Schedule,Average Sale Price (ASP) x 6,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.49,40,,0.49,percent of total billed charges,Drugs,0.85,70,,0.85,percent of total billed charges,All Other,0.44,36,,0.44,percent of total billed charges,Drugs,0.44,36,,0.44,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.92,,,0.92,Other,225% of Medicaid,0.57,,,0.57,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.18,,,7.18,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.87,,,0.87,Other,215% Medicaid APG methodology,0.87,,,0.87,Other,215% Medicaid APG methodology,0.51,,,0.51,Other,125% Medicaid APG methodology,0.01,7.38,
EPINEPHRINE INJ 1 MG/ML 30 ML,J0171,HCPCS,,80000052,CDM,636,RC,42023016801,NDC,both,1,ML,0.81,7.38,,,7.38,Other,150% of Medicare + 9.63% HCRA Surcharge,4.49,,,4.49,Fee Schedule,Average Sale Price (ASP) x 6,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,34,,0.28,percent of total billed charges,Drugs,0.28,34,,0.28,percent of total billed charges,Drugs,0.28,34,,0.28,percent of total billed charges,Drugs,0.28,34,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.32,40,,0.32,percent of total billed charges,Drugs,0.57,70,,0.57,percent of total billed charges,All Other,0.29,36,,0.29,percent of total billed charges,Drugs,0.29,36,,0.29,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.61,,,0.61,Other,225% of Medicaid,0.38,,,0.38,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.18,,,7.18,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.58,,,0.58,Other,215% Medicaid APG methodology,0.58,,,0.58,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,7.38,
ALBUMIN HUMAN 25% 50ML,P9047,HCPCS,,80000053,CDM,636,RC,944049301,NDC,both,24,ML,77.61,523.69,,,523.69,Other,150% of Medicare + 9.63% HCRA Surcharge,318.46,,,318.46,Fee Schedule,Average Sale Price (ASP) x 6,27.16,35,,27.16,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,26.39,34,,26.39,percent of total billed charges,Drugs,26.39,34,,26.39,percent of total billed charges,Drugs,26.39,34,,26.39,percent of total billed charges,Drugs,26.39,34,,26.39,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,31.05,40,,31.05,percent of total billed charges,Drugs,54.33,70,,54.33,percent of total billed charges,All Other,27.94,36,,27.94,percent of total billed charges,Drugs,27.94,36,,27.94,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,27.16,35,,27.16,percent of total billed charges,Drugs,25.87,,,25.87,Other,Drug Cost,25.87,,,25.87,Other,Drug Cost,25.87,,,25.87,Other,Drug Cost,25.87,,,25.87,Other,Drug Cost,25.87,,,25.87,Other,Drug Cost,25.87,,,25.87,Other,Drug Cost,58.21,,,58.21,Other,225% of Medicaid,36.22,,,36.22,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,509.54,,,509.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",55.62,,,55.62,Other,215% Medicaid APG methodology,55.62,,,55.62,Other,215% Medicaid APG methodology,32.34,,,32.34,Other,125% Medicaid APG methodology,0.01,523.69,
ALBUMIN HUMAN 5% 250ML,P9045,HCPCS,,80000054,CDM,636,RC,44206031025,NDC,both,1,ML,74.85,523.69,,,523.69,Other,150% of Medicare + 9.63% HCRA Surcharge,318.46,,,318.46,Fee Schedule,Average Sale Price (ASP) x 6,26.2,35,,26.2,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,25.45,34,,25.45,percent of total billed charges,Drugs,25.45,34,,25.45,percent of total billed charges,Drugs,25.45,34,,25.45,percent of total billed charges,Drugs,25.45,34,,25.45,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,29.94,40,,29.94,percent of total billed charges,Drugs,52.4,70,,52.4,percent of total billed charges,All Other,26.95,36,,26.95,percent of total billed charges,Drugs,26.95,36,,26.95,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,26.2,35,,26.2,percent of total billed charges,Drugs,24.95,,,24.95,Other,Drug Cost,24.95,,,24.95,Other,Drug Cost,24.95,,,24.95,Other,Drug Cost,24.95,,,24.95,Other,Drug Cost,24.95,,,24.95,Other,Drug Cost,24.95,,,24.95,Other,Drug Cost,56.14,,,56.14,Other,225% of Medicaid,34.93,,,34.93,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,509.54,,,509.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",53.64,,,53.64,Other,215% Medicaid APG methodology,53.64,,,53.64,Other,215% Medicaid APG methodology,31.19,,,31.19,Other,125% Medicaid APG methodology,0.01,523.69,
AMIKACIN (PF) 250MG/ML 2ML,J0278,HCPCS,,80000078,CDM,636,RC,23155029041,NDC,both,10,ML,6.67,8.18,,,8.18,Other,150% of Medicare + 9.63% HCRA Surcharge,4.97,,,4.97,Fee Schedule,Average Sale Price (ASP) x 6,2.34,35,,2.34,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,2.27,34,,2.27,percent of total billed charges,Drugs,2.27,34,,2.27,percent of total billed charges,Drugs,2.27,34,,2.27,percent of total billed charges,Drugs,2.27,34,,2.27,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,2.67,40,,2.67,percent of total billed charges,Drugs,4.67,70,,4.67,percent of total billed charges,All Other,2.4,36,,2.4,percent of total billed charges,Drugs,2.4,36,,2.4,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,2.34,35,,2.34,percent of total billed charges,Drugs,2.22,,,2.22,Other,Drug Cost,2.22,,,2.22,Other,Drug Cost,2.22,,,2.22,Other,Drug Cost,2.22,,,2.22,Other,Drug Cost,2.22,,,2.22,Other,Drug Cost,2.22,,,2.22,Other,Drug Cost,5,,,5,Other,225% of Medicaid,3.11,,,3.11,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.96,,,7.96,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.78,,,4.78,Other,215% Medicaid APG methodology,4.78,,,4.78,Other,215% Medicaid APG methodology,2.78,,,2.78,Other,125% Medicaid APG methodology,0.01,8.18,
AMIKACIN SULFATE 250MG/ML 4ML INJ,J0278,HCPCS,,80000079,CDM,636,RC,703904003,NDC,both,10,ML,66.61,8.18,,,8.18,Other,150% of Medicare + 9.63% HCRA Surcharge,4.97,,,4.97,Fee Schedule,Average Sale Price (ASP) x 6,23.31,35,,23.31,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,22.65,34,,22.65,percent of total billed charges,Drugs,22.65,34,,22.65,percent of total billed charges,Drugs,22.65,34,,22.65,percent of total billed charges,Drugs,22.65,34,,22.65,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,26.64,40,,26.64,percent of total billed charges,Drugs,46.63,70,,46.63,percent of total billed charges,All Other,23.98,36,,23.98,percent of total billed charges,Drugs,23.98,36,,23.98,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,23.31,35,,23.31,percent of total billed charges,Drugs,22.2,,,22.2,Other,Drug Cost,22.2,,,22.2,Other,Drug Cost,22.2,,,22.2,Other,Drug Cost,22.2,,,22.2,Other,Drug Cost,22.2,,,22.2,Other,Drug Cost,22.2,,,22.2,Other,Drug Cost,49.96,,,49.96,Other,225% of Medicaid,31.09,,,31.09,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.96,,,7.96,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",47.74,,,47.74,Other,215% Medicaid APG methodology,47.74,,,47.74,Other,215% Medicaid APG methodology,27.76,,,27.76,Other,125% Medicaid APG methodology,0.01,49.96,
AMINOPHYLLINE 500MG/20ML INJ,J0280,HCPCS,,80000090,CDM,636,RC,409592201,NDC,both,25,ML,15.14,50.64,,,50.64,Other,150% of Medicare + 9.63% HCRA Surcharge,30.79,,,30.79,Fee Schedule,Average Sale Price (ASP) x 6,5.3,35,,5.3,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,5.15,34,,5.15,percent of total billed charges,Drugs,5.15,34,,5.15,percent of total billed charges,Drugs,5.15,34,,5.15,percent of total billed charges,Drugs,5.15,34,,5.15,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,6.06,40,,6.06,percent of total billed charges,Drugs,10.6,70,,10.6,percent of total billed charges,All Other,5.45,36,,5.45,percent of total billed charges,Drugs,5.45,36,,5.45,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,5.3,35,,5.3,percent of total billed charges,Drugs,5.05,,,5.05,Other,Drug Cost,5.05,,,5.05,Other,Drug Cost,5.05,,,5.05,Other,Drug Cost,5.05,,,5.05,Other,Drug Cost,5.05,,,5.05,Other,Drug Cost,5.05,,,5.05,Other,Drug Cost,11.36,,,11.36,Other,225% of Medicaid,7.07,,,7.07,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,49.27,,,49.27,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",10.85,,,10.85,Other,215% Medicaid APG methodology,10.85,,,10.85,Other,215% Medicaid APG methodology,6.31,,,6.31,Other,125% Medicaid APG methodology,0.01,50.64,
AMIODARON HCL INJ 30 MG (150MG/3ML),J0282,HCPCS,,80000094,CDM,636,RC,63323061603,NDC,both,25,ML,2.42,0.95,39.4668,,0.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.85,35,,0.85,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.82,34,,0.82,percent of total billed charges,Drugs,0.82,34,,0.82,percent of total billed charges,Drugs,0.82,34,,0.82,percent of total billed charges,Drugs,0.82,34,,0.82,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.97,40,,0.97,percent of total billed charges,Drugs,1.69,70,,1.69,percent of total billed charges,All Other,0.87,36,,0.87,percent of total billed charges,Drugs,0.87,36,,0.87,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.85,35,,0.85,percent of total billed charges,Drugs,0.81,,,0.81,Other,Drug Cost,0.81,,,0.81,Other,Drug Cost,0.81,,,0.81,Other,Drug Cost,0.81,,,0.81,Other,Drug Cost,0.81,,,0.81,Other,Drug Cost,0.81,,,0.81,Other,Drug Cost,1.81,,,1.81,Other,225% of Medicaid,1.13,,,1.13,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.73,,,1.73,Other,215% Medicaid APG methodology,1.73,,,1.73,Other,215% Medicaid APG methodology,1.01,,,1.01,Other,125% Medicaid APG methodology,0.01,1.81,
AMIODARON HCL INJ 30 MG (900MG/18ML),J0282,HCPCS,,80000095,CDM,636,RC,67457015318,NDC,both,1,ML,23.37,9.22,39.4668,,9.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,8.18,35,,8.18,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,7.95,34,,7.95,percent of total billed charges,Drugs,7.95,34,,7.95,percent of total billed charges,Drugs,7.95,34,,7.95,percent of total billed charges,Drugs,7.95,34,,7.95,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,9.35,40,,9.35,percent of total billed charges,Drugs,16.36,70,,16.36,percent of total billed charges,All Other,8.41,36,,8.41,percent of total billed charges,Drugs,8.41,36,,8.41,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,8.18,35,,8.18,percent of total billed charges,Drugs,7.79,,,7.79,Other,Drug Cost,7.79,,,7.79,Other,Drug Cost,7.79,,,7.79,Other,Drug Cost,7.79,,,7.79,Other,Drug Cost,7.79,,,7.79,Other,Drug Cost,7.79,,,7.79,Other,Drug Cost,17.53,,,17.53,Other,225% of Medicaid,10.91,,,10.91,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",16.75,,,16.75,Other,215% Medicaid APG methodology,16.75,,,16.75,Other,215% Medicaid APG methodology,9.74,,,9.74,Other,125% Medicaid APG methodology,0.01,17.53,
AMPHOTERICIN B 50MG INJ,J0285,HCPCS,,80000133,CDM,636,RC,39822105505,NDC,both,1,EA,41.01,94.09,,,94.09,Other,150% of Medicare + 9.63% HCRA Surcharge,57.22,,,57.22,Fee Schedule,Average Sale Price (ASP) x 6,14.35,35,,14.35,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,13.94,34,,13.94,percent of total billed charges,Drugs,13.94,34,,13.94,percent of total billed charges,Drugs,13.94,34,,13.94,percent of total billed charges,Drugs,13.94,34,,13.94,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,16.4,40,,16.4,percent of total billed charges,Drugs,28.71,70,,28.71,percent of total billed charges,All Other,14.76,36,,14.76,percent of total billed charges,Drugs,14.76,36,,14.76,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,14.35,35,,14.35,percent of total billed charges,Drugs,13.67,,,13.67,Other,Drug Cost,13.67,,,13.67,Other,Drug Cost,13.67,,,13.67,Other,Drug Cost,13.67,,,13.67,Other,Drug Cost,13.67,,,13.67,Other,Drug Cost,13.67,,,13.67,Other,Drug Cost,30.76,,,30.76,Other,225% of Medicaid,19.14,,,19.14,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,91.55,,,91.55,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",29.39,,,29.39,Other,215% Medicaid APG methodology,29.39,,,29.39,Other,215% Medicaid APG methodology,17.09,,,17.09,Other,125% Medicaid APG methodology,0.01,94.09,
AMPHOTERICIN B 50MG LIPID CMPLX,J0287,HCPCS,,80000134,CDM,636,RC,57665010141,NDC,both,1,ML,204.9,80.87,39.4668,,80.87,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,71.72,35,,71.72,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,69.67,34,,69.67,percent of total billed charges,Drugs,69.67,34,,69.67,percent of total billed charges,Drugs,69.67,34,,69.67,percent of total billed charges,Drugs,69.67,34,,69.67,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,81.96,40,,81.96,percent of total billed charges,Drugs,143.43,70,,143.43,percent of total billed charges,All Other,73.76,36,,73.76,percent of total billed charges,Drugs,73.76,36,,73.76,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,71.72,35,,71.72,percent of total billed charges,Drugs,68.3,,,68.3,Other,Drug Cost,68.3,,,68.3,Other,Drug Cost,68.3,,,68.3,Other,Drug Cost,68.3,,,68.3,Other,Drug Cost,68.3,,,68.3,Other,Drug Cost,68.3,,,68.3,Other,Drug Cost,153.68,,,153.68,Other,225% of Medicaid,95.62,,,95.62,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",146.85,,,146.85,Other,215% Medicaid APG methodology,146.85,,,146.85,Other,215% Medicaid APG methodology,85.38,,,85.38,Other,125% Medicaid APG methodology,0.01,153.68,
AMPHOTERICIN B LIPOSOMAL 50 MG INJ,J0289,HCPCS,,80000135,CDM,636,RC,469305130,NDC,both,1,EA,839.88,263.03,,,263.03,Other,150% of Medicare + 9.63% HCRA Surcharge,159.95,,,159.95,Fee Schedule,Average Sale Price (ASP) x 6,293.96,35,,293.96,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,285.56,34,,285.56,percent of total billed charges,Drugs,285.56,34,,285.56,percent of total billed charges,Drugs,285.56,34,,285.56,percent of total billed charges,Drugs,285.56,34,,285.56,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,285.56,34,"If Charge > 500, then 34 percent",285.56,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,335.95,40,,335.95,percent of total billed charges,Drugs,587.92,70,,587.92,percent of total billed charges,All Other,302.36,36,,302.36,percent of total billed charges,Drugs,302.36,36,,302.36,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,293.96,35,,293.96,percent of total billed charges,Drugs,279.96,,,279.96,Other,Drug Cost,279.96,,,279.96,Other,Drug Cost,279.96,,,279.96,Other,Drug Cost,279.96,,,279.96,Other,Drug Cost,279.96,,,279.96,Other,Drug Cost,279.96,,,279.96,Other,Drug Cost,629.91,,,629.91,Other,225% of Medicaid,391.94,,,391.94,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,255.92,,,255.92,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",601.91,,,601.91,Other,215% Medicaid APG methodology,601.91,,,601.91,Other,215% Medicaid APG methodology,349.95,,,349.95,Other,125% Medicaid APG methodology,0.01,629.91,
AMPICILLIN 2G INJ,J0290,HCPCS,,80000139,CDM,636,RC,55150011420,NDC,both,10,EA,6.88,9.98,,,9.98,Other,150% of Medicare + 9.63% HCRA Surcharge,6.07,,,6.07,Fee Schedule,Average Sale Price (ASP) x 6,2.41,35,,2.41,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,2.34,34,,2.34,percent of total billed charges,Drugs,2.34,34,,2.34,percent of total billed charges,Drugs,2.34,34,,2.34,percent of total billed charges,Drugs,2.34,34,,2.34,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,2.75,40,,2.75,percent of total billed charges,Drugs,4.82,70,,4.82,percent of total billed charges,All Other,2.48,36,,2.48,percent of total billed charges,Drugs,2.48,36,,2.48,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,2.41,35,,2.41,percent of total billed charges,Drugs,2.29,,,2.29,Other,Drug Cost,2.29,,,2.29,Other,Drug Cost,2.29,,,2.29,Other,Drug Cost,2.29,,,2.29,Other,Drug Cost,2.29,,,2.29,Other,Drug Cost,2.29,,,2.29,Other,Drug Cost,5.16,,,5.16,Other,225% of Medicaid,3.21,,,3.21,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,9.71,,,9.71,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.93,,,4.93,Other,215% Medicaid APG methodology,4.93,,,4.93,Other,215% Medicaid APG methodology,2.87,,,2.87,Other,125% Medicaid APG methodology,0.01,9.98,
AMPICILLIN 500MG INJECTION,J0290,HCPCS,,80000140,CDM,636,RC,44567010110,NDC,both,10,EA,5.11,9.98,,,9.98,Other,150% of Medicare + 9.63% HCRA Surcharge,6.07,,,6.07,Fee Schedule,Average Sale Price (ASP) x 6,1.79,35,,1.79,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,1.74,34,,1.74,percent of total billed charges,Drugs,1.74,34,,1.74,percent of total billed charges,Drugs,1.74,34,,1.74,percent of total billed charges,Drugs,1.74,34,,1.74,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,2.04,40,,2.04,percent of total billed charges,Drugs,3.58,70,,3.58,percent of total billed charges,All Other,1.84,36,,1.84,percent of total billed charges,Drugs,1.84,36,,1.84,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,1.79,35,,1.79,percent of total billed charges,Drugs,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,3.83,,,3.83,Other,225% of Medicaid,2.38,,,2.38,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,9.71,,,9.71,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.66,,,3.66,Other,215% Medicaid APG methodology,3.66,,,3.66,Other,215% Medicaid APG methodology,2.13,,,2.13,Other,125% Medicaid APG methodology,0.01,9.98,
AMPICILLIN/SULBACTAM (UNASYN) 1.5 GM INJ,J0295,HCPCS,,80000142,CDM,636,RC,55150011620,NDC,both,10,EA,2.46,17.45,,,17.45,Other,150% of Medicare + 9.63% HCRA Surcharge,10.61,,,10.61,Fee Schedule,Average Sale Price (ASP) x 6,0.86,35,,0.86,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.84,34,,0.84,percent of total billed charges,Drugs,0.84,34,,0.84,percent of total billed charges,Drugs,0.84,34,,0.84,percent of total billed charges,Drugs,0.84,34,,0.84,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.99,40,,0.99,percent of total billed charges,Drugs,1.72,70,,1.72,percent of total billed charges,All Other,0.89,36,,0.89,percent of total billed charges,Drugs,0.89,36,,0.89,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.86,35,,0.86,percent of total billed charges,Drugs,0.82,,,0.82,Other,Drug Cost,0.82,,,0.82,Other,Drug Cost,0.82,,,0.82,Other,Drug Cost,0.82,,,0.82,Other,Drug Cost,0.82,,,0.82,Other,Drug Cost,0.82,,,0.82,Other,Drug Cost,1.85,,,1.85,Other,225% of Medicaid,1.15,,,1.15,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,16.98,,,16.98,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.77,,,1.77,Other,215% Medicaid APG methodology,1.77,,,1.77,Other,215% Medicaid APG methodology,1.03,,,1.03,Other,125% Medicaid APG methodology,0.01,17.45,
AMPICILLIN/SULBACTAM (UNASYN) 3 GM INJ,J0295,HCPCS,,80000143,CDM,636,RC,55150011720,NDC,both,10,EA,6.64,17.45,,,17.45,Other,150% of Medicare + 9.63% HCRA Surcharge,10.61,,,10.61,Fee Schedule,Average Sale Price (ASP) x 6,2.32,35,,2.32,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,2.26,34,,2.26,percent of total billed charges,Drugs,2.26,34,,2.26,percent of total billed charges,Drugs,2.26,34,,2.26,percent of total billed charges,Drugs,2.26,34,,2.26,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,2.65,40,,2.65,percent of total billed charges,Drugs,4.65,70,,4.65,percent of total billed charges,All Other,2.39,36,,2.39,percent of total billed charges,Drugs,2.39,36,,2.39,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,2.32,35,,2.32,percent of total billed charges,Drugs,2.21,,,2.21,Other,Drug Cost,2.21,,,2.21,Other,Drug Cost,2.21,,,2.21,Other,Drug Cost,2.21,,,2.21,Other,Drug Cost,2.21,,,2.21,Other,Drug Cost,2.21,,,2.21,Other,Drug Cost,4.98,,,4.98,Other,225% of Medicaid,3.1,,,3.1,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,16.98,,,16.98,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.76,,,4.76,Other,215% Medicaid APG methodology,4.76,,,4.76,Other,215% Medicaid APG methodology,2.77,,,2.77,Other,125% Medicaid APG methodology,0.01,17.45,
AMPICILLIN/SULBACTAM 1.5GM/50ML NS,J0295,HCPCS,,80000144,CDM,636,RC,409268901,NDC,both,10,EA,7.48,17.45,,,17.45,Other,150% of Medicare + 9.63% HCRA Surcharge,10.61,,,10.61,Fee Schedule,Average Sale Price (ASP) x 6,2.62,35,,2.62,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,2.54,34,,2.54,percent of total billed charges,Drugs,2.54,34,,2.54,percent of total billed charges,Drugs,2.54,34,,2.54,percent of total billed charges,Drugs,2.54,34,,2.54,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,2.99,40,,2.99,percent of total billed charges,Drugs,5.24,70,,5.24,percent of total billed charges,All Other,2.69,36,,2.69,percent of total billed charges,Drugs,2.69,36,,2.69,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,2.62,35,,2.62,percent of total billed charges,Drugs,2.49,,,2.49,Other,Drug Cost,2.49,,,2.49,Other,Drug Cost,2.49,,,2.49,Other,Drug Cost,2.49,,,2.49,Other,Drug Cost,2.49,,,2.49,Other,Drug Cost,2.49,,,2.49,Other,Drug Cost,5.61,,,5.61,Other,225% of Medicaid,3.49,,,3.49,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,16.98,,,16.98,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.36,,,5.36,Other,215% Medicaid APG methodology,5.36,,,5.36,Other,215% Medicaid APG methodology,3.12,,,3.12,Other,125% Medicaid APG methodology,0.01,17.45,
ANTITHYMOCYTE GLOB EQUINE 250MG,J7504,HCPCS,,80000152,CDM,636,RC,9722402,NDC,both,5,ML,0.14,35435.84,,,35435.84,Other,150% of Medicare + 9.63% HCRA Surcharge,21548.75,,,21548.75,Fee Schedule,Average Sale Price (ASP) x 6,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,34,,0.05,percent of total billed charges,Drugs,0.05,34,,0.05,percent of total billed charges,Drugs,0.05,34,,0.05,percent of total billed charges,Drugs,0.05,34,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.06,40,,0.06,percent of total billed charges,Drugs,0.1,70,,0.1,percent of total billed charges,All Other,0.05,36,,0.05,percent of total billed charges,Drugs,0.05,36,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.1,,,0.1,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,34478,,,34478,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.1,,,0.1,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,35435.84,
ANTIVENIN (CROTALIDAE) POLYVALENT INJ,J0840,HCPCS,,80000153,CDM,636,RC,50633011012,NDC,both,2,EA,3558.23,19239.25,,,19239.25,Other,150% of Medicare + 9.63% HCRA Surcharge,11699.5,,,11699.5,Fee Schedule,Average Sale Price (ASP) x 6,1245.38,35,,1245.38,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1209.8,34,,1209.8,percent of total billed charges,Drugs,1209.8,34,,1209.8,percent of total billed charges,Drugs,1209.8,34,,1209.8,percent of total billed charges,Drugs,1209.8,34,,1209.8,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1209.8,34,"If Charge > 500, then 34 percent",1209.8,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1423.29,40,,1423.29,percent of total billed charges,Drugs,2490.76,70,,2490.76,percent of total billed charges,All Other,1280.96,36,,1280.96,percent of total billed charges,Drugs,1280.96,36,,1280.96,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1245.38,35,,1245.38,percent of total billed charges,Drugs,1186.08,,,1186.08,Other,Drug Cost,1186.08,,,1186.08,Other,Drug Cost,1186.08,,,1186.08,Other,Drug Cost,1186.08,,,1186.08,Other,Drug Cost,1186.08,,,1186.08,Other,Drug Cost,1186.08,,,1186.08,Other,Drug Cost,2668.67,,,2668.67,Other,225% of Medicaid,1660.51,,,1660.51,Other,140% of Medicaid,1209.8,34,"If Charge > 2,000, then 34 percent",1209.8,percent of total billed charges,Drugs,18719.2,,,18719.2,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2550.06,,,2550.06,Other,215% Medicaid APG methodology,2550.06,,,2550.06,Other,215% Medicaid APG methodology,1482.59,,,1482.59,Other,125% Medicaid APG methodology,0.01,19239.25,
ARANESP (POLYSORBATE) 150MCG/0.3ML,J0882,HCPCS,,80000161,CDM,636,RC,55513002704,NDC,both,4,ML,795.04,28.91,,,28.91,Other,150% of Medicare + 9.63% HCRA Surcharge,17.58,,,17.58,Fee Schedule,Average Sale Price (ASP) x 6,278.26,35,,278.26,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,270.31,34,,270.31,percent of total billed charges,Drugs,270.31,34,,270.31,percent of total billed charges,Drugs,270.31,34,,270.31,percent of total billed charges,Drugs,270.31,34,,270.31,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,270.31,34,"If Charge > 500, then 34 percent",270.31,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,318.02,40,,318.02,percent of total billed charges,Drugs,556.53,70,,556.53,percent of total billed charges,All Other,286.21,36,,286.21,percent of total billed charges,Drugs,286.21,36,,286.21,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,278.26,35,,278.26,percent of total billed charges,Drugs,265.01,,,265.01,Other,Drug Cost,265.01,,,265.01,Other,Drug Cost,265.01,,,265.01,Other,Drug Cost,265.01,,,265.01,Other,Drug Cost,265.01,,,265.01,Other,Drug Cost,265.01,,,265.01,Other,Drug Cost,596.28,,,596.28,Other,225% of Medicaid,371.02,,,371.02,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,28.13,,,28.13,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",569.78,,,569.78,Other,215% Medicaid APG methodology,569.78,,,569.78,Other,215% Medicaid APG methodology,331.27,,,331.27,Other,125% Medicaid APG methodology,0.01,596.28,
ATROPINE SULFATE INJECTION 0.1MG 10 ML,J0461,HCPCS,,80000197,CDM,636,RC,409163010,NDC,both,10,ML,7.19,0.75,,,0.75,Other,150% of Medicare + 9.63% HCRA Surcharge,0.46,,,0.46,Fee Schedule,Average Sale Price (ASP) x 6,2.52,35,,2.52,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,2.44,34,,2.44,percent of total billed charges,Drugs,2.44,34,,2.44,percent of total billed charges,Drugs,2.44,34,,2.44,percent of total billed charges,Drugs,2.44,34,,2.44,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,2.88,40,,2.88,percent of total billed charges,Drugs,5.03,70,,5.03,percent of total billed charges,All Other,2.59,36,,2.59,percent of total billed charges,Drugs,2.59,36,,2.59,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,2.52,35,,2.52,percent of total billed charges,Drugs,2.4,,,2.4,Other,Drug Cost,2.4,,,2.4,Other,Drug Cost,2.4,,,2.4,Other,Drug Cost,2.4,,,2.4,Other,Drug Cost,2.4,,,2.4,Other,Drug Cost,2.4,,,2.4,Other,Drug Cost,5.39,,,5.39,Other,225% of Medicaid,3.36,,,3.36,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.73,,,0.73,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.15,,,5.15,Other,215% Medicaid APG methodology,5.15,,,5.15,Other,215% Medicaid APG methodology,3,,,3,Other,125% Medicaid APG methodology,0.01,5.39,
ATROPINE SULFATE INJECTION 0.1MG 5 ML,J0461,HCPCS,,80000198,CDM,636,RC,409491034,NDC,both,10,ML,25.38,0.75,,,0.75,Other,150% of Medicare + 9.63% HCRA Surcharge,0.46,,,0.46,Fee Schedule,Average Sale Price (ASP) x 6,8.88,35,,8.88,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,8.63,34,,8.63,percent of total billed charges,Drugs,8.63,34,,8.63,percent of total billed charges,Drugs,8.63,34,,8.63,percent of total billed charges,Drugs,8.63,34,,8.63,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,10.15,40,,10.15,percent of total billed charges,Drugs,17.77,70,,17.77,percent of total billed charges,All Other,9.14,36,,9.14,percent of total billed charges,Drugs,9.14,36,,9.14,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,8.88,35,,8.88,percent of total billed charges,Drugs,8.46,,,8.46,Other,Drug Cost,8.46,,,8.46,Other,Drug Cost,8.46,,,8.46,Other,Drug Cost,8.46,,,8.46,Other,Drug Cost,8.46,,,8.46,Other,Drug Cost,8.46,,,8.46,Other,Drug Cost,19.04,,,19.04,Other,225% of Medicaid,11.84,,,11.84,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.73,,,0.73,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",18.19,,,18.19,Other,215% Medicaid APG methodology,18.19,,,18.19,Other,215% Medicaid APG methodology,10.58,,,10.58,Other,125% Medicaid APG methodology,0.01,19.04,
AZACITIDINE INJECTION 100 MG,J9025,HCPCS,,80000203,CDM,636,RC,59572010201,NDC,both,1,EA,1737.27,3.48,,,3.48,Other,150% of Medicare + 9.63% HCRA Surcharge,2.12,,,2.12,Fee Schedule,Average Sale Price (ASP) x 6,608.04,35,,608.04,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,590.67,34,,590.67,percent of total billed charges,Drugs,590.67,34,,590.67,percent of total billed charges,Drugs,590.67,34,,590.67,percent of total billed charges,Drugs,590.67,34,,590.67,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,590.67,34,"If Charge > 500, then 34 percent",590.67,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,694.91,40,,694.91,percent of total billed charges,Drugs,1216.09,70,,1216.09,percent of total billed charges,All Other,625.42,36,,625.42,percent of total billed charges,Drugs,625.42,36,,625.42,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,608.04,35,,608.04,percent of total billed charges,Drugs,579.09,,,579.09,Other,Drug Cost,579.09,,,579.09,Other,Drug Cost,579.09,,,579.09,Other,Drug Cost,579.09,,,579.09,Other,Drug Cost,579.09,,,579.09,Other,Drug Cost,579.09,,,579.09,Other,Drug Cost,1302.95,,,1302.95,Other,225% of Medicaid,810.73,,,810.73,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,3.39,,,3.39,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1245.04,,,1245.04,Other,215% Medicaid APG methodology,1245.04,,,1245.04,Other,215% Medicaid APG methodology,723.86,,,723.86,Other,125% Medicaid APG methodology,0.01,1302.95,
AZATHIOPRINE-ORAL TAB 50 MG,J7500,HCPCS,,80000204,CDM,636,RC,67877049301,NDC,both,100,EA,0.18,44.98,,,44.98,Other,150% of Medicare + 9.63% HCRA Surcharge,27.35,,,27.35,Fee Schedule,Average Sale Price (ASP) x 6,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.07,40,,0.07,percent of total billed charges,Drugs,0.12,70,,0.12,percent of total billed charges,All Other,0.06,36,,0.06,percent of total billed charges,Drugs,0.06,36,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,43.77,,,43.77,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,44.98,
AZITHROMYCIN 500 MG INJ,J0456,HCPCS,,80000208,CDM,636,RC,70860010010,NDC,both,10,EA,3.33,25.65,,,25.65,Other,150% of Medicare + 9.63% HCRA Surcharge,15.6,,,15.6,Fee Schedule,Average Sale Price (ASP) x 6,1.17,35,,1.17,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,1.13,34,,1.13,percent of total billed charges,Drugs,1.13,34,,1.13,percent of total billed charges,Drugs,1.13,34,,1.13,percent of total billed charges,Drugs,1.13,34,,1.13,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,1.33,40,,1.33,percent of total billed charges,Drugs,2.33,70,,2.33,percent of total billed charges,All Other,1.2,36,,1.2,percent of total billed charges,Drugs,1.2,36,,1.2,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,1.17,35,,1.17,percent of total billed charges,Drugs,1.11,,,1.11,Other,Drug Cost,1.11,,,1.11,Other,Drug Cost,1.11,,,1.11,Other,Drug Cost,1.11,,,1.11,Other,Drug Cost,1.11,,,1.11,Other,Drug Cost,1.11,,,1.11,Other,Drug Cost,2.5,,,2.5,Other,225% of Medicaid,1.56,,,1.56,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,24.96,,,24.96,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.39,,,2.39,Other,215% Medicaid APG methodology,2.39,,,2.39,Other,215% Medicaid APG methodology,1.39,,,1.39,Other,125% Medicaid APG methodology,0.01,25.65,
AZTREONAM (AZACTAM) 1 GM IV,J0457,HCPCS,,80000210,CDM,636,RC,63323040120,NDC,both,10,EA,29.9,25.05,,,25.05,Other,150% of Medicare + 9.63% HCRA Surcharge,15.23,,,15.23,Fee Schedule,Average Sale Price (ASP) x 6,10.46,35,,10.46,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,10.16,34,,10.16,percent of total billed charges,Drugs,10.16,34,,10.16,percent of total billed charges,Drugs,10.16,34,,10.16,percent of total billed charges,Drugs,10.16,34,,10.16,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,11.96,40,,11.96,percent of total billed charges,Drugs,20.93,70,,20.93,percent of total billed charges,All Other,10.76,36,,10.76,percent of total billed charges,Drugs,10.76,36,,10.76,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,10.46,35,,10.46,percent of total billed charges,Drugs,9.97,,,9.97,Other,Drug Cost,9.97,,,9.97,Other,Drug Cost,9.97,,,9.97,Other,Drug Cost,9.97,,,9.97,Other,Drug Cost,9.97,,,9.97,Other,Drug Cost,9.97,,,9.97,Other,Drug Cost,22.42,,,22.42,Other,225% of Medicaid,13.95,,,13.95,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,24.37,,,24.37,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",21.42,,,21.42,Other,215% Medicaid APG methodology,21.42,,,21.42,Other,215% Medicaid APG methodology,12.46,,,12.46,Other,125% Medicaid APG methodology,0.01,25.05,
AZACTAM 1GM/50ML NS,J0457,HCPCS,,80000211,CDM,636,RC,409082901,NDC,both,10,EA,57.63,25.05,,,25.05,Other,150% of Medicare + 9.63% HCRA Surcharge,15.23,,,15.23,Fee Schedule,Average Sale Price (ASP) x 6,20.17,35,,20.17,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,19.6,34,,19.6,percent of total billed charges,Drugs,19.6,34,,19.6,percent of total billed charges,Drugs,19.6,34,,19.6,percent of total billed charges,Drugs,19.6,34,,19.6,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,23.05,40,,23.05,percent of total billed charges,Drugs,40.34,70,,40.34,percent of total billed charges,All Other,20.75,36,,20.75,percent of total billed charges,Drugs,20.75,36,,20.75,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,20.17,35,,20.17,percent of total billed charges,Drugs,19.21,,,19.21,Other,Drug Cost,19.21,,,19.21,Other,Drug Cost,19.21,,,19.21,Other,Drug Cost,19.21,,,19.21,Other,Drug Cost,19.21,,,19.21,Other,Drug Cost,19.21,,,19.21,Other,Drug Cost,43.22,,,43.22,Other,225% of Medicaid,26.9,,,26.9,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,24.37,,,24.37,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",41.3,,,41.3,Other,215% Medicaid APG methodology,41.3,,,41.3,Other,215% Medicaid APG methodology,24.01,,,24.01,Other,125% Medicaid APG methodology,0.01,43.22,
AZTREONAM (AZACTAM) 2 G,J0457,HCPCS,,80000212,CDM,636,RC,63323040220,NDC,both,10,EA,59.79,25.05,,,25.05,Other,150% of Medicare + 9.63% HCRA Surcharge,15.23,,,15.23,Fee Schedule,Average Sale Price (ASP) x 6,20.93,35,,20.93,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,20.33,34,,20.33,percent of total billed charges,Drugs,20.33,34,,20.33,percent of total billed charges,Drugs,20.33,34,,20.33,percent of total billed charges,Drugs,20.33,34,,20.33,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,23.92,40,,23.92,percent of total billed charges,Drugs,41.85,70,,41.85,percent of total billed charges,All Other,21.52,36,,21.52,percent of total billed charges,Drugs,21.52,36,,21.52,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,20.93,35,,20.93,percent of total billed charges,Drugs,19.93,,,19.93,Other,Drug Cost,19.93,,,19.93,Other,Drug Cost,19.93,,,19.93,Other,Drug Cost,19.93,,,19.93,Other,Drug Cost,19.93,,,19.93,Other,Drug Cost,19.93,,,19.93,Other,Drug Cost,44.84,,,44.84,Other,225% of Medicaid,27.9,,,27.9,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,24.37,,,24.37,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",42.85,,,42.85,Other,215% Medicaid APG methodology,42.85,,,42.85,Other,215% Medicaid APG methodology,24.91,,,24.91,Other,125% Medicaid APG methodology,0.01,44.84,
BENZTROPINE 2 MG/ 2ML INJECTION,J0515,HCPCS,,80000242,CDM,636,RC,63323097002,NDC,both,5,ML,54.94,162.16,,,162.16,Other,150% of Medicare + 9.63% HCRA Surcharge,98.61,,,98.61,Fee Schedule,Average Sale Price (ASP) x 6,19.23,35,,19.23,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,18.68,34,,18.68,percent of total billed charges,Drugs,18.68,34,,18.68,percent of total billed charges,Drugs,18.68,34,,18.68,percent of total billed charges,Drugs,18.68,34,,18.68,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,21.97,40,,21.97,percent of total billed charges,Drugs,38.46,70,,38.46,percent of total billed charges,All Other,19.78,36,,19.78,percent of total billed charges,Drugs,19.78,36,,19.78,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,19.23,35,,19.23,percent of total billed charges,Drugs,18.31,,,18.31,Other,Drug Cost,18.31,,,18.31,Other,Drug Cost,18.31,,,18.31,Other,Drug Cost,18.31,,,18.31,Other,Drug Cost,18.31,,,18.31,Other,Drug Cost,18.31,,,18.31,Other,Drug Cost,41.2,,,41.2,Other,225% of Medicaid,25.64,,,25.64,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,157.78,,,157.78,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",39.37,,,39.37,Other,215% Medicaid APG methodology,39.37,,,39.37,Other,215% Medicaid APG methodology,22.89,,,22.89,Other,125% Medicaid APG methodology,0.01,162.16,
BETAMETHASONE ACET&SOD PHOSP 3MG,J0702,HCPCS,,80000249,CDM,636,RC,78206011801,NDC,both,1,ML,53.4,67.25,,,67.25,Other,150% of Medicare + 9.63% HCRA Surcharge,40.9,,,40.9,Fee Schedule,Average Sale Price (ASP) x 6,18.69,35,,18.69,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,18.16,34,,18.16,percent of total billed charges,Drugs,18.16,34,,18.16,percent of total billed charges,Drugs,18.16,34,,18.16,percent of total billed charges,Drugs,18.16,34,,18.16,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,21.36,40,,21.36,percent of total billed charges,Drugs,37.38,70,,37.38,percent of total billed charges,All Other,19.22,36,,19.22,percent of total billed charges,Drugs,19.22,36,,19.22,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,18.69,35,,18.69,percent of total billed charges,Drugs,17.8,,,17.8,Other,Drug Cost,17.8,,,17.8,Other,Drug Cost,17.8,,,17.8,Other,Drug Cost,17.8,,,17.8,Other,Drug Cost,17.8,,,17.8,Other,Drug Cost,17.8,,,17.8,Other,Drug Cost,40.05,,,40.05,Other,225% of Medicaid,24.92,,,24.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,65.43,,,65.43,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",38.27,,,38.27,Other,215% Medicaid APG methodology,38.27,,,38.27,Other,215% Medicaid APG methodology,22.25,,,22.25,Other,125% Medicaid APG methodology,0.01,67.25,
BLEOMYCIN SULFATE INJECTION 15 UNITS,J9040,HCPCS,,80000268,CDM,636,RC,703315401,NDC,both,1,EA,155.46,207.44,,,207.44,Other,150% of Medicare + 9.63% HCRA Surcharge,126.14,,,126.14,Fee Schedule,Average Sale Price (ASP) x 6,54.41,35,,54.41,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,52.86,34,,52.86,percent of total billed charges,Drugs,52.86,34,,52.86,percent of total billed charges,Drugs,52.86,34,,52.86,percent of total billed charges,Drugs,52.86,34,,52.86,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,62.18,40,,62.18,percent of total billed charges,Drugs,108.82,70,,108.82,percent of total billed charges,All Other,55.97,36,,55.97,percent of total billed charges,Drugs,55.97,36,,55.97,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,54.41,35,,54.41,percent of total billed charges,Drugs,51.82,,,51.82,Other,Drug Cost,51.82,,,51.82,Other,Drug Cost,51.82,,,51.82,Other,Drug Cost,51.82,,,51.82,Other,Drug Cost,51.82,,,51.82,Other,Drug Cost,51.82,,,51.82,Other,Drug Cost,116.6,,,116.6,Other,225% of Medicaid,72.55,,,72.55,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,201.83,,,201.83,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",111.41,,,111.41,Other,215% Medicaid APG methodology,111.41,,,111.41,Other,215% Medicaid APG methodology,64.78,,,64.78,Other,125% Medicaid APG methodology,0.01,207.44,
BORTEZOMIB (VELCADE) 3.5 MG INJ,J9041,HCPCS,,80000270,CDM,636,RC,63020004901,NDC,both,1,EA,4809,19.33,,,19.33,Other,150% of Medicare + 9.63% HCRA Surcharge,11.75,,,11.75,Fee Schedule,Average Sale Price (ASP) x 6,1683.15,35,,1683.15,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1635.06,34,,1635.06,percent of total billed charges,Drugs,1635.06,34,,1635.06,percent of total billed charges,Drugs,1635.06,34,,1635.06,percent of total billed charges,Drugs,1635.06,34,,1635.06,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1635.06,34,"If Charge > 500, then 34 percent",1635.06,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1923.6,40,,1923.6,percent of total billed charges,Drugs,3366.3,70,,3366.3,percent of total billed charges,All Other,1731.24,36,,1731.24,percent of total billed charges,Drugs,1731.24,36,,1731.24,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1683.15,35,,1683.15,percent of total billed charges,Drugs,1603,,,1603,Other,Drug Cost,1603,,,1603,Other,Drug Cost,1603,,,1603,Other,Drug Cost,1603,,,1603,Other,Drug Cost,1603,,,1603,Other,Drug Cost,1603,,,1603,Other,Drug Cost,3606.75,,,3606.75,Other,225% of Medicaid,2244.2,,,2244.2,Other,140% of Medicaid,1635.06,34,"If Charge > 2,000, then 34 percent",1635.06,percent of total billed charges,Drugs,18.81,,,18.81,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3446.45,,,3446.45,Other,215% Medicaid APG methodology,3446.45,,,3446.45,Other,215% Medicaid APG methodology,2003.75,,,2003.75,Other,125% Medicaid APG methodology,0.01,3606.75,
BRENTUXIMAB VEDOTIN (ADCETRIS) 50 MG,J9042,HCPCS,,80000271,CDM,636,RC,51144005001,NDC,both,1,EA,35226,2275.4,,,2275.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1383.68,,,1383.68,Fee Schedule,Average Sale Price (ASP) x 6,12329.1,35,,12329.1,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,11976.84,34,,11976.84,percent of total billed charges,Drugs,11976.84,34,,11976.84,percent of total billed charges,Drugs,11976.84,34,,11976.84,percent of total billed charges,Drugs,11976.84,34,,11976.84,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,11976.84,34,"If Charge > 500, then 34 percent",11976.84,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,14090.4,40,,14090.4,percent of total billed charges,Drugs,24658.2,70,,24658.2,percent of total billed charges,All Other,12681.36,36,,12681.36,percent of total billed charges,Drugs,12681.36,36,,12681.36,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,12329.1,35,,12329.1,percent of total billed charges,Drugs,11742,,,11742,Other,Drug Cost,11742,,,11742,Other,Drug Cost,11742,,,11742,Other,Drug Cost,11742,,,11742,Other,Drug Cost,11742,,,11742,Other,Drug Cost,11742,,,11742,Other,Drug Cost,26419.5,,,26419.5,Other,225% of Medicaid,16438.8,,,16438.8,Other,140% of Medicaid,11976.84,34,"If Charge > 2,000, then 34 percent",11976.84,percent of total billed charges,Drugs,2213.89,,,2213.89,Other,160% Medicare Fee Schedule,11976.84,34,,11976.84,Other,"Drug Charges > 20,000, then 34% of Charges",25245.3,,,25245.3,Other,215% Medicaid APG methodology,25245.3,,,25245.3,Other,215% Medicaid APG methodology,14677.5,,,14677.5,Other,125% Medicaid APG methodology,1383.68,26419.5,
BREVIBLOC 2500MG/250ML IV,J3490,HCPCS,,80000273,CDM,636,RC,10019005561,NDC,both,10,ML,126.02,49.74,39.4668,,49.74,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,44.11,35,,44.11,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,42.85,34,,42.85,percent of total billed charges,Drugs,42.85,34,,42.85,percent of total billed charges,Drugs,42.85,34,,42.85,percent of total billed charges,Drugs,42.85,34,,42.85,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,50.41,40,,50.41,percent of total billed charges,Drugs,88.21,70,,88.21,percent of total billed charges,All Other,45.37,36,,45.37,percent of total billed charges,Drugs,45.37,36,,45.37,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,44.11,35,,44.11,percent of total billed charges,Drugs,42.01,,,42.01,Other,Drug Cost,42.01,,,42.01,Other,Drug Cost,42.01,,,42.01,Other,Drug Cost,42.01,,,42.01,Other,Drug Cost,42.01,,,42.01,Other,Drug Cost,42.01,,,42.01,Other,Drug Cost,94.52,,,94.52,Other,225% of Medicaid,58.81,,,58.81,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",90.32,,,90.32,Other,215% Medicaid APG methodology,90.32,,,90.32,Other,215% Medicaid APG methodology,52.51,,,52.51,Other,125% Medicaid APG methodology,0.01,94.52,
CABAZITAXEL 60MG/1.5ML INJECTION,J9043,HCPCS,,80000317,CDM,636,RC,24582411,NDC,both,1,ML,24731.97,2076.48,,,2076.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1262.72,,,1262.72,Fee Schedule,Average Sale Price (ASP) x 6,8656.19,35,,8656.19,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,8408.87,34,,8408.87,percent of total billed charges,Drugs,8408.87,34,,8408.87,percent of total billed charges,Drugs,8408.87,34,,8408.87,percent of total billed charges,Drugs,8408.87,34,,8408.87,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,8408.87,34,"If Charge > 500, then 34 percent",8408.87,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,9892.79,40,,9892.79,percent of total billed charges,Drugs,17312.38,70,,17312.38,percent of total billed charges,All Other,8903.51,36,,8903.51,percent of total billed charges,Drugs,8903.51,36,,8903.51,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,8656.19,35,,8656.19,percent of total billed charges,Drugs,8243.99,,,8243.99,Other,Drug Cost,8243.99,,,8243.99,Other,Drug Cost,8243.99,,,8243.99,Other,Drug Cost,8243.99,,,8243.99,Other,Drug Cost,8243.99,,,8243.99,Other,Drug Cost,8243.99,,,8243.99,Other,Drug Cost,18548.98,,,18548.98,Other,225% of Medicaid,11541.59,,,11541.59,Other,140% of Medicaid,8408.87,34,"If Charge > 2,000, then 34 percent",8408.87,percent of total billed charges,Drugs,2020.35,,,2020.35,Other,160% Medicare Fee Schedule,8408.87,34,,8408.87,Other,"Drug Charges > 20,000, then 34% of Charges",17724.58,,,17724.58,Other,215% Medicaid APG methodology,17724.58,,,17724.58,Other,215% Medicaid APG methodology,10304.99,,,10304.99,Other,125% Medicaid APG methodology,1262.72,18548.98,
CALCIUM GLUCONATE INJECTION 10 ML,J0612,HCPCS,,80000331,CDM,636,RC,63323036019,NDC,both,25,ML,4.24,0.49,,,0.49,Other,150% of Medicare + 9.63% HCRA Surcharge,0.3,,,0.3,Fee Schedule,Average Sale Price (ASP) x 6,1.48,35,,1.48,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,1.44,34,,1.44,percent of total billed charges,Drugs,1.44,34,,1.44,percent of total billed charges,Drugs,1.44,34,,1.44,percent of total billed charges,Drugs,1.44,34,,1.44,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,1.7,40,,1.7,percent of total billed charges,Drugs,2.97,70,,2.97,percent of total billed charges,All Other,1.53,36,,1.53,percent of total billed charges,Drugs,1.53,36,,1.53,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,1.48,35,,1.48,percent of total billed charges,Drugs,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,1.41,,,1.41,Other,Drug Cost,3.18,,,3.18,Other,225% of Medicaid,1.98,,,1.98,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.48,,,0.48,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.04,,,3.04,Other,215% Medicaid APG methodology,3.04,,,3.04,Other,215% Medicaid APG methodology,1.77,,,1.77,Other,125% Medicaid APG methodology,0.01,3.18,
CAPECITABINE ORAL 500 MG,J8521,HCPCS,,80000338,CDM,636,RC,16729007329,NDC,both,120,EA,1.73,5.66,,,5.66,Other,150% of Medicare + 9.63% HCRA Surcharge,3.44,,,3.44,Fee Schedule,Average Sale Price (ASP) x 6,0.61,35,,0.61,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.59,34,,0.59,percent of total billed charges,Drugs,0.59,34,,0.59,percent of total billed charges,Drugs,0.59,34,,0.59,percent of total billed charges,Drugs,0.59,34,,0.59,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.69,40,,0.69,percent of total billed charges,Drugs,1.21,70,,1.21,percent of total billed charges,All Other,0.62,36,,0.62,percent of total billed charges,Drugs,0.62,36,,0.62,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.61,35,,0.61,percent of total billed charges,Drugs,0.58,,,0.58,Other,Drug Cost,0.58,,,0.58,Other,Drug Cost,0.58,,,0.58,Other,Drug Cost,0.58,,,0.58,Other,Drug Cost,0.58,,,0.58,Other,Drug Cost,0.58,,,0.58,Other,Drug Cost,1.3,,,1.3,Other,225% of Medicaid,0.81,,,0.81,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,5.51,,,5.51,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.24,,,1.24,Other,215% Medicaid APG methodology,1.24,,,1.24,Other,215% Medicaid APG methodology,0.72,,,0.72,Other,125% Medicaid APG methodology,0.01,5.66,
CARBOPLATIN INJECTION 50 MG/5ML,J9045,HCPCS,,80000370,CDM,636,RC,61703033918,NDC,both,1,ML,7.86,35.51,,,35.51,Other,150% of Medicare + 9.63% HCRA Surcharge,21.59,,,21.59,Fee Schedule,Average Sale Price (ASP) x 6,2.75,35,,2.75,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,2.67,34,,2.67,percent of total billed charges,Drugs,2.67,34,,2.67,percent of total billed charges,Drugs,2.67,34,,2.67,percent of total billed charges,Drugs,2.67,34,,2.67,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,3.14,40,,3.14,percent of total billed charges,Drugs,5.5,70,,5.5,percent of total billed charges,All Other,2.83,36,,2.83,percent of total billed charges,Drugs,2.83,36,,2.83,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,2.75,35,,2.75,percent of total billed charges,Drugs,2.62,,,2.62,Other,Drug Cost,2.62,,,2.62,Other,Drug Cost,2.62,,,2.62,Other,Drug Cost,2.62,,,2.62,Other,Drug Cost,2.62,,,2.62,Other,Drug Cost,2.62,,,2.62,Other,Drug Cost,5.9,,,5.9,Other,225% of Medicaid,3.67,,,3.67,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,34.55,,,34.55,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.63,,,5.63,Other,215% Medicaid APG methodology,5.63,,,5.63,Other,215% Medicaid APG methodology,3.28,,,3.28,Other,125% Medicaid APG methodology,0.01,35.51,
CEFAZOLIN SODIUM 1GM,J0690,HCPCS,,80000387,CDM,636,RC,781345196,NDC,both,25,EA,1.63,7.53,,,7.53,Other,150% of Medicare + 9.63% HCRA Surcharge,4.58,,,4.58,Fee Schedule,Average Sale Price (ASP) x 6,0.57,35,,0.57,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.55,34,,0.55,percent of total billed charges,Drugs,0.55,34,,0.55,percent of total billed charges,Drugs,0.55,34,,0.55,percent of total billed charges,Drugs,0.55,34,,0.55,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.65,40,,0.65,percent of total billed charges,Drugs,1.14,70,,1.14,percent of total billed charges,All Other,0.59,36,,0.59,percent of total billed charges,Drugs,0.59,36,,0.59,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.57,35,,0.57,percent of total billed charges,Drugs,0.54,,,0.54,Other,Drug Cost,0.54,,,0.54,Other,Drug Cost,0.54,,,0.54,Other,Drug Cost,0.54,,,0.54,Other,Drug Cost,0.54,,,0.54,Other,Drug Cost,0.54,,,0.54,Other,Drug Cost,1.22,,,1.22,Other,225% of Medicaid,0.76,,,0.76,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.32,,,7.32,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.17,,,1.17,Other,215% Medicaid APG methodology,1.17,,,1.17,Other,215% Medicaid APG methodology,0.68,,,0.68,Other,125% Medicaid APG methodology,0.01,7.53,
CEFAZOLIN SODIUM 500MG,J0690,HCPCS,,80000388,CDM,636,RC,143992390,NDC,both,25,EA,2.96,7.53,,,7.53,Other,150% of Medicare + 9.63% HCRA Surcharge,4.58,,,4.58,Fee Schedule,Average Sale Price (ASP) x 6,1.04,35,,1.04,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,1.01,34,,1.01,percent of total billed charges,Drugs,1.01,34,,1.01,percent of total billed charges,Drugs,1.01,34,,1.01,percent of total billed charges,Drugs,1.01,34,,1.01,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,1.19,40,,1.19,percent of total billed charges,Drugs,2.07,70,,2.07,percent of total billed charges,All Other,1.07,36,,1.07,percent of total billed charges,Drugs,1.07,36,,1.07,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,1.04,35,,1.04,percent of total billed charges,Drugs,0.99,,,0.99,Other,Drug Cost,0.99,,,0.99,Other,Drug Cost,0.99,,,0.99,Other,Drug Cost,0.99,,,0.99,Other,Drug Cost,0.99,,,0.99,Other,Drug Cost,0.99,,,0.99,Other,Drug Cost,2.22,,,2.22,Other,225% of Medicaid,1.38,,,1.38,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.32,,,7.32,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.12,,,2.12,Other,215% Medicaid APG methodology,2.12,,,2.12,Other,215% Medicaid APG methodology,1.23,,,1.23,Other,125% Medicaid APG methodology,0.01,7.53,
CEFEPIME HCL INJ 1GM,J0692,HCPCS,,80000389,CDM,636,RC,44567024010,NDC,both,10,EA,6.31,12.45,,,12.45,Other,150% of Medicare + 9.63% HCRA Surcharge,7.57,,,7.57,Fee Schedule,Average Sale Price (ASP) x 6,2.21,35,,2.21,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,2.14,34,,2.14,percent of total billed charges,Drugs,2.14,34,,2.14,percent of total billed charges,Drugs,2.14,34,,2.14,percent of total billed charges,Drugs,2.14,34,,2.14,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,2.52,40,,2.52,percent of total billed charges,Drugs,4.41,70,,4.41,percent of total billed charges,All Other,2.27,36,,2.27,percent of total billed charges,Drugs,2.27,36,,2.27,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,2.21,35,,2.21,percent of total billed charges,Drugs,2.1,,,2.1,Other,Drug Cost,2.1,,,2.1,Other,Drug Cost,2.1,,,2.1,Other,Drug Cost,2.1,,,2.1,Other,Drug Cost,2.1,,,2.1,Other,Drug Cost,2.1,,,2.1,Other,Drug Cost,4.73,,,4.73,Other,225% of Medicaid,2.94,,,2.94,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,12.12,,,12.12,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.52,,,4.52,Other,215% Medicaid APG methodology,4.52,,,4.52,Other,215% Medicaid APG methodology,2.63,,,2.63,Other,125% Medicaid APG methodology,0.01,12.45,
CEFEPIME HCL INJ 2GM,J0692,HCPCS,,80000390,CDM,636,RC,60505614700,NDC,both,1,EA,11.01,12.45,,,12.45,Other,150% of Medicare + 9.63% HCRA Surcharge,7.57,,,7.57,Fee Schedule,Average Sale Price (ASP) x 6,3.85,35,,3.85,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,3.74,34,,3.74,percent of total billed charges,Drugs,3.74,34,,3.74,percent of total billed charges,Drugs,3.74,34,,3.74,percent of total billed charges,Drugs,3.74,34,,3.74,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,4.4,40,,4.4,percent of total billed charges,Drugs,7.71,70,,7.71,percent of total billed charges,All Other,3.96,36,,3.96,percent of total billed charges,Drugs,3.96,36,,3.96,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,3.85,35,,3.85,percent of total billed charges,Drugs,3.67,,,3.67,Other,Drug Cost,3.67,,,3.67,Other,Drug Cost,3.67,,,3.67,Other,Drug Cost,3.67,,,3.67,Other,Drug Cost,3.67,,,3.67,Other,Drug Cost,3.67,,,3.67,Other,Drug Cost,8.26,,,8.26,Other,225% of Medicaid,5.14,,,5.14,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,12.12,,,12.12,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.89,,,7.89,Other,215% Medicaid APG methodology,7.89,,,7.89,Other,215% Medicaid APG methodology,4.59,,,4.59,Other,125% Medicaid APG methodology,0.01,12.45,
CEFOXITIN SODIUM INJ 1 GM,J0694,HCPCS,,80000395,CDM,636,RC,63323034125,NDC,both,25,EA,8.29,50.11,,,50.11,Other,150% of Medicare + 9.63% HCRA Surcharge,30.47,,,30.47,Fee Schedule,Average Sale Price (ASP) x 6,2.9,35,,2.9,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,2.82,34,,2.82,percent of total billed charges,Drugs,2.82,34,,2.82,percent of total billed charges,Drugs,2.82,34,,2.82,percent of total billed charges,Drugs,2.82,34,,2.82,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,3.32,40,,3.32,percent of total billed charges,Drugs,5.8,70,,5.8,percent of total billed charges,All Other,2.98,36,,2.98,percent of total billed charges,Drugs,2.98,36,,2.98,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,2.9,35,,2.9,percent of total billed charges,Drugs,2.76,,,2.76,Other,Drug Cost,2.76,,,2.76,Other,Drug Cost,2.76,,,2.76,Other,Drug Cost,2.76,,,2.76,Other,Drug Cost,2.76,,,2.76,Other,Drug Cost,2.76,,,2.76,Other,Drug Cost,6.22,,,6.22,Other,225% of Medicaid,3.87,,,3.87,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,48.76,,,48.76,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.94,,,5.94,Other,215% Medicaid APG methodology,5.94,,,5.94,Other,215% Medicaid APG methodology,3.45,,,3.45,Other,125% Medicaid APG methodology,0.01,50.11,
CEFOXITIN SODIUM INJ 2 GM,J0694,HCPCS,,80000396,CDM,636,RC,63323034225,NDC,both,25,EA,16.06,50.11,,,50.11,Other,150% of Medicare + 9.63% HCRA Surcharge,30.47,,,30.47,Fee Schedule,Average Sale Price (ASP) x 6,5.62,35,,5.62,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,5.46,34,,5.46,percent of total billed charges,Drugs,5.46,34,,5.46,percent of total billed charges,Drugs,5.46,34,,5.46,percent of total billed charges,Drugs,5.46,34,,5.46,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,6.42,40,,6.42,percent of total billed charges,Drugs,11.24,70,,11.24,percent of total billed charges,All Other,5.78,36,,5.78,percent of total billed charges,Drugs,5.78,36,,5.78,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,5.62,35,,5.62,percent of total billed charges,Drugs,5.35,,,5.35,Other,Drug Cost,5.35,,,5.35,Other,Drug Cost,5.35,,,5.35,Other,Drug Cost,5.35,,,5.35,Other,Drug Cost,5.35,,,5.35,Other,Drug Cost,5.35,,,5.35,Other,Drug Cost,12.05,,,12.05,Other,225% of Medicaid,7.5,,,7.5,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,48.76,,,48.76,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",11.51,,,11.51,Other,215% Medicaid APG methodology,11.51,,,11.51,Other,215% Medicaid APG methodology,6.69,,,6.69,Other,125% Medicaid APG methodology,0.01,50.11,
CEFTAROLINE FOSAMIL INJ 400MG,J0712,HCPCS,,80000398,CDM,636,RC,456040010,NDC,both,10,EA,11.06,37.84,,,37.84,Other,150% of Medicare + 9.63% HCRA Surcharge,23.01,,,23.01,Fee Schedule,Average Sale Price (ASP) x 6,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.76,34,,3.76,percent of total billed charges,Drugs,3.76,34,,3.76,percent of total billed charges,Drugs,3.76,34,,3.76,percent of total billed charges,Drugs,3.76,34,,3.76,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,4.42,40,,4.42,percent of total billed charges,Drugs,7.74,70,,7.74,percent of total billed charges,All Other,3.98,36,,3.98,percent of total billed charges,Drugs,3.98,36,,3.98,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.69,,,3.69,Other,Drug Cost,3.69,,,3.69,Other,Drug Cost,3.69,,,3.69,Other,Drug Cost,3.69,,,3.69,Other,Drug Cost,3.69,,,3.69,Other,Drug Cost,3.69,,,3.69,Other,Drug Cost,8.29,,,8.29,Other,225% of Medicaid,5.16,,,5.16,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,36.82,,,36.82,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.92,,,7.92,Other,215% Medicaid APG methodology,7.92,,,7.92,Other,215% Medicaid APG methodology,4.61,,,4.61,Other,125% Medicaid APG methodology,0.01,37.84,
CEFTAROLINE FOSAMIL INJ 600MG,J0712,HCPCS,,80000399,CDM,636,RC,456060010,NDC,both,10,EA,14.41,37.84,,,37.84,Other,150% of Medicare + 9.63% HCRA Surcharge,23.01,,,23.01,Fee Schedule,Average Sale Price (ASP) x 6,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,4.9,34,,4.9,percent of total billed charges,Drugs,4.9,34,,4.9,percent of total billed charges,Drugs,4.9,34,,4.9,percent of total billed charges,Drugs,4.9,34,,4.9,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.76,40,,5.76,percent of total billed charges,Drugs,10.08,70,,10.08,percent of total billed charges,All Other,5.19,36,,5.19,percent of total billed charges,Drugs,5.19,36,,5.19,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,10.8,,,10.8,Other,225% of Medicaid,6.72,,,6.72,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,36.82,,,36.82,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",10.32,,,10.32,Other,215% Medicaid APG methodology,10.32,,,10.32,Other,215% Medicaid APG methodology,6,,,6,Other,125% Medicaid APG methodology,0.01,37.84,
CEFTAZADIME (FORTAZ)  2GM INJ,J0713,HCPCS,,80000400,CDM,636,RC,25021012850,NDC,both,10,EA,15.12,16.71,,,16.71,Other,150% of Medicare + 9.63% HCRA Surcharge,10.16,,,10.16,Fee Schedule,Average Sale Price (ASP) x 6,5.29,35,,5.29,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,5.14,34,,5.14,percent of total billed charges,Drugs,5.14,34,,5.14,percent of total billed charges,Drugs,5.14,34,,5.14,percent of total billed charges,Drugs,5.14,34,,5.14,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,6.05,40,,6.05,percent of total billed charges,Drugs,10.59,70,,10.59,percent of total billed charges,All Other,5.44,36,,5.44,percent of total billed charges,Drugs,5.44,36,,5.44,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,5.29,35,,5.29,percent of total billed charges,Drugs,5.04,,,5.04,Other,Drug Cost,5.04,,,5.04,Other,Drug Cost,5.04,,,5.04,Other,Drug Cost,5.04,,,5.04,Other,Drug Cost,5.04,,,5.04,Other,Drug Cost,5.04,,,5.04,Other,Drug Cost,11.34,,,11.34,Other,225% of Medicaid,7.06,,,7.06,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,16.26,,,16.26,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",10.84,,,10.84,Other,215% Medicaid APG methodology,10.84,,,10.84,Other,215% Medicaid APG methodology,6.3,,,6.3,Other,125% Medicaid APG methodology,0.01,16.71,
CEFTAZIDIME 1GM INJ,J0713,HCPCS,,80000402,CDM,636,RC,409508216,NDC,both,25,EA,8.02,16.71,,,16.71,Other,150% of Medicare + 9.63% HCRA Surcharge,10.16,,,10.16,Fee Schedule,Average Sale Price (ASP) x 6,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.73,34,,2.73,percent of total billed charges,Drugs,2.73,34,,2.73,percent of total billed charges,Drugs,2.73,34,,2.73,percent of total billed charges,Drugs,2.73,34,,2.73,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,3.21,40,,3.21,percent of total billed charges,Drugs,5.61,70,,5.61,percent of total billed charges,All Other,2.89,36,,2.89,percent of total billed charges,Drugs,2.89,36,,2.89,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.67,,,2.67,Other,Drug Cost,2.67,,,2.67,Other,Drug Cost,2.67,,,2.67,Other,Drug Cost,2.67,,,2.67,Other,Drug Cost,2.67,,,2.67,Other,Drug Cost,2.67,,,2.67,Other,Drug Cost,6.01,,,6.01,Other,225% of Medicaid,3.74,,,3.74,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,16.26,,,16.26,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.75,,,5.75,Other,215% Medicaid APG methodology,5.75,,,5.75,Other,215% Medicaid APG methodology,3.34,,,3.34,Other,125% Medicaid APG methodology,0.01,16.71,
CEFTRIAXONE 1GM INJ,J0696,HCPCS,,80000405,CDM,636,RC,781320885,NDC,both,1,EA,1.14,4.84,,,4.84,Other,150% of Medicare + 9.63% HCRA Surcharge,2.95,,,2.95,Fee Schedule,Average Sale Price (ASP) x 6,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.39,34,,0.39,percent of total billed charges,Drugs,0.39,34,,0.39,percent of total billed charges,Drugs,0.39,34,,0.39,percent of total billed charges,Drugs,0.39,34,,0.39,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.46,40,,0.46,percent of total billed charges,Drugs,0.8,70,,0.8,percent of total billed charges,All Other,0.41,36,,0.41,percent of total billed charges,Drugs,0.41,36,,0.41,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.86,,,0.86,Other,225% of Medicaid,0.53,,,0.53,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.71,,,4.71,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.82,,,0.82,Other,215% Medicaid APG methodology,0.82,,,0.82,Other,215% Medicaid APG methodology,0.48,,,0.48,Other,125% Medicaid APG methodology,0.01,4.84,
CEFTRIAXONE 2GM INJ,J0696,HCPCS,,80000406,CDM,636,RC,143985625,NDC,both,25,EA,4.53,4.84,,,4.84,Other,150% of Medicare + 9.63% HCRA Surcharge,2.95,,,2.95,Fee Schedule,Average Sale Price (ASP) x 6,1.59,35,,1.59,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,1.54,34,,1.54,percent of total billed charges,Drugs,1.54,34,,1.54,percent of total billed charges,Drugs,1.54,34,,1.54,percent of total billed charges,Drugs,1.54,34,,1.54,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,1.81,40,,1.81,percent of total billed charges,Drugs,3.17,70,,3.17,percent of total billed charges,All Other,1.63,36,,1.63,percent of total billed charges,Drugs,1.63,36,,1.63,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,1.59,35,,1.59,percent of total billed charges,Drugs,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,3.4,,,3.4,Other,225% of Medicaid,2.12,,,2.12,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.71,,,4.71,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.25,,,3.25,Other,215% Medicaid APG methodology,3.25,,,3.25,Other,215% Medicaid APG methodology,1.89,,,1.89,Other,125% Medicaid APG methodology,0.01,4.84,
CEFTRIAXONE 500MG INJ,J0696,HCPCS,,80000407,CDM,636,RC,409733801,NDC,both,10,EA,1.72,4.84,,,4.84,Other,150% of Medicare + 9.63% HCRA Surcharge,2.95,,,2.95,Fee Schedule,Average Sale Price (ASP) x 6,0.6,35,,0.6,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.59,34,,0.59,percent of total billed charges,Drugs,0.59,34,,0.59,percent of total billed charges,Drugs,0.59,34,,0.59,percent of total billed charges,Drugs,0.59,34,,0.59,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.69,40,,0.69,percent of total billed charges,Drugs,1.21,70,,1.21,percent of total billed charges,All Other,0.62,36,,0.62,percent of total billed charges,Drugs,0.62,36,,0.62,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.6,35,,0.6,percent of total billed charges,Drugs,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,0.57,,,0.57,Other,Drug Cost,1.29,,,1.29,Other,225% of Medicaid,0.8,,,0.8,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.71,,,4.71,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.23,,,1.23,Other,215% Medicaid APG methodology,1.23,,,1.23,Other,215% Medicaid APG methodology,0.72,,,0.72,Other,125% Medicaid APG methodology,0.01,4.84,
CETUXIMAB 100MG/50ML INJ,J9055,HCPCS,,80000419,CDM,636,RC,66733094823,NDC,both,1,ML,2303.73,727.37,,,727.37,Other,150% of Medicare + 9.63% HCRA Surcharge,442.32,,,442.32,Fee Schedule,Average Sale Price (ASP) x 6,806.31,35,,806.31,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,783.27,34,,783.27,percent of total billed charges,Drugs,783.27,34,,783.27,percent of total billed charges,Drugs,783.27,34,,783.27,percent of total billed charges,Drugs,783.27,34,,783.27,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,783.27,34,"If Charge > 500, then 34 percent",783.27,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,921.49,40,,921.49,percent of total billed charges,Drugs,1612.61,70,,1612.61,percent of total billed charges,All Other,829.34,36,,829.34,percent of total billed charges,Drugs,829.34,36,,829.34,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,806.31,35,,806.31,percent of total billed charges,Drugs,767.91,,,767.91,Other,Drug Cost,767.91,,,767.91,Other,Drug Cost,767.91,,,767.91,Other,Drug Cost,767.91,,,767.91,Other,Drug Cost,767.91,,,767.91,Other,Drug Cost,767.91,,,767.91,Other,Drug Cost,1727.8,,,1727.8,Other,225% of Medicaid,1075.07,,,1075.07,Other,140% of Medicaid,783.27,34,"If Charge > 2,000, then 34 percent",783.27,percent of total billed charges,Drugs,707.71,,,707.71,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1651.01,,,1651.01,Other,215% Medicaid APG methodology,1651.01,,,1651.01,Other,215% Medicaid APG methodology,959.89,,,959.89,Other,125% Medicaid APG methodology,0.01,1727.8,
CHLORPROMAZINE HCL INJ 25 MG/1ML,J3230,HCPCS,,80000441,CDM,636,RC,641139735,NDC,both,25,ML,37.89,293.89,,,293.89,Other,150% of Medicare + 9.63% HCRA Surcharge,178.72,,,178.72,Fee Schedule,Average Sale Price (ASP) x 6,13.26,35,,13.26,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,12.88,34,,12.88,percent of total billed charges,Drugs,12.88,34,,12.88,percent of total billed charges,Drugs,12.88,34,,12.88,percent of total billed charges,Drugs,12.88,34,,12.88,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,15.15,40,,15.15,percent of total billed charges,Drugs,26.52,70,,26.52,percent of total billed charges,All Other,13.64,36,,13.64,percent of total billed charges,Drugs,13.64,36,,13.64,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,13.26,35,,13.26,percent of total billed charges,Drugs,12.63,,,12.63,Other,Drug Cost,12.63,,,12.63,Other,Drug Cost,12.63,,,12.63,Other,Drug Cost,12.63,,,12.63,Other,Drug Cost,12.63,,,12.63,Other,Drug Cost,12.63,,,12.63,Other,Drug Cost,28.41,,,28.41,Other,225% of Medicaid,17.68,,,17.68,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,285.95,,,285.95,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",27.15,,,27.15,Other,215% Medicaid APG methodology,27.15,,,27.15,Other,215% Medicaid APG methodology,15.79,,,15.79,Other,125% Medicaid APG methodology,0.01,293.89,
CIDOFOVIR 375 MG/ 5 ML INJ,J0740,HCPCS,,80000449,CDM,636,RC,23155021631,NDC,both,1,ML,1299.75,5468.05,,,5468.05,Other,150% of Medicare + 9.63% HCRA Surcharge,3325.15,,,3325.15,Fee Schedule,Average Sale Price (ASP) x 6,454.91,35,,454.91,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,441.92,34,,441.92,percent of total billed charges,Drugs,441.92,34,,441.92,percent of total billed charges,Drugs,441.92,34,,441.92,percent of total billed charges,Drugs,441.92,34,,441.92,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,441.92,34,"If Charge > 500, then 34 percent",441.92,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,519.9,40,,519.9,percent of total billed charges,Drugs,909.83,70,,909.83,percent of total billed charges,All Other,467.91,36,,467.91,percent of total billed charges,Drugs,467.91,36,,467.91,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,454.91,35,,454.91,percent of total billed charges,Drugs,433.25,,,433.25,Other,Drug Cost,433.25,,,433.25,Other,Drug Cost,433.25,,,433.25,Other,Drug Cost,433.25,,,433.25,Other,Drug Cost,433.25,,,433.25,Other,Drug Cost,433.25,,,433.25,Other,Drug Cost,974.81,,,974.81,Other,225% of Medicaid,606.55,,,606.55,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,5320.24,,,5320.24,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",931.49,,,931.49,Other,215% Medicaid APG methodology,931.49,,,931.49,Other,215% Medicaid APG methodology,541.56,,,541.56,Other,125% Medicaid APG methodology,0.01,5468.05,
CIPROFLOXACIN IV 400MG,J0744,HCPCS,,80000460,CDM,636,RC,25021011487,NDC,both,24,ML,8.05,19.07,,,19.07,Other,150% of Medicare + 9.63% HCRA Surcharge,11.6,,,11.6,Fee Schedule,Average Sale Price (ASP) x 6,2.82,35,,2.82,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,2.74,34,,2.74,percent of total billed charges,Drugs,2.74,34,,2.74,percent of total billed charges,Drugs,2.74,34,,2.74,percent of total billed charges,Drugs,2.74,34,,2.74,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,3.22,40,,3.22,percent of total billed charges,Drugs,5.64,70,,5.64,percent of total billed charges,All Other,2.9,36,,2.9,percent of total billed charges,Drugs,2.9,36,,2.9,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,2.82,35,,2.82,percent of total billed charges,Drugs,2.68,,,2.68,Other,Drug Cost,2.68,,,2.68,Other,Drug Cost,2.68,,,2.68,Other,Drug Cost,2.68,,,2.68,Other,Drug Cost,2.68,,,2.68,Other,Drug Cost,2.68,,,2.68,Other,Drug Cost,6.04,,,6.04,Other,225% of Medicaid,3.76,,,3.76,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,18.56,,,18.56,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.77,,,5.77,Other,215% Medicaid APG methodology,5.77,,,5.77,Other,215% Medicaid APG methodology,3.36,,,3.36,Other,125% Medicaid APG methodology,0.01,19.07,
CISPLATIN 1MG/ML INJECTION 50ML,J9060,HCPCS,,80000463,CDM,636,RC,16729028811,NDC,both,1,ML,26.4,39.85,,,39.85,Other,150% of Medicare + 9.63% HCRA Surcharge,24.23,,,24.23,Fee Schedule,Average Sale Price (ASP) x 6,9.24,35,,9.24,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,8.98,34,,8.98,percent of total billed charges,Drugs,8.98,34,,8.98,percent of total billed charges,Drugs,8.98,34,,8.98,percent of total billed charges,Drugs,8.98,34,,8.98,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,10.56,40,,10.56,percent of total billed charges,Drugs,18.48,70,,18.48,percent of total billed charges,All Other,9.5,36,,9.5,percent of total billed charges,Drugs,9.5,36,,9.5,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,9.24,35,,9.24,percent of total billed charges,Drugs,8.8,,,8.8,Other,Drug Cost,8.8,,,8.8,Other,Drug Cost,8.8,,,8.8,Other,Drug Cost,8.8,,,8.8,Other,Drug Cost,8.8,,,8.8,Other,Drug Cost,8.8,,,8.8,Other,Drug Cost,19.8,,,19.8,Other,225% of Medicaid,12.32,,,12.32,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,38.77,,,38.77,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",18.92,,,18.92,Other,215% Medicaid APG methodology,18.92,,,18.92,Other,215% Medicaid APG methodology,11,,,11,Other,125% Medicaid APG methodology,0.01,39.85,
CLADRIBINE 1 MG/ML 10ML INJ,J9065,HCPCS,,80000471,CDM,636,RC,63323014010,NDC,both,1,ML,319.56,155.63,,,155.63,Other,150% of Medicare + 9.63% HCRA Surcharge,94.64,,,94.64,Fee Schedule,Average Sale Price (ASP) x 6,111.85,35,,111.85,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,108.65,34,,108.65,percent of total billed charges,Drugs,108.65,34,,108.65,percent of total billed charges,Drugs,108.65,34,,108.65,percent of total billed charges,Drugs,108.65,34,,108.65,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,127.82,40,,127.82,percent of total billed charges,Drugs,223.69,70,,223.69,percent of total billed charges,All Other,115.04,36,,115.04,percent of total billed charges,Drugs,115.04,36,,115.04,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,111.85,35,,111.85,percent of total billed charges,Drugs,106.52,,,106.52,Other,Drug Cost,106.52,,,106.52,Other,Drug Cost,106.52,,,106.52,Other,Drug Cost,106.52,,,106.52,Other,Drug Cost,106.52,,,106.52,Other,Drug Cost,106.52,,,106.52,Other,Drug Cost,239.67,,,239.67,Other,225% of Medicaid,149.13,,,149.13,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,151.42,,,151.42,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",229.02,,,229.02,Other,215% Medicaid APG methodology,229.02,,,229.02,Other,215% Medicaid APG methodology,133.15,,,133.15,Other,125% Medicaid APG methodology,0.01,239.67,
COSYNTROPIN (CORTROSYN) INJ 0.25 MG,J0834,HCPCS,,80000535,CDM,636,RC,548590000,NDC,both,10,EA,16.44,267.53,,,267.53,Other,150% of Medicare + 9.63% HCRA Surcharge,162.68,,,162.68,Fee Schedule,Average Sale Price (ASP) x 6,5.76,35,,5.76,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,5.59,34,,5.59,percent of total billed charges,Drugs,5.59,34,,5.59,percent of total billed charges,Drugs,5.59,34,,5.59,percent of total billed charges,Drugs,5.59,34,,5.59,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,6.58,40,,6.58,percent of total billed charges,Drugs,11.51,70,,11.51,percent of total billed charges,All Other,5.92,36,,5.92,percent of total billed charges,Drugs,5.92,36,,5.92,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,5.76,35,,5.76,percent of total billed charges,Drugs,5.48,,,5.48,Other,Drug Cost,5.48,,,5.48,Other,Drug Cost,5.48,,,5.48,Other,Drug Cost,5.48,,,5.48,Other,Drug Cost,5.48,,,5.48,Other,Drug Cost,5.48,,,5.48,Other,Drug Cost,12.33,,,12.33,Other,225% of Medicaid,7.67,,,7.67,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,260.29,,,260.29,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",11.78,,,11.78,Other,215% Medicaid APG methodology,11.78,,,11.78,Other,215% Medicaid APG methodology,6.85,,,6.85,Other,125% Medicaid APG methodology,0.01,267.53,
CYCLOPHOSPHAMIDE 1GM INJ,J9070,HCPCS,,80000545,CDM,636,RC,781324494,NDC,both,1,EA,312.84,198.84,,,198.84,Other,150% of Medicare + 9.63% HCRA Surcharge,120.92,,,120.92,Fee Schedule,Average Sale Price (ASP) x 6,109.49,35,,109.49,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,106.37,34,,106.37,percent of total billed charges,Drugs,106.37,34,,106.37,percent of total billed charges,Drugs,106.37,34,,106.37,percent of total billed charges,Drugs,106.37,34,,106.37,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,125.14,40,,125.14,percent of total billed charges,Drugs,218.99,70,,218.99,percent of total billed charges,All Other,112.62,36,,112.62,percent of total billed charges,Drugs,112.62,36,,112.62,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,109.49,35,,109.49,percent of total billed charges,Drugs,104.28,,,104.28,Other,Drug Cost,104.28,,,104.28,Other,Drug Cost,104.28,,,104.28,Other,Drug Cost,104.28,,,104.28,Other,Drug Cost,104.28,,,104.28,Other,Drug Cost,104.28,,,104.28,Other,Drug Cost,234.63,,,234.63,Other,225% of Medicaid,145.99,,,145.99,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,193.47,,,193.47,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",224.2,,,224.2,Other,215% Medicaid APG methodology,224.2,,,224.2,Other,215% Medicaid APG methodology,130.35,,,130.35,Other,125% Medicaid APG methodology,0.01,234.63,
CYCLOPHOSPHAMIDE 2GM INJ,J9070,HCPCS,,80000547,CDM,636,RC,10019095701,NDC,both,1,EA,316.2,198.84,,,198.84,Other,150% of Medicare + 9.63% HCRA Surcharge,120.92,,,120.92,Fee Schedule,Average Sale Price (ASP) x 6,110.67,35,,110.67,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,107.51,34,,107.51,percent of total billed charges,Drugs,107.51,34,,107.51,percent of total billed charges,Drugs,107.51,34,,107.51,percent of total billed charges,Drugs,107.51,34,,107.51,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,126.48,40,,126.48,percent of total billed charges,Drugs,221.34,70,,221.34,percent of total billed charges,All Other,113.83,36,,113.83,percent of total billed charges,Drugs,113.83,36,,113.83,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,110.67,35,,110.67,percent of total billed charges,Drugs,105.4,,,105.4,Other,Drug Cost,105.4,,,105.4,Other,Drug Cost,105.4,,,105.4,Other,Drug Cost,105.4,,,105.4,Other,Drug Cost,105.4,,,105.4,Other,Drug Cost,105.4,,,105.4,Other,Drug Cost,237.15,,,237.15,Other,225% of Medicaid,147.56,,,147.56,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,193.47,,,193.47,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",226.61,,,226.61,Other,215% Medicaid APG methodology,226.61,,,226.61,Other,215% Medicaid APG methodology,131.75,,,131.75,Other,125% Medicaid APG methodology,0.01,237.15,
CYCLOPHOSPHAMIDE 500MG INJ,J9070,HCPCS,,80000548,CDM,636,RC,70121123801,NDC,both,1,EA,186.42,198.84,,,198.84,Other,150% of Medicare + 9.63% HCRA Surcharge,120.92,,,120.92,Fee Schedule,Average Sale Price (ASP) x 6,65.25,35,,65.25,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,63.38,34,,63.38,percent of total billed charges,Drugs,63.38,34,,63.38,percent of total billed charges,Drugs,63.38,34,,63.38,percent of total billed charges,Drugs,63.38,34,,63.38,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,74.57,40,,74.57,percent of total billed charges,Drugs,130.49,70,,130.49,percent of total billed charges,All Other,67.11,36,,67.11,percent of total billed charges,Drugs,67.11,36,,67.11,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,65.25,35,,65.25,percent of total billed charges,Drugs,62.14,,,62.14,Other,Drug Cost,62.14,,,62.14,Other,Drug Cost,62.14,,,62.14,Other,Drug Cost,62.14,,,62.14,Other,Drug Cost,62.14,,,62.14,Other,Drug Cost,62.14,,,62.14,Other,Drug Cost,139.82,,,139.82,Other,225% of Medicaid,87,,,87,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,193.47,,,193.47,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",133.6,,,133.6,Other,215% Medicaid APG methodology,133.6,,,133.6,Other,215% Medicaid APG methodology,77.68,,,77.68,Other,125% Medicaid APG methodology,0.01,198.84,
CYCLOSPORINE 25MG CAPS,J7515,HCPCS,,80000554,CDM,636,RC,60505013300,NDC,both,30,EA,1.81,8.26,,,8.26,Other,150% of Medicare + 9.63% HCRA Surcharge,5.02,,,5.02,Fee Schedule,Average Sale Price (ASP) x 6,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.62,34,,0.62,percent of total billed charges,Drugs,0.62,34,,0.62,percent of total billed charges,Drugs,0.62,34,,0.62,percent of total billed charges,Drugs,0.62,34,,0.62,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.73,40,,0.73,percent of total billed charges,Drugs,1.27,70,,1.27,percent of total billed charges,All Other,0.65,36,,0.65,percent of total billed charges,Drugs,0.65,36,,0.65,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,1.36,,,1.36,Other,225% of Medicaid,0.85,,,0.85,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,8.04,,,8.04,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.3,,,1.3,Other,215% Medicaid APG methodology,1.3,,,1.3,Other,215% Medicaid APG methodology,0.76,,,0.76,Other,125% Medicaid APG methodology,0.01,8.26,
D5W / NORMAL SALINE (500 ML=1 UNIT),J7042,HCPCS,,80000568,CDM,636,RC,264761010,NDC,both,24,ML,1.32,15.66,,,15.66,Other,150% of Medicare + 9.63% HCRA Surcharge,9.52,,,9.52,Fee Schedule,Average Sale Price (ASP) x 6,0.46,35,,0.46,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.45,34,,0.45,percent of total billed charges,Drugs,0.45,34,,0.45,percent of total billed charges,Drugs,0.45,34,,0.45,percent of total billed charges,Drugs,0.45,34,,0.45,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.53,40,,0.53,percent of total billed charges,Drugs,0.92,70,,0.92,percent of total billed charges,All Other,0.47,36,,0.47,percent of total billed charges,Drugs,0.47,36,,0.47,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.46,35,,0.46,percent of total billed charges,Drugs,0.44,,,0.44,Other,Drug Cost,0.44,,,0.44,Other,Drug Cost,0.44,,,0.44,Other,Drug Cost,0.44,,,0.44,Other,Drug Cost,0.44,,,0.44,Other,Drug Cost,0.44,,,0.44,Other,Drug Cost,0.99,,,0.99,Other,225% of Medicaid,0.62,,,0.62,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,15.24,,,15.24,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.95,,,0.95,Other,215% Medicaid APG methodology,0.95,,,0.95,Other,215% Medicaid APG methodology,0.55,,,0.55,Other,125% Medicaid APG methodology,0.01,15.66,
D5W 1000 ML(500 ML = 1 UNIT),J7060,HCPCS,,80000570,CDM,636,RC,338001704,NDC,both,14,ML,5.41,19.05,,,19.05,Other,150% of Medicare + 9.63% HCRA Surcharge,11.59,,,11.59,Fee Schedule,Average Sale Price (ASP) x 6,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.84,34,,1.84,percent of total billed charges,Drugs,1.84,34,,1.84,percent of total billed charges,Drugs,1.84,34,,1.84,percent of total billed charges,Drugs,1.84,34,,1.84,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,2.16,40,,2.16,percent of total billed charges,Drugs,3.79,70,,3.79,percent of total billed charges,All Other,1.95,36,,1.95,percent of total billed charges,Drugs,1.95,36,,1.95,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.8,,,1.8,Other,Drug Cost,1.8,,,1.8,Other,Drug Cost,1.8,,,1.8,Other,Drug Cost,1.8,,,1.8,Other,Drug Cost,1.8,,,1.8,Other,Drug Cost,1.8,,,1.8,Other,Drug Cost,4.06,,,4.06,Other,225% of Medicaid,2.52,,,2.52,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,18.54,,,18.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.88,,,3.88,Other,215% Medicaid APG methodology,3.88,,,3.88,Other,215% Medicaid APG methodology,2.25,,,2.25,Other,125% Medicaid APG methodology,0.01,19.05,
D5W 250ML  (500 ML = 1 UNIT),J7060,HCPCS,,80000571,CDM,636,RC,264751020,NDC,both,24,ML,1.52,19.05,,,19.05,Other,150% of Medicare + 9.63% HCRA Surcharge,11.59,,,11.59,Fee Schedule,Average Sale Price (ASP) x 6,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.52,34,,0.52,percent of total billed charges,Drugs,0.52,34,,0.52,percent of total billed charges,Drugs,0.52,34,,0.52,percent of total billed charges,Drugs,0.52,34,,0.52,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.61,40,,0.61,percent of total billed charges,Drugs,1.06,70,,1.06,percent of total billed charges,All Other,0.55,36,,0.55,percent of total billed charges,Drugs,0.55,36,,0.55,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,1.14,,,1.14,Other,225% of Medicaid,0.71,,,0.71,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,18.54,,,18.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.09,,,1.09,Other,215% Medicaid APG methodology,1.09,,,1.09,Other,215% Medicaid APG methodology,0.63,,,0.63,Other,125% Medicaid APG methodology,0.01,19.05,
D5W 500ML  (500 ML = 1 UNIT),J7060,HCPCS,,80000572,CDM,636,RC,264751010,NDC,both,24,ML,3.04,19.05,,,19.05,Other,150% of Medicare + 9.63% HCRA Surcharge,11.59,,,11.59,Fee Schedule,Average Sale Price (ASP) x 6,1.06,35,,1.06,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,1.03,34,,1.03,percent of total billed charges,Drugs,1.03,34,,1.03,percent of total billed charges,Drugs,1.03,34,,1.03,percent of total billed charges,Drugs,1.03,34,,1.03,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,1.22,40,,1.22,percent of total billed charges,Drugs,2.13,70,,2.13,percent of total billed charges,All Other,1.09,36,,1.09,percent of total billed charges,Drugs,1.09,36,,1.09,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,1.06,35,,1.06,percent of total billed charges,Drugs,1.01,,,1.01,Other,Drug Cost,1.01,,,1.01,Other,Drug Cost,1.01,,,1.01,Other,Drug Cost,1.01,,,1.01,Other,Drug Cost,1.01,,,1.01,Other,Drug Cost,1.01,,,1.01,Other,Drug Cost,2.28,,,2.28,Other,225% of Medicaid,1.42,,,1.42,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,18.54,,,18.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.18,,,2.18,Other,215% Medicaid APG methodology,2.18,,,2.18,Other,215% Medicaid APG methodology,1.27,,,1.27,Other,125% Medicaid APG methodology,0.01,19.05,
DACARBAZINE 200 MG INJ,J9130,HCPCS,,80000578,CDM,636,RC,703507501,NDC,both,1,EA,44.61,36.83,,,36.83,Other,150% of Medicare + 9.63% HCRA Surcharge,22.4,,,22.4,Fee Schedule,Average Sale Price (ASP) x 6,15.61,35,,15.61,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,15.17,34,,15.17,percent of total billed charges,Drugs,15.17,34,,15.17,percent of total billed charges,Drugs,15.17,34,,15.17,percent of total billed charges,Drugs,15.17,34,,15.17,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,17.84,40,,17.84,percent of total billed charges,Drugs,31.23,70,,31.23,percent of total billed charges,All Other,16.06,36,,16.06,percent of total billed charges,Drugs,16.06,36,,16.06,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,15.61,35,,15.61,percent of total billed charges,Drugs,14.87,,,14.87,Other,Drug Cost,14.87,,,14.87,Other,Drug Cost,14.87,,,14.87,Other,Drug Cost,14.87,,,14.87,Other,Drug Cost,14.87,,,14.87,Other,Drug Cost,14.87,,,14.87,Other,Drug Cost,33.46,,,33.46,Other,225% of Medicaid,20.82,,,20.82,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,35.84,,,35.84,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",31.97,,,31.97,Other,215% Medicaid APG methodology,31.97,,,31.97,Other,215% Medicaid APG methodology,18.59,,,18.59,Other,125% Medicaid APG methodology,0.01,36.83,
DAPTOMYCIN (CUBICIN) 500 MG INJ,J0878,HCPCS,,80000584,CDM,636,RC,55150034401,NDC,both,1,EA,33.81,0.37,,,0.37,Other,150% of Medicare + 9.63% HCRA Surcharge,0.23,,,0.23,Fee Schedule,Average Sale Price (ASP) x 6,11.83,35,,11.83,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,11.5,34,,11.5,percent of total billed charges,Drugs,11.5,34,,11.5,percent of total billed charges,Drugs,11.5,34,,11.5,percent of total billed charges,Drugs,11.5,34,,11.5,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,13.52,40,,13.52,percent of total billed charges,Drugs,23.67,70,,23.67,percent of total billed charges,All Other,12.17,36,,12.17,percent of total billed charges,Drugs,12.17,36,,12.17,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,11.83,35,,11.83,percent of total billed charges,Drugs,11.27,,,11.27,Other,Drug Cost,11.27,,,11.27,Other,Drug Cost,11.27,,,11.27,Other,Drug Cost,11.27,,,11.27,Other,Drug Cost,11.27,,,11.27,Other,Drug Cost,11.27,,,11.27,Other,Drug Cost,25.36,,,25.36,Other,225% of Medicaid,15.78,,,15.78,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.36,,,0.36,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",24.23,,,24.23,Other,215% Medicaid APG methodology,24.23,,,24.23,Other,215% Medicaid APG methodology,14.09,,,14.09,Other,125% Medicaid APG methodology,0.01,25.36,
DARBEPOETIN ALFA ESRD USE 100MCG,J0882,HCPCS,,80000585,CDM,636,RC,55513002504,NDC,both,4,ML,530.03,28.91,,,28.91,Other,150% of Medicare + 9.63% HCRA Surcharge,17.58,,,17.58,Fee Schedule,Average Sale Price (ASP) x 6,185.51,35,,185.51,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,180.21,34,,180.21,percent of total billed charges,Drugs,180.21,34,,180.21,percent of total billed charges,Drugs,180.21,34,,180.21,percent of total billed charges,Drugs,180.21,34,,180.21,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,180.21,34,"If Charge > 500, then 34 percent",180.21,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,212.01,40,,212.01,percent of total billed charges,Drugs,371.02,70,,371.02,percent of total billed charges,All Other,190.81,36,,190.81,percent of total billed charges,Drugs,190.81,36,,190.81,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,185.51,35,,185.51,percent of total billed charges,Drugs,176.68,,,176.68,Other,Drug Cost,176.68,,,176.68,Other,Drug Cost,176.68,,,176.68,Other,Drug Cost,176.68,,,176.68,Other,Drug Cost,176.68,,,176.68,Other,Drug Cost,176.68,,,176.68,Other,Drug Cost,397.52,,,397.52,Other,225% of Medicaid,247.35,,,247.35,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,28.13,,,28.13,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",379.85,,,379.85,Other,215% Medicaid APG methodology,379.85,,,379.85,Other,215% Medicaid APG methodology,220.84,,,220.84,Other,125% Medicaid APG methodology,0.01,397.52,
DARBEPOETIN ALFA ESRD USE 25MCG,J0882,HCPCS,,80000586,CDM,636,RC,55513005704,NDC,both,4,ML,114.37,28.91,,,28.91,Other,150% of Medicare + 9.63% HCRA Surcharge,17.58,,,17.58,Fee Schedule,Average Sale Price (ASP) x 6,40.03,35,,40.03,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,38.88,34,,38.88,percent of total billed charges,Drugs,38.88,34,,38.88,percent of total billed charges,Drugs,38.88,34,,38.88,percent of total billed charges,Drugs,38.88,34,,38.88,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,45.75,40,,45.75,percent of total billed charges,Drugs,80.06,70,,80.06,percent of total billed charges,All Other,41.17,36,,41.17,percent of total billed charges,Drugs,41.17,36,,41.17,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,40.03,35,,40.03,percent of total billed charges,Drugs,38.12,,,38.12,Other,Drug Cost,38.12,,,38.12,Other,Drug Cost,38.12,,,38.12,Other,Drug Cost,38.12,,,38.12,Other,Drug Cost,38.12,,,38.12,Other,Drug Cost,38.12,,,38.12,Other,Drug Cost,85.78,,,85.78,Other,225% of Medicaid,53.37,,,53.37,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,28.13,,,28.13,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",81.96,,,81.96,Other,215% Medicaid APG methodology,81.96,,,81.96,Other,215% Medicaid APG methodology,47.65,,,47.65,Other,125% Medicaid APG methodology,0.01,85.78,
DARBEPOETIN ALFA ESRD USE 40MCG,J0882,HCPCS,,80000587,CDM,636,RC,55513002104,NDC,both,4,ML,212.01,28.91,,,28.91,Other,150% of Medicare + 9.63% HCRA Surcharge,17.58,,,17.58,Fee Schedule,Average Sale Price (ASP) x 6,74.2,35,,74.2,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,72.08,34,,72.08,percent of total billed charges,Drugs,72.08,34,,72.08,percent of total billed charges,Drugs,72.08,34,,72.08,percent of total billed charges,Drugs,72.08,34,,72.08,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,84.8,40,,84.8,percent of total billed charges,Drugs,148.41,70,,148.41,percent of total billed charges,All Other,76.32,36,,76.32,percent of total billed charges,Drugs,76.32,36,,76.32,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,74.2,35,,74.2,percent of total billed charges,Drugs,70.67,,,70.67,Other,Drug Cost,70.67,,,70.67,Other,Drug Cost,70.67,,,70.67,Other,Drug Cost,70.67,,,70.67,Other,Drug Cost,70.67,,,70.67,Other,Drug Cost,70.67,,,70.67,Other,Drug Cost,159.01,,,159.01,Other,225% of Medicaid,98.94,,,98.94,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,28.13,,,28.13,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",151.94,,,151.94,Other,215% Medicaid APG methodology,151.94,,,151.94,Other,215% Medicaid APG methodology,88.34,,,88.34,Other,125% Medicaid APG methodology,0.01,159.01,
DARBEPOETIN ALFA ESRD USE 60MCG,J0882,HCPCS,,80000588,CDM,636,RC,55513002304,NDC,both,4,ML,318.02,28.91,,,28.91,Other,150% of Medicare + 9.63% HCRA Surcharge,17.58,,,17.58,Fee Schedule,Average Sale Price (ASP) x 6,111.31,35,,111.31,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,108.13,34,,108.13,percent of total billed charges,Drugs,108.13,34,,108.13,percent of total billed charges,Drugs,108.13,34,,108.13,percent of total billed charges,Drugs,108.13,34,,108.13,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,127.21,40,,127.21,percent of total billed charges,Drugs,222.61,70,,222.61,percent of total billed charges,All Other,114.49,36,,114.49,percent of total billed charges,Drugs,114.49,36,,114.49,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,111.31,35,,111.31,percent of total billed charges,Drugs,106.01,,,106.01,Other,Drug Cost,106.01,,,106.01,Other,Drug Cost,106.01,,,106.01,Other,Drug Cost,106.01,,,106.01,Other,Drug Cost,106.01,,,106.01,Other,Drug Cost,106.01,,,106.01,Other,Drug Cost,238.51,,,238.51,Other,225% of Medicaid,148.41,,,148.41,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,28.13,,,28.13,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",227.91,,,227.91,Other,215% Medicaid APG methodology,227.91,,,227.91,Other,215% Medicaid APG methodology,132.51,,,132.51,Other,125% Medicaid APG methodology,0.01,238.51,
DECITABINE INJECTION 50 MG,J0894,HCPCS,,80000592,CDM,636,RC,55111055610,NDC,both,1,EA,77.46,16.71,,,16.71,Other,150% of Medicare + 9.63% HCRA Surcharge,10.16,,,10.16,Fee Schedule,Average Sale Price (ASP) x 6,27.11,35,,27.11,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,26.34,34,,26.34,percent of total billed charges,Drugs,26.34,34,,26.34,percent of total billed charges,Drugs,26.34,34,,26.34,percent of total billed charges,Drugs,26.34,34,,26.34,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,30.98,40,,30.98,percent of total billed charges,Drugs,54.22,70,,54.22,percent of total billed charges,All Other,27.89,36,,27.89,percent of total billed charges,Drugs,27.89,36,,27.89,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,27.11,35,,27.11,percent of total billed charges,Drugs,25.82,,,25.82,Other,Drug Cost,25.82,,,25.82,Other,Drug Cost,25.82,,,25.82,Other,Drug Cost,25.82,,,25.82,Other,Drug Cost,25.82,,,25.82,Other,Drug Cost,25.82,,,25.82,Other,Drug Cost,58.1,,,58.1,Other,225% of Medicaid,36.15,,,36.15,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,16.26,,,16.26,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",55.51,,,55.51,Other,215% Medicaid APG methodology,55.51,,,55.51,Other,215% Medicaid APG methodology,32.28,,,32.28,Other,125% Medicaid APG methodology,0.01,58.1,
DEFEROXAMINE 500MG INJ,J0895,HCPCS,,80000593,CDM,636,RC,78046791,NDC,both,4,EA,17.86,84.82,,,84.82,Other,150% of Medicare + 9.63% HCRA Surcharge,51.58,,,51.58,Fee Schedule,Average Sale Price (ASP) x 6,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.07,34,,6.07,percent of total billed charges,Drugs,6.07,34,,6.07,percent of total billed charges,Drugs,6.07,34,,6.07,percent of total billed charges,Drugs,6.07,34,,6.07,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,7.14,40,,7.14,percent of total billed charges,Drugs,12.5,70,,12.5,percent of total billed charges,All Other,6.43,36,,6.43,percent of total billed charges,Drugs,6.43,36,,6.43,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,5.95,,,5.95,Other,Drug Cost,5.95,,,5.95,Other,Drug Cost,5.95,,,5.95,Other,Drug Cost,5.95,,,5.95,Other,Drug Cost,5.95,,,5.95,Other,Drug Cost,5.95,,,5.95,Other,Drug Cost,13.39,,,13.39,Other,225% of Medicaid,8.33,,,8.33,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,82.53,,,82.53,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",12.8,,,12.8,Other,215% Medicaid APG methodology,12.8,,,12.8,Other,215% Medicaid APG methodology,7.44,,,7.44,Other,125% Medicaid APG methodology,0.01,84.82,
DESMOPRESSIN ACETATE 4MCG/ML INJ,J2597,HCPCS,,80000603,CDM,636,RC,55566220000,NDC,both,10,ML,22.45,62.44,,,62.44,Other,150% of Medicare + 9.63% HCRA Surcharge,37.97,,,37.97,Fee Schedule,Average Sale Price (ASP) x 6,7.86,35,,7.86,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,7.63,34,,7.63,percent of total billed charges,Drugs,7.63,34,,7.63,percent of total billed charges,Drugs,7.63,34,,7.63,percent of total billed charges,Drugs,7.63,34,,7.63,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,8.98,40,,8.98,percent of total billed charges,Drugs,15.72,70,,15.72,percent of total billed charges,All Other,8.08,36,,8.08,percent of total billed charges,Drugs,8.08,36,,8.08,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,7.86,35,,7.86,percent of total billed charges,Drugs,7.48,,,7.48,Other,Drug Cost,7.48,,,7.48,Other,Drug Cost,7.48,,,7.48,Other,Drug Cost,7.48,,,7.48,Other,Drug Cost,7.48,,,7.48,Other,Drug Cost,7.48,,,7.48,Other,Drug Cost,16.84,,,16.84,Other,225% of Medicaid,10.48,,,10.48,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,60.75,,,60.75,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",16.09,,,16.09,Other,215% Medicaid APG methodology,16.09,,,16.09,Other,215% Medicaid APG methodology,9.36,,,9.36,Other,125% Medicaid APG methodology,0.01,62.44,
DEXAMETH SOD  4MG INJ,J1100,HCPCS,,80000608,CDM,636,RC,641614525,NDC,both,25,ML,1.07,1.17,,,1.17,Other,150% of Medicare + 9.63% HCRA Surcharge,0.71,,,0.71,Fee Schedule,Average Sale Price (ASP) x 6,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.43,40,,0.43,percent of total billed charges,Drugs,0.75,70,,0.75,percent of total billed charges,All Other,0.39,36,,0.39,percent of total billed charges,Drugs,0.39,36,,0.39,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.81,,,0.81,Other,225% of Medicaid,0.5,,,0.5,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.14,,,1.14,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.77,,,0.77,Other,215% Medicaid APG methodology,0.77,,,0.77,Other,215% Medicaid APG methodology,0.45,,,0.45,Other,125% Medicaid APG methodology,0.01,1.17,
DEXAMETH SOD 20MG INJ,J1100,HCPCS,,80000609,CDM,636,RC,67457042254,NDC,both,25,ML,1.36,1.17,,,1.17,Other,150% of Medicare + 9.63% HCRA Surcharge,0.71,,,0.71,Fee Schedule,Average Sale Price (ASP) x 6,0.48,35,,0.48,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.46,34,,0.46,percent of total billed charges,Drugs,0.46,34,,0.46,percent of total billed charges,Drugs,0.46,34,,0.46,percent of total billed charges,Drugs,0.46,34,,0.46,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.55,40,,0.55,percent of total billed charges,Drugs,0.95,70,,0.95,percent of total billed charges,All Other,0.49,36,,0.49,percent of total billed charges,Drugs,0.49,36,,0.49,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.48,35,,0.48,percent of total billed charges,Drugs,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,1.02,,,1.02,Other,225% of Medicaid,0.64,,,0.64,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.14,,,1.14,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.98,,,0.98,Other,215% Medicaid APG methodology,0.98,,,0.98,Other,215% Medicaid APG methodology,0.57,,,0.57,Other,125% Medicaid APG methodology,0.01,1.17,
DEXAMETHASONE 0.5 MG TAB,J8540,HCPCS,,80000610,CDM,636,RC,54417925,NDC,both,100,EA,0.12,0.82,,,0.82,Other,150% of Medicare + 9.63% HCRA Surcharge,0.5,,,0.5,Fee Schedule,Average Sale Price (ASP) x 6,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,34,,0.04,percent of total billed charges,Drugs,0.04,34,,0.04,percent of total billed charges,Drugs,0.04,34,,0.04,percent of total billed charges,Drugs,0.04,34,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.05,40,,0.05,percent of total billed charges,Drugs,0.08,70,,0.08,percent of total billed charges,All Other,0.04,36,,0.04,percent of total billed charges,Drugs,0.04,36,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.04,,,0.04,Other,Drug Cost,0.09,,,0.09,Other,225% of Medicaid,0.06,,,0.06,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.8,,,0.8,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.09,,,0.09,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,125% Medicaid APG methodology,0.01,0.82,
DEXAMETHASONE 0.75 MG TAB,J8540,HCPCS,,80000611,CDM,636,RC,54418025,NDC,both,100,EA,0.18,0.82,,,0.82,Other,150% of Medicare + 9.63% HCRA Surcharge,0.5,,,0.5,Fee Schedule,Average Sale Price (ASP) x 6,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.07,40,,0.07,percent of total billed charges,Drugs,0.12,70,,0.12,percent of total billed charges,All Other,0.06,36,,0.06,percent of total billed charges,Drugs,0.06,36,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.8,,,0.8,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.82,
DEXAMETHASONE 4 MG TAB,J8540,HCPCS,,80000612,CDM,636,RC,54418425,NDC,both,100,EA,0.04,0.82,,,0.82,Other,150% of Medicare + 9.63% HCRA Surcharge,0.5,,,0.5,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.03,70,,0.03,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.03,,,0.03,Other,225% of Medicaid,0.02,,,0.02,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.8,,,0.8,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.03,,,0.03,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,0.82,
DEXRAZOXANE HCL 500 MG INJ,J1190,HCPCS,,80000614,CDM,636,RC,72611071601,NDC,both,1,EA,396.78,1065.66,,,1065.66,Other,150% of Medicare + 9.63% HCRA Surcharge,648.04,,,648.04,Fee Schedule,Average Sale Price (ASP) x 6,138.87,35,,138.87,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,134.91,34,,134.91,percent of total billed charges,Drugs,134.91,34,,134.91,percent of total billed charges,Drugs,134.91,34,,134.91,percent of total billed charges,Drugs,134.91,34,,134.91,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,158.71,40,,158.71,percent of total billed charges,Drugs,277.75,70,,277.75,percent of total billed charges,All Other,142.84,36,,142.84,percent of total billed charges,Drugs,142.84,36,,142.84,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,138.87,35,,138.87,percent of total billed charges,Drugs,132.26,,,132.26,Other,Drug Cost,132.26,,,132.26,Other,Drug Cost,132.26,,,132.26,Other,Drug Cost,132.26,,,132.26,Other,Drug Cost,132.26,,,132.26,Other,Drug Cost,132.26,,,132.26,Other,Drug Cost,297.59,,,297.59,Other,225% of Medicaid,185.16,,,185.16,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1036.86,,,1036.86,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",284.36,,,284.36,Other,215% Medicaid APG methodology,284.36,,,284.36,Other,215% Medicaid APG methodology,165.33,,,165.33,Other,125% Medicaid APG methodology,0.01,1065.66,
DEXTRAN 40/ NS 500 ML,J7100,HCPCS,,80000615,CDM,636,RC,409741903,NDC,both,12,ML,52.94,20.9,39.4668,,20.9,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,18.53,35,,18.53,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,18,34,,18,percent of total billed charges,Drugs,18,34,,18,percent of total billed charges,Drugs,18,34,,18,percent of total billed charges,Drugs,18,34,,18,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,21.18,40,,21.18,percent of total billed charges,Drugs,37.06,70,,37.06,percent of total billed charges,All Other,19.06,36,,19.06,percent of total billed charges,Drugs,19.06,36,,19.06,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,18.53,35,,18.53,percent of total billed charges,Drugs,17.65,,,17.65,Other,Drug Cost,17.65,,,17.65,Other,Drug Cost,17.65,,,17.65,Other,Drug Cost,17.65,,,17.65,Other,Drug Cost,17.65,,,17.65,Other,Drug Cost,17.65,,,17.65,Other,Drug Cost,39.71,,,39.71,Other,225% of Medicaid,24.71,,,24.71,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",37.94,,,37.94,Other,215% Medicaid APG methodology,37.94,,,37.94,Other,215% Medicaid APG methodology,22.06,,,22.06,Other,125% Medicaid APG methodology,0.01,39.71,
DIAZEPAM  5 MG/ML 2ML INJ,J3360,HCPCS,,80000635,CDM,636,RC,409127332,NDC,both,10,ML,28.22,53.92,,,53.92,Other,150% of Medicare + 9.63% HCRA Surcharge,32.79,,,32.79,Fee Schedule,Average Sale Price (ASP) x 6,9.88,35,,9.88,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,9.6,34,,9.6,percent of total billed charges,Drugs,9.6,34,,9.6,percent of total billed charges,Drugs,9.6,34,,9.6,percent of total billed charges,Drugs,9.6,34,,9.6,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,11.29,40,,11.29,percent of total billed charges,Drugs,19.75,70,,19.75,percent of total billed charges,All Other,10.16,36,,10.16,percent of total billed charges,Drugs,10.16,36,,10.16,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,9.88,35,,9.88,percent of total billed charges,Drugs,9.41,,,9.41,Other,Drug Cost,9.41,,,9.41,Other,Drug Cost,9.41,,,9.41,Other,Drug Cost,9.41,,,9.41,Other,Drug Cost,9.41,,,9.41,Other,Drug Cost,9.41,,,9.41,Other,Drug Cost,21.17,,,21.17,Other,225% of Medicaid,13.17,,,13.17,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,52.46,,,52.46,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",20.23,,,20.23,Other,215% Medicaid APG methodology,20.23,,,20.23,Other,215% Medicaid APG methodology,11.76,,,11.76,Other,125% Medicaid APG methodology,0.01,53.92,
DICYCLOMINE 10MG/ML 2ML INJ,J0500,HCPCS,,80000645,CDM,636,RC,58914008052,NDC,both,5,ML,0.05,246.32,,,246.32,Other,150% of Medicare + 9.63% HCRA Surcharge,149.79,,,149.79,Fee Schedule,Average Sale Price (ASP) x 6,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,40,,0.02,percent of total billed charges,Drugs,0.04,70,,0.04,percent of total billed charges,All Other,0.02,36,,0.02,percent of total billed charges,Drugs,0.02,36,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,239.66,,,239.66,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,246.32,
DIGOXIN IMMUNE FAB (OVINE) PER VIAL,J1162,HCPCS,,80000653,CDM,636,RC,50633012011,NDC,both,1,EA,12998.76,47137.58,,,47137.58,Other,150% of Medicare + 9.63% HCRA Surcharge,28664.65,,,28664.65,Fee Schedule,Average Sale Price (ASP) x 6,4549.57,35,,4549.57,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,4419.58,34,,4419.58,percent of total billed charges,Drugs,4419.58,34,,4419.58,percent of total billed charges,Drugs,4419.58,34,,4419.58,percent of total billed charges,Drugs,4419.58,34,,4419.58,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,4419.58,34,"If Charge > 500, then 34 percent",4419.58,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,5199.5,40,,5199.5,percent of total billed charges,Drugs,9099.13,70,,9099.13,percent of total billed charges,All Other,4679.55,36,,4679.55,percent of total billed charges,Drugs,4679.55,36,,4679.55,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,4549.57,35,,4549.57,percent of total billed charges,Drugs,4332.92,,,4332.92,Other,Drug Cost,4332.92,,,4332.92,Other,Drug Cost,4332.92,,,4332.92,Other,Drug Cost,4332.92,,,4332.92,Other,Drug Cost,4332.92,,,4332.92,Other,Drug Cost,4332.92,,,4332.92,Other,Drug Cost,9749.07,,,9749.07,Other,225% of Medicaid,6066.09,,,6066.09,Other,140% of Medicaid,4419.58,34,"If Charge > 2,000, then 34 percent",4419.58,percent of total billed charges,Drugs,45863.43,,,45863.43,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",9315.78,,,9315.78,Other,215% Medicaid APG methodology,9315.78,,,9315.78,Other,215% Medicaid APG methodology,5416.15,,,5416.15,Other,125% Medicaid APG methodology,0.01,47137.58,
DIGOXIN INJ 0.25MG/ML 2ML,J1160,HCPCS,,80000655,CDM,636,RC,781305995,NDC,both,10,ML,5.1,92.83,,,92.83,Other,150% of Medicare + 9.63% HCRA Surcharge,56.45,,,56.45,Fee Schedule,Average Sale Price (ASP) x 6,1.78,35,,1.78,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,1.73,34,,1.73,percent of total billed charges,Drugs,1.73,34,,1.73,percent of total billed charges,Drugs,1.73,34,,1.73,percent of total billed charges,Drugs,1.73,34,,1.73,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,2.04,40,,2.04,percent of total billed charges,Drugs,3.57,70,,3.57,percent of total billed charges,All Other,1.83,36,,1.83,percent of total billed charges,Drugs,1.83,36,,1.83,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,1.78,35,,1.78,percent of total billed charges,Drugs,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,1.7,,,1.7,Other,Drug Cost,3.82,,,3.82,Other,225% of Medicaid,2.38,,,2.38,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,90.32,,,90.32,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.65,,,3.65,Other,215% Medicaid APG methodology,3.65,,,3.65,Other,215% Medicaid APG methodology,2.12,,,2.12,Other,125% Medicaid APG methodology,0.01,92.83,
DIPHENHYDRAMINE (BENADRYL) INJ 50MG,J1200,HCPCS,,80000673,CDM,636,RC,641037625,NDC,both,25,ML,1.47,7.93,,,7.93,Other,150% of Medicare + 9.63% HCRA Surcharge,4.82,,,4.82,Fee Schedule,Average Sale Price (ASP) x 6,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.5,34,,0.5,percent of total billed charges,Drugs,0.5,34,,0.5,percent of total billed charges,Drugs,0.5,34,,0.5,percent of total billed charges,Drugs,0.5,34,,0.5,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.59,40,,0.59,percent of total billed charges,Drugs,1.03,70,,1.03,percent of total billed charges,All Other,0.53,36,,0.53,percent of total billed charges,Drugs,0.53,36,,0.53,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,1.1,,,1.1,Other,225% of Medicaid,0.68,,,0.68,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.72,,,7.72,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.05,,,1.05,Other,215% Medicaid APG methodology,1.05,,,1.05,Other,215% Medicaid APG methodology,0.61,,,0.61,Other,125% Medicaid APG methodology,0.01,7.93,
DIPHTH PERTUSS (ACELL) TET,90715,HCPCS,,80000679,CDM,636,RC,58160084211,NDC,both,10,ML,113.32,44.72,39.4668,,44.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,39.66,35,,39.66,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,38.53,34,,38.53,percent of total billed charges,Drugs,38.53,34,,38.53,percent of total billed charges,Drugs,38.53,34,,38.53,percent of total billed charges,Drugs,38.53,34,,38.53,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,45.33,40,,45.33,percent of total billed charges,Drugs,79.32,70,,79.32,percent of total billed charges,All Other,40.79,36,,40.79,percent of total billed charges,Drugs,40.79,36,,40.79,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,39.66,35,,39.66,percent of total billed charges,Drugs,37.77,,,37.77,Other,Drug Cost,37.77,,,37.77,Other,Drug Cost,37.77,,,37.77,Other,Drug Cost,37.77,,,37.77,Other,Drug Cost,37.77,,,37.77,Other,Drug Cost,37.77,,,37.77,Other,Drug Cost,84.99,,,84.99,Other,225% of Medicaid,52.88,,,52.88,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",81.21,,,81.21,Other,215% Medicaid APG methodology,81.21,,,81.21,Other,215% Medicaid APG methodology,47.22,,,47.22,Other,125% Medicaid APG methodology,0.01,84.99,
DOBUTAMINE (DOBUTREX) INJ 250MG/20ML,J1250,HCPCS,,80000692,CDM,636,RC,409234402,NDC,both,10,ML,12.2,97.17,,,97.17,Other,150% of Medicare + 9.63% HCRA Surcharge,59.09,,,59.09,Fee Schedule,Average Sale Price (ASP) x 6,4.27,35,,4.27,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,4.15,34,,4.15,percent of total billed charges,Drugs,4.15,34,,4.15,percent of total billed charges,Drugs,4.15,34,,4.15,percent of total billed charges,Drugs,4.15,34,,4.15,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,4.88,40,,4.88,percent of total billed charges,Drugs,8.54,70,,8.54,percent of total billed charges,All Other,4.39,36,,4.39,percent of total billed charges,Drugs,4.39,36,,4.39,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,4.27,35,,4.27,percent of total billed charges,Drugs,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,4.07,,,4.07,Other,Drug Cost,9.15,,,9.15,Other,225% of Medicaid,5.69,,,5.69,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,94.54,,,94.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8.74,,,8.74,Other,215% Medicaid APG methodology,8.74,,,8.74,Other,215% Medicaid APG methodology,5.08,,,5.08,Other,125% Medicaid APG methodology,0.01,97.17,
DOBUTAMINE (DOBUTREX) INJ 250MG/250ML,J1250,HCPCS,,80000693,CDM,636,RC,338107302,NDC,both,18,ML,6.8,97.17,,,97.17,Other,150% of Medicare + 9.63% HCRA Surcharge,59.09,,,59.09,Fee Schedule,Average Sale Price (ASP) x 6,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.31,34,,2.31,percent of total billed charges,Drugs,2.31,34,,2.31,percent of total billed charges,Drugs,2.31,34,,2.31,percent of total billed charges,Drugs,2.31,34,,2.31,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.72,40,,2.72,percent of total billed charges,Drugs,4.76,70,,4.76,percent of total billed charges,All Other,2.45,36,,2.45,percent of total billed charges,Drugs,2.45,36,,2.45,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,5.1,,,5.1,Other,225% of Medicaid,3.17,,,3.17,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,94.54,,,94.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.87,,,4.87,Other,215% Medicaid APG methodology,4.87,,,4.87,Other,215% Medicaid APG methodology,2.83,,,2.83,Other,125% Medicaid APG methodology,0.01,97.17,
DOCETAXEL INJECTION 20 MG/1ML,J9171,HCPCS,,80000694,CDM,636,RC,16729026763,NDC,both,1,ML,20.22,9.82,,,9.82,Other,150% of Medicare + 9.63% HCRA Surcharge,5.97,,,5.97,Fee Schedule,Average Sale Price (ASP) x 6,7.08,35,,7.08,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,6.87,34,,6.87,percent of total billed charges,Drugs,6.87,34,,6.87,percent of total billed charges,Drugs,6.87,34,,6.87,percent of total billed charges,Drugs,6.87,34,,6.87,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,8.09,40,,8.09,percent of total billed charges,Drugs,14.15,70,,14.15,percent of total billed charges,All Other,7.28,36,,7.28,percent of total billed charges,Drugs,7.28,36,,7.28,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,7.08,35,,7.08,percent of total billed charges,Drugs,6.74,,,6.74,Other,Drug Cost,6.74,,,6.74,Other,Drug Cost,6.74,,,6.74,Other,Drug Cost,6.74,,,6.74,Other,Drug Cost,6.74,,,6.74,Other,Drug Cost,6.74,,,6.74,Other,Drug Cost,15.17,,,15.17,Other,225% of Medicaid,9.44,,,9.44,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,9.55,,,9.55,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",14.49,,,14.49,Other,215% Medicaid APG methodology,14.49,,,14.49,Other,215% Medicaid APG methodology,8.43,,,8.43,Other,125% Medicaid APG methodology,0.01,15.17,
DOPAMINE INJECTION 400MG/10ML,J1265,HCPCS,,80000706,CDM,636,RC,409910420,NDC,both,25,ML,4.48,7.62,,,7.62,Other,150% of Medicare + 9.63% HCRA Surcharge,4.63,,,4.63,Fee Schedule,Average Sale Price (ASP) x 6,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.52,34,,1.52,percent of total billed charges,Drugs,1.52,34,,1.52,percent of total billed charges,Drugs,1.52,34,,1.52,percent of total billed charges,Drugs,1.52,34,,1.52,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.79,40,,1.79,percent of total billed charges,Drugs,3.14,70,,3.14,percent of total billed charges,All Other,1.61,36,,1.61,percent of total billed charges,Drugs,1.61,36,,1.61,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,1.49,,,1.49,Other,Drug Cost,3.36,,,3.36,Other,225% of Medicaid,2.09,,,2.09,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.41,,,7.41,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.21,,,3.21,Other,215% Medicaid APG methodology,3.21,,,3.21,Other,215% Medicaid APG methodology,1.87,,,1.87,Other,125% Medicaid APG methodology,0.01,7.62,
DOPAMINE INJECTION 400MG/250ML,J1265,HCPCS,,80000707,CDM,636,RC,338100702,NDC,both,18,ML,10.63,7.62,,,7.62,Other,150% of Medicare + 9.63% HCRA Surcharge,4.63,,,4.63,Fee Schedule,Average Sale Price (ASP) x 6,3.72,35,,3.72,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,3.61,34,,3.61,percent of total billed charges,Drugs,3.61,34,,3.61,percent of total billed charges,Drugs,3.61,34,,3.61,percent of total billed charges,Drugs,3.61,34,,3.61,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,4.25,40,,4.25,percent of total billed charges,Drugs,7.44,70,,7.44,percent of total billed charges,All Other,3.83,36,,3.83,percent of total billed charges,Drugs,3.83,36,,3.83,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,3.72,35,,3.72,percent of total billed charges,Drugs,3.54,,,3.54,Other,Drug Cost,3.54,,,3.54,Other,Drug Cost,3.54,,,3.54,Other,Drug Cost,3.54,,,3.54,Other,Drug Cost,3.54,,,3.54,Other,Drug Cost,3.54,,,3.54,Other,Drug Cost,7.97,,,7.97,Other,225% of Medicaid,4.96,,,4.96,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.41,,,7.41,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.62,,,7.62,Other,215% Medicaid APG methodology,7.62,,,7.62,Other,215% Medicaid APG methodology,4.43,,,4.43,Other,125% Medicaid APG methodology,0.01,7.97,
DOPAMINE INJECTION 800MG/500ML,J1265,HCPCS,,80000708,CDM,636,RC,338100703,NDC,both,12,ML,21.25,7.62,,,7.62,Other,150% of Medicare + 9.63% HCRA Surcharge,4.63,,,4.63,Fee Schedule,Average Sale Price (ASP) x 6,7.44,35,,7.44,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,7.23,34,,7.23,percent of total billed charges,Drugs,7.23,34,,7.23,percent of total billed charges,Drugs,7.23,34,,7.23,percent of total billed charges,Drugs,7.23,34,,7.23,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,8.5,40,,8.5,percent of total billed charges,Drugs,14.88,70,,14.88,percent of total billed charges,All Other,7.65,36,,7.65,percent of total billed charges,Drugs,7.65,36,,7.65,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,7.44,35,,7.44,percent of total billed charges,Drugs,7.08,,,7.08,Other,Drug Cost,7.08,,,7.08,Other,Drug Cost,7.08,,,7.08,Other,Drug Cost,7.08,,,7.08,Other,Drug Cost,7.08,,,7.08,Other,Drug Cost,7.08,,,7.08,Other,Drug Cost,15.94,,,15.94,Other,225% of Medicaid,9.92,,,9.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.41,,,7.41,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",15.23,,,15.23,Other,215% Medicaid APG methodology,15.23,,,15.23,Other,215% Medicaid APG methodology,8.86,,,8.86,Other,125% Medicaid APG methodology,0.01,15.94,
DOXORUBICIN HCL INJECTION 50MG,J9000,HCPCS,,80000724,CDM,636,RC,69303220,NDC,both,1,ML,20.52,32.35,,,32.35,Other,150% of Medicare + 9.63% HCRA Surcharge,19.67,,,19.67,Fee Schedule,Average Sale Price (ASP) x 6,7.18,35,,7.18,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,6.98,34,,6.98,percent of total billed charges,Drugs,6.98,34,,6.98,percent of total billed charges,Drugs,6.98,34,,6.98,percent of total billed charges,Drugs,6.98,34,,6.98,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,8.21,40,,8.21,percent of total billed charges,Drugs,14.36,70,,14.36,percent of total billed charges,All Other,7.39,36,,7.39,percent of total billed charges,Drugs,7.39,36,,7.39,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,7.18,35,,7.18,percent of total billed charges,Drugs,6.84,,,6.84,Other,Drug Cost,6.84,,,6.84,Other,Drug Cost,6.84,,,6.84,Other,Drug Cost,6.84,,,6.84,Other,Drug Cost,6.84,,,6.84,Other,Drug Cost,6.84,,,6.84,Other,Drug Cost,15.39,,,15.39,Other,225% of Medicaid,9.58,,,9.58,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,31.48,,,31.48,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",14.71,,,14.71,Other,215% Medicaid APG methodology,14.71,,,14.71,Other,215% Medicaid APG methodology,8.55,,,8.55,Other,125% Medicaid APG methodology,0.01,32.35,
DOXORUBICIN HCL LIPOSOME  2 MG/ML 25ML,Q2050,HCPCS,,80000725,CDM,636,RC,338006301,NDC,both,1,ML,296.16,843.44,,,843.44,Other,150% of Medicare + 9.63% HCRA Surcharge,512.9,,,512.9,Fee Schedule,Average Sale Price (ASP) x 6,103.66,35,,103.66,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,100.69,34,,100.69,percent of total billed charges,Drugs,100.69,34,,100.69,percent of total billed charges,Drugs,100.69,34,,100.69,percent of total billed charges,Drugs,100.69,34,,100.69,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,118.46,40,,118.46,percent of total billed charges,Drugs,207.31,70,,207.31,percent of total billed charges,All Other,106.62,36,,106.62,percent of total billed charges,Drugs,106.62,36,,106.62,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,103.66,35,,103.66,percent of total billed charges,Drugs,98.72,,,98.72,Other,Drug Cost,98.72,,,98.72,Other,Drug Cost,98.72,,,98.72,Other,Drug Cost,98.72,,,98.72,Other,Drug Cost,98.72,,,98.72,Other,Drug Cost,98.72,,,98.72,Other,Drug Cost,222.12,,,222.12,Other,225% of Medicaid,138.21,,,138.21,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,820.65,,,820.65,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",212.25,,,212.25,Other,215% Medicaid APG methodology,212.25,,,212.25,Other,215% Medicaid APG methodology,123.4,,,123.4,Other,125% Medicaid APG methodology,0.01,843.44,
DRONABINOL 2.5 MG CAPS,Q0167,HCPCS,,80000729,CDM,636,RC,67877075360,NDC,both,60,EA,1.59,8,,,8,Other,150% of Medicare + 9.63% HCRA Surcharge,4.87,,,4.87,Fee Schedule,Average Sale Price (ASP) x 6,0.56,35,,0.56,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.54,34,,0.54,percent of total billed charges,Drugs,0.54,34,,0.54,percent of total billed charges,Drugs,0.54,34,,0.54,percent of total billed charges,Drugs,0.54,34,,0.54,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.64,40,,0.64,percent of total billed charges,Drugs,1.11,70,,1.11,percent of total billed charges,All Other,0.57,36,,0.57,percent of total billed charges,Drugs,0.57,36,,0.57,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.56,35,,0.56,percent of total billed charges,Drugs,0.53,,,0.53,Other,Drug Cost,0.53,,,0.53,Other,Drug Cost,0.53,,,0.53,Other,Drug Cost,0.53,,,0.53,Other,Drug Cost,0.53,,,0.53,Other,Drug Cost,0.53,,,0.53,Other,Drug Cost,1.19,,,1.19,Other,225% of Medicaid,0.74,,,0.74,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.79,,,7.79,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.14,,,1.14,Other,215% Medicaid APG methodology,1.14,,,1.14,Other,215% Medicaid APG methodology,0.66,,,0.66,Other,125% Medicaid APG methodology,0.01,8,
DROPERIDOL INJ TO 5 MG,J1790,HCPCS,,80000731,CDM,636,RC,517970225,NDC,both,25,ML,8.1,3.2,39.4668,,3.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.76,34,,2.76,percent of total billed charges,Drugs,2.76,34,,2.76,percent of total billed charges,Drugs,2.76,34,,2.76,percent of total billed charges,Drugs,2.76,34,,2.76,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,3.24,40,,3.24,percent of total billed charges,Drugs,5.67,70,,5.67,percent of total billed charges,All Other,2.92,36,,2.92,percent of total billed charges,Drugs,2.92,36,,2.92,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.7,,,2.7,Other,Drug Cost,2.7,,,2.7,Other,Drug Cost,2.7,,,2.7,Other,Drug Cost,2.7,,,2.7,Other,Drug Cost,2.7,,,2.7,Other,Drug Cost,2.7,,,2.7,Other,Drug Cost,6.08,,,6.08,Other,225% of Medicaid,3.78,,,3.78,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.81,,,5.81,Other,215% Medicaid APG methodology,5.81,,,5.81,Other,215% Medicaid APG methodology,3.38,,,3.38,Other,125% Medicaid APG methodology,0.01,6.08,
ENOXAPARIN (LOVENOX) 100MG INJ,J1650,HCPCS,,80000752,CDM,636,RC,955101010,NDC,both,10,ML,12.77,6.71,,,6.71,Other,150% of Medicare + 9.63% HCRA Surcharge,4.08,,,4.08,Fee Schedule,Average Sale Price (ASP) x 6,4.47,35,,4.47,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,4.34,34,,4.34,percent of total billed charges,Drugs,4.34,34,,4.34,percent of total billed charges,Drugs,4.34,34,,4.34,percent of total billed charges,Drugs,4.34,34,,4.34,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,5.11,40,,5.11,percent of total billed charges,Drugs,8.94,70,,8.94,percent of total billed charges,All Other,4.6,36,,4.6,percent of total billed charges,Drugs,4.6,36,,4.6,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,4.47,35,,4.47,percent of total billed charges,Drugs,4.26,,,4.26,Other,Drug Cost,4.26,,,4.26,Other,Drug Cost,4.26,,,4.26,Other,Drug Cost,4.26,,,4.26,Other,Drug Cost,4.26,,,4.26,Other,Drug Cost,4.26,,,4.26,Other,Drug Cost,9.58,,,9.58,Other,225% of Medicaid,5.96,,,5.96,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.53,,,6.53,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",9.15,,,9.15,Other,215% Medicaid APG methodology,9.15,,,9.15,Other,215% Medicaid APG methodology,5.32,,,5.32,Other,125% Medicaid APG methodology,0.01,9.58,
ENOXAPARIN (LOVENOX) 120MG INJ,J1650,HCPCS,,80000753,CDM,636,RC,75291201,NDC,both,10,ML,15.49,6.71,,,6.71,Other,150% of Medicare + 9.63% HCRA Surcharge,4.08,,,4.08,Fee Schedule,Average Sale Price (ASP) x 6,5.42,35,,5.42,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,5.27,34,,5.27,percent of total billed charges,Drugs,5.27,34,,5.27,percent of total billed charges,Drugs,5.27,34,,5.27,percent of total billed charges,Drugs,5.27,34,,5.27,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,6.2,40,,6.2,percent of total billed charges,Drugs,10.84,70,,10.84,percent of total billed charges,All Other,5.58,36,,5.58,percent of total billed charges,Drugs,5.58,36,,5.58,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,5.42,35,,5.42,percent of total billed charges,Drugs,5.16,,,5.16,Other,Drug Cost,5.16,,,5.16,Other,Drug Cost,5.16,,,5.16,Other,Drug Cost,5.16,,,5.16,Other,Drug Cost,5.16,,,5.16,Other,Drug Cost,5.16,,,5.16,Other,Drug Cost,11.62,,,11.62,Other,225% of Medicaid,7.23,,,7.23,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.53,,,6.53,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",11.1,,,11.1,Other,215% Medicaid APG methodology,11.1,,,11.1,Other,215% Medicaid APG methodology,6.46,,,6.46,Other,125% Medicaid APG methodology,0.01,11.62,
ENOXAPARIN (LOVENOX) 150MG INJ,J1650,HCPCS,,80000754,CDM,636,RC,955101510,NDC,both,10,ML,17.85,6.71,,,6.71,Other,150% of Medicare + 9.63% HCRA Surcharge,4.08,,,4.08,Fee Schedule,Average Sale Price (ASP) x 6,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.07,34,,6.07,percent of total billed charges,Drugs,6.07,34,,6.07,percent of total billed charges,Drugs,6.07,34,,6.07,percent of total billed charges,Drugs,6.07,34,,6.07,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,7.14,40,,7.14,percent of total billed charges,Drugs,12.5,70,,12.5,percent of total billed charges,All Other,6.43,36,,6.43,percent of total billed charges,Drugs,6.43,36,,6.43,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,6.25,35,,6.25,percent of total billed charges,Drugs,5.95,,,5.95,Other,Drug Cost,5.95,,,5.95,Other,Drug Cost,5.95,,,5.95,Other,Drug Cost,5.95,,,5.95,Other,Drug Cost,5.95,,,5.95,Other,Drug Cost,5.95,,,5.95,Other,Drug Cost,13.39,,,13.39,Other,225% of Medicaid,8.33,,,8.33,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.53,,,6.53,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",12.79,,,12.79,Other,215% Medicaid APG methodology,12.79,,,12.79,Other,215% Medicaid APG methodology,7.44,,,7.44,Other,125% Medicaid APG methodology,0.01,13.39,
ENOXAPARIN (LOVENOX) 30MG INJ,J1650,HCPCS,,80000755,CDM,636,RC,955100310,NDC,both,10,ML,4.61,6.71,,,6.71,Other,150% of Medicare + 9.63% HCRA Surcharge,4.08,,,4.08,Fee Schedule,Average Sale Price (ASP) x 6,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.57,34,,1.57,percent of total billed charges,Drugs,1.57,34,,1.57,percent of total billed charges,Drugs,1.57,34,,1.57,percent of total billed charges,Drugs,1.57,34,,1.57,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.85,40,,1.85,percent of total billed charges,Drugs,3.23,70,,3.23,percent of total billed charges,All Other,1.66,36,,1.66,percent of total billed charges,Drugs,1.66,36,,1.66,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,1.54,,,1.54,Other,Drug Cost,3.46,,,3.46,Other,225% of Medicaid,2.15,,,2.15,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.53,,,6.53,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.31,,,3.31,Other,215% Medicaid APG methodology,3.31,,,3.31,Other,215% Medicaid APG methodology,1.92,,,1.92,Other,125% Medicaid APG methodology,0.01,6.71,
ENOXAPARIN (LOVENOX) 40MG INJ,J1650,HCPCS,,80000756,CDM,636,RC,955100410,NDC,both,10,ML,5.41,6.71,,,6.71,Other,150% of Medicare + 9.63% HCRA Surcharge,4.08,,,4.08,Fee Schedule,Average Sale Price (ASP) x 6,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.84,34,,1.84,percent of total billed charges,Drugs,1.84,34,,1.84,percent of total billed charges,Drugs,1.84,34,,1.84,percent of total billed charges,Drugs,1.84,34,,1.84,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,2.16,40,,2.16,percent of total billed charges,Drugs,3.79,70,,3.79,percent of total billed charges,All Other,1.95,36,,1.95,percent of total billed charges,Drugs,1.95,36,,1.95,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.89,35,,1.89,percent of total billed charges,Drugs,1.8,,,1.8,Other,Drug Cost,1.8,,,1.8,Other,Drug Cost,1.8,,,1.8,Other,Drug Cost,1.8,,,1.8,Other,Drug Cost,1.8,,,1.8,Other,Drug Cost,1.8,,,1.8,Other,Drug Cost,4.06,,,4.06,Other,225% of Medicaid,2.53,,,2.53,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.53,,,6.53,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.88,,,3.88,Other,215% Medicaid APG methodology,3.88,,,3.88,Other,215% Medicaid APG methodology,2.26,,,2.26,Other,125% Medicaid APG methodology,0.01,6.71,
ENOXAPARIN (LOVENOX) 60MG INJ,J1650,HCPCS,,80000757,CDM,636,RC,955100610,NDC,both,10,ML,8.42,6.71,,,6.71,Other,150% of Medicare + 9.63% HCRA Surcharge,4.08,,,4.08,Fee Schedule,Average Sale Price (ASP) x 6,2.95,35,,2.95,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,2.86,34,,2.86,percent of total billed charges,Drugs,2.86,34,,2.86,percent of total billed charges,Drugs,2.86,34,,2.86,percent of total billed charges,Drugs,2.86,34,,2.86,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,3.37,40,,3.37,percent of total billed charges,Drugs,5.9,70,,5.9,percent of total billed charges,All Other,3.03,36,,3.03,percent of total billed charges,Drugs,3.03,36,,3.03,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,2.95,35,,2.95,percent of total billed charges,Drugs,2.81,,,2.81,Other,Drug Cost,2.81,,,2.81,Other,Drug Cost,2.81,,,2.81,Other,Drug Cost,2.81,,,2.81,Other,Drug Cost,2.81,,,2.81,Other,Drug Cost,2.81,,,2.81,Other,Drug Cost,6.32,,,6.32,Other,225% of Medicaid,3.93,,,3.93,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.53,,,6.53,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6.04,,,6.04,Other,215% Medicaid APG methodology,6.04,,,6.04,Other,215% Medicaid APG methodology,3.51,,,3.51,Other,125% Medicaid APG methodology,0.01,6.71,
ENOXAPARIN (LOVENOX) 80MG INJ,J1650,HCPCS,,80000758,CDM,636,RC,75062280,NDC,both,10,ML,10.33,6.71,,,6.71,Other,150% of Medicare + 9.63% HCRA Surcharge,4.08,,,4.08,Fee Schedule,Average Sale Price (ASP) x 6,3.61,35,,3.61,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,3.51,34,,3.51,percent of total billed charges,Drugs,3.51,34,,3.51,percent of total billed charges,Drugs,3.51,34,,3.51,percent of total billed charges,Drugs,3.51,34,,3.51,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,4.13,40,,4.13,percent of total billed charges,Drugs,7.23,70,,7.23,percent of total billed charges,All Other,3.72,36,,3.72,percent of total billed charges,Drugs,3.72,36,,3.72,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,3.61,35,,3.61,percent of total billed charges,Drugs,3.44,,,3.44,Other,Drug Cost,3.44,,,3.44,Other,Drug Cost,3.44,,,3.44,Other,Drug Cost,3.44,,,3.44,Other,Drug Cost,3.44,,,3.44,Other,Drug Cost,3.44,,,3.44,Other,Drug Cost,7.74,,,7.74,Other,225% of Medicaid,4.82,,,4.82,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.53,,,6.53,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.4,,,7.4,Other,215% Medicaid APG methodology,7.4,,,7.4,Other,215% Medicaid APG methodology,4.3,,,4.3,Other,125% Medicaid APG methodology,0.01,7.74,
EPINEPHRINE (EPIPEN) 1:1000 INJ,J0171,HCPCS,,80000761,CDM,636,RC,49502050002,NDC,both,2,EA,0.06,7.38,,,7.38,Other,150% of Medicare + 9.63% HCRA Surcharge,4.49,,,4.49,Fee Schedule,Average Sale Price (ASP) x 6,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,40,,0.02,percent of total billed charges,Drugs,0.04,70,,0.04,percent of total billed charges,All Other,0.02,36,,0.02,percent of total billed charges,Drugs,0.02,36,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.18,,,7.18,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,7.38,
EPOETIN ALFA NON-ESRD 10000 UNITS,J0885,HCPCS,,80000764,CDM,636,RC,59676031002,NDC,both,25,ML,422.11,87.68,,,87.68,Other,150% of Medicare + 9.63% HCRA Surcharge,53.32,,,53.32,Fee Schedule,Average Sale Price (ASP) x 6,147.74,35,,147.74,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,143.52,34,,143.52,percent of total billed charges,Drugs,143.52,34,,143.52,percent of total billed charges,Drugs,143.52,34,,143.52,percent of total billed charges,Drugs,143.52,34,,143.52,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,168.84,40,,168.84,percent of total billed charges,Drugs,295.47,70,,295.47,percent of total billed charges,All Other,151.96,36,,151.96,percent of total billed charges,Drugs,151.96,36,,151.96,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,147.74,35,,147.74,percent of total billed charges,Drugs,140.7,,,140.7,Other,Drug Cost,140.7,,,140.7,Other,Drug Cost,140.7,,,140.7,Other,Drug Cost,140.7,,,140.7,Other,Drug Cost,140.7,,,140.7,Other,Drug Cost,140.7,,,140.7,Other,Drug Cost,316.58,,,316.58,Other,225% of Medicaid,196.98,,,196.98,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,85.31,,,85.31,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",302.51,,,302.51,Other,215% Medicaid APG methodology,302.51,,,302.51,Other,215% Medicaid APG methodology,175.88,,,175.88,Other,125% Medicaid APG methodology,0.01,316.58,
EPOETIN ALFA NON-ESRD 2000 UNITS,J0885,HCPCS,,80000765,CDM,636,RC,55513012610,NDC,both,10,ML,95,87.68,,,87.68,Other,150% of Medicare + 9.63% HCRA Surcharge,53.32,,,53.32,Fee Schedule,Average Sale Price (ASP) x 6,33.25,35,,33.25,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,32.3,34,,32.3,percent of total billed charges,Drugs,32.3,34,,32.3,percent of total billed charges,Drugs,32.3,34,,32.3,percent of total billed charges,Drugs,32.3,34,,32.3,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,38,40,,38,percent of total billed charges,Drugs,66.5,70,,66.5,percent of total billed charges,All Other,34.2,36,,34.2,percent of total billed charges,Drugs,34.2,36,,34.2,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,33.25,35,,33.25,percent of total billed charges,Drugs,31.67,,,31.67,Other,Drug Cost,31.67,,,31.67,Other,Drug Cost,31.67,,,31.67,Other,Drug Cost,31.67,,,31.67,Other,Drug Cost,31.67,,,31.67,Other,Drug Cost,31.67,,,31.67,Other,Drug Cost,71.25,,,71.25,Other,225% of Medicaid,44.34,,,44.34,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,85.31,,,85.31,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",68.09,,,68.09,Other,215% Medicaid APG methodology,68.09,,,68.09,Other,215% Medicaid APG methodology,39.59,,,39.59,Other,125% Medicaid APG methodology,0.01,87.68,
EPOETIN ALFA NON-ESRD 20000 UNITS,J0885,HCPCS,,80000766,CDM,636,RC,59676032004,NDC,both,4,ML,844.25,87.68,,,87.68,Other,150% of Medicare + 9.63% HCRA Surcharge,53.32,,,53.32,Fee Schedule,Average Sale Price (ASP) x 6,295.49,35,,295.49,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,287.04,34,,287.04,percent of total billed charges,Drugs,287.04,34,,287.04,percent of total billed charges,Drugs,287.04,34,,287.04,percent of total billed charges,Drugs,287.04,34,,287.04,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,287.04,34,"If Charge > 500, then 34 percent",287.04,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,337.7,40,,337.7,percent of total billed charges,Drugs,590.97,70,,590.97,percent of total billed charges,All Other,303.93,36,,303.93,percent of total billed charges,Drugs,303.93,36,,303.93,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,295.49,35,,295.49,percent of total billed charges,Drugs,281.42,,,281.42,Other,Drug Cost,281.42,,,281.42,Other,Drug Cost,281.42,,,281.42,Other,Drug Cost,281.42,,,281.42,Other,Drug Cost,281.42,,,281.42,Other,Drug Cost,281.42,,,281.42,Other,Drug Cost,633.18,,,633.18,Other,225% of Medicaid,393.98,,,393.98,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,85.31,,,85.31,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",605.04,,,605.04,Other,215% Medicaid APG methodology,605.04,,,605.04,Other,215% Medicaid APG methodology,351.77,,,351.77,Other,125% Medicaid APG methodology,0.01,633.18,
EPOETIN ALFA NON-ESRD 4000 UNITS,J0885,HCPCS,,80000767,CDM,636,RC,55513014810,NDC,both,10,ML,190.01,87.68,,,87.68,Other,150% of Medicare + 9.63% HCRA Surcharge,53.32,,,53.32,Fee Schedule,Average Sale Price (ASP) x 6,66.5,35,,66.5,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,64.6,34,,64.6,percent of total billed charges,Drugs,64.6,34,,64.6,percent of total billed charges,Drugs,64.6,34,,64.6,percent of total billed charges,Drugs,64.6,34,,64.6,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,76,40,,76,percent of total billed charges,Drugs,133.01,70,,133.01,percent of total billed charges,All Other,68.4,36,,68.4,percent of total billed charges,Drugs,68.4,36,,68.4,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,66.5,35,,66.5,percent of total billed charges,Drugs,63.34,,,63.34,Other,Drug Cost,63.34,,,63.34,Other,Drug Cost,63.34,,,63.34,Other,Drug Cost,63.34,,,63.34,Other,Drug Cost,63.34,,,63.34,Other,Drug Cost,63.34,,,63.34,Other,Drug Cost,142.51,,,142.51,Other,225% of Medicaid,88.67,,,88.67,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,85.31,,,85.31,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",136.17,,,136.17,Other,215% Medicaid APG methodology,136.17,,,136.17,Other,215% Medicaid APG methodology,79.17,,,79.17,Other,125% Medicaid APG methodology,0.01,142.51,
EPOETIN ALFA NON-ESRD 40000 UNITS,J0885,HCPCS,,80000768,CDM,636,RC,59676034001,NDC,both,4,ML,1688.48,87.68,,,87.68,Other,150% of Medicare + 9.63% HCRA Surcharge,53.32,,,53.32,Fee Schedule,Average Sale Price (ASP) x 6,590.97,35,,590.97,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,574.08,34,,574.08,percent of total billed charges,Drugs,574.08,34,,574.08,percent of total billed charges,Drugs,574.08,34,,574.08,percent of total billed charges,Drugs,574.08,34,,574.08,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,574.08,34,"If Charge > 500, then 34 percent",574.08,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,675.39,40,,675.39,percent of total billed charges,Drugs,1181.94,70,,1181.94,percent of total billed charges,All Other,607.85,36,,607.85,percent of total billed charges,Drugs,607.85,36,,607.85,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,590.97,35,,590.97,percent of total billed charges,Drugs,562.83,,,562.83,Other,Drug Cost,562.83,,,562.83,Other,Drug Cost,562.83,,,562.83,Other,Drug Cost,562.83,,,562.83,Other,Drug Cost,562.83,,,562.83,Other,Drug Cost,562.83,,,562.83,Other,Drug Cost,1266.36,,,1266.36,Other,225% of Medicaid,787.96,,,787.96,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,85.31,,,85.31,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1210.08,,,1210.08,Other,215% Medicaid APG methodology,1210.08,,,1210.08,Other,215% Medicaid APG methodology,703.53,,,703.53,Other,125% Medicaid APG methodology,0.01,1266.36,
EPTIFIBATIDE 0.75MG/ML INJ 100ML,J1327,HCPCS,,80000770,CDM,636,RC,70436002780,NDC,both,1,ML,26.91,10.62,39.4668,,10.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,9.42,35,,9.42,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,9.15,34,,9.15,percent of total billed charges,Drugs,9.15,34,,9.15,percent of total billed charges,Drugs,9.15,34,,9.15,percent of total billed charges,Drugs,9.15,34,,9.15,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,10.76,40,,10.76,percent of total billed charges,Drugs,18.84,70,,18.84,percent of total billed charges,All Other,9.69,36,,9.69,percent of total billed charges,Drugs,9.69,36,,9.69,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,9.42,35,,9.42,percent of total billed charges,Drugs,8.97,,,8.97,Other,Drug Cost,8.97,,,8.97,Other,Drug Cost,8.97,,,8.97,Other,Drug Cost,8.97,,,8.97,Other,Drug Cost,8.97,,,8.97,Other,Drug Cost,8.97,,,8.97,Other,Drug Cost,20.18,,,20.18,Other,225% of Medicaid,12.56,,,12.56,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",19.29,,,19.29,Other,215% Medicaid APG methodology,19.29,,,19.29,Other,215% Medicaid APG methodology,11.21,,,11.21,Other,125% Medicaid APG methodology,0.01,20.18,
EPTIFIBATIDE 2MG/ML INJ 10ML,J1327,HCPCS,,80000772,CDM,636,RC,67457062910,NDC,both,1,ML,41.7,16.46,39.4668,,16.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,14.6,35,,14.6,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,14.18,34,,14.18,percent of total billed charges,Drugs,14.18,34,,14.18,percent of total billed charges,Drugs,14.18,34,,14.18,percent of total billed charges,Drugs,14.18,34,,14.18,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,16.68,40,,16.68,percent of total billed charges,Drugs,29.19,70,,29.19,percent of total billed charges,All Other,15.01,36,,15.01,percent of total billed charges,Drugs,15.01,36,,15.01,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,14.6,35,,14.6,percent of total billed charges,Drugs,13.9,,,13.9,Other,Drug Cost,13.9,,,13.9,Other,Drug Cost,13.9,,,13.9,Other,Drug Cost,13.9,,,13.9,Other,Drug Cost,13.9,,,13.9,Other,Drug Cost,13.9,,,13.9,Other,Drug Cost,31.28,,,31.28,Other,225% of Medicaid,19.46,,,19.46,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",29.89,,,29.89,Other,215% Medicaid APG methodology,29.89,,,29.89,Other,215% Medicaid APG methodology,17.38,,,17.38,Other,125% Medicaid APG methodology,0.01,31.28,
ERIBULIN MESYLATE 1MG/2ML INJECTION,J9179,HCPCS,,80000776,CDM,636,RC,62856038901,NDC,both,1,ML,2589.69,1322.31,,,1322.31,Other,150% of Medicare + 9.63% HCRA Surcharge,804.1,,,804.1,Fee Schedule,Average Sale Price (ASP) x 6,906.39,35,,906.39,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,880.49,34,,880.49,percent of total billed charges,Drugs,880.49,34,,880.49,percent of total billed charges,Drugs,880.49,34,,880.49,percent of total billed charges,Drugs,880.49,34,,880.49,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,880.49,34,"If Charge > 500, then 34 percent",880.49,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,1035.88,40,,1035.88,percent of total billed charges,Drugs,1812.78,70,,1812.78,percent of total billed charges,All Other,932.29,36,,932.29,percent of total billed charges,Drugs,932.29,36,,932.29,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,906.39,35,,906.39,percent of total billed charges,Drugs,863.23,,,863.23,Other,Drug Cost,863.23,,,863.23,Other,Drug Cost,863.23,,,863.23,Other,Drug Cost,863.23,,,863.23,Other,Drug Cost,863.23,,,863.23,Other,Drug Cost,863.23,,,863.23,Other,Drug Cost,1942.27,,,1942.27,Other,225% of Medicaid,1208.52,,,1208.52,Other,140% of Medicaid,880.49,34,"If Charge > 2,000, then 34 percent",880.49,percent of total billed charges,Drugs,1286.56,,,1286.56,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1855.94,,,1855.94,Other,215% Medicaid APG methodology,1855.94,,,1855.94,Other,215% Medicaid APG methodology,1079.04,,,1079.04,Other,125% Medicaid APG methodology,0.01,1942.27,
ERTAPENEM SODIUM 1GM INJ,J1335,HCPCS,,80000778,CDM,636,RC,55150028220,NDC,both,10,EA,48.77,127.92,,,127.92,Other,150% of Medicare + 9.63% HCRA Surcharge,77.79,,,77.79,Fee Schedule,Average Sale Price (ASP) x 6,17.07,35,,17.07,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,16.58,34,,16.58,percent of total billed charges,Drugs,16.58,34,,16.58,percent of total billed charges,Drugs,16.58,34,,16.58,percent of total billed charges,Drugs,16.58,34,,16.58,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,19.51,40,,19.51,percent of total billed charges,Drugs,34.14,70,,34.14,percent of total billed charges,All Other,17.56,36,,17.56,percent of total billed charges,Drugs,17.56,36,,17.56,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,17.07,35,,17.07,percent of total billed charges,Drugs,16.26,,,16.26,Other,Drug Cost,16.26,,,16.26,Other,Drug Cost,16.26,,,16.26,Other,Drug Cost,16.26,,,16.26,Other,Drug Cost,16.26,,,16.26,Other,Drug Cost,16.26,,,16.26,Other,Drug Cost,36.58,,,36.58,Other,225% of Medicaid,22.76,,,22.76,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,124.46,,,124.46,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",34.95,,,34.95,Other,215% Medicaid APG methodology,34.95,,,34.95,Other,215% Medicaid APG methodology,20.32,,,20.32,Other,125% Medicaid APG methodology,0.01,127.92,
ERTAPENEM SODIUM 500 MG INJ,J1335,HCPCS,,80000779,CDM,636,RC,42023022110,NDC,both,10,EA,48.8,127.92,,,127.92,Other,150% of Medicare + 9.63% HCRA Surcharge,77.79,,,77.79,Fee Schedule,Average Sale Price (ASP) x 6,17.08,35,,17.08,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,16.59,34,,16.59,percent of total billed charges,Drugs,16.59,34,,16.59,percent of total billed charges,Drugs,16.59,34,,16.59,percent of total billed charges,Drugs,16.59,34,,16.59,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,19.52,40,,19.52,percent of total billed charges,Drugs,34.16,70,,34.16,percent of total billed charges,All Other,17.57,36,,17.57,percent of total billed charges,Drugs,17.57,36,,17.57,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,17.08,35,,17.08,percent of total billed charges,Drugs,16.27,,,16.27,Other,Drug Cost,16.27,,,16.27,Other,Drug Cost,16.27,,,16.27,Other,Drug Cost,16.27,,,16.27,Other,Drug Cost,16.27,,,16.27,Other,Drug Cost,16.27,,,16.27,Other,Drug Cost,36.6,,,36.6,Other,225% of Medicaid,22.78,,,22.78,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,124.46,,,124.46,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",34.98,,,34.98,Other,215% Medicaid APG methodology,34.98,,,34.98,Other,215% Medicaid APG methodology,20.34,,,20.34,Other,125% Medicaid APG methodology,0.01,127.92,
ERYTHROCIN 500 MG INJ,J1364,HCPCS,,80000780,CDM,636,RC,409648201,NDC,both,10,EA,0.03,796.98,,,796.98,Other,150% of Medicare + 9.63% HCRA Surcharge,484.65,,,484.65,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,775.44,,,775.44,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,796.98,
ESTRADIOL VALERATE 20 MG/ML 5ML  INJ,J1380,HCPCS,,80000790,CDM,636,RC,42023011101,NDC,both,1,ML,76.53,91.13,,,91.13,Other,150% of Medicare + 9.63% HCRA Surcharge,55.42,,,55.42,Fee Schedule,Average Sale Price (ASP) x 6,26.79,35,,26.79,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,26.02,34,,26.02,percent of total billed charges,Drugs,26.02,34,,26.02,percent of total billed charges,Drugs,26.02,34,,26.02,percent of total billed charges,Drugs,26.02,34,,26.02,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,30.61,40,,30.61,percent of total billed charges,Drugs,53.57,70,,53.57,percent of total billed charges,All Other,27.55,36,,27.55,percent of total billed charges,Drugs,27.55,36,,27.55,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,26.79,35,,26.79,percent of total billed charges,Drugs,25.51,,,25.51,Other,Drug Cost,25.51,,,25.51,Other,Drug Cost,25.51,,,25.51,Other,Drug Cost,25.51,,,25.51,Other,Drug Cost,25.51,,,25.51,Other,Drug Cost,25.51,,,25.51,Other,Drug Cost,57.4,,,57.4,Other,225% of Medicaid,35.71,,,35.71,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,88.67,,,88.67,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",54.85,,,54.85,Other,215% Medicaid APG methodology,54.85,,,54.85,Other,215% Medicaid APG methodology,31.89,,,31.89,Other,125% Medicaid APG methodology,0.01,91.13,
ESTROGEN (PREMARIN) 25MG INJ,J1410,HCPCS,,80000791,CDM,636,RC,46074905,NDC,both,1,EA,0.03,3671.85,,,3671.85,Other,150% of Medicare + 9.63% HCRA Surcharge,2232.88,,,2232.88,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,3572.6,,,3572.6,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,3671.85,
ETOPOSIDE 20MG/ML 5ML INJECTION,J9181,HCPCS,,80000802,CDM,636,RC,16729011431,NDC,both,1,ML,12.24,9.8,,,9.8,Other,150% of Medicare + 9.63% HCRA Surcharge,5.96,,,5.96,Fee Schedule,Average Sale Price (ASP) x 6,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.16,34,,4.16,percent of total billed charges,Drugs,4.16,34,,4.16,percent of total billed charges,Drugs,4.16,34,,4.16,percent of total billed charges,Drugs,4.16,34,,4.16,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.9,40,,4.9,percent of total billed charges,Drugs,8.57,70,,8.57,percent of total billed charges,All Other,4.41,36,,4.41,percent of total billed charges,Drugs,4.41,36,,4.41,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.08,,,4.08,Other,Drug Cost,4.08,,,4.08,Other,Drug Cost,4.08,,,4.08,Other,Drug Cost,4.08,,,4.08,Other,Drug Cost,4.08,,,4.08,Other,Drug Cost,4.08,,,4.08,Other,Drug Cost,9.18,,,9.18,Other,225% of Medicaid,5.71,,,5.71,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,9.53,,,9.53,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8.77,,,8.77,Other,215% Medicaid APG methodology,8.77,,,8.77,Other,215% Medicaid APG methodology,5.1,,,5.1,Other,125% Medicaid APG methodology,0.01,9.8,
FENTANYL CITRATE INJ 1000MCG/20ML,J3010,HCPCS,,80000835,CDM,636,RC,409909431,NDC,both,25,ML,10.07,9.55,,,9.55,Other,150% of Medicare + 9.63% HCRA Surcharge,5.81,,,5.81,Fee Schedule,Average Sale Price (ASP) x 6,3.52,35,,3.52,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,3.42,34,,3.42,percent of total billed charges,Drugs,3.42,34,,3.42,percent of total billed charges,Drugs,3.42,34,,3.42,percent of total billed charges,Drugs,3.42,34,,3.42,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,4.03,40,,4.03,percent of total billed charges,Drugs,7.05,70,,7.05,percent of total billed charges,All Other,3.62,36,,3.62,percent of total billed charges,Drugs,3.62,36,,3.62,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,3.52,35,,3.52,percent of total billed charges,Drugs,3.36,,,3.36,Other,Drug Cost,3.36,,,3.36,Other,Drug Cost,3.36,,,3.36,Other,Drug Cost,3.36,,,3.36,Other,Drug Cost,3.36,,,3.36,Other,Drug Cost,3.36,,,3.36,Other,Drug Cost,7.55,,,7.55,Other,225% of Medicaid,4.7,,,4.7,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,9.29,,,9.29,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.22,,,7.22,Other,215% Medicaid APG methodology,7.22,,,7.22,Other,215% Medicaid APG methodology,4.2,,,4.2,Other,125% Medicaid APG methodology,0.01,9.55,
FENTANYL CITRATE INJ 100MCG/2ML,J3010,HCPCS,,80000836,CDM,636,RC,409909332,NDC,both,10,ML,1.22,9.55,,,9.55,Other,150% of Medicare + 9.63% HCRA Surcharge,5.81,,,5.81,Fee Schedule,Average Sale Price (ASP) x 6,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.49,40,,0.49,percent of total billed charges,Drugs,0.85,70,,0.85,percent of total billed charges,All Other,0.44,36,,0.44,percent of total billed charges,Drugs,0.44,36,,0.44,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.91,,,0.91,Other,225% of Medicaid,0.57,,,0.57,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,9.29,,,9.29,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.87,,,0.87,Other,215% Medicaid APG methodology,0.87,,,0.87,Other,215% Medicaid APG methodology,0.51,,,0.51,Other,125% Medicaid APG methodology,0.01,9.55,
FENTANYL CITRATE INJ 250MCG/5ML,J3010,HCPCS,,80000837,CDM,636,RC,409909335,NDC,both,10,ML,3.05,9.55,,,9.55,Other,150% of Medicare + 9.63% HCRA Surcharge,5.81,,,5.81,Fee Schedule,Average Sale Price (ASP) x 6,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.22,40,,1.22,percent of total billed charges,Drugs,2.13,70,,2.13,percent of total billed charges,All Other,1.1,36,,1.1,percent of total billed charges,Drugs,1.1,36,,1.1,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,2.29,,,2.29,Other,225% of Medicaid,1.42,,,1.42,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,9.29,,,9.29,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.18,,,2.18,Other,215% Medicaid APG methodology,2.18,,,2.18,Other,215% Medicaid APG methodology,1.27,,,1.27,Other,125% Medicaid APG methodology,0.01,9.55,
FERRLECIT 62.5MG/5ML INJ,J2916,HCPCS,,80000840,CDM,636,RC,24279210,NDC,both,10,ML,19.02,23.42,,,23.42,Other,150% of Medicare + 9.63% HCRA Surcharge,14.24,,,14.24,Fee Schedule,Average Sale Price (ASP) x 6,6.66,35,,6.66,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,6.47,34,,6.47,percent of total billed charges,Drugs,6.47,34,,6.47,percent of total billed charges,Drugs,6.47,34,,6.47,percent of total billed charges,Drugs,6.47,34,,6.47,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,7.61,40,,7.61,percent of total billed charges,Drugs,13.32,70,,13.32,percent of total billed charges,All Other,6.85,36,,6.85,percent of total billed charges,Drugs,6.85,36,,6.85,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,6.66,35,,6.66,percent of total billed charges,Drugs,6.34,,,6.34,Other,Drug Cost,6.34,,,6.34,Other,Drug Cost,6.34,,,6.34,Other,Drug Cost,6.34,,,6.34,Other,Drug Cost,6.34,,,6.34,Other,Drug Cost,6.34,,,6.34,Other,Drug Cost,14.27,,,14.27,Other,225% of Medicaid,8.88,,,8.88,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,22.79,,,22.79,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",13.63,,,13.63,Other,215% Medicaid APG methodology,13.63,,,13.63,Other,215% Medicaid APG methodology,7.93,,,7.93,Other,125% Medicaid APG methodology,0.01,23.42,
FILGRASTIM 480 MCG INJ,J1442,HCPCS,,80000848,CDM,636,RC,55513054610,NDC,both,10,ML,1434.87,9.72,,,9.72,Other,150% of Medicare + 9.63% HCRA Surcharge,5.91,,,5.91,Fee Schedule,Average Sale Price (ASP) x 6,502.21,35,,502.21,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,487.86,34,,487.86,percent of total billed charges,Drugs,487.86,34,,487.86,percent of total billed charges,Drugs,487.86,34,,487.86,percent of total billed charges,Drugs,487.86,34,,487.86,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,487.86,34,"If Charge > 500, then 34 percent",487.86,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,573.95,40,,573.95,percent of total billed charges,Drugs,1004.41,70,,1004.41,percent of total billed charges,All Other,516.55,36,,516.55,percent of total billed charges,Drugs,516.55,36,,516.55,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,502.21,35,,502.21,percent of total billed charges,Drugs,478.29,,,478.29,Other,Drug Cost,478.29,,,478.29,Other,Drug Cost,478.29,,,478.29,Other,Drug Cost,478.29,,,478.29,Other,Drug Cost,478.29,,,478.29,Other,Drug Cost,478.29,,,478.29,Other,Drug Cost,1076.15,,,1076.15,Other,225% of Medicaid,669.61,,,669.61,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,9.46,,,9.46,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1028.33,,,1028.33,Other,215% Medicaid APG methodology,1028.33,,,1028.33,Other,215% Medicaid APG methodology,597.86,,,597.86,Other,125% Medicaid APG methodology,0.01,1076.15,
FLUCONAZOLE (DIFLUCAN) 200MG/NS 100ML,J1450,HCPCS,,80000854,CDM,636,RC,25021018482,NDC,both,10,ML,8.8,27.6,,,27.6,Other,150% of Medicare + 9.63% HCRA Surcharge,16.78,,,16.78,Fee Schedule,Average Sale Price (ASP) x 6,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,2.99,34,,2.99,percent of total billed charges,Drugs,2.99,34,,2.99,percent of total billed charges,Drugs,2.99,34,,2.99,percent of total billed charges,Drugs,2.99,34,,2.99,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.52,40,,3.52,percent of total billed charges,Drugs,6.16,70,,6.16,percent of total billed charges,All Other,3.17,36,,3.17,percent of total billed charges,Drugs,3.17,36,,3.17,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,6.6,,,6.6,Other,225% of Medicaid,4.11,,,4.11,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,26.85,,,26.85,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6.31,,,6.31,Other,215% Medicaid APG methodology,6.31,,,6.31,Other,215% Medicaid APG methodology,3.67,,,3.67,Other,125% Medicaid APG methodology,0.01,27.6,
FLUCONAZOLE (DIFLUCAN) 400MG/NS 200ML,J1450,HCPCS,,80000855,CDM,636,RC,25021018487,NDC,both,10,ML,12.24,27.6,,,27.6,Other,150% of Medicare + 9.63% HCRA Surcharge,16.78,,,16.78,Fee Schedule,Average Sale Price (ASP) x 6,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.16,34,,4.16,percent of total billed charges,Drugs,4.16,34,,4.16,percent of total billed charges,Drugs,4.16,34,,4.16,percent of total billed charges,Drugs,4.16,34,,4.16,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.9,40,,4.9,percent of total billed charges,Drugs,8.57,70,,8.57,percent of total billed charges,All Other,4.41,36,,4.41,percent of total billed charges,Drugs,4.41,36,,4.41,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.28,35,,4.28,percent of total billed charges,Drugs,4.08,,,4.08,Other,Drug Cost,4.08,,,4.08,Other,Drug Cost,4.08,,,4.08,Other,Drug Cost,4.08,,,4.08,Other,Drug Cost,4.08,,,4.08,Other,Drug Cost,4.08,,,4.08,Other,Drug Cost,9.18,,,9.18,Other,225% of Medicaid,5.71,,,5.71,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,26.85,,,26.85,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8.77,,,8.77,Other,215% Medicaid APG methodology,8.77,,,8.77,Other,215% Medicaid APG methodology,5.1,,,5.1,Other,125% Medicaid APG methodology,0.01,27.6,
FLUDARABINE PHOSPHATE INJ 25 MG/ML 2ML,J9185,HCPCS,,80000861,CDM,636,RC,63323019202,NDC,both,1,ML,114.96,1716.5,,,1716.5,Other,150% of Medicare + 9.63% HCRA Surcharge,1043.81,,,1043.81,Fee Schedule,Average Sale Price (ASP) x 6,40.24,35,,40.24,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,39.09,34,,39.09,percent of total billed charges,Drugs,39.09,34,,39.09,percent of total billed charges,Drugs,39.09,34,,39.09,percent of total billed charges,Drugs,39.09,34,,39.09,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,45.98,40,,45.98,percent of total billed charges,Drugs,80.47,70,,80.47,percent of total billed charges,All Other,41.39,36,,41.39,percent of total billed charges,Drugs,41.39,36,,41.39,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,40.24,35,,40.24,percent of total billed charges,Drugs,38.32,,,38.32,Other,Drug Cost,38.32,,,38.32,Other,Drug Cost,38.32,,,38.32,Other,Drug Cost,38.32,,,38.32,Other,Drug Cost,38.32,,,38.32,Other,Drug Cost,38.32,,,38.32,Other,Drug Cost,86.22,,,86.22,Other,225% of Medicaid,53.65,,,53.65,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1670.1,,,1670.1,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",82.39,,,82.39,Other,215% Medicaid APG methodology,82.39,,,82.39,Other,215% Medicaid APG methodology,47.9,,,47.9,Other,125% Medicaid APG methodology,0.01,1716.5,
FLUOROURACIL 50 MG/ML 10ML INJ,J9190,HCPCS,,80000876,CDM,636,RC,70700018623,NDC,both,10,ML,4.29,31.72,,,31.72,Other,150% of Medicare + 9.63% HCRA Surcharge,19.29,,,19.29,Fee Schedule,Average Sale Price (ASP) x 6,1.5,35,,1.5,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,1.46,34,,1.46,percent of total billed charges,Drugs,1.46,34,,1.46,percent of total billed charges,Drugs,1.46,34,,1.46,percent of total billed charges,Drugs,1.46,34,,1.46,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,1.72,40,,1.72,percent of total billed charges,Drugs,3.01,70,,3.01,percent of total billed charges,All Other,1.55,36,,1.55,percent of total billed charges,Drugs,1.55,36,,1.55,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,1.5,35,,1.5,percent of total billed charges,Drugs,1.43,,,1.43,Other,Drug Cost,1.43,,,1.43,Other,Drug Cost,1.43,,,1.43,Other,Drug Cost,1.43,,,1.43,Other,Drug Cost,1.43,,,1.43,Other,Drug Cost,1.43,,,1.43,Other,Drug Cost,3.22,,,3.22,Other,225% of Medicaid,2,,,2,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,30.86,,,30.86,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.08,,,3.08,Other,215% Medicaid APG methodology,3.08,,,3.08,Other,215% Medicaid APG methodology,1.79,,,1.79,Other,125% Medicaid APG methodology,0.01,31.72,
FLUOROURACIL 50 MG/ML 50ML INJ,J9190,HCPCS,,80000877,CDM,636,RC,63323011751,NDC,both,1,ML,22.86,31.72,,,31.72,Other,150% of Medicare + 9.63% HCRA Surcharge,19.29,,,19.29,Fee Schedule,Average Sale Price (ASP) x 6,8,35,,8,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,7.77,34,,7.77,percent of total billed charges,Drugs,7.77,34,,7.77,percent of total billed charges,Drugs,7.77,34,,7.77,percent of total billed charges,Drugs,7.77,34,,7.77,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,9.14,40,,9.14,percent of total billed charges,Drugs,16,70,,16,percent of total billed charges,All Other,8.23,36,,8.23,percent of total billed charges,Drugs,8.23,36,,8.23,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,8,35,,8,percent of total billed charges,Drugs,7.62,,,7.62,Other,Drug Cost,7.62,,,7.62,Other,Drug Cost,7.62,,,7.62,Other,Drug Cost,7.62,,,7.62,Other,Drug Cost,7.62,,,7.62,Other,Drug Cost,7.62,,,7.62,Other,Drug Cost,17.15,,,17.15,Other,225% of Medicaid,10.67,,,10.67,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,30.86,,,30.86,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",16.38,,,16.38,Other,215% Medicaid APG methodology,16.38,,,16.38,Other,215% Medicaid APG methodology,9.53,,,9.53,Other,125% Medicaid APG methodology,0.01,31.72,
FOMEPIZOLE 1 G/ML 1.5ML SOLN,J1451,HCPCS,,80000908,CDM,636,RC,67457021102,NDC,both,1,ML,1241.43,489.95,39.4668,,489.95,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,434.5,35,,434.5,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,422.09,34,,422.09,percent of total billed charges,Drugs,422.09,34,,422.09,percent of total billed charges,Drugs,422.09,34,,422.09,percent of total billed charges,Drugs,422.09,34,,422.09,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,422.09,34,"If Charge > 500, then 34 percent",422.09,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,496.57,40,,496.57,percent of total billed charges,Drugs,869,70,,869,percent of total billed charges,All Other,446.91,36,,446.91,percent of total billed charges,Drugs,446.91,36,,446.91,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,434.5,35,,434.5,percent of total billed charges,Drugs,413.81,,,413.81,Other,Drug Cost,413.81,,,413.81,Other,Drug Cost,413.81,,,413.81,Other,Drug Cost,413.81,,,413.81,Other,Drug Cost,413.81,,,413.81,Other,Drug Cost,413.81,,,413.81,Other,Drug Cost,931.07,,,931.07,Other,225% of Medicaid,579.33,,,579.33,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",889.69,,,889.69,Other,215% Medicaid APG methodology,889.69,,,889.69,Other,215% Medicaid APG methodology,517.26,,,517.26,Other,125% Medicaid APG methodology,0.01,931.07,
FONDAPARINUX SODIUM (ARIXTRA) 7.5MG,J1652,HCPCS,,80000910,CDM,636,RC,67457058406,NDC,both,10,ML,23.04,10.78,,,10.78,Other,150% of Medicare + 9.63% HCRA Surcharge,6.56,,,6.56,Fee Schedule,Average Sale Price (ASP) x 6,8.06,35,,8.06,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,7.83,34,,7.83,percent of total billed charges,Drugs,7.83,34,,7.83,percent of total billed charges,Drugs,7.83,34,,7.83,percent of total billed charges,Drugs,7.83,34,,7.83,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,9.22,40,,9.22,percent of total billed charges,Drugs,16.13,70,,16.13,percent of total billed charges,All Other,8.29,36,,8.29,percent of total billed charges,Drugs,8.29,36,,8.29,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,8.06,35,,8.06,percent of total billed charges,Drugs,7.68,,,7.68,Other,Drug Cost,7.68,,,7.68,Other,Drug Cost,7.68,,,7.68,Other,Drug Cost,7.68,,,7.68,Other,Drug Cost,7.68,,,7.68,Other,Drug Cost,7.68,,,7.68,Other,Drug Cost,17.28,,,17.28,Other,225% of Medicaid,10.75,,,10.75,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,10.49,,,10.49,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",16.51,,,16.51,Other,215% Medicaid APG methodology,16.51,,,16.51,Other,215% Medicaid APG methodology,9.6,,,9.6,Other,125% Medicaid APG methodology,0.01,17.28,
FOSPHENYTOIN 50MG/ML 10ML INJ,Q2009,HCPCS,,80000914,CDM,636,RC,63323040310,NDC,both,10,ML,21.96,8.67,39.4668,,8.67,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,7.69,35,,7.69,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,7.47,34,,7.47,percent of total billed charges,Drugs,7.47,34,,7.47,percent of total billed charges,Drugs,7.47,34,,7.47,percent of total billed charges,Drugs,7.47,34,,7.47,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,8.78,40,,8.78,percent of total billed charges,Drugs,15.37,70,,15.37,percent of total billed charges,All Other,7.91,36,,7.91,percent of total billed charges,Drugs,7.91,36,,7.91,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,7.69,35,,7.69,percent of total billed charges,Drugs,7.32,,,7.32,Other,Drug Cost,7.32,,,7.32,Other,Drug Cost,7.32,,,7.32,Other,Drug Cost,7.32,,,7.32,Other,Drug Cost,7.32,,,7.32,Other,Drug Cost,7.32,,,7.32,Other,Drug Cost,16.47,,,16.47,Other,225% of Medicaid,10.25,,,10.25,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",15.74,,,15.74,Other,215% Medicaid APG methodology,15.74,,,15.74,Other,215% Medicaid APG methodology,9.15,,,9.15,Other,125% Medicaid APG methodology,0.01,16.47,
FOSPHENYTOIN 50MG/ML 2ML INJ,Q2009,HCPCS,,80000915,CDM,636,RC,63323040302,NDC,both,25,ML,4.38,1.73,39.4668,,1.73,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,1.53,35,,1.53,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,1.49,34,,1.49,percent of total billed charges,Drugs,1.49,34,,1.49,percent of total billed charges,Drugs,1.49,34,,1.49,percent of total billed charges,Drugs,1.49,34,,1.49,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,1.75,40,,1.75,percent of total billed charges,Drugs,3.06,70,,3.06,percent of total billed charges,All Other,1.58,36,,1.58,percent of total billed charges,Drugs,1.58,36,,1.58,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,1.53,35,,1.53,percent of total billed charges,Drugs,1.46,,,1.46,Other,Drug Cost,1.46,,,1.46,Other,Drug Cost,1.46,,,1.46,Other,Drug Cost,1.46,,,1.46,Other,Drug Cost,1.46,,,1.46,Other,Drug Cost,1.46,,,1.46,Other,Drug Cost,3.28,,,3.28,Other,225% of Medicaid,2.04,,,2.04,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.14,,,3.14,Other,215% Medicaid APG methodology,3.14,,,3.14,Other,215% Medicaid APG methodology,1.82,,,1.82,Other,125% Medicaid APG methodology,0.01,3.28,
FULVESTRANT 50MG/ML 5ML INJ,J9395,HCPCS,,80000916,CDM,636,RC,43598026202,NDC,both,2,ML,33.33,83.32,,,83.32,Other,150% of Medicare + 9.63% HCRA Surcharge,50.67,,,50.67,Fee Schedule,Average Sale Price (ASP) x 6,11.67,35,,11.67,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,11.33,34,,11.33,percent of total billed charges,Drugs,11.33,34,,11.33,percent of total billed charges,Drugs,11.33,34,,11.33,percent of total billed charges,Drugs,11.33,34,,11.33,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,13.33,40,,13.33,percent of total billed charges,Drugs,23.33,70,,23.33,percent of total billed charges,All Other,12,36,,12,percent of total billed charges,Drugs,12,36,,12,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,11.67,35,,11.67,percent of total billed charges,Drugs,11.11,,,11.11,Other,Drug Cost,11.11,,,11.11,Other,Drug Cost,11.11,,,11.11,Other,Drug Cost,11.11,,,11.11,Other,Drug Cost,11.11,,,11.11,Other,Drug Cost,11.11,,,11.11,Other,Drug Cost,25,,,25,Other,225% of Medicaid,15.55,,,15.55,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,81.07,,,81.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",23.89,,,23.89,Other,215% Medicaid APG methodology,23.89,,,23.89,Other,215% Medicaid APG methodology,13.89,,,13.89,Other,125% Medicaid APG methodology,0.01,83.32,
FUROSEMIDE (LASIX) INJ 100MG,J1940,HCPCS,,80000917,CDM,636,RC,36000028425,NDC,both,25,ML,2.28,5.65,,,5.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3.44,,,3.44,Fee Schedule,Average Sale Price (ASP) x 6,0.8,35,,0.8,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.78,34,,0.78,percent of total billed charges,Drugs,0.78,34,,0.78,percent of total billed charges,Drugs,0.78,34,,0.78,percent of total billed charges,Drugs,0.78,34,,0.78,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.91,40,,0.91,percent of total billed charges,Drugs,1.6,70,,1.6,percent of total billed charges,All Other,0.82,36,,0.82,percent of total billed charges,Drugs,0.82,36,,0.82,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.8,35,,0.8,percent of total billed charges,Drugs,0.76,,,0.76,Other,Drug Cost,0.76,,,0.76,Other,Drug Cost,0.76,,,0.76,Other,Drug Cost,0.76,,,0.76,Other,Drug Cost,0.76,,,0.76,Other,Drug Cost,0.76,,,0.76,Other,Drug Cost,1.71,,,1.71,Other,225% of Medicaid,1.07,,,1.07,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,5.5,,,5.5,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.64,,,1.64,Other,215% Medicaid APG methodology,1.64,,,1.64,Other,215% Medicaid APG methodology,0.95,,,0.95,Other,125% Medicaid APG methodology,0.01,5.65,
FUROSEMIDE (LASIX) INJ 20MG,J1940,HCPCS,,80000918,CDM,636,RC,36000028225,NDC,both,25,ML,0.9,5.65,,,5.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3.44,,,3.44,Fee Schedule,Average Sale Price (ASP) x 6,0.31,35,,0.31,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.3,34,,0.3,percent of total billed charges,Drugs,0.3,34,,0.3,percent of total billed charges,Drugs,0.3,34,,0.3,percent of total billed charges,Drugs,0.3,34,,0.3,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.36,40,,0.36,percent of total billed charges,Drugs,0.63,70,,0.63,percent of total billed charges,All Other,0.32,36,,0.32,percent of total billed charges,Drugs,0.32,36,,0.32,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.31,35,,0.31,percent of total billed charges,Drugs,0.3,,,0.3,Other,Drug Cost,0.3,,,0.3,Other,Drug Cost,0.3,,,0.3,Other,Drug Cost,0.3,,,0.3,Other,Drug Cost,0.3,,,0.3,Other,Drug Cost,0.3,,,0.3,Other,Drug Cost,0.67,,,0.67,Other,225% of Medicaid,0.42,,,0.42,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,5.5,,,5.5,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.64,,,0.64,Other,215% Medicaid APG methodology,0.64,,,0.64,Other,215% Medicaid APG methodology,0.37,,,0.37,Other,125% Medicaid APG methodology,0.01,5.65,
FUROSEMIDE (LASIX) INJ 40MG,J1940,HCPCS,,80000919,CDM,636,RC,36000028325,NDC,both,25,ML,1.14,5.65,,,5.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3.44,,,3.44,Fee Schedule,Average Sale Price (ASP) x 6,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.39,34,,0.39,percent of total billed charges,Drugs,0.39,34,,0.39,percent of total billed charges,Drugs,0.39,34,,0.39,percent of total billed charges,Drugs,0.39,34,,0.39,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.46,40,,0.46,percent of total billed charges,Drugs,0.8,70,,0.8,percent of total billed charges,All Other,0.41,36,,0.41,percent of total billed charges,Drugs,0.41,36,,0.41,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.4,35,,0.4,percent of total billed charges,Drugs,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.38,,,0.38,Other,Drug Cost,0.86,,,0.86,Other,225% of Medicaid,0.53,,,0.53,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,5.5,,,5.5,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.82,,,0.82,Other,215% Medicaid APG methodology,0.82,,,0.82,Other,215% Medicaid APG methodology,0.48,,,0.48,Other,125% Medicaid APG methodology,0.01,5.65,
GANCICLOVIR SODIUM 500 MG,J1570,HCPCS,,80000931,CDM,636,RC,70436008955,NDC,both,25,EA,27.34,443.23,,,443.23,Other,150% of Medicare + 9.63% HCRA Surcharge,269.53,,,269.53,Fee Schedule,Average Sale Price (ASP) x 6,9.57,35,,9.57,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,9.3,34,,9.3,percent of total billed charges,Drugs,9.3,34,,9.3,percent of total billed charges,Drugs,9.3,34,,9.3,percent of total billed charges,Drugs,9.3,34,,9.3,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,10.94,40,,10.94,percent of total billed charges,Drugs,19.14,70,,19.14,percent of total billed charges,All Other,9.84,36,,9.84,percent of total billed charges,Drugs,9.84,36,,9.84,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,9.57,35,,9.57,percent of total billed charges,Drugs,9.11,,,9.11,Other,Drug Cost,9.11,,,9.11,Other,Drug Cost,9.11,,,9.11,Other,Drug Cost,9.11,,,9.11,Other,Drug Cost,9.11,,,9.11,Other,Drug Cost,9.11,,,9.11,Other,Drug Cost,20.5,,,20.5,Other,225% of Medicaid,12.76,,,12.76,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,431.25,,,431.25,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",19.59,,,19.59,Other,215% Medicaid APG methodology,19.59,,,19.59,Other,215% Medicaid APG methodology,11.39,,,11.39,Other,125% Medicaid APG methodology,0.01,443.23,
GEMCITABINE HCL INJECTION 200 MG,J9201,HCPCS,,80000934,CDM,636,RC,63323010213,NDC,both,1,EA,12.15,36.02,,,36.02,Other,150% of Medicare + 9.63% HCRA Surcharge,21.91,,,21.91,Fee Schedule,Average Sale Price (ASP) x 6,4.25,35,,4.25,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,4.13,34,,4.13,percent of total billed charges,Drugs,4.13,34,,4.13,percent of total billed charges,Drugs,4.13,34,,4.13,percent of total billed charges,Drugs,4.13,34,,4.13,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,4.86,40,,4.86,percent of total billed charges,Drugs,8.51,70,,8.51,percent of total billed charges,All Other,4.37,36,,4.37,percent of total billed charges,Drugs,4.37,36,,4.37,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,4.25,35,,4.25,percent of total billed charges,Drugs,4.05,,,4.05,Other,Drug Cost,4.05,,,4.05,Other,Drug Cost,4.05,,,4.05,Other,Drug Cost,4.05,,,4.05,Other,Drug Cost,4.05,,,4.05,Other,Drug Cost,4.05,,,4.05,Other,Drug Cost,9.11,,,9.11,Other,225% of Medicaid,5.67,,,5.67,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,35.05,,,35.05,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8.71,,,8.71,Other,215% Medicaid APG methodology,8.71,,,8.71,Other,215% Medicaid APG methodology,5.06,,,5.06,Other,125% Medicaid APG methodology,0.01,36.02,
GENTAMICIN (GARAMYCIN) 20MG/2ML INJ,J1580,HCPCS,,80000937,CDM,636,RC,63323017302,NDC,both,25,ML,3.75,26.49,,,26.49,Other,150% of Medicare + 9.63% HCRA Surcharge,16.11,,,16.11,Fee Schedule,Average Sale Price (ASP) x 6,1.31,35,,1.31,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,1.28,34,,1.28,percent of total billed charges,Drugs,1.28,34,,1.28,percent of total billed charges,Drugs,1.28,34,,1.28,percent of total billed charges,Drugs,1.28,34,,1.28,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,1.5,40,,1.5,percent of total billed charges,Drugs,2.63,70,,2.63,percent of total billed charges,All Other,1.35,36,,1.35,percent of total billed charges,Drugs,1.35,36,,1.35,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,1.31,35,,1.31,percent of total billed charges,Drugs,1.25,,,1.25,Other,Drug Cost,1.25,,,1.25,Other,Drug Cost,1.25,,,1.25,Other,Drug Cost,1.25,,,1.25,Other,Drug Cost,1.25,,,1.25,Other,Drug Cost,1.25,,,1.25,Other,Drug Cost,2.81,,,2.81,Other,225% of Medicaid,1.75,,,1.75,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,25.78,,,25.78,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.69,,,2.69,Other,215% Medicaid APG methodology,2.69,,,2.69,Other,215% Medicaid APG methodology,1.56,,,1.56,Other,125% Medicaid APG methodology,0.01,26.49,
GENTAMICIN (GARAMYCIN) 40MG/ML 20ML INJ,J1580,HCPCS,,80000938,CDM,636,RC,63323001020,NDC,both,25,ML,35.93,26.49,,,26.49,Other,150% of Medicare + 9.63% HCRA Surcharge,16.11,,,16.11,Fee Schedule,Average Sale Price (ASP) x 6,12.57,35,,12.57,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,12.22,34,,12.22,percent of total billed charges,Drugs,12.22,34,,12.22,percent of total billed charges,Drugs,12.22,34,,12.22,percent of total billed charges,Drugs,12.22,34,,12.22,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,14.37,40,,14.37,percent of total billed charges,Drugs,25.15,70,,25.15,percent of total billed charges,All Other,12.93,36,,12.93,percent of total billed charges,Drugs,12.93,36,,12.93,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,12.57,35,,12.57,percent of total billed charges,Drugs,11.98,,,11.98,Other,Drug Cost,11.98,,,11.98,Other,Drug Cost,11.98,,,11.98,Other,Drug Cost,11.98,,,11.98,Other,Drug Cost,11.98,,,11.98,Other,Drug Cost,11.98,,,11.98,Other,Drug Cost,26.95,,,26.95,Other,225% of Medicaid,16.77,,,16.77,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,25.78,,,25.78,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",25.75,,,25.75,Other,215% Medicaid APG methodology,25.75,,,25.75,Other,215% Medicaid APG methodology,14.97,,,14.97,Other,125% Medicaid APG methodology,0.01,26.95,
GLUCAGON HCL 1 MG KIT,J1610,HCPCS,,80000952,CDM,636,RC,63323059303,NDC,both,1,EA,271.05,1858.56,,,1858.56,Other,150% of Medicare + 9.63% HCRA Surcharge,1130.2,,,1130.2,Fee Schedule,Average Sale Price (ASP) x 6,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,92.16,34,,92.16,percent of total billed charges,Drugs,92.16,34,,92.16,percent of total billed charges,Drugs,92.16,34,,92.16,percent of total billed charges,Drugs,92.16,34,,92.16,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,108.42,40,,108.42,percent of total billed charges,Drugs,189.74,70,,189.74,percent of total billed charges,All Other,97.58,36,,97.58,percent of total billed charges,Drugs,97.58,36,,97.58,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,90.35,,,90.35,Other,Drug Cost,90.35,,,90.35,Other,Drug Cost,90.35,,,90.35,Other,Drug Cost,90.35,,,90.35,Other,Drug Cost,90.35,,,90.35,Other,Drug Cost,90.35,,,90.35,Other,Drug Cost,203.29,,,203.29,Other,225% of Medicaid,126.49,,,126.49,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1808.32,,,1808.32,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",194.25,,,194.25,Other,215% Medicaid APG methodology,194.25,,,194.25,Other,215% Medicaid APG methodology,112.94,,,112.94,Other,125% Medicaid APG methodology,0.01,1858.56,
GRANISETRON HCL (KYTRIL) 1MG/1ML INJ,J1626,HCPCS,,80000963,CDM,636,RC,143974410,NDC,both,10,ML,7.08,3.76,,,3.76,Other,150% of Medicare + 9.63% HCRA Surcharge,2.29,,,2.29,Fee Schedule,Average Sale Price (ASP) x 6,2.48,35,,2.48,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,2.41,34,,2.41,percent of total billed charges,Drugs,2.41,34,,2.41,percent of total billed charges,Drugs,2.41,34,,2.41,percent of total billed charges,Drugs,2.41,34,,2.41,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,2.83,40,,2.83,percent of total billed charges,Drugs,4.95,70,,4.95,percent of total billed charges,All Other,2.55,36,,2.55,percent of total billed charges,Drugs,2.55,36,,2.55,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,2.48,35,,2.48,percent of total billed charges,Drugs,2.36,,,2.36,Other,Drug Cost,2.36,,,2.36,Other,Drug Cost,2.36,,,2.36,Other,Drug Cost,2.36,,,2.36,Other,Drug Cost,2.36,,,2.36,Other,Drug Cost,2.36,,,2.36,Other,Drug Cost,5.31,,,5.31,Other,225% of Medicaid,3.3,,,3.3,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,3.66,,,3.66,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.07,,,5.07,Other,215% Medicaid APG methodology,5.07,,,5.07,Other,215% Medicaid APG methodology,2.95,,,2.95,Other,125% Medicaid APG methodology,0.01,5.31,
GRANISETRON HCL INJECTION 1MG/1ML,J1626,HCPCS,,80000964,CDM,636,RC,67457086301,NDC,both,1,ML,5.7,3.76,,,3.76,Other,150% of Medicare + 9.63% HCRA Surcharge,2.29,,,2.29,Fee Schedule,Average Sale Price (ASP) x 6,2,35,,2,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,1.94,34,,1.94,percent of total billed charges,Drugs,1.94,34,,1.94,percent of total billed charges,Drugs,1.94,34,,1.94,percent of total billed charges,Drugs,1.94,34,,1.94,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,2.28,40,,2.28,percent of total billed charges,Drugs,3.99,70,,3.99,percent of total billed charges,All Other,2.05,36,,2.05,percent of total billed charges,Drugs,2.05,36,,2.05,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,2,35,,2,percent of total billed charges,Drugs,1.9,,,1.9,Other,Drug Cost,1.9,,,1.9,Other,Drug Cost,1.9,,,1.9,Other,Drug Cost,1.9,,,1.9,Other,Drug Cost,1.9,,,1.9,Other,Drug Cost,1.9,,,1.9,Other,Drug Cost,4.28,,,4.28,Other,225% of Medicaid,2.66,,,2.66,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,3.66,,,3.66,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.09,,,4.09,Other,215% Medicaid APG methodology,4.09,,,4.09,Other,215% Medicaid APG methodology,2.38,,,2.38,Other,125% Medicaid APG methodology,0.01,4.28,
HALOPERIDOL  5 MG/1ML INJ,J1630,HCPCS,,80000974,CDM,636,RC,67457042612,NDC,both,25,ML,1.55,13.97,,,13.97,Other,150% of Medicare + 9.63% HCRA Surcharge,8.5,,,8.5,Fee Schedule,Average Sale Price (ASP) x 6,0.54,35,,0.54,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.53,34,,0.53,percent of total billed charges,Drugs,0.53,34,,0.53,percent of total billed charges,Drugs,0.53,34,,0.53,percent of total billed charges,Drugs,0.53,34,,0.53,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.62,40,,0.62,percent of total billed charges,Drugs,1.08,70,,1.08,percent of total billed charges,All Other,0.56,36,,0.56,percent of total billed charges,Drugs,0.56,36,,0.56,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.54,35,,0.54,percent of total billed charges,Drugs,0.52,,,0.52,Other,Drug Cost,0.52,,,0.52,Other,Drug Cost,0.52,,,0.52,Other,Drug Cost,0.52,,,0.52,Other,Drug Cost,0.52,,,0.52,Other,Drug Cost,0.52,,,0.52,Other,Drug Cost,1.16,,,1.16,Other,225% of Medicaid,0.72,,,0.72,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,13.59,,,13.59,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.11,,,1.11,Other,215% Medicaid APG methodology,1.11,,,1.11,Other,215% Medicaid APG methodology,0.64,,,0.64,Other,125% Medicaid APG methodology,0.01,13.97,
HALOPERIDOL DECANOATE 100MG/ML,J1631,HCPCS,,80000979,CDM,636,RC,50458025414,NDC,both,5,ML,0.03,86.6,,,86.6,Other,150% of Medicare + 9.63% HCRA Surcharge,52.66,,,52.66,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,84.26,,,84.26,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,86.6,
HALOPERIDOL DECANOATE 50MG/ML,J1631,HCPCS,,80000981,CDM,636,RC,25021083101,NDC,both,10,ML,9.16,86.6,,,86.6,Other,150% of Medicare + 9.63% HCRA Surcharge,52.66,,,52.66,Fee Schedule,Average Sale Price (ASP) x 6,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.11,34,,3.11,percent of total billed charges,Drugs,3.11,34,,3.11,percent of total billed charges,Drugs,3.11,34,,3.11,percent of total billed charges,Drugs,3.11,34,,3.11,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.66,40,,3.66,percent of total billed charges,Drugs,6.41,70,,6.41,percent of total billed charges,All Other,3.3,36,,3.3,percent of total billed charges,Drugs,3.3,36,,3.3,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.05,,,3.05,Other,Drug Cost,3.05,,,3.05,Other,Drug Cost,3.05,,,3.05,Other,Drug Cost,3.05,,,3.05,Other,Drug Cost,3.05,,,3.05,Other,Drug Cost,3.05,,,3.05,Other,Drug Cost,6.87,,,6.87,Other,225% of Medicaid,4.27,,,4.27,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,84.26,,,84.26,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6.56,,,6.56,Other,215% Medicaid APG methodology,6.56,,,6.56,Other,215% Medicaid APG methodology,3.82,,,3.82,Other,125% Medicaid APG methodology,0.01,86.6,
HEP B IG HUMAN 312UNITS/ML IM 5ML,90371,HCPCS,,80000984,CDM,636,RC,69800420301,NDC,both,1,ML,948.21,374.23,39.4668,,374.23,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,331.87,35,,331.87,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,322.39,34,,322.39,percent of total billed charges,Drugs,322.39,34,,322.39,percent of total billed charges,Drugs,322.39,34,,322.39,percent of total billed charges,Drugs,322.39,34,,322.39,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,322.39,34,"If Charge > 500, then 34 percent",322.39,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,379.28,40,,379.28,percent of total billed charges,Drugs,663.75,70,,663.75,percent of total billed charges,All Other,341.36,36,,341.36,percent of total billed charges,Drugs,341.36,36,,341.36,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,331.87,35,,331.87,percent of total billed charges,Drugs,316.07,,,316.07,Other,Drug Cost,316.07,,,316.07,Other,Drug Cost,316.07,,,316.07,Other,Drug Cost,316.07,,,316.07,Other,Drug Cost,316.07,,,316.07,Other,Drug Cost,316.07,,,316.07,Other,Drug Cost,711.16,,,711.16,Other,225% of Medicaid,442.5,,,442.5,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",679.55,,,679.55,Other,215% Medicaid APG methodology,679.55,,,679.55,Other,215% Medicaid APG methodology,395.09,,,395.09,Other,125% Medicaid APG methodology,0.01,711.16,
HEP B IG HUMAN IM 312 UNIT/ML 1ML,90371,HCPCS,,80000985,CDM,636,RC,69800420201,NDC,both,1,ML,189.63,74.84,39.4668,,74.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,66.37,35,,66.37,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,64.47,34,,64.47,percent of total billed charges,Drugs,64.47,34,,64.47,percent of total billed charges,Drugs,64.47,34,,64.47,percent of total billed charges,Drugs,64.47,34,,64.47,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,75.85,40,,75.85,percent of total billed charges,Drugs,132.74,70,,132.74,percent of total billed charges,All Other,68.27,36,,68.27,percent of total billed charges,Drugs,68.27,36,,68.27,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,66.37,35,,66.37,percent of total billed charges,Drugs,63.21,,,63.21,Other,Drug Cost,63.21,,,63.21,Other,Drug Cost,63.21,,,63.21,Other,Drug Cost,63.21,,,63.21,Other,Drug Cost,63.21,,,63.21,Other,Drug Cost,63.21,,,63.21,Other,Drug Cost,142.22,,,142.22,Other,225% of Medicaid,88.49,,,88.49,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",135.9,,,135.9,Other,215% Medicaid APG methodology,135.9,,,135.9,Other,215% Medicaid APG methodology,79.01,,,79.01,Other,125% Medicaid APG methodology,0.01,142.22,
HEP B VACC 10MCG/0.5ML,90743,HCPCS,,80000986,CDM,636,RC,58160082052,NDC,both,10,ML,52.1,20.56,39.4668,,20.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,18.23,35,,18.23,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,17.71,34,,17.71,percent of total billed charges,Drugs,17.71,34,,17.71,percent of total billed charges,Drugs,17.71,34,,17.71,percent of total billed charges,Drugs,17.71,34,,17.71,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,20.84,40,,20.84,percent of total billed charges,Drugs,36.47,70,,36.47,percent of total billed charges,All Other,18.75,36,,18.75,percent of total billed charges,Drugs,18.75,36,,18.75,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,18.23,35,,18.23,percent of total billed charges,Drugs,17.37,,,17.37,Other,Drug Cost,17.37,,,17.37,Other,Drug Cost,17.37,,,17.37,Other,Drug Cost,17.37,,,17.37,Other,Drug Cost,17.37,,,17.37,Other,Drug Cost,17.37,,,17.37,Other,Drug Cost,39.07,,,39.07,Other,225% of Medicaid,24.31,,,24.31,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",37.33,,,37.33,Other,215% Medicaid APG methodology,37.33,,,37.33,Other,215% Medicaid APG methodology,21.71,,,21.71,Other,125% Medicaid APG methodology,0.01,39.07,
HEPARIN SODIUM 1000 UNIT/ML INJ,J1644,HCPCS,,80000992,CDM,636,RC,409272001,NDC,both,25,ML,0.33,2.64,,,2.64,Other,150% of Medicare + 9.63% HCRA Surcharge,1.61,,,1.61,Fee Schedule,Average Sale Price (ASP) x 6,0.11,35,,0.11,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.11,34,,0.11,percent of total billed charges,Drugs,0.11,34,,0.11,percent of total billed charges,Drugs,0.11,34,,0.11,percent of total billed charges,Drugs,0.11,34,,0.11,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.13,40,,0.13,percent of total billed charges,Drugs,0.23,70,,0.23,percent of total billed charges,All Other,0.12,36,,0.12,percent of total billed charges,Drugs,0.12,36,,0.12,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.11,35,,0.11,percent of total billed charges,Drugs,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.24,,,0.24,Other,225% of Medicaid,0.15,,,0.15,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.57,,,2.57,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.23,,,0.23,Other,215% Medicaid APG methodology,0.23,,,0.23,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,2.64,
HEPARIN SODIUM 5000 UNIT/ML INJ,J1644,HCPCS,,80000996,CDM,636,RC,69005903,NDC,both,25,ML,0.34,2.64,,,2.64,Other,150% of Medicare + 9.63% HCRA Surcharge,1.61,,,1.61,Fee Schedule,Average Sale Price (ASP) x 6,0.12,35,,0.12,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.12,34,,0.12,percent of total billed charges,Drugs,0.12,34,,0.12,percent of total billed charges,Drugs,0.12,34,,0.12,percent of total billed charges,Drugs,0.12,34,,0.12,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.14,40,,0.14,percent of total billed charges,Drugs,0.24,70,,0.24,percent of total billed charges,All Other,0.12,36,,0.12,percent of total billed charges,Drugs,0.12,36,,0.12,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.12,35,,0.12,percent of total billed charges,Drugs,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.11,,,0.11,Other,Drug Cost,0.26,,,0.26,Other,225% of Medicaid,0.16,,,0.16,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.57,,,2.57,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.24,,,0.24,Other,215% Medicaid APG methodology,0.24,,,0.24,Other,215% Medicaid APG methodology,0.14,,,0.14,Other,125% Medicaid APG methodology,0.01,2.64,
HYDRALAZINE HCL 20 MG/1ML INJ,J0360,HCPCS,,80001008,CDM,636,RC,517090125,NDC,both,25,ML,2.76,55.13,,,55.13,Other,150% of Medicare + 9.63% HCRA Surcharge,33.52,,,33.52,Fee Schedule,Average Sale Price (ASP) x 6,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.94,34,,0.94,percent of total billed charges,Drugs,0.94,34,,0.94,percent of total billed charges,Drugs,0.94,34,,0.94,percent of total billed charges,Drugs,0.94,34,,0.94,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,1.1,40,,1.1,percent of total billed charges,Drugs,1.93,70,,1.93,percent of total billed charges,All Other,0.99,36,,0.99,percent of total billed charges,Drugs,0.99,36,,0.99,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,2.07,,,2.07,Other,225% of Medicaid,1.29,,,1.29,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,53.64,,,53.64,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.98,,,1.98,Other,215% Medicaid APG methodology,1.98,,,1.98,Other,215% Medicaid APG methodology,1.15,,,1.15,Other,125% Medicaid APG methodology,0.01,55.13,
HYDROCORT SOD SUCC 100MG INJ,J1720,HCPCS,,80001019,CDM,636,RC,9001104,NDC,both,25,EA,0.03,176.07,,,176.07,Other,150% of Medicare + 9.63% HCRA Surcharge,107.07,,,107.07,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,171.31,,,171.31,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,176.07,
HYDROMORPHONE (DILAUDID) 2MG/1ML INJ,J1170,HCPCS,,80001032,CDM,636,RC,409131230,NDC,both,10,ML,0.74,45.3,,,45.3,Other,150% of Medicare + 9.63% HCRA Surcharge,27.55,,,27.55,Fee Schedule,Average Sale Price (ASP) x 6,0.26,35,,0.26,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.25,34,,0.25,percent of total billed charges,Drugs,0.25,34,,0.25,percent of total billed charges,Drugs,0.25,34,,0.25,percent of total billed charges,Drugs,0.25,34,,0.25,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.29,40,,0.29,percent of total billed charges,Drugs,0.51,70,,0.51,percent of total billed charges,All Other,0.26,36,,0.26,percent of total billed charges,Drugs,0.26,36,,0.26,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.26,35,,0.26,percent of total billed charges,Drugs,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.55,,,0.55,Other,225% of Medicaid,0.34,,,0.34,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,44.07,,,44.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.53,,,0.53,Other,215% Medicaid APG methodology,0.53,,,0.53,Other,215% Medicaid APG methodology,0.31,,,0.31,Other,125% Medicaid APG methodology,0.01,45.3,
HYDROMORPHONE HCL 10MG/1ML INJ,J1170,HCPCS,,80001036,CDM,636,RC,409263401,NDC,both,10,ML,4.64,45.3,,,45.3,Other,150% of Medicare + 9.63% HCRA Surcharge,27.55,,,27.55,Fee Schedule,Average Sale Price (ASP) x 6,1.62,35,,1.62,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,1.58,34,,1.58,percent of total billed charges,Drugs,1.58,34,,1.58,percent of total billed charges,Drugs,1.58,34,,1.58,percent of total billed charges,Drugs,1.58,34,,1.58,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,1.86,40,,1.86,percent of total billed charges,Drugs,3.25,70,,3.25,percent of total billed charges,All Other,1.67,36,,1.67,percent of total billed charges,Drugs,1.67,36,,1.67,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,1.62,35,,1.62,percent of total billed charges,Drugs,1.55,,,1.55,Other,Drug Cost,1.55,,,1.55,Other,Drug Cost,1.55,,,1.55,Other,Drug Cost,1.55,,,1.55,Other,Drug Cost,1.55,,,1.55,Other,Drug Cost,1.55,,,1.55,Other,Drug Cost,3.48,,,3.48,Other,225% of Medicaid,2.17,,,2.17,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,44.07,,,44.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.33,,,3.33,Other,215% Medicaid APG methodology,3.33,,,3.33,Other,215% Medicaid APG methodology,1.93,,,1.93,Other,125% Medicaid APG methodology,0.01,45.3,
HYDROMORPHONE HCL 10MG/ML 50ML INJ,J1170,HCPCS,,80001037,CDM,636,RC,409263450,NDC,both,1,ML,232.08,45.3,,,45.3,Other,150% of Medicare + 9.63% HCRA Surcharge,27.55,,,27.55,Fee Schedule,Average Sale Price (ASP) x 6,81.23,35,,81.23,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,78.91,34,,78.91,percent of total billed charges,Drugs,78.91,34,,78.91,percent of total billed charges,Drugs,78.91,34,,78.91,percent of total billed charges,Drugs,78.91,34,,78.91,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,92.83,40,,92.83,percent of total billed charges,Drugs,162.46,70,,162.46,percent of total billed charges,All Other,83.55,36,,83.55,percent of total billed charges,Drugs,83.55,36,,83.55,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,81.23,35,,81.23,percent of total billed charges,Drugs,77.36,,,77.36,Other,Drug Cost,77.36,,,77.36,Other,Drug Cost,77.36,,,77.36,Other,Drug Cost,77.36,,,77.36,Other,Drug Cost,77.36,,,77.36,Other,Drug Cost,77.36,,,77.36,Other,Drug Cost,174.06,,,174.06,Other,225% of Medicaid,108.3,,,108.3,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,44.07,,,44.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",166.32,,,166.32,Other,215% Medicaid APG methodology,166.32,,,166.32,Other,215% Medicaid APG methodology,96.7,,,96.7,Other,125% Medicaid APG methodology,0.01,174.06,
HYDROXYZINE HCL 50MG/1ML INJ,J3410,HCPCS,,80001046,CDM,636,RC,517560125,NDC,both,25,ML,0.03,97.76,,,97.76,Other,150% of Medicare + 9.63% HCRA Surcharge,59.45,,,59.45,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,95.12,,,95.12,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,97.76,
IBUTILIDE FUMARATE 1MG/10ML INJ,J1742,HCPCS,,80001058,CDM,636,RC,9379401,NDC,both,1,ML,60.24,23.77,39.4668,,23.77,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,21.08,35,,21.08,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,20.48,34,,20.48,percent of total billed charges,Drugs,20.48,34,,20.48,percent of total billed charges,Drugs,20.48,34,,20.48,percent of total billed charges,Drugs,20.48,34,,20.48,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,24.1,40,,24.1,percent of total billed charges,Drugs,42.17,70,,42.17,percent of total billed charges,All Other,21.69,36,,21.69,percent of total billed charges,Drugs,21.69,36,,21.69,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,21.08,35,,21.08,percent of total billed charges,Drugs,20.08,,,20.08,Other,Drug Cost,20.08,,,20.08,Other,Drug Cost,20.08,,,20.08,Other,Drug Cost,20.08,,,20.08,Other,Drug Cost,20.08,,,20.08,Other,Drug Cost,20.08,,,20.08,Other,Drug Cost,45.18,,,45.18,Other,225% of Medicaid,28.11,,,28.11,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",43.17,,,43.17,Other,215% Medicaid APG methodology,43.17,,,43.17,Other,215% Medicaid APG methodology,25.1,,,25.1,Other,125% Medicaid APG methodology,0.01,45.18,
IDARUBICIN HCL INJECTION 10MG/10ML,J9211,HCPCS,,80001059,CDM,636,RC,13258691,NDC,both,1,ML,180.42,423.58,,,423.58,Other,150% of Medicare + 9.63% HCRA Surcharge,257.58,,,257.58,Fee Schedule,Average Sale Price (ASP) x 6,63.15,35,,63.15,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,61.34,34,,61.34,percent of total billed charges,Drugs,61.34,34,,61.34,percent of total billed charges,Drugs,61.34,34,,61.34,percent of total billed charges,Drugs,61.34,34,,61.34,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,72.17,40,,72.17,percent of total billed charges,Drugs,126.29,70,,126.29,percent of total billed charges,All Other,64.95,36,,64.95,percent of total billed charges,Drugs,64.95,36,,64.95,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,63.15,35,,63.15,percent of total billed charges,Drugs,60.14,,,60.14,Other,Drug Cost,60.14,,,60.14,Other,Drug Cost,60.14,,,60.14,Other,Drug Cost,60.14,,,60.14,Other,Drug Cost,60.14,,,60.14,Other,Drug Cost,60.14,,,60.14,Other,Drug Cost,135.32,,,135.32,Other,225% of Medicaid,84.2,,,84.2,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,412.13,,,412.13,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",129.3,,,129.3,Other,215% Medicaid APG methodology,129.3,,,129.3,Other,215% Medicaid APG methodology,75.18,,,75.18,Other,125% Medicaid APG methodology,0.01,423.58,
IDARUBICIN HCL INJECTION 5 MG/5ML,J9211,HCPCS,,80001060,CDM,636,RC,13257691,NDC,both,1,ML,92.91,423.58,,,423.58,Other,150% of Medicare + 9.63% HCRA Surcharge,257.58,,,257.58,Fee Schedule,Average Sale Price (ASP) x 6,32.52,35,,32.52,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,31.59,34,,31.59,percent of total billed charges,Drugs,31.59,34,,31.59,percent of total billed charges,Drugs,31.59,34,,31.59,percent of total billed charges,Drugs,31.59,34,,31.59,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,37.16,40,,37.16,percent of total billed charges,Drugs,65.04,70,,65.04,percent of total billed charges,All Other,33.45,36,,33.45,percent of total billed charges,Drugs,33.45,36,,33.45,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,32.52,35,,32.52,percent of total billed charges,Drugs,30.97,,,30.97,Other,Drug Cost,30.97,,,30.97,Other,Drug Cost,30.97,,,30.97,Other,Drug Cost,30.97,,,30.97,Other,Drug Cost,30.97,,,30.97,Other,Drug Cost,30.97,,,30.97,Other,Drug Cost,69.68,,,69.68,Other,225% of Medicaid,43.36,,,43.36,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,412.13,,,412.13,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",66.59,,,66.59,Other,215% Medicaid APG methodology,66.59,,,66.59,Other,215% Medicaid APG methodology,38.71,,,38.71,Other,125% Medicaid APG methodology,0.01,423.58,
IFOSFAMIDE INJECTION 1GM,J9208,HCPCS,,80001061,CDM,636,RC,63323014210,NDC,both,1,EA,71.52,263.95,,,263.95,Other,150% of Medicare + 9.63% HCRA Surcharge,160.51,,,160.51,Fee Schedule,Average Sale Price (ASP) x 6,25.03,35,,25.03,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,24.32,34,,24.32,percent of total billed charges,Drugs,24.32,34,,24.32,percent of total billed charges,Drugs,24.32,34,,24.32,percent of total billed charges,Drugs,24.32,34,,24.32,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,28.61,40,,28.61,percent of total billed charges,Drugs,50.06,70,,50.06,percent of total billed charges,All Other,25.75,36,,25.75,percent of total billed charges,Drugs,25.75,36,,25.75,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,25.03,35,,25.03,percent of total billed charges,Drugs,23.84,,,23.84,Other,Drug Cost,23.84,,,23.84,Other,Drug Cost,23.84,,,23.84,Other,Drug Cost,23.84,,,23.84,Other,Drug Cost,23.84,,,23.84,Other,Drug Cost,23.84,,,23.84,Other,Drug Cost,53.64,,,53.64,Other,225% of Medicaid,33.38,,,33.38,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,256.82,,,256.82,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",51.26,,,51.26,Other,215% Medicaid APG methodology,51.26,,,51.26,Other,215% Medicaid APG methodology,29.8,,,29.8,Other,125% Medicaid APG methodology,0.01,263.95,
IFOSFAMIDE INJECTION 3GM,J9208,HCPCS,,80001062,CDM,636,RC,10019092602,NDC,both,1,EA,77.1,263.95,,,263.95,Other,150% of Medicare + 9.63% HCRA Surcharge,160.51,,,160.51,Fee Schedule,Average Sale Price (ASP) x 6,26.99,35,,26.99,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,26.21,34,,26.21,percent of total billed charges,Drugs,26.21,34,,26.21,percent of total billed charges,Drugs,26.21,34,,26.21,percent of total billed charges,Drugs,26.21,34,,26.21,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,30.84,40,,30.84,percent of total billed charges,Drugs,53.97,70,,53.97,percent of total billed charges,All Other,27.76,36,,27.76,percent of total billed charges,Drugs,27.76,36,,27.76,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,26.99,35,,26.99,percent of total billed charges,Drugs,25.7,,,25.7,Other,Drug Cost,25.7,,,25.7,Other,Drug Cost,25.7,,,25.7,Other,Drug Cost,25.7,,,25.7,Other,Drug Cost,25.7,,,25.7,Other,Drug Cost,25.7,,,25.7,Other,Drug Cost,57.83,,,57.83,Other,225% of Medicaid,35.98,,,35.98,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,256.82,,,256.82,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",55.26,,,55.26,Other,215% Medicaid APG methodology,55.26,,,55.26,Other,215% Medicaid APG methodology,32.13,,,32.13,Other,125% Medicaid APG methodology,0.01,263.95,
INFLIXIMAB INJ 100 MG,J1745,HCPCS,,80001080,CDM,636,RC,57894016001,NDC,both,1,EA,1360.89,317.32,,,317.32,Other,150% of Medicare + 9.63% HCRA Surcharge,192.97,,,192.97,Fee Schedule,Average Sale Price (ASP) x 6,476.31,35,,476.31,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,462.7,34,,462.7,percent of total billed charges,Drugs,462.7,34,,462.7,percent of total billed charges,Drugs,462.7,34,,462.7,percent of total billed charges,Drugs,462.7,34,,462.7,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,462.7,34,"If Charge > 500, then 34 percent",462.7,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,544.36,40,,544.36,percent of total billed charges,Drugs,952.62,70,,952.62,percent of total billed charges,All Other,489.92,36,,489.92,percent of total billed charges,Drugs,489.92,36,,489.92,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,476.31,35,,476.31,percent of total billed charges,Drugs,453.63,,,453.63,Other,Drug Cost,453.63,,,453.63,Other,Drug Cost,453.63,,,453.63,Other,Drug Cost,453.63,,,453.63,Other,Drug Cost,453.63,,,453.63,Other,Drug Cost,453.63,,,453.63,Other,Drug Cost,1020.67,,,1020.67,Other,225% of Medicaid,635.08,,,635.08,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,308.75,,,308.75,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",975.3,,,975.3,Other,215% Medicaid APG methodology,975.3,,,975.3,Other,215% Medicaid APG methodology,567.04,,,567.04,Other,125% Medicaid APG methodology,0.01,1020.67,
IPILIMUMAB (YERVOY) 5MG/ML 10ML INJ,J9228,HCPCS,,80001093,CDM,636,RC,3232711,NDC,both,1,ML,25835.28,1701.21,,,1701.21,Other,150% of Medicare + 9.63% HCRA Surcharge,1034.51,,,1034.51,Fee Schedule,Average Sale Price (ASP) x 6,9042.35,35,,9042.35,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,8784,34,,8784,percent of total billed charges,Drugs,8784,34,,8784,percent of total billed charges,Drugs,8784,34,,8784,percent of total billed charges,Drugs,8784,34,,8784,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,8784,34,"If Charge > 500, then 34 percent",8784,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,10334.11,40,,10334.11,percent of total billed charges,Drugs,18084.7,70,,18084.7,percent of total billed charges,All Other,9300.7,36,,9300.7,percent of total billed charges,Drugs,9300.7,36,,9300.7,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,9042.35,35,,9042.35,percent of total billed charges,Drugs,8611.76,,,8611.76,Other,Drug Cost,8611.76,,,8611.76,Other,Drug Cost,8611.76,,,8611.76,Other,Drug Cost,8611.76,,,8611.76,Other,Drug Cost,8611.76,,,8611.76,Other,Drug Cost,8611.76,,,8611.76,Other,Drug Cost,19376.46,,,19376.46,Other,225% of Medicaid,12056.46,,,12056.46,Other,140% of Medicaid,8784,34,"If Charge > 2,000, then 34 percent",8784,percent of total billed charges,Drugs,1655.22,,,1655.22,Other,160% Medicare Fee Schedule,8784,34,,8784,Other,"Drug Charges > 20,000, then 34% of Charges",18515.28,,,18515.28,Other,215% Medicaid APG methodology,18515.28,,,18515.28,Other,215% Medicaid APG methodology,10764.7,,,10764.7,Other,125% Medicaid APG methodology,1034.51,19376.46,
IRON SUCROSE (VENOFER) INJ 20MG/ML 5ML,J1756,HCPCS,,80001102,CDM,636,RC,517234010,NDC,both,10,ML,74.74,2.18,,,2.18,Other,150% of Medicare + 9.63% HCRA Surcharge,1.33,,,1.33,Fee Schedule,Average Sale Price (ASP) x 6,26.16,35,,26.16,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,25.41,34,,25.41,percent of total billed charges,Drugs,25.41,34,,25.41,percent of total billed charges,Drugs,25.41,34,,25.41,percent of total billed charges,Drugs,25.41,34,,25.41,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,29.89,40,,29.89,percent of total billed charges,Drugs,52.32,70,,52.32,percent of total billed charges,All Other,26.9,36,,26.9,percent of total billed charges,Drugs,26.9,36,,26.9,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,26.16,35,,26.16,percent of total billed charges,Drugs,24.91,,,24.91,Other,Drug Cost,24.91,,,24.91,Other,Drug Cost,24.91,,,24.91,Other,Drug Cost,24.91,,,24.91,Other,Drug Cost,24.91,,,24.91,Other,Drug Cost,24.91,,,24.91,Other,Drug Cost,56.05,,,56.05,Other,225% of Medicaid,34.88,,,34.88,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.12,,,2.12,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",53.56,,,53.56,Other,215% Medicaid APG methodology,53.56,,,53.56,Other,215% Medicaid APG methodology,31.14,,,31.14,Other,125% Medicaid APG methodology,0.01,56.05,
LACOSAMIDE (VIMPAT) 10MG/ML 20ML INJ,C9254,HCPCS,,80001135,CDM,636,RC,131181067,NDC,both,10,ML,88.19,34.81,39.4668,,34.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,30.87,35,,30.87,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,29.98,34,,29.98,percent of total billed charges,Drugs,29.98,34,,29.98,percent of total billed charges,Drugs,29.98,34,,29.98,percent of total billed charges,Drugs,29.98,34,,29.98,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,35.28,40,,35.28,percent of total billed charges,Drugs,61.73,70,,61.73,percent of total billed charges,All Other,31.75,36,,31.75,percent of total billed charges,Drugs,31.75,36,,31.75,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,30.87,35,,30.87,percent of total billed charges,Drugs,29.4,,,29.4,Other,Drug Cost,29.4,,,29.4,Other,Drug Cost,29.4,,,29.4,Other,Drug Cost,29.4,,,29.4,Other,Drug Cost,29.4,,,29.4,Other,Drug Cost,29.4,,,29.4,Other,Drug Cost,66.14,,,66.14,Other,225% of Medicaid,41.16,,,41.16,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",63.2,,,63.2,Other,215% Medicaid APG methodology,63.2,,,63.2,Other,215% Medicaid APG methodology,36.75,,,36.75,Other,125% Medicaid APG methodology,0.01,66.14,
LACTATED RINGERS 1000ML,J7120,HCPCS,,80001139,CDM,636,RC,264775000,NDC,both,1000,ML,2.91,25.56,,,25.56,Other,150% of Medicare + 9.63% HCRA Surcharge,15.55,,,15.55,Fee Schedule,Average Sale Price (ASP) x 6,1.02,35,,1.02,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,0.99,34,,0.99,percent of total billed charges,Drugs,0.99,34,,0.99,percent of total billed charges,Drugs,0.99,34,,0.99,percent of total billed charges,Drugs,0.99,34,,0.99,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,1.16,40,,1.16,percent of total billed charges,Drugs,2.03,70,,2.03,percent of total billed charges,All Other,1.05,36,,1.05,percent of total billed charges,Drugs,1.05,36,,1.05,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,1.02,35,,1.02,percent of total billed charges,Drugs,0.97,,,0.97,Other,Drug Cost,0.97,,,0.97,Other,Drug Cost,0.97,,,0.97,Other,Drug Cost,0.97,,,0.97,Other,Drug Cost,0.97,,,0.97,Other,Drug Cost,0.97,,,0.97,Other,Drug Cost,2.18,,,2.18,Other,225% of Medicaid,1.36,,,1.36,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,24.87,,,24.87,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.08,,,2.08,Other,215% Medicaid APG methodology,2.08,,,2.08,Other,215% Medicaid APG methodology,1.21,,,1.21,Other,125% Medicaid APG methodology,0.01,25.56,
LACTATED RINGERS 500ML,J7120,HCPCS,,80001140,CDM,636,RC,264775010,NDC,both,24,ML,1.45,25.56,,,25.56,Other,150% of Medicare + 9.63% HCRA Surcharge,15.55,,,15.55,Fee Schedule,Average Sale Price (ASP) x 6,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.49,34,,0.49,percent of total billed charges,Drugs,0.49,34,,0.49,percent of total billed charges,Drugs,0.49,34,,0.49,percent of total billed charges,Drugs,0.49,34,,0.49,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.58,40,,0.58,percent of total billed charges,Drugs,1.02,70,,1.02,percent of total billed charges,All Other,0.52,36,,0.52,percent of total billed charges,Drugs,0.52,36,,0.52,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.51,35,,0.51,percent of total billed charges,Drugs,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,1.09,,,1.09,Other,225% of Medicaid,0.68,,,0.68,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,24.87,,,24.87,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.04,,,1.04,Other,215% Medicaid APG methodology,1.04,,,1.04,Other,215% Medicaid APG methodology,0.61,,,0.61,Other,125% Medicaid APG methodology,0.01,25.56,
LEUCOVORIN CALCIUM 100MG INJ,J0640,HCPCS,,80001152,CDM,636,RC,25021081430,NDC,both,1,EA,19.32,44.1,,,44.1,Other,150% of Medicare + 9.63% HCRA Surcharge,26.82,,,26.82,Fee Schedule,Average Sale Price (ASP) x 6,6.76,35,,6.76,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,6.57,34,,6.57,percent of total billed charges,Drugs,6.57,34,,6.57,percent of total billed charges,Drugs,6.57,34,,6.57,percent of total billed charges,Drugs,6.57,34,,6.57,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,7.73,40,,7.73,percent of total billed charges,Drugs,13.52,70,,13.52,percent of total billed charges,All Other,6.96,36,,6.96,percent of total billed charges,Drugs,6.96,36,,6.96,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,6.76,35,,6.76,percent of total billed charges,Drugs,6.44,,,6.44,Other,Drug Cost,6.44,,,6.44,Other,Drug Cost,6.44,,,6.44,Other,Drug Cost,6.44,,,6.44,Other,Drug Cost,6.44,,,6.44,Other,Drug Cost,6.44,,,6.44,Other,Drug Cost,14.49,,,14.49,Other,225% of Medicaid,9.02,,,9.02,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,42.91,,,42.91,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",13.85,,,13.85,Other,215% Medicaid APG methodology,13.85,,,13.85,Other,215% Medicaid APG methodology,8.05,,,8.05,Other,125% Medicaid APG methodology,0.01,44.1,
LEUCOVORIN CALCIUM 200MG INJ,J0640,HCPCS,,80001153,CDM,636,RC,143936801,NDC,both,1,EA,27.3,44.1,,,44.1,Other,150% of Medicare + 9.63% HCRA Surcharge,26.82,,,26.82,Fee Schedule,Average Sale Price (ASP) x 6,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.28,34,,9.28,percent of total billed charges,Drugs,9.28,34,,9.28,percent of total billed charges,Drugs,9.28,34,,9.28,percent of total billed charges,Drugs,9.28,34,,9.28,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,10.92,40,,10.92,percent of total billed charges,Drugs,19.11,70,,19.11,percent of total billed charges,All Other,9.83,36,,9.83,percent of total billed charges,Drugs,9.83,36,,9.83,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,20.48,,,20.48,Other,225% of Medicaid,12.74,,,12.74,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,42.91,,,42.91,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",19.57,,,19.57,Other,215% Medicaid APG methodology,19.57,,,19.57,Other,215% Medicaid APG methodology,11.38,,,11.38,Other,125% Medicaid APG methodology,0.01,44.1,
LEUCOVORIN CALCIUM 50MG INJ,J0640,HCPCS,,80001154,CDM,636,RC,143955501,NDC,both,1,EA,2.76,44.1,,,44.1,Other,150% of Medicare + 9.63% HCRA Surcharge,26.82,,,26.82,Fee Schedule,Average Sale Price (ASP) x 6,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.94,34,,0.94,percent of total billed charges,Drugs,0.94,34,,0.94,percent of total billed charges,Drugs,0.94,34,,0.94,percent of total billed charges,Drugs,0.94,34,,0.94,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,1.1,40,,1.1,percent of total billed charges,Drugs,1.93,70,,1.93,percent of total billed charges,All Other,0.99,36,,0.99,percent of total billed charges,Drugs,0.99,36,,0.99,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.97,35,,0.97,percent of total billed charges,Drugs,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,0.92,,,0.92,Other,Drug Cost,2.07,,,2.07,Other,225% of Medicaid,1.29,,,1.29,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,42.91,,,42.91,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.98,,,1.98,Other,215% Medicaid APG methodology,1.98,,,1.98,Other,215% Medicaid APG methodology,1.15,,,1.15,Other,125% Medicaid APG methodology,0.01,44.1,
LEUPROLIDE ACETATE (LUPRON DEPOT) 3.75MG,J1950,HCPCS,,80001156,CDM,636,RC,74364103,NDC,both,1,EA,4661.79,15437.48,,,15437.48,Other,150% of Medicare + 9.63% HCRA Surcharge,9387.62,,,9387.62,Fee Schedule,Average Sale Price (ASP) x 6,1631.63,35,,1631.63,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1585.01,34,,1585.01,percent of total billed charges,Drugs,1585.01,34,,1585.01,percent of total billed charges,Drugs,1585.01,34,,1585.01,percent of total billed charges,Drugs,1585.01,34,,1585.01,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1585.01,34,"If Charge > 500, then 34 percent",1585.01,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1864.72,40,,1864.72,percent of total billed charges,Drugs,3263.25,70,,3263.25,percent of total billed charges,All Other,1678.24,36,,1678.24,percent of total billed charges,Drugs,1678.24,36,,1678.24,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1631.63,35,,1631.63,percent of total billed charges,Drugs,1553.93,,,1553.93,Other,Drug Cost,1553.93,,,1553.93,Other,Drug Cost,1553.93,,,1553.93,Other,Drug Cost,1553.93,,,1553.93,Other,Drug Cost,1553.93,,,1553.93,Other,Drug Cost,1553.93,,,1553.93,Other,Drug Cost,3496.34,,,3496.34,Other,225% of Medicaid,2175.5,,,2175.5,Other,140% of Medicaid,1585.01,34,"If Charge > 2,000, then 34 percent",1585.01,percent of total billed charges,Drugs,15020.2,,,15020.2,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3340.95,,,3340.95,Other,215% Medicaid APG methodology,3340.95,,,3340.95,Other,215% Medicaid APG methodology,1942.41,,,1942.41,Other,125% Medicaid APG methodology,0.01,15437.48,
LEVETIRACETAM INJECTION 500MG/5ML,J1953,HCPCS,,80001163,CDM,636,RC,25021078005,NDC,both,10,ML,3.13,0.62,,,0.62,Other,150% of Medicare + 9.63% HCRA Surcharge,0.38,,,0.38,Fee Schedule,Average Sale Price (ASP) x 6,1.09,35,,1.09,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,1.06,34,,1.06,percent of total billed charges,Drugs,1.06,34,,1.06,percent of total billed charges,Drugs,1.06,34,,1.06,percent of total billed charges,Drugs,1.06,34,,1.06,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,1.25,40,,1.25,percent of total billed charges,Drugs,2.19,70,,2.19,percent of total billed charges,All Other,1.13,36,,1.13,percent of total billed charges,Drugs,1.13,36,,1.13,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,1.09,35,,1.09,percent of total billed charges,Drugs,1.04,,,1.04,Other,Drug Cost,1.04,,,1.04,Other,Drug Cost,1.04,,,1.04,Other,Drug Cost,1.04,,,1.04,Other,Drug Cost,1.04,,,1.04,Other,Drug Cost,1.04,,,1.04,Other,Drug Cost,2.34,,,2.34,Other,225% of Medicaid,1.46,,,1.46,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.6,,,0.6,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.24,,,2.24,Other,215% Medicaid APG methodology,2.24,,,2.24,Other,215% Medicaid APG methodology,1.3,,,1.3,Other,125% Medicaid APG methodology,0.01,2.34,
LEVOFLOXACIN 250 MG/50ML IV,J1956,HCPCS,,80001170,CDM,636,RC,25021013281,NDC,both,24,ML,4.03,8.96,,,8.96,Other,150% of Medicare + 9.63% HCRA Surcharge,5.45,,,5.45,Fee Schedule,Average Sale Price (ASP) x 6,1.41,35,,1.41,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,1.37,34,,1.37,percent of total billed charges,Drugs,1.37,34,,1.37,percent of total billed charges,Drugs,1.37,34,,1.37,percent of total billed charges,Drugs,1.37,34,,1.37,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,1.61,40,,1.61,percent of total billed charges,Drugs,2.82,70,,2.82,percent of total billed charges,All Other,1.45,36,,1.45,percent of total billed charges,Drugs,1.45,36,,1.45,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,1.41,35,,1.41,percent of total billed charges,Drugs,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,1.34,,,1.34,Other,Drug Cost,3.02,,,3.02,Other,225% of Medicaid,1.88,,,1.88,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,8.72,,,8.72,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.89,,,2.89,Other,215% Medicaid APG methodology,2.89,,,2.89,Other,215% Medicaid APG methodology,1.68,,,1.68,Other,125% Medicaid APG methodology,0.01,8.96,
LEVOFLOXACIN 500MG/100ML IV,J1956,HCPCS,,80001173,CDM,636,RC,143972124,NDC,both,24,ML,4.59,8.96,,,8.96,Other,150% of Medicare + 9.63% HCRA Surcharge,5.45,,,5.45,Fee Schedule,Average Sale Price (ASP) x 6,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.56,34,,1.56,percent of total billed charges,Drugs,1.56,34,,1.56,percent of total billed charges,Drugs,1.56,34,,1.56,percent of total billed charges,Drugs,1.56,34,,1.56,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.84,40,,1.84,percent of total billed charges,Drugs,3.21,70,,3.21,percent of total billed charges,All Other,1.65,36,,1.65,percent of total billed charges,Drugs,1.65,36,,1.65,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.61,35,,1.61,percent of total billed charges,Drugs,1.53,,,1.53,Other,Drug Cost,1.53,,,1.53,Other,Drug Cost,1.53,,,1.53,Other,Drug Cost,1.53,,,1.53,Other,Drug Cost,1.53,,,1.53,Other,Drug Cost,1.53,,,1.53,Other,Drug Cost,3.44,,,3.44,Other,225% of Medicaid,2.14,,,2.14,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,8.72,,,8.72,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.29,,,3.29,Other,215% Medicaid APG methodology,3.29,,,3.29,Other,215% Medicaid APG methodology,1.91,,,1.91,Other,125% Medicaid APG methodology,0.01,8.96,
LEVOFLOXACIN 750MG/150ML IV,J1956,HCPCS,,80001175,CDM,636,RC,409052835,NDC,both,24,ML,4.25,8.96,,,8.96,Other,150% of Medicare + 9.63% HCRA Surcharge,5.45,,,5.45,Fee Schedule,Average Sale Price (ASP) x 6,1.49,35,,1.49,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,1.45,34,,1.45,percent of total billed charges,Drugs,1.45,34,,1.45,percent of total billed charges,Drugs,1.45,34,,1.45,percent of total billed charges,Drugs,1.45,34,,1.45,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,1.7,40,,1.7,percent of total billed charges,Drugs,2.98,70,,2.98,percent of total billed charges,All Other,1.53,36,,1.53,percent of total billed charges,Drugs,1.53,36,,1.53,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,1.49,35,,1.49,percent of total billed charges,Drugs,1.42,,,1.42,Other,Drug Cost,1.42,,,1.42,Other,Drug Cost,1.42,,,1.42,Other,Drug Cost,1.42,,,1.42,Other,Drug Cost,1.42,,,1.42,Other,Drug Cost,1.42,,,1.42,Other,Drug Cost,3.19,,,3.19,Other,225% of Medicaid,1.98,,,1.98,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,8.72,,,8.72,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.05,,,3.05,Other,215% Medicaid APG methodology,3.05,,,3.05,Other,215% Medicaid APG methodology,1.77,,,1.77,Other,125% Medicaid APG methodology,0.01,8.96,
LIDOCAINE HCL  2GM/500ML IV,J2001,HCPCS,,80001200,CDM,636,RC,338040903,NDC,both,18,ML,10.84,0.27,,,0.27,Other,150% of Medicare + 9.63% HCRA Surcharge,0.16,,,0.16,Fee Schedule,Average Sale Price (ASP) x 6,3.79,35,,3.79,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,3.69,34,,3.69,percent of total billed charges,Drugs,3.69,34,,3.69,percent of total billed charges,Drugs,3.69,34,,3.69,percent of total billed charges,Drugs,3.69,34,,3.69,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,4.34,40,,4.34,percent of total billed charges,Drugs,7.59,70,,7.59,percent of total billed charges,All Other,3.9,36,,3.9,percent of total billed charges,Drugs,3.9,36,,3.9,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,3.79,35,,3.79,percent of total billed charges,Drugs,3.61,,,3.61,Other,Drug Cost,3.61,,,3.61,Other,Drug Cost,3.61,,,3.61,Other,Drug Cost,3.61,,,3.61,Other,Drug Cost,3.61,,,3.61,Other,Drug Cost,3.61,,,3.61,Other,Drug Cost,8.13,,,8.13,Other,225% of Medicaid,5.06,,,5.06,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.26,,,0.26,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.77,,,7.77,Other,215% Medicaid APG methodology,7.77,,,7.77,Other,215% Medicaid APG methodology,4.52,,,4.52,Other,125% Medicaid APG methodology,0.01,8.13,
LIDOCAINE HCL 20 MG/ML 5ML ABBOJ,J2001,HCPCS,,80001202,CDM,636,RC,409132305,NDC,both,10,ML,5.77,0.27,,,0.27,Other,150% of Medicare + 9.63% HCRA Surcharge,0.16,,,0.16,Fee Schedule,Average Sale Price (ASP) x 6,2.02,35,,2.02,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,1.96,34,,1.96,percent of total billed charges,Drugs,1.96,34,,1.96,percent of total billed charges,Drugs,1.96,34,,1.96,percent of total billed charges,Drugs,1.96,34,,1.96,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,2.31,40,,2.31,percent of total billed charges,Drugs,4.04,70,,4.04,percent of total billed charges,All Other,2.08,36,,2.08,percent of total billed charges,Drugs,2.08,36,,2.08,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,2.02,35,,2.02,percent of total billed charges,Drugs,1.92,,,1.92,Other,Drug Cost,1.92,,,1.92,Other,Drug Cost,1.92,,,1.92,Other,Drug Cost,1.92,,,1.92,Other,Drug Cost,1.92,,,1.92,Other,Drug Cost,1.92,,,1.92,Other,Drug Cost,4.33,,,4.33,Other,225% of Medicaid,2.69,,,2.69,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.26,,,0.26,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.14,,,4.14,Other,215% Medicaid APG methodology,4.14,,,4.14,Other,215% Medicaid APG methodology,2.41,,,2.41,Other,125% Medicaid APG methodology,0.01,4.33,
LINEZOLID 600MG/300ML IV,J2020,HCPCS,,80001217,CDM,636,RC,55150024251,NDC,both,10,ML,14.25,32.54,,,32.54,Other,150% of Medicare + 9.63% HCRA Surcharge,19.79,,,19.79,Fee Schedule,Average Sale Price (ASP) x 6,4.99,35,,4.99,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,4.85,34,,4.85,percent of total billed charges,Drugs,4.85,34,,4.85,percent of total billed charges,Drugs,4.85,34,,4.85,percent of total billed charges,Drugs,4.85,34,,4.85,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,5.7,40,,5.7,percent of total billed charges,Drugs,9.98,70,,9.98,percent of total billed charges,All Other,5.13,36,,5.13,percent of total billed charges,Drugs,5.13,36,,5.13,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,4.99,35,,4.99,percent of total billed charges,Drugs,4.75,,,4.75,Other,Drug Cost,4.75,,,4.75,Other,Drug Cost,4.75,,,4.75,Other,Drug Cost,4.75,,,4.75,Other,Drug Cost,4.75,,,4.75,Other,Drug Cost,4.75,,,4.75,Other,Drug Cost,10.69,,,10.69,Other,225% of Medicaid,6.65,,,6.65,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,31.66,,,31.66,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",10.21,,,10.21,Other,215% Medicaid APG methodology,10.21,,,10.21,Other,215% Medicaid APG methodology,5.94,,,5.94,Other,125% Medicaid APG methodology,0.01,32.54,
LORAZEPAM INJ 2 MG/ML,J2060,HCPCS,,80001244,CDM,636,RC,641604425,NDC,both,25,ML,1.08,11.07,,,11.07,Other,150% of Medicare + 9.63% HCRA Surcharge,6.73,,,6.73,Fee Schedule,Average Sale Price (ASP) x 6,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.43,40,,0.43,percent of total billed charges,Drugs,0.76,70,,0.76,percent of total billed charges,All Other,0.39,36,,0.39,percent of total billed charges,Drugs,0.39,36,,0.39,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.81,,,0.81,Other,225% of Medicaid,0.5,,,0.5,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,10.77,,,10.77,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.77,,,0.77,Other,215% Medicaid APG methodology,0.77,,,0.77,Other,215% Medicaid APG methodology,0.45,,,0.45,Other,125% Medicaid APG methodology,0.01,11.07,
MAGNESIUM SULFATE 2GM/50ML,J3475,HCPCS,,80001263,CDM,636,RC,25021061281,NDC,both,10,ML,4.08,6.82,,,6.82,Other,150% of Medicare + 9.63% HCRA Surcharge,4.15,,,4.15,Fee Schedule,Average Sale Price (ASP) x 6,1.43,35,,1.43,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,1.39,34,,1.39,percent of total billed charges,Drugs,1.39,34,,1.39,percent of total billed charges,Drugs,1.39,34,,1.39,percent of total billed charges,Drugs,1.39,34,,1.39,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,1.63,40,,1.63,percent of total billed charges,Drugs,2.85,70,,2.85,percent of total billed charges,All Other,1.47,36,,1.47,percent of total billed charges,Drugs,1.47,36,,1.47,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,1.43,35,,1.43,percent of total billed charges,Drugs,1.36,,,1.36,Other,Drug Cost,1.36,,,1.36,Other,Drug Cost,1.36,,,1.36,Other,Drug Cost,1.36,,,1.36,Other,Drug Cost,1.36,,,1.36,Other,Drug Cost,1.36,,,1.36,Other,Drug Cost,3.06,,,3.06,Other,225% of Medicaid,1.9,,,1.9,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.63,,,6.63,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.92,,,2.92,Other,215% Medicaid APG methodology,2.92,,,2.92,Other,215% Medicaid APG methodology,1.7,,,1.7,Other,125% Medicaid APG methodology,0.01,6.82,
MAGNESIUM SULFATE 4MEQ/ML 2ML INJ,J3475,HCPCS,,80001265,CDM,636,RC,63323006403,NDC,both,25,ML,0.81,6.82,,,6.82,Other,150% of Medicare + 9.63% HCRA Surcharge,4.15,,,4.15,Fee Schedule,Average Sale Price (ASP) x 6,0.29,35,,0.29,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.28,34,,0.28,percent of total billed charges,Drugs,0.28,34,,0.28,percent of total billed charges,Drugs,0.28,34,,0.28,percent of total billed charges,Drugs,0.28,34,,0.28,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.33,40,,0.33,percent of total billed charges,Drugs,0.57,70,,0.57,percent of total billed charges,All Other,0.29,36,,0.29,percent of total billed charges,Drugs,0.29,36,,0.29,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.29,35,,0.29,percent of total billed charges,Drugs,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.27,,,0.27,Other,Drug Cost,0.61,,,0.61,Other,225% of Medicaid,0.38,,,0.38,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.63,,,6.63,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.58,,,0.58,Other,215% Medicaid APG methodology,0.58,,,0.58,Other,215% Medicaid APG methodology,0.34,,,0.34,Other,125% Medicaid APG methodology,0.01,6.82,
MANNITOL INJ 25% IN 50 ML,J2150,HCPCS,,80001267,CDM,636,RC,409403101,NDC,both,25,ML,4.42,25.6,,,25.6,Other,150% of Medicare + 9.63% HCRA Surcharge,15.57,,,15.57,Fee Schedule,Average Sale Price (ASP) x 6,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.5,34,,1.5,percent of total billed charges,Drugs,1.5,34,,1.5,percent of total billed charges,Drugs,1.5,34,,1.5,percent of total billed charges,Drugs,1.5,34,,1.5,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.77,40,,1.77,percent of total billed charges,Drugs,3.09,70,,3.09,percent of total billed charges,All Other,1.59,36,,1.59,percent of total billed charges,Drugs,1.59,36,,1.59,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.47,,,1.47,Other,Drug Cost,1.47,,,1.47,Other,Drug Cost,1.47,,,1.47,Other,Drug Cost,1.47,,,1.47,Other,Drug Cost,1.47,,,1.47,Other,Drug Cost,1.47,,,1.47,Other,Drug Cost,3.32,,,3.32,Other,225% of Medicaid,2.06,,,2.06,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,24.91,,,24.91,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.17,,,3.17,Other,215% Medicaid APG methodology,3.17,,,3.17,Other,215% Medicaid APG methodology,1.84,,,1.84,Other,125% Medicaid APG methodology,0.01,25.6,
MEPERIDINE (DEMEROL) HCL 50MG INJ,J2175,HCPCS,,80001289,CDM,636,RC,409117830,NDC,both,10,ML,0.03,72.02,,,72.02,Other,150% of Medicare + 9.63% HCRA Surcharge,43.79,,,43.79,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,70.07,,,70.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,72.02,
MEPIVACAINE 1.5% 30ML INJ,J0670,HCPCS,,80001292,CDM,636,RC,63323029337,NDC,both,25,ML,19.08,32.46,,,32.46,Other,150% of Medicare + 9.63% HCRA Surcharge,19.74,,,19.74,Fee Schedule,Average Sale Price (ASP) x 6,6.68,35,,6.68,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,6.49,34,,6.49,percent of total billed charges,Drugs,6.49,34,,6.49,percent of total billed charges,Drugs,6.49,34,,6.49,percent of total billed charges,Drugs,6.49,34,,6.49,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,7.63,40,,7.63,percent of total billed charges,Drugs,13.36,70,,13.36,percent of total billed charges,All Other,6.87,36,,6.87,percent of total billed charges,Drugs,6.87,36,,6.87,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,6.68,35,,6.68,percent of total billed charges,Drugs,6.36,,,6.36,Other,Drug Cost,6.36,,,6.36,Other,Drug Cost,6.36,,,6.36,Other,Drug Cost,6.36,,,6.36,Other,Drug Cost,6.36,,,6.36,Other,Drug Cost,6.36,,,6.36,Other,Drug Cost,14.31,,,14.31,Other,225% of Medicaid,8.9,,,8.9,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,31.58,,,31.58,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",13.67,,,13.67,Other,215% Medicaid APG methodology,13.67,,,13.67,Other,215% Medicaid APG methodology,7.95,,,7.95,Other,125% Medicaid APG methodology,0.01,32.46,
MEPIVACAINE HCL 1% INJ 30ML,J0670,HCPCS,,80001296,CDM,636,RC,63323026037,NDC,both,25,ML,11.96,32.46,,,32.46,Other,150% of Medicare + 9.63% HCRA Surcharge,19.74,,,19.74,Fee Schedule,Average Sale Price (ASP) x 6,4.19,35,,4.19,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,4.07,34,,4.07,percent of total billed charges,Drugs,4.07,34,,4.07,percent of total billed charges,Drugs,4.07,34,,4.07,percent of total billed charges,Drugs,4.07,34,,4.07,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,4.78,40,,4.78,percent of total billed charges,Drugs,8.37,70,,8.37,percent of total billed charges,All Other,4.3,36,,4.3,percent of total billed charges,Drugs,4.3,36,,4.3,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,4.19,35,,4.19,percent of total billed charges,Drugs,3.99,,,3.99,Other,Drug Cost,3.99,,,3.99,Other,Drug Cost,3.99,,,3.99,Other,Drug Cost,3.99,,,3.99,Other,Drug Cost,3.99,,,3.99,Other,Drug Cost,3.99,,,3.99,Other,Drug Cost,8.97,,,8.97,Other,225% of Medicaid,5.58,,,5.58,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,31.58,,,31.58,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8.57,,,8.57,Other,215% Medicaid APG methodology,8.57,,,8.57,Other,215% Medicaid APG methodology,4.98,,,4.98,Other,125% Medicaid APG methodology,0.01,32.46,
MEROPENEM 100 MG INJ,J2185,HCPCS,,80001301,CDM,636,RC,63323050830,NDC,both,10,EA,6.16,4.46,,,4.46,Other,150% of Medicare + 9.63% HCRA Surcharge,2.71,,,2.71,Fee Schedule,Average Sale Price (ASP) x 6,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.1,34,,2.1,percent of total billed charges,Drugs,2.1,34,,2.1,percent of total billed charges,Drugs,2.1,34,,2.1,percent of total billed charges,Drugs,2.1,34,,2.1,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.46,40,,2.46,percent of total billed charges,Drugs,4.31,70,,4.31,percent of total billed charges,All Other,2.22,36,,2.22,percent of total billed charges,Drugs,2.22,36,,2.22,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.05,,,2.05,Other,Drug Cost,2.05,,,2.05,Other,Drug Cost,2.05,,,2.05,Other,Drug Cost,2.05,,,2.05,Other,Drug Cost,2.05,,,2.05,Other,Drug Cost,2.05,,,2.05,Other,Drug Cost,4.62,,,4.62,Other,225% of Medicaid,2.88,,,2.88,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.34,,,4.34,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.42,,,4.42,Other,215% Medicaid APG methodology,4.42,,,4.42,Other,215% Medicaid APG methodology,2.57,,,2.57,Other,125% Medicaid APG methodology,0.01,4.62,
MESNA 200MG INJ,J9209,HCPCS,,80001308,CDM,636,RC,25021020110,NDC,both,1,ML,14.4,13.54,,,13.54,Other,150% of Medicare + 9.63% HCRA Surcharge,8.23,,,8.23,Fee Schedule,Average Sale Price (ASP) x 6,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,4.9,34,,4.9,percent of total billed charges,Drugs,4.9,34,,4.9,percent of total billed charges,Drugs,4.9,34,,4.9,percent of total billed charges,Drugs,4.9,34,,4.9,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.76,40,,5.76,percent of total billed charges,Drugs,10.08,70,,10.08,percent of total billed charges,All Other,5.18,36,,5.18,percent of total billed charges,Drugs,5.18,36,,5.18,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,5.04,35,,5.04,percent of total billed charges,Drugs,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,4.8,,,4.8,Other,Drug Cost,10.8,,,10.8,Other,225% of Medicaid,6.72,,,6.72,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,13.17,,,13.17,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",10.32,,,10.32,Other,215% Medicaid APG methodology,10.32,,,10.32,Other,215% Medicaid APG methodology,6,,,6,Other,125% Medicaid APG methodology,0.01,13.54,
METHOTREXATE 100MG/4ML INJ,J9250,HCPCS,,80001329,CDM,636,RC,61703035038,NDC,both,5,ML,8.36,3.03,,,3.03,Other,150% of Medicare + 9.63% HCRA Surcharge,1.84,,,1.84,Fee Schedule,Average Sale Price (ASP) x 6,2.93,35,,2.93,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,2.84,34,,2.84,percent of total billed charges,Drugs,2.84,34,,2.84,percent of total billed charges,Drugs,2.84,34,,2.84,percent of total billed charges,Drugs,2.84,34,,2.84,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,3.34,40,,3.34,percent of total billed charges,Drugs,5.85,70,,5.85,percent of total billed charges,All Other,3.01,36,,3.01,percent of total billed charges,Drugs,3.01,36,,3.01,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,2.93,35,,2.93,percent of total billed charges,Drugs,2.79,,,2.79,Other,Drug Cost,2.79,,,2.79,Other,Drug Cost,2.79,,,2.79,Other,Drug Cost,2.79,,,2.79,Other,Drug Cost,2.79,,,2.79,Other,Drug Cost,2.79,,,2.79,Other,Drug Cost,6.27,,,6.27,Other,225% of Medicaid,3.9,,,3.9,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.95,,,2.95,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.99,,,5.99,Other,215% Medicaid APG methodology,5.99,,,5.99,Other,215% Medicaid APG methodology,3.48,,,3.48,Other,125% Medicaid APG methodology,0.01,6.27,
METHOTREXATE 2.5MG TAB,J8610,HCPCS,,80001330,CDM,636,RC,54455025,NDC,both,100,EA,0.1,2.63,,,2.63,Other,150% of Medicare + 9.63% HCRA Surcharge,1.6,,,1.6,Fee Schedule,Average Sale Price (ASP) x 6,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,40,,0.04,percent of total billed charges,Drugs,0.07,70,,0.07,percent of total billed charges,All Other,0.04,36,,0.04,percent of total billed charges,Drugs,0.04,36,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.56,,,2.56,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,2.63,
METHYLNALTREXONE 12MG INJ,J2212,HCPCS,,80001335,CDM,636,RC,65649055103,NDC,both,7,ML,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
METHYLPREDNISOLONE 125 MG INJ,J2930,HCPCS,,80001338,CDM,636,RC,9004722,NDC,both,25,EA,3.05,58.04,,,58.04,Other,150% of Medicare + 9.63% HCRA Surcharge,35.29,,,35.29,Fee Schedule,Average Sale Price (ASP) x 6,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.22,40,,1.22,percent of total billed charges,Drugs,2.14,70,,2.14,percent of total billed charges,All Other,1.1,36,,1.1,percent of total billed charges,Drugs,1.1,36,,1.1,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,2.29,,,2.29,Other,225% of Medicaid,1.42,,,1.42,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,56.47,,,56.47,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.19,,,2.19,Other,215% Medicaid APG methodology,2.19,,,2.19,Other,215% Medicaid APG methodology,1.27,,,1.27,Other,125% Medicaid APG methodology,0.01,58.04,
METHYLPREDNISOLONE 4 MG TAB,J7509,HCPCS,,80001339,CDM,636,RC,603459321,NDC,both,100,EA,0.03,2.24,,,2.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1.36,,,1.36,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.18,,,2.18,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,2.24,
METHYLPREDNISOLONE ACETATE 80 MG INJ,J1040,HCPCS,,80001340,CDM,636,RC,9347501,NDC,both,1,ML,6.57,96.72,,,96.72,Other,150% of Medicare + 9.63% HCRA Surcharge,58.82,,,58.82,Fee Schedule,Average Sale Price (ASP) x 6,2.3,35,,2.3,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,2.23,34,,2.23,percent of total billed charges,Drugs,2.23,34,,2.23,percent of total billed charges,Drugs,2.23,34,,2.23,percent of total billed charges,Drugs,2.23,34,,2.23,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,2.63,40,,2.63,percent of total billed charges,Drugs,4.6,70,,4.6,percent of total billed charges,All Other,2.37,36,,2.37,percent of total billed charges,Drugs,2.37,36,,2.37,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,2.3,35,,2.3,percent of total billed charges,Drugs,2.19,,,2.19,Other,Drug Cost,2.19,,,2.19,Other,Drug Cost,2.19,,,2.19,Other,Drug Cost,2.19,,,2.19,Other,Drug Cost,2.19,,,2.19,Other,Drug Cost,2.19,,,2.19,Other,Drug Cost,4.93,,,4.93,Other,225% of Medicaid,3.07,,,3.07,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,94.11,,,94.11,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.71,,,4.71,Other,215% Medicaid APG methodology,4.71,,,4.71,Other,215% Medicaid APG methodology,2.74,,,2.74,Other,125% Medicaid APG methodology,0.01,96.72,
METHYLPREDNISOLONE INJ 40MG/ML,J2920,HCPCS,,80001342,CDM,636,RC,9003928,NDC,both,25,EA,1.43,41.32,,,41.32,Other,150% of Medicare + 9.63% HCRA Surcharge,25.13,,,25.13,Fee Schedule,Average Sale Price (ASP) x 6,0.5,35,,0.5,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.48,34,,0.48,percent of total billed charges,Drugs,0.48,34,,0.48,percent of total billed charges,Drugs,0.48,34,,0.48,percent of total billed charges,Drugs,0.48,34,,0.48,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.57,40,,0.57,percent of total billed charges,Drugs,1,70,,1,percent of total billed charges,All Other,0.51,36,,0.51,percent of total billed charges,Drugs,0.51,36,,0.51,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.5,35,,0.5,percent of total billed charges,Drugs,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,0.48,,,0.48,Other,Drug Cost,1.07,,,1.07,Other,225% of Medicaid,0.67,,,0.67,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,40.2,,,40.2,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.02,,,1.02,Other,215% Medicaid APG methodology,1.02,,,1.02,Other,215% Medicaid APG methodology,0.59,,,0.59,Other,125% Medicaid APG methodology,0.01,41.32,
METOCLOPRAMIDE 10MG INJ,J2765,HCPCS,,80001343,CDM,636,RC,703450204,NDC,both,25,ML,1.03,10.79,,,10.79,Other,150% of Medicare + 9.63% HCRA Surcharge,6.56,,,6.56,Fee Schedule,Average Sale Price (ASP) x 6,0.36,35,,0.36,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.35,34,,0.35,percent of total billed charges,Drugs,0.35,34,,0.35,percent of total billed charges,Drugs,0.35,34,,0.35,percent of total billed charges,Drugs,0.35,34,,0.35,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.41,40,,0.41,percent of total billed charges,Drugs,0.72,70,,0.72,percent of total billed charges,All Other,0.37,36,,0.37,percent of total billed charges,Drugs,0.37,36,,0.37,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.36,35,,0.36,percent of total billed charges,Drugs,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.34,,,0.34,Other,Drug Cost,0.77,,,0.77,Other,225% of Medicaid,0.48,,,0.48,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,10.5,,,10.5,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.74,,,0.74,Other,215% Medicaid APG methodology,0.74,,,0.74,Other,215% Medicaid APG methodology,0.43,,,0.43,Other,125% Medicaid APG methodology,0.01,10.79,
MICAFUNGIN 100MG INJ,J2248,HCPCS,,80001360,CDM,636,RC,25021019110,NDC,both,1,EA,84.39,7.47,,,7.47,Other,150% of Medicare + 9.63% HCRA Surcharge,4.54,,,4.54,Fee Schedule,Average Sale Price (ASP) x 6,29.54,35,,29.54,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,28.69,34,,28.69,percent of total billed charges,Drugs,28.69,34,,28.69,percent of total billed charges,Drugs,28.69,34,,28.69,percent of total billed charges,Drugs,28.69,34,,28.69,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,33.76,40,,33.76,percent of total billed charges,Drugs,59.07,70,,59.07,percent of total billed charges,All Other,30.38,36,,30.38,percent of total billed charges,Drugs,30.38,36,,30.38,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,29.54,35,,29.54,percent of total billed charges,Drugs,28.13,,,28.13,Other,Drug Cost,28.13,,,28.13,Other,Drug Cost,28.13,,,28.13,Other,Drug Cost,28.13,,,28.13,Other,Drug Cost,28.13,,,28.13,Other,Drug Cost,28.13,,,28.13,Other,Drug Cost,63.29,,,63.29,Other,225% of Medicaid,39.38,,,39.38,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.27,,,7.27,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",60.48,,,60.48,Other,215% Medicaid APG methodology,60.48,,,60.48,Other,215% Medicaid APG methodology,35.16,,,35.16,Other,125% Medicaid APG methodology,0.01,63.29,
MICAFUNGIN 50MG INJ,J2248,HCPCS,,80001361,CDM,636,RC,469325010,NDC,both,1,EA,68.61,7.47,,,7.47,Other,150% of Medicare + 9.63% HCRA Surcharge,4.54,,,4.54,Fee Schedule,Average Sale Price (ASP) x 6,24.01,35,,24.01,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,23.33,34,,23.33,percent of total billed charges,Drugs,23.33,34,,23.33,percent of total billed charges,Drugs,23.33,34,,23.33,percent of total billed charges,Drugs,23.33,34,,23.33,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,27.44,40,,27.44,percent of total billed charges,Drugs,48.03,70,,48.03,percent of total billed charges,All Other,24.7,36,,24.7,percent of total billed charges,Drugs,24.7,36,,24.7,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,24.01,35,,24.01,percent of total billed charges,Drugs,22.87,,,22.87,Other,Drug Cost,22.87,,,22.87,Other,Drug Cost,22.87,,,22.87,Other,Drug Cost,22.87,,,22.87,Other,Drug Cost,22.87,,,22.87,Other,Drug Cost,22.87,,,22.87,Other,Drug Cost,51.46,,,51.46,Other,225% of Medicaid,32.02,,,32.02,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.27,,,7.27,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",49.17,,,49.17,Other,215% Medicaid APG methodology,49.17,,,49.17,Other,215% Medicaid APG methodology,28.59,,,28.59,Other,125% Medicaid APG methodology,0.01,51.46,
MIDAZOLAM  INJ 2MG/2ML,J2250,HCPCS,,80001369,CDM,636,RC,63323041112,NDC,both,25,ML,0.79,1.4,,,1.4,Other,150% of Medicare + 9.63% HCRA Surcharge,0.85,,,0.85,Fee Schedule,Average Sale Price (ASP) x 6,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.27,34,,0.27,percent of total billed charges,Drugs,0.27,34,,0.27,percent of total billed charges,Drugs,0.27,34,,0.27,percent of total billed charges,Drugs,0.27,34,,0.27,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.32,40,,0.32,percent of total billed charges,Drugs,0.55,70,,0.55,percent of total billed charges,All Other,0.28,36,,0.28,percent of total billed charges,Drugs,0.28,36,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.28,35,,0.28,percent of total billed charges,Drugs,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.26,,,0.26,Other,Drug Cost,0.59,,,0.59,Other,225% of Medicaid,0.37,,,0.37,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.36,,,1.36,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.57,,,0.57,Other,215% Medicaid APG methodology,0.57,,,0.57,Other,215% Medicaid APG methodology,0.33,,,0.33,Other,125% Medicaid APG methodology,0.01,1.4,
MIDAZOLAM  INJ 5MG/5ML,J2250,HCPCS,,80001370,CDM,636,RC,63323041125,NDC,both,25,ML,2.01,1.4,,,1.4,Other,150% of Medicare + 9.63% HCRA Surcharge,0.85,,,0.85,Fee Schedule,Average Sale Price (ASP) x 6,0.7,35,,0.7,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.68,34,,0.68,percent of total billed charges,Drugs,0.68,34,,0.68,percent of total billed charges,Drugs,0.68,34,,0.68,percent of total billed charges,Drugs,0.68,34,,0.68,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.8,40,,0.8,percent of total billed charges,Drugs,1.41,70,,1.41,percent of total billed charges,All Other,0.72,36,,0.72,percent of total billed charges,Drugs,0.72,36,,0.72,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.7,35,,0.7,percent of total billed charges,Drugs,0.67,,,0.67,Other,Drug Cost,0.67,,,0.67,Other,Drug Cost,0.67,,,0.67,Other,Drug Cost,0.67,,,0.67,Other,Drug Cost,0.67,,,0.67,Other,Drug Cost,0.67,,,0.67,Other,Drug Cost,1.51,,,1.51,Other,225% of Medicaid,0.94,,,0.94,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.36,,,1.36,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.44,,,1.44,Other,215% Medicaid APG methodology,1.44,,,1.44,Other,215% Medicaid APG methodology,0.84,,,0.84,Other,125% Medicaid APG methodology,0.01,1.51,
MILRINONE 10MG/10ML INJ,J2260,HCPCS,,80001376,CDM,636,RC,409021201,NDC,both,10,ML,4.67,15.41,,,15.41,Other,150% of Medicare + 9.63% HCRA Surcharge,9.37,,,9.37,Fee Schedule,Average Sale Price (ASP) x 6,1.63,35,,1.63,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,1.59,34,,1.59,percent of total billed charges,Drugs,1.59,34,,1.59,percent of total billed charges,Drugs,1.59,34,,1.59,percent of total billed charges,Drugs,1.59,34,,1.59,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,1.87,40,,1.87,percent of total billed charges,Drugs,3.27,70,,3.27,percent of total billed charges,All Other,1.68,36,,1.68,percent of total billed charges,Drugs,1.68,36,,1.68,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,1.63,35,,1.63,percent of total billed charges,Drugs,1.56,,,1.56,Other,Drug Cost,1.56,,,1.56,Other,Drug Cost,1.56,,,1.56,Other,Drug Cost,1.56,,,1.56,Other,Drug Cost,1.56,,,1.56,Other,Drug Cost,1.56,,,1.56,Other,Drug Cost,3.5,,,3.5,Other,225% of Medicaid,2.18,,,2.18,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,15,,,15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.34,,,3.34,Other,215% Medicaid APG methodology,3.34,,,3.34,Other,215% Medicaid APG methodology,1.94,,,1.94,Other,125% Medicaid APG methodology,0.01,15.41,
MILRINONE 20MG/100ML INJ,J2260,HCPCS,,80001377,CDM,636,RC,143971910,NDC,both,10,ML,13.21,15.41,,,15.41,Other,150% of Medicare + 9.63% HCRA Surcharge,9.37,,,9.37,Fee Schedule,Average Sale Price (ASP) x 6,4.62,35,,4.62,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,4.49,34,,4.49,percent of total billed charges,Drugs,4.49,34,,4.49,percent of total billed charges,Drugs,4.49,34,,4.49,percent of total billed charges,Drugs,4.49,34,,4.49,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,5.28,40,,5.28,percent of total billed charges,Drugs,9.25,70,,9.25,percent of total billed charges,All Other,4.76,36,,4.76,percent of total billed charges,Drugs,4.76,36,,4.76,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,4.62,35,,4.62,percent of total billed charges,Drugs,4.4,,,4.4,Other,Drug Cost,4.4,,,4.4,Other,Drug Cost,4.4,,,4.4,Other,Drug Cost,4.4,,,4.4,Other,Drug Cost,4.4,,,4.4,Other,Drug Cost,4.4,,,4.4,Other,Drug Cost,9.91,,,9.91,Other,225% of Medicaid,6.16,,,6.16,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,15,,,15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",9.47,,,9.47,Other,215% Medicaid APG methodology,9.47,,,9.47,Other,215% Medicaid APG methodology,5.5,,,5.5,Other,125% Medicaid APG methodology,0.01,15.41,
MITOMYCIN 20MG INJ,J9280,HCPCS,,80001390,CDM,636,RC,16729010811,NDC,both,1,EA,173.52,625.04,,,625.04,Other,150% of Medicare + 9.63% HCRA Surcharge,380.09,,,380.09,Fee Schedule,Average Sale Price (ASP) x 6,60.73,35,,60.73,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,59,34,,59,percent of total billed charges,Drugs,59,34,,59,percent of total billed charges,Drugs,59,34,,59,percent of total billed charges,Drugs,59,34,,59,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,69.41,40,,69.41,percent of total billed charges,Drugs,121.46,70,,121.46,percent of total billed charges,All Other,62.47,36,,62.47,percent of total billed charges,Drugs,62.47,36,,62.47,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,60.73,35,,60.73,percent of total billed charges,Drugs,57.84,,,57.84,Other,Drug Cost,57.84,,,57.84,Other,Drug Cost,57.84,,,57.84,Other,Drug Cost,57.84,,,57.84,Other,Drug Cost,57.84,,,57.84,Other,Drug Cost,57.84,,,57.84,Other,Drug Cost,130.14,,,130.14,Other,225% of Medicaid,80.98,,,80.98,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,608.14,,,608.14,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",124.36,,,124.36,Other,215% Medicaid APG methodology,124.36,,,124.36,Other,215% Medicaid APG methodology,72.3,,,72.3,Other,125% Medicaid APG methodology,0.01,625.04,
MITOMYCIN 40MG INJ,J9280,HCPCS,,80001391,CDM,636,RC,16729011638,NDC,both,1,EA,538.59,625.04,,,625.04,Other,150% of Medicare + 9.63% HCRA Surcharge,380.09,,,380.09,Fee Schedule,Average Sale Price (ASP) x 6,188.51,35,,188.51,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,183.12,34,,183.12,percent of total billed charges,Drugs,183.12,34,,183.12,percent of total billed charges,Drugs,183.12,34,,183.12,percent of total billed charges,Drugs,183.12,34,,183.12,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,183.12,34,"If Charge > 500, then 34 percent",183.12,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,215.44,40,,215.44,percent of total billed charges,Drugs,377.01,70,,377.01,percent of total billed charges,All Other,193.89,36,,193.89,percent of total billed charges,Drugs,193.89,36,,193.89,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,188.51,35,,188.51,percent of total billed charges,Drugs,179.53,,,179.53,Other,Drug Cost,179.53,,,179.53,Other,Drug Cost,179.53,,,179.53,Other,Drug Cost,179.53,,,179.53,Other,Drug Cost,179.53,,,179.53,Other,Drug Cost,179.53,,,179.53,Other,Drug Cost,403.94,,,403.94,Other,225% of Medicaid,251.34,,,251.34,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,608.14,,,608.14,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",385.99,,,385.99,Other,215% Medicaid APG methodology,385.99,,,385.99,Other,215% Medicaid APG methodology,224.41,,,224.41,Other,125% Medicaid APG methodology,0.01,625.04,
MITOXANTRONE 20MG/10ML INJ,J9293,HCPCS,,80001392,CDM,636,RC,61703034318,NDC,both,1,ML,339.21,429.97,,,429.97,Other,150% of Medicare + 9.63% HCRA Surcharge,261.47,,,261.47,Fee Schedule,Average Sale Price (ASP) x 6,118.72,35,,118.72,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,115.33,34,,115.33,percent of total billed charges,Drugs,115.33,34,,115.33,percent of total billed charges,Drugs,115.33,34,,115.33,percent of total billed charges,Drugs,115.33,34,,115.33,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,135.68,40,,135.68,percent of total billed charges,Drugs,237.45,70,,237.45,percent of total billed charges,All Other,122.12,36,,122.12,percent of total billed charges,Drugs,122.12,36,,122.12,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,118.72,35,,118.72,percent of total billed charges,Drugs,113.07,,,113.07,Other,Drug Cost,113.07,,,113.07,Other,Drug Cost,113.07,,,113.07,Other,Drug Cost,113.07,,,113.07,Other,Drug Cost,113.07,,,113.07,Other,Drug Cost,113.07,,,113.07,Other,Drug Cost,254.41,,,254.41,Other,225% of Medicaid,158.3,,,158.3,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,418.35,,,418.35,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",243.1,,,243.1,Other,215% Medicaid APG methodology,243.1,,,243.1,Other,215% Medicaid APG methodology,141.34,,,141.34,Other,125% Medicaid APG methodology,0.01,429.97,
MYCOPHENOLATE MOFETIL 250MG CAP,J7517,HCPCS,,80001424,CDM,636,RC,16729009401,NDC,both,100,EA,0.09,1.85,,,1.85,Other,150% of Medicare + 9.63% HCRA Surcharge,1.13,,,1.13,Fee Schedule,Average Sale Price (ASP) x 6,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.04,40,,0.04,percent of total billed charges,Drugs,0.06,70,,0.06,percent of total billed charges,All Other,0.03,36,,0.03,percent of total billed charges,Drugs,0.03,36,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.04,,,0.04,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.8,,,1.8,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,1.85,
MYCOPHENOLATE MOFETIL 500MG CAP,J7517,HCPCS,,80001425,CDM,636,RC,16729001901,NDC,both,100,EA,0.38,1.85,,,1.85,Other,150% of Medicare + 9.63% HCRA Surcharge,1.13,,,1.13,Fee Schedule,Average Sale Price (ASP) x 6,0.13,35,,0.13,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.13,34,,0.13,percent of total billed charges,Drugs,0.13,34,,0.13,percent of total billed charges,Drugs,0.13,34,,0.13,percent of total billed charges,Drugs,0.13,34,,0.13,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.15,40,,0.15,percent of total billed charges,Drugs,0.26,70,,0.26,percent of total billed charges,All Other,0.14,36,,0.14,percent of total billed charges,Drugs,0.14,36,,0.14,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.13,35,,0.13,percent of total billed charges,Drugs,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.13,,,0.13,Other,Drug Cost,0.28,,,0.28,Other,225% of Medicaid,0.18,,,0.18,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.8,,,1.8,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.27,,,0.27,Other,215% Medicaid APG methodology,0.27,,,0.27,Other,215% Medicaid APG methodology,0.16,,,0.16,Other,125% Medicaid APG methodology,0.01,1.85,
NALOXONE INJ 0.4MG/1ML,J2310,HCPCS,,80001431,CDM,636,RC,641613225,NDC,both,25,ML,6.17,71.91,,,71.91,Other,150% of Medicare + 9.63% HCRA Surcharge,43.73,,,43.73,Fee Schedule,Average Sale Price (ASP) x 6,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.1,34,,2.1,percent of total billed charges,Drugs,2.1,34,,2.1,percent of total billed charges,Drugs,2.1,34,,2.1,percent of total billed charges,Drugs,2.1,34,,2.1,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.47,40,,2.47,percent of total billed charges,Drugs,4.32,70,,4.32,percent of total billed charges,All Other,2.22,36,,2.22,percent of total billed charges,Drugs,2.22,36,,2.22,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.16,35,,2.16,percent of total billed charges,Drugs,2.06,,,2.06,Other,Drug Cost,2.06,,,2.06,Other,Drug Cost,2.06,,,2.06,Other,Drug Cost,2.06,,,2.06,Other,Drug Cost,2.06,,,2.06,Other,Drug Cost,2.06,,,2.06,Other,Drug Cost,4.63,,,4.63,Other,225% of Medicaid,2.88,,,2.88,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,69.96,,,69.96,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.42,,,4.42,Other,215% Medicaid APG methodology,4.42,,,4.42,Other,215% Medicaid APG methodology,2.57,,,2.57,Other,125% Medicaid APG methodology,0.01,71.91,
NALOXONE INJ 2MG/2ML,J2310,HCPCS,,80001432,CDM,636,RC,641620510,NDC,both,10,ML,27.14,71.91,,,71.91,Other,150% of Medicare + 9.63% HCRA Surcharge,43.73,,,43.73,Fee Schedule,Average Sale Price (ASP) x 6,9.5,35,,9.5,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,9.23,34,,9.23,percent of total billed charges,Drugs,9.23,34,,9.23,percent of total billed charges,Drugs,9.23,34,,9.23,percent of total billed charges,Drugs,9.23,34,,9.23,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,10.86,40,,10.86,percent of total billed charges,Drugs,19,70,,19,percent of total billed charges,All Other,9.77,36,,9.77,percent of total billed charges,Drugs,9.77,36,,9.77,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,9.5,35,,9.5,percent of total billed charges,Drugs,9.05,,,9.05,Other,Drug Cost,9.05,,,9.05,Other,Drug Cost,9.05,,,9.05,Other,Drug Cost,9.05,,,9.05,Other,Drug Cost,9.05,,,9.05,Other,Drug Cost,9.05,,,9.05,Other,Drug Cost,20.36,,,20.36,Other,225% of Medicaid,12.67,,,12.67,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,69.96,,,69.96,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",19.45,,,19.45,Other,215% Medicaid APG methodology,19.45,,,19.45,Other,215% Medicaid APG methodology,11.31,,,11.31,Other,125% Medicaid APG methodology,0.01,71.91,
OCTREOTIDE 1000MCG/5ML INJ,J2354,HCPCS,,80001524,CDM,636,RC,703334301,NDC,both,1,ML,652.26,11.72,,,11.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7.13,,,7.13,Fee Schedule,Average Sale Price (ASP) x 6,228.29,35,,228.29,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,221.77,34,,221.77,percent of total billed charges,Drugs,221.77,34,,221.77,percent of total billed charges,Drugs,221.77,34,,221.77,percent of total billed charges,Drugs,221.77,34,,221.77,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,221.77,34,"If Charge > 500, then 34 percent",221.77,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,260.9,40,,260.9,percent of total billed charges,Drugs,456.58,70,,456.58,percent of total billed charges,All Other,234.81,36,,234.81,percent of total billed charges,Drugs,234.81,36,,234.81,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,228.29,35,,228.29,percent of total billed charges,Drugs,217.42,,,217.42,Other,Drug Cost,217.42,,,217.42,Other,Drug Cost,217.42,,,217.42,Other,Drug Cost,217.42,,,217.42,Other,Drug Cost,217.42,,,217.42,Other,Drug Cost,217.42,,,217.42,Other,Drug Cost,489.2,,,489.2,Other,225% of Medicaid,304.39,,,304.39,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,11.4,,,11.4,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",467.45,,,467.45,Other,215% Medicaid APG methodology,467.45,,,467.45,Other,215% Medicaid APG methodology,271.78,,,271.78,Other,125% Medicaid APG methodology,0.01,489.2,
ONABOTULINUMTOXINA 100 UNIT,J0585,HCPCS,,80001536,CDM,636,RC,23114501,NDC,both,1,EA,1938,62.43,,,62.43,Other,150% of Medicare + 9.63% HCRA Surcharge,37.96,,,37.96,Fee Schedule,Average Sale Price (ASP) x 6,678.3,35,,678.3,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,658.92,34,,658.92,percent of total billed charges,Drugs,658.92,34,,658.92,percent of total billed charges,Drugs,658.92,34,,658.92,percent of total billed charges,Drugs,658.92,34,,658.92,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,658.92,34,"If Charge > 500, then 34 percent",658.92,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,775.2,40,,775.2,percent of total billed charges,Drugs,1356.6,70,,1356.6,percent of total billed charges,All Other,697.68,36,,697.68,percent of total billed charges,Drugs,697.68,36,,697.68,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,678.3,35,,678.3,percent of total billed charges,Drugs,646,,,646,Other,Drug Cost,646,,,646,Other,Drug Cost,646,,,646,Other,Drug Cost,646,,,646,Other,Drug Cost,646,,,646,Other,Drug Cost,646,,,646,Other,Drug Cost,1453.5,,,1453.5,Other,225% of Medicaid,904.4,,,904.4,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,60.74,,,60.74,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1388.9,,,1388.9,Other,215% Medicaid APG methodology,1388.9,,,1388.9,Other,215% Medicaid APG methodology,807.5,,,807.5,Other,125% Medicaid APG methodology,0.01,1453.5,
ONDANSETRON INJ 4MG/2ML,J2405,HCPCS,,80001538,CDM,636,RC,60505613005,NDC,both,25,ML,0.59,0.99,,,0.99,Other,150% of Medicare + 9.63% HCRA Surcharge,0.6,,,0.6,Fee Schedule,Average Sale Price (ASP) x 6,0.2,35,,0.2,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.2,34,,0.2,percent of total billed charges,Drugs,0.2,34,,0.2,percent of total billed charges,Drugs,0.2,34,,0.2,percent of total billed charges,Drugs,0.2,34,,0.2,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.23,40,,0.23,percent of total billed charges,Drugs,0.41,70,,0.41,percent of total billed charges,All Other,0.21,36,,0.21,percent of total billed charges,Drugs,0.21,36,,0.21,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.2,35,,0.2,percent of total billed charges,Drugs,0.2,,,0.2,Other,Drug Cost,0.2,,,0.2,Other,Drug Cost,0.2,,,0.2,Other,Drug Cost,0.2,,,0.2,Other,Drug Cost,0.2,,,0.2,Other,Drug Cost,0.2,,,0.2,Other,Drug Cost,0.44,,,0.44,Other,225% of Medicaid,0.27,,,0.27,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.96,,,0.96,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.42,,,0.42,Other,215% Medicaid APG methodology,0.42,,,0.42,Other,215% Medicaid APG methodology,0.24,,,0.24,Other,125% Medicaid APG methodology,0.01,0.99,
ONDANSETRON ODT 4MG,Q0162,HCPCS,,80001539,CDM,636,RC,68462015713,NDC,both,30,EA,0.15,0.14,,,0.14,Other,150% of Medicare + 9.63% HCRA Surcharge,0.08,,,0.08,Fee Schedule,Average Sale Price (ASP) x 6,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,34,,0.05,percent of total billed charges,Drugs,0.05,34,,0.05,percent of total billed charges,Drugs,0.05,34,,0.05,percent of total billed charges,Drugs,0.05,34,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.06,40,,0.06,percent of total billed charges,Drugs,0.11,70,,0.11,percent of total billed charges,All Other,0.05,36,,0.05,percent of total billed charges,Drugs,0.05,36,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,35,,0.05,percent of total billed charges,Drugs,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.05,,,0.05,Other,Drug Cost,0.11,,,0.11,Other,225% of Medicaid,0.07,,,0.07,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.13,,,0.13,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.11,,,0.11,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,215% Medicaid APG methodology,0.06,,,0.06,Other,125% Medicaid APG methodology,0.01,0.14,
OXALIPLATIN 50MG/10ML,J9263,HCPCS,,80001546,CDM,636,RC,60505613206,NDC,both,1,ML,4.44,0.7,,,0.7,Other,150% of Medicare + 9.63% HCRA Surcharge,0.43,,,0.43,Fee Schedule,Average Sale Price (ASP) x 6,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.51,34,,1.51,percent of total billed charges,Drugs,1.51,34,,1.51,percent of total billed charges,Drugs,1.51,34,,1.51,percent of total billed charges,Drugs,1.51,34,,1.51,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.78,40,,1.78,percent of total billed charges,Drugs,3.11,70,,3.11,percent of total billed charges,All Other,1.6,36,,1.6,percent of total billed charges,Drugs,1.6,36,,1.6,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.55,35,,1.55,percent of total billed charges,Drugs,1.48,,,1.48,Other,Drug Cost,1.48,,,1.48,Other,Drug Cost,1.48,,,1.48,Other,Drug Cost,1.48,,,1.48,Other,Drug Cost,1.48,,,1.48,Other,Drug Cost,1.48,,,1.48,Other,Drug Cost,3.33,,,3.33,Other,225% of Medicaid,2.07,,,2.07,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.68,,,0.68,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.18,,,3.18,Other,215% Medicaid APG methodology,3.18,,,3.18,Other,215% Medicaid APG methodology,1.85,,,1.85,Other,125% Medicaid APG methodology,0.01,3.33,
OXYTOCIN 10UNITS/ML INJ,J2590,HCPCS,,80001562,CDM,636,RC,42023011625,NDC,both,25,ML,1.35,0.53,39.4668,,0.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.47,35,,0.47,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.46,34,,0.46,percent of total billed charges,Drugs,0.46,34,,0.46,percent of total billed charges,Drugs,0.46,34,,0.46,percent of total billed charges,Drugs,0.46,34,,0.46,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.54,40,,0.54,percent of total billed charges,Drugs,0.94,70,,0.94,percent of total billed charges,All Other,0.49,36,,0.49,percent of total billed charges,Drugs,0.49,36,,0.49,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.47,35,,0.47,percent of total billed charges,Drugs,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,0.45,,,0.45,Other,Drug Cost,1.01,,,1.01,Other,225% of Medicaid,0.63,,,0.63,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.97,,,0.97,Other,215% Medicaid APG methodology,0.97,,,0.97,Other,215% Medicaid APG methodology,0.56,,,0.56,Other,125% Medicaid APG methodology,0.01,1.01,
PACLITAXEL 6MG/ML 5ML,J9267,HCPCS,,80001567,CDM,636,RC,61703034209,NDC,both,1,ML,6,1.07,,,1.07,Other,150% of Medicare + 9.63% HCRA Surcharge,0.65,,,0.65,Fee Schedule,Average Sale Price (ASP) x 6,2.1,35,,2.1,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,2.04,34,,2.04,percent of total billed charges,Drugs,2.04,34,,2.04,percent of total billed charges,Drugs,2.04,34,,2.04,percent of total billed charges,Drugs,2.04,34,,2.04,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,2.4,40,,2.4,percent of total billed charges,Drugs,4.2,70,,4.2,percent of total billed charges,All Other,2.16,36,,2.16,percent of total billed charges,Drugs,2.16,36,,2.16,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,2.1,35,,2.1,percent of total billed charges,Drugs,2,,,2,Other,Drug Cost,2,,,2,Other,Drug Cost,2,,,2,Other,Drug Cost,2,,,2,Other,Drug Cost,2,,,2,Other,Drug Cost,2,,,2,Other,Drug Cost,4.5,,,4.5,Other,225% of Medicaid,2.8,,,2.8,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.04,,,1.04,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.3,,,4.3,Other,215% Medicaid APG methodology,4.3,,,4.3,Other,215% Medicaid APG methodology,2.5,,,2.5,Other,125% Medicaid APG methodology,0.01,4.5,
PACLITAXEL PROTEIN BOUND 100MG INJ,J9264,HCPCS,,80001568,CDM,636,RC,68817013450,NDC,both,1,EA,4526.88,141.03,,,141.03,Other,150% of Medicare + 9.63% HCRA Surcharge,85.76,,,85.76,Fee Schedule,Average Sale Price (ASP) x 6,1584.41,35,,1584.41,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1539.14,34,,1539.14,percent of total billed charges,Drugs,1539.14,34,,1539.14,percent of total billed charges,Drugs,1539.14,34,,1539.14,percent of total billed charges,Drugs,1539.14,34,,1539.14,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1539.14,34,"If Charge > 500, then 34 percent",1539.14,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1810.75,40,,1810.75,percent of total billed charges,Drugs,3168.82,70,,3168.82,percent of total billed charges,All Other,1629.68,36,,1629.68,percent of total billed charges,Drugs,1629.68,36,,1629.68,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1584.41,35,,1584.41,percent of total billed charges,Drugs,1508.96,,,1508.96,Other,Drug Cost,1508.96,,,1508.96,Other,Drug Cost,1508.96,,,1508.96,Other,Drug Cost,1508.96,,,1508.96,Other,Drug Cost,1508.96,,,1508.96,Other,Drug Cost,1508.96,,,1508.96,Other,Drug Cost,3395.16,,,3395.16,Other,225% of Medicaid,2112.54,,,2112.54,Other,140% of Medicaid,1539.14,34,"If Charge > 2,000, then 34 percent",1539.14,percent of total billed charges,Drugs,137.22,,,137.22,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3244.26,,,3244.26,Other,215% Medicaid APG methodology,3244.26,,,3244.26,Other,215% Medicaid APG methodology,1886.2,,,1886.2,Other,125% Medicaid APG methodology,0.01,3395.16,
PALIPERIDONE PALMITATE 117MG INJ,J2426,HCPCS,,80001572,CDM,636,RC,50458056201,NDC,both,1,ML,1784.79,141.27,,,141.27,Other,150% of Medicare + 9.63% HCRA Surcharge,85.91,,,85.91,Fee Schedule,Average Sale Price (ASP) x 6,624.68,35,,624.68,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,606.83,34,,606.83,percent of total billed charges,Drugs,606.83,34,,606.83,percent of total billed charges,Drugs,606.83,34,,606.83,percent of total billed charges,Drugs,606.83,34,,606.83,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,606.83,34,"If Charge > 500, then 34 percent",606.83,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,713.92,40,,713.92,percent of total billed charges,Drugs,1249.35,70,,1249.35,percent of total billed charges,All Other,642.52,36,,642.52,percent of total billed charges,Drugs,642.52,36,,642.52,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,624.68,35,,624.68,percent of total billed charges,Drugs,594.93,,,594.93,Other,Drug Cost,594.93,,,594.93,Other,Drug Cost,594.93,,,594.93,Other,Drug Cost,594.93,,,594.93,Other,Drug Cost,594.93,,,594.93,Other,Drug Cost,594.93,,,594.93,Other,Drug Cost,1338.59,,,1338.59,Other,225% of Medicaid,832.9,,,832.9,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,137.45,,,137.45,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1279.1,,,1279.1,Other,215% Medicaid APG methodology,1279.1,,,1279.1,Other,215% Medicaid APG methodology,743.66,,,743.66,Other,125% Medicaid APG methodology,0.01,1338.59,
PALIPERIDONE PALMITATE 156MG INJ,J2426,HCPCS,,80001573,CDM,636,RC,50458056301,NDC,both,1,ML,2283.75,141.27,,,141.27,Other,150% of Medicare + 9.63% HCRA Surcharge,85.91,,,85.91,Fee Schedule,Average Sale Price (ASP) x 6,799.31,35,,799.31,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,776.48,34,,776.48,percent of total billed charges,Drugs,776.48,34,,776.48,percent of total billed charges,Drugs,776.48,34,,776.48,percent of total billed charges,Drugs,776.48,34,,776.48,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,776.48,34,"If Charge > 500, then 34 percent",776.48,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,913.5,40,,913.5,percent of total billed charges,Drugs,1598.63,70,,1598.63,percent of total billed charges,All Other,822.15,36,,822.15,percent of total billed charges,Drugs,822.15,36,,822.15,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,799.31,35,,799.31,percent of total billed charges,Drugs,761.25,,,761.25,Other,Drug Cost,761.25,,,761.25,Other,Drug Cost,761.25,,,761.25,Other,Drug Cost,761.25,,,761.25,Other,Drug Cost,761.25,,,761.25,Other,Drug Cost,761.25,,,761.25,Other,Drug Cost,1712.81,,,1712.81,Other,225% of Medicaid,1065.75,,,1065.75,Other,140% of Medicaid,776.48,34,"If Charge > 2,000, then 34 percent",776.48,percent of total billed charges,Drugs,137.45,,,137.45,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1636.69,,,1636.69,Other,215% Medicaid APG methodology,1636.69,,,1636.69,Other,215% Medicaid APG methodology,951.56,,,951.56,Other,125% Medicaid APG methodology,0.01,1712.81,
PALIPERIDONE PALMITATE 234MG INJ,J2426,HCPCS,,80001574,CDM,636,RC,50458056401,NDC,both,1,ML,3433.47,141.27,,,141.27,Other,150% of Medicare + 9.63% HCRA Surcharge,85.91,,,85.91,Fee Schedule,Average Sale Price (ASP) x 6,1201.71,35,,1201.71,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1167.38,34,,1167.38,percent of total billed charges,Drugs,1167.38,34,,1167.38,percent of total billed charges,Drugs,1167.38,34,,1167.38,percent of total billed charges,Drugs,1167.38,34,,1167.38,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1167.38,34,"If Charge > 500, then 34 percent",1167.38,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1373.39,40,,1373.39,percent of total billed charges,Drugs,2403.43,70,,2403.43,percent of total billed charges,All Other,1236.05,36,,1236.05,percent of total billed charges,Drugs,1236.05,36,,1236.05,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1201.71,35,,1201.71,percent of total billed charges,Drugs,1144.49,,,1144.49,Other,Drug Cost,1144.49,,,1144.49,Other,Drug Cost,1144.49,,,1144.49,Other,Drug Cost,1144.49,,,1144.49,Other,Drug Cost,1144.49,,,1144.49,Other,Drug Cost,1144.49,,,1144.49,Other,Drug Cost,2575.1,,,2575.1,Other,225% of Medicaid,1602.29,,,1602.29,Other,140% of Medicaid,1167.38,34,"If Charge > 2,000, then 34 percent",1167.38,percent of total billed charges,Drugs,137.45,,,137.45,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2460.65,,,2460.65,Other,215% Medicaid APG methodology,2460.65,,,2460.65,Other,215% Medicaid APG methodology,1430.61,,,1430.61,Other,125% Medicaid APG methodology,0.01,2575.1,
PALONOSETRON HCL 25MCG TO 0.25MG INJ,J2469,HCPCS,,80001576,CDM,636,RC,60505619301,NDC,both,1,ML,1.8,8.34,,,8.34,Other,150% of Medicare + 9.63% HCRA Surcharge,5.07,,,5.07,Fee Schedule,Average Sale Price (ASP) x 6,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.61,34,,0.61,percent of total billed charges,Drugs,0.61,34,,0.61,percent of total billed charges,Drugs,0.61,34,,0.61,percent of total billed charges,Drugs,0.61,34,,0.61,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.72,40,,0.72,percent of total billed charges,Drugs,1.26,70,,1.26,percent of total billed charges,All Other,0.65,36,,0.65,percent of total billed charges,Drugs,0.65,36,,0.65,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.63,35,,0.63,percent of total billed charges,Drugs,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,0.6,,,0.6,Other,Drug Cost,1.35,,,1.35,Other,225% of Medicaid,0.84,,,0.84,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,8.11,,,8.11,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.29,,,1.29,Other,215% Medicaid APG methodology,1.29,,,1.29,Other,215% Medicaid APG methodology,0.75,,,0.75,Other,125% Medicaid APG methodology,0.01,8.34,
PAMIDRONATE DISODIUM 3MG/ML 10ML,J2430,HCPCS,,80001578,CDM,636,RC,67457043010,NDC,both,1,ML,25.65,87.56,,,87.56,Other,150% of Medicare + 9.63% HCRA Surcharge,53.24,,,53.24,Fee Schedule,Average Sale Price (ASP) x 6,8.98,35,,8.98,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,8.72,34,,8.72,percent of total billed charges,Drugs,8.72,34,,8.72,percent of total billed charges,Drugs,8.72,34,,8.72,percent of total billed charges,Drugs,8.72,34,,8.72,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,10.26,40,,10.26,percent of total billed charges,Drugs,17.96,70,,17.96,percent of total billed charges,All Other,9.23,36,,9.23,percent of total billed charges,Drugs,9.23,36,,9.23,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,8.98,35,,8.98,percent of total billed charges,Drugs,8.55,,,8.55,Other,Drug Cost,8.55,,,8.55,Other,Drug Cost,8.55,,,8.55,Other,Drug Cost,8.55,,,8.55,Other,Drug Cost,8.55,,,8.55,Other,Drug Cost,8.55,,,8.55,Other,Drug Cost,19.24,,,19.24,Other,225% of Medicaid,11.97,,,11.97,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,85.19,,,85.19,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",18.38,,,18.38,Other,215% Medicaid APG methodology,18.38,,,18.38,Other,215% Medicaid APG methodology,10.69,,,10.69,Other,125% Medicaid APG methodology,0.01,87.56,
PAMIDRONATE DISODIUM 9MG/ML 10ML,J2430,HCPCS,,80001580,CDM,636,RC,61703032618,NDC,both,1,ML,70.11,87.56,,,87.56,Other,150% of Medicare + 9.63% HCRA Surcharge,53.24,,,53.24,Fee Schedule,Average Sale Price (ASP) x 6,24.54,35,,24.54,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,23.84,34,,23.84,percent of total billed charges,Drugs,23.84,34,,23.84,percent of total billed charges,Drugs,23.84,34,,23.84,percent of total billed charges,Drugs,23.84,34,,23.84,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,28.04,40,,28.04,percent of total billed charges,Drugs,49.08,70,,49.08,percent of total billed charges,All Other,25.24,36,,25.24,percent of total billed charges,Drugs,25.24,36,,25.24,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,24.54,35,,24.54,percent of total billed charges,Drugs,23.37,,,23.37,Other,Drug Cost,23.37,,,23.37,Other,Drug Cost,23.37,,,23.37,Other,Drug Cost,23.37,,,23.37,Other,Drug Cost,23.37,,,23.37,Other,Drug Cost,23.37,,,23.37,Other,Drug Cost,52.58,,,52.58,Other,225% of Medicaid,32.72,,,32.72,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,85.19,,,85.19,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",50.25,,,50.25,Other,215% Medicaid APG methodology,50.25,,,50.25,Other,215% Medicaid APG methodology,29.21,,,29.21,Other,125% Medicaid APG methodology,0.01,87.56,
PANITUMUMAB INJECTION 100MG INJ,J9303,HCPCS,,80001581,CDM,636,RC,55513095401,NDC,both,1,ML,2467.17,1486.51,,,1486.51,Other,150% of Medicare + 9.63% HCRA Surcharge,903.95,,,903.95,Fee Schedule,Average Sale Price (ASP) x 6,863.51,35,,863.51,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,838.84,34,,838.84,percent of total billed charges,Drugs,838.84,34,,838.84,percent of total billed charges,Drugs,838.84,34,,838.84,percent of total billed charges,Drugs,838.84,34,,838.84,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,838.84,34,"If Charge > 500, then 34 percent",838.84,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,986.87,40,,986.87,percent of total billed charges,Drugs,1727.02,70,,1727.02,percent of total billed charges,All Other,888.18,36,,888.18,percent of total billed charges,Drugs,888.18,36,,888.18,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,863.51,35,,863.51,percent of total billed charges,Drugs,822.39,,,822.39,Other,Drug Cost,822.39,,,822.39,Other,Drug Cost,822.39,,,822.39,Other,Drug Cost,822.39,,,822.39,Other,Drug Cost,822.39,,,822.39,Other,Drug Cost,822.39,,,822.39,Other,Drug Cost,1850.38,,,1850.38,Other,225% of Medicaid,1151.35,,,1151.35,Other,140% of Medicaid,838.84,34,"If Charge > 2,000, then 34 percent",838.84,percent of total billed charges,Drugs,1446.33,,,1446.33,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1768.14,,,1768.14,Other,215% Medicaid APG methodology,1768.14,,,1768.14,Other,215% Medicaid APG methodology,1027.99,,,1027.99,Other,125% Medicaid APG methodology,0.01,1850.38,
PANTOPRAZOLE SODIUM 40MG INJ,C9113,HCPCS,,80001582,CDM,636,RC,8092355,NDC,both,10,EA,0.03,0.01,39.4668,,0.01,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,0.02,
PARICALCITOL 2MCG/ML INJ,J2501,HCPCS,,80001586,CDM,636,RC,74463701,NDC,both,25,ML,11.13,6.56,,,6.56,Other,150% of Medicare + 9.63% HCRA Surcharge,3.99,,,3.99,Fee Schedule,Average Sale Price (ASP) x 6,3.89,35,,3.89,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,3.78,34,,3.78,percent of total billed charges,Drugs,3.78,34,,3.78,percent of total billed charges,Drugs,3.78,34,,3.78,percent of total billed charges,Drugs,3.78,34,,3.78,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,4.45,40,,4.45,percent of total billed charges,Drugs,7.79,70,,7.79,percent of total billed charges,All Other,4.01,36,,4.01,percent of total billed charges,Drugs,4.01,36,,4.01,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,3.89,35,,3.89,percent of total billed charges,Drugs,3.71,,,3.71,Other,Drug Cost,3.71,,,3.71,Other,Drug Cost,3.71,,,3.71,Other,Drug Cost,3.71,,,3.71,Other,Drug Cost,3.71,,,3.71,Other,Drug Cost,3.71,,,3.71,Other,Drug Cost,8.34,,,8.34,Other,225% of Medicaid,5.19,,,5.19,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.38,,,6.38,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.97,,,7.97,Other,215% Medicaid APG methodology,7.97,,,7.97,Other,215% Medicaid APG methodology,4.64,,,4.64,Other,125% Medicaid APG methodology,0.01,8.34,
PARICALCITOL 5MCG/ML INJ,J2501,HCPCS,,80001588,CDM,636,RC,74165801,NDC,both,25,ML,27.81,6.56,,,6.56,Other,150% of Medicare + 9.63% HCRA Surcharge,3.99,,,3.99,Fee Schedule,Average Sale Price (ASP) x 6,9.73,35,,9.73,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,9.46,34,,9.46,percent of total billed charges,Drugs,9.46,34,,9.46,percent of total billed charges,Drugs,9.46,34,,9.46,percent of total billed charges,Drugs,9.46,34,,9.46,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,11.13,40,,11.13,percent of total billed charges,Drugs,19.47,70,,19.47,percent of total billed charges,All Other,10.01,36,,10.01,percent of total billed charges,Drugs,10.01,36,,10.01,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,9.73,35,,9.73,percent of total billed charges,Drugs,9.27,,,9.27,Other,Drug Cost,9.27,,,9.27,Other,Drug Cost,9.27,,,9.27,Other,Drug Cost,9.27,,,9.27,Other,Drug Cost,9.27,,,9.27,Other,Drug Cost,9.27,,,9.27,Other,Drug Cost,20.86,,,20.86,Other,225% of Medicaid,12.98,,,12.98,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.38,,,6.38,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",19.93,,,19.93,Other,215% Medicaid APG methodology,19.93,,,19.93,Other,215% Medicaid APG methodology,11.59,,,11.59,Other,125% Medicaid APG methodology,0.01,20.86,
PEGFILGRASTIM 6 MG INJ,J2506,HCPCS,,80001594,CDM,636,RC,55513019001,NDC,both,1,ML,12577.5,500.02,,,500.02,Other,150% of Medicare + 9.63% HCRA Surcharge,304.07,,,304.07,Fee Schedule,Average Sale Price (ASP) x 6,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4276.35,34,,4276.35,percent of total billed charges,Drugs,4276.35,34,,4276.35,percent of total billed charges,Drugs,4276.35,34,,4276.35,percent of total billed charges,Drugs,4276.35,34,,4276.35,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4276.35,34,"If Charge > 500, then 34 percent",4276.35,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,5031,40,,5031,percent of total billed charges,Drugs,8804.25,70,,8804.25,percent of total billed charges,All Other,4527.9,36,,4527.9,percent of total billed charges,Drugs,4527.9,36,,4527.9,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4192.5,,,4192.5,Other,Drug Cost,4192.5,,,4192.5,Other,Drug Cost,4192.5,,,4192.5,Other,Drug Cost,4192.5,,,4192.5,Other,Drug Cost,4192.5,,,4192.5,Other,Drug Cost,4192.5,,,4192.5,Other,Drug Cost,9433.13,,,9433.13,Other,225% of Medicaid,5869.5,,,5869.5,Other,140% of Medicaid,4276.35,34,"If Charge > 2,000, then 34 percent",4276.35,percent of total billed charges,Drugs,486.51,,,486.51,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",9013.88,,,9013.88,Other,215% Medicaid APG methodology,9013.88,,,9013.88,Other,215% Medicaid APG methodology,5240.63,,,5240.63,Other,125% Medicaid APG methodology,0.01,9433.13,
PEMETREXED 500MG INJ,J9305,HCPCS,,80001595,CDM,636,RC,71288016795,NDC,both,1,EA,143.79,43.13,,,43.13,Other,150% of Medicare + 9.63% HCRA Surcharge,26.23,,,26.23,Fee Schedule,Average Sale Price (ASP) x 6,50.33,35,,50.33,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,48.89,34,,48.89,percent of total billed charges,Drugs,48.89,34,,48.89,percent of total billed charges,Drugs,48.89,34,,48.89,percent of total billed charges,Drugs,48.89,34,,48.89,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,57.52,40,,57.52,percent of total billed charges,Drugs,100.65,70,,100.65,percent of total billed charges,All Other,51.76,36,,51.76,percent of total billed charges,Drugs,51.76,36,,51.76,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,50.33,35,,50.33,percent of total billed charges,Drugs,47.93,,,47.93,Other,Drug Cost,47.93,,,47.93,Other,Drug Cost,47.93,,,47.93,Other,Drug Cost,47.93,,,47.93,Other,Drug Cost,47.93,,,47.93,Other,Drug Cost,47.93,,,47.93,Other,Drug Cost,107.84,,,107.84,Other,225% of Medicaid,67.1,,,67.1,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,41.96,,,41.96,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",103.05,,,103.05,Other,215% Medicaid APG methodology,103.05,,,103.05,Other,215% Medicaid APG methodology,59.91,,,59.91,Other,125% Medicaid APG methodology,0.01,107.84,
PENTOSTATIN 10MG INJ,J9268,HCPCS,,80001602,CDM,636,RC,409080101,NDC,both,1,EA,5290.68,22428.52,,,22428.52,Other,150% of Medicare + 9.63% HCRA Surcharge,13638.92,,,13638.92,Fee Schedule,Average Sale Price (ASP) x 6,1851.74,35,,1851.74,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,1798.83,34,,1798.83,percent of total billed charges,Drugs,1798.83,34,,1798.83,percent of total billed charges,Drugs,1798.83,34,,1798.83,percent of total billed charges,Drugs,1798.83,34,,1798.83,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,1798.83,34,"If Charge > 500, then 34 percent",1798.83,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,2116.27,40,,2116.27,percent of total billed charges,Drugs,3703.48,70,,3703.48,percent of total billed charges,All Other,1904.64,36,,1904.64,percent of total billed charges,Drugs,1904.64,36,,1904.64,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,1851.74,35,,1851.74,percent of total billed charges,Drugs,1763.56,,,1763.56,Other,Drug Cost,1763.56,,,1763.56,Other,Drug Cost,1763.56,,,1763.56,Other,Drug Cost,1763.56,,,1763.56,Other,Drug Cost,1763.56,,,1763.56,Other,Drug Cost,1763.56,,,1763.56,Other,Drug Cost,3968.01,,,3968.01,Other,225% of Medicaid,2468.98,,,2468.98,Other,140% of Medicaid,1798.83,34,"If Charge > 2,000, then 34 percent",1798.83,percent of total billed charges,Drugs,21822.27,,,21822.27,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3791.65,,,3791.65,Other,215% Medicaid APG methodology,3791.65,,,3791.65,Other,215% Medicaid APG methodology,2204.45,,,2204.45,Other,125% Medicaid APG methodology,0.01,22428.52,
PHENOBARBITAL 130MG INJ,J2560,HCPCS,,80001621,CDM,636,RC,641047725,NDC,both,25,ML,52.72,310.13,,,310.13,Other,150% of Medicare + 9.63% HCRA Surcharge,188.59,,,188.59,Fee Schedule,Average Sale Price (ASP) x 6,18.45,35,,18.45,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,17.93,34,,17.93,percent of total billed charges,Drugs,17.93,34,,17.93,percent of total billed charges,Drugs,17.93,34,,17.93,percent of total billed charges,Drugs,17.93,34,,17.93,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,21.09,40,,21.09,percent of total billed charges,Drugs,36.91,70,,36.91,percent of total billed charges,All Other,18.98,36,,18.98,percent of total billed charges,Drugs,18.98,36,,18.98,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,18.45,35,,18.45,percent of total billed charges,Drugs,17.57,,,17.57,Other,Drug Cost,17.57,,,17.57,Other,Drug Cost,17.57,,,17.57,Other,Drug Cost,17.57,,,17.57,Other,Drug Cost,17.57,,,17.57,Other,Drug Cost,17.57,,,17.57,Other,Drug Cost,39.54,,,39.54,Other,225% of Medicaid,24.6,,,24.6,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,301.75,,,301.75,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",37.78,,,37.78,Other,215% Medicaid APG methodology,37.78,,,37.78,Other,215% Medicaid APG methodology,21.97,,,21.97,Other,125% Medicaid APG methodology,0.01,310.13,
PHENYLEPHRINE 10MG/ML INJ,J2371,HCPCS,,80001632,CDM,636,RC,641614225,NDC,both,25,ML,2.12,0.84,39.4668,,0.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.74,35,,0.74,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.72,34,,0.72,percent of total billed charges,Drugs,0.72,34,,0.72,percent of total billed charges,Drugs,0.72,34,,0.72,percent of total billed charges,Drugs,0.72,34,,0.72,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.85,40,,0.85,percent of total billed charges,Drugs,1.48,70,,1.48,percent of total billed charges,All Other,0.76,36,,0.76,percent of total billed charges,Drugs,0.76,36,,0.76,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.74,35,,0.74,percent of total billed charges,Drugs,0.71,,,0.71,Other,Drug Cost,0.71,,,0.71,Other,Drug Cost,0.71,,,0.71,Other,Drug Cost,0.71,,,0.71,Other,Drug Cost,0.71,,,0.71,Other,Drug Cost,0.71,,,0.71,Other,Drug Cost,1.59,,,1.59,Other,225% of Medicaid,0.99,,,0.99,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.52,,,1.52,Other,215% Medicaid APG methodology,1.52,,,1.52,Other,215% Medicaid APG methodology,0.88,,,0.88,Other,125% Medicaid APG methodology,0.01,1.59,
PHENYTOIN (DILANTIN) INJ 100MG/2ML,J1165,HCPCS,,80001637,CDM,636,RC,641049325,NDC,both,25,ML,2.26,6.22,,,6.22,Other,150% of Medicare + 9.63% HCRA Surcharge,3.78,,,3.78,Fee Schedule,Average Sale Price (ASP) x 6,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.77,34,,0.77,percent of total billed charges,Drugs,0.77,34,,0.77,percent of total billed charges,Drugs,0.77,34,,0.77,percent of total billed charges,Drugs,0.77,34,,0.77,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.9,40,,0.9,percent of total billed charges,Drugs,1.58,70,,1.58,percent of total billed charges,All Other,0.81,36,,0.81,percent of total billed charges,Drugs,0.81,36,,0.81,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,1.69,,,1.69,Other,225% of Medicaid,1.05,,,1.05,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.05,,,6.05,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.62,,,1.62,Other,215% Medicaid APG methodology,1.62,,,1.62,Other,215% Medicaid APG methodology,0.94,,,0.94,Other,125% Medicaid APG methodology,0.01,6.22,
PIPERACILLIN/TAZOBACTAMINJ 3.375GM,J2543,HCPCS,,80001655,CDM,636,RC,781311395,NDC,both,10,EA,0.03,11.61,,,11.61,Other,150% of Medicare + 9.63% HCRA Surcharge,7.06,,,7.06,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,11.3,,,11.3,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,11.61,
PIPERACILLIN/TAZOBACTAMINJ 4.5GM,J2543,HCPCS,,80001656,CDM,636,RC,781311495,NDC,both,10,EA,0.1,11.61,,,11.61,Other,150% of Medicare + 9.63% HCRA Surcharge,7.06,,,7.06,Fee Schedule,Average Sale Price (ASP) x 6,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,40,,0.04,percent of total billed charges,Drugs,0.07,70,,0.07,percent of total billed charges,All Other,0.04,36,,0.04,percent of total billed charges,Drugs,0.04,36,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.04,35,,0.04,percent of total billed charges,Drugs,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.08,,,0.08,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,11.3,,,11.3,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,11.61,
PNEUMOCOCCAL VACCINE 23 VALENT,90732,HCPCS,,80001661,CDM,636,RC,6483703,NDC,both,10,ML,318.19,125.58,39.4668,,125.58,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,111.37,35,,111.37,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,108.19,34,,108.19,percent of total billed charges,Drugs,108.19,34,,108.19,percent of total billed charges,Drugs,108.19,34,,108.19,percent of total billed charges,Drugs,108.19,34,,108.19,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,127.28,40,,127.28,percent of total billed charges,Drugs,222.73,70,,222.73,percent of total billed charges,All Other,114.55,36,,114.55,percent of total billed charges,Drugs,114.55,36,,114.55,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,111.37,35,,111.37,percent of total billed charges,Drugs,106.06,,,106.06,Other,Drug Cost,106.06,,,106.06,Other,Drug Cost,106.06,,,106.06,Other,Drug Cost,106.06,,,106.06,Other,Drug Cost,106.06,,,106.06,Other,Drug Cost,106.06,,,106.06,Other,Drug Cost,238.64,,,238.64,Other,225% of Medicaid,148.49,,,148.49,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",228.04,,,228.04,Other,215% Medicaid APG methodology,228.04,,,228.04,Other,215% Medicaid APG methodology,132.58,,,132.58,Other,125% Medicaid APG methodology,0.01,238.64,
POTASS CL 10 MEQ/100 ML INJ,J3480,HCPCS,,80001668,CDM,636,RC,990707426,NDC,both,24,ML,3.29,1.18,,,1.18,Other,150% of Medicare + 9.63% HCRA Surcharge,0.72,,,0.72,Fee Schedule,Average Sale Price (ASP) x 6,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.12,34,,1.12,percent of total billed charges,Drugs,1.12,34,,1.12,percent of total billed charges,Drugs,1.12,34,,1.12,percent of total billed charges,Drugs,1.12,34,,1.12,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.32,40,,1.32,percent of total billed charges,Drugs,2.3,70,,2.3,percent of total billed charges,All Other,1.18,36,,1.18,percent of total billed charges,Drugs,1.18,36,,1.18,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.1,,,1.1,Other,Drug Cost,1.1,,,1.1,Other,Drug Cost,1.1,,,1.1,Other,Drug Cost,1.1,,,1.1,Other,Drug Cost,1.1,,,1.1,Other,Drug Cost,1.1,,,1.1,Other,Drug Cost,2.47,,,2.47,Other,225% of Medicaid,1.53,,,1.53,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.15,,,1.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.36,,,2.36,Other,215% Medicaid APG methodology,2.36,,,2.36,Other,215% Medicaid APG methodology,1.37,,,1.37,Other,125% Medicaid APG methodology,0.01,2.47,
POTASS CL 20 MEQ/100 ML INJ,J3480,HCPCS,,80001669,CDM,636,RC,990707526,NDC,both,24,ML,3.56,1.18,,,1.18,Other,150% of Medicare + 9.63% HCRA Surcharge,0.72,,,0.72,Fee Schedule,Average Sale Price (ASP) x 6,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.21,34,,1.21,percent of total billed charges,Drugs,1.21,34,,1.21,percent of total billed charges,Drugs,1.21,34,,1.21,percent of total billed charges,Drugs,1.21,34,,1.21,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.42,40,,1.42,percent of total billed charges,Drugs,2.49,70,,2.49,percent of total billed charges,All Other,1.28,36,,1.28,percent of total billed charges,Drugs,1.28,36,,1.28,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.19,,,1.19,Other,Drug Cost,1.19,,,1.19,Other,Drug Cost,1.19,,,1.19,Other,Drug Cost,1.19,,,1.19,Other,Drug Cost,1.19,,,1.19,Other,Drug Cost,1.19,,,1.19,Other,Drug Cost,2.67,,,2.67,Other,225% of Medicaid,1.66,,,1.66,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.15,,,1.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.55,,,2.55,Other,215% Medicaid APG methodology,2.55,,,2.55,Other,215% Medicaid APG methodology,1.48,,,1.48,Other,125% Medicaid APG methodology,0.01,2.67,
PREDNISONE 1 MG TAB,J7512,HCPCS,,80001692,CDM,636,RC,54474125,NDC,both,100,EA,0.1,0.07,,,0.07,Other,150% of Medicare + 9.63% HCRA Surcharge,0.04,,,0.04,Fee Schedule,Average Sale Price (ASP) x 6,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,34,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.04,40,,0.04,percent of total billed charges,Drugs,0.07,70,,0.07,percent of total billed charges,All Other,0.03,36,,0.03,percent of total billed charges,Drugs,0.03,36,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.03,,,0.03,Other,Drug Cost,0.07,,,0.07,Other,225% of Medicaid,0.05,,,0.05,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.07,,,0.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.07,,,0.07,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,125% Medicaid APG methodology,0.01,0.07,
PREDNISONE 10 MG TAB,J7512,HCPCS,,80001693,CDM,636,RC,603533821,NDC,both,100,EA,0.18,0.07,,,0.07,Other,150% of Medicare + 9.63% HCRA Surcharge,0.04,,,0.04,Fee Schedule,Average Sale Price (ASP) x 6,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,34,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.07,40,,0.07,percent of total billed charges,Drugs,0.12,70,,0.12,percent of total billed charges,All Other,0.06,36,,0.06,percent of total billed charges,Drugs,0.06,36,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,35,,0.06,percent of total billed charges,Drugs,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.06,,,0.06,Other,Drug Cost,0.13,,,0.13,Other,225% of Medicaid,0.08,,,0.08,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.07,,,0.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.13,,,0.13,Other,215% Medicaid APG methodology,0.13,,,0.13,Other,215% Medicaid APG methodology,0.07,,,0.07,Other,125% Medicaid APG methodology,0.01,0.13,
PREDNISONE 20 MG TAB,J7512,HCPCS,,80001694,CDM,636,RC,59746017506,NDC,both,100,EA,0.07,0.07,,,0.07,Other,150% of Medicare + 9.63% HCRA Surcharge,0.04,,,0.04,Fee Schedule,Average Sale Price (ASP) x 6,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,40,,0.03,percent of total billed charges,Drugs,0.05,70,,0.05,percent of total billed charges,All Other,0.03,36,,0.03,percent of total billed charges,Drugs,0.03,36,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.07,,,0.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.07,
PREDNISONE 50 MG TAB,J7512,HCPCS,,80001696,CDM,636,RC,54001925,NDC,both,100,EA,0.25,0.07,,,0.07,Other,150% of Medicare + 9.63% HCRA Surcharge,0.04,,,0.04,Fee Schedule,Average Sale Price (ASP) x 6,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.08,34,,0.08,percent of total billed charges,Drugs,0.08,34,,0.08,percent of total billed charges,Drugs,0.08,34,,0.08,percent of total billed charges,Drugs,0.08,34,,0.08,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.1,40,,0.1,percent of total billed charges,Drugs,0.17,70,,0.17,percent of total billed charges,All Other,0.09,36,,0.09,percent of total billed charges,Drugs,0.09,36,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.19,,,0.19,Other,225% of Medicaid,0.12,,,0.12,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.07,,,0.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.18,,,0.18,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,0.19,
PROPOFOL (DIPRIVAN) 10MG/ML  20ML,J2704,HCPCS,,80001718,CDM,636,RC,63323026929,NDC,both,10,ML,4.5,1.26,,,1.26,Other,150% of Medicare + 9.63% HCRA Surcharge,0.77,,,0.77,Fee Schedule,Average Sale Price (ASP) x 6,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.53,34,,1.53,percent of total billed charges,Drugs,1.53,34,,1.53,percent of total billed charges,Drugs,1.53,34,,1.53,percent of total billed charges,Drugs,1.53,34,,1.53,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.8,40,,1.8,percent of total billed charges,Drugs,3.15,70,,3.15,percent of total billed charges,All Other,1.62,36,,1.62,percent of total billed charges,Drugs,1.62,36,,1.62,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.57,35,,1.57,percent of total billed charges,Drugs,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,1.5,,,1.5,Other,Drug Cost,3.37,,,3.37,Other,225% of Medicaid,2.1,,,2.1,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.23,,,1.23,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.22,,,3.22,Other,215% Medicaid APG methodology,3.22,,,3.22,Other,215% Medicaid APG methodology,1.87,,,1.87,Other,125% Medicaid APG methodology,0.01,3.37,
PROPOFOL (DIPRIVAN) 10MG/ML 100ML,J2704,HCPCS,,80001719,CDM,636,RC,409469924,NDC,both,10,ML,20.79,1.26,,,1.26,Other,150% of Medicare + 9.63% HCRA Surcharge,0.77,,,0.77,Fee Schedule,Average Sale Price (ASP) x 6,7.28,35,,7.28,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,7.07,34,,7.07,percent of total billed charges,Drugs,7.07,34,,7.07,percent of total billed charges,Drugs,7.07,34,,7.07,percent of total billed charges,Drugs,7.07,34,,7.07,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,8.32,40,,8.32,percent of total billed charges,Drugs,14.55,70,,14.55,percent of total billed charges,All Other,7.48,36,,7.48,percent of total billed charges,Drugs,7.48,36,,7.48,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,7.28,35,,7.28,percent of total billed charges,Drugs,6.93,,,6.93,Other,Drug Cost,6.93,,,6.93,Other,Drug Cost,6.93,,,6.93,Other,Drug Cost,6.93,,,6.93,Other,Drug Cost,6.93,,,6.93,Other,Drug Cost,6.93,,,6.93,Other,Drug Cost,15.59,,,15.59,Other,225% of Medicaid,9.7,,,9.7,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.23,,,1.23,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",14.9,,,14.9,Other,215% Medicaid APG methodology,14.9,,,14.9,Other,215% Medicaid APG methodology,8.66,,,8.66,Other,125% Medicaid APG methodology,0.01,15.59,
PROPOFOL (DIPRIVAN) 10MG/ML 50ML,J2704,HCPCS,,80001720,CDM,636,RC,409469933,NDC,both,20,ML,10.4,1.26,,,1.26,Other,150% of Medicare + 9.63% HCRA Surcharge,0.77,,,0.77,Fee Schedule,Average Sale Price (ASP) x 6,3.64,35,,3.64,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,3.53,34,,3.53,percent of total billed charges,Drugs,3.53,34,,3.53,percent of total billed charges,Drugs,3.53,34,,3.53,percent of total billed charges,Drugs,3.53,34,,3.53,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,4.16,40,,4.16,percent of total billed charges,Drugs,7.28,70,,7.28,percent of total billed charges,All Other,3.74,36,,3.74,percent of total billed charges,Drugs,3.74,36,,3.74,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,3.64,35,,3.64,percent of total billed charges,Drugs,3.47,,,3.47,Other,Drug Cost,3.47,,,3.47,Other,Drug Cost,3.47,,,3.47,Other,Drug Cost,3.47,,,3.47,Other,Drug Cost,3.47,,,3.47,Other,Drug Cost,3.47,,,3.47,Other,Drug Cost,7.8,,,7.8,Other,225% of Medicaid,4.85,,,4.85,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.23,,,1.23,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.45,,,7.45,Other,215% Medicaid APG methodology,7.45,,,7.45,Other,215% Medicaid APG methodology,4.33,,,4.33,Other,125% Medicaid APG methodology,0.01,7.8,
PROTAMINE 50MG INJ,J2720,HCPCS,,80001732,CDM,636,RC,63323022905,NDC,both,25,ML,9.87,16.36,,,16.36,Other,150% of Medicare + 9.63% HCRA Surcharge,9.95,,,9.95,Fee Schedule,Average Sale Price (ASP) x 6,3.45,35,,3.45,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,3.35,34,,3.35,percent of total billed charges,Drugs,3.35,34,,3.35,percent of total billed charges,Drugs,3.35,34,,3.35,percent of total billed charges,Drugs,3.35,34,,3.35,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,3.95,40,,3.95,percent of total billed charges,Drugs,6.91,70,,6.91,percent of total billed charges,All Other,3.55,36,,3.55,percent of total billed charges,Drugs,3.55,36,,3.55,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,3.45,35,,3.45,percent of total billed charges,Drugs,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,3.29,,,3.29,Other,Drug Cost,7.4,,,7.4,Other,225% of Medicaid,4.6,,,4.6,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,15.92,,,15.92,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.07,,,7.07,Other,215% Medicaid APG methodology,7.07,,,7.07,Other,215% Medicaid APG methodology,4.11,,,4.11,Other,125% Medicaid APG methodology,0.01,16.36,
RABIES IMMUNE GLOB HUMAN 300IU/1ML INJ,90375,HCPCS,,80001755,CDM,636,RC,13533031801,NDC,both,1,ML,1237.77,488.51,39.4668,,488.51,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,433.22,35,,433.22,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,420.84,34,,420.84,percent of total billed charges,Drugs,420.84,34,,420.84,percent of total billed charges,Drugs,420.84,34,,420.84,percent of total billed charges,Drugs,420.84,34,,420.84,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,420.84,34,"If Charge > 500, then 34 percent",420.84,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,495.11,40,,495.11,percent of total billed charges,Drugs,866.44,70,,866.44,percent of total billed charges,All Other,445.6,36,,445.6,percent of total billed charges,Drugs,445.6,36,,445.6,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,433.22,35,,433.22,percent of total billed charges,Drugs,412.59,,,412.59,Other,Drug Cost,412.59,,,412.59,Other,Drug Cost,412.59,,,412.59,Other,Drug Cost,412.59,,,412.59,Other,Drug Cost,412.59,,,412.59,Other,Drug Cost,412.59,,,412.59,Other,Drug Cost,928.33,,,928.33,Other,225% of Medicaid,577.63,,,577.63,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",887.07,,,887.07,Other,215% Medicaid APG methodology,887.07,,,887.07,Other,215% Medicaid APG methodology,515.74,,,515.74,Other,125% Medicaid APG methodology,0.01,928.33,
RABIES VACCINE (IMOVAX) 2.5 UNITS IM,90675,HCPCS,,80001756,CDM,636,RC,50632001001,NDC,both,1,EA,847.17,334.35,39.4668,,334.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,296.51,35,,296.51,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,288.04,34,,288.04,percent of total billed charges,Drugs,288.04,34,,288.04,percent of total billed charges,Drugs,288.04,34,,288.04,percent of total billed charges,Drugs,288.04,34,,288.04,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,288.04,34,"If Charge > 500, then 34 percent",288.04,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,338.87,40,,338.87,percent of total billed charges,Drugs,593.02,70,,593.02,percent of total billed charges,All Other,304.98,36,,304.98,percent of total billed charges,Drugs,304.98,36,,304.98,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,296.51,35,,296.51,percent of total billed charges,Drugs,282.39,,,282.39,Other,Drug Cost,282.39,,,282.39,Other,Drug Cost,282.39,,,282.39,Other,Drug Cost,282.39,,,282.39,Other,Drug Cost,282.39,,,282.39,Other,Drug Cost,282.39,,,282.39,Other,Drug Cost,635.38,,,635.38,Other,225% of Medicaid,395.35,,,395.35,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",607.14,,,607.14,Other,215% Medicaid APG methodology,607.14,,,607.14,Other,215% Medicaid APG methodology,352.99,,,352.99,Other,125% Medicaid APG methodology,0.01,635.38,
RASBURICASE 1.5MG,J2783,HCPCS,,80001766,CDM,636,RC,24515010,NDC,both,3,EA,3189.7,3623.72,,,3623.72,Other,150% of Medicare + 9.63% HCRA Surcharge,2203.61,,,2203.61,Fee Schedule,Average Sale Price (ASP) x 6,1116.4,35,,1116.4,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1084.5,34,,1084.5,percent of total billed charges,Drugs,1084.5,34,,1084.5,percent of total billed charges,Drugs,1084.5,34,,1084.5,percent of total billed charges,Drugs,1084.5,34,,1084.5,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1084.5,34,"If Charge > 500, then 34 percent",1084.5,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1275.88,40,,1275.88,percent of total billed charges,Drugs,2232.79,70,,2232.79,percent of total billed charges,All Other,1148.29,36,,1148.29,percent of total billed charges,Drugs,1148.29,36,,1148.29,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1116.4,35,,1116.4,percent of total billed charges,Drugs,1063.23,,,1063.23,Other,Drug Cost,1063.23,,,1063.23,Other,Drug Cost,1063.23,,,1063.23,Other,Drug Cost,1063.23,,,1063.23,Other,Drug Cost,1063.23,,,1063.23,Other,Drug Cost,1063.23,,,1063.23,Other,Drug Cost,2392.27,,,2392.27,Other,225% of Medicaid,1488.53,,,1488.53,Other,140% of Medicaid,1084.5,34,"If Charge > 2,000, then 34 percent",1084.5,percent of total billed charges,Drugs,3525.77,,,3525.77,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2285.95,,,2285.95,Other,215% Medicaid APG methodology,2285.95,,,2285.95,Other,215% Medicaid APG methodology,1329.04,,,1329.04,Other,125% Medicaid APG methodology,0.01,3623.72,
RASBURICASE 7.5MG,J2783,HCPCS,,80001767,CDM,636,RC,24515175,NDC,both,1,EA,15948.48,3623.72,,,3623.72,Other,150% of Medicare + 9.63% HCRA Surcharge,2203.61,,,2203.61,Fee Schedule,Average Sale Price (ASP) x 6,5581.97,35,,5581.97,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,5422.48,34,,5422.48,percent of total billed charges,Drugs,5422.48,34,,5422.48,percent of total billed charges,Drugs,5422.48,34,,5422.48,percent of total billed charges,Drugs,5422.48,34,,5422.48,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,5422.48,34,"If Charge > 500, then 34 percent",5422.48,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,6379.39,40,,6379.39,percent of total billed charges,Drugs,11163.94,70,,11163.94,percent of total billed charges,All Other,5741.45,36,,5741.45,percent of total billed charges,Drugs,5741.45,36,,5741.45,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,5581.97,35,,5581.97,percent of total billed charges,Drugs,5316.16,,,5316.16,Other,Drug Cost,5316.16,,,5316.16,Other,Drug Cost,5316.16,,,5316.16,Other,Drug Cost,5316.16,,,5316.16,Other,Drug Cost,5316.16,,,5316.16,Other,Drug Cost,5316.16,,,5316.16,Other,Drug Cost,11961.36,,,11961.36,Other,225% of Medicaid,7442.62,,,7442.62,Other,140% of Medicaid,5422.48,34,"If Charge > 2,000, then 34 percent",5422.48,percent of total billed charges,Drugs,3525.77,,,3525.77,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",11429.74,,,11429.74,Other,215% Medicaid APG methodology,11429.74,,,11429.74,Other,215% Medicaid APG methodology,6645.2,,,6645.2,Other,125% Medicaid APG methodology,0.01,11961.36,
REGADENOSON INJECTION 0.1 MG,J2785,HCPCS,,80001768,CDM,636,RC,60505611600,NDC,both,1,ML,8.82,140.9,,,140.9,Other,150% of Medicare + 9.63% HCRA Surcharge,85.68,,,85.68,Fee Schedule,Average Sale Price (ASP) x 6,3.09,35,,3.09,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,3,34,,3,percent of total billed charges,Drugs,3,34,,3,percent of total billed charges,Drugs,3,34,,3,percent of total billed charges,Drugs,3,34,,3,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,3.53,40,,3.53,percent of total billed charges,Drugs,6.17,70,,6.17,percent of total billed charges,All Other,3.18,36,,3.18,percent of total billed charges,Drugs,3.18,36,,3.18,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,3.09,35,,3.09,percent of total billed charges,Drugs,2.94,,,2.94,Other,Drug Cost,2.94,,,2.94,Other,Drug Cost,2.94,,,2.94,Other,Drug Cost,2.94,,,2.94,Other,Drug Cost,2.94,,,2.94,Other,Drug Cost,2.94,,,2.94,Other,Drug Cost,6.62,,,6.62,Other,225% of Medicaid,4.12,,,4.12,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,137.09,,,137.09,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6.32,,,6.32,Other,215% Medicaid APG methodology,6.32,,,6.32,Other,215% Medicaid APG methodology,3.68,,,3.68,Other,125% Medicaid APG methodology,0.01,140.9,
RISPERIDONE LG ACTNG 25MG/2ML INJ,J2794,HCPCS,,80001795,CDM,636,RC,50458030611,NDC,both,1,EA,609.18,119.89,,,119.89,Other,150% of Medicare + 9.63% HCRA Surcharge,72.91,,,72.91,Fee Schedule,Average Sale Price (ASP) x 6,213.21,35,,213.21,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,207.12,34,,207.12,percent of total billed charges,Drugs,207.12,34,,207.12,percent of total billed charges,Drugs,207.12,34,,207.12,percent of total billed charges,Drugs,207.12,34,,207.12,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,207.12,34,"If Charge > 500, then 34 percent",207.12,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,243.67,40,,243.67,percent of total billed charges,Drugs,426.43,70,,426.43,percent of total billed charges,All Other,219.3,36,,219.3,percent of total billed charges,Drugs,219.3,36,,219.3,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,213.21,35,,213.21,percent of total billed charges,Drugs,203.06,,,203.06,Other,Drug Cost,203.06,,,203.06,Other,Drug Cost,203.06,,,203.06,Other,Drug Cost,203.06,,,203.06,Other,Drug Cost,203.06,,,203.06,Other,Drug Cost,203.06,,,203.06,Other,Drug Cost,456.89,,,456.89,Other,225% of Medicaid,284.28,,,284.28,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,116.65,,,116.65,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",436.58,,,436.58,Other,215% Medicaid APG methodology,436.58,,,436.58,Other,215% Medicaid APG methodology,253.83,,,253.83,Other,125% Medicaid APG methodology,0.01,456.89,
RISPERIDONE LG ACTNG 37.5MG/2ML INJ,J2794,HCPCS,,80001796,CDM,636,RC,50458030711,NDC,both,1,EA,901.38,119.89,,,119.89,Other,150% of Medicare + 9.63% HCRA Surcharge,72.91,,,72.91,Fee Schedule,Average Sale Price (ASP) x 6,315.48,35,,315.48,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,306.47,34,,306.47,percent of total billed charges,Drugs,306.47,34,,306.47,percent of total billed charges,Drugs,306.47,34,,306.47,percent of total billed charges,Drugs,306.47,34,,306.47,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,306.47,34,"If Charge > 500, then 34 percent",306.47,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,360.55,40,,360.55,percent of total billed charges,Drugs,630.97,70,,630.97,percent of total billed charges,All Other,324.5,36,,324.5,percent of total billed charges,Drugs,324.5,36,,324.5,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,315.48,35,,315.48,percent of total billed charges,Drugs,300.46,,,300.46,Other,Drug Cost,300.46,,,300.46,Other,Drug Cost,300.46,,,300.46,Other,Drug Cost,300.46,,,300.46,Other,Drug Cost,300.46,,,300.46,Other,Drug Cost,300.46,,,300.46,Other,Drug Cost,676.04,,,676.04,Other,225% of Medicaid,420.64,,,420.64,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,116.65,,,116.65,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",645.99,,,645.99,Other,215% Medicaid APG methodology,645.99,,,645.99,Other,215% Medicaid APG methodology,375.58,,,375.58,Other,125% Medicaid APG methodology,0.01,676.04,
RISPERIDONE LG ACTNG 50MG/2ML INJ,J2794,HCPCS,,80001797,CDM,636,RC,50458030811,NDC,both,1,EA,1221.54,119.89,,,119.89,Other,150% of Medicare + 9.63% HCRA Surcharge,72.91,,,72.91,Fee Schedule,Average Sale Price (ASP) x 6,427.54,35,,427.54,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,415.32,34,,415.32,percent of total billed charges,Drugs,415.32,34,,415.32,percent of total billed charges,Drugs,415.32,34,,415.32,percent of total billed charges,Drugs,415.32,34,,415.32,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,415.32,34,"If Charge > 500, then 34 percent",415.32,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,488.62,40,,488.62,percent of total billed charges,Drugs,855.08,70,,855.08,percent of total billed charges,All Other,439.75,36,,439.75,percent of total billed charges,Drugs,439.75,36,,439.75,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,427.54,35,,427.54,percent of total billed charges,Drugs,407.18,,,407.18,Other,Drug Cost,407.18,,,407.18,Other,Drug Cost,407.18,,,407.18,Other,Drug Cost,407.18,,,407.18,Other,Drug Cost,407.18,,,407.18,Other,Drug Cost,407.18,,,407.18,Other,Drug Cost,916.16,,,916.16,Other,225% of Medicaid,570.05,,,570.05,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,116.65,,,116.65,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",875.44,,,875.44,Other,215% Medicaid APG methodology,875.44,,,875.44,Other,215% Medicaid APG methodology,508.98,,,508.98,Other,125% Medicaid APG methodology,0.01,916.16,
RITUXIMAB INJECTION 100 MG,J9312,HCPCS,,80001799,CDM,636,RC,50242005121,NDC,both,1,ML,2788.98,781.42,,,781.42,Other,150% of Medicare + 9.63% HCRA Surcharge,475.19,,,475.19,Fee Schedule,Average Sale Price (ASP) x 6,976.14,35,,976.14,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,948.25,34,,948.25,percent of total billed charges,Drugs,948.25,34,,948.25,percent of total billed charges,Drugs,948.25,34,,948.25,percent of total billed charges,Drugs,948.25,34,,948.25,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,948.25,34,"If Charge > 500, then 34 percent",948.25,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,1115.59,40,,1115.59,percent of total billed charges,Drugs,1952.29,70,,1952.29,percent of total billed charges,All Other,1004.03,36,,1004.03,percent of total billed charges,Drugs,1004.03,36,,1004.03,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,976.14,35,,976.14,percent of total billed charges,Drugs,929.66,,,929.66,Other,Drug Cost,929.66,,,929.66,Other,Drug Cost,929.66,,,929.66,Other,Drug Cost,929.66,,,929.66,Other,Drug Cost,929.66,,,929.66,Other,Drug Cost,929.66,,,929.66,Other,Drug Cost,2091.74,,,2091.74,Other,225% of Medicaid,1301.52,,,1301.52,Other,140% of Medicaid,948.25,34,"If Charge > 2,000, then 34 percent",948.25,percent of total billed charges,Drugs,760.3,,,760.3,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1998.77,,,1998.77,Other,215% Medicaid APG methodology,1998.77,,,1998.77,Other,215% Medicaid APG methodology,1162.08,,,1162.08,Other,125% Medicaid APG methodology,0.01,2091.74,
ROMIPLOSTIM 500MCG INJ,J2796,HCPCS,,80001805,CDM,636,RC,55513022201,NDC,both,1,EA,15566.31,947.47,,,947.47,Other,150% of Medicare + 9.63% HCRA Surcharge,576.16,,,576.16,Fee Schedule,Average Sale Price (ASP) x 6,5448.21,35,,5448.21,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,5292.55,34,,5292.55,percent of total billed charges,Drugs,5292.55,34,,5292.55,percent of total billed charges,Drugs,5292.55,34,,5292.55,percent of total billed charges,Drugs,5292.55,34,,5292.55,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,5292.55,34,"If Charge > 500, then 34 percent",5292.55,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,6226.52,40,,6226.52,percent of total billed charges,Drugs,10896.42,70,,10896.42,percent of total billed charges,All Other,5603.87,36,,5603.87,percent of total billed charges,Drugs,5603.87,36,,5603.87,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,5448.21,35,,5448.21,percent of total billed charges,Drugs,5188.77,,,5188.77,Other,Drug Cost,5188.77,,,5188.77,Other,Drug Cost,5188.77,,,5188.77,Other,Drug Cost,5188.77,,,5188.77,Other,Drug Cost,5188.77,,,5188.77,Other,Drug Cost,5188.77,,,5188.77,Other,Drug Cost,11674.73,,,11674.73,Other,225% of Medicaid,7264.28,,,7264.28,Other,140% of Medicaid,5292.55,34,"If Charge > 2,000, then 34 percent",5292.55,percent of total billed charges,Drugs,921.86,,,921.86,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",11155.86,,,11155.86,Other,215% Medicaid APG methodology,11155.86,,,11155.86,Other,215% Medicaid APG methodology,6485.96,,,6485.96,Other,125% Medicaid APG methodology,0.01,11674.73,
ROPIVACAINE 0.5% INJECTION,J2795,HCPCS,,80001810,CDM,636,RC,55150019720,NDC,both,25,ML,6.48,0.76,,,0.76,Other,150% of Medicare + 9.63% HCRA Surcharge,0.46,,,0.46,Fee Schedule,Average Sale Price (ASP) x 6,2.27,35,,2.27,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,2.2,34,,2.2,percent of total billed charges,Drugs,2.2,34,,2.2,percent of total billed charges,Drugs,2.2,34,,2.2,percent of total billed charges,Drugs,2.2,34,,2.2,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,2.59,40,,2.59,percent of total billed charges,Drugs,4.53,70,,4.53,percent of total billed charges,All Other,2.33,36,,2.33,percent of total billed charges,Drugs,2.33,36,,2.33,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,2.27,35,,2.27,percent of total billed charges,Drugs,2.16,,,2.16,Other,Drug Cost,2.16,,,2.16,Other,Drug Cost,2.16,,,2.16,Other,Drug Cost,2.16,,,2.16,Other,Drug Cost,2.16,,,2.16,Other,Drug Cost,2.16,,,2.16,Other,Drug Cost,4.86,,,4.86,Other,225% of Medicaid,3.02,,,3.02,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.74,,,0.74,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.64,,,4.64,Other,215% Medicaid APG methodology,4.64,,,4.64,Other,215% Medicaid APG methodology,2.7,,,2.7,Other,125% Medicaid APG methodology,0.01,4.86,
ROPIVACAINE 0.75% INJECTION,J2795,HCPCS,,80001811,CDM,636,RC,63323028720,NDC,both,5,ML,11.3,0.76,,,0.76,Other,150% of Medicare + 9.63% HCRA Surcharge,0.46,,,0.46,Fee Schedule,Average Sale Price (ASP) x 6,3.96,35,,3.96,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,3.84,34,,3.84,percent of total billed charges,Drugs,3.84,34,,3.84,percent of total billed charges,Drugs,3.84,34,,3.84,percent of total billed charges,Drugs,3.84,34,,3.84,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,4.52,40,,4.52,percent of total billed charges,Drugs,7.91,70,,7.91,percent of total billed charges,All Other,4.07,36,,4.07,percent of total billed charges,Drugs,4.07,36,,4.07,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,3.96,35,,3.96,percent of total billed charges,Drugs,3.77,,,3.77,Other,Drug Cost,3.77,,,3.77,Other,Drug Cost,3.77,,,3.77,Other,Drug Cost,3.77,,,3.77,Other,Drug Cost,3.77,,,3.77,Other,Drug Cost,3.77,,,3.77,Other,Drug Cost,8.48,,,8.48,Other,225% of Medicaid,5.28,,,5.28,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.74,,,0.74,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8.1,,,8.1,Other,215% Medicaid APG methodology,8.1,,,8.1,Other,215% Medicaid APG methodology,4.71,,,4.71,Other,125% Medicaid APG methodology,0.01,8.48,
ROPIVACAINE HCL INJ 0.2% 100ML,J2795,HCPCS,,80001812,CDM,636,RC,63323028565,NDC,both,12,ML,32.32,0.76,,,0.76,Other,150% of Medicare + 9.63% HCRA Surcharge,0.46,,,0.46,Fee Schedule,Average Sale Price (ASP) x 6,11.31,35,,11.31,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,10.99,34,,10.99,percent of total billed charges,Drugs,10.99,34,,10.99,percent of total billed charges,Drugs,10.99,34,,10.99,percent of total billed charges,Drugs,10.99,34,,10.99,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,12.93,40,,12.93,percent of total billed charges,Drugs,22.62,70,,22.62,percent of total billed charges,All Other,11.63,36,,11.63,percent of total billed charges,Drugs,11.63,36,,11.63,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,11.31,35,,11.31,percent of total billed charges,Drugs,10.77,,,10.77,Other,Drug Cost,10.77,,,10.77,Other,Drug Cost,10.77,,,10.77,Other,Drug Cost,10.77,,,10.77,Other,Drug Cost,10.77,,,10.77,Other,Drug Cost,10.77,,,10.77,Other,Drug Cost,24.24,,,24.24,Other,225% of Medicaid,15.08,,,15.08,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.74,,,0.74,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",23.16,,,23.16,Other,215% Medicaid APG methodology,23.16,,,23.16,Other,215% Medicaid APG methodology,13.46,,,13.46,Other,125% Medicaid APG methodology,0.01,24.24,
ROPIVACAINE HCL INJ 0.2% 200ML,J2795,HCPCS,,80001813,CDM,636,RC,63323028564,NDC,both,12,ML,64.63,0.76,,,0.76,Other,150% of Medicare + 9.63% HCRA Surcharge,0.46,,,0.46,Fee Schedule,Average Sale Price (ASP) x 6,22.62,35,,22.62,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,21.97,34,,21.97,percent of total billed charges,Drugs,21.97,34,,21.97,percent of total billed charges,Drugs,21.97,34,,21.97,percent of total billed charges,Drugs,21.97,34,,21.97,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,25.85,40,,25.85,percent of total billed charges,Drugs,45.24,70,,45.24,percent of total billed charges,All Other,23.27,36,,23.27,percent of total billed charges,Drugs,23.27,36,,23.27,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,22.62,35,,22.62,percent of total billed charges,Drugs,21.54,,,21.54,Other,Drug Cost,21.54,,,21.54,Other,Drug Cost,21.54,,,21.54,Other,Drug Cost,21.54,,,21.54,Other,Drug Cost,21.54,,,21.54,Other,Drug Cost,21.54,,,21.54,Other,Drug Cost,48.47,,,48.47,Other,225% of Medicaid,30.16,,,30.16,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.74,,,0.74,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",46.32,,,46.32,Other,215% Medicaid APG methodology,46.32,,,46.32,Other,215% Medicaid APG methodology,26.93,,,26.93,Other,125% Medicaid APG methodology,0.01,48.47,
SINCALIDE INJECTION 5 MICROGRAMS,J2805,HCPCS,,80001854,CDM,636,RC,270055615,NDC,both,10,EA,354.56,1313.25,,,1313.25,Other,150% of Medicare + 9.63% HCRA Surcharge,798.59,,,798.59,Fee Schedule,Average Sale Price (ASP) x 6,124.1,35,,124.1,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,120.55,34,,120.55,percent of total billed charges,Drugs,120.55,34,,120.55,percent of total billed charges,Drugs,120.55,34,,120.55,percent of total billed charges,Drugs,120.55,34,,120.55,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,141.82,40,,141.82,percent of total billed charges,Drugs,248.19,70,,248.19,percent of total billed charges,All Other,127.64,36,,127.64,percent of total billed charges,Drugs,127.64,36,,127.64,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,124.1,35,,124.1,percent of total billed charges,Drugs,118.19,,,118.19,Other,Drug Cost,118.19,,,118.19,Other,Drug Cost,118.19,,,118.19,Other,Drug Cost,118.19,,,118.19,Other,Drug Cost,118.19,,,118.19,Other,Drug Cost,118.19,,,118.19,Other,Drug Cost,265.92,,,265.92,Other,225% of Medicaid,165.46,,,165.46,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1277.75,,,1277.75,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",254.1,,,254.1,Other,215% Medicaid APG methodology,254.1,,,254.1,Other,215% Medicaid APG methodology,147.73,,,147.73,Other,125% Medicaid APG methodology,0.01,1313.25,
SODIUM CHLORIDE 0.9% 250ML,J7050,HCPCS,,80001878,CDM,636,RC,264780020,NDC,both,24,ML,0.76,6.64,,,6.64,Other,150% of Medicare + 9.63% HCRA Surcharge,4.04,,,4.04,Fee Schedule,Average Sale Price (ASP) x 6,0.27,35,,0.27,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.26,34,,0.26,percent of total billed charges,Drugs,0.26,34,,0.26,percent of total billed charges,Drugs,0.26,34,,0.26,percent of total billed charges,Drugs,0.26,34,,0.26,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.31,40,,0.31,percent of total billed charges,Drugs,0.53,70,,0.53,percent of total billed charges,All Other,0.27,36,,0.27,percent of total billed charges,Drugs,0.27,36,,0.27,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.27,35,,0.27,percent of total billed charges,Drugs,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.25,,,0.25,Other,Drug Cost,0.57,,,0.57,Other,225% of Medicaid,0.36,,,0.36,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.46,,,6.46,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.55,,,0.55,Other,215% Medicaid APG methodology,0.55,,,0.55,Other,215% Medicaid APG methodology,0.32,,,0.32,Other,125% Medicaid APG methodology,0.01,6.64,
SODIUM CHLORIDE 1000ML,J7030,HCPCS,,80001882,CDM,636,RC,264780000,NDC,both,12,ML,3.06,26.55,,,26.55,Other,150% of Medicare + 9.63% HCRA Surcharge,16.15,,,16.15,Fee Schedule,Average Sale Price (ASP) x 6,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.04,34,,1.04,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.22,40,,1.22,percent of total billed charges,Drugs,2.14,70,,2.14,percent of total billed charges,All Other,1.1,36,,1.1,percent of total billed charges,Drugs,1.1,36,,1.1,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.07,35,,1.07,percent of total billed charges,Drugs,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,1.02,,,1.02,Other,Drug Cost,2.29,,,2.29,Other,225% of Medicaid,1.43,,,1.43,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,25.83,,,25.83,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.19,,,2.19,Other,215% Medicaid APG methodology,2.19,,,2.19,Other,215% Medicaid APG methodology,1.27,,,1.27,Other,125% Medicaid APG methodology,0.01,26.55,
ECULIZUMAB 10MG/ML 30 ML,J1300,HCPCS,,80001898,CDM,636,RC,25682000101,NDC,both,1,ML,19569,2226.77,,,2226.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1354.11,,,1354.11,Fee Schedule,Average Sale Price (ASP) x 6,6849.15,35,,6849.15,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,6653.46,34,,6653.46,percent of total billed charges,Drugs,6653.46,34,,6653.46,percent of total billed charges,Drugs,6653.46,34,,6653.46,percent of total billed charges,Drugs,6653.46,34,,6653.46,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,6653.46,34,"If Charge > 500, then 34 percent",6653.46,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,7827.6,40,,7827.6,percent of total billed charges,Drugs,13698.3,70,,13698.3,percent of total billed charges,All Other,7044.84,36,,7044.84,percent of total billed charges,Drugs,7044.84,36,,7044.84,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,6849.15,35,,6849.15,percent of total billed charges,Drugs,6523,,,6523,Other,Drug Cost,6523,,,6523,Other,Drug Cost,6523,,,6523,Other,Drug Cost,6523,,,6523,Other,Drug Cost,6523,,,6523,Other,Drug Cost,6523,,,6523,Other,Drug Cost,14676.75,,,14676.75,Other,225% of Medicaid,9132.2,,,9132.2,Other,140% of Medicaid,6653.46,34,"If Charge > 2,000, then 34 percent",6653.46,percent of total billed charges,Drugs,2166.58,,,2166.58,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",14024.45,,,14024.45,Other,215% Medicaid APG methodology,14024.45,,,14024.45,Other,215% Medicaid APG methodology,8153.75,,,8153.75,Other,125% Medicaid APG methodology,0.01,14676.75,
STREPTOMYCIN 1GM INJ,J3000,HCPCS,,80001915,CDM,636,RC,39822070602,NDC,both,10,EA,31.97,320.83,,,320.83,Other,150% of Medicare + 9.63% HCRA Surcharge,195.1,,,195.1,Fee Schedule,Average Sale Price (ASP) x 6,11.19,35,,11.19,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,10.87,34,,10.87,percent of total billed charges,Drugs,10.87,34,,10.87,percent of total billed charges,Drugs,10.87,34,,10.87,percent of total billed charges,Drugs,10.87,34,,10.87,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,12.79,40,,12.79,percent of total billed charges,Drugs,22.38,70,,22.38,percent of total billed charges,All Other,11.51,36,,11.51,percent of total billed charges,Drugs,11.51,36,,11.51,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,11.19,35,,11.19,percent of total billed charges,Drugs,10.66,,,10.66,Other,Drug Cost,10.66,,,10.66,Other,Drug Cost,10.66,,,10.66,Other,Drug Cost,10.66,,,10.66,Other,Drug Cost,10.66,,,10.66,Other,Drug Cost,10.66,,,10.66,Other,Drug Cost,23.98,,,23.98,Other,225% of Medicaid,14.92,,,14.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,312.15,,,312.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",22.91,,,22.91,Other,215% Medicaid APG methodology,22.91,,,22.91,Other,215% Medicaid APG methodology,13.32,,,13.32,Other,125% Medicaid APG methodology,0.01,320.83,
SUCCINYLCHOLINE CHLORIDE 20MG INJ,J0330,HCPCS,,80001918,CDM,636,RC,409662902,NDC,both,25,ML,0.27,0.11,39.4668,,0.11,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,34,,0.09,percent of total billed charges,Drugs,0.09,34,,0.09,percent of total billed charges,Drugs,0.09,34,,0.09,percent of total billed charges,Drugs,0.09,34,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.11,40,,0.11,percent of total billed charges,Drugs,0.19,70,,0.19,percent of total billed charges,All Other,0.1,36,,0.1,percent of total billed charges,Drugs,0.1,36,,0.1,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,35,,0.09,percent of total billed charges,Drugs,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.19,,,0.19,Other,215% Medicaid APG methodology,0.19,,,0.19,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,0.2,
SUMATRIPTAN SUCC (IMITREX) 6MG/0.5ML INJ,J3030,HCPCS,,80001928,CDM,636,RC,55150017301,NDC,both,5,ML,8.8,3.47,39.4668,,3.47,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,2.99,34,,2.99,percent of total billed charges,Drugs,2.99,34,,2.99,percent of total billed charges,Drugs,2.99,34,,2.99,percent of total billed charges,Drugs,2.99,34,,2.99,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.52,40,,3.52,percent of total billed charges,Drugs,6.16,70,,6.16,percent of total billed charges,All Other,3.17,36,,3.17,percent of total billed charges,Drugs,3.17,36,,3.17,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,3.08,35,,3.08,percent of total billed charges,Drugs,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,2.93,,,2.93,Other,Drug Cost,6.6,,,6.6,Other,225% of Medicaid,4.1,,,4.1,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6.3,,,6.3,Other,215% Medicaid APG methodology,6.3,,,6.3,Other,215% Medicaid APG methodology,3.67,,,3.67,Other,125% Medicaid APG methodology,0.01,6.6,
TACROLIMUS 1 MG CAP,J7507,HCPCS,,80001932,CDM,636,RC,16729004201,NDC,both,100,EA,0.21,2.33,,,2.33,Other,150% of Medicare + 9.63% HCRA Surcharge,1.42,,,1.42,Fee Schedule,Average Sale Price (ASP) x 6,0.07,35,,0.07,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.07,34,,0.07,percent of total billed charges,Drugs,0.07,34,,0.07,percent of total billed charges,Drugs,0.07,34,,0.07,percent of total billed charges,Drugs,0.07,34,,0.07,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.08,40,,0.08,percent of total billed charges,Drugs,0.15,70,,0.15,percent of total billed charges,All Other,0.08,36,,0.08,percent of total billed charges,Drugs,0.08,36,,0.08,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.07,35,,0.07,percent of total billed charges,Drugs,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.07,,,0.07,Other,Drug Cost,0.16,,,0.16,Other,225% of Medicaid,0.1,,,0.1,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.27,,,2.27,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.15,,,0.15,Other,215% Medicaid APG methodology,0.15,,,0.15,Other,215% Medicaid APG methodology,0.09,,,0.09,Other,125% Medicaid APG methodology,0.01,2.33,
TEMOZOLAMIDE 140MG CASULE,J8700,HCPCS,,80001941,CDM,636,RC,67877054007,NDC,both,5,EA,138.11,2.77,,,2.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1.69,,,1.69,Fee Schedule,Average Sale Price (ASP) x 6,48.34,35,,48.34,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,46.96,34,,46.96,percent of total billed charges,Drugs,46.96,34,,46.96,percent of total billed charges,Drugs,46.96,34,,46.96,percent of total billed charges,Drugs,46.96,34,,46.96,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,55.25,40,,55.25,percent of total billed charges,Drugs,96.68,70,,96.68,percent of total billed charges,All Other,49.72,36,,49.72,percent of total billed charges,Drugs,49.72,36,,49.72,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,48.34,35,,48.34,percent of total billed charges,Drugs,46.04,,,46.04,Other,Drug Cost,46.04,,,46.04,Other,Drug Cost,46.04,,,46.04,Other,Drug Cost,46.04,,,46.04,Other,Drug Cost,46.04,,,46.04,Other,Drug Cost,46.04,,,46.04,Other,Drug Cost,103.59,,,103.59,Other,225% of Medicaid,64.45,,,64.45,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.7,,,2.7,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",98.98,,,98.98,Other,215% Medicaid APG methodology,98.98,,,98.98,Other,215% Medicaid APG methodology,57.55,,,57.55,Other,125% Medicaid APG methodology,0.01,103.59,
TENECTEPLASE INJECTION 50 MG VIAL,J3101,HCPCS,,80001942,CDM,636,RC,50242012047,NDC,both,1,EA,5580.57,1510.73,,,1510.73,Other,150% of Medicare + 9.63% HCRA Surcharge,918.68,,,918.68,Fee Schedule,Average Sale Price (ASP) x 6,1953.2,35,,1953.2,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,1897.39,34,,1897.39,percent of total billed charges,Drugs,1897.39,34,,1897.39,percent of total billed charges,Drugs,1897.39,34,,1897.39,percent of total billed charges,Drugs,1897.39,34,,1897.39,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,1897.39,34,"If Charge > 500, then 34 percent",1897.39,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,2232.23,40,,2232.23,percent of total billed charges,Drugs,3906.4,70,,3906.4,percent of total billed charges,All Other,2009.01,36,,2009.01,percent of total billed charges,Drugs,2009.01,36,,2009.01,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,1953.2,35,,1953.2,percent of total billed charges,Drugs,1860.19,,,1860.19,Other,Drug Cost,1860.19,,,1860.19,Other,Drug Cost,1860.19,,,1860.19,Other,Drug Cost,1860.19,,,1860.19,Other,Drug Cost,1860.19,,,1860.19,Other,Drug Cost,1860.19,,,1860.19,Other,Drug Cost,4185.43,,,4185.43,Other,225% of Medicaid,2604.27,,,2604.27,Other,140% of Medicaid,1897.39,34,"If Charge > 2,000, then 34 percent",1897.39,percent of total billed charges,Drugs,1469.89,,,1469.89,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3999.41,,,3999.41,Other,215% Medicaid APG methodology,3999.41,,,3999.41,Other,215% Medicaid APG methodology,2325.24,,,2325.24,Other,125% Medicaid APG methodology,0.01,4185.43,
TERBUTALINE SULFATE INJ TO 1 MG,J3105,HCPCS,,80001949,CDM,636,RC,143974610,NDC,both,10,ML,3.56,76.9,,,76.9,Other,150% of Medicare + 9.63% HCRA Surcharge,46.76,,,46.76,Fee Schedule,Average Sale Price (ASP) x 6,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.21,34,,1.21,percent of total billed charges,Drugs,1.21,34,,1.21,percent of total billed charges,Drugs,1.21,34,,1.21,percent of total billed charges,Drugs,1.21,34,,1.21,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.42,40,,1.42,percent of total billed charges,Drugs,2.49,70,,2.49,percent of total billed charges,All Other,1.28,36,,1.28,percent of total billed charges,Drugs,1.28,36,,1.28,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.25,35,,1.25,percent of total billed charges,Drugs,1.19,,,1.19,Other,Drug Cost,1.19,,,1.19,Other,Drug Cost,1.19,,,1.19,Other,Drug Cost,1.19,,,1.19,Other,Drug Cost,1.19,,,1.19,Other,Drug Cost,1.19,,,1.19,Other,Drug Cost,2.67,,,2.67,Other,225% of Medicaid,1.66,,,1.66,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,74.82,,,74.82,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.55,,,2.55,Other,215% Medicaid APG methodology,2.55,,,2.55,Other,215% Medicaid APG methodology,1.48,,,1.48,Other,125% Medicaid APG methodology,0.01,76.9,
TESTOSTERONE CYPIONATE 200MG/ML INJ,J1071,HCPCS,,80001953,CDM,636,RC,9041701,NDC,both,1,ML,11.61,0.27,,,0.27,Other,150% of Medicare + 9.63% HCRA Surcharge,0.16,,,0.16,Fee Schedule,Average Sale Price (ASP) x 6,4.06,35,,4.06,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,3.95,34,,3.95,percent of total billed charges,Drugs,3.95,34,,3.95,percent of total billed charges,Drugs,3.95,34,,3.95,percent of total billed charges,Drugs,3.95,34,,3.95,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,4.64,40,,4.64,percent of total billed charges,Drugs,8.13,70,,8.13,percent of total billed charges,All Other,4.18,36,,4.18,percent of total billed charges,Drugs,4.18,36,,4.18,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,4.06,35,,4.06,percent of total billed charges,Drugs,3.87,,,3.87,Other,Drug Cost,3.87,,,3.87,Other,Drug Cost,3.87,,,3.87,Other,Drug Cost,3.87,,,3.87,Other,Drug Cost,3.87,,,3.87,Other,Drug Cost,3.87,,,3.87,Other,Drug Cost,8.71,,,8.71,Other,225% of Medicaid,5.42,,,5.42,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.26,,,0.26,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8.32,,,8.32,Other,215% Medicaid APG methodology,8.32,,,8.32,Other,215% Medicaid APG methodology,4.84,,,4.84,Other,125% Medicaid APG methodology,0.01,8.71,
TETANUS IMMUNE GLOBULIN 250 U INJ,J1670,HCPCS,,80001954,CDM,636,RC,13533063402,NDC,both,1,ML,0.03,5709,,,5709,Other,150% of Medicare + 9.63% HCRA Surcharge,3471.68,,,3471.68,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,5554.68,,,5554.68,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,5709,
THIAMINE HCL 100 MG INJ,J3411,HCPCS,,80001965,CDM,636,RC,25021050002,NDC,both,25,ML,9.3,24.25,,,24.25,Other,150% of Medicare + 9.63% HCRA Surcharge,14.75,,,14.75,Fee Schedule,Average Sale Price (ASP) x 6,3.25,35,,3.25,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,3.16,34,,3.16,percent of total billed charges,Drugs,3.16,34,,3.16,percent of total billed charges,Drugs,3.16,34,,3.16,percent of total billed charges,Drugs,3.16,34,,3.16,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,3.72,40,,3.72,percent of total billed charges,Drugs,6.51,70,,6.51,percent of total billed charges,All Other,3.35,36,,3.35,percent of total billed charges,Drugs,3.35,36,,3.35,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,3.25,35,,3.25,percent of total billed charges,Drugs,3.1,,,3.1,Other,Drug Cost,3.1,,,3.1,Other,Drug Cost,3.1,,,3.1,Other,Drug Cost,3.1,,,3.1,Other,Drug Cost,3.1,,,3.1,Other,Drug Cost,3.1,,,3.1,Other,Drug Cost,6.97,,,6.97,Other,225% of Medicaid,4.34,,,4.34,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,23.6,,,23.6,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6.66,,,6.66,Other,215% Medicaid APG methodology,6.66,,,6.66,Other,215% Medicaid APG methodology,3.87,,,3.87,Other,125% Medicaid APG methodology,0.01,24.25,
TIGECYCLINE 50MG INJ,J3243,HCPCS,,80001974,CDM,636,RC,8499020,NDC,both,10,EA,20.4,7.26,,,7.26,Other,150% of Medicare + 9.63% HCRA Surcharge,4.42,,,4.42,Fee Schedule,Average Sale Price (ASP) x 6,7.14,35,,7.14,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,6.94,34,,6.94,percent of total billed charges,Drugs,6.94,34,,6.94,percent of total billed charges,Drugs,6.94,34,,6.94,percent of total billed charges,Drugs,6.94,34,,6.94,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,8.16,40,,8.16,percent of total billed charges,Drugs,14.28,70,,14.28,percent of total billed charges,All Other,7.34,36,,7.34,percent of total billed charges,Drugs,7.34,36,,7.34,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,7.14,35,,7.14,percent of total billed charges,Drugs,6.8,,,6.8,Other,Drug Cost,6.8,,,6.8,Other,Drug Cost,6.8,,,6.8,Other,Drug Cost,6.8,,,6.8,Other,Drug Cost,6.8,,,6.8,Other,Drug Cost,6.8,,,6.8,Other,Drug Cost,15.3,,,15.3,Other,225% of Medicaid,9.52,,,9.52,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.07,,,7.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",14.62,,,14.62,Other,215% Medicaid APG methodology,14.62,,,14.62,Other,215% Medicaid APG methodology,8.5,,,8.5,Other,125% Medicaid APG methodology,0.01,15.3,
TOBRAMYCIN SULFATE INJ TO 80 MG,J3260,HCPCS,,80001993,CDM,636,RC,63323030602,NDC,both,25,ML,2.55,26.28,,,26.28,Other,150% of Medicare + 9.63% HCRA Surcharge,15.98,,,15.98,Fee Schedule,Average Sale Price (ASP) x 6,0.89,35,,0.89,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,0.87,34,,0.87,percent of total billed charges,Drugs,0.87,34,,0.87,percent of total billed charges,Drugs,0.87,34,,0.87,percent of total billed charges,Drugs,0.87,34,,0.87,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,1.02,40,,1.02,percent of total billed charges,Drugs,1.79,70,,1.79,percent of total billed charges,All Other,0.92,36,,0.92,percent of total billed charges,Drugs,0.92,36,,0.92,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,0.89,35,,0.89,percent of total billed charges,Drugs,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,0.85,,,0.85,Other,Drug Cost,1.92,,,1.92,Other,225% of Medicaid,1.19,,,1.19,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,25.57,,,25.57,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.83,,,1.83,Other,215% Medicaid APG methodology,1.83,,,1.83,Other,215% Medicaid APG methodology,1.06,,,1.06,Other,125% Medicaid APG methodology,0.01,26.28,
TORADOL INJ 30MG,J1885,HCPCS,,80002002,CDM,636,RC,25021070101,NDC,both,25,ML,1.08,4.81,,,4.81,Other,150% of Medicare + 9.63% HCRA Surcharge,2.93,,,2.93,Fee Schedule,Average Sale Price (ASP) x 6,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.37,34,,0.37,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.43,40,,0.43,percent of total billed charges,Drugs,0.75,70,,0.75,percent of total billed charges,All Other,0.39,36,,0.39,percent of total billed charges,Drugs,0.39,36,,0.39,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.38,35,,0.38,percent of total billed charges,Drugs,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.36,,,0.36,Other,Drug Cost,0.81,,,0.81,Other,225% of Medicaid,0.5,,,0.5,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.68,,,4.68,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.77,,,0.77,Other,215% Medicaid APG methodology,0.77,,,0.77,Other,215% Medicaid APG methodology,0.45,,,0.45,Other,125% Medicaid APG methodology,0.01,4.81,
TORADOL INJ 60MG,J1885,HCPCS,,80002003,CDM,636,RC,63323016202,NDC,both,25,ML,2.39,4.81,,,4.81,Other,150% of Medicare + 9.63% HCRA Surcharge,2.93,,,2.93,Fee Schedule,Average Sale Price (ASP) x 6,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.96,40,,0.96,percent of total billed charges,Drugs,1.67,70,,1.67,percent of total billed charges,All Other,0.86,36,,0.86,percent of total billed charges,Drugs,0.86,36,,0.86,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,1.79,,,1.79,Other,225% of Medicaid,1.12,,,1.12,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.68,,,4.68,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.71,,,1.71,Other,215% Medicaid APG methodology,1.71,,,1.71,Other,215% Medicaid APG methodology,1,,,1,Other,125% Medicaid APG methodology,0.01,4.81,
TPA INJ 100MG,J2997,HCPCS,,80002007,CDM,636,RC,50242008527,NDC,both,1,EA,23916.75,877.88,,,877.88,Other,150% of Medicare + 9.63% HCRA Surcharge,533.84,,,533.84,Fee Schedule,Average Sale Price (ASP) x 6,8370.86,35,,8370.86,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,8131.7,34,,8131.7,percent of total billed charges,Drugs,8131.7,34,,8131.7,percent of total billed charges,Drugs,8131.7,34,,8131.7,percent of total billed charges,Drugs,8131.7,34,,8131.7,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,8131.7,34,"If Charge > 500, then 34 percent",8131.7,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,9566.7,40,,9566.7,percent of total billed charges,Drugs,16741.73,70,,16741.73,percent of total billed charges,All Other,8610.03,36,,8610.03,percent of total billed charges,Drugs,8610.03,36,,8610.03,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,8370.86,35,,8370.86,percent of total billed charges,Drugs,7972.25,,,7972.25,Other,Drug Cost,7972.25,,,7972.25,Other,Drug Cost,7972.25,,,7972.25,Other,Drug Cost,7972.25,,,7972.25,Other,Drug Cost,7972.25,,,7972.25,Other,Drug Cost,7972.25,,,7972.25,Other,Drug Cost,17937.56,,,17937.56,Other,225% of Medicaid,11161.15,,,11161.15,Other,140% of Medicaid,8131.7,34,"If Charge > 2,000, then 34 percent",8131.7,percent of total billed charges,Drugs,854.15,,,854.15,Other,160% Medicare Fee Schedule,8131.7,34,,8131.7,Other,"Drug Charges > 20,000, then 34% of Charges",17140.34,,,17140.34,Other,215% Medicaid APG methodology,17140.34,,,17140.34,Other,215% Medicaid APG methodology,9965.31,,,9965.31,Other,125% Medicaid APG methodology,533.84,17937.56,
TPA INJ 2 MG (CATHFLO),J2997,HCPCS,,80002008,CDM,636,RC,50242004164,NDC,both,1,EA,130.68,877.88,,,877.88,Other,150% of Medicare + 9.63% HCRA Surcharge,533.84,,,533.84,Fee Schedule,Average Sale Price (ASP) x 6,45.74,35,,45.74,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,44.43,34,,44.43,percent of total billed charges,Drugs,44.43,34,,44.43,percent of total billed charges,Drugs,44.43,34,,44.43,percent of total billed charges,Drugs,44.43,34,,44.43,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,52.27,40,,52.27,percent of total billed charges,Drugs,91.48,70,,91.48,percent of total billed charges,All Other,47.04,36,,47.04,percent of total billed charges,Drugs,47.04,36,,47.04,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,45.74,35,,45.74,percent of total billed charges,Drugs,43.56,,,43.56,Other,Drug Cost,43.56,,,43.56,Other,Drug Cost,43.56,,,43.56,Other,Drug Cost,43.56,,,43.56,Other,Drug Cost,43.56,,,43.56,Other,Drug Cost,43.56,,,43.56,Other,Drug Cost,98.01,,,98.01,Other,225% of Medicaid,60.98,,,60.98,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,854.15,,,854.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",93.65,,,93.65,Other,215% Medicaid APG methodology,93.65,,,93.65,Other,215% Medicaid APG methodology,54.45,,,54.45,Other,125% Medicaid APG methodology,0.01,877.88,
TRIAMCINOLONE ACET INJ 50MG/5ML,J3301,HCPCS,,80002023,CDM,636,RC,3049420,NDC,both,1,ML,15.99,9.33,,,9.33,Other,150% of Medicare + 9.63% HCRA Surcharge,5.68,,,5.68,Fee Schedule,Average Sale Price (ASP) x 6,5.6,35,,5.6,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,5.44,34,,5.44,percent of total billed charges,Drugs,5.44,34,,5.44,percent of total billed charges,Drugs,5.44,34,,5.44,percent of total billed charges,Drugs,5.44,34,,5.44,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,6.4,40,,6.4,percent of total billed charges,Drugs,11.19,70,,11.19,percent of total billed charges,All Other,5.76,36,,5.76,percent of total billed charges,Drugs,5.76,36,,5.76,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,5.6,35,,5.6,percent of total billed charges,Drugs,5.33,,,5.33,Other,Drug Cost,5.33,,,5.33,Other,Drug Cost,5.33,,,5.33,Other,Drug Cost,5.33,,,5.33,Other,Drug Cost,5.33,,,5.33,Other,Drug Cost,5.33,,,5.33,Other,Drug Cost,11.99,,,11.99,Other,225% of Medicaid,7.46,,,7.46,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,9.08,,,9.08,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",11.46,,,11.46,Other,215% Medicaid APG methodology,11.46,,,11.46,Other,215% Medicaid APG methodology,6.66,,,6.66,Other,125% Medicaid APG methodology,0.01,11.99,
VANCOMYCIN HCL 1000MG INJ,J3370,HCPCS,,80002066,CDM,636,RC,70436002182,NDC,both,10,EA,2.04,22.76,,,22.76,Other,150% of Medicare + 9.63% HCRA Surcharge,13.84,,,13.84,Fee Schedule,Average Sale Price (ASP) x 6,0.71,35,,0.71,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.69,34,,0.69,percent of total billed charges,Drugs,0.69,34,,0.69,percent of total billed charges,Drugs,0.69,34,,0.69,percent of total billed charges,Drugs,0.69,34,,0.69,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.81,40,,0.81,percent of total billed charges,Drugs,1.43,70,,1.43,percent of total billed charges,All Other,0.73,36,,0.73,percent of total billed charges,Drugs,0.73,36,,0.73,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.71,35,,0.71,percent of total billed charges,Drugs,0.68,,,0.68,Other,Drug Cost,0.68,,,0.68,Other,Drug Cost,0.68,,,0.68,Other,Drug Cost,0.68,,,0.68,Other,Drug Cost,0.68,,,0.68,Other,Drug Cost,0.68,,,0.68,Other,Drug Cost,1.53,,,1.53,Other,225% of Medicaid,0.95,,,0.95,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,22.15,,,22.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.46,,,1.46,Other,215% Medicaid APG methodology,1.46,,,1.46,Other,215% Medicaid APG methodology,0.85,,,0.85,Other,125% Medicaid APG methodology,0.01,22.76,
VANCOMYCIN HCL 500 MG INJ,J3370,HCPCS,,80002067,CDM,636,RC,70436002082,NDC,both,10,EA,3.83,22.76,,,22.76,Other,150% of Medicare + 9.63% HCRA Surcharge,13.84,,,13.84,Fee Schedule,Average Sale Price (ASP) x 6,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.3,34,,1.3,percent of total billed charges,Drugs,1.3,34,,1.3,percent of total billed charges,Drugs,1.3,34,,1.3,percent of total billed charges,Drugs,1.3,34,,1.3,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.53,40,,1.53,percent of total billed charges,Drugs,2.68,70,,2.68,percent of total billed charges,All Other,1.38,36,,1.38,percent of total billed charges,Drugs,1.38,36,,1.38,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,2.87,,,2.87,Other,225% of Medicaid,1.79,,,1.79,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,22.15,,,22.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.75,,,2.75,Other,215% Medicaid APG methodology,2.75,,,2.75,Other,215% Medicaid APG methodology,1.6,,,1.6,Other,125% Medicaid APG methodology,0.01,22.76,
VANCOMYCIN 750MG/250ML NS,J3370,HCPCS,,80002068,CDM,636,RC,338358048,NDC,both,6,ML,0.01,22.76,,,22.76,Other,150% of Medicare + 9.63% HCRA Surcharge,13.84,,,13.84,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.01,70,,0.01,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,22.15,,,22.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,22.76,
VAPRISOL 20MG/100ML,C9488,HCPCS,,80002070,CDM,636,RC,66220016010,NDC,both,1,ML,1196.49,472.22,39.4668,,472.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,418.77,35,,418.77,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,406.81,34,,406.81,percent of total billed charges,Drugs,406.81,34,,406.81,percent of total billed charges,Drugs,406.81,34,,406.81,percent of total billed charges,Drugs,406.81,34,,406.81,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,406.81,34,"If Charge > 500, then 34 percent",406.81,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,478.6,40,,478.6,percent of total billed charges,Drugs,837.54,70,,837.54,percent of total billed charges,All Other,430.74,36,,430.74,percent of total billed charges,Drugs,430.74,36,,430.74,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,418.77,35,,418.77,percent of total billed charges,Drugs,398.83,,,398.83,Other,Drug Cost,398.83,,,398.83,Other,Drug Cost,398.83,,,398.83,Other,Drug Cost,398.83,,,398.83,Other,Drug Cost,398.83,,,398.83,Other,Drug Cost,398.83,,,398.83,Other,Drug Cost,897.37,,,897.37,Other,225% of Medicaid,558.36,,,558.36,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",857.48,,,857.48,Other,215% Medicaid APG methodology,857.48,,,857.48,Other,215% Medicaid APG methodology,498.54,,,498.54,Other,125% Medicaid APG methodology,0.01,897.37,
VINBLASTINE SULFATE INJ 1 MG,J9360,HCPCS,,80002088,CDM,636,RC,63323027810,NDC,both,1,ML,62.67,41.6,,,41.6,Other,150% of Medicare + 9.63% HCRA Surcharge,25.3,,,25.3,Fee Schedule,Average Sale Price (ASP) x 6,21.93,35,,21.93,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,21.31,34,,21.31,percent of total billed charges,Drugs,21.31,34,,21.31,percent of total billed charges,Drugs,21.31,34,,21.31,percent of total billed charges,Drugs,21.31,34,,21.31,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,25.07,40,,25.07,percent of total billed charges,Drugs,43.87,70,,43.87,percent of total billed charges,All Other,22.56,36,,22.56,percent of total billed charges,Drugs,22.56,36,,22.56,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,21.93,35,,21.93,percent of total billed charges,Drugs,20.89,,,20.89,Other,Drug Cost,20.89,,,20.89,Other,Drug Cost,20.89,,,20.89,Other,Drug Cost,20.89,,,20.89,Other,Drug Cost,20.89,,,20.89,Other,Drug Cost,20.89,,,20.89,Other,Drug Cost,47,,,47,Other,225% of Medicaid,29.25,,,29.25,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,40.47,,,40.47,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",44.91,,,44.91,Other,215% Medicaid APG methodology,44.91,,,44.91,Other,215% Medicaid APG methodology,26.11,,,26.11,Other,125% Medicaid APG methodology,0.01,47,
VINCRISTINE SULFATE 1 MG,J9370,HCPCS,,80002089,CDM,636,RC,61703030906,NDC,both,1,ML,12.51,76.22,,,76.22,Other,150% of Medicare + 9.63% HCRA Surcharge,46.35,,,46.35,Fee Schedule,Average Sale Price (ASP) x 6,4.38,35,,4.38,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,4.25,34,,4.25,percent of total billed charges,Drugs,4.25,34,,4.25,percent of total billed charges,Drugs,4.25,34,,4.25,percent of total billed charges,Drugs,4.25,34,,4.25,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,5,40,,5,percent of total billed charges,Drugs,8.76,70,,8.76,percent of total billed charges,All Other,4.5,36,,4.5,percent of total billed charges,Drugs,4.5,36,,4.5,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,4.38,35,,4.38,percent of total billed charges,Drugs,4.17,,,4.17,Other,Drug Cost,4.17,,,4.17,Other,Drug Cost,4.17,,,4.17,Other,Drug Cost,4.17,,,4.17,Other,Drug Cost,4.17,,,4.17,Other,Drug Cost,4.17,,,4.17,Other,Drug Cost,9.38,,,9.38,Other,225% of Medicaid,5.84,,,5.84,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,74.16,,,74.16,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8.97,,,8.97,Other,215% Medicaid APG methodology,8.97,,,8.97,Other,215% Medicaid APG methodology,5.21,,,5.21,Other,125% Medicaid APG methodology,0.01,76.22,
VINORELBINE TARTRATE INJ 10 MG,J9390,HCPCS,,80002090,CDM,636,RC,25021020405,NDC,both,1,ML,95.97,73.17,,,73.17,Other,150% of Medicare + 9.63% HCRA Surcharge,44.5,,,44.5,Fee Schedule,Average Sale Price (ASP) x 6,33.59,35,,33.59,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,32.63,34,,32.63,percent of total billed charges,Drugs,32.63,34,,32.63,percent of total billed charges,Drugs,32.63,34,,32.63,percent of total billed charges,Drugs,32.63,34,,32.63,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,38.39,40,,38.39,percent of total billed charges,Drugs,67.18,70,,67.18,percent of total billed charges,All Other,34.55,36,,34.55,percent of total billed charges,Drugs,34.55,36,,34.55,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,33.59,35,,33.59,percent of total billed charges,Drugs,31.99,,,31.99,Other,Drug Cost,31.99,,,31.99,Other,Drug Cost,31.99,,,31.99,Other,Drug Cost,31.99,,,31.99,Other,Drug Cost,31.99,,,31.99,Other,Drug Cost,31.99,,,31.99,Other,Drug Cost,71.98,,,71.98,Other,225% of Medicaid,44.79,,,44.79,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,71.19,,,71.19,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",68.78,,,68.78,Other,215% Medicaid APG methodology,68.78,,,68.78,Other,215% Medicaid APG methodology,39.99,,,39.99,Other,125% Medicaid APG methodology,0.01,73.17,
VITAMIN B-12 INJECTION TO 1000 MCG,J3420,HCPCS,,80002099,CDM,636,RC,517003125,NDC,both,25,ML,0.85,14.24,,,14.24,Other,150% of Medicare + 9.63% HCRA Surcharge,8.66,,,8.66,Fee Schedule,Average Sale Price (ASP) x 6,0.3,35,,0.3,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.29,34,,0.29,percent of total billed charges,Drugs,0.29,34,,0.29,percent of total billed charges,Drugs,0.29,34,,0.29,percent of total billed charges,Drugs,0.29,34,,0.29,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.34,40,,0.34,percent of total billed charges,Drugs,0.59,70,,0.59,percent of total billed charges,All Other,0.31,36,,0.31,percent of total billed charges,Drugs,0.31,36,,0.31,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.3,35,,0.3,percent of total billed charges,Drugs,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.28,,,0.28,Other,Drug Cost,0.64,,,0.64,Other,225% of Medicaid,0.4,,,0.4,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,13.85,,,13.85,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.61,,,0.61,Other,215% Medicaid APG methodology,0.61,,,0.61,Other,215% Medicaid APG methodology,0.35,,,0.35,Other,125% Medicaid APG methodology,0.01,14.24,
PHYTONADIONE INJ 1MG/0.5ML SYRINGE,J3430,HCPCS,,80002108,CDM,636,RC,76329124001,NDC,both,10,ML,3.83,28.6,,,28.6,Other,150% of Medicare + 9.63% HCRA Surcharge,17.39,,,17.39,Fee Schedule,Average Sale Price (ASP) x 6,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.3,34,,1.3,percent of total billed charges,Drugs,1.3,34,,1.3,percent of total billed charges,Drugs,1.3,34,,1.3,percent of total billed charges,Drugs,1.3,34,,1.3,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.53,40,,1.53,percent of total billed charges,Drugs,2.68,70,,2.68,percent of total billed charges,All Other,1.38,36,,1.38,percent of total billed charges,Drugs,1.38,36,,1.38,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.34,35,,1.34,percent of total billed charges,Drugs,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,1.28,,,1.28,Other,Drug Cost,2.87,,,2.87,Other,225% of Medicaid,1.79,,,1.79,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,27.83,,,27.83,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.75,,,2.75,Other,215% Medicaid APG methodology,2.75,,,2.75,Other,215% Medicaid APG methodology,1.6,,,1.6,Other,125% Medicaid APG methodology,0.01,28.6,
ZIDOVUDINE (AZT) INJ 10MG/ML 20ML,J3485,HCPCS,,80002125,CDM,636,RC,49702021326,NDC,both,5,ML,64.1,14.91,,,14.91,Other,150% of Medicare + 9.63% HCRA Surcharge,9.07,,,9.07,Fee Schedule,Average Sale Price (ASP) x 6,22.43,35,,22.43,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,21.79,34,,21.79,percent of total billed charges,Drugs,21.79,34,,21.79,percent of total billed charges,Drugs,21.79,34,,21.79,percent of total billed charges,Drugs,21.79,34,,21.79,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,25.64,40,,25.64,percent of total billed charges,Drugs,44.87,70,,44.87,percent of total billed charges,All Other,23.08,36,,23.08,percent of total billed charges,Drugs,23.08,36,,23.08,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,22.43,35,,22.43,percent of total billed charges,Drugs,21.37,,,21.37,Other,Drug Cost,21.37,,,21.37,Other,Drug Cost,21.37,,,21.37,Other,Drug Cost,21.37,,,21.37,Other,Drug Cost,21.37,,,21.37,Other,Drug Cost,21.37,,,21.37,Other,Drug Cost,48.07,,,48.07,Other,225% of Medicaid,29.91,,,29.91,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,14.51,,,14.51,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",45.94,,,45.94,Other,215% Medicaid APG methodology,45.94,,,45.94,Other,215% Medicaid APG methodology,26.71,,,26.71,Other,125% Medicaid APG methodology,0.01,48.07,
ZIPRASIDONE MESYLATE 10 MG INJ,J3486,HCPCS,,80002137,CDM,636,RC,72266016042,NDC,both,10,EA,35.66,96.25,,,96.25,Other,150% of Medicare + 9.63% HCRA Surcharge,58.53,,,58.53,Fee Schedule,Average Sale Price (ASP) x 6,12.48,35,,12.48,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,12.12,34,,12.12,percent of total billed charges,Drugs,12.12,34,,12.12,percent of total billed charges,Drugs,12.12,34,,12.12,percent of total billed charges,Drugs,12.12,34,,12.12,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,14.26,40,,14.26,percent of total billed charges,Drugs,24.96,70,,24.96,percent of total billed charges,All Other,12.84,36,,12.84,percent of total billed charges,Drugs,12.84,36,,12.84,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,12.48,35,,12.48,percent of total billed charges,Drugs,11.89,,,11.89,Other,Drug Cost,11.89,,,11.89,Other,Drug Cost,11.89,,,11.89,Other,Drug Cost,11.89,,,11.89,Other,Drug Cost,11.89,,,11.89,Other,Drug Cost,11.89,,,11.89,Other,Drug Cost,26.75,,,26.75,Other,225% of Medicaid,16.64,,,16.64,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,93.65,,,93.65,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",25.56,,,25.56,Other,215% Medicaid APG methodology,25.56,,,25.56,Other,215% Medicaid APG methodology,14.86,,,14.86,Other,125% Medicaid APG methodology,0.01,96.25,
ZOLEDRONIC ACID 4MG/100ML,J3489,HCPCS,,80002140,CDM,636,RC,25021082682,NDC,both,1,ML,20.37,71.17,,,71.17,Other,150% of Medicare + 9.63% HCRA Surcharge,43.28,,,43.28,Fee Schedule,Average Sale Price (ASP) x 6,7.13,35,,7.13,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,6.93,34,,6.93,percent of total billed charges,Drugs,6.93,34,,6.93,percent of total billed charges,Drugs,6.93,34,,6.93,percent of total billed charges,Drugs,6.93,34,,6.93,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,8.15,40,,8.15,percent of total billed charges,Drugs,14.26,70,,14.26,percent of total billed charges,All Other,7.33,36,,7.33,percent of total billed charges,Drugs,7.33,36,,7.33,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,7.13,35,,7.13,percent of total billed charges,Drugs,6.79,,,6.79,Other,Drug Cost,6.79,,,6.79,Other,Drug Cost,6.79,,,6.79,Other,Drug Cost,6.79,,,6.79,Other,Drug Cost,6.79,,,6.79,Other,Drug Cost,6.79,,,6.79,Other,Drug Cost,15.28,,,15.28,Other,225% of Medicaid,9.51,,,9.51,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,69.24,,,69.24,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",14.6,,,14.6,Other,215% Medicaid APG methodology,14.6,,,14.6,Other,215% Medicaid APG methodology,8.49,,,8.49,Other,125% Medicaid APG methodology,0.01,71.17,
ZOLEDRONIC ACID 4MG/5ML,J3489,HCPCS,,80002141,CDM,636,RC,67457039054,NDC,both,1,ML,61.95,71.17,,,71.17,Other,150% of Medicare + 9.63% HCRA Surcharge,43.28,,,43.28,Fee Schedule,Average Sale Price (ASP) x 6,21.68,35,,21.68,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,21.06,34,,21.06,percent of total billed charges,Drugs,21.06,34,,21.06,percent of total billed charges,Drugs,21.06,34,,21.06,percent of total billed charges,Drugs,21.06,34,,21.06,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,24.78,40,,24.78,percent of total billed charges,Drugs,43.37,70,,43.37,percent of total billed charges,All Other,22.3,36,,22.3,percent of total billed charges,Drugs,22.3,36,,22.3,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,21.68,35,,21.68,percent of total billed charges,Drugs,20.65,,,20.65,Other,Drug Cost,20.65,,,20.65,Other,Drug Cost,20.65,,,20.65,Other,Drug Cost,20.65,,,20.65,Other,Drug Cost,20.65,,,20.65,Other,Drug Cost,20.65,,,20.65,Other,Drug Cost,46.46,,,46.46,Other,225% of Medicaid,28.91,,,28.91,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,69.24,,,69.24,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",44.4,,,44.4,Other,215% Medicaid APG methodology,44.4,,,44.4,Other,215% Medicaid APG methodology,25.81,,,25.81,Other,125% Medicaid APG methodology,0.01,71.17,
CEFAZOLIN 1GM/50ML NS,J0690,HCPCS,,80002162,CDM,636,RC,264310311,NDC,both,24,EA,9.17,7.53,,,7.53,Other,150% of Medicare + 9.63% HCRA Surcharge,4.58,,,4.58,Fee Schedule,Average Sale Price (ASP) x 6,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.12,34,,3.12,percent of total billed charges,Drugs,3.12,34,,3.12,percent of total billed charges,Drugs,3.12,34,,3.12,percent of total billed charges,Drugs,3.12,34,,3.12,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.67,40,,3.67,percent of total billed charges,Drugs,6.42,70,,6.42,percent of total billed charges,All Other,3.3,36,,3.3,percent of total billed charges,Drugs,3.3,36,,3.3,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.21,35,,3.21,percent of total billed charges,Drugs,3.06,,,3.06,Other,Drug Cost,3.06,,,3.06,Other,Drug Cost,3.06,,,3.06,Other,Drug Cost,3.06,,,3.06,Other,Drug Cost,3.06,,,3.06,Other,Drug Cost,3.06,,,3.06,Other,Drug Cost,6.88,,,6.88,Other,225% of Medicaid,4.28,,,4.28,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.32,,,7.32,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6.57,,,6.57,Other,215% Medicaid APG methodology,6.57,,,6.57,Other,215% Medicaid APG methodology,3.82,,,3.82,Other,125% Medicaid APG methodology,0.01,7.53,
CEFTRIAXONE 250MG INJ,J0696,HCPCS,,80002168,CDM,636,RC,781320695,NDC,both,10,EA,1.22,4.84,,,4.84,Other,150% of Medicare + 9.63% HCRA Surcharge,2.95,,,2.95,Fee Schedule,Average Sale Price (ASP) x 6,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.41,34,,0.41,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.49,40,,0.49,percent of total billed charges,Drugs,0.85,70,,0.85,percent of total billed charges,All Other,0.44,36,,0.44,percent of total billed charges,Drugs,0.44,36,,0.44,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.91,,,0.91,Other,225% of Medicaid,0.57,,,0.57,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.71,,,4.71,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.87,,,0.87,Other,215% Medicaid APG methodology,0.87,,,0.87,Other,215% Medicaid APG methodology,0.51,,,0.51,Other,125% Medicaid APG methodology,0.01,4.84,
GENTAMICIN 80MG/2ML INJ,J1580,HCPCS,,80002177,CDM,636,RC,63323001002,NDC,both,25,ML,3.59,26.49,,,26.49,Other,150% of Medicare + 9.63% HCRA Surcharge,16.11,,,16.11,Fee Schedule,Average Sale Price (ASP) x 6,1.26,35,,1.26,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,1.22,34,,1.22,percent of total billed charges,Drugs,1.22,34,,1.22,percent of total billed charges,Drugs,1.22,34,,1.22,percent of total billed charges,Drugs,1.22,34,,1.22,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,1.43,40,,1.43,percent of total billed charges,Drugs,2.51,70,,2.51,percent of total billed charges,All Other,1.29,36,,1.29,percent of total billed charges,Drugs,1.29,36,,1.29,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,1.26,35,,1.26,percent of total billed charges,Drugs,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,1.2,,,1.2,Other,Drug Cost,2.69,,,2.69,Other,225% of Medicaid,1.67,,,1.67,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,25.78,,,25.78,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.57,,,2.57,Other,215% Medicaid APG methodology,2.57,,,2.57,Other,215% Medicaid APG methodology,1.49,,,1.49,Other,125% Medicaid APG methodology,0.01,26.49,
ARGATROBAN 50MG/50ML IV,J0883,HCPCS,,80002190,CDM,636,RC,55150024101,NDC,both,1,ML,49.68,19.61,39.4668,,19.61,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,17.39,35,,17.39,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,16.89,34,,16.89,percent of total billed charges,Drugs,16.89,34,,16.89,percent of total billed charges,Drugs,16.89,34,,16.89,percent of total billed charges,Drugs,16.89,34,,16.89,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,19.87,40,,19.87,percent of total billed charges,Drugs,34.78,70,,34.78,percent of total billed charges,All Other,17.88,36,,17.88,percent of total billed charges,Drugs,17.88,36,,17.88,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,17.39,35,,17.39,percent of total billed charges,Drugs,16.56,,,16.56,Other,Drug Cost,16.56,,,16.56,Other,Drug Cost,16.56,,,16.56,Other,Drug Cost,16.56,,,16.56,Other,Drug Cost,16.56,,,16.56,Other,Drug Cost,16.56,,,16.56,Other,Drug Cost,37.26,,,37.26,Other,225% of Medicaid,23.18,,,23.18,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",35.6,,,35.6,Other,215% Medicaid APG methodology,35.6,,,35.6,Other,215% Medicaid APG methodology,20.7,,,20.7,Other,125% Medicaid APG methodology,0.01,37.26,
KETOROLAC 15MG/ML INJ,J1885,HCPCS,,80002200,CDM,636,RC,25021070001,NDC,both,25,ML,1.52,4.81,,,4.81,Other,150% of Medicare + 9.63% HCRA Surcharge,2.93,,,2.93,Fee Schedule,Average Sale Price (ASP) x 6,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.52,34,,0.52,percent of total billed charges,Drugs,0.52,34,,0.52,percent of total billed charges,Drugs,0.52,34,,0.52,percent of total billed charges,Drugs,0.52,34,,0.52,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.61,40,,0.61,percent of total billed charges,Drugs,1.07,70,,1.07,percent of total billed charges,All Other,0.55,36,,0.55,percent of total billed charges,Drugs,0.55,36,,0.55,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.53,35,,0.53,percent of total billed charges,Drugs,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,0.51,,,0.51,Other,Drug Cost,1.14,,,1.14,Other,225% of Medicaid,0.71,,,0.71,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.68,,,4.68,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.09,,,1.09,Other,215% Medicaid APG methodology,1.09,,,1.09,Other,215% Medicaid APG methodology,0.63,,,0.63,Other,125% Medicaid APG methodology,0.01,4.81,
PROMETHAZINE 25MG/1ML AMP,J2550,HCPCS,,80002207,CDM,636,RC,641092825,NDC,both,25,ML,1.97,35.42,,,35.42,Other,150% of Medicare + 9.63% HCRA Surcharge,21.54,,,21.54,Fee Schedule,Average Sale Price (ASP) x 6,0.69,35,,0.69,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.67,34,,0.67,percent of total billed charges,Drugs,0.67,34,,0.67,percent of total billed charges,Drugs,0.67,34,,0.67,percent of total billed charges,Drugs,0.67,34,,0.67,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.79,40,,0.79,percent of total billed charges,Drugs,1.38,70,,1.38,percent of total billed charges,All Other,0.71,36,,0.71,percent of total billed charges,Drugs,0.71,36,,0.71,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.69,35,,0.69,percent of total billed charges,Drugs,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,0.66,,,0.66,Other,Drug Cost,1.48,,,1.48,Other,225% of Medicaid,0.92,,,0.92,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,34.46,,,34.46,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.41,,,1.41,Other,215% Medicaid APG methodology,1.41,,,1.41,Other,215% Medicaid APG methodology,0.82,,,0.82,Other,125% Medicaid APG methodology,0.01,35.42,
METHYLPREDNISOLONE ACETATE 40MG/ML INJ,J1030,HCPCS,,80002208,CDM,636,RC,9307301,NDC,both,1,ML,7.44,63.33,,,63.33,Other,150% of Medicare + 9.63% HCRA Surcharge,38.51,,,38.51,Fee Schedule,Average Sale Price (ASP) x 6,2.6,35,,2.6,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,2.53,34,,2.53,percent of total billed charges,Drugs,2.53,34,,2.53,percent of total billed charges,Drugs,2.53,34,,2.53,percent of total billed charges,Drugs,2.53,34,,2.53,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,2.98,40,,2.98,percent of total billed charges,Drugs,5.21,70,,5.21,percent of total billed charges,All Other,2.68,36,,2.68,percent of total billed charges,Drugs,2.68,36,,2.68,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,2.6,35,,2.6,percent of total billed charges,Drugs,2.48,,,2.48,Other,Drug Cost,2.48,,,2.48,Other,Drug Cost,2.48,,,2.48,Other,Drug Cost,2.48,,,2.48,Other,Drug Cost,2.48,,,2.48,Other,Drug Cost,2.48,,,2.48,Other,Drug Cost,5.58,,,5.58,Other,225% of Medicaid,3.47,,,3.47,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,61.62,,,61.62,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.33,,,5.33,Other,215% Medicaid APG methodology,5.33,,,5.33,Other,215% Medicaid APG methodology,3.1,,,3.1,Other,125% Medicaid APG methodology,0.01,63.33,
LIDOCAINE 0.5% 50ML VIAL,J2001,HCPCS,,80002209,CDM,636,RC,409427801,NDC,both,25,ML,6.4,0.27,,,0.27,Other,150% of Medicare + 9.63% HCRA Surcharge,0.16,,,0.16,Fee Schedule,Average Sale Price (ASP) x 6,2.24,35,,2.24,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,2.18,34,,2.18,percent of total billed charges,Drugs,2.18,34,,2.18,percent of total billed charges,Drugs,2.18,34,,2.18,percent of total billed charges,Drugs,2.18,34,,2.18,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,2.56,40,,2.56,percent of total billed charges,Drugs,4.48,70,,4.48,percent of total billed charges,All Other,2.3,36,,2.3,percent of total billed charges,Drugs,2.3,36,,2.3,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,2.24,35,,2.24,percent of total billed charges,Drugs,2.13,,,2.13,Other,Drug Cost,2.13,,,2.13,Other,Drug Cost,2.13,,,2.13,Other,Drug Cost,2.13,,,2.13,Other,Drug Cost,2.13,,,2.13,Other,Drug Cost,2.13,,,2.13,Other,Drug Cost,4.8,,,4.8,Other,225% of Medicaid,2.99,,,2.99,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.26,,,0.26,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.58,,,4.58,Other,215% Medicaid APG methodology,4.58,,,4.58,Other,215% Medicaid APG methodology,2.67,,,2.67,Other,125% Medicaid APG methodology,0.01,4.8,
CEFAZOLIN 2GM/50ML NS,J0690,HCPCS,,80002226,CDM,636,RC,264310511,NDC,both,24,EA,19.05,7.53,,,7.53,Other,150% of Medicare + 9.63% HCRA Surcharge,4.58,,,4.58,Fee Schedule,Average Sale Price (ASP) x 6,6.67,35,,6.67,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,6.48,34,,6.48,percent of total billed charges,Drugs,6.48,34,,6.48,percent of total billed charges,Drugs,6.48,34,,6.48,percent of total billed charges,Drugs,6.48,34,,6.48,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,7.62,40,,7.62,percent of total billed charges,Drugs,13.34,70,,13.34,percent of total billed charges,All Other,6.86,36,,6.86,percent of total billed charges,Drugs,6.86,36,,6.86,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,6.67,35,,6.67,percent of total billed charges,Drugs,6.35,,,6.35,Other,Drug Cost,6.35,,,6.35,Other,Drug Cost,6.35,,,6.35,Other,Drug Cost,6.35,,,6.35,Other,Drug Cost,6.35,,,6.35,Other,Drug Cost,6.35,,,6.35,Other,Drug Cost,14.29,,,14.29,Other,225% of Medicaid,8.89,,,8.89,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.32,,,7.32,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",13.66,,,13.66,Other,215% Medicaid APG methodology,13.66,,,13.66,Other,215% Medicaid APG methodology,7.94,,,7.94,Other,125% Medicaid APG methodology,0.01,14.29,
CEFOXITIN 1GM/50ML NS,J0694,HCPCS,,80002230,CDM,636,RC,143987825,NDC,both,25,EA,7.61,50.11,,,50.11,Other,150% of Medicare + 9.63% HCRA Surcharge,30.47,,,30.47,Fee Schedule,Average Sale Price (ASP) x 6,2.66,35,,2.66,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,2.59,34,,2.59,percent of total billed charges,Drugs,2.59,34,,2.59,percent of total billed charges,Drugs,2.59,34,,2.59,percent of total billed charges,Drugs,2.59,34,,2.59,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,3.04,40,,3.04,percent of total billed charges,Drugs,5.33,70,,5.33,percent of total billed charges,All Other,2.74,36,,2.74,percent of total billed charges,Drugs,2.74,36,,2.74,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,2.66,35,,2.66,percent of total billed charges,Drugs,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,2.54,,,2.54,Other,Drug Cost,5.71,,,5.71,Other,225% of Medicaid,3.55,,,3.55,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,48.76,,,48.76,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.45,,,5.45,Other,215% Medicaid APG methodology,5.45,,,5.45,Other,215% Medicaid APG methodology,3.17,,,3.17,Other,125% Medicaid APG methodology,0.01,50.11,
CEFOXITIN 2GM/50ML NS,J0694,HCPCS,,80002231,CDM,636,RC,143987725,NDC,both,25,EA,10.77,50.11,,,50.11,Other,150% of Medicare + 9.63% HCRA Surcharge,30.47,,,30.47,Fee Schedule,Average Sale Price (ASP) x 6,3.77,35,,3.77,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,3.66,34,,3.66,percent of total billed charges,Drugs,3.66,34,,3.66,percent of total billed charges,Drugs,3.66,34,,3.66,percent of total billed charges,Drugs,3.66,34,,3.66,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,4.31,40,,4.31,percent of total billed charges,Drugs,7.54,70,,7.54,percent of total billed charges,All Other,3.88,36,,3.88,percent of total billed charges,Drugs,3.88,36,,3.88,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,3.77,35,,3.77,percent of total billed charges,Drugs,3.59,,,3.59,Other,Drug Cost,3.59,,,3.59,Other,Drug Cost,3.59,,,3.59,Other,Drug Cost,3.59,,,3.59,Other,Drug Cost,3.59,,,3.59,Other,Drug Cost,3.59,,,3.59,Other,Drug Cost,8.07,,,8.07,Other,225% of Medicaid,5.02,,,5.02,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,48.76,,,48.76,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.72,,,7.72,Other,215% Medicaid APG methodology,7.72,,,7.72,Other,215% Medicaid APG methodology,4.49,,,4.49,Other,125% Medicaid APG methodology,0.01,50.11,
CEFTRIAXONE 1GM/50ML NS,J0696,HCPCS,,80002235,CDM,636,RC,409733220,NDC,both,10,EA,2.8,4.84,,,4.84,Other,150% of Medicare + 9.63% HCRA Surcharge,2.95,,,2.95,Fee Schedule,Average Sale Price (ASP) x 6,0.98,35,,0.98,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,0.95,34,,0.95,percent of total billed charges,Drugs,0.95,34,,0.95,percent of total billed charges,Drugs,0.95,34,,0.95,percent of total billed charges,Drugs,0.95,34,,0.95,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,1.12,40,,1.12,percent of total billed charges,Drugs,1.96,70,,1.96,percent of total billed charges,All Other,1.01,36,,1.01,percent of total billed charges,Drugs,1.01,36,,1.01,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,0.98,35,,0.98,percent of total billed charges,Drugs,0.93,,,0.93,Other,Drug Cost,0.93,,,0.93,Other,Drug Cost,0.93,,,0.93,Other,Drug Cost,0.93,,,0.93,Other,Drug Cost,0.93,,,0.93,Other,Drug Cost,0.93,,,0.93,Other,Drug Cost,2.1,,,2.1,Other,225% of Medicaid,1.3,,,1.3,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.71,,,4.71,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2,,,2,Other,215% Medicaid APG methodology,2,,,2,Other,215% Medicaid APG methodology,1.17,,,1.17,Other,125% Medicaid APG methodology,0.01,4.84,
CEFTRIAXONE 2GM/100ML NS,J0696,HCPCS,,80002237,CDM,636,RC,60505614904,NDC,both,10,EA,4.52,4.84,,,4.84,Other,150% of Medicare + 9.63% HCRA Surcharge,2.95,,,2.95,Fee Schedule,Average Sale Price (ASP) x 6,1.58,35,,1.58,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,1.54,34,,1.54,percent of total billed charges,Drugs,1.54,34,,1.54,percent of total billed charges,Drugs,1.54,34,,1.54,percent of total billed charges,Drugs,1.54,34,,1.54,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,1.81,40,,1.81,percent of total billed charges,Drugs,3.17,70,,3.17,percent of total billed charges,All Other,1.63,36,,1.63,percent of total billed charges,Drugs,1.63,36,,1.63,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,1.58,35,,1.58,percent of total billed charges,Drugs,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,1.51,,,1.51,Other,Drug Cost,3.39,,,3.39,Other,225% of Medicaid,2.11,,,2.11,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.71,,,4.71,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.24,,,3.24,Other,215% Medicaid APG methodology,3.24,,,3.24,Other,215% Medicaid APG methodology,1.89,,,1.89,Other,125% Medicaid APG methodology,0.01,4.84,
TYGACIL 50MG/100ML NS,J3243,HCPCS,,80002250,CDM,636,RC,70121164707,NDC,both,10,EA,42.94,7.26,,,7.26,Other,150% of Medicare + 9.63% HCRA Surcharge,4.42,,,4.42,Fee Schedule,Average Sale Price (ASP) x 6,15.03,35,,15.03,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,14.6,34,,14.6,percent of total billed charges,Drugs,14.6,34,,14.6,percent of total billed charges,Drugs,14.6,34,,14.6,percent of total billed charges,Drugs,14.6,34,,14.6,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,17.18,40,,17.18,percent of total billed charges,Drugs,30.06,70,,30.06,percent of total billed charges,All Other,15.46,36,,15.46,percent of total billed charges,Drugs,15.46,36,,15.46,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,15.03,35,,15.03,percent of total billed charges,Drugs,14.31,,,14.31,Other,Drug Cost,14.31,,,14.31,Other,Drug Cost,14.31,,,14.31,Other,Drug Cost,14.31,,,14.31,Other,Drug Cost,14.31,,,14.31,Other,Drug Cost,14.31,,,14.31,Other,Drug Cost,32.2,,,32.2,Other,225% of Medicaid,20.04,,,20.04,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.07,,,7.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",30.77,,,30.77,Other,215% Medicaid APG methodology,30.77,,,30.77,Other,215% Medicaid APG methodology,17.89,,,17.89,Other,125% Medicaid APG methodology,0.01,32.2,
VANCOMYCIN 1GM/250ML NS,J3370,HCPCS,,80002252,CDM,636,RC,67457034001,NDC,both,10,EA,3.64,22.76,,,22.76,Other,150% of Medicare + 9.63% HCRA Surcharge,13.84,,,13.84,Fee Schedule,Average Sale Price (ASP) x 6,1.27,35,,1.27,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,1.24,34,,1.24,percent of total billed charges,Drugs,1.24,34,,1.24,percent of total billed charges,Drugs,1.24,34,,1.24,percent of total billed charges,Drugs,1.24,34,,1.24,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,1.46,40,,1.46,percent of total billed charges,Drugs,2.55,70,,2.55,percent of total billed charges,All Other,1.31,36,,1.31,percent of total billed charges,Drugs,1.31,36,,1.31,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,1.27,35,,1.27,percent of total billed charges,Drugs,1.21,,,1.21,Other,Drug Cost,1.21,,,1.21,Other,Drug Cost,1.21,,,1.21,Other,Drug Cost,1.21,,,1.21,Other,Drug Cost,1.21,,,1.21,Other,Drug Cost,1.21,,,1.21,Other,Drug Cost,2.73,,,2.73,Other,225% of Medicaid,1.7,,,1.7,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,22.15,,,22.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.61,,,2.61,Other,215% Medicaid APG methodology,2.61,,,2.61,Other,215% Medicaid APG methodology,1.52,,,1.52,Other,125% Medicaid APG methodology,0.01,22.76,
ZOSYN 2.25GM/50ML NS,J2543,HCPCS,,80002254,CDM,636,RC,781311095,NDC,both,10,EA,0.03,11.61,,,11.61,Other,150% of Medicare + 9.63% HCRA Surcharge,7.06,,,7.06,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,11.3,,,11.3,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,11.61,
RHO D IMMUNE GLOBULIN INJ 300MCG,J2790,HCPCS,,80002259,CDM,636,RC,44206030001,NDC,both,1,ML,157.53,800.79,,,800.79,Other,150% of Medicare + 9.63% HCRA Surcharge,486.97,,,486.97,Fee Schedule,Average Sale Price (ASP) x 6,55.14,35,,55.14,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,53.56,34,,53.56,percent of total billed charges,Drugs,53.56,34,,53.56,percent of total billed charges,Drugs,53.56,34,,53.56,percent of total billed charges,Drugs,53.56,34,,53.56,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,63.01,40,,63.01,percent of total billed charges,Drugs,110.27,70,,110.27,percent of total billed charges,All Other,56.71,36,,56.71,percent of total billed charges,Drugs,56.71,36,,56.71,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,55.14,35,,55.14,percent of total billed charges,Drugs,52.51,,,52.51,Other,Drug Cost,52.51,,,52.51,Other,Drug Cost,52.51,,,52.51,Other,Drug Cost,52.51,,,52.51,Other,Drug Cost,52.51,,,52.51,Other,Drug Cost,52.51,,,52.51,Other,Drug Cost,118.15,,,118.15,Other,225% of Medicaid,73.51,,,73.51,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,779.15,,,779.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",112.9,,,112.9,Other,215% Medicaid APG methodology,112.9,,,112.9,Other,215% Medicaid APG methodology,65.64,,,65.64,Other,125% Medicaid APG methodology,0.01,800.79,
D5W 50ML,J7060,HCPCS,,80002262,CDM,636,RC,264151031,NDC,both,84,ML,1.89,19.05,,,19.05,Other,150% of Medicare + 9.63% HCRA Surcharge,11.59,,,11.59,Fee Schedule,Average Sale Price (ASP) x 6,0.66,35,,0.66,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.64,34,,0.64,percent of total billed charges,Drugs,0.64,34,,0.64,percent of total billed charges,Drugs,0.64,34,,0.64,percent of total billed charges,Drugs,0.64,34,,0.64,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.76,40,,0.76,percent of total billed charges,Drugs,1.32,70,,1.32,percent of total billed charges,All Other,0.68,36,,0.68,percent of total billed charges,Drugs,0.68,36,,0.68,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.66,35,,0.66,percent of total billed charges,Drugs,0.63,,,0.63,Other,Drug Cost,0.63,,,0.63,Other,Drug Cost,0.63,,,0.63,Other,Drug Cost,0.63,,,0.63,Other,Drug Cost,0.63,,,0.63,Other,Drug Cost,0.63,,,0.63,Other,Drug Cost,1.42,,,1.42,Other,225% of Medicaid,0.88,,,0.88,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,18.54,,,18.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.36,,,1.36,Other,215% Medicaid APG methodology,1.36,,,1.36,Other,215% Medicaid APG methodology,0.79,,,0.79,Other,125% Medicaid APG methodology,0.01,19.05,
HEPATITIS B 20MCG/ML 1ML,90746,HCPCS,,80002264,CDM,636,RC,58160082111,NDC,both,10,ML,135.24,53.37,39.4668,,53.37,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,47.33,35,,47.33,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,45.98,34,,45.98,percent of total billed charges,Drugs,45.98,34,,45.98,percent of total billed charges,Drugs,45.98,34,,45.98,percent of total billed charges,Drugs,45.98,34,,45.98,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,54.1,40,,54.1,percent of total billed charges,Drugs,94.67,70,,94.67,percent of total billed charges,All Other,48.69,36,,48.69,percent of total billed charges,Drugs,48.69,36,,48.69,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,47.33,35,,47.33,percent of total billed charges,Drugs,45.08,,,45.08,Other,Drug Cost,45.08,,,45.08,Other,Drug Cost,45.08,,,45.08,Other,Drug Cost,45.08,,,45.08,Other,Drug Cost,45.08,,,45.08,Other,Drug Cost,45.08,,,45.08,Other,Drug Cost,101.43,,,101.43,Other,225% of Medicaid,63.11,,,63.11,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",96.92,,,96.92,Other,215% Medicaid APG methodology,96.92,,,96.92,Other,215% Medicaid APG methodology,56.35,,,56.35,Other,125% Medicaid APG methodology,0.01,101.43,
HYDROMORPHONE 1MG/ML,J1170,HCPCS,,80002265,CDM,636,RC,409128331,NDC,both,10,ML,0.42,45.3,,,45.3,Other,150% of Medicare + 9.63% HCRA Surcharge,27.55,,,27.55,Fee Schedule,Average Sale Price (ASP) x 6,0.15,35,,0.15,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.14,34,,0.14,percent of total billed charges,Drugs,0.14,34,,0.14,percent of total billed charges,Drugs,0.14,34,,0.14,percent of total billed charges,Drugs,0.14,34,,0.14,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.17,40,,0.17,percent of total billed charges,Drugs,0.29,70,,0.29,percent of total billed charges,All Other,0.15,36,,0.15,percent of total billed charges,Drugs,0.15,36,,0.15,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.15,35,,0.15,percent of total billed charges,Drugs,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.14,,,0.14,Other,Drug Cost,0.32,,,0.32,Other,225% of Medicaid,0.2,,,0.2,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,44.07,,,44.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.3,,,0.3,Other,215% Medicaid APG methodology,0.3,,,0.3,Other,215% Medicaid APG methodology,0.18,,,0.18,Other,125% Medicaid APG methodology,0.01,45.3,
BEVACIZUMAB 100MG/4ML INJ,J9035,HCPCS,,80002281,CDM,636,RC,50242006001,NDC,both,1,ML,2365.71,730.86,,,730.86,Other,150% of Medicare + 9.63% HCRA Surcharge,444.44,,,444.44,Fee Schedule,Average Sale Price (ASP) x 6,828,35,,828,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,804.34,34,,804.34,percent of total billed charges,Drugs,804.34,34,,804.34,percent of total billed charges,Drugs,804.34,34,,804.34,percent of total billed charges,Drugs,804.34,34,,804.34,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,804.34,34,"If Charge > 500, then 34 percent",804.34,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,946.28,40,,946.28,percent of total billed charges,Drugs,1656,70,,1656,percent of total billed charges,All Other,851.66,36,,851.66,percent of total billed charges,Drugs,851.66,36,,851.66,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,828,35,,828,percent of total billed charges,Drugs,788.57,,,788.57,Other,Drug Cost,788.57,,,788.57,Other,Drug Cost,788.57,,,788.57,Other,Drug Cost,788.57,,,788.57,Other,Drug Cost,788.57,,,788.57,Other,Drug Cost,788.57,,,788.57,Other,Drug Cost,1774.28,,,1774.28,Other,225% of Medicaid,1104,,,1104,Other,140% of Medicaid,804.34,34,"If Charge > 2,000, then 34 percent",804.34,percent of total billed charges,Drugs,711.1,,,711.1,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1695.43,,,1695.43,Other,215% Medicaid APG methodology,1695.43,,,1695.43,Other,215% Medicaid APG methodology,985.71,,,985.71,Other,125% Medicaid APG methodology,0.01,1774.28,
RHO D IMMUNE GLOBULIN 50MCG INJ,J2788,HCPCS,,80002282,CDM,636,RC,562780601,NDC,both,1,EA,55.77,234.82,,,234.82,Other,150% of Medicare + 9.63% HCRA Surcharge,142.79,,,142.79,Fee Schedule,Average Sale Price (ASP) x 6,19.52,35,,19.52,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,18.96,34,,18.96,percent of total billed charges,Drugs,18.96,34,,18.96,percent of total billed charges,Drugs,18.96,34,,18.96,percent of total billed charges,Drugs,18.96,34,,18.96,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,22.31,40,,22.31,percent of total billed charges,Drugs,39.04,70,,39.04,percent of total billed charges,All Other,20.08,36,,20.08,percent of total billed charges,Drugs,20.08,36,,20.08,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,19.52,35,,19.52,percent of total billed charges,Drugs,18.59,,,18.59,Other,Drug Cost,18.59,,,18.59,Other,Drug Cost,18.59,,,18.59,Other,Drug Cost,18.59,,,18.59,Other,Drug Cost,18.59,,,18.59,Other,Drug Cost,18.59,,,18.59,Other,Drug Cost,41.83,,,41.83,Other,225% of Medicaid,26.03,,,26.03,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,228.47,,,228.47,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",39.97,,,39.97,Other,215% Medicaid APG methodology,39.97,,,39.97,Other,215% Medicaid APG methodology,23.24,,,23.24,Other,125% Medicaid APG methodology,0.01,234.82,
CEFUROXIME 750MG ADVANTAGE 750MG VIAL,J0697,HCPCS,,80002295,CDM,636,RC,25021011810,NDC,both,25,EA,6.2,19.99,,,19.99,Other,150% of Medicare + 9.63% HCRA Surcharge,12.16,,,12.16,Fee Schedule,Average Sale Price (ASP) x 6,2.17,35,,2.17,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,2.11,34,,2.11,percent of total billed charges,Drugs,2.11,34,,2.11,percent of total billed charges,Drugs,2.11,34,,2.11,percent of total billed charges,Drugs,2.11,34,,2.11,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,2.48,40,,2.48,percent of total billed charges,Drugs,4.34,70,,4.34,percent of total billed charges,All Other,2.23,36,,2.23,percent of total billed charges,Drugs,2.23,36,,2.23,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,2.17,35,,2.17,percent of total billed charges,Drugs,2.07,,,2.07,Other,Drug Cost,2.07,,,2.07,Other,Drug Cost,2.07,,,2.07,Other,Drug Cost,2.07,,,2.07,Other,Drug Cost,2.07,,,2.07,Other,Drug Cost,2.07,,,2.07,Other,Drug Cost,4.65,,,4.65,Other,225% of Medicaid,2.89,,,2.89,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,19.45,,,19.45,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.44,,,4.44,Other,215% Medicaid APG methodology,4.44,,,4.44,Other,215% Medicaid APG methodology,2.58,,,2.58,Other,125% Medicaid APG methodology,0.01,19.99,
MIDAZOLAM HCL 5MG/ML 1ML VIAL,J2250,HCPCS,,80002344,CDM,636,RC,63323041225,NDC,both,25,ML,1.25,1.4,,,1.4,Other,150% of Medicare + 9.63% HCRA Surcharge,0.85,,,0.85,Fee Schedule,Average Sale Price (ASP) x 6,0.44,35,,0.44,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.43,34,,0.43,percent of total billed charges,Drugs,0.43,34,,0.43,percent of total billed charges,Drugs,0.43,34,,0.43,percent of total billed charges,Drugs,0.43,34,,0.43,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.5,40,,0.5,percent of total billed charges,Drugs,0.88,70,,0.88,percent of total billed charges,All Other,0.45,36,,0.45,percent of total billed charges,Drugs,0.45,36,,0.45,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.44,35,,0.44,percent of total billed charges,Drugs,0.42,,,0.42,Other,Drug Cost,0.42,,,0.42,Other,Drug Cost,0.42,,,0.42,Other,Drug Cost,0.42,,,0.42,Other,Drug Cost,0.42,,,0.42,Other,Drug Cost,0.42,,,0.42,Other,Drug Cost,0.94,,,0.94,Other,225% of Medicaid,0.58,,,0.58,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.36,,,1.36,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.9,,,0.9,Other,215% Medicaid APG methodology,0.9,,,0.9,Other,215% Medicaid APG methodology,0.52,,,0.52,Other,125% Medicaid APG methodology,0.01,1.4,
MORPHINE SULF (1MG/ML) 10MG/10ML AMP,J2270,HCPCS,,80002349,CDM,636,RC,641601910,NDC,both,10,ML,0.27,46.03,,,46.03,Other,150% of Medicare + 9.63% HCRA Surcharge,27.99,,,27.99,Fee Schedule,Average Sale Price (ASP) x 6,0.1,35,,0.1,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.09,34,,0.09,percent of total billed charges,Drugs,0.09,34,,0.09,percent of total billed charges,Drugs,0.09,34,,0.09,percent of total billed charges,Drugs,0.09,34,,0.09,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.11,40,,0.11,percent of total billed charges,Drugs,0.19,70,,0.19,percent of total billed charges,All Other,0.1,36,,0.1,percent of total billed charges,Drugs,0.1,36,,0.1,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.1,35,,0.1,percent of total billed charges,Drugs,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.09,,,0.09,Other,Drug Cost,0.2,,,0.2,Other,225% of Medicaid,0.13,,,0.13,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,44.78,,,44.78,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.2,,,0.2,Other,215% Medicaid APG methodology,0.2,,,0.2,Other,215% Medicaid APG methodology,0.11,,,0.11,Other,125% Medicaid APG methodology,0.01,46.03,
MORPHINE SULFATE 10MG/ML 1ML VIAL,J2270,HCPCS,,80002350,CDM,636,RC,641612725,NDC,both,25,ML,2.39,46.03,,,46.03,Other,150% of Medicare + 9.63% HCRA Surcharge,27.99,,,27.99,Fee Schedule,Average Sale Price (ASP) x 6,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.96,40,,0.96,percent of total billed charges,Drugs,1.67,70,,1.67,percent of total billed charges,All Other,0.86,36,,0.86,percent of total billed charges,Drugs,0.86,36,,0.86,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,1.79,,,1.79,Other,225% of Medicaid,1.11,,,1.11,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,44.78,,,44.78,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.71,,,1.71,Other,215% Medicaid APG methodology,1.71,,,1.71,Other,215% Medicaid APG methodology,1,,,1,Other,125% Medicaid APG methodology,0.01,46.03,
NALBUPHINE HCL 10MG/ML 1ML AMP,J2300,HCPCS,,80002354,CDM,636,RC,409146301,NDC,both,10,ML,1.94,27.74,,,27.74,Other,150% of Medicare + 9.63% HCRA Surcharge,16.87,,,16.87,Fee Schedule,Average Sale Price (ASP) x 6,0.68,35,,0.68,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.66,34,,0.66,percent of total billed charges,Drugs,0.66,34,,0.66,percent of total billed charges,Drugs,0.66,34,,0.66,percent of total billed charges,Drugs,0.66,34,,0.66,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.78,40,,0.78,percent of total billed charges,Drugs,1.36,70,,1.36,percent of total billed charges,All Other,0.7,36,,0.7,percent of total billed charges,Drugs,0.7,36,,0.7,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.68,35,,0.68,percent of total billed charges,Drugs,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,0.65,,,0.65,Other,Drug Cost,1.46,,,1.46,Other,225% of Medicaid,0.91,,,0.91,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,26.99,,,26.99,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.39,,,1.39,Other,215% Medicaid APG methodology,1.39,,,1.39,Other,215% Medicaid APG methodology,0.81,,,0.81,Other,125% Medicaid APG methodology,0.01,27.74,
NEOSTIGMINE METHYLSULF 1:1000 10ML VIAL,J2710,HCPCS,,80002357,CDM,636,RC,25021061110,NDC,both,10,ML,4.35,1.72,39.4668,,1.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,1.52,35,,1.52,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,1.48,34,,1.48,percent of total billed charges,Drugs,1.48,34,,1.48,percent of total billed charges,Drugs,1.48,34,,1.48,percent of total billed charges,Drugs,1.48,34,,1.48,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,1.74,40,,1.74,percent of total billed charges,Drugs,3.04,70,,3.04,percent of total billed charges,All Other,1.56,36,,1.56,percent of total billed charges,Drugs,1.56,36,,1.56,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,1.52,35,,1.52,percent of total billed charges,Drugs,1.45,,,1.45,Other,Drug Cost,1.45,,,1.45,Other,Drug Cost,1.45,,,1.45,Other,Drug Cost,1.45,,,1.45,Other,Drug Cost,1.45,,,1.45,Other,Drug Cost,1.45,,,1.45,Other,Drug Cost,3.26,,,3.26,Other,225% of Medicaid,2.03,,,2.03,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.12,,,3.12,Other,215% Medicaid APG methodology,3.12,,,3.12,Other,215% Medicaid APG methodology,1.81,,,1.81,Other,125% Medicaid APG methodology,0.01,3.26,
PENICILLIN G BENZATHINE 1.2 MILLION SYR,J0561,HCPCS,,80002361,CDM,636,RC,60793070110,NDC,both,10,ML,0.05,214.4,,,214.4,Other,150% of Medicare + 9.63% HCRA Surcharge,130.38,,,130.38,Fee Schedule,Average Sale Price (ASP) x 6,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,40,,0.02,percent of total billed charges,Drugs,0.04,70,,0.04,percent of total billed charges,All Other,0.02,36,,0.02,percent of total billed charges,Drugs,0.02,36,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.04,,,0.04,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,208.61,,,208.61,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,125% Medicaid APG methodology,0.01,214.4,
PROCHLORPERAZINE EDISYL 5MG/ML 2ML VIAL,J0780,HCPCS,,80002370,CDM,636,RC,25021079002,NDC,both,10,ML,4.7,33.83,,,33.83,Other,150% of Medicare + 9.63% HCRA Surcharge,20.57,,,20.57,Fee Schedule,Average Sale Price (ASP) x 6,1.65,35,,1.65,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,1.6,34,,1.6,percent of total billed charges,Drugs,1.6,34,,1.6,percent of total billed charges,Drugs,1.6,34,,1.6,percent of total billed charges,Drugs,1.6,34,,1.6,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,1.88,40,,1.88,percent of total billed charges,Drugs,3.29,70,,3.29,percent of total billed charges,All Other,1.69,36,,1.69,percent of total billed charges,Drugs,1.69,36,,1.69,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,1.65,35,,1.65,percent of total billed charges,Drugs,1.57,,,1.57,Other,Drug Cost,1.57,,,1.57,Other,Drug Cost,1.57,,,1.57,Other,Drug Cost,1.57,,,1.57,Other,Drug Cost,1.57,,,1.57,Other,Drug Cost,1.57,,,1.57,Other,Drug Cost,3.53,,,3.53,Other,225% of Medicaid,2.19,,,2.19,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,32.92,,,32.92,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.37,,,3.37,Other,215% Medicaid APG methodology,3.37,,,3.37,Other,215% Medicaid APG methodology,1.96,,,1.96,Other,125% Medicaid APG methodology,0.01,33.83,
PROMETHAZINE HCL 12.5MG SUPP RECT,J8498,HCPCS,,80002372,CDM,636,RC,713053612,NDC,both,12,EA,2.5,0.99,39.4668,,0.99,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.88,35,,0.88,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,0.85,34,,0.85,percent of total billed charges,Drugs,0.85,34,,0.85,percent of total billed charges,Drugs,0.85,34,,0.85,percent of total billed charges,Drugs,0.85,34,,0.85,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,1,40,,1,percent of total billed charges,Drugs,1.75,70,,1.75,percent of total billed charges,All Other,0.9,36,,0.9,percent of total billed charges,Drugs,0.9,36,,0.9,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,0.88,35,,0.88,percent of total billed charges,Drugs,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,0.83,,,0.83,Other,Drug Cost,1.88,,,1.88,Other,225% of Medicaid,1.17,,,1.17,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.79,,,1.79,Other,215% Medicaid APG methodology,1.79,,,1.79,Other,215% Medicaid APG methodology,1.04,,,1.04,Other,125% Medicaid APG methodology,0.01,1.88,
ROCURONIUM BROMIDE 10MG/ML 5ML VIAL,J3490,HCPCS,,80002375,CDM,636,RC,63323042605,NDC,both,10,ML,3.86,1.52,39.4668,,1.52,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,1.35,35,,1.35,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,1.31,34,,1.31,percent of total billed charges,Drugs,1.31,34,,1.31,percent of total billed charges,Drugs,1.31,34,,1.31,percent of total billed charges,Drugs,1.31,34,,1.31,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,1.54,40,,1.54,percent of total billed charges,Drugs,2.7,70,,2.7,percent of total billed charges,All Other,1.39,36,,1.39,percent of total billed charges,Drugs,1.39,36,,1.39,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,1.35,35,,1.35,percent of total billed charges,Drugs,1.29,,,1.29,Other,Drug Cost,1.29,,,1.29,Other,Drug Cost,1.29,,,1.29,Other,Drug Cost,1.29,,,1.29,Other,Drug Cost,1.29,,,1.29,Other,Drug Cost,1.29,,,1.29,Other,Drug Cost,2.89,,,2.89,Other,225% of Medicaid,1.8,,,1.8,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.76,,,2.76,Other,215% Medicaid APG methodology,2.76,,,2.76,Other,215% Medicaid APG methodology,1.61,,,1.61,Other,125% Medicaid APG methodology,0.01,2.89,
PHYTONADIONE 10MG/ML INJ,J3430,HCPCS,,80002405,CDM,636,RC,409915801,NDC,both,25,ML,65.1,28.6,,,28.6,Other,150% of Medicare + 9.63% HCRA Surcharge,17.39,,,17.39,Fee Schedule,Average Sale Price (ASP) x 6,22.79,35,,22.79,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,22.13,34,,22.13,percent of total billed charges,Drugs,22.13,34,,22.13,percent of total billed charges,Drugs,22.13,34,,22.13,percent of total billed charges,Drugs,22.13,34,,22.13,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,26.04,40,,26.04,percent of total billed charges,Drugs,45.57,70,,45.57,percent of total billed charges,All Other,23.44,36,,23.44,percent of total billed charges,Drugs,23.44,36,,23.44,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,22.79,35,,22.79,percent of total billed charges,Drugs,21.7,,,21.7,Other,Drug Cost,21.7,,,21.7,Other,Drug Cost,21.7,,,21.7,Other,Drug Cost,21.7,,,21.7,Other,Drug Cost,21.7,,,21.7,Other,Drug Cost,21.7,,,21.7,Other,Drug Cost,48.83,,,48.83,Other,225% of Medicaid,30.38,,,30.38,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,27.83,,,27.83,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",46.66,,,46.66,Other,215% Medicaid APG methodology,46.66,,,46.66,Other,215% Medicaid APG methodology,27.13,,,27.13,Other,125% Medicaid APG methodology,0.01,48.83,
MEASLES/MUMPS/RUBELLA VACC,90707,HCPCS,,80002423,CDM,636,RC,6468100,NDC,both,10,EA,259.36,102.36,39.4668,,102.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,90.78,35,,90.78,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,88.18,34,,88.18,percent of total billed charges,Drugs,88.18,34,,88.18,percent of total billed charges,Drugs,88.18,34,,88.18,percent of total billed charges,Drugs,88.18,34,,88.18,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,103.74,40,,103.74,percent of total billed charges,Drugs,181.55,70,,181.55,percent of total billed charges,All Other,93.37,36,,93.37,percent of total billed charges,Drugs,93.37,36,,93.37,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,90.78,35,,90.78,percent of total billed charges,Drugs,86.45,,,86.45,Other,Drug Cost,86.45,,,86.45,Other,Drug Cost,86.45,,,86.45,Other,Drug Cost,86.45,,,86.45,Other,Drug Cost,86.45,,,86.45,Other,Drug Cost,86.45,,,86.45,Other,Drug Cost,194.52,,,194.52,Other,225% of Medicaid,121.04,,,121.04,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",185.88,,,185.88,Other,215% Medicaid APG methodology,185.88,,,185.88,Other,215% Medicaid APG methodology,108.07,,,108.07,Other,125% Medicaid APG methodology,0.01,194.52,
0.9% NACL  WITH KCL 20MEQ 1000ML,J3480,HCPCS,,80002434,CDM,636,RC,264786500,NDC,both,1000,ML,3.39,1.18,,,1.18,Other,150% of Medicare + 9.63% HCRA Surcharge,0.72,,,0.72,Fee Schedule,Average Sale Price (ASP) x 6,1.19,35,,1.19,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,1.15,34,,1.15,percent of total billed charges,Drugs,1.15,34,,1.15,percent of total billed charges,Drugs,1.15,34,,1.15,percent of total billed charges,Drugs,1.15,34,,1.15,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,1.36,40,,1.36,percent of total billed charges,Drugs,2.37,70,,2.37,percent of total billed charges,All Other,1.22,36,,1.22,percent of total billed charges,Drugs,1.22,36,,1.22,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,1.19,35,,1.19,percent of total billed charges,Drugs,1.13,,,1.13,Other,Drug Cost,1.13,,,1.13,Other,Drug Cost,1.13,,,1.13,Other,Drug Cost,1.13,,,1.13,Other,Drug Cost,1.13,,,1.13,Other,Drug Cost,1.13,,,1.13,Other,Drug Cost,2.54,,,2.54,Other,225% of Medicaid,1.58,,,1.58,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.15,,,1.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.43,,,2.43,Other,215% Medicaid APG methodology,2.43,,,2.43,Other,215% Medicaid APG methodology,1.41,,,1.41,Other,125% Medicaid APG methodology,0.01,2.54,
POTASSIUM CHLORIDE 40MEQ/20ML INJ,J3480,HCPCS,,80002436,CDM,636,RC,63323096520,NDC,both,25,ML,2.64,1.18,,,1.18,Other,150% of Medicare + 9.63% HCRA Surcharge,0.72,,,0.72,Fee Schedule,Average Sale Price (ASP) x 6,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.9,34,,0.9,percent of total billed charges,Drugs,0.9,34,,0.9,percent of total billed charges,Drugs,0.9,34,,0.9,percent of total billed charges,Drugs,0.9,34,,0.9,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,1.05,40,,1.05,percent of total billed charges,Drugs,1.85,70,,1.85,percent of total billed charges,All Other,0.95,36,,0.95,percent of total billed charges,Drugs,0.95,36,,0.95,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,1.98,,,1.98,Other,225% of Medicaid,1.23,,,1.23,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.15,,,1.15,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.89,,,1.89,Other,215% Medicaid APG methodology,1.89,,,1.89,Other,215% Medicaid APG methodology,1.1,,,1.1,Other,125% Medicaid APG methodology,0.01,1.98,
GENTAMICIN 80MG/NACL 50ML,J1580,HCPCS,,80002444,CDM,636,RC,338050941,NDC,both,24,ML,5.9,26.49,,,26.49,Other,150% of Medicare + 9.63% HCRA Surcharge,16.11,,,16.11,Fee Schedule,Average Sale Price (ASP) x 6,2.06,35,,2.06,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,2.01,34,,2.01,percent of total billed charges,Drugs,2.01,34,,2.01,percent of total billed charges,Drugs,2.01,34,,2.01,percent of total billed charges,Drugs,2.01,34,,2.01,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,2.36,40,,2.36,percent of total billed charges,Drugs,4.13,70,,4.13,percent of total billed charges,All Other,2.12,36,,2.12,percent of total billed charges,Drugs,2.12,36,,2.12,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,2.06,35,,2.06,percent of total billed charges,Drugs,1.97,,,1.97,Other,Drug Cost,1.97,,,1.97,Other,Drug Cost,1.97,,,1.97,Other,Drug Cost,1.97,,,1.97,Other,Drug Cost,1.97,,,1.97,Other,Drug Cost,1.97,,,1.97,Other,Drug Cost,4.42,,,4.42,Other,225% of Medicaid,2.75,,,2.75,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,25.78,,,25.78,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.23,,,4.23,Other,215% Medicaid APG methodology,4.23,,,4.23,Other,215% Medicaid APG methodology,2.46,,,2.46,Other,125% Medicaid APG methodology,0.01,26.49,
METHYLPREDNISOLONE 1GM INJ,J2930,HCPCS,,80002485,CDM,636,RC,9069801,NDC,both,1,EA,0.03,58.04,,,58.04,Other,150% of Medicare + 9.63% HCRA Surcharge,35.29,,,35.29,Fee Schedule,Average Sale Price (ASP) x 6,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,34,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,40,,0.01,percent of total billed charges,Drugs,0.02,70,,0.02,percent of total billed charges,All Other,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,36,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,35,,0.01,percent of total billed charges,Drugs,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.01,,,0.01,Other,Drug Cost,0.02,,,0.02,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,56.47,,,56.47,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.02,,,0.02,Other,215% Medicaid APG methodology,0.02,,,0.02,Other,215% Medicaid APG methodology,0.01,,,0.01,Other,125% Medicaid APG methodology,0.01,58.04,
DOBUTAMINE 500MG/250ML IV,J1250,HCPCS,,80002540,CDM,636,RC,338107502,NDC,both,18,ML,6.8,97.17,,,97.17,Other,150% of Medicare + 9.63% HCRA Surcharge,59.09,,,59.09,Fee Schedule,Average Sale Price (ASP) x 6,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.31,34,,2.31,percent of total billed charges,Drugs,2.31,34,,2.31,percent of total billed charges,Drugs,2.31,34,,2.31,percent of total billed charges,Drugs,2.31,34,,2.31,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.72,40,,2.72,percent of total billed charges,Drugs,4.76,70,,4.76,percent of total billed charges,All Other,2.45,36,,2.45,percent of total billed charges,Drugs,2.45,36,,2.45,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.38,35,,2.38,percent of total billed charges,Drugs,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,2.27,,,2.27,Other,Drug Cost,5.1,,,5.1,Other,225% of Medicaid,3.17,,,3.17,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,94.54,,,94.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.87,,,4.87,Other,215% Medicaid APG methodology,4.87,,,4.87,Other,215% Medicaid APG methodology,2.83,,,2.83,Other,125% Medicaid APG methodology,0.01,97.17,
HYDROMORPHONE 10MG/ML 5ML INJ,J1170,HCPCS,,80002553,CDM,636,RC,409263405,NDC,both,10,ML,23.21,45.3,,,45.3,Other,150% of Medicare + 9.63% HCRA Surcharge,27.55,,,27.55,Fee Schedule,Average Sale Price (ASP) x 6,8.12,35,,8.12,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,7.89,34,,7.89,percent of total billed charges,Drugs,7.89,34,,7.89,percent of total billed charges,Drugs,7.89,34,,7.89,percent of total billed charges,Drugs,7.89,34,,7.89,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,9.28,40,,9.28,percent of total billed charges,Drugs,16.25,70,,16.25,percent of total billed charges,All Other,8.35,36,,8.35,percent of total billed charges,Drugs,8.35,36,,8.35,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,8.12,35,,8.12,percent of total billed charges,Drugs,7.74,,,7.74,Other,Drug Cost,7.74,,,7.74,Other,Drug Cost,7.74,,,7.74,Other,Drug Cost,7.74,,,7.74,Other,Drug Cost,7.74,,,7.74,Other,Drug Cost,7.74,,,7.74,Other,Drug Cost,17.41,,,17.41,Other,225% of Medicaid,10.83,,,10.83,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,44.07,,,44.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",16.63,,,16.63,Other,215% Medicaid APG methodology,16.63,,,16.63,Other,215% Medicaid APG methodology,9.67,,,9.67,Other,125% Medicaid APG methodology,0.01,45.3,
IMMUNE GLOBULIN(PRIVIGEN) LIQUID 20GM,J1459,HCPCS,,80002554,CDM,636,RC,44206043820,NDC,both,1,ML,4281.33,476.46,,,476.46,Other,150% of Medicare + 9.63% HCRA Surcharge,289.74,,,289.74,Fee Schedule,Average Sale Price (ASP) x 6,1498.47,35,,1498.47,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1455.65,34,,1455.65,percent of total billed charges,Drugs,1455.65,34,,1455.65,percent of total billed charges,Drugs,1455.65,34,,1455.65,percent of total billed charges,Drugs,1455.65,34,,1455.65,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1455.65,34,"If Charge > 500, then 34 percent",1455.65,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1712.53,40,,1712.53,percent of total billed charges,Drugs,2996.93,70,,2996.93,percent of total billed charges,All Other,1541.28,36,,1541.28,percent of total billed charges,Drugs,1541.28,36,,1541.28,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1498.47,35,,1498.47,percent of total billed charges,Drugs,1427.11,,,1427.11,Other,Drug Cost,1427.11,,,1427.11,Other,Drug Cost,1427.11,,,1427.11,Other,Drug Cost,1427.11,,,1427.11,Other,Drug Cost,1427.11,,,1427.11,Other,Drug Cost,1427.11,,,1427.11,Other,Drug Cost,3211,,,3211,Other,225% of Medicaid,1997.95,,,1997.95,Other,140% of Medicaid,1455.65,34,"If Charge > 2,000, then 34 percent",1455.65,percent of total billed charges,Drugs,463.58,,,463.58,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3068.29,,,3068.29,Other,215% Medicaid APG methodology,3068.29,,,3068.29,Other,215% Medicaid APG methodology,1783.89,,,1783.89,Other,125% Medicaid APG methodology,0.01,3211,
IMMUNE GLOBULIN(PRIVIGEN) LIQUID 10GM,J1459,HCPCS,,80002555,CDM,636,RC,44206043710,NDC,both,1,ML,2122.65,476.46,,,476.46,Other,150% of Medicare + 9.63% HCRA Surcharge,289.74,,,289.74,Fee Schedule,Average Sale Price (ASP) x 6,742.93,35,,742.93,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,721.7,34,,721.7,percent of total billed charges,Drugs,721.7,34,,721.7,percent of total billed charges,Drugs,721.7,34,,721.7,percent of total billed charges,Drugs,721.7,34,,721.7,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,721.7,34,"If Charge > 500, then 34 percent",721.7,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,849.06,40,,849.06,percent of total billed charges,Drugs,1485.86,70,,1485.86,percent of total billed charges,All Other,764.15,36,,764.15,percent of total billed charges,Drugs,764.15,36,,764.15,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,742.93,35,,742.93,percent of total billed charges,Drugs,707.55,,,707.55,Other,Drug Cost,707.55,,,707.55,Other,Drug Cost,707.55,,,707.55,Other,Drug Cost,707.55,,,707.55,Other,Drug Cost,707.55,,,707.55,Other,Drug Cost,707.55,,,707.55,Other,Drug Cost,1591.99,,,1591.99,Other,225% of Medicaid,990.57,,,990.57,Other,140% of Medicaid,721.7,34,"If Charge > 2,000, then 34 percent",721.7,percent of total billed charges,Drugs,463.58,,,463.58,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1521.23,,,1521.23,Other,215% Medicaid APG methodology,1521.23,,,1521.23,Other,215% Medicaid APG methodology,884.44,,,884.44,Other,125% Medicaid APG methodology,0.01,1591.99,
METHYLPREDNISOLONE (PF) 500MG INJ,J2930,HCPCS,,80002564,CDM,636,RC,9000302,NDC,both,1,EA,0.24,58.04,,,58.04,Other,150% of Medicare + 9.63% HCRA Surcharge,35.29,,,35.29,Fee Schedule,Average Sale Price (ASP) x 6,0.08,35,,0.08,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.08,34,,0.08,percent of total billed charges,Drugs,0.08,34,,0.08,percent of total billed charges,Drugs,0.08,34,,0.08,percent of total billed charges,Drugs,0.08,34,,0.08,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.1,40,,0.1,percent of total billed charges,Drugs,0.17,70,,0.17,percent of total billed charges,All Other,0.09,36,,0.09,percent of total billed charges,Drugs,0.09,36,,0.09,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.08,35,,0.08,percent of total billed charges,Drugs,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.08,,,0.08,Other,Drug Cost,0.18,,,0.18,Other,225% of Medicaid,0.11,,,0.11,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,56.47,,,56.47,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.17,,,0.17,Other,215% Medicaid APG methodology,0.17,,,0.17,Other,215% Medicaid APG methodology,0.1,,,0.1,Other,125% Medicaid APG methodology,0.01,58.04,
MORPHINE PF 4MG/ML CARP,J2270,HCPCS,,80002570,CDM,636,RC,409189101,NDC,both,10,ML,2.39,46.03,,,46.03,Other,150% of Medicare + 9.63% HCRA Surcharge,27.99,,,27.99,Fee Schedule,Average Sale Price (ASP) x 6,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.81,34,,0.81,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.96,40,,0.96,percent of total billed charges,Drugs,1.67,70,,1.67,percent of total billed charges,All Other,0.86,36,,0.86,percent of total billed charges,Drugs,0.86,36,,0.86,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.84,35,,0.84,percent of total billed charges,Drugs,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,0.8,,,0.8,Other,Drug Cost,1.79,,,1.79,Other,225% of Medicaid,1.12,,,1.12,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,44.78,,,44.78,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.71,,,1.71,Other,215% Medicaid APG methodology,1.71,,,1.71,Other,215% Medicaid APG methodology,1,,,1,Other,125% Medicaid APG methodology,0.01,46.03,
MORPHINE 5MG/10ML INJ,J2274,HCPCS,,80002571,CDM,636,RC,641602010,NDC,both,10,ML,2.26,110.94,,,110.94,Other,150% of Medicare + 9.63% HCRA Surcharge,67.46,,,67.46,Fee Schedule,Average Sale Price (ASP) x 6,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.77,34,,0.77,percent of total billed charges,Drugs,0.77,34,,0.77,percent of total billed charges,Drugs,0.77,34,,0.77,percent of total billed charges,Drugs,0.77,34,,0.77,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.9,40,,0.9,percent of total billed charges,Drugs,1.58,70,,1.58,percent of total billed charges,All Other,0.81,36,,0.81,percent of total billed charges,Drugs,0.81,36,,0.81,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.79,35,,0.79,percent of total billed charges,Drugs,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,0.75,,,0.75,Other,Drug Cost,1.69,,,1.69,Other,225% of Medicaid,1.05,,,1.05,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,107.94,,,107.94,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.62,,,1.62,Other,215% Medicaid APG methodology,1.62,,,1.62,Other,215% Medicaid APG methodology,0.94,,,0.94,Other,125% Medicaid APG methodology,0.01,110.94,
TETANUS- DIPHTHERIA TOXOIDS FOR 7YRS &UP,90714,HCPCS,,80002599,CDM,636,RC,49281021515,NDC,both,10,ML,101.26,39.96,39.4668,,39.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,35.44,35,,35.44,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,34.43,34,,34.43,percent of total billed charges,Drugs,34.43,34,,34.43,percent of total billed charges,Drugs,34.43,34,,34.43,percent of total billed charges,Drugs,34.43,34,,34.43,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,40.5,40,,40.5,percent of total billed charges,Drugs,70.88,70,,70.88,percent of total billed charges,All Other,36.45,36,,36.45,percent of total billed charges,Drugs,36.45,36,,36.45,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,35.44,35,,35.44,percent of total billed charges,Drugs,33.75,,,33.75,Other,Drug Cost,33.75,,,33.75,Other,Drug Cost,33.75,,,33.75,Other,Drug Cost,33.75,,,33.75,Other,Drug Cost,33.75,,,33.75,Other,Drug Cost,33.75,,,33.75,Other,Drug Cost,75.94,,,75.94,Other,225% of Medicaid,47.25,,,47.25,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",72.57,,,72.57,Other,215% Medicaid APG methodology,72.57,,,72.57,Other,215% Medicaid APG methodology,42.19,,,42.19,Other,125% Medicaid APG methodology,0.01,75.94,
BUPIV LIPOSOME 266MG/20ML,C9290,HCPCS,,80002613,CDM,636,RC,65250026609,NDC,both,10,ML,823.39,324.96,39.4668,,324.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,288.19,35,,288.19,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,279.95,34,,279.95,percent of total billed charges,Drugs,279.95,34,,279.95,percent of total billed charges,Drugs,279.95,34,,279.95,percent of total billed charges,Drugs,279.95,34,,279.95,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,279.95,34,"If Charge > 500, then 34 percent",279.95,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,329.35,40,,329.35,percent of total billed charges,Drugs,576.37,70,,576.37,percent of total billed charges,All Other,296.42,36,,296.42,percent of total billed charges,Drugs,296.42,36,,296.42,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,288.19,35,,288.19,percent of total billed charges,Drugs,274.46,,,274.46,Other,Drug Cost,274.46,,,274.46,Other,Drug Cost,274.46,,,274.46,Other,Drug Cost,274.46,,,274.46,Other,Drug Cost,274.46,,,274.46,Other,Drug Cost,274.46,,,274.46,Other,Drug Cost,617.54,,,617.54,Other,225% of Medicaid,384.25,,,384.25,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",590.09,,,590.09,Other,215% Medicaid APG methodology,590.09,,,590.09,Other,215% Medicaid APG methodology,343.08,,,343.08,Other,125% Medicaid APG methodology,0.01,617.54,
PERTUZUMAB 30MG/ML 14ML,J9306,HCPCS,,80002619,CDM,636,RC,50242014501,NDC,both,1,ML,11848.02,152.21,,,152.21,Other,150% of Medicare + 9.63% HCRA Surcharge,92.56,,,92.56,Fee Schedule,Average Sale Price (ASP) x 6,4146.81,35,,4146.81,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,4028.33,34,,4028.33,percent of total billed charges,Drugs,4028.33,34,,4028.33,percent of total billed charges,Drugs,4028.33,34,,4028.33,percent of total billed charges,Drugs,4028.33,34,,4028.33,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,4028.33,34,"If Charge > 500, then 34 percent",4028.33,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,4739.21,40,,4739.21,percent of total billed charges,Drugs,8293.61,70,,8293.61,percent of total billed charges,All Other,4265.29,36,,4265.29,percent of total billed charges,Drugs,4265.29,36,,4265.29,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,4146.81,35,,4146.81,percent of total billed charges,Drugs,3949.34,,,3949.34,Other,Drug Cost,3949.34,,,3949.34,Other,Drug Cost,3949.34,,,3949.34,Other,Drug Cost,3949.34,,,3949.34,Other,Drug Cost,3949.34,,,3949.34,Other,Drug Cost,3949.34,,,3949.34,Other,Drug Cost,8886.02,,,8886.02,Other,225% of Medicaid,5529.08,,,5529.08,Other,140% of Medicaid,4028.33,34,"If Charge > 2,000, then 34 percent",4028.33,percent of total billed charges,Drugs,148.1,,,148.1,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8491.08,,,8491.08,Other,215% Medicaid APG methodology,8491.08,,,8491.08,Other,215% Medicaid APG methodology,4936.68,,,4936.68,Other,125% Medicaid APG methodology,0.01,8886.02,
GOSERELIN ACETATE 3.6MG IMPLANT,J9202,HCPCS,,80002623,CDM,636,RC,70720095036,NDC,both,1,EA,2243.82,6008.91,,,6008.91,Other,150% of Medicare + 9.63% HCRA Surcharge,3654.05,,,3654.05,Fee Schedule,Average Sale Price (ASP) x 6,785.34,35,,785.34,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,762.9,34,,762.9,percent of total billed charges,Drugs,762.9,34,,762.9,percent of total billed charges,Drugs,762.9,34,,762.9,percent of total billed charges,Drugs,762.9,34,,762.9,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,762.9,34,"If Charge > 500, then 34 percent",762.9,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,897.53,40,,897.53,percent of total billed charges,Drugs,1570.67,70,,1570.67,percent of total billed charges,All Other,807.78,36,,807.78,percent of total billed charges,Drugs,807.78,36,,807.78,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,785.34,35,,785.34,percent of total billed charges,Drugs,747.94,,,747.94,Other,Drug Cost,747.94,,,747.94,Other,Drug Cost,747.94,,,747.94,Other,Drug Cost,747.94,,,747.94,Other,Drug Cost,747.94,,,747.94,Other,Drug Cost,747.94,,,747.94,Other,Drug Cost,1682.87,,,1682.87,Other,225% of Medicaid,1047.12,,,1047.12,Other,140% of Medicaid,762.9,34,"If Charge > 2,000, then 34 percent",762.9,percent of total billed charges,Drugs,5846.49,,,5846.49,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1608.07,,,1608.07,Other,215% Medicaid APG methodology,1608.07,,,1608.07,Other,215% Medicaid APG methodology,934.93,,,934.93,Other,125% Medicaid APG methodology,0.01,6008.91,
IOTHALAMATE MEGLUMINE 60% 50ML,Q9961,HCPCS,,80002632,CDM,636,RC,19095305,NDC,both,25,ML,35.05,2.72,,,2.72,Other,150% of Medicare + 9.63% HCRA Surcharge,1.66,,,1.66,Fee Schedule,Average Sale Price (ASP) x 6,12.27,35,,12.27,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,11.92,34,,11.92,percent of total billed charges,Drugs,11.92,34,,11.92,percent of total billed charges,Drugs,11.92,34,,11.92,percent of total billed charges,Drugs,11.92,34,,11.92,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,14.02,40,,14.02,percent of total billed charges,Drugs,24.53,70,,24.53,percent of total billed charges,All Other,12.62,36,,12.62,percent of total billed charges,Drugs,12.62,36,,12.62,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,12.27,35,,12.27,percent of total billed charges,Drugs,11.68,,,11.68,Other,Drug Cost,11.68,,,11.68,Other,Drug Cost,11.68,,,11.68,Other,Drug Cost,11.68,,,11.68,Other,Drug Cost,11.68,,,11.68,Other,Drug Cost,11.68,,,11.68,Other,Drug Cost,26.29,,,26.29,Other,225% of Medicaid,16.36,,,16.36,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.65,,,2.65,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",25.12,,,25.12,Other,215% Medicaid APG methodology,25.12,,,25.12,Other,215% Medicaid APG methodology,14.6,,,14.6,Other,125% Medicaid APG methodology,0.01,26.29,
PREDNISOLONE 15MG 5ML SYRUP,J7510,HCPCS,,80002635,CDM,636,RC,121075908,NDC,both,1,ML,8.04,4.13,,,4.13,Other,150% of Medicare + 9.63% HCRA Surcharge,2.51,,,2.51,Fee Schedule,Average Sale Price (ASP) x 6,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.73,34,,2.73,percent of total billed charges,Drugs,2.73,34,,2.73,percent of total billed charges,Drugs,2.73,34,,2.73,percent of total billed charges,Drugs,2.73,34,,2.73,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,3.22,40,,3.22,percent of total billed charges,Drugs,5.63,70,,5.63,percent of total billed charges,All Other,2.89,36,,2.89,percent of total billed charges,Drugs,2.89,36,,2.89,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.81,35,,2.81,percent of total billed charges,Drugs,2.68,,,2.68,Other,Drug Cost,2.68,,,2.68,Other,Drug Cost,2.68,,,2.68,Other,Drug Cost,2.68,,,2.68,Other,Drug Cost,2.68,,,2.68,Other,Drug Cost,2.68,,,2.68,Other,Drug Cost,6.03,,,6.03,Other,225% of Medicaid,3.75,,,3.75,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.02,,,4.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.76,,,5.76,Other,215% Medicaid APG methodology,5.76,,,5.76,Other,215% Medicaid APG methodology,3.35,,,3.35,Other,125% Medicaid APG methodology,0.01,6.03,
ALBUMIN 5% 500ML,P9045,HCPCS,,80002639,CDM,636,RC,68516521402,NDC,both,1,ML,165.69,523.69,,,523.69,Other,150% of Medicare + 9.63% HCRA Surcharge,318.46,,,318.46,Fee Schedule,Average Sale Price (ASP) x 6,57.99,35,,57.99,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,56.33,34,,56.33,percent of total billed charges,Drugs,56.33,34,,56.33,percent of total billed charges,Drugs,56.33,34,,56.33,percent of total billed charges,Drugs,56.33,34,,56.33,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,66.28,40,,66.28,percent of total billed charges,Drugs,115.98,70,,115.98,percent of total billed charges,All Other,59.65,36,,59.65,percent of total billed charges,Drugs,59.65,36,,59.65,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,57.99,35,,57.99,percent of total billed charges,Drugs,55.23,,,55.23,Other,Drug Cost,55.23,,,55.23,Other,Drug Cost,55.23,,,55.23,Other,Drug Cost,55.23,,,55.23,Other,Drug Cost,55.23,,,55.23,Other,Drug Cost,55.23,,,55.23,Other,Drug Cost,124.27,,,124.27,Other,225% of Medicaid,77.32,,,77.32,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,509.54,,,509.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",118.74,,,118.74,Other,215% Medicaid APG methodology,118.74,,,118.74,Other,215% Medicaid APG methodology,69.04,,,69.04,Other,125% Medicaid APG methodology,0.01,523.69,
AMINOPHYLLINE 250MG 10ML VIAL,J0280,HCPCS,,80002640,CDM,636,RC,409592101,NDC,both,25,ML,7.8,50.64,,,50.64,Other,150% of Medicare + 9.63% HCRA Surcharge,30.79,,,30.79,Fee Schedule,Average Sale Price (ASP) x 6,2.73,35,,2.73,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,2.65,34,,2.65,percent of total billed charges,Drugs,2.65,34,,2.65,percent of total billed charges,Drugs,2.65,34,,2.65,percent of total billed charges,Drugs,2.65,34,,2.65,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,3.12,40,,3.12,percent of total billed charges,Drugs,5.46,70,,5.46,percent of total billed charges,All Other,2.81,36,,2.81,percent of total billed charges,Drugs,2.81,36,,2.81,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,2.73,35,,2.73,percent of total billed charges,Drugs,2.6,,,2.6,Other,Drug Cost,2.6,,,2.6,Other,Drug Cost,2.6,,,2.6,Other,Drug Cost,2.6,,,2.6,Other,Drug Cost,2.6,,,2.6,Other,Drug Cost,2.6,,,2.6,Other,Drug Cost,5.85,,,5.85,Other,225% of Medicaid,3.64,,,3.64,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,49.27,,,49.27,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.59,,,5.59,Other,215% Medicaid APG methodology,5.59,,,5.59,Other,215% Medicaid APG methodology,3.25,,,3.25,Other,125% Medicaid APG methodology,0.01,50.64,
RECLAST 5MG/100ML,J3489,HCPCS,,80002648,CDM,636,RC,25021083082,NDC,both,1,ML,38.46,71.17,,,71.17,Other,150% of Medicare + 9.63% HCRA Surcharge,43.28,,,43.28,Fee Schedule,Average Sale Price (ASP) x 6,13.46,35,,13.46,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,13.08,34,,13.08,percent of total billed charges,Drugs,13.08,34,,13.08,percent of total billed charges,Drugs,13.08,34,,13.08,percent of total billed charges,Drugs,13.08,34,,13.08,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,15.38,40,,15.38,percent of total billed charges,Drugs,26.92,70,,26.92,percent of total billed charges,All Other,13.85,36,,13.85,percent of total billed charges,Drugs,13.85,36,,13.85,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,13.46,35,,13.46,percent of total billed charges,Drugs,12.82,,,12.82,Other,Drug Cost,12.82,,,12.82,Other,Drug Cost,12.82,,,12.82,Other,Drug Cost,12.82,,,12.82,Other,Drug Cost,12.82,,,12.82,Other,Drug Cost,12.82,,,12.82,Other,Drug Cost,28.85,,,28.85,Other,225% of Medicaid,17.95,,,17.95,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,69.24,,,69.24,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",27.56,,,27.56,Other,215% Medicaid APG methodology,27.56,,,27.56,Other,215% Medicaid APG methodology,16.03,,,16.03,Other,125% Medicaid APG methodology,0.01,71.17,
RISPERIDONE LG ACTING 12.5MG/2ML INJ,J2794,HCPCS,,80002659,CDM,636,RC,50458030911,NDC,both,1,EA,283.29,119.89,,,119.89,Other,150% of Medicare + 9.63% HCRA Surcharge,72.91,,,72.91,Fee Schedule,Average Sale Price (ASP) x 6,99.15,35,,99.15,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,96.32,34,,96.32,percent of total billed charges,Drugs,96.32,34,,96.32,percent of total billed charges,Drugs,96.32,34,,96.32,percent of total billed charges,Drugs,96.32,34,,96.32,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,113.32,40,,113.32,percent of total billed charges,Drugs,198.3,70,,198.3,percent of total billed charges,All Other,101.98,36,,101.98,percent of total billed charges,Drugs,101.98,36,,101.98,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,99.15,35,,99.15,percent of total billed charges,Drugs,94.43,,,94.43,Other,Drug Cost,94.43,,,94.43,Other,Drug Cost,94.43,,,94.43,Other,Drug Cost,94.43,,,94.43,Other,Drug Cost,94.43,,,94.43,Other,Drug Cost,94.43,,,94.43,Other,Drug Cost,212.47,,,212.47,Other,225% of Medicaid,132.2,,,132.2,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,116.65,,,116.65,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",203.02,,,203.02,Other,215% Medicaid APG methodology,203.02,,,203.02,Other,215% Medicaid APG methodology,118.04,,,118.04,Other,125% Medicaid APG methodology,0.01,212.47,
FOSAPREPITANT 150MG INJ,J1453,HCPCS,,80002661,CDM,636,RC,72205005401,NDC,both,1,EA,22.02,1.36,,,1.36,Other,150% of Medicare + 9.63% HCRA Surcharge,0.83,,,0.83,Fee Schedule,Average Sale Price (ASP) x 6,7.71,35,,7.71,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,7.49,34,,7.49,percent of total billed charges,Drugs,7.49,34,,7.49,percent of total billed charges,Drugs,7.49,34,,7.49,percent of total billed charges,Drugs,7.49,34,,7.49,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,8.81,40,,8.81,percent of total billed charges,Drugs,15.41,70,,15.41,percent of total billed charges,All Other,7.93,36,,7.93,percent of total billed charges,Drugs,7.93,36,,7.93,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,7.71,35,,7.71,percent of total billed charges,Drugs,7.34,,,7.34,Other,Drug Cost,7.34,,,7.34,Other,Drug Cost,7.34,,,7.34,Other,Drug Cost,7.34,,,7.34,Other,Drug Cost,7.34,,,7.34,Other,Drug Cost,7.34,,,7.34,Other,Drug Cost,16.52,,,16.52,Other,225% of Medicaid,10.28,,,10.28,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.33,,,1.33,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",15.78,,,15.78,Other,215% Medicaid APG methodology,15.78,,,15.78,Other,215% Medicaid APG methodology,9.18,,,9.18,Other,125% Medicaid APG methodology,0.01,16.52,
FLU VAC NO PRSV 4 VAL 6 MOS+,90686,HCPCS,,80002671,CDM,636,RC,49281042350,NDC,both,10,ML,58.67,23.15,39.4668,,23.15,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,20.53,35,,20.53,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,19.95,34,,19.95,percent of total billed charges,Drugs,19.95,34,,19.95,percent of total billed charges,Drugs,19.95,34,,19.95,percent of total billed charges,Drugs,19.95,34,,19.95,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,23.47,40,,23.47,percent of total billed charges,Drugs,41.07,70,,41.07,percent of total billed charges,All Other,21.12,36,,21.12,percent of total billed charges,Drugs,21.12,36,,21.12,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,20.53,35,,20.53,percent of total billed charges,Drugs,19.56,,,19.56,Other,Drug Cost,19.56,,,19.56,Other,Drug Cost,19.56,,,19.56,Other,Drug Cost,19.56,,,19.56,Other,Drug Cost,19.56,,,19.56,Other,Drug Cost,19.56,,,19.56,Other,Drug Cost,44,,,44,Other,225% of Medicaid,27.38,,,27.38,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",42.05,,,42.05,Other,215% Medicaid APG methodology,42.05,,,42.05,Other,215% Medicaid APG methodology,24.45,,,24.45,Other,125% Medicaid APG methodology,0.01,44,
ANTIHEMOPHILIC FACTOR 1974 IU,J7187,HCPCS,,80002678,CDM,636,RC,63833061702,NDC,both,1,EA,4275.18,13.3,,,13.3,Other,150% of Medicare + 9.63% HCRA Surcharge,8.09,,,8.09,Fee Schedule,Average Sale Price (ASP) x 6,1496.31,35,,1496.31,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1453.56,34,,1453.56,percent of total billed charges,Drugs,1453.56,34,,1453.56,percent of total billed charges,Drugs,1453.56,34,,1453.56,percent of total billed charges,Drugs,1453.56,34,,1453.56,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1453.56,34,"If Charge > 500, then 34 percent",1453.56,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1710.07,40,,1710.07,percent of total billed charges,Drugs,2992.63,70,,2992.63,percent of total billed charges,All Other,1539.06,36,,1539.06,percent of total billed charges,Drugs,1539.06,36,,1539.06,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1496.31,35,,1496.31,percent of total billed charges,Drugs,1425.06,,,1425.06,Other,Drug Cost,1425.06,,,1425.06,Other,Drug Cost,1425.06,,,1425.06,Other,Drug Cost,1425.06,,,1425.06,Other,Drug Cost,1425.06,,,1425.06,Other,Drug Cost,1425.06,,,1425.06,Other,Drug Cost,3206.39,,,3206.39,Other,225% of Medicaid,1995.08,,,1995.08,Other,140% of Medicaid,1453.56,34,"If Charge > 2,000, then 34 percent",1453.56,percent of total billed charges,Drugs,12.94,,,12.94,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3063.88,,,3063.88,Other,215% Medicaid APG methodology,3063.88,,,3063.88,Other,215% Medicaid APG methodology,1781.33,,,1781.33,Other,125% Medicaid APG methodology,0.01,3206.39,
ANTIHEMOPHILIC FACTOR 492 IU,J7187,HCPCS,,80002679,CDM,636,RC,63833061502,NDC,both,1,EA,1124.91,13.3,,,13.3,Other,150% of Medicare + 9.63% HCRA Surcharge,8.09,,,8.09,Fee Schedule,Average Sale Price (ASP) x 6,393.72,35,,393.72,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,382.47,34,,382.47,percent of total billed charges,Drugs,382.47,34,,382.47,percent of total billed charges,Drugs,382.47,34,,382.47,percent of total billed charges,Drugs,382.47,34,,382.47,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,382.47,34,"If Charge > 500, then 34 percent",382.47,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,449.96,40,,449.96,percent of total billed charges,Drugs,787.44,70,,787.44,percent of total billed charges,All Other,404.97,36,,404.97,percent of total billed charges,Drugs,404.97,36,,404.97,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,393.72,35,,393.72,percent of total billed charges,Drugs,374.97,,,374.97,Other,Drug Cost,374.97,,,374.97,Other,Drug Cost,374.97,,,374.97,Other,Drug Cost,374.97,,,374.97,Other,Drug Cost,374.97,,,374.97,Other,Drug Cost,374.97,,,374.97,Other,Drug Cost,843.68,,,843.68,Other,225% of Medicaid,524.96,,,524.96,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,12.94,,,12.94,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",806.19,,,806.19,Other,215% Medicaid APG methodology,806.19,,,806.19,Other,215% Medicaid APG methodology,468.71,,,468.71,Other,125% Medicaid APG methodology,0.01,843.68,
VORICONAZOLE 200MG INJ,J3465,HCPCS,,80002684,CDM,636,RC,49319028,NDC,both,1,EA,9.12,11.43,,,11.43,Other,150% of Medicare + 9.63% HCRA Surcharge,6.95,,,6.95,Fee Schedule,Average Sale Price (ASP) x 6,3.19,35,,3.19,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,3.1,34,,3.1,percent of total billed charges,Drugs,3.1,34,,3.1,percent of total billed charges,Drugs,3.1,34,,3.1,percent of total billed charges,Drugs,3.1,34,,3.1,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,3.65,40,,3.65,percent of total billed charges,Drugs,6.38,70,,6.38,percent of total billed charges,All Other,3.28,36,,3.28,percent of total billed charges,Drugs,3.28,36,,3.28,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,3.19,35,,3.19,percent of total billed charges,Drugs,3.04,,,3.04,Other,Drug Cost,3.04,,,3.04,Other,Drug Cost,3.04,,,3.04,Other,Drug Cost,3.04,,,3.04,Other,Drug Cost,3.04,,,3.04,Other,Drug Cost,3.04,,,3.04,Other,Drug Cost,6.84,,,6.84,Other,225% of Medicaid,4.26,,,4.26,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,11.12,,,11.12,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6.54,,,6.54,Other,215% Medicaid APG methodology,6.54,,,6.54,Other,215% Medicaid APG methodology,3.8,,,3.8,Other,125% Medicaid APG methodology,0.01,11.43,
BCG LIVE INTRAVESICAL INSTILLATION 1MG,J9030,HCPCS,,80002694,CDM,636,RC,52060202,NDC,both,1,EA,343.98,28.51,,,28.51,Other,150% of Medicare + 9.63% HCRA Surcharge,17.34,,,17.34,Fee Schedule,Average Sale Price (ASP) x 6,120.39,35,,120.39,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,116.95,34,,116.95,percent of total billed charges,Drugs,116.95,34,,116.95,percent of total billed charges,Drugs,116.95,34,,116.95,percent of total billed charges,Drugs,116.95,34,,116.95,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,137.59,40,,137.59,percent of total billed charges,Drugs,240.79,70,,240.79,percent of total billed charges,All Other,123.83,36,,123.83,percent of total billed charges,Drugs,123.83,36,,123.83,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,120.39,35,,120.39,percent of total billed charges,Drugs,114.66,,,114.66,Other,Drug Cost,114.66,,,114.66,Other,Drug Cost,114.66,,,114.66,Other,Drug Cost,114.66,,,114.66,Other,Drug Cost,114.66,,,114.66,Other,Drug Cost,114.66,,,114.66,Other,Drug Cost,257.99,,,257.99,Other,225% of Medicaid,160.52,,,160.52,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,27.74,,,27.74,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",246.52,,,246.52,Other,215% Medicaid APG methodology,246.52,,,246.52,Other,215% Medicaid APG methodology,143.33,,,143.33,Other,125% Medicaid APG methodology,0.01,257.99,
TBO-FILGRASTIM 300MCG INJ,J1447,HCPCS,,80002702,CDM,636,RC,63459091015,NDC,both,10,ML,163.31,4.33,,,4.33,Other,150% of Medicare + 9.63% HCRA Surcharge,2.63,,,2.63,Fee Schedule,Average Sale Price (ASP) x 6,57.16,35,,57.16,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,55.52,34,,55.52,percent of total billed charges,Drugs,55.52,34,,55.52,percent of total billed charges,Drugs,55.52,34,,55.52,percent of total billed charges,Drugs,55.52,34,,55.52,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,65.32,40,,65.32,percent of total billed charges,Drugs,114.31,70,,114.31,percent of total billed charges,All Other,58.79,36,,58.79,percent of total billed charges,Drugs,58.79,36,,58.79,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,57.16,35,,57.16,percent of total billed charges,Drugs,54.44,,,54.44,Other,Drug Cost,54.44,,,54.44,Other,Drug Cost,54.44,,,54.44,Other,Drug Cost,54.44,,,54.44,Other,Drug Cost,54.44,,,54.44,Other,Drug Cost,54.44,,,54.44,Other,Drug Cost,122.48,,,122.48,Other,225% of Medicaid,76.21,,,76.21,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.21,,,4.21,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",117.04,,,117.04,Other,215% Medicaid APG methodology,117.04,,,117.04,Other,215% Medicaid APG methodology,68.04,,,68.04,Other,125% Medicaid APG methodology,0.01,122.48,
TBO-FILGRASTIM 480MCG INJ,J1447,HCPCS,,80002703,CDM,636,RC,63459091211,NDC,both,1,ML,259.59,4.33,,,4.33,Other,150% of Medicare + 9.63% HCRA Surcharge,2.63,,,2.63,Fee Schedule,Average Sale Price (ASP) x 6,90.86,35,,90.86,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,88.26,34,,88.26,percent of total billed charges,Drugs,88.26,34,,88.26,percent of total billed charges,Drugs,88.26,34,,88.26,percent of total billed charges,Drugs,88.26,34,,88.26,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,103.84,40,,103.84,percent of total billed charges,Drugs,181.71,70,,181.71,percent of total billed charges,All Other,93.45,36,,93.45,percent of total billed charges,Drugs,93.45,36,,93.45,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,90.86,35,,90.86,percent of total billed charges,Drugs,86.53,,,86.53,Other,Drug Cost,86.53,,,86.53,Other,Drug Cost,86.53,,,86.53,Other,Drug Cost,86.53,,,86.53,Other,Drug Cost,86.53,,,86.53,Other,Drug Cost,86.53,,,86.53,Other,Drug Cost,194.69,,,194.69,Other,225% of Medicaid,121.14,,,121.14,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.21,,,4.21,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",186.04,,,186.04,Other,215% Medicaid APG methodology,186.04,,,186.04,Other,215% Medicaid APG methodology,108.16,,,108.16,Other,125% Medicaid APG methodology,0.01,194.69,
D5W/ NS 1000ML,J7042,HCPCS,,80002727,CDM,636,RC,264761000,NDC,both,1000,ML,2.64,15.66,,,15.66,Other,150% of Medicare + 9.63% HCRA Surcharge,9.52,,,9.52,Fee Schedule,Average Sale Price (ASP) x 6,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.9,34,,0.9,percent of total billed charges,Drugs,0.9,34,,0.9,percent of total billed charges,Drugs,0.9,34,,0.9,percent of total billed charges,Drugs,0.9,34,,0.9,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,1.06,40,,1.06,percent of total billed charges,Drugs,1.85,70,,1.85,percent of total billed charges,All Other,0.95,36,,0.95,percent of total billed charges,Drugs,0.95,36,,0.95,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.92,35,,0.92,percent of total billed charges,Drugs,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,0.88,,,0.88,Other,Drug Cost,1.98,,,1.98,Other,225% of Medicaid,1.23,,,1.23,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,15.24,,,15.24,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.89,,,1.89,Other,215% Medicaid APG methodology,1.89,,,1.89,Other,215% Medicaid APG methodology,1.1,,,1.1,Other,125% Medicaid APG methodology,0.01,15.66,
SOD CHLORIDE 3% 500ML,J7131,HCPCS,,80002728,CDM,636,RC,264780510,NDC,both,24,ML,4.84,1.91,39.4668,,1.91,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,1.69,35,,1.69,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,1.64,34,,1.64,percent of total billed charges,Drugs,1.64,34,,1.64,percent of total billed charges,Drugs,1.64,34,,1.64,percent of total billed charges,Drugs,1.64,34,,1.64,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,1.93,40,,1.93,percent of total billed charges,Drugs,3.38,70,,3.38,percent of total billed charges,All Other,1.74,36,,1.74,percent of total billed charges,Drugs,1.74,36,,1.74,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,1.69,35,,1.69,percent of total billed charges,Drugs,1.61,,,1.61,Other,Drug Cost,1.61,,,1.61,Other,Drug Cost,1.61,,,1.61,Other,Drug Cost,1.61,,,1.61,Other,Drug Cost,1.61,,,1.61,Other,Drug Cost,1.61,,,1.61,Other,Drug Cost,3.63,,,3.63,Other,225% of Medicaid,2.26,,,2.26,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3.47,,,3.47,Other,215% Medicaid APG methodology,3.47,,,3.47,Other,215% Medicaid APG methodology,2.01,,,2.01,Other,125% Medicaid APG methodology,0.01,3.63,
TEMOZOLAMIDE 100MG INJ,J9328,HCPCS,,80002737,CDM,636,RC,85138101,NDC,both,1,EA,1259.37,102.64,,,102.64,Other,150% of Medicare + 9.63% HCRA Surcharge,62.42,,,62.42,Fee Schedule,Average Sale Price (ASP) x 6,440.78,35,,440.78,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,428.19,34,,428.19,percent of total billed charges,Drugs,428.19,34,,428.19,percent of total billed charges,Drugs,428.19,34,,428.19,percent of total billed charges,Drugs,428.19,34,,428.19,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,428.19,34,"If Charge > 500, then 34 percent",428.19,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,503.75,40,,503.75,percent of total billed charges,Drugs,881.56,70,,881.56,percent of total billed charges,All Other,453.37,36,,453.37,percent of total billed charges,Drugs,453.37,36,,453.37,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,440.78,35,,440.78,percent of total billed charges,Drugs,419.79,,,419.79,Other,Drug Cost,419.79,,,419.79,Other,Drug Cost,419.79,,,419.79,Other,Drug Cost,419.79,,,419.79,Other,Drug Cost,419.79,,,419.79,Other,Drug Cost,419.79,,,419.79,Other,Drug Cost,944.53,,,944.53,Other,225% of Medicaid,587.71,,,587.71,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,99.87,,,99.87,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",902.55,,,902.55,Other,215% Medicaid APG methodology,902.55,,,902.55,Other,215% Medicaid APG methodology,524.74,,,524.74,Other,125% Medicaid APG methodology,0.01,944.53,
HEPARIN 1000UN/NS 500ML,J1644,HCPCS,,80002743,CDM,636,RC,264987210,NDC,both,24,ML,5.95,2.64,,,2.64,Other,150% of Medicare + 9.63% HCRA Surcharge,1.61,,,1.61,Fee Schedule,Average Sale Price (ASP) x 6,2.08,35,,2.08,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,2.02,34,,2.02,percent of total billed charges,Drugs,2.02,34,,2.02,percent of total billed charges,Drugs,2.02,34,,2.02,percent of total billed charges,Drugs,2.02,34,,2.02,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,2.38,40,,2.38,percent of total billed charges,Drugs,4.16,70,,4.16,percent of total billed charges,All Other,2.14,36,,2.14,percent of total billed charges,Drugs,2.14,36,,2.14,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,2.08,35,,2.08,percent of total billed charges,Drugs,1.98,,,1.98,Other,Drug Cost,1.98,,,1.98,Other,Drug Cost,1.98,,,1.98,Other,Drug Cost,1.98,,,1.98,Other,Drug Cost,1.98,,,1.98,Other,Drug Cost,1.98,,,1.98,Other,Drug Cost,4.46,,,4.46,Other,225% of Medicaid,2.77,,,2.77,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.57,,,2.57,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.26,,,4.26,Other,215% Medicaid APG methodology,4.26,,,4.26,Other,215% Medicaid APG methodology,2.48,,,2.48,Other,125% Medicaid APG methodology,0.01,4.46,
CARFILZOMIB 60MG INJ,J9047,HCPCS,,80002748,CDM,636,RC,76075010101,NDC,both,1,EA,9722.37,464.57,,,464.57,Other,150% of Medicare + 9.63% HCRA Surcharge,282.51,,,282.51,Fee Schedule,Average Sale Price (ASP) x 6,3402.83,35,,3402.83,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3305.61,34,,3305.61,percent of total billed charges,Drugs,3305.61,34,,3305.61,percent of total billed charges,Drugs,3305.61,34,,3305.61,percent of total billed charges,Drugs,3305.61,34,,3305.61,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3305.61,34,"If Charge > 500, then 34 percent",3305.61,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3888.95,40,,3888.95,percent of total billed charges,Drugs,6805.66,70,,6805.66,percent of total billed charges,All Other,3500.05,36,,3500.05,percent of total billed charges,Drugs,3500.05,36,,3500.05,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3402.83,35,,3402.83,percent of total billed charges,Drugs,3240.79,,,3240.79,Other,Drug Cost,3240.79,,,3240.79,Other,Drug Cost,3240.79,,,3240.79,Other,Drug Cost,3240.79,,,3240.79,Other,Drug Cost,3240.79,,,3240.79,Other,Drug Cost,3240.79,,,3240.79,Other,Drug Cost,7291.78,,,7291.78,Other,225% of Medicaid,4537.11,,,4537.11,Other,140% of Medicaid,3305.61,34,"If Charge > 2,000, then 34 percent",3305.61,percent of total billed charges,Drugs,452.02,,,452.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6967.7,,,6967.7,Other,215% Medicaid APG methodology,6967.7,,,6967.7,Other,215% Medicaid APG methodology,4050.99,,,4050.99,Other,125% Medicaid APG methodology,0.01,7291.78,
RAMUCIRUMAB 10MG/ML,J9308,HCPCS,,80002749,CDM,636,RC,2766901,NDC,both,1,ML,4324.47,693.08,,,693.08,Other,150% of Medicare + 9.63% HCRA Surcharge,421.46,,,421.46,Fee Schedule,Average Sale Price (ASP) x 6,1513.56,35,,1513.56,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1470.32,34,,1470.32,percent of total billed charges,Drugs,1470.32,34,,1470.32,percent of total billed charges,Drugs,1470.32,34,,1470.32,percent of total billed charges,Drugs,1470.32,34,,1470.32,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1470.32,34,"If Charge > 500, then 34 percent",1470.32,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1729.79,40,,1729.79,percent of total billed charges,Drugs,3027.13,70,,3027.13,percent of total billed charges,All Other,1556.81,36,,1556.81,percent of total billed charges,Drugs,1556.81,36,,1556.81,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1513.56,35,,1513.56,percent of total billed charges,Drugs,1441.49,,,1441.49,Other,Drug Cost,1441.49,,,1441.49,Other,Drug Cost,1441.49,,,1441.49,Other,Drug Cost,1441.49,,,1441.49,Other,Drug Cost,1441.49,,,1441.49,Other,Drug Cost,1441.49,,,1441.49,Other,Drug Cost,3243.35,,,3243.35,Other,225% of Medicaid,2018.09,,,2018.09,Other,140% of Medicaid,1470.32,34,"If Charge > 2,000, then 34 percent",1470.32,percent of total billed charges,Drugs,674.34,,,674.34,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3099.2,,,3099.2,Other,215% Medicaid APG methodology,3099.2,,,3099.2,Other,215% Medicaid APG methodology,1801.86,,,1801.86,Other,125% Medicaid APG methodology,0.01,3243.35,
GOLIMUMAB 12.5 MG/ML 4ML INJ,J1602,HCPCS,,80002755,CDM,636,RC,57894035001,NDC,both,1,ML,5727.69,121.76,,,121.76,Other,150% of Medicare + 9.63% HCRA Surcharge,74.05,,,74.05,Fee Schedule,Average Sale Price (ASP) x 6,2004.69,35,,2004.69,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,1947.41,34,,1947.41,percent of total billed charges,Drugs,1947.41,34,,1947.41,percent of total billed charges,Drugs,1947.41,34,,1947.41,percent of total billed charges,Drugs,1947.41,34,,1947.41,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,1947.41,34,"If Charge > 500, then 34 percent",1947.41,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,2291.08,40,,2291.08,percent of total billed charges,Drugs,4009.38,70,,4009.38,percent of total billed charges,All Other,2061.97,36,,2061.97,percent of total billed charges,Drugs,2061.97,36,,2061.97,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,2004.69,35,,2004.69,percent of total billed charges,Drugs,1909.23,,,1909.23,Other,Drug Cost,1909.23,,,1909.23,Other,Drug Cost,1909.23,,,1909.23,Other,Drug Cost,1909.23,,,1909.23,Other,Drug Cost,1909.23,,,1909.23,Other,Drug Cost,1909.23,,,1909.23,Other,Drug Cost,4295.77,,,4295.77,Other,225% of Medicaid,2672.92,,,2672.92,Other,140% of Medicaid,1947.41,34,"If Charge > 2,000, then 34 percent",1947.41,percent of total billed charges,Drugs,118.47,,,118.47,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4104.84,,,4104.84,Other,215% Medicaid APG methodology,4104.84,,,4104.84,Other,215% Medicaid APG methodology,2386.54,,,2386.54,Other,125% Medicaid APG methodology,0.01,4295.77,
ABILIFY MAINTENA 400MG INJECTION,J0401,HCPCS,,80002758,CDM,636,RC,59148001971,NDC,both,1,EA,3491.52,67.18,,,67.18,Other,150% of Medicare + 9.63% HCRA Surcharge,40.85,,,40.85,Fee Schedule,Average Sale Price (ASP) x 6,1222.03,35,,1222.03,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1187.12,34,,1187.12,percent of total billed charges,Drugs,1187.12,34,,1187.12,percent of total billed charges,Drugs,1187.12,34,,1187.12,percent of total billed charges,Drugs,1187.12,34,,1187.12,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1187.12,34,"If Charge > 500, then 34 percent",1187.12,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1396.61,40,,1396.61,percent of total billed charges,Drugs,2444.06,70,,2444.06,percent of total billed charges,All Other,1256.95,36,,1256.95,percent of total billed charges,Drugs,1256.95,36,,1256.95,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1222.03,35,,1222.03,percent of total billed charges,Drugs,1163.84,,,1163.84,Other,Drug Cost,1163.84,,,1163.84,Other,Drug Cost,1163.84,,,1163.84,Other,Drug Cost,1163.84,,,1163.84,Other,Drug Cost,1163.84,,,1163.84,Other,Drug Cost,1163.84,,,1163.84,Other,Drug Cost,2618.64,,,2618.64,Other,225% of Medicaid,1629.38,,,1629.38,Other,140% of Medicaid,1187.12,34,"If Charge > 2,000, then 34 percent",1187.12,percent of total billed charges,Drugs,65.37,,,65.37,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2502.26,,,2502.26,Other,215% Medicaid APG methodology,2502.26,,,2502.26,Other,215% Medicaid APG methodology,1454.8,,,1454.8,Other,125% Medicaid APG methodology,0.01,2618.64,
ECALLANTIDE 10MG/ML INJ,J1290,HCPCS,,80002760,CDM,636,RC,47783010101,NDC,both,3,ML,14767.63,5321.38,,,5321.38,Other,150% of Medicare + 9.63% HCRA Surcharge,3235.96,,,3235.96,Fee Schedule,Average Sale Price (ASP) x 6,5168.67,35,,5168.67,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,5020.99,34,,5020.99,percent of total billed charges,Drugs,5020.99,34,,5020.99,percent of total billed charges,Drugs,5020.99,34,,5020.99,percent of total billed charges,Drugs,5020.99,34,,5020.99,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,5020.99,34,"If Charge > 500, then 34 percent",5020.99,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,5907.05,40,,5907.05,percent of total billed charges,Drugs,10337.34,70,,10337.34,percent of total billed charges,All Other,5316.35,36,,5316.35,percent of total billed charges,Drugs,5316.35,36,,5316.35,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,5168.67,35,,5168.67,percent of total billed charges,Drugs,4922.54,,,4922.54,Other,Drug Cost,4922.54,,,4922.54,Other,Drug Cost,4922.54,,,4922.54,Other,Drug Cost,4922.54,,,4922.54,Other,Drug Cost,4922.54,,,4922.54,Other,Drug Cost,4922.54,,,4922.54,Other,Drug Cost,11075.72,,,11075.72,Other,225% of Medicaid,6891.56,,,6891.56,Other,140% of Medicaid,5020.99,34,"If Charge > 2,000, then 34 percent",5020.99,percent of total billed charges,Drugs,5177.54,,,5177.54,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",10583.47,,,10583.47,Other,215% Medicaid APG methodology,10583.47,,,10583.47,Other,215% Medicaid APG methodology,6153.18,,,6153.18,Other,125% Medicaid APG methodology,0.01,11075.72,
PROTHROMBIN COMPLEX CONCENTRATE 500U INJ,J7168,HCPCS,,80002764,CDM,636,RC,63833038602,NDC,both,1,EA,1797.9,709.57,39.4668,,709.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,629.27,35,,629.27,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,611.29,34,,611.29,percent of total billed charges,Drugs,611.29,34,,611.29,percent of total billed charges,Drugs,611.29,34,,611.29,percent of total billed charges,Drugs,611.29,34,,611.29,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,611.29,34,"If Charge > 500, then 34 percent",611.29,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,719.16,40,,719.16,percent of total billed charges,Drugs,1258.53,70,,1258.53,percent of total billed charges,All Other,647.24,36,,647.24,percent of total billed charges,Drugs,647.24,36,,647.24,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,629.27,35,,629.27,percent of total billed charges,Drugs,599.3,,,599.3,Other,Drug Cost,599.3,,,599.3,Other,Drug Cost,599.3,,,599.3,Other,Drug Cost,599.3,,,599.3,Other,Drug Cost,599.3,,,599.3,Other,Drug Cost,599.3,,,599.3,Other,Drug Cost,1348.43,,,1348.43,Other,225% of Medicaid,839.02,,,839.02,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1288.5,,,1288.5,Other,215% Medicaid APG methodology,1288.5,,,1288.5,Other,215% Medicaid APG methodology,749.13,,,749.13,Other,125% Medicaid APG methodology,0.01,1348.43,
LEVETIRACETAM 1000MG/100ML IV,J1953,HCPCS,,80002765,CDM,636,RC,70860060382,NDC,both,10,ML,11.06,0.62,,,0.62,Other,150% of Medicare + 9.63% HCRA Surcharge,0.38,,,0.38,Fee Schedule,Average Sale Price (ASP) x 6,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.76,34,,3.76,percent of total billed charges,Drugs,3.76,34,,3.76,percent of total billed charges,Drugs,3.76,34,,3.76,percent of total billed charges,Drugs,3.76,34,,3.76,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,4.42,40,,4.42,percent of total billed charges,Drugs,7.74,70,,7.74,percent of total billed charges,All Other,3.98,36,,3.98,percent of total billed charges,Drugs,3.98,36,,3.98,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.87,35,,3.87,percent of total billed charges,Drugs,3.69,,,3.69,Other,Drug Cost,3.69,,,3.69,Other,Drug Cost,3.69,,,3.69,Other,Drug Cost,3.69,,,3.69,Other,Drug Cost,3.69,,,3.69,Other,Drug Cost,3.69,,,3.69,Other,Drug Cost,8.29,,,8.29,Other,225% of Medicaid,5.16,,,5.16,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.6,,,0.6,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.92,,,7.92,Other,215% Medicaid APG methodology,7.92,,,7.92,Other,215% Medicaid APG methodology,4.61,,,4.61,Other,125% Medicaid APG methodology,0.01,8.29,
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,,80002766,CDM,636,RC,64764030020,NDC,both,1,EA,14057.7,217.69,,,217.69,Other,150% of Medicare + 9.63% HCRA Surcharge,132.38,,,132.38,Fee Schedule,Average Sale Price (ASP) x 6,4920.2,35,,4920.2,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,4779.62,34,,4779.62,percent of total billed charges,Drugs,4779.62,34,,4779.62,percent of total billed charges,Drugs,4779.62,34,,4779.62,percent of total billed charges,Drugs,4779.62,34,,4779.62,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,4779.62,34,"If Charge > 500, then 34 percent",4779.62,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,5623.08,40,,5623.08,percent of total billed charges,Drugs,9840.39,70,,9840.39,percent of total billed charges,All Other,5060.77,36,,5060.77,percent of total billed charges,Drugs,5060.77,36,,5060.77,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,4920.2,35,,4920.2,percent of total billed charges,Drugs,4685.9,,,4685.9,Other,Drug Cost,4685.9,,,4685.9,Other,Drug Cost,4685.9,,,4685.9,Other,Drug Cost,4685.9,,,4685.9,Other,Drug Cost,4685.9,,,4685.9,Other,Drug Cost,4685.9,,,4685.9,Other,Drug Cost,10543.28,,,10543.28,Other,225% of Medicaid,6560.26,,,6560.26,Other,140% of Medicaid,4779.62,34,"If Charge > 2,000, then 34 percent",4779.62,percent of total billed charges,Drugs,211.8,,,211.8,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",10074.69,,,10074.69,Other,215% Medicaid APG methodology,10074.69,,,10074.69,Other,215% Medicaid APG methodology,5857.38,,,5857.38,Other,125% Medicaid APG methodology,0.01,10543.28,
TEMSIROLIIMUS 25MG/1ML,J9330,HCPCS,,80002771,CDM,636,RC,8117901,NDC,both,1,ML,3528.63,305.8,,,305.8,Other,150% of Medicare + 9.63% HCRA Surcharge,185.96,,,185.96,Fee Schedule,Average Sale Price (ASP) x 6,1235.02,35,,1235.02,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1199.73,34,,1199.73,percent of total billed charges,Drugs,1199.73,34,,1199.73,percent of total billed charges,Drugs,1199.73,34,,1199.73,percent of total billed charges,Drugs,1199.73,34,,1199.73,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1199.73,34,"If Charge > 500, then 34 percent",1199.73,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1411.45,40,,1411.45,percent of total billed charges,Drugs,2470.04,70,,2470.04,percent of total billed charges,All Other,1270.31,36,,1270.31,percent of total billed charges,Drugs,1270.31,36,,1270.31,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1235.02,35,,1235.02,percent of total billed charges,Drugs,1176.21,,,1176.21,Other,Drug Cost,1176.21,,,1176.21,Other,Drug Cost,1176.21,,,1176.21,Other,Drug Cost,1176.21,,,1176.21,Other,Drug Cost,1176.21,,,1176.21,Other,Drug Cost,1176.21,,,1176.21,Other,Drug Cost,2646.47,,,2646.47,Other,225% of Medicaid,1646.69,,,1646.69,Other,140% of Medicaid,1199.73,34,"If Charge > 2,000, then 34 percent",1199.73,percent of total billed charges,Drugs,297.53,,,297.53,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2528.85,,,2528.85,Other,215% Medicaid APG methodology,2528.85,,,2528.85,Other,215% Medicaid APG methodology,1470.26,,,1470.26,Other,125% Medicaid APG methodology,0.01,2646.47,
BUTORPHANOL 1MG/ML INJ,J0595,HCPCS,,80002776,CDM,636,RC,409162301,NDC,both,10,ML,7.39,27.61,,,27.61,Other,150% of Medicare + 9.63% HCRA Surcharge,16.79,,,16.79,Fee Schedule,Average Sale Price (ASP) x 6,2.59,35,,2.59,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,2.51,34,,2.51,percent of total billed charges,Drugs,2.51,34,,2.51,percent of total billed charges,Drugs,2.51,34,,2.51,percent of total billed charges,Drugs,2.51,34,,2.51,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,2.96,40,,2.96,percent of total billed charges,Drugs,5.17,70,,5.17,percent of total billed charges,All Other,2.66,36,,2.66,percent of total billed charges,Drugs,2.66,36,,2.66,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,2.59,35,,2.59,percent of total billed charges,Drugs,2.46,,,2.46,Other,Drug Cost,2.46,,,2.46,Other,Drug Cost,2.46,,,2.46,Other,Drug Cost,2.46,,,2.46,Other,Drug Cost,2.46,,,2.46,Other,Drug Cost,2.46,,,2.46,Other,Drug Cost,5.54,,,5.54,Other,225% of Medicaid,3.45,,,3.45,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,26.86,,,26.86,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.3,,,5.3,Other,215% Medicaid APG methodology,5.3,,,5.3,Other,215% Medicaid APG methodology,3.08,,,3.08,Other,125% Medicaid APG methodology,0.01,27.61,
DANTROLENE 250MG VIAL,J3490,HCPCS,,80002777,CDM,636,RC,42367054032,NDC,both,1,EA,2921.7,1153.1,39.4668,,1153.1,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,1022.6,35,,1022.6,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,993.38,34,,993.38,percent of total billed charges,Drugs,993.38,34,,993.38,percent of total billed charges,Drugs,993.38,34,,993.38,percent of total billed charges,Drugs,993.38,34,,993.38,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,993.38,34,"If Charge > 500, then 34 percent",993.38,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,1168.68,40,,1168.68,percent of total billed charges,Drugs,2045.19,70,,2045.19,percent of total billed charges,All Other,1051.81,36,,1051.81,percent of total billed charges,Drugs,1051.81,36,,1051.81,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,1022.6,35,,1022.6,percent of total billed charges,Drugs,973.9,,,973.9,Other,Drug Cost,973.9,,,973.9,Other,Drug Cost,973.9,,,973.9,Other,Drug Cost,973.9,,,973.9,Other,Drug Cost,973.9,,,973.9,Other,Drug Cost,973.9,,,973.9,Other,Drug Cost,2191.28,,,2191.28,Other,225% of Medicaid,1363.46,,,1363.46,Other,140% of Medicaid,993.38,34,"If Charge > 2,000, then 34 percent",993.38,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2093.89,,,2093.89,Other,215% Medicaid APG methodology,2093.89,,,2093.89,Other,215% Medicaid APG methodology,1217.38,,,1217.38,Other,125% Medicaid APG methodology,0.01,2191.28,
LEVETIRACETAM 500MG/100ML IV,J1953,HCPCS,,80002781,CDM,636,RC,70860060282,NDC,both,10,ML,1.11,0.62,,,0.62,Other,150% of Medicare + 9.63% HCRA Surcharge,0.38,,,0.38,Fee Schedule,Average Sale Price (ASP) x 6,0.39,35,,0.39,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.38,34,,0.38,percent of total billed charges,Drugs,0.38,34,,0.38,percent of total billed charges,Drugs,0.38,34,,0.38,percent of total billed charges,Drugs,0.38,34,,0.38,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.44,40,,0.44,percent of total billed charges,Drugs,0.78,70,,0.78,percent of total billed charges,All Other,0.4,36,,0.4,percent of total billed charges,Drugs,0.4,36,,0.4,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.39,35,,0.39,percent of total billed charges,Drugs,0.37,,,0.37,Other,Drug Cost,0.37,,,0.37,Other,Drug Cost,0.37,,,0.37,Other,Drug Cost,0.37,,,0.37,Other,Drug Cost,0.37,,,0.37,Other,Drug Cost,0.37,,,0.37,Other,Drug Cost,0.83,,,0.83,Other,225% of Medicaid,0.52,,,0.52,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.6,,,0.6,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.8,,,0.8,Other,215% Medicaid APG methodology,0.8,,,0.8,Other,215% Medicaid APG methodology,0.46,,,0.46,Other,125% Medicaid APG methodology,0.01,0.83,
MEROPENEM 500MG / VIAL,J2185,HCPCS,,80002793,CDM,636,RC,63323050720,NDC,both,10,EA,3.28,4.46,,,4.46,Other,150% of Medicare + 9.63% HCRA Surcharge,2.71,,,2.71,Fee Schedule,Average Sale Price (ASP) x 6,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.11,34,,1.11,percent of total billed charges,Drugs,1.11,34,,1.11,percent of total billed charges,Drugs,1.11,34,,1.11,percent of total billed charges,Drugs,1.11,34,,1.11,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.31,40,,1.31,percent of total billed charges,Drugs,2.3,70,,2.3,percent of total billed charges,All Other,1.18,36,,1.18,percent of total billed charges,Drugs,1.18,36,,1.18,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.15,35,,1.15,percent of total billed charges,Drugs,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,1.09,,,1.09,Other,Drug Cost,2.46,,,2.46,Other,225% of Medicaid,1.53,,,1.53,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,4.34,,,4.34,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2.35,,,2.35,Other,215% Medicaid APG methodology,2.35,,,2.35,Other,215% Medicaid APG methodology,1.37,,,1.37,Other,125% Medicaid APG methodology,0.01,4.46,
CEFTAZIDIME-AVIBACTAM 2.5GM INJ,J3490,HCPCS,,80002795,CDM,636,RC,456270010,NDC,both,10,EA,750.92,296.36,39.4668,,296.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,262.82,35,,262.82,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,255.31,34,,255.31,percent of total billed charges,Drugs,255.31,34,,255.31,percent of total billed charges,Drugs,255.31,34,,255.31,percent of total billed charges,Drugs,255.31,34,,255.31,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,255.31,34,"If Charge > 500, then 34 percent",255.31,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,300.37,40,,300.37,percent of total billed charges,Drugs,525.64,70,,525.64,percent of total billed charges,All Other,270.33,36,,270.33,percent of total billed charges,Drugs,270.33,36,,270.33,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,262.82,35,,262.82,percent of total billed charges,Drugs,250.31,,,250.31,Other,Drug Cost,250.31,,,250.31,Other,Drug Cost,250.31,,,250.31,Other,Drug Cost,250.31,,,250.31,Other,Drug Cost,250.31,,,250.31,Other,Drug Cost,250.31,,,250.31,Other,Drug Cost,563.19,,,563.19,Other,225% of Medicaid,350.43,,,350.43,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",538.16,,,538.16,Other,215% Medicaid APG methodology,538.16,,,538.16,Other,215% Medicaid APG methodology,312.88,,,312.88,Other,125% Medicaid APG methodology,0.01,563.19,
NIVOLUMAB 10MG/ML 10ML VIAL,J9299,HCPCS,,80002797,CDM,636,RC,3377412,NDC,both,1,ML,9443.07,306.75,,,306.75,Other,150% of Medicare + 9.63% HCRA Surcharge,186.53,,,186.53,Fee Schedule,Average Sale Price (ASP) x 6,3305.07,35,,3305.07,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3210.64,34,,3210.64,percent of total billed charges,Drugs,3210.64,34,,3210.64,percent of total billed charges,Drugs,3210.64,34,,3210.64,percent of total billed charges,Drugs,3210.64,34,,3210.64,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3210.64,34,"If Charge > 500, then 34 percent",3210.64,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3777.23,40,,3777.23,percent of total billed charges,Drugs,6610.15,70,,6610.15,percent of total billed charges,All Other,3399.51,36,,3399.51,percent of total billed charges,Drugs,3399.51,36,,3399.51,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3305.07,35,,3305.07,percent of total billed charges,Drugs,3147.69,,,3147.69,Other,Drug Cost,3147.69,,,3147.69,Other,Drug Cost,3147.69,,,3147.69,Other,Drug Cost,3147.69,,,3147.69,Other,Drug Cost,3147.69,,,3147.69,Other,Drug Cost,3147.69,,,3147.69,Other,Drug Cost,7082.3,,,7082.3,Other,225% of Medicaid,4406.77,,,4406.77,Other,140% of Medicaid,3210.64,34,"If Charge > 2,000, then 34 percent",3210.64,percent of total billed charges,Drugs,298.45,,,298.45,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6767.53,,,6767.53,Other,215% Medicaid APG methodology,6767.53,,,6767.53,Other,215% Medicaid APG methodology,3934.61,,,3934.61,Other,125% Medicaid APG methodology,0.01,7082.3,
NIVOLUMAB 10MG/ML 4ML VIAL,J9299,HCPCS,,80002798,CDM,636,RC,3377211,NDC,both,1,ML,3777.24,306.75,,,306.75,Other,150% of Medicare + 9.63% HCRA Surcharge,186.53,,,186.53,Fee Schedule,Average Sale Price (ASP) x 6,1322.03,35,,1322.03,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1284.26,34,,1284.26,percent of total billed charges,Drugs,1284.26,34,,1284.26,percent of total billed charges,Drugs,1284.26,34,,1284.26,percent of total billed charges,Drugs,1284.26,34,,1284.26,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1284.26,34,"If Charge > 500, then 34 percent",1284.26,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1510.9,40,,1510.9,percent of total billed charges,Drugs,2644.07,70,,2644.07,percent of total billed charges,All Other,1359.81,36,,1359.81,percent of total billed charges,Drugs,1359.81,36,,1359.81,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1322.03,35,,1322.03,percent of total billed charges,Drugs,1259.08,,,1259.08,Other,Drug Cost,1259.08,,,1259.08,Other,Drug Cost,1259.08,,,1259.08,Other,Drug Cost,1259.08,,,1259.08,Other,Drug Cost,1259.08,,,1259.08,Other,Drug Cost,1259.08,,,1259.08,Other,Drug Cost,2832.93,,,2832.93,Other,225% of Medicaid,1762.71,,,1762.71,Other,140% of Medicaid,1284.26,34,"If Charge > 2,000, then 34 percent",1284.26,percent of total billed charges,Drugs,298.45,,,298.45,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2707.02,,,2707.02,Other,215% Medicaid APG methodology,2707.02,,,2707.02,Other,215% Medicaid APG methodology,1573.85,,,1573.85,Other,125% Medicaid APG methodology,0.01,2832.93,
CEFTOLOZANE/TAZOBACTAM 1.5GM INJ,J0695,HCPCS,,80002800,CDM,636,RC,67919003001,NDC,both,10,EA,193.92,72.72,,,72.72,Other,150% of Medicare + 9.63% HCRA Surcharge,44.22,,,44.22,Fee Schedule,Average Sale Price (ASP) x 6,67.87,35,,67.87,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,65.93,34,,65.93,percent of total billed charges,Drugs,65.93,34,,65.93,percent of total billed charges,Drugs,65.93,34,,65.93,percent of total billed charges,Drugs,65.93,34,,65.93,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,77.57,40,,77.57,percent of total billed charges,Drugs,135.75,70,,135.75,percent of total billed charges,All Other,69.81,36,,69.81,percent of total billed charges,Drugs,69.81,36,,69.81,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,67.87,35,,67.87,percent of total billed charges,Drugs,64.64,,,64.64,Other,Drug Cost,64.64,,,64.64,Other,Drug Cost,64.64,,,64.64,Other,Drug Cost,64.64,,,64.64,Other,Drug Cost,64.64,,,64.64,Other,Drug Cost,64.64,,,64.64,Other,Drug Cost,145.44,,,145.44,Other,225% of Medicaid,90.5,,,90.5,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,70.75,,,70.75,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",138.98,,,138.98,Other,215% Medicaid APG methodology,138.98,,,138.98,Other,215% Medicaid APG methodology,80.8,,,80.8,Other,125% Medicaid APG methodology,0.01,145.44,
ROMIDEPSIN 10MG INJ,J9319,HCPCS,,80002801,CDM,636,RC,59572098401,NDC,both,1,EA,9495.18,315.35,,,315.35,Other,150% of Medicare + 9.63% HCRA Surcharge,191.77,,,191.77,Fee Schedule,Average Sale Price (ASP) x 6,3323.31,35,,3323.31,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3228.36,34,,3228.36,percent of total billed charges,Drugs,3228.36,34,,3228.36,percent of total billed charges,Drugs,3228.36,34,,3228.36,percent of total billed charges,Drugs,3228.36,34,,3228.36,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3228.36,34,"If Charge > 500, then 34 percent",3228.36,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3798.07,40,,3798.07,percent of total billed charges,Drugs,6646.63,70,,6646.63,percent of total billed charges,All Other,3418.26,36,,3418.26,percent of total billed charges,Drugs,3418.26,36,,3418.26,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3323.31,35,,3323.31,percent of total billed charges,Drugs,3165.06,,,3165.06,Other,Drug Cost,3165.06,,,3165.06,Other,Drug Cost,3165.06,,,3165.06,Other,Drug Cost,3165.06,,,3165.06,Other,Drug Cost,3165.06,,,3165.06,Other,Drug Cost,3165.06,,,3165.06,Other,Drug Cost,7121.39,,,7121.39,Other,225% of Medicaid,4431.08,,,4431.08,Other,140% of Medicaid,3228.36,34,"If Charge > 2,000, then 34 percent",3228.36,percent of total billed charges,Drugs,306.83,,,306.83,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6804.88,,,6804.88,Other,215% Medicaid APG methodology,6804.88,,,6804.88,Other,215% Medicaid APG methodology,3956.33,,,3956.33,Other,125% Medicaid APG methodology,0.01,7121.39,
DARATUMUMAB 400MG/20ML INJECTION,J9145,HCPCS,,80002821,CDM,636,RC,57894050220,NDC,both,1,ML,8731.26,608.82,,,608.82,Other,150% of Medicare + 9.63% HCRA Surcharge,370.23,,,370.23,Fee Schedule,Average Sale Price (ASP) x 6,3055.94,35,,3055.94,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,2968.63,34,,2968.63,percent of total billed charges,Drugs,2968.63,34,,2968.63,percent of total billed charges,Drugs,2968.63,34,,2968.63,percent of total billed charges,Drugs,2968.63,34,,2968.63,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,2968.63,34,"If Charge > 500, then 34 percent",2968.63,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,3492.5,40,,3492.5,percent of total billed charges,Drugs,6111.88,70,,6111.88,percent of total billed charges,All Other,3143.25,36,,3143.25,percent of total billed charges,Drugs,3143.25,36,,3143.25,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,3055.94,35,,3055.94,percent of total billed charges,Drugs,2910.42,,,2910.42,Other,Drug Cost,2910.42,,,2910.42,Other,Drug Cost,2910.42,,,2910.42,Other,Drug Cost,2910.42,,,2910.42,Other,Drug Cost,2910.42,,,2910.42,Other,Drug Cost,2910.42,,,2910.42,Other,Drug Cost,6548.45,,,6548.45,Other,225% of Medicaid,4074.59,,,4074.59,Other,140% of Medicaid,2968.63,34,"If Charge > 2,000, then 34 percent",2968.63,percent of total billed charges,Drugs,592.37,,,592.37,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6257.4,,,6257.4,Other,215% Medicaid APG methodology,6257.4,,,6257.4,Other,215% Medicaid APG methodology,3638.03,,,3638.03,Other,125% Medicaid APG methodology,0.01,6548.45,
IRINOTECAN LIPOSOMAL 4.3MG/ML (10ML),J9205,HCPCS,,80002830,CDM,636,RC,15054004301,NDC,both,1,ML,8415.69,611.93,,,611.93,Other,150% of Medicare + 9.63% HCRA Surcharge,372.12,,,372.12,Fee Schedule,Average Sale Price (ASP) x 6,2945.49,35,,2945.49,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,2861.33,34,,2861.33,percent of total billed charges,Drugs,2861.33,34,,2861.33,percent of total billed charges,Drugs,2861.33,34,,2861.33,percent of total billed charges,Drugs,2861.33,34,,2861.33,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,2861.33,34,"If Charge > 500, then 34 percent",2861.33,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,3366.28,40,,3366.28,percent of total billed charges,Drugs,5890.98,70,,5890.98,percent of total billed charges,All Other,3029.65,36,,3029.65,percent of total billed charges,Drugs,3029.65,36,,3029.65,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,2945.49,35,,2945.49,percent of total billed charges,Drugs,2805.23,,,2805.23,Other,Drug Cost,2805.23,,,2805.23,Other,Drug Cost,2805.23,,,2805.23,Other,Drug Cost,2805.23,,,2805.23,Other,Drug Cost,2805.23,,,2805.23,Other,Drug Cost,2805.23,,,2805.23,Other,Drug Cost,6311.77,,,6311.77,Other,225% of Medicaid,3927.32,,,3927.32,Other,140% of Medicaid,2861.33,34,"If Charge > 2,000, then 34 percent",2861.33,percent of total billed charges,Drugs,595.39,,,595.39,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6031.24,,,6031.24,Other,215% Medicaid APG methodology,6031.24,,,6031.24,Other,215% Medicaid APG methodology,3506.54,,,3506.54,Other,125% Medicaid APG methodology,0.01,6311.77,
PRAXBIND 50MG/ML 50ML,C9399,HCPCS,,80002835,CDM,636,RC,597019705,NDC,both,2,ML,5137.53,2027.62,39.4668,,2027.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,1798.14,35,,1798.14,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,1746.76,34,,1746.76,percent of total billed charges,Drugs,1746.76,34,,1746.76,percent of total billed charges,Drugs,1746.76,34,,1746.76,percent of total billed charges,Drugs,1746.76,34,,1746.76,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,1746.76,34,"If Charge > 500, then 34 percent",1746.76,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,2055.01,40,,2055.01,percent of total billed charges,Drugs,3596.27,70,,3596.27,percent of total billed charges,All Other,1849.51,36,,1849.51,percent of total billed charges,Drugs,1849.51,36,,1849.51,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,1798.14,35,,1798.14,percent of total billed charges,Drugs,1712.51,,,1712.51,Other,Drug Cost,1712.51,,,1712.51,Other,Drug Cost,1712.51,,,1712.51,Other,Drug Cost,1712.51,,,1712.51,Other,Drug Cost,1712.51,,,1712.51,Other,Drug Cost,1712.51,,,1712.51,Other,Drug Cost,3853.15,,,3853.15,Other,225% of Medicaid,2397.51,,,2397.51,Other,140% of Medicaid,1746.76,34,"If Charge > 2,000, then 34 percent",1746.76,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3681.9,,,3681.9,Other,215% Medicaid APG methodology,3681.9,,,3681.9,Other,215% Medicaid APG methodology,2140.64,,,2140.64,Other,125% Medicaid APG methodology,0.01,3853.15,
DOPAMINE HCL 200MG/D5W 250ML,J1265,HCPCS,,80002838,CDM,636,RC,338100502,NDC,both,18,ML,8.67,7.62,,,7.62,Other,150% of Medicare + 9.63% HCRA Surcharge,4.63,,,4.63,Fee Schedule,Average Sale Price (ASP) x 6,3.03,35,,3.03,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,2.95,34,,2.95,percent of total billed charges,Drugs,2.95,34,,2.95,percent of total billed charges,Drugs,2.95,34,,2.95,percent of total billed charges,Drugs,2.95,34,,2.95,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,3.47,40,,3.47,percent of total billed charges,Drugs,6.07,70,,6.07,percent of total billed charges,All Other,3.12,36,,3.12,percent of total billed charges,Drugs,3.12,36,,3.12,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,3.03,35,,3.03,percent of total billed charges,Drugs,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,2.89,,,2.89,Other,Drug Cost,6.5,,,6.5,Other,225% of Medicaid,4.05,,,4.05,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.41,,,7.41,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6.21,,,6.21,Other,215% Medicaid APG methodology,6.21,,,6.21,Other,215% Medicaid APG methodology,3.61,,,3.61,Other,125% Medicaid APG methodology,0.01,7.62,
BENDAMUSTINE 25MG/ML,J9034,HCPCS,,80002840,CDM,636,RC,63459034804,NDC,both,1,ML,2806.53,145.59,,,145.59,Other,150% of Medicare + 9.63% HCRA Surcharge,88.54,,,88.54,Fee Schedule,Average Sale Price (ASP) x 6,982.29,35,,982.29,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,954.22,34,,954.22,percent of total billed charges,Drugs,954.22,34,,954.22,percent of total billed charges,Drugs,954.22,34,,954.22,percent of total billed charges,Drugs,954.22,34,,954.22,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,954.22,34,"If Charge > 500, then 34 percent",954.22,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,1122.61,40,,1122.61,percent of total billed charges,Drugs,1964.57,70,,1964.57,percent of total billed charges,All Other,1010.35,36,,1010.35,percent of total billed charges,Drugs,1010.35,36,,1010.35,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,982.29,35,,982.29,percent of total billed charges,Drugs,935.51,,,935.51,Other,Drug Cost,935.51,,,935.51,Other,Drug Cost,935.51,,,935.51,Other,Drug Cost,935.51,,,935.51,Other,Drug Cost,935.51,,,935.51,Other,Drug Cost,935.51,,,935.51,Other,Drug Cost,2104.9,,,2104.9,Other,225% of Medicaid,1309.71,,,1309.71,Other,140% of Medicaid,954.22,34,"If Charge > 2,000, then 34 percent",954.22,percent of total billed charges,Drugs,141.66,,,141.66,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2011.35,,,2011.35,Other,215% Medicaid APG methodology,2011.35,,,2011.35,Other,215% Medicaid APG methodology,1169.39,,,1169.39,Other,125% Medicaid APG methodology,0.01,2104.9,
MAGNESIUM 20GM/500ML,J3475,HCPCS,,80023640,CDM,636,RC,63323010615,NDC,both,24,ML,10.6,6.82,,,6.82,Other,150% of Medicare + 9.63% HCRA Surcharge,4.15,,,4.15,Fee Schedule,Average Sale Price (ASP) x 6,3.71,35,,3.71,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,3.6,34,,3.6,percent of total billed charges,Drugs,3.6,34,,3.6,percent of total billed charges,Drugs,3.6,34,,3.6,percent of total billed charges,Drugs,3.6,34,,3.6,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,4.24,40,,4.24,percent of total billed charges,Drugs,7.42,70,,7.42,percent of total billed charges,All Other,3.82,36,,3.82,percent of total billed charges,Drugs,3.82,36,,3.82,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,3.71,35,,3.71,percent of total billed charges,Drugs,3.53,,,3.53,Other,Drug Cost,3.53,,,3.53,Other,Drug Cost,3.53,,,3.53,Other,Drug Cost,3.53,,,3.53,Other,Drug Cost,3.53,,,3.53,Other,Drug Cost,3.53,,,3.53,Other,Drug Cost,7.95,,,7.95,Other,225% of Medicaid,4.95,,,4.95,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.63,,,6.63,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7.59,,,7.59,Other,215% Medicaid APG methodology,7.59,,,7.59,Other,215% Medicaid APG methodology,4.42,,,4.42,Other,125% Medicaid APG methodology,0.01,7.95,
CEFEPIME 1GM/ D5W50ML,J0692,HCPCS,,80023642,CDM,636,RC,264319311,NDC,both,24,EA,27.3,12.45,,,12.45,Other,150% of Medicare + 9.63% HCRA Surcharge,7.57,,,7.57,Fee Schedule,Average Sale Price (ASP) x 6,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.28,34,,9.28,percent of total billed charges,Drugs,9.28,34,,9.28,percent of total billed charges,Drugs,9.28,34,,9.28,percent of total billed charges,Drugs,9.28,34,,9.28,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,10.92,40,,10.92,percent of total billed charges,Drugs,19.11,70,,19.11,percent of total billed charges,All Other,9.83,36,,9.83,percent of total billed charges,Drugs,9.83,36,,9.83,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.56,35,,9.56,percent of total billed charges,Drugs,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,9.1,,,9.1,Other,Drug Cost,20.48,,,20.48,Other,225% of Medicaid,12.74,,,12.74,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,12.12,,,12.12,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",19.57,,,19.57,Other,215% Medicaid APG methodology,19.57,,,19.57,Other,215% Medicaid APG methodology,11.38,,,11.38,Other,125% Medicaid APG methodology,0.01,20.48,
OCTREOTIDE DEPOT 20 MG INJ,J2353,HCPCS,,80023644,CDM,636,RC,78081881,NDC,both,1,EA,12545.73,2080.19,,,2080.19,Other,150% of Medicare + 9.63% HCRA Surcharge,1264.97,,,1264.97,Fee Schedule,Average Sale Price (ASP) x 6,4391.01,35,,4391.01,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,4265.55,34,,4265.55,percent of total billed charges,Drugs,4265.55,34,,4265.55,percent of total billed charges,Drugs,4265.55,34,,4265.55,percent of total billed charges,Drugs,4265.55,34,,4265.55,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,4265.55,34,"If Charge > 500, then 34 percent",4265.55,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,5018.29,40,,5018.29,percent of total billed charges,Drugs,8782.01,70,,8782.01,percent of total billed charges,All Other,4516.46,36,,4516.46,percent of total billed charges,Drugs,4516.46,36,,4516.46,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,4391.01,35,,4391.01,percent of total billed charges,Drugs,4181.91,,,4181.91,Other,Drug Cost,4181.91,,,4181.91,Other,Drug Cost,4181.91,,,4181.91,Other,Drug Cost,4181.91,,,4181.91,Other,Drug Cost,4181.91,,,4181.91,Other,Drug Cost,4181.91,,,4181.91,Other,Drug Cost,9409.3,,,9409.3,Other,225% of Medicaid,5854.67,,,5854.67,Other,140% of Medicaid,4265.55,34,"If Charge > 2,000, then 34 percent",4265.55,percent of total billed charges,Drugs,2023.96,,,2023.96,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8991.11,,,8991.11,Other,215% Medicaid APG methodology,8991.11,,,8991.11,Other,215% Medicaid APG methodology,5227.39,,,5227.39,Other,125% Medicaid APG methodology,0.01,9409.3,
PROCAINAMIDE HCL 1GM/2ML,J2690,HCPCS,,80023645,CDM,636,RC,14789090002,NDC,both,10,ML,113.06,1443.67,,,1443.67,Other,150% of Medicare + 9.63% HCRA Surcharge,877.9,,,877.9,Fee Schedule,Average Sale Price (ASP) x 6,39.57,35,,39.57,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,38.44,34,,38.44,percent of total billed charges,Drugs,38.44,34,,38.44,percent of total billed charges,Drugs,38.44,34,,38.44,percent of total billed charges,Drugs,38.44,34,,38.44,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,45.22,40,,45.22,percent of total billed charges,Drugs,79.14,70,,79.14,percent of total billed charges,All Other,40.7,36,,40.7,percent of total billed charges,Drugs,40.7,36,,40.7,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,39.57,35,,39.57,percent of total billed charges,Drugs,37.69,,,37.69,Other,Drug Cost,37.69,,,37.69,Other,Drug Cost,37.69,,,37.69,Other,Drug Cost,37.69,,,37.69,Other,Drug Cost,37.69,,,37.69,Other,Drug Cost,37.69,,,37.69,Other,Drug Cost,84.79,,,84.79,Other,225% of Medicaid,52.76,,,52.76,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1404.64,,,1404.64,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",81.02,,,81.02,Other,215% Medicaid APG methodology,81.02,,,81.02,Other,215% Medicaid APG methodology,47.11,,,47.11,Other,125% Medicaid APG methodology,0.01,1443.67,
KEYTRUDA 25MG/ML 4ML,J9271,HCPCS,,80023648,CDM,636,RC,6302604,NDC,both,2,ML,12264.38,549.87,,,549.87,Other,150% of Medicare + 9.63% HCRA Surcharge,334.38,,,334.38,Fee Schedule,Average Sale Price (ASP) x 6,4292.53,35,,4292.53,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4169.89,34,,4169.89,percent of total billed charges,Drugs,4169.89,34,,4169.89,percent of total billed charges,Drugs,4169.89,34,,4169.89,percent of total billed charges,Drugs,4169.89,34,,4169.89,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4169.89,34,"If Charge > 500, then 34 percent",4169.89,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4905.75,40,,4905.75,percent of total billed charges,Drugs,8585.06,70,,8585.06,percent of total billed charges,All Other,4415.18,36,,4415.18,percent of total billed charges,Drugs,4415.18,36,,4415.18,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4292.53,35,,4292.53,percent of total billed charges,Drugs,4088.13,,,4088.13,Other,Drug Cost,4088.13,,,4088.13,Other,Drug Cost,4088.13,,,4088.13,Other,Drug Cost,4088.13,,,4088.13,Other,Drug Cost,4088.13,,,4088.13,Other,Drug Cost,4088.13,,,4088.13,Other,Drug Cost,9198.28,,,9198.28,Other,225% of Medicaid,5723.38,,,5723.38,Other,140% of Medicaid,4169.89,34,"If Charge > 2,000, then 34 percent",4169.89,percent of total billed charges,Drugs,535.01,,,535.01,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8789.47,,,8789.47,Other,215% Medicaid APG methodology,8789.47,,,8789.47,Other,215% Medicaid APG methodology,5110.16,,,5110.16,Other,125% Medicaid APG methodology,0.01,9198.28,
ABILIFY MAINTENA 300 MG INJECTION,J0401,HCPCS,,80023650,CDM,636,RC,59148001871,NDC,both,1,EA,2619.72,67.18,,,67.18,Other,150% of Medicare + 9.63% HCRA Surcharge,40.85,,,40.85,Fee Schedule,Average Sale Price (ASP) x 6,916.9,35,,916.9,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,890.7,34,,890.7,percent of total billed charges,Drugs,890.7,34,,890.7,percent of total billed charges,Drugs,890.7,34,,890.7,percent of total billed charges,Drugs,890.7,34,,890.7,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,890.7,34,"If Charge > 500, then 34 percent",890.7,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,1047.89,40,,1047.89,percent of total billed charges,Drugs,1833.8,70,,1833.8,percent of total billed charges,All Other,943.1,36,,943.1,percent of total billed charges,Drugs,943.1,36,,943.1,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,916.9,35,,916.9,percent of total billed charges,Drugs,873.24,,,873.24,Other,Drug Cost,873.24,,,873.24,Other,Drug Cost,873.24,,,873.24,Other,Drug Cost,873.24,,,873.24,Other,Drug Cost,873.24,,,873.24,Other,Drug Cost,873.24,,,873.24,Other,Drug Cost,1964.79,,,1964.79,Other,225% of Medicaid,1222.54,,,1222.54,Other,140% of Medicaid,890.7,34,"If Charge > 2,000, then 34 percent",890.7,percent of total billed charges,Drugs,65.37,,,65.37,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1877.47,,,1877.47,Other,215% Medicaid APG methodology,1877.47,,,1877.47,Other,215% Medicaid APG methodology,1091.55,,,1091.55,Other,125% Medicaid APG methodology,0.01,1964.79,
BUPRENORPHINE 2 MG TABLET,J0571,HCPCS,,80023653,CDM,636,RC,42858050103,NDC,both,30,EA,0.54,0.21,39.4668,,0.21,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.19,35,,0.19,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.18,34,,0.18,percent of total billed charges,Drugs,0.18,34,,0.18,percent of total billed charges,Drugs,0.18,34,,0.18,percent of total billed charges,Drugs,0.18,34,,0.18,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.21,40,,0.21,percent of total billed charges,Drugs,0.38,70,,0.38,percent of total billed charges,All Other,0.19,36,,0.19,percent of total billed charges,Drugs,0.19,36,,0.19,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.19,35,,0.19,percent of total billed charges,Drugs,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.18,,,0.18,Other,Drug Cost,0.4,,,0.4,Other,225% of Medicaid,0.25,,,0.25,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.38,,,0.38,Other,215% Medicaid APG methodology,0.38,,,0.38,Other,215% Medicaid APG methodology,0.22,,,0.22,Other,125% Medicaid APG methodology,0.01,0.4,
BUPRENORPHINE 8 MG TABLET,J0571,HCPCS,,80023654,CDM,636,RC,54017713,NDC,both,30,EA,1.23,0.48,39.4668,,0.48,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.42,34,,0.42,percent of total billed charges,Drugs,0.42,34,,0.42,percent of total billed charges,Drugs,0.42,34,,0.42,percent of total billed charges,Drugs,0.42,34,,0.42,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.49,40,,0.49,percent of total billed charges,Drugs,0.86,70,,0.86,percent of total billed charges,All Other,0.44,36,,0.44,percent of total billed charges,Drugs,0.44,36,,0.44,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.43,35,,0.43,percent of total billed charges,Drugs,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.41,,,0.41,Other,Drug Cost,0.92,,,0.92,Other,225% of Medicaid,0.57,,,0.57,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.88,,,0.88,Other,215% Medicaid APG methodology,0.88,,,0.88,Other,215% Medicaid APG methodology,0.51,,,0.51,Other,125% Medicaid APG methodology,0.01,0.92,
HYDROMORPHONE 0.5MG/0.5ML INJ,J1170,HCPCS,,80023657,CDM,636,RC,76045000906,NDC,both,10,ML,1.48,45.3,,,45.3,Other,150% of Medicare + 9.63% HCRA Surcharge,27.55,,,27.55,Fee Schedule,Average Sale Price (ASP) x 6,0.52,35,,0.52,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.5,34,,0.5,percent of total billed charges,Drugs,0.5,34,,0.5,percent of total billed charges,Drugs,0.5,34,,0.5,percent of total billed charges,Drugs,0.5,34,,0.5,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.59,40,,0.59,percent of total billed charges,Drugs,1.04,70,,1.04,percent of total billed charges,All Other,0.53,36,,0.53,percent of total billed charges,Drugs,0.53,36,,0.53,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.52,35,,0.52,percent of total billed charges,Drugs,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,0.49,,,0.49,Other,Drug Cost,1.11,,,1.11,Other,225% of Medicaid,0.69,,,0.69,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,44.07,,,44.07,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.06,,,1.06,Other,215% Medicaid APG methodology,1.06,,,1.06,Other,215% Medicaid APG methodology,0.62,,,0.62,Other,125% Medicaid APG methodology,0.01,45.3,
GAMMAGARD LIQUID 5GM,J1569,HCPCS,,80023663,CDM,636,RC,944270004,NDC,both,1,ML,930.18,435.63,,,435.63,Other,150% of Medicare + 9.63% HCRA Surcharge,264.91,,,264.91,Fee Schedule,Average Sale Price (ASP) x 6,325.56,35,,325.56,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,316.26,34,,316.26,percent of total billed charges,Drugs,316.26,34,,316.26,percent of total billed charges,Drugs,316.26,34,,316.26,percent of total billed charges,Drugs,316.26,34,,316.26,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,316.26,34,"If Charge > 500, then 34 percent",316.26,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,372.07,40,,372.07,percent of total billed charges,Drugs,651.13,70,,651.13,percent of total billed charges,All Other,334.86,36,,334.86,percent of total billed charges,Drugs,334.86,36,,334.86,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,325.56,35,,325.56,percent of total billed charges,Drugs,310.06,,,310.06,Other,Drug Cost,310.06,,,310.06,Other,Drug Cost,310.06,,,310.06,Other,Drug Cost,310.06,,,310.06,Other,Drug Cost,310.06,,,310.06,Other,Drug Cost,310.06,,,310.06,Other,Drug Cost,697.64,,,697.64,Other,225% of Medicaid,434.08,,,434.08,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,423.86,,,423.86,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",666.63,,,666.63,Other,215% Medicaid APG methodology,666.63,,,666.63,Other,215% Medicaid APG methodology,387.58,,,387.58,Other,125% Medicaid APG methodology,0.01,697.64,
MEPOLIZUMAB 100MG INJ,J2182,HCPCS,,80023664,CDM,636,RC,173088101,NDC,both,1,EA,8938.65,300.98,,,300.98,Other,150% of Medicare + 9.63% HCRA Surcharge,183.03,,,183.03,Fee Schedule,Average Sale Price (ASP) x 6,3128.53,35,,3128.53,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,3039.14,34,,3039.14,percent of total billed charges,Drugs,3039.14,34,,3039.14,percent of total billed charges,Drugs,3039.14,34,,3039.14,percent of total billed charges,Drugs,3039.14,34,,3039.14,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,3039.14,34,"If Charge > 500, then 34 percent",3039.14,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,3575.46,40,,3575.46,percent of total billed charges,Drugs,6257.06,70,,6257.06,percent of total billed charges,All Other,3217.91,36,,3217.91,percent of total billed charges,Drugs,3217.91,36,,3217.91,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,3128.53,35,,3128.53,percent of total billed charges,Drugs,2979.55,,,2979.55,Other,Drug Cost,2979.55,,,2979.55,Other,Drug Cost,2979.55,,,2979.55,Other,Drug Cost,2979.55,,,2979.55,Other,Drug Cost,2979.55,,,2979.55,Other,Drug Cost,2979.55,,,2979.55,Other,Drug Cost,6703.99,,,6703.99,Other,225% of Medicaid,4171.37,,,4171.37,Other,140% of Medicaid,3039.14,34,"If Charge > 2,000, then 34 percent",3039.14,percent of total billed charges,Drugs,292.85,,,292.85,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6406.03,,,6406.03,Other,215% Medicaid APG methodology,6406.03,,,6406.03,Other,215% Medicaid APG methodology,3724.44,,,3724.44,Other,125% Medicaid APG methodology,0.01,6703.99,
ARIPIPRAZOLE LAUROXIL 441MG INJ,J1944,HCPCS,,80023665,CDM,636,RC,65757040103,NDC,both,1,ML,2752.38,30.68,,,30.68,Other,150% of Medicare + 9.63% HCRA Surcharge,18.65,,,18.65,Fee Schedule,Average Sale Price (ASP) x 6,963.33,35,,963.33,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,935.81,34,,935.81,percent of total billed charges,Drugs,935.81,34,,935.81,percent of total billed charges,Drugs,935.81,34,,935.81,percent of total billed charges,Drugs,935.81,34,,935.81,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,935.81,34,"If Charge > 500, then 34 percent",935.81,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,1100.95,40,,1100.95,percent of total billed charges,Drugs,1926.67,70,,1926.67,percent of total billed charges,All Other,990.86,36,,990.86,percent of total billed charges,Drugs,990.86,36,,990.86,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,963.33,35,,963.33,percent of total billed charges,Drugs,917.46,,,917.46,Other,Drug Cost,917.46,,,917.46,Other,Drug Cost,917.46,,,917.46,Other,Drug Cost,917.46,,,917.46,Other,Drug Cost,917.46,,,917.46,Other,Drug Cost,917.46,,,917.46,Other,Drug Cost,2064.29,,,2064.29,Other,225% of Medicaid,1284.44,,,1284.44,Other,140% of Medicaid,935.81,34,"If Charge > 2,000, then 34 percent",935.81,percent of total billed charges,Drugs,29.85,,,29.85,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1972.54,,,1972.54,Other,215% Medicaid APG methodology,1972.54,,,1972.54,Other,215% Medicaid APG methodology,1146.83,,,1146.83,Other,125% Medicaid APG methodology,0.01,2064.29,
ARIPIPRAZOLE LAUROXIL 662MG INJ,J1944,HCPCS,,80023666,CDM,636,RC,65757040203,NDC,both,1,ML,4114.08,30.68,,,30.68,Other,150% of Medicare + 9.63% HCRA Surcharge,18.65,,,18.65,Fee Schedule,Average Sale Price (ASP) x 6,1439.93,35,,1439.93,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1398.79,34,,1398.79,percent of total billed charges,Drugs,1398.79,34,,1398.79,percent of total billed charges,Drugs,1398.79,34,,1398.79,percent of total billed charges,Drugs,1398.79,34,,1398.79,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1398.79,34,"If Charge > 500, then 34 percent",1398.79,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1645.63,40,,1645.63,percent of total billed charges,Drugs,2879.86,70,,2879.86,percent of total billed charges,All Other,1481.07,36,,1481.07,percent of total billed charges,Drugs,1481.07,36,,1481.07,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1439.93,35,,1439.93,percent of total billed charges,Drugs,1371.36,,,1371.36,Other,Drug Cost,1371.36,,,1371.36,Other,Drug Cost,1371.36,,,1371.36,Other,Drug Cost,1371.36,,,1371.36,Other,Drug Cost,1371.36,,,1371.36,Other,Drug Cost,1371.36,,,1371.36,Other,Drug Cost,3085.56,,,3085.56,Other,225% of Medicaid,1919.9,,,1919.9,Other,140% of Medicaid,1398.79,34,"If Charge > 2,000, then 34 percent",1398.79,percent of total billed charges,Drugs,29.85,,,29.85,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2948.42,,,2948.42,Other,215% Medicaid APG methodology,2948.42,,,2948.42,Other,215% Medicaid APG methodology,1714.2,,,1714.2,Other,125% Medicaid APG methodology,0.01,3085.56,
ARIPIPRAZOLE LAUROXIL 882MG INJ,J1944,HCPCS,,80023667,CDM,636,RC,65757040303,NDC,both,1,ML,5469.69,30.68,,,30.68,Other,150% of Medicare + 9.63% HCRA Surcharge,18.65,,,18.65,Fee Schedule,Average Sale Price (ASP) x 6,1914.39,35,,1914.39,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,1859.69,34,,1859.69,percent of total billed charges,Drugs,1859.69,34,,1859.69,percent of total billed charges,Drugs,1859.69,34,,1859.69,percent of total billed charges,Drugs,1859.69,34,,1859.69,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,1859.69,34,"If Charge > 500, then 34 percent",1859.69,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,2187.88,40,,2187.88,percent of total billed charges,Drugs,3828.78,70,,3828.78,percent of total billed charges,All Other,1969.09,36,,1969.09,percent of total billed charges,Drugs,1969.09,36,,1969.09,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,1914.39,35,,1914.39,percent of total billed charges,Drugs,1823.23,,,1823.23,Other,Drug Cost,1823.23,,,1823.23,Other,Drug Cost,1823.23,,,1823.23,Other,Drug Cost,1823.23,,,1823.23,Other,Drug Cost,1823.23,,,1823.23,Other,Drug Cost,1823.23,,,1823.23,Other,Drug Cost,4102.27,,,4102.27,Other,225% of Medicaid,2552.52,,,2552.52,Other,140% of Medicaid,1859.69,34,"If Charge > 2,000, then 34 percent",1859.69,percent of total billed charges,Drugs,29.85,,,29.85,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3919.94,,,3919.94,Other,215% Medicaid APG methodology,3919.94,,,3919.94,Other,215% Medicaid APG methodology,2279.04,,,2279.04,Other,125% Medicaid APG methodology,0.01,4102.27,
ATEZOLIZUMAB 1200MG/20ML,J9022,HCPCS,,80023669,CDM,636,RC,50242091701,NDC,both,1,ML,32428.17,838.78,,,838.78,Other,150% of Medicare + 9.63% HCRA Surcharge,510.07,,,510.07,Fee Schedule,Average Sale Price (ASP) x 6,11349.86,35,,11349.86,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,11025.58,34,,11025.58,percent of total billed charges,Drugs,11025.58,34,,11025.58,percent of total billed charges,Drugs,11025.58,34,,11025.58,percent of total billed charges,Drugs,11025.58,34,,11025.58,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,11025.58,34,"If Charge > 500, then 34 percent",11025.58,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,12971.27,40,,12971.27,percent of total billed charges,Drugs,22699.72,70,,22699.72,percent of total billed charges,All Other,11674.14,36,,11674.14,percent of total billed charges,Drugs,11674.14,36,,11674.14,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,11349.86,35,,11349.86,percent of total billed charges,Drugs,10809.39,,,10809.39,Other,Drug Cost,10809.39,,,10809.39,Other,Drug Cost,10809.39,,,10809.39,Other,Drug Cost,10809.39,,,10809.39,Other,Drug Cost,10809.39,,,10809.39,Other,Drug Cost,10809.39,,,10809.39,Other,Drug Cost,24321.13,,,24321.13,Other,225% of Medicaid,15133.15,,,15133.15,Other,140% of Medicaid,11025.58,34,"If Charge > 2,000, then 34 percent",11025.58,percent of total billed charges,Drugs,816.11,,,816.11,Other,160% Medicare Fee Schedule,11025.58,34,,11025.58,Other,"Drug Charges > 20,000, then 34% of Charges",23240.19,,,23240.19,Other,215% Medicaid APG methodology,23240.19,,,23240.19,Other,215% Medicaid APG methodology,13511.74,,,13511.74,Other,125% Medicaid APG methodology,510.07,24321.13,
MAGNESIUM SULFATE 4G/100ML,J3475,HCPCS,,80023671,CDM,636,RC,63323010601,NDC,both,24,ML,6.54,6.82,,,6.82,Other,150% of Medicare + 9.63% HCRA Surcharge,4.15,,,4.15,Fee Schedule,Average Sale Price (ASP) x 6,2.29,35,,2.29,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,2.22,34,,2.22,percent of total billed charges,Drugs,2.22,34,,2.22,percent of total billed charges,Drugs,2.22,34,,2.22,percent of total billed charges,Drugs,2.22,34,,2.22,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,2.61,40,,2.61,percent of total billed charges,Drugs,4.58,70,,4.58,percent of total billed charges,All Other,2.35,36,,2.35,percent of total billed charges,Drugs,2.35,36,,2.35,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,2.29,35,,2.29,percent of total billed charges,Drugs,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,2.18,,,2.18,Other,Drug Cost,4.9,,,4.9,Other,225% of Medicaid,3.05,,,3.05,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,6.63,,,6.63,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.68,,,4.68,Other,215% Medicaid APG methodology,4.68,,,4.68,Other,215% Medicaid APG methodology,2.72,,,2.72,Other,125% Medicaid APG methodology,0.01,6.82,
HEMIN 350MG,J1640,HCPCS,,80023673,CDM,636,RC,55292070255,NDC,both,1,EA,19762.83,309.3,,,309.3,Other,150% of Medicare + 9.63% HCRA Surcharge,188.09,,,188.09,Fee Schedule,Average Sale Price (ASP) x 6,6916.99,35,,6916.99,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,6719.36,34,,6719.36,percent of total billed charges,Drugs,6719.36,34,,6719.36,percent of total billed charges,Drugs,6719.36,34,,6719.36,percent of total billed charges,Drugs,6719.36,34,,6719.36,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,6719.36,34,"If Charge > 500, then 34 percent",6719.36,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,7905.13,40,,7905.13,percent of total billed charges,Drugs,13833.98,70,,13833.98,percent of total billed charges,All Other,7114.62,36,,7114.62,percent of total billed charges,Drugs,7114.62,36,,7114.62,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,6916.99,35,,6916.99,percent of total billed charges,Drugs,6587.61,,,6587.61,Other,Drug Cost,6587.61,,,6587.61,Other,Drug Cost,6587.61,,,6587.61,Other,Drug Cost,6587.61,,,6587.61,Other,Drug Cost,6587.61,,,6587.61,Other,Drug Cost,6587.61,,,6587.61,Other,Drug Cost,14822.12,,,14822.12,Other,225% of Medicaid,9222.65,,,9222.65,Other,140% of Medicaid,6719.36,34,"If Charge > 2,000, then 34 percent",6719.36,percent of total billed charges,Drugs,300.94,,,300.94,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",14163.36,,,14163.36,Other,215% Medicaid APG methodology,14163.36,,,14163.36,Other,215% Medicaid APG methodology,8234.51,,,8234.51,Other,125% Medicaid APG methodology,0.01,14822.12,
HERCEPTIN 150MG,J9355,HCPCS,,80023674,CDM,636,RC,50242013201,NDC,both,1,EA,4626.18,793.92,,,793.92,Other,150% of Medicare + 9.63% HCRA Surcharge,482.79,,,482.79,Fee Schedule,Average Sale Price (ASP) x 6,1619.16,35,,1619.16,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1572.9,34,,1572.9,percent of total billed charges,Drugs,1572.9,34,,1572.9,percent of total billed charges,Drugs,1572.9,34,,1572.9,percent of total billed charges,Drugs,1572.9,34,,1572.9,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1572.9,34,"If Charge > 500, then 34 percent",1572.9,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1850.47,40,,1850.47,percent of total billed charges,Drugs,3238.33,70,,3238.33,percent of total billed charges,All Other,1665.42,36,,1665.42,percent of total billed charges,Drugs,1665.42,36,,1665.42,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1619.16,35,,1619.16,percent of total billed charges,Drugs,1542.06,,,1542.06,Other,Drug Cost,1542.06,,,1542.06,Other,Drug Cost,1542.06,,,1542.06,Other,Drug Cost,1542.06,,,1542.06,Other,Drug Cost,1542.06,,,1542.06,Other,Drug Cost,1542.06,,,1542.06,Other,Drug Cost,3469.64,,,3469.64,Other,225% of Medicaid,2158.88,,,2158.88,Other,140% of Medicaid,1572.9,34,"If Charge > 2,000, then 34 percent",1572.9,percent of total billed charges,Drugs,772.46,,,772.46,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3315.43,,,3315.43,Other,215% Medicaid APG methodology,3315.43,,,3315.43,Other,215% Medicaid APG methodology,1927.58,,,1927.58,Other,125% Medicaid APG methodology,0.01,3469.64,
DALBAVANCIN 500MG INJ,J0875,HCPCS,,80023679,CDM,636,RC,57970010001,NDC,both,1,EA,2174.16,150.89,,,150.89,Other,150% of Medicare + 9.63% HCRA Surcharge,91.76,,,91.76,Fee Schedule,Average Sale Price (ASP) x 6,760.96,35,,760.96,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,739.21,34,,739.21,percent of total billed charges,Drugs,739.21,34,,739.21,percent of total billed charges,Drugs,739.21,34,,739.21,percent of total billed charges,Drugs,739.21,34,,739.21,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,739.21,34,"If Charge > 500, then 34 percent",739.21,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,869.66,40,,869.66,percent of total billed charges,Drugs,1521.91,70,,1521.91,percent of total billed charges,All Other,782.7,36,,782.7,percent of total billed charges,Drugs,782.7,36,,782.7,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,760.96,35,,760.96,percent of total billed charges,Drugs,724.72,,,724.72,Other,Drug Cost,724.72,,,724.72,Other,Drug Cost,724.72,,,724.72,Other,Drug Cost,724.72,,,724.72,Other,Drug Cost,724.72,,,724.72,Other,Drug Cost,724.72,,,724.72,Other,Drug Cost,1630.62,,,1630.62,Other,225% of Medicaid,1014.61,,,1014.61,Other,140% of Medicaid,739.21,34,"If Charge > 2,000, then 34 percent",739.21,percent of total billed charges,Drugs,146.81,,,146.81,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1558.15,,,1558.15,Other,215% Medicaid APG methodology,1558.15,,,1558.15,Other,215% Medicaid APG methodology,905.9,,,905.9,Other,125% Medicaid APG methodology,0.01,1630.62,
DURVALUMAB 50 MG/ML 2.4ML,J9173,HCPCS,,80023766,CDM,636,RC,310450012,NDC,both,1,ML,2940.9,796.3,,,796.3,Other,150% of Medicare + 9.63% HCRA Surcharge,484.24,,,484.24,Fee Schedule,Average Sale Price (ASP) x 6,1029.32,35,,1029.32,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,999.91,34,,999.91,percent of total billed charges,Drugs,999.91,34,,999.91,percent of total billed charges,Drugs,999.91,34,,999.91,percent of total billed charges,Drugs,999.91,34,,999.91,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,999.91,34,"If Charge > 500, then 34 percent",999.91,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,1176.36,40,,1176.36,percent of total billed charges,Drugs,2058.63,70,,2058.63,percent of total billed charges,All Other,1058.72,36,,1058.72,percent of total billed charges,Drugs,1058.72,36,,1058.72,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,1029.32,35,,1029.32,percent of total billed charges,Drugs,980.3,,,980.3,Other,Drug Cost,980.3,,,980.3,Other,Drug Cost,980.3,,,980.3,Other,Drug Cost,980.3,,,980.3,Other,Drug Cost,980.3,,,980.3,Other,Drug Cost,980.3,,,980.3,Other,Drug Cost,2205.68,,,2205.68,Other,225% of Medicaid,1372.42,,,1372.42,Other,140% of Medicaid,999.91,34,"If Charge > 2,000, then 34 percent",999.91,percent of total billed charges,Drugs,774.78,,,774.78,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2107.65,,,2107.65,Other,215% Medicaid APG methodology,2107.65,,,2107.65,Other,215% Medicaid APG methodology,1225.38,,,1225.38,Other,125% Medicaid APG methodology,0.01,2205.68,
BENRALIZUMAB 30MG/1ML INJ,J0517,HCPCS,,80023778,CDM,636,RC,310173030,NDC,both,1,ML,10918.23,1672.42,,,1672.42,Other,150% of Medicare + 9.63% HCRA Surcharge,1017.01,,,1017.01,Fee Schedule,Average Sale Price (ASP) x 6,3821.38,35,,3821.38,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,3712.2,34,,3712.2,percent of total billed charges,Drugs,3712.2,34,,3712.2,percent of total billed charges,Drugs,3712.2,34,,3712.2,percent of total billed charges,Drugs,3712.2,34,,3712.2,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,3712.2,34,"If Charge > 500, then 34 percent",3712.2,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,4367.29,40,,4367.29,percent of total billed charges,Drugs,7642.76,70,,7642.76,percent of total billed charges,All Other,3930.56,36,,3930.56,percent of total billed charges,Drugs,3930.56,36,,3930.56,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,3821.38,35,,3821.38,percent of total billed charges,Drugs,3639.41,,,3639.41,Other,Drug Cost,3639.41,,,3639.41,Other,Drug Cost,3639.41,,,3639.41,Other,Drug Cost,3639.41,,,3639.41,Other,Drug Cost,3639.41,,,3639.41,Other,Drug Cost,3639.41,,,3639.41,Other,Drug Cost,8188.67,,,8188.67,Other,225% of Medicaid,5095.17,,,5095.17,Other,140% of Medicaid,3712.2,34,"If Charge > 2,000, then 34 percent",3712.2,percent of total billed charges,Drugs,1627.21,,,1627.21,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7824.73,,,7824.73,Other,215% Medicaid APG methodology,7824.73,,,7824.73,Other,215% Medicaid APG methodology,4549.26,,,4549.26,Other,125% Medicaid APG methodology,0.01,8188.67,
ETELCALCETIDE 2.5MG/0.5ML,J0606,HCPCS,,80023809,CDM,636,RC,55513074010,NDC,both,10,ML,268.49,105.96,39.4668,,105.96,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,93.97,35,,93.97,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,91.28,34,,91.28,percent of total billed charges,Drugs,91.28,34,,91.28,percent of total billed charges,Drugs,91.28,34,,91.28,percent of total billed charges,Drugs,91.28,34,,91.28,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,107.39,40,,107.39,percent of total billed charges,Drugs,187.94,70,,187.94,percent of total billed charges,All Other,96.65,36,,96.65,percent of total billed charges,Drugs,96.65,36,,96.65,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,93.97,35,,93.97,percent of total billed charges,Drugs,89.5,,,89.5,Other,Drug Cost,89.5,,,89.5,Other,Drug Cost,89.5,,,89.5,Other,Drug Cost,89.5,,,89.5,Other,Drug Cost,89.5,,,89.5,Other,Drug Cost,89.5,,,89.5,Other,Drug Cost,201.36,,,201.36,Other,225% of Medicaid,125.29,,,125.29,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",192.41,,,192.41,Other,215% Medicaid APG methodology,192.41,,,192.41,Other,215% Medicaid APG methodology,111.87,,,111.87,Other,125% Medicaid APG methodology,0.01,201.36,
ETELCALCETIDE 5MG/ML,J0606,HCPCS,,80023810,CDM,636,RC,55513074110,NDC,both,10,ML,536.98,211.93,39.4668,,211.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,187.94,35,,187.94,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,182.57,34,,182.57,percent of total billed charges,Drugs,182.57,34,,182.57,percent of total billed charges,Drugs,182.57,34,,182.57,percent of total billed charges,Drugs,182.57,34,,182.57,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,182.57,34,"If Charge > 500, then 34 percent",182.57,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,214.79,40,,214.79,percent of total billed charges,Drugs,375.88,70,,375.88,percent of total billed charges,All Other,193.31,36,,193.31,percent of total billed charges,Drugs,193.31,36,,193.31,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,187.94,35,,187.94,percent of total billed charges,Drugs,178.99,,,178.99,Other,Drug Cost,178.99,,,178.99,Other,Drug Cost,178.99,,,178.99,Other,Drug Cost,178.99,,,178.99,Other,Drug Cost,178.99,,,178.99,Other,Drug Cost,178.99,,,178.99,Other,Drug Cost,402.73,,,402.73,Other,225% of Medicaid,250.59,,,250.59,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",384.83,,,384.83,Other,215% Medicaid APG methodology,384.83,,,384.83,Other,215% Medicaid APG methodology,223.74,,,223.74,Other,125% Medicaid APG methodology,0.01,402.73,
ETELCALCETIDE 10MG/2ML,J0606,HCPCS,,80023811,CDM,636,RC,55513074210,NDC,both,10,ML,1073.95,423.85,39.4668,,423.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,375.88,35,,375.88,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,365.14,34,,365.14,percent of total billed charges,Drugs,365.14,34,,365.14,percent of total billed charges,Drugs,365.14,34,,365.14,percent of total billed charges,Drugs,365.14,34,,365.14,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,365.14,34,"If Charge > 500, then 34 percent",365.14,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,429.58,40,,429.58,percent of total billed charges,Drugs,751.77,70,,751.77,percent of total billed charges,All Other,386.62,36,,386.62,percent of total billed charges,Drugs,386.62,36,,386.62,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,375.88,35,,375.88,percent of total billed charges,Drugs,357.98,,,357.98,Other,Drug Cost,357.98,,,357.98,Other,Drug Cost,357.98,,,357.98,Other,Drug Cost,357.98,,,357.98,Other,Drug Cost,357.98,,,357.98,Other,Drug Cost,357.98,,,357.98,Other,Drug Cost,805.46,,,805.46,Other,225% of Medicaid,501.18,,,501.18,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",769.67,,,769.67,Other,215% Medicaid APG methodology,769.67,,,769.67,Other,215% Medicaid APG methodology,447.48,,,447.48,Other,125% Medicaid APG methodology,0.01,805.46,
OBINUTUZUMAB 25MG/ML 40 ML,J9301,HCPCS,,80023814,CDM,636,RC,50242007001,NDC,both,1,ML,24465.9,694.04,,,694.04,Other,150% of Medicare + 9.63% HCRA Surcharge,422.05,,,422.05,Fee Schedule,Average Sale Price (ASP) x 6,8563.07,35,,8563.07,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,8318.41,34,,8318.41,percent of total billed charges,Drugs,8318.41,34,,8318.41,percent of total billed charges,Drugs,8318.41,34,,8318.41,percent of total billed charges,Drugs,8318.41,34,,8318.41,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,8318.41,34,"If Charge > 500, then 34 percent",8318.41,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,9786.36,40,,9786.36,percent of total billed charges,Drugs,17126.13,70,,17126.13,percent of total billed charges,All Other,8807.72,36,,8807.72,percent of total billed charges,Drugs,8807.72,36,,8807.72,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,8563.07,35,,8563.07,percent of total billed charges,Drugs,8155.3,,,8155.3,Other,Drug Cost,8155.3,,,8155.3,Other,Drug Cost,8155.3,,,8155.3,Other,Drug Cost,8155.3,,,8155.3,Other,Drug Cost,8155.3,,,8155.3,Other,Drug Cost,8155.3,,,8155.3,Other,Drug Cost,18349.43,,,18349.43,Other,225% of Medicaid,11417.42,,,11417.42,Other,140% of Medicaid,8318.41,34,"If Charge > 2,000, then 34 percent",8318.41,percent of total billed charges,Drugs,675.28,,,675.28,Other,160% Medicare Fee Schedule,8318.41,34,,8318.41,Other,"Drug Charges > 20,000, then 34% of Charges",17533.9,,,17533.9,Other,215% Medicaid APG methodology,17533.9,,,17533.9,Other,215% Medicaid APG methodology,10194.13,,,10194.13,Other,125% Medicaid APG methodology,422.05,18349.43,
CAFFEINE CITRATE 60 MG/ 3 ML,J0706,HCPCS,,80023830,CDM,636,RC,51754050001,NDC,both,1,ML,17.25,6.81,39.4668,,6.81,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,6.04,35,,6.04,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,5.87,34,,5.87,percent of total billed charges,Drugs,5.87,34,,5.87,percent of total billed charges,Drugs,5.87,34,,5.87,percent of total billed charges,Drugs,5.87,34,,5.87,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,6.9,40,,6.9,percent of total billed charges,Drugs,12.08,70,,12.08,percent of total billed charges,All Other,6.21,36,,6.21,percent of total billed charges,Drugs,6.21,36,,6.21,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,6.04,35,,6.04,percent of total billed charges,Drugs,5.75,,,5.75,Other,Drug Cost,5.75,,,5.75,Other,Drug Cost,5.75,,,5.75,Other,Drug Cost,5.75,,,5.75,Other,Drug Cost,5.75,,,5.75,Other,Drug Cost,5.75,,,5.75,Other,Drug Cost,12.94,,,12.94,Other,225% of Medicaid,8.05,,,8.05,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",12.36,,,12.36,Other,215% Medicaid APG methodology,12.36,,,12.36,Other,215% Medicaid APG methodology,7.19,,,7.19,Other,125% Medicaid APG methodology,0.01,12.94,
ARIPIPRAZOLE LAUROXIL 675MG/2.4ML ER INJ,J1943,HCPCS,,80023835,CDM,636,RC,65757050003,NDC,both,1,ML,4350.09,30.5,,,30.5,Other,150% of Medicare + 9.63% HCRA Surcharge,18.55,,,18.55,Fee Schedule,Average Sale Price (ASP) x 6,1522.53,35,,1522.53,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1479.03,34,,1479.03,percent of total billed charges,Drugs,1479.03,34,,1479.03,percent of total billed charges,Drugs,1479.03,34,,1479.03,percent of total billed charges,Drugs,1479.03,34,,1479.03,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1479.03,34,"If Charge > 500, then 34 percent",1479.03,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1740.04,40,,1740.04,percent of total billed charges,Drugs,3045.06,70,,3045.06,percent of total billed charges,All Other,1566.03,36,,1566.03,percent of total billed charges,Drugs,1566.03,36,,1566.03,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1522.53,35,,1522.53,percent of total billed charges,Drugs,1450.03,,,1450.03,Other,Drug Cost,1450.03,,,1450.03,Other,Drug Cost,1450.03,,,1450.03,Other,Drug Cost,1450.03,,,1450.03,Other,Drug Cost,1450.03,,,1450.03,Other,Drug Cost,1450.03,,,1450.03,Other,Drug Cost,3262.57,,,3262.57,Other,225% of Medicaid,2030.04,,,2030.04,Other,140% of Medicaid,1479.03,34,"If Charge > 2,000, then 34 percent",1479.03,percent of total billed charges,Drugs,29.67,,,29.67,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3117.56,,,3117.56,Other,215% Medicaid APG methodology,3117.56,,,3117.56,Other,215% Medicaid APG methodology,1812.54,,,1812.54,Other,125% Medicaid APG methodology,0.01,3262.57,
OCRELIZUMAB 300MG/10ML INJ,J2350,HCPCS,,80023836,CDM,636,RC,50242015001,NDC,both,1,ML,39308.07,589.55,,,589.55,Other,150% of Medicare + 9.63% HCRA Surcharge,358.51,,,358.51,Fee Schedule,Average Sale Price (ASP) x 6,13757.82,35,,13757.82,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,13364.74,34,,13364.74,percent of total billed charges,Drugs,13364.74,34,,13364.74,percent of total billed charges,Drugs,13364.74,34,,13364.74,percent of total billed charges,Drugs,13364.74,34,,13364.74,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,13364.74,34,"If Charge > 500, then 34 percent",13364.74,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,15723.23,40,,15723.23,percent of total billed charges,Drugs,27515.65,70,,27515.65,percent of total billed charges,All Other,14150.91,36,,14150.91,percent of total billed charges,Drugs,14150.91,36,,14150.91,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,13757.82,35,,13757.82,percent of total billed charges,Drugs,13102.69,,,13102.69,Other,Drug Cost,13102.69,,,13102.69,Other,Drug Cost,13102.69,,,13102.69,Other,Drug Cost,13102.69,,,13102.69,Other,Drug Cost,13102.69,,,13102.69,Other,Drug Cost,13102.69,,,13102.69,Other,Drug Cost,29481.05,,,29481.05,Other,225% of Medicaid,18343.77,,,18343.77,Other,140% of Medicaid,13364.74,34,"If Charge > 2,000, then 34 percent",13364.74,percent of total billed charges,Drugs,573.61,,,573.61,Other,160% Medicare Fee Schedule,13364.74,34,,13364.74,Other,"Drug Charges > 20,000, then 34% of Charges",28170.78,,,28170.78,Other,215% Medicaid APG methodology,28170.78,,,28170.78,Other,215% Medicaid APG methodology,16378.36,,,16378.36,Other,125% Medicaid APG methodology,358.51,29481.05,
FILGRASTIM-SNDZ 300 MCG/0.5ML,Q5101,HCPCS,,80023837,CDM,636,RC,61314031801,NDC,both,1,ML,225,3.15,,,3.15,Other,150% of Medicare + 9.63% HCRA Surcharge,1.91,,,1.91,Fee Schedule,Average Sale Price (ASP) x 6,78.75,35,,78.75,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,76.5,34,,76.5,percent of total billed charges,Drugs,76.5,34,,76.5,percent of total billed charges,Drugs,76.5,34,,76.5,percent of total billed charges,Drugs,76.5,34,,76.5,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,90,40,,90,percent of total billed charges,Drugs,157.5,70,,157.5,percent of total billed charges,All Other,81,36,,81,percent of total billed charges,Drugs,81,36,,81,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,78.75,35,,78.75,percent of total billed charges,Drugs,75,,,75,Other,Drug Cost,75,,,75,Other,Drug Cost,75,,,75,Other,Drug Cost,75,,,75,Other,Drug Cost,75,,,75,Other,Drug Cost,75,,,75,Other,Drug Cost,168.75,,,168.75,Other,225% of Medicaid,105,,,105,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,3.06,,,3.06,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",161.25,,,161.25,Other,215% Medicaid APG methodology,161.25,,,161.25,Other,215% Medicaid APG methodology,93.75,,,93.75,Other,125% Medicaid APG methodology,0.01,168.75,
FILGRASTIM-SNDZ 480 MCG/ 0.8ML,Q5101,HCPCS,,80023838,CDM,636,RC,61314032601,NDC,both,1,ML,344.43,3.15,,,3.15,Other,150% of Medicare + 9.63% HCRA Surcharge,1.91,,,1.91,Fee Schedule,Average Sale Price (ASP) x 6,120.55,35,,120.55,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,117.11,34,,117.11,percent of total billed charges,Drugs,117.11,34,,117.11,percent of total billed charges,Drugs,117.11,34,,117.11,percent of total billed charges,Drugs,117.11,34,,117.11,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,137.77,40,,137.77,percent of total billed charges,Drugs,241.1,70,,241.1,percent of total billed charges,All Other,123.99,36,,123.99,percent of total billed charges,Drugs,123.99,36,,123.99,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,120.55,35,,120.55,percent of total billed charges,Drugs,114.81,,,114.81,Other,Drug Cost,114.81,,,114.81,Other,Drug Cost,114.81,,,114.81,Other,Drug Cost,114.81,,,114.81,Other,Drug Cost,114.81,,,114.81,Other,Drug Cost,114.81,,,114.81,Other,Drug Cost,258.32,,,258.32,Other,225% of Medicaid,160.73,,,160.73,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,3.06,,,3.06,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",246.84,,,246.84,Other,215% Medicaid APG methodology,246.84,,,246.84,Other,215% Medicaid APG methodology,143.51,,,143.51,Other,125% Medicaid APG methodology,0.01,258.32,
OCTAGAM 10% 5 GM LIQUID,J1568,HCPCS,,80023839,CDM,636,RC,68982085002,NDC,both,1,ML,951.15,443.78,,,443.78,Other,150% of Medicare + 9.63% HCRA Surcharge,269.87,,,269.87,Fee Schedule,Average Sale Price (ASP) x 6,332.9,35,,332.9,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,323.39,34,,323.39,percent of total billed charges,Drugs,323.39,34,,323.39,percent of total billed charges,Drugs,323.39,34,,323.39,percent of total billed charges,Drugs,323.39,34,,323.39,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,323.39,34,"If Charge > 500, then 34 percent",323.39,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,380.46,40,,380.46,percent of total billed charges,Drugs,665.81,70,,665.81,percent of total billed charges,All Other,342.41,36,,342.41,percent of total billed charges,Drugs,342.41,36,,342.41,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,332.9,35,,332.9,percent of total billed charges,Drugs,317.05,,,317.05,Other,Drug Cost,317.05,,,317.05,Other,Drug Cost,317.05,,,317.05,Other,Drug Cost,317.05,,,317.05,Other,Drug Cost,317.05,,,317.05,Other,Drug Cost,317.05,,,317.05,Other,Drug Cost,713.36,,,713.36,Other,225% of Medicaid,443.87,,,443.87,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,431.79,,,431.79,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",681.66,,,681.66,Other,215% Medicaid APG methodology,681.66,,,681.66,Other,215% Medicaid APG methodology,396.31,,,396.31,Other,125% Medicaid APG methodology,0.01,713.36,
BELATACEPT 250MG INJ,J0485,HCPCS,,80023854,CDM,636,RC,3037113,NDC,both,1,EA,2879.1,38.22,,,38.22,Other,150% of Medicare + 9.63% HCRA Surcharge,23.24,,,23.24,Fee Schedule,Average Sale Price (ASP) x 6,1007.69,35,,1007.69,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,978.89,34,,978.89,percent of total billed charges,Drugs,978.89,34,,978.89,percent of total billed charges,Drugs,978.89,34,,978.89,percent of total billed charges,Drugs,978.89,34,,978.89,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,978.89,34,"If Charge > 500, then 34 percent",978.89,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,1151.64,40,,1151.64,percent of total billed charges,Drugs,2015.37,70,,2015.37,percent of total billed charges,All Other,1036.48,36,,1036.48,percent of total billed charges,Drugs,1036.48,36,,1036.48,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,1007.69,35,,1007.69,percent of total billed charges,Drugs,959.7,,,959.7,Other,Drug Cost,959.7,,,959.7,Other,Drug Cost,959.7,,,959.7,Other,Drug Cost,959.7,,,959.7,Other,Drug Cost,959.7,,,959.7,Other,Drug Cost,959.7,,,959.7,Other,Drug Cost,2159.33,,,2159.33,Other,225% of Medicaid,1343.58,,,1343.58,Other,140% of Medicaid,978.89,34,"If Charge > 2,000, then 34 percent",978.89,percent of total billed charges,Drugs,37.19,,,37.19,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2063.36,,,2063.36,Other,215% Medicaid APG methodology,2063.36,,,2063.36,Other,215% Medicaid APG methodology,1199.63,,,1199.63,Other,125% Medicaid APG methodology,0.01,2159.33,
IGG - HYALURONIDASE 5GM,J1575,HCPCS,,80023860,CDM,636,RC,944251102,NDC,both,1,ML,1492.8,168.57,,,168.57,Other,150% of Medicare + 9.63% HCRA Surcharge,102.51,,,102.51,Fee Schedule,Average Sale Price (ASP) x 6,522.48,35,,522.48,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,507.55,34,,507.55,percent of total billed charges,Drugs,507.55,34,,507.55,percent of total billed charges,Drugs,507.55,34,,507.55,percent of total billed charges,Drugs,507.55,34,,507.55,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,507.55,34,"If Charge > 500, then 34 percent",507.55,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,597.12,40,,597.12,percent of total billed charges,Drugs,1044.96,70,,1044.96,percent of total billed charges,All Other,537.41,36,,537.41,percent of total billed charges,Drugs,537.41,36,,537.41,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,522.48,35,,522.48,percent of total billed charges,Drugs,497.6,,,497.6,Other,Drug Cost,497.6,,,497.6,Other,Drug Cost,497.6,,,497.6,Other,Drug Cost,497.6,,,497.6,Other,Drug Cost,497.6,,,497.6,Other,Drug Cost,497.6,,,497.6,Other,Drug Cost,1119.6,,,1119.6,Other,225% of Medicaid,696.64,,,696.64,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,164.02,,,164.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1069.84,,,1069.84,Other,215% Medicaid APG methodology,1069.84,,,1069.84,Other,215% Medicaid APG methodology,622,,,622,Other,125% Medicaid APG methodology,0.01,1119.6,
CYCLOPHOSPHAMIDE 25MG CAPS,J8530,HCPCS,,80023866,CDM,636,RC,54038225,NDC,both,100,EA,2.6,6.1,,,6.1,Other,150% of Medicare + 9.63% HCRA Surcharge,3.71,,,3.71,Fee Schedule,Average Sale Price (ASP) x 6,0.91,35,,0.91,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,0.88,34,,0.88,percent of total billed charges,Drugs,0.88,34,,0.88,percent of total billed charges,Drugs,0.88,34,,0.88,percent of total billed charges,Drugs,0.88,34,,0.88,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,1.04,40,,1.04,percent of total billed charges,Drugs,1.82,70,,1.82,percent of total billed charges,All Other,0.93,36,,0.93,percent of total billed charges,Drugs,0.93,36,,0.93,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,0.91,35,,0.91,percent of total billed charges,Drugs,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,0.87,,,0.87,Other,Drug Cost,1.95,,,1.95,Other,225% of Medicaid,1.21,,,1.21,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,5.93,,,5.93,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1.86,,,1.86,Other,215% Medicaid APG methodology,1.86,,,1.86,Other,215% Medicaid APG methodology,1.08,,,1.08,Other,125% Medicaid APG methodology,0.01,6.1,
CEFEPIME 2GM/ D5W 50ML,J0692,HCPCS,,80023872,CDM,636,RC,264319511,NDC,both,24,EA,40.96,12.45,,,12.45,Other,150% of Medicare + 9.63% HCRA Surcharge,7.57,,,7.57,Fee Schedule,Average Sale Price (ASP) x 6,14.34,35,,14.34,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,13.93,34,,13.93,percent of total billed charges,Drugs,13.93,34,,13.93,percent of total billed charges,Drugs,13.93,34,,13.93,percent of total billed charges,Drugs,13.93,34,,13.93,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,16.38,40,,16.38,percent of total billed charges,Drugs,28.67,70,,28.67,percent of total billed charges,All Other,14.74,36,,14.74,percent of total billed charges,Drugs,14.74,36,,14.74,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,14.34,35,,14.34,percent of total billed charges,Drugs,13.65,,,13.65,Other,Drug Cost,13.65,,,13.65,Other,Drug Cost,13.65,,,13.65,Other,Drug Cost,13.65,,,13.65,Other,Drug Cost,13.65,,,13.65,Other,Drug Cost,13.65,,,13.65,Other,Drug Cost,30.72,,,30.72,Other,225% of Medicaid,19.11,,,19.11,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,12.12,,,12.12,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",29.35,,,29.35,Other,215% Medicaid APG methodology,29.35,,,29.35,Other,215% Medicaid APG methodology,17.07,,,17.07,Other,125% Medicaid APG methodology,0.01,30.72,
CEFOXITIN 2G/ 50ML DEXTROSE,J0694,HCPCS,,80023874,CDM,636,RC,264312511,NDC,both,24,EA,50.33,50.11,,,50.11,Other,150% of Medicare + 9.63% HCRA Surcharge,30.47,,,30.47,Fee Schedule,Average Sale Price (ASP) x 6,17.61,35,,17.61,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,17.11,34,,17.11,percent of total billed charges,Drugs,17.11,34,,17.11,percent of total billed charges,Drugs,17.11,34,,17.11,percent of total billed charges,Drugs,17.11,34,,17.11,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,20.13,40,,20.13,percent of total billed charges,Drugs,35.23,70,,35.23,percent of total billed charges,All Other,18.12,36,,18.12,percent of total billed charges,Drugs,18.12,36,,18.12,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,17.61,35,,17.61,percent of total billed charges,Drugs,16.78,,,16.78,Other,Drug Cost,16.78,,,16.78,Other,Drug Cost,16.78,,,16.78,Other,Drug Cost,16.78,,,16.78,Other,Drug Cost,16.78,,,16.78,Other,Drug Cost,16.78,,,16.78,Other,Drug Cost,37.75,,,37.75,Other,225% of Medicaid,23.49,,,23.49,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,48.76,,,48.76,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",36.07,,,36.07,Other,215% Medicaid APG methodology,36.07,,,36.07,Other,215% Medicaid APG methodology,20.97,,,20.97,Other,125% Medicaid APG methodology,0.01,50.11,
OMALIZUMAB 150MG INJ,J2357,HCPCS,,80023879,CDM,636,RC,50242004062,NDC,both,1,EA,1362.84,389.33,,,389.33,Other,150% of Medicare + 9.63% HCRA Surcharge,236.75,,,236.75,Fee Schedule,Average Sale Price (ASP) x 6,476.99,35,,476.99,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,463.37,34,,463.37,percent of total billed charges,Drugs,463.37,34,,463.37,percent of total billed charges,Drugs,463.37,34,,463.37,percent of total billed charges,Drugs,463.37,34,,463.37,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,463.37,34,"If Charge > 500, then 34 percent",463.37,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,545.14,40,,545.14,percent of total billed charges,Drugs,953.99,70,,953.99,percent of total billed charges,All Other,490.62,36,,490.62,percent of total billed charges,Drugs,490.62,36,,490.62,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,476.99,35,,476.99,percent of total billed charges,Drugs,454.28,,,454.28,Other,Drug Cost,454.28,,,454.28,Other,Drug Cost,454.28,,,454.28,Other,Drug Cost,454.28,,,454.28,Other,Drug Cost,454.28,,,454.28,Other,Drug Cost,454.28,,,454.28,Other,Drug Cost,1022.13,,,1022.13,Other,225% of Medicaid,635.99,,,635.99,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,378.81,,,378.81,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",976.7,,,976.7,Other,215% Medicaid APG methodology,976.7,,,976.7,Other,215% Medicaid APG methodology,567.85,,,567.85,Other,125% Medicaid APG methodology,0.01,1022.13,
CEFOXITIN 1GM/50ML DEXTROSE,J0694,HCPCS,,80023882,CDM,636,RC,264312311,NDC,both,24,EA,26.73,50.11,,,50.11,Other,150% of Medicare + 9.63% HCRA Surcharge,30.47,,,30.47,Fee Schedule,Average Sale Price (ASP) x 6,9.36,35,,9.36,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,9.09,34,,9.09,percent of total billed charges,Drugs,9.09,34,,9.09,percent of total billed charges,Drugs,9.09,34,,9.09,percent of total billed charges,Drugs,9.09,34,,9.09,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,10.69,40,,10.69,percent of total billed charges,Drugs,18.71,70,,18.71,percent of total billed charges,All Other,9.62,36,,9.62,percent of total billed charges,Drugs,9.62,36,,9.62,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,9.36,35,,9.36,percent of total billed charges,Drugs,8.91,,,8.91,Other,Drug Cost,8.91,,,8.91,Other,Drug Cost,8.91,,,8.91,Other,Drug Cost,8.91,,,8.91,Other,Drug Cost,8.91,,,8.91,Other,Drug Cost,8.91,,,8.91,Other,Drug Cost,20.05,,,20.05,Other,225% of Medicaid,12.48,,,12.48,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,48.76,,,48.76,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",19.16,,,19.16,Other,215% Medicaid APG methodology,19.16,,,19.16,Other,215% Medicaid APG methodology,11.14,,,11.14,Other,125% Medicaid APG methodology,0.01,50.11,
LEUPROLIDE 22.5MG INJ,J9217,HCPCS,,80023886,CDM,636,RC,74334603,NDC,both,1,EA,16665.66,1788.85,,,1788.85,Other,150% of Medicare + 9.63% HCRA Surcharge,1087.81,,,1087.81,Fee Schedule,Average Sale Price (ASP) x 6,5832.98,35,,5832.98,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,5666.32,34,,5666.32,percent of total billed charges,Drugs,5666.32,34,,5666.32,percent of total billed charges,Drugs,5666.32,34,,5666.32,percent of total billed charges,Drugs,5666.32,34,,5666.32,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,5666.32,34,"If Charge > 500, then 34 percent",5666.32,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,6666.26,40,,6666.26,percent of total billed charges,Drugs,11665.96,70,,11665.96,percent of total billed charges,All Other,5999.64,36,,5999.64,percent of total billed charges,Drugs,5999.64,36,,5999.64,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,5832.98,35,,5832.98,percent of total billed charges,Drugs,5555.22,,,5555.22,Other,Drug Cost,5555.22,,,5555.22,Other,Drug Cost,5555.22,,,5555.22,Other,Drug Cost,5555.22,,,5555.22,Other,Drug Cost,5555.22,,,5555.22,Other,Drug Cost,5555.22,,,5555.22,Other,Drug Cost,12499.25,,,12499.25,Other,225% of Medicaid,7777.31,,,7777.31,Other,140% of Medicaid,5666.32,34,"If Charge > 2,000, then 34 percent",5666.32,percent of total billed charges,Drugs,1740.5,,,1740.5,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",11943.72,,,11943.72,Other,215% Medicaid APG methodology,11943.72,,,11943.72,Other,215% Medicaid APG methodology,6944.03,,,6944.03,Other,125% Medicaid APG methodology,0.01,12499.25,
OCTREOTIDE ACETATE 30MG INJ,J2353,HCPCS,,80023887,CDM,636,RC,78082581,NDC,both,1,EA,18786.27,2080.19,,,2080.19,Other,150% of Medicare + 9.63% HCRA Surcharge,1264.97,,,1264.97,Fee Schedule,Average Sale Price (ASP) x 6,6575.19,35,,6575.19,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,6387.33,34,,6387.33,percent of total billed charges,Drugs,6387.33,34,,6387.33,percent of total billed charges,Drugs,6387.33,34,,6387.33,percent of total billed charges,Drugs,6387.33,34,,6387.33,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,6387.33,34,"If Charge > 500, then 34 percent",6387.33,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,7514.51,40,,7514.51,percent of total billed charges,Drugs,13150.39,70,,13150.39,percent of total billed charges,All Other,6763.06,36,,6763.06,percent of total billed charges,Drugs,6763.06,36,,6763.06,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,6575.19,35,,6575.19,percent of total billed charges,Drugs,6262.09,,,6262.09,Other,Drug Cost,6262.09,,,6262.09,Other,Drug Cost,6262.09,,,6262.09,Other,Drug Cost,6262.09,,,6262.09,Other,Drug Cost,6262.09,,,6262.09,Other,Drug Cost,6262.09,,,6262.09,Other,Drug Cost,14089.7,,,14089.7,Other,225% of Medicaid,8766.93,,,8766.93,Other,140% of Medicaid,6387.33,34,"If Charge > 2,000, then 34 percent",6387.33,percent of total billed charges,Drugs,2023.96,,,2023.96,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",13463.49,,,13463.49,Other,215% Medicaid APG methodology,13463.49,,,13463.49,Other,215% Medicaid APG methodology,7827.61,,,7827.61,Other,125% Medicaid APG methodology,0.01,14089.7,
METHYLENE BLUE 0.5% 10ML,Q9968,HCPCS,,80023888,CDM,636,RC,517037405,NDC,both,5,ML,271.77,107.26,39.4668,,107.26,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,95.12,35,,95.12,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,92.4,34,,92.4,percent of total billed charges,Drugs,92.4,34,,92.4,percent of total billed charges,Drugs,92.4,34,,92.4,percent of total billed charges,Drugs,92.4,34,,92.4,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,108.71,40,,108.71,percent of total billed charges,Drugs,190.24,70,,190.24,percent of total billed charges,All Other,97.84,36,,97.84,percent of total billed charges,Drugs,97.84,36,,97.84,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,95.12,35,,95.12,percent of total billed charges,Drugs,90.59,,,90.59,Other,Drug Cost,90.59,,,90.59,Other,Drug Cost,90.59,,,90.59,Other,Drug Cost,90.59,,,90.59,Other,Drug Cost,90.59,,,90.59,Other,Drug Cost,90.59,,,90.59,Other,Drug Cost,203.83,,,203.83,Other,225% of Medicaid,126.83,,,126.83,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",194.77,,,194.77,Other,215% Medicaid APG methodology,194.77,,,194.77,Other,215% Medicaid APG methodology,113.24,,,113.24,Other,125% Medicaid APG methodology,0.01,203.83,
LANREOTIDE 120MG INJECTION,J1930,HCPCS,,80023890,CDM,636,RC,15054112004,NDC,both,1,ML,28384.8,477.97,,,477.97,Other,150% of Medicare + 9.63% HCRA Surcharge,290.66,,,290.66,Fee Schedule,Average Sale Price (ASP) x 6,9934.68,35,,9934.68,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,9650.83,34,,9650.83,percent of total billed charges,Drugs,9650.83,34,,9650.83,percent of total billed charges,Drugs,9650.83,34,,9650.83,percent of total billed charges,Drugs,9650.83,34,,9650.83,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,9650.83,34,"If Charge > 500, then 34 percent",9650.83,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,11353.92,40,,11353.92,percent of total billed charges,Drugs,19869.36,70,,19869.36,percent of total billed charges,All Other,10218.53,36,,10218.53,percent of total billed charges,Drugs,10218.53,36,,10218.53,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,9934.68,35,,9934.68,percent of total billed charges,Drugs,9461.6,,,9461.6,Other,Drug Cost,9461.6,,,9461.6,Other,Drug Cost,9461.6,,,9461.6,Other,Drug Cost,9461.6,,,9461.6,Other,Drug Cost,9461.6,,,9461.6,Other,Drug Cost,9461.6,,,9461.6,Other,Drug Cost,21288.6,,,21288.6,Other,225% of Medicaid,13246.24,,,13246.24,Other,140% of Medicaid,9650.83,34,"If Charge > 2,000, then 34 percent",9650.83,percent of total billed charges,Drugs,465.05,,,465.05,Other,160% Medicare Fee Schedule,9650.83,34,,9650.83,Other,"Drug Charges > 20,000, then 34% of Charges",20342.44,,,20342.44,Other,215% Medicaid APG methodology,20342.44,,,20342.44,Other,215% Medicaid APG methodology,11827,,,11827,Other,125% Medicaid APG methodology,290.66,21288.6,
PEGLOTICASE 1MG/1ML INJ,J2507,HCPCS,,80023892,CDM,636,RC,75987008010,NDC,both,1,ML,79930.05,33261.4,,,33261.4,Other,150% of Medicare + 9.63% HCRA Surcharge,20226.46,,,20226.46,Fee Schedule,Average Sale Price (ASP) x 6,27975.52,35,,27975.52,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,27176.22,34,,27176.22,percent of total billed charges,Drugs,27176.22,34,,27176.22,percent of total billed charges,Drugs,27176.22,34,,27176.22,percent of total billed charges,Drugs,27176.22,34,,27176.22,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,27176.22,34,"If Charge > 500, then 34 percent",27176.22,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,31972.02,40,,31972.02,percent of total billed charges,Drugs,55951.04,70,,55951.04,percent of total billed charges,All Other,28774.82,36,,28774.82,percent of total billed charges,Drugs,28774.82,36,,28774.82,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,27975.52,35,,27975.52,percent of total billed charges,Drugs,26643.35,,,26643.35,Other,Drug Cost,26643.35,,,26643.35,Other,Drug Cost,26643.35,,,26643.35,Other,Drug Cost,26643.35,,,26643.35,Other,Drug Cost,26643.35,,,26643.35,Other,Drug Cost,26643.35,,,26643.35,Other,Drug Cost,59947.54,,,59947.54,Other,225% of Medicaid,37300.69,,,37300.69,Other,140% of Medicaid,27176.22,34,"If Charge > 2,000, then 34 percent",27176.22,percent of total billed charges,Drugs,32362.33,,,32362.33,Other,160% Medicare Fee Schedule,27176.22,34,,27176.22,Other,"Drug Charges > 20,000, then 34% of Charges",57283.2,,,57283.2,Other,215% Medicaid APG methodology,57283.2,,,57283.2,Other,215% Medicaid APG methodology,33304.19,,,33304.19,Other,125% Medicaid APG methodology,20226.46,59947.54,
LEUPROLIDE ACETATE 7.5MG INJ,J9217,HCPCS,,80023893,CDM,636,RC,74364203,NDC,both,1,EA,5555.25,1788.85,,,1788.85,Other,150% of Medicare + 9.63% HCRA Surcharge,1087.81,,,1087.81,Fee Schedule,Average Sale Price (ASP) x 6,1944.34,35,,1944.34,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,1888.79,34,,1888.79,percent of total billed charges,Drugs,1888.79,34,,1888.79,percent of total billed charges,Drugs,1888.79,34,,1888.79,percent of total billed charges,Drugs,1888.79,34,,1888.79,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,1888.79,34,"If Charge > 500, then 34 percent",1888.79,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,2222.1,40,,2222.1,percent of total billed charges,Drugs,3888.68,70,,3888.68,percent of total billed charges,All Other,1999.89,36,,1999.89,percent of total billed charges,Drugs,1999.89,36,,1999.89,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,1944.34,35,,1944.34,percent of total billed charges,Drugs,1851.75,,,1851.75,Other,Drug Cost,1851.75,,,1851.75,Other,Drug Cost,1851.75,,,1851.75,Other,Drug Cost,1851.75,,,1851.75,Other,Drug Cost,1851.75,,,1851.75,Other,Drug Cost,1851.75,,,1851.75,Other,Drug Cost,4166.44,,,4166.44,Other,225% of Medicaid,2592.45,,,2592.45,Other,140% of Medicaid,1888.79,34,"If Charge > 2,000, then 34 percent",1888.79,percent of total billed charges,Drugs,1740.5,,,1740.5,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3981.26,,,3981.26,Other,215% Medicaid APG methodology,3981.26,,,3981.26,Other,215% Medicaid APG methodology,2314.69,,,2314.69,Other,125% Medicaid APG methodology,0.01,4166.44,
DENOSUMAB 60MG INJ,J0897,HCPCS,,80023894,CDM,636,RC,55513071001,NDC,both,1,ML,2161.71,248.62,,,248.62,Other,150% of Medicare + 9.63% HCRA Surcharge,151.19,,,151.19,Fee Schedule,Average Sale Price (ASP) x 6,756.6,35,,756.6,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,734.98,34,,734.98,percent of total billed charges,Drugs,734.98,34,,734.98,percent of total billed charges,Drugs,734.98,34,,734.98,percent of total billed charges,Drugs,734.98,34,,734.98,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,734.98,34,"If Charge > 500, then 34 percent",734.98,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,864.68,40,,864.68,percent of total billed charges,Drugs,1513.2,70,,1513.2,percent of total billed charges,All Other,778.22,36,,778.22,percent of total billed charges,Drugs,778.22,36,,778.22,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,756.6,35,,756.6,percent of total billed charges,Drugs,720.57,,,720.57,Other,Drug Cost,720.57,,,720.57,Other,Drug Cost,720.57,,,720.57,Other,Drug Cost,720.57,,,720.57,Other,Drug Cost,720.57,,,720.57,Other,Drug Cost,720.57,,,720.57,Other,Drug Cost,1621.28,,,1621.28,Other,225% of Medicaid,1008.8,,,1008.8,Other,140% of Medicaid,734.98,34,"If Charge > 2,000, then 34 percent",734.98,percent of total billed charges,Drugs,241.9,,,241.9,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1549.23,,,1549.23,Other,215% Medicaid APG methodology,1549.23,,,1549.23,Other,215% Medicaid APG methodology,900.71,,,900.71,Other,125% Medicaid APG methodology,0.01,1621.28,
GAMUNEX-C 5GM/50ML,J1561,HCPCS,,80023896,CDM,636,RC,13533080020,NDC,both,1,ML,1005,491.22,,,491.22,Other,150% of Medicare + 9.63% HCRA Surcharge,298.72,,,298.72,Fee Schedule,Average Sale Price (ASP) x 6,351.75,35,,351.75,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,341.7,34,,341.7,percent of total billed charges,Drugs,341.7,34,,341.7,percent of total billed charges,Drugs,341.7,34,,341.7,percent of total billed charges,Drugs,341.7,34,,341.7,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,341.7,34,"If Charge > 500, then 34 percent",341.7,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,402,40,,402,percent of total billed charges,Drugs,703.5,70,,703.5,percent of total billed charges,All Other,361.8,36,,361.8,percent of total billed charges,Drugs,361.8,36,,361.8,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,351.75,35,,351.75,percent of total billed charges,Drugs,335,,,335,Other,Drug Cost,335,,,335,Other,Drug Cost,335,,,335,Other,Drug Cost,335,,,335,Other,Drug Cost,335,,,335,Other,Drug Cost,335,,,335,Other,Drug Cost,753.75,,,753.75,Other,225% of Medicaid,469,,,469,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,477.95,,,477.95,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",720.25,,,720.25,Other,215% Medicaid APG methodology,720.25,,,720.25,Other,215% Medicaid APG methodology,418.75,,,418.75,Other,125% Medicaid APG methodology,0.01,753.75,
ELOTUZUMAB 300MG INJ,J9176,HCPCS,,80023897,CDM,636,RC,3229111,NDC,both,1,EA,6622.83,72.82,,,72.82,Other,150% of Medicare + 9.63% HCRA Surcharge,44.28,,,44.28,Fee Schedule,Average Sale Price (ASP) x 6,2317.99,35,,2317.99,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2251.76,34,,2251.76,percent of total billed charges,Drugs,2251.76,34,,2251.76,percent of total billed charges,Drugs,2251.76,34,,2251.76,percent of total billed charges,Drugs,2251.76,34,,2251.76,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2251.76,34,"If Charge > 500, then 34 percent",2251.76,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2649.13,40,,2649.13,percent of total billed charges,Drugs,4635.98,70,,4635.98,percent of total billed charges,All Other,2384.22,36,,2384.22,percent of total billed charges,Drugs,2384.22,36,,2384.22,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2317.99,35,,2317.99,percent of total billed charges,Drugs,2207.61,,,2207.61,Other,Drug Cost,2207.61,,,2207.61,Other,Drug Cost,2207.61,,,2207.61,Other,Drug Cost,2207.61,,,2207.61,Other,Drug Cost,2207.61,,,2207.61,Other,Drug Cost,2207.61,,,2207.61,Other,Drug Cost,4967.12,,,4967.12,Other,225% of Medicaid,3090.65,,,3090.65,Other,140% of Medicaid,2251.76,34,"If Charge > 2,000, then 34 percent",2251.76,percent of total billed charges,Drugs,70.85,,,70.85,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4746.36,,,4746.36,Other,215% Medicaid APG methodology,4746.36,,,4746.36,Other,215% Medicaid APG methodology,2759.51,,,2759.51,Other,125% Medicaid APG methodology,0.01,4967.12,
ADO-TRASTUZUMAB EMT 100MG INJ,J9354,HCPCS,,80023901,CDM,636,RC,50242008801,NDC,both,1,EA,8257.59,378.57,,,378.57,Other,150% of Medicare + 9.63% HCRA Surcharge,230.21,,,230.21,Fee Schedule,Average Sale Price (ASP) x 6,2890.16,35,,2890.16,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,2807.58,34,,2807.58,percent of total billed charges,Drugs,2807.58,34,,2807.58,percent of total billed charges,Drugs,2807.58,34,,2807.58,percent of total billed charges,Drugs,2807.58,34,,2807.58,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,2807.58,34,"If Charge > 500, then 34 percent",2807.58,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,3303.04,40,,3303.04,percent of total billed charges,Drugs,5780.31,70,,5780.31,percent of total billed charges,All Other,2972.73,36,,2972.73,percent of total billed charges,Drugs,2972.73,36,,2972.73,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,2890.16,35,,2890.16,percent of total billed charges,Drugs,2752.53,,,2752.53,Other,Drug Cost,2752.53,,,2752.53,Other,Drug Cost,2752.53,,,2752.53,Other,Drug Cost,2752.53,,,2752.53,Other,Drug Cost,2752.53,,,2752.53,Other,Drug Cost,2752.53,,,2752.53,Other,Drug Cost,6193.19,,,6193.19,Other,225% of Medicaid,3853.54,,,3853.54,Other,140% of Medicaid,2807.58,34,"If Charge > 2,000, then 34 percent",2807.58,percent of total billed charges,Drugs,368.33,,,368.33,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5917.94,,,5917.94,Other,215% Medicaid APG methodology,5917.94,,,5917.94,Other,215% Medicaid APG methodology,3440.66,,,3440.66,Other,125% Medicaid APG methodology,0.01,6193.19,
DENOSUMAB 120MG/1.7ML,J0897,HCPCS,,80023902,CDM,636,RC,55513073001,NDC,both,1,ML,8928.03,248.62,,,248.62,Other,150% of Medicare + 9.63% HCRA Surcharge,151.19,,,151.19,Fee Schedule,Average Sale Price (ASP) x 6,3124.81,35,,3124.81,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,3035.53,34,,3035.53,percent of total billed charges,Drugs,3035.53,34,,3035.53,percent of total billed charges,Drugs,3035.53,34,,3035.53,percent of total billed charges,Drugs,3035.53,34,,3035.53,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,3035.53,34,"If Charge > 500, then 34 percent",3035.53,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,3571.21,40,,3571.21,percent of total billed charges,Drugs,6249.62,70,,6249.62,percent of total billed charges,All Other,3214.09,36,,3214.09,percent of total billed charges,Drugs,3214.09,36,,3214.09,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,3124.81,35,,3124.81,percent of total billed charges,Drugs,2976.01,,,2976.01,Other,Drug Cost,2976.01,,,2976.01,Other,Drug Cost,2976.01,,,2976.01,Other,Drug Cost,2976.01,,,2976.01,Other,Drug Cost,2976.01,,,2976.01,Other,Drug Cost,2976.01,,,2976.01,Other,Drug Cost,6696.02,,,6696.02,Other,225% of Medicaid,4166.41,,,4166.41,Other,140% of Medicaid,3035.53,34,"If Charge > 2,000, then 34 percent",3035.53,percent of total billed charges,Drugs,241.9,,,241.9,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6398.42,,,6398.42,Other,215% Medicaid APG methodology,6398.42,,,6398.42,Other,215% Medicaid APG methodology,3720.01,,,3720.01,Other,125% Medicaid APG methodology,0.01,6696.02,
PEGFILGRASTIM ONPRO 6MG/0.6ML,J2506,HCPCS,,80023903,CDM,636,RC,55513019201,NDC,both,1,ML,12577.5,500.02,,,500.02,Other,150% of Medicare + 9.63% HCRA Surcharge,304.07,,,304.07,Fee Schedule,Average Sale Price (ASP) x 6,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4276.35,34,,4276.35,percent of total billed charges,Drugs,4276.35,34,,4276.35,percent of total billed charges,Drugs,4276.35,34,,4276.35,percent of total billed charges,Drugs,4276.35,34,,4276.35,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4276.35,34,"If Charge > 500, then 34 percent",4276.35,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,5031,40,,5031,percent of total billed charges,Drugs,8804.25,70,,8804.25,percent of total billed charges,All Other,4527.9,36,,4527.9,percent of total billed charges,Drugs,4527.9,36,,4527.9,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4402.13,35,,4402.13,percent of total billed charges,Drugs,4192.5,,,4192.5,Other,Drug Cost,4192.5,,,4192.5,Other,Drug Cost,4192.5,,,4192.5,Other,Drug Cost,4192.5,,,4192.5,Other,Drug Cost,4192.5,,,4192.5,Other,Drug Cost,4192.5,,,4192.5,Other,Drug Cost,9433.13,,,9433.13,Other,225% of Medicaid,5869.5,,,5869.5,Other,140% of Medicaid,4276.35,34,"If Charge > 2,000, then 34 percent",4276.35,percent of total billed charges,Drugs,486.51,,,486.51,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",9013.88,,,9013.88,Other,215% Medicaid APG methodology,9013.88,,,9013.88,Other,215% Medicaid APG methodology,5240.63,,,5240.63,Other,125% Medicaid APG methodology,0.01,9433.13,
IBANDRONATE SODIUM 3MG/ML 3ML,J1740,HCPCS,,80023904,CDM,636,RC,67457052433,NDC,both,1,ML,131.04,252.55,,,252.55,Other,150% of Medicare + 9.63% HCRA Surcharge,153.58,,,153.58,Fee Schedule,Average Sale Price (ASP) x 6,45.86,35,,45.86,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,44.55,34,,44.55,percent of total billed charges,Drugs,44.55,34,,44.55,percent of total billed charges,Drugs,44.55,34,,44.55,percent of total billed charges,Drugs,44.55,34,,44.55,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,52.42,40,,52.42,percent of total billed charges,Drugs,91.73,70,,91.73,percent of total billed charges,All Other,47.17,36,,47.17,percent of total billed charges,Drugs,47.17,36,,47.17,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,45.86,35,,45.86,percent of total billed charges,Drugs,43.68,,,43.68,Other,Drug Cost,43.68,,,43.68,Other,Drug Cost,43.68,,,43.68,Other,Drug Cost,43.68,,,43.68,Other,Drug Cost,43.68,,,43.68,Other,Drug Cost,43.68,,,43.68,Other,Drug Cost,98.28,,,98.28,Other,225% of Medicaid,61.15,,,61.15,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,245.72,,,245.72,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",93.91,,,93.91,Other,215% Medicaid APG methodology,93.91,,,93.91,Other,215% Medicaid APG methodology,54.6,,,54.6,Other,125% Medicaid APG methodology,0.01,252.55,
FERRIC CARBOXYMALTOS 50MG/ML 15ML INJ,J1439,HCPCS,,80023907,CDM,636,RC,517065001,NDC,both,1,ML,1704.18,11.32,,,11.32,Other,150% of Medicare + 9.63% HCRA Surcharge,6.88,,,6.88,Fee Schedule,Average Sale Price (ASP) x 6,596.46,35,,596.46,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,579.42,34,,579.42,percent of total billed charges,Drugs,579.42,34,,579.42,percent of total billed charges,Drugs,579.42,34,,579.42,percent of total billed charges,Drugs,579.42,34,,579.42,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,579.42,34,"If Charge > 500, then 34 percent",579.42,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,681.67,40,,681.67,percent of total billed charges,Drugs,1192.93,70,,1192.93,percent of total billed charges,All Other,613.5,36,,613.5,percent of total billed charges,Drugs,613.5,36,,613.5,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,596.46,35,,596.46,percent of total billed charges,Drugs,568.06,,,568.06,Other,Drug Cost,568.06,,,568.06,Other,Drug Cost,568.06,,,568.06,Other,Drug Cost,568.06,,,568.06,Other,Drug Cost,568.06,,,568.06,Other,Drug Cost,568.06,,,568.06,Other,Drug Cost,1278.14,,,1278.14,Other,225% of Medicaid,795.28,,,795.28,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,11.01,,,11.01,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1221.33,,,1221.33,Other,215% Medicaid APG methodology,1221.33,,,1221.33,Other,215% Medicaid APG methodology,710.08,,,710.08,Other,125% Medicaid APG methodology,0.01,1278.14,
DIPHENHYDRAMINE 25MG/50ML,J1200,HCPCS,,80023908,CDM,636,RC,67457012410,NDC,both,1,ML,19.98,7.93,,,7.93,Other,150% of Medicare + 9.63% HCRA Surcharge,4.82,,,4.82,Fee Schedule,Average Sale Price (ASP) x 6,6.99,35,,6.99,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,6.79,34,,6.79,percent of total billed charges,Drugs,6.79,34,,6.79,percent of total billed charges,Drugs,6.79,34,,6.79,percent of total billed charges,Drugs,6.79,34,,6.79,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,7.99,40,,7.99,percent of total billed charges,Drugs,13.99,70,,13.99,percent of total billed charges,All Other,7.19,36,,7.19,percent of total billed charges,Drugs,7.19,36,,7.19,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,6.99,35,,6.99,percent of total billed charges,Drugs,6.66,,,6.66,Other,Drug Cost,6.66,,,6.66,Other,Drug Cost,6.66,,,6.66,Other,Drug Cost,6.66,,,6.66,Other,Drug Cost,6.66,,,6.66,Other,Drug Cost,6.66,,,6.66,Other,Drug Cost,14.99,,,14.99,Other,225% of Medicaid,9.32,,,9.32,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,7.72,,,7.72,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",14.32,,,14.32,Other,215% Medicaid APG methodology,14.32,,,14.32,Other,215% Medicaid APG methodology,8.33,,,8.33,Other,125% Medicaid APG methodology,0.01,14.99,
PEGFILGRASTIM-CBQV 6MG/0.6ML INJ,Q5111,HCPCS,,80023909,CDM,636,RC,70114010101,NDC,both,1,ML,3575.52,1204.75,,,1204.75,Other,150% of Medicare + 9.63% HCRA Surcharge,732.62,,,732.62,Fee Schedule,Average Sale Price (ASP) x 6,1251.43,35,,1251.43,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1215.68,34,,1215.68,percent of total billed charges,Drugs,1215.68,34,,1215.68,percent of total billed charges,Drugs,1215.68,34,,1215.68,percent of total billed charges,Drugs,1215.68,34,,1215.68,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1215.68,34,"If Charge > 500, then 34 percent",1215.68,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1430.21,40,,1430.21,percent of total billed charges,Drugs,2502.86,70,,2502.86,percent of total billed charges,All Other,1287.19,36,,1287.19,percent of total billed charges,Drugs,1287.19,36,,1287.19,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1251.43,35,,1251.43,percent of total billed charges,Drugs,1191.84,,,1191.84,Other,Drug Cost,1191.84,,,1191.84,Other,Drug Cost,1191.84,,,1191.84,Other,Drug Cost,1191.84,,,1191.84,Other,Drug Cost,1191.84,,,1191.84,Other,Drug Cost,1191.84,,,1191.84,Other,Drug Cost,2681.64,,,2681.64,Other,225% of Medicaid,1668.58,,,1668.58,Other,140% of Medicaid,1215.68,34,"If Charge > 2,000, then 34 percent",1215.68,percent of total billed charges,Drugs,1172.19,,,1172.19,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2562.46,,,2562.46,Other,215% Medicaid APG methodology,2562.46,,,2562.46,Other,215% Medicaid APG methodology,1489.8,,,1489.8,Other,125% Medicaid APG methodology,0.01,2681.64,
ONDANSETRON INJ 12 MG/50 ML,J2405,HCPCS,,80023917,CDM,636,RC,72266012401,NDC,both,1,ML,7.47,0.99,,,0.99,Other,150% of Medicare + 9.63% HCRA Surcharge,0.6,,,0.6,Fee Schedule,Average Sale Price (ASP) x 6,2.61,35,,2.61,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,2.54,34,,2.54,percent of total billed charges,Drugs,2.54,34,,2.54,percent of total billed charges,Drugs,2.54,34,,2.54,percent of total billed charges,Drugs,2.54,34,,2.54,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,2.99,40,,2.99,percent of total billed charges,Drugs,5.23,70,,5.23,percent of total billed charges,All Other,2.69,36,,2.69,percent of total billed charges,Drugs,2.69,36,,2.69,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,2.61,35,,2.61,percent of total billed charges,Drugs,2.49,,,2.49,Other,Drug Cost,2.49,,,2.49,Other,Drug Cost,2.49,,,2.49,Other,Drug Cost,2.49,,,2.49,Other,Drug Cost,2.49,,,2.49,Other,Drug Cost,2.49,,,2.49,Other,Drug Cost,5.6,,,5.6,Other,225% of Medicaid,3.49,,,3.49,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.96,,,0.96,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.35,,,5.35,Other,215% Medicaid APG methodology,5.35,,,5.35,Other,215% Medicaid APG methodology,3.11,,,3.11,Other,125% Medicaid APG methodology,0.01,5.6,
DEXAMETHASONE INJ 10 MG/50 ML,J1100,HCPCS,,80023919,CDM,636,RC,67457042130,NDC,both,25,ML,15.1,1.17,,,1.17,Other,150% of Medicare + 9.63% HCRA Surcharge,0.71,,,0.71,Fee Schedule,Average Sale Price (ASP) x 6,5.28,35,,5.28,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,5.13,34,,5.13,percent of total billed charges,Drugs,5.13,34,,5.13,percent of total billed charges,Drugs,5.13,34,,5.13,percent of total billed charges,Drugs,5.13,34,,5.13,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,6.04,40,,6.04,percent of total billed charges,Drugs,10.57,70,,10.57,percent of total billed charges,All Other,5.43,36,,5.43,percent of total billed charges,Drugs,5.43,36,,5.43,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,5.28,35,,5.28,percent of total billed charges,Drugs,5.03,,,5.03,Other,Drug Cost,5.03,,,5.03,Other,Drug Cost,5.03,,,5.03,Other,Drug Cost,5.03,,,5.03,Other,Drug Cost,5.03,,,5.03,Other,Drug Cost,5.03,,,5.03,Other,Drug Cost,11.32,,,11.32,Other,225% of Medicaid,7.05,,,7.05,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.14,,,1.14,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",10.82,,,10.82,Other,215% Medicaid APG methodology,10.82,,,10.82,Other,215% Medicaid APG methodology,6.29,,,6.29,Other,125% Medicaid APG methodology,0.01,11.32,
DEXAMETHASONE INJ 16 MG/50 ML,J1100,HCPCS,,80023920,CDM,636,RC,55150023930,NDC,both,25,ML,14,1.17,,,1.17,Other,150% of Medicare + 9.63% HCRA Surcharge,0.71,,,0.71,Fee Schedule,Average Sale Price (ASP) x 6,4.9,35,,4.9,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,4.76,34,,4.76,percent of total billed charges,Drugs,4.76,34,,4.76,percent of total billed charges,Drugs,4.76,34,,4.76,percent of total billed charges,Drugs,4.76,34,,4.76,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,5.6,40,,5.6,percent of total billed charges,Drugs,9.8,70,,9.8,percent of total billed charges,All Other,5.04,36,,5.04,percent of total billed charges,Drugs,5.04,36,,5.04,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,4.9,35,,4.9,percent of total billed charges,Drugs,4.67,,,4.67,Other,Drug Cost,4.67,,,4.67,Other,Drug Cost,4.67,,,4.67,Other,Drug Cost,4.67,,,4.67,Other,Drug Cost,4.67,,,4.67,Other,Drug Cost,4.67,,,4.67,Other,Drug Cost,10.5,,,10.5,Other,225% of Medicaid,6.54,,,6.54,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.14,,,1.14,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",10.04,,,10.04,Other,215% Medicaid APG methodology,10.04,,,10.04,Other,215% Medicaid APG methodology,5.84,,,5.84,Other,125% Medicaid APG methodology,0.01,10.5,
DEXAMETHASONE INJ 20 MG/50 ML,J1100,HCPCS,,80023921,CDM,636,RC,63323016530,NDC,both,1,ML,55.59,1.17,,,1.17,Other,150% of Medicare + 9.63% HCRA Surcharge,0.71,,,0.71,Fee Schedule,Average Sale Price (ASP) x 6,19.46,35,,19.46,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,18.9,34,,18.9,percent of total billed charges,Drugs,18.9,34,,18.9,percent of total billed charges,Drugs,18.9,34,,18.9,percent of total billed charges,Drugs,18.9,34,,18.9,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,22.24,40,,22.24,percent of total billed charges,Drugs,38.91,70,,38.91,percent of total billed charges,All Other,20.01,36,,20.01,percent of total billed charges,Drugs,20.01,36,,20.01,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,19.46,35,,19.46,percent of total billed charges,Drugs,18.53,,,18.53,Other,Drug Cost,18.53,,,18.53,Other,Drug Cost,18.53,,,18.53,Other,Drug Cost,18.53,,,18.53,Other,Drug Cost,18.53,,,18.53,Other,Drug Cost,18.53,,,18.53,Other,Drug Cost,41.69,,,41.69,Other,225% of Medicaid,25.94,,,25.94,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1.14,,,1.14,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",39.84,,,39.84,Other,215% Medicaid APG methodology,39.84,,,39.84,Other,215% Medicaid APG methodology,23.16,,,23.16,Other,125% Medicaid APG methodology,0.01,41.69,
CISTRACURIUM 200MG/ 20ML INJ,J3490,HCPCS,,80023924,CDM,636,RC,74438220,NDC,both,10,ML,807.15,318.56,39.4668,,318.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,282.5,35,,282.5,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,274.43,34,,274.43,percent of total billed charges,Drugs,274.43,34,,274.43,percent of total billed charges,Drugs,274.43,34,,274.43,percent of total billed charges,Drugs,274.43,34,,274.43,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,274.43,34,"If Charge > 500, then 34 percent",274.43,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,322.86,40,,322.86,percent of total billed charges,Drugs,565.01,70,,565.01,percent of total billed charges,All Other,290.57,36,,290.57,percent of total billed charges,Drugs,290.57,36,,290.57,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,282.5,35,,282.5,percent of total billed charges,Drugs,269.05,,,269.05,Other,Drug Cost,269.05,,,269.05,Other,Drug Cost,269.05,,,269.05,Other,Drug Cost,269.05,,,269.05,Other,Drug Cost,269.05,,,269.05,Other,Drug Cost,269.05,,,269.05,Other,Drug Cost,605.36,,,605.36,Other,225% of Medicaid,376.67,,,376.67,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",578.46,,,578.46,Other,215% Medicaid APG methodology,578.46,,,578.46,Other,215% Medicaid APG methodology,336.31,,,336.31,Other,125% Medicaid APG methodology,0.01,605.36,
TERIPARATIDE ACETATE 20MCG/ DOSE 2.4ML,J3110,HCPCS,,80023926,CDM,636,RC,2840001,NDC,both,1,ML,11658.63,4601.29,39.4668,,4601.29,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,4080.52,35,,4080.52,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,3963.93,34,,3963.93,percent of total billed charges,Drugs,3963.93,34,,3963.93,percent of total billed charges,Drugs,3963.93,34,,3963.93,percent of total billed charges,Drugs,3963.93,34,,3963.93,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,3963.93,34,"If Charge > 500, then 34 percent",3963.93,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,4663.45,40,,4663.45,percent of total billed charges,Drugs,8161.04,70,,8161.04,percent of total billed charges,All Other,4197.11,36,,4197.11,percent of total billed charges,Drugs,4197.11,36,,4197.11,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,4080.52,35,,4080.52,percent of total billed charges,Drugs,3886.21,,,3886.21,Other,Drug Cost,3886.21,,,3886.21,Other,Drug Cost,3886.21,,,3886.21,Other,Drug Cost,3886.21,,,3886.21,Other,Drug Cost,3886.21,,,3886.21,Other,Drug Cost,3886.21,,,3886.21,Other,Drug Cost,8743.97,,,8743.97,Other,225% of Medicaid,5440.69,,,5440.69,Other,140% of Medicaid,3963.93,34,"If Charge > 2,000, then 34 percent",3963.93,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8355.35,,,8355.35,Other,215% Medicaid APG methodology,8355.35,,,8355.35,Other,215% Medicaid APG methodology,4857.76,,,4857.76,Other,125% Medicaid APG methodology,0.01,8743.97,
MOXIFLOXACIN 400MG/250ML,J2280,HCPCS,,80023927,CDM,636,RC,63323085074,NDC,both,12,ML,62.19,93,,,93,Other,150% of Medicare + 9.63% HCRA Surcharge,56.56,,,56.56,Fee Schedule,Average Sale Price (ASP) x 6,21.77,35,,21.77,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,21.15,34,,21.15,percent of total billed charges,Drugs,21.15,34,,21.15,percent of total billed charges,Drugs,21.15,34,,21.15,percent of total billed charges,Drugs,21.15,34,,21.15,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,24.88,40,,24.88,percent of total billed charges,Drugs,43.53,70,,43.53,percent of total billed charges,All Other,22.39,36,,22.39,percent of total billed charges,Drugs,22.39,36,,22.39,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,21.77,35,,21.77,percent of total billed charges,Drugs,20.73,,,20.73,Other,Drug Cost,20.73,,,20.73,Other,Drug Cost,20.73,,,20.73,Other,Drug Cost,20.73,,,20.73,Other,Drug Cost,20.73,,,20.73,Other,Drug Cost,20.73,,,20.73,Other,Drug Cost,46.64,,,46.64,Other,225% of Medicaid,29.02,,,29.02,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,90.49,,,90.49,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",44.57,,,44.57,Other,215% Medicaid APG methodology,44.57,,,44.57,Other,215% Medicaid APG methodology,25.91,,,25.91,Other,125% Medicaid APG methodology,0.01,93,
Dextrose 10% 250mL,J7799,HCPCS,,80023933,CDM,636,RC,338002302,NDC,both,36,ML,6.65,2.63,39.4668,,2.63,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,2.33,35,,2.33,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,2.26,34,,2.26,percent of total billed charges,Drugs,2.26,34,,2.26,percent of total billed charges,Drugs,2.26,34,,2.26,percent of total billed charges,Drugs,2.26,34,,2.26,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,2.66,40,,2.66,percent of total billed charges,Drugs,4.66,70,,4.66,percent of total billed charges,All Other,2.4,36,,2.4,percent of total billed charges,Drugs,2.4,36,,2.4,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,2.33,35,,2.33,percent of total billed charges,Drugs,2.22,,,2.22,Other,Drug Cost,2.22,,,2.22,Other,Drug Cost,2.22,,,2.22,Other,Drug Cost,2.22,,,2.22,Other,Drug Cost,2.22,,,2.22,Other,Drug Cost,2.22,,,2.22,Other,Drug Cost,4.99,,,4.99,Other,225% of Medicaid,3.1,,,3.1,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4.77,,,4.77,Other,215% Medicaid APG methodology,4.77,,,4.77,Other,215% Medicaid APG methodology,2.77,,,2.77,Other,125% Medicaid APG methodology,0.01,4.99,
Hyaluronidase inj 150unit/mL (1mL),J3470,HCPCS,,80023936,CDM,636,RC,548909010,NDC,both,10,ML,49.22,19.42,39.4668,,19.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,17.23,35,,17.23,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,16.73,34,,16.73,percent of total billed charges,Drugs,16.73,34,,16.73,percent of total billed charges,Drugs,16.73,34,,16.73,percent of total billed charges,Drugs,16.73,34,,16.73,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,19.69,40,,19.69,percent of total billed charges,Drugs,34.45,70,,34.45,percent of total billed charges,All Other,17.72,36,,17.72,percent of total billed charges,Drugs,17.72,36,,17.72,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,17.23,35,,17.23,percent of total billed charges,Drugs,16.41,,,16.41,Other,Drug Cost,16.41,,,16.41,Other,Drug Cost,16.41,,,16.41,Other,Drug Cost,16.41,,,16.41,Other,Drug Cost,16.41,,,16.41,Other,Drug Cost,16.41,,,16.41,Other,Drug Cost,36.91,,,36.91,Other,225% of Medicaid,22.97,,,22.97,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",35.27,,,35.27,Other,215% Medicaid APG methodology,35.27,,,35.27,Other,215% Medicaid APG methodology,20.51,,,20.51,Other,125% Medicaid APG methodology,0.01,36.91,
FAM-TRASTUZUMAB DERUXTECN- NXKI 100MG,J9358,HCPCS,,80023938,CDM,636,RC,65597040601,NDC,both,1,EA,8336.64,268.77,,,268.77,Other,150% of Medicare + 9.63% HCRA Surcharge,163.44,,,163.44,Fee Schedule,Average Sale Price (ASP) x 6,2917.82,35,,2917.82,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,2834.46,34,,2834.46,percent of total billed charges,Drugs,2834.46,34,,2834.46,percent of total billed charges,Drugs,2834.46,34,,2834.46,percent of total billed charges,Drugs,2834.46,34,,2834.46,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,2834.46,34,"If Charge > 500, then 34 percent",2834.46,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,3334.66,40,,3334.66,percent of total billed charges,Drugs,5835.65,70,,5835.65,percent of total billed charges,All Other,3001.19,36,,3001.19,percent of total billed charges,Drugs,3001.19,36,,3001.19,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,2917.82,35,,2917.82,percent of total billed charges,Drugs,2778.88,,,2778.88,Other,Drug Cost,2778.88,,,2778.88,Other,Drug Cost,2778.88,,,2778.88,Other,Drug Cost,2778.88,,,2778.88,Other,Drug Cost,2778.88,,,2778.88,Other,Drug Cost,2778.88,,,2778.88,Other,Drug Cost,6252.48,,,6252.48,Other,225% of Medicaid,3890.43,,,3890.43,Other,140% of Medicaid,2834.46,34,"If Charge > 2,000, then 34 percent",2834.46,percent of total billed charges,Drugs,261.5,,,261.5,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5974.59,,,5974.59,Other,215% Medicaid APG methodology,5974.59,,,5974.59,Other,215% Medicaid APG methodology,3473.6,,,3473.6,Other,125% Medicaid APG methodology,0.01,6252.48,
TOCILIZUMAB 400 MG/20 ML INJ,J3262,HCPCS,,80023940,CDM,636,RC,50242013701,NDC,both,1,ML,7608.93,60.38,,,60.38,Other,150% of Medicare + 9.63% HCRA Surcharge,36.72,,,36.72,Fee Schedule,Average Sale Price (ASP) x 6,2663.13,35,,2663.13,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,2587.04,34,,2587.04,percent of total billed charges,Drugs,2587.04,34,,2587.04,percent of total billed charges,Drugs,2587.04,34,,2587.04,percent of total billed charges,Drugs,2587.04,34,,2587.04,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,2587.04,34,"If Charge > 500, then 34 percent",2587.04,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,3043.57,40,,3043.57,percent of total billed charges,Drugs,5326.25,70,,5326.25,percent of total billed charges,All Other,2739.21,36,,2739.21,percent of total billed charges,Drugs,2739.21,36,,2739.21,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,2663.13,35,,2663.13,percent of total billed charges,Drugs,2536.31,,,2536.31,Other,Drug Cost,2536.31,,,2536.31,Other,Drug Cost,2536.31,,,2536.31,Other,Drug Cost,2536.31,,,2536.31,Other,Drug Cost,2536.31,,,2536.31,Other,Drug Cost,2536.31,,,2536.31,Other,Drug Cost,5706.7,,,5706.7,Other,225% of Medicaid,3550.83,,,3550.83,Other,140% of Medicaid,2587.04,34,"If Charge > 2,000, then 34 percent",2587.04,percent of total billed charges,Drugs,58.75,,,58.75,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5453.07,,,5453.07,Other,215% Medicaid APG methodology,5453.07,,,5453.07,Other,215% Medicaid APG methodology,3170.39,,,3170.39,Other,125% Medicaid APG methodology,0.01,5706.7,
DEXAMETHASONE 2 MG TABLET,J8540,HCPCS,,80023951,CDM,636,RC,54418325,NDC,both,100,EA,0.52,0.82,,,0.82,Other,150% of Medicare + 9.63% HCRA Surcharge,0.5,,,0.5,Fee Schedule,Average Sale Price (ASP) x 6,0.18,35,,0.18,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.18,34,,0.18,percent of total billed charges,Drugs,0.18,34,,0.18,percent of total billed charges,Drugs,0.18,34,,0.18,percent of total billed charges,Drugs,0.18,34,,0.18,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.21,40,,0.21,percent of total billed charges,Drugs,0.36,70,,0.36,percent of total billed charges,All Other,0.19,36,,0.19,percent of total billed charges,Drugs,0.19,36,,0.19,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.18,35,,0.18,percent of total billed charges,Drugs,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.17,,,0.17,Other,Drug Cost,0.39,,,0.39,Other,225% of Medicaid,0.24,,,0.24,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.8,,,0.8,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.37,,,0.37,Other,215% Medicaid APG methodology,0.37,,,0.37,Other,215% Medicaid APG methodology,0.22,,,0.22,Other,125% Medicaid APG methodology,0.01,0.82,
DEXAMETHASONE 6MG TABLET,J8540,HCPCS,,80023956,CDM,636,RC,54418625,NDC,both,100,EA,0.07,0.82,,,0.82,Other,150% of Medicare + 9.63% HCRA Surcharge,0.5,,,0.5,Fee Schedule,Average Sale Price (ASP) x 6,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,40,,0.03,percent of total billed charges,Drugs,0.05,70,,0.05,percent of total billed charges,All Other,0.03,36,,0.03,percent of total billed charges,Drugs,0.03,36,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.03,35,,0.03,percent of total billed charges,Drugs,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.8,,,0.8,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.05,,,0.05,Other,215% Medicaid APG methodology,0.05,,,0.05,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,0.82,
"EPOETIN ALA-EPBX 40,000 UNIT",Q5106,HCPCS,,80023957,CDM,636,RC,69130904,NDC,both,4,ML,559.87,77.2,,,77.2,Other,150% of Medicare + 9.63% HCRA Surcharge,46.94,,,46.94,Fee Schedule,Average Sale Price (ASP) x 6,195.95,35,,195.95,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,190.35,34,,190.35,percent of total billed charges,Drugs,190.35,34,,190.35,percent of total billed charges,Drugs,190.35,34,,190.35,percent of total billed charges,Drugs,190.35,34,,190.35,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,190.35,34,"If Charge > 500, then 34 percent",190.35,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,223.95,40,,223.95,percent of total billed charges,Drugs,391.91,70,,391.91,percent of total billed charges,All Other,201.55,36,,201.55,percent of total billed charges,Drugs,201.55,36,,201.55,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,195.95,35,,195.95,percent of total billed charges,Drugs,186.62,,,186.62,Other,Drug Cost,186.62,,,186.62,Other,Drug Cost,186.62,,,186.62,Other,Drug Cost,186.62,,,186.62,Other,Drug Cost,186.62,,,186.62,Other,Drug Cost,186.62,,,186.62,Other,Drug Cost,419.9,,,419.9,Other,225% of Medicaid,261.27,,,261.27,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,75.11,,,75.11,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",401.24,,,401.24,Other,215% Medicaid APG methodology,401.24,,,401.24,Other,215% Medicaid APG methodology,233.28,,,233.28,Other,125% Medicaid APG methodology,0.01,419.9,
FLU VACC HIGH-DOSE QUAD 65YRS+,90662,HCPCS,,80023966,CDM,636,RC,49281012365,NDC,both,10,ML,191.53,75.59,39.4668,,75.59,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,67.04,35,,67.04,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,65.12,34,,65.12,percent of total billed charges,Drugs,65.12,34,,65.12,percent of total billed charges,Drugs,65.12,34,,65.12,percent of total billed charges,Drugs,65.12,34,,65.12,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,76.61,40,,76.61,percent of total billed charges,Drugs,134.07,70,,134.07,percent of total billed charges,All Other,68.95,36,,68.95,percent of total billed charges,Drugs,68.95,36,,68.95,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,67.04,35,,67.04,percent of total billed charges,Drugs,63.84,,,63.84,Other,Drug Cost,63.84,,,63.84,Other,Drug Cost,63.84,,,63.84,Other,Drug Cost,63.84,,,63.84,Other,Drug Cost,63.84,,,63.84,Other,Drug Cost,63.84,,,63.84,Other,Drug Cost,143.65,,,143.65,Other,225% of Medicaid,89.38,,,89.38,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",137.26,,,137.26,Other,215% Medicaid APG methodology,137.26,,,137.26,Other,215% Medicaid APG methodology,79.8,,,79.8,Other,125% Medicaid APG methodology,0.01,143.65,
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,,80023967,CDM,636,RC,59338077501,NDC,both,1,ML,345.27,3.52,,,3.52,Other,150% of Medicare + 9.63% HCRA Surcharge,2.14,,,2.14,Fee Schedule,Average Sale Price (ASP) x 6,120.84,35,,120.84,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,117.39,34,,117.39,percent of total billed charges,Drugs,117.39,34,,117.39,percent of total billed charges,Drugs,117.39,34,,117.39,percent of total billed charges,Drugs,117.39,34,,117.39,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,138.11,40,,138.11,percent of total billed charges,Drugs,241.69,70,,241.69,percent of total billed charges,All Other,124.3,36,,124.3,percent of total billed charges,Drugs,124.3,36,,124.3,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,120.84,35,,120.84,percent of total billed charges,Drugs,115.09,,,115.09,Other,Drug Cost,115.09,,,115.09,Other,Drug Cost,115.09,,,115.09,Other,Drug Cost,115.09,,,115.09,Other,Drug Cost,115.09,,,115.09,Other,Drug Cost,115.09,,,115.09,Other,Drug Cost,258.95,,,258.95,Other,225% of Medicaid,161.13,,,161.13,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,3.43,,,3.43,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",247.44,,,247.44,Other,215% Medicaid APG methodology,247.44,,,247.44,Other,215% Medicaid APG methodology,143.86,,,143.86,Other,125% Medicaid APG methodology,0.01,258.95,
FACTOR X-A INACTIVATED-ZHZO 200MG INJ,J7169,HCPCS,,80023968,CDM,636,RC,69853010201,NDC,both,4,EA,7421.25,2928.93,39.4668,,2928.93,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,2597.44,35,,2597.44,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2523.23,34,,2523.23,percent of total billed charges,Drugs,2523.23,34,,2523.23,percent of total billed charges,Drugs,2523.23,34,,2523.23,percent of total billed charges,Drugs,2523.23,34,,2523.23,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2523.23,34,"If Charge > 500, then 34 percent",2523.23,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2968.5,40,,2968.5,percent of total billed charges,Drugs,5194.88,70,,5194.88,percent of total billed charges,All Other,2671.65,36,,2671.65,percent of total billed charges,Drugs,2671.65,36,,2671.65,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2597.44,35,,2597.44,percent of total billed charges,Drugs,2473.75,,,2473.75,Other,Drug Cost,2473.75,,,2473.75,Other,Drug Cost,2473.75,,,2473.75,Other,Drug Cost,2473.75,,,2473.75,Other,Drug Cost,2473.75,,,2473.75,Other,Drug Cost,2473.75,,,2473.75,Other,Drug Cost,5565.94,,,5565.94,Other,225% of Medicaid,3463.25,,,3463.25,Other,140% of Medicaid,2523.23,34,"If Charge > 2,000, then 34 percent",2523.23,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5318.56,,,5318.56,Other,215% Medicaid APG methodology,5318.56,,,5318.56,Other,215% Medicaid APG methodology,3092.19,,,3092.19,Other,125% Medicaid APG methodology,0.01,5565.94,
RITUXIMAB-PVVR 10MG/ML 10ML,Q5119,HCPCS,,80023969,CDM,636,RC,69023801,NDC,both,1,ML,242.01,201.74,,,201.74,Other,150% of Medicare + 9.63% HCRA Surcharge,122.68,,,122.68,Fee Schedule,Average Sale Price (ASP) x 6,84.7,35,,84.7,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,82.28,34,,82.28,percent of total billed charges,Drugs,82.28,34,,82.28,percent of total billed charges,Drugs,82.28,34,,82.28,percent of total billed charges,Drugs,82.28,34,,82.28,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,96.8,40,,96.8,percent of total billed charges,Drugs,169.41,70,,169.41,percent of total billed charges,All Other,87.12,36,,87.12,percent of total billed charges,Drugs,87.12,36,,87.12,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,84.7,35,,84.7,percent of total billed charges,Drugs,80.67,,,80.67,Other,Drug Cost,80.67,,,80.67,Other,Drug Cost,80.67,,,80.67,Other,Drug Cost,80.67,,,80.67,Other,Drug Cost,80.67,,,80.67,Other,Drug Cost,80.67,,,80.67,Other,Drug Cost,181.51,,,181.51,Other,225% of Medicaid,112.94,,,112.94,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,196.29,,,196.29,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",173.44,,,173.44,Other,215% Medicaid APG methodology,173.44,,,173.44,Other,215% Medicaid APG methodology,100.84,,,100.84,Other,125% Medicaid APG methodology,0.01,201.74,
ISATUXIMAB-IRFC 100MG/5ML,J9227,HCPCS,,80023971,CDM,636,RC,24065401,NDC,both,1,ML,2349.54,754.77,,,754.77,Other,150% of Medicare + 9.63% HCRA Surcharge,458.98,,,458.98,Fee Schedule,Average Sale Price (ASP) x 6,822.34,35,,822.34,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,798.84,34,,798.84,percent of total billed charges,Drugs,798.84,34,,798.84,percent of total billed charges,Drugs,798.84,34,,798.84,percent of total billed charges,Drugs,798.84,34,,798.84,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,798.84,34,"If Charge > 500, then 34 percent",798.84,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,939.82,40,,939.82,percent of total billed charges,Drugs,1644.68,70,,1644.68,percent of total billed charges,All Other,845.83,36,,845.83,percent of total billed charges,Drugs,845.83,36,,845.83,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,822.34,35,,822.34,percent of total billed charges,Drugs,783.18,,,783.18,Other,Drug Cost,783.18,,,783.18,Other,Drug Cost,783.18,,,783.18,Other,Drug Cost,783.18,,,783.18,Other,Drug Cost,783.18,,,783.18,Other,Drug Cost,783.18,,,783.18,Other,Drug Cost,1762.16,,,1762.16,Other,225% of Medicaid,1096.45,,,1096.45,Other,140% of Medicaid,798.84,34,"If Charge > 2,000, then 34 percent",798.84,percent of total billed charges,Drugs,734.37,,,734.37,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1683.84,,,1683.84,Other,215% Medicaid APG methodology,1683.84,,,1683.84,Other,215% Medicaid APG methodology,978.98,,,978.98,Other,125% Medicaid APG methodology,0.01,1762.16,
INFLIXIMAB-DYYB 100MG INJ,Q5103,HCPCS,,80023972,CDM,636,RC,69080901,NDC,both,1,EA,224.4,141.03,,,141.03,Other,150% of Medicare + 9.63% HCRA Surcharge,85.76,,,85.76,Fee Schedule,Average Sale Price (ASP) x 6,78.54,35,,78.54,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,76.3,34,,76.3,percent of total billed charges,Drugs,76.3,34,,76.3,percent of total billed charges,Drugs,76.3,34,,76.3,percent of total billed charges,Drugs,76.3,34,,76.3,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,89.76,40,,89.76,percent of total billed charges,Drugs,157.08,70,,157.08,percent of total billed charges,All Other,80.78,36,,80.78,percent of total billed charges,Drugs,80.78,36,,80.78,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,78.54,35,,78.54,percent of total billed charges,Drugs,74.8,,,74.8,Other,Drug Cost,74.8,,,74.8,Other,Drug Cost,74.8,,,74.8,Other,Drug Cost,74.8,,,74.8,Other,Drug Cost,74.8,,,74.8,Other,Drug Cost,74.8,,,74.8,Other,Drug Cost,168.3,,,168.3,Other,225% of Medicaid,104.72,,,104.72,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,137.22,,,137.22,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",160.82,,,160.82,Other,215% Medicaid APG methodology,160.82,,,160.82,Other,215% Medicaid APG methodology,93.5,,,93.5,Other,125% Medicaid APG methodology,0.01,168.3,
DARZALEX FASPRO 1800MG-30000UN/15ML INJ,J9144,HCPCS,,80023975,CDM,636,RC,57894050301,NDC,both,1,ML,29752.17,483.97,,,483.97,Other,150% of Medicare + 9.63% HCRA Surcharge,294.31,,,294.31,Fee Schedule,Average Sale Price (ASP) x 6,10413.26,35,,10413.26,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,10115.74,34,,10115.74,percent of total billed charges,Drugs,10115.74,34,,10115.74,percent of total billed charges,Drugs,10115.74,34,,10115.74,percent of total billed charges,Drugs,10115.74,34,,10115.74,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,10115.74,34,"If Charge > 500, then 34 percent",10115.74,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,11900.87,40,,11900.87,percent of total billed charges,Drugs,20826.52,70,,20826.52,percent of total billed charges,All Other,10710.78,36,,10710.78,percent of total billed charges,Drugs,10710.78,36,,10710.78,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,10413.26,35,,10413.26,percent of total billed charges,Drugs,9917.39,,,9917.39,Other,Drug Cost,9917.39,,,9917.39,Other,Drug Cost,9917.39,,,9917.39,Other,Drug Cost,9917.39,,,9917.39,Other,Drug Cost,9917.39,,,9917.39,Other,Drug Cost,9917.39,,,9917.39,Other,Drug Cost,22314.13,,,22314.13,Other,225% of Medicaid,13884.35,,,13884.35,Other,140% of Medicaid,10115.74,34,"If Charge > 2,000, then 34 percent",10115.74,percent of total billed charges,Drugs,470.89,,,470.89,Other,160% Medicare Fee Schedule,10115.74,34,,10115.74,Other,"Drug Charges > 20,000, then 34% of Charges",21322.39,,,21322.39,Other,215% Medicaid APG methodology,21322.39,,,21322.39,Other,215% Medicaid APG methodology,12396.74,,,12396.74,Other,125% Medicaid APG methodology,294.31,22314.13,
LEUPROLIDE 30MG INJ,J9217,HCPCS,,80023977,CDM,636,RC,74368303,NDC,both,1,EA,22220.94,1788.85,,,1788.85,Other,150% of Medicare + 9.63% HCRA Surcharge,1087.81,,,1087.81,Fee Schedule,Average Sale Price (ASP) x 6,7777.33,35,,7777.33,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,7555.12,34,,7555.12,percent of total billed charges,Drugs,7555.12,34,,7555.12,percent of total billed charges,Drugs,7555.12,34,,7555.12,percent of total billed charges,Drugs,7555.12,34,,7555.12,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,7555.12,34,"If Charge > 500, then 34 percent",7555.12,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,8888.38,40,,8888.38,percent of total billed charges,Drugs,15554.66,70,,15554.66,percent of total billed charges,All Other,7999.54,36,,7999.54,percent of total billed charges,Drugs,7999.54,36,,7999.54,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,7777.33,35,,7777.33,percent of total billed charges,Drugs,7406.98,,,7406.98,Other,Drug Cost,7406.98,,,7406.98,Other,Drug Cost,7406.98,,,7406.98,Other,Drug Cost,7406.98,,,7406.98,Other,Drug Cost,7406.98,,,7406.98,Other,Drug Cost,7406.98,,,7406.98,Other,Drug Cost,16665.71,,,16665.71,Other,225% of Medicaid,10369.77,,,10369.77,Other,140% of Medicaid,7555.12,34,"If Charge > 2,000, then 34 percent",7555.12,percent of total billed charges,Drugs,1740.5,,,1740.5,Other,160% Medicare Fee Schedule,7555.12,34,,7555.12,Other,"Drug Charges > 20,000, then 34% of Charges",15925.01,,,15925.01,Other,215% Medicaid APG methodology,15925.01,,,15925.01,Other,215% Medicaid APG methodology,9258.73,,,9258.73,Other,125% Medicaid APG methodology,1087.81,16665.71,
USTEKINUMAB 130MG/26ML,J3358,HCPCS,,80023987,CDM,636,RC,57894005427,NDC,both,1,ML,6009.75,124.51,,,124.51,Other,150% of Medicare + 9.63% HCRA Surcharge,75.71,,,75.71,Fee Schedule,Average Sale Price (ASP) x 6,2103.41,35,,2103.41,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2043.32,34,,2043.32,percent of total billed charges,Drugs,2043.32,34,,2043.32,percent of total billed charges,Drugs,2043.32,34,,2043.32,percent of total billed charges,Drugs,2043.32,34,,2043.32,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2043.32,34,"If Charge > 500, then 34 percent",2043.32,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2403.9,40,,2403.9,percent of total billed charges,Drugs,4206.83,70,,4206.83,percent of total billed charges,All Other,2163.51,36,,2163.51,percent of total billed charges,Drugs,2163.51,36,,2163.51,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2103.41,35,,2103.41,percent of total billed charges,Drugs,2003.25,,,2003.25,Other,Drug Cost,2003.25,,,2003.25,Other,Drug Cost,2003.25,,,2003.25,Other,Drug Cost,2003.25,,,2003.25,Other,Drug Cost,2003.25,,,2003.25,Other,Drug Cost,2003.25,,,2003.25,Other,Drug Cost,4507.31,,,4507.31,Other,225% of Medicaid,2804.55,,,2804.55,Other,140% of Medicaid,2043.32,34,"If Charge > 2,000, then 34 percent",2043.32,percent of total billed charges,Drugs,121.14,,,121.14,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4306.99,,,4306.99,Other,215% Medicaid APG methodology,4306.99,,,4306.99,Other,215% Medicaid APG methodology,2504.06,,,2504.06,Other,125% Medicaid APG methodology,0.01,4507.31,
CEFIDEROCOL 1GM,J0693,HCPCS,,80023988,CDM,636,RC,59630026610,NDC,both,10,EA,454.97,179.56,39.4668,,179.56,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,159.24,35,,159.24,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,154.69,34,,154.69,percent of total billed charges,Drugs,154.69,34,,154.69,percent of total billed charges,Drugs,154.69,34,,154.69,percent of total billed charges,Drugs,154.69,34,,154.69,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,181.99,40,,181.99,percent of total billed charges,Drugs,318.48,70,,318.48,percent of total billed charges,All Other,163.79,36,,163.79,percent of total billed charges,Drugs,163.79,36,,163.79,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,159.24,35,,159.24,percent of total billed charges,Drugs,151.66,,,151.66,Other,Drug Cost,151.66,,,151.66,Other,Drug Cost,151.66,,,151.66,Other,Drug Cost,151.66,,,151.66,Other,Drug Cost,151.66,,,151.66,Other,Drug Cost,151.66,,,151.66,Other,Drug Cost,341.23,,,341.23,Other,225% of Medicaid,212.32,,,212.32,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",326.06,,,326.06,Other,215% Medicaid APG methodology,326.06,,,326.06,Other,215% Medicaid APG methodology,189.57,,,189.57,Other,125% Medicaid APG methodology,0.01,341.23,
DARBEPOETIN ALFA NON ESRD 200MCG,J0881,HCPCS,,80023989,CDM,636,RC,55513002801,NDC,both,1,ML,1060.05,28.91,,,28.91,Other,150% of Medicare + 9.63% HCRA Surcharge,17.58,,,17.58,Fee Schedule,Average Sale Price (ASP) x 6,371.02,35,,371.02,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,360.42,34,,360.42,percent of total billed charges,Drugs,360.42,34,,360.42,percent of total billed charges,Drugs,360.42,34,,360.42,percent of total billed charges,Drugs,360.42,34,,360.42,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,360.42,34,"If Charge > 500, then 34 percent",360.42,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,424.02,40,,424.02,percent of total billed charges,Drugs,742.04,70,,742.04,percent of total billed charges,All Other,381.62,36,,381.62,percent of total billed charges,Drugs,381.62,36,,381.62,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,371.02,35,,371.02,percent of total billed charges,Drugs,353.35,,,353.35,Other,Drug Cost,353.35,,,353.35,Other,Drug Cost,353.35,,,353.35,Other,Drug Cost,353.35,,,353.35,Other,Drug Cost,353.35,,,353.35,Other,Drug Cost,353.35,,,353.35,Other,Drug Cost,795.04,,,795.04,Other,225% of Medicaid,494.69,,,494.69,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,28.13,,,28.13,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",759.7,,,759.7,Other,215% Medicaid APG methodology,759.7,,,759.7,Other,215% Medicaid APG methodology,441.69,,,441.69,Other,125% Medicaid APG methodology,0.01,795.04,
BIVALIRUDIN 250 MG VIAL,J0583,HCPCS,,80024002,CDM,636,RC,70860040210,NDC,both,10,EA,104.57,2.11,,,2.11,Other,150% of Medicare + 9.63% HCRA Surcharge,1.28,,,1.28,Fee Schedule,Average Sale Price (ASP) x 6,36.6,35,,36.6,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,35.55,34,,35.55,percent of total billed charges,Drugs,35.55,34,,35.55,percent of total billed charges,Drugs,35.55,34,,35.55,percent of total billed charges,Drugs,35.55,34,,35.55,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,41.83,40,,41.83,percent of total billed charges,Drugs,73.2,70,,73.2,percent of total billed charges,All Other,37.64,36,,37.64,percent of total billed charges,Drugs,37.64,36,,37.64,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,36.6,35,,36.6,percent of total billed charges,Drugs,34.86,,,34.86,Other,Drug Cost,34.86,,,34.86,Other,Drug Cost,34.86,,,34.86,Other,Drug Cost,34.86,,,34.86,Other,Drug Cost,34.86,,,34.86,Other,Drug Cost,34.86,,,34.86,Other,Drug Cost,78.42,,,78.42,Other,225% of Medicaid,48.8,,,48.8,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.05,,,2.05,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",74.94,,,74.94,Other,215% Medicaid APG methodology,74.94,,,74.94,Other,215% Medicaid APG methodology,43.57,,,43.57,Other,125% Medicaid APG methodology,0.01,78.42,
CANGRELOR 50 MG INJ,C9460,HCPCS,,80024003,CDM,636,RC,10122062010,NDC,both,10,EA,1849.99,730.13,39.4668,,730.13,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,647.5,35,,647.5,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,629,34,,629,percent of total billed charges,Drugs,629,34,,629,percent of total billed charges,Drugs,629,34,,629,percent of total billed charges,Drugs,629,34,,629,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,629,34,"If Charge > 500, then 34 percent",629,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,740,40,,740,percent of total billed charges,Drugs,1294.99,70,,1294.99,percent of total billed charges,All Other,666,36,,666,percent of total billed charges,Drugs,666,36,,666,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,647.5,35,,647.5,percent of total billed charges,Drugs,616.66,,,616.66,Other,Drug Cost,616.66,,,616.66,Other,Drug Cost,616.66,,,616.66,Other,Drug Cost,616.66,,,616.66,Other,Drug Cost,616.66,,,616.66,Other,Drug Cost,616.66,,,616.66,Other,Drug Cost,1387.49,,,1387.49,Other,225% of Medicaid,863.33,,,863.33,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1325.83,,,1325.83,Other,215% Medicaid APG methodology,1325.83,,,1325.83,Other,215% Medicaid APG methodology,770.83,,,770.83,Other,125% Medicaid APG methodology,0.01,1387.49,
BEVACIZUMAB-AWWB 25MG/ML 4ML,Q5107,HCPCS,,80024008,CDM,636,RC,55513020601,NDC,both,1,ML,421.5,252.78,,,252.78,Other,150% of Medicare + 9.63% HCRA Surcharge,153.72,,,153.72,Fee Schedule,Average Sale Price (ASP) x 6,147.53,35,,147.53,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,143.31,34,,143.31,percent of total billed charges,Drugs,143.31,34,,143.31,percent of total billed charges,Drugs,143.31,34,,143.31,percent of total billed charges,Drugs,143.31,34,,143.31,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,168.6,40,,168.6,percent of total billed charges,Drugs,295.05,70,,295.05,percent of total billed charges,All Other,151.74,36,,151.74,percent of total billed charges,Drugs,151.74,36,,151.74,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,147.53,35,,147.53,percent of total billed charges,Drugs,140.5,,,140.5,Other,Drug Cost,140.5,,,140.5,Other,Drug Cost,140.5,,,140.5,Other,Drug Cost,140.5,,,140.5,Other,Drug Cost,140.5,,,140.5,Other,Drug Cost,140.5,,,140.5,Other,Drug Cost,316.13,,,316.13,Other,225% of Medicaid,196.7,,,196.7,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,245.95,,,245.95,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",302.08,,,302.08,Other,215% Medicaid APG methodology,302.08,,,302.08,Other,215% Medicaid APG methodology,175.63,,,175.63,Other,125% Medicaid APG methodology,0.01,316.13,
ADENSOINE 90MG/30ML INJ,J0153,HCPCS,,80024010,CDM,636,RC,55150019301,NDC,both,1,ML,51.27,5.93,,,5.93,Other,150% of Medicare + 9.63% HCRA Surcharge,3.61,,,3.61,Fee Schedule,Average Sale Price (ASP) x 6,17.94,35,,17.94,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,17.43,34,,17.43,percent of total billed charges,Drugs,17.43,34,,17.43,percent of total billed charges,Drugs,17.43,34,,17.43,percent of total billed charges,Drugs,17.43,34,,17.43,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,20.51,40,,20.51,percent of total billed charges,Drugs,35.89,70,,35.89,percent of total billed charges,All Other,18.46,36,,18.46,percent of total billed charges,Drugs,18.46,36,,18.46,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,17.94,35,,17.94,percent of total billed charges,Drugs,17.09,,,17.09,Other,Drug Cost,17.09,,,17.09,Other,Drug Cost,17.09,,,17.09,Other,Drug Cost,17.09,,,17.09,Other,Drug Cost,17.09,,,17.09,Other,Drug Cost,17.09,,,17.09,Other,Drug Cost,38.45,,,38.45,Other,225% of Medicaid,23.93,,,23.93,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,5.77,,,5.77,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",36.74,,,36.74,Other,215% Medicaid APG methodology,36.74,,,36.74,Other,215% Medicaid APG methodology,21.36,,,21.36,Other,125% Medicaid APG methodology,0.01,38.45,
RAVULIZUMAB-CWVZ 100MG/ML 11ML,J1303,HCPCS,,80024011,CDM,636,RC,25682002801,NDC,both,1,ML,70443.99,2188.17,,,2188.17,Other,150% of Medicare + 9.63% HCRA Surcharge,1330.64,,,1330.64,Fee Schedule,Average Sale Price (ASP) x 6,24655.4,35,,24655.4,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,23950.96,34,,23950.96,percent of total billed charges,Drugs,23950.96,34,,23950.96,percent of total billed charges,Drugs,23950.96,34,,23950.96,percent of total billed charges,Drugs,23950.96,34,,23950.96,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,23950.96,34,"If Charge > 500, then 34 percent",23950.96,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,28177.6,40,,28177.6,percent of total billed charges,Drugs,49310.79,70,,49310.79,percent of total billed charges,All Other,25359.84,36,,25359.84,percent of total billed charges,Drugs,25359.84,36,,25359.84,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,24655.4,35,,24655.4,percent of total billed charges,Drugs,23481.33,,,23481.33,Other,Drug Cost,23481.33,,,23481.33,Other,Drug Cost,23481.33,,,23481.33,Other,Drug Cost,23481.33,,,23481.33,Other,Drug Cost,23481.33,,,23481.33,Other,Drug Cost,23481.33,,,23481.33,Other,Drug Cost,52832.99,,,52832.99,Other,225% of Medicaid,32873.86,,,32873.86,Other,140% of Medicaid,23950.96,34,"If Charge > 2,000, then 34 percent",23950.96,percent of total billed charges,Drugs,2129.02,,,2129.02,Other,160% Medicare Fee Schedule,23950.96,34,,23950.96,Other,"Drug Charges > 20,000, then 34% of Charges",50484.86,,,50484.86,Other,215% Medicaid APG methodology,50484.86,,,50484.86,Other,215% Medicaid APG methodology,29351.66,,,29351.66,Other,125% Medicaid APG methodology,1330.64,52832.99,
AVELUMAB 20MG/ML 10ML,J9023,HCPCS,,80024015,CDM,636,RC,44087353501,NDC,both,1,ML,5747.13,911.38,,,911.38,Other,150% of Medicare + 9.63% HCRA Surcharge,554.21,,,554.21,Fee Schedule,Average Sale Price (ASP) x 6,2011.5,35,,2011.5,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,1954.02,34,,1954.02,percent of total billed charges,Drugs,1954.02,34,,1954.02,percent of total billed charges,Drugs,1954.02,34,,1954.02,percent of total billed charges,Drugs,1954.02,34,,1954.02,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,1954.02,34,"If Charge > 500, then 34 percent",1954.02,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,2298.85,40,,2298.85,percent of total billed charges,Drugs,4022.99,70,,4022.99,percent of total billed charges,All Other,2068.97,36,,2068.97,percent of total billed charges,Drugs,2068.97,36,,2068.97,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,2011.5,35,,2011.5,percent of total billed charges,Drugs,1915.71,,,1915.71,Other,Drug Cost,1915.71,,,1915.71,Other,Drug Cost,1915.71,,,1915.71,Other,Drug Cost,1915.71,,,1915.71,Other,Drug Cost,1915.71,,,1915.71,Other,Drug Cost,1915.71,,,1915.71,Other,Drug Cost,4310.35,,,4310.35,Other,225% of Medicaid,2681.99,,,2681.99,Other,140% of Medicaid,1954.02,34,"If Charge > 2,000, then 34 percent",1954.02,percent of total billed charges,Drugs,886.74,,,886.74,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",4118.78,,,4118.78,Other,215% Medicaid APG methodology,4118.78,,,4118.78,Other,215% Medicaid APG methodology,2394.64,,,2394.64,Other,125% Medicaid APG methodology,0.01,4310.35,
DOSTARLIMAB-GXLY 50MG/ML 10ML,J9272,HCPCS,,80024017,CDM,636,RC,173089803,NDC,both,1,ML,25487.64,2301.49,,,2301.49,Other,150% of Medicare + 9.63% HCRA Surcharge,1399.55,,,1399.55,Fee Schedule,Average Sale Price (ASP) x 6,8920.67,35,,8920.67,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,8665.8,34,,8665.8,percent of total billed charges,Drugs,8665.8,34,,8665.8,percent of total billed charges,Drugs,8665.8,34,,8665.8,percent of total billed charges,Drugs,8665.8,34,,8665.8,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,8665.8,34,"If Charge > 500, then 34 percent",8665.8,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,10195.06,40,,10195.06,percent of total billed charges,Drugs,17841.35,70,,17841.35,percent of total billed charges,All Other,9175.55,36,,9175.55,percent of total billed charges,Drugs,9175.55,36,,9175.55,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,8920.67,35,,8920.67,percent of total billed charges,Drugs,8495.88,,,8495.88,Other,Drug Cost,8495.88,,,8495.88,Other,Drug Cost,8495.88,,,8495.88,Other,Drug Cost,8495.88,,,8495.88,Other,Drug Cost,8495.88,,,8495.88,Other,Drug Cost,8495.88,,,8495.88,Other,Drug Cost,19115.73,,,19115.73,Other,225% of Medicaid,11894.23,,,11894.23,Other,140% of Medicaid,8665.8,34,"If Charge > 2,000, then 34 percent",8665.8,percent of total billed charges,Drugs,2239.28,,,2239.28,Other,160% Medicare Fee Schedule,8665.8,34,,8665.8,Other,"Drug Charges > 20,000, then 34% of Charges",18266.14,,,18266.14,Other,215% Medicaid APG methodology,18266.14,,,18266.14,Other,215% Medicaid APG methodology,10619.85,,,10619.85,Other,125% Medicaid APG methodology,1399.55,19115.73,
"EPOETIN ALFA-EPBX 20,000 UNIT NON-ESRD",Q5106,HCPCS,,80024019,CDM,636,RC,69131110,NDC,both,10,ML,279.93,77.2,,,77.2,Other,150% of Medicare + 9.63% HCRA Surcharge,46.94,,,46.94,Fee Schedule,Average Sale Price (ASP) x 6,97.98,35,,97.98,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,95.18,34,,95.18,percent of total billed charges,Drugs,95.18,34,,95.18,percent of total billed charges,Drugs,95.18,34,,95.18,percent of total billed charges,Drugs,95.18,34,,95.18,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,111.97,40,,111.97,percent of total billed charges,Drugs,195.95,70,,195.95,percent of total billed charges,All Other,100.78,36,,100.78,percent of total billed charges,Drugs,100.78,36,,100.78,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,97.98,35,,97.98,percent of total billed charges,Drugs,93.31,,,93.31,Other,Drug Cost,93.31,,,93.31,Other,Drug Cost,93.31,,,93.31,Other,Drug Cost,93.31,,,93.31,Other,Drug Cost,93.31,,,93.31,Other,Drug Cost,93.31,,,93.31,Other,Drug Cost,209.95,,,209.95,Other,225% of Medicaid,130.64,,,130.64,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,75.11,,,75.11,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",200.62,,,200.62,Other,215% Medicaid APG methodology,200.62,,,200.62,Other,215% Medicaid APG methodology,116.64,,,116.64,Other,125% Medicaid APG methodology,0.01,209.95,
TRASTUZUMAB-ANNS 150MG,Q5117,HCPCS,,80024023,CDM,636,RC,55513014101,NDC,both,1,EA,131.31,132.71,,,132.71,Other,150% of Medicare + 9.63% HCRA Surcharge,80.7,,,80.7,Fee Schedule,Average Sale Price (ASP) x 6,45.96,35,,45.96,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,44.65,34,,44.65,percent of total billed charges,Drugs,44.65,34,,44.65,percent of total billed charges,Drugs,44.65,34,,44.65,percent of total billed charges,Drugs,44.65,34,,44.65,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,52.52,40,,52.52,percent of total billed charges,Drugs,91.92,70,,91.92,percent of total billed charges,All Other,47.27,36,,47.27,percent of total billed charges,Drugs,47.27,36,,47.27,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,45.96,35,,45.96,percent of total billed charges,Drugs,43.77,,,43.77,Other,Drug Cost,43.77,,,43.77,Other,Drug Cost,43.77,,,43.77,Other,Drug Cost,43.77,,,43.77,Other,Drug Cost,43.77,,,43.77,Other,Drug Cost,43.77,,,43.77,Other,Drug Cost,98.48,,,98.48,Other,225% of Medicaid,61.28,,,61.28,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,129.12,,,129.12,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",94.11,,,94.11,Other,215% Medicaid APG methodology,94.11,,,94.11,Other,215% Medicaid APG methodology,54.71,,,54.71,Other,125% Medicaid APG methodology,0.01,132.71,
SACITUZUMAB GOVITECAN-HZIY 180MG VIAL,J9317,HCPCS,,80024024,CDM,636,RC,55135013201,NDC,both,1,EA,5375.22,336.23,,,336.23,Other,150% of Medicare + 9.63% HCRA Surcharge,204.46,,,204.46,Fee Schedule,Average Sale Price (ASP) x 6,1881.33,35,,1881.33,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,1827.57,34,,1827.57,percent of total billed charges,Drugs,1827.57,34,,1827.57,percent of total billed charges,Drugs,1827.57,34,,1827.57,percent of total billed charges,Drugs,1827.57,34,,1827.57,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,1827.57,34,"If Charge > 500, then 34 percent",1827.57,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,2150.09,40,,2150.09,percent of total billed charges,Drugs,3762.65,70,,3762.65,percent of total billed charges,All Other,1935.08,36,,1935.08,percent of total billed charges,Drugs,1935.08,36,,1935.08,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,1881.33,35,,1881.33,percent of total billed charges,Drugs,1791.74,,,1791.74,Other,Drug Cost,1791.74,,,1791.74,Other,Drug Cost,1791.74,,,1791.74,Other,Drug Cost,1791.74,,,1791.74,Other,Drug Cost,1791.74,,,1791.74,Other,Drug Cost,1791.74,,,1791.74,Other,Drug Cost,4031.42,,,4031.42,Other,225% of Medicaid,2508.44,,,2508.44,Other,140% of Medicaid,1827.57,34,"If Charge > 2,000, then 34 percent",1827.57,percent of total billed charges,Drugs,327.14,,,327.14,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3852.24,,,3852.24,Other,215% Medicaid APG methodology,3852.24,,,3852.24,Other,215% Medicaid APG methodology,2239.68,,,2239.68,Other,125% Medicaid APG methodology,0.01,4031.42,
TAFASITAMAB-CXIX 200MG INJ,J9349,HCPCS,,80024025,CDM,636,RC,73535020801,NDC,both,1,EA,4002.12,134.15,,,134.15,Other,150% of Medicare + 9.63% HCRA Surcharge,81.58,,,81.58,Fee Schedule,Average Sale Price (ASP) x 6,1400.74,35,,1400.74,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1360.72,34,,1360.72,percent of total billed charges,Drugs,1360.72,34,,1360.72,percent of total billed charges,Drugs,1360.72,34,,1360.72,percent of total billed charges,Drugs,1360.72,34,,1360.72,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1360.72,34,"If Charge > 500, then 34 percent",1360.72,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1600.85,40,,1600.85,percent of total billed charges,Drugs,2801.48,70,,2801.48,percent of total billed charges,All Other,1440.76,36,,1440.76,percent of total billed charges,Drugs,1440.76,36,,1440.76,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1400.74,35,,1400.74,percent of total billed charges,Drugs,1334.04,,,1334.04,Other,Drug Cost,1334.04,,,1334.04,Other,Drug Cost,1334.04,,,1334.04,Other,Drug Cost,1334.04,,,1334.04,Other,Drug Cost,1334.04,,,1334.04,Other,Drug Cost,1334.04,,,1334.04,Other,Drug Cost,3001.59,,,3001.59,Other,225% of Medicaid,1867.66,,,1867.66,Other,140% of Medicaid,1360.72,34,"If Charge > 2,000, then 34 percent",1360.72,percent of total billed charges,Drugs,130.52,,,130.52,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2868.19,,,2868.19,Other,215% Medicaid APG methodology,2868.19,,,2868.19,Other,215% Medicaid APG methodology,1667.55,,,1667.55,Other,125% Medicaid APG methodology,0.01,3001.59,
FILGRASTIM 480MCG/0.8ML INJ,J1442,HCPCS,,80024028,CDM,636,RC,55513020991,NDC,both,1,ML,1521.03,9.72,,,9.72,Other,150% of Medicare + 9.63% HCRA Surcharge,5.91,,,5.91,Fee Schedule,Average Sale Price (ASP) x 6,532.36,35,,532.36,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,517.15,34,,517.15,percent of total billed charges,Drugs,517.15,34,,517.15,percent of total billed charges,Drugs,517.15,34,,517.15,percent of total billed charges,Drugs,517.15,34,,517.15,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,517.15,34,"If Charge > 500, then 34 percent",517.15,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,608.41,40,,608.41,percent of total billed charges,Drugs,1064.72,70,,1064.72,percent of total billed charges,All Other,547.57,36,,547.57,percent of total billed charges,Drugs,547.57,36,,547.57,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,532.36,35,,532.36,percent of total billed charges,Drugs,507.01,,,507.01,Other,Drug Cost,507.01,,,507.01,Other,Drug Cost,507.01,,,507.01,Other,Drug Cost,507.01,,,507.01,Other,Drug Cost,507.01,,,507.01,Other,Drug Cost,507.01,,,507.01,Other,Drug Cost,1140.77,,,1140.77,Other,225% of Medicaid,709.81,,,709.81,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,9.46,,,9.46,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1090.07,,,1090.07,Other,215% Medicaid APG methodology,1090.07,,,1090.07,Other,215% Medicaid APG methodology,633.76,,,633.76,Other,125% Medicaid APG methodology,0.01,1140.77,
BEVACIZUMAB-BVZR 25MG/ML,Q5118,HCPCS,,80024032,CDM,636,RC,69031501,NDC,both,1,ML,246.96,212.24,,,212.24,Other,150% of Medicare + 9.63% HCRA Surcharge,129.07,,,129.07,Fee Schedule,Average Sale Price (ASP) x 6,86.44,35,,86.44,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,83.97,34,,83.97,percent of total billed charges,Drugs,83.97,34,,83.97,percent of total billed charges,Drugs,83.97,34,,83.97,percent of total billed charges,Drugs,83.97,34,,83.97,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,98.78,40,,98.78,percent of total billed charges,Drugs,172.87,70,,172.87,percent of total billed charges,All Other,88.91,36,,88.91,percent of total billed charges,Drugs,88.91,36,,88.91,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,86.44,35,,86.44,percent of total billed charges,Drugs,82.32,,,82.32,Other,Drug Cost,82.32,,,82.32,Other,Drug Cost,82.32,,,82.32,Other,Drug Cost,82.32,,,82.32,Other,Drug Cost,82.32,,,82.32,Other,Drug Cost,82.32,,,82.32,Other,Drug Cost,185.22,,,185.22,Other,225% of Medicaid,115.25,,,115.25,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,206.51,,,206.51,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",176.99,,,176.99,Other,215% Medicaid APG methodology,176.99,,,176.99,Other,215% Medicaid APG methodology,102.9,,,102.9,Other,125% Medicaid APG methodology,0.01,212.24,
ENFORTUMAB VEDOTIN-EJFV 30MG INJ,J9177,HCPCS,,80024046,CDM,636,RC,51144003001,NDC,both,1,EA,8495.37,345.61,,,345.61,Other,150% of Medicare + 9.63% HCRA Surcharge,210.17,,,210.17,Fee Schedule,Average Sale Price (ASP) x 6,2973.38,35,,2973.38,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,2888.43,34,,2888.43,percent of total billed charges,Drugs,2888.43,34,,2888.43,percent of total billed charges,Drugs,2888.43,34,,2888.43,percent of total billed charges,Drugs,2888.43,34,,2888.43,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,2888.43,34,"If Charge > 500, then 34 percent",2888.43,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,3398.15,40,,3398.15,percent of total billed charges,Drugs,5946.76,70,,5946.76,percent of total billed charges,All Other,3058.33,36,,3058.33,percent of total billed charges,Drugs,3058.33,36,,3058.33,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,2973.38,35,,2973.38,percent of total billed charges,Drugs,2831.79,,,2831.79,Other,Drug Cost,2831.79,,,2831.79,Other,Drug Cost,2831.79,,,2831.79,Other,Drug Cost,2831.79,,,2831.79,Other,Drug Cost,2831.79,,,2831.79,Other,Drug Cost,2831.79,,,2831.79,Other,Drug Cost,6371.53,,,6371.53,Other,225% of Medicaid,3964.51,,,3964.51,Other,140% of Medicaid,2888.43,34,"If Charge > 2,000, then 34 percent",2888.43,percent of total billed charges,Drugs,336.27,,,336.27,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",6088.35,,,6088.35,Other,215% Medicaid APG methodology,6088.35,,,6088.35,Other,215% Medicaid APG methodology,3539.74,,,3539.74,Other,125% Medicaid APG methodology,0.01,6371.53,
TRILACICLIB 300 MG INJ,J1448,HCPCS,,80024054,CDM,636,RC,73462010101,NDC,both,1,EA,3415.2,51.32,,,51.32,Other,150% of Medicare + 9.63% HCRA Surcharge,31.21,,,31.21,Fee Schedule,Average Sale Price (ASP) x 6,1195.32,35,,1195.32,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1161.17,34,,1161.17,percent of total billed charges,Drugs,1161.17,34,,1161.17,percent of total billed charges,Drugs,1161.17,34,,1161.17,percent of total billed charges,Drugs,1161.17,34,,1161.17,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1161.17,34,"If Charge > 500, then 34 percent",1161.17,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1366.08,40,,1366.08,percent of total billed charges,Drugs,2390.64,70,,2390.64,percent of total billed charges,All Other,1229.47,36,,1229.47,percent of total billed charges,Drugs,1229.47,36,,1229.47,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1195.32,35,,1195.32,percent of total billed charges,Drugs,1138.4,,,1138.4,Other,Drug Cost,1138.4,,,1138.4,Other,Drug Cost,1138.4,,,1138.4,Other,Drug Cost,1138.4,,,1138.4,Other,Drug Cost,1138.4,,,1138.4,Other,Drug Cost,1138.4,,,1138.4,Other,Drug Cost,2561.4,,,2561.4,Other,225% of Medicaid,1593.76,,,1593.76,Other,140% of Medicaid,1161.17,34,"If Charge > 2,000, then 34 percent",1161.17,percent of total billed charges,Drugs,49.93,,,49.93,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2447.56,,,2447.56,Other,215% Medicaid APG methodology,2447.56,,,2447.56,Other,215% Medicaid APG methodology,1423,,,1423,Other,125% Medicaid APG methodology,0.01,2561.4,
DEGARELIX ACETATE 1240MG INJ,J9155,HCPCS,,80024056,CDM,636,RC,55566840301,NDC,both,2,EA,938.64,41.31,,,41.31,Other,150% of Medicare + 9.63% HCRA Surcharge,25.12,,,25.12,Fee Schedule,Average Sale Price (ASP) x 6,328.52,35,,328.52,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,319.14,34,,319.14,percent of total billed charges,Drugs,319.14,34,,319.14,percent of total billed charges,Drugs,319.14,34,,319.14,percent of total billed charges,Drugs,319.14,34,,319.14,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,319.14,34,"If Charge > 500, then 34 percent",319.14,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,375.46,40,,375.46,percent of total billed charges,Drugs,657.05,70,,657.05,percent of total billed charges,All Other,337.91,36,,337.91,percent of total billed charges,Drugs,337.91,36,,337.91,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,328.52,35,,328.52,percent of total billed charges,Drugs,312.88,,,312.88,Other,Drug Cost,312.88,,,312.88,Other,Drug Cost,312.88,,,312.88,Other,Drug Cost,312.88,,,312.88,Other,Drug Cost,312.88,,,312.88,Other,Drug Cost,312.88,,,312.88,Other,Drug Cost,703.98,,,703.98,Other,225% of Medicaid,438.03,,,438.03,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,40.2,,,40.2,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",672.69,,,672.69,Other,215% Medicaid APG methodology,672.69,,,672.69,Other,215% Medicaid APG methodology,391.1,,,391.1,Other,125% Medicaid APG methodology,0.01,703.98,
LURBINECTEDIN 4MG INJ,J9223,HCPCS,,80024057,CDM,636,RC,68727071201,NDC,both,1,EA,23837.07,1973.43,,,1973.43,Other,150% of Medicare + 9.63% HCRA Surcharge,1200.05,,,1200.05,Fee Schedule,Average Sale Price (ASP) x 6,8342.97,35,,8342.97,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,8104.6,34,,8104.6,percent of total billed charges,Drugs,8104.6,34,,8104.6,percent of total billed charges,Drugs,8104.6,34,,8104.6,percent of total billed charges,Drugs,8104.6,34,,8104.6,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,8104.6,34,"If Charge > 500, then 34 percent",8104.6,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,9534.83,40,,9534.83,percent of total billed charges,Drugs,16685.95,70,,16685.95,percent of total billed charges,All Other,8581.35,36,,8581.35,percent of total billed charges,Drugs,8581.35,36,,8581.35,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,8342.97,35,,8342.97,percent of total billed charges,Drugs,7945.69,,,7945.69,Other,Drug Cost,7945.69,,,7945.69,Other,Drug Cost,7945.69,,,7945.69,Other,Drug Cost,7945.69,,,7945.69,Other,Drug Cost,7945.69,,,7945.69,Other,Drug Cost,7945.69,,,7945.69,Other,Drug Cost,17877.8,,,17877.8,Other,225% of Medicaid,11123.97,,,11123.97,Other,140% of Medicaid,8104.6,34,"If Charge > 2,000, then 34 percent",8104.6,percent of total billed charges,Drugs,1920.09,,,1920.09,Other,160% Medicare Fee Schedule,8104.6,34,,8104.6,Other,"Drug Charges > 20,000, then 34% of Charges",17083.23,,,17083.23,Other,215% Medicaid APG methodology,17083.23,,,17083.23,Other,215% Medicaid APG methodology,9932.11,,,9932.11,Other,125% Medicaid APG methodology,1200.05,17877.8,
DEGARELIX 80MG INJ,J9155,HCPCS,,80024058,CDM,636,RC,55566830301,NDC,both,1,EA,650.46,41.31,,,41.31,Other,150% of Medicare + 9.63% HCRA Surcharge,25.12,,,25.12,Fee Schedule,Average Sale Price (ASP) x 6,227.66,35,,227.66,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,221.16,34,,221.16,percent of total billed charges,Drugs,221.16,34,,221.16,percent of total billed charges,Drugs,221.16,34,,221.16,percent of total billed charges,Drugs,221.16,34,,221.16,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,221.16,34,"If Charge > 500, then 34 percent",221.16,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,260.18,40,,260.18,percent of total billed charges,Drugs,455.32,70,,455.32,percent of total billed charges,All Other,234.17,36,,234.17,percent of total billed charges,Drugs,234.17,36,,234.17,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,227.66,35,,227.66,percent of total billed charges,Drugs,216.82,,,216.82,Other,Drug Cost,216.82,,,216.82,Other,Drug Cost,216.82,,,216.82,Other,Drug Cost,216.82,,,216.82,Other,Drug Cost,216.82,,,216.82,Other,Drug Cost,216.82,,,216.82,Other,Drug Cost,487.85,,,487.85,Other,225% of Medicaid,303.55,,,303.55,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,40.2,,,40.2,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",466.16,,,466.16,Other,215% Medicaid APG methodology,466.16,,,466.16,Other,215% Medicaid APG methodology,271.03,,,271.03,Other,125% Medicaid APG methodology,0.01,487.85,
EFGARTIGIMOD ALFA-FCAB 400MG/20ML INJ,J9332,HCPCS,,80024063,CDM,636,RC,73475304105,NDC,both,1,ML,18571.14,316.52,,,316.52,Other,150% of Medicare + 9.63% HCRA Surcharge,192.48,,,192.48,Fee Schedule,Average Sale Price (ASP) x 6,6499.9,35,,6499.9,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,6314.19,34,,6314.19,percent of total billed charges,Drugs,6314.19,34,,6314.19,percent of total billed charges,Drugs,6314.19,34,,6314.19,percent of total billed charges,Drugs,6314.19,34,,6314.19,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,6314.19,34,"If Charge > 500, then 34 percent",6314.19,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,7428.46,40,,7428.46,percent of total billed charges,Drugs,12999.8,70,,12999.8,percent of total billed charges,All Other,6685.61,36,,6685.61,percent of total billed charges,Drugs,6685.61,36,,6685.61,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,6499.9,35,,6499.9,percent of total billed charges,Drugs,6190.38,,,6190.38,Other,Drug Cost,6190.38,,,6190.38,Other,Drug Cost,6190.38,,,6190.38,Other,Drug Cost,6190.38,,,6190.38,Other,Drug Cost,6190.38,,,6190.38,Other,Drug Cost,6190.38,,,6190.38,Other,Drug Cost,13928.36,,,13928.36,Other,225% of Medicaid,8666.53,,,8666.53,Other,140% of Medicaid,6314.19,34,"If Charge > 2,000, then 34 percent",6314.19,percent of total billed charges,Drugs,307.97,,,307.97,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",13309.32,,,13309.32,Other,215% Medicaid APG methodology,13309.32,,,13309.32,Other,215% Medicaid APG methodology,7737.98,,,7737.98,Other,125% Medicaid APG methodology,0.01,13928.36,
AMIODARONE 360MG/200ML,J0282,HCPCS,,80024065,CDM,636,RC,43066036020,NDC,both,10,ML,66.39,26.2,39.4668,,26.2,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,23.24,35,,23.24,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,22.57,34,,22.57,percent of total billed charges,Drugs,22.57,34,,22.57,percent of total billed charges,Drugs,22.57,34,,22.57,percent of total billed charges,Drugs,22.57,34,,22.57,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,26.56,40,,26.56,percent of total billed charges,Drugs,46.48,70,,46.48,percent of total billed charges,All Other,23.9,36,,23.9,percent of total billed charges,Drugs,23.9,36,,23.9,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,23.24,35,,23.24,percent of total billed charges,Drugs,22.13,,,22.13,Other,Drug Cost,22.13,,,22.13,Other,Drug Cost,22.13,,,22.13,Other,Drug Cost,22.13,,,22.13,Other,Drug Cost,22.13,,,22.13,Other,Drug Cost,22.13,,,22.13,Other,Drug Cost,49.79,,,49.79,Other,225% of Medicaid,30.98,,,30.98,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",47.58,,,47.58,Other,215% Medicaid APG methodology,47.58,,,47.58,Other,215% Medicaid APG methodology,27.66,,,27.66,Other,125% Medicaid APG methodology,0.01,49.79,
BUPIVACAINE/MELOXICAM ER 400MG/12MG SOLN,C9088,HCPCS,,80024066,CDM,636,RC,47426030102,NDC,both,1,ML,609.51,240.55,39.4668,,240.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,213.33,35,,213.33,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,207.23,34,,207.23,percent of total billed charges,Drugs,207.23,34,,207.23,percent of total billed charges,Drugs,207.23,34,,207.23,percent of total billed charges,Drugs,207.23,34,,207.23,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,207.23,34,"If Charge > 500, then 34 percent",207.23,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,243.8,40,,243.8,percent of total billed charges,Drugs,426.66,70,,426.66,percent of total billed charges,All Other,219.42,36,,219.42,percent of total billed charges,Drugs,219.42,36,,219.42,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,213.33,35,,213.33,percent of total billed charges,Drugs,203.17,,,203.17,Other,Drug Cost,203.17,,,203.17,Other,Drug Cost,203.17,,,203.17,Other,Drug Cost,203.17,,,203.17,Other,Drug Cost,203.17,,,203.17,Other,Drug Cost,203.17,,,203.17,Other,Drug Cost,457.13,,,457.13,Other,225% of Medicaid,284.44,,,284.44,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",436.82,,,436.82,Other,215% Medicaid APG methodology,436.82,,,436.82,Other,215% Medicaid APG methodology,253.96,,,253.96,Other,125% Medicaid APG methodology,0.01,457.13,
BUPIVACIANE/MELOXICAM ER 200MG/6MG SOLN,C9088,HCPCS,,80024067,CDM,636,RC,47426030301,NDC,both,1,ML,309.24,122.05,39.4668,,122.05,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,108.23,35,,108.23,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,105.14,34,,105.14,percent of total billed charges,Drugs,105.14,34,,105.14,percent of total billed charges,Drugs,105.14,34,,105.14,percent of total billed charges,Drugs,105.14,34,,105.14,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,123.7,40,,123.7,percent of total billed charges,Drugs,216.47,70,,216.47,percent of total billed charges,All Other,111.33,36,,111.33,percent of total billed charges,Drugs,111.33,36,,111.33,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,108.23,35,,108.23,percent of total billed charges,Drugs,103.08,,,103.08,Other,Drug Cost,103.08,,,103.08,Other,Drug Cost,103.08,,,103.08,Other,Drug Cost,103.08,,,103.08,Other,Drug Cost,103.08,,,103.08,Other,Drug Cost,103.08,,,103.08,Other,Drug Cost,231.93,,,231.93,Other,225% of Medicaid,144.31,,,144.31,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",221.62,,,221.62,Other,215% Medicaid APG methodology,221.62,,,221.62,Other,215% Medicaid APG methodology,128.85,,,128.85,Other,125% Medicaid APG methodology,0.01,231.93,
LUSPATERCEPT-AAMT 25 MG INJ,J0896,HCPCS,,80024069,CDM,636,RC,59572071101,NDC,both,1,EA,11735.73,394.38,,,394.38,Other,150% of Medicare + 9.63% HCRA Surcharge,239.83,,,239.83,Fee Schedule,Average Sale Price (ASP) x 6,4107.51,35,,4107.51,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,3990.15,34,,3990.15,percent of total billed charges,Drugs,3990.15,34,,3990.15,percent of total billed charges,Drugs,3990.15,34,,3990.15,percent of total billed charges,Drugs,3990.15,34,,3990.15,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,3990.15,34,"If Charge > 500, then 34 percent",3990.15,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,4694.29,40,,4694.29,percent of total billed charges,Drugs,8215.01,70,,8215.01,percent of total billed charges,All Other,4224.86,36,,4224.86,percent of total billed charges,Drugs,4224.86,36,,4224.86,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,4107.51,35,,4107.51,percent of total billed charges,Drugs,3911.91,,,3911.91,Other,Drug Cost,3911.91,,,3911.91,Other,Drug Cost,3911.91,,,3911.91,Other,Drug Cost,3911.91,,,3911.91,Other,Drug Cost,3911.91,,,3911.91,Other,Drug Cost,3911.91,,,3911.91,Other,Drug Cost,8801.8,,,8801.8,Other,225% of Medicaid,5476.67,,,5476.67,Other,140% of Medicaid,3990.15,34,"If Charge > 2,000, then 34 percent",3990.15,percent of total billed charges,Drugs,383.72,,,383.72,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8410.61,,,8410.61,Other,215% Medicaid APG methodology,8410.61,,,8410.61,Other,215% Medicaid APG methodology,4889.89,,,4889.89,Other,125% Medicaid APG methodology,0.01,8801.8,
PNEUMOCOCCAL 20 VALENT CONJUGATED VACC,90677,HCPCS,,80024076,CDM,636,RC,5200010,NDC,both,10,ML,682.7,269.44,39.4668,,269.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,238.95,35,,238.95,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,232.12,34,,232.12,percent of total billed charges,Drugs,232.12,34,,232.12,percent of total billed charges,Drugs,232.12,34,,232.12,percent of total billed charges,Drugs,232.12,34,,232.12,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,232.12,34,"If Charge > 500, then 34 percent",232.12,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,273.08,40,,273.08,percent of total billed charges,Drugs,477.89,70,,477.89,percent of total billed charges,All Other,245.77,36,,245.77,percent of total billed charges,Drugs,245.77,36,,245.77,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,238.95,35,,238.95,percent of total billed charges,Drugs,227.57,,,227.57,Other,Drug Cost,227.57,,,227.57,Other,Drug Cost,227.57,,,227.57,Other,Drug Cost,227.57,,,227.57,Other,Drug Cost,227.57,,,227.57,Other,Drug Cost,227.57,,,227.57,Other,Drug Cost,512.03,,,512.03,Other,225% of Medicaid,318.59,,,318.59,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",489.27,,,489.27,Other,215% Medicaid APG methodology,489.27,,,489.27,Other,215% Medicaid APG methodology,284.46,,,284.46,Other,125% Medicaid APG methodology,0.01,512.03,
"EPOETIN ALFA-EPBX 10,000 UNIT",Q5106,HCPCS,,80024077,CDM,636,RC,69130810,NDC,both,10,ML,43.94,77.2,,,77.2,Other,150% of Medicare + 9.63% HCRA Surcharge,46.94,,,46.94,Fee Schedule,Average Sale Price (ASP) x 6,15.38,35,,15.38,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,14.94,34,,14.94,percent of total billed charges,Drugs,14.94,34,,14.94,percent of total billed charges,Drugs,14.94,34,,14.94,percent of total billed charges,Drugs,14.94,34,,14.94,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,17.58,40,,17.58,percent of total billed charges,Drugs,30.76,70,,30.76,percent of total billed charges,All Other,15.82,36,,15.82,percent of total billed charges,Drugs,15.82,36,,15.82,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,15.38,35,,15.38,percent of total billed charges,Drugs,14.65,,,14.65,Other,Drug Cost,14.65,,,14.65,Other,Drug Cost,14.65,,,14.65,Other,Drug Cost,14.65,,,14.65,Other,Drug Cost,14.65,,,14.65,Other,Drug Cost,14.65,,,14.65,Other,Drug Cost,32.96,,,32.96,Other,225% of Medicaid,20.51,,,20.51,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,75.11,,,75.11,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",31.49,,,31.49,Other,215% Medicaid APG methodology,31.49,,,31.49,Other,215% Medicaid APG methodology,18.31,,,18.31,Other,125% Medicaid APG methodology,0.01,77.2,
DARBEPOETIN ALFA 300MCG/0.6ML NON-ESRD,J0881,HCPCS,,80024080,CDM,636,RC,55513011101,NDC,both,1,ML,1608.87,28.91,,,28.91,Other,150% of Medicare + 9.63% HCRA Surcharge,17.58,,,17.58,Fee Schedule,Average Sale Price (ASP) x 6,563.1,35,,563.1,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,547.02,34,,547.02,percent of total billed charges,Drugs,547.02,34,,547.02,percent of total billed charges,Drugs,547.02,34,,547.02,percent of total billed charges,Drugs,547.02,34,,547.02,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,547.02,34,"If Charge > 500, then 34 percent",547.02,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,643.55,40,,643.55,percent of total billed charges,Drugs,1126.21,70,,1126.21,percent of total billed charges,All Other,579.19,36,,579.19,percent of total billed charges,Drugs,579.19,36,,579.19,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,563.1,35,,563.1,percent of total billed charges,Drugs,536.29,,,536.29,Other,Drug Cost,536.29,,,536.29,Other,Drug Cost,536.29,,,536.29,Other,Drug Cost,536.29,,,536.29,Other,Drug Cost,536.29,,,536.29,Other,Drug Cost,536.29,,,536.29,Other,Drug Cost,1206.65,,,1206.65,Other,225% of Medicaid,750.81,,,750.81,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,28.13,,,28.13,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",1153.02,,,1153.02,Other,215% Medicaid APG methodology,1153.02,,,1153.02,Other,215% Medicaid APG methodology,670.36,,,670.36,Other,125% Medicaid APG methodology,0.01,1206.65,
EPTINEZUMAB-JJMR 100MG/ML INJ,J3032,HCPCS,,80024086,CDM,636,RC,67386013051,NDC,both,1,ML,4016.04,178.18,,,178.18,Other,150% of Medicare + 9.63% HCRA Surcharge,108.35,,,108.35,Fee Schedule,Average Sale Price (ASP) x 6,1405.61,35,,1405.61,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1365.45,34,,1365.45,percent of total billed charges,Drugs,1365.45,34,,1365.45,percent of total billed charges,Drugs,1365.45,34,,1365.45,percent of total billed charges,Drugs,1365.45,34,,1365.45,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1365.45,34,"If Charge > 500, then 34 percent",1365.45,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1606.42,40,,1606.42,percent of total billed charges,Drugs,2811.23,70,,2811.23,percent of total billed charges,All Other,1445.77,36,,1445.77,percent of total billed charges,Drugs,1445.77,36,,1445.77,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1405.61,35,,1405.61,percent of total billed charges,Drugs,1338.68,,,1338.68,Other,Drug Cost,1338.68,,,1338.68,Other,Drug Cost,1338.68,,,1338.68,Other,Drug Cost,1338.68,,,1338.68,Other,Drug Cost,1338.68,,,1338.68,Other,Drug Cost,1338.68,,,1338.68,Other,Drug Cost,3012.03,,,3012.03,Other,225% of Medicaid,1874.15,,,1874.15,Other,140% of Medicaid,1365.45,34,"If Charge > 2,000, then 34 percent",1365.45,percent of total billed charges,Drugs,173.37,,,173.37,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",2878.16,,,2878.16,Other,215% Medicaid APG methodology,2878.16,,,2878.16,Other,215% Medicaid APG methodology,1673.35,,,1673.35,Other,125% Medicaid APG methodology,0.01,3012.03,
CALCIUM GLUCONATE 2GM/100ML,J0613,HCPCS,,80024092,CDM,636,RC,44567062124,NDC,both,24,ML,37.66,0.88,,,0.88,Other,150% of Medicare + 9.63% HCRA Surcharge,0.53,,,0.53,Fee Schedule,Average Sale Price (ASP) x 6,13.18,35,,13.18,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,12.81,34,,12.81,percent of total billed charges,Drugs,12.81,34,,12.81,percent of total billed charges,Drugs,12.81,34,,12.81,percent of total billed charges,Drugs,12.81,34,,12.81,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,15.07,40,,15.07,percent of total billed charges,Drugs,26.36,70,,26.36,percent of total billed charges,All Other,13.56,36,,13.56,percent of total billed charges,Drugs,13.56,36,,13.56,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,13.18,35,,13.18,percent of total billed charges,Drugs,12.55,,,12.55,Other,Drug Cost,12.55,,,12.55,Other,Drug Cost,12.55,,,12.55,Other,Drug Cost,12.55,,,12.55,Other,Drug Cost,12.55,,,12.55,Other,Drug Cost,12.55,,,12.55,Other,Drug Cost,28.25,,,28.25,Other,225% of Medicaid,17.58,,,17.58,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.85,,,0.85,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",26.99,,,26.99,Other,215% Medicaid APG methodology,26.99,,,26.99,Other,215% Medicaid APG methodology,15.69,,,15.69,Other,125% Medicaid APG methodology,0.01,28.25,
POLATUZUMAB VEDOTIN-PIIQ 140MG INJ,J9309,HCPCS,,80024098,CDM,636,RC,50242010501,NDC,both,1,EA,53638.8,1226.32,,,1226.32,Other,150% of Medicare + 9.63% HCRA Surcharge,745.73,,,745.73,Fee Schedule,Average Sale Price (ASP) x 6,18773.58,35,,18773.58,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,18237.19,34,,18237.19,percent of total billed charges,Drugs,18237.19,34,,18237.19,percent of total billed charges,Drugs,18237.19,34,,18237.19,percent of total billed charges,Drugs,18237.19,34,,18237.19,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,18237.19,34,"If Charge > 500, then 34 percent",18237.19,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,21455.52,40,,21455.52,percent of total billed charges,Drugs,37547.16,70,,37547.16,percent of total billed charges,All Other,19309.97,36,,19309.97,percent of total billed charges,Drugs,19309.97,36,,19309.97,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,18773.58,35,,18773.58,percent of total billed charges,Drugs,17879.6,,,17879.6,Other,Drug Cost,17879.6,,,17879.6,Other,Drug Cost,17879.6,,,17879.6,Other,Drug Cost,17879.6,,,17879.6,Other,Drug Cost,17879.6,,,17879.6,Other,Drug Cost,17879.6,,,17879.6,Other,Drug Cost,40229.1,,,40229.1,Other,225% of Medicaid,25031.44,,,25031.44,Other,140% of Medicaid,18237.19,34,"If Charge > 2,000, then 34 percent",18237.19,percent of total billed charges,Drugs,1193.17,,,1193.17,Other,160% Medicare Fee Schedule,18237.19,34,,18237.19,Other,"Drug Charges > 20,000, then 34% of Charges",38441.14,,,38441.14,Other,215% Medicaid APG methodology,38441.14,,,38441.14,Other,215% Medicaid APG methodology,22349.5,,,22349.5,Other,125% Medicaid APG methodology,745.73,40229.1,
POLATUZUMAB VEDOTIN-PIIQ 30MG INJ,J9309,HCPCS,,80024099,CDM,636,RC,50242010301,NDC,both,1,EA,11494.05,1226.32,,,1226.32,Other,150% of Medicare + 9.63% HCRA Surcharge,745.73,,,745.73,Fee Schedule,Average Sale Price (ASP) x 6,4022.92,35,,4022.92,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,3907.98,34,,3907.98,percent of total billed charges,Drugs,3907.98,34,,3907.98,percent of total billed charges,Drugs,3907.98,34,,3907.98,percent of total billed charges,Drugs,3907.98,34,,3907.98,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,3907.98,34,"If Charge > 500, then 34 percent",3907.98,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,4597.62,40,,4597.62,percent of total billed charges,Drugs,8045.84,70,,8045.84,percent of total billed charges,All Other,4137.86,36,,4137.86,percent of total billed charges,Drugs,4137.86,36,,4137.86,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,4022.92,35,,4022.92,percent of total billed charges,Drugs,3831.35,,,3831.35,Other,Drug Cost,3831.35,,,3831.35,Other,Drug Cost,3831.35,,,3831.35,Other,Drug Cost,3831.35,,,3831.35,Other,Drug Cost,3831.35,,,3831.35,Other,Drug Cost,3831.35,,,3831.35,Other,Drug Cost,8620.54,,,8620.54,Other,225% of Medicaid,5363.89,,,5363.89,Other,140% of Medicaid,3907.98,34,"If Charge > 2,000, then 34 percent",3907.98,percent of total billed charges,Drugs,1193.17,,,1193.17,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",8237.4,,,8237.4,Other,215% Medicaid APG methodology,8237.4,,,8237.4,Other,215% Medicaid APG methodology,4789.19,,,4789.19,Other,125% Medicaid APG methodology,0.01,8620.54,
GLUCAGON 1MG VIAL,J1611,HCPCS,,80024101,CDM,636,RC,63323059613,NDC,both,10,EA,271.05,1221.79,,,1221.79,Other,150% of Medicare + 9.63% HCRA Surcharge,742.98,,,742.98,Fee Schedule,Average Sale Price (ASP) x 6,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,92.16,34,,92.16,percent of total billed charges,Drugs,92.16,34,,92.16,percent of total billed charges,Drugs,92.16,34,,92.16,percent of total billed charges,Drugs,92.16,34,,92.16,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,108.42,40,,108.42,percent of total billed charges,Drugs,189.73,70,,189.73,percent of total billed charges,All Other,97.58,36,,97.58,percent of total billed charges,Drugs,97.58,36,,97.58,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,94.87,35,,94.87,percent of total billed charges,Drugs,90.35,,,90.35,Other,Drug Cost,90.35,,,90.35,Other,Drug Cost,90.35,,,90.35,Other,Drug Cost,90.35,,,90.35,Other,Drug Cost,90.35,,,90.35,Other,Drug Cost,90.35,,,90.35,Other,Drug Cost,203.29,,,203.29,Other,225% of Medicaid,126.49,,,126.49,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,1188.77,,,1188.77,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",194.25,,,194.25,Other,215% Medicaid APG methodology,194.25,,,194.25,Other,215% Medicaid APG methodology,112.94,,,112.94,Other,125% Medicaid APG methodology,0.01,1221.79,
FONDAPARINUX 5 MG/ 0.4ML INJ,J1652,HCPCS,,80024103,CDM,636,RC,55111067910,NDC,both,10,ML,39.64,10.78,,,10.78,Other,150% of Medicare + 9.63% HCRA Surcharge,6.56,,,6.56,Fee Schedule,Average Sale Price (ASP) x 6,13.87,35,,13.87,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,13.48,34,,13.48,percent of total billed charges,Drugs,13.48,34,,13.48,percent of total billed charges,Drugs,13.48,34,,13.48,percent of total billed charges,Drugs,13.48,34,,13.48,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,15.86,40,,15.86,percent of total billed charges,Drugs,27.75,70,,27.75,percent of total billed charges,All Other,14.27,36,,14.27,percent of total billed charges,Drugs,14.27,36,,14.27,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,13.87,35,,13.87,percent of total billed charges,Drugs,13.21,,,13.21,Other,Drug Cost,13.21,,,13.21,Other,Drug Cost,13.21,,,13.21,Other,Drug Cost,13.21,,,13.21,Other,Drug Cost,13.21,,,13.21,Other,Drug Cost,13.21,,,13.21,Other,Drug Cost,29.73,,,29.73,Other,225% of Medicaid,18.5,,,18.5,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,10.49,,,10.49,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",28.41,,,28.41,Other,215% Medicaid APG methodology,28.41,,,28.41,Other,215% Medicaid APG methodology,16.52,,,16.52,Other,125% Medicaid APG methodology,0.01,29.73,
FILGRASTIM-AAFI 480MCG/0.8ML,Q5110,HCPCS,,80024105,CDM,636,RC,69029201,NDC,both,1,ML,222.72,2.87,,,2.87,Other,150% of Medicare + 9.63% HCRA Surcharge,1.75,,,1.75,Fee Schedule,Average Sale Price (ASP) x 6,77.95,35,,77.95,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,75.72,34,,75.72,percent of total billed charges,Drugs,75.72,34,,75.72,percent of total billed charges,Drugs,75.72,34,,75.72,percent of total billed charges,Drugs,75.72,34,,75.72,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,89.09,40,,89.09,percent of total billed charges,Drugs,155.9,70,,155.9,percent of total billed charges,All Other,80.18,36,,80.18,percent of total billed charges,Drugs,80.18,36,,80.18,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,77.95,35,,77.95,percent of total billed charges,Drugs,74.24,,,74.24,Other,Drug Cost,74.24,,,74.24,Other,Drug Cost,74.24,,,74.24,Other,Drug Cost,74.24,,,74.24,Other,Drug Cost,74.24,,,74.24,Other,Drug Cost,74.24,,,74.24,Other,Drug Cost,167.04,,,167.04,Other,225% of Medicaid,103.94,,,103.94,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.79,,,2.79,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",159.62,,,159.62,Other,215% Medicaid APG methodology,159.62,,,159.62,Other,215% Medicaid APG methodology,92.8,,,92.8,Other,125% Medicaid APG methodology,0.01,167.04,
RITUXIMAB-ABBS 10MG/ML 10 ML,Q5115,HCPCS,,80024107,CDM,636,RC,63459010310,NDC,both,1,ML,372.6,354.14,,,354.14,Other,150% of Medicare + 9.63% HCRA Surcharge,215.35,,,215.35,Fee Schedule,Average Sale Price (ASP) x 6,130.41,35,,130.41,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,126.68,34,,126.68,percent of total billed charges,Drugs,126.68,34,,126.68,percent of total billed charges,Drugs,126.68,34,,126.68,percent of total billed charges,Drugs,126.68,34,,126.68,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,149.04,40,,149.04,percent of total billed charges,Drugs,260.82,70,,260.82,percent of total billed charges,All Other,134.14,36,,134.14,percent of total billed charges,Drugs,134.14,36,,134.14,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,130.41,35,,130.41,percent of total billed charges,Drugs,124.2,,,124.2,Other,Drug Cost,124.2,,,124.2,Other,Drug Cost,124.2,,,124.2,Other,Drug Cost,124.2,,,124.2,Other,Drug Cost,124.2,,,124.2,Other,Drug Cost,124.2,,,124.2,Other,Drug Cost,279.45,,,279.45,Other,225% of Medicaid,173.88,,,173.88,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,344.56,,,344.56,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",267.03,,,267.03,Other,215% Medicaid APG methodology,267.03,,,267.03,Other,215% Medicaid APG methodology,155.25,,,155.25,Other,125% Medicaid APG methodology,0.01,354.14,
"EPOETIN ALFA-EPBX 20,000 UN/ 2ML",Q5106,HCPCS,,80024111,CDM,636,RC,69131810,NDC,both,10,ML,87.89,77.2,,,77.2,Other,150% of Medicare + 9.63% HCRA Surcharge,46.94,,,46.94,Fee Schedule,Average Sale Price (ASP) x 6,30.76,35,,30.76,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,29.88,34,,29.88,percent of total billed charges,Drugs,29.88,34,,29.88,percent of total billed charges,Drugs,29.88,34,,29.88,percent of total billed charges,Drugs,29.88,34,,29.88,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,35.16,40,,35.16,percent of total billed charges,Drugs,61.52,70,,61.52,percent of total billed charges,All Other,31.64,36,,31.64,percent of total billed charges,Drugs,31.64,36,,31.64,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,30.76,35,,30.76,percent of total billed charges,Drugs,29.3,,,29.3,Other,Drug Cost,29.3,,,29.3,Other,Drug Cost,29.3,,,29.3,Other,Drug Cost,29.3,,,29.3,Other,Drug Cost,29.3,,,29.3,Other,Drug Cost,29.3,,,29.3,Other,Drug Cost,65.92,,,65.92,Other,225% of Medicaid,41.01,,,41.01,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,75.11,,,75.11,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",62.99,,,62.99,Other,215% Medicaid APG methodology,62.99,,,62.99,Other,215% Medicaid APG methodology,36.62,,,36.62,Other,125% Medicaid APG methodology,0.01,77.2,
"Mening Vac A,CY,W135 10mcg/0.5mL",90619,HCPCS,,80024112,CDM,636,RC,49281059005,NDC,both,5,ML,432.35,170.64,39.4668,,170.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,151.32,35,,151.32,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,147,34,,147,percent of total billed charges,Drugs,147,34,,147,percent of total billed charges,Drugs,147,34,,147,percent of total billed charges,Drugs,147,34,,147,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,172.94,40,,172.94,percent of total billed charges,Drugs,302.65,70,,302.65,percent of total billed charges,All Other,155.65,36,,155.65,percent of total billed charges,Drugs,155.65,36,,155.65,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,151.32,35,,151.32,percent of total billed charges,Drugs,144.12,,,144.12,Other,Drug Cost,144.12,,,144.12,Other,Drug Cost,144.12,,,144.12,Other,Drug Cost,144.12,,,144.12,Other,Drug Cost,144.12,,,144.12,Other,Drug Cost,144.12,,,144.12,Other,Drug Cost,324.27,,,324.27,Other,225% of Medicaid,201.77,,,201.77,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",309.85,,,309.85,Other,215% Medicaid APG methodology,309.85,,,309.85,Other,215% Medicaid APG methodology,180.15,,,180.15,Other,125% Medicaid APG methodology,0.01,324.27,
GLATIRAMER ACETATE 40MG INJ,J1595,HCPCS,,80024119,CDM,636,RC,68546032512,NDC,both,12,ML,1392.39,549.53,39.4668,,549.53,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,487.34,35,,487.34,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,473.41,34,,473.41,percent of total billed charges,Drugs,473.41,34,,473.41,percent of total billed charges,Drugs,473.41,34,,473.41,percent of total billed charges,Drugs,473.41,34,,473.41,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,473.41,34,"If Charge > 500, then 34 percent",473.41,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,556.96,40,,556.96,percent of total billed charges,Drugs,974.67,70,,974.67,percent of total billed charges,All Other,501.26,36,,501.26,percent of total billed charges,Drugs,501.26,36,,501.26,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,487.34,35,,487.34,percent of total billed charges,Drugs,464.13,,,464.13,Other,Drug Cost,464.13,,,464.13,Other,Drug Cost,464.13,,,464.13,Other,Drug Cost,464.13,,,464.13,Other,Drug Cost,464.13,,,464.13,Other,Drug Cost,464.13,,,464.13,Other,Drug Cost,1044.29,,,1044.29,Other,225% of Medicaid,649.78,,,649.78,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",997.88,,,997.88,Other,215% Medicaid APG methodology,997.88,,,997.88,Other,215% Medicaid APG methodology,580.16,,,580.16,Other,125% Medicaid APG methodology,0.01,1044.29,
RABIES IMMUNE GLOBULIN 150 UNITS/ML,90377,HCPCS,,80024122,CDM,636,RC,76125015002,NDC,both,1,ML,1152.09,454.69,39.4668,,454.69,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,403.23,35,,403.23,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,391.71,34,,391.71,percent of total billed charges,Drugs,391.71,34,,391.71,percent of total billed charges,Drugs,391.71,34,,391.71,percent of total billed charges,Drugs,391.71,34,,391.71,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,391.71,34,"If Charge > 500, then 34 percent",391.71,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,460.84,40,,460.84,percent of total billed charges,Drugs,806.46,70,,806.46,percent of total billed charges,All Other,414.75,36,,414.75,percent of total billed charges,Drugs,414.75,36,,414.75,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,403.23,35,,403.23,percent of total billed charges,Drugs,384.03,,,384.03,Other,Drug Cost,384.03,,,384.03,Other,Drug Cost,384.03,,,384.03,Other,Drug Cost,384.03,,,384.03,Other,Drug Cost,384.03,,,384.03,Other,Drug Cost,384.03,,,384.03,Other,Drug Cost,864.07,,,864.07,Other,225% of Medicaid,537.64,,,537.64,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",825.66,,,825.66,Other,215% Medicaid APG methodology,825.66,,,825.66,Other,215% Medicaid APG methodology,480.04,,,480.04,Other,125% Medicaid APG methodology,0.01,864.07,
BIVALIRUDIN 5MG/ML 50ML,J0583,HCPCS,,80024125,CDM,636,RC,42023062210,NDC,both,10,ML,67.94,2.11,,,2.11,Other,150% of Medicare + 9.63% HCRA Surcharge,1.28,,,1.28,Fee Schedule,Average Sale Price (ASP) x 6,23.78,35,,23.78,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,23.1,34,,23.1,percent of total billed charges,Drugs,23.1,34,,23.1,percent of total billed charges,Drugs,23.1,34,,23.1,percent of total billed charges,Drugs,23.1,34,,23.1,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,27.18,40,,27.18,percent of total billed charges,Drugs,47.56,70,,47.56,percent of total billed charges,All Other,24.46,36,,24.46,percent of total billed charges,Drugs,24.46,36,,24.46,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,23.78,35,,23.78,percent of total billed charges,Drugs,22.65,,,22.65,Other,Drug Cost,22.65,,,22.65,Other,Drug Cost,22.65,,,22.65,Other,Drug Cost,22.65,,,22.65,Other,Drug Cost,22.65,,,22.65,Other,Drug Cost,22.65,,,22.65,Other,Drug Cost,50.96,,,50.96,Other,225% of Medicaid,31.71,,,31.71,Other,140% of Medicaid,0.01,34,"If Charge > 2,000, then 34 percent",0.01,percent of total billed charges,Drugs,2.05,,,2.05,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",48.69,,,48.69,Other,215% Medicaid APG methodology,48.69,,,48.69,Other,215% Medicaid APG methodology,28.31,,,28.31,Other,125% Medicaid APG methodology,0.01,50.96,
MARGETUXIMAB-CMKB 25 MG/ML 10 ML VIAL,J9353,HCPCS,,80024127,CDM,636,RC,74527002202,NDC,both,1,ML,5183.31,464.24,,,464.24,Other,150% of Medicare + 9.63% HCRA Surcharge,282.31,,,282.31,Fee Schedule,Average Sale Price (ASP) x 6,1814.16,35,,1814.16,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,1762.33,34,,1762.33,percent of total billed charges,Drugs,1762.33,34,,1762.33,percent of total billed charges,Drugs,1762.33,34,,1762.33,percent of total billed charges,Drugs,1762.33,34,,1762.33,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,1762.33,34,"If Charge > 500, then 34 percent",1762.33,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,2073.32,40,,2073.32,percent of total billed charges,Drugs,3628.32,70,,3628.32,percent of total billed charges,All Other,1865.99,36,,1865.99,percent of total billed charges,Drugs,1865.99,36,,1865.99,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,1814.16,35,,1814.16,percent of total billed charges,Drugs,1727.77,,,1727.77,Other,Drug Cost,1727.77,,,1727.77,Other,Drug Cost,1727.77,,,1727.77,Other,Drug Cost,1727.77,,,1727.77,Other,Drug Cost,1727.77,,,1727.77,Other,Drug Cost,1727.77,,,1727.77,Other,Drug Cost,3887.48,,,3887.48,Other,225% of Medicaid,2418.88,,,2418.88,Other,140% of Medicaid,1762.33,34,"If Charge > 2,000, then 34 percent",1762.33,percent of total billed charges,Drugs,451.69,,,451.69,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",3714.71,,,3714.71,Other,215% Medicaid APG methodology,3714.71,,,3714.71,Other,215% Medicaid APG methodology,2159.71,,,2159.71,Other,125% Medicaid APG methodology,0.01,3887.48,
ALPROSTADIL 500MCG INJ,J0270,HCPCS,,80000071,CDM,637,RC,9316906,NDC,both,5,ML,260.61,102.85,39.4668,,102.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,91.21,35,,91.21,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,88.61,34,,88.61,percent of total billed charges,Drugs,88.61,34,,88.61,percent of total billed charges,Drugs,88.61,34,,88.61,percent of total billed charges,Drugs,88.61,34,,88.61,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,104.24,40,,104.24,percent of total billed charges,Drugs,182.43,70,,182.43,percent of total billed charges,All Other,93.82,36,,93.82,percent of total billed charges,Drugs,93.82,36,,93.82,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,91.21,35,,91.21,percent of total billed charges,Drugs,86.87,,,86.87,Other,Drug Cost,86.87,,,86.87,Other,Drug Cost,86.87,,,86.87,Other,Drug Cost,86.87,,,86.87,Other,Drug Cost,86.87,,,86.87,Other,Drug Cost,86.87,,,86.87,Other,Drug Cost,195.46,,,195.46,Other,225% of Medicaid,121.62,,,121.62,Other,140% of Medicaid,0.01,34,,0.01,Other,"Drug Charges > 2,000, then 34% of Charges",0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",186.77,,,186.77,Other,215% Medicaid APG methodology,186.77,,,186.77,Other,215% Medicaid APG methodology,108.59,,,108.59,Other,125% Medicaid APG methodology,0.01,195.46,
CALCITONIN SALMON INJ TO 400 UNITS,J0630,HCPCS,,80000325,CDM,637,RC,67457067502,NDC,both,1,ML,0.06,10552.43,,,10552.43,Other,150% of Medicare + 9.63% HCRA Surcharge,6416.99,,,6416.99,Fee Schedule,Average Sale Price (ASP) x 6,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,34,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,40,,0.02,percent of total billed charges,Drugs,0.04,70,,0.04,percent of total billed charges,All Other,0.02,36,,0.02,percent of total billed charges,Drugs,0.02,36,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,35,,0.02,percent of total billed charges,Drugs,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.02,,,0.02,Other,Drug Cost,0.05,,,0.05,Other,225% of Medicaid,0.03,,,0.03,Other,140% of Medicaid,0.01,34,,0.01,Other,"Drug Charges > 2,000, then 34% of Charges",10267.19,,,10267.19,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",0.04,,,0.04,Other,215% Medicaid APG methodology,0.04,,,0.04,Other,215% Medicaid APG methodology,0.03,,,0.03,Other,125% Medicaid APG methodology,0.01,10552.43,
OCTREOTIDE 500MCG/1ML INJ,J2354,HCPCS,,80001525,CDM,637,RC,63323037701,NDC,both,10,ML,32.69,11.72,,,11.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7.13,,,7.13,Fee Schedule,Average Sale Price (ASP) x 6,11.44,35,,11.44,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,11.11,34,,11.11,percent of total billed charges,Drugs,11.11,34,,11.11,percent of total billed charges,Drugs,11.11,34,,11.11,percent of total billed charges,Drugs,11.11,34,,11.11,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,13.07,40,,13.07,percent of total billed charges,Drugs,22.88,70,,22.88,percent of total billed charges,All Other,11.77,36,,11.77,percent of total billed charges,Drugs,11.77,36,,11.77,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,11.44,35,,11.44,percent of total billed charges,Drugs,10.9,,,10.9,Other,Drug Cost,10.9,,,10.9,Other,Drug Cost,10.9,,,10.9,Other,Drug Cost,10.9,,,10.9,Other,Drug Cost,10.9,,,10.9,Other,Drug Cost,10.9,,,10.9,Other,Drug Cost,24.51,,,24.51,Other,225% of Medicaid,15.25,,,15.25,Other,140% of Medicaid,0.01,34,,0.01,Other,"Drug Charges > 2,000, then 34% of Charges",11.4,,,11.4,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",23.42,,,23.42,Other,215% Medicaid APG methodology,23.42,,,23.42,Other,215% Medicaid APG methodology,13.62,,,13.62,Other,125% Medicaid APG methodology,0.01,24.51,
PAPAVERIN HCL 60MG/2ML INJ,J2440,HCPCS,,80001584,CDM,637,RC,517400225,NDC,both,25,ML,24.63,9.72,39.4668,,9.72,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,8.62,35,,8.62,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,8.38,34,,8.38,percent of total billed charges,Drugs,8.38,34,,8.38,percent of total billed charges,Drugs,8.38,34,,8.38,percent of total billed charges,Drugs,8.38,34,,8.38,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,9.85,40,,9.85,percent of total billed charges,Drugs,17.24,70,,17.24,percent of total billed charges,All Other,8.87,36,,8.87,percent of total billed charges,Drugs,8.87,36,,8.87,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,8.62,35,,8.62,percent of total billed charges,Drugs,8.21,,,8.21,Other,Drug Cost,8.21,,,8.21,Other,Drug Cost,8.21,,,8.21,Other,Drug Cost,8.21,,,8.21,Other,Drug Cost,8.21,,,8.21,Other,Drug Cost,8.21,,,8.21,Other,Drug Cost,18.48,,,18.48,Other,225% of Medicaid,11.5,,,11.5,Other,140% of Medicaid,0.01,34,,0.01,Other,"Drug Charges > 2,000, then 34% of Charges",0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",17.65,,,17.65,Other,215% Medicaid APG methodology,17.65,,,17.65,Other,215% Medicaid APG methodology,10.26,,,10.26,Other,125% Medicaid APG methodology,0.01,18.48,
PHENTOLAMINE MESYLATE 5MG VIAL,J2760,HCPCS,,80002366,CDM,637,RC,51224001220,NDC,both,1,EA,809.01,4408.41,,,4408.41,Other,150% of Medicare + 9.63% HCRA Surcharge,2680.78,,,2680.78,Fee Schedule,Average Sale Price (ASP) x 6,283.15,35,,283.15,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,275.06,34,,275.06,percent of total billed charges,Drugs,275.06,34,,275.06,percent of total billed charges,Drugs,275.06,34,,275.06,percent of total billed charges,Drugs,275.06,34,,275.06,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,275.06,34,"If Charge > 500, then 34 percent",275.06,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,323.6,40,,323.6,percent of total billed charges,Drugs,566.31,70,,566.31,percent of total billed charges,All Other,291.24,36,,291.24,percent of total billed charges,Drugs,291.24,36,,291.24,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,283.15,35,,283.15,percent of total billed charges,Drugs,269.67,,,269.67,Other,Drug Cost,269.67,,,269.67,Other,Drug Cost,269.67,,,269.67,Other,Drug Cost,269.67,,,269.67,Other,Drug Cost,269.67,,,269.67,Other,Drug Cost,269.67,,,269.67,Other,Drug Cost,606.76,,,606.76,Other,225% of Medicaid,377.54,,,377.54,Other,140% of Medicaid,0.01,34,,0.01,Other,"Drug Charges > 2,000, then 34% of Charges",4289.25,,,4289.25,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",579.79,,,579.79,Other,215% Medicaid APG methodology,579.79,,,579.79,Other,215% Medicaid APG methodology,337.09,,,337.09,Other,125% Medicaid APG methodology,0.01,4408.41,
OCTREOTIDE 50MCG/1ML INJ,J2354,HCPCS,,80002641,CDM,637,RC,67457023901,NDC,both,10,ML,8.1,11.72,,,11.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7.13,,,7.13,Fee Schedule,Average Sale Price (ASP) x 6,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.75,34,,2.75,percent of total billed charges,Drugs,2.75,34,,2.75,percent of total billed charges,Drugs,2.75,34,,2.75,percent of total billed charges,Drugs,2.75,34,,2.75,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,3.24,40,,3.24,percent of total billed charges,Drugs,5.67,70,,5.67,percent of total billed charges,All Other,2.92,36,,2.92,percent of total billed charges,Drugs,2.92,36,,2.92,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.84,35,,2.84,percent of total billed charges,Drugs,2.7,,,2.7,Other,Drug Cost,2.7,,,2.7,Other,Drug Cost,2.7,,,2.7,Other,Drug Cost,2.7,,,2.7,Other,Drug Cost,2.7,,,2.7,Other,Drug Cost,2.7,,,2.7,Other,Drug Cost,6.08,,,6.08,Other,225% of Medicaid,3.78,,,3.78,Other,140% of Medicaid,0.01,34,,0.01,Other,"Drug Charges > 2,000, then 34% of Charges",11.4,,,11.4,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5.81,,,5.81,Other,215% Medicaid APG methodology,5.81,,,5.81,Other,215% Medicaid APG methodology,3.38,,,3.38,Other,125% Medicaid APG methodology,0.01,11.72,
OCTREOTIDE 100MCG/1ML INJ,J2354,HCPCS,,80002658,CDM,637,RC,63323037601,NDC,both,10,ML,6.98,11.72,,,11.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7.13,,,7.13,Fee Schedule,Average Sale Price (ASP) x 6,2.44,35,,2.44,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,2.37,34,,2.37,percent of total billed charges,Drugs,2.37,34,,2.37,percent of total billed charges,Drugs,2.37,34,,2.37,percent of total billed charges,Drugs,2.37,34,,2.37,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,0.01,34,"If Charge > 500, then 34 percent",0.01,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,2.79,40,,2.79,percent of total billed charges,Drugs,4.89,70,,4.89,percent of total billed charges,All Other,2.51,36,,2.51,percent of total billed charges,Drugs,2.51,36,,2.51,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,2.44,35,,2.44,percent of total billed charges,Drugs,2.33,,,2.33,Other,Drug Cost,2.33,,,2.33,Other,Drug Cost,2.33,,,2.33,Other,Drug Cost,2.33,,,2.33,Other,Drug Cost,2.33,,,2.33,Other,Drug Cost,2.33,,,2.33,Other,Drug Cost,5.24,,,5.24,Other,225% of Medicaid,3.26,,,3.26,Other,140% of Medicaid,0.01,34,,0.01,Other,"Drug Charges > 2,000, then 34% of Charges",11.4,,,11.4,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",5,,,5,Other,215% Medicaid APG methodology,5,,,5,Other,215% Medicaid APG methodology,2.91,,,2.91,Other,125% Medicaid APG methodology,0.01,11.72,
ADALIMUMAB PEN 40MG/0.8ML,J0135,HCPCS,,80002759,CDM,637,RC,74433902,NDC,both,2,EA,9916.65,3913.78,39.4668,,3913.78,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Fee Schedule,Average Sale Price (ASP) x 6,3470.83,35,,3470.83,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3371.66,34,,3371.66,percent of total billed charges,Drugs,3371.66,34,,3371.66,percent of total billed charges,Drugs,3371.66,34,,3371.66,percent of total billed charges,Drugs,3371.66,34,,3371.66,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3371.66,34,"If Charge > 500, then 34 percent",3371.66,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3966.66,40,,3966.66,percent of total billed charges,Drugs,6941.66,70,,6941.66,percent of total billed charges,All Other,3569.99,36,,3569.99,percent of total billed charges,Drugs,3569.99,36,,3569.99,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3470.83,35,,3470.83,percent of total billed charges,Drugs,3305.55,,,3305.55,Other,Drug Cost,3305.55,,,3305.55,Other,Drug Cost,3305.55,,,3305.55,Other,Drug Cost,3305.55,,,3305.55,Other,Drug Cost,3305.55,,,3305.55,Other,Drug Cost,3305.55,,,3305.55,Other,Drug Cost,7437.49,,,7437.49,Other,225% of Medicaid,4627.77,,,4627.77,Other,140% of Medicaid,3371.66,34,,3371.66,Other,"Drug Charges > 2,000, then 34% of Charges",0.02,,,0.02,Other,160% Medicare Fee Schedule,0.01,34,,0.01,Other,"Drug Charges > 20,000, then 34% of Charges",7106.93,,,7106.93,Other,215% Medicaid APG methodology,7106.93,,,7106.93,Other,215% Medicaid APG methodology,4131.94,,,4131.94,Other,125% Medicaid APG methodology,0.01,7437.49,
TRAUMA RESPONSE LEVEL ONE,G0390,HCPCS,,30000070,CDM,681,RC,,,both,,,7478,2473.98,,,2473.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1504.45,,,1504.45,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,5234.6,70,,5234.6,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,5234.6,
TRAUMA RESPONSE LEVEL TWO,G0390,HCPCS,,30000071,CDM,681,RC,,,both,,,5981,2473.98,,,2473.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1504.45,,,1504.45,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,4186.7,70,,4186.7,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,4186.7,
TRAUMA RESPONS W/ HOSP CRITI LV3,G0390,HCPCS,,30000092,CDM,683,RC,,,both,,,4786,2473.98,,,2473.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1504.45,,,1504.45,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,186% of Medicaid,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,3350.2,70,,3350.2,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3350.2,
INSERT CERVICAL DILATOR,59200,CPT,,26059200,CDM,720,RC,,,both,,,690,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",483,70,,483,percent of total billed charges,All Other,469.2,68,,469.2,percent of total billed charges,All Other,1178,,,1178,Other,186% of Medicaid,552,80,,552,percent of total billed charges,All Other,572.7,83,,572.7,percent of total billed charges,All Other,572.7,83,,,percent of total billed charges,All Other,552,80,,552,percent of total billed charges,All Other,572.7,83,,572.7,percent of total billed charges,All Other,552,80,,552,percent of total billed charges,All Other,483,70,,483,percent of total billed charges,,214.84,,,214.84,Fee Schedule,,182.09,,,182.09,Fee Schedule,,1713,,,1713,Case Rate,,1541,,,1541,Case Rate,,1713,,,1713,Case Rate,,1456,,,1456,Case Rate,,633.19,,,633.19,Other,100% of Medicaid,633.19,,,633.19,Other,100% of Medicaid,633.19,,,633.19,Other,100% of Medicaid,633.19,,,633.19,Other,100% of Medicaid,1424.68,,,1424.68,Other,225% of Medicaid,968.78,,,968.78,Other,153% of Medicaid,1424.68,,,1424.68,Other,225% of Medicaid,886.47,,,886.47,Other,140% of Medicaid,1424.68,,,1424.68,Other,225% of Medicaid,1646.3,,,1646.3,Other,250% of Medicaid,2051.54,,,2051.54,Other,324% of Medicaid,1361.36,,,1361.36,Other,215% of Medicaid,1361.36,,,1361.36,Other,215% of Medicaid,791.49,,,791.49,Other,125% of Medicaid,182.09,3228,
CIRCUMCISION W/REGIONL BLOCK,54150,CPT,,26054150,CDM,723,RC,,,both,,,4256,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2766.4,65,,2766.4,percent of total billed charges,All Other,2511.04,59,,2511.04,percent of total billed charges,All Other,3255.84,76.5,,3255.84,percent of total billed charges,All Other,2936.64,69,,2936.64,percent of total billed charges,All Other,2766.4,65,,2766.4,percent of total billed charges,All Other,2979.2,70,,2979.2,percent of total billed charges,All Other,2894.08,68,,2894.08,percent of total billed charges,All Other,1465,,,1465,Other,186% of Medicaid,3404.8,80,,3404.8,percent of total billed charges,All Other,3532.48,83,,3532.48,percent of total billed charges,All Other,3532.48,83,,,percent of total billed charges,All Other,3404.8,80,,3404.8,percent of total billed charges,All Other,3532.48,83,,3532.48,percent of total billed charges,All Other,3404.8,80,,3404.8,percent of total billed charges,All Other,2979.2,70,,2979.2,percent of total billed charges,,465.76,,,465.76,Fee Schedule,,394.76,,,394.76,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,787.7,,,787.7,Other,100% of Medicaid,787.7,,,787.7,Other,100% of Medicaid,787.7,,,787.7,Other,100% of Medicaid,787.7,,,787.7,Other,100% of Medicaid,1772.32,,,1772.32,Other,225% of Medicaid,1205.18,,,1205.18,Other,153% of Medicaid,1772.32,,,1772.32,Other,225% of Medicaid,1102.78,,,1102.78,Other,140% of Medicaid,1772.32,,,1772.32,Other,225% of Medicaid,2048.01,,,2048.01,Other,250% of Medicaid,2552.14,,,2552.14,Other,324% of Medicaid,1693.55,,,1693.55,Other,215% of Medicaid,1693.55,,,1693.55,Other,215% of Medicaid,984.62,,,984.62,Other,125% of Medicaid,0.01,3680.55,
CIRCUMCISION W/O REGIONL BLOCK,54150,CPT,52,26154150,CDM,723,RC,,,both,,,3405,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2213.25,65,,2213.25,percent of total billed charges,All Other,2008.95,59,,2008.95,percent of total billed charges,All Other,2604.83,76.5,,2604.83,percent of total billed charges,All Other,2349.45,69,,2349.45,percent of total billed charges,All Other,2213.25,65,,2213.25,percent of total billed charges,All Other,2383.5,70,,2383.5,percent of total billed charges,All Other,2315.4,68,,2315.4,percent of total billed charges,All Other,1465,,,1465,Other,186% of Medicaid,2724,80,,2724,percent of total billed charges,All Other,2826.15,83,,2826.15,percent of total billed charges,All Other,2826.15,83,,,percent of total billed charges,All Other,2724,80,,2724,percent of total billed charges,All Other,2826.15,83,,2826.15,percent of total billed charges,All Other,2724,80,,2724,percent of total billed charges,All Other,2383.5,70,,2383.5,percent of total billed charges,,465.76,,,465.76,Fee Schedule,,394.76,,,394.76,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,787.7,,,787.7,Other,100% of Medicaid,787.7,,,787.7,Other,100% of Medicaid,787.7,,,787.7,Other,100% of Medicaid,787.7,,,787.7,Other,100% of Medicaid,1772.32,,,1772.32,Other,225% of Medicaid,1205.18,,,1205.18,Other,153% of Medicaid,1772.32,,,1772.32,Other,225% of Medicaid,1102.78,,,1102.78,Other,140% of Medicaid,1772.32,,,1772.32,Other,225% of Medicaid,2048.01,,,2048.01,Other,250% of Medicaid,2552.14,,,2552.14,Other,324% of Medicaid,1693.55,,,1693.55,Other,215% of Medicaid,1693.55,,,1693.55,Other,215% of Medicaid,984.62,,,984.62,Other,125% of Medicaid,0.01,3680.55,
CIRCUM 28 DAYS OR OLDER,54161,CPT,,26054161,CDM,723,RC,,,both,,,4176,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2923.2,70,,2923.2,percent of total billed charges,All Other,2839.68,,,2839.68,Other,ASC Grouper table,1762,,,1762,Other,186% of Medicaid,3340.8,,,3340.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3340.8,,,3340.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3340.8,80,,3340.8,percent of total billed charges,All Other,2923.2,70,,2923.2,percent of total billed charges,,947.92,,,947.92,Fee Schedule,,803.42,,,803.42,Fee Schedule,,2923.2,70,,2923.2,percent of total billed charges,All Other,2923.2,70,,2923.2,percent of total billed charges,All Other,2923.2,70,,2923.2,percent of total billed charges,All Other,2923.2,70,,2923.2,percent of total billed charges,All Other,947.38,,,947.38,Other,100% of Medicaid,947.38,,,947.38,Other,100% of Medicaid,947.38,,,947.38,Other,100% of Medicaid,947.38,,,947.38,Other,100% of Medicaid,2131.62,,,2131.62,Other,225% of Medicaid,1449.5,,,1449.5,Other,153% of Medicaid,2131.62,,,2131.62,Other,225% of Medicaid,1326.34,,,1326.34,Other,140% of Medicaid,2131.62,,,2131.62,Other,225% of Medicaid,2463.2,,,2463.2,Other,250% of Medicaid,3069.53,,,3069.53,Other,324% of Medicaid,2036.88,,,2036.88,Other,215% of Medicaid,2036.88,,,2036.88,Other,215% of Medicaid,1184.23,,,1184.23,Other,125% of Medicaid,803.42,7216,
12 LEAD EKG; TRACING ONLY,93005,CPT,,48093005,CDM,730,RC,,,both,,,149,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,20.44,,,20.44,Fee Schedule,,18.43,,,18.43,Fee Schedule,,76.23,,,76.23,Fee Schedule,,68.58,,,68.58,Fee Schedule,,64.82,,,64.82,Fee Schedule,,104.3,70,,104.3,percent of total billed charges,All Other,101.32,68,,101.32,percent of total billed charges,All Other,78,,,78,Other,186% of Medicaid,119.2,80,,119.2,percent of total billed charges,All Other,123.67,83,,123.67,percent of total billed charges,All Other,123.67,83,,123.67,percent of total billed charges,All Other,119.2,80,,119.2,percent of total billed charges,All Other,123.67,83,,123.67,percent of total billed charges,All Other,119.2,80,,119.2,percent of total billed charges,All Other,104.3,70,,104.3,percent of total billed charges,,29.52,,,29.52,Fee Schedule,,25.02,,,25.02,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,64.34,,,64.34,Other,153% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,58.87,,,58.87,Other,140% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,109.34,,,109.34,Other,250% of Medicaid,136.25,,,136.25,Other,324% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,52.57,,,52.57,Other,125% of Medicaid,18.43,667,
EKG,93005,CPT,,51093005,CDM,730,RC,,,both,,,149,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,20.44,,,20.44,Fee Schedule,,18.43,,,18.43,Fee Schedule,,76.23,,,76.23,Fee Schedule,,68.58,,,68.58,Fee Schedule,,64.82,,,64.82,Fee Schedule,,104.3,70,,104.3,percent of total billed charges,All Other,101.32,68,,101.32,percent of total billed charges,All Other,78,,,78,Other,186% of Medicaid,119.2,80,,119.2,percent of total billed charges,All Other,123.67,83,,123.67,percent of total billed charges,All Other,123.67,83,,123.67,percent of total billed charges,All Other,119.2,80,,119.2,percent of total billed charges,All Other,123.67,83,,123.67,percent of total billed charges,All Other,119.2,80,,119.2,percent of total billed charges,All Other,104.3,70,,104.3,percent of total billed charges,,29.52,,,29.52,Fee Schedule,,25.02,,,25.02,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,64.34,,,64.34,Other,153% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,58.87,,,58.87,Other,140% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,109.34,,,109.34,Other,250% of Medicaid,136.25,,,136.25,Other,324% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,52.57,,,52.57,Other,125% of Medicaid,18.43,667,
EKG SIGNAL-AVERAGED,93278,CPT,,48093278,CDM,730,RC,,,both,,,131,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,62.13,,,62.13,Fee Schedule,,56.02,,,56.02,Fee Schedule,,100.22,76.5,,100.22,percent of total billed charges,All Other,90.39,69,,90.39,percent of total billed charges,All Other,85.15,65,,85.15,percent of total billed charges,All Other,91.7,70,,91.7,percent of total billed charges,All Other,89.08,68,,89.08,percent of total billed charges,All Other,78,,,78,Other,186% of Medicaid,104.8,80,,104.8,percent of total billed charges,All Other,81.22,62,,81.22,percent of total billed charges,Lab & Radiology,72.05,55,,,percent of total billed charges,Default if not in Fee Schedule,104.8,80,,104.8,percent of total billed charges,All Other,81.22,62,,81.22,percent of total billed charges,Lab & Radiology,83.19,,,83.19,Fee Schedule,,91.7,70,,91.7,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,667,,,667,Case Rate,,600,,,600,Case Rate,,667,,,667,Case Rate,,567,,,567,Case Rate,,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,64.34,,,64.34,Other,153% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,58.87,,,58.87,Other,140% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,109.34,,,109.34,Other,250% of Medicaid,136.25,,,136.25,Other,324% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,52.57,,,52.57,Other,125% of Medicaid,42.05,667,
ECG UP TO 48 HRS RECORDING,93225,CPT,,48093225,CDM,731,RC,,,both,,,1087,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,58.91,,,58.91,Fee Schedule,,53.12,,,53.12,Fee Schedule,,219.04,,,219.04,Fee Schedule,,197.05,,,197.05,Fee Schedule,,186.26,,,186.26,Fee Schedule,,760.9,70,,760.9,percent of total billed charges,All Other,739.16,68,,739.16,percent of total billed charges,All Other,299,,,299,Other,186% of Medicaid,869.6,80,,869.6,percent of total billed charges,All Other,902.21,83,,902.21,percent of total billed charges,All Other,902.21,83,,902.21,percent of total billed charges,All Other,869.6,80,,869.6,percent of total billed charges,All Other,902.21,83,,902.21,percent of total billed charges,All Other,869.6,80,,869.6,percent of total billed charges,All Other,760.9,70,,760.9,percent of total billed charges,,93.48,,,93.48,Fee Schedule,,79.23,,,79.23,Fee Schedule,,438,,,438,Case Rate,,394,,,394,Case Rate,,438,,,438,Case Rate,,372,,,372,Case Rate,,160.56,,,160.56,Other,100% of Medicaid,160.56,,,160.56,Other,100% of Medicaid,160.56,,,160.56,Other,100% of Medicaid,160.56,,,160.56,Other,100% of Medicaid,361.25,,,361.25,Other,225% of Medicaid,245.65,,,245.65,Other,153% of Medicaid,361.25,,,361.25,Other,225% of Medicaid,224.78,,,224.78,Other,140% of Medicaid,361.25,,,361.25,Other,225% of Medicaid,417.45,,,417.45,Other,250% of Medicaid,520.21,,,520.21,Other,324% of Medicaid,345.2,,,345.2,Other,215% of Medicaid,345.2,,,345.2,Other,215% of Medicaid,200.7,,,200.7,Other,125% of Medicaid,53.12,902.21,
ECG MONIT/ W REPRT UP TO 48 HR,93226,CPT,,48093226,CDM,731,RC,,,both,,,846,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,114.46,,,114.46,Fee Schedule,,103.21,,,103.21,Fee Schedule,,323.7,,,323.7,Fee Schedule,,291.22,,,291.22,Fee Schedule,,275.27,,,275.27,Fee Schedule,,592.2,70,,592.2,percent of total billed charges,All Other,575.28,68,,575.28,percent of total billed charges,All Other,299,,,299,Other,186% of Medicaid,676.8,80,,676.8,percent of total billed charges,All Other,702.18,83,,702.18,percent of total billed charges,All Other,702.18,83,,702.18,percent of total billed charges,All Other,676.8,80,,676.8,percent of total billed charges,All Other,702.18,83,,702.18,percent of total billed charges,All Other,676.8,80,,676.8,percent of total billed charges,All Other,592.2,70,,592.2,percent of total billed charges,,183.68,,,183.68,Fee Schedule,,155.68,,,155.68,Fee Schedule,,438,,,438,Case Rate,,394,,,394,Case Rate,,438,,,438,Case Rate,,372,,,372,Case Rate,,160.56,,,160.56,Other,100% of Medicaid,160.56,,,160.56,Other,100% of Medicaid,160.56,,,160.56,Other,100% of Medicaid,160.56,,,160.56,Other,100% of Medicaid,361.25,,,361.25,Other,225% of Medicaid,245.65,,,245.65,Other,153% of Medicaid,361.25,,,361.25,Other,225% of Medicaid,224.78,,,224.78,Other,140% of Medicaid,361.25,,,361.25,Other,225% of Medicaid,417.45,,,417.45,Other,250% of Medicaid,520.21,,,520.21,Other,324% of Medicaid,345.2,,,345.2,Other,215% of Medicaid,345.2,,,345.2,Other,215% of Medicaid,200.7,,,200.7,Other,125% of Medicaid,67.21,702.18,
REMOTE 30 DAY ECG REV REPORT,93270,CPT,,48093270,CDM,731,RC,,,both,,,337,68.14,,,68.14,Other,150% of Medicare + 9.63% HCRA Surcharge,41.44,,,41.44,Other,Medicare OPPS,26.87,,,26.87,Fee Schedule,,24.23,,,24.23,Fee Schedule,,101.91,,,101.91,Fee Schedule,,91.74,,,91.74,Fee Schedule,,86.65,,,86.65,Fee Schedule,,235.9,70,,235.9,percent of total billed charges,All Other,229.16,68,,229.16,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,269.6,80,,269.6,percent of total billed charges,All Other,208.94,62,,208.94,percent of total billed charges,Lab & Radiology,185.35,55,,,percent of total billed charges,Default if not in Fee Schedule,269.6,80,,269.6,percent of total billed charges,All Other,208.94,62,,208.94,percent of total billed charges,Lab & Radiology,35.98,,,35.98,Fee Schedule,,235.9,70,,235.9,percent of total billed charges,,41,,,41,Fee Schedule,,34.75,,,34.75,Fee Schedule,,438,,,438,Case Rate,,394,,,394,Case Rate,,438,,,438,Case Rate,,372,,,372,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,438,
TELEMETRY,93799,CPT,,23093041,CDM,732,RC,,,both,,,176,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,114.4,65,,114.4,percent of total billed charges,All Other,103.84,59,,103.84,percent of total billed charges,All Other,134.64,76.5,,134.64,percent of total billed charges,All Other,121.44,69,,121.44,percent of total billed charges,All Other,114.4,65,,114.4,percent of total billed charges,All Other,123.2,70,,123.2,percent of total billed charges,All Other,119.68,68,,119.68,percent of total billed charges,All Other,78,,,78,Other,186% of Medicaid,140.8,80,,140.8,percent of total billed charges,All Other,109.12,62,,109.12,percent of total billed charges,Lab & Radiology,96.8,55,,,percent of total billed charges,Default if not in Fee Schedule,140.8,80,,140.8,percent of total billed charges,All Other,109.12,62,,109.12,percent of total billed charges,Lab & Radiology,140.8,80,,140.8,percent of total billed charges,All Other,123.2,70,,123.2,percent of total billed charges,,114.4,65,,114.4,percent of total billed charges,All Other,114.4,65,,114.4,percent of total billed charges,All Other,438,,,438,Case Rate,,394,,,394,Case Rate,,438,,,438,Case Rate,,372,,,372,Case Rate,,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,64.34,,,64.34,Other,153% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,58.87,,,58.87,Other,140% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,109.34,,,109.34,Other,250% of Medicaid,136.25,,,136.25,Other,324% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,52.57,,,52.57,Other,125% of Medicaid,42.05,438,
TELEMETRY,93799,CPT,,30093041,CDM,732,RC,,,both,,,176,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,114.4,65,,114.4,percent of total billed charges,All Other,103.84,59,,103.84,percent of total billed charges,All Other,134.64,76.5,,134.64,percent of total billed charges,All Other,121.44,69,,121.44,percent of total billed charges,All Other,114.4,65,,114.4,percent of total billed charges,All Other,123.2,70,,123.2,percent of total billed charges,All Other,119.68,68,,119.68,percent of total billed charges,All Other,78,,,78,Other,186% of Medicaid,140.8,80,,140.8,percent of total billed charges,All Other,109.12,62,,109.12,percent of total billed charges,Lab & Radiology,96.8,55,,,percent of total billed charges,Default if not in Fee Schedule,140.8,80,,140.8,percent of total billed charges,All Other,109.12,62,,109.12,percent of total billed charges,Lab & Radiology,140.8,80,,140.8,percent of total billed charges,All Other,123.2,70,,123.2,percent of total billed charges,,114.4,65,,114.4,percent of total billed charges,All Other,114.4,65,,114.4,percent of total billed charges,All Other,438,,,438,Case Rate,,394,,,394,Case Rate,,438,,,438,Case Rate,,372,,,372,Case Rate,,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,64.34,,,64.34,Other,153% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,58.87,,,58.87,Other,140% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,109.34,,,109.34,Other,250% of Medicaid,136.25,,,136.25,Other,324% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,52.57,,,52.57,Other,125% of Medicaid,42.05,438,
TELEMETRY,93799,CPT,,51093041,CDM,732,RC,,,both,,,176,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,114.4,65,,114.4,percent of total billed charges,All Other,103.84,59,,103.84,percent of total billed charges,All Other,134.64,76.5,,134.64,percent of total billed charges,All Other,121.44,69,,121.44,percent of total billed charges,All Other,114.4,65,,114.4,percent of total billed charges,All Other,123.2,70,,123.2,percent of total billed charges,All Other,119.68,68,,119.68,percent of total billed charges,All Other,78,,,78,Other,186% of Medicaid,140.8,80,,140.8,percent of total billed charges,All Other,109.12,62,,109.12,percent of total billed charges,Lab & Radiology,96.8,55,,,percent of total billed charges,Default if not in Fee Schedule,140.8,80,,140.8,percent of total billed charges,All Other,109.12,62,,109.12,percent of total billed charges,Lab & Radiology,140.8,80,,140.8,percent of total billed charges,All Other,123.2,70,,123.2,percent of total billed charges,,114.4,65,,114.4,percent of total billed charges,All Other,114.4,65,,114.4,percent of total billed charges,All Other,438,,,438,Case Rate,,394,,,394,Case Rate,,438,,,438,Case Rate,,372,,,372,Case Rate,,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,64.34,,,64.34,Other,153% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,58.87,,,58.87,Other,140% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,109.34,,,109.34,Other,250% of Medicaid,136.25,,,136.25,Other,324% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,52.57,,,52.57,Other,125% of Medicaid,42.05,438,
EEG CONT REC W/ VID EEG TECH,95700,CPT,,48095700,CDM,740,RC,,,both,,,940,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,611,65,,611,percent of total billed charges,All Other,554.6,59,,554.6,percent of total billed charges,All Other,307.45,,,307.45,Fee Schedule,,307.45,,,307.45,Fee Schedule,,307.45,,,307.45,Fee Schedule,,658,70,,658,percent of total billed charges,All Other,639.2,68,,639.2,percent of total billed charges,All Other,287,,,287,Other,186% of Medicaid,752,80,,752,percent of total billed charges,All Other,780.2,83,,780.2,percent of total billed charges,All Other,780.2,83,,,percent of total billed charges,All Other,752,80,,752,percent of total billed charges,All Other,780.2,83,,780.2,percent of total billed charges,All Other,752,80,,752,percent of total billed charges,All Other,658,70,,658,percent of total billed charges,,611,65,,611,percent of total billed charges,All Other,611,65,,611,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,906,
EEG W/O VID 2-12 HR UNMNTR,95705,CPT,,48095705,CDM,740,RC,,,both,,,940,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,611,65,,611,percent of total billed charges,All Other,554.6,59,,554.6,percent of total billed charges,All Other,550.28,,,550.28,Fee Schedule,,550.28,,,550.28,Fee Schedule,,550.28,,,550.28,Fee Schedule,,658,70,,658,percent of total billed charges,All Other,639.2,68,,639.2,percent of total billed charges,All Other,287,,,287,Other,186% of Medicaid,752,80,,752,percent of total billed charges,All Other,780.2,83,,780.2,percent of total billed charges,All Other,780.2,83,,,percent of total billed charges,All Other,752,80,,752,percent of total billed charges,All Other,780.2,83,,780.2,percent of total billed charges,All Other,752,80,,752,percent of total billed charges,All Other,658,70,,658,percent of total billed charges,,611,65,,611,percent of total billed charges,All Other,611,65,,611,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,906,
EEG W/O VID 2-12 HR INTMT MNTR,95706,CPT,,48095706,CDM,740,RC,,,both,,,878,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,570.7,65,,570.7,percent of total billed charges,All Other,518.02,59,,518.02,percent of total billed charges,All Other,671.67,76.5,,671.67,percent of total billed charges,All Other,605.82,69,,605.82,percent of total billed charges,All Other,570.7,65,,570.7,percent of total billed charges,All Other,614.6,70,,614.6,percent of total billed charges,All Other,597.04,68,,597.04,percent of total billed charges,All Other,287,,,287,Other,186% of Medicaid,702.4,80,,702.4,percent of total billed charges,All Other,728.74,83,,728.74,Fee Schedule,,728.74,83,,,percent of total billed charges,All Other,702.4,80,,702.4,percent of total billed charges,All Other,728.74,83,,728.74,Fee Schedule,,702.4,80,,702.4,percent of total billed charges,All Other,614.6,70,,614.6,percent of total billed charges,,570.7,65,,570.7,percent of total billed charges,All Other,570.7,65,,570.7,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,906,
EEG W/O VID 2-12 HR CONT MNTR,95707,CPT,,48095707,CDM,740,RC,,,both,,,878,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,570.7,65,,570.7,percent of total billed charges,All Other,518.02,59,,518.02,percent of total billed charges,All Other,671.67,76.5,,671.67,percent of total billed charges,All Other,605.82,69,,605.82,percent of total billed charges,All Other,570.7,65,,570.7,percent of total billed charges,All Other,614.6,70,,614.6,percent of total billed charges,All Other,597.04,68,,597.04,percent of total billed charges,All Other,287,,,287,Other,186% of Medicaid,702.4,80,,702.4,percent of total billed charges,All Other,544.36,62,,544.36,Fee Schedule,,482.9,55,,,percent of total billed charges,Default if not in Fee Schedule,702.4,80,,702.4,percent of total billed charges,All Other,544.36,62,,544.36,Fee Schedule,,702.4,80,,702.4,percent of total billed charges,All Other,614.6,70,,614.6,percent of total billed charges,,570.7,65,,570.7,percent of total billed charges,All Other,570.7,65,,570.7,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,906,
EEG W/O VID EA 12-26 HR UNMNTR,95708,CPT,,48095708,CDM,740,RC,,,both,,,1805,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,1173.25,65,,1173.25,percent of total billed charges,All Other,1064.95,59,,1064.95,percent of total billed charges,All Other,550.28,,,550.28,Fee Schedule,,550.28,,,550.28,Fee Schedule,,550.28,,,550.28,Fee Schedule,,1263.5,70,,1263.5,percent of total billed charges,All Other,1227.4,68,,1227.4,percent of total billed charges,All Other,508,,,508,Other,186% of Medicaid,1444,80,,1444,percent of total billed charges,All Other,1498.15,83,,1498.15,percent of total billed charges,All Other,1498.15,83,,,percent of total billed charges,All Other,1444,80,,1444,percent of total billed charges,All Other,1498.15,83,,1498.15,percent of total billed charges,All Other,1444,80,,1444,percent of total billed charges,All Other,1263.5,70,,1263.5,percent of total billed charges,,1173.25,65,,1173.25,percent of total billed charges,All Other,1173.25,65,,1173.25,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,418.18,,,418.18,Other,153% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,382.65,,,382.65,Other,140% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,710.64,,,710.64,Other,250% of Medicaid,885.56,,,885.56,Other,324% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,341.65,,,341.65,Other,125% of Medicaid,273.32,1498.15,
EEG W/O VID EA 12-26 HR INTMT,95709,CPT,,48095709,CDM,740,RC,,,both,,,1686,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,1095.9,65,,1095.9,percent of total billed charges,All Other,994.74,59,,994.74,percent of total billed charges,All Other,1289.79,76.5,,1289.79,percent of total billed charges,All Other,1163.34,69,,1163.34,percent of total billed charges,All Other,1095.9,65,,1095.9,percent of total billed charges,All Other,1180.2,70,,1180.2,percent of total billed charges,All Other,1146.48,68,,1146.48,percent of total billed charges,All Other,508,,,508,Other,186% of Medicaid,1348.8,80,,1348.8,percent of total billed charges,All Other,1399.38,83,,1399.38,percent of total billed charges,All Other,1399.38,83,,,percent of total billed charges,All Other,1348.8,80,,1348.8,percent of total billed charges,All Other,1399.38,83,,1399.38,percent of total billed charges,All Other,1348.8,80,,1348.8,percent of total billed charges,All Other,1180.2,70,,1180.2,percent of total billed charges,,1095.9,65,,1095.9,percent of total billed charges,All Other,1095.9,65,,1095.9,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,418.18,,,418.18,Other,153% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,382.65,,,382.65,Other,140% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,710.64,,,710.64,Other,250% of Medicaid,885.56,,,885.56,Other,324% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,341.65,,,341.65,Other,125% of Medicaid,273.32,1399.38,
EEG W/O VID EA 12-26 HR CONT,95710,CPT,,48095710,CDM,740,RC,,,both,,,1686,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,1095.9,65,,1095.9,percent of total billed charges,All Other,994.74,59,,994.74,percent of total billed charges,All Other,253.03,,,253.03,Fee Schedule,,253.03,,,253.03,Fee Schedule,,253.03,,,253.03,Fee Schedule,,1180.2,70,,1180.2,percent of total billed charges,All Other,1146.48,68,,1146.48,percent of total billed charges,All Other,508,,,508,Other,186% of Medicaid,1348.8,80,,1348.8,percent of total billed charges,All Other,1045.32,62,,1045.32,percent of total billed charges,Lab & Radiology,927.3,55,,,percent of total billed charges,Default if not in Fee Schedule,1348.8,80,,1348.8,percent of total billed charges,All Other,1045.32,62,,1045.32,percent of total billed charges,Lab & Radiology,1348.8,80,,1348.8,percent of total billed charges,All Other,1180.2,70,,1180.2,percent of total billed charges,,1095.9,65,,1095.9,percent of total billed charges,All Other,1095.9,65,,1095.9,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,418.18,,,418.18,Other,153% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,382.65,,,382.65,Other,140% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,710.64,,,710.64,Other,250% of Medicaid,885.56,,,885.56,Other,324% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,341.65,,,341.65,Other,125% of Medicaid,253.03,1348.8,
VEEG 2-12 HR UNMONITORED,95711,CPT,,48095711,CDM,740,RC,,,both,,,878,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,570.7,65,,570.7,percent of total billed charges,All Other,518.02,59,,518.02,percent of total billed charges,All Other,550.28,,,550.28,Fee Schedule,,550.28,,,550.28,Fee Schedule,,550.28,,,550.28,Fee Schedule,,614.6,70,,614.6,percent of total billed charges,All Other,597.04,68,,597.04,percent of total billed charges,All Other,287,,,287,Other,186% of Medicaid,702.4,80,,702.4,percent of total billed charges,All Other,544.36,62,,544.36,percent of total billed charges,Lab & Radiology,482.9,55,,,percent of total billed charges,Default if not in Fee Schedule,702.4,80,,702.4,percent of total billed charges,All Other,544.36,62,,544.36,percent of total billed charges,Lab & Radiology,702.4,80,,702.4,percent of total billed charges,All Other,614.6,70,,614.6,percent of total billed charges,,570.7,65,,570.7,percent of total billed charges,All Other,570.7,65,,570.7,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,906,
VEEG 2-12 HR INTMT MNTR,95712,CPT,,48095712,CDM,740,RC,,,both,,,940,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,611,65,,611,percent of total billed charges,All Other,554.6,59,,554.6,percent of total billed charges,All Other,550.28,,,550.28,Fee Schedule,,550.28,,,550.28,Fee Schedule,,550.28,,,550.28,Fee Schedule,,658,70,,658,percent of total billed charges,All Other,639.2,68,,639.2,percent of total billed charges,All Other,287,,,287,Other,186% of Medicaid,752,80,,752,percent of total billed charges,All Other,780.2,83,,780.2,percent of total billed charges,All Other,780.2,83,,,percent of total billed charges,All Other,752,80,,752,percent of total billed charges,All Other,780.2,83,,780.2,percent of total billed charges,All Other,752,80,,752,percent of total billed charges,All Other,658,70,,658,percent of total billed charges,,611,65,,611,percent of total billed charges,All Other,611,65,,611,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,906,
VEEG 2-12 HR CONT MNTR,95713,CPT,,48095713,CDM,740,RC,,,both,,,1686,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,1095.9,65,,1095.9,percent of total billed charges,All Other,994.74,59,,994.74,percent of total billed charges,All Other,550.28,,,550.28,Fee Schedule,,550.28,,,550.28,Fee Schedule,,550.28,,,550.28,Fee Schedule,,1180.2,70,,1180.2,percent of total billed charges,All Other,1146.48,68,,1146.48,percent of total billed charges,All Other,287,,,287,Other,186% of Medicaid,1348.8,80,,1348.8,percent of total billed charges,All Other,1399.38,83,,1399.38,percent of total billed charges,All Other,1399.38,83,,,percent of total billed charges,All Other,1348.8,80,,1348.8,percent of total billed charges,All Other,1399.38,83,,1399.38,percent of total billed charges,All Other,1348.8,80,,1348.8,percent of total billed charges,All Other,1180.2,70,,1180.2,percent of total billed charges,,1095.9,65,,1095.9,percent of total billed charges,All Other,1095.9,65,,1095.9,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,1399.38,
VEEG EA 12-26 HR UNMNTR,95714,CPT,,48095714,CDM,740,RC,,,both,,,1686,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,1095.9,65,,1095.9,percent of total billed charges,All Other,994.74,59,,994.74,percent of total billed charges,All Other,260.82,,,260.82,Fee Schedule,,260.82,,,260.82,Fee Schedule,,260.82,,,260.82,Fee Schedule,,1180.2,70,,1180.2,percent of total billed charges,All Other,1146.48,68,,1146.48,percent of total billed charges,All Other,508,,,508,Other,186% of Medicaid,1348.8,80,,1348.8,percent of total billed charges,All Other,1045.32,62,,1045.32,percent of total billed charges,Lab & Radiology,927.3,55,,,percent of total billed charges,Default if not in Fee Schedule,1348.8,80,,1348.8,percent of total billed charges,All Other,1045.32,62,,1045.32,percent of total billed charges,Lab & Radiology,1348.8,80,,1348.8,percent of total billed charges,All Other,1180.2,70,,1180.2,percent of total billed charges,,1095.9,65,,1095.9,percent of total billed charges,All Other,1095.9,65,,1095.9,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,418.18,,,418.18,Other,153% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,382.65,,,382.65,Other,140% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,710.64,,,710.64,Other,250% of Medicaid,885.56,,,885.56,Other,324% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,341.65,,,341.65,Other,125% of Medicaid,260.82,1348.8,
VEEG EA 12-26 HR INTMT MNTR,95715,CPT,,48095715,CDM,740,RC,,,both,,,1805,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,1173.25,65,,1173.25,percent of total billed charges,All Other,1064.95,59,,1064.95,percent of total billed charges,All Other,1361.61,,,1361.61,Fee Schedule,,1361.61,,,1361.61,Fee Schedule,,1361.61,,,1361.61,Fee Schedule,,1263.5,70,,1263.5,percent of total billed charges,All Other,1227.4,68,,1227.4,percent of total billed charges,All Other,508,,,508,Other,186% of Medicaid,1444,80,,1444,percent of total billed charges,All Other,1498.15,83,,1498.15,percent of total billed charges,All Other,1498.15,83,,,percent of total billed charges,All Other,1444,80,,1444,percent of total billed charges,All Other,1498.15,83,,1498.15,percent of total billed charges,All Other,1444,80,,1444,percent of total billed charges,All Other,1263.5,70,,1263.5,percent of total billed charges,,1173.25,65,,1173.25,percent of total billed charges,All Other,1173.25,65,,1173.25,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,418.18,,,418.18,Other,153% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,382.65,,,382.65,Other,140% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,710.64,,,710.64,Other,250% of Medicaid,885.56,,,885.56,Other,324% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,341.65,,,341.65,Other,125% of Medicaid,273.32,1498.15,
VEEG EA 12-26 HR CONT MNTR,95716,CPT,,48095716,CDM,740,RC,,,both,,,3154,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS,2050.1,65,,2050.1,percent of total billed charges,All Other,1860.86,59,,1860.86,percent of total billed charges,All Other,1361.61,,,1361.61,Fee Schedule,,1361.61,,,1361.61,Fee Schedule,,1361.61,,,1361.61,Fee Schedule,,2207.8,70,,2207.8,percent of total billed charges,All Other,2144.72,68,,2144.72,percent of total billed charges,All Other,508,,,508,Other,186% of Medicaid,2523.2,80,,2523.2,percent of total billed charges,All Other,2617.82,83,,2617.82,percent of total billed charges,All Other,2617.82,83,,,percent of total billed charges,All Other,2523.2,80,,2523.2,percent of total billed charges,All Other,2617.82,83,,2617.82,percent of total billed charges,All Other,2523.2,80,,2523.2,percent of total billed charges,All Other,2207.8,70,,2207.8,percent of total billed charges,,2050.1,65,,2050.1,percent of total billed charges,All Other,2050.1,65,,2050.1,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,418.18,,,418.18,Other,153% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,382.65,,,382.65,Other,140% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,710.64,,,710.64,Other,250% of Medicaid,885.56,,,885.56,Other,324% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,341.65,,,341.65,Other,125% of Medicaid,273.32,2617.82,
SLEEP STUDY ATTENDED (PAP NAP),95807,CPT,52,72095807,CDM,740,RC,,,both,,,1790,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,2849.33,,,2849.33,Fee Schedule,,2563.35,,,2563.35,Fee Schedule,,2422.97,,,2422.97,Fee Schedule,,1253,70,,1253,percent of total billed charges,All Other,1217.2,68,,1217.2,percent of total billed charges,All Other,1329,,,1329,Other,186% of Medicaid,1432,80,,1432,percent of total billed charges,All Other,1485.7,83,,1485.7,percent of total billed charges,All Other,1485.7,83,,1485.7,percent of total billed charges,All Other,1432,80,,1432,percent of total billed charges,All Other,1485.7,83,,1485.7,percent of total billed charges,All Other,1432,80,,1432,percent of total billed charges,All Other,1253,70,,1253,percent of total billed charges,,1551.44,,,1551.44,Fee Schedule,,1314.94,,,1314.94,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1093.52,,,1093.52,Other,153% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1000.6,,,1000.6,Other,140% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1858.26,,,1858.26,Other,250% of Medicaid,2315.68,,,2315.68,Other,324% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,893.4,,,893.4,Other,125% of Medicaid,588.97,3524,
EEG 41-60 MINUTES,95812,CPT,TC,53095812,CDM,740,RC,,,both,,,966,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,946.12,,,946.12,Fee Schedule,,853.12,,,853.12,Fee Schedule,,1827.8,,,1827.8,Fee Schedule,,1644.35,,,1644.35,Fee Schedule,,1554.3,,,1554.3,Fee Schedule,,676.2,70,,676.2,percent of total billed charges,All Other,1215.53,,,1215.53,Fee Schedule,,508,,,508,Other,186% of Medicaid,1430.41,,,1430.41,Fee Schedule,,598.92,,,598.92,Fee Schedule,,673.51,,,,Fee Schedule,,1430.41,,,1430.41,Fee Schedule,,598.92,,,598.92,Fee Schedule,,772.8,80,,772.8,percent of total billed charges,All Other,676.2,70,,676.2,percent of total billed charges,,1413.68,,,1413.68,Fee Schedule,,1198.18,,,1198.18,Fee Schedule,,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,418.18,,,418.18,Other,153% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,382.65,,,382.65,Other,140% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,710.64,,,710.64,Other,250% of Medicaid,885.56,,,885.56,Other,324% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,341.65,,,341.65,Other,125% of Medicaid,273.32,1827.8,
EEG OVER 1 HOUR,95813,CPT,TC,53095813,CDM,740,RC,,,both,,,1083,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,1152.48,,,1152.48,Fee Schedule,,1039.18,,,1039.18,Fee Schedule,,1882.6,,,1882.6,Fee Schedule,,1693.65,,,1693.65,Fee Schedule,,1600.9,,,1600.9,Fee Schedule,,758.1,70,,758.1,percent of total billed charges,All Other,1480.64,,,1480.64,Fee Schedule,,508,,,508,Other,186% of Medicaid,1742.39,,,1742.39,Fee Schedule,,671.46,,,671.46,Fee Schedule,,820.41,,,,Fee Schedule,,1742.39,,,1742.39,Fee Schedule,,671.46,,,671.46,Fee Schedule,,866.4,80,,866.4,percent of total billed charges,All Other,758.1,70,,758.1,percent of total billed charges,,1671.16,,,1671.16,Fee Schedule,,1416.41,,,1416.41,Fee Schedule,,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,273.32,,,273.32,Other,100% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,418.18,,,418.18,Other,153% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,382.65,,,382.65,Other,140% of Medicaid,614.97,,,614.97,Other,225% of Medicaid,710.64,,,710.64,Other,250% of Medicaid,885.56,,,885.56,Other,324% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,587.64,,,587.64,Other,215% of Medicaid,341.65,,,341.65,Other,125% of Medicaid,273.32,1882.6,
EEG AWAKE AND DROWSY,95816,CPT,TC,53095816,CDM,740,RC,,,both,,,1711,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,1088.37,,,1088.37,Fee Schedule,,981.38,,,981.38,Fee Schedule,,1661.21,,,1661.21,Fee Schedule,,1494.48,,,1494.48,Fee Schedule,,1412.63,,,1412.63,Fee Schedule,,1197.7,70,,1197.7,percent of total billed charges,All Other,1398.28,,,1398.28,Fee Schedule,,287,,,287,Other,186% of Medicaid,1645.47,,,1645.47,Fee Schedule,,1060.82,,,1060.82,Fee Schedule,,774.77,,,,Fee Schedule,,1645.47,,,1645.47,Fee Schedule,,1060.82,,,1060.82,Fee Schedule,,1368.8,80,,1368.8,percent of total billed charges,All Other,1197.7,70,,1197.7,percent of total billed charges,,1587.52,,,1587.52,Fee Schedule,,1345.52,,,1345.52,Fee Schedule,,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,1661.21,
EEG AWAKE AND DROWSY LIMITED,95816,CPT,52TC,53195816,CDM,740,RC,,,both,,,1369,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,1088.37,,,1088.37,Fee Schedule,,981.38,,,981.38,Fee Schedule,,1661.21,,,1661.21,Fee Schedule,,1494.48,,,1494.48,Fee Schedule,,1412.63,,,1412.63,Fee Schedule,,958.3,70,,958.3,percent of total billed charges,All Other,1398.28,,,1398.28,Fee Schedule,,287,,,287,Other,186% of Medicaid,1645.47,,,1645.47,Fee Schedule,,848.78,,,848.78,Fee Schedule,,774.77,,,,Fee Schedule,,1645.47,,,1645.47,Fee Schedule,,848.78,,,848.78,Fee Schedule,,1095.2,80,,1095.2,percent of total billed charges,All Other,958.3,70,,958.3,percent of total billed charges,,1587.52,,,1587.52,Fee Schedule,,1345.52,,,1345.52,Fee Schedule,,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,1661.21,
EEG AWAKE AND ASLEEP STUDY,95819,CPT,TC,53095819,CDM,740,RC,,,both,,,1597,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,1280.83,,,1280.83,Fee Schedule,,1154.92,,,1154.92,Fee Schedule,,1899.15,,,1899.15,Fee Schedule,,1708.54,,,1708.54,Fee Schedule,,1614.97,,,1614.97,Fee Schedule,,1117.9,70,,1117.9,percent of total billed charges,All Other,1645.54,,,1645.54,Fee Schedule,,287,,,287,Other,186% of Medicaid,1936.44,,,1936.44,Fee Schedule,,990.14,,,990.14,Fee Schedule,,911.78,,,,Fee Schedule,,1936.44,,,1936.44,Fee Schedule,,990.14,,,990.14,Fee Schedule,,1277.6,80,,1277.6,percent of total billed charges,All Other,1117.9,70,,1117.9,percent of total billed charges,,1908.96,,,1908.96,Fee Schedule,,1617.96,,,1617.96,Fee Schedule,,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,1936.44,
EEG COMA OR SLEEP ONLY,95822,CPT,TC,53095822,CDM,740,RC,,,both,,,850,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,1147.11,,,1147.11,Fee Schedule,,1034.34,,,1034.34,Fee Schedule,,1751.63,,,1751.63,Fee Schedule,,1575.83,,,1575.83,Fee Schedule,,1489.52,,,1489.52,Fee Schedule,,595,70,,595,percent of total billed charges,All Other,1473.74,,,1473.74,Fee Schedule,,287,,,287,Other,186% of Medicaid,1734.27,,,1734.27,Fee Schedule,,527,,,527,Fee Schedule,,816.59,,,,Fee Schedule,,1734.27,,,1734.27,Fee Schedule,,527,,,527,Fee Schedule,,680,80,,680,percent of total billed charges,All Other,595,70,,595,percent of total billed charges,,1753.16,,,1753.16,Fee Schedule,,1485.91,,,1485.91,Fee Schedule,,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,154.29,1753.16,
EEG; CEREBRAL SILENCE,95824,CPT,TC,53095824,CDM,740,RC,,,both,,,3139,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,2040.35,65,,2040.35,percent of total billed charges,All Other,1852.01,59,,1852.01,percent of total billed charges,All Other,60.2,,,60.2,Fee Schedule,,60.2,,,60.2,Fee Schedule,,60.2,,,60.2,Fee Schedule,,2197.3,70,,2197.3,percent of total billed charges,All Other,2134.52,68,,2134.52,percent of total billed charges,All Other,287,,,287,Other,186% of Medicaid,2511.2,80,,2511.2,percent of total billed charges,All Other,2605.37,83,,2605.37,percent of total billed charges,All Other,2605.37,83,,,percent of total billed charges,All Other,2511.2,80,,2511.2,percent of total billed charges,All Other,2605.37,83,,2605.37,percent of total billed charges,All Other,2511.2,80,,2511.2,percent of total billed charges,All Other,2197.3,70,,2197.3,percent of total billed charges,,2040.35,65,,2040.35,percent of total billed charges,All Other,2040.35,65,,2040.35,percent of total billed charges,All Other,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,60.2,2605.37,
UGI W BX SGL MULTIPLE,43249,CPT,,30043249,CDM,750,RC,,,both,,,3921,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2666.28,,,2666.28,Other,ASC Grouper table,1531,,,1531,Other,186% of Medicaid,3136.8,,,3136.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3136.8,,,3136.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2744.7,70,,2744.7,percent of total billed charges,,3387,,,3387,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2879,,,2879,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2744.7,70,,2744.7,percent of total billed charges,All Other,2744.7,70,,2744.7,percent of total billed charges,All Other,2744.7,70,,2744.7,percent of total billed charges,All Other,2744.7,70,,2744.7,percent of total billed charges,All Other,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1258.98,,,1258.98,Other,153% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1152.01,,,1152.01,Other,140% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,2139.45,,,2139.45,Other,250% of Medicaid,2666.08,,,2666.08,Other,324% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1028.58,,,1028.58,Other,125% of Medicaid,822.86,7216,
UGI BALLOON DIL ESOPH - < 30 MM DIA,43249,CPT,,34043249,CDM,750,RC,,,both,,,3921,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2666.28,,,2666.28,Other,ASC Grouper table,1531,,,1531,Other,186% of Medicaid,3136.8,,,3136.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3136.8,,,3136.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2744.7,70,,2744.7,percent of total billed charges,,3387,,,3387,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2879,,,2879,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2744.7,70,,2744.7,percent of total billed charges,All Other,2744.7,70,,2744.7,percent of total billed charges,All Other,2744.7,70,,2744.7,percent of total billed charges,All Other,2744.7,70,,2744.7,percent of total billed charges,All Other,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,822.86,,,822.86,Other,100% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1258.98,,,1258.98,Other,153% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,1152.01,,,1152.01,Other,140% of Medicaid,1851.44,,,1851.44,Other,225% of Medicaid,2139.45,,,2139.45,Other,250% of Medicaid,2666.08,,,2666.08,Other,324% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1769.16,,,1769.16,Other,215% of Medicaid,1028.58,,,1028.58,Other,125% of Medicaid,822.86,7216,
INTROD LONG GI TUBE,44500,CPT,,82044500,CDM,750,RC,,,both,,,2409,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1686.3,70,,1686.3,percent of total billed charges,All Other,1638.12,,,1638.12,Other,ASC Grouper table,1030,,,1030,Other,186% of Medicaid,1927.2,,,1927.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1927.2,,,1927.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1927.2,80,,1927.2,percent of total billed charges,All Other,1686.3,70,,1686.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1686.3,70,,1686.3,percent of total billed charges,All Other,1686.3,70,,1686.3,percent of total billed charges,All Other,1686.3,70,,1686.3,percent of total billed charges,All Other,1686.3,70,,1686.3,percent of total billed charges,All Other,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,553.78,,,553.78,Other,100% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,847.29,,,847.29,Other,153% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,775.29,,,775.29,Other,140% of Medicaid,1246.01,,,1246.01,Other,225% of Medicaid,1439.83,,,1439.83,Other,250% of Medicaid,1794.25,,,1794.25,Other,324% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,1190.63,,,1190.63,Other,215% of Medicaid,692.23,,,692.23,Other,125% of Medicaid,553.78,7216,
G-ESOPH REFLUX W MUCOSAL PH,91035,CPT,,35091035,CDM,750,RC,,,both,,,1275,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4109,,,4109,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2671.84,,,2671.84,Fee Schedule,,2405.17,,,2405.17,Fee Schedule,,2271.84,,,2271.84,Fee Schedule,,892.5,70,,892.5,percent of total billed charges,All Other,867,,,867,Other,ASC Grouper table,784,,,784,Other,186% of Medicaid,1020,,,1020,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1020,,,1020,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1020,80,,1020,percent of total billed charges,All Other,892.5,70,,892.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",892.5,70,,892.5,percent of total billed charges,All Other,892.5,70,,892.5,percent of total billed charges,All Other,892.5,70,,892.5,percent of total billed charges,All Other,892.5,70,,892.5,percent of total billed charges,All Other,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,645.06,,,645.06,Other,153% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,590.25,,,590.25,Other,140% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,1096.18,,,1096.18,Other,250% of Medicaid,1366.01,,,1366.01,Other,324% of Medicaid,906.45,,,906.45,Other,215% of Medicaid,906.45,,,906.45,Other,215% of Medicaid,527.01,,,527.01,Other,125% of Medicaid,421.61,7216,
GI TRACT CAPSULE ENDOSCOPY,91110,CPT,,34091110,CDM,750,RC,,,both,,,3976,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2584.4,65,,2584.4,percent of total billed charges,All Other,2345.84,59,,2345.84,percent of total billed charges,All Other,5063.74,,,5063.74,Fee Schedule,,4555.52,,,4555.52,Fee Schedule,,4306.03,,,4306.03,Fee Schedule,,2783.2,70,,2783.2,percent of total billed charges,All Other,2703.68,68,,2703.68,percent of total billed charges,All Other,784,,,784,Other,186% of Medicaid,3180.8,80,,3180.8,percent of total billed charges,All Other,3300.08,83,,3300.08,percent of total billed charges,All Other,3300.08,83,,,percent of total billed charges,All Other,3180.8,80,,3180.8,percent of total billed charges,All Other,3300.08,83,,3300.08,percent of total billed charges,All Other,3180.8,80,,3180.8,percent of total billed charges,All Other,2783.2,70,,2783.2,percent of total billed charges,,3280,,,3280,Fee Schedule,,2780,,,2780,Fee Schedule,,2783.2,70,,2783.2,percent of total billed charges,All Other,2783.2,70,,2783.2,percent of total billed charges,All Other,2783.2,70,,2783.2,percent of total billed charges,All Other,2783.2,70,,2783.2,percent of total billed charges,All Other,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,645.06,,,645.06,Other,153% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,590.25,,,590.25,Other,140% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,1096.18,,,1096.18,Other,250% of Medicaid,1366.01,,,1366.01,Other,324% of Medicaid,906.45,,,906.45,Other,215% of Medicaid,906.45,,,906.45,Other,215% of Medicaid,527.01,,,527.01,Other,125% of Medicaid,421.61,5063.74,
GI TRACT CAPSULE ENDOSCOPY,91110,CPT,,35091110,CDM,750,RC,,,both,,,3976,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2584.4,65,,2584.4,percent of total billed charges,All Other,2345.84,59,,2345.84,percent of total billed charges,All Other,5063.74,,,5063.74,Fee Schedule,,4555.52,,,4555.52,Fee Schedule,,4306.03,,,4306.03,Fee Schedule,,2783.2,70,,2783.2,percent of total billed charges,All Other,2703.68,68,,2703.68,percent of total billed charges,All Other,784,,,784,Other,186% of Medicaid,3180.8,80,,3180.8,percent of total billed charges,All Other,3300.08,83,,3300.08,percent of total billed charges,All Other,3300.08,83,,,percent of total billed charges,All Other,3180.8,80,,3180.8,percent of total billed charges,All Other,3300.08,83,,3300.08,percent of total billed charges,All Other,3180.8,80,,3180.8,percent of total billed charges,All Other,2783.2,70,,2783.2,percent of total billed charges,,3280,,,3280,Fee Schedule,,2780,,,2780,Fee Schedule,,2783.2,70,,2783.2,percent of total billed charges,All Other,2783.2,70,,2783.2,percent of total billed charges,All Other,2783.2,70,,2783.2,percent of total billed charges,All Other,2783.2,70,,2783.2,percent of total billed charges,All Other,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,421.61,,,421.61,Other,100% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,645.06,,,645.06,Other,153% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,590.25,,,590.25,Other,140% of Medicaid,948.61,,,948.61,Other,225% of Medicaid,1096.18,,,1096.18,Other,250% of Medicaid,1366.01,,,1366.01,Other,324% of Medicaid,906.45,,,906.45,Other,215% of Medicaid,906.45,,,906.45,Other,215% of Medicaid,527.01,,,527.01,Other,125% of Medicaid,421.61,5063.74,
I&D ABSC; SMPL OR SGL,10060,CPT,,73010060,CDM,761,RC,,,both,,,587,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",410.9,70,,410.9,percent of total billed charges,All Other,399.16,,,399.16,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,469.6,,,469.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",469.6,,,469.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",469.6,,,469.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",410.9,70,,410.9,percent of total billed charges,,505.12,,,505.12,Fee Schedule,,428.12,,,428.12,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,219.99,7216,
I&D ABSC; COMPL OR MULTI,10061,CPT,,73010061,CDM,761,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",571.88,,,571.88,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,393.96,7216,
I&D PILONID CYS; SMPL,10080,CPT,,73010080,CDM,761,RC,,,both,,,1462,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1023.4,70,,1023.4,percent of total billed charges,All Other,994.16,,,994.16,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1169.6,,,1169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1023.4,70,,1023.4,percent of total billed charges,,506.76,,,506.76,Fee Schedule,,429.51,,,429.51,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,393.96,7216,
I&D PILONID CYST; CPLX,10081,CPT,,73010081,CDM,761,RC,,,both,,,3098,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2168.6,70,,2168.6,percent of total billed charges,All Other,2106.64,,,2106.64,Other,ASC Grouper table,1207,,,1207,Other,186% of Medicaid,2478.4,,,2478.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2478.4,,,2478.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2478.4,,,2478.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2168.6,70,,2168.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,992.66,,,992.66,Other,153% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,908.32,,,908.32,Other,140% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,1686.88,,,1686.88,Other,250% of Medicaid,2102.11,,,2102.11,Other,324% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,811,,,811,Other,125% of Medicaid,648.8,7216,
I&D HEMATOMA/FLUID,10140,CPT,,73010140,CDM,761,RC,,,both,,,4951,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3465.7,70,,3465.7,percent of total billed charges,All Other,3366.68,,,3366.68,Other,ASC Grouper table,1207,,,1207,Other,186% of Medicaid,3960.8,,,3960.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3960.8,,,3960.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3960.8,,,3960.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3465.7,70,,3465.7,percent of total billed charges,,569.08,,,569.08,Fee Schedule,,482.33,,,482.33,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,648.8,,,648.8,Other,100% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,992.66,,,992.66,Other,153% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,908.32,,,908.32,Other,140% of Medicaid,1459.8,,,1459.8,Other,225% of Medicaid,1686.88,,,1686.88,Other,250% of Medicaid,2102.11,,,2102.11,Other,324% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,1394.92,,,1394.92,Other,215% of Medicaid,811,,,811,Other,125% of Medicaid,482.33,7216,
PUNCT ASP - ABSC HEMAT CYST,10160,CPT,,73010160,CDM,761,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",588.7,70,,588.7,percent of total billed charges,All Other,571.88,,,571.88,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,457.56,,,457.56,Fee Schedule,,387.81,,,387.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,387.81,7216,
I&D CPLX POSTOP WND INF,10180,CPT,,73010180,CDM,761,RC,,,both,,,5816,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3954.88,,,3954.88,Other,ASC Grouper table,2493,,,2493,Other,186% of Medicaid,4652.8,,,4652.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4652.8,,,4652.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4071.2,70,,4071.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,1340.06,7216,
DEBR EXZ/INF SKIN; 10% BS,11000,CPT,,73011000,CDM,761,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",916.3,70,,916.3,percent of total billed charges,All Other,890.12,,,890.12,Other,ASC Grouper table,1352,,,1352,Other,186% of Medicaid,1047.2,,,1047.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1047.2,,,1047.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1047.2,,,1047.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",916.3,70,,916.3,percent of total billed charges,,132.84,,,132.84,Fee Schedule,,112.59,,,112.59,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,112.59,7216,
DEBRIDE INFECTED SKIN ADD-ON =<10% BS,11001,CPT,,73011001,CDM,761,RC,,,both,,,225,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",157.5,70,,157.5,percent of total billed charges,All Other,153,,,153,Other,ASC Grouper table,1352,,,1352,Other,186% of Medicaid,180,,,180,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",180,,,180,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",180,,,180,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",157.5,70,,157.5,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,7216,
DEBRIDE SKIN AT FX SITE,11010,CPT,,73011010,CDM,761,RC,,,both,,,1528,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1039.04,,,1039.04,Other,ASC Grouper table,1352,,,1352,Other,186% of Medicaid,1222.4,,,1222.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1222.4,,,1222.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1069.6,70,,1069.6,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,726.99,7216,
DEB SUBQ TISSUE 20 SQ CM/<,11042,CPT,,73011042,CDM,761,RC,,,both,,,1041,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",707.88,,,707.88,Other,ASC Grouper table,1352,,,1352,Other,186% of Medicaid,832.8,,,832.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",832.8,,,832.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",728.7,70,,728.7,percent of total billed charges,,288.64,,,288.64,Fee Schedule,,244.64,,,244.64,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,244.64,7216,
DEB MUSC/FASCIA 20 SQ CM/<,11043,CPT,,73011043,CDM,761,RC,,,both,,,1402,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",953.36,,,953.36,Other,ASC Grouper table,1352,,,1352,Other,186% of Medicaid,1121.6,,,1121.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1121.6,,,1121.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",981.4,70,,981.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,690.13,7216,
DEB BONE 20 SQ CM/<,11044,CPT,,73011044,CDM,761,RC,,,both,,,3377,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2296.36,,,2296.36,Other,ASC Grouper table,2493,,,2493,Other,186% of Medicaid,2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2701.6,,,2701.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2363.9,70,,2363.9,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,1340.06,7216,
DEB SUBQ TISSUE ADD-ON =<20 SQ CM,11045,CPT,,73011045,CDM,761,RC,,,both,,,930,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",632.4,,,632.4,Other,ASC Grouper table,2493,,,2493,Other,186% of Medicaid,744,,,744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",744,,,744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",744,,,744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",651,70,,651,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,0.01,7216,
DEB MUSC/FASCIA ADD-ON =<20 SQ CM,11046,CPT,,73011046,CDM,761,RC,,,both,,,930,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",632.4,,,632.4,Other,ASC Grouper table,2493,,,2493,Other,186% of Medicaid,744,,,744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",744,,,744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",744,,,744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",651,70,,651,percent of total billed charges,,267.32,,,267.32,Fee Schedule,,226.57,,,226.57,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,0.01,7216,
DEB BONE ADD-ON =<20 SQ CM,11047,CPT,,73011047,CDM,761,RC,,,both,,,2327,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1582.36,,,1582.36,Other,ASC Grouper table,2493,,,2493,Other,186% of Medicaid,1861.6,,,1861.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1861.6,,,1861.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1861.6,,,1861.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1628.9,70,,1628.9,percent of total billed charges,,467.4,,,467.4,Fee Schedule,,396.15,,,396.15,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,0.01,7216,
PARE BENIGN LES; SGL,11055,CPT,,73011055,CDM,761,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",285.6,70,,285.6,percent of total billed charges,All Other,277.44,,,277.44,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",285.6,70,,285.6,percent of total billed charges,,77.08,,,77.08,Fee Schedule,,65.33,,,65.33,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,65.33,7216,
TRIM SKIN LESIONS 2 TO 4,11056,CPT,,73011056,CDM,761,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",285.6,70,,285.6,percent of total billed charges,All Other,277.44,,,277.44,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",285.6,70,,285.6,percent of total billed charges,,106.6,,,106.6,Fee Schedule,,90.35,,,90.35,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,90.35,7216,
TRIM SKIN LESIONS OVER 4,11057,CPT,,73011057,CDM,761,RC,,,both,,,460,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",322,70,,322,percent of total billed charges,All Other,312.8,,,312.8,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,368,,,368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",368,,,368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",368,,,368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",322,70,,322,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,116.76,7216,
PUNCH BX SKIN SINGLE LESION,11104,CPT,,54011104,CDM,761,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",588.7,70,,588.7,percent of total billed charges,All Other,571.88,,,571.88,Other,ASC Grouper table,1240,,,1240,Other,186% of Medicaid,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,224.68,,,224.68,Fee Schedule,,190.43,,,190.43,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,190.43,7216,
PUNCH BX SKIN SINGLE LESION,11104,CPT,,73011104,CDM,761,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",588.7,70,,588.7,percent of total billed charges,All Other,571.88,,,571.88,Other,ASC Grouper table,1240,,,1240,Other,186% of Medicaid,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,224.68,,,224.68,Fee Schedule,,190.43,,,190.43,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,190.43,7216,
PUNCH BX SKIN EA SEP/ADDL,11105,CPT,,73011105,CDM,761,RC,,,both,,,695,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",486.5,70,,486.5,percent of total billed charges,All Other,472.6,,,472.6,Other,ASC Grouper table,1240,,,1240,Other,186% of Medicaid,556,,,556,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",556,,,556,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",556,,,556,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",486.5,70,,486.5,percent of total billed charges,,123,,,123,Fee Schedule,,104.25,,,104.25,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,7216,
INCAL BX SKN SINGLE LES,11106,CPT,,73011106,CDM,761,RC,,,both,,,1353,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",947.1,70,,947.1,percent of total billed charges,All Other,920.04,,,920.04,Other,ASC Grouper table,1240,,,1240,Other,186% of Medicaid,1082.4,,,1082.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1082.4,,,1082.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1082.4,,,1082.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",947.1,70,,947.1,percent of total billed charges,,272.24,,,272.24,Fee Schedule,,230.74,,,230.74,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,230.74,7216,
INCAL BX SKN EA SEP/ADDL,11107,CPT,,73011107,CDM,761,RC,,,both,,,445,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",311.5,70,,311.5,percent of total billed charges,All Other,302.6,,,302.6,Other,ASC Grouper table,1240,,,1240,Other,186% of Medicaid,356,,,356,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",356,,,356,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",356,,,356,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",311.5,70,,311.5,percent of total billed charges,,149.24,,,149.24,Fee Schedule,,126.49,,,126.49,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,0.01,7216,
REM SKIN TAGS; <=15 LESIONS,11200,CPT,,73011200,CDM,761,RC,,,both,,,439,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",307.3,70,,307.3,percent of total billed charges,All Other,298.52,,,298.52,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,351.2,,,351.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",351.2,,,351.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",351.2,,,351.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",307.3,70,,307.3,percent of total billed charges,,364.08,,,364.08,Fee Schedule,,308.58,,,308.58,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,219.99,7216,
DEBRIDE NAIL 1-5,11720,CPT,,73011720,CDM,761,RC,,,both,,,198,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",138.6,70,,138.6,percent of total billed charges,All Other,134.64,,,134.64,Other,ASC Grouper table,353,,,353,Other,186% of Medicaid,158.4,,,158.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",158.4,,,158.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",158.4,,,158.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",138.6,70,,138.6,percent of total billed charges,,70.52,,,70.52,Fee Schedule,,59.77,,,59.77,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,290.55,,,290.55,Other,153% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,265.86,,,265.86,Other,140% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,493.74,,,493.74,Other,250% of Medicaid,615.28,,,615.28,Other,324% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,237.38,,,237.38,Other,125% of Medicaid,59.77,7216,
DEBRIDE NAIL 6 OR MORE,11721,CPT,,73011721,CDM,761,RC,,,both,,,212,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",148.4,70,,148.4,percent of total billed charges,All Other,144.16,,,144.16,Other,ASC Grouper table,353,,,353,Other,186% of Medicaid,169.6,,,169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",169.6,,,169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",169.6,,,169.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",148.4,70,,148.4,percent of total billed charges,,114.8,,,114.8,Fee Schedule,,97.3,,,97.3,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,290.55,,,290.55,Other,153% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,265.86,,,265.86,Other,140% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,493.74,,,493.74,Other,250% of Medicaid,615.28,,,615.28,Other,324% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,237.38,,,237.38,Other,125% of Medicaid,67.21,7216,
SPL AVULSE NP; SGL,11730,CPT,,73011730,CDM,761,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",285.6,70,,285.6,percent of total billed charges,All Other,277.44,,,277.44,Other,ASC Grouper table,353,,,353,Other,186% of Medicaid,326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",285.6,70,,285.6,percent of total billed charges,,257.48,,,257.48,Fee Schedule,,218.23,,,218.23,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,290.55,,,290.55,Other,153% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,265.86,,,265.86,Other,140% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,493.74,,,493.74,Other,250% of Medicaid,615.28,,,615.28,Other,324% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,237.38,,,237.38,Other,125% of Medicaid,189.9,7216,
SPL AVULSE NP; EA ADDTL,11732,CPT,,73011732,CDM,761,RC,,,both,,,300,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",210,70,,210,percent of total billed charges,All Other,204,,,204,Other,ASC Grouper table,353,,,353,Other,186% of Medicaid,240,,,240,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",240,,,240,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",240,,,240,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",210,70,,210,percent of total billed charges,,83.64,,,83.64,Fee Schedule,,70.89,,,70.89,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,189.9,,,189.9,Other,100% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,290.55,,,290.55,Other,153% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,265.86,,,265.86,Other,140% of Medicaid,427.28,,,427.28,Other,225% of Medicaid,493.74,,,493.74,Other,250% of Medicaid,615.28,,,615.28,Other,324% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,408.29,,,408.29,Other,215% of Medicaid,237.38,,,237.38,Other,125% of Medicaid,0.01,7216,
REMOVAL OF NAIL BED,11750,CPT,,73011750,CDM,761,RC,,,both,,,1876,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",1313.2,70,,1313.2,percent of total billed charges,All Other,1275.68,,,1275.68,Other,ASC Grouper table,1240,,,1240,Other,186% of Medicaid,1500.8,,,1500.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1500.8,,,1500.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1500.8,,,1500.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1313.2,70,,1313.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,438.16,7216,
LCL SURG WND/DEH EXTENS,13160,CPT,,73013160,CDM,761,RC,,,both,,,5981,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4067.08,,,4067.08,Other,ASC Grouper table,2493,,,2493,Other,186% of Medicaid,4784.8,,,4784.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4784.8,,,4784.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4186.7,70,,4186.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,1340.06,7216,
WOUND PREP TRK/ARM/LEG 100 SQ CM/1% BA,15002,CPT,,73015002,CDM,761,RC,,,both,,,3886,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2642.48,,,2642.48,Other,ASC Grouper table,2493,,,2493,Other,186% of Medicaid,3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2720.2,70,,2720.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,1340.06,7216,
WOUND PREP ADDL 100 CM,15003,CPT,,73015003,CDM,761,RC,,,both,,,1710,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1162.8,,,1162.8,Other,ASC Grouper table,1352,,,1352,Other,186% of Medicaid,1368,,,1368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1368,,,1368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1197,70,,1197,percent of total billed charges,,219.76,,,219.76,Fee Schedule,,186.26,,,186.26,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,7216,
WOUND PREP F/N/HF/G 100 SQ CM/1% BA,15004,CPT,,73015004,CDM,761,RC,,,both,,,1309,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",890.12,,,890.12,Other,ASC Grouper table,2493,,,2493,Other,186% of Medicaid,1047.2,,,1047.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1047.2,,,1047.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",916.3,70,,916.3,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,1340.06,,,1340.06,Other,100% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,2050.29,,,2050.29,Other,153% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,1876.08,,,1876.08,Other,140% of Medicaid,3015.14,,,3015.14,Other,225% of Medicaid,3484.16,,,3484.16,Other,250% of Medicaid,4341.8,,,4341.8,Other,324% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,2881.13,,,2881.13,Other,215% of Medicaid,1675.08,,,1675.08,Other,125% of Medicaid,690.13,7216,
WND PREP F/N/HF/G ADDL 100 SQ CM/1% BA,15005,CPT,,73015005,CDM,761,RC,,,both,,,1492,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1014.56,,,1014.56,Other,ASC Grouper table,1352,,,1352,Other,186% of Medicaid,1193.6,,,1193.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1193.6,,,1193.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1044.4,70,,1044.4,percent of total billed charges,,439.52,,,439.52,Fee Schedule,,372.52,,,372.52,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,0.01,7216,
PINCH GRFT SM; DEFECT TO 2CM,15050,CPT,,73015050,CDM,761,RC,,,both,,,1710,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1162.8,,,1162.8,Other,ASC Grouper table,1240,,,1240,Other,186% of Medicaid,1368,,,1368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1368,,,1368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1197,70,,1197,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,666.93,,,666.93,Other,100% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1020.41,,,1020.41,Other,153% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,933.71,,,933.71,Other,140% of Medicaid,1500.6,,,1500.6,Other,225% of Medicaid,1734.02,,,1734.02,Other,250% of Medicaid,2160.86,,,2160.86,Other,324% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,1433.91,,,1433.91,Other,215% of Medicaid,833.67,,,833.67,Other,125% of Medicaid,666.93,7216,
SKIN SUB GRAFT TRNK/ARM/LEG,15271,CPT,,73015271,CDM,761,RC,,,both,,,3886,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2642.48,,,2642.48,Other,ASC Grouper table,2593,,,2593,Other,186% of Medicaid,3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2720.2,70,,2720.2,percent of total billed charges,,403.44,,,403.44,Fee Schedule,,341.94,,,341.94,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,341.94,7216,
SKIN SUB GRAFT T/A/L ADD-ON,15272,CPT,,73015272,CDM,761,RC,,,both,,,414,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",281.52,,,281.52,Other,ASC Grouper table,2593,,,2593,Other,186% of Medicaid,331.2,,,331.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",331.2,,,331.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",331.2,,,331.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",289.8,70,,289.8,percent of total billed charges,,85.28,,,85.28,Fee Schedule,,72.28,,,72.28,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,0.01,7216,
SKIN SUB GRFT T/ARM/LG CHILD,15273,CPT,,73015273,CDM,761,RC,,,both,,,7323,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4979.64,,,4979.64,Other,ASC Grouper table,2593,,,2593,Other,186% of Medicaid,5858.4,,,5858.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5858.4,,,5858.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5858.4,,,5858.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",5126.1,70,,5126.1,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4422,,,4422,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4913,,,4913,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4176,,,4176,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,1394.2,7216,
SKN SUB GRFT T/A/L CHILD ADD,15274,CPT,,73015274,CDM,761,RC,,,both,,,961,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",653.48,,,653.48,Other,ASC Grouper table,2593,,,2593,Other,186% of Medicaid,768.8,,,768.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",768.8,,,768.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",768.8,,,768.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.7,70,,672.7,percent of total billed charges,,219.76,,,219.76,Fee Schedule,,186.26,,,186.26,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,0.01,7216,
SKIN SUB GRAFT FACE/NK/HF/G,15275,CPT,,73015275,CDM,761,RC,,,both,,,3886,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2642.48,,,2642.48,Other,ASC Grouper table,2593,,,2593,Other,186% of Medicaid,3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2720.2,70,,2720.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,1394.2,7216,
SKIN SUB GRAFT F/N/HF/G ADDL,15276,CPT,,73015276,CDM,761,RC,,,both,,,378,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",257.04,,,257.04,Other,ASC Grouper table,2593,,,2593,Other,186% of Medicaid,302.4,,,302.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",302.4,,,302.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",302.4,,,302.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",264.6,70,,264.6,percent of total billed charges,,123,,,123,Fee Schedule,,104.25,,,104.25,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,0.01,7216,
SKN SUB GRFT F/N/HF/G CHILD,15277,CPT,,73015277,CDM,761,RC,,,both,,,3886,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2642.48,,,2642.48,Other,ASC Grouper table,2593,,,2593,Other,186% of Medicaid,3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3108.8,,,3108.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2720.2,70,,2720.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,1394.2,7216,
SKN SUB GRFT F/N/HF/G CH ADD,15278,CPT,,73015278,CDM,761,RC,,,both,,,961,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",653.48,,,653.48,Other,ASC Grouper table,2593,,,2593,Other,186% of Medicaid,768.8,,,768.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",768.8,,,768.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",768.8,,,768.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.7,70,,672.7,percent of total billed charges,,273.88,,,273.88,Fee Schedule,,232.13,,,232.13,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,1394.2,,,1394.2,Other,100% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,2133.12,,,2133.12,Other,153% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,1951.87,,,1951.87,Other,140% of Medicaid,3136.94,,,3136.94,Other,225% of Medicaid,3624.91,,,3624.91,Other,250% of Medicaid,4517.19,,,4517.19,Other,324% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,2997.52,,,2997.52,Other,215% of Medicaid,1742.74,,,1742.74,Other,125% of Medicaid,0.01,7216,
DRESS/DEBRID P-THICK BURN S,16020,CPT,,34016020,CDM,761,RC,,,both,,,573,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",401.1,70,,401.1,percent of total billed charges,All Other,389.64,,,389.64,Other,ASC Grouper table,957,,,957,Other,186% of Medicaid,458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",401.1,70,,401.1,percent of total billed charges,,262.4,,,262.4,Fee Schedule,,222.4,,,222.4,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,219.99,7216,
DRESS/DEBRID P-THICK BURN S,16020,CPT,,73016020,CDM,761,RC,,,both,,,573,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",401.1,70,,401.1,percent of total billed charges,All Other,389.64,,,389.64,Other,ASC Grouper table,957,,,957,Other,186% of Medicaid,458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",401.1,70,,401.1,percent of total billed charges,,262.4,,,262.4,Fee Schedule,,222.4,,,222.4,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,219.99,7216,
DRESS/DEBRID P-THICK BURN M,16025,CPT,,34016025,CDM,761,RC,,,both,,,535,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",363.8,,,363.8,Other,ASC Grouper table,957,,,957,Other,186% of Medicaid,428,,,428,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",428,,,428,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",374.5,70,,374.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,219.99,7216,
DRESS/DEBRID P-THICK BURN M,16025,CPT,,73016025,CDM,761,RC,,,both,,,535,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",363.8,,,363.8,Other,ASC Grouper table,957,,,957,Other,186% of Medicaid,428,,,428,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",428,,,428,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",374.5,70,,374.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,514.72,,,514.72,Other,100% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,787.52,,,787.52,Other,153% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,720.61,,,720.61,Other,140% of Medicaid,1158.12,,,1158.12,Other,225% of Medicaid,1338.27,,,1338.27,Other,250% of Medicaid,1667.69,,,1667.69,Other,324% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,1106.65,,,1106.65,Other,215% of Medicaid,643.4,,,643.4,Other,125% of Medicaid,219.99,7216,
DRESS/DEBRID P-THICK BURN L,16030,CPT,,73016030,CDM,761,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",571.88,,,571.88,Other,ASC Grouper table,1352,,,1352,Other,186% of Medicaid,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,726.99,,,726.99,Other,100% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1112.29,,,1112.29,Other,153% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1017.78,,,1017.78,Other,140% of Medicaid,1635.72,,,1635.72,Other,225% of Medicaid,1890.16,,,1890.16,Other,250% of Medicaid,2355.44,,,2355.44,Other,324% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,1563.02,,,1563.02,Other,215% of Medicaid,908.73,,,908.73,Other,125% of Medicaid,438.16,7216,
DESTRUCT PREMALG LESION,17000,CPT,,73017000,CDM,761,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",285.6,70,,285.6,percent of total billed charges,All Other,277.44,,,277.44,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",285.6,70,,285.6,percent of total billed charges,,264.04,,,264.04,Fee Schedule,,223.79,,,223.79,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,219.99,7216,
DESTRUCT PREMALG LES 2-14,17003,CPT,,73017003,CDM,761,RC,,,both,,,184,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",128.8,70,,128.8,percent of total billed charges,All Other,125.12,,,125.12,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,147.2,,,147.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",147.2,,,147.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",147.2,,,147.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",128.8,70,,128.8,percent of total billed charges,,9.84,,,9.84,Fee Schedule,,8.34,,,8.34,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,0.01,7216,
DESTRUCT B9 LESION 1-14,17110,CPT,,73017110,CDM,761,RC,,,both,,,1205,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",843.5,70,,843.5,percent of total billed charges,All Other,819.4,,,819.4,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,964,,,964,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",964,,,964,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",964,,,964,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",843.5,70,,843.5,percent of total billed charges,,319.8,,,319.8,Fee Schedule,,271.05,,,271.05,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,219.99,7216,
CHEM CAUT GRANULATION TISS,17250,CPT,,73017250,CDM,761,RC,,,both,,,697,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",487.9,70,,487.9,percent of total billed charges,All Other,473.96,,,473.96,Other,ASC Grouper table,733,,,733,Other,186% of Medicaid,557.6,,,557.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",557.6,,,557.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",557.6,,,557.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",487.9,70,,487.9,percent of total billed charges,,180.4,,,180.4,Fee Schedule,,152.9,,,152.9,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,393.96,,,393.96,Other,100% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,602.77,,,602.77,Other,153% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,551.55,,,551.55,Other,140% of Medicaid,886.42,,,886.42,Other,225% of Medicaid,1024.31,,,1024.31,Other,250% of Medicaid,1276.45,,,1276.45,Other,324% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,847.02,,,847.02,Other,215% of Medicaid,492.46,,,492.46,Other,125% of Medicaid,152.9,7216,
BONE BX TR/NDL; SUPERF,20220,CPT,,73020220,CDM,761,RC,,,both,,,3426,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2329.68,,,2329.68,Other,ASC Grouper table,1037,,,1037,Other,186% of Medicaid,2740.8,,,2740.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2740.8,,,2740.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2398.2,70,,2398.2,percent of total billed charges,,416.56,,,416.56,Fee Schedule,,353.06,,,353.06,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,557.64,,,557.64,Other,100% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,853.19,,,853.19,Other,153% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,780.7,,,780.7,Other,140% of Medicaid,1254.7,,,1254.7,Other,225% of Medicaid,1449.87,,,1449.87,Other,250% of Medicaid,1806.76,,,1806.76,Other,324% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,1198.93,,,1198.93,Other,215% of Medicaid,697.05,,,697.05,Other,125% of Medicaid,353.06,7216,
OPEN SUPERF BONE BX,20240,CPT,,73020240,CDM,761,RC,,,both,,,5816,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4778,,,4778,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4300,,,4300,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4061,,,4061,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3414,,,3414,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3954.88,,,3954.88,Other,ASC Grouper table,1660.99,,,1660.99,Other,186% of Medicaid,4652.8,,,4652.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4652.8,,,4652.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4252,,,4252,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",4071.2,70,,4071.2,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4079,,,4079,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4531,,,4531,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3852,,,3852,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",893.01,,,893.01,Other,100% of Medicaid,893.01,,,893.01,Other,100% of Medicaid,893.01,,,893.01,Other,100% of Medicaid,893.01,,,893.01,Other,100% of Medicaid,2009.26,,,2009.26,Other,225% of Medicaid,1366.3,,,1366.3,Other,153% of Medicaid,2009.26,,,2009.26,Other,225% of Medicaid,1250.21,,,1250.21,Other,140% of Medicaid,2009.26,,,2009.26,Other,225% of Medicaid,2321.81,,,2321.81,Other,250% of Medicaid,2893.34,,,2893.34,Other,324% of Medicaid,1919.96,,,1919.96,Other,215% of Medicaid,1919.96,,,1919.96,Other,215% of Medicaid,1116.26,,,1116.26,Other,125% of Medicaid,893.01,7216,
APPLY SH LEG CAST,29405,CPT,,73029405,CDM,761,RC,,,both,,,794,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,516.1,65,,516.1,percent of total billed charges,All Other,468.46,59,,468.46,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",555.8,70,,555.8,percent of total billed charges,All Other,539.92,68,,539.92,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,635.2,80,,635.2,percent of total billed charges,All Other,659.02,83,,659.02,percent of total billed charges,All Other,659.02,83,,,percent of total billed charges,All Other,635.2,80,,635.2,percent of total billed charges,All Other,659.02,83,,659.02,percent of total billed charges,All Other,635.2,80,,635.2,percent of total billed charges,All Other,555.8,70,,555.8,percent of total billed charges,,278.8,,,278.8,Fee Schedule,,236.3,,,236.3,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,236.3,3228,
APPLY WLKR SH LEG CAST,29425,CPT,,73029425,CDM,761,RC,,,both,,,721,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",504.7,70,,504.7,percent of total billed charges,All Other,490.28,,,490.28,Other,ASC Grouper table,680,,,680,Other,186% of Medicaid,576.8,,,576.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",576.8,,,576.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",576.8,,,576.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",504.7,70,,504.7,percent of total billed charges,,259.12,,,259.12,Fee Schedule,,219.62,,,219.62,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,365.53,,,365.53,Other,100% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,559.25,,,559.25,Other,153% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,511.74,,,511.74,Other,140% of Medicaid,822.43,,,822.43,Other,225% of Medicaid,950.37,,,950.37,Other,250% of Medicaid,1184.3,,,1184.3,Other,324% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,785.88,,,785.88,Other,215% of Medicaid,456.91,,,456.91,Other,125% of Medicaid,219.62,7216,
APPLY RIGID TOTAL CONTACT LEG CAST,29445,CPT,,73029445,CDM,761,RC,,,both,,,842,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,547.3,65,,547.3,percent of total billed charges,All Other,496.78,59,,496.78,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",589.4,70,,589.4,percent of total billed charges,All Other,572.56,68,,572.56,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,673.6,80,,673.6,percent of total billed charges,All Other,698.86,83,,698.86,percent of total billed charges,All Other,698.86,83,,,percent of total billed charges,All Other,673.6,80,,673.6,percent of total billed charges,All Other,698.86,83,,698.86,percent of total billed charges,All Other,673.6,,,673.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",589.4,70,,589.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,246.51,3933,
APPLY RIGID TOTAL CONTACT LEG CAST W/MOD,29445,CPT,59,73129445,CDM,761,RC,,,both,,,842,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS,547.3,65,,547.3,percent of total billed charges,All Other,496.78,59,,496.78,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",589.4,70,,589.4,percent of total billed charges,All Other,572.56,68,,572.56,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,673.6,80,,673.6,percent of total billed charges,All Other,698.86,83,,698.86,percent of total billed charges,All Other,698.86,83,,,percent of total billed charges,All Other,673.6,80,,673.6,percent of total billed charges,All Other,698.86,83,,698.86,percent of total billed charges,All Other,673.6,,,673.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",589.4,70,,589.4,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,246.51,3933,
UNNA BOOT STRAPPING,29580,CPT,,34029580,CDM,761,RC,,,both,,,427,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,277.55,65,,277.55,percent of total billed charges,All Other,251.93,59,,251.93,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",298.9,70,,298.9,percent of total billed charges,All Other,290.36,68,,290.36,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,341.6,80,,341.6,percent of total billed charges,All Other,354.41,83,,354.41,percent of total billed charges,All Other,354.41,83,,,percent of total billed charges,All Other,341.6,80,,341.6,percent of total billed charges,All Other,354.41,83,,354.41,percent of total billed charges,All Other,341.6,,,341.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",298.9,70,,298.9,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,109.81,3228,
UNNA BOOT STRAPPING BILATERAL,29580,CPT,50,34129580,CDM,761,RC,,,both,,,641,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,416.65,65,,416.65,percent of total billed charges,All Other,378.19,59,,378.19,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",448.7,70,,448.7,percent of total billed charges,All Other,435.88,68,,435.88,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,512.8,80,,512.8,percent of total billed charges,All Other,532.03,83,,532.03,percent of total billed charges,All Other,532.03,83,,,percent of total billed charges,All Other,512.8,80,,512.8,percent of total billed charges,All Other,532.03,83,,532.03,percent of total billed charges,All Other,512.8,,,512.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",448.7,70,,448.7,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,109.81,3228,
UNNA BOOT STRAPPING,29580,CPT,,73029580,CDM,761,RC,,,both,,,427,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,277.55,65,,277.55,percent of total billed charges,All Other,251.93,59,,251.93,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",298.9,70,,298.9,percent of total billed charges,All Other,290.36,68,,290.36,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,341.6,80,,341.6,percent of total billed charges,All Other,354.41,83,,354.41,percent of total billed charges,All Other,354.41,83,,,percent of total billed charges,All Other,341.6,80,,341.6,percent of total billed charges,All Other,354.41,83,,354.41,percent of total billed charges,All Other,341.6,,,341.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",298.9,70,,298.9,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,109.81,3228,
UNNA BOOT STRAPPING BILATERAL,29580,CPT,50,73129580,CDM,761,RC,,,both,,,641,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,416.65,65,,416.65,percent of total billed charges,All Other,378.19,59,,378.19,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",448.7,70,,448.7,percent of total billed charges,All Other,435.88,68,,435.88,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,512.8,80,,512.8,percent of total billed charges,All Other,532.03,83,,532.03,percent of total billed charges,All Other,532.03,83,,,percent of total billed charges,All Other,512.8,80,,512.8,percent of total billed charges,All Other,532.03,83,,532.03,percent of total billed charges,All Other,512.8,,,512.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",448.7,70,,448.7,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,109.81,3228,
UNNA BOOT STRAPPING W/59 MOD,29580,CPT,59,73229580,CDM,761,RC,,,both,,,427,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,277.55,65,,277.55,percent of total billed charges,All Other,251.93,59,,251.93,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",298.9,70,,298.9,percent of total billed charges,All Other,290.36,68,,290.36,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,341.6,80,,341.6,percent of total billed charges,All Other,354.41,83,,354.41,percent of total billed charges,All Other,354.41,83,,,percent of total billed charges,All Other,341.6,80,,341.6,percent of total billed charges,All Other,354.41,83,,354.41,percent of total billed charges,All Other,341.6,,,341.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",298.9,70,,298.9,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,109.81,3228,
UNNA BOOT STRAPPING BILATERAL W/59 MOD,29580,CPT,5059,73329580,CDM,761,RC,,,both,,,641,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,416.65,65,,416.65,percent of total billed charges,All Other,378.19,59,,378.19,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",448.7,70,,448.7,percent of total billed charges,All Other,435.88,68,,435.88,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,512.8,80,,512.8,percent of total billed charges,All Other,532.03,83,,532.03,percent of total billed charges,All Other,532.03,83,,,percent of total billed charges,All Other,512.8,80,,512.8,percent of total billed charges,All Other,532.03,83,,532.03,percent of total billed charges,All Other,512.8,,,512.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",448.7,70,,448.7,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,109.81,3228,
APPLY MULTLAY COMPRS LWR LEG,29581,CPT,,34029581,CDM,761,RC,,,both,,,393,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,255.45,65,,255.45,percent of total billed charges,All Other,231.87,59,,231.87,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",275.1,70,,275.1,percent of total billed charges,All Other,267.24,68,,267.24,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,314.4,80,,314.4,percent of total billed charges,All Other,326.19,83,,326.19,percent of total billed charges,All Other,326.19,83,,,percent of total billed charges,All Other,314.4,80,,314.4,percent of total billed charges,All Other,326.19,83,,326.19,percent of total billed charges,All Other,314.4,80,,314.4,percent of total billed charges,All Other,275.1,70,,275.1,percent of total billed charges,,131.2,,,131.2,Fee Schedule,,111.2,,,111.2,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,111.2,3228,
APPLY MULTLAY COMPRS LWR LEG BILATERAL,29581,CPT,50,34129581,CDM,761,RC,,,both,,,590,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,383.5,65,,383.5,percent of total billed charges,All Other,348.1,59,,348.1,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",413,70,,413,percent of total billed charges,All Other,401.2,68,,401.2,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,472,80,,472,percent of total billed charges,All Other,489.7,83,,489.7,percent of total billed charges,All Other,489.7,83,,,percent of total billed charges,All Other,472,80,,472,percent of total billed charges,All Other,489.7,83,,489.7,percent of total billed charges,All Other,472,80,,472,percent of total billed charges,All Other,413,70,,413,percent of total billed charges,,131.2,,,131.2,Fee Schedule,,111.2,,,111.2,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,111.2,3228,
APPLY MULTLAY COMPRS LWR LEG,29581,CPT,,73029581,CDM,761,RC,,,both,,,393,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,255.45,65,,255.45,percent of total billed charges,All Other,231.87,59,,231.87,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",275.1,70,,275.1,percent of total billed charges,All Other,267.24,68,,267.24,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,314.4,80,,314.4,percent of total billed charges,All Other,326.19,83,,326.19,percent of total billed charges,All Other,326.19,83,,,percent of total billed charges,All Other,314.4,80,,314.4,percent of total billed charges,All Other,326.19,83,,326.19,percent of total billed charges,All Other,314.4,80,,314.4,percent of total billed charges,All Other,275.1,70,,275.1,percent of total billed charges,,131.2,,,131.2,Fee Schedule,,111.2,,,111.2,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,111.2,3228,
APPLY MULTLAY COMPRS LWR LEG,29581,CPT,,73129581,CDM,761,RC,,,both,,,393,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS,255.45,65,,255.45,percent of total billed charges,All Other,231.87,59,,231.87,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",275.1,70,,275.1,percent of total billed charges,All Other,267.24,68,,267.24,percent of total billed charges,All Other,459,,,459,Other,186% of Medicaid,314.4,80,,314.4,percent of total billed charges,All Other,326.19,83,,326.19,percent of total billed charges,All Other,326.19,83,,,percent of total billed charges,All Other,314.4,80,,314.4,percent of total billed charges,All Other,326.19,83,,326.19,percent of total billed charges,All Other,314.4,80,,314.4,percent of total billed charges,All Other,275.1,70,,275.1,percent of total billed charges,,131.2,,,131.2,Fee Schedule,,111.2,,,111.2,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,246.51,,,246.51,Other,100% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,377.16,,,377.16,Other,153% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,345.11,,,345.11,Other,140% of Medicaid,554.65,,,554.65,Other,225% of Medicaid,640.93,,,640.93,Other,250% of Medicaid,798.69,,,798.69,Other,324% of Medicaid,530,,,530,Other,215% of Medicaid,530,,,530,Other,215% of Medicaid,308.14,,,308.14,Other,125% of Medicaid,111.2,3228,
TRACH TUBE CHG BEFORE FISTULA TRACT,31502,CPT,,34031502,CDM,761,RC,,,both,,,491,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",343.7,70,,343.7,percent of total billed charges,All Other,333.88,,,333.88,Other,ASC Grouper table,219.33,,,219.33,Other,186% of Medicaid,392.8,,,392.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",392.8,,,392.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",392.8,,,392.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",343.7,70,,343.7,percent of total billed charges,,168.92,,,168.92,Fee Schedule,,143.17,,,143.17,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",117.92,,,117.92,Other,100% of Medicaid,117.92,,,117.92,Other,100% of Medicaid,117.92,,,117.92,Other,100% of Medicaid,117.92,,,117.92,Other,100% of Medicaid,265.31,,,265.31,Other,225% of Medicaid,180.41,,,180.41,Other,153% of Medicaid,265.31,,,265.31,Other,225% of Medicaid,165.08,,,165.08,Other,140% of Medicaid,265.31,,,265.31,Other,225% of Medicaid,306.59,,,306.59,Other,250% of Medicaid,382.05,,,382.05,Other,324% of Medicaid,253.52,,,253.52,Other,215% of Medicaid,253.52,,,253.52,Other,215% of Medicaid,147.4,,,147.4,Other,125% of Medicaid,117.92,7216,
NONSELECTIVE CATH PLACEMENT IN VEIN,36000,CPT,,34036000,CDM,761,RC,,,both,,,248,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",4565,,,4565,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",173.6,70,,173.6,percent of total billed charges,All Other,168.64,,,168.64,Other,ASC Grouper table,62.89,,,62.89,Other,186% of Medicaid,198.4,,,198.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",198.4,,,198.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",198.4,,,198.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",173.6,70,,173.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,7216,
APHERESIS PLASMA,36514,CPT,,77036514,CDM,761,RC,,,both,,,3431,2772.54,,,2772.54,Other,150% of Medicare + 9.63% HCRA Surcharge,1686,,,1686,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2401.7,70,,2401.7,percent of total billed charges,All Other,2333.08,,,2333.08,Other,ASC Grouper table,3574,,,3574,Other,186% of Medicaid,2744.8,,,2744.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2744.8,,,2744.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2744.8,,,2744.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2401.7,70,,2401.7,percent of total billed charges,,449.36,,,449.36,Fee Schedule,,380.86,,,380.86,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1921.25,,,1921.25,Other,100% of Medicaid,1921.25,,,1921.25,Other,100% of Medicaid,1921.25,,,1921.25,Other,100% of Medicaid,1921.25,,,1921.25,Other,100% of Medicaid,4322.82,,,4322.82,Other,225% of Medicaid,2939.52,,,2939.52,Other,153% of Medicaid,4322.82,,,4322.82,Other,225% of Medicaid,2689.75,,,2689.75,Other,140% of Medicaid,4322.82,,,4322.82,Other,225% of Medicaid,4995.26,,,4995.26,Other,250% of Medicaid,6224.86,,,6224.86,Other,324% of Medicaid,4130.69,,,4130.69,Other,215% of Medicaid,4130.69,,,4130.69,Other,215% of Medicaid,2401.57,,,2401.57,Other,125% of Medicaid,380.86,7216,
COLLECT BLOOD FROM VAD,36591,CPT,,34036591,CDM,761,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,178.84,68,,178.84,percent of total billed charges,All Other,63,,,63,Other,186% of Medicaid,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,218.29,83,,,percent of total billed charges,All Other,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",184.1,70,,184.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,3227,
COLLECT BLOOD FROM VAD,36591,CPT,,75036591,CDM,761,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,178.84,68,,178.84,percent of total billed charges,All Other,63,,,63,Other,186% of Medicaid,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,218.29,83,,,percent of total billed charges,All Other,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",184.1,70,,184.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,3227,
COLLECT BLOOD FROM VAD,36591,CPT,,82036591,CDM,761,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,161.93,,,161.93,Fee Schedule,,145.68,,,145.68,Fee Schedule,,137.7,,,137.7,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,178.84,68,,178.84,percent of total billed charges,All Other,63,,,63,Other,186% of Medicaid,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,218.29,83,,,percent of total billed charges,All Other,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",184.1,70,,184.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,3227,
COLLECT BLOOD FROM PICC,36592,CPT,,75036592,CDM,761,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,180.95,,,180.95,Fee Schedule,,162.79,,,162.79,Fee Schedule,,153.87,,,153.87,Fee Schedule,,184.1,70,,184.1,percent of total billed charges,All Other,178.84,68,,178.84,percent of total billed charges,All Other,63,,,63,Other,186% of Medicaid,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,218.29,83,,,percent of total billed charges,All Other,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",184.1,70,,184.1,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,0.01,3227,
DECLOT VASCULAR DEVICE,36593,CPT,,34036593,CDM,761,RC,,,both,,,896,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",627.2,70,,627.2,percent of total billed charges,All Other,609.28,,,609.28,Other,ASC Grouper table,425.03,,,425.03,Other,186% of Medicaid,716.8,,,716.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",716.8,,,716.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",716.8,,,716.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",627.2,70,,627.2,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,134.83,7216,
DECLOT VASCULAR DEVICE,36593,CPT,,75036593,CDM,761,RC,,,both,,,896,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",627.2,70,,627.2,percent of total billed charges,All Other,609.28,,,609.28,Other,ASC Grouper table,425.03,,,425.03,Other,186% of Medicaid,716.8,,,716.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",716.8,,,716.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",716.8,,,716.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",627.2,70,,627.2,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,134.83,7216,
INJ W/FLUOR EVAL CV DEVICE,36598,CPT,,42036598,CDM,761,RC,,,both,,,794,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",555.8,70,,555.8,percent of total billed charges,All Other,539.92,,,539.92,Other,ASC Grouper table,967,,,967,Other,186% of Medicaid,635.2,,,635.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",635.2,,,635.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",635.2,,,635.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",555.8,70,,555.8,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,519.68,,,519.68,Other,100% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,795.1,,,795.1,Other,153% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,727.55,,,727.55,Other,140% of Medicaid,1169.27,,,1169.27,Other,225% of Medicaid,1351.16,,,1351.16,Other,250% of Medicaid,1683.75,,,1683.75,Other,324% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,1117.3,,,1117.3,Other,215% of Medicaid,649.59,,,649.59,Other,125% of Medicaid,147.34,7216,
BONE MARROW BIOPSY,38221,CPT,,34038221,CDM,761,RC,,,both,,,3926,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2669.68,,,2669.68,Other,ASC Grouper table,790.86,,,790.86,Other,186% of Medicaid,3140.8,,,3140.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3140.8,,,3140.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3140.8,,,3140.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2748.2,70,,2748.2,percent of total billed charges,,339.48,,,339.48,Fee Schedule,,287.73,,,287.73,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,650.55,,,650.55,Other,153% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,595.27,,,595.27,Other,140% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,1105.51,,,1105.51,Other,250% of Medicaid,1377.63,,,1377.63,Other,324% of Medicaid,914.17,,,914.17,Other,215% of Medicaid,914.17,,,914.17,Other,215% of Medicaid,531.49,,,531.49,Other,125% of Medicaid,287.73,7216,
BONE MARROW BIOPSY,38221,CPT,,75038221,CDM,761,RC,,,both,,,3926,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2669.68,,,2669.68,Other,ASC Grouper table,790.86,,,790.86,Other,186% of Medicaid,3140.8,,,3140.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3140.8,,,3140.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3140.8,,,3140.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2748.2,70,,2748.2,percent of total billed charges,,339.48,,,339.48,Fee Schedule,,287.73,,,287.73,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,650.55,,,650.55,Other,153% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,595.27,,,595.27,Other,140% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,1105.51,,,1105.51,Other,250% of Medicaid,1377.63,,,1377.63,Other,324% of Medicaid,914.17,,,914.17,Other,215% of Medicaid,914.17,,,914.17,Other,215% of Medicaid,531.49,,,531.49,Other,125% of Medicaid,287.73,7216,
BONE MARROW BIOPSY,38221,CPT,,82038221,CDM,761,RC,,,both,,,3926,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2669.68,,,2669.68,Other,ASC Grouper table,790.86,,,790.86,Other,186% of Medicaid,3140.8,,,3140.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3140.8,,,3140.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3140.8,,,3140.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2748.2,70,,2748.2,percent of total billed charges,,339.48,,,339.48,Fee Schedule,,287.73,,,287.73,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,425.2,,,425.2,Other,100% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,650.55,,,650.55,Other,153% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,595.27,,,595.27,Other,140% of Medicaid,956.69,,,956.69,Other,225% of Medicaid,1105.51,,,1105.51,Other,250% of Medicaid,1377.63,,,1377.63,Other,324% of Medicaid,914.17,,,914.17,Other,215% of Medicaid,914.17,,,914.17,Other,215% of Medicaid,531.49,,,531.49,Other,125% of Medicaid,287.73,7216,
NEEDLE BX LIVER; PERCUTANEOUS,47000,CPT,,34047000,CDM,761,RC,,,both,,,3495,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3894,,,3894,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3505,,,3505,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3310,,,3310,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",2376.6,,,2376.6,Other,ASC Grouper table,1196,,,1196,Other,186% of Medicaid,2796,,,2796,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2796,,,2796,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",3578,,,3578,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2446.5,70,,2446.5,percent of total billed charges,,3933,,,3933,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",3343,,,3343,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,643.17,7216,
ABD PARACENTESIS,49082,CPT,,34049082,CDM,761,RC,,,both,,,1860,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1264.8,,,1264.8,Other,ASC Grouper table,1196,,,1196,Other,186% of Medicaid,1488,,,1488,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1488,,,1488,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1488,,,1488,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1302,70,,1302,percent of total billed charges,,354.24,,,354.24,Fee Schedule,,300.24,,,300.24,Fee Schedule,,4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3649,,,3649,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",4055,,,4055,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3448,,,3448,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,643.17,,,643.17,Other,100% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,984.06,,,984.06,Other,153% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,900.44,,,900.44,Other,140% of Medicaid,1447.14,,,1447.14,Other,225% of Medicaid,1672.25,,,1672.25,Other,250% of Medicaid,2083.89,,,2083.89,Other,324% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,1382.83,,,1382.83,Other,215% of Medicaid,803.97,,,803.97,Other,125% of Medicaid,300.24,7216,
SIMPLE BLADDER IRRIGATE LAVAGE/INSTILL,51700,CPT,,34051700,CDM,761,RC,,,both,,,776,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",543.2,70,,543.2,percent of total billed charges,All Other,527.68,,,527.68,Other,ASC Grouper table,847,,,847,Other,186% of Medicaid,620.8,,,620.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",620.8,,,620.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",620.8,,,620.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",543.2,70,,543.2,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,455.63,,,455.63,Other,100% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,697.11,,,697.11,Other,153% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,637.88,,,637.88,Other,140% of Medicaid,1025.16,,,1025.16,Other,225% of Medicaid,1184.63,,,1184.63,Other,250% of Medicaid,1476.23,,,1476.23,Other,324% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,979.6,,,979.6,Other,215% of Medicaid,569.53,,,569.53,Other,125% of Medicaid,125.1,7216,
INSERT STRAIGHT CATHETER,51701,CPT,,82151701,CDM,761,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",184.1,70,,184.1,percent of total billed charges,All Other,178.84,,,178.84,Other,ASC Grouper table,614.38,,,614.38,Other,186% of Medicaid,210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",184.1,70,,184.1,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,105.64,7216,
INS TEMP BLADDER CATH,51702,CPT,,34051702,CDM,761,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",184.1,70,,184.1,percent of total billed charges,All Other,178.84,,,178.84,Other,ASC Grouper table,614.38,,,614.38,Other,186% of Medicaid,210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",184.1,70,,184.1,percent of total billed charges,,123,,,123,Fee Schedule,,104.25,,,104.25,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,104.25,7216,
INS TEMP BLADDER CATH,51702,CPT,,75051702,CDM,761,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",184.1,70,,184.1,percent of total billed charges,All Other,178.84,,,178.84,Other,ASC Grouper table,614.38,,,614.38,Other,186% of Medicaid,210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",210.4,,,210.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",184.1,70,,184.1,percent of total billed charges,,123,,,123,Fee Schedule,,104.25,,,104.25,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,104.25,7216,
INS TEMP BLADDER CATH,51702,CPT,,82051702,CDM,761,RC,,,both,,,271,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",189.7,70,,189.7,percent of total billed charges,All Other,184.28,,,184.28,Other,ASC Grouper table,614.38,,,614.38,Other,186% of Medicaid,216.8,,,216.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",216.8,,,216.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",216.8,,,216.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",189.7,70,,189.7,percent of total billed charges,,123,,,123,Fee Schedule,,104.25,,,104.25,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,104.25,7216,
TREATMENT OF BLADDER LESION,51720,CPT,,75051720,CDM,761,RC,,,both,,,1409,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",986.3,70,,986.3,percent of total billed charges,All Other,958.12,,,958.12,Other,ASC Grouper table,903,,,903,Other,186% of Medicaid,1127.2,,,1127.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1127.2,,,1127.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1127.2,,,1127.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",986.3,70,,986.3,percent of total billed charges,,208.28,,,208.28,Fee Schedule,,176.53,,,176.53,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,485.54,,,485.54,Other,100% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,742.87,,,742.87,Other,153% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,679.75,,,679.75,Other,140% of Medicaid,1092.45,,,1092.45,Other,225% of Medicaid,1262.39,,,1262.39,Other,250% of Medicaid,1573.13,,,1573.13,Other,324% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,1043.9,,,1043.9,Other,215% of Medicaid,606.92,,,606.92,Other,125% of Medicaid,176.53,7216,
US PV RESIDUAL URINE,51798,CPT,,82051798,CDM,761,RC,,,both,,,258,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,167.7,65,,167.7,percent of total billed charges,All Other,152.22,59,,152.22,percent of total billed charges,All Other,138.1,,,138.1,Fee Schedule,,124.24,,,124.24,Fee Schedule,,117.43,,,117.43,Fee Schedule,,180.6,70,,180.6,percent of total billed charges,All Other,175.44,68,,175.44,percent of total billed charges,All Other,614,,,614,Other,186% of Medicaid,206.4,80,,206.4,percent of total billed charges,All Other,214.14,83,,214.14,percent of total billed charges,All Other,214.14,83,,,percent of total billed charges,All Other,206.4,80,,206.4,percent of total billed charges,All Other,214.14,83,,214.14,percent of total billed charges,All Other,206.4,,,206.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",180.6,70,,180.6,percent of total billed charges,,50.84,,,50.84,Fee Schedule,,43.09,,,43.09,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,330.31,,,330.31,Other,100% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,505.38,,,505.38,Other,153% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,462.44,,,462.44,Other,140% of Medicaid,743.2,,,743.2,Other,225% of Medicaid,858.81,,,858.81,Other,250% of Medicaid,1070.21,,,1070.21,Other,324% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,710.17,,,710.17,Other,215% of Medicaid,412.89,,,412.89,Other,125% of Medicaid,43.09,3227,
NJX INTERLAMINAR LMBR/SAC,62322,CPT,,34062322,CDM,761,RC,,,both,,,2579,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2546,,,2546,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 50% 3rd",1753.72,,,1753.72,Other,ASC Grouper table,1116,,,1116,Other,186% of Medicaid,2063.2,,,2063.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2063.2,,,2063.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",2063.2,,,2063.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",1805.3,70,,1805.3,percent of total billed charges,,390.32,,,390.32,Fee Schedule,,330.82,,,330.82,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,600.01,,,600.01,Other,100% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,918.01,,,918.01,Other,153% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,840.01,,,840.01,Other,140% of Medicaid,1350.02,,,1350.02,Other,225% of Medicaid,1560.02,,,1560.02,Other,250% of Medicaid,1944.03,,,1944.03,Other,324% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,1290.02,,,1290.02,Other,215% of Medicaid,750.01,,,750.01,Other,125% of Medicaid,330.82,7216,
ANALYZE SP INF PUMP W/REPROG,62368,CPT,,34062368,CDM,761,RC,,,both,,,624,539.74,,,539.74,Other,150% of Medicare + 9.63% HCRA Surcharge,328.22,,,328.22,Other,Medicare OPPS,2480,,,2480,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2232,,,2232,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",436.8,70,,436.8,percent of total billed charges,All Other,424.32,,,424.32,Other,ASC Grouper table,141.62,,,141.62,Other,186% of Medicaid,499.2,,,499.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",499.2,,,499.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",499.2,,,499.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",436.8,70,,436.8,percent of total billed charges,,168.92,,,168.92,Fee Schedule,,143.17,,,143.17,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,76.14,,,76.14,Other,100% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,116.5,,,116.5,Other,153% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,106.6,,,106.6,Other,140% of Medicaid,171.32,,,171.32,Other,225% of Medicaid,197.97,,,197.97,Other,250% of Medicaid,246.7,,,246.7,Other,324% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,163.71,,,163.71,Other,215% of Medicaid,95.18,,,95.18,Other,125% of Medicaid,76.14,7216,
REMOVE IMPACTED EAR WAX 1-2 EARS,69210,CPT,,73069210,CDM,761,RC,,,both,,,258,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",180.6,70,,180.6,percent of total billed charges,All Other,175.44,,,175.44,Other,ASC Grouper table,0.01,,,0.01,Other,186% of Medicaid,206.4,,,206.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",206.4,,,206.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",206.4,,,206.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",180.6,70,,180.6,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,7216,
UPR/LXTR ART STDY 3+ LVLS,93923,CPT,,73093923,CDM,761,RC,,,both,,,1054,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,349.81,,,349.81,Fee Schedule,,315.42,,,315.42,Fee Schedule,,1037.58,,,1037.58,Fee Schedule,,933.45,,,933.45,Fee Schedule,,882.32,,,882.32,Fee Schedule,,737.8,70,,737.8,percent of total billed charges,All Other,716.72,68,,716.72,percent of total billed charges,All Other,269,,,269,Other,186% of Medicaid,843.2,80,,843.2,percent of total billed charges,All Other,874.82,83,,874.82,percent of total billed charges,All Other,874.82,83,,,percent of total billed charges,All Other,843.2,80,,843.2,percent of total billed charges,All Other,874.82,83,,874.82,percent of total billed charges,All Other,843.2,,,843.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",737.8,70,,737.8,percent of total billed charges,,523.16,,,523.16,Fee Schedule,,443.41,,,443.41,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,221.52,,,221.52,Other,153% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,202.7,,,202.7,Other,140% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,376.44,,,376.44,Other,250% of Medicaid,469.11,,,469.11,Other,324% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,180.98,,,180.98,Other,125% of Medicaid,144.79,3227,
UPR/LXTR ART STDY 3+ LVLS,93923,CPT,,74093923,CDM,761,RC,,,both,,,1054,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,349.81,,,349.81,Fee Schedule,,315.42,,,315.42,Fee Schedule,,1037.58,,,1037.58,Fee Schedule,,933.45,,,933.45,Fee Schedule,,882.32,,,882.32,Fee Schedule,,737.8,70,,737.8,percent of total billed charges,All Other,716.72,68,,716.72,percent of total billed charges,All Other,269,,,269,Other,186% of Medicaid,843.2,80,,843.2,percent of total billed charges,All Other,874.82,83,,874.82,percent of total billed charges,All Other,874.82,83,,,percent of total billed charges,All Other,843.2,80,,843.2,percent of total billed charges,All Other,874.82,83,,874.82,percent of total billed charges,All Other,843.2,,,843.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",737.8,70,,737.8,percent of total billed charges,,523.16,,,523.16,Fee Schedule,,443.41,,,443.41,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,221.52,,,221.52,Other,153% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,202.7,,,202.7,Other,140% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,376.44,,,376.44,Other,250% of Medicaid,469.11,,,469.11,Other,324% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,180.98,,,180.98,Other,125% of Medicaid,144.79,3227,
PRO ALLERG IMT,95115,CPT,,34095115,CDM,761,RC,,,both,,,266,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,172.9,65,,172.9,percent of total billed charges,All Other,156.94,59,,156.94,percent of total billed charges,All Other,67.99,,,67.99,Fee Schedule,,61.2,,,61.2,Fee Schedule,,57.81,,,57.81,Fee Schedule,,186.2,70,,186.2,percent of total billed charges,All Other,180.88,68,,180.88,percent of total billed charges,All Other,64,,,64,Other,186% of Medicaid,212.8,80,,212.8,percent of total billed charges,All Other,220.78,83,,220.78,percent of total billed charges,All Other,220.78,83,,,percent of total billed charges,All Other,212.8,80,,212.8,percent of total billed charges,All Other,220.78,83,,220.78,percent of total billed charges,All Other,212.8,,,212.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",186.2,70,,186.2,percent of total billed charges,,45.92,,,45.92,Fee Schedule,,38.92,,,38.92,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",34.56,,,34.56,Other,100% of Medicaid,34.56,,,34.56,Other,100% of Medicaid,34.56,,,34.56,Other,100% of Medicaid,34.56,,,34.56,Other,100% of Medicaid,77.75,,,77.75,Other,225% of Medicaid,52.87,,,52.87,Other,153% of Medicaid,77.75,,,77.75,Other,225% of Medicaid,48.38,,,48.38,Other,140% of Medicaid,77.75,,,77.75,Other,225% of Medicaid,89.84,,,89.84,Other,250% of Medicaid,111.96,,,111.96,Other,324% of Medicaid,74.29,,,74.29,Other,215% of Medicaid,74.29,,,74.29,Other,215% of Medicaid,43.19,,,43.19,Other,125% of Medicaid,34.56,3227,
IMMUNOTHERAPY 2+ INJECTIONS,95117,CPT,,34095117,CDM,761,RC,,,both,,,285,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,185.25,65,,185.25,percent of total billed charges,All Other,168.15,59,,168.15,percent of total billed charges,All Other,83.83,,,83.83,Fee Schedule,,75.46,,,75.46,Fee Schedule,,71.28,,,71.28,Fee Schedule,,199.5,70,,199.5,percent of total billed charges,All Other,193.8,68,,193.8,percent of total billed charges,All Other,64,,,64,Other,186% of Medicaid,228,80,,228,percent of total billed charges,All Other,236.55,83,,236.55,percent of total billed charges,All Other,236.55,83,,,percent of total billed charges,All Other,228,80,,228,percent of total billed charges,All Other,236.55,83,,236.55,percent of total billed charges,All Other,228,,,228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",199.5,70,,199.5,percent of total billed charges,,55.76,,,55.76,Fee Schedule,,47.26,,,47.26,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",34.56,,,34.56,Other,100% of Medicaid,34.56,,,34.56,Other,100% of Medicaid,34.56,,,34.56,Other,100% of Medicaid,34.56,,,34.56,Other,100% of Medicaid,77.75,,,77.75,Other,225% of Medicaid,52.87,,,52.87,Other,153% of Medicaid,77.75,,,77.75,Other,225% of Medicaid,48.38,,,48.38,Other,140% of Medicaid,77.75,,,77.75,Other,225% of Medicaid,89.84,,,89.84,Other,250% of Medicaid,111.96,,,111.96,Other,324% of Medicaid,74.29,,,74.29,Other,215% of Medicaid,74.29,,,74.29,Other,215% of Medicaid,43.19,,,43.19,Other,125% of Medicaid,34.56,3227,
RAPID DESENSITIZATION,95180,CPT,,82095180,CDM,761,RC,,,both,,,853,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS,554.45,65,,554.45,percent of total billed charges,All Other,503.27,59,,503.27,percent of total billed charges,All Other,858.45,,,858.45,Fee Schedule,,772.77,,,772.77,Fee Schedule,,729.93,,,729.93,Fee Schedule,,597.1,70,,597.1,percent of total billed charges,All Other,580.04,68,,580.04,percent of total billed charges,All Other,402,,,402,Other,186% of Medicaid,682.4,80,,682.4,percent of total billed charges,All Other,707.99,83,,707.99,percent of total billed charges,All Other,707.99,83,,,percent of total billed charges,All Other,682.4,80,,682.4,percent of total billed charges,All Other,707.99,83,,707.99,percent of total billed charges,All Other,682.4,,,682.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",597.1,70,,597.1,percent of total billed charges,,490.36,,,490.36,Fee Schedule,,415.61,,,415.61,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",216.04,,,216.04,Other,100% of Medicaid,216.04,,,216.04,Other,100% of Medicaid,216.04,,,216.04,Other,100% of Medicaid,216.04,,,216.04,Other,100% of Medicaid,486.08,,,486.08,Other,225% of Medicaid,330.53,,,330.53,Other,153% of Medicaid,486.08,,,486.08,Other,225% of Medicaid,302.45,,,302.45,Other,140% of Medicaid,486.08,,,486.08,Other,225% of Medicaid,561.69,,,561.69,Other,250% of Medicaid,699.96,,,699.96,Other,324% of Medicaid,464.48,,,464.48,Other,215% of Medicaid,464.48,,,464.48,Other,215% of Medicaid,270.04,,,270.04,Other,125% of Medicaid,216.04,3227,
THER/PROPH/DIAG INJ SC/IM,96372,CPT,,73096372,CDM,761,RC,,,both,,,460,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,351.9,76.5,,351.9,percent of total billed charges,All Other,317.4,69,,317.4,percent of total billed charges,All Other,299,65,,299,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,381.8,,,381.8,Fee Schedule,,381.8,,,381.8,Case Rate,,381.8,,,,Case Rate,,381.8,,,381.8,Fee Schedule,,381.8,,,381.8,Case Rate,,368,,,368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",322,70,,322,percent of total billed charges,,68.88,,,68.88,Fee Schedule,,58.38,,,58.38,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,3227,
PORT FLUSH SUBSEQUENT,96523,CPT,,45096523,CDM,761,RC,,,both,,,243,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,598,,,598,Fee Schedule,,538,,,538,Fee Schedule,,176.89,,,176.89,Fee Schedule,,159.14,,,159.14,Fee Schedule,,150.42,,,150.42,Fee Schedule,,170.1,70,,170.1,percent of total billed charges,All Other,165.24,68,,165.24,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,201.69,,,201.69,Fee Schedule,,201.69,,,201.69,Case Rate,,201.69,,,,Case Rate,,201.69,,,201.69,Fee Schedule,,201.69,,,201.69,Case Rate,,194.4,,,194.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",170.1,70,,170.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,3227,
PORT FLUSH SUBSEQUENT,96523,CPT,,75096523,CDM,761,RC,,,both,,,243,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,598,,,598,Fee Schedule,,538,,,538,Fee Schedule,,176.89,,,176.89,Fee Schedule,,159.14,,,159.14,Fee Schedule,,150.42,,,150.42,Fee Schedule,,170.1,70,,170.1,percent of total billed charges,All Other,165.24,68,,165.24,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,201.69,,,201.69,Fee Schedule,,201.69,,,201.69,Case Rate,,201.69,,,,Case Rate,,201.69,,,201.69,Fee Schedule,,201.69,,,201.69,Case Rate,,194.4,,,194.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",170.1,70,,170.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,3227,
PORT FLUSH,96523,CPT,,82096523,CDM,761,RC,,,both,,,243,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,598,,,598,Fee Schedule,,538,,,538,Fee Schedule,,176.89,,,176.89,Fee Schedule,,159.14,,,159.14,Fee Schedule,,150.42,,,150.42,Fee Schedule,,170.1,70,,170.1,percent of total billed charges,All Other,165.24,68,,165.24,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,201.69,,,201.69,Fee Schedule,,201.69,,,201.69,Case Rate,,201.69,,,,Case Rate,,201.69,,,201.69,Fee Schedule,,201.69,,,201.69,Case Rate,,194.4,,,194.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",170.1,70,,170.1,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,38.65,3227,
SLCTV WND DEBRIDEM 20 CM OR <,97597,CPT,,73097597,CDM,761,RC,,,both,,,573,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",401.1,70,,401.1,percent of total billed charges,All Other,389.64,,,389.64,Other,ASC Grouper table,716.61,,,716.61,Other,186% of Medicaid,458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",401.1,70,,401.1,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,589.47,,,589.47,Other,153% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,539.38,,,539.38,Other,140% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,1001.71,,,1001.71,Other,250% of Medicaid,1248.29,,,1248.29,Other,324% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,481.59,,,481.59,Other,125% of Medicaid,147.34,7216,
SLCTV WND DEBRIDEM 20 CM OR <,97597,CPT,,82097597,CDM,761,RC,,,both,,,573,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",401.1,70,,401.1,percent of total billed charges,All Other,389.64,,,389.64,Other,ASC Grouper table,716.61,,,716.61,Other,186% of Medicaid,458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",401.1,70,,401.1,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,589.47,,,589.47,Other,153% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,539.38,,,539.38,Other,140% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,1001.71,,,1001.71,Other,250% of Medicaid,1248.29,,,1248.29,Other,324% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,481.59,,,481.59,Other,125% of Medicaid,147.34,7216,
SLCTV WND DEBRIDEM ADDL 20 CM/<,97598,CPT,,73097598,CDM,761,RC,,,both,,,573,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,2281,,,2281,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2053,,,2053,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",401.1,70,,401.1,percent of total billed charges,All Other,389.64,,,389.64,Other,ASC Grouper table,2144.44,,,2144.44,Other,186% of Medicaid,458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",7216,,,7216,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",458.4,,,458.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",401.1,70,,401.1,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",1152.93,,,1152.93,Other,100% of Medicaid,1152.93,,,1152.93,Other,100% of Medicaid,1152.93,,,1152.93,Other,100% of Medicaid,1152.93,,,1152.93,Other,100% of Medicaid,2594.08,,,2594.08,Other,225% of Medicaid,1763.98,,,1763.98,Other,153% of Medicaid,2594.08,,,2594.08,Other,225% of Medicaid,1614.1,,,1614.1,Other,140% of Medicaid,2594.08,,,2594.08,Other,225% of Medicaid,2997.61,,,2997.61,Other,250% of Medicaid,3735.48,,,3735.48,Other,324% of Medicaid,2478.79,,,2478.79,Other,215% of Medicaid,2478.79,,,2478.79,Other,215% of Medicaid,1441.16,,,1441.16,Other,125% of Medicaid,0.01,7216,
NSW DEBRIDEM WO A/SESSION,97602,CPT,,73097602,CDM,761,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,265.2,65,,265.2,percent of total billed charges,All Other,240.72,59,,240.72,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",285.6,70,,285.6,percent of total billed charges,All Other,277.44,68,,277.44,percent of total billed charges,All Other,1084,,,1084,Other,186% of Medicaid,326.4,80,,326.4,percent of total billed charges,All Other,338.64,83,,338.64,percent of total billed charges,All Other,338.64,83,,,percent of total billed charges,All Other,326.4,80,,326.4,percent of total billed charges,All Other,338.64,83,,338.64,percent of total billed charges,All Other,326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",285.6,70,,285.6,percent of total billed charges,,265.2,65,,265.2,percent of total billed charges,All Other,265.2,65,,265.2,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,891.54,,,891.54,Other,153% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,815.79,,,815.79,Other,140% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,1515.03,,,1515.03,Other,250% of Medicaid,1887.96,,,1887.96,Other,324% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,728.38,,,728.38,Other,125% of Medicaid,219.99,3228,
NSW DEBRIDEM WO A/SESSION,97602,CPT,,82097602,CDM,761,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,265.2,65,,265.2,percent of total billed charges,All Other,240.72,59,,240.72,percent of total billed charges,All Other,3228,,,3228,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2905,,,2905,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",2744,,,2744,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% subsequent",285.6,70,,285.6,percent of total billed charges,All Other,277.44,68,,277.44,percent of total billed charges,All Other,1084,,,1084,Other,186% of Medicaid,326.4,80,,326.4,percent of total billed charges,All Other,338.64,83,,338.64,percent of total billed charges,All Other,338.64,83,,,percent of total billed charges,All Other,326.4,80,,326.4,percent of total billed charges,All Other,338.64,83,,338.64,percent of total billed charges,All Other,326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",285.6,70,,285.6,percent of total billed charges,,265.2,65,,265.2,percent of total billed charges,All Other,265.2,65,,265.2,percent of total billed charges,All Other,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,891.54,,,891.54,Other,153% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,815.79,,,815.79,Other,140% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,1515.03,,,1515.03,Other,250% of Medicaid,1887.96,,,1887.96,Other,324% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,728.38,,,728.38,Other,125% of Medicaid,219.99,3228,
NEG PRESS WOUND TX < 50 CM,97605,CPT,,34097605,CDM,761,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,265.2,65,,265.2,percent of total billed charges,All Other,240.72,59,,240.72,percent of total billed charges,All Other,312.12,76.5,,312.12,percent of total billed charges,All Other,281.52,69,,281.52,percent of total billed charges,All Other,265.2,65,,265.2,percent of total billed charges,All Other,285.6,70,,285.6,percent of total billed charges,All Other,277.44,68,,277.44,percent of total billed charges,All Other,717,,,717,Other,186% of Medicaid,326.4,80,,326.4,percent of total billed charges,All Other,338.64,83,,338.64,percent of total billed charges,All Other,338.64,83,,,percent of total billed charges,All Other,326.4,80,,326.4,percent of total billed charges,All Other,338.64,83,,338.64,percent of total billed charges,All Other,326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",285.6,70,,285.6,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,589.47,,,589.47,Other,153% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,539.38,,,539.38,Other,140% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,1001.71,,,1001.71,Other,250% of Medicaid,1248.29,,,1248.29,Other,324% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,481.59,,,481.59,Other,125% of Medicaid,101.47,3227,
NEG PRESS WOUND TX < 50 CM,97605,CPT,,73097605,CDM,761,RC,,,both,,,408,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS,265.2,65,,265.2,percent of total billed charges,All Other,240.72,59,,240.72,percent of total billed charges,All Other,312.12,76.5,,312.12,percent of total billed charges,All Other,281.52,69,,281.52,percent of total billed charges,All Other,265.2,65,,265.2,percent of total billed charges,All Other,285.6,70,,285.6,percent of total billed charges,All Other,277.44,68,,277.44,percent of total billed charges,All Other,717,,,717,Other,186% of Medicaid,326.4,80,,326.4,percent of total billed charges,All Other,338.64,83,,338.64,percent of total billed charges,All Other,338.64,83,,,percent of total billed charges,All Other,326.4,80,,326.4,percent of total billed charges,All Other,338.64,83,,338.64,percent of total billed charges,All Other,326.4,,,326.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",285.6,70,,285.6,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,385.27,,,385.27,Other,100% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,589.47,,,589.47,Other,153% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,539.38,,,539.38,Other,140% of Medicaid,866.87,,,866.87,Other,225% of Medicaid,1001.71,,,1001.71,Other,250% of Medicaid,1248.29,,,1248.29,Other,324% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,828.34,,,828.34,Other,215% of Medicaid,481.59,,,481.59,Other,125% of Medicaid,101.47,3227,
NEG PRESS WOUND TX > 50 CM,97606,CPT,,34097606,CDM,761,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,546.65,65,,546.65,percent of total billed charges,All Other,496.19,59,,496.19,percent of total billed charges,All Other,643.37,76.5,,643.37,percent of total billed charges,All Other,580.29,69,,580.29,percent of total billed charges,All Other,546.65,65,,546.65,percent of total billed charges,All Other,588.7,70,,588.7,percent of total billed charges,All Other,571.88,68,,571.88,percent of total billed charges,All Other,1084,,,1084,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,83,,698.03,percent of total billed charges,All Other,698.03,83,,,percent of total billed charges,All Other,672.8,80,,672.8,percent of total billed charges,All Other,698.03,83,,698.03,percent of total billed charges,All Other,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,131.2,,,131.2,Fee Schedule,,111.2,,,111.2,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,891.54,,,891.54,Other,153% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,815.79,,,815.79,Other,140% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,1515.03,,,1515.03,Other,250% of Medicaid,1887.96,,,1887.96,Other,324% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,728.38,,,728.38,Other,125% of Medicaid,111.2,3227,
NEG PRESS WOUND TX > 50 CM,97606,CPT,,73097606,CDM,761,RC,,,both,,,841,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,546.65,65,,546.65,percent of total billed charges,All Other,496.19,59,,496.19,percent of total billed charges,All Other,643.37,76.5,,643.37,percent of total billed charges,All Other,580.29,69,,580.29,percent of total billed charges,All Other,546.65,65,,546.65,percent of total billed charges,All Other,588.7,70,,588.7,percent of total billed charges,All Other,571.88,68,,571.88,percent of total billed charges,All Other,1084,,,1084,Other,186% of Medicaid,672.8,80,,672.8,percent of total billed charges,All Other,698.03,83,,698.03,percent of total billed charges,All Other,698.03,83,,,percent of total billed charges,All Other,672.8,80,,672.8,percent of total billed charges,All Other,698.03,83,,698.03,percent of total billed charges,All Other,672.8,,,672.8,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",588.7,70,,588.7,percent of total billed charges,,131.2,,,131.2,Fee Schedule,,111.2,,,111.2,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,891.54,,,891.54,Other,153% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,815.79,,,815.79,Other,140% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,1515.03,,,1515.03,Other,250% of Medicaid,1887.96,,,1887.96,Other,324% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,728.38,,,728.38,Other,125% of Medicaid,111.2,3227,
NEG PRESS WND TX < =50 SQ CM,97607,CPT,,73097607,CDM,761,RC,,,both,,,1119,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,727.35,65,,727.35,percent of total billed charges,All Other,660.21,59,,660.21,percent of total billed charges,All Other,856.04,76.5,,856.04,percent of total billed charges,All Other,772.11,69,,772.11,percent of total billed charges,All Other,727.35,65,,727.35,percent of total billed charges,All Other,783.3,70,,783.3,percent of total billed charges,All Other,760.92,68,,760.92,percent of total billed charges,All Other,1084,,,1084,Other,186% of Medicaid,895.2,80,,895.2,percent of total billed charges,All Other,928.77,83,,928.77,percent of total billed charges,All Other,928.77,83,,,percent of total billed charges,All Other,895.2,80,,895.2,percent of total billed charges,All Other,928.77,83,,928.77,percent of total billed charges,All Other,895.2,,,895.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",783.3,70,,783.3,percent of total billed charges,,108.24,,,108.24,Fee Schedule,,91.74,,,91.74,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,891.54,,,891.54,Other,153% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,815.79,,,815.79,Other,140% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,1515.03,,,1515.03,Other,250% of Medicaid,1887.96,,,1887.96,Other,324% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,728.38,,,728.38,Other,125% of Medicaid,91.74,3227,
NEG PRESS WOUND TX > 50CM,97608,CPT,,73097608,CDM,761,RC,,,both,,,1119,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS,727.35,65,,727.35,percent of total billed charges,All Other,660.21,59,,660.21,percent of total billed charges,All Other,856.04,76.5,,856.04,percent of total billed charges,All Other,772.11,69,,772.11,percent of total billed charges,All Other,727.35,65,,727.35,percent of total billed charges,All Other,783.3,70,,783.3,percent of total billed charges,All Other,760.92,68,,760.92,percent of total billed charges,All Other,1084,,,1084,Other,186% of Medicaid,895.2,80,,895.2,percent of total billed charges,All Other,928.77,83,,928.77,percent of total billed charges,All Other,928.77,83,,,percent of total billed charges,All Other,895.2,80,,895.2,percent of total billed charges,All Other,928.77,83,,928.77,percent of total billed charges,All Other,895.2,,,895.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",783.3,70,,783.3,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,582.7,,,582.7,Other,100% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,891.54,,,891.54,Other,153% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,815.79,,,815.79,Other,140% of Medicaid,1311.09,,,1311.09,Other,225% of Medicaid,1515.03,,,1515.03,Other,250% of Medicaid,1887.96,,,1887.96,Other,324% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,1252.81,,,1252.81,Other,215% of Medicaid,728.38,,,728.38,Other,125% of Medicaid,102.86,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 2,99202,CPT,,34099202,CDM,761,RC,,,both,,,252,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,,,201.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",176.4,70,,176.4,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 2,99202,CPT,,73099202,CDM,761,RC,,,both,,,252,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,,,201.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",176.4,70,,176.4,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 2,99202,CPT,25,73199202,CDM,761,RC,,,both,,,252,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,,,201.6,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",176.4,70,,176.4,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 3,99203,CPT,,34099203,CDM,761,RC,,,both,,,345,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,,,276,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",241.5,70,,241.5,percent of total billed charges,,400.16,,,400.16,Fee Schedule,,339.16,,,339.16,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 3,99203,CPT,,73099203,CDM,761,RC,,,both,,,345,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,,,276,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",241.5,70,,241.5,percent of total billed charges,,400.16,,,400.16,Fee Schedule,,339.16,,,339.16,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 3,99203,CPT,25,73199203,CDM,761,RC,,,both,,,345,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,,,276,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",241.5,70,,241.5,percent of total billed charges,,400.16,,,400.16,Fee Schedule,,339.16,,,339.16,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 4,99204,CPT,,34099204,CDM,761,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,,,368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",322,70,,322,percent of total billed charges,,647.8,,,647.8,Fee Schedule,,549.05,,,549.05,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 4,99204,CPT,,73099204,CDM,761,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,,,368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",322,70,,322,percent of total billed charges,,647.8,,,647.8,Fee Schedule,,549.05,,,549.05,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 4,99204,CPT,25,73199204,CDM,761,RC,,,both,,,460,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,,,368,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",322,70,,322,percent of total billed charges,,647.8,,,647.8,Fee Schedule,,549.05,,,549.05,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 5,99205,CPT,,34099205,CDM,761,RC,,,both,,,628,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,,,502.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",439.6,70,,439.6,percent of total billed charges,,879.04,,,879.04,Fee Schedule,,745.04,,,745.04,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 5,99205,CPT,,73099205,CDM,761,RC,,,both,,,628,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,,,502.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",439.6,70,,439.6,percent of total billed charges,,879.04,,,879.04,Fee Schedule,,745.04,,,745.04,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT NEW LVL 5,99205,CPT,25,73199205,CDM,761,RC,,,both,,,628,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,,,502.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",439.6,70,,439.6,percent of total billed charges,,879.04,,,879.04,Fee Schedule,,745.04,,,745.04,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 1,99211,CPT,,34099211,CDM,761,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,,,182.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LV,99211,CPT,,46099211,CDM,761,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,,,182.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LV,99211,CPT,,47099211,CDM,761,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,,,182.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LV,99211,CPT,,49099211,CDM,761,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,,,182.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPAT VISIT EST 5 MIN,99211,CPT,,54099211,CDM,761,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,,,182.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 1,99211,CPT,,73099211,CDM,761,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,,,182.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 1,99211,CPT,25,73199211,CDM,761,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,,,182.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
E & M LOW LEVEL,99211,CPT,,75099211,CDM,761,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,,,182.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
REMOVAL OF PICC LINE OP,99211,CPT,,75199211,CDM,761,RC,,,both,,,228,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,,,182.4,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 2,99212,CPT,,34099212,CDM,761,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,,,207.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",181.3,70,,181.3,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 2,99212,CPT,,73099212,CDM,761,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,,,207.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",181.3,70,,181.3,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 2,99212,CPT,25,73199212,CDM,761,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,,,207.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",181.3,70,,181.3,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 3,99213,CPT,,34099213,CDM,761,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,,,207.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",181.3,70,,181.3,percent of total billed charges,,319.8,,,319.8,Fee Schedule,,271.05,,,271.05,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
REMOVAL GASTROSTOMY TUBE,99213,CPT,,34999213,CDM,761,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,,,207.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",181.3,70,,181.3,percent of total billed charges,,319.8,,,319.8,Fee Schedule,,271.05,,,271.05,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
REMOVAL GASTROSTOMY TUBE,99213,CPT,,35099213,CDM,761,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,,,207.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",181.3,70,,181.3,percent of total billed charges,,319.8,,,319.8,Fee Schedule,,271.05,,,271.05,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 3,99213,CPT,,73099213,CDM,761,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,,,207.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",181.3,70,,181.3,percent of total billed charges,,319.8,,,319.8,Fee Schedule,,271.05,,,271.05,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 3,99213,CPT,25,73199213,CDM,761,RC,,,both,,,259,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,,,207.2,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",181.3,70,,181.3,percent of total billed charges,,319.8,,,319.8,Fee Schedule,,271.05,,,271.05,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 4,99214,CPT,,34099214,CDM,761,RC,,,both,,,340,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,,,272,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",238,70,,238,percent of total billed charges,,469.04,,,469.04,Fee Schedule,,397.54,,,397.54,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 4,99214,CPT,,73099214,CDM,761,RC,,,both,,,340,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,,,272,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",238,70,,238,percent of total billed charges,,469.04,,,469.04,Fee Schedule,,397.54,,,397.54,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 4,99214,CPT,25,73199214,CDM,761,RC,,,both,,,340,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,,,272,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",238,70,,238,percent of total billed charges,,469.04,,,469.04,Fee Schedule,,397.54,,,397.54,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 5,99215,CPT,,34099215,CDM,761,RC,,,both,,,440,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,,,352,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",308,70,,308,percent of total billed charges,,697,,,697,Fee Schedule,,590.75,,,590.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 5,99215,CPT,,73099215,CDM,761,RC,,,both,,,440,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,,,352,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",308,70,,308,percent of total billed charges,,697,,,697,Fee Schedule,,590.75,,,590.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OFFICE/OUTPATIENT VISIT EST LVL 5,99215,CPT,25,73199215,CDM,761,RC,,,both,,,440,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Servcie,0.01,,,0.01,Other,Non Covered Services,0.01,,,0.01,Other,Non Covered Service,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,,,352,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, subsequent 25%",308,70,,308,percent of total billed charges,,697,,,697,Fee Schedule,,590.75,,,590.75,Fee Schedule,,3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2904,,,2904,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",3227,,,3227,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",2743,,,2743,Other,"ASC Grouper table. Multiple procedure discount 100% 1st, 50% 2nd, 25% 3rd",0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,3227,
OBSERVATION HRLY 3 BWAY,G0378,HCPCS,,10000002,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY 2 BWAY,G0378,HCPCS,,11000002,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY 2 WEST,G0378,HCPCS,,12000002,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY 3 EAST,G0378,HCPCS,,13000002,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY 3 WEST,G0378,HCPCS,,14000002,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY 3 SPELL,G0378,HCPCS,,15000002,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY 3 SMC,G0378,HCPCS,,16000002,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY 4 SMC,G0378,HCPCS,,17000005,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY 4 SPELL,G0378,HCPCS,,18000002,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY ICU,G0378,HCPCS,,24000003,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY DIRECT ADMIT ICU,G0378,HCPCS,,24000009,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY OB,G0378,HCPCS,,25000002,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
HRLY OBSERVATION,G0378,HCPCS,,30000010,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY MAIN ED,G0378,HCPCS,,30000021,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY AMB SURG,G0378,HCPCS,,34000027,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY 5 SPELLMAN,G0378,HCPCS,,86000003,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY 5 SMC,G0378,HCPCS,,87000003,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION HRLY STEP DOWN,G0378,HCPCS,,88000003,CDM,762,RC,,,both,,,2480,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,58,,,58,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,31.08,,,31.08,Other,100% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,47.55,,,47.55,Other,153% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,43.51,,,43.51,Other,140% of Medicaid,69.92,,,69.92,Other,225% of Medicaid,80.8,,,80.8,Other,250% of Medicaid,100.69,,,100.69,Other,324% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,66.81,,,66.81,Other,215% of Medicaid,38.85,,,38.85,Other,125% of Medicaid,0.01,8698,
OBSERVATION DIRECT ADMIT 3 BWAY,G0379,HCPCS,,10000003,CDM,762,RC,,,both,,,2480,1160.67,,,1160.67,Other,150% of Medicare + 9.63% HCRA Surcharge,705.81,,,705.81,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8698,
OBSERVATION DIRECT ADMIT 2 BWAY,G0379,HCPCS,,11000004,CDM,762,RC,,,both,,,2480,1160.67,,,1160.67,Other,150% of Medicare + 9.63% HCRA Surcharge,705.81,,,705.81,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8698,
OBSERVATION DIRECT ADMIT 2 WEST,G0379,HCPCS,,12000003,CDM,762,RC,,,both,,,2480,1160.67,,,1160.67,Other,150% of Medicare + 9.63% HCRA Surcharge,705.81,,,705.81,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8698,
OBSERVATION DIRECT ADMIT 3 EAST,G0379,HCPCS,,13000003,CDM,762,RC,,,both,,,2480,1160.67,,,1160.67,Other,150% of Medicare + 9.63% HCRA Surcharge,705.81,,,705.81,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8698,
OBSERVATION DIRECT ADMIT 3 WEST,G0379,HCPCS,,14000003,CDM,762,RC,,,both,,,2480,1160.67,,,1160.67,Other,150% of Medicare + 9.63% HCRA Surcharge,705.81,,,705.81,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8698,
OBSERVATION DIRECT ADMIT 4 SPELL,G0379,HCPCS,,18000003,CDM,762,RC,,,both,,,2480,1160.67,,,1160.67,Other,150% of Medicare + 9.63% HCRA Surcharge,705.81,,,705.81,Other,Medicare OPPS,5767,,,5767,Case Rate,Observation Per Case,5190,,,5190,Case Rate,Observation Per Case,8698,,,8698,Case Rate,Observation Per Case,7828,,,7828,Case Rate,Observation Per Case,7393,,,7393,Case Rate,Observation Per Case,5671,,,5671,Case Rate,Observation Per Case,1686.4,68,,1686.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,2058.4,83,,,percent of total billed charges,All Other,1984,80,,1984,percent of total billed charges,All Other,2058.4,83,,2058.4,percent of total billed charges,All Other,5529,,,5529,Case Rate,Observation Per Case,1736,70,,1736,percent of total billed charges,,6578,,,6578,Case Rate,Observation Per Case,5591,,,5591,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3576,,,3576,Case Rate,Observation Per Case,3973,,,3973,Case Rate,Observation Per Case,3377,,,3377,Case Rate,Observation Per Case,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,8698,
PFIZER ADM SARSCOV2 30MCG/0.3ML 1ST,0001A,HCPCS,,80023980,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,40,,,40,Fee Schedule,,37,,,37,Other,186% of Medicaid,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
PFIZER ADM SARSCOV2 30MCG/0.3ML 2ND,0002A,HCPCS,,80023982,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,40,,,40,Case Rate,,37,,,37,Other,186% of Medicaid,40,,,40,Case Rate,,40,83,,40,percent of total billed charges,All Other,40,83,,,percent of total billed charges,All Other,40,,,40,Case Rate,,40,83,,40,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
PFIZER ADM SARSOV2 30MCG/0.3ML 3RD,0003A,HCPCS,,80024029,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,40,,,40,Fee Schedule,,37,,,37,Other,186% of Medicaid,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
PFIZER ADM SARSCOV2 30MCG/0.3ML BST,0004A,HCPCS,,80024033,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,40,,,40,Fee Schedule,,37,,,37,Other,186% of Medicaid,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
MODERNA ADM SARSCOV2 100MCG/0.5ML 1ST,0011A,HCPCS,,80023981,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,40,,,40,Case Rate,,37,,,37,Other,186% of Medicaid,40,,,40,Case Rate,,40,83,,40,percent of total billed charges,All Other,40,83,,,percent of total billed charges,All Other,40,,,40,Case Rate,,40,83,,40,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
MODERNA ADM SARSCOV2 100MCG/0.5ML 2ND,0012A,HCPCS,,80023983,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,40,,,40,Fee Schedule,,37,,,37,Other,186% of Medicaid,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
MODERNA ADM SARSOV2 100MCG/0.5ML 3RD,0013A,HCPCS,,80024030,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,40,,,40,Fee Schedule,,37,,,37,Other,186% of Medicaid,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
J&J ADM SARSCOV2VAC AD26 .5ML,0031A,HCPCS,,80023999,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,40,,,40,Fee Schedule,,37,,,37,Other,186% of Medicaid,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
J&J ADM SARSCOV2 VAC AD26 .5ML BST,0034A,HCPCS,,80024036,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,91.8,76.5,,91.8,percent of total billed charges,All Other,82.8,69,,82.8,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,40,,,40,Fee Schedule,,37,,,37,Other,186% of Medicaid,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
MODERNA ADM SARSCOV2 50MCG/0.25ML BST,0064A,HCPCS,,80024035,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,All Other,40,,,40,Fee Schedule,,37,,,37,Other,186% of Medicaid,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
PFIZER PED ADM SARCV2 10MCG TRS-SUCR 1,0071A,HCPCS,,80024038,CDM,771,RC,,,both,,,40,15.79,39.4668,,15.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,28,70,,28,percent of total billed charges,All Other,40,,,40,Case Rate,,37,,,37,Other,186% of Medicaid,40,,,40,Case Rate,,40,83,,40,percent of total billed charges,All Other,40,83,,,percent of total billed charges,All Other,40,,,40,Case Rate,,40,83,,40,percent of total billed charges,All Other,32,80,,32,percent of total billed charges,All Other,28,70,,28,percent of total billed charges,,26,65,,26,percent of total billed charges,All Other,26,65,,26,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
PFIZER PED ADM SARSCV2 10MCG TRS-SUCR 2,0072A,HCPCS,,80024039,CDM,771,RC,,,both,,,40,15.79,39.4668,,15.79,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,28,70,,28,percent of total billed charges,All Other,40,,,40,Case Rate,,37,,,37,Other,186% of Medicaid,40,,,40,Case Rate,,40,83,,40,percent of total billed charges,All Other,40,83,,,percent of total billed charges,All Other,40,,,40,Case Rate,,40,83,,40,percent of total billed charges,All Other,32,80,,32,percent of total billed charges,All Other,28,70,,28,percent of total billed charges,,26,65,,26,percent of total billed charges,All Other,26,65,,26,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
PFIZER ADM SARSCV2 3MCG TRS-SUCR 1,0081A,HCPCS,,80024051,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78,65,,78,percent of total billed charges,All Other,70.8,59,,70.8,percent of total billed charges,All Other,91.8,76.5,,91.8,percent of total billed charges,All Other,82.8,69,,82.8,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,81.6,68,,81.6,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,99.6,83,,,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
PFIZER ADM SARSCV2 3MCG TRS-SUCR 2,0082A,HCPCS,,80024052,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78,65,,78,percent of total billed charges,All Other,70.8,59,,70.8,percent of total billed charges,All Other,91.8,76.5,,91.8,percent of total billed charges,All Other,82.8,69,,82.8,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,81.6,68,,81.6,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,99.6,83,,,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
MODERNA ADM SARSCOV2 50MCG/0.5ML  2NDBST,0094A,HCPCS,,80024061,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,91.8,76.5,,91.8,percent of total billed charges,All Other,82.8,69,,82.8,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,40,,,40,Fee Schedule,,37,,,37,Other,186% of Medicaid,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,40,,,40,Fee Schedule,,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
PFIZER ADM SARSCOV2 30MCG/0.3ML BST,0124A,HCPCS,,80024082,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78,65,,78,percent of total billed charges,All Other,70.8,59,,70.8,percent of total billed charges,All Other,91.8,76.5,,91.8,percent of total billed charges,All Other,82.8,69,,82.8,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,81.6,68,,81.6,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,99.6,83,,,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
MODERNA ADM SARSCOV2 50MCG/0.5ML BST,0134A,HCPCS,,80024084,CDM,771,RC,,,both,,,120,47.36,39.4668,,47.36,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,78,65,,78,percent of total billed charges,All Other,70.8,59,,70.8,percent of total billed charges,All Other,91.8,76.5,,91.8,percent of total billed charges,All Other,82.8,69,,82.8,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,81.6,68,,81.6,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,99.6,83,,,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,238,
IMMUNIZATION ADMIN 1 VACCINE,90471,CPT,,26090471,CDM,771,RC,,,both,,,153,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,99.45,65,,99.45,percent of total billed charges,All Other,90.27,59,,90.27,percent of total billed charges,All Other,117.05,76.5,,117.05,percent of total billed charges,All Other,105.57,69,,105.57,percent of total billed charges,All Other,99.45,65,,99.45,percent of total billed charges,All Other,107.1,70,,107.1,percent of total billed charges,All Other,104.04,68,,104.04,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,122.4,80,,122.4,percent of total billed charges,All Other,126.99,83,,126.99,percent of total billed charges,All Other,126.99,83,,,percent of total billed charges,All Other,122.4,80,,122.4,percent of total billed charges,All Other,126.99,83,,126.99,percent of total billed charges,All Other,122.4,80,,122.4,percent of total billed charges,All Other,107.1,70,,107.1,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,127.3,
IMMUNIZATION ADMINISTRATION,90471,CPT,,30090471,CDM,771,RC,,,both,,,153,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,99.45,65,,99.45,percent of total billed charges,All Other,90.27,59,,90.27,percent of total billed charges,All Other,117.05,76.5,,117.05,percent of total billed charges,All Other,105.57,69,,105.57,percent of total billed charges,All Other,99.45,65,,99.45,percent of total billed charges,All Other,107.1,70,,107.1,percent of total billed charges,All Other,104.04,68,,104.04,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,122.4,80,,122.4,percent of total billed charges,All Other,126.99,83,,126.99,percent of total billed charges,All Other,126.99,83,,,percent of total billed charges,All Other,122.4,80,,122.4,percent of total billed charges,All Other,126.99,83,,126.99,percent of total billed charges,All Other,122.4,80,,122.4,percent of total billed charges,All Other,107.1,70,,107.1,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,127.3,
IMMUNIZATION ADMIN 1 VACCINE,90471,CPT,,34090471,CDM,771,RC,,,both,,,153,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,99.45,65,,99.45,percent of total billed charges,All Other,90.27,59,,90.27,percent of total billed charges,All Other,117.05,76.5,,117.05,percent of total billed charges,All Other,105.57,69,,105.57,percent of total billed charges,All Other,99.45,65,,99.45,percent of total billed charges,All Other,107.1,70,,107.1,percent of total billed charges,All Other,104.04,68,,104.04,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,122.4,80,,122.4,percent of total billed charges,All Other,126.99,83,,126.99,percent of total billed charges,All Other,126.99,83,,,percent of total billed charges,All Other,122.4,80,,122.4,percent of total billed charges,All Other,126.99,83,,126.99,percent of total billed charges,All Other,122.4,80,,122.4,percent of total billed charges,All Other,107.1,70,,107.1,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,127.3,
IMMUNIZATION ADMIN 1ST,90471,CPT,,75090471,CDM,771,RC,,,both,,,153,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,99.45,65,,99.45,percent of total billed charges,All Other,90.27,59,,90.27,percent of total billed charges,All Other,117.05,76.5,,117.05,percent of total billed charges,All Other,105.57,69,,105.57,percent of total billed charges,All Other,99.45,65,,99.45,percent of total billed charges,All Other,107.1,70,,107.1,percent of total billed charges,All Other,104.04,68,,104.04,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,122.4,80,,122.4,percent of total billed charges,All Other,126.99,83,,126.99,percent of total billed charges,All Other,126.99,83,,,percent of total billed charges,All Other,122.4,80,,122.4,percent of total billed charges,All Other,126.99,83,,126.99,percent of total billed charges,All Other,122.4,80,,122.4,percent of total billed charges,All Other,107.1,70,,107.1,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,127.3,
IMMUNIZATION ADMIN 1 VACCINE,90471,CPT,,82090471,CDM,771,RC,,,both,,,153,127.3,,,127.3,Other,150% of Medicare + 9.63% HCRA Surcharge,77.41,,,77.41,Other,Medicare OPPS,99.45,65,,99.45,percent of total billed charges,All Other,90.27,59,,90.27,percent of total billed charges,All Other,117.05,76.5,,117.05,percent of total billed charges,All Other,105.57,69,,105.57,percent of total billed charges,All Other,99.45,65,,99.45,percent of total billed charges,All Other,107.1,70,,107.1,percent of total billed charges,All Other,104.04,68,,104.04,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,122.4,80,,122.4,percent of total billed charges,All Other,126.99,83,,126.99,percent of total billed charges,All Other,126.99,83,,,percent of total billed charges,All Other,122.4,80,,122.4,percent of total billed charges,All Other,126.99,83,,126.99,percent of total billed charges,All Other,122.4,80,,122.4,percent of total billed charges,All Other,107.1,70,,107.1,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,127.3,
IMMUNIZATION ADM EA ADDL,90472,CPT,,30090472,CDM,771,RC,,,both,,,22,8.68,39.4668,,8.68,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,47.23,,,47.23,Fee Schedule,,42.52,,,42.52,Fee Schedule,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.4,70,,15.4,percent of total billed charges,All Other,14.96,68,,14.96,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,17.6,80,,17.6,percent of total billed charges,All Other,18.26,,,18.26,Other,Non Covered Service,18.26,,,,Other,Non Covered Service,17.6,80,,17.6,percent of total billed charges,All Other,18.26,,,18.26,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,15.4,70,,15.4,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,64.63,
ADMN SARSCOV2 VACC 1 DOSE,90480,CPT,,80024129,CDM,771,RC,,,both,,,120,78.74,,,78.74,Other,150% of Medicare + 9.63% HCRA Surcharge,47.89,,,47.89,Other,Medicare OPPS,78,65,,78,percent of total billed charges,All Other,70.8,59,,70.8,percent of total billed charges,All Other,91.8,76.5,,91.8,percent of total billed charges,All Other,82.8,69,,82.8,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,All Other,81.6,68,,81.6,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,99.6,83,,,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,99.6,83,,99.6,percent of total billed charges,All Other,96,80,,96,percent of total billed charges,All Other,84,70,,84,percent of total billed charges,,78,65,,78,percent of total billed charges,All Other,78,65,,78,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,99.6,
ADMIN FLU VIRUS VACCINE,G0008,HCPCS,,30000054,CDM,771,RC,,,both,,,97,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,63.05,65,,63.05,percent of total billed charges,All Other,57.23,59,,57.23,percent of total billed charges,All Other,74.21,76.5,,74.21,percent of total billed charges,All Other,66.93,69,,66.93,percent of total billed charges,All Other,63.05,65,,63.05,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,All Other,65.96,68,,65.96,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,80.51,83,,,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,85.84,
ADMIN FLU VIRUS VACCINE,G0008,HCPCS,,40000001,CDM,771,RC,,,both,,,97,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,63.05,65,,63.05,percent of total billed charges,All Other,57.23,59,,57.23,percent of total billed charges,All Other,74.21,76.5,,74.21,percent of total billed charges,All Other,66.93,69,,66.93,percent of total billed charges,All Other,63.05,65,,63.05,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,All Other,65.96,68,,65.96,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,80.51,83,,,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,85.84,
ADMIN INFLUENZA VACCINE,G0008,HCPCS,,81000001,CDM,771,RC,,,both,,,97,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,63.05,65,,63.05,percent of total billed charges,All Other,57.23,59,,57.23,percent of total billed charges,All Other,74.21,76.5,,74.21,percent of total billed charges,All Other,66.93,69,,66.93,percent of total billed charges,All Other,63.05,65,,63.05,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,All Other,65.96,68,,65.96,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,80.51,83,,,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,85.84,
ADMIN HIGH DOSE INFLUENZA VACC,G0008,HCPCS,,81000002,CDM,771,RC,,,both,,,97,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,63.05,65,,63.05,percent of total billed charges,All Other,57.23,59,,57.23,percent of total billed charges,All Other,74.21,76.5,,74.21,percent of total billed charges,All Other,66.93,69,,66.93,percent of total billed charges,All Other,63.05,65,,63.05,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,All Other,65.96,68,,65.96,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,80.51,83,,,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,85.84,
ADMIN FLU VIRUS VACCINE,G0008,HCPCS,,82000001,CDM,771,RC,,,both,,,97,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,63.05,65,,63.05,percent of total billed charges,All Other,57.23,59,,57.23,percent of total billed charges,All Other,74.21,76.5,,74.21,percent of total billed charges,All Other,66.93,69,,66.93,percent of total billed charges,All Other,63.05,65,,63.05,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,All Other,65.96,68,,65.96,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,80.51,83,,,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,85.84,
ADMIN PNEUMONIA VACCINE,G0009,HCPCS,,82000002,CDM,771,RC,,,both,,,97,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,63.05,65,,63.05,percent of total billed charges,All Other,57.23,59,,57.23,percent of total billed charges,All Other,74.21,76.5,,74.21,percent of total billed charges,All Other,66.93,69,,66.93,percent of total billed charges,All Other,63.05,65,,63.05,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,All Other,65.96,68,,65.96,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,80.51,83,,,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,85.84,
ADMIN HEPATITIS B VACCINE,G0010,HCPCS,,30000055,CDM,771,RC,,,both,,,97,85.84,,,85.84,Other,150% of Medicare + 9.63% HCRA Surcharge,52.2,,,52.2,Other,Medicare OPPS,63.05,65,,63.05,percent of total billed charges,All Other,57.23,59,,57.23,percent of total billed charges,All Other,74.21,76.5,,74.21,percent of total billed charges,All Other,66.93,69,,66.93,percent of total billed charges,All Other,63.05,65,,63.05,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,All Other,65.96,68,,65.96,percent of total billed charges,All Other,37,,,37,Other,186% of Medicaid,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,80.51,83,,,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,80.51,83,,80.51,percent of total billed charges,All Other,77.6,80,,77.6,percent of total billed charges,All Other,67.9,70,,67.9,percent of total billed charges,,63.05,65,,63.05,percent of total billed charges,All Other,63.05,65,,63.05,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,19.95,,,19.95,Other,100% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,30.52,,,30.52,Other,153% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,27.93,,,27.93,Other,140% of Medicaid,44.89,,,44.89,Other,225% of Medicaid,51.87,,,51.87,Other,250% of Medicaid,64.63,,,64.63,Other,324% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,42.89,,,42.89,Other,215% of Medicaid,24.94,,,24.94,Other,125% of Medicaid,0.01,85.84,
TIXAGEV AND CILGAV INJ,M0220,HCPCS,,34000022,CDM,771,RC,,,both,,,1875,740,39.4668,,740,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.5,,,150.5,Fee Schedule,,150.5,,,150.5,Fee Schedule,,150.5,,,150.5,Fee Schedule,,150.5,,,150.5,Fee Schedule,,150.5,,,150.5,Fee Schedule,,1312.5,70,,1312.5,percent of total billed charges,All Other,150.5,,,150.5,Case Rate,,72,,,72,Other,186% of Medicaid,150.5,,,150.5,Case Rate,,150.5,83,,150.5,percent of total billed charges,All Other,150.5,83,,,percent of total billed charges,All Other,150.5,,,150.5,Case Rate,,150.5,83,,150.5,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,1500,
TIXAGEV AND CILGAV INJ,M0220,HCPCS,,75000005,CDM,771,RC,,,both,,,1875,740,39.4668,,740,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,150.5,,,150.5,Fee Schedule,,150.5,,,150.5,Fee Schedule,,150.5,,,150.5,Fee Schedule,,150.5,,,150.5,Fee Schedule,,150.5,,,150.5,Fee Schedule,,1312.5,70,,1312.5,percent of total billed charges,All Other,150.5,,,150.5,Case Rate,,72,,,72,Other,186% of Medicaid,150.5,,,150.5,Case Rate,,150.5,83,,150.5,percent of total billed charges,All Other,150.5,83,,,percent of total billed charges,All Other,150.5,,,150.5,Case Rate,,150.5,83,,150.5,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,1500,
TIXAGEV AND CILGAV INJ HM,M0221,HCPCS,,30000091,CDM,771,RC,,,both,,,1875,475.08,,,475.08,Other,150% of Medicare + 9.63% HCRA Surcharge,288.9,,,288.9,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1556.25,83,,,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,1556.25,
TIXAGEV AND CILGAV INJ HM,M0221,HCPCS,,34000025,CDM,771,RC,,,both,,,1875,475.08,,,475.08,Other,150% of Medicare + 9.63% HCRA Surcharge,288.9,,,288.9,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1556.25,83,,,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,1556.25,
TIXAGEV AND CILGAV INJ HM,M0221,HCPCS,,75000008,CDM,771,RC,,,both,,,1875,475.08,,,475.08,Other,150% of Medicare + 9.63% HCRA Surcharge,288.9,,,288.9,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1556.25,83,,,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,1556.25,
BEBTELOVIMAB INJ,M0222,HCPCS,,30000089,CDM,771,RC,,,both,,,1875,664.74,,,664.74,Other,150% of Medicare + 9.63% HCRA Surcharge,404.23,,,404.23,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1556.25,83,,,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,1556.25,
BEBTELOVIMAB INJ,M0222,HCPCS,,34000023,CDM,771,RC,,,both,,,1875,664.74,,,664.74,Other,150% of Medicare + 9.63% HCRA Surcharge,404.23,,,404.23,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1556.25,83,,,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,1556.25,
BEBTELOVIMAB INJ,M0222,HCPCS,,75000006,CDM,771,RC,,,both,,,1875,664.74,,,664.74,Other,150% of Medicare + 9.63% HCRA Surcharge,404.23,,,404.23,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1556.25,62,,1556.25,percent of total billed charges,Lab & Radiology,1556.25,83,,,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1556.25,62,,1556.25,percent of total billed charges,Lab & Radiology,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,1556.25,
BEBTELOVIMAB INJ HOME,M0223,HCPCS,,30000090,CDM,771,RC,,,both,,,1875,1044.05,,,1044.05,Other,150% of Medicare + 9.63% HCRA Surcharge,634.89,,,634.89,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1162.5,62,,1162.5,percent of total billed charges,Lab & Radiology,1031.25,55,,,percent of total billed charges,Default if not in Fee Schedule,1500,80,,1500,percent of total billed charges,All Other,1162.5,62,,1162.5,percent of total billed charges,Lab & Radiology,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
BEBTELOVIMAB INJ HOME,M0223,HCPCS,,34000024,CDM,771,RC,,,both,,,1875,1044.05,,,1044.05,Other,150% of Medicare + 9.63% HCRA Surcharge,634.89,,,634.89,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1162.5,62,,1162.5,percent of total billed charges,Lab & Radiology,1031.25,55,,,percent of total billed charges,Default if not in Fee Schedule,1500,80,,1500,percent of total billed charges,All Other,1162.5,62,,1162.5,percent of total billed charges,Lab & Radiology,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
BEBTELOVIMAB INJ HOME,M0223,HCPCS,,75000007,CDM,771,RC,,,both,,,1875,1044.05,,,1044.05,Other,150% of Medicare + 9.63% HCRA Surcharge,634.89,,,634.89,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1162.5,62,,1162.5,percent of total billed charges,Lab & Radiology,1031.25,55,,,percent of total billed charges,Default if not in Fee Schedule,1500,80,,1500,percent of total billed charges,All Other,1162.5,62,,1162.5,percent of total billed charges,Lab & Radiology,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,1500,
BAMLANIVIMAB-XXXX INFUSION,M0239,HCPCS,,30000084,CDM,771,RC,,,both,,,1875,740,39.4668,,740,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,309.6,,,309.6,Fee Schedule,,425,,,425,Other,186% of Medicaid,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,309.6,,,,Fee Schedule,,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1434.38,
BAMLANIVIMAB-XXXX-INFUSION,M0239,HCPCS,,34000019,CDM,771,RC,,,both,,,1875,740,39.4668,,740,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,309.6,,,309.6,Fee Schedule,,425,,,425,Other,186% of Medicaid,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,309.6,,,,Fee Schedule,,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1434.38,
BAMLANIVIMAB-XXXX INFUSION,M0239,HCPCS,,75000001,CDM,771,RC,,,both,,,1875,740,39.4668,,740,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,309.6,,,309.6,Fee Schedule,,425,,,425,Other,186% of Medicaid,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,309.6,,,,Fee Schedule,,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,238,,,238,Case Rate,,214,,,214,Case Rate,,238,,,238,Case Rate,,202,,,202,Case Rate,,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1434.38,
CASIRIVI AND IMDEVI INFUSION,M0243,HCPCS,,30000085,CDM,771,RC,,,both,,,1875,854.39,,,854.39,Other,150% of Medicare + 9.63% HCRA Surcharge,519.56,,,519.56,Other,Medicare OPPS,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,309.6,,,309.6,Case Rate,,425,,,425,Other,186% of Medicaid,309.6,,,309.6,Case Rate,,309.6,83,,309.6,percent of total billed charges,All Other,309.6,83,,,percent of total billed charges,All Other,309.6,,,309.6,Case Rate,,309.6,83,,309.6,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1500,
CASIRIVI AND IMDEVI INFUSION,M0243,HCPCS,,34000020,CDM,771,RC,,,both,,,1875,854.39,,,854.39,Other,150% of Medicare + 9.63% HCRA Surcharge,519.56,,,519.56,Other,Medicare OPPS,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,309.6,,,309.6,Case Rate,,425,,,425,Other,186% of Medicaid,309.6,,,309.6,Case Rate,,309.6,83,,309.6,percent of total billed charges,All Other,309.6,83,,,percent of total billed charges,All Other,309.6,,,309.6,Case Rate,,309.6,83,,309.6,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1500,
CASIRIVI AND IMDEVI INFUSION,M0243,HCPCS,,75000002,CDM,771,RC,,,both,,,1875,854.39,,,854.39,Other,150% of Medicare + 9.63% HCRA Surcharge,519.56,,,519.56,Other,Medicare OPPS,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,309.6,,,309.6,Case Rate,,425,,,425,Other,186% of Medicaid,309.6,,,309.6,Case Rate,,309.6,83,,309.6,percent of total billed charges,All Other,309.6,83,,,percent of total billed charges,All Other,309.6,,,309.6,Case Rate,,309.6,83,,309.6,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1500,
BAMLAN AND ETESEV INFUSION,M0245,HCPCS,,30000087,CDM,771,RC,,,both,,,1875,854.39,,,854.39,Other,150% of Medicare + 9.63% HCRA Surcharge,519.56,,,519.56,Other,Medicare OPPS,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,450,,,450,Fee Schedule,,450,,,450,Fee Schedule,,450,,,450,Fee Schedule,,1312.5,70,,1312.5,percent of total billed charges,All Other,309.6,,,309.6,Case Rate,,425,,,425,Other,186% of Medicaid,309.6,,,309.6,Case Rate,,309.6,83,,309.6,percent of total billed charges,All Other,309.6,83,,,percent of total billed charges,All Other,309.6,,,309.6,Case Rate,,309.6,83,,309.6,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1500,
BAMLAN AND ETESEV INFUSION,M0245,HCPCS,,75000003,CDM,771,RC,,,both,,,1875,854.39,,,854.39,Other,150% of Medicare + 9.63% HCRA Surcharge,519.56,,,519.56,Other,Medicare OPPS,309.6,,,309.6,Fee Schedule,,309.6,,,309.6,Fee Schedule,,450,,,450,Fee Schedule,,450,,,450,Fee Schedule,,450,,,450,Fee Schedule,,1312.5,70,,1312.5,percent of total billed charges,All Other,309.6,,,309.6,Case Rate,,425,,,425,Other,186% of Medicaid,309.6,,,309.6,Case Rate,,309.6,83,,309.6,percent of total billed charges,All Other,309.6,83,,,percent of total billed charges,All Other,309.6,,,309.6,Case Rate,,309.6,83,,309.6,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1500,
SOTROVIMAB INFUSION,M0247,HCPCS,,30000088,CDM,771,RC,,,both,,,1875,854.39,,,854.39,Other,150% of Medicare + 9.63% HCRA Surcharge,519.56,,,519.56,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1556.25,83,,,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1556.25,
SOTROVIMAB INFUSION,M0247,HCPCS,,34000021,CDM,771,RC,,,both,,,1875,854.39,,,854.39,Other,150% of Medicare + 9.63% HCRA Surcharge,519.56,,,519.56,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1556.25,83,,,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1556.25,
SOTROVIMAB INFUSION,M0247,HCPCS,,75000004,CDM,771,RC,,,both,,,1875,854.39,,,854.39,Other,150% of Medicare + 9.63% HCRA Surcharge,519.56,,,519.56,Other,Medicare OPPS,1218.75,65,,1218.75,percent of total billed charges,All Other,1106.25,59,,1106.25,percent of total billed charges,All Other,1434.38,76.5,,1434.38,percent of total billed charges,All Other,1293.75,69,,1293.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,All Other,1275,68,,1275,percent of total billed charges,All Other,425,,,425,Other,186% of Medicaid,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1556.25,83,,,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1556.25,83,,1556.25,percent of total billed charges,All Other,1500,80,,1500,percent of total billed charges,All Other,1312.5,70,,1312.5,percent of total billed charges,,1218.75,65,,1218.75,percent of total billed charges,All Other,1218.75,65,,1218.75,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,228.51,,,228.51,Other,100% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,349.62,,,349.62,Other,153% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,319.92,,,319.92,Other,140% of Medicaid,514.15,,,514.15,Other,225% of Medicaid,594.13,,,594.13,Other,250% of Medicaid,740.38,,,740.38,Other,324% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,491.3,,,491.3,Other,215% of Medicaid,285.64,,,285.64,Other,125% of Medicaid,0.01,1556.25,
TELEHEALTH FACILITY FEE,Q3014,HCPCS,GT,34000016,CDM,780,RC,,,both,,,161,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,104.65,65,,104.65,percent of total billed charges,All Other,94.99,59,,94.99,percent of total billed charges,All Other,123.17,76.5,,123.17,percent of total billed charges,All Other,111.09,69,,111.09,percent of total billed charges,All Other,104.65,65,,104.65,percent of total billed charges,All Other,112.7,70,,112.7,percent of total billed charges,All Other,109.48,68,,109.48,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,128.8,80,,128.8,percent of total billed charges,All Other,133.63,83,,133.63,percent of total billed charges,All Other,133.63,83,,,percent of total billed charges,All Other,128.8,80,,128.8,percent of total billed charges,All Other,133.63,83,,133.63,percent of total billed charges,All Other,128.8,80,,128.8,percent of total billed charges,All Other,112.7,70,,112.7,percent of total billed charges,,104.65,65,,104.65,percent of total billed charges,All Other,104.65,65,,104.65,percent of total billed charges,All Other,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,133.63,
HEMODIALYSIS ONE EVALUATION,90935,CPT,,68090935,CDM,821,RC,,,both,,,2133,1262.74,,,1262.74,Other,150% of Medicare + 9.63% HCRA Surcharge,767.88,,,767.88,Other,Medicare OPPS,289.33,,,289.33,Fee Schedule,,260.61,,,260.61,Fee Schedule,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,817,,,817,Case Rate,,1450.44,68,,1450.44,percent of total billed charges,All Other,398,,,398,Other,186% of Medicaid,1706.4,80,,1706.4,percent of total billed charges,All Other,1770.39,,,1770.39,Other,Non Covered Service,1770.39,,,,Other,Non Covered Service,1706.4,80,,1706.4,percent of total billed charges,All Other,1770.39,,,1770.39,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1493.1,70,,1493.1,percent of total billed charges,,1211,,,1211,Case Rate,,1029,,,1029,Case Rate,,743,,,743,Case Rate,,669,,,669,Case Rate,,743,,,743,Case Rate,,631,,,631,Case Rate,,213.8,,,213.8,Other,100% of Medicaid,213.8,,,213.8,Other,100% of Medicaid,213.8,,,213.8,Other,100% of Medicaid,213.8,,,213.8,Other,100% of Medicaid,481.06,,,481.06,Other,225% of Medicaid,327.12,,,327.12,Other,153% of Medicaid,481.06,,,481.06,Other,225% of Medicaid,299.33,,,299.33,Other,140% of Medicaid,481.06,,,481.06,Other,225% of Medicaid,555.89,,,555.89,Other,250% of Medicaid,692.73,,,692.73,Other,324% of Medicaid,459.68,,,459.68,Other,215% of Medicaid,459.68,,,459.68,Other,215% of Medicaid,267.26,,,267.26,Other,125% of Medicaid,0.01,1770.39,
HEMODIALYSIS OP,90937,CPT,,68090937,CDM,821,RC,,,both,,,1821,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,416.27,,,416.27,Fee Schedule,,374.96,,,374.96,Fee Schedule,,1784,,,1784,Case Rate,,1606,,,1606,Case Rate,,1516,,,1516,Case Rate,,817,,,817,Case Rate,,1238.28,68,,1238.28,percent of total billed charges,All Other,398,,,398,Other,186% of Medicaid,1456.8,80,,1456.8,percent of total billed charges,All Other,2029,,,2029,Case Rate,,2029,,,,Case Rate,,1456.8,80,,1456.8,percent of total billed charges,All Other,2029,,,2029,Case Rate,,1778,,,1778,Case Rate,,1274.7,70,,1274.7,percent of total billed charges,,1211,,,1211,Case Rate,,1029,,,1029,Case Rate,,743,,,743,Case Rate,,669,,,669,Case Rate,,743,,,743,Case Rate,,631,,,631,Case Rate,,213.8,,,213.8,Other,100% of Medicaid,213.8,,,213.8,Other,100% of Medicaid,213.8,,,213.8,Other,100% of Medicaid,213.8,,,213.8,Other,100% of Medicaid,481.06,,,481.06,Other,225% of Medicaid,327.12,,,327.12,Other,153% of Medicaid,481.06,,,481.06,Other,225% of Medicaid,299.33,,,299.33,Other,140% of Medicaid,481.06,,,481.06,Other,225% of Medicaid,555.89,,,555.89,Other,250% of Medicaid,692.73,,,692.73,Other,324% of Medicaid,459.68,,,459.68,Other,215% of Medicaid,459.68,,,459.68,Other,215% of Medicaid,267.26,,,267.26,Other,125% of Medicaid,0.01,2029,
EMERG DIALYSIS ESRD PT,G0257,HCPCS,,68000007,CDM,880,RC,,,both,,,2217,1262.74,,,1262.74,Other,150% of Medicare + 9.63% HCRA Surcharge,767.88,,,767.88,Other,Medicare OPPS,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1507.56,68,,1507.56,percent of total billed charges,All Other,398,,,398,Other,186% of Medicaid,1773.6,80,,1773.6,percent of total billed charges,All Other,1840.11,,,1840.11,Other,Non Covered Service,1840.11,,,,Other,Non Covered Service,1773.6,80,,1773.6,percent of total billed charges,All Other,1840.11,,,1840.11,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,1551.9,70,,1551.9,percent of total billed charges,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,Non Covered Service,0.01,,,0.01,Other,Non Covered Service,213.8,,,213.8,Other,100% of Medicaid,213.8,,,213.8,Other,100% of Medicaid,213.8,,,213.8,Other,100% of Medicaid,213.8,,,213.8,Other,100% of Medicaid,481.06,,,481.06,Other,225% of Medicaid,327.12,,,327.12,Other,153% of Medicaid,481.06,,,481.06,Other,225% of Medicaid,299.33,,,299.33,Other,140% of Medicaid,481.06,,,481.06,Other,225% of Medicaid,555.89,,,555.89,Other,250% of Medicaid,692.73,,,692.73,Other,324% of Medicaid,459.68,,,459.68,Other,215% of Medicaid,459.68,,,459.68,Other,215% of Medicaid,267.26,,,267.26,Other,125% of Medicaid,0.01,1840.11,
PSYCH DIAGNOSTIC EVALUATION,90791,CPT,,36090791,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,154,,,154,Fee Schedule,,230.13,,,230.13,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
TH-PSYCH DIAGNOSTIC EVALUATION,90791,CPT,95,36490791,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,154,,,154,Fee Schedule,,230.13,,,230.13,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAGNOSTIC EVALUATION,90791,CPT,,37090791,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,154,,,154,Fee Schedule,,230.13,,,230.13,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
TH-PSYCH DIAGNOSTIC EVALUATION,90791,CPT,95,37490791,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,154,,,154,Fee Schedule,,230.13,,,230.13,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAGNOSTIC EVALUATION,90791,CPT,,38090791,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,154,,,154,Fee Schedule,,230.13,,,230.13,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAGNOSTIC EVALUATION-TH,90791,CPT,95,38390791,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,154,,,154,Fee Schedule,,230.13,,,230.13,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAGNOSTIC EVALUATION,90791,CPT,,39090791,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,154,,,154,Fee Schedule,,230.13,,,230.13,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAGNOSTIC EVALUATION - TH,90791,CPT,,39190791,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,154,,,154,Fee Schedule,,230.13,,,230.13,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAGNOSTIC EVALUATION,90791,CPT,,40090791,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,154,,,154,Fee Schedule,,230.13,,,230.13,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAGNOSTIC EVALUATION - TELEPSYCH,90791,CPT,95,40190791,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,154,,,154,Fee Schedule,,230.13,,,230.13,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,230.13,,,230.13,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
EVAL WITH MED MANAGEMENT,90792,CPT,,36090792,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,279.3,70,,279.3,percent of total billed charges,All Other,265.07,,,265.07,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
TH- EVAL WITH MED MANAGEMENT,90792,CPT,95,36490792,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,279.3,70,,279.3,percent of total billed charges,All Other,265.07,,,265.07,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAG EVAL W/MD,90792,CPT,,37090792,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,279.3,70,,279.3,percent of total billed charges,All Other,265.07,,,265.07,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
TH-PSYCH DIAG EVAL W/MD,90792,CPT,95,37490792,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,279.3,70,,279.3,percent of total billed charges,All Other,265.07,,,265.07,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAG EVAL W/MD,90792,CPT,,38090792,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,279.3,70,,279.3,percent of total billed charges,All Other,265.07,,,265.07,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAG EVAL W/MD-TH,90792,CPT,95,38390792,CDM,900,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,279.3,70,,279.3,percent of total billed charges,All Other,265.07,,,265.07,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
OFFICE/OUTPAT VISIT NEW 15 MIN,99202,CPT,,36099202,CDM,900,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,156.24,62,,156.24,percent of total billed charges,Behavioral Health,141.12,56,,141.12,percent of total billed charges,Behavioral Health,136.08,54,,136.08,percent of total billed charges,Behavioral Health,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,64.56,70,,64.56,percent of total billed charges,,64.56,,,64.56,Other,130% of Medicare,64.56,,,64.56,Other,130% of Medicare,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.16,
TH-OFFICE/OUTPAT VISIT NEW 15 MIN,99202,CPT,95,36499202,CDM,900,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,156.24,62,,156.24,percent of total billed charges,Behavioral Health,141.12,56,,141.12,percent of total billed charges,Behavioral Health,136.08,54,,136.08,percent of total billed charges,Behavioral Health,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,64.56,70,,64.56,percent of total billed charges,,64.56,,,64.56,Other,130% of Medicare,64.56,,,64.56,Other,130% of Medicare,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.16,
OFFICE/OUTPAT VISIT NEW 15 MIN,99202,CPT,,37099202,CDM,900,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,156.24,62,,156.24,percent of total billed charges,Behavioral Health,141.12,56,,141.12,percent of total billed charges,Behavioral Health,136.08,54,,136.08,percent of total billed charges,Behavioral Health,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,64.56,70,,64.56,percent of total billed charges,,64.56,,,64.56,Other,130% of Medicare,64.56,,,64.56,Other,130% of Medicare,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.16,
TH-OFFICE/OUTPAT VISIT NEW 15 MIN,99202,CPT,95,37499202,CDM,900,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,156.24,62,,156.24,percent of total billed charges,Behavioral Health,141.12,56,,141.12,percent of total billed charges,Behavioral Health,136.08,54,,136.08,percent of total billed charges,Behavioral Health,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,64.56,70,,64.56,percent of total billed charges,,64.56,,,64.56,Other,130% of Medicare,64.56,,,64.56,Other,130% of Medicare,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.16,
OFFICE/OUTPAT VISIT NEW 15 MIN,99202,CPT,,38099202,CDM,900,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,156.24,62,,156.24,percent of total billed charges,Behavioral Health,141.12,56,,141.12,percent of total billed charges,Behavioral Health,136.08,54,,136.08,percent of total billed charges,Behavioral Health,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,64.56,70,,64.56,percent of total billed charges,,64.56,,,64.56,Other,130% of Medicare,64.56,,,64.56,Other,130% of Medicare,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.16,
OFFICE/OUTPAT VISIT NEW 15 MIN-TH,99202,CPT,95,38399202,CDM,900,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,156.24,62,,156.24,percent of total billed charges,Behavioral Health,141.12,56,,141.12,percent of total billed charges,Behavioral Health,136.08,54,,136.08,percent of total billed charges,Behavioral Health,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,64.56,70,,64.56,percent of total billed charges,,64.56,,,64.56,Other,130% of Medicare,64.56,,,64.56,Other,130% of Medicare,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.16,
OFFICE/OUTPAT VISIT NEW 15 MIN,99202,CPT,HE,39099202,CDM,900,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,156.24,62,,156.24,percent of total billed charges,Behavioral Health,141.12,56,,141.12,percent of total billed charges,Behavioral Health,136.08,54,,136.08,percent of total billed charges,Behavioral Health,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,64.56,70,,64.56,percent of total billed charges,,64.56,,,64.56,Other,130% of Medicare,64.56,,,64.56,Other,130% of Medicare,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.16,
OFFICE/OUTPAT VISIT NEW 15 MIN TELEPSYCH,99202,CPT,HE95,39199202,CDM,900,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,156.24,62,,156.24,percent of total billed charges,Behavioral Health,141.12,56,,141.12,percent of total billed charges,Behavioral Health,136.08,54,,136.08,percent of total billed charges,Behavioral Health,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,64.56,70,,64.56,percent of total billed charges,,64.56,,,64.56,Other,130% of Medicare,64.56,,,64.56,Other,130% of Medicare,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.16,
OFFICE/OUTPAT VISIT NEW 15 MIN,99202,CPT,HE,40099202,CDM,900,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,156.24,62,,156.24,percent of total billed charges,Behavioral Health,141.12,56,,141.12,percent of total billed charges,Behavioral Health,136.08,54,,136.08,percent of total billed charges,Behavioral Health,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,64.56,70,,64.56,percent of total billed charges,,64.56,,,64.56,Other,130% of Medicare,64.56,,,64.56,Other,130% of Medicare,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.16,
OFFICE/OUTPAT VISIT NEW 15 MIN TELEPSYCH,99202,CPT,HE95,40199202,CDM,900,RC,,,both,,,252,99.46,39.4668,,99.46,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,163.8,65,,163.8,percent of total billed charges,All Other,148.68,59,,148.68,percent of total billed charges,All Other,156.24,62,,156.24,percent of total billed charges,Behavioral Health,141.12,56,,141.12,percent of total billed charges,Behavioral Health,136.08,54,,136.08,percent of total billed charges,Behavioral Health,176.4,70,,176.4,percent of total billed charges,All Other,171.36,68,,171.36,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,209.16,83,,,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,209.16,83,,209.16,percent of total billed charges,All Other,201.6,80,,201.6,percent of total billed charges,All Other,64.56,70,,64.56,percent of total billed charges,,64.56,,,64.56,Other,130% of Medicare,64.56,,,64.56,Other,130% of Medicare,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,23.95,,,23.95,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,209.16,
OFFICE/OUTPAT VISIT NEW 30 MIN,99203,CPT,,36099203,CDM,900,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,213.9,62,,213.9,percent of total billed charges,Behavioral Health,193.2,56,,193.2,percent of total billed charges,Behavioral Health,186.3,54,,186.3,percent of total billed charges,Behavioral Health,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,241.5,70,,241.5,percent of total billed charges,,111.9,,,111.9,Other,130% of Medicare,111.9,,,111.9,Other,130% of Medicare,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,286.35,
TH-OFFICE/OUTPAT VISIT NEW 30 MIN,99203,CPT,95,36499203,CDM,900,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,213.9,62,,213.9,percent of total billed charges,Behavioral Health,193.2,56,,193.2,percent of total billed charges,Behavioral Health,186.3,54,,186.3,percent of total billed charges,Behavioral Health,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,241.5,70,,241.5,percent of total billed charges,,111.9,,,111.9,Other,130% of Medicare,111.9,,,111.9,Other,130% of Medicare,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,286.35,
OFFICE/OUTPAT VISIT NEW 30 MIN,99203,CPT,,37099203,CDM,900,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,213.9,62,,213.9,percent of total billed charges,Behavioral Health,193.2,56,,193.2,percent of total billed charges,Behavioral Health,186.3,54,,186.3,percent of total billed charges,Behavioral Health,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,241.5,70,,241.5,percent of total billed charges,,111.9,,,111.9,Other,130% of Medicare,111.9,,,111.9,Other,130% of Medicare,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,286.35,
TH-OFFICE/OUTPAT VISIT NEW 30 MIN,99203,CPT,95,37499203,CDM,900,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,213.9,62,,213.9,percent of total billed charges,Behavioral Health,193.2,56,,193.2,percent of total billed charges,Behavioral Health,186.3,54,,186.3,percent of total billed charges,Behavioral Health,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,241.5,70,,241.5,percent of total billed charges,,111.9,,,111.9,Other,130% of Medicare,111.9,,,111.9,Other,130% of Medicare,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,286.35,
OFFICE/OUTPAT VISIT NEW 30 MIN,99203,CPT,,38099203,CDM,900,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,213.9,62,,213.9,percent of total billed charges,Behavioral Health,193.2,56,,193.2,percent of total billed charges,Behavioral Health,186.3,54,,186.3,percent of total billed charges,Behavioral Health,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,241.5,70,,241.5,percent of total billed charges,,111.9,,,111.9,Other,130% of Medicare,111.9,,,111.9,Other,130% of Medicare,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,286.35,
OFFICE/OUTPAT VISIT NEW 30 MIN-TH,99203,CPT,95,38399203,CDM,900,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,213.9,62,,213.9,percent of total billed charges,Behavioral Health,193.2,56,,193.2,percent of total billed charges,Behavioral Health,186.3,54,,186.3,percent of total billed charges,Behavioral Health,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,241.5,70,,241.5,percent of total billed charges,,111.9,,,111.9,Other,130% of Medicare,111.9,,,111.9,Other,130% of Medicare,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,286.35,
OFFICE/OUTPAT VISIT NEW 30 MIN,99203,CPT,HE,39099203,CDM,900,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,213.9,62,,213.9,percent of total billed charges,Behavioral Health,193.2,56,,193.2,percent of total billed charges,Behavioral Health,186.3,54,,186.3,percent of total billed charges,Behavioral Health,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,241.5,70,,241.5,percent of total billed charges,,111.9,,,111.9,Other,130% of Medicare,111.9,,,111.9,Other,130% of Medicare,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,286.35,
OFFICE/OUTPAT VISIT NEW 30 MIN TELEPSYCH,99203,CPT,HE95,39199203,CDM,900,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,213.9,62,,213.9,percent of total billed charges,Behavioral Health,193.2,56,,193.2,percent of total billed charges,Behavioral Health,186.3,54,,186.3,percent of total billed charges,Behavioral Health,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,241.5,70,,241.5,percent of total billed charges,,111.9,,,111.9,Other,130% of Medicare,111.9,,,111.9,Other,130% of Medicare,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,286.35,
OFFICE/OUTPAT VISIT NEW 30 MIN,99203,CPT,HE,40099203,CDM,900,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,213.9,62,,213.9,percent of total billed charges,Behavioral Health,193.2,56,,193.2,percent of total billed charges,Behavioral Health,186.3,54,,186.3,percent of total billed charges,Behavioral Health,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,241.5,70,,241.5,percent of total billed charges,,111.9,,,111.9,Other,130% of Medicare,111.9,,,111.9,Other,130% of Medicare,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,286.35,
OFFICE/OUTPAT VISIT NEW 30 MIN TELEPSYCH,99203,CPT,HE95,40199203,CDM,900,RC,,,both,,,345,136.16,39.4668,,136.16,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,224.25,65,,224.25,percent of total billed charges,All Other,203.55,59,,203.55,percent of total billed charges,All Other,213.9,62,,213.9,percent of total billed charges,Behavioral Health,193.2,56,,193.2,percent of total billed charges,Behavioral Health,186.3,54,,186.3,percent of total billed charges,Behavioral Health,241.5,70,,241.5,percent of total billed charges,All Other,234.6,68,,234.6,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,286.35,83,,,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,286.35,83,,286.35,percent of total billed charges,All Other,276,80,,276,percent of total billed charges,All Other,241.5,70,,241.5,percent of total billed charges,,111.9,,,111.9,Other,130% of Medicare,111.9,,,111.9,Other,130% of Medicare,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,41.89,,,41.89,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,286.35,
OFFICE/OUTPAT VISIT NEW 45 MIN,99204,CPT,,36099204,CDM,900,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,285.2,62,,285.2,percent of total billed charges,Behavioral Health,257.6,56,,257.6,percent of total billed charges,Behavioral Health,248.4,54,,248.4,percent of total billed charges,Behavioral Health,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,,181.94,,,181.94,Other,130% of Medicare,181.94,,,181.94,Other,130% of Medicare,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.8,
TH-OFFICE/OUTPAT VISIT NEW 45 MIN,99204,CPT,95,36499204,CDM,900,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,285.2,62,,285.2,percent of total billed charges,Behavioral Health,257.6,56,,257.6,percent of total billed charges,Behavioral Health,248.4,54,,248.4,percent of total billed charges,Behavioral Health,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,,181.94,,,181.94,Other,130% of Medicare,181.94,,,181.94,Other,130% of Medicare,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.8,
OFFICE/OUTPAT VISIT NEW 45 MIN,99204,CPT,,37099204,CDM,900,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,285.2,62,,285.2,percent of total billed charges,Behavioral Health,257.6,56,,257.6,percent of total billed charges,Behavioral Health,248.4,54,,248.4,percent of total billed charges,Behavioral Health,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,,181.94,,,181.94,Other,130% of Medicare,181.94,,,181.94,Other,130% of Medicare,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.8,
TH-OFFICE/OUTPAT VISIT NEW 45 MIN,99204,CPT,95,37499204,CDM,900,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,285.2,62,,285.2,percent of total billed charges,Behavioral Health,257.6,56,,257.6,percent of total billed charges,Behavioral Health,248.4,54,,248.4,percent of total billed charges,Behavioral Health,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,,181.94,,,181.94,Other,130% of Medicare,181.94,,,181.94,Other,130% of Medicare,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.8,
OFFICE/OUTPAT VISIT NEW 45 MIN,99204,CPT,,38099204,CDM,900,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,285.2,62,,285.2,percent of total billed charges,Behavioral Health,257.6,56,,257.6,percent of total billed charges,Behavioral Health,248.4,54,,248.4,percent of total billed charges,Behavioral Health,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,,181.94,,,181.94,Other,130% of Medicare,181.94,,,181.94,Other,130% of Medicare,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.8,
OFFICE/OUTPAT VISIT NEW 45 MIN-TH,99204,CPT,95,38399204,CDM,900,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,285.2,62,,285.2,percent of total billed charges,Behavioral Health,257.6,56,,257.6,percent of total billed charges,Behavioral Health,248.4,54,,248.4,percent of total billed charges,Behavioral Health,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,,181.94,,,181.94,Other,130% of Medicare,181.94,,,181.94,Other,130% of Medicare,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.8,
OFFICE/OUTPAT VISIT NEW 45 MIN,99204,CPT,HE,39099204,CDM,900,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,285.2,62,,285.2,percent of total billed charges,Behavioral Health,257.6,56,,257.6,percent of total billed charges,Behavioral Health,248.4,54,,248.4,percent of total billed charges,Behavioral Health,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,,181.94,,,181.94,Other,130% of Medicare,181.94,,,181.94,Other,130% of Medicare,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.8,
OFFICE/OUTPAT VISIT NEW 45 MIN TELEPSYCH,99204,CPT,HE95,39199204,CDM,900,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,285.2,62,,285.2,percent of total billed charges,Behavioral Health,257.6,56,,257.6,percent of total billed charges,Behavioral Health,248.4,54,,248.4,percent of total billed charges,Behavioral Health,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,,181.94,,,181.94,Other,130% of Medicare,181.94,,,181.94,Other,130% of Medicare,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.8,
OFFICE/OUTPAT VISIT NEW 45 MIN,99204,CPT,HE,40099204,CDM,900,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,285.2,62,,285.2,percent of total billed charges,Behavioral Health,257.6,56,,257.6,percent of total billed charges,Behavioral Health,248.4,54,,248.4,percent of total billed charges,Behavioral Health,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,,181.94,,,181.94,Other,130% of Medicare,181.94,,,181.94,Other,130% of Medicare,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.8,
OFFICE/OUTPAT VISIT NEW 45 MIN TELEPSYCH,99204,CPT,HE95,40199204,CDM,900,RC,,,both,,,460,181.55,39.4668,,181.55,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,299,65,,299,percent of total billed charges,All Other,271.4,59,,271.4,percent of total billed charges,All Other,285.2,62,,285.2,percent of total billed charges,Behavioral Health,257.6,56,,257.6,percent of total billed charges,Behavioral Health,248.4,54,,248.4,percent of total billed charges,Behavioral Health,322,70,,322,percent of total billed charges,All Other,312.8,68,,312.8,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,381.8,83,,,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,381.8,83,,381.8,percent of total billed charges,All Other,368,80,,368,percent of total billed charges,All Other,322,70,,322,percent of total billed charges,,181.94,,,181.94,Other,130% of Medicare,181.94,,,181.94,Other,130% of Medicare,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,68.97,,,68.97,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,381.8,
OFFICE/OUTPAT VISIT NEW 60 MIN,99205,CPT,,36099205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
TH-OFFICE/OUTPAT VISIT NEW 60 MIN,99205,CPT,95,36499205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
OFFICE/OUTPAT VISIT NEW 60 MIN,99205,CPT,,37099205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
TH-OFFICE/OUTPAT VISIT NEW 60 MIN,99205,CPT,95,37499205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
OFFICE/OUTPAT VISIT NEW 60 MIN,99205,CPT,,38099205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
TH-OFFICE/OUTPAT VISIT NEW 60 MIN,99205,CPT,95,38399205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
OFFICE/OUTPAT VISIT NEW 60 MIN,99205,CPT,HE,39099205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
OFFICE/OUTPAT VISIT NEW 60 MIN TELEPSYCH,99205,CPT,HE95,39199205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
OFFICE/OUTPAT VISIT NEW 60 MIN,99205,CPT,HE,40099205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
OFFICE/OUTPAT VISIT NEW 60 MIN TELEPSYCH,99205,CPT,HE95,40199205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
OFFICE/OUTPAT VISIT NEW 60 MIN,99205,CPT,,48099205,CDM,900,RC,,,both,,,628,247.85,39.4668,,247.85,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,408.2,65,,408.2,percent of total billed charges,All Other,370.52,59,,370.52,percent of total billed charges,All Other,389.36,62,,389.36,percent of total billed charges,Behavioral Health,351.68,56,,351.68,percent of total billed charges,Behavioral Health,339.12,54,,339.12,percent of total billed charges,Behavioral Health,439.6,70,,439.6,percent of total billed charges,All Other,427.04,68,,427.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,521.24,83,,,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,521.24,83,,521.24,percent of total billed charges,All Other,502.4,80,,502.4,percent of total billed charges,All Other,439.6,70,,439.6,percent of total billed charges,,247.59,,,247.59,Other,130% of Medicare,247.59,,,247.59,Other,130% of Medicare,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,98.55,,,98.55,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,521.24,
OFFICE/OUTPAT VISIT EST 5 MIN,99211,CPT,,36099211,CDM,900,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,141.36,62,,141.36,percent of total billed charges,Behavioral Health,127.68,56,,127.68,percent of total billed charges,Behavioral Health,123.12,54,,123.12,percent of total billed charges,Behavioral Health,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,52,,,52,Fee Schedule,Behavioral Health,44,,,44,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
OFFICE/OUTPAT VISIT EST 5 MIN 25 MOD,99211,CPT,25,36199211,CDM,900,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,141.36,62,,141.36,percent of total billed charges,Behavioral Health,127.68,56,,127.68,percent of total billed charges,Behavioral Health,123.12,54,,123.12,percent of total billed charges,Behavioral Health,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,52,,,52,Fee Schedule,Behavioral Health,44,,,44,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
OFFICE/OUTPAT VISIT EST 5 MIN,99211,CPT,,37099211,CDM,900,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,141.36,62,,141.36,percent of total billed charges,Behavioral Health,127.68,56,,127.68,percent of total billed charges,Behavioral Health,123.12,54,,123.12,percent of total billed charges,Behavioral Health,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,52,,,52,Fee Schedule,Behavioral Health,44,,,44,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
OFFICE/OUTPAT VISIT EST 5 MIN 25 MOD,99211,CPT,25,37199211,CDM,900,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,141.36,62,,141.36,percent of total billed charges,Behavioral Health,127.68,56,,127.68,percent of total billed charges,Behavioral Health,123.12,54,,123.12,percent of total billed charges,Behavioral Health,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,52,,,52,Fee Schedule,Behavioral Health,44,,,44,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
OFFICE/OUTPAT VISIT EST 5 MIN,99211,CPT,,38099211,CDM,900,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,141.36,62,,141.36,percent of total billed charges,Behavioral Health,127.68,56,,127.68,percent of total billed charges,Behavioral Health,123.12,54,,123.12,percent of total billed charges,Behavioral Health,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,52,,,52,Fee Schedule,Behavioral Health,44,,,44,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
OFFICE/OUTPAT VISIT EST 5 MIN 25 MOD,99211,CPT,25,38199211,CDM,900,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,141.36,62,,141.36,percent of total billed charges,Behavioral Health,127.68,56,,127.68,percent of total billed charges,Behavioral Health,123.12,54,,123.12,percent of total billed charges,Behavioral Health,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,52,,,52,Fee Schedule,Behavioral Health,44,,,44,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
OFFICE/OUTPAT VISIT EST 5 MIN,99211,CPT,HE,39099211,CDM,900,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,141.36,62,,141.36,percent of total billed charges,Behavioral Health,127.68,56,,127.68,percent of total billed charges,Behavioral Health,123.12,54,,123.12,percent of total billed charges,Behavioral Health,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,52,,,52,Fee Schedule,Behavioral Health,44,,,44,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
OFFICE/OUTPAT VISIT EST 5 MIN TELEPSYCH,99211,CPT,HEGT,39199211,CDM,900,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,141.36,62,,141.36,percent of total billed charges,Behavioral Health,127.68,56,,127.68,percent of total billed charges,Behavioral Health,123.12,54,,123.12,percent of total billed charges,Behavioral Health,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,52,,,52,Fee Schedule,Behavioral Health,44,,,44,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
OFFICE/OUTPAT VISIT EST 5 MIN,99211,CPT,HE,40099211,CDM,900,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,141.36,62,,141.36,percent of total billed charges,Behavioral Health,127.68,56,,127.68,percent of total billed charges,Behavioral Health,123.12,54,,123.12,percent of total billed charges,Behavioral Health,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,52,,,52,Fee Schedule,Behavioral Health,44,,,44,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
OFFICE/OUTPAT VISIT EST 5 MIN TELEPSYCH,99211,CPT,HEGT,40199211,CDM,900,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,141.36,62,,141.36,percent of total billed charges,Behavioral Health,127.68,56,,127.68,percent of total billed charges,Behavioral Health,123.12,54,,123.12,percent of total billed charges,Behavioral Health,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,52,,,52,Fee Schedule,Behavioral Health,44,,,44,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,48.23,,,48.23,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
OFFICE/OUTPAT VISIT EST 10 MIN,99212,CPT,,36099212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN 25 MOD,99212,CPT,25,36199212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
TH-OFFICE/OUTPAT VISIT EST 10 MIN 25 MOD,99212,CPT,2595,36499212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
TH-OFFICE/OUTPAT VISIT EST 10 MIN 25 MOD,99212,CPT,2595,36599212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN,99212,CPT,,37099212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN 25 MOD,99212,CPT,25,37199212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
TH-OFFICE/OUTPAT VISIT EST 10 MIN 25 MOD,99212,CPT,2595,37499212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
TH-OFFICE/OUTPAT VISIT EST 10 MIN 25 MOD,99212,CPT,2595,37599212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN,99212,CPT,,38099212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN 25 MOD,99212,CPT,25,38199212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN-TH,99212,CPT,95,38399212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN 25 MOD-TH,99212,CPT,9525,38499212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN,99212,CPT,HE,39099212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN TELEPSYCH,99212,CPT,HE95,39199212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN,99212,CPT,HE,40099212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 10 MIN TELEPSYCH,99212,CPT,HE95,40199212,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,97,,,97,Fee Schedule,Behavioral Health,82,,,82,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN,99213,CPT,,36099213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN 25 MOD,99213,CPT,25,36199213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
TH-OFFICE/OUTPAT VISIT EST 20 MIN,99213,CPT,95,36499213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
TH-OFFICE/OUTPAT VISIT EST 20 MIN 25 MOD,99213,CPT,2595,36599213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN,99213,CPT,,37099213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN 25 MOD,99213,CPT,25,37199213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
TH-OFFICE/OUTPAT VISIT EST 20 MIN,99213,CPT,95,37499213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
TH-OFFICE/OUTPAT VISIT EST 20 MIN 25 MOD,99213,CPT,2595,37599213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN,99213,CPT,,38099213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN 25 MOD,99213,CPT,25,38199213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN-TH,99213,CPT,95,38399213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN 25 MOD-TH,99213,CPT,2595,38499213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN,99213,CPT,HE,39099213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN TELEPSYCH,99213,CPT,HE95,39199213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN,99213,CPT,HE,40099213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 20 MIN TELEPSYCH,99213,CPT,HE95,40199213,CDM,900,RC,,,both,,,259,102.22,39.4668,,102.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,168.35,65,,168.35,percent of total billed charges,All Other,152.81,59,,152.81,percent of total billed charges,All Other,160.58,62,,160.58,percent of total billed charges,Behavioral Health,145.04,56,,145.04,percent of total billed charges,Behavioral Health,139.86,54,,139.86,percent of total billed charges,Behavioral Health,181.3,70,,181.3,percent of total billed charges,All Other,176.12,68,,176.12,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,214.97,83,,,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,214.97,83,,214.97,percent of total billed charges,All Other,207.2,80,,207.2,percent of total billed charges,All Other,181.3,70,,181.3,percent of total billed charges,,115,,,115,Fee Schedule,Behavioral Health,98,,,98,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,55.27,,,55.27,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,214.97,
OFFICE/OUTPAT VISIT EST 30 MIN,99214,CPT,,36099214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN 25 MOD,99214,CPT,25,36199214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
TH-OFFICE/OUTPAT VISIT EST 30 MIN,99214,CPT,95,36499214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
TH-OFFICE/OUTPAT VISIT EST 30 MIN 25 MOD,99214,CPT,2595,36599214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN,99214,CPT,,37099214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN 25 MOD,99214,CPT,25,37199214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
TH-OFFICE/OUTPAT VISIT EST 30 MIN,99214,CPT,95,37499214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
TH-OFFICE/OUTPAT VISIT EST 30 MIN 25 MOD,99214,CPT,2595,37599214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN,99214,CPT,,38099214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN 25 MOD,99214,CPT,25,38199214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN-TH,99214,CPT,95,38399214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN 25 MOD-TH,99214,CPT,2595,38499214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN,99214,CPT,HE,39099214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN TELEPSYCH,99214,CPT,HEGT,39199214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN,99214,CPT,HE,40099214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 30 MIN TELEPSYCH,99214,CPT,HE95,40199214,CDM,900,RC,,,both,,,340,134.19,39.4668,,134.19,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,221,65,,221,percent of total billed charges,All Other,200.6,59,,200.6,percent of total billed charges,All Other,210.8,62,,210.8,percent of total billed charges,Behavioral Health,190.4,56,,190.4,percent of total billed charges,Behavioral Health,183.6,54,,183.6,percent of total billed charges,Behavioral Health,238,70,,238,percent of total billed charges,All Other,231.2,68,,231.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,282.2,83,,,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,282.2,83,,282.2,percent of total billed charges,All Other,272,80,,272,percent of total billed charges,All Other,238,70,,238,percent of total billed charges,,130,,,130,Fee Schedule,Behavioral Health,111,,,111,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,77.42,,,77.42,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,282.2,
OFFICE/OUTPAT VISIT EST 40 MIN,99215,CPT,,36099215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN 25 MOD,99215,CPT,25,36199215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
TH-OFFICE/OUTPAT VISIT EST 40 MIN,99215,CPT,95,36499215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
TH-OFFICE/OUTPAT VISIT EST 40 MIN 25 MOD,99215,CPT,2595,36599215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN,99215,CPT,,37099215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN 25 MOD,99215,CPT,25,37199215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
TH-OFFICE/OUTPAT VISIT EST 40 MIN,99215,CPT,95,37499215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
TH-OFFICE/OUTPAT VISIT EST 40 MIN 25 MOD,99215,CPT,2595,37599215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN,99215,CPT,,38099215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN 25 MOD,99215,CPT,25,38199215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN-TH,99215,CPT,95,38399215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN 25 MOD-TH,99215,CPT,2595,38499215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN,99215,CPT,HE,39099215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN TELEPSYCH,99215,CPT,HE95,39199215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN,99215,CPT,HE,40099215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
OFFICE/OUTPAT VISIT EST 40 MIN TELEPSYCH,99215,CPT,HE95,40199215,CDM,900,RC,,,both,,,440,173.65,39.4668,,173.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,286,65,,286,percent of total billed charges,All Other,259.6,59,,259.6,percent of total billed charges,All Other,272.8,62,,272.8,percent of total billed charges,Behavioral Health,246.4,56,,246.4,percent of total billed charges,Behavioral Health,237.6,54,,237.6,percent of total billed charges,Behavioral Health,308,70,,308,percent of total billed charges,All Other,299.2,68,,299.2,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,365.2,83,,,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,365.2,83,,365.2,percent of total billed charges,All Other,352,80,,352,percent of total billed charges,All Other,308,70,,308,percent of total billed charges,,209,,,209,Fee Schedule,Behavioral Health,178,,,178,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,114.4,,,114.4,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,365.2,
MED ASSIST TX METH WEEKLY,G2067,HCPCS,,38000009,CDM,900,RC,,,both,,,234,92.35,39.4668,,92.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,152.1,65,,152.1,percent of total billed charges,All Other,138.06,59,,138.06,percent of total billed charges,All Other,145.08,62,,145.08,percent of total billed charges,Behavioral Health,131.04,56,,131.04,percent of total billed charges,Behavioral Health,126.36,54,,126.36,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,117,50,,117,percent of total billed charges,Behavioral Health,0.01,,,0.01,Other,186% of Medicaid,117,50,,117,percent of total billed charges,Behavioral Health,117,50,,117,percent of total billed charges,Behavioral Health,117,50,,,percent of total billed charges,Behavioral Health,117,50,,117,percent of total billed charges,Behavioral Health,117,50,,117,percent of total billed charges,Behavioral Health,187.2,80,,187.2,percent of total billed charges,All Other,163.8,70,,163.8,percent of total billed charges,,152.1,65,,152.1,percent of total billed charges,Behavioral Health,152.1,65,,152.1,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357,
ALCOHOL/DRUG; METHADONE TX,H0020,HCPCS,,38000002,CDM,900,RC,,,both,,,45,17.76,39.4668,,17.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,29.25,65,,29.25,percent of total billed charges,All Other,26.55,59,,26.55,percent of total billed charges,All Other,27.9,62,,27.9,percent of total billed charges,Behavioral Health,25.2,56,,25.2,percent of total billed charges,Behavioral Health,24.3,54,,24.3,percent of total billed charges,Behavioral Health,325,,,325,Other,Weekly Rate,22.5,50,,22.5,percent of total billed charges,Behavioral Health,51,,,51,Other,186% of Medicaid,22.5,50,,22.5,percent of total billed charges,Behavioral Health,22.5,50,,22.5,percent of total billed charges,Behavioral Health,22.5,50,,,percent of total billed charges,Behavioral Health,22.5,50,,22.5,percent of total billed charges,Behavioral Health,22.5,50,,22.5,percent of total billed charges,Behavioral Health,36,80,,36,percent of total billed charges,All Other,31.5,70,,31.5,percent of total billed charges,,218,,,218,Fee Schedule,Behavioral Health,185,,,185,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,42.27,,,42.27,Other,153% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,38.68,,,38.68,Other,140% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,71.84,,,71.84,Other,250% of Medicaid,89.52,,,89.52,Other,324% of Medicaid,59.4,,,59.4,Other,215% of Medicaid,59.4,,,59.4,Other,215% of Medicaid,34.54,,,34.54,Other,125% of Medicaid,0.01,325,
METHADONE GUEST TREATMENT,H0020,HCPCS,,38000004,CDM,900,RC,,,both,,,45,17.76,39.4668,,17.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,29.25,65,,29.25,percent of total billed charges,All Other,26.55,59,,26.55,percent of total billed charges,All Other,27.9,62,,27.9,percent of total billed charges,Behavioral Health,25.2,56,,25.2,percent of total billed charges,Behavioral Health,24.3,54,,24.3,percent of total billed charges,Behavioral Health,325,,,325,Other,Weekly Rate,22.5,50,,22.5,percent of total billed charges,Behavioral Health,51,,,51,Other,186% of Medicaid,22.5,50,,22.5,percent of total billed charges,Behavioral Health,22.5,50,,22.5,percent of total billed charges,Behavioral Health,22.5,50,,,percent of total billed charges,Behavioral Health,22.5,50,,22.5,percent of total billed charges,Behavioral Health,22.5,50,,22.5,percent of total billed charges,Behavioral Health,36,80,,36,percent of total billed charges,All Other,31.5,70,,31.5,percent of total billed charges,,218,,,218,Fee Schedule,Behavioral Health,185,,,185,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,42.27,,,42.27,Other,153% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,38.68,,,38.68,Other,140% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,71.84,,,71.84,Other,250% of Medicaid,89.52,,,89.52,Other,324% of Medicaid,59.4,,,59.4,Other,215% of Medicaid,59.4,,,59.4,Other,215% of Medicaid,34.54,,,34.54,Other,125% of Medicaid,0.01,325,
ALCOHOL/DRUG; METHADONE TX FIRST WEEKLY,H0020,HCPCS,KP,38000007,CDM,900,RC,,,both,,,45,17.76,39.4668,,17.76,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,29.25,65,,29.25,percent of total billed charges,All Other,26.55,59,,26.55,percent of total billed charges,All Other,27.9,62,,27.9,percent of total billed charges,Behavioral Health,25.2,56,,25.2,percent of total billed charges,Behavioral Health,24.3,54,,24.3,percent of total billed charges,Behavioral Health,325,,,325,Other,Weekly Rate,22.5,50,,22.5,percent of total billed charges,Behavioral Health,51,,,51,Other,186% of Medicaid,22.5,50,,22.5,percent of total billed charges,Behavioral Health,22.5,50,,22.5,percent of total billed charges,Behavioral Health,22.5,50,,,percent of total billed charges,Behavioral Health,22.5,50,,22.5,percent of total billed charges,Behavioral Health,22.5,50,,22.5,percent of total billed charges,Behavioral Health,36,80,,36,percent of total billed charges,All Other,31.5,70,,31.5,percent of total billed charges,,218,,,218,Fee Schedule,Behavioral Health,185,,,185,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,42.27,,,42.27,Other,153% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,38.68,,,38.68,Other,140% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,71.84,,,71.84,Other,250% of Medicaid,89.52,,,89.52,Other,324% of Medicaid,59.4,,,59.4,Other,215% of Medicaid,59.4,,,59.4,Other,215% of Medicaid,34.54,,,34.54,Other,125% of Medicaid,0.01,325,
ADOL ACT THRPY PER SESS 45+ MINS,G0176,HCPCS,,39000001,CDM,904,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.25,65,,68.25,percent of total billed charges,All Other,61.95,59,,61.95,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Behavioral Health,58.8,56,,58.8,percent of total billed charges,Behavioral Health,56.7,54,,56.7,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,52.5,50,,52.5,percent of total billed charges,Behavioral Health,0.01,,,0.01,Other,186% of Medicaid,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,84,80,,84,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,,68.25,65,,68.25,percent of total billed charges,Behavioral Health,68.25,65,,68.25,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357,
ADOL ACT THRPY PER SESS 45+ MINS-TH,G0176,HCPCS,GT,39100001,CDM,904,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.25,65,,68.25,percent of total billed charges,All Other,61.95,59,,61.95,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Behavioral Health,58.8,56,,58.8,percent of total billed charges,Behavioral Health,56.7,54,,56.7,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,52.5,50,,52.5,percent of total billed charges,Behavioral Health,0.01,,,0.01,Other,186% of Medicaid,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,84,80,,84,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,,68.25,65,,68.25,percent of total billed charges,Behavioral Health,68.25,65,,68.25,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357,
ACTIVITY THERAPY PER SESS 45+ MINS,G0176,HCPCS,,40000002,CDM,904,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.25,65,,68.25,percent of total billed charges,All Other,61.95,59,,61.95,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Behavioral Health,58.8,56,,58.8,percent of total billed charges,Behavioral Health,56.7,54,,56.7,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,52.5,50,,52.5,percent of total billed charges,Behavioral Health,0.01,,,0.01,Other,186% of Medicaid,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,84,80,,84,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,,68.25,65,,68.25,percent of total billed charges,Behavioral Health,68.25,65,,68.25,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357,
ACTIVITY THERAPY PER SESS 45+ MINS-TH,G0176,HCPCS,GT,40100001,CDM,904,RC,,,both,,,105,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.25,65,,68.25,percent of total billed charges,All Other,61.95,59,,61.95,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Behavioral Health,58.8,56,,58.8,percent of total billed charges,Behavioral Health,56.7,54,,56.7,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,52.5,50,,52.5,percent of total billed charges,Behavioral Health,0.01,,,0.01,Other,186% of Medicaid,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,52.5,50,,52.5,percent of total billed charges,Behavioral Health,84,80,,84,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,,68.25,65,,68.25,percent of total billed charges,Behavioral Health,68.25,65,,68.25,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,357,
PSYCH DIAG EVAL W/MD,90792,CPT,,39090792,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,279.3,70,,279.3,percent of total billed charges,All Other,265.07,,,265.07,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAG EVAL W/MD TELEPSYCH,90792,CPT,95,39190792,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,279.3,70,,279.3,percent of total billed charges,All Other,265.07,,,265.07,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAG EVAL W/MD,90792,CPT,,40090792,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,279.3,70,,279.3,percent of total billed charges,All Other,265.07,,,265.07,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYCH DIAG EVAL W/MD TELEPSYCH,90792,CPT,95,40190792,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,204,,,204,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,173,,,173,Fee Schedule,Behavioral Health,279.3,70,,279.3,percent of total billed charges,All Other,265.07,,,265.07,Fee Schedule,Behavioral Health,305,,,305,Other,186% of Medicaid,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,265.07,,,265.07,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,217,,,217,Fee Schedule,Behavioral Health,184,,,184,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,139.73,,,139.73,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,139.73,530.75,
PSYTX PT&/FAMILY 30 MIN,90832,CPT,,36090832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
IOP PSYTX PT&/FAMILY 30 MIN,90832,CPT,,36190832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
ATP PSYTX PT&/FAMILY 30 MIN,90832,CPT,,36290832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
TH-IOP PSYTX PT&/FAMILY 30 MIN,90832,CPT,95,36490832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
TH-IOP PSYTX PT&/FAMILY 30 MIN,90832,CPT,95,36590832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
TH-ATP PSYTX PT&/FAMILY 30 MIN,90832,CPT,95,36690832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
TH-ADR PSYTX PT&/FAMILY 30 MIN,90832,CPT,95,36790832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
ADR PSYTX PT&/FAMILY 30 MIN,90832,CPT,,36890832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
PSYTX PT&/FAMILY 30 MIN,90832,CPT,,37090832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
IOP PSYTX PT&/FAMILY 30 MIN,90832,CPT,,37190832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
ATP PSYTX PT&/FAMILY 30 MIN,90832,CPT,,37290832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
TH-ATP PSYTX PT&/FAMILY 30 MIN,90832,CPT,95,37490832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
TH-IOP PSYTX PT&/FAMILY 30 MIN,90832,CPT,95,37590832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
TH-ATP PSYTX PT&/FAMILY 30 MIN,90832,CPT,95,37690832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
PSYTX PT&/FAMILY 30 MIN,90832,CPT,,38090832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
TH -PSYTX PT&/FAMILY 30 MIN,90832,CPT,95,38390832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
PSYTX PT&/FAMILY 30 MINUTES,90832,CPT,,39090832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
PSYTX PT&/FAMILY 30 MINUTES-TH,90832,CPT,95,39190832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
PSYTX PT&/FAMILY 30 MINUTES,90832,CPT,,40090832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
PSYTX PT&/FAMILY 30 MINUTES-TH,90832,CPT,95,40190832,CDM,914,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,87,,,87,Fee Schedule,Behavioral Health,78,,,78,Fee Schedule,Behavioral Health,74,,,74,Fee Schedule,Behavioral Health,72,,,72,Fee Schedule,,106.52,,,106.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,106.52,,,106.52,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,69.32,,,69.32,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,69.32,328.11,
PSYTX PT&/FAM W/MD 30 MIN,90833,CPT,,36090833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
PSYTX PT&/FAM W/PSYCH 30 MIN,90833,CPT,,36190833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
TH-PSYTX PT&/FAM W/PSYCH 30 MIN,90833,CPT,,36290833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
PSYTX PT&/FAM W/MD 30 MIN,90833,CPT,,37090833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
PSYTX PT&/FAM W/PSYCH 30 MIN,90833,CPT,,37190833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
PSYTX PT&/FAM W/MD 30 MIN,90833,CPT,,38090833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
PSYTX PT&/FAM W/PSYCH 30 MIN,90833,CPT,,38190833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
TH-PSYTX PT&/FAM W/PSYCH 30 MIN,90833,CPT,,38290833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
PSYTX PT&/FAM W/MD 30 MIN,90833,CPT,HE,39090833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
PSYTX PT&/FAM W/MD 30 MIN TELEPSYCH,90833,CPT,HE95,39190833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
PSYTX PT&/FAM W/MD 30 MIN,90833,CPT,HE,40090833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
PSYTX PT&/FAM W/MD 30 MIN TELEPSYCH,90833,CPT,HE95,40190833,CDM,914,RC,,,both,,,108,42.62,39.4668,,42.62,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,70.2,65,,70.2,percent of total billed charges,All Other,63.72,59,,63.72,percent of total billed charges,All Other,82.62,76.5,,82.62,percent of total billed charges,All Other,74.52,69,,74.52,percent of total billed charges,All Other,70.2,65,,70.2,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,All Other,100.23,,,100.23,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,100.23,,,100.23,Fee Schedule,Behavioral Health,86.4,80,,86.4,percent of total billed charges,All Other,75.6,70,,75.6,percent of total billed charges,,28,,,28,Fee Schedule,Behavioral Health,24,,,24,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,52.8,,,52.8,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
PSYTX PT&/FAMILY 45 MIN,90834,CPT,,36090834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
IOP PSYTX PT&/FAMILY 45 MIN,90834,CPT,,36190834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
ATP PSYTX PT&/FAMILY 45 MIN,90834,CPT,,36290834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
TH-PSYTX PT&/FAMILY 45 MIN,90834,CPT,95,36490834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
TH-IOP PSYTX PT&/FAMILY 45 MIN,90834,CPT,95,36590834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
TH-ATP PSYTX PT&/FAMILY 45 MIN,90834,CPT,95,36690834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
TH-ADR PSYTX PT&/FAMILY 45 MIN,90834,CPT,95,36790834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
ADR PSYTX PT&/FAMILY 45 MIN,90834,CPT,,36890834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
PSYTX PT&/FAMILY 45 MIN,90834,CPT,,37090834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
IOP PSYTX PT&/FAMILY 45 MIN,90834,CPT,,37190834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
ATP PSYTX PT&/FAMILY 45 MIN,90834,CPT,,37290834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
TH-PSYTX PT&/FAMILY 45 MIN,90834,CPT,95,37490834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
TH-IOP PSYTX PT&/FAMILY 45 MIN,90834,CPT,95,37590834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
TH-ATP PSYTX PT&/FAMILY 45 MIN,90834,CPT,95,37690834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
PSYTX PT&/FAMILY 45 MIN,90834,CPT,,38090834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
TH -PSYTX PT&/FAMILY 45 MIN,90834,CPT,95,38390834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
PSYTX PT&/FAMILY 45 MIN,90834,CPT,,39090834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
PSYTX PT&/FAMILY 45 MIN-TH,90834,CPT,HE95,39190834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
PSYTX PT&/FAMILY 45 MIN,90834,CPT,,40090834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
PSYTX PT&/FAMILY 45 MIN-TH,90834,CPT,95,40190834,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,140.78,,,140.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,140.78,,,140.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,104.53,,,104.53,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,104.53,429.43,
PSYTX PT&/FAM W/MD 45 MIN,90836,CPT,,36090836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/PSYCH 45 MIN,90836,CPT,,36190836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
TH-PSYTX PT&/FAM W/PSYCH 45 MIN,90836,CPT,,36290836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 45 MIN,90836,CPT,,37090836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/PSYCH 45 MIN,90836,CPT,,37190836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 45 MIN,90836,CPT,,38090836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/PSYCH 45 MIN,90836,CPT,,38190836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
TH-PSYTX PT&/FAM W/PSYCH 45 MIN,90836,CPT,,38290836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 45 MIN,90836,CPT,HE,39090836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 45 MIN TELEPSYCH,90836,CPT,HE95,39190836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 45 MIN,90836,CPT,HE,40090836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 45 MIN TELEPSYCH,90836,CPT,HE95,40190836,CDM,914,RC,,,both,,,175,69.07,39.4668,,69.07,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,113.75,65,,113.75,percent of total billed charges,All Other,103.25,59,,103.25,percent of total billed charges,All Other,133.88,76.5,,133.88,percent of total billed charges,All Other,120.75,69,,120.75,percent of total billed charges,All Other,113.75,65,,113.75,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,All Other,126.78,,,126.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,126.78,,,126.78,Fee Schedule,Behavioral Health,140,80,,140,percent of total billed charges,All Other,122.5,70,,122.5,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,79.55,,,79.55,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAMILY 60 MIN,90837,CPT,,36090837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
IOP PSYTX PT&/FAMILY 60 MIN,90837,CPT,,36190837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
TH -PSYTX PT&/FAMILY 60 MIN,90837,CPT,95,36490837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
PSYTX PT&/FAMILY 60 MIN,90837,CPT,,37090837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
IOP PSYTX PT&/FAMILY 60 MIN,90837,CPT,,37190837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
TH- PSYTX PT&/FAMILY 60 MIN,90837,CPT,95,37490837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
TH -IOP PSYTX PT&/FAMILY 60 MIN,90837,CPT,95,37590837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
PSYTX PT&/FAMILY 60 MIN,90837,CPT,,38090837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
PSYTX PT&/FAMILY 60 MIN-TH,90837,CPT,95,38390837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
PSYTX PT&/FAMILY 60 MIN,90837,CPT,,39090837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
PSYTX PT&/FAMILY 60 MIN-TH,90837,CPT,95,39190837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
PSYTX PT&/FAMILY 60 MIN,90837,CPT,,40090837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
PSYTX PT&/FAMILY 60 MIN-TH,90837,CPT,95,40190837,CDM,914,RC,,,both,,,399,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,259.35,65,,259.35,percent of total billed charges,All Other,235.41,59,,235.41,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,207.78,,,207.78,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,207.78,,,207.78,Fee Schedule,Behavioral Health,319.2,80,,319.2,percent of total billed charges,All Other,279.3,70,,279.3,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,110.87,,,110.87,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,110.87,429.43,
PSYTX PT&/FAM W/MD 60 MIN,90838,CPT,,36090838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/PSYCH 60 MIN,90838,CPT,,36190838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
TH-PSYTX PT&/FAM W/MD 60 MIN,90838,CPT,95,36490838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
TH-PSYTX PT&/FAM W/PSYCH 60 MIN,90838,CPT,95,36590838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 60 MIN,90838,CPT,,37090838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/PSYCH 60 MIN,90838,CPT,,37190838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
TH-PSYTX PT&/FAM W/MD 60 MIN,90838,CPT,95,37490838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 60 MIN,90838,CPT,,38090838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/PSYCH 60 MIN,90838,CPT,,38190838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
TH-PSYTX PT&/FAM W/PSYCH 60 MIN,90838,CPT,,38290838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 60 MIN,90838,CPT,HE,39090838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 60 MIN TELEPSYCH,90838,CPT,HE95,39190838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 60 MIN,90838,CPT,HE,40090838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX PT&/FAM W/MD 60 MIN TELEPSYCH,90838,CPT,HE95,40190838,CDM,914,RC,,,both,,,282,111.3,39.4668,,111.3,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.3,65,,183.3,percent of total billed charges,All Other,166.38,59,,166.38,percent of total billed charges,All Other,215.73,76.5,,215.73,percent of total billed charges,All Other,194.58,69,,194.58,percent of total billed charges,All Other,183.3,65,,183.3,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,All Other,168.08,,,168.08,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,168.08,,,168.08,Fee Schedule,Behavioral Health,225.6,80,,225.6,percent of total billed charges,All Other,197.4,70,,197.4,percent of total billed charges,,121,,,121,Fee Schedule,Behavioral Health,103,,,103,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,106.31,,,106.31,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX CRISIS INITIAL 60 MIN,90839,CPT,,39090839,CDM,914,RC,,,both,,,402,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,261.3,65,,261.3,percent of total billed charges,All Other,237.18,59,,237.18,percent of total billed charges,All Other,307.53,76.5,,307.53,percent of total billed charges,All Other,277.38,69,,277.38,percent of total billed charges,All Other,261.3,65,,261.3,percent of total billed charges,All Other,281.4,70,,281.4,percent of total billed charges,All Other,201.36,,,201.36,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,321.6,80,,321.6,percent of total billed charges,All Other,281.4,70,,281.4,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,131,429.43,
PSYTX CRISIS INITIAL 60 MIN-TH,90839,CPT,GT,39190839,CDM,914,RC,,,both,,,402,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,261.3,65,,261.3,percent of total billed charges,All Other,237.18,59,,237.18,percent of total billed charges,All Other,307.53,76.5,,307.53,percent of total billed charges,All Other,277.38,69,,277.38,percent of total billed charges,All Other,261.3,65,,261.3,percent of total billed charges,All Other,281.4,70,,281.4,percent of total billed charges,All Other,201.36,,,201.36,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,321.6,80,,321.6,percent of total billed charges,All Other,281.4,70,,281.4,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,131,429.43,
PSYTX CRISIS INITIAL 60 MIN,90839,CPT,,40090839,CDM,914,RC,,,both,,,402,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,261.3,65,,261.3,percent of total billed charges,All Other,237.18,59,,237.18,percent of total billed charges,All Other,307.53,76.5,,307.53,percent of total billed charges,All Other,277.38,69,,277.38,percent of total billed charges,All Other,261.3,65,,261.3,percent of total billed charges,All Other,281.4,70,,281.4,percent of total billed charges,All Other,201.36,,,201.36,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,321.6,80,,321.6,percent of total billed charges,All Other,281.4,70,,281.4,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,131,429.43,
PSYTX CRISIS INITIAL 60 MIN-TH,90839,CPT,GT,40190839,CDM,914,RC,,,both,,,402,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,261.3,65,,261.3,percent of total billed charges,All Other,237.18,59,,237.18,percent of total billed charges,All Other,307.53,76.5,,307.53,percent of total billed charges,All Other,277.38,69,,277.38,percent of total billed charges,All Other,261.3,65,,261.3,percent of total billed charges,All Other,281.4,70,,281.4,percent of total billed charges,All Other,201.36,,,201.36,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,201.36,,,201.36,Fee Schedule,Behavioral Health,321.6,80,,321.6,percent of total billed charges,All Other,281.4,70,,281.4,percent of total billed charges,,154,,,154,Fee Schedule,Behavioral Health,131,,,131,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.69,,,132.69,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,131,429.43,
PSYTX CRISIS EA ADDL 30 MIN,90840,CPT,,39090840,CDM,914,RC,,,both,,,140,55.25,39.4668,,55.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91,65,,91,percent of total billed charges,All Other,82.6,59,,82.6,percent of total billed charges,All Other,107.1,76.5,,107.1,percent of total billed charges,All Other,96.6,69,,96.6,percent of total billed charges,All Other,91,65,,91,percent of total billed charges,All Other,98,70,,98,percent of total billed charges,All Other,101.4,,,101.4,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,112,80,,112,percent of total billed charges,All Other,98,70,,98,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX CRISIS EA ADDL 30 MIN-TH,90840,CPT,GT,39190840,CDM,914,RC,,,both,,,140,55.25,39.4668,,55.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91,65,,91,percent of total billed charges,All Other,82.6,59,,82.6,percent of total billed charges,All Other,107.1,76.5,,107.1,percent of total billed charges,All Other,96.6,69,,96.6,percent of total billed charges,All Other,91,65,,91,percent of total billed charges,All Other,98,70,,98,percent of total billed charges,All Other,101.4,,,101.4,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,112,80,,112,percent of total billed charges,All Other,98,70,,98,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX CRISIS EA ADDL 30 MIN,90840,CPT,,40090840,CDM,914,RC,,,both,,,140,55.25,39.4668,,55.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91,65,,91,percent of total billed charges,All Other,82.6,59,,82.6,percent of total billed charges,All Other,107.1,76.5,,107.1,percent of total billed charges,All Other,96.6,69,,96.6,percent of total billed charges,All Other,91,65,,91,percent of total billed charges,All Other,98,70,,98,percent of total billed charges,All Other,101.4,,,101.4,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,112,80,,112,percent of total billed charges,All Other,98,70,,98,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PSYTX CRISIS EA ADDL 30 MIN-TH,90840,CPT,95,40190840,CDM,914,RC,,,both,,,140,55.25,39.4668,,55.25,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,91,65,,91,percent of total billed charges,All Other,82.6,59,,82.6,percent of total billed charges,All Other,107.1,76.5,,107.1,percent of total billed charges,All Other,96.6,69,,96.6,percent of total billed charges,All Other,91,65,,91,percent of total billed charges,All Other,98,70,,98,percent of total billed charges,All Other,101.4,,,101.4,Fee Schedule,Behavioral Health,247,,,247,Other,186% of Medicaid,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,101.4,,,101.4,Fee Schedule,Behavioral Health,112,80,,112,percent of total billed charges,All Other,98,70,,98,percent of total billed charges,,99,,,99,Fee Schedule,Behavioral Health,84,,,84,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,6.69,,,6.69,Fee Schedule,Behavioral Health,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,132.54,,,132.54,Other,100% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,202.79,,,202.79,Other,153% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,185.56,,,185.56,Other,140% of Medicaid,298.21,,,298.21,Other,225% of Medicaid,344.6,,,344.6,Other,250% of Medicaid,429.43,,,429.43,Other,324% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,284.96,,,284.96,Other,215% of Medicaid,165.67,,,165.67,Other,125% of Medicaid,0.01,429.43,
PHARMACOLOGIC MGMT W/PSYTX,90863,CPT,,38090863,CDM,914,RC,,,both,,,272,107.35,39.4668,,107.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,176.8,65,,176.8,percent of total billed charges,All Other,160.48,59,,160.48,percent of total billed charges,All Other,208.08,76.5,,208.08,percent of total billed charges,All Other,187.68,69,,187.68,percent of total billed charges,All Other,176.8,65,,176.8,percent of total billed charges,All Other,190.4,70,,190.4,percent of total billed charges,All Other,184.96,68,,184.96,percent of total billed charges,All Other,51,,,51,Other,186% of Medicaid,217.6,80,,217.6,percent of total billed charges,All Other,225.76,83,,225.76,percent of total billed charges,All Other,225.76,83,,,percent of total billed charges,All Other,217.6,80,,217.6,percent of total billed charges,All Other,225.76,83,,225.76,percent of total billed charges,All Other,217.6,80,,217.6,percent of total billed charges,All Other,190.4,70,,190.4,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,42.27,,,42.27,Other,153% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,38.68,,,38.68,Other,140% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,71.84,,,71.84,Other,250% of Medicaid,89.52,,,89.52,Other,324% of Medicaid,59.4,,,59.4,Other,215% of Medicaid,59.4,,,59.4,Other,215% of Medicaid,34.54,,,34.54,Other,125% of Medicaid,0.01,225.76,
PHARMACOLOGIC MGMT W/PSYTX ACUTE,90863,CPT,,38190863,CDM,914,RC,,,both,,,272,107.35,39.4668,,107.35,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,176.8,65,,176.8,percent of total billed charges,All Other,160.48,59,,160.48,percent of total billed charges,All Other,208.08,76.5,,208.08,percent of total billed charges,All Other,187.68,69,,187.68,percent of total billed charges,All Other,176.8,65,,176.8,percent of total billed charges,All Other,190.4,70,,190.4,percent of total billed charges,All Other,184.96,68,,184.96,percent of total billed charges,All Other,51,,,51,Other,186% of Medicaid,217.6,80,,217.6,percent of total billed charges,All Other,225.76,83,,225.76,percent of total billed charges,All Other,225.76,83,,,percent of total billed charges,All Other,217.6,80,,217.6,percent of total billed charges,All Other,225.76,83,,225.76,percent of total billed charges,All Other,217.6,80,,217.6,percent of total billed charges,All Other,190.4,70,,190.4,percent of total billed charges,,100,,,100,Fee Schedule,Behavioral Health,85,,,85,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,27.63,,,27.63,Other,100% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,42.27,,,42.27,Other,153% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,38.68,,,38.68,Other,140% of Medicaid,62.17,,,62.17,Other,225% of Medicaid,71.84,,,71.84,Other,250% of Medicaid,89.52,,,89.52,Other,324% of Medicaid,59.4,,,59.4,Other,215% of Medicaid,59.4,,,59.4,Other,215% of Medicaid,34.54,,,34.54,Other,125% of Medicaid,0.01,225.76,
ALCOHOL OR DRUG ASSESSMENT,H0001,HCPCS,,38000001,CDM,914,RC,,,both,,,203,80.12,39.4668,,80.12,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,131.95,65,,131.95,percent of total billed charges,All Other,119.77,59,,119.77,percent of total billed charges,All Other,125.86,62,,125.86,percent of total billed charges,Behavioral Health,113.68,56,,113.68,percent of total billed charges,Behavioral Health,109.62,54,,109.62,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,101.5,50,,101.5,percent of total billed charges,Behavioral Health,305,,,305,Other,186% of Medicaid,101.5,50,,101.5,percent of total billed charges,Behavioral Health,101.5,50,,101.5,percent of total billed charges,Behavioral Health,101.5,50,,,percent of total billed charges,Behavioral Health,101.5,50,,101.5,percent of total billed charges,Behavioral Health,101.5,50,,101.5,percent of total billed charges,Behavioral Health,162.4,80,,162.4,percent of total billed charges,All Other,142.1,70,,142.1,percent of total billed charges,,131.95,65,,131.95,percent of total billed charges,Behavioral Health,131.95,65,,131.95,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,163.81,,,163.81,Other,100% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,250.63,,,250.63,Other,153% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,229.34,,,229.34,Other,140% of Medicaid,368.58,,,368.58,Other,225% of Medicaid,425.91,,,425.91,Other,250% of Medicaid,530.75,,,530.75,Other,324% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,352.2,,,352.2,Other,215% of Medicaid,204.76,,,204.76,Other,125% of Medicaid,0.01,530.75,
TH- ADR ALCOHOL/DRUG C&T PER 15 MINS,H0004,HCPCS,GT,36200001,CDM,914,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,46.8,65,,46.8,percent of total billed charges,All Other,42.48,59,,42.48,percent of total billed charges,All Other,44.64,62,,44.64,percent of total billed charges,Behavioral Health,40.32,56,,40.32,percent of total billed charges,Behavioral Health,38.88,54,,38.88,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,36,50,,36,percent of total billed charges,Behavioral Health,188,,,188,Other,186% of Medicaid,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,57.6,80,,57.6,percent of total billed charges,All Other,50.4,70,,50.4,percent of total billed charges,,46.8,65,,46.8,percent of total billed charges,Behavioral Health,46.8,65,,46.8,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,357,
TH-ALCOHOL/DRUG SERVICES C&T PER 15 MINS,H0004,HCPCS,GT,37000001,CDM,914,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,46.8,65,,46.8,percent of total billed charges,All Other,42.48,59,,42.48,percent of total billed charges,All Other,44.64,62,,44.64,percent of total billed charges,Behavioral Health,40.32,56,,40.32,percent of total billed charges,Behavioral Health,38.88,54,,38.88,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,36,50,,36,percent of total billed charges,Behavioral Health,188,,,188,Other,186% of Medicaid,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,57.6,80,,57.6,percent of total billed charges,All Other,50.4,70,,50.4,percent of total billed charges,,46.8,65,,46.8,percent of total billed charges,Behavioral Health,46.8,65,,46.8,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,357,
ALCOHOL/DRUG SERVICES C&T PER 15 MINS,H0004,HCPCS,,38000008,CDM,914,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,46.8,65,,46.8,percent of total billed charges,All Other,42.48,59,,42.48,percent of total billed charges,All Other,44.64,62,,44.64,percent of total billed charges,Behavioral Health,40.32,56,,40.32,percent of total billed charges,Behavioral Health,38.88,54,,38.88,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,36,50,,36,percent of total billed charges,Behavioral Health,188,,,188,Other,186% of Medicaid,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,57.6,80,,57.6,percent of total billed charges,All Other,50.4,70,,50.4,percent of total billed charges,,46.8,65,,46.8,percent of total billed charges,Behavioral Health,46.8,65,,46.8,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,357,
TH-ALCOHOL/DRUG SERVICES C&T PER 15 MINS,H0004,HCPCS,GT,38000011,CDM,914,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,46.8,65,,46.8,percent of total billed charges,All Other,42.48,59,,42.48,percent of total billed charges,All Other,44.64,62,,44.64,percent of total billed charges,Behavioral Health,40.32,56,,40.32,percent of total billed charges,Behavioral Health,38.88,54,,38.88,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,36,50,,36,percent of total billed charges,Behavioral Health,188,,,188,Other,186% of Medicaid,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,36,50,,36,percent of total billed charges,Behavioral Health,57.6,80,,57.6,percent of total billed charges,All Other,50.4,70,,50.4,percent of total billed charges,,46.8,65,,46.8,percent of total billed charges,Behavioral Health,46.8,65,,46.8,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,357,
PROGRAM INTAKE ASSESSMENT,T1023,HCPCS,,38000003,CDM,914,RC,,,both,,,147,58.02,39.4668,,58.02,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,95.55,65,,95.55,percent of total billed charges,All Other,86.73,59,,86.73,percent of total billed charges,All Other,29.45,,,29.45,Fee Schedule,Behavioral Health,29.45,,,29.45,Fee Schedule,Behavioral Health,29.45,,,29.45,Fee Schedule,Behavioral Health,357,,,357,Case Rate,,73.5,50,,73.5,percent of total billed charges,Behavioral Health,93,,,93,Other,186% of Medicaid,73.5,50,,73.5,percent of total billed charges,Behavioral Health,73.5,50,,73.5,percent of total billed charges,Behavioral Health,73.5,50,,,percent of total billed charges,Behavioral Health,73.5,50,,73.5,percent of total billed charges,Behavioral Health,73.5,50,,73.5,percent of total billed charges,Behavioral Health,117.6,80,,117.6,percent of total billed charges,All Other,102.9,70,,102.9,percent of total billed charges,,95.55,65,,95.55,percent of total billed charges,Behavioral Health,95.55,65,,95.55,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,76.23,,,76.23,Other,153% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,69.75,,,69.75,Other,140% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,129.53,,,129.53,Other,250% of Medicaid,161.42,,,161.42,Other,324% of Medicaid,107.11,,,107.11,Other,215% of Medicaid,107.11,,,107.11,Other,215% of Medicaid,62.28,,,62.28,Other,125% of Medicaid,0.01,357,
MULTI-FAMILY GROUP THERAPY,90849,CPT,,36090849,CDM,915,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,46.14,,,46.14,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,46.14,,,46.14,Fee Schedule,Behavioral Health,46.14,,,46.14,Fee Schedule,Behavioral Health,46.14,,,,Fee Schedule,Behavioral Health,46.14,,,46.14,Fee Schedule,Behavioral Health,46.14,,,46.14,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,39.99,,,39.99,Other,130% of Medicare,39.99,,,39.99,Other,130% of Medicare,62.67,,,62.67,Fee Schedule,Behavioral Health,62.67,,,62.67,Fee Schedule,Behavioral Health,62.67,,,62.67,Fee Schedule,Behavioral Health,62.67,,,62.67,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,39.99,288.1,
MULTI-FAMILY GROUP THERAPY,90849,CPT,,37090849,CDM,915,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,46.14,,,46.14,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,46.14,,,46.14,Fee Schedule,Behavioral Health,46.14,,,46.14,Fee Schedule,Behavioral Health,46.14,,,,Fee Schedule,Behavioral Health,46.14,,,46.14,Fee Schedule,Behavioral Health,46.14,,,46.14,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,39.99,,,39.99,Other,130% of Medicare,39.99,,,39.99,Other,130% of Medicare,62.67,,,62.67,Fee Schedule,Behavioral Health,62.67,,,62.67,Fee Schedule,Behavioral Health,62.67,,,62.67,Fee Schedule,Behavioral Health,62.67,,,62.67,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,39.99,288.1,
GROUP THERAPY NOT MULTI-FAMILY,90853,CPT,,36090853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
IOP GROUP THERAPY NOT MULTI-FAMILY,90853,CPT,,36190853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
ADR GROUP THERAPY NOT MF 120-240,90853,CPT,,36290853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
ATP GROUP THERAPY NOT MF,90853,CPT,,36390853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
TH -GROUP THERAPY NOT MULTI-FAMILY,90853,CPT,95,36490853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
TH-IOP GROUP THERAPY NOT MULTI-FAMILY,90853,CPT,95,36590853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
TH-ADR GROUP THERAPY NOT MF 120-240,90853,CPT,95,36690853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
TH- ATP GROUP THERAPY NOT MF,90853,CPT,95,36790853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
GROUP THERAPY NOT MULTI-FAMILY,90853,CPT,,37090853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
IOP GROUP THERAPY NOT MULTI-FAMILY,90853,CPT,,37190853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
ATP GROUP THERAPY NOT MF,90853,CPT,,37390853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
TH -GROUP THERAPY NOT MULTI-FAMILY,90853,CPT,95,37490853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
TH- IOP GROUP THERAPY NOT MULTI-FAMILY,90853,CPT,95,37590853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
TH-ATP GROUP THERAPY NOT MF,90853,CPT,95,37690853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
GROUP THERAPY NOT MULTI-FAMILY,90853,CPT,,38090853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
TH - GROUP THERAPY NOT MULTI-FAMILY,90853,CPT,95,38390853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
ADOL GROUP THERAPY,90853,CPT,,39090853,CDM,915,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
GROUP THRPY PARTIAL HOSP 45-50,G0410,HCPCS,,39000004,CDM,915,RC,,,both,,,194,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,126.1,65,,126.1,percent of total billed charges,All Other,114.46,59,,114.46,percent of total billed charges,All Other,120.28,62,,120.28,percent of total billed charges,Behavioral Health,108.64,56,,108.64,percent of total billed charges,Behavioral Health,104.76,54,,104.76,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,97,50,,97,percent of total billed charges,Behavioral Health,104,,,104,Other,186% of Medicaid,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,155.2,80,,155.2,percent of total billed charges,All Other,135.8,70,,135.8,percent of total billed charges,,126.1,65,,126.1,percent of total billed charges,Behavioral Health,126.1,65,,126.1,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,0.01,357,
GROUP THRPY PARTIAL HOSP 45-50-TH,G0410,HCPCS,GT,39100003,CDM,915,RC,,,both,,,194,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,126.1,65,,126.1,percent of total billed charges,All Other,114.46,59,,114.46,percent of total billed charges,All Other,120.28,62,,120.28,percent of total billed charges,Behavioral Health,108.64,56,,108.64,percent of total billed charges,Behavioral Health,104.76,54,,104.76,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,97,50,,97,percent of total billed charges,Behavioral Health,104,,,104,Other,186% of Medicaid,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,155.2,80,,155.2,percent of total billed charges,All Other,135.8,70,,135.8,percent of total billed charges,,126.1,65,,126.1,percent of total billed charges,Behavioral Health,126.1,65,,126.1,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,0.01,357,
GROUP THRPY PARTIAL HOSP 45-50,G0410,HCPCS,,40000004,CDM,915,RC,,,both,,,194,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,126.1,65,,126.1,percent of total billed charges,All Other,114.46,59,,114.46,percent of total billed charges,All Other,120.28,62,,120.28,percent of total billed charges,Behavioral Health,108.64,56,,108.64,percent of total billed charges,Behavioral Health,104.76,54,,104.76,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,97,50,,97,percent of total billed charges,Behavioral Health,104,,,104,Other,186% of Medicaid,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,155.2,80,,155.2,percent of total billed charges,All Other,135.8,70,,135.8,percent of total billed charges,,126.1,65,,126.1,percent of total billed charges,Behavioral Health,126.1,65,,126.1,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,0.01,357,
GROUP THRPY PARTIAL HOSP 45-50-TH,G0410,HCPCS,GT,40100003,CDM,915,RC,,,both,,,194,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,126.1,65,,126.1,percent of total billed charges,All Other,114.46,59,,114.46,percent of total billed charges,All Other,120.28,62,,120.28,percent of total billed charges,Behavioral Health,108.64,56,,108.64,percent of total billed charges,Behavioral Health,104.76,54,,104.76,percent of total billed charges,Behavioral Health,357,,,357,Case Rate,,97,50,,97,percent of total billed charges,Behavioral Health,104,,,104,Other,186% of Medicaid,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,97,50,,97,percent of total billed charges,Behavioral Health,155.2,80,,155.2,percent of total billed charges,All Other,135.8,70,,135.8,percent of total billed charges,,126.1,65,,126.1,percent of total billed charges,Behavioral Health,126.1,65,,126.1,percent of total billed charges,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,0.01,,,0.01,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,0.01,357,
FAMILY THERAPY WO PT,90846,CPT,,36090846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
IOP FAMILY THERAPY WO PT,90846,CPT,,36190846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
TH-IOP FAMILY THERAPY WO PT,90846,CPT,95,36490846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
TH-IOP FAMILY THERAPY WO PT,90846,CPT,95,36590846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
FAMILY THERAPY WO PT,90846,CPT,,37090846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
IOP FAMILY THERAPY WO PT,90846,CPT,,37190846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
TH-FAMILY THERAPY WO PT,90846,CPT,95,37490846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
IOP FAMILY THERAPY WO PT- TH,90846,CPT,95,37590846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
ADOL FAMILY THERAPY WO PT,90846,CPT,,39090846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
ADOL FAMILY THERAPY WO PT-TH,90846,CPT,95,39190846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
FAMILY THERAPY WO PT,90846,CPT,,40090846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
FAMILY THERAPY WO PT-TH,90846,CPT,95,40190846,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,151.79,,,151.79,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,151.79,,,151.79,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,148,,,148,Fee Schedule,Behavioral Health,126,,,126,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
FAMILY THERAPY W PT,90847,CPT,,36090847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
IOP FAMILY THERAPY W PT,90847,CPT,,36190847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
IOP FAMILY THERAPY W PT-TH,90847,CPT,95,36590847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
FAMILY THERAPY W PT,90847,CPT,,37090847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
IOP FAMILY THERAPY W PT,90847,CPT,,37190847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
IOP FAMILY THERAPY W PT- TH,90847,CPT,95,37590847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
FAMILY THERAPY W PT,90847,CPT,,38090847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
ADOL FAMILY THERAPY W PT,90847,CPT,,39090847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
ADOL FAMILY THERAPY W PT-TH,90847,CPT,95,39190847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
FAMILY THERAPY W PT,90847,CPT,,40090847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
FAMILY THERAPY W PT-TH,90847,CPT,95,40190847,CDM,916,RC,,,both,,,466,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,302.9,65,,302.9,percent of total billed charges,All Other,274.94,59,,274.94,percent of total billed charges,All Other,169,,,169,Fee Schedule,Behavioral Health,152,,,152,Fee Schedule,Behavioral Health,144,,,144,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,158.52,,,158.52,Fee Schedule,Behavioral Health,188,,,188,Other,186% of Medicaid,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,158.52,,,158.52,Fee Schedule,Behavioral Health,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,170,,,170,Fee Schedule,Behavioral Health,145,,,145,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,105.22,,,105.22,Fee Schedule,Behavioral Health,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,101.27,372.8,
MULTI FAMILY GROUP THERAPY,90849,CPT,,40090849,CDM,916,RC,,,both,,,329,288.1,,,288.1,Other,150% of Medicare + 9.63% HCRA Surcharge,175.2,,,175.2,Other,Medicare OPPS,213.85,65,,213.85,percent of total billed charges,All Other,194.11,59,,194.11,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,124,,,124,Fee Schedule,,46.14,,,46.14,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,46.14,,,46.14,Fee Schedule,Behavioral Health,46.14,,,46.14,Fee Schedule,Behavioral Health,46.14,,,,Fee Schedule,Behavioral Health,46.14,,,46.14,Fee Schedule,Behavioral Health,46.14,,,46.14,Fee Schedule,Behavioral Health,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,39.99,,,39.99,Other,130% of Medicare,39.99,,,39.99,Other,130% of Medicare,62.67,,,62.67,Fee Schedule,Behavioral Health,62.67,,,62.67,Fee Schedule,Behavioral Health,62.67,,,62.67,Fee Schedule,Behavioral Health,62.67,,,62.67,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,39.99,288.1,
ADOL GROUP THERAPY-TH,90853,CPT,GT,39190853,CDM,916,RC,,,both,,,210,161.07,,,161.07,Other,150% of Medicare + 9.63% HCRA Surcharge,97.95,,,97.95,Other,Medicare OPPS,136.5,65,,136.5,percent of total billed charges,All Other,123.9,59,,123.9,percent of total billed charges,All Other,141,,,141,Fee Schedule,Behavioral Health,127,,,127,Fee Schedule,Behavioral Health,120,,,120,Fee Schedule,Behavioral Health,81,,,81,Fee Schedule,,37.44,,,37.44,Fee Schedule,Behavioral Health,104,,,104,Other,186% of Medicaid,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,37.44,,,37.44,Fee Schedule,Behavioral Health,168,80,,168,percent of total billed charges,All Other,147,70,,147,percent of total billed charges,,103,,,103,Fee Schedule,Behavioral Health,88,,,88,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,63.36,,,63.36,Fee Schedule,Behavioral Health,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,55.92,,,55.92,Other,100% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,85.56,,,85.56,Other,153% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,78.29,,,78.29,Other,140% of Medicaid,125.82,,,125.82,Other,225% of Medicaid,145.4,,,145.4,Other,250% of Medicaid,181.19,,,181.19,Other,324% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,120.23,,,120.23,Other,215% of Medicaid,69.9,,,69.9,Other,125% of Medicaid,37.44,181.19,
FETAL CONTRACTION STRESS TEST,59020,CPT,,26059020,CDM,920,RC,,,both,,,667,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS,121.48,,,121.48,Fee Schedule,,109.29,,,109.29,Fee Schedule,,510.26,76.5,,510.26,percent of total billed charges,All Other,460.23,69,,460.23,percent of total billed charges,All Other,433.55,65,,433.55,percent of total billed charges,All Other,466.9,70,,466.9,percent of total billed charges,All Other,144.32,,,144.32,Fee Schedule,,594,,,594,Other,186% of Medicaid,169.84,,,169.84,Fee Schedule,,413.54,,,413.54,Fee Schedule,,79.97,,,,Fee Schedule,,169.84,,,169.84,Fee Schedule,,413.54,,,413.54,Fee Schedule,,533.6,80,,533.6,percent of total billed charges,All Other,466.9,70,,466.9,percent of total billed charges,,162.36,,,162.36,Fee Schedule,,137.61,,,137.61,Fee Schedule,,333.5,,,333.5,Case Rate,,333.5,,,333.5,Case Rate,,333.5,,,333.5,Case Rate,,333.5,,,333.5,Case Rate,,319.27,,,319.27,Other,100% of Medicaid,319.27,,,319.27,Other,100% of Medicaid,319.27,,,319.27,Other,100% of Medicaid,319.27,,,319.27,Other,100% of Medicaid,718.36,,,718.36,Other,225% of Medicaid,488.48,,,488.48,Other,153% of Medicaid,718.36,,,718.36,Other,225% of Medicaid,446.98,,,446.98,Other,140% of Medicaid,718.36,,,718.36,Other,225% of Medicaid,830.1,,,830.1,Other,250% of Medicaid,1034.43,,,1034.43,Other,324% of Medicaid,686.43,,,686.43,Other,215% of Medicaid,686.43,,,686.43,Other,215% of Medicaid,399.09,,,399.09,Other,125% of Medicaid,79.97,1034.43,
FETAL NON-STRESS TEST,59025,CPT,,26059025,CDM,920,RC,,,both,,,408,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS,70.63,,,70.63,Fee Schedule,,63.54,,,63.54,Fee Schedule,,121.44,,,121.44,Fee Schedule,,109.25,,,109.25,Fee Schedule,,103.27,,,103.27,Fee Schedule,,285.6,70,,285.6,percent of total billed charges,All Other,83.91,,,83.91,Fee Schedule,,594,,,594,Other,186% of Medicaid,98.74,,,98.74,Fee Schedule,,252.96,,,252.96,Fee Schedule,,46.49,,,,Fee Schedule,,98.74,,,98.74,Fee Schedule,,252.96,,,252.96,Fee Schedule,,326.4,80,,326.4,percent of total billed charges,All Other,285.6,70,,285.6,percent of total billed charges,,95.12,,,95.12,Fee Schedule,,80.62,,,80.62,Fee Schedule,,204,,,204,Case Rate,,204,,,204,Case Rate,,204,,,204,Case Rate,,204,,,204,Case Rate,,319.27,,,319.27,Other,100% of Medicaid,319.27,,,319.27,Other,100% of Medicaid,319.27,,,319.27,Other,100% of Medicaid,319.27,,,319.27,Other,100% of Medicaid,718.36,,,718.36,Other,225% of Medicaid,488.48,,,488.48,Other,153% of Medicaid,718.36,,,718.36,Other,225% of Medicaid,446.98,,,446.98,Other,140% of Medicaid,718.36,,,718.36,Other,225% of Medicaid,830.1,,,830.1,Other,250% of Medicaid,1034.43,,,1034.43,Other,324% of Medicaid,686.43,,,686.43,Other,215% of Medicaid,686.43,,,686.43,Other,215% of Medicaid,399.09,,,399.09,Other,125% of Medicaid,46.49,1034.43,
ELECTRO-OCULOGRAPHY W INT & REP,92270,CPT,,66092270,CDM,920,RC,,,both,,,270,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,243.91,,,243.91,Fee Schedule,,219.93,,,219.93,Fee Schedule,,310.05,,,310.05,Fee Schedule,,279.1,,,279.1,Fee Schedule,,263.63,,,263.63,Fee Schedule,,189,70,,189,percent of total billed charges,All Other,313.36,,,313.36,Fee Schedule,,153,,,153,Other,186% of Medicaid,368.75,,,368.75,Fee Schedule,,167.4,,,167.4,Fee Schedule,,173.63,,,,Fee Schedule,,368.75,,,368.75,Fee Schedule,,167.4,,,167.4,Fee Schedule,,326.59,,,326.59,Fee Schedule,,189,70,,189,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,135,,,135,Case Rate,,135,,,135,Case Rate,,135,,,135,Case Rate,,135,,,135,Case Rate,,82.31,,,82.31,Other,100% of Medicaid,82.31,,,82.31,Other,100% of Medicaid,82.31,,,82.31,Other,100% of Medicaid,82.31,,,82.31,Other,100% of Medicaid,185.19,,,185.19,Other,225% of Medicaid,125.93,,,125.93,Other,153% of Medicaid,185.19,,,185.19,Other,225% of Medicaid,115.23,,,115.23,Other,140% of Medicaid,185.19,,,185.19,Other,225% of Medicaid,214,,,214,Other,250% of Medicaid,266.67,,,266.67,Other,324% of Medicaid,176.96,,,176.96,Other,215% of Medicaid,176.96,,,176.96,Other,215% of Medicaid,102.88,,,102.88,Other,125% of Medicaid,82.31,368.75,
DUPLX VENOUS BILAT,93970,CPT,TC,44093970,CDM,920,RC,,,both,,,2036,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,496.19,,,496.19,Fee Schedule,,447.41,,,447.41,Fee Schedule,,1073.26,,,1073.26,Fee Schedule,,965.54,,,965.54,Fee Schedule,,912.66,,,912.66,Fee Schedule,,1425.2,70,,1425.2,percent of total billed charges,All Other,1384.48,68,,1384.48,percent of total billed charges,All Other,996,,,996,Other,186% of Medicaid,1628.8,80,,1628.8,percent of total billed charges,All Other,1689.88,83,,1689.88,percent of total billed charges,All Other,1689.88,83,,1689.88,percent of total billed charges,All Other,1628.8,80,,1628.8,percent of total billed charges,All Other,1689.88,83,,1689.88,percent of total billed charges,All Other,1628.8,80,,1628.8,percent of total billed charges,All Other,1425.2,70,,1425.2,percent of total billed charges,,765.88,,,765.88,Fee Schedule,,649.13,,,649.13,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,269.26,1734.3,
VENOUS DOPPLER UNILATERAL LT,93971,CPT,TCLT,44193971,CDM,920,RC,,,both,,,1360,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,315.47,,,315.47,Fee Schedule,,284.46,,,284.46,Fee Schedule,,675.9,,,675.9,Fee Schedule,,608.07,,,608.07,Fee Schedule,,574.76,,,574.76,Fee Schedule,,952,70,,952,percent of total billed charges,All Other,924.8,68,,924.8,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,1088,80,,1088,percent of total billed charges,All Other,1128.8,83,,1128.8,percent of total billed charges,All Other,1128.8,83,,1128.8,percent of total billed charges,All Other,1088,80,,1088,percent of total billed charges,All Other,1128.8,83,,1128.8,percent of total billed charges,All Other,1088,80,,1088,percent of total billed charges,All Other,952,70,,952,percent of total billed charges,,485.44,,,485.44,Fee Schedule,,411.44,,,411.44,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,1128.8,
VENOUS DOPPLER UNILATERAL RT,93971,CPT,TCRT,44293971,CDM,920,RC,,,both,,,1360,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,315.47,,,315.47,Fee Schedule,,284.46,,,284.46,Fee Schedule,,675.9,,,675.9,Fee Schedule,,608.07,,,608.07,Fee Schedule,,574.76,,,574.76,Fee Schedule,,952,70,,952,percent of total billed charges,All Other,924.8,68,,924.8,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,1088,80,,1088,percent of total billed charges,All Other,1128.8,83,,1128.8,percent of total billed charges,All Other,1128.8,83,,1128.8,percent of total billed charges,All Other,1088,80,,1088,percent of total billed charges,All Other,1128.8,83,,1128.8,percent of total billed charges,All Other,1088,80,,1088,percent of total billed charges,All Other,952,70,,952,percent of total billed charges,,485.44,,,485.44,Fee Schedule,,411.44,,,411.44,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,1128.8,
US AORTA DUPLEX COMPLETE,93978,CPT,TC,44093978,CDM,920,RC,,,both,,,1632,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,458.78,,,458.78,Fee Schedule,,413.68,,,413.68,Fee Schedule,,1073.26,,,1073.26,Fee Schedule,,965.54,,,965.54,Fee Schedule,,912.66,,,912.66,Fee Schedule,,1142.4,70,,1142.4,percent of total billed charges,All Other,1109.76,68,,1109.76,percent of total billed charges,All Other,996,,,996,Other,186% of Medicaid,1305.6,80,,1305.6,percent of total billed charges,All Other,1354.56,83,,1354.56,percent of total billed charges,All Other,1354.56,83,,1354.56,percent of total billed charges,All Other,1305.6,80,,1305.6,percent of total billed charges,All Other,1354.56,83,,1354.56,percent of total billed charges,All Other,1305.6,80,,1305.6,percent of total billed charges,All Other,1142.4,70,,1142.4,percent of total billed charges,,708.48,,,708.48,Fee Schedule,,600.48,,,600.48,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,269.26,1734.3,
US AORTA DUPLEX UNIL OR LTD,93979,CPT,TC,44093979,CDM,920,RC,,,both,,,746,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,303.73,,,303.73,Fee Schedule,,273.87,,,273.87,Fee Schedule,,675.9,,,675.9,Fee Schedule,,608.07,,,608.07,Fee Schedule,,574.76,,,574.76,Fee Schedule,,522.2,70,,522.2,percent of total billed charges,All Other,507.28,68,,507.28,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,596.8,80,,596.8,percent of total billed charges,All Other,619.18,83,,619.18,percent of total billed charges,All Other,619.18,83,,619.18,percent of total billed charges,All Other,596.8,80,,596.8,percent of total billed charges,All Other,619.18,83,,619.18,percent of total billed charges,All Other,596.8,80,,596.8,percent of total billed charges,All Other,522.2,70,,522.2,percent of total billed charges,,465.76,,,465.76,Fee Schedule,,394.76,,,394.76,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,811,
CONT GLUC MNTR PT PROV EQP,95249,CPT,,70095249,CDM,920,RC,,,both,,,194,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,227.13,,,227.13,Fee Schedule,,204.34,,,204.34,Fee Schedule,,148.41,76.5,,148.41,percent of total billed charges,All Other,133.86,69,,133.86,percent of total billed charges,All Other,126.1,65,,126.1,percent of total billed charges,All Other,135.8,70,,135.8,percent of total billed charges,All Other,269.85,,,269.85,Fee Schedule,,0.01,,,0.01,Other,186% of Medicaid,317.55,,,317.55,Fee Schedule,,120.28,,,120.28,Fee Schedule,,149.52,,,,Fee Schedule,,317.55,,,317.55,Fee Schedule,,120.28,,,120.28,Fee Schedule,,155.2,80,,155.2,percent of total billed charges,All Other,135.8,70,,135.8,percent of total billed charges,,283.72,,,283.72,Fee Schedule,,240.47,,,240.47,Fee Schedule,,97,,,97,Case Rate,,97,,,97,Case Rate,,97,,,97,Case Rate,,97,,,97,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,317.55,
GLUCOSE MONITORING CONT 72+ HRS,95250,CPT,,70095250,CDM,920,RC,,,both,,,1068,238.87,,,238.87,Other,150% of Medicare + 9.63% HCRA Surcharge,145.26,,,145.26,Other,Medicare OPPS,512.47,,,512.47,Fee Schedule,,461.07,,,461.07,Fee Schedule,,1037.58,,,1037.58,Fee Schedule,,933.45,,,933.45,Fee Schedule,,882.32,,,882.32,Fee Schedule,,747.6,70,,747.6,percent of total billed charges,All Other,608.86,,,608.86,Fee Schedule,,299,,,299,Other,186% of Medicaid,716.5,,,716.5,Fee Schedule,,662.16,,,662.16,Fee Schedule,,337.37,,,,Fee Schedule,,716.5,,,716.5,Fee Schedule,,662.16,,,662.16,Fee Schedule,,854.4,80,,854.4,percent of total billed charges,All Other,747.6,70,,747.6,percent of total billed charges,,718.32,,,718.32,Fee Schedule,,608.82,,,608.82,Fee Schedule,,534,,,534,Case Rate,,534,,,534,Case Rate,,534,,,534,Case Rate,,534,,,534,Case Rate,,160.56,,,160.56,Other,100% of Medicaid,160.56,,,160.56,Other,100% of Medicaid,160.56,,,160.56,Other,100% of Medicaid,160.56,,,160.56,Other,100% of Medicaid,361.25,,,361.25,Other,225% of Medicaid,245.65,,,245.65,Other,153% of Medicaid,361.25,,,361.25,Other,225% of Medicaid,224.78,,,224.78,Other,140% of Medicaid,361.25,,,361.25,Other,225% of Medicaid,417.45,,,417.45,Other,250% of Medicaid,520.21,,,520.21,Other,324% of Medicaid,345.2,,,345.2,Other,215% of Medicaid,345.2,,,345.2,Other,215% of Medicaid,200.7,,,200.7,Other,125% of Medicaid,145.26,1037.58,
POLYSOM <6 YRS 4> PARAMTRS,95782,CPT,,72095782,CDM,920,RC,,,both,,,2304,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,761.82,,,761.82,Fee Schedule,,761.82,,,761.82,Fee Schedule,,761.82,,,761.82,Fee Schedule,,1612.8,70,,1612.8,percent of total billed charges,All Other,1566.72,68,,1566.72,percent of total billed charges,All Other,1329,,,1329,Other,186% of Medicaid,1843.2,80,,1843.2,percent of total billed charges,All Other,1912.32,83,,1912.32,percent of total billed charges,All Other,1912.32,83,,1912.32,percent of total billed charges,All Other,1843.2,80,,1843.2,percent of total billed charges,All Other,1912.32,83,,1912.32,percent of total billed charges,All Other,1843.2,80,,1843.2,percent of total billed charges,All Other,1612.8,70,,1612.8,percent of total billed charges,,3986.84,,,3986.84,Fee Schedule,,3379.09,,,3379.09,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1093.52,,,1093.52,Other,153% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1000.6,,,1000.6,Other,140% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1858.26,,,1858.26,Other,250% of Medicaid,2315.68,,,2315.68,Other,324% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,893.4,,,893.4,Other,125% of Medicaid,714.72,3986.84,
POLYSOM <6 YRS 4> PARAMTRS <7 HOURS,95782,CPT,52,72195782,CDM,920,RC,,,both,,,1844,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,761.82,,,761.82,Fee Schedule,,761.82,,,761.82,Fee Schedule,,761.82,,,761.82,Fee Schedule,,1290.8,70,,1290.8,percent of total billed charges,All Other,1253.92,68,,1253.92,percent of total billed charges,All Other,1329,,,1329,Other,186% of Medicaid,1475.2,80,,1475.2,percent of total billed charges,All Other,1530.52,83,,1530.52,percent of total billed charges,All Other,1530.52,83,,1530.52,percent of total billed charges,All Other,1475.2,80,,1475.2,percent of total billed charges,All Other,1530.52,83,,1530.52,percent of total billed charges,All Other,1475.2,80,,1475.2,percent of total billed charges,All Other,1290.8,70,,1290.8,percent of total billed charges,,3986.84,,,3986.84,Fee Schedule,,3379.09,,,3379.09,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1093.52,,,1093.52,Other,153% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1000.6,,,1000.6,Other,140% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1858.26,,,1858.26,Other,250% of Medicaid,2315.68,,,2315.68,Other,324% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,893.4,,,893.4,Other,125% of Medicaid,714.72,3986.84,
POLYSOM <6 YRS CPAP/BILVL,95783,CPT,,72095783,CDM,920,RC,,,both,,,2466,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,809.78,,,809.78,Fee Schedule,,809.78,,,809.78,Fee Schedule,,809.78,,,809.78,Fee Schedule,,1726.2,70,,1726.2,percent of total billed charges,All Other,1676.88,68,,1676.88,percent of total billed charges,All Other,1329,,,1329,Other,186% of Medicaid,1972.8,80,,1972.8,percent of total billed charges,All Other,2046.78,83,,2046.78,percent of total billed charges,All Other,2046.78,83,,2046.78,percent of total billed charges,All Other,1972.8,80,,1972.8,percent of total billed charges,All Other,2046.78,83,,2046.78,percent of total billed charges,All Other,1972.8,80,,1972.8,percent of total billed charges,All Other,1726.2,70,,1726.2,percent of total billed charges,,4204.96,,,4204.96,Fee Schedule,,3563.96,,,3563.96,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1093.52,,,1093.52,Other,153% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1000.6,,,1000.6,Other,140% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1858.26,,,1858.26,Other,250% of Medicaid,2315.68,,,2315.68,Other,324% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,893.4,,,893.4,Other,125% of Medicaid,714.72,4204.96,
POLYSOM <6 YRS CPAP/BILVL <7 HOURS,95783,CPT,52,72195783,CDM,920,RC,,,both,,,1973,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,809.78,,,809.78,Fee Schedule,,809.78,,,809.78,Fee Schedule,,809.78,,,809.78,Fee Schedule,,1381.1,70,,1381.1,percent of total billed charges,All Other,1341.64,68,,1341.64,percent of total billed charges,All Other,1329,,,1329,Other,186% of Medicaid,1578.4,80,,1578.4,percent of total billed charges,All Other,1637.59,83,,1637.59,percent of total billed charges,All Other,1637.59,83,,1637.59,percent of total billed charges,All Other,1578.4,80,,1578.4,percent of total billed charges,All Other,1637.59,83,,1637.59,percent of total billed charges,All Other,1578.4,80,,1578.4,percent of total billed charges,All Other,1381.1,70,,1381.1,percent of total billed charges,,4204.96,,,4204.96,Fee Schedule,,3563.96,,,3563.96,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1093.52,,,1093.52,Other,153% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1000.6,,,1000.6,Other,140% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1858.26,,,1858.26,Other,250% of Medicaid,2315.68,,,2315.68,Other,324% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,893.4,,,893.4,Other,125% of Medicaid,714.72,4204.96,
MULTIPLE SLEEP LATENCY TEST,95805,CPT,,72095805,CDM,920,RC,,,both,,,4362,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,2441.83,,,2441.83,Fee Schedule,,2196.76,,,2196.76,Fee Schedule,,2076.45,,,2076.45,Fee Schedule,,3053.4,70,,3053.4,percent of total billed charges,All Other,2966.16,68,,2966.16,percent of total billed charges,All Other,1329,,,1329,Other,186% of Medicaid,3489.6,80,,3489.6,percent of total billed charges,All Other,3620.46,83,,3620.46,percent of total billed charges,All Other,3620.46,83,,3620.46,percent of total billed charges,All Other,3489.6,80,,3489.6,percent of total billed charges,All Other,3620.46,83,,3620.46,percent of total billed charges,All Other,3489.6,80,,3489.6,percent of total billed charges,All Other,3053.4,70,,3053.4,percent of total billed charges,,1748.24,,,1748.24,Fee Schedule,,1481.74,,,1481.74,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1093.52,,,1093.52,Other,153% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1000.6,,,1000.6,Other,140% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1858.26,,,1858.26,Other,250% of Medicaid,2315.68,,,2315.68,Other,324% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,893.4,,,893.4,Other,125% of Medicaid,588.97,3620.46,
SLEEP STUDY UNATT&RESP EFFT(HOME),95806,CPT,,72095806,CDM,920,RC,,,both,,,1336,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,835.54,,,835.54,Fee Schedule,,751.68,,,751.68,Fee Schedule,,710.51,,,710.51,Fee Schedule,,935.2,70,,935.2,percent of total billed charges,All Other,908.48,68,,908.48,percent of total billed charges,All Other,755,,,755,Other,186% of Medicaid,1068.8,80,,1068.8,percent of total billed charges,All Other,1108.88,83,,1108.88,percent of total billed charges,All Other,1108.88,83,,1108.88,percent of total billed charges,All Other,1068.8,80,,1068.8,percent of total billed charges,All Other,1108.88,83,,1108.88,percent of total billed charges,All Other,1068.8,80,,1068.8,percent of total billed charges,All Other,935.2,70,,935.2,percent of total billed charges,,229.6,,,229.6,Fee Schedule,,194.6,,,194.6,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,406.01,,,406.01,Other,100% of Medicaid,406.01,,,406.01,Other,100% of Medicaid,406.01,,,406.01,Other,100% of Medicaid,406.01,,,406.01,Other,100% of Medicaid,913.53,,,913.53,Other,225% of Medicaid,621.2,,,621.2,Other,153% of Medicaid,913.53,,,913.53,Other,225% of Medicaid,568.42,,,568.42,Other,140% of Medicaid,913.53,,,913.53,Other,225% of Medicaid,1055.64,,,1055.64,Other,250% of Medicaid,1315.48,,,1315.48,Other,324% of Medicaid,872.93,,,872.93,Other,215% of Medicaid,872.93,,,872.93,Other,215% of Medicaid,507.52,,,507.52,Other,125% of Medicaid,171.65,3524,
POLYSOMNOGRAPHY 4 OR MORE,95810,CPT,,72095810,CDM,920,RC,,,both,,,4362,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,3984.45,,,3984.45,Fee Schedule,,3584.55,,,3584.55,Fee Schedule,,3388.24,,,3388.24,Fee Schedule,,3053.4,70,,3053.4,percent of total billed charges,All Other,2966.16,68,,2966.16,percent of total billed charges,All Other,1329,,,1329,Other,186% of Medicaid,3489.6,80,,3489.6,percent of total billed charges,All Other,3620.46,83,,3620.46,percent of total billed charges,All Other,3620.46,83,,3620.46,percent of total billed charges,All Other,3489.6,80,,3489.6,percent of total billed charges,All Other,3620.46,83,,3620.46,percent of total billed charges,All Other,3489.6,80,,3489.6,percent of total billed charges,All Other,3053.4,70,,3053.4,percent of total billed charges,,2376.36,,,2376.36,Fee Schedule,,2014.11,,,2014.11,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1093.52,,,1093.52,Other,153% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1000.6,,,1000.6,Other,140% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1858.26,,,1858.26,Other,250% of Medicaid,2315.68,,,2315.68,Other,324% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,893.4,,,893.4,Other,125% of Medicaid,714.72,3984.45,
REDUCED POLYSOMOGRAPHY,95810,CPT,52,72195810,CDM,920,RC,,,both,,,3490,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,3984.45,,,3984.45,Fee Schedule,,3584.55,,,3584.55,Fee Schedule,,3388.24,,,3388.24,Fee Schedule,,2443,70,,2443,percent of total billed charges,All Other,2373.2,68,,2373.2,percent of total billed charges,All Other,1329,,,1329,Other,186% of Medicaid,2792,80,,2792,percent of total billed charges,All Other,2896.7,83,,2896.7,percent of total billed charges,All Other,2896.7,83,,2896.7,percent of total billed charges,All Other,2792,80,,2792,percent of total billed charges,All Other,2896.7,83,,2896.7,percent of total billed charges,All Other,2792,80,,2792,percent of total billed charges,All Other,2443,70,,2443,percent of total billed charges,,2376.36,,,2376.36,Fee Schedule,,2014.11,,,2014.11,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1093.52,,,1093.52,Other,153% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1000.6,,,1000.6,Other,140% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1858.26,,,1858.26,Other,250% of Medicaid,2315.68,,,2315.68,Other,324% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,893.4,,,893.4,Other,125% of Medicaid,714.72,3984.45,
POLYSOMNOGRAPHY WITH CPAP,95811,CPT,,72095811,CDM,920,RC,,,both,,,4362,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,4329.64,,,4329.64,Fee Schedule,,3895.09,,,3895.09,Fee Schedule,,3681.77,,,3681.77,Fee Schedule,,3053.4,70,,3053.4,percent of total billed charges,All Other,2966.16,68,,2966.16,percent of total billed charges,All Other,1329,,,1329,Other,186% of Medicaid,3489.6,80,,3489.6,percent of total billed charges,All Other,3620.46,83,,3620.46,percent of total billed charges,All Other,3620.46,83,,3620.46,percent of total billed charges,All Other,3489.6,80,,3489.6,percent of total billed charges,All Other,3620.46,83,,3620.46,percent of total billed charges,All Other,3489.6,80,,3489.6,percent of total billed charges,All Other,3053.4,70,,3053.4,percent of total billed charges,,2484.6,,,2484.6,Fee Schedule,,2105.85,,,2105.85,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1093.52,,,1093.52,Other,153% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1000.6,,,1000.6,Other,140% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1858.26,,,1858.26,Other,250% of Medicaid,2315.68,,,2315.68,Other,324% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,893.4,,,893.4,Other,125% of Medicaid,714.72,4329.64,
REDUCED POLYSOMNOGRAPHY WITH CPAP,95811,CPT,52,72195811,CDM,920,RC,,,both,,,3490,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS,2882,,,2882,Case Rate,Sleep Study,2594,,,2594,Case Rate,Sleep Study,4329.64,,,4329.64,Fee Schedule,,3895.09,,,3895.09,Fee Schedule,,3681.77,,,3681.77,Fee Schedule,,2443,70,,2443,percent of total billed charges,All Other,2373.2,68,,2373.2,percent of total billed charges,All Other,1329,,,1329,Other,186% of Medicaid,2792,80,,2792,percent of total billed charges,All Other,2896.7,83,,2896.7,percent of total billed charges,All Other,2896.7,83,,2896.7,percent of total billed charges,All Other,2792,80,,2792,percent of total billed charges,All Other,2896.7,83,,2896.7,percent of total billed charges,All Other,2792,80,,2792,percent of total billed charges,All Other,2443,70,,2443,percent of total billed charges,,2484.6,,,2484.6,Fee Schedule,,2105.85,,,2105.85,Fee Schedule,,3524,,,3524,Case Rate,Sleep Study,3171,,,3171,Case Rate,Sleep Study,3524,,,3524,Case Rate,Sleep Study,2995,,,2995,Case Rate,Sleep Study,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,714.72,,,714.72,Other,100% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1093.52,,,1093.52,Other,153% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1000.6,,,1000.6,Other,140% of Medicaid,1608.11,,,1608.11,Other,225% of Medicaid,1858.26,,,1858.26,Other,250% of Medicaid,2315.68,,,2315.68,Other,324% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,1536.64,,,1536.64,Other,215% of Medicaid,893.4,,,893.4,Other,125% of Medicaid,714.72,4329.64,
SAFE PASSAGE NEURO MONITORING PER 15 MIN,95955,CPT,,79006693,CDM,920,RC,,,both,,,728,287.32,39.4668,,287.32,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,479.62,,,479.62,Fee Schedule,,431.5,,,431.5,Fee Schedule,,823.42,,,823.42,Fee Schedule,,740.78,,,740.78,Fee Schedule,,700.21,,,700.21,Fee Schedule,,509.6,70,,509.6,percent of total billed charges,All Other,569.83,,,569.83,Fee Schedule,,287,,,287,Other,186% of Medicaid,670.56,,,670.56,Fee Schedule,,451.36,,,451.36,Fee Schedule,,315.74,,,,Fee Schedule,,670.56,,,670.56,Fee Schedule,,451.36,,,451.36,Fee Schedule,,582.4,80,,582.4,percent of total billed charges,All Other,509.6,70,,509.6,percent of total billed charges,,739.64,,,739.64,Fee Schedule,,626.89,,,626.89,Fee Schedule,,906,,,906,Case Rate,,816,,,816,Case Rate,,906,,,906,Case Rate,,770,,,770,Case Rate,,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,154.29,,,154.29,Other,100% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,236.06,,,236.06,Other,153% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,216,,,216,Other,140% of Medicaid,347.15,,,347.15,Other,225% of Medicaid,401.15,,,401.15,Other,250% of Medicaid,499.9,,,499.9,Other,324% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,331.72,,,331.72,Other,215% of Medicaid,192.86,,,192.86,Other,125% of Medicaid,0.01,906,
DUPLX EXTRACRANIAL  BILAT,93880,CPT,TC,44093880,CDM,921,RC,,,both,,,2002,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,489.79,,,489.79,Fee Schedule,,441.64,,,441.64,Fee Schedule,,1073.26,,,1073.26,Fee Schedule,,965.54,,,965.54,Fee Schedule,,912.66,,,912.66,Fee Schedule,,1401.4,70,,1401.4,percent of total billed charges,All Other,1361.36,68,,1361.36,percent of total billed charges,All Other,996,,,996,Other,186% of Medicaid,1601.6,80,,1601.6,percent of total billed charges,All Other,1661.66,83,,1661.66,percent of total billed charges,All Other,1661.66,83,,1661.66,percent of total billed charges,All Other,1601.6,80,,1601.6,percent of total billed charges,All Other,1661.66,83,,1661.66,percent of total billed charges,All Other,1601.6,80,,1601.6,percent of total billed charges,All Other,1401.4,70,,1401.4,percent of total billed charges,,757.68,,,757.68,Fee Schedule,,642.18,,,642.18,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,269.26,1734.3,
DUPLX EXTRACRANIAL UNILAT,93882,CPT,TC,44093882,CDM,921,RC,,,both,,,873,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,325.09,,,325.09,Fee Schedule,,293.13,,,293.13,Fee Schedule,,1070.9,,,1070.9,Fee Schedule,,963.42,,,963.42,Fee Schedule,,910.66,,,910.66,Fee Schedule,,611.1,70,,611.1,percent of total billed charges,All Other,593.64,68,,593.64,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,698.4,80,,698.4,percent of total billed charges,All Other,724.59,83,,724.59,percent of total billed charges,All Other,724.59,83,,724.59,percent of total billed charges,All Other,698.4,80,,698.4,percent of total billed charges,All Other,724.59,83,,724.59,percent of total billed charges,All Other,698.4,80,,698.4,percent of total billed charges,All Other,611.1,70,,611.1,percent of total billed charges,,500.2,,,500.2,Fee Schedule,,423.95,,,423.95,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,1070.9,
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,,34093922,CDM,921,RC,,,both,,,706,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,226.8,,,226.8,Fee Schedule,,204.5,,,204.5,Fee Schedule,,687.79,,,687.79,Fee Schedule,,618.76,,,618.76,Fee Schedule,,584.88,,,584.88,Fee Schedule,,494.2,70,,494.2,percent of total billed charges,All Other,480.08,68,,480.08,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,564.8,80,,564.8,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,564.8,80,,564.8,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,564.8,80,,564.8,percent of total billed charges,All Other,494.2,70,,494.2,percent of total billed charges,,342.76,,,342.76,Fee Schedule,,290.51,,,290.51,Fee Schedule,,353,,,353,Case Rate,,353,,,353,Case Rate,,353,,,353,Case Rate,,353,,,353,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,129.13,687.79,
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,TC,44093922,CDM,921,RC,,,both,,,706,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,226.8,,,226.8,Fee Schedule,,204.5,,,204.5,Fee Schedule,,687.79,,,687.79,Fee Schedule,,618.76,,,618.76,Fee Schedule,,584.88,,,584.88,Fee Schedule,,494.2,70,,494.2,percent of total billed charges,All Other,480.08,68,,480.08,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,564.8,80,,564.8,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,564.8,80,,564.8,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,564.8,80,,564.8,percent of total billed charges,All Other,494.2,70,,494.2,percent of total billed charges,,342.76,,,342.76,Fee Schedule,,290.51,,,290.51,Fee Schedule,,353,,,353,Case Rate,,353,,,353,Case Rate,,353,,,353,Case Rate,,353,,,353,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,129.13,687.79,
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,,73093922,CDM,921,RC,,,both,,,706,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,226.8,,,226.8,Fee Schedule,,204.5,,,204.5,Fee Schedule,,687.79,,,687.79,Fee Schedule,,618.76,,,618.76,Fee Schedule,,584.88,,,584.88,Fee Schedule,,494.2,70,,494.2,percent of total billed charges,All Other,480.08,68,,480.08,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,564.8,80,,564.8,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,564.8,80,,564.8,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,564.8,80,,564.8,percent of total billed charges,All Other,494.2,70,,494.2,percent of total billed charges,,342.76,,,342.76,Fee Schedule,,290.51,,,290.51,Fee Schedule,,353,,,353,Case Rate,,353,,,353,Case Rate,,353,,,353,Case Rate,,353,,,353,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,129.13,687.79,
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,,74093922,CDM,921,RC,,,both,,,706,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,226.8,,,226.8,Fee Schedule,,204.5,,,204.5,Fee Schedule,,687.79,,,687.79,Fee Schedule,,618.76,,,618.76,Fee Schedule,,584.88,,,584.88,Fee Schedule,,494.2,70,,494.2,percent of total billed charges,All Other,480.08,68,,480.08,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,564.8,80,,564.8,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,564.8,80,,564.8,percent of total billed charges,All Other,585.98,83,,585.98,percent of total billed charges,All Other,564.8,80,,564.8,percent of total billed charges,All Other,494.2,70,,494.2,percent of total billed charges,,342.76,,,342.76,Fee Schedule,,290.51,,,290.51,Fee Schedule,,353,,,353,Case Rate,,353,,,353,Case Rate,,353,,,353,Case Rate,,353,,,353,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,129.13,687.79,
EXTREM PVR BILATERAL,93923,CPT,TC,44093923,CDM,921,RC,,,both,,,1054,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,349.81,,,349.81,Fee Schedule,,315.42,,,315.42,Fee Schedule,,1037.58,,,1037.58,Fee Schedule,,933.45,,,933.45,Fee Schedule,,882.32,,,882.32,Fee Schedule,,737.8,70,,737.8,percent of total billed charges,All Other,716.72,68,,716.72,percent of total billed charges,All Other,269,,,269,Other,186% of Medicaid,843.2,80,,843.2,percent of total billed charges,All Other,874.82,83,,874.82,percent of total billed charges,All Other,874.82,83,,874.82,percent of total billed charges,All Other,843.2,80,,843.2,percent of total billed charges,All Other,874.82,83,,874.82,percent of total billed charges,All Other,843.2,80,,843.2,percent of total billed charges,All Other,737.8,70,,737.8,percent of total billed charges,,523.16,,,523.16,Fee Schedule,,443.41,,,443.41,Fee Schedule,,527,,,527,Case Rate,,527,,,527,Case Rate,,527,,,527,Case Rate,,527,,,527,Case Rate,,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,221.52,,,221.52,Other,153% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,202.7,,,202.7,Other,140% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,376.44,,,376.44,Other,250% of Medicaid,469.11,,,469.11,Other,324% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,180.98,,,180.98,Other,125% of Medicaid,144.79,1037.58,
PVR W STRESS BILAT COMPL,93924,CPT,TC,44093924,CDM,921,RC,,,both,,,1343,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,438.49,,,438.49,Fee Schedule,,395.38,,,395.38,Fee Schedule,,1318.38,,,1318.38,Fee Schedule,,1186.06,,,1186.06,Fee Schedule,,1121.1,,,1121.1,Fee Schedule,,940.1,70,,940.1,percent of total billed charges,All Other,913.24,68,,913.24,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,1074.4,80,,1074.4,percent of total billed charges,All Other,1114.69,83,,1114.69,percent of total billed charges,All Other,1114.69,83,,1114.69,percent of total billed charges,All Other,1074.4,80,,1074.4,percent of total billed charges,All Other,1114.69,83,,1114.69,percent of total billed charges,All Other,1074.4,80,,1074.4,percent of total billed charges,All Other,940.1,70,,940.1,percent of total billed charges,,659.28,,,659.28,Fee Schedule,,558.78,,,558.78,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,129.13,1318.38,
DUPLEX LE ART/BPG; BILAT,93925,CPT,TC,44093925,CDM,921,RC,,,both,,,2012,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,652.33,,,652.33,Fee Schedule,,588.21,,,588.21,Fee Schedule,,1073.37,,,1073.37,Fee Schedule,,965.64,,,965.64,Fee Schedule,,912.75,,,912.75,Fee Schedule,,1408.4,70,,1408.4,percent of total billed charges,All Other,1368.16,68,,1368.16,percent of total billed charges,All Other,996,,,996,Other,186% of Medicaid,1609.6,80,,1609.6,percent of total billed charges,All Other,1669.96,83,,1669.96,percent of total billed charges,All Other,1669.96,83,,1669.96,percent of total billed charges,All Other,1609.6,80,,1609.6,percent of total billed charges,All Other,1669.96,83,,1669.96,percent of total billed charges,All Other,1609.6,80,,1609.6,percent of total billed charges,All Other,1408.4,70,,1408.4,percent of total billed charges,,1011.88,,,1011.88,Fee Schedule,,857.63,,,857.63,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,269.26,1734.3,
DUPLEX LE ART/BPG; UNIL/LIMIT,93926,CPT,TC,44093926,CDM,921,RC,,,both,,,1167,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,342.35,,,342.35,Fee Schedule,,308.69,,,308.69,Fee Schedule,,675.9,,,675.9,Fee Schedule,,608.07,,,608.07,Fee Schedule,,574.76,,,574.76,Fee Schedule,,816.9,70,,816.9,percent of total billed charges,All Other,793.56,68,,793.56,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,933.6,80,,933.6,percent of total billed charges,All Other,968.61,83,,968.61,percent of total billed charges,All Other,968.61,83,,968.61,percent of total billed charges,All Other,933.6,80,,933.6,percent of total billed charges,All Other,968.61,83,,968.61,percent of total billed charges,All Other,933.6,80,,933.6,percent of total billed charges,All Other,816.9,70,,816.9,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,968.61,
DUPLX LE ART UNILAT LT,93926,CPT,TCLT,44193926,CDM,921,RC,,,both,,,1167,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,342.35,,,342.35,Fee Schedule,,308.69,,,308.69,Fee Schedule,,675.9,,,675.9,Fee Schedule,,608.07,,,608.07,Fee Schedule,,574.76,,,574.76,Fee Schedule,,816.9,70,,816.9,percent of total billed charges,All Other,793.56,68,,793.56,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,933.6,80,,933.6,percent of total billed charges,All Other,968.61,83,,968.61,percent of total billed charges,All Other,968.61,83,,968.61,percent of total billed charges,All Other,933.6,80,,933.6,percent of total billed charges,All Other,968.61,83,,968.61,percent of total billed charges,All Other,933.6,80,,933.6,percent of total billed charges,All Other,816.9,70,,816.9,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,968.61,
DUPLX LE ART UNILAT RT,93926,CPT,TCRT,44293926,CDM,921,RC,,,both,,,1167,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,342.35,,,342.35,Fee Schedule,,308.69,,,308.69,Fee Schedule,,675.9,,,675.9,Fee Schedule,,608.07,,,608.07,Fee Schedule,,574.76,,,574.76,Fee Schedule,,816.9,70,,816.9,percent of total billed charges,All Other,793.56,68,,793.56,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,933.6,80,,933.6,percent of total billed charges,All Other,968.61,83,,968.61,percent of total billed charges,All Other,968.61,83,,968.61,percent of total billed charges,All Other,933.6,80,,933.6,percent of total billed charges,All Other,968.61,83,,968.61,percent of total billed charges,All Other,933.6,80,,933.6,percent of total billed charges,All Other,816.9,70,,816.9,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,968.61,
DUPLX UPPR EXTREM  ART BILAT,93930,CPT,TC,44093930,CDM,921,RC,,,both,,,1410,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,515.42,,,515.42,Fee Schedule,,464.76,,,464.76,Fee Schedule,,1073.26,,,1073.26,Fee Schedule,,965.54,,,965.54,Fee Schedule,,912.66,,,912.66,Fee Schedule,,987,70,,987,percent of total billed charges,All Other,958.8,68,,958.8,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,1128,80,,1128,percent of total billed charges,All Other,1170.3,83,,1170.3,percent of total billed charges,All Other,1170.3,83,,1170.3,percent of total billed charges,All Other,1128,80,,1128,percent of total billed charges,All Other,1170.3,83,,1170.3,percent of total billed charges,All Other,1128,80,,1128,percent of total billed charges,All Other,987,70,,987,percent of total billed charges,,783.92,,,783.92,Fee Schedule,,664.42,,,664.42,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,129.13,1170.3,
DUPLEX UE ART/BPG; UNIL/LIMIT,93931,CPT,TC,44093931,CDM,921,RC,,,both,,,954,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,322.97,,,322.97,Fee Schedule,,291.22,,,291.22,Fee Schedule,,675.9,,,675.9,Fee Schedule,,608.07,,,608.07,Fee Schedule,,574.76,,,574.76,Fee Schedule,,667.8,70,,667.8,percent of total billed charges,All Other,648.72,68,,648.72,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,763.2,80,,763.2,percent of total billed charges,All Other,791.82,83,,791.82,percent of total billed charges,All Other,791.82,83,,791.82,percent of total billed charges,All Other,763.2,80,,763.2,percent of total billed charges,All Other,791.82,83,,791.82,percent of total billed charges,All Other,763.2,80,,763.2,percent of total billed charges,All Other,667.8,70,,667.8,percent of total billed charges,,498.56,,,498.56,Fee Schedule,,422.56,,,422.56,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,811,
DUPLX UE ART UNILAT LT,93931,CPT,TCLT,44193931,CDM,921,RC,,,both,,,954,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,322.97,,,322.97,Fee Schedule,,291.22,,,291.22,Fee Schedule,,675.9,,,675.9,Fee Schedule,,608.07,,,608.07,Fee Schedule,,574.76,,,574.76,Fee Schedule,,667.8,70,,667.8,percent of total billed charges,All Other,648.72,68,,648.72,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,763.2,80,,763.2,percent of total billed charges,All Other,791.82,83,,791.82,percent of total billed charges,All Other,791.82,83,,791.82,percent of total billed charges,All Other,763.2,80,,763.2,percent of total billed charges,All Other,791.82,83,,791.82,percent of total billed charges,All Other,763.2,80,,763.2,percent of total billed charges,All Other,667.8,70,,667.8,percent of total billed charges,,498.56,,,498.56,Fee Schedule,,422.56,,,422.56,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,811,
DUPLX UE ART UNILAT RT,93931,CPT,TCRT,44293931,CDM,921,RC,,,both,,,954,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,322.97,,,322.97,Fee Schedule,,291.22,,,291.22,Fee Schedule,,675.9,,,675.9,Fee Schedule,,608.07,,,608.07,Fee Schedule,,574.76,,,574.76,Fee Schedule,,667.8,70,,667.8,percent of total billed charges,All Other,648.72,68,,648.72,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,763.2,80,,763.2,percent of total billed charges,All Other,791.82,83,,791.82,percent of total billed charges,All Other,791.82,83,,791.82,percent of total billed charges,All Other,763.2,80,,763.2,percent of total billed charges,All Other,791.82,83,,791.82,percent of total billed charges,All Other,763.2,80,,763.2,percent of total billed charges,All Other,667.8,70,,667.8,percent of total billed charges,,498.56,,,498.56,Fee Schedule,,422.56,,,422.56,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,811,
DUPLEX EXT VEINS; UNIL/LIMIT,93971,CPT,TC,44093971,CDM,921,RC,,,both,,,1360,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,315.47,,,315.47,Fee Schedule,,284.46,,,284.46,Fee Schedule,,675.9,,,675.9,Fee Schedule,,608.07,,,608.07,Fee Schedule,,574.76,,,574.76,Fee Schedule,,952,70,,952,percent of total billed charges,All Other,924.8,68,,924.8,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,1088,80,,1088,percent of total billed charges,All Other,1128.8,83,,1128.8,percent of total billed charges,All Other,1128.8,83,,1128.8,percent of total billed charges,All Other,1088,80,,1088,percent of total billed charges,All Other,1128.8,83,,1128.8,percent of total billed charges,All Other,1088,80,,1088,percent of total billed charges,All Other,952,70,,952,percent of total billed charges,,485.44,,,485.44,Fee Schedule,,411.44,,,411.44,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,1128.8,
DUPLEX ARTERIAL FLOW; COMPL,93975,CPT,TC,44093975,CDM,921,RC,,,both,,,1880,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS,674.75,,,674.75,Fee Schedule,,608.42,,,608.42,Fee Schedule,,1073.37,,,1073.37,Fee Schedule,,965.64,,,965.64,Fee Schedule,,912.75,,,912.75,Fee Schedule,,1316,70,,1316,percent of total billed charges,All Other,1278.4,68,,1278.4,percent of total billed charges,All Other,996,,,996,Other,186% of Medicaid,1504,80,,1504,percent of total billed charges,All Other,1560.4,83,,1560.4,percent of total billed charges,All Other,1560.4,83,,1560.4,percent of total billed charges,All Other,1504,80,,1504,percent of total billed charges,All Other,1560.4,83,,1560.4,percent of total billed charges,All Other,1504,80,,1504,percent of total billed charges,All Other,1316,70,,1316,percent of total billed charges,,1044.68,,,1044.68,Fee Schedule,,885.43,,,885.43,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,269.26,1734.3,
DUPLEX ARTERIAL FLOW; LIMITED,93976,CPT,TC,44093976,CDM,921,RC,,,both,,,1131,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,342.2,,,342.2,Fee Schedule,,308.56,,,308.56,Fee Schedule,,1070.9,,,1070.9,Fee Schedule,,963.42,,,963.42,Fee Schedule,,910.66,,,910.66,Fee Schedule,,791.7,70,,791.7,percent of total billed charges,All Other,769.08,68,,769.08,percent of total billed charges,All Other,996,,,996,Other,186% of Medicaid,904.8,80,,904.8,percent of total billed charges,All Other,938.73,83,,938.73,percent of total billed charges,All Other,938.73,83,,938.73,percent of total billed charges,All Other,904.8,80,,904.8,percent of total billed charges,All Other,938.73,83,,938.73,percent of total billed charges,All Other,904.8,80,,904.8,percent of total billed charges,All Other,791.7,70,,791.7,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,535.28,,,535.28,Other,100% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,818.97,,,818.97,Other,153% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,749.39,,,749.39,Other,140% of Medicaid,1204.37,,,1204.37,Other,225% of Medicaid,1391.72,,,1391.72,Other,250% of Medicaid,1734.3,,,1734.3,Other,324% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,1150.85,,,1150.85,Other,215% of Medicaid,669.1,,,669.1,Other,125% of Medicaid,120.81,1734.3,
DUPLEX HEMODIALYSIS ACCESS,93990,CPT,TC,44093990,CDM,921,RC,,,both,,,1261,198.66,,,198.66,Other,150% of Medicare + 9.63% HCRA Surcharge,120.81,,,120.81,Other,Medicare OPPS,342.35,,,342.35,Fee Schedule,,308.69,,,308.69,Fee Schedule,,673.38,,,673.38,Fee Schedule,,605.8,,,605.8,Fee Schedule,,572.62,,,572.62,Fee Schedule,,882.7,70,,882.7,percent of total billed charges,All Other,857.48,68,,857.48,percent of total billed charges,All Other,240,,,240,Other,186% of Medicaid,1008.8,80,,1008.8,percent of total billed charges,All Other,1046.63,83,,1046.63,percent of total billed charges,All Other,1046.63,83,,1046.63,percent of total billed charges,All Other,1008.8,80,,1008.8,percent of total billed charges,All Other,1046.63,83,,1046.63,percent of total billed charges,All Other,1008.8,80,,1008.8,percent of total billed charges,All Other,882.7,70,,882.7,percent of total billed charges,,613.36,,,613.36,Fee Schedule,,519.86,,,519.86,Fee Schedule,,811,,,811,Case Rate,,730,,,730,Case Rate,,811,,,811,Case Rate,,689,,,689,Case Rate,,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,129.13,,,129.13,Other,100% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,197.57,,,197.57,Other,153% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,180.79,,,180.79,Other,140% of Medicaid,290.55,,,290.55,Other,225% of Medicaid,335.75,,,335.75,Other,250% of Medicaid,418.39,,,418.39,Other,324% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,277.64,,,277.64,Other,215% of Medicaid,161.42,,,161.42,Other,125% of Medicaid,120.81,1046.63,
EMG-1 EXTREMITY,95860,CPT,TC,53095860,CDM,922,RC,,,both,,,441,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,217.37,,,217.37,Fee Schedule,,195.56,,,195.56,Fee Schedule,,285.67,,,285.67,Fee Schedule,,257,,,257,Fee Schedule,,242.93,,,242.93,Fee Schedule,,308.7,70,,308.7,percent of total billed charges,All Other,258.25,,,258.25,Fee Schedule,,224,,,224,Other,186% of Medicaid,303.9,,,303.9,Fee Schedule,,273.42,,,273.42,Fee Schedule,,143.09,,,,Fee Schedule,,303.9,,,303.9,Fee Schedule,,273.42,,,273.42,Fee Schedule,,352.8,80,,352.8,percent of total billed charges,All Other,308.7,70,,308.7,percent of total billed charges,,311.6,,,311.6,Fee Schedule,,264.1,,,264.1,Fee Schedule,,716,,,716,Case Rate,,644,,,644,Case Rate,,716,,,716,Case Rate,,609,,,609,Case Rate,,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,184.32,,,184.32,Other,153% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,168.66,,,168.66,Other,140% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,313.23,,,313.23,Other,250% of Medicaid,390.33,,,390.33,Other,324% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,150.59,,,150.59,Other,125% of Medicaid,120.47,716,
EMG-2 EXTREMITIES,95861,CPT,TC,53095861,CDM,922,RC,,,both,,,705,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,277.43,,,277.43,Fee Schedule,,249.6,,,249.6,Fee Schedule,,364.15,,,364.15,Fee Schedule,,327.6,,,327.6,Fee Schedule,,309.66,,,309.66,Fee Schedule,,493.5,70,,493.5,percent of total billed charges,All Other,329.62,,,329.62,Fee Schedule,,224,,,224,Other,186% of Medicaid,387.89,,,387.89,Fee Schedule,,437.1,,,437.1,Fee Schedule,,182.64,,,,Fee Schedule,,387.89,,,387.89,Fee Schedule,,437.1,,,437.1,Fee Schedule,,564,80,,564,percent of total billed charges,All Other,493.5,70,,493.5,percent of total billed charges,,411.64,,,411.64,Fee Schedule,,348.89,,,348.89,Fee Schedule,,716,,,716,Case Rate,,644,,,644,Case Rate,,716,,,716,Case Rate,,609,,,609,Case Rate,,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,184.32,,,184.32,Other,153% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,168.66,,,168.66,Other,140% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,313.23,,,313.23,Other,250% of Medicaid,390.33,,,390.33,Other,324% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,150.59,,,150.59,Other,125% of Medicaid,120.47,716,
NERVE CNDJ TEST 1-2 STUDIES,95907,CPT,TC,53095907,CDM,922,RC,,,both,,,329,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS,133.02,,,133.02,Fee Schedule,,119.68,,,119.68,Fee Schedule,,83.4,,,83.4,Fee Schedule,,83.4,,,83.4,Fee Schedule,,83.4,,,83.4,Fee Schedule,,230.3,70,,230.3,percent of total billed charges,All Other,158.04,,,158.04,Fee Schedule,,224,,,224,Other,186% of Medicaid,185.98,,,185.98,Fee Schedule,,203.98,,,203.98,Fee Schedule,,87.57,,,,Fee Schedule,,185.98,,,185.98,Fee Schedule,,203.98,,,203.98,Fee Schedule,,263.2,80,,263.2,percent of total billed charges,All Other,230.3,70,,230.3,percent of total billed charges,,191.88,,,191.88,Fee Schedule,,162.63,,,162.63,Fee Schedule,,716,,,716,Case Rate,,644,,,644,Case Rate,,716,,,716,Case Rate,,609,,,609,Case Rate,,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,184.32,,,184.32,Other,153% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,168.66,,,168.66,Other,140% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,313.23,,,313.23,Other,250% of Medicaid,390.33,,,390.33,Other,324% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,150.59,,,150.59,Other,125% of Medicaid,83.4,716,
NERVE CNDJ TEST 3-4 STUDIES,95908,CPT,TC,53095908,CDM,922,RC,,,both,,,632,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,163.07,,,163.07,Fee Schedule,,146.71,,,146.71,Fee Schedule,,108,,,108,Fee Schedule,,108,,,108,Fee Schedule,,108,,,108,Fee Schedule,,442.4,70,,442.4,percent of total billed charges,All Other,193.74,,,193.74,Fee Schedule,,224,,,224,Other,186% of Medicaid,228,,,228,Fee Schedule,,391.84,,,391.84,Fee Schedule,,107.35,,,,Fee Schedule,,228,,,228,Fee Schedule,,391.84,,,391.84,Fee Schedule,,505.6,80,,505.6,percent of total billed charges,All Other,442.4,70,,442.4,percent of total billed charges,,237.8,,,237.8,Fee Schedule,,201.55,,,201.55,Fee Schedule,,716,,,716,Case Rate,,644,,,644,Case Rate,,716,,,716,Case Rate,,609,,,609,Case Rate,,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,184.32,,,184.32,Other,153% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,168.66,,,168.66,Other,140% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,313.23,,,313.23,Other,250% of Medicaid,390.33,,,390.33,Other,324% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,150.59,,,150.59,Other,125% of Medicaid,107.35,716,
NERVE CNDJ TEST 5-6 STUDIES,95909,CPT,TC,53095909,CDM,922,RC,,,both,,,632,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,196.57,,,196.57,Fee Schedule,,176.85,,,176.85,Fee Schedule,,128.7,,,128.7,Fee Schedule,,128.7,,,128.7,Fee Schedule,,128.7,,,128.7,Fee Schedule,,442.4,70,,442.4,percent of total billed charges,All Other,233.54,,,233.54,Fee Schedule,,224,,,224,Other,186% of Medicaid,274.83,,,274.83,Fee Schedule,,391.84,,,391.84,Fee Schedule,,129.4,,,,Fee Schedule,,274.83,,,274.83,Fee Schedule,,391.84,,,391.84,Fee Schedule,,505.6,80,,505.6,percent of total billed charges,All Other,442.4,70,,442.4,percent of total billed charges,,285.36,,,285.36,Fee Schedule,,241.86,,,241.86,Fee Schedule,,716,,,716,Case Rate,,644,,,644,Case Rate,,716,,,716,Case Rate,,609,,,609,Case Rate,,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,184.32,,,184.32,Other,153% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,168.66,,,168.66,Other,140% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,313.23,,,313.23,Other,250% of Medicaid,390.33,,,390.33,Other,324% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,150.59,,,150.59,Other,125% of Medicaid,120.47,716,
NERVE CNDJ TEST 7-8 STUDIES,95910,CPT,TC,53095910,CDM,922,RC,,,both,,,632,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS,249.71,,,249.71,Fee Schedule,,224.66,,,224.66,Fee Schedule,,169.5,,,169.5,Fee Schedule,,169.5,,,169.5,Fee Schedule,,169.5,,,169.5,Fee Schedule,,442.4,70,,442.4,percent of total billed charges,All Other,296.68,,,296.68,Fee Schedule,,224,,,224,Other,186% of Medicaid,349.13,,,349.13,Fee Schedule,,391.84,,,391.84,Fee Schedule,,164.39,,,,Fee Schedule,,349.13,,,349.13,Fee Schedule,,391.84,,,391.84,Fee Schedule,,505.6,80,,505.6,percent of total billed charges,All Other,442.4,70,,442.4,percent of total billed charges,,362.44,,,362.44,Fee Schedule,,307.19,,,307.19,Fee Schedule,,716,,,716,Case Rate,,644,,,644,Case Rate,,716,,,716,Case Rate,,609,,,609,Case Rate,,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,184.32,,,184.32,Other,153% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,168.66,,,168.66,Other,140% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,313.23,,,313.23,Other,250% of Medicaid,390.33,,,390.33,Other,324% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,150.59,,,150.59,Other,125% of Medicaid,120.47,716,
NERVE CNDJ TEST 9-10 STUDIES,95911,CPT,TC,53095911,CDM,922,RC,,,both,,,1090,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,285.51,,,285.51,Fee Schedule,,256.87,,,256.87,Fee Schedule,,202.2,,,202.2,Fee Schedule,,202.2,,,202.2,Fee Schedule,,202.2,,,202.2,Fee Schedule,,763,70,,763,percent of total billed charges,All Other,339.21,,,339.21,Fee Schedule,,224,,,224,Other,186% of Medicaid,399.17,,,399.17,Fee Schedule,,675.8,,,675.8,Fee Schedule,,187.95,,,,Fee Schedule,,399.17,,,399.17,Fee Schedule,,675.8,,,675.8,Fee Schedule,,872,80,,872,percent of total billed charges,All Other,763,70,,763,percent of total billed charges,,416.56,,,416.56,Fee Schedule,,353.06,,,353.06,Fee Schedule,,716,,,716,Case Rate,,644,,,644,Case Rate,,716,,,716,Case Rate,,609,,,609,Case Rate,,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,184.32,,,184.32,Other,153% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,168.66,,,168.66,Other,140% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,313.23,,,313.23,Other,250% of Medicaid,390.33,,,390.33,Other,324% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,150.59,,,150.59,Other,125% of Medicaid,120.47,968.53,
NERVE CNDJ TEST 11-12 STUDIES,95912,CPT,TC,53095912,CDM,922,RC,,,both,,,1090,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,322.67,,,322.67,Fee Schedule,,290.3,,,290.3,Fee Schedule,,224.4,,,224.4,Fee Schedule,,224.4,,,224.4,Fee Schedule,,224.4,,,224.4,Fee Schedule,,763,70,,763,percent of total billed charges,All Other,383.36,,,383.36,Fee Schedule,,224,,,224,Other,186% of Medicaid,451.13,,,451.13,Fee Schedule,,675.8,,,675.8,Fee Schedule,,212.42,,,,Fee Schedule,,451.13,,,451.13,Fee Schedule,,675.8,,,675.8,Fee Schedule,,872,80,,872,percent of total billed charges,All Other,763,70,,763,percent of total billed charges,,467.4,,,467.4,Fee Schedule,,396.15,,,396.15,Fee Schedule,,716,,,716,Case Rate,,644,,,644,Case Rate,,716,,,716,Case Rate,,609,,,609,Case Rate,,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,184.32,,,184.32,Other,153% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,168.66,,,168.66,Other,140% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,313.23,,,313.23,Other,250% of Medicaid,390.33,,,390.33,Other,324% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,150.59,,,150.59,Other,125% of Medicaid,120.47,968.53,
NERVE CNDJ TEST 13/> STUDIES,95913,CPT,TC,53095913,CDM,922,RC,,,both,,,1090,968.53,,,968.53,Other,150% of Medicare + 9.63% HCRA Surcharge,588.97,,,588.97,Other,Medicare OPPS,357.31,,,357.31,Fee Schedule,,321.47,,,321.47,Fee Schedule,,258.9,,,258.9,Fee Schedule,,258.9,,,258.9,Fee Schedule,,258.9,,,258.9,Fee Schedule,,763,70,,763,percent of total billed charges,All Other,424.52,,,424.52,Fee Schedule,,224,,,224,Other,186% of Medicaid,499.56,,,499.56,Fee Schedule,,675.8,,,675.8,Fee Schedule,,235.22,,,,Fee Schedule,,499.56,,,499.56,Fee Schedule,,675.8,,,675.8,Fee Schedule,,872,80,,872,percent of total billed charges,All Other,763,70,,763,percent of total billed charges,,518.24,,,518.24,Fee Schedule,,439.24,,,439.24,Fee Schedule,,716,,,716,Case Rate,,644,,,644,Case Rate,,716,,,716,Case Rate,,609,,,609,Case Rate,,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,120.47,,,120.47,Other,100% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,184.32,,,184.32,Other,153% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,168.66,,,168.66,Other,140% of Medicaid,271.06,,,271.06,Other,225% of Medicaid,313.23,,,313.23,Other,250% of Medicaid,390.33,,,390.33,Other,324% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,259.01,,,259.01,Other,215% of Medicaid,150.59,,,150.59,Other,125% of Medicaid,120.47,968.53,
SCR PAP SMER UP TO 3 TECH W/MD,P3000,HCPCS,,78000004,CDM,923,RC,,,both,,,81,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,53.46,,,53.46,Fee Schedule,,48.13,,,48.13,Fee Schedule,,77.47,,,77.47,Fee Schedule,,69.74,,,69.74,Fee Schedule,,65.87,,,65.87,Fee Schedule,,56.7,70,,56.7,percent of total billed charges,All Other,55.94,,,55.94,Fee Schedule,,65,,,65,Other,186% of Medicaid,65.89,,,65.89,Fee Schedule,,37.3,,,37.3,Fee Schedule,,37.3,,,,Fee Schedule,,65.89,,,65.89,Fee Schedule,,37.3,,,37.3,Fee Schedule,,70.15,,,70.15,Fee Schedule,,56.7,70,,56.7,percent of total billed charges,,75.45,,,75.45,Fee Schedule,,63.94,,,63.94,Fee Schedule,,22.68,,,22.68,Fee Schedule,,22.68,,,22.68,Fee Schedule,,22.68,,,22.68,Fee Schedule,,22.68,,,22.68,Fee Schedule,,34.77,,,34.77,Other,100% of Medicaid,34.77,,,34.77,Other,100% of Medicaid,34.77,,,34.77,Other,100% of Medicaid,34.77,,,34.77,Other,100% of Medicaid,78.24,,,78.24,Other,225% of Medicaid,53.2,,,53.2,Other,153% of Medicaid,78.24,,,78.24,Other,225% of Medicaid,48.68,,,48.68,Other,140% of Medicaid,78.24,,,78.24,Other,225% of Medicaid,90.41,,,90.41,Other,250% of Medicaid,112.67,,,112.67,Other,324% of Medicaid,74.76,,,74.76,Other,215% of Medicaid,74.76,,,74.76,Other,215% of Medicaid,43.47,,,43.47,Other,125% of Medicaid,0.01,112.67,
SCR PAP SMER UP TO 3 RQR INTER,P3001,HCPCS,,78000005,CDM,923,RC,,,both,,,89,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,77.12,,,77.12,Fee Schedule,,69.43,,,69.43,Fee Schedule,,175.63,,,175.63,Fee Schedule,,158.1,,,158.1,Fee Schedule,,149.34,,,149.34,Fee Schedule,,62.3,70,,62.3,percent of total billed charges,All Other,80.7,,,80.7,Fee Schedule,,65,,,65,Other,186% of Medicaid,95.05,,,95.05,Fee Schedule,,53.8,,,53.8,Fee Schedule,,53.8,,,,Fee Schedule,,95.05,,,95.05,Fee Schedule,,53.8,,,53.8,Fee Schedule,,101.2,,,101.2,Fee Schedule,,62.3,70,,62.3,percent of total billed charges,,106.6,,,106.6,Fee Schedule,,90.35,,,90.35,Fee Schedule,,39.53,,,39.53,Fee Schedule,,39.53,,,39.53,Fee Schedule,,39.53,,,39.53,Fee Schedule,,39.53,,,39.53,Fee Schedule,,34.77,,,34.77,Other,100% of Medicaid,34.77,,,34.77,Other,100% of Medicaid,34.77,,,34.77,Other,100% of Medicaid,34.77,,,34.77,Other,100% of Medicaid,78.24,,,78.24,Other,225% of Medicaid,53.2,,,53.2,Other,153% of Medicaid,78.24,,,78.24,Other,225% of Medicaid,48.68,,,48.68,Other,140% of Medicaid,78.24,,,78.24,Other,225% of Medicaid,90.41,,,90.41,Other,250% of Medicaid,112.67,,,112.67,Other,324% of Medicaid,74.76,,,74.76,Other,215% of Medicaid,74.76,,,74.76,Other,215% of Medicaid,43.47,,,43.47,Other,125% of Medicaid,0.01,175.63,
THER/PROPH/DIAG IV PUSH INITIA,96374,CPT,,48096374,CDM,940,RC,,,both,,,466,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS,126.29,,,126.29,Fee Schedule,,113.62,,,113.62,Fee Schedule,,356.49,76.5,,356.49,percent of total billed charges,All Other,321.54,69,,321.54,percent of total billed charges,All Other,302.9,65,,302.9,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,All Other,316.88,68,,316.88,percent of total billed charges,All Other,72,,,72,Other,186% of Medicaid,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,386.78,83,,,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,386.78,83,,386.78,percent of total billed charges,All Other,372.8,80,,372.8,percent of total billed charges,All Other,326.2,70,,326.2,percent of total billed charges,,190.24,,,190.24,Fee Schedule,,161.24,,,161.24,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,38.65,,,38.65,Other,100% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,59.13,,,59.13,Other,153% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,54.11,,,54.11,Other,140% of Medicaid,86.96,,,86.96,Other,225% of Medicaid,100.49,,,100.49,Other,250% of Medicaid,125.22,,,125.22,Other,324% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,83.1,,,83.1,Other,215% of Medicaid,48.31,,,48.31,Other,125% of Medicaid,0.01,387.31,
PHLEBOTOMY THERAPEUTIC,99195,CPT,,34099195,CDM,940,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,332.59,,,332.59,Fee Schedule,,299.23,,,299.23,Fee Schedule,,201.2,76.5,,201.2,percent of total billed charges,All Other,181.47,69,,181.47,percent of total billed charges,All Other,170.95,65,,170.95,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,All Other,178.84,68,,178.84,percent of total billed charges,All Other,63,,,63,Other,186% of Medicaid,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,218.29,83,,,percent of total billed charges,All Other,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,210.4,80,,210.4,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,,493.64,,,493.64,Fee Schedule,,418.39,,,418.39,Fee Schedule,,131.5,,,131.5,Case Rate,,131.5,,,131.5,Case Rate,,131.5,,,131.5,Case Rate,,131.5,,,131.5,Case Rate,,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,33.81,493.64,
PHLEBOTOMY THERAPEUTIC,99195,CPT,,75099195,CDM,940,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,332.59,,,332.59,Fee Schedule,,299.23,,,299.23,Fee Schedule,,201.2,76.5,,201.2,percent of total billed charges,All Other,181.47,69,,181.47,percent of total billed charges,All Other,170.95,65,,170.95,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,All Other,178.84,68,,178.84,percent of total billed charges,All Other,63,,,63,Other,186% of Medicaid,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,218.29,83,,,percent of total billed charges,All Other,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,210.4,80,,210.4,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,,493.64,,,493.64,Fee Schedule,,418.39,,,418.39,Fee Schedule,,131.5,,,131.5,Case Rate,,131.5,,,131.5,Case Rate,,131.5,,,131.5,Case Rate,,131.5,,,131.5,Case Rate,,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,33.81,493.64,
PHLEBOTOMY THERAPEUTIC,99195,CPT,,82099195,CDM,940,RC,,,both,,,263,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS,332.59,,,332.59,Fee Schedule,,299.23,,,299.23,Fee Schedule,,201.2,76.5,,201.2,percent of total billed charges,All Other,181.47,69,,181.47,percent of total billed charges,All Other,170.95,65,,170.95,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,All Other,178.84,68,,178.84,percent of total billed charges,All Other,63,,,63,Other,186% of Medicaid,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,218.29,83,,,percent of total billed charges,All Other,210.4,80,,210.4,percent of total billed charges,All Other,218.29,83,,218.29,percent of total billed charges,All Other,210.4,80,,210.4,percent of total billed charges,All Other,184.1,70,,184.1,percent of total billed charges,,493.64,,,493.64,Fee Schedule,,418.39,,,418.39,Fee Schedule,,131.5,,,131.5,Case Rate,,131.5,,,131.5,Case Rate,,131.5,,,131.5,Case Rate,,131.5,,,131.5,Case Rate,,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,33.81,,,33.81,Other,100% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,51.73,,,51.73,Other,153% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,47.34,,,47.34,Other,140% of Medicaid,76.08,,,76.08,Other,225% of Medicaid,87.91,,,87.91,Other,250% of Medicaid,109.55,,,109.55,Other,324% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,72.7,,,72.7,Other,215% of Medicaid,42.27,,,42.27,Other,125% of Medicaid,33.81,493.64,
PULMONARY REHAB W EXER,G0424,HCPCS,,71000021,CDM,940,RC,,,both,,,221,87.22,39.4668,,87.22,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,143.65,65,,143.65,percent of total billed charges,All Other,130.39,59,,130.39,percent of total billed charges,All Other,192.61,,,192.61,Fee Schedule,,173.39,,,173.39,Fee Schedule,,163.78,,,163.78,Fee Schedule,,154.7,70,,154.7,percent of total billed charges,All Other,150.28,68,,150.28,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,176.8,80,,176.8,percent of total billed charges,All Other,137.02,62,,137.02,percent of total billed charges,Lab & Radiology,121.55,55,,,percent of total billed charges,Default if not in Fee Schedule,176.8,80,,176.8,percent of total billed charges,All Other,137.02,62,,137.02,percent of total billed charges,Lab & Radiology,176.8,80,,176.8,percent of total billed charges,All Other,154.7,70,,154.7,percent of total billed charges,,143.65,65,,143.65,percent of total billed charges,All Other,143.65,65,,143.65,percent of total billed charges,All Other,110.5,,,110.5,Case Rate,,110.5,,,110.5,Case Rate,,110.5,,,110.5,Case Rate,,110.5,,,110.5,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,192.61,
INIT NUTRITION THERAPY EACH 15M-TH,97802,CPT,95,70000012,CDM,942,RC,,,both,,,141,55.65,39.4668,,55.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.61,,,106.61,Fee Schedule,,95.92,,,95.92,Fee Schedule,,107.87,76.5,,107.87,percent of total billed charges,All Other,97.29,69,,97.29,percent of total billed charges,All Other,91.65,65,,91.65,percent of total billed charges,All Other,98.7,70,,98.7,percent of total billed charges,All Other,95.88,68,,95.88,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,112.8,80,,112.8,percent of total billed charges,All Other,117.03,83,,117.03,percent of total billed charges,All Other,117.03,83,,,percent of total billed charges,All Other,112.8,80,,112.8,percent of total billed charges,All Other,117.03,83,,117.03,percent of total billed charges,All Other,112.8,80,,112.8,percent of total billed charges,All Other,98.7,70,,98.7,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,155.8,
INIT NUTRITION THERAPY; EACH 15M,97802,CPT,,70097802,CDM,942,RC,,,both,,,141,55.65,39.4668,,55.65,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.61,,,106.61,Fee Schedule,,95.92,,,95.92,Fee Schedule,,107.87,76.5,,107.87,percent of total billed charges,All Other,97.29,69,,97.29,percent of total billed charges,All Other,91.65,65,,91.65,percent of total billed charges,All Other,98.7,70,,98.7,percent of total billed charges,All Other,95.88,68,,95.88,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,112.8,80,,112.8,percent of total billed charges,All Other,117.03,83,,117.03,percent of total billed charges,All Other,117.03,83,,,percent of total billed charges,All Other,112.8,80,,112.8,percent of total billed charges,All Other,117.03,83,,117.03,percent of total billed charges,All Other,112.8,80,,112.8,percent of total billed charges,All Other,98.7,70,,98.7,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,155.8,
RE-ASSESS NUTRITION THER EA 15M-TH,97803,CPT,95,70000013,CDM,942,RC,,,both,,,118,46.57,39.4668,,46.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,90.92,,,90.92,Fee Schedule,,81.8,,,81.8,Fee Schedule,,90.27,76.5,,90.27,percent of total billed charges,All Other,81.42,69,,81.42,percent of total billed charges,All Other,76.7,65,,76.7,percent of total billed charges,All Other,82.6,70,,82.6,percent of total billed charges,All Other,80.24,68,,80.24,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,94.4,80,,94.4,percent of total billed charges,All Other,97.94,83,,97.94,percent of total billed charges,All Other,97.94,83,,,percent of total billed charges,All Other,94.4,80,,94.4,percent of total billed charges,All Other,97.94,83,,97.94,percent of total billed charges,All Other,94.4,80,,94.4,percent of total billed charges,All Other,82.6,70,,82.6,percent of total billed charges,,132.84,,,132.84,Fee Schedule,,112.59,,,112.59,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,143,
RE-ASSESS NUTRITION THER; EA 15M,97803,CPT,,70097803,CDM,942,RC,,,both,,,118,46.57,39.4668,,46.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,90.92,,,90.92,Fee Schedule,,81.8,,,81.8,Fee Schedule,,90.27,76.5,,90.27,percent of total billed charges,All Other,81.42,69,,81.42,percent of total billed charges,All Other,76.7,65,,76.7,percent of total billed charges,All Other,82.6,70,,82.6,percent of total billed charges,All Other,80.24,68,,80.24,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,94.4,80,,94.4,percent of total billed charges,All Other,97.94,83,,97.94,percent of total billed charges,All Other,97.94,83,,,percent of total billed charges,All Other,94.4,80,,94.4,percent of total billed charges,All Other,97.94,83,,97.94,percent of total billed charges,All Other,94.4,80,,94.4,percent of total billed charges,All Other,82.6,70,,82.6,percent of total billed charges,,132.84,,,132.84,Fee Schedule,,112.59,,,112.59,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,143,
NUTRITIONAL THERAPY FOLLOW UP 15 MIN,97803,CPT,,83097803,CDM,942,RC,,,both,,,118,46.57,39.4668,,46.57,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,90.92,,,90.92,Fee Schedule,,81.8,,,81.8,Fee Schedule,,90.27,76.5,,90.27,percent of total billed charges,All Other,81.42,69,,81.42,percent of total billed charges,All Other,76.7,65,,76.7,percent of total billed charges,All Other,82.6,70,,82.6,percent of total billed charges,All Other,80.24,68,,80.24,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,94.4,80,,94.4,percent of total billed charges,All Other,97.94,83,,97.94,percent of total billed charges,All Other,97.94,83,,,percent of total billed charges,All Other,94.4,80,,94.4,percent of total billed charges,All Other,97.94,83,,97.94,percent of total billed charges,All Other,94.4,80,,94.4,percent of total billed charges,All Other,82.6,70,,82.6,percent of total billed charges,,132.84,,,132.84,Fee Schedule,,112.59,,,112.59,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,143,
GRP NUTRITION THERAPY; EA 30M,97804,CPT,,70097804,CDM,942,RC,,,both,,,68,26.84,39.4668,,26.84,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51.74,,,51.74,Fee Schedule,,46.55,,,46.55,Fee Schedule,,52.02,76.5,,52.02,percent of total billed charges,All Other,46.92,69,,46.92,percent of total billed charges,All Other,44.2,65,,44.2,percent of total billed charges,All Other,47.6,70,,47.6,percent of total billed charges,All Other,46.24,68,,46.24,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,54.4,80,,54.4,percent of total billed charges,All Other,56.44,83,,56.44,percent of total billed charges,All Other,56.44,83,,,percent of total billed charges,All Other,54.4,80,,54.4,percent of total billed charges,All Other,56.44,83,,56.44,percent of total billed charges,All Other,54.4,80,,54.4,percent of total billed charges,All Other,47.6,70,,47.6,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,143,
DIET INSTRUCTION FOLLOW UP,99211,CPT,,83099211,CDM,942,RC,,,both,,,228,89.98,39.4668,,89.98,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,148.2,65,,148.2,percent of total billed charges,All Other,134.52,59,,134.52,percent of total billed charges,All Other,174.42,76.5,,174.42,percent of total billed charges,All Other,157.32,69,,157.32,percent of total billed charges,All Other,148.2,65,,148.2,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,All Other,155.04,68,,155.04,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,189.24,83,,,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,189.24,83,,189.24,percent of total billed charges,All Other,182.4,80,,182.4,percent of total billed charges,All Other,159.6,70,,159.6,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,189.24,
BEHAV CHNG SMOKING 3-10 MIN,99406,CPT,,30099406,CDM,942,RC,,,both,,,114,51.85,,,51.85,Other,150% of Medicare + 9.63% HCRA Surcharge,31.53,,,31.53,Other,Medicare OPPS,74.1,65,,74.1,percent of total billed charges,All Other,67.26,59,,67.26,percent of total billed charges,All Other,87.21,76.5,,87.21,percent of total billed charges,All Other,78.66,69,,78.66,percent of total billed charges,All Other,74.1,65,,74.1,percent of total billed charges,All Other,79.8,70,,79.8,percent of total billed charges,All Other,77.52,68,,77.52,percent of total billed charges,All Other,93,,,93,Other,186% of Medicaid,91.2,80,,91.2,percent of total billed charges,All Other,94.62,83,,94.62,percent of total billed charges,All Other,94.62,83,,,percent of total billed charges,All Other,91.2,80,,91.2,percent of total billed charges,All Other,94.62,83,,94.62,percent of total billed charges,All Other,91.2,80,,91.2,percent of total billed charges,All Other,79.8,70,,79.8,percent of total billed charges,,57.4,,,57.4,Fee Schedule,,48.65,,,48.65,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,76.23,,,76.23,Other,153% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,69.75,,,69.75,Other,140% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,129.53,,,129.53,Other,250% of Medicaid,161.42,,,161.42,Other,324% of Medicaid,107.11,,,107.11,Other,215% of Medicaid,107.11,,,107.11,Other,215% of Medicaid,62.28,,,62.28,Other,125% of Medicaid,31.53,161.42,
BEHAV CHNG SMOKING 3-10 MIN,99406,CPT,,71099406,CDM,942,RC,,,both,,,114,51.85,,,51.85,Other,150% of Medicare + 9.63% HCRA Surcharge,31.53,,,31.53,Other,Medicare OPPS,74.1,65,,74.1,percent of total billed charges,All Other,67.26,59,,67.26,percent of total billed charges,All Other,87.21,76.5,,87.21,percent of total billed charges,All Other,78.66,69,,78.66,percent of total billed charges,All Other,74.1,65,,74.1,percent of total billed charges,All Other,79.8,70,,79.8,percent of total billed charges,All Other,77.52,68,,77.52,percent of total billed charges,All Other,93,,,93,Other,186% of Medicaid,91.2,80,,91.2,percent of total billed charges,All Other,94.62,83,,94.62,percent of total billed charges,All Other,94.62,83,,,percent of total billed charges,All Other,91.2,80,,91.2,percent of total billed charges,All Other,94.62,83,,94.62,percent of total billed charges,All Other,91.2,80,,91.2,percent of total billed charges,All Other,79.8,70,,79.8,percent of total billed charges,,57.4,,,57.4,Fee Schedule,,48.65,,,48.65,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,76.23,,,76.23,Other,153% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,69.75,,,69.75,Other,140% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,129.53,,,129.53,Other,250% of Medicaid,161.42,,,161.42,Other,324% of Medicaid,107.11,,,107.11,Other,215% of Medicaid,107.11,,,107.11,Other,215% of Medicaid,62.28,,,62.28,Other,125% of Medicaid,31.53,161.42,
BEHAV CHNG SMOKING > 10 MIN,99407,CPT,,30099407,CDM,942,RC,,,both,,,114,51.85,,,51.85,Other,150% of Medicare + 9.63% HCRA Surcharge,31.53,,,31.53,Other,Medicare OPPS,74.1,65,,74.1,percent of total billed charges,All Other,67.26,59,,67.26,percent of total billed charges,All Other,87.21,76.5,,87.21,percent of total billed charges,All Other,78.66,69,,78.66,percent of total billed charges,All Other,74.1,65,,74.1,percent of total billed charges,All Other,79.8,70,,79.8,percent of total billed charges,All Other,77.52,68,,77.52,percent of total billed charges,All Other,93,,,93,Other,186% of Medicaid,91.2,80,,91.2,percent of total billed charges,All Other,94.62,83,,94.62,percent of total billed charges,All Other,94.62,83,,,percent of total billed charges,All Other,91.2,80,,91.2,percent of total billed charges,All Other,94.62,83,,94.62,percent of total billed charges,All Other,91.2,80,,91.2,percent of total billed charges,All Other,79.8,70,,79.8,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,76.23,,,76.23,Other,153% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,69.75,,,69.75,Other,140% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,129.53,,,129.53,Other,250% of Medicaid,161.42,,,161.42,Other,324% of Medicaid,107.11,,,107.11,Other,215% of Medicaid,107.11,,,107.11,Other,215% of Medicaid,62.28,,,62.28,Other,125% of Medicaid,31.53,161.42,
BEHAV CHNG SMOKING > 10 MIN,99407,CPT,,71099407,CDM,942,RC,,,both,,,114,51.85,,,51.85,Other,150% of Medicare + 9.63% HCRA Surcharge,31.53,,,31.53,Other,Medicare OPPS,74.1,65,,74.1,percent of total billed charges,All Other,67.26,59,,67.26,percent of total billed charges,All Other,87.21,76.5,,87.21,percent of total billed charges,All Other,78.66,69,,78.66,percent of total billed charges,All Other,74.1,65,,74.1,percent of total billed charges,All Other,79.8,70,,79.8,percent of total billed charges,All Other,77.52,68,,77.52,percent of total billed charges,All Other,93,,,93,Other,186% of Medicaid,91.2,80,,91.2,percent of total billed charges,All Other,94.62,83,,94.62,percent of total billed charges,All Other,94.62,83,,,percent of total billed charges,All Other,91.2,80,,91.2,percent of total billed charges,All Other,94.62,83,,94.62,percent of total billed charges,All Other,91.2,80,,91.2,percent of total billed charges,All Other,79.8,70,,79.8,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,143,,,143,Case Rate,,131,,,131,Case Rate,,143,,,143,Case Rate,,122,,,122,Case Rate,,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,49.82,,,49.82,Other,100% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,76.23,,,76.23,Other,153% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,69.75,,,69.75,Other,140% of Medicaid,112.1,,,112.1,Other,225% of Medicaid,129.53,,,129.53,Other,250% of Medicaid,161.42,,,161.42,Other,324% of Medicaid,107.11,,,107.11,Other,215% of Medicaid,107.11,,,107.11,Other,215% of Medicaid,62.28,,,62.28,Other,125% of Medicaid,31.53,161.42,
DM OP SMT INDIV PER 30 MIN,G0108,HCPCS,,70000005,CDM,942,RC,,,both,,,237,93.54,39.4668,,93.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.36,,,183.36,Fee Schedule,,164.97,,,164.97,Fee Schedule,,181.31,76.5,,181.31,percent of total billed charges,All Other,163.53,69,,163.53,percent of total billed charges,All Other,154.05,65,,154.05,percent of total billed charges,All Other,165.9,70,,165.9,percent of total billed charges,All Other,217.85,,,217.85,Case Rate,,0.01,,,0.01,Other,186% of Medicaid,256.36,,,256.36,Case Rate,,120.71,,,120.71,Fee Schedule,,120.71,,,,Fee Schedule,,256.36,,,256.36,Case Rate,,120.71,,,120.71,Fee Schedule,,189.6,80,,189.6,percent of total billed charges,All Other,165.9,70,,165.9,percent of total billed charges,,265.68,,,265.68,Fee Schedule,,225.18,,,225.18,Fee Schedule,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,265.68,
DM OP SMT INDIV PER 30 MIN-TH,G0108,HCPCS,GQ,70000011,CDM,942,RC,,,both,,,237,93.54,39.4668,,93.54,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,183.36,,,183.36,Fee Schedule,,164.97,,,164.97,Fee Schedule,,181.31,76.5,,181.31,percent of total billed charges,All Other,163.53,69,,163.53,percent of total billed charges,All Other,154.05,65,,154.05,percent of total billed charges,All Other,165.9,70,,165.9,percent of total billed charges,All Other,217.85,,,217.85,Case Rate,,0.01,,,0.01,Other,186% of Medicaid,256.36,,,256.36,Case Rate,,120.71,,,120.71,Fee Schedule,,120.71,,,,Fee Schedule,,256.36,,,256.36,Case Rate,,120.71,,,120.71,Fee Schedule,,189.6,80,,189.6,percent of total billed charges,All Other,165.9,70,,165.9,percent of total billed charges,,265.68,,,265.68,Fee Schedule,,225.18,,,225.18,Fee Schedule,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,265.68,
DM OP SMT GRP PER 30 MIN,G0109,HCPCS,,70000006,CDM,942,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.89,,,52.89,Fee Schedule,,47.58,,,47.58,Fee Schedule,,55.08,76.5,,55.08,percent of total billed charges,All Other,49.68,69,,49.68,percent of total billed charges,All Other,46.8,65,,46.8,percent of total billed charges,All Other,50.4,70,,50.4,percent of total billed charges,All Other,62.84,,,62.84,Case Rate,,0.01,,,0.01,Other,186% of Medicaid,73.95,,,73.95,Case Rate,,34.82,,,34.82,Fee Schedule,,34.82,,,,Fee Schedule,,73.95,,,73.95,Case Rate,,34.82,,,34.82,Fee Schedule,,57.6,80,,57.6,percent of total billed charges,All Other,50.4,70,,50.4,percent of total billed charges,,75.44,,,75.44,Fee Schedule,,63.94,,,63.94,Fee Schedule,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,75.44,
DM OP SMT GRP PER 30 MIN - TH,G0109,HCPCS,GQ,70000014,CDM,942,RC,,,both,,,72,28.42,39.4668,,28.42,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,52.89,,,52.89,Fee Schedule,,47.58,,,47.58,Fee Schedule,,55.08,76.5,,55.08,percent of total billed charges,All Other,49.68,69,,49.68,percent of total billed charges,All Other,46.8,65,,46.8,percent of total billed charges,All Other,50.4,70,,50.4,percent of total billed charges,All Other,62.84,,,62.84,Case Rate,,0.01,,,0.01,Other,186% of Medicaid,73.95,,,73.95,Case Rate,,34.82,,,34.82,Fee Schedule,,34.82,,,,Fee Schedule,,73.95,,,73.95,Case Rate,,34.82,,,34.82,Fee Schedule,,57.6,80,,57.6,percent of total billed charges,All Other,50.4,70,,50.4,percent of total billed charges,,75.44,,,75.44,Fee Schedule,,63.94,,,63.94,Fee Schedule,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,75.44,
ADOL TRAIN & EDUC PER SESS 45+ MINS,G0177,HCPCS,,39000002,CDM,942,RC,,,both,,,105,41.44,39.4668,,41.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.25,65,,68.25,percent of total billed charges,All Other,61.95,59,,61.95,percent of total billed charges,All Other,80.33,76.5,,80.33,percent of total billed charges,All Other,72.45,69,,72.45,percent of total billed charges,All Other,68.25,65,,68.25,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,All Other,71.4,68,,71.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,84,80,,84,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Lab & Radiology,57.75,55,,,percent of total billed charges,Default if not in Fee Schedule,84,80,,84,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Lab & Radiology,84,80,,84,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,,68.25,65,,68.25,percent of total billed charges,All Other,68.25,65,,68.25,percent of total billed charges,All Other,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
ADOL TRAIN & EDUC PER SESS 45+ MINS-TH,G0177,HCPCS,GT,39100002,CDM,942,RC,,,both,,,105,41.44,39.4668,,41.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.25,65,,68.25,percent of total billed charges,All Other,61.95,59,,61.95,percent of total billed charges,All Other,80.33,76.5,,80.33,percent of total billed charges,All Other,72.45,69,,72.45,percent of total billed charges,All Other,68.25,65,,68.25,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,All Other,71.4,68,,71.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,84,80,,84,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Lab & Radiology,57.75,55,,,percent of total billed charges,Default if not in Fee Schedule,84,80,,84,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Lab & Radiology,84,80,,84,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,,68.25,65,,68.25,percent of total billed charges,All Other,68.25,65,,68.25,percent of total billed charges,All Other,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
TRAIN & EDUC PER SESS 45+ MINS,G0177,HCPCS,,40000003,CDM,942,RC,,,both,,,105,41.44,39.4668,,41.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.25,65,,68.25,percent of total billed charges,All Other,61.95,59,,61.95,percent of total billed charges,All Other,80.33,76.5,,80.33,percent of total billed charges,All Other,72.45,69,,72.45,percent of total billed charges,All Other,68.25,65,,68.25,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,All Other,71.4,68,,71.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,84,80,,84,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Lab & Radiology,57.75,55,,,percent of total billed charges,Default if not in Fee Schedule,84,80,,84,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Lab & Radiology,84,80,,84,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,,68.25,65,,68.25,percent of total billed charges,All Other,68.25,65,,68.25,percent of total billed charges,All Other,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
TRAIN & EDUC PER SESS 45+ MINS-TH,G0177,HCPCS,GT,40100002,CDM,942,RC,,,both,,,105,41.44,39.4668,,41.44,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,68.25,65,,68.25,percent of total billed charges,All Other,61.95,59,,61.95,percent of total billed charges,All Other,80.33,76.5,,80.33,percent of total billed charges,All Other,72.45,69,,72.45,percent of total billed charges,All Other,68.25,65,,68.25,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,All Other,71.4,68,,71.4,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,84,80,,84,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Lab & Radiology,57.75,55,,,percent of total billed charges,Default if not in Fee Schedule,84,80,,84,percent of total billed charges,All Other,65.1,62,,65.1,percent of total billed charges,Lab & Radiology,84,80,,84,percent of total billed charges,All Other,73.5,70,,73.5,percent of total billed charges,,68.25,65,,68.25,percent of total billed charges,All Other,68.25,65,,68.25,percent of total billed charges,All Other,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,84,
MNT EA 15 M AFTER 2ND REFRL,G0270,HCPCS,,70000007,CDM,942,RC,,,both,,,106,41.83,39.4668,,41.83,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,90.92,,,90.92,Fee Schedule,,81.8,,,81.8,Fee Schedule,,81.09,76.5,,81.09,percent of total billed charges,All Other,73.14,69,,73.14,percent of total billed charges,All Other,68.9,65,,68.9,percent of total billed charges,All Other,74.2,70,,74.2,percent of total billed charges,All Other,108.02,,,108.02,Case Rate,,0.01,,,0.01,Other,186% of Medicaid,127.11,,,127.11,Case Rate,,59.85,,,59.85,Fee Schedule,,59.85,,,,Fee Schedule,,127.11,,,127.11,Case Rate,,59.85,,,59.85,Fee Schedule,,112.58,,,112.58,Fee Schedule,,74.2,70,,74.2,percent of total billed charges,,132.84,,,132.84,Fee Schedule,,112.59,,,112.59,Fee Schedule,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,132.84,
MNT GRP/30M AFTER 2ND RFERL,G0271,HCPCS,,70000008,CDM,942,RC,,,both,,,54,21.31,39.4668,,21.31,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,51.74,,,51.74,Fee Schedule,,46.55,,,46.55,Fee Schedule,,41.31,76.5,,41.31,percent of total billed charges,All Other,37.26,69,,37.26,percent of total billed charges,All Other,35.1,65,,35.1,percent of total billed charges,All Other,37.8,70,,37.8,percent of total billed charges,All Other,61.47,,,61.47,Case Rate,,0.01,,,0.01,Other,186% of Medicaid,72.34,,,72.34,Case Rate,,34.06,,,34.06,Fee Schedule,,34.06,,,,Fee Schedule,,72.34,,,72.34,Case Rate,,34.06,,,34.06,Fee Schedule,,64.07,,,64.07,Fee Schedule,,37.8,70,,37.8,percent of total billed charges,,73.8,,,73.8,Fee Schedule,,62.55,,,62.55,Fee Schedule,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,73.8,
PT EDUCATION NOC INDIVID LACTATION COUNS,S9445,HCPCS,,26000009,CDM,942,RC,,,both,,,217,85.64,39.4668,,85.64,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,141.05,65,,141.05,percent of total billed charges,All Other,128.03,59,,128.03,percent of total billed charges,All Other,166.01,76.5,,166.01,percent of total billed charges,All Other,149.73,69,,149.73,percent of total billed charges,All Other,141.05,65,,141.05,percent of total billed charges,All Other,151.9,70,,151.9,percent of total billed charges,All Other,147.56,68,,147.56,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,173.6,80,,173.6,percent of total billed charges,All Other,134.54,62,,134.54,percent of total billed charges,Lab & Radiology,119.35,55,,,percent of total billed charges,Default if not in Fee Schedule,173.6,80,,173.6,percent of total billed charges,All Other,134.54,62,,134.54,percent of total billed charges,Lab & Radiology,173.6,80,,173.6,percent of total billed charges,All Other,151.9,70,,151.9,percent of total billed charges,,141.05,65,,141.05,percent of total billed charges,All Other,141.05,65,,141.05,percent of total billed charges,All Other,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,173.6,
PT EDUCATION NOC GROUP LACTATION COUNS,S9446,HCPCS,,26000010,CDM,942,RC,,,both,,,63,24.86,39.4668,,24.86,percent of total billed charges,Non-covered Medicare Charges 36% + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,40.95,65,,40.95,percent of total billed charges,All Other,37.17,59,,37.17,percent of total billed charges,All Other,48.2,76.5,,48.2,percent of total billed charges,All Other,43.47,69,,43.47,percent of total billed charges,All Other,40.95,65,,40.95,percent of total billed charges,All Other,44.1,70,,44.1,percent of total billed charges,All Other,42.84,68,,42.84,percent of total billed charges,All Other,0.01,,,0.01,Other,186% of Medicaid,50.4,80,,50.4,percent of total billed charges,All Other,39.06,62,,39.06,percent of total billed charges,Lab & Radiology,34.65,55,,,percent of total billed charges,Default if not in Fee Schedule,50.4,80,,50.4,percent of total billed charges,All Other,39.06,62,,39.06,percent of total billed charges,Lab & Radiology,50.4,80,,50.4,percent of total billed charges,All Other,44.1,70,,44.1,percent of total billed charges,,40.95,65,,40.95,percent of total billed charges,All Other,40.95,65,,40.95,percent of total billed charges,All Other,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Case Rate,,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,100% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,153% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,140% of Medicaid,0.01,,,0.01,Other,225% of Medicaid,0.01,,,0.01,Other,250% of Medicaid,0.01,,,0.01,Other,324% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,215% of Medicaid,0.01,,,0.01,Other,125% of Medicaid,0.01,50.4,
PAD REHAB PER SESSION,93668,CPT,,52093668,CDM,943,RC,,,both,,,362,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS,47.17,,,47.17,Fee Schedule,,42.53,,,42.53,Fee Schedule,,18.33,,,18.33,Fee Schedule,,18.33,,,18.33,Fee Schedule,,18.33,,,18.33,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,All Other,60.6,,,60.6,Fee Schedule,,269,,,269,Other,186% of Medicaid,71.32,,,71.32,Fee Schedule,,224.44,,,224.44,Fee Schedule,,33.58,,,,Fee Schedule,,71.32,,,71.32,Fee Schedule,,224.44,,,224.44,Fee Schedule,,63.16,,,63.16,Fee Schedule,,253.4,70,,253.4,percent of total billed charges,,67.24,,,67.24,Fee Schedule,,56.99,,,56.99,Fee Schedule,,181,,,181,Case Rate,,181,,,181,Case Rate,,181,,,181,Case Rate,,181,,,181,Case Rate,,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,144.79,,,144.79,Other,100% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,221.52,,,221.52,Other,153% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,202.7,,,202.7,Other,140% of Medicaid,325.77,,,325.77,Other,225% of Medicaid,376.44,,,376.44,Other,250% of Medicaid,469.11,,,469.11,Other,324% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,311.29,,,311.29,Other,215% of Medicaid,180.98,,,180.98,Other,125% of Medicaid,18.33,469.11,
CARDIAC REHAB; W CONT ECG,93798,CPT,,52093798,CDM,943,RC,,,both,,,295,238.77,,,238.77,Other,150% of Medicare + 9.63% HCRA Surcharge,145.2,,,145.2,Other,Medicare OPPS,41.42,,,41.42,Fee Schedule,,37.35,,,37.35,Fee Schedule,,158.49,,,158.49,Fee Schedule,,142.67,,,142.67,Fee Schedule,,134.76,,,134.76,Fee Schedule,,206.5,70,,206.5,percent of total billed charges,All Other,53.21,,,53.21,Fee Schedule,,72,,,72,Other,186% of Medicaid,62.62,,,62.62,Fee Schedule,,182.9,,,182.9,Fee Schedule,,29.48,,,,Fee Schedule,,62.62,,,62.62,Fee Schedule,,182.9,,,182.9,Fee Schedule,,55.46,,,55.46,Fee Schedule,,206.5,70,,206.5,percent of total billed charges,,65.6,,,65.6,Fee Schedule,,55.6,,,55.6,Fee Schedule,,147.5,,,147.5,Case Rate,,147.5,,,147.5,Case Rate,,147.5,,,147.5,Case Rate,,147.5,,,147.5,Case Rate,,38.82,,,38.82,Other,100% of Medicaid,38.82,,,38.82,Other,100% of Medicaid,38.82,,,38.82,Other,100% of Medicaid,38.82,,,38.82,Other,100% of Medicaid,87.34,,,87.34,Other,225% of Medicaid,59.39,,,59.39,Other,153% of Medicaid,87.34,,,87.34,Other,225% of Medicaid,54.35,,,54.35,Other,140% of Medicaid,87.34,,,87.34,Other,225% of Medicaid,100.93,,,100.93,Other,250% of Medicaid,125.77,,,125.77,Other,324% of Medicaid,83.46,,,83.46,Other,215% of Medicaid,83.46,,,83.46,Other,215% of Medicaid,48.52,,,48.52,Other,125% of Medicaid,29.48,238.77,
CARDIAC REHAB; W CONT ECG W KX MOD,93798,CPT,KX,52193798,CDM,943,RC,,,both,,,295,238.77,,,238.77,Other,150% of Medicare + 9.63% HCRA Surcharge,145.2,,,145.2,Other,Medicare OPPS,41.42,,,41.42,Fee Schedule,,37.35,,,37.35,Fee Schedule,,158.49,,,158.49,Fee Schedule,,142.67,,,142.67,Fee Schedule,,134.76,,,134.76,Fee Schedule,,206.5,70,,206.5,percent of total billed charges,All Other,53.21,,,53.21,Fee Schedule,,72,,,72,Other,186% of Medicaid,62.62,,,62.62,Fee Schedule,,182.9,,,182.9,Fee Schedule,,29.48,,,,Fee Schedule,,62.62,,,62.62,Fee Schedule,,182.9,,,182.9,Fee Schedule,,55.46,,,55.46,Fee Schedule,,206.5,70,,206.5,percent of total billed charges,,65.6,,,65.6,Fee Schedule,,55.6,,,55.6,Fee Schedule,,147.5,,,147.5,Case Rate,,147.5,,,147.5,Case Rate,,147.5,,,147.5,Case Rate,,147.5,,,147.5,Case Rate,,38.82,,,38.82,Other,100% of Medicaid,38.82,,,38.82,Other,100% of Medicaid,38.82,,,38.82,Other,100% of Medicaid,38.82,,,38.82,Other,100% of Medicaid,87.34,,,87.34,Other,225% of Medicaid,59.39,,,59.39,Other,153% of Medicaid,87.34,,,87.34,Other,225% of Medicaid,54.35,,,54.35,Other,140% of Medicaid,87.34,,,87.34,Other,225% of Medicaid,100.93,,,100.93,Other,250% of Medicaid,125.77,,,125.77,Other,324% of Medicaid,83.46,,,83.46,Other,215% of Medicaid,83.46,,,83.46,Other,215% of Medicaid,48.52,,,48.52,Other,125% of Medicaid,29.48,238.77,
TH-ALCOHOL/DRUG SERVICES C&T PER 15 MINS,H0004,HCPCS,GT,36000001,CDM,944,RC,,,both,,,72,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Non Covered Service,46.8,65,,46.8,percent of total billed charges,All Other,42.48,59,,42.48,percent of total billed charges,All Other,55.08,76.5,,55.08,percent of total billed charges,All Other,49.68,69,,49.68,percent of total billed charges,All Other,46.8,65,,46.8,percent of total billed charges,All Other,50.4,70,,50.4,percent of total billed charges,All Other,48.96,68,,48.96,percent of total billed charges,All Other,188,,,188,Other,186% of Medicaid,57.6,80,,57.6,percent of total billed charges,All Other,44.64,62,,44.64,percent of total billed charges,Lab & Radiology,39.6,55,,,percent of total billed charges,Default if not in Fee Schedule,57.6,80,,57.6,percent of total billed charges,All Other,44.64,62,,44.64,percent of total billed charges,Lab & Radiology,57.6,80,,57.6,percent of total billed charges,All Other,50.4,70,,50.4,percent of total billed charges,,46.8,65,,46.8,percent of total billed charges,All Other,46.8,65,,46.8,percent of total billed charges,All Other,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,0.01,,,0.01,Fee Schedule,,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,101.27,,,101.27,Other,100% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,154.94,,,154.94,Other,153% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,141.77,,,141.77,Other,140% of Medicaid,227.85,,,227.85,Other,225% of Medicaid,263.29,,,263.29,Other,250% of Medicaid,328.11,,,328.11,Other,324% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,217.72,,,217.72,Other,215% of Medicaid,126.58,,,126.58,Other,125% of Medicaid,0.01,328.11,
CYTO/MOLECULAR REPORT,88291,CPT,,78088291,CDM,971,RC,,,both,,,682,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,106.25,,,106.25,Fee Schedule,,95.66,,,95.66,Fee Schedule,,182.87,,,182.87,Fee Schedule,,164.51,,,164.51,Fee Schedule,,155.5,,,155.5,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,All Other,111.2,,,111.2,Fee Schedule,,117,,,117,Other,186% of Medicaid,130.96,,,130.96,Fee Schedule,,74.13,,,74.13,Fee Schedule,,74.13,,,,Fee Schedule,,130.96,,,130.96,Fee Schedule,,74.13,,,74.13,Fee Schedule,,139.44,,,139.44,Fee Schedule,,477.4,70,,477.4,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,51.98,,,51.98,Fee Schedule,,51.98,,,51.98,Fee Schedule,,51.98,,,51.98,Fee Schedule,,51.98,,,51.98,Fee Schedule,,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,63.06,,,63.06,Other,100% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,96.48,,,96.48,Other,153% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,88.29,,,88.29,Other,140% of Medicaid,141.89,,,141.89,Other,225% of Medicaid,163.96,,,163.96,Other,250% of Medicaid,204.32,,,204.32,Other,324% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,135.58,,,135.58,Other,215% of Medicaid,78.83,,,78.83,Other,125% of Medicaid,0.01,477.4,
RHYTHM ECG REPORT,93042,CPT,,30093042,CDM,985,RC,,,both,,,41,0.01,,,0.01,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS,20.65,,,20.65,Fee Schedule,,18.62,,,18.62,Fee Schedule,,31.37,76.5,,31.37,percent of total billed charges,All Other,28.29,69,,28.29,percent of total billed charges,All Other,26.65,65,,26.65,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,All Other,27.88,68,,27.88,percent of total billed charges,All Other,78,,,78,Other,186% of Medicaid,32.8,80,,32.8,percent of total billed charges,All Other,34.03,83,,34.03,percent of total billed charges,All Other,34.03,83,,34.03,percent of total billed charges,All Other,32.8,80,,32.8,percent of total billed charges,All Other,34.03,83,,34.03,percent of total billed charges,All Other,27.65,,,27.65,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,,32.8,,,32.8,Fee Schedule,,27.8,,,27.8,Fee Schedule,,28.7,70,,28.7,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,All Other,28.7,70,,28.7,percent of total billed charges,All Other,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,42.05,,,42.05,Other,100% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,64.34,,,64.34,Other,153% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,58.87,,,58.87,Other,140% of Medicaid,94.62,,,94.62,Other,225% of Medicaid,109.34,,,109.34,Other,250% of Medicaid,136.25,,,136.25,Other,324% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,90.41,,,90.41,Other,215% of Medicaid,52.57,,,52.57,Other,125% of Medicaid,0.01,136.25,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,,,,inpatient,,,2142512.18,293824,,,293824,Other,150% of Medicare + 9.63% HCRA Surcharge,178676.02,,,178676.02,Other,Medicare IPPS methodology,533988,,"25,046 x DRG weight",533988,Other,base rate x DRG weight,480581,,"22,541 x DRG weight",480581,Other,base rate x DRG weight,684190,,"32,091 x DRG weight",684190,Other,base rate x DRG weight,615773,,"28,882 x DRG weight",615773,Other,base rate x DRG weight,581554,,"27,277 x DRG weight",581554,Other,base rate x DRG weight,513393,,"24,080 x DRG weight",513393,Other,base rate x DRG weight,478918,,"22,463 x DRG weight",478918,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,563410,,"26,426 x DRG weight",563410,Other,base rate x DRG weight,827420,,"38,809 x DRG weight",827420,Other,base rate x DRG weight,827420,,"38,809 x DRG weight",827420,Other,base rate x DRG weight,563410,,"26,426 x DRG weight",563410,Other,base rate x DRG weight,827420,,"38,809 x DRG weight",827420,Other,base rate x DRG weight,232250,,"6,363 x patient days",232250,Per diem,,1499759,70,,1499759,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,534223,,"25,057 x DRG weight",534223,Other,base rate x DRG weight,480815,,"22,552 x DRG weight",480815,Other,base rate x DRG weight,534223,,"25,057 x DRG weight",534223,Other,base rate x DRG weight,454080,,"21,298 x DRG weight",454080,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,1499759,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,,,,inpatient,,,2138389.4,202755,,,202755,Other,150% of Medicare + 9.63% HCRA Surcharge,123296.7,,,123296.7,Other,Medicare IPPS methodology,368176,,"25,046 x DRG weight",368176,Other,base rate x DRG weight,331353,,"22,541 x DRG weight",331353,Other,base rate x DRG weight,471738,,"32,091 x DRG weight",471738,Other,base rate x DRG weight,424565,,"28,882 x DRG weight",424565,Other,base rate x DRG weight,400972,,"27,277 x DRG weight",400972,Other,base rate x DRG weight,353976,,"24,080 x DRG weight",353976,Other,base rate x DRG weight,330206,,"22,463 x DRG weight",330206,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,388462,,"26,426 x DRG weight",388462,Other,base rate x DRG weight,570492,,"38,809 x DRG weight",570492,Other,base rate x DRG weight,570492,,"38,809 x DRG weight",570492,Other,base rate x DRG weight,388462,,"26,426 x DRG weight",388462,Other,base rate x DRG weight,570492,,"38,809 x DRG weight",570492,Other,base rate x DRG weight,203616,,"6,363 x patient days",203616,Per diem,,1496873,70,,1496873,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,368338,,"25,057 x DRG weight",368338,Other,base rate x DRG weight,331514,,"22,552 x DRG weight",331514,Other,base rate x DRG weight,368338,,"25,057 x DRG weight",368338,Other,base rate x DRG weight,313081,,"21,298 x DRG weight",313081,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,1496873,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,,,,inpatient,,,1018970.79,71473,,,71473,Other,150% of Medicare + 9.63% HCRA Surcharge,43462.92,,,43462.92,Other,Medicare IPPS methodology,129145,,"25,046 x DRG weight",129145,Other,base rate x DRG weight,116228,,"22,541 x DRG weight",116228,Other,base rate x DRG weight,165471,,"32,091 x DRG weight",165471,Other,base rate x DRG weight,148924,,"28,882 x DRG weight",148924,Other,base rate x DRG weight,140648,,"27,277 x DRG weight",140648,Other,base rate x DRG weight,124164,,"24,080 x DRG weight",124164,Other,base rate x DRG weight,115826,,"22,463 x DRG weight",115826,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,136260,,"26,426 x DRG weight",136260,Other,base rate x DRG weight,200111,,"38,809 x DRG weight",200111,Other,base rate x DRG weight,200111,,"38,809 x DRG weight",200111,Other,base rate x DRG weight,136260,,"26,426 x DRG weight",136260,Other,base rate x DRG weight,200111,,"38,809 x DRG weight",200111,Other,base rate x DRG weight,94172,,"6,363 x patient days",94172,Per diem,,713280,70,,713280,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,129201,,"25,057 x DRG weight",129201,Other,base rate x DRG weight,116285,,"22,552 x DRG weight",116285,Other,base rate x DRG weight,129201,,"25,057 x DRG weight",129201,Other,base rate x DRG weight,109819,,"21,298 x DRG weight",109819,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,713280,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,,,,inpatient,,,746089.01,55634,,,55634,Other,150% of Medicare + 9.63% HCRA Surcharge,33831.37,,,33831.37,Other,Medicare IPPS methodology,100307,,"25,046 x DRG weight",100307,Other,base rate x DRG weight,90274,,"22,541 x DRG weight",90274,Other,base rate x DRG weight,128521,,"32,091 x DRG weight",128521,Other,base rate x DRG weight,115670,,"28,882 x DRG weight",115670,Other,base rate x DRG weight,109242,,"27,277 x DRG weight",109242,Other,base rate x DRG weight,96438,,"24,080 x DRG weight",96438,Other,base rate x DRG weight,89962,,"22,463 x DRG weight",89962,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,105833,,"26,426 x DRG weight",105833,Other,base rate x DRG weight,155426,,"38,809 x DRG weight",155426,Other,base rate x DRG weight,155426,,"38,809 x DRG weight",155426,Other,base rate x DRG weight,105833,,"26,426 x DRG weight",105833,Other,base rate x DRG weight,155426,,"38,809 x DRG weight",155426,Other,base rate x DRG weight,62357,,"6,363 x patient days",62357,Per diem,,522262,70,,522262,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,100351,,"25,057 x DRG weight",100351,Other,base rate x DRG weight,90319,,"22,552 x DRG weight",90319,Other,base rate x DRG weight,100351,,"25,057 x DRG weight",100351,Other,base rate x DRG weight,85296,,"21,298 x DRG weight",85296,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,522262,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,,,,inpatient,,,640772.94,37487,,,37487,Other,150% of Medicare + 9.63% HCRA Surcharge,22796.16,,,22796.16,Other,Medicare IPPS methodology,67266,,"25,046 x DRG weight",67266,Other,base rate x DRG weight,60538,,"22,541 x DRG weight",60538,Other,base rate x DRG weight,86187,,"32,091 x DRG weight",86187,Other,base rate x DRG weight,77568,,"28,882 x DRG weight",77568,Other,base rate x DRG weight,73258,,"27,277 x DRG weight",73258,Other,base rate x DRG weight,64672,,"24,080 x DRG weight",64672,Other,base rate x DRG weight,60329,,"22,463 x DRG weight",60329,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,70972,,"26,426 x DRG weight",70972,Other,base rate x DRG weight,104229,,"38,809 x DRG weight",104229,Other,base rate x DRG weight,104229,,"38,809 x DRG weight",104229,Other,base rate x DRG weight,70972,,"26,426 x DRG weight",70972,Other,base rate x DRG weight,104229,,"38,809 x DRG weight",104229,Other,base rate x DRG weight,44541,,"6,363 x patient days",44541,Per diem,,448541,70,,448541,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,67296,,"25,057 x DRG weight",67296,Other,base rate x DRG weight,60568,,"22,552 x DRG weight",60568,Other,base rate x DRG weight,67296,,"25,057 x DRG weight",67296,Other,base rate x DRG weight,57200,,"21,298 x DRG weight",57200,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,448541,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,,,,inpatient,,,2269653,507349,,,507349,Other,150% of Medicare + 9.63% HCRA Surcharge,308522.09,,,308522.09,Other,Medicare IPPS methodology,922762,,"25,046 x DRG weight",922762,Other,base rate x DRG weight,830471,,"22,541 x DRG weight",830471,Other,base rate x DRG weight,1182319,,"32,091 x DRG weight",1182319,Other,base rate x DRG weight,1064091,,"28,882 x DRG weight",1064091,Other,base rate x DRG weight,1004958,,"27,277 x DRG weight",1004958,Other,base rate x DRG weight,887172,,"24,080 x DRG weight",887172,Other,base rate x DRG weight,827598,,"22,463 x DRG weight",827598,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,973605,,"26,426 x DRG weight",973605,Other,base rate x DRG weight,1429828,,"38,809 x DRG weight",1429828,Other,base rate x DRG weight,1429828,,"38,809 x DRG weight",1429828,Other,base rate x DRG weight,973605,,"26,426 x DRG weight",973605,Other,base rate x DRG weight,1429828,,"38,809 x DRG weight",1429828,Other,base rate x DRG weight,96081,,"6,363 x patient days",96081,Per diem,,1588757,70,,1588757,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,923168,,"25,057 x DRG weight",923168,Other,base rate x DRG weight,830877,,"22,552 x DRG weight",830877,Other,base rate x DRG weight,923168,,"25,057 x DRG weight",923168,Other,base rate x DRG weight,784676,,"21,298 x DRG weight",784676,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,1588757,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,,,,inpatient,,,843972.12,116814,,,116814,Other,150% of Medicare + 9.63% HCRA Surcharge,71035.05,,,71035.05,Other,Medicare IPPS methodology,211699,,"25,046 x DRG weight",211699,Other,base rate x DRG weight,190526,,"22,541 x DRG weight",190526,Other,base rate x DRG weight,271246,,"32,091 x DRG weight",271246,Other,base rate x DRG weight,244122,,"28,882 x DRG weight",244122,Other,base rate x DRG weight,230556,,"27,277 x DRG weight",230556,Other,base rate x DRG weight,203534,,"24,080 x DRG weight",203534,Other,base rate x DRG weight,189866,,"22,463 x DRG weight",189866,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,223363,,"26,426 x DRG weight",223363,Other,base rate x DRG weight,328029,,"38,809 x DRG weight",328029,Other,base rate x DRG weight,328029,,"38,809 x DRG weight",328029,Other,base rate x DRG weight,223363,,"26,426 x DRG weight",223363,Other,base rate x DRG weight,328029,,"38,809 x DRG weight",328029,Other,base rate x DRG weight,89718,,"6,363 x patient days",89718,Per diem,,590780,70,,590780,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,211792,,"25,057 x DRG weight",211792,Other,base rate x DRG weight,190619,,"22,552 x DRG weight",190619,Other,base rate x DRG weight,211792,,"25,057 x DRG weight",211792,Other,base rate x DRG weight,180019,,"21,298 x DRG weight",180019,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,590780,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,,,,inpatient,,,431596.61,85024,,,85024,Other,150% of Medicare + 9.63% HCRA Surcharge,51703.35,,,51703.35,Other,Medicare IPPS methodology,153818,,"25,046 x DRG weight",153818,Other,base rate x DRG weight,138433,,"22,541 x DRG weight",138433,Other,base rate x DRG weight,197084,,"32,091 x DRG weight",197084,Other,base rate x DRG weight,177376,,"28,882 x DRG weight",177376,Other,base rate x DRG weight,167519,,"27,277 x DRG weight",167519,Other,base rate x DRG weight,147885,,"24,080 x DRG weight",147885,Other,base rate x DRG weight,137954,,"22,463 x DRG weight",137954,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,162293,,"26,426 x DRG weight",162293,Other,base rate x DRG weight,238342,,"38,809 x DRG weight",238342,Other,base rate x DRG weight,238342,,"38,809 x DRG weight",238342,Other,base rate x DRG weight,162293,,"26,426 x DRG weight",162293,Other,base rate x DRG weight,238342,,"38,809 x DRG weight",238342,Other,base rate x DRG weight,57267,,"6,363 x patient days",57267,Per diem,,302118,70,,302118,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,153885,,"25,057 x DRG weight",153885,Other,base rate x DRG weight,138501,,"22,552 x DRG weight",138501,Other,base rate x DRG weight,153885,,"25,057 x DRG weight",153885,Other,base rate x DRG weight,130800,,"21,298 x DRG weight",130800,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,302118,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,,,,inpatient,,,383655.44,54503,,,54503,Other,150% of Medicare + 9.63% HCRA Surcharge,33143.76,,,33143.76,Other,Medicare IPPS methodology,98248,,"25,046 x DRG weight",98248,Other,base rate x DRG weight,88422,,"22,541 x DRG weight",88422,Other,base rate x DRG weight,125883,,"32,091 x DRG weight",125883,Other,base rate x DRG weight,113295,,"28,882 x DRG weight",113295,Other,base rate x DRG weight,106999,,"27,277 x DRG weight",106999,Other,base rate x DRG weight,94459,,"24,080 x DRG weight",94459,Other,base rate x DRG weight,88116,,"22,463 x DRG weight",88116,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,103661,,"26,426 x DRG weight",103661,Other,base rate x DRG weight,152236,,"38,809 x DRG weight",152236,Other,base rate x DRG weight,152236,,"38,809 x DRG weight",152236,Other,base rate x DRG weight,103661,,"26,426 x DRG weight",103661,Other,base rate x DRG weight,152236,,"38,809 x DRG weight",152236,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,268559,70,,268559,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,98291,,"25,057 x DRG weight",98291,Other,base rate x DRG weight,88465,,"22,552 x DRG weight",88465,Other,base rate x DRG weight,98291,,"25,057 x DRG weight",98291,Other,base rate x DRG weight,83546,,"21,298 x DRG weight",83546,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,268559,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,,,,inpatient,,,464200.84,78523,,,78523,Other,150% of Medicare + 9.63% HCRA Surcharge,47750.02,,,47750.02,Other,Medicare IPPS methodology,141981,,"25,046 x DRG weight",141981,Other,base rate x DRG weight,127780,,"22,541 x DRG weight",127780,Other,base rate x DRG weight,181917,,"32,091 x DRG weight",181917,Other,base rate x DRG weight,163726,,"28,882 x DRG weight",163726,Other,base rate x DRG weight,154628,,"27,277 x DRG weight",154628,Other,base rate x DRG weight,136505,,"24,080 x DRG weight",136505,Other,base rate x DRG weight,127338,,"22,463 x DRG weight",127338,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,149804,,"26,426 x DRG weight",149804,Other,base rate x DRG weight,220000,,"38,809 x DRG weight",220000,Other,base rate x DRG weight,220000,,"38,809 x DRG weight",220000,Other,base rate x DRG weight,149804,,"26,426 x DRG weight",149804,Other,base rate x DRG weight,220000,,"38,809 x DRG weight",220000,Other,base rate x DRG weight,66812,,"6,363 x patient days",66812,Per diem,,324941,70,,324941,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,142043,,"25,057 x DRG weight",142043,Other,base rate x DRG weight,127843,,"22,552 x DRG weight",127843,Other,base rate x DRG weight,142043,,"25,057 x DRG weight",142043,Other,base rate x DRG weight,120734,,"21,298 x DRG weight",120734,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,324941,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,,,,inpatient,,,345432.72,52661,,,52661,Other,150% of Medicare + 9.63% HCRA Surcharge,32023.67,,,32023.67,Other,Medicare IPPS methodology,94894,,"25,046 x DRG weight",94894,Other,base rate x DRG weight,85403,,"22,541 x DRG weight",85403,Other,base rate x DRG weight,121586,,"32,091 x DRG weight",121586,Other,base rate x DRG weight,109428,,"28,882 x DRG weight",109428,Other,base rate x DRG weight,103347,,"27,277 x DRG weight",103347,Other,base rate x DRG weight,91234,,"24,080 x DRG weight",91234,Other,base rate x DRG weight,85108,,"22,463 x DRG weight",85108,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,100123,,"26,426 x DRG weight",100123,Other,base rate x DRG weight,147040,,"38,809 x DRG weight",147040,Other,base rate x DRG weight,147040,,"38,809 x DRG weight",147040,Other,base rate x DRG weight,100123,,"26,426 x DRG weight",100123,Other,base rate x DRG weight,147040,,"38,809 x DRG weight",147040,Other,base rate x DRG weight,33088,,"6,363 x patient days",33088,Per diem,,241803,70,,241803,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,94936,,"25,057 x DRG weight",94936,Other,base rate x DRG weight,85445,,"22,552 x DRG weight",85445,Other,base rate x DRG weight,94936,,"25,057 x DRG weight",94936,Other,base rate x DRG weight,80694,,"21,298 x DRG weight",80694,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,241803,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,,,,inpatient,,,461817.62,61289,,,61289,Other,150% of Medicare + 9.63% HCRA Surcharge,37270.25,,,37270.25,Other,Medicare IPPS methodology,110603,,"25,046 x DRG weight",110603,Other,base rate x DRG weight,99541,,"22,541 x DRG weight",99541,Other,base rate x DRG weight,141714,,"32,091 x DRG weight",141714,Other,base rate x DRG weight,127543,,"28,882 x DRG weight",127543,Other,base rate x DRG weight,120455,,"27,277 x DRG weight",120455,Other,base rate x DRG weight,106337,,"24,080 x DRG weight",106337,Other,base rate x DRG weight,99197,,"22,463 x DRG weight",99197,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,116697,,"26,426 x DRG weight",116697,Other,base rate x DRG weight,171381,,"38,809 x DRG weight",171381,Other,base rate x DRG weight,171381,,"38,809 x DRG weight",171381,Other,base rate x DRG weight,116697,,"26,426 x DRG weight",116697,Other,base rate x DRG weight,171381,,"38,809 x DRG weight",171381,Other,base rate x DRG weight,57903,,"6,363 x patient days",57903,Per diem,,323272,70,,323272,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,110652,,"25,057 x DRG weight",110652,Other,base rate x DRG weight,99590,,"22,552 x DRG weight",99590,Other,base rate x DRG weight,110652,,"25,057 x DRG weight",110652,Other,base rate x DRG weight,94052,,"21,298 x DRG weight",94052,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,323272,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,,,,inpatient,,,336299.27,41165,,,41165,Other,150% of Medicare + 9.63% HCRA Surcharge,25032.98,,,25032.98,Other,Medicare IPPS methodology,73963,,"25,046 x DRG weight",73963,Other,base rate x DRG weight,66566,,"22,541 x DRG weight",66566,Other,base rate x DRG weight,94768,,"32,091 x DRG weight",94768,Other,base rate x DRG weight,85291,,"28,882 x DRG weight",85291,Other,base rate x DRG weight,80552,,"27,277 x DRG weight",80552,Other,base rate x DRG weight,71111,,"24,080 x DRG weight",71111,Other,base rate x DRG weight,66335,,"22,463 x DRG weight",66335,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,78039,,"26,426 x DRG weight",78039,Other,base rate x DRG weight,114607,,"38,809 x DRG weight",114607,Other,base rate x DRG weight,114607,,"38,809 x DRG weight",114607,Other,base rate x DRG weight,78039,,"26,426 x DRG weight",78039,Other,base rate x DRG weight,114607,,"38,809 x DRG weight",114607,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,235409,70,,235409,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,73996,,"25,057 x DRG weight",73996,Other,base rate x DRG weight,66598,,"22,552 x DRG weight",66598,Other,base rate x DRG weight,73996,,"25,057 x DRG weight",73996,Other,base rate x DRG weight,62895,,"21,298 x DRG weight",62895,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,235409,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,,,,inpatient,,,206391.91,34010,,,34010,Other,150% of Medicare + 9.63% HCRA Surcharge,20681.47,,,20681.47,Other,Medicare IPPS methodology,60934,,"25,046 x DRG weight",60934,Other,base rate x DRG weight,54840,,"22,541 x DRG weight",54840,Other,base rate x DRG weight,78074,,"32,091 x DRG weight",78074,Other,base rate x DRG weight,70267,,"28,882 x DRG weight",70267,Other,base rate x DRG weight,66362,,"27,277 x DRG weight",66362,Other,base rate x DRG weight,58584,,"24,080 x DRG weight",58584,Other,base rate x DRG weight,54650,,"22,463 x DRG weight",54650,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,64292,,"26,426 x DRG weight",64292,Other,base rate x DRG weight,94418,,"38,809 x DRG weight",94418,Other,base rate x DRG weight,94418,,"38,809 x DRG weight",94418,Other,base rate x DRG weight,64292,,"26,426 x DRG weight",64292,Other,base rate x DRG weight,94418,,"38,809 x DRG weight",94418,Other,base rate x DRG weight,13362,,"6,363 x patient days",13362,Per diem,,144474,70,,144474,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,60961,,"25,057 x DRG weight",60961,Other,base rate x DRG weight,54867,,"22,552 x DRG weight",54867,Other,base rate x DRG weight,60961,,"25,057 x DRG weight",60961,Other,base rate x DRG weight,51816,,"21,298 x DRG weight",51816,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,144474,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,,,,inpatient,,,524282.81,83438,,,83438,Other,150% of Medicare + 9.63% HCRA Surcharge,50738.86,,,50738.86,Other,Medicare IPPS methodology,150930,,"25,046 x DRG weight",150930,Other,base rate x DRG weight,135834,,"22,541 x DRG weight",135834,Other,base rate x DRG weight,193384,,"32,091 x DRG weight",193384,Other,base rate x DRG weight,174046,,"28,882 x DRG weight",174046,Other,base rate x DRG weight,164374,,"27,277 x DRG weight",164374,Other,base rate x DRG weight,145108,,"24,080 x DRG weight",145108,Other,base rate x DRG weight,135364,,"22,463 x DRG weight",135364,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,159246,,"26,426 x DRG weight",159246,Other,base rate x DRG weight,233867,,"38,809 x DRG weight",233867,Other,base rate x DRG weight,233867,,"38,809 x DRG weight",233867,Other,base rate x DRG weight,159246,,"26,426 x DRG weight",159246,Other,base rate x DRG weight,233867,,"38,809 x DRG weight",233867,Other,base rate x DRG weight,83992,,"6,363 x patient days",83992,Per diem,,366998,70,,366998,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,150996,,"25,057 x DRG weight",150996,Other,base rate x DRG weight,135901,,"22,552 x DRG weight",135901,Other,base rate x DRG weight,150996,,"25,057 x DRG weight",150996,Other,base rate x DRG weight,128344,,"21,298 x DRG weight",128344,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,366998,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,,,,inpatient,,,391448.89,47701,,,47701,Other,150% of Medicare + 9.63% HCRA Surcharge,29007.23,,,29007.23,Other,Medicare IPPS methodology,85863,,"25,046 x DRG weight",85863,Other,base rate x DRG weight,77275,,"22,541 x DRG weight",77275,Other,base rate x DRG weight,110014,,"32,091 x DRG weight",110014,Other,base rate x DRG weight,99013,,"28,882 x DRG weight",99013,Other,base rate x DRG weight,93511,,"27,277 x DRG weight",93511,Other,base rate x DRG weight,82551,,"24,080 x DRG weight",82551,Other,base rate x DRG weight,77008,,"22,463 x DRG weight",77008,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,90594,,"26,426 x DRG weight",90594,Other,base rate x DRG weight,133045,,"38,809 x DRG weight",133045,Other,base rate x DRG weight,133045,,"38,809 x DRG weight",133045,Other,base rate x DRG weight,90594,,"26,426 x DRG weight",90594,Other,base rate x DRG weight,133045,,"38,809 x DRG weight",133045,Other,base rate x DRG weight,41360,,"6,363 x patient days",41360,Per diem,,274014,70,,274014,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,85900,,"25,057 x DRG weight",85900,Other,base rate x DRG weight,77313,,"22,552 x DRG weight",77313,Other,base rate x DRG weight,85900,,"25,057 x DRG weight",85900,Other,base rate x DRG weight,73014,,"21,298 x DRG weight",73014,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,274014,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,,,,inpatient,,,216991.21,32443,,,32443,Other,150% of Medicare + 9.63% HCRA Surcharge,19728.68,,,19728.68,Other,Medicare IPPS methodology,58082,,"25,046 x DRG weight",58082,Other,base rate x DRG weight,52273,,"22,541 x DRG weight",52273,Other,base rate x DRG weight,74419,,"32,091 x DRG weight",74419,Other,base rate x DRG weight,66977,,"28,882 x DRG weight",66977,Other,base rate x DRG weight,63255,,"27,277 x DRG weight",63255,Other,base rate x DRG weight,55842,,"24,080 x DRG weight",55842,Other,base rate x DRG weight,52092,,"22,463 x DRG weight",52092,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,61282,,"26,426 x DRG weight",61282,Other,base rate x DRG weight,89998,,"38,809 x DRG weight",89998,Other,base rate x DRG weight,89998,,"38,809 x DRG weight",89998,Other,base rate x DRG weight,61282,,"26,426 x DRG weight",61282,Other,base rate x DRG weight,89998,,"38,809 x DRG weight",89998,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,151894,70,,151894,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,58107,,"25,057 x DRG weight",58107,Other,base rate x DRG weight,52298,,"22,552 x DRG weight",52298,Other,base rate x DRG weight,58107,,"25,057 x DRG weight",58107,Other,base rate x DRG weight,49390,,"21,298 x DRG weight",49390,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,151894,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,,,,inpatient,,,307699.13,57171,,,57171,Other,150% of Medicare + 9.63% HCRA Surcharge,34765.75,,,34765.75,Other,Medicare IPPS methodology,103104,,"25,046 x DRG weight",103104,Other,base rate x DRG weight,92792,,"22,541 x DRG weight",92792,Other,base rate x DRG weight,132106,,"32,091 x DRG weight",132106,Other,base rate x DRG weight,118896,,"28,882 x DRG weight",118896,Other,base rate x DRG weight,112288,,"27,277 x DRG weight",112288,Other,base rate x DRG weight,99128,,"24,080 x DRG weight",99128,Other,base rate x DRG weight,92471,,"22,463 x DRG weight",92471,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,108785,,"26,426 x DRG weight",108785,Other,base rate x DRG weight,159761,,"38,809 x DRG weight",159761,Other,base rate x DRG weight,159761,,"38,809 x DRG weight",159761,Other,base rate x DRG weight,108785,,"26,426 x DRG weight",108785,Other,base rate x DRG weight,159761,,"38,809 x DRG weight",159761,Other,base rate x DRG weight,66175,,"6,363 x patient days",66175,Per diem,,215389,70,,215389,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,103150,,"25,057 x DRG weight",103150,Other,base rate x DRG weight,92838,,"22,552 x DRG weight",92838,Other,base rate x DRG weight,103150,,"25,057 x DRG weight",103150,Other,base rate x DRG weight,87675,,"21,298 x DRG weight",87675,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,215389,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,,,,inpatient,,,206595.31,30170,,,30170,Other,150% of Medicare + 9.63% HCRA Surcharge,18346.77,,,18346.77,Other,Medicare IPPS methodology,53944,,"25,046 x DRG weight",53944,Other,base rate x DRG weight,48549,,"22,541 x DRG weight",48549,Other,base rate x DRG weight,69118,,"32,091 x DRG weight",69118,Other,base rate x DRG weight,62206,,"28,882 x DRG weight",62206,Other,base rate x DRG weight,58749,,"27,277 x DRG weight",58749,Other,base rate x DRG weight,51864,,"24,080 x DRG weight",51864,Other,base rate x DRG weight,48381,,"22,463 x DRG weight",48381,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,56916,,"26,426 x DRG weight",56916,Other,base rate x DRG weight,83587,,"38,809 x DRG weight",83587,Other,base rate x DRG weight,83587,,"38,809 x DRG weight",83587,Other,base rate x DRG weight,56916,,"26,426 x DRG weight",56916,Other,base rate x DRG weight,83587,,"38,809 x DRG weight",83587,Other,base rate x DRG weight,26088,,"6,363 x patient days",26088,Per diem,,144617,70,,144617,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,53968,,"25,057 x DRG weight",53968,Other,base rate x DRG weight,48572,,"22,552 x DRG weight",48572,Other,base rate x DRG weight,53968,,"25,057 x DRG weight",53968,Other,base rate x DRG weight,45872,,"21,298 x DRG weight",45872,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,144617,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,,,,inpatient,,,190809.61,22867,,,22867,Other,150% of Medicare + 9.63% HCRA Surcharge,13905.75,,,13905.75,Other,Medicare IPPS methodology,40647,,"25,046 x DRG weight",40647,Other,base rate x DRG weight,36582,,"22,541 x DRG weight",36582,Other,base rate x DRG weight,52080,,"32,091 x DRG weight",52080,Other,base rate x DRG weight,46873,,"28,882 x DRG weight",46873,Other,base rate x DRG weight,44268,,"27,277 x DRG weight",44268,Other,base rate x DRG weight,39079,,"24,080 x DRG weight",39079,Other,base rate x DRG weight,36455,,"22,463 x DRG weight",36455,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42887,,"26,426 x DRG weight",42887,Other,base rate x DRG weight,62983,,"38,809 x DRG weight",62983,Other,base rate x DRG weight,62983,,"38,809 x DRG weight",62983,Other,base rate x DRG weight,42887,,"26,426 x DRG weight",42887,Other,base rate x DRG weight,62983,,"38,809 x DRG weight",62983,Other,base rate x DRG weight,12726,,"6,363 x patient days",12726,Per diem,,133567,70,,133567,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40665,,"25,057 x DRG weight",40665,Other,base rate x DRG weight,36600,,"22,552 x DRG weight",36600,Other,base rate x DRG weight,40665,,"25,057 x DRG weight",40665,Other,base rate x DRG weight,34565,,"21,298 x DRG weight",34565,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,133567,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,,,,inpatient,,,474493.8,54210,,,54210,Other,150% of Medicare + 9.63% HCRA Surcharge,32965.58,,,32965.58,Other,Medicare IPPS methodology,97714,,"25,046 x DRG weight",97714,Other,base rate x DRG weight,87941,,"22,541 x DRG weight",87941,Other,base rate x DRG weight,125200,,"32,091 x DRG weight",125200,Other,base rate x DRG weight,112680,,"28,882 x DRG weight",112680,Other,base rate x DRG weight,106418,,"27,277 x DRG weight",106418,Other,base rate x DRG weight,93946,,"24,080 x DRG weight",93946,Other,base rate x DRG weight,87637,,"22,463 x DRG weight",87637,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,103098,,"26,426 x DRG weight",103098,Other,base rate x DRG weight,151409,,"38,809 x DRG weight",151409,Other,base rate x DRG weight,151409,,"38,809 x DRG weight",151409,Other,base rate x DRG weight,103098,,"26,426 x DRG weight",103098,Other,base rate x DRG weight,151409,,"38,809 x DRG weight",151409,Other,base rate x DRG weight,47086,,"6,363 x patient days",47086,Per diem,,332146,70,,332146,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,97757,,"25,057 x DRG weight",97757,Other,base rate x DRG weight,87984,,"22,552 x DRG weight",87984,Other,base rate x DRG weight,97757,,"25,057 x DRG weight",97757,Other,base rate x DRG weight,83092,,"21,298 x DRG weight",83092,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,332146,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,,,,inpatient,,,159638.37,32175,,,32175,Other,150% of Medicare + 9.63% HCRA Surcharge,19565.56,,,19565.56,Other,Medicare IPPS methodology,57593,,"25,046 x DRG weight",57593,Other,base rate x DRG weight,51833,,"22,541 x DRG weight",51833,Other,base rate x DRG weight,73793,,"32,091 x DRG weight",73793,Other,base rate x DRG weight,66414,,"28,882 x DRG weight",66414,Other,base rate x DRG weight,62723,,"27,277 x DRG weight",62723,Other,base rate x DRG weight,55372,,"24,080 x DRG weight",55372,Other,base rate x DRG weight,51654,,"22,463 x DRG weight",51654,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,60767,,"26,426 x DRG weight",60767,Other,base rate x DRG weight,89241,,"38,809 x DRG weight",89241,Other,base rate x DRG weight,89241,,"38,809 x DRG weight",89241,Other,base rate x DRG weight,60767,,"26,426 x DRG weight",60767,Other,base rate x DRG weight,89241,,"38,809 x DRG weight",89241,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,111747,70,,111747,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,57619,,"25,057 x DRG weight",57619,Other,base rate x DRG weight,51858,,"22,552 x DRG weight",51858,Other,base rate x DRG weight,57619,,"25,057 x DRG weight",57619,Other,base rate x DRG weight,48975,,"21,298 x DRG weight",48975,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,111747,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,,,,inpatient,,,118825.49,25416,,,25416,Other,150% of Medicare + 9.63% HCRA Surcharge,15455.8,,,15455.8,Other,Medicare IPPS methodology,45288,,"25,046 x DRG weight",45288,Other,base rate x DRG weight,40759,,"22,541 x DRG weight",40759,Other,base rate x DRG weight,58027,,"32,091 x DRG weight",58027,Other,base rate x DRG weight,52224,,"28,882 x DRG weight",52224,Other,base rate x DRG weight,49322,,"27,277 x DRG weight",49322,Other,base rate x DRG weight,43541,,"24,080 x DRG weight",43541,Other,base rate x DRG weight,40618,,"22,463 x DRG weight",40618,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,47783,,"26,426 x DRG weight",47783,Other,base rate x DRG weight,70174,,"38,809 x DRG weight",70174,Other,base rate x DRG weight,70174,,"38,809 x DRG weight",70174,Other,base rate x DRG weight,47783,,"26,426 x DRG weight",47783,Other,base rate x DRG weight,70174,,"38,809 x DRG weight",70174,Other,base rate x DRG weight,8908,,"6,363 x patient days",8908,Per diem,,83178,70,,83178,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,45308,,"25,057 x DRG weight",45308,Other,base rate x DRG weight,40779,,"22,552 x DRG weight",40779,Other,base rate x DRG weight,45308,,"25,057 x DRG weight",45308,Other,base rate x DRG weight,38511,,"21,298 x DRG weight",38511,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,83178,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,,,,inpatient,,,377407.72,46977,,,46977,Other,150% of Medicare + 9.63% HCRA Surcharge,28567.22,,,28567.22,Other,Medicare IPPS methodology,84545,,"25,046 x DRG weight",84545,Other,base rate x DRG weight,76089,,"22,541 x DRG weight",76089,Other,base rate x DRG weight,108326,,"32,091 x DRG weight",108326,Other,base rate x DRG weight,97494,,"28,882 x DRG weight",97494,Other,base rate x DRG weight,92076,,"27,277 x DRG weight",92076,Other,base rate x DRG weight,81284,,"24,080 x DRG weight",81284,Other,base rate x DRG weight,75826,,"22,463 x DRG weight",75826,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,89204,,"26,426 x DRG weight",89204,Other,base rate x DRG weight,131004,,"38,809 x DRG weight",131004,Other,base rate x DRG weight,131004,,"38,809 x DRG weight",131004,Other,base rate x DRG weight,89204,,"26,426 x DRG weight",89204,Other,base rate x DRG weight,131004,,"38,809 x DRG weight",131004,Other,base rate x DRG weight,51540,,"6,363 x patient days",51540,Per diem,,264185,70,,264185,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,84582,,"25,057 x DRG weight",84582,Other,base rate x DRG weight,76127,,"22,552 x DRG weight",76127,Other,base rate x DRG weight,84582,,"25,057 x DRG weight",84582,Other,base rate x DRG weight,71894,,"21,298 x DRG weight",71894,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,264185,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,,,,inpatient,,,218233.89,22551,,,22551,Other,150% of Medicare + 9.63% HCRA Surcharge,13713.36,,,13713.36,Other,Medicare IPPS methodology,40071,,"25,046 x DRG weight",40071,Other,base rate x DRG weight,36063,,"22,541 x DRG weight",36063,Other,base rate x DRG weight,51342,,"32,091 x DRG weight",51342,Other,base rate x DRG weight,46208,,"28,882 x DRG weight",46208,Other,base rate x DRG weight,43640,,"27,277 x DRG weight",43640,Other,base rate x DRG weight,38526,,"24,080 x DRG weight",38526,Other,base rate x DRG weight,35939,,"22,463 x DRG weight",35939,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42279,,"26,426 x DRG weight",42279,Other,base rate x DRG weight,62091,,"38,809 x DRG weight",62091,Other,base rate x DRG weight,62091,,"38,809 x DRG weight",62091,Other,base rate x DRG weight,42279,,"26,426 x DRG weight",42279,Other,base rate x DRG weight,62091,,"38,809 x DRG weight",62091,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,152764,70,,152764,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40089,,"25,057 x DRG weight",40089,Other,base rate x DRG weight,36081,,"22,552 x DRG weight",36081,Other,base rate x DRG weight,40089,,"25,057 x DRG weight",40089,Other,base rate x DRG weight,34075,,"21,298 x DRG weight",34075,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,152764,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,,,,inpatient,,,158873.59,16238,,,16238,Other,150% of Medicare + 9.63% HCRA Surcharge,9874.62,,,9874.62,Other,Medicare IPPS methodology,28577,,"25,046 x DRG weight",28577,Other,base rate x DRG weight,25719,,"22,541 x DRG weight",25719,Other,base rate x DRG weight,36616,,"32,091 x DRG weight",36616,Other,base rate x DRG weight,32954,,"28,882 x DRG weight",32954,Other,base rate x DRG weight,31123,,"27,277 x DRG weight",31123,Other,base rate x DRG weight,27475,,"24,080 x DRG weight",27475,Other,base rate x DRG weight,25630,,"22,463 x DRG weight",25630,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,30152,,"26,426 x DRG weight",30152,Other,base rate x DRG weight,44281,,"38,809 x DRG weight",44281,Other,base rate x DRG weight,44281,,"38,809 x DRG weight",44281,Other,base rate x DRG weight,30152,,"26,426 x DRG weight",30152,Other,base rate x DRG weight,44281,,"38,809 x DRG weight",44281,Other,base rate x DRG weight,8908,,"6,363 x patient days",8908,Per diem,,111212,70,,111212,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,28590,,"25,057 x DRG weight",28590,Other,base rate x DRG weight,25732,,"22,552 x DRG weight",25732,Other,base rate x DRG weight,28590,,"25,057 x DRG weight",28590,Other,base rate x DRG weight,24301,,"21,298 x DRG weight",24301,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,111212,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,,,,inpatient,,,392203.02,53510,,,53510,Other,150% of Medicare + 9.63% HCRA Surcharge,32539.8,,,32539.8,Other,Medicare IPPS methodology,96440,,"25,046 x DRG weight",96440,Other,base rate x DRG weight,86794,,"22,541 x DRG weight",86794,Other,base rate x DRG weight,123566,,"32,091 x DRG weight",123566,Other,base rate x DRG weight,111210,,"28,882 x DRG weight",111210,Other,base rate x DRG weight,105030,,"27,277 x DRG weight",105030,Other,base rate x DRG weight,92720,,"24,080 x DRG weight",92720,Other,base rate x DRG weight,86494,,"22,463 x DRG weight",86494,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,101753,,"26,426 x DRG weight",101753,Other,base rate x DRG weight,149434,,"38,809 x DRG weight",149434,Other,base rate x DRG weight,149434,,"38,809 x DRG weight",149434,Other,base rate x DRG weight,101753,,"26,426 x DRG weight",101753,Other,base rate x DRG weight,149434,,"38,809 x DRG weight",149434,Other,base rate x DRG weight,68720,,"6,363 x patient days",68720,Per diem,,274542,70,,274542,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,96482,,"25,057 x DRG weight",96482,Other,base rate x DRG weight,86836,,"22,552 x DRG weight",86836,Other,base rate x DRG weight,96482,,"25,057 x DRG weight",96482,Other,base rate x DRG weight,82008,,"21,298 x DRG weight",82008,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,274542,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,,,,inpatient,,,281707.97,31228,,,31228,Other,150% of Medicare + 9.63% HCRA Surcharge,18990.05,,,18990.05,Other,Medicare IPPS methodology,55870,,"25,046 x DRG weight",55870,Other,base rate x DRG weight,50282,,"22,541 x DRG weight",50282,Other,base rate x DRG weight,71585,,"32,091 x DRG weight",71585,Other,base rate x DRG weight,64427,,"28,882 x DRG weight",64427,Other,base rate x DRG weight,60847,,"27,277 x DRG weight",60847,Other,base rate x DRG weight,53715,,"24,080 x DRG weight",53715,Other,base rate x DRG weight,50108,,"22,463 x DRG weight",50108,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,58948,,"26,426 x DRG weight",58948,Other,base rate x DRG weight,86571,,"38,809 x DRG weight",86571,Other,base rate x DRG weight,86571,,"38,809 x DRG weight",86571,Other,base rate x DRG weight,58948,,"26,426 x DRG weight",58948,Other,base rate x DRG weight,86571,,"38,809 x DRG weight",86571,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,197196,70,,197196,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,55895,,"25,057 x DRG weight",55895,Other,base rate x DRG weight,50307,,"22,552 x DRG weight",50307,Other,base rate x DRG weight,55895,,"25,057 x DRG weight",55895,Other,base rate x DRG weight,47509,,"21,298 x DRG weight",47509,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,197196,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,,,,inpatient,,,196612.99,24475,,,24475,Other,150% of Medicare + 9.63% HCRA Surcharge,14883.63,,,14883.63,Other,Medicare IPPS methodology,43575,,"25,046 x DRG weight",43575,Other,base rate x DRG weight,39217,,"22,541 x DRG weight",39217,Other,base rate x DRG weight,55832,,"32,091 x DRG weight",55832,Other,base rate x DRG weight,50249,,"28,882 x DRG weight",50249,Other,base rate x DRG weight,47457,,"27,277 x DRG weight",47457,Other,base rate x DRG weight,41894,,"24,080 x DRG weight",41894,Other,base rate x DRG weight,39081,,"22,463 x DRG weight",39081,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45976,,"26,426 x DRG weight",45976,Other,base rate x DRG weight,67520,,"38,809 x DRG weight",67520,Other,base rate x DRG weight,67520,,"38,809 x DRG weight",67520,Other,base rate x DRG weight,45976,,"26,426 x DRG weight",45976,Other,base rate x DRG weight,67520,,"38,809 x DRG weight",67520,Other,base rate x DRG weight,19089,,"6,363 x patient days",19089,Per diem,,137629,70,,137629,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43594,,"25,057 x DRG weight",43594,Other,base rate x DRG weight,39236,,"22,552 x DRG weight",39236,Other,base rate x DRG weight,43594,,"25,057 x DRG weight",43594,Other,base rate x DRG weight,37054,,"21,298 x DRG weight",37054,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,137629,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,,,,inpatient,,,241819.82,27291,,,27291,Other,150% of Medicare + 9.63% HCRA Surcharge,16595.96,,,16595.96,Other,Medicare IPPS methodology,48702,,"25,046 x DRG weight",48702,Other,base rate x DRG weight,43831,,"22,541 x DRG weight",43831,Other,base rate x DRG weight,62401,,"32,091 x DRG weight",62401,Other,base rate x DRG weight,56161,,"28,882 x DRG weight",56161,Other,base rate x DRG weight,53040,,"27,277 x DRG weight",53040,Other,base rate x DRG weight,46824,,"24,080 x DRG weight",46824,Other,base rate x DRG weight,43679,,"22,463 x DRG weight",43679,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,51385,,"26,426 x DRG weight",51385,Other,base rate x DRG weight,75464,,"38,809 x DRG weight",75464,Other,base rate x DRG weight,75464,,"38,809 x DRG weight",75464,Other,base rate x DRG weight,51385,,"26,426 x DRG weight",51385,Other,base rate x DRG weight,75464,,"38,809 x DRG weight",75464,Other,base rate x DRG weight,41996,,"6,363 x patient days",41996,Per diem,,169274,70,,169274,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,48723,,"25,057 x DRG weight",48723,Other,base rate x DRG weight,43852,,"22,552 x DRG weight",43852,Other,base rate x DRG weight,48723,,"25,057 x DRG weight",48723,Other,base rate x DRG weight,41414,,"21,298 x DRG weight",41414,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,169274,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,,,,inpatient,,,259436.94,14076,,,14076,Other,150% of Medicare + 9.63% HCRA Surcharge,8559.63,,,8559.63,Other,Medicare IPPS methodology,24640,,"25,046 x DRG weight",24640,Other,base rate x DRG weight,22176,,"22,541 x DRG weight",22176,Other,base rate x DRG weight,31571,,"32,091 x DRG weight",31571,Other,base rate x DRG weight,28414,,"28,882 x DRG weight",28414,Other,base rate x DRG weight,26835,,"27,277 x DRG weight",26835,Other,base rate x DRG weight,23690,,"24,080 x DRG weight",23690,Other,base rate x DRG weight,22099,,"22,463 x DRG weight",22099,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25998,,"26,426 x DRG weight",25998,Other,base rate x DRG weight,38180,,"38,809 x DRG weight",38180,Other,base rate x DRG weight,38180,,"38,809 x DRG weight",38180,Other,base rate x DRG weight,25998,,"26,426 x DRG weight",25998,Other,base rate x DRG weight,38180,,"38,809 x DRG weight",38180,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,181606,70,,181606,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24651,,"25,057 x DRG weight",24651,Other,base rate x DRG weight,22187,,"22,552 x DRG weight",22187,Other,base rate x DRG weight,24651,,"25,057 x DRG weight",24651,Other,base rate x DRG weight,20953,,"21,298 x DRG weight",20953,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,181606,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,,,,inpatient,,,232111.95,20812,,,20812,Other,150% of Medicare + 9.63% HCRA Surcharge,12656.01,,,12656.01,Other,Medicare IPPS methodology,36905,,"25,046 x DRG weight",36905,Other,base rate x DRG weight,33214,,"22,541 x DRG weight",33214,Other,base rate x DRG weight,47286,,"32,091 x DRG weight",47286,Other,base rate x DRG weight,42558,,"28,882 x DRG weight",42558,Other,base rate x DRG weight,40193,,"27,277 x DRG weight",40193,Other,base rate x DRG weight,35482,,"24,080 x DRG weight",35482,Other,base rate x DRG weight,33099,,"22,463 x DRG weight",33099,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,38939,,"26,426 x DRG weight",38939,Other,base rate x DRG weight,57185,,"38,809 x DRG weight",57185,Other,base rate x DRG weight,57185,,"38,809 x DRG weight",57185,Other,base rate x DRG weight,38939,,"26,426 x DRG weight",38939,Other,base rate x DRG weight,57185,,"38,809 x DRG weight",57185,Other,base rate x DRG weight,36905,,"6,363 x patient days",36905,Per diem,,162478,70,,162478,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,36921,,"25,057 x DRG weight",36921,Other,base rate x DRG weight,33230,,"22,552 x DRG weight",33230,Other,base rate x DRG weight,36921,,"25,057 x DRG weight",36921,Other,base rate x DRG weight,31383,,"21,298 x DRG weight",31383,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,162478,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,,,,inpatient,,,191422.93,15306,,,15306,Other,150% of Medicare + 9.63% HCRA Surcharge,9307.47,,,9307.47,Other,Medicare IPPS methodology,26879,,"25,046 x DRG weight",26879,Other,base rate x DRG weight,24191,,"22,541 x DRG weight",24191,Other,base rate x DRG weight,34440,,"32,091 x DRG weight",34440,Other,base rate x DRG weight,30996,,"28,882 x DRG weight",30996,Other,base rate x DRG weight,29274,,"27,277 x DRG weight",29274,Other,base rate x DRG weight,25843,,"24,080 x DRG weight",25843,Other,base rate x DRG weight,24107,,"22,463 x DRG weight",24107,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28360,,"26,426 x DRG weight",28360,Other,base rate x DRG weight,41650,,"38,809 x DRG weight",41650,Other,base rate x DRG weight,41650,,"38,809 x DRG weight",41650,Other,base rate x DRG weight,28360,,"26,426 x DRG weight",28360,Other,base rate x DRG weight,41650,,"38,809 x DRG weight",41650,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,133996,70,,133996,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26891,,"25,057 x DRG weight",26891,Other,base rate x DRG weight,24203,,"22,552 x DRG weight",24203,Other,base rate x DRG weight,26891,,"25,057 x DRG weight",26891,Other,base rate x DRG weight,22857,,"21,298 x DRG weight",22857,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,133996,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,,,,inpatient,,,328732.92,33475,,,33475,Other,150% of Medicare + 9.63% HCRA Surcharge,20356.06,,,20356.06,Other,Medicare IPPS methodology,59960,,"25,046 x DRG weight",59960,Other,base rate x DRG weight,53963,,"22,541 x DRG weight",53963,Other,base rate x DRG weight,76826,,"32,091 x DRG weight",76826,Other,base rate x DRG weight,69144,,"28,882 x DRG weight",69144,Other,base rate x DRG weight,65301,,"27,277 x DRG weight",65301,Other,base rate x DRG weight,57648,,"24,080 x DRG weight",57648,Other,base rate x DRG weight,53776,,"22,463 x DRG weight",53776,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,63264,,"26,426 x DRG weight",63264,Other,base rate x DRG weight,92909,,"38,809 x DRG weight",92909,Other,base rate x DRG weight,92909,,"38,809 x DRG weight",92909,Other,base rate x DRG weight,63264,,"26,426 x DRG weight",63264,Other,base rate x DRG weight,92909,,"38,809 x DRG weight",92909,Other,base rate x DRG weight,61721,,"6,363 x patient days",61721,Per diem,,230113,70,,230113,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,59986,,"25,057 x DRG weight",59986,Other,base rate x DRG weight,53989,,"22,552 x DRG weight",53989,Other,base rate x DRG weight,59986,,"25,057 x DRG weight",59986,Other,base rate x DRG weight,50987,,"21,298 x DRG weight",50987,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,230113,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,,,,inpatient,,,207796.84,19295,,,19295,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.34,,,11733.34,Other,Medicare IPPS methodology,34143,,"25,046 x DRG weight",34143,Other,base rate x DRG weight,30728,,"22,541 x DRG weight",30728,Other,base rate x DRG weight,43746,,"32,091 x DRG weight",43746,Other,base rate x DRG weight,39372,,"28,882 x DRG weight",39372,Other,base rate x DRG weight,37184,,"27,277 x DRG weight",37184,Other,base rate x DRG weight,32826,,"24,080 x DRG weight",32826,Other,base rate x DRG weight,30622,,"22,463 x DRG weight",30622,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,36024,,"26,426 x DRG weight",36024,Other,base rate x DRG weight,52904,,"38,809 x DRG weight",52904,Other,base rate x DRG weight,52904,,"38,809 x DRG weight",52904,Other,base rate x DRG weight,36024,,"26,426 x DRG weight",36024,Other,base rate x DRG weight,52904,,"38,809 x DRG weight",52904,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,145458,70,,145458,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,34158,,"25,057 x DRG weight",34158,Other,base rate x DRG weight,30743,,"22,552 x DRG weight",30743,Other,base rate x DRG weight,34158,,"25,057 x DRG weight",34158,Other,base rate x DRG weight,29033,,"21,298 x DRG weight",29033,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,145458,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,,,,inpatient,,,120609,24312,,,24312,Other,150% of Medicare + 9.63% HCRA Surcharge,14784.09,,,14784.09,Other,Medicare IPPS methodology,43277,,"25,046 x DRG weight",43277,Other,base rate x DRG weight,38949,,"22,541 x DRG weight",38949,Other,base rate x DRG weight,55450,,"32,091 x DRG weight",55450,Other,base rate x DRG weight,49905,,"28,882 x DRG weight",49905,Other,base rate x DRG weight,47132,,"27,277 x DRG weight",47132,Other,base rate x DRG weight,41608,,"24,080 x DRG weight",41608,Other,base rate x DRG weight,38814,,"22,463 x DRG weight",38814,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45661,,"26,426 x DRG weight",45661,Other,base rate x DRG weight,67058,,"38,809 x DRG weight",67058,Other,base rate x DRG weight,67058,,"38,809 x DRG weight",67058,Other,base rate x DRG weight,45661,,"26,426 x DRG weight",45661,Other,base rate x DRG weight,67058,,"38,809 x DRG weight",67058,Other,base rate x DRG weight,45177,,"6,363 x patient days",45177,Per diem,,84426,70,,84426,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43296,,"25,057 x DRG weight",43296,Other,base rate x DRG weight,38968,,"22,552 x DRG weight",38968,Other,base rate x DRG weight,43296,,"25,057 x DRG weight",43296,Other,base rate x DRG weight,36801,,"21,298 x DRG weight",36801,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,84426,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,,,,inpatient,,,173761,16874,,,16874,Other,150% of Medicare + 9.63% HCRA Surcharge,10261.09,,,10261.09,Other,Medicare IPPS methodology,29735,,"25,046 x DRG weight",29735,Other,base rate x DRG weight,26761,,"22,541 x DRG weight",26761,Other,base rate x DRG weight,38098,,"32,091 x DRG weight",38098,Other,base rate x DRG weight,34289,,"28,882 x DRG weight",34289,Other,base rate x DRG weight,32383,,"27,277 x DRG weight",32383,Other,base rate x DRG weight,28588,,"24,080 x DRG weight",28588,Other,base rate x DRG weight,26668,,"22,463 x DRG weight",26668,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31373,,"26,426 x DRG weight",31373,Other,base rate x DRG weight,46074,,"38,809 x DRG weight",46074,Other,base rate x DRG weight,46074,,"38,809 x DRG weight",46074,Other,base rate x DRG weight,31373,,"26,426 x DRG weight",31373,Other,base rate x DRG weight,46074,,"38,809 x DRG weight",46074,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,121633,70,,121633,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29748,,"25,057 x DRG weight",29748,Other,base rate x DRG weight,26774,,"22,552 x DRG weight",26774,Other,base rate x DRG weight,29748,,"25,057 x DRG weight",29748,Other,base rate x DRG weight,25285,,"21,298 x DRG weight",25285,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,121633,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,,,,inpatient,,,96942.45,12887,,,12887,Other,150% of Medicare + 9.63% HCRA Surcharge,7836.89,,,7836.89,Other,Medicare IPPS methodology,22476,,"25,046 x DRG weight",22476,Other,base rate x DRG weight,20228,,"22,541 x DRG weight",20228,Other,base rate x DRG weight,28798,,"32,091 x DRG weight",28798,Other,base rate x DRG weight,25919,,"28,882 x DRG weight",25919,Other,base rate x DRG weight,24478,,"27,277 x DRG weight",24478,Other,base rate x DRG weight,21609,,"24,080 x DRG weight",21609,Other,base rate x DRG weight,20158,,"22,463 x DRG weight",20158,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23715,,"26,426 x DRG weight",23715,Other,base rate x DRG weight,34827,,"38,809 x DRG weight",34827,Other,base rate x DRG weight,34827,,"38,809 x DRG weight",34827,Other,base rate x DRG weight,23715,,"26,426 x DRG weight",23715,Other,base rate x DRG weight,34827,,"38,809 x DRG weight",34827,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,67860,70,,67860,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22486,,"25,057 x DRG weight",22486,Other,base rate x DRG weight,20238,,"22,552 x DRG weight",20238,Other,base rate x DRG weight,22486,,"25,057 x DRG weight",22486,Other,base rate x DRG weight,19113,,"21,298 x DRG weight",19113,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,67860,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,,,,inpatient,,,402567.78,39098,,,39098,Other,150% of Medicare + 9.63% HCRA Surcharge,23775.71,,,23775.71,Other,Medicare IPPS methodology,70199,,"25,046 x DRG weight",70199,Other,base rate x DRG weight,63178,,"22,541 x DRG weight",63178,Other,base rate x DRG weight,89945,,"32,091 x DRG weight",89945,Other,base rate x DRG weight,80950,,"28,882 x DRG weight",80950,Other,base rate x DRG weight,76452,,"27,277 x DRG weight",76452,Other,base rate x DRG weight,67491,,"24,080 x DRG weight",67491,Other,base rate x DRG weight,62959,,"22,463 x DRG weight",62959,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,74067,,"26,426 x DRG weight",74067,Other,base rate x DRG weight,108774,,"38,809 x DRG weight",108774,Other,base rate x DRG weight,108774,,"38,809 x DRG weight",108774,Other,base rate x DRG weight,74067,,"26,426 x DRG weight",74067,Other,base rate x DRG weight,108774,,"38,809 x DRG weight",108774,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,281797,70,,281797,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,70230,,"25,057 x DRG weight",70230,Other,base rate x DRG weight,63209,,"22,552 x DRG weight",63209,Other,base rate x DRG weight,70230,,"25,057 x DRG weight",70230,Other,base rate x DRG weight,59694,,"21,298 x DRG weight",59694,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,281797,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,,,,inpatient,,,187858.06,26290,,,26290,Other,150% of Medicare + 9.63% HCRA Surcharge,15986.98,,,15986.98,Other,Medicare IPPS methodology,46879,,"25,046 x DRG weight",46879,Other,base rate x DRG weight,42190,,"22,541 x DRG weight",42190,Other,base rate x DRG weight,60065,,"32,091 x DRG weight",60065,Other,base rate x DRG weight,54058,,"28,882 x DRG weight",54058,Other,base rate x DRG weight,51054,,"27,277 x DRG weight",51054,Other,base rate x DRG weight,45071,,"24,080 x DRG weight",45071,Other,base rate x DRG weight,42044,,"22,463 x DRG weight",42044,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49462,,"26,426 x DRG weight",49462,Other,base rate x DRG weight,72639,,"38,809 x DRG weight",72639,Other,base rate x DRG weight,72639,,"38,809 x DRG weight",72639,Other,base rate x DRG weight,49462,,"26,426 x DRG weight",49462,Other,base rate x DRG weight,72639,,"38,809 x DRG weight",72639,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,131501,70,,131501,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46899,,"25,057 x DRG weight",46899,Other,base rate x DRG weight,42211,,"22,552 x DRG weight",42211,Other,base rate x DRG weight,46899,,"25,057 x DRG weight",46899,Other,base rate x DRG weight,39863,,"21,298 x DRG weight",39863,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,131501,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,,,,inpatient,,,146396.43,20995,,,20995,Other,150% of Medicare + 9.63% HCRA Surcharge,12767.27,,,12767.27,Other,Medicare IPPS methodology,37238,,"25,046 x DRG weight",37238,Other,base rate x DRG weight,33514,,"22,541 x DRG weight",33514,Other,base rate x DRG weight,47713,,"32,091 x DRG weight",47713,Other,base rate x DRG weight,42942,,"28,882 x DRG weight",42942,Other,base rate x DRG weight,40555,,"27,277 x DRG weight",40555,Other,base rate x DRG weight,35802,,"24,080 x DRG weight",35802,Other,base rate x DRG weight,33398,,"22,463 x DRG weight",33398,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39290,,"26,426 x DRG weight",39290,Other,base rate x DRG weight,57701,,"38,809 x DRG weight",57701,Other,base rate x DRG weight,57701,,"38,809 x DRG weight",57701,Other,base rate x DRG weight,39290,,"26,426 x DRG weight",39290,Other,base rate x DRG weight,57701,,"38,809 x DRG weight",57701,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,102477,70,,102477,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37255,,"25,057 x DRG weight",37255,Other,base rate x DRG weight,33530,,"22,552 x DRG weight",33530,Other,base rate x DRG weight,37255,,"25,057 x DRG weight",37255,Other,base rate x DRG weight,31666,,"21,298 x DRG weight",31666,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,102477,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,,,,inpatient,,,276477.92,28096,,,28096,Other,150% of Medicare + 9.63% HCRA Surcharge,17085.32,,,17085.32,Other,Medicare IPPS methodology,50167,,"25,046 x DRG weight",50167,Other,base rate x DRG weight,45150,,"22,541 x DRG weight",45150,Other,base rate x DRG weight,64278,,"32,091 x DRG weight",64278,Other,base rate x DRG weight,57851,,"28,882 x DRG weight",57851,Other,base rate x DRG weight,54636,,"27,277 x DRG weight",54636,Other,base rate x DRG weight,48232,,"24,080 x DRG weight",48232,Other,base rate x DRG weight,44993,,"22,463 x DRG weight",44993,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52931,,"26,426 x DRG weight",52931,Other,base rate x DRG weight,77734,,"38,809 x DRG weight",77734,Other,base rate x DRG weight,77734,,"38,809 x DRG weight",77734,Other,base rate x DRG weight,52931,,"26,426 x DRG weight",52931,Other,base rate x DRG weight,77734,,"38,809 x DRG weight",77734,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,193535,70,,193535,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,50189,,"25,057 x DRG weight",50189,Other,base rate x DRG weight,45172,,"22,552 x DRG weight",45172,Other,base rate x DRG weight,50189,,"25,057 x DRG weight",50189,Other,base rate x DRG weight,42660,,"21,298 x DRG weight",42660,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,193535,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,,,,inpatient,,,180198.81,14524,,,14524,Other,150% of Medicare + 9.63% HCRA Surcharge,8832.33,,,8832.33,Other,Medicare IPPS methodology,25457,,"25,046 x DRG weight",25457,Other,base rate x DRG weight,22911,,"22,541 x DRG weight",22911,Other,base rate x DRG weight,32617,,"32,091 x DRG weight",32617,Other,base rate x DRG weight,29356,,"28,882 x DRG weight",29356,Other,base rate x DRG weight,27724,,"27,277 x DRG weight",27724,Other,base rate x DRG weight,24475,,"24,080 x DRG weight",24475,Other,base rate x DRG weight,22831,,"22,463 x DRG weight",22831,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26859,,"26,426 x DRG weight",26859,Other,base rate x DRG weight,39445,,"38,809 x DRG weight",39445,Other,base rate x DRG weight,39445,,"38,809 x DRG weight",39445,Other,base rate x DRG weight,26859,,"26,426 x DRG weight",26859,Other,base rate x DRG weight,39445,,"38,809 x DRG weight",39445,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,126139,70,,126139,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25468,,"25,057 x DRG weight",25468,Other,base rate x DRG weight,22922,,"22,552 x DRG weight",22922,Other,base rate x DRG weight,25468,,"25,057 x DRG weight",25468,Other,base rate x DRG weight,21647,,"21,298 x DRG weight",21647,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,126139,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,,,,inpatient,,,140690.68,10000,,,10000,Other,150% of Medicare + 9.63% HCRA Surcharge,6081.06,,,6081.06,Other,Medicare IPPS methodology,17219,,"25,046 x DRG weight",17219,Other,base rate x DRG weight,15497,,"22,541 x DRG weight",15497,Other,base rate x DRG weight,22063,,"32,091 x DRG weight",22063,Other,base rate x DRG weight,19856,,"28,882 x DRG weight",19856,Other,base rate x DRG weight,18753,,"27,277 x DRG weight",18753,Other,base rate x DRG weight,16555,,"24,080 x DRG weight",16555,Other,base rate x DRG weight,15443,,"22,463 x DRG weight",15443,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18168,,"26,426 x DRG weight",18168,Other,base rate x DRG weight,26681,,"38,809 x DRG weight",26681,Other,base rate x DRG weight,26681,,"38,809 x DRG weight",26681,Other,base rate x DRG weight,18168,,"26,426 x DRG weight",18168,Other,base rate x DRG weight,26681,,"38,809 x DRG weight",26681,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,98483,70,,98483,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17227,,"25,057 x DRG weight",17227,Other,base rate x DRG weight,15505,,"22,552 x DRG weight",15505,Other,base rate x DRG weight,17227,,"25,057 x DRG weight",17227,Other,base rate x DRG weight,14642,,"21,298 x DRG weight",14642,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,98483,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,,,,inpatient,,,288204.73,20034,,,20034,Other,150% of Medicare + 9.63% HCRA Surcharge,12182.55,,,12182.55,Other,Medicare IPPS methodology,35488,,"25,046 x DRG weight",35488,Other,base rate x DRG weight,31938,,"22,541 x DRG weight",31938,Other,base rate x DRG weight,45470,,"32,091 x DRG weight",45470,Other,base rate x DRG weight,40923,,"28,882 x DRG weight",40923,Other,base rate x DRG weight,38649,,"27,277 x DRG weight",38649,Other,base rate x DRG weight,34119,,"24,080 x DRG weight",34119,Other,base rate x DRG weight,31828,,"22,463 x DRG weight",31828,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37443,,"26,426 x DRG weight",37443,Other,base rate x DRG weight,54988,,"38,809 x DRG weight",54988,Other,base rate x DRG weight,54988,,"38,809 x DRG weight",54988,Other,base rate x DRG weight,37443,,"26,426 x DRG weight",37443,Other,base rate x DRG weight,54988,,"38,809 x DRG weight",54988,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,201743,70,,201743,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35503,,"25,057 x DRG weight",35503,Other,base rate x DRG weight,31954,,"22,552 x DRG weight",31954,Other,base rate x DRG weight,35503,,"25,057 x DRG weight",35503,Other,base rate x DRG weight,30177,,"21,298 x DRG weight",30177,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,201743,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,,,,inpatient,,,108189.13,12524,,,12524,Other,150% of Medicare + 9.63% HCRA Surcharge,7616.05,,,7616.05,Other,Medicare IPPS methodology,21815,,"25,046 x DRG weight",21815,Other,base rate x DRG weight,19633,,"22,541 x DRG weight",19633,Other,base rate x DRG weight,27951,,"32,091 x DRG weight",27951,Other,base rate x DRG weight,25156,,"28,882 x DRG weight",25156,Other,base rate x DRG weight,23758,,"27,277 x DRG weight",23758,Other,base rate x DRG weight,20974,,"24,080 x DRG weight",20974,Other,base rate x DRG weight,19565,,"22,463 x DRG weight",19565,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23017,,"26,426 x DRG weight",23017,Other,base rate x DRG weight,33803,,"38,809 x DRG weight",33803,Other,base rate x DRG weight,33803,,"38,809 x DRG weight",33803,Other,base rate x DRG weight,23017,,"26,426 x DRG weight",23017,Other,base rate x DRG weight,33803,,"38,809 x DRG weight",33803,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,75732,70,,75732,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21825,,"25,057 x DRG weight",21825,Other,base rate x DRG weight,19643,,"22,552 x DRG weight",19643,Other,base rate x DRG weight,21825,,"25,057 x DRG weight",21825,Other,base rate x DRG weight,18551,,"21,298 x DRG weight",18551,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,75732,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,,,,inpatient,,,111705.66,11530,,,11530,Other,150% of Medicare + 9.63% HCRA Surcharge,7011.26,,,7011.26,Other,Medicare IPPS methodology,20004,,"25,046 x DRG weight",20004,Other,base rate x DRG weight,18003,,"22,541 x DRG weight",18003,Other,base rate x DRG weight,25631,,"32,091 x DRG weight",25631,Other,base rate x DRG weight,23068,,"28,882 x DRG weight",23068,Other,base rate x DRG weight,21786,,"27,277 x DRG weight",21786,Other,base rate x DRG weight,19233,,"24,080 x DRG weight",19233,Other,base rate x DRG weight,17941,,"22,463 x DRG weight",17941,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21106,,"26,426 x DRG weight",21106,Other,base rate x DRG weight,30997,,"38,809 x DRG weight",30997,Other,base rate x DRG weight,30997,,"38,809 x DRG weight",30997,Other,base rate x DRG weight,21106,,"26,426 x DRG weight",21106,Other,base rate x DRG weight,30997,,"38,809 x DRG weight",30997,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,78194,70,,78194,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20013,,"25,057 x DRG weight",20013,Other,base rate x DRG weight,18012,,"22,552 x DRG weight",18012,Other,base rate x DRG weight,20013,,"25,057 x DRG weight",20013,Other,base rate x DRG weight,17011,,"21,298 x DRG weight",17011,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,78194,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,,,,inpatient,,,190249.44,25159,,,25159,Other,150% of Medicare + 9.63% HCRA Surcharge,15299.38,,,15299.38,Other,Medicare IPPS methodology,44820,,"25,046 x DRG weight",44820,Other,base rate x DRG weight,40337,,"22,541 x DRG weight",40337,Other,base rate x DRG weight,57427,,"32,091 x DRG weight",57427,Other,base rate x DRG weight,51684,,"28,882 x DRG weight",51684,Other,base rate x DRG weight,48812,,"27,277 x DRG weight",48812,Other,base rate x DRG weight,43091,,"24,080 x DRG weight",43091,Other,base rate x DRG weight,40198,,"22,463 x DRG weight",40198,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,47289,,"26,426 x DRG weight",47289,Other,base rate x DRG weight,69449,,"38,809 x DRG weight",69449,Other,base rate x DRG weight,69449,,"38,809 x DRG weight",69449,Other,base rate x DRG weight,47289,,"26,426 x DRG weight",47289,Other,base rate x DRG weight,69449,,"38,809 x DRG weight",69449,Other,base rate x DRG weight,45177,,"6,363 x patient days",45177,Per diem,,133175,70,,133175,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,44840,,"25,057 x DRG weight",44840,Other,base rate x DRG weight,40357,,"22,552 x DRG weight",40357,Other,base rate x DRG weight,44840,,"25,057 x DRG weight",44840,Other,base rate x DRG weight,38113,,"21,298 x DRG weight",38113,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,133175,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,,,,inpatient,,,184199.33,15149,,,15149,Other,150% of Medicare + 9.63% HCRA Surcharge,9212.11,,,9212.11,Other,Medicare IPPS methodology,26594,,"25,046 x DRG weight",26594,Other,base rate x DRG weight,23934,,"22,541 x DRG weight",23934,Other,base rate x DRG weight,34074,,"32,091 x DRG weight",34074,Other,base rate x DRG weight,30667,,"28,882 x DRG weight",30667,Other,base rate x DRG weight,28963,,"27,277 x DRG weight",28963,Other,base rate x DRG weight,25568,,"24,080 x DRG weight",25568,Other,base rate x DRG weight,23851,,"22,463 x DRG weight",23851,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28059,,"26,426 x DRG weight",28059,Other,base rate x DRG weight,41207,,"38,809 x DRG weight",41207,Other,base rate x DRG weight,41207,,"38,809 x DRG weight",41207,Other,base rate x DRG weight,28059,,"26,426 x DRG weight",28059,Other,base rate x DRG weight,41207,,"38,809 x DRG weight",41207,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,128940,70,,128940,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26606,,"25,057 x DRG weight",26606,Other,base rate x DRG weight,23946,,"22,552 x DRG weight",23946,Other,base rate x DRG weight,26606,,"25,057 x DRG weight",26606,Other,base rate x DRG weight,22614,,"21,298 x DRG weight",22614,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,128940,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,,,,inpatient,,,66397.16,11314,,,11314,Other,150% of Medicare + 9.63% HCRA Surcharge,6879.93,,,6879.93,Other,Medicare IPPS methodology,19611,,"25,046 x DRG weight",19611,Other,base rate x DRG weight,17650,,"22,541 x DRG weight",17650,Other,base rate x DRG weight,25127,,"32,091 x DRG weight",25127,Other,base rate x DRG weight,22615,,"28,882 x DRG weight",22615,Other,base rate x DRG weight,21358,,"27,277 x DRG weight",21358,Other,base rate x DRG weight,18855,,"24,080 x DRG weight",18855,Other,base rate x DRG weight,17589,,"22,463 x DRG weight",17589,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20692,,"26,426 x DRG weight",20692,Other,base rate x DRG weight,30387,,"38,809 x DRG weight",30387,Other,base rate x DRG weight,30387,,"38,809 x DRG weight",30387,Other,base rate x DRG weight,20692,,"26,426 x DRG weight",20692,Other,base rate x DRG weight,30387,,"38,809 x DRG weight",30387,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,46478,70,,46478,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19620,,"25,057 x DRG weight",19620,Other,base rate x DRG weight,17658,,"22,552 x DRG weight",17658,Other,base rate x DRG weight,19620,,"25,057 x DRG weight",19620,Other,base rate x DRG weight,16676,,"21,298 x DRG weight",16676,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,46478,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,,,,inpatient,,,195231.93,21356,,,21356,Other,150% of Medicare + 9.63% HCRA Surcharge,12986.43,,,12986.43,Other,Medicare IPPS methodology,37895,,"25,046 x DRG weight",37895,Other,base rate x DRG weight,34105,,"22,541 x DRG weight",34105,Other,base rate x DRG weight,48554,,"32,091 x DRG weight",48554,Other,base rate x DRG weight,43698,,"28,882 x DRG weight",43698,Other,base rate x DRG weight,41270,,"27,277 x DRG weight",41270,Other,base rate x DRG weight,36433,,"24,080 x DRG weight",36433,Other,base rate x DRG weight,33987,,"22,463 x DRG weight",33987,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39983,,"26,426 x DRG weight",39983,Other,base rate x DRG weight,58718,,"38,809 x DRG weight",58718,Other,base rate x DRG weight,58718,,"38,809 x DRG weight",58718,Other,base rate x DRG weight,39983,,"26,426 x DRG weight",39983,Other,base rate x DRG weight,58718,,"38,809 x DRG weight",58718,Other,base rate x DRG weight,36905,,"6,363 x patient days",36905,Per diem,,136662,70,,136662,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37911,,"25,057 x DRG weight",37911,Other,base rate x DRG weight,34121,,"22,552 x DRG weight",34121,Other,base rate x DRG weight,37911,,"25,057 x DRG weight",37911,Other,base rate x DRG weight,32224,,"21,298 x DRG weight",32224,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,136662,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,,,,inpatient,,,176051.52,14659,,,14659,Other,150% of Medicare + 9.63% HCRA Surcharge,8914.31,,,8914.31,Other,Medicare IPPS methodology,25702,,"25,046 x DRG weight",25702,Other,base rate x DRG weight,23132,,"22,541 x DRG weight",23132,Other,base rate x DRG weight,32932,,"32,091 x DRG weight",32932,Other,base rate x DRG weight,29639,,"28,882 x DRG weight",29639,Other,base rate x DRG weight,27992,,"27,277 x DRG weight",27992,Other,base rate x DRG weight,24711,,"24,080 x DRG weight",24711,Other,base rate x DRG weight,23052,,"22,463 x DRG weight",23052,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27118,,"26,426 x DRG weight",27118,Other,base rate x DRG weight,39826,,"38,809 x DRG weight",39826,Other,base rate x DRG weight,39826,,"38,809 x DRG weight",39826,Other,base rate x DRG weight,27118,,"26,426 x DRG weight",27118,Other,base rate x DRG weight,39826,,"38,809 x DRG weight",39826,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,123236,70,,123236,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25713,,"25,057 x DRG weight",25713,Other,base rate x DRG weight,23143,,"22,552 x DRG weight",23143,Other,base rate x DRG weight,25713,,"25,057 x DRG weight",25713,Other,base rate x DRG weight,21856,,"21,298 x DRG weight",21856,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,123236,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,,,,inpatient,,,166616.58,26869,,,26869,Other,150% of Medicare + 9.63% HCRA Surcharge,16339.15,,,16339.15,Other,Medicare IPPS methodology,47933,,"25,046 x DRG weight",47933,Other,base rate x DRG weight,43139,,"22,541 x DRG weight",43139,Other,base rate x DRG weight,61416,,"32,091 x DRG weight",61416,Other,base rate x DRG weight,55274,,"28,882 x DRG weight",55274,Other,base rate x DRG weight,52203,,"27,277 x DRG weight",52203,Other,base rate x DRG weight,46084,,"24,080 x DRG weight",46084,Other,base rate x DRG weight,42990,,"22,463 x DRG weight",42990,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,50574,,"26,426 x DRG weight",50574,Other,base rate x DRG weight,74273,,"38,809 x DRG weight",74273,Other,base rate x DRG weight,74273,,"38,809 x DRG weight",74273,Other,base rate x DRG weight,50574,,"26,426 x DRG weight",50574,Other,base rate x DRG weight,74273,,"38,809 x DRG weight",74273,Other,base rate x DRG weight,48995,,"6,363 x patient days",48995,Per diem,,116632,70,,116632,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,47954,,"25,057 x DRG weight",47954,Other,base rate x DRG weight,43160,,"22,552 x DRG weight",43160,Other,base rate x DRG weight,47954,,"25,057 x DRG weight",47954,Other,base rate x DRG weight,40760,,"21,298 x DRG weight",40760,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,116632,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,,,,inpatient,,,65979.44,13233,,,13233,Other,150% of Medicare + 9.63% HCRA Surcharge,8046.85,,,8046.85,Other,Medicare IPPS methodology,23105,,"25,046 x DRG weight",23105,Other,base rate x DRG weight,20794,,"22,541 x DRG weight",20794,Other,base rate x DRG weight,29604,,"32,091 x DRG weight",29604,Other,base rate x DRG weight,26644,,"28,882 x DRG weight",26644,Other,base rate x DRG weight,25163,,"27,277 x DRG weight",25163,Other,base rate x DRG weight,22214,,"24,080 x DRG weight",22214,Other,base rate x DRG weight,20722,,"22,463 x DRG weight",20722,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24378,,"26,426 x DRG weight",24378,Other,base rate x DRG weight,35801,,"38,809 x DRG weight",35801,Other,base rate x DRG weight,35801,,"38,809 x DRG weight",35801,Other,base rate x DRG weight,24378,,"26,426 x DRG weight",24378,Other,base rate x DRG weight,35801,,"38,809 x DRG weight",35801,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,46186,70,,46186,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23115,,"25,057 x DRG weight",23115,Other,base rate x DRG weight,20804,,"22,552 x DRG weight",20804,Other,base rate x DRG weight,23115,,"25,057 x DRG weight",23115,Other,base rate x DRG weight,19647,,"21,298 x DRG weight",19647,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,46186,
HYPERTENSIVE ENCEPHALOPATHY WITH MCC,77,MS-DRG,,,,,,,,inpatient,,,88267,21327,,,21327,Other,150% of Medicare + 9.63% HCRA Surcharge,12968.86,,,12968.86,Other,Medicare IPPS methodology,37842,,"25,046 x DRG weight",37842,Other,base rate x DRG weight,34057,,"22,541 x DRG weight",34057,Other,base rate x DRG weight,48486,,"32,091 x DRG weight",48486,Other,base rate x DRG weight,43638,,"28,882 x DRG weight",43638,Other,base rate x DRG weight,41213,,"27,277 x DRG weight",41213,Other,base rate x DRG weight,36382,,"24,080 x DRG weight",36382,Other,base rate x DRG weight,33939,,"22,463 x DRG weight",33939,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39927,,"26,426 x DRG weight",39927,Other,base rate x DRG weight,58637,,"38,809 x DRG weight",58637,Other,base rate x DRG weight,58637,,"38,809 x DRG weight",58637,Other,base rate x DRG weight,39927,,"26,426 x DRG weight",39927,Other,base rate x DRG weight,58637,,"38,809 x DRG weight",58637,Other,base rate x DRG weight,35633,,"6,363 x patient days",35633,Per diem,,61787,70,,61787,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37859,,"25,057 x DRG weight",37859,Other,base rate x DRG weight,34074,,"22,552 x DRG weight",34074,Other,base rate x DRG weight,37859,,"25,057 x DRG weight",37859,Other,base rate x DRG weight,32179,,"21,298 x DRG weight",32179,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,61787,
HYPERTENSIVE ENCEPHALOPATHY WITH CC,78,MS-DRG,,,,,,,,inpatient,,,181671,14531,,,14531,Other,150% of Medicare + 9.63% HCRA Surcharge,8836.52,,,8836.52,Other,Medicare IPPS methodology,25469,,"25,046 x DRG weight",25469,Other,base rate x DRG weight,22922,,"22,541 x DRG weight",22922,Other,base rate x DRG weight,32633,,"32,091 x DRG weight",32633,Other,base rate x DRG weight,29370,,"28,882 x DRG weight",29370,Other,base rate x DRG weight,27738,,"27,277 x DRG weight",27738,Other,base rate x DRG weight,24487,,"24,080 x DRG weight",24487,Other,base rate x DRG weight,22843,,"22,463 x DRG weight",22843,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26873,,"26,426 x DRG weight",26873,Other,base rate x DRG weight,39465,,"38,809 x DRG weight",39465,Other,base rate x DRG weight,39465,,"38,809 x DRG weight",39465,Other,base rate x DRG weight,26873,,"26,426 x DRG weight",26873,Other,base rate x DRG weight,39465,,"38,809 x DRG weight",39465,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,127170,70,,127170,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25480,,"25,057 x DRG weight",25480,Other,base rate x DRG weight,22933,,"22,552 x DRG weight",22933,Other,base rate x DRG weight,25480,,"25,057 x DRG weight",25480,Other,base rate x DRG weight,21658,,"21,298 x DRG weight",21658,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,127170,
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,79,MS-DRG,,,,,,,,inpatient,,,64503,10733,,,10733,Other,150% of Medicare + 9.63% HCRA Surcharge,6526.92,,,6526.92,Other,Medicare IPPS methodology,18554,,"25,046 x DRG weight",18554,Other,base rate x DRG weight,16698,,"22,541 x DRG weight",16698,Other,base rate x DRG weight,23773,,"32,091 x DRG weight",23773,Other,base rate x DRG weight,21396,,"28,882 x DRG weight",21396,Other,base rate x DRG weight,20207,,"27,277 x DRG weight",20207,Other,base rate x DRG weight,17838,,"24,080 x DRG weight",17838,Other,base rate x DRG weight,16641,,"22,463 x DRG weight",16641,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19576,,"26,426 x DRG weight",19576,Other,base rate x DRG weight,28750,,"38,809 x DRG weight",28750,Other,base rate x DRG weight,28750,,"38,809 x DRG weight",28750,Other,base rate x DRG weight,19576,,"26,426 x DRG weight",19576,Other,base rate x DRG weight,28750,,"38,809 x DRG weight",28750,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,45152,70,,45152,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18562,,"25,057 x DRG weight",18562,Other,base rate x DRG weight,16707,,"22,552 x DRG weight",16707,Other,base rate x DRG weight,18562,,"25,057 x DRG weight",18562,Other,base rate x DRG weight,15778,,"21,298 x DRG weight",15778,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,45152,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,,,,inpatient,,,255939.76,30926,,,30926,Other,150% of Medicare + 9.63% HCRA Surcharge,18806.02,,,18806.02,Other,Medicare IPPS methodology,55319,,"25,046 x DRG weight",55319,Other,base rate x DRG weight,49786,,"22,541 x DRG weight",49786,Other,base rate x DRG weight,70879,,"32,091 x DRG weight",70879,Other,base rate x DRG weight,63792,,"28,882 x DRG weight",63792,Other,base rate x DRG weight,60247,,"27,277 x DRG weight",60247,Other,base rate x DRG weight,53185,,"24,080 x DRG weight",53185,Other,base rate x DRG weight,49614,,"22,463 x DRG weight",49614,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,58367,,"26,426 x DRG weight",58367,Other,base rate x DRG weight,85717,,"38,809 x DRG weight",85717,Other,base rate x DRG weight,85717,,"38,809 x DRG weight",85717,Other,base rate x DRG weight,58367,,"26,426 x DRG weight",58367,Other,base rate x DRG weight,85717,,"38,809 x DRG weight",85717,Other,base rate x DRG weight,54086,,"6,363 x patient days",54086,Per diem,,179158,70,,179158,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,55343,,"25,057 x DRG weight",55343,Other,base rate x DRG weight,49811,,"22,552 x DRG weight",49811,Other,base rate x DRG weight,55343,,"25,057 x DRG weight",55343,Other,base rate x DRG weight,47041,,"21,298 x DRG weight",47041,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,179158,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,,,,inpatient,,,121420.68,13054,,,13054,Other,150% of Medicare + 9.63% HCRA Surcharge,7938.11,,,7938.11,Other,Medicare IPPS methodology,22779,,"25,046 x DRG weight",22779,Other,base rate x DRG weight,20501,,"22,541 x DRG weight",20501,Other,base rate x DRG weight,29187,,"32,091 x DRG weight",29187,Other,base rate x DRG weight,26268,,"28,882 x DRG weight",26268,Other,base rate x DRG weight,24808,,"27,277 x DRG weight",24808,Other,base rate x DRG weight,21901,,"24,080 x DRG weight",21901,Other,base rate x DRG weight,20430,,"22,463 x DRG weight",20430,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24034,,"26,426 x DRG weight",24034,Other,base rate x DRG weight,35297,,"38,809 x DRG weight",35297,Other,base rate x DRG weight,35297,,"38,809 x DRG weight",35297,Other,base rate x DRG weight,24034,,"26,426 x DRG weight",24034,Other,base rate x DRG weight,35297,,"38,809 x DRG weight",35297,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,84994,70,,84994,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22789,,"25,057 x DRG weight",22789,Other,base rate x DRG weight,20511,,"22,552 x DRG weight",20511,Other,base rate x DRG weight,22789,,"25,057 x DRG weight",22789,Other,base rate x DRG weight,19371,,"21,298 x DRG weight",19371,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,84994,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,,,,inpatient,,,283860.77,31883,,,31883,Other,150% of Medicare + 9.63% HCRA Surcharge,19388.22,,,19388.22,Other,Medicare IPPS methodology,57062,,"25,046 x DRG weight",57062,Other,base rate x DRG weight,51355,,"22,541 x DRG weight",51355,Other,base rate x DRG weight,73113,,"32,091 x DRG weight",73113,Other,base rate x DRG weight,65802,,"28,882 x DRG weight",65802,Other,base rate x DRG weight,62145,,"27,277 x DRG weight",62145,Other,base rate x DRG weight,54861,,"24,080 x DRG weight",54861,Other,base rate x DRG weight,51177,,"22,463 x DRG weight",51177,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,60206,,"26,426 x DRG weight",60206,Other,base rate x DRG weight,88419,,"38,809 x DRG weight",88419,Other,base rate x DRG weight,88419,,"38,809 x DRG weight",88419,Other,base rate x DRG weight,60206,,"26,426 x DRG weight",60206,Other,base rate x DRG weight,88419,,"38,809 x DRG weight",88419,Other,base rate x DRG weight,45177,,"6,363 x patient days",45177,Per diem,,198703,70,,198703,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,57087,,"25,057 x DRG weight",57087,Other,base rate x DRG weight,51380,,"22,552 x DRG weight",51380,Other,base rate x DRG weight,57087,,"25,057 x DRG weight",57087,Other,base rate x DRG weight,48523,,"21,298 x DRG weight",48523,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,198703,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,,,,inpatient,,,200124.21,19201,,,19201,Other,150% of Medicare + 9.63% HCRA Surcharge,11676.46,,,11676.46,Other,Medicare IPPS methodology,33972,,"25,046 x DRG weight",33972,Other,base rate x DRG weight,30575,,"22,541 x DRG weight",30575,Other,base rate x DRG weight,43528,,"32,091 x DRG weight",43528,Other,base rate x DRG weight,39176,,"28,882 x DRG weight",39176,Other,base rate x DRG weight,36999,,"27,277 x DRG weight",36999,Other,base rate x DRG weight,32662,,"24,080 x DRG weight",32662,Other,base rate x DRG weight,30469,,"22,463 x DRG weight",30469,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,35844,,"26,426 x DRG weight",35844,Other,base rate x DRG weight,52641,,"38,809 x DRG weight",52641,Other,base rate x DRG weight,52641,,"38,809 x DRG weight",52641,Other,base rate x DRG weight,35844,,"26,426 x DRG weight",35844,Other,base rate x DRG weight,52641,,"38,809 x DRG weight",52641,Other,base rate x DRG weight,27997,,"6,363 x patient days",27997,Per diem,,140087,70,,140087,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33987,,"25,057 x DRG weight",33987,Other,base rate x DRG weight,30590,,"22,552 x DRG weight",30590,Other,base rate x DRG weight,33987,,"25,057 x DRG weight",33987,Other,base rate x DRG weight,28889,,"21,298 x DRG weight",28889,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,140087,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,,,,inpatient,,,117757.53,13194,,,13194,Other,150% of Medicare + 9.63% HCRA Surcharge,8023.43,,,8023.43,Other,Medicare IPPS methodology,23035,,"25,046 x DRG weight",23035,Other,base rate x DRG weight,20731,,"22,541 x DRG weight",20731,Other,base rate x DRG weight,29514,,"32,091 x DRG weight",29514,Other,base rate x DRG weight,26563,,"28,882 x DRG weight",26563,Other,base rate x DRG weight,25087,,"27,277 x DRG weight",25087,Other,base rate x DRG weight,22146,,"24,080 x DRG weight",22146,Other,base rate x DRG weight,20659,,"22,463 x DRG weight",20659,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24304,,"26,426 x DRG weight",24304,Other,base rate x DRG weight,35693,,"38,809 x DRG weight",35693,Other,base rate x DRG weight,35693,,"38,809 x DRG weight",35693,Other,base rate x DRG weight,24304,,"26,426 x DRG weight",24304,Other,base rate x DRG weight,35693,,"38,809 x DRG weight",35693,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,82430,70,,82430,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23045,,"25,057 x DRG weight",23045,Other,base rate x DRG weight,20741,,"22,552 x DRG weight",20741,Other,base rate x DRG weight,23045,,"25,057 x DRG weight",23045,Other,base rate x DRG weight,19588,,"21,298 x DRG weight",19588,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,82430,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,,,,inpatient,,,256151.69,31807,,,31807,Other,150% of Medicare + 9.63% HCRA Surcharge,19342.22,,,19342.22,Other,Medicare IPPS methodology,56925,,"25,046 x DRG weight",56925,Other,base rate x DRG weight,51231,,"22,541 x DRG weight",51231,Other,base rate x DRG weight,72936,,"32,091 x DRG weight",72936,Other,base rate x DRG weight,65643,,"28,882 x DRG weight",65643,Other,base rate x DRG weight,61995,,"27,277 x DRG weight",61995,Other,base rate x DRG weight,54729,,"24,080 x DRG weight",54729,Other,base rate x DRG weight,51054,,"22,463 x DRG weight",51054,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,60061,,"26,426 x DRG weight",60061,Other,base rate x DRG weight,88205,,"38,809 x DRG weight",88205,Other,base rate x DRG weight,88205,,"38,809 x DRG weight",88205,Other,base rate x DRG weight,60061,,"26,426 x DRG weight",60061,Other,base rate x DRG weight,88205,,"38,809 x DRG weight",88205,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,179306,70,,179306,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,56950,,"25,057 x DRG weight",56950,Other,base rate x DRG weight,51256,,"22,552 x DRG weight",51256,Other,base rate x DRG weight,56950,,"25,057 x DRG weight",56950,Other,base rate x DRG weight,48406,,"21,298 x DRG weight",48406,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,179306,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,,,,inpatient,,,177275.48,18661,,,18661,Other,150% of Medicare + 9.63% HCRA Surcharge,11347.71,,,11347.71,Other,Medicare IPPS methodology,32988,,"25,046 x DRG weight",32988,Other,base rate x DRG weight,29689,,"22,541 x DRG weight",29689,Other,base rate x DRG weight,42267,,"32,091 x DRG weight",42267,Other,base rate x DRG weight,38040,,"28,882 x DRG weight",38040,Other,base rate x DRG weight,35927,,"27,277 x DRG weight",35927,Other,base rate x DRG weight,31716,,"24,080 x DRG weight",31716,Other,base rate x DRG weight,29586,,"22,463 x DRG weight",29586,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34806,,"26,426 x DRG weight",34806,Other,base rate x DRG weight,51115,,"38,809 x DRG weight",51115,Other,base rate x DRG weight,51115,,"38,809 x DRG weight",51115,Other,base rate x DRG weight,34806,,"26,426 x DRG weight",34806,Other,base rate x DRG weight,51115,,"38,809 x DRG weight",51115,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,124093,70,,124093,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33003,,"25,057 x DRG weight",33003,Other,base rate x DRG weight,29703,,"22,552 x DRG weight",29703,Other,base rate x DRG weight,33003,,"25,057 x DRG weight",33003,Other,base rate x DRG weight,28052,,"21,298 x DRG weight",28052,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,124093,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,,,,inpatient,,,80254.97,12733,,,12733,Other,150% of Medicare + 9.63% HCRA Surcharge,7743.2,,,7743.2,Other,Medicare IPPS methodology,22196,,"25,046 x DRG weight",22196,Other,base rate x DRG weight,19976,,"22,541 x DRG weight",19976,Other,base rate x DRG weight,28439,,"32,091 x DRG weight",28439,Other,base rate x DRG weight,25595,,"28,882 x DRG weight",25595,Other,base rate x DRG weight,24173,,"27,277 x DRG weight",24173,Other,base rate x DRG weight,21340,,"24,080 x DRG weight",21340,Other,base rate x DRG weight,19907,,"22,463 x DRG weight",19907,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23419,,"26,426 x DRG weight",23419,Other,base rate x DRG weight,34393,,"38,809 x DRG weight",34393,Other,base rate x DRG weight,34393,,"38,809 x DRG weight",34393,Other,base rate x DRG weight,23419,,"26,426 x DRG weight",23419,Other,base rate x DRG weight,34393,,"38,809 x DRG weight",34393,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,56178,70,,56178,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22206,,"25,057 x DRG weight",22206,Other,base rate x DRG weight,19986,,"22,552 x DRG weight",19986,Other,base rate x DRG weight,22206,,"25,057 x DRG weight",22206,Other,base rate x DRG weight,18874,,"21,298 x DRG weight",18874,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,56178,
CONCUSSION WITH MCC,88,MS-DRG,,,,,,,,inpatient,,,131096.93,21642,,,21642,Other,150% of Medicare + 9.63% HCRA Surcharge,13160.43,,,13160.43,Other,Medicare IPPS methodology,38416,,"25,046 x DRG weight",38416,Other,base rate x DRG weight,34573,,"22,541 x DRG weight",34573,Other,base rate x DRG weight,49221,,"32,091 x DRG weight",49221,Other,base rate x DRG weight,44299,,"28,882 x DRG weight",44299,Other,base rate x DRG weight,41837,,"27,277 x DRG weight",41837,Other,base rate x DRG weight,36934,,"24,080 x DRG weight",36934,Other,base rate x DRG weight,34454,,"22,463 x DRG weight",34454,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40532,,"26,426 x DRG weight",40532,Other,base rate x DRG weight,59525,,"38,809 x DRG weight",59525,Other,base rate x DRG weight,59525,,"38,809 x DRG weight",59525,Other,base rate x DRG weight,40532,,"26,426 x DRG weight",40532,Other,base rate x DRG weight,59525,,"38,809 x DRG weight",59525,Other,base rate x DRG weight,34360,,"6,363 x patient days",34360,Per diem,,91768,70,,91768,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38432,,"25,057 x DRG weight",38432,Other,base rate x DRG weight,34590,,"22,552 x DRG weight",34590,Other,base rate x DRG weight,38432,,"25,057 x DRG weight",38432,Other,base rate x DRG weight,32667,,"21,298 x DRG weight",32667,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,91768,
CONCUSSION WITH CC,89,MS-DRG,,,,,,,,inpatient,,,145574.28,16361,,,16361,Other,150% of Medicare + 9.63% HCRA Surcharge,9949.07,,,9949.07,Other,Medicare IPPS methodology,28800,,"25,046 x DRG weight",28800,Other,base rate x DRG weight,25920,,"22,541 x DRG weight",25920,Other,base rate x DRG weight,36901,,"32,091 x DRG weight",36901,Other,base rate x DRG weight,33211,,"28,882 x DRG weight",33211,Other,base rate x DRG weight,31366,,"27,277 x DRG weight",31366,Other,base rate x DRG weight,27690,,"24,080 x DRG weight",27690,Other,base rate x DRG weight,25830,,"22,463 x DRG weight",25830,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,30387,,"26,426 x DRG weight",30387,Other,base rate x DRG weight,44626,,"38,809 x DRG weight",44626,Other,base rate x DRG weight,44626,,"38,809 x DRG weight",44626,Other,base rate x DRG weight,30387,,"26,426 x DRG weight",30387,Other,base rate x DRG weight,44626,,"38,809 x DRG weight",44626,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,101902,70,,101902,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,28813,,"25,057 x DRG weight",28813,Other,base rate x DRG weight,25933,,"22,552 x DRG weight",25933,Other,base rate x DRG weight,28813,,"25,057 x DRG weight",28813,Other,base rate x DRG weight,24491,,"21,298 x DRG weight",24491,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,101902,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,,,,inpatient,,,91120.84,13402,,,13402,Other,150% of Medicare + 9.63% HCRA Surcharge,8149.74,,,8149.74,Other,Medicare IPPS methodology,23413,,"25,046 x DRG weight",23413,Other,base rate x DRG weight,21071,,"22,541 x DRG weight",21071,Other,base rate x DRG weight,29999,,"32,091 x DRG weight",29999,Other,base rate x DRG weight,26999,,"28,882 x DRG weight",26999,Other,base rate x DRG weight,25499,,"27,277 x DRG weight",25499,Other,base rate x DRG weight,22510,,"24,080 x DRG weight",22510,Other,base rate x DRG weight,20998,,"22,463 x DRG weight",20998,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24703,,"26,426 x DRG weight",24703,Other,base rate x DRG weight,36279,,"38,809 x DRG weight",36279,Other,base rate x DRG weight,36279,,"38,809 x DRG weight",36279,Other,base rate x DRG weight,24703,,"26,426 x DRG weight",24703,Other,base rate x DRG weight,36279,,"38,809 x DRG weight",36279,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,63785,70,,63785,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23423,,"25,057 x DRG weight",23423,Other,base rate x DRG weight,21082,,"22,552 x DRG weight",21082,Other,base rate x DRG weight,23423,,"25,057 x DRG weight",23423,Other,base rate x DRG weight,19909,,"21,298 x DRG weight",19909,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,63785,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,,,,inpatient,,,247322.39,25155,,,25155,Other,150% of Medicare + 9.63% HCRA Surcharge,15296.87,,,15296.87,Other,Medicare IPPS methodology,44812,,"25,046 x DRG weight",44812,Other,base rate x DRG weight,40330,,"22,541 x DRG weight",40330,Other,base rate x DRG weight,57417,,"32,091 x DRG weight",57417,Other,base rate x DRG weight,51676,,"28,882 x DRG weight",51676,Other,base rate x DRG weight,48804,,"27,277 x DRG weight",48804,Other,base rate x DRG weight,43084,,"24,080 x DRG weight",43084,Other,base rate x DRG weight,40191,,"22,463 x DRG weight",40191,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,47281,,"26,426 x DRG weight",47281,Other,base rate x DRG weight,69437,,"38,809 x DRG weight",69437,Other,base rate x DRG weight,69437,,"38,809 x DRG weight",69437,Other,base rate x DRG weight,47281,,"26,426 x DRG weight",47281,Other,base rate x DRG weight,69437,,"38,809 x DRG weight",69437,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,173126,70,,173126,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,44832,,"25,057 x DRG weight",44832,Other,base rate x DRG weight,40350,,"22,552 x DRG weight",40350,Other,base rate x DRG weight,44832,,"25,057 x DRG weight",44832,Other,base rate x DRG weight,38106,,"21,298 x DRG weight",38106,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,173126,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,,,,inpatient,,,163311.23,14658,,,14658,Other,150% of Medicare + 9.63% HCRA Surcharge,8913.48,,,8913.48,Other,Medicare IPPS methodology,25700,,"25,046 x DRG weight",25700,Other,base rate x DRG weight,23129,,"22,541 x DRG weight",23129,Other,base rate x DRG weight,32929,,"32,091 x DRG weight",32929,Other,base rate x DRG weight,29636,,"28,882 x DRG weight",29636,Other,base rate x DRG weight,27989,,"27,277 x DRG weight",27989,Other,base rate x DRG weight,24708,,"24,080 x DRG weight",24708,Other,base rate x DRG weight,23049,,"22,463 x DRG weight",23049,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27116,,"26,426 x DRG weight",27116,Other,base rate x DRG weight,39822,,"38,809 x DRG weight",39822,Other,base rate x DRG weight,39822,,"38,809 x DRG weight",39822,Other,base rate x DRG weight,27116,,"26,426 x DRG weight",27116,Other,base rate x DRG weight,39822,,"38,809 x DRG weight",39822,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,114318,70,,114318,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25711,,"25,057 x DRG weight",25711,Other,base rate x DRG weight,23141,,"22,552 x DRG weight",23141,Other,base rate x DRG weight,25711,,"25,057 x DRG weight",25711,Other,base rate x DRG weight,21854,,"21,298 x DRG weight",21854,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,114318,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,,,,inpatient,,,94602.58,11195,,,11195,Other,150% of Medicare + 9.63% HCRA Surcharge,6807.99,,,6807.99,Other,Medicare IPPS methodology,19396,,"25,046 x DRG weight",19396,Other,base rate x DRG weight,17456,,"22,541 x DRG weight",17456,Other,base rate x DRG weight,24851,,"32,091 x DRG weight",24851,Other,base rate x DRG weight,22366,,"28,882 x DRG weight",22366,Other,base rate x DRG weight,21123,,"27,277 x DRG weight",21123,Other,base rate x DRG weight,18648,,"24,080 x DRG weight",18648,Other,base rate x DRG weight,17395,,"22,463 x DRG weight",17395,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20464,,"26,426 x DRG weight",20464,Other,base rate x DRG weight,30054,,"38,809 x DRG weight",30054,Other,base rate x DRG weight,30054,,"38,809 x DRG weight",30054,Other,base rate x DRG weight,20464,,"26,426 x DRG weight",20464,Other,base rate x DRG weight,30054,,"38,809 x DRG weight",30054,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,66222,70,,66222,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19404,,"25,057 x DRG weight",19404,Other,base rate x DRG weight,17464,,"22,552 x DRG weight",17464,Other,base rate x DRG weight,19404,,"25,057 x DRG weight",19404,Other,base rate x DRG weight,16493,,"21,298 x DRG weight",16493,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,66222,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,,,,inpatient,,,348015.49,50376,,,50376,Other,150% of Medicare + 9.63% HCRA Surcharge,30634.23,,,30634.23,Other,Medicare IPPS methodology,90734,,"25,046 x DRG weight",90734,Other,base rate x DRG weight,81659,,"22,541 x DRG weight",81659,Other,base rate x DRG weight,116256,,"32,091 x DRG weight",116256,Other,base rate x DRG weight,104631,,"28,882 x DRG weight",104631,Other,base rate x DRG weight,98816,,"27,277 x DRG weight",98816,Other,base rate x DRG weight,87235,,"24,080 x DRG weight",87235,Other,base rate x DRG weight,81377,,"22,463 x DRG weight",81377,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,95733,,"26,426 x DRG weight",95733,Other,base rate x DRG weight,140593,,"38,809 x DRG weight",140593,Other,base rate x DRG weight,140593,,"38,809 x DRG weight",140593,Other,base rate x DRG weight,95733,,"26,426 x DRG weight",95733,Other,base rate x DRG weight,140593,,"38,809 x DRG weight",140593,Other,base rate x DRG weight,73175,,"6,363 x patient days",73175,Per diem,,243611,70,,243611,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,90774,,"25,057 x DRG weight",90774,Other,base rate x DRG weight,81699,,"22,552 x DRG weight",81699,Other,base rate x DRG weight,90774,,"25,057 x DRG weight",90774,Other,base rate x DRG weight,77156,,"21,298 x DRG weight",77156,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,243611,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,,,,inpatient,,,251747.23,33340,,,33340,Other,150% of Medicare + 9.63% HCRA Surcharge,20274.09,,,20274.09,Other,Medicare IPPS methodology,59715,,"25,046 x DRG weight",59715,Other,base rate x DRG weight,53742,,"22,541 x DRG weight",53742,Other,base rate x DRG weight,76511,,"32,091 x DRG weight",76511,Other,base rate x DRG weight,68860,,"28,882 x DRG weight",68860,Other,base rate x DRG weight,65034,,"27,277 x DRG weight",65034,Other,base rate x DRG weight,57412,,"24,080 x DRG weight",57412,Other,base rate x DRG weight,53556,,"22,463 x DRG weight",53556,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,63005,,"26,426 x DRG weight",63005,Other,base rate x DRG weight,92528,,"38,809 x DRG weight",92528,Other,base rate x DRG weight,92528,,"38,809 x DRG weight",92528,Other,base rate x DRG weight,63005,,"26,426 x DRG weight",63005,Other,base rate x DRG weight,92528,,"38,809 x DRG weight",92528,Other,base rate x DRG weight,46450,,"6,363 x patient days",46450,Per diem,,176223,70,,176223,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,59741,,"25,057 x DRG weight",59741,Other,base rate x DRG weight,53768,,"22,552 x DRG weight",53768,Other,base rate x DRG weight,59741,,"25,057 x DRG weight",59741,Other,base rate x DRG weight,50779,,"21,298 x DRG weight",50779,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,176223,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,,,,inpatient,,,206916.67,30527,,,30527,Other,150% of Medicare + 9.63% HCRA Surcharge,18563.43,,,18563.43,Other,Medicare IPPS methodology,54593,,"25,046 x DRG weight",54593,Other,base rate x DRG weight,49133,,"22,541 x DRG weight",49133,Other,base rate x DRG weight,69949,,"32,091 x DRG weight",69949,Other,base rate x DRG weight,62954,,"28,882 x DRG weight",62954,Other,base rate x DRG weight,59456,,"27,277 x DRG weight",59456,Other,base rate x DRG weight,52487,,"24,080 x DRG weight",52487,Other,base rate x DRG weight,48963,,"22,463 x DRG weight",48963,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,57601,,"26,426 x DRG weight",57601,Other,base rate x DRG weight,84592,,"38,809 x DRG weight",84592,Other,base rate x DRG weight,84592,,"38,809 x DRG weight",84592,Other,base rate x DRG weight,57601,,"26,426 x DRG weight",57601,Other,base rate x DRG weight,84592,,"38,809 x DRG weight",84592,Other,base rate x DRG weight,33724,,"6,363 x patient days",33724,Per diem,,144842,70,,144842,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,54617,,"25,057 x DRG weight",54617,Other,base rate x DRG weight,49157,,"22,552 x DRG weight",49157,Other,base rate x DRG weight,54617,,"25,057 x DRG weight",54617,Other,base rate x DRG weight,46423,,"21,298 x DRG weight",46423,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,144842,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,,,,inpatient,,,411465.66,50572,,,50572,Other,150% of Medicare + 9.63% HCRA Surcharge,30753.02,,,30753.02,Other,Medicare IPPS methodology,91090,,"25,046 x DRG weight",91090,Other,base rate x DRG weight,81979,,"22,541 x DRG weight",81979,Other,base rate x DRG weight,116712,,"32,091 x DRG weight",116712,Other,base rate x DRG weight,105041,,"28,882 x DRG weight",105041,Other,base rate x DRG weight,99204,,"27,277 x DRG weight",99204,Other,base rate x DRG weight,87577,,"24,080 x DRG weight",87577,Other,base rate x DRG weight,81696,,"22,463 x DRG weight",81696,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,96109,,"26,426 x DRG weight",96109,Other,base rate x DRG weight,141144,,"38,809 x DRG weight",141144,Other,base rate x DRG weight,141144,,"38,809 x DRG weight",141144,Other,base rate x DRG weight,96109,,"26,426 x DRG weight",96109,Other,base rate x DRG weight,141144,,"38,809 x DRG weight",141144,Other,base rate x DRG weight,79538,,"6,363 x patient days",79538,Per diem,,288026,70,,288026,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,91130,,"25,057 x DRG weight",91130,Other,base rate x DRG weight,82019,,"22,552 x DRG weight",82019,Other,base rate x DRG weight,91130,,"25,057 x DRG weight",91130,Other,base rate x DRG weight,77459,,"21,298 x DRG weight",77459,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,288026,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,,,,inpatient,,,305591.59,30180,,,30180,Other,150% of Medicare + 9.63% HCRA Surcharge,18352.63,,,18352.63,Other,Medicare IPPS methodology,53962,,"25,046 x DRG weight",53962,Other,base rate x DRG weight,48565,,"22,541 x DRG weight",48565,Other,base rate x DRG weight,69140,,"32,091 x DRG weight",69140,Other,base rate x DRG weight,62226,,"28,882 x DRG weight",62226,Other,base rate x DRG weight,58768,,"27,277 x DRG weight",58768,Other,base rate x DRG weight,51880,,"24,080 x DRG weight",51880,Other,base rate x DRG weight,48397,,"22,463 x DRG weight",48397,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,56935,,"26,426 x DRG weight",56935,Other,base rate x DRG weight,83614,,"38,809 x DRG weight",83614,Other,base rate x DRG weight,83614,,"38,809 x DRG weight",83614,Other,base rate x DRG weight,56935,,"26,426 x DRG weight",56935,Other,base rate x DRG weight,83614,,"38,809 x DRG weight",83614,Other,base rate x DRG weight,52177,,"6,363 x patient days",52177,Per diem,,213914,70,,213914,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,53985,,"25,057 x DRG weight",53985,Other,base rate x DRG weight,48588,,"22,552 x DRG weight",48588,Other,base rate x DRG weight,53985,,"25,057 x DRG weight",53985,Other,base rate x DRG weight,45887,,"21,298 x DRG weight",45887,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,213914,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,,,,inpatient,,,127994.65,18703,,,18703,Other,150% of Medicare + 9.63% HCRA Surcharge,11373.64,,,11373.64,Other,Medicare IPPS methodology,33066,,"25,046 x DRG weight",33066,Other,base rate x DRG weight,29759,,"22,541 x DRG weight",29759,Other,base rate x DRG weight,42367,,"32,091 x DRG weight",42367,Other,base rate x DRG weight,38130,,"28,882 x DRG weight",38130,Other,base rate x DRG weight,36011,,"27,277 x DRG weight",36011,Other,base rate x DRG weight,31790,,"24,080 x DRG weight",31790,Other,base rate x DRG weight,29656,,"22,463 x DRG weight",29656,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34888,,"26,426 x DRG weight",34888,Other,base rate x DRG weight,51236,,"38,809 x DRG weight",51236,Other,base rate x DRG weight,51236,,"38,809 x DRG weight",51236,Other,base rate x DRG weight,34888,,"26,426 x DRG weight",34888,Other,base rate x DRG weight,51236,,"38,809 x DRG weight",51236,Other,base rate x DRG weight,30542,,"6,363 x patient days",30542,Per diem,,89596,70,,89596,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33080,,"25,057 x DRG weight",33080,Other,base rate x DRG weight,29773,,"22,552 x DRG weight",29773,Other,base rate x DRG weight,33080,,"25,057 x DRG weight",33080,Other,base rate x DRG weight,28118,,"21,298 x DRG weight",28118,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,89596,
SEIZURES WITH MCC,100,MS-DRG,,,,,,,,inpatient,,,212740.77,27814,,,27814,Other,150% of Medicare + 9.63% HCRA Surcharge,16913.84,,,16913.84,Other,Medicare IPPS methodology,49654,,"25,046 x DRG weight",49654,Other,base rate x DRG weight,44688,,"22,541 x DRG weight",44688,Other,base rate x DRG weight,63620,,"32,091 x DRG weight",63620,Other,base rate x DRG weight,57259,,"28,882 x DRG weight",57259,Other,base rate x DRG weight,54077,,"27,277 x DRG weight",54077,Other,base rate x DRG weight,47739,,"24,080 x DRG weight",47739,Other,base rate x DRG weight,44533,,"22,463 x DRG weight",44533,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52390,,"26,426 x DRG weight",52390,Other,base rate x DRG weight,76939,,"38,809 x DRG weight",76939,Other,base rate x DRG weight,76939,,"38,809 x DRG weight",76939,Other,base rate x DRG weight,52390,,"26,426 x DRG weight",52390,Other,base rate x DRG weight,76939,,"38,809 x DRG weight",76939,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,148919,70,,148919,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49676,,"25,057 x DRG weight",49676,Other,base rate x DRG weight,44709,,"22,552 x DRG weight",44709,Other,base rate x DRG weight,49676,,"25,057 x DRG weight",49676,Other,base rate x DRG weight,42223,,"21,298 x DRG weight",42223,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,148919,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,,inpatient,,,89221.08,13055,,,13055,Other,150% of Medicare + 9.63% HCRA Surcharge,7938.94,,,7938.94,Other,Medicare IPPS methodology,22782,,"25,046 x DRG weight",22782,Other,base rate x DRG weight,20503,,"22,541 x DRG weight",20503,Other,base rate x DRG weight,29190,,"32,091 x DRG weight",29190,Other,base rate x DRG weight,26271,,"28,882 x DRG weight",26271,Other,base rate x DRG weight,24811,,"27,277 x DRG weight",24811,Other,base rate x DRG weight,21903,,"24,080 x DRG weight",21903,Other,base rate x DRG weight,20432,,"22,463 x DRG weight",20432,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24037,,"26,426 x DRG weight",24037,Other,base rate x DRG weight,35301,,"38,809 x DRG weight",35301,Other,base rate x DRG weight,35301,,"38,809 x DRG weight",35301,Other,base rate x DRG weight,24037,,"26,426 x DRG weight",24037,Other,base rate x DRG weight,35301,,"38,809 x DRG weight",35301,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,62455,70,,62455,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22792,,"25,057 x DRG weight",22792,Other,base rate x DRG weight,20513,,"22,552 x DRG weight",20513,Other,base rate x DRG weight,22792,,"25,057 x DRG weight",22792,Other,base rate x DRG weight,19373,,"21,298 x DRG weight",19373,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,62455,
HEADACHES WITH MCC,102,MS-DRG,,,,,,,,inpatient,,,188017.58,17141,,,17141,Other,150% of Medicare + 9.63% HCRA Surcharge,10423.37,,,10423.37,Other,Medicare IPPS methodology,30221,,"25,046 x DRG weight",30221,Other,base rate x DRG weight,27198,,"22,541 x DRG weight",27198,Other,base rate x DRG weight,38721,,"32,091 x DRG weight",38721,Other,base rate x DRG weight,34849,,"28,882 x DRG weight",34849,Other,base rate x DRG weight,32912,,"27,277 x DRG weight",32912,Other,base rate x DRG weight,29055,,"24,080 x DRG weight",29055,Other,base rate x DRG weight,27104,,"22,463 x DRG weight",27104,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31886,,"26,426 x DRG weight",31886,Other,base rate x DRG weight,46827,,"38,809 x DRG weight",46827,Other,base rate x DRG weight,46827,,"38,809 x DRG weight",46827,Other,base rate x DRG weight,31886,,"26,426 x DRG weight",31886,Other,base rate x DRG weight,46827,,"38,809 x DRG weight",46827,Other,base rate x DRG weight,28634,,"6,363 x patient days",28634,Per diem,,131612,70,,131612,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30234,,"25,057 x DRG weight",30234,Other,base rate x DRG weight,27211,,"22,552 x DRG weight",27211,Other,base rate x DRG weight,30234,,"25,057 x DRG weight",30234,Other,base rate x DRG weight,25698,,"21,298 x DRG weight",25698,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,131612,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,,inpatient,,,110728.85,12131,,,12131,Other,150% of Medicare + 9.63% HCRA Surcharge,7376.81,,,7376.81,Other,Medicare IPPS methodology,21099,,"25,046 x DRG weight",21099,Other,base rate x DRG weight,18989,,"22,541 x DRG weight",18989,Other,base rate x DRG weight,27033,,"32,091 x DRG weight",27033,Other,base rate x DRG weight,24330,,"28,882 x DRG weight",24330,Other,base rate x DRG weight,22978,,"27,277 x DRG weight",22978,Other,base rate x DRG weight,20285,,"24,080 x DRG weight",20285,Other,base rate x DRG weight,18923,,"22,463 x DRG weight",18923,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22261,,"26,426 x DRG weight",22261,Other,base rate x DRG weight,32693,,"38,809 x DRG weight",32693,Other,base rate x DRG weight,32693,,"38,809 x DRG weight",32693,Other,base rate x DRG weight,22261,,"26,426 x DRG weight",22261,Other,base rate x DRG weight,32693,,"38,809 x DRG weight",32693,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,77510,70,,77510,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21108,,"25,057 x DRG weight",21108,Other,base rate x DRG weight,18998,,"22,552 x DRG weight",18998,Other,base rate x DRG weight,21108,,"25,057 x DRG weight",21108,Other,base rate x DRG weight,17941,,"21,298 x DRG weight",17941,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,77510,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,,inpatient,,,464263.93,35033,,,35033,Other,150% of Medicare + 9.63% HCRA Surcharge,21303.83,,,21303.83,Other,Medicare IPPS methodology,62798,,"25,046 x DRG weight",62798,Other,base rate x DRG weight,56517,,"22,541 x DRG weight",56517,Other,base rate x DRG weight,80462,,"32,091 x DRG weight",80462,Other,base rate x DRG weight,72416,,"28,882 x DRG weight",72416,Other,base rate x DRG weight,68392,,"27,277 x DRG weight",68392,Other,base rate x DRG weight,60376,,"24,080 x DRG weight",60376,Other,base rate x DRG weight,56321,,"22,463 x DRG weight",56321,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,66258,,"26,426 x DRG weight",66258,Other,base rate x DRG weight,97306,,"38,809 x DRG weight",97306,Other,base rate x DRG weight,97306,,"38,809 x DRG weight",97306,Other,base rate x DRG weight,66258,,"26,426 x DRG weight",66258,Other,base rate x DRG weight,97306,,"38,809 x DRG weight",97306,Other,base rate x DRG weight,50268,,"6,363 x patient days",50268,Per diem,,324985,70,,324985,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,62825,,"25,057 x DRG weight",62825,Other,base rate x DRG weight,56545,,"22,552 x DRG weight",56545,Other,base rate x DRG weight,62825,,"25,057 x DRG weight",62825,Other,base rate x DRG weight,53400,,"21,298 x DRG weight",53400,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,324985,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,,inpatient,,,92286.06,17487,,,17487,Other,150% of Medicare + 9.63% HCRA Surcharge,10634.17,,,10634.17,Other,Medicare IPPS methodology,30852,,"25,046 x DRG weight",30852,Other,base rate x DRG weight,27766,,"22,541 x DRG weight",27766,Other,base rate x DRG weight,39530,,"32,091 x DRG weight",39530,Other,base rate x DRG weight,35577,,"28,882 x DRG weight",35577,Other,base rate x DRG weight,33600,,"27,277 x DRG weight",33600,Other,base rate x DRG weight,29662,,"24,080 x DRG weight",29662,Other,base rate x DRG weight,27670,,"22,463 x DRG weight",27670,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,32552,,"26,426 x DRG weight",32552,Other,base rate x DRG weight,47805,,"38,809 x DRG weight",47805,Other,base rate x DRG weight,47805,,"38,809 x DRG weight",47805,Other,base rate x DRG weight,32552,,"26,426 x DRG weight",32552,Other,base rate x DRG weight,47805,,"38,809 x DRG weight",47805,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,64600,70,,64600,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30865,,"25,057 x DRG weight",30865,Other,base rate x DRG weight,27780,,"22,552 x DRG weight",27780,Other,base rate x DRG weight,30865,,"25,057 x DRG weight",30865,Other,base rate x DRG weight,26235,,"21,298 x DRG weight",26235,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,64600,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,,inpatient,,,172972.87,22063,,,22063,Other,150% of Medicare + 9.63% HCRA Surcharge,13416.4,,,13416.4,Other,Medicare IPPS methodology,39182,,"25,046 x DRG weight",39182,Other,base rate x DRG weight,35263,,"22,541 x DRG weight",35263,Other,base rate x DRG weight,50203,,"32,091 x DRG weight",50203,Other,base rate x DRG weight,45183,,"28,882 x DRG weight",45183,Other,base rate x DRG weight,42672,,"27,277 x DRG weight",42672,Other,base rate x DRG weight,37671,,"24,080 x DRG weight",37671,Other,base rate x DRG weight,35141,,"22,463 x DRG weight",35141,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41341,,"26,426 x DRG weight",41341,Other,base rate x DRG weight,60713,,"38,809 x DRG weight",60713,Other,base rate x DRG weight,60713,,"38,809 x DRG weight",60713,Other,base rate x DRG weight,41341,,"26,426 x DRG weight",41341,Other,base rate x DRG weight,60713,,"38,809 x DRG weight",60713,Other,base rate x DRG weight,31179,,"6,363 x patient days",31179,Per diem,,121081,70,,121081,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39199,,"25,057 x DRG weight",39199,Other,base rate x DRG weight,35280,,"22,552 x DRG weight",35280,Other,base rate x DRG weight,39199,,"25,057 x DRG weight",39199,Other,base rate x DRG weight,33319,,"21,298 x DRG weight",33319,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,121081,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,,inpatient,,,161700.79,25727,,,25727,Other,150% of Medicare + 9.63% HCRA Surcharge,15644.85,,,15644.85,Other,Medicare IPPS methodology,45854,,"25,046 x DRG weight",45854,Other,base rate x DRG weight,41268,,"22,541 x DRG weight",41268,Other,base rate x DRG weight,58752,,"32,091 x DRG weight",58752,Other,base rate x DRG weight,52877,,"28,882 x DRG weight",52877,Other,base rate x DRG weight,49939,,"27,277 x DRG weight",49939,Other,base rate x DRG weight,44086,,"24,080 x DRG weight",44086,Other,base rate x DRG weight,41125,,"22,463 x DRG weight",41125,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48381,,"26,426 x DRG weight",48381,Other,base rate x DRG weight,71052,,"38,809 x DRG weight",71052,Other,base rate x DRG weight,71052,,"38,809 x DRG weight",71052,Other,base rate x DRG weight,48381,,"26,426 x DRG weight",48381,Other,base rate x DRG weight,71052,,"38,809 x DRG weight",71052,Other,base rate x DRG weight,39451,,"6,363 x patient days",39451,Per diem,,113191,70,,113191,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,45874,,"25,057 x DRG weight",45874,Other,base rate x DRG weight,41288,,"22,552 x DRG weight",41288,Other,base rate x DRG weight,45874,,"25,057 x DRG weight",45874,Other,base rate x DRG weight,38992,,"21,298 x DRG weight",38992,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,113191,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,,inpatient,,,87477.7,17028,,,17028,Other,150% of Medicare + 9.63% HCRA Surcharge,10354.78,,,10354.78,Other,Medicare IPPS methodology,30015,,"25,046 x DRG weight",30015,Other,base rate x DRG weight,27013,,"22,541 x DRG weight",27013,Other,base rate x DRG weight,38458,,"32,091 x DRG weight",38458,Other,base rate x DRG weight,34612,,"28,882 x DRG weight",34612,Other,base rate x DRG weight,32689,,"27,277 x DRG weight",32689,Other,base rate x DRG weight,28857,,"24,080 x DRG weight",28857,Other,base rate x DRG weight,26920,,"22,463 x DRG weight",26920,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31669,,"26,426 x DRG weight",31669,Other,base rate x DRG weight,46509,,"38,809 x DRG weight",46509,Other,base rate x DRG weight,46509,,"38,809 x DRG weight",46509,Other,base rate x DRG weight,31669,,"26,426 x DRG weight",31669,Other,base rate x DRG weight,46509,,"38,809 x DRG weight",46509,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,61234,70,,61234,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30028,,"25,057 x DRG weight",30028,Other,base rate x DRG weight,27026,,"22,552 x DRG weight",27026,Other,base rate x DRG weight,30028,,"25,057 x DRG weight",30028,Other,base rate x DRG weight,25524,,"21,298 x DRG weight",25524,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,61234,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,,inpatient,,,101124.95,18167,,,18167,Other,150% of Medicare + 9.63% HCRA Surcharge,11047.41,,,11047.41,Other,Medicare IPPS methodology,32089,,"25,046 x DRG weight",32089,Other,base rate x DRG weight,28880,,"22,541 x DRG weight",28880,Other,base rate x DRG weight,41115,,"32,091 x DRG weight",41115,Other,base rate x DRG weight,37004,,"28,882 x DRG weight",37004,Other,base rate x DRG weight,34947,,"27,277 x DRG weight",34947,Other,base rate x DRG weight,30851,,"24,080 x DRG weight",30851,Other,base rate x DRG weight,28780,,"22,463 x DRG weight",28780,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,33857,,"26,426 x DRG weight",33857,Other,base rate x DRG weight,49722,,"38,809 x DRG weight",49722,Other,base rate x DRG weight,49722,,"38,809 x DRG weight",49722,Other,base rate x DRG weight,33857,,"26,426 x DRG weight",33857,Other,base rate x DRG weight,49722,,"38,809 x DRG weight",49722,Other,base rate x DRG weight,39451,,"6,363 x patient days",39451,Per diem,,70787,70,,70787,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32103,,"25,057 x DRG weight",32103,Other,base rate x DRG weight,28894,,"22,552 x DRG weight",28894,Other,base rate x DRG weight,32103,,"25,057 x DRG weight",32103,Other,base rate x DRG weight,27287,,"21,298 x DRG weight",27287,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,70787,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,,inpatient,,,74313.11,10784,,,10784,Other,150% of Medicare + 9.63% HCRA Surcharge,6557.87,,,6557.87,Other,Medicare IPPS methodology,18647,,"25,046 x DRG weight",18647,Other,base rate x DRG weight,16782,,"22,541 x DRG weight",16782,Other,base rate x DRG weight,23892,,"32,091 x DRG weight",23892,Other,base rate x DRG weight,21503,,"28,882 x DRG weight",21503,Other,base rate x DRG weight,20308,,"27,277 x DRG weight",20308,Other,base rate x DRG weight,17928,,"24,080 x DRG weight",17928,Other,base rate x DRG weight,16724,,"22,463 x DRG weight",16724,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19674,,"26,426 x DRG weight",19674,Other,base rate x DRG weight,28893,,"38,809 x DRG weight",28893,Other,base rate x DRG weight,28893,,"38,809 x DRG weight",28893,Other,base rate x DRG weight,19674,,"26,426 x DRG weight",19674,Other,base rate x DRG weight,28893,,"38,809 x DRG weight",28893,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,52019,70,,52019,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18655,,"25,057 x DRG weight",18655,Other,base rate x DRG weight,16790,,"22,552 x DRG weight",16790,Other,base rate x DRG weight,18655,,"25,057 x DRG weight",18655,Other,base rate x DRG weight,15856,,"21,298 x DRG weight",15856,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,52019,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,,inpatient,,,151775.32,11603,,,11603,Other,150% of Medicare + 9.63% HCRA Surcharge,7055.59,,,7055.59,Other,Medicare IPPS methodology,20137,,"25,046 x DRG weight",20137,Other,base rate x DRG weight,18123,,"22,541 x DRG weight",18123,Other,base rate x DRG weight,25801,,"32,091 x DRG weight",25801,Other,base rate x DRG weight,23221,,"28,882 x DRG weight",23221,Other,base rate x DRG weight,21931,,"27,277 x DRG weight",21931,Other,base rate x DRG weight,19360,,"24,080 x DRG weight",19360,Other,base rate x DRG weight,18060,,"22,463 x DRG weight",18060,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21247,,"26,426 x DRG weight",21247,Other,base rate x DRG weight,31202,,"38,809 x DRG weight",31202,Other,base rate x DRG weight,31202,,"38,809 x DRG weight",31202,Other,base rate x DRG weight,21247,,"26,426 x DRG weight",21247,Other,base rate x DRG weight,31202,,"38,809 x DRG weight",31202,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,106243,70,,106243,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20146,,"25,057 x DRG weight",20146,Other,base rate x DRG weight,18132,,"22,552 x DRG weight",18132,Other,base rate x DRG weight,20146,,"25,057 x DRG weight",20146,Other,base rate x DRG weight,17124,,"21,298 x DRG weight",17124,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,106243,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,,inpatient,,,234515.92,18727,,,18727,Other,150% of Medicare + 9.63% HCRA Surcharge,11387.87,,,11387.87,Other,Medicare IPPS methodology,33108,,"25,046 x DRG weight",33108,Other,base rate x DRG weight,29797,,"22,541 x DRG weight",29797,Other,base rate x DRG weight,42421,,"32,091 x DRG weight",42421,Other,base rate x DRG weight,38179,,"28,882 x DRG weight",38179,Other,base rate x DRG weight,36057,,"27,277 x DRG weight",36057,Other,base rate x DRG weight,31831,,"24,080 x DRG weight",31831,Other,base rate x DRG weight,29694,,"22,463 x DRG weight",29694,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34933,,"26,426 x DRG weight",34933,Other,base rate x DRG weight,51302,,"38,809 x DRG weight",51302,Other,base rate x DRG weight,51302,,"38,809 x DRG weight",51302,Other,base rate x DRG weight,34933,,"26,426 x DRG weight",34933,Other,base rate x DRG weight,51302,,"38,809 x DRG weight",51302,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,164161,70,,164161,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33123,,"25,057 x DRG weight",33123,Other,base rate x DRG weight,29811,,"22,552 x DRG weight",29811,Other,base rate x DRG weight,33123,,"25,057 x DRG weight",33123,Other,base rate x DRG weight,28154,,"21,298 x DRG weight",28154,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,164161,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,,inpatient,,,148165.28,11513,,,11513,Other,150% of Medicare + 9.63% HCRA Surcharge,7001.22,,,7001.22,Other,Medicare IPPS methodology,19974,,"25,046 x DRG weight",19974,Other,base rate x DRG weight,17976,,"22,541 x DRG weight",17976,Other,base rate x DRG weight,25593,,"32,091 x DRG weight",25593,Other,base rate x DRG weight,23033,,"28,882 x DRG weight",23033,Other,base rate x DRG weight,21753,,"27,277 x DRG weight",21753,Other,base rate x DRG weight,19204,,"24,080 x DRG weight",19204,Other,base rate x DRG weight,17914,,"22,463 x DRG weight",17914,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21075,,"26,426 x DRG weight",21075,Other,base rate x DRG weight,30950,,"38,809 x DRG weight",30950,Other,base rate x DRG weight,30950,,"38,809 x DRG weight",30950,Other,base rate x DRG weight,21075,,"26,426 x DRG weight",21075,Other,base rate x DRG weight,30950,,"38,809 x DRG weight",30950,Other,base rate x DRG weight,19089,,"6,363 x patient days",19089,Per diem,,103716,70,,103716,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19983,,"25,057 x DRG weight",19983,Other,base rate x DRG weight,17985,,"22,552 x DRG weight",17985,Other,base rate x DRG weight,19983,,"25,057 x DRG weight",19983,Other,base rate x DRG weight,16985,,"21,298 x DRG weight",16985,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,103716,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,,inpatient,,,263085.12,37025,,,37025,Other,150% of Medicare + 9.63% HCRA Surcharge,22515.09,,,22515.09,Other,Medicare IPPS methodology,66424,,"25,046 x DRG weight",66424,Other,base rate x DRG weight,59781,,"22,541 x DRG weight",59781,Other,base rate x DRG weight,85109,,"32,091 x DRG weight",85109,Other,base rate x DRG weight,76598,,"28,882 x DRG weight",76598,Other,base rate x DRG weight,72341,,"27,277 x DRG weight",72341,Other,base rate x DRG weight,63863,,"24,080 x DRG weight",63863,Other,base rate x DRG weight,59574,,"22,463 x DRG weight",59574,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,70084,,"26,426 x DRG weight",70084,Other,base rate x DRG weight,102925,,"38,809 x DRG weight",102925,Other,base rate x DRG weight,102925,,"38,809 x DRG weight",102925,Other,base rate x DRG weight,70084,,"26,426 x DRG weight",70084,Other,base rate x DRG weight,102925,,"38,809 x DRG weight",102925,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,184160,70,,184160,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,66454,,"25,057 x DRG weight",66454,Other,base rate x DRG weight,59810,,"22,552 x DRG weight",59810,Other,base rate x DRG weight,66454,,"25,057 x DRG weight",66454,Other,base rate x DRG weight,56484,,"21,298 x DRG weight",56484,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,184160,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,,inpatient,,,136004.4,14908,,,14908,Other,150% of Medicare + 9.63% HCRA Surcharge,9065.72,,,9065.72,Other,Medicare IPPS methodology,26156,,"25,046 x DRG weight",26156,Other,base rate x DRG weight,23540,,"22,541 x DRG weight",23540,Other,base rate x DRG weight,33513,,"32,091 x DRG weight",33513,Other,base rate x DRG weight,30161,,"28,882 x DRG weight",30161,Other,base rate x DRG weight,28485,,"27,277 x DRG weight",28485,Other,base rate x DRG weight,25147,,"24,080 x DRG weight",25147,Other,base rate x DRG weight,23458,,"22,463 x DRG weight",23458,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27597,,"26,426 x DRG weight",27597,Other,base rate x DRG weight,40528,,"38,809 x DRG weight",40528,Other,base rate x DRG weight,40528,,"38,809 x DRG weight",40528,Other,base rate x DRG weight,27597,,"26,426 x DRG weight",27597,Other,base rate x DRG weight,40528,,"38,809 x DRG weight",40528,Other,base rate x DRG weight,9545,,"6,363 x patient days",9545,Per diem,,95203,70,,95203,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26167,,"25,057 x DRG weight",26167,Other,base rate x DRG weight,23551,,"22,552 x DRG weight",23551,Other,base rate x DRG weight,26167,,"25,057 x DRG weight",26167,Other,base rate x DRG weight,22242,,"21,298 x DRG weight",22242,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95203,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,,inpatient,,,174872.07,21241,,,21241,Other,150% of Medicare + 9.63% HCRA Surcharge,12917,,,12917,Other,Medicare IPPS methodology,37687,,"25,046 x DRG weight",37687,Other,base rate x DRG weight,33917,,"22,541 x DRG weight",33917,Other,base rate x DRG weight,48287,,"32,091 x DRG weight",48287,Other,base rate x DRG weight,43459,,"28,882 x DRG weight",43459,Other,base rate x DRG weight,41044,,"27,277 x DRG weight",41044,Other,base rate x DRG weight,36233,,"24,080 x DRG weight",36233,Other,base rate x DRG weight,33800,,"22,463 x DRG weight",33800,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39763,,"26,426 x DRG weight",39763,Other,base rate x DRG weight,58396,,"38,809 x DRG weight",58396,Other,base rate x DRG weight,58396,,"38,809 x DRG weight",58396,Other,base rate x DRG weight,39763,,"26,426 x DRG weight",39763,Other,base rate x DRG weight,58396,,"38,809 x DRG weight",58396,Other,base rate x DRG weight,33088,,"6,363 x patient days",33088,Per diem,,122410,70,,122410,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37703,,"25,057 x DRG weight",37703,Other,base rate x DRG weight,33934,,"22,552 x DRG weight",33934,Other,base rate x DRG weight,37703,,"25,057 x DRG weight",37703,Other,base rate x DRG weight,32047,,"21,298 x DRG weight",32047,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,122410,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,,inpatient,,,222907.05,12451,,,12451,Other,150% of Medicare + 9.63% HCRA Surcharge,7571.72,,,7571.72,Other,Medicare IPPS methodology,21682,,"25,046 x DRG weight",21682,Other,base rate x DRG weight,19514,,"22,541 x DRG weight",19514,Other,base rate x DRG weight,27781,,"32,091 x DRG weight",27781,Other,base rate x DRG weight,25003,,"28,882 x DRG weight",25003,Other,base rate x DRG weight,23614,,"27,277 x DRG weight",23614,Other,base rate x DRG weight,20846,,"24,080 x DRG weight",20846,Other,base rate x DRG weight,19446,,"22,463 x DRG weight",19446,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22877,,"26,426 x DRG weight",22877,Other,base rate x DRG weight,33597,,"38,809 x DRG weight",33597,Other,base rate x DRG weight,33597,,"38,809 x DRG weight",33597,Other,base rate x DRG weight,22877,,"26,426 x DRG weight",22877,Other,base rate x DRG weight,33597,,"38,809 x DRG weight",33597,Other,base rate x DRG weight,12726,,"6,363 x patient days",12726,Per diem,,156035,70,,156035,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21692,,"25,057 x DRG weight",21692,Other,base rate x DRG weight,19523,,"22,552 x DRG weight",19523,Other,base rate x DRG weight,21692,,"25,057 x DRG weight",21692,Other,base rate x DRG weight,18438,,"21,298 x DRG weight",18438,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,156035,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,,inpatient,,,185599.04,16881,,,16881,Other,150% of Medicare + 9.63% HCRA Surcharge,10265.27,,,10265.27,Other,Medicare IPPS methodology,29747,,"25,046 x DRG weight",29747,Other,base rate x DRG weight,26772,,"22,541 x DRG weight",26772,Other,base rate x DRG weight,38114,,"32,091 x DRG weight",38114,Other,base rate x DRG weight,34303,,"28,882 x DRG weight",34303,Other,base rate x DRG weight,32397,,"27,277 x DRG weight",32397,Other,base rate x DRG weight,28600,,"24,080 x DRG weight",28600,Other,base rate x DRG weight,26679,,"22,463 x DRG weight",26679,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31386,,"26,426 x DRG weight",31386,Other,base rate x DRG weight,46093,,"38,809 x DRG weight",46093,Other,base rate x DRG weight,46093,,"38,809 x DRG weight",46093,Other,base rate x DRG weight,31386,,"26,426 x DRG weight",31386,Other,base rate x DRG weight,46093,,"38,809 x DRG weight",46093,Other,base rate x DRG weight,20998,,"6,363 x patient days",20998,Per diem,,129919,70,,129919,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29760,,"25,057 x DRG weight",29760,Other,base rate x DRG weight,26785,,"22,552 x DRG weight",26785,Other,base rate x DRG weight,29760,,"25,057 x DRG weight",29760,Other,base rate x DRG weight,25296,,"21,298 x DRG weight",25296,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,129919,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,,inpatient,,,540714.02,52514,,,52514,Other,150% of Medicare + 9.63% HCRA Surcharge,31934.17,,,31934.17,Other,Medicare IPPS methodology,94626,,"25,046 x DRG weight",94626,Other,base rate x DRG weight,85162,,"22,541 x DRG weight",85162,Other,base rate x DRG weight,121243,,"32,091 x DRG weight",121243,Other,base rate x DRG weight,109119,,"28,882 x DRG weight",109119,Other,base rate x DRG weight,103055,,"27,277 x DRG weight",103055,Other,base rate x DRG weight,90977,,"24,080 x DRG weight",90977,Other,base rate x DRG weight,84867,,"22,463 x DRG weight",84867,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,99840,,"26,426 x DRG weight",99840,Other,base rate x DRG weight,146624,,"38,809 x DRG weight",146624,Other,base rate x DRG weight,146624,,"38,809 x DRG weight",146624,Other,base rate x DRG weight,99840,,"26,426 x DRG weight",99840,Other,base rate x DRG weight,146624,,"38,809 x DRG weight",146624,Other,base rate x DRG weight,61085,,"6,363 x patient days",61085,Per diem,,378500,70,,378500,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,94668,,"25,057 x DRG weight",94668,Other,base rate x DRG weight,85204,,"22,552 x DRG weight",85204,Other,base rate x DRG weight,94668,,"25,057 x DRG weight",94668,Other,base rate x DRG weight,80466,,"21,298 x DRG weight",80466,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,378500,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,,inpatient,,,305703.48,29041,,,29041,Other,150% of Medicare + 9.63% HCRA Surcharge,17660,,,17660,Other,Medicare IPPS methodology,51888,,"25,046 x DRG weight",51888,Other,base rate x DRG weight,46698,,"22,541 x DRG weight",46698,Other,base rate x DRG weight,66483,,"32,091 x DRG weight",66483,Other,base rate x DRG weight,59835,,"28,882 x DRG weight",59835,Other,base rate x DRG weight,56510,,"27,277 x DRG weight",56510,Other,base rate x DRG weight,49887,,"24,080 x DRG weight",49887,Other,base rate x DRG weight,46537,,"22,463 x DRG weight",46537,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,54747,,"26,426 x DRG weight",54747,Other,base rate x DRG weight,80401,,"38,809 x DRG weight",80401,Other,base rate x DRG weight,80401,,"38,809 x DRG weight",80401,Other,base rate x DRG weight,54747,,"26,426 x DRG weight",54747,Other,base rate x DRG weight,80401,,"38,809 x DRG weight",80401,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,213992,70,,213992,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,51911,,"25,057 x DRG weight",51911,Other,base rate x DRG weight,46721,,"22,552 x DRG weight",46721,Other,base rate x DRG weight,51911,,"25,057 x DRG weight",51911,Other,base rate x DRG weight,44123,,"21,298 x DRG weight",44123,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,213992,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,,inpatient,,,151922.26,21796,,,21796,Other,150% of Medicare + 9.63% HCRA Surcharge,13254.11,,,13254.11,Other,Medicare IPPS methodology,38696,,"25,046 x DRG weight",38696,Other,base rate x DRG weight,34826,,"22,541 x DRG weight",34826,Other,base rate x DRG weight,49581,,"32,091 x DRG weight",49581,Other,base rate x DRG weight,44623,,"28,882 x DRG weight",44623,Other,base rate x DRG weight,42143,,"27,277 x DRG weight",42143,Other,base rate x DRG weight,37204,,"24,080 x DRG weight",37204,Other,base rate x DRG weight,34705,,"22,463 x DRG weight",34705,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40828,,"26,426 x DRG weight",40828,Other,base rate x DRG weight,59960,,"38,809 x DRG weight",59960,Other,base rate x DRG weight,59960,,"38,809 x DRG weight",59960,Other,base rate x DRG weight,40828,,"26,426 x DRG weight",40828,Other,base rate x DRG weight,59960,,"38,809 x DRG weight",59960,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,106346,70,,106346,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38713,,"25,057 x DRG weight",38713,Other,base rate x DRG weight,34843,,"22,552 x DRG weight",34843,Other,base rate x DRG weight,38713,,"25,057 x DRG weight",38713,Other,base rate x DRG weight,32905,,"21,298 x DRG weight",32905,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,106346,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,,inpatient,,,298063.22,46290,,,46290,Other,150% of Medicare + 9.63% HCRA Surcharge,28148.97,,,28148.97,Other,Medicare IPPS methodology,83293,,"25,046 x DRG weight",83293,Other,base rate x DRG weight,74962,,"22,541 x DRG weight",74962,Other,base rate x DRG weight,106722,,"32,091 x DRG weight",106722,Other,base rate x DRG weight,96050,,"28,882 x DRG weight",96050,Other,base rate x DRG weight,90712,,"27,277 x DRG weight",90712,Other,base rate x DRG weight,80080,,"24,080 x DRG weight",80080,Other,base rate x DRG weight,74703,,"22,463 x DRG weight",74703,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,87882,,"26,426 x DRG weight",87882,Other,base rate x DRG weight,129063,,"38,809 x DRG weight",129063,Other,base rate x DRG weight,129063,,"38,809 x DRG weight",129063,Other,base rate x DRG weight,87882,,"26,426 x DRG weight",87882,Other,base rate x DRG weight,129063,,"38,809 x DRG weight",129063,Other,base rate x DRG weight,57903,,"6,363 x patient days",57903,Per diem,,208644,70,,208644,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,83330,,"25,057 x DRG weight",83330,Other,base rate x DRG weight,74999,,"22,552 x DRG weight",74999,Other,base rate x DRG weight,83330,,"25,057 x DRG weight",83330,Other,base rate x DRG weight,70829,,"21,298 x DRG weight",70829,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,208644,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,,inpatient,,,116858.05,24347,,,24347,Other,150% of Medicare + 9.63% HCRA Surcharge,14805.84,,,14805.84,Other,Medicare IPPS methodology,43342,,"25,046 x DRG weight",43342,Other,base rate x DRG weight,39007,,"22,541 x DRG weight",39007,Other,base rate x DRG weight,55533,,"32,091 x DRG weight",55533,Other,base rate x DRG weight,49980,,"28,882 x DRG weight",49980,Other,base rate x DRG weight,47203,,"27,277 x DRG weight",47203,Other,base rate x DRG weight,41670,,"24,080 x DRG weight",41670,Other,base rate x DRG weight,38872,,"22,463 x DRG weight",38872,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45730,,"26,426 x DRG weight",45730,Other,base rate x DRG weight,67159,,"38,809 x DRG weight",67159,Other,base rate x DRG weight,67159,,"38,809 x DRG weight",67159,Other,base rate x DRG weight,45730,,"26,426 x DRG weight",45730,Other,base rate x DRG weight,67159,,"38,809 x DRG weight",67159,Other,base rate x DRG weight,26088,,"6,363 x patient days",26088,Per diem,,81801,70,,81801,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43361,,"25,057 x DRG weight",43361,Other,base rate x DRG weight,39026,,"22,552 x DRG weight",39026,Other,base rate x DRG weight,43361,,"25,057 x DRG weight",43361,Other,base rate x DRG weight,36856,,"21,298 x DRG weight",36856,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,81801,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,,inpatient,,,71466.59,17340,,,17340,Other,150% of Medicare + 9.63% HCRA Surcharge,10544.67,,,10544.67,Other,Medicare IPPS methodology,30584,,"25,046 x DRG weight",30584,Other,base rate x DRG weight,27525,,"22,541 x DRG weight",27525,Other,base rate x DRG weight,39186,,"32,091 x DRG weight",39186,Other,base rate x DRG weight,35268,,"28,882 x DRG weight",35268,Other,base rate x DRG weight,33308,,"27,277 x DRG weight",33308,Other,base rate x DRG weight,29404,,"24,080 x DRG weight",29404,Other,base rate x DRG weight,27430,,"22,463 x DRG weight",27430,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,32269,,"26,426 x DRG weight",32269,Other,base rate x DRG weight,47390,,"38,809 x DRG weight",47390,Other,base rate x DRG weight,47390,,"38,809 x DRG weight",47390,Other,base rate x DRG weight,32269,,"26,426 x DRG weight",32269,Other,base rate x DRG weight,47390,,"38,809 x DRG weight",47390,Other,base rate x DRG weight,13362,,"6,363 x patient days",13362,Per diem,,50027,70,,50027,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30597,,"25,057 x DRG weight",30597,Other,base rate x DRG weight,27538,,"22,552 x DRG weight",27538,Other,base rate x DRG weight,30597,,"25,057 x DRG weight",30597,Other,base rate x DRG weight,26007,,"21,298 x DRG weight",26007,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,50027,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,,inpatient,,,242841.51,29582,,,29582,Other,150% of Medicare + 9.63% HCRA Surcharge,17988.75,,,17988.75,Other,Medicare IPPS methodology,52872,,"25,046 x DRG weight",52872,Other,base rate x DRG weight,47584,,"22,541 x DRG weight",47584,Other,base rate x DRG weight,67744,,"32,091 x DRG weight",67744,Other,base rate x DRG weight,60970,,"28,882 x DRG weight",60970,Other,base rate x DRG weight,57582,,"27,277 x DRG weight",57582,Other,base rate x DRG weight,50833,,"24,080 x DRG weight",50833,Other,base rate x DRG weight,47419,,"22,463 x DRG weight",47419,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,55785,,"26,426 x DRG weight",55785,Other,base rate x DRG weight,81926,,"38,809 x DRG weight",81926,Other,base rate x DRG weight,81926,,"38,809 x DRG weight",81926,Other,base rate x DRG weight,55785,,"26,426 x DRG weight",55785,Other,base rate x DRG weight,81926,,"38,809 x DRG weight",81926,Other,base rate x DRG weight,53449,,"6,363 x patient days",53449,Per diem,,169989,70,,169989,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52895,,"25,057 x DRG weight",52895,Other,base rate x DRG weight,47607,,"22,552 x DRG weight",47607,Other,base rate x DRG weight,52895,,"25,057 x DRG weight",52895,Other,base rate x DRG weight,44960,,"21,298 x DRG weight",44960,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,169989,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,,inpatient,,,195187.52,17542,,,17542,Other,150% of Medicare + 9.63% HCRA Surcharge,10667.63,,,10667.63,Other,Medicare IPPS methodology,30952,,"25,046 x DRG weight",30952,Other,base rate x DRG weight,27856,,"22,541 x DRG weight",27856,Other,base rate x DRG weight,39658,,"32,091 x DRG weight",39658,Other,base rate x DRG weight,35692,,"28,882 x DRG weight",35692,Other,base rate x DRG weight,33709,,"27,277 x DRG weight",33709,Other,base rate x DRG weight,29758,,"24,080 x DRG weight",29758,Other,base rate x DRG weight,27760,,"22,463 x DRG weight",27760,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,32657,,"26,426 x DRG weight",32657,Other,base rate x DRG weight,47960,,"38,809 x DRG weight",47960,Other,base rate x DRG weight,47960,,"38,809 x DRG weight",47960,Other,base rate x DRG weight,32657,,"26,426 x DRG weight",32657,Other,base rate x DRG weight,47960,,"38,809 x DRG weight",47960,Other,base rate x DRG weight,32451,,"6,363 x patient days",32451,Per diem,,136631,70,,136631,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30965,,"25,057 x DRG weight",30965,Other,base rate x DRG weight,27870,,"22,552 x DRG weight",27870,Other,base rate x DRG weight,30965,,"25,057 x DRG weight",30965,Other,base rate x DRG weight,26320,,"21,298 x DRG weight",26320,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,136631,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,,inpatient,,,106260,12781,,,12781,Other,150% of Medicare + 9.63% HCRA Surcharge,7772.48,,,7772.48,Other,Medicare IPPS methodology,22283,,"25,046 x DRG weight",22283,Other,base rate x DRG weight,20055,,"22,541 x DRG weight",20055,Other,base rate x DRG weight,28551,,"32,091 x DRG weight",28551,Other,base rate x DRG weight,25696,,"28,882 x DRG weight",25696,Other,base rate x DRG weight,24268,,"27,277 x DRG weight",24268,Other,base rate x DRG weight,21424,,"24,080 x DRG weight",21424,Other,base rate x DRG weight,19985,,"22,463 x DRG weight",19985,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23511,,"26,426 x DRG weight",23511,Other,base rate x DRG weight,34528,,"38,809 x DRG weight",34528,Other,base rate x DRG weight,34528,,"38,809 x DRG weight",34528,Other,base rate x DRG weight,23511,,"26,426 x DRG weight",23511,Other,base rate x DRG weight,34528,,"38,809 x DRG weight",34528,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,74382,70,,74382,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22293,,"25,057 x DRG weight",22293,Other,base rate x DRG weight,20065,,"22,552 x DRG weight",20065,Other,base rate x DRG weight,22293,,"25,057 x DRG weight",22293,Other,base rate x DRG weight,18949,,"21,298 x DRG weight",18949,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,74382,
DYSEQUILIBRIUM,149,MS-DRG,,,,,,,,inpatient,,,119203.93,10787,,,10787,Other,150% of Medicare + 9.63% HCRA Surcharge,6559.54,,,6559.54,Other,Medicare IPPS methodology,18652,,"25,046 x DRG weight",18652,Other,base rate x DRG weight,16786,,"22,541 x DRG weight",16786,Other,base rate x DRG weight,23898,,"32,091 x DRG weight",23898,Other,base rate x DRG weight,21508,,"28,882 x DRG weight",21508,Other,base rate x DRG weight,20313,,"27,277 x DRG weight",20313,Other,base rate x DRG weight,17932,,"24,080 x DRG weight",17932,Other,base rate x DRG weight,16728,,"22,463 x DRG weight",16728,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19679,,"26,426 x DRG weight",19679,Other,base rate x DRG weight,28901,,"38,809 x DRG weight",28901,Other,base rate x DRG weight,28901,,"38,809 x DRG weight",28901,Other,base rate x DRG weight,19679,,"26,426 x DRG weight",19679,Other,base rate x DRG weight,28901,,"38,809 x DRG weight",28901,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,83443,70,,83443,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18660,,"25,057 x DRG weight",18660,Other,base rate x DRG weight,16794,,"22,552 x DRG weight",16794,Other,base rate x DRG weight,18660,,"25,057 x DRG weight",18660,Other,base rate x DRG weight,15861,,"21,298 x DRG weight",15861,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,83443,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,,inpatient,,,211777.46,18625,,,18625,Other,150% of Medicare + 9.63% HCRA Surcharge,11325.96,,,11325.96,Other,Medicare IPPS methodology,32923,,"25,046 x DRG weight",32923,Other,base rate x DRG weight,29630,,"22,541 x DRG weight",29630,Other,base rate x DRG weight,42184,,"32,091 x DRG weight",42184,Other,base rate x DRG weight,37965,,"28,882 x DRG weight",37965,Other,base rate x DRG weight,35856,,"27,277 x DRG weight",35856,Other,base rate x DRG weight,31653,,"24,080 x DRG weight",31653,Other,base rate x DRG weight,29528,,"22,463 x DRG weight",29528,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34737,,"26,426 x DRG weight",34737,Other,base rate x DRG weight,51014,,"38,809 x DRG weight",51014,Other,base rate x DRG weight,51014,,"38,809 x DRG weight",51014,Other,base rate x DRG weight,34737,,"26,426 x DRG weight",34737,Other,base rate x DRG weight,51014,,"38,809 x DRG weight",51014,Other,base rate x DRG weight,28634,,"6,363 x patient days",28634,Per diem,,148244,70,,148244,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32937,,"25,057 x DRG weight",32937,Other,base rate x DRG weight,29645,,"22,552 x DRG weight",29645,Other,base rate x DRG weight,32937,,"25,057 x DRG weight",32937,Other,base rate x DRG weight,27996,,"21,298 x DRG weight",27996,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,148244,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,,inpatient,,,79887.08,11144,,,11144,Other,150% of Medicare + 9.63% HCRA Surcharge,6777.03,,,6777.03,Other,Medicare IPPS methodology,19303,,"25,046 x DRG weight",19303,Other,base rate x DRG weight,17372,,"22,541 x DRG weight",17372,Other,base rate x DRG weight,24733,,"32,091 x DRG weight",24733,Other,base rate x DRG weight,22259,,"28,882 x DRG weight",22259,Other,base rate x DRG weight,21022,,"27,277 x DRG weight",21022,Other,base rate x DRG weight,18558,,"24,080 x DRG weight",18558,Other,base rate x DRG weight,17312,,"22,463 x DRG weight",17312,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20367,,"26,426 x DRG weight",20367,Other,base rate x DRG weight,29910,,"38,809 x DRG weight",29910,Other,base rate x DRG weight,29910,,"38,809 x DRG weight",29910,Other,base rate x DRG weight,20367,,"26,426 x DRG weight",20367,Other,base rate x DRG weight,29910,,"38,809 x DRG weight",29910,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,55921,70,,55921,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19311,,"25,057 x DRG weight",19311,Other,base rate x DRG weight,17381,,"22,552 x DRG weight",17381,Other,base rate x DRG weight,19311,,"25,057 x DRG weight",19311,Other,base rate x DRG weight,16414,,"21,298 x DRG weight",16414,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,55921,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,,inpatient,,,79823.68,16888,,,16888,Other,150% of Medicare + 9.63% HCRA Surcharge,10269.45,,,10269.45,Other,Medicare IPPS methodology,29760,,"25,046 x DRG weight",29760,Other,base rate x DRG weight,26783,,"22,541 x DRG weight",26783,Other,base rate x DRG weight,38131,,"32,091 x DRG weight",38131,Other,base rate x DRG weight,34318,,"28,882 x DRG weight",34318,Other,base rate x DRG weight,32411,,"27,277 x DRG weight",32411,Other,base rate x DRG weight,28612,,"24,080 x DRG weight",28612,Other,base rate x DRG weight,26691,,"22,463 x DRG weight",26691,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31399,,"26,426 x DRG weight",31399,Other,base rate x DRG weight,46113,,"38,809 x DRG weight",46113,Other,base rate x DRG weight,46113,,"38,809 x DRG weight",46113,Other,base rate x DRG weight,31399,,"26,426 x DRG weight",31399,Other,base rate x DRG weight,46113,,"38,809 x DRG weight",46113,Other,base rate x DRG weight,27997,,"6,363 x patient days",27997,Per diem,,55877,70,,55877,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29773,,"25,057 x DRG weight",29773,Other,base rate x DRG weight,26796,,"22,552 x DRG weight",26796,Other,base rate x DRG weight,29773,,"25,057 x DRG weight",29773,Other,base rate x DRG weight,25306,,"21,298 x DRG weight",25306,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,55877,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,,inpatient,,,64792.2,10651,,,10651,Other,150% of Medicare + 9.63% HCRA Surcharge,6476.73,,,6476.73,Other,Medicare IPPS methodology,18404,,"25,046 x DRG weight",18404,Other,base rate x DRG weight,16563,,"22,541 x DRG weight",16563,Other,base rate x DRG weight,23580,,"32,091 x DRG weight",23580,Other,base rate x DRG weight,21222,,"28,882 x DRG weight",21222,Other,base rate x DRG weight,20043,,"27,277 x DRG weight",20043,Other,base rate x DRG weight,17694,,"24,080 x DRG weight",17694,Other,base rate x DRG weight,16506,,"22,463 x DRG weight",16506,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19418,,"26,426 x DRG weight",19418,Other,base rate x DRG weight,28517,,"38,809 x DRG weight",28517,Other,base rate x DRG weight,28517,,"38,809 x DRG weight",28517,Other,base rate x DRG weight,19418,,"26,426 x DRG weight",19418,Other,base rate x DRG weight,28517,,"38,809 x DRG weight",28517,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,45355,70,,45355,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18412,,"25,057 x DRG weight",18412,Other,base rate x DRG weight,16571,,"22,552 x DRG weight",16571,Other,base rate x DRG weight,18412,,"25,057 x DRG weight",18412,Other,base rate x DRG weight,15650,,"21,298 x DRG weight",15650,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,45355,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,,inpatient,,,260488.17,21702,,,21702,Other,150% of Medicare + 9.63% HCRA Surcharge,13197.23,,,13197.23,Other,Medicare IPPS methodology,38526,,"25,046 x DRG weight",38526,Other,base rate x DRG weight,34673,,"22,541 x DRG weight",34673,Other,base rate x DRG weight,49362,,"32,091 x DRG weight",49362,Other,base rate x DRG weight,44426,,"28,882 x DRG weight",44426,Other,base rate x DRG weight,41957,,"27,277 x DRG weight",41957,Other,base rate x DRG weight,37040,,"24,080 x DRG weight",37040,Other,base rate x DRG weight,34553,,"22,463 x DRG weight",34553,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40648,,"26,426 x DRG weight",40648,Other,base rate x DRG weight,59696,,"38,809 x DRG weight",59696,Other,base rate x DRG weight,59696,,"38,809 x DRG weight",59696,Other,base rate x DRG weight,40648,,"26,426 x DRG weight",40648,Other,base rate x DRG weight,59696,,"38,809 x DRG weight",59696,Other,base rate x DRG weight,36905,,"6,363 x patient days",36905,Per diem,,182342,70,,182342,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38543,,"25,057 x DRG weight",38543,Other,base rate x DRG weight,34689,,"22,552 x DRG weight",34689,Other,base rate x DRG weight,38543,,"25,057 x DRG weight",38543,Other,base rate x DRG weight,32761,,"21,298 x DRG weight",32761,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,182342,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,,inpatient,,,112500.78,13564,,,13564,Other,150% of Medicare + 9.63% HCRA Surcharge,8248.45,,,8248.45,Other,Medicare IPPS methodology,23709,,"25,046 x DRG weight",23709,Other,base rate x DRG weight,21337,,"22,541 x DRG weight",21337,Other,base rate x DRG weight,30377,,"32,091 x DRG weight",30377,Other,base rate x DRG weight,27340,,"28,882 x DRG weight",27340,Other,base rate x DRG weight,25820,,"27,277 x DRG weight",25820,Other,base rate x DRG weight,22794,,"24,080 x DRG weight",22794,Other,base rate x DRG weight,21263,,"22,463 x DRG weight",21263,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25015,,"26,426 x DRG weight",25015,Other,base rate x DRG weight,36737,,"38,809 x DRG weight",36737,Other,base rate x DRG weight,36737,,"38,809 x DRG weight",36737,Other,base rate x DRG weight,25015,,"26,426 x DRG weight",25015,Other,base rate x DRG weight,36737,,"38,809 x DRG weight",36737,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,78751,70,,78751,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23719,,"25,057 x DRG weight",23719,Other,base rate x DRG weight,21348,,"22,552 x DRG weight",21348,Other,base rate x DRG weight,23719,,"25,057 x DRG weight",23719,Other,base rate x DRG weight,20161,,"21,298 x DRG weight",20161,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,78751,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,,inpatient,,,72738.95,9560,,,9560,Other,150% of Medicare + 9.63% HCRA Surcharge,5813.38,,,5813.38,Other,Medicare IPPS methodology,16418,,"25,046 x DRG weight",16418,Other,base rate x DRG weight,14776,,"22,541 x DRG weight",14776,Other,base rate x DRG weight,21036,,"32,091 x DRG weight",21036,Other,base rate x DRG weight,18932,,"28,882 x DRG weight",18932,Other,base rate x DRG weight,17880,,"27,277 x DRG weight",17880,Other,base rate x DRG weight,15784,,"24,080 x DRG weight",15784,Other,base rate x DRG weight,14724,,"22,463 x DRG weight",14724,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,17322,,"26,426 x DRG weight",17322,Other,base rate x DRG weight,25439,,"38,809 x DRG weight",25439,Other,base rate x DRG weight,25439,,"38,809 x DRG weight",25439,Other,base rate x DRG weight,17322,,"26,426 x DRG weight",17322,Other,base rate x DRG weight,25439,,"38,809 x DRG weight",25439,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,50917,70,,50917,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,16425,,"25,057 x DRG weight",16425,Other,base rate x DRG weight,14783,,"22,552 x DRG weight",14783,Other,base rate x DRG weight,16425,,"25,057 x DRG weight",16425,Other,base rate x DRG weight,13961,,"21,298 x DRG weight",13961,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,50917,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,,inpatient,,,131007.38,24024,,,24024,Other,150% of Medicare + 9.63% HCRA Surcharge,14609.26,,,14609.26,Other,Medicare IPPS methodology,42754,,"25,046 x DRG weight",42754,Other,base rate x DRG weight,38477,,"22,541 x DRG weight",38477,Other,base rate x DRG weight,54779,,"32,091 x DRG weight",54779,Other,base rate x DRG weight,49302,,"28,882 x DRG weight",49302,Other,base rate x DRG weight,46562,,"27,277 x DRG weight",46562,Other,base rate x DRG weight,41105,,"24,080 x DRG weight",41105,Other,base rate x DRG weight,38344,,"22,463 x DRG weight",38344,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45109,,"26,426 x DRG weight",45109,Other,base rate x DRG weight,66247,,"38,809 x DRG weight",66247,Other,base rate x DRG weight,66247,,"38,809 x DRG weight",66247,Other,base rate x DRG weight,45109,,"26,426 x DRG weight",45109,Other,base rate x DRG weight,66247,,"38,809 x DRG weight",66247,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,91705,70,,91705,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,42772,,"25,057 x DRG weight",42772,Other,base rate x DRG weight,38496,,"22,552 x DRG weight",38496,Other,base rate x DRG weight,42772,,"25,057 x DRG weight",42772,Other,base rate x DRG weight,36356,,"21,298 x DRG weight",36356,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,91705,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,,inpatient,,,144648.14,13453,,,13453,Other,150% of Medicare + 9.63% HCRA Surcharge,8180.69,,,8180.69,Other,Medicare IPPS methodology,23506,,"25,046 x DRG weight",23506,Other,base rate x DRG weight,21155,,"22,541 x DRG weight",21155,Other,base rate x DRG weight,30117,,"32,091 x DRG weight",30117,Other,base rate x DRG weight,27106,,"28,882 x DRG weight",27106,Other,base rate x DRG weight,25599,,"27,277 x DRG weight",25599,Other,base rate x DRG weight,22599,,"24,080 x DRG weight",22599,Other,base rate x DRG weight,21082,,"22,463 x DRG weight",21082,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24801,,"26,426 x DRG weight",24801,Other,base rate x DRG weight,36422,,"38,809 x DRG weight",36422,Other,base rate x DRG weight,36422,,"38,809 x DRG weight",36422,Other,base rate x DRG weight,24801,,"26,426 x DRG weight",24801,Other,base rate x DRG weight,36422,,"38,809 x DRG weight",36422,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,101254,70,,101254,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23516,,"25,057 x DRG weight",23516,Other,base rate x DRG weight,21165,,"22,552 x DRG weight",21165,Other,base rate x DRG weight,23516,,"25,057 x DRG weight",23516,Other,base rate x DRG weight,19988,,"21,298 x DRG weight",19988,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,101254,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,,inpatient,,,79825.68,9831,,,9831,Other,150% of Medicare + 9.63% HCRA Surcharge,5978.17,,,5978.17,Other,Medicare IPPS methodology,16911,,"25,046 x DRG weight",16911,Other,base rate x DRG weight,15220,,"22,541 x DRG weight",15220,Other,base rate x DRG weight,21668,,"32,091 x DRG weight",21668,Other,base rate x DRG weight,19501,,"28,882 x DRG weight",19501,Other,base rate x DRG weight,18417,,"27,277 x DRG weight",18417,Other,base rate x DRG weight,16259,,"24,080 x DRG weight",16259,Other,base rate x DRG weight,15167,,"22,463 x DRG weight",15167,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,17843,,"26,426 x DRG weight",17843,Other,base rate x DRG weight,26204,,"38,809 x DRG weight",26204,Other,base rate x DRG weight,26204,,"38,809 x DRG weight",26204,Other,base rate x DRG weight,17843,,"26,426 x DRG weight",17843,Other,base rate x DRG weight,26204,,"38,809 x DRG weight",26204,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,55878,70,,55878,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,16918,,"25,057 x DRG weight",16918,Other,base rate x DRG weight,15227,,"22,552 x DRG weight",15227,Other,base rate x DRG weight,16918,,"25,057 x DRG weight",16918,Other,base rate x DRG weight,14380,,"21,298 x DRG weight",14380,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,55878,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,,inpatient,,,582271.14,65383,,,65383,Other,150% of Medicare + 9.63% HCRA Surcharge,39759.7,,,39759.7,Other,Medicare IPPS methodology,118057,,"25,046 x DRG weight",118057,Other,base rate x DRG weight,106249,,"22,541 x DRG weight",106249,Other,base rate x DRG weight,151264,,"32,091 x DRG weight",151264,Other,base rate x DRG weight,136138,,"28,882 x DRG weight",136138,Other,base rate x DRG weight,128573,,"27,277 x DRG weight",128573,Other,base rate x DRG weight,113503,,"24,080 x DRG weight",113503,Other,base rate x DRG weight,105882,,"22,463 x DRG weight",105882,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,124562,,"26,426 x DRG weight",124562,Other,base rate x DRG weight,182930,,"38,809 x DRG weight",182930,Other,base rate x DRG weight,182930,,"38,809 x DRG weight",182930,Other,base rate x DRG weight,124562,,"26,426 x DRG weight",124562,Other,base rate x DRG weight,182930,,"38,809 x DRG weight",182930,Other,base rate x DRG weight,65539,,"6,363 x patient days",65539,Per diem,,407590,70,,407590,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,118109,,"25,057 x DRG weight",118109,Other,base rate x DRG weight,106301,,"22,552 x DRG weight",106301,Other,base rate x DRG weight,118109,,"25,057 x DRG weight",118109,Other,base rate x DRG weight,100390,,"21,298 x DRG weight",100390,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,407590,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,,inpatient,,,292149.29,35626,,,35626,Other,150% of Medicare + 9.63% HCRA Surcharge,21664.36,,,21664.36,Other,Medicare IPPS methodology,63877,,"25,046 x DRG weight",63877,Other,base rate x DRG weight,57489,,"22,541 x DRG weight",57489,Other,base rate x DRG weight,81845,,"32,091 x DRG weight",81845,Other,base rate x DRG weight,73661,,"28,882 x DRG weight",73661,Other,base rate x DRG weight,69567,,"27,277 x DRG weight",69567,Other,base rate x DRG weight,61414,,"24,080 x DRG weight",61414,Other,base rate x DRG weight,57290,,"22,463 x DRG weight",57290,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,67397,,"26,426 x DRG weight",67397,Other,base rate x DRG weight,98978,,"38,809 x DRG weight",98978,Other,base rate x DRG weight,98978,,"38,809 x DRG weight",98978,Other,base rate x DRG weight,67397,,"26,426 x DRG weight",67397,Other,base rate x DRG weight,98978,,"38,809 x DRG weight",98978,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,204505,70,,204505,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,63905,,"25,057 x DRG weight",63905,Other,base rate x DRG weight,57517,,"22,552 x DRG weight",57517,Other,base rate x DRG weight,63905,,"25,057 x DRG weight",63905,Other,base rate x DRG weight,54318,,"21,298 x DRG weight",54318,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,204505,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,,inpatient,,,176343.39,26354,,,26354,Other,150% of Medicare + 9.63% HCRA Surcharge,16026.3,,,16026.3,Other,Medicare IPPS methodology,46996,,"25,046 x DRG weight",46996,Other,base rate x DRG weight,42296,,"22,541 x DRG weight",42296,Other,base rate x DRG weight,60216,,"32,091 x DRG weight",60216,Other,base rate x DRG weight,54194,,"28,882 x DRG weight",54194,Other,base rate x DRG weight,51183,,"27,277 x DRG weight",51183,Other,base rate x DRG weight,45184,,"24,080 x DRG weight",45184,Other,base rate x DRG weight,42150,,"22,463 x DRG weight",42150,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49586,,"26,426 x DRG weight",49586,Other,base rate x DRG weight,72821,,"38,809 x DRG weight",72821,Other,base rate x DRG weight,72821,,"38,809 x DRG weight",72821,Other,base rate x DRG weight,49586,,"26,426 x DRG weight",49586,Other,base rate x DRG weight,72821,,"38,809 x DRG weight",72821,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,123440,70,,123440,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,47017,,"25,057 x DRG weight",47017,Other,base rate x DRG weight,42317,,"22,552 x DRG weight",42317,Other,base rate x DRG weight,47017,,"25,057 x DRG weight",47017,Other,base rate x DRG weight,39964,,"21,298 x DRG weight",39964,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,123440,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,,inpatient,,,460006.21,56362,,,56362,Other,150% of Medicare + 9.63% HCRA Surcharge,34273.88,,,34273.88,Other,Medicare IPPS methodology,101632,,"25,046 x DRG weight",101632,Other,base rate x DRG weight,91467,,"22,541 x DRG weight",91467,Other,base rate x DRG weight,130219,,"32,091 x DRG weight",130219,Other,base rate x DRG weight,117197,,"28,882 x DRG weight",117197,Other,base rate x DRG weight,110685,,"27,277 x DRG weight",110685,Other,base rate x DRG weight,97712,,"24,080 x DRG weight",97712,Other,base rate x DRG weight,91150,,"22,463 x DRG weight",91150,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,107231,,"26,426 x DRG weight",107231,Other,base rate x DRG weight,157479,,"38,809 x DRG weight",157479,Other,base rate x DRG weight,157479,,"38,809 x DRG weight",157479,Other,base rate x DRG weight,107231,,"26,426 x DRG weight",107231,Other,base rate x DRG weight,157479,,"38,809 x DRG weight",157479,Other,base rate x DRG weight,75720,,"6,363 x patient days",75720,Per diem,,322004,70,,322004,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,101676,,"25,057 x DRG weight",101676,Other,base rate x DRG weight,91512,,"22,552 x DRG weight",91512,Other,base rate x DRG weight,101676,,"25,057 x DRG weight",101676,Other,base rate x DRG weight,86423,,"21,298 x DRG weight",86423,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,322004,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,,inpatient,,,225094.23,25576,,,25576,Other,150% of Medicare + 9.63% HCRA Surcharge,15552.84,,,15552.84,Other,Medicare IPPS methodology,45579,,"25,046 x DRG weight",45579,Other,base rate x DRG weight,41020,,"22,541 x DRG weight",41020,Other,base rate x DRG weight,58399,,"32,091 x DRG weight",58399,Other,base rate x DRG weight,52559,,"28,882 x DRG weight",52559,Other,base rate x DRG weight,49639,,"27,277 x DRG weight",49639,Other,base rate x DRG weight,43821,,"24,080 x DRG weight",43821,Other,base rate x DRG weight,40878,,"22,463 x DRG weight",40878,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48090,,"26,426 x DRG weight",48090,Other,base rate x DRG weight,70625,,"38,809 x DRG weight",70625,Other,base rate x DRG weight,70625,,"38,809 x DRG weight",70625,Other,base rate x DRG weight,48090,,"26,426 x DRG weight",48090,Other,base rate x DRG weight,70625,,"38,809 x DRG weight",70625,Other,base rate x DRG weight,30542,,"6,363 x patient days",30542,Per diem,,157566,70,,157566,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,45599,,"25,057 x DRG weight",45599,Other,base rate x DRG weight,41040,,"22,552 x DRG weight",41040,Other,base rate x DRG weight,45599,,"25,057 x DRG weight",45599,Other,base rate x DRG weight,38758,,"21,298 x DRG weight",38758,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,157566,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,,inpatient,,,182152.28,19192,,,19192,Other,150% of Medicare + 9.63% HCRA Surcharge,11670.6,,,11670.6,Other,Medicare IPPS methodology,33955,,"25,046 x DRG weight",33955,Other,base rate x DRG weight,30559,,"22,541 x DRG weight",30559,Other,base rate x DRG weight,43506,,"32,091 x DRG weight",43506,Other,base rate x DRG weight,39155,,"28,882 x DRG weight",39155,Other,base rate x DRG weight,36979,,"27,277 x DRG weight",36979,Other,base rate x DRG weight,32645,,"24,080 x DRG weight",32645,Other,base rate x DRG weight,30453,,"22,463 x DRG weight",30453,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,35826,,"26,426 x DRG weight",35826,Other,base rate x DRG weight,52613,,"38,809 x DRG weight",52613,Other,base rate x DRG weight,52613,,"38,809 x DRG weight",52613,Other,base rate x DRG weight,35826,,"26,426 x DRG weight",35826,Other,base rate x DRG weight,52613,,"38,809 x DRG weight",52613,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,127507,70,,127507,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33970,,"25,057 x DRG weight",33970,Other,base rate x DRG weight,30574,,"22,552 x DRG weight",30574,Other,base rate x DRG weight,33970,,"25,057 x DRG weight",33970,Other,base rate x DRG weight,28874,,"21,298 x DRG weight",28874,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,127507,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,,inpatient,,,244798.28,42842,,,42842,Other,150% of Medicare + 9.63% HCRA Surcharge,26052.68,,,26052.68,Other,Medicare IPPS methodology,77016,,"25,046 x DRG weight",77016,Other,base rate x DRG weight,69314,,"22,541 x DRG weight",69314,Other,base rate x DRG weight,98680,,"32,091 x DRG weight",98680,Other,base rate x DRG weight,88812,,"28,882 x DRG weight",88812,Other,base rate x DRG weight,83877,,"27,277 x DRG weight",83877,Other,base rate x DRG weight,74046,,"24,080 x DRG weight",74046,Other,base rate x DRG weight,69074,,"22,463 x DRG weight",69074,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,81260,,"26,426 x DRG weight",81260,Other,base rate x DRG weight,119338,,"38,809 x DRG weight",119338,Other,base rate x DRG weight,119338,,"38,809 x DRG weight",119338,Other,base rate x DRG weight,81260,,"26,426 x DRG weight",81260,Other,base rate x DRG weight,119338,,"38,809 x DRG weight",119338,Other,base rate x DRG weight,30542,,"6,363 x patient days",30542,Per diem,,171359,70,,171359,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,77050,,"25,057 x DRG weight",77050,Other,base rate x DRG weight,69347,,"22,552 x DRG weight",69347,Other,base rate x DRG weight,77050,,"25,057 x DRG weight",77050,Other,base rate x DRG weight,65491,,"21,298 x DRG weight",65491,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,171359,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,,inpatient,,,216094.4,19842,,,19842,Other,150% of Medicare + 9.63% HCRA Surcharge,12066.27,,,12066.27,Other,Medicare IPPS methodology,35140,,"25,046 x DRG weight",35140,Other,base rate x DRG weight,31625,,"22,541 x DRG weight",31625,Other,base rate x DRG weight,45024,,"32,091 x DRG weight",45024,Other,base rate x DRG weight,40521,,"28,882 x DRG weight",40521,Other,base rate x DRG weight,38270,,"27,277 x DRG weight",38270,Other,base rate x DRG weight,33784,,"24,080 x DRG weight",33784,Other,base rate x DRG weight,31516,,"22,463 x DRG weight",31516,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37076,,"26,426 x DRG weight",37076,Other,base rate x DRG weight,54449,,"38,809 x DRG weight",54449,Other,base rate x DRG weight,54449,,"38,809 x DRG weight",54449,Other,base rate x DRG weight,37076,,"26,426 x DRG weight",37076,Other,base rate x DRG weight,54449,,"38,809 x DRG weight",54449,Other,base rate x DRG weight,33088,,"6,363 x patient days",33088,Per diem,,151266,70,,151266,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35155,,"25,057 x DRG weight",35155,Other,base rate x DRG weight,31640,,"22,552 x DRG weight",31640,Other,base rate x DRG weight,35155,,"25,057 x DRG weight",35155,Other,base rate x DRG weight,29881,,"21,298 x DRG weight",29881,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,151266,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,,inpatient,,,136811.29,11762,,,11762,Other,150% of Medicare + 9.63% HCRA Surcharge,7152.63,,,7152.63,Other,Medicare IPPS methodology,20428,,"25,046 x DRG weight",20428,Other,base rate x DRG weight,18384,,"22,541 x DRG weight",18384,Other,base rate x DRG weight,26173,,"32,091 x DRG weight",26173,Other,base rate x DRG weight,23556,,"28,882 x DRG weight",23556,Other,base rate x DRG weight,22247,,"27,277 x DRG weight",22247,Other,base rate x DRG weight,19640,,"24,080 x DRG weight",19640,Other,base rate x DRG weight,18321,,"22,463 x DRG weight",18321,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21553,,"26,426 x DRG weight",21553,Other,base rate x DRG weight,31653,,"38,809 x DRG weight",31653,Other,base rate x DRG weight,31653,,"38,809 x DRG weight",31653,Other,base rate x DRG weight,21553,,"26,426 x DRG weight",21553,Other,base rate x DRG weight,31653,,"38,809 x DRG weight",31653,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,95768,70,,95768,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20436,,"25,057 x DRG weight",20436,Other,base rate x DRG weight,18393,,"22,552 x DRG weight",18393,Other,base rate x DRG weight,20436,,"25,057 x DRG weight",20436,Other,base rate x DRG weight,17371,,"21,298 x DRG weight",17371,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95768,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,,inpatient,,,205105.76,23878,,,23878,Other,150% of Medicare + 9.63% HCRA Surcharge,14520.59,,,14520.59,Other,Medicare IPPS methodology,42488,,"25,046 x DRG weight",42488,Other,base rate x DRG weight,38239,,"22,541 x DRG weight",38239,Other,base rate x DRG weight,54439,,"32,091 x DRG weight",54439,Other,base rate x DRG weight,48995,,"28,882 x DRG weight",48995,Other,base rate x DRG weight,46273,,"27,277 x DRG weight",46273,Other,base rate x DRG weight,40849,,"24,080 x DRG weight",40849,Other,base rate x DRG weight,38106,,"22,463 x DRG weight",38106,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,44829,,"26,426 x DRG weight",44829,Other,base rate x DRG weight,65836,,"38,809 x DRG weight",65836,Other,base rate x DRG weight,65836,,"38,809 x DRG weight",65836,Other,base rate x DRG weight,44829,,"26,426 x DRG weight",44829,Other,base rate x DRG weight,65836,,"38,809 x DRG weight",65836,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,143574,70,,143574,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,42507,,"25,057 x DRG weight",42507,Other,base rate x DRG weight,38257,,"22,552 x DRG weight",38257,Other,base rate x DRG weight,42507,,"25,057 x DRG weight",42507,Other,base rate x DRG weight,36130,,"21,298 x DRG weight",36130,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,143574,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,,inpatient,,,118142.66,14116,,,14116,Other,150% of Medicare + 9.63% HCRA Surcharge,8583.89,,,8583.89,Other,Medicare IPPS methodology,24713,,"25,046 x DRG weight",24713,Other,base rate x DRG weight,22241,,"22,541 x DRG weight",22241,Other,base rate x DRG weight,31664,,"32,091 x DRG weight",31664,Other,base rate x DRG weight,28498,,"28,882 x DRG weight",28498,Other,base rate x DRG weight,26914,,"27,277 x DRG weight",26914,Other,base rate x DRG weight,23760,,"24,080 x DRG weight",23760,Other,base rate x DRG weight,22164,,"22,463 x DRG weight",22164,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26075,,"26,426 x DRG weight",26075,Other,base rate x DRG weight,38293,,"38,809 x DRG weight",38293,Other,base rate x DRG weight,38293,,"38,809 x DRG weight",38293,Other,base rate x DRG weight,26075,,"26,426 x DRG weight",26075,Other,base rate x DRG weight,38293,,"38,809 x DRG weight",38293,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,82700,70,,82700,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24724,,"25,057 x DRG weight",24724,Other,base rate x DRG weight,22252,,"22,552 x DRG weight",22252,Other,base rate x DRG weight,24724,,"25,057 x DRG weight",24724,Other,base rate x DRG weight,21015,,"21,298 x DRG weight",21015,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,82700,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,,inpatient,,,78523.2,11043,,,11043,Other,150% of Medicare + 9.63% HCRA Surcharge,6715.13,,,6715.13,Other,Medicare IPPS methodology,19118,,"25,046 x DRG weight",19118,Other,base rate x DRG weight,17206,,"22,541 x DRG weight",17206,Other,base rate x DRG weight,24495,,"32,091 x DRG weight",24495,Other,base rate x DRG weight,22046,,"28,882 x DRG weight",22046,Other,base rate x DRG weight,20821,,"27,277 x DRG weight",20821,Other,base rate x DRG weight,18380,,"24,080 x DRG weight",18380,Other,base rate x DRG weight,17146,,"22,463 x DRG weight",17146,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20171,,"26,426 x DRG weight",20171,Other,base rate x DRG weight,29623,,"38,809 x DRG weight",29623,Other,base rate x DRG weight,29623,,"38,809 x DRG weight",29623,Other,base rate x DRG weight,20171,,"26,426 x DRG weight",20171,Other,base rate x DRG weight,29623,,"38,809 x DRG weight",29623,Other,base rate x DRG weight,20998,,"6,363 x patient days",20998,Per diem,,54966,70,,54966,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19126,,"25,057 x DRG weight",19126,Other,base rate x DRG weight,17214,,"22,552 x DRG weight",17214,Other,base rate x DRG weight,19126,,"25,057 x DRG weight",19126,Other,base rate x DRG weight,16257,,"21,298 x DRG weight",16257,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,54966,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,,inpatient,,,278728.13,24453,,,24453,Other,150% of Medicare + 9.63% HCRA Surcharge,14870.25,,,14870.25,Other,Medicare IPPS methodology,43535,,"25,046 x DRG weight",43535,Other,base rate x DRG weight,39181,,"22,541 x DRG weight",39181,Other,base rate x DRG weight,55781,,"32,091 x DRG weight",55781,Other,base rate x DRG weight,50203,,"28,882 x DRG weight",50203,Other,base rate x DRG weight,47413,,"27,277 x DRG weight",47413,Other,base rate x DRG weight,41856,,"24,080 x DRG weight",41856,Other,base rate x DRG weight,39045,,"22,463 x DRG weight",39045,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45934,,"26,426 x DRG weight",45934,Other,base rate x DRG weight,67458,,"38,809 x DRG weight",67458,Other,base rate x DRG weight,67458,,"38,809 x DRG weight",67458,Other,base rate x DRG weight,45934,,"26,426 x DRG weight",45934,Other,base rate x DRG weight,67458,,"38,809 x DRG weight",67458,Other,base rate x DRG weight,41996,,"6,363 x patient days",41996,Per diem,,195110,70,,195110,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43554,,"25,057 x DRG weight",43554,Other,base rate x DRG weight,39200,,"22,552 x DRG weight",39200,Other,base rate x DRG weight,43554,,"25,057 x DRG weight",43554,Other,base rate x DRG weight,37020,,"21,298 x DRG weight",37020,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,195110,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,,inpatient,,,176490.82,15689,,,15689,Other,150% of Medicare + 9.63% HCRA Surcharge,9540.86,,,9540.86,Other,Medicare IPPS methodology,27578,,"25,046 x DRG weight",27578,Other,base rate x DRG weight,24820,,"22,541 x DRG weight",24820,Other,base rate x DRG weight,35335,,"32,091 x DRG weight",35335,Other,base rate x DRG weight,31802,,"28,882 x DRG weight",31802,Other,base rate x DRG weight,30035,,"27,277 x DRG weight",30035,Other,base rate x DRG weight,26514,,"24,080 x DRG weight",26514,Other,base rate x DRG weight,24734,,"22,463 x DRG weight",24734,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,29098,,"26,426 x DRG weight",29098,Other,base rate x DRG weight,42733,,"38,809 x DRG weight",42733,Other,base rate x DRG weight,42733,,"38,809 x DRG weight",42733,Other,base rate x DRG weight,29098,,"26,426 x DRG weight",29098,Other,base rate x DRG weight,42733,,"38,809 x DRG weight",42733,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,123544,70,,123544,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27590,,"25,057 x DRG weight",27590,Other,base rate x DRG weight,24832,,"22,552 x DRG weight",24832,Other,base rate x DRG weight,27590,,"25,057 x DRG weight",27590,Other,base rate x DRG weight,23451,,"21,298 x DRG weight",23451,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,123544,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,,inpatient,,,107644.72,11531,,,11531,Other,150% of Medicare + 9.63% HCRA Surcharge,7012.09,,,7012.09,Other,Medicare IPPS methodology,20007,,"25,046 x DRG weight",20007,Other,base rate x DRG weight,18006,,"22,541 x DRG weight",18006,Other,base rate x DRG weight,25634,,"32,091 x DRG weight",25634,Other,base rate x DRG weight,23071,,"28,882 x DRG weight",23071,Other,base rate x DRG weight,21789,,"27,277 x DRG weight",21789,Other,base rate x DRG weight,19235,,"24,080 x DRG weight",19235,Other,base rate x DRG weight,17943,,"22,463 x DRG weight",17943,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21109,,"26,426 x DRG weight",21109,Other,base rate x DRG weight,31001,,"38,809 x DRG weight",31001,Other,base rate x DRG weight,31001,,"38,809 x DRG weight",31001,Other,base rate x DRG weight,21109,,"26,426 x DRG weight",21109,Other,base rate x DRG weight,31001,,"38,809 x DRG weight",31001,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,75351,70,,75351,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20016,,"25,057 x DRG weight",20016,Other,base rate x DRG weight,18015,,"22,552 x DRG weight",18015,Other,base rate x DRG weight,20016,,"25,057 x DRG weight",20016,Other,base rate x DRG weight,17013,,"21,298 x DRG weight",17013,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,75351,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,,inpatient,,,189879.65,22202,,,22202,Other,150% of Medicare + 9.63% HCRA Surcharge,13500.88,,,13500.88,Other,Medicare IPPS methodology,39435,,"25,046 x DRG weight",39435,Other,base rate x DRG weight,35491,,"22,541 x DRG weight",35491,Other,base rate x DRG weight,50527,,"32,091 x DRG weight",50527,Other,base rate x DRG weight,45475,,"28,882 x DRG weight",45475,Other,base rate x DRG weight,42948,,"27,277 x DRG weight",42948,Other,base rate x DRG weight,37914,,"24,080 x DRG weight",37914,Other,base rate x DRG weight,35368,,"22,463 x DRG weight",35368,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41608,,"26,426 x DRG weight",41608,Other,base rate x DRG weight,61105,,"38,809 x DRG weight",61105,Other,base rate x DRG weight,61105,,"38,809 x DRG weight",61105,Other,base rate x DRG weight,41608,,"26,426 x DRG weight",41608,Other,base rate x DRG weight,61105,,"38,809 x DRG weight",61105,Other,base rate x DRG weight,38178,,"6,363 x patient days",38178,Per diem,,132916,70,,132916,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39452,,"25,057 x DRG weight",39452,Other,base rate x DRG weight,35508,,"22,552 x DRG weight",35508,Other,base rate x DRG weight,39452,,"25,057 x DRG weight",39452,Other,base rate x DRG weight,33534,,"21,298 x DRG weight",33534,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,132916,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,,inpatient,,,167982.92,15013,,,15013,Other,150% of Medicare + 9.63% HCRA Surcharge,9129.29,,,9129.29,Other,Medicare IPPS methodology,26346,,"25,046 x DRG weight",26346,Other,base rate x DRG weight,23711,,"22,541 x DRG weight",23711,Other,base rate x DRG weight,33757,,"32,091 x DRG weight",33757,Other,base rate x DRG weight,30381,,"28,882 x DRG weight",30381,Other,base rate x DRG weight,28693,,"27,277 x DRG weight",28693,Other,base rate x DRG weight,25330,,"24,080 x DRG weight",25330,Other,base rate x DRG weight,23629,,"22,463 x DRG weight",23629,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27798,,"26,426 x DRG weight",27798,Other,base rate x DRG weight,40823,,"38,809 x DRG weight",40823,Other,base rate x DRG weight,40823,,"38,809 x DRG weight",40823,Other,base rate x DRG weight,27798,,"26,426 x DRG weight",27798,Other,base rate x DRG weight,40823,,"38,809 x DRG weight",40823,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,117588,70,,117588,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26357,,"25,057 x DRG weight",26357,Other,base rate x DRG weight,23722,,"22,552 x DRG weight",23722,Other,base rate x DRG weight,26357,,"25,057 x DRG weight",26357,Other,base rate x DRG weight,22403,,"21,298 x DRG weight",22403,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,117588,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,,inpatient,,,90469.83,10938,,,10938,Other,150% of Medicare + 9.63% HCRA Surcharge,6651.56,,,6651.56,Other,Medicare IPPS methodology,18927,,"25,046 x DRG weight",18927,Other,base rate x DRG weight,17034,,"22,541 x DRG weight",17034,Other,base rate x DRG weight,24251,,"32,091 x DRG weight",24251,Other,base rate x DRG weight,21826,,"28,882 x DRG weight",21826,Other,base rate x DRG weight,20613,,"27,277 x DRG weight",20613,Other,base rate x DRG weight,18197,,"24,080 x DRG weight",18197,Other,base rate x DRG weight,16975,,"22,463 x DRG weight",16975,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19970,,"26,426 x DRG weight",19970,Other,base rate x DRG weight,29328,,"38,809 x DRG weight",29328,Other,base rate x DRG weight,29328,,"38,809 x DRG weight",29328,Other,base rate x DRG weight,19970,,"26,426 x DRG weight",19970,Other,base rate x DRG weight,29328,,"38,809 x DRG weight",29328,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,63329,70,,63329,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18936,,"25,057 x DRG weight",18936,Other,base rate x DRG weight,17043,,"22,552 x DRG weight",17043,Other,base rate x DRG weight,18936,,"25,057 x DRG weight",18936,Other,base rate x DRG weight,16095,,"21,298 x DRG weight",16095,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,63329,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,,inpatient,,,180027.88,21893,,,21893,Other,150% of Medicare + 9.63% HCRA Surcharge,13313.51,,,13313.51,Other,Medicare IPPS methodology,38874,,"25,046 x DRG weight",38874,Other,base rate x DRG weight,34986,,"22,541 x DRG weight",34986,Other,base rate x DRG weight,49808,,"32,091 x DRG weight",49808,Other,base rate x DRG weight,44828,,"28,882 x DRG weight",44828,Other,base rate x DRG weight,42337,,"27,277 x DRG weight",42337,Other,base rate x DRG weight,37375,,"24,080 x DRG weight",37375,Other,base rate x DRG weight,34865,,"22,463 x DRG weight",34865,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41016,,"26,426 x DRG weight",41016,Other,base rate x DRG weight,60235,,"38,809 x DRG weight",60235,Other,base rate x DRG weight,60235,,"38,809 x DRG weight",60235,Other,base rate x DRG weight,41016,,"26,426 x DRG weight",41016,Other,base rate x DRG weight,60235,,"38,809 x DRG weight",60235,Other,base rate x DRG weight,37542,,"6,363 x patient days",37542,Per diem,,126020,70,,126020,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38891,,"25,057 x DRG weight",38891,Other,base rate x DRG weight,35003,,"22,552 x DRG weight",35003,Other,base rate x DRG weight,38891,,"25,057 x DRG weight",38891,Other,base rate x DRG weight,33057,,"21,298 x DRG weight",33057,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,126020,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,,inpatient,,,131722.63,14248,,,14248,Other,150% of Medicare + 9.63% HCRA Surcharge,8664.2,,,8664.2,Other,Medicare IPPS methodology,24953,,"25,046 x DRG weight",24953,Other,base rate x DRG weight,22458,,"22,541 x DRG weight",22458,Other,base rate x DRG weight,31972,,"32,091 x DRG weight",31972,Other,base rate x DRG weight,28775,,"28,882 x DRG weight",28775,Other,base rate x DRG weight,27176,,"27,277 x DRG weight",27176,Other,base rate x DRG weight,23991,,"24,080 x DRG weight",23991,Other,base rate x DRG weight,22380,,"22,463 x DRG weight",22380,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26328,,"26,426 x DRG weight",26328,Other,base rate x DRG weight,38665,,"38,809 x DRG weight",38665,Other,base rate x DRG weight,38665,,"38,809 x DRG weight",38665,Other,base rate x DRG weight,26328,,"26,426 x DRG weight",26328,Other,base rate x DRG weight,38665,,"38,809 x DRG weight",38665,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,92206,70,,92206,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24964,,"25,057 x DRG weight",24964,Other,base rate x DRG weight,22469,,"22,552 x DRG weight",22469,Other,base rate x DRG weight,24964,,"25,057 x DRG weight",24964,Other,base rate x DRG weight,21219,,"21,298 x DRG weight",21219,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,92206,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,,inpatient,,,94434,10812,,,10812,Other,150% of Medicare + 9.63% HCRA Surcharge,6574.6,,,6574.6,Other,Medicare IPPS methodology,18697,,"25,046 x DRG weight",18697,Other,base rate x DRG weight,16827,,"22,541 x DRG weight",16827,Other,base rate x DRG weight,23956,,"32,091 x DRG weight",23956,Other,base rate x DRG weight,21560,,"28,882 x DRG weight",21560,Other,base rate x DRG weight,20362,,"27,277 x DRG weight",20362,Other,base rate x DRG weight,17976,,"24,080 x DRG weight",17976,Other,base rate x DRG weight,16769,,"22,463 x DRG weight",16769,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19727,,"26,426 x DRG weight",19727,Other,base rate x DRG weight,28971,,"38,809 x DRG weight",28971,Other,base rate x DRG weight,28971,,"38,809 x DRG weight",28971,Other,base rate x DRG weight,19727,,"26,426 x DRG weight",19727,Other,base rate x DRG weight,28971,,"38,809 x DRG weight",28971,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,66104,70,,66104,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18705,,"25,057 x DRG weight",18705,Other,base rate x DRG weight,16835,,"22,552 x DRG weight",16835,Other,base rate x DRG weight,18705,,"25,057 x DRG weight",18705,Other,base rate x DRG weight,15899,,"21,298 x DRG weight",15899,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,66104,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,,inpatient,,,131495.35,17490,,,17490,Other,150% of Medicare + 9.63% HCRA Surcharge,10635.84,,,10635.84,Other,Medicare IPPS methodology,30857,,"25,046 x DRG weight",30857,Other,base rate x DRG weight,27771,,"22,541 x DRG weight",27771,Other,base rate x DRG weight,39536,,"32,091 x DRG weight",39536,Other,base rate x DRG weight,35583,,"28,882 x DRG weight",35583,Other,base rate x DRG weight,33605,,"27,277 x DRG weight",33605,Other,base rate x DRG weight,29667,,"24,080 x DRG weight",29667,Other,base rate x DRG weight,27674,,"22,463 x DRG weight",27674,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,32557,,"26,426 x DRG weight",32557,Other,base rate x DRG weight,47813,,"38,809 x DRG weight",47813,Other,base rate x DRG weight,47813,,"38,809 x DRG weight",47813,Other,base rate x DRG weight,32557,,"26,426 x DRG weight",32557,Other,base rate x DRG weight,47813,,"38,809 x DRG weight",47813,Other,base rate x DRG weight,31179,,"6,363 x patient days",31179,Per diem,,92047,70,,92047,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30870,,"25,057 x DRG weight",30870,Other,base rate x DRG weight,27784,,"22,552 x DRG weight",27784,Other,base rate x DRG weight,30870,,"25,057 x DRG weight",30870,Other,base rate x DRG weight,26239,,"21,298 x DRG weight",26239,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,92047,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,,inpatient,,,141350.82,15702,,,15702,Other,150% of Medicare + 9.63% HCRA Surcharge,9548.38,,,9548.38,Other,Medicare IPPS methodology,27601,,"25,046 x DRG weight",27601,Other,base rate x DRG weight,24840,,"22,541 x DRG weight",24840,Other,base rate x DRG weight,35364,,"32,091 x DRG weight",35364,Other,base rate x DRG weight,31828,,"28,882 x DRG weight",31828,Other,base rate x DRG weight,30059,,"27,277 x DRG weight",30059,Other,base rate x DRG weight,26536,,"24,080 x DRG weight",26536,Other,base rate x DRG weight,24754,,"22,463 x DRG weight",24754,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,29121,,"26,426 x DRG weight",29121,Other,base rate x DRG weight,42768,,"38,809 x DRG weight",42768,Other,base rate x DRG weight,42768,,"38,809 x DRG weight",42768,Other,base rate x DRG weight,29121,,"26,426 x DRG weight",29121,Other,base rate x DRG weight,42768,,"38,809 x DRG weight",42768,Other,base rate x DRG weight,27997,,"6,363 x patient days",27997,Per diem,,98946,70,,98946,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27613,,"25,057 x DRG weight",27613,Other,base rate x DRG weight,24852,,"22,552 x DRG weight",24852,Other,base rate x DRG weight,27613,,"25,057 x DRG weight",27613,Other,base rate x DRG weight,23470,,"21,298 x DRG weight",23470,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,98946,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,,inpatient,,,114478.28,12222,,,12222,Other,150% of Medicare + 9.63% HCRA Surcharge,7432.02,,,7432.02,Other,Medicare IPPS methodology,21264,,"25,046 x DRG weight",21264,Other,base rate x DRG weight,19137,,"22,541 x DRG weight",19137,Other,base rate x DRG weight,27245,,"32,091 x DRG weight",27245,Other,base rate x DRG weight,24521,,"28,882 x DRG weight",24521,Other,base rate x DRG weight,23158,,"27,277 x DRG weight",23158,Other,base rate x DRG weight,20444,,"24,080 x DRG weight",20444,Other,base rate x DRG weight,19071,,"22,463 x DRG weight",19071,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22436,,"26,426 x DRG weight",22436,Other,base rate x DRG weight,32949,,"38,809 x DRG weight",32949,Other,base rate x DRG weight,32949,,"38,809 x DRG weight",32949,Other,base rate x DRG weight,22436,,"26,426 x DRG weight",22436,Other,base rate x DRG weight,32949,,"38,809 x DRG weight",32949,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,80135,70,,80135,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21273,,"25,057 x DRG weight",21273,Other,base rate x DRG weight,19147,,"22,552 x DRG weight",19147,Other,base rate x DRG weight,21273,,"25,057 x DRG weight",21273,Other,base rate x DRG weight,18082,,"21,298 x DRG weight",18082,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,80135,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,,inpatient,,,68831.45,9371,,,9371,Other,150% of Medicare + 9.63% HCRA Surcharge,5698.78,,,5698.78,Other,Medicare IPPS methodology,16075,,"25,046 x DRG weight",16075,Other,base rate x DRG weight,14467,,"22,541 x DRG weight",14467,Other,base rate x DRG weight,20596,,"32,091 x DRG weight",20596,Other,base rate x DRG weight,18536,,"28,882 x DRG weight",18536,Other,base rate x DRG weight,17506,,"27,277 x DRG weight",17506,Other,base rate x DRG weight,15455,,"24,080 x DRG weight",15455,Other,base rate x DRG weight,14417,,"22,463 x DRG weight",14417,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,16960,,"26,426 x DRG weight",16960,Other,base rate x DRG weight,24908,,"38,809 x DRG weight",24908,Other,base rate x DRG weight,24908,,"38,809 x DRG weight",24908,Other,base rate x DRG weight,16960,,"26,426 x DRG weight",16960,Other,base rate x DRG weight,24908,,"38,809 x DRG weight",24908,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,48182,70,,48182,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,16082,,"25,057 x DRG weight",16082,Other,base rate x DRG weight,14474,,"22,552 x DRG weight",14474,Other,base rate x DRG weight,16082,,"25,057 x DRG weight",16082,Other,base rate x DRG weight,13669,,"21,298 x DRG weight",13669,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,48182,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,,inpatient,,,159275.83,18791,,,18791,Other,150% of Medicare + 9.63% HCRA Surcharge,11427.18,,,11427.18,Other,Medicare IPPS methodology,33226,,"25,046 x DRG weight",33226,Other,base rate x DRG weight,29903,,"22,541 x DRG weight",29903,Other,base rate x DRG weight,42572,,"32,091 x DRG weight",42572,Other,base rate x DRG weight,38315,,"28,882 x DRG weight",38315,Other,base rate x DRG weight,36186,,"27,277 x DRG weight",36186,Other,base rate x DRG weight,31945,,"24,080 x DRG weight",31945,Other,base rate x DRG weight,29799,,"22,463 x DRG weight",29799,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,35057,,"26,426 x DRG weight",35057,Other,base rate x DRG weight,51484,,"38,809 x DRG weight",51484,Other,base rate x DRG weight,51484,,"38,809 x DRG weight",51484,Other,base rate x DRG weight,35057,,"26,426 x DRG weight",35057,Other,base rate x DRG weight,51484,,"38,809 x DRG weight",51484,Other,base rate x DRG weight,33088,,"6,363 x patient days",33088,Per diem,,111493,70,,111493,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33241,,"25,057 x DRG weight",33241,Other,base rate x DRG weight,29917,,"22,552 x DRG weight",29917,Other,base rate x DRG weight,33241,,"25,057 x DRG weight",33241,Other,base rate x DRG weight,28254,,"21,298 x DRG weight",28254,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,111493,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,,inpatient,,,98405.59,11853,,,11853,Other,150% of Medicare + 9.63% HCRA Surcharge,7207.84,,,7207.84,Other,Medicare IPPS methodology,20593,,"25,046 x DRG weight",20593,Other,base rate x DRG weight,18533,,"22,541 x DRG weight",18533,Other,base rate x DRG weight,26385,,"32,091 x DRG weight",26385,Other,base rate x DRG weight,23747,,"28,882 x DRG weight",23747,Other,base rate x DRG weight,22427,,"27,277 x DRG weight",22427,Other,base rate x DRG weight,19799,,"24,080 x DRG weight",19799,Other,base rate x DRG weight,18469,,"22,463 x DRG weight",18469,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21727,,"26,426 x DRG weight",21727,Other,base rate x DRG weight,31909,,"38,809 x DRG weight",31909,Other,base rate x DRG weight,31909,,"38,809 x DRG weight",31909,Other,base rate x DRG weight,21727,,"26,426 x DRG weight",21727,Other,base rate x DRG weight,31909,,"38,809 x DRG weight",31909,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,68884,70,,68884,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20602,,"25,057 x DRG weight",20602,Other,base rate x DRG weight,18542,,"22,552 x DRG weight",18542,Other,base rate x DRG weight,20602,,"25,057 x DRG weight",20602,Other,base rate x DRG weight,17511,,"21,298 x DRG weight",17511,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,68884,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,,inpatient,,,64782.22,9149,,,9149,Other,150% of Medicare + 9.63% HCRA Surcharge,5563.26,,,5563.26,Other,Medicare IPPS methodology,15669,,"25,046 x DRG weight",15669,Other,base rate x DRG weight,14102,,"22,541 x DRG weight",14102,Other,base rate x DRG weight,20076,,"32,091 x DRG weight",20076,Other,base rate x DRG weight,18069,,"28,882 x DRG weight",18069,Other,base rate x DRG weight,17064,,"27,277 x DRG weight",17064,Other,base rate x DRG weight,15064,,"24,080 x DRG weight",15064,Other,base rate x DRG weight,14053,,"22,463 x DRG weight",14053,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,16532,,"26,426 x DRG weight",16532,Other,base rate x DRG weight,24279,,"38,809 x DRG weight",24279,Other,base rate x DRG weight,24279,,"38,809 x DRG weight",24279,Other,base rate x DRG weight,16532,,"26,426 x DRG weight",16532,Other,base rate x DRG weight,24279,,"38,809 x DRG weight",24279,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,45348,70,,45348,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15676,,"25,057 x DRG weight",15676,Other,base rate x DRG weight,14109,,"22,552 x DRG weight",14109,Other,base rate x DRG weight,15676,,"25,057 x DRG weight",15676,Other,base rate x DRG weight,13324,,"21,298 x DRG weight",13324,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,45348,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,,inpatient,,,196429.88,26616,,,26616,Other,150% of Medicare + 9.63% HCRA Surcharge,16185.24,,,16185.24,Other,Medicare IPPS methodology,47472,,"25,046 x DRG weight",47472,Other,base rate x DRG weight,42724,,"22,541 x DRG weight",42724,Other,base rate x DRG weight,60825,,"32,091 x DRG weight",60825,Other,base rate x DRG weight,54743,,"28,882 x DRG weight",54743,Other,base rate x DRG weight,51701,,"27,277 x DRG weight",51701,Other,base rate x DRG weight,45641,,"24,080 x DRG weight",45641,Other,base rate x DRG weight,42576,,"22,463 x DRG weight",42576,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,50088,,"26,426 x DRG weight",50088,Other,base rate x DRG weight,73559,,"38,809 x DRG weight",73559,Other,base rate x DRG weight,73559,,"38,809 x DRG weight",73559,Other,base rate x DRG weight,50088,,"26,426 x DRG weight",50088,Other,base rate x DRG weight,73559,,"38,809 x DRG weight",73559,Other,base rate x DRG weight,44541,,"6,363 x patient days",44541,Per diem,,137501,70,,137501,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,47493,,"25,057 x DRG weight",47493,Other,base rate x DRG weight,42745,,"22,552 x DRG weight",42745,Other,base rate x DRG weight,47493,,"25,057 x DRG weight",47493,Other,base rate x DRG weight,40368,,"21,298 x DRG weight",40368,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,137501,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,,inpatient,,,116692.32,14264,,,14264,Other,150% of Medicare + 9.63% HCRA Surcharge,8674.23,,,8674.23,Other,Medicare IPPS methodology,24983,,"25,046 x DRG weight",24983,Other,base rate x DRG weight,22485,,"22,541 x DRG weight",22485,Other,base rate x DRG weight,32011,,"32,091 x DRG weight",32011,Other,base rate x DRG weight,28810,,"28,882 x DRG weight",28810,Other,base rate x DRG weight,27209,,"27,277 x DRG weight",27209,Other,base rate x DRG weight,24020,,"24,080 x DRG weight",24020,Other,base rate x DRG weight,22407,,"22,463 x DRG weight",22407,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26360,,"26,426 x DRG weight",26360,Other,base rate x DRG weight,38712,,"38,809 x DRG weight",38712,Other,base rate x DRG weight,38712,,"38,809 x DRG weight",38712,Other,base rate x DRG weight,26360,,"26,426 x DRG weight",26360,Other,base rate x DRG weight,38712,,"38,809 x DRG weight",38712,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,81685,70,,81685,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24994,,"25,057 x DRG weight",24994,Other,base rate x DRG weight,22496,,"22,552 x DRG weight",22496,Other,base rate x DRG weight,24994,,"25,057 x DRG weight",24994,Other,base rate x DRG weight,21245,,"21,298 x DRG weight",21245,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,81685,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,,inpatient,,,53318,11248,,,11248,Other,150% of Medicare + 9.63% HCRA Surcharge,6839.77,,,6839.77,Other,Medicare IPPS methodology,19491,,"25,046 x DRG weight",19491,Other,base rate x DRG weight,17541,,"22,541 x DRG weight",17541,Other,base rate x DRG weight,24973,,"32,091 x DRG weight",24973,Other,base rate x DRG weight,22476,,"28,882 x DRG weight",22476,Other,base rate x DRG weight,21227,,"27,277 x DRG weight",21227,Other,base rate x DRG weight,18739,,"24,080 x DRG weight",18739,Other,base rate x DRG weight,17481,,"22,463 x DRG weight",17481,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20565,,"26,426 x DRG weight",20565,Other,base rate x DRG weight,30201,,"38,809 x DRG weight",30201,Other,base rate x DRG weight,30201,,"38,809 x DRG weight",30201,Other,base rate x DRG weight,20565,,"26,426 x DRG weight",20565,Other,base rate x DRG weight,30201,,"38,809 x DRG weight",30201,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,37323,70,,37323,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19499,,"25,057 x DRG weight",19499,Other,base rate x DRG weight,17550,,"22,552 x DRG weight",17550,Other,base rate x DRG weight,19499,,"25,057 x DRG weight",19499,Other,base rate x DRG weight,16574,,"21,298 x DRG weight",16574,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,37323,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,,inpatient,,,183491.29,24947,,,24947,Other,150% of Medicare + 9.63% HCRA Surcharge,15170.55,,,15170.55,Other,Medicare IPPS methodology,44434,,"25,046 x DRG weight",44434,Other,base rate x DRG weight,39990,,"22,541 x DRG weight",39990,Other,base rate x DRG weight,56933,,"32,091 x DRG weight",56933,Other,base rate x DRG weight,51240,,"28,882 x DRG weight",51240,Other,base rate x DRG weight,48392,,"27,277 x DRG weight",48392,Other,base rate x DRG weight,42720,,"24,080 x DRG weight",42720,Other,base rate x DRG weight,39852,,"22,463 x DRG weight",39852,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,46882,,"26,426 x DRG weight",46882,Other,base rate x DRG weight,68851,,"38,809 x DRG weight",68851,Other,base rate x DRG weight,68851,,"38,809 x DRG weight",68851,Other,base rate x DRG weight,46882,,"26,426 x DRG weight",46882,Other,base rate x DRG weight,68851,,"38,809 x DRG weight",68851,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,128444,70,,128444,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,44454,,"25,057 x DRG weight",44454,Other,base rate x DRG weight,40010,,"22,552 x DRG weight",40010,Other,base rate x DRG weight,44454,,"25,057 x DRG weight",44454,Other,base rate x DRG weight,37785,,"21,298 x DRG weight",37785,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,128444,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,,inpatient,,,145711.42,15358,,,15358,Other,150% of Medicare + 9.63% HCRA Surcharge,9339.26,,,9339.26,Other,Medicare IPPS methodology,26975,,"25,046 x DRG weight",26975,Other,base rate x DRG weight,24277,,"22,541 x DRG weight",24277,Other,base rate x DRG weight,34562,,"32,091 x DRG weight",34562,Other,base rate x DRG weight,31106,,"28,882 x DRG weight",31106,Other,base rate x DRG weight,29377,,"27,277 x DRG weight",29377,Other,base rate x DRG weight,25934,,"24,080 x DRG weight",25934,Other,base rate x DRG weight,24193,,"22,463 x DRG weight",24193,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28461,,"26,426 x DRG weight",28461,Other,base rate x DRG weight,41797,,"38,809 x DRG weight",41797,Other,base rate x DRG weight,41797,,"38,809 x DRG weight",41797,Other,base rate x DRG weight,28461,,"26,426 x DRG weight",28461,Other,base rate x DRG weight,41797,,"38,809 x DRG weight",41797,Other,base rate x DRG weight,26088,,"6,363 x patient days",26088,Per diem,,101998,70,,101998,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26986,,"25,057 x DRG weight",26986,Other,base rate x DRG weight,24289,,"22,552 x DRG weight",24289,Other,base rate x DRG weight,26986,,"25,057 x DRG weight",26986,Other,base rate x DRG weight,22938,,"21,298 x DRG weight",22938,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,101998,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,,inpatient,,,72268.8,10256,,,10256,Other,150% of Medicare + 9.63% HCRA Surcharge,6236.65,,,6236.65,Other,Medicare IPPS methodology,17685,,"25,046 x DRG weight",17685,Other,base rate x DRG weight,15916,,"22,541 x DRG weight",15916,Other,base rate x DRG weight,22659,,"32,091 x DRG weight",22659,Other,base rate x DRG weight,20394,,"28,882 x DRG weight",20394,Other,base rate x DRG weight,19260,,"27,277 x DRG weight",19260,Other,base rate x DRG weight,17003,,"24,080 x DRG weight",17003,Other,base rate x DRG weight,15861,,"22,463 x DRG weight",15861,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18659,,"26,426 x DRG weight",18659,Other,base rate x DRG weight,27403,,"38,809 x DRG weight",27403,Other,base rate x DRG weight,27403,,"38,809 x DRG weight",27403,Other,base rate x DRG weight,18659,,"26,426 x DRG weight",18659,Other,base rate x DRG weight,27403,,"38,809 x DRG weight",27403,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,50588,70,,50588,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17693,,"25,057 x DRG weight",17693,Other,base rate x DRG weight,15924,,"22,552 x DRG weight",15924,Other,base rate x DRG weight,17693,,"25,057 x DRG weight",17693,Other,base rate x DRG weight,15039,,"21,298 x DRG weight",15039,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,50588,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,,inpatient,,,91494.19,13714,,,13714,Other,150% of Medicare + 9.63% HCRA Surcharge,8339.63,,,8339.63,Other,Medicare IPPS methodology,23982,,"25,046 x DRG weight",23982,Other,base rate x DRG weight,21583,,"22,541 x DRG weight",21583,Other,base rate x DRG weight,30727,,"32,091 x DRG weight",30727,Other,base rate x DRG weight,27655,,"28,882 x DRG weight",27655,Other,base rate x DRG weight,26118,,"27,277 x DRG weight",26118,Other,base rate x DRG weight,23057,,"24,080 x DRG weight",23057,Other,base rate x DRG weight,21508,,"22,463 x DRG weight",21508,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25303,,"26,426 x DRG weight",25303,Other,base rate x DRG weight,37160,,"38,809 x DRG weight",37160,Other,base rate x DRG weight,37160,,"38,809 x DRG weight",37160,Other,base rate x DRG weight,25303,,"26,426 x DRG weight",25303,Other,base rate x DRG weight,37160,,"38,809 x DRG weight",37160,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,64046,70,,64046,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23992,,"25,057 x DRG weight",23992,Other,base rate x DRG weight,21594,,"22,552 x DRG weight",21594,Other,base rate x DRG weight,23992,,"25,057 x DRG weight",23992,Other,base rate x DRG weight,20393,,"21,298 x DRG weight",20393,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,64046,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,,inpatient,,,58971.87,10102,,,10102,Other,150% of Medicare + 9.63% HCRA Surcharge,6142.96,,,6142.96,Other,Medicare IPPS methodology,17404,,"25,046 x DRG weight",17404,Other,base rate x DRG weight,15664,,"22,541 x DRG weight",15664,Other,base rate x DRG weight,22300,,"32,091 x DRG weight",22300,Other,base rate x DRG weight,20070,,"28,882 x DRG weight",20070,Other,base rate x DRG weight,18955,,"27,277 x DRG weight",18955,Other,base rate x DRG weight,16733,,"24,080 x DRG weight",16733,Other,base rate x DRG weight,15610,,"22,463 x DRG weight",15610,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18363,,"26,426 x DRG weight",18363,Other,base rate x DRG weight,26968,,"38,809 x DRG weight",26968,Other,base rate x DRG weight,26968,,"38,809 x DRG weight",26968,Other,base rate x DRG weight,18363,,"26,426 x DRG weight",18363,Other,base rate x DRG weight,26968,,"38,809 x DRG weight",26968,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,41280,70,,41280,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17412,,"25,057 x DRG weight",17412,Other,base rate x DRG weight,15671,,"22,552 x DRG weight",15671,Other,base rate x DRG weight,17412,,"25,057 x DRG weight",17412,Other,base rate x DRG weight,14800,,"21,298 x DRG weight",14800,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,41280,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,,inpatient,,,144451.95,11863,,,11863,Other,150% of Medicare + 9.63% HCRA Surcharge,7213.69,,,7213.69,Other,Medicare IPPS methodology,20610,,"25,046 x DRG weight",20610,Other,base rate x DRG weight,18549,,"22,541 x DRG weight",18549,Other,base rate x DRG weight,26408,,"32,091 x DRG weight",26408,Other,base rate x DRG weight,23767,,"28,882 x DRG weight",23767,Other,base rate x DRG weight,22446,,"27,277 x DRG weight",22446,Other,base rate x DRG weight,19815,,"24,080 x DRG weight",19815,Other,base rate x DRG weight,18485,,"22,463 x DRG weight",18485,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21746,,"26,426 x DRG weight",21746,Other,base rate x DRG weight,31936,,"38,809 x DRG weight",31936,Other,base rate x DRG weight,31936,,"38,809 x DRG weight",31936,Other,base rate x DRG weight,21746,,"26,426 x DRG weight",21746,Other,base rate x DRG weight,31936,,"38,809 x DRG weight",31936,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,101116,70,,101116,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20619,,"25,057 x DRG weight",20619,Other,base rate x DRG weight,18558,,"22,552 x DRG weight",18558,Other,base rate x DRG weight,20619,,"25,057 x DRG weight",20619,Other,base rate x DRG weight,17526,,"21,298 x DRG weight",17526,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,101116,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,,inpatient,,,195278.34,25445,,,25445,Other,150% of Medicare + 9.63% HCRA Surcharge,15473.37,,,15473.37,Other,Medicare IPPS methodology,45341,,"25,046 x DRG weight",45341,Other,base rate x DRG weight,40806,,"22,541 x DRG weight",40806,Other,base rate x DRG weight,58094,,"32,091 x DRG weight",58094,Other,base rate x DRG weight,52285,,"28,882 x DRG weight",52285,Other,base rate x DRG weight,49380,,"27,277 x DRG weight",49380,Other,base rate x DRG weight,43592,,"24,080 x DRG weight",43592,Other,base rate x DRG weight,40665,,"22,463 x DRG weight",40665,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,47839,,"26,426 x DRG weight",47839,Other,base rate x DRG weight,70256,,"38,809 x DRG weight",70256,Other,base rate x DRG weight,70256,,"38,809 x DRG weight",70256,Other,base rate x DRG weight,47839,,"26,426 x DRG weight",47839,Other,base rate x DRG weight,70256,,"38,809 x DRG weight",70256,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,136695,70,,136695,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,45361,,"25,057 x DRG weight",45361,Other,base rate x DRG weight,40826,,"22,552 x DRG weight",40826,Other,base rate x DRG weight,45361,,"25,057 x DRG weight",45361,Other,base rate x DRG weight,38556,,"21,298 x DRG weight",38556,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,136695,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,,inpatient,,,107739.98,13109,,,13109,Other,150% of Medicare + 9.63% HCRA Surcharge,7971.57,,,7971.57,Other,Medicare IPPS methodology,22880,,"25,046 x DRG weight",22880,Other,base rate x DRG weight,20591,,"22,541 x DRG weight",20591,Other,base rate x DRG weight,29315,,"32,091 x DRG weight",29315,Other,base rate x DRG weight,26384,,"28,882 x DRG weight",26384,Other,base rate x DRG weight,24918,,"27,277 x DRG weight",24918,Other,base rate x DRG weight,21997,,"24,080 x DRG weight",21997,Other,base rate x DRG weight,20520,,"22,463 x DRG weight",20520,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24140,,"26,426 x DRG weight",24140,Other,base rate x DRG weight,35452,,"38,809 x DRG weight",35452,Other,base rate x DRG weight,35452,,"38,809 x DRG weight",35452,Other,base rate x DRG weight,24140,,"26,426 x DRG weight",24140,Other,base rate x DRG weight,35452,,"38,809 x DRG weight",35452,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,75418,70,,75418,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22890,,"25,057 x DRG weight",22890,Other,base rate x DRG weight,20601,,"22,552 x DRG weight",20601,Other,base rate x DRG weight,22890,,"25,057 x DRG weight",22890,Other,base rate x DRG weight,19456,,"21,298 x DRG weight",19456,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,75418,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,,inpatient,,,585406.73,95569,,,95569,Other,150% of Medicare + 9.63% HCRA Surcharge,58116.02,,,58116.02,Other,Medicare IPPS methodology,173018,,"25,046 x DRG weight",173018,Other,base rate x DRG weight,155713,,"22,541 x DRG weight",155713,Other,base rate x DRG weight,221685,,"32,091 x DRG weight",221685,Other,base rate x DRG weight,199517,,"28,882 x DRG weight",199517,Other,base rate x DRG weight,188430,,"27,277 x DRG weight",188430,Other,base rate x DRG weight,166345,,"24,080 x DRG weight",166345,Other,base rate x DRG weight,155174,,"22,463 x DRG weight",155174,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,182551,,"26,426 x DRG weight",182551,Other,base rate x DRG weight,268093,,"38,809 x DRG weight",268093,Other,base rate x DRG weight,268093,,"38,809 x DRG weight",268093,Other,base rate x DRG weight,182551,,"26,426 x DRG weight",182551,Other,base rate x DRG weight,268093,,"38,809 x DRG weight",268093,Other,base rate x DRG weight,110716,,"6,363 x patient days",110716,Per diem,,409785,70,,409785,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,173094,,"25,057 x DRG weight",173094,Other,base rate x DRG weight,155789,,"22,552 x DRG weight",155789,Other,base rate x DRG weight,173094,,"25,057 x DRG weight",173094,Other,base rate x DRG weight,147127,,"21,298 x DRG weight",147127,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,409785,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,,inpatient,,,244798.28,37736,,,37736,Other,150% of Medicare + 9.63% HCRA Surcharge,22947.57,,,22947.57,Other,Medicare IPPS methodology,67719,,"25,046 x DRG weight",67719,Other,base rate x DRG weight,60946,,"22,541 x DRG weight",60946,Other,base rate x DRG weight,86768,,"32,091 x DRG weight",86768,Other,base rate x DRG weight,78091,,"28,882 x DRG weight",78091,Other,base rate x DRG weight,73752,,"27,277 x DRG weight",73752,Other,base rate x DRG weight,65108,,"24,080 x DRG weight",65108,Other,base rate x DRG weight,60735,,"22,463 x DRG weight",60735,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,71451,,"26,426 x DRG weight",71451,Other,base rate x DRG weight,104932,,"38,809 x DRG weight",104932,Other,base rate x DRG weight,104932,,"38,809 x DRG weight",104932,Other,base rate x DRG weight,71451,,"26,426 x DRG weight",71451,Other,base rate x DRG weight,104932,,"38,809 x DRG weight",104932,Other,base rate x DRG weight,48995,,"6,363 x patient days",48995,Per diem,,171359,70,,171359,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,67749,,"25,057 x DRG weight",67749,Other,base rate x DRG weight,60976,,"22,552 x DRG weight",60976,Other,base rate x DRG weight,67749,,"25,057 x DRG weight",67749,Other,base rate x DRG weight,57586,,"21,298 x DRG weight",57586,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,171359,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,,inpatient,,,1520385.15,148704,,,148704,Other,150% of Medicare + 9.63% HCRA Surcharge,90427.8,,,90427.8,Other,Medicare IPPS methodology,269763,,"25,046 x DRG weight",269763,Other,base rate x DRG weight,242782,,"22,541 x DRG weight",242782,Other,base rate x DRG weight,345643,,"32,091 x DRG weight",345643,Other,base rate x DRG weight,311079,,"28,882 x DRG weight",311079,Other,base rate x DRG weight,293792,,"27,277 x DRG weight",293792,Other,base rate x DRG weight,259358,,"24,080 x DRG weight",259358,Other,base rate x DRG weight,241942,,"22,463 x DRG weight",241942,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,284627,,"26,426 x DRG weight",284627,Other,base rate x DRG weight,418000,,"38,809 x DRG weight",418000,Other,base rate x DRG weight,418000,,"38,809 x DRG weight",418000,Other,base rate x DRG weight,284627,,"26,426 x DRG weight",284627,Other,base rate x DRG weight,418000,,"38,809 x DRG weight",418000,Other,base rate x DRG weight,99899,,"6,363 x patient days",99899,Per diem,,1064270,70,,1064270,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,269881,,"25,057 x DRG weight",269881,Other,base rate x DRG weight,242901,,"22,552 x DRG weight",242901,Other,base rate x DRG weight,269881,,"25,057 x DRG weight",269881,Other,base rate x DRG weight,229394,,"21,298 x DRG weight",229394,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,1064270,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,,inpatient,,,1281378.9,141057,,,141057,Other,150% of Medicare + 9.63% HCRA Surcharge,85777.66,,,85777.66,Other,Medicare IPPS methodology,255840,,"25,046 x DRG weight",255840,Other,base rate x DRG weight,230252,,"22,541 x DRG weight",230252,Other,base rate x DRG weight,327803,,"32,091 x DRG weight",327803,Other,base rate x DRG weight,295024,,"28,882 x DRG weight",295024,Other,base rate x DRG weight,278629,,"27,277 x DRG weight",278629,Other,base rate x DRG weight,245972,,"24,080 x DRG weight",245972,Other,base rate x DRG weight,229455,,"22,463 x DRG weight",229455,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,269936,,"26,426 x DRG weight",269936,Other,base rate x DRG weight,396426,,"38,809 x DRG weight",396426,Other,base rate x DRG weight,396426,,"38,809 x DRG weight",396426,Other,base rate x DRG weight,269936,,"26,426 x DRG weight",269936,Other,base rate x DRG weight,396426,,"38,809 x DRG weight",396426,Other,base rate x DRG weight,57267,,"6,363 x patient days",57267,Per diem,,896965,70,,896965,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,255952,,"25,057 x DRG weight",255952,Other,base rate x DRG weight,230364,,"22,552 x DRG weight",230364,Other,base rate x DRG weight,255952,,"25,057 x DRG weight",255952,Other,base rate x DRG weight,217555,,"21,298 x DRG weight",217555,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,896965,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,,inpatient,,,953897.27,134048,,,134048,Other,150% of Medicare + 9.63% HCRA Surcharge,81515.65,,,81515.65,Other,Medicare IPPS methodology,243079,,"25,046 x DRG weight",243079,Other,base rate x DRG weight,218767,,"22,541 x DRG weight",218767,Other,base rate x DRG weight,311453,,"32,091 x DRG weight",311453,Other,base rate x DRG weight,280308,,"28,882 x DRG weight",280308,Other,base rate x DRG weight,264731,,"27,277 x DRG weight",264731,Other,base rate x DRG weight,233704,,"24,080 x DRG weight",233704,Other,base rate x DRG weight,218010,,"22,463 x DRG weight",218010,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,256472,,"26,426 x DRG weight",256472,Other,base rate x DRG weight,376653,,"38,809 x DRG weight",376653,Other,base rate x DRG weight,376653,,"38,809 x DRG weight",376653,Other,base rate x DRG weight,256472,,"26,426 x DRG weight",256472,Other,base rate x DRG weight,376653,,"38,809 x DRG weight",376653,Other,base rate x DRG weight,92264,,"6,363 x patient days",92264,Per diem,,667728,70,,667728,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,243186,,"25,057 x DRG weight",243186,Other,base rate x DRG weight,218874,,"22,552 x DRG weight",218874,Other,base rate x DRG weight,243186,,"25,057 x DRG weight",243186,Other,base rate x DRG weight,206703,,"21,298 x DRG weight",206703,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,667728,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,,inpatient,,,677974.07,88104,,,88104,Other,150% of Medicare + 9.63% HCRA Surcharge,53576.29,,,53576.29,Other,Medicare IPPS methodology,159425,,"25,046 x DRG weight",159425,Other,base rate x DRG weight,143480,,"22,541 x DRG weight",143480,Other,base rate x DRG weight,204269,,"32,091 x DRG weight",204269,Other,base rate x DRG weight,183843,,"28,882 x DRG weight",183843,Other,base rate x DRG weight,173626,,"27,277 x DRG weight",173626,Other,base rate x DRG weight,153276,,"24,080 x DRG weight",153276,Other,base rate x DRG weight,142984,,"22,463 x DRG weight",142984,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,168209,,"26,426 x DRG weight",168209,Other,base rate x DRG weight,247031,,"38,809 x DRG weight",247031,Other,base rate x DRG weight,247031,,"38,809 x DRG weight",247031,Other,base rate x DRG weight,168209,,"26,426 x DRG weight",168209,Other,base rate x DRG weight,247031,,"38,809 x DRG weight",247031,Other,base rate x DRG weight,45177,,"6,363 x patient days",45177,Per diem,,474582,70,,474582,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,159495,,"25,057 x DRG weight",159495,Other,base rate x DRG weight,143550,,"22,552 x DRG weight",143550,Other,base rate x DRG weight,159495,,"25,057 x DRG weight",159495,Other,base rate x DRG weight,135568,,"21,298 x DRG weight",135568,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,474582,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,,inpatient,,,568710.96,78906,,,78906,Other,150% of Medicare + 9.63% HCRA Surcharge,47983.4,,,47983.4,Other,Medicare IPPS methodology,142680,,"25,046 x DRG weight",142680,Other,base rate x DRG weight,128409,,"22,541 x DRG weight",128409,Other,base rate x DRG weight,182813,,"32,091 x DRG weight",182813,Other,base rate x DRG weight,164532,,"28,882 x DRG weight",164532,Other,base rate x DRG weight,155389,,"27,277 x DRG weight",155389,Other,base rate x DRG weight,137177,,"24,080 x DRG weight",137177,Other,base rate x DRG weight,127965,,"22,463 x DRG weight",127965,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,150541,,"26,426 x DRG weight",150541,Other,base rate x DRG weight,221083,,"38,809 x DRG weight",221083,Other,base rate x DRG weight,221083,,"38,809 x DRG weight",221083,Other,base rate x DRG weight,150541,,"26,426 x DRG weight",150541,Other,base rate x DRG weight,221083,,"38,809 x DRG weight",221083,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,398098,70,,398098,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,142742,,"25,057 x DRG weight",142742,Other,base rate x DRG weight,128472,,"22,552 x DRG weight",128472,Other,base rate x DRG weight,142742,,"25,057 x DRG weight",142742,Other,base rate x DRG weight,121328,,"21,298 x DRG weight",121328,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,398098,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,,inpatient,,,779264.3,106618,,,106618,Other,150% of Medicare + 9.63% HCRA Surcharge,64834.85,,,64834.85,Other,Medicare IPPS methodology,193135,,"25,046 x DRG weight",193135,Other,base rate x DRG weight,173818,,"22,541 x DRG weight",173818,Other,base rate x DRG weight,247460,,"32,091 x DRG weight",247460,Other,base rate x DRG weight,222715,,"28,882 x DRG weight",222715,Other,base rate x DRG weight,210338,,"27,277 x DRG weight",210338,Other,base rate x DRG weight,185686,,"24,080 x DRG weight",185686,Other,base rate x DRG weight,173217,,"22,463 x DRG weight",173217,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,203776,,"26,426 x DRG weight",203776,Other,base rate x DRG weight,299264,,"38,809 x DRG weight",299264,Other,base rate x DRG weight,299264,,"38,809 x DRG weight",299264,Other,base rate x DRG weight,203776,,"26,426 x DRG weight",203776,Other,base rate x DRG weight,299264,,"38,809 x DRG weight",299264,Other,base rate x DRG weight,68084,,"6,363 x patient days",68084,Per diem,,545485,70,,545485,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,193220,,"25,057 x DRG weight",193220,Other,base rate x DRG weight,173903,,"22,552 x DRG weight",173903,Other,base rate x DRG weight,193220,,"25,057 x DRG weight",193220,Other,base rate x DRG weight,164233,,"21,298 x DRG weight",164233,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,545485,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,,inpatient,,,583822.96,72687,,,72687,Other,150% of Medicare + 9.63% HCRA Surcharge,44201.55,,,44201.55,Other,Medicare IPPS methodology,131356,,"25,046 x DRG weight",131356,Other,base rate x DRG weight,118219,,"22,541 x DRG weight",118219,Other,base rate x DRG weight,168304,,"32,091 x DRG weight",168304,Other,base rate x DRG weight,151475,,"28,882 x DRG weight",151475,Other,base rate x DRG weight,143057,,"27,277 x DRG weight",143057,Other,base rate x DRG weight,126290,,"24,080 x DRG weight",126290,Other,base rate x DRG weight,117809,,"22,463 x DRG weight",117809,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,138594,,"26,426 x DRG weight",138594,Other,base rate x DRG weight,203538,,"38,809 x DRG weight",203538,Other,base rate x DRG weight,203538,,"38,809 x DRG weight",203538,Other,base rate x DRG weight,138594,,"26,426 x DRG weight",138594,Other,base rate x DRG weight,203538,,"38,809 x DRG weight",203538,Other,base rate x DRG weight,40087,,"6,363 x patient days",40087,Per diem,,408676,70,,408676,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,131414,,"25,057 x DRG weight",131414,Other,base rate x DRG weight,118276,,"22,552 x DRG weight",118276,Other,base rate x DRG weight,131414,,"25,057 x DRG weight",131414,Other,base rate x DRG weight,111699,,"21,298 x DRG weight",111699,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,408676,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,,inpatient,,,416384.25,64489,,,64489,Other,150% of Medicare + 9.63% HCRA Surcharge,39215.97,,,39215.97,Other,Medicare IPPS methodology,116429,,"25,046 x DRG weight",116429,Other,base rate x DRG weight,104784,,"22,541 x DRG weight",104784,Other,base rate x DRG weight,149178,,"32,091 x DRG weight",149178,Other,base rate x DRG weight,134261,,"28,882 x DRG weight",134261,Other,base rate x DRG weight,126800,,"27,277 x DRG weight",126800,Other,base rate x DRG weight,111938,,"24,080 x DRG weight",111938,Other,base rate x DRG weight,104422,,"22,463 x DRG weight",104422,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,122844,,"26,426 x DRG weight",122844,Other,base rate x DRG weight,180408,,"38,809 x DRG weight",180408,Other,base rate x DRG weight,180408,,"38,809 x DRG weight",180408,Other,base rate x DRG weight,122844,,"26,426 x DRG weight",122844,Other,base rate x DRG weight,180408,,"38,809 x DRG weight",180408,Other,base rate x DRG weight,25452,,"6,363 x patient days",25452,Per diem,,291469,70,,291469,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,116480,,"25,057 x DRG weight",116480,Other,base rate x DRG weight,104835,,"22,552 x DRG weight",104835,Other,base rate x DRG weight,116480,,"25,057 x DRG weight",116480,Other,base rate x DRG weight,99006,,"21,298 x DRG weight",99006,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,291469,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,,inpatient,,,573616.59,69855,,,69855,Other,150% of Medicare + 9.63% HCRA Surcharge,42479.18,,,42479.18,Other,Medicare IPPS methodology,126199,,"25,046 x DRG weight",126199,Other,base rate x DRG weight,113577,,"22,541 x DRG weight",113577,Other,base rate x DRG weight,161697,,"32,091 x DRG weight",161697,Other,base rate x DRG weight,145528,,"28,882 x DRG weight",145528,Other,base rate x DRG weight,137441,,"27,277 x DRG weight",137441,Other,base rate x DRG weight,121332,,"24,080 x DRG weight",121332,Other,base rate x DRG weight,113184,,"22,463 x DRG weight",113184,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,133153,,"26,426 x DRG weight",133153,Other,base rate x DRG weight,195547,,"38,809 x DRG weight",195547,Other,base rate x DRG weight,195547,,"38,809 x DRG weight",195547,Other,base rate x DRG weight,133153,,"26,426 x DRG weight",133153,Other,base rate x DRG weight,195547,,"38,809 x DRG weight",195547,Other,base rate x DRG weight,57903,,"6,363 x patient days",57903,Per diem,,401532,70,,401532,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,126255,,"25,057 x DRG weight",126255,Other,base rate x DRG weight,113633,,"22,552 x DRG weight",113633,Other,base rate x DRG weight,126255,,"25,057 x DRG weight",126255,Other,base rate x DRG weight,107314,,"21,298 x DRG weight",107314,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,401532,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,,inpatient,,,301670.68,44281,,,44281,Other,150% of Medicare + 9.63% HCRA Surcharge,26927.67,,,26927.67,Other,Medicare IPPS methodology,79636,,"25,046 x DRG weight",79636,Other,base rate x DRG weight,71671,,"22,541 x DRG weight",71671,Other,base rate x DRG weight,102037,,"32,091 x DRG weight",102037,Other,base rate x DRG weight,91833,,"28,882 x DRG weight",91833,Other,base rate x DRG weight,86730,,"27,277 x DRG weight",86730,Other,base rate x DRG weight,76565,,"24,080 x DRG weight",76565,Other,base rate x DRG weight,71423,,"22,463 x DRG weight",71423,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,84024,,"26,426 x DRG weight",84024,Other,base rate x DRG weight,123397,,"38,809 x DRG weight",123397,Other,base rate x DRG weight,123397,,"38,809 x DRG weight",123397,Other,base rate x DRG weight,84024,,"26,426 x DRG weight",84024,Other,base rate x DRG weight,123397,,"38,809 x DRG weight",123397,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,211169,70,,211169,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,79671,,"25,057 x DRG weight",79671,Other,base rate x DRG weight,71706,,"22,552 x DRG weight",71706,Other,base rate x DRG weight,79671,,"25,057 x DRG weight",79671,Other,base rate x DRG weight,67719,,"21,298 x DRG weight",67719,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,211169,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,,inpatient,,,1154004.57,112175,,,112175,Other,150% of Medicare + 9.63% HCRA Surcharge,68214.34,,,68214.34,Other,Medicare IPPS methodology,203253,,"25,046 x DRG weight",203253,Other,base rate x DRG weight,182925,,"22,541 x DRG weight",182925,Other,base rate x DRG weight,260425,,"32,091 x DRG weight",260425,Other,base rate x DRG weight,234383,,"28,882 x DRG weight",234383,Other,base rate x DRG weight,221358,,"27,277 x DRG weight",221358,Other,base rate x DRG weight,195414,,"24,080 x DRG weight",195414,Other,base rate x DRG weight,182292,,"22,463 x DRG weight",182292,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,214452,,"26,426 x DRG weight",214452,Other,base rate x DRG weight,314943,,"38,809 x DRG weight",314943,Other,base rate x DRG weight,314943,,"38,809 x DRG weight",314943,Other,base rate x DRG weight,214452,,"26,426 x DRG weight",214452,Other,base rate x DRG weight,314943,,"38,809 x DRG weight",314943,Other,base rate x DRG weight,76356,,"6,363 x patient days",76356,Per diem,,807803,70,,807803,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,203343,,"25,057 x DRG weight",203343,Other,base rate x DRG weight,183014,,"22,552 x DRG weight",183014,Other,base rate x DRG weight,203343,,"25,057 x DRG weight",203343,Other,base rate x DRG weight,172838,,"21,298 x DRG weight",172838,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,807803,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,,inpatient,,,588002.47,82371,,,82371,Other,150% of Medicare + 9.63% HCRA Surcharge,50090.57,,,50090.57,Other,Medicare IPPS methodology,148989,,"25,046 x DRG weight",148989,Other,base rate x DRG weight,134087,,"22,541 x DRG weight",134087,Other,base rate x DRG weight,190897,,"32,091 x DRG weight",190897,Other,base rate x DRG weight,171807,,"28,882 x DRG weight",171807,Other,base rate x DRG weight,162260,,"27,277 x DRG weight",162260,Other,base rate x DRG weight,143242,,"24,080 x DRG weight",143242,Other,base rate x DRG weight,133623,,"22,463 x DRG weight",133623,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,157198,,"26,426 x DRG weight",157198,Other,base rate x DRG weight,230859,,"38,809 x DRG weight",230859,Other,base rate x DRG weight,230859,,"38,809 x DRG weight",230859,Other,base rate x DRG weight,157198,,"26,426 x DRG weight",157198,Other,base rate x DRG weight,230859,,"38,809 x DRG weight",230859,Other,base rate x DRG weight,52813,,"6,363 x patient days",52813,Per diem,,411602,70,,411602,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,149054,,"25,057 x DRG weight",149054,Other,base rate x DRG weight,134153,,"22,552 x DRG weight",134153,Other,base rate x DRG weight,149054,,"25,057 x DRG weight",149054,Other,base rate x DRG weight,126693,,"21,298 x DRG weight",126693,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,411602,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,,inpatient,,,764165.03,107834,,,107834,Other,150% of Medicare + 9.63% HCRA Surcharge,65574.32,,,65574.32,Other,Medicare IPPS methodology,195349,,"25,046 x DRG weight",195349,Other,base rate x DRG weight,175811,,"22,541 x DRG weight",175811,Other,base rate x DRG weight,250297,,"32,091 x DRG weight",250297,Other,base rate x DRG weight,225268,,"28,882 x DRG weight",225268,Other,base rate x DRG weight,212750,,"27,277 x DRG weight",212750,Other,base rate x DRG weight,187814,,"24,080 x DRG weight",187814,Other,base rate x DRG weight,175202,,"22,463 x DRG weight",175202,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,206112,,"26,426 x DRG weight",206112,Other,base rate x DRG weight,302695,,"38,809 x DRG weight",302695,Other,base rate x DRG weight,302695,,"38,809 x DRG weight",302695,Other,base rate x DRG weight,206112,,"26,426 x DRG weight",206112,Other,base rate x DRG weight,302695,,"38,809 x DRG weight",302695,Other,base rate x DRG weight,81446,,"6,363 x patient days",81446,Per diem,,534916,70,,534916,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,195435,,"25,057 x DRG weight",195435,Other,base rate x DRG weight,175897,,"22,552 x DRG weight",175897,Other,base rate x DRG weight,195435,,"25,057 x DRG weight",195435,Other,base rate x DRG weight,166116,,"21,298 x DRG weight",166116,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,534916,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,,inpatient,,,578985.14,72045,,,72045,Other,150% of Medicare + 9.63% HCRA Surcharge,43810.9,,,43810.9,Other,Medicare IPPS methodology,130187,,"25,046 x DRG weight",130187,Other,base rate x DRG weight,117166,,"22,541 x DRG weight",117166,Other,base rate x DRG weight,166806,,"32,091 x DRG weight",166806,Other,base rate x DRG weight,150126,,"28,882 x DRG weight",150126,Other,base rate x DRG weight,141783,,"27,277 x DRG weight",141783,Other,base rate x DRG weight,125165,,"24,080 x DRG weight",125165,Other,base rate x DRG weight,116760,,"22,463 x DRG weight",116760,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,137360,,"26,426 x DRG weight",137360,Other,base rate x DRG weight,201725,,"38,809 x DRG weight",201725,Other,base rate x DRG weight,201725,,"38,809 x DRG weight",201725,Other,base rate x DRG weight,137360,,"26,426 x DRG weight",137360,Other,base rate x DRG weight,201725,,"38,809 x DRG weight",201725,Other,base rate x DRG weight,54722,,"6,363 x patient days",54722,Per diem,,405290,70,,405290,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,130244,,"25,057 x DRG weight",130244,Other,base rate x DRG weight,117223,,"22,552 x DRG weight",117223,Other,base rate x DRG weight,130244,,"25,057 x DRG weight",130244,Other,base rate x DRG weight,110705,,"21,298 x DRG weight",110705,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,405290,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,,inpatient,,,616184.41,81436,,,81436,Other,150% of Medicare + 9.63% HCRA Surcharge,49521.74,,,49521.74,Other,Medicare IPPS methodology,147286,,"25,046 x DRG weight",147286,Other,base rate x DRG weight,132555,,"22,541 x DRG weight",132555,Other,base rate x DRG weight,188714,,"32,091 x DRG weight",188714,Other,base rate x DRG weight,169843,,"28,882 x DRG weight",169843,Other,base rate x DRG weight,160405,,"27,277 x DRG weight",160405,Other,base rate x DRG weight,141605,,"24,080 x DRG weight",141605,Other,base rate x DRG weight,132096,,"22,463 x DRG weight",132096,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,155401,,"26,426 x DRG weight",155401,Other,base rate x DRG weight,228220,,"38,809 x DRG weight",228220,Other,base rate x DRG weight,228220,,"38,809 x DRG weight",228220,Other,base rate x DRG weight,155401,,"26,426 x DRG weight",155401,Other,base rate x DRG weight,228220,,"38,809 x DRG weight",228220,Other,base rate x DRG weight,60449,,"6,363 x patient days",60449,Per diem,,431329,70,,431329,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,147350,,"25,057 x DRG weight",147350,Other,base rate x DRG weight,132619,,"22,552 x DRG weight",132619,Other,base rate x DRG weight,147350,,"25,057 x DRG weight",147350,Other,base rate x DRG weight,125245,,"21,298 x DRG weight",125245,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,431329,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,,inpatient,,,486448.72,56133,,,56133,Other,150% of Medicare + 9.63% HCRA Surcharge,34135.02,,,34135.02,Other,Medicare IPPS methodology,101216,,"25,046 x DRG weight",101216,Other,base rate x DRG weight,91093,,"22,541 x DRG weight",91093,Other,base rate x DRG weight,129686,,"32,091 x DRG weight",129686,Other,base rate x DRG weight,116718,,"28,882 x DRG weight",116718,Other,base rate x DRG weight,110232,,"27,277 x DRG weight",110232,Other,base rate x DRG weight,97312,,"24,080 x DRG weight",97312,Other,base rate x DRG weight,90777,,"22,463 x DRG weight",90777,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,106793,,"26,426 x DRG weight",106793,Other,base rate x DRG weight,156835,,"38,809 x DRG weight",156835,Other,base rate x DRG weight,156835,,"38,809 x DRG weight",156835,Other,base rate x DRG weight,106793,,"26,426 x DRG weight",106793,Other,base rate x DRG weight,156835,,"38,809 x DRG weight",156835,Other,base rate x DRG weight,40087,,"6,363 x patient days",40087,Per diem,,340514,70,,340514,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,101260,,"25,057 x DRG weight",101260,Other,base rate x DRG weight,91137,,"22,552 x DRG weight",91137,Other,base rate x DRG weight,101260,,"25,057 x DRG weight",101260,Other,base rate x DRG weight,86069,,"21,298 x DRG weight",86069,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,340514,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,,inpatient,,,922646.48,66665,,,66665,Other,150% of Medicare + 9.63% HCRA Surcharge,40539.32,,,40539.32,Other,Medicare IPPS methodology,120391,,"25,046 x DRG weight",120391,Other,base rate x DRG weight,108350,,"22,541 x DRG weight",108350,Other,base rate x DRG weight,154255,,"32,091 x DRG weight",154255,Other,base rate x DRG weight,138830,,"28,882 x DRG weight",138830,Other,base rate x DRG weight,131115,,"27,277 x DRG weight",131115,Other,base rate x DRG weight,115748,,"24,080 x DRG weight",115748,Other,base rate x DRG weight,107975,,"22,463 x DRG weight",107975,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,127024,,"26,426 x DRG weight",127024,Other,base rate x DRG weight,186547,,"38,809 x DRG weight",186547,Other,base rate x DRG weight,186547,,"38,809 x DRG weight",186547,Other,base rate x DRG weight,127024,,"26,426 x DRG weight",127024,Other,base rate x DRG weight,186547,,"38,809 x DRG weight",186547,Other,base rate x DRG weight,90355,,"6,363 x patient days",90355,Per diem,,645853,70,,645853,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,120444,,"25,057 x DRG weight",120444,Other,base rate x DRG weight,108403,,"22,552 x DRG weight",108403,Other,base rate x DRG weight,120444,,"25,057 x DRG weight",120444,Other,base rate x DRG weight,102375,,"21,298 x DRG weight",102375,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,645853,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,,inpatient,,,628646.8,39186,,,39186,Other,150% of Medicare + 9.63% HCRA Surcharge,23829.24,,,23829.24,Other,Medicare IPPS methodology,70359,,"25,046 x DRG weight",70359,Other,base rate x DRG weight,63322,,"22,541 x DRG weight",63322,Other,base rate x DRG weight,90150,,"32,091 x DRG weight",90150,Other,base rate x DRG weight,81135,,"28,882 x DRG weight",81135,Other,base rate x DRG weight,76627,,"27,277 x DRG weight",76627,Other,base rate x DRG weight,67646,,"24,080 x DRG weight",67646,Other,base rate x DRG weight,63103,,"22,463 x DRG weight",63103,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,74236,,"26,426 x DRG weight",74236,Other,base rate x DRG weight,109022,,"38,809 x DRG weight",109022,Other,base rate x DRG weight,109022,,"38,809 x DRG weight",109022,Other,base rate x DRG weight,74236,,"26,426 x DRG weight",74236,Other,base rate x DRG weight,109022,,"38,809 x DRG weight",109022,Other,base rate x DRG weight,55358,,"6,363 x patient days",55358,Per diem,,440053,70,,440053,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,70390,,"25,057 x DRG weight",70390,Other,base rate x DRG weight,63353,,"22,552 x DRG weight",63353,Other,base rate x DRG weight,70390,,"25,057 x DRG weight",70390,Other,base rate x DRG weight,59830,,"21,298 x DRG weight",59830,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,440053,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,,inpatient,,,278137.31,19719,,,19719,Other,150% of Medicare + 9.63% HCRA Surcharge,11990.99,,,11990.99,Other,Medicare IPPS methodology,34914,,"25,046 x DRG weight",34914,Other,base rate x DRG weight,31422,,"22,541 x DRG weight",31422,Other,base rate x DRG weight,44735,,"32,091 x DRG weight",44735,Other,base rate x DRG weight,40262,,"28,882 x DRG weight",40262,Other,base rate x DRG weight,38024,,"27,277 x DRG weight",38024,Other,base rate x DRG weight,33568,,"24,080 x DRG weight",33568,Other,base rate x DRG weight,31313,,"22,463 x DRG weight",31313,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,36838,,"26,426 x DRG weight",36838,Other,base rate x DRG weight,54100,,"38,809 x DRG weight",54100,Other,base rate x DRG weight,54100,,"38,809 x DRG weight",54100,Other,base rate x DRG weight,36838,,"26,426 x DRG weight",36838,Other,base rate x DRG weight,54100,,"38,809 x DRG weight",54100,Other,base rate x DRG weight,32451,,"6,363 x patient days",32451,Per diem,,194696,70,,194696,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,34929,,"25,057 x DRG weight",34929,Other,base rate x DRG weight,31437,,"22,552 x DRG weight",31437,Other,base rate x DRG weight,34929,,"25,057 x DRG weight",34929,Other,base rate x DRG weight,29689,,"21,298 x DRG weight",29689,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,194696,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,,inpatient,,,517066.14,48071,,,48071,Other,150% of Medicare + 9.63% HCRA Surcharge,29232.25,,,29232.25,Other,Medicare IPPS methodology,86536,,"25,046 x DRG weight",86536,Other,base rate x DRG weight,77881,,"22,541 x DRG weight",77881,Other,base rate x DRG weight,110878,,"32,091 x DRG weight",110878,Other,base rate x DRG weight,99790,,"28,882 x DRG weight",99790,Other,base rate x DRG weight,94245,,"27,277 x DRG weight",94245,Other,base rate x DRG weight,83199,,"24,080 x DRG weight",83199,Other,base rate x DRG weight,77612,,"22,463 x DRG weight",77612,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,91304,,"26,426 x DRG weight",91304,Other,base rate x DRG weight,134089,,"38,809 x DRG weight",134089,Other,base rate x DRG weight,134089,,"38,809 x DRG weight",134089,Other,base rate x DRG weight,91304,,"26,426 x DRG weight",91304,Other,base rate x DRG weight,134089,,"38,809 x DRG weight",134089,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,361946,70,,361946,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,86574,,"25,057 x DRG weight",86574,Other,base rate x DRG weight,77919,,"22,552 x DRG weight",77919,Other,base rate x DRG weight,86574,,"25,057 x DRG weight",86574,Other,base rate x DRG weight,73587,,"21,298 x DRG weight",73587,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,361946,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,,inpatient,,,286481.93,31873,,,31873,Other,150% of Medicare + 9.63% HCRA Surcharge,19382.37,,,19382.37,Other,Medicare IPPS methodology,57045,,"25,046 x DRG weight",57045,Other,base rate x DRG weight,51339,,"22,541 x DRG weight",51339,Other,base rate x DRG weight,73090,,"32,091 x DRG weight",73090,Other,base rate x DRG weight,65782,,"28,882 x DRG weight",65782,Other,base rate x DRG weight,62126,,"27,277 x DRG weight",62126,Other,base rate x DRG weight,54845,,"24,080 x DRG weight",54845,Other,base rate x DRG weight,51162,,"22,463 x DRG weight",51162,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,60188,,"26,426 x DRG weight",60188,Other,base rate x DRG weight,88391,,"38,809 x DRG weight",88391,Other,base rate x DRG weight,88391,,"38,809 x DRG weight",88391,Other,base rate x DRG weight,60188,,"26,426 x DRG weight",60188,Other,base rate x DRG weight,88391,,"38,809 x DRG weight",88391,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,200537,70,,200537,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,57070,,"25,057 x DRG weight",57070,Other,base rate x DRG weight,51364,,"22,552 x DRG weight",51364,Other,base rate x DRG weight,57070,,"25,057 x DRG weight",57070,Other,base rate x DRG weight,48508,,"21,298 x DRG weight",48508,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,200537,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,,inpatient,,,204054.44,25709,,,25709,Other,150% of Medicare + 9.63% HCRA Surcharge,15633.98,,,15633.98,Other,Medicare IPPS methodology,45822,,"25,046 x DRG weight",45822,Other,base rate x DRG weight,41239,,"22,541 x DRG weight",41239,Other,base rate x DRG weight,58710,,"32,091 x DRG weight",58710,Other,base rate x DRG weight,52840,,"28,882 x DRG weight",52840,Other,base rate x DRG weight,49903,,"27,277 x DRG weight",49903,Other,base rate x DRG weight,44054,,"24,080 x DRG weight",44054,Other,base rate x DRG weight,41096,,"22,463 x DRG weight",41096,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48346,,"26,426 x DRG weight",48346,Other,base rate x DRG weight,71001,,"38,809 x DRG weight",71001,Other,base rate x DRG weight,71001,,"38,809 x DRG weight",71001,Other,base rate x DRG weight,48346,,"26,426 x DRG weight",48346,Other,base rate x DRG weight,71001,,"38,809 x DRG weight",71001,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,142838,70,,142838,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,45842,,"25,057 x DRG weight",45842,Other,base rate x DRG weight,41259,,"22,552 x DRG weight",41259,Other,base rate x DRG weight,45842,,"25,057 x DRG weight",45842,Other,base rate x DRG weight,38965,,"21,298 x DRG weight",38965,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,142838,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,,inpatient,,,449127.75,62876,,,62876,Other,150% of Medicare + 9.63% HCRA Surcharge,38235.58,,,38235.58,Other,Medicare IPPS methodology,113493,,"25,046 x DRG weight",113493,Other,base rate x DRG weight,102142,,"22,541 x DRG weight",102142,Other,base rate x DRG weight,145417,,"32,091 x DRG weight",145417,Other,base rate x DRG weight,130876,,"28,882 x DRG weight",130876,Other,base rate x DRG weight,123603,,"27,277 x DRG weight",123603,Other,base rate x DRG weight,109116,,"24,080 x DRG weight",109116,Other,base rate x DRG weight,101789,,"22,463 x DRG weight",101789,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,119747,,"26,426 x DRG weight",119747,Other,base rate x DRG weight,175859,,"38,809 x DRG weight",175859,Other,base rate x DRG weight,175859,,"38,809 x DRG weight",175859,Other,base rate x DRG weight,119747,,"26,426 x DRG weight",119747,Other,base rate x DRG weight,175859,,"38,809 x DRG weight",175859,Other,base rate x DRG weight,36905,,"6,363 x patient days",36905,Per diem,,314389,70,,314389,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,113543,,"25,057 x DRG weight",113543,Other,base rate x DRG weight,102192,,"22,552 x DRG weight",102192,Other,base rate x DRG weight,113543,,"25,057 x DRG weight",113543,Other,base rate x DRG weight,96510,,"21,298 x DRG weight",96510,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,314389,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,,inpatient,,,338735.7,32880,,,32880,Other,150% of Medicare + 9.63% HCRA Surcharge,19994.69,,,19994.69,Other,Medicare IPPS methodology,58878,,"25,046 x DRG weight",58878,Other,base rate x DRG weight,52989,,"22,541 x DRG weight",52989,Other,base rate x DRG weight,75440,,"32,091 x DRG weight",75440,Other,base rate x DRG weight,67896,,"28,882 x DRG weight",67896,Other,base rate x DRG weight,64123,,"27,277 x DRG weight",64123,Other,base rate x DRG weight,56607,,"24,080 x DRG weight",56607,Other,base rate x DRG weight,52806,,"22,463 x DRG weight",52806,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,62122,,"26,426 x DRG weight",62122,Other,base rate x DRG weight,91232,,"38,809 x DRG weight",91232,Other,base rate x DRG weight,91232,,"38,809 x DRG weight",91232,Other,base rate x DRG weight,62122,,"26,426 x DRG weight",62122,Other,base rate x DRG weight,91232,,"38,809 x DRG weight",91232,Other,base rate x DRG weight,30542,,"6,363 x patient days",30542,Per diem,,237115,70,,237115,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,58904,,"25,057 x DRG weight",58904,Other,base rate x DRG weight,53015,,"22,552 x DRG weight",53015,Other,base rate x DRG weight,58904,,"25,057 x DRG weight",58904,Other,base rate x DRG weight,50067,,"21,298 x DRG weight",50067,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,237115,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,,inpatient,,,128369.42,22372,,,22372,Other,150% of Medicare + 9.63% HCRA Surcharge,13604.61,,,13604.61,Other,Medicare IPPS methodology,39745,,"25,046 x DRG weight",39745,Other,base rate x DRG weight,35770,,"22,541 x DRG weight",35770,Other,base rate x DRG weight,50925,,"32,091 x DRG weight",50925,Other,base rate x DRG weight,45833,,"28,882 x DRG weight",45833,Other,base rate x DRG weight,43286,,"27,277 x DRG weight",43286,Other,base rate x DRG weight,38213,,"24,080 x DRG weight",38213,Other,base rate x DRG weight,35647,,"22,463 x DRG weight",35647,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41935,,"26,426 x DRG weight",41935,Other,base rate x DRG weight,61586,,"38,809 x DRG weight",61586,Other,base rate x DRG weight,61586,,"38,809 x DRG weight",61586,Other,base rate x DRG weight,41935,,"26,426 x DRG weight",41935,Other,base rate x DRG weight,61586,,"38,809 x DRG weight",61586,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,89859,70,,89859,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39763,,"25,057 x DRG weight",39763,Other,base rate x DRG weight,35788,,"22,552 x DRG weight",35788,Other,base rate x DRG weight,39763,,"25,057 x DRG weight",39763,Other,base rate x DRG weight,33798,,"21,298 x DRG weight",33798,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,89859,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,,inpatient,,,419441.03,46677,,,46677,Other,150% of Medicare + 9.63% HCRA Surcharge,28384.87,,,28384.87,Other,Medicare IPPS methodology,83999,,"25,046 x DRG weight",83999,Other,base rate x DRG weight,75598,,"22,541 x DRG weight",75598,Other,base rate x DRG weight,107627,,"32,091 x DRG weight",107627,Other,base rate x DRG weight,96864,,"28,882 x DRG weight",96864,Other,base rate x DRG weight,91482,,"27,277 x DRG weight",91482,Other,base rate x DRG weight,80760,,"24,080 x DRG weight",80760,Other,base rate x DRG weight,75336,,"22,463 x DRG weight",75336,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,88628,,"26,426 x DRG weight",88628,Other,base rate x DRG weight,130158,,"38,809 x DRG weight",130158,Other,base rate x DRG weight,130158,,"38,809 x DRG weight",130158,Other,base rate x DRG weight,88628,,"26,426 x DRG weight",88628,Other,base rate x DRG weight,130158,,"38,809 x DRG weight",130158,Other,base rate x DRG weight,50904,,"6,363 x patient days",50904,Per diem,,293609,70,,293609,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,84036,,"25,057 x DRG weight",84036,Other,base rate x DRG weight,75635,,"22,552 x DRG weight",75635,Other,base rate x DRG weight,84036,,"25,057 x DRG weight",84036,Other,base rate x DRG weight,71429,,"21,298 x DRG weight",71429,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,293609,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,,inpatient,,,373894.59,35636,,,35636,Other,150% of Medicare + 9.63% HCRA Surcharge,21670.22,,,21670.22,Other,Medicare IPPS methodology,63895,,"25,046 x DRG weight",63895,Other,base rate x DRG weight,57504,,"22,541 x DRG weight",57504,Other,base rate x DRG weight,81867,,"32,091 x DRG weight",81867,Other,base rate x DRG weight,73681,,"28,882 x DRG weight",73681,Other,base rate x DRG weight,69586,,"27,277 x DRG weight",69586,Other,base rate x DRG weight,61430,,"24,080 x DRG weight",61430,Other,base rate x DRG weight,57305,,"22,463 x DRG weight",57305,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,67415,,"26,426 x DRG weight",67415,Other,base rate x DRG weight,99006,,"38,809 x DRG weight",99006,Other,base rate x DRG weight,99006,,"38,809 x DRG weight",99006,Other,base rate x DRG weight,67415,,"26,426 x DRG weight",67415,Other,base rate x DRG weight,99006,,"38,809 x DRG weight",99006,Other,base rate x DRG weight,33088,,"6,363 x patient days",33088,Per diem,,261726,70,,261726,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,63923,,"25,057 x DRG weight",63923,Other,base rate x DRG weight,57532,,"22,552 x DRG weight",57532,Other,base rate x DRG weight,63923,,"25,057 x DRG weight",63923,Other,base rate x DRG weight,54333,,"21,298 x DRG weight",54333,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,261726,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,,inpatient,,,167941.28,24411,,,24411,Other,150% of Medicare + 9.63% HCRA Surcharge,14844.32,,,14844.32,Other,Medicare IPPS methodology,43457,,"25,046 x DRG weight",43457,Other,base rate x DRG weight,39111,,"22,541 x DRG weight",39111,Other,base rate x DRG weight,55681,,"32,091 x DRG weight",55681,Other,base rate x DRG weight,50113,,"28,882 x DRG weight",50113,Other,base rate x DRG weight,47328,,"27,277 x DRG weight",47328,Other,base rate x DRG weight,41781,,"24,080 x DRG weight",41781,Other,base rate x DRG weight,38976,,"22,463 x DRG weight",38976,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45852,,"26,426 x DRG weight",45852,Other,base rate x DRG weight,67337,,"38,809 x DRG weight",67337,Other,base rate x DRG weight,67337,,"38,809 x DRG weight",67337,Other,base rate x DRG weight,45852,,"26,426 x DRG weight",45852,Other,base rate x DRG weight,67337,,"38,809 x DRG weight",67337,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,117559,70,,117559,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43476,,"25,057 x DRG weight",43476,Other,base rate x DRG weight,39130,,"22,552 x DRG weight",39130,Other,base rate x DRG weight,43476,,"25,057 x DRG weight",43476,Other,base rate x DRG weight,36954,,"21,298 x DRG weight",36954,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,117559,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,,inpatient,,,266996.59,38336,,,38336,Other,150% of Medicare + 9.63% HCRA Surcharge,23312.28,,,23312.28,Other,Medicare IPPS methodology,68811,,"25,046 x DRG weight",68811,Other,base rate x DRG weight,61929,,"22,541 x DRG weight",61929,Other,base rate x DRG weight,88167,,"32,091 x DRG weight",88167,Other,base rate x DRG weight,79350,,"28,882 x DRG weight",79350,Other,base rate x DRG weight,74941,,"27,277 x DRG weight",74941,Other,base rate x DRG weight,66157,,"24,080 x DRG weight",66157,Other,base rate x DRG weight,61715,,"22,463 x DRG weight",61715,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,72603,,"26,426 x DRG weight",72603,Other,base rate x DRG weight,106624,,"38,809 x DRG weight",106624,Other,base rate x DRG weight,106624,,"38,809 x DRG weight",106624,Other,base rate x DRG weight,72603,,"26,426 x DRG weight",72603,Other,base rate x DRG weight,106624,,"38,809 x DRG weight",106624,Other,base rate x DRG weight,57903,,"6,363 x patient days",57903,Per diem,,186898,70,,186898,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,68842,,"25,057 x DRG weight",68842,Other,base rate x DRG weight,61959,,"22,552 x DRG weight",61959,Other,base rate x DRG weight,68842,,"25,057 x DRG weight",68842,Other,base rate x DRG weight,58514,,"21,298 x DRG weight",58514,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,186898,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,,inpatient,,,306098.74,23098,,,23098,Other,150% of Medicare + 9.63% HCRA Surcharge,14046.29,,,14046.29,Other,Medicare IPPS methodology,41068,,"25,046 x DRG weight",41068,Other,base rate x DRG weight,36960,,"22,541 x DRG weight",36960,Other,base rate x DRG weight,52620,,"32,091 x DRG weight",52620,Other,base rate x DRG weight,47358,,"28,882 x DRG weight",47358,Other,base rate x DRG weight,44726,,"27,277 x DRG weight",44726,Other,base rate x DRG weight,39484,,"24,080 x DRG weight",39484,Other,base rate x DRG weight,36833,,"22,463 x DRG weight",36833,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43331,,"26,426 x DRG weight",43331,Other,base rate x DRG weight,63635,,"38,809 x DRG weight",63635,Other,base rate x DRG weight,63635,,"38,809 x DRG weight",63635,Other,base rate x DRG weight,43331,,"26,426 x DRG weight",43331,Other,base rate x DRG weight,63635,,"38,809 x DRG weight",63635,Other,base rate x DRG weight,38178,,"6,363 x patient days",38178,Per diem,,214269,70,,214269,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,41086,,"25,057 x DRG weight",41086,Other,base rate x DRG weight,36979,,"22,552 x DRG weight",36979,Other,base rate x DRG weight,41086,,"25,057 x DRG weight",41086,Other,base rate x DRG weight,34922,,"21,298 x DRG weight",34922,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,214269,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,,inpatient,,,131488.65,14175,,,14175,Other,150% of Medicare + 9.63% HCRA Surcharge,8619.86,,,8619.86,Other,Medicare IPPS methodology,24821,,"25,046 x DRG weight",24821,Other,base rate x DRG weight,22338,,"22,541 x DRG weight",22338,Other,base rate x DRG weight,31802,,"32,091 x DRG weight",31802,Other,base rate x DRG weight,28622,,"28,882 x DRG weight",28622,Other,base rate x DRG weight,27032,,"27,277 x DRG weight",27032,Other,base rate x DRG weight,23863,,"24,080 x DRG weight",23863,Other,base rate x DRG weight,22261,,"22,463 x DRG weight",22261,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26188,,"26,426 x DRG weight",26188,Other,base rate x DRG weight,38460,,"38,809 x DRG weight",38460,Other,base rate x DRG weight,38460,,"38,809 x DRG weight",38460,Other,base rate x DRG weight,26188,,"26,426 x DRG weight",26188,Other,base rate x DRG weight,38460,,"38,809 x DRG weight",38460,Other,base rate x DRG weight,25452,,"6,363 x patient days",25452,Per diem,,92042,70,,92042,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24831,,"25,057 x DRG weight",24831,Other,base rate x DRG weight,22349,,"22,552 x DRG weight",22349,Other,base rate x DRG weight,24831,,"25,057 x DRG weight",24831,Other,base rate x DRG weight,21106,,"21,298 x DRG weight",21106,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,92042,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,,inpatient,,,324936,37802,,,37802,Other,150% of Medicare + 9.63% HCRA Surcharge,22987.72,,,22987.72,Other,Medicare IPPS methodology,67840,,"25,046 x DRG weight",67840,Other,base rate x DRG weight,61055,,"22,541 x DRG weight",61055,Other,base rate x DRG weight,86922,,"32,091 x DRG weight",86922,Other,base rate x DRG weight,78230,,"28,882 x DRG weight",78230,Other,base rate x DRG weight,73882,,"27,277 x DRG weight",73882,Other,base rate x DRG weight,65223,,"24,080 x DRG weight",65223,Other,base rate x DRG weight,60843,,"22,463 x DRG weight",60843,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,71577,,"26,426 x DRG weight",71577,Other,base rate x DRG weight,105118,,"38,809 x DRG weight",105118,Other,base rate x DRG weight,105118,,"38,809 x DRG weight",105118,Other,base rate x DRG weight,71577,,"26,426 x DRG weight",71577,Other,base rate x DRG weight,105118,,"38,809 x DRG weight",105118,Other,base rate x DRG weight,40087,,"6,363 x patient days",40087,Per diem,,227455,70,,227455,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,67869,,"25,057 x DRG weight",67869,Other,base rate x DRG weight,61084,,"22,552 x DRG weight",61084,Other,base rate x DRG weight,67869,,"25,057 x DRG weight",67869,Other,base rate x DRG weight,57688,,"21,298 x DRG weight",57688,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,227455,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,,inpatient,,,163347,26220,,,26220,Other,150% of Medicare + 9.63% HCRA Surcharge,15944.32,,,15944.32,Other,Medicare IPPS methodology,46751,,"25,046 x DRG weight",46751,Other,base rate x DRG weight,42075,,"22,541 x DRG weight",42075,Other,base rate x DRG weight,59901,,"32,091 x DRG weight",59901,Other,base rate x DRG weight,53911,,"28,882 x DRG weight",53911,Other,base rate x DRG weight,50915,,"27,277 x DRG weight",50915,Other,base rate x DRG weight,44948,,"24,080 x DRG weight",44948,Other,base rate x DRG weight,41929,,"22,463 x DRG weight",41929,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49327,,"26,426 x DRG weight",49327,Other,base rate x DRG weight,72441,,"38,809 x DRG weight",72441,Other,base rate x DRG weight,72441,,"38,809 x DRG weight",72441,Other,base rate x DRG weight,49327,,"26,426 x DRG weight",49327,Other,base rate x DRG weight,72441,,"38,809 x DRG weight",72441,Other,base rate x DRG weight,19089,,"6,363 x patient days",19089,Per diem,,114343,70,,114343,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46771,,"25,057 x DRG weight",46771,Other,base rate x DRG weight,42096,,"22,552 x DRG weight",42096,Other,base rate x DRG weight,46771,,"25,057 x DRG weight",46771,Other,base rate x DRG weight,39755,,"21,298 x DRG weight",39755,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,114343,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,,inpatient,,,378802.63,46147,,,46147,Other,150% of Medicare + 9.63% HCRA Surcharge,28061.97,,,28061.97,Other,Medicare IPPS methodology,83032,,"25,046 x DRG weight",83032,Other,base rate x DRG weight,74728,,"22,541 x DRG weight",74728,Other,base rate x DRG weight,106388,,"32,091 x DRG weight",106388,Other,base rate x DRG weight,95750,,"28,882 x DRG weight",95750,Other,base rate x DRG weight,90429,,"27,277 x DRG weight",90429,Other,base rate x DRG weight,79830,,"24,080 x DRG weight",79830,Other,base rate x DRG weight,74469,,"22,463 x DRG weight",74469,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,87607,,"26,426 x DRG weight",87607,Other,base rate x DRG weight,128660,,"38,809 x DRG weight",128660,Other,base rate x DRG weight,128660,,"38,809 x DRG weight",128660,Other,base rate x DRG weight,87607,,"26,426 x DRG weight",87607,Other,base rate x DRG weight,128660,,"38,809 x DRG weight",128660,Other,base rate x DRG weight,53449,,"6,363 x patient days",53449,Per diem,,265162,70,,265162,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,83069,,"25,057 x DRG weight",83069,Other,base rate x DRG weight,74764,,"22,552 x DRG weight",74764,Other,base rate x DRG weight,83069,,"25,057 x DRG weight",83069,Other,base rate x DRG weight,70607,,"21,298 x DRG weight",70607,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,265162,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,,inpatient,,,247238.56,26429,,,26429,Other,150% of Medicare + 9.63% HCRA Surcharge,16071.47,,,16071.47,Other,Medicare IPPS methodology,47132,,"25,046 x DRG weight",47132,Other,base rate x DRG weight,42418,,"22,541 x DRG weight",42418,Other,base rate x DRG weight,60389,,"32,091 x DRG weight",60389,Other,base rate x DRG weight,54350,,"28,882 x DRG weight",54350,Other,base rate x DRG weight,51330,,"27,277 x DRG weight",51330,Other,base rate x DRG weight,45314,,"24,080 x DRG weight",45314,Other,base rate x DRG weight,42271,,"22,463 x DRG weight",42271,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49728,,"26,426 x DRG weight",49728,Other,base rate x DRG weight,73031,,"38,809 x DRG weight",73031,Other,base rate x DRG weight,73031,,"38,809 x DRG weight",73031,Other,base rate x DRG weight,49728,,"26,426 x DRG weight",49728,Other,base rate x DRG weight,73031,,"38,809 x DRG weight",73031,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,173067,70,,173067,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,47152,,"25,057 x DRG weight",47152,Other,base rate x DRG weight,42438,,"22,552 x DRG weight",42438,Other,base rate x DRG weight,47152,,"25,057 x DRG weight",47152,Other,base rate x DRG weight,40079,,"21,298 x DRG weight",40079,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,173067,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,,inpatient,,,184977.61,23175,,,23175,Other,150% of Medicare + 9.63% HCRA Surcharge,14093.13,,,14093.13,Other,Medicare IPPS methodology,41208,,"25,046 x DRG weight",41208,Other,base rate x DRG weight,37087,,"22,541 x DRG weight",37087,Other,base rate x DRG weight,52799,,"32,091 x DRG weight",52799,Other,base rate x DRG weight,47520,,"28,882 x DRG weight",47520,Other,base rate x DRG weight,44879,,"27,277 x DRG weight",44879,Other,base rate x DRG weight,39619,,"24,080 x DRG weight",39619,Other,base rate x DRG weight,36958,,"22,463 x DRG weight",36958,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43479,,"26,426 x DRG weight",43479,Other,base rate x DRG weight,63852,,"38,809 x DRG weight",63852,Other,base rate x DRG weight,63852,,"38,809 x DRG weight",63852,Other,base rate x DRG weight,43479,,"26,426 x DRG weight",43479,Other,base rate x DRG weight,63852,,"38,809 x DRG weight",63852,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,129484,70,,129484,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,41226,,"25,057 x DRG weight",41226,Other,base rate x DRG weight,37105,,"22,552 x DRG weight",37105,Other,base rate x DRG weight,41226,,"25,057 x DRG weight",41226,Other,base rate x DRG weight,35042,,"21,298 x DRG weight",35042,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,129484,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,,inpatient,,,720089.09,39406,,,39406,Other,150% of Medicare + 9.63% HCRA Surcharge,23963.09,,,23963.09,Other,Medicare IPPS methodology,70760,,"25,046 x DRG weight",70760,Other,base rate x DRG weight,63683,,"22,541 x DRG weight",63683,Other,base rate x DRG weight,90663,,"32,091 x DRG weight",90663,Other,base rate x DRG weight,81597,,"28,882 x DRG weight",81597,Other,base rate x DRG weight,77063,,"27,277 x DRG weight",77063,Other,base rate x DRG weight,68031,,"24,080 x DRG weight",68031,Other,base rate x DRG weight,63462,,"22,463 x DRG weight",63462,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,74659,,"26,426 x DRG weight",74659,Other,base rate x DRG weight,109643,,"38,809 x DRG weight",109643,Other,base rate x DRG weight,109643,,"38,809 x DRG weight",109643,Other,base rate x DRG weight,74659,,"26,426 x DRG weight",74659,Other,base rate x DRG weight,109643,,"38,809 x DRG weight",109643,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,504062,70,,504062,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,70791,,"25,057 x DRG weight",70791,Other,base rate x DRG weight,63714,,"22,552 x DRG weight",63714,Other,base rate x DRG weight,70791,,"25,057 x DRG weight",70791,Other,base rate x DRG weight,60171,,"21,298 x DRG weight",60171,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,504062,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,,inpatient,,,500471.13,45470,,,45470,Other,150% of Medicare + 9.63% HCRA Surcharge,27650.41,,,27650.41,Other,Medicare IPPS methodology,81800,,"25,046 x DRG weight",81800,Other,base rate x DRG weight,73619,,"22,541 x DRG weight",73619,Other,base rate x DRG weight,104809,,"32,091 x DRG weight",104809,Other,base rate x DRG weight,94329,,"28,882 x DRG weight",94329,Other,base rate x DRG weight,89087,,"27,277 x DRG weight",89087,Other,base rate x DRG weight,78645,,"24,080 x DRG weight",78645,Other,base rate x DRG weight,73364,,"22,463 x DRG weight",73364,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,86307,,"26,426 x DRG weight",86307,Other,base rate x DRG weight,126750,,"38,809 x DRG weight",126750,Other,base rate x DRG weight,126750,,"38,809 x DRG weight",126750,Other,base rate x DRG weight,86307,,"26,426 x DRG weight",86307,Other,base rate x DRG weight,126750,,"38,809 x DRG weight",126750,Other,base rate x DRG weight,62994,,"6,363 x patient days",62994,Per diem,,350330,70,,350330,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,81836,,"25,057 x DRG weight",81836,Other,base rate x DRG weight,73655,,"22,552 x DRG weight",73655,Other,base rate x DRG weight,81836,,"25,057 x DRG weight",81836,Other,base rate x DRG weight,69559,,"21,298 x DRG weight",69559,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,350330,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,,inpatient,,,876391.52,49158,,,49158,Other,150% of Medicare + 9.63% HCRA Surcharge,29893.09,,,29893.09,Other,Medicare IPPS methodology,88515,,"25,046 x DRG weight",88515,Other,base rate x DRG weight,79662,,"22,541 x DRG weight",79662,Other,base rate x DRG weight,113413,,"32,091 x DRG weight",113413,Other,base rate x DRG weight,102072,,"28,882 x DRG weight",102072,Other,base rate x DRG weight,96400,,"27,277 x DRG weight",96400,Other,base rate x DRG weight,85101,,"24,080 x DRG weight",85101,Other,base rate x DRG weight,79386,,"22,463 x DRG weight",79386,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,93392,,"26,426 x DRG weight",93392,Other,base rate x DRG weight,137155,,"38,809 x DRG weight",137155,Other,base rate x DRG weight,137155,,"38,809 x DRG weight",137155,Other,base rate x DRG weight,93392,,"26,426 x DRG weight",93392,Other,base rate x DRG weight,137155,,"38,809 x DRG weight",137155,Other,base rate x DRG weight,35633,,"6,363 x patient days",35633,Per diem,,613474,70,,613474,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,88554,,"25,057 x DRG weight",88554,Other,base rate x DRG weight,79701,,"22,552 x DRG weight",79701,Other,base rate x DRG weight,88554,,"25,057 x DRG weight",88554,Other,base rate x DRG weight,75269,,"21,298 x DRG weight",75269,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,613474,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,,inpatient,,,567767.19,86464,,,86464,Other,150% of Medicare + 9.63% HCRA Surcharge,52579.18,,,52579.18,Other,Medicare IPPS methodology,156440,,"25,046 x DRG weight",156440,Other,base rate x DRG weight,140793,,"22,541 x DRG weight",140793,Other,base rate x DRG weight,200444,,"32,091 x DRG weight",200444,Other,base rate x DRG weight,180400,,"28,882 x DRG weight",180400,Other,base rate x DRG weight,170375,,"27,277 x DRG weight",170375,Other,base rate x DRG weight,150406,,"24,080 x DRG weight",150406,Other,base rate x DRG weight,140306,,"22,463 x DRG weight",140306,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,165059,,"26,426 x DRG weight",165059,Other,base rate x DRG weight,242405,,"38,809 x DRG weight",242405,Other,base rate x DRG weight,242405,,"38,809 x DRG weight",242405,Other,base rate x DRG weight,165059,,"26,426 x DRG weight",165059,Other,base rate x DRG weight,242405,,"38,809 x DRG weight",242405,Other,base rate x DRG weight,31179,,"6,363 x patient days",31179,Per diem,,397437,70,,397437,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,156509,,"25,057 x DRG weight",156509,Other,base rate x DRG weight,140862,,"22,552 x DRG weight",140862,Other,base rate x DRG weight,156509,,"25,057 x DRG weight",156509,Other,base rate x DRG weight,133029,,"21,298 x DRG weight",133029,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,397437,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,,inpatient,,,351716.98,67675,,,67675,Other,150% of Medicare + 9.63% HCRA Surcharge,41153.32,,,41153.32,Other,Medicare IPPS methodology,122229,,"25,046 x DRG weight",122229,Other,base rate x DRG weight,110005,,"22,541 x DRG weight",110005,Other,base rate x DRG weight,156610,,"32,091 x DRG weight",156610,Other,base rate x DRG weight,140950,,"28,882 x DRG weight",140950,Other,base rate x DRG weight,133117,,"27,277 x DRG weight",133117,Other,base rate x DRG weight,117515,,"24,080 x DRG weight",117515,Other,base rate x DRG weight,109624,,"22,463 x DRG weight",109624,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,128964,,"26,426 x DRG weight",128964,Other,base rate x DRG weight,189396,,"38,809 x DRG weight",189396,Other,base rate x DRG weight,189396,,"38,809 x DRG weight",189396,Other,base rate x DRG weight,128964,,"26,426 x DRG weight",128964,Other,base rate x DRG weight,189396,,"38,809 x DRG weight",189396,Other,base rate x DRG weight,10181,,"6,363 x patient days",10181,Per diem,,246202,70,,246202,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,122283,,"25,057 x DRG weight",122283,Other,base rate x DRG weight,110058,,"22,552 x DRG weight",110058,Other,base rate x DRG weight,122283,,"25,057 x DRG weight",122283,Other,base rate x DRG weight,103938,,"21,298 x DRG weight",103938,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,246202,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,,inpatient,,,527800.13,94836,,,94836,Other,150% of Medicare + 9.63% HCRA Surcharge,57670.16,,,57670.16,Other,Medicare IPPS methodology,171683,,"25,046 x DRG weight",171683,Other,base rate x DRG weight,154512,,"22,541 x DRG weight",154512,Other,base rate x DRG weight,219974,,"32,091 x DRG weight",219974,Other,base rate x DRG weight,197977,,"28,882 x DRG weight",197977,Other,base rate x DRG weight,186976,,"27,277 x DRG weight",186976,Other,base rate x DRG weight,165061,,"24,080 x DRG weight",165061,Other,base rate x DRG weight,153977,,"22,463 x DRG weight",153977,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,181142,,"26,426 x DRG weight",181142,Other,base rate x DRG weight,266024,,"38,809 x DRG weight",266024,Other,base rate x DRG weight,266024,,"38,809 x DRG weight",266024,Other,base rate x DRG weight,181142,,"26,426 x DRG weight",181142,Other,base rate x DRG weight,266024,,"38,809 x DRG weight",266024,Other,base rate x DRG weight,60449,,"6,363 x patient days",60449,Per diem,,369460,70,,369460,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,171758,,"25,057 x DRG weight",171758,Other,base rate x DRG weight,154587,,"22,552 x DRG weight",154587,Other,base rate x DRG weight,171758,,"25,057 x DRG weight",171758,Other,base rate x DRG weight,145991,,"21,298 x DRG weight",145991,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,369460,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,,inpatient,,,238295.27,57748,,,57748,Other,150% of Medicare + 9.63% HCRA Surcharge,35117.08,,,35117.08,Other,Medicare IPPS methodology,104156,,"25,046 x DRG weight",104156,Other,base rate x DRG weight,93739,,"22,541 x DRG weight",93739,Other,base rate x DRG weight,133454,,"32,091 x DRG weight",133454,Other,base rate x DRG weight,120109,,"28,882 x DRG weight",120109,Other,base rate x DRG weight,113434,,"27,277 x DRG weight",113434,Other,base rate x DRG weight,100139,,"24,080 x DRG weight",100139,Other,base rate x DRG weight,93415,,"22,463 x DRG weight",93415,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,109895,,"26,426 x DRG weight",109895,Other,base rate x DRG weight,161391,,"38,809 x DRG weight",161391,Other,base rate x DRG weight,161391,,"38,809 x DRG weight",161391,Other,base rate x DRG weight,109895,,"26,426 x DRG weight",109895,Other,base rate x DRG weight,161391,,"38,809 x DRG weight",161391,Other,base rate x DRG weight,13362,,"6,363 x patient days",13362,Per diem,,166807,70,,166807,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,104202,,"25,057 x DRG weight",104202,Other,base rate x DRG weight,93785,,"22,552 x DRG weight",93785,Other,base rate x DRG weight,104202,,"25,057 x DRG weight",104202,Other,base rate x DRG weight,88570,,"21,298 x DRG weight",88570,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,166807,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,,inpatient,,,574901.75,70105,,,70105,Other,150% of Medicare + 9.63% HCRA Surcharge,42631.43,,,42631.43,Other,Medicare IPPS methodology,126655,,"25,046 x DRG weight",126655,Other,base rate x DRG weight,113988,,"22,541 x DRG weight",113988,Other,base rate x DRG weight,162281,,"32,091 x DRG weight",162281,Other,base rate x DRG weight,146053,,"28,882 x DRG weight",146053,Other,base rate x DRG weight,137937,,"27,277 x DRG weight",137937,Other,base rate x DRG weight,121770,,"24,080 x DRG weight",121770,Other,base rate x DRG weight,113593,,"22,463 x DRG weight",113593,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,133634,,"26,426 x DRG weight",133634,Other,base rate x DRG weight,196253,,"38,809 x DRG weight",196253,Other,base rate x DRG weight,196253,,"38,809 x DRG weight",196253,Other,base rate x DRG weight,133634,,"26,426 x DRG weight",133634,Other,base rate x DRG weight,196253,,"38,809 x DRG weight",196253,Other,base rate x DRG weight,60449,,"6,363 x patient days",60449,Per diem,,402431,70,,402431,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,126711,,"25,057 x DRG weight",126711,Other,base rate x DRG weight,114043,,"22,552 x DRG weight",114043,Other,base rate x DRG weight,126711,,"25,057 x DRG weight",126711,Other,base rate x DRG weight,107702,,"21,298 x DRG weight",107702,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,402431,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,,inpatient,,,365025.15,48086,,,48086,Other,150% of Medicare + 9.63% HCRA Surcharge,29241.45,,,29241.45,Other,Medicare IPPS methodology,86564,,"25,046 x DRG weight",86564,Other,base rate x DRG weight,77906,,"22,541 x DRG weight",77906,Other,base rate x DRG weight,110913,,"32,091 x DRG weight",110913,Other,base rate x DRG weight,99822,,"28,882 x DRG weight",99822,Other,base rate x DRG weight,94275,,"27,277 x DRG weight",94275,Other,base rate x DRG weight,83225,,"24,080 x DRG weight",83225,Other,base rate x DRG weight,77637,,"22,463 x DRG weight",77637,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,91334,,"26,426 x DRG weight",91334,Other,base rate x DRG weight,134132,,"38,809 x DRG weight",134132,Other,base rate x DRG weight,134132,,"38,809 x DRG weight",134132,Other,base rate x DRG weight,91334,,"26,426 x DRG weight",91334,Other,base rate x DRG weight,134132,,"38,809 x DRG weight",134132,Other,base rate x DRG weight,34360,,"6,363 x patient days",34360,Per diem,,255518,70,,255518,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,86602,,"25,057 x DRG weight",86602,Other,base rate x DRG weight,77944,,"22,552 x DRG weight",77944,Other,base rate x DRG weight,86602,,"25,057 x DRG weight",86602,Other,base rate x DRG weight,73610,,"21,298 x DRG weight",73610,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,255518,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,,inpatient,,,234749.99,34100,,,34100,Other,150% of Medicare + 9.63% HCRA Surcharge,20736.68,,,20736.68,Other,Medicare IPPS methodology,61100,,"25,046 x DRG weight",61100,Other,base rate x DRG weight,54989,,"22,541 x DRG weight",54989,Other,base rate x DRG weight,78286,,"32,091 x DRG weight",78286,Other,base rate x DRG weight,70458,,"28,882 x DRG weight",70458,Other,base rate x DRG weight,66542,,"27,277 x DRG weight",66542,Other,base rate x DRG weight,58743,,"24,080 x DRG weight",58743,Other,base rate x DRG weight,54798,,"22,463 x DRG weight",54798,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,64466,,"26,426 x DRG weight",64466,Other,base rate x DRG weight,94675,,"38,809 x DRG weight",94675,Other,base rate x DRG weight,94675,,"38,809 x DRG weight",94675,Other,base rate x DRG weight,64466,,"26,426 x DRG weight",64466,Other,base rate x DRG weight,94675,,"38,809 x DRG weight",94675,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,164325,70,,164325,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,61127,,"25,057 x DRG weight",61127,Other,base rate x DRG weight,55016,,"22,552 x DRG weight",55016,Other,base rate x DRG weight,61127,,"25,057 x DRG weight",61127,Other,base rate x DRG weight,51956,,"21,298 x DRG weight",51956,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,164325,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,,inpatient,,,427760.46,54150,,,54150,Other,150% of Medicare + 9.63% HCRA Surcharge,32928.78,,,32928.78,Other,Medicare IPPS methodology,97604,,"25,046 x DRG weight",97604,Other,base rate x DRG weight,87842,,"22,541 x DRG weight",87842,Other,base rate x DRG weight,125059,,"32,091 x DRG weight",125059,Other,base rate x DRG weight,112553,,"28,882 x DRG weight",112553,Other,base rate x DRG weight,106298,,"27,277 x DRG weight",106298,Other,base rate x DRG weight,93840,,"24,080 x DRG weight",93840,Other,base rate x DRG weight,87538,,"22,463 x DRG weight",87538,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,102982,,"26,426 x DRG weight",102982,Other,base rate x DRG weight,151239,,"38,809 x DRG weight",151239,Other,base rate x DRG weight,151239,,"38,809 x DRG weight",151239,Other,base rate x DRG weight,102982,,"26,426 x DRG weight",102982,Other,base rate x DRG weight,151239,,"38,809 x DRG weight",151239,Other,base rate x DRG weight,34997,,"6,363 x patient days",34997,Per diem,,299432,70,,299432,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,97647,,"25,057 x DRG weight",97647,Other,base rate x DRG weight,87885,,"22,552 x DRG weight",87885,Other,base rate x DRG weight,97647,,"25,057 x DRG weight",97647,Other,base rate x DRG weight,82998,,"21,298 x DRG weight",82998,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,299432,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,,inpatient,,,273708.33,45123,,,45123,Other,150% of Medicare + 9.63% HCRA Surcharge,27439.61,,,27439.61,Other,Medicare IPPS methodology,81169,,"25,046 x DRG weight",81169,Other,base rate x DRG weight,73051,,"22,541 x DRG weight",73051,Other,base rate x DRG weight,104001,,"32,091 x DRG weight",104001,Other,base rate x DRG weight,93601,,"28,882 x DRG weight",93601,Other,base rate x DRG weight,88399,,"27,277 x DRG weight",88399,Other,base rate x DRG weight,78038,,"24,080 x DRG weight",78038,Other,base rate x DRG weight,72798,,"22,463 x DRG weight",72798,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,85641,,"26,426 x DRG weight",85641,Other,base rate x DRG weight,125772,,"38,809 x DRG weight",125772,Other,base rate x DRG weight,125772,,"38,809 x DRG weight",125772,Other,base rate x DRG weight,85641,,"26,426 x DRG weight",85641,Other,base rate x DRG weight,125772,,"38,809 x DRG weight",125772,Other,base rate x DRG weight,9545,,"6,363 x patient days",9545,Per diem,,191596,70,,191596,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,81205,,"25,057 x DRG weight",81205,Other,base rate x DRG weight,73087,,"22,552 x DRG weight",73087,Other,base rate x DRG weight,81205,,"25,057 x DRG weight",81205,Other,base rate x DRG weight,69023,,"21,298 x DRG weight",69023,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,191596,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,,inpatient,,,679165.74,97327,,,97327,Other,150% of Medicare + 9.63% HCRA Surcharge,59185.08,,,59185.08,Other,Medicare IPPS methodology,176219,,"25,046 x DRG weight",176219,Other,base rate x DRG weight,158594,,"22,541 x DRG weight",158594,Other,base rate x DRG weight,225786,,"32,091 x DRG weight",225786,Other,base rate x DRG weight,203208,,"28,882 x DRG weight",203208,Other,base rate x DRG weight,191916,,"27,277 x DRG weight",191916,Other,base rate x DRG weight,169422,,"24,080 x DRG weight",169422,Other,base rate x DRG weight,158045,,"22,463 x DRG weight",158045,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,185928,,"26,426 x DRG weight",185928,Other,base rate x DRG weight,273052,,"38,809 x DRG weight",273052,Other,base rate x DRG weight,273052,,"38,809 x DRG weight",273052,Other,base rate x DRG weight,185928,,"26,426 x DRG weight",185928,Other,base rate x DRG weight,273052,,"38,809 x DRG weight",273052,Other,base rate x DRG weight,62994,,"6,363 x patient days",62994,Per diem,,475416,70,,475416,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,176296,,"25,057 x DRG weight",176296,Other,base rate x DRG weight,158671,,"22,552 x DRG weight",158671,Other,base rate x DRG weight,176296,,"25,057 x DRG weight",176296,Other,base rate x DRG weight,149848,,"21,298 x DRG weight",149848,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,475416,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC,276,MS-DRG,,,,,,,,inpatient,,,527800.13,85970,,,85970,Other,150% of Medicare + 9.63% HCRA Surcharge,52278.87,,,52278.87,Other,Medicare IPPS methodology,155541,,"25,046 x DRG weight",155541,Other,base rate x DRG weight,139984,,"22,541 x DRG weight",139984,Other,base rate x DRG weight,199292,,"32,091 x DRG weight",199292,Other,base rate x DRG weight,179363,,"28,882 x DRG weight",179363,Other,base rate x DRG weight,169396,,"27,277 x DRG weight",169396,Other,base rate x DRG weight,149542,,"24,080 x DRG weight",149542,Other,base rate x DRG weight,139500,,"22,463 x DRG weight",139500,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,164111,,"26,426 x DRG weight",164111,Other,base rate x DRG weight,241012,,"38,809 x DRG weight",241012,Other,base rate x DRG weight,241012,,"38,809 x DRG weight",241012,Other,base rate x DRG weight,164111,,"26,426 x DRG weight",164111,Other,base rate x DRG weight,241012,,"38,809 x DRG weight",241012,Other,base rate x DRG weight,52813,,"6,363 x patient days",52813,Per diem,,369460,70,,369460,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,155609,,"25,057 x DRG weight",155609,Other,base rate x DRG weight,140052,,"22,552 x DRG weight",140052,Other,base rate x DRG weight,155609,,"25,057 x DRG weight",155609,Other,base rate x DRG weight,132265,,"21,298 x DRG weight",132265,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,369460,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,,inpatient,,,396793.25,66329,,,66329,Other,150% of Medicare + 9.63% HCRA Surcharge,40335.21,,,40335.21,Other,Medicare IPPS methodology,119780,,"25,046 x DRG weight",119780,Other,base rate x DRG weight,107800,,"22,541 x DRG weight",107800,Other,base rate x DRG weight,153472,,"32,091 x DRG weight",153472,Other,base rate x DRG weight,138125,,"28,882 x DRG weight",138125,Other,base rate x DRG weight,130450,,"27,277 x DRG weight",130450,Other,base rate x DRG weight,115160,,"24,080 x DRG weight",115160,Other,base rate x DRG weight,107427,,"22,463 x DRG weight",107427,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,126380,,"26,426 x DRG weight",126380,Other,base rate x DRG weight,185600,,"38,809 x DRG weight",185600,Other,base rate x DRG weight,185600,,"38,809 x DRG weight",185600,Other,base rate x DRG weight,126380,,"26,426 x DRG weight",126380,Other,base rate x DRG weight,185600,,"38,809 x DRG weight",185600,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,277755,70,,277755,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,119833,,"25,057 x DRG weight",119833,Other,base rate x DRG weight,107853,,"22,552 x DRG weight",107853,Other,base rate x DRG weight,119833,,"25,057 x DRG weight",119833,Other,base rate x DRG weight,101856,,"21,298 x DRG weight",101856,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,277755,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,,inpatient,,,624536.85,61900,,,61900,Other,150% of Medicare + 9.63% HCRA Surcharge,37641.66,,,37641.66,Other,Medicare IPPS methodology,111715,,"25,046 x DRG weight",111715,Other,base rate x DRG weight,100542,,"22,541 x DRG weight",100542,Other,base rate x DRG weight,143139,,"32,091 x DRG weight",143139,Other,base rate x DRG weight,128825,,"28,882 x DRG weight",128825,Other,base rate x DRG weight,121666,,"27,277 x DRG weight",121666,Other,base rate x DRG weight,107406,,"24,080 x DRG weight",107406,Other,base rate x DRG weight,100194,,"22,463 x DRG weight",100194,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,117871,,"26,426 x DRG weight",117871,Other,base rate x DRG weight,173104,,"38,809 x DRG weight",173104,Other,base rate x DRG weight,173104,,"38,809 x DRG weight",173104,Other,base rate x DRG weight,117871,,"26,426 x DRG weight",117871,Other,base rate x DRG weight,173104,,"38,809 x DRG weight",173104,Other,base rate x DRG weight,54086,,"6,363 x patient days",54086,Per diem,,437176,70,,437176,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,111764,,"25,057 x DRG weight",111764,Other,base rate x DRG weight,100591,,"22,552 x DRG weight",100591,Other,base rate x DRG weight,111764,,"25,057 x DRG weight",111764,Other,base rate x DRG weight,94998,,"21,298 x DRG weight",94998,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,437176,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,,inpatient,,,503452,44570,,,44570,Other,150% of Medicare + 9.63% HCRA Surcharge,27103.34,,,27103.34,Other,Medicare IPPS methodology,80162,,"25,046 x DRG weight",80162,Other,base rate x DRG weight,72145,,"22,541 x DRG weight",72145,Other,base rate x DRG weight,102710,,"32,091 x DRG weight",102710,Other,base rate x DRG weight,92440,,"28,882 x DRG weight",92440,Other,base rate x DRG weight,87303,,"27,277 x DRG weight",87303,Other,base rate x DRG weight,77070,,"24,080 x DRG weight",77070,Other,base rate x DRG weight,71895,,"22,463 x DRG weight",71895,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,84579,,"26,426 x DRG weight",84579,Other,base rate x DRG weight,124212,,"38,809 x DRG weight",124212,Other,base rate x DRG weight,124212,,"38,809 x DRG weight",124212,Other,base rate x DRG weight,84579,,"26,426 x DRG weight",84579,Other,base rate x DRG weight,124212,,"38,809 x DRG weight",124212,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,352416,70,,352416,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,80197,,"25,057 x DRG weight",80197,Other,base rate x DRG weight,72180,,"22,552 x DRG weight",72180,Other,base rate x DRG weight,80197,,"25,057 x DRG weight",80197,Other,base rate x DRG weight,68166,,"21,298 x DRG weight",68166,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,352416,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,,inpatient,,,187163.71,22367,,,22367,Other,150% of Medicare + 9.63% HCRA Surcharge,13601.26,,,13601.26,Other,Medicare IPPS methodology,39735,,"25,046 x DRG weight",39735,Other,base rate x DRG weight,35761,,"22,541 x DRG weight",35761,Other,base rate x DRG weight,50912,,"32,091 x DRG weight",50912,Other,base rate x DRG weight,45821,,"28,882 x DRG weight",45821,Other,base rate x DRG weight,43275,,"27,277 x DRG weight",43275,Other,base rate x DRG weight,38203,,"24,080 x DRG weight",38203,Other,base rate x DRG weight,35638,,"22,463 x DRG weight",35638,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41925,,"26,426 x DRG weight",41925,Other,base rate x DRG weight,61570,,"38,809 x DRG weight",61570,Other,base rate x DRG weight,61570,,"38,809 x DRG weight",61570,Other,base rate x DRG weight,41925,,"26,426 x DRG weight",41925,Other,base rate x DRG weight,61570,,"38,809 x DRG weight",61570,Other,base rate x DRG weight,34997,,"6,363 x patient days",34997,Per diem,,131015,70,,131015,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39753,,"25,057 x DRG weight",39753,Other,base rate x DRG weight,35779,,"22,552 x DRG weight",35779,Other,base rate x DRG weight,39753,,"25,057 x DRG weight",39753,Other,base rate x DRG weight,33789,,"21,298 x DRG weight",33789,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,131015,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,,inpatient,,,165079.79,13102,,,13102,Other,150% of Medicare + 9.63% HCRA Surcharge,7967.39,,,7967.39,Other,Medicare IPPS methodology,22867,,"25,046 x DRG weight",22867,Other,base rate x DRG weight,20580,,"22,541 x DRG weight",20580,Other,base rate x DRG weight,29299,,"32,091 x DRG weight",29299,Other,base rate x DRG weight,26369,,"28,882 x DRG weight",26369,Other,base rate x DRG weight,24904,,"27,277 x DRG weight",24904,Other,base rate x DRG weight,21985,,"24,080 x DRG weight",21985,Other,base rate x DRG weight,20509,,"22,463 x DRG weight",20509,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24127,,"26,426 x DRG weight",24127,Other,base rate x DRG weight,35433,,"38,809 x DRG weight",35433,Other,base rate x DRG weight,35433,,"38,809 x DRG weight",35433,Other,base rate x DRG weight,24127,,"26,426 x DRG weight",24127,Other,base rate x DRG weight,35433,,"38,809 x DRG weight",35433,Other,base rate x DRG weight,19089,,"6,363 x patient days",19089,Per diem,,115556,70,,115556,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22877,,"25,057 x DRG weight",22877,Other,base rate x DRG weight,20590,,"22,552 x DRG weight",20590,Other,base rate x DRG weight,22877,,"25,057 x DRG weight",22877,Other,base rate x DRG weight,19445,,"21,298 x DRG weight",19445,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,115556,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,,inpatient,,,125225.93,10421,,,10421,Other,150% of Medicare + 9.63% HCRA Surcharge,6337.03,,,6337.03,Other,Medicare IPPS methodology,17986,,"25,046 x DRG weight",17986,Other,base rate x DRG weight,16187,,"22,541 x DRG weight",16187,Other,base rate x DRG weight,23045,,"32,091 x DRG weight",23045,Other,base rate x DRG weight,20740,,"28,882 x DRG weight",20740,Other,base rate x DRG weight,19588,,"27,277 x DRG weight",19588,Other,base rate x DRG weight,17292,,"24,080 x DRG weight",17292,Other,base rate x DRG weight,16131,,"22,463 x DRG weight",16131,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18977,,"26,426 x DRG weight",18977,Other,base rate x DRG weight,27869,,"38,809 x DRG weight",27869,Other,base rate x DRG weight,27869,,"38,809 x DRG weight",27869,Other,base rate x DRG weight,18977,,"26,426 x DRG weight",18977,Other,base rate x DRG weight,27869,,"38,809 x DRG weight",27869,Other,base rate x DRG weight,13362,,"6,363 x patient days",13362,Per diem,,87658,70,,87658,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17993,,"25,057 x DRG weight",17993,Other,base rate x DRG weight,16195,,"22,552 x DRG weight",16195,Other,base rate x DRG weight,17993,,"25,057 x DRG weight",17993,Other,base rate x DRG weight,15294,,"21,298 x DRG weight",15294,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,87658,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,,inpatient,,,325734.2,27661,,,27661,Other,150% of Medicare + 9.63% HCRA Surcharge,16820.98,,,16820.98,Other,Medicare IPPS methodology,49376,,"25,046 x DRG weight",49376,Other,base rate x DRG weight,44437,,"22,541 x DRG weight",44437,Other,base rate x DRG weight,63264,,"32,091 x DRG weight",63264,Other,base rate x DRG weight,56938,,"28,882 x DRG weight",56938,Other,base rate x DRG weight,53774,,"27,277 x DRG weight",53774,Other,base rate x DRG weight,47471,,"24,080 x DRG weight",47471,Other,base rate x DRG weight,44284,,"22,463 x DRG weight",44284,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52096,,"26,426 x DRG weight",52096,Other,base rate x DRG weight,76508,,"38,809 x DRG weight",76508,Other,base rate x DRG weight,76508,,"38,809 x DRG weight",76508,Other,base rate x DRG weight,52096,,"26,426 x DRG weight",52096,Other,base rate x DRG weight,76508,,"38,809 x DRG weight",76508,Other,base rate x DRG weight,34360,,"6,363 x patient days",34360,Per diem,,228014,70,,228014,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49397,,"25,057 x DRG weight",49397,Other,base rate x DRG weight,44459,,"22,552 x DRG weight",44459,Other,base rate x DRG weight,49397,,"25,057 x DRG weight",49397,Other,base rate x DRG weight,41987,,"21,298 x DRG weight",41987,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,228014,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,,inpatient,,,155313.68,10718,,,10718,Other,150% of Medicare + 9.63% HCRA Surcharge,6517.72,,,6517.72,Other,Medicare IPPS methodology,18527,,"25,046 x DRG weight",18527,Other,base rate x DRG weight,16674,,"22,541 x DRG weight",16674,Other,base rate x DRG weight,23738,,"32,091 x DRG weight",23738,Other,base rate x DRG weight,21364,,"28,882 x DRG weight",21364,Other,base rate x DRG weight,20177,,"27,277 x DRG weight",20177,Other,base rate x DRG weight,17812,,"24,080 x DRG weight",17812,Other,base rate x DRG weight,16616,,"22,463 x DRG weight",16616,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19547,,"26,426 x DRG weight",19547,Other,base rate x DRG weight,28707,,"38,809 x DRG weight",28707,Other,base rate x DRG weight,28707,,"38,809 x DRG weight",28707,Other,base rate x DRG weight,19547,,"26,426 x DRG weight",19547,Other,base rate x DRG weight,28707,,"38,809 x DRG weight",28707,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,108720,70,,108720,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18535,,"25,057 x DRG weight",18535,Other,base rate x DRG weight,16682,,"22,552 x DRG weight",16682,Other,base rate x DRG weight,18535,,"25,057 x DRG weight",18535,Other,base rate x DRG weight,15754,,"21,298 x DRG weight",15754,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,108720,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,,inpatient,,,62179.52,7265,,,7265,Other,150% of Medicare + 9.63% HCRA Surcharge,4418.08,,,4418.08,Other,Medicare IPPS methodology,12240,,"25,046 x DRG weight",12240,Other,base rate x DRG weight,11016,,"22,541 x DRG weight",11016,Other,base rate x DRG weight,15683,,"32,091 x DRG weight",15683,Other,base rate x DRG weight,14115,,"28,882 x DRG weight",14115,Other,base rate x DRG weight,13330,,"27,277 x DRG weight",13330,Other,base rate x DRG weight,11768,,"24,080 x DRG weight",11768,Other,base rate x DRG weight,10978,,"22,463 x DRG weight",10978,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,12914,,"26,426 x DRG weight",12914,Other,base rate x DRG weight,18966,,"38,809 x DRG weight",18966,Other,base rate x DRG weight,18966,,"38,809 x DRG weight",18966,Other,base rate x DRG weight,12914,,"26,426 x DRG weight",12914,Other,base rate x DRG weight,18966,,"38,809 x DRG weight",18966,Other,base rate x DRG weight,8908,,"6,363 x patient days",8908,Per diem,,43526,70,,43526,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,12245,,"25,057 x DRG weight",12245,Other,base rate x DRG weight,11021,,"22,552 x DRG weight",11021,Other,base rate x DRG weight,12245,,"25,057 x DRG weight",12245,Other,base rate x DRG weight,10408,,"21,298 x DRG weight",10408,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,43526,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,,inpatient,,,320162.29,30195,,,30195,Other,150% of Medicare + 9.63% HCRA Surcharge,18361.83,,,18361.83,Other,Medicare IPPS methodology,53989,,"25,046 x DRG weight",53989,Other,base rate x DRG weight,48589,,"22,541 x DRG weight",48589,Other,base rate x DRG weight,69175,,"32,091 x DRG weight",69175,Other,base rate x DRG weight,62258,,"28,882 x DRG weight",62258,Other,base rate x DRG weight,58798,,"27,277 x DRG weight",58798,Other,base rate x DRG weight,51907,,"24,080 x DRG weight",51907,Other,base rate x DRG weight,48421,,"22,463 x DRG weight",48421,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,56964,,"26,426 x DRG weight",56964,Other,base rate x DRG weight,83657,,"38,809 x DRG weight",83657,Other,base rate x DRG weight,83657,,"38,809 x DRG weight",83657,Other,base rate x DRG weight,56964,,"26,426 x DRG weight",56964,Other,base rate x DRG weight,83657,,"38,809 x DRG weight",83657,Other,base rate x DRG weight,45814,,"6,363 x patient days",45814,Per diem,,224114,70,,224114,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,54013,,"25,057 x DRG weight",54013,Other,base rate x DRG weight,48613,,"22,552 x DRG weight",48613,Other,base rate x DRG weight,54013,,"25,057 x DRG weight",54013,Other,base rate x DRG weight,45910,,"21,298 x DRG weight",45910,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,224114,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,,inpatient,,,197727.89,15421,,,15421,Other,150% of Medicare + 9.63% HCRA Surcharge,9377.74,,,9377.74,Other,Medicare IPPS methodology,27090,,"25,046 x DRG weight",27090,Other,base rate x DRG weight,24380,,"22,541 x DRG weight",24380,Other,base rate x DRG weight,34710,,"32,091 x DRG weight",34710,Other,base rate x DRG weight,31239,,"28,882 x DRG weight",31239,Other,base rate x DRG weight,29503,,"27,277 x DRG weight",29503,Other,base rate x DRG weight,26045,,"24,080 x DRG weight",26045,Other,base rate x DRG weight,24296,,"22,463 x DRG weight",24296,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28582,,"26,426 x DRG weight",28582,Other,base rate x DRG weight,41976,,"38,809 x DRG weight",41976,Other,base rate x DRG weight,41976,,"38,809 x DRG weight",41976,Other,base rate x DRG weight,28582,,"26,426 x DRG weight",28582,Other,base rate x DRG weight,41976,,"38,809 x DRG weight",41976,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,138410,70,,138410,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27102,,"25,057 x DRG weight",27102,Other,base rate x DRG weight,24392,,"22,552 x DRG weight",24392,Other,base rate x DRG weight,27102,,"25,057 x DRG weight",27102,Other,base rate x DRG weight,23036,,"21,298 x DRG weight",23036,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,138410,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,,inpatient,,,234961.3,36212,,,36212,Other,150% of Medicare + 9.63% HCRA Surcharge,22020.71,,,22020.71,Other,Medicare IPPS methodology,64944,,"25,046 x DRG weight",64944,Other,base rate x DRG weight,58449,,"22,541 x DRG weight",58449,Other,base rate x DRG weight,83212,,"32,091 x DRG weight",83212,Other,base rate x DRG weight,74891,,"28,882 x DRG weight",74891,Other,base rate x DRG weight,70729,,"27,277 x DRG weight",70729,Other,base rate x DRG weight,62439,,"24,080 x DRG weight",62439,Other,base rate x DRG weight,58247,,"22,463 x DRG weight",58247,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,68523,,"26,426 x DRG weight",68523,Other,base rate x DRG weight,100632,,"38,809 x DRG weight",100632,Other,base rate x DRG weight,100632,,"38,809 x DRG weight",100632,Other,base rate x DRG weight,68523,,"26,426 x DRG weight",68523,Other,base rate x DRG weight,100632,,"38,809 x DRG weight",100632,Other,base rate x DRG weight,62994,,"6,363 x patient days",62994,Per diem,,164473,70,,164473,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,64973,,"25,057 x DRG weight",64973,Other,base rate x DRG weight,58477,,"22,552 x DRG weight",58477,Other,base rate x DRG weight,64973,,"25,057 x DRG weight",64973,Other,base rate x DRG weight,55226,,"21,298 x DRG weight",55226,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,164473,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,,inpatient,,,75012,20870,,,20870,Other,150% of Medicare + 9.63% HCRA Surcharge,12691.14,,,12691.14,Other,Medicare IPPS methodology,37010,,"25,046 x DRG weight",37010,Other,base rate x DRG weight,33309,,"22,541 x DRG weight",33309,Other,base rate x DRG weight,47421,,"32,091 x DRG weight",47421,Other,base rate x DRG weight,42679,,"28,882 x DRG weight",42679,Other,base rate x DRG weight,40307,,"27,277 x DRG weight",40307,Other,base rate x DRG weight,35583,,"24,080 x DRG weight",35583,Other,base rate x DRG weight,33194,,"22,463 x DRG weight",33194,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39050,,"26,426 x DRG weight",39050,Other,base rate x DRG weight,57348,,"38,809 x DRG weight",57348,Other,base rate x DRG weight,57348,,"38,809 x DRG weight",57348,Other,base rate x DRG weight,39050,,"26,426 x DRG weight",39050,Other,base rate x DRG weight,57348,,"38,809 x DRG weight",57348,Other,base rate x DRG weight,39451,,"6,363 x patient days",39451,Per diem,,52508,70,,52508,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37027,,"25,057 x DRG weight",37027,Other,base rate x DRG weight,33325,,"22,552 x DRG weight",33325,Other,base rate x DRG weight,37027,,"25,057 x DRG weight",37027,Other,base rate x DRG weight,31472,,"21,298 x DRG weight",31472,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,57348,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,,inpatient,,,365016,15469,,,15469,Other,150% of Medicare + 9.63% HCRA Surcharge,9407.02,,,9407.02,Other,Medicare IPPS methodology,27177,,"25,046 x DRG weight",27177,Other,base rate x DRG weight,24459,,"22,541 x DRG weight",24459,Other,base rate x DRG weight,34822,,"32,091 x DRG weight",34822,Other,base rate x DRG weight,31340,,"28,882 x DRG weight",31340,Other,base rate x DRG weight,29598,,"27,277 x DRG weight",29598,Other,base rate x DRG weight,26129,,"24,080 x DRG weight",26129,Other,base rate x DRG weight,24375,,"22,463 x DRG weight",24375,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28675,,"26,426 x DRG weight",28675,Other,base rate x DRG weight,42112,,"38,809 x DRG weight",42112,Other,base rate x DRG weight,42112,,"38,809 x DRG weight",42112,Other,base rate x DRG weight,28675,,"26,426 x DRG weight",28675,Other,base rate x DRG weight,42112,,"38,809 x DRG weight",42112,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,255511,70,,255511,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27189,,"25,057 x DRG weight",27189,Other,base rate x DRG weight,24471,,"22,552 x DRG weight",24471,Other,base rate x DRG weight,27189,,"25,057 x DRG weight",27189,Other,base rate x DRG weight,23110,,"21,298 x DRG weight",23110,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,255511,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,,inpatient,,,180437.03,18204,,,18204,Other,150% of Medicare + 9.63% HCRA Surcharge,11069.99,,,11069.99,Other,Medicare IPPS methodology,32157,,"25,046 x DRG weight",32157,Other,base rate x DRG weight,28940,,"22,541 x DRG weight",28940,Other,base rate x DRG weight,41202,,"32,091 x DRG weight",41202,Other,base rate x DRG weight,37082,,"28,882 x DRG weight",37082,Other,base rate x DRG weight,35021,,"27,277 x DRG weight",35021,Other,base rate x DRG weight,30916,,"24,080 x DRG weight",30916,Other,base rate x DRG weight,28840,,"22,463 x DRG weight",28840,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,33928,,"26,426 x DRG weight",33928,Other,base rate x DRG weight,49827,,"38,809 x DRG weight",49827,Other,base rate x DRG weight,49827,,"38,809 x DRG weight",49827,Other,base rate x DRG weight,33928,,"26,426 x DRG weight",33928,Other,base rate x DRG weight,49827,,"38,809 x DRG weight",49827,Other,base rate x DRG weight,32451,,"6,363 x patient days",32451,Per diem,,126306,70,,126306,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32171,,"25,057 x DRG weight",32171,Other,base rate x DRG weight,28955,,"22,552 x DRG weight",28955,Other,base rate x DRG weight,32171,,"25,057 x DRG weight",32171,Other,base rate x DRG weight,27345,,"21,298 x DRG weight",27345,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,126306,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,,inpatient,,,140436.83,12325,,,12325,Other,150% of Medicare + 9.63% HCRA Surcharge,7494.76,,,7494.76,Other,Medicare IPPS methodology,21452,,"25,046 x DRG weight",21452,Other,base rate x DRG weight,19306,,"22,541 x DRG weight",19306,Other,base rate x DRG weight,27486,,"32,091 x DRG weight",27486,Other,base rate x DRG weight,24737,,"28,882 x DRG weight",24737,Other,base rate x DRG weight,23363,,"27,277 x DRG weight",23363,Other,base rate x DRG weight,20625,,"24,080 x DRG weight",20625,Other,base rate x DRG weight,19240,,"22,463 x DRG weight",19240,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22634,,"26,426 x DRG weight",22634,Other,base rate x DRG weight,33240,,"38,809 x DRG weight",33240,Other,base rate x DRG weight,33240,,"38,809 x DRG weight",33240,Other,base rate x DRG weight,22634,,"26,426 x DRG weight",22634,Other,base rate x DRG weight,33240,,"38,809 x DRG weight",33240,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,98306,70,,98306,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21461,,"25,057 x DRG weight",21461,Other,base rate x DRG weight,19316,,"22,552 x DRG weight",19316,Other,base rate x DRG weight,21461,,"25,057 x DRG weight",21461,Other,base rate x DRG weight,18242,,"21,298 x DRG weight",18242,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,98306,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,,inpatient,,,158996.19,8267,,,8267,Other,150% of Medicare + 9.63% HCRA Surcharge,5027.06,,,5027.06,Other,Medicare IPPS methodology,14063,,"25,046 x DRG weight",14063,Other,base rate x DRG weight,12657,,"22,541 x DRG weight",12657,Other,base rate x DRG weight,18019,,"32,091 x DRG weight",18019,Other,base rate x DRG weight,16217,,"28,882 x DRG weight",16217,Other,base rate x DRG weight,15316,,"27,277 x DRG weight",15316,Other,base rate x DRG weight,13521,,"24,080 x DRG weight",13521,Other,base rate x DRG weight,12613,,"22,463 x DRG weight",12613,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,14838,,"26,426 x DRG weight",14838,Other,base rate x DRG weight,21791,,"38,809 x DRG weight",21791,Other,base rate x DRG weight,21791,,"38,809 x DRG weight",21791,Other,base rate x DRG weight,14838,,"26,426 x DRG weight",14838,Other,base rate x DRG weight,21791,,"38,809 x DRG weight",21791,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,111297,70,,111297,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,14070,,"25,057 x DRG weight",14070,Other,base rate x DRG weight,12663,,"22,552 x DRG weight",12663,Other,base rate x DRG weight,14070,,"25,057 x DRG weight",14070,Other,base rate x DRG weight,11959,,"21,298 x DRG weight",11959,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,111297,
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,294,MS-DRG,,,,,,,,inpatient,,,365016,15588,,,15588,Other,150% of Medicare + 9.63% HCRA Surcharge,9478.95,,,9478.95,Other,Medicare IPPS methodology,27393,,"25,046 x DRG weight",27393,Other,base rate x DRG weight,24653,,"22,541 x DRG weight",24653,Other,base rate x DRG weight,35098,,"32,091 x DRG weight",35098,Other,base rate x DRG weight,31588,,"28,882 x DRG weight",31588,Other,base rate x DRG weight,29833,,"27,277 x DRG weight",29833,Other,base rate x DRG weight,26336,,"24,080 x DRG weight",26336,Other,base rate x DRG weight,24568,,"22,463 x DRG weight",24568,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28902,,"26,426 x DRG weight",28902,Other,base rate x DRG weight,42445,,"38,809 x DRG weight",42445,Other,base rate x DRG weight,42445,,"38,809 x DRG weight",42445,Other,base rate x DRG weight,28902,,"26,426 x DRG weight",28902,Other,base rate x DRG weight,42445,,"38,809 x DRG weight",42445,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,255511,70,,255511,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27405,,"25,057 x DRG weight",27405,Other,base rate x DRG weight,24665,,"22,552 x DRG weight",24665,Other,base rate x DRG weight,27405,,"25,057 x DRG weight",27405,Other,base rate x DRG weight,23294,,"21,298 x DRG weight",23294,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,255511,
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,295,MS-DRG,,,,,,,,inpatient,,,57778,11508,,,11508,Other,150% of Medicare + 9.63% HCRA Surcharge,6997.87,,,6997.87,Other,Medicare IPPS methodology,19964,,"25,046 x DRG weight",19964,Other,base rate x DRG weight,17967,,"22,541 x DRG weight",17967,Other,base rate x DRG weight,25580,,"32,091 x DRG weight",25580,Other,base rate x DRG weight,23022,,"28,882 x DRG weight",23022,Other,base rate x DRG weight,21742,,"27,277 x DRG weight",21742,Other,base rate x DRG weight,19194,,"24,080 x DRG weight",19194,Other,base rate x DRG weight,17905,,"22,463 x DRG weight",17905,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21064,,"26,426 x DRG weight",21064,Other,base rate x DRG weight,30935,,"38,809 x DRG weight",30935,Other,base rate x DRG weight,30935,,"38,809 x DRG weight",30935,Other,base rate x DRG weight,21064,,"26,426 x DRG weight",21064,Other,base rate x DRG weight,30935,,"38,809 x DRG weight",30935,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,40445,70,,40445,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19973,,"25,057 x DRG weight",19973,Other,base rate x DRG weight,17976,,"22,552 x DRG weight",17976,Other,base rate x DRG weight,19973,,"25,057 x DRG weight",19973,Other,base rate x DRG weight,16977,,"21,298 x DRG weight",16977,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,40445,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,,inpatient,,,302456.76,22596,,,22596,Other,150% of Medicare + 9.63% HCRA Surcharge,13740.96,,,13740.96,Other,Medicare IPPS methodology,40154,,"25,046 x DRG weight",40154,Other,base rate x DRG weight,36138,,"22,541 x DRG weight",36138,Other,base rate x DRG weight,51448,,"32,091 x DRG weight",51448,Other,base rate x DRG weight,46304,,"28,882 x DRG weight",46304,Other,base rate x DRG weight,43730,,"27,277 x DRG weight",43730,Other,base rate x DRG weight,38605,,"24,080 x DRG weight",38605,Other,base rate x DRG weight,36013,,"22,463 x DRG weight",36013,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42366,,"26,426 x DRG weight",42366,Other,base rate x DRG weight,62219,,"38,809 x DRG weight",62219,Other,base rate x DRG weight,62219,,"38,809 x DRG weight",62219,Other,base rate x DRG weight,42366,,"26,426 x DRG weight",42366,Other,base rate x DRG weight,62219,,"38,809 x DRG weight",62219,Other,base rate x DRG weight,20998,,"6,363 x patient days",20998,Per diem,,211720,70,,211720,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40171,,"25,057 x DRG weight",40171,Other,base rate x DRG weight,36155,,"22,552 x DRG weight",36155,Other,base rate x DRG weight,40171,,"25,057 x DRG weight",40171,Other,base rate x DRG weight,34145,,"21,298 x DRG weight",34145,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,211720,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,,inpatient,,,57778,10565,,,10565,Other,150% of Medicare + 9.63% HCRA Surcharge,6424.87,,,6424.87,Other,Medicare IPPS methodology,18249,,"25,046 x DRG weight",18249,Other,base rate x DRG weight,16423,,"22,541 x DRG weight",16423,Other,base rate x DRG weight,23382,,"32,091 x DRG weight",23382,Other,base rate x DRG weight,21043,,"28,882 x DRG weight",21043,Other,base rate x DRG weight,19874,,"27,277 x DRG weight",19874,Other,base rate x DRG weight,17545,,"24,080 x DRG weight",17545,Other,base rate x DRG weight,16367,,"22,463 x DRG weight",16367,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19254,,"26,426 x DRG weight",19254,Other,base rate x DRG weight,28276,,"38,809 x DRG weight",28276,Other,base rate x DRG weight,28276,,"38,809 x DRG weight",28276,Other,base rate x DRG weight,19254,,"26,426 x DRG weight",19254,Other,base rate x DRG weight,28276,,"38,809 x DRG weight",28276,Other,base rate x DRG weight,10181,,"6,363 x patient days",10181,Per diem,,40445,70,,40445,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18257,,"25,057 x DRG weight",18257,Other,base rate x DRG weight,16431,,"22,552 x DRG weight",16431,Other,base rate x DRG weight,18257,,"25,057 x DRG weight",18257,Other,base rate x DRG weight,15518,,"21,298 x DRG weight",15518,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,40445,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,,inpatient,,,39243,6591,,,6591,Other,150% of Medicare + 9.63% HCRA Surcharge,4008.19,,,4008.19,Other,Medicare IPPS methodology,11013,,"25,046 x DRG weight",11013,Other,base rate x DRG weight,9911,,"22,541 x DRG weight",9911,Other,base rate x DRG weight,14110,,"32,091 x DRG weight",14110,Other,base rate x DRG weight,12699,,"28,882 x DRG weight",12699,Other,base rate x DRG weight,11994,,"27,277 x DRG weight",11994,Other,base rate x DRG weight,10588,,"24,080 x DRG weight",10588,Other,base rate x DRG weight,9877,,"22,463 x DRG weight",9877,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,11620,,"26,426 x DRG weight",11620,Other,base rate x DRG weight,17064,,"38,809 x DRG weight",17064,Other,base rate x DRG weight,17064,,"38,809 x DRG weight",17064,Other,base rate x DRG weight,11620,,"26,426 x DRG weight",11620,Other,base rate x DRG weight,17064,,"38,809 x DRG weight",17064,Other,base rate x DRG weight,6999,,"6,363 x patient days",6999,Per diem,,27470,70,,27470,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,11018,,"25,057 x DRG weight",11018,Other,base rate x DRG weight,9916,,"22,552 x DRG weight",9916,Other,base rate x DRG weight,11018,,"25,057 x DRG weight",11018,Other,base rate x DRG weight,9365,,"21,298 x DRG weight",9365,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,27470,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,,inpatient,,,188166.23,22225,,,22225,Other,150% of Medicare + 9.63% HCRA Surcharge,13515.1,,,13515.1,Other,Medicare IPPS methodology,39478,,"25,046 x DRG weight",39478,Other,base rate x DRG weight,35529,,"22,541 x DRG weight",35529,Other,base rate x DRG weight,50582,,"32,091 x DRG weight",50582,Other,base rate x DRG weight,45524,,"28,882 x DRG weight",45524,Other,base rate x DRG weight,42994,,"27,277 x DRG weight",42994,Other,base rate x DRG weight,37955,,"24,080 x DRG weight",37955,Other,base rate x DRG weight,35406,,"22,463 x DRG weight",35406,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41653,,"26,426 x DRG weight",41653,Other,base rate x DRG weight,61171,,"38,809 x DRG weight",61171,Other,base rate x DRG weight,61171,,"38,809 x DRG weight",61171,Other,base rate x DRG weight,41653,,"26,426 x DRG weight",41653,Other,base rate x DRG weight,61171,,"38,809 x DRG weight",61171,Other,base rate x DRG weight,35633,,"6,363 x patient days",35633,Per diem,,131716,70,,131716,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39495,,"25,057 x DRG weight",39495,Other,base rate x DRG weight,35546,,"22,552 x DRG weight",35546,Other,base rate x DRG weight,39495,,"25,057 x DRG weight",39495,Other,base rate x DRG weight,33570,,"21,298 x DRG weight",33570,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,131716,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,,inpatient,,,123909.19,15220,,,15220,Other,150% of Medicare + 9.63% HCRA Surcharge,9255.61,,,9255.61,Other,Medicare IPPS methodology,26724,,"25,046 x DRG weight",26724,Other,base rate x DRG weight,24051,,"22,541 x DRG weight",24051,Other,base rate x DRG weight,34241,,"32,091 x DRG weight",34241,Other,base rate x DRG weight,30817,,"28,882 x DRG weight",30817,Other,base rate x DRG weight,29105,,"27,277 x DRG weight",29105,Other,base rate x DRG weight,25693,,"24,080 x DRG weight",25693,Other,base rate x DRG weight,23968,,"22,463 x DRG weight",23968,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28197,,"26,426 x DRG weight",28197,Other,base rate x DRG weight,41409,,"38,809 x DRG weight",41409,Other,base rate x DRG weight,41409,,"38,809 x DRG weight",41409,Other,base rate x DRG weight,28197,,"26,426 x DRG weight",28197,Other,base rate x DRG weight,41409,,"38,809 x DRG weight",41409,Other,base rate x DRG weight,25452,,"6,363 x patient days",25452,Per diem,,86736,70,,86736,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26736,,"25,057 x DRG weight",26736,Other,base rate x DRG weight,24063,,"22,552 x DRG weight",24063,Other,base rate x DRG weight,26736,,"25,057 x DRG weight",26736,Other,base rate x DRG weight,22725,,"21,298 x DRG weight",22725,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,86736,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,,inpatient,,,108696.83,10307,,,10307,Other,150% of Medicare + 9.63% HCRA Surcharge,6267.6,,,6267.6,Other,Medicare IPPS methodology,17778,,"25,046 x DRG weight",17778,Other,base rate x DRG weight,16000,,"22,541 x DRG weight",16000,Other,base rate x DRG weight,22778,,"32,091 x DRG weight",22778,Other,base rate x DRG weight,20500,,"28,882 x DRG weight",20500,Other,base rate x DRG weight,19361,,"27,277 x DRG weight",19361,Other,base rate x DRG weight,17092,,"24,080 x DRG weight",17092,Other,base rate x DRG weight,15944,,"22,463 x DRG weight",15944,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18757,,"26,426 x DRG weight",18757,Other,base rate x DRG weight,27547,,"38,809 x DRG weight",27547,Other,base rate x DRG weight,27547,,"38,809 x DRG weight",27547,Other,base rate x DRG weight,18757,,"26,426 x DRG weight",18757,Other,base rate x DRG weight,27547,,"38,809 x DRG weight",27547,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,76088,70,,76088,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17785,,"25,057 x DRG weight",17785,Other,base rate x DRG weight,16007,,"22,552 x DRG weight",16007,Other,base rate x DRG weight,17785,,"25,057 x DRG weight",17785,Other,base rate x DRG weight,15117,,"21,298 x DRG weight",15117,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,76088,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,,inpatient,,,118462.97,15965,,,15965,Other,150% of Medicare + 9.63% HCRA Surcharge,9708.16,,,9708.16,Other,Medicare IPPS methodology,28079,,"25,046 x DRG weight",28079,Other,base rate x DRG weight,25271,,"22,541 x DRG weight",25271,Other,base rate x DRG weight,35977,,"32,091 x DRG weight",35977,Other,base rate x DRG weight,32380,,"28,882 x DRG weight",32380,Other,base rate x DRG weight,30580,,"27,277 x DRG weight",30580,Other,base rate x DRG weight,26996,,"24,080 x DRG weight",26996,Other,base rate x DRG weight,25183,,"22,463 x DRG weight",25183,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,29626,,"26,426 x DRG weight",29626,Other,base rate x DRG weight,43509,,"38,809 x DRG weight",43509,Other,base rate x DRG weight,43509,,"38,809 x DRG weight",43509,Other,base rate x DRG weight,29626,,"26,426 x DRG weight",29626,Other,base rate x DRG weight,43509,,"38,809 x DRG weight",43509,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,82924,70,,82924,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,28091,,"25,057 x DRG weight",28091,Other,base rate x DRG weight,25283,,"22,552 x DRG weight",25283,Other,base rate x DRG weight,28091,,"25,057 x DRG weight",28091,Other,base rate x DRG weight,23877,,"21,298 x DRG weight",23877,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,82924,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,,inpatient,,,109760.62,9596,,,9596,Other,150% of Medicare + 9.63% HCRA Surcharge,5835.13,,,5835.13,Other,Medicare IPPS methodology,16483,,"25,046 x DRG weight",16483,Other,base rate x DRG weight,14834,,"22,541 x DRG weight",14834,Other,base rate x DRG weight,21119,,"32,091 x DRG weight",21119,Other,base rate x DRG weight,19007,,"28,882 x DRG weight",19007,Other,base rate x DRG weight,17951,,"27,277 x DRG weight",17951,Other,base rate x DRG weight,15847,,"24,080 x DRG weight",15847,Other,base rate x DRG weight,14783,,"22,463 x DRG weight",14783,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,17391,,"26,426 x DRG weight",17391,Other,base rate x DRG weight,25540,,"38,809 x DRG weight",25540,Other,base rate x DRG weight,25540,,"38,809 x DRG weight",25540,Other,base rate x DRG weight,17391,,"26,426 x DRG weight",17391,Other,base rate x DRG weight,25540,,"38,809 x DRG weight",25540,Other,base rate x DRG weight,13999,,"6,363 x patient days",13999,Per diem,,76832,70,,76832,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,16490,,"25,057 x DRG weight",16490,Other,base rate x DRG weight,14841,,"22,552 x DRG weight",14841,Other,base rate x DRG weight,16490,,"25,057 x DRG weight",16490,Other,base rate x DRG weight,14016,,"21,298 x DRG weight",14016,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,76832,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,,inpatient,,,164718.08,16348,,,16348,Other,150% of Medicare + 9.63% HCRA Surcharge,9941.54,,,9941.54,Other,Medicare IPPS methodology,28778,,"25,046 x DRG weight",28778,Other,base rate x DRG weight,25900,,"22,541 x DRG weight",25900,Other,base rate x DRG weight,36873,,"32,091 x DRG weight",36873,Other,base rate x DRG weight,33185,,"28,882 x DRG weight",33185,Other,base rate x DRG weight,31341,,"27,277 x DRG weight",31341,Other,base rate x DRG weight,27668,,"24,080 x DRG weight",27668,Other,base rate x DRG weight,25810,,"22,463 x DRG weight",25810,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,30363,,"26,426 x DRG weight",30363,Other,base rate x DRG weight,44592,,"38,809 x DRG weight",44592,Other,base rate x DRG weight,44592,,"38,809 x DRG weight",44592,Other,base rate x DRG weight,30363,,"26,426 x DRG weight",30363,Other,base rate x DRG weight,44592,,"38,809 x DRG weight",44592,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,115303,70,,115303,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,28790,,"25,057 x DRG weight",28790,Other,base rate x DRG weight,25912,,"22,552 x DRG weight",25912,Other,base rate x DRG weight,28790,,"25,057 x DRG weight",28790,Other,base rate x DRG weight,24471,,"21,298 x DRG weight",24471,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,115303,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,,inpatient,,,116227.06,10908,,,10908,Other,150% of Medicare + 9.63% HCRA Surcharge,6633.16,,,6633.16,Other,Medicare IPPS methodology,18872,,"25,046 x DRG weight",18872,Other,base rate x DRG weight,16985,,"22,541 x DRG weight",16985,Other,base rate x DRG weight,24181,,"32,091 x DRG weight",24181,Other,base rate x DRG weight,21763,,"28,882 x DRG weight",21763,Other,base rate x DRG weight,20553,,"27,277 x DRG weight",20553,Other,base rate x DRG weight,18144,,"24,080 x DRG weight",18144,Other,base rate x DRG weight,16926,,"22,463 x DRG weight",16926,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19912,,"26,426 x DRG weight",19912,Other,base rate x DRG weight,29243,,"38,809 x DRG weight",29243,Other,base rate x DRG weight,29243,,"38,809 x DRG weight",29243,Other,base rate x DRG weight,19912,,"26,426 x DRG weight",19912,Other,base rate x DRG weight,29243,,"38,809 x DRG weight",29243,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,81359,70,,81359,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18880,,"25,057 x DRG weight",18880,Other,base rate x DRG weight,16993,,"22,552 x DRG weight",16993,Other,base rate x DRG weight,18880,,"25,057 x DRG weight",18880,Other,base rate x DRG weight,16048,,"21,298 x DRG weight",16048,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,81359,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,,inpatient,,,546948.46,21683,,,21683,Other,150% of Medicare + 9.63% HCRA Surcharge,13185.52,,,13185.52,Other,Medicare IPPS methodology,38491,,"25,046 x DRG weight",38491,Other,base rate x DRG weight,34641,,"22,541 x DRG weight",34641,Other,base rate x DRG weight,49317,,"32,091 x DRG weight",49317,Other,base rate x DRG weight,44386,,"28,882 x DRG weight",44386,Other,base rate x DRG weight,41919,,"27,277 x DRG weight",41919,Other,base rate x DRG weight,37006,,"24,080 x DRG weight",37006,Other,base rate x DRG weight,34521,,"22,463 x DRG weight",34521,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40611,,"26,426 x DRG weight",40611,Other,base rate x DRG weight,59642,,"38,809 x DRG weight",59642,Other,base rate x DRG weight,59642,,"38,809 x DRG weight",59642,Other,base rate x DRG weight,40611,,"26,426 x DRG weight",40611,Other,base rate x DRG weight,59642,,"38,809 x DRG weight",59642,Other,base rate x DRG weight,33724,,"6,363 x patient days",33724,Per diem,,382864,70,,382864,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38508,,"25,057 x DRG weight",38508,Other,base rate x DRG weight,34658,,"22,552 x DRG weight",34658,Other,base rate x DRG weight,38508,,"25,057 x DRG weight",38508,Other,base rate x DRG weight,32731,,"21,298 x DRG weight",32731,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,382864,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,,inpatient,,,126821.63,13509,,,13509,Other,150% of Medicare + 9.63% HCRA Surcharge,8214.99,,,8214.99,Other,Medicare IPPS methodology,23608,,"25,046 x DRG weight",23608,Other,base rate x DRG weight,21247,,"22,541 x DRG weight",21247,Other,base rate x DRG weight,30249,,"32,091 x DRG weight",30249,Other,base rate x DRG weight,27224,,"28,882 x DRG weight",27224,Other,base rate x DRG weight,25711,,"27,277 x DRG weight",25711,Other,base rate x DRG weight,22698,,"24,080 x DRG weight",22698,Other,base rate x DRG weight,21174,,"22,463 x DRG weight",21174,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24909,,"26,426 x DRG weight",24909,Other,base rate x DRG weight,36581,,"38,809 x DRG weight",36581,Other,base rate x DRG weight,36581,,"38,809 x DRG weight",36581,Other,base rate x DRG weight,24909,,"26,426 x DRG weight",24909,Other,base rate x DRG weight,36581,,"38,809 x DRG weight",36581,Other,base rate x DRG weight,19089,,"6,363 x patient days",19089,Per diem,,88775,70,,88775,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23619,,"25,057 x DRG weight",23619,Other,base rate x DRG weight,21258,,"22,552 x DRG weight",21258,Other,base rate x DRG weight,23619,,"25,057 x DRG weight",23619,Other,base rate x DRG weight,20075,,"21,298 x DRG weight",20075,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,88775,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,,inpatient,,,176568.14,17080,,,17080,Other,150% of Medicare + 9.63% HCRA Surcharge,10386.57,,,10386.57,Other,Medicare IPPS methodology,30110,,"25,046 x DRG weight",30110,Other,base rate x DRG weight,27099,,"22,541 x DRG weight",27099,Other,base rate x DRG weight,38580,,"32,091 x DRG weight",38580,Other,base rate x DRG weight,34722,,"28,882 x DRG weight",34722,Other,base rate x DRG weight,32792,,"27,277 x DRG weight",32792,Other,base rate x DRG weight,28949,,"24,080 x DRG weight",28949,Other,base rate x DRG weight,27005,,"22,463 x DRG weight",27005,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31769,,"26,426 x DRG weight",31769,Other,base rate x DRG weight,46656,,"38,809 x DRG weight",46656,Other,base rate x DRG weight,46656,,"38,809 x DRG weight",46656,Other,base rate x DRG weight,31769,,"26,426 x DRG weight",31769,Other,base rate x DRG weight,46656,,"38,809 x DRG weight",46656,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,123598,70,,123598,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30124,,"25,057 x DRG weight",30124,Other,base rate x DRG weight,27112,,"22,552 x DRG weight",27112,Other,base rate x DRG weight,30124,,"25,057 x DRG weight",30124,Other,base rate x DRG weight,25604,,"21,298 x DRG weight",25604,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,123598,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,,inpatient,,,122201.12,10787,,,10787,Other,150% of Medicare + 9.63% HCRA Surcharge,6559.54,,,6559.54,Other,Medicare IPPS methodology,18652,,"25,046 x DRG weight",18652,Other,base rate x DRG weight,16786,,"22,541 x DRG weight",16786,Other,base rate x DRG weight,23898,,"32,091 x DRG weight",23898,Other,base rate x DRG weight,21508,,"28,882 x DRG weight",21508,Other,base rate x DRG weight,20313,,"27,277 x DRG weight",20313,Other,base rate x DRG weight,17932,,"24,080 x DRG weight",17932,Other,base rate x DRG weight,16728,,"22,463 x DRG weight",16728,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19679,,"26,426 x DRG weight",19679,Other,base rate x DRG weight,28901,,"38,809 x DRG weight",28901,Other,base rate x DRG weight,28901,,"38,809 x DRG weight",28901,Other,base rate x DRG weight,19679,,"26,426 x DRG weight",19679,Other,base rate x DRG weight,28901,,"38,809 x DRG weight",28901,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,85541,70,,85541,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18660,,"25,057 x DRG weight",18660,Other,base rate x DRG weight,16794,,"22,552 x DRG weight",16794,Other,base rate x DRG weight,18660,,"25,057 x DRG weight",18660,Other,base rate x DRG weight,15861,,"21,298 x DRG weight",15861,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,85541,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,,inpatient,,,67364.96,8150,,,8150,Other,150% of Medicare + 9.63% HCRA Surcharge,4955.96,,,4955.96,Other,Medicare IPPS methodology,13850,,"25,046 x DRG weight",13850,Other,base rate x DRG weight,12465,,"22,541 x DRG weight",12465,Other,base rate x DRG weight,17746,,"32,091 x DRG weight",17746,Other,base rate x DRG weight,15972,,"28,882 x DRG weight",15972,Other,base rate x DRG weight,15084,,"27,277 x DRG weight",15084,Other,base rate x DRG weight,13316,,"24,080 x DRG weight",13316,Other,base rate x DRG weight,12422,,"22,463 x DRG weight",12422,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,14614,,"26,426 x DRG weight",14614,Other,base rate x DRG weight,21461,,"38,809 x DRG weight",21461,Other,base rate x DRG weight,21461,,"38,809 x DRG weight",21461,Other,base rate x DRG weight,14614,,"26,426 x DRG weight",14614,Other,base rate x DRG weight,21461,,"38,809 x DRG weight",21461,Other,base rate x DRG weight,13362,,"6,363 x patient days",13362,Per diem,,47155,70,,47155,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,13857,,"25,057 x DRG weight",13857,Other,base rate x DRG weight,12471,,"22,552 x DRG weight",12471,Other,base rate x DRG weight,13857,,"25,057 x DRG weight",13857,Other,base rate x DRG weight,11778,,"21,298 x DRG weight",11778,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,47155,
ANGINA PECTORIS,311,MS-DRG,,,,,,,,inpatient,,,85151.04,10146,,,10146,Other,150% of Medicare + 9.63% HCRA Surcharge,6169.73,,,6169.73,Other,Medicare IPPS methodology,17485,,"25,046 x DRG weight",17485,Other,base rate x DRG weight,15736,,"22,541 x DRG weight",15736,Other,base rate x DRG weight,22403,,"32,091 x DRG weight",22403,Other,base rate x DRG weight,20163,,"28,882 x DRG weight",20163,Other,base rate x DRG weight,19042,,"27,277 x DRG weight",19042,Other,base rate x DRG weight,16810,,"24,080 x DRG weight",16810,Other,base rate x DRG weight,15681,,"22,463 x DRG weight",15681,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18448,,"26,426 x DRG weight",18448,Other,base rate x DRG weight,27093,,"38,809 x DRG weight",27093,Other,base rate x DRG weight,27093,,"38,809 x DRG weight",27093,Other,base rate x DRG weight,18448,,"26,426 x DRG weight",18448,Other,base rate x DRG weight,27093,,"38,809 x DRG weight",27093,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,59606,70,,59606,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17492,,"25,057 x DRG weight",17492,Other,base rate x DRG weight,15744,,"22,552 x DRG weight",15744,Other,base rate x DRG weight,17492,,"25,057 x DRG weight",17492,Other,base rate x DRG weight,14868,,"21,298 x DRG weight",14868,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,59606,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,,inpatient,,,135930.04,12421,,,12421,Other,150% of Medicare + 9.63% HCRA Surcharge,7553.31,,,7553.31,Other,Medicare IPPS methodology,21627,,"25,046 x DRG weight",21627,Other,base rate x DRG weight,19464,,"22,541 x DRG weight",19464,Other,base rate x DRG weight,27711,,"32,091 x DRG weight",27711,Other,base rate x DRG weight,24940,,"28,882 x DRG weight",24940,Other,base rate x DRG weight,23554,,"27,277 x DRG weight",23554,Other,base rate x DRG weight,20793,,"24,080 x DRG weight",20793,Other,base rate x DRG weight,19397,,"22,463 x DRG weight",19397,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22819,,"26,426 x DRG weight",22819,Other,base rate x DRG weight,33512,,"38,809 x DRG weight",33512,Other,base rate x DRG weight,33512,,"38,809 x DRG weight",33512,Other,base rate x DRG weight,22819,,"26,426 x DRG weight",22819,Other,base rate x DRG weight,33512,,"38,809 x DRG weight",33512,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,95151,70,,95151,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21637,,"25,057 x DRG weight",21637,Other,base rate x DRG weight,19474,,"22,552 x DRG weight",19474,Other,base rate x DRG weight,21637,,"25,057 x DRG weight",21637,Other,base rate x DRG weight,18391,,"21,298 x DRG weight",18391,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95151,
CHEST PAIN,313,MS-DRG,,,,,,,,inpatient,,,100121.91,10497,,,10497,Other,150% of Medicare + 9.63% HCRA Surcharge,6383.04,,,6383.04,Other,Medicare IPPS methodology,18123,,"25,046 x DRG weight",18123,Other,base rate x DRG weight,16311,,"22,541 x DRG weight",16311,Other,base rate x DRG weight,23221,,"32,091 x DRG weight",23221,Other,base rate x DRG weight,20899,,"28,882 x DRG weight",20899,Other,base rate x DRG weight,19738,,"27,277 x DRG weight",19738,Other,base rate x DRG weight,17424,,"24,080 x DRG weight",17424,Other,base rate x DRG weight,16254,,"22,463 x DRG weight",16254,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19122,,"26,426 x DRG weight",19122,Other,base rate x DRG weight,28082,,"38,809 x DRG weight",28082,Other,base rate x DRG weight,28082,,"38,809 x DRG weight",28082,Other,base rate x DRG weight,19122,,"26,426 x DRG weight",19122,Other,base rate x DRG weight,28082,,"38,809 x DRG weight",28082,Other,base rate x DRG weight,13999,,"6,363 x patient days",13999,Per diem,,70085,70,,70085,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18131,,"25,057 x DRG weight",18131,Other,base rate x DRG weight,16319,,"22,552 x DRG weight",16319,Other,base rate x DRG weight,18131,,"25,057 x DRG weight",18131,Other,base rate x DRG weight,15411,,"21,298 x DRG weight",15411,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,70085,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,,inpatient,,,310115.72,29341,,,29341,Other,150% of Medicare + 9.63% HCRA Surcharge,17842.36,,,17842.36,Other,Medicare IPPS methodology,52434,,"25,046 x DRG weight",52434,Other,base rate x DRG weight,47190,,"22,541 x DRG weight",47190,Other,base rate x DRG weight,67183,,"32,091 x DRG weight",67183,Other,base rate x DRG weight,60464,,"28,882 x DRG weight",60464,Other,base rate x DRG weight,57104,,"27,277 x DRG weight",57104,Other,base rate x DRG weight,50411,,"24,080 x DRG weight",50411,Other,base rate x DRG weight,47026,,"22,463 x DRG weight",47026,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,55323,,"26,426 x DRG weight",55323,Other,base rate x DRG weight,81247,,"38,809 x DRG weight",81247,Other,base rate x DRG weight,81247,,"38,809 x DRG weight",81247,Other,base rate x DRG weight,55323,,"26,426 x DRG weight",55323,Other,base rate x DRG weight,81247,,"38,809 x DRG weight",81247,Other,base rate x DRG weight,45177,,"6,363 x patient days",45177,Per diem,,217081,70,,217081,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52457,,"25,057 x DRG weight",52457,Other,base rate x DRG weight,47213,,"22,552 x DRG weight",47213,Other,base rate x DRG weight,52457,,"25,057 x DRG weight",52457,Other,base rate x DRG weight,44587,,"21,298 x DRG weight",44587,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,217081,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,,inpatient,,,143896.63,13849,,,13849,Other,150% of Medicare + 9.63% HCRA Surcharge,8421.61,,,8421.61,Other,Medicare IPPS methodology,24227,,"25,046 x DRG weight",24227,Other,base rate x DRG weight,21804,,"22,541 x DRG weight",21804,Other,base rate x DRG weight,31042,,"32,091 x DRG weight",31042,Other,base rate x DRG weight,27938,,"28,882 x DRG weight",27938,Other,base rate x DRG weight,26385,,"27,277 x DRG weight",26385,Other,base rate x DRG weight,23293,,"24,080 x DRG weight",23293,Other,base rate x DRG weight,21728,,"22,463 x DRG weight",21728,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25562,,"26,426 x DRG weight",25562,Other,base rate x DRG weight,37540,,"38,809 x DRG weight",37540,Other,base rate x DRG weight,37540,,"38,809 x DRG weight",37540,Other,base rate x DRG weight,25562,,"26,426 x DRG weight",25562,Other,base rate x DRG weight,37540,,"38,809 x DRG weight",37540,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,100728,70,,100728,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24238,,"25,057 x DRG weight",24238,Other,base rate x DRG weight,21815,,"22,552 x DRG weight",21815,Other,base rate x DRG weight,24238,,"25,057 x DRG weight",24238,Other,base rate x DRG weight,20602,,"21,298 x DRG weight",20602,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,100728,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,,inpatient,,,98929.04,10072,,,10072,Other,150% of Medicare + 9.63% HCRA Surcharge,6124.56,,,6124.56,Other,Medicare IPPS methodology,17349,,"25,046 x DRG weight",17349,Other,base rate x DRG weight,15614,,"22,541 x DRG weight",15614,Other,base rate x DRG weight,22229,,"32,091 x DRG weight",22229,Other,base rate x DRG weight,20007,,"28,882 x DRG weight",20007,Other,base rate x DRG weight,18895,,"27,277 x DRG weight",18895,Other,base rate x DRG weight,16680,,"24,080 x DRG weight",16680,Other,base rate x DRG weight,15560,,"22,463 x DRG weight",15560,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18305,,"26,426 x DRG weight",18305,Other,base rate x DRG weight,26883,,"38,809 x DRG weight",26883,Other,base rate x DRG weight,26883,,"38,809 x DRG weight",26883,Other,base rate x DRG weight,18305,,"26,426 x DRG weight",18305,Other,base rate x DRG weight,26883,,"38,809 x DRG weight",26883,Other,base rate x DRG weight,13999,,"6,363 x patient days",13999,Per diem,,69250,70,,69250,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17357,,"25,057 x DRG weight",17357,Other,base rate x DRG weight,15622,,"22,552 x DRG weight",15622,Other,base rate x DRG weight,17357,,"25,057 x DRG weight",17357,Other,base rate x DRG weight,14753,,"21,298 x DRG weight",14753,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,69250,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,,inpatient,,,818007.19,60545,,,60545,Other,150% of Medicare + 9.63% HCRA Surcharge,36817.7,,,36817.7,Other,Medicare IPPS methodology,109248,,"25,046 x DRG weight",109248,Other,base rate x DRG weight,98322,,"22,541 x DRG weight",98322,Other,base rate x DRG weight,139978,,"32,091 x DRG weight",139978,Other,base rate x DRG weight,125980,,"28,882 x DRG weight",125980,Other,base rate x DRG weight,118980,,"27,277 x DRG weight",118980,Other,base rate x DRG weight,105035,,"24,080 x DRG weight",105035,Other,base rate x DRG weight,97981,,"22,463 x DRG weight",97981,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,115268,,"26,426 x DRG weight",115268,Other,base rate x DRG weight,169281,,"38,809 x DRG weight",169281,Other,base rate x DRG weight,169281,,"38,809 x DRG weight",169281,Other,base rate x DRG weight,115268,,"26,426 x DRG weight",115268,Other,base rate x DRG weight,169281,,"38,809 x DRG weight",169281,Other,base rate x DRG weight,66175,,"6,363 x patient days",66175,Per diem,,572605,70,,572605,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,109296,,"25,057 x DRG weight",109296,Other,base rate x DRG weight,98370,,"22,552 x DRG weight",98370,Other,base rate x DRG weight,109296,,"25,057 x DRG weight",109296,Other,base rate x DRG weight,92900,,"21,298 x DRG weight",92900,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,572605,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,,inpatient,,,421986.5,31164,,,31164,Other,150% of Medicare + 9.63% HCRA Surcharge,18950.73,,,18950.73,Other,Medicare IPPS methodology,55752,,"25,046 x DRG weight",55752,Other,base rate x DRG weight,50176,,"22,541 x DRG weight",50176,Other,base rate x DRG weight,71435,,"32,091 x DRG weight",71435,Other,base rate x DRG weight,64291,,"28,882 x DRG weight",64291,Other,base rate x DRG weight,60719,,"27,277 x DRG weight",60719,Other,base rate x DRG weight,53602,,"24,080 x DRG weight",53602,Other,base rate x DRG weight,50003,,"22,463 x DRG weight",50003,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,58824,,"26,426 x DRG weight",58824,Other,base rate x DRG weight,86389,,"38,809 x DRG weight",86389,Other,base rate x DRG weight,86389,,"38,809 x DRG weight",86389,Other,base rate x DRG weight,58824,,"26,426 x DRG weight",58824,Other,base rate x DRG weight,86389,,"38,809 x DRG weight",86389,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,295391,70,,295391,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,55777,,"25,057 x DRG weight",55777,Other,base rate x DRG weight,50201,,"22,552 x DRG weight",50201,Other,base rate x DRG weight,55777,,"25,057 x DRG weight",55777,Other,base rate x DRG weight,47409,,"21,298 x DRG weight",47409,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,295391,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,,inpatient,,,345470.51,40087,,,40087,Other,150% of Medicare + 9.63% HCRA Surcharge,24377.16,,,24377.16,Other,Medicare IPPS methodology,72000,,"25,046 x DRG weight",72000,Other,base rate x DRG weight,64799,,"22,541 x DRG weight",64799,Other,base rate x DRG weight,92252,,"32,091 x DRG weight",92252,Other,base rate x DRG weight,83027,,"28,882 x DRG weight",83027,Other,base rate x DRG weight,78413,,"27,277 x DRG weight",78413,Other,base rate x DRG weight,69223,,"24,080 x DRG weight",69223,Other,base rate x DRG weight,64574,,"22,463 x DRG weight",64574,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,75967,,"26,426 x DRG weight",75967,Other,base rate x DRG weight,111564,,"38,809 x DRG weight",111564,Other,base rate x DRG weight,111564,,"38,809 x DRG weight",111564,Other,base rate x DRG weight,75967,,"26,426 x DRG weight",75967,Other,base rate x DRG weight,111564,,"38,809 x DRG weight",111564,Other,base rate x DRG weight,33088,,"6,363 x patient days",33088,Per diem,,241829,70,,241829,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,72031,,"25,057 x DRG weight",72031,Other,base rate x DRG weight,64830,,"22,552 x DRG weight",64830,Other,base rate x DRG weight,72031,,"25,057 x DRG weight",72031,Other,base rate x DRG weight,61225,,"21,298 x DRG weight",61225,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,241829,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,,inpatient,,,204191.54,25625,,,25625,Other,150% of Medicare + 9.63% HCRA Surcharge,15582.95,,,15582.95,Other,Medicare IPPS methodology,45669,,"25,046 x DRG weight",45669,Other,base rate x DRG weight,41101,,"22,541 x DRG weight",41101,Other,base rate x DRG weight,58515,,"32,091 x DRG weight",58515,Other,base rate x DRG weight,52663,,"28,882 x DRG weight",52663,Other,base rate x DRG weight,49737,,"27,277 x DRG weight",49737,Other,base rate x DRG weight,43907,,"24,080 x DRG weight",43907,Other,base rate x DRG weight,40959,,"22,463 x DRG weight",40959,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48185,,"26,426 x DRG weight",48185,Other,base rate x DRG weight,70764,,"38,809 x DRG weight",70764,Other,base rate x DRG weight,70764,,"38,809 x DRG weight",70764,Other,base rate x DRG weight,48185,,"26,426 x DRG weight",48185,Other,base rate x DRG weight,70764,,"38,809 x DRG weight",70764,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,142934,70,,142934,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,45689,,"25,057 x DRG weight",45689,Other,base rate x DRG weight,41121,,"22,552 x DRG weight",41121,Other,base rate x DRG weight,45689,,"25,057 x DRG weight",45689,Other,base rate x DRG weight,38835,,"21,298 x DRG weight",38835,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,142934,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,,inpatient,,,230036,57492,,,57492,Other,150% of Medicare + 9.63% HCRA Surcharge,34961.49,,,34961.49,Other,Medicare IPPS methodology,103690,,"25,046 x DRG weight",103690,Other,base rate x DRG weight,93320,,"22,541 x DRG weight",93320,Other,base rate x DRG weight,132857,,"32,091 x DRG weight",132857,Other,base rate x DRG weight,119571,,"28,882 x DRG weight",119571,Other,base rate x DRG weight,112927,,"27,277 x DRG weight",112927,Other,base rate x DRG weight,99691,,"24,080 x DRG weight",99691,Other,base rate x DRG weight,92997,,"22,463 x DRG weight",92997,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,109404,,"26,426 x DRG weight",109404,Other,base rate x DRG weight,160669,,"38,809 x DRG weight",160669,Other,base rate x DRG weight,160669,,"38,809 x DRG weight",160669,Other,base rate x DRG weight,109404,,"26,426 x DRG weight",109404,Other,base rate x DRG weight,160669,,"38,809 x DRG weight",160669,Other,base rate x DRG weight,40087,,"6,363 x patient days",40087,Per diem,,161025,70,,161025,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,103736,,"25,057 x DRG weight",103736,Other,base rate x DRG weight,93365,,"22,552 x DRG weight",93365,Other,base rate x DRG weight,103736,,"25,057 x DRG weight",103736,Other,base rate x DRG weight,88174,,"21,298 x DRG weight",88174,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,161025,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,,inpatient,,,285419.08,41379,,,41379,Other,150% of Medicare + 9.63% HCRA Surcharge,25162.64,,,25162.64,Other,Medicare IPPS methodology,74352,,"25,046 x DRG weight",74352,Other,base rate x DRG weight,66915,,"22,541 x DRG weight",66915,Other,base rate x DRG weight,95265,,"32,091 x DRG weight",95265,Other,base rate x DRG weight,85739,,"28,882 x DRG weight",85739,Other,base rate x DRG weight,80975,,"27,277 x DRG weight",80975,Other,base rate x DRG weight,71484,,"24,080 x DRG weight",71484,Other,base rate x DRG weight,66684,,"22,463 x DRG weight",66684,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,78448,,"26,426 x DRG weight",78448,Other,base rate x DRG weight,115208,,"38,809 x DRG weight",115208,Other,base rate x DRG weight,115208,,"38,809 x DRG weight",115208,Other,base rate x DRG weight,78448,,"26,426 x DRG weight",78448,Other,base rate x DRG weight,115208,,"38,809 x DRG weight",115208,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,199793,70,,199793,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,74384,,"25,057 x DRG weight",74384,Other,base rate x DRG weight,66948,,"22,552 x DRG weight",66948,Other,base rate x DRG weight,74384,,"25,057 x DRG weight",74384,Other,base rate x DRG weight,63225,,"21,298 x DRG weight",63225,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,199793,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,,inpatient,,,421986.5,36918,,,36918,Other,150% of Medicare + 9.63% HCRA Surcharge,22449.84,,,22449.84,Other,Medicare IPPS methodology,66229,,"25,046 x DRG weight",66229,Other,base rate x DRG weight,59605,,"22,541 x DRG weight",59605,Other,base rate x DRG weight,84858,,"32,091 x DRG weight",84858,Other,base rate x DRG weight,76373,,"28,882 x DRG weight",76373,Other,base rate x DRG weight,72129,,"27,277 x DRG weight",72129,Other,base rate x DRG weight,63675,,"24,080 x DRG weight",63675,Other,base rate x DRG weight,59399,,"22,463 x DRG weight",59399,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,69878,,"26,426 x DRG weight",69878,Other,base rate x DRG weight,102623,,"38,809 x DRG weight",102623,Other,base rate x DRG weight,102623,,"38,809 x DRG weight",102623,Other,base rate x DRG weight,69878,,"26,426 x DRG weight",69878,Other,base rate x DRG weight,102623,,"38,809 x DRG weight",102623,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,295391,70,,295391,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,66258,,"25,057 x DRG weight",66258,Other,base rate x DRG weight,59634,,"22,552 x DRG weight",59634,Other,base rate x DRG weight,66258,,"25,057 x DRG weight",66258,Other,base rate x DRG weight,56318,,"21,298 x DRG weight",56318,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,295391,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,,inpatient,,,510319.69,70409,,,70409,Other,150% of Medicare + 9.63% HCRA Surcharge,42816.3,,,42816.3,Other,Medicare IPPS methodology,127209,,"25,046 x DRG weight",127209,Other,base rate x DRG weight,114486,,"22,541 x DRG weight",114486,Other,base rate x DRG weight,162990,,"32,091 x DRG weight",162990,Other,base rate x DRG weight,146692,,"28,882 x DRG weight",146692,Other,base rate x DRG weight,138540,,"27,277 x DRG weight",138540,Other,base rate x DRG weight,122302,,"24,080 x DRG weight",122302,Other,base rate x DRG weight,114090,,"22,463 x DRG weight",114090,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,134218,,"26,426 x DRG weight",134218,Other,base rate x DRG weight,197111,,"38,809 x DRG weight",197111,Other,base rate x DRG weight,197111,,"38,809 x DRG weight",197111,Other,base rate x DRG weight,134218,,"26,426 x DRG weight",134218,Other,base rate x DRG weight,197111,,"38,809 x DRG weight",197111,Other,base rate x DRG weight,82719,,"6,363 x patient days",82719,Per diem,,357224,70,,357224,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,127265,,"25,057 x DRG weight",127265,Other,base rate x DRG weight,114542,,"22,552 x DRG weight",114542,Other,base rate x DRG weight,127265,,"25,057 x DRG weight",127265,Other,base rate x DRG weight,108173,,"21,298 x DRG weight",108173,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,357224,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,,inpatient,,,210636.53,34897,,,34897,Other,150% of Medicare + 9.63% HCRA Surcharge,21221.01,,,21221.01,Other,Medicare IPPS methodology,62550,,"25,046 x DRG weight",62550,Other,base rate x DRG weight,56294,,"22,541 x DRG weight",56294,Other,base rate x DRG weight,80144,,"32,091 x DRG weight",80144,Other,base rate x DRG weight,72130,,"28,882 x DRG weight",72130,Other,base rate x DRG weight,68122,,"27,277 x DRG weight",68122,Other,base rate x DRG weight,60137,,"24,080 x DRG weight",60137,Other,base rate x DRG weight,56099,,"22,463 x DRG weight",56099,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,65996,,"26,426 x DRG weight",65996,Other,base rate x DRG weight,96922,,"38,809 x DRG weight",96922,Other,base rate x DRG weight,96922,,"38,809 x DRG weight",96922,Other,base rate x DRG weight,65996,,"26,426 x DRG weight",65996,Other,base rate x DRG weight,96922,,"38,809 x DRG weight",96922,Other,base rate x DRG weight,38178,,"6,363 x patient days",38178,Per diem,,147446,70,,147446,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,62577,,"25,057 x DRG weight",62577,Other,base rate x DRG weight,56321,,"22,552 x DRG weight",56321,Other,base rate x DRG weight,62577,,"25,057 x DRG weight",62577,Other,base rate x DRG weight,53190,,"21,298 x DRG weight",53190,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,147446,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,,inpatient,,,104022.57,22515,,,22515,Other,150% of Medicare + 9.63% HCRA Surcharge,13691.61,,,13691.61,Other,Medicare IPPS methodology,40006,,"25,046 x DRG weight",40006,Other,base rate x DRG weight,36005,,"22,541 x DRG weight",36005,Other,base rate x DRG weight,51259,,"32,091 x DRG weight",51259,Other,base rate x DRG weight,46133,,"28,882 x DRG weight",46133,Other,base rate x DRG weight,43570,,"27,277 x DRG weight",43570,Other,base rate x DRG weight,38463,,"24,080 x DRG weight",38463,Other,base rate x DRG weight,35880,,"22,463 x DRG weight",35880,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42210,,"26,426 x DRG weight",42210,Other,base rate x DRG weight,61990,,"38,809 x DRG weight",61990,Other,base rate x DRG weight,61990,,"38,809 x DRG weight",61990,Other,base rate x DRG weight,42210,,"26,426 x DRG weight",42210,Other,base rate x DRG weight,61990,,"38,809 x DRG weight",61990,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,72816,70,,72816,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40024,,"25,057 x DRG weight",40024,Other,base rate x DRG weight,36022,,"22,552 x DRG weight",36022,Other,base rate x DRG weight,40024,,"25,057 x DRG weight",40024,Other,base rate x DRG weight,34019,,"21,298 x DRG weight",34019,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,72816,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,,inpatient,,,541805.78,62676,,,62676,Other,150% of Medicare + 9.63% HCRA Surcharge,38113.45,,,38113.45,Other,Medicare IPPS methodology,113128,,"25,046 x DRG weight",113128,Other,base rate x DRG weight,101813,,"22,541 x DRG weight",101813,Other,base rate x DRG weight,144949,,"32,091 x DRG weight",144949,Other,base rate x DRG weight,130454,,"28,882 x DRG weight",130454,Other,base rate x DRG weight,123205,,"27,277 x DRG weight",123205,Other,base rate x DRG weight,108765,,"24,080 x DRG weight",108765,Other,base rate x DRG weight,101461,,"22,463 x DRG weight",101461,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,119361,,"26,426 x DRG weight",119361,Other,base rate x DRG weight,175292,,"38,809 x DRG weight",175292,Other,base rate x DRG weight,175292,,"38,809 x DRG weight",175292,Other,base rate x DRG weight,119361,,"26,426 x DRG weight",119361,Other,base rate x DRG weight,175292,,"38,809 x DRG weight",175292,Other,base rate x DRG weight,80810,,"6,363 x patient days",80810,Per diem,,379264,70,,379264,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,113177,,"25,057 x DRG weight",113177,Other,base rate x DRG weight,101863,,"22,552 x DRG weight",101863,Other,base rate x DRG weight,113177,,"25,057 x DRG weight",113177,Other,base rate x DRG weight,96199,,"21,298 x DRG weight",96199,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,379264,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,,inpatient,,,262953.11,33173,,,33173,Other,150% of Medicare + 9.63% HCRA Surcharge,20172.87,,,20172.87,Other,Medicare IPPS methodology,59412,,"25,046 x DRG weight",59412,Other,base rate x DRG weight,53470,,"22,541 x DRG weight",53470,Other,base rate x DRG weight,76123,,"32,091 x DRG weight",76123,Other,base rate x DRG weight,68511,,"28,882 x DRG weight",68511,Other,base rate x DRG weight,64704,,"27,277 x DRG weight",64704,Other,base rate x DRG weight,57120,,"24,080 x DRG weight",57120,Other,base rate x DRG weight,53284,,"22,463 x DRG weight",53284,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,62685,,"26,426 x DRG weight",62685,Other,base rate x DRG weight,92059,,"38,809 x DRG weight",92059,Other,base rate x DRG weight,92059,,"38,809 x DRG weight",92059,Other,base rate x DRG weight,62685,,"26,426 x DRG weight",62685,Other,base rate x DRG weight,92059,,"38,809 x DRG weight",92059,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,184067,70,,184067,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,59438,,"25,057 x DRG weight",59438,Other,base rate x DRG weight,53496,,"22,552 x DRG weight",53496,Other,base rate x DRG weight,59438,,"25,057 x DRG weight",59438,Other,base rate x DRG weight,50521,,"21,298 x DRG weight",50521,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,184067,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,,inpatient,,,144011.03,23543,,,23543,Other,150% of Medicare + 9.63% HCRA Surcharge,14316.48,,,14316.48,Other,Medicare IPPS methodology,41877,,"25,046 x DRG weight",41877,Other,base rate x DRG weight,37689,,"22,541 x DRG weight",37689,Other,base rate x DRG weight,53656,,"32,091 x DRG weight",53656,Other,base rate x DRG weight,48291,,"28,882 x DRG weight",48291,Other,base rate x DRG weight,45607,,"27,277 x DRG weight",45607,Other,base rate x DRG weight,40262,,"24,080 x DRG weight",40262,Other,base rate x DRG weight,37558,,"22,463 x DRG weight",37558,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,44184,,"26,426 x DRG weight",44184,Other,base rate x DRG weight,64889,,"38,809 x DRG weight",64889,Other,base rate x DRG weight,64889,,"38,809 x DRG weight",64889,Other,base rate x DRG weight,44184,,"26,426 x DRG weight",44184,Other,base rate x DRG weight,64889,,"38,809 x DRG weight",64889,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,100808,70,,100808,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,41895,,"25,057 x DRG weight",41895,Other,base rate x DRG weight,37707,,"22,552 x DRG weight",37707,Other,base rate x DRG weight,41895,,"25,057 x DRG weight",41895,Other,base rate x DRG weight,35610,,"21,298 x DRG weight",35610,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,100808,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,,inpatient,,,511895.78,50811,,,50811,Other,150% of Medicare + 9.63% HCRA Surcharge,30898.57,,,30898.57,Other,Medicare IPPS methodology,91526,,"25,046 x DRG weight",91526,Other,base rate x DRG weight,82372,,"22,541 x DRG weight",82372,Other,base rate x DRG weight,117270,,"32,091 x DRG weight",117270,Other,base rate x DRG weight,105543,,"28,882 x DRG weight",105543,Other,base rate x DRG weight,99678,,"27,277 x DRG weight",99678,Other,base rate x DRG weight,87996,,"24,080 x DRG weight",87996,Other,base rate x DRG weight,82087,,"22,463 x DRG weight",82087,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,96569,,"26,426 x DRG weight",96569,Other,base rate x DRG weight,141820,,"38,809 x DRG weight",141820,Other,base rate x DRG weight,141820,,"38,809 x DRG weight",141820,Other,base rate x DRG weight,96569,,"26,426 x DRG weight",96569,Other,base rate x DRG weight,141820,,"38,809 x DRG weight",141820,Other,base rate x DRG weight,57267,,"6,363 x patient days",57267,Per diem,,358327,70,,358327,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,91566,,"25,057 x DRG weight",91566,Other,base rate x DRG weight,82412,,"22,552 x DRG weight",82412,Other,base rate x DRG weight,91566,,"25,057 x DRG weight",91566,Other,base rate x DRG weight,77829,,"21,298 x DRG weight",77829,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,358327,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,,inpatient,,,86800.71,29148,,,29148,Other,150% of Medicare + 9.63% HCRA Surcharge,17725.25,,,17725.25,Other,Medicare IPPS methodology,52083,,"25,046 x DRG weight",52083,Other,base rate x DRG weight,46874,,"22,541 x DRG weight",46874,Other,base rate x DRG weight,66733,,"32,091 x DRG weight",66733,Other,base rate x DRG weight,60060,,"28,882 x DRG weight",60060,Other,base rate x DRG weight,56723,,"27,277 x DRG weight",56723,Other,base rate x DRG weight,50074,,"24,080 x DRG weight",50074,Other,base rate x DRG weight,46712,,"22,463 x DRG weight",46712,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,54953,,"26,426 x DRG weight",54953,Other,base rate x DRG weight,80703,,"38,809 x DRG weight",80703,Other,base rate x DRG weight,80703,,"38,809 x DRG weight",80703,Other,base rate x DRG weight,54953,,"26,426 x DRG weight",54953,Other,base rate x DRG weight,80703,,"38,809 x DRG weight",80703,Other,base rate x DRG weight,27997,,"6,363 x patient days",27997,Per diem,,60760,70,,60760,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52106,,"25,057 x DRG weight",52106,Other,base rate x DRG weight,46897,,"22,552 x DRG weight",46897,Other,base rate x DRG weight,52106,,"25,057 x DRG weight",52106,Other,base rate x DRG weight,44289,,"21,298 x DRG weight",44289,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,80703,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,,inpatient,,,126740.94,22622,,,22622,Other,150% of Medicare + 9.63% HCRA Surcharge,13756.86,,,13756.86,Other,Medicare IPPS methodology,40201,,"25,046 x DRG weight",40201,Other,base rate x DRG weight,36181,,"22,541 x DRG weight",36181,Other,base rate x DRG weight,51509,,"32,091 x DRG weight",51509,Other,base rate x DRG weight,46358,,"28,882 x DRG weight",46358,Other,base rate x DRG weight,43782,,"27,277 x DRG weight",43782,Other,base rate x DRG weight,38651,,"24,080 x DRG weight",38651,Other,base rate x DRG weight,36055,,"22,463 x DRG weight",36055,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42416,,"26,426 x DRG weight",42416,Other,base rate x DRG weight,62292,,"38,809 x DRG weight",62292,Other,base rate x DRG weight,62292,,"38,809 x DRG weight",62292,Other,base rate x DRG weight,42416,,"26,426 x DRG weight",42416,Other,base rate x DRG weight,62292,,"38,809 x DRG weight",62292,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,88719,70,,88719,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40219,,"25,057 x DRG weight",40219,Other,base rate x DRG weight,36198,,"22,552 x DRG weight",36198,Other,base rate x DRG weight,40219,,"25,057 x DRG weight",40219,Other,base rate x DRG weight,34185,,"21,298 x DRG weight",34185,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,88719,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,,inpatient,,,353724.21,49720,,,49720,Other,150% of Medicare + 9.63% HCRA Surcharge,30235.22,,,30235.22,Other,Medicare IPPS methodology,89539,,"25,046 x DRG weight",89539,Other,base rate x DRG weight,80584,,"22,541 x DRG weight",80584,Other,base rate x DRG weight,114725,,"32,091 x DRG weight",114725,Other,base rate x DRG weight,103253,,"28,882 x DRG weight",103253,Other,base rate x DRG weight,97515,,"27,277 x DRG weight",97515,Other,base rate x DRG weight,86086,,"24,080 x DRG weight",86086,Other,base rate x DRG weight,80305,,"22,463 x DRG weight",80305,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,94473,,"26,426 x DRG weight",94473,Other,base rate x DRG weight,138742,,"38,809 x DRG weight",138742,Other,base rate x DRG weight,138742,,"38,809 x DRG weight",138742,Other,base rate x DRG weight,94473,,"26,426 x DRG weight",94473,Other,base rate x DRG weight,138742,,"38,809 x DRG weight",138742,Other,base rate x DRG weight,71266,,"6,363 x patient days",71266,Per diem,,247607,70,,247607,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,89579,,"25,057 x DRG weight",89579,Other,base rate x DRG weight,80623,,"22,552 x DRG weight",80623,Other,base rate x DRG weight,89579,,"25,057 x DRG weight",89579,Other,base rate x DRG weight,76140,,"21,298 x DRG weight",76140,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,247607,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,,inpatient,,,240481.91,29503,,,29503,Other,150% of Medicare + 9.63% HCRA Surcharge,17941.07,,,17941.07,Other,Medicare IPPS methodology,52729,,"25,046 x DRG weight",52729,Other,base rate x DRG weight,47456,,"22,541 x DRG weight",47456,Other,base rate x DRG weight,67561,,"32,091 x DRG weight",67561,Other,base rate x DRG weight,60805,,"28,882 x DRG weight",60805,Other,base rate x DRG weight,57426,,"27,277 x DRG weight",57426,Other,base rate x DRG weight,50696,,"24,080 x DRG weight",50696,Other,base rate x DRG weight,47291,,"22,463 x DRG weight",47291,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,55635,,"26,426 x DRG weight",55635,Other,base rate x DRG weight,81705,,"38,809 x DRG weight",81705,Other,base rate x DRG weight,81705,,"38,809 x DRG weight",81705,Other,base rate x DRG weight,55635,,"26,426 x DRG weight",55635,Other,base rate x DRG weight,81705,,"38,809 x DRG weight",81705,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,168337,70,,168337,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52753,,"25,057 x DRG weight",52753,Other,base rate x DRG weight,47479,,"22,552 x DRG weight",47479,Other,base rate x DRG weight,52753,,"25,057 x DRG weight",52753,Other,base rate x DRG weight,44839,,"21,298 x DRG weight",44839,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,168337,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,,inpatient,,,130269.51,21127,,,21127,Other,150% of Medicare + 9.63% HCRA Surcharge,12847.57,,,12847.57,Other,Medicare IPPS methodology,37479,,"25,046 x DRG weight",37479,Other,base rate x DRG weight,33730,,"22,541 x DRG weight",33730,Other,base rate x DRG weight,48021,,"32,091 x DRG weight",48021,Other,base rate x DRG weight,43219,,"28,882 x DRG weight",43219,Other,base rate x DRG weight,40817,,"27,277 x DRG weight",40817,Other,base rate x DRG weight,36033,,"24,080 x DRG weight",36033,Other,base rate x DRG weight,33614,,"22,463 x DRG weight",33614,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39544,,"26,426 x DRG weight",39544,Other,base rate x DRG weight,58074,,"38,809 x DRG weight",58074,Other,base rate x DRG weight,58074,,"38,809 x DRG weight",58074,Other,base rate x DRG weight,39544,,"26,426 x DRG weight",39544,Other,base rate x DRG weight,58074,,"38,809 x DRG weight",58074,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,91189,70,,91189,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37495,,"25,057 x DRG weight",37495,Other,base rate x DRG weight,33747,,"22,552 x DRG weight",33747,Other,base rate x DRG weight,37495,,"25,057 x DRG weight",37495,Other,base rate x DRG weight,31870,,"21,298 x DRG weight",31870,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,91189,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,,inpatient,,,260881.91,38240,,,38240,Other,150% of Medicare + 9.63% HCRA Surcharge,23253.73,,,23253.73,Other,Medicare IPPS methodology,68636,,"25,046 x DRG weight",68636,Other,base rate x DRG weight,61771,,"22,541 x DRG weight",61771,Other,base rate x DRG weight,87942,,"32,091 x DRG weight",87942,Other,base rate x DRG weight,79148,,"28,882 x DRG weight",79148,Other,base rate x DRG weight,74750,,"27,277 x DRG weight",74750,Other,base rate x DRG weight,65989,,"24,080 x DRG weight",65989,Other,base rate x DRG weight,61558,,"22,463 x DRG weight",61558,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,72418,,"26,426 x DRG weight",72418,Other,base rate x DRG weight,106352,,"38,809 x DRG weight",106352,Other,base rate x DRG weight,106352,,"38,809 x DRG weight",106352,Other,base rate x DRG weight,72418,,"26,426 x DRG weight",72418,Other,base rate x DRG weight,106352,,"38,809 x DRG weight",106352,Other,base rate x DRG weight,62357,,"6,363 x patient days",62357,Per diem,,182617,70,,182617,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,68666,,"25,057 x DRG weight",68666,Other,base rate x DRG weight,61802,,"22,552 x DRG weight",61802,Other,base rate x DRG weight,68666,,"25,057 x DRG weight",68666,Other,base rate x DRG weight,58365,,"21,298 x DRG weight",58365,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,182617,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,,inpatient,,,217741.13,21735,,,21735,Other,150% of Medicare + 9.63% HCRA Surcharge,13217.31,,,13217.31,Other,Medicare IPPS methodology,38586,,"25,046 x DRG weight",38586,Other,base rate x DRG weight,34727,,"22,541 x DRG weight",34727,Other,base rate x DRG weight,49439,,"32,091 x DRG weight",49439,Other,base rate x DRG weight,44496,,"28,882 x DRG weight",44496,Other,base rate x DRG weight,42023,,"27,277 x DRG weight",42023,Other,base rate x DRG weight,37098,,"24,080 x DRG weight",37098,Other,base rate x DRG weight,34606,,"22,463 x DRG weight",34606,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40712,,"26,426 x DRG weight",40712,Other,base rate x DRG weight,59789,,"38,809 x DRG weight",59789,Other,base rate x DRG weight,59789,,"38,809 x DRG weight",59789,Other,base rate x DRG weight,40712,,"26,426 x DRG weight",40712,Other,base rate x DRG weight,59789,,"38,809 x DRG weight",59789,Other,base rate x DRG weight,33724,,"6,363 x patient days",33724,Per diem,,152419,70,,152419,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38603,,"25,057 x DRG weight",38603,Other,base rate x DRG weight,34744,,"22,552 x DRG weight",34744,Other,base rate x DRG weight,38603,,"25,057 x DRG weight",38603,Other,base rate x DRG weight,32812,,"21,298 x DRG weight",32812,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,152419,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,,inpatient,,,124639,18258,,,18258,Other,150% of Medicare + 9.63% HCRA Surcharge,11102.62,,,11102.62,Other,Medicare IPPS methodology,32254,,"25,046 x DRG weight",32254,Other,base rate x DRG weight,29028,,"22,541 x DRG weight",29028,Other,base rate x DRG weight,41327,,"32,091 x DRG weight",41327,Other,base rate x DRG weight,37194,,"28,882 x DRG weight",37194,Other,base rate x DRG weight,35127,,"27,277 x DRG weight",35127,Other,base rate x DRG weight,31010,,"24,080 x DRG weight",31010,Other,base rate x DRG weight,28928,,"22,463 x DRG weight",28928,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34031,,"26,426 x DRG weight",34031,Other,base rate x DRG weight,49978,,"38,809 x DRG weight",49978,Other,base rate x DRG weight,49978,,"38,809 x DRG weight",49978,Other,base rate x DRG weight,34031,,"26,426 x DRG weight",34031,Other,base rate x DRG weight,49978,,"38,809 x DRG weight",49978,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,87247,70,,87247,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32268,,"25,057 x DRG weight",32268,Other,base rate x DRG weight,29042,,"22,552 x DRG weight",29042,Other,base rate x DRG weight,32268,,"25,057 x DRG weight",32268,Other,base rate x DRG weight,27428,,"21,298 x DRG weight",27428,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,87247,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,,inpatient,,,429562.31,35608,,,35608,Other,150% of Medicare + 9.63% HCRA Surcharge,21653.49,,,21653.49,Other,Medicare IPPS methodology,63845,,"25,046 x DRG weight",63845,Other,base rate x DRG weight,57459,,"22,541 x DRG weight",57459,Other,base rate x DRG weight,81803,,"32,091 x DRG weight",81803,Other,base rate x DRG weight,73623,,"28,882 x DRG weight",73623,Other,base rate x DRG weight,69532,,"27,277 x DRG weight",69532,Other,base rate x DRG weight,61382,,"24,080 x DRG weight",61382,Other,base rate x DRG weight,57260,,"22,463 x DRG weight",57260,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,67363,,"26,426 x DRG weight",67363,Other,base rate x DRG weight,98928,,"38,809 x DRG weight",98928,Other,base rate x DRG weight,98928,,"38,809 x DRG weight",98928,Other,base rate x DRG weight,67363,,"26,426 x DRG weight",67363,Other,base rate x DRG weight,98928,,"38,809 x DRG weight",98928,Other,base rate x DRG weight,49631,,"6,363 x patient days",49631,Per diem,,300694,70,,300694,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,63873,,"25,057 x DRG weight",63873,Other,base rate x DRG weight,57487,,"22,552 x DRG weight",57487,Other,base rate x DRG weight,63873,,"25,057 x DRG weight",63873,Other,base rate x DRG weight,54291,,"21,298 x DRG weight",54291,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,300694,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,,inpatient,,,139982.84,18445,,,18445,Other,150% of Medicare + 9.63% HCRA Surcharge,11216.38,,,11216.38,Other,Medicare IPPS methodology,32595,,"25,046 x DRG weight",32595,Other,base rate x DRG weight,29335,,"22,541 x DRG weight",29335,Other,base rate x DRG weight,41763,,"32,091 x DRG weight",41763,Other,base rate x DRG weight,37587,,"28,882 x DRG weight",37587,Other,base rate x DRG weight,35498,,"27,277 x DRG weight",35498,Other,base rate x DRG weight,31338,,"24,080 x DRG weight",31338,Other,base rate x DRG weight,29233,,"22,463 x DRG weight",29233,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34391,,"26,426 x DRG weight",34391,Other,base rate x DRG weight,50506,,"38,809 x DRG weight",50506,Other,base rate x DRG weight,50506,,"38,809 x DRG weight",50506,Other,base rate x DRG weight,34391,,"26,426 x DRG weight",34391,Other,base rate x DRG weight,50506,,"38,809 x DRG weight",50506,Other,base rate x DRG weight,26088,,"6,363 x patient days",26088,Per diem,,97988,70,,97988,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32609,,"25,057 x DRG weight",32609,Other,base rate x DRG weight,29349,,"22,552 x DRG weight",29349,Other,base rate x DRG weight,32609,,"25,057 x DRG weight",32609,Other,base rate x DRG weight,27717,,"21,298 x DRG weight",27717,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,97988,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,,inpatient,,,58439.29,13966,,,13966,Other,150% of Medicare + 9.63% HCRA Surcharge,8492.71,,,8492.71,Other,Medicare IPPS methodology,24440,,"25,046 x DRG weight",24440,Other,base rate x DRG weight,21996,,"22,541 x DRG weight",21996,Other,base rate x DRG weight,31314,,"32,091 x DRG weight",31314,Other,base rate x DRG weight,28183,,"28,882 x DRG weight",28183,Other,base rate x DRG weight,26617,,"27,277 x DRG weight",26617,Other,base rate x DRG weight,23497,,"24,080 x DRG weight",23497,Other,base rate x DRG weight,21919,,"22,463 x DRG weight",21919,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25786,,"26,426 x DRG weight",25786,Other,base rate x DRG weight,37870,,"38,809 x DRG weight",37870,Other,base rate x DRG weight,37870,,"38,809 x DRG weight",37870,Other,base rate x DRG weight,25786,,"26,426 x DRG weight",25786,Other,base rate x DRG weight,37870,,"38,809 x DRG weight",37870,Other,base rate x DRG weight,13999,,"6,363 x patient days",13999,Per diem,,40908,70,,40908,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24451,,"25,057 x DRG weight",24451,Other,base rate x DRG weight,22006,,"22,552 x DRG weight",22006,Other,base rate x DRG weight,24451,,"25,057 x DRG weight",24451,Other,base rate x DRG weight,20783,,"21,298 x DRG weight",20783,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,40908,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,,inpatient,,,146612.33,33557,,,33557,Other,150% of Medicare + 9.63% HCRA Surcharge,20406.25,,,20406.25,Other,Medicare IPPS methodology,60110,,"25,046 x DRG weight",60110,Other,base rate x DRG weight,54098,,"22,541 x DRG weight",54098,Other,base rate x DRG weight,77018,,"32,091 x DRG weight",77018,Other,base rate x DRG weight,69317,,"28,882 x DRG weight",69317,Other,base rate x DRG weight,65465,,"27,277 x DRG weight",65465,Other,base rate x DRG weight,57792,,"24,080 x DRG weight",57792,Other,base rate x DRG weight,53911,,"22,463 x DRG weight",53911,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,63422,,"26,426 x DRG weight",63422,Other,base rate x DRG weight,93142,,"38,809 x DRG weight",93142,Other,base rate x DRG weight,93142,,"38,809 x DRG weight",93142,Other,base rate x DRG weight,63422,,"26,426 x DRG weight",63422,Other,base rate x DRG weight,93142,,"38,809 x DRG weight",93142,Other,base rate x DRG weight,41360,,"6,363 x patient days",41360,Per diem,,102629,70,,102629,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,60137,,"25,057 x DRG weight",60137,Other,base rate x DRG weight,54125,,"22,552 x DRG weight",54125,Other,base rate x DRG weight,60137,,"25,057 x DRG weight",60137,Other,base rate x DRG weight,51115,,"21,298 x DRG weight",51115,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,102629,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,,inpatient,,,134953.04,20566,,,20566,Other,150% of Medicare + 9.63% HCRA Surcharge,12506.28,,,12506.28,Other,Medicare IPPS methodology,36457,,"25,046 x DRG weight",36457,Other,base rate x DRG weight,32811,,"22,541 x DRG weight",32811,Other,base rate x DRG weight,46712,,"32,091 x DRG weight",46712,Other,base rate x DRG weight,42041,,"28,882 x DRG weight",42041,Other,base rate x DRG weight,39704,,"27,277 x DRG weight",39704,Other,base rate x DRG weight,35051,,"24,080 x DRG weight",35051,Other,base rate x DRG weight,32697,,"22,463 x DRG weight",32697,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,38466,,"26,426 x DRG weight",38466,Other,base rate x DRG weight,56490,,"38,809 x DRG weight",56490,Other,base rate x DRG weight,56490,,"38,809 x DRG weight",56490,Other,base rate x DRG weight,38466,,"26,426 x DRG weight",38466,Other,base rate x DRG weight,56490,,"38,809 x DRG weight",56490,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,94467,70,,94467,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,36473,,"25,057 x DRG weight",36473,Other,base rate x DRG weight,32827,,"22,552 x DRG weight",32827,Other,base rate x DRG weight,36473,,"25,057 x DRG weight",36473,Other,base rate x DRG weight,31001,,"21,298 x DRG weight",31001,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,94467,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,,inpatient,,,111772.39,15798,,,15798,Other,150% of Medicare + 9.63% HCRA Surcharge,9606.94,,,9606.94,Other,Medicare IPPS methodology,27776,,"25,046 x DRG weight",27776,Other,base rate x DRG weight,24998,,"22,541 x DRG weight",24998,Other,base rate x DRG weight,35589,,"32,091 x DRG weight",35589,Other,base rate x DRG weight,32030,,"28,882 x DRG weight",32030,Other,base rate x DRG weight,30250,,"27,277 x DRG weight",30250,Other,base rate x DRG weight,26705,,"24,080 x DRG weight",26705,Other,base rate x DRG weight,24911,,"22,463 x DRG weight",24911,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,29306,,"26,426 x DRG weight",29306,Other,base rate x DRG weight,43039,,"38,809 x DRG weight",43039,Other,base rate x DRG weight,43039,,"38,809 x DRG weight",43039,Other,base rate x DRG weight,29306,,"26,426 x DRG weight",29306,Other,base rate x DRG weight,43039,,"38,809 x DRG weight",43039,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,78241,70,,78241,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27788,,"25,057 x DRG weight",27788,Other,base rate x DRG weight,25010,,"22,552 x DRG weight",25010,Other,base rate x DRG weight,27788,,"25,057 x DRG weight",27788,Other,base rate x DRG weight,23619,,"21,298 x DRG weight",23619,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,78241,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,,inpatient,,,253158.37,40769,,,40769,Other,150% of Medicare + 9.63% HCRA Surcharge,24792.06,,,24792.06,Other,Medicare IPPS methodology,73242,,"25,046 x DRG weight",73242,Other,base rate x DRG weight,65917,,"22,541 x DRG weight",65917,Other,base rate x DRG weight,93844,,"32,091 x DRG weight",93844,Other,base rate x DRG weight,84460,,"28,882 x DRG weight",84460,Other,base rate x DRG weight,79766,,"27,277 x DRG weight",79766,Other,base rate x DRG weight,70417,,"24,080 x DRG weight",70417,Other,base rate x DRG weight,65689,,"22,463 x DRG weight",65689,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,77278,,"26,426 x DRG weight",77278,Other,base rate x DRG weight,113489,,"38,809 x DRG weight",113489,Other,base rate x DRG weight,113489,,"38,809 x DRG weight",113489,Other,base rate x DRG weight,77278,,"26,426 x DRG weight",77278,Other,base rate x DRG weight,113489,,"38,809 x DRG weight",113489,Other,base rate x DRG weight,51540,,"6,363 x patient days",51540,Per diem,,177211,70,,177211,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,73274,,"25,057 x DRG weight",73274,Other,base rate x DRG weight,65949,,"22,552 x DRG weight",65949,Other,base rate x DRG weight,73274,,"25,057 x DRG weight",73274,Other,base rate x DRG weight,62282,,"21,298 x DRG weight",62282,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,177211,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,,inpatient,,,207376.47,24173,,,24173,Other,150% of Medicare + 9.63% HCRA Surcharge,14699.6,,,14699.6,Other,Medicare IPPS methodology,43024,,"25,046 x DRG weight",43024,Other,base rate x DRG weight,38721,,"22,541 x DRG weight",38721,Other,base rate x DRG weight,55126,,"32,091 x DRG weight",55126,Other,base rate x DRG weight,49613,,"28,882 x DRG weight",49613,Other,base rate x DRG weight,46856,,"27,277 x DRG weight",46856,Other,base rate x DRG weight,41365,,"24,080 x DRG weight",41365,Other,base rate x DRG weight,38587,,"22,463 x DRG weight",38587,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45395,,"26,426 x DRG weight",45395,Other,base rate x DRG weight,66666,,"38,809 x DRG weight",66666,Other,base rate x DRG weight,66666,,"38,809 x DRG weight",66666,Other,base rate x DRG weight,45395,,"26,426 x DRG weight",45395,Other,base rate x DRG weight,66666,,"38,809 x DRG weight",66666,Other,base rate x DRG weight,27997,,"6,363 x patient days",27997,Per diem,,145164,70,,145164,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43043,,"25,057 x DRG weight",43043,Other,base rate x DRG weight,38740,,"22,552 x DRG weight",38740,Other,base rate x DRG weight,43043,,"25,057 x DRG weight",43043,Other,base rate x DRG weight,36586,,"21,298 x DRG weight",36586,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,145164,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,,inpatient,,,96443.6,19287,,,19287,Other,150% of Medicare + 9.63% HCRA Surcharge,11728.32,,,11728.32,Other,Medicare IPPS methodology,34128,,"25,046 x DRG weight",34128,Other,base rate x DRG weight,30714,,"22,541 x DRG weight",30714,Other,base rate x DRG weight,43727,,"32,091 x DRG weight",43727,Other,base rate x DRG weight,39355,,"28,882 x DRG weight",39355,Other,base rate x DRG weight,37168,,"27,277 x DRG weight",37168,Other,base rate x DRG weight,32811,,"24,080 x DRG weight",32811,Other,base rate x DRG weight,30608,,"22,463 x DRG weight",30608,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,36008,,"26,426 x DRG weight",36008,Other,base rate x DRG weight,52881,,"38,809 x DRG weight",52881,Other,base rate x DRG weight,52881,,"38,809 x DRG weight",52881,Other,base rate x DRG weight,36008,,"26,426 x DRG weight",36008,Other,base rate x DRG weight,52881,,"38,809 x DRG weight",52881,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,67511,70,,67511,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,34143,,"25,057 x DRG weight",34143,Other,base rate x DRG weight,30729,,"22,552 x DRG weight",30729,Other,base rate x DRG weight,34143,,"25,057 x DRG weight",34143,Other,base rate x DRG weight,29021,,"21,298 x DRG weight",29021,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,67511,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,,inpatient,,,610805.36,59400,,,59400,Other,150% of Medicare + 9.63% HCRA Surcharge,36121.72,,,36121.72,Other,Medicare IPPS methodology,107164,,"25,046 x DRG weight",107164,Other,base rate x DRG weight,96446,,"22,541 x DRG weight",96446,Other,base rate x DRG weight,137308,,"32,091 x DRG weight",137308,Other,base rate x DRG weight,123577,,"28,882 x DRG weight",123577,Other,base rate x DRG weight,116710,,"27,277 x DRG weight",116710,Other,base rate x DRG weight,103031,,"24,080 x DRG weight",103031,Other,base rate x DRG weight,96112,,"22,463 x DRG weight",96112,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,113069,,"26,426 x DRG weight",113069,Other,base rate x DRG weight,166052,,"38,809 x DRG weight",166052,Other,base rate x DRG weight,166052,,"38,809 x DRG weight",166052,Other,base rate x DRG weight,113069,,"26,426 x DRG weight",113069,Other,base rate x DRG weight,166052,,"38,809 x DRG weight",166052,Other,base rate x DRG weight,69993,,"6,363 x patient days",69993,Per diem,,427564,70,,427564,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,107211,,"25,057 x DRG weight",107211,Other,base rate x DRG weight,96493,,"22,552 x DRG weight",96493,Other,base rate x DRG weight,107211,,"25,057 x DRG weight",107211,Other,base rate x DRG weight,91128,,"21,298 x DRG weight",91128,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,427564,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,,inpatient,,,250970.93,30762,,,30762,Other,150% of Medicare + 9.63% HCRA Surcharge,18706.47,,,18706.47,Other,Medicare IPPS methodology,55021,,"25,046 x DRG weight",55021,Other,base rate x DRG weight,49518,,"22,541 x DRG weight",49518,Other,base rate x DRG weight,70498,,"32,091 x DRG weight",70498,Other,base rate x DRG weight,63448,,"28,882 x DRG weight",63448,Other,base rate x DRG weight,59922,,"27,277 x DRG weight",59922,Other,base rate x DRG weight,52899,,"24,080 x DRG weight",52899,Other,base rate x DRG weight,49347,,"22,463 x DRG weight",49347,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,58053,,"26,426 x DRG weight",58053,Other,base rate x DRG weight,85256,,"38,809 x DRG weight",85256,Other,base rate x DRG weight,85256,,"38,809 x DRG weight",85256,Other,base rate x DRG weight,58053,,"26,426 x DRG weight",58053,Other,base rate x DRG weight,85256,,"38,809 x DRG weight",85256,Other,base rate x DRG weight,36269,,"6,363 x patient days",36269,Per diem,,175680,70,,175680,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,55045,,"25,057 x DRG weight",55045,Other,base rate x DRG weight,49542,,"22,552 x DRG weight",49542,Other,base rate x DRG weight,55045,,"25,057 x DRG weight",55045,Other,base rate x DRG weight,46787,,"21,298 x DRG weight",46787,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,175680,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,,inpatient,,,147974.66,18166,,,18166,Other,150% of Medicare + 9.63% HCRA Surcharge,11046.57,,,11046.57,Other,Medicare IPPS methodology,32086,,"25,046 x DRG weight",32086,Other,base rate x DRG weight,28877,,"22,541 x DRG weight",28877,Other,base rate x DRG weight,41112,,"32,091 x DRG weight",41112,Other,base rate x DRG weight,37001,,"28,882 x DRG weight",37001,Other,base rate x DRG weight,34945,,"27,277 x DRG weight",34945,Other,base rate x DRG weight,30849,,"24,080 x DRG weight",30849,Other,base rate x DRG weight,28777,,"22,463 x DRG weight",28777,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,33854,,"26,426 x DRG weight",33854,Other,base rate x DRG weight,49718,,"38,809 x DRG weight",49718,Other,base rate x DRG weight,49718,,"38,809 x DRG weight",49718,Other,base rate x DRG weight,33854,,"26,426 x DRG weight",33854,Other,base rate x DRG weight,49718,,"38,809 x DRG weight",49718,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,103582,70,,103582,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32101,,"25,057 x DRG weight",32101,Other,base rate x DRG weight,28891,,"22,552 x DRG weight",28891,Other,base rate x DRG weight,32101,,"25,057 x DRG weight",32101,Other,base rate x DRG weight,27285,,"21,298 x DRG weight",27285,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,103582,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,,inpatient,,,125057.04,23268,,,23268,Other,150% of Medicare + 9.63% HCRA Surcharge,14149.18,,,14149.18,Other,Medicare IPPS methodology,41376,,"25,046 x DRG weight",41376,Other,base rate x DRG weight,37238,,"22,541 x DRG weight",37238,Other,base rate x DRG weight,53014,,"32,091 x DRG weight",53014,Other,base rate x DRG weight,47713,,"28,882 x DRG weight",47713,Other,base rate x DRG weight,45062,,"27,277 x DRG weight",45062,Other,base rate x DRG weight,39780,,"24,080 x DRG weight",39780,Other,base rate x DRG weight,37109,,"22,463 x DRG weight",37109,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43656,,"26,426 x DRG weight",43656,Other,base rate x DRG weight,64112,,"38,809 x DRG weight",64112,Other,base rate x DRG weight,64112,,"38,809 x DRG weight",64112,Other,base rate x DRG weight,43656,,"26,426 x DRG weight",43656,Other,base rate x DRG weight,64112,,"38,809 x DRG weight",64112,Other,base rate x DRG weight,35633,,"6,363 x patient days",35633,Per diem,,87540,70,,87540,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,41394,,"25,057 x DRG weight",41394,Other,base rate x DRG weight,37256,,"22,552 x DRG weight",37256,Other,base rate x DRG weight,41394,,"25,057 x DRG weight",41394,Other,base rate x DRG weight,35184,,"21,298 x DRG weight",35184,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,87540,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,,inpatient,,,136788.2,14138,,,14138,Other,150% of Medicare + 9.63% HCRA Surcharge,8597.28,,,8597.28,Other,Medicare IPPS methodology,24753,,"25,046 x DRG weight",24753,Other,base rate x DRG weight,22277,,"22,541 x DRG weight",22277,Other,base rate x DRG weight,31716,,"32,091 x DRG weight",31716,Other,base rate x DRG weight,28544,,"28,882 x DRG weight",28544,Other,base rate x DRG weight,26958,,"27,277 x DRG weight",26958,Other,base rate x DRG weight,23798,,"24,080 x DRG weight",23798,Other,base rate x DRG weight,22200,,"22,463 x DRG weight",22200,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26117,,"26,426 x DRG weight",26117,Other,base rate x DRG weight,38355,,"38,809 x DRG weight",38355,Other,base rate x DRG weight,38355,,"38,809 x DRG weight",38355,Other,base rate x DRG weight,26117,,"26,426 x DRG weight",26117,Other,base rate x DRG weight,38355,,"38,809 x DRG weight",38355,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,95752,70,,95752,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24764,,"25,057 x DRG weight",24764,Other,base rate x DRG weight,22288,,"22,552 x DRG weight",22288,Other,base rate x DRG weight,24764,,"25,057 x DRG weight",24764,Other,base rate x DRG weight,21049,,"21,298 x DRG weight",21049,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95752,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,,inpatient,,,55938.84,10773,,,10773,Other,150% of Medicare + 9.63% HCRA Surcharge,6551.18,,,6551.18,Other,Medicare IPPS methodology,18627,,"25,046 x DRG weight",18627,Other,base rate x DRG weight,16764,,"22,541 x DRG weight",16764,Other,base rate x DRG weight,23866,,"32,091 x DRG weight",23866,Other,base rate x DRG weight,21480,,"28,882 x DRG weight",21480,Other,base rate x DRG weight,20286,,"27,277 x DRG weight",20286,Other,base rate x DRG weight,17908,,"24,080 x DRG weight",17908,Other,base rate x DRG weight,16706,,"22,463 x DRG weight",16706,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19653,,"26,426 x DRG weight",19653,Other,base rate x DRG weight,28862,,"38,809 x DRG weight",28862,Other,base rate x DRG weight,28862,,"38,809 x DRG weight",28862,Other,base rate x DRG weight,19653,,"26,426 x DRG weight",19653,Other,base rate x DRG weight,28862,,"38,809 x DRG weight",28862,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,39157,70,,39157,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18635,,"25,057 x DRG weight",18635,Other,base rate x DRG weight,16772,,"22,552 x DRG weight",16772,Other,base rate x DRG weight,18635,,"25,057 x DRG weight",18635,Other,base rate x DRG weight,15839,,"21,298 x DRG weight",15839,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,39157,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,,inpatient,,,264384.74,24584,,,24584,Other,150% of Medicare + 9.63% HCRA Surcharge,14949.72,,,14949.72,Other,Medicare IPPS methodology,43773,,"25,046 x DRG weight",43773,Other,base rate x DRG weight,39395,,"22,541 x DRG weight",39395,Other,base rate x DRG weight,56085,,"32,091 x DRG weight",56085,Other,base rate x DRG weight,50477,,"28,882 x DRG weight",50477,Other,base rate x DRG weight,47672,,"27,277 x DRG weight",47672,Other,base rate x DRG weight,42085,,"24,080 x DRG weight",42085,Other,base rate x DRG weight,39259,,"22,463 x DRG weight",39259,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,46185,,"26,426 x DRG weight",46185,Other,base rate x DRG weight,67826,,"38,809 x DRG weight",67826,Other,base rate x DRG weight,67826,,"38,809 x DRG weight",67826,Other,base rate x DRG weight,46185,,"26,426 x DRG weight",46185,Other,base rate x DRG weight,67826,,"38,809 x DRG weight",67826,Other,base rate x DRG weight,45814,,"6,363 x patient days",45814,Per diem,,185069,70,,185069,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43792,,"25,057 x DRG weight",43792,Other,base rate x DRG weight,39414,,"22,552 x DRG weight",39414,Other,base rate x DRG weight,43792,,"25,057 x DRG weight",43792,Other,base rate x DRG weight,37223,,"21,298 x DRG weight",37223,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,185069,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,,inpatient,,,140654.67,14881,,,14881,Other,150% of Medicare + 9.63% HCRA Surcharge,9048.99,,,9048.99,Other,Medicare IPPS methodology,26105,,"25,046 x DRG weight",26105,Other,base rate x DRG weight,23494,,"22,541 x DRG weight",23494,Other,base rate x DRG weight,33448,,"32,091 x DRG weight",33448,Other,base rate x DRG weight,30104,,"28,882 x DRG weight",30104,Other,base rate x DRG weight,28431,,"27,277 x DRG weight",28431,Other,base rate x DRG weight,25099,,"24,080 x DRG weight",25099,Other,base rate x DRG weight,23413,,"22,463 x DRG weight",23413,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27544,,"26,426 x DRG weight",27544,Other,base rate x DRG weight,40451,,"38,809 x DRG weight",40451,Other,base rate x DRG weight,40451,,"38,809 x DRG weight",40451,Other,base rate x DRG weight,27544,,"26,426 x DRG weight",27544,Other,base rate x DRG weight,40451,,"38,809 x DRG weight",40451,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,98458,70,,98458,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26117,,"25,057 x DRG weight",26117,Other,base rate x DRG weight,23506,,"22,552 x DRG weight",23506,Other,base rate x DRG weight,26117,,"25,057 x DRG weight",26117,Other,base rate x DRG weight,22199,,"21,298 x DRG weight",22199,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,98458,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,,inpatient,,,87175.27,10399,,,10399,Other,150% of Medicare + 9.63% HCRA Surcharge,6323.65,,,6323.65,Other,Medicare IPPS methodology,17945,,"25,046 x DRG weight",17945,Other,base rate x DRG weight,16151,,"22,541 x DRG weight",16151,Other,base rate x DRG weight,22993,,"32,091 x DRG weight",22993,Other,base rate x DRG weight,20694,,"28,882 x DRG weight",20694,Other,base rate x DRG weight,19544,,"27,277 x DRG weight",19544,Other,base rate x DRG weight,17253,,"24,080 x DRG weight",17253,Other,base rate x DRG weight,16095,,"22,463 x DRG weight",16095,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18934,,"26,426 x DRG weight",18934,Other,base rate x DRG weight,27807,,"38,809 x DRG weight",27807,Other,base rate x DRG weight,27807,,"38,809 x DRG weight",27807,Other,base rate x DRG weight,18934,,"26,426 x DRG weight",18934,Other,base rate x DRG weight,27807,,"38,809 x DRG weight",27807,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,61023,70,,61023,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17953,,"25,057 x DRG weight",17953,Other,base rate x DRG weight,16159,,"22,552 x DRG weight",16159,Other,base rate x DRG weight,17953,,"25,057 x DRG weight",17953,Other,base rate x DRG weight,15260,,"21,298 x DRG weight",15260,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,61023,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,,inpatient,,,334803.01,29417,,,29417,Other,150% of Medicare + 9.63% HCRA Surcharge,17888.37,,,17888.37,Other,Medicare IPPS methodology,52572,,"25,046 x DRG weight",52572,Other,base rate x DRG weight,47314,,"22,541 x DRG weight",47314,Other,base rate x DRG weight,67359,,"32,091 x DRG weight",67359,Other,base rate x DRG weight,60623,,"28,882 x DRG weight",60623,Other,base rate x DRG weight,57254,,"27,277 x DRG weight",57254,Other,base rate x DRG weight,50544,,"24,080 x DRG weight",50544,Other,base rate x DRG weight,47150,,"22,463 x DRG weight",47150,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,55468,,"26,426 x DRG weight",55468,Other,base rate x DRG weight,81460,,"38,809 x DRG weight",81460,Other,base rate x DRG weight,81460,,"38,809 x DRG weight",81460,Other,base rate x DRG weight,55468,,"26,426 x DRG weight",55468,Other,base rate x DRG weight,81460,,"38,809 x DRG weight",81460,Other,base rate x DRG weight,48995,,"6,363 x patient days",48995,Per diem,,234362,70,,234362,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52595,,"25,057 x DRG weight",52595,Other,base rate x DRG weight,47337,,"22,552 x DRG weight",47337,Other,base rate x DRG weight,52595,,"25,057 x DRG weight",52595,Other,base rate x DRG weight,44705,,"21,298 x DRG weight",44705,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,234362,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,,inpatient,,,290067.91,17027,,,17027,Other,150% of Medicare + 9.63% HCRA Surcharge,10353.94,,,10353.94,Other,Medicare IPPS methodology,30013,,"25,046 x DRG weight",30013,Other,base rate x DRG weight,27011,,"22,541 x DRG weight",27011,Other,base rate x DRG weight,38455,,"32,091 x DRG weight",38455,Other,base rate x DRG weight,34609,,"28,882 x DRG weight",34609,Other,base rate x DRG weight,32686,,"27,277 x DRG weight",32686,Other,base rate x DRG weight,28855,,"24,080 x DRG weight",28855,Other,base rate x DRG weight,26917,,"22,463 x DRG weight",26917,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31666,,"26,426 x DRG weight",31666,Other,base rate x DRG weight,46505,,"38,809 x DRG weight",46505,Other,base rate x DRG weight,46505,,"38,809 x DRG weight",46505,Other,base rate x DRG weight,31666,,"26,426 x DRG weight",31666,Other,base rate x DRG weight,46505,,"38,809 x DRG weight",46505,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,203048,70,,203048,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30026,,"25,057 x DRG weight",30026,Other,base rate x DRG weight,27024,,"22,552 x DRG weight",27024,Other,base rate x DRG weight,30026,,"25,057 x DRG weight",30026,Other,base rate x DRG weight,25521,,"21,298 x DRG weight",25521,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,203048,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,,inpatient,,,154497.32,12805,,,12805,Other,150% of Medicare + 9.63% HCRA Surcharge,7786.7,,,7786.7,Other,Medicare IPPS methodology,22326,,"25,046 x DRG weight",22326,Other,base rate x DRG weight,20093,,"22,541 x DRG weight",20093,Other,base rate x DRG weight,28606,,"32,091 x DRG weight",28606,Other,base rate x DRG weight,25745,,"28,882 x DRG weight",25745,Other,base rate x DRG weight,24315,,"27,277 x DRG weight",24315,Other,base rate x DRG weight,21465,,"24,080 x DRG weight",21465,Other,base rate x DRG weight,20024,,"22,463 x DRG weight",20024,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23556,,"26,426 x DRG weight",23556,Other,base rate x DRG weight,34594,,"38,809 x DRG weight",34594,Other,base rate x DRG weight,34594,,"38,809 x DRG weight",34594,Other,base rate x DRG weight,23556,,"26,426 x DRG weight",23556,Other,base rate x DRG weight,34594,,"38,809 x DRG weight",34594,Other,base rate x DRG weight,19089,,"6,363 x patient days",19089,Per diem,,108148,70,,108148,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22336,,"25,057 x DRG weight",22336,Other,base rate x DRG weight,20103,,"22,552 x DRG weight",20103,Other,base rate x DRG weight,22336,,"25,057 x DRG weight",22336,Other,base rate x DRG weight,18985,,"21,298 x DRG weight",18985,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,108148,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,,inpatient,,,267641.88,25170,,,25170,Other,150% of Medicare + 9.63% HCRA Surcharge,15306.07,,,15306.07,Other,Medicare IPPS methodology,44840,,"25,046 x DRG weight",44840,Other,base rate x DRG weight,40355,,"22,541 x DRG weight",40355,Other,base rate x DRG weight,57453,,"32,091 x DRG weight",57453,Other,base rate x DRG weight,51707,,"28,882 x DRG weight",51707,Other,base rate x DRG weight,48834,,"27,277 x DRG weight",48834,Other,base rate x DRG weight,43110,,"24,080 x DRG weight",43110,Other,base rate x DRG weight,40216,,"22,463 x DRG weight",40216,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,47310,,"26,426 x DRG weight",47310,Other,base rate x DRG weight,69480,,"38,809 x DRG weight",69480,Other,base rate x DRG weight,69480,,"38,809 x DRG weight",69480,Other,base rate x DRG weight,47310,,"26,426 x DRG weight",47310,Other,base rate x DRG weight,69480,,"38,809 x DRG weight",69480,Other,base rate x DRG weight,38178,,"6,363 x patient days",38178,Per diem,,187349,70,,187349,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,44860,,"25,057 x DRG weight",44860,Other,base rate x DRG weight,40375,,"22,552 x DRG weight",40375,Other,base rate x DRG weight,44860,,"25,057 x DRG weight",44860,Other,base rate x DRG weight,38130,,"21,298 x DRG weight",38130,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,187349,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,,inpatient,,,137968.46,14076,,,14076,Other,150% of Medicare + 9.63% HCRA Surcharge,8559.63,,,8559.63,Other,Medicare IPPS methodology,24640,,"25,046 x DRG weight",24640,Other,base rate x DRG weight,22176,,"22,541 x DRG weight",22176,Other,base rate x DRG weight,31571,,"32,091 x DRG weight",31571,Other,base rate x DRG weight,28414,,"28,882 x DRG weight",28414,Other,base rate x DRG weight,26835,,"27,277 x DRG weight",26835,Other,base rate x DRG weight,23690,,"24,080 x DRG weight",23690,Other,base rate x DRG weight,22099,,"22,463 x DRG weight",22099,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25998,,"26,426 x DRG weight",25998,Other,base rate x DRG weight,38180,,"38,809 x DRG weight",38180,Other,base rate x DRG weight,38180,,"38,809 x DRG weight",38180,Other,base rate x DRG weight,25998,,"26,426 x DRG weight",25998,Other,base rate x DRG weight,38180,,"38,809 x DRG weight",38180,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,96578,70,,96578,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24651,,"25,057 x DRG weight",24651,Other,base rate x DRG weight,22187,,"22,552 x DRG weight",22187,Other,base rate x DRG weight,24651,,"25,057 x DRG weight",24651,Other,base rate x DRG weight,20953,,"21,298 x DRG weight",20953,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,96578,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,,inpatient,,,99890.04,9253,,,9253,Other,150% of Medicare + 9.63% HCRA Surcharge,5626.84,,,5626.84,Other,Medicare IPPS methodology,15859,,"25,046 x DRG weight",15859,Other,base rate x DRG weight,14273,,"22,541 x DRG weight",14273,Other,base rate x DRG weight,20320,,"32,091 x DRG weight",20320,Other,base rate x DRG weight,18288,,"28,882 x DRG weight",18288,Other,base rate x DRG weight,17272,,"27,277 x DRG weight",17272,Other,base rate x DRG weight,15247,,"24,080 x DRG weight",15247,Other,base rate x DRG weight,14224,,"22,463 x DRG weight",14224,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,16733,,"26,426 x DRG weight",16733,Other,base rate x DRG weight,24574,,"38,809 x DRG weight",24574,Other,base rate x DRG weight,24574,,"38,809 x DRG weight",24574,Other,base rate x DRG weight,16733,,"26,426 x DRG weight",16733,Other,base rate x DRG weight,24574,,"38,809 x DRG weight",24574,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,69923,70,,69923,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15866,,"25,057 x DRG weight",15866,Other,base rate x DRG weight,14280,,"22,552 x DRG weight",14280,Other,base rate x DRG weight,15866,,"25,057 x DRG weight",15866,Other,base rate x DRG weight,13486,,"21,298 x DRG weight",13486,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,69923,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,,inpatient,,,331567.02,27346,,,27346,Other,150% of Medicare + 9.63% HCRA Surcharge,16629.42,,,16629.42,Other,Medicare IPPS methodology,48802,,"25,046 x DRG weight",48802,Other,base rate x DRG weight,43921,,"22,541 x DRG weight",43921,Other,base rate x DRG weight,62529,,"32,091 x DRG weight",62529,Other,base rate x DRG weight,56277,,"28,882 x DRG weight",56277,Other,base rate x DRG weight,53149,,"27,277 x DRG weight",53149,Other,base rate x DRG weight,46920,,"24,080 x DRG weight",46920,Other,base rate x DRG weight,43769,,"22,463 x DRG weight",43769,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,51491,,"26,426 x DRG weight",51491,Other,base rate x DRG weight,75619,,"38,809 x DRG weight",75619,Other,base rate x DRG weight,75619,,"38,809 x DRG weight",75619,Other,base rate x DRG weight,51491,,"26,426 x DRG weight",51491,Other,base rate x DRG weight,75619,,"38,809 x DRG weight",75619,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,232097,70,,232097,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,48824,,"25,057 x DRG weight",48824,Other,base rate x DRG weight,43943,,"22,552 x DRG weight",43943,Other,base rate x DRG weight,48824,,"25,057 x DRG weight",48824,Other,base rate x DRG weight,41499,,"21,298 x DRG weight",41499,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,232097,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,,inpatient,,,259555.62,15303,,,15303,Other,150% of Medicare + 9.63% HCRA Surcharge,9305.8,,,9305.8,Other,Medicare IPPS methodology,26874,,"25,046 x DRG weight",26874,Other,base rate x DRG weight,24186,,"22,541 x DRG weight",24186,Other,base rate x DRG weight,34434,,"32,091 x DRG weight",34434,Other,base rate x DRG weight,30990,,"28,882 x DRG weight",30990,Other,base rate x DRG weight,29268,,"27,277 x DRG weight",29268,Other,base rate x DRG weight,25838,,"24,080 x DRG weight",25838,Other,base rate x DRG weight,24103,,"22,463 x DRG weight",24103,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28355,,"26,426 x DRG weight",28355,Other,base rate x DRG weight,41642,,"38,809 x DRG weight",41642,Other,base rate x DRG weight,41642,,"38,809 x DRG weight",41642,Other,base rate x DRG weight,28355,,"26,426 x DRG weight",28355,Other,base rate x DRG weight,41642,,"38,809 x DRG weight",41642,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,181689,70,,181689,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26886,,"25,057 x DRG weight",26886,Other,base rate x DRG weight,24198,,"22,552 x DRG weight",24198,Other,base rate x DRG weight,26886,,"25,057 x DRG weight",26886,Other,base rate x DRG weight,22853,,"21,298 x DRG weight",22853,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,181689,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,,inpatient,,,172009,10957,,,10957,Other,150% of Medicare + 9.63% HCRA Surcharge,6663.27,,,6663.27,Other,Medicare IPPS methodology,18962,,"25,046 x DRG weight",18962,Other,base rate x DRG weight,17066,,"22,541 x DRG weight",17066,Other,base rate x DRG weight,24296,,"32,091 x DRG weight",24296,Other,base rate x DRG weight,21867,,"28,882 x DRG weight",21867,Other,base rate x DRG weight,20651,,"27,277 x DRG weight",20651,Other,base rate x DRG weight,18231,,"24,080 x DRG weight",18231,Other,base rate x DRG weight,17007,,"22,463 x DRG weight",17007,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20007,,"26,426 x DRG weight",20007,Other,base rate x DRG weight,29382,,"38,809 x DRG weight",29382,Other,base rate x DRG weight,29382,,"38,809 x DRG weight",29382,Other,base rate x DRG weight,20007,,"26,426 x DRG weight",20007,Other,base rate x DRG weight,29382,,"38,809 x DRG weight",29382,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,120406,70,,120406,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18971,,"25,057 x DRG weight",18971,Other,base rate x DRG weight,17074,,"22,552 x DRG weight",17074,Other,base rate x DRG weight,18971,,"25,057 x DRG weight",18971,Other,base rate x DRG weight,16125,,"21,298 x DRG weight",16125,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,120406,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,,inpatient,,,378280.8,19776,,,19776,Other,150% of Medicare + 9.63% HCRA Surcharge,12026.12,,,12026.12,Other,Medicare IPPS methodology,35019,,"25,046 x DRG weight",35019,Other,base rate x DRG weight,31517,,"22,541 x DRG weight",31517,Other,base rate x DRG weight,44870,,"32,091 x DRG weight",44870,Other,base rate x DRG weight,40383,,"28,882 x DRG weight",40383,Other,base rate x DRG weight,38139,,"27,277 x DRG weight",38139,Other,base rate x DRG weight,33669,,"24,080 x DRG weight",33669,Other,base rate x DRG weight,31408,,"22,463 x DRG weight",31408,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,36949,,"26,426 x DRG weight",36949,Other,base rate x DRG weight,54263,,"38,809 x DRG weight",54263,Other,base rate x DRG weight,54263,,"38,809 x DRG weight",54263,Other,base rate x DRG weight,36949,,"26,426 x DRG weight",36949,Other,base rate x DRG weight,54263,,"38,809 x DRG weight",54263,Other,base rate x DRG weight,31179,,"6,363 x patient days",31179,Per diem,,264797,70,,264797,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35035,,"25,057 x DRG weight",35035,Other,base rate x DRG weight,31532,,"22,552 x DRG weight",31532,Other,base rate x DRG weight,35035,,"25,057 x DRG weight",35035,Other,base rate x DRG weight,29779,,"21,298 x DRG weight",29779,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,264797,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,,inpatient,,,101786.77,12589,,,12589,Other,150% of Medicare + 9.63% HCRA Surcharge,7655.37,,,7655.37,Other,Medicare IPPS methodology,21933,,"25,046 x DRG weight",21933,Other,base rate x DRG weight,19739,,"22,541 x DRG weight",19739,Other,base rate x DRG weight,28102,,"32,091 x DRG weight",28102,Other,base rate x DRG weight,25292,,"28,882 x DRG weight",25292,Other,base rate x DRG weight,23886,,"27,277 x DRG weight",23886,Other,base rate x DRG weight,21087,,"24,080 x DRG weight",21087,Other,base rate x DRG weight,19671,,"22,463 x DRG weight",19671,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23141,,"26,426 x DRG weight",23141,Other,base rate x DRG weight,33985,,"38,809 x DRG weight",33985,Other,base rate x DRG weight,33985,,"38,809 x DRG weight",33985,Other,base rate x DRG weight,23141,,"26,426 x DRG weight",23141,Other,base rate x DRG weight,33985,,"38,809 x DRG weight",33985,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,71251,70,,71251,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21942,,"25,057 x DRG weight",21942,Other,base rate x DRG weight,19749,,"22,552 x DRG weight",19749,Other,base rate x DRG weight,21942,,"25,057 x DRG weight",21942,Other,base rate x DRG weight,18651,,"21,298 x DRG weight",18651,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,71251,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,,inpatient,,,270251.77,22097,,,22097,Other,150% of Medicare + 9.63% HCRA Surcharge,13437.31,,,13437.31,Other,Medicare IPPS methodology,39245,,"25,046 x DRG weight",39245,Other,base rate x DRG weight,35319,,"22,541 x DRG weight",35319,Other,base rate x DRG weight,50283,,"32,091 x DRG weight",50283,Other,base rate x DRG weight,45255,,"28,882 x DRG weight",45255,Other,base rate x DRG weight,42740,,"27,277 x DRG weight",42740,Other,base rate x DRG weight,37731,,"24,080 x DRG weight",37731,Other,base rate x DRG weight,35197,,"22,463 x DRG weight",35197,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41407,,"26,426 x DRG weight",41407,Other,base rate x DRG weight,60810,,"38,809 x DRG weight",60810,Other,base rate x DRG weight,60810,,"38,809 x DRG weight",60810,Other,base rate x DRG weight,41407,,"26,426 x DRG weight",41407,Other,base rate x DRG weight,60810,,"38,809 x DRG weight",60810,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,189176,70,,189176,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39262,,"25,057 x DRG weight",39262,Other,base rate x DRG weight,35337,,"22,552 x DRG weight",35337,Other,base rate x DRG weight,39262,,"25,057 x DRG weight",39262,Other,base rate x DRG weight,33372,,"21,298 x DRG weight",33372,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,189176,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,,inpatient,,,176957.37,13908,,,13908,Other,150% of Medicare + 9.63% HCRA Surcharge,8457.58,,,8457.58,Other,Medicare IPPS methodology,24335,,"25,046 x DRG weight",24335,Other,base rate x DRG weight,21901,,"22,541 x DRG weight",21901,Other,base rate x DRG weight,31180,,"32,091 x DRG weight",31180,Other,base rate x DRG weight,28062,,"28,882 x DRG weight",28062,Other,base rate x DRG weight,26502,,"27,277 x DRG weight",26502,Other,base rate x DRG weight,23396,,"24,080 x DRG weight",23396,Other,base rate x DRG weight,21825,,"22,463 x DRG weight",21825,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25676,,"26,426 x DRG weight",25676,Other,base rate x DRG weight,37707,,"38,809 x DRG weight",37707,Other,base rate x DRG weight,37707,,"38,809 x DRG weight",37707,Other,base rate x DRG weight,25676,,"26,426 x DRG weight",25676,Other,base rate x DRG weight,37707,,"38,809 x DRG weight",37707,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,123870,70,,123870,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24345,,"25,057 x DRG weight",24345,Other,base rate x DRG weight,21912,,"22,552 x DRG weight",21912,Other,base rate x DRG weight,24345,,"25,057 x DRG weight",24345,Other,base rate x DRG weight,20693,,"21,298 x DRG weight",20693,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,123870,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,,inpatient,,,123584.17,9953,,,9953,Other,150% of Medicare + 9.63% HCRA Surcharge,6052.62,,,6052.62,Other,Medicare IPPS methodology,17134,,"25,046 x DRG weight",17134,Other,base rate x DRG weight,15420,,"22,541 x DRG weight",15420,Other,base rate x DRG weight,21953,,"32,091 x DRG weight",21953,Other,base rate x DRG weight,19758,,"28,882 x DRG weight",19758,Other,base rate x DRG weight,18660,,"27,277 x DRG weight",18660,Other,base rate x DRG weight,16473,,"24,080 x DRG weight",16473,Other,base rate x DRG weight,15367,,"22,463 x DRG weight",15367,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18078,,"26,426 x DRG weight",18078,Other,base rate x DRG weight,26549,,"38,809 x DRG weight",26549,Other,base rate x DRG weight,26549,,"38,809 x DRG weight",26549,Other,base rate x DRG weight,18078,,"26,426 x DRG weight",18078,Other,base rate x DRG weight,26549,,"38,809 x DRG weight",26549,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,86509,70,,86509,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17141,,"25,057 x DRG weight",17141,Other,base rate x DRG weight,15428,,"22,552 x DRG weight",15428,Other,base rate x DRG weight,17141,,"25,057 x DRG weight",17141,Other,base rate x DRG weight,14570,,"21,298 x DRG weight",14570,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,86509,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,,inpatient,,,197166.6,20537,,,20537,Other,150% of Medicare + 9.63% HCRA Surcharge,12488.71,,,12488.71,Other,Medicare IPPS methodology,36404,,"25,046 x DRG weight",36404,Other,base rate x DRG weight,32763,,"22,541 x DRG weight",32763,Other,base rate x DRG weight,46644,,"32,091 x DRG weight",46644,Other,base rate x DRG weight,41980,,"28,882 x DRG weight",41980,Other,base rate x DRG weight,39647,,"27,277 x DRG weight",39647,Other,base rate x DRG weight,35000,,"24,080 x DRG weight",35000,Other,base rate x DRG weight,32650,,"22,463 x DRG weight",32650,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,38410,,"26,426 x DRG weight",38410,Other,base rate x DRG weight,56409,,"38,809 x DRG weight",56409,Other,base rate x DRG weight,56409,,"38,809 x DRG weight",56409,Other,base rate x DRG weight,38410,,"26,426 x DRG weight",38410,Other,base rate x DRG weight,56409,,"38,809 x DRG weight",56409,Other,base rate x DRG weight,38814,,"6,363 x patient days",38814,Per diem,,138017,70,,138017,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,36420,,"25,057 x DRG weight",36420,Other,base rate x DRG weight,32779,,"22,552 x DRG weight",32779,Other,base rate x DRG weight,36420,,"25,057 x DRG weight",36420,Other,base rate x DRG weight,30957,,"21,298 x DRG weight",30957,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,138017,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,,inpatient,,,116946.79,11498,,,11498,Other,150% of Medicare + 9.63% HCRA Surcharge,6992.02,,,6992.02,Other,Medicare IPPS methodology,19947,,"25,046 x DRG weight",19947,Other,base rate x DRG weight,17952,,"22,541 x DRG weight",17952,Other,base rate x DRG weight,25557,,"32,091 x DRG weight",25557,Other,base rate x DRG weight,23002,,"28,882 x DRG weight",23002,Other,base rate x DRG weight,21723,,"27,277 x DRG weight",21723,Other,base rate x DRG weight,19177,,"24,080 x DRG weight",19177,Other,base rate x DRG weight,17890,,"22,463 x DRG weight",17890,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21046,,"26,426 x DRG weight",21046,Other,base rate x DRG weight,30907,,"38,809 x DRG weight",30907,Other,base rate x DRG weight,30907,,"38,809 x DRG weight",30907,Other,base rate x DRG weight,21046,,"26,426 x DRG weight",21046,Other,base rate x DRG weight,30907,,"38,809 x DRG weight",30907,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,81863,70,,81863,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19955,,"25,057 x DRG weight",19955,Other,base rate x DRG weight,17960,,"22,552 x DRG weight",17960,Other,base rate x DRG weight,19955,,"25,057 x DRG weight",19955,Other,base rate x DRG weight,16962,,"21,298 x DRG weight",16962,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,81863,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,,inpatient,,,84892.15,8232,,,8232,Other,150% of Medicare + 9.63% HCRA Surcharge,5006.15,,,5006.15,Other,Medicare IPPS methodology,14001,,"25,046 x DRG weight",14001,Other,base rate x DRG weight,12600,,"22,541 x DRG weight",12600,Other,base rate x DRG weight,17939,,"32,091 x DRG weight",17939,Other,base rate x DRG weight,16145,,"28,882 x DRG weight",16145,Other,base rate x DRG weight,15248,,"27,277 x DRG weight",15248,Other,base rate x DRG weight,13461,,"24,080 x DRG weight",13461,Other,base rate x DRG weight,12557,,"22,463 x DRG weight",12557,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,14772,,"26,426 x DRG weight",14772,Other,base rate x DRG weight,21694,,"38,809 x DRG weight",21694,Other,base rate x DRG weight,21694,,"38,809 x DRG weight",21694,Other,base rate x DRG weight,14772,,"26,426 x DRG weight",14772,Other,base rate x DRG weight,21694,,"38,809 x DRG weight",21694,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,59425,70,,59425,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,14007,,"25,057 x DRG weight",14007,Other,base rate x DRG weight,12607,,"22,552 x DRG weight",12607,Other,base rate x DRG weight,14007,,"25,057 x DRG weight",14007,Other,base rate x DRG weight,11906,,"21,298 x DRG weight",11906,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,59425,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,,inpatient,,,153223.48,18091,,,18091,Other,150% of Medicare + 9.63% HCRA Surcharge,11001.4,,,11001.4,Other,Medicare IPPS methodology,31951,,"25,046 x DRG weight",31951,Other,base rate x DRG weight,28756,,"22,541 x DRG weight",28756,Other,base rate x DRG weight,40938,,"32,091 x DRG weight",40938,Other,base rate x DRG weight,36845,,"28,882 x DRG weight",36845,Other,base rate x DRG weight,34797,,"27,277 x DRG weight",34797,Other,base rate x DRG weight,30719,,"24,080 x DRG weight",30719,Other,base rate x DRG weight,28656,,"22,463 x DRG weight",28656,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,33712,,"26,426 x DRG weight",33712,Other,base rate x DRG weight,49509,,"38,809 x DRG weight",49509,Other,base rate x DRG weight,49509,,"38,809 x DRG weight",49509,Other,base rate x DRG weight,33712,,"26,426 x DRG weight",33712,Other,base rate x DRG weight,49509,,"38,809 x DRG weight",49509,Other,base rate x DRG weight,33724,,"6,363 x patient days",33724,Per diem,,107256,70,,107256,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,31965,,"25,057 x DRG weight",31965,Other,base rate x DRG weight,28770,,"22,552 x DRG weight",28770,Other,base rate x DRG weight,31965,,"25,057 x DRG weight",31965,Other,base rate x DRG weight,27170,,"21,298 x DRG weight",27170,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,107256,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,,inpatient,,,110388.6,11349,,,11349,Other,150% of Medicare + 9.63% HCRA Surcharge,6901.67,,,6901.67,Other,Medicare IPPS methodology,19676,,"25,046 x DRG weight",19676,Other,base rate x DRG weight,17708,,"22,541 x DRG weight",17708,Other,base rate x DRG weight,25211,,"32,091 x DRG weight",25211,Other,base rate x DRG weight,22690,,"28,882 x DRG weight",22690,Other,base rate x DRG weight,21429,,"27,277 x DRG weight",21429,Other,base rate x DRG weight,18917,,"24,080 x DRG weight",18917,Other,base rate x DRG weight,17647,,"22,463 x DRG weight",17647,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20760,,"26,426 x DRG weight",20760,Other,base rate x DRG weight,30488,,"38,809 x DRG weight",30488,Other,base rate x DRG weight,30488,,"38,809 x DRG weight",30488,Other,base rate x DRG weight,20760,,"26,426 x DRG weight",20760,Other,base rate x DRG weight,30488,,"38,809 x DRG weight",30488,Other,base rate x DRG weight,20998,,"6,363 x patient days",20998,Per diem,,77272,70,,77272,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19685,,"25,057 x DRG weight",19685,Other,base rate x DRG weight,17717,,"22,552 x DRG weight",17717,Other,base rate x DRG weight,19685,,"25,057 x DRG weight",19685,Other,base rate x DRG weight,16732,,"21,298 x DRG weight",16732,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,77272,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,,inpatient,,,233240.19,22822,,,22822,Other,150% of Medicare + 9.63% HCRA Surcharge,13878.15,,,13878.15,Other,Medicare IPPS methodology,40565,,"25,046 x DRG weight",40565,Other,base rate x DRG weight,36507,,"22,541 x DRG weight",36507,Other,base rate x DRG weight,51975,,"32,091 x DRG weight",51975,Other,base rate x DRG weight,46777,,"28,882 x DRG weight",46777,Other,base rate x DRG weight,44178,,"27,277 x DRG weight",44178,Other,base rate x DRG weight,39000,,"24,080 x DRG weight",39000,Other,base rate x DRG weight,36381,,"22,463 x DRG weight",36381,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42800,,"26,426 x DRG weight",42800,Other,base rate x DRG weight,62855,,"38,809 x DRG weight",62855,Other,base rate x DRG weight,62855,,"38,809 x DRG weight",62855,Other,base rate x DRG weight,42800,,"26,426 x DRG weight",42800,Other,base rate x DRG weight,62855,,"38,809 x DRG weight",62855,Other,base rate x DRG weight,39451,,"6,363 x patient days",39451,Per diem,,163268,70,,163268,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40582,,"25,057 x DRG weight",40582,Other,base rate x DRG weight,36525,,"22,552 x DRG weight",36525,Other,base rate x DRG weight,40582,,"25,057 x DRG weight",40582,Other,base rate x DRG weight,34494,,"21,298 x DRG weight",34494,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,163268,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,,inpatient,,,140935.12,13431,,,13431,Other,150% of Medicare + 9.63% HCRA Surcharge,8167.31,,,8167.31,Other,Medicare IPPS methodology,23466,,"25,046 x DRG weight",23466,Other,base rate x DRG weight,21119,,"22,541 x DRG weight",21119,Other,base rate x DRG weight,30066,,"32,091 x DRG weight",30066,Other,base rate x DRG weight,27060,,"28,882 x DRG weight",27060,Other,base rate x DRG weight,25556,,"27,277 x DRG weight",25556,Other,base rate x DRG weight,22561,,"24,080 x DRG weight",22561,Other,base rate x DRG weight,21046,,"22,463 x DRG weight",21046,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24759,,"26,426 x DRG weight",24759,Other,base rate x DRG weight,36360,,"38,809 x DRG weight",36360,Other,base rate x DRG weight,36360,,"38,809 x DRG weight",36360,Other,base rate x DRG weight,24759,,"26,426 x DRG weight",24759,Other,base rate x DRG weight,36360,,"38,809 x DRG weight",36360,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,98655,70,,98655,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23476,,"25,057 x DRG weight",23476,Other,base rate x DRG weight,21129,,"22,552 x DRG weight",21129,Other,base rate x DRG weight,23476,,"25,057 x DRG weight",23476,Other,base rate x DRG weight,19954,,"21,298 x DRG weight",19954,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,98655,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,,inpatient,,,93151.05,9450,,,9450,Other,150% of Medicare + 9.63% HCRA Surcharge,5746.46,,,5746.46,Other,Medicare IPPS methodology,16217,,"25,046 x DRG weight",16217,Other,base rate x DRG weight,14595,,"22,541 x DRG weight",14595,Other,base rate x DRG weight,20779,,"32,091 x DRG weight",20779,Other,base rate x DRG weight,18701,,"28,882 x DRG weight",18701,Other,base rate x DRG weight,17662,,"27,277 x DRG weight",17662,Other,base rate x DRG weight,15592,,"24,080 x DRG weight",15592,Other,base rate x DRG weight,14545,,"22,463 x DRG weight",14545,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,17111,,"26,426 x DRG weight",17111,Other,base rate x DRG weight,25129,,"38,809 x DRG weight",25129,Other,base rate x DRG weight,25129,,"38,809 x DRG weight",25129,Other,base rate x DRG weight,17111,,"26,426 x DRG weight",17111,Other,base rate x DRG weight,25129,,"38,809 x DRG weight",25129,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,65206,70,,65206,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,16224,,"25,057 x DRG weight",16224,Other,base rate x DRG weight,14602,,"22,552 x DRG weight",14602,Other,base rate x DRG weight,16224,,"25,057 x DRG weight",16224,Other,base rate x DRG weight,13790,,"21,298 x DRG weight",13790,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,65206,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,,inpatient,,,164873.11,31447,,,31447,Other,150% of Medicare + 9.63% HCRA Surcharge,19123.05,,,19123.05,Other,Medicare IPPS methodology,56268,,"25,046 x DRG weight",56268,Other,base rate x DRG weight,50641,,"22,541 x DRG weight",50641,Other,base rate x DRG weight,72096,,"32,091 x DRG weight",72096,Other,base rate x DRG weight,64886,,"28,882 x DRG weight",64886,Other,base rate x DRG weight,61281,,"27,277 x DRG weight",61281,Other,base rate x DRG weight,54098,,"24,080 x DRG weight",54098,Other,base rate x DRG weight,50465,,"22,463 x DRG weight",50465,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,59369,,"26,426 x DRG weight",59369,Other,base rate x DRG weight,87188,,"38,809 x DRG weight",87188,Other,base rate x DRG weight,87188,,"38,809 x DRG weight",87188,Other,base rate x DRG weight,59369,,"26,426 x DRG weight",59369,Other,base rate x DRG weight,87188,,"38,809 x DRG weight",87188,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,115411,70,,115411,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,56293,,"25,057 x DRG weight",56293,Other,base rate x DRG weight,50665,,"22,552 x DRG weight",50665,Other,base rate x DRG weight,56293,,"25,057 x DRG weight",56293,Other,base rate x DRG weight,47848,,"21,298 x DRG weight",47848,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,115411,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,,inpatient,,,103380.07,21360,,,21360,Other,150% of Medicare + 9.63% HCRA Surcharge,12988.94,,,12988.94,Other,Medicare IPPS methodology,37902,,"25,046 x DRG weight",37902,Other,base rate x DRG weight,34111,,"22,541 x DRG weight",34111,Other,base rate x DRG weight,48563,,"32,091 x DRG weight",48563,Other,base rate x DRG weight,43707,,"28,882 x DRG weight",43707,Other,base rate x DRG weight,41278,,"27,277 x DRG weight",41278,Other,base rate x DRG weight,36440,,"24,080 x DRG weight",36440,Other,base rate x DRG weight,33993,,"22,463 x DRG weight",33993,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39990,,"26,426 x DRG weight",39990,Other,base rate x DRG weight,58730,,"38,809 x DRG weight",58730,Other,base rate x DRG weight,58730,,"38,809 x DRG weight",58730,Other,base rate x DRG weight,39990,,"26,426 x DRG weight",39990,Other,base rate x DRG weight,58730,,"38,809 x DRG weight",58730,Other,base rate x DRG weight,25452,,"6,363 x patient days",25452,Per diem,,72366,70,,72366,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37919,,"25,057 x DRG weight",37919,Other,base rate x DRG weight,34128,,"22,552 x DRG weight",34128,Other,base rate x DRG weight,37919,,"25,057 x DRG weight",37919,Other,base rate x DRG weight,32230,,"21,298 x DRG weight",32230,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,72366,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,,inpatient,,,89201.58,15855,,,15855,Other,150% of Medicare + 9.63% HCRA Surcharge,9641.24,,,9641.24,Other,Medicare IPPS methodology,27879,,"25,046 x DRG weight",27879,Other,base rate x DRG weight,25090,,"22,541 x DRG weight",25090,Other,base rate x DRG weight,35720,,"32,091 x DRG weight",35720,Other,base rate x DRG weight,32149,,"28,882 x DRG weight",32149,Other,base rate x DRG weight,30362,,"27,277 x DRG weight",30362,Other,base rate x DRG weight,26803,,"24,080 x DRG weight",26803,Other,base rate x DRG weight,25004,,"22,463 x DRG weight",25004,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,29415,,"26,426 x DRG weight",29415,Other,base rate x DRG weight,43198,,"38,809 x DRG weight",43198,Other,base rate x DRG weight,43198,,"38,809 x DRG weight",43198,Other,base rate x DRG weight,29415,,"26,426 x DRG weight",29415,Other,base rate x DRG weight,43198,,"38,809 x DRG weight",43198,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,62441,70,,62441,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27891,,"25,057 x DRG weight",27891,Other,base rate x DRG weight,25103,,"22,552 x DRG weight",25103,Other,base rate x DRG weight,27891,,"25,057 x DRG weight",27891,Other,base rate x DRG weight,23707,,"21,298 x DRG weight",23707,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,62441,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,,inpatient,,,619797.78,76272,,,76272,Other,150% of Medicare + 9.63% HCRA Surcharge,46381.49,,,46381.49,Other,Medicare IPPS methodology,137883,,"25,046 x DRG weight",137883,Other,base rate x DRG weight,124093,,"22,541 x DRG weight",124093,Other,base rate x DRG weight,176667,,"32,091 x DRG weight",176667,Other,base rate x DRG weight,159001,,"28,882 x DRG weight",159001,Other,base rate x DRG weight,150165,,"27,277 x DRG weight",150165,Other,base rate x DRG weight,132565,,"24,080 x DRG weight",132565,Other,base rate x DRG weight,123663,,"22,463 x DRG weight",123663,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,145480,,"26,426 x DRG weight",145480,Other,base rate x DRG weight,213651,,"38,809 x DRG weight",213651,Other,base rate x DRG weight,213651,,"38,809 x DRG weight",213651,Other,base rate x DRG weight,145480,,"26,426 x DRG weight",145480,Other,base rate x DRG weight,213651,,"38,809 x DRG weight",213651,Other,base rate x DRG weight,80174,,"6,363 x patient days",80174,Per diem,,433858,70,,433858,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,137944,,"25,057 x DRG weight",137944,Other,base rate x DRG weight,124153,,"22,552 x DRG weight",124153,Other,base rate x DRG weight,137944,,"25,057 x DRG weight",137944,Other,base rate x DRG weight,117250,,"21,298 x DRG weight",117250,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,433858,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,,inpatient,,,260950.29,40262,,,40262,Other,150% of Medicare + 9.63% HCRA Surcharge,24483.39,,,24483.39,Other,Medicare IPPS methodology,72318,,"25,046 x DRG weight",72318,Other,base rate x DRG weight,65085,,"22,541 x DRG weight",65085,Other,base rate x DRG weight,92660,,"32,091 x DRG weight",92660,Other,base rate x DRG weight,83394,,"28,882 x DRG weight",83394,Other,base rate x DRG weight,78760,,"27,277 x DRG weight",78760,Other,base rate x DRG weight,69529,,"24,080 x DRG weight",69529,Other,base rate x DRG weight,64860,,"22,463 x DRG weight",64860,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,76302,,"26,426 x DRG weight",76302,Other,base rate x DRG weight,112057,,"38,809 x DRG weight",112057,Other,base rate x DRG weight,112057,,"38,809 x DRG weight",112057,Other,base rate x DRG weight,76302,,"26,426 x DRG weight",76302,Other,base rate x DRG weight,112057,,"38,809 x DRG weight",112057,Other,base rate x DRG weight,39451,,"6,363 x patient days",39451,Per diem,,182665,70,,182665,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,72350,,"25,057 x DRG weight",72350,Other,base rate x DRG weight,65117,,"22,552 x DRG weight",65117,Other,base rate x DRG weight,72350,,"25,057 x DRG weight",72350,Other,base rate x DRG weight,61496,,"21,298 x DRG weight",61496,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,182665,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,,inpatient,,,225852.18,30132,,,30132,Other,150% of Medicare + 9.63% HCRA Surcharge,18323.35,,,18323.35,Other,Medicare IPPS methodology,53874,,"25,046 x DRG weight",53874,Other,base rate x DRG weight,48486,,"22,541 x DRG weight",48486,Other,base rate x DRG weight,69028,,"32,091 x DRG weight",69028,Other,base rate x DRG weight,62125,,"28,882 x DRG weight",62125,Other,base rate x DRG weight,58673,,"27,277 x DRG weight",58673,Other,base rate x DRG weight,51796,,"24,080 x DRG weight",51796,Other,base rate x DRG weight,48318,,"22,463 x DRG weight",48318,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,56842,,"26,426 x DRG weight",56842,Other,base rate x DRG weight,83478,,"38,809 x DRG weight",83478,Other,base rate x DRG weight,83478,,"38,809 x DRG weight",83478,Other,base rate x DRG weight,56842,,"26,426 x DRG weight",56842,Other,base rate x DRG weight,83478,,"38,809 x DRG weight",83478,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,158097,70,,158097,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,53898,,"25,057 x DRG weight",53898,Other,base rate x DRG weight,48509,,"22,552 x DRG weight",48509,Other,base rate x DRG weight,53898,,"25,057 x DRG weight",53898,Other,base rate x DRG weight,45812,,"21,298 x DRG weight",45812,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,158097,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,,inpatient,,,636079.48,51745,,,51745,Other,150% of Medicare + 9.63% HCRA Surcharge,31466.56,,,31466.56,Other,Medicare IPPS methodology,93226,,"25,046 x DRG weight",93226,Other,base rate x DRG weight,83902,,"22,541 x DRG weight",83902,Other,base rate x DRG weight,119449,,"32,091 x DRG weight",119449,Other,base rate x DRG weight,107505,,"28,882 x DRG weight",107505,Other,base rate x DRG weight,101530,,"27,277 x DRG weight",101530,Other,base rate x DRG weight,89631,,"24,080 x DRG weight",89631,Other,base rate x DRG weight,83612,,"22,463 x DRG weight",83612,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,98363,,"26,426 x DRG weight",98363,Other,base rate x DRG weight,144455,,"38,809 x DRG weight",144455,Other,base rate x DRG weight,144455,,"38,809 x DRG weight",144455,Other,base rate x DRG weight,98363,,"26,426 x DRG weight",98363,Other,base rate x DRG weight,144455,,"38,809 x DRG weight",144455,Other,base rate x DRG weight,69357,,"6,363 x patient days",69357,Per diem,,445256,70,,445256,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,93267,,"25,057 x DRG weight",93267,Other,base rate x DRG weight,83943,,"22,552 x DRG weight",83943,Other,base rate x DRG weight,93267,,"25,057 x DRG weight",93267,Other,base rate x DRG weight,79275,,"21,298 x DRG weight",79275,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,445256,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,,inpatient,,,297030.96,27467,,,27467,Other,150% of Medicare + 9.63% HCRA Surcharge,16703.04,,,16703.04,Other,Medicare IPPS methodology,49023,,"25,046 x DRG weight",49023,Other,base rate x DRG weight,44119,,"22,541 x DRG weight",44119,Other,base rate x DRG weight,62812,,"32,091 x DRG weight",62812,Other,base rate x DRG weight,56531,,"28,882 x DRG weight",56531,Other,base rate x DRG weight,53389,,"27,277 x DRG weight",53389,Other,base rate x DRG weight,47132,,"24,080 x DRG weight",47132,Other,base rate x DRG weight,43967,,"22,463 x DRG weight",43967,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,51724,,"26,426 x DRG weight",51724,Other,base rate x DRG weight,75961,,"38,809 x DRG weight",75961,Other,base rate x DRG weight,75961,,"38,809 x DRG weight",75961,Other,base rate x DRG weight,51724,,"26,426 x DRG weight",51724,Other,base rate x DRG weight,75961,,"38,809 x DRG weight",75961,Other,base rate x DRG weight,36269,,"6,363 x patient days",36269,Per diem,,207922,70,,207922,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49044,,"25,057 x DRG weight",49044,Other,base rate x DRG weight,44141,,"22,552 x DRG weight",44141,Other,base rate x DRG weight,49044,,"25,057 x DRG weight",49044,Other,base rate x DRG weight,41687,,"21,298 x DRG weight",41687,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,207922,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,,inpatient,,,122727.59,22074,,,22074,Other,150% of Medicare + 9.63% HCRA Surcharge,13423.09,,,13423.09,Other,Medicare IPPS methodology,39202,,"25,046 x DRG weight",39202,Other,base rate x DRG weight,35281,,"22,541 x DRG weight",35281,Other,base rate x DRG weight,50229,,"32,091 x DRG weight",50229,Other,base rate x DRG weight,45206,,"28,882 x DRG weight",45206,Other,base rate x DRG weight,42694,,"27,277 x DRG weight",42694,Other,base rate x DRG weight,37690,,"24,080 x DRG weight",37690,Other,base rate x DRG weight,35159,,"22,463 x DRG weight",35159,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41362,,"26,426 x DRG weight",41362,Other,base rate x DRG weight,60744,,"38,809 x DRG weight",60744,Other,base rate x DRG weight,60744,,"38,809 x DRG weight",60744,Other,base rate x DRG weight,41362,,"26,426 x DRG weight",41362,Other,base rate x DRG weight,60744,,"38,809 x DRG weight",60744,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,85909,70,,85909,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39219,,"25,057 x DRG weight",39219,Other,base rate x DRG weight,35298,,"22,552 x DRG weight",35298,Other,base rate x DRG weight,39219,,"25,057 x DRG weight",39219,Other,base rate x DRG weight,33336,,"21,298 x DRG weight",33336,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,85909,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,,inpatient,,,636079.48,42366,,,42366,Other,150% of Medicare + 9.63% HCRA Surcharge,25763.25,,,25763.25,Other,Medicare IPPS methodology,76150,,"25,046 x DRG weight",76150,Other,base rate x DRG weight,68534,,"22,541 x DRG weight",68534,Other,base rate x DRG weight,97569,,"32,091 x DRG weight",97569,Other,base rate x DRG weight,87813,,"28,882 x DRG weight",87813,Other,base rate x DRG weight,82933,,"27,277 x DRG weight",82933,Other,base rate x DRG weight,73213,,"24,080 x DRG weight",73213,Other,base rate x DRG weight,68297,,"22,463 x DRG weight",68297,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,80346,,"26,426 x DRG weight",80346,Other,base rate x DRG weight,117995,,"38,809 x DRG weight",117995,Other,base rate x DRG weight,117995,,"38,809 x DRG weight",117995,Other,base rate x DRG weight,80346,,"26,426 x DRG weight",80346,Other,base rate x DRG weight,117995,,"38,809 x DRG weight",117995,Other,base rate x DRG weight,51540,,"6,363 x patient days",51540,Per diem,,445256,70,,445256,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,76183,,"25,057 x DRG weight",76183,Other,base rate x DRG weight,68567,,"22,552 x DRG weight",68567,Other,base rate x DRG weight,76183,,"25,057 x DRG weight",76183,Other,base rate x DRG weight,64754,,"21,298 x DRG weight",64754,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,445256,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,,inpatient,,,142251.57,28964,,,28964,Other,150% of Medicare + 9.63% HCRA Surcharge,17613.16,,,17613.16,Other,Medicare IPPS methodology,51748,,"25,046 x DRG weight",51748,Other,base rate x DRG weight,46572,,"22,541 x DRG weight",46572,Other,base rate x DRG weight,66303,,"32,091 x DRG weight",66303,Other,base rate x DRG weight,59673,,"28,882 x DRG weight",59673,Other,base rate x DRG weight,56357,,"27,277 x DRG weight",56357,Other,base rate x DRG weight,49752,,"24,080 x DRG weight",49752,Other,base rate x DRG weight,46411,,"22,463 x DRG weight",46411,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,54599,,"26,426 x DRG weight",54599,Other,base rate x DRG weight,80183,,"38,809 x DRG weight",80183,Other,base rate x DRG weight,80183,,"38,809 x DRG weight",80183,Other,base rate x DRG weight,54599,,"26,426 x DRG weight",54599,Other,base rate x DRG weight,80183,,"38,809 x DRG weight",80183,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,99576,70,,99576,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,51770,,"25,057 x DRG weight",51770,Other,base rate x DRG weight,46595,,"22,552 x DRG weight",46595,Other,base rate x DRG weight,51770,,"25,057 x DRG weight",51770,Other,base rate x DRG weight,44004,,"21,298 x DRG weight",44004,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,99576,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,,inpatient,,,336831.31,21309,,,21309,Other,150% of Medicare + 9.63% HCRA Surcharge,12957.99,,,12957.99,Other,Medicare IPPS methodology,37809,,"25,046 x DRG weight",37809,Other,base rate x DRG weight,34028,,"22,541 x DRG weight",34028,Other,base rate x DRG weight,48445,,"32,091 x DRG weight",48445,Other,base rate x DRG weight,43600,,"28,882 x DRG weight",43600,Other,base rate x DRG weight,41177,,"27,277 x DRG weight",41177,Other,base rate x DRG weight,36351,,"24,080 x DRG weight",36351,Other,base rate x DRG weight,33910,,"22,463 x DRG weight",33910,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39893,,"26,426 x DRG weight",39893,Other,base rate x DRG weight,58586,,"38,809 x DRG weight",58586,Other,base rate x DRG weight,58586,,"38,809 x DRG weight",58586,Other,base rate x DRG weight,39893,,"26,426 x DRG weight",39893,Other,base rate x DRG weight,58586,,"38,809 x DRG weight",58586,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,235782,70,,235782,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37826,,"25,057 x DRG weight",37826,Other,base rate x DRG weight,34044,,"22,552 x DRG weight",34044,Other,base rate x DRG weight,37826,,"25,057 x DRG weight",37826,Other,base rate x DRG weight,32151,,"21,298 x DRG weight",32151,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,235782,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,,inpatient,,,411884.91,49035,,,49035,Other,150% of Medicare + 9.63% HCRA Surcharge,29818.64,,,29818.64,Other,Medicare IPPS methodology,88292,,"25,046 x DRG weight",88292,Other,base rate x DRG weight,79462,,"22,541 x DRG weight",79462,Other,base rate x DRG weight,113127,,"32,091 x DRG weight",113127,Other,base rate x DRG weight,101815,,"28,882 x DRG weight",101815,Other,base rate x DRG weight,96157,,"27,277 x DRG weight",96157,Other,base rate x DRG weight,84887,,"24,080 x DRG weight",84887,Other,base rate x DRG weight,79187,,"22,463 x DRG weight",79187,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,93157,,"26,426 x DRG weight",93157,Other,base rate x DRG weight,136809,,"38,809 x DRG weight",136809,Other,base rate x DRG weight,136809,,"38,809 x DRG weight",136809,Other,base rate x DRG weight,93157,,"26,426 x DRG weight",93157,Other,base rate x DRG weight,136809,,"38,809 x DRG weight",136809,Other,base rate x DRG weight,62994,,"6,363 x patient days",62994,Per diem,,288319,70,,288319,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,88331,,"25,057 x DRG weight",88331,Other,base rate x DRG weight,79500,,"22,552 x DRG weight",79500,Other,base rate x DRG weight,88331,,"25,057 x DRG weight",88331,Other,base rate x DRG weight,75080,,"21,298 x DRG weight",75080,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,288319,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,,inpatient,,,214840.92,27722,,,27722,Other,150% of Medicare + 9.63% HCRA Surcharge,16857.79,,,16857.79,Other,Medicare IPPS methodology,49486,,"25,046 x DRG weight",49486,Other,base rate x DRG weight,44537,,"22,541 x DRG weight",44537,Other,base rate x DRG weight,63405,,"32,091 x DRG weight",63405,Other,base rate x DRG weight,57065,,"28,882 x DRG weight",57065,Other,base rate x DRG weight,53894,,"27,277 x DRG weight",53894,Other,base rate x DRG weight,47577,,"24,080 x DRG weight",47577,Other,base rate x DRG weight,44382,,"22,463 x DRG weight",44382,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52212,,"26,426 x DRG weight",52212,Other,base rate x DRG weight,76679,,"38,809 x DRG weight",76679,Other,base rate x DRG weight,76679,,"38,809 x DRG weight",76679,Other,base rate x DRG weight,52212,,"26,426 x DRG weight",52212,Other,base rate x DRG weight,76679,,"38,809 x DRG weight",76679,Other,base rate x DRG weight,36269,,"6,363 x patient days",36269,Per diem,,150389,70,,150389,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49508,,"25,057 x DRG weight",49508,Other,base rate x DRG weight,44558,,"22,552 x DRG weight",44558,Other,base rate x DRG weight,49508,,"25,057 x DRG weight",49508,Other,base rate x DRG weight,42081,,"21,298 x DRG weight",42081,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,150389,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,,inpatient,,,179180.51,18965,,,18965,Other,150% of Medicare + 9.63% HCRA Surcharge,11532.58,,,11532.58,Other,Medicare IPPS methodology,33542,,"25,046 x DRG weight",33542,Other,base rate x DRG weight,30187,,"22,541 x DRG weight",30187,Other,base rate x DRG weight,42976,,"32,091 x DRG weight",42976,Other,base rate x DRG weight,38679,,"28,882 x DRG weight",38679,Other,base rate x DRG weight,36529,,"27,277 x DRG weight",36529,Other,base rate x DRG weight,32248,,"24,080 x DRG weight",32248,Other,base rate x DRG weight,30082,,"22,463 x DRG weight",30082,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,35390,,"26,426 x DRG weight",35390,Other,base rate x DRG weight,51973,,"38,809 x DRG weight",51973,Other,base rate x DRG weight,51973,,"38,809 x DRG weight",51973,Other,base rate x DRG weight,35390,,"26,426 x DRG weight",35390,Other,base rate x DRG weight,51973,,"38,809 x DRG weight",51973,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,125426,70,,125426,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33556,,"25,057 x DRG weight",33556,Other,base rate x DRG weight,30202,,"22,552 x DRG weight",30202,Other,base rate x DRG weight,33556,,"25,057 x DRG weight",33556,Other,base rate x DRG weight,28522,,"21,298 x DRG weight",28522,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,125426,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,,inpatient,,,212879.52,32426,,,32426,Other,150% of Medicare + 9.63% HCRA Surcharge,19718.65,,,19718.65,Other,Medicare IPPS methodology,58052,,"25,046 x DRG weight",58052,Other,base rate x DRG weight,52246,,"22,541 x DRG weight",52246,Other,base rate x DRG weight,74381,,"32,091 x DRG weight",74381,Other,base rate x DRG weight,66943,,"28,882 x DRG weight",66943,Other,base rate x DRG weight,63223,,"27,277 x DRG weight",63223,Other,base rate x DRG weight,55813,,"24,080 x DRG weight",55813,Other,base rate x DRG weight,52065,,"22,463 x DRG weight",52065,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,61250,,"26,426 x DRG weight",61250,Other,base rate x DRG weight,89952,,"38,809 x DRG weight",89952,Other,base rate x DRG weight,89952,,"38,809 x DRG weight",89952,Other,base rate x DRG weight,61250,,"26,426 x DRG weight",61250,Other,base rate x DRG weight,89952,,"38,809 x DRG weight",89952,Other,base rate x DRG weight,40087,,"6,363 x patient days",40087,Per diem,,149016,70,,149016,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,58077,,"25,057 x DRG weight",58077,Other,base rate x DRG weight,52271,,"22,552 x DRG weight",52271,Other,base rate x DRG weight,58077,,"25,057 x DRG weight",58077,Other,base rate x DRG weight,49365,,"21,298 x DRG weight",49365,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,149016,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,,inpatient,,,182591.62,23030,,,23030,Other,150% of Medicare + 9.63% HCRA Surcharge,14004.46,,,14004.46,Other,Medicare IPPS methodology,40943,,"25,046 x DRG weight",40943,Other,base rate x DRG weight,36848,,"22,541 x DRG weight",36848,Other,base rate x DRG weight,52459,,"32,091 x DRG weight",52459,Other,base rate x DRG weight,47213,,"28,882 x DRG weight",47213,Other,base rate x DRG weight,44590,,"27,277 x DRG weight",44590,Other,base rate x DRG weight,39364,,"24,080 x DRG weight",39364,Other,base rate x DRG weight,36720,,"22,463 x DRG weight",36720,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43199,,"26,426 x DRG weight",43199,Other,base rate x DRG weight,63441,,"38,809 x DRG weight",63441,Other,base rate x DRG weight,63441,,"38,809 x DRG weight",63441,Other,base rate x DRG weight,43199,,"26,426 x DRG weight",43199,Other,base rate x DRG weight,63441,,"38,809 x DRG weight",63441,Other,base rate x DRG weight,26088,,"6,363 x patient days",26088,Per diem,,127814,70,,127814,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40961,,"25,057 x DRG weight",40961,Other,base rate x DRG weight,36866,,"22,552 x DRG weight",36866,Other,base rate x DRG weight,40961,,"25,057 x DRG weight",40961,Other,base rate x DRG weight,34816,,"21,298 x DRG weight",34816,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,127814,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,,inpatient,,,128377.27,18607,,,18607,Other,150% of Medicare + 9.63% HCRA Surcharge,11315.09,,,11315.09,Other,Medicare IPPS methodology,32890,,"25,046 x DRG weight",32890,Other,base rate x DRG weight,29601,,"22,541 x DRG weight",29601,Other,base rate x DRG weight,42142,,"32,091 x DRG weight",42142,Other,base rate x DRG weight,37928,,"28,882 x DRG weight",37928,Other,base rate x DRG weight,35820,,"27,277 x DRG weight",35820,Other,base rate x DRG weight,31622,,"24,080 x DRG weight",31622,Other,base rate x DRG weight,29498,,"22,463 x DRG weight",29498,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34703,,"26,426 x DRG weight",34703,Other,base rate x DRG weight,50964,,"38,809 x DRG weight",50964,Other,base rate x DRG weight,50964,,"38,809 x DRG weight",50964,Other,base rate x DRG weight,34703,,"26,426 x DRG weight",34703,Other,base rate x DRG weight,50964,,"38,809 x DRG weight",50964,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,89864,70,,89864,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32905,,"25,057 x DRG weight",32905,Other,base rate x DRG weight,29615,,"22,552 x DRG weight",29615,Other,base rate x DRG weight,32905,,"25,057 x DRG weight",32905,Other,base rate x DRG weight,27969,,"21,298 x DRG weight",27969,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,89864,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,,inpatient,,,341777.81,44573,,,44573,Other,150% of Medicare + 9.63% HCRA Surcharge,27105.01,,,27105.01,Other,Medicare IPPS methodology,80167,,"25,046 x DRG weight",80167,Other,base rate x DRG weight,72149,,"22,541 x DRG weight",72149,Other,base rate x DRG weight,102717,,"32,091 x DRG weight",102717,Other,base rate x DRG weight,92446,,"28,882 x DRG weight",92446,Other,base rate x DRG weight,87308,,"27,277 x DRG weight",87308,Other,base rate x DRG weight,77075,,"24,080 x DRG weight",77075,Other,base rate x DRG weight,71900,,"22,463 x DRG weight",71900,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,84584,,"26,426 x DRG weight",84584,Other,base rate x DRG weight,124220,,"38,809 x DRG weight",124220,Other,base rate x DRG weight,124220,,"38,809 x DRG weight",124220,Other,base rate x DRG weight,84584,,"26,426 x DRG weight",84584,Other,base rate x DRG weight,124220,,"38,809 x DRG weight",124220,Other,base rate x DRG weight,62994,,"6,363 x patient days",62994,Per diem,,239244,70,,239244,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,80202,,"25,057 x DRG weight",80202,Other,base rate x DRG weight,72184,,"22,552 x DRG weight",72184,Other,base rate x DRG weight,80202,,"25,057 x DRG weight",80202,Other,base rate x DRG weight,68171,,"21,298 x DRG weight",68171,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,239244,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,,inpatient,,,105017.04,24060,,,24060,Other,150% of Medicare + 9.63% HCRA Surcharge,14631.01,,,14631.01,Other,Medicare IPPS methodology,42819,,"25,046 x DRG weight",42819,Other,base rate x DRG weight,38536,,"22,541 x DRG weight",38536,Other,base rate x DRG weight,54863,,"32,091 x DRG weight",54863,Other,base rate x DRG weight,49377,,"28,882 x DRG weight",49377,Other,base rate x DRG weight,46633,,"27,277 x DRG weight",46633,Other,base rate x DRG weight,41167,,"24,080 x DRG weight",41167,Other,base rate x DRG weight,38403,,"22,463 x DRG weight",38403,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45178,,"26,426 x DRG weight",45178,Other,base rate x DRG weight,66348,,"38,809 x DRG weight",66348,Other,base rate x DRG weight,66348,,"38,809 x DRG weight",66348,Other,base rate x DRG weight,45178,,"26,426 x DRG weight",45178,Other,base rate x DRG weight,66348,,"38,809 x DRG weight",66348,Other,base rate x DRG weight,30542,,"6,363 x patient days",30542,Per diem,,73512,70,,73512,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,42837,,"25,057 x DRG weight",42837,Other,base rate x DRG weight,38555,,"22,552 x DRG weight",38555,Other,base rate x DRG weight,42837,,"25,057 x DRG weight",42837,Other,base rate x DRG weight,36411,,"21,298 x DRG weight",36411,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,73512,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,,inpatient,,,107453.52,19952,,,19952,Other,150% of Medicare + 9.63% HCRA Surcharge,12133.19,,,12133.19,Other,Medicare IPPS methodology,35340,,"25,046 x DRG weight",35340,Other,base rate x DRG weight,31805,,"22,541 x DRG weight",31805,Other,base rate x DRG weight,45280,,"32,091 x DRG weight",45280,Other,base rate x DRG weight,40753,,"28,882 x DRG weight",40753,Other,base rate x DRG weight,38488,,"27,277 x DRG weight",38488,Other,base rate x DRG weight,33977,,"24,080 x DRG weight",33977,Other,base rate x DRG weight,31695,,"22,463 x DRG weight",31695,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37287,,"26,426 x DRG weight",37287,Other,base rate x DRG weight,54759,,"38,809 x DRG weight",54759,Other,base rate x DRG weight,54759,,"38,809 x DRG weight",54759,Other,base rate x DRG weight,37287,,"26,426 x DRG weight",37287,Other,base rate x DRG weight,54759,,"38,809 x DRG weight",54759,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,75217,70,,75217,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35355,,"25,057 x DRG weight",35355,Other,base rate x DRG weight,31821,,"22,552 x DRG weight",31821,Other,base rate x DRG weight,35355,,"25,057 x DRG weight",35355,Other,base rate x DRG weight,30051,,"21,298 x DRG weight",30051,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,75217,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,,inpatient,,,1102167.42,54341,,,54341,Other,150% of Medicare + 9.63% HCRA Surcharge,33045.05,,,33045.05,Other,Medicare IPPS methodology,97952,,"25,046 x DRG weight",97952,Other,base rate x DRG weight,88156,,"22,541 x DRG weight",88156,Other,base rate x DRG weight,125505,,"32,091 x DRG weight",125505,Other,base rate x DRG weight,112955,,"28,882 x DRG weight",112955,Other,base rate x DRG weight,106678,,"27,277 x DRG weight",106678,Other,base rate x DRG weight,94174,,"24,080 x DRG weight",94174,Other,base rate x DRG weight,87851,,"22,463 x DRG weight",87851,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,103349,,"26,426 x DRG weight",103349,Other,base rate x DRG weight,151778,,"38,809 x DRG weight",151778,Other,base rate x DRG weight,151778,,"38,809 x DRG weight",151778,Other,base rate x DRG weight,103349,,"26,426 x DRG weight",103349,Other,base rate x DRG weight,151778,,"38,809 x DRG weight",151778,Other,base rate x DRG weight,69993,,"6,363 x patient days",69993,Per diem,,771517,70,,771517,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,97995,,"25,057 x DRG weight",97995,Other,base rate x DRG weight,88199,,"22,552 x DRG weight",88199,Other,base rate x DRG weight,97995,,"25,057 x DRG weight",97995,Other,base rate x DRG weight,83294,,"21,298 x DRG weight",83294,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,771517,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,,inpatient,,,233759.2,29866,,,29866,Other,150% of Medicare + 9.63% HCRA Surcharge,18161.9,,,18161.9,Other,Medicare IPPS methodology,53391,,"25,046 x DRG weight",53391,Other,base rate x DRG weight,48051,,"22,541 x DRG weight",48051,Other,base rate x DRG weight,68408,,"32,091 x DRG weight",68408,Other,base rate x DRG weight,61568,,"28,882 x DRG weight",61568,Other,base rate x DRG weight,58146,,"27,277 x DRG weight",58146,Other,base rate x DRG weight,51331,,"24,080 x DRG weight",51331,Other,base rate x DRG weight,47884,,"22,463 x DRG weight",47884,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,56332,,"26,426 x DRG weight",56332,Other,base rate x DRG weight,82729,,"38,809 x DRG weight",82729,Other,base rate x DRG weight,82729,,"38,809 x DRG weight",82729,Other,base rate x DRG weight,56332,,"26,426 x DRG weight",56332,Other,base rate x DRG weight,82729,,"38,809 x DRG weight",82729,Other,base rate x DRG weight,38178,,"6,363 x patient days",38178,Per diem,,163631,70,,163631,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,53414,,"25,057 x DRG weight",53414,Other,base rate x DRG weight,48074,,"22,552 x DRG weight",48074,Other,base rate x DRG weight,53414,,"25,057 x DRG weight",53414,Other,base rate x DRG weight,45401,,"21,298 x DRG weight",45401,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,163631,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,,inpatient,,,224128.8,22578,,,22578,Other,150% of Medicare + 9.63% HCRA Surcharge,13730.09,,,13730.09,Other,Medicare IPPS methodology,40121,,"25,046 x DRG weight",40121,Other,base rate x DRG weight,36108,,"22,541 x DRG weight",36108,Other,base rate x DRG weight,51407,,"32,091 x DRG weight",51407,Other,base rate x DRG weight,46266,,"28,882 x DRG weight",46266,Other,base rate x DRG weight,43695,,"27,277 x DRG weight",43695,Other,base rate x DRG weight,38574,,"24,080 x DRG weight",38574,Other,base rate x DRG weight,35983,,"22,463 x DRG weight",35983,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42332,,"26,426 x DRG weight",42332,Other,base rate x DRG weight,62168,,"38,809 x DRG weight",62168,Other,base rate x DRG weight,62168,,"38,809 x DRG weight",62168,Other,base rate x DRG weight,42332,,"26,426 x DRG weight",42332,Other,base rate x DRG weight,62168,,"38,809 x DRG weight",62168,Other,base rate x DRG weight,20998,,"6,363 x patient days",20998,Per diem,,156890,70,,156890,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40139,,"25,057 x DRG weight",40139,Other,base rate x DRG weight,36126,,"22,552 x DRG weight",36126,Other,base rate x DRG weight,40139,,"25,057 x DRG weight",40139,Other,base rate x DRG weight,34117,,"21,298 x DRG weight",34117,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,156890,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,,inpatient,,,338325.67,26899,,,26899,Other,150% of Medicare + 9.63% HCRA Surcharge,16357.56,,,16357.56,Other,Medicare IPPS methodology,47988,,"25,046 x DRG weight",47988,Other,base rate x DRG weight,43189,,"22,541 x DRG weight",43189,Other,base rate x DRG weight,61486,,"32,091 x DRG weight",61486,Other,base rate x DRG weight,55338,,"28,882 x DRG weight",55338,Other,base rate x DRG weight,52263,,"27,277 x DRG weight",52263,Other,base rate x DRG weight,46137,,"24,080 x DRG weight",46137,Other,base rate x DRG weight,43039,,"22,463 x DRG weight",43039,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,50632,,"26,426 x DRG weight",50632,Other,base rate x DRG weight,74358,,"38,809 x DRG weight",74358,Other,base rate x DRG weight,74358,,"38,809 x DRG weight",74358,Other,base rate x DRG weight,50632,,"26,426 x DRG weight",50632,Other,base rate x DRG weight,74358,,"38,809 x DRG weight",74358,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,236828,70,,236828,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,48009,,"25,057 x DRG weight",48009,Other,base rate x DRG weight,43210,,"22,552 x DRG weight",43210,Other,base rate x DRG weight,48009,,"25,057 x DRG weight",48009,Other,base rate x DRG weight,40807,,"21,298 x DRG weight",40807,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,236828,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,,inpatient,,,160499.33,14725,,,14725,Other,150% of Medicare + 9.63% HCRA Surcharge,8954.46,,,8954.46,Other,Medicare IPPS methodology,25822,,"25,046 x DRG weight",25822,Other,base rate x DRG weight,23240,,"22,541 x DRG weight",23240,Other,base rate x DRG weight,33086,,"32,091 x DRG weight",33086,Other,base rate x DRG weight,29777,,"28,882 x DRG weight",29777,Other,base rate x DRG weight,28123,,"27,277 x DRG weight",28123,Other,base rate x DRG weight,24826,,"24,080 x DRG weight",24826,Other,base rate x DRG weight,23159,,"22,463 x DRG weight",23159,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27245,,"26,426 x DRG weight",27245,Other,base rate x DRG weight,40012,,"38,809 x DRG weight",40012,Other,base rate x DRG weight,40012,,"38,809 x DRG weight",40012,Other,base rate x DRG weight,27245,,"26,426 x DRG weight",27245,Other,base rate x DRG weight,40012,,"38,809 x DRG weight",40012,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,112350,70,,112350,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25834,,"25,057 x DRG weight",25834,Other,base rate x DRG weight,23251,,"22,552 x DRG weight",23251,Other,base rate x DRG weight,25834,,"25,057 x DRG weight",25834,Other,base rate x DRG weight,21958,,"21,298 x DRG weight",21958,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,112350,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,,inpatient,,,136029.08,9752,,,9752,Other,150% of Medicare + 9.63% HCRA Surcharge,5930.49,,,5930.49,Other,Medicare IPPS methodology,16768,,"25,046 x DRG weight",16768,Other,base rate x DRG weight,15091,,"22,541 x DRG weight",15091,Other,base rate x DRG weight,21485,,"32,091 x DRG weight",21485,Other,base rate x DRG weight,19336,,"28,882 x DRG weight",19336,Other,base rate x DRG weight,18262,,"27,277 x DRG weight",18262,Other,base rate x DRG weight,16122,,"24,080 x DRG weight",16122,Other,base rate x DRG weight,15039,,"22,463 x DRG weight",15039,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,17692,,"26,426 x DRG weight",17692,Other,base rate x DRG weight,25983,,"38,809 x DRG weight",25983,Other,base rate x DRG weight,25983,,"38,809 x DRG weight",25983,Other,base rate x DRG weight,17692,,"26,426 x DRG weight",17692,Other,base rate x DRG weight,25983,,"38,809 x DRG weight",25983,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,95220,70,,95220,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,16776,,"25,057 x DRG weight",16776,Other,base rate x DRG weight,15099,,"22,552 x DRG weight",15099,Other,base rate x DRG weight,16776,,"25,057 x DRG weight",16776,Other,base rate x DRG weight,14259,,"21,298 x DRG weight",14259,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95220,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,,inpatient,,,260130.32,24752,,,24752,Other,150% of Medicare + 9.63% HCRA Surcharge,15051.77,,,15051.77,Other,Medicare IPPS methodology,44078,,"25,046 x DRG weight",44078,Other,base rate x DRG weight,39670,,"22,541 x DRG weight",39670,Other,base rate x DRG weight,56477,,"32,091 x DRG weight",56477,Other,base rate x DRG weight,50829,,"28,882 x DRG weight",50829,Other,base rate x DRG weight,48005,,"27,277 x DRG weight",48005,Other,base rate x DRG weight,42378,,"24,080 x DRG weight",42378,Other,base rate x DRG weight,39533,,"22,463 x DRG weight",39533,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,46507,,"26,426 x DRG weight",46507,Other,base rate x DRG weight,68300,,"38,809 x DRG weight",68300,Other,base rate x DRG weight,68300,,"38,809 x DRG weight",68300,Other,base rate x DRG weight,46507,,"26,426 x DRG weight",46507,Other,base rate x DRG weight,68300,,"38,809 x DRG weight",68300,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,182091,70,,182091,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,44098,,"25,057 x DRG weight",44098,Other,base rate x DRG weight,39689,,"22,552 x DRG weight",39689,Other,base rate x DRG weight,44098,,"25,057 x DRG weight",44098,Other,base rate x DRG weight,37482,,"21,298 x DRG weight",37482,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,182091,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,,inpatient,,,165540.76,15684,,,15684,Other,150% of Medicare + 9.63% HCRA Surcharge,9537.51,,,9537.51,Other,Medicare IPPS methodology,27568,,"25,046 x DRG weight",27568,Other,base rate x DRG weight,24811,,"22,541 x DRG weight",24811,Other,base rate x DRG weight,35323,,"32,091 x DRG weight",35323,Other,base rate x DRG weight,31790,,"28,882 x DRG weight",31790,Other,base rate x DRG weight,30024,,"27,277 x DRG weight",30024,Other,base rate x DRG weight,26505,,"24,080 x DRG weight",26505,Other,base rate x DRG weight,24725,,"22,463 x DRG weight",24725,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,29087,,"26,426 x DRG weight",29087,Other,base rate x DRG weight,42717,,"38,809 x DRG weight",42717,Other,base rate x DRG weight,42717,,"38,809 x DRG weight",42717,Other,base rate x DRG weight,29087,,"26,426 x DRG weight",29087,Other,base rate x DRG weight,42717,,"38,809 x DRG weight",42717,Other,base rate x DRG weight,27997,,"6,363 x patient days",27997,Per diem,,115879,70,,115879,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27580,,"25,057 x DRG weight",27580,Other,base rate x DRG weight,24823,,"22,552 x DRG weight",24823,Other,base rate x DRG weight,27580,,"25,057 x DRG weight",27580,Other,base rate x DRG weight,23443,,"21,298 x DRG weight",23443,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,115879,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,,inpatient,,,139705.79,11975,,,11975,Other,150% of Medicare + 9.63% HCRA Surcharge,7282.29,,,7282.29,Other,Medicare IPPS methodology,20816,,"25,046 x DRG weight",20816,Other,base rate x DRG weight,18734,,"22,541 x DRG weight",18734,Other,base rate x DRG weight,26671,,"32,091 x DRG weight",26671,Other,base rate x DRG weight,24004,,"28,882 x DRG weight",24004,Other,base rate x DRG weight,22670,,"27,277 x DRG weight",22670,Other,base rate x DRG weight,20013,,"24,080 x DRG weight",20013,Other,base rate x DRG weight,18669,,"22,463 x DRG weight",18669,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21963,,"26,426 x DRG weight",21963,Other,base rate x DRG weight,32254,,"38,809 x DRG weight",32254,Other,base rate x DRG weight,32254,,"38,809 x DRG weight",32254,Other,base rate x DRG weight,21963,,"26,426 x DRG weight",21963,Other,base rate x DRG weight,32254,,"38,809 x DRG weight",32254,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,97794,70,,97794,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20825,,"25,057 x DRG weight",20825,Other,base rate x DRG weight,18743,,"22,552 x DRG weight",18743,Other,base rate x DRG weight,20825,,"25,057 x DRG weight",20825,Other,base rate x DRG weight,17701,,"21,298 x DRG weight",17701,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,97794,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,,inpatient,,,231225.22,23499,,,23499,Other,150% of Medicare + 9.63% HCRA Surcharge,14289.71,,,14289.71,Other,Medicare IPPS methodology,41797,,"25,046 x DRG weight",41797,Other,base rate x DRG weight,37616,,"22,541 x DRG weight",37616,Other,base rate x DRG weight,53553,,"32,091 x DRG weight",53553,Other,base rate x DRG weight,48198,,"28,882 x DRG weight",48198,Other,base rate x DRG weight,45520,,"27,277 x DRG weight",45520,Other,base rate x DRG weight,40185,,"24,080 x DRG weight",40185,Other,base rate x DRG weight,37486,,"22,463 x DRG weight",37486,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,44100,,"26,426 x DRG weight",44100,Other,base rate x DRG weight,64764,,"38,809 x DRG weight",64764,Other,base rate x DRG weight,64764,,"38,809 x DRG weight",64764,Other,base rate x DRG weight,44100,,"26,426 x DRG weight",44100,Other,base rate x DRG weight,64764,,"38,809 x DRG weight",64764,Other,base rate x DRG weight,41996,,"6,363 x patient days",41996,Per diem,,161858,70,,161858,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,41815,,"25,057 x DRG weight",41815,Other,base rate x DRG weight,37635,,"22,552 x DRG weight",37635,Other,base rate x DRG weight,41815,,"25,057 x DRG weight",41815,Other,base rate x DRG weight,35542,,"21,298 x DRG weight",35542,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,161858,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,,inpatient,,,154774.29,12307,,,12307,Other,150% of Medicare + 9.63% HCRA Surcharge,7483.88,,,7483.88,Other,Medicare IPPS methodology,21419,,"25,046 x DRG weight",21419,Other,base rate x DRG weight,19277,,"22,541 x DRG weight",19277,Other,base rate x DRG weight,27444,,"32,091 x DRG weight",27444,Other,base rate x DRG weight,24700,,"28,882 x DRG weight",24700,Other,base rate x DRG weight,23327,,"27,277 x DRG weight",23327,Other,base rate x DRG weight,20593,,"24,080 x DRG weight",20593,Other,base rate x DRG weight,19210,,"22,463 x DRG weight",19210,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22600,,"26,426 x DRG weight",22600,Other,base rate x DRG weight,33189,,"38,809 x DRG weight",33189,Other,base rate x DRG weight,33189,,"38,809 x DRG weight",33189,Other,base rate x DRG weight,22600,,"26,426 x DRG weight",22600,Other,base rate x DRG weight,33189,,"38,809 x DRG weight",33189,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,108342,70,,108342,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21429,,"25,057 x DRG weight",21429,Other,base rate x DRG weight,19286,,"22,552 x DRG weight",19286,Other,base rate x DRG weight,21429,,"25,057 x DRG weight",21429,Other,base rate x DRG weight,18214,,"21,298 x DRG weight",18214,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,108342,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,,inpatient,,,93885.21,9011,,,9011,Other,150% of Medicare + 9.63% HCRA Surcharge,5479.61,,,5479.61,Other,Medicare IPPS methodology,15418,,"25,046 x DRG weight",15418,Other,base rate x DRG weight,13876,,"22,541 x DRG weight",13876,Other,base rate x DRG weight,19755,,"32,091 x DRG weight",19755,Other,base rate x DRG weight,17780,,"28,882 x DRG weight",17780,Other,base rate x DRG weight,16792,,"27,277 x DRG weight",16792,Other,base rate x DRG weight,14824,,"24,080 x DRG weight",14824,Other,base rate x DRG weight,13828,,"22,463 x DRG weight",13828,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,16268,,"26,426 x DRG weight",16268,Other,base rate x DRG weight,23891,,"38,809 x DRG weight",23891,Other,base rate x DRG weight,23891,,"38,809 x DRG weight",23891,Other,base rate x DRG weight,16268,,"26,426 x DRG weight",16268,Other,base rate x DRG weight,23891,,"38,809 x DRG weight",23891,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,65720,70,,65720,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15425,,"25,057 x DRG weight",15425,Other,base rate x DRG weight,13883,,"22,552 x DRG weight",13883,Other,base rate x DRG weight,15425,,"25,057 x DRG weight",15425,Other,base rate x DRG weight,13111,,"21,298 x DRG weight",13111,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,65720,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,,inpatient,,,292904.11,25691,,,25691,Other,150% of Medicare + 9.63% HCRA Surcharge,15623.1,,,15623.1,Other,Medicare IPPS methodology,45789,,"25,046 x DRG weight",45789,Other,base rate x DRG weight,41209,,"22,541 x DRG weight",41209,Other,base rate x DRG weight,58669,,"32,091 x DRG weight",58669,Other,base rate x DRG weight,52802,,"28,882 x DRG weight",52802,Other,base rate x DRG weight,49868,,"27,277 x DRG weight",49868,Other,base rate x DRG weight,44023,,"24,080 x DRG weight",44023,Other,base rate x DRG weight,41067,,"22,463 x DRG weight",41067,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48312,,"26,426 x DRG weight",48312,Other,base rate x DRG weight,70951,,"38,809 x DRG weight",70951,Other,base rate x DRG weight,70951,,"38,809 x DRG weight",70951,Other,base rate x DRG weight,48312,,"26,426 x DRG weight",48312,Other,base rate x DRG weight,70951,,"38,809 x DRG weight",70951,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,205033,70,,205033,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,45809,,"25,057 x DRG weight",45809,Other,base rate x DRG weight,41230,,"22,552 x DRG weight",41230,Other,base rate x DRG weight,45809,,"25,057 x DRG weight",45809,Other,base rate x DRG weight,38937,,"21,298 x DRG weight",38937,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,205033,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,,inpatient,,,154877.1,13632,,,13632,Other,150% of Medicare + 9.63% HCRA Surcharge,8289.44,,,8289.44,Other,Medicare IPPS methodology,23831,,"25,046 x DRG weight",23831,Other,base rate x DRG weight,21448,,"22,541 x DRG weight",21448,Other,base rate x DRG weight,30535,,"32,091 x DRG weight",30535,Other,base rate x DRG weight,27481,,"28,882 x DRG weight",27481,Other,base rate x DRG weight,25954,,"27,277 x DRG weight",25954,Other,base rate x DRG weight,22912,,"24,080 x DRG weight",22912,Other,base rate x DRG weight,21374,,"22,463 x DRG weight",21374,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25144,,"26,426 x DRG weight",25144,Other,base rate x DRG weight,36927,,"38,809 x DRG weight",36927,Other,base rate x DRG weight,36927,,"38,809 x DRG weight",36927,Other,base rate x DRG weight,25144,,"26,426 x DRG weight",25144,Other,base rate x DRG weight,36927,,"38,809 x DRG weight",36927,Other,base rate x DRG weight,26088,,"6,363 x patient days",26088,Per diem,,108414,70,,108414,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23842,,"25,057 x DRG weight",23842,Other,base rate x DRG weight,21458,,"22,552 x DRG weight",21458,Other,base rate x DRG weight,23842,,"25,057 x DRG weight",23842,Other,base rate x DRG weight,20265,,"21,298 x DRG weight",20265,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,108414,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,,inpatient,,,124494.32,10374,,,10374,Other,150% of Medicare + 9.63% HCRA Surcharge,6308.59,,,6308.59,Other,Medicare IPPS methodology,17900,,"25,046 x DRG weight",17900,Other,base rate x DRG weight,16110,,"22,541 x DRG weight",16110,Other,base rate x DRG weight,22935,,"32,091 x DRG weight",22935,Other,base rate x DRG weight,20642,,"28,882 x DRG weight",20642,Other,base rate x DRG weight,19495,,"27,277 x DRG weight",19495,Other,base rate x DRG weight,17210,,"24,080 x DRG weight",17210,Other,base rate x DRG weight,16054,,"22,463 x DRG weight",16054,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18887,,"26,426 x DRG weight",18887,Other,base rate x DRG weight,27737,,"38,809 x DRG weight",27737,Other,base rate x DRG weight,27737,,"38,809 x DRG weight",27737,Other,base rate x DRG weight,18887,,"26,426 x DRG weight",18887,Other,base rate x DRG weight,27737,,"38,809 x DRG weight",27737,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,87146,70,,87146,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17908,,"25,057 x DRG weight",17908,Other,base rate x DRG weight,16118,,"22,552 x DRG weight",16118,Other,base rate x DRG weight,17908,,"25,057 x DRG weight",17908,Other,base rate x DRG weight,15222,,"21,298 x DRG weight",15222,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,87146,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,,inpatient,,,229395.79,23009,,,23009,Other,150% of Medicare + 9.63% HCRA Surcharge,13991.91,,,13991.91,Other,Medicare IPPS methodology,40905,,"25,046 x DRG weight",40905,Other,base rate x DRG weight,36814,,"22,541 x DRG weight",36814,Other,base rate x DRG weight,52411,,"32,091 x DRG weight",52411,Other,base rate x DRG weight,47170,,"28,882 x DRG weight",47170,Other,base rate x DRG weight,44549,,"27,277 x DRG weight",44549,Other,base rate x DRG weight,39327,,"24,080 x DRG weight",39327,Other,base rate x DRG weight,36687,,"22,463 x DRG weight",36687,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43159,,"26,426 x DRG weight",43159,Other,base rate x DRG weight,63383,,"38,809 x DRG weight",63383,Other,base rate x DRG weight,63383,,"38,809 x DRG weight",63383,Other,base rate x DRG weight,43159,,"26,426 x DRG weight",43159,Other,base rate x DRG weight,63383,,"38,809 x DRG weight",63383,Other,base rate x DRG weight,37542,,"6,363 x patient days",37542,Per diem,,160577,70,,160577,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40923,,"25,057 x DRG weight",40923,Other,base rate x DRG weight,36832,,"22,552 x DRG weight",36832,Other,base rate x DRG weight,40923,,"25,057 x DRG weight",40923,Other,base rate x DRG weight,34784,,"21,298 x DRG weight",34784,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,160577,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,,inpatient,,,155190.87,15493,,,15493,Other,150% of Medicare + 9.63% HCRA Surcharge,9421.24,,,9421.24,Other,Medicare IPPS methodology,27220,,"25,046 x DRG weight",27220,Other,base rate x DRG weight,24498,,"22,541 x DRG weight",24498,Other,base rate x DRG weight,34876,,"32,091 x DRG weight",34876,Other,base rate x DRG weight,31389,,"28,882 x DRG weight",31389,Other,base rate x DRG weight,29645,,"27,277 x DRG weight",29645,Other,base rate x DRG weight,26170,,"24,080 x DRG weight",26170,Other,base rate x DRG weight,24413,,"22,463 x DRG weight",24413,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28720,,"26,426 x DRG weight",28720,Other,base rate x DRG weight,42178,,"38,809 x DRG weight",42178,Other,base rate x DRG weight,42178,,"38,809 x DRG weight",42178,Other,base rate x DRG weight,28720,,"26,426 x DRG weight",28720,Other,base rate x DRG weight,42178,,"38,809 x DRG weight",42178,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,108634,70,,108634,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27232,,"25,057 x DRG weight",27232,Other,base rate x DRG weight,24510,,"22,552 x DRG weight",24510,Other,base rate x DRG weight,27232,,"25,057 x DRG weight",27232,Other,base rate x DRG weight,23147,,"21,298 x DRG weight",23147,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,108634,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,,inpatient,,,90748.1,11568,,,11568,Other,150% of Medicare + 9.63% HCRA Surcharge,7034.68,,,7034.68,Other,Medicare IPPS methodology,20074,,"25,046 x DRG weight",20074,Other,base rate x DRG weight,18067,,"22,541 x DRG weight",18067,Other,base rate x DRG weight,25721,,"32,091 x DRG weight",25721,Other,base rate x DRG weight,23149,,"28,882 x DRG weight",23149,Other,base rate x DRG weight,21863,,"27,277 x DRG weight",21863,Other,base rate x DRG weight,19300,,"24,080 x DRG weight",19300,Other,base rate x DRG weight,18004,,"22,463 x DRG weight",18004,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21180,,"26,426 x DRG weight",21180,Other,base rate x DRG weight,31105,,"38,809 x DRG weight",31105,Other,base rate x DRG weight,31105,,"38,809 x DRG weight",31105,Other,base rate x DRG weight,21180,,"26,426 x DRG weight",21180,Other,base rate x DRG weight,31105,,"38,809 x DRG weight",31105,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,63524,70,,63524,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20083,,"25,057 x DRG weight",20083,Other,base rate x DRG weight,18075,,"22,552 x DRG weight",18075,Other,base rate x DRG weight,20083,,"25,057 x DRG weight",20083,Other,base rate x DRG weight,17070,,"21,298 x DRG weight",17070,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,63524,
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,453,MS-DRG,,,,,,,,inpatient,,,633098.44,122440,,,122440,Other,150% of Medicare + 9.63% HCRA Surcharge,74456.36,,,74456.36,Other,Medicare IPPS methodology,221943,,"25,046 x DRG weight",221943,Other,base rate x DRG weight,199745,,"22,541 x DRG weight",199745,Other,base rate x DRG weight,284371,,"32,091 x DRG weight",284371,Other,base rate x DRG weight,255935,,"28,882 x DRG weight",255935,Other,base rate x DRG weight,241712,,"27,277 x DRG weight",241712,Other,base rate x DRG weight,213383,,"24,080 x DRG weight",213383,Other,base rate x DRG weight,199054,,"22,463 x DRG weight",199054,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,234171,,"26,426 x DRG weight",234171,Other,base rate x DRG weight,343902,,"38,809 x DRG weight",343902,Other,base rate x DRG weight,343902,,"38,809 x DRG weight",343902,Other,base rate x DRG weight,234171,,"26,426 x DRG weight",234171,Other,base rate x DRG weight,343902,,"38,809 x DRG weight",343902,Other,base rate x DRG weight,59812,,"6,363 x patient days",59812,Per diem,,443169,70,,443169,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,222040,,"25,057 x DRG weight",222040,Other,base rate x DRG weight,199842,,"22,552 x DRG weight",199842,Other,base rate x DRG weight,222040,,"25,057 x DRG weight",222040,Other,base rate x DRG weight,188730,,"21,298 x DRG weight",188730,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,443169,
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,454,MS-DRG,,,,,,,,inpatient,,,567022.09,84678,,,84678,Other,150% of Medicare + 9.63% HCRA Surcharge,51493.39,,,51493.39,Other,Medicare IPPS methodology,153189,,"25,046 x DRG weight",153189,Other,base rate x DRG weight,137868,,"22,541 x DRG weight",137868,Other,base rate x DRG weight,196278,,"32,091 x DRG weight",196278,Other,base rate x DRG weight,176651,,"28,882 x DRG weight",176651,Other,base rate x DRG weight,166834,,"27,277 x DRG weight",166834,Other,base rate x DRG weight,147281,,"24,080 x DRG weight",147281,Other,base rate x DRG weight,137390,,"22,463 x DRG weight",137390,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,161629,,"26,426 x DRG weight",161629,Other,base rate x DRG weight,237367,,"38,809 x DRG weight",237367,Other,base rate x DRG weight,237367,,"38,809 x DRG weight",237367,Other,base rate x DRG weight,161629,,"26,426 x DRG weight",161629,Other,base rate x DRG weight,237367,,"38,809 x DRG weight",237367,Other,base rate x DRG weight,27997,,"6,363 x patient days",27997,Per diem,,396915,70,,396915,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,153256,,"25,057 x DRG weight",153256,Other,base rate x DRG weight,137935,,"22,552 x DRG weight",137935,Other,base rate x DRG weight,153256,,"25,057 x DRG weight",153256,Other,base rate x DRG weight,130265,,"21,298 x DRG weight",130265,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,396915,
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,455,MS-DRG,,,,,,,,inpatient,,,369111.85,63897,,,63897,Other,150% of Medicare + 9.63% HCRA Surcharge,38856.27,,,38856.27,Other,Medicare IPPS methodology,115352,,"25,046 x DRG weight",115352,Other,base rate x DRG weight,103815,,"22,541 x DRG weight",103815,Other,base rate x DRG weight,147798,,"32,091 x DRG weight",147798,Other,base rate x DRG weight,133019,,"28,882 x DRG weight",133019,Other,base rate x DRG weight,125627,,"27,277 x DRG weight",125627,Other,base rate x DRG weight,110903,,"24,080 x DRG weight",110903,Other,base rate x DRG weight,103456,,"22,463 x DRG weight",103456,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,121708,,"26,426 x DRG weight",121708,Other,base rate x DRG weight,178739,,"38,809 x DRG weight",178739,Other,base rate x DRG weight,178739,,"38,809 x DRG weight",178739,Other,base rate x DRG weight,121708,,"26,426 x DRG weight",121708,Other,base rate x DRG weight,178739,,"38,809 x DRG weight",178739,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,258378,70,,258378,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,115403,,"25,057 x DRG weight",115403,Other,base rate x DRG weight,103865,,"22,552 x DRG weight",103865,Other,base rate x DRG weight,115403,,"25,057 x DRG weight",115403,Other,base rate x DRG weight,98090,,"21,298 x DRG weight",98090,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,258378,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,,inpatient,,,843561.74,116497,,,116497,Other,150% of Medicare + 9.63% HCRA Surcharge,70842.65,,,70842.65,Other,Medicare IPPS methodology,211123,,"25,046 x DRG weight",211123,Other,base rate x DRG weight,190007,,"22,541 x DRG weight",190007,Other,base rate x DRG weight,270508,,"32,091 x DRG weight",270508,Other,base rate x DRG weight,243458,,"28,882 x DRG weight",243458,Other,base rate x DRG weight,229929,,"27,277 x DRG weight",229929,Other,base rate x DRG weight,202980,,"24,080 x DRG weight",202980,Other,base rate x DRG weight,189350,,"22,463 x DRG weight",189350,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,222755,,"26,426 x DRG weight",222755,Other,base rate x DRG weight,327137,,"38,809 x DRG weight",327137,Other,base rate x DRG weight,327137,,"38,809 x DRG weight",327137,Other,base rate x DRG weight,222755,,"26,426 x DRG weight",222755,Other,base rate x DRG weight,327137,,"38,809 x DRG weight",327137,Other,base rate x DRG weight,84628,,"6,363 x patient days",84628,Per diem,,590493,70,,590493,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,211215,,"25,057 x DRG weight",211215,Other,base rate x DRG weight,190100,,"22,552 x DRG weight",190100,Other,base rate x DRG weight,211215,,"25,057 x DRG weight",211215,Other,base rate x DRG weight,179529,,"21,298 x DRG weight",179529,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,590493,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,,inpatient,,,595047.79,84114,,,84114,Other,150% of Medicare + 9.63% HCRA Surcharge,51150.42,,,51150.42,Other,Medicare IPPS methodology,152162,,"25,046 x DRG weight",152162,Other,base rate x DRG weight,136943,,"22,541 x DRG weight",136943,Other,base rate x DRG weight,194962,,"32,091 x DRG weight",194962,Other,base rate x DRG weight,175467,,"28,882 x DRG weight",175467,Other,base rate x DRG weight,165716,,"27,277 x DRG weight",165716,Other,base rate x DRG weight,146293,,"24,080 x DRG weight",146293,Other,base rate x DRG weight,136469,,"22,463 x DRG weight",136469,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,160546,,"26,426 x DRG weight",160546,Other,base rate x DRG weight,235776,,"38,809 x DRG weight",235776,Other,base rate x DRG weight,235776,,"38,809 x DRG weight",235776,Other,base rate x DRG weight,160546,,"26,426 x DRG weight",160546,Other,base rate x DRG weight,235776,,"38,809 x DRG weight",235776,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,416533,70,,416533,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,152229,,"25,057 x DRG weight",152229,Other,base rate x DRG weight,137010,,"22,552 x DRG weight",137010,Other,base rate x DRG weight,152229,,"25,057 x DRG weight",152229,Other,base rate x DRG weight,129392,,"21,298 x DRG weight",129392,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,416533,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,,inpatient,,,361625.58,62871,,,62871,Other,150% of Medicare + 9.63% HCRA Surcharge,38232.23,,,38232.23,Other,Medicare IPPS methodology,113483,,"25,046 x DRG weight",113483,Other,base rate x DRG weight,102133,,"22,541 x DRG weight",102133,Other,base rate x DRG weight,145404,,"32,091 x DRG weight",145404,Other,base rate x DRG weight,130864,,"28,882 x DRG weight",130864,Other,base rate x DRG weight,123592,,"27,277 x DRG weight",123592,Other,base rate x DRG weight,109106,,"24,080 x DRG weight",109106,Other,base rate x DRG weight,101780,,"22,463 x DRG weight",101780,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,119736,,"26,426 x DRG weight",119736,Other,base rate x DRG weight,175844,,"38,809 x DRG weight",175844,Other,base rate x DRG weight,175844,,"38,809 x DRG weight",175844,Other,base rate x DRG weight,119736,,"26,426 x DRG weight",119736,Other,base rate x DRG weight,175844,,"38,809 x DRG weight",175844,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,253138,70,,253138,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,113533,,"25,057 x DRG weight",113533,Other,base rate x DRG weight,102183,,"22,552 x DRG weight",102183,Other,base rate x DRG weight,113533,,"25,057 x DRG weight",113533,Other,base rate x DRG weight,96501,,"21,298 x DRG weight",96501,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,253138,
SPINAL FUSION EXCEPT CERVICAL WITH MCC,459,MS-DRG,,,,,,,,inpatient,,,571947.85,91776,,,91776,Other,150% of Medicare + 9.63% HCRA Surcharge,55809.77,,,55809.77,Other,Medicare IPPS methodology,166113,,"25,046 x DRG weight",166113,Other,base rate x DRG weight,149499,,"22,541 x DRG weight",149499,Other,base rate x DRG weight,212837,,"32,091 x DRG weight",212837,Other,base rate x DRG weight,191554,,"28,882 x DRG weight",191554,Other,base rate x DRG weight,180909,,"27,277 x DRG weight",180909,Other,base rate x DRG weight,159706,,"24,080 x DRG weight",159706,Other,base rate x DRG weight,148981,,"22,463 x DRG weight",148981,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,175265,,"26,426 x DRG weight",175265,Other,base rate x DRG weight,257393,,"38,809 x DRG weight",257393,Other,base rate x DRG weight,257393,,"38,809 x DRG weight",257393,Other,base rate x DRG weight,175265,,"26,426 x DRG weight",175265,Other,base rate x DRG weight,257393,,"38,809 x DRG weight",257393,Other,base rate x DRG weight,62357,,"6,363 x patient days",62357,Per diem,,400363,70,,400363,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,166186,,"25,057 x DRG weight",166186,Other,base rate x DRG weight,149572,,"22,552 x DRG weight",149572,Other,base rate x DRG weight,166186,,"25,057 x DRG weight",166186,Other,base rate x DRG weight,141255,,"21,298 x DRG weight",141255,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,400363,
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,460,MS-DRG,,,,,,,,inpatient,,,412534.11,50861,,,50861,Other,150% of Medicare + 9.63% HCRA Surcharge,30928.69,,,30928.69,Other,Medicare IPPS methodology,91616,,"25,046 x DRG weight",91616,Other,base rate x DRG weight,82453,,"22,541 x DRG weight",82453,Other,base rate x DRG weight,117386,,"32,091 x DRG weight",117386,Other,base rate x DRG weight,105647,,"28,882 x DRG weight",105647,Other,base rate x DRG weight,99777,,"27,277 x DRG weight",99777,Other,base rate x DRG weight,88082,,"24,080 x DRG weight",88082,Other,base rate x DRG weight,82167,,"22,463 x DRG weight",82167,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,96664,,"26,426 x DRG weight",96664,Other,base rate x DRG weight,141959,,"38,809 x DRG weight",141959,Other,base rate x DRG weight,141959,,"38,809 x DRG weight",141959,Other,base rate x DRG weight,96664,,"26,426 x DRG weight",96664,Other,base rate x DRG weight,141959,,"38,809 x DRG weight",141959,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,288774,70,,288774,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,91656,,"25,057 x DRG weight",91656,Other,base rate x DRG weight,82493,,"22,552 x DRG weight",82493,Other,base rate x DRG weight,91656,,"25,057 x DRG weight",91656,Other,base rate x DRG weight,77906,,"21,298 x DRG weight",77906,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,288774,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,,inpatient,,,375453.95,94338,,,94338,Other,150% of Medicare + 9.63% HCRA Surcharge,57367.35,,,57367.35,Other,Medicare IPPS methodology,170776,,"25,046 x DRG weight",170776,Other,base rate x DRG weight,153696,,"22,541 x DRG weight",153696,Other,base rate x DRG weight,218812,,"32,091 x DRG weight",218812,Other,base rate x DRG weight,196932,,"28,882 x DRG weight",196932,Other,base rate x DRG weight,185988,,"27,277 x DRG weight",185988,Other,base rate x DRG weight,164189,,"24,080 x DRG weight",164189,Other,base rate x DRG weight,153164,,"22,463 x DRG weight",153164,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,180186,,"26,426 x DRG weight",180186,Other,base rate x DRG weight,264619,,"38,809 x DRG weight",264619,Other,base rate x DRG weight,264619,,"38,809 x DRG weight",264619,Other,base rate x DRG weight,180186,,"26,426 x DRG weight",180186,Other,base rate x DRG weight,264619,,"38,809 x DRG weight",264619,Other,base rate x DRG weight,67448,,"6,363 x patient days",67448,Per diem,,262818,70,,262818,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,170851,,"25,057 x DRG weight",170851,Other,base rate x DRG weight,153771,,"22,552 x DRG weight",153771,Other,base rate x DRG weight,170851,,"25,057 x DRG weight",170851,Other,base rate x DRG weight,145220,,"21,298 x DRG weight",145220,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,264619,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,,inpatient,,,213954.99,39696,,,39696,Other,150% of Medicare + 9.63% HCRA Surcharge,24139.59,,,24139.59,Other,Medicare IPPS methodology,71288,,"25,046 x DRG weight",71288,Other,base rate x DRG weight,64158,,"22,541 x DRG weight",64158,Other,base rate x DRG weight,91341,,"32,091 x DRG weight",91341,Other,base rate x DRG weight,82207,,"28,882 x DRG weight",82207,Other,base rate x DRG weight,77639,,"27,277 x DRG weight",77639,Other,base rate x DRG weight,68539,,"24,080 x DRG weight",68539,Other,base rate x DRG weight,63936,,"22,463 x DRG weight",63936,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,75216,,"26,426 x DRG weight",75216,Other,base rate x DRG weight,110462,,"38,809 x DRG weight",110462,Other,base rate x DRG weight,110462,,"38,809 x DRG weight",110462,Other,base rate x DRG weight,75216,,"26,426 x DRG weight",75216,Other,base rate x DRG weight,110462,,"38,809 x DRG weight",110462,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,149768,70,,149768,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,71320,,"25,057 x DRG weight",71320,Other,base rate x DRG weight,64190,,"22,552 x DRG weight",64190,Other,base rate x DRG weight,71320,,"25,057 x DRG weight",71320,Other,base rate x DRG weight,60620,,"21,298 x DRG weight",60620,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,149768,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,,inpatient,,,848239.31,78452,,,78452,Other,150% of Medicare + 9.63% HCRA Surcharge,47707.36,,,47707.36,Other,Medicare IPPS methodology,141853,,"25,046 x DRG weight",141853,Other,base rate x DRG weight,127665,,"22,541 x DRG weight",127665,Other,base rate x DRG weight,181754,,"32,091 x DRG weight",181754,Other,base rate x DRG weight,163579,,"28,882 x DRG weight",163579,Other,base rate x DRG weight,154489,,"27,277 x DRG weight",154489,Other,base rate x DRG weight,136382,,"24,080 x DRG weight",136382,Other,base rate x DRG weight,127224,,"22,463 x DRG weight",127224,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,149669,,"26,426 x DRG weight",149669,Other,base rate x DRG weight,219803,,"38,809 x DRG weight",219803,Other,base rate x DRG weight,219803,,"38,809 x DRG weight",219803,Other,base rate x DRG weight,149669,,"26,426 x DRG weight",149669,Other,base rate x DRG weight,219803,,"38,809 x DRG weight",219803,Other,base rate x DRG weight,97990,,"6,363 x patient days",97990,Per diem,,593768,70,,593768,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,141915,,"25,057 x DRG weight",141915,Other,base rate x DRG weight,127728,,"22,552 x DRG weight",127728,Other,base rate x DRG weight,141915,,"25,057 x DRG weight",141915,Other,base rate x DRG weight,120625,,"21,298 x DRG weight",120625,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,593768,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,,inpatient,,,544659.96,41830,,,41830,Other,150% of Medicare + 9.63% HCRA Surcharge,25437.01,,,25437.01,Other,Medicare IPPS methodology,75173,,"25,046 x DRG weight",75173,Other,base rate x DRG weight,67655,,"22,541 x DRG weight",67655,Other,base rate x DRG weight,96318,,"32,091 x DRG weight",96318,Other,base rate x DRG weight,86686,,"28,882 x DRG weight",86686,Other,base rate x DRG weight,81869,,"27,277 x DRG weight",81869,Other,base rate x DRG weight,72274,,"24,080 x DRG weight",72274,Other,base rate x DRG weight,67420,,"22,463 x DRG weight",67420,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,79315,,"26,426 x DRG weight",79315,Other,base rate x DRG weight,116481,,"38,809 x DRG weight",116481,Other,base rate x DRG weight,116481,,"38,809 x DRG weight",116481,Other,base rate x DRG weight,79315,,"26,426 x DRG weight",79315,Other,base rate x DRG weight,116481,,"38,809 x DRG weight",116481,Other,base rate x DRG weight,47086,,"6,363 x patient days",47086,Per diem,,381262,70,,381262,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,75206,,"25,057 x DRG weight",75206,Other,base rate x DRG weight,67688,,"22,552 x DRG weight",67688,Other,base rate x DRG weight,75206,,"25,057 x DRG weight",75206,Other,base rate x DRG weight,63924,,"21,298 x DRG weight",63924,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,381262,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,,inpatient,,,300547.76,26277,,,26277,Other,150% of Medicare + 9.63% HCRA Surcharge,15979.46,,,15979.46,Other,Medicare IPPS methodology,46856,,"25,046 x DRG weight",46856,Other,base rate x DRG weight,42170,,"22,541 x DRG weight",42170,Other,base rate x DRG weight,60036,,"32,091 x DRG weight",60036,Other,base rate x DRG weight,54032,,"28,882 x DRG weight",54032,Other,base rate x DRG weight,51030,,"27,277 x DRG weight",51030,Other,base rate x DRG weight,45049,,"24,080 x DRG weight",45049,Other,base rate x DRG weight,42024,,"22,463 x DRG weight",42024,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49438,,"26,426 x DRG weight",49438,Other,base rate x DRG weight,72604,,"38,809 x DRG weight",72604,Other,base rate x DRG weight,72604,,"38,809 x DRG weight",72604,Other,base rate x DRG weight,49438,,"26,426 x DRG weight",49438,Other,base rate x DRG weight,72604,,"38,809 x DRG weight",72604,Other,base rate x DRG weight,20998,,"6,363 x patient days",20998,Per diem,,210383,70,,210383,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46877,,"25,057 x DRG weight",46877,Other,base rate x DRG weight,42190,,"22,552 x DRG weight",42190,Other,base rate x DRG weight,46877,,"25,057 x DRG weight",46877,Other,base rate x DRG weight,39844,,"21,298 x DRG weight",39844,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,210383,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,,inpatient,,,415619.59,71889,,,71889,Other,150% of Medicare + 9.63% HCRA Surcharge,43716.38,,,43716.38,Other,Medicare IPPS methodology,129904,,"25,046 x DRG weight",129904,Other,base rate x DRG weight,116911,,"22,541 x DRG weight",116911,Other,base rate x DRG weight,166443,,"32,091 x DRG weight",166443,Other,base rate x DRG weight,149799,,"28,882 x DRG weight",149799,Other,base rate x DRG weight,141475,,"27,277 x DRG weight",141475,Other,base rate x DRG weight,124893,,"24,080 x DRG weight",124893,Other,base rate x DRG weight,116507,,"22,463 x DRG weight",116507,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,137061,,"26,426 x DRG weight",137061,Other,base rate x DRG weight,201287,,"38,809 x DRG weight",201287,Other,base rate x DRG weight,201287,,"38,809 x DRG weight",201287,Other,base rate x DRG weight,137061,,"26,426 x DRG weight",137061,Other,base rate x DRG weight,201287,,"38,809 x DRG weight",201287,Other,base rate x DRG weight,59812,,"6,363 x patient days",59812,Per diem,,290934,70,,290934,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,129961,,"25,057 x DRG weight",129961,Other,base rate x DRG weight,116968,,"22,552 x DRG weight",116968,Other,base rate x DRG weight,129961,,"25,057 x DRG weight",129961,Other,base rate x DRG weight,110464,,"21,298 x DRG weight",110464,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,290934,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,,inpatient,,,301348.69,48500,,,48500,Other,150% of Medicare + 9.63% HCRA Surcharge,29493.24,,,29493.24,Other,Medicare IPPS methodology,87318,,"25,046 x DRG weight",87318,Other,base rate x DRG weight,78585,,"22,541 x DRG weight",78585,Other,base rate x DRG weight,111879,,"32,091 x DRG weight",111879,Other,base rate x DRG weight,100691,,"28,882 x DRG weight",100691,Other,base rate x DRG weight,95096,,"27,277 x DRG weight",95096,Other,base rate x DRG weight,83950,,"24,080 x DRG weight",83950,Other,base rate x DRG weight,78313,,"22,463 x DRG weight",78313,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,92129,,"26,426 x DRG weight",92129,Other,base rate x DRG weight,135300,,"38,809 x DRG weight",135300,Other,base rate x DRG weight,135300,,"38,809 x DRG weight",135300,Other,base rate x DRG weight,92129,,"26,426 x DRG weight",92129,Other,base rate x DRG weight,135300,,"38,809 x DRG weight",135300,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,210944,70,,210944,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,87356,,"25,057 x DRG weight",87356,Other,base rate x DRG weight,78623,,"22,552 x DRG weight",78623,Other,base rate x DRG weight,87356,,"25,057 x DRG weight",87356,Other,base rate x DRG weight,74251,,"21,298 x DRG weight",74251,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,210944,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,,inpatient,,,176455.89,37266,,,37266,Other,150% of Medicare + 9.63% HCRA Surcharge,22661.48,,,22661.48,Other,Medicare IPPS methodology,66863,,"25,046 x DRG weight",66863,Other,base rate x DRG weight,60175,,"22,541 x DRG weight",60175,Other,base rate x DRG weight,85670,,"32,091 x DRG weight",85670,Other,base rate x DRG weight,77103,,"28,882 x DRG weight",77103,Other,base rate x DRG weight,72819,,"27,277 x DRG weight",72819,Other,base rate x DRG weight,64284,,"24,080 x DRG weight",64284,Other,base rate x DRG weight,59967,,"22,463 x DRG weight",59967,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,70547,,"26,426 x DRG weight",70547,Other,base rate x DRG weight,103605,,"38,809 x DRG weight",103605,Other,base rate x DRG weight,103605,,"38,809 x DRG weight",103605,Other,base rate x DRG weight,70547,,"26,426 x DRG weight",70547,Other,base rate x DRG weight,103605,,"38,809 x DRG weight",103605,Other,base rate x DRG weight,12726,,"6,363 x patient days",12726,Per diem,,123519,70,,123519,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,66892,,"25,057 x DRG weight",66892,Other,base rate x DRG weight,60205,,"22,552 x DRG weight",60205,Other,base rate x DRG weight,66892,,"25,057 x DRG weight",66892,Other,base rate x DRG weight,56857,,"21,298 x DRG weight",56857,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,123519,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,,inpatient,,,267132.55,46347,,,46347,Other,150% of Medicare + 9.63% HCRA Surcharge,28184.1,,,28184.1,Other,Medicare IPPS methodology,83398,,"25,046 x DRG weight",83398,Other,base rate x DRG weight,75057,,"22,541 x DRG weight",75057,Other,base rate x DRG weight,106857,,"32,091 x DRG weight",106857,Other,base rate x DRG weight,96171,,"28,882 x DRG weight",96171,Other,base rate x DRG weight,90827,,"27,277 x DRG weight",90827,Other,base rate x DRG weight,80182,,"24,080 x DRG weight",80182,Other,base rate x DRG weight,74797,,"22,463 x DRG weight",74797,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,87993,,"26,426 x DRG weight",87993,Other,base rate x DRG weight,129226,,"38,809 x DRG weight",129226,Other,base rate x DRG weight,129226,,"38,809 x DRG weight",129226,Other,base rate x DRG weight,87993,,"26,426 x DRG weight",87993,Other,base rate x DRG weight,129226,,"38,809 x DRG weight",129226,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,186993,70,,186993,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,83435,,"25,057 x DRG weight",83435,Other,base rate x DRG weight,75094,,"22,552 x DRG weight",75094,Other,base rate x DRG weight,83435,,"25,057 x DRG weight",83435,Other,base rate x DRG weight,70918,,"21,298 x DRG weight",70918,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,186993,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,,inpatient,,,151090.61,26427,,,26427,Other,150% of Medicare + 9.63% HCRA Surcharge,16070.64,,,16070.64,Other,Medicare IPPS methodology,47129,,"25,046 x DRG weight",47129,Other,base rate x DRG weight,42415,,"22,541 x DRG weight",42415,Other,base rate x DRG weight,60386,,"32,091 x DRG weight",60386,Other,base rate x DRG weight,54347,,"28,882 x DRG weight",54347,Other,base rate x DRG weight,51327,,"27,277 x DRG weight",51327,Other,base rate x DRG weight,45311,,"24,080 x DRG weight",45311,Other,base rate x DRG weight,42269,,"22,463 x DRG weight",42269,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49726,,"26,426 x DRG weight",49726,Other,base rate x DRG weight,73027,,"38,809 x DRG weight",73027,Other,base rate x DRG weight,73027,,"38,809 x DRG weight",73027,Other,base rate x DRG weight,49726,,"26,426 x DRG weight",49726,Other,base rate x DRG weight,73027,,"38,809 x DRG weight",73027,Other,base rate x DRG weight,12726,,"6,363 x patient days",12726,Per diem,,105763,70,,105763,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,47150,,"25,057 x DRG weight",47150,Other,base rate x DRG weight,42436,,"22,552 x DRG weight",42436,Other,base rate x DRG weight,47150,,"25,057 x DRG weight",47150,Other,base rate x DRG weight,40076,,"21,298 x DRG weight",40076,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,105763,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,,inpatient,,,489370.33,68208,,,68208,Other,150% of Medicare + 9.63% HCRA Surcharge,41477.88,,,41477.88,Other,Medicare IPPS methodology,123201,,"25,046 x DRG weight",123201,Other,base rate x DRG weight,110879,,"22,541 x DRG weight",110879,Other,base rate x DRG weight,157856,,"32,091 x DRG weight",157856,Other,base rate x DRG weight,142071,,"28,882 x DRG weight",142071,Other,base rate x DRG weight,134176,,"27,277 x DRG weight",134176,Other,base rate x DRG weight,118450,,"24,080 x DRG weight",118450,Other,base rate x DRG weight,110495,,"22,463 x DRG weight",110495,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,129989,,"26,426 x DRG weight",129989,Other,base rate x DRG weight,190901,,"38,809 x DRG weight",190901,Other,base rate x DRG weight,190901,,"38,809 x DRG weight",190901,Other,base rate x DRG weight,129989,,"26,426 x DRG weight",129989,Other,base rate x DRG weight,190901,,"38,809 x DRG weight",190901,Other,base rate x DRG weight,61721,,"6,363 x patient days",61721,Per diem,,342559,70,,342559,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,123255,,"25,057 x DRG weight",123255,Other,base rate x DRG weight,110933,,"22,552 x DRG weight",110933,Other,base rate x DRG weight,123255,,"25,057 x DRG weight",123255,Other,base rate x DRG weight,104765,,"21,298 x DRG weight",104765,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,342559,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,,inpatient,,,288821.42,41197,,,41197,Other,150% of Medicare + 9.63% HCRA Surcharge,25052.22,,,25052.22,Other,Medicare IPPS methodology,74021,,"25,046 x DRG weight",74021,Other,base rate x DRG weight,66618,,"22,541 x DRG weight",66618,Other,base rate x DRG weight,94842,,"32,091 x DRG weight",94842,Other,base rate x DRG weight,85358,,"28,882 x DRG weight",85358,Other,base rate x DRG weight,80614,,"27,277 x DRG weight",80614,Other,base rate x DRG weight,71166,,"24,080 x DRG weight",71166,Other,base rate x DRG weight,66387,,"22,463 x DRG weight",66387,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,78099,,"26,426 x DRG weight",78099,Other,base rate x DRG weight,114696,,"38,809 x DRG weight",114696,Other,base rate x DRG weight,114696,,"38,809 x DRG weight",114696,Other,base rate x DRG weight,78099,,"26,426 x DRG weight",78099,Other,base rate x DRG weight,114696,,"38,809 x DRG weight",114696,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,202175,70,,202175,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,74053,,"25,057 x DRG weight",74053,Other,base rate x DRG weight,66650,,"22,552 x DRG weight",66650,Other,base rate x DRG weight,74053,,"25,057 x DRG weight",74053,Other,base rate x DRG weight,62944,,"21,298 x DRG weight",62944,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,202175,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,,inpatient,,,189159.65,34391,,,34391,Other,150% of Medicare + 9.63% HCRA Surcharge,20913.18,,,20913.18,Other,Medicare IPPS methodology,61628,,"25,046 x DRG weight",61628,Other,base rate x DRG weight,55464,,"22,541 x DRG weight",55464,Other,base rate x DRG weight,78963,,"32,091 x DRG weight",78963,Other,base rate x DRG weight,71067,,"28,882 x DRG weight",71067,Other,base rate x DRG weight,67118,,"27,277 x DRG weight",67118,Other,base rate x DRG weight,59251,,"24,080 x DRG weight",59251,Other,base rate x DRG weight,55272,,"22,463 x DRG weight",55272,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,65024,,"26,426 x DRG weight",65024,Other,base rate x DRG weight,95493,,"38,809 x DRG weight",95493,Other,base rate x DRG weight,95493,,"38,809 x DRG weight",95493,Other,base rate x DRG weight,65024,,"26,426 x DRG weight",65024,Other,base rate x DRG weight,95493,,"38,809 x DRG weight",95493,Other,base rate x DRG weight,12726,,"6,363 x patient days",12726,Per diem,,132412,70,,132412,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,61655,,"25,057 x DRG weight",61655,Other,base rate x DRG weight,55491,,"22,552 x DRG weight",55491,Other,base rate x DRG weight,61655,,"25,057 x DRG weight",61655,Other,base rate x DRG weight,52406,,"21,298 x DRG weight",52406,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,132412,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,,inpatient,,,544842.37,59732,,,59732,Other,150% of Medicare + 9.63% HCRA Surcharge,36323.32,,,36323.32,Other,Medicare IPPS methodology,107768,,"25,046 x DRG weight",107768,Other,base rate x DRG weight,96989,,"22,541 x DRG weight",96989,Other,base rate x DRG weight,138081,,"32,091 x DRG weight",138081,Other,base rate x DRG weight,124273,,"28,882 x DRG weight",124273,Other,base rate x DRG weight,117367,,"27,277 x DRG weight",117367,Other,base rate x DRG weight,103611,,"24,080 x DRG weight",103611,Other,base rate x DRG weight,96654,,"22,463 x DRG weight",96654,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,113706,,"26,426 x DRG weight",113706,Other,base rate x DRG weight,166987,,"38,809 x DRG weight",166987,Other,base rate x DRG weight,166987,,"38,809 x DRG weight",166987,Other,base rate x DRG weight,113706,,"26,426 x DRG weight",113706,Other,base rate x DRG weight,166987,,"38,809 x DRG weight",166987,Other,base rate x DRG weight,83355,,"6,363 x patient days",83355,Per diem,,381390,70,,381390,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,107815,,"25,057 x DRG weight",107815,Other,base rate x DRG weight,97037,,"22,552 x DRG weight",97037,Other,base rate x DRG weight,107815,,"25,057 x DRG weight",107815,Other,base rate x DRG weight,91641,,"21,298 x DRG weight",91641,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,381390,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,,inpatient,,,263729.03,30045,,,30045,Other,150% of Medicare + 9.63% HCRA Surcharge,18270.65,,,18270.65,Other,Medicare IPPS methodology,53716,,"25,046 x DRG weight",53716,Other,base rate x DRG weight,48344,,"22,541 x DRG weight",48344,Other,base rate x DRG weight,68826,,"32,091 x DRG weight",68826,Other,base rate x DRG weight,61943,,"28,882 x DRG weight",61943,Other,base rate x DRG weight,58501,,"27,277 x DRG weight",58501,Other,base rate x DRG weight,51644,,"24,080 x DRG weight",51644,Other,base rate x DRG weight,48176,,"22,463 x DRG weight",48176,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,56676,,"26,426 x DRG weight",56676,Other,base rate x DRG weight,83234,,"38,809 x DRG weight",83234,Other,base rate x DRG weight,83234,,"38,809 x DRG weight",83234,Other,base rate x DRG weight,56676,,"26,426 x DRG weight",56676,Other,base rate x DRG weight,83234,,"38,809 x DRG weight",83234,Other,base rate x DRG weight,46450,,"6,363 x patient days",46450,Per diem,,184610,70,,184610,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,53740,,"25,057 x DRG weight",53740,Other,base rate x DRG weight,48367,,"22,552 x DRG weight",48367,Other,base rate x DRG weight,53740,,"25,057 x DRG weight",53740,Other,base rate x DRG weight,45678,,"21,298 x DRG weight",45678,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,184610,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,,inpatient,,,139055.76,16732,,,16732,Other,150% of Medicare + 9.63% HCRA Surcharge,10174.93,,,10174.93,Other,Medicare IPPS methodology,29477,,"25,046 x DRG weight",29477,Other,base rate x DRG weight,26529,,"22,541 x DRG weight",26529,Other,base rate x DRG weight,37768,,"32,091 x DRG weight",37768,Other,base rate x DRG weight,33991,,"28,882 x DRG weight",33991,Other,base rate x DRG weight,32102,,"27,277 x DRG weight",32102,Other,base rate x DRG weight,28340,,"24,080 x DRG weight",28340,Other,base rate x DRG weight,26437,,"22,463 x DRG weight",26437,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31101,,"26,426 x DRG weight",31101,Other,base rate x DRG weight,45674,,"38,809 x DRG weight",45674,Other,base rate x DRG weight,45674,,"38,809 x DRG weight",45674,Other,base rate x DRG weight,31101,,"26,426 x DRG weight",31101,Other,base rate x DRG weight,45674,,"38,809 x DRG weight",45674,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,97339,70,,97339,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29490,,"25,057 x DRG weight",29490,Other,base rate x DRG weight,26541,,"22,552 x DRG weight",26541,Other,base rate x DRG weight,29490,,"25,057 x DRG weight",29490,Other,base rate x DRG weight,25066,,"21,298 x DRG weight",25066,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,97339,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,,inpatient,,,534816.66,46887,,,46887,Other,150% of Medicare + 9.63% HCRA Surcharge,28512.01,,,28512.01,Other,Medicare IPPS methodology,84380,,"25,046 x DRG weight",84380,Other,base rate x DRG weight,75941,,"22,541 x DRG weight",75941,Other,base rate x DRG weight,108115,,"32,091 x DRG weight",108115,Other,base rate x DRG weight,97303,,"28,882 x DRG weight",97303,Other,base rate x DRG weight,91896,,"27,277 x DRG weight",91896,Other,base rate x DRG weight,81126,,"24,080 x DRG weight",81126,Other,base rate x DRG weight,75678,,"22,463 x DRG weight",75678,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,89029,,"26,426 x DRG weight",89029,Other,base rate x DRG weight,130748,,"38,809 x DRG weight",130748,Other,base rate x DRG weight,130748,,"38,809 x DRG weight",130748,Other,base rate x DRG weight,89029,,"26,426 x DRG weight",89029,Other,base rate x DRG weight,130748,,"38,809 x DRG weight",130748,Other,base rate x DRG weight,69993,,"6,363 x patient days",69993,Per diem,,374372,70,,374372,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,84417,,"25,057 x DRG weight",84417,Other,base rate x DRG weight,75978,,"22,552 x DRG weight",75978,Other,base rate x DRG weight,84417,,"25,057 x DRG weight",84417,Other,base rate x DRG weight,71753,,"21,298 x DRG weight",71753,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,374372,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,,inpatient,,,300553.25,33333,,,33333,Other,150% of Medicare + 9.63% HCRA Surcharge,20269.9,,,20269.9,Other,Medicare IPPS methodology,59702,,"25,046 x DRG weight",59702,Other,base rate x DRG weight,53731,,"22,541 x DRG weight",53731,Other,base rate x DRG weight,76495,,"32,091 x DRG weight",76495,Other,base rate x DRG weight,68846,,"28,882 x DRG weight",68846,Other,base rate x DRG weight,65020,,"27,277 x DRG weight",65020,Other,base rate x DRG weight,57399,,"24,080 x DRG weight",57399,Other,base rate x DRG weight,53545,,"22,463 x DRG weight",53545,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,62992,,"26,426 x DRG weight",62992,Other,base rate x DRG weight,92509,,"38,809 x DRG weight",92509,Other,base rate x DRG weight,92509,,"38,809 x DRG weight",92509,Other,base rate x DRG weight,62992,,"26,426 x DRG weight",62992,Other,base rate x DRG weight,92509,,"38,809 x DRG weight",92509,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,210387,70,,210387,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,59728,,"25,057 x DRG weight",59728,Other,base rate x DRG weight,53757,,"22,552 x DRG weight",53757,Other,base rate x DRG weight,59728,,"25,057 x DRG weight",59728,Other,base rate x DRG weight,50768,,"21,298 x DRG weight",50768,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,210387,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,,inpatient,,,252720.48,26184,,,26184,Other,150% of Medicare + 9.63% HCRA Surcharge,15922.57,,,15922.57,Other,Medicare IPPS methodology,46686,,"25,046 x DRG weight",46686,Other,base rate x DRG weight,42016,,"22,541 x DRG weight",42016,Other,base rate x DRG weight,59818,,"32,091 x DRG weight",59818,Other,base rate x DRG weight,53836,,"28,882 x DRG weight",53836,Other,base rate x DRG weight,50844,,"27,277 x DRG weight",50844,Other,base rate x DRG weight,44885,,"24,080 x DRG weight",44885,Other,base rate x DRG weight,41871,,"22,463 x DRG weight",41871,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49258,,"26,426 x DRG weight",49258,Other,base rate x DRG weight,72340,,"38,809 x DRG weight",72340,Other,base rate x DRG weight,72340,,"38,809 x DRG weight",72340,Other,base rate x DRG weight,49258,,"26,426 x DRG weight",49258,Other,base rate x DRG weight,72340,,"38,809 x DRG weight",72340,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,176904,70,,176904,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46706,,"25,057 x DRG weight",46706,Other,base rate x DRG weight,42037,,"22,552 x DRG weight",42037,Other,base rate x DRG weight,46706,,"25,057 x DRG weight",46706,Other,base rate x DRG weight,39699,,"21,298 x DRG weight",39699,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,176904,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,,inpatient,,,332195.9,41108,,,41108,Other,150% of Medicare + 9.63% HCRA Surcharge,24997.85,,,24997.85,Other,Medicare IPPS methodology,73858,,"25,046 x DRG weight",73858,Other,base rate x DRG weight,66471,,"22,541 x DRG weight",66471,Other,base rate x DRG weight,94633,,"32,091 x DRG weight",94633,Other,base rate x DRG weight,85170,,"28,882 x DRG weight",85170,Other,base rate x DRG weight,80437,,"27,277 x DRG weight",80437,Other,base rate x DRG weight,71010,,"24,080 x DRG weight",71010,Other,base rate x DRG weight,66241,,"22,463 x DRG weight",66241,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,77928,,"26,426 x DRG weight",77928,Other,base rate x DRG weight,114444,,"38,809 x DRG weight",114444,Other,base rate x DRG weight,114444,,"38,809 x DRG weight",114444,Other,base rate x DRG weight,77928,,"26,426 x DRG weight",77928,Other,base rate x DRG weight,114444,,"38,809 x DRG weight",114444,Other,base rate x DRG weight,50268,,"6,363 x patient days",50268,Per diem,,232537,70,,232537,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,73891,,"25,057 x DRG weight",73891,Other,base rate x DRG weight,66504,,"22,552 x DRG weight",66504,Other,base rate x DRG weight,73891,,"25,057 x DRG weight",73891,Other,base rate x DRG weight,62806,,"21,298 x DRG weight",62806,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,232537,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,,inpatient,,,253655.8,29085,,,29085,Other,150% of Medicare + 9.63% HCRA Surcharge,17686.77,,,17686.77,Other,Medicare IPPS methodology,51968,,"25,046 x DRG weight",51968,Other,base rate x DRG weight,46770,,"22,541 x DRG weight",46770,Other,base rate x DRG weight,66586,,"32,091 x DRG weight",66586,Other,base rate x DRG weight,59927,,"28,882 x DRG weight",59927,Other,base rate x DRG weight,56597,,"27,277 x DRG weight",56597,Other,base rate x DRG weight,49964,,"24,080 x DRG weight",49964,Other,base rate x DRG weight,46608,,"22,463 x DRG weight",46608,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,54831,,"26,426 x DRG weight",54831,Other,base rate x DRG weight,80525,,"38,809 x DRG weight",80525,Other,base rate x DRG weight,80525,,"38,809 x DRG weight",80525,Other,base rate x DRG weight,54831,,"26,426 x DRG weight",54831,Other,base rate x DRG weight,80525,,"38,809 x DRG weight",80525,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,177559,70,,177559,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,51991,,"25,057 x DRG weight",51991,Other,base rate x DRG weight,46793,,"22,552 x DRG weight",46793,Other,base rate x DRG weight,51991,,"25,057 x DRG weight",51991,Other,base rate x DRG weight,44191,,"21,298 x DRG weight",44191,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,177559,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,,inpatient,,,183953.55,22393,,,22393,Other,150% of Medicare + 9.63% HCRA Surcharge,13617.16,,,13617.16,Other,Medicare IPPS methodology,39783,,"25,046 x DRG weight",39783,Other,base rate x DRG weight,35804,,"22,541 x DRG weight",35804,Other,base rate x DRG weight,50973,,"32,091 x DRG weight",50973,Other,base rate x DRG weight,45876,,"28,882 x DRG weight",45876,Other,base rate x DRG weight,43327,,"27,277 x DRG weight",43327,Other,base rate x DRG weight,38249,,"24,080 x DRG weight",38249,Other,base rate x DRG weight,35680,,"22,463 x DRG weight",35680,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41975,,"26,426 x DRG weight",41975,Other,base rate x DRG weight,61644,,"38,809 x DRG weight",61644,Other,base rate x DRG weight,61644,,"38,809 x DRG weight",61644,Other,base rate x DRG weight,41975,,"26,426 x DRG weight",41975,Other,base rate x DRG weight,61644,,"38,809 x DRG weight",61644,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,128767,70,,128767,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39801,,"25,057 x DRG weight",39801,Other,base rate x DRG weight,35822,,"22,552 x DRG weight",35822,Other,base rate x DRG weight,39801,,"25,057 x DRG weight",39801,Other,base rate x DRG weight,33830,,"21,298 x DRG weight",33830,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,128767,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,,inpatient,,,271272.5,34715,,,34715,Other,150% of Medicare + 9.63% HCRA Surcharge,21110.59,,,21110.59,Other,Medicare IPPS methodology,62219,,"25,046 x DRG weight",62219,Other,base rate x DRG weight,55996,,"22,541 x DRG weight",55996,Other,base rate x DRG weight,79720,,"32,091 x DRG weight",79720,Other,base rate x DRG weight,71749,,"28,882 x DRG weight",71749,Other,base rate x DRG weight,67762,,"27,277 x DRG weight",67762,Other,base rate x DRG weight,59820,,"24,080 x DRG weight",59820,Other,base rate x DRG weight,55803,,"22,463 x DRG weight",55803,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,65647,,"26,426 x DRG weight",65647,Other,base rate x DRG weight,96409,,"38,809 x DRG weight",96409,Other,base rate x DRG weight,96409,,"38,809 x DRG weight",96409,Other,base rate x DRG weight,65647,,"26,426 x DRG weight",65647,Other,base rate x DRG weight,96409,,"38,809 x DRG weight",96409,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,189891,70,,189891,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,62247,,"25,057 x DRG weight",62247,Other,base rate x DRG weight,56024,,"22,552 x DRG weight",56024,Other,base rate x DRG weight,62247,,"25,057 x DRG weight",62247,Other,base rate x DRG weight,52908,,"21,298 x DRG weight",52908,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,189891,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,,inpatient,,,502414.13,45855,,,45855,Other,150% of Medicare + 9.63% HCRA Surcharge,27884.63,,,27884.63,Other,Medicare IPPS methodology,82502,,"25,046 x DRG weight",82502,Other,base rate x DRG weight,74250,,"22,541 x DRG weight",74250,Other,base rate x DRG weight,105708,,"32,091 x DRG weight",105708,Other,base rate x DRG weight,95137,,"28,882 x DRG weight",95137,Other,base rate x DRG weight,89850,,"27,277 x DRG weight",89850,Other,base rate x DRG weight,79320,,"24,080 x DRG weight",79320,Other,base rate x DRG weight,73993,,"22,463 x DRG weight",73993,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,87047,,"26,426 x DRG weight",87047,Other,base rate x DRG weight,127837,,"38,809 x DRG weight",127837,Other,base rate x DRG weight,127837,,"38,809 x DRG weight",127837,Other,base rate x DRG weight,87047,,"26,426 x DRG weight",87047,Other,base rate x DRG weight,127837,,"38,809 x DRG weight",127837,Other,base rate x DRG weight,64266,,"6,363 x patient days",64266,Per diem,,351690,70,,351690,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,82538,,"25,057 x DRG weight",82538,Other,base rate x DRG weight,74286,,"22,552 x DRG weight",74286,Other,base rate x DRG weight,82538,,"25,057 x DRG weight",82538,Other,base rate x DRG weight,70156,,"21,298 x DRG weight",70156,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,351690,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,,inpatient,,,261162.63,28169,,,28169,Other,150% of Medicare + 9.63% HCRA Surcharge,17129.65,,,17129.65,Other,Medicare IPPS methodology,50300,,"25,046 x DRG weight",50300,Other,base rate x DRG weight,45269,,"22,541 x DRG weight",45269,Other,base rate x DRG weight,64448,,"32,091 x DRG weight",64448,Other,base rate x DRG weight,58004,,"28,882 x DRG weight",58004,Other,base rate x DRG weight,54780,,"27,277 x DRG weight",54780,Other,base rate x DRG weight,48360,,"24,080 x DRG weight",48360,Other,base rate x DRG weight,45112,,"22,463 x DRG weight",45112,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,53071,,"26,426 x DRG weight",53071,Other,base rate x DRG weight,77940,,"38,809 x DRG weight",77940,Other,base rate x DRG weight,77940,,"38,809 x DRG weight",77940,Other,base rate x DRG weight,53071,,"26,426 x DRG weight",53071,Other,base rate x DRG weight,77940,,"38,809 x DRG weight",77940,Other,base rate x DRG weight,37542,,"6,363 x patient days",37542,Per diem,,182814,70,,182814,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,50322,,"25,057 x DRG weight",50322,Other,base rate x DRG weight,45291,,"22,552 x DRG weight",45291,Other,base rate x DRG weight,50322,,"25,057 x DRG weight",50322,Other,base rate x DRG weight,42773,,"21,298 x DRG weight",42773,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,182814,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,,inpatient,,,164039.72,21794,,,21794,Other,150% of Medicare + 9.63% HCRA Surcharge,13253.28,,,13253.28,Other,Medicare IPPS methodology,38694,,"25,046 x DRG weight",38694,Other,base rate x DRG weight,34824,,"22,541 x DRG weight",34824,Other,base rate x DRG weight,49577,,"32,091 x DRG weight",49577,Other,base rate x DRG weight,44620,,"28,882 x DRG weight",44620,Other,base rate x DRG weight,42140,,"27,277 x DRG weight",42140,Other,base rate x DRG weight,37201,,"24,080 x DRG weight",37201,Other,base rate x DRG weight,34703,,"22,463 x DRG weight",34703,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40826,,"26,426 x DRG weight",40826,Other,base rate x DRG weight,59956,,"38,809 x DRG weight",59956,Other,base rate x DRG weight,59956,,"38,809 x DRG weight",59956,Other,base rate x DRG weight,40826,,"26,426 x DRG weight",40826,Other,base rate x DRG weight,59956,,"38,809 x DRG weight",59956,Other,base rate x DRG weight,26088,,"6,363 x patient days",26088,Per diem,,114828,70,,114828,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38711,,"25,057 x DRG weight",38711,Other,base rate x DRG weight,34841,,"22,552 x DRG weight",34841,Other,base rate x DRG weight,38711,,"25,057 x DRG weight",38711,Other,base rate x DRG weight,32903,,"21,298 x DRG weight",32903,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,114828,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,,inpatient,,,322882.32,29521,,,29521,Other,150% of Medicare + 9.63% HCRA Surcharge,17951.94,,,17951.94,Other,Medicare IPPS methodology,52762,,"25,046 x DRG weight",52762,Other,base rate x DRG weight,47485,,"22,541 x DRG weight",47485,Other,base rate x DRG weight,67603,,"32,091 x DRG weight",67603,Other,base rate x DRG weight,60843,,"28,882 x DRG weight",60843,Other,base rate x DRG weight,57462,,"27,277 x DRG weight",57462,Other,base rate x DRG weight,50727,,"24,080 x DRG weight",50727,Other,base rate x DRG weight,47321,,"22,463 x DRG weight",47321,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,55669,,"26,426 x DRG weight",55669,Other,base rate x DRG weight,81755,,"38,809 x DRG weight",81755,Other,base rate x DRG weight,81755,,"38,809 x DRG weight",81755,Other,base rate x DRG weight,55669,,"26,426 x DRG weight",55669,Other,base rate x DRG weight,81755,,"38,809 x DRG weight",81755,Other,base rate x DRG weight,28634,,"6,363 x patient days",28634,Per diem,,226018,70,,226018,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52785,,"25,057 x DRG weight",52785,Other,base rate x DRG weight,47508,,"22,552 x DRG weight",47508,Other,base rate x DRG weight,52785,,"25,057 x DRG weight",52785,Other,base rate x DRG weight,44866,,"21,298 x DRG weight",44866,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,226018,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,,inpatient,,,190126.09,17569,,,17569,Other,150% of Medicare + 9.63% HCRA Surcharge,10683.53,,,10683.53,Other,Medicare IPPS methodology,30999,,"25,046 x DRG weight",30999,Other,base rate x DRG weight,27899,,"22,541 x DRG weight",27899,Other,base rate x DRG weight,39719,,"32,091 x DRG weight",39719,Other,base rate x DRG weight,35747,,"28,882 x DRG weight",35747,Other,base rate x DRG weight,33761,,"27,277 x DRG weight",33761,Other,base rate x DRG weight,29804,,"24,080 x DRG weight",29804,Other,base rate x DRG weight,27802,,"22,463 x DRG weight",27802,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,32707,,"26,426 x DRG weight",32707,Other,base rate x DRG weight,48034,,"38,809 x DRG weight",48034,Other,base rate x DRG weight,48034,,"38,809 x DRG weight",48034,Other,base rate x DRG weight,32707,,"26,426 x DRG weight",32707,Other,base rate x DRG weight,48034,,"38,809 x DRG weight",48034,Other,base rate x DRG weight,12090,,"6,363 x patient days",12090,Per diem,,133088,70,,133088,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,31013,,"25,057 x DRG weight",31013,Other,base rate x DRG weight,27913,,"22,552 x DRG weight",27913,Other,base rate x DRG weight,31013,,"25,057 x DRG weight",31013,Other,base rate x DRG weight,26361,,"21,298 x DRG weight",26361,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,133088,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,,inpatient,,,407050.77,48167,,,48167,Other,150% of Medicare + 9.63% HCRA Surcharge,29290.8,,,29290.8,Other,Medicare IPPS methodology,86712,,"25,046 x DRG weight",86712,Other,base rate x DRG weight,78039,,"22,541 x DRG weight",78039,Other,base rate x DRG weight,111102,,"32,091 x DRG weight",111102,Other,base rate x DRG weight,99992,,"28,882 x DRG weight",99992,Other,base rate x DRG weight,94436,,"27,277 x DRG weight",94436,Other,base rate x DRG weight,83367,,"24,080 x DRG weight",83367,Other,base rate x DRG weight,77769,,"22,463 x DRG weight",77769,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,91489,,"26,426 x DRG weight",91489,Other,base rate x DRG weight,134361,,"38,809 x DRG weight",134361,Other,base rate x DRG weight,134361,,"38,809 x DRG weight",134361,Other,base rate x DRG weight,91489,,"26,426 x DRG weight",91489,Other,base rate x DRG weight,134361,,"38,809 x DRG weight",134361,Other,base rate x DRG weight,54722,,"6,363 x patient days",54722,Per diem,,284936,70,,284936,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,86750,,"25,057 x DRG weight",86750,Other,base rate x DRG weight,78077,,"22,552 x DRG weight",78077,Other,base rate x DRG weight,86750,,"25,057 x DRG weight",86750,Other,base rate x DRG weight,73736,,"21,298 x DRG weight",73736,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,284936,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,,inpatient,,,277949.72,33580,,,33580,Other,150% of Medicare + 9.63% HCRA Surcharge,20420.48,,,20420.48,Other,Medicare IPPS methodology,60153,,"25,046 x DRG weight",60153,Other,base rate x DRG weight,54137,,"22,541 x DRG weight",54137,Other,base rate x DRG weight,77073,,"32,091 x DRG weight",77073,Other,base rate x DRG weight,69366,,"28,882 x DRG weight",69366,Other,base rate x DRG weight,65511,,"27,277 x DRG weight",65511,Other,base rate x DRG weight,57833,,"24,080 x DRG weight",57833,Other,base rate x DRG weight,53949,,"22,463 x DRG weight",53949,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,63467,,"26,426 x DRG weight",63467,Other,base rate x DRG weight,93208,,"38,809 x DRG weight",93208,Other,base rate x DRG weight,93208,,"38,809 x DRG weight",93208,Other,base rate x DRG weight,63467,,"26,426 x DRG weight",63467,Other,base rate x DRG weight,93208,,"38,809 x DRG weight",93208,Other,base rate x DRG weight,33088,,"6,363 x patient days",33088,Per diem,,194565,70,,194565,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,60179,,"25,057 x DRG weight",60179,Other,base rate x DRG weight,54163,,"22,552 x DRG weight",54163,Other,base rate x DRG weight,60179,,"25,057 x DRG weight",60179,Other,base rate x DRG weight,51151,,"21,298 x DRG weight",51151,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,194565,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,,inpatient,,,207862.3,26255,,,26255,Other,150% of Medicare + 9.63% HCRA Surcharge,15966.07,,,15966.07,Other,Medicare IPPS methodology,46816,,"25,046 x DRG weight",46816,Other,base rate x DRG weight,42134,,"22,541 x DRG weight",42134,Other,base rate x DRG weight,59984,,"32,091 x DRG weight",59984,Other,base rate x DRG weight,53986,,"28,882 x DRG weight",53986,Other,base rate x DRG weight,50986,,"27,277 x DRG weight",50986,Other,base rate x DRG weight,45010,,"24,080 x DRG weight",45010,Other,base rate x DRG weight,41988,,"22,463 x DRG weight",41988,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49395,,"26,426 x DRG weight",49395,Other,base rate x DRG weight,72542,,"38,809 x DRG weight",72542,Other,base rate x DRG weight,72542,,"38,809 x DRG weight",72542,Other,base rate x DRG weight,49395,,"26,426 x DRG weight",49395,Other,base rate x DRG weight,72542,,"38,809 x DRG weight",72542,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,145504,70,,145504,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46837,,"25,057 x DRG weight",46837,Other,base rate x DRG weight,42154,,"22,552 x DRG weight",42154,Other,base rate x DRG weight,46837,,"25,057 x DRG weight",46837,Other,base rate x DRG weight,39810,,"21,298 x DRG weight",39810,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,145504,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,,inpatient,,,1130144.9,49806,,,49806,Other,150% of Medicare + 9.63% HCRA Surcharge,30287.08,,,30287.08,Other,Medicare IPPS methodology,89695,,"25,046 x DRG weight",89695,Other,base rate x DRG weight,80724,,"22,541 x DRG weight",80724,Other,base rate x DRG weight,114924,,"32,091 x DRG weight",114924,Other,base rate x DRG weight,103432,,"28,882 x DRG weight",103432,Other,base rate x DRG weight,97684,,"27,277 x DRG weight",97684,Other,base rate x DRG weight,86235,,"24,080 x DRG weight",86235,Other,base rate x DRG weight,80444,,"22,463 x DRG weight",80444,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,94637,,"26,426 x DRG weight",94637,Other,base rate x DRG weight,138983,,"38,809 x DRG weight",138983,Other,base rate x DRG weight,138983,,"38,809 x DRG weight",138983,Other,base rate x DRG weight,94637,,"26,426 x DRG weight",94637,Other,base rate x DRG weight,138983,,"38,809 x DRG weight",138983,Other,base rate x DRG weight,66812,,"6,363 x patient days",66812,Per diem,,791101,70,,791101,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,89734,,"25,057 x DRG weight",89734,Other,base rate x DRG weight,80763,,"22,552 x DRG weight",80763,Other,base rate x DRG weight,89734,,"25,057 x DRG weight",89734,Other,base rate x DRG weight,76272,,"21,298 x DRG weight",76272,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,791101,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,,inpatient,,,239548.84,27883,,,27883,Other,150% of Medicare + 9.63% HCRA Surcharge,16955.66,,,16955.66,Other,Medicare IPPS methodology,49779,,"25,046 x DRG weight",49779,Other,base rate x DRG weight,44800,,"22,541 x DRG weight",44800,Other,base rate x DRG weight,63781,,"32,091 x DRG weight",63781,Other,base rate x DRG weight,57403,,"28,882 x DRG weight",57403,Other,base rate x DRG weight,54213,,"27,277 x DRG weight",54213,Other,base rate x DRG weight,47859,,"24,080 x DRG weight",47859,Other,base rate x DRG weight,44645,,"22,463 x DRG weight",44645,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52522,,"26,426 x DRG weight",52522,Other,base rate x DRG weight,77133,,"38,809 x DRG weight",77133,Other,base rate x DRG weight,77133,,"38,809 x DRG weight",77133,Other,base rate x DRG weight,52522,,"26,426 x DRG weight",52522,Other,base rate x DRG weight,77133,,"38,809 x DRG weight",77133,Other,base rate x DRG weight,29270,,"6,363 x patient days",29270,Per diem,,167684,70,,167684,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49801,,"25,057 x DRG weight",49801,Other,base rate x DRG weight,44822,,"22,552 x DRG weight",44822,Other,base rate x DRG weight,49801,,"25,057 x DRG weight",49801,Other,base rate x DRG weight,42330,,"21,298 x DRG weight",42330,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,167684,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,,inpatient,,,111107.51,20178,,,20178,Other,150% of Medicare + 9.63% HCRA Surcharge,12270.38,,,12270.38,Other,Medicare IPPS methodology,35751,,"25,046 x DRG weight",35751,Other,base rate x DRG weight,32175,,"22,541 x DRG weight",32175,Other,base rate x DRG weight,45807,,"32,091 x DRG weight",45807,Other,base rate x DRG weight,41226,,"28,882 x DRG weight",41226,Other,base rate x DRG weight,38935,,"27,277 x DRG weight",38935,Other,base rate x DRG weight,34372,,"24,080 x DRG weight",34372,Other,base rate x DRG weight,32064,,"22,463 x DRG weight",32064,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37720,,"26,426 x DRG weight",37720,Other,base rate x DRG weight,55396,,"38,809 x DRG weight",55396,Other,base rate x DRG weight,55396,,"38,809 x DRG weight",55396,Other,base rate x DRG weight,37720,,"26,426 x DRG weight",37720,Other,base rate x DRG weight,55396,,"38,809 x DRG weight",55396,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,77775,70,,77775,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35766,,"25,057 x DRG weight",35766,Other,base rate x DRG weight,32191,,"22,552 x DRG weight",32191,Other,base rate x DRG weight,35766,,"25,057 x DRG weight",35766,Other,base rate x DRG weight,30401,,"21,298 x DRG weight",30401,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,77775,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,,inpatient,,,433070.13,36460,,,36460,Other,150% of Medicare + 9.63% HCRA Surcharge,22171.29,,,22171.29,Other,Medicare IPPS methodology,65395,,"25,046 x DRG weight",65395,Other,base rate x DRG weight,58855,,"22,541 x DRG weight",58855,Other,base rate x DRG weight,83790,,"32,091 x DRG weight",83790,Other,base rate x DRG weight,75411,,"28,882 x DRG weight",75411,Other,base rate x DRG weight,71220,,"27,277 x DRG weight",71220,Other,base rate x DRG weight,62873,,"24,080 x DRG weight",62873,Other,base rate x DRG weight,58651,,"22,463 x DRG weight",58651,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,68998,,"26,426 x DRG weight",68998,Other,base rate x DRG weight,101330,,"38,809 x DRG weight",101330,Other,base rate x DRG weight,101330,,"38,809 x DRG weight",101330,Other,base rate x DRG weight,68998,,"26,426 x DRG weight",68998,Other,base rate x DRG weight,101330,,"38,809 x DRG weight",101330,Other,base rate x DRG weight,53449,,"6,363 x patient days",53449,Per diem,,303149,70,,303149,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,65424,,"25,057 x DRG weight",65424,Other,base rate x DRG weight,58883,,"22,552 x DRG weight",58883,Other,base rate x DRG weight,65424,,"25,057 x DRG weight",65424,Other,base rate x DRG weight,55609,,"21,298 x DRG weight",55609,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,303149,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,,inpatient,,,175437.85,18285,,,18285,Other,150% of Medicare + 9.63% HCRA Surcharge,11119.35,,,11119.35,Other,Medicare IPPS methodology,32304,,"25,046 x DRG weight",32304,Other,base rate x DRG weight,29073,,"22,541 x DRG weight",29073,Other,base rate x DRG weight,41391,,"32,091 x DRG weight",41391,Other,base rate x DRG weight,37252,,"28,882 x DRG weight",37252,Other,base rate x DRG weight,35182,,"27,277 x DRG weight",35182,Other,base rate x DRG weight,31058,,"24,080 x DRG weight",31058,Other,base rate x DRG weight,28973,,"22,463 x DRG weight",28973,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34084,,"26,426 x DRG weight",34084,Other,base rate x DRG weight,50056,,"38,809 x DRG weight",50056,Other,base rate x DRG weight,50056,,"38,809 x DRG weight",50056,Other,base rate x DRG weight,34084,,"26,426 x DRG weight",34084,Other,base rate x DRG weight,50056,,"38,809 x DRG weight",50056,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,122806,70,,122806,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32319,,"25,057 x DRG weight",32319,Other,base rate x DRG weight,29088,,"22,552 x DRG weight",29088,Other,base rate x DRG weight,32319,,"25,057 x DRG weight",32319,Other,base rate x DRG weight,27470,,"21,298 x DRG weight",27470,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,122806,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,,inpatient,,,262912.23,45151,,,45151,Other,150% of Medicare + 9.63% HCRA Surcharge,27456.34,,,27456.34,Other,Medicare IPPS methodology,81219,,"25,046 x DRG weight",81219,Other,base rate x DRG weight,73096,,"22,541 x DRG weight",73096,Other,base rate x DRG weight,104065,,"32,091 x DRG weight",104065,Other,base rate x DRG weight,93659,,"28,882 x DRG weight",93659,Other,base rate x DRG weight,88454,,"27,277 x DRG weight",88454,Other,base rate x DRG weight,78087,,"24,080 x DRG weight",78087,Other,base rate x DRG weight,72843,,"22,463 x DRG weight",72843,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,85694,,"26,426 x DRG weight",85694,Other,base rate x DRG weight,125850,,"38,809 x DRG weight",125850,Other,base rate x DRG weight,125850,,"38,809 x DRG weight",125850,Other,base rate x DRG weight,85694,,"26,426 x DRG weight",85694,Other,base rate x DRG weight,125850,,"38,809 x DRG weight",125850,Other,base rate x DRG weight,67448,,"6,363 x patient days",67448,Per diem,,184039,70,,184039,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,81255,,"25,057 x DRG weight",81255,Other,base rate x DRG weight,73132,,"22,552 x DRG weight",73132,Other,base rate x DRG weight,81255,,"25,057 x DRG weight",81255,Other,base rate x DRG weight,69065,,"21,298 x DRG weight",69065,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,184039,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,,inpatient,,,275120.97,24419,,,24419,Other,150% of Medicare + 9.63% HCRA Surcharge,14849.33,,,14849.33,Other,Medicare IPPS methodology,43472,,"25,046 x DRG weight",43472,Other,base rate x DRG weight,39124,,"22,541 x DRG weight",39124,Other,base rate x DRG weight,55700,,"32,091 x DRG weight",55700,Other,base rate x DRG weight,50130,,"28,882 x DRG weight",50130,Other,base rate x DRG weight,47345,,"27,277 x DRG weight",47345,Other,base rate x DRG weight,41796,,"24,080 x DRG weight",41796,Other,base rate x DRG weight,38989,,"22,463 x DRG weight",38989,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45868,,"26,426 x DRG weight",45868,Other,base rate x DRG weight,67361,,"38,809 x DRG weight",67361,Other,base rate x DRG weight,67361,,"38,809 x DRG weight",67361,Other,base rate x DRG weight,45868,,"26,426 x DRG weight",45868,Other,base rate x DRG weight,67361,,"38,809 x DRG weight",67361,Other,base rate x DRG weight,33724,,"6,363 x patient days",33724,Per diem,,192585,70,,192585,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43491,,"25,057 x DRG weight",43491,Other,base rate x DRG weight,39144,,"22,552 x DRG weight",39144,Other,base rate x DRG weight,43491,,"25,057 x DRG weight",43491,Other,base rate x DRG weight,36967,,"21,298 x DRG weight",36967,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,192585,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,,inpatient,,,174345.25,19563,,,19563,Other,150% of Medicare + 9.63% HCRA Surcharge,11896.46,,,11896.46,Other,Medicare IPPS methodology,34631,,"25,046 x DRG weight",34631,Other,base rate x DRG weight,31167,,"22,541 x DRG weight",31167,Other,base rate x DRG weight,44372,,"32,091 x DRG weight",44372,Other,base rate x DRG weight,39935,,"28,882 x DRG weight",39935,Other,base rate x DRG weight,37716,,"27,277 x DRG weight",37716,Other,base rate x DRG weight,33295,,"24,080 x DRG weight",33295,Other,base rate x DRG weight,31060,,"22,463 x DRG weight",31060,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,36539,,"26,426 x DRG weight",36539,Other,base rate x DRG weight,53661,,"38,809 x DRG weight",53661,Other,base rate x DRG weight,53661,,"38,809 x DRG weight",53661,Other,base rate x DRG weight,36539,,"26,426 x DRG weight",36539,Other,base rate x DRG weight,53661,,"38,809 x DRG weight",53661,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,122042,70,,122042,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,34646,,"25,057 x DRG weight",34646,Other,base rate x DRG weight,31183,,"22,552 x DRG weight",31183,Other,base rate x DRG weight,34646,,"25,057 x DRG weight",34646,Other,base rate x DRG weight,29449,,"21,298 x DRG weight",29449,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,122042,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,,inpatient,,,335847.49,37435,,,37435,Other,150% of Medicare + 9.63% HCRA Surcharge,22764.37,,,22764.37,Other,Medicare IPPS methodology,67171,,"25,046 x DRG weight",67171,Other,base rate x DRG weight,60453,,"22,541 x DRG weight",60453,Other,base rate x DRG weight,86065,,"32,091 x DRG weight",86065,Other,base rate x DRG weight,77459,,"28,882 x DRG weight",77459,Other,base rate x DRG weight,73154,,"27,277 x DRG weight",73154,Other,base rate x DRG weight,64580,,"24,080 x DRG weight",64580,Other,base rate x DRG weight,60244,,"22,463 x DRG weight",60244,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,70872,,"26,426 x DRG weight",70872,Other,base rate x DRG weight,104082,,"38,809 x DRG weight",104082,Other,base rate x DRG weight,104082,,"38,809 x DRG weight",104082,Other,base rate x DRG weight,70872,,"26,426 x DRG weight",70872,Other,base rate x DRG weight,104082,,"38,809 x DRG weight",104082,Other,base rate x DRG weight,57903,,"6,363 x patient days",57903,Per diem,,235093,70,,235093,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,67200,,"25,057 x DRG weight",67200,Other,base rate x DRG weight,60482,,"22,552 x DRG weight",60482,Other,base rate x DRG weight,67200,,"25,057 x DRG weight",67200,Other,base rate x DRG weight,57119,,"21,298 x DRG weight",57119,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,235093,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,,inpatient,,,217277.38,24301,,,24301,Other,150% of Medicare + 9.63% HCRA Surcharge,14777.39,,,14777.39,Other,Medicare IPPS methodology,43257,,"25,046 x DRG weight",43257,Other,base rate x DRG weight,38931,,"22,541 x DRG weight",38931,Other,base rate x DRG weight,55424,,"32,091 x DRG weight",55424,Other,base rate x DRG weight,49882,,"28,882 x DRG weight",49882,Other,base rate x DRG weight,47110,,"27,277 x DRG weight",47110,Other,base rate x DRG weight,41589,,"24,080 x DRG weight",41589,Other,base rate x DRG weight,38796,,"22,463 x DRG weight",38796,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45640,,"26,426 x DRG weight",45640,Other,base rate x DRG weight,67027,,"38,809 x DRG weight",67027,Other,base rate x DRG weight,67027,,"38,809 x DRG weight",67027,Other,base rate x DRG weight,45640,,"26,426 x DRG weight",45640,Other,base rate x DRG weight,67027,,"38,809 x DRG weight",67027,Other,base rate x DRG weight,35633,,"6,363 x patient days",35633,Per diem,,152094,70,,152094,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43276,,"25,057 x DRG weight",43276,Other,base rate x DRG weight,38950,,"22,552 x DRG weight",38950,Other,base rate x DRG weight,43276,,"25,057 x DRG weight",43276,Other,base rate x DRG weight,36784,,"21,298 x DRG weight",36784,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,152094,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,,inpatient,,,226961.08,24006,,,24006,Other,150% of Medicare + 9.63% HCRA Surcharge,14598.38,,,14598.38,Other,Medicare IPPS methodology,42721,,"25,046 x DRG weight",42721,Other,base rate x DRG weight,38448,,"22,541 x DRG weight",38448,Other,base rate x DRG weight,54738,,"32,091 x DRG weight",54738,Other,base rate x DRG weight,49264,,"28,882 x DRG weight",49264,Other,base rate x DRG weight,46526,,"27,277 x DRG weight",46526,Other,base rate x DRG weight,41073,,"24,080 x DRG weight",41073,Other,base rate x DRG weight,38315,,"22,463 x DRG weight",38315,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45075,,"26,426 x DRG weight",45075,Other,base rate x DRG weight,66197,,"38,809 x DRG weight",66197,Other,base rate x DRG weight,66197,,"38,809 x DRG weight",66197,Other,base rate x DRG weight,45075,,"26,426 x DRG weight",45075,Other,base rate x DRG weight,66197,,"38,809 x DRG weight",66197,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,158873,70,,158873,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,42740,,"25,057 x DRG weight",42740,Other,base rate x DRG weight,38467,,"22,552 x DRG weight",38467,Other,base rate x DRG weight,42740,,"25,057 x DRG weight",42740,Other,base rate x DRG weight,36328,,"21,298 x DRG weight",36328,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,158873,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,,inpatient,,,342220.88,20662,,,20662,Other,150% of Medicare + 9.63% HCRA Surcharge,12564.83,,,12564.83,Other,Medicare IPPS methodology,36632,,"25,046 x DRG weight",36632,Other,base rate x DRG weight,32968,,"22,541 x DRG weight",32968,Other,base rate x DRG weight,46936,,"32,091 x DRG weight",46936,Other,base rate x DRG weight,42243,,"28,882 x DRG weight",42243,Other,base rate x DRG weight,39895,,"27,277 x DRG weight",39895,Other,base rate x DRG weight,35219,,"24,080 x DRG weight",35219,Other,base rate x DRG weight,32854,,"22,463 x DRG weight",32854,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,38651,,"26,426 x DRG weight",38651,Other,base rate x DRG weight,56762,,"38,809 x DRG weight",56762,Other,base rate x DRG weight,56762,,"38,809 x DRG weight",56762,Other,base rate x DRG weight,38651,,"26,426 x DRG weight",38651,Other,base rate x DRG weight,56762,,"38,809 x DRG weight",56762,Other,base rate x DRG weight,32451,,"6,363 x patient days",32451,Per diem,,239555,70,,239555,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,36648,,"25,057 x DRG weight",36648,Other,base rate x DRG weight,32985,,"22,552 x DRG weight",32985,Other,base rate x DRG weight,36648,,"25,057 x DRG weight",36648,Other,base rate x DRG weight,31150,,"21,298 x DRG weight",31150,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,239555,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,,inpatient,,,398980.37,29866,,,29866,Other,150% of Medicare + 9.63% HCRA Surcharge,18161.9,,,18161.9,Other,Medicare IPPS methodology,53391,,"25,046 x DRG weight",53391,Other,base rate x DRG weight,48051,,"22,541 x DRG weight",48051,Other,base rate x DRG weight,68408,,"32,091 x DRG weight",68408,Other,base rate x DRG weight,61568,,"28,882 x DRG weight",61568,Other,base rate x DRG weight,58146,,"27,277 x DRG weight",58146,Other,base rate x DRG weight,51331,,"24,080 x DRG weight",51331,Other,base rate x DRG weight,47884,,"22,463 x DRG weight",47884,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,56332,,"26,426 x DRG weight",56332,Other,base rate x DRG weight,82729,,"38,809 x DRG weight",82729,Other,base rate x DRG weight,82729,,"38,809 x DRG weight",82729,Other,base rate x DRG weight,56332,,"26,426 x DRG weight",56332,Other,base rate x DRG weight,82729,,"38,809 x DRG weight",82729,Other,base rate x DRG weight,45177,,"6,363 x patient days",45177,Per diem,,279286,70,,279286,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,53414,,"25,057 x DRG weight",53414,Other,base rate x DRG weight,48074,,"22,552 x DRG weight",48074,Other,base rate x DRG weight,53414,,"25,057 x DRG weight",53414,Other,base rate x DRG weight,45401,,"21,298 x DRG weight",45401,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,279286,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,,inpatient,,,173438.38,20269,,,20269,Other,150% of Medicare + 9.63% HCRA Surcharge,12325.59,,,12325.59,Other,Medicare IPPS methodology,35916,,"25,046 x DRG weight",35916,Other,base rate x DRG weight,32324,,"22,541 x DRG weight",32324,Other,base rate x DRG weight,46018,,"32,091 x DRG weight",46018,Other,base rate x DRG weight,41417,,"28,882 x DRG weight",41417,Other,base rate x DRG weight,39115,,"27,277 x DRG weight",39115,Other,base rate x DRG weight,34531,,"24,080 x DRG weight",34531,Other,base rate x DRG weight,32212,,"22,463 x DRG weight",32212,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37895,,"26,426 x DRG weight",37895,Other,base rate x DRG weight,55652,,"38,809 x DRG weight",55652,Other,base rate x DRG weight,55652,,"38,809 x DRG weight",55652,Other,base rate x DRG weight,37895,,"26,426 x DRG weight",37895,Other,base rate x DRG weight,55652,,"38,809 x DRG weight",55652,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,121407,70,,121407,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35932,,"25,057 x DRG weight",35932,Other,base rate x DRG weight,32340,,"22,552 x DRG weight",32340,Other,base rate x DRG weight,35932,,"25,057 x DRG weight",35932,Other,base rate x DRG weight,30541,,"21,298 x DRG weight",30541,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,121407,
ARTHROSCOPY,509,MS-DRG,,,,,,,,inpatient,,,173438.38,19335,,,19335,Other,150% of Medicare + 9.63% HCRA Surcharge,11757.6,,,11757.6,Other,Medicare IPPS methodology,34215,,"25,046 x DRG weight",34215,Other,base rate x DRG weight,30793,,"22,541 x DRG weight",30793,Other,base rate x DRG weight,43840,,"32,091 x DRG weight",43840,Other,base rate x DRG weight,39456,,"28,882 x DRG weight",39456,Other,base rate x DRG weight,37263,,"27,277 x DRG weight",37263,Other,base rate x DRG weight,32896,,"24,080 x DRG weight",32896,Other,base rate x DRG weight,30687,,"22,463 x DRG weight",30687,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,36101,,"26,426 x DRG weight",36101,Other,base rate x DRG weight,53017,,"38,809 x DRG weight",53017,Other,base rate x DRG weight,53017,,"38,809 x DRG weight",53017,Other,base rate x DRG weight,36101,,"26,426 x DRG weight",36101,Other,base rate x DRG weight,53017,,"38,809 x DRG weight",53017,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,121407,70,,121407,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,34230,,"25,057 x DRG weight",34230,Other,base rate x DRG weight,30808,,"22,552 x DRG weight",30808,Other,base rate x DRG weight,34230,,"25,057 x DRG weight",34230,Other,base rate x DRG weight,29095,,"21,298 x DRG weight",29095,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,121407,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,,inpatient,,,318283.56,37967,,,37967,Other,150% of Medicare + 9.63% HCRA Surcharge,23088.1,,,23088.1,Other,Medicare IPPS methodology,68140,,"25,046 x DRG weight",68140,Other,base rate x DRG weight,61325,,"22,541 x DRG weight",61325,Other,base rate x DRG weight,87307,,"32,091 x DRG weight",87307,Other,base rate x DRG weight,78576,,"28,882 x DRG weight",78576,Other,base rate x DRG weight,74210,,"27,277 x DRG weight",74210,Other,base rate x DRG weight,65512,,"24,080 x DRG weight",65512,Other,base rate x DRG weight,61113,,"22,463 x DRG weight",61113,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,71895,,"26,426 x DRG weight",71895,Other,base rate x DRG weight,105584,,"38,809 x DRG weight",105584,Other,base rate x DRG weight,105584,,"38,809 x DRG weight",105584,Other,base rate x DRG weight,71895,,"26,426 x DRG weight",71895,Other,base rate x DRG weight,105584,,"38,809 x DRG weight",105584,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,222798,70,,222798,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,68170,,"25,057 x DRG weight",68170,Other,base rate x DRG weight,61355,,"22,552 x DRG weight",61355,Other,base rate x DRG weight,68170,,"25,057 x DRG weight",68170,Other,base rate x DRG weight,57943,,"21,298 x DRG weight",57943,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,222798,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,,inpatient,,,247003.25,27969,,,27969,Other,150% of Medicare + 9.63% HCRA Surcharge,17008.36,,,17008.36,Other,Medicare IPPS methodology,49937,,"25,046 x DRG weight",49937,Other,base rate x DRG weight,44942,,"22,541 x DRG weight",44942,Other,base rate x DRG weight,63983,,"32,091 x DRG weight",63983,Other,base rate x DRG weight,57585,,"28,882 x DRG weight",57585,Other,base rate x DRG weight,54385,,"27,277 x DRG weight",54385,Other,base rate x DRG weight,48011,,"24,080 x DRG weight",48011,Other,base rate x DRG weight,44787,,"22,463 x DRG weight",44787,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52688,,"26,426 x DRG weight",52688,Other,base rate x DRG weight,77377,,"38,809 x DRG weight",77377,Other,base rate x DRG weight,77377,,"38,809 x DRG weight",77377,Other,base rate x DRG weight,52688,,"26,426 x DRG weight",52688,Other,base rate x DRG weight,77377,,"38,809 x DRG weight",77377,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,172902,70,,172902,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49959,,"25,057 x DRG weight",49959,Other,base rate x DRG weight,44964,,"22,552 x DRG weight",44964,Other,base rate x DRG weight,49959,,"25,057 x DRG weight",49959,Other,base rate x DRG weight,42464,,"21,298 x DRG weight",42464,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,172902,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,,inpatient,,,160689.07,22742,,,22742,Other,150% of Medicare + 9.63% HCRA Surcharge,13829.63,,,13829.63,Other,Medicare IPPS methodology,40419,,"25,046 x DRG weight",40419,Other,base rate x DRG weight,36377,,"22,541 x DRG weight",36377,Other,base rate x DRG weight,51788,,"32,091 x DRG weight",51788,Other,base rate x DRG weight,46610,,"28,882 x DRG weight",46610,Other,base rate x DRG weight,44020,,"27,277 x DRG weight",44020,Other,base rate x DRG weight,38860,,"24,080 x DRG weight",38860,Other,base rate x DRG weight,36251,,"22,463 x DRG weight",36251,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42646,,"26,426 x DRG weight",42646,Other,base rate x DRG weight,62630,,"38,809 x DRG weight",62630,Other,base rate x DRG weight,62630,,"38,809 x DRG weight",62630,Other,base rate x DRG weight,42646,,"26,426 x DRG weight",42646,Other,base rate x DRG weight,62630,,"38,809 x DRG weight",62630,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,112482,70,,112482,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40437,,"25,057 x DRG weight",40437,Other,base rate x DRG weight,36394,,"22,552 x DRG weight",36394,Other,base rate x DRG weight,40437,,"25,057 x DRG weight",40437,Other,base rate x DRG weight,34371,,"21,298 x DRG weight",34371,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,112482,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,,inpatient,,,192311.1,22841,,,22841,Other,150% of Medicare + 9.63% HCRA Surcharge,13889.86,,,13889.86,Other,Medicare IPPS methodology,40600,,"25,046 x DRG weight",40600,Other,base rate x DRG weight,36539,,"22,541 x DRG weight",36539,Other,base rate x DRG weight,52020,,"32,091 x DRG weight",52020,Other,base rate x DRG weight,46818,,"28,882 x DRG weight",46818,Other,base rate x DRG weight,44216,,"27,277 x DRG weight",44216,Other,base rate x DRG weight,39034,,"24,080 x DRG weight",39034,Other,base rate x DRG weight,36413,,"22,463 x DRG weight",36413,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42837,,"26,426 x DRG weight",42837,Other,base rate x DRG weight,62909,,"38,809 x DRG weight",62909,Other,base rate x DRG weight,62909,,"38,809 x DRG weight",62909,Other,base rate x DRG weight,42837,,"26,426 x DRG weight",42837,Other,base rate x DRG weight,62909,,"38,809 x DRG weight",62909,Other,base rate x DRG weight,34997,,"6,363 x patient days",34997,Per diem,,134618,70,,134618,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40617,,"25,057 x DRG weight",40617,Other,base rate x DRG weight,36557,,"22,552 x DRG weight",36557,Other,base rate x DRG weight,40617,,"25,057 x DRG weight",40617,Other,base rate x DRG weight,34524,,"21,298 x DRG weight",34524,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,134618,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,,inpatient,,,129155.97,14870,,,14870,Other,150% of Medicare + 9.63% HCRA Surcharge,9042.3,,,9042.3,Other,Medicare IPPS methodology,26085,,"25,046 x DRG weight",26085,Other,base rate x DRG weight,23476,,"22,541 x DRG weight",23476,Other,base rate x DRG weight,33423,,"32,091 x DRG weight",33423,Other,base rate x DRG weight,30081,,"28,882 x DRG weight",30081,Other,base rate x DRG weight,28409,,"27,277 x DRG weight",28409,Other,base rate x DRG weight,25079,,"24,080 x DRG weight",25079,Other,base rate x DRG weight,23395,,"22,463 x DRG weight",23395,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27523,,"26,426 x DRG weight",27523,Other,base rate x DRG weight,40420,,"38,809 x DRG weight",40420,Other,base rate x DRG weight,40420,,"38,809 x DRG weight",40420,Other,base rate x DRG weight,27523,,"26,426 x DRG weight",27523,Other,base rate x DRG weight,40420,,"38,809 x DRG weight",40420,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,90409,70,,90409,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26097,,"25,057 x DRG weight",26097,Other,base rate x DRG weight,23488,,"22,552 x DRG weight",23488,Other,base rate x DRG weight,26097,,"25,057 x DRG weight",26097,Other,base rate x DRG weight,22182,,"21,298 x DRG weight",22182,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,90409,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,,inpatient,,,390024.67,44032,,,44032,Other,150% of Medicare + 9.63% HCRA Surcharge,26776.26,,,26776.26,Other,Medicare IPPS methodology,79183,,"25,046 x DRG weight",79183,Other,base rate x DRG weight,71263,,"22,541 x DRG weight",71263,Other,base rate x DRG weight,101456,,"32,091 x DRG weight",101456,Other,base rate x DRG weight,91310,,"28,882 x DRG weight",91310,Other,base rate x DRG weight,86236,,"27,277 x DRG weight",86236,Other,base rate x DRG weight,76129,,"24,080 x DRG weight",76129,Other,base rate x DRG weight,71017,,"22,463 x DRG weight",71017,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,83546,,"26,426 x DRG weight",83546,Other,base rate x DRG weight,122695,,"38,809 x DRG weight",122695,Other,base rate x DRG weight,122695,,"38,809 x DRG weight",122695,Other,base rate x DRG weight,83546,,"26,426 x DRG weight",83546,Other,base rate x DRG weight,122695,,"38,809 x DRG weight",122695,Other,base rate x DRG weight,57267,,"6,363 x patient days",57267,Per diem,,273017,70,,273017,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,79218,,"25,057 x DRG weight",79218,Other,base rate x DRG weight,71298,,"22,552 x DRG weight",71298,Other,base rate x DRG weight,79218,,"25,057 x DRG weight",79218,Other,base rate x DRG weight,67334,,"21,298 x DRG weight",67334,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,273017,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,,inpatient,,,265776.1,28616,,,28616,Other,150% of Medicare + 9.63% HCRA Surcharge,17401.52,,,17401.52,Other,Medicare IPPS methodology,51114,,"25,046 x DRG weight",51114,Other,base rate x DRG weight,46002,,"22,541 x DRG weight",46002,Other,base rate x DRG weight,65491,,"32,091 x DRG weight",65491,Other,base rate x DRG weight,58942,,"28,882 x DRG weight",58942,Other,base rate x DRG weight,55667,,"27,277 x DRG weight",55667,Other,base rate x DRG weight,49142,,"24,080 x DRG weight",49142,Other,base rate x DRG weight,45842,,"22,463 x DRG weight",45842,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,53930,,"26,426 x DRG weight",53930,Other,base rate x DRG weight,79201,,"38,809 x DRG weight",79201,Other,base rate x DRG weight,79201,,"38,809 x DRG weight",79201,Other,base rate x DRG weight,53930,,"26,426 x DRG weight",53930,Other,base rate x DRG weight,79201,,"38,809 x DRG weight",79201,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,186043,70,,186043,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,51136,,"25,057 x DRG weight",51136,Other,base rate x DRG weight,46024,,"22,552 x DRG weight",46024,Other,base rate x DRG weight,51136,,"25,057 x DRG weight",51136,Other,base rate x DRG weight,43465,,"21,298 x DRG weight",43465,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,186043,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,,inpatient,,,202936.2,21100,,,21100,Other,150% of Medicare + 9.63% HCRA Surcharge,12830.84,,,12830.84,Other,Medicare IPPS methodology,37429,,"25,046 x DRG weight",37429,Other,base rate x DRG weight,33685,,"22,541 x DRG weight",33685,Other,base rate x DRG weight,47957,,"32,091 x DRG weight",47957,Other,base rate x DRG weight,43161,,"28,882 x DRG weight",43161,Other,base rate x DRG weight,40763,,"27,277 x DRG weight",40763,Other,base rate x DRG weight,35985,,"24,080 x DRG weight",35985,Other,base rate x DRG weight,33569,,"22,463 x DRG weight",33569,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39491,,"26,426 x DRG weight",39491,Other,base rate x DRG weight,57996,,"38,809 x DRG weight",57996,Other,base rate x DRG weight,57996,,"38,809 x DRG weight",57996,Other,base rate x DRG weight,39491,,"26,426 x DRG weight",39491,Other,base rate x DRG weight,57996,,"38,809 x DRG weight",57996,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,142055,70,,142055,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37445,,"25,057 x DRG weight",37445,Other,base rate x DRG weight,33702,,"22,552 x DRG weight",33702,Other,base rate x DRG weight,37445,,"25,057 x DRG weight",37445,Other,base rate x DRG weight,31828,,"21,298 x DRG weight",31828,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,142055,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,,inpatient,,,405596.54,50777,,,50777,Other,150% of Medicare + 9.63% HCRA Surcharge,30877.66,,,30877.66,Other,Medicare IPPS methodology,91463,,"25,046 x DRG weight",91463,Other,base rate x DRG weight,82315,,"22,541 x DRG weight",82315,Other,base rate x DRG weight,117190,,"32,091 x DRG weight",117190,Other,base rate x DRG weight,105471,,"28,882 x DRG weight",105471,Other,base rate x DRG weight,99610,,"27,277 x DRG weight",99610,Other,base rate x DRG weight,87935,,"24,080 x DRG weight",87935,Other,base rate x DRG weight,82030,,"22,463 x DRG weight",82030,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,96502,,"26,426 x DRG weight",96502,Other,base rate x DRG weight,141723,,"38,809 x DRG weight",141723,Other,base rate x DRG weight,141723,,"38,809 x DRG weight",141723,Other,base rate x DRG weight,96502,,"26,426 x DRG weight",96502,Other,base rate x DRG weight,141723,,"38,809 x DRG weight",141723,Other,base rate x DRG weight,50904,,"6,363 x patient days",50904,Per diem,,283918,70,,283918,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,91503,,"25,057 x DRG weight",91503,Other,base rate x DRG weight,82355,,"22,552 x DRG weight",82355,Other,base rate x DRG weight,91503,,"25,057 x DRG weight",91503,Other,base rate x DRG weight,77776,,"21,298 x DRG weight",77776,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,283918,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,,inpatient,,,306057.09,27623,,,27623,Other,150% of Medicare + 9.63% HCRA Surcharge,16797.56,,,16797.56,Other,Medicare IPPS methodology,49306,,"25,046 x DRG weight",49306,Other,base rate x DRG weight,44374,,"22,541 x DRG weight",44374,Other,base rate x DRG weight,63174,,"32,091 x DRG weight",63174,Other,base rate x DRG weight,56857,,"28,882 x DRG weight",56857,Other,base rate x DRG weight,53698,,"27,277 x DRG weight",53698,Other,base rate x DRG weight,47404,,"24,080 x DRG weight",47404,Other,base rate x DRG weight,44221,,"22,463 x DRG weight",44221,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52022,,"26,426 x DRG weight",52022,Other,base rate x DRG weight,76399,,"38,809 x DRG weight",76399,Other,base rate x DRG weight,76399,,"38,809 x DRG weight",76399,Other,base rate x DRG weight,52022,,"26,426 x DRG weight",52022,Other,base rate x DRG weight,76399,,"38,809 x DRG weight",76399,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,214240,70,,214240,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49327,,"25,057 x DRG weight",49327,Other,base rate x DRG weight,44396,,"22,552 x DRG weight",44396,Other,base rate x DRG weight,49327,,"25,057 x DRG weight",49327,Other,base rate x DRG weight,41927,,"21,298 x DRG weight",41927,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,214240,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,,inpatient,,,189873.17,20234,,,20234,Other,150% of Medicare + 9.63% HCRA Surcharge,12304.68,,,12304.68,Other,Medicare IPPS methodology,35853,,"25,046 x DRG weight",35853,Other,base rate x DRG weight,32267,,"22,541 x DRG weight",32267,Other,base rate x DRG weight,45938,,"32,091 x DRG weight",45938,Other,base rate x DRG weight,41345,,"28,882 x DRG weight",41345,Other,base rate x DRG weight,39047,,"27,277 x DRG weight",39047,Other,base rate x DRG weight,34471,,"24,080 x DRG weight",34471,Other,base rate x DRG weight,32156,,"22,463 x DRG weight",32156,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37829,,"26,426 x DRG weight",37829,Other,base rate x DRG weight,55555,,"38,809 x DRG weight",55555,Other,base rate x DRG weight,55555,,"38,809 x DRG weight",55555,Other,base rate x DRG weight,37829,,"26,426 x DRG weight",37829,Other,base rate x DRG weight,55555,,"38,809 x DRG weight",55555,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,132911,70,,132911,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35869,,"25,057 x DRG weight",35869,Other,base rate x DRG weight,32283,,"22,552 x DRG weight",32283,Other,base rate x DRG weight,35869,,"25,057 x DRG weight",35869,Other,base rate x DRG weight,30488,,"21,298 x DRG weight",30488,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,132911,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,,inpatient,,,352051.27,41731,,,41731,Other,150% of Medicare + 9.63% HCRA Surcharge,25376.78,,,25376.78,Other,Medicare IPPS methodology,74993,,"25,046 x DRG weight",74993,Other,base rate x DRG weight,67492,,"22,541 x DRG weight",67492,Other,base rate x DRG weight,96087,,"32,091 x DRG weight",96087,Other,base rate x DRG weight,86478,,"28,882 x DRG weight",86478,Other,base rate x DRG weight,81673,,"27,277 x DRG weight",81673,Other,base rate x DRG weight,72100,,"24,080 x DRG weight",72100,Other,base rate x DRG weight,67259,,"22,463 x DRG weight",67259,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,79125,,"26,426 x DRG weight",79125,Other,base rate x DRG weight,116202,,"38,809 x DRG weight",116202,Other,base rate x DRG weight,116202,,"38,809 x DRG weight",116202,Other,base rate x DRG weight,79125,,"26,426 x DRG weight",79125,Other,base rate x DRG weight,116202,,"38,809 x DRG weight",116202,Other,base rate x DRG weight,48995,,"6,363 x patient days",48995,Per diem,,246436,70,,246436,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,75026,,"25,057 x DRG weight",75026,Other,base rate x DRG weight,67525,,"22,552 x DRG weight",67525,Other,base rate x DRG weight,75026,,"25,057 x DRG weight",75026,Other,base rate x DRG weight,63770,,"21,298 x DRG weight",63770,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,246436,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,,inpatient,,,229904.83,29598,,,29598,Other,150% of Medicare + 9.63% HCRA Surcharge,17998.79,,,17998.79,Other,Medicare IPPS methodology,52902,,"25,046 x DRG weight",52902,Other,base rate x DRG weight,47611,,"22,541 x DRG weight",47611,Other,base rate x DRG weight,67783,,"32,091 x DRG weight",67783,Other,base rate x DRG weight,61005,,"28,882 x DRG weight",61005,Other,base rate x DRG weight,57614,,"27,277 x DRG weight",57614,Other,base rate x DRG weight,50862,,"24,080 x DRG weight",50862,Other,base rate x DRG weight,47446,,"22,463 x DRG weight",47446,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,55817,,"26,426 x DRG weight",55817,Other,base rate x DRG weight,81972,,"38,809 x DRG weight",81972,Other,base rate x DRG weight,81972,,"38,809 x DRG weight",81972,Other,base rate x DRG weight,55817,,"26,426 x DRG weight",55817,Other,base rate x DRG weight,81972,,"38,809 x DRG weight",81972,Other,base rate x DRG weight,29270,,"6,363 x patient days",29270,Per diem,,160933,70,,160933,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52925,,"25,057 x DRG weight",52925,Other,base rate x DRG weight,47634,,"22,552 x DRG weight",47634,Other,base rate x DRG weight,52925,,"25,057 x DRG weight",52925,Other,base rate x DRG weight,44986,,"21,298 x DRG weight",44986,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,160933,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,,inpatient,,,247711.73,22984,,,22984,Other,150% of Medicare + 9.63% HCRA Surcharge,13976.86,,,13976.86,Other,Medicare IPPS methodology,40860,,"25,046 x DRG weight",40860,Other,base rate x DRG weight,36773,,"22,541 x DRG weight",36773,Other,base rate x DRG weight,52353,,"32,091 x DRG weight",52353,Other,base rate x DRG weight,47118,,"28,882 x DRG weight",47118,Other,base rate x DRG weight,44500,,"27,277 x DRG weight",44500,Other,base rate x DRG weight,39284,,"24,080 x DRG weight",39284,Other,base rate x DRG weight,36646,,"22,463 x DRG weight",36646,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43111,,"26,426 x DRG weight",43111,Other,base rate x DRG weight,63313,,"38,809 x DRG weight",63313,Other,base rate x DRG weight,63313,,"38,809 x DRG weight",63313,Other,base rate x DRG weight,43111,,"26,426 x DRG weight",43111,Other,base rate x DRG weight,63313,,"38,809 x DRG weight",63313,Other,base rate x DRG weight,41360,,"6,363 x patient days",41360,Per diem,,173398,70,,173398,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40878,,"25,057 x DRG weight",40878,Other,base rate x DRG weight,36791,,"22,552 x DRG weight",36791,Other,base rate x DRG weight,40878,,"25,057 x DRG weight",40878,Other,base rate x DRG weight,34746,,"21,298 x DRG weight",34746,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,173398,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,,inpatient,,,99141.01,11685,,,11685,Other,150% of Medicare + 9.63% HCRA Surcharge,7105.78,,,7105.78,Other,Medicare IPPS methodology,20287,,"25,046 x DRG weight",20287,Other,base rate x DRG weight,18258,,"22,541 x DRG weight",18258,Other,base rate x DRG weight,25994,,"32,091 x DRG weight",25994,Other,base rate x DRG weight,23394,,"28,882 x DRG weight",23394,Other,base rate x DRG weight,22094,,"27,277 x DRG weight",22094,Other,base rate x DRG weight,19505,,"24,080 x DRG weight",19505,Other,base rate x DRG weight,18195,,"22,463 x DRG weight",18195,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21405,,"26,426 x DRG weight",21405,Other,base rate x DRG weight,31435,,"38,809 x DRG weight",31435,Other,base rate x DRG weight,31435,,"38,809 x DRG weight",31435,Other,base rate x DRG weight,21405,,"26,426 x DRG weight",21405,Other,base rate x DRG weight,31435,,"38,809 x DRG weight",31435,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,69399,70,,69399,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20296,,"25,057 x DRG weight",20296,Other,base rate x DRG weight,18267,,"22,552 x DRG weight",18267,Other,base rate x DRG weight,20296,,"25,057 x DRG weight",20296,Other,base rate x DRG weight,17251,,"21,298 x DRG weight",17251,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,69399,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,,inpatient,,,210494.22,18380,,,18380,Other,150% of Medicare + 9.63% HCRA Surcharge,11177.07,,,11177.07,Other,Medicare IPPS methodology,32477,,"25,046 x DRG weight",32477,Other,base rate x DRG weight,29229,,"22,541 x DRG weight",29229,Other,base rate x DRG weight,41612,,"32,091 x DRG weight",41612,Other,base rate x DRG weight,37451,,"28,882 x DRG weight",37451,Other,base rate x DRG weight,35370,,"27,277 x DRG weight",35370,Other,base rate x DRG weight,31225,,"24,080 x DRG weight",31225,Other,base rate x DRG weight,29128,,"22,463 x DRG weight",29128,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34267,,"26,426 x DRG weight",34267,Other,base rate x DRG weight,50324,,"38,809 x DRG weight",50324,Other,base rate x DRG weight,50324,,"38,809 x DRG weight",50324,Other,base rate x DRG weight,34267,,"26,426 x DRG weight",34267,Other,base rate x DRG weight,50324,,"38,809 x DRG weight",50324,Other,base rate x DRG weight,33088,,"6,363 x patient days",33088,Per diem,,147346,70,,147346,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32491,,"25,057 x DRG weight",32491,Other,base rate x DRG weight,29243,,"22,552 x DRG weight",29243,Other,base rate x DRG weight,32491,,"25,057 x DRG weight",32491,Other,base rate x DRG weight,27617,,"21,298 x DRG weight",27617,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,147346,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,,inpatient,,,125096.21,11370,,,11370,Other,150% of Medicare + 9.63% HCRA Surcharge,6914.22,,,6914.22,Other,Medicare IPPS methodology,19714,,"25,046 x DRG weight",19714,Other,base rate x DRG weight,17742,,"22,541 x DRG weight",17742,Other,base rate x DRG weight,25259,,"32,091 x DRG weight",25259,Other,base rate x DRG weight,22733,,"28,882 x DRG weight",22733,Other,base rate x DRG weight,21470,,"27,277 x DRG weight",21470,Other,base rate x DRG weight,18953,,"24,080 x DRG weight",18953,Other,base rate x DRG weight,17681,,"22,463 x DRG weight",17681,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20800,,"26,426 x DRG weight",20800,Other,base rate x DRG weight,30547,,"38,809 x DRG weight",30547,Other,base rate x DRG weight,30547,,"38,809 x DRG weight",30547,Other,base rate x DRG weight,20800,,"26,426 x DRG weight",20800,Other,base rate x DRG weight,30547,,"38,809 x DRG weight",30547,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,87567,70,,87567,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19722,,"25,057 x DRG weight",19722,Other,base rate x DRG weight,17751,,"22,552 x DRG weight",17751,Other,base rate x DRG weight,19722,,"25,057 x DRG weight",19722,Other,base rate x DRG weight,16764,,"21,298 x DRG weight",16764,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,87567,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,,inpatient,,,413970,13845,,,13845,Other,150% of Medicare + 9.63% HCRA Surcharge,8419.1,,,8419.1,Other,Medicare IPPS methodology,24219,,"25,046 x DRG weight",24219,Other,base rate x DRG weight,21797,,"22,541 x DRG weight",21797,Other,base rate x DRG weight,31032,,"32,091 x DRG weight",31032,Other,base rate x DRG weight,27929,,"28,882 x DRG weight",27929,Other,base rate x DRG weight,26377,,"27,277 x DRG weight",26377,Other,base rate x DRG weight,23285,,"24,080 x DRG weight",23285,Other,base rate x DRG weight,21722,,"22,463 x DRG weight",21722,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25554,,"26,426 x DRG weight",25554,Other,base rate x DRG weight,37528,,"38,809 x DRG weight",37528,Other,base rate x DRG weight,37528,,"38,809 x DRG weight",37528,Other,base rate x DRG weight,25554,,"26,426 x DRG weight",25554,Other,base rate x DRG weight,37528,,"38,809 x DRG weight",37528,Other,base rate x DRG weight,25452,,"6,363 x patient days",25452,Per diem,,289779,70,,289779,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24230,,"25,057 x DRG weight",24230,Other,base rate x DRG weight,21808,,"22,552 x DRG weight",21808,Other,base rate x DRG weight,24230,,"25,057 x DRG weight",24230,Other,base rate x DRG weight,20595,,"21,298 x DRG weight",20595,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,289779,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,,inpatient,,,30498,10297,,,10297,Other,150% of Medicare + 9.63% HCRA Surcharge,6261.75,,,6261.75,Other,Medicare IPPS methodology,17760,,"25,046 x DRG weight",17760,Other,base rate x DRG weight,15984,,"22,541 x DRG weight",15984,Other,base rate x DRG weight,22756,,"32,091 x DRG weight",22756,Other,base rate x DRG weight,20480,,"28,882 x DRG weight",20480,Other,base rate x DRG weight,19342,,"27,277 x DRG weight",19342,Other,base rate x DRG weight,17075,,"24,080 x DRG weight",17075,Other,base rate x DRG weight,15929,,"22,463 x DRG weight",15929,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18739,,"26,426 x DRG weight",18739,Other,base rate x DRG weight,27519,,"38,809 x DRG weight",27519,Other,base rate x DRG weight,27519,,"38,809 x DRG weight",27519,Other,base rate x DRG weight,18739,,"26,426 x DRG weight",18739,Other,base rate x DRG weight,27519,,"38,809 x DRG weight",27519,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,21349,70,,21349,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17768,,"25,057 x DRG weight",17768,Other,base rate x DRG weight,15992,,"22,552 x DRG weight",15992,Other,base rate x DRG weight,17768,,"25,057 x DRG weight",17768,Other,base rate x DRG weight,15102,,"21,298 x DRG weight",15102,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,27519,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,,inpatient,,,445794.23,27840,,,27840,Other,150% of Medicare + 9.63% HCRA Surcharge,16929.73,,,16929.73,Other,Medicare IPPS methodology,49701,,"25,046 x DRG weight",49701,Other,base rate x DRG weight,44730,,"22,541 x DRG weight",44730,Other,base rate x DRG weight,63681,,"32,091 x DRG weight",63681,Other,base rate x DRG weight,57313,,"28,882 x DRG weight",57313,Other,base rate x DRG weight,54128,,"27,277 x DRG weight",54128,Other,base rate x DRG weight,47784,,"24,080 x DRG weight",47784,Other,base rate x DRG weight,44576,,"22,463 x DRG weight",44576,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52440,,"26,426 x DRG weight",52440,Other,base rate x DRG weight,77013,,"38,809 x DRG weight",77013,Other,base rate x DRG weight,77013,,"38,809 x DRG weight",77013,Other,base rate x DRG weight,52440,,"26,426 x DRG weight",52440,Other,base rate x DRG weight,77013,,"38,809 x DRG weight",77013,Other,base rate x DRG weight,54722,,"6,363 x patient days",54722,Per diem,,312056,70,,312056,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49723,,"25,057 x DRG weight",49723,Other,base rate x DRG weight,44752,,"22,552 x DRG weight",44752,Other,base rate x DRG weight,49723,,"25,057 x DRG weight",49723,Other,base rate x DRG weight,42264,,"21,298 x DRG weight",42264,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,312056,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,,inpatient,,,161586.34,18401,,,18401,Other,150% of Medicare + 9.63% HCRA Surcharge,11189.61,,,11189.61,Other,Medicare IPPS methodology,32515,,"25,046 x DRG weight",32515,Other,base rate x DRG weight,29263,,"22,541 x DRG weight",29263,Other,base rate x DRG weight,41661,,"32,091 x DRG weight",41661,Other,base rate x DRG weight,37495,,"28,882 x DRG weight",37495,Other,base rate x DRG weight,35411,,"27,277 x DRG weight",35411,Other,base rate x DRG weight,31261,,"24,080 x DRG weight",31261,Other,base rate x DRG weight,29161,,"22,463 x DRG weight",29161,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34306,,"26,426 x DRG weight",34306,Other,base rate x DRG weight,50382,,"38,809 x DRG weight",50382,Other,base rate x DRG weight,50382,,"38,809 x DRG weight",50382,Other,base rate x DRG weight,34306,,"26,426 x DRG weight",34306,Other,base rate x DRG weight,50382,,"38,809 x DRG weight",50382,Other,base rate x DRG weight,36269,,"6,363 x patient days",36269,Per diem,,113110,70,,113110,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32529,,"25,057 x DRG weight",32529,Other,base rate x DRG weight,29277,,"22,552 x DRG weight",29277,Other,base rate x DRG weight,32529,,"25,057 x DRG weight",32529,Other,base rate x DRG weight,27649,,"21,298 x DRG weight",27649,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,113110,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,,inpatient,,,95377.2,12344,,,12344,Other,150% of Medicare + 9.63% HCRA Surcharge,7506.47,,,7506.47,Other,Medicare IPPS methodology,21487,,"25,046 x DRG weight",21487,Other,base rate x DRG weight,19338,,"22,541 x DRG weight",19338,Other,base rate x DRG weight,27531,,"32,091 x DRG weight",27531,Other,base rate x DRG weight,24778,,"28,882 x DRG weight",24778,Other,base rate x DRG weight,23401,,"27,277 x DRG weight",23401,Other,base rate x DRG weight,20658,,"24,080 x DRG weight",20658,Other,base rate x DRG weight,19271,,"22,463 x DRG weight",19271,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22671,,"26,426 x DRG weight",22671,Other,base rate x DRG weight,33294,,"38,809 x DRG weight",33294,Other,base rate x DRG weight,33294,,"38,809 x DRG weight",33294,Other,base rate x DRG weight,22671,,"26,426 x DRG weight",22671,Other,base rate x DRG weight,33294,,"38,809 x DRG weight",33294,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,66764,70,,66764,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21496,,"25,057 x DRG weight",21496,Other,base rate x DRG weight,19347,,"22,552 x DRG weight",19347,Other,base rate x DRG weight,21496,,"25,057 x DRG weight",21496,Other,base rate x DRG weight,18272,,"21,298 x DRG weight",18272,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,66764,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,,inpatient,,,295335.51,25630,,,25630,Other,150% of Medicare + 9.63% HCRA Surcharge,15585.46,,,15585.46,Other,Medicare IPPS methodology,45676,,"25,046 x DRG weight",45676,Other,base rate x DRG weight,41108,,"22,541 x DRG weight",41108,Other,base rate x DRG weight,58524,,"32,091 x DRG weight",58524,Other,base rate x DRG weight,52672,,"28,882 x DRG weight",52672,Other,base rate x DRG weight,49745,,"27,277 x DRG weight",49745,Other,base rate x DRG weight,43915,,"24,080 x DRG weight",43915,Other,base rate x DRG weight,40966,,"22,463 x DRG weight",40966,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48193,,"26,426 x DRG weight",48193,Other,base rate x DRG weight,70776,,"38,809 x DRG weight",70776,Other,base rate x DRG weight,70776,,"38,809 x DRG weight",70776,Other,base rate x DRG weight,48193,,"26,426 x DRG weight",48193,Other,base rate x DRG weight,70776,,"38,809 x DRG weight",70776,Other,base rate x DRG weight,45177,,"6,363 x patient days",45177,Per diem,,206735,70,,206735,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,45696,,"25,057 x DRG weight",45696,Other,base rate x DRG weight,41128,,"22,552 x DRG weight",41128,Other,base rate x DRG weight,45696,,"25,057 x DRG weight",45696,Other,base rate x DRG weight,38841,,"21,298 x DRG weight",38841,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,206735,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,,inpatient,,,305965.02,15546,,,15546,Other,150% of Medicare + 9.63% HCRA Surcharge,9453.86,,,9453.86,Other,Medicare IPPS methodology,27318,,"25,046 x DRG weight",27318,Other,base rate x DRG weight,24585,,"22,541 x DRG weight",24585,Other,base rate x DRG weight,35002,,"32,091 x DRG weight",35002,Other,base rate x DRG weight,31502,,"28,882 x DRG weight",31502,Other,base rate x DRG weight,29751,,"27,277 x DRG weight",29751,Other,base rate x DRG weight,26264,,"24,080 x DRG weight",26264,Other,base rate x DRG weight,24500,,"22,463 x DRG weight",24500,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28823,,"26,426 x DRG weight",28823,Other,base rate x DRG weight,42329,,"38,809 x DRG weight",42329,Other,base rate x DRG weight,42329,,"38,809 x DRG weight",42329,Other,base rate x DRG weight,28823,,"26,426 x DRG weight",28823,Other,base rate x DRG weight,42329,,"38,809 x DRG weight",42329,Other,base rate x DRG weight,28634,,"6,363 x patient days",28634,Per diem,,214176,70,,214176,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27330,,"25,057 x DRG weight",27330,Other,base rate x DRG weight,24597,,"22,552 x DRG weight",24597,Other,base rate x DRG weight,27330,,"25,057 x DRG weight",27330,Other,base rate x DRG weight,23230,,"21,298 x DRG weight",23230,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,214176,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,,inpatient,,,137580.85,11100,,,11100,Other,150% of Medicare + 9.63% HCRA Surcharge,6750.27,,,6750.27,Other,Medicare IPPS methodology,19223,,"25,046 x DRG weight",19223,Other,base rate x DRG weight,17300,,"22,541 x DRG weight",17300,Other,base rate x DRG weight,24630,,"32,091 x DRG weight",24630,Other,base rate x DRG weight,22167,,"28,882 x DRG weight",22167,Other,base rate x DRG weight,20935,,"27,277 x DRG weight",20935,Other,base rate x DRG weight,18481,,"24,080 x DRG weight",18481,Other,base rate x DRG weight,17240,,"22,463 x DRG weight",17240,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20282,,"26,426 x DRG weight",20282,Other,base rate x DRG weight,29786,,"38,809 x DRG weight",29786,Other,base rate x DRG weight,29786,,"38,809 x DRG weight",29786,Other,base rate x DRG weight,20282,,"26,426 x DRG weight",20282,Other,base rate x DRG weight,29786,,"38,809 x DRG weight",29786,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,96307,70,,96307,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19231,,"25,057 x DRG weight",19231,Other,base rate x DRG weight,17309,,"22,552 x DRG weight",17309,Other,base rate x DRG weight,19231,,"25,057 x DRG weight",19231,Other,base rate x DRG weight,16346,,"21,298 x DRG weight",16346,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,96307,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,,inpatient,,,402996.07,34839,,,34839,Other,150% of Medicare + 9.63% HCRA Surcharge,21185.88,,,21185.88,Other,Medicare IPPS methodology,62445,,"25,046 x DRG weight",62445,Other,base rate x DRG weight,56199,,"22,541 x DRG weight",56199,Other,base rate x DRG weight,80009,,"32,091 x DRG weight",80009,Other,base rate x DRG weight,72009,,"28,882 x DRG weight",72009,Other,base rate x DRG weight,68007,,"27,277 x DRG weight",68007,Other,base rate x DRG weight,60036,,"24,080 x DRG weight",60036,Other,base rate x DRG weight,56005,,"22,463 x DRG weight",56005,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,65885,,"26,426 x DRG weight",65885,Other,base rate x DRG weight,96759,,"38,809 x DRG weight",96759,Other,base rate x DRG weight,96759,,"38,809 x DRG weight",96759,Other,base rate x DRG weight,65885,,"26,426 x DRG weight",65885,Other,base rate x DRG weight,96759,,"38,809 x DRG weight",96759,Other,base rate x DRG weight,54722,,"6,363 x patient days",54722,Per diem,,282097,70,,282097,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,62472,,"25,057 x DRG weight",62472,Other,base rate x DRG weight,56227,,"22,552 x DRG weight",56227,Other,base rate x DRG weight,62472,,"25,057 x DRG weight",62472,Other,base rate x DRG weight,53100,,"21,298 x DRG weight",53100,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,282097,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,,inpatient,,,171715.72,17040,,,17040,Other,150% of Medicare + 9.63% HCRA Surcharge,10362.31,,,10362.31,Other,Medicare IPPS methodology,30038,,"25,046 x DRG weight",30038,Other,base rate x DRG weight,27033,,"22,541 x DRG weight",27033,Other,base rate x DRG weight,38487,,"32,091 x DRG weight",38487,Other,base rate x DRG weight,34638,,"28,882 x DRG weight",34638,Other,base rate x DRG weight,32713,,"27,277 x DRG weight",32713,Other,base rate x DRG weight,28879,,"24,080 x DRG weight",28879,Other,base rate x DRG weight,26940,,"22,463 x DRG weight",26940,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31693,,"26,426 x DRG weight",31693,Other,base rate x DRG weight,46544,,"38,809 x DRG weight",46544,Other,base rate x DRG weight,46544,,"38,809 x DRG weight",46544,Other,base rate x DRG weight,31693,,"26,426 x DRG weight",31693,Other,base rate x DRG weight,46544,,"38,809 x DRG weight",46544,Other,base rate x DRG weight,29270,,"6,363 x patient days",29270,Per diem,,120201,70,,120201,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30051,,"25,057 x DRG weight",30051,Other,base rate x DRG weight,27047,,"22,552 x DRG weight",27047,Other,base rate x DRG weight,30051,,"25,057 x DRG weight",30051,Other,base rate x DRG weight,25543,,"21,298 x DRG weight",25543,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,120201,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,,inpatient,,,119033.23,11868,,,11868,Other,150% of Medicare + 9.63% HCRA Surcharge,7217.04,,,7217.04,Other,Medicare IPPS methodology,20620,,"25,046 x DRG weight",20620,Other,base rate x DRG weight,18558,,"22,541 x DRG weight",18558,Other,base rate x DRG weight,26421,,"32,091 x DRG weight",26421,Other,base rate x DRG weight,23779,,"28,882 x DRG weight",23779,Other,base rate x DRG weight,22457,,"27,277 x DRG weight",22457,Other,base rate x DRG weight,19825,,"24,080 x DRG weight",19825,Other,base rate x DRG weight,18494,,"22,463 x DRG weight",18494,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21757,,"26,426 x DRG weight",21757,Other,base rate x DRG weight,31951,,"38,809 x DRG weight",31951,Other,base rate x DRG weight,31951,,"38,809 x DRG weight",31951,Other,base rate x DRG weight,21757,,"26,426 x DRG weight",21757,Other,base rate x DRG weight,31951,,"38,809 x DRG weight",31951,Other,base rate x DRG weight,19089,,"6,363 x patient days",19089,Per diem,,83323,70,,83323,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20629,,"25,057 x DRG weight",20629,Other,base rate x DRG weight,18567,,"22,552 x DRG weight",18567,Other,base rate x DRG weight,20629,,"25,057 x DRG weight",20629,Other,base rate x DRG weight,17535,,"21,298 x DRG weight",17535,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,83323,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,,inpatient,,,145414.91,27364,,,27364,Other,150% of Medicare + 9.63% HCRA Surcharge,16640.3,,,16640.3,Other,Medicare IPPS methodology,48835,,"25,046 x DRG weight",48835,Other,base rate x DRG weight,43950,,"22,541 x DRG weight",43950,Other,base rate x DRG weight,62571,,"32,091 x DRG weight",62571,Other,base rate x DRG weight,56314,,"28,882 x DRG weight",56314,Other,base rate x DRG weight,53185,,"27,277 x DRG weight",53185,Other,base rate x DRG weight,46951,,"24,080 x DRG weight",46951,Other,base rate x DRG weight,43798,,"22,463 x DRG weight",43798,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,51525,,"26,426 x DRG weight",51525,Other,base rate x DRG weight,75670,,"38,809 x DRG weight",75670,Other,base rate x DRG weight,75670,,"38,809 x DRG weight",75670,Other,base rate x DRG weight,51525,,"26,426 x DRG weight",51525,Other,base rate x DRG weight,75670,,"38,809 x DRG weight",75670,Other,base rate x DRG weight,53449,,"6,363 x patient days",53449,Per diem,,101790,70,,101790,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,48856,,"25,057 x DRG weight",48856,Other,base rate x DRG weight,43972,,"22,552 x DRG weight",43972,Other,base rate x DRG weight,48856,,"25,057 x DRG weight",48856,Other,base rate x DRG weight,41527,,"21,298 x DRG weight",41527,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,101790,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,,inpatient,,,153496.95,17135,,,17135,Other,150% of Medicare + 9.63% HCRA Surcharge,10420.03,,,10420.03,Other,Medicare IPPS methodology,30210,,"25,046 x DRG weight",30210,Other,base rate x DRG weight,27189,,"22,541 x DRG weight",27189,Other,base rate x DRG weight,38708,,"32,091 x DRG weight",38708,Other,base rate x DRG weight,34837,,"28,882 x DRG weight",34837,Other,base rate x DRG weight,32902,,"27,277 x DRG weight",32902,Other,base rate x DRG weight,29045,,"24,080 x DRG weight",29045,Other,base rate x DRG weight,27095,,"22,463 x DRG weight",27095,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31875,,"26,426 x DRG weight",31875,Other,base rate x DRG weight,46811,,"38,809 x DRG weight",46811,Other,base rate x DRG weight,46811,,"38,809 x DRG weight",46811,Other,base rate x DRG weight,31875,,"26,426 x DRG weight",31875,Other,base rate x DRG weight,46811,,"38,809 x DRG weight",46811,Other,base rate x DRG weight,33724,,"6,363 x patient days",33724,Per diem,,107448,70,,107448,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30224,,"25,057 x DRG weight",30224,Other,base rate x DRG weight,27202,,"22,552 x DRG weight",27202,Other,base rate x DRG weight,30224,,"25,057 x DRG weight",30224,Other,base rate x DRG weight,25690,,"21,298 x DRG weight",25690,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,107448,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,,inpatient,,,71104.5,13522,,,13522,Other,150% of Medicare + 9.63% HCRA Surcharge,8222.52,,,8222.52,Other,Medicare IPPS methodology,23631,,"25,046 x DRG weight",23631,Other,base rate x DRG weight,21267,,"22,541 x DRG weight",21267,Other,base rate x DRG weight,30278,,"32,091 x DRG weight",30278,Other,base rate x DRG weight,27250,,"28,882 x DRG weight",27250,Other,base rate x DRG weight,25736,,"27,277 x DRG weight",25736,Other,base rate x DRG weight,22719,,"24,080 x DRG weight",22719,Other,base rate x DRG weight,21194,,"22,463 x DRG weight",21194,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24933,,"26,426 x DRG weight",24933,Other,base rate x DRG weight,36616,,"38,809 x DRG weight",36616,Other,base rate x DRG weight,36616,,"38,809 x DRG weight",36616,Other,base rate x DRG weight,24933,,"26,426 x DRG weight",24933,Other,base rate x DRG weight,36616,,"38,809 x DRG weight",36616,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,49773,70,,49773,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23641,,"25,057 x DRG weight",23641,Other,base rate x DRG weight,21278,,"22,552 x DRG weight",21278,Other,base rate x DRG weight,23641,,"25,057 x DRG weight",23641,Other,base rate x DRG weight,20095,,"21,298 x DRG weight",20095,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,49773,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,,inpatient,,,222008.27,23954,,,23954,Other,150% of Medicare + 9.63% HCRA Surcharge,14566.59,,,14566.59,Other,Medicare IPPS methodology,42626,,"25,046 x DRG weight",42626,Other,base rate x DRG weight,38363,,"22,541 x DRG weight",38363,Other,base rate x DRG weight,54616,,"32,091 x DRG weight",54616,Other,base rate x DRG weight,49154,,"28,882 x DRG weight",49154,Other,base rate x DRG weight,46423,,"27,277 x DRG weight",46423,Other,base rate x DRG weight,40982,,"24,080 x DRG weight",40982,Other,base rate x DRG weight,38230,,"22,463 x DRG weight",38230,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,44974,,"26,426 x DRG weight",44974,Other,base rate x DRG weight,66049,,"38,809 x DRG weight",66049,Other,base rate x DRG weight,66049,,"38,809 x DRG weight",66049,Other,base rate x DRG weight,44974,,"26,426 x DRG weight",44974,Other,base rate x DRG weight,66049,,"38,809 x DRG weight",66049,Other,base rate x DRG weight,39451,,"6,363 x patient days",39451,Per diem,,155406,70,,155406,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,42645,,"25,057 x DRG weight",42645,Other,base rate x DRG weight,38381,,"22,552 x DRG weight",38381,Other,base rate x DRG weight,42645,,"25,057 x DRG weight",42645,Other,base rate x DRG weight,36247,,"21,298 x DRG weight",36247,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,155406,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,,inpatient,,,149351.04,13835,,,13835,Other,150% of Medicare + 9.63% HCRA Surcharge,8413.24,,,8413.24,Other,Medicare IPPS methodology,24202,,"25,046 x DRG weight",24202,Other,base rate x DRG weight,21781,,"22,541 x DRG weight",21781,Other,base rate x DRG weight,31010,,"32,091 x DRG weight",31010,Other,base rate x DRG weight,27909,,"28,882 x DRG weight",27909,Other,base rate x DRG weight,26358,,"27,277 x DRG weight",26358,Other,base rate x DRG weight,23269,,"24,080 x DRG weight",23269,Other,base rate x DRG weight,21706,,"22,463 x DRG weight",21706,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25535,,"26,426 x DRG weight",25535,Other,base rate x DRG weight,37501,,"38,809 x DRG weight",37501,Other,base rate x DRG weight,37501,,"38,809 x DRG weight",37501,Other,base rate x DRG weight,25535,,"26,426 x DRG weight",25535,Other,base rate x DRG weight,37501,,"38,809 x DRG weight",37501,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,104546,70,,104546,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24213,,"25,057 x DRG weight",24213,Other,base rate x DRG weight,21792,,"22,552 x DRG weight",21792,Other,base rate x DRG weight,24213,,"25,057 x DRG weight",24213,Other,base rate x DRG weight,20580,,"21,298 x DRG weight",20580,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,104546,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,,inpatient,,,154011.39,19134,,,19134,Other,150% of Medicare + 9.63% HCRA Surcharge,11635.47,,,11635.47,Other,Medicare IPPS methodology,33850,,"25,046 x DRG weight",33850,Other,base rate x DRG weight,30464,,"22,541 x DRG weight",30464,Other,base rate x DRG weight,43371,,"32,091 x DRG weight",43371,Other,base rate x DRG weight,39034,,"28,882 x DRG weight",39034,Other,base rate x DRG weight,36865,,"27,277 x DRG weight",36865,Other,base rate x DRG weight,32544,,"24,080 x DRG weight",32544,Other,base rate x DRG weight,30359,,"22,463 x DRG weight",30359,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,35715,,"26,426 x DRG weight",35715,Other,base rate x DRG weight,52450,,"38,809 x DRG weight",52450,Other,base rate x DRG weight,52450,,"38,809 x DRG weight",52450,Other,base rate x DRG weight,35715,,"26,426 x DRG weight",35715,Other,base rate x DRG weight,52450,,"38,809 x DRG weight",52450,Other,base rate x DRG weight,36269,,"6,363 x patient days",36269,Per diem,,107808,70,,107808,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33865,,"25,057 x DRG weight",33865,Other,base rate x DRG weight,30479,,"22,552 x DRG weight",30479,Other,base rate x DRG weight,33865,,"25,057 x DRG weight",33865,Other,base rate x DRG weight,28784,,"21,298 x DRG weight",28784,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,107808,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,,inpatient,,,135978.72,11847,,,11847,Other,150% of Medicare + 9.63% HCRA Surcharge,7204.49,,,7204.49,Other,Medicare IPPS methodology,20583,,"25,046 x DRG weight",20583,Other,base rate x DRG weight,18524,,"22,541 x DRG weight",18524,Other,base rate x DRG weight,26372,,"32,091 x DRG weight",26372,Other,base rate x DRG weight,23735,,"28,882 x DRG weight",23735,Other,base rate x DRG weight,22416,,"27,277 x DRG weight",22416,Other,base rate x DRG weight,19789,,"24,080 x DRG weight",19789,Other,base rate x DRG weight,18460,,"22,463 x DRG weight",18460,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21717,,"26,426 x DRG weight",21717,Other,base rate x DRG weight,31893,,"38,809 x DRG weight",31893,Other,base rate x DRG weight,31893,,"38,809 x DRG weight",31893,Other,base rate x DRG weight,21717,,"26,426 x DRG weight",21717,Other,base rate x DRG weight,31893,,"38,809 x DRG weight",31893,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,95185,70,,95185,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20592,,"25,057 x DRG weight",20592,Other,base rate x DRG weight,18533,,"22,552 x DRG weight",18533,Other,base rate x DRG weight,20592,,"25,057 x DRG weight",20592,Other,base rate x DRG weight,17503,,"21,298 x DRG weight",17503,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95185,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,,inpatient,,,111419.12,19787,,,19787,Other,150% of Medicare + 9.63% HCRA Surcharge,12032.81,,,12032.81,Other,Medicare IPPS methodology,35039,,"25,046 x DRG weight",35039,Other,base rate x DRG weight,31535,,"22,541 x DRG weight",31535,Other,base rate x DRG weight,44895,,"32,091 x DRG weight",44895,Other,base rate x DRG weight,40406,,"28,882 x DRG weight",40406,Other,base rate x DRG weight,38161,,"27,277 x DRG weight",38161,Other,base rate x DRG weight,33688,,"24,080 x DRG weight",33688,Other,base rate x DRG weight,31426,,"22,463 x DRG weight",31426,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,36970,,"26,426 x DRG weight",36970,Other,base rate x DRG weight,54294,,"38,809 x DRG weight",54294,Other,base rate x DRG weight,54294,,"38,809 x DRG weight",54294,Other,base rate x DRG weight,36970,,"26,426 x DRG weight",36970,Other,base rate x DRG weight,54294,,"38,809 x DRG weight",54294,Other,base rate x DRG weight,35633,,"6,363 x patient days",35633,Per diem,,77993,70,,77993,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35055,,"25,057 x DRG weight",35055,Other,base rate x DRG weight,31550,,"22,552 x DRG weight",31550,Other,base rate x DRG weight,35055,,"25,057 x DRG weight",35055,Other,base rate x DRG weight,29796,,"21,298 x DRG weight",29796,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,77993,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,,inpatient,,,114607.91,11883,,,11883,Other,150% of Medicare + 9.63% HCRA Surcharge,7226.24,,,7226.24,Other,Medicare IPPS methodology,20648,,"25,046 x DRG weight",20648,Other,base rate x DRG weight,18583,,"22,541 x DRG weight",18583,Other,base rate x DRG weight,26456,,"32,091 x DRG weight",26456,Other,base rate x DRG weight,23810,,"28,882 x DRG weight",23810,Other,base rate x DRG weight,22487,,"27,277 x DRG weight",22487,Other,base rate x DRG weight,19852,,"24,080 x DRG weight",19852,Other,base rate x DRG weight,18518,,"22,463 x DRG weight",18518,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21786,,"26,426 x DRG weight",21786,Other,base rate x DRG weight,31994,,"38,809 x DRG weight",31994,Other,base rate x DRG weight,31994,,"38,809 x DRG weight",31994,Other,base rate x DRG weight,21786,,"26,426 x DRG weight",21786,Other,base rate x DRG weight,31994,,"38,809 x DRG weight",31994,Other,base rate x DRG weight,20998,,"6,363 x patient days",20998,Per diem,,80226,70,,80226,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20657,,"25,057 x DRG weight",20657,Other,base rate x DRG weight,18592,,"22,552 x DRG weight",18592,Other,base rate x DRG weight,20657,,"25,057 x DRG weight",20657,Other,base rate x DRG weight,17558,,"21,298 x DRG weight",17558,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,80226,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,,inpatient,,,219778.64,21958,,,21958,Other,150% of Medicare + 9.63% HCRA Surcharge,13352.82,,,13352.82,Other,Medicare IPPS methodology,38992,,"25,046 x DRG weight",38992,Other,base rate x DRG weight,35092,,"22,541 x DRG weight",35092,Other,base rate x DRG weight,49959,,"32,091 x DRG weight",49959,Other,base rate x DRG weight,44963,,"28,882 x DRG weight",44963,Other,base rate x DRG weight,42465,,"27,277 x DRG weight",42465,Other,base rate x DRG weight,37488,,"24,080 x DRG weight",37488,Other,base rate x DRG weight,34970,,"22,463 x DRG weight",34970,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41140,,"26,426 x DRG weight",41140,Other,base rate x DRG weight,60418,,"38,809 x DRG weight",60418,Other,base rate x DRG weight,60418,,"38,809 x DRG weight",60418,Other,base rate x DRG weight,41140,,"26,426 x DRG weight",41140,Other,base rate x DRG weight,60418,,"38,809 x DRG weight",60418,Other,base rate x DRG weight,44541,,"6,363 x patient days",44541,Per diem,,153845,70,,153845,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39009,,"25,057 x DRG weight",39009,Other,base rate x DRG weight,35109,,"22,552 x DRG weight",35109,Other,base rate x DRG weight,39009,,"25,057 x DRG weight",39009,Other,base rate x DRG weight,33157,,"21,298 x DRG weight",33157,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,153845,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,,inpatient,,,88055.18,12626,,,12626,Other,150% of Medicare + 9.63% HCRA Surcharge,7677.95,,,7677.95,Other,Medicare IPPS methodology,22000,,"25,046 x DRG weight",22000,Other,base rate x DRG weight,19800,,"22,541 x DRG weight",19800,Other,base rate x DRG weight,28189,,"32,091 x DRG weight",28189,Other,base rate x DRG weight,25370,,"28,882 x DRG weight",25370,Other,base rate x DRG weight,23960,,"27,277 x DRG weight",23960,Other,base rate x DRG weight,21152,,"24,080 x DRG weight",21152,Other,base rate x DRG weight,19731,,"22,463 x DRG weight",19731,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23213,,"26,426 x DRG weight",23213,Other,base rate x DRG weight,34090,,"38,809 x DRG weight",34090,Other,base rate x DRG weight,34090,,"38,809 x DRG weight",34090,Other,base rate x DRG weight,23213,,"26,426 x DRG weight",23213,Other,base rate x DRG weight,34090,,"38,809 x DRG weight",34090,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,61639,70,,61639,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22010,,"25,057 x DRG weight",22010,Other,base rate x DRG weight,19810,,"22,552 x DRG weight",19810,Other,base rate x DRG weight,22010,,"25,057 x DRG weight",22010,Other,base rate x DRG weight,18708,,"21,298 x DRG weight",18708,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,61639,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,,inpatient,,,185727.45,25998,,,25998,Other,150% of Medicare + 9.63% HCRA Surcharge,15809.64,,,15809.64,Other,Medicare IPPS methodology,46348,,"25,046 x DRG weight",46348,Other,base rate x DRG weight,41712,,"22,541 x DRG weight",41712,Other,base rate x DRG weight,59384,,"32,091 x DRG weight",59384,Other,base rate x DRG weight,53446,,"28,882 x DRG weight",53446,Other,base rate x DRG weight,50476,,"27,277 x DRG weight",50476,Other,base rate x DRG weight,44560,,"24,080 x DRG weight",44560,Other,base rate x DRG weight,41568,,"22,463 x DRG weight",41568,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48901,,"26,426 x DRG weight",48901,Other,base rate x DRG weight,71816,,"38,809 x DRG weight",71816,Other,base rate x DRG weight,71816,,"38,809 x DRG weight",71816,Other,base rate x DRG weight,48901,,"26,426 x DRG weight",48901,Other,base rate x DRG weight,71816,,"38,809 x DRG weight",71816,Other,base rate x DRG weight,46450,,"6,363 x patient days",46450,Per diem,,130009,70,,130009,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46368,,"25,057 x DRG weight",46368,Other,base rate x DRG weight,41732,,"22,552 x DRG weight",41732,Other,base rate x DRG weight,46368,,"25,057 x DRG weight",46368,Other,base rate x DRG weight,39412,,"21,298 x DRG weight",39412,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,130009,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,,inpatient,,,150931.77,16116,,,16116,Other,150% of Medicare + 9.63% HCRA Surcharge,9800.17,,,9800.17,Other,Medicare IPPS methodology,28355,,"25,046 x DRG weight",28355,Other,base rate x DRG weight,25519,,"22,541 x DRG weight",25519,Other,base rate x DRG weight,36330,,"32,091 x DRG weight",36330,Other,base rate x DRG weight,32697,,"28,882 x DRG weight",32697,Other,base rate x DRG weight,30880,,"27,277 x DRG weight",30880,Other,base rate x DRG weight,27261,,"24,080 x DRG weight",27261,Other,base rate x DRG weight,25430,,"22,463 x DRG weight",25430,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,29917,,"26,426 x DRG weight",29917,Other,base rate x DRG weight,43936,,"38,809 x DRG weight",43936,Other,base rate x DRG weight,43936,,"38,809 x DRG weight",43936,Other,base rate x DRG weight,29917,,"26,426 x DRG weight",29917,Other,base rate x DRG weight,43936,,"38,809 x DRG weight",43936,Other,base rate x DRG weight,33724,,"6,363 x patient days",33724,Per diem,,105652,70,,105652,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,28367,,"25,057 x DRG weight",28367,Other,base rate x DRG weight,25531,,"22,552 x DRG weight",25531,Other,base rate x DRG weight,28367,,"25,057 x DRG weight",28367,Other,base rate x DRG weight,24111,,"21,298 x DRG weight",24111,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,105652,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,,inpatient,,,125772.49,11275,,,11275,Other,150% of Medicare + 9.63% HCRA Surcharge,6856.5,,,6856.5,Other,Medicare IPPS methodology,19541,,"25,046 x DRG weight",19541,Other,base rate x DRG weight,17586,,"22,541 x DRG weight",17586,Other,base rate x DRG weight,25037,,"32,091 x DRG weight",25037,Other,base rate x DRG weight,22534,,"28,882 x DRG weight",22534,Other,base rate x DRG weight,21282,,"27,277 x DRG weight",21282,Other,base rate x DRG weight,18787,,"24,080 x DRG weight",18787,Other,base rate x DRG weight,17526,,"22,463 x DRG weight",17526,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20618,,"26,426 x DRG weight",20618,Other,base rate x DRG weight,30279,,"38,809 x DRG weight",30279,Other,base rate x DRG weight,30279,,"38,809 x DRG weight",30279,Other,base rate x DRG weight,20618,,"26,426 x DRG weight",20618,Other,base rate x DRG weight,30279,,"38,809 x DRG weight",30279,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,88041,70,,88041,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19549,,"25,057 x DRG weight",19549,Other,base rate x DRG weight,17595,,"22,552 x DRG weight",17595,Other,base rate x DRG weight,19549,,"25,057 x DRG weight",19549,Other,base rate x DRG weight,16617,,"21,298 x DRG weight",16617,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,88041,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,,inpatient,,,209266.75,21461,,,21461,Other,150% of Medicare + 9.63% HCRA Surcharge,13050.84,,,13050.84,Other,Medicare IPPS methodology,38087,,"25,046 x DRG weight",38087,Other,base rate x DRG weight,34278,,"22,541 x DRG weight",34278,Other,base rate x DRG weight,48801,,"32,091 x DRG weight",48801,Other,base rate x DRG weight,43921,,"28,882 x DRG weight",43921,Other,base rate x DRG weight,41480,,"27,277 x DRG weight",41480,Other,base rate x DRG weight,36618,,"24,080 x DRG weight",36618,Other,base rate x DRG weight,34159,,"22,463 x DRG weight",34159,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40186,,"26,426 x DRG weight",40186,Other,base rate x DRG weight,59017,,"38,809 x DRG weight",59017,Other,base rate x DRG weight,59017,,"38,809 x DRG weight",59017,Other,base rate x DRG weight,40186,,"26,426 x DRG weight",40186,Other,base rate x DRG weight,59017,,"38,809 x DRG weight",59017,Other,base rate x DRG weight,36905,,"6,363 x patient days",36905,Per diem,,146487,70,,146487,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38104,,"25,057 x DRG weight",38104,Other,base rate x DRG weight,34295,,"22,552 x DRG weight",34295,Other,base rate x DRG weight,38104,,"25,057 x DRG weight",38104,Other,base rate x DRG weight,32388,,"21,298 x DRG weight",32388,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,146487,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,,inpatient,,,116010.17,12863,,,12863,Other,150% of Medicare + 9.63% HCRA Surcharge,7821.83,,,7821.83,Other,Medicare IPPS methodology,22431,,"25,046 x DRG weight",22431,Other,base rate x DRG weight,20188,,"22,541 x DRG weight",20188,Other,base rate x DRG weight,28741,,"32,091 x DRG weight",28741,Other,base rate x DRG weight,25867,,"28,882 x DRG weight",25867,Other,base rate x DRG weight,24429,,"27,277 x DRG weight",24429,Other,base rate x DRG weight,21566,,"24,080 x DRG weight",21566,Other,base rate x DRG weight,20118,,"22,463 x DRG weight",20118,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23667,,"26,426 x DRG weight",23667,Other,base rate x DRG weight,34757,,"38,809 x DRG weight",34757,Other,base rate x DRG weight,34757,,"38,809 x DRG weight",34757,Other,base rate x DRG weight,23667,,"26,426 x DRG weight",23667,Other,base rate x DRG weight,34757,,"38,809 x DRG weight",34757,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,81207,70,,81207,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22441,,"25,057 x DRG weight",22441,Other,base rate x DRG weight,20198,,"22,552 x DRG weight",20198,Other,base rate x DRG weight,22441,,"25,057 x DRG weight",22441,Other,base rate x DRG weight,19074,,"21,298 x DRG weight",19074,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,81207,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,,inpatient,,,286985.36,22028,,,22028,Other,150% of Medicare + 9.63% HCRA Surcharge,13395.48,,,13395.48,Other,Medicare IPPS methodology,39119,,"25,046 x DRG weight",39119,Other,base rate x DRG weight,35207,,"22,541 x DRG weight",35207,Other,base rate x DRG weight,50123,,"32,091 x DRG weight",50123,Other,base rate x DRG weight,45111,,"28,882 x DRG weight",45111,Other,base rate x DRG weight,42604,,"27,277 x DRG weight",42604,Other,base rate x DRG weight,37611,,"24,080 x DRG weight",37611,Other,base rate x DRG weight,35085,,"22,463 x DRG weight",35085,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41275,,"26,426 x DRG weight",41275,Other,base rate x DRG weight,60616,,"38,809 x DRG weight",60616,Other,base rate x DRG weight,60616,,"38,809 x DRG weight",60616,Other,base rate x DRG weight,41275,,"26,426 x DRG weight",41275,Other,base rate x DRG weight,60616,,"38,809 x DRG weight",60616,Other,base rate x DRG weight,41360,,"6,363 x patient days",41360,Per diem,,200890,70,,200890,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39137,,"25,057 x DRG weight",39137,Other,base rate x DRG weight,35224,,"22,552 x DRG weight",35224,Other,base rate x DRG weight,39137,,"25,057 x DRG weight",39137,Other,base rate x DRG weight,33265,,"21,298 x DRG weight",33265,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,200890,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,,inpatient,,,146472.21,14290,,,14290,Other,150% of Medicare + 9.63% HCRA Surcharge,8690.13,,,8690.13,Other,Medicare IPPS methodology,25031,,"25,046 x DRG weight",25031,Other,base rate x DRG weight,22527,,"22,541 x DRG weight",22527,Other,base rate x DRG weight,32072,,"32,091 x DRG weight",32072,Other,base rate x DRG weight,28865,,"28,882 x DRG weight",28865,Other,base rate x DRG weight,27261,,"27,277 x DRG weight",27261,Other,base rate x DRG weight,24066,,"24,080 x DRG weight",24066,Other,base rate x DRG weight,22450,,"22,463 x DRG weight",22450,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26410,,"26,426 x DRG weight",26410,Other,base rate x DRG weight,38786,,"38,809 x DRG weight",38786,Other,base rate x DRG weight,38786,,"38,809 x DRG weight",38786,Other,base rate x DRG weight,26410,,"26,426 x DRG weight",26410,Other,base rate x DRG weight,38786,,"38,809 x DRG weight",38786,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,102531,70,,102531,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25042,,"25,057 x DRG weight",25042,Other,base rate x DRG weight,22538,,"22,552 x DRG weight",22538,Other,base rate x DRG weight,25042,,"25,057 x DRG weight",25042,Other,base rate x DRG weight,21285,,"21,298 x DRG weight",21285,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,102531,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,,inpatient,,,77997.2,10867,,,10867,Other,150% of Medicare + 9.63% HCRA Surcharge,6608.06,,,6608.06,Other,Medicare IPPS methodology,18797,,"25,046 x DRG weight",18797,Other,base rate x DRG weight,16917,,"22,541 x DRG weight",16917,Other,base rate x DRG weight,24084,,"32,091 x DRG weight",24084,Other,base rate x DRG weight,21676,,"28,882 x DRG weight",21676,Other,base rate x DRG weight,20471,,"27,277 x DRG weight",20471,Other,base rate x DRG weight,18072,,"24,080 x DRG weight",18072,Other,base rate x DRG weight,16858,,"22,463 x DRG weight",16858,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19833,,"26,426 x DRG weight",19833,Other,base rate x DRG weight,29126,,"38,809 x DRG weight",29126,Other,base rate x DRG weight,29126,,"38,809 x DRG weight",29126,Other,base rate x DRG weight,19833,,"26,426 x DRG weight",19833,Other,base rate x DRG weight,29126,,"38,809 x DRG weight",29126,Other,base rate x DRG weight,19089,,"6,363 x patient days",19089,Per diem,,54598,70,,54598,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18805,,"25,057 x DRG weight",18805,Other,base rate x DRG weight,16925,,"22,552 x DRG weight",16925,Other,base rate x DRG weight,18805,,"25,057 x DRG weight",18805,Other,base rate x DRG weight,15984,,"21,298 x DRG weight",15984,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,54598,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,,inpatient,,,296566.47,40740,,,40740,Other,150% of Medicare + 9.63% HCRA Surcharge,24774.5,,,24774.5,Other,Medicare IPPS methodology,73189,,"25,046 x DRG weight",73189,Other,base rate x DRG weight,65869,,"22,541 x DRG weight",65869,Other,base rate x DRG weight,93776,,"32,091 x DRG weight",93776,Other,base rate x DRG weight,84399,,"28,882 x DRG weight",84399,Other,base rate x DRG weight,79709,,"27,277 x DRG weight",79709,Other,base rate x DRG weight,70367,,"24,080 x DRG weight",70367,Other,base rate x DRG weight,65641,,"22,463 x DRG weight",65641,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,77222,,"26,426 x DRG weight",77222,Other,base rate x DRG weight,113408,,"38,809 x DRG weight",113408,Other,base rate x DRG weight,113408,,"38,809 x DRG weight",113408,Other,base rate x DRG weight,77222,,"26,426 x DRG weight",77222,Other,base rate x DRG weight,113408,,"38,809 x DRG weight",113408,Other,base rate x DRG weight,68084,,"6,363 x patient days",68084,Per diem,,207597,70,,207597,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,73222,,"25,057 x DRG weight",73222,Other,base rate x DRG weight,65901,,"22,552 x DRG weight",65901,Other,base rate x DRG weight,73222,,"25,057 x DRG weight",73222,Other,base rate x DRG weight,62237,,"21,298 x DRG weight",62237,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,207597,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,,inpatient,,,230034.64,23816,,,23816,Other,150% of Medicare + 9.63% HCRA Surcharge,14482.94,,,14482.94,Other,Medicare IPPS methodology,42375,,"25,046 x DRG weight",42375,Other,base rate x DRG weight,38137,,"22,541 x DRG weight",38137,Other,base rate x DRG weight,54295,,"32,091 x DRG weight",54295,Other,base rate x DRG weight,48865,,"28,882 x DRG weight",48865,Other,base rate x DRG weight,46150,,"27,277 x DRG weight",46150,Other,base rate x DRG weight,40741,,"24,080 x DRG weight",40741,Other,base rate x DRG weight,38005,,"22,463 x DRG weight",38005,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,44710,,"26,426 x DRG weight",44710,Other,base rate x DRG weight,65661,,"38,809 x DRG weight",65661,Other,base rate x DRG weight,65661,,"38,809 x DRG weight",65661,Other,base rate x DRG weight,44710,,"26,426 x DRG weight",44710,Other,base rate x DRG weight,65661,,"38,809 x DRG weight",65661,Other,base rate x DRG weight,41360,,"6,363 x patient days",41360,Per diem,,161024,70,,161024,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,42394,,"25,057 x DRG weight",42394,Other,base rate x DRG weight,38156,,"22,552 x DRG weight",38156,Other,base rate x DRG weight,42394,,"25,057 x DRG weight",42394,Other,base rate x DRG weight,36034,,"21,298 x DRG weight",36034,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,161024,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,,inpatient,,,116935.28,16219,,,16219,Other,150% of Medicare + 9.63% HCRA Surcharge,9862.91,,,9862.91,Other,Medicare IPPS methodology,28542,,"25,046 x DRG weight",28542,Other,base rate x DRG weight,25688,,"22,541 x DRG weight",25688,Other,base rate x DRG weight,36571,,"32,091 x DRG weight",36571,Other,base rate x DRG weight,32914,,"28,882 x DRG weight",32914,Other,base rate x DRG weight,31085,,"27,277 x DRG weight",31085,Other,base rate x DRG weight,27442,,"24,080 x DRG weight",27442,Other,base rate x DRG weight,25599,,"22,463 x DRG weight",25599,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,30115,,"26,426 x DRG weight",30115,Other,base rate x DRG weight,44227,,"38,809 x DRG weight",44227,Other,base rate x DRG weight,44227,,"38,809 x DRG weight",44227,Other,base rate x DRG weight,30115,,"26,426 x DRG weight",30115,Other,base rate x DRG weight,44227,,"38,809 x DRG weight",44227,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,81855,70,,81855,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,28555,,"25,057 x DRG weight",28555,Other,base rate x DRG weight,25700,,"22,552 x DRG weight",25700,Other,base rate x DRG weight,28555,,"25,057 x DRG weight",28555,Other,base rate x DRG weight,24271,,"21,298 x DRG weight",24271,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,81855,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,,inpatient,,,990952.69,86079,,,86079,Other,150% of Medicare + 9.63% HCRA Surcharge,52344.96,,,52344.96,Other,Medicare IPPS methodology,155739,,"25,046 x DRG weight",155739,Other,base rate x DRG weight,140162,,"22,541 x DRG weight",140162,Other,base rate x DRG weight,199545,,"32,091 x DRG weight",199545,Other,base rate x DRG weight,179591,,"28,882 x DRG weight",179591,Other,base rate x DRG weight,169611,,"27,277 x DRG weight",169611,Other,base rate x DRG weight,149732,,"24,080 x DRG weight",149732,Other,base rate x DRG weight,139677,,"22,463 x DRG weight",139677,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,164320,,"26,426 x DRG weight",164320,Other,base rate x DRG weight,241318,,"38,809 x DRG weight",241318,Other,base rate x DRG weight,241318,,"38,809 x DRG weight",241318,Other,base rate x DRG weight,164320,,"26,426 x DRG weight",164320,Other,base rate x DRG weight,241318,,"38,809 x DRG weight",241318,Other,base rate x DRG weight,111989,,"6,363 x patient days",111989,Per diem,,693667,70,,693667,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,155807,,"25,057 x DRG weight",155807,Other,base rate x DRG weight,140231,,"22,552 x DRG weight",140231,Other,base rate x DRG weight,155807,,"25,057 x DRG weight",155807,Other,base rate x DRG weight,132433,,"21,298 x DRG weight",132433,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,693667,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,,inpatient,,,415535.65,47393,,,47393,Other,150% of Medicare + 9.63% HCRA Surcharge,28819.85,,,28819.85,Other,Medicare IPPS methodology,85302,,"25,046 x DRG weight",85302,Other,base rate x DRG weight,76770,,"22,541 x DRG weight",76770,Other,base rate x DRG weight,109296,,"32,091 x DRG weight",109296,Other,base rate x DRG weight,98366,,"28,882 x DRG weight",98366,Other,base rate x DRG weight,92900,,"27,277 x DRG weight",92900,Other,base rate x DRG weight,82012,,"24,080 x DRG weight",82012,Other,base rate x DRG weight,76504,,"22,463 x DRG weight",76504,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,90002,,"26,426 x DRG weight",90002,Other,base rate x DRG weight,132176,,"38,809 x DRG weight",132176,Other,base rate x DRG weight,132176,,"38,809 x DRG weight",132176,Other,base rate x DRG weight,90002,,"26,426 x DRG weight",90002,Other,base rate x DRG weight,132176,,"38,809 x DRG weight",132176,Other,base rate x DRG weight,71902,,"6,363 x patient days",71902,Per diem,,290875,70,,290875,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,85339,,"25,057 x DRG weight",85339,Other,base rate x DRG weight,76808,,"22,552 x DRG weight",76808,Other,base rate x DRG weight,85339,,"25,057 x DRG weight",85339,Other,base rate x DRG weight,72537,,"21,298 x DRG weight",72537,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,290875,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,,inpatient,,,126628.96,28687,,,28687,Other,150% of Medicare + 9.63% HCRA Surcharge,17445.02,,,17445.02,Other,Medicare IPPS methodology,51244,,"25,046 x DRG weight",51244,Other,base rate x DRG weight,46119,,"22,541 x DRG weight",46119,Other,base rate x DRG weight,65658,,"32,091 x DRG weight",65658,Other,base rate x DRG weight,59093,,"28,882 x DRG weight",59093,Other,base rate x DRG weight,55809,,"27,277 x DRG weight",55809,Other,base rate x DRG weight,49268,,"24,080 x DRG weight",49268,Other,base rate x DRG weight,45959,,"22,463 x DRG weight",45959,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,54068,,"26,426 x DRG weight",54068,Other,base rate x DRG weight,79403,,"38,809 x DRG weight",79403,Other,base rate x DRG weight,79403,,"38,809 x DRG weight",79403,Other,base rate x DRG weight,54068,,"26,426 x DRG weight",54068,Other,base rate x DRG weight,79403,,"38,809 x DRG weight",79403,Other,base rate x DRG weight,36269,,"6,363 x patient days",36269,Per diem,,88640,70,,88640,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,51267,,"25,057 x DRG weight",51267,Other,base rate x DRG weight,46141,,"22,552 x DRG weight",46141,Other,base rate x DRG weight,51267,,"25,057 x DRG weight",51267,Other,base rate x DRG weight,43576,,"21,298 x DRG weight",43576,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,88640,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,,inpatient,,,1204252.37,78719,,,78719,Other,150% of Medicare + 9.63% HCRA Surcharge,47869.64,,,47869.64,Other,Medicare IPPS methodology,142339,,"25,046 x DRG weight",142339,Other,base rate x DRG weight,128103,,"22,541 x DRG weight",128103,Other,base rate x DRG weight,182376,,"32,091 x DRG weight",182376,Other,base rate x DRG weight,164139,,"28,882 x DRG weight",164139,Other,base rate x DRG weight,155018,,"27,277 x DRG weight",155018,Other,base rate x DRG weight,136849,,"24,080 x DRG weight",136849,Other,base rate x DRG weight,127659,,"22,463 x DRG weight",127659,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,150182,,"26,426 x DRG weight",150182,Other,base rate x DRG weight,220555,,"38,809 x DRG weight",220555,Other,base rate x DRG weight,220555,,"38,809 x DRG weight",220555,Other,base rate x DRG weight,150182,,"26,426 x DRG weight",150182,Other,base rate x DRG weight,220555,,"38,809 x DRG weight",220555,Other,base rate x DRG weight,93536,,"6,363 x patient days",93536,Per diem,,842977,70,,842977,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,142401,,"25,057 x DRG weight",142401,Other,base rate x DRG weight,128165,,"22,552 x DRG weight",128165,Other,base rate x DRG weight,142401,,"25,057 x DRG weight",142401,Other,base rate x DRG weight,121039,,"21,298 x DRG weight",121039,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,842977,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,,inpatient,,,447661.57,36984,,,36984,Other,150% of Medicare + 9.63% HCRA Surcharge,22490,,,22490,Other,Medicare IPPS methodology,66349,,"25,046 x DRG weight",66349,Other,base rate x DRG weight,59713,,"22,541 x DRG weight",59713,Other,base rate x DRG weight,85012,,"32,091 x DRG weight",85012,Other,base rate x DRG weight,76511,,"28,882 x DRG weight",76511,Other,base rate x DRG weight,72260,,"27,277 x DRG weight",72260,Other,base rate x DRG weight,63790,,"24,080 x DRG weight",63790,Other,base rate x DRG weight,59507,,"22,463 x DRG weight",59507,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,70005,,"26,426 x DRG weight",70005,Other,base rate x DRG weight,102809,,"38,809 x DRG weight",102809,Other,base rate x DRG weight,102809,,"38,809 x DRG weight",102809,Other,base rate x DRG weight,70005,,"26,426 x DRG weight",70005,Other,base rate x DRG weight,102809,,"38,809 x DRG weight",102809,Other,base rate x DRG weight,43905,,"6,363 x patient days",43905,Per diem,,313363,70,,313363,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,66378,,"25,057 x DRG weight",66378,Other,base rate x DRG weight,59743,,"22,552 x DRG weight",59743,Other,base rate x DRG weight,66378,,"25,057 x DRG weight",66378,Other,base rate x DRG weight,56421,,"21,298 x DRG weight",56421,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,313363,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,,inpatient,,,107260.28,22697,,,22697,Other,150% of Medicare + 9.63% HCRA Surcharge,13802.03,,,13802.03,Other,Medicare IPPS methodology,40337,,"25,046 x DRG weight",40337,Other,base rate x DRG weight,36302,,"22,541 x DRG weight",36302,Other,base rate x DRG weight,51683,,"32,091 x DRG weight",51683,Other,base rate x DRG weight,46514,,"28,882 x DRG weight",46514,Other,base rate x DRG weight,43930,,"27,277 x DRG weight",43930,Other,base rate x DRG weight,38781,,"24,080 x DRG weight",38781,Other,base rate x DRG weight,36177,,"22,463 x DRG weight",36177,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42559,,"26,426 x DRG weight",42559,Other,base rate x DRG weight,62502,,"38,809 x DRG weight",62502,Other,base rate x DRG weight,62502,,"38,809 x DRG weight",62502,Other,base rate x DRG weight,42559,,"26,426 x DRG weight",42559,Other,base rate x DRG weight,62502,,"38,809 x DRG weight",62502,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,75082,70,,75082,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40354,,"25,057 x DRG weight",40354,Other,base rate x DRG weight,36320,,"22,552 x DRG weight",36320,Other,base rate x DRG weight,40354,,"25,057 x DRG weight",40354,Other,base rate x DRG weight,34300,,"21,298 x DRG weight",34300,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,75082,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,,inpatient,,,290583.64,46518,,,46518,Other,150% of Medicare + 9.63% HCRA Surcharge,28287.83,,,28287.83,Other,Medicare IPPS methodology,83709,,"25,046 x DRG weight",83709,Other,base rate x DRG weight,75337,,"22,541 x DRG weight",75337,Other,base rate x DRG weight,107255,,"32,091 x DRG weight",107255,Other,base rate x DRG weight,96529,,"28,882 x DRG weight",96529,Other,base rate x DRG weight,91165,,"27,277 x DRG weight",91165,Other,base rate x DRG weight,80480,,"24,080 x DRG weight",80480,Other,base rate x DRG weight,75076,,"22,463 x DRG weight",75076,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,88321,,"26,426 x DRG weight",88321,Other,base rate x DRG weight,129707,,"38,809 x DRG weight",129707,Other,base rate x DRG weight,129707,,"38,809 x DRG weight",129707,Other,base rate x DRG weight,88321,,"26,426 x DRG weight",88321,Other,base rate x DRG weight,129707,,"38,809 x DRG weight",129707,Other,base rate x DRG weight,70629,,"6,363 x patient days",70629,Per diem,,203409,70,,203409,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,83746,,"25,057 x DRG weight",83746,Other,base rate x DRG weight,75373,,"22,552 x DRG weight",75373,Other,base rate x DRG weight,83746,,"25,057 x DRG weight",83746,Other,base rate x DRG weight,71182,,"21,298 x DRG weight",71182,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,203409,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,,inpatient,,,208980.23,24569,,,24569,Other,150% of Medicare + 9.63% HCRA Surcharge,14940.51,,,14940.51,Other,Medicare IPPS methodology,43745,,"25,046 x DRG weight",43745,Other,base rate x DRG weight,39370,,"22,541 x DRG weight",39370,Other,base rate x DRG weight,56050,,"32,091 x DRG weight",56050,Other,base rate x DRG weight,50445,,"28,882 x DRG weight",50445,Other,base rate x DRG weight,47642,,"27,277 x DRG weight",47642,Other,base rate x DRG weight,42058,,"24,080 x DRG weight",42058,Other,base rate x DRG weight,39234,,"22,463 x DRG weight",39234,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,46156,,"26,426 x DRG weight",46156,Other,base rate x DRG weight,67784,,"38,809 x DRG weight",67784,Other,base rate x DRG weight,67784,,"38,809 x DRG weight",67784,Other,base rate x DRG weight,46156,,"26,426 x DRG weight",46156,Other,base rate x DRG weight,67784,,"38,809 x DRG weight",67784,Other,base rate x DRG weight,35633,,"6,363 x patient days",35633,Per diem,,146286,70,,146286,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43765,,"25,057 x DRG weight",43765,Other,base rate x DRG weight,39389,,"22,552 x DRG weight",39389,Other,base rate x DRG weight,43765,,"25,057 x DRG weight",43765,Other,base rate x DRG weight,37199,,"21,298 x DRG weight",37199,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,146286,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,,inpatient,,,140192.28,19068,,,19068,Other,150% of Medicare + 9.63% HCRA Surcharge,11595.32,,,11595.32,Other,Medicare IPPS methodology,33729,,"25,046 x DRG weight",33729,Other,base rate x DRG weight,30356,,"22,541 x DRG weight",30356,Other,base rate x DRG weight,43217,,"32,091 x DRG weight",43217,Other,base rate x DRG weight,38895,,"28,882 x DRG weight",38895,Other,base rate x DRG weight,36734,,"27,277 x DRG weight",36734,Other,base rate x DRG weight,32429,,"24,080 x DRG weight",32429,Other,base rate x DRG weight,30251,,"22,463 x DRG weight",30251,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,35588,,"26,426 x DRG weight",35588,Other,base rate x DRG weight,52264,,"38,809 x DRG weight",52264,Other,base rate x DRG weight,52264,,"38,809 x DRG weight",52264,Other,base rate x DRG weight,35588,,"26,426 x DRG weight",35588,Other,base rate x DRG weight,52264,,"38,809 x DRG weight",52264,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,98135,70,,98135,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33744,,"25,057 x DRG weight",33744,Other,base rate x DRG weight,30371,,"22,552 x DRG weight",30371,Other,base rate x DRG weight,33744,,"25,057 x DRG weight",33744,Other,base rate x DRG weight,28682,,"21,298 x DRG weight",28682,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,98135,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,,inpatient,,,452655.36,24496,,,24496,Other,150% of Medicare + 9.63% HCRA Surcharge,14896.18,,,14896.18,Other,Medicare IPPS methodology,43613,,"25,046 x DRG weight",43613,Other,base rate x DRG weight,39251,,"22,541 x DRG weight",39251,Other,base rate x DRG weight,55880,,"32,091 x DRG weight",55880,Other,base rate x DRG weight,50292,,"28,882 x DRG weight",50292,Other,base rate x DRG weight,47497,,"27,277 x DRG weight",47497,Other,base rate x DRG weight,41931,,"24,080 x DRG weight",41931,Other,base rate x DRG weight,39115,,"22,463 x DRG weight",39115,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,46016,,"26,426 x DRG weight",46016,Other,base rate x DRG weight,67578,,"38,809 x DRG weight",67578,Other,base rate x DRG weight,67578,,"38,809 x DRG weight",67578,Other,base rate x DRG weight,46016,,"26,426 x DRG weight",46016,Other,base rate x DRG weight,67578,,"38,809 x DRG weight",67578,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,316859,70,,316859,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43632,,"25,057 x DRG weight",43632,Other,base rate x DRG weight,39270,,"22,552 x DRG weight",39270,Other,base rate x DRG weight,43632,,"25,057 x DRG weight",43632,Other,base rate x DRG weight,37086,,"21,298 x DRG weight",37086,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,316859,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,,inpatient,,,262765.06,21478,,,21478,Other,150% of Medicare + 9.63% HCRA Surcharge,13060.88,,,13060.88,Other,Medicare IPPS methodology,38118,,"25,046 x DRG weight",38118,Other,base rate x DRG weight,34305,,"22,541 x DRG weight",34305,Other,base rate x DRG weight,48839,,"32,091 x DRG weight",48839,Other,base rate x DRG weight,43956,,"28,882 x DRG weight",43956,Other,base rate x DRG weight,41513,,"27,277 x DRG weight",41513,Other,base rate x DRG weight,36647,,"24,080 x DRG weight",36647,Other,base rate x DRG weight,34186,,"22,463 x DRG weight",34186,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40218,,"26,426 x DRG weight",40218,Other,base rate x DRG weight,59063,,"38,809 x DRG weight",59063,Other,base rate x DRG weight,59063,,"38,809 x DRG weight",59063,Other,base rate x DRG weight,40218,,"26,426 x DRG weight",40218,Other,base rate x DRG weight,59063,,"38,809 x DRG weight",59063,Other,base rate x DRG weight,12726,,"6,363 x patient days",12726,Per diem,,183936,70,,183936,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38134,,"25,057 x DRG weight",38134,Other,base rate x DRG weight,34322,,"22,552 x DRG weight",34322,Other,base rate x DRG weight,38134,,"25,057 x DRG weight",38134,Other,base rate x DRG weight,32413,,"21,298 x DRG weight",32413,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,183936,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,,inpatient,,,281117.77,27485,,,27485,Other,150% of Medicare + 9.63% HCRA Surcharge,16713.91,,,16713.91,Other,Medicare IPPS methodology,49055,,"25,046 x DRG weight",49055,Other,base rate x DRG weight,44149,,"22,541 x DRG weight",44149,Other,base rate x DRG weight,62853,,"32,091 x DRG weight",62853,Other,base rate x DRG weight,56568,,"28,882 x DRG weight",56568,Other,base rate x DRG weight,53425,,"27,277 x DRG weight",53425,Other,base rate x DRG weight,47163,,"24,080 x DRG weight",47163,Other,base rate x DRG weight,43996,,"22,463 x DRG weight",43996,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,51758,,"26,426 x DRG weight",51758,Other,base rate x DRG weight,76011,,"38,809 x DRG weight",76011,Other,base rate x DRG weight,76011,,"38,809 x DRG weight",76011,Other,base rate x DRG weight,51758,,"26,426 x DRG weight",51758,Other,base rate x DRG weight,76011,,"38,809 x DRG weight",76011,Other,base rate x DRG weight,28634,,"6,363 x patient days",28634,Per diem,,196782,70,,196782,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49077,,"25,057 x DRG weight",49077,Other,base rate x DRG weight,44170,,"22,552 x DRG weight",44170,Other,base rate x DRG weight,49077,,"25,057 x DRG weight",49077,Other,base rate x DRG weight,41714,,"21,298 x DRG weight",41714,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,196782,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,,inpatient,,,166960.29,23708,,,23708,Other,150% of Medicare + 9.63% HCRA Surcharge,14416.86,,,14416.86,Other,Medicare IPPS methodology,42177,,"25,046 x DRG weight",42177,Other,base rate x DRG weight,37959,,"22,541 x DRG weight",37959,Other,base rate x DRG weight,54041,,"32,091 x DRG weight",54041,Other,base rate x DRG weight,48637,,"28,882 x DRG weight",48637,Other,base rate x DRG weight,45934,,"27,277 x DRG weight",45934,Other,base rate x DRG weight,40551,,"24,080 x DRG weight",40551,Other,base rate x DRG weight,37828,,"22,463 x DRG weight",37828,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,44501,,"26,426 x DRG weight",44501,Other,base rate x DRG weight,65354,,"38,809 x DRG weight",65354,Other,base rate x DRG weight,65354,,"38,809 x DRG weight",65354,Other,base rate x DRG weight,44501,,"26,426 x DRG weight",44501,Other,base rate x DRG weight,65354,,"38,809 x DRG weight",65354,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,116872,70,,116872,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,42196,,"25,057 x DRG weight",42196,Other,base rate x DRG weight,37978,,"22,552 x DRG weight",37978,Other,base rate x DRG weight,42196,,"25,057 x DRG weight",42196,Other,base rate x DRG weight,35866,,"21,298 x DRG weight",35866,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,116872,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,,inpatient,,,154357.17,29294,,,29294,Other,150% of Medicare + 9.63% HCRA Surcharge,17813.92,,,17813.92,Other,Medicare IPPS methodology,52349,,"25,046 x DRG weight",52349,Other,base rate x DRG weight,47113,,"22,541 x DRG weight",47113,Other,base rate x DRG weight,67073,,"32,091 x DRG weight",67073,Other,base rate x DRG weight,60366,,"28,882 x DRG weight",60366,Other,base rate x DRG weight,57012,,"27,277 x DRG weight",57012,Other,base rate x DRG weight,50330,,"24,080 x DRG weight",50330,Other,base rate x DRG weight,46950,,"22,463 x DRG weight",46950,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,55233,,"26,426 x DRG weight",55233,Other,base rate x DRG weight,81115,,"38,809 x DRG weight",81115,Other,base rate x DRG weight,81115,,"38,809 x DRG weight",81115,Other,base rate x DRG weight,55233,,"26,426 x DRG weight",55233,Other,base rate x DRG weight,81115,,"38,809 x DRG weight",81115,Other,base rate x DRG weight,55358,,"6,363 x patient days",55358,Per diem,,108050,70,,108050,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52372,,"25,057 x DRG weight",52372,Other,base rate x DRG weight,47136,,"22,552 x DRG weight",47136,Other,base rate x DRG weight,52372,,"25,057 x DRG weight",52372,Other,base rate x DRG weight,44515,,"21,298 x DRG weight",44515,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,108050,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,,inpatient,,,75200.5,17186,,,17186,Other,150% of Medicare + 9.63% HCRA Surcharge,10450.98,,,10450.98,Other,Medicare IPPS methodology,30303,,"25,046 x DRG weight",30303,Other,base rate x DRG weight,27272,,"22,541 x DRG weight",27272,Other,base rate x DRG weight,38827,,"32,091 x DRG weight",38827,Other,base rate x DRG weight,34944,,"28,882 x DRG weight",34944,Other,base rate x DRG weight,33002,,"27,277 x DRG weight",33002,Other,base rate x DRG weight,29134,,"24,080 x DRG weight",29134,Other,base rate x DRG weight,27178,,"22,463 x DRG weight",27178,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31973,,"26,426 x DRG weight",31973,Other,base rate x DRG weight,46955,,"38,809 x DRG weight",46955,Other,base rate x DRG weight,46955,,"38,809 x DRG weight",46955,Other,base rate x DRG weight,31973,,"26,426 x DRG weight",31973,Other,base rate x DRG weight,46955,,"38,809 x DRG weight",46955,Other,base rate x DRG weight,36269,,"6,363 x patient days",36269,Per diem,,52640,70,,52640,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30316,,"25,057 x DRG weight",30316,Other,base rate x DRG weight,27286,,"22,552 x DRG weight",27286,Other,base rate x DRG weight,30316,,"25,057 x DRG weight",30316,Other,base rate x DRG weight,25768,,"21,298 x DRG weight",25768,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,52640,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,,inpatient,,,41415,11374,,,11374,Other,150% of Medicare + 9.63% HCRA Surcharge,6916.73,,,6916.73,Other,Medicare IPPS methodology,19721,,"25,046 x DRG weight",19721,Other,base rate x DRG weight,17749,,"22,541 x DRG weight",17749,Other,base rate x DRG weight,25268,,"32,091 x DRG weight",25268,Other,base rate x DRG weight,22742,,"28,882 x DRG weight",22742,Other,base rate x DRG weight,21478,,"27,277 x DRG weight",21478,Other,base rate x DRG weight,18961,,"24,080 x DRG weight",18961,Other,base rate x DRG weight,17687,,"22,463 x DRG weight",17687,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20808,,"26,426 x DRG weight",20808,Other,base rate x DRG weight,30558,,"38,809 x DRG weight",30558,Other,base rate x DRG weight,30558,,"38,809 x DRG weight",30558,Other,base rate x DRG weight,20808,,"26,426 x DRG weight",20808,Other,base rate x DRG weight,30558,,"38,809 x DRG weight",30558,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,28991,70,,28991,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19730,,"25,057 x DRG weight",19730,Other,base rate x DRG weight,17757,,"22,552 x DRG weight",17757,Other,base rate x DRG weight,19730,,"25,057 x DRG weight",19730,Other,base rate x DRG weight,16770,,"21,298 x DRG weight",16770,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,30558,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,,inpatient,,,357838.87,30462,,,30462,Other,150% of Medicare + 9.63% HCRA Surcharge,18524.11,,,18524.11,Other,Medicare IPPS methodology,54475,,"25,046 x DRG weight",54475,Other,base rate x DRG weight,49027,,"22,541 x DRG weight",49027,Other,base rate x DRG weight,69798,,"32,091 x DRG weight",69798,Other,base rate x DRG weight,62818,,"28,882 x DRG weight",62818,Other,base rate x DRG weight,59327,,"27,277 x DRG weight",59327,Other,base rate x DRG weight,52374,,"24,080 x DRG weight",52374,Other,base rate x DRG weight,48857,,"22,463 x DRG weight",48857,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,57477,,"26,426 x DRG weight",57477,Other,base rate x DRG weight,84410,,"38,809 x DRG weight",84410,Other,base rate x DRG weight,84410,,"38,809 x DRG weight",84410,Other,base rate x DRG weight,57477,,"26,426 x DRG weight",57477,Other,base rate x DRG weight,84410,,"38,809 x DRG weight",84410,Other,base rate x DRG weight,50904,,"6,363 x patient days",50904,Per diem,,250487,70,,250487,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,54499,,"25,057 x DRG weight",54499,Other,base rate x DRG weight,49051,,"22,552 x DRG weight",49051,Other,base rate x DRG weight,54499,,"25,057 x DRG weight",54499,Other,base rate x DRG weight,46323,,"21,298 x DRG weight",46323,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,250487,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,,inpatient,,,121904.89,14423,,,14423,Other,150% of Medicare + 9.63% HCRA Surcharge,8770.43,,,8770.43,Other,Medicare IPPS methodology,25271,,"25,046 x DRG weight",25271,Other,base rate x DRG weight,22744,,"22,541 x DRG weight",22744,Other,base rate x DRG weight,32380,,"32,091 x DRG weight",32380,Other,base rate x DRG weight,29142,,"28,882 x DRG weight",29142,Other,base rate x DRG weight,27522,,"27,277 x DRG weight",27522,Other,base rate x DRG weight,24297,,"24,080 x DRG weight",24297,Other,base rate x DRG weight,22665,,"22,463 x DRG weight",22665,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26664,,"26,426 x DRG weight",26664,Other,base rate x DRG weight,39158,,"38,809 x DRG weight",39158,Other,base rate x DRG weight,39158,,"38,809 x DRG weight",39158,Other,base rate x DRG weight,26664,,"26,426 x DRG weight",26664,Other,base rate x DRG weight,39158,,"38,809 x DRG weight",39158,Other,base rate x DRG weight,29270,,"6,363 x patient days",29270,Per diem,,85333,70,,85333,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25283,,"25,057 x DRG weight",25283,Other,base rate x DRG weight,22755,,"22,552 x DRG weight",22755,Other,base rate x DRG weight,25283,,"25,057 x DRG weight",25283,Other,base rate x DRG weight,21490,,"21,298 x DRG weight",21490,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,85333,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,,inpatient,,,231290.93,22559,,,22559,Other,150% of Medicare + 9.63% HCRA Surcharge,13718.38,,,13718.38,Other,Medicare IPPS methodology,40086,,"25,046 x DRG weight",40086,Other,base rate x DRG weight,36077,,"22,541 x DRG weight",36077,Other,base rate x DRG weight,51362,,"32,091 x DRG weight",51362,Other,base rate x DRG weight,46226,,"28,882 x DRG weight",46226,Other,base rate x DRG weight,43657,,"27,277 x DRG weight",43657,Other,base rate x DRG weight,38540,,"24,080 x DRG weight",38540,Other,base rate x DRG weight,35952,,"22,463 x DRG weight",35952,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42295,,"26,426 x DRG weight",42295,Other,base rate x DRG weight,62114,,"38,809 x DRG weight",62114,Other,base rate x DRG weight,62114,,"38,809 x DRG weight",62114,Other,base rate x DRG weight,42295,,"26,426 x DRG weight",42295,Other,base rate x DRG weight,62114,,"38,809 x DRG weight",62114,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,161904,70,,161904,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40104,,"25,057 x DRG weight",40104,Other,base rate x DRG weight,36094,,"22,552 x DRG weight",36094,Other,base rate x DRG weight,40104,,"25,057 x DRG weight",40104,Other,base rate x DRG weight,34087,,"21,298 x DRG weight",34087,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,161904,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,,inpatient,,,134604.21,17033,,,17033,Other,150% of Medicare + 9.63% HCRA Surcharge,10358.12,,,10358.12,Other,Medicare IPPS methodology,30025,,"25,046 x DRG weight",30025,Other,base rate x DRG weight,27022,,"22,541 x DRG weight",27022,Other,base rate x DRG weight,38471,,"32,091 x DRG weight",38471,Other,base rate x DRG weight,34624,,"28,882 x DRG weight",34624,Other,base rate x DRG weight,32700,,"27,277 x DRG weight",32700,Other,base rate x DRG weight,28867,,"24,080 x DRG weight",28867,Other,base rate x DRG weight,26929,,"22,463 x DRG weight",26929,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31679,,"26,426 x DRG weight",31679,Other,base rate x DRG weight,46524,,"38,809 x DRG weight",46524,Other,base rate x DRG weight,46524,,"38,809 x DRG weight",46524,Other,base rate x DRG weight,31679,,"26,426 x DRG weight",31679,Other,base rate x DRG weight,46524,,"38,809 x DRG weight",46524,Other,base rate x DRG weight,31179,,"6,363 x patient days",31179,Per diem,,94223,70,,94223,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30038,,"25,057 x DRG weight",30038,Other,base rate x DRG weight,27035,,"22,552 x DRG weight",27035,Other,base rate x DRG weight,30038,,"25,057 x DRG weight",30038,Other,base rate x DRG weight,25532,,"21,298 x DRG weight",25532,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,94223,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,,inpatient,,,121904.89,9798,,,9798,Other,150% of Medicare + 9.63% HCRA Surcharge,5958.09,,,5958.09,Other,Medicare IPPS methodology,16851,,"25,046 x DRG weight",16851,Other,base rate x DRG weight,15166,,"22,541 x DRG weight",15166,Other,base rate x DRG weight,21591,,"32,091 x DRG weight",21591,Other,base rate x DRG weight,19432,,"28,882 x DRG weight",19432,Other,base rate x DRG weight,18352,,"27,277 x DRG weight",18352,Other,base rate x DRG weight,16201,,"24,080 x DRG weight",16201,Other,base rate x DRG weight,15113,,"22,463 x DRG weight",15113,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,17779,,"26,426 x DRG weight",17779,Other,base rate x DRG weight,26111,,"38,809 x DRG weight",26111,Other,base rate x DRG weight,26111,,"38,809 x DRG weight",26111,Other,base rate x DRG weight,17779,,"26,426 x DRG weight",17779,Other,base rate x DRG weight,26111,,"38,809 x DRG weight",26111,Other,base rate x DRG weight,13999,,"6,363 x patient days",13999,Per diem,,85333,70,,85333,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,16858,,"25,057 x DRG weight",16858,Other,base rate x DRG weight,15173,,"22,552 x DRG weight",15173,Other,base rate x DRG weight,16858,,"25,057 x DRG weight",16858,Other,base rate x DRG weight,14329,,"21,298 x DRG weight",14329,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,85333,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,,inpatient,,,307554.34,14650,,,14650,Other,150% of Medicare + 9.63% HCRA Surcharge,8908.46,,,8908.46,Other,Medicare IPPS methodology,25685,,"25,046 x DRG weight",25685,Other,base rate x DRG weight,23116,,"22,541 x DRG weight",23116,Other,base rate x DRG weight,32909,,"32,091 x DRG weight",32909,Other,base rate x DRG weight,29618,,"28,882 x DRG weight",29618,Other,base rate x DRG weight,27973,,"27,277 x DRG weight",27973,Other,base rate x DRG weight,24694,,"24,080 x DRG weight",24694,Other,base rate x DRG weight,23036,,"22,463 x DRG weight",23036,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27100,,"26,426 x DRG weight",27100,Other,base rate x DRG weight,39799,,"38,809 x DRG weight",39799,Other,base rate x DRG weight,39799,,"38,809 x DRG weight",39799,Other,base rate x DRG weight,27100,,"26,426 x DRG weight",27100,Other,base rate x DRG weight,39799,,"38,809 x DRG weight",39799,Other,base rate x DRG weight,27997,,"6,363 x patient days",27997,Per diem,,215288,70,,215288,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25696,,"25,057 x DRG weight",25696,Other,base rate x DRG weight,23127,,"22,552 x DRG weight",23127,Other,base rate x DRG weight,25696,,"25,057 x DRG weight",25696,Other,base rate x DRG weight,21841,,"21,298 x DRG weight",21841,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,215288,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,,inpatient,,,54660.52,9257,,,9257,Other,150% of Medicare + 9.63% HCRA Surcharge,5629.35,,,5629.35,Other,Medicare IPPS methodology,15867,,"25,046 x DRG weight",15867,Other,base rate x DRG weight,14280,,"22,541 x DRG weight",14280,Other,base rate x DRG weight,20330,,"32,091 x DRG weight",20330,Other,base rate x DRG weight,18297,,"28,882 x DRG weight",18297,Other,base rate x DRG weight,17280,,"27,277 x DRG weight",17280,Other,base rate x DRG weight,15255,,"24,080 x DRG weight",15255,Other,base rate x DRG weight,14230,,"22,463 x DRG weight",14230,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,16741,,"26,426 x DRG weight",16741,Other,base rate x DRG weight,24586,,"38,809 x DRG weight",24586,Other,base rate x DRG weight,24586,,"38,809 x DRG weight",24586,Other,base rate x DRG weight,16741,,"26,426 x DRG weight",16741,Other,base rate x DRG weight,24586,,"38,809 x DRG weight",24586,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,38262,70,,38262,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15874,,"25,057 x DRG weight",15874,Other,base rate x DRG weight,14287,,"22,552 x DRG weight",14287,Other,base rate x DRG weight,15874,,"25,057 x DRG weight",15874,Other,base rate x DRG weight,13492,,"21,298 x DRG weight",13492,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,38262,
CELLULITIS WITH MCC,602,MS-DRG,,,,,,,,inpatient,,,167772.02,21005,,,21005,Other,150% of Medicare + 9.63% HCRA Surcharge,12773.12,,,12773.12,Other,Medicare IPPS methodology,37256,,"25,046 x DRG weight",37256,Other,base rate x DRG weight,33530,,"22,541 x DRG weight",33530,Other,base rate x DRG weight,47735,,"32,091 x DRG weight",47735,Other,base rate x DRG weight,42962,,"28,882 x DRG weight",42962,Other,base rate x DRG weight,40575,,"27,277 x DRG weight",40575,Other,base rate x DRG weight,35819,,"24,080 x DRG weight",35819,Other,base rate x DRG weight,33414,,"22,463 x DRG weight",33414,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39309,,"26,426 x DRG weight",39309,Other,base rate x DRG weight,57728,,"38,809 x DRG weight",57728,Other,base rate x DRG weight,57728,,"38,809 x DRG weight",57728,Other,base rate x DRG weight,39309,,"26,426 x DRG weight",39309,Other,base rate x DRG weight,57728,,"38,809 x DRG weight",57728,Other,base rate x DRG weight,39451,,"6,363 x patient days",39451,Per diem,,117440,70,,117440,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37272,,"25,057 x DRG weight",37272,Other,base rate x DRG weight,33546,,"22,552 x DRG weight",33546,Other,base rate x DRG weight,37272,,"25,057 x DRG weight",37272,Other,base rate x DRG weight,31681,,"21,298 x DRG weight",31681,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,117440,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,,inpatient,,,93896.51,12713,,,12713,Other,150% of Medicare + 9.63% HCRA Surcharge,7730.65,,,7730.65,Other,Medicare IPPS methodology,22158,,"25,046 x DRG weight",22158,Other,base rate x DRG weight,19942,,"22,541 x DRG weight",19942,Other,base rate x DRG weight,28391,,"32,091 x DRG weight",28391,Other,base rate x DRG weight,25552,,"28,882 x DRG weight",25552,Other,base rate x DRG weight,24132,,"27,277 x DRG weight",24132,Other,base rate x DRG weight,21304,,"24,080 x DRG weight",21304,Other,base rate x DRG weight,19873,,"22,463 x DRG weight",19873,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23379,,"26,426 x DRG weight",23379,Other,base rate x DRG weight,34334,,"38,809 x DRG weight",34334,Other,base rate x DRG weight,34334,,"38,809 x DRG weight",34334,Other,base rate x DRG weight,23379,,"26,426 x DRG weight",23379,Other,base rate x DRG weight,34334,,"38,809 x DRG weight",34334,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,65728,70,,65728,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22168,,"25,057 x DRG weight",22168,Other,base rate x DRG weight,19952,,"22,552 x DRG weight",19952,Other,base rate x DRG weight,22168,,"25,057 x DRG weight",22168,Other,base rate x DRG weight,18842,,"21,298 x DRG weight",18842,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,65728,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,,inpatient,,,201464.97,21262,,,21262,Other,150% of Medicare + 9.63% HCRA Surcharge,12929.55,,,12929.55,Other,Medicare IPPS methodology,37724,,"25,046 x DRG weight",37724,Other,base rate x DRG weight,33951,,"22,541 x DRG weight",33951,Other,base rate x DRG weight,48335,,"32,091 x DRG weight",48335,Other,base rate x DRG weight,43502,,"28,882 x DRG weight",43502,Other,base rate x DRG weight,41085,,"27,277 x DRG weight",41085,Other,base rate x DRG weight,36269,,"24,080 x DRG weight",36269,Other,base rate x DRG weight,33834,,"22,463 x DRG weight",33834,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39803,,"26,426 x DRG weight",39803,Other,base rate x DRG weight,58454,,"38,809 x DRG weight",58454,Other,base rate x DRG weight,58454,,"38,809 x DRG weight",58454,Other,base rate x DRG weight,39803,,"26,426 x DRG weight",39803,Other,base rate x DRG weight,58454,,"38,809 x DRG weight",58454,Other,base rate x DRG weight,34997,,"6,363 x patient days",34997,Per diem,,141025,70,,141025,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37741,,"25,057 x DRG weight",37741,Other,base rate x DRG weight,33968,,"22,552 x DRG weight",33968,Other,base rate x DRG weight,37741,,"25,057 x DRG weight",37741,Other,base rate x DRG weight,32079,,"21,298 x DRG weight",32079,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,141025,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,,inpatient,,,101598.7,13044,,,13044,Other,150% of Medicare + 9.63% HCRA Surcharge,7932.25,,,7932.25,Other,Medicare IPPS methodology,22762,,"25,046 x DRG weight",22762,Other,base rate x DRG weight,20485,,"22,541 x DRG weight",20485,Other,base rate x DRG weight,29164,,"32,091 x DRG weight",29164,Other,base rate x DRG weight,26248,,"28,882 x DRG weight",26248,Other,base rate x DRG weight,24789,,"27,277 x DRG weight",24789,Other,base rate x DRG weight,21884,,"24,080 x DRG weight",21884,Other,base rate x DRG weight,20414,,"22,463 x DRG weight",20414,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24016,,"26,426 x DRG weight",24016,Other,base rate x DRG weight,35270,,"38,809 x DRG weight",35270,Other,base rate x DRG weight,35270,,"38,809 x DRG weight",35270,Other,base rate x DRG weight,24016,,"26,426 x DRG weight",24016,Other,base rate x DRG weight,35270,,"38,809 x DRG weight",35270,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,71119,70,,71119,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22772,,"25,057 x DRG weight",22772,Other,base rate x DRG weight,20495,,"22,552 x DRG weight",20495,Other,base rate x DRG weight,22772,,"25,057 x DRG weight",22772,Other,base rate x DRG weight,19356,,"21,298 x DRG weight",19356,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,71119,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,,inpatient,,,288867.89,22357,,,22357,Other,150% of Medicare + 9.63% HCRA Surcharge,13595.41,,,13595.41,Other,Medicare IPPS methodology,39718,,"25,046 x DRG weight",39718,Other,base rate x DRG weight,35746,,"22,541 x DRG weight",35746,Other,base rate x DRG weight,50890,,"32,091 x DRG weight",50890,Other,base rate x DRG weight,45801,,"28,882 x DRG weight",45801,Other,base rate x DRG weight,43256,,"27,277 x DRG weight",43256,Other,base rate x DRG weight,38186,,"24,080 x DRG weight",38186,Other,base rate x DRG weight,35622,,"22,463 x DRG weight",35622,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41906,,"26,426 x DRG weight",41906,Other,base rate x DRG weight,61543,,"38,809 x DRG weight",61543,Other,base rate x DRG weight,61543,,"38,809 x DRG weight",61543,Other,base rate x DRG weight,41906,,"26,426 x DRG weight",41906,Other,base rate x DRG weight,61543,,"38,809 x DRG weight",61543,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,202208,70,,202208,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39735,,"25,057 x DRG weight",39735,Other,base rate x DRG weight,35763,,"22,552 x DRG weight",35763,Other,base rate x DRG weight,39735,,"25,057 x DRG weight",39735,Other,base rate x DRG weight,33774,,"21,298 x DRG weight",33774,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,202208,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,,inpatient,,,124704.26,12834,,,12834,Other,150% of Medicare + 9.63% HCRA Surcharge,7804.27,,,7804.27,Other,Medicare IPPS methodology,22379,,"25,046 x DRG weight",22379,Other,base rate x DRG weight,20140,,"22,541 x DRG weight",20140,Other,base rate x DRG weight,28673,,"32,091 x DRG weight",28673,Other,base rate x DRG weight,25806,,"28,882 x DRG weight",25806,Other,base rate x DRG weight,24372,,"27,277 x DRG weight",24372,Other,base rate x DRG weight,21515,,"24,080 x DRG weight",21515,Other,base rate x DRG weight,20071,,"22,463 x DRG weight",20071,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23612,,"26,426 x DRG weight",23612,Other,base rate x DRG weight,34676,,"38,809 x DRG weight",34676,Other,base rate x DRG weight,34676,,"38,809 x DRG weight",34676,Other,base rate x DRG weight,23612,,"26,426 x DRG weight",23612,Other,base rate x DRG weight,34676,,"38,809 x DRG weight",34676,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,87293,70,,87293,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22388,,"25,057 x DRG weight",22388,Other,base rate x DRG weight,20150,,"22,552 x DRG weight",20150,Other,base rate x DRG weight,22388,,"25,057 x DRG weight",22388,Other,base rate x DRG weight,19030,,"21,298 x DRG weight",19030,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,87293,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,,inpatient,,,290925.87,31527,,,31527,Other,150% of Medicare + 9.63% HCRA Surcharge,19171.57,,,19171.57,Other,Medicare IPPS methodology,56414,,"25,046 x DRG weight",56414,Other,base rate x DRG weight,50771,,"22,541 x DRG weight",50771,Other,base rate x DRG weight,72282,,"32,091 x DRG weight",72282,Other,base rate x DRG weight,65054,,"28,882 x DRG weight",65054,Other,base rate x DRG weight,61439,,"27,277 x DRG weight",61439,Other,base rate x DRG weight,54238,,"24,080 x DRG weight",54238,Other,base rate x DRG weight,50596,,"22,463 x DRG weight",50596,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,59522,,"26,426 x DRG weight",59522,Other,base rate x DRG weight,87413,,"38,809 x DRG weight",87413,Other,base rate x DRG weight,87413,,"38,809 x DRG weight",87413,Other,base rate x DRG weight,59522,,"26,426 x DRG weight",59522,Other,base rate x DRG weight,87413,,"38,809 x DRG weight",87413,Other,base rate x DRG weight,26088,,"6,363 x patient days",26088,Per diem,,203648,70,,203648,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,56438,,"25,057 x DRG weight",56438,Other,base rate x DRG weight,50796,,"22,552 x DRG weight",50796,Other,base rate x DRG weight,56438,,"25,057 x DRG weight",56438,Other,base rate x DRG weight,47972,,"21,298 x DRG weight",47972,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,203648,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,,inpatient,,,252737.71,20779,,,20779,Other,150% of Medicare + 9.63% HCRA Surcharge,12635.93,,,12635.93,Other,Medicare IPPS methodology,36845,,"25,046 x DRG weight",36845,Other,base rate x DRG weight,33160,,"22,541 x DRG weight",33160,Other,base rate x DRG weight,47209,,"32,091 x DRG weight",47209,Other,base rate x DRG weight,42488,,"28,882 x DRG weight",42488,Other,base rate x DRG weight,40127,,"27,277 x DRG weight",40127,Other,base rate x DRG weight,35424,,"24,080 x DRG weight",35424,Other,base rate x DRG weight,33045,,"22,463 x DRG weight",33045,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,38875,,"26,426 x DRG weight",38875,Other,base rate x DRG weight,57092,,"38,809 x DRG weight",57092,Other,base rate x DRG weight,57092,,"38,809 x DRG weight",57092,Other,base rate x DRG weight,38875,,"26,426 x DRG weight",38875,Other,base rate x DRG weight,57092,,"38,809 x DRG weight",57092,Other,base rate x DRG weight,11453,,"6,363 x patient days",11453,Per diem,,176916,70,,176916,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,36861,,"25,057 x DRG weight",36861,Other,base rate x DRG weight,33176,,"22,552 x DRG weight",33176,Other,base rate x DRG weight,36861,,"25,057 x DRG weight",36861,Other,base rate x DRG weight,31331,,"21,298 x DRG weight",31331,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,176916,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,,inpatient,,,496608.26,54985,,,54985,Other,150% of Medicare + 9.63% HCRA Surcharge,33436.54,,,33436.54,Other,Medicare IPPS methodology,99125,,"25,046 x DRG weight",99125,Other,base rate x DRG weight,89211,,"22,541 x DRG weight",89211,Other,base rate x DRG weight,127007,,"32,091 x DRG weight",127007,Other,base rate x DRG weight,114306,,"28,882 x DRG weight",114306,Other,base rate x DRG weight,107954,,"27,277 x DRG weight",107954,Other,base rate x DRG weight,95301,,"24,080 x DRG weight",95301,Other,base rate x DRG weight,88902,,"22,463 x DRG weight",88902,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,104586,,"26,426 x DRG weight",104586,Other,base rate x DRG weight,153594,,"38,809 x DRG weight",153594,Other,base rate x DRG weight,153594,,"38,809 x DRG weight",153594,Other,base rate x DRG weight,104586,,"26,426 x DRG weight",104586,Other,base rate x DRG weight,153594,,"38,809 x DRG weight",153594,Other,base rate x DRG weight,82719,,"6,363 x patient days",82719,Per diem,,347626,70,,347626,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,99168,,"25,057 x DRG weight",99168,Other,base rate x DRG weight,89254,,"22,552 x DRG weight",89254,Other,base rate x DRG weight,99168,,"25,057 x DRG weight",99168,Other,base rate x DRG weight,84291,,"21,298 x DRG weight",84291,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,347626,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,,inpatient,,,211436.08,27841,,,27841,Other,150% of Medicare + 9.63% HCRA Surcharge,16930.57,,,16930.57,Other,Medicare IPPS methodology,49704,,"25,046 x DRG weight",49704,Other,base rate x DRG weight,44733,,"22,541 x DRG weight",44733,Other,base rate x DRG weight,63685,,"32,091 x DRG weight",63685,Other,base rate x DRG weight,57316,,"28,882 x DRG weight",57316,Other,base rate x DRG weight,54131,,"27,277 x DRG weight",54131,Other,base rate x DRG weight,47787,,"24,080 x DRG weight",47787,Other,base rate x DRG weight,44578,,"22,463 x DRG weight",44578,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52442,,"26,426 x DRG weight",52442,Other,base rate x DRG weight,77016,,"38,809 x DRG weight",77016,Other,base rate x DRG weight,77016,,"38,809 x DRG weight",77016,Other,base rate x DRG weight,52442,,"26,426 x DRG weight",52442,Other,base rate x DRG weight,77016,,"38,809 x DRG weight",77016,Other,base rate x DRG weight,44541,,"6,363 x patient days",44541,Per diem,,148005,70,,148005,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49726,,"25,057 x DRG weight",49726,Other,base rate x DRG weight,44754,,"22,552 x DRG weight",44754,Other,base rate x DRG weight,49726,,"25,057 x DRG weight",49726,Other,base rate x DRG weight,42266,,"21,298 x DRG weight",42266,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,148005,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,,inpatient,,,82460.9,16520,,,16520,Other,150% of Medicare + 9.63% HCRA Surcharge,10046.11,,,10046.11,Other,Medicare IPPS methodology,29091,,"25,046 x DRG weight",29091,Other,base rate x DRG weight,26181,,"22,541 x DRG weight",26181,Other,base rate x DRG weight,37274,,"32,091 x DRG weight",37274,Other,base rate x DRG weight,33546,,"28,882 x DRG weight",33546,Other,base rate x DRG weight,31682,,"27,277 x DRG weight",31682,Other,base rate x DRG weight,27969,,"24,080 x DRG weight",27969,Other,base rate x DRG weight,26091,,"22,463 x DRG weight",26091,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,30694,,"26,426 x DRG weight",30694,Other,base rate x DRG weight,45077,,"38,809 x DRG weight",45077,Other,base rate x DRG weight,45077,,"38,809 x DRG weight",45077,Other,base rate x DRG weight,30694,,"26,426 x DRG weight",30694,Other,base rate x DRG weight,45077,,"38,809 x DRG weight",45077,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,57723,70,,57723,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29104,,"25,057 x DRG weight",29104,Other,base rate x DRG weight,26194,,"22,552 x DRG weight",26194,Other,base rate x DRG weight,29104,,"25,057 x DRG weight",29104,Other,base rate x DRG weight,24738,,"21,298 x DRG weight",24738,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,57723,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,,inpatient,,,65001.95,36343,,,36343,Other,150% of Medicare + 9.63% HCRA Surcharge,22100.18,,,22100.18,Other,Medicare IPPS methodology,65182,,"25,046 x DRG weight",65182,Other,base rate x DRG weight,58663,,"22,541 x DRG weight",58663,Other,base rate x DRG weight,83517,,"32,091 x DRG weight",83517,Other,base rate x DRG weight,75165,,"28,882 x DRG weight",75165,Other,base rate x DRG weight,70988,,"27,277 x DRG weight",70988,Other,base rate x DRG weight,62668,,"24,080 x DRG weight",62668,Other,base rate x DRG weight,58460,,"22,463 x DRG weight",58460,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,68774,,"26,426 x DRG weight",68774,Other,base rate x DRG weight,101000,,"38,809 x DRG weight",101000,Other,base rate x DRG weight,101000,,"38,809 x DRG weight",101000,Other,base rate x DRG weight,68774,,"26,426 x DRG weight",68774,Other,base rate x DRG weight,101000,,"38,809 x DRG weight",101000,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,45501,70,,45501,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,65211,,"25,057 x DRG weight",65211,Other,base rate x DRG weight,58692,,"22,552 x DRG weight",58692,Other,base rate x DRG weight,65211,,"25,057 x DRG weight",65211,Other,base rate x DRG weight,55428,,"21,298 x DRG weight",55428,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,101000,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,,inpatient,,,76851.85,22858,,,22858,Other,150% of Medicare + 9.63% HCRA Surcharge,13899.9,,,13899.9,Other,Medicare IPPS methodology,40630,,"25,046 x DRG weight",40630,Other,base rate x DRG weight,36566,,"22,541 x DRG weight",36566,Other,base rate x DRG weight,52058,,"32,091 x DRG weight",52058,Other,base rate x DRG weight,46852,,"28,882 x DRG weight",46852,Other,base rate x DRG weight,44249,,"27,277 x DRG weight",44249,Other,base rate x DRG weight,39063,,"24,080 x DRG weight",39063,Other,base rate x DRG weight,36439,,"22,463 x DRG weight",36439,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42868,,"26,426 x DRG weight",42868,Other,base rate x DRG weight,62956,,"38,809 x DRG weight",62956,Other,base rate x DRG weight,62956,,"38,809 x DRG weight",62956,Other,base rate x DRG weight,42868,,"26,426 x DRG weight",42868,Other,base rate x DRG weight,62956,,"38,809 x DRG weight",62956,Other,base rate x DRG weight,12090,,"6,363 x patient days",12090,Per diem,,53796,70,,53796,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40647,,"25,057 x DRG weight",40647,Other,base rate x DRG weight,36584,,"22,552 x DRG weight",36584,Other,base rate x DRG weight,40647,,"25,057 x DRG weight",40647,Other,base rate x DRG weight,34550,,"21,298 x DRG weight",34550,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,62956,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,,inpatient,,,70766.77,21415,,,21415,Other,150% of Medicare + 9.63% HCRA Surcharge,13022.4,,,13022.4,Other,Medicare IPPS methodology,23600,,,23600,Case Rate,,21240,,,21240,Case Rate,,48692,,"32,091 x DRG weight",48692,Other,base rate x DRG weight,43823,,"28,882 x DRG weight",43823,Other,base rate x DRG weight,41387,,"27,277 x DRG weight",41387,Other,base rate x DRG weight,36537,,"24,080 x DRG weight",36537,Other,base rate x DRG weight,34083,,"22,463 x DRG weight",34083,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40096,,"26,426 x DRG weight",40096,Other,base rate x DRG weight,58885,,"38,809 x DRG weight",58885,Other,base rate x DRG weight,58885,,"38,809 x DRG weight",58885,Other,base rate x DRG weight,40096,,"26,426 x DRG weight",40096,Other,base rate x DRG weight,58885,,"38,809 x DRG weight",58885,Other,base rate x DRG weight,8908,,"6,363 x patient days",8908,Per diem,,49537,70,,49537,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38019,,"25,057 x DRG weight",38019,Other,base rate x DRG weight,34218,,"22,552 x DRG weight",34218,Other,base rate x DRG weight,38019,,"25,057 x DRG weight",38019,Other,base rate x DRG weight,32315,,"21,298 x DRG weight",32315,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,58885,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,,inpatient,,,1025121.9,53168,,,53168,Other,150% of Medicare + 9.63% HCRA Surcharge,32331.51,,,32331.51,Other,Medicare IPPS methodology,95816,,"25,046 x DRG weight",95816,Other,base rate x DRG weight,86233,,"22,541 x DRG weight",86233,Other,base rate x DRG weight,122767,,"32,091 x DRG weight",122767,Other,base rate x DRG weight,110491,,"28,882 x DRG weight",110491,Other,base rate x DRG weight,104351,,"27,277 x DRG weight",104351,Other,base rate x DRG weight,92120,,"24,080 x DRG weight",92120,Other,base rate x DRG weight,85934,,"22,463 x DRG weight",85934,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,101095,,"26,426 x DRG weight",101095,Other,base rate x DRG weight,148468,,"38,809 x DRG weight",148468,Other,base rate x DRG weight,148468,,"38,809 x DRG weight",148468,Other,base rate x DRG weight,101095,,"26,426 x DRG weight",101095,Other,base rate x DRG weight,148468,,"38,809 x DRG weight",148468,Other,base rate x DRG weight,81446,,"6,363 x patient days",81446,Per diem,,717585,70,,717585,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,95858,,"25,057 x DRG weight",95858,Other,base rate x DRG weight,86275,,"22,552 x DRG weight",86275,Other,base rate x DRG weight,95858,,"25,057 x DRG weight",95858,Other,base rate x DRG weight,81478,,"21,298 x DRG weight",81478,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,717585,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,,inpatient,,,335410.92,26148,,,26148,Other,150% of Medicare + 9.63% HCRA Surcharge,15900.82,,,15900.82,Other,Medicare IPPS methodology,46621,,"25,046 x DRG weight",46621,Other,base rate x DRG weight,41958,,"22,541 x DRG weight",41958,Other,base rate x DRG weight,59734,,"32,091 x DRG weight",59734,Other,base rate x DRG weight,53761,,"28,882 x DRG weight",53761,Other,base rate x DRG weight,50773,,"27,277 x DRG weight",50773,Other,base rate x DRG weight,44823,,"24,080 x DRG weight",44823,Other,base rate x DRG weight,41813,,"22,463 x DRG weight",41813,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49189,,"26,426 x DRG weight",49189,Other,base rate x DRG weight,72239,,"38,809 x DRG weight",72239,Other,base rate x DRG weight,72239,,"38,809 x DRG weight",72239,Other,base rate x DRG weight,49189,,"26,426 x DRG weight",49189,Other,base rate x DRG weight,72239,,"38,809 x DRG weight",72239,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,234788,70,,234788,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46641,,"25,057 x DRG weight",46641,Other,base rate x DRG weight,41978,,"22,552 x DRG weight",41978,Other,base rate x DRG weight,46641,,"25,057 x DRG weight",46641,Other,base rate x DRG weight,39644,,"21,298 x DRG weight",39644,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,234788,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,,inpatient,,,82460.9,15874,,,15874,Other,150% of Medicare + 9.63% HCRA Surcharge,9652.95,,,9652.95,Other,Medicare IPPS methodology,27914,,"25,046 x DRG weight",27914,Other,base rate x DRG weight,25122,,"22,541 x DRG weight",25122,Other,base rate x DRG weight,35765,,"32,091 x DRG weight",35765,Other,base rate x DRG weight,32189,,"28,882 x DRG weight",32189,Other,base rate x DRG weight,30400,,"27,277 x DRG weight",30400,Other,base rate x DRG weight,26837,,"24,080 x DRG weight",26837,Other,base rate x DRG weight,25035,,"22,463 x DRG weight",25035,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,29452,,"26,426 x DRG weight",29452,Other,base rate x DRG weight,43253,,"38,809 x DRG weight",43253,Other,base rate x DRG weight,43253,,"38,809 x DRG weight",43253,Other,base rate x DRG weight,29452,,"26,426 x DRG weight",29452,Other,base rate x DRG weight,43253,,"38,809 x DRG weight",43253,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,57723,70,,57723,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27926,,"25,057 x DRG weight",27926,Other,base rate x DRG weight,25134,,"22,552 x DRG weight",25134,Other,base rate x DRG weight,27926,,"25,057 x DRG weight",27926,Other,base rate x DRG weight,23737,,"21,298 x DRG weight",23737,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,57723,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,,inpatient,,,458181.8,40727,,,40727,Other,150% of Medicare + 9.63% HCRA Surcharge,24766.13,,,24766.13,Other,Medicare IPPS methodology,73164,,"25,046 x DRG weight",73164,Other,base rate x DRG weight,65847,,"22,541 x DRG weight",65847,Other,base rate x DRG weight,93744,,"32,091 x DRG weight",93744,Other,base rate x DRG weight,84370,,"28,882 x DRG weight",84370,Other,base rate x DRG weight,79682,,"27,277 x DRG weight",79682,Other,base rate x DRG weight,70342,,"24,080 x DRG weight",70342,Other,base rate x DRG weight,65619,,"22,463 x DRG weight",65619,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,77196,,"26,426 x DRG weight",77196,Other,base rate x DRG weight,113369,,"38,809 x DRG weight",113369,Other,base rate x DRG weight,113369,,"38,809 x DRG weight",113369,Other,base rate x DRG weight,77196,,"26,426 x DRG weight",77196,Other,base rate x DRG weight,113369,,"38,809 x DRG weight",113369,Other,base rate x DRG weight,51540,,"6,363 x patient days",51540,Per diem,,320727,70,,320727,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,73197,,"25,057 x DRG weight",73197,Other,base rate x DRG weight,65879,,"22,552 x DRG weight",65879,Other,base rate x DRG weight,73197,,"25,057 x DRG weight",73197,Other,base rate x DRG weight,62216,,"21,298 x DRG weight",62216,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,320727,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,,inpatient,,,205070.14,21065,,,21065,Other,150% of Medicare + 9.63% HCRA Surcharge,12809.93,,,12809.93,Other,Medicare IPPS methodology,37366,,"25,046 x DRG weight",37366,Other,base rate x DRG weight,33629,,"22,541 x DRG weight",33629,Other,base rate x DRG weight,47877,,"32,091 x DRG weight",47877,Other,base rate x DRG weight,43089,,"28,882 x DRG weight",43089,Other,base rate x DRG weight,40695,,"27,277 x DRG weight",40695,Other,base rate x DRG weight,35925,,"24,080 x DRG weight",35925,Other,base rate x DRG weight,33513,,"22,463 x DRG weight",33513,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39425,,"26,426 x DRG weight",39425,Other,base rate x DRG weight,57899,,"38,809 x DRG weight",57899,Other,base rate x DRG weight,57899,,"38,809 x DRG weight",57899,Other,base rate x DRG weight,39425,,"26,426 x DRG weight",39425,Other,base rate x DRG weight,57899,,"38,809 x DRG weight",57899,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,143549,70,,143549,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37383,,"25,057 x DRG weight",37383,Other,base rate x DRG weight,33645,,"22,552 x DRG weight",33645,Other,base rate x DRG weight,37383,,"25,057 x DRG weight",37383,Other,base rate x DRG weight,31774,,"21,298 x DRG weight",31774,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,143549,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,,inpatient,,,115715.03,17545,,,17545,Other,150% of Medicare + 9.63% HCRA Surcharge,10669.31,,,10669.31,Other,Medicare IPPS methodology,30957,,"25,046 x DRG weight",30957,Other,base rate x DRG weight,27861,,"22,541 x DRG weight",27861,Other,base rate x DRG weight,39664,,"32,091 x DRG weight",39664,Other,base rate x DRG weight,35698,,"28,882 x DRG weight",35698,Other,base rate x DRG weight,33714,,"27,277 x DRG weight",33714,Other,base rate x DRG weight,29763,,"24,080 x DRG weight",29763,Other,base rate x DRG weight,27764,,"22,463 x DRG weight",27764,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,32663,,"26,426 x DRG weight",32663,Other,base rate x DRG weight,47968,,"38,809 x DRG weight",47968,Other,base rate x DRG weight,47968,,"38,809 x DRG weight",47968,Other,base rate x DRG weight,32663,,"26,426 x DRG weight",32663,Other,base rate x DRG weight,47968,,"38,809 x DRG weight",47968,Other,base rate x DRG weight,9545,,"6,363 x patient days",9545,Per diem,,81001,70,,81001,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30970,,"25,057 x DRG weight",30970,Other,base rate x DRG weight,27874,,"22,552 x DRG weight",27874,Other,base rate x DRG weight,30970,,"25,057 x DRG weight",30970,Other,base rate x DRG weight,26324,,"21,298 x DRG weight",26324,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,81001,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,,inpatient,,,493924.97,55766,,,55766,Other,150% of Medicare + 9.63% HCRA Surcharge,33911.67,,,33911.67,Other,Medicare IPPS methodology,100547,,"25,046 x DRG weight",100547,Other,base rate x DRG weight,90491,,"22,541 x DRG weight",90491,Other,base rate x DRG weight,128829,,"32,091 x DRG weight",128829,Other,base rate x DRG weight,115947,,"28,882 x DRG weight",115947,Other,base rate x DRG weight,109504,,"27,277 x DRG weight",109504,Other,base rate x DRG weight,96669,,"24,080 x DRG weight",96669,Other,base rate x DRG weight,90178,,"22,463 x DRG weight",90178,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,106087,,"26,426 x DRG weight",106087,Other,base rate x DRG weight,155799,,"38,809 x DRG weight",155799,Other,base rate x DRG weight,155799,,"38,809 x DRG weight",155799,Other,base rate x DRG weight,106087,,"26,426 x DRG weight",106087,Other,base rate x DRG weight,155799,,"38,809 x DRG weight",155799,Other,base rate x DRG weight,76992,,"6,363 x patient days",76992,Per diem,,345747,70,,345747,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,100591,,"25,057 x DRG weight",100591,Other,base rate x DRG weight,90535,,"22,552 x DRG weight",90535,Other,base rate x DRG weight,100591,,"25,057 x DRG weight",100591,Other,base rate x DRG weight,85501,,"21,298 x DRG weight",85501,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,345747,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,,inpatient,,,254257.07,31670,,,31670,Other,150% of Medicare + 9.63% HCRA Surcharge,19258.57,,,19258.57,Other,Medicare IPPS methodology,56674,,"25,046 x DRG weight",56674,Other,base rate x DRG weight,51006,,"22,541 x DRG weight",51006,Other,base rate x DRG weight,72616,,"32,091 x DRG weight",72616,Other,base rate x DRG weight,65354,,"28,882 x DRG weight",65354,Other,base rate x DRG weight,61722,,"27,277 x DRG weight",61722,Other,base rate x DRG weight,54488,,"24,080 x DRG weight",54488,Other,base rate x DRG weight,50829,,"22,463 x DRG weight",50829,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,59797,,"26,426 x DRG weight",59797,Other,base rate x DRG weight,87817,,"38,809 x DRG weight",87817,Other,base rate x DRG weight,87817,,"38,809 x DRG weight",87817,Other,base rate x DRG weight,59797,,"26,426 x DRG weight",59797,Other,base rate x DRG weight,87817,,"38,809 x DRG weight",87817,Other,base rate x DRG weight,47086,,"6,363 x patient days",47086,Per diem,,177980,70,,177980,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,56699,,"25,057 x DRG weight",56699,Other,base rate x DRG weight,51031,,"22,552 x DRG weight",51031,Other,base rate x DRG weight,56699,,"25,057 x DRG weight",56699,Other,base rate x DRG weight,48193,,"21,298 x DRG weight",48193,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,177980,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,,inpatient,,,255914.82,19750,,,19750,Other,150% of Medicare + 9.63% HCRA Surcharge,12010.23,,,12010.23,Other,Medicare IPPS methodology,34972,,"25,046 x DRG weight",34972,Other,base rate x DRG weight,31474,,"22,541 x DRG weight",31474,Other,base rate x DRG weight,44809,,"32,091 x DRG weight",44809,Other,base rate x DRG weight,40328,,"28,882 x DRG weight",40328,Other,base rate x DRG weight,38087,,"27,277 x DRG weight",38087,Other,base rate x DRG weight,33623,,"24,080 x DRG weight",33623,Other,base rate x DRG weight,31365,,"22,463 x DRG weight",31365,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,36899,,"26,426 x DRG weight",36899,Other,base rate x DRG weight,54189,,"38,809 x DRG weight",54189,Other,base rate x DRG weight,54189,,"38,809 x DRG weight",54189,Other,base rate x DRG weight,36899,,"26,426 x DRG weight",36899,Other,base rate x DRG weight,54189,,"38,809 x DRG weight",54189,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,179140,70,,179140,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,34987,,"25,057 x DRG weight",34987,Other,base rate x DRG weight,31489,,"22,552 x DRG weight",31489,Other,base rate x DRG weight,34987,,"25,057 x DRG weight",34987,Other,base rate x DRG weight,29738,,"21,298 x DRG weight",29738,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,179140,
DIABETES WITH MCC,637,MS-DRG,,,,,,,,inpatient,,,159288.06,20479,,,20479,Other,150% of Medicare + 9.63% HCRA Surcharge,12453.58,,,12453.58,Other,Medicare IPPS methodology,36299,,"25,046 x DRG weight",36299,Other,base rate x DRG weight,32669,,"22,541 x DRG weight",32669,Other,base rate x DRG weight,46509,,"32,091 x DRG weight",46509,Other,base rate x DRG weight,41859,,"28,882 x DRG weight",41859,Other,base rate x DRG weight,39533,,"27,277 x DRG weight",39533,Other,base rate x DRG weight,34899,,"24,080 x DRG weight",34899,Other,base rate x DRG weight,32556,,"22,463 x DRG weight",32556,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,38299,,"26,426 x DRG weight",38299,Other,base rate x DRG weight,56246,,"38,809 x DRG weight",56246,Other,base rate x DRG weight,56246,,"38,809 x DRG weight",56246,Other,base rate x DRG weight,38299,,"26,426 x DRG weight",38299,Other,base rate x DRG weight,56246,,"38,809 x DRG weight",56246,Other,base rate x DRG weight,35633,,"6,363 x patient days",35633,Per diem,,111502,70,,111502,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,36315,,"25,057 x DRG weight",36315,Other,base rate x DRG weight,32685,,"22,552 x DRG weight",32685,Other,base rate x DRG weight,36315,,"25,057 x DRG weight",36315,Other,base rate x DRG weight,30867,,"21,298 x DRG weight",30867,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,111502,
DIABETES WITH CC,638,MS-DRG,,,,,,,,inpatient,,,110017.24,12915,,,12915,Other,150% of Medicare + 9.63% HCRA Surcharge,7853.62,,,7853.62,Other,Medicare IPPS methodology,22526,,"25,046 x DRG weight",22526,Other,base rate x DRG weight,20273,,"22,541 x DRG weight",20273,Other,base rate x DRG weight,28863,,"32,091 x DRG weight",28863,Other,base rate x DRG weight,25976,,"28,882 x DRG weight",25976,Other,base rate x DRG weight,24533,,"27,277 x DRG weight",24533,Other,base rate x DRG weight,21658,,"24,080 x DRG weight",21658,Other,base rate x DRG weight,20203,,"22,463 x DRG weight",20203,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23768,,"26,426 x DRG weight",23768,Other,base rate x DRG weight,34905,,"38,809 x DRG weight",34905,Other,base rate x DRG weight,34905,,"38,809 x DRG weight",34905,Other,base rate x DRG weight,23768,,"26,426 x DRG weight",23768,Other,base rate x DRG weight,34905,,"38,809 x DRG weight",34905,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,77012,70,,77012,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22536,,"25,057 x DRG weight",22536,Other,base rate x DRG weight,20283,,"22,552 x DRG weight",20283,Other,base rate x DRG weight,22536,,"25,057 x DRG weight",22536,Other,base rate x DRG weight,19155,,"21,298 x DRG weight",19155,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,77012,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,,inpatient,,,69968.93,9106,,,9106,Other,150% of Medicare + 9.63% HCRA Surcharge,5537.33,,,5537.33,Other,Medicare IPPS methodology,15591,,"25,046 x DRG weight",15591,Other,base rate x DRG weight,14032,,"22,541 x DRG weight",14032,Other,base rate x DRG weight,19977,,"32,091 x DRG weight",19977,Other,base rate x DRG weight,17979,,"28,882 x DRG weight",17979,Other,base rate x DRG weight,16980,,"27,277 x DRG weight",16980,Other,base rate x DRG weight,14990,,"24,080 x DRG weight",14990,Other,base rate x DRG weight,13983,,"22,463 x DRG weight",13983,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,16450,,"26,426 x DRG weight",16450,Other,base rate x DRG weight,24159,,"38,809 x DRG weight",24159,Other,base rate x DRG weight,24159,,"38,809 x DRG weight",24159,Other,base rate x DRG weight,16450,,"26,426 x DRG weight",16450,Other,base rate x DRG weight,24159,,"38,809 x DRG weight",24159,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,48978,70,,48978,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15598,,"25,057 x DRG weight",15598,Other,base rate x DRG weight,14039,,"22,552 x DRG weight",14039,Other,base rate x DRG weight,15598,,"25,057 x DRG weight",15598,Other,base rate x DRG weight,13258,,"21,298 x DRG weight",13258,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,48978,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,,inpatient,,,195858.9,18635,,,18635,Other,150% of Medicare + 9.63% HCRA Surcharge,11331.82,,,11331.82,Other,Medicare IPPS methodology,32940,,"25,046 x DRG weight",32940,Other,base rate x DRG weight,29646,,"22,541 x DRG weight",29646,Other,base rate x DRG weight,42206,,"32,091 x DRG weight",42206,Other,base rate x DRG weight,37986,,"28,882 x DRG weight",37986,Other,base rate x DRG weight,35875,,"27,277 x DRG weight",35875,Other,base rate x DRG weight,31670,,"24,080 x DRG weight",31670,Other,base rate x DRG weight,29543,,"22,463 x DRG weight",29543,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34755,,"26,426 x DRG weight",34755,Other,base rate x DRG weight,51042,,"38,809 x DRG weight",51042,Other,base rate x DRG weight,51042,,"38,809 x DRG weight",51042,Other,base rate x DRG weight,34755,,"26,426 x DRG weight",34755,Other,base rate x DRG weight,51042,,"38,809 x DRG weight",51042,Other,base rate x DRG weight,33088,,"6,363 x patient days",33088,Per diem,,137101,70,,137101,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32955,,"25,057 x DRG weight",32955,Other,base rate x DRG weight,29660,,"22,552 x DRG weight",29660,Other,base rate x DRG weight,32955,,"25,057 x DRG weight",32955,Other,base rate x DRG weight,28011,,"21,298 x DRG weight",28011,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,137101,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,,inpatient,,,132454.53,11292,,,11292,Other,150% of Medicare + 9.63% HCRA Surcharge,6866.54,,,6866.54,Other,Medicare IPPS methodology,19571,,"25,046 x DRG weight",19571,Other,base rate x DRG weight,17614,,"22,541 x DRG weight",17614,Other,base rate x DRG weight,25076,,"32,091 x DRG weight",25076,Other,base rate x DRG weight,22568,,"28,882 x DRG weight",22568,Other,base rate x DRG weight,21314,,"27,277 x DRG weight",21314,Other,base rate x DRG weight,18816,,"24,080 x DRG weight",18816,Other,base rate x DRG weight,17553,,"22,463 x DRG weight",17553,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20649,,"26,426 x DRG weight",20649,Other,base rate x DRG weight,30325,,"38,809 x DRG weight",30325,Other,base rate x DRG weight,30325,,"38,809 x DRG weight",30325,Other,base rate x DRG weight,20649,,"26,426 x DRG weight",20649,Other,base rate x DRG weight,30325,,"38,809 x DRG weight",30325,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,92718,70,,92718,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19580,,"25,057 x DRG weight",19580,Other,base rate x DRG weight,17622,,"22,552 x DRG weight",17622,Other,base rate x DRG weight,19580,,"25,057 x DRG weight",19580,Other,base rate x DRG weight,16642,,"21,298 x DRG weight",16642,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,92718,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,,inpatient,,,93890.09,18471,,,18471,Other,150% of Medicare + 9.63% HCRA Surcharge,11232.27,,,11232.27,Other,Medicare IPPS methodology,32642,,"25,046 x DRG weight",32642,Other,base rate x DRG weight,29378,,"22,541 x DRG weight",29378,Other,base rate x DRG weight,41824,,"32,091 x DRG weight",41824,Other,base rate x DRG weight,37642,,"28,882 x DRG weight",37642,Other,base rate x DRG weight,35550,,"27,277 x DRG weight",35550,Other,base rate x DRG weight,31383,,"24,080 x DRG weight",31383,Other,base rate x DRG weight,29276,,"22,463 x DRG weight",29276,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34441,,"26,426 x DRG weight",34441,Other,base rate x DRG weight,50580,,"38,809 x DRG weight",50580,Other,base rate x DRG weight,50580,,"38,809 x DRG weight",50580,Other,base rate x DRG weight,34441,,"26,426 x DRG weight",34441,Other,base rate x DRG weight,50580,,"38,809 x DRG weight",50580,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,65723,70,,65723,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32657,,"25,057 x DRG weight",32657,Other,base rate x DRG weight,29392,,"22,552 x DRG weight",29392,Other,base rate x DRG weight,32657,,"25,057 x DRG weight",32657,Other,base rate x DRG weight,27758,,"21,298 x DRG weight",27758,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,65723,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,,inpatient,,,190340.66,23173,,,23173,Other,150% of Medicare + 9.63% HCRA Surcharge,14091.46,,,14091.46,Other,Medicare IPPS methodology,41203,,"25,046 x DRG weight",41203,Other,base rate x DRG weight,37082,,"22,541 x DRG weight",37082,Other,base rate x DRG weight,52793,,"32,091 x DRG weight",52793,Other,base rate x DRG weight,47514,,"28,882 x DRG weight",47514,Other,base rate x DRG weight,44873,,"27,277 x DRG weight",44873,Other,base rate x DRG weight,39614,,"24,080 x DRG weight",39614,Other,base rate x DRG weight,36954,,"22,463 x DRG weight",36954,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43473,,"26,426 x DRG weight",43473,Other,base rate x DRG weight,63845,,"38,809 x DRG weight",63845,Other,base rate x DRG weight,63845,,"38,809 x DRG weight",63845,Other,base rate x DRG weight,43473,,"26,426 x DRG weight",43473,Other,base rate x DRG weight,63845,,"38,809 x DRG weight",63845,Other,base rate x DRG weight,41996,,"6,363 x patient days",41996,Per diem,,133238,70,,133238,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,41221,,"25,057 x DRG weight",41221,Other,base rate x DRG weight,37100,,"22,552 x DRG weight",37100,Other,base rate x DRG weight,41221,,"25,057 x DRG weight",41221,Other,base rate x DRG weight,35037,,"21,298 x DRG weight",35037,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,133238,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,,inpatient,,,153940.75,15147,,,15147,Other,150% of Medicare + 9.63% HCRA Surcharge,9211.27,,,9211.27,Other,Medicare IPPS methodology,26591,,"25,046 x DRG weight",26591,Other,base rate x DRG weight,23932,,"22,541 x DRG weight",23932,Other,base rate x DRG weight,34071,,"32,091 x DRG weight",34071,Other,base rate x DRG weight,30664,,"28,882 x DRG weight",30664,Other,base rate x DRG weight,28960,,"27,277 x DRG weight",28960,Other,base rate x DRG weight,25566,,"24,080 x DRG weight",25566,Other,base rate x DRG weight,23849,,"22,463 x DRG weight",23849,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28056,,"26,426 x DRG weight",28056,Other,base rate x DRG weight,41204,,"38,809 x DRG weight",41204,Other,base rate x DRG weight,41204,,"38,809 x DRG weight",41204,Other,base rate x DRG weight,28056,,"26,426 x DRG weight",28056,Other,base rate x DRG weight,41204,,"38,809 x DRG weight",41204,Other,base rate x DRG weight,28634,,"6,363 x patient days",28634,Per diem,,107759,70,,107759,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26603,,"25,057 x DRG weight",26603,Other,base rate x DRG weight,23943,,"22,552 x DRG weight",23943,Other,base rate x DRG weight,26603,,"25,057 x DRG weight",26603,Other,base rate x DRG weight,22612,,"21,298 x DRG weight",22612,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,107759,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,,inpatient,,,82997.27,11010,,,11010,Other,150% of Medicare + 9.63% HCRA Surcharge,6695.06,,,6695.06,Other,Medicare IPPS methodology,19058,,"25,046 x DRG weight",19058,Other,base rate x DRG weight,17151,,"22,541 x DRG weight",17151,Other,base rate x DRG weight,24418,,"32,091 x DRG weight",24418,Other,base rate x DRG weight,21976,,"28,882 x DRG weight",21976,Other,base rate x DRG weight,20755,,"27,277 x DRG weight",20755,Other,base rate x DRG weight,18322,,"24,080 x DRG weight",18322,Other,base rate x DRG weight,17092,,"22,463 x DRG weight",17092,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20108,,"26,426 x DRG weight",20108,Other,base rate x DRG weight,29530,,"38,809 x DRG weight",29530,Other,base rate x DRG weight,29530,,"38,809 x DRG weight",29530,Other,base rate x DRG weight,20108,,"26,426 x DRG weight",20108,Other,base rate x DRG weight,29530,,"38,809 x DRG weight",29530,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,58098,70,,58098,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19066,,"25,057 x DRG weight",19066,Other,base rate x DRG weight,17160,,"22,552 x DRG weight",17160,Other,base rate x DRG weight,19066,,"25,057 x DRG weight",19066,Other,base rate x DRG weight,16206,,"21,298 x DRG weight",16206,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,58098,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,,inpatient,,,995537.36,75012,,,75012,Other,150% of Medicare + 9.63% HCRA Surcharge,45615.25,,,45615.25,Other,Medicare IPPS methodology,135589,,"25,046 x DRG weight",135589,Other,base rate x DRG weight,122028,,"22,541 x DRG weight",122028,Other,base rate x DRG weight,173728,,"32,091 x DRG weight",173728,Other,base rate x DRG weight,156356,,"28,882 x DRG weight",156356,Other,base rate x DRG weight,147667,,"27,277 x DRG weight",147667,Other,base rate x DRG weight,130359,,"24,080 x DRG weight",130359,Other,base rate x DRG weight,121606,,"22,463 x DRG weight",121606,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,143060,,"26,426 x DRG weight",143060,Other,base rate x DRG weight,210096,,"38,809 x DRG weight",210096,Other,base rate x DRG weight,210096,,"38,809 x DRG weight",210096,Other,base rate x DRG weight,143060,,"26,426 x DRG weight",143060,Other,base rate x DRG weight,210096,,"38,809 x DRG weight",210096,Other,base rate x DRG weight,84628,,"6,363 x patient days",84628,Per diem,,696876,70,,696876,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,135649,,"25,057 x DRG weight",135649,Other,base rate x DRG weight,122088,,"22,552 x DRG weight",122088,Other,base rate x DRG weight,135649,,"25,057 x DRG weight",135649,Other,base rate x DRG weight,115299,,"21,298 x DRG weight",115299,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,696876,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,,inpatient,,,341123.2,38200,,,38200,Other,150% of Medicare + 9.63% HCRA Surcharge,23229.47,,,23229.47,Other,Medicare IPPS methodology,68563,,"25,046 x DRG weight",68563,Other,base rate x DRG weight,61706,,"22,541 x DRG weight",61706,Other,base rate x DRG weight,87849,,"32,091 x DRG weight",87849,Other,base rate x DRG weight,79064,,"28,882 x DRG weight",79064,Other,base rate x DRG weight,74671,,"27,277 x DRG weight",74671,Other,base rate x DRG weight,65919,,"24,080 x DRG weight",65919,Other,base rate x DRG weight,61492,,"22,463 x DRG weight",61492,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,72341,,"26,426 x DRG weight",72341,Other,base rate x DRG weight,106240,,"38,809 x DRG weight",106240,Other,base rate x DRG weight,106240,,"38,809 x DRG weight",106240,Other,base rate x DRG weight,72341,,"26,426 x DRG weight",72341,Other,base rate x DRG weight,106240,,"38,809 x DRG weight",106240,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,238786,70,,238786,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,68594,,"25,057 x DRG weight",68594,Other,base rate x DRG weight,61736,,"22,552 x DRG weight",61736,Other,base rate x DRG weight,68594,,"25,057 x DRG weight",68594,Other,base rate x DRG weight,58303,,"21,298 x DRG weight",58303,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,238786,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,,inpatient,,,232323.22,29538,,,29538,Other,150% of Medicare + 9.63% HCRA Surcharge,17961.98,,,17961.98,Other,Medicare IPPS methodology,52792,,"25,046 x DRG weight",52792,Other,base rate x DRG weight,47512,,"22,541 x DRG weight",47512,Other,base rate x DRG weight,67641,,"32,091 x DRG weight",67641,Other,base rate x DRG weight,60877,,"28,882 x DRG weight",60877,Other,base rate x DRG weight,57494,,"27,277 x DRG weight",57494,Other,base rate x DRG weight,50756,,"24,080 x DRG weight",50756,Other,base rate x DRG weight,47348,,"22,463 x DRG weight",47348,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,55701,,"26,426 x DRG weight",55701,Other,base rate x DRG weight,81802,,"38,809 x DRG weight",81802,Other,base rate x DRG weight,81802,,"38,809 x DRG weight",81802,Other,base rate x DRG weight,55701,,"26,426 x DRG weight",55701,Other,base rate x DRG weight,81802,,"38,809 x DRG weight",81802,Other,base rate x DRG weight,25452,,"6,363 x patient days",25452,Per diem,,162626,70,,162626,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52815,,"25,057 x DRG weight",52815,Other,base rate x DRG weight,47535,,"22,552 x DRG weight",47535,Other,base rate x DRG weight,52815,,"25,057 x DRG weight",52815,Other,base rate x DRG weight,44892,,"21,298 x DRG weight",44892,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,162626,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,,inpatient,,,427366.57,43703,,,43703,Other,150% of Medicare + 9.63% HCRA Surcharge,26576.34,,,26576.34,Other,Medicare IPPS methodology,78584,,"25,046 x DRG weight",78584,Other,base rate x DRG weight,70725,,"22,541 x DRG weight",70725,Other,base rate x DRG weight,100689,,"32,091 x DRG weight",100689,Other,base rate x DRG weight,90620,,"28,882 x DRG weight",90620,Other,base rate x DRG weight,85584,,"27,277 x DRG weight",85584,Other,base rate x DRG weight,75553,,"24,080 x DRG weight",75553,Other,base rate x DRG weight,70480,,"22,463 x DRG weight",70480,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,82914,,"26,426 x DRG weight",82914,Other,base rate x DRG weight,121767,,"38,809 x DRG weight",121767,Other,base rate x DRG weight,121767,,"38,809 x DRG weight",121767,Other,base rate x DRG weight,82914,,"26,426 x DRG weight",82914,Other,base rate x DRG weight,121767,,"38,809 x DRG weight",121767,Other,base rate x DRG weight,47086,,"6,363 x patient days",47086,Per diem,,299157,70,,299157,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,78619,,"25,057 x DRG weight",78619,Other,base rate x DRG weight,70759,,"22,552 x DRG weight",70759,Other,base rate x DRG weight,78619,,"25,057 x DRG weight",78619,Other,base rate x DRG weight,66825,,"21,298 x DRG weight",66825,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,299157,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,,inpatient,,,168435.95,25912,,,25912,Other,150% of Medicare + 9.63% HCRA Surcharge,15756.95,,,15756.95,Other,Medicare IPPS methodology,46190,,"25,046 x DRG weight",46190,Other,base rate x DRG weight,41570,,"22,541 x DRG weight",41570,Other,base rate x DRG weight,59182,,"32,091 x DRG weight",59182,Other,base rate x DRG weight,53264,,"28,882 x DRG weight",53264,Other,base rate x DRG weight,50304,,"27,277 x DRG weight",50304,Other,base rate x DRG weight,44408,,"24,080 x DRG weight",44408,Other,base rate x DRG weight,41426,,"22,463 x DRG weight",41426,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48735,,"26,426 x DRG weight",48735,Other,base rate x DRG weight,71572,,"38,809 x DRG weight",71572,Other,base rate x DRG weight,71572,,"38,809 x DRG weight",71572,Other,base rate x DRG weight,48735,,"26,426 x DRG weight",48735,Other,base rate x DRG weight,71572,,"38,809 x DRG weight",71572,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,117905,70,,117905,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46210,,"25,057 x DRG weight",46210,Other,base rate x DRG weight,41590,,"22,552 x DRG weight",41590,Other,base rate x DRG weight,46210,,"25,057 x DRG weight",46210,Other,base rate x DRG weight,39278,,"21,298 x DRG weight",39278,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,117905,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,,inpatient,,,79976.07,20907,,,20907,Other,150% of Medicare + 9.63% HCRA Surcharge,12713.73,,,12713.73,Other,Medicare IPPS methodology,37078,,"25,046 x DRG weight",37078,Other,base rate x DRG weight,33370,,"22,541 x DRG weight",33370,Other,base rate x DRG weight,47508,,"32,091 x DRG weight",47508,Other,base rate x DRG weight,42757,,"28,882 x DRG weight",42757,Other,base rate x DRG weight,40381,,"27,277 x DRG weight",40381,Other,base rate x DRG weight,35648,,"24,080 x DRG weight",35648,Other,base rate x DRG weight,33254,,"22,463 x DRG weight",33254,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39121,,"26,426 x DRG weight",39121,Other,base rate x DRG weight,57453,,"38,809 x DRG weight",57453,Other,base rate x DRG weight,57453,,"38,809 x DRG weight",57453,Other,base rate x DRG weight,39121,,"26,426 x DRG weight",39121,Other,base rate x DRG weight,57453,,"38,809 x DRG weight",57453,Other,base rate x DRG weight,12726,,"6,363 x patient days",12726,Per diem,,55983,70,,55983,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37094,,"25,057 x DRG weight",37094,Other,base rate x DRG weight,33386,,"22,552 x DRG weight",33386,Other,base rate x DRG weight,37094,,"25,057 x DRG weight",37094,Other,base rate x DRG weight,31530,,"21,298 x DRG weight",31530,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,57453,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,,inpatient,,,388139.55,36156,,,36156,Other,150% of Medicare + 9.63% HCRA Surcharge,21986.42,,,21986.42,Other,Medicare IPPS methodology,64842,,"25,046 x DRG weight",64842,Other,base rate x DRG weight,58356,,"22,541 x DRG weight",58356,Other,base rate x DRG weight,83080,,"32,091 x DRG weight",83080,Other,base rate x DRG weight,74773,,"28,882 x DRG weight",74773,Other,base rate x DRG weight,70617,,"27,277 x DRG weight",70617,Other,base rate x DRG weight,62341,,"24,080 x DRG weight",62341,Other,base rate x DRG weight,58154,,"22,463 x DRG weight",58154,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,68414,,"26,426 x DRG weight",68414,Other,base rate x DRG weight,100473,,"38,809 x DRG weight",100473,Other,base rate x DRG weight,100473,,"38,809 x DRG weight",100473,Other,base rate x DRG weight,68414,,"26,426 x DRG weight",68414,Other,base rate x DRG weight,100473,,"38,809 x DRG weight",100473,Other,base rate x DRG weight,52177,,"6,363 x patient days",52177,Per diem,,271698,70,,271698,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,64870,,"25,057 x DRG weight",64870,Other,base rate x DRG weight,58385,,"22,552 x DRG weight",58385,Other,base rate x DRG weight,64870,,"25,057 x DRG weight",64870,Other,base rate x DRG weight,55138,,"21,298 x DRG weight",55138,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,271698,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,,inpatient,,,183635.31,19057,,,19057,Other,150% of Medicare + 9.63% HCRA Surcharge,11588.63,,,11588.63,Other,Medicare IPPS methodology,33709,,"25,046 x DRG weight",33709,Other,base rate x DRG weight,30338,,"22,541 x DRG weight",30338,Other,base rate x DRG weight,43191,,"32,091 x DRG weight",43191,Other,base rate x DRG weight,38872,,"28,882 x DRG weight",38872,Other,base rate x DRG weight,36712,,"27,277 x DRG weight",36712,Other,base rate x DRG weight,32409,,"24,080 x DRG weight",32409,Other,base rate x DRG weight,30233,,"22,463 x DRG weight",30233,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,35567,,"26,426 x DRG weight",35567,Other,base rate x DRG weight,52233,,"38,809 x DRG weight",52233,Other,base rate x DRG weight,52233,,"38,809 x DRG weight",52233,Other,base rate x DRG weight,35567,,"26,426 x DRG weight",35567,Other,base rate x DRG weight,52233,,"38,809 x DRG weight",52233,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,128545,70,,128545,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33724,,"25,057 x DRG weight",33724,Other,base rate x DRG weight,30353,,"22,552 x DRG weight",30353,Other,base rate x DRG weight,33724,,"25,057 x DRG weight",33724,Other,base rate x DRG weight,28665,,"21,298 x DRG weight",28665,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,128545,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,,inpatient,,,97671.39,14965,,,14965,Other,150% of Medicare + 9.63% HCRA Surcharge,9100.02,,,9100.02,Other,Medicare IPPS methodology,26258,,"25,046 x DRG weight",26258,Other,base rate x DRG weight,23632,,"22,541 x DRG weight",23632,Other,base rate x DRG weight,33644,,"32,091 x DRG weight",33644,Other,base rate x DRG weight,30280,,"28,882 x DRG weight",30280,Other,base rate x DRG weight,28597,,"27,277 x DRG weight",28597,Other,base rate x DRG weight,25245,,"24,080 x DRG weight",25245,Other,base rate x DRG weight,23550,,"22,463 x DRG weight",23550,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27705,,"26,426 x DRG weight",27705,Other,base rate x DRG weight,40687,,"38,809 x DRG weight",40687,Other,base rate x DRG weight,40687,,"38,809 x DRG weight",40687,Other,base rate x DRG weight,27705,,"26,426 x DRG weight",27705,Other,base rate x DRG weight,40687,,"38,809 x DRG weight",40687,Other,base rate x DRG weight,13999,,"6,363 x patient days",13999,Per diem,,68370,70,,68370,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26270,,"25,057 x DRG weight",26270,Other,base rate x DRG weight,23644,,"22,552 x DRG weight",23644,Other,base rate x DRG weight,26270,,"25,057 x DRG weight",26270,Other,base rate x DRG weight,22329,,"21,298 x DRG weight",22329,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,68370,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,,inpatient,,,275160.83,41765,,,41765,Other,150% of Medicare + 9.63% HCRA Surcharge,25397.7,,,25397.7,Other,Medicare IPPS methodology,75055,,"25,046 x DRG weight",75055,Other,base rate x DRG weight,67549,,"22,541 x DRG weight",67549,Other,base rate x DRG weight,96167,,"32,091 x DRG weight",96167,Other,base rate x DRG weight,86551,,"28,882 x DRG weight",86551,Other,base rate x DRG weight,81741,,"27,277 x DRG weight",81741,Other,base rate x DRG weight,72161,,"24,080 x DRG weight",72161,Other,base rate x DRG weight,67315,,"22,463 x DRG weight",67315,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,79191,,"26,426 x DRG weight",79191,Other,base rate x DRG weight,116299,,"38,809 x DRG weight",116299,Other,base rate x DRG weight,116299,,"38,809 x DRG weight",116299,Other,base rate x DRG weight,79191,,"26,426 x DRG weight",79191,Other,base rate x DRG weight,116299,,"38,809 x DRG weight",116299,Other,base rate x DRG weight,63630,,"6,363 x patient days",63630,Per diem,,192613,70,,192613,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,75088,,"25,057 x DRG weight",75088,Other,base rate x DRG weight,67582,,"22,552 x DRG weight",67582,Other,base rate x DRG weight,75088,,"25,057 x DRG weight",75088,Other,base rate x DRG weight,63824,,"21,298 x DRG weight",63824,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,192613,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,,inpatient,,,169235.84,20613,,,20613,Other,150% of Medicare + 9.63% HCRA Surcharge,12534.72,,,12534.72,Other,Medicare IPPS methodology,36542,,"25,046 x DRG weight",36542,Other,base rate x DRG weight,32887,,"22,541 x DRG weight",32887,Other,base rate x DRG weight,46821,,"32,091 x DRG weight",46821,Other,base rate x DRG weight,42139,,"28,882 x DRG weight",42139,Other,base rate x DRG weight,39797,,"27,277 x DRG weight",39797,Other,base rate x DRG weight,35133,,"24,080 x DRG weight",35133,Other,base rate x DRG weight,32774,,"22,463 x DRG weight",32774,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,38556,,"26,426 x DRG weight",38556,Other,base rate x DRG weight,56622,,"38,809 x DRG weight",56622,Other,base rate x DRG weight,56622,,"38,809 x DRG weight",56622,Other,base rate x DRG weight,38556,,"26,426 x DRG weight",38556,Other,base rate x DRG weight,56622,,"38,809 x DRG weight",56622,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,118465,70,,118465,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,36558,,"25,057 x DRG weight",36558,Other,base rate x DRG weight,32903,,"22,552 x DRG weight",32903,Other,base rate x DRG weight,36558,,"25,057 x DRG weight",36558,Other,base rate x DRG weight,31074,,"21,298 x DRG weight",31074,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,118465,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,,inpatient,,,136684.75,15146,,,15146,Other,150% of Medicare + 9.63% HCRA Surcharge,9210.44,,,9210.44,Other,Medicare IPPS methodology,26589,,"25,046 x DRG weight",26589,Other,base rate x DRG weight,23930,,"22,541 x DRG weight",23930,Other,base rate x DRG weight,34068,,"32,091 x DRG weight",34068,Other,base rate x DRG weight,30661,,"28,882 x DRG weight",30661,Other,base rate x DRG weight,28957,,"27,277 x DRG weight",28957,Other,base rate x DRG weight,25563,,"24,080 x DRG weight",25563,Other,base rate x DRG weight,23847,,"22,463 x DRG weight",23847,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28054,,"26,426 x DRG weight",28054,Other,base rate x DRG weight,41200,,"38,809 x DRG weight",41200,Other,base rate x DRG weight,41200,,"38,809 x DRG weight",41200,Other,base rate x DRG weight,28054,,"26,426 x DRG weight",28054,Other,base rate x DRG weight,41200,,"38,809 x DRG weight",41200,Other,base rate x DRG weight,13999,,"6,363 x patient days",13999,Per diem,,95679,70,,95679,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26601,,"25,057 x DRG weight",26601,Other,base rate x DRG weight,23941,,"22,552 x DRG weight",23941,Other,base rate x DRG weight,26601,,"25,057 x DRG weight",26601,Other,base rate x DRG weight,22610,,"21,298 x DRG weight",22610,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95679,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,,inpatient,,,166503.8,43036,,,43036,Other,150% of Medicare + 9.63% HCRA Surcharge,26170.63,,,26170.63,Other,Medicare IPPS methodology,77370,,"25,046 x DRG weight",77370,Other,base rate x DRG weight,69631,,"22,541 x DRG weight",69631,Other,base rate x DRG weight,99132,,"32,091 x DRG weight",99132,Other,base rate x DRG weight,89219,,"28,882 x DRG weight",89219,Other,base rate x DRG weight,84261,,"27,277 x DRG weight",84261,Other,base rate x DRG weight,74386,,"24,080 x DRG weight",74386,Other,base rate x DRG weight,69390,,"22,463 x DRG weight",69390,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,81633,,"26,426 x DRG weight",81633,Other,base rate x DRG weight,119885,,"38,809 x DRG weight",119885,Other,base rate x DRG weight,119885,,"38,809 x DRG weight",119885,Other,base rate x DRG weight,81633,,"26,426 x DRG weight",81633,Other,base rate x DRG weight,119885,,"38,809 x DRG weight",119885,Other,base rate x DRG weight,67448,,"6,363 x patient days",67448,Per diem,,116553,70,,116553,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,77404,,"25,057 x DRG weight",77404,Other,base rate x DRG weight,69665,,"22,552 x DRG weight",69665,Other,base rate x DRG weight,77404,,"25,057 x DRG weight",77404,Other,base rate x DRG weight,65792,,"21,298 x DRG weight",65792,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,119885,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,,inpatient,,,199155.01,24167,,,24167,Other,150% of Medicare + 9.63% HCRA Surcharge,14696.25,,,14696.25,Other,Medicare IPPS methodology,43014,,"25,046 x DRG weight",43014,Other,base rate x DRG weight,38712,,"22,541 x DRG weight",38712,Other,base rate x DRG weight,55113,,"32,091 x DRG weight",55113,Other,base rate x DRG weight,49602,,"28,882 x DRG weight",49602,Other,base rate x DRG weight,46846,,"27,277 x DRG weight",46846,Other,base rate x DRG weight,41355,,"24,080 x DRG weight",41355,Other,base rate x DRG weight,38578,,"22,463 x DRG weight",38578,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45384,,"26,426 x DRG weight",45384,Other,base rate x DRG weight,66651,,"38,809 x DRG weight",66651,Other,base rate x DRG weight,66651,,"38,809 x DRG weight",66651,Other,base rate x DRG weight,45384,,"26,426 x DRG weight",45384,Other,base rate x DRG weight,66651,,"38,809 x DRG weight",66651,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,139409,70,,139409,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43033,,"25,057 x DRG weight",43033,Other,base rate x DRG weight,38731,,"22,552 x DRG weight",38731,Other,base rate x DRG weight,43033,,"25,057 x DRG weight",43033,Other,base rate x DRG weight,36577,,"21,298 x DRG weight",36577,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,139409,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,,inpatient,,,67691.82,14981,,,14981,Other,150% of Medicare + 9.63% HCRA Surcharge,9110.05,,,9110.05,Other,Medicare IPPS methodology,26288,,"25,046 x DRG weight",26288,Other,base rate x DRG weight,23659,,"22,541 x DRG weight",23659,Other,base rate x DRG weight,33683,,"32,091 x DRG weight",33683,Other,base rate x DRG weight,30315,,"28,882 x DRG weight",30315,Other,base rate x DRG weight,28630,,"27,277 x DRG weight",28630,Other,base rate x DRG weight,25274,,"24,080 x DRG weight",25274,Other,base rate x DRG weight,23577,,"22,463 x DRG weight",23577,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27737,,"26,426 x DRG weight",27737,Other,base rate x DRG weight,40734,,"38,809 x DRG weight",40734,Other,base rate x DRG weight,40734,,"38,809 x DRG weight",40734,Other,base rate x DRG weight,27737,,"26,426 x DRG weight",27737,Other,base rate x DRG weight,40734,,"38,809 x DRG weight",40734,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,47384,70,,47384,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26300,,"25,057 x DRG weight",26300,Other,base rate x DRG weight,23671,,"22,552 x DRG weight",23671,Other,base rate x DRG weight,26300,,"25,057 x DRG weight",26300,Other,base rate x DRG weight,22354,,"21,298 x DRG weight",22354,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,47384,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,,inpatient,,,152868.85,39307,,,39307,Other,150% of Medicare + 9.63% HCRA Surcharge,23902.86,,,23902.86,Other,Medicare IPPS methodology,70580,,"25,046 x DRG weight",70580,Other,base rate x DRG weight,63521,,"22,541 x DRG weight",63521,Other,base rate x DRG weight,90432,,"32,091 x DRG weight",90432,Other,base rate x DRG weight,81389,,"28,882 x DRG weight",81389,Other,base rate x DRG weight,76867,,"27,277 x DRG weight",76867,Other,base rate x DRG weight,67857,,"24,080 x DRG weight",67857,Other,base rate x DRG weight,63301,,"22,463 x DRG weight",63301,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,74468,,"26,426 x DRG weight",74468,Other,base rate x DRG weight,109364,,"38,809 x DRG weight",109364,Other,base rate x DRG weight,109364,,"38,809 x DRG weight",109364,Other,base rate x DRG weight,74468,,"26,426 x DRG weight",74468,Other,base rate x DRG weight,109364,,"38,809 x DRG weight",109364,Other,base rate x DRG weight,62357,,"6,363 x patient days",62357,Per diem,,107008,70,,107008,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,70611,,"25,057 x DRG weight",70611,Other,base rate x DRG weight,63552,,"22,552 x DRG weight",63552,Other,base rate x DRG weight,70611,,"25,057 x DRG weight",70611,Other,base rate x DRG weight,60018,,"21,298 x DRG weight",60018,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,109364,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,,inpatient,,,213964.49,21653,,,21653,Other,150% of Medicare + 9.63% HCRA Surcharge,13167.12,,,13167.12,Other,Medicare IPPS methodology,38436,,"25,046 x DRG weight",38436,Other,base rate x DRG weight,34591,,"22,541 x DRG weight",34591,Other,base rate x DRG weight,49247,,"32,091 x DRG weight",49247,Other,base rate x DRG weight,44322,,"28,882 x DRG weight",44322,Other,base rate x DRG weight,41859,,"27,277 x DRG weight",41859,Other,base rate x DRG weight,36953,,"24,080 x DRG weight",36953,Other,base rate x DRG weight,34472,,"22,463 x DRG weight",34472,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40553,,"26,426 x DRG weight",40553,Other,base rate x DRG weight,59556,,"38,809 x DRG weight",59556,Other,base rate x DRG weight,59556,,"38,809 x DRG weight",59556,Other,base rate x DRG weight,40553,,"26,426 x DRG weight",40553,Other,base rate x DRG weight,59556,,"38,809 x DRG weight",59556,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,149775,70,,149775,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38452,,"25,057 x DRG weight",38452,Other,base rate x DRG weight,34608,,"22,552 x DRG weight",34608,Other,base rate x DRG weight,38452,,"25,057 x DRG weight",38452,Other,base rate x DRG weight,32684,,"21,298 x DRG weight",32684,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,149775,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,,inpatient,,,111634.82,13784,,,13784,Other,150% of Medicare + 9.63% HCRA Surcharge,8382.29,,,8382.29,Other,Medicare IPPS methodology,24109,,"25,046 x DRG weight",24109,Other,base rate x DRG weight,21698,,"22,541 x DRG weight",21698,Other,base rate x DRG weight,30891,,"32,091 x DRG weight",30891,Other,base rate x DRG weight,27802,,"28,882 x DRG weight",27802,Other,base rate x DRG weight,26257,,"27,277 x DRG weight",26257,Other,base rate x DRG weight,23179,,"24,080 x DRG weight",23179,Other,base rate x DRG weight,21623,,"22,463 x DRG weight",21623,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25438,,"26,426 x DRG weight",25438,Other,base rate x DRG weight,37358,,"38,809 x DRG weight",37358,Other,base rate x DRG weight,37358,,"38,809 x DRG weight",37358,Other,base rate x DRG weight,25438,,"26,426 x DRG weight",25438,Other,base rate x DRG weight,37358,,"38,809 x DRG weight",37358,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,78144,70,,78144,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24120,,"25,057 x DRG weight",24120,Other,base rate x DRG weight,21709,,"22,552 x DRG weight",21709,Other,base rate x DRG weight,24120,,"25,057 x DRG weight",24120,Other,base rate x DRG weight,20501,,"21,298 x DRG weight",20501,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,78144,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,,inpatient,,,1092892.95,24092,,,24092,Other,150% of Medicare + 9.63% HCRA Surcharge,14650.25,,,14650.25,Other,Medicare IPPS methodology,42876,,"25,046 x DRG weight",42876,Other,base rate x DRG weight,38588,,"22,541 x DRG weight",38588,Other,base rate x DRG weight,54937,,"32,091 x DRG weight",54937,Other,base rate x DRG weight,49443,,"28,882 x DRG weight",49443,Other,base rate x DRG weight,46695,,"27,277 x DRG weight",46695,Other,base rate x DRG weight,41223,,"24,080 x DRG weight",41223,Other,base rate x DRG weight,38454,,"22,463 x DRG weight",38454,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,45239,,"26,426 x DRG weight",45239,Other,base rate x DRG weight,66437,,"38,809 x DRG weight",66437,Other,base rate x DRG weight,66437,,"38,809 x DRG weight",66437,Other,base rate x DRG weight,45239,,"26,426 x DRG weight",45239,Other,base rate x DRG weight,66437,,"38,809 x DRG weight",66437,Other,base rate x DRG weight,35633,,"6,363 x patient days",35633,Per diem,,765025,70,,765025,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,42895,,"25,057 x DRG weight",42895,Other,base rate x DRG weight,38607,,"22,552 x DRG weight",38607,Other,base rate x DRG weight,42895,,"25,057 x DRG weight",42895,Other,base rate x DRG weight,36460,,"21,298 x DRG weight",36460,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,765025,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,,inpatient,,,122264.34,13439,,,13439,Other,150% of Medicare + 9.63% HCRA Surcharge,8172.33,,,8172.33,Other,Medicare IPPS methodology,23481,,"25,046 x DRG weight",23481,Other,base rate x DRG weight,21132,,"22,541 x DRG weight",21132,Other,base rate x DRG weight,30085,,"32,091 x DRG weight",30085,Other,base rate x DRG weight,27077,,"28,882 x DRG weight",27077,Other,base rate x DRG weight,25572,,"27,277 x DRG weight",25572,Other,base rate x DRG weight,22575,,"24,080 x DRG weight",22575,Other,base rate x DRG weight,21059,,"22,463 x DRG weight",21059,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24774,,"26,426 x DRG weight",24774,Other,base rate x DRG weight,36383,,"38,809 x DRG weight",36383,Other,base rate x DRG weight,36383,,"38,809 x DRG weight",36383,Other,base rate x DRG weight,24774,,"26,426 x DRG weight",24774,Other,base rate x DRG weight,36383,,"38,809 x DRG weight",36383,Other,base rate x DRG weight,11453,,"6,363 x patient days",11453,Per diem,,85585,70,,85585,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23491,,"25,057 x DRG weight",23491,Other,base rate x DRG weight,21143,,"22,552 x DRG weight",21143,Other,base rate x DRG weight,23491,,"25,057 x DRG weight",23491,Other,base rate x DRG weight,19967,,"21,298 x DRG weight",19967,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,85585,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,,inpatient,,,547788.05,51412,,,51412,Other,150% of Medicare + 9.63% HCRA Surcharge,31264.12,,,31264.12,Other,Medicare IPPS methodology,92620,,"25,046 x DRG weight",92620,Other,base rate x DRG weight,83357,,"22,541 x DRG weight",83357,Other,base rate x DRG weight,118673,,"32,091 x DRG weight",118673,Other,base rate x DRG weight,106806,,"28,882 x DRG weight",106806,Other,base rate x DRG weight,100870,,"27,277 x DRG weight",100870,Other,base rate x DRG weight,89048,,"24,080 x DRG weight",89048,Other,base rate x DRG weight,83068,,"22,463 x DRG weight",83068,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,97723,,"26,426 x DRG weight",97723,Other,base rate x DRG weight,143516,,"38,809 x DRG weight",143516,Other,base rate x DRG weight,143516,,"38,809 x DRG weight",143516,Other,base rate x DRG weight,97723,,"26,426 x DRG weight",97723,Other,base rate x DRG weight,143516,,"38,809 x DRG weight",143516,Other,base rate x DRG weight,77629,,"6,363 x patient days",77629,Per diem,,383452,70,,383452,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,92661,,"25,057 x DRG weight",92661,Other,base rate x DRG weight,83397,,"22,552 x DRG weight",83397,Other,base rate x DRG weight,92661,,"25,057 x DRG weight",92661,Other,base rate x DRG weight,78760,,"21,298 x DRG weight",78760,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,383452,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,,inpatient,,,385911.79,33312,,,33312,Other,150% of Medicare + 9.63% HCRA Surcharge,20257.36,,,20257.36,Other,Medicare IPPS methodology,59665,,"25,046 x DRG weight",59665,Other,base rate x DRG weight,53697,,"22,541 x DRG weight",53697,Other,base rate x DRG weight,76447,,"32,091 x DRG weight",76447,Other,base rate x DRG weight,68803,,"28,882 x DRG weight",68803,Other,base rate x DRG weight,64979,,"27,277 x DRG weight",64979,Other,base rate x DRG weight,57363,,"24,080 x DRG weight",57363,Other,base rate x DRG weight,53511,,"22,463 x DRG weight",53511,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,62952,,"26,426 x DRG weight",62952,Other,base rate x DRG weight,92451,,"38,809 x DRG weight",92451,Other,base rate x DRG weight,92451,,"38,809 x DRG weight",92451,Other,base rate x DRG weight,62952,,"26,426 x DRG weight",62952,Other,base rate x DRG weight,92451,,"38,809 x DRG weight",92451,Other,base rate x DRG weight,49631,,"6,363 x patient days",49631,Per diem,,270138,70,,270138,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,59691,,"25,057 x DRG weight",59691,Other,base rate x DRG weight,53723,,"22,552 x DRG weight",53723,Other,base rate x DRG weight,59691,,"25,057 x DRG weight",59691,Other,base rate x DRG weight,50736,,"21,298 x DRG weight",50736,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,270138,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,,inpatient,,,107041,22367,,,22367,Other,150% of Medicare + 9.63% HCRA Surcharge,13601.26,,,13601.26,Other,Medicare IPPS methodology,39735,,"25,046 x DRG weight",39735,Other,base rate x DRG weight,35761,,"22,541 x DRG weight",35761,Other,base rate x DRG weight,50912,,"32,091 x DRG weight",50912,Other,base rate x DRG weight,45821,,"28,882 x DRG weight",45821,Other,base rate x DRG weight,43275,,"27,277 x DRG weight",43275,Other,base rate x DRG weight,38203,,"24,080 x DRG weight",38203,Other,base rate x DRG weight,35638,,"22,463 x DRG weight",35638,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41925,,"26,426 x DRG weight",41925,Other,base rate x DRG weight,61570,,"38,809 x DRG weight",61570,Other,base rate x DRG weight,61570,,"38,809 x DRG weight",61570,Other,base rate x DRG weight,41925,,"26,426 x DRG weight",41925,Other,base rate x DRG weight,61570,,"38,809 x DRG weight",61570,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,74929,70,,74929,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39753,,"25,057 x DRG weight",39753,Other,base rate x DRG weight,35779,,"22,552 x DRG weight",35779,Other,base rate x DRG weight,39753,,"25,057 x DRG weight",39753,Other,base rate x DRG weight,33789,,"21,298 x DRG weight",33789,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,74929,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,,inpatient,,,237883.59,21188,,,21188,Other,150% of Medicare + 9.63% HCRA Surcharge,12884.38,,,12884.38,Other,Medicare IPPS methodology,37589,,"25,046 x DRG weight",37589,Other,base rate x DRG weight,33830,,"22,541 x DRG weight",33830,Other,base rate x DRG weight,48162,,"32,091 x DRG weight",48162,Other,base rate x DRG weight,43346,,"28,882 x DRG weight",43346,Other,base rate x DRG weight,40937,,"27,277 x DRG weight",40937,Other,base rate x DRG weight,36139,,"24,080 x DRG weight",36139,Other,base rate x DRG weight,33712,,"22,463 x DRG weight",33712,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39660,,"26,426 x DRG weight",39660,Other,base rate x DRG weight,58245,,"38,809 x DRG weight",58245,Other,base rate x DRG weight,58245,,"38,809 x DRG weight",58245,Other,base rate x DRG weight,39660,,"26,426 x DRG weight",39660,Other,base rate x DRG weight,58245,,"38,809 x DRG weight",58245,Other,base rate x DRG weight,38178,,"6,363 x patient days",38178,Per diem,,166519,70,,166519,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37606,,"25,057 x DRG weight",37606,Other,base rate x DRG weight,33846,,"22,552 x DRG weight",33846,Other,base rate x DRG weight,37606,,"25,057 x DRG weight",37606,Other,base rate x DRG weight,31964,,"21,298 x DRG weight",31964,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,166519,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,,inpatient,,,135915.06,12934,,,12934,Other,150% of Medicare + 9.63% HCRA Surcharge,7865.33,,,7865.33,Other,Medicare IPPS methodology,22561,,"25,046 x DRG weight",22561,Other,base rate x DRG weight,20305,,"22,541 x DRG weight",20305,Other,base rate x DRG weight,28908,,"32,091 x DRG weight",28908,Other,base rate x DRG weight,26017,,"28,882 x DRG weight",26017,Other,base rate x DRG weight,24571,,"27,277 x DRG weight",24571,Other,base rate x DRG weight,21691,,"24,080 x DRG weight",21691,Other,base rate x DRG weight,20235,,"22,463 x DRG weight",20235,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23805,,"26,426 x DRG weight",23805,Other,base rate x DRG weight,34959,,"38,809 x DRG weight",34959,Other,base rate x DRG weight,34959,,"38,809 x DRG weight",34959,Other,base rate x DRG weight,23805,,"26,426 x DRG weight",23805,Other,base rate x DRG weight,34959,,"38,809 x DRG weight",34959,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,95141,70,,95141,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22571,,"25,057 x DRG weight",22571,Other,base rate x DRG weight,20315,,"22,552 x DRG weight",20315,Other,base rate x DRG weight,22571,,"25,057 x DRG weight",22571,Other,base rate x DRG weight,19185,,"21,298 x DRG weight",19185,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95141,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,,inpatient,,,87987.72,8913,,,8913,Other,150% of Medicare + 9.63% HCRA Surcharge,5420.22,,,5420.22,Other,Medicare IPPS methodology,15240,,"25,046 x DRG weight",15240,Other,base rate x DRG weight,13716,,"22,541 x DRG weight",13716,Other,base rate x DRG weight,19527,,"32,091 x DRG weight",19527,Other,base rate x DRG weight,17575,,"28,882 x DRG weight",17575,Other,base rate x DRG weight,16598,,"27,277 x DRG weight",16598,Other,base rate x DRG weight,14653,,"24,080 x DRG weight",14653,Other,base rate x DRG weight,13669,,"22,463 x DRG weight",13669,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,16080,,"26,426 x DRG weight",16080,Other,base rate x DRG weight,23615,,"38,809 x DRG weight",23615,Other,base rate x DRG weight,23615,,"38,809 x DRG weight",23615,Other,base rate x DRG weight,16080,,"26,426 x DRG weight",16080,Other,base rate x DRG weight,23615,,"38,809 x DRG weight",23615,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,61591,70,,61591,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15247,,"25,057 x DRG weight",15247,Other,base rate x DRG weight,13723,,"22,552 x DRG weight",13723,Other,base rate x DRG weight,15247,,"25,057 x DRG weight",15247,Other,base rate x DRG weight,12960,,"21,298 x DRG weight",12960,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,61591,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,,inpatient,,,155268.42,25845,,,25845,Other,150% of Medicare + 9.63% HCRA Surcharge,15716.79,,,15716.79,Other,Medicare IPPS methodology,46070,,"25,046 x DRG weight",46070,Other,base rate x DRG weight,41462,,"22,541 x DRG weight",41462,Other,base rate x DRG weight,59028,,"32,091 x DRG weight",59028,Other,base rate x DRG weight,53126,,"28,882 x DRG weight",53126,Other,base rate x DRG weight,50173,,"27,277 x DRG weight",50173,Other,base rate x DRG weight,44293,,"24,080 x DRG weight",44293,Other,base rate x DRG weight,41318,,"22,463 x DRG weight",41318,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48608,,"26,426 x DRG weight",48608,Other,base rate x DRG weight,71385,,"38,809 x DRG weight",71385,Other,base rate x DRG weight,71385,,"38,809 x DRG weight",71385,Other,base rate x DRG weight,48608,,"26,426 x DRG weight",48608,Other,base rate x DRG weight,71385,,"38,809 x DRG weight",71385,Other,base rate x DRG weight,46450,,"6,363 x patient days",46450,Per diem,,108688,70,,108688,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46090,,"25,057 x DRG weight",46090,Other,base rate x DRG weight,41482,,"22,552 x DRG weight",41482,Other,base rate x DRG weight,46090,,"25,057 x DRG weight",46090,Other,base rate x DRG weight,39176,,"21,298 x DRG weight",39176,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,108688,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,,inpatient,,,263020.16,14922,,,14922,Other,150% of Medicare + 9.63% HCRA Surcharge,9074.08,,,9074.08,Other,Medicare IPPS methodology,26181,,"25,046 x DRG weight",26181,Other,base rate x DRG weight,23562,,"22,541 x DRG weight",23562,Other,base rate x DRG weight,33545,,"32,091 x DRG weight",33545,Other,base rate x DRG weight,30190,,"28,882 x DRG weight",30190,Other,base rate x DRG weight,28513,,"27,277 x DRG weight",28513,Other,base rate x DRG weight,25171,,"24,080 x DRG weight",25171,Other,base rate x DRG weight,23481,,"22,463 x DRG weight",23481,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27623,,"26,426 x DRG weight",27623,Other,base rate x DRG weight,40567,,"38,809 x DRG weight",40567,Other,base rate x DRG weight,40567,,"38,809 x DRG weight",40567,Other,base rate x DRG weight,27623,,"26,426 x DRG weight",27623,Other,base rate x DRG weight,40567,,"38,809 x DRG weight",40567,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,184114,70,,184114,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26192,,"25,057 x DRG weight",26192,Other,base rate x DRG weight,23574,,"22,552 x DRG weight",23574,Other,base rate x DRG weight,26192,,"25,057 x DRG weight",26192,Other,base rate x DRG weight,22263,,"21,298 x DRG weight",22263,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,184114,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,,inpatient,,,96103.05,11285,,,11285,Other,150% of Medicare + 9.63% HCRA Surcharge,6862.36,,,6862.36,Other,Medicare IPPS methodology,19558,,"25,046 x DRG weight",19558,Other,base rate x DRG weight,17602,,"22,541 x DRG weight",17602,Other,base rate x DRG weight,25060,,"32,091 x DRG weight",25060,Other,base rate x DRG weight,22554,,"28,882 x DRG weight",22554,Other,base rate x DRG weight,21301,,"27,277 x DRG weight",21301,Other,base rate x DRG weight,18804,,"24,080 x DRG weight",18804,Other,base rate x DRG weight,17541,,"22,463 x DRG weight",17541,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20636,,"26,426 x DRG weight",20636,Other,base rate x DRG weight,30306,,"38,809 x DRG weight",30306,Other,base rate x DRG weight,30306,,"38,809 x DRG weight",30306,Other,base rate x DRG weight,20636,,"26,426 x DRG weight",20636,Other,base rate x DRG weight,30306,,"38,809 x DRG weight",30306,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,67272,70,,67272,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19567,,"25,057 x DRG weight",19567,Other,base rate x DRG weight,17611,,"22,552 x DRG weight",17611,Other,base rate x DRG weight,19567,,"25,057 x DRG weight",19567,Other,base rate x DRG weight,16632,,"21,298 x DRG weight",16632,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,67272,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,,inpatient,,,214037.92,16698,,,16698,Other,150% of Medicare + 9.63% HCRA Surcharge,10154.02,,,10154.02,Other,Medicare IPPS methodology,29414,,"25,046 x DRG weight",29414,Other,base rate x DRG weight,26472,,"22,541 x DRG weight",26472,Other,base rate x DRG weight,37688,,"32,091 x DRG weight",37688,Other,base rate x DRG weight,33919,,"28,882 x DRG weight",33919,Other,base rate x DRG weight,32034,,"27,277 x DRG weight",32034,Other,base rate x DRG weight,28280,,"24,080 x DRG weight",28280,Other,base rate x DRG weight,26381,,"22,463 x DRG weight",26381,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31035,,"26,426 x DRG weight",31035,Other,base rate x DRG weight,45577,,"38,809 x DRG weight",45577,Other,base rate x DRG weight,45577,,"38,809 x DRG weight",45577,Other,base rate x DRG weight,31035,,"26,426 x DRG weight",31035,Other,base rate x DRG weight,45577,,"38,809 x DRG weight",45577,Other,base rate x DRG weight,33088,,"6,363 x patient days",33088,Per diem,,149827,70,,149827,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29427,,"25,057 x DRG weight",29427,Other,base rate x DRG weight,26485,,"22,552 x DRG weight",26485,Other,base rate x DRG weight,29427,,"25,057 x DRG weight",29427,Other,base rate x DRG weight,25012,,"21,298 x DRG weight",25012,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,149827,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,,inpatient,,,109233.76,11642,,,11642,Other,150% of Medicare + 9.63% HCRA Surcharge,7079.85,,,7079.85,Other,Medicare IPPS methodology,20210,,"25,046 x DRG weight",20210,Other,base rate x DRG weight,18188,,"22,541 x DRG weight",18188,Other,base rate x DRG weight,25894,,"32,091 x DRG weight",25894,Other,base rate x DRG weight,23305,,"28,882 x DRG weight",23305,Other,base rate x DRG weight,22010,,"27,277 x DRG weight",22010,Other,base rate x DRG weight,19430,,"24,080 x DRG weight",19430,Other,base rate x DRG weight,18125,,"22,463 x DRG weight",18125,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21323,,"26,426 x DRG weight",21323,Other,base rate x DRG weight,31315,,"38,809 x DRG weight",31315,Other,base rate x DRG weight,31315,,"38,809 x DRG weight",31315,Other,base rate x DRG weight,21323,,"26,426 x DRG weight",21323,Other,base rate x DRG weight,31315,,"38,809 x DRG weight",31315,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,76464,70,,76464,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20218,,"25,057 x DRG weight",20218,Other,base rate x DRG weight,18197,,"22,552 x DRG weight",18197,Other,base rate x DRG weight,20218,,"25,057 x DRG weight",20218,Other,base rate x DRG weight,17185,,"21,298 x DRG weight",17185,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,76464,
URINARY STONES WITH MCC,693,MS-DRG,,,,,,,,inpatient,,,188718.89,20025,,,20025,Other,150% of Medicare + 9.63% HCRA Surcharge,12177.53,,,12177.53,Other,Medicare IPPS methodology,35473,,"25,046 x DRG weight",35473,Other,base rate x DRG weight,31925,,"22,541 x DRG weight",31925,Other,base rate x DRG weight,45450,,"32,091 x DRG weight",45450,Other,base rate x DRG weight,40906,,"28,882 x DRG weight",40906,Other,base rate x DRG weight,38632,,"27,277 x DRG weight",38632,Other,base rate x DRG weight,34105,,"24,080 x DRG weight",34105,Other,base rate x DRG weight,31814,,"22,463 x DRG weight",31814,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37427,,"26,426 x DRG weight",37427,Other,base rate x DRG weight,54965,,"38,809 x DRG weight",54965,Other,base rate x DRG weight,54965,,"38,809 x DRG weight",54965,Other,base rate x DRG weight,37427,,"26,426 x DRG weight",37427,Other,base rate x DRG weight,54965,,"38,809 x DRG weight",54965,Other,base rate x DRG weight,34360,,"6,363 x patient days",34360,Per diem,,132103,70,,132103,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35488,,"25,057 x DRG weight",35488,Other,base rate x DRG weight,31940,,"22,552 x DRG weight",31940,Other,base rate x DRG weight,35488,,"25,057 x DRG weight",35488,Other,base rate x DRG weight,30164,,"21,298 x DRG weight",30164,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,132103,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,,inpatient,,,71696.51,11310,,,11310,Other,150% of Medicare + 9.63% HCRA Surcharge,6877.42,,,6877.42,Other,Medicare IPPS methodology,19604,,"25,046 x DRG weight",19604,Other,base rate x DRG weight,17643,,"22,541 x DRG weight",17643,Other,base rate x DRG weight,25118,,"32,091 x DRG weight",25118,Other,base rate x DRG weight,22606,,"28,882 x DRG weight",22606,Other,base rate x DRG weight,21350,,"27,277 x DRG weight",21350,Other,base rate x DRG weight,18847,,"24,080 x DRG weight",18847,Other,base rate x DRG weight,17582,,"22,463 x DRG weight",17582,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,20684,,"26,426 x DRG weight",20684,Other,base rate x DRG weight,30376,,"38,809 x DRG weight",30376,Other,base rate x DRG weight,30376,,"38,809 x DRG weight",30376,Other,base rate x DRG weight,20684,,"26,426 x DRG weight",20684,Other,base rate x DRG weight,30376,,"38,809 x DRG weight",30376,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,50188,70,,50188,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19612,,"25,057 x DRG weight",19612,Other,base rate x DRG weight,17651,,"22,552 x DRG weight",17651,Other,base rate x DRG weight,19612,,"25,057 x DRG weight",19612,Other,base rate x DRG weight,16670,,"21,298 x DRG weight",16670,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,50188,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,,inpatient,,,171132,16995,,,16995,Other,150% of Medicare + 9.63% HCRA Surcharge,10334.7,,,10334.7,Other,Medicare IPPS methodology,29955,,"25,046 x DRG weight",29955,Other,base rate x DRG weight,26959,,"22,541 x DRG weight",26959,Other,base rate x DRG weight,38381,,"32,091 x DRG weight",38381,Other,base rate x DRG weight,34543,,"28,882 x DRG weight",34543,Other,base rate x DRG weight,32623,,"27,277 x DRG weight",32623,Other,base rate x DRG weight,28800,,"24,080 x DRG weight",28800,Other,base rate x DRG weight,26866,,"22,463 x DRG weight",26866,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31605,,"26,426 x DRG weight",31605,Other,base rate x DRG weight,46416,,"38,809 x DRG weight",46416,Other,base rate x DRG weight,46416,,"38,809 x DRG weight",46416,Other,base rate x DRG weight,31605,,"26,426 x DRG weight",31605,Other,base rate x DRG weight,46416,,"38,809 x DRG weight",46416,Other,base rate x DRG weight,31179,,"6,363 x patient days",31179,Per diem,,119792,70,,119792,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29968,,"25,057 x DRG weight",29968,Other,base rate x DRG weight,26972,,"22,552 x DRG weight",26972,Other,base rate x DRG weight,29968,,"25,057 x DRG weight",29968,Other,base rate x DRG weight,25472,,"21,298 x DRG weight",25472,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,119792,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,,inpatient,,,100621.85,10063,,,10063,Other,150% of Medicare + 9.63% HCRA Surcharge,6119.54,,,6119.54,Other,Medicare IPPS methodology,17334,,"25,046 x DRG weight",17334,Other,base rate x DRG weight,15601,,"22,541 x DRG weight",15601,Other,base rate x DRG weight,22210,,"32,091 x DRG weight",22210,Other,base rate x DRG weight,19989,,"28,882 x DRG weight",19989,Other,base rate x DRG weight,18878,,"27,277 x DRG weight",18878,Other,base rate x DRG weight,16666,,"24,080 x DRG weight",16666,Other,base rate x DRG weight,15547,,"22,463 x DRG weight",15547,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18289,,"26,426 x DRG weight",18289,Other,base rate x DRG weight,26860,,"38,809 x DRG weight",26860,Other,base rate x DRG weight,26860,,"38,809 x DRG weight",26860,Other,base rate x DRG weight,18289,,"26,426 x DRG weight",18289,Other,base rate x DRG weight,26860,,"38,809 x DRG weight",26860,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,70435,70,,70435,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17342,,"25,057 x DRG weight",17342,Other,base rate x DRG weight,15608,,"22,552 x DRG weight",15608,Other,base rate x DRG weight,17342,,"25,057 x DRG weight",17342,Other,base rate x DRG weight,14740,,"21,298 x DRG weight",14740,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,70435,
URETHRAL STRICTURE,697,MS-DRG,,,,,,,,inpatient,,,94621.51,15855,,,15855,Other,150% of Medicare + 9.63% HCRA Surcharge,9641.24,,,9641.24,Other,Medicare IPPS methodology,27879,,"25,046 x DRG weight",27879,Other,base rate x DRG weight,25090,,"22,541 x DRG weight",25090,Other,base rate x DRG weight,35720,,"32,091 x DRG weight",35720,Other,base rate x DRG weight,32149,,"28,882 x DRG weight",32149,Other,base rate x DRG weight,30362,,"27,277 x DRG weight",30362,Other,base rate x DRG weight,26803,,"24,080 x DRG weight",26803,Other,base rate x DRG weight,25004,,"22,463 x DRG weight",25004,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,29415,,"26,426 x DRG weight",29415,Other,base rate x DRG weight,43198,,"38,809 x DRG weight",43198,Other,base rate x DRG weight,43198,,"38,809 x DRG weight",43198,Other,base rate x DRG weight,29415,,"26,426 x DRG weight",29415,Other,base rate x DRG weight,43198,,"38,809 x DRG weight",43198,Other,base rate x DRG weight,23543,,"6,363 x patient days",23543,Per diem,,66235,70,,66235,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27891,,"25,057 x DRG weight",27891,Other,base rate x DRG weight,25103,,"22,552 x DRG weight",25103,Other,base rate x DRG weight,27891,,"25,057 x DRG weight",27891,Other,base rate x DRG weight,23707,,"21,298 x DRG weight",23707,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,66235,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,,inpatient,,,184205.46,23301,,,23301,Other,150% of Medicare + 9.63% HCRA Surcharge,14169.25,,,14169.25,Other,Medicare IPPS methodology,41436,,"25,046 x DRG weight",41436,Other,base rate x DRG weight,37292,,"22,541 x DRG weight",37292,Other,base rate x DRG weight,53091,,"32,091 x DRG weight",53091,Other,base rate x DRG weight,47782,,"28,882 x DRG weight",47782,Other,base rate x DRG weight,45127,,"27,277 x DRG weight",45127,Other,base rate x DRG weight,39838,,"24,080 x DRG weight",39838,Other,base rate x DRG weight,37163,,"22,463 x DRG weight",37163,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43719,,"26,426 x DRG weight",43719,Other,base rate x DRG weight,64206,,"38,809 x DRG weight",64206,Other,base rate x DRG weight,64206,,"38,809 x DRG weight",64206,Other,base rate x DRG weight,43719,,"26,426 x DRG weight",43719,Other,base rate x DRG weight,64206,,"38,809 x DRG weight",64206,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,128944,70,,128944,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,41454,,"25,057 x DRG weight",41454,Other,base rate x DRG weight,37310,,"22,552 x DRG weight",37310,Other,base rate x DRG weight,41454,,"25,057 x DRG weight",41454,Other,base rate x DRG weight,35235,,"21,298 x DRG weight",35235,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,128944,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,,inpatient,,,140422.98,14585,,,14585,Other,150% of Medicare + 9.63% HCRA Surcharge,8869.14,,,8869.14,Other,Medicare IPPS methodology,25567,,"25,046 x DRG weight",25567,Other,base rate x DRG weight,23010,,"22,541 x DRG weight",23010,Other,base rate x DRG weight,32758,,"32,091 x DRG weight",32758,Other,base rate x DRG weight,29483,,"28,882 x DRG weight",29483,Other,base rate x DRG weight,27844,,"27,277 x DRG weight",27844,Other,base rate x DRG weight,24581,,"24,080 x DRG weight",24581,Other,base rate x DRG weight,22930,,"22,463 x DRG weight",22930,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26976,,"26,426 x DRG weight",26976,Other,base rate x DRG weight,39616,,"38,809 x DRG weight",39616,Other,base rate x DRG weight,39616,,"38,809 x DRG weight",39616,Other,base rate x DRG weight,26976,,"26,426 x DRG weight",26976,Other,base rate x DRG weight,39616,,"38,809 x DRG weight",39616,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,98296,70,,98296,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25578,,"25,057 x DRG weight",25578,Other,base rate x DRG weight,23021,,"22,552 x DRG weight",23021,Other,base rate x DRG weight,25578,,"25,057 x DRG weight",25578,Other,base rate x DRG weight,21741,,"21,298 x DRG weight",21741,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,98296,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,,inpatient,,,93081.62,10286,,,10286,Other,150% of Medicare + 9.63% HCRA Surcharge,6255.05,,,6255.05,Other,Medicare IPPS methodology,17740,,"25,046 x DRG weight",17740,Other,base rate x DRG weight,15966,,"22,541 x DRG weight",15966,Other,base rate x DRG weight,22730,,"32,091 x DRG weight",22730,Other,base rate x DRG weight,20457,,"28,882 x DRG weight",20457,Other,base rate x DRG weight,19320,,"27,277 x DRG weight",19320,Other,base rate x DRG weight,17056,,"24,080 x DRG weight",17056,Other,base rate x DRG weight,15911,,"22,463 x DRG weight",15911,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18718,,"26,426 x DRG weight",18718,Other,base rate x DRG weight,27488,,"38,809 x DRG weight",27488,Other,base rate x DRG weight,27488,,"38,809 x DRG weight",27488,Other,base rate x DRG weight,18718,,"26,426 x DRG weight",18718,Other,base rate x DRG weight,27488,,"38,809 x DRG weight",27488,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,65157,70,,65157,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17748,,"25,057 x DRG weight",17748,Other,base rate x DRG weight,15974,,"22,552 x DRG weight",15974,Other,base rate x DRG weight,17748,,"25,057 x DRG weight",17748,Other,base rate x DRG weight,15085,,"21,298 x DRG weight",15085,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,65157,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,,inpatient,,,165828.54,27531,,,27531,Other,150% of Medicare + 9.63% HCRA Surcharge,16741.51,,,16741.51,Other,Medicare IPPS methodology,49138,,"25,046 x DRG weight",49138,Other,base rate x DRG weight,44223,,"22,541 x DRG weight",44223,Other,base rate x DRG weight,62959,,"32,091 x DRG weight",62959,Other,base rate x DRG weight,56664,,"28,882 x DRG weight",56664,Other,base rate x DRG weight,53515,,"27,277 x DRG weight",53515,Other,base rate x DRG weight,47243,,"24,080 x DRG weight",47243,Other,base rate x DRG weight,44070,,"22,463 x DRG weight",44070,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,51845,,"26,426 x DRG weight",51845,Other,base rate x DRG weight,76139,,"38,809 x DRG weight",76139,Other,base rate x DRG weight,76139,,"38,809 x DRG weight",76139,Other,base rate x DRG weight,51845,,"26,426 x DRG weight",51845,Other,base rate x DRG weight,76139,,"38,809 x DRG weight",76139,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,116080,70,,116080,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49159,,"25,057 x DRG weight",49159,Other,base rate x DRG weight,44245,,"22,552 x DRG weight",44245,Other,base rate x DRG weight,49159,,"25,057 x DRG weight",49159,Other,base rate x DRG weight,41785,,"21,298 x DRG weight",41785,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,116080,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,,inpatient,,,89728.12,20606,,,20606,Other,150% of Medicare + 9.63% HCRA Surcharge,12530.53,,,12530.53,Other,Medicare IPPS methodology,36530,,"25,046 x DRG weight",36530,Other,base rate x DRG weight,32876,,"22,541 x DRG weight",32876,Other,base rate x DRG weight,46805,,"32,091 x DRG weight",46805,Other,base rate x DRG weight,42124,,"28,882 x DRG weight",42124,Other,base rate x DRG weight,39784,,"27,277 x DRG weight",39784,Other,base rate x DRG weight,35121,,"24,080 x DRG weight",35121,Other,base rate x DRG weight,32762,,"22,463 x DRG weight",32762,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,38542,,"26,426 x DRG weight",38542,Other,base rate x DRG weight,56603,,"38,809 x DRG weight",56603,Other,base rate x DRG weight,56603,,"38,809 x DRG weight",56603,Other,base rate x DRG weight,38542,,"26,426 x DRG weight",38542,Other,base rate x DRG weight,56603,,"38,809 x DRG weight",56603,Other,base rate x DRG weight,10181,,"6,363 x patient days",10181,Per diem,,62810,70,,62810,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,36546,,"25,057 x DRG weight",36546,Other,base rate x DRG weight,32892,,"22,552 x DRG weight",32892,Other,base rate x DRG weight,36546,,"25,057 x DRG weight",36546,Other,base rate x DRG weight,31063,,"21,298 x DRG weight",31063,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,62810,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,,inpatient,,,153367.65,30404,,,30404,Other,150% of Medicare + 9.63% HCRA Surcharge,18488.98,,,18488.98,Other,Medicare IPPS methodology,54370,,"25,046 x DRG weight",54370,Other,base rate x DRG weight,48932,,"22,541 x DRG weight",48932,Other,base rate x DRG weight,69663,,"32,091 x DRG weight",69663,Other,base rate x DRG weight,62697,,"28,882 x DRG weight",62697,Other,base rate x DRG weight,59213,,"27,277 x DRG weight",59213,Other,base rate x DRG weight,52273,,"24,080 x DRG weight",52273,Other,base rate x DRG weight,48763,,"22,463 x DRG weight",48763,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,57366,,"26,426 x DRG weight",57366,Other,base rate x DRG weight,84247,,"38,809 x DRG weight",84247,Other,base rate x DRG weight,84247,,"38,809 x DRG weight",84247,Other,base rate x DRG weight,57366,,"26,426 x DRG weight",57366,Other,base rate x DRG weight,84247,,"38,809 x DRG weight",84247,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,107357,70,,107357,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,54394,,"25,057 x DRG weight",54394,Other,base rate x DRG weight,48956,,"22,552 x DRG weight",48956,Other,base rate x DRG weight,54394,,"25,057 x DRG weight",54394,Other,base rate x DRG weight,46234,,"21,298 x DRG weight",46234,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,107357,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,,inpatient,,,85369.11,18388,,,18388,Other,150% of Medicare + 9.63% HCRA Surcharge,11182.08,,,11182.08,Other,Medicare IPPS methodology,32492,,"25,046 x DRG weight",32492,Other,base rate x DRG weight,29242,,"22,541 x DRG weight",29242,Other,base rate x DRG weight,41632,,"32,091 x DRG weight",41632,Other,base rate x DRG weight,37469,,"28,882 x DRG weight",37469,Other,base rate x DRG weight,35386,,"27,277 x DRG weight",35386,Other,base rate x DRG weight,31239,,"24,080 x DRG weight",31239,Other,base rate x DRG weight,29141,,"22,463 x DRG weight",29141,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34282,,"26,426 x DRG weight",34282,Other,base rate x DRG weight,50347,,"38,809 x DRG weight",50347,Other,base rate x DRG weight,50347,,"38,809 x DRG weight",50347,Other,base rate x DRG weight,34282,,"26,426 x DRG weight",34282,Other,base rate x DRG weight,50347,,"38,809 x DRG weight",50347,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,59758,70,,59758,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32506,,"25,057 x DRG weight",32506,Other,base rate x DRG weight,29257,,"22,552 x DRG weight",29257,Other,base rate x DRG weight,32506,,"25,057 x DRG weight",32506,Other,base rate x DRG weight,27630,,"21,298 x DRG weight",27630,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,59758,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,,inpatient,,,73437.13,29745,,,29745,Other,150% of Medicare + 9.63% HCRA Surcharge,18088.29,,,18088.29,Other,Medicare IPPS methodology,53170,,"25,046 x DRG weight",53170,Other,base rate x DRG weight,47852,,"22,541 x DRG weight",47852,Other,base rate x DRG weight,68126,,"32,091 x DRG weight",68126,Other,base rate x DRG weight,61314,,"28,882 x DRG weight",61314,Other,base rate x DRG weight,57906,,"27,277 x DRG weight",57906,Other,base rate x DRG weight,51119,,"24,080 x DRG weight",51119,Other,base rate x DRG weight,47687,,"22,463 x DRG weight",47687,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,56100,,"26,426 x DRG weight",56100,Other,base rate x DRG weight,82388,,"38,809 x DRG weight",82388,Other,base rate x DRG weight,82388,,"38,809 x DRG weight",82388,Other,base rate x DRG weight,56100,,"26,426 x DRG weight",56100,Other,base rate x DRG weight,82388,,"38,809 x DRG weight",82388,Other,base rate x DRG weight,45177,,"6,363 x patient days",45177,Per diem,,51406,70,,51406,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,53194,,"25,057 x DRG weight",53194,Other,base rate x DRG weight,47876,,"22,552 x DRG weight",47876,Other,base rate x DRG weight,53194,,"25,057 x DRG weight",53194,Other,base rate x DRG weight,45214,,"21,298 x DRG weight",45214,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,82388,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,,inpatient,,,73198,16890,,,16890,Other,150% of Medicare + 9.63% HCRA Surcharge,10271.13,,,10271.13,Other,Medicare IPPS methodology,29765,,"25,046 x DRG weight",29765,Other,base rate x DRG weight,26788,,"22,541 x DRG weight",26788,Other,base rate x DRG weight,38137,,"32,091 x DRG weight",38137,Other,base rate x DRG weight,34323,,"28,882 x DRG weight",34323,Other,base rate x DRG weight,32416,,"27,277 x DRG weight",32416,Other,base rate x DRG weight,28617,,"24,080 x DRG weight",28617,Other,base rate x DRG weight,26695,,"22,463 x DRG weight",26695,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31405,,"26,426 x DRG weight",31405,Other,base rate x DRG weight,46121,,"38,809 x DRG weight",46121,Other,base rate x DRG weight,46121,,"38,809 x DRG weight",46121,Other,base rate x DRG weight,31405,,"26,426 x DRG weight",31405,Other,base rate x DRG weight,46121,,"38,809 x DRG weight",46121,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,51239,70,,51239,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29778,,"25,057 x DRG weight",29778,Other,base rate x DRG weight,26801,,"22,552 x DRG weight",26801,Other,base rate x DRG weight,29778,,"25,057 x DRG weight",29778,Other,base rate x DRG weight,25311,,"21,298 x DRG weight",25311,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,51239,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,,inpatient,,,82123.62,20499,,,20499,Other,150% of Medicare + 9.63% HCRA Surcharge,12465.29,,,12465.29,Other,Medicare IPPS methodology,36334,,"25,046 x DRG weight",36334,Other,base rate x DRG weight,32700,,"22,541 x DRG weight",32700,Other,base rate x DRG weight,46554,,"32,091 x DRG weight",46554,Other,base rate x DRG weight,41899,,"28,882 x DRG weight",41899,Other,base rate x DRG weight,39571,,"27,277 x DRG weight",39571,Other,base rate x DRG weight,34933,,"24,080 x DRG weight",34933,Other,base rate x DRG weight,32587,,"22,463 x DRG weight",32587,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,38336,,"26,426 x DRG weight",38336,Other,base rate x DRG weight,56300,,"38,809 x DRG weight",56300,Other,base rate x DRG weight,56300,,"38,809 x DRG weight",56300,Other,base rate x DRG weight,38336,,"26,426 x DRG weight",38336,Other,base rate x DRG weight,56300,,"38,809 x DRG weight",56300,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,57487,70,,57487,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,36350,,"25,057 x DRG weight",36350,Other,base rate x DRG weight,32716,,"22,552 x DRG weight",32716,Other,base rate x DRG weight,36350,,"25,057 x DRG weight",36350,Other,base rate x DRG weight,30897,,"21,298 x DRG weight",30897,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,57487,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,,inpatient,,,72648.49,13728,,,13728,Other,150% of Medicare + 9.63% HCRA Surcharge,8348,,,8348,Other,Medicare IPPS methodology,24007,,"25,046 x DRG weight",24007,Other,base rate x DRG weight,21606,,"22,541 x DRG weight",21606,Other,base rate x DRG weight,30759,,"32,091 x DRG weight",30759,Other,base rate x DRG weight,27683,,"28,882 x DRG weight",27683,Other,base rate x DRG weight,26145,,"27,277 x DRG weight",26145,Other,base rate x DRG weight,23081,,"24,080 x DRG weight",23081,Other,base rate x DRG weight,21531,,"22,463 x DRG weight",21531,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25329,,"26,426 x DRG weight",25329,Other,base rate x DRG weight,37198,,"38,809 x DRG weight",37198,Other,base rate x DRG weight,37198,,"38,809 x DRG weight",37198,Other,base rate x DRG weight,25329,,"26,426 x DRG weight",25329,Other,base rate x DRG weight,37198,,"38,809 x DRG weight",37198,Other,base rate x DRG weight,10817,,"6,363 x patient days",10817,Per diem,,50854,70,,50854,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24017,,"25,057 x DRG weight",24017,Other,base rate x DRG weight,21616,,"22,552 x DRG weight",21616,Other,base rate x DRG weight,24017,,"25,057 x DRG weight",24017,Other,base rate x DRG weight,20414,,"21,298 x DRG weight",20414,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,50854,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,,inpatient,,,672810.72,30909,,,30909,Other,150% of Medicare + 9.63% HCRA Surcharge,18795.98,,,18795.98,Other,Medicare IPPS methodology,55289,,"25,046 x DRG weight",55289,Other,base rate x DRG weight,49759,,"22,541 x DRG weight",49759,Other,base rate x DRG weight,70841,,"32,091 x DRG weight",70841,Other,base rate x DRG weight,63757,,"28,882 x DRG weight",63757,Other,base rate x DRG weight,60214,,"27,277 x DRG weight",60214,Other,base rate x DRG weight,53157,,"24,080 x DRG weight",53157,Other,base rate x DRG weight,49587,,"22,463 x DRG weight",49587,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,58335,,"26,426 x DRG weight",58335,Other,base rate x DRG weight,85671,,"38,809 x DRG weight",85671,Other,base rate x DRG weight,85671,,"38,809 x DRG weight",85671,Other,base rate x DRG weight,58335,,"26,426 x DRG weight",58335,Other,base rate x DRG weight,85671,,"38,809 x DRG weight",85671,Other,base rate x DRG weight,48995,,"6,363 x patient days",48995,Per diem,,470968,70,,470968,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,55313,,"25,057 x DRG weight",55313,Other,base rate x DRG weight,49784,,"22,552 x DRG weight",49784,Other,base rate x DRG weight,55313,,"25,057 x DRG weight",55313,Other,base rate x DRG weight,47015,,"21,298 x DRG weight",47015,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,470968,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,,inpatient,,,85878.08,20106,,,20106,Other,150% of Medicare + 9.63% HCRA Surcharge,12226.88,,,12226.88,Other,Medicare IPPS methodology,35620,,"25,046 x DRG weight",35620,Other,base rate x DRG weight,32058,,"22,541 x DRG weight",32058,Other,base rate x DRG weight,45640,,"32,091 x DRG weight",45640,Other,base rate x DRG weight,41076,,"28,882 x DRG weight",41076,Other,base rate x DRG weight,38793,,"27,277 x DRG weight",38793,Other,base rate x DRG weight,34247,,"24,080 x DRG weight",34247,Other,base rate x DRG weight,31947,,"22,463 x DRG weight",31947,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37583,,"26,426 x DRG weight",37583,Other,base rate x DRG weight,55194,,"38,809 x DRG weight",55194,Other,base rate x DRG weight,55194,,"38,809 x DRG weight",55194,Other,base rate x DRG weight,37583,,"26,426 x DRG weight",37583,Other,base rate x DRG weight,55194,,"38,809 x DRG weight",55194,Other,base rate x DRG weight,12090,,"6,363 x patient days",12090,Per diem,,60115,70,,60115,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35636,,"25,057 x DRG weight",35636,Other,base rate x DRG weight,32073,,"22,552 x DRG weight",32073,Other,base rate x DRG weight,35636,,"25,057 x DRG weight",35636,Other,base rate x DRG weight,30290,,"21,298 x DRG weight",30290,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,60115,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,,inpatient,,,193611.43,25492,,,25492,Other,150% of Medicare + 9.63% HCRA Surcharge,15501.81,,,15501.81,Other,Medicare IPPS methodology,45426,,"25,046 x DRG weight",45426,Other,base rate x DRG weight,40883,,"22,541 x DRG weight",40883,Other,base rate x DRG weight,58203,,"32,091 x DRG weight",58203,Other,base rate x DRG weight,52383,,"28,882 x DRG weight",52383,Other,base rate x DRG weight,49472,,"27,277 x DRG weight",49472,Other,base rate x DRG weight,43674,,"24,080 x DRG weight",43674,Other,base rate x DRG weight,40741,,"22,463 x DRG weight",40741,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,47929,,"26,426 x DRG weight",47929,Other,base rate x DRG weight,70388,,"38,809 x DRG weight",70388,Other,base rate x DRG weight,70388,,"38,809 x DRG weight",70388,Other,base rate x DRG weight,47929,,"26,426 x DRG weight",47929,Other,base rate x DRG weight,70388,,"38,809 x DRG weight",70388,Other,base rate x DRG weight,33724,,"6,363 x patient days",33724,Per diem,,135528,70,,135528,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,45446,,"25,057 x DRG weight",45446,Other,base rate x DRG weight,40903,,"22,552 x DRG weight",40903,Other,base rate x DRG weight,45446,,"25,057 x DRG weight",45446,Other,base rate x DRG weight,38628,,"21,298 x DRG weight",38628,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,135528,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,,inpatient,,,86665.45,16717,,,16717,Other,150% of Medicare + 9.63% HCRA Surcharge,10165.73,,,10165.73,Other,Medicare IPPS methodology,29449,,"25,046 x DRG weight",29449,Other,base rate x DRG weight,26504,,"22,541 x DRG weight",26504,Other,base rate x DRG weight,37733,,"32,091 x DRG weight",37733,Other,base rate x DRG weight,33959,,"28,882 x DRG weight",33959,Other,base rate x DRG weight,32072,,"27,277 x DRG weight",32072,Other,base rate x DRG weight,28313,,"24,080 x DRG weight",28313,Other,base rate x DRG weight,26412,,"22,463 x DRG weight",26412,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31072,,"26,426 x DRG weight",31072,Other,base rate x DRG weight,45632,,"38,809 x DRG weight",45632,Other,base rate x DRG weight,45632,,"38,809 x DRG weight",45632,Other,base rate x DRG weight,31072,,"26,426 x DRG weight",31072,Other,base rate x DRG weight,45632,,"38,809 x DRG weight",45632,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,60666,70,,60666,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29462,,"25,057 x DRG weight",29462,Other,base rate x DRG weight,26517,,"22,552 x DRG weight",26517,Other,base rate x DRG weight,29462,,"25,057 x DRG weight",29462,Other,base rate x DRG weight,25042,,"21,298 x DRG weight",25042,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,60666,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,,inpatient,,,66917,26332,,,26332,Other,150% of Medicare + 9.63% HCRA Surcharge,16012.92,,,16012.92,Other,Medicare IPPS methodology,46956,,"25,046 x DRG weight",46956,Other,base rate x DRG weight,42260,,"22,541 x DRG weight",42260,Other,base rate x DRG weight,60164,,"32,091 x DRG weight",60164,Other,base rate x DRG weight,54148,,"28,882 x DRG weight",54148,Other,base rate x DRG weight,51139,,"27,277 x DRG weight",51139,Other,base rate x DRG weight,45145,,"24,080 x DRG weight",45145,Other,base rate x DRG weight,42114,,"22,463 x DRG weight",42114,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49543,,"26,426 x DRG weight",49543,Other,base rate x DRG weight,72759,,"38,809 x DRG weight",72759,Other,base rate x DRG weight,72759,,"38,809 x DRG weight",72759,Other,base rate x DRG weight,49543,,"26,426 x DRG weight",49543,Other,base rate x DRG weight,72759,,"38,809 x DRG weight",72759,Other,base rate x DRG weight,49631,,"6,363 x patient days",49631,Per diem,,46842,70,,46842,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46977,,"25,057 x DRG weight",46977,Other,base rate x DRG weight,42280,,"22,552 x DRG weight",42280,Other,base rate x DRG weight,46977,,"25,057 x DRG weight",46977,Other,base rate x DRG weight,39929,,"21,298 x DRG weight",39929,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,72759,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,,inpatient,,,173080.84,15871,,,15871,Other,150% of Medicare + 9.63% HCRA Surcharge,9651.28,,,9651.28,Other,Medicare IPPS methodology,27909,,"25,046 x DRG weight",27909,Other,base rate x DRG weight,25117,,"22,541 x DRG weight",25117,Other,base rate x DRG weight,35759,,"32,091 x DRG weight",35759,Other,base rate x DRG weight,32183,,"28,882 x DRG weight",32183,Other,base rate x DRG weight,30395,,"27,277 x DRG weight",30395,Other,base rate x DRG weight,26832,,"24,080 x DRG weight",26832,Other,base rate x DRG weight,25031,,"22,463 x DRG weight",25031,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,29446,,"26,426 x DRG weight",29446,Other,base rate x DRG weight,43245,,"38,809 x DRG weight",43245,Other,base rate x DRG weight,43245,,"38,809 x DRG weight",43245,Other,base rate x DRG weight,29446,,"26,426 x DRG weight",29446,Other,base rate x DRG weight,43245,,"38,809 x DRG weight",43245,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,121157,70,,121157,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27921,,"25,057 x DRG weight",27921,Other,base rate x DRG weight,25130,,"22,552 x DRG weight",25130,Other,base rate x DRG weight,27921,,"25,057 x DRG weight",27921,Other,base rate x DRG weight,23732,,"21,298 x DRG weight",23732,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,121157,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,,inpatient,,,19635,11678,,,11678,Other,150% of Medicare + 9.63% HCRA Surcharge,7101.6,,,7101.6,Other,Medicare IPPS methodology,20275,,"25,046 x DRG weight",20275,Other,base rate x DRG weight,18247,,"22,541 x DRG weight",18247,Other,base rate x DRG weight,25978,,"32,091 x DRG weight",25978,Other,base rate x DRG weight,23380,,"28,882 x DRG weight",23380,Other,base rate x DRG weight,22081,,"27,277 x DRG weight",22081,Other,base rate x DRG weight,19493,,"24,080 x DRG weight",19493,Other,base rate x DRG weight,18184,,"22,463 x DRG weight",18184,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21392,,"26,426 x DRG weight",21392,Other,base rate x DRG weight,31416,,"38,809 x DRG weight",31416,Other,base rate x DRG weight,31416,,"38,809 x DRG weight",31416,Other,base rate x DRG weight,21392,,"26,426 x DRG weight",21392,Other,base rate x DRG weight,31416,,"38,809 x DRG weight",31416,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,13745,70,,13745,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20284,,"25,057 x DRG weight",20284,Other,base rate x DRG weight,18256,,"22,552 x DRG weight",18256,Other,base rate x DRG weight,20284,,"25,057 x DRG weight",20284,Other,base rate x DRG weight,17241,,"21,298 x DRG weight",17241,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,31416,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,,inpatient,,,105831,17613,,,17613,Other,150% of Medicare + 9.63% HCRA Surcharge,10710.29,,,10710.29,Other,Medicare IPPS methodology,31080,,"25,046 x DRG weight",31080,Other,base rate x DRG weight,27971,,"22,541 x DRG weight",27971,Other,base rate x DRG weight,39822,,"32,091 x DRG weight",39822,Other,base rate x DRG weight,35840,,"28,882 x DRG weight",35840,Other,base rate x DRG weight,33848,,"27,277 x DRG weight",33848,Other,base rate x DRG weight,29881,,"24,080 x DRG weight",29881,Other,base rate x DRG weight,27874,,"22,463 x DRG weight",27874,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,32792,,"26,426 x DRG weight",32792,Other,base rate x DRG weight,48158,,"38,809 x DRG weight",48158,Other,base rate x DRG weight,48158,,"38,809 x DRG weight",48158,Other,base rate x DRG weight,32792,,"26,426 x DRG weight",32792,Other,base rate x DRG weight,48158,,"38,809 x DRG weight",48158,Other,base rate x DRG weight,35633,,"6,363 x patient days",35633,Per diem,,74082,70,,74082,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,31093,,"25,057 x DRG weight",31093,Other,base rate x DRG weight,27985,,"22,552 x DRG weight",27985,Other,base rate x DRG weight,31093,,"25,057 x DRG weight",31093,Other,base rate x DRG weight,26429,,"21,298 x DRG weight",26429,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,74082,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,,inpatient,,,135159.5,10597,,,10597,Other,150% of Medicare + 9.63% HCRA Surcharge,6444.1,,,6444.1,Other,Medicare IPPS methodology,18306,,"25,046 x DRG weight",18306,Other,base rate x DRG weight,16475,,"22,541 x DRG weight",16475,Other,base rate x DRG weight,23455,,"32,091 x DRG weight",23455,Other,base rate x DRG weight,21110,,"28,882 x DRG weight",21110,Other,base rate x DRG weight,19937,,"27,277 x DRG weight",19937,Other,base rate x DRG weight,17600,,"24,080 x DRG weight",17600,Other,base rate x DRG weight,16418,,"22,463 x DRG weight",16418,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19315,,"26,426 x DRG weight",19315,Other,base rate x DRG weight,28365,,"38,809 x DRG weight",28365,Other,base rate x DRG weight,28365,,"38,809 x DRG weight",28365,Other,base rate x DRG weight,19315,,"26,426 x DRG weight",19315,Other,base rate x DRG weight,28365,,"38,809 x DRG weight",28365,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,94612,70,,94612,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18314,,"25,057 x DRG weight",18314,Other,base rate x DRG weight,16483,,"22,552 x DRG weight",16483,Other,base rate x DRG weight,18314,,"25,057 x DRG weight",18314,Other,base rate x DRG weight,15567,,"21,298 x DRG weight",15567,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,94612,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,,inpatient,,,121672.4,22841,,,22841,Other,150% of Medicare + 9.63% HCRA Surcharge,13889.86,,,13889.86,Other,Medicare IPPS methodology,40600,,"25,046 x DRG weight",40600,Other,base rate x DRG weight,36539,,"22,541 x DRG weight",36539,Other,base rate x DRG weight,52020,,"32,091 x DRG weight",52020,Other,base rate x DRG weight,46818,,"28,882 x DRG weight",46818,Other,base rate x DRG weight,44216,,"27,277 x DRG weight",44216,Other,base rate x DRG weight,39034,,"24,080 x DRG weight",39034,Other,base rate x DRG weight,36413,,"22,463 x DRG weight",36413,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42837,,"26,426 x DRG weight",42837,Other,base rate x DRG weight,62909,,"38,809 x DRG weight",62909,Other,base rate x DRG weight,62909,,"38,809 x DRG weight",62909,Other,base rate x DRG weight,42837,,"26,426 x DRG weight",42837,Other,base rate x DRG weight,62909,,"38,809 x DRG weight",62909,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,85171,70,,85171,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40617,,"25,057 x DRG weight",40617,Other,base rate x DRG weight,36557,,"22,552 x DRG weight",36557,Other,base rate x DRG weight,40617,,"25,057 x DRG weight",40617,Other,base rate x DRG weight,34524,,"21,298 x DRG weight",34524,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,85171,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,,inpatient,,,107991.3,11549,,,11549,Other,150% of Medicare + 9.63% HCRA Surcharge,7022.97,,,7022.97,Other,Medicare IPPS methodology,20039,,"25,046 x DRG weight",20039,Other,base rate x DRG weight,18035,,"22,541 x DRG weight",18035,Other,base rate x DRG weight,25676,,"32,091 x DRG weight",25676,Other,base rate x DRG weight,23108,,"28,882 x DRG weight",23108,Other,base rate x DRG weight,21824,,"27,277 x DRG weight",21824,Other,base rate x DRG weight,19266,,"24,080 x DRG weight",19266,Other,base rate x DRG weight,17973,,"22,463 x DRG weight",17973,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21143,,"26,426 x DRG weight",21143,Other,base rate x DRG weight,31051,,"38,809 x DRG weight",31051,Other,base rate x DRG weight,31051,,"38,809 x DRG weight",31051,Other,base rate x DRG weight,21143,,"26,426 x DRG weight",21143,Other,base rate x DRG weight,31051,,"38,809 x DRG weight",31051,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,75594,70,,75594,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20048,,"25,057 x DRG weight",20048,Other,base rate x DRG weight,18044,,"22,552 x DRG weight",18044,Other,base rate x DRG weight,20048,,"25,057 x DRG weight",20048,Other,base rate x DRG weight,17041,,"21,298 x DRG weight",17041,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,75594,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,,inpatient,,,150200.13,14352,,,14352,Other,150% of Medicare + 9.63% HCRA Surcharge,8727.77,,,8727.77,Other,Medicare IPPS methodology,25144,,"25,046 x DRG weight",25144,Other,base rate x DRG weight,22629,,"22,541 x DRG weight",22629,Other,base rate x DRG weight,32216,,"32,091 x DRG weight",32216,Other,base rate x DRG weight,28995,,"28,882 x DRG weight",28995,Other,base rate x DRG weight,27383,,"27,277 x DRG weight",27383,Other,base rate x DRG weight,24174,,"24,080 x DRG weight",24174,Other,base rate x DRG weight,22551,,"22,463 x DRG weight",22551,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26529,,"26,426 x DRG weight",26529,Other,base rate x DRG weight,38960,,"38,809 x DRG weight",38960,Other,base rate x DRG weight,38960,,"38,809 x DRG weight",38960,Other,base rate x DRG weight,26529,,"26,426 x DRG weight",26529,Other,base rate x DRG weight,38960,,"38,809 x DRG weight",38960,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,105140,70,,105140,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25155,,"25,057 x DRG weight",25155,Other,base rate x DRG weight,22640,,"22,552 x DRG weight",22640,Other,base rate x DRG weight,25155,,"25,057 x DRG weight",25155,Other,base rate x DRG weight,21381,,"21,298 x DRG weight",21381,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,105140,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,,inpatient,,,45266,9093,,,9093,Other,150% of Medicare + 9.63% HCRA Surcharge,5529.8,,,5529.8,Other,Medicare IPPS methodology,15569,,"25,046 x DRG weight",15569,Other,base rate x DRG weight,14011,,"22,541 x DRG weight",14011,Other,base rate x DRG weight,19948,,"32,091 x DRG weight",19948,Other,base rate x DRG weight,17953,,"28,882 x DRG weight",17953,Other,base rate x DRG weight,16955,,"27,277 x DRG weight",16955,Other,base rate x DRG weight,14968,,"24,080 x DRG weight",14968,Other,base rate x DRG weight,13963,,"22,463 x DRG weight",13963,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,16426,,"26,426 x DRG weight",16426,Other,base rate x DRG weight,24124,,"38,809 x DRG weight",24124,Other,base rate x DRG weight,24124,,"38,809 x DRG weight",24124,Other,base rate x DRG weight,16426,,"26,426 x DRG weight",16426,Other,base rate x DRG weight,24124,,"38,809 x DRG weight",24124,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,31686,70,,31686,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15575,,"25,057 x DRG weight",15575,Other,base rate x DRG weight,14018,,"22,552 x DRG weight",14018,Other,base rate x DRG weight,15575,,"25,057 x DRG weight",15575,Other,base rate x DRG weight,13239,,"21,298 x DRG weight",13239,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,31686,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,,inpatient,,,266811.89,30443,,,30443,Other,150% of Medicare + 9.63% HCRA Surcharge,18512.4,,,18512.4,Other,Medicare IPPS methodology,54440,,"25,046 x DRG weight",54440,Other,base rate x DRG weight,48995,,"22,541 x DRG weight",48995,Other,base rate x DRG weight,69753,,"32,091 x DRG weight",69753,Other,base rate x DRG weight,62778,,"28,882 x DRG weight",62778,Other,base rate x DRG weight,59289,,"27,277 x DRG weight",59289,Other,base rate x DRG weight,52340,,"24,080 x DRG weight",52340,Other,base rate x DRG weight,48826,,"22,463 x DRG weight",48826,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,57440,,"26,426 x DRG weight",57440,Other,base rate x DRG weight,84355,,"38,809 x DRG weight",84355,Other,base rate x DRG weight,84355,,"38,809 x DRG weight",84355,Other,base rate x DRG weight,57440,,"26,426 x DRG weight",57440,Other,base rate x DRG weight,84355,,"38,809 x DRG weight",84355,Other,base rate x DRG weight,30542,,"6,363 x patient days",30542,Per diem,,186768,70,,186768,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,54464,,"25,057 x DRG weight",54464,Other,base rate x DRG weight,49019,,"22,552 x DRG weight",49019,Other,base rate x DRG weight,54464,,"25,057 x DRG weight",54464,Other,base rate x DRG weight,46293,,"21,298 x DRG weight",46293,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,186768,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,,inpatient,,,138118.19,17878,,,17878,Other,150% of Medicare + 9.63% HCRA Surcharge,10871.74,,,10871.74,Other,Medicare IPPS methodology,31563,,"25,046 x DRG weight",31563,Other,base rate x DRG weight,28406,,"22,541 x DRG weight",28406,Other,base rate x DRG weight,40441,,"32,091 x DRG weight",40441,Other,base rate x DRG weight,36397,,"28,882 x DRG weight",36397,Other,base rate x DRG weight,34374,,"27,277 x DRG weight",34374,Other,base rate x DRG weight,30346,,"24,080 x DRG weight",30346,Other,base rate x DRG weight,28308,,"22,463 x DRG weight",28308,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,33302,,"26,426 x DRG weight",33302,Other,base rate x DRG weight,48907,,"38,809 x DRG weight",48907,Other,base rate x DRG weight,48907,,"38,809 x DRG weight",48907,Other,base rate x DRG weight,33302,,"26,426 x DRG weight",33302,Other,base rate x DRG weight,48907,,"38,809 x DRG weight",48907,Other,base rate x DRG weight,12090,,"6,363 x patient days",12090,Per diem,,96683,70,,96683,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,31577,,"25,057 x DRG weight",31577,Other,base rate x DRG weight,28420,,"22,552 x DRG weight",28420,Other,base rate x DRG weight,31577,,"25,057 x DRG weight",31577,Other,base rate x DRG weight,26840,,"21,298 x DRG weight",26840,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,96683,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,,inpatient,,,395451.85,54015,,,54015,Other,150% of Medicare + 9.63% HCRA Surcharge,32846.8,,,32846.8,Other,Medicare IPPS methodology,97359,,"25,046 x DRG weight",97359,Other,base rate x DRG weight,87621,,"22,541 x DRG weight",87621,Other,base rate x DRG weight,124744,,"32,091 x DRG weight",124744,Other,base rate x DRG weight,112270,,"28,882 x DRG weight",112270,Other,base rate x DRG weight,106031,,"27,277 x DRG weight",106031,Other,base rate x DRG weight,93604,,"24,080 x DRG weight",93604,Other,base rate x DRG weight,87318,,"22,463 x DRG weight",87318,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,102723,,"26,426 x DRG weight",102723,Other,base rate x DRG weight,150858,,"38,809 x DRG weight",150858,Other,base rate x DRG weight,150858,,"38,809 x DRG weight",150858,Other,base rate x DRG weight,102723,,"26,426 x DRG weight",102723,Other,base rate x DRG weight,150858,,"38,809 x DRG weight",150858,Other,base rate x DRG weight,65539,,"6,363 x patient days",65539,Per diem,,276816,70,,276816,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,97402,,"25,057 x DRG weight",97402,Other,base rate x DRG weight,87664,,"22,552 x DRG weight",87664,Other,base rate x DRG weight,97402,,"25,057 x DRG weight",97402,Other,base rate x DRG weight,82790,,"21,298 x DRG weight",82790,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,276816,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,,inpatient,,,230661.41,27694,,,27694,Other,150% of Medicare + 9.63% HCRA Surcharge,16841.06,,,16841.06,Other,Medicare IPPS methodology,49436,,"25,046 x DRG weight",49436,Other,base rate x DRG weight,44491,,"22,541 x DRG weight",44491,Other,base rate x DRG weight,63341,,"32,091 x DRG weight",63341,Other,base rate x DRG weight,57007,,"28,882 x DRG weight",57007,Other,base rate x DRG weight,53839,,"27,277 x DRG weight",53839,Other,base rate x DRG weight,47529,,"24,080 x DRG weight",47529,Other,base rate x DRG weight,44337,,"22,463 x DRG weight",44337,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52160,,"26,426 x DRG weight",52160,Other,base rate x DRG weight,76601,,"38,809 x DRG weight",76601,Other,base rate x DRG weight,76601,,"38,809 x DRG weight",76601,Other,base rate x DRG weight,52160,,"26,426 x DRG weight",52160,Other,base rate x DRG weight,76601,,"38,809 x DRG weight",76601,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,161463,70,,161463,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49458,,"25,057 x DRG weight",49458,Other,base rate x DRG weight,44513,,"22,552 x DRG weight",44513,Other,base rate x DRG weight,49458,,"25,057 x DRG weight",49458,Other,base rate x DRG weight,42038,,"21,298 x DRG weight",42038,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,161463,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,,inpatient,,,154592.47,19314,,,19314,Other,150% of Medicare + 9.63% HCRA Surcharge,11745.05,,,11745.05,Other,Medicare IPPS methodology,34178,,"25,046 x DRG weight",34178,Other,base rate x DRG weight,30759,,"22,541 x DRG weight",30759,Other,base rate x DRG weight,43791,,"32,091 x DRG weight",43791,Other,base rate x DRG weight,39412,,"28,882 x DRG weight",39412,Other,base rate x DRG weight,37222,,"27,277 x DRG weight",37222,Other,base rate x DRG weight,32860,,"24,080 x DRG weight",32860,Other,base rate x DRG weight,30653,,"22,463 x DRG weight",30653,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,36061,,"26,426 x DRG weight",36061,Other,base rate x DRG weight,52959,,"38,809 x DRG weight",52959,Other,base rate x DRG weight,52959,,"38,809 x DRG weight",52959,Other,base rate x DRG weight,36061,,"26,426 x DRG weight",36061,Other,base rate x DRG weight,52959,,"38,809 x DRG weight",52959,Other,base rate x DRG weight,16544,,"6,363 x patient days",16544,Per diem,,108215,70,,108215,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,34193,,"25,057 x DRG weight",34193,Other,base rate x DRG weight,30774,,"22,552 x DRG weight",30774,Other,base rate x DRG weight,34193,,"25,057 x DRG weight",34193,Other,base rate x DRG weight,29063,,"21,298 x DRG weight",29063,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,108215,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,,inpatient,,,394301.66,50288,,,50288,Other,150% of Medicare + 9.63% HCRA Surcharge,30580.7,,,30580.7,Other,Medicare IPPS methodology,90574,,"25,046 x DRG weight",90574,Other,base rate x DRG weight,81515,,"22,541 x DRG weight",81515,Other,base rate x DRG weight,116051,,"32,091 x DRG weight",116051,Other,base rate x DRG weight,104446,,"28,882 x DRG weight",104446,Other,base rate x DRG weight,98642,,"27,277 x DRG weight",98642,Other,base rate x DRG weight,87081,,"24,080 x DRG weight",87081,Other,base rate x DRG weight,81233,,"22,463 x DRG weight",81233,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,95564,,"26,426 x DRG weight",95564,Other,base rate x DRG weight,140345,,"38,809 x DRG weight",140345,Other,base rate x DRG weight,140345,,"38,809 x DRG weight",140345,Other,base rate x DRG weight,95564,,"26,426 x DRG weight",95564,Other,base rate x DRG weight,140345,,"38,809 x DRG weight",140345,Other,base rate x DRG weight,57267,,"6,363 x patient days",57267,Per diem,,276011,70,,276011,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,90614,,"25,057 x DRG weight",90614,Other,base rate x DRG weight,81555,,"22,552 x DRG weight",81555,Other,base rate x DRG weight,90614,,"25,057 x DRG weight",90614,Other,base rate x DRG weight,77020,,"21,298 x DRG weight",77020,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,276011,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,,inpatient,,,224338.12,25125,,,25125,Other,150% of Medicare + 9.63% HCRA Surcharge,15278.46,,,15278.46,Other,Medicare IPPS methodology,44757,,"25,046 x DRG weight",44757,Other,base rate x DRG weight,40281,,"22,541 x DRG weight",40281,Other,base rate x DRG weight,57347,,"32,091 x DRG weight",57347,Other,base rate x DRG weight,51612,,"28,882 x DRG weight",51612,Other,base rate x DRG weight,48744,,"27,277 x DRG weight",48744,Other,base rate x DRG weight,43031,,"24,080 x DRG weight",43031,Other,base rate x DRG weight,40141,,"22,463 x DRG weight",40141,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,47223,,"26,426 x DRG weight",47223,Other,base rate x DRG weight,69352,,"38,809 x DRG weight",69352,Other,base rate x DRG weight,69352,,"38,809 x DRG weight",69352,Other,base rate x DRG weight,47223,,"26,426 x DRG weight",47223,Other,base rate x DRG weight,69352,,"38,809 x DRG weight",69352,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,157037,70,,157037,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,44777,,"25,057 x DRG weight",44777,Other,base rate x DRG weight,40300,,"22,552 x DRG weight",40300,Other,base rate x DRG weight,44777,,"25,057 x DRG weight",44777,Other,base rate x DRG weight,38060,,"21,298 x DRG weight",38060,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,157037,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,,inpatient,,,119467.87,18416,,,18416,Other,150% of Medicare + 9.63% HCRA Surcharge,11198.81,,,11198.81,Other,Medicare IPPS methodology,32542,,"25,046 x DRG weight",32542,Other,base rate x DRG weight,29288,,"22,541 x DRG weight",29288,Other,base rate x DRG weight,41696,,"32,091 x DRG weight",41696,Other,base rate x DRG weight,37526,,"28,882 x DRG weight",37526,Other,base rate x DRG weight,35441,,"27,277 x DRG weight",35441,Other,base rate x DRG weight,31287,,"24,080 x DRG weight",31287,Other,base rate x DRG weight,29186,,"22,463 x DRG weight",29186,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34335,,"26,426 x DRG weight",34335,Other,base rate x DRG weight,50425,,"38,809 x DRG weight",50425,Other,base rate x DRG weight,50425,,"38,809 x DRG weight",50425,Other,base rate x DRG weight,34335,,"26,426 x DRG weight",34335,Other,base rate x DRG weight,50425,,"38,809 x DRG weight",50425,Other,base rate x DRG weight,12090,,"6,363 x patient days",12090,Per diem,,83628,70,,83628,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32557,,"25,057 x DRG weight",32557,Other,base rate x DRG weight,29302,,"22,552 x DRG weight",29302,Other,base rate x DRG weight,32557,,"25,057 x DRG weight",32557,Other,base rate x DRG weight,27672,,"21,298 x DRG weight",27672,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,83628,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,,inpatient,,,143911.13,25055,,,25055,Other,150% of Medicare + 9.63% HCRA Surcharge,15235.8,,,15235.8,Other,Medicare IPPS methodology,44629,,"25,046 x DRG weight",44629,Other,base rate x DRG weight,40166,,"22,541 x DRG weight",40166,Other,base rate x DRG weight,57183,,"32,091 x DRG weight",57183,Other,base rate x DRG weight,51465,,"28,882 x DRG weight",51465,Other,base rate x DRG weight,48605,,"27,277 x DRG weight",48605,Other,base rate x DRG weight,42908,,"24,080 x DRG weight",42908,Other,base rate x DRG weight,40027,,"22,463 x DRG weight",40027,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,47088,,"26,426 x DRG weight",47088,Other,base rate x DRG weight,69154,,"38,809 x DRG weight",69154,Other,base rate x DRG weight,69154,,"38,809 x DRG weight",69154,Other,base rate x DRG weight,47088,,"26,426 x DRG weight",47088,Other,base rate x DRG weight,69154,,"38,809 x DRG weight",69154,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,100738,70,,100738,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,44649,,"25,057 x DRG weight",44649,Other,base rate x DRG weight,40185,,"22,552 x DRG weight",40185,Other,base rate x DRG weight,44649,,"25,057 x DRG weight",44649,Other,base rate x DRG weight,37951,,"21,298 x DRG weight",37951,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,100738,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,,inpatient,,,119614.78,16527,,,16527,Other,150% of Medicare + 9.63% HCRA Surcharge,10050.29,,,10050.29,Other,Medicare IPPS methodology,29103,,"25,046 x DRG weight",29103,Other,base rate x DRG weight,26193,,"22,541 x DRG weight",26193,Other,base rate x DRG weight,37290,,"32,091 x DRG weight",37290,Other,base rate x DRG weight,33561,,"28,882 x DRG weight",33561,Other,base rate x DRG weight,31696,,"27,277 x DRG weight",31696,Other,base rate x DRG weight,27981,,"24,080 x DRG weight",27981,Other,base rate x DRG weight,26102,,"22,463 x DRG weight",26102,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,30707,,"26,426 x DRG weight",30707,Other,base rate x DRG weight,45096,,"38,809 x DRG weight",45096,Other,base rate x DRG weight,45096,,"38,809 x DRG weight",45096,Other,base rate x DRG weight,30707,,"26,426 x DRG weight",30707,Other,base rate x DRG weight,45096,,"38,809 x DRG weight",45096,Other,base rate x DRG weight,11453,,"6,363 x patient days",11453,Per diem,,83730,70,,83730,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29116,,"25,057 x DRG weight",29116,Other,base rate x DRG weight,26205,,"22,552 x DRG weight",26205,Other,base rate x DRG weight,29116,,"25,057 x DRG weight",29116,Other,base rate x DRG weight,24748,,"21,298 x DRG weight",24748,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,83730,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,,inpatient,,,188345.52,26437,,,26437,Other,150% of Medicare + 9.63% HCRA Surcharge,16076.49,,,16076.49,Other,Medicare IPPS methodology,47147,,"25,046 x DRG weight",47147,Other,base rate x DRG weight,42431,,"22,541 x DRG weight",42431,Other,base rate x DRG weight,60408,,"32,091 x DRG weight",60408,Other,base rate x DRG weight,54367,,"28,882 x DRG weight",54367,Other,base rate x DRG weight,51346,,"27,277 x DRG weight",51346,Other,base rate x DRG weight,45328,,"24,080 x DRG weight",45328,Other,base rate x DRG weight,42284,,"22,463 x DRG weight",42284,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49744,,"26,426 x DRG weight",49744,Other,base rate x DRG weight,73054,,"38,809 x DRG weight",73054,Other,base rate x DRG weight,73054,,"38,809 x DRG weight",73054,Other,base rate x DRG weight,49744,,"26,426 x DRG weight",49744,Other,base rate x DRG weight,73054,,"38,809 x DRG weight",73054,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,131842,70,,131842,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,47167,,"25,057 x DRG weight",47167,Other,base rate x DRG weight,42452,,"22,552 x DRG weight",42452,Other,base rate x DRG weight,47167,,"25,057 x DRG weight",47167,Other,base rate x DRG weight,40091,,"21,298 x DRG weight",40091,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,131842,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,,inpatient,,,105015.35,14793,,,14793,Other,150% of Medicare + 9.63% HCRA Surcharge,8995.45,,,8995.45,Other,Medicare IPPS methodology,25945,,"25,046 x DRG weight",25945,Other,base rate x DRG weight,23350,,"22,541 x DRG weight",23350,Other,base rate x DRG weight,33243,,"32,091 x DRG weight",33243,Other,base rate x DRG weight,29919,,"28,882 x DRG weight",29919,Other,base rate x DRG weight,28256,,"27,277 x DRG weight",28256,Other,base rate x DRG weight,24944,,"24,080 x DRG weight",24944,Other,base rate x DRG weight,23269,,"22,463 x DRG weight",23269,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27375,,"26,426 x DRG weight",27375,Other,base rate x DRG weight,40202,,"38,809 x DRG weight",40202,Other,base rate x DRG weight,40202,,"38,809 x DRG weight",40202,Other,base rate x DRG weight,27375,,"26,426 x DRG weight",27375,Other,base rate x DRG weight,40202,,"38,809 x DRG weight",40202,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,73511,70,,73511,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25957,,"25,057 x DRG weight",25957,Other,base rate x DRG weight,23362,,"22,552 x DRG weight",23362,Other,base rate x DRG weight,25957,,"25,057 x DRG weight",25957,Other,base rate x DRG weight,22063,,"21,298 x DRG weight",22063,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,73511,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,,inpatient,,,318480.73,23599,,,23599,Other,150% of Medicare + 9.63% HCRA Surcharge,14350.78,,,14350.78,Other,Medicare IPPS methodology,41980,,"25,046 x DRG weight",41980,Other,base rate x DRG weight,37781,,"22,541 x DRG weight",37781,Other,base rate x DRG weight,53788,,"32,091 x DRG weight",53788,Other,base rate x DRG weight,48409,,"28,882 x DRG weight",48409,Other,base rate x DRG weight,45719,,"27,277 x DRG weight",45719,Other,base rate x DRG weight,40360,,"24,080 x DRG weight",40360,Other,base rate x DRG weight,37650,,"22,463 x DRG weight",37650,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,44293,,"26,426 x DRG weight",44293,Other,base rate x DRG weight,65048,,"38,809 x DRG weight",65048,Other,base rate x DRG weight,65048,,"38,809 x DRG weight",65048,Other,base rate x DRG weight,44293,,"26,426 x DRG weight",44293,Other,base rate x DRG weight,65048,,"38,809 x DRG weight",65048,Other,base rate x DRG weight,34997,,"6,363 x patient days",34997,Per diem,,222937,70,,222937,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,41998,,"25,057 x DRG weight",41998,Other,base rate x DRG weight,37799,,"22,552 x DRG weight",37799,Other,base rate x DRG weight,41998,,"25,057 x DRG weight",41998,Other,base rate x DRG weight,35698,,"21,298 x DRG weight",35698,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,222937,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,,inpatient,,,120820.28,12747,,,12747,Other,150% of Medicare + 9.63% HCRA Surcharge,7751.57,,,7751.57,Other,Medicare IPPS methodology,22221,,"25,046 x DRG weight",22221,Other,base rate x DRG weight,19998,,"22,541 x DRG weight",19998,Other,base rate x DRG weight,28471,,"32,091 x DRG weight",28471,Other,base rate x DRG weight,25624,,"28,882 x DRG weight",25624,Other,base rate x DRG weight,24200,,"27,277 x DRG weight",24200,Other,base rate x DRG weight,21364,,"24,080 x DRG weight",21364,Other,base rate x DRG weight,19929,,"22,463 x DRG weight",19929,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23445,,"26,426 x DRG weight",23445,Other,base rate x DRG weight,34431,,"38,809 x DRG weight",34431,Other,base rate x DRG weight,34431,,"38,809 x DRG weight",34431,Other,base rate x DRG weight,23445,,"26,426 x DRG weight",23445,Other,base rate x DRG weight,34431,,"38,809 x DRG weight",34431,Other,base rate x DRG weight,10181,,"6,363 x patient days",10181,Per diem,,84574,70,,84574,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22231,,"25,057 x DRG weight",22231,Other,base rate x DRG weight,20008,,"22,552 x DRG weight",20008,Other,base rate x DRG weight,22231,,"25,057 x DRG weight",22231,Other,base rate x DRG weight,18896,,"21,298 x DRG weight",18896,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,84574,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,,inpatient,,,117580.68,19869,,,19869,Other,150% of Medicare + 9.63% HCRA Surcharge,12082.17,,,12082.17,Other,Medicare IPPS methodology,35187,,"25,046 x DRG weight",35187,Other,base rate x DRG weight,31668,,"22,541 x DRG weight",31668,Other,base rate x DRG weight,45085,,"32,091 x DRG weight",45085,Other,base rate x DRG weight,40576,,"28,882 x DRG weight",40576,Other,base rate x DRG weight,38321,,"27,277 x DRG weight",38321,Other,base rate x DRG weight,33830,,"24,080 x DRG weight",33830,Other,base rate x DRG weight,31558,,"22,463 x DRG weight",31558,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37126,,"26,426 x DRG weight",37126,Other,base rate x DRG weight,54523,,"38,809 x DRG weight",54523,Other,base rate x DRG weight,54523,,"38,809 x DRG weight",54523,Other,base rate x DRG weight,37126,,"26,426 x DRG weight",37126,Other,base rate x DRG weight,54523,,"38,809 x DRG weight",54523,Other,base rate x DRG weight,11453,,"6,363 x patient days",11453,Per diem,,82306,70,,82306,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35203,,"25,057 x DRG weight",35203,Other,base rate x DRG weight,31683,,"22,552 x DRG weight",31683,Other,base rate x DRG weight,35203,,"25,057 x DRG weight",35203,Other,base rate x DRG weight,29922,,"21,298 x DRG weight",29922,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,82306,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,,inpatient,,,154320.11,35169,,,35169,Other,150% of Medicare + 9.63% HCRA Surcharge,21386.64,,,21386.64,Other,Medicare IPPS methodology,63046,,"25,046 x DRG weight",63046,Other,base rate x DRG weight,56740,,"22,541 x DRG weight",56740,Other,base rate x DRG weight,80779,,"32,091 x DRG weight",80779,Other,base rate x DRG weight,72702,,"28,882 x DRG weight",72702,Other,base rate x DRG weight,68662,,"27,277 x DRG weight",68662,Other,base rate x DRG weight,60614,,"24,080 x DRG weight",60614,Other,base rate x DRG weight,56544,,"22,463 x DRG weight",56544,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,66520,,"26,426 x DRG weight",66520,Other,base rate x DRG weight,97690,,"38,809 x DRG weight",97690,Other,base rate x DRG weight,97690,,"38,809 x DRG weight",97690,Other,base rate x DRG weight,66520,,"26,426 x DRG weight",66520,Other,base rate x DRG weight,97690,,"38,809 x DRG weight",97690,Other,base rate x DRG weight,48359,,"6,363 x patient days",48359,Per diem,,108024,70,,108024,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,63073,,"25,057 x DRG weight",63073,Other,base rate x DRG weight,56768,,"22,552 x DRG weight",56768,Other,base rate x DRG weight,63073,,"25,057 x DRG weight",63073,Other,base rate x DRG weight,53611,,"21,298 x DRG weight",53611,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,108024,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,,inpatient,,,77672.49,19251,,,19251,Other,150% of Medicare + 9.63% HCRA Surcharge,11706.57,,,11706.57,Other,Medicare IPPS methodology,34063,,"25,046 x DRG weight",34063,Other,base rate x DRG weight,30656,,"22,541 x DRG weight",30656,Other,base rate x DRG weight,43644,,"32,091 x DRG weight",43644,Other,base rate x DRG weight,39280,,"28,882 x DRG weight",39280,Other,base rate x DRG weight,37097,,"27,277 x DRG weight",37097,Other,base rate x DRG weight,32749,,"24,080 x DRG weight",32749,Other,base rate x DRG weight,30550,,"22,463 x DRG weight",30550,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,35939,,"26,426 x DRG weight",35939,Other,base rate x DRG weight,52780,,"38,809 x DRG weight",52780,Other,base rate x DRG weight,52780,,"38,809 x DRG weight",52780,Other,base rate x DRG weight,35939,,"26,426 x DRG weight",35939,Other,base rate x DRG weight,52780,,"38,809 x DRG weight",52780,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,54371,70,,54371,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,34078,,"25,057 x DRG weight",34078,Other,base rate x DRG weight,30671,,"22,552 x DRG weight",30671,Other,base rate x DRG weight,34078,,"25,057 x DRG weight",34078,Other,base rate x DRG weight,28965,,"21,298 x DRG weight",28965,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,54371,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,,inpatient,,,223184.5,26026,,,26026,Other,150% of Medicare + 9.63% HCRA Surcharge,15826.38,,,15826.38,Other,Medicare IPPS methodology,46398,,"25,046 x DRG weight",46398,Other,base rate x DRG weight,41757,,"22,541 x DRG weight",41757,Other,base rate x DRG weight,59449,,"32,091 x DRG weight",59449,Other,base rate x DRG weight,53504,,"28,882 x DRG weight",53504,Other,base rate x DRG weight,50531,,"27,277 x DRG weight",50531,Other,base rate x DRG weight,44608,,"24,080 x DRG weight",44608,Other,base rate x DRG weight,41613,,"22,463 x DRG weight",41613,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48954,,"26,426 x DRG weight",48954,Other,base rate x DRG weight,71894,,"38,809 x DRG weight",71894,Other,base rate x DRG weight,71894,,"38,809 x DRG weight",71894,Other,base rate x DRG weight,48954,,"26,426 x DRG weight",48954,Other,base rate x DRG weight,71894,,"38,809 x DRG weight",71894,Other,base rate x DRG weight,47086,,"6,363 x patient days",47086,Per diem,,156229,70,,156229,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46418,,"25,057 x DRG weight",46418,Other,base rate x DRG weight,41778,,"22,552 x DRG weight",41778,Other,base rate x DRG weight,46418,,"25,057 x DRG weight",46418,Other,base rate x DRG weight,39455,,"21,298 x DRG weight",39455,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,156229,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,,inpatient,,,225371.75,15464,,,15464,Other,150% of Medicare + 9.63% HCRA Surcharge,9403.67,,,9403.67,Other,Medicare IPPS methodology,27167,,"25,046 x DRG weight",27167,Other,base rate x DRG weight,24450,,"22,541 x DRG weight",24450,Other,base rate x DRG weight,34809,,"32,091 x DRG weight",34809,Other,base rate x DRG weight,31328,,"28,882 x DRG weight",31328,Other,base rate x DRG weight,29587,,"27,277 x DRG weight",29587,Other,base rate x DRG weight,26120,,"24,080 x DRG weight",26120,Other,base rate x DRG weight,24366,,"22,463 x DRG weight",24366,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28664,,"26,426 x DRG weight",28664,Other,base rate x DRG weight,42096,,"38,809 x DRG weight",42096,Other,base rate x DRG weight,42096,,"38,809 x DRG weight",42096,Other,base rate x DRG weight,28664,,"26,426 x DRG weight",28664,Other,base rate x DRG weight,42096,,"38,809 x DRG weight",42096,Other,base rate x DRG weight,27997,,"6,363 x patient days",27997,Per diem,,157760,70,,157760,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27179,,"25,057 x DRG weight",27179,Other,base rate x DRG weight,24462,,"22,552 x DRG weight",24462,Other,base rate x DRG weight,27179,,"25,057 x DRG weight",27179,Other,base rate x DRG weight,23102,,"21,298 x DRG weight",23102,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,157760,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,,inpatient,,,94960,14157,,,14157,Other,150% of Medicare + 9.63% HCRA Surcharge,8608.99,,,8608.99,Other,Medicare IPPS methodology,24788,,"25,046 x DRG weight",24788,Other,base rate x DRG weight,22309,,"22,541 x DRG weight",22309,Other,base rate x DRG weight,31760,,"32,091 x DRG weight",31760,Other,base rate x DRG weight,28585,,"28,882 x DRG weight",28585,Other,base rate x DRG weight,26996,,"27,277 x DRG weight",26996,Other,base rate x DRG weight,23832,,"24,080 x DRG weight",23832,Other,base rate x DRG weight,22232,,"22,463 x DRG weight",22232,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26154,,"26,426 x DRG weight",26154,Other,base rate x DRG weight,38409,,"38,809 x DRG weight",38409,Other,base rate x DRG weight,38409,,"38,809 x DRG weight",38409,Other,base rate x DRG weight,26154,,"26,426 x DRG weight",26154,Other,base rate x DRG weight,38409,,"38,809 x DRG weight",38409,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,66472,70,,66472,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24799,,"25,057 x DRG weight",24799,Other,base rate x DRG weight,22320,,"22,552 x DRG weight",22320,Other,base rate x DRG weight,24799,,"25,057 x DRG weight",24799,Other,base rate x DRG weight,21079,,"21,298 x DRG weight",21079,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,66472,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,,inpatient,,,109570.47,21061,,,21061,Other,150% of Medicare + 9.63% HCRA Surcharge,12807.42,,,12807.42,Other,Medicare IPPS methodology,37359,,"25,046 x DRG weight",37359,Other,base rate x DRG weight,33622,,"22,541 x DRG weight",33622,Other,base rate x DRG weight,47867,,"32,091 x DRG weight",47867,Other,base rate x DRG weight,43080,,"28,882 x DRG weight",43080,Other,base rate x DRG weight,40686,,"27,277 x DRG weight",40686,Other,base rate x DRG weight,35918,,"24,080 x DRG weight",35918,Other,base rate x DRG weight,33506,,"22,463 x DRG weight",33506,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39417,,"26,426 x DRG weight",39417,Other,base rate x DRG weight,57888,,"38,809 x DRG weight",57888,Other,base rate x DRG weight,57888,,"38,809 x DRG weight",57888,Other,base rate x DRG weight,39417,,"26,426 x DRG weight",39417,Other,base rate x DRG weight,57888,,"38,809 x DRG weight",57888,Other,base rate x DRG weight,41996,,"6,363 x patient days",41996,Per diem,,76699,70,,76699,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37375,,"25,057 x DRG weight",37375,Other,base rate x DRG weight,33639,,"22,552 x DRG weight",33639,Other,base rate x DRG weight,37375,,"25,057 x DRG weight",37375,Other,base rate x DRG weight,31768,,"21,298 x DRG weight",31768,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,76699,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,,inpatient,,,140774.2,14197,,,14197,Other,150% of Medicare + 9.63% HCRA Surcharge,8633.25,,,8633.25,Other,Medicare IPPS methodology,24861,,"25,046 x DRG weight",24861,Other,base rate x DRG weight,22374,,"22,541 x DRG weight",22374,Other,base rate x DRG weight,31854,,"32,091 x DRG weight",31854,Other,base rate x DRG weight,28668,,"28,882 x DRG weight",28668,Other,base rate x DRG weight,27075,,"27,277 x DRG weight",27075,Other,base rate x DRG weight,23902,,"24,080 x DRG weight",23902,Other,base rate x DRG weight,22297,,"22,463 x DRG weight",22297,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26230,,"26,426 x DRG weight",26230,Other,base rate x DRG weight,38522,,"38,809 x DRG weight",38522,Other,base rate x DRG weight,38522,,"38,809 x DRG weight",38522,Other,base rate x DRG weight,26230,,"26,426 x DRG weight",26230,Other,base rate x DRG weight,38522,,"38,809 x DRG weight",38522,Other,base rate x DRG weight,29270,,"6,363 x patient days",29270,Per diem,,98542,70,,98542,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24872,,"25,057 x DRG weight",24872,Other,base rate x DRG weight,22385,,"22,552 x DRG weight",22385,Other,base rate x DRG weight,24872,,"25,057 x DRG weight",24872,Other,base rate x DRG weight,21140,,"21,298 x DRG weight",21140,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,98542,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,,inpatient,,,80688.03,9432,,,9432,Other,150% of Medicare + 9.63% HCRA Surcharge,5735.58,,,5735.58,Other,Medicare IPPS methodology,16185,,"25,046 x DRG weight",16185,Other,base rate x DRG weight,14566,,"22,541 x DRG weight",14566,Other,base rate x DRG weight,20737,,"32,091 x DRG weight",20737,Other,base rate x DRG weight,18664,,"28,882 x DRG weight",18664,Other,base rate x DRG weight,17626,,"27,277 x DRG weight",17626,Other,base rate x DRG weight,15560,,"24,080 x DRG weight",15560,Other,base rate x DRG weight,14516,,"22,463 x DRG weight",14516,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,17076,,"26,426 x DRG weight",17076,Other,base rate x DRG weight,25078,,"38,809 x DRG weight",25078,Other,base rate x DRG weight,25078,,"38,809 x DRG weight",25078,Other,base rate x DRG weight,17076,,"26,426 x DRG weight",17076,Other,base rate x DRG weight,25078,,"38,809 x DRG weight",25078,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,56482,70,,56482,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,16192,,"25,057 x DRG weight",16192,Other,base rate x DRG weight,14573,,"22,552 x DRG weight",14573,Other,base rate x DRG weight,16192,,"25,057 x DRG weight",16192,Other,base rate x DRG weight,13763,,"21,298 x DRG weight",13763,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,56482,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,,inpatient,,,75978.04,14235,,,14235,Other,150% of Medicare + 9.63% HCRA Surcharge,8656.67,,,8656.67,Other,Medicare IPPS methodology,24931,,"25,046 x DRG weight",24931,Other,base rate x DRG weight,22437,,"22,541 x DRG weight",22437,Other,base rate x DRG weight,31943,,"32,091 x DRG weight",31943,Other,base rate x DRG weight,28749,,"28,882 x DRG weight",28749,Other,base rate x DRG weight,27152,,"27,277 x DRG weight",27152,Other,base rate x DRG weight,23969,,"24,080 x DRG weight",23969,Other,base rate x DRG weight,22360,,"22,463 x DRG weight",22360,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26304,,"26,426 x DRG weight",26304,Other,base rate x DRG weight,38630,,"38,809 x DRG weight",38630,Other,base rate x DRG weight,38630,,"38,809 x DRG weight",38630,Other,base rate x DRG weight,26304,,"26,426 x DRG weight",26304,Other,base rate x DRG weight,38630,,"38,809 x DRG weight",38630,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,53185,70,,53185,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24942,,"25,057 x DRG weight",24942,Other,base rate x DRG weight,22448,,"22,552 x DRG weight",22448,Other,base rate x DRG weight,24942,,"25,057 x DRG weight",24942,Other,base rate x DRG weight,21200,,"21,298 x DRG weight",21200,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,53185,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,,inpatient,,,72379.63,8873,,,8873,Other,150% of Medicare + 9.63% HCRA Surcharge,5395.96,,,5395.96,Other,Medicare IPPS methodology,15168,,"25,046 x DRG weight",15168,Other,base rate x DRG weight,13651,,"22,541 x DRG weight",13651,Other,base rate x DRG weight,19434,,"32,091 x DRG weight",19434,Other,base rate x DRG weight,17491,,"28,882 x DRG weight",17491,Other,base rate x DRG weight,16519,,"27,277 x DRG weight",16519,Other,base rate x DRG weight,14583,,"24,080 x DRG weight",14583,Other,base rate x DRG weight,13604,,"22,463 x DRG weight",13604,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,16004,,"26,426 x DRG weight",16004,Other,base rate x DRG weight,23503,,"38,809 x DRG weight",23503,Other,base rate x DRG weight,23503,,"38,809 x DRG weight",23503,Other,base rate x DRG weight,16004,,"26,426 x DRG weight",16004,Other,base rate x DRG weight,23503,,"38,809 x DRG weight",23503,Other,base rate x DRG weight,13362,,"6,363 x patient days",13362,Per diem,,50666,70,,50666,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15175,,"25,057 x DRG weight",15175,Other,base rate x DRG weight,13657,,"22,552 x DRG weight",13657,Other,base rate x DRG weight,15175,,"25,057 x DRG weight",15175,Other,base rate x DRG weight,12898,,"21,298 x DRG weight",12898,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,50666,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,,inpatient,,,94083.98,17299,,,17299,Other,150% of Medicare + 9.63% HCRA Surcharge,10519.57,,,10519.57,Other,Medicare IPPS methodology,13608,,,13608,Case Rate,,12247,,,12247,Case Rate,,39090,,"32,091 x DRG weight",39090,Other,base rate x DRG weight,35181,,"28,882 x DRG weight",35181,Other,base rate x DRG weight,33226,,"27,277 x DRG weight",33226,Other,base rate x DRG weight,29332,,"24,080 x DRG weight",29332,Other,base rate x DRG weight,10042,,,10042,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,18158,,,18158,Case Rate,,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,19290,,,19290,Case Rate,,65859,70,,65859,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,11119,,,11119,Case Rate,,10007,,,10007,Case Rate,,11119,,,11119,Case Rate,,9451,,,9451,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,65859,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,,inpatient,,,204856.68,21781,,,21781,Other,150% of Medicare + 9.63% HCRA Surcharge,13244.91,,,13244.91,Other,Medicare IPPS methodology,38669,,"25,046 x DRG weight",38669,Other,base rate x DRG weight,34801,,"22,541 x DRG weight",34801,Other,base rate x DRG weight,49545,,"32,091 x DRG weight",49545,Other,base rate x DRG weight,44591,,"28,882 x DRG weight",44591,Other,base rate x DRG weight,42113,,"27,277 x DRG weight",42113,Other,base rate x DRG weight,37177,,"24,080 x DRG weight",37177,Other,base rate x DRG weight,34681,,"22,463 x DRG weight",34681,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,40799,,"26,426 x DRG weight",40799,Other,base rate x DRG weight,59917,,"38,809 x DRG weight",59917,Other,base rate x DRG weight,59917,,"38,809 x DRG weight",59917,Other,base rate x DRG weight,40799,,"26,426 x DRG weight",40799,Other,base rate x DRG weight,59917,,"38,809 x DRG weight",59917,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,143400,70,,143400,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,38686,,"25,057 x DRG weight",38686,Other,base rate x DRG weight,34818,,"22,552 x DRG weight",34818,Other,base rate x DRG weight,38686,,"25,057 x DRG weight",38686,Other,base rate x DRG weight,32882,,"21,298 x DRG weight",32882,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,143400,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,,inpatient,,,121738.67,11530,,,11530,Other,150% of Medicare + 9.63% HCRA Surcharge,7011.26,,,7011.26,Other,Medicare IPPS methodology,20004,,"25,046 x DRG weight",20004,Other,base rate x DRG weight,18003,,"22,541 x DRG weight",18003,Other,base rate x DRG weight,25631,,"32,091 x DRG weight",25631,Other,base rate x DRG weight,23068,,"28,882 x DRG weight",23068,Other,base rate x DRG weight,21786,,"27,277 x DRG weight",21786,Other,base rate x DRG weight,19233,,"24,080 x DRG weight",19233,Other,base rate x DRG weight,17941,,"22,463 x DRG weight",17941,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21106,,"26,426 x DRG weight",21106,Other,base rate x DRG weight,30997,,"38,809 x DRG weight",30997,Other,base rate x DRG weight,30997,,"38,809 x DRG weight",30997,Other,base rate x DRG weight,21106,,"26,426 x DRG weight",21106,Other,base rate x DRG weight,30997,,"38,809 x DRG weight",30997,Other,base rate x DRG weight,12726,,"6,363 x patient days",12726,Per diem,,85217,70,,85217,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20013,,"25,057 x DRG weight",20013,Other,base rate x DRG weight,18012,,"22,552 x DRG weight",18012,Other,base rate x DRG weight,20013,,"25,057 x DRG weight",20013,Other,base rate x DRG weight,17011,,"21,298 x DRG weight",17011,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,85217,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,,inpatient,,,80412.78,10402,,,10402,Other,150% of Medicare + 9.63% HCRA Surcharge,6325.32,,,6325.32,Other,Medicare IPPS methodology,17950,,"25,046 x DRG weight",17950,Other,base rate x DRG weight,16155,,"22,541 x DRG weight",16155,Other,base rate x DRG weight,23000,,"32,091 x DRG weight",23000,Other,base rate x DRG weight,20700,,"28,882 x DRG weight",20700,Other,base rate x DRG weight,19549,,"27,277 x DRG weight",19549,Other,base rate x DRG weight,17258,,"24,080 x DRG weight",17258,Other,base rate x DRG weight,16099,,"22,463 x DRG weight",16099,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18940,,"26,426 x DRG weight",18940,Other,base rate x DRG weight,27814,,"38,809 x DRG weight",27814,Other,base rate x DRG weight,27814,,"38,809 x DRG weight",27814,Other,base rate x DRG weight,18940,,"26,426 x DRG weight",18940,Other,base rate x DRG weight,27814,,"38,809 x DRG weight",27814,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,56289,70,,56289,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17958,,"25,057 x DRG weight",17958,Other,base rate x DRG weight,16163,,"22,552 x DRG weight",16163,Other,base rate x DRG weight,17958,,"25,057 x DRG weight",17958,Other,base rate x DRG weight,15264,,"21,298 x DRG weight",15264,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,56289,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,,inpatient,,,161268.53,14150,,,14150,Other,150% of Medicare + 9.63% HCRA Surcharge,8604.8,,,8604.8,Other,Medicare IPPS methodology,24776,,"25,046 x DRG weight",24776,Other,base rate x DRG weight,22298,,"22,541 x DRG weight",22298,Other,base rate x DRG weight,31744,,"32,091 x DRG weight",31744,Other,base rate x DRG weight,28570,,"28,882 x DRG weight",28570,Other,base rate x DRG weight,26982,,"27,277 x DRG weight",26982,Other,base rate x DRG weight,23820,,"24,080 x DRG weight",23820,Other,base rate x DRG weight,22220,,"22,463 x DRG weight",22220,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26141,,"26,426 x DRG weight",26141,Other,base rate x DRG weight,38390,,"38,809 x DRG weight",38390,Other,base rate x DRG weight,38390,,"38,809 x DRG weight",38390,Other,base rate x DRG weight,26141,,"26,426 x DRG weight",26141,Other,base rate x DRG weight,38390,,"38,809 x DRG weight",38390,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,112888,70,,112888,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24786,,"25,057 x DRG weight",24786,Other,base rate x DRG weight,22308,,"22,552 x DRG weight",22308,Other,base rate x DRG weight,24786,,"25,057 x DRG weight",24786,Other,base rate x DRG weight,21068,,"21,298 x DRG weight",21068,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,112888,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,,inpatient,,,326103.8,24916,,,24916,Other,150% of Medicare + 9.63% HCRA Surcharge,15151.31,,,15151.31,Other,Medicare IPPS methodology,22698,,,22698,Case Rate,,20428,,,20428,Case Rate,,56859,,"32,091 x DRG weight",56859,Other,base rate x DRG weight,51173,,"28,882 x DRG weight",51173,Other,base rate x DRG weight,48329,,"27,277 x DRG weight",48329,Other,base rate x DRG weight,42665,,"24,080 x DRG weight",42665,Other,base rate x DRG weight,15062,,,15062,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,25662,,,25662,Case Rate,,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,19290,,,19290,Case Rate,,228273,70,,228273,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15017,,,15017,Case Rate,,13515,,,13515,Case Rate,,15017,,,15017,Case Rate,,12765,,,12765,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,228273,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,,inpatient,,,136580.72,14630,,,14630,Other,150% of Medicare + 9.63% HCRA Surcharge,8896.75,,,8896.75,Other,Medicare IPPS methodology,22698,,,22698,Case Rate,,20428,,,20428,Case Rate,,32864,,"32,091 x DRG weight",32864,Other,base rate x DRG weight,29578,,"28,882 x DRG weight",29578,Other,base rate x DRG weight,27934,,"27,277 x DRG weight",27934,Other,base rate x DRG weight,24660,,"24,080 x DRG weight",24660,Other,base rate x DRG weight,15062,,,15062,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,25662,,,25662,Case Rate,,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,19290,,,19290,Case Rate,,95607,70,,95607,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15017,,,15017,Case Rate,,13515,,,13515,Case Rate,,15017,,,15017,Case Rate,,12765,,,12765,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95607,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,,inpatient,,,129444.36,12460,,,12460,Other,150% of Medicare + 9.63% HCRA Surcharge,7576.74,,,7576.74,Other,Medicare IPPS methodology,18113,,,18113,Case Rate,,16302,,,16302,Case Rate,,27800,,"32,091 x DRG weight",27800,Other,base rate x DRG weight,25020,,"28,882 x DRG weight",25020,Other,base rate x DRG weight,23630,,"27,277 x DRG weight",23630,Other,base rate x DRG weight,20861,,"24,080 x DRG weight",20861,Other,base rate x DRG weight,15062,,,15062,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,25662,,,25662,Case Rate,,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,19290,,,19290,Case Rate,,90611,70,,90611,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15017,,,15017,Case Rate,,13515,,,13515,Case Rate,,15017,,,15017,Case Rate,,12765,,,12765,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,90611,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,,inpatient,,,180273.63,24609,,,24609,Other,150% of Medicare + 9.63% HCRA Surcharge,14964.77,,,14964.77,Other,Medicare IPPS methodology,22698,,,22698,Case Rate,,20428,,,20428,Case Rate,,56143,,"32,091 x DRG weight",56143,Other,base rate x DRG weight,50529,,"28,882 x DRG weight",50529,Other,base rate x DRG weight,47721,,"27,277 x DRG weight",47721,Other,base rate x DRG weight,42128,,"24,080 x DRG weight",42128,Other,base rate x DRG weight,15062,,,15062,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,25662,,,25662,Case Rate,,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,19290,,,19290,Case Rate,,126192,70,,126192,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15017,,,15017,Case Rate,,13515,,,13515,Case Rate,,15017,,,15017,Case Rate,,12765,,,12765,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,126192,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,,inpatient,,,152105.02,15002,,,15002,Other,150% of Medicare + 9.63% HCRA Surcharge,9122.6,,,9122.6,Other,Medicare IPPS methodology,22698,,,22698,Case Rate,,20428,,,20428,Case Rate,,33731,,"32,091 x DRG weight",33731,Other,base rate x DRG weight,30358,,"28,882 x DRG weight",30358,Other,base rate x DRG weight,28671,,"27,277 x DRG weight",28671,Other,base rate x DRG weight,25310,,"24,080 x DRG weight",25310,Other,base rate x DRG weight,15062,,,15062,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,25662,,,25662,Case Rate,,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,19290,,,19290,Case Rate,,106474,70,,106474,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15017,,,15017,Case Rate,,13515,,,13515,Case Rate,,15017,,,15017,Case Rate,,12765,,,12765,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,106474,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,,inpatient,,,117547.07,12304,,,12304,Other,150% of Medicare + 9.63% HCRA Surcharge,7482.21,,,7482.21,Other,Medicare IPPS methodology,18113,,,18113,Case Rate,,16300,,,16300,Case Rate,,27438,,"32,091 x DRG weight",27438,Other,base rate x DRG weight,24694,,"28,882 x DRG weight",24694,Other,base rate x DRG weight,23322,,"27,277 x DRG weight",23322,Other,base rate x DRG weight,20588,,"24,080 x DRG weight",20588,Other,base rate x DRG weight,15062,,,15062,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,25662,,,25662,Case Rate,,17720,,,17720,Case Rate,,25662,,,25662,Case Rate,,19290,,,19290,Case Rate,,82283,70,,82283,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,15017,,,15017,Case Rate,,13515,,,13515,Case Rate,,15017,,,15017,Case Rate,,12765,,,12765,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,82283,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,,inpatient,,,1418836.78,25570,,,25570,Other,150% of Medicare + 9.63% HCRA Surcharge,15549.49,,,15549.49,Other,Medicare IPPS methodology,8815,,"4,897 x patient days",8815,Per diem,,7933,,"4,407 x patient days",7933,Per diem,,58386,,"32,091 x DRG weight",58386,Other,base rate x DRG weight,52548,,"28,882 x DRG weight",52548,Other,base rate x DRG weight,49628,,"27,277 x DRG weight",49628,Other,base rate x DRG weight,43811,,"24,080 x DRG weight",43811,Other,base rate x DRG weight,3369.6,,"6,223 x patient days",3369.6,Per diem,,0.01,,,0.01,Other,See APR-DRG information,13177.8,,"7,321 x patient days",13177.8,Per diem,,9180,,"5,100 x patient days",9180,Per diem,,9180,,"5,100 x patient days",9180,Per diem,,13178,,"7,321 x patient days",13178,Per diem,,9180,,"5,100 x patient days",9180,Per diem,,3809,,,3809,Case Rate,,993186,70,,993186,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,10510.2,,"5,839 x patient days",10510.2,Per diem,,9459,,"5,255 x patient days",9459,Per diem,,10510.2,,"5,839 x patient days",10510.2,Per diem,,8933,,"4,963 x patient days",8933,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,993186,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,,inpatient,,,1430505.82,83080,,,83080,Other,150% of Medicare + 9.63% HCRA Surcharge,50521.37,,,50521.37,Other,Medicare IPPS methodology,137741,,"7,695 x patient days",137741,Per diem,,123975,,"6,926 x patient days",123975,Per diem,,192549,,"32,091 x DRG weight",192549,Other,base rate x DRG weight,173295,,"28,882 x DRG weight",173295,Other,base rate x DRG weight,163665,,"27,277 x DRG weight",163665,Other,base rate x DRG weight,144482,,"24,080 x DRG weight",144482,Other,base rate x DRG weight,33508.8,,"6,223 x patient days",33508.8,Per diem,,0.01,,,0.01,Other,See APR-DRG information,131045.9,,"7,321 x patient days",131045.9,Per diem,,91290,,"5,100 x patient days",91290,Per diem,,91290,,"5,100 x patient days",91290,Per diem,,131046,,"7,321 x patient days",131046,Per diem,,91290,,"5,100 x patient days",91290,Per diem,,3809,,,3809,Case Rate,,1001354,70,,1001354,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,104786.6,,"5,854 x patient days",104786.6,Per diem,,100920,,"5,638 x patient days",100920,Per diem,,104786.6,,"5,854 x patient days",104786.6,Per diem,,95300,,"5,324 x patient days",95300,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,1001354,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,,inpatient,,,467884.73,56911,,,56911,Other,150% of Medicare + 9.63% HCRA Surcharge,34607.65,,,34607.65,Other,Medicare IPPS methodology,102344,,"7,695 x patient days",102344,Per diem,,92116,,"6,926 x patient days",92116,Per diem,,131499,,"32,091 x DRG weight",131499,Other,base rate x DRG weight,118350,,"28,882 x DRG weight",118350,Other,base rate x DRG weight,111773,,"27,277 x DRG weight",111773,Other,base rate x DRG weight,98673,,"24,080 x DRG weight",98673,Other,base rate x DRG weight,24897.6,,"6,223 x patient days",24897.6,Per diem,,0.01,,,0.01,Other,See APR-DRG information,97369.3,,"7,321 x patient days",97369.3,Per diem,,67830,,"5,100 x patient days",67830,Per diem,,67830,,"5,100 x patient days",67830,Per diem,,97369,,"7,321 x patient days",97369,Per diem,,67830,,"5,100 x patient days",67830,Per diem,,3809,,,3809,Case Rate,,327519,70,,327519,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,83311.2,,"6,264 x patient days",83311.2,Per diem,,74985,,"5,638 x patient days",74985,Per diem,,83311.2,,"6,264 x patient days",83311.2,Per diem,,66181,,"4,976 x patient days",66181,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,327519,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,,inpatient,,,188718.27,34554,,,34554,Other,150% of Medicare + 9.63% HCRA Surcharge,21012.72,,,21012.72,Other,Medicare IPPS methodology,42114,,"4,897 x patient days",42114,Per diem,,37900,,"4,407 x patient days",37900,Per diem,,79345,,"32,091 x DRG weight",79345,Other,base rate x DRG weight,71411,,"28,882 x DRG weight",71411,Other,base rate x DRG weight,67442,,"27,277 x DRG weight",67442,Other,base rate x DRG weight,59538,,"24,080 x DRG weight",59538,Other,base rate x DRG weight,16099.2,,"6,223 x patient days",16099.2,Per diem,,0.01,,,0.01,Other,See APR-DRG information,62960.6,,"7,321 x patient days",62960.6,Per diem,,43860,,"5,100 x patient days",43860,Per diem,,43860,,"5,100 x patient days",43860,Per diem,,62961,,"7,321 x patient days",62961,Per diem,,43860,,"5,100 x patient days",43860,Per diem,,3809,,,3809,Case Rate,,132103,70,,132103,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,50215.4,,"5,839 x patient days",50215.4,Per diem,,45193,,"5,255 x patient days",45193,Per diem,,50215.4,,"5,839 x patient days",50215.4,Per diem,,42682,,"4,963 x patient days",42682,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,132103,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,,inpatient,,,267942.92,58446,,,58446,Other,150% of Medicare + 9.63% HCRA Surcharge,35541.19,,,35541.19,Other,Medicare IPPS methodology,36167,,"7,695 x patient days",36167,Per diem,,32552,,"6,926 x patient days",32552,Per diem,,135081,,"32,091 x DRG weight",135081,Other,base rate x DRG weight,121573,,"28,882 x DRG weight",121573,Other,base rate x DRG weight,114817,,"27,277 x DRG weight",114817,Other,base rate x DRG weight,101360,,"24,080 x DRG weight",101360,Other,base rate x DRG weight,8798.4,,"6,223 x patient days",8798.4,Per diem,,0.01,,,0.01,Other,See APR-DRG information,34408.7,,"7,321 x patient days",34408.7,Per diem,,23970,,"5,100 x patient days",23970,Per diem,,23970,,"5,100 x patient days",23970,Per diem,,34409,,"7,321 x patient days",34409,Per diem,,23970,,"5,100 x patient days",23970,Per diem,,3809,,,3809,Case Rate,,187560,70,,187560,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,29440.8,,"6,264 x patient days",29440.8,Per diem,,26499,,"5,638 x patient days",26499,Per diem,,29440.8,,"6,264 x patient days",29440.8,Per diem,,25023,,"5,324 x patient days",25023,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,187560,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,,inpatient,,,52210.18,21038,,,21038,Other,150% of Medicare + 9.63% HCRA Surcharge,12793.2,,,12793.2,Other,Medicare IPPS methodology,16650,,"4,897 x patient days",16650,Per diem,,14984,,"4,407 x patient days",14984,Per diem,,47812,,"32,091 x DRG weight",47812,Other,base rate x DRG weight,43031,,"28,882 x DRG weight",43031,Other,base rate x DRG weight,40640,,"27,277 x DRG weight",40640,Other,base rate x DRG weight,35877,,"24,080 x DRG weight",35877,Other,base rate x DRG weight,6364.8,,"6,223 x patient days",6364.8,Per diem,,0.01,,,0.01,Other,See APR-DRG information,24891.4,,"7,321 x patient days",24891.4,Per diem,,17340,,"5,100 x patient days",17340,Per diem,,17340,,"5,100 x patient days",17340,Per diem,,24891,,"7,321 x patient days",24891,Per diem,,17340,,"5,100 x patient days",17340,Per diem,,3809,,,3809,Case Rate,,36547,70,,36547,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,19852.6,,"5,839 x patient days",19852.6,Per diem,,17867,,"5,255 x patient days",17867,Per diem,,19852.6,,"5,839 x patient days",19852.6,Per diem,,16874,,"4,963 x patient days",16874,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,47812,
NORMAL NEWBORN,795,MS-DRG,,,,,,,,inpatient,,,22159.76,3317,,,3317,Other,150% of Medicare + 9.63% HCRA Surcharge,2017.31,,,2017.31,Other,Medicare IPPS methodology,13014,,"4,198 x patient days",13014,Per diem,,11712,,"3,778 x patient days",11712,Per diem,,6473,,"32,091 x DRG weight",6473,Other,base rate x DRG weight,5825,,"28,882 x DRG weight",5825,Other,base rate x DRG weight,5502,,"27,277 x DRG weight",5502,Other,base rate x DRG weight,4857,,"24,080 x DRG weight",4857,Other,base rate x DRG weight,5803.2,,"1,872 x patient days",5803.2,Per diem,,0.01,,,0.01,Other,See APR-DRG information,6826.2,,"2,202 x patient days",6826.2,Per diem,,11776.9,,"3,799 x patient days",11776.9,Per diem,,11776.9,,"3,799 x patient days",11776.9,Per diem,,6800,,"2,202 x patient days",6800,Per diem,,11776.9,,"3,799 x patient days",11776.9,Per diem,,3809,,,3809,Case Rate,,15512,70,,15512,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,5871.4,,"1,894 x patient days",5871.4,Per diem,,5286,,"1,705 x patient days",5286,Per diem,,5871.4,,"1,894 x patient days",5871.4,Per diem,,4991,,"1,610 x patient days",4991,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,15512,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,,inpatient,,,116164.8,20054,,,20054,Other,150% of Medicare + 9.63% HCRA Surcharge,12195.1,,,12195.1,Other,Medicare IPPS methodology,12705,,,12705,Case Rate,,11435,,,11435,Case Rate,,45518,,"32,091 x DRG weight",45518,Other,base rate x DRG weight,40966,,"28,882 x DRG weight",40966,Other,base rate x DRG weight,38690,,"27,277 x DRG weight",38690,Other,base rate x DRG weight,34155,,"24,080 x DRG weight",34155,Other,base rate x DRG weight,10042,,,10042,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,18158,,,18158,Case Rate,,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,19290,,,19290,Case Rate,,81315,70,,81315,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,11119,,,11119,Case Rate,,10007,,,10007,Case Rate,,11119,,,11119,Case Rate,,9451,,,9451,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,81315,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,,inpatient,,,225725.21,14242,,,14242,Other,150% of Medicare + 9.63% HCRA Surcharge,8660.85,,,8660.85,Other,Medicare IPPS methodology,12700,,,12700,Case Rate,,11435,,,11435,Case Rate,,31959,,"32,091 x DRG weight",31959,Other,base rate x DRG weight,28764,,"28,882 x DRG weight",28764,Other,base rate x DRG weight,27165,,"27,277 x DRG weight",27165,Other,base rate x DRG weight,23981,,"24,080 x DRG weight",23981,Other,base rate x DRG weight,10042,,,10042,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,18158,,,18158,Case Rate,,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,19290,,,19290,Case Rate,,158008,70,,158008,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,11119,,,11119,Case Rate,,10007,,,10007,Case Rate,,11119,,,11119,Case Rate,,9451,,,9451,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,158008,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,,inpatient,,,111119.12,12030,,,12030,Other,150% of Medicare + 9.63% HCRA Surcharge,7315.75,,,7315.75,Other,Medicare IPPS methodology,12705,,,12705,Case Rate,,11435,,,11435,Case Rate,,26799,,"32,091 x DRG weight",26799,Other,base rate x DRG weight,24119,,"28,882 x DRG weight",24119,Other,base rate x DRG weight,22779,,"27,277 x DRG weight",22779,Other,base rate x DRG weight,20109,,"24,080 x DRG weight",20109,Other,base rate x DRG weight,10042,,,10042,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,18158,,,18158,Case Rate,,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,19290,,,19290,Case Rate,,77783,70,,77783,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,11119,,,11119,Case Rate,,10007,,,10007,Case Rate,,11119,,,11119,Case Rate,,9451,,,9451,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,77783,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,,inpatient,,,201209,68698,,,68698,Other,150% of Medicare + 9.63% HCRA Surcharge,41775.68,,,41775.68,Other,Medicare IPPS methodology,124093,,"25,046 x DRG weight",124093,Other,base rate x DRG weight,111682,,"22,541 x DRG weight",111682,Other,base rate x DRG weight,158998,,"32,091 x DRG weight",158998,Other,base rate x DRG weight,143099,,"28,882 x DRG weight",143099,Other,base rate x DRG weight,135147,,"27,277 x DRG weight",135147,Other,base rate x DRG weight,119307,,"24,080 x DRG weight",119307,Other,base rate x DRG weight,111295,,"22,463 x DRG weight",111295,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,130930,,"26,426 x DRG weight",130930,Other,base rate x DRG weight,192283,,"38,809 x DRG weight",192283,Other,base rate x DRG weight,192283,,"38,809 x DRG weight",192283,Other,base rate x DRG weight,130930,,"26,426 x DRG weight",130930,Other,base rate x DRG weight,192283,,"38,809 x DRG weight",192283,Other,base rate x DRG weight,64903,,"6,363 x patient days",64903,Per diem,,140846,70,,140846,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,124147,,"25,057 x DRG weight",124147,Other,base rate x DRG weight,111736,,"22,552 x DRG weight",111736,Other,base rate x DRG weight,124147,,"25,057 x DRG weight",124147,Other,base rate x DRG weight,105523,,"21,298 x DRG weight",105523,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,192283,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,,inpatient,,,134326.23,39303,,,39303,Other,150% of Medicare + 9.63% HCRA Surcharge,23900.35,,,23900.35,Other,Medicare IPPS methodology,70572,,"25,046 x DRG weight",70572,Other,base rate x DRG weight,63514,,"22,541 x DRG weight",63514,Other,base rate x DRG weight,90423,,"32,091 x DRG weight",90423,Other,base rate x DRG weight,81381,,"28,882 x DRG weight",81381,Other,base rate x DRG weight,76858,,"27,277 x DRG weight",76858,Other,base rate x DRG weight,67850,,"24,080 x DRG weight",67850,Other,base rate x DRG weight,63294,,"22,463 x DRG weight",63294,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,74461,,"26,426 x DRG weight",74461,Other,base rate x DRG weight,109352,,"38,809 x DRG weight",109352,Other,base rate x DRG weight,109352,,"38,809 x DRG weight",109352,Other,base rate x DRG weight,74461,,"26,426 x DRG weight",74461,Other,base rate x DRG weight,109352,,"38,809 x DRG weight",109352,Other,base rate x DRG weight,36269,,"6,363 x patient days",36269,Per diem,,94028,70,,94028,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,70603,,"25,057 x DRG weight",70603,Other,base rate x DRG weight,63545,,"22,552 x DRG weight",63545,Other,base rate x DRG weight,70603,,"25,057 x DRG weight",70603,Other,base rate x DRG weight,60011,,"21,298 x DRG weight",60011,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,109352,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,,inpatient,,,81755.94,25162,,,25162,Other,150% of Medicare + 9.63% HCRA Surcharge,15301.05,,,15301.05,Other,Medicare IPPS methodology,44825,,"25,046 x DRG weight",44825,Other,base rate x DRG weight,40342,,"22,541 x DRG weight",40342,Other,base rate x DRG weight,57433,,"32,091 x DRG weight",57433,Other,base rate x DRG weight,51690,,"28,882 x DRG weight",51690,Other,base rate x DRG weight,48818,,"27,277 x DRG weight",48818,Other,base rate x DRG weight,43096,,"24,080 x DRG weight",43096,Other,base rate x DRG weight,40202,,"22,463 x DRG weight",40202,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,47295,,"26,426 x DRG weight",47295,Other,base rate x DRG weight,69456,,"38,809 x DRG weight",69456,Other,base rate x DRG weight,69456,,"38,809 x DRG weight",69456,Other,base rate x DRG weight,47295,,"26,426 x DRG weight",47295,Other,base rate x DRG weight,69456,,"38,809 x DRG weight",69456,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,57229,70,,57229,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,44845,,"25,057 x DRG weight",44845,Other,base rate x DRG weight,40361,,"22,552 x DRG weight",40361,Other,base rate x DRG weight,44845,,"25,057 x DRG weight",44845,Other,base rate x DRG weight,38117,,"21,298 x DRG weight",38117,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,69456,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,,inpatient,,,285425.59,47737,,,47737,Other,150% of Medicare + 9.63% HCRA Surcharge,29028.98,,,29028.98,Other,Medicare IPPS methodology,85928,,"25,046 x DRG weight",85928,Other,base rate x DRG weight,77334,,"22,541 x DRG weight",77334,Other,base rate x DRG weight,110098,,"32,091 x DRG weight",110098,Other,base rate x DRG weight,99088,,"28,882 x DRG weight",99088,Other,base rate x DRG weight,93582,,"27,277 x DRG weight",93582,Other,base rate x DRG weight,82614,,"24,080 x DRG weight",82614,Other,base rate x DRG weight,77066,,"22,463 x DRG weight",77066,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,90662,,"26,426 x DRG weight",90662,Other,base rate x DRG weight,133146,,"38,809 x DRG weight",133146,Other,base rate x DRG weight,133146,,"38,809 x DRG weight",133146,Other,base rate x DRG weight,90662,,"26,426 x DRG weight",90662,Other,base rate x DRG weight,133146,,"38,809 x DRG weight",133146,Other,base rate x DRG weight,68720,,"6,363 x patient days",68720,Per diem,,199798,70,,199798,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,85966,,"25,057 x DRG weight",85966,Other,base rate x DRG weight,77371,,"22,552 x DRG weight",77371,Other,base rate x DRG weight,85966,,"25,057 x DRG weight",85966,Other,base rate x DRG weight,73069,,"21,298 x DRG weight",73069,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,199798,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,,inpatient,,,157504.65,26104,,,26104,Other,150% of Medicare + 9.63% HCRA Surcharge,15874.06,,,15874.06,Other,Medicare IPPS methodology,46540,,"25,046 x DRG weight",46540,Other,base rate x DRG weight,41886,,"22,541 x DRG weight",41886,Other,base rate x DRG weight,59631,,"32,091 x DRG weight",59631,Other,base rate x DRG weight,53669,,"28,882 x DRG weight",53669,Other,base rate x DRG weight,50686,,"27,277 x DRG weight",50686,Other,base rate x DRG weight,44745,,"24,080 x DRG weight",44745,Other,base rate x DRG weight,41741,,"22,463 x DRG weight",41741,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49105,,"26,426 x DRG weight",49105,Other,base rate x DRG weight,72115,,"38,809 x DRG weight",72115,Other,base rate x DRG weight,72115,,"38,809 x DRG weight",72115,Other,base rate x DRG weight,49105,,"26,426 x DRG weight",49105,Other,base rate x DRG weight,72115,,"38,809 x DRG weight",72115,Other,base rate x DRG weight,33724,,"6,363 x patient days",33724,Per diem,,110253,70,,110253,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46561,,"25,057 x DRG weight",46561,Other,base rate x DRG weight,41906,,"22,552 x DRG weight",41906,Other,base rate x DRG weight,46561,,"25,057 x DRG weight",46561,Other,base rate x DRG weight,39576,,"21,298 x DRG weight",39576,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,110253,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,,inpatient,,,172279.15,17193,,,17193,Other,150% of Medicare + 9.63% HCRA Surcharge,10455.16,,,10455.16,Other,Medicare IPPS methodology,30316,,"25,046 x DRG weight",30316,Other,base rate x DRG weight,27284,,"22,541 x DRG weight",27284,Other,base rate x DRG weight,38843,,"32,091 x DRG weight",38843,Other,base rate x DRG weight,34959,,"28,882 x DRG weight",34959,Other,base rate x DRG weight,33016,,"27,277 x DRG weight",33016,Other,base rate x DRG weight,29146,,"24,080 x DRG weight",29146,Other,base rate x DRG weight,27189,,"22,463 x DRG weight",27189,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31986,,"26,426 x DRG weight",31986,Other,base rate x DRG weight,46974,,"38,809 x DRG weight",46974,Other,base rate x DRG weight,46974,,"38,809 x DRG weight",46974,Other,base rate x DRG weight,31986,,"26,426 x DRG weight",31986,Other,base rate x DRG weight,46974,,"38,809 x DRG weight",46974,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,120595,70,,120595,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30329,,"25,057 x DRG weight",30329,Other,base rate x DRG weight,27297,,"22,552 x DRG weight",27297,Other,base rate x DRG weight,30329,,"25,057 x DRG weight",30329,Other,base rate x DRG weight,25779,,"21,298 x DRG weight",25779,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,120595,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,,inpatient,,,104120.21,14412,,,14412,Other,150% of Medicare + 9.63% HCRA Surcharge,8763.74,,,8763.74,Other,Medicare IPPS methodology,13608,,,13608,Case Rate,,12247,,,12247,Case Rate,,32354,,"32,091 x DRG weight",32354,Other,base rate x DRG weight,29119,,"28,882 x DRG weight",29119,Other,base rate x DRG weight,27501,,"27,277 x DRG weight",27501,Other,base rate x DRG weight,24277,,"24,080 x DRG weight",24277,Other,base rate x DRG weight,10042,,,10042,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,18158,,,18158,Case Rate,,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,19290,,,19290,Case Rate,,72884,70,,72884,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,11119,,,11119,Case Rate,,10007,,,10007,Case Rate,,11119,,,11119,Case Rate,,9451,,,9451,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,72884,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,,inpatient,,,81857.31,10814,,,10814,Other,150% of Medicare + 9.63% HCRA Surcharge,6576.27,,,6576.27,Other,Medicare IPPS methodology,13608,,,13608,Case Rate,,12247,,,12247,Case Rate,,23962,,"32,091 x DRG weight",23962,Other,base rate x DRG weight,21566,,"28,882 x DRG weight",21566,Other,base rate x DRG weight,20368,,"27,277 x DRG weight",20368,Other,base rate x DRG weight,17981,,"24,080 x DRG weight",17981,Other,base rate x DRG weight,10042,,,10042,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,18158,,,18158,Case Rate,,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,19290,,,19290,Case Rate,,57300,70,,57300,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,11119,,,11119,Case Rate,,10007,,,10007,Case Rate,,11119,,,11119,Case Rate,,9451,,,9451,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,57300,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,,inpatient,,,71402.35,9543,,,9543,Other,150% of Medicare + 9.63% HCRA Surcharge,5803.34,,,5803.34,Other,Medicare IPPS methodology,13608,,,13608,Case Rate,,12247,,,12247,Case Rate,,20997,,"32,091 x DRG weight",20997,Other,base rate x DRG weight,18897,,"28,882 x DRG weight",18897,Other,base rate x DRG weight,17847,,"27,277 x DRG weight",17847,Other,base rate x DRG weight,15756,,"24,080 x DRG weight",15756,Other,base rate x DRG weight,10042,,,10042,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,18158,,,18158,Case Rate,,11813,,,11813,Case Rate,,18158,,,18158,Case Rate,,19290,,,19290,Case Rate,,49982,70,,49982,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,11119,,,11119,Case Rate,,10007,,,10007,Case Rate,,11119,,,11119,Case Rate,,9451,,,9451,Case Rate,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,49982,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,,inpatient,,,320861.91,30670,,,30670,Other,150% of Medicare + 9.63% HCRA Surcharge,18650.43,,,18650.43,Other,Medicare IPPS methodology,54853,,"25,046 x DRG weight",54853,Other,base rate x DRG weight,49367,,"22,541 x DRG weight",49367,Other,base rate x DRG weight,70282,,"32,091 x DRG weight",70282,Other,base rate x DRG weight,63254,,"28,882 x DRG weight",63254,Other,base rate x DRG weight,59739,,"27,277 x DRG weight",59739,Other,base rate x DRG weight,52738,,"24,080 x DRG weight",52738,Other,base rate x DRG weight,49196,,"22,463 x DRG weight",49196,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,57876,,"26,426 x DRG weight",57876,Other,base rate x DRG weight,84996,,"38,809 x DRG weight",84996,Other,base rate x DRG weight,84996,,"38,809 x DRG weight",84996,Other,base rate x DRG weight,57876,,"26,426 x DRG weight",57876,Other,base rate x DRG weight,84996,,"38,809 x DRG weight",84996,Other,base rate x DRG weight,47086,,"6,363 x patient days",47086,Per diem,,224603,70,,224603,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,54877,,"25,057 x DRG weight",54877,Other,base rate x DRG weight,49391,,"22,552 x DRG weight",49391,Other,base rate x DRG weight,54877,,"25,057 x DRG weight",54877,Other,base rate x DRG weight,46645,,"21,298 x DRG weight",46645,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,224603,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,,inpatient,,,155465.23,17110,,,17110,Other,150% of Medicare + 9.63% HCRA Surcharge,10404.97,,,10404.97,Other,Medicare IPPS methodology,30165,,"25,046 x DRG weight",30165,Other,base rate x DRG weight,27148,,"22,541 x DRG weight",27148,Other,base rate x DRG weight,38650,,"32,091 x DRG weight",38650,Other,base rate x DRG weight,34785,,"28,882 x DRG weight",34785,Other,base rate x DRG weight,32852,,"27,277 x DRG weight",32852,Other,base rate x DRG weight,29002,,"24,080 x DRG weight",29002,Other,base rate x DRG weight,27054,,"22,463 x DRG weight",27054,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,31827,,"26,426 x DRG weight",31827,Other,base rate x DRG weight,46742,,"38,809 x DRG weight",46742,Other,base rate x DRG weight,46742,,"38,809 x DRG weight",46742,Other,base rate x DRG weight,31827,,"26,426 x DRG weight",31827,Other,base rate x DRG weight,46742,,"38,809 x DRG weight",46742,Other,base rate x DRG weight,27997,,"6,363 x patient days",27997,Per diem,,108826,70,,108826,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30179,,"25,057 x DRG weight",30179,Other,base rate x DRG weight,27162,,"22,552 x DRG weight",27162,Other,base rate x DRG weight,30179,,"25,057 x DRG weight",30179,Other,base rate x DRG weight,25651,,"21,298 x DRG weight",25651,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,108826,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,,inpatient,,,148218.26,14361,,,14361,Other,150% of Medicare + 9.63% HCRA Surcharge,8732.79,,,8732.79,Other,Medicare IPPS methodology,25159,,"25,046 x DRG weight",25159,Other,base rate x DRG weight,22642,,"22,541 x DRG weight",22642,Other,base rate x DRG weight,32235,,"32,091 x DRG weight",32235,Other,base rate x DRG weight,29012,,"28,882 x DRG weight",29012,Other,base rate x DRG weight,27400,,"27,277 x DRG weight",27400,Other,base rate x DRG weight,24188,,"24,080 x DRG weight",24188,Other,base rate x DRG weight,22564,,"22,463 x DRG weight",22564,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26545,,"26,426 x DRG weight",26545,Other,base rate x DRG weight,38984,,"38,809 x DRG weight",38984,Other,base rate x DRG weight,38984,,"38,809 x DRG weight",38984,Other,base rate x DRG weight,26545,,"26,426 x DRG weight",26545,Other,base rate x DRG weight,38984,,"38,809 x DRG weight",38984,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,103753,70,,103753,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25170,,"25,057 x DRG weight",25170,Other,base rate x DRG weight,22653,,"22,552 x DRG weight",22653,Other,base rate x DRG weight,25170,,"25,057 x DRG weight",25170,Other,base rate x DRG weight,21394,,"21,298 x DRG weight",21394,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,103753,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,,inpatient,,,193444.49,19851,,,19851,Other,150% of Medicare + 9.63% HCRA Surcharge,12071.29,,,12071.29,Other,Medicare IPPS methodology,35155,,"25,046 x DRG weight",35155,Other,base rate x DRG weight,31639,,"22,541 x DRG weight",31639,Other,base rate x DRG weight,45043,,"32,091 x DRG weight",45043,Other,base rate x DRG weight,40539,,"28,882 x DRG weight",40539,Other,base rate x DRG weight,38286,,"27,277 x DRG weight",38286,Other,base rate x DRG weight,33799,,"24,080 x DRG weight",33799,Other,base rate x DRG weight,31529,,"22,463 x DRG weight",31529,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37092,,"26,426 x DRG weight",37092,Other,base rate x DRG weight,54472,,"38,809 x DRG weight",54472,Other,base rate x DRG weight,54472,,"38,809 x DRG weight",54472,Other,base rate x DRG weight,37092,,"26,426 x DRG weight",37092,Other,base rate x DRG weight,54472,,"38,809 x DRG weight",54472,Other,base rate x DRG weight,32451,,"6,363 x patient days",32451,Per diem,,135411,70,,135411,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35170,,"25,057 x DRG weight",35170,Other,base rate x DRG weight,31654,,"22,552 x DRG weight",31654,Other,base rate x DRG weight,35170,,"25,057 x DRG weight",35170,Other,base rate x DRG weight,29894,,"21,298 x DRG weight",29894,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,135411,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,,inpatient,,,136529.49,12933,,,12933,Other,150% of Medicare + 9.63% HCRA Surcharge,7864.49,,,7864.49,Other,Medicare IPPS methodology,22559,,"25,046 x DRG weight",22559,Other,base rate x DRG weight,20303,,"22,541 x DRG weight",20303,Other,base rate x DRG weight,28904,,"32,091 x DRG weight",28904,Other,base rate x DRG weight,26014,,"28,882 x DRG weight",26014,Other,base rate x DRG weight,24568,,"27,277 x DRG weight",24568,Other,base rate x DRG weight,21689,,"24,080 x DRG weight",21689,Other,base rate x DRG weight,20232,,"22,463 x DRG weight",20232,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23802,,"26,426 x DRG weight",23802,Other,base rate x DRG weight,34955,,"38,809 x DRG weight",34955,Other,base rate x DRG weight,34955,,"38,809 x DRG weight",34955,Other,base rate x DRG weight,23802,,"26,426 x DRG weight",23802,Other,base rate x DRG weight,34955,,"38,809 x DRG weight",34955,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,95571,70,,95571,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22569,,"25,057 x DRG weight",22569,Other,base rate x DRG weight,20313,,"22,552 x DRG weight",20313,Other,base rate x DRG weight,22569,,"25,057 x DRG weight",22569,Other,base rate x DRG weight,19183,,"21,298 x DRG weight",19183,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95571,
COAGULATION DISORDERS,813,MS-DRG,,,,,,,,inpatient,,,150549.26,22002,,,22002,Other,150% of Medicare + 9.63% HCRA Surcharge,13379.59,,,13379.59,Other,Medicare IPPS methodology,39072,,"25,046 x DRG weight",39072,Other,base rate x DRG weight,35164,,"22,541 x DRG weight",35164,Other,base rate x DRG weight,50062,,"32,091 x DRG weight",50062,Other,base rate x DRG weight,45056,,"28,882 x DRG weight",45056,Other,base rate x DRG weight,42552,,"27,277 x DRG weight",42552,Other,base rate x DRG weight,37565,,"24,080 x DRG weight",37565,Other,base rate x DRG weight,35042,,"22,463 x DRG weight",35042,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41225,,"26,426 x DRG weight",41225,Other,base rate x DRG weight,60542,,"38,809 x DRG weight",60542,Other,base rate x DRG weight,60542,,"38,809 x DRG weight",60542,Other,base rate x DRG weight,41225,,"26,426 x DRG weight",41225,Other,base rate x DRG weight,60542,,"38,809 x DRG weight",60542,Other,base rate x DRG weight,31179,,"6,363 x patient days",31179,Per diem,,105384,70,,105384,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39089,,"25,057 x DRG weight",39089,Other,base rate x DRG weight,35181,,"22,552 x DRG weight",35181,Other,base rate x DRG weight,39089,,"25,057 x DRG weight",39089,Other,base rate x DRG weight,33225,,"21,298 x DRG weight",33225,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,105384,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,,inpatient,,,442077.65,29817,,,29817,Other,150% of Medicare + 9.63% HCRA Surcharge,18131.79,,,18131.79,Other,Medicare IPPS methodology,53300,,"25,046 x DRG weight",53300,Other,base rate x DRG weight,47970,,"22,541 x DRG weight",47970,Other,base rate x DRG weight,68293,,"32,091 x DRG weight",68293,Other,base rate x DRG weight,61464,,"28,882 x DRG weight",61464,Other,base rate x DRG weight,58048,,"27,277 x DRG weight",58048,Other,base rate x DRG weight,51245,,"24,080 x DRG weight",51245,Other,base rate x DRG weight,47804,,"22,463 x DRG weight",47804,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,56237,,"26,426 x DRG weight",56237,Other,base rate x DRG weight,82589,,"38,809 x DRG weight",82589,Other,base rate x DRG weight,82589,,"38,809 x DRG weight",82589,Other,base rate x DRG weight,56237,,"26,426 x DRG weight",56237,Other,base rate x DRG weight,82589,,"38,809 x DRG weight",82589,Other,base rate x DRG weight,45814,,"6,363 x patient days",45814,Per diem,,309454,70,,309454,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,53324,,"25,057 x DRG weight",53324,Other,base rate x DRG weight,47993,,"22,552 x DRG weight",47993,Other,base rate x DRG weight,53324,,"25,057 x DRG weight",53324,Other,base rate x DRG weight,45324,,"21,298 x DRG weight",45324,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,309454,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,,inpatient,,,124895.14,14219,,,14219,Other,150% of Medicare + 9.63% HCRA Surcharge,8646.63,,,8646.63,Other,Medicare IPPS methodology,24901,,"25,046 x DRG weight",24901,Other,base rate x DRG weight,22410,,"22,541 x DRG weight",22410,Other,base rate x DRG weight,31905,,"32,091 x DRG weight",31905,Other,base rate x DRG weight,28714,,"28,882 x DRG weight",28714,Other,base rate x DRG weight,27119,,"27,277 x DRG weight",27119,Other,base rate x DRG weight,23940,,"24,080 x DRG weight",23940,Other,base rate x DRG weight,22333,,"22,463 x DRG weight",22333,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26273,,"26,426 x DRG weight",26273,Other,base rate x DRG weight,38584,,"38,809 x DRG weight",38584,Other,base rate x DRG weight,38584,,"38,809 x DRG weight",38584,Other,base rate x DRG weight,26273,,"26,426 x DRG weight",26273,Other,base rate x DRG weight,38584,,"38,809 x DRG weight",38584,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,87427,70,,87427,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,24912,,"25,057 x DRG weight",24912,Other,base rate x DRG weight,22421,,"22,552 x DRG weight",22421,Other,base rate x DRG weight,24912,,"25,057 x DRG weight",24912,Other,base rate x DRG weight,21174,,"21,298 x DRG weight",21174,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,87427,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,,inpatient,,,82618.99,10312,,,10312,Other,150% of Medicare + 9.63% HCRA Surcharge,6270.95,,,6270.95,Other,Medicare IPPS methodology,17788,,"25,046 x DRG weight",17788,Other,base rate x DRG weight,16009,,"22,541 x DRG weight",16009,Other,base rate x DRG weight,22791,,"32,091 x DRG weight",22791,Other,base rate x DRG weight,20512,,"28,882 x DRG weight",20512,Other,base rate x DRG weight,19372,,"27,277 x DRG weight",19372,Other,base rate x DRG weight,17102,,"24,080 x DRG weight",17102,Other,base rate x DRG weight,15953,,"22,463 x DRG weight",15953,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18768,,"26,426 x DRG weight",18768,Other,base rate x DRG weight,27562,,"38,809 x DRG weight",27562,Other,base rate x DRG weight,27562,,"38,809 x DRG weight",27562,Other,base rate x DRG weight,18768,,"26,426 x DRG weight",18768,Other,base rate x DRG weight,27562,,"38,809 x DRG weight",27562,Other,base rate x DRG weight,18453,,"6,363 x patient days",18453,Per diem,,57833,70,,57833,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17795,,"25,057 x DRG weight",17795,Other,base rate x DRG weight,16016,,"22,552 x DRG weight",16016,Other,base rate x DRG weight,17795,,"25,057 x DRG weight",17795,Other,base rate x DRG weight,15126,,"21,298 x DRG weight",15126,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,57833,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,,inpatient,,,203739,39291,,,39291,Other,150% of Medicare + 9.63% HCRA Surcharge,23892.82,,,23892.82,Other,Medicare IPPS methodology,70550,,"25,046 x DRG weight",70550,Other,base rate x DRG weight,63493,,"22,541 x DRG weight",63493,Other,base rate x DRG weight,90394,,"32,091 x DRG weight",90394,Other,base rate x DRG weight,81355,,"28,882 x DRG weight",81355,Other,base rate x DRG weight,76834,,"27,277 x DRG weight",76834,Other,base rate x DRG weight,67829,,"24,080 x DRG weight",67829,Other,base rate x DRG weight,63274,,"22,463 x DRG weight",63274,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,74437,,"26,426 x DRG weight",74437,Other,base rate x DRG weight,109317,,"38,809 x DRG weight",109317,Other,base rate x DRG weight,109317,,"38,809 x DRG weight",109317,Other,base rate x DRG weight,74437,,"26,426 x DRG weight",74437,Other,base rate x DRG weight,109317,,"38,809 x DRG weight",109317,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,142617,70,,142617,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,70581,,"25,057 x DRG weight",70581,Other,base rate x DRG weight,63524,,"22,552 x DRG weight",63524,Other,base rate x DRG weight,70581,,"25,057 x DRG weight",70581,Other,base rate x DRG weight,59992,,"21,298 x DRG weight",59992,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,142617,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,,inpatient,,,171139.33,20229,,,20229,Other,150% of Medicare + 9.63% HCRA Surcharge,12301.33,,,12301.33,Other,Medicare IPPS methodology,35843,,"25,046 x DRG weight",35843,Other,base rate x DRG weight,32258,,"22,541 x DRG weight",32258,Other,base rate x DRG weight,45925,,"32,091 x DRG weight",45925,Other,base rate x DRG weight,41333,,"28,882 x DRG weight",41333,Other,base rate x DRG weight,39036,,"27,277 x DRG weight",39036,Other,base rate x DRG weight,34461,,"24,080 x DRG weight",34461,Other,base rate x DRG weight,32147,,"22,463 x DRG weight",32147,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37818,,"26,426 x DRG weight",37818,Other,base rate x DRG weight,55540,,"38,809 x DRG weight",55540,Other,base rate x DRG weight,55540,,"38,809 x DRG weight",55540,Other,base rate x DRG weight,37818,,"26,426 x DRG weight",37818,Other,base rate x DRG weight,55540,,"38,809 x DRG weight",55540,Other,base rate x DRG weight,19089,,"6,363 x patient days",19089,Per diem,,119798,70,,119798,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35859,,"25,057 x DRG weight",35859,Other,base rate x DRG weight,32274,,"22,552 x DRG weight",32274,Other,base rate x DRG weight,35859,,"25,057 x DRG weight",35859,Other,base rate x DRG weight,30480,,"21,298 x DRG weight",30480,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,119798,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,,inpatient,,,88619.17,13022,,,13022,Other,150% of Medicare + 9.63% HCRA Surcharge,7918.87,,,7918.87,Other,Medicare IPPS methodology,22722,,"25,046 x DRG weight",22722,Other,base rate x DRG weight,20449,,"22,541 x DRG weight",20449,Other,base rate x DRG weight,29113,,"32,091 x DRG weight",29113,Other,base rate x DRG weight,26202,,"28,882 x DRG weight",26202,Other,base rate x DRG weight,24746,,"27,277 x DRG weight",24746,Other,base rate x DRG weight,21845,,"24,080 x DRG weight",21845,Other,base rate x DRG weight,20378,,"22,463 x DRG weight",20378,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23974,,"26,426 x DRG weight",23974,Other,base rate x DRG weight,35208,,"38,809 x DRG weight",35208,Other,base rate x DRG weight,35208,,"38,809 x DRG weight",35208,Other,base rate x DRG weight,23974,,"26,426 x DRG weight",23974,Other,base rate x DRG weight,35208,,"38,809 x DRG weight",35208,Other,base rate x DRG weight,15271,,"6,363 x patient days",15271,Per diem,,62033,70,,62033,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22732,,"25,057 x DRG weight",22732,Other,base rate x DRG weight,20459,,"22,552 x DRG weight",20459,Other,base rate x DRG weight,22732,,"25,057 x DRG weight",22732,Other,base rate x DRG weight,19322,,"21,298 x DRG weight",19322,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,62033,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,,inpatient,,,1390777.53,83721,,,83721,Other,150% of Medicare + 9.63% HCRA Surcharge,50911.18,,,50911.18,Other,Medicare IPPS methodology,151446,,"25,046 x DRG weight",151446,Other,base rate x DRG weight,136299,,"22,541 x DRG weight",136299,Other,base rate x DRG weight,194045,,"32,091 x DRG weight",194045,Other,base rate x DRG weight,174641,,"28,882 x DRG weight",174641,Other,base rate x DRG weight,164936,,"27,277 x DRG weight",164936,Other,base rate x DRG weight,145605,,"24,080 x DRG weight",145605,Other,base rate x DRG weight,135827,,"22,463 x DRG weight",135827,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,159790,,"26,426 x DRG weight",159790,Other,base rate x DRG weight,234666,,"38,809 x DRG weight",234666,Other,base rate x DRG weight,234666,,"38,809 x DRG weight",234666,Other,base rate x DRG weight,159790,,"26,426 x DRG weight",159790,Other,base rate x DRG weight,234666,,"38,809 x DRG weight",234666,Other,base rate x DRG weight,109444,,"6,363 x patient days",109444,Per diem,,973544,70,,973544,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,151512,,"25,057 x DRG weight",151512,Other,base rate x DRG weight,136365,,"22,552 x DRG weight",136365,Other,base rate x DRG weight,151512,,"25,057 x DRG weight",151512,Other,base rate x DRG weight,128783,,"21,298 x DRG weight",128783,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,973544,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,,inpatient,,,699365.59,31247,,,31247,Other,150% of Medicare + 9.63% HCRA Surcharge,19001.76,,,19001.76,Other,Medicare IPPS methodology,55905,,"25,046 x DRG weight",55905,Other,base rate x DRG weight,50314,,"22,541 x DRG weight",50314,Other,base rate x DRG weight,71630,,"32,091 x DRG weight",71630,Other,base rate x DRG weight,64468,,"28,882 x DRG weight",64468,Other,base rate x DRG weight,60885,,"27,277 x DRG weight",60885,Other,base rate x DRG weight,53749,,"24,080 x DRG weight",53749,Other,base rate x DRG weight,50140,,"22,463 x DRG weight",50140,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,58985,,"26,426 x DRG weight",58985,Other,base rate x DRG weight,86626,,"38,809 x DRG weight",86626,Other,base rate x DRG weight,86626,,"38,809 x DRG weight",86626,Other,base rate x DRG weight,58985,,"26,426 x DRG weight",58985,Other,base rate x DRG weight,86626,,"38,809 x DRG weight",86626,Other,base rate x DRG weight,34997,,"6,363 x patient days",34997,Per diem,,489556,70,,489556,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,55930,,"25,057 x DRG weight",55930,Other,base rate x DRG weight,50338,,"22,552 x DRG weight",50338,Other,base rate x DRG weight,55930,,"25,057 x DRG weight",55930,Other,base rate x DRG weight,47539,,"21,298 x DRG weight",47539,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,489556,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,,inpatient,,,410703.18,17584,,,17584,Other,150% of Medicare + 9.63% HCRA Surcharge,10692.73,,,10692.73,Other,Medicare IPPS methodology,31027,,"25,046 x DRG weight",31027,Other,base rate x DRG weight,27924,,"22,541 x DRG weight",27924,Other,base rate x DRG weight,39754,,"32,091 x DRG weight",39754,Other,base rate x DRG weight,35779,,"28,882 x DRG weight",35779,Other,base rate x DRG weight,33791,,"27,277 x DRG weight",33791,Other,base rate x DRG weight,29830,,"24,080 x DRG weight",29830,Other,base rate x DRG weight,27827,,"22,463 x DRG weight",27827,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,32737,,"26,426 x DRG weight",32737,Other,base rate x DRG weight,48077,,"38,809 x DRG weight",48077,Other,base rate x DRG weight,48077,,"38,809 x DRG weight",48077,Other,base rate x DRG weight,32737,,"26,426 x DRG weight",32737,Other,base rate x DRG weight,48077,,"38,809 x DRG weight",48077,Other,base rate x DRG weight,12726,,"6,363 x patient days",12726,Per diem,,287492,70,,287492,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,31041,,"25,057 x DRG weight",31041,Other,base rate x DRG weight,27937,,"22,552 x DRG weight",27937,Other,base rate x DRG weight,31041,,"25,057 x DRG weight",31041,Other,base rate x DRG weight,26384,,"21,298 x DRG weight",26384,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,287492,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,,inpatient,,,637850.16,62471,,,62471,Other,150% of Medicare + 9.63% HCRA Surcharge,37988.81,,,37988.81,Other,Medicare IPPS methodology,112755,,"25,046 x DRG weight",112755,Other,base rate x DRG weight,101477,,"22,541 x DRG weight",101477,Other,base rate x DRG weight,144470,,"32,091 x DRG weight",144470,Other,base rate x DRG weight,130024,,"28,882 x DRG weight",130024,Other,base rate x DRG weight,122798,,"27,277 x DRG weight",122798,Other,base rate x DRG weight,108406,,"24,080 x DRG weight",108406,Other,base rate x DRG weight,101126,,"22,463 x DRG weight",101126,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,118967,,"26,426 x DRG weight",118967,Other,base rate x DRG weight,174714,,"38,809 x DRG weight",174714,Other,base rate x DRG weight,174714,,"38,809 x DRG weight",174714,Other,base rate x DRG weight,118967,,"26,426 x DRG weight",118967,Other,base rate x DRG weight,174714,,"38,809 x DRG weight",174714,Other,base rate x DRG weight,89082,,"6,363 x patient days",89082,Per diem,,446495,70,,446495,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,112804,,"25,057 x DRG weight",112804,Other,base rate x DRG weight,101527,,"22,552 x DRG weight",101527,Other,base rate x DRG weight,112804,,"25,057 x DRG weight",112804,Other,base rate x DRG weight,95881,,"21,298 x DRG weight",95881,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,446495,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,,inpatient,,,416247.07,31258,,,31258,Other,150% of Medicare + 9.63% HCRA Surcharge,19008.45,,,19008.45,Other,Medicare IPPS methodology,55925,,"25,046 x DRG weight",55925,Other,base rate x DRG weight,50332,,"22,541 x DRG weight",50332,Other,base rate x DRG weight,71656,,"32,091 x DRG weight",71656,Other,base rate x DRG weight,64491,,"28,882 x DRG weight",64491,Other,base rate x DRG weight,60907,,"27,277 x DRG weight",60907,Other,base rate x DRG weight,53768,,"24,080 x DRG weight",53768,Other,base rate x DRG weight,50158,,"22,463 x DRG weight",50158,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,59007,,"26,426 x DRG weight",59007,Other,base rate x DRG weight,86657,,"38,809 x DRG weight",86657,Other,base rate x DRG weight,86657,,"38,809 x DRG weight",86657,Other,base rate x DRG weight,59007,,"26,426 x DRG weight",59007,Other,base rate x DRG weight,86657,,"38,809 x DRG weight",86657,Other,base rate x DRG weight,44541,,"6,363 x patient days",44541,Per diem,,291373,70,,291373,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,55950,,"25,057 x DRG weight",55950,Other,base rate x DRG weight,50356,,"22,552 x DRG weight",50356,Other,base rate x DRG weight,55950,,"25,057 x DRG weight",55950,Other,base rate x DRG weight,47556,,"21,298 x DRG weight",47556,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,291373,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,,inpatient,,,181929.93,18307,,,18307,Other,150% of Medicare + 9.63% HCRA Surcharge,11132.73,,,11132.73,Other,Medicare IPPS methodology,32344,,"25,046 x DRG weight",32344,Other,base rate x DRG weight,29109,,"22,541 x DRG weight",29109,Other,base rate x DRG weight,41442,,"32,091 x DRG weight",41442,Other,base rate x DRG weight,37298,,"28,882 x DRG weight",37298,Other,base rate x DRG weight,35226,,"27,277 x DRG weight",35226,Other,base rate x DRG weight,31097,,"24,080 x DRG weight",31097,Other,base rate x DRG weight,29009,,"22,463 x DRG weight",29009,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34127,,"26,426 x DRG weight",34127,Other,base rate x DRG weight,50118,,"38,809 x DRG weight",50118,Other,base rate x DRG weight,50118,,"38,809 x DRG weight",50118,Other,base rate x DRG weight,34127,,"26,426 x DRG weight",34127,Other,base rate x DRG weight,50118,,"38,809 x DRG weight",50118,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,127351,70,,127351,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32359,,"25,057 x DRG weight",32359,Other,base rate x DRG weight,29124,,"22,552 x DRG weight",29124,Other,base rate x DRG weight,32359,,"25,057 x DRG weight",32359,Other,base rate x DRG weight,27504,,"21,298 x DRG weight",27504,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,127351,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,,inpatient,,,949759.67,64201,,,64201,Other,150% of Medicare + 9.63% HCRA Surcharge,39041.14,,,39041.14,Other,Medicare IPPS methodology,115905,,"25,046 x DRG weight",115905,Other,base rate x DRG weight,104313,,"22,541 x DRG weight",104313,Other,base rate x DRG weight,148508,,"32,091 x DRG weight",148508,Other,base rate x DRG weight,133657,,"28,882 x DRG weight",133657,Other,base rate x DRG weight,126230,,"27,277 x DRG weight",126230,Other,base rate x DRG weight,111435,,"24,080 x DRG weight",111435,Other,base rate x DRG weight,103952,,"22,463 x DRG weight",103952,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,122292,,"26,426 x DRG weight",122292,Other,base rate x DRG weight,179596,,"38,809 x DRG weight",179596,Other,base rate x DRG weight,179596,,"38,809 x DRG weight",179596,Other,base rate x DRG weight,122292,,"26,426 x DRG weight",122292,Other,base rate x DRG weight,179596,,"38,809 x DRG weight",179596,Other,base rate x DRG weight,75083,,"6,363 x patient days",75083,Per diem,,664832,70,,664832,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,115956,,"25,057 x DRG weight",115956,Other,base rate x DRG weight,104364,,"22,552 x DRG weight",104364,Other,base rate x DRG weight,115956,,"25,057 x DRG weight",115956,Other,base rate x DRG weight,98561,,"21,298 x DRG weight",98561,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,664832,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,,inpatient,,,244097.37,32418,,,32418,Other,150% of Medicare + 9.63% HCRA Surcharge,19713.63,,,19713.63,Other,Medicare IPPS methodology,58037,,"25,046 x DRG weight",58037,Other,base rate x DRG weight,52232,,"22,541 x DRG weight",52232,Other,base rate x DRG weight,74361,,"32,091 x DRG weight",74361,Other,base rate x DRG weight,66925,,"28,882 x DRG weight",66925,Other,base rate x DRG weight,63206,,"27,277 x DRG weight",63206,Other,base rate x DRG weight,55798,,"24,080 x DRG weight",55798,Other,base rate x DRG weight,52051,,"22,463 x DRG weight",52051,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,61234,,"26,426 x DRG weight",61234,Other,base rate x DRG weight,89928,,"38,809 x DRG weight",89928,Other,base rate x DRG weight,89928,,"38,809 x DRG weight",89928,Other,base rate x DRG weight,61234,,"26,426 x DRG weight",61234,Other,base rate x DRG weight,89928,,"38,809 x DRG weight",89928,Other,base rate x DRG weight,34997,,"6,363 x patient days",34997,Per diem,,170868,70,,170868,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,58062,,"25,057 x DRG weight",58062,Other,base rate x DRG weight,52257,,"22,552 x DRG weight",52257,Other,base rate x DRG weight,58062,,"25,057 x DRG weight",58062,Other,base rate x DRG weight,49352,,"21,298 x DRG weight",49352,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,170868,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,,inpatient,,,218325.59,23108,,,23108,Other,150% of Medicare + 9.63% HCRA Surcharge,14052.14,,,14052.14,Other,Medicare IPPS methodology,41085,,"25,046 x DRG weight",41085,Other,base rate x DRG weight,36976,,"22,541 x DRG weight",36976,Other,base rate x DRG weight,52642,,"32,091 x DRG weight",52642,Other,base rate x DRG weight,47378,,"28,882 x DRG weight",47378,Other,base rate x DRG weight,44745,,"27,277 x DRG weight",44745,Other,base rate x DRG weight,39501,,"24,080 x DRG weight",39501,Other,base rate x DRG weight,36848,,"22,463 x DRG weight",36848,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43349,,"26,426 x DRG weight",43349,Other,base rate x DRG weight,63662,,"38,809 x DRG weight",63662,Other,base rate x DRG weight,63662,,"38,809 x DRG weight",63662,Other,base rate x DRG weight,43349,,"26,426 x DRG weight",43349,Other,base rate x DRG weight,63662,,"38,809 x DRG weight",63662,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,152828,70,,152828,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,41104,,"25,057 x DRG weight",41104,Other,base rate x DRG weight,36994,,"22,552 x DRG weight",36994,Other,base rate x DRG weight,41104,,"25,057 x DRG weight",41104,Other,base rate x DRG weight,34937,,"21,298 x DRG weight",34937,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,152828,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,,inpatient,,,430007.92,43926,,,43926,Other,150% of Medicare + 9.63% HCRA Surcharge,26711.85,,,26711.85,Other,Medicare IPPS methodology,78990,,"25,046 x DRG weight",78990,Other,base rate x DRG weight,71090,,"22,541 x DRG weight",71090,Other,base rate x DRG weight,101209,,"32,091 x DRG weight",101209,Other,base rate x DRG weight,91088,,"28,882 x DRG weight",91088,Other,base rate x DRG weight,86026,,"27,277 x DRG weight",86026,Other,base rate x DRG weight,75944,,"24,080 x DRG weight",75944,Other,base rate x DRG weight,70844,,"22,463 x DRG weight",70844,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,83342,,"26,426 x DRG weight",83342,Other,base rate x DRG weight,122396,,"38,809 x DRG weight",122396,Other,base rate x DRG weight,122396,,"38,809 x DRG weight",122396,Other,base rate x DRG weight,83342,,"26,426 x DRG weight",83342,Other,base rate x DRG weight,122396,,"38,809 x DRG weight",122396,Other,base rate x DRG weight,58540,,"6,363 x patient days",58540,Per diem,,301006,70,,301006,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,79025,,"25,057 x DRG weight",79025,Other,base rate x DRG weight,71124,,"22,552 x DRG weight",71124,Other,base rate x DRG weight,79025,,"25,057 x DRG weight",79025,Other,base rate x DRG weight,67170,,"21,298 x DRG weight",67170,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,301006,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,,inpatient,,,123797.2,22294,,,22294,Other,150% of Medicare + 9.63% HCRA Surcharge,13556.93,,,13556.93,Other,Medicare IPPS methodology,39603,,"25,046 x DRG weight",39603,Other,base rate x DRG weight,35642,,"22,541 x DRG weight",35642,Other,base rate x DRG weight,50742,,"32,091 x DRG weight",50742,Other,base rate x DRG weight,45668,,"28,882 x DRG weight",45668,Other,base rate x DRG weight,43130,,"27,277 x DRG weight",43130,Other,base rate x DRG weight,38075,,"24,080 x DRG weight",38075,Other,base rate x DRG weight,35518,,"22,463 x DRG weight",35518,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41785,,"26,426 x DRG weight",41785,Other,base rate x DRG weight,61365,,"38,809 x DRG weight",61365,Other,base rate x DRG weight,61365,,"38,809 x DRG weight",61365,Other,base rate x DRG weight,41785,,"26,426 x DRG weight",41785,Other,base rate x DRG weight,61365,,"38,809 x DRG weight",61365,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,86658,70,,86658,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39620,,"25,057 x DRG weight",39620,Other,base rate x DRG weight,35659,,"22,552 x DRG weight",35659,Other,base rate x DRG weight,39620,,"25,057 x DRG weight",39620,Other,base rate x DRG weight,33676,,"21,298 x DRG weight",33676,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,86658,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,,inpatient,,,111509.39,15335,,,15335,Other,150% of Medicare + 9.63% HCRA Surcharge,9325.04,,,9325.04,Other,Medicare IPPS methodology,26932,,"25,046 x DRG weight",26932,Other,base rate x DRG weight,24238,,"22,541 x DRG weight",24238,Other,base rate x DRG weight,34507,,"32,091 x DRG weight",34507,Other,base rate x DRG weight,31057,,"28,882 x DRG weight",31057,Other,base rate x DRG weight,29331,,"27,277 x DRG weight",29331,Other,base rate x DRG weight,25893,,"24,080 x DRG weight",25893,Other,base rate x DRG weight,24154,,"22,463 x DRG weight",24154,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28416,,"26,426 x DRG weight",28416,Other,base rate x DRG weight,41731,,"38,809 x DRG weight",41731,Other,base rate x DRG weight,41731,,"38,809 x DRG weight",41731,Other,base rate x DRG weight,28416,,"26,426 x DRG weight",28416,Other,base rate x DRG weight,41731,,"38,809 x DRG weight",41731,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,78057,70,,78057,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26944,,"25,057 x DRG weight",26944,Other,base rate x DRG weight,24250,,"22,552 x DRG weight",24250,Other,base rate x DRG weight,26944,,"25,057 x DRG weight",26944,Other,base rate x DRG weight,22902,,"21,298 x DRG weight",22902,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,78057,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,,inpatient,,,106476.69,10691,,,10691,Other,150% of Medicare + 9.63% HCRA Surcharge,6500.99,,,6500.99,Other,Medicare IPPS methodology,18476,,"25,046 x DRG weight",18476,Other,base rate x DRG weight,16628,,"22,541 x DRG weight",16628,Other,base rate x DRG weight,23674,,"32,091 x DRG weight",23674,Other,base rate x DRG weight,21306,,"28,882 x DRG weight",21306,Other,base rate x DRG weight,20122,,"27,277 x DRG weight",20122,Other,base rate x DRG weight,17764,,"24,080 x DRG weight",17764,Other,base rate x DRG weight,16571,,"22,463 x DRG weight",16571,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,19494,,"26,426 x DRG weight",19494,Other,base rate x DRG weight,28629,,"38,809 x DRG weight",28629,Other,base rate x DRG weight,28629,,"38,809 x DRG weight",28629,Other,base rate x DRG weight,19494,,"26,426 x DRG weight",19494,Other,base rate x DRG weight,28629,,"38,809 x DRG weight",28629,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,74534,70,,74534,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,18485,,"25,057 x DRG weight",18485,Other,base rate x DRG weight,16637,,"22,552 x DRG weight",16637,Other,base rate x DRG weight,18485,,"25,057 x DRG weight",18485,Other,base rate x DRG weight,15712,,"21,298 x DRG weight",15712,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,74534,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,,inpatient,,,79106,7583,,,7583,Other,150% of Medicare + 9.63% HCRA Surcharge,4611.32,,,4611.32,Other,Medicare IPPS methodology,12819,,"25,046 x DRG weight",12819,Other,base rate x DRG weight,11536,,"22,541 x DRG weight",11536,Other,base rate x DRG weight,16424,,"32,091 x DRG weight",16424,Other,base rate x DRG weight,14782,,"28,882 x DRG weight",14782,Other,base rate x DRG weight,13960,,"27,277 x DRG weight",13960,Other,base rate x DRG weight,12324,,"24,080 x DRG weight",12324,Other,base rate x DRG weight,11497,,"22,463 x DRG weight",11497,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,13525,,"26,426 x DRG weight",13525,Other,base rate x DRG weight,19862,,"38,809 x DRG weight",19862,Other,base rate x DRG weight,19862,,"38,809 x DRG weight",19862,Other,base rate x DRG weight,13525,,"26,426 x DRG weight",13525,Other,base rate x DRG weight,19862,,"38,809 x DRG weight",19862,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,55374,70,,55374,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,12824,,"25,057 x DRG weight",12824,Other,base rate x DRG weight,11542,,"22,552 x DRG weight",11542,Other,base rate x DRG weight,12824,,"25,057 x DRG weight",12824,Other,base rate x DRG weight,10900,,"21,298 x DRG weight",10900,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,55374,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,834,MS-DRG,,,,,,,,inpatient,,,796579.88,77562,,,77562,Other,150% of Medicare + 9.63% HCRA Surcharge,47166.14,,,47166.14,Other,Medicare IPPS methodology,140233,,"25,046 x DRG weight",140233,Other,base rate x DRG weight,126207,,"22,541 x DRG weight",126207,Other,base rate x DRG weight,179678,,"32,091 x DRG weight",179678,Other,base rate x DRG weight,161710,,"28,882 x DRG weight",161710,Other,base rate x DRG weight,152724,,"27,277 x DRG weight",152724,Other,base rate x DRG weight,134824,,"24,080 x DRG weight",134824,Other,base rate x DRG weight,125770,,"22,463 x DRG weight",125770,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,147959,,"26,426 x DRG weight",147959,Other,base rate x DRG weight,217292,,"38,809 x DRG weight",217292,Other,base rate x DRG weight,217292,,"38,809 x DRG weight",217292,Other,base rate x DRG weight,147959,,"26,426 x DRG weight",147959,Other,base rate x DRG weight,217292,,"38,809 x DRG weight",217292,Other,base rate x DRG weight,103717,,"6,363 x patient days",103717,Per diem,,557606,70,,557606,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,140294,,"25,057 x DRG weight",140294,Other,base rate x DRG weight,126269,,"22,552 x DRG weight",126269,Other,base rate x DRG weight,140294,,"25,057 x DRG weight",140294,Other,base rate x DRG weight,119248,,"21,298 x DRG weight",119248,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,557606,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,835,MS-DRG,,,,,,,,inpatient,,,623373.46,31294,,,31294,Other,150% of Medicare + 9.63% HCRA Surcharge,19030.2,,,19030.2,Other,Medicare IPPS methodology,55990,,"25,046 x DRG weight",55990,Other,base rate x DRG weight,50390,,"22,541 x DRG weight",50390,Other,base rate x DRG weight,71739,,"32,091 x DRG weight",71739,Other,base rate x DRG weight,64566,,"28,882 x DRG weight",64566,Other,base rate x DRG weight,60978,,"27,277 x DRG weight",60978,Other,base rate x DRG weight,53831,,"24,080 x DRG weight",53831,Other,base rate x DRG weight,50216,,"22,463 x DRG weight",50216,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,59075,,"26,426 x DRG weight",59075,Other,base rate x DRG weight,86758,,"38,809 x DRG weight",86758,Other,base rate x DRG weight,86758,,"38,809 x DRG weight",86758,Other,base rate x DRG weight,59075,,"26,426 x DRG weight",59075,Other,base rate x DRG weight,86758,,"38,809 x DRG weight",86758,Other,base rate x DRG weight,45814,,"6,363 x patient days",45814,Per diem,,436361,70,,436361,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,56015,,"25,057 x DRG weight",56015,Other,base rate x DRG weight,50415,,"22,552 x DRG weight",50415,Other,base rate x DRG weight,56015,,"25,057 x DRG weight",56015,Other,base rate x DRG weight,47612,,"21,298 x DRG weight",47612,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,436361,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,836,MS-DRG,,,,,,,,inpatient,,,216729.11,19965,,,19965,Other,150% of Medicare + 9.63% HCRA Surcharge,12140.72,,,12140.72,Other,Medicare IPPS methodology,35362,,"25,046 x DRG weight",35362,Other,base rate x DRG weight,31826,,"22,541 x DRG weight",31826,Other,base rate x DRG weight,45309,,"32,091 x DRG weight",45309,Other,base rate x DRG weight,40778,,"28,882 x DRG weight",40778,Other,base rate x DRG weight,38512,,"27,277 x DRG weight",38512,Other,base rate x DRG weight,33999,,"24,080 x DRG weight",33999,Other,base rate x DRG weight,31716,,"22,463 x DRG weight",31716,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37311,,"26,426 x DRG weight",37311,Other,base rate x DRG weight,54794,,"38,809 x DRG weight",54794,Other,base rate x DRG weight,54794,,"38,809 x DRG weight",54794,Other,base rate x DRG weight,37311,,"26,426 x DRG weight",37311,Other,base rate x DRG weight,54794,,"38,809 x DRG weight",54794,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,151710,70,,151710,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35378,,"25,057 x DRG weight",35378,Other,base rate x DRG weight,31841,,"22,552 x DRG weight",31841,Other,base rate x DRG weight,35378,,"25,057 x DRG weight",35378,Other,base rate x DRG weight,30071,,"21,298 x DRG weight",30071,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,151710,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,,inpatient,,,621914.21,67177,,,67177,Other,150% of Medicare + 9.63% HCRA Surcharge,40850.5,,,40850.5,Other,Medicare IPPS methodology,121323,,"25,046 x DRG weight",121323,Other,base rate x DRG weight,109189,,"22,541 x DRG weight",109189,Other,base rate x DRG weight,155449,,"32,091 x DRG weight",155449,Other,base rate x DRG weight,139904,,"28,882 x DRG weight",139904,Other,base rate x DRG weight,132130,,"27,277 x DRG weight",132130,Other,base rate x DRG weight,116644,,"24,080 x DRG weight",116644,Other,base rate x DRG weight,108811,,"22,463 x DRG weight",108811,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,128008,,"26,426 x DRG weight",128008,Other,base rate x DRG weight,187991,,"38,809 x DRG weight",187991,Other,base rate x DRG weight,187991,,"38,809 x DRG weight",187991,Other,base rate x DRG weight,128008,,"26,426 x DRG weight",128008,Other,base rate x DRG weight,187991,,"38,809 x DRG weight",187991,Other,base rate x DRG weight,101808,,"6,363 x patient days",101808,Per diem,,435340,70,,435340,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,121376,,"25,057 x DRG weight",121376,Other,base rate x DRG weight,109242,,"22,552 x DRG weight",109242,Other,base rate x DRG weight,121376,,"25,057 x DRG weight",121376,Other,base rate x DRG weight,103168,,"21,298 x DRG weight",103168,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,435340,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,,inpatient,,,283819.16,28078,,,28078,Other,150% of Medicare + 9.63% HCRA Surcharge,17074.44,,,17074.44,Other,Medicare IPPS methodology,50135,,"25,046 x DRG weight",50135,Other,base rate x DRG weight,45120,,"22,541 x DRG weight",45120,Other,base rate x DRG weight,64237,,"32,091 x DRG weight",64237,Other,base rate x DRG weight,57813,,"28,882 x DRG weight",57813,Other,base rate x DRG weight,54600,,"27,277 x DRG weight",54600,Other,base rate x DRG weight,48201,,"24,080 x DRG weight",48201,Other,base rate x DRG weight,44964,,"22,463 x DRG weight",44964,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52897,,"26,426 x DRG weight",52897,Other,base rate x DRG weight,77684,,"38,809 x DRG weight",77684,Other,base rate x DRG weight,77684,,"38,809 x DRG weight",77684,Other,base rate x DRG weight,52897,,"26,426 x DRG weight",52897,Other,base rate x DRG weight,77684,,"38,809 x DRG weight",77684,Other,base rate x DRG weight,41996,,"6,363 x patient days",41996,Per diem,,198673,70,,198673,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,50157,,"25,057 x DRG weight",50157,Other,base rate x DRG weight,45142,,"22,552 x DRG weight",45142,Other,base rate x DRG weight,50157,,"25,057 x DRG weight",50157,Other,base rate x DRG weight,42632,,"21,298 x DRG weight",42632,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,198673,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,,inpatient,,,164472.38,18468,,,18468,Other,150% of Medicare + 9.63% HCRA Surcharge,11230.6,,,11230.6,Other,Medicare IPPS methodology,32637,,"25,046 x DRG weight",32637,Other,base rate x DRG weight,29373,,"22,541 x DRG weight",29373,Other,base rate x DRG weight,41818,,"32,091 x DRG weight",41818,Other,base rate x DRG weight,37636,,"28,882 x DRG weight",37636,Other,base rate x DRG weight,35545,,"27,277 x DRG weight",35545,Other,base rate x DRG weight,31379,,"24,080 x DRG weight",31379,Other,base rate x DRG weight,29272,,"22,463 x DRG weight",29272,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,34436,,"26,426 x DRG weight",34436,Other,base rate x DRG weight,50572,,"38,809 x DRG weight",50572,Other,base rate x DRG weight,50572,,"38,809 x DRG weight",50572,Other,base rate x DRG weight,34436,,"26,426 x DRG weight",34436,Other,base rate x DRG weight,50572,,"38,809 x DRG weight",50572,Other,base rate x DRG weight,28634,,"6,363 x patient days",28634,Per diem,,115131,70,,115131,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32652,,"25,057 x DRG weight",32652,Other,base rate x DRG weight,29388,,"22,552 x DRG weight",29388,Other,base rate x DRG weight,32652,,"25,057 x DRG weight",32652,Other,base rate x DRG weight,27753,,"21,298 x DRG weight",27753,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,115131,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,,inpatient,,,435632.41,43533,,,43533,Other,150% of Medicare + 9.63% HCRA Surcharge,26472.61,,,26472.61,Other,Medicare IPPS methodology,78274,,"25,046 x DRG weight",78274,Other,base rate x DRG weight,70445,,"22,541 x DRG weight",70445,Other,base rate x DRG weight,100291,,"32,091 x DRG weight",100291,Other,base rate x DRG weight,90262,,"28,882 x DRG weight",90262,Other,base rate x DRG weight,85246,,"27,277 x DRG weight",85246,Other,base rate x DRG weight,75255,,"24,080 x DRG weight",75255,Other,base rate x DRG weight,70201,,"22,463 x DRG weight",70201,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,82587,,"26,426 x DRG weight",82587,Other,base rate x DRG weight,121286,,"38,809 x DRG weight",121286,Other,base rate x DRG weight,121286,,"38,809 x DRG weight",121286,Other,base rate x DRG weight,82587,,"26,426 x DRG weight",82587,Other,base rate x DRG weight,121286,,"38,809 x DRG weight",121286,Other,base rate x DRG weight,62994,,"6,363 x patient days",62994,Per diem,,304943,70,,304943,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,78308,,"25,057 x DRG weight",78308,Other,base rate x DRG weight,70480,,"22,552 x DRG weight",70480,Other,base rate x DRG weight,78308,,"25,057 x DRG weight",78308,Other,base rate x DRG weight,66561,,"21,298 x DRG weight",66561,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,304943,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,,inpatient,,,330332.43,22188,,,22188,Other,150% of Medicare + 9.63% HCRA Surcharge,13492.52,,,13492.52,Other,Medicare IPPS methodology,39410,,"25,046 x DRG weight",39410,Other,base rate x DRG weight,35468,,"22,541 x DRG weight",35468,Other,base rate x DRG weight,50495,,"32,091 x DRG weight",50495,Other,base rate x DRG weight,45446,,"28,882 x DRG weight",45446,Other,base rate x DRG weight,42920,,"27,277 x DRG weight",42920,Other,base rate x DRG weight,37890,,"24,080 x DRG weight",37890,Other,base rate x DRG weight,35346,,"22,463 x DRG weight",35346,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41581,,"26,426 x DRG weight",41581,Other,base rate x DRG weight,61066,,"38,809 x DRG weight",61066,Other,base rate x DRG weight,61066,,"38,809 x DRG weight",61066,Other,base rate x DRG weight,41581,,"26,426 x DRG weight",41581,Other,base rate x DRG weight,61066,,"38,809 x DRG weight",61066,Other,base rate x DRG weight,34997,,"6,363 x patient days",34997,Per diem,,231233,70,,231233,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39427,,"25,057 x DRG weight",39427,Other,base rate x DRG weight,35486,,"22,552 x DRG weight",35486,Other,base rate x DRG weight,39427,,"25,057 x DRG weight",39427,Other,base rate x DRG weight,33512,,"21,298 x DRG weight",33512,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,231233,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,,inpatient,,,208498.44,15212,,,15212,Other,150% of Medicare + 9.63% HCRA Surcharge,9250.59,,,9250.59,Other,Medicare IPPS methodology,26709,,"25,046 x DRG weight",26709,Other,base rate x DRG weight,24038,,"22,541 x DRG weight",24038,Other,base rate x DRG weight,34222,,"32,091 x DRG weight",34222,Other,base rate x DRG weight,30800,,"28,882 x DRG weight",30800,Other,base rate x DRG weight,29088,,"27,277 x DRG weight",29088,Other,base rate x DRG weight,25679,,"24,080 x DRG weight",25679,Other,base rate x DRG weight,23955,,"22,463 x DRG weight",23955,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28181,,"26,426 x DRG weight",28181,Other,base rate x DRG weight,41386,,"38,809 x DRG weight",41386,Other,base rate x DRG weight,41386,,"38,809 x DRG weight",41386,Other,base rate x DRG weight,28181,,"26,426 x DRG weight",28181,Other,base rate x DRG weight,41386,,"38,809 x DRG weight",41386,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,145949,70,,145949,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26721,,"25,057 x DRG weight",26721,Other,base rate x DRG weight,24049,,"22,552 x DRG weight",24049,Other,base rate x DRG weight,26721,,"25,057 x DRG weight",26721,Other,base rate x DRG weight,22712,,"21,298 x DRG weight",22712,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,145949,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,,inpatient,,,524795.41,26137,,,26137,Other,150% of Medicare + 9.63% HCRA Surcharge,15894.13,,,15894.13,Other,Medicare IPPS methodology,46601,,"25,046 x DRG weight",46601,Other,base rate x DRG weight,41940,,"22,541 x DRG weight",41940,Other,base rate x DRG weight,59709,,"32,091 x DRG weight",59709,Other,base rate x DRG weight,53738,,"28,882 x DRG weight",53738,Other,base rate x DRG weight,50752,,"27,277 x DRG weight",50752,Other,base rate x DRG weight,44803,,"24,080 x DRG weight",44803,Other,base rate x DRG weight,41795,,"22,463 x DRG weight",41795,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49168,,"26,426 x DRG weight",49168,Other,base rate x DRG weight,72208,,"38,809 x DRG weight",72208,Other,base rate x DRG weight,72208,,"38,809 x DRG weight",72208,Other,base rate x DRG weight,49168,,"26,426 x DRG weight",49168,Other,base rate x DRG weight,72208,,"38,809 x DRG weight",72208,Other,base rate x DRG weight,47086,,"6,363 x patient days",47086,Per diem,,367357,70,,367357,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46621,,"25,057 x DRG weight",46621,Other,base rate x DRG weight,41960,,"22,552 x DRG weight",41960,Other,base rate x DRG weight,46621,,"25,057 x DRG weight",46621,Other,base rate x DRG weight,39627,,"21,298 x DRG weight",39627,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,367357,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,,inpatient,,,423023.75,16461,,,16461,Other,150% of Medicare + 9.63% HCRA Surcharge,10010.14,,,10010.14,Other,Medicare IPPS methodology,28983,,"25,046 x DRG weight",28983,Other,base rate x DRG weight,26084,,"22,541 x DRG weight",26084,Other,base rate x DRG weight,37136,,"32,091 x DRG weight",37136,Other,base rate x DRG weight,33422,,"28,882 x DRG weight",33422,Other,base rate x DRG weight,31565,,"27,277 x DRG weight",31565,Other,base rate x DRG weight,27865,,"24,080 x DRG weight",27865,Other,base rate x DRG weight,25994,,"22,463 x DRG weight",25994,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,30580,,"26,426 x DRG weight",30580,Other,base rate x DRG weight,44910,,"38,809 x DRG weight",44910,Other,base rate x DRG weight,44910,,"38,809 x DRG weight",44910,Other,base rate x DRG weight,30580,,"26,426 x DRG weight",30580,Other,base rate x DRG weight,44910,,"38,809 x DRG weight",44910,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,296117,70,,296117,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,28996,,"25,057 x DRG weight",28996,Other,base rate x DRG weight,26097,,"22,552 x DRG weight",26097,Other,base rate x DRG weight,28996,,"25,057 x DRG weight",28996,Other,base rate x DRG weight,24646,,"21,298 x DRG weight",24646,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,296117,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,,inpatient,,,80786,12440,,,12440,Other,150% of Medicare + 9.63% HCRA Surcharge,7565.03,,,7565.03,Other,Medicare IPPS methodology,21662,,"25,046 x DRG weight",21662,Other,base rate x DRG weight,19496,,"22,541 x DRG weight",19496,Other,base rate x DRG weight,27756,,"32,091 x DRG weight",27756,Other,base rate x DRG weight,24980,,"28,882 x DRG weight",24980,Other,base rate x DRG weight,23592,,"27,277 x DRG weight",23592,Other,base rate x DRG weight,20827,,"24,080 x DRG weight",20827,Other,base rate x DRG weight,19428,,"22,463 x DRG weight",19428,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22856,,"26,426 x DRG weight",22856,Other,base rate x DRG weight,33566,,"38,809 x DRG weight",33566,Other,base rate x DRG weight,33566,,"38,809 x DRG weight",33566,Other,base rate x DRG weight,22856,,"26,426 x DRG weight",22856,Other,base rate x DRG weight,33566,,"38,809 x DRG weight",33566,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,56550,70,,56550,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21672,,"25,057 x DRG weight",21672,Other,base rate x DRG weight,19505,,"22,552 x DRG weight",19505,Other,base rate x DRG weight,21672,,"25,057 x DRG weight",21672,Other,base rate x DRG weight,18421,,"21,298 x DRG weight",18421,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,56550,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,,inpatient,,,271697,34162,,,34162,Other,150% of Medicare + 9.63% HCRA Surcharge,20774.32,,,20774.32,Other,Medicare IPPS methodology,61212,,"25,046 x DRG weight",61212,Other,base rate x DRG weight,55090,,"22,541 x DRG weight",55090,Other,base rate x DRG weight,78430,,"32,091 x DRG weight",78430,Other,base rate x DRG weight,70588,,"28,882 x DRG weight",70588,Other,base rate x DRG weight,66665,,"27,277 x DRG weight",66665,Other,base rate x DRG weight,58852,,"24,080 x DRG weight",58852,Other,base rate x DRG weight,54900,,"22,463 x DRG weight",54900,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,64585,,"26,426 x DRG weight",64585,Other,base rate x DRG weight,94849,,"38,809 x DRG weight",94849,Other,base rate x DRG weight,94849,,"38,809 x DRG weight",94849,Other,base rate x DRG weight,64585,,"26,426 x DRG weight",64585,Other,base rate x DRG weight,94849,,"38,809 x DRG weight",94849,Other,base rate x DRG weight,50268,,"6,363 x patient days",50268,Per diem,,190188,70,,190188,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,61239,,"25,057 x DRG weight",61239,Other,base rate x DRG weight,55117,,"22,552 x DRG weight",55117,Other,base rate x DRG weight,61239,,"25,057 x DRG weight",61239,Other,base rate x DRG weight,52052,,"21,298 x DRG weight",52052,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,190188,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,,inpatient,,,110806.33,17223,,,17223,Other,150% of Medicare + 9.63% HCRA Surcharge,10473.56,,,10473.56,Other,Medicare IPPS methodology,30371,,"25,046 x DRG weight",30371,Other,base rate x DRG weight,27333,,"22,541 x DRG weight",27333,Other,base rate x DRG weight,38914,,"32,091 x DRG weight",38914,Other,base rate x DRG weight,35022,,"28,882 x DRG weight",35022,Other,base rate x DRG weight,33076,,"27,277 x DRG weight",33076,Other,base rate x DRG weight,29199,,"24,080 x DRG weight",29199,Other,base rate x DRG weight,27239,,"22,463 x DRG weight",27239,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,32044,,"26,426 x DRG weight",32044,Other,base rate x DRG weight,47060,,"38,809 x DRG weight",47060,Other,base rate x DRG weight,47060,,"38,809 x DRG weight",47060,Other,base rate x DRG weight,32044,,"26,426 x DRG weight",32044,Other,base rate x DRG weight,47060,,"38,809 x DRG weight",47060,Other,base rate x DRG weight,26725,,"6,363 x patient days",26725,Per diem,,77564,70,,77564,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,30384,,"25,057 x DRG weight",30384,Other,base rate x DRG weight,27347,,"22,552 x DRG weight",27347,Other,base rate x DRG weight,30384,,"25,057 x DRG weight",30384,Other,base rate x DRG weight,25826,,"21,298 x DRG weight",25826,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,77564,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,,inpatient,,,75000.87,12046,,,12046,Other,150% of Medicare + 9.63% HCRA Surcharge,7324.95,,,7324.95,Other,Medicare IPPS methodology,20943,,"25,046 x DRG weight",20943,Other,base rate x DRG weight,18849,,"22,541 x DRG weight",18849,Other,base rate x DRG weight,26834,,"32,091 x DRG weight",26834,Other,base rate x DRG weight,24151,,"28,882 x DRG weight",24151,Other,base rate x DRG weight,22809,,"27,277 x DRG weight",22809,Other,base rate x DRG weight,20136,,"24,080 x DRG weight",20136,Other,base rate x DRG weight,18784,,"22,463 x DRG weight",18784,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22097,,"26,426 x DRG weight",22097,Other,base rate x DRG weight,32452,,"38,809 x DRG weight",32452,Other,base rate x DRG weight,32452,,"38,809 x DRG weight",32452,Other,base rate x DRG weight,22097,,"26,426 x DRG weight",22097,Other,base rate x DRG weight,32452,,"38,809 x DRG weight",32452,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,52501,70,,52501,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20953,,"25,057 x DRG weight",20953,Other,base rate x DRG weight,18858,,"22,552 x DRG weight",18858,Other,base rate x DRG weight,20953,,"25,057 x DRG weight",20953,Other,base rate x DRG weight,17809,,"21,298 x DRG weight",17809,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,52501,
RADIOTHERAPY,849,MS-DRG,,,,,,,,inpatient,,,177682.96,37566,,,37566,Other,150% of Medicare + 9.63% HCRA Surcharge,22843.84,,,22843.84,Other,Medicare IPPS methodology,67409,,"25,046 x DRG weight",67409,Other,base rate x DRG weight,60667,,"22,541 x DRG weight",60667,Other,base rate x DRG weight,86370,,"32,091 x DRG weight",86370,Other,base rate x DRG weight,77733,,"28,882 x DRG weight",77733,Other,base rate x DRG weight,73413,,"27,277 x DRG weight",73413,Other,base rate x DRG weight,64809,,"24,080 x DRG weight",64809,Other,base rate x DRG weight,60457,,"22,463 x DRG weight",60457,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,71123,,"26,426 x DRG weight",71123,Other,base rate x DRG weight,104451,,"38,809 x DRG weight",104451,Other,base rate x DRG weight,104451,,"38,809 x DRG weight",104451,Other,base rate x DRG weight,71123,,"26,426 x DRG weight",71123,Other,base rate x DRG weight,104451,,"38,809 x DRG weight",104451,Other,base rate x DRG weight,66175,,"6,363 x patient days",66175,Per diem,,124378,70,,124378,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,67438,,"25,057 x DRG weight",67438,Other,base rate x DRG weight,60696,,"22,552 x DRG weight",60696,Other,base rate x DRG weight,67438,,"25,057 x DRG weight",67438,Other,base rate x DRG weight,57321,,"21,298 x DRG weight",57321,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,124378,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,,inpatient,,,645394.83,69313,,,69313,Other,150% of Medicare + 9.63% HCRA Surcharge,42149.6,,,42149.6,Other,Medicare IPPS methodology,125212,,"25,046 x DRG weight",125212,Other,base rate x DRG weight,112689,,"22,541 x DRG weight",112689,Other,base rate x DRG weight,160433,,"32,091 x DRG weight",160433,Other,base rate x DRG weight,144390,,"28,882 x DRG weight",144390,Other,base rate x DRG weight,136366,,"27,277 x DRG weight",136366,Other,base rate x DRG weight,120383,,"24,080 x DRG weight",120383,Other,base rate x DRG weight,112299,,"22,463 x DRG weight",112299,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,132112,,"26,426 x DRG weight",132112,Other,base rate x DRG weight,194018,,"38,809 x DRG weight",194018,Other,base rate x DRG weight,194018,,"38,809 x DRG weight",194018,Other,base rate x DRG weight,132112,,"26,426 x DRG weight",132112,Other,base rate x DRG weight,194018,,"38,809 x DRG weight",194018,Other,base rate x DRG weight,84628,,"6,363 x patient days",84628,Per diem,,451776,70,,451776,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,125267,,"25,057 x DRG weight",125267,Other,base rate x DRG weight,112744,,"22,552 x DRG weight",112744,Other,base rate x DRG weight,125267,,"25,057 x DRG weight",125267,Other,base rate x DRG weight,106475,,"21,298 x DRG weight",106475,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,451776,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,,inpatient,,,221748.51,28580,,,28580,Other,150% of Medicare + 9.63% HCRA Surcharge,17379.77,,,17379.77,Other,Medicare IPPS methodology,51049,,"25,046 x DRG weight",51049,Other,base rate x DRG weight,45943,,"22,541 x DRG weight",45943,Other,base rate x DRG weight,65408,,"32,091 x DRG weight",65408,Other,base rate x DRG weight,58867,,"28,882 x DRG weight",58867,Other,base rate x DRG weight,55596,,"27,277 x DRG weight",55596,Other,base rate x DRG weight,49080,,"24,080 x DRG weight",49080,Other,base rate x DRG weight,45784,,"22,463 x DRG weight",45784,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,53861,,"26,426 x DRG weight",53861,Other,base rate x DRG weight,79101,,"38,809 x DRG weight",79101,Other,base rate x DRG weight,79101,,"38,809 x DRG weight",79101,Other,base rate x DRG weight,53861,,"26,426 x DRG weight",53861,Other,base rate x DRG weight,79101,,"38,809 x DRG weight",79101,Other,base rate x DRG weight,41996,,"6,363 x patient days",41996,Per diem,,155224,70,,155224,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,51071,,"25,057 x DRG weight",51071,Other,base rate x DRG weight,45965,,"22,552 x DRG weight",45965,Other,base rate x DRG weight,51071,,"25,057 x DRG weight",51071,Other,base rate x DRG weight,43410,,"21,298 x DRG weight",43410,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,155224,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,,inpatient,,,246890.84,23953,,,23953,Other,150% of Medicare + 9.63% HCRA Surcharge,14565.76,,,14565.76,Other,Medicare IPPS methodology,42623,,"25,046 x DRG weight",42623,Other,base rate x DRG weight,38360,,"22,541 x DRG weight",38360,Other,base rate x DRG weight,54612,,"32,091 x DRG weight",54612,Other,base rate x DRG weight,49151,,"28,882 x DRG weight",49151,Other,base rate x DRG weight,46420,,"27,277 x DRG weight",46420,Other,base rate x DRG weight,40979,,"24,080 x DRG weight",40979,Other,base rate x DRG weight,38228,,"22,463 x DRG weight",38228,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,44972,,"26,426 x DRG weight",44972,Other,base rate x DRG weight,66045,,"38,809 x DRG weight",66045,Other,base rate x DRG weight,66045,,"38,809 x DRG weight",66045,Other,base rate x DRG weight,44972,,"26,426 x DRG weight",44972,Other,base rate x DRG weight,66045,,"38,809 x DRG weight",66045,Other,base rate x DRG weight,28634,,"6,363 x patient days",28634,Per diem,,172824,70,,172824,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,42642,,"25,057 x DRG weight",42642,Other,base rate x DRG weight,38379,,"22,552 x DRG weight",38379,Other,base rate x DRG weight,42642,,"25,057 x DRG weight",42642,Other,base rate x DRG weight,36245,,"21,298 x DRG weight",36245,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,172824,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,,inpatient,,,744269.96,61460,,,61460,Other,150% of Medicare + 9.63% HCRA Surcharge,37373.98,,,37373.98,Other,Medicare IPPS methodology,110914,,"25,046 x DRG weight",110914,Other,base rate x DRG weight,99821,,"22,541 x DRG weight",99821,Other,base rate x DRG weight,142112,,"32,091 x DRG weight",142112,Other,base rate x DRG weight,127901,,"28,882 x DRG weight",127901,Other,base rate x DRG weight,120793,,"27,277 x DRG weight",120793,Other,base rate x DRG weight,106636,,"24,080 x DRG weight",106636,Other,base rate x DRG weight,99475,,"22,463 x DRG weight",99475,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,117025,,"26,426 x DRG weight",117025,Other,base rate x DRG weight,171862,,"38,809 x DRG weight",171862,Other,base rate x DRG weight,171862,,"38,809 x DRG weight",171862,Other,base rate x DRG weight,117025,,"26,426 x DRG weight",117025,Other,base rate x DRG weight,171862,,"38,809 x DRG weight",171862,Other,base rate x DRG weight,79538,,"6,363 x patient days",79538,Per diem,,520989,70,,520989,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,110962,,"25,057 x DRG weight",110962,Other,base rate x DRG weight,99869,,"22,552 x DRG weight",99869,Other,base rate x DRG weight,110962,,"25,057 x DRG weight",110962,Other,base rate x DRG weight,94316,,"21,298 x DRG weight",94316,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,520989,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,,inpatient,,,276880.94,29921,,,29921,Other,150% of Medicare + 9.63% HCRA Surcharge,18195.36,,,18195.36,Other,Medicare IPPS methodology,53491,,"25,046 x DRG weight",53491,Other,base rate x DRG weight,48141,,"22,541 x DRG weight",48141,Other,base rate x DRG weight,68537,,"32,091 x DRG weight",68537,Other,base rate x DRG weight,61683,,"28,882 x DRG weight",61683,Other,base rate x DRG weight,58255,,"27,277 x DRG weight",58255,Other,base rate x DRG weight,51428,,"24,080 x DRG weight",51428,Other,base rate x DRG weight,47974,,"22,463 x DRG weight",47974,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,56438,,"26,426 x DRG weight",56438,Other,base rate x DRG weight,82884,,"38,809 x DRG weight",82884,Other,base rate x DRG weight,82884,,"38,809 x DRG weight",82884,Other,base rate x DRG weight,56438,,"26,426 x DRG weight",56438,Other,base rate x DRG weight,82884,,"38,809 x DRG weight",82884,Other,base rate x DRG weight,43905,,"6,363 x patient days",43905,Per diem,,193817,70,,193817,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,53514,,"25,057 x DRG weight",53514,Other,base rate x DRG weight,48164,,"22,552 x DRG weight",48164,Other,base rate x DRG weight,53514,,"25,057 x DRG weight",53514,Other,base rate x DRG weight,45486,,"21,298 x DRG weight",45486,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,193817,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,,inpatient,,,68959.4,18197,,,18197,Other,150% of Medicare + 9.63% HCRA Surcharge,11065.81,,,11065.81,Other,Medicare IPPS methodology,32144,,"25,046 x DRG weight",32144,Other,base rate x DRG weight,28929,,"22,541 x DRG weight",28929,Other,base rate x DRG weight,41186,,"32,091 x DRG weight",41186,Other,base rate x DRG weight,37067,,"28,882 x DRG weight",37067,Other,base rate x DRG weight,35007,,"27,277 x DRG weight",35007,Other,base rate x DRG weight,30904,,"24,080 x DRG weight",30904,Other,base rate x DRG weight,28829,,"22,463 x DRG weight",28829,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,33915,,"26,426 x DRG weight",33915,Other,base rate x DRG weight,49807,,"38,809 x DRG weight",49807,Other,base rate x DRG weight,49807,,"38,809 x DRG weight",49807,Other,base rate x DRG weight,33915,,"26,426 x DRG weight",33915,Other,base rate x DRG weight,49807,,"38,809 x DRG weight",49807,Other,base rate x DRG weight,26088,,"6,363 x patient days",26088,Per diem,,48272,70,,48272,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,32158,,"25,057 x DRG weight",32158,Other,base rate x DRG weight,28943,,"22,552 x DRG weight",28943,Other,base rate x DRG weight,32158,,"25,057 x DRG weight",32158,Other,base rate x DRG weight,27334,,"21,298 x DRG weight",27334,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,49807,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,,inpatient,,,234292.57,25881,,,25881,Other,150% of Medicare + 9.63% HCRA Surcharge,15738.54,,,15738.54,Other,Medicare IPPS methodology,46135,,"25,046 x DRG weight",46135,Other,base rate x DRG weight,41521,,"22,541 x DRG weight",41521,Other,base rate x DRG weight,59112,,"32,091 x DRG weight",59112,Other,base rate x DRG weight,53201,,"28,882 x DRG weight",53201,Other,base rate x DRG weight,50244,,"27,277 x DRG weight",50244,Other,base rate x DRG weight,44355,,"24,080 x DRG weight",44355,Other,base rate x DRG weight,41377,,"22,463 x DRG weight",41377,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48677,,"26,426 x DRG weight",48677,Other,base rate x DRG weight,71486,,"38,809 x DRG weight",71486,Other,base rate x DRG weight,71486,,"38,809 x DRG weight",71486,Other,base rate x DRG weight,48677,,"26,426 x DRG weight",48677,Other,base rate x DRG weight,71486,,"38,809 x DRG weight",71486,Other,base rate x DRG weight,43268,,"6,363 x patient days",43268,Per diem,,164005,70,,164005,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46155,,"25,057 x DRG weight",46155,Other,base rate x DRG weight,41541,,"22,552 x DRG weight",41541,Other,base rate x DRG weight,46155,,"25,057 x DRG weight",46155,Other,base rate x DRG weight,39231,,"21,298 x DRG weight",39231,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,164005,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,,inpatient,,,126665.38,14374,,,14374,Other,150% of Medicare + 9.63% HCRA Surcharge,8741.15,,,8741.15,Other,Medicare IPPS methodology,25184,,"25,046 x DRG weight",25184,Other,base rate x DRG weight,22665,,"22,541 x DRG weight",22665,Other,base rate x DRG weight,32268,,"32,091 x DRG weight",32268,Other,base rate x DRG weight,29041,,"28,882 x DRG weight",29041,Other,base rate x DRG weight,27427,,"27,277 x DRG weight",27427,Other,base rate x DRG weight,24212,,"24,080 x DRG weight",24212,Other,base rate x DRG weight,22587,,"22,463 x DRG weight",22587,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26571,,"26,426 x DRG weight",26571,Other,base rate x DRG weight,39022,,"38,809 x DRG weight",39022,Other,base rate x DRG weight,39022,,"38,809 x DRG weight",39022,Other,base rate x DRG weight,26571,,"26,426 x DRG weight",26571,Other,base rate x DRG weight,39022,,"38,809 x DRG weight",39022,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,88666,70,,88666,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25195,,"25,057 x DRG weight",25195,Other,base rate x DRG weight,22676,,"22,552 x DRG weight",22676,Other,base rate x DRG weight,25195,,"25,057 x DRG weight",25195,Other,base rate x DRG weight,21415,,"21,298 x DRG weight",21415,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,88666,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,,inpatient,,,89742.06,12687,,,12687,Other,150% of Medicare + 9.63% HCRA Surcharge,7714.76,,,7714.76,Other,Medicare IPPS methodology,22111,,"25,046 x DRG weight",22111,Other,base rate x DRG weight,19899,,"22,541 x DRG weight",19899,Other,base rate x DRG weight,28330,,"32,091 x DRG weight",28330,Other,base rate x DRG weight,25497,,"28,882 x DRG weight",25497,Other,base rate x DRG weight,24080,,"27,277 x DRG weight",24080,Other,base rate x DRG weight,21258,,"24,080 x DRG weight",21258,Other,base rate x DRG weight,19830,,"22,463 x DRG weight",19830,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23329,,"26,426 x DRG weight",23329,Other,base rate x DRG weight,34261,,"38,809 x DRG weight",34261,Other,base rate x DRG weight,34261,,"38,809 x DRG weight",34261,Other,base rate x DRG weight,23329,,"26,426 x DRG weight",23329,Other,base rate x DRG weight,34261,,"38,809 x DRG weight",34261,Other,base rate x DRG weight,21634,,"6,363 x patient days",21634,Per diem,,62819,70,,62819,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22120,,"25,057 x DRG weight",22120,Other,base rate x DRG weight,19909,,"22,552 x DRG weight",19909,Other,base rate x DRG weight,22120,,"25,057 x DRG weight",22120,Other,base rate x DRG weight,18802,,"21,298 x DRG weight",18802,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,62819,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,,inpatient,,,116548.9,23101,,,23101,Other,150% of Medicare + 9.63% HCRA Surcharge,14047.96,,,14047.96,Other,Medicare IPPS methodology,41073,,"25,046 x DRG weight",41073,Other,base rate x DRG weight,36965,,"22,541 x DRG weight",36965,Other,base rate x DRG weight,52626,,"32,091 x DRG weight",52626,Other,base rate x DRG weight,47364,,"28,882 x DRG weight",47364,Other,base rate x DRG weight,44732,,"27,277 x DRG weight",44732,Other,base rate x DRG weight,39489,,"24,080 x DRG weight",39489,Other,base rate x DRG weight,36837,,"22,463 x DRG weight",36837,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43336,,"26,426 x DRG weight",43336,Other,base rate x DRG weight,63643,,"38,809 x DRG weight",63643,Other,base rate x DRG weight,63643,,"38,809 x DRG weight",63643,Other,base rate x DRG weight,43336,,"26,426 x DRG weight",43336,Other,base rate x DRG weight,63643,,"38,809 x DRG weight",63643,Other,base rate x DRG weight,40087,,"6,363 x patient days",40087,Per diem,,81584,70,,81584,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,41091,,"25,057 x DRG weight",41091,Other,base rate x DRG weight,36983,,"22,552 x DRG weight",36983,Other,base rate x DRG weight,41091,,"25,057 x DRG weight",41091,Other,base rate x DRG weight,34927,,"21,298 x DRG weight",34927,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,81584,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,,inpatient,,,103943.58,13167,,,13167,Other,150% of Medicare + 9.63% HCRA Surcharge,8006.7,,,8006.7,Other,Medicare IPPS methodology,22985,,"25,046 x DRG weight",22985,Other,base rate x DRG weight,20686,,"22,541 x DRG weight",20686,Other,base rate x DRG weight,29450,,"32,091 x DRG weight",29450,Other,base rate x DRG weight,26505,,"28,882 x DRG weight",26505,Other,base rate x DRG weight,25032,,"27,277 x DRG weight",25032,Other,base rate x DRG weight,22098,,"24,080 x DRG weight",22098,Other,base rate x DRG weight,20614,,"22,463 x DRG weight",20614,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,24251,,"26,426 x DRG weight",24251,Other,base rate x DRG weight,35615,,"38,809 x DRG weight",35615,Other,base rate x DRG weight,35615,,"38,809 x DRG weight",35615,Other,base rate x DRG weight,24251,,"26,426 x DRG weight",24251,Other,base rate x DRG weight,35615,,"38,809 x DRG weight",35615,Other,base rate x DRG weight,24179,,"6,363 x patient days",24179,Per diem,,72761,70,,72761,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22995,,"25,057 x DRG weight",22995,Other,base rate x DRG weight,20696,,"22,552 x DRG weight",20696,Other,base rate x DRG weight,22995,,"25,057 x DRG weight",22995,Other,base rate x DRG weight,19545,,"21,298 x DRG weight",19545,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,72761,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,,inpatient,,,194621.4,29324,,,29324,Other,150% of Medicare + 9.63% HCRA Surcharge,17832.32,,,17832.32,Other,Medicare IPPS methodology,52404,,"25,046 x DRG weight",52404,Other,base rate x DRG weight,47163,,"22,541 x DRG weight",47163,Other,base rate x DRG weight,67144,,"32,091 x DRG weight",67144,Other,base rate x DRG weight,60430,,"28,882 x DRG weight",60430,Other,base rate x DRG weight,57072,,"27,277 x DRG weight",57072,Other,base rate x DRG weight,50383,,"24,080 x DRG weight",50383,Other,base rate x DRG weight,46999,,"22,463 x DRG weight",46999,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,55291,,"26,426 x DRG weight",55291,Other,base rate x DRG weight,81200,,"38,809 x DRG weight",81200,Other,base rate x DRG weight,81200,,"38,809 x DRG weight",81200,Other,base rate x DRG weight,55291,,"26,426 x DRG weight",55291,Other,base rate x DRG weight,81200,,"38,809 x DRG weight",81200,Other,base rate x DRG weight,49631,,"6,363 x patient days",49631,Per diem,,136235,70,,136235,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52427,,"25,057 x DRG weight",52427,Other,base rate x DRG weight,47186,,"22,552 x DRG weight",47186,Other,base rate x DRG weight,52427,,"25,057 x DRG weight",52427,Other,base rate x DRG weight,44562,,"21,298 x DRG weight",44562,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,136235,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,,inpatient,,,101550.82,15475,,,15475,Other,150% of Medicare + 9.63% HCRA Surcharge,9410.36,,,9410.36,Other,Medicare IPPS methodology,27187,,"25,046 x DRG weight",27187,Other,base rate x DRG weight,24468,,"22,541 x DRG weight",24468,Other,base rate x DRG weight,34835,,"32,091 x DRG weight",34835,Other,base rate x DRG weight,31351,,"28,882 x DRG weight",31351,Other,base rate x DRG weight,29609,,"27,277 x DRG weight",29609,Other,base rate x DRG weight,26139,,"24,080 x DRG weight",26139,Other,base rate x DRG weight,24384,,"22,463 x DRG weight",24384,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28685,,"26,426 x DRG weight",28685,Other,base rate x DRG weight,42127,,"38,809 x DRG weight",42127,Other,base rate x DRG weight,42127,,"38,809 x DRG weight",42127,Other,base rate x DRG weight,28685,,"26,426 x DRG weight",28685,Other,base rate x DRG weight,42127,,"38,809 x DRG weight",42127,Other,base rate x DRG weight,30542,,"6,363 x patient days",30542,Per diem,,71086,70,,71086,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27199,,"25,057 x DRG weight",27199,Other,base rate x DRG weight,24480,,"22,552 x DRG weight",24480,Other,base rate x DRG weight,27199,,"25,057 x DRG weight",27199,Other,base rate x DRG weight,23119,,"21,298 x DRG weight",23119,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,71086,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,,inpatient,,,91651.41,10044,,,10044,Other,150% of Medicare + 9.63% HCRA Surcharge,6107.83,,,6107.83,Other,Medicare IPPS methodology,17299,,"25,046 x DRG weight",17299,Other,base rate x DRG weight,15569,,"22,541 x DRG weight",15569,Other,base rate x DRG weight,22165,,"32,091 x DRG weight",22165,Other,base rate x DRG weight,19949,,"28,882 x DRG weight",19949,Other,base rate x DRG weight,18840,,"27,277 x DRG weight",18840,Other,base rate x DRG weight,16632,,"24,080 x DRG weight",16632,Other,base rate x DRG weight,15515,,"22,463 x DRG weight",15515,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18252,,"26,426 x DRG weight",18252,Other,base rate x DRG weight,26805,,"38,809 x DRG weight",26805,Other,base rate x DRG weight,26805,,"38,809 x DRG weight",26805,Other,base rate x DRG weight,18252,,"26,426 x DRG weight",18252,Other,base rate x DRG weight,26805,,"38,809 x DRG weight",26805,Other,base rate x DRG weight,19725,,"6,363 x patient days",19725,Per diem,,64156,70,,64156,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17307,,"25,057 x DRG weight",17307,Other,base rate x DRG weight,15577,,"22,552 x DRG weight",15577,Other,base rate x DRG weight,17307,,"25,057 x DRG weight",17307,Other,base rate x DRG weight,14711,,"21,298 x DRG weight",14711,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,64156,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,,inpatient,,,800008.95,96352,,,96352,Other,150% of Medicare + 9.63% HCRA Surcharge,58591.99,,,58591.99,Other,Medicare IPPS methodology,174443,,"25,046 x DRG weight",174443,Other,base rate x DRG weight,156996,,"22,541 x DRG weight",156996,Other,base rate x DRG weight,223511,,"32,091 x DRG weight",223511,Other,base rate x DRG weight,201160,,"28,882 x DRG weight",201160,Other,base rate x DRG weight,189982,,"27,277 x DRG weight",189982,Other,base rate x DRG weight,167715,,"24,080 x DRG weight",167715,Other,base rate x DRG weight,156453,,"22,463 x DRG weight",156453,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,184054,,"26,426 x DRG weight",184054,Other,base rate x DRG weight,270301,,"38,809 x DRG weight",270301,Other,base rate x DRG weight,270301,,"38,809 x DRG weight",270301,Other,base rate x DRG weight,184054,,"26,426 x DRG weight",184054,Other,base rate x DRG weight,270301,,"38,809 x DRG weight",270301,Other,base rate x DRG weight,102444,,"6,363 x patient days",102444,Per diem,,560006,70,,560006,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,174519,,"25,057 x DRG weight",174519,Other,base rate x DRG weight,157072,,"22,552 x DRG weight",157072,Other,base rate x DRG weight,174519,,"25,057 x DRG weight",174519,Other,base rate x DRG weight,148338,,"21,298 x DRG weight",148338,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,560006,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,,inpatient,,,229554.05,27815,,,27815,Other,150% of Medicare + 9.63% HCRA Surcharge,16914.67,,,16914.67,Other,Medicare IPPS methodology,49656,,"25,046 x DRG weight",49656,Other,base rate x DRG weight,44690,,"22,541 x DRG weight",44690,Other,base rate x DRG weight,63624,,"32,091 x DRG weight",63624,Other,base rate x DRG weight,57261,,"28,882 x DRG weight",57261,Other,base rate x DRG weight,54079,,"27,277 x DRG weight",54079,Other,base rate x DRG weight,47741,,"24,080 x DRG weight",47741,Other,base rate x DRG weight,44535,,"22,463 x DRG weight",44535,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52392,,"26,426 x DRG weight",52392,Other,base rate x DRG weight,76943,,"38,809 x DRG weight",76943,Other,base rate x DRG weight,76943,,"38,809 x DRG weight",76943,Other,base rate x DRG weight,52392,,"26,426 x DRG weight",52392,Other,base rate x DRG weight,76943,,"38,809 x DRG weight",76943,Other,base rate x DRG weight,43905,,"6,363 x patient days",43905,Per diem,,160688,70,,160688,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,49678,,"25,057 x DRG weight",49678,Other,base rate x DRG weight,44712,,"22,552 x DRG weight",44712,Other,base rate x DRG weight,49678,,"25,057 x DRG weight",49678,Other,base rate x DRG weight,42225,,"21,298 x DRG weight",42225,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,160688,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,,inpatient,,,131995.42,14710,,,14710,Other,150% of Medicare + 9.63% HCRA Surcharge,8945.26,,,8945.26,Other,Medicare IPPS methodology,25795,,"25,046 x DRG weight",25795,Other,base rate x DRG weight,23215,,"22,541 x DRG weight",23215,Other,base rate x DRG weight,33051,,"32,091 x DRG weight",33051,Other,base rate x DRG weight,29746,,"28,882 x DRG weight",29746,Other,base rate x DRG weight,28093,,"27,277 x DRG weight",28093,Other,base rate x DRG weight,24800,,"24,080 x DRG weight",24800,Other,base rate x DRG weight,23135,,"22,463 x DRG weight",23135,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27216,,"26,426 x DRG weight",27216,Other,base rate x DRG weight,39969,,"38,809 x DRG weight",39969,Other,base rate x DRG weight,39969,,"38,809 x DRG weight",39969,Other,base rate x DRG weight,27216,,"26,426 x DRG weight",27216,Other,base rate x DRG weight,39969,,"38,809 x DRG weight",39969,Other,base rate x DRG weight,27361,,"6,363 x patient days",27361,Per diem,,92397,70,,92397,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25806,,"25,057 x DRG weight",25806,Other,base rate x DRG weight,23226,,"22,552 x DRG weight",23226,Other,base rate x DRG weight,25806,,"25,057 x DRG weight",25806,Other,base rate x DRG weight,21935,,"21,298 x DRG weight",21935,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,92397,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,,inpatient,,,333359.01,51873,,,51873,Other,150% of Medicare + 9.63% HCRA Surcharge,31544.35,,,31544.35,Other,Medicare IPPS methodology,93459,,"25,046 x DRG weight",93459,Other,base rate x DRG weight,84112,,"22,541 x DRG weight",84112,Other,base rate x DRG weight,119748,,"32,091 x DRG weight",119748,Other,base rate x DRG weight,107773,,"28,882 x DRG weight",107773,Other,base rate x DRG weight,101784,,"27,277 x DRG weight",101784,Other,base rate x DRG weight,89855,,"24,080 x DRG weight",89855,Other,base rate x DRG weight,83821,,"22,463 x DRG weight",83821,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,98609,,"26,426 x DRG weight",98609,Other,base rate x DRG weight,144816,,"38,809 x DRG weight",144816,Other,base rate x DRG weight,144816,,"38,809 x DRG weight",144816,Other,base rate x DRG weight,98609,,"26,426 x DRG weight",98609,Other,base rate x DRG weight,144816,,"38,809 x DRG weight",144816,Other,base rate x DRG weight,112625,,"6,363 x patient days",112625,Per diem,,233351,70,,233351,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,93500,,"25,057 x DRG weight",93500,Other,base rate x DRG weight,84153,,"22,552 x DRG weight",84153,Other,base rate x DRG weight,93500,,"25,057 x DRG weight",93500,Other,base rate x DRG weight,79473,,"21,298 x DRG weight",79473,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,233351,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,,inpatient,,,100811.95,13674,,,13674,Other,150% of Medicare + 9.63% HCRA Surcharge,8315.37,,,8315.37,Other,Medicare IPPS methodology,12254,,"2,785 x patient days",12254,Per diem,,11031,,"2,507 x patient days",11031,Per diem,,9935,,"2,258 x patient days",9935,Per diem,,9337,,"2,122 x patient days",9337,Per diem,,8818,,"2,004 x patient days",8818,Per diem,,7779,,"1,768 x patient days",7779,Per diem,,4884,,"1,110 x patient days",4884,Per diem,,0.01,,,0.01,Other,See APR-DRG information,4721.2,,"1,073 x patient days",4721.2,Per diem,,4721.2,,"1,073 x patient days",4721.2,Per diem,,4721.2,,"1,073 x patient days",4721.2,Per diem,,4900,,"1,073 x patient days",4900,Per diem,,4884,,"1,110 x patient days",4884,Per diem,,13354,,"6,363 x patient days",13354,Per diem,,70568,70,,70568,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,4778,,"1,086 x patient days",4778,Per diem,,4778,,"1,086 x patient days",4778,Per diem,,4778.4,,"1,086 x patient days",4778.4,Per diem,,4778,,"1,086 x patient days",4778,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,70568,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,,inpatient,,,79658.5,13013,,,13013,Other,150% of Medicare + 9.63% HCRA Surcharge,7913.01,,,7913.01,Other,Medicare IPPS methodology,16432,,"2,785 x patient days",16432,Per diem,,14791,,"2,507 x patient days",14791,Per diem,,13322,,"2,258 x patient days",13322,Per diem,,12520,,"2,122 x patient days",12520,Per diem,,11824,,"2,004 x patient days",11824,Per diem,,10431,,"1,768 x patient days",10431,Per diem,,6549,,"1,110 x patient days",6549,Per diem,,0.01,,,0.01,Other,See APR-DRG information,6330.7,,"1,073 x patient days",6330.7,Per diem,,6330.7,,"1,073 x patient days",6330.7,Per diem,,6330.7,,"1,073 x patient days",6330.7,Per diem,,6500,,"1,073 x patient days",6500,Per diem,,6549,,"1,110 x patient days",6549,Per diem,,17907,,"6,363 x patient days",17907,Per diem,,55761,70,,55761,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,6407,,"1,086 x patient days",6407,Per diem,,6407,,"1,086 x patient days",6407,Per diem,,6407.4,,"1,086 x patient days",6407.4,Per diem,,6407,,"1,086 x patient days",6407,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,55761,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,,inpatient,,,61647.11,13464,,,13464,Other,150% of Medicare + 9.63% HCRA Surcharge,8187.39,,,8187.39,Other,Medicare IPPS methodology,15875,,"2,785 x patient days",15875,Per diem,,14290,,"2,507 x patient days",14290,Per diem,,12871,,"2,258 x patient days",12871,Per diem,,12095,,"2,122 x patient days",12095,Per diem,,11423,,"2,004 x patient days",11423,Per diem,,10078,,"1,768 x patient days",10078,Per diem,,6327,,"1,110 x patient days",6327,Per diem,,0.01,,,0.01,Other,See APR-DRG information,6116.1,,"1,073 x patient days",6116.1,Per diem,,6116.1,,"1,073 x patient days",6116.1,Per diem,,6116.1,,"1,073 x patient days",6116.1,Per diem,,6300,,"1,073 x patient days",6300,Per diem,,6327,,"1,110 x patient days",6327,Per diem,,17300,,"6,363 x patient days",17300,Per diem,,43153,70,,43153,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,6190,,"1,086 x patient days",6190,Per diem,,6190,,"1,086 x patient days",6190,Per diem,,6190.2,,"1,086 x patient days",6190.2,Per diem,,6190,,"1,086 x patient days",6190,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,43153,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,,inpatient,,,148268.15,26341,,,26341,Other,150% of Medicare + 9.63% HCRA Surcharge,16017.94,,,16017.94,Other,Medicare IPPS methodology,31749,,"2,785 x patient days",31749,Per diem,,28580,,"2,507 x patient days",28580,Per diem,,25741,,"2,258 x patient days",25741,Per diem,,24191,,"2,122 x patient days",24191,Per diem,,22846,,"2,004 x patient days",22846,Per diem,,20155,,"1,768 x patient days",20155,Per diem,,12654,,"1,110 x patient days",12654,Per diem,,0.01,,,0.01,Other,See APR-DRG information,12232.2,,"1,073 x patient days",12232.2,Per diem,,12232.2,,"1,073 x patient days",12232.2,Per diem,,12232.2,,"1,073 x patient days",12232.2,Per diem,,12654,,"1,073 x patient days",12654,Per diem,,12654,,"1,110 x patient days",12654,Per diem,,34599,,"6,363 x patient days",34599,Per diem,,103788,70,,103788,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,12380,,"1,086 x patient days",12380,Per diem,,12380,,"1,086 x patient days",12380,Per diem,,12380.4,,"1,086 x patient days",12380.4,Per diem,,12380,,"1,086 x patient days",12380,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,103788,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,,inpatient,,,207868.37,24711,,,24711,Other,150% of Medicare + 9.63% HCRA Surcharge,15026.67,,,15026.67,Other,Medicare IPPS methodology,25622,,"2,785 x patient days",25622,Per diem,,23064,,"2,507 x patient days",23064,Per diem,,20774,,"2,258 x patient days",20774,Per diem,,19522,,"2,122 x patient days",19522,Per diem,,18437,,"2,004 x patient days",18437,Per diem,,16266,,"1,768 x patient days",16266,Per diem,,10212,,"1,110 x patient days",10212,Per diem,,0.01,,,0.01,Other,See APR-DRG information,9871.6,,"1,073 x patient days",9871.6,Per diem,,9871.6,,"1,073 x patient days",9871.6,Per diem,,9871.6,,"1,073 x patient days",9871.6,Per diem,,10212,,"1,073 x patient days",10212,Per diem,,10212,,"1,110 x patient days",10212,Per diem,,27922,,"6,363 x patient days",27922,Per diem,,145508,70,,145508,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,9991,,"1,086 x patient days",9991,Per diem,,9991,,"1,086 x patient days",9991,Per diem,,9991.2,,"1,086 x patient days",9991.2,Per diem,,9991,,"1,086 x patient days",9991,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,145508,
PSYCHOSES,885,MS-DRG,,,,,,,,inpatient,,,119996.71,19339,,,19339,Other,150% of Medicare + 9.63% HCRA Surcharge,11760.11,,,11760.11,Other,Medicare IPPS methodology,27015,,"2,785 x patient days",27015,Per diem,,24318,,"2,507 x patient days",24318,Per diem,,21903,,"2,258 x patient days",21903,Per diem,,20583,,"2,122 x patient days",20583,Per diem,,19439,,"2,004 x patient days",19439,Per diem,,17150,,"1,768 x patient days",17150,Per diem,,10767,,"1,110 x patient days",10767,Per diem,,0.01,,,0.01,Other,See APR-DRG information,10408.1,,"1,073 x patient days",10408.1,Per diem,,10408.1,,"1,073 x patient days",10408.1,Per diem,,10408.1,,"1,073 x patient days",10408.1,Per diem,,10767,,"1,073 x patient days",10767,Per diem,,10767,,"1,110 x patient days",10767,Per diem,,29440,,"6,363 x patient days",29440,Per diem,,83998,70,,83998,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,10534,,"1,086 x patient days",10534,Per diem,,10534,,"1,086 x patient days",10534,Per diem,,10534.2,,"1,086 x patient days",10534.2,Per diem,,10534,,"1,086 x patient days",10534,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,83998,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,,inpatient,,,97932.45,23676,,,23676,Other,150% of Medicare + 9.63% HCRA Surcharge,14397.62,,,14397.62,Other,Medicare IPPS methodology,28686,,"2,785 x patient days",28686,Per diem,,25822,,"2,507 x patient days",25822,Per diem,,23257,,"2,258 x patient days",23257,Per diem,,21857,,"2,122 x patient days",21857,Per diem,,20641,,"2,004 x patient days",20641,Per diem,,18210,,"1,768 x patient days",18210,Per diem,,11433,,"1,110 x patient days",11433,Per diem,,0.01,,,0.01,Other,See APR-DRG information,11051.9,,"1,073 x patient days",11051.9,Per diem,,11051.9,,"1,073 x patient days",11051.9,Per diem,,11051.9,,"1,073 x patient days",11051.9,Per diem,,11433,,"1,073 x patient days",11433,Per diem,,11433,,"1,110 x patient days",11433,Per diem,,31261,,"6,363 x patient days",31261,Per diem,,68553,70,,68553,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,11186,,"1,086 x patient days",11186,Per diem,,11186,,"1,086 x patient days",11186,Per diem,,11185.8,,"1,086 x patient days",11185.8,Per diem,,11186,,"1,086 x patient days",11186,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,68553,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,,inpatient,,,79008.71,18365,,,18365,Other,150% of Medicare + 9.63% HCRA Surcharge,11167.86,,,11167.86,Other,Medicare IPPS methodology,18103,,"2,785 x patient days",18103,Per diem,,16296,,"2,507 x patient days",16296,Per diem,,14677,,"2,258 x patient days",14677,Per diem,,13793,,"2,122 x patient days",13793,Per diem,,13026,,"2,004 x patient days",13026,Per diem,,11492,,"1,768 x patient days",11492,Per diem,,7215,,"1,110 x patient days",7215,Per diem,,0.01,,,0.01,Other,See APR-DRG information,6974.5,,"1,073 x patient days",6974.5,Per diem,,6974.5,,"1,073 x patient days",6974.5,Per diem,,6974.5,,"1,073 x patient days",6974.5,Per diem,,7200,,"1,073 x patient days",7200,Per diem,,7215,,"1,110 x patient days",7215,Per diem,,19728,,"6,363 x patient days",19728,Per diem,,55306,70,,55306,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,7059,,"1,086 x patient days",7059,Per diem,,7059,,"1,086 x patient days",7059,Per diem,,7059,,"1,086 x patient days",7059,Per diem,,7059,,"1,086 x patient days",7059,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,55306,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,,inpatient,,,44703.82,8446,,,8446,Other,150% of Medicare + 9.63% HCRA Surcharge,5135.81,,,5135.81,Other,Medicare IPPS methodology,8077,,"2,785 x patient days",8077,Per diem,,7270,,"2,507 x patient days",7270,Per diem,,9411,,"3,245 x patient days",9411,Per diem,,8471,,"2,921 x patient days",8471,Per diem,,7998,,"2,758 x patient days",7998,Per diem,,5127,,"1,768 x patient days",5127,Per diem,,3094.3,,"1,067 x patient days",3094.3,Per diem,,0.01,,,0.01,Other,See APR-DRG information,2946.4,,"1,016 x patient days",2946.4,Per diem,,2946.4,,"1,016 x patient days",2946.4,Per diem,,2946.4,,"1,016 x patient days",2946.4,Per diem,,3100,,"1,016 x patient days",3100,Per diem,,3094.3,,"1,067 x patient days",3094.3,Per diem,,9672,,"6,363 x patient days",9672,Per diem,,31293,70,,31293,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,3437,,"1,185 x patient days",3437,Per diem,,3437,,"1,185 x patient days",3437,Per diem,,3436.5,,"1,185 x patient days",3436.5,Per diem,,3437,,"1,185 x patient days",3437,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,31293,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,,inpatient,,,110308.21,22673,,,22673,Other,150% of Medicare + 9.63% HCRA Surcharge,13787.81,,,13787.81,Other,Medicare IPPS methodology,32306,,"2,785 x patient days",32306,Per diem,,29081,,"2,507 x patient days",29081,Per diem,,37642,,"3,245 x patient days",37642,Per diem,,33884,,"2,921 x patient days",33884,Per diem,,31993,,"2,758 x patient days",31993,Per diem,,20509,,"1,768 x patient days",20509,Per diem,,12876,,"1,110 x patient days",12876,Per diem,,0.01,,,0.01,Other,See APR-DRG information,10846,,935 x patient days,10846,Per diem,,10846,,935 x patient days,10846,Per diem,,10846,,935 x patient days,10846,Per diem,,12876,,935 x patient days,12876,Per diem,,12876,,"1,110 x patient days",12876,Per diem,,38686,,"6,363 x patient days",38686,Per diem,,77216,70,,77216,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,12598,,"1,086 x patient days",12598,Per diem,,12598,,"1,086 x patient days",12598,Per diem,,12597.6,,"1,086 x patient days",12597.6,Per diem,,12598,,"1,086 x patient days",12598,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,77216,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,,inpatient,,,156174.86,25002,,,25002,Other,150% of Medicare + 9.63% HCRA Surcharge,15204.01,,,15204.01,Other,Medicare IPPS methodology,20609,,"2,785 x patient days",20609,Per diem,,18552,,"2,507 x patient days",18552,Per diem,,24013,,"3,245 x patient days",24013,Per diem,,21615,,"2,921 x patient days",21615,Per diem,,20409,,"2,758 x patient days",20409,Per diem,,13083,,"1,768 x patient days",13083,Per diem,,7895.8,,"1,067 x patient days",7895.8,Per diem,,0.01,,,0.01,Other,See APR-DRG information,7518.4,,"1,016 x patient days",7518.4,Per diem,,7518.4,,"1,016 x patient days",7518.4,Per diem,,7518.4,,"1,016 x patient days",7518.4,Per diem,,7900,,"1,016 x patient days",7900,Per diem,,7895.8,,"1,067 x patient days",7895.8,Per diem,,24679,,"6,363 x patient days",24679,Per diem,,109322,70,,109322,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,8769,,"1,185 x patient days",8769,Per diem,,8769,,"1,185 x patient days",8769,Per diem,,8769,,"1,185 x patient days",8769,Per diem,,8769,,"1,185 x patient days",8769,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,109322,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,,inpatient,,,51639.53,12312,,,12312,Other,150% of Medicare + 9.63% HCRA Surcharge,7487.23,,,7487.23,Other,Medicare IPPS methodology,12254,,"2,785 x patient days",12254,Per diem,,11031,,"2,507 x patient days",11031,Per diem,,14278,,"3,245 x patient days",14278,Per diem,,12852,,"2,921 x patient days",12852,Per diem,,12135,,"2,758 x patient days",12135,Per diem,,7779,,"1,768 x patient days",7779,Per diem,,4694.8,,"1,067 x patient days",4694.8,Per diem,,0.01,,,0.01,Other,See APR-DRG information,4470.4,,"1,016 x patient days",4470.4,Per diem,,4470.4,,"1,016 x patient days",4470.4,Per diem,,4470.4,,"1,016 x patient days",4470.4,Per diem,,4700,,"1,016 x patient days",4700,Per diem,,4694.8,,"1,067 x patient days",4694.8,Per diem,,14674,,"6,363 x patient days",14674,Per diem,,36148,70,,36148,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,5214,,"1,185 x patient days",5214,Per diem,,5214,,"1,185 x patient days",5214,Per diem,,5214,,"1,185 x patient days",5214,Per diem,,5214,,"1,185 x patient days",5214,Per diem,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,36148,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,,inpatient,,,1190531.27,60076,,,60076,Other,150% of Medicare + 9.63% HCRA Surcharge,36532.45,,,36532.45,Other,Medicare IPPS methodology,108394,,"25,046 x DRG weight",108394,Other,base rate x DRG weight,97553,,"22,541 x DRG weight",97553,Other,base rate x DRG weight,138883,,"32,091 x DRG weight",138883,Other,base rate x DRG weight,124996,,"28,882 x DRG weight",124996,Other,base rate x DRG weight,118049,,"27,277 x DRG weight",118049,Other,base rate x DRG weight,104213,,"24,080 x DRG weight",104213,Other,base rate x DRG weight,97215,,"22,463 x DRG weight",97215,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,114366,,"26,426 x DRG weight",114366,Other,base rate x DRG weight,167958,,"38,809 x DRG weight",167958,Other,base rate x DRG weight,167958,,"38,809 x DRG weight",167958,Other,base rate x DRG weight,114366,,"26,426 x DRG weight",114366,Other,base rate x DRG weight,167958,,"38,809 x DRG weight",167958,Other,base rate x DRG weight,93536,,"6,363 x patient days",93536,Per diem,,833372,70,,833372,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,108442,,"25,057 x DRG weight",108442,Other,base rate x DRG weight,97601,,"22,552 x DRG weight",97601,Other,base rate x DRG weight,108442,,"25,057 x DRG weight",108442,Other,base rate x DRG weight,92173,,"21,298 x DRG weight",92173,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,833372,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,,inpatient,,,101203.96,26469,,,26469,Other,150% of Medicare + 9.63% HCRA Surcharge,16095.73,,,16095.73,Other,Medicare IPPS methodology,47204,,"25,046 x DRG weight",47204,Other,base rate x DRG weight,42483,,"22,541 x DRG weight",42483,Other,base rate x DRG weight,60482,,"32,091 x DRG weight",60482,Other,base rate x DRG weight,54434,,"28,882 x DRG weight",54434,Other,base rate x DRG weight,51409,,"27,277 x DRG weight",51409,Other,base rate x DRG weight,45384,,"24,080 x DRG weight",45384,Other,base rate x DRG weight,42336,,"22,463 x DRG weight",42336,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49805,,"26,426 x DRG weight",49805,Other,base rate x DRG weight,73143,,"38,809 x DRG weight",73143,Other,base rate x DRG weight,73143,,"38,809 x DRG weight",73143,Other,base rate x DRG weight,49805,,"26,426 x DRG weight",49805,Other,base rate x DRG weight,73143,,"38,809 x DRG weight",73143,Other,base rate x DRG weight,41996,,"6,363 x patient days",41996,Per diem,,70843,70,,70843,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,47225,,"25,057 x DRG weight",47225,Other,base rate x DRG weight,42504,,"22,552 x DRG weight",42504,Other,base rate x DRG weight,47225,,"25,057 x DRG weight",47225,Other,base rate x DRG weight,40140,,"21,298 x DRG weight",40140,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,73143,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,,inpatient,,,129098.3,17621,,,17621,Other,150% of Medicare + 9.63% HCRA Surcharge,10715.31,,,10715.31,Other,Medicare IPPS methodology,31095,,"25,046 x DRG weight",31095,Other,base rate x DRG weight,27985,,"22,541 x DRG weight",27985,Other,base rate x DRG weight,39841,,"32,091 x DRG weight",39841,Other,base rate x DRG weight,35857,,"28,882 x DRG weight",35857,Other,base rate x DRG weight,33864,,"27,277 x DRG weight",33864,Other,base rate x DRG weight,29895,,"24,080 x DRG weight",29895,Other,base rate x DRG weight,27888,,"22,463 x DRG weight",27888,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,32808,,"26,426 x DRG weight",32808,Other,base rate x DRG weight,48181,,"38,809 x DRG weight",48181,Other,base rate x DRG weight,48181,,"38,809 x DRG weight",48181,Other,base rate x DRG weight,32808,,"26,426 x DRG weight",32808,Other,base rate x DRG weight,48181,,"38,809 x DRG weight",48181,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,90369,70,,90369,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,31108,,"25,057 x DRG weight",31108,Other,base rate x DRG weight,27998,,"22,552 x DRG weight",27998,Other,base rate x DRG weight,31108,,"25,057 x DRG weight",31108,Other,base rate x DRG weight,26441,,"21,298 x DRG weight",26441,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,90369,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,,inpatient,,,725620.05,45335,,,45335,Other,150% of Medicare + 9.63% HCRA Surcharge,27568.43,,,27568.43,Other,Medicare IPPS methodology,81555,,"25,046 x DRG weight",81555,Other,base rate x DRG weight,73398,,"22,541 x DRG weight",73398,Other,base rate x DRG weight,104495,,"32,091 x DRG weight",104495,Other,base rate x DRG weight,94046,,"28,882 x DRG weight",94046,Other,base rate x DRG weight,88819,,"27,277 x DRG weight",88819,Other,base rate x DRG weight,78409,,"24,080 x DRG weight",78409,Other,base rate x DRG weight,73144,,"22,463 x DRG weight",73144,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,86048,,"26,426 x DRG weight",86048,Other,base rate x DRG weight,126370,,"38,809 x DRG weight",126370,Other,base rate x DRG weight,126370,,"38,809 x DRG weight",126370,Other,base rate x DRG weight,86048,,"26,426 x DRG weight",86048,Other,base rate x DRG weight,126370,,"38,809 x DRG weight",126370,Other,base rate x DRG weight,63630,,"6,363 x patient days",63630,Per diem,,507934,70,,507934,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,81591,,"25,057 x DRG weight",81591,Other,base rate x DRG weight,73434,,"22,552 x DRG weight",73434,Other,base rate x DRG weight,81591,,"25,057 x DRG weight",81591,Other,base rate x DRG weight,69351,,"21,298 x DRG weight",69351,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,507934,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,,inpatient,,,143321.31,22328,,,22328,Other,150% of Medicare + 9.63% HCRA Surcharge,13577.84,,,13577.84,Other,Medicare IPPS methodology,39665,,"25,046 x DRG weight",39665,Other,base rate x DRG weight,35698,,"22,541 x DRG weight",35698,Other,base rate x DRG weight,50823,,"32,091 x DRG weight",50823,Other,base rate x DRG weight,45740,,"28,882 x DRG weight",45740,Other,base rate x DRG weight,43199,,"27,277 x DRG weight",43199,Other,base rate x DRG weight,38135,,"24,080 x DRG weight",38135,Other,base rate x DRG weight,35575,,"22,463 x DRG weight",35575,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,41851,,"26,426 x DRG weight",41851,Other,base rate x DRG weight,61462,,"38,809 x DRG weight",61462,Other,base rate x DRG weight,61462,,"38,809 x DRG weight",61462,Other,base rate x DRG weight,41851,,"26,426 x DRG weight",41851,Other,base rate x DRG weight,61462,,"38,809 x DRG weight",61462,Other,base rate x DRG weight,29906,,"6,363 x patient days",29906,Per diem,,100325,70,,100325,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39683,,"25,057 x DRG weight",39683,Other,base rate x DRG weight,35716,,"22,552 x DRG weight",35716,Other,base rate x DRG weight,39683,,"25,057 x DRG weight",39683,Other,base rate x DRG weight,33730,,"21,298 x DRG weight",33730,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,100325,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,,inpatient,,,145480.88,26426,,,26426,Other,150% of Medicare + 9.63% HCRA Surcharge,16069.8,,,16069.8,Other,Medicare IPPS methodology,47127,,"25,046 x DRG weight",47127,Other,base rate x DRG weight,42413,,"22,541 x DRG weight",42413,Other,base rate x DRG weight,60382,,"32,091 x DRG weight",60382,Other,base rate x DRG weight,54344,,"28,882 x DRG weight",54344,Other,base rate x DRG weight,51324,,"27,277 x DRG weight",51324,Other,base rate x DRG weight,45309,,"24,080 x DRG weight",45309,Other,base rate x DRG weight,42266,,"22,463 x DRG weight",42266,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49723,,"26,426 x DRG weight",49723,Other,base rate x DRG weight,73023,,"38,809 x DRG weight",73023,Other,base rate x DRG weight,73023,,"38,809 x DRG weight",73023,Other,base rate x DRG weight,49723,,"26,426 x DRG weight",49723,Other,base rate x DRG weight,73023,,"38,809 x DRG weight",73023,Other,base rate x DRG weight,32451,,"6,363 x patient days",32451,Per diem,,101837,70,,101837,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,47147,,"25,057 x DRG weight",47147,Other,base rate x DRG weight,42434,,"22,552 x DRG weight",42434,Other,base rate x DRG weight,47147,,"25,057 x DRG weight",47147,Other,base rate x DRG weight,40074,,"21,298 x DRG weight",40074,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,101837,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,,inpatient,,,404436.95,51708,,,51708,Other,150% of Medicare + 9.63% HCRA Surcharge,31443.97,,,31443.97,Other,Medicare IPPS methodology,93159,,"25,046 x DRG weight",93159,Other,base rate x DRG weight,83841,,"22,541 x DRG weight",83841,Other,base rate x DRG weight,119362,,"32,091 x DRG weight",119362,Other,base rate x DRG weight,107427,,"28,882 x DRG weight",107427,Other,base rate x DRG weight,101457,,"27,277 x DRG weight",101457,Other,base rate x DRG weight,89566,,"24,080 x DRG weight",89566,Other,base rate x DRG weight,83551,,"22,463 x DRG weight",83551,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,98292,,"26,426 x DRG weight",98292,Other,base rate x DRG weight,144350,,"38,809 x DRG weight",144350,Other,base rate x DRG weight,144350,,"38,809 x DRG weight",144350,Other,base rate x DRG weight,98292,,"26,426 x DRG weight",98292,Other,base rate x DRG weight,144350,,"38,809 x DRG weight",144350,Other,base rate x DRG weight,61721,,"6,363 x patient days",61721,Per diem,,283106,70,,283106,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,93200,,"25,057 x DRG weight",93200,Other,base rate x DRG weight,83882,,"22,552 x DRG weight",83882,Other,base rate x DRG weight,93200,,"25,057 x DRG weight",93200,Other,base rate x DRG weight,79218,,"21,298 x DRG weight",79218,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,283106,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,,inpatient,,,280457.16,28111,,,28111,Other,150% of Medicare + 9.63% HCRA Surcharge,17094.52,,,17094.52,Other,Medicare IPPS methodology,50195,,"25,046 x DRG weight",50195,Other,base rate x DRG weight,45174,,"22,541 x DRG weight",45174,Other,base rate x DRG weight,64314,,"32,091 x DRG weight",64314,Other,base rate x DRG weight,57882,,"28,882 x DRG weight",57882,Other,base rate x DRG weight,54666,,"27,277 x DRG weight",54666,Other,base rate x DRG weight,48259,,"24,080 x DRG weight",48259,Other,base rate x DRG weight,45018,,"22,463 x DRG weight",45018,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,52960,,"26,426 x DRG weight",52960,Other,base rate x DRG weight,77777,,"38,809 x DRG weight",77777,Other,base rate x DRG weight,77777,,"38,809 x DRG weight",77777,Other,base rate x DRG weight,52960,,"26,426 x DRG weight",52960,Other,base rate x DRG weight,77777,,"38,809 x DRG weight",77777,Other,base rate x DRG weight,32451,,"6,363 x patient days",32451,Per diem,,196320,70,,196320,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,50217,,"25,057 x DRG weight",50217,Other,base rate x DRG weight,45196,,"22,552 x DRG weight",45196,Other,base rate x DRG weight,50217,,"25,057 x DRG weight",50217,Other,base rate x DRG weight,42683,,"21,298 x DRG weight",42683,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,196320,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,,inpatient,,,151285.75,19200,,,19200,Other,150% of Medicare + 9.63% HCRA Surcharge,11675.62,,,11675.62,Other,Medicare IPPS methodology,33970,,"25,046 x DRG weight",33970,Other,base rate x DRG weight,30572,,"22,541 x DRG weight",30572,Other,base rate x DRG weight,43525,,"32,091 x DRG weight",43525,Other,base rate x DRG weight,39173,,"28,882 x DRG weight",39173,Other,base rate x DRG weight,36996,,"27,277 x DRG weight",36996,Other,base rate x DRG weight,32660,,"24,080 x DRG weight",32660,Other,base rate x DRG weight,30467,,"22,463 x DRG weight",30467,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,35842,,"26,426 x DRG weight",35842,Other,base rate x DRG weight,52637,,"38,809 x DRG weight",52637,Other,base rate x DRG weight,52637,,"38,809 x DRG weight",52637,Other,base rate x DRG weight,35842,,"26,426 x DRG weight",35842,Other,base rate x DRG weight,52637,,"38,809 x DRG weight",52637,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,105900,70,,105900,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,33985,,"25,057 x DRG weight",33985,Other,base rate x DRG weight,30587,,"22,552 x DRG weight",30587,Other,base rate x DRG weight,33985,,"25,057 x DRG weight",33985,Other,base rate x DRG weight,28886,,"21,298 x DRG weight",28886,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,105900,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,,inpatient,,,300873.47,21101,,,21101,Other,150% of Medicare + 9.63% HCRA Surcharge,12831.68,,,12831.68,Other,Medicare IPPS methodology,37431,,"25,046 x DRG weight",37431,Other,base rate x DRG weight,33688,,"22,541 x DRG weight",33688,Other,base rate x DRG weight,47960,,"32,091 x DRG weight",47960,Other,base rate x DRG weight,43164,,"28,882 x DRG weight",43164,Other,base rate x DRG weight,40765,,"27,277 x DRG weight",40765,Other,base rate x DRG weight,35988,,"24,080 x DRG weight",35988,Other,base rate x DRG weight,33571,,"22,463 x DRG weight",33571,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39494,,"26,426 x DRG weight",39494,Other,base rate x DRG weight,58000,,"38,809 x DRG weight",58000,Other,base rate x DRG weight,58000,,"38,809 x DRG weight",58000,Other,base rate x DRG weight,39494,,"26,426 x DRG weight",39494,Other,base rate x DRG weight,58000,,"38,809 x DRG weight",58000,Other,base rate x DRG weight,36269,,"6,363 x patient days",36269,Per diem,,210611,70,,210611,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37448,,"25,057 x DRG weight",37448,Other,base rate x DRG weight,33704,,"22,552 x DRG weight",33704,Other,base rate x DRG weight,37448,,"25,057 x DRG weight",37448,Other,base rate x DRG weight,31830,,"21,298 x DRG weight",31830,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,210611,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,,inpatient,,,86778.14,13029,,,13029,Other,150% of Medicare + 9.63% HCRA Surcharge,7923.05,,,7923.05,Other,Medicare IPPS methodology,22734,,"25,046 x DRG weight",22734,Other,base rate x DRG weight,20460,,"22,541 x DRG weight",20460,Other,base rate x DRG weight,29129,,"32,091 x DRG weight",29129,Other,base rate x DRG weight,26216,,"28,882 x DRG weight",26216,Other,base rate x DRG weight,24759,,"27,277 x DRG weight",24759,Other,base rate x DRG weight,21857,,"24,080 x DRG weight",21857,Other,base rate x DRG weight,20390,,"22,463 x DRG weight",20390,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,23987,,"26,426 x DRG weight",23987,Other,base rate x DRG weight,35227,,"38,809 x DRG weight",35227,Other,base rate x DRG weight,35227,,"38,809 x DRG weight",35227,Other,base rate x DRG weight,23987,,"26,426 x DRG weight",23987,Other,base rate x DRG weight,35227,,"38,809 x DRG weight",35227,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,60745,70,,60745,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,22744,,"25,057 x DRG weight",22744,Other,base rate x DRG weight,20470,,"22,552 x DRG weight",20470,Other,base rate x DRG weight,22744,,"25,057 x DRG weight",22744,Other,base rate x DRG weight,19332,,"21,298 x DRG weight",19332,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,60745,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,,inpatient,,,202183.18,24946,,,24946,Other,150% of Medicare + 9.63% HCRA Surcharge,15169.72,,,15169.72,Other,Medicare IPPS methodology,44432,,"25,046 x DRG weight",44432,Other,base rate x DRG weight,39988,,"22,541 x DRG weight",39988,Other,base rate x DRG weight,56929,,"32,091 x DRG weight",56929,Other,base rate x DRG weight,51237,,"28,882 x DRG weight",51237,Other,base rate x DRG weight,48389,,"27,277 x DRG weight",48389,Other,base rate x DRG weight,42718,,"24,080 x DRG weight",42718,Other,base rate x DRG weight,39849,,"22,463 x DRG weight",39849,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,46880,,"26,426 x DRG weight",46880,Other,base rate x DRG weight,68847,,"38,809 x DRG weight",68847,Other,base rate x DRG weight,68847,,"38,809 x DRG weight",68847,Other,base rate x DRG weight,46880,,"26,426 x DRG weight",46880,Other,base rate x DRG weight,68847,,"38,809 x DRG weight",68847,Other,base rate x DRG weight,34360,,"6,363 x patient days",34360,Per diem,,141528,70,,141528,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,44451,,"25,057 x DRG weight",44451,Other,base rate x DRG weight,40007,,"22,552 x DRG weight",40007,Other,base rate x DRG weight,44451,,"25,057 x DRG weight",44451,Other,base rate x DRG weight,37783,,"21,298 x DRG weight",37783,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,141528,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,,inpatient,,,84150.39,9605,,,9605,Other,150% of Medicare + 9.63% HCRA Surcharge,5840.98,,,5840.98,Other,Medicare IPPS methodology,16500,,"25,046 x DRG weight",16500,Other,base rate x DRG weight,14850,,"22,541 x DRG weight",14850,Other,base rate x DRG weight,21142,,"32,091 x DRG weight",21142,Other,base rate x DRG weight,19027,,"28,882 x DRG weight",19027,Other,base rate x DRG weight,17970,,"27,277 x DRG weight",17970,Other,base rate x DRG weight,15864,,"24,080 x DRG weight",15864,Other,base rate x DRG weight,14799,,"22,463 x DRG weight",14799,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,17409,,"26,426 x DRG weight",17409,Other,base rate x DRG weight,25567,,"38,809 x DRG weight",25567,Other,base rate x DRG weight,25567,,"38,809 x DRG weight",25567,Other,base rate x DRG weight,17409,,"26,426 x DRG weight",17409,Other,base rate x DRG weight,25567,,"38,809 x DRG weight",25567,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,58905,70,,58905,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,16508,,"25,057 x DRG weight",16508,Other,base rate x DRG weight,14857,,"22,552 x DRG weight",14857,Other,base rate x DRG weight,16508,,"25,057 x DRG weight",16508,Other,base rate x DRG weight,14031,,"21,298 x DRG weight",14031,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,58905,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,,inpatient,,,189693.48,22496,,,22496,Other,150% of Medicare + 9.63% HCRA Surcharge,13679.9,,,13679.9,Other,Medicare IPPS methodology,39971,,"25,046 x DRG weight",39971,Other,base rate x DRG weight,35973,,"22,541 x DRG weight",35973,Other,base rate x DRG weight,51214,,"32,091 x DRG weight",51214,Other,base rate x DRG weight,46093,,"28,882 x DRG weight",46093,Other,base rate x DRG weight,43531,,"27,277 x DRG weight",43531,Other,base rate x DRG weight,38429,,"24,080 x DRG weight",38429,Other,base rate x DRG weight,35849,,"22,463 x DRG weight",35849,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,42173,,"26,426 x DRG weight",42173,Other,base rate x DRG weight,61935,,"38,809 x DRG weight",61935,Other,base rate x DRG weight,61935,,"38,809 x DRG weight",61935,Other,base rate x DRG weight,42173,,"26,426 x DRG weight",42173,Other,base rate x DRG weight,61935,,"38,809 x DRG weight",61935,Other,base rate x DRG weight,36269,,"6,363 x patient days",36269,Per diem,,132785,70,,132785,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,39988,,"25,057 x DRG weight",39988,Other,base rate x DRG weight,35991,,"22,552 x DRG weight",35991,Other,base rate x DRG weight,39988,,"25,057 x DRG weight",39988,Other,base rate x DRG weight,33989,,"21,298 x DRG weight",33989,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,132785,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,,inpatient,,,90526.71,12385,,,12385,Other,150% of Medicare + 9.63% HCRA Surcharge,7531.56,,,7531.56,Other,Medicare IPPS methodology,21562,,"25,046 x DRG weight",21562,Other,base rate x DRG weight,19406,,"22,541 x DRG weight",19406,Other,base rate x DRG weight,27627,,"32,091 x DRG weight",27627,Other,base rate x DRG weight,24865,,"28,882 x DRG weight",24865,Other,base rate x DRG weight,23483,,"27,277 x DRG weight",23483,Other,base rate x DRG weight,20730,,"24,080 x DRG weight",20730,Other,base rate x DRG weight,19338,,"22,463 x DRG weight",19338,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22750,,"26,426 x DRG weight",22750,Other,base rate x DRG weight,33411,,"38,809 x DRG weight",33411,Other,base rate x DRG weight,33411,,"38,809 x DRG weight",33411,Other,base rate x DRG weight,22750,,"26,426 x DRG weight",22750,Other,base rate x DRG weight,33411,,"38,809 x DRG weight",33411,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,63369,70,,63369,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21572,,"25,057 x DRG weight",21572,Other,base rate x DRG weight,19415,,"22,552 x DRG weight",19415,Other,base rate x DRG weight,21572,,"25,057 x DRG weight",21572,Other,base rate x DRG weight,18335,,"21,298 x DRG weight",18335,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,63369,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,,inpatient,,,198006.82,25643,,,25643,Other,150% of Medicare + 9.63% HCRA Surcharge,15593.83,,,15593.83,Other,Medicare IPPS methodology,45701,,"25,046 x DRG weight",45701,Other,base rate x DRG weight,41131,,"22,541 x DRG weight",41131,Other,base rate x DRG weight,58556,,"32,091 x DRG weight",58556,Other,base rate x DRG weight,52701,,"28,882 x DRG weight",52701,Other,base rate x DRG weight,49772,,"27,277 x DRG weight",49772,Other,base rate x DRG weight,43939,,"24,080 x DRG weight",43939,Other,base rate x DRG weight,40988,,"22,463 x DRG weight",40988,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,48220,,"26,426 x DRG weight",48220,Other,base rate x DRG weight,70815,,"38,809 x DRG weight",70815,Other,base rate x DRG weight,70815,,"38,809 x DRG weight",70815,Other,base rate x DRG weight,48220,,"26,426 x DRG weight",48220,Other,base rate x DRG weight,70815,,"38,809 x DRG weight",70815,Other,base rate x DRG weight,39451,,"6,363 x patient days",39451,Per diem,,138605,70,,138605,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,45722,,"25,057 x DRG weight",45722,Other,base rate x DRG weight,41151,,"22,552 x DRG weight",41151,Other,base rate x DRG weight,45722,,"25,057 x DRG weight",45722,Other,base rate x DRG weight,38862,,"21,298 x DRG weight",38862,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,138605,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,,inpatient,,,161505.57,14764,,,14764,Other,150% of Medicare + 9.63% HCRA Surcharge,8977.89,,,8977.89,Other,Medicare IPPS methodology,25893,,"25,046 x DRG weight",25893,Other,base rate x DRG weight,23303,,"22,541 x DRG weight",23303,Other,base rate x DRG weight,33176,,"32,091 x DRG weight",33176,Other,base rate x DRG weight,29858,,"28,882 x DRG weight",29858,Other,base rate x DRG weight,28199,,"27,277 x DRG weight",28199,Other,base rate x DRG weight,24894,,"24,080 x DRG weight",24894,Other,base rate x DRG weight,23222,,"22,463 x DRG weight",23222,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,27319,,"26,426 x DRG weight",27319,Other,base rate x DRG weight,40121,,"38,809 x DRG weight",40121,Other,base rate x DRG weight,40121,,"38,809 x DRG weight",40121,Other,base rate x DRG weight,27319,,"26,426 x DRG weight",27319,Other,base rate x DRG weight,40121,,"38,809 x DRG weight",40121,Other,base rate x DRG weight,24816,,"6,363 x patient days",24816,Per diem,,113054,70,,113054,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25904,,"25,057 x DRG weight",25904,Other,base rate x DRG weight,23314,,"22,552 x DRG weight",23314,Other,base rate x DRG weight,25904,,"25,057 x DRG weight",25904,Other,base rate x DRG weight,22018,,"21,298 x DRG weight",22018,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,113054,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,,inpatient,,,90123.85,10142,,,10142,Other,150% of Medicare + 9.63% HCRA Surcharge,6167.22,,,6167.22,Other,Medicare IPPS methodology,17477,,"25,046 x DRG weight",17477,Other,base rate x DRG weight,15729,,"22,541 x DRG weight",15729,Other,base rate x DRG weight,22393,,"32,091 x DRG weight",22393,Other,base rate x DRG weight,20154,,"28,882 x DRG weight",20154,Other,base rate x DRG weight,19034,,"27,277 x DRG weight",19034,Other,base rate x DRG weight,16803,,"24,080 x DRG weight",16803,Other,base rate x DRG weight,15675,,"22,463 x DRG weight",15675,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,18440,,"26,426 x DRG weight",18440,Other,base rate x DRG weight,27081,,"38,809 x DRG weight",27081,Other,base rate x DRG weight,27081,,"38,809 x DRG weight",27081,Other,base rate x DRG weight,18440,,"26,426 x DRG weight",18440,Other,base rate x DRG weight,27081,,"38,809 x DRG weight",27081,Other,base rate x DRG weight,17180,,"6,363 x patient days",17180,Per diem,,63087,70,,63087,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,17485,,"25,057 x DRG weight",17485,Other,base rate x DRG weight,15737,,"22,552 x DRG weight",15737,Other,base rate x DRG weight,17485,,"25,057 x DRG weight",17485,Other,base rate x DRG weight,14862,,"21,298 x DRG weight",14862,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,63087,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,,inpatient,,,353327.55,24546,,,24546,Other,150% of Medicare + 9.63% HCRA Surcharge,14926.29,,,14926.29,Other,Medicare IPPS methodology,43703,,"25,046 x DRG weight",43703,Other,base rate x DRG weight,39332,,"22,541 x DRG weight",39332,Other,base rate x DRG weight,55996,,"32,091 x DRG weight",55996,Other,base rate x DRG weight,50396,,"28,882 x DRG weight",50396,Other,base rate x DRG weight,47596,,"27,277 x DRG weight",47596,Other,base rate x DRG weight,42017,,"24,080 x DRG weight",42017,Other,base rate x DRG weight,39196,,"22,463 x DRG weight",39196,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,46111,,"26,426 x DRG weight",46111,Other,base rate x DRG weight,67718,,"38,809 x DRG weight",67718,Other,base rate x DRG weight,67718,,"38,809 x DRG weight",67718,Other,base rate x DRG weight,46111,,"26,426 x DRG weight",46111,Other,base rate x DRG weight,67718,,"38,809 x DRG weight",67718,Other,base rate x DRG weight,48995,,"6,363 x patient days",48995,Per diem,,247329,70,,247329,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,43722,,"25,057 x DRG weight",43722,Other,base rate x DRG weight,39351,,"22,552 x DRG weight",39351,Other,base rate x DRG weight,43722,,"25,057 x DRG weight",43722,Other,base rate x DRG weight,37163,,"21,298 x DRG weight",37163,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,247329,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,,inpatient,,,232553.09,14456,,,14456,Other,150% of Medicare + 9.63% HCRA Surcharge,8790.51,,,8790.51,Other,Medicare IPPS methodology,25332,,"25,046 x DRG weight",25332,Other,base rate x DRG weight,22798,,"22,541 x DRG weight",22798,Other,base rate x DRG weight,32457,,"32,091 x DRG weight",32457,Other,base rate x DRG weight,29211,,"28,882 x DRG weight",29211,Other,base rate x DRG weight,27588,,"27,277 x DRG weight",27588,Other,base rate x DRG weight,24355,,"24,080 x DRG weight",24355,Other,base rate x DRG weight,22719,,"22,463 x DRG weight",22719,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26727,,"26,426 x DRG weight",26727,Other,base rate x DRG weight,39251,,"38,809 x DRG weight",39251,Other,base rate x DRG weight,39251,,"38,809 x DRG weight",39251,Other,base rate x DRG weight,26727,,"26,426 x DRG weight",26727,Other,base rate x DRG weight,39251,,"38,809 x DRG weight",39251,Other,base rate x DRG weight,30542,,"6,363 x patient days",30542,Per diem,,162787,70,,162787,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25343,,"25,057 x DRG weight",25343,Other,base rate x DRG weight,22809,,"22,552 x DRG weight",22809,Other,base rate x DRG weight,25343,,"25,057 x DRG weight",25343,Other,base rate x DRG weight,21541,,"21,298 x DRG weight",21541,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,162787,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,,inpatient,,,1868428.79,363132,,,363132,Other,150% of Medicare + 9.63% HCRA Surcharge,220822.63,,,220822.63,Other,Medicare IPPS methodology,660180,,"25,046 x DRG weight",660180,Other,base rate x DRG weight,594151,,"22,541 x DRG weight",594151,Other,base rate x DRG weight,845877,,"32,091 x DRG weight",845877,Other,base rate x DRG weight,761292,,"28,882 x DRG weight",761292,Other,base rate x DRG weight,718986,,"27,277 x DRG weight",718986,Other,base rate x DRG weight,634717,,"24,080 x DRG weight",634717,Other,base rate x DRG weight,592095,,"22,463 x DRG weight",592095,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,696555,,"26,426 x DRG weight",696555,Other,base rate x DRG weight,1022955,,"38,809 x DRG weight",1022955,Other,base rate x DRG weight,1022955,,"38,809 x DRG weight",1022955,Other,base rate x DRG weight,696555,,"26,426 x DRG weight",696555,Other,base rate x DRG weight,1022955,,"38,809 x DRG weight",1022955,Other,base rate x DRG weight,229068,,"6,363 x patient days",229068,Per diem,,1307900,70,,1307900,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,660470,,"25,057 x DRG weight",660470,Other,base rate x DRG weight,594441,,"22,552 x DRG weight",594441,Other,base rate x DRG weight,660470,,"25,057 x DRG weight",660470,Other,base rate x DRG weight,561388,,"21,298 x DRG weight",561388,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,1307900,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,,inpatient,,,699323.95,95730,,,95730,Other,150% of Medicare + 9.63% HCRA Surcharge,58213.89,,,58213.89,Other,Medicare IPPS methodology,173311,,"25,046 x DRG weight",173311,Other,base rate x DRG weight,155977,,"22,541 x DRG weight",155977,Other,base rate x DRG weight,222060,,"32,091 x DRG weight",222060,Other,base rate x DRG weight,199855,,"28,882 x DRG weight",199855,Other,base rate x DRG weight,188749,,"27,277 x DRG weight",188749,Other,base rate x DRG weight,166626,,"24,080 x DRG weight",166626,Other,base rate x DRG weight,155437,,"22,463 x DRG weight",155437,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,182860,,"26,426 x DRG weight",182860,Other,base rate x DRG weight,268547,,"38,809 x DRG weight",268547,Other,base rate x DRG weight,268547,,"38,809 x DRG weight",268547,Other,base rate x DRG weight,182860,,"26,426 x DRG weight",182860,Other,base rate x DRG weight,268547,,"38,809 x DRG weight",268547,Other,base rate x DRG weight,108807,,"6,363 x patient days",108807,Per diem,,489527,70,,489527,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,173387,,"25,057 x DRG weight",173387,Other,base rate x DRG weight,156053,,"22,552 x DRG weight",156053,Other,base rate x DRG weight,173387,,"25,057 x DRG weight",173387,Other,base rate x DRG weight,147376,,"21,298 x DRG weight",147376,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,489527,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,,inpatient,,,487625.04,44775,,,44775,Other,150% of Medicare + 9.63% HCRA Surcharge,27227.98,,,27227.98,Other,Medicare IPPS methodology,80535,,"25,046 x DRG weight",80535,Other,base rate x DRG weight,72481,,"22,541 x DRG weight",72481,Other,base rate x DRG weight,103189,,"32,091 x DRG weight",103189,Other,base rate x DRG weight,92870,,"28,882 x DRG weight",92870,Other,base rate x DRG weight,87709,,"27,277 x DRG weight",87709,Other,base rate x DRG weight,77429,,"24,080 x DRG weight",77429,Other,base rate x DRG weight,72230,,"22,463 x DRG weight",72230,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,84973,,"26,426 x DRG weight",84973,Other,base rate x DRG weight,124790,,"38,809 x DRG weight",124790,Other,base rate x DRG weight,124790,,"38,809 x DRG weight",124790,Other,base rate x DRG weight,84973,,"26,426 x DRG weight",84973,Other,base rate x DRG weight,124790,,"38,809 x DRG weight",124790,Other,base rate x DRG weight,52813,,"6,363 x patient days",52813,Per diem,,341338,70,,341338,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,80571,,"25,057 x DRG weight",80571,Other,base rate x DRG weight,72516,,"22,552 x DRG weight",72516,Other,base rate x DRG weight,80571,,"25,057 x DRG weight",80571,Other,base rate x DRG weight,68484,,"21,298 x DRG weight",68484,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,341338,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,,inpatient,,,250045.33,42251,,,42251,Other,150% of Medicare + 9.63% HCRA Surcharge,25692.98,,,25692.98,Other,Medicare IPPS methodology,75939,,"25,046 x DRG weight",75939,Other,base rate x DRG weight,68344,,"22,541 x DRG weight",68344,Other,base rate x DRG weight,97300,,"32,091 x DRG weight",97300,Other,base rate x DRG weight,87570,,"28,882 x DRG weight",87570,Other,base rate x DRG weight,82704,,"27,277 x DRG weight",82704,Other,base rate x DRG weight,73011,,"24,080 x DRG weight",73011,Other,base rate x DRG weight,68108,,"22,463 x DRG weight",68108,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,80124,,"26,426 x DRG weight",80124,Other,base rate x DRG weight,117669,,"38,809 x DRG weight",117669,Other,base rate x DRG weight,117669,,"38,809 x DRG weight",117669,Other,base rate x DRG weight,80124,,"26,426 x DRG weight",80124,Other,base rate x DRG weight,117669,,"38,809 x DRG weight",117669,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,175032,70,,175032,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,75973,,"25,057 x DRG weight",75973,Other,base rate x DRG weight,68378,,"22,552 x DRG weight",68378,Other,base rate x DRG weight,75973,,"25,057 x DRG weight",75973,Other,base rate x DRG weight,64576,,"21,298 x DRG weight",64576,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,175032,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,,inpatient,,,402958.87,29327,,,29327,Other,150% of Medicare + 9.63% HCRA Surcharge,17833.99,,,17833.99,Other,Medicare IPPS methodology,52409,,"25,046 x DRG weight",52409,Other,base rate x DRG weight,47167,,"22,541 x DRG weight",47167,Other,base rate x DRG weight,67150,,"32,091 x DRG weight",67150,Other,base rate x DRG weight,60436,,"28,882 x DRG weight",60436,Other,base rate x DRG weight,57077,,"27,277 x DRG weight",57077,Other,base rate x DRG weight,50387,,"24,080 x DRG weight",50387,Other,base rate x DRG weight,47004,,"22,463 x DRG weight",47004,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,55296,,"26,426 x DRG weight",55296,Other,base rate x DRG weight,81208,,"38,809 x DRG weight",81208,Other,base rate x DRG weight,81208,,"38,809 x DRG weight",81208,Other,base rate x DRG weight,55296,,"26,426 x DRG weight",55296,Other,base rate x DRG weight,81208,,"38,809 x DRG weight",81208,Other,base rate x DRG weight,46450,,"6,363 x patient days",46450,Per diem,,282071,70,,282071,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,52432,,"25,057 x DRG weight",52432,Other,base rate x DRG weight,47190,,"22,552 x DRG weight",47190,Other,base rate x DRG weight,52432,,"25,057 x DRG weight",52432,Other,base rate x DRG weight,44566,,"21,298 x DRG weight",44566,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,282071,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,,inpatient,,,270505.91,28620,,,28620,Other,150% of Medicare + 9.63% HCRA Surcharge,17404.03,,,17404.03,Other,Medicare IPPS methodology,51121,,"25,046 x DRG weight",51121,Other,base rate x DRG weight,46008,,"22,541 x DRG weight",46008,Other,base rate x DRG weight,65501,,"32,091 x DRG weight",65501,Other,base rate x DRG weight,58951,,"28,882 x DRG weight",58951,Other,base rate x DRG weight,55675,,"27,277 x DRG weight",55675,Other,base rate x DRG weight,49150,,"24,080 x DRG weight",49150,Other,base rate x DRG weight,45849,,"22,463 x DRG weight",45849,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,53938,,"26,426 x DRG weight",53938,Other,base rate x DRG weight,79213,,"38,809 x DRG weight",79213,Other,base rate x DRG weight,79213,,"38,809 x DRG weight",79213,Other,base rate x DRG weight,53938,,"26,426 x DRG weight",53938,Other,base rate x DRG weight,79213,,"38,809 x DRG weight",79213,Other,base rate x DRG weight,34997,,"6,363 x patient days",34997,Per diem,,189354,70,,189354,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,51144,,"25,057 x DRG weight",51144,Other,base rate x DRG weight,46031,,"22,552 x DRG weight",46031,Other,base rate x DRG weight,51144,,"25,057 x DRG weight",51144,Other,base rate x DRG weight,43471,,"21,298 x DRG weight",43471,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,189354,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,,inpatient,,,254493.41,44772,,,44772,Other,150% of Medicare + 9.63% HCRA Surcharge,27226.3,,,27226.3,Other,Medicare IPPS methodology,80530,,"25,046 x DRG weight",80530,Other,base rate x DRG weight,72476,,"22,541 x DRG weight",72476,Other,base rate x DRG weight,103182,,"32,091 x DRG weight",103182,Other,base rate x DRG weight,92864,,"28,882 x DRG weight",92864,Other,base rate x DRG weight,87704,,"27,277 x DRG weight",87704,Other,base rate x DRG weight,77424,,"24,080 x DRG weight",77424,Other,base rate x DRG weight,72225,,"22,463 x DRG weight",72225,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,84968,,"26,426 x DRG weight",84968,Other,base rate x DRG weight,124783,,"38,809 x DRG weight",124783,Other,base rate x DRG weight,124783,,"38,809 x DRG weight",124783,Other,base rate x DRG weight,84968,,"26,426 x DRG weight",84968,Other,base rate x DRG weight,124783,,"38,809 x DRG weight",124783,Other,base rate x DRG weight,59812,,"6,363 x patient days",59812,Per diem,,178145,70,,178145,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,80566,,"25,057 x DRG weight",80566,Other,base rate x DRG weight,72511,,"22,552 x DRG weight",72511,Other,base rate x DRG weight,80566,,"25,057 x DRG weight",80566,Other,base rate x DRG weight,68479,,"21,298 x DRG weight",68479,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,178145,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,,inpatient,,,250994.14,30346,,,30346,Other,150% of Medicare + 9.63% HCRA Surcharge,18453.85,,,18453.85,Other,Medicare IPPS methodology,54265,,"25,046 x DRG weight",54265,Other,base rate x DRG weight,48837,,"22,541 x DRG weight",48837,Other,base rate x DRG weight,69528,,"32,091 x DRG weight",69528,Other,base rate x DRG weight,62576,,"28,882 x DRG weight",62576,Other,base rate x DRG weight,59098,,"27,277 x DRG weight",59098,Other,base rate x DRG weight,52172,,"24,080 x DRG weight",52172,Other,base rate x DRG weight,48668,,"22,463 x DRG weight",48668,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,57255,,"26,426 x DRG weight",57255,Other,base rate x DRG weight,84084,,"38,809 x DRG weight",84084,Other,base rate x DRG weight,84084,,"38,809 x DRG weight",84084,Other,base rate x DRG weight,57255,,"26,426 x DRG weight",57255,Other,base rate x DRG weight,84084,,"38,809 x DRG weight",84084,Other,base rate x DRG weight,29270,,"6,363 x patient days",29270,Per diem,,175696,70,,175696,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,54288,,"25,057 x DRG weight",54288,Other,base rate x DRG weight,48861,,"22,552 x DRG weight",48861,Other,base rate x DRG weight,54288,,"25,057 x DRG weight",54288,Other,base rate x DRG weight,46144,,"21,298 x DRG weight",46144,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,175696,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,,inpatient,,,117589.06,26074,,,26074,Other,150% of Medicare + 9.63% HCRA Surcharge,15855.65,,,15855.65,Other,Medicare IPPS methodology,46485,,"25,046 x DRG weight",46485,Other,base rate x DRG weight,41836,,"22,541 x DRG weight",41836,Other,base rate x DRG weight,59561,,"32,091 x DRG weight",59561,Other,base rate x DRG weight,53605,,"28,882 x DRG weight",53605,Other,base rate x DRG weight,50626,,"27,277 x DRG weight",50626,Other,base rate x DRG weight,44692,,"24,080 x DRG weight",44692,Other,base rate x DRG weight,41691,,"22,463 x DRG weight",41691,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,49047,,"26,426 x DRG weight",49047,Other,base rate x DRG weight,72030,,"38,809 x DRG weight",72030,Other,base rate x DRG weight,72030,,"38,809 x DRG weight",72030,Other,base rate x DRG weight,49047,,"26,426 x DRG weight",49047,Other,base rate x DRG weight,72030,,"38,809 x DRG weight",72030,Other,base rate x DRG weight,14635,,"6,363 x patient days",14635,Per diem,,82312,70,,82312,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,46506,,"25,057 x DRG weight",46506,Other,base rate x DRG weight,41857,,"22,552 x DRG weight",41857,Other,base rate x DRG weight,46506,,"25,057 x DRG weight",46506,Other,base rate x DRG weight,39529,,"21,298 x DRG weight",39529,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,82312,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,,inpatient,,,193392.58,21307,,,21307,Other,150% of Medicare + 9.63% HCRA Surcharge,12957.15,,,12957.15,Other,Medicare IPPS methodology,37807,,"25,046 x DRG weight",37807,Other,base rate x DRG weight,34026,,"22,541 x DRG weight",34026,Other,base rate x DRG weight,48441,,"32,091 x DRG weight",48441,Other,base rate x DRG weight,43597,,"28,882 x DRG weight",43597,Other,base rate x DRG weight,41175,,"27,277 x DRG weight",41175,Other,base rate x DRG weight,36349,,"24,080 x DRG weight",36349,Other,base rate x DRG weight,33908,,"22,463 x DRG weight",33908,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39890,,"26,426 x DRG weight",39890,Other,base rate x DRG weight,58582,,"38,809 x DRG weight",58582,Other,base rate x DRG weight,58582,,"38,809 x DRG weight",58582,Other,base rate x DRG weight,39890,,"26,426 x DRG weight",39890,Other,base rate x DRG weight,58582,,"38,809 x DRG weight",58582,Other,base rate x DRG weight,42632,,"6,363 x patient days",42632,Per diem,,135375,70,,135375,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37824,,"25,057 x DRG weight",37824,Other,base rate x DRG weight,34042,,"22,552 x DRG weight",34042,Other,base rate x DRG weight,37824,,"25,057 x DRG weight",37824,Other,base rate x DRG weight,32149,,"21,298 x DRG weight",32149,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,135375,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,,inpatient,,,162109.27,14473,,,14473,Other,150% of Medicare + 9.63% HCRA Surcharge,8801.38,,,8801.38,Other,Medicare IPPS methodology,25364,,"25,046 x DRG weight",25364,Other,base rate x DRG weight,22827,,"22,541 x DRG weight",22827,Other,base rate x DRG weight,32499,,"32,091 x DRG weight",32499,Other,base rate x DRG weight,29249,,"28,882 x DRG weight",29249,Other,base rate x DRG weight,27623,,"27,277 x DRG weight",27623,Other,base rate x DRG weight,24386,,"24,080 x DRG weight",24386,Other,base rate x DRG weight,22748,,"22,463 x DRG weight",22748,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,26762,,"26,426 x DRG weight",26762,Other,base rate x DRG weight,39302,,"38,809 x DRG weight",39302,Other,base rate x DRG weight,39302,,"38,809 x DRG weight",39302,Other,base rate x DRG weight,26762,,"26,426 x DRG weight",26762,Other,base rate x DRG weight,39302,,"38,809 x DRG weight",39302,Other,base rate x DRG weight,28634,,"6,363 x patient days",28634,Per diem,,113476,70,,113476,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,25375,,"25,057 x DRG weight",25375,Other,base rate x DRG weight,22838,,"22,552 x DRG weight",22838,Other,base rate x DRG weight,25375,,"25,057 x DRG weight",25375,Other,base rate x DRG weight,21568,,"21,298 x DRG weight",21568,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,113476,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,,inpatient,,,315077.54,17760,,,17760,Other,150% of Medicare + 9.63% HCRA Surcharge,10799.8,,,10799.8,Other,Medicare IPPS methodology,31348,,"25,046 x DRG weight",31348,Other,base rate x DRG weight,28212,,"22,541 x DRG weight",28212,Other,base rate x DRG weight,40165,,"32,091 x DRG weight",40165,Other,base rate x DRG weight,36149,,"28,882 x DRG weight",36149,Other,base rate x DRG weight,34140,,"27,277 x DRG weight",34140,Other,base rate x DRG weight,30139,,"24,080 x DRG weight",30139,Other,base rate x DRG weight,28115,,"22,463 x DRG weight",28115,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,33075,,"26,426 x DRG weight",33075,Other,base rate x DRG weight,48573,,"38,809 x DRG weight",48573,Other,base rate x DRG weight,48573,,"38,809 x DRG weight",48573,Other,base rate x DRG weight,33075,,"26,426 x DRG weight",33075,Other,base rate x DRG weight,48573,,"38,809 x DRG weight",48573,Other,base rate x DRG weight,33724,,"6,363 x patient days",33724,Per diem,,220554,70,,220554,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,31361,,"25,057 x DRG weight",31361,Other,base rate x DRG weight,28226,,"22,552 x DRG weight",28226,Other,base rate x DRG weight,31361,,"25,057 x DRG weight",31361,Other,base rate x DRG weight,26657,,"21,298 x DRG weight",26657,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,220554,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,,inpatient,,,107235.24,11561,,,11561,Other,150% of Medicare + 9.63% HCRA Surcharge,7030.5,,,7030.5,Other,Medicare IPPS methodology,20062,,"25,046 x DRG weight",20062,Other,base rate x DRG weight,18055,,"22,541 x DRG weight",18055,Other,base rate x DRG weight,25705,,"32,091 x DRG weight",25705,Other,base rate x DRG weight,23134,,"28,882 x DRG weight",23134,Other,base rate x DRG weight,21849,,"27,277 x DRG weight",21849,Other,base rate x DRG weight,19288,,"24,080 x DRG weight",19288,Other,base rate x DRG weight,17993,,"22,463 x DRG weight",17993,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,21167,,"26,426 x DRG weight",21167,Other,base rate x DRG weight,31086,,"38,809 x DRG weight",31086,Other,base rate x DRG weight,31086,,"38,809 x DRG weight",31086,Other,base rate x DRG weight,21167,,"26,426 x DRG weight",21167,Other,base rate x DRG weight,31086,,"38,809 x DRG weight",31086,Other,base rate x DRG weight,22271,,"6,363 x patient days",22271,Per diem,,75065,70,,75065,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,20071,,"25,057 x DRG weight",20071,Other,base rate x DRG weight,18064,,"22,552 x DRG weight",18064,Other,base rate x DRG weight,20071,,"25,057 x DRG weight",20071,Other,base rate x DRG weight,17060,,"21,298 x DRG weight",17060,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,75065,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,,inpatient,,,152010.9,15300,,,15300,Other,150% of Medicare + 9.63% HCRA Surcharge,9304.12,,,9304.12,Other,Medicare IPPS methodology,26869,,"25,046 x DRG weight",26869,Other,base rate x DRG weight,24182,,"22,541 x DRG weight",24182,Other,base rate x DRG weight,34427,,"32,091 x DRG weight",34427,Other,base rate x DRG weight,30985,,"28,882 x DRG weight",30985,Other,base rate x DRG weight,29263,,"27,277 x DRG weight",29263,Other,base rate x DRG weight,25833,,"24,080 x DRG weight",25833,Other,base rate x DRG weight,24098,,"22,463 x DRG weight",24098,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28350,,"26,426 x DRG weight",28350,Other,base rate x DRG weight,41634,,"38,809 x DRG weight",41634,Other,base rate x DRG weight,41634,,"38,809 x DRG weight",41634,Other,base rate x DRG weight,28350,,"26,426 x DRG weight",28350,Other,base rate x DRG weight,41634,,"38,809 x DRG weight",41634,Other,base rate x DRG weight,40723,,"6,363 x patient days",40723,Per diem,,106408,70,,106408,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,26881,,"25,057 x DRG weight",26881,Other,base rate x DRG weight,24194,,"22,552 x DRG weight",24194,Other,base rate x DRG weight,26881,,"25,057 x DRG weight",26881,Other,base rate x DRG weight,22848,,"21,298 x DRG weight",22848,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,106408,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,,inpatient,,,91528.2,9327,,,9327,Other,150% of Medicare + 9.63% HCRA Surcharge,5672.01,,,5672.01,Other,Medicare IPPS methodology,15994,,"25,046 x DRG weight",15994,Other,base rate x DRG weight,14395,,"22,541 x DRG weight",14395,Other,base rate x DRG weight,20493,,"32,091 x DRG weight",20493,Other,base rate x DRG weight,18444,,"28,882 x DRG weight",18444,Other,base rate x DRG weight,17419,,"27,277 x DRG weight",17419,Other,base rate x DRG weight,15377,,"24,080 x DRG weight",15377,Other,base rate x DRG weight,14345,,"22,463 x DRG weight",14345,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,16876,,"26,426 x DRG weight",16876,Other,base rate x DRG weight,24783,,"38,809 x DRG weight",24783,Other,base rate x DRG weight,24783,,"38,809 x DRG weight",24783,Other,base rate x DRG weight,16876,,"26,426 x DRG weight",16876,Other,base rate x DRG weight,24783,,"38,809 x DRG weight",24783,Other,base rate x DRG weight,25452,,"6,363 x patient days",25452,Per diem,,64070,70,,64070,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,16001,,"25,057 x DRG weight",16001,Other,base rate x DRG weight,14402,,"22,552 x DRG weight",14402,Other,base rate x DRG weight,16001,,"25,057 x DRG weight",16001,Other,base rate x DRG weight,13601,,"21,298 x DRG weight",13601,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,64070,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,,inpatient,,,103021.31,8659,,,8659,Other,150% of Medicare + 9.63% HCRA Surcharge,5265.47,,,5265.47,Other,Medicare IPPS methodology,14777,,"25,046 x DRG weight",14777,Other,base rate x DRG weight,13299,,"22,541 x DRG weight",13299,Other,base rate x DRG weight,18934,,"32,091 x DRG weight",18934,Other,base rate x DRG weight,17040,,"28,882 x DRG weight",17040,Other,base rate x DRG weight,16093,,"27,277 x DRG weight",16093,Other,base rate x DRG weight,14207,,"24,080 x DRG weight",14207,Other,base rate x DRG weight,13253,,"22,463 x DRG weight",13253,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,15591,,"26,426 x DRG weight",15591,Other,base rate x DRG weight,22897,,"38,809 x DRG weight",22897,Other,base rate x DRG weight,22897,,"38,809 x DRG weight",22897,Other,base rate x DRG weight,15591,,"26,426 x DRG weight",15591,Other,base rate x DRG weight,22897,,"38,809 x DRG weight",22897,Other,base rate x DRG weight,17816,,"6,363 x patient days",17816,Per diem,,72115,70,,72115,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,14784,,"25,057 x DRG weight",14784,Other,base rate x DRG weight,13306,,"22,552 x DRG weight",13306,Other,base rate x DRG weight,14784,,"25,057 x DRG weight",14784,Other,base rate x DRG weight,12566,,"21,298 x DRG weight",12566,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,72115,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,,inpatient,,,666307.7,84319,,,84319,Other,150% of Medicare + 9.63% HCRA Surcharge,51275.06,,,51275.06,Other,Medicare IPPS methodology,152535,,"25,046 x DRG weight",152535,Other,base rate x DRG weight,137279,,"22,541 x DRG weight",137279,Other,base rate x DRG weight,195441,,"32,091 x DRG weight",195441,Other,base rate x DRG weight,175897,,"28,882 x DRG weight",175897,Other,base rate x DRG weight,166122,,"27,277 x DRG weight",166122,Other,base rate x DRG weight,146652,,"24,080 x DRG weight",146652,Other,base rate x DRG weight,136804,,"22,463 x DRG weight",136804,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,160940,,"26,426 x DRG weight",160940,Other,base rate x DRG weight,236355,,"38,809 x DRG weight",236355,Other,base rate x DRG weight,236355,,"38,809 x DRG weight",236355,Other,base rate x DRG weight,160940,,"26,426 x DRG weight",160940,Other,base rate x DRG weight,236355,,"38,809 x DRG weight",236355,Other,base rate x DRG weight,77629,,"6,363 x patient days",77629,Per diem,,466415,70,,466415,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,152602,,"25,057 x DRG weight",152602,Other,base rate x DRG weight,137346,,"22,552 x DRG weight",137346,Other,base rate x DRG weight,152602,,"25,057 x DRG weight",152602,Other,base rate x DRG weight,129709,,"21,298 x DRG weight",129709,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,466415,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,,inpatient,,,651853.98,53891,,,53891,Other,150% of Medicare + 9.63% HCRA Surcharge,32771.51,,,32771.51,Other,Medicare IPPS methodology,97133,,"25,046 x DRG weight",97133,Other,base rate x DRG weight,87419,,"22,541 x DRG weight",87419,Other,base rate x DRG weight,124455,,"32,091 x DRG weight",124455,Other,base rate x DRG weight,112010,,"28,882 x DRG weight",112010,Other,base rate x DRG weight,105786,,"27,277 x DRG weight",105786,Other,base rate x DRG weight,93387,,"24,080 x DRG weight",93387,Other,base rate x DRG weight,87116,,"22,463 x DRG weight",87116,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,102485,,"26,426 x DRG weight",102485,Other,base rate x DRG weight,150509,,"38,809 x DRG weight",150509,Other,base rate x DRG weight,150509,,"38,809 x DRG weight",150509,Other,base rate x DRG weight,102485,,"26,426 x DRG weight",102485,Other,base rate x DRG weight,150509,,"38,809 x DRG weight",150509,Other,base rate x DRG weight,50904,,"6,363 x patient days",50904,Per diem,,456298,70,,456298,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,97176,,"25,057 x DRG weight",97176,Other,base rate x DRG weight,87461,,"22,552 x DRG weight",87461,Other,base rate x DRG weight,97176,,"25,057 x DRG weight",97176,Other,base rate x DRG weight,82598,,"21,298 x DRG weight",82598,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,456298,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,,inpatient,,,644915.06,100033,,,100033,Other,150% of Medicare + 9.63% HCRA Surcharge,60830.49,,,60830.49,Other,Medicare IPPS methodology,181145,,"25,046 x DRG weight",181145,Other,base rate x DRG weight,163028,,"22,541 x DRG weight",163028,Other,base rate x DRG weight,232098,,"32,091 x DRG weight",232098,Other,base rate x DRG weight,208889,,"28,882 x DRG weight",208889,Other,base rate x DRG weight,197281,,"27,277 x DRG weight",197281,Other,base rate x DRG weight,174159,,"24,080 x DRG weight",174159,Other,base rate x DRG weight,162464,,"22,463 x DRG weight",162464,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,191126,,"26,426 x DRG weight",191126,Other,base rate x DRG weight,280686,,"38,809 x DRG weight",280686,Other,base rate x DRG weight,280686,,"38,809 x DRG weight",280686,Other,base rate x DRG weight,191126,,"26,426 x DRG weight",191126,Other,base rate x DRG weight,280686,,"38,809 x DRG weight",280686,Other,base rate x DRG weight,92264,,"6,363 x patient days",92264,Per diem,,451441,70,,451441,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,181225,,"25,057 x DRG weight",181225,Other,base rate x DRG weight,163107,,"22,552 x DRG weight",163107,Other,base rate x DRG weight,181225,,"25,057 x DRG weight",181225,Other,base rate x DRG weight,154038,,"21,298 x DRG weight",154038,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,451441,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,,inpatient,,,450638.53,56183,,,56183,Other,150% of Medicare + 9.63% HCRA Surcharge,34165.13,,,34165.13,Other,Medicare IPPS methodology,101306,,"25,046 x DRG weight",101306,Other,base rate x DRG weight,91174,,"22,541 x DRG weight",91174,Other,base rate x DRG weight,129802,,"32,091 x DRG weight",129802,Other,base rate x DRG weight,116822,,"28,882 x DRG weight",116822,Other,base rate x DRG weight,110330,,"27,277 x DRG weight",110330,Other,base rate x DRG weight,97399,,"24,080 x DRG weight",97399,Other,base rate x DRG weight,90858,,"22,463 x DRG weight",90858,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,106888,,"26,426 x DRG weight",106888,Other,base rate x DRG weight,156975,,"38,809 x DRG weight",156975,Other,base rate x DRG weight,156975,,"38,809 x DRG weight",156975,Other,base rate x DRG weight,106888,,"26,426 x DRG weight",106888,Other,base rate x DRG weight,156975,,"38,809 x DRG weight",156975,Other,base rate x DRG weight,52177,,"6,363 x patient days",52177,Per diem,,315447,70,,315447,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,101351,,"25,057 x DRG weight",101351,Other,base rate x DRG weight,91218,,"22,552 x DRG weight",91218,Other,base rate x DRG weight,101351,,"25,057 x DRG weight",101351,Other,base rate x DRG weight,86146,,"21,298 x DRG weight",86146,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,315447,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,,inpatient,,,429728.36,35378,,,35378,Other,150% of Medicare + 9.63% HCRA Surcharge,21513.79,,,21513.79,Other,Medicare IPPS methodology,63426,,"25,046 x DRG weight",63426,Other,base rate x DRG weight,57083,,"22,541 x DRG weight",57083,Other,base rate x DRG weight,81267,,"32,091 x DRG weight",81267,Other,base rate x DRG weight,73141,,"28,882 x DRG weight",73141,Other,base rate x DRG weight,69076,,"27,277 x DRG weight",69076,Other,base rate x DRG weight,60980,,"24,080 x DRG weight",60980,Other,base rate x DRG weight,56885,,"22,463 x DRG weight",56885,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,66921,,"26,426 x DRG weight",66921,Other,base rate x DRG weight,98280,,"38,809 x DRG weight",98280,Other,base rate x DRG weight,98280,,"38,809 x DRG weight",98280,Other,base rate x DRG weight,66921,,"26,426 x DRG weight",66921,Other,base rate x DRG weight,98280,,"38,809 x DRG weight",98280,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,300810,70,,300810,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,63454,,"25,057 x DRG weight",63454,Other,base rate x DRG weight,57111,,"22,552 x DRG weight",57111,Other,base rate x DRG weight,63454,,"25,057 x DRG weight",63454,Other,base rate x DRG weight,53935,,"21,298 x DRG weight",53935,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,300810,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,,inpatient,,,288738.68,38156,,,38156,Other,150% of Medicare + 9.63% HCRA Surcharge,23202.7,,,23202.7,Other,Medicare IPPS methodology,68483,,"25,046 x DRG weight",68483,Other,base rate x DRG weight,61634,,"22,541 x DRG weight",61634,Other,base rate x DRG weight,87746,,"32,091 x DRG weight",87746,Other,base rate x DRG weight,78972,,"28,882 x DRG weight",78972,Other,base rate x DRG weight,74584,,"27,277 x DRG weight",74584,Other,base rate x DRG weight,65842,,"24,080 x DRG weight",65842,Other,base rate x DRG weight,61421,,"22,463 x DRG weight",61421,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,72257,,"26,426 x DRG weight",72257,Other,base rate x DRG weight,106115,,"38,809 x DRG weight",106115,Other,base rate x DRG weight,106115,,"38,809 x DRG weight",106115,Other,base rate x DRG weight,72257,,"26,426 x DRG weight",72257,Other,base rate x DRG weight,106115,,"38,809 x DRG weight",106115,Other,base rate x DRG weight,52177,,"6,363 x patient days",52177,Per diem,,202117,70,,202117,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,68513,,"25,057 x DRG weight",68513,Other,base rate x DRG weight,61664,,"22,552 x DRG weight",61664,Other,base rate x DRG weight,68513,,"25,057 x DRG weight",68513,Other,base rate x DRG weight,58235,,"21,298 x DRG weight",58235,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,202117,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,,inpatient,,,177696.36,21190,,,21190,Other,150% of Medicare + 9.63% HCRA Surcharge,12886.05,,,12886.05,Other,Medicare IPPS methodology,37594,,"25,046 x DRG weight",37594,Other,base rate x DRG weight,33834,,"22,541 x DRG weight",33834,Other,base rate x DRG weight,48169,,"32,091 x DRG weight",48169,Other,base rate x DRG weight,43352,,"28,882 x DRG weight",43352,Other,base rate x DRG weight,40943,,"27,277 x DRG weight",40943,Other,base rate x DRG weight,36144,,"24,080 x DRG weight",36144,Other,base rate x DRG weight,33717,,"22,463 x DRG weight",33717,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,39665,,"26,426 x DRG weight",39665,Other,base rate x DRG weight,58252,,"38,809 x DRG weight",58252,Other,base rate x DRG weight,58252,,"38,809 x DRG weight",58252,Other,base rate x DRG weight,39665,,"26,426 x DRG weight",39665,Other,base rate x DRG weight,58252,,"38,809 x DRG weight",58252,Other,base rate x DRG weight,31815,,"6,363 x patient days",31815,Per diem,,124387,70,,124387,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,37611,,"25,057 x DRG weight",37611,Other,base rate x DRG weight,33851,,"22,552 x DRG weight",33851,Other,base rate x DRG weight,37611,,"25,057 x DRG weight",37611,Other,base rate x DRG weight,31968,,"21,298 x DRG weight",31968,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,124387,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,,inpatient,,,136727.25,13692,,,13692,Other,150% of Medicare + 9.63% HCRA Surcharge,8326.25,,,8326.25,Other,Medicare IPPS methodology,23941,,"25,046 x DRG weight",23941,Other,base rate x DRG weight,21547,,"22,541 x DRG weight",21547,Other,base rate x DRG weight,30676,,"32,091 x DRG weight",30676,Other,base rate x DRG weight,27608,,"28,882 x DRG weight",27608,Other,base rate x DRG weight,26074,,"27,277 x DRG weight",26074,Other,base rate x DRG weight,23018,,"24,080 x DRG weight",23018,Other,base rate x DRG weight,21472,,"22,463 x DRG weight",21472,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,25261,,"26,426 x DRG weight",25261,Other,base rate x DRG weight,37098,,"38,809 x DRG weight",37098,Other,base rate x DRG weight,37098,,"38,809 x DRG weight",37098,Other,base rate x DRG weight,25261,,"26,426 x DRG weight",25261,Other,base rate x DRG weight,37098,,"38,809 x DRG weight",37098,Other,base rate x DRG weight,20362,,"6,363 x patient days",20362,Per diem,,95709,70,,95709,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,23952,,"25,057 x DRG weight",23952,Other,base rate x DRG weight,21557,,"22,552 x DRG weight",21557,Other,base rate x DRG weight,23952,,"25,057 x DRG weight",23952,Other,base rate x DRG weight,20359,,"21,298 x DRG weight",20359,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,95709,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,,inpatient,,,2067235,95082,,,95082,Other,150% of Medicare + 9.63% HCRA Surcharge,57819.9,,,57819.9,Other,Medicare IPPS methodology,172131,,"25,046 x DRG weight",172131,Other,base rate x DRG weight,154915,,"22,541 x DRG weight",154915,Other,base rate x DRG weight,220549,,"32,091 x DRG weight",220549,Other,base rate x DRG weight,198494,,"28,882 x DRG weight",198494,Other,base rate x DRG weight,187464,,"27,277 x DRG weight",187464,Other,base rate x DRG weight,165492,,"24,080 x DRG weight",165492,Other,base rate x DRG weight,154379,,"22,463 x DRG weight",154379,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,181615,,"26,426 x DRG weight",181615,Other,base rate x DRG weight,266719,,"38,809 x DRG weight",266719,Other,base rate x DRG weight,266719,,"38,809 x DRG weight",266719,Other,base rate x DRG weight,181615,,"26,426 x DRG weight",181615,Other,base rate x DRG weight,266719,,"38,809 x DRG weight",266719,Other,base rate x DRG weight,128533,,"6,363 x patient days",128533,Per diem,,1447065,70,,1447065,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,172207,,"25,057 x DRG weight",172207,Other,base rate x DRG weight,154991,,"22,552 x DRG weight",154991,Other,base rate x DRG weight,172207,,"25,057 x DRG weight",172207,Other,base rate x DRG weight,146373,,"21,298 x DRG weight",146373,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,1447065,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,,inpatient,,,2067235,38779,,,38779,Other,150% of Medicare + 9.63% HCRA Surcharge,23581.64,,,23581.64,Other,Medicare IPPS methodology,69618,,"25,046 x DRG weight",69618,Other,base rate x DRG weight,62655,,"22,541 x DRG weight",62655,Other,base rate x DRG weight,89200,,"32,091 x DRG weight",89200,Other,base rate x DRG weight,80280,,"28,882 x DRG weight",80280,Other,base rate x DRG weight,75819,,"27,277 x DRG weight",75819,Other,base rate x DRG weight,66933,,"24,080 x DRG weight",66933,Other,base rate x DRG weight,62438,,"22,463 x DRG weight",62438,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,73454,,"26,426 x DRG weight",73454,Other,base rate x DRG weight,107873,,"38,809 x DRG weight",107873,Other,base rate x DRG weight,107873,,"38,809 x DRG weight",107873,Other,base rate x DRG weight,73454,,"26,426 x DRG weight",73454,Other,base rate x DRG weight,107873,,"38,809 x DRG weight",107873,Other,base rate x DRG weight,51540,,"6,363 x patient days",51540,Per diem,,1447065,70,,1447065,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,69648,,"25,057 x DRG weight",69648,Other,base rate x DRG weight,62686,,"22,552 x DRG weight",62686,Other,base rate x DRG weight,69648,,"25,057 x DRG weight",69648,Other,base rate x DRG weight,59200,,"21,298 x DRG weight",59200,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,1447065,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,,inpatient,,,720980.75,40662,,,40662,Other,150% of Medicare + 9.63% HCRA Surcharge,24726.82,,,24726.82,Other,Medicare IPPS methodology,73047,,"25,046 x DRG weight",73047,Other,base rate x DRG weight,65741,,"22,541 x DRG weight",65741,Other,base rate x DRG weight,93593,,"32,091 x DRG weight",93593,Other,base rate x DRG weight,84234,,"28,882 x DRG weight",84234,Other,base rate x DRG weight,79553,,"27,277 x DRG weight",79553,Other,base rate x DRG weight,70229,,"24,080 x DRG weight",70229,Other,base rate x DRG weight,65513,,"22,463 x DRG weight",65513,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,77071,,"26,426 x DRG weight",77071,Other,base rate x DRG weight,113186,,"38,809 x DRG weight",113186,Other,base rate x DRG weight,113186,,"38,809 x DRG weight",113186,Other,base rate x DRG weight,77071,,"26,426 x DRG weight",77071,Other,base rate x DRG weight,113186,,"38,809 x DRG weight",113186,Other,base rate x DRG weight,66812,,"6,363 x patient days",66812,Per diem,,504687,70,,504687,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,73079,,"25,057 x DRG weight",73079,Other,base rate x DRG weight,65773,,"22,552 x DRG weight",65773,Other,base rate x DRG weight,73079,,"25,057 x DRG weight",73079,Other,base rate x DRG weight,62116,,"21,298 x DRG weight",62116,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,504687,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,,inpatient,,,197222.56,19296,,,19296,Other,150% of Medicare + 9.63% HCRA Surcharge,11734.18,,,11734.18,Other,Medicare IPPS methodology,34145,,"25,046 x DRG weight",34145,Other,base rate x DRG weight,30730,,"22,541 x DRG weight",30730,Other,base rate x DRG weight,43750,,"32,091 x DRG weight",43750,Other,base rate x DRG weight,39375,,"28,882 x DRG weight",39375,Other,base rate x DRG weight,37187,,"27,277 x DRG weight",37187,Other,base rate x DRG weight,32828,,"24,080 x DRG weight",32828,Other,base rate x DRG weight,30624,,"22,463 x DRG weight",30624,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,36027,,"26,426 x DRG weight",36027,Other,base rate x DRG weight,52908,,"38,809 x DRG weight",52908,Other,base rate x DRG weight,52908,,"38,809 x DRG weight",52908,Other,base rate x DRG weight,36027,,"26,426 x DRG weight",36027,Other,base rate x DRG weight,52908,,"38,809 x DRG weight",52908,Other,base rate x DRG weight,37542,,"6,363 x patient days",37542,Per diem,,138056,70,,138056,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,34160,,"25,057 x DRG weight",34160,Other,base rate x DRG weight,30745,,"22,552 x DRG weight",30745,Other,base rate x DRG weight,34160,,"25,057 x DRG weight",34160,Other,base rate x DRG weight,29036,,"21,298 x DRG weight",29036,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,138056,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,,inpatient,,,122280.7,12171,,,12171,Other,150% of Medicare + 9.63% HCRA Surcharge,7401.07,,,7401.07,Other,Medicare IPPS methodology,21171,,"25,046 x DRG weight",21171,Other,base rate x DRG weight,19054,,"22,541 x DRG weight",19054,Other,base rate x DRG weight,27127,,"32,091 x DRG weight",27127,Other,base rate x DRG weight,24414,,"28,882 x DRG weight",24414,Other,base rate x DRG weight,23057,,"27,277 x DRG weight",23057,Other,base rate x DRG weight,20355,,"24,080 x DRG weight",20355,Other,base rate x DRG weight,18988,,"22,463 x DRG weight",18988,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,22338,,"26,426 x DRG weight",22338,Other,base rate x DRG weight,32805,,"38,809 x DRG weight",32805,Other,base rate x DRG weight,32805,,"38,809 x DRG weight",32805,Other,base rate x DRG weight,22338,,"26,426 x DRG weight",22338,Other,base rate x DRG weight,32805,,"38,809 x DRG weight",32805,Other,base rate x DRG weight,22907,,"6,363 x patient days",22907,Per diem,,85596,70,,85596,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,21181,,"25,057 x DRG weight",21181,Other,base rate x DRG weight,19063,,"22,552 x DRG weight",19063,Other,base rate x DRG weight,21181,,"25,057 x DRG weight",21181,Other,base rate x DRG weight,18003,,"21,298 x DRG weight",18003,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,85596,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,,inpatient,,,338221.04,20023,,,20023,Other,150% of Medicare + 9.63% HCRA Surcharge,12175.86,,,12175.86,Other,Medicare IPPS methodology,35468,,"25,046 x DRG weight",35468,Other,base rate x DRG weight,31920,,"22,541 x DRG weight",31920,Other,base rate x DRG weight,45444,,"32,091 x DRG weight",45444,Other,base rate x DRG weight,40900,,"28,882 x DRG weight",40900,Other,base rate x DRG weight,38627,,"27,277 x DRG weight",38627,Other,base rate x DRG weight,34100,,"24,080 x DRG weight",34100,Other,base rate x DRG weight,31810,,"22,463 x DRG weight",31810,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,37422,,"26,426 x DRG weight",37422,Other,base rate x DRG weight,54957,,"38,809 x DRG weight",54957,Other,base rate x DRG weight,54957,,"38,809 x DRG weight",54957,Other,base rate x DRG weight,37422,,"26,426 x DRG weight",37422,Other,base rate x DRG weight,54957,,"38,809 x DRG weight",54957,Other,base rate x DRG weight,39451,,"6,363 x patient days",39451,Per diem,,236755,70,,236755,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,35483,,"25,057 x DRG weight",35483,Other,base rate x DRG weight,31936,,"22,552 x DRG weight",31936,Other,base rate x DRG weight,35483,,"25,057 x DRG weight",35483,Other,base rate x DRG weight,30160,,"21,298 x DRG weight",30160,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,236755,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,,inpatient,,,796330.3,65751,,,65751,Other,150% of Medicare + 9.63% HCRA Surcharge,39983.88,,,39983.88,Other,Medicare IPPS methodology,118728,,"25,046 x DRG weight",118728,Other,base rate x DRG weight,106853,,"22,541 x DRG weight",106853,Other,base rate x DRG weight,152124,,"32,091 x DRG weight",152124,Other,base rate x DRG weight,136912,,"28,882 x DRG weight",136912,Other,base rate x DRG weight,129304,,"27,277 x DRG weight",129304,Other,base rate x DRG weight,114149,,"24,080 x DRG weight",114149,Other,base rate x DRG weight,106484,,"22,463 x DRG weight",106484,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,125270,,"26,426 x DRG weight",125270,Other,base rate x DRG weight,183970,,"38,809 x DRG weight",183970,Other,base rate x DRG weight,183970,,"38,809 x DRG weight",183970,Other,base rate x DRG weight,125270,,"26,426 x DRG weight",125270,Other,base rate x DRG weight,183970,,"38,809 x DRG weight",183970,Other,base rate x DRG weight,81446,,"6,363 x patient days",81446,Per diem,,557431,70,,557431,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,118780,,"25,057 x DRG weight",118780,Other,base rate x DRG weight,106906,,"22,552 x DRG weight",106906,Other,base rate x DRG weight,118780,,"25,057 x DRG weight",118780,Other,base rate x DRG weight,100961,,"21,298 x DRG weight",100961,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,557431,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,,inpatient,,,273227.72,34740,,,34740,Other,150% of Medicare + 9.63% HCRA Surcharge,21125.65,,,21125.65,Other,Medicare IPPS methodology,62264,,"25,046 x DRG weight",62264,Other,base rate x DRG weight,56037,,"22,541 x DRG weight",56037,Other,base rate x DRG weight,79778,,"32,091 x DRG weight",79778,Other,base rate x DRG weight,71801,,"28,882 x DRG weight",71801,Other,base rate x DRG weight,67811,,"27,277 x DRG weight",67811,Other,base rate x DRG weight,59863,,"24,080 x DRG weight",59863,Other,base rate x DRG weight,55843,,"22,463 x DRG weight",55843,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,65695,,"26,426 x DRG weight",65695,Other,base rate x DRG weight,96479,,"38,809 x DRG weight",96479,Other,base rate x DRG weight,96479,,"38,809 x DRG weight",96479,Other,base rate x DRG weight,65695,,"26,426 x DRG weight",65695,Other,base rate x DRG weight,96479,,"38,809 x DRG weight",96479,Other,base rate x DRG weight,37542,,"6,363 x patient days",37542,Per diem,,191259,70,,191259,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,62292,,"25,057 x DRG weight",62292,Other,base rate x DRG weight,56064,,"22,552 x DRG weight",56064,Other,base rate x DRG weight,62292,,"25,057 x DRG weight",62292,Other,base rate x DRG weight,52947,,"21,298 x DRG weight",52947,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,191259,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,,inpatient,,,111288.85,23037,,,23037,Other,150% of Medicare + 9.63% HCRA Surcharge,14008.64,,,14008.64,Other,Medicare IPPS methodology,40955,,"25,046 x DRG weight",40955,Other,base rate x DRG weight,36859,,"22,541 x DRG weight",36859,Other,base rate x DRG weight,52475,,"32,091 x DRG weight",52475,Other,base rate x DRG weight,47228,,"28,882 x DRG weight",47228,Other,base rate x DRG weight,44603,,"27,277 x DRG weight",44603,Other,base rate x DRG weight,39376,,"24,080 x DRG weight",39376,Other,base rate x DRG weight,36731,,"22,463 x DRG weight",36731,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,43212,,"26,426 x DRG weight",43212,Other,base rate x DRG weight,63460,,"38,809 x DRG weight",63460,Other,base rate x DRG weight,63460,,"38,809 x DRG weight",63460,Other,base rate x DRG weight,43212,,"26,426 x DRG weight",43212,Other,base rate x DRG weight,63460,,"38,809 x DRG weight",63460,Other,base rate x DRG weight,15908,,"6,363 x patient days",15908,Per diem,,77902,70,,77902,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,40973,,"25,057 x DRG weight",40973,Other,base rate x DRG weight,36877,,"22,552 x DRG weight",36877,Other,base rate x DRG weight,40973,,"25,057 x DRG weight",40973,Other,base rate x DRG weight,34826,,"21,298 x DRG weight",34826,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,77902,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,,inpatient,,,493854.01,46993,,,46993,Other,150% of Medicare + 9.63% HCRA Surcharge,28576.43,,,28576.43,Other,Medicare IPPS methodology,84573,,"25,046 x DRG weight",84573,Other,base rate x DRG weight,76114,,"22,541 x DRG weight",76114,Other,base rate x DRG weight,108362,,"32,091 x DRG weight",108362,Other,base rate x DRG weight,97526,,"28,882 x DRG weight",97526,Other,base rate x DRG weight,92106,,"27,277 x DRG weight",92106,Other,base rate x DRG weight,81311,,"24,080 x DRG weight",81311,Other,base rate x DRG weight,75851,,"22,463 x DRG weight",75851,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,89233,,"26,426 x DRG weight",89233,Other,base rate x DRG weight,131046,,"38,809 x DRG weight",131046,Other,base rate x DRG weight,131046,,"38,809 x DRG weight",131046,Other,base rate x DRG weight,89233,,"26,426 x DRG weight",89233,Other,base rate x DRG weight,131046,,"38,809 x DRG weight",131046,Other,base rate x DRG weight,72538,,"6,363 x patient days",72538,Per diem,,345698,70,,345698,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,84610,,"25,057 x DRG weight",84610,Other,base rate x DRG weight,76151,,"22,552 x DRG weight",76151,Other,base rate x DRG weight,84610,,"25,057 x DRG weight",84610,Other,base rate x DRG weight,71917,,"21,298 x DRG weight",71917,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,345698,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,,inpatient,,,272581.15,23887,,,23887,Other,150% of Medicare + 9.63% HCRA Surcharge,14525.61,,,14525.61,Other,Medicare IPPS methodology,42503,,"25,046 x DRG weight",42503,Other,base rate x DRG weight,38252,,"22,541 x DRG weight",38252,Other,base rate x DRG weight,54458,,"32,091 x DRG weight",54458,Other,base rate x DRG weight,49013,,"28,882 x DRG weight",49013,Other,base rate x DRG weight,46289,,"27,277 x DRG weight",46289,Other,base rate x DRG weight,40864,,"24,080 x DRG weight",40864,Other,base rate x DRG weight,38120,,"22,463 x DRG weight",38120,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,44845,,"26,426 x DRG weight",44845,Other,base rate x DRG weight,65859,,"38,809 x DRG weight",65859,Other,base rate x DRG weight,65859,,"38,809 x DRG weight",65859,Other,base rate x DRG weight,44845,,"26,426 x DRG weight",44845,Other,base rate x DRG weight,65859,,"38,809 x DRG weight",65859,Other,base rate x DRG weight,37542,,"6,363 x patient days",37542,Per diem,,190807,70,,190807,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,42522,,"25,057 x DRG weight",42522,Other,base rate x DRG weight,38271,,"22,552 x DRG weight",38271,Other,base rate x DRG weight,42522,,"25,057 x DRG weight",42522,Other,base rate x DRG weight,36143,,"21,298 x DRG weight",36143,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,190807,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,,inpatient,,,110395.47,15403,,,15403,Other,150% of Medicare + 9.63% HCRA Surcharge,9366.86,,,9366.86,Other,Medicare IPPS methodology,27057,,"25,046 x DRG weight",27057,Other,base rate x DRG weight,24351,,"22,541 x DRG weight",24351,Other,base rate x DRG weight,34668,,"32,091 x DRG weight",34668,Other,base rate x DRG weight,31201,,"28,882 x DRG weight",31201,Other,base rate x DRG weight,29467,,"27,277 x DRG weight",29467,Other,base rate x DRG weight,26014,,"24,080 x DRG weight",26014,Other,base rate x DRG weight,24267,,"22,463 x DRG weight",24267,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,28548,,"26,426 x DRG weight",28548,Other,base rate x DRG weight,41925,,"38,809 x DRG weight",41925,Other,base rate x DRG weight,41925,,"38,809 x DRG weight",41925,Other,base rate x DRG weight,28548,,"26,426 x DRG weight",28548,Other,base rate x DRG weight,41925,,"38,809 x DRG weight",41925,Other,base rate x DRG weight,19089,,"6,363 x patient days",19089,Per diem,,77277,70,,77277,Percent of Total Billed Charges,,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,27069,,"25,057 x DRG weight",27069,Other,base rate x DRG weight,24363,,"22,552 x DRG weight",24363,Other,base rate x DRG weight,27069,,"25,057 x DRG weight",27069,Other,base rate x DRG weight,23008,,"21,298 x DRG weight",23008,Other,base rate x DRG weight,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,,,0.01,Other,See APR-DRG information,0.01,77277,
Tracheostomy w MV 96+ hours w extensive procedure or ECMO,004-1,APR-DRG,,,,,,,,inpatient,,,578945.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,85785,,186% x Medicaid HMO amount,85785,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,198650,,"27,634 x DRG Weight",198650,Other,DRG Base Rate x DRG Weight,168846,,"23,488 x DRG Weight",168846,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46121.21,,DRG base rate x DRG weight + capital per discharge,46121.21,Other,100% of NY Medicaid HMO DRG,46121,,DRG base rate x DRG weight + capital per discharge,46121,Other,100% of NY Medicaid HMO DRG,46121,,DRG base rate x DRG weight + capital per discharge,46121,Other,100% of NY Medicaid HMO DRG,46121,,DRG base rate x DRG weight + capital per discharge,46121,Other,100% of NY Medicaid HMO DRG,103773,,225% x Medicaid HMO amount,103773,Other,225% of NY Medicaid HMO DRG,70565,,153% x Medicaid HMO amount,70565,Other,153% of NY Medicaid HMO DRG,103773,,225% x Medicaid HMO amount,103773,Other,225% of NY Medicaid HMO DRG,64570,,140% x Medicaid HMO amount,64570,Other,140% of NY Medicaid HMO DRG,103773,,DRG base rate x DRG weight + capital per discharge,103773,Other,225% of NY Medicaid HMO DRG,126833,,275% x Medicaid HMO amount,126833,Other,275% of NY Medicaid HMO DRG,149433,,324% x Medicaid HMO amount,149433,Other,324% of NY Medicaid HMO DRG,99161,,215% x Medicaid HMO amount,99161,Other,215% of NY Medicaid HMO DRG,99161,,215% x Medicaid HMO amount,99161,Other,215% of NY Medicaid HMO DRG,57652,,125% x Medicaid HMO amount,57652,Other,125% of NY Medicaid HMO DRG,0.01,198650,
Tracheostomy w MV 96+ hours w extensive procedure or ECMO,004-2,APR-DRG,,,,,,,,inpatient,,,578945.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,85785,,186% x Medicaid HMO amount,85785,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,198650,,"27,634 x DRG Weight",198650,Other,DRG Base Rate x DRG Weight,168846,,"23,488 x DRG Weight",168846,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46121.21,,DRG base rate x DRG weight + capital per discharge,46121.21,Other,100% of NY Medicaid HMO DRG,46121,,DRG base rate x DRG weight + capital per discharge,46121,Other,100% of NY Medicaid HMO DRG,46121,,DRG base rate x DRG weight + capital per discharge,46121,Other,100% of NY Medicaid HMO DRG,46121,,DRG base rate x DRG weight + capital per discharge,46121,Other,100% of NY Medicaid HMO DRG,103773,,225% x Medicaid HMO amount,103773,Other,225% of NY Medicaid HMO DRG,70565,,153% x Medicaid HMO amount,70565,Other,153% of NY Medicaid HMO DRG,103773,,225% x Medicaid HMO amount,103773,Other,225% of NY Medicaid HMO DRG,64570,,140% x Medicaid HMO amount,64570,Other,140% of NY Medicaid HMO DRG,103773,,DRG base rate x DRG weight + capital per discharge,103773,Other,225% of NY Medicaid HMO DRG,126833,,275% x Medicaid HMO amount,126833,Other,275% of NY Medicaid HMO DRG,149433,,324% x Medicaid HMO amount,149433,Other,324% of NY Medicaid HMO DRG,99161,,215% x Medicaid HMO amount,99161,Other,215% of NY Medicaid HMO DRG,99161,,215% x Medicaid HMO amount,99161,Other,215% of NY Medicaid HMO DRG,57652,,125% x Medicaid HMO amount,57652,Other,125% of NY Medicaid HMO DRG,0.01,198650,
Tracheostomy w MV 96+ hours w extensive procedure or ECMO,004-3,APR-DRG,,,,,,,,inpatient,,,1276065.57,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,119823,,186% x Medicaid HMO amount,119823,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,278291,,"27,634 x DRG Weight",278291,Other,DRG Base Rate x DRG Weight,236538,,"23,488 x DRG Weight",236538,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64421.21,,DRG base rate x DRG weight + capital per discharge,64421.21,Other,100% of NY Medicaid HMO DRG,64421,,DRG base rate x DRG weight + capital per discharge,64421,Other,100% of NY Medicaid HMO DRG,64421,,DRG base rate x DRG weight + capital per discharge,64421,Other,100% of NY Medicaid HMO DRG,64421,,DRG base rate x DRG weight + capital per discharge,64421,Other,100% of NY Medicaid HMO DRG,144948,,225% x Medicaid HMO amount,144948,Other,225% of NY Medicaid HMO DRG,98564,,153% x Medicaid HMO amount,98564,Other,153% of NY Medicaid HMO DRG,144948,,225% x Medicaid HMO amount,144948,Other,225% of NY Medicaid HMO DRG,90190,,140% x Medicaid HMO amount,90190,Other,140% of NY Medicaid HMO DRG,144948,,DRG base rate x DRG weight + capital per discharge,144948,Other,225% of NY Medicaid HMO DRG,177158,,275% x Medicaid HMO amount,177158,Other,275% of NY Medicaid HMO DRG,208725,,324% x Medicaid HMO amount,208725,Other,324% of NY Medicaid HMO DRG,138506,,215% x Medicaid HMO amount,138506,Other,215% of NY Medicaid HMO DRG,138506,,215% x Medicaid HMO amount,138506,Other,215% of NY Medicaid HMO DRG,80527,,125% x Medicaid HMO amount,80527,Other,125% of NY Medicaid HMO DRG,0.01,278291,
Tracheostomy w MV 96+ hours w extensive procedure or ECMO,004-4,APR-DRG,,,,,,,,inpatient,,,2232524.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,214330,,186% x Medicaid HMO amount,214330,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,499404,,"27,634 x DRG Weight",499404,Other,DRG Base Rate x DRG Weight,424477,,"23,488 x DRG Weight",424477,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,115231.21,,DRG base rate x DRG weight + capital per discharge,115231.21,Other,100% of NY Medicaid HMO DRG,115231,,DRG base rate x DRG weight + capital per discharge,115231,Other,100% of NY Medicaid HMO DRG,115231,,DRG base rate x DRG weight + capital per discharge,115231,Other,100% of NY Medicaid HMO DRG,115231,,DRG base rate x DRG weight + capital per discharge,115231,Other,100% of NY Medicaid HMO DRG,259270,,225% x Medicaid HMO amount,259270,Other,225% of NY Medicaid HMO DRG,176304,,153% x Medicaid HMO amount,176304,Other,153% of NY Medicaid HMO DRG,259270,,225% x Medicaid HMO amount,259270,Other,225% of NY Medicaid HMO DRG,161324,,140% x Medicaid HMO amount,161324,Other,140% of NY Medicaid HMO DRG,259270,,DRG base rate x DRG weight + capital per discharge,259270,Other,225% of NY Medicaid HMO DRG,316886,,275% x Medicaid HMO amount,316886,Other,275% of NY Medicaid HMO DRG,373349,,324% x Medicaid HMO amount,373349,Other,324% of NY Medicaid HMO DRG,247747,,215% x Medicaid HMO amount,247747,Other,215% of NY Medicaid HMO DRG,247747,,215% x Medicaid HMO amount,247747,Other,215% of NY Medicaid HMO DRG,144039,,125% x Medicaid HMO amount,144039,Other,125% of NY Medicaid HMO DRG,0.01,499404,
Tracheostomy w MV 96+ hours w/o extensive procedure,005-1,APR-DRG,,,,,,,,inpatient,,,843405.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,68156,,186% x Medicaid HMO amount,68156,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,157406,,"27,634 x DRG Weight",157406,Other,DRG Base Rate x DRG Weight,133790,,"23,488 x DRG Weight",133790,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36643.21,,DRG base rate x DRG weight + capital per discharge,36643.21,Other,100% of NY Medicaid HMO DRG,36643,,DRG base rate x DRG weight + capital per discharge,36643,Other,100% of NY Medicaid HMO DRG,36643,,DRG base rate x DRG weight + capital per discharge,36643,Other,100% of NY Medicaid HMO DRG,36643,,DRG base rate x DRG weight + capital per discharge,36643,Other,100% of NY Medicaid HMO DRG,82447,,225% x Medicaid HMO amount,82447,Other,225% of NY Medicaid HMO DRG,56064,,153% x Medicaid HMO amount,56064,Other,153% of NY Medicaid HMO DRG,82447,,225% x Medicaid HMO amount,82447,Other,225% of NY Medicaid HMO DRG,51300,,140% x Medicaid HMO amount,51300,Other,140% of NY Medicaid HMO DRG,82447,,DRG base rate x DRG weight + capital per discharge,82447,Other,225% of NY Medicaid HMO DRG,100769,,275% x Medicaid HMO amount,100769,Other,275% of NY Medicaid HMO DRG,118724,,324% x Medicaid HMO amount,118724,Other,324% of NY Medicaid HMO DRG,78783,,215% x Medicaid HMO amount,78783,Other,215% of NY Medicaid HMO DRG,78783,,215% x Medicaid HMO amount,78783,Other,215% of NY Medicaid HMO DRG,45804,,125% x Medicaid HMO amount,45804,Other,125% of NY Medicaid HMO DRG,0.01,157406,
Tracheostomy w MV 96+ hours w/o extensive procedure,005-2,APR-DRG,,,,,,,,inpatient,,,843405.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69899,,186% x Medicaid HMO amount,69899,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,161482,,"27,634 x DRG Weight",161482,Other,DRG Base Rate x DRG Weight,137254,,"23,488 x DRG Weight",137254,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37580.21,,DRG base rate x DRG weight + capital per discharge,37580.21,Other,100% of NY Medicaid HMO DRG,37580,,DRG base rate x DRG weight + capital per discharge,37580,Other,100% of NY Medicaid HMO DRG,37580,,DRG base rate x DRG weight + capital per discharge,37580,Other,100% of NY Medicaid HMO DRG,37580,,DRG base rate x DRG weight + capital per discharge,37580,Other,100% of NY Medicaid HMO DRG,84555,,225% x Medicaid HMO amount,84555,Other,225% of NY Medicaid HMO DRG,57498,,153% x Medicaid HMO amount,57498,Other,153% of NY Medicaid HMO DRG,84555,,225% x Medicaid HMO amount,84555,Other,225% of NY Medicaid HMO DRG,52612,,140% x Medicaid HMO amount,52612,Other,140% of NY Medicaid HMO DRG,84555,,DRG base rate x DRG weight + capital per discharge,84555,Other,225% of NY Medicaid HMO DRG,103346,,275% x Medicaid HMO amount,103346,Other,275% of NY Medicaid HMO DRG,121760,,324% x Medicaid HMO amount,121760,Other,324% of NY Medicaid HMO DRG,80797,,215% x Medicaid HMO amount,80797,Other,215% of NY Medicaid HMO DRG,80797,,215% x Medicaid HMO amount,80797,Other,215% of NY Medicaid HMO DRG,46975,,125% x Medicaid HMO amount,46975,Other,125% of NY Medicaid HMO DRG,0.01,161482,
Tracheostomy w MV 96+ hours w/o extensive procedure,005-3,APR-DRG,,,,,,,,inpatient,,,1220871.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,109928,,186% x Medicaid HMO amount,109928,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,255136,,"27,634 x DRG Weight",255136,Other,DRG Base Rate x DRG Weight,216858,,"23,488 x DRG Weight",216858,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59101.21,,DRG base rate x DRG weight + capital per discharge,59101.21,Other,100% of NY Medicaid HMO DRG,59101,,DRG base rate x DRG weight + capital per discharge,59101,Other,100% of NY Medicaid HMO DRG,59101,,DRG base rate x DRG weight + capital per discharge,59101,Other,100% of NY Medicaid HMO DRG,59101,,DRG base rate x DRG weight + capital per discharge,59101,Other,100% of NY Medicaid HMO DRG,132978,,225% x Medicaid HMO amount,132978,Other,225% of NY Medicaid HMO DRG,90425,,153% x Medicaid HMO amount,90425,Other,153% of NY Medicaid HMO DRG,132978,,225% x Medicaid HMO amount,132978,Other,225% of NY Medicaid HMO DRG,82742,,140% x Medicaid HMO amount,82742,Other,140% of NY Medicaid HMO DRG,132978,,DRG base rate x DRG weight + capital per discharge,132978,Other,225% of NY Medicaid HMO DRG,162528,,275% x Medicaid HMO amount,162528,Other,275% of NY Medicaid HMO DRG,191488,,324% x Medicaid HMO amount,191488,Other,324% of NY Medicaid HMO DRG,127068,,215% x Medicaid HMO amount,127068,Other,215% of NY Medicaid HMO DRG,127068,,215% x Medicaid HMO amount,127068,Other,215% of NY Medicaid HMO DRG,73877,,125% x Medicaid HMO amount,73877,Other,125% of NY Medicaid HMO DRG,0.01,255136,
Tracheostomy w MV 96+ hours w/o extensive procedure,005-4,APR-DRG,,,,,,,,inpatient,,,1735098.49,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,163747,,186% x Medicaid HMO amount,163747,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,381059,,"27,634 x DRG Weight",381059,Other,DRG Base Rate x DRG Weight,323888,,"23,488 x DRG Weight",323888,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,88036.21,,DRG base rate x DRG weight + capital per discharge,88036.21,Other,100% of NY Medicaid HMO DRG,88036,,DRG base rate x DRG weight + capital per discharge,88036,Other,100% of NY Medicaid HMO DRG,88036,,DRG base rate x DRG weight + capital per discharge,88036,Other,100% of NY Medicaid HMO DRG,88036,,DRG base rate x DRG weight + capital per discharge,88036,Other,100% of NY Medicaid HMO DRG,198081,,225% x Medicaid HMO amount,198081,Other,225% of NY Medicaid HMO DRG,134695,,153% x Medicaid HMO amount,134695,Other,153% of NY Medicaid HMO DRG,198081,,225% x Medicaid HMO amount,198081,Other,225% of NY Medicaid HMO DRG,123251,,140% x Medicaid HMO amount,123251,Other,140% of NY Medicaid HMO DRG,198081,,DRG base rate x DRG weight + capital per discharge,198081,Other,225% of NY Medicaid HMO DRG,242100,,275% x Medicaid HMO amount,242100,Other,275% of NY Medicaid HMO DRG,285237,,324% x Medicaid HMO amount,285237,Other,324% of NY Medicaid HMO DRG,189278,,215% x Medicaid HMO amount,189278,Other,215% of NY Medicaid HMO DRG,189278,,215% x Medicaid HMO amount,189278,Other,215% of NY Medicaid HMO DRG,110045,,125% x Medicaid HMO amount,110045,Other,125% of NY Medicaid HMO DRG,0.01,381059,
Craniotomy for trauma,020-1,APR-DRG,,,,,,,,inpatient,,,172052.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21968,,186% x Medicaid HMO amount,21968,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49343,,"27,634 x DRG Weight",49343,Other,DRG Base Rate x DRG Weight,41940,,"23,488 x DRG Weight",41940,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11811.21,,DRG base rate x DRG weight + capital per discharge,11811.21,Other,100% of NY Medicaid HMO DRG,11811,,DRG base rate x DRG weight + capital per discharge,11811,Other,100% of NY Medicaid HMO DRG,11811,,DRG base rate x DRG weight + capital per discharge,11811,Other,100% of NY Medicaid HMO DRG,11811,,DRG base rate x DRG weight + capital per discharge,11811,Other,100% of NY Medicaid HMO DRG,26575,,225% x Medicaid HMO amount,26575,Other,225% of NY Medicaid HMO DRG,18071,,153% x Medicaid HMO amount,18071,Other,153% of NY Medicaid HMO DRG,26575,,225% x Medicaid HMO amount,26575,Other,225% of NY Medicaid HMO DRG,16536,,140% x Medicaid HMO amount,16536,Other,140% of NY Medicaid HMO DRG,26575,,DRG base rate x DRG weight + capital per discharge,26575,Other,225% of NY Medicaid HMO DRG,32481,,275% x Medicaid HMO amount,32481,Other,275% of NY Medicaid HMO DRG,38268,,324% x Medicaid HMO amount,38268,Other,324% of NY Medicaid HMO DRG,25394,,215% x Medicaid HMO amount,25394,Other,215% of NY Medicaid HMO DRG,25394,,215% x Medicaid HMO amount,25394,Other,215% of NY Medicaid HMO DRG,14764,,125% x Medicaid HMO amount,14764,Other,125% of NY Medicaid HMO DRG,0.01,49343,
Craniotomy for trauma,020-2,APR-DRG,,,,,,,,inpatient,,,193932.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27519,,186% x Medicaid HMO amount,27519,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62326,,"27,634 x DRG Weight",62326,Other,DRG Base Rate x DRG Weight,52975,,"23,488 x DRG Weight",52975,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14795.21,,DRG base rate x DRG weight + capital per discharge,14795.21,Other,100% of NY Medicaid HMO DRG,14795,,DRG base rate x DRG weight + capital per discharge,14795,Other,100% of NY Medicaid HMO DRG,14795,,DRG base rate x DRG weight + capital per discharge,14795,Other,100% of NY Medicaid HMO DRG,14795,,DRG base rate x DRG weight + capital per discharge,14795,Other,100% of NY Medicaid HMO DRG,33289,,225% x Medicaid HMO amount,33289,Other,225% of NY Medicaid HMO DRG,22637,,153% x Medicaid HMO amount,22637,Other,153% of NY Medicaid HMO DRG,33289,,225% x Medicaid HMO amount,33289,Other,225% of NY Medicaid HMO DRG,20713,,140% x Medicaid HMO amount,20713,Other,140% of NY Medicaid HMO DRG,33289,,DRG base rate x DRG weight + capital per discharge,33289,Other,225% of NY Medicaid HMO DRG,40687,,275% x Medicaid HMO amount,40687,Other,275% of NY Medicaid HMO DRG,47936,,324% x Medicaid HMO amount,47936,Other,324% of NY Medicaid HMO DRG,31810,,215% x Medicaid HMO amount,31810,Other,215% of NY Medicaid HMO DRG,31810,,215% x Medicaid HMO amount,31810,Other,215% of NY Medicaid HMO DRG,18494,,125% x Medicaid HMO amount,18494,Other,125% of NY Medicaid HMO DRG,0.01,62326,
Craniotomy for trauma,020-3,APR-DRG,,,,,,,,inpatient,,,496264.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42719,,186% x Medicaid HMO amount,42719,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,97891,,"27,634 x DRG Weight",97891,Other,DRG Base Rate x DRG Weight,83204,,"23,488 x DRG Weight",83204,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22967.21,,DRG base rate x DRG weight + capital per discharge,22967.21,Other,100% of NY Medicaid HMO DRG,22967,,DRG base rate x DRG weight + capital per discharge,22967,Other,100% of NY Medicaid HMO DRG,22967,,DRG base rate x DRG weight + capital per discharge,22967,Other,100% of NY Medicaid HMO DRG,22967,,DRG base rate x DRG weight + capital per discharge,22967,Other,100% of NY Medicaid HMO DRG,51676,,225% x Medicaid HMO amount,51676,Other,225% of NY Medicaid HMO DRG,35140,,153% x Medicaid HMO amount,35140,Other,153% of NY Medicaid HMO DRG,51676,,225% x Medicaid HMO amount,51676,Other,225% of NY Medicaid HMO DRG,32154,,140% x Medicaid HMO amount,32154,Other,140% of NY Medicaid HMO DRG,51676,,DRG base rate x DRG weight + capital per discharge,51676,Other,225% of NY Medicaid HMO DRG,63160,,275% x Medicaid HMO amount,63160,Other,275% of NY Medicaid HMO DRG,74414,,324% x Medicaid HMO amount,74414,Other,324% of NY Medicaid HMO DRG,49380,,215% x Medicaid HMO amount,49380,Other,215% of NY Medicaid HMO DRG,49380,,215% x Medicaid HMO amount,49380,Other,215% of NY Medicaid HMO DRG,28709,,125% x Medicaid HMO amount,28709,Other,125% of NY Medicaid HMO DRG,0.01,97891,
Craniotomy for trauma,020-4,APR-DRG,,,,,,,,inpatient,,,914478.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,79894,,186% x Medicaid HMO amount,79894,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,184871,,"27,634 x DRG Weight",184871,Other,DRG Base Rate x DRG Weight,157135,,"23,488 x DRG Weight",157135,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42954.21,,DRG base rate x DRG weight + capital per discharge,42954.21,Other,100% of NY Medicaid HMO DRG,42954,,DRG base rate x DRG weight + capital per discharge,42954,Other,100% of NY Medicaid HMO DRG,42954,,DRG base rate x DRG weight + capital per discharge,42954,Other,100% of NY Medicaid HMO DRG,42954,,DRG base rate x DRG weight + capital per discharge,42954,Other,100% of NY Medicaid HMO DRG,96647,,225% x Medicaid HMO amount,96647,Other,225% of NY Medicaid HMO DRG,65720,,153% x Medicaid HMO amount,65720,Other,153% of NY Medicaid HMO DRG,96647,,225% x Medicaid HMO amount,96647,Other,225% of NY Medicaid HMO DRG,60136,,140% x Medicaid HMO amount,60136,Other,140% of NY Medicaid HMO DRG,96647,,DRG base rate x DRG weight + capital per discharge,96647,Other,225% of NY Medicaid HMO DRG,118124,,275% x Medicaid HMO amount,118124,Other,275% of NY Medicaid HMO DRG,139172,,324% x Medicaid HMO amount,139172,Other,324% of NY Medicaid HMO DRG,92352,,215% x Medicaid HMO amount,92352,Other,215% of NY Medicaid HMO DRG,92352,,215% x Medicaid HMO amount,92352,Other,215% of NY Medicaid HMO DRG,53693,,125% x Medicaid HMO amount,53693,Other,125% of NY Medicaid HMO DRG,0.01,184871,
Craniotomy except for trauma,021-1,APR-DRG,,,,,,,,inpatient,,,289033.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23250,,186% x Medicaid HMO amount,23250,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,52342,,"27,634 x DRG Weight",52342,Other,DRG Base Rate x DRG Weight,44489,,"23,488 x DRG Weight",44489,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12500.21,,DRG base rate x DRG weight + capital per discharge,12500.21,Other,100% of NY Medicaid HMO DRG,12500,,DRG base rate x DRG weight + capital per discharge,12500,Other,100% of NY Medicaid HMO DRG,12500,,DRG base rate x DRG weight + capital per discharge,12500,Other,100% of NY Medicaid HMO DRG,12500,,DRG base rate x DRG weight + capital per discharge,12500,Other,100% of NY Medicaid HMO DRG,28125,,225% x Medicaid HMO amount,28125,Other,225% of NY Medicaid HMO DRG,19125,,153% x Medicaid HMO amount,19125,Other,153% of NY Medicaid HMO DRG,28125,,225% x Medicaid HMO amount,28125,Other,225% of NY Medicaid HMO DRG,17500,,140% x Medicaid HMO amount,17500,Other,140% of NY Medicaid HMO DRG,28125,,DRG base rate x DRG weight + capital per discharge,28125,Other,225% of NY Medicaid HMO DRG,34376,,275% x Medicaid HMO amount,34376,Other,275% of NY Medicaid HMO DRG,40501,,324% x Medicaid HMO amount,40501,Other,324% of NY Medicaid HMO DRG,26875,,215% x Medicaid HMO amount,26875,Other,215% of NY Medicaid HMO DRG,26875,,215% x Medicaid HMO amount,26875,Other,215% of NY Medicaid HMO DRG,15625,,125% x Medicaid HMO amount,15625,Other,125% of NY Medicaid HMO DRG,0.01,52342,
Craniotomy except for trauma,021-2,APR-DRG,,,,,,,,inpatient,,,292310.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32500,,186% x Medicaid HMO amount,32500,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73982,,"27,634 x DRG Weight",73982,Other,DRG Base Rate x DRG Weight,62882,,"23,488 x DRG Weight",62882,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17473.21,,DRG base rate x DRG weight + capital per discharge,17473.21,Other,100% of NY Medicaid HMO DRG,17473,,DRG base rate x DRG weight + capital per discharge,17473,Other,100% of NY Medicaid HMO DRG,17473,,DRG base rate x DRG weight + capital per discharge,17473,Other,100% of NY Medicaid HMO DRG,17473,,DRG base rate x DRG weight + capital per discharge,17473,Other,100% of NY Medicaid HMO DRG,39315,,225% x Medicaid HMO amount,39315,Other,225% of NY Medicaid HMO DRG,26734,,153% x Medicaid HMO amount,26734,Other,153% of NY Medicaid HMO DRG,39315,,225% x Medicaid HMO amount,39315,Other,225% of NY Medicaid HMO DRG,24462,,140% x Medicaid HMO amount,24462,Other,140% of NY Medicaid HMO DRG,39315,,DRG base rate x DRG weight + capital per discharge,39315,Other,225% of NY Medicaid HMO DRG,48051,,275% x Medicaid HMO amount,48051,Other,275% of NY Medicaid HMO DRG,56613,,324% x Medicaid HMO amount,56613,Other,324% of NY Medicaid HMO DRG,37567,,215% x Medicaid HMO amount,37567,Other,215% of NY Medicaid HMO DRG,37567,,215% x Medicaid HMO amount,37567,Other,215% of NY Medicaid HMO DRG,21842,,125% x Medicaid HMO amount,21842,Other,125% of NY Medicaid HMO DRG,0.01,73982,
Craniotomy except for trauma,021-3,APR-DRG,,,,,,,,inpatient,,,429083.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,52043,,186% x Medicaid HMO amount,52043,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,119708,,"27,634 x DRG Weight",119708,Other,DRG Base Rate x DRG Weight,101748,,"23,488 x DRG Weight",101748,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27980.21,,DRG base rate x DRG weight + capital per discharge,27980.21,Other,100% of NY Medicaid HMO DRG,27980,,DRG base rate x DRG weight + capital per discharge,27980,Other,100% of NY Medicaid HMO DRG,27980,,DRG base rate x DRG weight + capital per discharge,27980,Other,100% of NY Medicaid HMO DRG,27980,,DRG base rate x DRG weight + capital per discharge,27980,Other,100% of NY Medicaid HMO DRG,62955,,225% x Medicaid HMO amount,62955,Other,225% of NY Medicaid HMO DRG,42810,,153% x Medicaid HMO amount,42810,Other,153% of NY Medicaid HMO DRG,62955,,225% x Medicaid HMO amount,62955,Other,225% of NY Medicaid HMO DRG,39172,,140% x Medicaid HMO amount,39172,Other,140% of NY Medicaid HMO DRG,62955,,DRG base rate x DRG weight + capital per discharge,62955,Other,225% of NY Medicaid HMO DRG,76946,,275% x Medicaid HMO amount,76946,Other,275% of NY Medicaid HMO DRG,90656,,324% x Medicaid HMO amount,90656,Other,324% of NY Medicaid HMO DRG,60157,,215% x Medicaid HMO amount,60157,Other,215% of NY Medicaid HMO DRG,60157,,215% x Medicaid HMO amount,60157,Other,215% of NY Medicaid HMO DRG,34975,,125% x Medicaid HMO amount,34975,Other,125% of NY Medicaid HMO DRG,0.01,119708,
Craniotomy except for trauma,021-4,APR-DRG,,,,,,,,inpatient,,,747089.04,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86408,,186% x Medicaid HMO amount,86408,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,200109,,"27,634 x DRG Weight",200109,Other,DRG Base Rate x DRG Weight,170086,,"23,488 x DRG Weight",170086,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46456.21,,DRG base rate x DRG weight + capital per discharge,46456.21,Other,100% of NY Medicaid HMO DRG,46456,,DRG base rate x DRG weight + capital per discharge,46456,Other,100% of NY Medicaid HMO DRG,46456,,DRG base rate x DRG weight + capital per discharge,46456,Other,100% of NY Medicaid HMO DRG,46456,,DRG base rate x DRG weight + capital per discharge,46456,Other,100% of NY Medicaid HMO DRG,104526,,225% x Medicaid HMO amount,104526,Other,225% of NY Medicaid HMO DRG,71078,,153% x Medicaid HMO amount,71078,Other,153% of NY Medicaid HMO DRG,104526,,225% x Medicaid HMO amount,104526,Other,225% of NY Medicaid HMO DRG,65039,,140% x Medicaid HMO amount,65039,Other,140% of NY Medicaid HMO DRG,104526,,DRG base rate x DRG weight + capital per discharge,104526,Other,225% of NY Medicaid HMO DRG,127755,,275% x Medicaid HMO amount,127755,Other,275% of NY Medicaid HMO DRG,150518,,324% x Medicaid HMO amount,150518,Other,324% of NY Medicaid HMO DRG,99881,,215% x Medicaid HMO amount,99881,Other,215% of NY Medicaid HMO DRG,99881,,215% x Medicaid HMO amount,99881,Other,215% of NY Medicaid HMO DRG,58070,,125% x Medicaid HMO amount,58070,Other,125% of NY Medicaid HMO DRG,0.01,200109,
Ventricular shunt procedures,022-1,APR-DRG,,,,,,,,inpatient,,,202387.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15936,,186% x Medicaid HMO amount,15936,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35228,,"27,634 x DRG Weight",35228,Other,DRG Base Rate x DRG Weight,29943,,"23,488 x DRG Weight",29943,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8568.21,,DRG base rate x DRG weight + capital per discharge,8568.21,Other,100% of NY Medicaid HMO DRG,8568,,DRG base rate x DRG weight + capital per discharge,8568,Other,100% of NY Medicaid HMO DRG,8568,,DRG base rate x DRG weight + capital per discharge,8568,Other,100% of NY Medicaid HMO DRG,8568,,DRG base rate x DRG weight + capital per discharge,8568,Other,100% of NY Medicaid HMO DRG,19278,,225% x Medicaid HMO amount,19278,Other,225% of NY Medicaid HMO DRG,13109,,153% x Medicaid HMO amount,13109,Other,153% of NY Medicaid HMO DRG,19278,,225% x Medicaid HMO amount,19278,Other,225% of NY Medicaid HMO DRG,11995,,140% x Medicaid HMO amount,11995,Other,140% of NY Medicaid HMO DRG,19278,,DRG base rate x DRG weight + capital per discharge,19278,Other,225% of NY Medicaid HMO DRG,23563,,275% x Medicaid HMO amount,23563,Other,275% of NY Medicaid HMO DRG,27761,,324% x Medicaid HMO amount,27761,Other,324% of NY Medicaid HMO DRG,18422,,215% x Medicaid HMO amount,18422,Other,215% of NY Medicaid HMO DRG,18422,,215% x Medicaid HMO amount,18422,Other,215% of NY Medicaid HMO DRG,10710,,125% x Medicaid HMO amount,10710,Other,125% of NY Medicaid HMO DRG,0.01,35228,
Ventricular shunt procedures,022-2,APR-DRG,,,,,,,,inpatient,,,268233.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20131,,186% x Medicaid HMO amount,20131,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45043,,"27,634 x DRG Weight",45043,Other,DRG Base Rate x DRG Weight,38285,,"23,488 x DRG Weight",38285,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10823.21,,DRG base rate x DRG weight + capital per discharge,10823.21,Other,100% of NY Medicaid HMO DRG,10823,,DRG base rate x DRG weight + capital per discharge,10823,Other,100% of NY Medicaid HMO DRG,10823,,DRG base rate x DRG weight + capital per discharge,10823,Other,100% of NY Medicaid HMO DRG,10823,,DRG base rate x DRG weight + capital per discharge,10823,Other,100% of NY Medicaid HMO DRG,24352,,225% x Medicaid HMO amount,24352,Other,225% of NY Medicaid HMO DRG,16560,,153% x Medicaid HMO amount,16560,Other,153% of NY Medicaid HMO DRG,24352,,225% x Medicaid HMO amount,24352,Other,225% of NY Medicaid HMO DRG,15152,,140% x Medicaid HMO amount,15152,Other,140% of NY Medicaid HMO DRG,24352,,DRG base rate x DRG weight + capital per discharge,24352,Other,225% of NY Medicaid HMO DRG,29764,,275% x Medicaid HMO amount,29764,Other,275% of NY Medicaid HMO DRG,35067,,324% x Medicaid HMO amount,35067,Other,324% of NY Medicaid HMO DRG,23270,,215% x Medicaid HMO amount,23270,Other,215% of NY Medicaid HMO DRG,23270,,215% x Medicaid HMO amount,23270,Other,215% of NY Medicaid HMO DRG,13529,,125% x Medicaid HMO amount,13529,Other,125% of NY Medicaid HMO DRG,0.01,45043,
Ventricular shunt procedures,022-3,APR-DRG,,,,,,,,inpatient,,,234390.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32438,,186% x Medicaid HMO amount,32438,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73838,,"27,634 x DRG Weight",73838,Other,DRG Base Rate x DRG Weight,62760,,"23,488 x DRG Weight",62760,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17440.21,,DRG base rate x DRG weight + capital per discharge,17440.21,Other,100% of NY Medicaid HMO DRG,17440,,DRG base rate x DRG weight + capital per discharge,17440,Other,100% of NY Medicaid HMO DRG,17440,,DRG base rate x DRG weight + capital per discharge,17440,Other,100% of NY Medicaid HMO DRG,17440,,DRG base rate x DRG weight + capital per discharge,17440,Other,100% of NY Medicaid HMO DRG,39240,,225% x Medicaid HMO amount,39240,Other,225% of NY Medicaid HMO DRG,26684,,153% x Medicaid HMO amount,26684,Other,153% of NY Medicaid HMO DRG,39240,,225% x Medicaid HMO amount,39240,Other,225% of NY Medicaid HMO DRG,24416,,140% x Medicaid HMO amount,24416,Other,140% of NY Medicaid HMO DRG,39240,,DRG base rate x DRG weight + capital per discharge,39240,Other,225% of NY Medicaid HMO DRG,47961,,275% x Medicaid HMO amount,47961,Other,275% of NY Medicaid HMO DRG,56506,,324% x Medicaid HMO amount,56506,Other,324% of NY Medicaid HMO DRG,37496,,215% x Medicaid HMO amount,37496,Other,215% of NY Medicaid HMO DRG,37496,,215% x Medicaid HMO amount,37496,Other,215% of NY Medicaid HMO DRG,21800,,125% x Medicaid HMO amount,21800,Other,125% of NY Medicaid HMO DRG,0.01,73838,
Ventricular shunt procedures,022-4,APR-DRG,,,,,,,,inpatient,,,1031318.43,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64512,,186% x Medicaid HMO amount,64512,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,148878,,"27,634 x DRG Weight",148878,Other,DRG Base Rate x DRG Weight,126542,,"23,488 x DRG Weight",126542,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34684.21,,DRG base rate x DRG weight + capital per discharge,34684.21,Other,100% of NY Medicaid HMO DRG,34684,,DRG base rate x DRG weight + capital per discharge,34684,Other,100% of NY Medicaid HMO DRG,34684,,DRG base rate x DRG weight + capital per discharge,34684,Other,100% of NY Medicaid HMO DRG,34684,,DRG base rate x DRG weight + capital per discharge,34684,Other,100% of NY Medicaid HMO DRG,78039,,225% x Medicaid HMO amount,78039,Other,225% of NY Medicaid HMO DRG,53067,,153% x Medicaid HMO amount,53067,Other,153% of NY Medicaid HMO DRG,78039,,225% x Medicaid HMO amount,78039,Other,225% of NY Medicaid HMO DRG,48558,,140% x Medicaid HMO amount,48558,Other,140% of NY Medicaid HMO DRG,78039,,DRG base rate x DRG weight + capital per discharge,78039,Other,225% of NY Medicaid HMO DRG,95382,,275% x Medicaid HMO amount,95382,Other,275% of NY Medicaid HMO DRG,112377,,324% x Medicaid HMO amount,112377,Other,324% of NY Medicaid HMO DRG,74571,,215% x Medicaid HMO amount,74571,Other,215% of NY Medicaid HMO DRG,74571,,215% x Medicaid HMO amount,74571,Other,215% of NY Medicaid HMO DRG,43355,,125% x Medicaid HMO amount,43355,Other,125% of NY Medicaid HMO DRG,0.01,148878,
Spinal procedures,023-1,APR-DRG,,,,,,,,inpatient,,,164749.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20261,,186% x Medicaid HMO amount,20261,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45347,,"27,634 x DRG Weight",45347,Other,DRG Base Rate x DRG Weight,38544,,"23,488 x DRG Weight",38544,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10893.21,,DRG base rate x DRG weight + capital per discharge,10893.21,Other,100% of NY Medicaid HMO DRG,10893,,DRG base rate x DRG weight + capital per discharge,10893,Other,100% of NY Medicaid HMO DRG,10893,,DRG base rate x DRG weight + capital per discharge,10893,Other,100% of NY Medicaid HMO DRG,10893,,DRG base rate x DRG weight + capital per discharge,10893,Other,100% of NY Medicaid HMO DRG,24510,,225% x Medicaid HMO amount,24510,Other,225% of NY Medicaid HMO DRG,16667,,153% x Medicaid HMO amount,16667,Other,153% of NY Medicaid HMO DRG,24510,,225% x Medicaid HMO amount,24510,Other,225% of NY Medicaid HMO DRG,15250,,140% x Medicaid HMO amount,15250,Other,140% of NY Medicaid HMO DRG,24510,,DRG base rate x DRG weight + capital per discharge,24510,Other,225% of NY Medicaid HMO DRG,29956,,275% x Medicaid HMO amount,29956,Other,275% of NY Medicaid HMO DRG,35294,,324% x Medicaid HMO amount,35294,Other,324% of NY Medicaid HMO DRG,23420,,215% x Medicaid HMO amount,23420,Other,215% of NY Medicaid HMO DRG,23420,,215% x Medicaid HMO amount,23420,Other,215% of NY Medicaid HMO DRG,13617,,125% x Medicaid HMO amount,13617,Other,125% of NY Medicaid HMO DRG,0.01,45347,
Spinal procedures,023-2,APR-DRG,,,,,,,,inpatient,,,294874.08,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26935,,186% x Medicaid HMO amount,26935,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60961,,"27,634 x DRG Weight",60961,Other,DRG Base Rate x DRG Weight,51815,,"23,488 x DRG Weight",51815,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14481.21,,DRG base rate x DRG weight + capital per discharge,14481.21,Other,100% of NY Medicaid HMO DRG,14481,,DRG base rate x DRG weight + capital per discharge,14481,Other,100% of NY Medicaid HMO DRG,14481,,DRG base rate x DRG weight + capital per discharge,14481,Other,100% of NY Medicaid HMO DRG,14481,,DRG base rate x DRG weight + capital per discharge,14481,Other,100% of NY Medicaid HMO DRG,32583,,225% x Medicaid HMO amount,32583,Other,225% of NY Medicaid HMO DRG,22156,,153% x Medicaid HMO amount,22156,Other,153% of NY Medicaid HMO DRG,32583,,225% x Medicaid HMO amount,32583,Other,225% of NY Medicaid HMO DRG,20274,,140% x Medicaid HMO amount,20274,Other,140% of NY Medicaid HMO DRG,32583,,DRG base rate x DRG weight + capital per discharge,32583,Other,225% of NY Medicaid HMO DRG,39823,,275% x Medicaid HMO amount,39823,Other,275% of NY Medicaid HMO DRG,46919,,324% x Medicaid HMO amount,46919,Other,324% of NY Medicaid HMO DRG,31135,,215% x Medicaid HMO amount,31135,Other,215% of NY Medicaid HMO DRG,31135,,215% x Medicaid HMO amount,31135,Other,215% of NY Medicaid HMO DRG,18102,,125% x Medicaid HMO amount,18102,Other,125% of NY Medicaid HMO DRG,0.01,60961,
Spinal procedures,023-3,APR-DRG,,,,,,,,inpatient,,,550176.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51624,,186% x Medicaid HMO amount,51624,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,118727,,"27,634 x DRG Weight",118727,Other,DRG Base Rate x DRG Weight,100914,,"23,488 x DRG Weight",100914,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27755.21,,DRG base rate x DRG weight + capital per discharge,27755.21,Other,100% of NY Medicaid HMO DRG,27755,,DRG base rate x DRG weight + capital per discharge,27755,Other,100% of NY Medicaid HMO DRG,27755,,DRG base rate x DRG weight + capital per discharge,27755,Other,100% of NY Medicaid HMO DRG,27755,,DRG base rate x DRG weight + capital per discharge,27755,Other,100% of NY Medicaid HMO DRG,62449,,225% x Medicaid HMO amount,62449,Other,225% of NY Medicaid HMO DRG,42465,,153% x Medicaid HMO amount,42465,Other,153% of NY Medicaid HMO DRG,62449,,225% x Medicaid HMO amount,62449,Other,225% of NY Medicaid HMO DRG,38857,,140% x Medicaid HMO amount,38857,Other,140% of NY Medicaid HMO DRG,62449,,DRG base rate x DRG weight + capital per discharge,62449,Other,225% of NY Medicaid HMO DRG,76327,,275% x Medicaid HMO amount,76327,Other,275% of NY Medicaid HMO DRG,89927,,324% x Medicaid HMO amount,89927,Other,324% of NY Medicaid HMO DRG,59674,,215% x Medicaid HMO amount,59674,Other,215% of NY Medicaid HMO DRG,59674,,215% x Medicaid HMO amount,59674,Other,215% of NY Medicaid HMO DRG,34694,,125% x Medicaid HMO amount,34694,Other,125% of NY Medicaid HMO DRG,0.01,118727,
Spinal procedures,023-4,APR-DRG,,,,,,,,inpatient,,,309827.1,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,96337,,186% x Medicaid HMO amount,96337,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,223341,,"27,634 x DRG Weight",223341,Other,DRG Base Rate x DRG Weight,189832,,"23,488 x DRG Weight",189832,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51794.21,,DRG base rate x DRG weight + capital per discharge,51794.21,Other,100% of NY Medicaid HMO DRG,51794,,DRG base rate x DRG weight + capital per discharge,51794,Other,100% of NY Medicaid HMO DRG,51794,,DRG base rate x DRG weight + capital per discharge,51794,Other,100% of NY Medicaid HMO DRG,51794,,DRG base rate x DRG weight + capital per discharge,51794,Other,100% of NY Medicaid HMO DRG,116537,,225% x Medicaid HMO amount,116537,Other,225% of NY Medicaid HMO DRG,79245,,153% x Medicaid HMO amount,79245,Other,153% of NY Medicaid HMO DRG,116537,,225% x Medicaid HMO amount,116537,Other,225% of NY Medicaid HMO DRG,72512,,140% x Medicaid HMO amount,72512,Other,140% of NY Medicaid HMO DRG,116537,,DRG base rate x DRG weight + capital per discharge,116537,Other,225% of NY Medicaid HMO DRG,142434,,275% x Medicaid HMO amount,142434,Other,275% of NY Medicaid HMO DRG,167813,,324% x Medicaid HMO amount,167813,Other,324% of NY Medicaid HMO DRG,111358,,215% x Medicaid HMO amount,111358,Other,215% of NY Medicaid HMO DRG,111358,,215% x Medicaid HMO amount,111358,Other,215% of NY Medicaid HMO DRG,64743,,125% x Medicaid HMO amount,64743,Other,125% of NY Medicaid HMO DRG,0.01,223341,
Extracranial vascular procedures,024-1,APR-DRG,,,,,,,,inpatient,,,162208.3,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18617,,186% x Medicaid HMO amount,18617,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41498,,"27,634 x DRG Weight",41498,Other,DRG Base Rate x DRG Weight,35272,,"23,488 x DRG Weight",35272,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10009.21,,DRG base rate x DRG weight + capital per discharge,10009.21,Other,100% of NY Medicaid HMO DRG,10009,,DRG base rate x DRG weight + capital per discharge,10009,Other,100% of NY Medicaid HMO DRG,10009,,DRG base rate x DRG weight + capital per discharge,10009,Other,100% of NY Medicaid HMO DRG,10009,,DRG base rate x DRG weight + capital per discharge,10009,Other,100% of NY Medicaid HMO DRG,22521,,225% x Medicaid HMO amount,22521,Other,225% of NY Medicaid HMO DRG,15314,,153% x Medicaid HMO amount,15314,Other,153% of NY Medicaid HMO DRG,22521,,225% x Medicaid HMO amount,22521,Other,225% of NY Medicaid HMO DRG,14013,,140% x Medicaid HMO amount,14013,Other,140% of NY Medicaid HMO DRG,22521,,DRG base rate x DRG weight + capital per discharge,22521,Other,225% of NY Medicaid HMO DRG,27525,,275% x Medicaid HMO amount,27525,Other,275% of NY Medicaid HMO DRG,32430,,324% x Medicaid HMO amount,32430,Other,324% of NY Medicaid HMO DRG,21520,,215% x Medicaid HMO amount,21520,Other,215% of NY Medicaid HMO DRG,21520,,215% x Medicaid HMO amount,21520,Other,215% of NY Medicaid HMO DRG,12512,,125% x Medicaid HMO amount,12512,Other,125% of NY Medicaid HMO DRG,0.01,41498,
Extracranial vascular procedures,024-2,APR-DRG,,,,,,,,inpatient,,,330447.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26044,,186% x Medicaid HMO amount,26044,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58874,,"27,634 x DRG Weight",58874,Other,DRG Base Rate x DRG Weight,50041,,"23,488 x DRG Weight",50041,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14002.21,,DRG base rate x DRG weight + capital per discharge,14002.21,Other,100% of NY Medicaid HMO DRG,14002,,DRG base rate x DRG weight + capital per discharge,14002,Other,100% of NY Medicaid HMO DRG,14002,,DRG base rate x DRG weight + capital per discharge,14002,Other,100% of NY Medicaid HMO DRG,14002,,DRG base rate x DRG weight + capital per discharge,14002,Other,100% of NY Medicaid HMO DRG,31505,,225% x Medicaid HMO amount,31505,Other,225% of NY Medicaid HMO DRG,21423,,153% x Medicaid HMO amount,21423,Other,153% of NY Medicaid HMO DRG,31505,,225% x Medicaid HMO amount,31505,Other,225% of NY Medicaid HMO DRG,19603,,140% x Medicaid HMO amount,19603,Other,140% of NY Medicaid HMO DRG,31505,,DRG base rate x DRG weight + capital per discharge,31505,Other,225% of NY Medicaid HMO DRG,38506,,275% x Medicaid HMO amount,38506,Other,275% of NY Medicaid HMO DRG,45367,,324% x Medicaid HMO amount,45367,Other,324% of NY Medicaid HMO DRG,30105,,215% x Medicaid HMO amount,30105,Other,215% of NY Medicaid HMO DRG,30105,,215% x Medicaid HMO amount,30105,Other,215% of NY Medicaid HMO DRG,17503,,125% x Medicaid HMO amount,17503,Other,125% of NY Medicaid HMO DRG,0.01,58874,
Extracranial vascular procedures,024-3,APR-DRG,,,,,,,,inpatient,,,524773.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44465,,186% x Medicaid HMO amount,44465,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,101978,,"27,634 x DRG Weight",101978,Other,DRG Base Rate x DRG Weight,86678,,"23,488 x DRG Weight",86678,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23906.21,,DRG base rate x DRG weight + capital per discharge,23906.21,Other,100% of NY Medicaid HMO DRG,23906,,DRG base rate x DRG weight + capital per discharge,23906,Other,100% of NY Medicaid HMO DRG,23906,,DRG base rate x DRG weight + capital per discharge,23906,Other,100% of NY Medicaid HMO DRG,23906,,DRG base rate x DRG weight + capital per discharge,23906,Other,100% of NY Medicaid HMO DRG,53789,,225% x Medicaid HMO amount,53789,Other,225% of NY Medicaid HMO DRG,36577,,153% x Medicaid HMO amount,36577,Other,153% of NY Medicaid HMO DRG,53789,,225% x Medicaid HMO amount,53789,Other,225% of NY Medicaid HMO DRG,33469,,140% x Medicaid HMO amount,33469,Other,140% of NY Medicaid HMO DRG,53789,,DRG base rate x DRG weight + capital per discharge,53789,Other,225% of NY Medicaid HMO DRG,65742,,275% x Medicaid HMO amount,65742,Other,275% of NY Medicaid HMO DRG,77456,,324% x Medicaid HMO amount,77456,Other,324% of NY Medicaid HMO DRG,51398,,215% x Medicaid HMO amount,51398,Other,215% of NY Medicaid HMO DRG,51398,,215% x Medicaid HMO amount,51398,Other,215% of NY Medicaid HMO DRG,29883,,125% x Medicaid HMO amount,29883,Other,125% of NY Medicaid HMO DRG,0.01,101978,
Extracranial vascular procedures,024-4,APR-DRG,,,,,,,,inpatient,,,516288.78,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,81118,,186% x Medicaid HMO amount,81118,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,187734,,"27,634 x DRG Weight",187734,Other,DRG Base Rate x DRG Weight,159568,,"23,488 x DRG Weight",159568,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43612.21,,DRG base rate x DRG weight + capital per discharge,43612.21,Other,100% of NY Medicaid HMO DRG,43612,,DRG base rate x DRG weight + capital per discharge,43612,Other,100% of NY Medicaid HMO DRG,43612,,DRG base rate x DRG weight + capital per discharge,43612,Other,100% of NY Medicaid HMO DRG,43612,,DRG base rate x DRG weight + capital per discharge,43612,Other,100% of NY Medicaid HMO DRG,98127,,225% x Medicaid HMO amount,98127,Other,225% of NY Medicaid HMO DRG,66727,,153% x Medicaid HMO amount,66727,Other,153% of NY Medicaid HMO DRG,98127,,225% x Medicaid HMO amount,98127,Other,225% of NY Medicaid HMO DRG,61057,,140% x Medicaid HMO amount,61057,Other,140% of NY Medicaid HMO DRG,98127,,DRG base rate x DRG weight + capital per discharge,98127,Other,225% of NY Medicaid HMO DRG,119934,,275% x Medicaid HMO amount,119934,Other,275% of NY Medicaid HMO DRG,141304,,324% x Medicaid HMO amount,141304,Other,324% of NY Medicaid HMO DRG,93766,,215% x Medicaid HMO amount,93766,Other,215% of NY Medicaid HMO DRG,93766,,215% x Medicaid HMO amount,93766,Other,215% of NY Medicaid HMO DRG,54515,,125% x Medicaid HMO amount,54515,Other,125% of NY Medicaid HMO DRG,0.01,187734,
Other nervous system & related procedures,026-1,APR-DRG,,,,,,,,inpatient,,,159967.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15367,,186% x Medicaid HMO amount,15367,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33899,,"27,634 x DRG Weight",33899,Other,DRG Base Rate x DRG Weight,28813,,"23,488 x DRG Weight",28813,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8262.21,,DRG base rate x DRG weight + capital per discharge,8262.21,Other,100% of NY Medicaid HMO DRG,8262,,DRG base rate x DRG weight + capital per discharge,8262,Other,100% of NY Medicaid HMO DRG,8262,,DRG base rate x DRG weight + capital per discharge,8262,Other,100% of NY Medicaid HMO DRG,8262,,DRG base rate x DRG weight + capital per discharge,8262,Other,100% of NY Medicaid HMO DRG,18590,,225% x Medicaid HMO amount,18590,Other,225% of NY Medicaid HMO DRG,12641,,153% x Medicaid HMO amount,12641,Other,153% of NY Medicaid HMO DRG,18590,,225% x Medicaid HMO amount,18590,Other,225% of NY Medicaid HMO DRG,11567,,140% x Medicaid HMO amount,11567,Other,140% of NY Medicaid HMO DRG,18590,,DRG base rate x DRG weight + capital per discharge,18590,Other,225% of NY Medicaid HMO DRG,22721,,275% x Medicaid HMO amount,22721,Other,275% of NY Medicaid HMO DRG,26770,,324% x Medicaid HMO amount,26770,Other,324% of NY Medicaid HMO DRG,17764,,215% x Medicaid HMO amount,17764,Other,215% of NY Medicaid HMO DRG,17764,,215% x Medicaid HMO amount,17764,Other,215% of NY Medicaid HMO DRG,10328,,125% x Medicaid HMO amount,10328,Other,125% of NY Medicaid HMO DRG,0.01,33899,
Other nervous system & related procedures,026-2,APR-DRG,,,,,,,,inpatient,,,273933.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22093,,186% x Medicaid HMO amount,22093,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49631,,"27,634 x DRG Weight",49631,Other,DRG Base Rate x DRG Weight,42184,,"23,488 x DRG Weight",42184,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11878.21,,DRG base rate x DRG weight + capital per discharge,11878.21,Other,100% of NY Medicaid HMO DRG,11878,,DRG base rate x DRG weight + capital per discharge,11878,Other,100% of NY Medicaid HMO DRG,11878,,DRG base rate x DRG weight + capital per discharge,11878,Other,100% of NY Medicaid HMO DRG,11878,,DRG base rate x DRG weight + capital per discharge,11878,Other,100% of NY Medicaid HMO DRG,26726,,225% x Medicaid HMO amount,26726,Other,225% of NY Medicaid HMO DRG,18174,,153% x Medicaid HMO amount,18174,Other,153% of NY Medicaid HMO DRG,26726,,225% x Medicaid HMO amount,26726,Other,225% of NY Medicaid HMO DRG,16629,,140% x Medicaid HMO amount,16629,Other,140% of NY Medicaid HMO DRG,26726,,DRG base rate x DRG weight + capital per discharge,26726,Other,225% of NY Medicaid HMO DRG,32665,,275% x Medicaid HMO amount,32665,Other,275% of NY Medicaid HMO DRG,38485,,324% x Medicaid HMO amount,38485,Other,324% of NY Medicaid HMO DRG,25538,,215% x Medicaid HMO amount,25538,Other,215% of NY Medicaid HMO DRG,25538,,215% x Medicaid HMO amount,25538,Other,215% of NY Medicaid HMO DRG,14848,,125% x Medicaid HMO amount,14848,Other,125% of NY Medicaid HMO DRG,0.01,49631,
Other nervous system & related procedures,026-3,APR-DRG,,,,,,,,inpatient,,,252795.91,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32396,,186% x Medicaid HMO amount,32396,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73739,,"27,634 x DRG Weight",73739,Other,DRG Base Rate x DRG Weight,62675,,"23,488 x DRG Weight",62675,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17417.21,,DRG base rate x DRG weight + capital per discharge,17417.21,Other,100% of NY Medicaid HMO DRG,17417,,DRG base rate x DRG weight + capital per discharge,17417,Other,100% of NY Medicaid HMO DRG,17417,,DRG base rate x DRG weight + capital per discharge,17417,Other,100% of NY Medicaid HMO DRG,17417,,DRG base rate x DRG weight + capital per discharge,17417,Other,100% of NY Medicaid HMO DRG,39189,,225% x Medicaid HMO amount,39189,Other,225% of NY Medicaid HMO DRG,26648,,153% x Medicaid HMO amount,26648,Other,153% of NY Medicaid HMO DRG,39189,,225% x Medicaid HMO amount,39189,Other,225% of NY Medicaid HMO DRG,24384,,140% x Medicaid HMO amount,24384,Other,140% of NY Medicaid HMO DRG,39189,,DRG base rate x DRG weight + capital per discharge,39189,Other,225% of NY Medicaid HMO DRG,47897,,275% x Medicaid HMO amount,47897,Other,275% of NY Medicaid HMO DRG,56432,,324% x Medicaid HMO amount,56432,Other,324% of NY Medicaid HMO DRG,37447,,215% x Medicaid HMO amount,37447,Other,215% of NY Medicaid HMO DRG,37447,,215% x Medicaid HMO amount,37447,Other,215% of NY Medicaid HMO DRG,21772,,125% x Medicaid HMO amount,21772,Other,125% of NY Medicaid HMO DRG,0.01,73739,
Other nervous system & related procedures,026-4,APR-DRG,,,,,,,,inpatient,,,1599828.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75005,,186% x Medicaid HMO amount,75005,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,173428,,"27,634 x DRG Weight",173428,Other,DRG Base Rate x DRG Weight,147408,,"23,488 x DRG Weight",147408,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40325.21,,DRG base rate x DRG weight + capital per discharge,40325.21,Other,100% of NY Medicaid HMO DRG,40325,,DRG base rate x DRG weight + capital per discharge,40325,Other,100% of NY Medicaid HMO DRG,40325,,DRG base rate x DRG weight + capital per discharge,40325,Other,100% of NY Medicaid HMO DRG,40325,,DRG base rate x DRG weight + capital per discharge,40325,Other,100% of NY Medicaid HMO DRG,90732,,225% x Medicaid HMO amount,90732,Other,225% of NY Medicaid HMO DRG,61698,,153% x Medicaid HMO amount,61698,Other,153% of NY Medicaid HMO DRG,90732,,225% x Medicaid HMO amount,90732,Other,225% of NY Medicaid HMO DRG,56455,,140% x Medicaid HMO amount,56455,Other,140% of NY Medicaid HMO DRG,90732,,DRG base rate x DRG weight + capital per discharge,90732,Other,225% of NY Medicaid HMO DRG,110894,,275% x Medicaid HMO amount,110894,Other,275% of NY Medicaid HMO DRG,130654,,324% x Medicaid HMO amount,130654,Other,324% of NY Medicaid HMO DRG,86699,,215% x Medicaid HMO amount,86699,Other,215% of NY Medicaid HMO DRG,86699,,215% x Medicaid HMO amount,86699,Other,215% of NY Medicaid HMO DRG,50407,,125% x Medicaid HMO amount,50407,Other,125% of NY Medicaid HMO DRG,0.01,173428,
Spinal disorders & injuries,040-1,APR-DRG,,,,,,,,inpatient,,,87432.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10516,,186% x Medicaid HMO amount,10516,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22547,,"27,634 x DRG Weight",22547,Other,DRG Base Rate x DRG Weight,19164,,"23,488 x DRG Weight",19164,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5654.21,,DRG base rate x DRG weight + capital per discharge,5654.21,Other,100% of NY Medicaid HMO DRG,5654,,DRG base rate x DRG weight + capital per discharge,5654,Other,100% of NY Medicaid HMO DRG,5654,,DRG base rate x DRG weight + capital per discharge,5654,Other,100% of NY Medicaid HMO DRG,5654,,DRG base rate x DRG weight + capital per discharge,5654,Other,100% of NY Medicaid HMO DRG,12722,,225% x Medicaid HMO amount,12722,Other,225% of NY Medicaid HMO DRG,8651,,153% x Medicaid HMO amount,8651,Other,153% of NY Medicaid HMO DRG,12722,,225% x Medicaid HMO amount,12722,Other,225% of NY Medicaid HMO DRG,7916,,140% x Medicaid HMO amount,7916,Other,140% of NY Medicaid HMO DRG,12722,,DRG base rate x DRG weight + capital per discharge,12722,Other,225% of NY Medicaid HMO DRG,15549,,275% x Medicaid HMO amount,15549,Other,275% of NY Medicaid HMO DRG,18320,,324% x Medicaid HMO amount,18320,Other,324% of NY Medicaid HMO DRG,12157,,215% x Medicaid HMO amount,12157,Other,215% of NY Medicaid HMO DRG,12157,,215% x Medicaid HMO amount,12157,Other,215% of NY Medicaid HMO DRG,7068,,125% x Medicaid HMO amount,7068,Other,125% of NY Medicaid HMO DRG,0.01,22547,
Spinal disorders & injuries,040-2,APR-DRG,,,,,,,,inpatient,,,153585.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16048,,186% x Medicaid HMO amount,16048,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35490,,"27,634 x DRG Weight",35490,Other,DRG Base Rate x DRG Weight,30166,,"23,488 x DRG Weight",30166,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8628.21,,DRG base rate x DRG weight + capital per discharge,8628.21,Other,100% of NY Medicaid HMO DRG,8628,,DRG base rate x DRG weight + capital per discharge,8628,Other,100% of NY Medicaid HMO DRG,8628,,DRG base rate x DRG weight + capital per discharge,8628,Other,100% of NY Medicaid HMO DRG,8628,,DRG base rate x DRG weight + capital per discharge,8628,Other,100% of NY Medicaid HMO DRG,19413,,225% x Medicaid HMO amount,19413,Other,225% of NY Medicaid HMO DRG,13201,,153% x Medicaid HMO amount,13201,Other,153% of NY Medicaid HMO DRG,19413,,225% x Medicaid HMO amount,19413,Other,225% of NY Medicaid HMO DRG,12079,,140% x Medicaid HMO amount,12079,Other,140% of NY Medicaid HMO DRG,19413,,DRG base rate x DRG weight + capital per discharge,19413,Other,225% of NY Medicaid HMO DRG,23728,,275% x Medicaid HMO amount,23728,Other,275% of NY Medicaid HMO DRG,27955,,324% x Medicaid HMO amount,27955,Other,324% of NY Medicaid HMO DRG,18551,,215% x Medicaid HMO amount,18551,Other,215% of NY Medicaid HMO DRG,18551,,215% x Medicaid HMO amount,18551,Other,215% of NY Medicaid HMO DRG,10785,,125% x Medicaid HMO amount,10785,Other,125% of NY Medicaid HMO DRG,0.01,35490,
Spinal disorders & injuries,040-3,APR-DRG,,,,,,,,inpatient,,,350638.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28004,,186% x Medicaid HMO amount,28004,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63461,,"27,634 x DRG Weight",63461,Other,DRG Base Rate x DRG Weight,53940,,"23,488 x DRG Weight",53940,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15056.21,,DRG base rate x DRG weight + capital per discharge,15056.21,Other,100% of NY Medicaid HMO DRG,15056,,DRG base rate x DRG weight + capital per discharge,15056,Other,100% of NY Medicaid HMO DRG,15056,,DRG base rate x DRG weight + capital per discharge,15056,Other,100% of NY Medicaid HMO DRG,15056,,DRG base rate x DRG weight + capital per discharge,15056,Other,100% of NY Medicaid HMO DRG,33876,,225% x Medicaid HMO amount,33876,Other,225% of NY Medicaid HMO DRG,23036,,153% x Medicaid HMO amount,23036,Other,153% of NY Medicaid HMO DRG,33876,,225% x Medicaid HMO amount,33876,Other,225% of NY Medicaid HMO DRG,21079,,140% x Medicaid HMO amount,21079,Other,140% of NY Medicaid HMO DRG,33876,,DRG base rate x DRG weight + capital per discharge,33876,Other,225% of NY Medicaid HMO DRG,41405,,275% x Medicaid HMO amount,41405,Other,275% of NY Medicaid HMO DRG,48782,,324% x Medicaid HMO amount,48782,Other,324% of NY Medicaid HMO DRG,32371,,215% x Medicaid HMO amount,32371,Other,215% of NY Medicaid HMO DRG,32371,,215% x Medicaid HMO amount,32371,Other,215% of NY Medicaid HMO DRG,18820,,125% x Medicaid HMO amount,18820,Other,125% of NY Medicaid HMO DRG,0.01,63461,
Spinal disorders & injuries,040-4,APR-DRG,,,,,,,,inpatient,,,350638.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32959,,186% x Medicaid HMO amount,32959,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75054,,"27,634 x DRG Weight",75054,Other,DRG Base Rate x DRG Weight,63793,,"23,488 x DRG Weight",63793,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17720.21,,DRG base rate x DRG weight + capital per discharge,17720.21,Other,100% of NY Medicaid HMO DRG,17720,,DRG base rate x DRG weight + capital per discharge,17720,Other,100% of NY Medicaid HMO DRG,17720,,DRG base rate x DRG weight + capital per discharge,17720,Other,100% of NY Medicaid HMO DRG,17720,,DRG base rate x DRG weight + capital per discharge,17720,Other,100% of NY Medicaid HMO DRG,39870,,225% x Medicaid HMO amount,39870,Other,225% of NY Medicaid HMO DRG,27112,,153% x Medicaid HMO amount,27112,Other,153% of NY Medicaid HMO DRG,39870,,225% x Medicaid HMO amount,39870,Other,225% of NY Medicaid HMO DRG,24808,,140% x Medicaid HMO amount,24808,Other,140% of NY Medicaid HMO DRG,39870,,DRG base rate x DRG weight + capital per discharge,39870,Other,225% of NY Medicaid HMO DRG,48731,,275% x Medicaid HMO amount,48731,Other,275% of NY Medicaid HMO DRG,57413,,324% x Medicaid HMO amount,57413,Other,324% of NY Medicaid HMO DRG,38098,,215% x Medicaid HMO amount,38098,Other,215% of NY Medicaid HMO DRG,38098,,215% x Medicaid HMO amount,38098,Other,215% of NY Medicaid HMO DRG,22150,,125% x Medicaid HMO amount,22150,Other,125% of NY Medicaid HMO DRG,0.01,75054,
Nervous system malignancy,041-1,APR-DRG,,,,,,,,inpatient,,,60218.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9746,,186% x Medicaid HMO amount,9746,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20748,,"27,634 x DRG Weight",20748,Other,DRG Base Rate x DRG Weight,17635,,"23,488 x DRG Weight",17635,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5240.21,,DRG base rate x DRG weight + capital per discharge,5240.21,Other,100% of NY Medicaid HMO DRG,5240,,DRG base rate x DRG weight + capital per discharge,5240,Other,100% of NY Medicaid HMO DRG,5240,,DRG base rate x DRG weight + capital per discharge,5240,Other,100% of NY Medicaid HMO DRG,5240,,DRG base rate x DRG weight + capital per discharge,5240,Other,100% of NY Medicaid HMO DRG,11790,,225% x Medicaid HMO amount,11790,Other,225% of NY Medicaid HMO DRG,8018,,153% x Medicaid HMO amount,8018,Other,153% of NY Medicaid HMO DRG,11790,,225% x Medicaid HMO amount,11790,Other,225% of NY Medicaid HMO DRG,7336,,140% x Medicaid HMO amount,7336,Other,140% of NY Medicaid HMO DRG,11790,,DRG base rate x DRG weight + capital per discharge,11790,Other,225% of NY Medicaid HMO DRG,14411,,275% x Medicaid HMO amount,14411,Other,275% of NY Medicaid HMO DRG,16978,,324% x Medicaid HMO amount,16978,Other,324% of NY Medicaid HMO DRG,11266,,215% x Medicaid HMO amount,11266,Other,215% of NY Medicaid HMO DRG,11266,,215% x Medicaid HMO amount,11266,Other,215% of NY Medicaid HMO DRG,6550,,125% x Medicaid HMO amount,6550,Other,125% of NY Medicaid HMO DRG,0.01,20748,
Nervous system malignancy,041-2,APR-DRG,,,,,,,,inpatient,,,70598.89,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11114,,186% x Medicaid HMO amount,11114,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23942,,"27,634 x DRG Weight",23942,Other,DRG Base Rate x DRG Weight,20350,,"23,488 x DRG Weight",20350,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5975.21,,DRG base rate x DRG weight + capital per discharge,5975.21,Other,100% of NY Medicaid HMO DRG,5975,,DRG base rate x DRG weight + capital per discharge,5975,Other,100% of NY Medicaid HMO DRG,5975,,DRG base rate x DRG weight + capital per discharge,5975,Other,100% of NY Medicaid HMO DRG,5975,,DRG base rate x DRG weight + capital per discharge,5975,Other,100% of NY Medicaid HMO DRG,13444,,225% x Medicaid HMO amount,13444,Other,225% of NY Medicaid HMO DRG,9142,,153% x Medicaid HMO amount,9142,Other,153% of NY Medicaid HMO DRG,13444,,225% x Medicaid HMO amount,13444,Other,225% of NY Medicaid HMO DRG,8365,,140% x Medicaid HMO amount,8365,Other,140% of NY Medicaid HMO DRG,13444,,DRG base rate x DRG weight + capital per discharge,13444,Other,225% of NY Medicaid HMO DRG,16432,,275% x Medicaid HMO amount,16432,Other,275% of NY Medicaid HMO DRG,19360,,324% x Medicaid HMO amount,19360,Other,324% of NY Medicaid HMO DRG,12847,,215% x Medicaid HMO amount,12847,Other,215% of NY Medicaid HMO DRG,12847,,215% x Medicaid HMO amount,12847,Other,215% of NY Medicaid HMO DRG,7469,,125% x Medicaid HMO amount,7469,Other,125% of NY Medicaid HMO DRG,0.01,23942,
Nervous system malignancy,041-3,APR-DRG,,,,,,,,inpatient,,,263831.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18288,,186% x Medicaid HMO amount,18288,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40730,,"27,634 x DRG Weight",40730,Other,DRG Base Rate x DRG Weight,34619,,"23,488 x DRG Weight",34619,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9832.21,,DRG base rate x DRG weight + capital per discharge,9832.21,Other,100% of NY Medicaid HMO DRG,9832,,DRG base rate x DRG weight + capital per discharge,9832,Other,100% of NY Medicaid HMO DRG,9832,,DRG base rate x DRG weight + capital per discharge,9832,Other,100% of NY Medicaid HMO DRG,9832,,DRG base rate x DRG weight + capital per discharge,9832,Other,100% of NY Medicaid HMO DRG,22122,,225% x Medicaid HMO amount,22122,Other,225% of NY Medicaid HMO DRG,15043,,153% x Medicaid HMO amount,15043,Other,153% of NY Medicaid HMO DRG,22122,,225% x Medicaid HMO amount,22122,Other,225% of NY Medicaid HMO DRG,13765,,140% x Medicaid HMO amount,13765,Other,140% of NY Medicaid HMO DRG,22122,,DRG base rate x DRG weight + capital per discharge,22122,Other,225% of NY Medicaid HMO DRG,27039,,275% x Medicaid HMO amount,27039,Other,275% of NY Medicaid HMO DRG,31856,,324% x Medicaid HMO amount,31856,Other,324% of NY Medicaid HMO DRG,21139,,215% x Medicaid HMO amount,21139,Other,215% of NY Medicaid HMO DRG,21139,,215% x Medicaid HMO amount,21139,Other,215% of NY Medicaid HMO DRG,12290,,125% x Medicaid HMO amount,12290,Other,125% of NY Medicaid HMO DRG,0.01,40730,
Nervous system malignancy,041-4,APR-DRG,,,,,,,,inpatient,,,133503.72,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33140,,186% x Medicaid HMO amount,33140,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75477,,"27,634 x DRG Weight",75477,Other,DRG Base Rate x DRG Weight,64153,,"23,488 x DRG Weight",64153,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17817.21,,DRG base rate x DRG weight + capital per discharge,17817.21,Other,100% of NY Medicaid HMO DRG,17817,,DRG base rate x DRG weight + capital per discharge,17817,Other,100% of NY Medicaid HMO DRG,17817,,DRG base rate x DRG weight + capital per discharge,17817,Other,100% of NY Medicaid HMO DRG,17817,,DRG base rate x DRG weight + capital per discharge,17817,Other,100% of NY Medicaid HMO DRG,40089,,225% x Medicaid HMO amount,40089,Other,225% of NY Medicaid HMO DRG,27260,,153% x Medicaid HMO amount,27260,Other,153% of NY Medicaid HMO DRG,40089,,225% x Medicaid HMO amount,40089,Other,225% of NY Medicaid HMO DRG,24944,,140% x Medicaid HMO amount,24944,Other,140% of NY Medicaid HMO DRG,40089,,DRG base rate x DRG weight + capital per discharge,40089,Other,225% of NY Medicaid HMO DRG,48997,,275% x Medicaid HMO amount,48997,Other,275% of NY Medicaid HMO DRG,57728,,324% x Medicaid HMO amount,57728,Other,324% of NY Medicaid HMO DRG,38307,,215% x Medicaid HMO amount,38307,Other,215% of NY Medicaid HMO DRG,38307,,215% x Medicaid HMO amount,38307,Other,215% of NY Medicaid HMO DRG,22272,,125% x Medicaid HMO amount,22272,Other,125% of NY Medicaid HMO DRG,0.01,75477,
Degenerative nervous system disorders exc mult sclerosis,042-1,APR-DRG,,,,,,,,inpatient,,,106754.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8405,,186% x Medicaid HMO amount,8405,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17608,,"27,634 x DRG Weight",17608,Other,DRG Base Rate x DRG Weight,14967,,"23,488 x DRG Weight",14967,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4519.21,,DRG base rate x DRG weight + capital per discharge,4519.21,Other,100% of NY Medicaid HMO DRG,4519,,DRG base rate x DRG weight + capital per discharge,4519,Other,100% of NY Medicaid HMO DRG,4519,,DRG base rate x DRG weight + capital per discharge,4519,Other,100% of NY Medicaid HMO DRG,4519,,DRG base rate x DRG weight + capital per discharge,4519,Other,100% of NY Medicaid HMO DRG,10168,,225% x Medicaid HMO amount,10168,Other,225% of NY Medicaid HMO DRG,6914,,153% x Medicaid HMO amount,6914,Other,153% of NY Medicaid HMO DRG,10168,,225% x Medicaid HMO amount,10168,Other,225% of NY Medicaid HMO DRG,6327,,140% x Medicaid HMO amount,6327,Other,140% of NY Medicaid HMO DRG,10168,,DRG base rate x DRG weight + capital per discharge,10168,Other,225% of NY Medicaid HMO DRG,12428,,275% x Medicaid HMO amount,12428,Other,275% of NY Medicaid HMO DRG,14642,,324% x Medicaid HMO amount,14642,Other,324% of NY Medicaid HMO DRG,9716,,215% x Medicaid HMO amount,9716,Other,215% of NY Medicaid HMO DRG,9716,,215% x Medicaid HMO amount,9716,Other,215% of NY Medicaid HMO DRG,5649,,125% x Medicaid HMO amount,5649,Other,125% of NY Medicaid HMO DRG,0.01,17608,
Degenerative nervous system disorders exc mult sclerosis,042-2,APR-DRG,,,,,,,,inpatient,,,173922.63,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11305,,186% x Medicaid HMO amount,11305,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24393,,"27,634 x DRG Weight",24393,Other,DRG Base Rate x DRG Weight,20733,,"23,488 x DRG Weight",20733,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6078.21,,DRG base rate x DRG weight + capital per discharge,6078.21,Other,100% of NY Medicaid HMO DRG,6078,,DRG base rate x DRG weight + capital per discharge,6078,Other,100% of NY Medicaid HMO DRG,6078,,DRG base rate x DRG weight + capital per discharge,6078,Other,100% of NY Medicaid HMO DRG,6078,,DRG base rate x DRG weight + capital per discharge,6078,Other,100% of NY Medicaid HMO DRG,13676,,225% x Medicaid HMO amount,13676,Other,225% of NY Medicaid HMO DRG,9300,,153% x Medicaid HMO amount,9300,Other,153% of NY Medicaid HMO DRG,13676,,225% x Medicaid HMO amount,13676,Other,225% of NY Medicaid HMO DRG,8509,,140% x Medicaid HMO amount,8509,Other,140% of NY Medicaid HMO DRG,13676,,DRG base rate x DRG weight + capital per discharge,13676,Other,225% of NY Medicaid HMO DRG,16715,,275% x Medicaid HMO amount,16715,Other,275% of NY Medicaid HMO DRG,19693,,324% x Medicaid HMO amount,19693,Other,324% of NY Medicaid HMO DRG,13068,,215% x Medicaid HMO amount,13068,Other,215% of NY Medicaid HMO DRG,13068,,215% x Medicaid HMO amount,13068,Other,215% of NY Medicaid HMO DRG,7598,,125% x Medicaid HMO amount,7598,Other,125% of NY Medicaid HMO DRG,0.01,24393,
Degenerative nervous system disorders exc mult sclerosis,042-3,APR-DRG,,,,,,,,inpatient,,,130034.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22443,,186% x Medicaid HMO amount,22443,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,50451,,"27,634 x DRG Weight",50451,Other,DRG Base Rate x DRG Weight,42882,,"23,488 x DRG Weight",42882,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12066.21,,DRG base rate x DRG weight + capital per discharge,12066.21,Other,100% of NY Medicaid HMO DRG,12066,,DRG base rate x DRG weight + capital per discharge,12066,Other,100% of NY Medicaid HMO DRG,12066,,DRG base rate x DRG weight + capital per discharge,12066,Other,100% of NY Medicaid HMO DRG,12066,,DRG base rate x DRG weight + capital per discharge,12066,Other,100% of NY Medicaid HMO DRG,27149,,225% x Medicaid HMO amount,27149,Other,225% of NY Medicaid HMO DRG,18461,,153% x Medicaid HMO amount,18461,Other,153% of NY Medicaid HMO DRG,27149,,225% x Medicaid HMO amount,27149,Other,225% of NY Medicaid HMO DRG,16893,,140% x Medicaid HMO amount,16893,Other,140% of NY Medicaid HMO DRG,27149,,DRG base rate x DRG weight + capital per discharge,27149,Other,225% of NY Medicaid HMO DRG,33182,,275% x Medicaid HMO amount,33182,Other,275% of NY Medicaid HMO DRG,39095,,324% x Medicaid HMO amount,39095,Other,324% of NY Medicaid HMO DRG,25942,,215% x Medicaid HMO amount,25942,Other,215% of NY Medicaid HMO DRG,25942,,215% x Medicaid HMO amount,25942,Other,215% of NY Medicaid HMO DRG,15083,,125% x Medicaid HMO amount,15083,Other,125% of NY Medicaid HMO DRG,0.01,50451,
Degenerative nervous system disorders exc mult sclerosis,042-4,APR-DRG,,,,,,,,inpatient,,,411649.05,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23832,,186% x Medicaid HMO amount,23832,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53704,,"27,634 x DRG Weight",53704,Other,DRG Base Rate x DRG Weight,45647,,"23,488 x DRG Weight",45647,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12813.21,,DRG base rate x DRG weight + capital per discharge,12813.21,Other,100% of NY Medicaid HMO DRG,12813,,DRG base rate x DRG weight + capital per discharge,12813,Other,100% of NY Medicaid HMO DRG,12813,,DRG base rate x DRG weight + capital per discharge,12813,Other,100% of NY Medicaid HMO DRG,12813,,DRG base rate x DRG weight + capital per discharge,12813,Other,100% of NY Medicaid HMO DRG,28830,,225% x Medicaid HMO amount,28830,Other,225% of NY Medicaid HMO DRG,19604,,153% x Medicaid HMO amount,19604,Other,153% of NY Medicaid HMO DRG,28830,,225% x Medicaid HMO amount,28830,Other,225% of NY Medicaid HMO DRG,17938,,140% x Medicaid HMO amount,17938,Other,140% of NY Medicaid HMO DRG,28830,,DRG base rate x DRG weight + capital per discharge,28830,Other,225% of NY Medicaid HMO DRG,35236,,275% x Medicaid HMO amount,35236,Other,275% of NY Medicaid HMO DRG,41515,,324% x Medicaid HMO amount,41515,Other,324% of NY Medicaid HMO DRG,27548,,215% x Medicaid HMO amount,27548,Other,215% of NY Medicaid HMO DRG,27548,,215% x Medicaid HMO amount,27548,Other,215% of NY Medicaid HMO DRG,16017,,125% x Medicaid HMO amount,16017,Other,125% of NY Medicaid HMO DRG,0.01,53704,
Multiple sclerosis & other demyelinating diseases,043-1,APR-DRG,,,,,,,,inpatient,,,63962,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10139,,186% x Medicaid HMO amount,10139,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21662,,"27,634 x DRG Weight",21662,Other,DRG Base Rate x DRG Weight,18412,,"23,488 x DRG Weight",18412,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5451.21,,DRG base rate x DRG weight + capital per discharge,5451.21,Other,100% of NY Medicaid HMO DRG,5451,,DRG base rate x DRG weight + capital per discharge,5451,Other,100% of NY Medicaid HMO DRG,5451,,DRG base rate x DRG weight + capital per discharge,5451,Other,100% of NY Medicaid HMO DRG,5451,,DRG base rate x DRG weight + capital per discharge,5451,Other,100% of NY Medicaid HMO DRG,12265,,225% x Medicaid HMO amount,12265,Other,225% of NY Medicaid HMO DRG,8340,,153% x Medicaid HMO amount,8340,Other,153% of NY Medicaid HMO DRG,12265,,225% x Medicaid HMO amount,12265,Other,225% of NY Medicaid HMO DRG,7632,,140% x Medicaid HMO amount,7632,Other,140% of NY Medicaid HMO DRG,12265,,DRG base rate x DRG weight + capital per discharge,12265,Other,225% of NY Medicaid HMO DRG,14991,,275% x Medicaid HMO amount,14991,Other,275% of NY Medicaid HMO DRG,17662,,324% x Medicaid HMO amount,17662,Other,324% of NY Medicaid HMO DRG,11720,,215% x Medicaid HMO amount,11720,Other,215% of NY Medicaid HMO DRG,11720,,215% x Medicaid HMO amount,11720,Other,215% of NY Medicaid HMO DRG,6814,,125% x Medicaid HMO amount,6814,Other,125% of NY Medicaid HMO DRG,0.01,21662,
Multiple sclerosis & other demyelinating diseases,043-2,APR-DRG,,,,,,,,inpatient,,,100947.22,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13574,,186% x Medicaid HMO amount,13574,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29701,,"27,634 x DRG Weight",29701,Other,DRG Base Rate x DRG Weight,25245,,"23,488 x DRG Weight",25245,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7298.21,,DRG base rate x DRG weight + capital per discharge,7298.21,Other,100% of NY Medicaid HMO DRG,7298,,DRG base rate x DRG weight + capital per discharge,7298,Other,100% of NY Medicaid HMO DRG,7298,,DRG base rate x DRG weight + capital per discharge,7298,Other,100% of NY Medicaid HMO DRG,7298,,DRG base rate x DRG weight + capital per discharge,7298,Other,100% of NY Medicaid HMO DRG,16421,,225% x Medicaid HMO amount,16421,Other,225% of NY Medicaid HMO DRG,11166,,153% x Medicaid HMO amount,11166,Other,153% of NY Medicaid HMO DRG,16421,,225% x Medicaid HMO amount,16421,Other,225% of NY Medicaid HMO DRG,10217,,140% x Medicaid HMO amount,10217,Other,140% of NY Medicaid HMO DRG,16421,,DRG base rate x DRG weight + capital per discharge,16421,Other,225% of NY Medicaid HMO DRG,20070,,275% x Medicaid HMO amount,20070,Other,275% of NY Medicaid HMO DRG,23646,,324% x Medicaid HMO amount,23646,Other,324% of NY Medicaid HMO DRG,15691,,215% x Medicaid HMO amount,15691,Other,215% of NY Medicaid HMO DRG,15691,,215% x Medicaid HMO amount,15691,Other,215% of NY Medicaid HMO DRG,9123,,125% x Medicaid HMO amount,9123,Other,125% of NY Medicaid HMO DRG,0.01,29701,
Multiple sclerosis & other demyelinating diseases,043-3,APR-DRG,,,,,,,,inpatient,,,138710.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27550,,186% x Medicaid HMO amount,27550,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62400,,"27,634 x DRG Weight",62400,Other,DRG Base Rate x DRG Weight,53038,,"23,488 x DRG Weight",53038,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14812.21,,DRG base rate x DRG weight + capital per discharge,14812.21,Other,100% of NY Medicaid HMO DRG,14812,,DRG base rate x DRG weight + capital per discharge,14812,Other,100% of NY Medicaid HMO DRG,14812,,DRG base rate x DRG weight + capital per discharge,14812,Other,100% of NY Medicaid HMO DRG,14812,,DRG base rate x DRG weight + capital per discharge,14812,Other,100% of NY Medicaid HMO DRG,33327,,225% x Medicaid HMO amount,33327,Other,225% of NY Medicaid HMO DRG,22663,,153% x Medicaid HMO amount,22663,Other,153% of NY Medicaid HMO DRG,33327,,225% x Medicaid HMO amount,33327,Other,225% of NY Medicaid HMO DRG,20737,,140% x Medicaid HMO amount,20737,Other,140% of NY Medicaid HMO DRG,33327,,DRG base rate x DRG weight + capital per discharge,33327,Other,225% of NY Medicaid HMO DRG,40734,,275% x Medicaid HMO amount,40734,Other,275% of NY Medicaid HMO DRG,47992,,324% x Medicaid HMO amount,47992,Other,324% of NY Medicaid HMO DRG,31846,,215% x Medicaid HMO amount,31846,Other,215% of NY Medicaid HMO DRG,31846,,215% x Medicaid HMO amount,31846,Other,215% of NY Medicaid HMO DRG,18515,,125% x Medicaid HMO amount,18515,Other,125% of NY Medicaid HMO DRG,0.01,62400,
Multiple sclerosis & other demyelinating diseases,043-4,APR-DRG,,,,,,,,inpatient,,,366821.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70773,,186% x Medicaid HMO amount,70773,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,163530,,"27,634 x DRG Weight",163530,Other,DRG Base Rate x DRG Weight,138995,,"23,488 x DRG Weight",138995,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38050.21,,DRG base rate x DRG weight + capital per discharge,38050.21,Other,100% of NY Medicaid HMO DRG,38050,,DRG base rate x DRG weight + capital per discharge,38050,Other,100% of NY Medicaid HMO DRG,38050,,DRG base rate x DRG weight + capital per discharge,38050,Other,100% of NY Medicaid HMO DRG,38050,,DRG base rate x DRG weight + capital per discharge,38050,Other,100% of NY Medicaid HMO DRG,85613,,225% x Medicaid HMO amount,85613,Other,225% of NY Medicaid HMO DRG,58217,,153% x Medicaid HMO amount,58217,Other,153% of NY Medicaid HMO DRG,85613,,225% x Medicaid HMO amount,85613,Other,225% of NY Medicaid HMO DRG,53270,,140% x Medicaid HMO amount,53270,Other,140% of NY Medicaid HMO DRG,85613,,DRG base rate x DRG weight + capital per discharge,85613,Other,225% of NY Medicaid HMO DRG,104638,,275% x Medicaid HMO amount,104638,Other,275% of NY Medicaid HMO DRG,123283,,324% x Medicaid HMO amount,123283,Other,324% of NY Medicaid HMO DRG,81808,,215% x Medicaid HMO amount,81808,Other,215% of NY Medicaid HMO DRG,81808,,215% x Medicaid HMO amount,81808,Other,215% of NY Medicaid HMO DRG,47563,,125% x Medicaid HMO amount,47563,Other,125% of NY Medicaid HMO DRG,0.01,163530,
Intracranial hemorrhage,044-1,APR-DRG,,,,,,,,inpatient,,,143706.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12693,,186% x Medicaid HMO amount,12693,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27637,,"27,634 x DRG Weight",27637,Other,DRG Base Rate x DRG Weight,23490,,"23,488 x DRG Weight",23490,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6824.21,,DRG base rate x DRG weight + capital per discharge,6824.21,Other,100% of NY Medicaid HMO DRG,6824,,DRG base rate x DRG weight + capital per discharge,6824,Other,100% of NY Medicaid HMO DRG,6824,,DRG base rate x DRG weight + capital per discharge,6824,Other,100% of NY Medicaid HMO DRG,6824,,DRG base rate x DRG weight + capital per discharge,6824,Other,100% of NY Medicaid HMO DRG,15354,,225% x Medicaid HMO amount,15354,Other,225% of NY Medicaid HMO DRG,10441,,153% x Medicaid HMO amount,10441,Other,153% of NY Medicaid HMO DRG,15354,,225% x Medicaid HMO amount,15354,Other,225% of NY Medicaid HMO DRG,9554,,140% x Medicaid HMO amount,9554,Other,140% of NY Medicaid HMO DRG,15354,,DRG base rate x DRG weight + capital per discharge,15354,Other,225% of NY Medicaid HMO DRG,18767,,275% x Medicaid HMO amount,18767,Other,275% of NY Medicaid HMO DRG,22110,,324% x Medicaid HMO amount,22110,Other,324% of NY Medicaid HMO DRG,14672,,215% x Medicaid HMO amount,14672,Other,215% of NY Medicaid HMO DRG,14672,,215% x Medicaid HMO amount,14672,Other,215% of NY Medicaid HMO DRG,8530,,125% x Medicaid HMO amount,8530,Other,125% of NY Medicaid HMO DRG,0.01,27637,
Intracranial hemorrhage,044-2,APR-DRG,,,,,,,,inpatient,,,134232.85,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18161,,186% x Medicaid HMO amount,18161,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40431,,"27,634 x DRG Weight",40431,Other,DRG Base Rate x DRG Weight,34365,,"23,488 x DRG Weight",34365,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9764.21,,DRG base rate x DRG weight + capital per discharge,9764.21,Other,100% of NY Medicaid HMO DRG,9764,,DRG base rate x DRG weight + capital per discharge,9764,Other,100% of NY Medicaid HMO DRG,9764,,DRG base rate x DRG weight + capital per discharge,9764,Other,100% of NY Medicaid HMO DRG,9764,,DRG base rate x DRG weight + capital per discharge,9764,Other,100% of NY Medicaid HMO DRG,21969,,225% x Medicaid HMO amount,21969,Other,225% of NY Medicaid HMO DRG,14939,,153% x Medicaid HMO amount,14939,Other,153% of NY Medicaid HMO DRG,21969,,225% x Medicaid HMO amount,21969,Other,225% of NY Medicaid HMO DRG,13670,,140% x Medicaid HMO amount,13670,Other,140% of NY Medicaid HMO DRG,21969,,DRG base rate x DRG weight + capital per discharge,21969,Other,225% of NY Medicaid HMO DRG,26852,,275% x Medicaid HMO amount,26852,Other,275% of NY Medicaid HMO DRG,31636,,324% x Medicaid HMO amount,31636,Other,324% of NY Medicaid HMO DRG,20993,,215% x Medicaid HMO amount,20993,Other,215% of NY Medicaid HMO DRG,20993,,215% x Medicaid HMO amount,20993,Other,215% of NY Medicaid HMO DRG,12205,,125% x Medicaid HMO amount,12205,Other,125% of NY Medicaid HMO DRG,0.01,40431,
Intracranial hemorrhage,044-3,APR-DRG,,,,,,,,inpatient,,,275985.91,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25865,,186% x Medicaid HMO amount,25865,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58460,,"27,634 x DRG Weight",58460,Other,DRG Base Rate x DRG Weight,49689,,"23,488 x DRG Weight",49689,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13906.21,,DRG base rate x DRG weight + capital per discharge,13906.21,Other,100% of NY Medicaid HMO DRG,13906,,DRG base rate x DRG weight + capital per discharge,13906,Other,100% of NY Medicaid HMO DRG,13906,,DRG base rate x DRG weight + capital per discharge,13906,Other,100% of NY Medicaid HMO DRG,13906,,DRG base rate x DRG weight + capital per discharge,13906,Other,100% of NY Medicaid HMO DRG,31289,,225% x Medicaid HMO amount,31289,Other,225% of NY Medicaid HMO DRG,21277,,153% x Medicaid HMO amount,21277,Other,153% of NY Medicaid HMO DRG,31289,,225% x Medicaid HMO amount,31289,Other,225% of NY Medicaid HMO DRG,19469,,140% x Medicaid HMO amount,19469,Other,140% of NY Medicaid HMO DRG,31289,,DRG base rate x DRG weight + capital per discharge,31289,Other,225% of NY Medicaid HMO DRG,38242,,275% x Medicaid HMO amount,38242,Other,275% of NY Medicaid HMO DRG,45056,,324% x Medicaid HMO amount,45056,Other,324% of NY Medicaid HMO DRG,29898,,215% x Medicaid HMO amount,29898,Other,215% of NY Medicaid HMO DRG,29898,,215% x Medicaid HMO amount,29898,Other,215% of NY Medicaid HMO DRG,17383,,125% x Medicaid HMO amount,17383,Other,125% of NY Medicaid HMO DRG,0.01,58460,
Intracranial hemorrhage,044-4,APR-DRG,,,,,,,,inpatient,,,479134.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33699,,186% x Medicaid HMO amount,33699,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,76787,,"27,634 x DRG Weight",76787,Other,DRG Base Rate x DRG Weight,65266,,"23,488 x DRG Weight",65266,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18118.21,,DRG base rate x DRG weight + capital per discharge,18118.21,Other,100% of NY Medicaid HMO DRG,18118,,DRG base rate x DRG weight + capital per discharge,18118,Other,100% of NY Medicaid HMO DRG,18118,,DRG base rate x DRG weight + capital per discharge,18118,Other,100% of NY Medicaid HMO DRG,18118,,DRG base rate x DRG weight + capital per discharge,18118,Other,100% of NY Medicaid HMO DRG,40766,,225% x Medicaid HMO amount,40766,Other,225% of NY Medicaid HMO DRG,27721,,153% x Medicaid HMO amount,27721,Other,153% of NY Medicaid HMO DRG,40766,,225% x Medicaid HMO amount,40766,Other,225% of NY Medicaid HMO DRG,25365,,140% x Medicaid HMO amount,25365,Other,140% of NY Medicaid HMO DRG,40766,,DRG base rate x DRG weight + capital per discharge,40766,Other,225% of NY Medicaid HMO DRG,49825,,275% x Medicaid HMO amount,49825,Other,275% of NY Medicaid HMO DRG,58703,,324% x Medicaid HMO amount,58703,Other,324% of NY Medicaid HMO DRG,38954,,215% x Medicaid HMO amount,38954,Other,215% of NY Medicaid HMO DRG,38954,,215% x Medicaid HMO amount,38954,Other,215% of NY Medicaid HMO DRG,22648,,125% x Medicaid HMO amount,22648,Other,125% of NY Medicaid HMO DRG,0.01,76787,
CVA & precerebral occlusion w infarct,045-1,APR-DRG,,,,,,,,inpatient,,,109772.6,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10297,,186% x Medicaid HMO amount,10297,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22033,,"27,634 x DRG Weight",22033,Other,DRG Base Rate x DRG Weight,18727,,"23,488 x DRG Weight",18727,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5536.21,,DRG base rate x DRG weight + capital per discharge,5536.21,Other,100% of NY Medicaid HMO DRG,5536,,DRG base rate x DRG weight + capital per discharge,5536,Other,100% of NY Medicaid HMO DRG,5536,,DRG base rate x DRG weight + capital per discharge,5536,Other,100% of NY Medicaid HMO DRG,5536,,DRG base rate x DRG weight + capital per discharge,5536,Other,100% of NY Medicaid HMO DRG,12456,,225% x Medicaid HMO amount,12456,Other,225% of NY Medicaid HMO DRG,8470,,153% x Medicaid HMO amount,8470,Other,153% of NY Medicaid HMO DRG,12456,,225% x Medicaid HMO amount,12456,Other,225% of NY Medicaid HMO DRG,7751,,140% x Medicaid HMO amount,7751,Other,140% of NY Medicaid HMO DRG,12456,,DRG base rate x DRG weight + capital per discharge,12456,Other,225% of NY Medicaid HMO DRG,15225,,275% x Medicaid HMO amount,15225,Other,275% of NY Medicaid HMO DRG,17937,,324% x Medicaid HMO amount,17937,Other,324% of NY Medicaid HMO DRG,11903,,215% x Medicaid HMO amount,11903,Other,215% of NY Medicaid HMO DRG,11903,,215% x Medicaid HMO amount,11903,Other,215% of NY Medicaid HMO DRG,6920,,125% x Medicaid HMO amount,6920,Other,125% of NY Medicaid HMO DRG,0.01,22033,
CVA & precerebral occlusion w infarct,045-2,APR-DRG,,,,,,,,inpatient,,,210289.76,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14006,,186% x Medicaid HMO amount,14006,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30710,,"27,634 x DRG Weight",30710,Other,DRG Base Rate x DRG Weight,26102,,"23,488 x DRG Weight",26102,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7530.21,,DRG base rate x DRG weight + capital per discharge,7530.21,Other,100% of NY Medicaid HMO DRG,7530,,DRG base rate x DRG weight + capital per discharge,7530,Other,100% of NY Medicaid HMO DRG,7530,,DRG base rate x DRG weight + capital per discharge,7530,Other,100% of NY Medicaid HMO DRG,7530,,DRG base rate x DRG weight + capital per discharge,7530,Other,100% of NY Medicaid HMO DRG,16943,,225% x Medicaid HMO amount,16943,Other,225% of NY Medicaid HMO DRG,11521,,153% x Medicaid HMO amount,11521,Other,153% of NY Medicaid HMO DRG,16943,,225% x Medicaid HMO amount,16943,Other,225% of NY Medicaid HMO DRG,10542,,140% x Medicaid HMO amount,10542,Other,140% of NY Medicaid HMO DRG,16943,,DRG base rate x DRG weight + capital per discharge,16943,Other,225% of NY Medicaid HMO DRG,20708,,275% x Medicaid HMO amount,20708,Other,275% of NY Medicaid HMO DRG,24398,,324% x Medicaid HMO amount,24398,Other,324% of NY Medicaid HMO DRG,16190,,215% x Medicaid HMO amount,16190,Other,215% of NY Medicaid HMO DRG,16190,,215% x Medicaid HMO amount,16190,Other,215% of NY Medicaid HMO DRG,9413,,125% x Medicaid HMO amount,9413,Other,125% of NY Medicaid HMO DRG,0.01,30710,
CVA & precerebral occlusion w infarct,045-3,APR-DRG,,,,,,,,inpatient,,,205432.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21210,,186% x Medicaid HMO amount,21210,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47566,,"27,634 x DRG Weight",47566,Other,DRG Base Rate x DRG Weight,40430,,"23,488 x DRG Weight",40430,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11403.21,,DRG base rate x DRG weight + capital per discharge,11403.21,Other,100% of NY Medicaid HMO DRG,11403,,DRG base rate x DRG weight + capital per discharge,11403,Other,100% of NY Medicaid HMO DRG,11403,,DRG base rate x DRG weight + capital per discharge,11403,Other,100% of NY Medicaid HMO DRG,11403,,DRG base rate x DRG weight + capital per discharge,11403,Other,100% of NY Medicaid HMO DRG,25657,,225% x Medicaid HMO amount,25657,Other,225% of NY Medicaid HMO DRG,17447,,153% x Medicaid HMO amount,17447,Other,153% of NY Medicaid HMO DRG,25657,,225% x Medicaid HMO amount,25657,Other,225% of NY Medicaid HMO DRG,15964,,140% x Medicaid HMO amount,15964,Other,140% of NY Medicaid HMO DRG,25657,,DRG base rate x DRG weight + capital per discharge,25657,Other,225% of NY Medicaid HMO DRG,31359,,275% x Medicaid HMO amount,31359,Other,275% of NY Medicaid HMO DRG,36946,,324% x Medicaid HMO amount,36946,Other,324% of NY Medicaid HMO DRG,24517,,215% x Medicaid HMO amount,24517,Other,215% of NY Medicaid HMO DRG,24517,,215% x Medicaid HMO amount,24517,Other,215% of NY Medicaid HMO DRG,14254,,125% x Medicaid HMO amount,14254,Other,125% of NY Medicaid HMO DRG,0.01,47566,
CVA & precerebral occlusion w infarct,045-4,APR-DRG,,,,,,,,inpatient,,,592370.68,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41275,,186% x Medicaid HMO amount,41275,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,94514,,"27,634 x DRG Weight",94514,Other,DRG Base Rate x DRG Weight,80334,,"23,488 x DRG Weight",80334,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22191.21,,DRG base rate x DRG weight + capital per discharge,22191.21,Other,100% of NY Medicaid HMO DRG,22191,,DRG base rate x DRG weight + capital per discharge,22191,Other,100% of NY Medicaid HMO DRG,22191,,DRG base rate x DRG weight + capital per discharge,22191,Other,100% of NY Medicaid HMO DRG,22191,,DRG base rate x DRG weight + capital per discharge,22191,Other,100% of NY Medicaid HMO DRG,49930,,225% x Medicaid HMO amount,49930,Other,225% of NY Medicaid HMO DRG,33953,,153% x Medicaid HMO amount,33953,Other,153% of NY Medicaid HMO DRG,49930,,225% x Medicaid HMO amount,49930,Other,225% of NY Medicaid HMO DRG,31068,,140% x Medicaid HMO amount,31068,Other,140% of NY Medicaid HMO DRG,49930,,DRG base rate x DRG weight + capital per discharge,49930,Other,225% of NY Medicaid HMO DRG,61026,,275% x Medicaid HMO amount,61026,Other,275% of NY Medicaid HMO DRG,71900,,324% x Medicaid HMO amount,71900,Other,324% of NY Medicaid HMO DRG,47711,,215% x Medicaid HMO amount,47711,Other,215% of NY Medicaid HMO DRG,47711,,215% x Medicaid HMO amount,47711,Other,215% of NY Medicaid HMO DRG,27739,,125% x Medicaid HMO amount,27739,Other,125% of NY Medicaid HMO DRG,0.01,94514,
Nonspecific CVA & precerebral occlusion w/o infarct,046-1,APR-DRG,,,,,,,,inpatient,,,63313.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8338,,186% x Medicaid HMO amount,8338,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17451,,"27,634 x DRG Weight",17451,Other,DRG Base Rate x DRG Weight,14833,,"23,488 x DRG Weight",14833,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4483.21,,DRG base rate x DRG weight + capital per discharge,4483.21,Other,100% of NY Medicaid HMO DRG,4483,,DRG base rate x DRG weight + capital per discharge,4483,Other,100% of NY Medicaid HMO DRG,4483,,DRG base rate x DRG weight + capital per discharge,4483,Other,100% of NY Medicaid HMO DRG,4483,,DRG base rate x DRG weight + capital per discharge,4483,Other,100% of NY Medicaid HMO DRG,10087,,225% x Medicaid HMO amount,10087,Other,225% of NY Medicaid HMO DRG,6859,,153% x Medicaid HMO amount,6859,Other,153% of NY Medicaid HMO DRG,10087,,225% x Medicaid HMO amount,10087,Other,225% of NY Medicaid HMO DRG,6276,,140% x Medicaid HMO amount,6276,Other,140% of NY Medicaid HMO DRG,10087,,DRG base rate x DRG weight + capital per discharge,10087,Other,225% of NY Medicaid HMO DRG,12329,,275% x Medicaid HMO amount,12329,Other,275% of NY Medicaid HMO DRG,14526,,324% x Medicaid HMO amount,14526,Other,324% of NY Medicaid HMO DRG,9639,,215% x Medicaid HMO amount,9639,Other,215% of NY Medicaid HMO DRG,9639,,215% x Medicaid HMO amount,9639,Other,215% of NY Medicaid HMO DRG,5604,,125% x Medicaid HMO amount,5604,Other,125% of NY Medicaid HMO DRG,0.01,17451,
Nonspecific CVA & precerebral occlusion w/o infarct,046-2,APR-DRG,,,,,,,,inpatient,,,125107.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10900,,186% x Medicaid HMO amount,10900,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23445,,"27,634 x DRG Weight",23445,Other,DRG Base Rate x DRG Weight,19927,,"23,488 x DRG Weight",19927,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5860.21,,DRG base rate x DRG weight + capital per discharge,5860.21,Other,100% of NY Medicaid HMO DRG,5860,,DRG base rate x DRG weight + capital per discharge,5860,Other,100% of NY Medicaid HMO DRG,5860,,DRG base rate x DRG weight + capital per discharge,5860,Other,100% of NY Medicaid HMO DRG,5860,,DRG base rate x DRG weight + capital per discharge,5860,Other,100% of NY Medicaid HMO DRG,13185,,225% x Medicaid HMO amount,13185,Other,225% of NY Medicaid HMO DRG,8966,,153% x Medicaid HMO amount,8966,Other,153% of NY Medicaid HMO DRG,13185,,225% x Medicaid HMO amount,13185,Other,225% of NY Medicaid HMO DRG,8204,,140% x Medicaid HMO amount,8204,Other,140% of NY Medicaid HMO DRG,13185,,DRG base rate x DRG weight + capital per discharge,13185,Other,225% of NY Medicaid HMO DRG,16116,,275% x Medicaid HMO amount,16116,Other,275% of NY Medicaid HMO DRG,18987,,324% x Medicaid HMO amount,18987,Other,324% of NY Medicaid HMO DRG,12599,,215% x Medicaid HMO amount,12599,Other,215% of NY Medicaid HMO DRG,12599,,215% x Medicaid HMO amount,12599,Other,215% of NY Medicaid HMO DRG,7325,,125% x Medicaid HMO amount,7325,Other,125% of NY Medicaid HMO DRG,0.01,23445,
Nonspecific CVA & precerebral occlusion w/o infarct,046-3,APR-DRG,,,,,,,,inpatient,,,91913.6,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13941,,186% x Medicaid HMO amount,13941,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30558,,"27,634 x DRG Weight",30558,Other,DRG Base Rate x DRG Weight,25973,,"23,488 x DRG Weight",25973,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7495.21,,DRG base rate x DRG weight + capital per discharge,7495.21,Other,100% of NY Medicaid HMO DRG,7495,,DRG base rate x DRG weight + capital per discharge,7495,Other,100% of NY Medicaid HMO DRG,7495,,DRG base rate x DRG weight + capital per discharge,7495,Other,100% of NY Medicaid HMO DRG,7495,,DRG base rate x DRG weight + capital per discharge,7495,Other,100% of NY Medicaid HMO DRG,16864,,225% x Medicaid HMO amount,16864,Other,225% of NY Medicaid HMO DRG,11468,,153% x Medicaid HMO amount,11468,Other,153% of NY Medicaid HMO DRG,16864,,225% x Medicaid HMO amount,16864,Other,225% of NY Medicaid HMO DRG,10493,,140% x Medicaid HMO amount,10493,Other,140% of NY Medicaid HMO DRG,16864,,DRG base rate x DRG weight + capital per discharge,16864,Other,225% of NY Medicaid HMO DRG,20612,,275% x Medicaid HMO amount,20612,Other,275% of NY Medicaid HMO DRG,24284,,324% x Medicaid HMO amount,24284,Other,324% of NY Medicaid HMO DRG,16115,,215% x Medicaid HMO amount,16115,Other,215% of NY Medicaid HMO DRG,16115,,215% x Medicaid HMO amount,16115,Other,215% of NY Medicaid HMO DRG,9369,,125% x Medicaid HMO amount,9369,Other,125% of NY Medicaid HMO DRG,0.01,30558,
Nonspecific CVA & precerebral occlusion w/o infarct,046-4,APR-DRG,,,,,,,,inpatient,,,170256,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14527,,186% x Medicaid HMO amount,14527,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31931,,"27,634 x DRG Weight",31931,Other,DRG Base Rate x DRG Weight,27140,,"23,488 x DRG Weight",27140,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7810.21,,DRG base rate x DRG weight + capital per discharge,7810.21,Other,100% of NY Medicaid HMO DRG,7810,,DRG base rate x DRG weight + capital per discharge,7810,Other,100% of NY Medicaid HMO DRG,7810,,DRG base rate x DRG weight + capital per discharge,7810,Other,100% of NY Medicaid HMO DRG,7810,,DRG base rate x DRG weight + capital per discharge,7810,Other,100% of NY Medicaid HMO DRG,17573,,225% x Medicaid HMO amount,17573,Other,225% of NY Medicaid HMO DRG,11950,,153% x Medicaid HMO amount,11950,Other,153% of NY Medicaid HMO DRG,17573,,225% x Medicaid HMO amount,17573,Other,225% of NY Medicaid HMO DRG,10934,,140% x Medicaid HMO amount,10934,Other,140% of NY Medicaid HMO DRG,17573,,DRG base rate x DRG weight + capital per discharge,17573,Other,225% of NY Medicaid HMO DRG,21478,,275% x Medicaid HMO amount,21478,Other,275% of NY Medicaid HMO DRG,25305,,324% x Medicaid HMO amount,25305,Other,324% of NY Medicaid HMO DRG,16792,,215% x Medicaid HMO amount,16792,Other,215% of NY Medicaid HMO DRG,16792,,215% x Medicaid HMO amount,16792,Other,215% of NY Medicaid HMO DRG,9763,,125% x Medicaid HMO amount,9763,Other,125% of NY Medicaid HMO DRG,0.01,31931,
Transient ischemia,047-1,APR-DRG,,,,,,,,inpatient,,,92888.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6943,,186% x Medicaid HMO amount,6943,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14187,,"27,634 x DRG Weight",14187,Other,DRG Base Rate x DRG Weight,12059,,"23,488 x DRG Weight",12059,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3733.21,,DRG base rate x DRG weight + capital per discharge,3733.21,Other,100% of NY Medicaid HMO DRG,3733,,DRG base rate x DRG weight + capital per discharge,3733,Other,100% of NY Medicaid HMO DRG,3733,,DRG base rate x DRG weight + capital per discharge,3733,Other,100% of NY Medicaid HMO DRG,3733,,DRG base rate x DRG weight + capital per discharge,3733,Other,100% of NY Medicaid HMO DRG,8400,,225% x Medicaid HMO amount,8400,Other,225% of NY Medicaid HMO DRG,5712,,153% x Medicaid HMO amount,5712,Other,153% of NY Medicaid HMO DRG,8400,,225% x Medicaid HMO amount,8400,Other,225% of NY Medicaid HMO DRG,5226,,140% x Medicaid HMO amount,5226,Other,140% of NY Medicaid HMO DRG,8400,,DRG base rate x DRG weight + capital per discharge,8400,Other,225% of NY Medicaid HMO DRG,10266,,275% x Medicaid HMO amount,10266,Other,275% of NY Medicaid HMO DRG,12096,,324% x Medicaid HMO amount,12096,Other,324% of NY Medicaid HMO DRG,8026,,215% x Medicaid HMO amount,8026,Other,215% of NY Medicaid HMO DRG,8026,,215% x Medicaid HMO amount,8026,Other,215% of NY Medicaid HMO DRG,4667,,125% x Medicaid HMO amount,4667,Other,125% of NY Medicaid HMO DRG,0.01,14187,
Transient ischemia,047-2,APR-DRG,,,,,,,,inpatient,,,114868.04,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8355,,186% x Medicaid HMO amount,8355,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17490,,"27,634 x DRG Weight",17490,Other,DRG Base Rate x DRG Weight,14866,,"23,488 x DRG Weight",14866,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4492.21,,DRG base rate x DRG weight + capital per discharge,4492.21,Other,100% of NY Medicaid HMO DRG,4492,,DRG base rate x DRG weight + capital per discharge,4492,Other,100% of NY Medicaid HMO DRG,4492,,DRG base rate x DRG weight + capital per discharge,4492,Other,100% of NY Medicaid HMO DRG,4492,,DRG base rate x DRG weight + capital per discharge,4492,Other,100% of NY Medicaid HMO DRG,10107,,225% x Medicaid HMO amount,10107,Other,225% of NY Medicaid HMO DRG,6873,,153% x Medicaid HMO amount,6873,Other,153% of NY Medicaid HMO DRG,10107,,225% x Medicaid HMO amount,10107,Other,225% of NY Medicaid HMO DRG,6289,,140% x Medicaid HMO amount,6289,Other,140% of NY Medicaid HMO DRG,10107,,DRG base rate x DRG weight + capital per discharge,10107,Other,225% of NY Medicaid HMO DRG,12354,,275% x Medicaid HMO amount,12354,Other,275% of NY Medicaid HMO DRG,14555,,324% x Medicaid HMO amount,14555,Other,324% of NY Medicaid HMO DRG,9658,,215% x Medicaid HMO amount,9658,Other,215% of NY Medicaid HMO DRG,9658,,215% x Medicaid HMO amount,9658,Other,215% of NY Medicaid HMO DRG,5615,,125% x Medicaid HMO amount,5615,Other,125% of NY Medicaid HMO DRG,0.01,17490,
Transient ischemia,047-3,APR-DRG,,,,,,,,inpatient,,,86204.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11221,,186% x Medicaid HMO amount,11221,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24196,,"27,634 x DRG Weight",24196,Other,DRG Base Rate x DRG Weight,20566,,"23,488 x DRG Weight",20566,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6033.21,,DRG base rate x DRG weight + capital per discharge,6033.21,Other,100% of NY Medicaid HMO DRG,6033,,DRG base rate x DRG weight + capital per discharge,6033,Other,100% of NY Medicaid HMO DRG,6033,,DRG base rate x DRG weight + capital per discharge,6033,Other,100% of NY Medicaid HMO DRG,6033,,DRG base rate x DRG weight + capital per discharge,6033,Other,100% of NY Medicaid HMO DRG,13575,,225% x Medicaid HMO amount,13575,Other,225% of NY Medicaid HMO DRG,9231,,153% x Medicaid HMO amount,9231,Other,153% of NY Medicaid HMO DRG,13575,,225% x Medicaid HMO amount,13575,Other,225% of NY Medicaid HMO DRG,8446,,140% x Medicaid HMO amount,8446,Other,140% of NY Medicaid HMO DRG,13575,,DRG base rate x DRG weight + capital per discharge,13575,Other,225% of NY Medicaid HMO DRG,16591,,275% x Medicaid HMO amount,16591,Other,275% of NY Medicaid HMO DRG,19548,,324% x Medicaid HMO amount,19548,Other,324% of NY Medicaid HMO DRG,12971,,215% x Medicaid HMO amount,12971,Other,215% of NY Medicaid HMO DRG,12971,,215% x Medicaid HMO amount,12971,Other,215% of NY Medicaid HMO DRG,7542,,125% x Medicaid HMO amount,7542,Other,125% of NY Medicaid HMO DRG,0.01,24196,
Transient ischemia,047-4,APR-DRG,,,,,,,,inpatient,,,114868.04,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11469,,186% x Medicaid HMO amount,11469,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24774,,"27,634 x DRG Weight",24774,Other,DRG Base Rate x DRG Weight,21057,,"23,488 x DRG Weight",21057,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6166.21,,DRG base rate x DRG weight + capital per discharge,6166.21,Other,100% of NY Medicaid HMO DRG,6166,,DRG base rate x DRG weight + capital per discharge,6166,Other,100% of NY Medicaid HMO DRG,6166,,DRG base rate x DRG weight + capital per discharge,6166,Other,100% of NY Medicaid HMO DRG,6166,,DRG base rate x DRG weight + capital per discharge,6166,Other,100% of NY Medicaid HMO DRG,13874,,225% x Medicaid HMO amount,13874,Other,225% of NY Medicaid HMO DRG,9434,,153% x Medicaid HMO amount,9434,Other,153% of NY Medicaid HMO DRG,13874,,225% x Medicaid HMO amount,13874,Other,225% of NY Medicaid HMO DRG,8633,,140% x Medicaid HMO amount,8633,Other,140% of NY Medicaid HMO DRG,13874,,DRG base rate x DRG weight + capital per discharge,13874,Other,225% of NY Medicaid HMO DRG,16957,,275% x Medicaid HMO amount,16957,Other,275% of NY Medicaid HMO DRG,19979,,324% x Medicaid HMO amount,19979,Other,324% of NY Medicaid HMO DRG,13257,,215% x Medicaid HMO amount,13257,Other,215% of NY Medicaid HMO DRG,13257,,215% x Medicaid HMO amount,13257,Other,215% of NY Medicaid HMO DRG,7708,,125% x Medicaid HMO amount,7708,Other,125% of NY Medicaid HMO DRG,0.01,24774,
"Peripheral, cranial & autonomic nerve disorders",048-1,APR-DRG,,,,,,,,inpatient,,,146144.94,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7421,,186% x Medicaid HMO amount,7421,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15304,,"27,634 x DRG Weight",15304,Other,DRG Base Rate x DRG Weight,13008,,"23,488 x DRG Weight",13008,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3990.21,,DRG base rate x DRG weight + capital per discharge,3990.21,Other,100% of NY Medicaid HMO DRG,3990,,DRG base rate x DRG weight + capital per discharge,3990,Other,100% of NY Medicaid HMO DRG,3990,,DRG base rate x DRG weight + capital per discharge,3990,Other,100% of NY Medicaid HMO DRG,3990,,DRG base rate x DRG weight + capital per discharge,3990,Other,100% of NY Medicaid HMO DRG,8978,,225% x Medicaid HMO amount,8978,Other,225% of NY Medicaid HMO DRG,6105,,153% x Medicaid HMO amount,6105,Other,153% of NY Medicaid HMO DRG,8978,,225% x Medicaid HMO amount,8978,Other,225% of NY Medicaid HMO DRG,5586,,140% x Medicaid HMO amount,5586,Other,140% of NY Medicaid HMO DRG,8978,,DRG base rate x DRG weight + capital per discharge,8978,Other,225% of NY Medicaid HMO DRG,10973,,275% x Medicaid HMO amount,10973,Other,275% of NY Medicaid HMO DRG,12928,,324% x Medicaid HMO amount,12928,Other,324% of NY Medicaid HMO DRG,8579,,215% x Medicaid HMO amount,8579,Other,215% of NY Medicaid HMO DRG,8579,,215% x Medicaid HMO amount,8579,Other,215% of NY Medicaid HMO DRG,4988,,125% x Medicaid HMO amount,4988,Other,125% of NY Medicaid HMO DRG,0.01,15304,
"Peripheral, cranial & autonomic nerve disorders",048-2,APR-DRG,,,,,,,,inpatient,,,250051.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9611,,186% x Medicaid HMO amount,9611,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20430,,"27,634 x DRG Weight",20430,Other,DRG Base Rate x DRG Weight,17365,,"23,488 x DRG Weight",17365,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5167.21,,DRG base rate x DRG weight + capital per discharge,5167.21,Other,100% of NY Medicaid HMO DRG,5167,,DRG base rate x DRG weight + capital per discharge,5167,Other,100% of NY Medicaid HMO DRG,5167,,DRG base rate x DRG weight + capital per discharge,5167,Other,100% of NY Medicaid HMO DRG,5167,,DRG base rate x DRG weight + capital per discharge,5167,Other,100% of NY Medicaid HMO DRG,11626,,225% x Medicaid HMO amount,11626,Other,225% of NY Medicaid HMO DRG,7906,,153% x Medicaid HMO amount,7906,Other,153% of NY Medicaid HMO DRG,11626,,225% x Medicaid HMO amount,11626,Other,225% of NY Medicaid HMO DRG,7234,,140% x Medicaid HMO amount,7234,Other,140% of NY Medicaid HMO DRG,11626,,DRG base rate x DRG weight + capital per discharge,11626,Other,225% of NY Medicaid HMO DRG,14210,,275% x Medicaid HMO amount,14210,Other,275% of NY Medicaid HMO DRG,16742,,324% x Medicaid HMO amount,16742,Other,324% of NY Medicaid HMO DRG,11110,,215% x Medicaid HMO amount,11110,Other,215% of NY Medicaid HMO DRG,11110,,215% x Medicaid HMO amount,11110,Other,215% of NY Medicaid HMO DRG,6459,,125% x Medicaid HMO amount,6459,Other,125% of NY Medicaid HMO DRG,0.01,20430,
"Peripheral, cranial & autonomic nerve disorders",048-3,APR-DRG,,,,,,,,inpatient,,,137867.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13944,,186% x Medicaid HMO amount,13944,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30566,,"27,634 x DRG Weight",30566,Other,DRG Base Rate x DRG Weight,25980,,"23,488 x DRG Weight",25980,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7497.21,,DRG base rate x DRG weight + capital per discharge,7497.21,Other,100% of NY Medicaid HMO DRG,7497,,DRG base rate x DRG weight + capital per discharge,7497,Other,100% of NY Medicaid HMO DRG,7497,,DRG base rate x DRG weight + capital per discharge,7497,Other,100% of NY Medicaid HMO DRG,7497,,DRG base rate x DRG weight + capital per discharge,7497,Other,100% of NY Medicaid HMO DRG,16869,,225% x Medicaid HMO amount,16869,Other,225% of NY Medicaid HMO DRG,11471,,153% x Medicaid HMO amount,11471,Other,153% of NY Medicaid HMO DRG,16869,,225% x Medicaid HMO amount,16869,Other,225% of NY Medicaid HMO DRG,10496,,140% x Medicaid HMO amount,10496,Other,140% of NY Medicaid HMO DRG,16869,,DRG base rate x DRG weight + capital per discharge,16869,Other,225% of NY Medicaid HMO DRG,20617,,275% x Medicaid HMO amount,20617,Other,275% of NY Medicaid HMO DRG,24291,,324% x Medicaid HMO amount,24291,Other,324% of NY Medicaid HMO DRG,16119,,215% x Medicaid HMO amount,16119,Other,215% of NY Medicaid HMO DRG,16119,,215% x Medicaid HMO amount,16119,Other,215% of NY Medicaid HMO DRG,9372,,125% x Medicaid HMO amount,9372,Other,125% of NY Medicaid HMO DRG,0.01,30566,
"Peripheral, cranial & autonomic nerve disorders",048-4,APR-DRG,,,,,,,,inpatient,,,240670.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42032,,186% x Medicaid HMO amount,42032,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,96285,,"27,634 x DRG Weight",96285,Other,DRG Base Rate x DRG Weight,81839,,"23,488 x DRG Weight",81839,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22598.21,,DRG base rate x DRG weight + capital per discharge,22598.21,Other,100% of NY Medicaid HMO DRG,22598,,DRG base rate x DRG weight + capital per discharge,22598,Other,100% of NY Medicaid HMO DRG,22598,,DRG base rate x DRG weight + capital per discharge,22598,Other,100% of NY Medicaid HMO DRG,22598,,DRG base rate x DRG weight + capital per discharge,22598,Other,100% of NY Medicaid HMO DRG,50846,,225% x Medicaid HMO amount,50846,Other,225% of NY Medicaid HMO DRG,34575,,153% x Medicaid HMO amount,34575,Other,153% of NY Medicaid HMO DRG,50846,,225% x Medicaid HMO amount,50846,Other,225% of NY Medicaid HMO DRG,31637,,140% x Medicaid HMO amount,31637,Other,140% of NY Medicaid HMO DRG,50846,,DRG base rate x DRG weight + capital per discharge,50846,Other,225% of NY Medicaid HMO DRG,62145,,275% x Medicaid HMO amount,62145,Other,275% of NY Medicaid HMO DRG,73218,,324% x Medicaid HMO amount,73218,Other,324% of NY Medicaid HMO DRG,48586,,215% x Medicaid HMO amount,48586,Other,215% of NY Medicaid HMO DRG,48586,,215% x Medicaid HMO amount,48586,Other,215% of NY Medicaid HMO DRG,28248,,125% x Medicaid HMO amount,28248,Other,125% of NY Medicaid HMO DRG,0.01,96285,
Bacterial & tuberculous infections of nervous system,049-1,APR-DRG,,,,,,,,inpatient,,,238126.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14636,,186% x Medicaid HMO amount,14636,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32188,,"27,634 x DRG Weight",32188,Other,DRG Base Rate x DRG Weight,27359,,"23,488 x DRG Weight",27359,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7869.21,,DRG base rate x DRG weight + capital per discharge,7869.21,Other,100% of NY Medicaid HMO DRG,7869,,DRG base rate x DRG weight + capital per discharge,7869,Other,100% of NY Medicaid HMO DRG,7869,,DRG base rate x DRG weight + capital per discharge,7869,Other,100% of NY Medicaid HMO DRG,7869,,DRG base rate x DRG weight + capital per discharge,7869,Other,100% of NY Medicaid HMO DRG,17706,,225% x Medicaid HMO amount,17706,Other,225% of NY Medicaid HMO DRG,12040,,153% x Medicaid HMO amount,12040,Other,153% of NY Medicaid HMO DRG,17706,,225% x Medicaid HMO amount,17706,Other,225% of NY Medicaid HMO DRG,11017,,140% x Medicaid HMO amount,11017,Other,140% of NY Medicaid HMO DRG,17706,,DRG base rate x DRG weight + capital per discharge,17706,Other,225% of NY Medicaid HMO DRG,21640,,275% x Medicaid HMO amount,21640,Other,275% of NY Medicaid HMO DRG,25496,,324% x Medicaid HMO amount,25496,Other,324% of NY Medicaid HMO DRG,16919,,215% x Medicaid HMO amount,16919,Other,215% of NY Medicaid HMO DRG,16919,,215% x Medicaid HMO amount,16919,Other,215% of NY Medicaid HMO DRG,9837,,125% x Medicaid HMO amount,9837,Other,125% of NY Medicaid HMO DRG,0.01,32188,
Bacterial & tuberculous infections of nervous system,049-2,APR-DRG,,,,,,,,inpatient,,,201766.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30279,,186% x Medicaid HMO amount,30279,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,68784,,"27,634 x DRG Weight",68784,Other,DRG Base Rate x DRG Weight,58464,,"23,488 x DRG Weight",58464,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16279.21,,DRG base rate x DRG weight + capital per discharge,16279.21,Other,100% of NY Medicaid HMO DRG,16279,,DRG base rate x DRG weight + capital per discharge,16279,Other,100% of NY Medicaid HMO DRG,16279,,DRG base rate x DRG weight + capital per discharge,16279,Other,100% of NY Medicaid HMO DRG,16279,,DRG base rate x DRG weight + capital per discharge,16279,Other,100% of NY Medicaid HMO DRG,36628,,225% x Medicaid HMO amount,36628,Other,225% of NY Medicaid HMO DRG,24907,,153% x Medicaid HMO amount,24907,Other,153% of NY Medicaid HMO DRG,36628,,225% x Medicaid HMO amount,36628,Other,225% of NY Medicaid HMO DRG,22791,,140% x Medicaid HMO amount,22791,Other,140% of NY Medicaid HMO DRG,36628,,DRG base rate x DRG weight + capital per discharge,36628,Other,225% of NY Medicaid HMO DRG,44768,,275% x Medicaid HMO amount,44768,Other,275% of NY Medicaid HMO DRG,52745,,324% x Medicaid HMO amount,52745,Other,324% of NY Medicaid HMO DRG,35000,,215% x Medicaid HMO amount,35000,Other,215% of NY Medicaid HMO DRG,35000,,215% x Medicaid HMO amount,35000,Other,215% of NY Medicaid HMO DRG,20349,,125% x Medicaid HMO amount,20349,Other,125% of NY Medicaid HMO DRG,0.01,68784,
Bacterial & tuberculous infections of nervous system,049-3,APR-DRG,,,,,,,,inpatient,,,393665.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38681,,186% x Medicaid HMO amount,38681,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,88443,,"27,634 x DRG Weight",88443,Other,DRG Base Rate x DRG Weight,75173,,"23,488 x DRG Weight",75173,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20796.21,,DRG base rate x DRG weight + capital per discharge,20796.21,Other,100% of NY Medicaid HMO DRG,20796,,DRG base rate x DRG weight + capital per discharge,20796,Other,100% of NY Medicaid HMO DRG,20796,,DRG base rate x DRG weight + capital per discharge,20796,Other,100% of NY Medicaid HMO DRG,20796,,DRG base rate x DRG weight + capital per discharge,20796,Other,100% of NY Medicaid HMO DRG,46791,,225% x Medicaid HMO amount,46791,Other,225% of NY Medicaid HMO DRG,31818,,153% x Medicaid HMO amount,31818,Other,153% of NY Medicaid HMO DRG,46791,,225% x Medicaid HMO amount,46791,Other,225% of NY Medicaid HMO DRG,29115,,140% x Medicaid HMO amount,29115,Other,140% of NY Medicaid HMO DRG,46791,,DRG base rate x DRG weight + capital per discharge,46791,Other,225% of NY Medicaid HMO DRG,57190,,275% x Medicaid HMO amount,57190,Other,275% of NY Medicaid HMO DRG,67380,,324% x Medicaid HMO amount,67380,Other,324% of NY Medicaid HMO DRG,44712,,215% x Medicaid HMO amount,44712,Other,215% of NY Medicaid HMO DRG,44712,,215% x Medicaid HMO amount,44712,Other,215% of NY Medicaid HMO DRG,25995,,125% x Medicaid HMO amount,25995,Other,125% of NY Medicaid HMO DRG,0.01,88443,
Bacterial & tuberculous infections of nervous system,049-4,APR-DRG,,,,,,,,inpatient,,,401539.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,71363,,186% x Medicaid HMO amount,71363,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,164906,,"27,634 x DRG Weight",164906,Other,DRG Base Rate x DRG Weight,140165,,"23,488 x DRG Weight",140165,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38367.21,,DRG base rate x DRG weight + capital per discharge,38367.21,Other,100% of NY Medicaid HMO DRG,38367,,DRG base rate x DRG weight + capital per discharge,38367,Other,100% of NY Medicaid HMO DRG,38367,,DRG base rate x DRG weight + capital per discharge,38367,Other,100% of NY Medicaid HMO DRG,38367,,DRG base rate x DRG weight + capital per discharge,38367,Other,100% of NY Medicaid HMO DRG,86326,,225% x Medicaid HMO amount,86326,Other,225% of NY Medicaid HMO DRG,58702,,153% x Medicaid HMO amount,58702,Other,153% of NY Medicaid HMO DRG,86326,,225% x Medicaid HMO amount,86326,Other,225% of NY Medicaid HMO DRG,53714,,140% x Medicaid HMO amount,53714,Other,140% of NY Medicaid HMO DRG,86326,,DRG base rate x DRG weight + capital per discharge,86326,Other,225% of NY Medicaid HMO DRG,105510,,275% x Medicaid HMO amount,105510,Other,275% of NY Medicaid HMO DRG,124310,,324% x Medicaid HMO amount,124310,Other,324% of NY Medicaid HMO DRG,82490,,215% x Medicaid HMO amount,82490,Other,215% of NY Medicaid HMO DRG,82490,,215% x Medicaid HMO amount,82490,Other,215% of NY Medicaid HMO DRG,47959,,125% x Medicaid HMO amount,47959,Other,125% of NY Medicaid HMO DRG,0.01,164906,
Non-bacterial infections of nervous system exc viral meningitis,050-1,APR-DRG,,,,,,,,inpatient,,,135796,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9745,,186% x Medicaid HMO amount,9745,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20739,,"27,634 x DRG Weight",20739,Other,DRG Base Rate x DRG Weight,17628,,"23,488 x DRG Weight",17628,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5239.21,,DRG base rate x DRG weight + capital per discharge,5239.21,Other,100% of NY Medicaid HMO DRG,5239,,DRG base rate x DRG weight + capital per discharge,5239,Other,100% of NY Medicaid HMO DRG,5239,,DRG base rate x DRG weight + capital per discharge,5239,Other,100% of NY Medicaid HMO DRG,5239,,DRG base rate x DRG weight + capital per discharge,5239,Other,100% of NY Medicaid HMO DRG,11788,,225% x Medicaid HMO amount,11788,Other,225% of NY Medicaid HMO DRG,8016,,153% x Medicaid HMO amount,8016,Other,153% of NY Medicaid HMO DRG,11788,,225% x Medicaid HMO amount,11788,Other,225% of NY Medicaid HMO DRG,7335,,140% x Medicaid HMO amount,7335,Other,140% of NY Medicaid HMO DRG,11788,,DRG base rate x DRG weight + capital per discharge,11788,Other,225% of NY Medicaid HMO DRG,14408,,275% x Medicaid HMO amount,14408,Other,275% of NY Medicaid HMO DRG,16975,,324% x Medicaid HMO amount,16975,Other,324% of NY Medicaid HMO DRG,11264,,215% x Medicaid HMO amount,11264,Other,215% of NY Medicaid HMO DRG,11264,,215% x Medicaid HMO amount,11264,Other,215% of NY Medicaid HMO DRG,6549,,125% x Medicaid HMO amount,6549,Other,125% of NY Medicaid HMO DRG,0.01,20739,
Non-bacterial infections of nervous system exc viral meningitis,050-2,APR-DRG,,,,,,,,inpatient,,,287236.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16853,,186% x Medicaid HMO amount,16853,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37375,,"27,634 x DRG Weight",37375,Other,DRG Base Rate x DRG Weight,31768,,"23,488 x DRG Weight",31768,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9061.21,,DRG base rate x DRG weight + capital per discharge,9061.21,Other,100% of NY Medicaid HMO DRG,9061,,DRG base rate x DRG weight + capital per discharge,9061,Other,100% of NY Medicaid HMO DRG,9061,,DRG base rate x DRG weight + capital per discharge,9061,Other,100% of NY Medicaid HMO DRG,9061,,DRG base rate x DRG weight + capital per discharge,9061,Other,100% of NY Medicaid HMO DRG,20388,,225% x Medicaid HMO amount,20388,Other,225% of NY Medicaid HMO DRG,13864,,153% x Medicaid HMO amount,13864,Other,153% of NY Medicaid HMO DRG,20388,,225% x Medicaid HMO amount,20388,Other,225% of NY Medicaid HMO DRG,12686,,140% x Medicaid HMO amount,12686,Other,140% of NY Medicaid HMO DRG,20388,,DRG base rate x DRG weight + capital per discharge,20388,Other,225% of NY Medicaid HMO DRG,24918,,275% x Medicaid HMO amount,24918,Other,275% of NY Medicaid HMO DRG,29358,,324% x Medicaid HMO amount,29358,Other,324% of NY Medicaid HMO DRG,19482,,215% x Medicaid HMO amount,19482,Other,215% of NY Medicaid HMO DRG,19482,,215% x Medicaid HMO amount,19482,Other,215% of NY Medicaid HMO DRG,11327,,125% x Medicaid HMO amount,11327,Other,125% of NY Medicaid HMO DRG,0.01,37375,
Non-bacterial infections of nervous system exc viral meningitis,050-3,APR-DRG,,,,,,,,inpatient,,,289045.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26918,,186% x Medicaid HMO amount,26918,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60922,,"27,634 x DRG Weight",60922,Other,DRG Base Rate x DRG Weight,51782,,"23,488 x DRG Weight",51782,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14472.21,,DRG base rate x DRG weight + capital per discharge,14472.21,Other,100% of NY Medicaid HMO DRG,14472,,DRG base rate x DRG weight + capital per discharge,14472,Other,100% of NY Medicaid HMO DRG,14472,,DRG base rate x DRG weight + capital per discharge,14472,Other,100% of NY Medicaid HMO DRG,14472,,DRG base rate x DRG weight + capital per discharge,14472,Other,100% of NY Medicaid HMO DRG,32562,,225% x Medicaid HMO amount,32562,Other,225% of NY Medicaid HMO DRG,22142,,153% x Medicaid HMO amount,22142,Other,153% of NY Medicaid HMO DRG,32562,,225% x Medicaid HMO amount,32562,Other,225% of NY Medicaid HMO DRG,20261,,140% x Medicaid HMO amount,20261,Other,140% of NY Medicaid HMO DRG,32562,,DRG base rate x DRG weight + capital per discharge,32562,Other,225% of NY Medicaid HMO DRG,39799,,275% x Medicaid HMO amount,39799,Other,275% of NY Medicaid HMO DRG,46890,,324% x Medicaid HMO amount,46890,Other,324% of NY Medicaid HMO DRG,31115,,215% x Medicaid HMO amount,31115,Other,215% of NY Medicaid HMO DRG,31115,,215% x Medicaid HMO amount,31115,Other,215% of NY Medicaid HMO DRG,18090,,125% x Medicaid HMO amount,18090,Other,125% of NY Medicaid HMO DRG,0.01,60922,
Non-bacterial infections of nervous system exc viral meningitis,050-4,APR-DRG,,,,,,,,inpatient,,,785355.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64027,,186% x Medicaid HMO amount,64027,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,147745,,"27,634 x DRG Weight",147745,Other,DRG Base Rate x DRG Weight,125579,,"23,488 x DRG Weight",125579,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34423.21,,DRG base rate x DRG weight + capital per discharge,34423.21,Other,100% of NY Medicaid HMO DRG,34423,,DRG base rate x DRG weight + capital per discharge,34423,Other,100% of NY Medicaid HMO DRG,34423,,DRG base rate x DRG weight + capital per discharge,34423,Other,100% of NY Medicaid HMO DRG,34423,,DRG base rate x DRG weight + capital per discharge,34423,Other,100% of NY Medicaid HMO DRG,77452,,225% x Medicaid HMO amount,77452,Other,225% of NY Medicaid HMO DRG,52668,,153% x Medicaid HMO amount,52668,Other,153% of NY Medicaid HMO DRG,77452,,225% x Medicaid HMO amount,77452,Other,225% of NY Medicaid HMO DRG,48192,,140% x Medicaid HMO amount,48192,Other,140% of NY Medicaid HMO DRG,77452,,DRG base rate x DRG weight + capital per discharge,77452,Other,225% of NY Medicaid HMO DRG,94664,,275% x Medicaid HMO amount,94664,Other,275% of NY Medicaid HMO DRG,111531,,324% x Medicaid HMO amount,111531,Other,324% of NY Medicaid HMO DRG,74010,,215% x Medicaid HMO amount,74010,Other,215% of NY Medicaid HMO DRG,74010,,215% x Medicaid HMO amount,74010,Other,215% of NY Medicaid HMO DRG,43029,,125% x Medicaid HMO amount,43029,Other,125% of NY Medicaid HMO DRG,0.01,147745,
Viral meningitis,051-1,APR-DRG,,,,,,,,inpatient,,,99340.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8169,,186% x Medicaid HMO amount,8169,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17056,,"27,634 x DRG Weight",17056,Other,DRG Base Rate x DRG Weight,14497,,"23,488 x DRG Weight",14497,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4392.21,,DRG base rate x DRG weight + capital per discharge,4392.21,Other,100% of NY Medicaid HMO DRG,4392,,DRG base rate x DRG weight + capital per discharge,4392,Other,100% of NY Medicaid HMO DRG,4392,,DRG base rate x DRG weight + capital per discharge,4392,Other,100% of NY Medicaid HMO DRG,4392,,DRG base rate x DRG weight + capital per discharge,4392,Other,100% of NY Medicaid HMO DRG,9882,,225% x Medicaid HMO amount,9882,Other,225% of NY Medicaid HMO DRG,6720,,153% x Medicaid HMO amount,6720,Other,153% of NY Medicaid HMO DRG,9882,,225% x Medicaid HMO amount,9882,Other,225% of NY Medicaid HMO DRG,6149,,140% x Medicaid HMO amount,6149,Other,140% of NY Medicaid HMO DRG,9882,,DRG base rate x DRG weight + capital per discharge,9882,Other,225% of NY Medicaid HMO DRG,12079,,275% x Medicaid HMO amount,12079,Other,275% of NY Medicaid HMO DRG,14231,,324% x Medicaid HMO amount,14231,Other,324% of NY Medicaid HMO DRG,9443,,215% x Medicaid HMO amount,9443,Other,215% of NY Medicaid HMO DRG,9443,,215% x Medicaid HMO amount,9443,Other,215% of NY Medicaid HMO DRG,5490,,125% x Medicaid HMO amount,5490,Other,125% of NY Medicaid HMO DRG,0.01,17056,
Viral meningitis,051-2,APR-DRG,,,,,,,,inpatient,,,68612.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10130,,186% x Medicaid HMO amount,10130,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21643,,"27,634 x DRG Weight",21643,Other,DRG Base Rate x DRG Weight,18396,,"23,488 x DRG Weight",18396,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5446.21,,DRG base rate x DRG weight + capital per discharge,5446.21,Other,100% of NY Medicaid HMO DRG,5446,,DRG base rate x DRG weight + capital per discharge,5446,Other,100% of NY Medicaid HMO DRG,5446,,DRG base rate x DRG weight + capital per discharge,5446,Other,100% of NY Medicaid HMO DRG,5446,,DRG base rate x DRG weight + capital per discharge,5446,Other,100% of NY Medicaid HMO DRG,12254,,225% x Medicaid HMO amount,12254,Other,225% of NY Medicaid HMO DRG,8333,,153% x Medicaid HMO amount,8333,Other,153% of NY Medicaid HMO DRG,12254,,225% x Medicaid HMO amount,12254,Other,225% of NY Medicaid HMO DRG,7625,,140% x Medicaid HMO amount,7625,Other,140% of NY Medicaid HMO DRG,12254,,DRG base rate x DRG weight + capital per discharge,12254,Other,225% of NY Medicaid HMO DRG,14977,,275% x Medicaid HMO amount,14977,Other,275% of NY Medicaid HMO DRG,17646,,324% x Medicaid HMO amount,17646,Other,324% of NY Medicaid HMO DRG,11709,,215% x Medicaid HMO amount,11709,Other,215% of NY Medicaid HMO DRG,11709,,215% x Medicaid HMO amount,11709,Other,215% of NY Medicaid HMO DRG,6808,,125% x Medicaid HMO amount,6808,Other,125% of NY Medicaid HMO DRG,0.01,21643,
Viral meningitis,051-3,APR-DRG,,,,,,,,inpatient,,,110348.54,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18795,,186% x Medicaid HMO amount,18795,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41915,,"27,634 x DRG Weight",41915,Other,DRG Base Rate x DRG Weight,35627,,"23,488 x DRG Weight",35627,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10105.21,,DRG base rate x DRG weight + capital per discharge,10105.21,Other,100% of NY Medicaid HMO DRG,10105,,DRG base rate x DRG weight + capital per discharge,10105,Other,100% of NY Medicaid HMO DRG,10105,,DRG base rate x DRG weight + capital per discharge,10105,Other,100% of NY Medicaid HMO DRG,10105,,DRG base rate x DRG weight + capital per discharge,10105,Other,100% of NY Medicaid HMO DRG,22737,,225% x Medicaid HMO amount,22737,Other,225% of NY Medicaid HMO DRG,15461,,153% x Medicaid HMO amount,15461,Other,153% of NY Medicaid HMO DRG,22737,,225% x Medicaid HMO amount,22737,Other,225% of NY Medicaid HMO DRG,14147,,140% x Medicaid HMO amount,14147,Other,140% of NY Medicaid HMO DRG,22737,,DRG base rate x DRG weight + capital per discharge,22737,Other,225% of NY Medicaid HMO DRG,27789,,275% x Medicaid HMO amount,27789,Other,275% of NY Medicaid HMO DRG,32741,,324% x Medicaid HMO amount,32741,Other,324% of NY Medicaid HMO DRG,21726,,215% x Medicaid HMO amount,21726,Other,215% of NY Medicaid HMO DRG,21726,,215% x Medicaid HMO amount,21726,Other,215% of NY Medicaid HMO DRG,12632,,125% x Medicaid HMO amount,12632,Other,125% of NY Medicaid HMO DRG,0.01,41915,
Viral meningitis,051-4,APR-DRG,,,,,,,,inpatient,,,356085.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21323,,186% x Medicaid HMO amount,21323,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47832,,"27,634 x DRG Weight",47832,Other,DRG Base Rate x DRG Weight,40655,,"23,488 x DRG Weight",40655,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11464.21,,DRG base rate x DRG weight + capital per discharge,11464.21,Other,100% of NY Medicaid HMO DRG,11464,,DRG base rate x DRG weight + capital per discharge,11464,Other,100% of NY Medicaid HMO DRG,11464,,DRG base rate x DRG weight + capital per discharge,11464,Other,100% of NY Medicaid HMO DRG,11464,,DRG base rate x DRG weight + capital per discharge,11464,Other,100% of NY Medicaid HMO DRG,25794,,225% x Medicaid HMO amount,25794,Other,225% of NY Medicaid HMO DRG,17540,,153% x Medicaid HMO amount,17540,Other,153% of NY Medicaid HMO DRG,25794,,225% x Medicaid HMO amount,25794,Other,225% of NY Medicaid HMO DRG,16050,,140% x Medicaid HMO amount,16050,Other,140% of NY Medicaid HMO DRG,25794,,DRG base rate x DRG weight + capital per discharge,25794,Other,225% of NY Medicaid HMO DRG,31527,,275% x Medicaid HMO amount,31527,Other,275% of NY Medicaid HMO DRG,37144,,324% x Medicaid HMO amount,37144,Other,324% of NY Medicaid HMO DRG,24648,,215% x Medicaid HMO amount,24648,Other,215% of NY Medicaid HMO DRG,24648,,215% x Medicaid HMO amount,24648,Other,215% of NY Medicaid HMO DRG,14330,,125% x Medicaid HMO amount,14330,Other,125% of NY Medicaid HMO DRG,0.01,47832,
Nontraumatic stupor & coma,052-1,APR-DRG,,,,,,,,inpatient,,,102492.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7438,,186% x Medicaid HMO amount,7438,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15345,,"27,634 x DRG Weight",15345,Other,DRG Base Rate x DRG Weight,13043,,"23,488 x DRG Weight",13043,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3999.21,,DRG base rate x DRG weight + capital per discharge,3999.21,Other,100% of NY Medicaid HMO DRG,3999,,DRG base rate x DRG weight + capital per discharge,3999,Other,100% of NY Medicaid HMO DRG,3999,,DRG base rate x DRG weight + capital per discharge,3999,Other,100% of NY Medicaid HMO DRG,3999,,DRG base rate x DRG weight + capital per discharge,3999,Other,100% of NY Medicaid HMO DRG,8998,,225% x Medicaid HMO amount,8998,Other,225% of NY Medicaid HMO DRG,6119,,153% x Medicaid HMO amount,6119,Other,153% of NY Medicaid HMO DRG,8998,,225% x Medicaid HMO amount,8998,Other,225% of NY Medicaid HMO DRG,5599,,140% x Medicaid HMO amount,5599,Other,140% of NY Medicaid HMO DRG,8998,,DRG base rate x DRG weight + capital per discharge,8998,Other,225% of NY Medicaid HMO DRG,10998,,275% x Medicaid HMO amount,10998,Other,275% of NY Medicaid HMO DRG,12957,,324% x Medicaid HMO amount,12957,Other,324% of NY Medicaid HMO DRG,8598,,215% x Medicaid HMO amount,8598,Other,215% of NY Medicaid HMO DRG,8598,,215% x Medicaid HMO amount,8598,Other,215% of NY Medicaid HMO DRG,4999,,125% x Medicaid HMO amount,4999,Other,125% of NY Medicaid HMO DRG,0.01,15345,
Nontraumatic stupor & coma,052-2,APR-DRG,,,,,,,,inpatient,,,92078.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9464,,186% x Medicaid HMO amount,9464,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20084,,"27,634 x DRG Weight",20084,Other,DRG Base Rate x DRG Weight,17071,,"23,488 x DRG Weight",17071,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5088.21,,DRG base rate x DRG weight + capital per discharge,5088.21,Other,100% of NY Medicaid HMO DRG,5088,,DRG base rate x DRG weight + capital per discharge,5088,Other,100% of NY Medicaid HMO DRG,5088,,DRG base rate x DRG weight + capital per discharge,5088,Other,100% of NY Medicaid HMO DRG,5088,,DRG base rate x DRG weight + capital per discharge,5088,Other,100% of NY Medicaid HMO DRG,11448,,225% x Medicaid HMO amount,11448,Other,225% of NY Medicaid HMO DRG,7785,,153% x Medicaid HMO amount,7785,Other,153% of NY Medicaid HMO DRG,11448,,225% x Medicaid HMO amount,11448,Other,225% of NY Medicaid HMO DRG,7123,,140% x Medicaid HMO amount,7123,Other,140% of NY Medicaid HMO DRG,11448,,DRG base rate x DRG weight + capital per discharge,11448,Other,225% of NY Medicaid HMO DRG,13993,,275% x Medicaid HMO amount,13993,Other,275% of NY Medicaid HMO DRG,16486,,324% x Medicaid HMO amount,16486,Other,324% of NY Medicaid HMO DRG,10940,,215% x Medicaid HMO amount,10940,Other,215% of NY Medicaid HMO DRG,10940,,215% x Medicaid HMO amount,10940,Other,215% of NY Medicaid HMO DRG,6360,,125% x Medicaid HMO amount,6360,Other,125% of NY Medicaid HMO DRG,0.01,20084,
Nontraumatic stupor & coma,052-3,APR-DRG,,,,,,,,inpatient,,,133418.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12719,,186% x Medicaid HMO amount,12719,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27698,,"27,634 x DRG Weight",27698,Other,DRG Base Rate x DRG Weight,23542,,"23,488 x DRG Weight",23542,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6838.21,,DRG base rate x DRG weight + capital per discharge,6838.21,Other,100% of NY Medicaid HMO DRG,6838,,DRG base rate x DRG weight + capital per discharge,6838,Other,100% of NY Medicaid HMO DRG,6838,,DRG base rate x DRG weight + capital per discharge,6838,Other,100% of NY Medicaid HMO DRG,6838,,DRG base rate x DRG weight + capital per discharge,6838,Other,100% of NY Medicaid HMO DRG,15386,,225% x Medicaid HMO amount,15386,Other,225% of NY Medicaid HMO DRG,10462,,153% x Medicaid HMO amount,10462,Other,153% of NY Medicaid HMO DRG,15386,,225% x Medicaid HMO amount,15386,Other,225% of NY Medicaid HMO DRG,9573,,140% x Medicaid HMO amount,9573,Other,140% of NY Medicaid HMO DRG,15386,,DRG base rate x DRG weight + capital per discharge,15386,Other,225% of NY Medicaid HMO DRG,18805,,275% x Medicaid HMO amount,18805,Other,275% of NY Medicaid HMO DRG,22156,,324% x Medicaid HMO amount,22156,Other,324% of NY Medicaid HMO DRG,14702,,215% x Medicaid HMO amount,14702,Other,215% of NY Medicaid HMO DRG,14702,,215% x Medicaid HMO amount,14702,Other,215% of NY Medicaid HMO DRG,8548,,125% x Medicaid HMO amount,8548,Other,125% of NY Medicaid HMO DRG,0.01,27698,
Nontraumatic stupor & coma,052-4,APR-DRG,,,,,,,,inpatient,,,393684.57,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27775,,186% x Medicaid HMO amount,27775,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62928,,"27,634 x DRG Weight",62928,Other,DRG Base Rate x DRG Weight,53487,,"23,488 x DRG Weight",53487,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14933.21,,DRG base rate x DRG weight + capital per discharge,14933.21,Other,100% of NY Medicaid HMO DRG,14933,,DRG base rate x DRG weight + capital per discharge,14933,Other,100% of NY Medicaid HMO DRG,14933,,DRG base rate x DRG weight + capital per discharge,14933,Other,100% of NY Medicaid HMO DRG,14933,,DRG base rate x DRG weight + capital per discharge,14933,Other,100% of NY Medicaid HMO DRG,33600,,225% x Medicaid HMO amount,33600,Other,225% of NY Medicaid HMO DRG,22848,,153% x Medicaid HMO amount,22848,Other,153% of NY Medicaid HMO DRG,33600,,225% x Medicaid HMO amount,33600,Other,225% of NY Medicaid HMO DRG,20906,,140% x Medicaid HMO amount,20906,Other,140% of NY Medicaid HMO DRG,33600,,DRG base rate x DRG weight + capital per discharge,33600,Other,225% of NY Medicaid HMO DRG,41066,,275% x Medicaid HMO amount,41066,Other,275% of NY Medicaid HMO DRG,48384,,324% x Medicaid HMO amount,48384,Other,324% of NY Medicaid HMO DRG,32106,,215% x Medicaid HMO amount,32106,Other,215% of NY Medicaid HMO DRG,32106,,215% x Medicaid HMO amount,32106,Other,215% of NY Medicaid HMO DRG,18667,,125% x Medicaid HMO amount,18667,Other,125% of NY Medicaid HMO DRG,0.01,62928,
Seizure,053-1,APR-DRG,,,,,,,,inpatient,,,72041.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6644,,186% x Medicaid HMO amount,6644,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13485,,"27,634 x DRG Weight",13485,Other,DRG Base Rate x DRG Weight,11462,,"23,488 x DRG Weight",11462,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3572.21,,DRG base rate x DRG weight + capital per discharge,3572.21,Other,100% of NY Medicaid HMO DRG,3572,,DRG base rate x DRG weight + capital per discharge,3572,Other,100% of NY Medicaid HMO DRG,3572,,DRG base rate x DRG weight + capital per discharge,3572,Other,100% of NY Medicaid HMO DRG,3572,,DRG base rate x DRG weight + capital per discharge,3572,Other,100% of NY Medicaid HMO DRG,8037,,225% x Medicaid HMO amount,8037,Other,225% of NY Medicaid HMO DRG,5465,,153% x Medicaid HMO amount,5465,Other,153% of NY Medicaid HMO DRG,8037,,225% x Medicaid HMO amount,8037,Other,225% of NY Medicaid HMO DRG,5001,,140% x Medicaid HMO amount,5001,Other,140% of NY Medicaid HMO DRG,8037,,DRG base rate x DRG weight + capital per discharge,8037,Other,225% of NY Medicaid HMO DRG,9824,,275% x Medicaid HMO amount,9824,Other,275% of NY Medicaid HMO DRG,11574,,324% x Medicaid HMO amount,11574,Other,324% of NY Medicaid HMO DRG,7680,,215% x Medicaid HMO amount,7680,Other,215% of NY Medicaid HMO DRG,7680,,215% x Medicaid HMO amount,7680,Other,215% of NY Medicaid HMO DRG,4465,,125% x Medicaid HMO amount,4465,Other,125% of NY Medicaid HMO DRG,0.01,13485,
Seizure,053-2,APR-DRG,,,,,,,,inpatient,,,83092.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7754,,186% x Medicaid HMO amount,7754,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16086,,"27,634 x DRG Weight",16086,Other,DRG Base Rate x DRG Weight,13672,,"23,488 x DRG Weight",13672,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4169.21,,DRG base rate x DRG weight + capital per discharge,4169.21,Other,100% of NY Medicaid HMO DRG,4169,,DRG base rate x DRG weight + capital per discharge,4169,Other,100% of NY Medicaid HMO DRG,4169,,DRG base rate x DRG weight + capital per discharge,4169,Other,100% of NY Medicaid HMO DRG,4169,,DRG base rate x DRG weight + capital per discharge,4169,Other,100% of NY Medicaid HMO DRG,9381,,225% x Medicaid HMO amount,9381,Other,225% of NY Medicaid HMO DRG,6379,,153% x Medicaid HMO amount,6379,Other,153% of NY Medicaid HMO DRG,9381,,225% x Medicaid HMO amount,9381,Other,225% of NY Medicaid HMO DRG,5837,,140% x Medicaid HMO amount,5837,Other,140% of NY Medicaid HMO DRG,9381,,DRG base rate x DRG weight + capital per discharge,9381,Other,225% of NY Medicaid HMO DRG,11465,,275% x Medicaid HMO amount,11465,Other,275% of NY Medicaid HMO DRG,13508,,324% x Medicaid HMO amount,13508,Other,324% of NY Medicaid HMO DRG,8964,,215% x Medicaid HMO amount,8964,Other,215% of NY Medicaid HMO DRG,8964,,215% x Medicaid HMO amount,8964,Other,215% of NY Medicaid HMO DRG,5212,,125% x Medicaid HMO amount,5212,Other,125% of NY Medicaid HMO DRG,0.01,16086,
Seizure,053-3,APR-DRG,,,,,,,,inpatient,,,116588.04,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10563,,186% x Medicaid HMO amount,10563,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22657,,"27,634 x DRG Weight",22657,Other,DRG Base Rate x DRG Weight,19258,,"23,488 x DRG Weight",19258,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5679.21,,DRG base rate x DRG weight + capital per discharge,5679.21,Other,100% of NY Medicaid HMO DRG,5679,,DRG base rate x DRG weight + capital per discharge,5679,Other,100% of NY Medicaid HMO DRG,5679,,DRG base rate x DRG weight + capital per discharge,5679,Other,100% of NY Medicaid HMO DRG,5679,,DRG base rate x DRG weight + capital per discharge,5679,Other,100% of NY Medicaid HMO DRG,12778,,225% x Medicaid HMO amount,12778,Other,225% of NY Medicaid HMO DRG,8689,,153% x Medicaid HMO amount,8689,Other,153% of NY Medicaid HMO DRG,12778,,225% x Medicaid HMO amount,12778,Other,225% of NY Medicaid HMO DRG,7951,,140% x Medicaid HMO amount,7951,Other,140% of NY Medicaid HMO DRG,12778,,DRG base rate x DRG weight + capital per discharge,12778,Other,225% of NY Medicaid HMO DRG,15618,,275% x Medicaid HMO amount,15618,Other,275% of NY Medicaid HMO DRG,18401,,324% x Medicaid HMO amount,18401,Other,324% of NY Medicaid HMO DRG,12210,,215% x Medicaid HMO amount,12210,Other,215% of NY Medicaid HMO DRG,12210,,215% x Medicaid HMO amount,12210,Other,215% of NY Medicaid HMO DRG,7099,,125% x Medicaid HMO amount,7099,Other,125% of NY Medicaid HMO DRG,0.01,22657,
Seizure,053-4,APR-DRG,,,,,,,,inpatient,,,293200.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32496,,186% x Medicaid HMO amount,32496,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73973,,"27,634 x DRG Weight",73973,Other,DRG Base Rate x DRG Weight,62875,,"23,488 x DRG Weight",62875,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17471.21,,DRG base rate x DRG weight + capital per discharge,17471.21,Other,100% of NY Medicaid HMO DRG,17471,,DRG base rate x DRG weight + capital per discharge,17471,Other,100% of NY Medicaid HMO DRG,17471,,DRG base rate x DRG weight + capital per discharge,17471,Other,100% of NY Medicaid HMO DRG,17471,,DRG base rate x DRG weight + capital per discharge,17471,Other,100% of NY Medicaid HMO DRG,39310,,225% x Medicaid HMO amount,39310,Other,225% of NY Medicaid HMO DRG,26731,,153% x Medicaid HMO amount,26731,Other,153% of NY Medicaid HMO DRG,39310,,225% x Medicaid HMO amount,39310,Other,225% of NY Medicaid HMO DRG,24460,,140% x Medicaid HMO amount,24460,Other,140% of NY Medicaid HMO DRG,39310,,DRG base rate x DRG weight + capital per discharge,39310,Other,225% of NY Medicaid HMO DRG,48046,,275% x Medicaid HMO amount,48046,Other,275% of NY Medicaid HMO DRG,56607,,324% x Medicaid HMO amount,56607,Other,324% of NY Medicaid HMO DRG,37563,,215% x Medicaid HMO amount,37563,Other,215% of NY Medicaid HMO DRG,37563,,215% x Medicaid HMO amount,37563,Other,215% of NY Medicaid HMO DRG,21839,,125% x Medicaid HMO amount,21839,Other,125% of NY Medicaid HMO DRG,0.01,73973,
Migraine & other headaches,054-1,APR-DRG,,,,,,,,inpatient,,,83169.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6692,,186% x Medicaid HMO amount,6692,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13599,,"27,634 x DRG Weight",13599,Other,DRG Base Rate x DRG Weight,11558,,"23,488 x DRG Weight",11558,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3598.21,,DRG base rate x DRG weight + capital per discharge,3598.21,Other,100% of NY Medicaid HMO DRG,3598,,DRG base rate x DRG weight + capital per discharge,3598,Other,100% of NY Medicaid HMO DRG,3598,,DRG base rate x DRG weight + capital per discharge,3598,Other,100% of NY Medicaid HMO DRG,3598,,DRG base rate x DRG weight + capital per discharge,3598,Other,100% of NY Medicaid HMO DRG,8096,,225% x Medicaid HMO amount,8096,Other,225% of NY Medicaid HMO DRG,5505,,153% x Medicaid HMO amount,5505,Other,153% of NY Medicaid HMO DRG,8096,,225% x Medicaid HMO amount,8096,Other,225% of NY Medicaid HMO DRG,5037,,140% x Medicaid HMO amount,5037,Other,140% of NY Medicaid HMO DRG,8096,,DRG base rate x DRG weight + capital per discharge,8096,Other,225% of NY Medicaid HMO DRG,9895,,275% x Medicaid HMO amount,9895,Other,275% of NY Medicaid HMO DRG,11658,,324% x Medicaid HMO amount,11658,Other,324% of NY Medicaid HMO DRG,7736,,215% x Medicaid HMO amount,7736,Other,215% of NY Medicaid HMO DRG,7736,,215% x Medicaid HMO amount,7736,Other,215% of NY Medicaid HMO DRG,4498,,125% x Medicaid HMO amount,4498,Other,125% of NY Medicaid HMO DRG,0.01,13599,
Migraine & other headaches,054-2,APR-DRG,,,,,,,,inpatient,,,106107.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8110,,186% x Medicaid HMO amount,8110,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16918,,"27,634 x DRG Weight",16918,Other,DRG Base Rate x DRG Weight,14379,,"23,488 x DRG Weight",14379,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4360.21,,DRG base rate x DRG weight + capital per discharge,4360.21,Other,100% of NY Medicaid HMO DRG,4360,,DRG base rate x DRG weight + capital per discharge,4360,Other,100% of NY Medicaid HMO DRG,4360,,DRG base rate x DRG weight + capital per discharge,4360,Other,100% of NY Medicaid HMO DRG,4360,,DRG base rate x DRG weight + capital per discharge,4360,Other,100% of NY Medicaid HMO DRG,9810,,225% x Medicaid HMO amount,9810,Other,225% of NY Medicaid HMO DRG,6671,,153% x Medicaid HMO amount,6671,Other,153% of NY Medicaid HMO DRG,9810,,225% x Medicaid HMO amount,9810,Other,225% of NY Medicaid HMO DRG,6104,,140% x Medicaid HMO amount,6104,Other,140% of NY Medicaid HMO DRG,9810,,DRG base rate x DRG weight + capital per discharge,9810,Other,225% of NY Medicaid HMO DRG,11991,,275% x Medicaid HMO amount,11991,Other,275% of NY Medicaid HMO DRG,14127,,324% x Medicaid HMO amount,14127,Other,324% of NY Medicaid HMO DRG,9374,,215% x Medicaid HMO amount,9374,Other,215% of NY Medicaid HMO DRG,9374,,215% x Medicaid HMO amount,9374,Other,215% of NY Medicaid HMO DRG,5450,,125% x Medicaid HMO amount,5450,Other,125% of NY Medicaid HMO DRG,0.01,16918,
Migraine & other headaches,054-3,APR-DRG,,,,,,,,inpatient,,,106098.11,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10210,,186% x Medicaid HMO amount,10210,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21828,,"27,634 x DRG Weight",21828,Other,DRG Base Rate x DRG Weight,18553,,"23,488 x DRG Weight",18553,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5489.21,,DRG base rate x DRG weight + capital per discharge,5489.21,Other,100% of NY Medicaid HMO DRG,5489,,DRG base rate x DRG weight + capital per discharge,5489,Other,100% of NY Medicaid HMO DRG,5489,,DRG base rate x DRG weight + capital per discharge,5489,Other,100% of NY Medicaid HMO DRG,5489,,DRG base rate x DRG weight + capital per discharge,5489,Other,100% of NY Medicaid HMO DRG,12351,,225% x Medicaid HMO amount,12351,Other,225% of NY Medicaid HMO DRG,8398,,153% x Medicaid HMO amount,8398,Other,153% of NY Medicaid HMO DRG,12351,,225% x Medicaid HMO amount,12351,Other,225% of NY Medicaid HMO DRG,7685,,140% x Medicaid HMO amount,7685,Other,140% of NY Medicaid HMO DRG,12351,,DRG base rate x DRG weight + capital per discharge,12351,Other,225% of NY Medicaid HMO DRG,15095,,275% x Medicaid HMO amount,15095,Other,275% of NY Medicaid HMO DRG,17785,,324% x Medicaid HMO amount,17785,Other,324% of NY Medicaid HMO DRG,11802,,215% x Medicaid HMO amount,11802,Other,215% of NY Medicaid HMO DRG,11802,,215% x Medicaid HMO amount,11802,Other,215% of NY Medicaid HMO DRG,6862,,125% x Medicaid HMO amount,6862,Other,125% of NY Medicaid HMO DRG,0.01,21828,
Migraine & other headaches,054-4,APR-DRG,,,,,,,,inpatient,,,137275.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10381,,186% x Medicaid HMO amount,10381,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22229,,"27,634 x DRG Weight",22229,Other,DRG Base Rate x DRG Weight,18894,,"23,488 x DRG Weight",18894,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5581.21,,DRG base rate x DRG weight + capital per discharge,5581.21,Other,100% of NY Medicaid HMO DRG,5581,,DRG base rate x DRG weight + capital per discharge,5581,Other,100% of NY Medicaid HMO DRG,5581,,DRG base rate x DRG weight + capital per discharge,5581,Other,100% of NY Medicaid HMO DRG,5581,,DRG base rate x DRG weight + capital per discharge,5581,Other,100% of NY Medicaid HMO DRG,12558,,225% x Medicaid HMO amount,12558,Other,225% of NY Medicaid HMO DRG,8539,,153% x Medicaid HMO amount,8539,Other,153% of NY Medicaid HMO DRG,12558,,225% x Medicaid HMO amount,12558,Other,225% of NY Medicaid HMO DRG,7814,,140% x Medicaid HMO amount,7814,Other,140% of NY Medicaid HMO DRG,12558,,DRG base rate x DRG weight + capital per discharge,12558,Other,225% of NY Medicaid HMO DRG,15348,,275% x Medicaid HMO amount,15348,Other,275% of NY Medicaid HMO DRG,18083,,324% x Medicaid HMO amount,18083,Other,324% of NY Medicaid HMO DRG,12000,,215% x Medicaid HMO amount,12000,Other,215% of NY Medicaid HMO DRG,12000,,215% x Medicaid HMO amount,12000,Other,215% of NY Medicaid HMO DRG,6977,,125% x Medicaid HMO amount,6977,Other,125% of NY Medicaid HMO DRG,0.01,22229,
Head trauma w coma >1 hr or hemorrhage,055-1,APR-DRG,,,,,,,,inpatient,,,77715.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7457,,186% x Medicaid HMO amount,7457,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15389,,"27,634 x DRG Weight",15389,Other,DRG Base Rate x DRG Weight,13080,,"23,488 x DRG Weight",13080,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4009.21,,DRG base rate x DRG weight + capital per discharge,4009.21,Other,100% of NY Medicaid HMO DRG,4009,,DRG base rate x DRG weight + capital per discharge,4009,Other,100% of NY Medicaid HMO DRG,4009,,DRG base rate x DRG weight + capital per discharge,4009,Other,100% of NY Medicaid HMO DRG,4009,,DRG base rate x DRG weight + capital per discharge,4009,Other,100% of NY Medicaid HMO DRG,9021,,225% x Medicaid HMO amount,9021,Other,225% of NY Medicaid HMO DRG,6134,,153% x Medicaid HMO amount,6134,Other,153% of NY Medicaid HMO DRG,9021,,225% x Medicaid HMO amount,9021,Other,225% of NY Medicaid HMO DRG,5613,,140% x Medicaid HMO amount,5613,Other,140% of NY Medicaid HMO DRG,9021,,DRG base rate x DRG weight + capital per discharge,9021,Other,225% of NY Medicaid HMO DRG,11025,,275% x Medicaid HMO amount,11025,Other,275% of NY Medicaid HMO DRG,12990,,324% x Medicaid HMO amount,12990,Other,324% of NY Medicaid HMO DRG,8620,,215% x Medicaid HMO amount,8620,Other,215% of NY Medicaid HMO DRG,8620,,215% x Medicaid HMO amount,8620,Other,215% of NY Medicaid HMO DRG,5012,,125% x Medicaid HMO amount,5012,Other,125% of NY Medicaid HMO DRG,0.01,15389,
Head trauma w coma >1 hr or hemorrhage,055-2,APR-DRG,,,,,,,,inpatient,,,141938.68,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11244,,186% x Medicaid HMO amount,11244,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24249,,"27,634 x DRG Weight",24249,Other,DRG Base Rate x DRG Weight,20611,,"23,488 x DRG Weight",20611,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6045.21,,DRG base rate x DRG weight + capital per discharge,6045.21,Other,100% of NY Medicaid HMO DRG,6045,,DRG base rate x DRG weight + capital per discharge,6045,Other,100% of NY Medicaid HMO DRG,6045,,DRG base rate x DRG weight + capital per discharge,6045,Other,100% of NY Medicaid HMO DRG,6045,,DRG base rate x DRG weight + capital per discharge,6045,Other,100% of NY Medicaid HMO DRG,13602,,225% x Medicaid HMO amount,13602,Other,225% of NY Medicaid HMO DRG,9249,,153% x Medicaid HMO amount,9249,Other,153% of NY Medicaid HMO DRG,13602,,225% x Medicaid HMO amount,13602,Other,225% of NY Medicaid HMO DRG,8463,,140% x Medicaid HMO amount,8463,Other,140% of NY Medicaid HMO DRG,13602,,DRG base rate x DRG weight + capital per discharge,13602,Other,225% of NY Medicaid HMO DRG,16624,,275% x Medicaid HMO amount,16624,Other,275% of NY Medicaid HMO DRG,19586,,324% x Medicaid HMO amount,19586,Other,324% of NY Medicaid HMO DRG,12997,,215% x Medicaid HMO amount,12997,Other,215% of NY Medicaid HMO DRG,12997,,215% x Medicaid HMO amount,12997,Other,215% of NY Medicaid HMO DRG,7557,,125% x Medicaid HMO amount,7557,Other,125% of NY Medicaid HMO DRG,0.01,24249,
Head trauma w coma >1 hr or hemorrhage,055-3,APR-DRG,,,,,,,,inpatient,,,224219.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18606,,186% x Medicaid HMO amount,18606,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41473,,"27,634 x DRG Weight",41473,Other,DRG Base Rate x DRG Weight,35251,,"23,488 x DRG Weight",35251,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10003.21,,DRG base rate x DRG weight + capital per discharge,10003.21,Other,100% of NY Medicaid HMO DRG,10003,,DRG base rate x DRG weight + capital per discharge,10003,Other,100% of NY Medicaid HMO DRG,10003,,DRG base rate x DRG weight + capital per discharge,10003,Other,100% of NY Medicaid HMO DRG,10003,,DRG base rate x DRG weight + capital per discharge,10003,Other,100% of NY Medicaid HMO DRG,22507,,225% x Medicaid HMO amount,22507,Other,225% of NY Medicaid HMO DRG,15305,,153% x Medicaid HMO amount,15305,Other,153% of NY Medicaid HMO DRG,22507,,225% x Medicaid HMO amount,22507,Other,225% of NY Medicaid HMO DRG,14004,,140% x Medicaid HMO amount,14004,Other,140% of NY Medicaid HMO DRG,22507,,DRG base rate x DRG weight + capital per discharge,22507,Other,225% of NY Medicaid HMO DRG,27509,,275% x Medicaid HMO amount,27509,Other,275% of NY Medicaid HMO DRG,32410,,324% x Medicaid HMO amount,32410,Other,324% of NY Medicaid HMO DRG,21507,,215% x Medicaid HMO amount,21507,Other,215% of NY Medicaid HMO DRG,21507,,215% x Medicaid HMO amount,21507,Other,215% of NY Medicaid HMO DRG,12504,,125% x Medicaid HMO amount,12504,Other,125% of NY Medicaid HMO DRG,0.01,41473,
Head trauma w coma >1 hr or hemorrhage,055-4,APR-DRG,,,,,,,,inpatient,,,556386.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40838,,186% x Medicaid HMO amount,40838,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,93491,,"27,634 x DRG Weight",93491,Other,DRG Base Rate x DRG Weight,79465,,"23,488 x DRG Weight",79465,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21956.21,,DRG base rate x DRG weight + capital per discharge,21956.21,Other,100% of NY Medicaid HMO DRG,21956,,DRG base rate x DRG weight + capital per discharge,21956,Other,100% of NY Medicaid HMO DRG,21956,,DRG base rate x DRG weight + capital per discharge,21956,Other,100% of NY Medicaid HMO DRG,21956,,DRG base rate x DRG weight + capital per discharge,21956,Other,100% of NY Medicaid HMO DRG,49401,,225% x Medicaid HMO amount,49401,Other,225% of NY Medicaid HMO DRG,33593,,153% x Medicaid HMO amount,33593,Other,153% of NY Medicaid HMO DRG,49401,,225% x Medicaid HMO amount,49401,Other,225% of NY Medicaid HMO DRG,30739,,140% x Medicaid HMO amount,30739,Other,140% of NY Medicaid HMO DRG,49401,,DRG base rate x DRG weight + capital per discharge,49401,Other,225% of NY Medicaid HMO DRG,60380,,275% x Medicaid HMO amount,60380,Other,275% of NY Medicaid HMO DRG,71138,,324% x Medicaid HMO amount,71138,Other,324% of NY Medicaid HMO DRG,47206,,215% x Medicaid HMO amount,47206,Other,215% of NY Medicaid HMO DRG,47206,,215% x Medicaid HMO amount,47206,Other,215% of NY Medicaid HMO DRG,27445,,125% x Medicaid HMO amount,27445,Other,125% of NY Medicaid HMO DRG,0.01,93491,
"Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma",056-1,APR-DRG,,,,,,,,inpatient,,,77715.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7012,,186% x Medicaid HMO amount,7012,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14350,,"27,634 x DRG Weight",14350,Other,DRG Base Rate x DRG Weight,12197,,"23,488 x DRG Weight",12197,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3770.21,,DRG base rate x DRG weight + capital per discharge,3770.21,Other,100% of NY Medicaid HMO DRG,3770,,DRG base rate x DRG weight + capital per discharge,3770,Other,100% of NY Medicaid HMO DRG,3770,,DRG base rate x DRG weight + capital per discharge,3770,Other,100% of NY Medicaid HMO DRG,3770,,DRG base rate x DRG weight + capital per discharge,3770,Other,100% of NY Medicaid HMO DRG,8483,,225% x Medicaid HMO amount,8483,Other,225% of NY Medicaid HMO DRG,5768,,153% x Medicaid HMO amount,5768,Other,153% of NY Medicaid HMO DRG,8483,,225% x Medicaid HMO amount,8483,Other,225% of NY Medicaid HMO DRG,5278,,140% x Medicaid HMO amount,5278,Other,140% of NY Medicaid HMO DRG,8483,,DRG base rate x DRG weight + capital per discharge,8483,Other,225% of NY Medicaid HMO DRG,10368,,275% x Medicaid HMO amount,10368,Other,275% of NY Medicaid HMO DRG,12215,,324% x Medicaid HMO amount,12215,Other,324% of NY Medicaid HMO DRG,8106,,215% x Medicaid HMO amount,8106,Other,215% of NY Medicaid HMO DRG,8106,,215% x Medicaid HMO amount,8106,Other,215% of NY Medicaid HMO DRG,4713,,125% x Medicaid HMO amount,4713,Other,125% of NY Medicaid HMO DRG,0.01,14350,
"Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma",056-2,APR-DRG,,,,,,,,inpatient,,,129437.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10347,,186% x Medicaid HMO amount,10347,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22151,,"27,634 x DRG Weight",22151,Other,DRG Base Rate x DRG Weight,18828,,"23,488 x DRG Weight",18828,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5563.21,,DRG base rate x DRG weight + capital per discharge,5563.21,Other,100% of NY Medicaid HMO DRG,5563,,DRG base rate x DRG weight + capital per discharge,5563,Other,100% of NY Medicaid HMO DRG,5563,,DRG base rate x DRG weight + capital per discharge,5563,Other,100% of NY Medicaid HMO DRG,5563,,DRG base rate x DRG weight + capital per discharge,5563,Other,100% of NY Medicaid HMO DRG,12517,,225% x Medicaid HMO amount,12517,Other,225% of NY Medicaid HMO DRG,8512,,153% x Medicaid HMO amount,8512,Other,153% of NY Medicaid HMO DRG,12517,,225% x Medicaid HMO amount,12517,Other,225% of NY Medicaid HMO DRG,7788,,140% x Medicaid HMO amount,7788,Other,140% of NY Medicaid HMO DRG,12517,,DRG base rate x DRG weight + capital per discharge,12517,Other,225% of NY Medicaid HMO DRG,15299,,275% x Medicaid HMO amount,15299,Other,275% of NY Medicaid HMO DRG,18025,,324% x Medicaid HMO amount,18025,Other,324% of NY Medicaid HMO DRG,11961,,215% x Medicaid HMO amount,11961,Other,215% of NY Medicaid HMO DRG,11961,,215% x Medicaid HMO amount,11961,Other,215% of NY Medicaid HMO DRG,6954,,125% x Medicaid HMO amount,6954,Other,125% of NY Medicaid HMO DRG,0.01,22151,
"Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma",056-3,APR-DRG,,,,,,,,inpatient,,,33187.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17730,,186% x Medicaid HMO amount,17730,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39425,,"27,634 x DRG Weight",39425,Other,DRG Base Rate x DRG Weight,33510,,"23,488 x DRG Weight",33510,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9532.21,,DRG base rate x DRG weight + capital per discharge,9532.21,Other,100% of NY Medicaid HMO DRG,9532,,DRG base rate x DRG weight + capital per discharge,9532,Other,100% of NY Medicaid HMO DRG,9532,,DRG base rate x DRG weight + capital per discharge,9532,Other,100% of NY Medicaid HMO DRG,9532,,DRG base rate x DRG weight + capital per discharge,9532,Other,100% of NY Medicaid HMO DRG,21447,,225% x Medicaid HMO amount,21447,Other,225% of NY Medicaid HMO DRG,14584,,153% x Medicaid HMO amount,14584,Other,153% of NY Medicaid HMO DRG,21447,,225% x Medicaid HMO amount,21447,Other,225% of NY Medicaid HMO DRG,13345,,140% x Medicaid HMO amount,13345,Other,140% of NY Medicaid HMO DRG,21447,,DRG base rate x DRG weight + capital per discharge,21447,Other,225% of NY Medicaid HMO DRG,26214,,275% x Medicaid HMO amount,26214,Other,275% of NY Medicaid HMO DRG,30884,,324% x Medicaid HMO amount,30884,Other,324% of NY Medicaid HMO DRG,20494,,215% x Medicaid HMO amount,20494,Other,215% of NY Medicaid HMO DRG,20494,,215% x Medicaid HMO amount,20494,Other,215% of NY Medicaid HMO DRG,11915,,125% x Medicaid HMO amount,11915,Other,125% of NY Medicaid HMO DRG,0.01,39425,
"Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma",056-4,APR-DRG,,,,,,,,inpatient,,,296222.6,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45808,,186% x Medicaid HMO amount,45808,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,105120,,"27,634 x DRG Weight",105120,Other,DRG Base Rate x DRG Weight,89348,,"23,488 x DRG Weight",89348,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24628.21,,DRG base rate x DRG weight + capital per discharge,24628.21,Other,100% of NY Medicaid HMO DRG,24628,,DRG base rate x DRG weight + capital per discharge,24628,Other,100% of NY Medicaid HMO DRG,24628,,DRG base rate x DRG weight + capital per discharge,24628,Other,100% of NY Medicaid HMO DRG,24628,,DRG base rate x DRG weight + capital per discharge,24628,Other,100% of NY Medicaid HMO DRG,55413,,225% x Medicaid HMO amount,55413,Other,225% of NY Medicaid HMO DRG,37681,,153% x Medicaid HMO amount,37681,Other,153% of NY Medicaid HMO DRG,55413,,225% x Medicaid HMO amount,55413,Other,225% of NY Medicaid HMO DRG,34479,,140% x Medicaid HMO amount,34479,Other,140% of NY Medicaid HMO DRG,55413,,DRG base rate x DRG weight + capital per discharge,55413,Other,225% of NY Medicaid HMO DRG,67728,,275% x Medicaid HMO amount,67728,Other,275% of NY Medicaid HMO DRG,79795,,324% x Medicaid HMO amount,79795,Other,324% of NY Medicaid HMO DRG,52951,,215% x Medicaid HMO amount,52951,Other,215% of NY Medicaid HMO DRG,52951,,215% x Medicaid HMO amount,52951,Other,215% of NY Medicaid HMO DRG,30785,,125% x Medicaid HMO amount,30785,Other,125% of NY Medicaid HMO DRG,0.01,105120,
"Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma",057-1,APR-DRG,,,,,,,,inpatient,,,87457.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5567,,186% x Medicaid HMO amount,5567,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10968,,"27,634 x DRG Weight",10968,Other,DRG Base Rate x DRG Weight,9322,,"23,488 x DRG Weight",9322,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2993.21,,DRG base rate x DRG weight + capital per discharge,2993.21,Other,100% of NY Medicaid HMO DRG,2993,,DRG base rate x DRG weight + capital per discharge,2993,Other,100% of NY Medicaid HMO DRG,2993,,DRG base rate x DRG weight + capital per discharge,2993,Other,100% of NY Medicaid HMO DRG,2993,,DRG base rate x DRG weight + capital per discharge,2993,Other,100% of NY Medicaid HMO DRG,6735,,225% x Medicaid HMO amount,6735,Other,225% of NY Medicaid HMO DRG,4580,,153% x Medicaid HMO amount,4580,Other,153% of NY Medicaid HMO DRG,6735,,225% x Medicaid HMO amount,6735,Other,225% of NY Medicaid HMO DRG,4190,,140% x Medicaid HMO amount,4190,Other,140% of NY Medicaid HMO DRG,6735,,DRG base rate x DRG weight + capital per discharge,6735,Other,225% of NY Medicaid HMO DRG,8231,,275% x Medicaid HMO amount,8231,Other,275% of NY Medicaid HMO DRG,9698,,324% x Medicaid HMO amount,9698,Other,324% of NY Medicaid HMO DRG,6435,,215% x Medicaid HMO amount,6435,Other,215% of NY Medicaid HMO DRG,6435,,215% x Medicaid HMO amount,6435,Other,215% of NY Medicaid HMO DRG,3742,,125% x Medicaid HMO amount,3742,Other,125% of NY Medicaid HMO DRG,0.01,10968,
"Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma",057-2,APR-DRG,,,,,,,,inpatient,,,82004.88,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7256,,186% x Medicaid HMO amount,7256,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14920,,"27,634 x DRG Weight",14920,Other,DRG Base Rate x DRG Weight,12681,,"23,488 x DRG Weight",12681,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3901.21,,DRG base rate x DRG weight + capital per discharge,3901.21,Other,100% of NY Medicaid HMO DRG,3901,,DRG base rate x DRG weight + capital per discharge,3901,Other,100% of NY Medicaid HMO DRG,3901,,DRG base rate x DRG weight + capital per discharge,3901,Other,100% of NY Medicaid HMO DRG,3901,,DRG base rate x DRG weight + capital per discharge,3901,Other,100% of NY Medicaid HMO DRG,8778,,225% x Medicaid HMO amount,8778,Other,225% of NY Medicaid HMO DRG,5969,,153% x Medicaid HMO amount,5969,Other,153% of NY Medicaid HMO DRG,8778,,225% x Medicaid HMO amount,8778,Other,225% of NY Medicaid HMO DRG,5462,,140% x Medicaid HMO amount,5462,Other,140% of NY Medicaid HMO DRG,8778,,DRG base rate x DRG weight + capital per discharge,8778,Other,225% of NY Medicaid HMO DRG,10728,,275% x Medicaid HMO amount,10728,Other,275% of NY Medicaid HMO DRG,12640,,324% x Medicaid HMO amount,12640,Other,324% of NY Medicaid HMO DRG,8388,,215% x Medicaid HMO amount,8388,Other,215% of NY Medicaid HMO DRG,8388,,215% x Medicaid HMO amount,8388,Other,215% of NY Medicaid HMO DRG,4877,,125% x Medicaid HMO amount,4877,Other,125% of NY Medicaid HMO DRG,0.01,14920,
"Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma",057-3,APR-DRG,,,,,,,,inpatient,,,109547.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12317,,186% x Medicaid HMO amount,12317,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26761,,"27,634 x DRG Weight",26761,Other,DRG Base Rate x DRG Weight,22746,,"23,488 x DRG Weight",22746,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6622.21,,DRG base rate x DRG weight + capital per discharge,6622.21,Other,100% of NY Medicaid HMO DRG,6622,,DRG base rate x DRG weight + capital per discharge,6622,Other,100% of NY Medicaid HMO DRG,6622,,DRG base rate x DRG weight + capital per discharge,6622,Other,100% of NY Medicaid HMO DRG,6622,,DRG base rate x DRG weight + capital per discharge,6622,Other,100% of NY Medicaid HMO DRG,14900,,225% x Medicaid HMO amount,14900,Other,225% of NY Medicaid HMO DRG,10132,,153% x Medicaid HMO amount,10132,Other,153% of NY Medicaid HMO DRG,14900,,225% x Medicaid HMO amount,14900,Other,225% of NY Medicaid HMO DRG,9271,,140% x Medicaid HMO amount,9271,Other,140% of NY Medicaid HMO DRG,14900,,DRG base rate x DRG weight + capital per discharge,14900,Other,225% of NY Medicaid HMO DRG,18211,,275% x Medicaid HMO amount,18211,Other,275% of NY Medicaid HMO DRG,21456,,324% x Medicaid HMO amount,21456,Other,324% of NY Medicaid HMO DRG,14238,,215% x Medicaid HMO amount,14238,Other,215% of NY Medicaid HMO DRG,14238,,215% x Medicaid HMO amount,14238,Other,215% of NY Medicaid HMO DRG,8278,,125% x Medicaid HMO amount,8278,Other,125% of NY Medicaid HMO DRG,0.01,26761,
"Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma",057-4,APR-DRG,,,,,,,,inpatient,,,160983.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35768,,186% x Medicaid HMO amount,35768,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,81625,,"27,634 x DRG Weight",81625,Other,DRG Base Rate x DRG Weight,69379,,"23,488 x DRG Weight",69379,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19230.21,,DRG base rate x DRG weight + capital per discharge,19230.21,Other,100% of NY Medicaid HMO DRG,19230,,DRG base rate x DRG weight + capital per discharge,19230,Other,100% of NY Medicaid HMO DRG,19230,,DRG base rate x DRG weight + capital per discharge,19230,Other,100% of NY Medicaid HMO DRG,19230,,DRG base rate x DRG weight + capital per discharge,19230,Other,100% of NY Medicaid HMO DRG,43268,,225% x Medicaid HMO amount,43268,Other,225% of NY Medicaid HMO DRG,29422,,153% x Medicaid HMO amount,29422,Other,153% of NY Medicaid HMO DRG,43268,,225% x Medicaid HMO amount,43268,Other,225% of NY Medicaid HMO DRG,26922,,140% x Medicaid HMO amount,26922,Other,140% of NY Medicaid HMO DRG,43268,,DRG base rate x DRG weight + capital per discharge,43268,Other,225% of NY Medicaid HMO DRG,52883,,275% x Medicaid HMO amount,52883,Other,275% of NY Medicaid HMO DRG,62306,,324% x Medicaid HMO amount,62306,Other,324% of NY Medicaid HMO DRG,41345,,215% x Medicaid HMO amount,41345,Other,215% of NY Medicaid HMO DRG,41345,,215% x Medicaid HMO amount,41345,Other,215% of NY Medicaid HMO DRG,24038,,125% x Medicaid HMO amount,24038,Other,125% of NY Medicaid HMO DRG,0.01,81625,
Other disorders of nervous system,058-1,APR-DRG,,,,,,,,inpatient,,,101846.62,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7239,,186% x Medicaid HMO amount,7239,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14881,,"27,634 x DRG Weight",14881,Other,DRG Base Rate x DRG Weight,12648,,"23,488 x DRG Weight",12648,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3892.21,,DRG base rate x DRG weight + capital per discharge,3892.21,Other,100% of NY Medicaid HMO DRG,3892,,DRG base rate x DRG weight + capital per discharge,3892,Other,100% of NY Medicaid HMO DRG,3892,,DRG base rate x DRG weight + capital per discharge,3892,Other,100% of NY Medicaid HMO DRG,3892,,DRG base rate x DRG weight + capital per discharge,3892,Other,100% of NY Medicaid HMO DRG,8757,,225% x Medicaid HMO amount,8757,Other,225% of NY Medicaid HMO DRG,5955,,153% x Medicaid HMO amount,5955,Other,153% of NY Medicaid HMO DRG,8757,,225% x Medicaid HMO amount,8757,Other,225% of NY Medicaid HMO DRG,5449,,140% x Medicaid HMO amount,5449,Other,140% of NY Medicaid HMO DRG,8757,,DRG base rate x DRG weight + capital per discharge,8757,Other,225% of NY Medicaid HMO DRG,10704,,275% x Medicaid HMO amount,10704,Other,275% of NY Medicaid HMO DRG,12611,,324% x Medicaid HMO amount,12611,Other,324% of NY Medicaid HMO DRG,8368,,215% x Medicaid HMO amount,8368,Other,215% of NY Medicaid HMO DRG,8368,,215% x Medicaid HMO amount,8368,Other,215% of NY Medicaid HMO DRG,4865,,125% x Medicaid HMO amount,4865,Other,125% of NY Medicaid HMO DRG,0.01,14881,
Other disorders of nervous system,058-2,APR-DRG,,,,,,,,inpatient,,,137387.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10126,,186% x Medicaid HMO amount,10126,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21635,,"27,634 x DRG Weight",21635,Other,DRG Base Rate x DRG Weight,18389,,"23,488 x DRG Weight",18389,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5444.21,,DRG base rate x DRG weight + capital per discharge,5444.21,Other,100% of NY Medicaid HMO DRG,5444,,DRG base rate x DRG weight + capital per discharge,5444,Other,100% of NY Medicaid HMO DRG,5444,,DRG base rate x DRG weight + capital per discharge,5444,Other,100% of NY Medicaid HMO DRG,5444,,DRG base rate x DRG weight + capital per discharge,5444,Other,100% of NY Medicaid HMO DRG,12249,,225% x Medicaid HMO amount,12249,Other,225% of NY Medicaid HMO DRG,8330,,153% x Medicaid HMO amount,8330,Other,153% of NY Medicaid HMO DRG,12249,,225% x Medicaid HMO amount,12249,Other,225% of NY Medicaid HMO DRG,7622,,140% x Medicaid HMO amount,7622,Other,140% of NY Medicaid HMO DRG,12249,,DRG base rate x DRG weight + capital per discharge,12249,Other,225% of NY Medicaid HMO DRG,14972,,275% x Medicaid HMO amount,14972,Other,275% of NY Medicaid HMO DRG,17639,,324% x Medicaid HMO amount,17639,Other,324% of NY Medicaid HMO DRG,11705,,215% x Medicaid HMO amount,11705,Other,215% of NY Medicaid HMO DRG,11705,,215% x Medicaid HMO amount,11705,Other,215% of NY Medicaid HMO DRG,6805,,125% x Medicaid HMO amount,6805,Other,125% of NY Medicaid HMO DRG,0.01,21635,
Other disorders of nervous system,058-3,APR-DRG,,,,,,,,inpatient,,,232142.62,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15812,,186% x Medicaid HMO amount,15812,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34938,,"27,634 x DRG Weight",34938,Other,DRG Base Rate x DRG Weight,29696,,"23,488 x DRG Weight",29696,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8501.21,,DRG base rate x DRG weight + capital per discharge,8501.21,Other,100% of NY Medicaid HMO DRG,8501,,DRG base rate x DRG weight + capital per discharge,8501,Other,100% of NY Medicaid HMO DRG,8501,,DRG base rate x DRG weight + capital per discharge,8501,Other,100% of NY Medicaid HMO DRG,8501,,DRG base rate x DRG weight + capital per discharge,8501,Other,100% of NY Medicaid HMO DRG,19128,,225% x Medicaid HMO amount,19128,Other,225% of NY Medicaid HMO DRG,13007,,153% x Medicaid HMO amount,13007,Other,153% of NY Medicaid HMO DRG,19128,,225% x Medicaid HMO amount,19128,Other,225% of NY Medicaid HMO DRG,11902,,140% x Medicaid HMO amount,11902,Other,140% of NY Medicaid HMO DRG,19128,,DRG base rate x DRG weight + capital per discharge,19128,Other,225% of NY Medicaid HMO DRG,23378,,275% x Medicaid HMO amount,23378,Other,275% of NY Medicaid HMO DRG,27544,,324% x Medicaid HMO amount,27544,Other,324% of NY Medicaid HMO DRG,18278,,215% x Medicaid HMO amount,18278,Other,215% of NY Medicaid HMO DRG,18278,,215% x Medicaid HMO amount,18278,Other,215% of NY Medicaid HMO DRG,10627,,125% x Medicaid HMO amount,10627,Other,125% of NY Medicaid HMO DRG,0.01,34938,
Other disorders of nervous system,058-4,APR-DRG,,,,,,,,inpatient,,,214088.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40900,,186% x Medicaid HMO amount,40900,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,93632,,"27,634 x DRG Weight",93632,Other,DRG Base Rate x DRG Weight,79584,,"23,488 x DRG Weight",79584,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21989.21,,DRG base rate x DRG weight + capital per discharge,21989.21,Other,100% of NY Medicaid HMO DRG,21989,,DRG base rate x DRG weight + capital per discharge,21989,Other,100% of NY Medicaid HMO DRG,21989,,DRG base rate x DRG weight + capital per discharge,21989,Other,100% of NY Medicaid HMO DRG,21989,,DRG base rate x DRG weight + capital per discharge,21989,Other,100% of NY Medicaid HMO DRG,49476,,225% x Medicaid HMO amount,49476,Other,225% of NY Medicaid HMO DRG,33643,,153% x Medicaid HMO amount,33643,Other,153% of NY Medicaid HMO DRG,49476,,225% x Medicaid HMO amount,49476,Other,225% of NY Medicaid HMO DRG,30785,,140% x Medicaid HMO amount,30785,Other,140% of NY Medicaid HMO DRG,49476,,DRG base rate x DRG weight + capital per discharge,49476,Other,225% of NY Medicaid HMO DRG,60470,,275% x Medicaid HMO amount,60470,Other,275% of NY Medicaid HMO DRG,71245,,324% x Medicaid HMO amount,71245,Other,324% of NY Medicaid HMO DRG,47277,,215% x Medicaid HMO amount,47277,Other,215% of NY Medicaid HMO DRG,47277,,215% x Medicaid HMO amount,47277,Other,215% of NY Medicaid HMO DRG,27487,,125% x Medicaid HMO amount,27487,Other,125% of NY Medicaid HMO DRG,0.01,93632,
Orbital procedures,070-1,APR-DRG,,,,,,,,inpatient,,,86402.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10379,,186% x Medicaid HMO amount,10379,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22223,,"27,634 x DRG Weight",22223,Other,DRG Base Rate x DRG Weight,18889,,"23,488 x DRG Weight",18889,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5580.21,,DRG base rate x DRG weight + capital per discharge,5580.21,Other,100% of NY Medicaid HMO DRG,5580,,DRG base rate x DRG weight + capital per discharge,5580,Other,100% of NY Medicaid HMO DRG,5580,,DRG base rate x DRG weight + capital per discharge,5580,Other,100% of NY Medicaid HMO DRG,5580,,DRG base rate x DRG weight + capital per discharge,5580,Other,100% of NY Medicaid HMO DRG,12555,,225% x Medicaid HMO amount,12555,Other,225% of NY Medicaid HMO DRG,8538,,153% x Medicaid HMO amount,8538,Other,153% of NY Medicaid HMO DRG,12555,,225% x Medicaid HMO amount,12555,Other,225% of NY Medicaid HMO DRG,7812,,140% x Medicaid HMO amount,7812,Other,140% of NY Medicaid HMO DRG,12555,,DRG base rate x DRG weight + capital per discharge,12555,Other,225% of NY Medicaid HMO DRG,15346,,275% x Medicaid HMO amount,15346,Other,275% of NY Medicaid HMO DRG,18080,,324% x Medicaid HMO amount,18080,Other,324% of NY Medicaid HMO DRG,11997,,215% x Medicaid HMO amount,11997,Other,215% of NY Medicaid HMO DRG,11997,,215% x Medicaid HMO amount,11997,Other,215% of NY Medicaid HMO DRG,6975,,125% x Medicaid HMO amount,6975,Other,125% of NY Medicaid HMO DRG,0.01,22223,
Orbital procedures,070-2,APR-DRG,,,,,,,,inpatient,,,134182.94,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15453,,186% x Medicaid HMO amount,15453,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34095,,"27,634 x DRG Weight",34095,Other,DRG Base Rate x DRG Weight,28979,,"23,488 x DRG Weight",28979,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8308.21,,DRG base rate x DRG weight + capital per discharge,8308.21,Other,100% of NY Medicaid HMO DRG,8308,,DRG base rate x DRG weight + capital per discharge,8308,Other,100% of NY Medicaid HMO DRG,8308,,DRG base rate x DRG weight + capital per discharge,8308,Other,100% of NY Medicaid HMO DRG,8308,,DRG base rate x DRG weight + capital per discharge,8308,Other,100% of NY Medicaid HMO DRG,18693,,225% x Medicaid HMO amount,18693,Other,225% of NY Medicaid HMO DRG,12712,,153% x Medicaid HMO amount,12712,Other,153% of NY Medicaid HMO DRG,18693,,225% x Medicaid HMO amount,18693,Other,225% of NY Medicaid HMO DRG,11631,,140% x Medicaid HMO amount,11631,Other,140% of NY Medicaid HMO DRG,18693,,DRG base rate x DRG weight + capital per discharge,18693,Other,225% of NY Medicaid HMO DRG,22848,,275% x Medicaid HMO amount,22848,Other,275% of NY Medicaid HMO DRG,26919,,324% x Medicaid HMO amount,26919,Other,324% of NY Medicaid HMO DRG,17863,,215% x Medicaid HMO amount,17863,Other,215% of NY Medicaid HMO DRG,17863,,215% x Medicaid HMO amount,17863,Other,215% of NY Medicaid HMO DRG,10385,,125% x Medicaid HMO amount,10385,Other,125% of NY Medicaid HMO DRG,0.01,34095,
Orbital procedures,070-3,APR-DRG,,,,,,,,inpatient,,,541419.85,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24961,,186% x Medicaid HMO amount,24961,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,56343,,"27,634 x DRG Weight",56343,Other,DRG Base Rate x DRG Weight,47890,,"23,488 x DRG Weight",47890,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13420.21,,DRG base rate x DRG weight + capital per discharge,13420.21,Other,100% of NY Medicaid HMO DRG,13420,,DRG base rate x DRG weight + capital per discharge,13420,Other,100% of NY Medicaid HMO DRG,13420,,DRG base rate x DRG weight + capital per discharge,13420,Other,100% of NY Medicaid HMO DRG,13420,,DRG base rate x DRG weight + capital per discharge,13420,Other,100% of NY Medicaid HMO DRG,30195,,225% x Medicaid HMO amount,30195,Other,225% of NY Medicaid HMO DRG,20533,,153% x Medicaid HMO amount,20533,Other,153% of NY Medicaid HMO DRG,30195,,225% x Medicaid HMO amount,30195,Other,225% of NY Medicaid HMO DRG,18788,,140% x Medicaid HMO amount,18788,Other,140% of NY Medicaid HMO DRG,30195,,DRG base rate x DRG weight + capital per discharge,30195,Other,225% of NY Medicaid HMO DRG,36906,,275% x Medicaid HMO amount,36906,Other,275% of NY Medicaid HMO DRG,43481,,324% x Medicaid HMO amount,43481,Other,324% of NY Medicaid HMO DRG,28853,,215% x Medicaid HMO amount,28853,Other,215% of NY Medicaid HMO DRG,28853,,215% x Medicaid HMO amount,28853,Other,215% of NY Medicaid HMO DRG,16775,,125% x Medicaid HMO amount,16775,Other,125% of NY Medicaid HMO DRG,0.01,56343,
Orbital procedures,070-4,APR-DRG,,,,,,,,inpatient,,,541419.85,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28289,,186% x Medicaid HMO amount,28289,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64130,,"27,634 x DRG Weight",64130,Other,DRG Base Rate x DRG Weight,54509,,"23,488 x DRG Weight",54509,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15209.21,,DRG base rate x DRG weight + capital per discharge,15209.21,Other,100% of NY Medicaid HMO DRG,15209,,DRG base rate x DRG weight + capital per discharge,15209,Other,100% of NY Medicaid HMO DRG,15209,,DRG base rate x DRG weight + capital per discharge,15209,Other,100% of NY Medicaid HMO DRG,15209,,DRG base rate x DRG weight + capital per discharge,15209,Other,100% of NY Medicaid HMO DRG,34221,,225% x Medicaid HMO amount,34221,Other,225% of NY Medicaid HMO DRG,23270,,153% x Medicaid HMO amount,23270,Other,153% of NY Medicaid HMO DRG,34221,,225% x Medicaid HMO amount,34221,Other,225% of NY Medicaid HMO DRG,21293,,140% x Medicaid HMO amount,21293,Other,140% of NY Medicaid HMO DRG,34221,,DRG base rate x DRG weight + capital per discharge,34221,Other,225% of NY Medicaid HMO DRG,41825,,275% x Medicaid HMO amount,41825,Other,275% of NY Medicaid HMO DRG,49278,,324% x Medicaid HMO amount,49278,Other,324% of NY Medicaid HMO DRG,32700,,215% x Medicaid HMO amount,32700,Other,215% of NY Medicaid HMO DRG,32700,,215% x Medicaid HMO amount,32700,Other,215% of NY Medicaid HMO DRG,19012,,125% x Medicaid HMO amount,19012,Other,125% of NY Medicaid HMO DRG,0.01,64130,
Eye procedures except orbit,073-1,APR-DRG,,,,,,,,inpatient,,,120793.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8664,,186% x Medicaid HMO amount,8664,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18211,,"27,634 x DRG Weight",18211,Other,DRG Base Rate x DRG Weight,15479,,"23,488 x DRG Weight",15479,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4658.21,,DRG base rate x DRG weight + capital per discharge,4658.21,Other,100% of NY Medicaid HMO DRG,4658,,DRG base rate x DRG weight + capital per discharge,4658,Other,100% of NY Medicaid HMO DRG,4658,,DRG base rate x DRG weight + capital per discharge,4658,Other,100% of NY Medicaid HMO DRG,4658,,DRG base rate x DRG weight + capital per discharge,4658,Other,100% of NY Medicaid HMO DRG,10481,,225% x Medicaid HMO amount,10481,Other,225% of NY Medicaid HMO DRG,7127,,153% x Medicaid HMO amount,7127,Other,153% of NY Medicaid HMO DRG,10481,,225% x Medicaid HMO amount,10481,Other,225% of NY Medicaid HMO DRG,6521,,140% x Medicaid HMO amount,6521,Other,140% of NY Medicaid HMO DRG,10481,,DRG base rate x DRG weight + capital per discharge,10481,Other,225% of NY Medicaid HMO DRG,12810,,275% x Medicaid HMO amount,12810,Other,275% of NY Medicaid HMO DRG,15093,,324% x Medicaid HMO amount,15093,Other,324% of NY Medicaid HMO DRG,10015,,215% x Medicaid HMO amount,10015,Other,215% of NY Medicaid HMO DRG,10015,,215% x Medicaid HMO amount,10015,Other,215% of NY Medicaid HMO DRG,5823,,125% x Medicaid HMO amount,5823,Other,125% of NY Medicaid HMO DRG,0.01,18211,
Eye procedures except orbit,073-2,APR-DRG,,,,,,,,inpatient,,,129700.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10872,,186% x Medicaid HMO amount,10872,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23378,,"27,634 x DRG Weight",23378,Other,DRG Base Rate x DRG Weight,19871,,"23,488 x DRG Weight",19871,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5845.21,,DRG base rate x DRG weight + capital per discharge,5845.21,Other,100% of NY Medicaid HMO DRG,5845,,DRG base rate x DRG weight + capital per discharge,5845,Other,100% of NY Medicaid HMO DRG,5845,,DRG base rate x DRG weight + capital per discharge,5845,Other,100% of NY Medicaid HMO DRG,5845,,DRG base rate x DRG weight + capital per discharge,5845,Other,100% of NY Medicaid HMO DRG,13152,,225% x Medicaid HMO amount,13152,Other,225% of NY Medicaid HMO DRG,8943,,153% x Medicaid HMO amount,8943,Other,153% of NY Medicaid HMO DRG,13152,,225% x Medicaid HMO amount,13152,Other,225% of NY Medicaid HMO DRG,8183,,140% x Medicaid HMO amount,8183,Other,140% of NY Medicaid HMO DRG,13152,,DRG base rate x DRG weight + capital per discharge,13152,Other,225% of NY Medicaid HMO DRG,16074,,275% x Medicaid HMO amount,16074,Other,275% of NY Medicaid HMO DRG,18938,,324% x Medicaid HMO amount,18938,Other,324% of NY Medicaid HMO DRG,12567,,215% x Medicaid HMO amount,12567,Other,215% of NY Medicaid HMO DRG,12567,,215% x Medicaid HMO amount,12567,Other,215% of NY Medicaid HMO DRG,7307,,125% x Medicaid HMO amount,7307,Other,125% of NY Medicaid HMO DRG,0.01,23378,
Eye procedures except orbit,073-3,APR-DRG,,,,,,,,inpatient,,,721787.24,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29991,,186% x Medicaid HMO amount,29991,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,68112,,"27,634 x DRG Weight",68112,Other,DRG Base Rate x DRG Weight,57893,,"23,488 x DRG Weight",57893,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16124.21,,DRG base rate x DRG weight + capital per discharge,16124.21,Other,100% of NY Medicaid HMO DRG,16124,,DRG base rate x DRG weight + capital per discharge,16124,Other,100% of NY Medicaid HMO DRG,16124,,DRG base rate x DRG weight + capital per discharge,16124,Other,100% of NY Medicaid HMO DRG,16124,,DRG base rate x DRG weight + capital per discharge,16124,Other,100% of NY Medicaid HMO DRG,36279,,225% x Medicaid HMO amount,36279,Other,225% of NY Medicaid HMO DRG,24670,,153% x Medicaid HMO amount,24670,Other,153% of NY Medicaid HMO DRG,36279,,225% x Medicaid HMO amount,36279,Other,225% of NY Medicaid HMO DRG,22574,,140% x Medicaid HMO amount,22574,Other,140% of NY Medicaid HMO DRG,36279,,DRG base rate x DRG weight + capital per discharge,36279,Other,225% of NY Medicaid HMO DRG,44342,,275% x Medicaid HMO amount,44342,Other,275% of NY Medicaid HMO DRG,52242,,324% x Medicaid HMO amount,52242,Other,324% of NY Medicaid HMO DRG,34667,,215% x Medicaid HMO amount,34667,Other,215% of NY Medicaid HMO DRG,34667,,215% x Medicaid HMO amount,34667,Other,215% of NY Medicaid HMO DRG,20155,,125% x Medicaid HMO amount,20155,Other,125% of NY Medicaid HMO DRG,0.01,68112,
Eye procedures except orbit,073-4,APR-DRG,,,,,,,,inpatient,,,285207.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31311,,186% x Medicaid HMO amount,31311,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,71202,,"27,634 x DRG Weight",71202,Other,DRG Base Rate x DRG Weight,60519,,"23,488 x DRG Weight",60519,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16834.21,,DRG base rate x DRG weight + capital per discharge,16834.21,Other,100% of NY Medicaid HMO DRG,16834,,DRG base rate x DRG weight + capital per discharge,16834,Other,100% of NY Medicaid HMO DRG,16834,,DRG base rate x DRG weight + capital per discharge,16834,Other,100% of NY Medicaid HMO DRG,16834,,DRG base rate x DRG weight + capital per discharge,16834,Other,100% of NY Medicaid HMO DRG,37877,,225% x Medicaid HMO amount,37877,Other,225% of NY Medicaid HMO DRG,25756,,153% x Medicaid HMO amount,25756,Other,153% of NY Medicaid HMO DRG,37877,,225% x Medicaid HMO amount,37877,Other,225% of NY Medicaid HMO DRG,23568,,140% x Medicaid HMO amount,23568,Other,140% of NY Medicaid HMO DRG,37877,,DRG base rate x DRG weight + capital per discharge,37877,Other,225% of NY Medicaid HMO DRG,46294,,275% x Medicaid HMO amount,46294,Other,275% of NY Medicaid HMO DRG,54543,,324% x Medicaid HMO amount,54543,Other,324% of NY Medicaid HMO DRG,36194,,215% x Medicaid HMO amount,36194,Other,215% of NY Medicaid HMO DRG,36194,,215% x Medicaid HMO amount,36194,Other,215% of NY Medicaid HMO DRG,21043,,125% x Medicaid HMO amount,21043,Other,125% of NY Medicaid HMO DRG,0.01,71202,
Acute major eye infections,080-1,APR-DRG,,,,,,,,inpatient,,,62248.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7371,,186% x Medicaid HMO amount,7371,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15190,,"27,634 x DRG Weight",15190,Other,DRG Base Rate x DRG Weight,12911,,"23,488 x DRG Weight",12911,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3963.21,,DRG base rate x DRG weight + capital per discharge,3963.21,Other,100% of NY Medicaid HMO DRG,3963,,DRG base rate x DRG weight + capital per discharge,3963,Other,100% of NY Medicaid HMO DRG,3963,,DRG base rate x DRG weight + capital per discharge,3963,Other,100% of NY Medicaid HMO DRG,3963,,DRG base rate x DRG weight + capital per discharge,3963,Other,100% of NY Medicaid HMO DRG,8917,,225% x Medicaid HMO amount,8917,Other,225% of NY Medicaid HMO DRG,6064,,153% x Medicaid HMO amount,6064,Other,153% of NY Medicaid HMO DRG,8917,,225% x Medicaid HMO amount,8917,Other,225% of NY Medicaid HMO DRG,5548,,140% x Medicaid HMO amount,5548,Other,140% of NY Medicaid HMO DRG,8917,,DRG base rate x DRG weight + capital per discharge,8917,Other,225% of NY Medicaid HMO DRG,10899,,275% x Medicaid HMO amount,10899,Other,275% of NY Medicaid HMO DRG,12841,,324% x Medicaid HMO amount,12841,Other,324% of NY Medicaid HMO DRG,8521,,215% x Medicaid HMO amount,8521,Other,215% of NY Medicaid HMO DRG,8521,,215% x Medicaid HMO amount,8521,Other,215% of NY Medicaid HMO DRG,4954,,125% x Medicaid HMO amount,4954,Other,125% of NY Medicaid HMO DRG,0.01,15190,
Acute major eye infections,080-2,APR-DRG,,,,,,,,inpatient,,,75862.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9175,,186% x Medicaid HMO amount,9175,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19407,,"27,634 x DRG Weight",19407,Other,DRG Base Rate x DRG Weight,16496,,"23,488 x DRG Weight",16496,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4933.21,,DRG base rate x DRG weight + capital per discharge,4933.21,Other,100% of NY Medicaid HMO DRG,4933,,DRG base rate x DRG weight + capital per discharge,4933,Other,100% of NY Medicaid HMO DRG,4933,,DRG base rate x DRG weight + capital per discharge,4933,Other,100% of NY Medicaid HMO DRG,4933,,DRG base rate x DRG weight + capital per discharge,4933,Other,100% of NY Medicaid HMO DRG,11100,,225% x Medicaid HMO amount,11100,Other,225% of NY Medicaid HMO DRG,7548,,153% x Medicaid HMO amount,7548,Other,153% of NY Medicaid HMO DRG,11100,,225% x Medicaid HMO amount,11100,Other,225% of NY Medicaid HMO DRG,6906,,140% x Medicaid HMO amount,6906,Other,140% of NY Medicaid HMO DRG,11100,,DRG base rate x DRG weight + capital per discharge,11100,Other,225% of NY Medicaid HMO DRG,13566,,275% x Medicaid HMO amount,13566,Other,275% of NY Medicaid HMO DRG,15984,,324% x Medicaid HMO amount,15984,Other,324% of NY Medicaid HMO DRG,10606,,215% x Medicaid HMO amount,10606,Other,215% of NY Medicaid HMO DRG,10606,,215% x Medicaid HMO amount,10606,Other,215% of NY Medicaid HMO DRG,6167,,125% x Medicaid HMO amount,6167,Other,125% of NY Medicaid HMO DRG,0.01,19407,
Acute major eye infections,080-3,APR-DRG,,,,,,,,inpatient,,,189423,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15185,,186% x Medicaid HMO amount,15185,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33470,,"27,634 x DRG Weight",33470,Other,DRG Base Rate x DRG Weight,28449,,"23,488 x DRG Weight",28449,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8164.21,,DRG base rate x DRG weight + capital per discharge,8164.21,Other,100% of NY Medicaid HMO DRG,8164,,DRG base rate x DRG weight + capital per discharge,8164,Other,100% of NY Medicaid HMO DRG,8164,,DRG base rate x DRG weight + capital per discharge,8164,Other,100% of NY Medicaid HMO DRG,8164,,DRG base rate x DRG weight + capital per discharge,8164,Other,100% of NY Medicaid HMO DRG,18369,,225% x Medicaid HMO amount,18369,Other,225% of NY Medicaid HMO DRG,12491,,153% x Medicaid HMO amount,12491,Other,153% of NY Medicaid HMO DRG,18369,,225% x Medicaid HMO amount,18369,Other,225% of NY Medicaid HMO DRG,11430,,140% x Medicaid HMO amount,11430,Other,140% of NY Medicaid HMO DRG,18369,,DRG base rate x DRG weight + capital per discharge,18369,Other,225% of NY Medicaid HMO DRG,22452,,275% x Medicaid HMO amount,22452,Other,275% of NY Medicaid HMO DRG,26452,,324% x Medicaid HMO amount,26452,Other,324% of NY Medicaid HMO DRG,17553,,215% x Medicaid HMO amount,17553,Other,215% of NY Medicaid HMO DRG,17553,,215% x Medicaid HMO amount,17553,Other,215% of NY Medicaid HMO DRG,10205,,125% x Medicaid HMO amount,10205,Other,125% of NY Medicaid HMO DRG,0.01,33470,
Acute major eye infections,080-4,APR-DRG,,,,,,,,inpatient,,,189423,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16848,,186% x Medicaid HMO amount,16848,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37361,,"27,634 x DRG Weight",37361,Other,DRG Base Rate x DRG Weight,31756,,"23,488 x DRG Weight",31756,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9058.21,,DRG base rate x DRG weight + capital per discharge,9058.21,Other,100% of NY Medicaid HMO DRG,9058,,DRG base rate x DRG weight + capital per discharge,9058,Other,100% of NY Medicaid HMO DRG,9058,,DRG base rate x DRG weight + capital per discharge,9058,Other,100% of NY Medicaid HMO DRG,9058,,DRG base rate x DRG weight + capital per discharge,9058,Other,100% of NY Medicaid HMO DRG,20381,,225% x Medicaid HMO amount,20381,Other,225% of NY Medicaid HMO DRG,13859,,153% x Medicaid HMO amount,13859,Other,153% of NY Medicaid HMO DRG,20381,,225% x Medicaid HMO amount,20381,Other,225% of NY Medicaid HMO DRG,12681,,140% x Medicaid HMO amount,12681,Other,140% of NY Medicaid HMO DRG,20381,,DRG base rate x DRG weight + capital per discharge,20381,Other,225% of NY Medicaid HMO DRG,24910,,275% x Medicaid HMO amount,24910,Other,275% of NY Medicaid HMO DRG,29349,,324% x Medicaid HMO amount,29349,Other,324% of NY Medicaid HMO DRG,19475,,215% x Medicaid HMO amount,19475,Other,215% of NY Medicaid HMO DRG,19475,,215% x Medicaid HMO amount,19475,Other,215% of NY Medicaid HMO DRG,11323,,125% x Medicaid HMO amount,11323,Other,125% of NY Medicaid HMO DRG,0.01,37361,
Eye disorders except major infections,082-1,APR-DRG,,,,,,,,inpatient,,,92331.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6661,,186% x Medicaid HMO amount,6661,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13527,,"27,634 x DRG Weight",13527,Other,DRG Base Rate x DRG Weight,11497,,"23,488 x DRG Weight",11497,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3581.21,,DRG base rate x DRG weight + capital per discharge,3581.21,Other,100% of NY Medicaid HMO DRG,3581,,DRG base rate x DRG weight + capital per discharge,3581,Other,100% of NY Medicaid HMO DRG,3581,,DRG base rate x DRG weight + capital per discharge,3581,Other,100% of NY Medicaid HMO DRG,3581,,DRG base rate x DRG weight + capital per discharge,3581,Other,100% of NY Medicaid HMO DRG,8058,,225% x Medicaid HMO amount,8058,Other,225% of NY Medicaid HMO DRG,5479,,153% x Medicaid HMO amount,5479,Other,153% of NY Medicaid HMO DRG,8058,,225% x Medicaid HMO amount,8058,Other,225% of NY Medicaid HMO DRG,5014,,140% x Medicaid HMO amount,5014,Other,140% of NY Medicaid HMO DRG,8058,,DRG base rate x DRG weight + capital per discharge,8058,Other,225% of NY Medicaid HMO DRG,9848,,275% x Medicaid HMO amount,9848,Other,275% of NY Medicaid HMO DRG,11603,,324% x Medicaid HMO amount,11603,Other,324% of NY Medicaid HMO DRG,7700,,215% x Medicaid HMO amount,7700,Other,215% of NY Medicaid HMO DRG,7700,,215% x Medicaid HMO amount,7700,Other,215% of NY Medicaid HMO DRG,4477,,125% x Medicaid HMO amount,4477,Other,125% of NY Medicaid HMO DRG,0.01,13527,
Eye disorders except major infections,082-2,APR-DRG,,,,,,,,inpatient,,,117692.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7890,,186% x Medicaid HMO amount,7890,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16401,,"27,634 x DRG Weight",16401,Other,DRG Base Rate x DRG Weight,13940,,"23,488 x DRG Weight",13940,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4242.21,,DRG base rate x DRG weight + capital per discharge,4242.21,Other,100% of NY Medicaid HMO DRG,4242,,DRG base rate x DRG weight + capital per discharge,4242,Other,100% of NY Medicaid HMO DRG,4242,,DRG base rate x DRG weight + capital per discharge,4242,Other,100% of NY Medicaid HMO DRG,4242,,DRG base rate x DRG weight + capital per discharge,4242,Other,100% of NY Medicaid HMO DRG,9545,,225% x Medicaid HMO amount,9545,Other,225% of NY Medicaid HMO DRG,6491,,153% x Medicaid HMO amount,6491,Other,153% of NY Medicaid HMO DRG,9545,,225% x Medicaid HMO amount,9545,Other,225% of NY Medicaid HMO DRG,5939,,140% x Medicaid HMO amount,5939,Other,140% of NY Medicaid HMO DRG,9545,,DRG base rate x DRG weight + capital per discharge,9545,Other,225% of NY Medicaid HMO DRG,11666,,275% x Medicaid HMO amount,11666,Other,275% of NY Medicaid HMO DRG,13745,,324% x Medicaid HMO amount,13745,Other,324% of NY Medicaid HMO DRG,9121,,215% x Medicaid HMO amount,9121,Other,215% of NY Medicaid HMO DRG,9121,,215% x Medicaid HMO amount,9121,Other,215% of NY Medicaid HMO DRG,5303,,125% x Medicaid HMO amount,5303,Other,125% of NY Medicaid HMO DRG,0.01,16401,
Eye disorders except major infections,082-3,APR-DRG,,,,,,,,inpatient,,,271037.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13000,,186% x Medicaid HMO amount,13000,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28355,,"27,634 x DRG Weight",28355,Other,DRG Base Rate x DRG Weight,24101,,"23,488 x DRG Weight",24101,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6989.21,,DRG base rate x DRG weight + capital per discharge,6989.21,Other,100% of NY Medicaid HMO DRG,6989,,DRG base rate x DRG weight + capital per discharge,6989,Other,100% of NY Medicaid HMO DRG,6989,,DRG base rate x DRG weight + capital per discharge,6989,Other,100% of NY Medicaid HMO DRG,6989,,DRG base rate x DRG weight + capital per discharge,6989,Other,100% of NY Medicaid HMO DRG,15726,,225% x Medicaid HMO amount,15726,Other,225% of NY Medicaid HMO DRG,10693,,153% x Medicaid HMO amount,10693,Other,153% of NY Medicaid HMO DRG,15726,,225% x Medicaid HMO amount,15726,Other,225% of NY Medicaid HMO DRG,9785,,140% x Medicaid HMO amount,9785,Other,140% of NY Medicaid HMO DRG,15726,,DRG base rate x DRG weight + capital per discharge,15726,Other,225% of NY Medicaid HMO DRG,19220,,275% x Medicaid HMO amount,19220,Other,275% of NY Medicaid HMO DRG,22645,,324% x Medicaid HMO amount,22645,Other,324% of NY Medicaid HMO DRG,15027,,215% x Medicaid HMO amount,15027,Other,215% of NY Medicaid HMO DRG,15027,,215% x Medicaid HMO amount,15027,Other,215% of NY Medicaid HMO DRG,8737,,125% x Medicaid HMO amount,8737,Other,125% of NY Medicaid HMO DRG,0.01,28355,
Eye disorders except major infections,082-4,APR-DRG,,,,,,,,inpatient,,,271037.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13340,,186% x Medicaid HMO amount,13340,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29151,,"27,634 x DRG Weight",29151,Other,DRG Base Rate x DRG Weight,24777,,"23,488 x DRG Weight",24777,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7172.21,,DRG base rate x DRG weight + capital per discharge,7172.21,Other,100% of NY Medicaid HMO DRG,7172,,DRG base rate x DRG weight + capital per discharge,7172,Other,100% of NY Medicaid HMO DRG,7172,,DRG base rate x DRG weight + capital per discharge,7172,Other,100% of NY Medicaid HMO DRG,7172,,DRG base rate x DRG weight + capital per discharge,7172,Other,100% of NY Medicaid HMO DRG,16137,,225% x Medicaid HMO amount,16137,Other,225% of NY Medicaid HMO DRG,10973,,153% x Medicaid HMO amount,10973,Other,153% of NY Medicaid HMO DRG,16137,,225% x Medicaid HMO amount,16137,Other,225% of NY Medicaid HMO DRG,10041,,140% x Medicaid HMO amount,10041,Other,140% of NY Medicaid HMO DRG,16137,,DRG base rate x DRG weight + capital per discharge,16137,Other,225% of NY Medicaid HMO DRG,19724,,275% x Medicaid HMO amount,19724,Other,275% of NY Medicaid HMO DRG,23238,,324% x Medicaid HMO amount,23238,Other,324% of NY Medicaid HMO DRG,15420,,215% x Medicaid HMO amount,15420,Other,215% of NY Medicaid HMO DRG,15420,,215% x Medicaid HMO amount,15420,Other,215% of NY Medicaid HMO DRG,8965,,125% x Medicaid HMO amount,8965,Other,125% of NY Medicaid HMO DRG,0.01,29151,
Major cranial/facial bone procedures,089-1,APR-DRG,,,,,,,,inpatient,,,163032.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16982,,186% x Medicaid HMO amount,16982,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37676,,"27,634 x DRG Weight",37676,Other,DRG Base Rate x DRG Weight,32024,,"23,488 x DRG Weight",32024,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9130.21,,DRG base rate x DRG weight + capital per discharge,9130.21,Other,100% of NY Medicaid HMO DRG,9130,,DRG base rate x DRG weight + capital per discharge,9130,Other,100% of NY Medicaid HMO DRG,9130,,DRG base rate x DRG weight + capital per discharge,9130,Other,100% of NY Medicaid HMO DRG,9130,,DRG base rate x DRG weight + capital per discharge,9130,Other,100% of NY Medicaid HMO DRG,20543,,225% x Medicaid HMO amount,20543,Other,225% of NY Medicaid HMO DRG,13969,,153% x Medicaid HMO amount,13969,Other,153% of NY Medicaid HMO DRG,20543,,225% x Medicaid HMO amount,20543,Other,225% of NY Medicaid HMO DRG,12782,,140% x Medicaid HMO amount,12782,Other,140% of NY Medicaid HMO DRG,20543,,DRG base rate x DRG weight + capital per discharge,20543,Other,225% of NY Medicaid HMO DRG,25108,,275% x Medicaid HMO amount,25108,Other,275% of NY Medicaid HMO DRG,29582,,324% x Medicaid HMO amount,29582,Other,324% of NY Medicaid HMO DRG,19630,,215% x Medicaid HMO amount,19630,Other,215% of NY Medicaid HMO DRG,19630,,215% x Medicaid HMO amount,19630,Other,215% of NY Medicaid HMO DRG,11413,,125% x Medicaid HMO amount,11413,Other,125% of NY Medicaid HMO DRG,0.01,37676,
Major cranial/facial bone procedures,089-2,APR-DRG,,,,,,,,inpatient,,,248871.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26418,,186% x Medicaid HMO amount,26418,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59750,,"27,634 x DRG Weight",59750,Other,DRG Base Rate x DRG Weight,50786,,"23,488 x DRG Weight",50786,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14203.21,,DRG base rate x DRG weight + capital per discharge,14203.21,Other,100% of NY Medicaid HMO DRG,14203,,DRG base rate x DRG weight + capital per discharge,14203,Other,100% of NY Medicaid HMO DRG,14203,,DRG base rate x DRG weight + capital per discharge,14203,Other,100% of NY Medicaid HMO DRG,14203,,DRG base rate x DRG weight + capital per discharge,14203,Other,100% of NY Medicaid HMO DRG,31957,,225% x Medicaid HMO amount,31957,Other,225% of NY Medicaid HMO DRG,21731,,153% x Medicaid HMO amount,21731,Other,153% of NY Medicaid HMO DRG,31957,,225% x Medicaid HMO amount,31957,Other,225% of NY Medicaid HMO DRG,19884,,140% x Medicaid HMO amount,19884,Other,140% of NY Medicaid HMO DRG,31957,,DRG base rate x DRG weight + capital per discharge,31957,Other,225% of NY Medicaid HMO DRG,39059,,275% x Medicaid HMO amount,39059,Other,275% of NY Medicaid HMO DRG,46018,,324% x Medicaid HMO amount,46018,Other,324% of NY Medicaid HMO DRG,30537,,215% x Medicaid HMO amount,30537,Other,215% of NY Medicaid HMO DRG,30537,,215% x Medicaid HMO amount,30537,Other,215% of NY Medicaid HMO DRG,17754,,125% x Medicaid HMO amount,17754,Other,125% of NY Medicaid HMO DRG,0.01,59750,
Major cranial/facial bone procedures,089-3,APR-DRG,,,,,,,,inpatient,,,509390.85,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45879,,186% x Medicaid HMO amount,45879,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,105286,,"27,634 x DRG Weight",105286,Other,DRG Base Rate x DRG Weight,89489,,"23,488 x DRG Weight",89489,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24666.21,,DRG base rate x DRG weight + capital per discharge,24666.21,Other,100% of NY Medicaid HMO DRG,24666,,DRG base rate x DRG weight + capital per discharge,24666,Other,100% of NY Medicaid HMO DRG,24666,,DRG base rate x DRG weight + capital per discharge,24666,Other,100% of NY Medicaid HMO DRG,24666,,DRG base rate x DRG weight + capital per discharge,24666,Other,100% of NY Medicaid HMO DRG,55499,,225% x Medicaid HMO amount,55499,Other,225% of NY Medicaid HMO DRG,37739,,153% x Medicaid HMO amount,37739,Other,153% of NY Medicaid HMO DRG,55499,,225% x Medicaid HMO amount,55499,Other,225% of NY Medicaid HMO DRG,34533,,140% x Medicaid HMO amount,34533,Other,140% of NY Medicaid HMO DRG,55499,,DRG base rate x DRG weight + capital per discharge,55499,Other,225% of NY Medicaid HMO DRG,67832,,275% x Medicaid HMO amount,67832,Other,275% of NY Medicaid HMO DRG,79919,,324% x Medicaid HMO amount,79919,Other,324% of NY Medicaid HMO DRG,53032,,215% x Medicaid HMO amount,53032,Other,215% of NY Medicaid HMO DRG,53032,,215% x Medicaid HMO amount,53032,Other,215% of NY Medicaid HMO DRG,30833,,125% x Medicaid HMO amount,30833,Other,125% of NY Medicaid HMO DRG,0.01,105286,
Major cranial/facial bone procedures,089-4,APR-DRG,,,,,,,,inpatient,,,1100723.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,81414,,186% x Medicaid HMO amount,81414,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,188425,,"27,634 x DRG Weight",188425,Other,DRG Base Rate x DRG Weight,160155,,"23,488 x DRG Weight",160155,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43771.21,,DRG base rate x DRG weight + capital per discharge,43771.21,Other,100% of NY Medicaid HMO DRG,43771,,DRG base rate x DRG weight + capital per discharge,43771,Other,100% of NY Medicaid HMO DRG,43771,,DRG base rate x DRG weight + capital per discharge,43771,Other,100% of NY Medicaid HMO DRG,43771,,DRG base rate x DRG weight + capital per discharge,43771,Other,100% of NY Medicaid HMO DRG,98485,,225% x Medicaid HMO amount,98485,Other,225% of NY Medicaid HMO DRG,66970,,153% x Medicaid HMO amount,66970,Other,153% of NY Medicaid HMO DRG,98485,,225% x Medicaid HMO amount,98485,Other,225% of NY Medicaid HMO DRG,61280,,140% x Medicaid HMO amount,61280,Other,140% of NY Medicaid HMO DRG,98485,,DRG base rate x DRG weight + capital per discharge,98485,Other,225% of NY Medicaid HMO DRG,120371,,275% x Medicaid HMO amount,120371,Other,275% of NY Medicaid HMO DRG,141819,,324% x Medicaid HMO amount,141819,Other,324% of NY Medicaid HMO DRG,94108,,215% x Medicaid HMO amount,94108,Other,215% of NY Medicaid HMO DRG,94108,,215% x Medicaid HMO amount,94108,Other,215% of NY Medicaid HMO DRG,54714,,125% x Medicaid HMO amount,54714,Other,125% of NY Medicaid HMO DRG,0.01,188425,
Major larynx & trachea procedures,090-1,APR-DRG,,,,,,,,inpatient,,,111215.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9839,,186% x Medicaid HMO amount,9839,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20963,,"27,634 x DRG Weight",20963,Other,DRG Base Rate x DRG Weight,17818,,"23,488 x DRG Weight",17818,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5290.21,,DRG base rate x DRG weight + capital per discharge,5290.21,Other,100% of NY Medicaid HMO DRG,5290,,DRG base rate x DRG weight + capital per discharge,5290,Other,100% of NY Medicaid HMO DRG,5290,,DRG base rate x DRG weight + capital per discharge,5290,Other,100% of NY Medicaid HMO DRG,5290,,DRG base rate x DRG weight + capital per discharge,5290,Other,100% of NY Medicaid HMO DRG,11903,,225% x Medicaid HMO amount,11903,Other,225% of NY Medicaid HMO DRG,8094,,153% x Medicaid HMO amount,8094,Other,153% of NY Medicaid HMO DRG,11903,,225% x Medicaid HMO amount,11903,Other,225% of NY Medicaid HMO DRG,7406,,140% x Medicaid HMO amount,7406,Other,140% of NY Medicaid HMO DRG,11903,,DRG base rate x DRG weight + capital per discharge,11903,Other,225% of NY Medicaid HMO DRG,14548,,275% x Medicaid HMO amount,14548,Other,275% of NY Medicaid HMO DRG,17140,,324% x Medicaid HMO amount,17140,Other,324% of NY Medicaid HMO DRG,11374,,215% x Medicaid HMO amount,11374,Other,215% of NY Medicaid HMO DRG,11374,,215% x Medicaid HMO amount,11374,Other,215% of NY Medicaid HMO DRG,6613,,125% x Medicaid HMO amount,6613,Other,125% of NY Medicaid HMO DRG,0.01,20963,
Major larynx & trachea procedures,090-2,APR-DRG,,,,,,,,inpatient,,,357205.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27716,,186% x Medicaid HMO amount,27716,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62787,,"27,634 x DRG Weight",62787,Other,DRG Base Rate x DRG Weight,53367,,"23,488 x DRG Weight",53367,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14901.21,,DRG base rate x DRG weight + capital per discharge,14901.21,Other,100% of NY Medicaid HMO DRG,14901,,DRG base rate x DRG weight + capital per discharge,14901,Other,100% of NY Medicaid HMO DRG,14901,,DRG base rate x DRG weight + capital per discharge,14901,Other,100% of NY Medicaid HMO DRG,14901,,DRG base rate x DRG weight + capital per discharge,14901,Other,100% of NY Medicaid HMO DRG,33528,,225% x Medicaid HMO amount,33528,Other,225% of NY Medicaid HMO DRG,22799,,153% x Medicaid HMO amount,22799,Other,153% of NY Medicaid HMO DRG,33528,,225% x Medicaid HMO amount,33528,Other,225% of NY Medicaid HMO DRG,20862,,140% x Medicaid HMO amount,20862,Other,140% of NY Medicaid HMO DRG,33528,,DRG base rate x DRG weight + capital per discharge,33528,Other,225% of NY Medicaid HMO DRG,40978,,275% x Medicaid HMO amount,40978,Other,275% of NY Medicaid HMO DRG,48280,,324% x Medicaid HMO amount,48280,Other,324% of NY Medicaid HMO DRG,32038,,215% x Medicaid HMO amount,32038,Other,215% of NY Medicaid HMO DRG,32038,,215% x Medicaid HMO amount,32038,Other,215% of NY Medicaid HMO DRG,18627,,125% x Medicaid HMO amount,18627,Other,125% of NY Medicaid HMO DRG,0.01,62787,
Major larynx & trachea procedures,090-3,APR-DRG,,,,,,,,inpatient,,,300761.19,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49147,,186% x Medicaid HMO amount,49147,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,112929,,"27,634 x DRG Weight",112929,Other,DRG Base Rate x DRG Weight,95986,,"23,488 x DRG Weight",95986,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26423.21,,DRG base rate x DRG weight + capital per discharge,26423.21,Other,100% of NY Medicaid HMO DRG,26423,,DRG base rate x DRG weight + capital per discharge,26423,Other,100% of NY Medicaid HMO DRG,26423,,DRG base rate x DRG weight + capital per discharge,26423,Other,100% of NY Medicaid HMO DRG,26423,,DRG base rate x DRG weight + capital per discharge,26423,Other,100% of NY Medicaid HMO DRG,59452,,225% x Medicaid HMO amount,59452,Other,225% of NY Medicaid HMO DRG,40428,,153% x Medicaid HMO amount,40428,Other,153% of NY Medicaid HMO DRG,59452,,225% x Medicaid HMO amount,59452,Other,225% of NY Medicaid HMO DRG,36992,,140% x Medicaid HMO amount,36992,Other,140% of NY Medicaid HMO DRG,59452,,DRG base rate x DRG weight + capital per discharge,59452,Other,225% of NY Medicaid HMO DRG,72664,,275% x Medicaid HMO amount,72664,Other,275% of NY Medicaid HMO DRG,85611,,324% x Medicaid HMO amount,85611,Other,324% of NY Medicaid HMO DRG,56810,,215% x Medicaid HMO amount,56810,Other,215% of NY Medicaid HMO DRG,56810,,215% x Medicaid HMO amount,56810,Other,215% of NY Medicaid HMO DRG,33029,,125% x Medicaid HMO amount,33029,Other,125% of NY Medicaid HMO DRG,0.01,112929,
Major larynx & trachea procedures,090-4,APR-DRG,,,,,,,,inpatient,,,1517996.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,133522,,186% x Medicaid HMO amount,133522,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,310341,,"27,634 x DRG Weight",310341,Other,DRG Base Rate x DRG Weight,263780,,"23,488 x DRG Weight",263780,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,71786.21,,DRG base rate x DRG weight + capital per discharge,71786.21,Other,100% of NY Medicaid HMO DRG,71786,,DRG base rate x DRG weight + capital per discharge,71786,Other,100% of NY Medicaid HMO DRG,71786,,DRG base rate x DRG weight + capital per discharge,71786,Other,100% of NY Medicaid HMO DRG,71786,,DRG base rate x DRG weight + capital per discharge,71786,Other,100% of NY Medicaid HMO DRG,161519,,225% x Medicaid HMO amount,161519,Other,225% of NY Medicaid HMO DRG,109833,,153% x Medicaid HMO amount,109833,Other,153% of NY Medicaid HMO DRG,161519,,225% x Medicaid HMO amount,161519,Other,225% of NY Medicaid HMO DRG,100501,,140% x Medicaid HMO amount,100501,Other,140% of NY Medicaid HMO DRG,161519,,DRG base rate x DRG weight + capital per discharge,161519,Other,225% of NY Medicaid HMO DRG,197412,,275% x Medicaid HMO amount,197412,Other,275% of NY Medicaid HMO DRG,232587,,324% x Medicaid HMO amount,232587,Other,324% of NY Medicaid HMO DRG,154340,,215% x Medicaid HMO amount,154340,Other,215% of NY Medicaid HMO DRG,154340,,215% x Medicaid HMO amount,154340,Other,215% of NY Medicaid HMO DRG,89733,,125% x Medicaid HMO amount,89733,Other,125% of NY Medicaid HMO DRG,0.01,310341,
Other major head & neck procedures,091-1,APR-DRG,,,,,,,,inpatient,,,591656.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16643,,186% x Medicaid HMO amount,16643,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36880,,"27,634 x DRG Weight",36880,Other,DRG Base Rate x DRG Weight,31347,,"23,488 x DRG Weight",31347,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8948.21,,DRG base rate x DRG weight + capital per discharge,8948.21,Other,100% of NY Medicaid HMO DRG,8948,,DRG base rate x DRG weight + capital per discharge,8948,Other,100% of NY Medicaid HMO DRG,8948,,DRG base rate x DRG weight + capital per discharge,8948,Other,100% of NY Medicaid HMO DRG,8948,,DRG base rate x DRG weight + capital per discharge,8948,Other,100% of NY Medicaid HMO DRG,20133,,225% x Medicaid HMO amount,20133,Other,225% of NY Medicaid HMO DRG,13691,,153% x Medicaid HMO amount,13691,Other,153% of NY Medicaid HMO DRG,20133,,225% x Medicaid HMO amount,20133,Other,225% of NY Medicaid HMO DRG,12527,,140% x Medicaid HMO amount,12527,Other,140% of NY Medicaid HMO DRG,20133,,DRG base rate x DRG weight + capital per discharge,20133,Other,225% of NY Medicaid HMO DRG,24608,,275% x Medicaid HMO amount,24608,Other,275% of NY Medicaid HMO DRG,28992,,324% x Medicaid HMO amount,28992,Other,324% of NY Medicaid HMO DRG,19239,,215% x Medicaid HMO amount,19239,Other,215% of NY Medicaid HMO DRG,19239,,215% x Medicaid HMO amount,19239,Other,215% of NY Medicaid HMO DRG,11185,,125% x Medicaid HMO amount,11185,Other,125% of NY Medicaid HMO DRG,0.01,36880,
Other major head & neck procedures,091-2,APR-DRG,,,,,,,,inpatient,,,591656.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34529,,186% x Medicaid HMO amount,34529,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78729,,"27,634 x DRG Weight",78729,Other,DRG Base Rate x DRG Weight,66917,,"23,488 x DRG Weight",66917,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18564.21,,DRG base rate x DRG weight + capital per discharge,18564.21,Other,100% of NY Medicaid HMO DRG,18564,,DRG base rate x DRG weight + capital per discharge,18564,Other,100% of NY Medicaid HMO DRG,18564,,DRG base rate x DRG weight + capital per discharge,18564,Other,100% of NY Medicaid HMO DRG,18564,,DRG base rate x DRG weight + capital per discharge,18564,Other,100% of NY Medicaid HMO DRG,41769,,225% x Medicaid HMO amount,41769,Other,225% of NY Medicaid HMO DRG,28403,,153% x Medicaid HMO amount,28403,Other,153% of NY Medicaid HMO DRG,41769,,225% x Medicaid HMO amount,41769,Other,225% of NY Medicaid HMO DRG,25990,,140% x Medicaid HMO amount,25990,Other,140% of NY Medicaid HMO DRG,41769,,DRG base rate x DRG weight + capital per discharge,41769,Other,225% of NY Medicaid HMO DRG,51052,,275% x Medicaid HMO amount,51052,Other,275% of NY Medicaid HMO DRG,60148,,324% x Medicaid HMO amount,60148,Other,324% of NY Medicaid HMO DRG,39913,,215% x Medicaid HMO amount,39913,Other,215% of NY Medicaid HMO DRG,39913,,215% x Medicaid HMO amount,39913,Other,215% of NY Medicaid HMO DRG,23205,,125% x Medicaid HMO amount,23205,Other,125% of NY Medicaid HMO DRG,0.01,78729,
Other major head & neck procedures,091-3,APR-DRG,,,,,,,,inpatient,,,553354.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44398,,186% x Medicaid HMO amount,44398,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,101820,,"27,634 x DRG Weight",101820,Other,DRG Base Rate x DRG Weight,86544,,"23,488 x DRG Weight",86544,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23870.21,,DRG base rate x DRG weight + capital per discharge,23870.21,Other,100% of NY Medicaid HMO DRG,23870,,DRG base rate x DRG weight + capital per discharge,23870,Other,100% of NY Medicaid HMO DRG,23870,,DRG base rate x DRG weight + capital per discharge,23870,Other,100% of NY Medicaid HMO DRG,23870,,DRG base rate x DRG weight + capital per discharge,23870,Other,100% of NY Medicaid HMO DRG,53708,,225% x Medicaid HMO amount,53708,Other,225% of NY Medicaid HMO DRG,36521,,153% x Medicaid HMO amount,36521,Other,153% of NY Medicaid HMO DRG,53708,,225% x Medicaid HMO amount,53708,Other,225% of NY Medicaid HMO DRG,33418,,140% x Medicaid HMO amount,33418,Other,140% of NY Medicaid HMO DRG,53708,,DRG base rate x DRG weight + capital per discharge,53708,Other,225% of NY Medicaid HMO DRG,65643,,275% x Medicaid HMO amount,65643,Other,275% of NY Medicaid HMO DRG,77339,,324% x Medicaid HMO amount,77339,Other,324% of NY Medicaid HMO DRG,51321,,215% x Medicaid HMO amount,51321,Other,215% of NY Medicaid HMO DRG,51321,,215% x Medicaid HMO amount,51321,Other,215% of NY Medicaid HMO DRG,29838,,125% x Medicaid HMO amount,29838,Other,125% of NY Medicaid HMO DRG,0.01,101820,
Other major head & neck procedures,091-4,APR-DRG,,,,,,,,inpatient,,,591656.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49809,,186% x Medicaid HMO amount,49809,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,114479,,"27,634 x DRG Weight",114479,Other,DRG Base Rate x DRG Weight,97304,,"23,488 x DRG Weight",97304,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26779.21,,DRG base rate x DRG weight + capital per discharge,26779.21,Other,100% of NY Medicaid HMO DRG,26779,,DRG base rate x DRG weight + capital per discharge,26779,Other,100% of NY Medicaid HMO DRG,26779,,DRG base rate x DRG weight + capital per discharge,26779,Other,100% of NY Medicaid HMO DRG,26779,,DRG base rate x DRG weight + capital per discharge,26779,Other,100% of NY Medicaid HMO DRG,60253,,225% x Medicaid HMO amount,60253,Other,225% of NY Medicaid HMO DRG,40972,,153% x Medicaid HMO amount,40972,Other,153% of NY Medicaid HMO DRG,60253,,225% x Medicaid HMO amount,60253,Other,225% of NY Medicaid HMO DRG,37491,,140% x Medicaid HMO amount,37491,Other,140% of NY Medicaid HMO DRG,60253,,DRG base rate x DRG weight + capital per discharge,60253,Other,225% of NY Medicaid HMO DRG,73643,,275% x Medicaid HMO amount,73643,Other,275% of NY Medicaid HMO DRG,86765,,324% x Medicaid HMO amount,86765,Other,324% of NY Medicaid HMO DRG,57575,,215% x Medicaid HMO amount,57575,Other,215% of NY Medicaid HMO DRG,57575,,215% x Medicaid HMO amount,57575,Other,215% of NY Medicaid HMO DRG,33474,,125% x Medicaid HMO amount,33474,Other,125% of NY Medicaid HMO DRG,0.01,114479,
Facial bone procedures except major cranial/facial bone procedures,092-1,APR-DRG,,,,,,,,inpatient,,,144089.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13301,,186% x Medicaid HMO amount,13301,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29060,,"27,634 x DRG Weight",29060,Other,DRG Base Rate x DRG Weight,24700,,"23,488 x DRG Weight",24700,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7151.21,,DRG base rate x DRG weight + capital per discharge,7151.21,Other,100% of NY Medicaid HMO DRG,7151,,DRG base rate x DRG weight + capital per discharge,7151,Other,100% of NY Medicaid HMO DRG,7151,,DRG base rate x DRG weight + capital per discharge,7151,Other,100% of NY Medicaid HMO DRG,7151,,DRG base rate x DRG weight + capital per discharge,7151,Other,100% of NY Medicaid HMO DRG,16090,,225% x Medicaid HMO amount,16090,Other,225% of NY Medicaid HMO DRG,10941,,153% x Medicaid HMO amount,10941,Other,153% of NY Medicaid HMO DRG,16090,,225% x Medicaid HMO amount,16090,Other,225% of NY Medicaid HMO DRG,10012,,140% x Medicaid HMO amount,10012,Other,140% of NY Medicaid HMO DRG,16090,,DRG base rate x DRG weight + capital per discharge,16090,Other,225% of NY Medicaid HMO DRG,19666,,275% x Medicaid HMO amount,19666,Other,275% of NY Medicaid HMO DRG,23170,,324% x Medicaid HMO amount,23170,Other,324% of NY Medicaid HMO DRG,15375,,215% x Medicaid HMO amount,15375,Other,215% of NY Medicaid HMO DRG,15375,,215% x Medicaid HMO amount,15375,Other,215% of NY Medicaid HMO DRG,8939,,125% x Medicaid HMO amount,8939,Other,125% of NY Medicaid HMO DRG,0.01,29060,
Facial bone procedures except major cranial/facial bone procedures,092-2,APR-DRG,,,,,,,,inpatient,,,228573.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16995,,186% x Medicaid HMO amount,16995,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37707,,"27,634 x DRG Weight",37707,Other,DRG Base Rate x DRG Weight,32049,,"23,488 x DRG Weight",32049,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9137.21,,DRG base rate x DRG weight + capital per discharge,9137.21,Other,100% of NY Medicaid HMO DRG,9137,,DRG base rate x DRG weight + capital per discharge,9137,Other,100% of NY Medicaid HMO DRG,9137,,DRG base rate x DRG weight + capital per discharge,9137,Other,100% of NY Medicaid HMO DRG,9137,,DRG base rate x DRG weight + capital per discharge,9137,Other,100% of NY Medicaid HMO DRG,20559,,225% x Medicaid HMO amount,20559,Other,225% of NY Medicaid HMO DRG,13980,,153% x Medicaid HMO amount,13980,Other,153% of NY Medicaid HMO DRG,20559,,225% x Medicaid HMO amount,20559,Other,225% of NY Medicaid HMO DRG,12792,,140% x Medicaid HMO amount,12792,Other,140% of NY Medicaid HMO DRG,20559,,DRG base rate x DRG weight + capital per discharge,20559,Other,225% of NY Medicaid HMO DRG,25127,,275% x Medicaid HMO amount,25127,Other,275% of NY Medicaid HMO DRG,29605,,324% x Medicaid HMO amount,29605,Other,324% of NY Medicaid HMO DRG,19645,,215% x Medicaid HMO amount,19645,Other,215% of NY Medicaid HMO DRG,19645,,215% x Medicaid HMO amount,19645,Other,215% of NY Medicaid HMO DRG,11422,,125% x Medicaid HMO amount,11422,Other,125% of NY Medicaid HMO DRG,0.01,37707,
Facial bone procedures except major cranial/facial bone procedures,092-3,APR-DRG,,,,,,,,inpatient,,,358636.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26618,,186% x Medicaid HMO amount,26618,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60220,,"27,634 x DRG Weight",60220,Other,DRG Base Rate x DRG Weight,51185,,"23,488 x DRG Weight",51185,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14311.21,,DRG base rate x DRG weight + capital per discharge,14311.21,Other,100% of NY Medicaid HMO DRG,14311,,DRG base rate x DRG weight + capital per discharge,14311,Other,100% of NY Medicaid HMO DRG,14311,,DRG base rate x DRG weight + capital per discharge,14311,Other,100% of NY Medicaid HMO DRG,14311,,DRG base rate x DRG weight + capital per discharge,14311,Other,100% of NY Medicaid HMO DRG,32200,,225% x Medicaid HMO amount,32200,Other,225% of NY Medicaid HMO DRG,21896,,153% x Medicaid HMO amount,21896,Other,153% of NY Medicaid HMO DRG,32200,,225% x Medicaid HMO amount,32200,Other,225% of NY Medicaid HMO DRG,20036,,140% x Medicaid HMO amount,20036,Other,140% of NY Medicaid HMO DRG,32200,,DRG base rate x DRG weight + capital per discharge,32200,Other,225% of NY Medicaid HMO DRG,39356,,275% x Medicaid HMO amount,39356,Other,275% of NY Medicaid HMO DRG,46368,,324% x Medicaid HMO amount,46368,Other,324% of NY Medicaid HMO DRG,30769,,215% x Medicaid HMO amount,30769,Other,215% of NY Medicaid HMO DRG,30769,,215% x Medicaid HMO amount,30769,Other,215% of NY Medicaid HMO DRG,17889,,125% x Medicaid HMO amount,17889,Other,125% of NY Medicaid HMO DRG,0.01,60220,
Facial bone procedures except major cranial/facial bone procedures,092-4,APR-DRG,,,,,,,,inpatient,,,957722.22,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,87731,,186% x Medicaid HMO amount,87731,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,203204,,"27,634 x DRG Weight",203204,Other,DRG Base Rate x DRG Weight,172717,,"23,488 x DRG Weight",172717,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47167.21,,DRG base rate x DRG weight + capital per discharge,47167.21,Other,100% of NY Medicaid HMO DRG,47167,,DRG base rate x DRG weight + capital per discharge,47167,Other,100% of NY Medicaid HMO DRG,47167,,DRG base rate x DRG weight + capital per discharge,47167,Other,100% of NY Medicaid HMO DRG,47167,,DRG base rate x DRG weight + capital per discharge,47167,Other,100% of NY Medicaid HMO DRG,106126,,225% x Medicaid HMO amount,106126,Other,225% of NY Medicaid HMO DRG,72166,,153% x Medicaid HMO amount,72166,Other,153% of NY Medicaid HMO DRG,106126,,225% x Medicaid HMO amount,106126,Other,225% of NY Medicaid HMO DRG,66034,,140% x Medicaid HMO amount,66034,Other,140% of NY Medicaid HMO DRG,106126,,DRG base rate x DRG weight + capital per discharge,106126,Other,225% of NY Medicaid HMO DRG,129710,,275% x Medicaid HMO amount,129710,Other,275% of NY Medicaid HMO DRG,152822,,324% x Medicaid HMO amount,152822,Other,324% of NY Medicaid HMO DRG,101410,,215% x Medicaid HMO amount,101410,Other,215% of NY Medicaid HMO DRG,101410,,215% x Medicaid HMO amount,101410,Other,215% of NY Medicaid HMO DRG,58959,,125% x Medicaid HMO amount,58959,Other,125% of NY Medicaid HMO DRG,0.01,203204,
Sinus & mastoid procedures,093-1,APR-DRG,,,,,,,,inpatient,,,92659.22,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11474,,186% x Medicaid HMO amount,11474,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24788,,"27,634 x DRG Weight",24788,Other,DRG Base Rate x DRG Weight,21069,,"23,488 x DRG Weight",21069,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6169.21,,DRG base rate x DRG weight + capital per discharge,6169.21,Other,100% of NY Medicaid HMO DRG,6169,,DRG base rate x DRG weight + capital per discharge,6169,Other,100% of NY Medicaid HMO DRG,6169,,DRG base rate x DRG weight + capital per discharge,6169,Other,100% of NY Medicaid HMO DRG,6169,,DRG base rate x DRG weight + capital per discharge,6169,Other,100% of NY Medicaid HMO DRG,13881,,225% x Medicaid HMO amount,13881,Other,225% of NY Medicaid HMO DRG,9439,,153% x Medicaid HMO amount,9439,Other,153% of NY Medicaid HMO DRG,13881,,225% x Medicaid HMO amount,13881,Other,225% of NY Medicaid HMO DRG,8637,,140% x Medicaid HMO amount,8637,Other,140% of NY Medicaid HMO DRG,13881,,DRG base rate x DRG weight + capital per discharge,13881,Other,225% of NY Medicaid HMO DRG,16965,,275% x Medicaid HMO amount,16965,Other,275% of NY Medicaid HMO DRG,19988,,324% x Medicaid HMO amount,19988,Other,324% of NY Medicaid HMO DRG,13264,,215% x Medicaid HMO amount,13264,Other,215% of NY Medicaid HMO DRG,13264,,215% x Medicaid HMO amount,13264,Other,215% of NY Medicaid HMO DRG,7712,,125% x Medicaid HMO amount,7712,Other,125% of NY Medicaid HMO DRG,0.01,24788,
Sinus & mastoid procedures,093-2,APR-DRG,,,,,,,,inpatient,,,168159.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15453,,186% x Medicaid HMO amount,15453,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34095,,"27,634 x DRG Weight",34095,Other,DRG Base Rate x DRG Weight,28979,,"23,488 x DRG Weight",28979,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8308.21,,DRG base rate x DRG weight + capital per discharge,8308.21,Other,100% of NY Medicaid HMO DRG,8308,,DRG base rate x DRG weight + capital per discharge,8308,Other,100% of NY Medicaid HMO DRG,8308,,DRG base rate x DRG weight + capital per discharge,8308,Other,100% of NY Medicaid HMO DRG,8308,,DRG base rate x DRG weight + capital per discharge,8308,Other,100% of NY Medicaid HMO DRG,18693,,225% x Medicaid HMO amount,18693,Other,225% of NY Medicaid HMO DRG,12712,,153% x Medicaid HMO amount,12712,Other,153% of NY Medicaid HMO DRG,18693,,225% x Medicaid HMO amount,18693,Other,225% of NY Medicaid HMO DRG,11631,,140% x Medicaid HMO amount,11631,Other,140% of NY Medicaid HMO DRG,18693,,DRG base rate x DRG weight + capital per discharge,18693,Other,225% of NY Medicaid HMO DRG,22848,,275% x Medicaid HMO amount,22848,Other,275% of NY Medicaid HMO DRG,26919,,324% x Medicaid HMO amount,26919,Other,324% of NY Medicaid HMO DRG,17863,,215% x Medicaid HMO amount,17863,Other,215% of NY Medicaid HMO DRG,17863,,215% x Medicaid HMO amount,17863,Other,215% of NY Medicaid HMO DRG,10385,,125% x Medicaid HMO amount,10385,Other,125% of NY Medicaid HMO DRG,0.01,34095,
Sinus & mastoid procedures,093-3,APR-DRG,,,,,,,,inpatient,,,320080.1,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28849,,186% x Medicaid HMO amount,28849,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65440,,"27,634 x DRG Weight",65440,Other,DRG Base Rate x DRG Weight,55622,,"23,488 x DRG Weight",55622,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15510.21,,DRG base rate x DRG weight + capital per discharge,15510.21,Other,100% of NY Medicaid HMO DRG,15510,,DRG base rate x DRG weight + capital per discharge,15510,Other,100% of NY Medicaid HMO DRG,15510,,DRG base rate x DRG weight + capital per discharge,15510,Other,100% of NY Medicaid HMO DRG,15510,,DRG base rate x DRG weight + capital per discharge,15510,Other,100% of NY Medicaid HMO DRG,34898,,225% x Medicaid HMO amount,34898,Other,225% of NY Medicaid HMO DRG,23731,,153% x Medicaid HMO amount,23731,Other,153% of NY Medicaid HMO DRG,34898,,225% x Medicaid HMO amount,34898,Other,225% of NY Medicaid HMO DRG,21714,,140% x Medicaid HMO amount,21714,Other,140% of NY Medicaid HMO DRG,34898,,DRG base rate x DRG weight + capital per discharge,34898,Other,225% of NY Medicaid HMO DRG,42653,,275% x Medicaid HMO amount,42653,Other,275% of NY Medicaid HMO DRG,50253,,324% x Medicaid HMO amount,50253,Other,324% of NY Medicaid HMO DRG,33347,,215% x Medicaid HMO amount,33347,Other,215% of NY Medicaid HMO DRG,33347,,215% x Medicaid HMO amount,33347,Other,215% of NY Medicaid HMO DRG,19388,,125% x Medicaid HMO amount,19388,Other,125% of NY Medicaid HMO DRG,0.01,65440,
Sinus & mastoid procedures,093-4,APR-DRG,,,,,,,,inpatient,,,350155.65,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33726,,186% x Medicaid HMO amount,33726,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,76850,,"27,634 x DRG Weight",76850,Other,DRG Base Rate x DRG Weight,65320,,"23,488 x DRG Weight",65320,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18132.21,,DRG base rate x DRG weight + capital per discharge,18132.21,Other,100% of NY Medicaid HMO DRG,18132,,DRG base rate x DRG weight + capital per discharge,18132,Other,100% of NY Medicaid HMO DRG,18132,,DRG base rate x DRG weight + capital per discharge,18132,Other,100% of NY Medicaid HMO DRG,18132,,DRG base rate x DRG weight + capital per discharge,18132,Other,100% of NY Medicaid HMO DRG,40797,,225% x Medicaid HMO amount,40797,Other,225% of NY Medicaid HMO DRG,27742,,153% x Medicaid HMO amount,27742,Other,153% of NY Medicaid HMO DRG,40797,,225% x Medicaid HMO amount,40797,Other,225% of NY Medicaid HMO DRG,25385,,140% x Medicaid HMO amount,25385,Other,140% of NY Medicaid HMO DRG,40797,,DRG base rate x DRG weight + capital per discharge,40797,Other,225% of NY Medicaid HMO DRG,49864,,275% x Medicaid HMO amount,49864,Other,275% of NY Medicaid HMO DRG,58748,,324% x Medicaid HMO amount,58748,Other,324% of NY Medicaid HMO DRG,38984,,215% x Medicaid HMO amount,38984,Other,215% of NY Medicaid HMO DRG,38984,,215% x Medicaid HMO amount,38984,Other,215% of NY Medicaid HMO DRG,22665,,125% x Medicaid HMO amount,22665,Other,125% of NY Medicaid HMO DRG,0.01,76850,
Cleft lip & palate repair,095-1,APR-DRG,,,,,,,,inpatient,,,93293.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9347,,186% x Medicaid HMO amount,9347,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19811,,"27,634 x DRG Weight",19811,Other,DRG Base Rate x DRG Weight,16839,,"23,488 x DRG Weight",16839,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5025.21,,DRG base rate x DRG weight + capital per discharge,5025.21,Other,100% of NY Medicaid HMO DRG,5025,,DRG base rate x DRG weight + capital per discharge,5025,Other,100% of NY Medicaid HMO DRG,5025,,DRG base rate x DRG weight + capital per discharge,5025,Other,100% of NY Medicaid HMO DRG,5025,,DRG base rate x DRG weight + capital per discharge,5025,Other,100% of NY Medicaid HMO DRG,11307,,225% x Medicaid HMO amount,11307,Other,225% of NY Medicaid HMO DRG,7689,,153% x Medicaid HMO amount,7689,Other,153% of NY Medicaid HMO DRG,11307,,225% x Medicaid HMO amount,11307,Other,225% of NY Medicaid HMO DRG,7035,,140% x Medicaid HMO amount,7035,Other,140% of NY Medicaid HMO DRG,11307,,DRG base rate x DRG weight + capital per discharge,11307,Other,225% of NY Medicaid HMO DRG,13819,,275% x Medicaid HMO amount,13819,Other,275% of NY Medicaid HMO DRG,16282,,324% x Medicaid HMO amount,16282,Other,324% of NY Medicaid HMO DRG,10804,,215% x Medicaid HMO amount,10804,Other,215% of NY Medicaid HMO DRG,10804,,215% x Medicaid HMO amount,10804,Other,215% of NY Medicaid HMO DRG,6282,,125% x Medicaid HMO amount,6282,Other,125% of NY Medicaid HMO DRG,0.01,19811,
Cleft lip & palate repair,095-2,APR-DRG,,,,,,,,inpatient,,,70312.7,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11592,,186% x Medicaid HMO amount,11592,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25064,,"27,634 x DRG Weight",25064,Other,DRG Base Rate x DRG Weight,21304,,"23,488 x DRG Weight",21304,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6232.21,,DRG base rate x DRG weight + capital per discharge,6232.21,Other,100% of NY Medicaid HMO DRG,6232,,DRG base rate x DRG weight + capital per discharge,6232,Other,100% of NY Medicaid HMO DRG,6232,,DRG base rate x DRG weight + capital per discharge,6232,Other,100% of NY Medicaid HMO DRG,6232,,DRG base rate x DRG weight + capital per discharge,6232,Other,100% of NY Medicaid HMO DRG,14022,,225% x Medicaid HMO amount,14022,Other,225% of NY Medicaid HMO DRG,9535,,153% x Medicaid HMO amount,9535,Other,153% of NY Medicaid HMO DRG,14022,,225% x Medicaid HMO amount,14022,Other,225% of NY Medicaid HMO DRG,8725,,140% x Medicaid HMO amount,8725,Other,140% of NY Medicaid HMO DRG,14022,,DRG base rate x DRG weight + capital per discharge,14022,Other,225% of NY Medicaid HMO DRG,17139,,275% x Medicaid HMO amount,17139,Other,275% of NY Medicaid HMO DRG,20192,,324% x Medicaid HMO amount,20192,Other,324% of NY Medicaid HMO DRG,13399,,215% x Medicaid HMO amount,13399,Other,215% of NY Medicaid HMO DRG,13399,,215% x Medicaid HMO amount,13399,Other,215% of NY Medicaid HMO DRG,7790,,125% x Medicaid HMO amount,7790,Other,125% of NY Medicaid HMO DRG,0.01,25064,
Cleft lip & palate repair,095-3,APR-DRG,,,,,,,,inpatient,,,93293.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17255,,186% x Medicaid HMO amount,17255,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38312,,"27,634 x DRG Weight",38312,Other,DRG Base Rate x DRG Weight,32564,,"23,488 x DRG Weight",32564,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9277.21,,DRG base rate x DRG weight + capital per discharge,9277.21,Other,100% of NY Medicaid HMO DRG,9277,,DRG base rate x DRG weight + capital per discharge,9277,Other,100% of NY Medicaid HMO DRG,9277,,DRG base rate x DRG weight + capital per discharge,9277,Other,100% of NY Medicaid HMO DRG,9277,,DRG base rate x DRG weight + capital per discharge,9277,Other,100% of NY Medicaid HMO DRG,20874,,225% x Medicaid HMO amount,20874,Other,225% of NY Medicaid HMO DRG,14194,,153% x Medicaid HMO amount,14194,Other,153% of NY Medicaid HMO DRG,20874,,225% x Medicaid HMO amount,20874,Other,225% of NY Medicaid HMO DRG,12988,,140% x Medicaid HMO amount,12988,Other,140% of NY Medicaid HMO DRG,20874,,DRG base rate x DRG weight + capital per discharge,20874,Other,225% of NY Medicaid HMO DRG,25512,,275% x Medicaid HMO amount,25512,Other,275% of NY Medicaid HMO DRG,30058,,324% x Medicaid HMO amount,30058,Other,324% of NY Medicaid HMO DRG,19946,,215% x Medicaid HMO amount,19946,Other,215% of NY Medicaid HMO DRG,19946,,215% x Medicaid HMO amount,19946,Other,215% of NY Medicaid HMO DRG,11597,,125% x Medicaid HMO amount,11597,Other,125% of NY Medicaid HMO DRG,0.01,38312,
Cleft lip & palate repair,095-4,APR-DRG,,,,,,,,inpatient,,,93293.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30921,,186% x Medicaid HMO amount,30921,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70287,,"27,634 x DRG Weight",70287,Other,DRG Base Rate x DRG Weight,59742,,"23,488 x DRG Weight",59742,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16624.21,,DRG base rate x DRG weight + capital per discharge,16624.21,Other,100% of NY Medicaid HMO DRG,16624,,DRG base rate x DRG weight + capital per discharge,16624,Other,100% of NY Medicaid HMO DRG,16624,,DRG base rate x DRG weight + capital per discharge,16624,Other,100% of NY Medicaid HMO DRG,16624,,DRG base rate x DRG weight + capital per discharge,16624,Other,100% of NY Medicaid HMO DRG,37404,,225% x Medicaid HMO amount,37404,Other,225% of NY Medicaid HMO DRG,25435,,153% x Medicaid HMO amount,25435,Other,153% of NY Medicaid HMO DRG,37404,,225% x Medicaid HMO amount,37404,Other,225% of NY Medicaid HMO DRG,23274,,140% x Medicaid HMO amount,23274,Other,140% of NY Medicaid HMO DRG,37404,,DRG base rate x DRG weight + capital per discharge,37404,Other,225% of NY Medicaid HMO DRG,45717,,275% x Medicaid HMO amount,45717,Other,275% of NY Medicaid HMO DRG,53862,,324% x Medicaid HMO amount,53862,Other,324% of NY Medicaid HMO DRG,35742,,215% x Medicaid HMO amount,35742,Other,215% of NY Medicaid HMO DRG,35742,,215% x Medicaid HMO amount,35742,Other,215% of NY Medicaid HMO DRG,20780,,125% x Medicaid HMO amount,20780,Other,125% of NY Medicaid HMO DRG,0.01,70287,
Tonsil & adenoid procedures,097-1,APR-DRG,,,,,,,,inpatient,,,59099.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6599,,186% x Medicaid HMO amount,6599,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13380,,"27,634 x DRG Weight",13380,Other,DRG Base Rate x DRG Weight,11373,,"23,488 x DRG Weight",11373,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3548.21,,DRG base rate x DRG weight + capital per discharge,3548.21,Other,100% of NY Medicaid HMO DRG,3548,,DRG base rate x DRG weight + capital per discharge,3548,Other,100% of NY Medicaid HMO DRG,3548,,DRG base rate x DRG weight + capital per discharge,3548,Other,100% of NY Medicaid HMO DRG,3548,,DRG base rate x DRG weight + capital per discharge,3548,Other,100% of NY Medicaid HMO DRG,7983,,225% x Medicaid HMO amount,7983,Other,225% of NY Medicaid HMO DRG,5429,,153% x Medicaid HMO amount,5429,Other,153% of NY Medicaid HMO DRG,7983,,225% x Medicaid HMO amount,7983,Other,225% of NY Medicaid HMO DRG,4967,,140% x Medicaid HMO amount,4967,Other,140% of NY Medicaid HMO DRG,7983,,DRG base rate x DRG weight + capital per discharge,7983,Other,225% of NY Medicaid HMO DRG,9758,,275% x Medicaid HMO amount,9758,Other,275% of NY Medicaid HMO DRG,11496,,324% x Medicaid HMO amount,11496,Other,324% of NY Medicaid HMO DRG,7629,,215% x Medicaid HMO amount,7629,Other,215% of NY Medicaid HMO DRG,7629,,215% x Medicaid HMO amount,7629,Other,215% of NY Medicaid HMO DRG,4435,,125% x Medicaid HMO amount,4435,Other,125% of NY Medicaid HMO DRG,0.01,13380,
Tonsil & adenoid procedures,097-2,APR-DRG,,,,,,,,inpatient,,,85499.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9036,,186% x Medicaid HMO amount,9036,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19084,,"27,634 x DRG Weight",19084,Other,DRG Base Rate x DRG Weight,16221,,"23,488 x DRG Weight",16221,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4858.21,,DRG base rate x DRG weight + capital per discharge,4858.21,Other,100% of NY Medicaid HMO DRG,4858,,DRG base rate x DRG weight + capital per discharge,4858,Other,100% of NY Medicaid HMO DRG,4858,,DRG base rate x DRG weight + capital per discharge,4858,Other,100% of NY Medicaid HMO DRG,4858,,DRG base rate x DRG weight + capital per discharge,4858,Other,100% of NY Medicaid HMO DRG,10931,,225% x Medicaid HMO amount,10931,Other,225% of NY Medicaid HMO DRG,7433,,153% x Medicaid HMO amount,7433,Other,153% of NY Medicaid HMO DRG,10931,,225% x Medicaid HMO amount,10931,Other,225% of NY Medicaid HMO DRG,6801,,140% x Medicaid HMO amount,6801,Other,140% of NY Medicaid HMO DRG,10931,,DRG base rate x DRG weight + capital per discharge,10931,Other,225% of NY Medicaid HMO DRG,13360,,275% x Medicaid HMO amount,13360,Other,275% of NY Medicaid HMO DRG,15741,,324% x Medicaid HMO amount,15741,Other,324% of NY Medicaid HMO DRG,10445,,215% x Medicaid HMO amount,10445,Other,215% of NY Medicaid HMO DRG,10445,,215% x Medicaid HMO amount,10445,Other,215% of NY Medicaid HMO DRG,6073,,125% x Medicaid HMO amount,6073,Other,125% of NY Medicaid HMO DRG,0.01,19084,
Tonsil & adenoid procedures,097-3,APR-DRG,,,,,,,,inpatient,,,121239.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18349,,186% x Medicaid HMO amount,18349,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40873,,"27,634 x DRG Weight",40873,Other,DRG Base Rate x DRG Weight,34741,,"23,488 x DRG Weight",34741,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9865.21,,DRG base rate x DRG weight + capital per discharge,9865.21,Other,100% of NY Medicaid HMO DRG,9865,,DRG base rate x DRG weight + capital per discharge,9865,Other,100% of NY Medicaid HMO DRG,9865,,DRG base rate x DRG weight + capital per discharge,9865,Other,100% of NY Medicaid HMO DRG,9865,,DRG base rate x DRG weight + capital per discharge,9865,Other,100% of NY Medicaid HMO DRG,22197,,225% x Medicaid HMO amount,22197,Other,225% of NY Medicaid HMO DRG,15094,,153% x Medicaid HMO amount,15094,Other,153% of NY Medicaid HMO DRG,22197,,225% x Medicaid HMO amount,22197,Other,225% of NY Medicaid HMO DRG,13811,,140% x Medicaid HMO amount,13811,Other,140% of NY Medicaid HMO DRG,22197,,DRG base rate x DRG weight + capital per discharge,22197,Other,225% of NY Medicaid HMO DRG,27129,,275% x Medicaid HMO amount,27129,Other,275% of NY Medicaid HMO DRG,31963,,324% x Medicaid HMO amount,31963,Other,324% of NY Medicaid HMO DRG,21210,,215% x Medicaid HMO amount,21210,Other,215% of NY Medicaid HMO DRG,21210,,215% x Medicaid HMO amount,21210,Other,215% of NY Medicaid HMO DRG,12332,,125% x Medicaid HMO amount,12332,Other,125% of NY Medicaid HMO DRG,0.01,40873,
Tonsil & adenoid procedures,097-4,APR-DRG,,,,,,,,inpatient,,,200632.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47819,,186% x Medicaid HMO amount,47819,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,109823,,"27,634 x DRG Weight",109823,Other,DRG Base Rate x DRG Weight,93346,,"23,488 x DRG Weight",93346,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25709.21,,DRG base rate x DRG weight + capital per discharge,25709.21,Other,100% of NY Medicaid HMO DRG,25709,,DRG base rate x DRG weight + capital per discharge,25709,Other,100% of NY Medicaid HMO DRG,25709,,DRG base rate x DRG weight + capital per discharge,25709,Other,100% of NY Medicaid HMO DRG,25709,,DRG base rate x DRG weight + capital per discharge,25709,Other,100% of NY Medicaid HMO DRG,57846,,225% x Medicaid HMO amount,57846,Other,225% of NY Medicaid HMO DRG,39335,,153% x Medicaid HMO amount,39335,Other,153% of NY Medicaid HMO DRG,57846,,225% x Medicaid HMO amount,57846,Other,225% of NY Medicaid HMO DRG,35993,,140% x Medicaid HMO amount,35993,Other,140% of NY Medicaid HMO DRG,57846,,DRG base rate x DRG weight + capital per discharge,57846,Other,225% of NY Medicaid HMO DRG,70700,,275% x Medicaid HMO amount,70700,Other,275% of NY Medicaid HMO DRG,83298,,324% x Medicaid HMO amount,83298,Other,324% of NY Medicaid HMO DRG,55275,,215% x Medicaid HMO amount,55275,Other,215% of NY Medicaid HMO DRG,55275,,215% x Medicaid HMO amount,55275,Other,215% of NY Medicaid HMO DRG,32137,,125% x Medicaid HMO amount,32137,Other,125% of NY Medicaid HMO DRG,0.01,109823,
"Other ear, nose, mouth & throat procedures",098-1,APR-DRG,,,,,,,,inpatient,,,92389.93,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8967,,186% x Medicaid HMO amount,8967,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18921,,"27,634 x DRG Weight",18921,Other,DRG Base Rate x DRG Weight,16082,,"23,488 x DRG Weight",16082,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4821.21,,DRG base rate x DRG weight + capital per discharge,4821.21,Other,100% of NY Medicaid HMO DRG,4821,,DRG base rate x DRG weight + capital per discharge,4821,Other,100% of NY Medicaid HMO DRG,4821,,DRG base rate x DRG weight + capital per discharge,4821,Other,100% of NY Medicaid HMO DRG,4821,,DRG base rate x DRG weight + capital per discharge,4821,Other,100% of NY Medicaid HMO DRG,10848,,225% x Medicaid HMO amount,10848,Other,225% of NY Medicaid HMO DRG,7376,,153% x Medicaid HMO amount,7376,Other,153% of NY Medicaid HMO DRG,10848,,225% x Medicaid HMO amount,10848,Other,225% of NY Medicaid HMO DRG,6750,,140% x Medicaid HMO amount,6750,Other,140% of NY Medicaid HMO DRG,10848,,DRG base rate x DRG weight + capital per discharge,10848,Other,225% of NY Medicaid HMO DRG,13258,,275% x Medicaid HMO amount,13258,Other,275% of NY Medicaid HMO DRG,15621,,324% x Medicaid HMO amount,15621,Other,324% of NY Medicaid HMO DRG,10366,,215% x Medicaid HMO amount,10366,Other,215% of NY Medicaid HMO DRG,10366,,215% x Medicaid HMO amount,10366,Other,215% of NY Medicaid HMO DRG,6027,,125% x Medicaid HMO amount,6027,Other,125% of NY Medicaid HMO DRG,0.01,18921,
"Other ear, nose, mouth & throat procedures",098-2,APR-DRG,,,,,,,,inpatient,,,124969.05,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12399,,186% x Medicaid HMO amount,12399,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26951,,"27,634 x DRG Weight",26951,Other,DRG Base Rate x DRG Weight,22908,,"23,488 x DRG Weight",22908,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6666.21,,DRG base rate x DRG weight + capital per discharge,6666.21,Other,100% of NY Medicaid HMO DRG,6666,,DRG base rate x DRG weight + capital per discharge,6666,Other,100% of NY Medicaid HMO DRG,6666,,DRG base rate x DRG weight + capital per discharge,6666,Other,100% of NY Medicaid HMO DRG,6666,,DRG base rate x DRG weight + capital per discharge,6666,Other,100% of NY Medicaid HMO DRG,14999,,225% x Medicaid HMO amount,14999,Other,225% of NY Medicaid HMO DRG,10199,,153% x Medicaid HMO amount,10199,Other,153% of NY Medicaid HMO DRG,14999,,225% x Medicaid HMO amount,14999,Other,225% of NY Medicaid HMO DRG,9333,,140% x Medicaid HMO amount,9333,Other,140% of NY Medicaid HMO DRG,14999,,DRG base rate x DRG weight + capital per discharge,14999,Other,225% of NY Medicaid HMO DRG,18332,,275% x Medicaid HMO amount,18332,Other,275% of NY Medicaid HMO DRG,21599,,324% x Medicaid HMO amount,21599,Other,324% of NY Medicaid HMO DRG,14332,,215% x Medicaid HMO amount,14332,Other,215% of NY Medicaid HMO DRG,14332,,215% x Medicaid HMO amount,14332,Other,215% of NY Medicaid HMO DRG,8333,,125% x Medicaid HMO amount,8333,Other,125% of NY Medicaid HMO DRG,0.01,26951,
"Other ear, nose, mouth & throat procedures",098-3,APR-DRG,,,,,,,,inpatient,,,273103.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22887,,186% x Medicaid HMO amount,22887,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51490,,"27,634 x DRG Weight",51490,Other,DRG Base Rate x DRG Weight,43765,,"23,488 x DRG Weight",43765,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12305.21,,DRG base rate x DRG weight + capital per discharge,12305.21,Other,100% of NY Medicaid HMO DRG,12305,,DRG base rate x DRG weight + capital per discharge,12305,Other,100% of NY Medicaid HMO DRG,12305,,DRG base rate x DRG weight + capital per discharge,12305,Other,100% of NY Medicaid HMO DRG,12305,,DRG base rate x DRG weight + capital per discharge,12305,Other,100% of NY Medicaid HMO DRG,27687,,225% x Medicaid HMO amount,27687,Other,225% of NY Medicaid HMO DRG,18827,,153% x Medicaid HMO amount,18827,Other,153% of NY Medicaid HMO DRG,27687,,225% x Medicaid HMO amount,27687,Other,225% of NY Medicaid HMO DRG,17227,,140% x Medicaid HMO amount,17227,Other,140% of NY Medicaid HMO DRG,27687,,DRG base rate x DRG weight + capital per discharge,27687,Other,225% of NY Medicaid HMO DRG,33839,,275% x Medicaid HMO amount,33839,Other,275% of NY Medicaid HMO DRG,39869,,324% x Medicaid HMO amount,39869,Other,324% of NY Medicaid HMO DRG,26456,,215% x Medicaid HMO amount,26456,Other,215% of NY Medicaid HMO DRG,26456,,215% x Medicaid HMO amount,26456,Other,215% of NY Medicaid HMO DRG,15382,,125% x Medicaid HMO amount,15382,Other,125% of NY Medicaid HMO DRG,0.01,51490,
"Other ear, nose, mouth & throat procedures",098-4,APR-DRG,,,,,,,,inpatient,,,813558.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,50030,,186% x Medicaid HMO amount,50030,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,114999,,"27,634 x DRG Weight",114999,Other,DRG Base Rate x DRG Weight,97745,,"23,488 x DRG Weight",97745,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26898.21,,DRG base rate x DRG weight + capital per discharge,26898.21,Other,100% of NY Medicaid HMO DRG,26898,,DRG base rate x DRG weight + capital per discharge,26898,Other,100% of NY Medicaid HMO DRG,26898,,DRG base rate x DRG weight + capital per discharge,26898,Other,100% of NY Medicaid HMO DRG,26898,,DRG base rate x DRG weight + capital per discharge,26898,Other,100% of NY Medicaid HMO DRG,60521,,225% x Medicaid HMO amount,60521,Other,225% of NY Medicaid HMO DRG,41154,,153% x Medicaid HMO amount,41154,Other,153% of NY Medicaid HMO DRG,60521,,225% x Medicaid HMO amount,60521,Other,225% of NY Medicaid HMO DRG,37657,,140% x Medicaid HMO amount,37657,Other,140% of NY Medicaid HMO DRG,60521,,DRG base rate x DRG weight + capital per discharge,60521,Other,225% of NY Medicaid HMO DRG,73970,,275% x Medicaid HMO amount,73970,Other,275% of NY Medicaid HMO DRG,87150,,324% x Medicaid HMO amount,87150,Other,324% of NY Medicaid HMO DRG,57831,,215% x Medicaid HMO amount,57831,Other,215% of NY Medicaid HMO DRG,57831,,215% x Medicaid HMO amount,57831,Other,215% of NY Medicaid HMO DRG,33623,,125% x Medicaid HMO amount,33623,Other,125% of NY Medicaid HMO DRG,0.01,114999,
"Ear, nose, mouth, throat, cranial/facial malignancies",110-1,APR-DRG,,,,,,,,inpatient,,,106260,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9350,,186% x Medicaid HMO amount,9350,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19819,,"27,634 x DRG Weight",19819,Other,DRG Base Rate x DRG Weight,16846,,"23,488 x DRG Weight",16846,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5027.21,,DRG base rate x DRG weight + capital per discharge,5027.21,Other,100% of NY Medicaid HMO DRG,5027,,DRG base rate x DRG weight + capital per discharge,5027,Other,100% of NY Medicaid HMO DRG,5027,,DRG base rate x DRG weight + capital per discharge,5027,Other,100% of NY Medicaid HMO DRG,5027,,DRG base rate x DRG weight + capital per discharge,5027,Other,100% of NY Medicaid HMO DRG,11311,,225% x Medicaid HMO amount,11311,Other,225% of NY Medicaid HMO DRG,7692,,153% x Medicaid HMO amount,7692,Other,153% of NY Medicaid HMO DRG,11311,,225% x Medicaid HMO amount,11311,Other,225% of NY Medicaid HMO DRG,7038,,140% x Medicaid HMO amount,7038,Other,140% of NY Medicaid HMO DRG,11311,,DRG base rate x DRG weight + capital per discharge,11311,Other,225% of NY Medicaid HMO DRG,13825,,275% x Medicaid HMO amount,13825,Other,275% of NY Medicaid HMO DRG,16288,,324% x Medicaid HMO amount,16288,Other,324% of NY Medicaid HMO DRG,10809,,215% x Medicaid HMO amount,10809,Other,215% of NY Medicaid HMO DRG,10809,,215% x Medicaid HMO amount,10809,Other,215% of NY Medicaid HMO DRG,6284,,125% x Medicaid HMO amount,6284,Other,125% of NY Medicaid HMO DRG,0.01,19819,
"Ear, nose, mouth, throat, cranial/facial malignancies",110-2,APR-DRG,,,,,,,,inpatient,,,79162,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11539,,186% x Medicaid HMO amount,11539,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24940,,"27,634 x DRG Weight",24940,Other,DRG Base Rate x DRG Weight,21198,,"23,488 x DRG Weight",21198,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6204.21,,DRG base rate x DRG weight + capital per discharge,6204.21,Other,100% of NY Medicaid HMO DRG,6204,,DRG base rate x DRG weight + capital per discharge,6204,Other,100% of NY Medicaid HMO DRG,6204,,DRG base rate x DRG weight + capital per discharge,6204,Other,100% of NY Medicaid HMO DRG,6204,,DRG base rate x DRG weight + capital per discharge,6204,Other,100% of NY Medicaid HMO DRG,13959,,225% x Medicaid HMO amount,13959,Other,225% of NY Medicaid HMO DRG,9492,,153% x Medicaid HMO amount,9492,Other,153% of NY Medicaid HMO DRG,13959,,225% x Medicaid HMO amount,13959,Other,225% of NY Medicaid HMO DRG,8686,,140% x Medicaid HMO amount,8686,Other,140% of NY Medicaid HMO DRG,13959,,DRG base rate x DRG weight + capital per discharge,13959,Other,225% of NY Medicaid HMO DRG,17062,,275% x Medicaid HMO amount,17062,Other,275% of NY Medicaid HMO DRG,20102,,324% x Medicaid HMO amount,20102,Other,324% of NY Medicaid HMO DRG,13339,,215% x Medicaid HMO amount,13339,Other,215% of NY Medicaid HMO DRG,13339,,215% x Medicaid HMO amount,13339,Other,215% of NY Medicaid HMO DRG,7755,,125% x Medicaid HMO amount,7755,Other,125% of NY Medicaid HMO DRG,0.01,24940,
"Ear, nose, mouth, throat, cranial/facial malignancies",110-3,APR-DRG,,,,,,,,inpatient,,,175765.11,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21827,,186% x Medicaid HMO amount,21827,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49009,,"27,634 x DRG Weight",49009,Other,DRG Base Rate x DRG Weight,41656,,"23,488 x DRG Weight",41656,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11735.21,,DRG base rate x DRG weight + capital per discharge,11735.21,Other,100% of NY Medicaid HMO DRG,11735,,DRG base rate x DRG weight + capital per discharge,11735,Other,100% of NY Medicaid HMO DRG,11735,,DRG base rate x DRG weight + capital per discharge,11735,Other,100% of NY Medicaid HMO DRG,11735,,DRG base rate x DRG weight + capital per discharge,11735,Other,100% of NY Medicaid HMO DRG,26404,,225% x Medicaid HMO amount,26404,Other,225% of NY Medicaid HMO DRG,17955,,153% x Medicaid HMO amount,17955,Other,153% of NY Medicaid HMO DRG,26404,,225% x Medicaid HMO amount,26404,Other,225% of NY Medicaid HMO DRG,16429,,140% x Medicaid HMO amount,16429,Other,140% of NY Medicaid HMO DRG,26404,,DRG base rate x DRG weight + capital per discharge,26404,Other,225% of NY Medicaid HMO DRG,32272,,275% x Medicaid HMO amount,32272,Other,275% of NY Medicaid HMO DRG,38022,,324% x Medicaid HMO amount,38022,Other,324% of NY Medicaid HMO DRG,25231,,215% x Medicaid HMO amount,25231,Other,215% of NY Medicaid HMO DRG,25231,,215% x Medicaid HMO amount,25231,Other,215% of NY Medicaid HMO DRG,14669,,125% x Medicaid HMO amount,14669,Other,125% of NY Medicaid HMO DRG,0.01,49009,
"Ear, nose, mouth, throat, cranial/facial malignancies",110-4,APR-DRG,,,,,,,,inpatient,,,609618.43,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43727,,186% x Medicaid HMO amount,43727,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,100248,,"27,634 x DRG Weight",100248,Other,DRG Base Rate x DRG Weight,85207,,"23,488 x DRG Weight",85207,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23509.21,,DRG base rate x DRG weight + capital per discharge,23509.21,Other,100% of NY Medicaid HMO DRG,23509,,DRG base rate x DRG weight + capital per discharge,23509,Other,100% of NY Medicaid HMO DRG,23509,,DRG base rate x DRG weight + capital per discharge,23509,Other,100% of NY Medicaid HMO DRG,23509,,DRG base rate x DRG weight + capital per discharge,23509,Other,100% of NY Medicaid HMO DRG,52896,,225% x Medicaid HMO amount,52896,Other,225% of NY Medicaid HMO DRG,35969,,153% x Medicaid HMO amount,35969,Other,153% of NY Medicaid HMO DRG,52896,,225% x Medicaid HMO amount,52896,Other,225% of NY Medicaid HMO DRG,32913,,140% x Medicaid HMO amount,32913,Other,140% of NY Medicaid HMO DRG,52896,,DRG base rate x DRG weight + capital per discharge,52896,Other,225% of NY Medicaid HMO DRG,64650,,275% x Medicaid HMO amount,64650,Other,275% of NY Medicaid HMO DRG,76170,,324% x Medicaid HMO amount,76170,Other,324% of NY Medicaid HMO DRG,50545,,215% x Medicaid HMO amount,50545,Other,215% of NY Medicaid HMO DRG,50545,,215% x Medicaid HMO amount,50545,Other,215% of NY Medicaid HMO DRG,29387,,125% x Medicaid HMO amount,29387,Other,125% of NY Medicaid HMO DRG,0.01,100248,
Vertigo & other labyrinth disorders,111-1,APR-DRG,,,,,,,,inpatient,,,94223.81,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6051,,186% x Medicaid HMO amount,6051,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12098,,"27,634 x DRG Weight",12098,Other,DRG Base Rate x DRG Weight,10283,,"23,488 x DRG Weight",10283,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3253.21,,DRG base rate x DRG weight + capital per discharge,3253.21,Other,100% of NY Medicaid HMO DRG,3253,,DRG base rate x DRG weight + capital per discharge,3253,Other,100% of NY Medicaid HMO DRG,3253,,DRG base rate x DRG weight + capital per discharge,3253,Other,100% of NY Medicaid HMO DRG,3253,,DRG base rate x DRG weight + capital per discharge,3253,Other,100% of NY Medicaid HMO DRG,7320,,225% x Medicaid HMO amount,7320,Other,225% of NY Medicaid HMO DRG,4977,,153% x Medicaid HMO amount,4977,Other,153% of NY Medicaid HMO DRG,7320,,225% x Medicaid HMO amount,7320,Other,225% of NY Medicaid HMO DRG,4554,,140% x Medicaid HMO amount,4554,Other,140% of NY Medicaid HMO DRG,7320,,DRG base rate x DRG weight + capital per discharge,7320,Other,225% of NY Medicaid HMO DRG,8946,,275% x Medicaid HMO amount,8946,Other,275% of NY Medicaid HMO DRG,10540,,324% x Medicaid HMO amount,10540,Other,324% of NY Medicaid HMO DRG,6994,,215% x Medicaid HMO amount,6994,Other,215% of NY Medicaid HMO DRG,6994,,215% x Medicaid HMO amount,6994,Other,215% of NY Medicaid HMO DRG,4067,,125% x Medicaid HMO amount,4067,Other,125% of NY Medicaid HMO DRG,0.01,12098,
Vertigo & other labyrinth disorders,111-2,APR-DRG,,,,,,,,inpatient,,,130338.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7278,,186% x Medicaid HMO amount,7278,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14969,,"27,634 x DRG Weight",14969,Other,DRG Base Rate x DRG Weight,12723,,"23,488 x DRG Weight",12723,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3913.21,,DRG base rate x DRG weight + capital per discharge,3913.21,Other,100% of NY Medicaid HMO DRG,3913,,DRG base rate x DRG weight + capital per discharge,3913,Other,100% of NY Medicaid HMO DRG,3913,,DRG base rate x DRG weight + capital per discharge,3913,Other,100% of NY Medicaid HMO DRG,3913,,DRG base rate x DRG weight + capital per discharge,3913,Other,100% of NY Medicaid HMO DRG,8805,,225% x Medicaid HMO amount,8805,Other,225% of NY Medicaid HMO DRG,5987,,153% x Medicaid HMO amount,5987,Other,153% of NY Medicaid HMO DRG,8805,,225% x Medicaid HMO amount,8805,Other,225% of NY Medicaid HMO DRG,5478,,140% x Medicaid HMO amount,5478,Other,140% of NY Medicaid HMO DRG,8805,,DRG base rate x DRG weight + capital per discharge,8805,Other,225% of NY Medicaid HMO DRG,10761,,275% x Medicaid HMO amount,10761,Other,275% of NY Medicaid HMO DRG,12679,,324% x Medicaid HMO amount,12679,Other,324% of NY Medicaid HMO DRG,8413,,215% x Medicaid HMO amount,8413,Other,215% of NY Medicaid HMO DRG,8413,,215% x Medicaid HMO amount,8413,Other,215% of NY Medicaid HMO DRG,4892,,125% x Medicaid HMO amount,4892,Other,125% of NY Medicaid HMO DRG,0.01,14969,
Vertigo & other labyrinth disorders,111-3,APR-DRG,,,,,,,,inpatient,,,121320.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9886,,186% x Medicaid HMO amount,9886,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21074,,"27,634 x DRG Weight",21074,Other,DRG Base Rate x DRG Weight,17912,,"23,488 x DRG Weight",17912,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5315.21,,DRG base rate x DRG weight + capital per discharge,5315.21,Other,100% of NY Medicaid HMO DRG,5315,,DRG base rate x DRG weight + capital per discharge,5315,Other,100% of NY Medicaid HMO DRG,5315,,DRG base rate x DRG weight + capital per discharge,5315,Other,100% of NY Medicaid HMO DRG,5315,,DRG base rate x DRG weight + capital per discharge,5315,Other,100% of NY Medicaid HMO DRG,11959,,225% x Medicaid HMO amount,11959,Other,225% of NY Medicaid HMO DRG,8132,,153% x Medicaid HMO amount,8132,Other,153% of NY Medicaid HMO DRG,11959,,225% x Medicaid HMO amount,11959,Other,225% of NY Medicaid HMO DRG,7441,,140% x Medicaid HMO amount,7441,Other,140% of NY Medicaid HMO DRG,11959,,DRG base rate x DRG weight + capital per discharge,11959,Other,225% of NY Medicaid HMO DRG,14617,,275% x Medicaid HMO amount,14617,Other,275% of NY Medicaid HMO DRG,17221,,324% x Medicaid HMO amount,17221,Other,324% of NY Medicaid HMO DRG,11428,,215% x Medicaid HMO amount,11428,Other,215% of NY Medicaid HMO DRG,11428,,215% x Medicaid HMO amount,11428,Other,215% of NY Medicaid HMO DRG,6644,,125% x Medicaid HMO amount,6644,Other,125% of NY Medicaid HMO DRG,0.01,21074,
Vertigo & other labyrinth disorders,111-4,APR-DRG,,,,,,,,inpatient,,,130338.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10051,,186% x Medicaid HMO amount,10051,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21458,,"27,634 x DRG Weight",21458,Other,DRG Base Rate x DRG Weight,18238,,"23,488 x DRG Weight",18238,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5404.21,,DRG base rate x DRG weight + capital per discharge,5404.21,Other,100% of NY Medicaid HMO DRG,5404,,DRG base rate x DRG weight + capital per discharge,5404,Other,100% of NY Medicaid HMO DRG,5404,,DRG base rate x DRG weight + capital per discharge,5404,Other,100% of NY Medicaid HMO DRG,5404,,DRG base rate x DRG weight + capital per discharge,5404,Other,100% of NY Medicaid HMO DRG,12159,,225% x Medicaid HMO amount,12159,Other,225% of NY Medicaid HMO DRG,8268,,153% x Medicaid HMO amount,8268,Other,153% of NY Medicaid HMO DRG,12159,,225% x Medicaid HMO amount,12159,Other,225% of NY Medicaid HMO DRG,7566,,140% x Medicaid HMO amount,7566,Other,140% of NY Medicaid HMO DRG,12159,,DRG base rate x DRG weight + capital per discharge,12159,Other,225% of NY Medicaid HMO DRG,14862,,275% x Medicaid HMO amount,14862,Other,275% of NY Medicaid HMO DRG,17510,,324% x Medicaid HMO amount,17510,Other,324% of NY Medicaid HMO DRG,11619,,215% x Medicaid HMO amount,11619,Other,215% of NY Medicaid HMO DRG,11619,,215% x Medicaid HMO amount,11619,Other,215% of NY Medicaid HMO DRG,6755,,125% x Medicaid HMO amount,6755,Other,125% of NY Medicaid HMO DRG,0.01,21458,
Infections of upper respiratory tract,113-1,APR-DRG,,,,,,,,inpatient,,,47537.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5463,,186% x Medicaid HMO amount,5463,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10725,,"27,634 x DRG Weight",10725,Other,DRG Base Rate x DRG Weight,9116,,"23,488 x DRG Weight",9116,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2937.21,,DRG base rate x DRG weight + capital per discharge,2937.21,Other,100% of NY Medicaid HMO DRG,2937,,DRG base rate x DRG weight + capital per discharge,2937,Other,100% of NY Medicaid HMO DRG,2937,,DRG base rate x DRG weight + capital per discharge,2937,Other,100% of NY Medicaid HMO DRG,2937,,DRG base rate x DRG weight + capital per discharge,2937,Other,100% of NY Medicaid HMO DRG,6609,,225% x Medicaid HMO amount,6609,Other,225% of NY Medicaid HMO DRG,4494,,153% x Medicaid HMO amount,4494,Other,153% of NY Medicaid HMO DRG,6609,,225% x Medicaid HMO amount,6609,Other,225% of NY Medicaid HMO DRG,4112,,140% x Medicaid HMO amount,4112,Other,140% of NY Medicaid HMO DRG,6609,,DRG base rate x DRG weight + capital per discharge,6609,Other,225% of NY Medicaid HMO DRG,8077,,275% x Medicaid HMO amount,8077,Other,275% of NY Medicaid HMO DRG,9517,,324% x Medicaid HMO amount,9517,Other,324% of NY Medicaid HMO DRG,6315,,215% x Medicaid HMO amount,6315,Other,215% of NY Medicaid HMO DRG,6315,,215% x Medicaid HMO amount,6315,Other,215% of NY Medicaid HMO DRG,3672,,125% x Medicaid HMO amount,3672,Other,125% of NY Medicaid HMO DRG,0.01,10725,
Infections of upper respiratory tract,113-2,APR-DRG,,,,,,,,inpatient,,,65903.7,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6754,,186% x Medicaid HMO amount,6754,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13745,,"27,634 x DRG Weight",13745,Other,DRG Base Rate x DRG Weight,11683,,"23,488 x DRG Weight",11683,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3631.21,,DRG base rate x DRG weight + capital per discharge,3631.21,Other,100% of NY Medicaid HMO DRG,3631,,DRG base rate x DRG weight + capital per discharge,3631,Other,100% of NY Medicaid HMO DRG,3631,,DRG base rate x DRG weight + capital per discharge,3631,Other,100% of NY Medicaid HMO DRG,3631,,DRG base rate x DRG weight + capital per discharge,3631,Other,100% of NY Medicaid HMO DRG,8170,,225% x Medicaid HMO amount,8170,Other,225% of NY Medicaid HMO DRG,5556,,153% x Medicaid HMO amount,5556,Other,153% of NY Medicaid HMO DRG,8170,,225% x Medicaid HMO amount,8170,Other,225% of NY Medicaid HMO DRG,5084,,140% x Medicaid HMO amount,5084,Other,140% of NY Medicaid HMO DRG,8170,,DRG base rate x DRG weight + capital per discharge,8170,Other,225% of NY Medicaid HMO DRG,9986,,275% x Medicaid HMO amount,9986,Other,275% of NY Medicaid HMO DRG,11765,,324% x Medicaid HMO amount,11765,Other,324% of NY Medicaid HMO DRG,7807,,215% x Medicaid HMO amount,7807,Other,215% of NY Medicaid HMO DRG,7807,,215% x Medicaid HMO amount,7807,Other,215% of NY Medicaid HMO DRG,4539,,125% x Medicaid HMO amount,4539,Other,125% of NY Medicaid HMO DRG,0.01,13745,
Infections of upper respiratory tract,113-3,APR-DRG,,,,,,,,inpatient,,,98363.09,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10076,,186% x Medicaid HMO amount,10076,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21516,,"27,634 x DRG Weight",21516,Other,DRG Base Rate x DRG Weight,18288,,"23,488 x DRG Weight",18288,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5417.21,,DRG base rate x DRG weight + capital per discharge,5417.21,Other,100% of NY Medicaid HMO DRG,5417,,DRG base rate x DRG weight + capital per discharge,5417,Other,100% of NY Medicaid HMO DRG,5417,,DRG base rate x DRG weight + capital per discharge,5417,Other,100% of NY Medicaid HMO DRG,5417,,DRG base rate x DRG weight + capital per discharge,5417,Other,100% of NY Medicaid HMO DRG,12189,,225% x Medicaid HMO amount,12189,Other,225% of NY Medicaid HMO DRG,8288,,153% x Medicaid HMO amount,8288,Other,153% of NY Medicaid HMO DRG,12189,,225% x Medicaid HMO amount,12189,Other,225% of NY Medicaid HMO DRG,7584,,140% x Medicaid HMO amount,7584,Other,140% of NY Medicaid HMO DRG,12189,,DRG base rate x DRG weight + capital per discharge,12189,Other,225% of NY Medicaid HMO DRG,14897,,275% x Medicaid HMO amount,14897,Other,275% of NY Medicaid HMO DRG,17552,,324% x Medicaid HMO amount,17552,Other,324% of NY Medicaid HMO DRG,11647,,215% x Medicaid HMO amount,11647,Other,215% of NY Medicaid HMO DRG,11647,,215% x Medicaid HMO amount,11647,Other,215% of NY Medicaid HMO DRG,6772,,125% x Medicaid HMO amount,6772,Other,125% of NY Medicaid HMO DRG,0.01,21516,
Infections of upper respiratory tract,113-4,APR-DRG,,,,,,,,inpatient,,,131847,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25523,,186% x Medicaid HMO amount,25523,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57656,,"27,634 x DRG Weight",57656,Other,DRG Base Rate x DRG Weight,49005,,"23,488 x DRG Weight",49005,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13722.21,,DRG base rate x DRG weight + capital per discharge,13722.21,Other,100% of NY Medicaid HMO DRG,13722,,DRG base rate x DRG weight + capital per discharge,13722,Other,100% of NY Medicaid HMO DRG,13722,,DRG base rate x DRG weight + capital per discharge,13722,Other,100% of NY Medicaid HMO DRG,13722,,DRG base rate x DRG weight + capital per discharge,13722,Other,100% of NY Medicaid HMO DRG,30875,,225% x Medicaid HMO amount,30875,Other,225% of NY Medicaid HMO DRG,20995,,153% x Medicaid HMO amount,20995,Other,153% of NY Medicaid HMO DRG,30875,,225% x Medicaid HMO amount,30875,Other,225% of NY Medicaid HMO DRG,19211,,140% x Medicaid HMO amount,19211,Other,140% of NY Medicaid HMO DRG,30875,,DRG base rate x DRG weight + capital per discharge,30875,Other,225% of NY Medicaid HMO DRG,37736,,275% x Medicaid HMO amount,37736,Other,275% of NY Medicaid HMO DRG,44460,,324% x Medicaid HMO amount,44460,Other,324% of NY Medicaid HMO DRG,29503,,215% x Medicaid HMO amount,29503,Other,215% of NY Medicaid HMO DRG,29503,,215% x Medicaid HMO amount,29503,Other,215% of NY Medicaid HMO DRG,17153,,125% x Medicaid HMO amount,17153,Other,125% of NY Medicaid HMO DRG,0.01,57656,
Dental & oral diseases & injuries,114-1,APR-DRG,,,,,,,,inpatient,,,57194.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6534,,186% x Medicaid HMO amount,6534,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13228,,"27,634 x DRG Weight",13228,Other,DRG Base Rate x DRG Weight,11244,,"23,488 x DRG Weight",11244,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3513.21,,DRG base rate x DRG weight + capital per discharge,3513.21,Other,100% of NY Medicaid HMO DRG,3513,,DRG base rate x DRG weight + capital per discharge,3513,Other,100% of NY Medicaid HMO DRG,3513,,DRG base rate x DRG weight + capital per discharge,3513,Other,100% of NY Medicaid HMO DRG,3513,,DRG base rate x DRG weight + capital per discharge,3513,Other,100% of NY Medicaid HMO DRG,7905,,225% x Medicaid HMO amount,7905,Other,225% of NY Medicaid HMO DRG,5375,,153% x Medicaid HMO amount,5375,Other,153% of NY Medicaid HMO DRG,7905,,225% x Medicaid HMO amount,7905,Other,225% of NY Medicaid HMO DRG,4918,,140% x Medicaid HMO amount,4918,Other,140% of NY Medicaid HMO DRG,7905,,DRG base rate x DRG weight + capital per discharge,7905,Other,225% of NY Medicaid HMO DRG,9661,,275% x Medicaid HMO amount,9661,Other,275% of NY Medicaid HMO DRG,11383,,324% x Medicaid HMO amount,11383,Other,324% of NY Medicaid HMO DRG,7553,,215% x Medicaid HMO amount,7553,Other,215% of NY Medicaid HMO DRG,7553,,215% x Medicaid HMO amount,7553,Other,215% of NY Medicaid HMO DRG,4392,,125% x Medicaid HMO amount,4392,Other,125% of NY Medicaid HMO DRG,0.01,13228,
Dental & oral diseases & injuries,114-2,APR-DRG,,,,,,,,inpatient,,,94020.35,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8030,,186% x Medicaid HMO amount,8030,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16730,,"27,634 x DRG Weight",16730,Other,DRG Base Rate x DRG Weight,14220,,"23,488 x DRG Weight",14220,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4317.21,,DRG base rate x DRG weight + capital per discharge,4317.21,Other,100% of NY Medicaid HMO DRG,4317,,DRG base rate x DRG weight + capital per discharge,4317,Other,100% of NY Medicaid HMO DRG,4317,,DRG base rate x DRG weight + capital per discharge,4317,Other,100% of NY Medicaid HMO DRG,4317,,DRG base rate x DRG weight + capital per discharge,4317,Other,100% of NY Medicaid HMO DRG,9714,,225% x Medicaid HMO amount,9714,Other,225% of NY Medicaid HMO DRG,6605,,153% x Medicaid HMO amount,6605,Other,153% of NY Medicaid HMO DRG,9714,,225% x Medicaid HMO amount,9714,Other,225% of NY Medicaid HMO DRG,6044,,140% x Medicaid HMO amount,6044,Other,140% of NY Medicaid HMO DRG,9714,,DRG base rate x DRG weight + capital per discharge,9714,Other,225% of NY Medicaid HMO DRG,11872,,275% x Medicaid HMO amount,11872,Other,275% of NY Medicaid HMO DRG,13988,,324% x Medicaid HMO amount,13988,Other,324% of NY Medicaid HMO DRG,9282,,215% x Medicaid HMO amount,9282,Other,215% of NY Medicaid HMO DRG,9282,,215% x Medicaid HMO amount,9282,Other,215% of NY Medicaid HMO DRG,5397,,125% x Medicaid HMO amount,5397,Other,125% of NY Medicaid HMO DRG,0.01,16730,
Dental & oral diseases & injuries,114-3,APR-DRG,,,,,,,,inpatient,,,237822.49,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15051,,186% x Medicaid HMO amount,15051,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33155,,"27,634 x DRG Weight",33155,Other,DRG Base Rate x DRG Weight,28181,,"23,488 x DRG Weight",28181,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8092.21,,DRG base rate x DRG weight + capital per discharge,8092.21,Other,100% of NY Medicaid HMO DRG,8092,,DRG base rate x DRG weight + capital per discharge,8092,Other,100% of NY Medicaid HMO DRG,8092,,DRG base rate x DRG weight + capital per discharge,8092,Other,100% of NY Medicaid HMO DRG,8092,,DRG base rate x DRG weight + capital per discharge,8092,Other,100% of NY Medicaid HMO DRG,18207,,225% x Medicaid HMO amount,18207,Other,225% of NY Medicaid HMO DRG,12381,,153% x Medicaid HMO amount,12381,Other,153% of NY Medicaid HMO DRG,18207,,225% x Medicaid HMO amount,18207,Other,225% of NY Medicaid HMO DRG,11329,,140% x Medicaid HMO amount,11329,Other,140% of NY Medicaid HMO DRG,18207,,DRG base rate x DRG weight + capital per discharge,18207,Other,225% of NY Medicaid HMO DRG,22254,,275% x Medicaid HMO amount,22254,Other,275% of NY Medicaid HMO DRG,26219,,324% x Medicaid HMO amount,26219,Other,324% of NY Medicaid HMO DRG,17398,,215% x Medicaid HMO amount,17398,Other,215% of NY Medicaid HMO DRG,17398,,215% x Medicaid HMO amount,17398,Other,215% of NY Medicaid HMO DRG,10115,,125% x Medicaid HMO amount,10115,Other,125% of NY Medicaid HMO DRG,0.01,33155,
Dental & oral diseases & injuries,114-4,APR-DRG,,,,,,,,inpatient,,,32501,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30024,,186% x Medicaid HMO amount,30024,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,68190,,"27,634 x DRG Weight",68190,Other,DRG Base Rate x DRG Weight,57959,,"23,488 x DRG Weight",57959,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16142.21,,DRG base rate x DRG weight + capital per discharge,16142.21,Other,100% of NY Medicaid HMO DRG,16142,,DRG base rate x DRG weight + capital per discharge,16142,Other,100% of NY Medicaid HMO DRG,16142,,DRG base rate x DRG weight + capital per discharge,16142,Other,100% of NY Medicaid HMO DRG,16142,,DRG base rate x DRG weight + capital per discharge,16142,Other,100% of NY Medicaid HMO DRG,36320,,225% x Medicaid HMO amount,36320,Other,225% of NY Medicaid HMO DRG,24698,,153% x Medicaid HMO amount,24698,Other,153% of NY Medicaid HMO DRG,36320,,225% x Medicaid HMO amount,36320,Other,225% of NY Medicaid HMO DRG,22599,,140% x Medicaid HMO amount,22599,Other,140% of NY Medicaid HMO DRG,36320,,DRG base rate x DRG weight + capital per discharge,36320,Other,225% of NY Medicaid HMO DRG,44391,,275% x Medicaid HMO amount,44391,Other,275% of NY Medicaid HMO DRG,52301,,324% x Medicaid HMO amount,52301,Other,324% of NY Medicaid HMO DRG,34706,,215% x Medicaid HMO amount,34706,Other,215% of NY Medicaid HMO DRG,34706,,215% x Medicaid HMO amount,34706,Other,215% of NY Medicaid HMO DRG,20178,,125% x Medicaid HMO amount,20178,Other,125% of NY Medicaid HMO DRG,0.01,68190,
"Other ear, nose, mouth,throat & cranial/facial diagnoses",115-1,APR-DRG,,,,,,,,inpatient,,,62696.36,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6095,,186% x Medicaid HMO amount,6095,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12203,,"27,634 x DRG Weight",12203,Other,DRG Base Rate x DRG Weight,10372,,"23,488 x DRG Weight",10372,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3277.21,,DRG base rate x DRG weight + capital per discharge,3277.21,Other,100% of NY Medicaid HMO DRG,3277,,DRG base rate x DRG weight + capital per discharge,3277,Other,100% of NY Medicaid HMO DRG,3277,,DRG base rate x DRG weight + capital per discharge,3277,Other,100% of NY Medicaid HMO DRG,3277,,DRG base rate x DRG weight + capital per discharge,3277,Other,100% of NY Medicaid HMO DRG,7374,,225% x Medicaid HMO amount,7374,Other,225% of NY Medicaid HMO DRG,5014,,153% x Medicaid HMO amount,5014,Other,153% of NY Medicaid HMO DRG,7374,,225% x Medicaid HMO amount,7374,Other,225% of NY Medicaid HMO DRG,4588,,140% x Medicaid HMO amount,4588,Other,140% of NY Medicaid HMO DRG,7374,,DRG base rate x DRG weight + capital per discharge,7374,Other,225% of NY Medicaid HMO DRG,9012,,275% x Medicaid HMO amount,9012,Other,275% of NY Medicaid HMO DRG,10618,,324% x Medicaid HMO amount,10618,Other,324% of NY Medicaid HMO DRG,7046,,215% x Medicaid HMO amount,7046,Other,215% of NY Medicaid HMO DRG,7046,,215% x Medicaid HMO amount,7046,Other,215% of NY Medicaid HMO DRG,4097,,125% x Medicaid HMO amount,4097,Other,125% of NY Medicaid HMO DRG,0.01,12203,
"Other ear, nose, mouth,throat & cranial/facial diagnoses",115-2,APR-DRG,,,,,,,,inpatient,,,109849.93,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7983,,186% x Medicaid HMO amount,7983,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16619,,"27,634 x DRG Weight",16619,Other,DRG Base Rate x DRG Weight,14126,,"23,488 x DRG Weight",14126,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4292.21,,DRG base rate x DRG weight + capital per discharge,4292.21,Other,100% of NY Medicaid HMO DRG,4292,,DRG base rate x DRG weight + capital per discharge,4292,Other,100% of NY Medicaid HMO DRG,4292,,DRG base rate x DRG weight + capital per discharge,4292,Other,100% of NY Medicaid HMO DRG,4292,,DRG base rate x DRG weight + capital per discharge,4292,Other,100% of NY Medicaid HMO DRG,9657,,225% x Medicaid HMO amount,9657,Other,225% of NY Medicaid HMO DRG,6567,,153% x Medicaid HMO amount,6567,Other,153% of NY Medicaid HMO DRG,9657,,225% x Medicaid HMO amount,9657,Other,225% of NY Medicaid HMO DRG,6009,,140% x Medicaid HMO amount,6009,Other,140% of NY Medicaid HMO DRG,9657,,DRG base rate x DRG weight + capital per discharge,9657,Other,225% of NY Medicaid HMO DRG,11804,,275% x Medicaid HMO amount,11804,Other,275% of NY Medicaid HMO DRG,13907,,324% x Medicaid HMO amount,13907,Other,324% of NY Medicaid HMO DRG,9228,,215% x Medicaid HMO amount,9228,Other,215% of NY Medicaid HMO DRG,9228,,215% x Medicaid HMO amount,9228,Other,215% of NY Medicaid HMO DRG,5365,,125% x Medicaid HMO amount,5365,Other,125% of NY Medicaid HMO DRG,0.01,16619,
"Other ear, nose, mouth,throat & cranial/facial diagnoses",115-3,APR-DRG,,,,,,,,inpatient,,,97821.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12607,,186% x Medicaid HMO amount,12607,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27441,,"27,634 x DRG Weight",27441,Other,DRG Base Rate x DRG Weight,23324,,"23,488 x DRG Weight",23324,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6778.21,,DRG base rate x DRG weight + capital per discharge,6778.21,Other,100% of NY Medicaid HMO DRG,6778,,DRG base rate x DRG weight + capital per discharge,6778,Other,100% of NY Medicaid HMO DRG,6778,,DRG base rate x DRG weight + capital per discharge,6778,Other,100% of NY Medicaid HMO DRG,6778,,DRG base rate x DRG weight + capital per discharge,6778,Other,100% of NY Medicaid HMO DRG,15251,,225% x Medicaid HMO amount,15251,Other,225% of NY Medicaid HMO DRG,10371,,153% x Medicaid HMO amount,10371,Other,153% of NY Medicaid HMO DRG,15251,,225% x Medicaid HMO amount,15251,Other,225% of NY Medicaid HMO DRG,9489,,140% x Medicaid HMO amount,9489,Other,140% of NY Medicaid HMO DRG,15251,,DRG base rate x DRG weight + capital per discharge,15251,Other,225% of NY Medicaid HMO DRG,18640,,275% x Medicaid HMO amount,18640,Other,275% of NY Medicaid HMO DRG,21961,,324% x Medicaid HMO amount,21961,Other,324% of NY Medicaid HMO DRG,14573,,215% x Medicaid HMO amount,14573,Other,215% of NY Medicaid HMO DRG,14573,,215% x Medicaid HMO amount,14573,Other,215% of NY Medicaid HMO DRG,8473,,125% x Medicaid HMO amount,8473,Other,125% of NY Medicaid HMO DRG,0.01,27441,
"Other ear, nose, mouth,throat & cranial/facial diagnoses",115-4,APR-DRG,,,,,,,,inpatient,,,341570.76,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31845,,186% x Medicaid HMO amount,31845,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72451,,"27,634 x DRG Weight",72451,Other,DRG Base Rate x DRG Weight,61581,,"23,488 x DRG Weight",61581,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17121.21,,DRG base rate x DRG weight + capital per discharge,17121.21,Other,100% of NY Medicaid HMO DRG,17121,,DRG base rate x DRG weight + capital per discharge,17121,Other,100% of NY Medicaid HMO DRG,17121,,DRG base rate x DRG weight + capital per discharge,17121,Other,100% of NY Medicaid HMO DRG,17121,,DRG base rate x DRG weight + capital per discharge,17121,Other,100% of NY Medicaid HMO DRG,38523,,225% x Medicaid HMO amount,38523,Other,225% of NY Medicaid HMO DRG,26195,,153% x Medicaid HMO amount,26195,Other,153% of NY Medicaid HMO DRG,38523,,225% x Medicaid HMO amount,38523,Other,225% of NY Medicaid HMO DRG,23970,,140% x Medicaid HMO amount,23970,Other,140% of NY Medicaid HMO DRG,38523,,DRG base rate x DRG weight + capital per discharge,38523,Other,225% of NY Medicaid HMO DRG,47083,,275% x Medicaid HMO amount,47083,Other,275% of NY Medicaid HMO DRG,55473,,324% x Medicaid HMO amount,55473,Other,324% of NY Medicaid HMO DRG,36811,,215% x Medicaid HMO amount,36811,Other,215% of NY Medicaid HMO DRG,36811,,215% x Medicaid HMO amount,36811,Other,215% of NY Medicaid HMO DRG,21402,,125% x Medicaid HMO amount,21402,Other,125% of NY Medicaid HMO DRG,0.01,72451,
Major respiratory & chest procedures,120-1,APR-DRG,,,,,,,,inpatient,,,176767.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21345,,186% x Medicaid HMO amount,21345,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47881,,"27,634 x DRG Weight",47881,Other,DRG Base Rate x DRG Weight,40698,,"23,488 x DRG Weight",40698,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11476.21,,DRG base rate x DRG weight + capital per discharge,11476.21,Other,100% of NY Medicaid HMO DRG,11476,,DRG base rate x DRG weight + capital per discharge,11476,Other,100% of NY Medicaid HMO DRG,11476,,DRG base rate x DRG weight + capital per discharge,11476,Other,100% of NY Medicaid HMO DRG,11476,,DRG base rate x DRG weight + capital per discharge,11476,Other,100% of NY Medicaid HMO DRG,25821,,225% x Medicaid HMO amount,25821,Other,225% of NY Medicaid HMO DRG,17559,,153% x Medicaid HMO amount,17559,Other,153% of NY Medicaid HMO DRG,25821,,225% x Medicaid HMO amount,25821,Other,225% of NY Medicaid HMO DRG,16067,,140% x Medicaid HMO amount,16067,Other,140% of NY Medicaid HMO DRG,25821,,DRG base rate x DRG weight + capital per discharge,25821,Other,225% of NY Medicaid HMO DRG,31560,,275% x Medicaid HMO amount,31560,Other,275% of NY Medicaid HMO DRG,37183,,324% x Medicaid HMO amount,37183,Other,324% of NY Medicaid HMO DRG,24674,,215% x Medicaid HMO amount,24674,Other,215% of NY Medicaid HMO DRG,24674,,215% x Medicaid HMO amount,24674,Other,215% of NY Medicaid HMO DRG,14345,,125% x Medicaid HMO amount,14345,Other,125% of NY Medicaid HMO DRG,0.01,47881,
Major respiratory & chest procedures,120-2,APR-DRG,,,,,,,,inpatient,,,209877.51,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25813,,186% x Medicaid HMO amount,25813,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58338,,"27,634 x DRG Weight",58338,Other,DRG Base Rate x DRG Weight,49586,,"23,488 x DRG Weight",49586,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13878.21,,DRG base rate x DRG weight + capital per discharge,13878.21,Other,100% of NY Medicaid HMO DRG,13878,,DRG base rate x DRG weight + capital per discharge,13878,Other,100% of NY Medicaid HMO DRG,13878,,DRG base rate x DRG weight + capital per discharge,13878,Other,100% of NY Medicaid HMO DRG,13878,,DRG base rate x DRG weight + capital per discharge,13878,Other,100% of NY Medicaid HMO DRG,31226,,225% x Medicaid HMO amount,31226,Other,225% of NY Medicaid HMO DRG,21234,,153% x Medicaid HMO amount,21234,Other,153% of NY Medicaid HMO DRG,31226,,225% x Medicaid HMO amount,31226,Other,225% of NY Medicaid HMO DRG,19429,,140% x Medicaid HMO amount,19429,Other,140% of NY Medicaid HMO DRG,31226,,DRG base rate x DRG weight + capital per discharge,31226,Other,225% of NY Medicaid HMO DRG,38165,,275% x Medicaid HMO amount,38165,Other,275% of NY Medicaid HMO DRG,44965,,324% x Medicaid HMO amount,44965,Other,324% of NY Medicaid HMO DRG,29838,,215% x Medicaid HMO amount,29838,Other,215% of NY Medicaid HMO DRG,29838,,215% x Medicaid HMO amount,29838,Other,215% of NY Medicaid HMO DRG,17348,,125% x Medicaid HMO amount,17348,Other,125% of NY Medicaid HMO DRG,0.01,58338,
Major respiratory & chest procedures,120-3,APR-DRG,,,,,,,,inpatient,,,513444.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40615,,186% x Medicaid HMO amount,40615,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,92969,,"27,634 x DRG Weight",92969,Other,DRG Base Rate x DRG Weight,79021,,"23,488 x DRG Weight",79021,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21836.21,,DRG base rate x DRG weight + capital per discharge,21836.21,Other,100% of NY Medicaid HMO DRG,21836,,DRG base rate x DRG weight + capital per discharge,21836,Other,100% of NY Medicaid HMO DRG,21836,,DRG base rate x DRG weight + capital per discharge,21836,Other,100% of NY Medicaid HMO DRG,21836,,DRG base rate x DRG weight + capital per discharge,21836,Other,100% of NY Medicaid HMO DRG,49131,,225% x Medicaid HMO amount,49131,Other,225% of NY Medicaid HMO DRG,33409,,153% x Medicaid HMO amount,33409,Other,153% of NY Medicaid HMO DRG,49131,,225% x Medicaid HMO amount,49131,Other,225% of NY Medicaid HMO DRG,30571,,140% x Medicaid HMO amount,30571,Other,140% of NY Medicaid HMO DRG,49131,,DRG base rate x DRG weight + capital per discharge,49131,Other,225% of NY Medicaid HMO DRG,60050,,275% x Medicaid HMO amount,60050,Other,275% of NY Medicaid HMO DRG,70749,,324% x Medicaid HMO amount,70749,Other,324% of NY Medicaid HMO DRG,46948,,215% x Medicaid HMO amount,46948,Other,215% of NY Medicaid HMO DRG,46948,,215% x Medicaid HMO amount,46948,Other,215% of NY Medicaid HMO DRG,27295,,125% x Medicaid HMO amount,27295,Other,125% of NY Medicaid HMO DRG,0.01,92969,
Major respiratory & chest procedures,120-4,APR-DRG,,,,,,,,inpatient,,,618420.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72817,,186% x Medicaid HMO amount,72817,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,168313,,"27,634 x DRG Weight",168313,Other,DRG Base Rate x DRG Weight,143061,,"23,488 x DRG Weight",143061,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39149.21,,DRG base rate x DRG weight + capital per discharge,39149.21,Other,100% of NY Medicaid HMO DRG,39149,,DRG base rate x DRG weight + capital per discharge,39149,Other,100% of NY Medicaid HMO DRG,39149,,DRG base rate x DRG weight + capital per discharge,39149,Other,100% of NY Medicaid HMO DRG,39149,,DRG base rate x DRG weight + capital per discharge,39149,Other,100% of NY Medicaid HMO DRG,88086,,225% x Medicaid HMO amount,88086,Other,225% of NY Medicaid HMO DRG,59898,,153% x Medicaid HMO amount,59898,Other,153% of NY Medicaid HMO DRG,88086,,225% x Medicaid HMO amount,88086,Other,225% of NY Medicaid HMO DRG,54809,,140% x Medicaid HMO amount,54809,Other,140% of NY Medicaid HMO DRG,88086,,DRG base rate x DRG weight + capital per discharge,88086,Other,225% of NY Medicaid HMO DRG,107660,,275% x Medicaid HMO amount,107660,Other,275% of NY Medicaid HMO DRG,126843,,324% x Medicaid HMO amount,126843,Other,324% of NY Medicaid HMO DRG,84171,,215% x Medicaid HMO amount,84171,Other,215% of NY Medicaid HMO DRG,84171,,215% x Medicaid HMO amount,84171,Other,215% of NY Medicaid HMO DRG,48937,,125% x Medicaid HMO amount,48937,Other,125% of NY Medicaid HMO DRG,0.01,168313,
Other respiratory & chest procedures,121-1,APR-DRG,,,,,,,,inpatient,,,105207.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15155,,186% x Medicaid HMO amount,15155,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33401,,"27,634 x DRG Weight",33401,Other,DRG Base Rate x DRG Weight,28390,,"23,488 x DRG Weight",28390,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8148.21,,DRG base rate x DRG weight + capital per discharge,8148.21,Other,100% of NY Medicaid HMO DRG,8148,,DRG base rate x DRG weight + capital per discharge,8148,Other,100% of NY Medicaid HMO DRG,8148,,DRG base rate x DRG weight + capital per discharge,8148,Other,100% of NY Medicaid HMO DRG,8148,,DRG base rate x DRG weight + capital per discharge,8148,Other,100% of NY Medicaid HMO DRG,18333,,225% x Medicaid HMO amount,18333,Other,225% of NY Medicaid HMO DRG,12467,,153% x Medicaid HMO amount,12467,Other,153% of NY Medicaid HMO DRG,18333,,225% x Medicaid HMO amount,18333,Other,225% of NY Medicaid HMO DRG,11407,,140% x Medicaid HMO amount,11407,Other,140% of NY Medicaid HMO DRG,18333,,DRG base rate x DRG weight + capital per discharge,18333,Other,225% of NY Medicaid HMO DRG,22408,,275% x Medicaid HMO amount,22408,Other,275% of NY Medicaid HMO DRG,26400,,324% x Medicaid HMO amount,26400,Other,324% of NY Medicaid HMO DRG,17519,,215% x Medicaid HMO amount,17519,Other,215% of NY Medicaid HMO DRG,17519,,215% x Medicaid HMO amount,17519,Other,215% of NY Medicaid HMO DRG,10185,,125% x Medicaid HMO amount,10185,Other,125% of NY Medicaid HMO DRG,0.01,33401,
Other respiratory & chest procedures,121-2,APR-DRG,,,,,,,,inpatient,,,325454.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20101,,186% x Medicaid HMO amount,20101,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44972,,"27,634 x DRG Weight",44972,Other,DRG Base Rate x DRG Weight,38224,,"23,488 x DRG Weight",38224,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10807.21,,DRG base rate x DRG weight + capital per discharge,10807.21,Other,100% of NY Medicaid HMO DRG,10807,,DRG base rate x DRG weight + capital per discharge,10807,Other,100% of NY Medicaid HMO DRG,10807,,DRG base rate x DRG weight + capital per discharge,10807,Other,100% of NY Medicaid HMO DRG,10807,,DRG base rate x DRG weight + capital per discharge,10807,Other,100% of NY Medicaid HMO DRG,24316,,225% x Medicaid HMO amount,24316,Other,225% of NY Medicaid HMO DRG,16535,,153% x Medicaid HMO amount,16535,Other,153% of NY Medicaid HMO DRG,24316,,225% x Medicaid HMO amount,24316,Other,225% of NY Medicaid HMO DRG,15130,,140% x Medicaid HMO amount,15130,Other,140% of NY Medicaid HMO DRG,24316,,DRG base rate x DRG weight + capital per discharge,24316,Other,225% of NY Medicaid HMO DRG,29720,,275% x Medicaid HMO amount,29720,Other,275% of NY Medicaid HMO DRG,35015,,324% x Medicaid HMO amount,35015,Other,324% of NY Medicaid HMO DRG,23236,,215% x Medicaid HMO amount,23236,Other,215% of NY Medicaid HMO DRG,23236,,215% x Medicaid HMO amount,23236,Other,215% of NY Medicaid HMO DRG,13509,,125% x Medicaid HMO amount,13509,Other,125% of NY Medicaid HMO DRG,0.01,44972,
Other respiratory & chest procedures,121-3,APR-DRG,,,,,,,,inpatient,,,560210.09,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34466,,186% x Medicaid HMO amount,34466,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78580,,"27,634 x DRG Weight",78580,Other,DRG Base Rate x DRG Weight,66790,,"23,488 x DRG Weight",66790,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18530.21,,DRG base rate x DRG weight + capital per discharge,18530.21,Other,100% of NY Medicaid HMO DRG,18530,,DRG base rate x DRG weight + capital per discharge,18530,Other,100% of NY Medicaid HMO DRG,18530,,DRG base rate x DRG weight + capital per discharge,18530,Other,100% of NY Medicaid HMO DRG,18530,,DRG base rate x DRG weight + capital per discharge,18530,Other,100% of NY Medicaid HMO DRG,41693,,225% x Medicaid HMO amount,41693,Other,225% of NY Medicaid HMO DRG,28351,,153% x Medicaid HMO amount,28351,Other,153% of NY Medicaid HMO DRG,41693,,225% x Medicaid HMO amount,41693,Other,225% of NY Medicaid HMO DRG,25942,,140% x Medicaid HMO amount,25942,Other,140% of NY Medicaid HMO DRG,41693,,DRG base rate x DRG weight + capital per discharge,41693,Other,225% of NY Medicaid HMO DRG,50958,,275% x Medicaid HMO amount,50958,Other,275% of NY Medicaid HMO DRG,60038,,324% x Medicaid HMO amount,60038,Other,324% of NY Medicaid HMO DRG,39840,,215% x Medicaid HMO amount,39840,Other,215% of NY Medicaid HMO DRG,39840,,215% x Medicaid HMO amount,39840,Other,215% of NY Medicaid HMO DRG,23163,,125% x Medicaid HMO amount,23163,Other,125% of NY Medicaid HMO DRG,0.01,78580,
Other respiratory & chest procedures,121-4,APR-DRG,,,,,,,,inpatient,,,933405.05,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72419,,186% x Medicaid HMO amount,72419,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,167382,,"27,634 x DRG Weight",167382,Other,DRG Base Rate x DRG Weight,142269,,"23,488 x DRG Weight",142269,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38935.21,,DRG base rate x DRG weight + capital per discharge,38935.21,Other,100% of NY Medicaid HMO DRG,38935,,DRG base rate x DRG weight + capital per discharge,38935,Other,100% of NY Medicaid HMO DRG,38935,,DRG base rate x DRG weight + capital per discharge,38935,Other,100% of NY Medicaid HMO DRG,38935,,DRG base rate x DRG weight + capital per discharge,38935,Other,100% of NY Medicaid HMO DRG,87604,,225% x Medicaid HMO amount,87604,Other,225% of NY Medicaid HMO DRG,59571,,153% x Medicaid HMO amount,59571,Other,153% of NY Medicaid HMO DRG,87604,,225% x Medicaid HMO amount,87604,Other,225% of NY Medicaid HMO DRG,54509,,140% x Medicaid HMO amount,54509,Other,140% of NY Medicaid HMO DRG,87604,,DRG base rate x DRG weight + capital per discharge,87604,Other,225% of NY Medicaid HMO DRG,107072,,275% x Medicaid HMO amount,107072,Other,275% of NY Medicaid HMO DRG,126150,,324% x Medicaid HMO amount,126150,Other,324% of NY Medicaid HMO DRG,83711,,215% x Medicaid HMO amount,83711,Other,215% of NY Medicaid HMO DRG,83711,,215% x Medicaid HMO amount,83711,Other,215% of NY Medicaid HMO DRG,48669,,125% x Medicaid HMO amount,48669,Other,125% of NY Medicaid HMO DRG,0.01,167382,
Respiratory system diagnosis w ventilator support 96+ hours,130-1,APR-DRG,,,,,,,,inpatient,,,116711,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41394,,186% x Medicaid HMO amount,41394,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,94790,,"27,634 x DRG Weight",94790,Other,DRG Base Rate x DRG Weight,80569,,"23,488 x DRG Weight",80569,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22255.21,,DRG base rate x DRG weight + capital per discharge,22255.21,Other,100% of NY Medicaid HMO DRG,22255,,DRG base rate x DRG weight + capital per discharge,22255,Other,100% of NY Medicaid HMO DRG,22255,,DRG base rate x DRG weight + capital per discharge,22255,Other,100% of NY Medicaid HMO DRG,22255,,DRG base rate x DRG weight + capital per discharge,22255,Other,100% of NY Medicaid HMO DRG,50074,,225% x Medicaid HMO amount,50074,Other,225% of NY Medicaid HMO DRG,34050,,153% x Medicaid HMO amount,34050,Other,153% of NY Medicaid HMO DRG,50074,,225% x Medicaid HMO amount,50074,Other,225% of NY Medicaid HMO DRG,31157,,140% x Medicaid HMO amount,31157,Other,140% of NY Medicaid HMO DRG,50074,,DRG base rate x DRG weight + capital per discharge,50074,Other,225% of NY Medicaid HMO DRG,61202,,275% x Medicaid HMO amount,61202,Other,275% of NY Medicaid HMO DRG,72107,,324% x Medicaid HMO amount,72107,Other,324% of NY Medicaid HMO DRG,47849,,215% x Medicaid HMO amount,47849,Other,215% of NY Medicaid HMO DRG,47849,,215% x Medicaid HMO amount,47849,Other,215% of NY Medicaid HMO DRG,27819,,125% x Medicaid HMO amount,27819,Other,125% of NY Medicaid HMO DRG,0.01,94790,
Respiratory system diagnosis w ventilator support 96+ hours,130-2,APR-DRG,,,,,,,,inpatient,,,296886,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41394,,186% x Medicaid HMO amount,41394,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,94790,,"27,634 x DRG Weight",94790,Other,DRG Base Rate x DRG Weight,80569,,"23,488 x DRG Weight",80569,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22255.21,,DRG base rate x DRG weight + capital per discharge,22255.21,Other,100% of NY Medicaid HMO DRG,22255,,DRG base rate x DRG weight + capital per discharge,22255,Other,100% of NY Medicaid HMO DRG,22255,,DRG base rate x DRG weight + capital per discharge,22255,Other,100% of NY Medicaid HMO DRG,22255,,DRG base rate x DRG weight + capital per discharge,22255,Other,100% of NY Medicaid HMO DRG,50074,,225% x Medicaid HMO amount,50074,Other,225% of NY Medicaid HMO DRG,34050,,153% x Medicaid HMO amount,34050,Other,153% of NY Medicaid HMO DRG,50074,,225% x Medicaid HMO amount,50074,Other,225% of NY Medicaid HMO DRG,31157,,140% x Medicaid HMO amount,31157,Other,140% of NY Medicaid HMO DRG,50074,,DRG base rate x DRG weight + capital per discharge,50074,Other,225% of NY Medicaid HMO DRG,61202,,275% x Medicaid HMO amount,61202,Other,275% of NY Medicaid HMO DRG,72107,,324% x Medicaid HMO amount,72107,Other,324% of NY Medicaid HMO DRG,47849,,215% x Medicaid HMO amount,47849,Other,215% of NY Medicaid HMO DRG,47849,,215% x Medicaid HMO amount,47849,Other,215% of NY Medicaid HMO DRG,27819,,125% x Medicaid HMO amount,27819,Other,125% of NY Medicaid HMO DRG,0.01,94790,
Respiratory system diagnosis w ventilator support 96+ hours,130-3,APR-DRG,,,,,,,,inpatient,,,481963.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51423,,186% x Medicaid HMO amount,51423,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,118257,,"27,634 x DRG Weight",118257,Other,DRG Base Rate x DRG Weight,100515,,"23,488 x DRG Weight",100515,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27647.21,,DRG base rate x DRG weight + capital per discharge,27647.21,Other,100% of NY Medicaid HMO DRG,27647,,DRG base rate x DRG weight + capital per discharge,27647,Other,100% of NY Medicaid HMO DRG,27647,,DRG base rate x DRG weight + capital per discharge,27647,Other,100% of NY Medicaid HMO DRG,27647,,DRG base rate x DRG weight + capital per discharge,27647,Other,100% of NY Medicaid HMO DRG,62206,,225% x Medicaid HMO amount,62206,Other,225% of NY Medicaid HMO DRG,42300,,153% x Medicaid HMO amount,42300,Other,153% of NY Medicaid HMO DRG,62206,,225% x Medicaid HMO amount,62206,Other,225% of NY Medicaid HMO DRG,38706,,140% x Medicaid HMO amount,38706,Other,140% of NY Medicaid HMO DRG,62206,,DRG base rate x DRG weight + capital per discharge,62206,Other,225% of NY Medicaid HMO DRG,76030,,275% x Medicaid HMO amount,76030,Other,275% of NY Medicaid HMO DRG,89577,,324% x Medicaid HMO amount,89577,Other,324% of NY Medicaid HMO DRG,59442,,215% x Medicaid HMO amount,59442,Other,215% of NY Medicaid HMO DRG,59442,,215% x Medicaid HMO amount,59442,Other,215% of NY Medicaid HMO DRG,34559,,125% x Medicaid HMO amount,34559,Other,125% of NY Medicaid HMO DRG,0.01,118257,
Respiratory system diagnosis w ventilator support 96+ hours,130-4,APR-DRG,,,,,,,,inpatient,,,1565318.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72605,,186% x Medicaid HMO amount,72605,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,167816,,"27,634 x DRG Weight",167816,Other,DRG Base Rate x DRG Weight,142638,,"23,488 x DRG Weight",142638,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39035.21,,DRG base rate x DRG weight + capital per discharge,39035.21,Other,100% of NY Medicaid HMO DRG,39035,,DRG base rate x DRG weight + capital per discharge,39035,Other,100% of NY Medicaid HMO DRG,39035,,DRG base rate x DRG weight + capital per discharge,39035,Other,100% of NY Medicaid HMO DRG,39035,,DRG base rate x DRG weight + capital per discharge,39035,Other,100% of NY Medicaid HMO DRG,87829,,225% x Medicaid HMO amount,87829,Other,225% of NY Medicaid HMO DRG,59724,,153% x Medicaid HMO amount,59724,Other,153% of NY Medicaid HMO DRG,87829,,225% x Medicaid HMO amount,87829,Other,225% of NY Medicaid HMO DRG,54649,,140% x Medicaid HMO amount,54649,Other,140% of NY Medicaid HMO DRG,87829,,DRG base rate x DRG weight + capital per discharge,87829,Other,225% of NY Medicaid HMO DRG,107347,,275% x Medicaid HMO amount,107347,Other,275% of NY Medicaid HMO DRG,126474,,324% x Medicaid HMO amount,126474,Other,324% of NY Medicaid HMO DRG,83926,,215% x Medicaid HMO amount,83926,Other,215% of NY Medicaid HMO DRG,83926,,215% x Medicaid HMO amount,83926,Other,215% of NY Medicaid HMO DRG,48794,,125% x Medicaid HMO amount,48794,Other,125% of NY Medicaid HMO DRG,0.01,167816,
Cystic fibrosis - pulmonary disease,131-1,APR-DRG,,,,,,,,inpatient,,,101263.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17179,,186% x Medicaid HMO amount,17179,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38135,,"27,634 x DRG Weight",38135,Other,DRG Base Rate x DRG Weight,32413,,"23,488 x DRG Weight",32413,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9236.21,,DRG base rate x DRG weight + capital per discharge,9236.21,Other,100% of NY Medicaid HMO DRG,9236,,DRG base rate x DRG weight + capital per discharge,9236,Other,100% of NY Medicaid HMO DRG,9236,,DRG base rate x DRG weight + capital per discharge,9236,Other,100% of NY Medicaid HMO DRG,9236,,DRG base rate x DRG weight + capital per discharge,9236,Other,100% of NY Medicaid HMO DRG,20781,,225% x Medicaid HMO amount,20781,Other,225% of NY Medicaid HMO DRG,14131,,153% x Medicaid HMO amount,14131,Other,153% of NY Medicaid HMO DRG,20781,,225% x Medicaid HMO amount,20781,Other,225% of NY Medicaid HMO DRG,12931,,140% x Medicaid HMO amount,12931,Other,140% of NY Medicaid HMO DRG,20781,,DRG base rate x DRG weight + capital per discharge,20781,Other,225% of NY Medicaid HMO DRG,25400,,275% x Medicaid HMO amount,25400,Other,275% of NY Medicaid HMO DRG,29925,,324% x Medicaid HMO amount,29925,Other,324% of NY Medicaid HMO DRG,19858,,215% x Medicaid HMO amount,19858,Other,215% of NY Medicaid HMO DRG,19858,,215% x Medicaid HMO amount,19858,Other,215% of NY Medicaid HMO DRG,11545,,125% x Medicaid HMO amount,11545,Other,125% of NY Medicaid HMO DRG,0.01,38135,
Cystic fibrosis - pulmonary disease,131-2,APR-DRG,,,,,,,,inpatient,,,115061.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21310,,186% x Medicaid HMO amount,21310,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47801,,"27,634 x DRG Weight",47801,Other,DRG Base Rate x DRG Weight,40630,,"23,488 x DRG Weight",40630,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11457.21,,DRG base rate x DRG weight + capital per discharge,11457.21,Other,100% of NY Medicaid HMO DRG,11457,,DRG base rate x DRG weight + capital per discharge,11457,Other,100% of NY Medicaid HMO DRG,11457,,DRG base rate x DRG weight + capital per discharge,11457,Other,100% of NY Medicaid HMO DRG,11457,,DRG base rate x DRG weight + capital per discharge,11457,Other,100% of NY Medicaid HMO DRG,25779,,225% x Medicaid HMO amount,25779,Other,225% of NY Medicaid HMO DRG,17530,,153% x Medicaid HMO amount,17530,Other,153% of NY Medicaid HMO DRG,25779,,225% x Medicaid HMO amount,25779,Other,225% of NY Medicaid HMO DRG,16040,,140% x Medicaid HMO amount,16040,Other,140% of NY Medicaid HMO DRG,25779,,DRG base rate x DRG weight + capital per discharge,25779,Other,225% of NY Medicaid HMO DRG,31507,,275% x Medicaid HMO amount,31507,Other,275% of NY Medicaid HMO DRG,37121,,324% x Medicaid HMO amount,37121,Other,324% of NY Medicaid HMO DRG,24633,,215% x Medicaid HMO amount,24633,Other,215% of NY Medicaid HMO DRG,24633,,215% x Medicaid HMO amount,24633,Other,215% of NY Medicaid HMO DRG,14322,,125% x Medicaid HMO amount,14322,Other,125% of NY Medicaid HMO DRG,0.01,47801,
Cystic fibrosis - pulmonary disease,131-3,APR-DRG,,,,,,,,inpatient,,,173087.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31038,,186% x Medicaid HMO amount,31038,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70561,,"27,634 x DRG Weight",70561,Other,DRG Base Rate x DRG Weight,59974,,"23,488 x DRG Weight",59974,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16687.21,,DRG base rate x DRG weight + capital per discharge,16687.21,Other,100% of NY Medicaid HMO DRG,16687,,DRG base rate x DRG weight + capital per discharge,16687,Other,100% of NY Medicaid HMO DRG,16687,,DRG base rate x DRG weight + capital per discharge,16687,Other,100% of NY Medicaid HMO DRG,16687,,DRG base rate x DRG weight + capital per discharge,16687,Other,100% of NY Medicaid HMO DRG,37546,,225% x Medicaid HMO amount,37546,Other,225% of NY Medicaid HMO DRG,25531,,153% x Medicaid HMO amount,25531,Other,153% of NY Medicaid HMO DRG,37546,,225% x Medicaid HMO amount,37546,Other,225% of NY Medicaid HMO DRG,23362,,140% x Medicaid HMO amount,23362,Other,140% of NY Medicaid HMO DRG,37546,,DRG base rate x DRG weight + capital per discharge,37546,Other,225% of NY Medicaid HMO DRG,45890,,275% x Medicaid HMO amount,45890,Other,275% of NY Medicaid HMO DRG,54067,,324% x Medicaid HMO amount,54067,Other,324% of NY Medicaid HMO DRG,35878,,215% x Medicaid HMO amount,35878,Other,215% of NY Medicaid HMO DRG,35878,,215% x Medicaid HMO amount,35878,Other,215% of NY Medicaid HMO DRG,20859,,125% x Medicaid HMO amount,20859,Other,125% of NY Medicaid HMO DRG,0.01,70561,
Cystic fibrosis - pulmonary disease,131-4,APR-DRG,,,,,,,,inpatient,,,259723.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33166,,186% x Medicaid HMO amount,33166,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75538,,"27,634 x DRG Weight",75538,Other,DRG Base Rate x DRG Weight,64204,,"23,488 x DRG Weight",64204,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17831.21,,DRG base rate x DRG weight + capital per discharge,17831.21,Other,100% of NY Medicaid HMO DRG,17831,,DRG base rate x DRG weight + capital per discharge,17831,Other,100% of NY Medicaid HMO DRG,17831,,DRG base rate x DRG weight + capital per discharge,17831,Other,100% of NY Medicaid HMO DRG,17831,,DRG base rate x DRG weight + capital per discharge,17831,Other,100% of NY Medicaid HMO DRG,40120,,225% x Medicaid HMO amount,40120,Other,225% of NY Medicaid HMO DRG,27282,,153% x Medicaid HMO amount,27282,Other,153% of NY Medicaid HMO DRG,40120,,225% x Medicaid HMO amount,40120,Other,225% of NY Medicaid HMO DRG,24964,,140% x Medicaid HMO amount,24964,Other,140% of NY Medicaid HMO DRG,40120,,DRG base rate x DRG weight + capital per discharge,40120,Other,225% of NY Medicaid HMO DRG,49036,,275% x Medicaid HMO amount,49036,Other,275% of NY Medicaid HMO DRG,57773,,324% x Medicaid HMO amount,57773,Other,324% of NY Medicaid HMO DRG,38337,,215% x Medicaid HMO amount,38337,Other,215% of NY Medicaid HMO DRG,38337,,215% x Medicaid HMO amount,38337,Other,215% of NY Medicaid HMO DRG,22289,,125% x Medicaid HMO amount,22289,Other,125% of NY Medicaid HMO DRG,0.01,75538,
BPD & oth chronic respiratory diseases arising in perinatal period,132-1,APR-DRG,,,,,,,,inpatient,,,134363.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7851,,186% x Medicaid HMO amount,7851,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16310,,"27,634 x DRG Weight",16310,Other,DRG Base Rate x DRG Weight,13863,,"23,488 x DRG Weight",13863,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4221.21,,DRG base rate x DRG weight + capital per discharge,4221.21,Other,100% of NY Medicaid HMO DRG,4221,,DRG base rate x DRG weight + capital per discharge,4221,Other,100% of NY Medicaid HMO DRG,4221,,DRG base rate x DRG weight + capital per discharge,4221,Other,100% of NY Medicaid HMO DRG,4221,,DRG base rate x DRG weight + capital per discharge,4221,Other,100% of NY Medicaid HMO DRG,9498,,225% x Medicaid HMO amount,9498,Other,225% of NY Medicaid HMO DRG,6458,,153% x Medicaid HMO amount,6458,Other,153% of NY Medicaid HMO DRG,9498,,225% x Medicaid HMO amount,9498,Other,225% of NY Medicaid HMO DRG,5910,,140% x Medicaid HMO amount,5910,Other,140% of NY Medicaid HMO DRG,9498,,DRG base rate x DRG weight + capital per discharge,9498,Other,225% of NY Medicaid HMO DRG,11608,,275% x Medicaid HMO amount,11608,Other,275% of NY Medicaid HMO DRG,13677,,324% x Medicaid HMO amount,13677,Other,324% of NY Medicaid HMO DRG,9076,,215% x Medicaid HMO amount,9076,Other,215% of NY Medicaid HMO DRG,9076,,215% x Medicaid HMO amount,9076,Other,215% of NY Medicaid HMO DRG,5277,,125% x Medicaid HMO amount,5277,Other,125% of NY Medicaid HMO DRG,0.01,16310,
BPD & oth chronic respiratory diseases arising in perinatal period,132-2,APR-DRG,,,,,,,,inpatient,,,130750.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10143,,186% x Medicaid HMO amount,10143,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21673,,"27,634 x DRG Weight",21673,Other,DRG Base Rate x DRG Weight,18422,,"23,488 x DRG Weight",18422,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5453.21,,DRG base rate x DRG weight + capital per discharge,5453.21,Other,100% of NY Medicaid HMO DRG,5453,,DRG base rate x DRG weight + capital per discharge,5453,Other,100% of NY Medicaid HMO DRG,5453,,DRG base rate x DRG weight + capital per discharge,5453,Other,100% of NY Medicaid HMO DRG,5453,,DRG base rate x DRG weight + capital per discharge,5453,Other,100% of NY Medicaid HMO DRG,12270,,225% x Medicaid HMO amount,12270,Other,225% of NY Medicaid HMO DRG,8343,,153% x Medicaid HMO amount,8343,Other,153% of NY Medicaid HMO DRG,12270,,225% x Medicaid HMO amount,12270,Other,225% of NY Medicaid HMO DRG,7634,,140% x Medicaid HMO amount,7634,Other,140% of NY Medicaid HMO DRG,12270,,DRG base rate x DRG weight + capital per discharge,12270,Other,225% of NY Medicaid HMO DRG,14996,,275% x Medicaid HMO amount,14996,Other,275% of NY Medicaid HMO DRG,17668,,324% x Medicaid HMO amount,17668,Other,324% of NY Medicaid HMO DRG,11724,,215% x Medicaid HMO amount,11724,Other,215% of NY Medicaid HMO DRG,11724,,215% x Medicaid HMO amount,11724,Other,215% of NY Medicaid HMO DRG,6817,,125% x Medicaid HMO amount,6817,Other,125% of NY Medicaid HMO DRG,0.01,21673,
BPD & oth chronic respiratory diseases arising in perinatal period,132-3,APR-DRG,,,,,,,,inpatient,,,99357.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16442,,186% x Medicaid HMO amount,16442,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36413,,"27,634 x DRG Weight",36413,Other,DRG Base Rate x DRG Weight,30950,,"23,488 x DRG Weight",30950,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8840.21,,DRG base rate x DRG weight + capital per discharge,8840.21,Other,100% of NY Medicaid HMO DRG,8840,,DRG base rate x DRG weight + capital per discharge,8840,Other,100% of NY Medicaid HMO DRG,8840,,DRG base rate x DRG weight + capital per discharge,8840,Other,100% of NY Medicaid HMO DRG,8840,,DRG base rate x DRG weight + capital per discharge,8840,Other,100% of NY Medicaid HMO DRG,19890,,225% x Medicaid HMO amount,19890,Other,225% of NY Medicaid HMO DRG,13526,,153% x Medicaid HMO amount,13526,Other,153% of NY Medicaid HMO DRG,19890,,225% x Medicaid HMO amount,19890,Other,225% of NY Medicaid HMO DRG,12376,,140% x Medicaid HMO amount,12376,Other,140% of NY Medicaid HMO DRG,19890,,DRG base rate x DRG weight + capital per discharge,19890,Other,225% of NY Medicaid HMO DRG,24311,,275% x Medicaid HMO amount,24311,Other,275% of NY Medicaid HMO DRG,28642,,324% x Medicaid HMO amount,28642,Other,324% of NY Medicaid HMO DRG,19006,,215% x Medicaid HMO amount,19006,Other,215% of NY Medicaid HMO DRG,19006,,215% x Medicaid HMO amount,19006,Other,215% of NY Medicaid HMO DRG,11050,,125% x Medicaid HMO amount,11050,Other,125% of NY Medicaid HMO DRG,0.01,36413,
BPD & oth chronic respiratory diseases arising in perinatal period,132-4,APR-DRG,,,,,,,,inpatient,,,222809.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29235,,186% x Medicaid HMO amount,29235,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,66344,,"27,634 x DRG Weight",66344,Other,DRG Base Rate x DRG Weight,56390,,"23,488 x DRG Weight",56390,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15718.21,,DRG base rate x DRG weight + capital per discharge,15718.21,Other,100% of NY Medicaid HMO DRG,15718,,DRG base rate x DRG weight + capital per discharge,15718,Other,100% of NY Medicaid HMO DRG,15718,,DRG base rate x DRG weight + capital per discharge,15718,Other,100% of NY Medicaid HMO DRG,15718,,DRG base rate x DRG weight + capital per discharge,15718,Other,100% of NY Medicaid HMO DRG,35366,,225% x Medicaid HMO amount,35366,Other,225% of NY Medicaid HMO DRG,24049,,153% x Medicaid HMO amount,24049,Other,153% of NY Medicaid HMO DRG,35366,,225% x Medicaid HMO amount,35366,Other,225% of NY Medicaid HMO DRG,22005,,140% x Medicaid HMO amount,22005,Other,140% of NY Medicaid HMO DRG,35366,,DRG base rate x DRG weight + capital per discharge,35366,Other,225% of NY Medicaid HMO DRG,43225,,275% x Medicaid HMO amount,43225,Other,275% of NY Medicaid HMO DRG,50927,,324% x Medicaid HMO amount,50927,Other,324% of NY Medicaid HMO DRG,33794,,215% x Medicaid HMO amount,33794,Other,215% of NY Medicaid HMO DRG,33794,,215% x Medicaid HMO amount,33794,Other,215% of NY Medicaid HMO DRG,19648,,125% x Medicaid HMO amount,19648,Other,125% of NY Medicaid HMO DRG,0.01,66344,
Respiratory Failure,133-1,APR-DRG,,,,,,,,inpatient,,,93911,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11763,,186% x Medicaid HMO amount,11763,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25465,,"27,634 x DRG Weight",25465,Other,DRG Base Rate x DRG Weight,21644,,"23,488 x DRG Weight",21644,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6324.21,,DRG base rate x DRG weight + capital per discharge,6324.21,Other,100% of NY Medicaid HMO DRG,6324,,DRG base rate x DRG weight + capital per discharge,6324,Other,100% of NY Medicaid HMO DRG,6324,,DRG base rate x DRG weight + capital per discharge,6324,Other,100% of NY Medicaid HMO DRG,6324,,DRG base rate x DRG weight + capital per discharge,6324,Other,100% of NY Medicaid HMO DRG,14229,,225% x Medicaid HMO amount,14229,Other,225% of NY Medicaid HMO DRG,9676,,153% x Medicaid HMO amount,9676,Other,153% of NY Medicaid HMO DRG,14229,,225% x Medicaid HMO amount,14229,Other,225% of NY Medicaid HMO DRG,8854,,140% x Medicaid HMO amount,8854,Other,140% of NY Medicaid HMO DRG,14229,,DRG base rate x DRG weight + capital per discharge,14229,Other,225% of NY Medicaid HMO DRG,17392,,275% x Medicaid HMO amount,17392,Other,275% of NY Medicaid HMO DRG,20490,,324% x Medicaid HMO amount,20490,Other,324% of NY Medicaid HMO DRG,13597,,215% x Medicaid HMO amount,13597,Other,215% of NY Medicaid HMO DRG,13597,,215% x Medicaid HMO amount,13597,Other,215% of NY Medicaid HMO DRG,7905,,125% x Medicaid HMO amount,7905,Other,125% of NY Medicaid HMO DRG,0.01,25465,
Respiratory Failure,133-2,APR-DRG,,,,,,,,inpatient,,,93911,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11785,,186% x Medicaid HMO amount,11785,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25517,,"27,634 x DRG Weight",25517,Other,DRG Base Rate x DRG Weight,21689,,"23,488 x DRG Weight",21689,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6336.21,,DRG base rate x DRG weight + capital per discharge,6336.21,Other,100% of NY Medicaid HMO DRG,6336,,DRG base rate x DRG weight + capital per discharge,6336,Other,100% of NY Medicaid HMO DRG,6336,,DRG base rate x DRG weight + capital per discharge,6336,Other,100% of NY Medicaid HMO DRG,6336,,DRG base rate x DRG weight + capital per discharge,6336,Other,100% of NY Medicaid HMO DRG,14256,,225% x Medicaid HMO amount,14256,Other,225% of NY Medicaid HMO DRG,9694,,153% x Medicaid HMO amount,9694,Other,153% of NY Medicaid HMO DRG,14256,,225% x Medicaid HMO amount,14256,Other,225% of NY Medicaid HMO DRG,8871,,140% x Medicaid HMO amount,8871,Other,140% of NY Medicaid HMO DRG,14256,,DRG base rate x DRG weight + capital per discharge,14256,Other,225% of NY Medicaid HMO DRG,17425,,275% x Medicaid HMO amount,17425,Other,275% of NY Medicaid HMO DRG,20529,,324% x Medicaid HMO amount,20529,Other,324% of NY Medicaid HMO DRG,13623,,215% x Medicaid HMO amount,13623,Other,215% of NY Medicaid HMO DRG,13623,,215% x Medicaid HMO amount,13623,Other,215% of NY Medicaid HMO DRG,7920,,125% x Medicaid HMO amount,7920,Other,125% of NY Medicaid HMO DRG,0.01,25517,
Respiratory Failure,133-3,APR-DRG,,,,,,,,inpatient,,,121549.43,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17023,,186% x Medicaid HMO amount,17023,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37770,,"27,634 x DRG Weight",37770,Other,DRG Base Rate x DRG Weight,32103,,"23,488 x DRG Weight",32103,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9152.21,,DRG base rate x DRG weight + capital per discharge,9152.21,Other,100% of NY Medicaid HMO DRG,9152,,DRG base rate x DRG weight + capital per discharge,9152,Other,100% of NY Medicaid HMO DRG,9152,,DRG base rate x DRG weight + capital per discharge,9152,Other,100% of NY Medicaid HMO DRG,9152,,DRG base rate x DRG weight + capital per discharge,9152,Other,100% of NY Medicaid HMO DRG,20592,,225% x Medicaid HMO amount,20592,Other,225% of NY Medicaid HMO DRG,14003,,153% x Medicaid HMO amount,14003,Other,153% of NY Medicaid HMO DRG,20592,,225% x Medicaid HMO amount,20592,Other,225% of NY Medicaid HMO DRG,12813,,140% x Medicaid HMO amount,12813,Other,140% of NY Medicaid HMO DRG,20592,,DRG base rate x DRG weight + capital per discharge,20592,Other,225% of NY Medicaid HMO DRG,25169,,275% x Medicaid HMO amount,25169,Other,275% of NY Medicaid HMO DRG,29653,,324% x Medicaid HMO amount,29653,Other,324% of NY Medicaid HMO DRG,19677,,215% x Medicaid HMO amount,19677,Other,215% of NY Medicaid HMO DRG,19677,,215% x Medicaid HMO amount,19677,Other,215% of NY Medicaid HMO DRG,11440,,125% x Medicaid HMO amount,11440,Other,125% of NY Medicaid HMO DRG,0.01,37770,
Respiratory Failure,133-4,APR-DRG,,,,,,,,inpatient,,,153146.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24703,,186% x Medicaid HMO amount,24703,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,55741,,"27,634 x DRG Weight",55741,Other,DRG Base Rate x DRG Weight,47378,,"23,488 x DRG Weight",47378,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13281.21,,DRG base rate x DRG weight + capital per discharge,13281.21,Other,100% of NY Medicaid HMO DRG,13281,,DRG base rate x DRG weight + capital per discharge,13281,Other,100% of NY Medicaid HMO DRG,13281,,DRG base rate x DRG weight + capital per discharge,13281,Other,100% of NY Medicaid HMO DRG,13281,,DRG base rate x DRG weight + capital per discharge,13281,Other,100% of NY Medicaid HMO DRG,29883,,225% x Medicaid HMO amount,29883,Other,225% of NY Medicaid HMO DRG,20320,,153% x Medicaid HMO amount,20320,Other,153% of NY Medicaid HMO DRG,29883,,225% x Medicaid HMO amount,29883,Other,225% of NY Medicaid HMO DRG,18594,,140% x Medicaid HMO amount,18594,Other,140% of NY Medicaid HMO DRG,29883,,DRG base rate x DRG weight + capital per discharge,29883,Other,225% of NY Medicaid HMO DRG,36523,,275% x Medicaid HMO amount,36523,Other,275% of NY Medicaid HMO DRG,43031,,324% x Medicaid HMO amount,43031,Other,324% of NY Medicaid HMO DRG,28555,,215% x Medicaid HMO amount,28555,Other,215% of NY Medicaid HMO DRG,28555,,215% x Medicaid HMO amount,28555,Other,215% of NY Medicaid HMO DRG,16602,,125% x Medicaid HMO amount,16602,Other,125% of NY Medicaid HMO DRG,0.01,55741,
Pulmonary embolism,134-1,APR-DRG,,,,,,,,inpatient,,,83186.91,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9203,,186% x Medicaid HMO amount,9203,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19474,,"27,634 x DRG Weight",19474,Other,DRG Base Rate x DRG Weight,16552,,"23,488 x DRG Weight",16552,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4948.21,,DRG base rate x DRG weight + capital per discharge,4948.21,Other,100% of NY Medicaid HMO DRG,4948,,DRG base rate x DRG weight + capital per discharge,4948,Other,100% of NY Medicaid HMO DRG,4948,,DRG base rate x DRG weight + capital per discharge,4948,Other,100% of NY Medicaid HMO DRG,4948,,DRG base rate x DRG weight + capital per discharge,4948,Other,100% of NY Medicaid HMO DRG,11133,,225% x Medicaid HMO amount,11133,Other,225% of NY Medicaid HMO DRG,7571,,153% x Medicaid HMO amount,7571,Other,153% of NY Medicaid HMO DRG,11133,,225% x Medicaid HMO amount,11133,Other,225% of NY Medicaid HMO DRG,6927,,140% x Medicaid HMO amount,6927,Other,140% of NY Medicaid HMO DRG,11133,,DRG base rate x DRG weight + capital per discharge,11133,Other,225% of NY Medicaid HMO DRG,13608,,275% x Medicaid HMO amount,13608,Other,275% of NY Medicaid HMO DRG,16032,,324% x Medicaid HMO amount,16032,Other,324% of NY Medicaid HMO DRG,10639,,215% x Medicaid HMO amount,10639,Other,215% of NY Medicaid HMO DRG,10639,,215% x Medicaid HMO amount,10639,Other,215% of NY Medicaid HMO DRG,6185,,125% x Medicaid HMO amount,6185,Other,125% of NY Medicaid HMO DRG,0.01,19474,
Pulmonary embolism,134-2,APR-DRG,,,,,,,,inpatient,,,141942.08,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11924,,186% x Medicaid HMO amount,11924,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25841,,"27,634 x DRG Weight",25841,Other,DRG Base Rate x DRG Weight,21964,,"23,488 x DRG Weight",21964,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6411.21,,DRG base rate x DRG weight + capital per discharge,6411.21,Other,100% of NY Medicaid HMO DRG,6411,,DRG base rate x DRG weight + capital per discharge,6411,Other,100% of NY Medicaid HMO DRG,6411,,DRG base rate x DRG weight + capital per discharge,6411,Other,100% of NY Medicaid HMO DRG,6411,,DRG base rate x DRG weight + capital per discharge,6411,Other,100% of NY Medicaid HMO DRG,14425,,225% x Medicaid HMO amount,14425,Other,225% of NY Medicaid HMO DRG,9809,,153% x Medicaid HMO amount,9809,Other,153% of NY Medicaid HMO DRG,14425,,225% x Medicaid HMO amount,14425,Other,225% of NY Medicaid HMO DRG,8976,,140% x Medicaid HMO amount,8976,Other,140% of NY Medicaid HMO DRG,14425,,DRG base rate x DRG weight + capital per discharge,14425,Other,225% of NY Medicaid HMO DRG,17631,,275% x Medicaid HMO amount,17631,Other,275% of NY Medicaid HMO DRG,20772,,324% x Medicaid HMO amount,20772,Other,324% of NY Medicaid HMO DRG,13784,,215% x Medicaid HMO amount,13784,Other,215% of NY Medicaid HMO DRG,13784,,215% x Medicaid HMO amount,13784,Other,215% of NY Medicaid HMO DRG,8014,,125% x Medicaid HMO amount,8014,Other,125% of NY Medicaid HMO DRG,0.01,25841,
Pulmonary embolism,134-3,APR-DRG,,,,,,,,inpatient,,,218830.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18708,,186% x Medicaid HMO amount,18708,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41711,,"27,634 x DRG Weight",41711,Other,DRG Base Rate x DRG Weight,35453,,"23,488 x DRG Weight",35453,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10058.21,,DRG base rate x DRG weight + capital per discharge,10058.21,Other,100% of NY Medicaid HMO DRG,10058,,DRG base rate x DRG weight + capital per discharge,10058,Other,100% of NY Medicaid HMO DRG,10058,,DRG base rate x DRG weight + capital per discharge,10058,Other,100% of NY Medicaid HMO DRG,10058,,DRG base rate x DRG weight + capital per discharge,10058,Other,100% of NY Medicaid HMO DRG,22631,,225% x Medicaid HMO amount,22631,Other,225% of NY Medicaid HMO DRG,15389,,153% x Medicaid HMO amount,15389,Other,153% of NY Medicaid HMO DRG,22631,,225% x Medicaid HMO amount,22631,Other,225% of NY Medicaid HMO DRG,14081,,140% x Medicaid HMO amount,14081,Other,140% of NY Medicaid HMO DRG,22631,,DRG base rate x DRG weight + capital per discharge,22631,Other,225% of NY Medicaid HMO DRG,27660,,275% x Medicaid HMO amount,27660,Other,275% of NY Medicaid HMO DRG,32589,,324% x Medicaid HMO amount,32589,Other,324% of NY Medicaid HMO DRG,21625,,215% x Medicaid HMO amount,21625,Other,215% of NY Medicaid HMO DRG,21625,,215% x Medicaid HMO amount,21625,Other,215% of NY Medicaid HMO DRG,12573,,125% x Medicaid HMO amount,12573,Other,125% of NY Medicaid HMO DRG,0.01,41711,
Pulmonary embolism,134-4,APR-DRG,,,,,,,,inpatient,,,673798.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31073,,186% x Medicaid HMO amount,31073,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70644,,"27,634 x DRG Weight",70644,Other,DRG Base Rate x DRG Weight,60045,,"23,488 x DRG Weight",60045,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16706.21,,DRG base rate x DRG weight + capital per discharge,16706.21,Other,100% of NY Medicaid HMO DRG,16706,,DRG base rate x DRG weight + capital per discharge,16706,Other,100% of NY Medicaid HMO DRG,16706,,DRG base rate x DRG weight + capital per discharge,16706,Other,100% of NY Medicaid HMO DRG,16706,,DRG base rate x DRG weight + capital per discharge,16706,Other,100% of NY Medicaid HMO DRG,37589,,225% x Medicaid HMO amount,37589,Other,225% of NY Medicaid HMO DRG,25561,,153% x Medicaid HMO amount,25561,Other,153% of NY Medicaid HMO DRG,37589,,225% x Medicaid HMO amount,37589,Other,225% of NY Medicaid HMO DRG,23389,,140% x Medicaid HMO amount,23389,Other,140% of NY Medicaid HMO DRG,37589,,DRG base rate x DRG weight + capital per discharge,37589,Other,225% of NY Medicaid HMO DRG,45942,,275% x Medicaid HMO amount,45942,Other,275% of NY Medicaid HMO DRG,54128,,324% x Medicaid HMO amount,54128,Other,324% of NY Medicaid HMO DRG,35918,,215% x Medicaid HMO amount,35918,Other,215% of NY Medicaid HMO DRG,35918,,215% x Medicaid HMO amount,35918,Other,215% of NY Medicaid HMO DRG,20883,,125% x Medicaid HMO amount,20883,Other,125% of NY Medicaid HMO DRG,0.01,70644,
Major chest & respiratory trauma,135-1,APR-DRG,,,,,,,,inpatient,,,112165.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6994,,186% x Medicaid HMO amount,6994,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14303,,"27,634 x DRG Weight",14303,Other,DRG Base Rate x DRG Weight,12157,,"23,488 x DRG Weight",12157,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3760.21,,DRG base rate x DRG weight + capital per discharge,3760.21,Other,100% of NY Medicaid HMO DRG,3760,,DRG base rate x DRG weight + capital per discharge,3760,Other,100% of NY Medicaid HMO DRG,3760,,DRG base rate x DRG weight + capital per discharge,3760,Other,100% of NY Medicaid HMO DRG,3760,,DRG base rate x DRG weight + capital per discharge,3760,Other,100% of NY Medicaid HMO DRG,8460,,225% x Medicaid HMO amount,8460,Other,225% of NY Medicaid HMO DRG,5753,,153% x Medicaid HMO amount,5753,Other,153% of NY Medicaid HMO DRG,8460,,225% x Medicaid HMO amount,8460,Other,225% of NY Medicaid HMO DRG,5264,,140% x Medicaid HMO amount,5264,Other,140% of NY Medicaid HMO DRG,8460,,DRG base rate x DRG weight + capital per discharge,8460,Other,225% of NY Medicaid HMO DRG,10341,,275% x Medicaid HMO amount,10341,Other,275% of NY Medicaid HMO DRG,12183,,324% x Medicaid HMO amount,12183,Other,324% of NY Medicaid HMO DRG,8084,,215% x Medicaid HMO amount,8084,Other,215% of NY Medicaid HMO DRG,8084,,215% x Medicaid HMO amount,8084,Other,215% of NY Medicaid HMO DRG,4700,,125% x Medicaid HMO amount,4700,Other,125% of NY Medicaid HMO DRG,0.01,14303,
Major chest & respiratory trauma,135-2,APR-DRG,,,,,,,,inpatient,,,152828.66,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9395,,186% x Medicaid HMO amount,9395,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19921,,"27,634 x DRG Weight",19921,Other,DRG Base Rate x DRG Weight,16932,,"23,488 x DRG Weight",16932,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5051.21,,DRG base rate x DRG weight + capital per discharge,5051.21,Other,100% of NY Medicaid HMO DRG,5051,,DRG base rate x DRG weight + capital per discharge,5051,Other,100% of NY Medicaid HMO DRG,5051,,DRG base rate x DRG weight + capital per discharge,5051,Other,100% of NY Medicaid HMO DRG,5051,,DRG base rate x DRG weight + capital per discharge,5051,Other,100% of NY Medicaid HMO DRG,11365,,225% x Medicaid HMO amount,11365,Other,225% of NY Medicaid HMO DRG,7728,,153% x Medicaid HMO amount,7728,Other,153% of NY Medicaid HMO DRG,11365,,225% x Medicaid HMO amount,11365,Other,225% of NY Medicaid HMO DRG,7072,,140% x Medicaid HMO amount,7072,Other,140% of NY Medicaid HMO DRG,11365,,DRG base rate x DRG weight + capital per discharge,11365,Other,225% of NY Medicaid HMO DRG,13891,,275% x Medicaid HMO amount,13891,Other,275% of NY Medicaid HMO DRG,16366,,324% x Medicaid HMO amount,16366,Other,324% of NY Medicaid HMO DRG,10860,,215% x Medicaid HMO amount,10860,Other,215% of NY Medicaid HMO DRG,10860,,215% x Medicaid HMO amount,10860,Other,215% of NY Medicaid HMO DRG,6314,,125% x Medicaid HMO amount,6314,Other,125% of NY Medicaid HMO DRG,0.01,19921,
Major chest & respiratory trauma,135-3,APR-DRG,,,,,,,,inpatient,,,198307.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15367,,186% x Medicaid HMO amount,15367,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33899,,"27,634 x DRG Weight",33899,Other,DRG Base Rate x DRG Weight,28813,,"23,488 x DRG Weight",28813,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8262.21,,DRG base rate x DRG weight + capital per discharge,8262.21,Other,100% of NY Medicaid HMO DRG,8262,,DRG base rate x DRG weight + capital per discharge,8262,Other,100% of NY Medicaid HMO DRG,8262,,DRG base rate x DRG weight + capital per discharge,8262,Other,100% of NY Medicaid HMO DRG,8262,,DRG base rate x DRG weight + capital per discharge,8262,Other,100% of NY Medicaid HMO DRG,18590,,225% x Medicaid HMO amount,18590,Other,225% of NY Medicaid HMO DRG,12641,,153% x Medicaid HMO amount,12641,Other,153% of NY Medicaid HMO DRG,18590,,225% x Medicaid HMO amount,18590,Other,225% of NY Medicaid HMO DRG,11567,,140% x Medicaid HMO amount,11567,Other,140% of NY Medicaid HMO DRG,18590,,DRG base rate x DRG weight + capital per discharge,18590,Other,225% of NY Medicaid HMO DRG,22721,,275% x Medicaid HMO amount,22721,Other,275% of NY Medicaid HMO DRG,26770,,324% x Medicaid HMO amount,26770,Other,324% of NY Medicaid HMO DRG,17764,,215% x Medicaid HMO amount,17764,Other,215% of NY Medicaid HMO DRG,17764,,215% x Medicaid HMO amount,17764,Other,215% of NY Medicaid HMO DRG,10328,,125% x Medicaid HMO amount,10328,Other,125% of NY Medicaid HMO DRG,0.01,33899,
Major chest & respiratory trauma,135-4,APR-DRG,,,,,,,,inpatient,,,181349.84,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22326,,186% x Medicaid HMO amount,22326,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,50175,,"27,634 x DRG Weight",50175,Other,DRG Base Rate x DRG Weight,42647,,"23,488 x DRG Weight",42647,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12003.21,,DRG base rate x DRG weight + capital per discharge,12003.21,Other,100% of NY Medicaid HMO DRG,12003,,DRG base rate x DRG weight + capital per discharge,12003,Other,100% of NY Medicaid HMO DRG,12003,,DRG base rate x DRG weight + capital per discharge,12003,Other,100% of NY Medicaid HMO DRG,12003,,DRG base rate x DRG weight + capital per discharge,12003,Other,100% of NY Medicaid HMO DRG,27007,,225% x Medicaid HMO amount,27007,Other,225% of NY Medicaid HMO DRG,18365,,153% x Medicaid HMO amount,18365,Other,153% of NY Medicaid HMO DRG,27007,,225% x Medicaid HMO amount,27007,Other,225% of NY Medicaid HMO DRG,16804,,140% x Medicaid HMO amount,16804,Other,140% of NY Medicaid HMO DRG,27007,,DRG base rate x DRG weight + capital per discharge,27007,Other,225% of NY Medicaid HMO DRG,33009,,275% x Medicaid HMO amount,33009,Other,275% of NY Medicaid HMO DRG,38890,,324% x Medicaid HMO amount,38890,Other,324% of NY Medicaid HMO DRG,25807,,215% x Medicaid HMO amount,25807,Other,215% of NY Medicaid HMO DRG,25807,,215% x Medicaid HMO amount,25807,Other,215% of NY Medicaid HMO DRG,15004,,125% x Medicaid HMO amount,15004,Other,125% of NY Medicaid HMO DRG,0.01,50175,
Respiratory malignancy,136-1,APR-DRG,,,,,,,,inpatient,,,140050,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7600,,186% x Medicaid HMO amount,7600,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15724,,"27,634 x DRG Weight",15724,Other,DRG Base Rate x DRG Weight,13365,,"23,488 x DRG Weight",13365,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4086.21,,DRG base rate x DRG weight + capital per discharge,4086.21,Other,100% of NY Medicaid HMO DRG,4086,,DRG base rate x DRG weight + capital per discharge,4086,Other,100% of NY Medicaid HMO DRG,4086,,DRG base rate x DRG weight + capital per discharge,4086,Other,100% of NY Medicaid HMO DRG,4086,,DRG base rate x DRG weight + capital per discharge,4086,Other,100% of NY Medicaid HMO DRG,9194,,225% x Medicaid HMO amount,9194,Other,225% of NY Medicaid HMO DRG,6252,,153% x Medicaid HMO amount,6252,Other,153% of NY Medicaid HMO DRG,9194,,225% x Medicaid HMO amount,9194,Other,225% of NY Medicaid HMO DRG,5721,,140% x Medicaid HMO amount,5721,Other,140% of NY Medicaid HMO DRG,9194,,DRG base rate x DRG weight + capital per discharge,9194,Other,225% of NY Medicaid HMO DRG,11237,,275% x Medicaid HMO amount,11237,Other,275% of NY Medicaid HMO DRG,13239,,324% x Medicaid HMO amount,13239,Other,324% of NY Medicaid HMO DRG,8785,,215% x Medicaid HMO amount,8785,Other,215% of NY Medicaid HMO DRG,8785,,215% x Medicaid HMO amount,8785,Other,215% of NY Medicaid HMO DRG,5108,,125% x Medicaid HMO amount,5108,Other,125% of NY Medicaid HMO DRG,0.01,15724,
Respiratory malignancy,136-2,APR-DRG,,,,,,,,inpatient,,,193028.83,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11556,,186% x Medicaid HMO amount,11556,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24978,,"27,634 x DRG Weight",24978,Other,DRG Base Rate x DRG Weight,21231,,"23,488 x DRG Weight",21231,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6213.21,,DRG base rate x DRG weight + capital per discharge,6213.21,Other,100% of NY Medicaid HMO DRG,6213,,DRG base rate x DRG weight + capital per discharge,6213,Other,100% of NY Medicaid HMO DRG,6213,,DRG base rate x DRG weight + capital per discharge,6213,Other,100% of NY Medicaid HMO DRG,6213,,DRG base rate x DRG weight + capital per discharge,6213,Other,100% of NY Medicaid HMO DRG,13980,,225% x Medicaid HMO amount,13980,Other,225% of NY Medicaid HMO DRG,9506,,153% x Medicaid HMO amount,9506,Other,153% of NY Medicaid HMO DRG,13980,,225% x Medicaid HMO amount,13980,Other,225% of NY Medicaid HMO DRG,8698,,140% x Medicaid HMO amount,8698,Other,140% of NY Medicaid HMO DRG,13980,,DRG base rate x DRG weight + capital per discharge,13980,Other,225% of NY Medicaid HMO DRG,17086,,275% x Medicaid HMO amount,17086,Other,275% of NY Medicaid HMO DRG,20131,,324% x Medicaid HMO amount,20131,Other,324% of NY Medicaid HMO DRG,13358,,215% x Medicaid HMO amount,13358,Other,215% of NY Medicaid HMO DRG,13358,,215% x Medicaid HMO amount,13358,Other,215% of NY Medicaid HMO DRG,7767,,125% x Medicaid HMO amount,7767,Other,125% of NY Medicaid HMO DRG,0.01,24978,
Respiratory malignancy,136-3,APR-DRG,,,,,,,,inpatient,,,278808.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19301,,186% x Medicaid HMO amount,19301,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43101,,"27,634 x DRG Weight",43101,Other,DRG Base Rate x DRG Weight,36634,,"23,488 x DRG Weight",36634,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10377.21,,DRG base rate x DRG weight + capital per discharge,10377.21,Other,100% of NY Medicaid HMO DRG,10377,,DRG base rate x DRG weight + capital per discharge,10377,Other,100% of NY Medicaid HMO DRG,10377,,DRG base rate x DRG weight + capital per discharge,10377,Other,100% of NY Medicaid HMO DRG,10377,,DRG base rate x DRG weight + capital per discharge,10377,Other,100% of NY Medicaid HMO DRG,23349,,225% x Medicaid HMO amount,23349,Other,225% of NY Medicaid HMO DRG,15877,,153% x Medicaid HMO amount,15877,Other,153% of NY Medicaid HMO DRG,23349,,225% x Medicaid HMO amount,23349,Other,225% of NY Medicaid HMO DRG,14528,,140% x Medicaid HMO amount,14528,Other,140% of NY Medicaid HMO DRG,23349,,DRG base rate x DRG weight + capital per discharge,23349,Other,225% of NY Medicaid HMO DRG,28537,,275% x Medicaid HMO amount,28537,Other,275% of NY Medicaid HMO DRG,33622,,324% x Medicaid HMO amount,33622,Other,324% of NY Medicaid HMO DRG,22311,,215% x Medicaid HMO amount,22311,Other,215% of NY Medicaid HMO DRG,22311,,215% x Medicaid HMO amount,22311,Other,215% of NY Medicaid HMO DRG,12972,,125% x Medicaid HMO amount,12972,Other,125% of NY Medicaid HMO DRG,0.01,43101,
Respiratory malignancy,136-4,APR-DRG,,,,,,,,inpatient,,,278808.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27969,,186% x Medicaid HMO amount,27969,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63381,,"27,634 x DRG Weight",63381,Other,DRG Base Rate x DRG Weight,53872,,"23,488 x DRG Weight",53872,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15037.21,,DRG base rate x DRG weight + capital per discharge,15037.21,Other,100% of NY Medicaid HMO DRG,15037,,DRG base rate x DRG weight + capital per discharge,15037,Other,100% of NY Medicaid HMO DRG,15037,,DRG base rate x DRG weight + capital per discharge,15037,Other,100% of NY Medicaid HMO DRG,15037,,DRG base rate x DRG weight + capital per discharge,15037,Other,100% of NY Medicaid HMO DRG,33834,,225% x Medicaid HMO amount,33834,Other,225% of NY Medicaid HMO DRG,23007,,153% x Medicaid HMO amount,23007,Other,153% of NY Medicaid HMO DRG,33834,,225% x Medicaid HMO amount,33834,Other,225% of NY Medicaid HMO DRG,21052,,140% x Medicaid HMO amount,21052,Other,140% of NY Medicaid HMO DRG,33834,,DRG base rate x DRG weight + capital per discharge,33834,Other,225% of NY Medicaid HMO DRG,41352,,275% x Medicaid HMO amount,41352,Other,275% of NY Medicaid HMO DRG,48721,,324% x Medicaid HMO amount,48721,Other,324% of NY Medicaid HMO DRG,32330,,215% x Medicaid HMO amount,32330,Other,215% of NY Medicaid HMO DRG,32330,,215% x Medicaid HMO amount,32330,Other,215% of NY Medicaid HMO DRG,18797,,125% x Medicaid HMO amount,18797,Other,125% of NY Medicaid HMO DRG,0.01,63381,
Major respiratory infections & inflammations,137-1,APR-DRG,,,,,,,,inpatient,,,58081,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9097,,186% x Medicaid HMO amount,9097,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19228,,"27,634 x DRG Weight",19228,Other,DRG Base Rate x DRG Weight,16343,,"23,488 x DRG Weight",16343,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4891.21,,DRG base rate x DRG weight + capital per discharge,4891.21,Other,100% of NY Medicaid HMO DRG,4891,,DRG base rate x DRG weight + capital per discharge,4891,Other,100% of NY Medicaid HMO DRG,4891,,DRG base rate x DRG weight + capital per discharge,4891,Other,100% of NY Medicaid HMO DRG,4891,,DRG base rate x DRG weight + capital per discharge,4891,Other,100% of NY Medicaid HMO DRG,11005,,225% x Medicaid HMO amount,11005,Other,225% of NY Medicaid HMO DRG,7484,,153% x Medicaid HMO amount,7484,Other,153% of NY Medicaid HMO DRG,11005,,225% x Medicaid HMO amount,11005,Other,225% of NY Medicaid HMO DRG,6848,,140% x Medicaid HMO amount,6848,Other,140% of NY Medicaid HMO DRG,11005,,DRG base rate x DRG weight + capital per discharge,11005,Other,225% of NY Medicaid HMO DRG,13451,,275% x Medicaid HMO amount,13451,Other,275% of NY Medicaid HMO DRG,15848,,324% x Medicaid HMO amount,15848,Other,324% of NY Medicaid HMO DRG,10516,,215% x Medicaid HMO amount,10516,Other,215% of NY Medicaid HMO DRG,10516,,215% x Medicaid HMO amount,10516,Other,215% of NY Medicaid HMO DRG,6114,,125% x Medicaid HMO amount,6114,Other,125% of NY Medicaid HMO DRG,0.01,19228,
Major respiratory infections & inflammations,137-2,APR-DRG,,,,,,,,inpatient,,,97455.91,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13053,,186% x Medicaid HMO amount,13053,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28485,,"27,634 x DRG Weight",28485,Other,DRG Base Rate x DRG Weight,24211,,"23,488 x DRG Weight",24211,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7018.21,,DRG base rate x DRG weight + capital per discharge,7018.21,Other,100% of NY Medicaid HMO DRG,7018,,DRG base rate x DRG weight + capital per discharge,7018,Other,100% of NY Medicaid HMO DRG,7018,,DRG base rate x DRG weight + capital per discharge,7018,Other,100% of NY Medicaid HMO DRG,7018,,DRG base rate x DRG weight + capital per discharge,7018,Other,100% of NY Medicaid HMO DRG,15791,,225% x Medicaid HMO amount,15791,Other,225% of NY Medicaid HMO DRG,10738,,153% x Medicaid HMO amount,10738,Other,153% of NY Medicaid HMO DRG,15791,,225% x Medicaid HMO amount,15791,Other,225% of NY Medicaid HMO DRG,9825,,140% x Medicaid HMO amount,9825,Other,140% of NY Medicaid HMO DRG,15791,,DRG base rate x DRG weight + capital per discharge,15791,Other,225% of NY Medicaid HMO DRG,19300,,275% x Medicaid HMO amount,19300,Other,275% of NY Medicaid HMO DRG,22739,,324% x Medicaid HMO amount,22739,Other,324% of NY Medicaid HMO DRG,15089,,215% x Medicaid HMO amount,15089,Other,215% of NY Medicaid HMO DRG,15089,,215% x Medicaid HMO amount,15089,Other,215% of NY Medicaid HMO DRG,8773,,125% x Medicaid HMO amount,8773,Other,125% of NY Medicaid HMO DRG,0.01,28485,
Major respiratory infections & inflammations,137-3,APR-DRG,,,,,,,,inpatient,,,138466.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20685,,186% x Medicaid HMO amount,20685,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46337,,"27,634 x DRG Weight",46337,Other,DRG Base Rate x DRG Weight,39385,,"23,488 x DRG Weight",39385,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11121.21,,DRG base rate x DRG weight + capital per discharge,11121.21,Other,100% of NY Medicaid HMO DRG,11121,,DRG base rate x DRG weight + capital per discharge,11121,Other,100% of NY Medicaid HMO DRG,11121,,DRG base rate x DRG weight + capital per discharge,11121,Other,100% of NY Medicaid HMO DRG,11121,,DRG base rate x DRG weight + capital per discharge,11121,Other,100% of NY Medicaid HMO DRG,25023,,225% x Medicaid HMO amount,25023,Other,225% of NY Medicaid HMO DRG,17015,,153% x Medicaid HMO amount,17015,Other,153% of NY Medicaid HMO DRG,25023,,225% x Medicaid HMO amount,25023,Other,225% of NY Medicaid HMO DRG,15570,,140% x Medicaid HMO amount,15570,Other,140% of NY Medicaid HMO DRG,25023,,DRG base rate x DRG weight + capital per discharge,25023,Other,225% of NY Medicaid HMO DRG,30583,,275% x Medicaid HMO amount,30583,Other,275% of NY Medicaid HMO DRG,36033,,324% x Medicaid HMO amount,36033,Other,324% of NY Medicaid HMO DRG,23911,,215% x Medicaid HMO amount,23911,Other,215% of NY Medicaid HMO DRG,23911,,215% x Medicaid HMO amount,23911,Other,215% of NY Medicaid HMO DRG,13902,,125% x Medicaid HMO amount,13902,Other,125% of NY Medicaid HMO DRG,0.01,46337,
Major respiratory infections & inflammations,137-4,APR-DRG,,,,,,,,inpatient,,,439858.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31732,,186% x Medicaid HMO amount,31732,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72183,,"27,634 x DRG Weight",72183,Other,DRG Base Rate x DRG Weight,61353,,"23,488 x DRG Weight",61353,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17060.21,,DRG base rate x DRG weight + capital per discharge,17060.21,Other,100% of NY Medicaid HMO DRG,17060,,DRG base rate x DRG weight + capital per discharge,17060,Other,100% of NY Medicaid HMO DRG,17060,,DRG base rate x DRG weight + capital per discharge,17060,Other,100% of NY Medicaid HMO DRG,17060,,DRG base rate x DRG weight + capital per discharge,17060,Other,100% of NY Medicaid HMO DRG,38385,,225% x Medicaid HMO amount,38385,Other,225% of NY Medicaid HMO DRG,26102,,153% x Medicaid HMO amount,26102,Other,153% of NY Medicaid HMO DRG,38385,,225% x Medicaid HMO amount,38385,Other,225% of NY Medicaid HMO DRG,23884,,140% x Medicaid HMO amount,23884,Other,140% of NY Medicaid HMO DRG,38385,,DRG base rate x DRG weight + capital per discharge,38385,Other,225% of NY Medicaid HMO DRG,46916,,275% x Medicaid HMO amount,46916,Other,275% of NY Medicaid HMO DRG,55275,,324% x Medicaid HMO amount,55275,Other,324% of NY Medicaid HMO DRG,36679,,215% x Medicaid HMO amount,36679,Other,215% of NY Medicaid HMO DRG,36679,,215% x Medicaid HMO amount,36679,Other,215% of NY Medicaid HMO DRG,21325,,125% x Medicaid HMO amount,21325,Other,125% of NY Medicaid HMO DRG,0.01,72183,
Bronchiolitis & RSV pneumonia,138-1,APR-DRG,,,,,,,,inpatient,,,49164.88,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6640,,186% x Medicaid HMO amount,6640,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13477,,"27,634 x DRG Weight",13477,Other,DRG Base Rate x DRG Weight,11455,,"23,488 x DRG Weight",11455,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3570.21,,DRG base rate x DRG weight + capital per discharge,3570.21,Other,100% of NY Medicaid HMO DRG,3570,,DRG base rate x DRG weight + capital per discharge,3570,Other,100% of NY Medicaid HMO DRG,3570,,DRG base rate x DRG weight + capital per discharge,3570,Other,100% of NY Medicaid HMO DRG,3570,,DRG base rate x DRG weight + capital per discharge,3570,Other,100% of NY Medicaid HMO DRG,8033,,225% x Medicaid HMO amount,8033,Other,225% of NY Medicaid HMO DRG,5462,,153% x Medicaid HMO amount,5462,Other,153% of NY Medicaid HMO DRG,8033,,225% x Medicaid HMO amount,8033,Other,225% of NY Medicaid HMO DRG,4998,,140% x Medicaid HMO amount,4998,Other,140% of NY Medicaid HMO DRG,8033,,DRG base rate x DRG weight + capital per discharge,8033,Other,225% of NY Medicaid HMO DRG,9818,,275% x Medicaid HMO amount,9818,Other,275% of NY Medicaid HMO DRG,11567,,324% x Medicaid HMO amount,11567,Other,324% of NY Medicaid HMO DRG,7676,,215% x Medicaid HMO amount,7676,Other,215% of NY Medicaid HMO DRG,7676,,215% x Medicaid HMO amount,7676,Other,215% of NY Medicaid HMO DRG,4463,,125% x Medicaid HMO amount,4463,Other,125% of NY Medicaid HMO DRG,0.01,13477,
Bronchiolitis & RSV pneumonia,138-2,APR-DRG,,,,,,,,inpatient,,,75374.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8324,,186% x Medicaid HMO amount,8324,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17418,,"27,634 x DRG Weight",17418,Other,DRG Base Rate x DRG Weight,14804,,"23,488 x DRG Weight",14804,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4475.21,,DRG base rate x DRG weight + capital per discharge,4475.21,Other,100% of NY Medicaid HMO DRG,4475,,DRG base rate x DRG weight + capital per discharge,4475,Other,100% of NY Medicaid HMO DRG,4475,,DRG base rate x DRG weight + capital per discharge,4475,Other,100% of NY Medicaid HMO DRG,4475,,DRG base rate x DRG weight + capital per discharge,4475,Other,100% of NY Medicaid HMO DRG,10069,,225% x Medicaid HMO amount,10069,Other,225% of NY Medicaid HMO DRG,6847,,153% x Medicaid HMO amount,6847,Other,153% of NY Medicaid HMO DRG,10069,,225% x Medicaid HMO amount,10069,Other,225% of NY Medicaid HMO DRG,6265,,140% x Medicaid HMO amount,6265,Other,140% of NY Medicaid HMO DRG,10069,,DRG base rate x DRG weight + capital per discharge,10069,Other,225% of NY Medicaid HMO DRG,12307,,275% x Medicaid HMO amount,12307,Other,275% of NY Medicaid HMO DRG,14500,,324% x Medicaid HMO amount,14500,Other,324% of NY Medicaid HMO DRG,9622,,215% x Medicaid HMO amount,9622,Other,215% of NY Medicaid HMO DRG,9622,,215% x Medicaid HMO amount,9622,Other,215% of NY Medicaid HMO DRG,5594,,125% x Medicaid HMO amount,5594,Other,125% of NY Medicaid HMO DRG,0.01,17418,
Bronchiolitis & RSV pneumonia,138-3,APR-DRG,,,,,,,,inpatient,,,121433.97,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16999,,186% x Medicaid HMO amount,16999,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37715,,"27,634 x DRG Weight",37715,Other,DRG Base Rate x DRG Weight,32056,,"23,488 x DRG Weight",32056,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9139.21,,DRG base rate x DRG weight + capital per discharge,9139.21,Other,100% of NY Medicaid HMO DRG,9139,,DRG base rate x DRG weight + capital per discharge,9139,Other,100% of NY Medicaid HMO DRG,9139,,DRG base rate x DRG weight + capital per discharge,9139,Other,100% of NY Medicaid HMO DRG,9139,,DRG base rate x DRG weight + capital per discharge,9139,Other,100% of NY Medicaid HMO DRG,20563,,225% x Medicaid HMO amount,20563,Other,225% of NY Medicaid HMO DRG,13983,,153% x Medicaid HMO amount,13983,Other,153% of NY Medicaid HMO DRG,20563,,225% x Medicaid HMO amount,20563,Other,225% of NY Medicaid HMO DRG,12795,,140% x Medicaid HMO amount,12795,Other,140% of NY Medicaid HMO DRG,20563,,DRG base rate x DRG weight + capital per discharge,20563,Other,225% of NY Medicaid HMO DRG,25133,,275% x Medicaid HMO amount,25133,Other,275% of NY Medicaid HMO DRG,29611,,324% x Medicaid HMO amount,29611,Other,324% of NY Medicaid HMO DRG,19649,,215% x Medicaid HMO amount,19649,Other,215% of NY Medicaid HMO DRG,19649,,215% x Medicaid HMO amount,19649,Other,215% of NY Medicaid HMO DRG,11424,,125% x Medicaid HMO amount,11424,Other,125% of NY Medicaid HMO DRG,0.01,37715,
Bronchiolitis & RSV pneumonia,138-4,APR-DRG,,,,,,,,inpatient,,,114746.81,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36592,,186% x Medicaid HMO amount,36592,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,83557,,"27,634 x DRG Weight",83557,Other,DRG Base Rate x DRG Weight,71021,,"23,488 x DRG Weight",71021,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19673.21,,DRG base rate x DRG weight + capital per discharge,19673.21,Other,100% of NY Medicaid HMO DRG,19673,,DRG base rate x DRG weight + capital per discharge,19673,Other,100% of NY Medicaid HMO DRG,19673,,DRG base rate x DRG weight + capital per discharge,19673,Other,100% of NY Medicaid HMO DRG,19673,,DRG base rate x DRG weight + capital per discharge,19673,Other,100% of NY Medicaid HMO DRG,44265,,225% x Medicaid HMO amount,44265,Other,225% of NY Medicaid HMO DRG,30100,,153% x Medicaid HMO amount,30100,Other,153% of NY Medicaid HMO DRG,44265,,225% x Medicaid HMO amount,44265,Other,225% of NY Medicaid HMO DRG,27542,,140% x Medicaid HMO amount,27542,Other,140% of NY Medicaid HMO DRG,44265,,DRG base rate x DRG weight + capital per discharge,44265,Other,225% of NY Medicaid HMO DRG,54101,,275% x Medicaid HMO amount,54101,Other,275% of NY Medicaid HMO DRG,63741,,324% x Medicaid HMO amount,63741,Other,324% of NY Medicaid HMO DRG,42297,,215% x Medicaid HMO amount,42297,Other,215% of NY Medicaid HMO DRG,42297,,215% x Medicaid HMO amount,42297,Other,215% of NY Medicaid HMO DRG,24592,,125% x Medicaid HMO amount,24592,Other,125% of NY Medicaid HMO DRG,0.01,83557,
Other pneumonia,139-1,APR-DRG,,,,,,,,inpatient,,,65208.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6947,,186% x Medicaid HMO amount,6947,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14196,,"27,634 x DRG Weight",14196,Other,DRG Base Rate x DRG Weight,12066,,"23,488 x DRG Weight",12066,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3735.21,,DRG base rate x DRG weight + capital per discharge,3735.21,Other,100% of NY Medicaid HMO DRG,3735,,DRG base rate x DRG weight + capital per discharge,3735,Other,100% of NY Medicaid HMO DRG,3735,,DRG base rate x DRG weight + capital per discharge,3735,Other,100% of NY Medicaid HMO DRG,3735,,DRG base rate x DRG weight + capital per discharge,3735,Other,100% of NY Medicaid HMO DRG,8404,,225% x Medicaid HMO amount,8404,Other,225% of NY Medicaid HMO DRG,5715,,153% x Medicaid HMO amount,5715,Other,153% of NY Medicaid HMO DRG,8404,,225% x Medicaid HMO amount,8404,Other,225% of NY Medicaid HMO DRG,5229,,140% x Medicaid HMO amount,5229,Other,140% of NY Medicaid HMO DRG,8404,,DRG base rate x DRG weight + capital per discharge,8404,Other,225% of NY Medicaid HMO DRG,10272,,275% x Medicaid HMO amount,10272,Other,275% of NY Medicaid HMO DRG,12102,,324% x Medicaid HMO amount,12102,Other,324% of NY Medicaid HMO DRG,8031,,215% x Medicaid HMO amount,8031,Other,215% of NY Medicaid HMO DRG,8031,,215% x Medicaid HMO amount,8031,Other,215% of NY Medicaid HMO DRG,4669,,125% x Medicaid HMO amount,4669,Other,125% of NY Medicaid HMO DRG,0.01,14196,
Other pneumonia,139-2,APR-DRG,,,,,,,,inpatient,,,78521.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8891,,186% x Medicaid HMO amount,8891,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18744,,"27,634 x DRG Weight",18744,Other,DRG Base Rate x DRG Weight,15932,,"23,488 x DRG Weight",15932,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4780.21,,DRG base rate x DRG weight + capital per discharge,4780.21,Other,100% of NY Medicaid HMO DRG,4780,,DRG base rate x DRG weight + capital per discharge,4780,Other,100% of NY Medicaid HMO DRG,4780,,DRG base rate x DRG weight + capital per discharge,4780,Other,100% of NY Medicaid HMO DRG,4780,,DRG base rate x DRG weight + capital per discharge,4780,Other,100% of NY Medicaid HMO DRG,10755,,225% x Medicaid HMO amount,10755,Other,225% of NY Medicaid HMO DRG,7314,,153% x Medicaid HMO amount,7314,Other,153% of NY Medicaid HMO DRG,10755,,225% x Medicaid HMO amount,10755,Other,225% of NY Medicaid HMO DRG,6692,,140% x Medicaid HMO amount,6692,Other,140% of NY Medicaid HMO DRG,10755,,DRG base rate x DRG weight + capital per discharge,10755,Other,225% of NY Medicaid HMO DRG,13146,,275% x Medicaid HMO amount,13146,Other,275% of NY Medicaid HMO DRG,15488,,324% x Medicaid HMO amount,15488,Other,324% of NY Medicaid HMO DRG,10277,,215% x Medicaid HMO amount,10277,Other,215% of NY Medicaid HMO DRG,10277,,215% x Medicaid HMO amount,10277,Other,215% of NY Medicaid HMO DRG,5975,,125% x Medicaid HMO amount,5975,Other,125% of NY Medicaid HMO DRG,0.01,18744,
Other pneumonia,139-3,APR-DRG,,,,,,,,inpatient,,,157119.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14322,,186% x Medicaid HMO amount,14322,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31450,,"27,634 x DRG Weight",31450,Other,DRG Base Rate x DRG Weight,26732,,"23,488 x DRG Weight",26732,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7700.21,,DRG base rate x DRG weight + capital per discharge,7700.21,Other,100% of NY Medicaid HMO DRG,7700,,DRG base rate x DRG weight + capital per discharge,7700,Other,100% of NY Medicaid HMO DRG,7700,,DRG base rate x DRG weight + capital per discharge,7700,Other,100% of NY Medicaid HMO DRG,7700,,DRG base rate x DRG weight + capital per discharge,7700,Other,100% of NY Medicaid HMO DRG,17325,,225% x Medicaid HMO amount,17325,Other,225% of NY Medicaid HMO DRG,11781,,153% x Medicaid HMO amount,11781,Other,153% of NY Medicaid HMO DRG,17325,,225% x Medicaid HMO amount,17325,Other,225% of NY Medicaid HMO DRG,10780,,140% x Medicaid HMO amount,10780,Other,140% of NY Medicaid HMO DRG,17325,,DRG base rate x DRG weight + capital per discharge,17325,Other,225% of NY Medicaid HMO DRG,21176,,275% x Medicaid HMO amount,21176,Other,275% of NY Medicaid HMO DRG,24949,,324% x Medicaid HMO amount,24949,Other,324% of NY Medicaid HMO DRG,16555,,215% x Medicaid HMO amount,16555,Other,215% of NY Medicaid HMO DRG,16555,,215% x Medicaid HMO amount,16555,Other,215% of NY Medicaid HMO DRG,9625,,125% x Medicaid HMO amount,9625,Other,125% of NY Medicaid HMO DRG,0.01,31450,
Other pneumonia,139-4,APR-DRG,,,,,,,,inpatient,,,257249.45,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26507,,186% x Medicaid HMO amount,26507,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59960,,"27,634 x DRG Weight",59960,Other,DRG Base Rate x DRG Weight,50964,,"23,488 x DRG Weight",50964,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14251.21,,DRG base rate x DRG weight + capital per discharge,14251.21,Other,100% of NY Medicaid HMO DRG,14251,,DRG base rate x DRG weight + capital per discharge,14251,Other,100% of NY Medicaid HMO DRG,14251,,DRG base rate x DRG weight + capital per discharge,14251,Other,100% of NY Medicaid HMO DRG,14251,,DRG base rate x DRG weight + capital per discharge,14251,Other,100% of NY Medicaid HMO DRG,32065,,225% x Medicaid HMO amount,32065,Other,225% of NY Medicaid HMO DRG,21804,,153% x Medicaid HMO amount,21804,Other,153% of NY Medicaid HMO DRG,32065,,225% x Medicaid HMO amount,32065,Other,225% of NY Medicaid HMO DRG,19952,,140% x Medicaid HMO amount,19952,Other,140% of NY Medicaid HMO DRG,32065,,DRG base rate x DRG weight + capital per discharge,32065,Other,225% of NY Medicaid HMO DRG,39191,,275% x Medicaid HMO amount,39191,Other,275% of NY Medicaid HMO DRG,46174,,324% x Medicaid HMO amount,46174,Other,324% of NY Medicaid HMO DRG,30640,,215% x Medicaid HMO amount,30640,Other,215% of NY Medicaid HMO DRG,30640,,215% x Medicaid HMO amount,30640,Other,215% of NY Medicaid HMO DRG,17814,,125% x Medicaid HMO amount,17814,Other,125% of NY Medicaid HMO DRG,0.01,59960,
Chronic obstructive pulmonary disease,140-1,APR-DRG,,,,,,,,inpatient,,,70974.51,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7673,,186% x Medicaid HMO amount,7673,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15892,,"27,634 x DRG Weight",15892,Other,DRG Base Rate x DRG Weight,13508,,"23,488 x DRG Weight",13508,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4125.21,,DRG base rate x DRG weight + capital per discharge,4125.21,Other,100% of NY Medicaid HMO DRG,4125,,DRG base rate x DRG weight + capital per discharge,4125,Other,100% of NY Medicaid HMO DRG,4125,,DRG base rate x DRG weight + capital per discharge,4125,Other,100% of NY Medicaid HMO DRG,4125,,DRG base rate x DRG weight + capital per discharge,4125,Other,100% of NY Medicaid HMO DRG,9282,,225% x Medicaid HMO amount,9282,Other,225% of NY Medicaid HMO DRG,6312,,153% x Medicaid HMO amount,6312,Other,153% of NY Medicaid HMO DRG,9282,,225% x Medicaid HMO amount,9282,Other,225% of NY Medicaid HMO DRG,5775,,140% x Medicaid HMO amount,5775,Other,140% of NY Medicaid HMO DRG,9282,,DRG base rate x DRG weight + capital per discharge,9282,Other,225% of NY Medicaid HMO DRG,11344,,275% x Medicaid HMO amount,11344,Other,275% of NY Medicaid HMO DRG,13366,,324% x Medicaid HMO amount,13366,Other,324% of NY Medicaid HMO DRG,8869,,215% x Medicaid HMO amount,8869,Other,215% of NY Medicaid HMO DRG,8869,,215% x Medicaid HMO amount,8869,Other,215% of NY Medicaid HMO DRG,5157,,125% x Medicaid HMO amount,5157,Other,125% of NY Medicaid HMO DRG,0.01,15892,
Chronic obstructive pulmonary disease,140-2,APR-DRG,,,,,,,,inpatient,,,80328.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9408,,186% x Medicaid HMO amount,9408,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19952,,"27,634 x DRG Weight",19952,Other,DRG Base Rate x DRG Weight,16958,,"23,488 x DRG Weight",16958,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5058.21,,DRG base rate x DRG weight + capital per discharge,5058.21,Other,100% of NY Medicaid HMO DRG,5058,,DRG base rate x DRG weight + capital per discharge,5058,Other,100% of NY Medicaid HMO DRG,5058,,DRG base rate x DRG weight + capital per discharge,5058,Other,100% of NY Medicaid HMO DRG,5058,,DRG base rate x DRG weight + capital per discharge,5058,Other,100% of NY Medicaid HMO DRG,11381,,225% x Medicaid HMO amount,11381,Other,225% of NY Medicaid HMO DRG,7739,,153% x Medicaid HMO amount,7739,Other,153% of NY Medicaid HMO DRG,11381,,225% x Medicaid HMO amount,11381,Other,225% of NY Medicaid HMO DRG,7081,,140% x Medicaid HMO amount,7081,Other,140% of NY Medicaid HMO DRG,11381,,DRG base rate x DRG weight + capital per discharge,11381,Other,225% of NY Medicaid HMO DRG,13910,,275% x Medicaid HMO amount,13910,Other,275% of NY Medicaid HMO DRG,16389,,324% x Medicaid HMO amount,16389,Other,324% of NY Medicaid HMO DRG,10875,,215% x Medicaid HMO amount,10875,Other,215% of NY Medicaid HMO DRG,10875,,215% x Medicaid HMO amount,10875,Other,215% of NY Medicaid HMO DRG,6323,,125% x Medicaid HMO amount,6323,Other,125% of NY Medicaid HMO DRG,0.01,19952,
Chronic obstructive pulmonary disease,140-3,APR-DRG,,,,,,,,inpatient,,,105230.1,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12836,,186% x Medicaid HMO amount,12836,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27974,,"27,634 x DRG Weight",27974,Other,DRG Base Rate x DRG Weight,23777,,"23,488 x DRG Weight",23777,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6901.21,,DRG base rate x DRG weight + capital per discharge,6901.21,Other,100% of NY Medicaid HMO DRG,6901,,DRG base rate x DRG weight + capital per discharge,6901,Other,100% of NY Medicaid HMO DRG,6901,,DRG base rate x DRG weight + capital per discharge,6901,Other,100% of NY Medicaid HMO DRG,6901,,DRG base rate x DRG weight + capital per discharge,6901,Other,100% of NY Medicaid HMO DRG,15528,,225% x Medicaid HMO amount,15528,Other,225% of NY Medicaid HMO DRG,10559,,153% x Medicaid HMO amount,10559,Other,153% of NY Medicaid HMO DRG,15528,,225% x Medicaid HMO amount,15528,Other,225% of NY Medicaid HMO DRG,9662,,140% x Medicaid HMO amount,9662,Other,140% of NY Medicaid HMO DRG,15528,,DRG base rate x DRG weight + capital per discharge,15528,Other,225% of NY Medicaid HMO DRG,18978,,275% x Medicaid HMO amount,18978,Other,275% of NY Medicaid HMO DRG,22360,,324% x Medicaid HMO amount,22360,Other,324% of NY Medicaid HMO DRG,14838,,215% x Medicaid HMO amount,14838,Other,215% of NY Medicaid HMO DRG,14838,,215% x Medicaid HMO amount,14838,Other,215% of NY Medicaid HMO DRG,8627,,125% x Medicaid HMO amount,8627,Other,125% of NY Medicaid HMO DRG,0.01,27974,
Chronic obstructive pulmonary disease,140-4,APR-DRG,,,,,,,,inpatient,,,212102.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24152,,186% x Medicaid HMO amount,24152,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54450,,"27,634 x DRG Weight",54450,Other,DRG Base Rate x DRG Weight,46281,,"23,488 x DRG Weight",46281,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12985.21,,DRG base rate x DRG weight + capital per discharge,12985.21,Other,100% of NY Medicaid HMO DRG,12985,,DRG base rate x DRG weight + capital per discharge,12985,Other,100% of NY Medicaid HMO DRG,12985,,DRG base rate x DRG weight + capital per discharge,12985,Other,100% of NY Medicaid HMO DRG,12985,,DRG base rate x DRG weight + capital per discharge,12985,Other,100% of NY Medicaid HMO DRG,29217,,225% x Medicaid HMO amount,29217,Other,225% of NY Medicaid HMO DRG,19867,,153% x Medicaid HMO amount,19867,Other,153% of NY Medicaid HMO DRG,29217,,225% x Medicaid HMO amount,29217,Other,225% of NY Medicaid HMO DRG,18179,,140% x Medicaid HMO amount,18179,Other,140% of NY Medicaid HMO DRG,29217,,DRG base rate x DRG weight + capital per discharge,29217,Other,225% of NY Medicaid HMO DRG,35709,,275% x Medicaid HMO amount,35709,Other,275% of NY Medicaid HMO DRG,42072,,324% x Medicaid HMO amount,42072,Other,324% of NY Medicaid HMO DRG,27918,,215% x Medicaid HMO amount,27918,Other,215% of NY Medicaid HMO DRG,27918,,215% x Medicaid HMO amount,27918,Other,215% of NY Medicaid HMO DRG,16232,,125% x Medicaid HMO amount,16232,Other,125% of NY Medicaid HMO DRG,0.01,54450,
Asthma,141-1,APR-DRG,,,,,,,,inpatient,,,60338.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6473,,186% x Medicaid HMO amount,6473,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13087,,"27,634 x DRG Weight",13087,Other,DRG Base Rate x DRG Weight,11124,,"23,488 x DRG Weight",11124,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3480.21,,DRG base rate x DRG weight + capital per discharge,3480.21,Other,100% of NY Medicaid HMO DRG,3480,,DRG base rate x DRG weight + capital per discharge,3480,Other,100% of NY Medicaid HMO DRG,3480,,DRG base rate x DRG weight + capital per discharge,3480,Other,100% of NY Medicaid HMO DRG,3480,,DRG base rate x DRG weight + capital per discharge,3480,Other,100% of NY Medicaid HMO DRG,7830,,225% x Medicaid HMO amount,7830,Other,225% of NY Medicaid HMO DRG,5325,,153% x Medicaid HMO amount,5325,Other,153% of NY Medicaid HMO DRG,7830,,225% x Medicaid HMO amount,7830,Other,225% of NY Medicaid HMO DRG,4872,,140% x Medicaid HMO amount,4872,Other,140% of NY Medicaid HMO DRG,7830,,DRG base rate x DRG weight + capital per discharge,7830,Other,225% of NY Medicaid HMO DRG,9571,,275% x Medicaid HMO amount,9571,Other,275% of NY Medicaid HMO DRG,11276,,324% x Medicaid HMO amount,11276,Other,324% of NY Medicaid HMO DRG,7482,,215% x Medicaid HMO amount,7482,Other,215% of NY Medicaid HMO DRG,7482,,215% x Medicaid HMO amount,7482,Other,215% of NY Medicaid HMO DRG,4350,,125% x Medicaid HMO amount,4350,Other,125% of NY Medicaid HMO DRG,0.01,13087,
Asthma,141-2,APR-DRG,,,,,,,,inpatient,,,70052.89,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8171,,186% x Medicaid HMO amount,8171,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17058,,"27,634 x DRG Weight",17058,Other,DRG Base Rate x DRG Weight,14499,,"23,488 x DRG Weight",14499,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4393.21,,DRG base rate x DRG weight + capital per discharge,4393.21,Other,100% of NY Medicaid HMO DRG,4393,,DRG base rate x DRG weight + capital per discharge,4393,Other,100% of NY Medicaid HMO DRG,4393,,DRG base rate x DRG weight + capital per discharge,4393,Other,100% of NY Medicaid HMO DRG,4393,,DRG base rate x DRG weight + capital per discharge,4393,Other,100% of NY Medicaid HMO DRG,9885,,225% x Medicaid HMO amount,9885,Other,225% of NY Medicaid HMO DRG,6722,,153% x Medicaid HMO amount,6722,Other,153% of NY Medicaid HMO DRG,9885,,225% x Medicaid HMO amount,9885,Other,225% of NY Medicaid HMO DRG,6150,,140% x Medicaid HMO amount,6150,Other,140% of NY Medicaid HMO DRG,9885,,DRG base rate x DRG weight + capital per discharge,9885,Other,225% of NY Medicaid HMO DRG,12081,,275% x Medicaid HMO amount,12081,Other,275% of NY Medicaid HMO DRG,14234,,324% x Medicaid HMO amount,14234,Other,324% of NY Medicaid HMO DRG,9445,,215% x Medicaid HMO amount,9445,Other,215% of NY Medicaid HMO DRG,9445,,215% x Medicaid HMO amount,9445,Other,215% of NY Medicaid HMO DRG,5492,,125% x Medicaid HMO amount,5492,Other,125% of NY Medicaid HMO DRG,0.01,17058,
Asthma,141-3,APR-DRG,,,,,,,,inpatient,,,92648.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11954,,186% x Medicaid HMO amount,11954,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25912,,"27,634 x DRG Weight",25912,Other,DRG Base Rate x DRG Weight,22025,,"23,488 x DRG Weight",22025,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6427.21,,DRG base rate x DRG weight + capital per discharge,6427.21,Other,100% of NY Medicaid HMO DRG,6427,,DRG base rate x DRG weight + capital per discharge,6427,Other,100% of NY Medicaid HMO DRG,6427,,DRG base rate x DRG weight + capital per discharge,6427,Other,100% of NY Medicaid HMO DRG,6427,,DRG base rate x DRG weight + capital per discharge,6427,Other,100% of NY Medicaid HMO DRG,14461,,225% x Medicaid HMO amount,14461,Other,225% of NY Medicaid HMO DRG,9834,,153% x Medicaid HMO amount,9834,Other,153% of NY Medicaid HMO DRG,14461,,225% x Medicaid HMO amount,14461,Other,225% of NY Medicaid HMO DRG,8998,,140% x Medicaid HMO amount,8998,Other,140% of NY Medicaid HMO DRG,14461,,DRG base rate x DRG weight + capital per discharge,14461,Other,225% of NY Medicaid HMO DRG,17675,,275% x Medicaid HMO amount,17675,Other,275% of NY Medicaid HMO DRG,20824,,324% x Medicaid HMO amount,20824,Other,324% of NY Medicaid HMO DRG,13819,,215% x Medicaid HMO amount,13819,Other,215% of NY Medicaid HMO DRG,13819,,215% x Medicaid HMO amount,13819,Other,215% of NY Medicaid HMO DRG,8034,,125% x Medicaid HMO amount,8034,Other,125% of NY Medicaid HMO DRG,0.01,25912,
Asthma,141-4,APR-DRG,,,,,,,,inpatient,,,123003.7,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20389,,186% x Medicaid HMO amount,20389,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45649,,"27,634 x DRG Weight",45649,Other,DRG Base Rate x DRG Weight,38800,,"23,488 x DRG Weight",38800,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10962.21,,DRG base rate x DRG weight + capital per discharge,10962.21,Other,100% of NY Medicaid HMO DRG,10962,,DRG base rate x DRG weight + capital per discharge,10962,Other,100% of NY Medicaid HMO DRG,10962,,DRG base rate x DRG weight + capital per discharge,10962,Other,100% of NY Medicaid HMO DRG,10962,,DRG base rate x DRG weight + capital per discharge,10962,Other,100% of NY Medicaid HMO DRG,24665,,225% x Medicaid HMO amount,24665,Other,225% of NY Medicaid HMO DRG,16772,,153% x Medicaid HMO amount,16772,Other,153% of NY Medicaid HMO DRG,24665,,225% x Medicaid HMO amount,24665,Other,225% of NY Medicaid HMO DRG,15347,,140% x Medicaid HMO amount,15347,Other,140% of NY Medicaid HMO DRG,24665,,DRG base rate x DRG weight + capital per discharge,24665,Other,225% of NY Medicaid HMO DRG,30146,,275% x Medicaid HMO amount,30146,Other,275% of NY Medicaid HMO DRG,35518,,324% x Medicaid HMO amount,35518,Other,324% of NY Medicaid HMO DRG,23569,,215% x Medicaid HMO amount,23569,Other,215% of NY Medicaid HMO DRG,23569,,215% x Medicaid HMO amount,23569,Other,215% of NY Medicaid HMO DRG,13703,,125% x Medicaid HMO amount,13703,Other,125% of NY Medicaid HMO DRG,0.01,45649,
Interstitial & alveolar lung diseases,142-1,APR-DRG,,,,,,,,inpatient,,,320544.88,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8759,,186% x Medicaid HMO amount,8759,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18435,,"27,634 x DRG Weight",18435,Other,DRG Base Rate x DRG Weight,15669,,"23,488 x DRG Weight",15669,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4709.21,,DRG base rate x DRG weight + capital per discharge,4709.21,Other,100% of NY Medicaid HMO DRG,4709,,DRG base rate x DRG weight + capital per discharge,4709,Other,100% of NY Medicaid HMO DRG,4709,,DRG base rate x DRG weight + capital per discharge,4709,Other,100% of NY Medicaid HMO DRG,4709,,DRG base rate x DRG weight + capital per discharge,4709,Other,100% of NY Medicaid HMO DRG,10596,,225% x Medicaid HMO amount,10596,Other,225% of NY Medicaid HMO DRG,7205,,153% x Medicaid HMO amount,7205,Other,153% of NY Medicaid HMO DRG,10596,,225% x Medicaid HMO amount,10596,Other,225% of NY Medicaid HMO DRG,6593,,140% x Medicaid HMO amount,6593,Other,140% of NY Medicaid HMO DRG,10596,,DRG base rate x DRG weight + capital per discharge,10596,Other,225% of NY Medicaid HMO DRG,12950,,275% x Medicaid HMO amount,12950,Other,275% of NY Medicaid HMO DRG,15258,,324% x Medicaid HMO amount,15258,Other,324% of NY Medicaid HMO DRG,10125,,215% x Medicaid HMO amount,10125,Other,215% of NY Medicaid HMO DRG,10125,,215% x Medicaid HMO amount,10125,Other,215% of NY Medicaid HMO DRG,5887,,125% x Medicaid HMO amount,5887,Other,125% of NY Medicaid HMO DRG,0.01,18435,
Interstitial & alveolar lung diseases,142-2,APR-DRG,,,,,,,,inpatient,,,167842.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11026,,186% x Medicaid HMO amount,11026,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23740,,"27,634 x DRG Weight",23740,Other,DRG Base Rate x DRG Weight,20179,,"23,488 x DRG Weight",20179,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5928.21,,DRG base rate x DRG weight + capital per discharge,5928.21,Other,100% of NY Medicaid HMO DRG,5928,,DRG base rate x DRG weight + capital per discharge,5928,Other,100% of NY Medicaid HMO DRG,5928,,DRG base rate x DRG weight + capital per discharge,5928,Other,100% of NY Medicaid HMO DRG,5928,,DRG base rate x DRG weight + capital per discharge,5928,Other,100% of NY Medicaid HMO DRG,13338,,225% x Medicaid HMO amount,13338,Other,225% of NY Medicaid HMO DRG,9070,,153% x Medicaid HMO amount,9070,Other,153% of NY Medicaid HMO DRG,13338,,225% x Medicaid HMO amount,13338,Other,225% of NY Medicaid HMO DRG,8299,,140% x Medicaid HMO amount,8299,Other,140% of NY Medicaid HMO DRG,13338,,DRG base rate x DRG weight + capital per discharge,13338,Other,225% of NY Medicaid HMO DRG,16303,,275% x Medicaid HMO amount,16303,Other,275% of NY Medicaid HMO DRG,19207,,324% x Medicaid HMO amount,19207,Other,324% of NY Medicaid HMO DRG,12746,,215% x Medicaid HMO amount,12746,Other,215% of NY Medicaid HMO DRG,12746,,215% x Medicaid HMO amount,12746,Other,215% of NY Medicaid HMO DRG,7410,,125% x Medicaid HMO amount,7410,Other,125% of NY Medicaid HMO DRG,0.01,23740,
Interstitial & alveolar lung diseases,142-3,APR-DRG,,,,,,,,inpatient,,,212654.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16597,,186% x Medicaid HMO amount,16597,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36775,,"27,634 x DRG Weight",36775,Other,DRG Base Rate x DRG Weight,31258,,"23,488 x DRG Weight",31258,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8923.21,,DRG base rate x DRG weight + capital per discharge,8923.21,Other,100% of NY Medicaid HMO DRG,8923,,DRG base rate x DRG weight + capital per discharge,8923,Other,100% of NY Medicaid HMO DRG,8923,,DRG base rate x DRG weight + capital per discharge,8923,Other,100% of NY Medicaid HMO DRG,8923,,DRG base rate x DRG weight + capital per discharge,8923,Other,100% of NY Medicaid HMO DRG,20077,,225% x Medicaid HMO amount,20077,Other,225% of NY Medicaid HMO DRG,13653,,153% x Medicaid HMO amount,13653,Other,153% of NY Medicaid HMO DRG,20077,,225% x Medicaid HMO amount,20077,Other,225% of NY Medicaid HMO DRG,12492,,140% x Medicaid HMO amount,12492,Other,140% of NY Medicaid HMO DRG,20077,,DRG base rate x DRG weight + capital per discharge,20077,Other,225% of NY Medicaid HMO DRG,24539,,275% x Medicaid HMO amount,24539,Other,275% of NY Medicaid HMO DRG,28911,,324% x Medicaid HMO amount,28911,Other,324% of NY Medicaid HMO DRG,19185,,215% x Medicaid HMO amount,19185,Other,215% of NY Medicaid HMO DRG,19185,,215% x Medicaid HMO amount,19185,Other,215% of NY Medicaid HMO DRG,11154,,125% x Medicaid HMO amount,11154,Other,125% of NY Medicaid HMO DRG,0.01,36775,
Interstitial & alveolar lung diseases,142-4,APR-DRG,,,,,,,,inpatient,,,415838,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33733,,186% x Medicaid HMO amount,33733,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,76867,,"27,634 x DRG Weight",76867,Other,DRG Base Rate x DRG Weight,65334,,"23,488 x DRG Weight",65334,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18136.21,,DRG base rate x DRG weight + capital per discharge,18136.21,Other,100% of NY Medicaid HMO DRG,18136,,DRG base rate x DRG weight + capital per discharge,18136,Other,100% of NY Medicaid HMO DRG,18136,,DRG base rate x DRG weight + capital per discharge,18136,Other,100% of NY Medicaid HMO DRG,18136,,DRG base rate x DRG weight + capital per discharge,18136,Other,100% of NY Medicaid HMO DRG,40806,,225% x Medicaid HMO amount,40806,Other,225% of NY Medicaid HMO DRG,27748,,153% x Medicaid HMO amount,27748,Other,153% of NY Medicaid HMO DRG,40806,,225% x Medicaid HMO amount,40806,Other,225% of NY Medicaid HMO DRG,25391,,140% x Medicaid HMO amount,25391,Other,140% of NY Medicaid HMO DRG,40806,,DRG base rate x DRG weight + capital per discharge,40806,Other,225% of NY Medicaid HMO DRG,49875,,275% x Medicaid HMO amount,49875,Other,275% of NY Medicaid HMO DRG,58761,,324% x Medicaid HMO amount,58761,Other,324% of NY Medicaid HMO DRG,38993,,215% x Medicaid HMO amount,38993,Other,215% of NY Medicaid HMO DRG,38993,,215% x Medicaid HMO amount,38993,Other,215% of NY Medicaid HMO DRG,22670,,125% x Medicaid HMO amount,22670,Other,125% of NY Medicaid HMO DRG,0.01,76867,
"Other respiratory diagnoses except signs, symptoms & minor diagnoses",143-1,APR-DRG,,,,,,,,inpatient,,,64108.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7152,,186% x Medicaid HMO amount,7152,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14676,,"27,634 x DRG Weight",14676,Other,DRG Base Rate x DRG Weight,12474,,"23,488 x DRG Weight",12474,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3845.21,,DRG base rate x DRG weight + capital per discharge,3845.21,Other,100% of NY Medicaid HMO DRG,3845,,DRG base rate x DRG weight + capital per discharge,3845,Other,100% of NY Medicaid HMO DRG,3845,,DRG base rate x DRG weight + capital per discharge,3845,Other,100% of NY Medicaid HMO DRG,3845,,DRG base rate x DRG weight + capital per discharge,3845,Other,100% of NY Medicaid HMO DRG,8652,,225% x Medicaid HMO amount,8652,Other,225% of NY Medicaid HMO DRG,5883,,153% x Medicaid HMO amount,5883,Other,153% of NY Medicaid HMO DRG,8652,,225% x Medicaid HMO amount,8652,Other,225% of NY Medicaid HMO DRG,5383,,140% x Medicaid HMO amount,5383,Other,140% of NY Medicaid HMO DRG,8652,,DRG base rate x DRG weight + capital per discharge,8652,Other,225% of NY Medicaid HMO DRG,10574,,275% x Medicaid HMO amount,10574,Other,275% of NY Medicaid HMO DRG,12458,,324% x Medicaid HMO amount,12458,Other,324% of NY Medicaid HMO DRG,8267,,215% x Medicaid HMO amount,8267,Other,215% of NY Medicaid HMO DRG,8267,,215% x Medicaid HMO amount,8267,Other,215% of NY Medicaid HMO DRG,4807,,125% x Medicaid HMO amount,4807,Other,125% of NY Medicaid HMO DRG,0.01,14676,
"Other respiratory diagnoses except signs, symptoms & minor diagnoses",143-2,APR-DRG,,,,,,,,inpatient,,,110654.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9845,,186% x Medicaid HMO amount,9845,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20974,,"27,634 x DRG Weight",20974,Other,DRG Base Rate x DRG Weight,17827,,"23,488 x DRG Weight",17827,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5293.21,,DRG base rate x DRG weight + capital per discharge,5293.21,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,11910,,225% x Medicaid HMO amount,11910,Other,225% of NY Medicaid HMO DRG,8099,,153% x Medicaid HMO amount,8099,Other,153% of NY Medicaid HMO DRG,11910,,225% x Medicaid HMO amount,11910,Other,225% of NY Medicaid HMO DRG,7410,,140% x Medicaid HMO amount,7410,Other,140% of NY Medicaid HMO DRG,11910,,DRG base rate x DRG weight + capital per discharge,11910,Other,225% of NY Medicaid HMO DRG,14556,,275% x Medicaid HMO amount,14556,Other,275% of NY Medicaid HMO DRG,17150,,324% x Medicaid HMO amount,17150,Other,324% of NY Medicaid HMO DRG,11380,,215% x Medicaid HMO amount,11380,Other,215% of NY Medicaid HMO DRG,11380,,215% x Medicaid HMO amount,11380,Other,215% of NY Medicaid HMO DRG,6617,,125% x Medicaid HMO amount,6617,Other,125% of NY Medicaid HMO DRG,0.01,20974,
"Other respiratory diagnoses except signs, symptoms & minor diagnoses",143-3,APR-DRG,,,,,,,,inpatient,,,155647.11,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16031,,186% x Medicaid HMO amount,16031,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35449,,"27,634 x DRG Weight",35449,Other,DRG Base Rate x DRG Weight,30130,,"23,488 x DRG Weight",30130,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8619.21,,DRG base rate x DRG weight + capital per discharge,8619.21,Other,100% of NY Medicaid HMO DRG,8619,,DRG base rate x DRG weight + capital per discharge,8619,Other,100% of NY Medicaid HMO DRG,8619,,DRG base rate x DRG weight + capital per discharge,8619,Other,100% of NY Medicaid HMO DRG,8619,,DRG base rate x DRG weight + capital per discharge,8619,Other,100% of NY Medicaid HMO DRG,19393,,225% x Medicaid HMO amount,19393,Other,225% of NY Medicaid HMO DRG,13187,,153% x Medicaid HMO amount,13187,Other,153% of NY Medicaid HMO DRG,19393,,225% x Medicaid HMO amount,19393,Other,225% of NY Medicaid HMO DRG,12067,,140% x Medicaid HMO amount,12067,Other,140% of NY Medicaid HMO DRG,19393,,DRG base rate x DRG weight + capital per discharge,19393,Other,225% of NY Medicaid HMO DRG,23703,,275% x Medicaid HMO amount,23703,Other,275% of NY Medicaid HMO DRG,27926,,324% x Medicaid HMO amount,27926,Other,324% of NY Medicaid HMO DRG,18531,,215% x Medicaid HMO amount,18531,Other,215% of NY Medicaid HMO DRG,18531,,215% x Medicaid HMO amount,18531,Other,215% of NY Medicaid HMO DRG,10774,,125% x Medicaid HMO amount,10774,Other,125% of NY Medicaid HMO DRG,0.01,35449,
"Other respiratory diagnoses except signs, symptoms & minor diagnoses",143-4,APR-DRG,,,,,,,,inpatient,,,136025.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25183,,186% x Medicaid HMO amount,25183,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,56862,,"27,634 x DRG Weight",56862,Other,DRG Base Rate x DRG Weight,48331,,"23,488 x DRG Weight",48331,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13539.21,,DRG base rate x DRG weight + capital per discharge,13539.21,Other,100% of NY Medicaid HMO DRG,13539,,DRG base rate x DRG weight + capital per discharge,13539,Other,100% of NY Medicaid HMO DRG,13539,,DRG base rate x DRG weight + capital per discharge,13539,Other,100% of NY Medicaid HMO DRG,13539,,DRG base rate x DRG weight + capital per discharge,13539,Other,100% of NY Medicaid HMO DRG,30463,,225% x Medicaid HMO amount,30463,Other,225% of NY Medicaid HMO DRG,20715,,153% x Medicaid HMO amount,20715,Other,153% of NY Medicaid HMO DRG,30463,,225% x Medicaid HMO amount,30463,Other,225% of NY Medicaid HMO DRG,18955,,140% x Medicaid HMO amount,18955,Other,140% of NY Medicaid HMO DRG,30463,,DRG base rate x DRG weight + capital per discharge,30463,Other,225% of NY Medicaid HMO DRG,37233,,275% x Medicaid HMO amount,37233,Other,275% of NY Medicaid HMO DRG,43867,,324% x Medicaid HMO amount,43867,Other,324% of NY Medicaid HMO DRG,29109,,215% x Medicaid HMO amount,29109,Other,215% of NY Medicaid HMO DRG,29109,,215% x Medicaid HMO amount,29109,Other,215% of NY Medicaid HMO DRG,16924,,125% x Medicaid HMO amount,16924,Other,125% of NY Medicaid HMO DRG,0.01,56862,
"Respiratory signs, symptoms & minor diagnoses",144-1,APR-DRG,,,,,,,,inpatient,,,73692.76,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6227,,186% x Medicaid HMO amount,6227,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12510,,"27,634 x DRG Weight",12510,Other,DRG Base Rate x DRG Weight,10633,,"23,488 x DRG Weight",10633,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3348.21,,DRG base rate x DRG weight + capital per discharge,3348.21,Other,100% of NY Medicaid HMO DRG,3348,,DRG base rate x DRG weight + capital per discharge,3348,Other,100% of NY Medicaid HMO DRG,3348,,DRG base rate x DRG weight + capital per discharge,3348,Other,100% of NY Medicaid HMO DRG,3348,,DRG base rate x DRG weight + capital per discharge,3348,Other,100% of NY Medicaid HMO DRG,7533,,225% x Medicaid HMO amount,7533,Other,225% of NY Medicaid HMO DRG,5123,,153% x Medicaid HMO amount,5123,Other,153% of NY Medicaid HMO DRG,7533,,225% x Medicaid HMO amount,7533,Other,225% of NY Medicaid HMO DRG,4687,,140% x Medicaid HMO amount,4687,Other,140% of NY Medicaid HMO DRG,7533,,DRG base rate x DRG weight + capital per discharge,7533,Other,225% of NY Medicaid HMO DRG,9208,,275% x Medicaid HMO amount,9208,Other,275% of NY Medicaid HMO DRG,10848,,324% x Medicaid HMO amount,10848,Other,324% of NY Medicaid HMO DRG,7199,,215% x Medicaid HMO amount,7199,Other,215% of NY Medicaid HMO DRG,7199,,215% x Medicaid HMO amount,7199,Other,215% of NY Medicaid HMO DRG,4185,,125% x Medicaid HMO amount,4185,Other,125% of NY Medicaid HMO DRG,0.01,12510,
"Respiratory signs, symptoms & minor diagnoses",144-2,APR-DRG,,,,,,,,inpatient,,,94240.84,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7598,,186% x Medicaid HMO amount,7598,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15721,,"27,634 x DRG Weight",15721,Other,DRG Base Rate x DRG Weight,13362,,"23,488 x DRG Weight",13362,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4085.21,,DRG base rate x DRG weight + capital per discharge,4085.21,Other,100% of NY Medicaid HMO DRG,4085,,DRG base rate x DRG weight + capital per discharge,4085,Other,100% of NY Medicaid HMO DRG,4085,,DRG base rate x DRG weight + capital per discharge,4085,Other,100% of NY Medicaid HMO DRG,4085,,DRG base rate x DRG weight + capital per discharge,4085,Other,100% of NY Medicaid HMO DRG,9192,,225% x Medicaid HMO amount,9192,Other,225% of NY Medicaid HMO DRG,6250,,153% x Medicaid HMO amount,6250,Other,153% of NY Medicaid HMO DRG,9192,,225% x Medicaid HMO amount,9192,Other,225% of NY Medicaid HMO DRG,5719,,140% x Medicaid HMO amount,5719,Other,140% of NY Medicaid HMO DRG,9192,,DRG base rate x DRG weight + capital per discharge,9192,Other,225% of NY Medicaid HMO DRG,11234,,275% x Medicaid HMO amount,11234,Other,275% of NY Medicaid HMO DRG,13236,,324% x Medicaid HMO amount,13236,Other,324% of NY Medicaid HMO DRG,8783,,215% x Medicaid HMO amount,8783,Other,215% of NY Medicaid HMO DRG,8783,,215% x Medicaid HMO amount,8783,Other,215% of NY Medicaid HMO DRG,5107,,125% x Medicaid HMO amount,5107,Other,125% of NY Medicaid HMO DRG,0.01,15721,
"Respiratory signs, symptoms & minor diagnoses",144-3,APR-DRG,,,,,,,,inpatient,,,120079.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11087,,186% x Medicaid HMO amount,11087,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23881,,"27,634 x DRG Weight",23881,Other,DRG Base Rate x DRG Weight,20298,,"23,488 x DRG Weight",20298,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5961.21,,DRG base rate x DRG weight + capital per discharge,5961.21,Other,100% of NY Medicaid HMO DRG,5961,,DRG base rate x DRG weight + capital per discharge,5961,Other,100% of NY Medicaid HMO DRG,5961,,DRG base rate x DRG weight + capital per discharge,5961,Other,100% of NY Medicaid HMO DRG,5961,,DRG base rate x DRG weight + capital per discharge,5961,Other,100% of NY Medicaid HMO DRG,13413,,225% x Medicaid HMO amount,13413,Other,225% of NY Medicaid HMO DRG,9121,,153% x Medicaid HMO amount,9121,Other,153% of NY Medicaid HMO DRG,13413,,225% x Medicaid HMO amount,13413,Other,225% of NY Medicaid HMO DRG,8346,,140% x Medicaid HMO amount,8346,Other,140% of NY Medicaid HMO DRG,13413,,DRG base rate x DRG weight + capital per discharge,13413,Other,225% of NY Medicaid HMO DRG,16393,,275% x Medicaid HMO amount,16393,Other,275% of NY Medicaid HMO DRG,19314,,324% x Medicaid HMO amount,19314,Other,324% of NY Medicaid HMO DRG,12817,,215% x Medicaid HMO amount,12817,Other,215% of NY Medicaid HMO DRG,12817,,215% x Medicaid HMO amount,12817,Other,215% of NY Medicaid HMO DRG,7452,,125% x Medicaid HMO amount,7452,Other,125% of NY Medicaid HMO DRG,0.01,23881,
"Respiratory signs, symptoms & minor diagnoses",144-4,APR-DRG,,,,,,,,inpatient,,,169840.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20945,,186% x Medicaid HMO amount,20945,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46947,,"27,634 x DRG Weight",46947,Other,DRG Base Rate x DRG Weight,39904,,"23,488 x DRG Weight",39904,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11261.21,,DRG base rate x DRG weight + capital per discharge,11261.21,Other,100% of NY Medicaid HMO DRG,11261,,DRG base rate x DRG weight + capital per discharge,11261,Other,100% of NY Medicaid HMO DRG,11261,,DRG base rate x DRG weight + capital per discharge,11261,Other,100% of NY Medicaid HMO DRG,11261,,DRG base rate x DRG weight + capital per discharge,11261,Other,100% of NY Medicaid HMO DRG,25338,,225% x Medicaid HMO amount,25338,Other,225% of NY Medicaid HMO DRG,17230,,153% x Medicaid HMO amount,17230,Other,153% of NY Medicaid HMO DRG,25338,,225% x Medicaid HMO amount,25338,Other,225% of NY Medicaid HMO DRG,15766,,140% x Medicaid HMO amount,15766,Other,140% of NY Medicaid HMO DRG,25338,,DRG base rate x DRG weight + capital per discharge,25338,Other,225% of NY Medicaid HMO DRG,30968,,275% x Medicaid HMO amount,30968,Other,275% of NY Medicaid HMO DRG,36486,,324% x Medicaid HMO amount,36486,Other,324% of NY Medicaid HMO DRG,24212,,215% x Medicaid HMO amount,24212,Other,215% of NY Medicaid HMO DRG,24212,,215% x Medicaid HMO amount,24212,Other,215% of NY Medicaid HMO DRG,14077,,125% x Medicaid HMO amount,14077,Other,125% of NY Medicaid HMO DRG,0.01,46947,
Major cardiothoracic repair of heart anomaly,160-1,APR-DRG,,,,,,,,inpatient,,,586096.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38039,,186% x Medicaid HMO amount,38039,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86942,,"27,634 x DRG Weight",86942,Other,DRG Base Rate x DRG Weight,73898,,"23,488 x DRG Weight",73898,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20451.21,,DRG base rate x DRG weight + capital per discharge,20451.21,Other,100% of NY Medicaid HMO DRG,20451,,DRG base rate x DRG weight + capital per discharge,20451,Other,100% of NY Medicaid HMO DRG,20451,,DRG base rate x DRG weight + capital per discharge,20451,Other,100% of NY Medicaid HMO DRG,20451,,DRG base rate x DRG weight + capital per discharge,20451,Other,100% of NY Medicaid HMO DRG,46015,,225% x Medicaid HMO amount,46015,Other,225% of NY Medicaid HMO DRG,31290,,153% x Medicaid HMO amount,31290,Other,153% of NY Medicaid HMO DRG,46015,,225% x Medicaid HMO amount,46015,Other,225% of NY Medicaid HMO DRG,28632,,140% x Medicaid HMO amount,28632,Other,140% of NY Medicaid HMO DRG,46015,,DRG base rate x DRG weight + capital per discharge,46015,Other,225% of NY Medicaid HMO DRG,56241,,275% x Medicaid HMO amount,56241,Other,275% of NY Medicaid HMO DRG,66262,,324% x Medicaid HMO amount,66262,Other,324% of NY Medicaid HMO DRG,43970,,215% x Medicaid HMO amount,43970,Other,215% of NY Medicaid HMO DRG,43970,,215% x Medicaid HMO amount,43970,Other,215% of NY Medicaid HMO DRG,25564,,125% x Medicaid HMO amount,25564,Other,125% of NY Medicaid HMO DRG,0.01,86942,
Major cardiothoracic repair of heart anomaly,160-2,APR-DRG,,,,,,,,inpatient,,,586096.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41011,,186% x Medicaid HMO amount,41011,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,93895,,"27,634 x DRG Weight",93895,Other,DRG Base Rate x DRG Weight,79808,,"23,488 x DRG Weight",79808,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22049.21,,DRG base rate x DRG weight + capital per discharge,22049.21,Other,100% of NY Medicaid HMO DRG,22049,,DRG base rate x DRG weight + capital per discharge,22049,Other,100% of NY Medicaid HMO DRG,22049,,DRG base rate x DRG weight + capital per discharge,22049,Other,100% of NY Medicaid HMO DRG,22049,,DRG base rate x DRG weight + capital per discharge,22049,Other,100% of NY Medicaid HMO DRG,49611,,225% x Medicaid HMO amount,49611,Other,225% of NY Medicaid HMO DRG,33735,,153% x Medicaid HMO amount,33735,Other,153% of NY Medicaid HMO DRG,49611,,225% x Medicaid HMO amount,49611,Other,225% of NY Medicaid HMO DRG,30869,,140% x Medicaid HMO amount,30869,Other,140% of NY Medicaid HMO DRG,49611,,DRG base rate x DRG weight + capital per discharge,49611,Other,225% of NY Medicaid HMO DRG,60635,,275% x Medicaid HMO amount,60635,Other,275% of NY Medicaid HMO DRG,71439,,324% x Medicaid HMO amount,71439,Other,324% of NY Medicaid HMO DRG,47406,,215% x Medicaid HMO amount,47406,Other,215% of NY Medicaid HMO DRG,47406,,215% x Medicaid HMO amount,47406,Other,215% of NY Medicaid HMO DRG,27562,,125% x Medicaid HMO amount,27562,Other,125% of NY Medicaid HMO DRG,0.01,93895,
Major cardiothoracic repair of heart anomaly,160-3,APR-DRG,,,,,,,,inpatient,,,843071.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57338,,186% x Medicaid HMO amount,57338,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,132093,,"27,634 x DRG Weight",132093,Other,DRG Base Rate x DRG Weight,112275,,"23,488 x DRG Weight",112275,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30827.21,,DRG base rate x DRG weight + capital per discharge,30827.21,Other,100% of NY Medicaid HMO DRG,30827,,DRG base rate x DRG weight + capital per discharge,30827,Other,100% of NY Medicaid HMO DRG,30827,,DRG base rate x DRG weight + capital per discharge,30827,Other,100% of NY Medicaid HMO DRG,30827,,DRG base rate x DRG weight + capital per discharge,30827,Other,100% of NY Medicaid HMO DRG,69361,,225% x Medicaid HMO amount,69361,Other,225% of NY Medicaid HMO DRG,47166,,153% x Medicaid HMO amount,47166,Other,153% of NY Medicaid HMO DRG,69361,,225% x Medicaid HMO amount,69361,Other,225% of NY Medicaid HMO DRG,43158,,140% x Medicaid HMO amount,43158,Other,140% of NY Medicaid HMO DRG,69361,,DRG base rate x DRG weight + capital per discharge,69361,Other,225% of NY Medicaid HMO DRG,84775,,275% x Medicaid HMO amount,84775,Other,275% of NY Medicaid HMO DRG,99880,,324% x Medicaid HMO amount,99880,Other,324% of NY Medicaid HMO DRG,66279,,215% x Medicaid HMO amount,66279,Other,215% of NY Medicaid HMO DRG,66279,,215% x Medicaid HMO amount,66279,Other,215% of NY Medicaid HMO DRG,38534,,125% x Medicaid HMO amount,38534,Other,125% of NY Medicaid HMO DRG,0.01,132093,
Major cardiothoracic repair of heart anomaly,160-4,APR-DRG,,,,,,,,inpatient,,,586096.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,118328,,186% x Medicaid HMO amount,118328,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,274790,,"27,634 x DRG Weight",274790,Other,DRG Base Rate x DRG Weight,233562,,"23,488 x DRG Weight",233562,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63617.21,,DRG base rate x DRG weight + capital per discharge,63617.21,Other,100% of NY Medicaid HMO DRG,63617,,DRG base rate x DRG weight + capital per discharge,63617,Other,100% of NY Medicaid HMO DRG,63617,,DRG base rate x DRG weight + capital per discharge,63617,Other,100% of NY Medicaid HMO DRG,63617,,DRG base rate x DRG weight + capital per discharge,63617,Other,100% of NY Medicaid HMO DRG,143139,,225% x Medicaid HMO amount,143139,Other,225% of NY Medicaid HMO DRG,97334,,153% x Medicaid HMO amount,97334,Other,153% of NY Medicaid HMO DRG,143139,,225% x Medicaid HMO amount,143139,Other,225% of NY Medicaid HMO DRG,89064,,140% x Medicaid HMO amount,89064,Other,140% of NY Medicaid HMO DRG,143139,,DRG base rate x DRG weight + capital per discharge,143139,Other,225% of NY Medicaid HMO DRG,174947,,275% x Medicaid HMO amount,174947,Other,275% of NY Medicaid HMO DRG,206120,,324% x Medicaid HMO amount,206120,Other,324% of NY Medicaid HMO DRG,136777,,215% x Medicaid HMO amount,136777,Other,215% of NY Medicaid HMO DRG,136777,,215% x Medicaid HMO amount,136777,Other,215% of NY Medicaid HMO DRG,79522,,125% x Medicaid HMO amount,79522,Other,125% of NY Medicaid HMO DRG,0.01,274790,
Cardiac defibrillator & heart assist implant,161-1,APR-DRG,,,,,,,,inpatient,,,284329.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48293,,186% x Medicaid HMO amount,48293,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,110931,,"27,634 x DRG Weight",110931,Other,DRG Base Rate x DRG Weight,94288,,"23,488 x DRG Weight",94288,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25964.21,,DRG base rate x DRG weight + capital per discharge,25964.21,Other,100% of NY Medicaid HMO DRG,25964,,DRG base rate x DRG weight + capital per discharge,25964,Other,100% of NY Medicaid HMO DRG,25964,,DRG base rate x DRG weight + capital per discharge,25964,Other,100% of NY Medicaid HMO DRG,25964,,DRG base rate x DRG weight + capital per discharge,25964,Other,100% of NY Medicaid HMO DRG,58419,,225% x Medicaid HMO amount,58419,Other,225% of NY Medicaid HMO DRG,39725,,153% x Medicaid HMO amount,39725,Other,153% of NY Medicaid HMO DRG,58419,,225% x Medicaid HMO amount,58419,Other,225% of NY Medicaid HMO DRG,36350,,140% x Medicaid HMO amount,36350,Other,140% of NY Medicaid HMO DRG,58419,,DRG base rate x DRG weight + capital per discharge,58419,Other,225% of NY Medicaid HMO DRG,71402,,275% x Medicaid HMO amount,71402,Other,275% of NY Medicaid HMO DRG,84124,,324% x Medicaid HMO amount,84124,Other,324% of NY Medicaid HMO DRG,55823,,215% x Medicaid HMO amount,55823,Other,215% of NY Medicaid HMO DRG,55823,,215% x Medicaid HMO amount,55823,Other,215% of NY Medicaid HMO DRG,32455,,125% x Medicaid HMO amount,32455,Other,125% of NY Medicaid HMO DRG,0.01,110931,
Cardiac defibrillator & heart assist implant,161-2,APR-DRG,,,,,,,,inpatient,,,538737.24,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73252,,186% x Medicaid HMO amount,73252,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,169330,,"27,634 x DRG Weight",169330,Other,DRG Base Rate x DRG Weight,143925,,"23,488 x DRG Weight",143925,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39383.21,,DRG base rate x DRG weight + capital per discharge,39383.21,Other,100% of NY Medicaid HMO DRG,39383,,DRG base rate x DRG weight + capital per discharge,39383,Other,100% of NY Medicaid HMO DRG,39383,,DRG base rate x DRG weight + capital per discharge,39383,Other,100% of NY Medicaid HMO DRG,39383,,DRG base rate x DRG weight + capital per discharge,39383,Other,100% of NY Medicaid HMO DRG,88612,,225% x Medicaid HMO amount,88612,Other,225% of NY Medicaid HMO DRG,60256,,153% x Medicaid HMO amount,60256,Other,153% of NY Medicaid HMO DRG,88612,,225% x Medicaid HMO amount,88612,Other,225% of NY Medicaid HMO DRG,55136,,140% x Medicaid HMO amount,55136,Other,140% of NY Medicaid HMO DRG,88612,,DRG base rate x DRG weight + capital per discharge,88612,Other,225% of NY Medicaid HMO DRG,108304,,275% x Medicaid HMO amount,108304,Other,275% of NY Medicaid HMO DRG,127602,,324% x Medicaid HMO amount,127602,Other,324% of NY Medicaid HMO DRG,84674,,215% x Medicaid HMO amount,84674,Other,215% of NY Medicaid HMO DRG,84674,,215% x Medicaid HMO amount,84674,Other,215% of NY Medicaid HMO DRG,49229,,125% x Medicaid HMO amount,49229,Other,125% of NY Medicaid HMO DRG,0.01,169330,
Cardiac defibrillator & heart assist implant,161-3,APR-DRG,,,,,,,,inpatient,,,494301.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,117094,,186% x Medicaid HMO amount,117094,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,271908,,"27,634 x DRG Weight",271908,Other,DRG Base Rate x DRG Weight,231113,,"23,488 x DRG Weight",231113,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62954.21,,DRG base rate x DRG weight + capital per discharge,62954.21,Other,100% of NY Medicaid HMO DRG,62954,,DRG base rate x DRG weight + capital per discharge,62954,Other,100% of NY Medicaid HMO DRG,62954,,DRG base rate x DRG weight + capital per discharge,62954,Other,100% of NY Medicaid HMO DRG,62954,,DRG base rate x DRG weight + capital per discharge,62954,Other,100% of NY Medicaid HMO DRG,141647,,225% x Medicaid HMO amount,141647,Other,225% of NY Medicaid HMO DRG,96320,,153% x Medicaid HMO amount,96320,Other,153% of NY Medicaid HMO DRG,141647,,225% x Medicaid HMO amount,141647,Other,225% of NY Medicaid HMO DRG,88136,,140% x Medicaid HMO amount,88136,Other,140% of NY Medicaid HMO DRG,141647,,DRG base rate x DRG weight + capital per discharge,141647,Other,225% of NY Medicaid HMO DRG,173124,,275% x Medicaid HMO amount,173124,Other,275% of NY Medicaid HMO DRG,203972,,324% x Medicaid HMO amount,203972,Other,324% of NY Medicaid HMO DRG,135352,,215% x Medicaid HMO amount,135352,Other,215% of NY Medicaid HMO DRG,135352,,215% x Medicaid HMO amount,135352,Other,215% of NY Medicaid HMO DRG,78693,,125% x Medicaid HMO amount,78693,Other,125% of NY Medicaid HMO DRG,0.01,271908,
Cardiac defibrillator & heart assist implant,161-4,APR-DRG,,,,,,,,inpatient,,,1641477.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,273487,,186% x Medicaid HMO amount,273487,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,637815,,"27,634 x DRG Weight",637815,Other,DRG Base Rate x DRG Weight,542122,,"23,488 x DRG Weight",542122,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,147036.21,,DRG base rate x DRG weight + capital per discharge,147036.21,Other,100% of NY Medicaid HMO DRG,147036,,DRG base rate x DRG weight + capital per discharge,147036,Other,100% of NY Medicaid HMO DRG,147036,,DRG base rate x DRG weight + capital per discharge,147036,Other,100% of NY Medicaid HMO DRG,147036,,DRG base rate x DRG weight + capital per discharge,147036,Other,100% of NY Medicaid HMO DRG,330831,,225% x Medicaid HMO amount,330831,Other,225% of NY Medicaid HMO DRG,224965,,153% x Medicaid HMO amount,224965,Other,153% of NY Medicaid HMO DRG,330831,,225% x Medicaid HMO amount,330831,Other,225% of NY Medicaid HMO DRG,205851,,140% x Medicaid HMO amount,205851,Other,140% of NY Medicaid HMO DRG,330831,,DRG base rate x DRG weight + capital per discharge,330831,Other,225% of NY Medicaid HMO DRG,404350,,275% x Medicaid HMO amount,404350,Other,275% of NY Medicaid HMO DRG,476397,,324% x Medicaid HMO amount,476397,Other,324% of NY Medicaid HMO DRG,316128,,215% x Medicaid HMO amount,316128,Other,215% of NY Medicaid HMO DRG,316128,,215% x Medicaid HMO amount,316128,Other,215% of NY Medicaid HMO DRG,183795,,125% x Medicaid HMO amount,183795,Other,125% of NY Medicaid HMO DRG,0.01,637815,
Cardiac valve procedures w AMI or complex PDX,162-1,APR-DRG,,,,,,,,inpatient,,,497337.94,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41770,,186% x Medicaid HMO amount,41770,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,95672,,"27,634 x DRG Weight",95672,Other,DRG Base Rate x DRG Weight,81318,,"23,488 x DRG Weight",81318,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22457.21,,DRG base rate x DRG weight + capital per discharge,22457.21,Other,100% of NY Medicaid HMO DRG,22457,,DRG base rate x DRG weight + capital per discharge,22457,Other,100% of NY Medicaid HMO DRG,22457,,DRG base rate x DRG weight + capital per discharge,22457,Other,100% of NY Medicaid HMO DRG,22457,,DRG base rate x DRG weight + capital per discharge,22457,Other,100% of NY Medicaid HMO DRG,50529,,225% x Medicaid HMO amount,50529,Other,225% of NY Medicaid HMO DRG,34360,,153% x Medicaid HMO amount,34360,Other,153% of NY Medicaid HMO DRG,50529,,225% x Medicaid HMO amount,50529,Other,225% of NY Medicaid HMO DRG,31440,,140% x Medicaid HMO amount,31440,Other,140% of NY Medicaid HMO DRG,50529,,DRG base rate x DRG weight + capital per discharge,50529,Other,225% of NY Medicaid HMO DRG,61757,,275% x Medicaid HMO amount,61757,Other,275% of NY Medicaid HMO DRG,72761,,324% x Medicaid HMO amount,72761,Other,324% of NY Medicaid HMO DRG,48283,,215% x Medicaid HMO amount,48283,Other,215% of NY Medicaid HMO DRG,48283,,215% x Medicaid HMO amount,48283,Other,215% of NY Medicaid HMO DRG,28072,,125% x Medicaid HMO amount,28072,Other,125% of NY Medicaid HMO DRG,0.01,95672,
Cardiac valve procedures w AMI or complex PDX,162-2,APR-DRG,,,,,,,,inpatient,,,446594.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53817,,186% x Medicaid HMO amount,53817,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,123858,,"27,634 x DRG Weight",123858,Other,DRG Base Rate x DRG Weight,105276,,"23,488 x DRG Weight",105276,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28934.21,,DRG base rate x DRG weight + capital per discharge,28934.21,Other,100% of NY Medicaid HMO DRG,28934,,DRG base rate x DRG weight + capital per discharge,28934,Other,100% of NY Medicaid HMO DRG,28934,,DRG base rate x DRG weight + capital per discharge,28934,Other,100% of NY Medicaid HMO DRG,28934,,DRG base rate x DRG weight + capital per discharge,28934,Other,100% of NY Medicaid HMO DRG,65102,,225% x Medicaid HMO amount,65102,Other,225% of NY Medicaid HMO DRG,44269,,153% x Medicaid HMO amount,44269,Other,153% of NY Medicaid HMO DRG,65102,,225% x Medicaid HMO amount,65102,Other,225% of NY Medicaid HMO DRG,40508,,140% x Medicaid HMO amount,40508,Other,140% of NY Medicaid HMO DRG,65102,,DRG base rate x DRG weight + capital per discharge,65102,Other,225% of NY Medicaid HMO DRG,79569,,275% x Medicaid HMO amount,79569,Other,275% of NY Medicaid HMO DRG,93747,,324% x Medicaid HMO amount,93747,Other,324% of NY Medicaid HMO DRG,62209,,215% x Medicaid HMO amount,62209,Other,215% of NY Medicaid HMO DRG,62209,,215% x Medicaid HMO amount,62209,Other,215% of NY Medicaid HMO DRG,36168,,125% x Medicaid HMO amount,36168,Other,125% of NY Medicaid HMO DRG,0.01,123858,
Cardiac valve procedures w AMI or complex PDX,162-3,APR-DRG,,,,,,,,inpatient,,,666539.54,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,68636,,186% x Medicaid HMO amount,68636,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,158528,,"27,634 x DRG Weight",158528,Other,DRG Base Rate x DRG Weight,134744,,"23,488 x DRG Weight",134744,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36901.21,,DRG base rate x DRG weight + capital per discharge,36901.21,Other,100% of NY Medicaid HMO DRG,36901,,DRG base rate x DRG weight + capital per discharge,36901,Other,100% of NY Medicaid HMO DRG,36901,,DRG base rate x DRG weight + capital per discharge,36901,Other,100% of NY Medicaid HMO DRG,36901,,DRG base rate x DRG weight + capital per discharge,36901,Other,100% of NY Medicaid HMO DRG,83028,,225% x Medicaid HMO amount,83028,Other,225% of NY Medicaid HMO DRG,56459,,153% x Medicaid HMO amount,56459,Other,153% of NY Medicaid HMO DRG,83028,,225% x Medicaid HMO amount,83028,Other,225% of NY Medicaid HMO DRG,51662,,140% x Medicaid HMO amount,51662,Other,140% of NY Medicaid HMO DRG,83028,,DRG base rate x DRG weight + capital per discharge,83028,Other,225% of NY Medicaid HMO DRG,101478,,275% x Medicaid HMO amount,101478,Other,275% of NY Medicaid HMO DRG,119560,,324% x Medicaid HMO amount,119560,Other,324% of NY Medicaid HMO DRG,79338,,215% x Medicaid HMO amount,79338,Other,215% of NY Medicaid HMO DRG,79338,,215% x Medicaid HMO amount,79338,Other,215% of NY Medicaid HMO DRG,46127,,125% x Medicaid HMO amount,46127,Other,125% of NY Medicaid HMO DRG,0.01,158528,
Cardiac valve procedures w AMI or complex PDX,162-4,APR-DRG,,,,,,,,inpatient,,,1293079.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,111723,,186% x Medicaid HMO amount,111723,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,259337,,"27,634 x DRG Weight",259337,Other,DRG Base Rate x DRG Weight,220428,,"23,488 x DRG Weight",220428,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60066.21,,DRG base rate x DRG weight + capital per discharge,60066.21,Other,100% of NY Medicaid HMO DRG,60066,,DRG base rate x DRG weight + capital per discharge,60066,Other,100% of NY Medicaid HMO DRG,60066,,DRG base rate x DRG weight + capital per discharge,60066,Other,100% of NY Medicaid HMO DRG,60066,,DRG base rate x DRG weight + capital per discharge,60066,Other,100% of NY Medicaid HMO DRG,135149,,225% x Medicaid HMO amount,135149,Other,225% of NY Medicaid HMO DRG,91901,,153% x Medicaid HMO amount,91901,Other,153% of NY Medicaid HMO DRG,135149,,225% x Medicaid HMO amount,135149,Other,225% of NY Medicaid HMO DRG,84093,,140% x Medicaid HMO amount,84093,Other,140% of NY Medicaid HMO DRG,135149,,DRG base rate x DRG weight + capital per discharge,135149,Other,225% of NY Medicaid HMO DRG,165182,,275% x Medicaid HMO amount,165182,Other,275% of NY Medicaid HMO DRG,194615,,324% x Medicaid HMO amount,194615,Other,324% of NY Medicaid HMO DRG,129142,,215% x Medicaid HMO amount,129142,Other,215% of NY Medicaid HMO DRG,129142,,215% x Medicaid HMO amount,129142,Other,215% of NY Medicaid HMO DRG,75083,,125% x Medicaid HMO amount,75083,Other,125% of NY Medicaid HMO DRG,0.01,259337,
Cardiac valve procedures w/o AMI or complex PDX,163-1,APR-DRG,,,,,,,,inpatient,,,368680.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36605,,186% x Medicaid HMO amount,36605,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,83585,,"27,634 x DRG Weight",83585,Other,DRG Base Rate x DRG Weight,71044,,"23,488 x DRG Weight",71044,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19680.21,,DRG base rate x DRG weight + capital per discharge,19680.21,Other,100% of NY Medicaid HMO DRG,19680,,DRG base rate x DRG weight + capital per discharge,19680,Other,100% of NY Medicaid HMO DRG,19680,,DRG base rate x DRG weight + capital per discharge,19680,Other,100% of NY Medicaid HMO DRG,19680,,DRG base rate x DRG weight + capital per discharge,19680,Other,100% of NY Medicaid HMO DRG,44280,,225% x Medicaid HMO amount,44280,Other,225% of NY Medicaid HMO DRG,30111,,153% x Medicaid HMO amount,30111,Other,153% of NY Medicaid HMO DRG,44280,,225% x Medicaid HMO amount,44280,Other,225% of NY Medicaid HMO DRG,27552,,140% x Medicaid HMO amount,27552,Other,140% of NY Medicaid HMO DRG,44280,,DRG base rate x DRG weight + capital per discharge,44280,Other,225% of NY Medicaid HMO DRG,54121,,275% x Medicaid HMO amount,54121,Other,275% of NY Medicaid HMO DRG,63764,,324% x Medicaid HMO amount,63764,Other,324% of NY Medicaid HMO DRG,42312,,215% x Medicaid HMO amount,42312,Other,215% of NY Medicaid HMO DRG,42312,,215% x Medicaid HMO amount,42312,Other,215% of NY Medicaid HMO DRG,24600,,125% x Medicaid HMO amount,24600,Other,125% of NY Medicaid HMO DRG,0.01,83585,
Cardiac valve procedures w/o AMI or complex PDX,163-2,APR-DRG,,,,,,,,inpatient,,,426385.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44582,,186% x Medicaid HMO amount,44582,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,102249,,"27,634 x DRG Weight",102249,Other,DRG Base Rate x DRG Weight,86908,,"23,488 x DRG Weight",86908,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23969.21,,DRG base rate x DRG weight + capital per discharge,23969.21,Other,100% of NY Medicaid HMO DRG,23969,,DRG base rate x DRG weight + capital per discharge,23969,Other,100% of NY Medicaid HMO DRG,23969,,DRG base rate x DRG weight + capital per discharge,23969,Other,100% of NY Medicaid HMO DRG,23969,,DRG base rate x DRG weight + capital per discharge,23969,Other,100% of NY Medicaid HMO DRG,53931,,225% x Medicaid HMO amount,53931,Other,225% of NY Medicaid HMO DRG,36673,,153% x Medicaid HMO amount,36673,Other,153% of NY Medicaid HMO DRG,53931,,225% x Medicaid HMO amount,53931,Other,225% of NY Medicaid HMO DRG,33557,,140% x Medicaid HMO amount,33557,Other,140% of NY Medicaid HMO DRG,53931,,DRG base rate x DRG weight + capital per discharge,53931,Other,225% of NY Medicaid HMO DRG,65915,,275% x Medicaid HMO amount,65915,Other,275% of NY Medicaid HMO DRG,77660,,324% x Medicaid HMO amount,77660,Other,324% of NY Medicaid HMO DRG,51534,,215% x Medicaid HMO amount,51534,Other,215% of NY Medicaid HMO DRG,51534,,215% x Medicaid HMO amount,51534,Other,215% of NY Medicaid HMO DRG,29962,,125% x Medicaid HMO amount,29962,Other,125% of NY Medicaid HMO DRG,0.01,102249,
Cardiac valve procedures w/o AMI or complex PDX,163-3,APR-DRG,,,,,,,,inpatient,,,770325.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54567,,186% x Medicaid HMO amount,54567,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,125613,,"27,634 x DRG Weight",125613,Other,DRG Base Rate x DRG Weight,106767,,"23,488 x DRG Weight",106767,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29337.21,,DRG base rate x DRG weight + capital per discharge,29337.21,Other,100% of NY Medicaid HMO DRG,29337,,DRG base rate x DRG weight + capital per discharge,29337,Other,100% of NY Medicaid HMO DRG,29337,,DRG base rate x DRG weight + capital per discharge,29337,Other,100% of NY Medicaid HMO DRG,29337,,DRG base rate x DRG weight + capital per discharge,29337,Other,100% of NY Medicaid HMO DRG,66009,,225% x Medicaid HMO amount,66009,Other,225% of NY Medicaid HMO DRG,44886,,153% x Medicaid HMO amount,44886,Other,153% of NY Medicaid HMO DRG,66009,,225% x Medicaid HMO amount,66009,Other,225% of NY Medicaid HMO DRG,41072,,140% x Medicaid HMO amount,41072,Other,140% of NY Medicaid HMO DRG,66009,,DRG base rate x DRG weight + capital per discharge,66009,Other,225% of NY Medicaid HMO DRG,80677,,275% x Medicaid HMO amount,80677,Other,275% of NY Medicaid HMO DRG,95053,,324% x Medicaid HMO amount,95053,Other,324% of NY Medicaid HMO DRG,63075,,215% x Medicaid HMO amount,63075,Other,215% of NY Medicaid HMO DRG,63075,,215% x Medicaid HMO amount,63075,Other,215% of NY Medicaid HMO DRG,36672,,125% x Medicaid HMO amount,36672,Other,125% of NY Medicaid HMO DRG,0.01,125613,
Cardiac valve procedures w/o AMI or complex PDX,163-4,APR-DRG,,,,,,,,inpatient,,,922959.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,84111,,186% x Medicaid HMO amount,84111,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,194737,,"27,634 x DRG Weight",194737,Other,DRG Base Rate x DRG Weight,165520,,"23,488 x DRG Weight",165520,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45221.21,,DRG base rate x DRG weight + capital per discharge,45221.21,Other,100% of NY Medicaid HMO DRG,45221,,DRG base rate x DRG weight + capital per discharge,45221,Other,100% of NY Medicaid HMO DRG,45221,,DRG base rate x DRG weight + capital per discharge,45221,Other,100% of NY Medicaid HMO DRG,45221,,DRG base rate x DRG weight + capital per discharge,45221,Other,100% of NY Medicaid HMO DRG,101748,,225% x Medicaid HMO amount,101748,Other,225% of NY Medicaid HMO DRG,69188,,153% x Medicaid HMO amount,69188,Other,153% of NY Medicaid HMO DRG,101748,,225% x Medicaid HMO amount,101748,Other,225% of NY Medicaid HMO DRG,63310,,140% x Medicaid HMO amount,63310,Other,140% of NY Medicaid HMO DRG,101748,,DRG base rate x DRG weight + capital per discharge,101748,Other,225% of NY Medicaid HMO DRG,124358,,275% x Medicaid HMO amount,124358,Other,275% of NY Medicaid HMO DRG,146517,,324% x Medicaid HMO amount,146517,Other,324% of NY Medicaid HMO DRG,97226,,215% x Medicaid HMO amount,97226,Other,215% of NY Medicaid HMO DRG,97226,,215% x Medicaid HMO amount,97226,Other,215% of NY Medicaid HMO DRG,56527,,125% x Medicaid HMO amount,56527,Other,125% of NY Medicaid HMO DRG,0.01,194737,
Coronary bypass w AMI or complex PDX,165-1,APR-DRG,,,,,,,,inpatient,,,498912.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47339,,186% x Medicaid HMO amount,47339,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,108698,,"27,634 x DRG Weight",108698,Other,DRG Base Rate x DRG Weight,92390,,"23,488 x DRG Weight",92390,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25451.21,,DRG base rate x DRG weight + capital per discharge,25451.21,Other,100% of NY Medicaid HMO DRG,25451,,DRG base rate x DRG weight + capital per discharge,25451,Other,100% of NY Medicaid HMO DRG,25451,,DRG base rate x DRG weight + capital per discharge,25451,Other,100% of NY Medicaid HMO DRG,25451,,DRG base rate x DRG weight + capital per discharge,25451,Other,100% of NY Medicaid HMO DRG,57265,,225% x Medicaid HMO amount,57265,Other,225% of NY Medicaid HMO DRG,38940,,153% x Medicaid HMO amount,38940,Other,153% of NY Medicaid HMO DRG,57265,,225% x Medicaid HMO amount,57265,Other,225% of NY Medicaid HMO DRG,35632,,140% x Medicaid HMO amount,35632,Other,140% of NY Medicaid HMO DRG,57265,,DRG base rate x DRG weight + capital per discharge,57265,Other,225% of NY Medicaid HMO DRG,69991,,275% x Medicaid HMO amount,69991,Other,275% of NY Medicaid HMO DRG,82462,,324% x Medicaid HMO amount,82462,Other,324% of NY Medicaid HMO DRG,54720,,215% x Medicaid HMO amount,54720,Other,215% of NY Medicaid HMO DRG,54720,,215% x Medicaid HMO amount,54720,Other,215% of NY Medicaid HMO DRG,31814,,125% x Medicaid HMO amount,31814,Other,125% of NY Medicaid HMO DRG,0.01,108698,
Coronary bypass w AMI or complex PDX,165-2,APR-DRG,,,,,,,,inpatient,,,498912.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47497,,186% x Medicaid HMO amount,47497,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,109071,,"27,634 x DRG Weight",109071,Other,DRG Base Rate x DRG Weight,92707,,"23,488 x DRG Weight",92707,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25536.21,,DRG base rate x DRG weight + capital per discharge,25536.21,Other,100% of NY Medicaid HMO DRG,25536,,DRG base rate x DRG weight + capital per discharge,25536,Other,100% of NY Medicaid HMO DRG,25536,,DRG base rate x DRG weight + capital per discharge,25536,Other,100% of NY Medicaid HMO DRG,25536,,DRG base rate x DRG weight + capital per discharge,25536,Other,100% of NY Medicaid HMO DRG,57456,,225% x Medicaid HMO amount,57456,Other,225% of NY Medicaid HMO DRG,39070,,153% x Medicaid HMO amount,39070,Other,153% of NY Medicaid HMO DRG,57456,,225% x Medicaid HMO amount,57456,Other,225% of NY Medicaid HMO DRG,35751,,140% x Medicaid HMO amount,35751,Other,140% of NY Medicaid HMO DRG,57456,,DRG base rate x DRG weight + capital per discharge,57456,Other,225% of NY Medicaid HMO DRG,70225,,275% x Medicaid HMO amount,70225,Other,275% of NY Medicaid HMO DRG,82737,,324% x Medicaid HMO amount,82737,Other,324% of NY Medicaid HMO DRG,54903,,215% x Medicaid HMO amount,54903,Other,215% of NY Medicaid HMO DRG,54903,,215% x Medicaid HMO amount,54903,Other,215% of NY Medicaid HMO DRG,31920,,125% x Medicaid HMO amount,31920,Other,125% of NY Medicaid HMO DRG,0.01,109071,
Coronary bypass w AMI or complex PDX,165-3,APR-DRG,,,,,,,,inpatient,,,722596.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58298,,186% x Medicaid HMO amount,58298,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,134340,,"27,634 x DRG Weight",134340,Other,DRG Base Rate x DRG Weight,114185,,"23,488 x DRG Weight",114185,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31343.21,,DRG base rate x DRG weight + capital per discharge,31343.21,Other,100% of NY Medicaid HMO DRG,31343,,DRG base rate x DRG weight + capital per discharge,31343,Other,100% of NY Medicaid HMO DRG,31343,,DRG base rate x DRG weight + capital per discharge,31343,Other,100% of NY Medicaid HMO DRG,31343,,DRG base rate x DRG weight + capital per discharge,31343,Other,100% of NY Medicaid HMO DRG,70522,,225% x Medicaid HMO amount,70522,Other,225% of NY Medicaid HMO DRG,47955,,153% x Medicaid HMO amount,47955,Other,153% of NY Medicaid HMO DRG,70522,,225% x Medicaid HMO amount,70522,Other,225% of NY Medicaid HMO DRG,43880,,140% x Medicaid HMO amount,43880,Other,140% of NY Medicaid HMO DRG,70522,,DRG base rate x DRG weight + capital per discharge,70522,Other,225% of NY Medicaid HMO DRG,86194,,275% x Medicaid HMO amount,86194,Other,275% of NY Medicaid HMO DRG,101552,,324% x Medicaid HMO amount,101552,Other,324% of NY Medicaid HMO DRG,67388,,215% x Medicaid HMO amount,67388,Other,215% of NY Medicaid HMO DRG,67388,,215% x Medicaid HMO amount,67388,Other,215% of NY Medicaid HMO DRG,39179,,125% x Medicaid HMO amount,39179,Other,125% of NY Medicaid HMO DRG,0.01,134340,
Coronary bypass w AMI or complex PDX,165-4,APR-DRG,,,,,,,,inpatient,,,1510877.43,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,84461,,186% x Medicaid HMO amount,84461,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,195555,,"27,634 x DRG Weight",195555,Other,DRG Base Rate x DRG Weight,166215,,"23,488 x DRG Weight",166215,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45409.21,,DRG base rate x DRG weight + capital per discharge,45409.21,Other,100% of NY Medicaid HMO DRG,45409,,DRG base rate x DRG weight + capital per discharge,45409,Other,100% of NY Medicaid HMO DRG,45409,,DRG base rate x DRG weight + capital per discharge,45409,Other,100% of NY Medicaid HMO DRG,45409,,DRG base rate x DRG weight + capital per discharge,45409,Other,100% of NY Medicaid HMO DRG,102171,,225% x Medicaid HMO amount,102171,Other,225% of NY Medicaid HMO DRG,69476,,153% x Medicaid HMO amount,69476,Other,153% of NY Medicaid HMO DRG,102171,,225% x Medicaid HMO amount,102171,Other,225% of NY Medicaid HMO DRG,63573,,140% x Medicaid HMO amount,63573,Other,140% of NY Medicaid HMO DRG,102171,,DRG base rate x DRG weight + capital per discharge,102171,Other,225% of NY Medicaid HMO DRG,124875,,275% x Medicaid HMO amount,124875,Other,275% of NY Medicaid HMO DRG,147126,,324% x Medicaid HMO amount,147126,Other,324% of NY Medicaid HMO DRG,97630,,215% x Medicaid HMO amount,97630,Other,215% of NY Medicaid HMO DRG,97630,,215% x Medicaid HMO amount,97630,Other,215% of NY Medicaid HMO DRG,56762,,125% x Medicaid HMO amount,56762,Other,125% of NY Medicaid HMO DRG,0.01,195555,
Coronary bypass w/o AMI or complex PDX,166-1,APR-DRG,,,,,,,,inpatient,,,355089.76,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36356,,186% x Medicaid HMO amount,36356,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,83004,,"27,634 x DRG Weight",83004,Other,DRG Base Rate x DRG Weight,70551,,"23,488 x DRG Weight",70551,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19546.21,,DRG base rate x DRG weight + capital per discharge,19546.21,Other,100% of NY Medicaid HMO DRG,19546,,DRG base rate x DRG weight + capital per discharge,19546,Other,100% of NY Medicaid HMO DRG,19546,,DRG base rate x DRG weight + capital per discharge,19546,Other,100% of NY Medicaid HMO DRG,19546,,DRG base rate x DRG weight + capital per discharge,19546,Other,100% of NY Medicaid HMO DRG,43979,,225% x Medicaid HMO amount,43979,Other,225% of NY Medicaid HMO DRG,29906,,153% x Medicaid HMO amount,29906,Other,153% of NY Medicaid HMO DRG,43979,,225% x Medicaid HMO amount,43979,Other,225% of NY Medicaid HMO DRG,27365,,140% x Medicaid HMO amount,27365,Other,140% of NY Medicaid HMO DRG,43979,,DRG base rate x DRG weight + capital per discharge,43979,Other,225% of NY Medicaid HMO DRG,53752,,275% x Medicaid HMO amount,53752,Other,275% of NY Medicaid HMO DRG,63330,,324% x Medicaid HMO amount,63330,Other,324% of NY Medicaid HMO DRG,42024,,215% x Medicaid HMO amount,42024,Other,215% of NY Medicaid HMO DRG,42024,,215% x Medicaid HMO amount,42024,Other,215% of NY Medicaid HMO DRG,24433,,125% x Medicaid HMO amount,24433,Other,125% of NY Medicaid HMO DRG,0.01,83004,
Coronary bypass w/o AMI or complex PDX,166-2,APR-DRG,,,,,,,,inpatient,,,541172.91,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39402,,186% x Medicaid HMO amount,39402,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,90131,,"27,634 x DRG Weight",90131,Other,DRG Base Rate x DRG Weight,76608,,"23,488 x DRG Weight",76608,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21184.21,,DRG base rate x DRG weight + capital per discharge,21184.21,Other,100% of NY Medicaid HMO DRG,21184,,DRG base rate x DRG weight + capital per discharge,21184,Other,100% of NY Medicaid HMO DRG,21184,,DRG base rate x DRG weight + capital per discharge,21184,Other,100% of NY Medicaid HMO DRG,21184,,DRG base rate x DRG weight + capital per discharge,21184,Other,100% of NY Medicaid HMO DRG,47664,,225% x Medicaid HMO amount,47664,Other,225% of NY Medicaid HMO DRG,32412,,153% x Medicaid HMO amount,32412,Other,153% of NY Medicaid HMO DRG,47664,,225% x Medicaid HMO amount,47664,Other,225% of NY Medicaid HMO DRG,29658,,140% x Medicaid HMO amount,29658,Other,140% of NY Medicaid HMO DRG,47664,,DRG base rate x DRG weight + capital per discharge,47664,Other,225% of NY Medicaid HMO DRG,58257,,275% x Medicaid HMO amount,58257,Other,275% of NY Medicaid HMO DRG,68637,,324% x Medicaid HMO amount,68637,Other,324% of NY Medicaid HMO DRG,45546,,215% x Medicaid HMO amount,45546,Other,215% of NY Medicaid HMO DRG,45546,,215% x Medicaid HMO amount,45546,Other,215% of NY Medicaid HMO DRG,26480,,125% x Medicaid HMO amount,26480,Other,125% of NY Medicaid HMO DRG,0.01,90131,
Coronary bypass w/o AMI or complex PDX,166-3,APR-DRG,,,,,,,,inpatient,,,482321.88,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48310,,186% x Medicaid HMO amount,48310,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,110973,,"27,634 x DRG Weight",110973,Other,DRG Base Rate x DRG Weight,94323,,"23,488 x DRG Weight",94323,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25973.21,,DRG base rate x DRG weight + capital per discharge,25973.21,Other,100% of NY Medicaid HMO DRG,25973,,DRG base rate x DRG weight + capital per discharge,25973,Other,100% of NY Medicaid HMO DRG,25973,,DRG base rate x DRG weight + capital per discharge,25973,Other,100% of NY Medicaid HMO DRG,25973,,DRG base rate x DRG weight + capital per discharge,25973,Other,100% of NY Medicaid HMO DRG,58440,,225% x Medicaid HMO amount,58440,Other,225% of NY Medicaid HMO DRG,39739,,153% x Medicaid HMO amount,39739,Other,153% of NY Medicaid HMO DRG,58440,,225% x Medicaid HMO amount,58440,Other,225% of NY Medicaid HMO DRG,36362,,140% x Medicaid HMO amount,36362,Other,140% of NY Medicaid HMO DRG,58440,,DRG base rate x DRG weight + capital per discharge,58440,Other,225% of NY Medicaid HMO DRG,71426,,275% x Medicaid HMO amount,71426,Other,275% of NY Medicaid HMO DRG,84153,,324% x Medicaid HMO amount,84153,Other,324% of NY Medicaid HMO DRG,55842,,215% x Medicaid HMO amount,55842,Other,215% of NY Medicaid HMO DRG,55842,,215% x Medicaid HMO amount,55842,Other,215% of NY Medicaid HMO DRG,32467,,125% x Medicaid HMO amount,32467,Other,125% of NY Medicaid HMO DRG,0.01,110973,
Coronary bypass w/o AMI or complex PDX,166-4,APR-DRG,,,,,,,,inpatient,,,614887.93,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74476,,186% x Medicaid HMO amount,74476,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,172193,,"27,634 x DRG Weight",172193,Other,DRG Base Rate x DRG Weight,146358,,"23,488 x DRG Weight",146358,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40041.21,,DRG base rate x DRG weight + capital per discharge,40041.21,Other,100% of NY Medicaid HMO DRG,40041,,DRG base rate x DRG weight + capital per discharge,40041,Other,100% of NY Medicaid HMO DRG,40041,,DRG base rate x DRG weight + capital per discharge,40041,Other,100% of NY Medicaid HMO DRG,40041,,DRG base rate x DRG weight + capital per discharge,40041,Other,100% of NY Medicaid HMO DRG,90093,,225% x Medicaid HMO amount,90093,Other,225% of NY Medicaid HMO DRG,61263,,153% x Medicaid HMO amount,61263,Other,153% of NY Medicaid HMO DRG,90093,,225% x Medicaid HMO amount,90093,Other,225% of NY Medicaid HMO DRG,56058,,140% x Medicaid HMO amount,56058,Other,140% of NY Medicaid HMO DRG,90093,,DRG base rate x DRG weight + capital per discharge,90093,Other,225% of NY Medicaid HMO DRG,110113,,275% x Medicaid HMO amount,110113,Other,275% of NY Medicaid HMO DRG,129734,,324% x Medicaid HMO amount,129734,Other,324% of NY Medicaid HMO DRG,86089,,215% x Medicaid HMO amount,86089,Other,215% of NY Medicaid HMO DRG,86089,,215% x Medicaid HMO amount,86089,Other,215% of NY Medicaid HMO DRG,50052,,125% x Medicaid HMO amount,50052,Other,125% of NY Medicaid HMO DRG,0.01,172193,
Other cardiothoracic & thoracic vascular procedures,167-1,APR-DRG,,,,,,,,inpatient,,,196915.88,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29529,,186% x Medicaid HMO amount,29529,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,67032,,"27,634 x DRG Weight",67032,Other,DRG Base Rate x DRG Weight,56975,,"23,488 x DRG Weight",56975,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15876.21,,DRG base rate x DRG weight + capital per discharge,15876.21,Other,100% of NY Medicaid HMO DRG,15876,,DRG base rate x DRG weight + capital per discharge,15876,Other,100% of NY Medicaid HMO DRG,15876,,DRG base rate x DRG weight + capital per discharge,15876,Other,100% of NY Medicaid HMO DRG,15876,,DRG base rate x DRG weight + capital per discharge,15876,Other,100% of NY Medicaid HMO DRG,35721,,225% x Medicaid HMO amount,35721,Other,225% of NY Medicaid HMO DRG,24291,,153% x Medicaid HMO amount,24291,Other,153% of NY Medicaid HMO DRG,35721,,225% x Medicaid HMO amount,35721,Other,225% of NY Medicaid HMO DRG,22227,,140% x Medicaid HMO amount,22227,Other,140% of NY Medicaid HMO DRG,35721,,DRG base rate x DRG weight + capital per discharge,35721,Other,225% of NY Medicaid HMO DRG,43660,,275% x Medicaid HMO amount,43660,Other,275% of NY Medicaid HMO DRG,51439,,324% x Medicaid HMO amount,51439,Other,324% of NY Medicaid HMO DRG,34134,,215% x Medicaid HMO amount,34134,Other,215% of NY Medicaid HMO DRG,34134,,215% x Medicaid HMO amount,34134,Other,215% of NY Medicaid HMO DRG,19845,,125% x Medicaid HMO amount,19845,Other,125% of NY Medicaid HMO DRG,0.01,67032,
Other cardiothoracic & thoracic vascular procedures,167-2,APR-DRG,,,,,,,,inpatient,,,369975.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34419,,186% x Medicaid HMO amount,34419,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78472,,"27,634 x DRG Weight",78472,Other,DRG Base Rate x DRG Weight,66699,,"23,488 x DRG Weight",66699,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18505.21,,DRG base rate x DRG weight + capital per discharge,18505.21,Other,100% of NY Medicaid HMO DRG,18505,,DRG base rate x DRG weight + capital per discharge,18505,Other,100% of NY Medicaid HMO DRG,18505,,DRG base rate x DRG weight + capital per discharge,18505,Other,100% of NY Medicaid HMO DRG,18505,,DRG base rate x DRG weight + capital per discharge,18505,Other,100% of NY Medicaid HMO DRG,41637,,225% x Medicaid HMO amount,41637,Other,225% of NY Medicaid HMO DRG,28313,,153% x Medicaid HMO amount,28313,Other,153% of NY Medicaid HMO DRG,41637,,225% x Medicaid HMO amount,41637,Other,225% of NY Medicaid HMO DRG,25907,,140% x Medicaid HMO amount,25907,Other,140% of NY Medicaid HMO DRG,41637,,DRG base rate x DRG weight + capital per discharge,41637,Other,225% of NY Medicaid HMO DRG,50889,,275% x Medicaid HMO amount,50889,Other,275% of NY Medicaid HMO DRG,59957,,324% x Medicaid HMO amount,59957,Other,324% of NY Medicaid HMO DRG,39786,,215% x Medicaid HMO amount,39786,Other,215% of NY Medicaid HMO DRG,39786,,215% x Medicaid HMO amount,39786,Other,215% of NY Medicaid HMO DRG,23132,,125% x Medicaid HMO amount,23132,Other,125% of NY Medicaid HMO DRG,0.01,78472,
Other cardiothoracic & thoracic vascular procedures,167-3,APR-DRG,,,,,,,,inpatient,,,565606.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44359,,186% x Medicaid HMO amount,44359,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,101726,,"27,634 x DRG Weight",101726,Other,DRG Base Rate x DRG Weight,86464,,"23,488 x DRG Weight",86464,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23849.21,,DRG base rate x DRG weight + capital per discharge,23849.21,Other,100% of NY Medicaid HMO DRG,23849,,DRG base rate x DRG weight + capital per discharge,23849,Other,100% of NY Medicaid HMO DRG,23849,,DRG base rate x DRG weight + capital per discharge,23849,Other,100% of NY Medicaid HMO DRG,23849,,DRG base rate x DRG weight + capital per discharge,23849,Other,100% of NY Medicaid HMO DRG,53661,,225% x Medicaid HMO amount,53661,Other,225% of NY Medicaid HMO DRG,36489,,153% x Medicaid HMO amount,36489,Other,153% of NY Medicaid HMO DRG,53661,,225% x Medicaid HMO amount,53661,Other,225% of NY Medicaid HMO DRG,33389,,140% x Medicaid HMO amount,33389,Other,140% of NY Medicaid HMO DRG,53661,,DRG base rate x DRG weight + capital per discharge,53661,Other,225% of NY Medicaid HMO DRG,65585,,275% x Medicaid HMO amount,65585,Other,275% of NY Medicaid HMO DRG,77271,,324% x Medicaid HMO amount,77271,Other,324% of NY Medicaid HMO DRG,51276,,215% x Medicaid HMO amount,51276,Other,215% of NY Medicaid HMO DRG,51276,,215% x Medicaid HMO amount,51276,Other,215% of NY Medicaid HMO DRG,29812,,125% x Medicaid HMO amount,29812,Other,125% of NY Medicaid HMO DRG,0.01,101726,
Other cardiothoracic & thoracic vascular procedures,167-4,APR-DRG,,,,,,,,inpatient,,,1019180.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,79201,,186% x Medicaid HMO amount,79201,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,183247,,"27,634 x DRG Weight",183247,Other,DRG Base Rate x DRG Weight,155754,,"23,488 x DRG Weight",155754,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42581.21,,DRG base rate x DRG weight + capital per discharge,42581.21,Other,100% of NY Medicaid HMO DRG,42581,,DRG base rate x DRG weight + capital per discharge,42581,Other,100% of NY Medicaid HMO DRG,42581,,DRG base rate x DRG weight + capital per discharge,42581,Other,100% of NY Medicaid HMO DRG,42581,,DRG base rate x DRG weight + capital per discharge,42581,Other,100% of NY Medicaid HMO DRG,95808,,225% x Medicaid HMO amount,95808,Other,225% of NY Medicaid HMO DRG,65149,,153% x Medicaid HMO amount,65149,Other,153% of NY Medicaid HMO DRG,95808,,225% x Medicaid HMO amount,95808,Other,225% of NY Medicaid HMO DRG,59614,,140% x Medicaid HMO amount,59614,Other,140% of NY Medicaid HMO DRG,95808,,DRG base rate x DRG weight + capital per discharge,95808,Other,225% of NY Medicaid HMO DRG,117098,,275% x Medicaid HMO amount,117098,Other,275% of NY Medicaid HMO DRG,137963,,324% x Medicaid HMO amount,137963,Other,324% of NY Medicaid HMO DRG,91550,,215% x Medicaid HMO amount,91550,Other,215% of NY Medicaid HMO DRG,91550,,215% x Medicaid HMO amount,91550,Other,215% of NY Medicaid HMO DRG,53227,,125% x Medicaid HMO amount,53227,Other,125% of NY Medicaid HMO DRG,0.01,183247,
Major abdominal vascular procedures,169-1,APR-DRG,,,,,,,,inpatient,,,224037.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21942,,186% x Medicaid HMO amount,21942,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49280,,"27,634 x DRG Weight",49280,Other,DRG Base Rate x DRG Weight,41886,,"23,488 x DRG Weight",41886,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11797.21,,DRG base rate x DRG weight + capital per discharge,11797.21,Other,100% of NY Medicaid HMO DRG,11797,,DRG base rate x DRG weight + capital per discharge,11797,Other,100% of NY Medicaid HMO DRG,11797,,DRG base rate x DRG weight + capital per discharge,11797,Other,100% of NY Medicaid HMO DRG,11797,,DRG base rate x DRG weight + capital per discharge,11797,Other,100% of NY Medicaid HMO DRG,26544,,225% x Medicaid HMO amount,26544,Other,225% of NY Medicaid HMO DRG,18050,,153% x Medicaid HMO amount,18050,Other,153% of NY Medicaid HMO DRG,26544,,225% x Medicaid HMO amount,26544,Other,225% of NY Medicaid HMO DRG,16516,,140% x Medicaid HMO amount,16516,Other,140% of NY Medicaid HMO DRG,26544,,DRG base rate x DRG weight + capital per discharge,26544,Other,225% of NY Medicaid HMO DRG,32442,,275% x Medicaid HMO amount,32442,Other,275% of NY Medicaid HMO DRG,38223,,324% x Medicaid HMO amount,38223,Other,324% of NY Medicaid HMO DRG,25364,,215% x Medicaid HMO amount,25364,Other,215% of NY Medicaid HMO DRG,25364,,215% x Medicaid HMO amount,25364,Other,215% of NY Medicaid HMO DRG,14747,,125% x Medicaid HMO amount,14747,Other,125% of NY Medicaid HMO DRG,0.01,49280,
Major abdominal vascular procedures,169-2,APR-DRG,,,,,,,,inpatient,,,320855.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27907,,186% x Medicaid HMO amount,27907,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63238,,"27,634 x DRG Weight",63238,Other,DRG Base Rate x DRG Weight,53750,,"23,488 x DRG Weight",53750,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15004.21,,DRG base rate x DRG weight + capital per discharge,15004.21,Other,100% of NY Medicaid HMO DRG,15004,,DRG base rate x DRG weight + capital per discharge,15004,Other,100% of NY Medicaid HMO DRG,15004,,DRG base rate x DRG weight + capital per discharge,15004,Other,100% of NY Medicaid HMO DRG,15004,,DRG base rate x DRG weight + capital per discharge,15004,Other,100% of NY Medicaid HMO DRG,33759,,225% x Medicaid HMO amount,33759,Other,225% of NY Medicaid HMO DRG,22956,,153% x Medicaid HMO amount,22956,Other,153% of NY Medicaid HMO DRG,33759,,225% x Medicaid HMO amount,33759,Other,225% of NY Medicaid HMO DRG,21006,,140% x Medicaid HMO amount,21006,Other,140% of NY Medicaid HMO DRG,33759,,DRG base rate x DRG weight + capital per discharge,33759,Other,225% of NY Medicaid HMO DRG,41262,,275% x Medicaid HMO amount,41262,Other,275% of NY Medicaid HMO DRG,48614,,324% x Medicaid HMO amount,48614,Other,324% of NY Medicaid HMO DRG,32259,,215% x Medicaid HMO amount,32259,Other,215% of NY Medicaid HMO DRG,32259,,215% x Medicaid HMO amount,32259,Other,215% of NY Medicaid HMO DRG,18755,,125% x Medicaid HMO amount,18755,Other,125% of NY Medicaid HMO DRG,0.01,63238,
Major abdominal vascular procedures,169-3,APR-DRG,,,,,,,,inpatient,,,471431.61,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44763,,186% x Medicaid HMO amount,44763,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,102671,,"27,634 x DRG Weight",102671,Other,DRG Base Rate x DRG Weight,87267,,"23,488 x DRG Weight",87267,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24066.21,,DRG base rate x DRG weight + capital per discharge,24066.21,Other,100% of NY Medicaid HMO DRG,24066,,DRG base rate x DRG weight + capital per discharge,24066,Other,100% of NY Medicaid HMO DRG,24066,,DRG base rate x DRG weight + capital per discharge,24066,Other,100% of NY Medicaid HMO DRG,24066,,DRG base rate x DRG weight + capital per discharge,24066,Other,100% of NY Medicaid HMO DRG,54149,,225% x Medicaid HMO amount,54149,Other,225% of NY Medicaid HMO DRG,36821,,153% x Medicaid HMO amount,36821,Other,153% of NY Medicaid HMO DRG,54149,,225% x Medicaid HMO amount,54149,Other,225% of NY Medicaid HMO DRG,33693,,140% x Medicaid HMO amount,33693,Other,140% of NY Medicaid HMO DRG,54149,,DRG base rate x DRG weight + capital per discharge,54149,Other,225% of NY Medicaid HMO DRG,66182,,275% x Medicaid HMO amount,66182,Other,275% of NY Medicaid HMO DRG,77975,,324% x Medicaid HMO amount,77975,Other,324% of NY Medicaid HMO DRG,51742,,215% x Medicaid HMO amount,51742,Other,215% of NY Medicaid HMO DRG,51742,,215% x Medicaid HMO amount,51742,Other,215% of NY Medicaid HMO DRG,30083,,125% x Medicaid HMO amount,30083,Other,125% of NY Medicaid HMO DRG,0.01,102671,
Major abdominal vascular procedures,169-4,APR-DRG,,,,,,,,inpatient,,,1233181.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,85716,,186% x Medicaid HMO amount,85716,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,198492,,"27,634 x DRG Weight",198492,Other,DRG Base Rate x DRG Weight,168712,,"23,488 x DRG Weight",168712,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46084.21,,DRG base rate x DRG weight + capital per discharge,46084.21,Other,100% of NY Medicaid HMO DRG,46084,,DRG base rate x DRG weight + capital per discharge,46084,Other,100% of NY Medicaid HMO DRG,46084,,DRG base rate x DRG weight + capital per discharge,46084,Other,100% of NY Medicaid HMO DRG,46084,,DRG base rate x DRG weight + capital per discharge,46084,Other,100% of NY Medicaid HMO DRG,103689,,225% x Medicaid HMO amount,103689,Other,225% of NY Medicaid HMO DRG,70509,,153% x Medicaid HMO amount,70509,Other,153% of NY Medicaid HMO DRG,103689,,225% x Medicaid HMO amount,103689,Other,225% of NY Medicaid HMO DRG,64518,,140% x Medicaid HMO amount,64518,Other,140% of NY Medicaid HMO DRG,103689,,DRG base rate x DRG weight + capital per discharge,103689,Other,225% of NY Medicaid HMO DRG,126732,,275% x Medicaid HMO amount,126732,Other,275% of NY Medicaid HMO DRG,149313,,324% x Medicaid HMO amount,149313,Other,324% of NY Medicaid HMO DRG,99081,,215% x Medicaid HMO amount,99081,Other,215% of NY Medicaid HMO DRG,99081,,215% x Medicaid HMO amount,99081,Other,215% of NY Medicaid HMO DRG,57605,,125% x Medicaid HMO amount,57605,Other,125% of NY Medicaid HMO DRG,0.01,198492,
"Permanent cardiac pacemaker implant w AMI, heart failure or shock",170-1,APR-DRG,,,,,,,,inpatient,,,272579,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32835,,186% x Medicaid HMO amount,32835,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74767,,"27,634 x DRG Weight",74767,Other,DRG Base Rate x DRG Weight,63549,,"23,488 x DRG Weight",63549,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17653.21,,DRG base rate x DRG weight + capital per discharge,17653.21,Other,100% of NY Medicaid HMO DRG,17653,,DRG base rate x DRG weight + capital per discharge,17653,Other,100% of NY Medicaid HMO DRG,17653,,DRG base rate x DRG weight + capital per discharge,17653,Other,100% of NY Medicaid HMO DRG,17653,,DRG base rate x DRG weight + capital per discharge,17653,Other,100% of NY Medicaid HMO DRG,39720,,225% x Medicaid HMO amount,39720,Other,225% of NY Medicaid HMO DRG,27009,,153% x Medicaid HMO amount,27009,Other,153% of NY Medicaid HMO DRG,39720,,225% x Medicaid HMO amount,39720,Other,225% of NY Medicaid HMO DRG,24714,,140% x Medicaid HMO amount,24714,Other,140% of NY Medicaid HMO DRG,39720,,DRG base rate x DRG weight + capital per discharge,39720,Other,225% of NY Medicaid HMO DRG,48546,,275% x Medicaid HMO amount,48546,Other,275% of NY Medicaid HMO DRG,57196,,324% x Medicaid HMO amount,57196,Other,324% of NY Medicaid HMO DRG,37954,,215% x Medicaid HMO amount,37954,Other,215% of NY Medicaid HMO DRG,37954,,215% x Medicaid HMO amount,37954,Other,215% of NY Medicaid HMO DRG,22067,,125% x Medicaid HMO amount,22067,Other,125% of NY Medicaid HMO DRG,0.01,74767,
"Permanent cardiac pacemaker implant w AMI, heart failure or shock",170-2,APR-DRG,,,,,,,,inpatient,,,256944.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33188,,186% x Medicaid HMO amount,33188,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75590,,"27,634 x DRG Weight",75590,Other,DRG Base Rate x DRG Weight,64249,,"23,488 x DRG Weight",64249,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17843.21,,DRG base rate x DRG weight + capital per discharge,17843.21,Other,100% of NY Medicaid HMO DRG,17843,,DRG base rate x DRG weight + capital per discharge,17843,Other,100% of NY Medicaid HMO DRG,17843,,DRG base rate x DRG weight + capital per discharge,17843,Other,100% of NY Medicaid HMO DRG,17843,,DRG base rate x DRG weight + capital per discharge,17843,Other,100% of NY Medicaid HMO DRG,40147,,225% x Medicaid HMO amount,40147,Other,225% of NY Medicaid HMO DRG,27300,,153% x Medicaid HMO amount,27300,Other,153% of NY Medicaid HMO DRG,40147,,225% x Medicaid HMO amount,40147,Other,225% of NY Medicaid HMO DRG,24980,,140% x Medicaid HMO amount,24980,Other,140% of NY Medicaid HMO DRG,40147,,DRG base rate x DRG weight + capital per discharge,40147,Other,225% of NY Medicaid HMO DRG,49069,,275% x Medicaid HMO amount,49069,Other,275% of NY Medicaid HMO DRG,57812,,324% x Medicaid HMO amount,57812,Other,324% of NY Medicaid HMO DRG,38363,,215% x Medicaid HMO amount,38363,Other,215% of NY Medicaid HMO DRG,38363,,215% x Medicaid HMO amount,38363,Other,215% of NY Medicaid HMO DRG,22304,,125% x Medicaid HMO amount,22304,Other,125% of NY Medicaid HMO DRG,0.01,75590,
"Permanent cardiac pacemaker implant w AMI, heart failure or shock",170-3,APR-DRG,,,,,,,,inpatient,,,406911.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43435,,186% x Medicaid HMO amount,43435,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,99565,,"27,634 x DRG Weight",99565,Other,DRG Base Rate x DRG Weight,84627,,"23,488 x DRG Weight",84627,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23352.21,,DRG base rate x DRG weight + capital per discharge,23352.21,Other,100% of NY Medicaid HMO DRG,23352,,DRG base rate x DRG weight + capital per discharge,23352,Other,100% of NY Medicaid HMO DRG,23352,,DRG base rate x DRG weight + capital per discharge,23352,Other,100% of NY Medicaid HMO DRG,23352,,DRG base rate x DRG weight + capital per discharge,23352,Other,100% of NY Medicaid HMO DRG,52542,,225% x Medicaid HMO amount,52542,Other,225% of NY Medicaid HMO DRG,35729,,153% x Medicaid HMO amount,35729,Other,153% of NY Medicaid HMO DRG,52542,,225% x Medicaid HMO amount,52542,Other,225% of NY Medicaid HMO DRG,32693,,140% x Medicaid HMO amount,32693,Other,140% of NY Medicaid HMO DRG,52542,,DRG base rate x DRG weight + capital per discharge,52542,Other,225% of NY Medicaid HMO DRG,64219,,275% x Medicaid HMO amount,64219,Other,275% of NY Medicaid HMO DRG,75661,,324% x Medicaid HMO amount,75661,Other,324% of NY Medicaid HMO DRG,50207,,215% x Medicaid HMO amount,50207,Other,215% of NY Medicaid HMO DRG,50207,,215% x Medicaid HMO amount,50207,Other,215% of NY Medicaid HMO DRG,29190,,125% x Medicaid HMO amount,29190,Other,125% of NY Medicaid HMO DRG,0.01,99565,
"Permanent cardiac pacemaker implant w AMI, heart failure or shock",170-4,APR-DRG,,,,,,,,inpatient,,,406911.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57720,,186% x Medicaid HMO amount,57720,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,132989,,"27,634 x DRG Weight",132989,Other,DRG Base Rate x DRG Weight,113036,,"23,488 x DRG Weight",113036,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31032.21,,DRG base rate x DRG weight + capital per discharge,31032.21,Other,100% of NY Medicaid HMO DRG,31032,,DRG base rate x DRG weight + capital per discharge,31032,Other,100% of NY Medicaid HMO DRG,31032,,DRG base rate x DRG weight + capital per discharge,31032,Other,100% of NY Medicaid HMO DRG,31032,,DRG base rate x DRG weight + capital per discharge,31032,Other,100% of NY Medicaid HMO DRG,69822,,225% x Medicaid HMO amount,69822,Other,225% of NY Medicaid HMO DRG,47479,,153% x Medicaid HMO amount,47479,Other,153% of NY Medicaid HMO DRG,69822,,225% x Medicaid HMO amount,69822,Other,225% of NY Medicaid HMO DRG,43445,,140% x Medicaid HMO amount,43445,Other,140% of NY Medicaid HMO DRG,69822,,DRG base rate x DRG weight + capital per discharge,69822,Other,225% of NY Medicaid HMO DRG,85339,,275% x Medicaid HMO amount,85339,Other,275% of NY Medicaid HMO DRG,100544,,324% x Medicaid HMO amount,100544,Other,324% of NY Medicaid HMO DRG,66719,,215% x Medicaid HMO amount,66719,Other,215% of NY Medicaid HMO DRG,66719,,215% x Medicaid HMO amount,66719,Other,215% of NY Medicaid HMO DRG,38790,,125% x Medicaid HMO amount,38790,Other,125% of NY Medicaid HMO DRG,0.01,132989,
"Perm cardiac pacemaker implant w/o AMI, heart failure or shock",171-1,APR-DRG,,,,,,,,inpatient,,,272579,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21429,,186% x Medicaid HMO amount,21429,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48078,,"27,634 x DRG Weight",48078,Other,DRG Base Rate x DRG Weight,40864,,"23,488 x DRG Weight",40864,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11521.21,,DRG base rate x DRG weight + capital per discharge,11521.21,Other,100% of NY Medicaid HMO DRG,11521,,DRG base rate x DRG weight + capital per discharge,11521,Other,100% of NY Medicaid HMO DRG,11521,,DRG base rate x DRG weight + capital per discharge,11521,Other,100% of NY Medicaid HMO DRG,11521,,DRG base rate x DRG weight + capital per discharge,11521,Other,100% of NY Medicaid HMO DRG,25923,,225% x Medicaid HMO amount,25923,Other,225% of NY Medicaid HMO DRG,17627,,153% x Medicaid HMO amount,17627,Other,153% of NY Medicaid HMO DRG,25923,,225% x Medicaid HMO amount,25923,Other,225% of NY Medicaid HMO DRG,16130,,140% x Medicaid HMO amount,16130,Other,140% of NY Medicaid HMO DRG,25923,,DRG base rate x DRG weight + capital per discharge,25923,Other,225% of NY Medicaid HMO DRG,31683,,275% x Medicaid HMO amount,31683,Other,275% of NY Medicaid HMO DRG,37329,,324% x Medicaid HMO amount,37329,Other,324% of NY Medicaid HMO DRG,24771,,215% x Medicaid HMO amount,24771,Other,215% of NY Medicaid HMO DRG,24771,,215% x Medicaid HMO amount,24771,Other,215% of NY Medicaid HMO DRG,14402,,125% x Medicaid HMO amount,14402,Other,125% of NY Medicaid HMO DRG,0.01,48078,
"Perm cardiac pacemaker implant w/o AMI, heart failure or shock",171-2,APR-DRG,,,,,,,,inpatient,,,256944.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26202,,186% x Medicaid HMO amount,26202,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59247,,"27,634 x DRG Weight",59247,Other,DRG Base Rate x DRG Weight,50358,,"23,488 x DRG Weight",50358,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14087.21,,DRG base rate x DRG weight + capital per discharge,14087.21,Other,100% of NY Medicaid HMO DRG,14087,,DRG base rate x DRG weight + capital per discharge,14087,Other,100% of NY Medicaid HMO DRG,14087,,DRG base rate x DRG weight + capital per discharge,14087,Other,100% of NY Medicaid HMO DRG,14087,,DRG base rate x DRG weight + capital per discharge,14087,Other,100% of NY Medicaid HMO DRG,31696,,225% x Medicaid HMO amount,31696,Other,225% of NY Medicaid HMO DRG,21553,,153% x Medicaid HMO amount,21553,Other,153% of NY Medicaid HMO DRG,31696,,225% x Medicaid HMO amount,31696,Other,225% of NY Medicaid HMO DRG,19722,,140% x Medicaid HMO amount,19722,Other,140% of NY Medicaid HMO DRG,31696,,DRG base rate x DRG weight + capital per discharge,31696,Other,225% of NY Medicaid HMO DRG,38740,,275% x Medicaid HMO amount,38740,Other,275% of NY Medicaid HMO DRG,45643,,324% x Medicaid HMO amount,45643,Other,324% of NY Medicaid HMO DRG,30288,,215% x Medicaid HMO amount,30288,Other,215% of NY Medicaid HMO DRG,30288,,215% x Medicaid HMO amount,30288,Other,215% of NY Medicaid HMO DRG,17609,,125% x Medicaid HMO amount,17609,Other,125% of NY Medicaid HMO DRG,0.01,59247,
"Perm cardiac pacemaker implant w/o AMI, heart failure or shock",171-3,APR-DRG,,,,,,,,inpatient,,,406911.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36170,,186% x Medicaid HMO amount,36170,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,82568,,"27,634 x DRG Weight",82568,Other,DRG Base Rate x DRG Weight,70180,,"23,488 x DRG Weight",70180,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19446.21,,DRG base rate x DRG weight + capital per discharge,19446.21,Other,100% of NY Medicaid HMO DRG,19446,,DRG base rate x DRG weight + capital per discharge,19446,Other,100% of NY Medicaid HMO DRG,19446,,DRG base rate x DRG weight + capital per discharge,19446,Other,100% of NY Medicaid HMO DRG,19446,,DRG base rate x DRG weight + capital per discharge,19446,Other,100% of NY Medicaid HMO DRG,43754,,225% x Medicaid HMO amount,43754,Other,225% of NY Medicaid HMO DRG,29753,,153% x Medicaid HMO amount,29753,Other,153% of NY Medicaid HMO DRG,43754,,225% x Medicaid HMO amount,43754,Other,225% of NY Medicaid HMO DRG,27225,,140% x Medicaid HMO amount,27225,Other,140% of NY Medicaid HMO DRG,43754,,DRG base rate x DRG weight + capital per discharge,43754,Other,225% of NY Medicaid HMO DRG,53477,,275% x Medicaid HMO amount,53477,Other,275% of NY Medicaid HMO DRG,63006,,324% x Medicaid HMO amount,63006,Other,324% of NY Medicaid HMO DRG,41809,,215% x Medicaid HMO amount,41809,Other,215% of NY Medicaid HMO DRG,41809,,215% x Medicaid HMO amount,41809,Other,215% of NY Medicaid HMO DRG,24308,,125% x Medicaid HMO amount,24308,Other,125% of NY Medicaid HMO DRG,0.01,82568,
"Perm cardiac pacemaker implant w/o AMI, heart failure or shock",171-4,APR-DRG,,,,,,,,inpatient,,,406911.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,71318,,186% x Medicaid HMO amount,71318,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,164804,,"27,634 x DRG Weight",164804,Other,DRG Base Rate x DRG Weight,140078,,"23,488 x DRG Weight",140078,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38343.21,,DRG base rate x DRG weight + capital per discharge,38343.21,Other,100% of NY Medicaid HMO DRG,38343,,DRG base rate x DRG weight + capital per discharge,38343,Other,100% of NY Medicaid HMO DRG,38343,,DRG base rate x DRG weight + capital per discharge,38343,Other,100% of NY Medicaid HMO DRG,38343,,DRG base rate x DRG weight + capital per discharge,38343,Other,100% of NY Medicaid HMO DRG,86272,,225% x Medicaid HMO amount,86272,Other,225% of NY Medicaid HMO DRG,58665,,153% x Medicaid HMO amount,58665,Other,153% of NY Medicaid HMO DRG,86272,,225% x Medicaid HMO amount,86272,Other,225% of NY Medicaid HMO DRG,53680,,140% x Medicaid HMO amount,53680,Other,140% of NY Medicaid HMO DRG,86272,,DRG base rate x DRG weight + capital per discharge,86272,Other,225% of NY Medicaid HMO DRG,105444,,275% x Medicaid HMO amount,105444,Other,275% of NY Medicaid HMO DRG,124232,,324% x Medicaid HMO amount,124232,Other,324% of NY Medicaid HMO DRG,82438,,215% x Medicaid HMO amount,82438,Other,215% of NY Medicaid HMO DRG,82438,,215% x Medicaid HMO amount,82438,Other,215% of NY Medicaid HMO DRG,47929,,125% x Medicaid HMO amount,47929,Other,125% of NY Medicaid HMO DRG,0.01,164804,
Percutaneous coronary intervention w AMI,174-1,APR-DRG,,,,,,,,inpatient,,,179858.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21727,,186% x Medicaid HMO amount,21727,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48774,,"27,634 x DRG Weight",48774,Other,DRG Base Rate x DRG Weight,41456,,"23,488 x DRG Weight",41456,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11681.21,,DRG base rate x DRG weight + capital per discharge,11681.21,Other,100% of NY Medicaid HMO DRG,11681,,DRG base rate x DRG weight + capital per discharge,11681,Other,100% of NY Medicaid HMO DRG,11681,,DRG base rate x DRG weight + capital per discharge,11681,Other,100% of NY Medicaid HMO DRG,11681,,DRG base rate x DRG weight + capital per discharge,11681,Other,100% of NY Medicaid HMO DRG,26283,,225% x Medicaid HMO amount,26283,Other,225% of NY Medicaid HMO DRG,17872,,153% x Medicaid HMO amount,17872,Other,153% of NY Medicaid HMO DRG,26283,,225% x Medicaid HMO amount,26283,Other,225% of NY Medicaid HMO DRG,16354,,140% x Medicaid HMO amount,16354,Other,140% of NY Medicaid HMO DRG,26283,,DRG base rate x DRG weight + capital per discharge,26283,Other,225% of NY Medicaid HMO DRG,32123,,275% x Medicaid HMO amount,32123,Other,275% of NY Medicaid HMO DRG,37847,,324% x Medicaid HMO amount,37847,Other,324% of NY Medicaid HMO DRG,25115,,215% x Medicaid HMO amount,25115,Other,215% of NY Medicaid HMO DRG,25115,,215% x Medicaid HMO amount,25115,Other,215% of NY Medicaid HMO DRG,14602,,125% x Medicaid HMO amount,14602,Other,125% of NY Medicaid HMO DRG,0.01,48774,
Percutaneous coronary intervention w AMI,174-2,APR-DRG,,,,,,,,inpatient,,,212603.48,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23821,,186% x Medicaid HMO amount,23821,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53674,,"27,634 x DRG Weight",53674,Other,DRG Base Rate x DRG Weight,45621,,"23,488 x DRG Weight",45621,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12807.21,,DRG base rate x DRG weight + capital per discharge,12807.21,Other,100% of NY Medicaid HMO DRG,12807,,DRG base rate x DRG weight + capital per discharge,12807,Other,100% of NY Medicaid HMO DRG,12807,,DRG base rate x DRG weight + capital per discharge,12807,Other,100% of NY Medicaid HMO DRG,12807,,DRG base rate x DRG weight + capital per discharge,12807,Other,100% of NY Medicaid HMO DRG,28816,,225% x Medicaid HMO amount,28816,Other,225% of NY Medicaid HMO DRG,19595,,153% x Medicaid HMO amount,19595,Other,153% of NY Medicaid HMO DRG,28816,,225% x Medicaid HMO amount,28816,Other,225% of NY Medicaid HMO DRG,17930,,140% x Medicaid HMO amount,17930,Other,140% of NY Medicaid HMO DRG,28816,,DRG base rate x DRG weight + capital per discharge,28816,Other,225% of NY Medicaid HMO DRG,35220,,275% x Medicaid HMO amount,35220,Other,275% of NY Medicaid HMO DRG,41495,,324% x Medicaid HMO amount,41495,Other,324% of NY Medicaid HMO DRG,27536,,215% x Medicaid HMO amount,27536,Other,215% of NY Medicaid HMO DRG,27536,,215% x Medicaid HMO amount,27536,Other,215% of NY Medicaid HMO DRG,16009,,125% x Medicaid HMO amount,16009,Other,125% of NY Medicaid HMO DRG,0.01,53674,
Percutaneous coronary intervention w AMI,174-3,APR-DRG,,,,,,,,inpatient,,,313907.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30484,,186% x Medicaid HMO amount,30484,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69262,,"27,634 x DRG Weight",69262,Other,DRG Base Rate x DRG Weight,58870,,"23,488 x DRG Weight",58870,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16389.21,,DRG base rate x DRG weight + capital per discharge,16389.21,Other,100% of NY Medicaid HMO DRG,16389,,DRG base rate x DRG weight + capital per discharge,16389,Other,100% of NY Medicaid HMO DRG,16389,,DRG base rate x DRG weight + capital per discharge,16389,Other,100% of NY Medicaid HMO DRG,16389,,DRG base rate x DRG weight + capital per discharge,16389,Other,100% of NY Medicaid HMO DRG,36876,,225% x Medicaid HMO amount,36876,Other,225% of NY Medicaid HMO DRG,25075,,153% x Medicaid HMO amount,25075,Other,153% of NY Medicaid HMO DRG,36876,,225% x Medicaid HMO amount,36876,Other,225% of NY Medicaid HMO DRG,22945,,140% x Medicaid HMO amount,22945,Other,140% of NY Medicaid HMO DRG,36876,,DRG base rate x DRG weight + capital per discharge,36876,Other,225% of NY Medicaid HMO DRG,45070,,275% x Medicaid HMO amount,45070,Other,275% of NY Medicaid HMO DRG,53101,,324% x Medicaid HMO amount,53101,Other,324% of NY Medicaid HMO DRG,35237,,215% x Medicaid HMO amount,35237,Other,215% of NY Medicaid HMO DRG,35237,,215% x Medicaid HMO amount,35237,Other,215% of NY Medicaid HMO DRG,20487,,125% x Medicaid HMO amount,20487,Other,125% of NY Medicaid HMO DRG,0.01,69262,
Percutaneous coronary intervention w AMI,174-4,APR-DRG,,,,,,,,inpatient,,,632784.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46102,,186% x Medicaid HMO amount,46102,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,105805,,"27,634 x DRG Weight",105805,Other,DRG Base Rate x DRG Weight,89931,,"23,488 x DRG Weight",89931,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24786.21,,DRG base rate x DRG weight + capital per discharge,24786.21,Other,100% of NY Medicaid HMO DRG,24786,,DRG base rate x DRG weight + capital per discharge,24786,Other,100% of NY Medicaid HMO DRG,24786,,DRG base rate x DRG weight + capital per discharge,24786,Other,100% of NY Medicaid HMO DRG,24786,,DRG base rate x DRG weight + capital per discharge,24786,Other,100% of NY Medicaid HMO DRG,55769,,225% x Medicaid HMO amount,55769,Other,225% of NY Medicaid HMO DRG,37923,,153% x Medicaid HMO amount,37923,Other,153% of NY Medicaid HMO DRG,55769,,225% x Medicaid HMO amount,55769,Other,225% of NY Medicaid HMO DRG,34701,,140% x Medicaid HMO amount,34701,Other,140% of NY Medicaid HMO DRG,55769,,DRG base rate x DRG weight + capital per discharge,55769,Other,225% of NY Medicaid HMO DRG,68162,,275% x Medicaid HMO amount,68162,Other,275% of NY Medicaid HMO DRG,80307,,324% x Medicaid HMO amount,80307,Other,324% of NY Medicaid HMO DRG,53290,,215% x Medicaid HMO amount,53290,Other,215% of NY Medicaid HMO DRG,53290,,215% x Medicaid HMO amount,53290,Other,215% of NY Medicaid HMO DRG,30983,,125% x Medicaid HMO amount,30983,Other,125% of NY Medicaid HMO DRG,0.01,105805,
Percutaneous coronary intervention w/o AMI,175-1,APR-DRG,,,,,,,,inpatient,,,201004.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18306,,186% x Medicaid HMO amount,18306,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40771,,"27,634 x DRG Weight",40771,Other,DRG Base Rate x DRG Weight,34654,,"23,488 x DRG Weight",34654,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9842.21,,DRG base rate x DRG weight + capital per discharge,9842.21,Other,100% of NY Medicaid HMO DRG,9842,,DRG base rate x DRG weight + capital per discharge,9842,Other,100% of NY Medicaid HMO DRG,9842,,DRG base rate x DRG weight + capital per discharge,9842,Other,100% of NY Medicaid HMO DRG,9842,,DRG base rate x DRG weight + capital per discharge,9842,Other,100% of NY Medicaid HMO DRG,22145,,225% x Medicaid HMO amount,22145,Other,225% of NY Medicaid HMO DRG,15059,,153% x Medicaid HMO amount,15059,Other,153% of NY Medicaid HMO DRG,22145,,225% x Medicaid HMO amount,22145,Other,225% of NY Medicaid HMO DRG,13779,,140% x Medicaid HMO amount,13779,Other,140% of NY Medicaid HMO DRG,22145,,DRG base rate x DRG weight + capital per discharge,22145,Other,225% of NY Medicaid HMO DRG,27066,,275% x Medicaid HMO amount,27066,Other,275% of NY Medicaid HMO DRG,31889,,324% x Medicaid HMO amount,31889,Other,324% of NY Medicaid HMO DRG,21161,,215% x Medicaid HMO amount,21161,Other,215% of NY Medicaid HMO DRG,21161,,215% x Medicaid HMO amount,21161,Other,215% of NY Medicaid HMO DRG,12303,,125% x Medicaid HMO amount,12303,Other,125% of NY Medicaid HMO DRG,0.01,40771,
Percutaneous coronary intervention w/o AMI,175-2,APR-DRG,,,,,,,,inpatient,,,455540.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20652,,186% x Medicaid HMO amount,20652,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46262,,"27,634 x DRG Weight",46262,Other,DRG Base Rate x DRG Weight,39321,,"23,488 x DRG Weight",39321,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11103.21,,DRG base rate x DRG weight + capital per discharge,11103.21,Other,100% of NY Medicaid HMO DRG,11103,,DRG base rate x DRG weight + capital per discharge,11103,Other,100% of NY Medicaid HMO DRG,11103,,DRG base rate x DRG weight + capital per discharge,11103,Other,100% of NY Medicaid HMO DRG,11103,,DRG base rate x DRG weight + capital per discharge,11103,Other,100% of NY Medicaid HMO DRG,24982,,225% x Medicaid HMO amount,24982,Other,225% of NY Medicaid HMO DRG,16988,,153% x Medicaid HMO amount,16988,Other,153% of NY Medicaid HMO DRG,24982,,225% x Medicaid HMO amount,24982,Other,225% of NY Medicaid HMO DRG,15544,,140% x Medicaid HMO amount,15544,Other,140% of NY Medicaid HMO DRG,24982,,DRG base rate x DRG weight + capital per discharge,24982,Other,225% of NY Medicaid HMO DRG,30534,,275% x Medicaid HMO amount,30534,Other,275% of NY Medicaid HMO DRG,35974,,324% x Medicaid HMO amount,35974,Other,324% of NY Medicaid HMO DRG,23872,,215% x Medicaid HMO amount,23872,Other,215% of NY Medicaid HMO DRG,23872,,215% x Medicaid HMO amount,23872,Other,215% of NY Medicaid HMO DRG,13879,,125% x Medicaid HMO amount,13879,Other,125% of NY Medicaid HMO DRG,0.01,46262,
Percutaneous coronary intervention w/o AMI,175-3,APR-DRG,,,,,,,,inpatient,,,339435.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29444,,186% x Medicaid HMO amount,29444,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,66830,,"27,634 x DRG Weight",66830,Other,DRG Base Rate x DRG Weight,56803,,"23,488 x DRG Weight",56803,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15830.21,,DRG base rate x DRG weight + capital per discharge,15830.21,Other,100% of NY Medicaid HMO DRG,15830,,DRG base rate x DRG weight + capital per discharge,15830,Other,100% of NY Medicaid HMO DRG,15830,,DRG base rate x DRG weight + capital per discharge,15830,Other,100% of NY Medicaid HMO DRG,15830,,DRG base rate x DRG weight + capital per discharge,15830,Other,100% of NY Medicaid HMO DRG,35618,,225% x Medicaid HMO amount,35618,Other,225% of NY Medicaid HMO DRG,24220,,153% x Medicaid HMO amount,24220,Other,153% of NY Medicaid HMO DRG,35618,,225% x Medicaid HMO amount,35618,Other,225% of NY Medicaid HMO DRG,22162,,140% x Medicaid HMO amount,22162,Other,140% of NY Medicaid HMO DRG,35618,,DRG base rate x DRG weight + capital per discharge,35618,Other,225% of NY Medicaid HMO DRG,43533,,275% x Medicaid HMO amount,43533,Other,275% of NY Medicaid HMO DRG,51290,,324% x Medicaid HMO amount,51290,Other,324% of NY Medicaid HMO DRG,34035,,215% x Medicaid HMO amount,34035,Other,215% of NY Medicaid HMO DRG,34035,,215% x Medicaid HMO amount,34035,Other,215% of NY Medicaid HMO DRG,19788,,125% x Medicaid HMO amount,19788,Other,125% of NY Medicaid HMO DRG,0.01,66830,
Percutaneous coronary intervention w/o AMI,175-4,APR-DRG,,,,,,,,inpatient,,,658090.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58880,,186% x Medicaid HMO amount,58880,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,135702,,"27,634 x DRG Weight",135702,Other,DRG Base Rate x DRG Weight,115343,,"23,488 x DRG Weight",115343,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31656.21,,DRG base rate x DRG weight + capital per discharge,31656.21,Other,100% of NY Medicaid HMO DRG,31656,,DRG base rate x DRG weight + capital per discharge,31656,Other,100% of NY Medicaid HMO DRG,31656,,DRG base rate x DRG weight + capital per discharge,31656,Other,100% of NY Medicaid HMO DRG,31656,,DRG base rate x DRG weight + capital per discharge,31656,Other,100% of NY Medicaid HMO DRG,71226,,225% x Medicaid HMO amount,71226,Other,225% of NY Medicaid HMO DRG,48434,,153% x Medicaid HMO amount,48434,Other,153% of NY Medicaid HMO DRG,71226,,225% x Medicaid HMO amount,71226,Other,225% of NY Medicaid HMO DRG,44319,,140% x Medicaid HMO amount,44319,Other,140% of NY Medicaid HMO DRG,71226,,DRG base rate x DRG weight + capital per discharge,71226,Other,225% of NY Medicaid HMO DRG,87055,,275% x Medicaid HMO amount,87055,Other,275% of NY Medicaid HMO DRG,102566,,324% x Medicaid HMO amount,102566,Other,324% of NY Medicaid HMO DRG,68061,,215% x Medicaid HMO amount,68061,Other,215% of NY Medicaid HMO DRG,68061,,215% x Medicaid HMO amount,68061,Other,215% of NY Medicaid HMO DRG,39570,,125% x Medicaid HMO amount,39570,Other,125% of NY Medicaid HMO DRG,0.01,135702,
Cardiac pacemaker & defibrillator device replacement,176-1,APR-DRG,,,,,,,,inpatient,,,449127.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17804,,186% x Medicaid HMO amount,17804,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39597,,"27,634 x DRG Weight",39597,Other,DRG Base Rate x DRG Weight,33656,,"23,488 x DRG Weight",33656,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9572.21,,DRG base rate x DRG weight + capital per discharge,9572.21,Other,100% of NY Medicaid HMO DRG,9572,,DRG base rate x DRG weight + capital per discharge,9572,Other,100% of NY Medicaid HMO DRG,9572,,DRG base rate x DRG weight + capital per discharge,9572,Other,100% of NY Medicaid HMO DRG,9572,,DRG base rate x DRG weight + capital per discharge,9572,Other,100% of NY Medicaid HMO DRG,21537,,225% x Medicaid HMO amount,21537,Other,225% of NY Medicaid HMO DRG,14645,,153% x Medicaid HMO amount,14645,Other,153% of NY Medicaid HMO DRG,21537,,225% x Medicaid HMO amount,21537,Other,225% of NY Medicaid HMO DRG,13401,,140% x Medicaid HMO amount,13401,Other,140% of NY Medicaid HMO DRG,21537,,DRG base rate x DRG weight + capital per discharge,21537,Other,225% of NY Medicaid HMO DRG,26324,,275% x Medicaid HMO amount,26324,Other,275% of NY Medicaid HMO DRG,31014,,324% x Medicaid HMO amount,31014,Other,324% of NY Medicaid HMO DRG,20580,,215% x Medicaid HMO amount,20580,Other,215% of NY Medicaid HMO DRG,20580,,215% x Medicaid HMO amount,20580,Other,215% of NY Medicaid HMO DRG,11965,,125% x Medicaid HMO amount,11965,Other,125% of NY Medicaid HMO DRG,0.01,39597,
Cardiac pacemaker & defibrillator device replacement,176-2,APR-DRG,,,,,,,,inpatient,,,449127.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32065,,186% x Medicaid HMO amount,32065,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72965,,"27,634 x DRG Weight",72965,Other,DRG Base Rate x DRG Weight,62018,,"23,488 x DRG Weight",62018,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17239.21,,DRG base rate x DRG weight + capital per discharge,17239.21,Other,100% of NY Medicaid HMO DRG,17239,,DRG base rate x DRG weight + capital per discharge,17239,Other,100% of NY Medicaid HMO DRG,17239,,DRG base rate x DRG weight + capital per discharge,17239,Other,100% of NY Medicaid HMO DRG,17239,,DRG base rate x DRG weight + capital per discharge,17239,Other,100% of NY Medicaid HMO DRG,38788,,225% x Medicaid HMO amount,38788,Other,225% of NY Medicaid HMO DRG,26376,,153% x Medicaid HMO amount,26376,Other,153% of NY Medicaid HMO DRG,38788,,225% x Medicaid HMO amount,38788,Other,225% of NY Medicaid HMO DRG,24135,,140% x Medicaid HMO amount,24135,Other,140% of NY Medicaid HMO DRG,38788,,DRG base rate x DRG weight + capital per discharge,38788,Other,225% of NY Medicaid HMO DRG,47408,,275% x Medicaid HMO amount,47408,Other,275% of NY Medicaid HMO DRG,55855,,324% x Medicaid HMO amount,55855,Other,324% of NY Medicaid HMO DRG,37064,,215% x Medicaid HMO amount,37064,Other,215% of NY Medicaid HMO DRG,37064,,215% x Medicaid HMO amount,37064,Other,215% of NY Medicaid HMO DRG,21549,,125% x Medicaid HMO amount,21549,Other,125% of NY Medicaid HMO DRG,0.01,72965,
Cardiac pacemaker & defibrillator device replacement,176-3,APR-DRG,,,,,,,,inpatient,,,500234,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40619,,186% x Medicaid HMO amount,40619,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,92977,,"27,634 x DRG Weight",92977,Other,DRG Base Rate x DRG Weight,79028,,"23,488 x DRG Weight",79028,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21838.21,,DRG base rate x DRG weight + capital per discharge,21838.21,Other,100% of NY Medicaid HMO DRG,21838,,DRG base rate x DRG weight + capital per discharge,21838,Other,100% of NY Medicaid HMO DRG,21838,,DRG base rate x DRG weight + capital per discharge,21838,Other,100% of NY Medicaid HMO DRG,21838,,DRG base rate x DRG weight + capital per discharge,21838,Other,100% of NY Medicaid HMO DRG,49136,,225% x Medicaid HMO amount,49136,Other,225% of NY Medicaid HMO DRG,33412,,153% x Medicaid HMO amount,33412,Other,153% of NY Medicaid HMO DRG,49136,,225% x Medicaid HMO amount,49136,Other,225% of NY Medicaid HMO DRG,30573,,140% x Medicaid HMO amount,30573,Other,140% of NY Medicaid HMO DRG,49136,,DRG base rate x DRG weight + capital per discharge,49136,Other,225% of NY Medicaid HMO DRG,60055,,275% x Medicaid HMO amount,60055,Other,275% of NY Medicaid HMO DRG,70756,,324% x Medicaid HMO amount,70756,Other,324% of NY Medicaid HMO DRG,46952,,215% x Medicaid HMO amount,46952,Other,215% of NY Medicaid HMO DRG,46952,,215% x Medicaid HMO amount,46952,Other,215% of NY Medicaid HMO DRG,27298,,125% x Medicaid HMO amount,27298,Other,125% of NY Medicaid HMO DRG,0.01,92977,
Cardiac pacemaker & defibrillator device replacement,176-4,APR-DRG,,,,,,,,inpatient,,,901458.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42821,,186% x Medicaid HMO amount,42821,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,98131,,"27,634 x DRG Weight",98131,Other,DRG Base Rate x DRG Weight,83408,,"23,488 x DRG Weight",83408,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23022.21,,DRG base rate x DRG weight + capital per discharge,23022.21,Other,100% of NY Medicaid HMO DRG,23022,,DRG base rate x DRG weight + capital per discharge,23022,Other,100% of NY Medicaid HMO DRG,23022,,DRG base rate x DRG weight + capital per discharge,23022,Other,100% of NY Medicaid HMO DRG,23022,,DRG base rate x DRG weight + capital per discharge,23022,Other,100% of NY Medicaid HMO DRG,51800,,225% x Medicaid HMO amount,51800,Other,225% of NY Medicaid HMO DRG,35224,,153% x Medicaid HMO amount,35224,Other,153% of NY Medicaid HMO DRG,51800,,225% x Medicaid HMO amount,51800,Other,225% of NY Medicaid HMO DRG,32231,,140% x Medicaid HMO amount,32231,Other,140% of NY Medicaid HMO DRG,51800,,DRG base rate x DRG weight + capital per discharge,51800,Other,225% of NY Medicaid HMO DRG,63311,,275% x Medicaid HMO amount,63311,Other,275% of NY Medicaid HMO DRG,74592,,324% x Medicaid HMO amount,74592,Other,324% of NY Medicaid HMO DRG,49498,,215% x Medicaid HMO amount,49498,Other,215% of NY Medicaid HMO DRG,49498,,215% x Medicaid HMO amount,49498,Other,215% of NY Medicaid HMO DRG,28778,,125% x Medicaid HMO amount,28778,Other,125% of NY Medicaid HMO DRG,0.01,98131,
Cardiac pacemaker & defibrillator revision except device replacement,177-1,APR-DRG,,,,,,,,inpatient,,,157007,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17346,,186% x Medicaid HMO amount,17346,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38527,,"27,634 x DRG Weight",38527,Other,DRG Base Rate x DRG Weight,32747,,"23,488 x DRG Weight",32747,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9326.21,,DRG base rate x DRG weight + capital per discharge,9326.21,Other,100% of NY Medicaid HMO DRG,9326,,DRG base rate x DRG weight + capital per discharge,9326,Other,100% of NY Medicaid HMO DRG,9326,,DRG base rate x DRG weight + capital per discharge,9326,Other,100% of NY Medicaid HMO DRG,9326,,DRG base rate x DRG weight + capital per discharge,9326,Other,100% of NY Medicaid HMO DRG,20984,,225% x Medicaid HMO amount,20984,Other,225% of NY Medicaid HMO DRG,14269,,153% x Medicaid HMO amount,14269,Other,153% of NY Medicaid HMO DRG,20984,,225% x Medicaid HMO amount,20984,Other,225% of NY Medicaid HMO DRG,13057,,140% x Medicaid HMO amount,13057,Other,140% of NY Medicaid HMO DRG,20984,,DRG base rate x DRG weight + capital per discharge,20984,Other,225% of NY Medicaid HMO DRG,25647,,275% x Medicaid HMO amount,25647,Other,275% of NY Medicaid HMO DRG,30217,,324% x Medicaid HMO amount,30217,Other,324% of NY Medicaid HMO DRG,20051,,215% x Medicaid HMO amount,20051,Other,215% of NY Medicaid HMO DRG,20051,,215% x Medicaid HMO amount,20051,Other,215% of NY Medicaid HMO DRG,11658,,125% x Medicaid HMO amount,11658,Other,125% of NY Medicaid HMO DRG,0.01,38527,
Cardiac pacemaker & defibrillator revision except device replacement,177-2,APR-DRG,,,,,,,,inpatient,,,157007,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21516,,186% x Medicaid HMO amount,21516,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48282,,"27,634 x DRG Weight",48282,Other,DRG Base Rate x DRG Weight,41038,,"23,488 x DRG Weight",41038,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11568.21,,DRG base rate x DRG weight + capital per discharge,11568.21,Other,100% of NY Medicaid HMO DRG,11568,,DRG base rate x DRG weight + capital per discharge,11568,Other,100% of NY Medicaid HMO DRG,11568,,DRG base rate x DRG weight + capital per discharge,11568,Other,100% of NY Medicaid HMO DRG,11568,,DRG base rate x DRG weight + capital per discharge,11568,Other,100% of NY Medicaid HMO DRG,26028,,225% x Medicaid HMO amount,26028,Other,225% of NY Medicaid HMO DRG,17699,,153% x Medicaid HMO amount,17699,Other,153% of NY Medicaid HMO DRG,26028,,225% x Medicaid HMO amount,26028,Other,225% of NY Medicaid HMO DRG,16195,,140% x Medicaid HMO amount,16195,Other,140% of NY Medicaid HMO DRG,26028,,DRG base rate x DRG weight + capital per discharge,26028,Other,225% of NY Medicaid HMO DRG,31813,,275% x Medicaid HMO amount,31813,Other,275% of NY Medicaid HMO DRG,37481,,324% x Medicaid HMO amount,37481,Other,324% of NY Medicaid HMO DRG,24872,,215% x Medicaid HMO amount,24872,Other,215% of NY Medicaid HMO DRG,24872,,215% x Medicaid HMO amount,24872,Other,215% of NY Medicaid HMO DRG,14460,,125% x Medicaid HMO amount,14460,Other,125% of NY Medicaid HMO DRG,0.01,48282,
Cardiac pacemaker & defibrillator revision except device replacement,177-3,APR-DRG,,,,,,,,inpatient,,,348888.27,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32541,,186% x Medicaid HMO amount,32541,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74076,,"27,634 x DRG Weight",74076,Other,DRG Base Rate x DRG Weight,62962,,"23,488 x DRG Weight",62962,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17495.21,,DRG base rate x DRG weight + capital per discharge,17495.21,Other,100% of NY Medicaid HMO DRG,17495,,DRG base rate x DRG weight + capital per discharge,17495,Other,100% of NY Medicaid HMO DRG,17495,,DRG base rate x DRG weight + capital per discharge,17495,Other,100% of NY Medicaid HMO DRG,17495,,DRG base rate x DRG weight + capital per discharge,17495,Other,100% of NY Medicaid HMO DRG,39364,,225% x Medicaid HMO amount,39364,Other,225% of NY Medicaid HMO DRG,26768,,153% x Medicaid HMO amount,26768,Other,153% of NY Medicaid HMO DRG,39364,,225% x Medicaid HMO amount,39364,Other,225% of NY Medicaid HMO DRG,24493,,140% x Medicaid HMO amount,24493,Other,140% of NY Medicaid HMO DRG,39364,,DRG base rate x DRG weight + capital per discharge,39364,Other,225% of NY Medicaid HMO DRG,48112,,275% x Medicaid HMO amount,48112,Other,275% of NY Medicaid HMO DRG,56684,,324% x Medicaid HMO amount,56684,Other,324% of NY Medicaid HMO DRG,37615,,215% x Medicaid HMO amount,37615,Other,215% of NY Medicaid HMO DRG,37615,,215% x Medicaid HMO amount,37615,Other,215% of NY Medicaid HMO DRG,21869,,125% x Medicaid HMO amount,21869,Other,125% of NY Medicaid HMO DRG,0.01,74076,
Cardiac pacemaker & defibrillator revision except device replacement,177-4,APR-DRG,,,,,,,,inpatient,,,170896,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75698,,186% x Medicaid HMO amount,75698,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,175050,,"27,634 x DRG Weight",175050,Other,DRG Base Rate x DRG Weight,148787,,"23,488 x DRG Weight",148787,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40698.21,,DRG base rate x DRG weight + capital per discharge,40698.21,Other,100% of NY Medicaid HMO DRG,40698,,DRG base rate x DRG weight + capital per discharge,40698,Other,100% of NY Medicaid HMO DRG,40698,,DRG base rate x DRG weight + capital per discharge,40698,Other,100% of NY Medicaid HMO DRG,40698,,DRG base rate x DRG weight + capital per discharge,40698,Other,100% of NY Medicaid HMO DRG,91571,,225% x Medicaid HMO amount,91571,Other,225% of NY Medicaid HMO DRG,62268,,153% x Medicaid HMO amount,62268,Other,153% of NY Medicaid HMO DRG,91571,,225% x Medicaid HMO amount,91571,Other,225% of NY Medicaid HMO DRG,56977,,140% x Medicaid HMO amount,56977,Other,140% of NY Medicaid HMO DRG,91571,,DRG base rate x DRG weight + capital per discharge,91571,Other,225% of NY Medicaid HMO DRG,111920,,275% x Medicaid HMO amount,111920,Other,275% of NY Medicaid HMO DRG,131862,,324% x Medicaid HMO amount,131862,Other,324% of NY Medicaid HMO DRG,87501,,215% x Medicaid HMO amount,87501,Other,215% of NY Medicaid HMO DRG,87501,,215% x Medicaid HMO amount,87501,Other,215% of NY Medicaid HMO DRG,50873,,125% x Medicaid HMO amount,50873,Other,125% of NY Medicaid HMO DRG,0.01,175050,
Other circulatory system procedures,180-1,APR-DRG,,,,,,,,inpatient,,,333865.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14333,,186% x Medicaid HMO amount,14333,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31475,,"27,634 x DRG Weight",31475,Other,DRG Base Rate x DRG Weight,26753,,"23,488 x DRG Weight",26753,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7706.21,,DRG base rate x DRG weight + capital per discharge,7706.21,Other,100% of NY Medicaid HMO DRG,7706,,DRG base rate x DRG weight + capital per discharge,7706,Other,100% of NY Medicaid HMO DRG,7706,,DRG base rate x DRG weight + capital per discharge,7706,Other,100% of NY Medicaid HMO DRG,7706,,DRG base rate x DRG weight + capital per discharge,7706,Other,100% of NY Medicaid HMO DRG,17339,,225% x Medicaid HMO amount,17339,Other,225% of NY Medicaid HMO DRG,11791,,153% x Medicaid HMO amount,11791,Other,153% of NY Medicaid HMO DRG,17339,,225% x Medicaid HMO amount,17339,Other,225% of NY Medicaid HMO DRG,10789,,140% x Medicaid HMO amount,10789,Other,140% of NY Medicaid HMO DRG,17339,,DRG base rate x DRG weight + capital per discharge,17339,Other,225% of NY Medicaid HMO DRG,21192,,275% x Medicaid HMO amount,21192,Other,275% of NY Medicaid HMO DRG,24968,,324% x Medicaid HMO amount,24968,Other,324% of NY Medicaid HMO DRG,16568,,215% x Medicaid HMO amount,16568,Other,215% of NY Medicaid HMO DRG,16568,,215% x Medicaid HMO amount,16568,Other,215% of NY Medicaid HMO DRG,9633,,125% x Medicaid HMO amount,9633,Other,125% of NY Medicaid HMO DRG,0.01,31475,
Other circulatory system procedures,180-2,APR-DRG,,,,,,,,inpatient,,,333865.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20322,,186% x Medicaid HMO amount,20322,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45491,,"27,634 x DRG Weight",45491,Other,DRG Base Rate x DRG Weight,38666,,"23,488 x DRG Weight",38666,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10926.21,,DRG base rate x DRG weight + capital per discharge,10926.21,Other,100% of NY Medicaid HMO DRG,10926,,DRG base rate x DRG weight + capital per discharge,10926,Other,100% of NY Medicaid HMO DRG,10926,,DRG base rate x DRG weight + capital per discharge,10926,Other,100% of NY Medicaid HMO DRG,10926,,DRG base rate x DRG weight + capital per discharge,10926,Other,100% of NY Medicaid HMO DRG,24584,,225% x Medicaid HMO amount,24584,Other,225% of NY Medicaid HMO DRG,16717,,153% x Medicaid HMO amount,16717,Other,153% of NY Medicaid HMO DRG,24584,,225% x Medicaid HMO amount,24584,Other,225% of NY Medicaid HMO DRG,15297,,140% x Medicaid HMO amount,15297,Other,140% of NY Medicaid HMO DRG,24584,,DRG base rate x DRG weight + capital per discharge,24584,Other,225% of NY Medicaid HMO DRG,30047,,275% x Medicaid HMO amount,30047,Other,275% of NY Medicaid HMO DRG,35401,,324% x Medicaid HMO amount,35401,Other,324% of NY Medicaid HMO DRG,23491,,215% x Medicaid HMO amount,23491,Other,215% of NY Medicaid HMO DRG,23491,,215% x Medicaid HMO amount,23491,Other,215% of NY Medicaid HMO DRG,13658,,125% x Medicaid HMO amount,13658,Other,125% of NY Medicaid HMO DRG,0.01,45491,
Other circulatory system procedures,180-3,APR-DRG,,,,,,,,inpatient,,,305442.72,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29457,,186% x Medicaid HMO amount,29457,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,66860,,"27,634 x DRG Weight",66860,Other,DRG Base Rate x DRG Weight,56829,,"23,488 x DRG Weight",56829,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15837.21,,DRG base rate x DRG weight + capital per discharge,15837.21,Other,100% of NY Medicaid HMO DRG,15837,,DRG base rate x DRG weight + capital per discharge,15837,Other,100% of NY Medicaid HMO DRG,15837,,DRG base rate x DRG weight + capital per discharge,15837,Other,100% of NY Medicaid HMO DRG,15837,,DRG base rate x DRG weight + capital per discharge,15837,Other,100% of NY Medicaid HMO DRG,35634,,225% x Medicaid HMO amount,35634,Other,225% of NY Medicaid HMO DRG,24231,,153% x Medicaid HMO amount,24231,Other,153% of NY Medicaid HMO DRG,35634,,225% x Medicaid HMO amount,35634,Other,225% of NY Medicaid HMO DRG,22172,,140% x Medicaid HMO amount,22172,Other,140% of NY Medicaid HMO DRG,35634,,DRG base rate x DRG weight + capital per discharge,35634,Other,225% of NY Medicaid HMO DRG,43552,,275% x Medicaid HMO amount,43552,Other,275% of NY Medicaid HMO DRG,51313,,324% x Medicaid HMO amount,51313,Other,324% of NY Medicaid HMO DRG,34050,,215% x Medicaid HMO amount,34050,Other,215% of NY Medicaid HMO DRG,34050,,215% x Medicaid HMO amount,34050,Other,215% of NY Medicaid HMO DRG,19797,,125% x Medicaid HMO amount,19797,Other,125% of NY Medicaid HMO DRG,0.01,66860,
Other circulatory system procedures,180-4,APR-DRG,,,,,,,,inpatient,,,617103.78,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57798,,186% x Medicaid HMO amount,57798,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,133171,,"27,634 x DRG Weight",133171,Other,DRG Base Rate x DRG Weight,113191,,"23,488 x DRG Weight",113191,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31074.21,,DRG base rate x DRG weight + capital per discharge,31074.21,Other,100% of NY Medicaid HMO DRG,31074,,DRG base rate x DRG weight + capital per discharge,31074,Other,100% of NY Medicaid HMO DRG,31074,,DRG base rate x DRG weight + capital per discharge,31074,Other,100% of NY Medicaid HMO DRG,31074,,DRG base rate x DRG weight + capital per discharge,31074,Other,100% of NY Medicaid HMO DRG,69917,,225% x Medicaid HMO amount,69917,Other,225% of NY Medicaid HMO DRG,47544,,153% x Medicaid HMO amount,47544,Other,153% of NY Medicaid HMO DRG,69917,,225% x Medicaid HMO amount,69917,Other,225% of NY Medicaid HMO DRG,43504,,140% x Medicaid HMO amount,43504,Other,140% of NY Medicaid HMO DRG,69917,,DRG base rate x DRG weight + capital per discharge,69917,Other,225% of NY Medicaid HMO DRG,85454,,275% x Medicaid HMO amount,85454,Other,275% of NY Medicaid HMO DRG,100680,,324% x Medicaid HMO amount,100680,Other,324% of NY Medicaid HMO DRG,66810,,215% x Medicaid HMO amount,66810,Other,215% of NY Medicaid HMO DRG,66810,,215% x Medicaid HMO amount,66810,Other,215% of NY Medicaid HMO DRG,38843,,125% x Medicaid HMO amount,38843,Other,125% of NY Medicaid HMO DRG,0.01,133171,
Lower extremity arterial procedures #,181-1,APR-DRG,,,,,,,,inpatient,,,274129.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17828,,186% x Medicaid HMO amount,17828,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39655,,"27,634 x DRG Weight",39655,Other,DRG Base Rate x DRG Weight,33705,,"23,488 x DRG Weight",33705,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9585.21,,DRG base rate x DRG weight + capital per discharge,9585.21,Other,100% of NY Medicaid HMO DRG,9585,,DRG base rate x DRG weight + capital per discharge,9585,Other,100% of NY Medicaid HMO DRG,9585,,DRG base rate x DRG weight + capital per discharge,9585,Other,100% of NY Medicaid HMO DRG,9585,,DRG base rate x DRG weight + capital per discharge,9585,Other,100% of NY Medicaid HMO DRG,21567,,225% x Medicaid HMO amount,21567,Other,225% of NY Medicaid HMO DRG,14665,,153% x Medicaid HMO amount,14665,Other,153% of NY Medicaid HMO DRG,21567,,225% x Medicaid HMO amount,21567,Other,225% of NY Medicaid HMO DRG,13419,,140% x Medicaid HMO amount,13419,Other,140% of NY Medicaid HMO DRG,21567,,DRG base rate x DRG weight + capital per discharge,21567,Other,225% of NY Medicaid HMO DRG,26359,,275% x Medicaid HMO amount,26359,Other,275% of NY Medicaid HMO DRG,31056,,324% x Medicaid HMO amount,31056,Other,324% of NY Medicaid HMO DRG,20608,,215% x Medicaid HMO amount,20608,Other,215% of NY Medicaid HMO DRG,20608,,215% x Medicaid HMO amount,20608,Other,215% of NY Medicaid HMO DRG,11982,,125% x Medicaid HMO amount,11982,Other,125% of NY Medicaid HMO DRG,0.01,39655,
Lower extremity arterial procedures #,181-2,APR-DRG,,,,,,,,inpatient,,,245632.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27781,,186% x Medicaid HMO amount,27781,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62942,,"27,634 x DRG Weight",62942,Other,DRG Base Rate x DRG Weight,53499,,"23,488 x DRG Weight",53499,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14936.21,,DRG base rate x DRG weight + capital per discharge,14936.21,Other,100% of NY Medicaid HMO DRG,14936,,DRG base rate x DRG weight + capital per discharge,14936,Other,100% of NY Medicaid HMO DRG,14936,,DRG base rate x DRG weight + capital per discharge,14936,Other,100% of NY Medicaid HMO DRG,14936,,DRG base rate x DRG weight + capital per discharge,14936,Other,100% of NY Medicaid HMO DRG,33606,,225% x Medicaid HMO amount,33606,Other,225% of NY Medicaid HMO DRG,22852,,153% x Medicaid HMO amount,22852,Other,153% of NY Medicaid HMO DRG,33606,,225% x Medicaid HMO amount,33606,Other,225% of NY Medicaid HMO DRG,20911,,140% x Medicaid HMO amount,20911,Other,140% of NY Medicaid HMO DRG,33606,,DRG base rate x DRG weight + capital per discharge,33606,Other,225% of NY Medicaid HMO DRG,41075,,275% x Medicaid HMO amount,41075,Other,275% of NY Medicaid HMO DRG,48393,,324% x Medicaid HMO amount,48393,Other,324% of NY Medicaid HMO DRG,32113,,215% x Medicaid HMO amount,32113,Other,215% of NY Medicaid HMO DRG,32113,,215% x Medicaid HMO amount,32113,Other,215% of NY Medicaid HMO DRG,18670,,125% x Medicaid HMO amount,18670,Other,125% of NY Medicaid HMO DRG,0.01,62942,
Lower extremity arterial procedures #,181-3,APR-DRG,,,,,,,,inpatient,,,733088.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49190,,186% x Medicaid HMO amount,49190,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,113031,,"27,634 x DRG Weight",113031,Other,DRG Base Rate x DRG Weight,96073,,"23,488 x DRG Weight",96073,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26446.21,,DRG base rate x DRG weight + capital per discharge,26446.21,Other,100% of NY Medicaid HMO DRG,26446,,DRG base rate x DRG weight + capital per discharge,26446,Other,100% of NY Medicaid HMO DRG,26446,,DRG base rate x DRG weight + capital per discharge,26446,Other,100% of NY Medicaid HMO DRG,26446,,DRG base rate x DRG weight + capital per discharge,26446,Other,100% of NY Medicaid HMO DRG,59504,,225% x Medicaid HMO amount,59504,Other,225% of NY Medicaid HMO DRG,40463,,153% x Medicaid HMO amount,40463,Other,153% of NY Medicaid HMO DRG,59504,,225% x Medicaid HMO amount,59504,Other,225% of NY Medicaid HMO DRG,37025,,140% x Medicaid HMO amount,37025,Other,140% of NY Medicaid HMO DRG,59504,,DRG base rate x DRG weight + capital per discharge,59504,Other,225% of NY Medicaid HMO DRG,72727,,275% x Medicaid HMO amount,72727,Other,275% of NY Medicaid HMO DRG,85686,,324% x Medicaid HMO amount,85686,Other,324% of NY Medicaid HMO DRG,56859,,215% x Medicaid HMO amount,56859,Other,215% of NY Medicaid HMO DRG,56859,,215% x Medicaid HMO amount,56859,Other,215% of NY Medicaid HMO DRG,33058,,125% x Medicaid HMO amount,33058,Other,125% of NY Medicaid HMO DRG,0.01,113031,
Lower extremity arterial procedures #,181-4,APR-DRG,,,,,,,,inpatient,,,854967.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,79028,,186% x Medicaid HMO amount,79028,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,182840,,"27,634 x DRG Weight",182840,Other,DRG Base Rate x DRG Weight,155408,,"23,488 x DRG Weight",155408,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42488.21,,DRG base rate x DRG weight + capital per discharge,42488.21,Other,100% of NY Medicaid HMO DRG,42488,,DRG base rate x DRG weight + capital per discharge,42488,Other,100% of NY Medicaid HMO DRG,42488,,DRG base rate x DRG weight + capital per discharge,42488,Other,100% of NY Medicaid HMO DRG,42488,,DRG base rate x DRG weight + capital per discharge,42488,Other,100% of NY Medicaid HMO DRG,95598,,225% x Medicaid HMO amount,95598,Other,225% of NY Medicaid HMO DRG,65007,,153% x Medicaid HMO amount,65007,Other,153% of NY Medicaid HMO DRG,95598,,225% x Medicaid HMO amount,95598,Other,225% of NY Medicaid HMO DRG,59483,,140% x Medicaid HMO amount,59483,Other,140% of NY Medicaid HMO DRG,95598,,DRG base rate x DRG weight + capital per discharge,95598,Other,225% of NY Medicaid HMO DRG,116843,,275% x Medicaid HMO amount,116843,Other,275% of NY Medicaid HMO DRG,137662,,324% x Medicaid HMO amount,137662,Other,324% of NY Medicaid HMO DRG,91350,,215% x Medicaid HMO amount,91350,Other,215% of NY Medicaid HMO DRG,91350,,215% x Medicaid HMO amount,91350,Other,215% of NY Medicaid HMO DRG,53110,,125% x Medicaid HMO amount,53110,Other,125% of NY Medicaid HMO DRG,0.01,182840,
Other peripheral vascular procedures #,182-1,APR-DRG,,,,,,,,inpatient,,,119359.66,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18600,,186% x Medicaid HMO amount,18600,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41462,,"27,634 x DRG Weight",41462,Other,DRG Base Rate x DRG Weight,35241,,"23,488 x DRG Weight",35241,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10000.21,,DRG base rate x DRG weight + capital per discharge,10000.21,Other,100% of NY Medicaid HMO DRG,10000,,DRG base rate x DRG weight + capital per discharge,10000,Other,100% of NY Medicaid HMO DRG,10000,,DRG base rate x DRG weight + capital per discharge,10000,Other,100% of NY Medicaid HMO DRG,10000,,DRG base rate x DRG weight + capital per discharge,10000,Other,100% of NY Medicaid HMO DRG,22500,,225% x Medicaid HMO amount,22500,Other,225% of NY Medicaid HMO DRG,15300,,153% x Medicaid HMO amount,15300,Other,153% of NY Medicaid HMO DRG,22500,,225% x Medicaid HMO amount,22500,Other,225% of NY Medicaid HMO DRG,14000,,140% x Medicaid HMO amount,14000,Other,140% of NY Medicaid HMO DRG,22500,,DRG base rate x DRG weight + capital per discharge,22500,Other,225% of NY Medicaid HMO DRG,27501,,275% x Medicaid HMO amount,27501,Other,275% of NY Medicaid HMO DRG,32401,,324% x Medicaid HMO amount,32401,Other,324% of NY Medicaid HMO DRG,21500,,215% x Medicaid HMO amount,21500,Other,215% of NY Medicaid HMO DRG,21500,,215% x Medicaid HMO amount,21500,Other,215% of NY Medicaid HMO DRG,12500,,125% x Medicaid HMO amount,12500,Other,125% of NY Medicaid HMO DRG,0.01,41462,
Other peripheral vascular procedures #,182-2,APR-DRG,,,,,,,,inpatient,,,401770.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25895,,186% x Medicaid HMO amount,25895,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58529,,"27,634 x DRG Weight",58529,Other,DRG Base Rate x DRG Weight,49748,,"23,488 x DRG Weight",49748,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13922.21,,DRG base rate x DRG weight + capital per discharge,13922.21,Other,100% of NY Medicaid HMO DRG,13922,,DRG base rate x DRG weight + capital per discharge,13922,Other,100% of NY Medicaid HMO DRG,13922,,DRG base rate x DRG weight + capital per discharge,13922,Other,100% of NY Medicaid HMO DRG,13922,,DRG base rate x DRG weight + capital per discharge,13922,Other,100% of NY Medicaid HMO DRG,31325,,225% x Medicaid HMO amount,31325,Other,225% of NY Medicaid HMO DRG,21301,,153% x Medicaid HMO amount,21301,Other,153% of NY Medicaid HMO DRG,31325,,225% x Medicaid HMO amount,31325,Other,225% of NY Medicaid HMO DRG,19491,,140% x Medicaid HMO amount,19491,Other,140% of NY Medicaid HMO DRG,31325,,DRG base rate x DRG weight + capital per discharge,31325,Other,225% of NY Medicaid HMO DRG,38286,,275% x Medicaid HMO amount,38286,Other,275% of NY Medicaid HMO DRG,45108,,324% x Medicaid HMO amount,45108,Other,324% of NY Medicaid HMO DRG,29933,,215% x Medicaid HMO amount,29933,Other,215% of NY Medicaid HMO DRG,29933,,215% x Medicaid HMO amount,29933,Other,215% of NY Medicaid HMO DRG,17403,,125% x Medicaid HMO amount,17403,Other,125% of NY Medicaid HMO DRG,0.01,58529,
Other peripheral vascular procedures #,182-3,APR-DRG,,,,,,,,inpatient,,,658418.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38958,,186% x Medicaid HMO amount,38958,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,89092,,"27,634 x DRG Weight",89092,Other,DRG Base Rate x DRG Weight,75725,,"23,488 x DRG Weight",75725,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20945.21,,DRG base rate x DRG weight + capital per discharge,20945.21,Other,100% of NY Medicaid HMO DRG,20945,,DRG base rate x DRG weight + capital per discharge,20945,Other,100% of NY Medicaid HMO DRG,20945,,DRG base rate x DRG weight + capital per discharge,20945,Other,100% of NY Medicaid HMO DRG,20945,,DRG base rate x DRG weight + capital per discharge,20945,Other,100% of NY Medicaid HMO DRG,47127,,225% x Medicaid HMO amount,47127,Other,225% of NY Medicaid HMO DRG,32046,,153% x Medicaid HMO amount,32046,Other,153% of NY Medicaid HMO DRG,47127,,225% x Medicaid HMO amount,47127,Other,225% of NY Medicaid HMO DRG,29323,,140% x Medicaid HMO amount,29323,Other,140% of NY Medicaid HMO DRG,47127,,DRG base rate x DRG weight + capital per discharge,47127,Other,225% of NY Medicaid HMO DRG,57599,,275% x Medicaid HMO amount,57599,Other,275% of NY Medicaid HMO DRG,67862,,324% x Medicaid HMO amount,67862,Other,324% of NY Medicaid HMO DRG,45032,,215% x Medicaid HMO amount,45032,Other,215% of NY Medicaid HMO DRG,45032,,215% x Medicaid HMO amount,45032,Other,215% of NY Medicaid HMO DRG,26182,,125% x Medicaid HMO amount,26182,Other,125% of NY Medicaid HMO DRG,0.01,89092,
Other peripheral vascular procedures #,182-4,APR-DRG,,,,,,,,inpatient,,,611609.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74958,,186% x Medicaid HMO amount,74958,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,173320,,"27,634 x DRG Weight",173320,Other,DRG Base Rate x DRG Weight,147317,,"23,488 x DRG Weight",147317,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40300.21,,DRG base rate x DRG weight + capital per discharge,40300.21,Other,100% of NY Medicaid HMO DRG,40300,,DRG base rate x DRG weight + capital per discharge,40300,Other,100% of NY Medicaid HMO DRG,40300,,DRG base rate x DRG weight + capital per discharge,40300,Other,100% of NY Medicaid HMO DRG,40300,,DRG base rate x DRG weight + capital per discharge,40300,Other,100% of NY Medicaid HMO DRG,90675,,225% x Medicaid HMO amount,90675,Other,225% of NY Medicaid HMO DRG,61659,,153% x Medicaid HMO amount,61659,Other,153% of NY Medicaid HMO DRG,90675,,225% x Medicaid HMO amount,90675,Other,225% of NY Medicaid HMO DRG,56420,,140% x Medicaid HMO amount,56420,Other,140% of NY Medicaid HMO DRG,90675,,DRG base rate x DRG weight + capital per discharge,90675,Other,225% of NY Medicaid HMO DRG,110826,,275% x Medicaid HMO amount,110826,Other,275% of NY Medicaid HMO DRG,130573,,324% x Medicaid HMO amount,130573,Other,324% of NY Medicaid HMO DRG,86645,,215% x Medicaid HMO amount,86645,Other,215% of NY Medicaid HMO DRG,86645,,215% x Medicaid HMO amount,86645,Other,215% of NY Medicaid HMO DRG,50375,,125% x Medicaid HMO amount,50375,Other,125% of NY Medicaid HMO DRG,0.01,173320,
Acute myocardial infarction,190-1,APR-DRG,,,,,,,,inpatient,,,121278.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9570,,186% x Medicaid HMO amount,9570,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20330,,"27,634 x DRG Weight",20330,Other,DRG Base Rate x DRG Weight,17280,,"23,488 x DRG Weight",17280,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5145.21,,DRG base rate x DRG weight + capital per discharge,5145.21,Other,100% of NY Medicaid HMO DRG,5145,,DRG base rate x DRG weight + capital per discharge,5145,Other,100% of NY Medicaid HMO DRG,5145,,DRG base rate x DRG weight + capital per discharge,5145,Other,100% of NY Medicaid HMO DRG,5145,,DRG base rate x DRG weight + capital per discharge,5145,Other,100% of NY Medicaid HMO DRG,11577,,225% x Medicaid HMO amount,11577,Other,225% of NY Medicaid HMO DRG,7872,,153% x Medicaid HMO amount,7872,Other,153% of NY Medicaid HMO DRG,11577,,225% x Medicaid HMO amount,11577,Other,225% of NY Medicaid HMO DRG,7203,,140% x Medicaid HMO amount,7203,Other,140% of NY Medicaid HMO DRG,11577,,DRG base rate x DRG weight + capital per discharge,11577,Other,225% of NY Medicaid HMO DRG,14149,,275% x Medicaid HMO amount,14149,Other,275% of NY Medicaid HMO DRG,16670,,324% x Medicaid HMO amount,16670,Other,324% of NY Medicaid HMO DRG,11062,,215% x Medicaid HMO amount,11062,Other,215% of NY Medicaid HMO DRG,11062,,215% x Medicaid HMO amount,11062,Other,215% of NY Medicaid HMO DRG,6432,,125% x Medicaid HMO amount,6432,Other,125% of NY Medicaid HMO DRG,0.01,20330,
Acute myocardial infarction,190-2,APR-DRG,,,,,,,,inpatient,,,113366.49,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12198,,186% x Medicaid HMO amount,12198,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26482,,"27,634 x DRG Weight",26482,Other,DRG Base Rate x DRG Weight,22509,,"23,488 x DRG Weight",22509,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6558.21,,DRG base rate x DRG weight + capital per discharge,6558.21,Other,100% of NY Medicaid HMO DRG,6558,,DRG base rate x DRG weight + capital per discharge,6558,Other,100% of NY Medicaid HMO DRG,6558,,DRG base rate x DRG weight + capital per discharge,6558,Other,100% of NY Medicaid HMO DRG,6558,,DRG base rate x DRG weight + capital per discharge,6558,Other,100% of NY Medicaid HMO DRG,14756,,225% x Medicaid HMO amount,14756,Other,225% of NY Medicaid HMO DRG,10034,,153% x Medicaid HMO amount,10034,Other,153% of NY Medicaid HMO DRG,14756,,225% x Medicaid HMO amount,14756,Other,225% of NY Medicaid HMO DRG,9181,,140% x Medicaid HMO amount,9181,Other,140% of NY Medicaid HMO DRG,14756,,DRG base rate x DRG weight + capital per discharge,14756,Other,225% of NY Medicaid HMO DRG,18035,,275% x Medicaid HMO amount,18035,Other,275% of NY Medicaid HMO DRG,21249,,324% x Medicaid HMO amount,21249,Other,324% of NY Medicaid HMO DRG,14100,,215% x Medicaid HMO amount,14100,Other,215% of NY Medicaid HMO DRG,14100,,215% x Medicaid HMO amount,14100,Other,215% of NY Medicaid HMO DRG,8198,,125% x Medicaid HMO amount,8198,Other,125% of NY Medicaid HMO DRG,0.01,26482,
Acute myocardial infarction,190-3,APR-DRG,,,,,,,,inpatient,,,161463.7,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18014,,186% x Medicaid HMO amount,18014,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40091,,"27,634 x DRG Weight",40091,Other,DRG Base Rate x DRG Weight,34076,,"23,488 x DRG Weight",34076,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9685.21,,DRG base rate x DRG weight + capital per discharge,9685.21,Other,100% of NY Medicaid HMO DRG,9685,,DRG base rate x DRG weight + capital per discharge,9685,Other,100% of NY Medicaid HMO DRG,9685,,DRG base rate x DRG weight + capital per discharge,9685,Other,100% of NY Medicaid HMO DRG,9685,,DRG base rate x DRG weight + capital per discharge,9685,Other,100% of NY Medicaid HMO DRG,21792,,225% x Medicaid HMO amount,21792,Other,225% of NY Medicaid HMO DRG,14818,,153% x Medicaid HMO amount,14818,Other,153% of NY Medicaid HMO DRG,21792,,225% x Medicaid HMO amount,21792,Other,225% of NY Medicaid HMO DRG,13559,,140% x Medicaid HMO amount,13559,Other,140% of NY Medicaid HMO DRG,21792,,DRG base rate x DRG weight + capital per discharge,21792,Other,225% of NY Medicaid HMO DRG,26634,,275% x Medicaid HMO amount,26634,Other,275% of NY Medicaid HMO DRG,31380,,324% x Medicaid HMO amount,31380,Other,324% of NY Medicaid HMO DRG,20823,,215% x Medicaid HMO amount,20823,Other,215% of NY Medicaid HMO DRG,20823,,215% x Medicaid HMO amount,20823,Other,215% of NY Medicaid HMO DRG,12107,,125% x Medicaid HMO amount,12107,Other,125% of NY Medicaid HMO DRG,0.01,40091,
Acute myocardial infarction,190-4,APR-DRG,,,,,,,,inpatient,,,350968.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34107,,186% x Medicaid HMO amount,34107,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,77740,,"27,634 x DRG Weight",77740,Other,DRG Base Rate x DRG Weight,66076,,"23,488 x DRG Weight",66076,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18337.21,,DRG base rate x DRG weight + capital per discharge,18337.21,Other,100% of NY Medicaid HMO DRG,18337,,DRG base rate x DRG weight + capital per discharge,18337,Other,100% of NY Medicaid HMO DRG,18337,,DRG base rate x DRG weight + capital per discharge,18337,Other,100% of NY Medicaid HMO DRG,18337,,DRG base rate x DRG weight + capital per discharge,18337,Other,100% of NY Medicaid HMO DRG,41259,,225% x Medicaid HMO amount,41259,Other,225% of NY Medicaid HMO DRG,28056,,153% x Medicaid HMO amount,28056,Other,153% of NY Medicaid HMO DRG,41259,,225% x Medicaid HMO amount,41259,Other,225% of NY Medicaid HMO DRG,25672,,140% x Medicaid HMO amount,25672,Other,140% of NY Medicaid HMO DRG,41259,,DRG base rate x DRG weight + capital per discharge,41259,Other,225% of NY Medicaid HMO DRG,50427,,275% x Medicaid HMO amount,50427,Other,275% of NY Medicaid HMO DRG,59413,,324% x Medicaid HMO amount,59413,Other,324% of NY Medicaid HMO DRG,39425,,215% x Medicaid HMO amount,39425,Other,215% of NY Medicaid HMO DRG,39425,,215% x Medicaid HMO amount,39425,Other,215% of NY Medicaid HMO DRG,22922,,125% x Medicaid HMO amount,22922,Other,125% of NY Medicaid HMO DRG,0.01,77740,
Cardiac catheterization for coronary artery disease,191-1,APR-DRG,,,,,,,,inpatient,,,161517.61,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9348,,186% x Medicaid HMO amount,9348,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19814,,"27,634 x DRG Weight",19814,Other,DRG Base Rate x DRG Weight,16841,,"23,488 x DRG Weight",16841,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5026.21,,DRG base rate x DRG weight + capital per discharge,5026.21,Other,100% of NY Medicaid HMO DRG,5026,,DRG base rate x DRG weight + capital per discharge,5026,Other,100% of NY Medicaid HMO DRG,5026,,DRG base rate x DRG weight + capital per discharge,5026,Other,100% of NY Medicaid HMO DRG,5026,,DRG base rate x DRG weight + capital per discharge,5026,Other,100% of NY Medicaid HMO DRG,11309,,225% x Medicaid HMO amount,11309,Other,225% of NY Medicaid HMO DRG,7690,,153% x Medicaid HMO amount,7690,Other,153% of NY Medicaid HMO DRG,11309,,225% x Medicaid HMO amount,11309,Other,225% of NY Medicaid HMO DRG,7037,,140% x Medicaid HMO amount,7037,Other,140% of NY Medicaid HMO DRG,11309,,DRG base rate x DRG weight + capital per discharge,11309,Other,225% of NY Medicaid HMO DRG,13822,,275% x Medicaid HMO amount,13822,Other,275% of NY Medicaid HMO DRG,16285,,324% x Medicaid HMO amount,16285,Other,324% of NY Medicaid HMO DRG,10806,,215% x Medicaid HMO amount,10806,Other,215% of NY Medicaid HMO DRG,10806,,215% x Medicaid HMO amount,10806,Other,215% of NY Medicaid HMO DRG,6283,,125% x Medicaid HMO amount,6283,Other,125% of NY Medicaid HMO DRG,0.01,19814,
Cardiac catheterization for coronary artery disease,191-2,APR-DRG,,,,,,,,inpatient,,,285660.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11229,,186% x Medicaid HMO amount,11229,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24213,,"27,634 x DRG Weight",24213,Other,DRG Base Rate x DRG Weight,20580,,"23,488 x DRG Weight",20580,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6037.21,,DRG base rate x DRG weight + capital per discharge,6037.21,Other,100% of NY Medicaid HMO DRG,6037,,DRG base rate x DRG weight + capital per discharge,6037,Other,100% of NY Medicaid HMO DRG,6037,,DRG base rate x DRG weight + capital per discharge,6037,Other,100% of NY Medicaid HMO DRG,6037,,DRG base rate x DRG weight + capital per discharge,6037,Other,100% of NY Medicaid HMO DRG,13584,,225% x Medicaid HMO amount,13584,Other,225% of NY Medicaid HMO DRG,9237,,153% x Medicaid HMO amount,9237,Other,153% of NY Medicaid HMO DRG,13584,,225% x Medicaid HMO amount,13584,Other,225% of NY Medicaid HMO DRG,8452,,140% x Medicaid HMO amount,8452,Other,140% of NY Medicaid HMO DRG,13584,,DRG base rate x DRG weight + capital per discharge,13584,Other,225% of NY Medicaid HMO DRG,16602,,275% x Medicaid HMO amount,16602,Other,275% of NY Medicaid HMO DRG,19561,,324% x Medicaid HMO amount,19561,Other,324% of NY Medicaid HMO DRG,12980,,215% x Medicaid HMO amount,12980,Other,215% of NY Medicaid HMO DRG,12980,,215% x Medicaid HMO amount,12980,Other,215% of NY Medicaid HMO DRG,7547,,125% x Medicaid HMO amount,7547,Other,125% of NY Medicaid HMO DRG,0.01,24213,
Cardiac catheterization for coronary artery disease,191-3,APR-DRG,,,,,,,,inpatient,,,378281.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17730,,186% x Medicaid HMO amount,17730,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39425,,"27,634 x DRG Weight",39425,Other,DRG Base Rate x DRG Weight,33510,,"23,488 x DRG Weight",33510,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9532.21,,DRG base rate x DRG weight + capital per discharge,9532.21,Other,100% of NY Medicaid HMO DRG,9532,,DRG base rate x DRG weight + capital per discharge,9532,Other,100% of NY Medicaid HMO DRG,9532,,DRG base rate x DRG weight + capital per discharge,9532,Other,100% of NY Medicaid HMO DRG,9532,,DRG base rate x DRG weight + capital per discharge,9532,Other,100% of NY Medicaid HMO DRG,21447,,225% x Medicaid HMO amount,21447,Other,225% of NY Medicaid HMO DRG,14584,,153% x Medicaid HMO amount,14584,Other,153% of NY Medicaid HMO DRG,21447,,225% x Medicaid HMO amount,21447,Other,225% of NY Medicaid HMO DRG,13345,,140% x Medicaid HMO amount,13345,Other,140% of NY Medicaid HMO DRG,21447,,DRG base rate x DRG weight + capital per discharge,21447,Other,225% of NY Medicaid HMO DRG,26214,,275% x Medicaid HMO amount,26214,Other,275% of NY Medicaid HMO DRG,30884,,324% x Medicaid HMO amount,30884,Other,324% of NY Medicaid HMO DRG,20494,,215% x Medicaid HMO amount,20494,Other,215% of NY Medicaid HMO DRG,20494,,215% x Medicaid HMO amount,20494,Other,215% of NY Medicaid HMO DRG,11915,,125% x Medicaid HMO amount,11915,Other,125% of NY Medicaid HMO DRG,0.01,39425,
Cardiac catheterization for coronary artery disease,191-4,APR-DRG,,,,,,,,inpatient,,,378281.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32150,,186% x Medicaid HMO amount,32150,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73161,,"27,634 x DRG Weight",73161,Other,DRG Base Rate x DRG Weight,62184,,"23,488 x DRG Weight",62184,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17285.21,,DRG base rate x DRG weight + capital per discharge,17285.21,Other,100% of NY Medicaid HMO DRG,17285,,DRG base rate x DRG weight + capital per discharge,17285,Other,100% of NY Medicaid HMO DRG,17285,,DRG base rate x DRG weight + capital per discharge,17285,Other,100% of NY Medicaid HMO DRG,17285,,DRG base rate x DRG weight + capital per discharge,17285,Other,100% of NY Medicaid HMO DRG,38892,,225% x Medicaid HMO amount,38892,Other,225% of NY Medicaid HMO DRG,26446,,153% x Medicaid HMO amount,26446,Other,153% of NY Medicaid HMO DRG,38892,,225% x Medicaid HMO amount,38892,Other,225% of NY Medicaid HMO DRG,24199,,140% x Medicaid HMO amount,24199,Other,140% of NY Medicaid HMO DRG,38892,,DRG base rate x DRG weight + capital per discharge,38892,Other,225% of NY Medicaid HMO DRG,47534,,275% x Medicaid HMO amount,47534,Other,275% of NY Medicaid HMO DRG,56004,,324% x Medicaid HMO amount,56004,Other,324% of NY Medicaid HMO DRG,37163,,215% x Medicaid HMO amount,37163,Other,215% of NY Medicaid HMO DRG,37163,,215% x Medicaid HMO amount,37163,Other,215% of NY Medicaid HMO DRG,21607,,125% x Medicaid HMO amount,21607,Other,125% of NY Medicaid HMO DRG,0.01,73161,
Cardiac catheterization for other non-coronary conditions,192-1,APR-DRG,,,,,,,,inpatient,,,161036.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9361,,186% x Medicaid HMO amount,9361,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19844,,"27,634 x DRG Weight",19844,Other,DRG Base Rate x DRG Weight,16867,,"23,488 x DRG Weight",16867,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5033.21,,DRG base rate x DRG weight + capital per discharge,5033.21,Other,100% of NY Medicaid HMO DRG,5033,,DRG base rate x DRG weight + capital per discharge,5033,Other,100% of NY Medicaid HMO DRG,5033,,DRG base rate x DRG weight + capital per discharge,5033,Other,100% of NY Medicaid HMO DRG,5033,,DRG base rate x DRG weight + capital per discharge,5033,Other,100% of NY Medicaid HMO DRG,11325,,225% x Medicaid HMO amount,11325,Other,225% of NY Medicaid HMO DRG,7701,,153% x Medicaid HMO amount,7701,Other,153% of NY Medicaid HMO DRG,11325,,225% x Medicaid HMO amount,11325,Other,225% of NY Medicaid HMO DRG,7046,,140% x Medicaid HMO amount,7046,Other,140% of NY Medicaid HMO DRG,11325,,DRG base rate x DRG weight + capital per discharge,11325,Other,225% of NY Medicaid HMO DRG,13841,,275% x Medicaid HMO amount,13841,Other,275% of NY Medicaid HMO DRG,16308,,324% x Medicaid HMO amount,16308,Other,324% of NY Medicaid HMO DRG,10821,,215% x Medicaid HMO amount,10821,Other,215% of NY Medicaid HMO DRG,10821,,215% x Medicaid HMO amount,10821,Other,215% of NY Medicaid HMO DRG,6292,,125% x Medicaid HMO amount,6292,Other,125% of NY Medicaid HMO DRG,0.01,19844,
Cardiac catheterization for other non-coronary conditions,192-2,APR-DRG,,,,,,,,inpatient,,,226320.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12920,,186% x Medicaid HMO amount,12920,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28170,,"27,634 x DRG Weight",28170,Other,DRG Base Rate x DRG Weight,23944,,"23,488 x DRG Weight",23944,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6946.21,,DRG base rate x DRG weight + capital per discharge,6946.21,Other,100% of NY Medicaid HMO DRG,6946,,DRG base rate x DRG weight + capital per discharge,6946,Other,100% of NY Medicaid HMO DRG,6946,,DRG base rate x DRG weight + capital per discharge,6946,Other,100% of NY Medicaid HMO DRG,6946,,DRG base rate x DRG weight + capital per discharge,6946,Other,100% of NY Medicaid HMO DRG,15629,,225% x Medicaid HMO amount,15629,Other,225% of NY Medicaid HMO DRG,10628,,153% x Medicaid HMO amount,10628,Other,153% of NY Medicaid HMO DRG,15629,,225% x Medicaid HMO amount,15629,Other,225% of NY Medicaid HMO DRG,9725,,140% x Medicaid HMO amount,9725,Other,140% of NY Medicaid HMO DRG,15629,,DRG base rate x DRG weight + capital per discharge,15629,Other,225% of NY Medicaid HMO DRG,19102,,275% x Medicaid HMO amount,19102,Other,275% of NY Medicaid HMO DRG,22506,,324% x Medicaid HMO amount,22506,Other,324% of NY Medicaid HMO DRG,14934,,215% x Medicaid HMO amount,14934,Other,215% of NY Medicaid HMO DRG,14934,,215% x Medicaid HMO amount,14934,Other,215% of NY Medicaid HMO DRG,8683,,125% x Medicaid HMO amount,8683,Other,125% of NY Medicaid HMO DRG,0.01,28170,
Cardiac catheterization for other non-coronary conditions,192-3,APR-DRG,,,,,,,,inpatient,,,270443.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22374,,186% x Medicaid HMO amount,22374,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,50291,,"27,634 x DRG Weight",50291,Other,DRG Base Rate x DRG Weight,42746,,"23,488 x DRG Weight",42746,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12029.21,,DRG base rate x DRG weight + capital per discharge,12029.21,Other,100% of NY Medicaid HMO DRG,12029,,DRG base rate x DRG weight + capital per discharge,12029,Other,100% of NY Medicaid HMO DRG,12029,,DRG base rate x DRG weight + capital per discharge,12029,Other,100% of NY Medicaid HMO DRG,12029,,DRG base rate x DRG weight + capital per discharge,12029,Other,100% of NY Medicaid HMO DRG,27066,,225% x Medicaid HMO amount,27066,Other,225% of NY Medicaid HMO DRG,18405,,153% x Medicaid HMO amount,18405,Other,153% of NY Medicaid HMO DRG,27066,,225% x Medicaid HMO amount,27066,Other,225% of NY Medicaid HMO DRG,16841,,140% x Medicaid HMO amount,16841,Other,140% of NY Medicaid HMO DRG,27066,,DRG base rate x DRG weight + capital per discharge,27066,Other,225% of NY Medicaid HMO DRG,33080,,275% x Medicaid HMO amount,33080,Other,275% of NY Medicaid HMO DRG,38975,,324% x Medicaid HMO amount,38975,Other,324% of NY Medicaid HMO DRG,25863,,215% x Medicaid HMO amount,25863,Other,215% of NY Medicaid HMO DRG,25863,,215% x Medicaid HMO amount,25863,Other,215% of NY Medicaid HMO DRG,15037,,125% x Medicaid HMO amount,15037,Other,125% of NY Medicaid HMO DRG,0.01,50291,
Cardiac catheterization for other non-coronary conditions,192-4,APR-DRG,,,,,,,,inpatient,,,566014.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49509,,186% x Medicaid HMO amount,49509,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,113777,,"27,634 x DRG Weight",113777,Other,DRG Base Rate x DRG Weight,96707,,"23,488 x DRG Weight",96707,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26618.21,,DRG base rate x DRG weight + capital per discharge,26618.21,Other,100% of NY Medicaid HMO DRG,26618,,DRG base rate x DRG weight + capital per discharge,26618,Other,100% of NY Medicaid HMO DRG,26618,,DRG base rate x DRG weight + capital per discharge,26618,Other,100% of NY Medicaid HMO DRG,26618,,DRG base rate x DRG weight + capital per discharge,26618,Other,100% of NY Medicaid HMO DRG,59891,,225% x Medicaid HMO amount,59891,Other,225% of NY Medicaid HMO DRG,40726,,153% x Medicaid HMO amount,40726,Other,153% of NY Medicaid HMO DRG,59891,,225% x Medicaid HMO amount,59891,Other,225% of NY Medicaid HMO DRG,37265,,140% x Medicaid HMO amount,37265,Other,140% of NY Medicaid HMO DRG,59891,,DRG base rate x DRG weight + capital per discharge,59891,Other,225% of NY Medicaid HMO DRG,73200,,275% x Medicaid HMO amount,73200,Other,275% of NY Medicaid HMO DRG,86243,,324% x Medicaid HMO amount,86243,Other,324% of NY Medicaid HMO DRG,57229,,215% x Medicaid HMO amount,57229,Other,215% of NY Medicaid HMO DRG,57229,,215% x Medicaid HMO amount,57229,Other,215% of NY Medicaid HMO DRG,33273,,125% x Medicaid HMO amount,33273,Other,125% of NY Medicaid HMO DRG,0.01,113777,
Acute & subacute endocarditis,193-1,APR-DRG,,,,,,,,inpatient,,,75012,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13067,,186% x Medicaid HMO amount,13067,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28513,,"27,634 x DRG Weight",28513,Other,DRG Base Rate x DRG Weight,24235,,"23,488 x DRG Weight",24235,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7025.21,,DRG base rate x DRG weight + capital per discharge,7025.21,Other,100% of NY Medicaid HMO DRG,7025,,DRG base rate x DRG weight + capital per discharge,7025,Other,100% of NY Medicaid HMO DRG,7025,,DRG base rate x DRG weight + capital per discharge,7025,Other,100% of NY Medicaid HMO DRG,7025,,DRG base rate x DRG weight + capital per discharge,7025,Other,100% of NY Medicaid HMO DRG,15807,,225% x Medicaid HMO amount,15807,Other,225% of NY Medicaid HMO DRG,10749,,153% x Medicaid HMO amount,10749,Other,153% of NY Medicaid HMO DRG,15807,,225% x Medicaid HMO amount,15807,Other,225% of NY Medicaid HMO DRG,9835,,140% x Medicaid HMO amount,9835,Other,140% of NY Medicaid HMO DRG,15807,,DRG base rate x DRG weight + capital per discharge,15807,Other,225% of NY Medicaid HMO DRG,19319,,275% x Medicaid HMO amount,19319,Other,275% of NY Medicaid HMO DRG,22762,,324% x Medicaid HMO amount,22762,Other,324% of NY Medicaid HMO DRG,15104,,215% x Medicaid HMO amount,15104,Other,215% of NY Medicaid HMO DRG,15104,,215% x Medicaid HMO amount,15104,Other,215% of NY Medicaid HMO DRG,8782,,125% x Medicaid HMO amount,8782,Other,125% of NY Medicaid HMO DRG,0.01,28513,
Acute & subacute endocarditis,193-2,APR-DRG,,,,,,,,inpatient,,,75012,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17157,,186% x Medicaid HMO amount,17157,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38082,,"27,634 x DRG Weight",38082,Other,DRG Base Rate x DRG Weight,32369,,"23,488 x DRG Weight",32369,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9224.21,,DRG base rate x DRG weight + capital per discharge,9224.21,Other,100% of NY Medicaid HMO DRG,9224,,DRG base rate x DRG weight + capital per discharge,9224,Other,100% of NY Medicaid HMO DRG,9224,,DRG base rate x DRG weight + capital per discharge,9224,Other,100% of NY Medicaid HMO DRG,9224,,DRG base rate x DRG weight + capital per discharge,9224,Other,100% of NY Medicaid HMO DRG,20754,,225% x Medicaid HMO amount,20754,Other,225% of NY Medicaid HMO DRG,14113,,153% x Medicaid HMO amount,14113,Other,153% of NY Medicaid HMO DRG,20754,,225% x Medicaid HMO amount,20754,Other,225% of NY Medicaid HMO DRG,12914,,140% x Medicaid HMO amount,12914,Other,140% of NY Medicaid HMO DRG,20754,,DRG base rate x DRG weight + capital per discharge,20754,Other,225% of NY Medicaid HMO DRG,25367,,275% x Medicaid HMO amount,25367,Other,275% of NY Medicaid HMO DRG,29886,,324% x Medicaid HMO amount,29886,Other,324% of NY Medicaid HMO DRG,19832,,215% x Medicaid HMO amount,19832,Other,215% of NY Medicaid HMO DRG,19832,,215% x Medicaid HMO amount,19832,Other,215% of NY Medicaid HMO DRG,11530,,125% x Medicaid HMO amount,11530,Other,125% of NY Medicaid HMO DRG,0.01,38082,
Acute & subacute endocarditis,193-3,APR-DRG,,,,,,,,inpatient,,,75012,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26312,,186% x Medicaid HMO amount,26312,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59502,,"27,634 x DRG Weight",59502,Other,DRG Base Rate x DRG Weight,50574,,"23,488 x DRG Weight",50574,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14146.21,,DRG base rate x DRG weight + capital per discharge,14146.21,Other,100% of NY Medicaid HMO DRG,14146,,DRG base rate x DRG weight + capital per discharge,14146,Other,100% of NY Medicaid HMO DRG,14146,,DRG base rate x DRG weight + capital per discharge,14146,Other,100% of NY Medicaid HMO DRG,14146,,DRG base rate x DRG weight + capital per discharge,14146,Other,100% of NY Medicaid HMO DRG,31829,,225% x Medicaid HMO amount,31829,Other,225% of NY Medicaid HMO DRG,21644,,153% x Medicaid HMO amount,21644,Other,153% of NY Medicaid HMO DRG,31829,,225% x Medicaid HMO amount,31829,Other,225% of NY Medicaid HMO DRG,19805,,140% x Medicaid HMO amount,19805,Other,140% of NY Medicaid HMO DRG,31829,,DRG base rate x DRG weight + capital per discharge,31829,Other,225% of NY Medicaid HMO DRG,38902,,275% x Medicaid HMO amount,38902,Other,275% of NY Medicaid HMO DRG,45834,,324% x Medicaid HMO amount,45834,Other,324% of NY Medicaid HMO DRG,30414,,215% x Medicaid HMO amount,30414,Other,215% of NY Medicaid HMO DRG,30414,,215% x Medicaid HMO amount,30414,Other,215% of NY Medicaid HMO DRG,17683,,125% x Medicaid HMO amount,17683,Other,125% of NY Medicaid HMO DRG,0.01,59502,
Acute & subacute endocarditis,193-4,APR-DRG,,,,,,,,inpatient,,,836588.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53607,,186% x Medicaid HMO amount,53607,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,123364,,"27,634 x DRG Weight",123364,Other,DRG Base Rate x DRG Weight,104855,,"23,488 x DRG Weight",104855,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28821.21,,DRG base rate x DRG weight + capital per discharge,28821.21,Other,100% of NY Medicaid HMO DRG,28821,,DRG base rate x DRG weight + capital per discharge,28821,Other,100% of NY Medicaid HMO DRG,28821,,DRG base rate x DRG weight + capital per discharge,28821,Other,100% of NY Medicaid HMO DRG,28821,,DRG base rate x DRG weight + capital per discharge,28821,Other,100% of NY Medicaid HMO DRG,64848,,225% x Medicaid HMO amount,64848,Other,225% of NY Medicaid HMO DRG,44096,,153% x Medicaid HMO amount,44096,Other,153% of NY Medicaid HMO DRG,64848,,225% x Medicaid HMO amount,64848,Other,225% of NY Medicaid HMO DRG,40350,,140% x Medicaid HMO amount,40350,Other,140% of NY Medicaid HMO DRG,64848,,DRG base rate x DRG weight + capital per discharge,64848,Other,225% of NY Medicaid HMO DRG,79258,,275% x Medicaid HMO amount,79258,Other,275% of NY Medicaid HMO DRG,93381,,324% x Medicaid HMO amount,93381,Other,324% of NY Medicaid HMO DRG,61966,,215% x Medicaid HMO amount,61966,Other,215% of NY Medicaid HMO DRG,61966,,215% x Medicaid HMO amount,61966,Other,215% of NY Medicaid HMO DRG,36027,,125% x Medicaid HMO amount,36027,Other,125% of NY Medicaid HMO DRG,0.01,123364,
Heart failure,194-1,APR-DRG,,,,,,,,inpatient,,,98706.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7609,,186% x Medicaid HMO amount,7609,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15746,,"27,634 x DRG Weight",15746,Other,DRG Base Rate x DRG Weight,13383,,"23,488 x DRG Weight",13383,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4091.21,,DRG base rate x DRG weight + capital per discharge,4091.21,Other,100% of NY Medicaid HMO DRG,4091,,DRG base rate x DRG weight + capital per discharge,4091,Other,100% of NY Medicaid HMO DRG,4091,,DRG base rate x DRG weight + capital per discharge,4091,Other,100% of NY Medicaid HMO DRG,4091,,DRG base rate x DRG weight + capital per discharge,4091,Other,100% of NY Medicaid HMO DRG,9205,,225% x Medicaid HMO amount,9205,Other,225% of NY Medicaid HMO DRG,6260,,153% x Medicaid HMO amount,6260,Other,153% of NY Medicaid HMO DRG,9205,,225% x Medicaid HMO amount,9205,Other,225% of NY Medicaid HMO DRG,5728,,140% x Medicaid HMO amount,5728,Other,140% of NY Medicaid HMO DRG,9205,,DRG base rate x DRG weight + capital per discharge,9205,Other,225% of NY Medicaid HMO DRG,11251,,275% x Medicaid HMO amount,11251,Other,275% of NY Medicaid HMO DRG,13256,,324% x Medicaid HMO amount,13256,Other,324% of NY Medicaid HMO DRG,8796,,215% x Medicaid HMO amount,8796,Other,215% of NY Medicaid HMO DRG,8796,,215% x Medicaid HMO amount,8796,Other,215% of NY Medicaid HMO DRG,5114,,125% x Medicaid HMO amount,5114,Other,125% of NY Medicaid HMO DRG,0.01,15746,
Heart failure,194-2,APR-DRG,,,,,,,,inpatient,,,140073.61,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10224,,186% x Medicaid HMO amount,10224,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21864,,"27,634 x DRG Weight",21864,Other,DRG Base Rate x DRG Weight,18584,,"23,488 x DRG Weight",18584,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5497.21,,DRG base rate x DRG weight + capital per discharge,5497.21,Other,100% of NY Medicaid HMO DRG,5497,,DRG base rate x DRG weight + capital per discharge,5497,Other,100% of NY Medicaid HMO DRG,5497,,DRG base rate x DRG weight + capital per discharge,5497,Other,100% of NY Medicaid HMO DRG,5497,,DRG base rate x DRG weight + capital per discharge,5497,Other,100% of NY Medicaid HMO DRG,12369,,225% x Medicaid HMO amount,12369,Other,225% of NY Medicaid HMO DRG,8411,,153% x Medicaid HMO amount,8411,Other,153% of NY Medicaid HMO DRG,12369,,225% x Medicaid HMO amount,12369,Other,225% of NY Medicaid HMO DRG,7696,,140% x Medicaid HMO amount,7696,Other,140% of NY Medicaid HMO DRG,12369,,DRG base rate x DRG weight + capital per discharge,12369,Other,225% of NY Medicaid HMO DRG,15117,,275% x Medicaid HMO amount,15117,Other,275% of NY Medicaid HMO DRG,17811,,324% x Medicaid HMO amount,17811,Other,324% of NY Medicaid HMO DRG,11819,,215% x Medicaid HMO amount,11819,Other,215% of NY Medicaid HMO DRG,11819,,215% x Medicaid HMO amount,11819,Other,215% of NY Medicaid HMO DRG,6872,,125% x Medicaid HMO amount,6872,Other,125% of NY Medicaid HMO DRG,0.01,21864,
Heart failure,194-3,APR-DRG,,,,,,,,inpatient,,,160572.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16160,,186% x Medicaid HMO amount,16160,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35750,,"27,634 x DRG Weight",35750,Other,DRG Base Rate x DRG Weight,30386,,"23,488 x DRG Weight",30386,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8688.21,,DRG base rate x DRG weight + capital per discharge,8688.21,Other,100% of NY Medicaid HMO DRG,8688,,DRG base rate x DRG weight + capital per discharge,8688,Other,100% of NY Medicaid HMO DRG,8688,,DRG base rate x DRG weight + capital per discharge,8688,Other,100% of NY Medicaid HMO DRG,8688,,DRG base rate x DRG weight + capital per discharge,8688,Other,100% of NY Medicaid HMO DRG,19548,,225% x Medicaid HMO amount,19548,Other,225% of NY Medicaid HMO DRG,13293,,153% x Medicaid HMO amount,13293,Other,153% of NY Medicaid HMO DRG,19548,,225% x Medicaid HMO amount,19548,Other,225% of NY Medicaid HMO DRG,12163,,140% x Medicaid HMO amount,12163,Other,140% of NY Medicaid HMO DRG,19548,,DRG base rate x DRG weight + capital per discharge,19548,Other,225% of NY Medicaid HMO DRG,23893,,275% x Medicaid HMO amount,23893,Other,275% of NY Medicaid HMO DRG,28150,,324% x Medicaid HMO amount,28150,Other,324% of NY Medicaid HMO DRG,18680,,215% x Medicaid HMO amount,18680,Other,215% of NY Medicaid HMO DRG,18680,,215% x Medicaid HMO amount,18680,Other,215% of NY Medicaid HMO DRG,10860,,125% x Medicaid HMO amount,10860,Other,125% of NY Medicaid HMO DRG,0.01,35750,
Heart failure,194-4,APR-DRG,,,,,,,,inpatient,,,310713.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34994,,186% x Medicaid HMO amount,34994,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,79818,,"27,634 x DRG Weight",79818,Other,DRG Base Rate x DRG Weight,67843,,"23,488 x DRG Weight",67843,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18814.21,,DRG base rate x DRG weight + capital per discharge,18814.21,Other,100% of NY Medicaid HMO DRG,18814,,DRG base rate x DRG weight + capital per discharge,18814,Other,100% of NY Medicaid HMO DRG,18814,,DRG base rate x DRG weight + capital per discharge,18814,Other,100% of NY Medicaid HMO DRG,18814,,DRG base rate x DRG weight + capital per discharge,18814,Other,100% of NY Medicaid HMO DRG,42332,,225% x Medicaid HMO amount,42332,Other,225% of NY Medicaid HMO DRG,28786,,153% x Medicaid HMO amount,28786,Other,153% of NY Medicaid HMO DRG,42332,,225% x Medicaid HMO amount,42332,Other,225% of NY Medicaid HMO DRG,26340,,140% x Medicaid HMO amount,26340,Other,140% of NY Medicaid HMO DRG,42332,,DRG base rate x DRG weight + capital per discharge,42332,Other,225% of NY Medicaid HMO DRG,51739,,275% x Medicaid HMO amount,51739,Other,275% of NY Medicaid HMO DRG,60958,,324% x Medicaid HMO amount,60958,Other,324% of NY Medicaid HMO DRG,40451,,215% x Medicaid HMO amount,40451,Other,215% of NY Medicaid HMO DRG,40451,,215% x Medicaid HMO amount,40451,Other,215% of NY Medicaid HMO DRG,23518,,125% x Medicaid HMO amount,23518,Other,125% of NY Medicaid HMO DRG,0.01,79818,
Cardiac arrest and shock,196-1,APR-DRG,,,,,,,,inpatient,,,39243,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7797,,186% x Medicaid HMO amount,7797,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16185,,"27,634 x DRG Weight",16185,Other,DRG Base Rate x DRG Weight,13757,,"23,488 x DRG Weight",13757,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4192.21,,DRG base rate x DRG weight + capital per discharge,4192.21,Other,100% of NY Medicaid HMO DRG,4192,,DRG base rate x DRG weight + capital per discharge,4192,Other,100% of NY Medicaid HMO DRG,4192,,DRG base rate x DRG weight + capital per discharge,4192,Other,100% of NY Medicaid HMO DRG,4192,,DRG base rate x DRG weight + capital per discharge,4192,Other,100% of NY Medicaid HMO DRG,9432,,225% x Medicaid HMO amount,9432,Other,225% of NY Medicaid HMO DRG,6414,,153% x Medicaid HMO amount,6414,Other,153% of NY Medicaid HMO DRG,9432,,225% x Medicaid HMO amount,9432,Other,225% of NY Medicaid HMO DRG,5869,,140% x Medicaid HMO amount,5869,Other,140% of NY Medicaid HMO DRG,9432,,DRG base rate x DRG weight + capital per discharge,9432,Other,225% of NY Medicaid HMO DRG,11529,,275% x Medicaid HMO amount,11529,Other,275% of NY Medicaid HMO DRG,13583,,324% x Medicaid HMO amount,13583,Other,324% of NY Medicaid HMO DRG,9013,,215% x Medicaid HMO amount,9013,Other,215% of NY Medicaid HMO DRG,9013,,215% x Medicaid HMO amount,9013,Other,215% of NY Medicaid HMO DRG,5240,,125% x Medicaid HMO amount,5240,Other,125% of NY Medicaid HMO DRG,0.01,16185,
Cardiac arrest and shock,196-2,APR-DRG,,,,,,,,inpatient,,,39243,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8344,,186% x Medicaid HMO amount,8344,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17465,,"27,634 x DRG Weight",17465,Other,DRG Base Rate x DRG Weight,14844,,"23,488 x DRG Weight",14844,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4486.21,,DRG base rate x DRG weight + capital per discharge,4486.21,Other,100% of NY Medicaid HMO DRG,4486,,DRG base rate x DRG weight + capital per discharge,4486,Other,100% of NY Medicaid HMO DRG,4486,,DRG base rate x DRG weight + capital per discharge,4486,Other,100% of NY Medicaid HMO DRG,4486,,DRG base rate x DRG weight + capital per discharge,4486,Other,100% of NY Medicaid HMO DRG,10094,,225% x Medicaid HMO amount,10094,Other,225% of NY Medicaid HMO DRG,6864,,153% x Medicaid HMO amount,6864,Other,153% of NY Medicaid HMO DRG,10094,,225% x Medicaid HMO amount,10094,Other,225% of NY Medicaid HMO DRG,6281,,140% x Medicaid HMO amount,6281,Other,140% of NY Medicaid HMO DRG,10094,,DRG base rate x DRG weight + capital per discharge,10094,Other,225% of NY Medicaid HMO DRG,12337,,275% x Medicaid HMO amount,12337,Other,275% of NY Medicaid HMO DRG,14535,,324% x Medicaid HMO amount,14535,Other,324% of NY Medicaid HMO DRG,9645,,215% x Medicaid HMO amount,9645,Other,215% of NY Medicaid HMO DRG,9645,,215% x Medicaid HMO amount,9645,Other,215% of NY Medicaid HMO DRG,5608,,125% x Medicaid HMO amount,5608,Other,125% of NY Medicaid HMO DRG,0.01,17465,
Cardiac arrest and shock,196-3,APR-DRG,,,,,,,,inpatient,,,58926,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9164,,186% x Medicaid HMO amount,9164,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19385,,"27,634 x DRG Weight",19385,Other,DRG Base Rate x DRG Weight,16477,,"23,488 x DRG Weight",16477,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4927.21,,DRG base rate x DRG weight + capital per discharge,4927.21,Other,100% of NY Medicaid HMO DRG,4927,,DRG base rate x DRG weight + capital per discharge,4927,Other,100% of NY Medicaid HMO DRG,4927,,DRG base rate x DRG weight + capital per discharge,4927,Other,100% of NY Medicaid HMO DRG,4927,,DRG base rate x DRG weight + capital per discharge,4927,Other,100% of NY Medicaid HMO DRG,11086,,225% x Medicaid HMO amount,11086,Other,225% of NY Medicaid HMO DRG,7539,,153% x Medicaid HMO amount,7539,Other,153% of NY Medicaid HMO DRG,11086,,225% x Medicaid HMO amount,11086,Other,225% of NY Medicaid HMO DRG,6898,,140% x Medicaid HMO amount,6898,Other,140% of NY Medicaid HMO DRG,11086,,DRG base rate x DRG weight + capital per discharge,11086,Other,225% of NY Medicaid HMO DRG,13550,,275% x Medicaid HMO amount,13550,Other,275% of NY Medicaid HMO DRG,15964,,324% x Medicaid HMO amount,15964,Other,324% of NY Medicaid HMO DRG,10594,,215% x Medicaid HMO amount,10594,Other,215% of NY Medicaid HMO DRG,10594,,215% x Medicaid HMO amount,10594,Other,215% of NY Medicaid HMO DRG,6159,,125% x Medicaid HMO amount,6159,Other,125% of NY Medicaid HMO DRG,0.01,19385,
Cardiac arrest and shock,196-4,APR-DRG,,,,,,,,inpatient,,,436026.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25573,,186% x Medicaid HMO amount,25573,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57777,,"27,634 x DRG Weight",57777,Other,DRG Base Rate x DRG Weight,49109,,"23,488 x DRG Weight",49109,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13749.21,,DRG base rate x DRG weight + capital per discharge,13749.21,Other,100% of NY Medicaid HMO DRG,13749,,DRG base rate x DRG weight + capital per discharge,13749,Other,100% of NY Medicaid HMO DRG,13749,,DRG base rate x DRG weight + capital per discharge,13749,Other,100% of NY Medicaid HMO DRG,13749,,DRG base rate x DRG weight + capital per discharge,13749,Other,100% of NY Medicaid HMO DRG,30936,,225% x Medicaid HMO amount,30936,Other,225% of NY Medicaid HMO DRG,21036,,153% x Medicaid HMO amount,21036,Other,153% of NY Medicaid HMO DRG,30936,,225% x Medicaid HMO amount,30936,Other,225% of NY Medicaid HMO DRG,19249,,140% x Medicaid HMO amount,19249,Other,140% of NY Medicaid HMO DRG,30936,,DRG base rate x DRG weight + capital per discharge,30936,Other,225% of NY Medicaid HMO DRG,37810,,275% x Medicaid HMO amount,37810,Other,275% of NY Medicaid HMO DRG,44547,,324% x Medicaid HMO amount,44547,Other,324% of NY Medicaid HMO DRG,29561,,215% x Medicaid HMO amount,29561,Other,215% of NY Medicaid HMO DRG,29561,,215% x Medicaid HMO amount,29561,Other,215% of NY Medicaid HMO DRG,17187,,125% x Medicaid HMO amount,17187,Other,125% of NY Medicaid HMO DRG,0.01,57777,
Peripheral & other vascular disorders,197-1,APR-DRG,,,,,,,,inpatient,,,67963.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7801,,186% x Medicaid HMO amount,7801,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16194,,"27,634 x DRG Weight",16194,Other,DRG Base Rate x DRG Weight,13764,,"23,488 x DRG Weight",13764,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4194.21,,DRG base rate x DRG weight + capital per discharge,4194.21,Other,100% of NY Medicaid HMO DRG,4194,,DRG base rate x DRG weight + capital per discharge,4194,Other,100% of NY Medicaid HMO DRG,4194,,DRG base rate x DRG weight + capital per discharge,4194,Other,100% of NY Medicaid HMO DRG,4194,,DRG base rate x DRG weight + capital per discharge,4194,Other,100% of NY Medicaid HMO DRG,9437,,225% x Medicaid HMO amount,9437,Other,225% of NY Medicaid HMO DRG,6417,,153% x Medicaid HMO amount,6417,Other,153% of NY Medicaid HMO DRG,9437,,225% x Medicaid HMO amount,9437,Other,225% of NY Medicaid HMO DRG,5872,,140% x Medicaid HMO amount,5872,Other,140% of NY Medicaid HMO DRG,9437,,DRG base rate x DRG weight + capital per discharge,9437,Other,225% of NY Medicaid HMO DRG,11534,,275% x Medicaid HMO amount,11534,Other,275% of NY Medicaid HMO DRG,13589,,324% x Medicaid HMO amount,13589,Other,324% of NY Medicaid HMO DRG,9018,,215% x Medicaid HMO amount,9018,Other,215% of NY Medicaid HMO DRG,9018,,215% x Medicaid HMO amount,9018,Other,215% of NY Medicaid HMO DRG,5243,,125% x Medicaid HMO amount,5243,Other,125% of NY Medicaid HMO DRG,0.01,16194,
Peripheral & other vascular disorders,197-2,APR-DRG,,,,,,,,inpatient,,,188289.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10237,,186% x Medicaid HMO amount,10237,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21894,,"27,634 x DRG Weight",21894,Other,DRG Base Rate x DRG Weight,18610,,"23,488 x DRG Weight",18610,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5504.21,,DRG base rate x DRG weight + capital per discharge,5504.21,Other,100% of NY Medicaid HMO DRG,5504,,DRG base rate x DRG weight + capital per discharge,5504,Other,100% of NY Medicaid HMO DRG,5504,,DRG base rate x DRG weight + capital per discharge,5504,Other,100% of NY Medicaid HMO DRG,5504,,DRG base rate x DRG weight + capital per discharge,5504,Other,100% of NY Medicaid HMO DRG,12384,,225% x Medicaid HMO amount,12384,Other,225% of NY Medicaid HMO DRG,8421,,153% x Medicaid HMO amount,8421,Other,153% of NY Medicaid HMO DRG,12384,,225% x Medicaid HMO amount,12384,Other,225% of NY Medicaid HMO DRG,7706,,140% x Medicaid HMO amount,7706,Other,140% of NY Medicaid HMO DRG,12384,,DRG base rate x DRG weight + capital per discharge,12384,Other,225% of NY Medicaid HMO DRG,15137,,275% x Medicaid HMO amount,15137,Other,275% of NY Medicaid HMO DRG,17834,,324% x Medicaid HMO amount,17834,Other,324% of NY Medicaid HMO DRG,11834,,215% x Medicaid HMO amount,11834,Other,215% of NY Medicaid HMO DRG,11834,,215% x Medicaid HMO amount,11834,Other,215% of NY Medicaid HMO DRG,6880,,125% x Medicaid HMO amount,6880,Other,125% of NY Medicaid HMO DRG,0.01,21894,
Peripheral & other vascular disorders,197-3,APR-DRG,,,,,,,,inpatient,,,141771.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14828,,186% x Medicaid HMO amount,14828,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32633,,"27,634 x DRG Weight",32633,Other,DRG Base Rate x DRG Weight,27737,,"23,488 x DRG Weight",27737,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7972.21,,DRG base rate x DRG weight + capital per discharge,7972.21,Other,100% of NY Medicaid HMO DRG,7972,,DRG base rate x DRG weight + capital per discharge,7972,Other,100% of NY Medicaid HMO DRG,7972,,DRG base rate x DRG weight + capital per discharge,7972,Other,100% of NY Medicaid HMO DRG,7972,,DRG base rate x DRG weight + capital per discharge,7972,Other,100% of NY Medicaid HMO DRG,17937,,225% x Medicaid HMO amount,17937,Other,225% of NY Medicaid HMO DRG,12197,,153% x Medicaid HMO amount,12197,Other,153% of NY Medicaid HMO DRG,17937,,225% x Medicaid HMO amount,17937,Other,225% of NY Medicaid HMO DRG,11161,,140% x Medicaid HMO amount,11161,Other,140% of NY Medicaid HMO DRG,17937,,DRG base rate x DRG weight + capital per discharge,17937,Other,225% of NY Medicaid HMO DRG,21924,,275% x Medicaid HMO amount,21924,Other,275% of NY Medicaid HMO DRG,25830,,324% x Medicaid HMO amount,25830,Other,324% of NY Medicaid HMO DRG,17140,,215% x Medicaid HMO amount,17140,Other,215% of NY Medicaid HMO DRG,17140,,215% x Medicaid HMO amount,17140,Other,215% of NY Medicaid HMO DRG,9965,,125% x Medicaid HMO amount,9965,Other,125% of NY Medicaid HMO DRG,0.01,32633,
Peripheral & other vascular disorders,197-4,APR-DRG,,,,,,,,inpatient,,,249807.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34706,,186% x Medicaid HMO amount,34706,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,79141,,"27,634 x DRG Weight",79141,Other,DRG Base Rate x DRG Weight,67267,,"23,488 x DRG Weight",67267,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18659.21,,DRG base rate x DRG weight + capital per discharge,18659.21,Other,100% of NY Medicaid HMO DRG,18659,,DRG base rate x DRG weight + capital per discharge,18659,Other,100% of NY Medicaid HMO DRG,18659,,DRG base rate x DRG weight + capital per discharge,18659,Other,100% of NY Medicaid HMO DRG,18659,,DRG base rate x DRG weight + capital per discharge,18659,Other,100% of NY Medicaid HMO DRG,41983,,225% x Medicaid HMO amount,41983,Other,225% of NY Medicaid HMO DRG,28549,,153% x Medicaid HMO amount,28549,Other,153% of NY Medicaid HMO DRG,41983,,225% x Medicaid HMO amount,41983,Other,225% of NY Medicaid HMO DRG,26123,,140% x Medicaid HMO amount,26123,Other,140% of NY Medicaid HMO DRG,41983,,DRG base rate x DRG weight + capital per discharge,41983,Other,225% of NY Medicaid HMO DRG,51313,,275% x Medicaid HMO amount,51313,Other,275% of NY Medicaid HMO DRG,60456,,324% x Medicaid HMO amount,60456,Other,324% of NY Medicaid HMO DRG,40117,,215% x Medicaid HMO amount,40117,Other,215% of NY Medicaid HMO DRG,40117,,215% x Medicaid HMO amount,40117,Other,215% of NY Medicaid HMO DRG,23324,,125% x Medicaid HMO amount,23324,Other,125% of NY Medicaid HMO DRG,0.01,79141,
Angina pectoris & coronary atherosclerosis,198-1,APR-DRG,,,,,,,,inpatient,,,102325.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5703,,186% x Medicaid HMO amount,5703,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11283,,"27,634 x DRG Weight",11283,Other,DRG Base Rate x DRG Weight,9590,,"23,488 x DRG Weight",9590,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3066.21,,DRG base rate x DRG weight + capital per discharge,3066.21,Other,100% of NY Medicaid HMO DRG,3066,,DRG base rate x DRG weight + capital per discharge,3066,Other,100% of NY Medicaid HMO DRG,3066,,DRG base rate x DRG weight + capital per discharge,3066,Other,100% of NY Medicaid HMO DRG,3066,,DRG base rate x DRG weight + capital per discharge,3066,Other,100% of NY Medicaid HMO DRG,6899,,225% x Medicaid HMO amount,6899,Other,225% of NY Medicaid HMO DRG,4691,,153% x Medicaid HMO amount,4691,Other,153% of NY Medicaid HMO DRG,6899,,225% x Medicaid HMO amount,6899,Other,225% of NY Medicaid HMO DRG,4293,,140% x Medicaid HMO amount,4293,Other,140% of NY Medicaid HMO DRG,6899,,DRG base rate x DRG weight + capital per discharge,6899,Other,225% of NY Medicaid HMO DRG,8432,,275% x Medicaid HMO amount,8432,Other,275% of NY Medicaid HMO DRG,9935,,324% x Medicaid HMO amount,9935,Other,324% of NY Medicaid HMO DRG,6592,,215% x Medicaid HMO amount,6592,Other,215% of NY Medicaid HMO DRG,6592,,215% x Medicaid HMO amount,6592,Other,215% of NY Medicaid HMO DRG,3833,,125% x Medicaid HMO amount,3833,Other,125% of NY Medicaid HMO DRG,0.01,11283,
Angina pectoris & coronary atherosclerosis,198-2,APR-DRG,,,,,,,,inpatient,,,85033.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7191,,186% x Medicaid HMO amount,7191,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14765,,"27,634 x DRG Weight",14765,Other,DRG Base Rate x DRG Weight,12550,,"23,488 x DRG Weight",12550,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3866.21,,DRG base rate x DRG weight + capital per discharge,3866.21,Other,100% of NY Medicaid HMO DRG,3866,,DRG base rate x DRG weight + capital per discharge,3866,Other,100% of NY Medicaid HMO DRG,3866,,DRG base rate x DRG weight + capital per discharge,3866,Other,100% of NY Medicaid HMO DRG,3866,,DRG base rate x DRG weight + capital per discharge,3866,Other,100% of NY Medicaid HMO DRG,8699,,225% x Medicaid HMO amount,8699,Other,225% of NY Medicaid HMO DRG,5915,,153% x Medicaid HMO amount,5915,Other,153% of NY Medicaid HMO DRG,8699,,225% x Medicaid HMO amount,8699,Other,225% of NY Medicaid HMO DRG,5413,,140% x Medicaid HMO amount,5413,Other,140% of NY Medicaid HMO DRG,8699,,DRG base rate x DRG weight + capital per discharge,8699,Other,225% of NY Medicaid HMO DRG,10632,,275% x Medicaid HMO amount,10632,Other,275% of NY Medicaid HMO DRG,12527,,324% x Medicaid HMO amount,12527,Other,324% of NY Medicaid HMO DRG,8312,,215% x Medicaid HMO amount,8312,Other,215% of NY Medicaid HMO DRG,8312,,215% x Medicaid HMO amount,8312,Other,215% of NY Medicaid HMO DRG,4833,,125% x Medicaid HMO amount,4833,Other,125% of NY Medicaid HMO DRG,0.01,14765,
Angina pectoris & coronary atherosclerosis,198-3,APR-DRG,,,,,,,,inpatient,,,81012.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10537,,186% x Medicaid HMO amount,10537,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22596,,"27,634 x DRG Weight",22596,Other,DRG Base Rate x DRG Weight,19206,,"23,488 x DRG Weight",19206,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5665.21,,DRG base rate x DRG weight + capital per discharge,5665.21,Other,100% of NY Medicaid HMO DRG,5665,,DRG base rate x DRG weight + capital per discharge,5665,Other,100% of NY Medicaid HMO DRG,5665,,DRG base rate x DRG weight + capital per discharge,5665,Other,100% of NY Medicaid HMO DRG,5665,,DRG base rate x DRG weight + capital per discharge,5665,Other,100% of NY Medicaid HMO DRG,12747,,225% x Medicaid HMO amount,12747,Other,225% of NY Medicaid HMO DRG,8668,,153% x Medicaid HMO amount,8668,Other,153% of NY Medicaid HMO DRG,12747,,225% x Medicaid HMO amount,12747,Other,225% of NY Medicaid HMO DRG,7931,,140% x Medicaid HMO amount,7931,Other,140% of NY Medicaid HMO DRG,12747,,DRG base rate x DRG weight + capital per discharge,12747,Other,225% of NY Medicaid HMO DRG,15579,,275% x Medicaid HMO amount,15579,Other,275% of NY Medicaid HMO DRG,18355,,324% x Medicaid HMO amount,18355,Other,324% of NY Medicaid HMO DRG,12180,,215% x Medicaid HMO amount,12180,Other,215% of NY Medicaid HMO DRG,12180,,215% x Medicaid HMO amount,12180,Other,215% of NY Medicaid HMO DRG,7082,,125% x Medicaid HMO amount,7082,Other,125% of NY Medicaid HMO DRG,0.01,22596,
Angina pectoris & coronary atherosclerosis,198-4,APR-DRG,,,,,,,,inpatient,,,90536,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29470,,186% x Medicaid HMO amount,29470,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,66894,,"27,634 x DRG Weight",66894,Other,DRG Base Rate x DRG Weight,56857,,"23,488 x DRG Weight",56857,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15844.21,,DRG base rate x DRG weight + capital per discharge,15844.21,Other,100% of NY Medicaid HMO DRG,15844,,DRG base rate x DRG weight + capital per discharge,15844,Other,100% of NY Medicaid HMO DRG,15844,,DRG base rate x DRG weight + capital per discharge,15844,Other,100% of NY Medicaid HMO DRG,15844,,DRG base rate x DRG weight + capital per discharge,15844,Other,100% of NY Medicaid HMO DRG,35649,,225% x Medicaid HMO amount,35649,Other,225% of NY Medicaid HMO DRG,24242,,153% x Medicaid HMO amount,24242,Other,153% of NY Medicaid HMO DRG,35649,,225% x Medicaid HMO amount,35649,Other,225% of NY Medicaid HMO DRG,22182,,140% x Medicaid HMO amount,22182,Other,140% of NY Medicaid HMO DRG,35649,,DRG base rate x DRG weight + capital per discharge,35649,Other,225% of NY Medicaid HMO DRG,43572,,275% x Medicaid HMO amount,43572,Other,275% of NY Medicaid HMO DRG,51335,,324% x Medicaid HMO amount,51335,Other,324% of NY Medicaid HMO DRG,34065,,215% x Medicaid HMO amount,34065,Other,215% of NY Medicaid HMO DRG,34065,,215% x Medicaid HMO amount,34065,Other,215% of NY Medicaid HMO DRG,19805,,125% x Medicaid HMO amount,19805,Other,125% of NY Medicaid HMO DRG,0.01,66894,
Hypertension,199-1,APR-DRG,,,,,,,,inpatient,,,92242.65,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6224,,186% x Medicaid HMO amount,6224,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12504,,"27,634 x DRG Weight",12504,Other,DRG Base Rate x DRG Weight,10628,,"23,488 x DRG Weight",10628,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3346.21,,DRG base rate x DRG weight + capital per discharge,3346.21,Other,100% of NY Medicaid HMO DRG,3346,,DRG base rate x DRG weight + capital per discharge,3346,Other,100% of NY Medicaid HMO DRG,3346,,DRG base rate x DRG weight + capital per discharge,3346,Other,100% of NY Medicaid HMO DRG,3346,,DRG base rate x DRG weight + capital per discharge,3346,Other,100% of NY Medicaid HMO DRG,7529,,225% x Medicaid HMO amount,7529,Other,225% of NY Medicaid HMO DRG,5120,,153% x Medicaid HMO amount,5120,Other,153% of NY Medicaid HMO DRG,7529,,225% x Medicaid HMO amount,7529,Other,225% of NY Medicaid HMO DRG,4685,,140% x Medicaid HMO amount,4685,Other,140% of NY Medicaid HMO DRG,7529,,DRG base rate x DRG weight + capital per discharge,7529,Other,225% of NY Medicaid HMO DRG,9202,,275% x Medicaid HMO amount,9202,Other,275% of NY Medicaid HMO DRG,10842,,324% x Medicaid HMO amount,10842,Other,324% of NY Medicaid HMO DRG,7194,,215% x Medicaid HMO amount,7194,Other,215% of NY Medicaid HMO DRG,7194,,215% x Medicaid HMO amount,7194,Other,215% of NY Medicaid HMO DRG,4183,,125% x Medicaid HMO amount,4183,Other,125% of NY Medicaid HMO DRG,0.01,12504,
Hypertension,199-2,APR-DRG,,,,,,,,inpatient,,,80019.84,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7877,,186% x Medicaid HMO amount,7877,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16370,,"27,634 x DRG Weight",16370,Other,DRG Base Rate x DRG Weight,13914,,"23,488 x DRG Weight",13914,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4235.21,,DRG base rate x DRG weight + capital per discharge,4235.21,Other,100% of NY Medicaid HMO DRG,4235,,DRG base rate x DRG weight + capital per discharge,4235,Other,100% of NY Medicaid HMO DRG,4235,,DRG base rate x DRG weight + capital per discharge,4235,Other,100% of NY Medicaid HMO DRG,4235,,DRG base rate x DRG weight + capital per discharge,4235,Other,100% of NY Medicaid HMO DRG,9529,,225% x Medicaid HMO amount,9529,Other,225% of NY Medicaid HMO DRG,6480,,153% x Medicaid HMO amount,6480,Other,153% of NY Medicaid HMO DRG,9529,,225% x Medicaid HMO amount,9529,Other,225% of NY Medicaid HMO DRG,5929,,140% x Medicaid HMO amount,5929,Other,140% of NY Medicaid HMO DRG,9529,,DRG base rate x DRG weight + capital per discharge,9529,Other,225% of NY Medicaid HMO DRG,11647,,275% x Medicaid HMO amount,11647,Other,275% of NY Medicaid HMO DRG,13722,,324% x Medicaid HMO amount,13722,Other,324% of NY Medicaid HMO DRG,9106,,215% x Medicaid HMO amount,9106,Other,215% of NY Medicaid HMO DRG,9106,,215% x Medicaid HMO amount,9106,Other,215% of NY Medicaid HMO DRG,5294,,125% x Medicaid HMO amount,5294,Other,125% of NY Medicaid HMO DRG,0.01,16370,
Hypertension,199-3,APR-DRG,,,,,,,,inpatient,,,143572.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11885,,186% x Medicaid HMO amount,11885,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25752,,"27,634 x DRG Weight",25752,Other,DRG Base Rate x DRG Weight,21888,,"23,488 x DRG Weight",21888,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6390.21,,DRG base rate x DRG weight + capital per discharge,6390.21,Other,100% of NY Medicaid HMO DRG,6390,,DRG base rate x DRG weight + capital per discharge,6390,Other,100% of NY Medicaid HMO DRG,6390,,DRG base rate x DRG weight + capital per discharge,6390,Other,100% of NY Medicaid HMO DRG,6390,,DRG base rate x DRG weight + capital per discharge,6390,Other,100% of NY Medicaid HMO DRG,14378,,225% x Medicaid HMO amount,14378,Other,225% of NY Medicaid HMO DRG,9777,,153% x Medicaid HMO amount,9777,Other,153% of NY Medicaid HMO DRG,14378,,225% x Medicaid HMO amount,14378,Other,225% of NY Medicaid HMO DRG,8946,,140% x Medicaid HMO amount,8946,Other,140% of NY Medicaid HMO DRG,14378,,DRG base rate x DRG weight + capital per discharge,14378,Other,225% of NY Medicaid HMO DRG,17573,,275% x Medicaid HMO amount,17573,Other,275% of NY Medicaid HMO DRG,20704,,324% x Medicaid HMO amount,20704,Other,324% of NY Medicaid HMO DRG,13739,,215% x Medicaid HMO amount,13739,Other,215% of NY Medicaid HMO DRG,13739,,215% x Medicaid HMO amount,13739,Other,215% of NY Medicaid HMO DRG,7988,,125% x Medicaid HMO amount,7988,Other,125% of NY Medicaid HMO DRG,0.01,25752,
Hypertension,199-4,APR-DRG,,,,,,,,inpatient,,,229473.45,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29890,,186% x Medicaid HMO amount,29890,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,67877,,"27,634 x DRG Weight",67877,Other,DRG Base Rate x DRG Weight,57694,,"23,488 x DRG Weight",57694,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16070.21,,DRG base rate x DRG weight + capital per discharge,16070.21,Other,100% of NY Medicaid HMO DRG,16070,,DRG base rate x DRG weight + capital per discharge,16070,Other,100% of NY Medicaid HMO DRG,16070,,DRG base rate x DRG weight + capital per discharge,16070,Other,100% of NY Medicaid HMO DRG,16070,,DRG base rate x DRG weight + capital per discharge,16070,Other,100% of NY Medicaid HMO DRG,36158,,225% x Medicaid HMO amount,36158,Other,225% of NY Medicaid HMO DRG,24587,,153% x Medicaid HMO amount,24587,Other,153% of NY Medicaid HMO DRG,36158,,225% x Medicaid HMO amount,36158,Other,225% of NY Medicaid HMO DRG,22498,,140% x Medicaid HMO amount,22498,Other,140% of NY Medicaid HMO DRG,36158,,DRG base rate x DRG weight + capital per discharge,36158,Other,225% of NY Medicaid HMO DRG,44193,,275% x Medicaid HMO amount,44193,Other,275% of NY Medicaid HMO DRG,52067,,324% x Medicaid HMO amount,52067,Other,324% of NY Medicaid HMO DRG,34551,,215% x Medicaid HMO amount,34551,Other,215% of NY Medicaid HMO DRG,34551,,215% x Medicaid HMO amount,34551,Other,215% of NY Medicaid HMO DRG,20088,,125% x Medicaid HMO amount,20088,Other,125% of NY Medicaid HMO DRG,0.01,67877,
Cardiac structural & valvular disorders,200-1,APR-DRG,,,,,,,,inpatient,,,47277.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6871,,186% x Medicaid HMO amount,6871,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14019,,"27,634 x DRG Weight",14019,Other,DRG Base Rate x DRG Weight,11915,,"23,488 x DRG Weight",11915,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3694.21,,DRG base rate x DRG weight + capital per discharge,3694.21,Other,100% of NY Medicaid HMO DRG,3694,,DRG base rate x DRG weight + capital per discharge,3694,Other,100% of NY Medicaid HMO DRG,3694,,DRG base rate x DRG weight + capital per discharge,3694,Other,100% of NY Medicaid HMO DRG,3694,,DRG base rate x DRG weight + capital per discharge,3694,Other,100% of NY Medicaid HMO DRG,8312,,225% x Medicaid HMO amount,8312,Other,225% of NY Medicaid HMO DRG,5652,,153% x Medicaid HMO amount,5652,Other,153% of NY Medicaid HMO DRG,8312,,225% x Medicaid HMO amount,8312,Other,225% of NY Medicaid HMO DRG,5172,,140% x Medicaid HMO amount,5172,Other,140% of NY Medicaid HMO DRG,8312,,DRG base rate x DRG weight + capital per discharge,8312,Other,225% of NY Medicaid HMO DRG,10159,,275% x Medicaid HMO amount,10159,Other,275% of NY Medicaid HMO DRG,11969,,324% x Medicaid HMO amount,11969,Other,324% of NY Medicaid HMO DRG,7943,,215% x Medicaid HMO amount,7943,Other,215% of NY Medicaid HMO DRG,7943,,215% x Medicaid HMO amount,7943,Other,215% of NY Medicaid HMO DRG,4618,,125% x Medicaid HMO amount,4618,Other,125% of NY Medicaid HMO DRG,0.01,14019,
Cardiac structural & valvular disorders,200-2,APR-DRG,,,,,,,,inpatient,,,85847.83,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9101,,186% x Medicaid HMO amount,9101,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19233,,"27,634 x DRG Weight",19233,Other,DRG Base Rate x DRG Weight,16348,,"23,488 x DRG Weight",16348,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4893.21,,DRG base rate x DRG weight + capital per discharge,4893.21,Other,100% of NY Medicaid HMO DRG,4893,,DRG base rate x DRG weight + capital per discharge,4893,Other,100% of NY Medicaid HMO DRG,4893,,DRG base rate x DRG weight + capital per discharge,4893,Other,100% of NY Medicaid HMO DRG,4893,,DRG base rate x DRG weight + capital per discharge,4893,Other,100% of NY Medicaid HMO DRG,11010,,225% x Medicaid HMO amount,11010,Other,225% of NY Medicaid HMO DRG,7487,,153% x Medicaid HMO amount,7487,Other,153% of NY Medicaid HMO DRG,11010,,225% x Medicaid HMO amount,11010,Other,225% of NY Medicaid HMO DRG,6850,,140% x Medicaid HMO amount,6850,Other,140% of NY Medicaid HMO DRG,11010,,DRG base rate x DRG weight + capital per discharge,11010,Other,225% of NY Medicaid HMO DRG,13456,,275% x Medicaid HMO amount,13456,Other,275% of NY Medicaid HMO DRG,15854,,324% x Medicaid HMO amount,15854,Other,324% of NY Medicaid HMO DRG,10520,,215% x Medicaid HMO amount,10520,Other,215% of NY Medicaid HMO DRG,10520,,215% x Medicaid HMO amount,10520,Other,215% of NY Medicaid HMO DRG,6117,,125% x Medicaid HMO amount,6117,Other,125% of NY Medicaid HMO DRG,0.01,19233,
Cardiac structural & valvular disorders,200-3,APR-DRG,,,,,,,,inpatient,,,219955.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15663,,186% x Medicaid HMO amount,15663,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34587,,"27,634 x DRG Weight",34587,Other,DRG Base Rate x DRG Weight,29398,,"23,488 x DRG Weight",29398,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8421.21,,DRG base rate x DRG weight + capital per discharge,8421.21,Other,100% of NY Medicaid HMO DRG,8421,,DRG base rate x DRG weight + capital per discharge,8421,Other,100% of NY Medicaid HMO DRG,8421,,DRG base rate x DRG weight + capital per discharge,8421,Other,100% of NY Medicaid HMO DRG,8421,,DRG base rate x DRG weight + capital per discharge,8421,Other,100% of NY Medicaid HMO DRG,18948,,225% x Medicaid HMO amount,18948,Other,225% of NY Medicaid HMO DRG,12884,,153% x Medicaid HMO amount,12884,Other,153% of NY Medicaid HMO DRG,18948,,225% x Medicaid HMO amount,18948,Other,225% of NY Medicaid HMO DRG,11790,,140% x Medicaid HMO amount,11790,Other,140% of NY Medicaid HMO DRG,18948,,DRG base rate x DRG weight + capital per discharge,18948,Other,225% of NY Medicaid HMO DRG,23158,,275% x Medicaid HMO amount,23158,Other,275% of NY Medicaid HMO DRG,27285,,324% x Medicaid HMO amount,27285,Other,324% of NY Medicaid HMO DRG,18106,,215% x Medicaid HMO amount,18106,Other,215% of NY Medicaid HMO DRG,18106,,215% x Medicaid HMO amount,18106,Other,215% of NY Medicaid HMO DRG,10527,,125% x Medicaid HMO amount,10527,Other,125% of NY Medicaid HMO DRG,0.01,34587,
Cardiac structural & valvular disorders,200-4,APR-DRG,,,,,,,,inpatient,,,36093,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47410,,186% x Medicaid HMO amount,47410,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,108864,,"27,634 x DRG Weight",108864,Other,DRG Base Rate x DRG Weight,92531,,"23,488 x DRG Weight",92531,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25489.21,,DRG base rate x DRG weight + capital per discharge,25489.21,Other,100% of NY Medicaid HMO DRG,25489,,DRG base rate x DRG weight + capital per discharge,25489,Other,100% of NY Medicaid HMO DRG,25489,,DRG base rate x DRG weight + capital per discharge,25489,Other,100% of NY Medicaid HMO DRG,25489,,DRG base rate x DRG weight + capital per discharge,25489,Other,100% of NY Medicaid HMO DRG,57351,,225% x Medicaid HMO amount,57351,Other,225% of NY Medicaid HMO DRG,38998,,153% x Medicaid HMO amount,38998,Other,153% of NY Medicaid HMO DRG,57351,,225% x Medicaid HMO amount,57351,Other,225% of NY Medicaid HMO DRG,35685,,140% x Medicaid HMO amount,35685,Other,140% of NY Medicaid HMO DRG,57351,,DRG base rate x DRG weight + capital per discharge,57351,Other,225% of NY Medicaid HMO DRG,70095,,275% x Medicaid HMO amount,70095,Other,275% of NY Medicaid HMO DRG,82585,,324% x Medicaid HMO amount,82585,Other,324% of NY Medicaid HMO DRG,54802,,215% x Medicaid HMO amount,54802,Other,215% of NY Medicaid HMO DRG,54802,,215% x Medicaid HMO amount,54802,Other,215% of NY Medicaid HMO DRG,31862,,125% x Medicaid HMO amount,31862,Other,125% of NY Medicaid HMO DRG,0.01,108864,
Cardiac arrhythmia & conduction disorders,201-1,APR-DRG,,,,,,,,inpatient,,,116319.68,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5987,,186% x Medicaid HMO amount,5987,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11952,,"27,634 x DRG Weight",11952,Other,DRG Base Rate x DRG Weight,10159,,"23,488 x DRG Weight",10159,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3219.21,,DRG base rate x DRG weight + capital per discharge,3219.21,Other,100% of NY Medicaid HMO DRG,3219,,DRG base rate x DRG weight + capital per discharge,3219,Other,100% of NY Medicaid HMO DRG,3219,,DRG base rate x DRG weight + capital per discharge,3219,Other,100% of NY Medicaid HMO DRG,3219,,DRG base rate x DRG weight + capital per discharge,3219,Other,100% of NY Medicaid HMO DRG,7243,,225% x Medicaid HMO amount,7243,Other,225% of NY Medicaid HMO DRG,4925,,153% x Medicaid HMO amount,4925,Other,153% of NY Medicaid HMO DRG,7243,,225% x Medicaid HMO amount,7243,Other,225% of NY Medicaid HMO DRG,4507,,140% x Medicaid HMO amount,4507,Other,140% of NY Medicaid HMO DRG,7243,,DRG base rate x DRG weight + capital per discharge,7243,Other,225% of NY Medicaid HMO DRG,8853,,275% x Medicaid HMO amount,8853,Other,275% of NY Medicaid HMO DRG,10430,,324% x Medicaid HMO amount,10430,Other,324% of NY Medicaid HMO DRG,6921,,215% x Medicaid HMO amount,6921,Other,215% of NY Medicaid HMO DRG,6921,,215% x Medicaid HMO amount,6921,Other,215% of NY Medicaid HMO DRG,4024,,125% x Medicaid HMO amount,4024,Other,125% of NY Medicaid HMO DRG,0.01,11952,
Cardiac arrhythmia & conduction disorders,201-2,APR-DRG,,,,,,,,inpatient,,,107906.78,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8258,,186% x Medicaid HMO amount,8258,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17263,,"27,634 x DRG Weight",17263,Other,DRG Base Rate x DRG Weight,14673,,"23,488 x DRG Weight",14673,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4440.21,,DRG base rate x DRG weight + capital per discharge,4440.21,Other,100% of NY Medicaid HMO DRG,4440,,DRG base rate x DRG weight + capital per discharge,4440,Other,100% of NY Medicaid HMO DRG,4440,,DRG base rate x DRG weight + capital per discharge,4440,Other,100% of NY Medicaid HMO DRG,4440,,DRG base rate x DRG weight + capital per discharge,4440,Other,100% of NY Medicaid HMO DRG,9990,,225% x Medicaid HMO amount,9990,Other,225% of NY Medicaid HMO DRG,6794,,153% x Medicaid HMO amount,6794,Other,153% of NY Medicaid HMO DRG,9990,,225% x Medicaid HMO amount,9990,Other,225% of NY Medicaid HMO DRG,6216,,140% x Medicaid HMO amount,6216,Other,140% of NY Medicaid HMO DRG,9990,,DRG base rate x DRG weight + capital per discharge,9990,Other,225% of NY Medicaid HMO DRG,12211,,275% x Medicaid HMO amount,12211,Other,275% of NY Medicaid HMO DRG,14386,,324% x Medicaid HMO amount,14386,Other,324% of NY Medicaid HMO DRG,9546,,215% x Medicaid HMO amount,9546,Other,215% of NY Medicaid HMO DRG,9546,,215% x Medicaid HMO amount,9546,Other,215% of NY Medicaid HMO DRG,5550,,125% x Medicaid HMO amount,5550,Other,125% of NY Medicaid HMO DRG,0.01,17263,
Cardiac arrhythmia & conduction disorders,201-3,APR-DRG,,,,,,,,inpatient,,,113020.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13693,,186% x Medicaid HMO amount,13693,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29980,,"27,634 x DRG Weight",29980,Other,DRG Base Rate x DRG Weight,25482,,"23,488 x DRG Weight",25482,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7362.21,,DRG base rate x DRG weight + capital per discharge,7362.21,Other,100% of NY Medicaid HMO DRG,7362,,DRG base rate x DRG weight + capital per discharge,7362,Other,100% of NY Medicaid HMO DRG,7362,,DRG base rate x DRG weight + capital per discharge,7362,Other,100% of NY Medicaid HMO DRG,7362,,DRG base rate x DRG weight + capital per discharge,7362,Other,100% of NY Medicaid HMO DRG,16565,,225% x Medicaid HMO amount,16565,Other,225% of NY Medicaid HMO DRG,11264,,153% x Medicaid HMO amount,11264,Other,153% of NY Medicaid HMO DRG,16565,,225% x Medicaid HMO amount,16565,Other,225% of NY Medicaid HMO DRG,10307,,140% x Medicaid HMO amount,10307,Other,140% of NY Medicaid HMO DRG,16565,,DRG base rate x DRG weight + capital per discharge,16565,Other,225% of NY Medicaid HMO DRG,20246,,275% x Medicaid HMO amount,20246,Other,275% of NY Medicaid HMO DRG,23854,,324% x Medicaid HMO amount,23854,Other,324% of NY Medicaid HMO DRG,15829,,215% x Medicaid HMO amount,15829,Other,215% of NY Medicaid HMO DRG,15829,,215% x Medicaid HMO amount,15829,Other,215% of NY Medicaid HMO DRG,9203,,125% x Medicaid HMO amount,9203,Other,125% of NY Medicaid HMO DRG,0.01,29980,
Cardiac arrhythmia & conduction disorders,201-4,APR-DRG,,,,,,,,inpatient,,,158033,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30880,,186% x Medicaid HMO amount,30880,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70190,,"27,634 x DRG Weight",70190,Other,DRG Base Rate x DRG Weight,59660,,"23,488 x DRG Weight",59660,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16602.21,,DRG base rate x DRG weight + capital per discharge,16602.21,Other,100% of NY Medicaid HMO DRG,16602,,DRG base rate x DRG weight + capital per discharge,16602,Other,100% of NY Medicaid HMO DRG,16602,,DRG base rate x DRG weight + capital per discharge,16602,Other,100% of NY Medicaid HMO DRG,16602,,DRG base rate x DRG weight + capital per discharge,16602,Other,100% of NY Medicaid HMO DRG,37355,,225% x Medicaid HMO amount,37355,Other,225% of NY Medicaid HMO DRG,25401,,153% x Medicaid HMO amount,25401,Other,153% of NY Medicaid HMO DRG,37355,,225% x Medicaid HMO amount,37355,Other,225% of NY Medicaid HMO DRG,23243,,140% x Medicaid HMO amount,23243,Other,140% of NY Medicaid HMO DRG,37355,,DRG base rate x DRG weight + capital per discharge,37355,Other,225% of NY Medicaid HMO DRG,45656,,275% x Medicaid HMO amount,45656,Other,275% of NY Medicaid HMO DRG,53791,,324% x Medicaid HMO amount,53791,Other,324% of NY Medicaid HMO DRG,35695,,215% x Medicaid HMO amount,35695,Other,215% of NY Medicaid HMO DRG,35695,,215% x Medicaid HMO amount,35695,Other,215% of NY Medicaid HMO DRG,20753,,125% x Medicaid HMO amount,20753,Other,125% of NY Medicaid HMO DRG,0.01,70190,
Chest pain,203-1,APR-DRG,,,,,,,,inpatient,,,115321.97,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5532,,186% x Medicaid HMO amount,5532,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10882,,"27,634 x DRG Weight",10882,Other,DRG Base Rate x DRG Weight,9250,,"23,488 x DRG Weight",9250,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2974.21,,DRG base rate x DRG weight + capital per discharge,2974.21,Other,100% of NY Medicaid HMO DRG,2974,,DRG base rate x DRG weight + capital per discharge,2974,Other,100% of NY Medicaid HMO DRG,2974,,DRG base rate x DRG weight + capital per discharge,2974,Other,100% of NY Medicaid HMO DRG,2974,,DRG base rate x DRG weight + capital per discharge,2974,Other,100% of NY Medicaid HMO DRG,6692,,225% x Medicaid HMO amount,6692,Other,225% of NY Medicaid HMO DRG,4551,,153% x Medicaid HMO amount,4551,Other,153% of NY Medicaid HMO DRG,6692,,225% x Medicaid HMO amount,6692,Other,225% of NY Medicaid HMO DRG,4164,,140% x Medicaid HMO amount,4164,Other,140% of NY Medicaid HMO DRG,6692,,DRG base rate x DRG weight + capital per discharge,6692,Other,225% of NY Medicaid HMO DRG,8179,,275% x Medicaid HMO amount,8179,Other,275% of NY Medicaid HMO DRG,9636,,324% x Medicaid HMO amount,9636,Other,324% of NY Medicaid HMO DRG,6395,,215% x Medicaid HMO amount,6395,Other,215% of NY Medicaid HMO DRG,6395,,215% x Medicaid HMO amount,6395,Other,215% of NY Medicaid HMO DRG,3718,,125% x Medicaid HMO amount,3718,Other,125% of NY Medicaid HMO DRG,0.01,10882,
Chest pain,203-2,APR-DRG,,,,,,,,inpatient,,,102165.3,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6683,,186% x Medicaid HMO amount,6683,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13577,,"27,634 x DRG Weight",13577,Other,DRG Base Rate x DRG Weight,11540,,"23,488 x DRG Weight",11540,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3593.21,,DRG base rate x DRG weight + capital per discharge,3593.21,Other,100% of NY Medicaid HMO DRG,3593,,DRG base rate x DRG weight + capital per discharge,3593,Other,100% of NY Medicaid HMO DRG,3593,,DRG base rate x DRG weight + capital per discharge,3593,Other,100% of NY Medicaid HMO DRG,3593,,DRG base rate x DRG weight + capital per discharge,3593,Other,100% of NY Medicaid HMO DRG,8085,,225% x Medicaid HMO amount,8085,Other,225% of NY Medicaid HMO DRG,5498,,153% x Medicaid HMO amount,5498,Other,153% of NY Medicaid HMO DRG,8085,,225% x Medicaid HMO amount,8085,Other,225% of NY Medicaid HMO DRG,5030,,140% x Medicaid HMO amount,5030,Other,140% of NY Medicaid HMO DRG,8085,,DRG base rate x DRG weight + capital per discharge,8085,Other,225% of NY Medicaid HMO DRG,9881,,275% x Medicaid HMO amount,9881,Other,275% of NY Medicaid HMO DRG,11642,,324% x Medicaid HMO amount,11642,Other,324% of NY Medicaid HMO DRG,7725,,215% x Medicaid HMO amount,7725,Other,215% of NY Medicaid HMO DRG,7725,,215% x Medicaid HMO amount,7725,Other,215% of NY Medicaid HMO DRG,4492,,125% x Medicaid HMO amount,4492,Other,125% of NY Medicaid HMO DRG,0.01,13577,
Chest pain,203-3,APR-DRG,,,,,,,,inpatient,,,123261,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9216,,186% x Medicaid HMO amount,9216,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19507,,"27,634 x DRG Weight",19507,Other,DRG Base Rate x DRG Weight,16580,,"23,488 x DRG Weight",16580,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4955.21,,DRG base rate x DRG weight + capital per discharge,4955.21,Other,100% of NY Medicaid HMO DRG,4955,,DRG base rate x DRG weight + capital per discharge,4955,Other,100% of NY Medicaid HMO DRG,4955,,DRG base rate x DRG weight + capital per discharge,4955,Other,100% of NY Medicaid HMO DRG,4955,,DRG base rate x DRG weight + capital per discharge,4955,Other,100% of NY Medicaid HMO DRG,11149,,225% x Medicaid HMO amount,11149,Other,225% of NY Medicaid HMO DRG,7581,,153% x Medicaid HMO amount,7581,Other,153% of NY Medicaid HMO DRG,11149,,225% x Medicaid HMO amount,11149,Other,225% of NY Medicaid HMO DRG,6937,,140% x Medicaid HMO amount,6937,Other,140% of NY Medicaid HMO DRG,11149,,DRG base rate x DRG weight + capital per discharge,11149,Other,225% of NY Medicaid HMO DRG,13627,,275% x Medicaid HMO amount,13627,Other,275% of NY Medicaid HMO DRG,16055,,324% x Medicaid HMO amount,16055,Other,324% of NY Medicaid HMO DRG,10654,,215% x Medicaid HMO amount,10654,Other,215% of NY Medicaid HMO DRG,10654,,215% x Medicaid HMO amount,10654,Other,215% of NY Medicaid HMO DRG,6194,,125% x Medicaid HMO amount,6194,Other,125% of NY Medicaid HMO DRG,0.01,19507,
Chest pain,203-4,APR-DRG,,,,,,,,inpatient,,,123261,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28696,,186% x Medicaid HMO amount,28696,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65084,,"27,634 x DRG Weight",65084,Other,DRG Base Rate x DRG Weight,55319,,"23,488 x DRG Weight",55319,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15428.21,,DRG base rate x DRG weight + capital per discharge,15428.21,Other,100% of NY Medicaid HMO DRG,15428,,DRG base rate x DRG weight + capital per discharge,15428,Other,100% of NY Medicaid HMO DRG,15428,,DRG base rate x DRG weight + capital per discharge,15428,Other,100% of NY Medicaid HMO DRG,15428,,DRG base rate x DRG weight + capital per discharge,15428,Other,100% of NY Medicaid HMO DRG,34713,,225% x Medicaid HMO amount,34713,Other,225% of NY Medicaid HMO DRG,23605,,153% x Medicaid HMO amount,23605,Other,153% of NY Medicaid HMO DRG,34713,,225% x Medicaid HMO amount,34713,Other,225% of NY Medicaid HMO DRG,21599,,140% x Medicaid HMO amount,21599,Other,140% of NY Medicaid HMO DRG,34713,,DRG base rate x DRG weight + capital per discharge,34713,Other,225% of NY Medicaid HMO DRG,42428,,275% x Medicaid HMO amount,42428,Other,275% of NY Medicaid HMO DRG,49987,,324% x Medicaid HMO amount,49987,Other,324% of NY Medicaid HMO DRG,33171,,215% x Medicaid HMO amount,33171,Other,215% of NY Medicaid HMO DRG,33171,,215% x Medicaid HMO amount,33171,Other,215% of NY Medicaid HMO DRG,19285,,125% x Medicaid HMO amount,19285,Other,125% of NY Medicaid HMO DRG,0.01,65084,
Syncope & collapse,204-1,APR-DRG,,,,,,,,inpatient,,,92229.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6317,,186% x Medicaid HMO amount,6317,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12720,,"27,634 x DRG Weight",12720,Other,DRG Base Rate x DRG Weight,10812,,"23,488 x DRG Weight",10812,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3396.21,,DRG base rate x DRG weight + capital per discharge,3396.21,Other,100% of NY Medicaid HMO DRG,3396,,DRG base rate x DRG weight + capital per discharge,3396,Other,100% of NY Medicaid HMO DRG,3396,,DRG base rate x DRG weight + capital per discharge,3396,Other,100% of NY Medicaid HMO DRG,3396,,DRG base rate x DRG weight + capital per discharge,3396,Other,100% of NY Medicaid HMO DRG,7641,,225% x Medicaid HMO amount,7641,Other,225% of NY Medicaid HMO DRG,5196,,153% x Medicaid HMO amount,5196,Other,153% of NY Medicaid HMO DRG,7641,,225% x Medicaid HMO amount,7641,Other,225% of NY Medicaid HMO DRG,4755,,140% x Medicaid HMO amount,4755,Other,140% of NY Medicaid HMO DRG,7641,,DRG base rate x DRG weight + capital per discharge,7641,Other,225% of NY Medicaid HMO DRG,9340,,275% x Medicaid HMO amount,9340,Other,275% of NY Medicaid HMO DRG,11004,,324% x Medicaid HMO amount,11004,Other,324% of NY Medicaid HMO DRG,7302,,215% x Medicaid HMO amount,7302,Other,215% of NY Medicaid HMO DRG,7302,,215% x Medicaid HMO amount,7302,Other,215% of NY Medicaid HMO DRG,4245,,125% x Medicaid HMO amount,4245,Other,125% of NY Medicaid HMO DRG,0.01,12720,
Syncope & collapse,204-2,APR-DRG,,,,,,,,inpatient,,,150563.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7671,,186% x Medicaid HMO amount,7671,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15890,,"27,634 x DRG Weight",15890,Other,DRG Base Rate x DRG Weight,13506,,"23,488 x DRG Weight",13506,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4124.21,,DRG base rate x DRG weight + capital per discharge,4124.21,Other,100% of NY Medicaid HMO DRG,4124,,DRG base rate x DRG weight + capital per discharge,4124,Other,100% of NY Medicaid HMO DRG,4124,,DRG base rate x DRG weight + capital per discharge,4124,Other,100% of NY Medicaid HMO DRG,4124,,DRG base rate x DRG weight + capital per discharge,4124,Other,100% of NY Medicaid HMO DRG,9279,,225% x Medicaid HMO amount,9279,Other,225% of NY Medicaid HMO DRG,6310,,153% x Medicaid HMO amount,6310,Other,153% of NY Medicaid HMO DRG,9279,,225% x Medicaid HMO amount,9279,Other,225% of NY Medicaid HMO DRG,5774,,140% x Medicaid HMO amount,5774,Other,140% of NY Medicaid HMO DRG,9279,,DRG base rate x DRG weight + capital per discharge,9279,Other,225% of NY Medicaid HMO DRG,11342,,275% x Medicaid HMO amount,11342,Other,275% of NY Medicaid HMO DRG,13362,,324% x Medicaid HMO amount,13362,Other,324% of NY Medicaid HMO DRG,8867,,215% x Medicaid HMO amount,8867,Other,215% of NY Medicaid HMO DRG,8867,,215% x Medicaid HMO amount,8867,Other,215% of NY Medicaid HMO DRG,5155,,125% x Medicaid HMO amount,5155,Other,125% of NY Medicaid HMO DRG,0.01,15890,
Syncope & collapse,204-3,APR-DRG,,,,,,,,inpatient,,,189869.65,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11030,,186% x Medicaid HMO amount,11030,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23749,,"27,634 x DRG Weight",23749,Other,DRG Base Rate x DRG Weight,20186,,"23,488 x DRG Weight",20186,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5930.21,,DRG base rate x DRG weight + capital per discharge,5930.21,Other,100% of NY Medicaid HMO DRG,5930,,DRG base rate x DRG weight + capital per discharge,5930,Other,100% of NY Medicaid HMO DRG,5930,,DRG base rate x DRG weight + capital per discharge,5930,Other,100% of NY Medicaid HMO DRG,5930,,DRG base rate x DRG weight + capital per discharge,5930,Other,100% of NY Medicaid HMO DRG,13343,,225% x Medicaid HMO amount,13343,Other,225% of NY Medicaid HMO DRG,9073,,153% x Medicaid HMO amount,9073,Other,153% of NY Medicaid HMO DRG,13343,,225% x Medicaid HMO amount,13343,Other,225% of NY Medicaid HMO DRG,8302,,140% x Medicaid HMO amount,8302,Other,140% of NY Medicaid HMO DRG,13343,,DRG base rate x DRG weight + capital per discharge,13343,Other,225% of NY Medicaid HMO DRG,16308,,275% x Medicaid HMO amount,16308,Other,275% of NY Medicaid HMO DRG,19214,,324% x Medicaid HMO amount,19214,Other,324% of NY Medicaid HMO DRG,12750,,215% x Medicaid HMO amount,12750,Other,215% of NY Medicaid HMO DRG,12750,,215% x Medicaid HMO amount,12750,Other,215% of NY Medicaid HMO DRG,7413,,125% x Medicaid HMO amount,7413,Other,125% of NY Medicaid HMO DRG,0.01,23749,
Syncope & collapse,204-4,APR-DRG,,,,,,,,inpatient,,,118084.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25927,,186% x Medicaid HMO amount,25927,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58603,,"27,634 x DRG Weight",58603,Other,DRG Base Rate x DRG Weight,49811,,"23,488 x DRG Weight",49811,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13939.21,,DRG base rate x DRG weight + capital per discharge,13939.21,Other,100% of NY Medicaid HMO DRG,13939,,DRG base rate x DRG weight + capital per discharge,13939,Other,100% of NY Medicaid HMO DRG,13939,,DRG base rate x DRG weight + capital per discharge,13939,Other,100% of NY Medicaid HMO DRG,13939,,DRG base rate x DRG weight + capital per discharge,13939,Other,100% of NY Medicaid HMO DRG,31363,,225% x Medicaid HMO amount,31363,Other,225% of NY Medicaid HMO DRG,21327,,153% x Medicaid HMO amount,21327,Other,153% of NY Medicaid HMO DRG,31363,,225% x Medicaid HMO amount,31363,Other,225% of NY Medicaid HMO DRG,19515,,140% x Medicaid HMO amount,19515,Other,140% of NY Medicaid HMO DRG,31363,,DRG base rate x DRG weight + capital per discharge,31363,Other,225% of NY Medicaid HMO DRG,38333,,275% x Medicaid HMO amount,38333,Other,275% of NY Medicaid HMO DRG,45163,,324% x Medicaid HMO amount,45163,Other,324% of NY Medicaid HMO DRG,29969,,215% x Medicaid HMO amount,29969,Other,215% of NY Medicaid HMO DRG,29969,,215% x Medicaid HMO amount,29969,Other,215% of NY Medicaid HMO DRG,17424,,125% x Medicaid HMO amount,17424,Other,125% of NY Medicaid HMO DRG,0.01,58603,
Cardiomyopathy,205-1,APR-DRG,,,,,,,,inpatient,,,36299.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7819,,186% x Medicaid HMO amount,7819,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16238,,"27,634 x DRG Weight",16238,Other,DRG Base Rate x DRG Weight,13802,,"23,488 x DRG Weight",13802,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4204.21,,DRG base rate x DRG weight + capital per discharge,4204.21,Other,100% of NY Medicaid HMO DRG,4204,,DRG base rate x DRG weight + capital per discharge,4204,Other,100% of NY Medicaid HMO DRG,4204,,DRG base rate x DRG weight + capital per discharge,4204,Other,100% of NY Medicaid HMO DRG,4204,,DRG base rate x DRG weight + capital per discharge,4204,Other,100% of NY Medicaid HMO DRG,9459,,225% x Medicaid HMO amount,9459,Other,225% of NY Medicaid HMO DRG,6432,,153% x Medicaid HMO amount,6432,Other,153% of NY Medicaid HMO DRG,9459,,225% x Medicaid HMO amount,9459,Other,225% of NY Medicaid HMO DRG,5886,,140% x Medicaid HMO amount,5886,Other,140% of NY Medicaid HMO DRG,9459,,DRG base rate x DRG weight + capital per discharge,9459,Other,225% of NY Medicaid HMO DRG,11562,,275% x Medicaid HMO amount,11562,Other,275% of NY Medicaid HMO DRG,13622,,324% x Medicaid HMO amount,13622,Other,324% of NY Medicaid HMO DRG,9039,,215% x Medicaid HMO amount,9039,Other,215% of NY Medicaid HMO DRG,9039,,215% x Medicaid HMO amount,9039,Other,215% of NY Medicaid HMO DRG,5255,,125% x Medicaid HMO amount,5255,Other,125% of NY Medicaid HMO DRG,0.01,16238,
Cardiomyopathy,205-2,APR-DRG,,,,,,,,inpatient,,,133924.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9694,,186% x Medicaid HMO amount,9694,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20623,,"27,634 x DRG Weight",20623,Other,DRG Base Rate x DRG Weight,17529,,"23,488 x DRG Weight",17529,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5212.21,,DRG base rate x DRG weight + capital per discharge,5212.21,Other,100% of NY Medicaid HMO DRG,5212,,DRG base rate x DRG weight + capital per discharge,5212,Other,100% of NY Medicaid HMO DRG,5212,,DRG base rate x DRG weight + capital per discharge,5212,Other,100% of NY Medicaid HMO DRG,5212,,DRG base rate x DRG weight + capital per discharge,5212,Other,100% of NY Medicaid HMO DRG,11727,,225% x Medicaid HMO amount,11727,Other,225% of NY Medicaid HMO DRG,7975,,153% x Medicaid HMO amount,7975,Other,153% of NY Medicaid HMO DRG,11727,,225% x Medicaid HMO amount,11727,Other,225% of NY Medicaid HMO DRG,7297,,140% x Medicaid HMO amount,7297,Other,140% of NY Medicaid HMO DRG,11727,,DRG base rate x DRG weight + capital per discharge,11727,Other,225% of NY Medicaid HMO DRG,14334,,275% x Medicaid HMO amount,14334,Other,275% of NY Medicaid HMO DRG,16888,,324% x Medicaid HMO amount,16888,Other,324% of NY Medicaid HMO DRG,11206,,215% x Medicaid HMO amount,11206,Other,215% of NY Medicaid HMO DRG,11206,,215% x Medicaid HMO amount,11206,Other,215% of NY Medicaid HMO DRG,6515,,125% x Medicaid HMO amount,6515,Other,125% of NY Medicaid HMO DRG,0.01,20623,
Cardiomyopathy,205-3,APR-DRG,,,,,,,,inpatient,,,121963.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18046,,186% x Medicaid HMO amount,18046,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40163,,"27,634 x DRG Weight",40163,Other,DRG Base Rate x DRG Weight,34137,,"23,488 x DRG Weight",34137,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9702.21,,DRG base rate x DRG weight + capital per discharge,9702.21,Other,100% of NY Medicaid HMO DRG,9702,,DRG base rate x DRG weight + capital per discharge,9702,Other,100% of NY Medicaid HMO DRG,9702,,DRG base rate x DRG weight + capital per discharge,9702,Other,100% of NY Medicaid HMO DRG,9702,,DRG base rate x DRG weight + capital per discharge,9702,Other,100% of NY Medicaid HMO DRG,21830,,225% x Medicaid HMO amount,21830,Other,225% of NY Medicaid HMO DRG,14844,,153% x Medicaid HMO amount,14844,Other,153% of NY Medicaid HMO DRG,21830,,225% x Medicaid HMO amount,21830,Other,225% of NY Medicaid HMO DRG,13583,,140% x Medicaid HMO amount,13583,Other,140% of NY Medicaid HMO DRG,21830,,DRG base rate x DRG weight + capital per discharge,21830,Other,225% of NY Medicaid HMO DRG,26681,,275% x Medicaid HMO amount,26681,Other,275% of NY Medicaid HMO DRG,31435,,324% x Medicaid HMO amount,31435,Other,324% of NY Medicaid HMO DRG,20860,,215% x Medicaid HMO amount,20860,Other,215% of NY Medicaid HMO DRG,20860,,215% x Medicaid HMO amount,20860,Other,215% of NY Medicaid HMO DRG,12128,,125% x Medicaid HMO amount,12128,Other,125% of NY Medicaid HMO DRG,0.01,40163,
Cardiomyopathy,205-4,APR-DRG,,,,,,,,inpatient,,,133924.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21810,,186% x Medicaid HMO amount,21810,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48970,,"27,634 x DRG Weight",48970,Other,DRG Base Rate x DRG Weight,41623,,"23,488 x DRG Weight",41623,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11726.21,,DRG base rate x DRG weight + capital per discharge,11726.21,Other,100% of NY Medicaid HMO DRG,11726,,DRG base rate x DRG weight + capital per discharge,11726,Other,100% of NY Medicaid HMO DRG,11726,,DRG base rate x DRG weight + capital per discharge,11726,Other,100% of NY Medicaid HMO DRG,11726,,DRG base rate x DRG weight + capital per discharge,11726,Other,100% of NY Medicaid HMO DRG,26384,,225% x Medicaid HMO amount,26384,Other,225% of NY Medicaid HMO DRG,17941,,153% x Medicaid HMO amount,17941,Other,153% of NY Medicaid HMO DRG,26384,,225% x Medicaid HMO amount,26384,Other,225% of NY Medicaid HMO DRG,16417,,140% x Medicaid HMO amount,16417,Other,140% of NY Medicaid HMO DRG,26384,,DRG base rate x DRG weight + capital per discharge,26384,Other,225% of NY Medicaid HMO DRG,32247,,275% x Medicaid HMO amount,32247,Other,275% of NY Medicaid HMO DRG,37993,,324% x Medicaid HMO amount,37993,Other,324% of NY Medicaid HMO DRG,25211,,215% x Medicaid HMO amount,25211,Other,215% of NY Medicaid HMO DRG,25211,,215% x Medicaid HMO amount,25211,Other,215% of NY Medicaid HMO DRG,14658,,125% x Medicaid HMO amount,14658,Other,125% of NY Medicaid HMO DRG,0.01,48970,
"Malfunction,reaction,complication of cardiac/vasc device or procedure",206-1,APR-DRG,,,,,,,,inpatient,,,135654.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7373,,186% x Medicaid HMO amount,7373,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15193,,"27,634 x DRG Weight",15193,Other,DRG Base Rate x DRG Weight,12914,,"23,488 x DRG Weight",12914,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3964.21,,DRG base rate x DRG weight + capital per discharge,3964.21,Other,100% of NY Medicaid HMO DRG,3964,,DRG base rate x DRG weight + capital per discharge,3964,Other,100% of NY Medicaid HMO DRG,3964,,DRG base rate x DRG weight + capital per discharge,3964,Other,100% of NY Medicaid HMO DRG,3964,,DRG base rate x DRG weight + capital per discharge,3964,Other,100% of NY Medicaid HMO DRG,8919,,225% x Medicaid HMO amount,8919,Other,225% of NY Medicaid HMO DRG,6065,,153% x Medicaid HMO amount,6065,Other,153% of NY Medicaid HMO DRG,8919,,225% x Medicaid HMO amount,8919,Other,225% of NY Medicaid HMO DRG,5550,,140% x Medicaid HMO amount,5550,Other,140% of NY Medicaid HMO DRG,8919,,DRG base rate x DRG weight + capital per discharge,8919,Other,225% of NY Medicaid HMO DRG,10902,,275% x Medicaid HMO amount,10902,Other,275% of NY Medicaid HMO DRG,12844,,324% x Medicaid HMO amount,12844,Other,324% of NY Medicaid HMO DRG,8523,,215% x Medicaid HMO amount,8523,Other,215% of NY Medicaid HMO DRG,8523,,215% x Medicaid HMO amount,8523,Other,215% of NY Medicaid HMO DRG,4955,,125% x Medicaid HMO amount,4955,Other,125% of NY Medicaid HMO DRG,0.01,15193,
"Malfunction,reaction,complication of cardiac/vasc device or procedure",206-2,APR-DRG,,,,,,,,inpatient,,,76262.3,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9475,,186% x Medicaid HMO amount,9475,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20109,,"27,634 x DRG Weight",20109,Other,DRG Base Rate x DRG Weight,17092,,"23,488 x DRG Weight",17092,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5094.21,,DRG base rate x DRG weight + capital per discharge,5094.21,Other,100% of NY Medicaid HMO DRG,5094,,DRG base rate x DRG weight + capital per discharge,5094,Other,100% of NY Medicaid HMO DRG,5094,,DRG base rate x DRG weight + capital per discharge,5094,Other,100% of NY Medicaid HMO DRG,5094,,DRG base rate x DRG weight + capital per discharge,5094,Other,100% of NY Medicaid HMO DRG,11462,,225% x Medicaid HMO amount,11462,Other,225% of NY Medicaid HMO DRG,7794,,153% x Medicaid HMO amount,7794,Other,153% of NY Medicaid HMO DRG,11462,,225% x Medicaid HMO amount,11462,Other,225% of NY Medicaid HMO DRG,7132,,140% x Medicaid HMO amount,7132,Other,140% of NY Medicaid HMO DRG,11462,,DRG base rate x DRG weight + capital per discharge,11462,Other,225% of NY Medicaid HMO DRG,14009,,275% x Medicaid HMO amount,14009,Other,275% of NY Medicaid HMO DRG,16505,,324% x Medicaid HMO amount,16505,Other,324% of NY Medicaid HMO DRG,10953,,215% x Medicaid HMO amount,10953,Other,215% of NY Medicaid HMO DRG,10953,,215% x Medicaid HMO amount,10953,Other,215% of NY Medicaid HMO DRG,6368,,125% x Medicaid HMO amount,6368,Other,125% of NY Medicaid HMO DRG,0.01,20109,
"Malfunction,reaction,complication of cardiac/vasc device or procedure",206-3,APR-DRG,,,,,,,,inpatient,,,213020.68,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15576,,186% x Medicaid HMO amount,15576,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34382,,"27,634 x DRG Weight",34382,Other,DRG Base Rate x DRG Weight,29224,,"23,488 x DRG Weight",29224,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8374.21,,DRG base rate x DRG weight + capital per discharge,8374.21,Other,100% of NY Medicaid HMO DRG,8374,,DRG base rate x DRG weight + capital per discharge,8374,Other,100% of NY Medicaid HMO DRG,8374,,DRG base rate x DRG weight + capital per discharge,8374,Other,100% of NY Medicaid HMO DRG,8374,,DRG base rate x DRG weight + capital per discharge,8374,Other,100% of NY Medicaid HMO DRG,18842,,225% x Medicaid HMO amount,18842,Other,225% of NY Medicaid HMO DRG,12813,,153% x Medicaid HMO amount,12813,Other,153% of NY Medicaid HMO DRG,18842,,225% x Medicaid HMO amount,18842,Other,225% of NY Medicaid HMO DRG,11724,,140% x Medicaid HMO amount,11724,Other,140% of NY Medicaid HMO DRG,18842,,DRG base rate x DRG weight + capital per discharge,18842,Other,225% of NY Medicaid HMO DRG,23029,,275% x Medicaid HMO amount,23029,Other,275% of NY Medicaid HMO DRG,27132,,324% x Medicaid HMO amount,27132,Other,324% of NY Medicaid HMO DRG,18005,,215% x Medicaid HMO amount,18005,Other,215% of NY Medicaid HMO DRG,18005,,215% x Medicaid HMO amount,18005,Other,215% of NY Medicaid HMO DRG,10468,,125% x Medicaid HMO amount,10468,Other,125% of NY Medicaid HMO DRG,0.01,34382,
"Malfunction,reaction,complication of cardiac/vasc device or procedure",206-4,APR-DRG,,,,,,,,inpatient,,,264277.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41089,,186% x Medicaid HMO amount,41089,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,94080,,"27,634 x DRG Weight",94080,Other,DRG Base Rate x DRG Weight,79965,,"23,488 x DRG Weight",79965,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22091.21,,DRG base rate x DRG weight + capital per discharge,22091.21,Other,100% of NY Medicaid HMO DRG,22091,,DRG base rate x DRG weight + capital per discharge,22091,Other,100% of NY Medicaid HMO DRG,22091,,DRG base rate x DRG weight + capital per discharge,22091,Other,100% of NY Medicaid HMO DRG,22091,,DRG base rate x DRG weight + capital per discharge,22091,Other,100% of NY Medicaid HMO DRG,49705,,225% x Medicaid HMO amount,49705,Other,225% of NY Medicaid HMO DRG,33800,,153% x Medicaid HMO amount,33800,Other,153% of NY Medicaid HMO DRG,49705,,225% x Medicaid HMO amount,49705,Other,225% of NY Medicaid HMO DRG,30928,,140% x Medicaid HMO amount,30928,Other,140% of NY Medicaid HMO DRG,49705,,DRG base rate x DRG weight + capital per discharge,49705,Other,225% of NY Medicaid HMO DRG,60751,,275% x Medicaid HMO amount,60751,Other,275% of NY Medicaid HMO DRG,71576,,324% x Medicaid HMO amount,71576,Other,324% of NY Medicaid HMO DRG,47496,,215% x Medicaid HMO amount,47496,Other,215% of NY Medicaid HMO DRG,47496,,215% x Medicaid HMO amount,47496,Other,215% of NY Medicaid HMO DRG,27614,,125% x Medicaid HMO amount,27614,Other,125% of NY Medicaid HMO DRG,0.01,94080,
Other circulatory system diagnoses,207-1,APR-DRG,,,,,,,,inpatient,,,64898.43,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6653,,186% x Medicaid HMO amount,6653,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13510,,"27,634 x DRG Weight",13510,Other,DRG Base Rate x DRG Weight,11483,,"23,488 x DRG Weight",11483,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3577.21,,DRG base rate x DRG weight + capital per discharge,3577.21,Other,100% of NY Medicaid HMO DRG,3577,,DRG base rate x DRG weight + capital per discharge,3577,Other,100% of NY Medicaid HMO DRG,3577,,DRG base rate x DRG weight + capital per discharge,3577,Other,100% of NY Medicaid HMO DRG,3577,,DRG base rate x DRG weight + capital per discharge,3577,Other,100% of NY Medicaid HMO DRG,8049,,225% x Medicaid HMO amount,8049,Other,225% of NY Medicaid HMO DRG,5473,,153% x Medicaid HMO amount,5473,Other,153% of NY Medicaid HMO DRG,8049,,225% x Medicaid HMO amount,8049,Other,225% of NY Medicaid HMO DRG,5008,,140% x Medicaid HMO amount,5008,Other,140% of NY Medicaid HMO DRG,8049,,DRG base rate x DRG weight + capital per discharge,8049,Other,225% of NY Medicaid HMO DRG,9837,,275% x Medicaid HMO amount,9837,Other,275% of NY Medicaid HMO DRG,11590,,324% x Medicaid HMO amount,11590,Other,324% of NY Medicaid HMO DRG,7691,,215% x Medicaid HMO amount,7691,Other,215% of NY Medicaid HMO DRG,7691,,215% x Medicaid HMO amount,7691,Other,215% of NY Medicaid HMO DRG,4472,,125% x Medicaid HMO amount,4472,Other,125% of NY Medicaid HMO DRG,0.01,13510,
Other circulatory system diagnoses,207-2,APR-DRG,,,,,,,,inpatient,,,137783.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9348,,186% x Medicaid HMO amount,9348,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19816,,"27,634 x DRG Weight",19816,Other,DRG Base Rate x DRG Weight,16843,,"23,488 x DRG Weight",16843,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5026.21,,DRG base rate x DRG weight + capital per discharge,5026.21,Other,100% of NY Medicaid HMO DRG,5026,,DRG base rate x DRG weight + capital per discharge,5026,Other,100% of NY Medicaid HMO DRG,5026,,DRG base rate x DRG weight + capital per discharge,5026,Other,100% of NY Medicaid HMO DRG,5026,,DRG base rate x DRG weight + capital per discharge,5026,Other,100% of NY Medicaid HMO DRG,11309,,225% x Medicaid HMO amount,11309,Other,225% of NY Medicaid HMO DRG,7690,,153% x Medicaid HMO amount,7690,Other,153% of NY Medicaid HMO DRG,11309,,225% x Medicaid HMO amount,11309,Other,225% of NY Medicaid HMO DRG,7037,,140% x Medicaid HMO amount,7037,Other,140% of NY Medicaid HMO DRG,11309,,DRG base rate x DRG weight + capital per discharge,11309,Other,225% of NY Medicaid HMO DRG,13822,,275% x Medicaid HMO amount,13822,Other,275% of NY Medicaid HMO DRG,16285,,324% x Medicaid HMO amount,16285,Other,324% of NY Medicaid HMO DRG,10806,,215% x Medicaid HMO amount,10806,Other,215% of NY Medicaid HMO DRG,10806,,215% x Medicaid HMO amount,10806,Other,215% of NY Medicaid HMO DRG,6283,,125% x Medicaid HMO amount,6283,Other,125% of NY Medicaid HMO DRG,0.01,19816,
Other circulatory system diagnoses,207-3,APR-DRG,,,,,,,,inpatient,,,190779.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15086,,186% x Medicaid HMO amount,15086,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33241,,"27,634 x DRG Weight",33241,Other,DRG Base Rate x DRG Weight,28254,,"23,488 x DRG Weight",28254,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8111.21,,DRG base rate x DRG weight + capital per discharge,8111.21,Other,100% of NY Medicaid HMO DRG,8111,,DRG base rate x DRG weight + capital per discharge,8111,Other,100% of NY Medicaid HMO DRG,8111,,DRG base rate x DRG weight + capital per discharge,8111,Other,100% of NY Medicaid HMO DRG,8111,,DRG base rate x DRG weight + capital per discharge,8111,Other,100% of NY Medicaid HMO DRG,18250,,225% x Medicaid HMO amount,18250,Other,225% of NY Medicaid HMO DRG,12410,,153% x Medicaid HMO amount,12410,Other,153% of NY Medicaid HMO DRG,18250,,225% x Medicaid HMO amount,18250,Other,225% of NY Medicaid HMO DRG,11356,,140% x Medicaid HMO amount,11356,Other,140% of NY Medicaid HMO DRG,18250,,DRG base rate x DRG weight + capital per discharge,18250,Other,225% of NY Medicaid HMO DRG,22306,,275% x Medicaid HMO amount,22306,Other,275% of NY Medicaid HMO DRG,26280,,324% x Medicaid HMO amount,26280,Other,324% of NY Medicaid HMO DRG,17439,,215% x Medicaid HMO amount,17439,Other,215% of NY Medicaid HMO DRG,17439,,215% x Medicaid HMO amount,17439,Other,215% of NY Medicaid HMO DRG,10139,,125% x Medicaid HMO amount,10139,Other,125% of NY Medicaid HMO DRG,0.01,33241,
Other circulatory system diagnoses,207-4,APR-DRG,,,,,,,,inpatient,,,350200.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30725,,186% x Medicaid HMO amount,30725,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69831,,"27,634 x DRG Weight",69831,Other,DRG Base Rate x DRG Weight,59354,,"23,488 x DRG Weight",59354,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16519.21,,DRG base rate x DRG weight + capital per discharge,16519.21,Other,100% of NY Medicaid HMO DRG,16519,,DRG base rate x DRG weight + capital per discharge,16519,Other,100% of NY Medicaid HMO DRG,16519,,DRG base rate x DRG weight + capital per discharge,16519,Other,100% of NY Medicaid HMO DRG,16519,,DRG base rate x DRG weight + capital per discharge,16519,Other,100% of NY Medicaid HMO DRG,37168,,225% x Medicaid HMO amount,37168,Other,225% of NY Medicaid HMO DRG,25274,,153% x Medicaid HMO amount,25274,Other,153% of NY Medicaid HMO DRG,37168,,225% x Medicaid HMO amount,37168,Other,225% of NY Medicaid HMO DRG,23127,,140% x Medicaid HMO amount,23127,Other,140% of NY Medicaid HMO DRG,37168,,DRG base rate x DRG weight + capital per discharge,37168,Other,225% of NY Medicaid HMO DRG,45428,,275% x Medicaid HMO amount,45428,Other,275% of NY Medicaid HMO DRG,53522,,324% x Medicaid HMO amount,53522,Other,324% of NY Medicaid HMO DRG,35516,,215% x Medicaid HMO amount,35516,Other,215% of NY Medicaid HMO DRG,35516,,215% x Medicaid HMO amount,35516,Other,215% of NY Medicaid HMO DRG,20649,,125% x Medicaid HMO amount,20649,Other,125% of NY Medicaid HMO DRG,0.01,69831,
"Major stomach, esophageal & duodenal procedures",220-1,APR-DRG,,,,,,,,inpatient,,,126137.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14564,,186% x Medicaid HMO amount,14564,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32017,,"27,634 x DRG Weight",32017,Other,DRG Base Rate x DRG Weight,27213,,"23,488 x DRG Weight",27213,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7830.21,,DRG base rate x DRG weight + capital per discharge,7830.21,Other,100% of NY Medicaid HMO DRG,7830,,DRG base rate x DRG weight + capital per discharge,7830,Other,100% of NY Medicaid HMO DRG,7830,,DRG base rate x DRG weight + capital per discharge,7830,Other,100% of NY Medicaid HMO DRG,7830,,DRG base rate x DRG weight + capital per discharge,7830,Other,100% of NY Medicaid HMO DRG,17618,,225% x Medicaid HMO amount,17618,Other,225% of NY Medicaid HMO DRG,11980,,153% x Medicaid HMO amount,11980,Other,153% of NY Medicaid HMO DRG,17618,,225% x Medicaid HMO amount,17618,Other,225% of NY Medicaid HMO DRG,10962,,140% x Medicaid HMO amount,10962,Other,140% of NY Medicaid HMO DRG,17618,,DRG base rate x DRG weight + capital per discharge,17618,Other,225% of NY Medicaid HMO DRG,21533,,275% x Medicaid HMO amount,21533,Other,275% of NY Medicaid HMO DRG,25370,,324% x Medicaid HMO amount,25370,Other,324% of NY Medicaid HMO DRG,16835,,215% x Medicaid HMO amount,16835,Other,215% of NY Medicaid HMO DRG,16835,,215% x Medicaid HMO amount,16835,Other,215% of NY Medicaid HMO DRG,9788,,125% x Medicaid HMO amount,9788,Other,125% of NY Medicaid HMO DRG,0.01,32017,
"Major stomach, esophageal & duodenal procedures",220-2,APR-DRG,,,,,,,,inpatient,,,83452.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22673,,186% x Medicaid HMO amount,22673,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,50990,,"27,634 x DRG Weight",50990,Other,DRG Base Rate x DRG Weight,43340,,"23,488 x DRG Weight",43340,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12190.21,,DRG base rate x DRG weight + capital per discharge,12190.21,Other,100% of NY Medicaid HMO DRG,12190,,DRG base rate x DRG weight + capital per discharge,12190,Other,100% of NY Medicaid HMO DRG,12190,,DRG base rate x DRG weight + capital per discharge,12190,Other,100% of NY Medicaid HMO DRG,12190,,DRG base rate x DRG weight + capital per discharge,12190,Other,100% of NY Medicaid HMO DRG,27428,,225% x Medicaid HMO amount,27428,Other,225% of NY Medicaid HMO DRG,18651,,153% x Medicaid HMO amount,18651,Other,153% of NY Medicaid HMO DRG,27428,,225% x Medicaid HMO amount,27428,Other,225% of NY Medicaid HMO DRG,17066,,140% x Medicaid HMO amount,17066,Other,140% of NY Medicaid HMO DRG,27428,,DRG base rate x DRG weight + capital per discharge,27428,Other,225% of NY Medicaid HMO DRG,33523,,275% x Medicaid HMO amount,33523,Other,275% of NY Medicaid HMO DRG,39496,,324% x Medicaid HMO amount,39496,Other,324% of NY Medicaid HMO DRG,26209,,215% x Medicaid HMO amount,26209,Other,215% of NY Medicaid HMO DRG,26209,,215% x Medicaid HMO amount,26209,Other,215% of NY Medicaid HMO DRG,15238,,125% x Medicaid HMO amount,15238,Other,125% of NY Medicaid HMO DRG,0.01,50990,
"Major stomach, esophageal & duodenal procedures",220-3,APR-DRG,,,,,,,,inpatient,,,232708.83,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41071,,186% x Medicaid HMO amount,41071,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,94033,,"27,634 x DRG Weight",94033,Other,DRG Base Rate x DRG Weight,79925,,"23,488 x DRG Weight",79925,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22081.21,,DRG base rate x DRG weight + capital per discharge,22081.21,Other,100% of NY Medicaid HMO DRG,22081,,DRG base rate x DRG weight + capital per discharge,22081,Other,100% of NY Medicaid HMO DRG,22081,,DRG base rate x DRG weight + capital per discharge,22081,Other,100% of NY Medicaid HMO DRG,22081,,DRG base rate x DRG weight + capital per discharge,22081,Other,100% of NY Medicaid HMO DRG,49683,,225% x Medicaid HMO amount,49683,Other,225% of NY Medicaid HMO DRG,33784,,153% x Medicaid HMO amount,33784,Other,153% of NY Medicaid HMO DRG,49683,,225% x Medicaid HMO amount,49683,Other,225% of NY Medicaid HMO DRG,30914,,140% x Medicaid HMO amount,30914,Other,140% of NY Medicaid HMO DRG,49683,,DRG base rate x DRG weight + capital per discharge,49683,Other,225% of NY Medicaid HMO DRG,60723,,275% x Medicaid HMO amount,60723,Other,275% of NY Medicaid HMO DRG,71543,,324% x Medicaid HMO amount,71543,Other,324% of NY Medicaid HMO DRG,47475,,215% x Medicaid HMO amount,47475,Other,215% of NY Medicaid HMO DRG,47475,,215% x Medicaid HMO amount,47475,Other,215% of NY Medicaid HMO DRG,27602,,125% x Medicaid HMO amount,27602,Other,125% of NY Medicaid HMO DRG,0.01,94033,
"Major stomach, esophageal & duodenal procedures",220-4,APR-DRG,,,,,,,,inpatient,,,1103905.49,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,84593,,186% x Medicaid HMO amount,84593,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,195862,,"27,634 x DRG Weight",195862,Other,DRG Base Rate x DRG Weight,166476,,"23,488 x DRG Weight",166476,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45480.21,,DRG base rate x DRG weight + capital per discharge,45480.21,Other,100% of NY Medicaid HMO DRG,45480,,DRG base rate x DRG weight + capital per discharge,45480,Other,100% of NY Medicaid HMO DRG,45480,,DRG base rate x DRG weight + capital per discharge,45480,Other,100% of NY Medicaid HMO DRG,45480,,DRG base rate x DRG weight + capital per discharge,45480,Other,100% of NY Medicaid HMO DRG,102330,,225% x Medicaid HMO amount,102330,Other,225% of NY Medicaid HMO DRG,69585,,153% x Medicaid HMO amount,69585,Other,153% of NY Medicaid HMO DRG,102330,,225% x Medicaid HMO amount,102330,Other,225% of NY Medicaid HMO DRG,63672,,140% x Medicaid HMO amount,63672,Other,140% of NY Medicaid HMO DRG,102330,,DRG base rate x DRG weight + capital per discharge,102330,Other,225% of NY Medicaid HMO DRG,125071,,275% x Medicaid HMO amount,125071,Other,275% of NY Medicaid HMO DRG,147356,,324% x Medicaid HMO amount,147356,Other,324% of NY Medicaid HMO DRG,97782,,215% x Medicaid HMO amount,97782,Other,215% of NY Medicaid HMO DRG,97782,,215% x Medicaid HMO amount,97782,Other,215% of NY Medicaid HMO DRG,56850,,125% x Medicaid HMO amount,56850,Other,125% of NY Medicaid HMO DRG,0.01,195862,
Major small & large bowel procedures,221-1,APR-DRG,,,,,,,,inpatient,,,161782.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18438,,186% x Medicaid HMO amount,18438,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41081,,"27,634 x DRG Weight",41081,Other,DRG Base Rate x DRG Weight,34917,,"23,488 x DRG Weight",34917,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9913.21,,DRG base rate x DRG weight + capital per discharge,9913.21,Other,100% of NY Medicaid HMO DRG,9913,,DRG base rate x DRG weight + capital per discharge,9913,Other,100% of NY Medicaid HMO DRG,9913,,DRG base rate x DRG weight + capital per discharge,9913,Other,100% of NY Medicaid HMO DRG,9913,,DRG base rate x DRG weight + capital per discharge,9913,Other,100% of NY Medicaid HMO DRG,22305,,225% x Medicaid HMO amount,22305,Other,225% of NY Medicaid HMO DRG,15167,,153% x Medicaid HMO amount,15167,Other,153% of NY Medicaid HMO DRG,22305,,225% x Medicaid HMO amount,22305,Other,225% of NY Medicaid HMO DRG,13878,,140% x Medicaid HMO amount,13878,Other,140% of NY Medicaid HMO DRG,22305,,DRG base rate x DRG weight + capital per discharge,22305,Other,225% of NY Medicaid HMO DRG,27261,,275% x Medicaid HMO amount,27261,Other,275% of NY Medicaid HMO DRG,32119,,324% x Medicaid HMO amount,32119,Other,324% of NY Medicaid HMO DRG,21313,,215% x Medicaid HMO amount,21313,Other,215% of NY Medicaid HMO DRG,21313,,215% x Medicaid HMO amount,21313,Other,215% of NY Medicaid HMO DRG,12392,,125% x Medicaid HMO amount,12392,Other,125% of NY Medicaid HMO DRG,0.01,41081,
Major small & large bowel procedures,221-2,APR-DRG,,,,,,,,inpatient,,,207501.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23116,,186% x Medicaid HMO amount,23116,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,52027,,"27,634 x DRG Weight",52027,Other,DRG Base Rate x DRG Weight,44221,,"23,488 x DRG Weight",44221,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12428.21,,DRG base rate x DRG weight + capital per discharge,12428.21,Other,100% of NY Medicaid HMO DRG,12428,,DRG base rate x DRG weight + capital per discharge,12428,Other,100% of NY Medicaid HMO DRG,12428,,DRG base rate x DRG weight + capital per discharge,12428,Other,100% of NY Medicaid HMO DRG,12428,,DRG base rate x DRG weight + capital per discharge,12428,Other,100% of NY Medicaid HMO DRG,27963,,225% x Medicaid HMO amount,27963,Other,225% of NY Medicaid HMO DRG,19015,,153% x Medicaid HMO amount,19015,Other,153% of NY Medicaid HMO DRG,27963,,225% x Medicaid HMO amount,27963,Other,225% of NY Medicaid HMO DRG,17399,,140% x Medicaid HMO amount,17399,Other,140% of NY Medicaid HMO DRG,27963,,DRG base rate x DRG weight + capital per discharge,27963,Other,225% of NY Medicaid HMO DRG,34178,,275% x Medicaid HMO amount,34178,Other,275% of NY Medicaid HMO DRG,40267,,324% x Medicaid HMO amount,40267,Other,324% of NY Medicaid HMO DRG,26721,,215% x Medicaid HMO amount,26721,Other,215% of NY Medicaid HMO DRG,26721,,215% x Medicaid HMO amount,26721,Other,215% of NY Medicaid HMO DRG,15535,,125% x Medicaid HMO amount,15535,Other,125% of NY Medicaid HMO DRG,0.01,52027,
Major small & large bowel procedures,221-3,APR-DRG,,,,,,,,inpatient,,,414882.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37511,,186% x Medicaid HMO amount,37511,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,85704,,"27,634 x DRG Weight",85704,Other,DRG Base Rate x DRG Weight,72846,,"23,488 x DRG Weight",72846,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20167.21,,DRG base rate x DRG weight + capital per discharge,20167.21,Other,100% of NY Medicaid HMO DRG,20167,,DRG base rate x DRG weight + capital per discharge,20167,Other,100% of NY Medicaid HMO DRG,20167,,DRG base rate x DRG weight + capital per discharge,20167,Other,100% of NY Medicaid HMO DRG,20167,,DRG base rate x DRG weight + capital per discharge,20167,Other,100% of NY Medicaid HMO DRG,45376,,225% x Medicaid HMO amount,45376,Other,225% of NY Medicaid HMO DRG,30856,,153% x Medicaid HMO amount,30856,Other,153% of NY Medicaid HMO DRG,45376,,225% x Medicaid HMO amount,45376,Other,225% of NY Medicaid HMO DRG,28234,,140% x Medicaid HMO amount,28234,Other,140% of NY Medicaid HMO DRG,45376,,DRG base rate x DRG weight + capital per discharge,45376,Other,225% of NY Medicaid HMO DRG,55460,,275% x Medicaid HMO amount,55460,Other,275% of NY Medicaid HMO DRG,65342,,324% x Medicaid HMO amount,65342,Other,324% of NY Medicaid HMO DRG,43360,,215% x Medicaid HMO amount,43360,Other,215% of NY Medicaid HMO DRG,43360,,215% x Medicaid HMO amount,43360,Other,215% of NY Medicaid HMO DRG,25209,,125% x Medicaid HMO amount,25209,Other,125% of NY Medicaid HMO DRG,0.01,85704,
Major small & large bowel procedures,221-4,APR-DRG,,,,,,,,inpatient,,,605283.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78931,,186% x Medicaid HMO amount,78931,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,182614,,"27,634 x DRG Weight",182614,Other,DRG Base Rate x DRG Weight,155216,,"23,488 x DRG Weight",155216,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42436.21,,DRG base rate x DRG weight + capital per discharge,42436.21,Other,100% of NY Medicaid HMO DRG,42436,,DRG base rate x DRG weight + capital per discharge,42436,Other,100% of NY Medicaid HMO DRG,42436,,DRG base rate x DRG weight + capital per discharge,42436,Other,100% of NY Medicaid HMO DRG,42436,,DRG base rate x DRG weight + capital per discharge,42436,Other,100% of NY Medicaid HMO DRG,95481,,225% x Medicaid HMO amount,95481,Other,225% of NY Medicaid HMO DRG,64927,,153% x Medicaid HMO amount,64927,Other,153% of NY Medicaid HMO DRG,95481,,225% x Medicaid HMO amount,95481,Other,225% of NY Medicaid HMO DRG,59411,,140% x Medicaid HMO amount,59411,Other,140% of NY Medicaid HMO DRG,95481,,DRG base rate x DRG weight + capital per discharge,95481,Other,225% of NY Medicaid HMO DRG,116700,,275% x Medicaid HMO amount,116700,Other,275% of NY Medicaid HMO DRG,137493,,324% x Medicaid HMO amount,137493,Other,324% of NY Medicaid HMO DRG,91238,,215% x Medicaid HMO amount,91238,Other,215% of NY Medicaid HMO DRG,91238,,215% x Medicaid HMO amount,91238,Other,215% of NY Medicaid HMO DRG,53045,,125% x Medicaid HMO amount,53045,Other,125% of NY Medicaid HMO DRG,0.01,182614,
"Other stomach, esophageal & duodenal procedures",222-1,APR-DRG,,,,,,,,inpatient,,,106756.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10598,,186% x Medicaid HMO amount,10598,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22740,,"27,634 x DRG Weight",22740,Other,DRG Base Rate x DRG Weight,19328,,"23,488 x DRG Weight",19328,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5698.21,,DRG base rate x DRG weight + capital per discharge,5698.21,Other,100% of NY Medicaid HMO DRG,5698,,DRG base rate x DRG weight + capital per discharge,5698,Other,100% of NY Medicaid HMO DRG,5698,,DRG base rate x DRG weight + capital per discharge,5698,Other,100% of NY Medicaid HMO DRG,5698,,DRG base rate x DRG weight + capital per discharge,5698,Other,100% of NY Medicaid HMO DRG,12821,,225% x Medicaid HMO amount,12821,Other,225% of NY Medicaid HMO DRG,8718,,153% x Medicaid HMO amount,8718,Other,153% of NY Medicaid HMO DRG,12821,,225% x Medicaid HMO amount,12821,Other,225% of NY Medicaid HMO DRG,7977,,140% x Medicaid HMO amount,7977,Other,140% of NY Medicaid HMO DRG,12821,,DRG base rate x DRG weight + capital per discharge,12821,Other,225% of NY Medicaid HMO DRG,15670,,275% x Medicaid HMO amount,15670,Other,275% of NY Medicaid HMO DRG,18462,,324% x Medicaid HMO amount,18462,Other,324% of NY Medicaid HMO DRG,12251,,215% x Medicaid HMO amount,12251,Other,215% of NY Medicaid HMO DRG,12251,,215% x Medicaid HMO amount,12251,Other,215% of NY Medicaid HMO DRG,7123,,125% x Medicaid HMO amount,7123,Other,125% of NY Medicaid HMO DRG,0.01,22740,
"Other stomach, esophageal & duodenal procedures",222-2,APR-DRG,,,,,,,,inpatient,,,185488.46,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14272,,186% x Medicaid HMO amount,14272,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31334,,"27,634 x DRG Weight",31334,Other,DRG Base Rate x DRG Weight,26633,,"23,488 x DRG Weight",26633,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7673.21,,DRG base rate x DRG weight + capital per discharge,7673.21,Other,100% of NY Medicaid HMO DRG,7673,,DRG base rate x DRG weight + capital per discharge,7673,Other,100% of NY Medicaid HMO DRG,7673,,DRG base rate x DRG weight + capital per discharge,7673,Other,100% of NY Medicaid HMO DRG,7673,,DRG base rate x DRG weight + capital per discharge,7673,Other,100% of NY Medicaid HMO DRG,17265,,225% x Medicaid HMO amount,17265,Other,225% of NY Medicaid HMO DRG,11740,,153% x Medicaid HMO amount,11740,Other,153% of NY Medicaid HMO DRG,17265,,225% x Medicaid HMO amount,17265,Other,225% of NY Medicaid HMO DRG,10742,,140% x Medicaid HMO amount,10742,Other,140% of NY Medicaid HMO DRG,17265,,DRG base rate x DRG weight + capital per discharge,17265,Other,225% of NY Medicaid HMO DRG,21101,,275% x Medicaid HMO amount,21101,Other,275% of NY Medicaid HMO DRG,24861,,324% x Medicaid HMO amount,24861,Other,324% of NY Medicaid HMO DRG,16497,,215% x Medicaid HMO amount,16497,Other,215% of NY Medicaid HMO DRG,16497,,215% x Medicaid HMO amount,16497,Other,215% of NY Medicaid HMO DRG,9592,,125% x Medicaid HMO amount,9592,Other,125% of NY Medicaid HMO DRG,0.01,31334,
"Other stomach, esophageal & duodenal procedures",222-3,APR-DRG,,,,,,,,inpatient,,,188404.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25065,,186% x Medicaid HMO amount,25065,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,56586,,"27,634 x DRG Weight",56586,Other,DRG Base Rate x DRG Weight,48096,,"23,488 x DRG Weight",48096,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13476.21,,DRG base rate x DRG weight + capital per discharge,13476.21,Other,100% of NY Medicaid HMO DRG,13476,,DRG base rate x DRG weight + capital per discharge,13476,Other,100% of NY Medicaid HMO DRG,13476,,DRG base rate x DRG weight + capital per discharge,13476,Other,100% of NY Medicaid HMO DRG,13476,,DRG base rate x DRG weight + capital per discharge,13476,Other,100% of NY Medicaid HMO DRG,30321,,225% x Medicaid HMO amount,30321,Other,225% of NY Medicaid HMO DRG,20619,,153% x Medicaid HMO amount,20619,Other,153% of NY Medicaid HMO DRG,30321,,225% x Medicaid HMO amount,30321,Other,225% of NY Medicaid HMO DRG,18867,,140% x Medicaid HMO amount,18867,Other,140% of NY Medicaid HMO DRG,30321,,DRG base rate x DRG weight + capital per discharge,30321,Other,225% of NY Medicaid HMO DRG,37060,,275% x Medicaid HMO amount,37060,Other,275% of NY Medicaid HMO DRG,43663,,324% x Medicaid HMO amount,43663,Other,324% of NY Medicaid HMO DRG,28974,,215% x Medicaid HMO amount,28974,Other,215% of NY Medicaid HMO DRG,28974,,215% x Medicaid HMO amount,28974,Other,215% of NY Medicaid HMO DRG,16845,,125% x Medicaid HMO amount,16845,Other,125% of NY Medicaid HMO DRG,0.01,56586,
"Other stomach, esophageal & duodenal procedures",222-4,APR-DRG,,,,,,,,inpatient,,,249880.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,66242,,186% x Medicaid HMO amount,66242,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,152927,,"27,634 x DRG Weight",152927,Other,DRG Base Rate x DRG Weight,129983,,"23,488 x DRG Weight",129983,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35614.21,,DRG base rate x DRG weight + capital per discharge,35614.21,Other,100% of NY Medicaid HMO DRG,35614,,DRG base rate x DRG weight + capital per discharge,35614,Other,100% of NY Medicaid HMO DRG,35614,,DRG base rate x DRG weight + capital per discharge,35614,Other,100% of NY Medicaid HMO DRG,35614,,DRG base rate x DRG weight + capital per discharge,35614,Other,100% of NY Medicaid HMO DRG,80132,,225% x Medicaid HMO amount,80132,Other,225% of NY Medicaid HMO DRG,54490,,153% x Medicaid HMO amount,54490,Other,153% of NY Medicaid HMO DRG,80132,,225% x Medicaid HMO amount,80132,Other,225% of NY Medicaid HMO DRG,49860,,140% x Medicaid HMO amount,49860,Other,140% of NY Medicaid HMO DRG,80132,,DRG base rate x DRG weight + capital per discharge,80132,Other,225% of NY Medicaid HMO DRG,97939,,275% x Medicaid HMO amount,97939,Other,275% of NY Medicaid HMO DRG,115390,,324% x Medicaid HMO amount,115390,Other,324% of NY Medicaid HMO DRG,76571,,215% x Medicaid HMO amount,76571,Other,215% of NY Medicaid HMO DRG,76571,,215% x Medicaid HMO amount,76571,Other,215% of NY Medicaid HMO DRG,44518,,125% x Medicaid HMO amount,44518,Other,125% of NY Medicaid HMO DRG,0.01,152927,
Other small & large bowel procedures,223-1,APR-DRG,,,,,,,,inpatient,,,116815.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14780,,186% x Medicaid HMO amount,14780,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32522,,"27,634 x DRG Weight",32522,Other,DRG Base Rate x DRG Weight,27643,,"23,488 x DRG Weight",27643,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7946.21,,DRG base rate x DRG weight + capital per discharge,7946.21,Other,100% of NY Medicaid HMO DRG,7946,,DRG base rate x DRG weight + capital per discharge,7946,Other,100% of NY Medicaid HMO DRG,7946,,DRG base rate x DRG weight + capital per discharge,7946,Other,100% of NY Medicaid HMO DRG,7946,,DRG base rate x DRG weight + capital per discharge,7946,Other,100% of NY Medicaid HMO DRG,17879,,225% x Medicaid HMO amount,17879,Other,225% of NY Medicaid HMO DRG,12158,,153% x Medicaid HMO amount,12158,Other,153% of NY Medicaid HMO DRG,17879,,225% x Medicaid HMO amount,17879,Other,225% of NY Medicaid HMO DRG,11125,,140% x Medicaid HMO amount,11125,Other,140% of NY Medicaid HMO DRG,17879,,DRG base rate x DRG weight + capital per discharge,17879,Other,225% of NY Medicaid HMO DRG,21852,,275% x Medicaid HMO amount,21852,Other,275% of NY Medicaid HMO DRG,25746,,324% x Medicaid HMO amount,25746,Other,324% of NY Medicaid HMO DRG,17084,,215% x Medicaid HMO amount,17084,Other,215% of NY Medicaid HMO DRG,17084,,215% x Medicaid HMO amount,17084,Other,215% of NY Medicaid HMO DRG,9933,,125% x Medicaid HMO amount,9933,Other,125% of NY Medicaid HMO DRG,0.01,32522,
Other small & large bowel procedures,223-2,APR-DRG,,,,,,,,inpatient,,,192783.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19478,,186% x Medicaid HMO amount,19478,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43512,,"27,634 x DRG Weight",43512,Other,DRG Base Rate x DRG Weight,36984,,"23,488 x DRG Weight",36984,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10472.21,,DRG base rate x DRG weight + capital per discharge,10472.21,Other,100% of NY Medicaid HMO DRG,10472,,DRG base rate x DRG weight + capital per discharge,10472,Other,100% of NY Medicaid HMO DRG,10472,,DRG base rate x DRG weight + capital per discharge,10472,Other,100% of NY Medicaid HMO DRG,10472,,DRG base rate x DRG weight + capital per discharge,10472,Other,100% of NY Medicaid HMO DRG,23562,,225% x Medicaid HMO amount,23562,Other,225% of NY Medicaid HMO DRG,16022,,153% x Medicaid HMO amount,16022,Other,153% of NY Medicaid HMO DRG,23562,,225% x Medicaid HMO amount,23562,Other,225% of NY Medicaid HMO DRG,14661,,140% x Medicaid HMO amount,14661,Other,140% of NY Medicaid HMO DRG,23562,,DRG base rate x DRG weight + capital per discharge,23562,Other,225% of NY Medicaid HMO DRG,28799,,275% x Medicaid HMO amount,28799,Other,275% of NY Medicaid HMO DRG,33930,,324% x Medicaid HMO amount,33930,Other,324% of NY Medicaid HMO DRG,22515,,215% x Medicaid HMO amount,22515,Other,215% of NY Medicaid HMO DRG,22515,,215% x Medicaid HMO amount,22515,Other,215% of NY Medicaid HMO DRG,13090,,125% x Medicaid HMO amount,13090,Other,125% of NY Medicaid HMO DRG,0.01,43512,
Other small & large bowel procedures,223-3,APR-DRG,,,,,,,,inpatient,,,334628.89,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32301,,186% x Medicaid HMO amount,32301,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73515,,"27,634 x DRG Weight",73515,Other,DRG Base Rate x DRG Weight,62485,,"23,488 x DRG Weight",62485,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17366.21,,DRG base rate x DRG weight + capital per discharge,17366.21,Other,100% of NY Medicaid HMO DRG,17366,,DRG base rate x DRG weight + capital per discharge,17366,Other,100% of NY Medicaid HMO DRG,17366,,DRG base rate x DRG weight + capital per discharge,17366,Other,100% of NY Medicaid HMO DRG,17366,,DRG base rate x DRG weight + capital per discharge,17366,Other,100% of NY Medicaid HMO DRG,39074,,225% x Medicaid HMO amount,39074,Other,225% of NY Medicaid HMO DRG,26570,,153% x Medicaid HMO amount,26570,Other,153% of NY Medicaid HMO DRG,39074,,225% x Medicaid HMO amount,39074,Other,225% of NY Medicaid HMO DRG,24313,,140% x Medicaid HMO amount,24313,Other,140% of NY Medicaid HMO DRG,39074,,DRG base rate x DRG weight + capital per discharge,39074,Other,225% of NY Medicaid HMO DRG,47757,,275% x Medicaid HMO amount,47757,Other,275% of NY Medicaid HMO DRG,56267,,324% x Medicaid HMO amount,56267,Other,324% of NY Medicaid HMO DRG,37337,,215% x Medicaid HMO amount,37337,Other,215% of NY Medicaid HMO DRG,37337,,215% x Medicaid HMO amount,37337,Other,215% of NY Medicaid HMO DRG,21708,,125% x Medicaid HMO amount,21708,Other,125% of NY Medicaid HMO DRG,0.01,73515,
Other small & large bowel procedures,223-4,APR-DRG,,,,,,,,inpatient,,,283345.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,66767,,186% x Medicaid HMO amount,66767,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,154156,,"27,634 x DRG Weight",154156,Other,DRG Base Rate x DRG Weight,131028,,"23,488 x DRG Weight",131028,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35896.21,,DRG base rate x DRG weight + capital per discharge,35896.21,Other,100% of NY Medicaid HMO DRG,35896,,DRG base rate x DRG weight + capital per discharge,35896,Other,100% of NY Medicaid HMO DRG,35896,,DRG base rate x DRG weight + capital per discharge,35896,Other,100% of NY Medicaid HMO DRG,35896,,DRG base rate x DRG weight + capital per discharge,35896,Other,100% of NY Medicaid HMO DRG,80766,,225% x Medicaid HMO amount,80766,Other,225% of NY Medicaid HMO DRG,54921,,153% x Medicaid HMO amount,54921,Other,153% of NY Medicaid HMO DRG,80766,,225% x Medicaid HMO amount,80766,Other,225% of NY Medicaid HMO DRG,50255,,140% x Medicaid HMO amount,50255,Other,140% of NY Medicaid HMO DRG,80766,,DRG base rate x DRG weight + capital per discharge,80766,Other,225% of NY Medicaid HMO DRG,98715,,275% x Medicaid HMO amount,98715,Other,275% of NY Medicaid HMO DRG,116304,,324% x Medicaid HMO amount,116304,Other,324% of NY Medicaid HMO DRG,77177,,215% x Medicaid HMO amount,77177,Other,215% of NY Medicaid HMO DRG,77177,,215% x Medicaid HMO amount,77177,Other,215% of NY Medicaid HMO DRG,44870,,125% x Medicaid HMO amount,44870,Other,125% of NY Medicaid HMO DRG,0.01,154156,
Peritoneal adhesiolysis,224-1,APR-DRG,,,,,,,,inpatient,,,124158.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15073,,186% x Medicaid HMO amount,15073,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33211,,"27,634 x DRG Weight",33211,Other,DRG Base Rate x DRG Weight,28228,,"23,488 x DRG Weight",28228,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8104.21,,DRG base rate x DRG weight + capital per discharge,8104.21,Other,100% of NY Medicaid HMO DRG,8104,,DRG base rate x DRG weight + capital per discharge,8104,Other,100% of NY Medicaid HMO DRG,8104,,DRG base rate x DRG weight + capital per discharge,8104,Other,100% of NY Medicaid HMO DRG,8104,,DRG base rate x DRG weight + capital per discharge,8104,Other,100% of NY Medicaid HMO DRG,18234,,225% x Medicaid HMO amount,18234,Other,225% of NY Medicaid HMO DRG,12399,,153% x Medicaid HMO amount,12399,Other,153% of NY Medicaid HMO DRG,18234,,225% x Medicaid HMO amount,18234,Other,225% of NY Medicaid HMO DRG,11346,,140% x Medicaid HMO amount,11346,Other,140% of NY Medicaid HMO DRG,18234,,DRG base rate x DRG weight + capital per discharge,18234,Other,225% of NY Medicaid HMO DRG,22287,,275% x Medicaid HMO amount,22287,Other,275% of NY Medicaid HMO DRG,26258,,324% x Medicaid HMO amount,26258,Other,324% of NY Medicaid HMO DRG,17424,,215% x Medicaid HMO amount,17424,Other,215% of NY Medicaid HMO DRG,17424,,215% x Medicaid HMO amount,17424,Other,215% of NY Medicaid HMO DRG,10130,,125% x Medicaid HMO amount,10130,Other,125% of NY Medicaid HMO DRG,0.01,33211,
Peritoneal adhesiolysis,224-2,APR-DRG,,,,,,,,inpatient,,,177502.78,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19792,,186% x Medicaid HMO amount,19792,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44250,,"27,634 x DRG Weight",44250,Other,DRG Base Rate x DRG Weight,37611,,"23,488 x DRG Weight",37611,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10641.21,,DRG base rate x DRG weight + capital per discharge,10641.21,Other,100% of NY Medicaid HMO DRG,10641,,DRG base rate x DRG weight + capital per discharge,10641,Other,100% of NY Medicaid HMO DRG,10641,,DRG base rate x DRG weight + capital per discharge,10641,Other,100% of NY Medicaid HMO DRG,10641,,DRG base rate x DRG weight + capital per discharge,10641,Other,100% of NY Medicaid HMO DRG,23943,,225% x Medicaid HMO amount,23943,Other,225% of NY Medicaid HMO DRG,16281,,153% x Medicaid HMO amount,16281,Other,153% of NY Medicaid HMO DRG,23943,,225% x Medicaid HMO amount,23943,Other,225% of NY Medicaid HMO DRG,14898,,140% x Medicaid HMO amount,14898,Other,140% of NY Medicaid HMO DRG,23943,,DRG base rate x DRG weight + capital per discharge,23943,Other,225% of NY Medicaid HMO DRG,29263,,275% x Medicaid HMO amount,29263,Other,275% of NY Medicaid HMO DRG,34478,,324% x Medicaid HMO amount,34478,Other,324% of NY Medicaid HMO DRG,22879,,215% x Medicaid HMO amount,22879,Other,215% of NY Medicaid HMO DRG,22879,,215% x Medicaid HMO amount,22879,Other,215% of NY Medicaid HMO DRG,13302,,125% x Medicaid HMO amount,13302,Other,125% of NY Medicaid HMO DRG,0.01,44250,
Peritoneal adhesiolysis,224-3,APR-DRG,,,,,,,,inpatient,,,605898.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32225,,186% x Medicaid HMO amount,32225,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73335,,"27,634 x DRG Weight",73335,Other,DRG Base Rate x DRG Weight,62332,,"23,488 x DRG Weight",62332,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17325.21,,DRG base rate x DRG weight + capital per discharge,17325.21,Other,100% of NY Medicaid HMO DRG,17325,,DRG base rate x DRG weight + capital per discharge,17325,Other,100% of NY Medicaid HMO DRG,17325,,DRG base rate x DRG weight + capital per discharge,17325,Other,100% of NY Medicaid HMO DRG,17325,,DRG base rate x DRG weight + capital per discharge,17325,Other,100% of NY Medicaid HMO DRG,38982,,225% x Medicaid HMO amount,38982,Other,225% of NY Medicaid HMO DRG,26508,,153% x Medicaid HMO amount,26508,Other,153% of NY Medicaid HMO DRG,38982,,225% x Medicaid HMO amount,38982,Other,225% of NY Medicaid HMO DRG,24255,,140% x Medicaid HMO amount,24255,Other,140% of NY Medicaid HMO DRG,38982,,DRG base rate x DRG weight + capital per discharge,38982,Other,225% of NY Medicaid HMO DRG,47644,,275% x Medicaid HMO amount,47644,Other,275% of NY Medicaid HMO DRG,56134,,324% x Medicaid HMO amount,56134,Other,324% of NY Medicaid HMO DRG,37249,,215% x Medicaid HMO amount,37249,Other,215% of NY Medicaid HMO DRG,37249,,215% x Medicaid HMO amount,37249,Other,215% of NY Medicaid HMO DRG,21657,,125% x Medicaid HMO amount,21657,Other,125% of NY Medicaid HMO DRG,0.01,73335,
Peritoneal adhesiolysis,224-4,APR-DRG,,,,,,,,inpatient,,,631151.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,66651,,186% x Medicaid HMO amount,66651,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,153883,,"27,634 x DRG Weight",153883,Other,DRG Base Rate x DRG Weight,130795,,"23,488 x DRG Weight",130795,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35834.21,,DRG base rate x DRG weight + capital per discharge,35834.21,Other,100% of NY Medicaid HMO DRG,35834,,DRG base rate x DRG weight + capital per discharge,35834,Other,100% of NY Medicaid HMO DRG,35834,,DRG base rate x DRG weight + capital per discharge,35834,Other,100% of NY Medicaid HMO DRG,35834,,DRG base rate x DRG weight + capital per discharge,35834,Other,100% of NY Medicaid HMO DRG,80627,,225% x Medicaid HMO amount,80627,Other,225% of NY Medicaid HMO DRG,54826,,153% x Medicaid HMO amount,54826,Other,153% of NY Medicaid HMO DRG,80627,,225% x Medicaid HMO amount,80627,Other,225% of NY Medicaid HMO DRG,50168,,140% x Medicaid HMO amount,50168,Other,140% of NY Medicaid HMO DRG,80627,,DRG base rate x DRG weight + capital per discharge,80627,Other,225% of NY Medicaid HMO DRG,98544,,275% x Medicaid HMO amount,98544,Other,275% of NY Medicaid HMO DRG,116103,,324% x Medicaid HMO amount,116103,Other,324% of NY Medicaid HMO DRG,77044,,215% x Medicaid HMO amount,77044,Other,215% of NY Medicaid HMO DRG,77044,,215% x Medicaid HMO amount,77044,Other,215% of NY Medicaid HMO DRG,44793,,125% x Medicaid HMO amount,44793,Other,125% of NY Medicaid HMO DRG,0.01,153883,
Appendectomy,225-1,APR-DRG,,,,,,,,inpatient,,,74424.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9384,,186% x Medicaid HMO amount,9384,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19896,,"27,634 x DRG Weight",19896,Other,DRG Base Rate x DRG Weight,16911,,"23,488 x DRG Weight",16911,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5045.21,,DRG base rate x DRG weight + capital per discharge,5045.21,Other,100% of NY Medicaid HMO DRG,5045,,DRG base rate x DRG weight + capital per discharge,5045,Other,100% of NY Medicaid HMO DRG,5045,,DRG base rate x DRG weight + capital per discharge,5045,Other,100% of NY Medicaid HMO DRG,5045,,DRG base rate x DRG weight + capital per discharge,5045,Other,100% of NY Medicaid HMO DRG,11352,,225% x Medicaid HMO amount,11352,Other,225% of NY Medicaid HMO DRG,7719,,153% x Medicaid HMO amount,7719,Other,153% of NY Medicaid HMO DRG,11352,,225% x Medicaid HMO amount,11352,Other,225% of NY Medicaid HMO DRG,7063,,140% x Medicaid HMO amount,7063,Other,140% of NY Medicaid HMO DRG,11352,,DRG base rate x DRG weight + capital per discharge,11352,Other,225% of NY Medicaid HMO DRG,13874,,275% x Medicaid HMO amount,13874,Other,275% of NY Medicaid HMO DRG,16346,,324% x Medicaid HMO amount,16346,Other,324% of NY Medicaid HMO DRG,10847,,215% x Medicaid HMO amount,10847,Other,215% of NY Medicaid HMO DRG,10847,,215% x Medicaid HMO amount,10847,Other,215% of NY Medicaid HMO DRG,6307,,125% x Medicaid HMO amount,6307,Other,125% of NY Medicaid HMO DRG,0.01,19896,
Appendectomy,225-2,APR-DRG,,,,,,,,inpatient,,,121347.09,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13924,,186% x Medicaid HMO amount,13924,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30519,,"27,634 x DRG Weight",30519,Other,DRG Base Rate x DRG Weight,25940,,"23,488 x DRG Weight",25940,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7486.21,,DRG base rate x DRG weight + capital per discharge,7486.21,Other,100% of NY Medicaid HMO DRG,7486,,DRG base rate x DRG weight + capital per discharge,7486,Other,100% of NY Medicaid HMO DRG,7486,,DRG base rate x DRG weight + capital per discharge,7486,Other,100% of NY Medicaid HMO DRG,7486,,DRG base rate x DRG weight + capital per discharge,7486,Other,100% of NY Medicaid HMO DRG,16844,,225% x Medicaid HMO amount,16844,Other,225% of NY Medicaid HMO DRG,11454,,153% x Medicaid HMO amount,11454,Other,153% of NY Medicaid HMO DRG,16844,,225% x Medicaid HMO amount,16844,Other,225% of NY Medicaid HMO DRG,10481,,140% x Medicaid HMO amount,10481,Other,140% of NY Medicaid HMO DRG,16844,,DRG base rate x DRG weight + capital per discharge,16844,Other,225% of NY Medicaid HMO DRG,20587,,275% x Medicaid HMO amount,20587,Other,275% of NY Medicaid HMO DRG,24255,,324% x Medicaid HMO amount,24255,Other,324% of NY Medicaid HMO DRG,16095,,215% x Medicaid HMO amount,16095,Other,215% of NY Medicaid HMO DRG,16095,,215% x Medicaid HMO amount,16095,Other,215% of NY Medicaid HMO DRG,9358,,125% x Medicaid HMO amount,9358,Other,125% of NY Medicaid HMO DRG,0.01,30519,
Appendectomy,225-3,APR-DRG,,,,,,,,inpatient,,,241930.68,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24842,,186% x Medicaid HMO amount,24842,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,56064,,"27,634 x DRG Weight",56064,Other,DRG Base Rate x DRG Weight,47652,,"23,488 x DRG Weight",47652,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13356.21,,DRG base rate x DRG weight + capital per discharge,13356.21,Other,100% of NY Medicaid HMO DRG,13356,,DRG base rate x DRG weight + capital per discharge,13356,Other,100% of NY Medicaid HMO DRG,13356,,DRG base rate x DRG weight + capital per discharge,13356,Other,100% of NY Medicaid HMO DRG,13356,,DRG base rate x DRG weight + capital per discharge,13356,Other,100% of NY Medicaid HMO DRG,30051,,225% x Medicaid HMO amount,30051,Other,225% of NY Medicaid HMO DRG,20435,,153% x Medicaid HMO amount,20435,Other,153% of NY Medicaid HMO DRG,30051,,225% x Medicaid HMO amount,30051,Other,225% of NY Medicaid HMO DRG,18699,,140% x Medicaid HMO amount,18699,Other,140% of NY Medicaid HMO DRG,30051,,DRG base rate x DRG weight + capital per discharge,30051,Other,225% of NY Medicaid HMO DRG,36730,,275% x Medicaid HMO amount,36730,Other,275% of NY Medicaid HMO DRG,43274,,324% x Medicaid HMO amount,43274,Other,324% of NY Medicaid HMO DRG,28716,,215% x Medicaid HMO amount,28716,Other,215% of NY Medicaid HMO DRG,28716,,215% x Medicaid HMO amount,28716,Other,215% of NY Medicaid HMO DRG,16695,,125% x Medicaid HMO amount,16695,Other,125% of NY Medicaid HMO DRG,0.01,56064,
Appendectomy,225-4,APR-DRG,,,,,,,,inpatient,,,285684.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48858,,186% x Medicaid HMO amount,48858,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,112255,,"27,634 x DRG Weight",112255,Other,DRG Base Rate x DRG Weight,95413,,"23,488 x DRG Weight",95413,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26268.21,,DRG base rate x DRG weight + capital per discharge,26268.21,Other,100% of NY Medicaid HMO DRG,26268,,DRG base rate x DRG weight + capital per discharge,26268,Other,100% of NY Medicaid HMO DRG,26268,,DRG base rate x DRG weight + capital per discharge,26268,Other,100% of NY Medicaid HMO DRG,26268,,DRG base rate x DRG weight + capital per discharge,26268,Other,100% of NY Medicaid HMO DRG,59103,,225% x Medicaid HMO amount,59103,Other,225% of NY Medicaid HMO DRG,40190,,153% x Medicaid HMO amount,40190,Other,153% of NY Medicaid HMO DRG,59103,,225% x Medicaid HMO amount,59103,Other,225% of NY Medicaid HMO DRG,36775,,140% x Medicaid HMO amount,36775,Other,140% of NY Medicaid HMO DRG,59103,,DRG base rate x DRG weight + capital per discharge,59103,Other,225% of NY Medicaid HMO DRG,72238,,275% x Medicaid HMO amount,72238,Other,275% of NY Medicaid HMO DRG,85109,,324% x Medicaid HMO amount,85109,Other,324% of NY Medicaid HMO DRG,56477,,215% x Medicaid HMO amount,56477,Other,215% of NY Medicaid HMO DRG,56477,,215% x Medicaid HMO amount,56477,Other,215% of NY Medicaid HMO DRG,32835,,125% x Medicaid HMO amount,32835,Other,125% of NY Medicaid HMO DRG,0.01,112255,
Anal procedures,226-1,APR-DRG,,,,,,,,inpatient,,,81392.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8190,,186% x Medicaid HMO amount,8190,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17103,,"27,634 x DRG Weight",17103,Other,DRG Base Rate x DRG Weight,14537,,"23,488 x DRG Weight",14537,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4403.21,,DRG base rate x DRG weight + capital per discharge,4403.21,Other,100% of NY Medicaid HMO DRG,4403,,DRG base rate x DRG weight + capital per discharge,4403,Other,100% of NY Medicaid HMO DRG,4403,,DRG base rate x DRG weight + capital per discharge,4403,Other,100% of NY Medicaid HMO DRG,4403,,DRG base rate x DRG weight + capital per discharge,4403,Other,100% of NY Medicaid HMO DRG,9907,,225% x Medicaid HMO amount,9907,Other,225% of NY Medicaid HMO DRG,6737,,153% x Medicaid HMO amount,6737,Other,153% of NY Medicaid HMO DRG,9907,,225% x Medicaid HMO amount,9907,Other,225% of NY Medicaid HMO DRG,6164,,140% x Medicaid HMO amount,6164,Other,140% of NY Medicaid HMO DRG,9907,,DRG base rate x DRG weight + capital per discharge,9907,Other,225% of NY Medicaid HMO DRG,12109,,275% x Medicaid HMO amount,12109,Other,275% of NY Medicaid HMO DRG,14266,,324% x Medicaid HMO amount,14266,Other,324% of NY Medicaid HMO DRG,9467,,215% x Medicaid HMO amount,9467,Other,215% of NY Medicaid HMO DRG,9467,,215% x Medicaid HMO amount,9467,Other,215% of NY Medicaid HMO DRG,5504,,125% x Medicaid HMO amount,5504,Other,125% of NY Medicaid HMO DRG,0.01,17103,
Anal procedures,226-2,APR-DRG,,,,,,,,inpatient,,,126614.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11309,,186% x Medicaid HMO amount,11309,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24401,,"27,634 x DRG Weight",24401,Other,DRG Base Rate x DRG Weight,20740,,"23,488 x DRG Weight",20740,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6080.21,,DRG base rate x DRG weight + capital per discharge,6080.21,Other,100% of NY Medicaid HMO DRG,6080,,DRG base rate x DRG weight + capital per discharge,6080,Other,100% of NY Medicaid HMO DRG,6080,,DRG base rate x DRG weight + capital per discharge,6080,Other,100% of NY Medicaid HMO DRG,6080,,DRG base rate x DRG weight + capital per discharge,6080,Other,100% of NY Medicaid HMO DRG,13680,,225% x Medicaid HMO amount,13680,Other,225% of NY Medicaid HMO DRG,9303,,153% x Medicaid HMO amount,9303,Other,153% of NY Medicaid HMO DRG,13680,,225% x Medicaid HMO amount,13680,Other,225% of NY Medicaid HMO DRG,8512,,140% x Medicaid HMO amount,8512,Other,140% of NY Medicaid HMO DRG,13680,,DRG base rate x DRG weight + capital per discharge,13680,Other,225% of NY Medicaid HMO DRG,16721,,275% x Medicaid HMO amount,16721,Other,275% of NY Medicaid HMO DRG,19700,,324% x Medicaid HMO amount,19700,Other,324% of NY Medicaid HMO DRG,13072,,215% x Medicaid HMO amount,13072,Other,215% of NY Medicaid HMO DRG,13072,,215% x Medicaid HMO amount,13072,Other,215% of NY Medicaid HMO DRG,7600,,125% x Medicaid HMO amount,7600,Other,125% of NY Medicaid HMO DRG,0.01,24401,
Anal procedures,226-3,APR-DRG,,,,,,,,inpatient,,,356419.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18578,,186% x Medicaid HMO amount,18578,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41407,,"27,634 x DRG Weight",41407,Other,DRG Base Rate x DRG Weight,35194,,"23,488 x DRG Weight",35194,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9988.21,,DRG base rate x DRG weight + capital per discharge,9988.21,Other,100% of NY Medicaid HMO DRG,9988,,DRG base rate x DRG weight + capital per discharge,9988,Other,100% of NY Medicaid HMO DRG,9988,,DRG base rate x DRG weight + capital per discharge,9988,Other,100% of NY Medicaid HMO DRG,9988,,DRG base rate x DRG weight + capital per discharge,9988,Other,100% of NY Medicaid HMO DRG,22473,,225% x Medicaid HMO amount,22473,Other,225% of NY Medicaid HMO DRG,15282,,153% x Medicaid HMO amount,15282,Other,153% of NY Medicaid HMO DRG,22473,,225% x Medicaid HMO amount,22473,Other,225% of NY Medicaid HMO DRG,13983,,140% x Medicaid HMO amount,13983,Other,140% of NY Medicaid HMO DRG,22473,,DRG base rate x DRG weight + capital per discharge,22473,Other,225% of NY Medicaid HMO DRG,27468,,275% x Medicaid HMO amount,27468,Other,275% of NY Medicaid HMO DRG,32362,,324% x Medicaid HMO amount,32362,Other,324% of NY Medicaid HMO DRG,21475,,215% x Medicaid HMO amount,21475,Other,215% of NY Medicaid HMO DRG,21475,,215% x Medicaid HMO amount,21475,Other,215% of NY Medicaid HMO DRG,12485,,125% x Medicaid HMO amount,12485,Other,125% of NY Medicaid HMO DRG,0.01,41407,
Anal procedures,226-4,APR-DRG,,,,,,,,inpatient,,,1092437.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43740,,186% x Medicaid HMO amount,43740,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,100281,,"27,634 x DRG Weight",100281,Other,DRG Base Rate x DRG Weight,85236,,"23,488 x DRG Weight",85236,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23516.21,,DRG base rate x DRG weight + capital per discharge,23516.21,Other,100% of NY Medicaid HMO DRG,23516,,DRG base rate x DRG weight + capital per discharge,23516,Other,100% of NY Medicaid HMO DRG,23516,,DRG base rate x DRG weight + capital per discharge,23516,Other,100% of NY Medicaid HMO DRG,23516,,DRG base rate x DRG weight + capital per discharge,23516,Other,100% of NY Medicaid HMO DRG,52911,,225% x Medicaid HMO amount,52911,Other,225% of NY Medicaid HMO DRG,35980,,153% x Medicaid HMO amount,35980,Other,153% of NY Medicaid HMO DRG,52911,,225% x Medicaid HMO amount,52911,Other,225% of NY Medicaid HMO DRG,32923,,140% x Medicaid HMO amount,32923,Other,140% of NY Medicaid HMO DRG,52911,,DRG base rate x DRG weight + capital per discharge,52911,Other,225% of NY Medicaid HMO DRG,64670,,275% x Medicaid HMO amount,64670,Other,275% of NY Medicaid HMO DRG,76193,,324% x Medicaid HMO amount,76193,Other,324% of NY Medicaid HMO DRG,50560,,215% x Medicaid HMO amount,50560,Other,215% of NY Medicaid HMO DRG,50560,,215% x Medicaid HMO amount,50560,Other,215% of NY Medicaid HMO DRG,29395,,125% x Medicaid HMO amount,29395,Other,125% of NY Medicaid HMO DRG,0.01,100281,
"Hernia procedures except inguinal, femoral & umbilical",227-1,APR-DRG,,,,,,,,inpatient,,,161537.48,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13156,,186% x Medicaid HMO amount,13156,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28723,,"27,634 x DRG Weight",28723,Other,DRG Base Rate x DRG Weight,24413,,"23,488 x DRG Weight",24413,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7073.21,,DRG base rate x DRG weight + capital per discharge,7073.21,Other,100% of NY Medicaid HMO DRG,7073,,DRG base rate x DRG weight + capital per discharge,7073,Other,100% of NY Medicaid HMO DRG,7073,,DRG base rate x DRG weight + capital per discharge,7073,Other,100% of NY Medicaid HMO DRG,7073,,DRG base rate x DRG weight + capital per discharge,7073,Other,100% of NY Medicaid HMO DRG,15915,,225% x Medicaid HMO amount,15915,Other,225% of NY Medicaid HMO DRG,10822,,153% x Medicaid HMO amount,10822,Other,153% of NY Medicaid HMO DRG,15915,,225% x Medicaid HMO amount,15915,Other,225% of NY Medicaid HMO DRG,9902,,140% x Medicaid HMO amount,9902,Other,140% of NY Medicaid HMO DRG,15915,,DRG base rate x DRG weight + capital per discharge,15915,Other,225% of NY Medicaid HMO DRG,19451,,275% x Medicaid HMO amount,19451,Other,275% of NY Medicaid HMO DRG,22917,,324% x Medicaid HMO amount,22917,Other,324% of NY Medicaid HMO DRG,15207,,215% x Medicaid HMO amount,15207,Other,215% of NY Medicaid HMO DRG,15207,,215% x Medicaid HMO amount,15207,Other,215% of NY Medicaid HMO DRG,8842,,125% x Medicaid HMO amount,8842,Other,125% of NY Medicaid HMO DRG,0.01,28723,
"Hernia procedures except inguinal, femoral & umbilical",227-2,APR-DRG,,,,,,,,inpatient,,,233346.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16829,,186% x Medicaid HMO amount,16829,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37317,,"27,634 x DRG Weight",37317,Other,DRG Base Rate x DRG Weight,31718,,"23,488 x DRG Weight",31718,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9048.21,,DRG base rate x DRG weight + capital per discharge,9048.21,Other,100% of NY Medicaid HMO DRG,9048,,DRG base rate x DRG weight + capital per discharge,9048,Other,100% of NY Medicaid HMO DRG,9048,,DRG base rate x DRG weight + capital per discharge,9048,Other,100% of NY Medicaid HMO DRG,9048,,DRG base rate x DRG weight + capital per discharge,9048,Other,100% of NY Medicaid HMO DRG,20358,,225% x Medicaid HMO amount,20358,Other,225% of NY Medicaid HMO DRG,13844,,153% x Medicaid HMO amount,13844,Other,153% of NY Medicaid HMO DRG,20358,,225% x Medicaid HMO amount,20358,Other,225% of NY Medicaid HMO DRG,12667,,140% x Medicaid HMO amount,12667,Other,140% of NY Medicaid HMO DRG,20358,,DRG base rate x DRG weight + capital per discharge,20358,Other,225% of NY Medicaid HMO DRG,24883,,275% x Medicaid HMO amount,24883,Other,275% of NY Medicaid HMO DRG,29316,,324% x Medicaid HMO amount,29316,Other,324% of NY Medicaid HMO DRG,19454,,215% x Medicaid HMO amount,19454,Other,215% of NY Medicaid HMO DRG,19454,,215% x Medicaid HMO amount,19454,Other,215% of NY Medicaid HMO DRG,11310,,125% x Medicaid HMO amount,11310,Other,125% of NY Medicaid HMO DRG,0.01,37317,
"Hernia procedures except inguinal, femoral & umbilical",227-3,APR-DRG,,,,,,,,inpatient,,,242045.54,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28263,,186% x Medicaid HMO amount,28263,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64067,,"27,634 x DRG Weight",64067,Other,DRG Base Rate x DRG Weight,54455,,"23,488 x DRG Weight",54455,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15195.21,,DRG base rate x DRG weight + capital per discharge,15195.21,Other,100% of NY Medicaid HMO DRG,15195,,DRG base rate x DRG weight + capital per discharge,15195,Other,100% of NY Medicaid HMO DRG,15195,,DRG base rate x DRG weight + capital per discharge,15195,Other,100% of NY Medicaid HMO DRG,15195,,DRG base rate x DRG weight + capital per discharge,15195,Other,100% of NY Medicaid HMO DRG,34189,,225% x Medicaid HMO amount,34189,Other,225% of NY Medicaid HMO DRG,23249,,153% x Medicaid HMO amount,23249,Other,153% of NY Medicaid HMO DRG,34189,,225% x Medicaid HMO amount,34189,Other,225% of NY Medicaid HMO DRG,21273,,140% x Medicaid HMO amount,21273,Other,140% of NY Medicaid HMO DRG,34189,,DRG base rate x DRG weight + capital per discharge,34189,Other,225% of NY Medicaid HMO DRG,41787,,275% x Medicaid HMO amount,41787,Other,275% of NY Medicaid HMO DRG,49232,,324% x Medicaid HMO amount,49232,Other,324% of NY Medicaid HMO DRG,32670,,215% x Medicaid HMO amount,32670,Other,215% of NY Medicaid HMO DRG,32670,,215% x Medicaid HMO amount,32670,Other,215% of NY Medicaid HMO DRG,18994,,125% x Medicaid HMO amount,18994,Other,125% of NY Medicaid HMO DRG,0.01,64067,
"Hernia procedures except inguinal, femoral & umbilical",227-4,APR-DRG,,,,,,,,inpatient,,,95511.63,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63167,,186% x Medicaid HMO amount,63167,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,145733,,"27,634 x DRG Weight",145733,Other,DRG Base Rate x DRG Weight,123869,,"23,488 x DRG Weight",123869,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33961.21,,DRG base rate x DRG weight + capital per discharge,33961.21,Other,100% of NY Medicaid HMO DRG,33961,,DRG base rate x DRG weight + capital per discharge,33961,Other,100% of NY Medicaid HMO DRG,33961,,DRG base rate x DRG weight + capital per discharge,33961,Other,100% of NY Medicaid HMO DRG,33961,,DRG base rate x DRG weight + capital per discharge,33961,Other,100% of NY Medicaid HMO DRG,76413,,225% x Medicaid HMO amount,76413,Other,225% of NY Medicaid HMO DRG,51961,,153% x Medicaid HMO amount,51961,Other,153% of NY Medicaid HMO DRG,76413,,225% x Medicaid HMO amount,76413,Other,225% of NY Medicaid HMO DRG,47546,,140% x Medicaid HMO amount,47546,Other,140% of NY Medicaid HMO DRG,76413,,DRG base rate x DRG weight + capital per discharge,76413,Other,225% of NY Medicaid HMO DRG,93393,,275% x Medicaid HMO amount,93393,Other,275% of NY Medicaid HMO DRG,110034,,324% x Medicaid HMO amount,110034,Other,324% of NY Medicaid HMO DRG,73017,,215% x Medicaid HMO amount,73017,Other,215% of NY Medicaid HMO DRG,73017,,215% x Medicaid HMO amount,73017,Other,215% of NY Medicaid HMO DRG,42452,,125% x Medicaid HMO amount,42452,Other,125% of NY Medicaid HMO DRG,0.01,145733,
"Inguinal, femoral & umbilical hernia procedures",228-1,APR-DRG,,,,,,,,inpatient,,,81869.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9114,,186% x Medicaid HMO amount,9114,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19266,,"27,634 x DRG Weight",19266,Other,DRG Base Rate x DRG Weight,16376,,"23,488 x DRG Weight",16376,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4900.21,,DRG base rate x DRG weight + capital per discharge,4900.21,Other,100% of NY Medicaid HMO DRG,4900,,DRG base rate x DRG weight + capital per discharge,4900,Other,100% of NY Medicaid HMO DRG,4900,,DRG base rate x DRG weight + capital per discharge,4900,Other,100% of NY Medicaid HMO DRG,4900,,DRG base rate x DRG weight + capital per discharge,4900,Other,100% of NY Medicaid HMO DRG,11025,,225% x Medicaid HMO amount,11025,Other,225% of NY Medicaid HMO DRG,7497,,153% x Medicaid HMO amount,7497,Other,153% of NY Medicaid HMO DRG,11025,,225% x Medicaid HMO amount,11025,Other,225% of NY Medicaid HMO DRG,6860,,140% x Medicaid HMO amount,6860,Other,140% of NY Medicaid HMO DRG,11025,,DRG base rate x DRG weight + capital per discharge,11025,Other,225% of NY Medicaid HMO DRG,13476,,275% x Medicaid HMO amount,13476,Other,275% of NY Medicaid HMO DRG,15877,,324% x Medicaid HMO amount,15877,Other,324% of NY Medicaid HMO DRG,10535,,215% x Medicaid HMO amount,10535,Other,215% of NY Medicaid HMO DRG,10535,,215% x Medicaid HMO amount,10535,Other,215% of NY Medicaid HMO DRG,6125,,125% x Medicaid HMO amount,6125,Other,125% of NY Medicaid HMO DRG,0.01,19266,
"Inguinal, femoral & umbilical hernia procedures",228-2,APR-DRG,,,,,,,,inpatient,,,161105.35,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12138,,186% x Medicaid HMO amount,12138,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26343,,"27,634 x DRG Weight",26343,Other,DRG Base Rate x DRG Weight,22391,,"23,488 x DRG Weight",22391,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6526.21,,DRG base rate x DRG weight + capital per discharge,6526.21,Other,100% of NY Medicaid HMO DRG,6526,,DRG base rate x DRG weight + capital per discharge,6526,Other,100% of NY Medicaid HMO DRG,6526,,DRG base rate x DRG weight + capital per discharge,6526,Other,100% of NY Medicaid HMO DRG,6526,,DRG base rate x DRG weight + capital per discharge,6526,Other,100% of NY Medicaid HMO DRG,14684,,225% x Medicaid HMO amount,14684,Other,225% of NY Medicaid HMO DRG,9985,,153% x Medicaid HMO amount,9985,Other,153% of NY Medicaid HMO DRG,14684,,225% x Medicaid HMO amount,14684,Other,225% of NY Medicaid HMO DRG,9137,,140% x Medicaid HMO amount,9137,Other,140% of NY Medicaid HMO DRG,14684,,DRG base rate x DRG weight + capital per discharge,14684,Other,225% of NY Medicaid HMO DRG,17947,,275% x Medicaid HMO amount,17947,Other,275% of NY Medicaid HMO DRG,21145,,324% x Medicaid HMO amount,21145,Other,324% of NY Medicaid HMO DRG,14031,,215% x Medicaid HMO amount,14031,Other,215% of NY Medicaid HMO DRG,14031,,215% x Medicaid HMO amount,14031,Other,215% of NY Medicaid HMO DRG,8158,,125% x Medicaid HMO amount,8158,Other,125% of NY Medicaid HMO DRG,0.01,26343,
"Inguinal, femoral & umbilical hernia procedures",228-3,APR-DRG,,,,,,,,inpatient,,,78257.78,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19937,,186% x Medicaid HMO amount,19937,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44590,,"27,634 x DRG Weight",44590,Other,DRG Base Rate x DRG Weight,37900,,"23,488 x DRG Weight",37900,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10719.21,,DRG base rate x DRG weight + capital per discharge,10719.21,Other,100% of NY Medicaid HMO DRG,10719,,DRG base rate x DRG weight + capital per discharge,10719,Other,100% of NY Medicaid HMO DRG,10719,,DRG base rate x DRG weight + capital per discharge,10719,Other,100% of NY Medicaid HMO DRG,10719,,DRG base rate x DRG weight + capital per discharge,10719,Other,100% of NY Medicaid HMO DRG,24118,,225% x Medicaid HMO amount,24118,Other,225% of NY Medicaid HMO DRG,16400,,153% x Medicaid HMO amount,16400,Other,153% of NY Medicaid HMO DRG,24118,,225% x Medicaid HMO amount,24118,Other,225% of NY Medicaid HMO DRG,15007,,140% x Medicaid HMO amount,15007,Other,140% of NY Medicaid HMO DRG,24118,,DRG base rate x DRG weight + capital per discharge,24118,Other,225% of NY Medicaid HMO DRG,29478,,275% x Medicaid HMO amount,29478,Other,275% of NY Medicaid HMO DRG,34730,,324% x Medicaid HMO amount,34730,Other,324% of NY Medicaid HMO DRG,23046,,215% x Medicaid HMO amount,23046,Other,215% of NY Medicaid HMO DRG,23046,,215% x Medicaid HMO amount,23046,Other,215% of NY Medicaid HMO DRG,13399,,125% x Medicaid HMO amount,13399,Other,125% of NY Medicaid HMO DRG,0.01,44590,
"Inguinal, femoral & umbilical hernia procedures",228-4,APR-DRG,,,,,,,,inpatient,,,454616.93,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53507,,186% x Medicaid HMO amount,53507,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,123132,,"27,634 x DRG Weight",123132,Other,DRG Base Rate x DRG Weight,104658,,"23,488 x DRG Weight",104658,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28767.21,,DRG base rate x DRG weight + capital per discharge,28767.21,Other,100% of NY Medicaid HMO DRG,28767,,DRG base rate x DRG weight + capital per discharge,28767,Other,100% of NY Medicaid HMO DRG,28767,,DRG base rate x DRG weight + capital per discharge,28767,Other,100% of NY Medicaid HMO DRG,28767,,DRG base rate x DRG weight + capital per discharge,28767,Other,100% of NY Medicaid HMO DRG,64726,,225% x Medicaid HMO amount,64726,Other,225% of NY Medicaid HMO DRG,44014,,153% x Medicaid HMO amount,44014,Other,153% of NY Medicaid HMO DRG,64726,,225% x Medicaid HMO amount,64726,Other,225% of NY Medicaid HMO DRG,40274,,140% x Medicaid HMO amount,40274,Other,140% of NY Medicaid HMO DRG,64726,,DRG base rate x DRG weight + capital per discharge,64726,Other,225% of NY Medicaid HMO DRG,79110,,275% x Medicaid HMO amount,79110,Other,275% of NY Medicaid HMO DRG,93206,,324% x Medicaid HMO amount,93206,Other,324% of NY Medicaid HMO DRG,61850,,215% x Medicaid HMO amount,61850,Other,215% of NY Medicaid HMO DRG,61850,,215% x Medicaid HMO amount,61850,Other,215% of NY Medicaid HMO DRG,35959,,125% x Medicaid HMO amount,35959,Other,125% of NY Medicaid HMO DRG,0.01,123132,
Other digestive system & abdominal procedures,229-1,APR-DRG,,,,,,,,inpatient,,,209990.27,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12942,,186% x Medicaid HMO amount,12942,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28223,,"27,634 x DRG Weight",28223,Other,DRG Base Rate x DRG Weight,23988,,"23,488 x DRG Weight",23988,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6958.21,,DRG base rate x DRG weight + capital per discharge,6958.21,Other,100% of NY Medicaid HMO DRG,6958,,DRG base rate x DRG weight + capital per discharge,6958,Other,100% of NY Medicaid HMO DRG,6958,,DRG base rate x DRG weight + capital per discharge,6958,Other,100% of NY Medicaid HMO DRG,6958,,DRG base rate x DRG weight + capital per discharge,6958,Other,100% of NY Medicaid HMO DRG,15656,,225% x Medicaid HMO amount,15656,Other,225% of NY Medicaid HMO DRG,10646,,153% x Medicaid HMO amount,10646,Other,153% of NY Medicaid HMO DRG,15656,,225% x Medicaid HMO amount,15656,Other,225% of NY Medicaid HMO DRG,9741,,140% x Medicaid HMO amount,9741,Other,140% of NY Medicaid HMO DRG,15656,,DRG base rate x DRG weight + capital per discharge,15656,Other,225% of NY Medicaid HMO DRG,19135,,275% x Medicaid HMO amount,19135,Other,275% of NY Medicaid HMO DRG,22545,,324% x Medicaid HMO amount,22545,Other,324% of NY Medicaid HMO DRG,14960,,215% x Medicaid HMO amount,14960,Other,215% of NY Medicaid HMO DRG,14960,,215% x Medicaid HMO amount,14960,Other,215% of NY Medicaid HMO DRG,8698,,125% x Medicaid HMO amount,8698,Other,125% of NY Medicaid HMO DRG,0.01,28223,
Other digestive system & abdominal procedures,229-2,APR-DRG,,,,,,,,inpatient,,,158747.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18362,,186% x Medicaid HMO amount,18362,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40904,,"27,634 x DRG Weight",40904,Other,DRG Base Rate x DRG Weight,34767,,"23,488 x DRG Weight",34767,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9872.21,,DRG base rate x DRG weight + capital per discharge,9872.21,Other,100% of NY Medicaid HMO DRG,9872,,DRG base rate x DRG weight + capital per discharge,9872,Other,100% of NY Medicaid HMO DRG,9872,,DRG base rate x DRG weight + capital per discharge,9872,Other,100% of NY Medicaid HMO DRG,9872,,DRG base rate x DRG weight + capital per discharge,9872,Other,100% of NY Medicaid HMO DRG,22212,,225% x Medicaid HMO amount,22212,Other,225% of NY Medicaid HMO DRG,15104,,153% x Medicaid HMO amount,15104,Other,153% of NY Medicaid HMO DRG,22212,,225% x Medicaid HMO amount,22212,Other,225% of NY Medicaid HMO DRG,13821,,140% x Medicaid HMO amount,13821,Other,140% of NY Medicaid HMO DRG,22212,,DRG base rate x DRG weight + capital per discharge,22212,Other,225% of NY Medicaid HMO DRG,27149,,275% x Medicaid HMO amount,27149,Other,275% of NY Medicaid HMO DRG,31986,,324% x Medicaid HMO amount,31986,Other,324% of NY Medicaid HMO DRG,21225,,215% x Medicaid HMO amount,21225,Other,215% of NY Medicaid HMO DRG,21225,,215% x Medicaid HMO amount,21225,Other,215% of NY Medicaid HMO DRG,12340,,125% x Medicaid HMO amount,12340,Other,125% of NY Medicaid HMO DRG,0.01,40904,
Other digestive system & abdominal procedures,229-3,APR-DRG,,,,,,,,inpatient,,,364897.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31655,,186% x Medicaid HMO amount,31655,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72006,,"27,634 x DRG Weight",72006,Other,DRG Base Rate x DRG Weight,61203,,"23,488 x DRG Weight",61203,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17019.21,,DRG base rate x DRG weight + capital per discharge,17019.21,Other,100% of NY Medicaid HMO DRG,17019,,DRG base rate x DRG weight + capital per discharge,17019,Other,100% of NY Medicaid HMO DRG,17019,,DRG base rate x DRG weight + capital per discharge,17019,Other,100% of NY Medicaid HMO DRG,17019,,DRG base rate x DRG weight + capital per discharge,17019,Other,100% of NY Medicaid HMO DRG,38293,,225% x Medicaid HMO amount,38293,Other,225% of NY Medicaid HMO DRG,26039,,153% x Medicaid HMO amount,26039,Other,153% of NY Medicaid HMO DRG,38293,,225% x Medicaid HMO amount,38293,Other,225% of NY Medicaid HMO DRG,23827,,140% x Medicaid HMO amount,23827,Other,140% of NY Medicaid HMO DRG,38293,,DRG base rate x DRG weight + capital per discharge,38293,Other,225% of NY Medicaid HMO DRG,46803,,275% x Medicaid HMO amount,46803,Other,275% of NY Medicaid HMO DRG,55142,,324% x Medicaid HMO amount,55142,Other,324% of NY Medicaid HMO DRG,36591,,215% x Medicaid HMO amount,36591,Other,215% of NY Medicaid HMO DRG,36591,,215% x Medicaid HMO amount,36591,Other,215% of NY Medicaid HMO DRG,21274,,125% x Medicaid HMO amount,21274,Other,125% of NY Medicaid HMO DRG,0.01,72006,
Other digestive system & abdominal procedures,229-4,APR-DRG,,,,,,,,inpatient,,,723373.83,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69227,,186% x Medicaid HMO amount,69227,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,159912,,"27,634 x DRG Weight",159912,Other,DRG Base Rate x DRG Weight,135920,,"23,488 x DRG Weight",135920,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37219.21,,DRG base rate x DRG weight + capital per discharge,37219.21,Other,100% of NY Medicaid HMO DRG,37219,,DRG base rate x DRG weight + capital per discharge,37219,Other,100% of NY Medicaid HMO DRG,37219,,DRG base rate x DRG weight + capital per discharge,37219,Other,100% of NY Medicaid HMO DRG,37219,,DRG base rate x DRG weight + capital per discharge,37219,Other,100% of NY Medicaid HMO DRG,83743,,225% x Medicaid HMO amount,83743,Other,225% of NY Medicaid HMO DRG,56945,,153% x Medicaid HMO amount,56945,Other,153% of NY Medicaid HMO DRG,83743,,225% x Medicaid HMO amount,83743,Other,225% of NY Medicaid HMO DRG,52107,,140% x Medicaid HMO amount,52107,Other,140% of NY Medicaid HMO DRG,83743,,DRG base rate x DRG weight + capital per discharge,83743,Other,225% of NY Medicaid HMO DRG,102353,,275% x Medicaid HMO amount,102353,Other,275% of NY Medicaid HMO DRG,120590,,324% x Medicaid HMO amount,120590,Other,324% of NY Medicaid HMO DRG,80021,,215% x Medicaid HMO amount,80021,Other,215% of NY Medicaid HMO DRG,80021,,215% x Medicaid HMO amount,80021,Other,215% of NY Medicaid HMO DRG,46524,,125% x Medicaid HMO amount,46524,Other,125% of NY Medicaid HMO DRG,0.01,159912,
Digestive malignancy,240-1,APR-DRG,,,,,,,,inpatient,,,175015.63,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9146,,186% x Medicaid HMO amount,9146,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19338,,"27,634 x DRG Weight",19338,Other,DRG Base Rate x DRG Weight,16437,,"23,488 x DRG Weight",16437,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4917.21,,DRG base rate x DRG weight + capital per discharge,4917.21,Other,100% of NY Medicaid HMO DRG,4917,,DRG base rate x DRG weight + capital per discharge,4917,Other,100% of NY Medicaid HMO DRG,4917,,DRG base rate x DRG weight + capital per discharge,4917,Other,100% of NY Medicaid HMO DRG,4917,,DRG base rate x DRG weight + capital per discharge,4917,Other,100% of NY Medicaid HMO DRG,11064,,225% x Medicaid HMO amount,11064,Other,225% of NY Medicaid HMO DRG,7523,,153% x Medicaid HMO amount,7523,Other,153% of NY Medicaid HMO DRG,11064,,225% x Medicaid HMO amount,11064,Other,225% of NY Medicaid HMO DRG,6884,,140% x Medicaid HMO amount,6884,Other,140% of NY Medicaid HMO DRG,11064,,DRG base rate x DRG weight + capital per discharge,11064,Other,225% of NY Medicaid HMO DRG,13522,,275% x Medicaid HMO amount,13522,Other,275% of NY Medicaid HMO DRG,15932,,324% x Medicaid HMO amount,15932,Other,324% of NY Medicaid HMO DRG,10572,,215% x Medicaid HMO amount,10572,Other,215% of NY Medicaid HMO DRG,10572,,215% x Medicaid HMO amount,10572,Other,215% of NY Medicaid HMO DRG,6147,,125% x Medicaid HMO amount,6147,Other,125% of NY Medicaid HMO DRG,0.01,19338,
Digestive malignancy,240-2,APR-DRG,,,,,,,,inpatient,,,363554.48,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12092,,186% x Medicaid HMO amount,12092,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26233,,"27,634 x DRG Weight",26233,Other,DRG Base Rate x DRG Weight,22297,,"23,488 x DRG Weight",22297,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6501.21,,DRG base rate x DRG weight + capital per discharge,6501.21,Other,100% of NY Medicaid HMO DRG,6501,,DRG base rate x DRG weight + capital per discharge,6501,Other,100% of NY Medicaid HMO DRG,6501,,DRG base rate x DRG weight + capital per discharge,6501,Other,100% of NY Medicaid HMO DRG,6501,,DRG base rate x DRG weight + capital per discharge,6501,Other,100% of NY Medicaid HMO DRG,14628,,225% x Medicaid HMO amount,14628,Other,225% of NY Medicaid HMO DRG,9947,,153% x Medicaid HMO amount,9947,Other,153% of NY Medicaid HMO DRG,14628,,225% x Medicaid HMO amount,14628,Other,225% of NY Medicaid HMO DRG,9102,,140% x Medicaid HMO amount,9102,Other,140% of NY Medicaid HMO DRG,14628,,DRG base rate x DRG weight + capital per discharge,14628,Other,225% of NY Medicaid HMO DRG,17878,,275% x Medicaid HMO amount,17878,Other,275% of NY Medicaid HMO DRG,21064,,324% x Medicaid HMO amount,21064,Other,324% of NY Medicaid HMO DRG,13978,,215% x Medicaid HMO amount,13978,Other,215% of NY Medicaid HMO DRG,13978,,215% x Medicaid HMO amount,13978,Other,215% of NY Medicaid HMO DRG,8127,,125% x Medicaid HMO amount,8127,Other,125% of NY Medicaid HMO DRG,0.01,26233,
Digestive malignancy,240-3,APR-DRG,,,,,,,,inpatient,,,394722.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19580,,186% x Medicaid HMO amount,19580,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43756,,"27,634 x DRG Weight",43756,Other,DRG Base Rate x DRG Weight,37191,,"23,488 x DRG Weight",37191,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10527.21,,DRG base rate x DRG weight + capital per discharge,10527.21,Other,100% of NY Medicaid HMO DRG,10527,,DRG base rate x DRG weight + capital per discharge,10527,Other,100% of NY Medicaid HMO DRG,10527,,DRG base rate x DRG weight + capital per discharge,10527,Other,100% of NY Medicaid HMO DRG,10527,,DRG base rate x DRG weight + capital per discharge,10527,Other,100% of NY Medicaid HMO DRG,23686,,225% x Medicaid HMO amount,23686,Other,225% of NY Medicaid HMO DRG,16107,,153% x Medicaid HMO amount,16107,Other,153% of NY Medicaid HMO DRG,23686,,225% x Medicaid HMO amount,23686,Other,225% of NY Medicaid HMO DRG,14738,,140% x Medicaid HMO amount,14738,Other,140% of NY Medicaid HMO DRG,23686,,DRG base rate x DRG weight + capital per discharge,23686,Other,225% of NY Medicaid HMO DRG,28950,,275% x Medicaid HMO amount,28950,Other,275% of NY Medicaid HMO DRG,34108,,324% x Medicaid HMO amount,34108,Other,324% of NY Medicaid HMO DRG,22634,,215% x Medicaid HMO amount,22634,Other,215% of NY Medicaid HMO DRG,22634,,215% x Medicaid HMO amount,22634,Other,215% of NY Medicaid HMO DRG,13159,,125% x Medicaid HMO amount,13159,Other,125% of NY Medicaid HMO DRG,0.01,43756,
Digestive malignancy,240-4,APR-DRG,,,,,,,,inpatient,,,508662.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36004,,186% x Medicaid HMO amount,36004,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,82181,,"27,634 x DRG Weight",82181,Other,DRG Base Rate x DRG Weight,69851,,"23,488 x DRG Weight",69851,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19357.21,,DRG base rate x DRG weight + capital per discharge,19357.21,Other,100% of NY Medicaid HMO DRG,19357,,DRG base rate x DRG weight + capital per discharge,19357,Other,100% of NY Medicaid HMO DRG,19357,,DRG base rate x DRG weight + capital per discharge,19357,Other,100% of NY Medicaid HMO DRG,19357,,DRG base rate x DRG weight + capital per discharge,19357,Other,100% of NY Medicaid HMO DRG,43554,,225% x Medicaid HMO amount,43554,Other,225% of NY Medicaid HMO DRG,29617,,153% x Medicaid HMO amount,29617,Other,153% of NY Medicaid HMO DRG,43554,,225% x Medicaid HMO amount,43554,Other,225% of NY Medicaid HMO DRG,27100,,140% x Medicaid HMO amount,27100,Other,140% of NY Medicaid HMO DRG,43554,,DRG base rate x DRG weight + capital per discharge,43554,Other,225% of NY Medicaid HMO DRG,53232,,275% x Medicaid HMO amount,53232,Other,275% of NY Medicaid HMO DRG,62717,,324% x Medicaid HMO amount,62717,Other,324% of NY Medicaid HMO DRG,41618,,215% x Medicaid HMO amount,41618,Other,215% of NY Medicaid HMO DRG,41618,,215% x Medicaid HMO amount,41618,Other,215% of NY Medicaid HMO DRG,24197,,125% x Medicaid HMO amount,24197,Other,125% of NY Medicaid HMO DRG,0.01,82181,
Peptic ulcer & gastritis,241-1,APR-DRG,,,,,,,,inpatient,,,98652.05,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7263,,186% x Medicaid HMO amount,7263,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14936,,"27,634 x DRG Weight",14936,Other,DRG Base Rate x DRG Weight,12695,,"23,488 x DRG Weight",12695,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3905.21,,DRG base rate x DRG weight + capital per discharge,3905.21,Other,100% of NY Medicaid HMO DRG,3905,,DRG base rate x DRG weight + capital per discharge,3905,Other,100% of NY Medicaid HMO DRG,3905,,DRG base rate x DRG weight + capital per discharge,3905,Other,100% of NY Medicaid HMO DRG,3905,,DRG base rate x DRG weight + capital per discharge,3905,Other,100% of NY Medicaid HMO DRG,8787,,225% x Medicaid HMO amount,8787,Other,225% of NY Medicaid HMO DRG,5975,,153% x Medicaid HMO amount,5975,Other,153% of NY Medicaid HMO DRG,8787,,225% x Medicaid HMO amount,8787,Other,225% of NY Medicaid HMO DRG,5467,,140% x Medicaid HMO amount,5467,Other,140% of NY Medicaid HMO DRG,8787,,DRG base rate x DRG weight + capital per discharge,8787,Other,225% of NY Medicaid HMO DRG,10739,,275% x Medicaid HMO amount,10739,Other,275% of NY Medicaid HMO DRG,12653,,324% x Medicaid HMO amount,12653,Other,324% of NY Medicaid HMO DRG,8396,,215% x Medicaid HMO amount,8396,Other,215% of NY Medicaid HMO DRG,8396,,215% x Medicaid HMO amount,8396,Other,215% of NY Medicaid HMO DRG,4882,,125% x Medicaid HMO amount,4882,Other,125% of NY Medicaid HMO DRG,0.01,14936,
Peptic ulcer & gastritis,241-2,APR-DRG,,,,,,,,inpatient,,,130688.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10042,,186% x Medicaid HMO amount,10042,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21436,,"27,634 x DRG Weight",21436,Other,DRG Base Rate x DRG Weight,18220,,"23,488 x DRG Weight",18220,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5399.21,,DRG base rate x DRG weight + capital per discharge,5399.21,Other,100% of NY Medicaid HMO DRG,5399,,DRG base rate x DRG weight + capital per discharge,5399,Other,100% of NY Medicaid HMO DRG,5399,,DRG base rate x DRG weight + capital per discharge,5399,Other,100% of NY Medicaid HMO DRG,5399,,DRG base rate x DRG weight + capital per discharge,5399,Other,100% of NY Medicaid HMO DRG,12148,,225% x Medicaid HMO amount,12148,Other,225% of NY Medicaid HMO DRG,8261,,153% x Medicaid HMO amount,8261,Other,153% of NY Medicaid HMO DRG,12148,,225% x Medicaid HMO amount,12148,Other,225% of NY Medicaid HMO DRG,7559,,140% x Medicaid HMO amount,7559,Other,140% of NY Medicaid HMO DRG,12148,,DRG base rate x DRG weight + capital per discharge,12148,Other,225% of NY Medicaid HMO DRG,14848,,275% x Medicaid HMO amount,14848,Other,275% of NY Medicaid HMO DRG,17493,,324% x Medicaid HMO amount,17493,Other,324% of NY Medicaid HMO DRG,11608,,215% x Medicaid HMO amount,11608,Other,215% of NY Medicaid HMO DRG,11608,,215% x Medicaid HMO amount,11608,Other,215% of NY Medicaid HMO DRG,6749,,125% x Medicaid HMO amount,6749,Other,125% of NY Medicaid HMO DRG,0.01,21436,
Peptic ulcer & gastritis,241-3,APR-DRG,,,,,,,,inpatient,,,152371.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15557,,186% x Medicaid HMO amount,15557,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34341,,"27,634 x DRG Weight",34341,Other,DRG Base Rate x DRG Weight,29189,,"23,488 x DRG Weight",29189,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8364.21,,DRG base rate x DRG weight + capital per discharge,8364.21,Other,100% of NY Medicaid HMO DRG,8364,,DRG base rate x DRG weight + capital per discharge,8364,Other,100% of NY Medicaid HMO DRG,8364,,DRG base rate x DRG weight + capital per discharge,8364,Other,100% of NY Medicaid HMO DRG,8364,,DRG base rate x DRG weight + capital per discharge,8364,Other,100% of NY Medicaid HMO DRG,18819,,225% x Medicaid HMO amount,18819,Other,225% of NY Medicaid HMO DRG,12797,,153% x Medicaid HMO amount,12797,Other,153% of NY Medicaid HMO DRG,18819,,225% x Medicaid HMO amount,18819,Other,225% of NY Medicaid HMO DRG,11710,,140% x Medicaid HMO amount,11710,Other,140% of NY Medicaid HMO DRG,18819,,DRG base rate x DRG weight + capital per discharge,18819,Other,225% of NY Medicaid HMO DRG,23002,,275% x Medicaid HMO amount,23002,Other,275% of NY Medicaid HMO DRG,27100,,324% x Medicaid HMO amount,27100,Other,324% of NY Medicaid HMO DRG,17983,,215% x Medicaid HMO amount,17983,Other,215% of NY Medicaid HMO DRG,17983,,215% x Medicaid HMO amount,17983,Other,215% of NY Medicaid HMO DRG,10455,,125% x Medicaid HMO amount,10455,Other,125% of NY Medicaid HMO DRG,0.01,34341,
Peptic ulcer & gastritis,241-4,APR-DRG,,,,,,,,inpatient,,,346158.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37844,,186% x Medicaid HMO amount,37844,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86486,,"27,634 x DRG Weight",86486,Other,DRG Base Rate x DRG Weight,73510,,"23,488 x DRG Weight",73510,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20346.21,,DRG base rate x DRG weight + capital per discharge,20346.21,Other,100% of NY Medicaid HMO DRG,20346,,DRG base rate x DRG weight + capital per discharge,20346,Other,100% of NY Medicaid HMO DRG,20346,,DRG base rate x DRG weight + capital per discharge,20346,Other,100% of NY Medicaid HMO DRG,20346,,DRG base rate x DRG weight + capital per discharge,20346,Other,100% of NY Medicaid HMO DRG,45779,,225% x Medicaid HMO amount,45779,Other,225% of NY Medicaid HMO DRG,31130,,153% x Medicaid HMO amount,31130,Other,153% of NY Medicaid HMO DRG,45779,,225% x Medicaid HMO amount,45779,Other,225% of NY Medicaid HMO DRG,28485,,140% x Medicaid HMO amount,28485,Other,140% of NY Medicaid HMO DRG,45779,,DRG base rate x DRG weight + capital per discharge,45779,Other,225% of NY Medicaid HMO DRG,55952,,275% x Medicaid HMO amount,55952,Other,275% of NY Medicaid HMO DRG,65922,,324% x Medicaid HMO amount,65922,Other,324% of NY Medicaid HMO DRG,43744,,215% x Medicaid HMO amount,43744,Other,215% of NY Medicaid HMO DRG,43744,,215% x Medicaid HMO amount,43744,Other,215% of NY Medicaid HMO DRG,25433,,125% x Medicaid HMO amount,25433,Other,125% of NY Medicaid HMO DRG,0.01,86486,
Major esophageal disorders,242-1,APR-DRG,,,,,,,,inpatient,,,49854,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7405,,186% x Medicaid HMO amount,7405,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15268,,"27,634 x DRG Weight",15268,Other,DRG Base Rate x DRG Weight,12977,,"23,488 x DRG Weight",12977,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3981.21,,DRG base rate x DRG weight + capital per discharge,3981.21,Other,100% of NY Medicaid HMO DRG,3981,,DRG base rate x DRG weight + capital per discharge,3981,Other,100% of NY Medicaid HMO DRG,3981,,DRG base rate x DRG weight + capital per discharge,3981,Other,100% of NY Medicaid HMO DRG,3981,,DRG base rate x DRG weight + capital per discharge,3981,Other,100% of NY Medicaid HMO DRG,8958,,225% x Medicaid HMO amount,8958,Other,225% of NY Medicaid HMO DRG,6091,,153% x Medicaid HMO amount,6091,Other,153% of NY Medicaid HMO DRG,8958,,225% x Medicaid HMO amount,8958,Other,225% of NY Medicaid HMO DRG,5574,,140% x Medicaid HMO amount,5574,Other,140% of NY Medicaid HMO DRG,8958,,DRG base rate x DRG weight + capital per discharge,8958,Other,225% of NY Medicaid HMO DRG,10948,,275% x Medicaid HMO amount,10948,Other,275% of NY Medicaid HMO DRG,12899,,324% x Medicaid HMO amount,12899,Other,324% of NY Medicaid HMO DRG,8560,,215% x Medicaid HMO amount,8560,Other,215% of NY Medicaid HMO DRG,8560,,215% x Medicaid HMO amount,8560,Other,215% of NY Medicaid HMO DRG,4977,,125% x Medicaid HMO amount,4977,Other,125% of NY Medicaid HMO DRG,0.01,15268,
Major esophageal disorders,242-2,APR-DRG,,,,,,,,inpatient,,,57789.91,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10262,,186% x Medicaid HMO amount,10262,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21952,,"27,634 x DRG Weight",21952,Other,DRG Base Rate x DRG Weight,18659,,"23,488 x DRG Weight",18659,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5517.21,,DRG base rate x DRG weight + capital per discharge,5517.21,Other,100% of NY Medicaid HMO DRG,5517,,DRG base rate x DRG weight + capital per discharge,5517,Other,100% of NY Medicaid HMO DRG,5517,,DRG base rate x DRG weight + capital per discharge,5517,Other,100% of NY Medicaid HMO DRG,5517,,DRG base rate x DRG weight + capital per discharge,5517,Other,100% of NY Medicaid HMO DRG,12414,,225% x Medicaid HMO amount,12414,Other,225% of NY Medicaid HMO DRG,8441,,153% x Medicaid HMO amount,8441,Other,153% of NY Medicaid HMO DRG,12414,,225% x Medicaid HMO amount,12414,Other,225% of NY Medicaid HMO DRG,7724,,140% x Medicaid HMO amount,7724,Other,140% of NY Medicaid HMO DRG,12414,,DRG base rate x DRG weight + capital per discharge,12414,Other,225% of NY Medicaid HMO DRG,15172,,275% x Medicaid HMO amount,15172,Other,275% of NY Medicaid HMO DRG,17876,,324% x Medicaid HMO amount,17876,Other,324% of NY Medicaid HMO DRG,11862,,215% x Medicaid HMO amount,11862,Other,215% of NY Medicaid HMO DRG,11862,,215% x Medicaid HMO amount,11862,Other,215% of NY Medicaid HMO DRG,6897,,125% x Medicaid HMO amount,6897,Other,125% of NY Medicaid HMO DRG,0.01,21952,
Major esophageal disorders,242-3,APR-DRG,,,,,,,,inpatient,,,95020.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15624,,186% x Medicaid HMO amount,15624,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34496,,"27,634 x DRG Weight",34496,Other,DRG Base Rate x DRG Weight,29320,,"23,488 x DRG Weight",29320,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8400.21,,DRG base rate x DRG weight + capital per discharge,8400.21,Other,100% of NY Medicaid HMO DRG,8400,,DRG base rate x DRG weight + capital per discharge,8400,Other,100% of NY Medicaid HMO DRG,8400,,DRG base rate x DRG weight + capital per discharge,8400,Other,100% of NY Medicaid HMO DRG,8400,,DRG base rate x DRG weight + capital per discharge,8400,Other,100% of NY Medicaid HMO DRG,18900,,225% x Medicaid HMO amount,18900,Other,225% of NY Medicaid HMO DRG,12852,,153% x Medicaid HMO amount,12852,Other,153% of NY Medicaid HMO DRG,18900,,225% x Medicaid HMO amount,18900,Other,225% of NY Medicaid HMO DRG,11760,,140% x Medicaid HMO amount,11760,Other,140% of NY Medicaid HMO DRG,18900,,DRG base rate x DRG weight + capital per discharge,18900,Other,225% of NY Medicaid HMO DRG,23101,,275% x Medicaid HMO amount,23101,Other,275% of NY Medicaid HMO DRG,27217,,324% x Medicaid HMO amount,27217,Other,324% of NY Medicaid HMO DRG,18060,,215% x Medicaid HMO amount,18060,Other,215% of NY Medicaid HMO DRG,18060,,215% x Medicaid HMO amount,18060,Other,215% of NY Medicaid HMO DRG,10500,,125% x Medicaid HMO amount,10500,Other,125% of NY Medicaid HMO DRG,0.01,34496,
Major esophageal disorders,242-4,APR-DRG,,,,,,,,inpatient,,,152089.88,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38145,,186% x Medicaid HMO amount,38145,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,87191,,"27,634 x DRG Weight",87191,Other,DRG Base Rate x DRG Weight,74109,,"23,488 x DRG Weight",74109,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20508.21,,DRG base rate x DRG weight + capital per discharge,20508.21,Other,100% of NY Medicaid HMO DRG,20508,,DRG base rate x DRG weight + capital per discharge,20508,Other,100% of NY Medicaid HMO DRG,20508,,DRG base rate x DRG weight + capital per discharge,20508,Other,100% of NY Medicaid HMO DRG,20508,,DRG base rate x DRG weight + capital per discharge,20508,Other,100% of NY Medicaid HMO DRG,46143,,225% x Medicaid HMO amount,46143,Other,225% of NY Medicaid HMO DRG,31378,,153% x Medicaid HMO amount,31378,Other,153% of NY Medicaid HMO DRG,46143,,225% x Medicaid HMO amount,46143,Other,225% of NY Medicaid HMO DRG,28711,,140% x Medicaid HMO amount,28711,Other,140% of NY Medicaid HMO DRG,46143,,DRG base rate x DRG weight + capital per discharge,46143,Other,225% of NY Medicaid HMO DRG,56398,,275% x Medicaid HMO amount,56398,Other,275% of NY Medicaid HMO DRG,66447,,324% x Medicaid HMO amount,66447,Other,324% of NY Medicaid HMO DRG,44093,,215% x Medicaid HMO amount,44093,Other,215% of NY Medicaid HMO DRG,44093,,215% x Medicaid HMO amount,44093,Other,215% of NY Medicaid HMO DRG,25635,,125% x Medicaid HMO amount,25635,Other,125% of NY Medicaid HMO DRG,0.01,87191,
Other esophageal disorders,243-1,APR-DRG,,,,,,,,inpatient,,,70883.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6013,,186% x Medicaid HMO amount,6013,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12010,,"27,634 x DRG Weight",12010,Other,DRG Base Rate x DRG Weight,10208,,"23,488 x DRG Weight",10208,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3233.21,,DRG base rate x DRG weight + capital per discharge,3233.21,Other,100% of NY Medicaid HMO DRG,3233,,DRG base rate x DRG weight + capital per discharge,3233,Other,100% of NY Medicaid HMO DRG,3233,,DRG base rate x DRG weight + capital per discharge,3233,Other,100% of NY Medicaid HMO DRG,3233,,DRG base rate x DRG weight + capital per discharge,3233,Other,100% of NY Medicaid HMO DRG,7275,,225% x Medicaid HMO amount,7275,Other,225% of NY Medicaid HMO DRG,4947,,153% x Medicaid HMO amount,4947,Other,153% of NY Medicaid HMO DRG,7275,,225% x Medicaid HMO amount,7275,Other,225% of NY Medicaid HMO DRG,4526,,140% x Medicaid HMO amount,4526,Other,140% of NY Medicaid HMO DRG,7275,,DRG base rate x DRG weight + capital per discharge,7275,Other,225% of NY Medicaid HMO DRG,8891,,275% x Medicaid HMO amount,8891,Other,275% of NY Medicaid HMO DRG,10476,,324% x Medicaid HMO amount,10476,Other,324% of NY Medicaid HMO DRG,6951,,215% x Medicaid HMO amount,6951,Other,215% of NY Medicaid HMO DRG,6951,,215% x Medicaid HMO amount,6951,Other,215% of NY Medicaid HMO DRG,4042,,125% x Medicaid HMO amount,4042,Other,125% of NY Medicaid HMO DRG,0.01,12010,
Other esophageal disorders,243-2,APR-DRG,,,,,,,,inpatient,,,138448.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8309,,186% x Medicaid HMO amount,8309,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17382,,"27,634 x DRG Weight",17382,Other,DRG Base Rate x DRG Weight,14774,,"23,488 x DRG Weight",14774,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4467.21,,DRG base rate x DRG weight + capital per discharge,4467.21,Other,100% of NY Medicaid HMO DRG,4467,,DRG base rate x DRG weight + capital per discharge,4467,Other,100% of NY Medicaid HMO DRG,4467,,DRG base rate x DRG weight + capital per discharge,4467,Other,100% of NY Medicaid HMO DRG,4467,,DRG base rate x DRG weight + capital per discharge,4467,Other,100% of NY Medicaid HMO DRG,10051,,225% x Medicaid HMO amount,10051,Other,225% of NY Medicaid HMO DRG,6835,,153% x Medicaid HMO amount,6835,Other,153% of NY Medicaid HMO DRG,10051,,225% x Medicaid HMO amount,10051,Other,225% of NY Medicaid HMO DRG,6254,,140% x Medicaid HMO amount,6254,Other,140% of NY Medicaid HMO DRG,10051,,DRG base rate x DRG weight + capital per discharge,10051,Other,225% of NY Medicaid HMO DRG,12285,,275% x Medicaid HMO amount,12285,Other,275% of NY Medicaid HMO DRG,14474,,324% x Medicaid HMO amount,14474,Other,324% of NY Medicaid HMO DRG,9605,,215% x Medicaid HMO amount,9605,Other,215% of NY Medicaid HMO DRG,9605,,215% x Medicaid HMO amount,9605,Other,215% of NY Medicaid HMO DRG,5584,,125% x Medicaid HMO amount,5584,Other,125% of NY Medicaid HMO DRG,0.01,17382,
Other esophageal disorders,243-3,APR-DRG,,,,,,,,inpatient,,,157721.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13342,,186% x Medicaid HMO amount,13342,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29157,,"27,634 x DRG Weight",29157,Other,DRG Base Rate x DRG Weight,24782,,"23,488 x DRG Weight",24782,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7173.21,,DRG base rate x DRG weight + capital per discharge,7173.21,Other,100% of NY Medicaid HMO DRG,7173,,DRG base rate x DRG weight + capital per discharge,7173,Other,100% of NY Medicaid HMO DRG,7173,,DRG base rate x DRG weight + capital per discharge,7173,Other,100% of NY Medicaid HMO DRG,7173,,DRG base rate x DRG weight + capital per discharge,7173,Other,100% of NY Medicaid HMO DRG,16140,,225% x Medicaid HMO amount,16140,Other,225% of NY Medicaid HMO DRG,10975,,153% x Medicaid HMO amount,10975,Other,153% of NY Medicaid HMO DRG,16140,,225% x Medicaid HMO amount,16140,Other,225% of NY Medicaid HMO DRG,10042,,140% x Medicaid HMO amount,10042,Other,140% of NY Medicaid HMO DRG,16140,,DRG base rate x DRG weight + capital per discharge,16140,Other,225% of NY Medicaid HMO DRG,19726,,275% x Medicaid HMO amount,19726,Other,275% of NY Medicaid HMO DRG,23241,,324% x Medicaid HMO amount,23241,Other,324% of NY Medicaid HMO DRG,15422,,215% x Medicaid HMO amount,15422,Other,215% of NY Medicaid HMO DRG,15422,,215% x Medicaid HMO amount,15422,Other,215% of NY Medicaid HMO DRG,8967,,125% x Medicaid HMO amount,8967,Other,125% of NY Medicaid HMO DRG,0.01,29157,
Other esophageal disorders,243-4,APR-DRG,,,,,,,,inpatient,,,580126.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28030,,186% x Medicaid HMO amount,28030,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63522,,"27,634 x DRG Weight",63522,Other,DRG Base Rate x DRG Weight,53992,,"23,488 x DRG Weight",53992,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15070.21,,DRG base rate x DRG weight + capital per discharge,15070.21,Other,100% of NY Medicaid HMO DRG,15070,,DRG base rate x DRG weight + capital per discharge,15070,Other,100% of NY Medicaid HMO DRG,15070,,DRG base rate x DRG weight + capital per discharge,15070,Other,100% of NY Medicaid HMO DRG,15070,,DRG base rate x DRG weight + capital per discharge,15070,Other,100% of NY Medicaid HMO DRG,33908,,225% x Medicaid HMO amount,33908,Other,225% of NY Medicaid HMO DRG,23057,,153% x Medicaid HMO amount,23057,Other,153% of NY Medicaid HMO DRG,33908,,225% x Medicaid HMO amount,33908,Other,225% of NY Medicaid HMO DRG,21098,,140% x Medicaid HMO amount,21098,Other,140% of NY Medicaid HMO DRG,33908,,DRG base rate x DRG weight + capital per discharge,33908,Other,225% of NY Medicaid HMO DRG,41443,,275% x Medicaid HMO amount,41443,Other,275% of NY Medicaid HMO DRG,48827,,324% x Medicaid HMO amount,48827,Other,324% of NY Medicaid HMO DRG,32401,,215% x Medicaid HMO amount,32401,Other,215% of NY Medicaid HMO DRG,32401,,215% x Medicaid HMO amount,32401,Other,215% of NY Medicaid HMO DRG,18838,,125% x Medicaid HMO amount,18838,Other,125% of NY Medicaid HMO DRG,0.01,63522,
Diverticulitis & diverticulosis,244-1,APR-DRG,,,,,,,,inpatient,,,75251.49,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7023,,186% x Medicaid HMO amount,7023,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14375,,"27,634 x DRG Weight",14375,Other,DRG Base Rate x DRG Weight,12218,,"23,488 x DRG Weight",12218,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3776.21,,DRG base rate x DRG weight + capital per discharge,3776.21,Other,100% of NY Medicaid HMO DRG,3776,,DRG base rate x DRG weight + capital per discharge,3776,Other,100% of NY Medicaid HMO DRG,3776,,DRG base rate x DRG weight + capital per discharge,3776,Other,100% of NY Medicaid HMO DRG,3776,,DRG base rate x DRG weight + capital per discharge,3776,Other,100% of NY Medicaid HMO DRG,8496,,225% x Medicaid HMO amount,8496,Other,225% of NY Medicaid HMO DRG,5778,,153% x Medicaid HMO amount,5778,Other,153% of NY Medicaid HMO DRG,8496,,225% x Medicaid HMO amount,8496,Other,225% of NY Medicaid HMO DRG,5287,,140% x Medicaid HMO amount,5287,Other,140% of NY Medicaid HMO DRG,8496,,DRG base rate x DRG weight + capital per discharge,8496,Other,225% of NY Medicaid HMO DRG,10385,,275% x Medicaid HMO amount,10385,Other,275% of NY Medicaid HMO DRG,12235,,324% x Medicaid HMO amount,12235,Other,324% of NY Medicaid HMO DRG,8119,,215% x Medicaid HMO amount,8119,Other,215% of NY Medicaid HMO DRG,8119,,215% x Medicaid HMO amount,8119,Other,215% of NY Medicaid HMO DRG,4720,,125% x Medicaid HMO amount,4720,Other,125% of NY Medicaid HMO DRG,0.01,14375,
Diverticulitis & diverticulosis,244-2,APR-DRG,,,,,,,,inpatient,,,66037.3,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9071,,186% x Medicaid HMO amount,9071,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19164,,"27,634 x DRG Weight",19164,Other,DRG Base Rate x DRG Weight,16289,,"23,488 x DRG Weight",16289,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4877.21,,DRG base rate x DRG weight + capital per discharge,4877.21,Other,100% of NY Medicaid HMO DRG,4877,,DRG base rate x DRG weight + capital per discharge,4877,Other,100% of NY Medicaid HMO DRG,4877,,DRG base rate x DRG weight + capital per discharge,4877,Other,100% of NY Medicaid HMO DRG,4877,,DRG base rate x DRG weight + capital per discharge,4877,Other,100% of NY Medicaid HMO DRG,10974,,225% x Medicaid HMO amount,10974,Other,225% of NY Medicaid HMO DRG,7462,,153% x Medicaid HMO amount,7462,Other,153% of NY Medicaid HMO DRG,10974,,225% x Medicaid HMO amount,10974,Other,225% of NY Medicaid HMO DRG,6828,,140% x Medicaid HMO amount,6828,Other,140% of NY Medicaid HMO DRG,10974,,DRG base rate x DRG weight + capital per discharge,10974,Other,225% of NY Medicaid HMO DRG,13412,,275% x Medicaid HMO amount,13412,Other,275% of NY Medicaid HMO DRG,15802,,324% x Medicaid HMO amount,15802,Other,324% of NY Medicaid HMO DRG,10486,,215% x Medicaid HMO amount,10486,Other,215% of NY Medicaid HMO DRG,10486,,215% x Medicaid HMO amount,10486,Other,215% of NY Medicaid HMO DRG,6097,,125% x Medicaid HMO amount,6097,Other,125% of NY Medicaid HMO DRG,0.01,19164,
Diverticulitis & diverticulosis,244-3,APR-DRG,,,,,,,,inpatient,,,141395.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14601,,186% x Medicaid HMO amount,14601,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32102,,"27,634 x DRG Weight",32102,Other,DRG Base Rate x DRG Weight,27286,,"23,488 x DRG Weight",27286,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7850.21,,DRG base rate x DRG weight + capital per discharge,7850.21,Other,100% of NY Medicaid HMO DRG,7850,,DRG base rate x DRG weight + capital per discharge,7850,Other,100% of NY Medicaid HMO DRG,7850,,DRG base rate x DRG weight + capital per discharge,7850,Other,100% of NY Medicaid HMO DRG,7850,,DRG base rate x DRG weight + capital per discharge,7850,Other,100% of NY Medicaid HMO DRG,17663,,225% x Medicaid HMO amount,17663,Other,225% of NY Medicaid HMO DRG,12011,,153% x Medicaid HMO amount,12011,Other,153% of NY Medicaid HMO DRG,17663,,225% x Medicaid HMO amount,17663,Other,225% of NY Medicaid HMO DRG,10990,,140% x Medicaid HMO amount,10990,Other,140% of NY Medicaid HMO DRG,17663,,DRG base rate x DRG weight + capital per discharge,17663,Other,225% of NY Medicaid HMO DRG,21588,,275% x Medicaid HMO amount,21588,Other,275% of NY Medicaid HMO DRG,25435,,324% x Medicaid HMO amount,25435,Other,324% of NY Medicaid HMO DRG,16878,,215% x Medicaid HMO amount,16878,Other,215% of NY Medicaid HMO DRG,16878,,215% x Medicaid HMO amount,16878,Other,215% of NY Medicaid HMO DRG,9813,,125% x Medicaid HMO amount,9813,Other,125% of NY Medicaid HMO DRG,0.01,32102,
Diverticulitis & diverticulosis,244-4,APR-DRG,,,,,,,,inpatient,,,141395.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37174,,186% x Medicaid HMO amount,37174,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,84917,,"27,634 x DRG Weight",84917,Other,DRG Base Rate x DRG Weight,72176,,"23,488 x DRG Weight",72176,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19986.21,,DRG base rate x DRG weight + capital per discharge,19986.21,Other,100% of NY Medicaid HMO DRG,19986,,DRG base rate x DRG weight + capital per discharge,19986,Other,100% of NY Medicaid HMO DRG,19986,,DRG base rate x DRG weight + capital per discharge,19986,Other,100% of NY Medicaid HMO DRG,19986,,DRG base rate x DRG weight + capital per discharge,19986,Other,100% of NY Medicaid HMO DRG,44969,,225% x Medicaid HMO amount,44969,Other,225% of NY Medicaid HMO DRG,30579,,153% x Medicaid HMO amount,30579,Other,153% of NY Medicaid HMO DRG,44969,,225% x Medicaid HMO amount,44969,Other,225% of NY Medicaid HMO DRG,27981,,140% x Medicaid HMO amount,27981,Other,140% of NY Medicaid HMO DRG,44969,,DRG base rate x DRG weight + capital per discharge,44969,Other,225% of NY Medicaid HMO DRG,54962,,275% x Medicaid HMO amount,54962,Other,275% of NY Medicaid HMO DRG,64755,,324% x Medicaid HMO amount,64755,Other,324% of NY Medicaid HMO DRG,42970,,215% x Medicaid HMO amount,42970,Other,215% of NY Medicaid HMO DRG,42970,,215% x Medicaid HMO amount,42970,Other,215% of NY Medicaid HMO DRG,24983,,125% x Medicaid HMO amount,24983,Other,125% of NY Medicaid HMO DRG,0.01,84917,
Inflammatory bowel disease,245-1,APR-DRG,,,,,,,,inpatient,,,108866.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8258,,186% x Medicaid HMO amount,8258,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17263,,"27,634 x DRG Weight",17263,Other,DRG Base Rate x DRG Weight,14673,,"23,488 x DRG Weight",14673,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4440.21,,DRG base rate x DRG weight + capital per discharge,4440.21,Other,100% of NY Medicaid HMO DRG,4440,,DRG base rate x DRG weight + capital per discharge,4440,Other,100% of NY Medicaid HMO DRG,4440,,DRG base rate x DRG weight + capital per discharge,4440,Other,100% of NY Medicaid HMO DRG,4440,,DRG base rate x DRG weight + capital per discharge,4440,Other,100% of NY Medicaid HMO DRG,9990,,225% x Medicaid HMO amount,9990,Other,225% of NY Medicaid HMO DRG,6794,,153% x Medicaid HMO amount,6794,Other,153% of NY Medicaid HMO DRG,9990,,225% x Medicaid HMO amount,9990,Other,225% of NY Medicaid HMO DRG,6216,,140% x Medicaid HMO amount,6216,Other,140% of NY Medicaid HMO DRG,9990,,DRG base rate x DRG weight + capital per discharge,9990,Other,225% of NY Medicaid HMO DRG,12211,,275% x Medicaid HMO amount,12211,Other,275% of NY Medicaid HMO DRG,14386,,324% x Medicaid HMO amount,14386,Other,324% of NY Medicaid HMO DRG,9546,,215% x Medicaid HMO amount,9546,Other,215% of NY Medicaid HMO DRG,9546,,215% x Medicaid HMO amount,9546,Other,215% of NY Medicaid HMO DRG,5550,,125% x Medicaid HMO amount,5550,Other,125% of NY Medicaid HMO DRG,0.01,17263,
Inflammatory bowel disease,245-2,APR-DRG,,,,,,,,inpatient,,,153893.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10038,,186% x Medicaid HMO amount,10038,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21430,,"27,634 x DRG Weight",21430,Other,DRG Base Rate x DRG Weight,18215,,"23,488 x DRG Weight",18215,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5397.21,,DRG base rate x DRG weight + capital per discharge,5397.21,Other,100% of NY Medicaid HMO DRG,5397,,DRG base rate x DRG weight + capital per discharge,5397,Other,100% of NY Medicaid HMO DRG,5397,,DRG base rate x DRG weight + capital per discharge,5397,Other,100% of NY Medicaid HMO DRG,5397,,DRG base rate x DRG weight + capital per discharge,5397,Other,100% of NY Medicaid HMO DRG,12144,,225% x Medicaid HMO amount,12144,Other,225% of NY Medicaid HMO DRG,8258,,153% x Medicaid HMO amount,8258,Other,153% of NY Medicaid HMO DRG,12144,,225% x Medicaid HMO amount,12144,Other,225% of NY Medicaid HMO DRG,7556,,140% x Medicaid HMO amount,7556,Other,140% of NY Medicaid HMO DRG,12144,,DRG base rate x DRG weight + capital per discharge,12144,Other,225% of NY Medicaid HMO DRG,14842,,275% x Medicaid HMO amount,14842,Other,275% of NY Medicaid HMO DRG,17487,,324% x Medicaid HMO amount,17487,Other,324% of NY Medicaid HMO DRG,11604,,215% x Medicaid HMO amount,11604,Other,215% of NY Medicaid HMO DRG,11604,,215% x Medicaid HMO amount,11604,Other,215% of NY Medicaid HMO DRG,6747,,125% x Medicaid HMO amount,6747,Other,125% of NY Medicaid HMO DRG,0.01,21430,
Inflammatory bowel disease,245-3,APR-DRG,,,,,,,,inpatient,,,172569.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15267,,186% x Medicaid HMO amount,15267,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33661,,"27,634 x DRG Weight",33661,Other,DRG Base Rate x DRG Weight,28611,,"23,488 x DRG Weight",28611,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8208.21,,DRG base rate x DRG weight + capital per discharge,8208.21,Other,100% of NY Medicaid HMO DRG,8208,,DRG base rate x DRG weight + capital per discharge,8208,Other,100% of NY Medicaid HMO DRG,8208,,DRG base rate x DRG weight + capital per discharge,8208,Other,100% of NY Medicaid HMO DRG,8208,,DRG base rate x DRG weight + capital per discharge,8208,Other,100% of NY Medicaid HMO DRG,18468,,225% x Medicaid HMO amount,18468,Other,225% of NY Medicaid HMO DRG,12559,,153% x Medicaid HMO amount,12559,Other,153% of NY Medicaid HMO DRG,18468,,225% x Medicaid HMO amount,18468,Other,225% of NY Medicaid HMO DRG,11491,,140% x Medicaid HMO amount,11491,Other,140% of NY Medicaid HMO DRG,18468,,DRG base rate x DRG weight + capital per discharge,18468,Other,225% of NY Medicaid HMO DRG,22573,,275% x Medicaid HMO amount,22573,Other,275% of NY Medicaid HMO DRG,26595,,324% x Medicaid HMO amount,26595,Other,324% of NY Medicaid HMO DRG,17648,,215% x Medicaid HMO amount,17648,Other,215% of NY Medicaid HMO DRG,17648,,215% x Medicaid HMO amount,17648,Other,215% of NY Medicaid HMO DRG,10260,,125% x Medicaid HMO amount,10260,Other,125% of NY Medicaid HMO DRG,0.01,33661,
Inflammatory bowel disease,245-4,APR-DRG,,,,,,,,inpatient,,,198353.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26338,,186% x Medicaid HMO amount,26338,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59562,,"27,634 x DRG Weight",59562,Other,DRG Base Rate x DRG Weight,50626,,"23,488 x DRG Weight",50626,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14160.21,,DRG base rate x DRG weight + capital per discharge,14160.21,Other,100% of NY Medicaid HMO DRG,14160,,DRG base rate x DRG weight + capital per discharge,14160,Other,100% of NY Medicaid HMO DRG,14160,,DRG base rate x DRG weight + capital per discharge,14160,Other,100% of NY Medicaid HMO DRG,14160,,DRG base rate x DRG weight + capital per discharge,14160,Other,100% of NY Medicaid HMO DRG,31860,,225% x Medicaid HMO amount,31860,Other,225% of NY Medicaid HMO DRG,21665,,153% x Medicaid HMO amount,21665,Other,153% of NY Medicaid HMO DRG,31860,,225% x Medicaid HMO amount,31860,Other,225% of NY Medicaid HMO DRG,19824,,140% x Medicaid HMO amount,19824,Other,140% of NY Medicaid HMO DRG,31860,,DRG base rate x DRG weight + capital per discharge,31860,Other,225% of NY Medicaid HMO DRG,38941,,275% x Medicaid HMO amount,38941,Other,275% of NY Medicaid HMO DRG,45879,,324% x Medicaid HMO amount,45879,Other,324% of NY Medicaid HMO DRG,30444,,215% x Medicaid HMO amount,30444,Other,215% of NY Medicaid HMO DRG,30444,,215% x Medicaid HMO amount,30444,Other,215% of NY Medicaid HMO DRG,17700,,125% x Medicaid HMO amount,17700,Other,125% of NY Medicaid HMO DRG,0.01,59562,
Gastrointestinal vascular insufficiency,246-1,APR-DRG,,,,,,,,inpatient,,,124504.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8240,,186% x Medicaid HMO amount,8240,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17219,,"27,634 x DRG Weight",17219,Other,DRG Base Rate x DRG Weight,14635,,"23,488 x DRG Weight",14635,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4430.21,,DRG base rate x DRG weight + capital per discharge,4430.21,Other,100% of NY Medicaid HMO DRG,4430,,DRG base rate x DRG weight + capital per discharge,4430,Other,100% of NY Medicaid HMO DRG,4430,,DRG base rate x DRG weight + capital per discharge,4430,Other,100% of NY Medicaid HMO DRG,4430,,DRG base rate x DRG weight + capital per discharge,4430,Other,100% of NY Medicaid HMO DRG,9968,,225% x Medicaid HMO amount,9968,Other,225% of NY Medicaid HMO DRG,6778,,153% x Medicaid HMO amount,6778,Other,153% of NY Medicaid HMO DRG,9968,,225% x Medicaid HMO amount,9968,Other,225% of NY Medicaid HMO DRG,6202,,140% x Medicaid HMO amount,6202,Other,140% of NY Medicaid HMO DRG,9968,,DRG base rate x DRG weight + capital per discharge,9968,Other,225% of NY Medicaid HMO DRG,12183,,275% x Medicaid HMO amount,12183,Other,275% of NY Medicaid HMO DRG,14354,,324% x Medicaid HMO amount,14354,Other,324% of NY Medicaid HMO DRG,9525,,215% x Medicaid HMO amount,9525,Other,215% of NY Medicaid HMO DRG,9525,,215% x Medicaid HMO amount,9525,Other,215% of NY Medicaid HMO DRG,5538,,125% x Medicaid HMO amount,5538,Other,125% of NY Medicaid HMO DRG,0.01,17219,
Gastrointestinal vascular insufficiency,246-2,APR-DRG,,,,,,,,inpatient,,,148396.93,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10146,,186% x Medicaid HMO amount,10146,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21682,,"27,634 x DRG Weight",21682,Other,DRG Base Rate x DRG Weight,18429,,"23,488 x DRG Weight",18429,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5455.21,,DRG base rate x DRG weight + capital per discharge,5455.21,Other,100% of NY Medicaid HMO DRG,5455,,DRG base rate x DRG weight + capital per discharge,5455,Other,100% of NY Medicaid HMO DRG,5455,,DRG base rate x DRG weight + capital per discharge,5455,Other,100% of NY Medicaid HMO DRG,5455,,DRG base rate x DRG weight + capital per discharge,5455,Other,100% of NY Medicaid HMO DRG,12274,,225% x Medicaid HMO amount,12274,Other,225% of NY Medicaid HMO DRG,8346,,153% x Medicaid HMO amount,8346,Other,153% of NY Medicaid HMO DRG,12274,,225% x Medicaid HMO amount,12274,Other,225% of NY Medicaid HMO DRG,7637,,140% x Medicaid HMO amount,7637,Other,140% of NY Medicaid HMO DRG,12274,,DRG base rate x DRG weight + capital per discharge,12274,Other,225% of NY Medicaid HMO DRG,15002,,275% x Medicaid HMO amount,15002,Other,275% of NY Medicaid HMO DRG,17675,,324% x Medicaid HMO amount,17675,Other,324% of NY Medicaid HMO DRG,11729,,215% x Medicaid HMO amount,11729,Other,215% of NY Medicaid HMO DRG,11729,,215% x Medicaid HMO amount,11729,Other,215% of NY Medicaid HMO DRG,6819,,125% x Medicaid HMO amount,6819,Other,125% of NY Medicaid HMO DRG,0.01,21682,
Gastrointestinal vascular insufficiency,246-3,APR-DRG,,,,,,,,inpatient,,,226363.48,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16149,,186% x Medicaid HMO amount,16149,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35722,,"27,634 x DRG Weight",35722,Other,DRG Base Rate x DRG Weight,30363,,"23,488 x DRG Weight",30363,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8682.21,,DRG base rate x DRG weight + capital per discharge,8682.21,Other,100% of NY Medicaid HMO DRG,8682,,DRG base rate x DRG weight + capital per discharge,8682,Other,100% of NY Medicaid HMO DRG,8682,,DRG base rate x DRG weight + capital per discharge,8682,Other,100% of NY Medicaid HMO DRG,8682,,DRG base rate x DRG weight + capital per discharge,8682,Other,100% of NY Medicaid HMO DRG,19535,,225% x Medicaid HMO amount,19535,Other,225% of NY Medicaid HMO DRG,13284,,153% x Medicaid HMO amount,13284,Other,153% of NY Medicaid HMO DRG,19535,,225% x Medicaid HMO amount,19535,Other,225% of NY Medicaid HMO DRG,12155,,140% x Medicaid HMO amount,12155,Other,140% of NY Medicaid HMO DRG,19535,,DRG base rate x DRG weight + capital per discharge,19535,Other,225% of NY Medicaid HMO DRG,23876,,275% x Medicaid HMO amount,23876,Other,275% of NY Medicaid HMO DRG,28130,,324% x Medicaid HMO amount,28130,Other,324% of NY Medicaid HMO DRG,18667,,215% x Medicaid HMO amount,18667,Other,215% of NY Medicaid HMO DRG,18667,,215% x Medicaid HMO amount,18667,Other,215% of NY Medicaid HMO DRG,10853,,125% x Medicaid HMO amount,10853,Other,125% of NY Medicaid HMO DRG,0.01,35722,
Gastrointestinal vascular insufficiency,246-4,APR-DRG,,,,,,,,inpatient,,,189923.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34559,,186% x Medicaid HMO amount,34559,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78798,,"27,634 x DRG Weight",78798,Other,DRG Base Rate x DRG Weight,66976,,"23,488 x DRG Weight",66976,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18580.21,,DRG base rate x DRG weight + capital per discharge,18580.21,Other,100% of NY Medicaid HMO DRG,18580,,DRG base rate x DRG weight + capital per discharge,18580,Other,100% of NY Medicaid HMO DRG,18580,,DRG base rate x DRG weight + capital per discharge,18580,Other,100% of NY Medicaid HMO DRG,18580,,DRG base rate x DRG weight + capital per discharge,18580,Other,100% of NY Medicaid HMO DRG,41805,,225% x Medicaid HMO amount,41805,Other,225% of NY Medicaid HMO DRG,28428,,153% x Medicaid HMO amount,28428,Other,153% of NY Medicaid HMO DRG,41805,,225% x Medicaid HMO amount,41805,Other,225% of NY Medicaid HMO DRG,26012,,140% x Medicaid HMO amount,26012,Other,140% of NY Medicaid HMO DRG,41805,,DRG base rate x DRG weight + capital per discharge,41805,Other,225% of NY Medicaid HMO DRG,51096,,275% x Medicaid HMO amount,51096,Other,275% of NY Medicaid HMO DRG,60200,,324% x Medicaid HMO amount,60200,Other,324% of NY Medicaid HMO DRG,39947,,215% x Medicaid HMO amount,39947,Other,215% of NY Medicaid HMO DRG,39947,,215% x Medicaid HMO amount,39947,Other,215% of NY Medicaid HMO DRG,23225,,125% x Medicaid HMO amount,23225,Other,125% of NY Medicaid HMO DRG,0.01,78798,
Intestinal obstruction,247-1,APR-DRG,,,,,,,,inpatient,,,137358.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6674,,186% x Medicaid HMO amount,6674,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13554,,"27,634 x DRG Weight",13554,Other,DRG Base Rate x DRG Weight,11521,,"23,488 x DRG Weight",11521,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3588.21,,DRG base rate x DRG weight + capital per discharge,3588.21,Other,100% of NY Medicaid HMO DRG,3588,,DRG base rate x DRG weight + capital per discharge,3588,Other,100% of NY Medicaid HMO DRG,3588,,DRG base rate x DRG weight + capital per discharge,3588,Other,100% of NY Medicaid HMO DRG,3588,,DRG base rate x DRG weight + capital per discharge,3588,Other,100% of NY Medicaid HMO DRG,8073,,225% x Medicaid HMO amount,8073,Other,225% of NY Medicaid HMO DRG,5490,,153% x Medicaid HMO amount,5490,Other,153% of NY Medicaid HMO DRG,8073,,225% x Medicaid HMO amount,8073,Other,225% of NY Medicaid HMO DRG,5023,,140% x Medicaid HMO amount,5023,Other,140% of NY Medicaid HMO DRG,8073,,DRG base rate x DRG weight + capital per discharge,8073,Other,225% of NY Medicaid HMO DRG,9868,,275% x Medicaid HMO amount,9868,Other,275% of NY Medicaid HMO DRG,11626,,324% x Medicaid HMO amount,11626,Other,324% of NY Medicaid HMO DRG,7715,,215% x Medicaid HMO amount,7715,Other,215% of NY Medicaid HMO DRG,7715,,215% x Medicaid HMO amount,7715,Other,215% of NY Medicaid HMO DRG,4485,,125% x Medicaid HMO amount,4485,Other,125% of NY Medicaid HMO DRG,0.01,13554,
Intestinal obstruction,247-2,APR-DRG,,,,,,,,inpatient,,,86834.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8828,,186% x Medicaid HMO amount,8828,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18598,,"27,634 x DRG Weight",18598,Other,DRG Base Rate x DRG Weight,15807,,"23,488 x DRG Weight",15807,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4746.21,,DRG base rate x DRG weight + capital per discharge,4746.21,Other,100% of NY Medicaid HMO DRG,4746,,DRG base rate x DRG weight + capital per discharge,4746,Other,100% of NY Medicaid HMO DRG,4746,,DRG base rate x DRG weight + capital per discharge,4746,Other,100% of NY Medicaid HMO DRG,4746,,DRG base rate x DRG weight + capital per discharge,4746,Other,100% of NY Medicaid HMO DRG,10679,,225% x Medicaid HMO amount,10679,Other,225% of NY Medicaid HMO DRG,7262,,153% x Medicaid HMO amount,7262,Other,153% of NY Medicaid HMO DRG,10679,,225% x Medicaid HMO amount,10679,Other,225% of NY Medicaid HMO DRG,6645,,140% x Medicaid HMO amount,6645,Other,140% of NY Medicaid HMO DRG,10679,,DRG base rate x DRG weight + capital per discharge,10679,Other,225% of NY Medicaid HMO DRG,13052,,275% x Medicaid HMO amount,13052,Other,275% of NY Medicaid HMO DRG,15378,,324% x Medicaid HMO amount,15378,Other,324% of NY Medicaid HMO DRG,10204,,215% x Medicaid HMO amount,10204,Other,215% of NY Medicaid HMO DRG,10204,,215% x Medicaid HMO amount,10204,Other,215% of NY Medicaid HMO DRG,5933,,125% x Medicaid HMO amount,5933,Other,125% of NY Medicaid HMO DRG,0.01,18598,
Intestinal obstruction,247-3,APR-DRG,,,,,,,,inpatient,,,205820.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15103,,186% x Medicaid HMO amount,15103,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33280,,"27,634 x DRG Weight",33280,Other,DRG Base Rate x DRG Weight,28287,,"23,488 x DRG Weight",28287,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8120.21,,DRG base rate x DRG weight + capital per discharge,8120.21,Other,100% of NY Medicaid HMO DRG,8120,,DRG base rate x DRG weight + capital per discharge,8120,Other,100% of NY Medicaid HMO DRG,8120,,DRG base rate x DRG weight + capital per discharge,8120,Other,100% of NY Medicaid HMO DRG,8120,,DRG base rate x DRG weight + capital per discharge,8120,Other,100% of NY Medicaid HMO DRG,18270,,225% x Medicaid HMO amount,18270,Other,225% of NY Medicaid HMO DRG,12424,,153% x Medicaid HMO amount,12424,Other,153% of NY Medicaid HMO DRG,18270,,225% x Medicaid HMO amount,18270,Other,225% of NY Medicaid HMO DRG,11368,,140% x Medicaid HMO amount,11368,Other,140% of NY Medicaid HMO DRG,18270,,DRG base rate x DRG weight + capital per discharge,18270,Other,225% of NY Medicaid HMO DRG,22331,,275% x Medicaid HMO amount,22331,Other,275% of NY Medicaid HMO DRG,26309,,324% x Medicaid HMO amount,26309,Other,324% of NY Medicaid HMO DRG,17458,,215% x Medicaid HMO amount,17458,Other,215% of NY Medicaid HMO DRG,17458,,215% x Medicaid HMO amount,17458,Other,215% of NY Medicaid HMO DRG,10150,,125% x Medicaid HMO amount,10150,Other,125% of NY Medicaid HMO DRG,0.01,33280,
Intestinal obstruction,247-4,APR-DRG,,,,,,,,inpatient,,,138423.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31066,,186% x Medicaid HMO amount,31066,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70624,,"27,634 x DRG Weight",70624,Other,DRG Base Rate x DRG Weight,60028,,"23,488 x DRG Weight",60028,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16702.21,,DRG base rate x DRG weight + capital per discharge,16702.21,Other,100% of NY Medicaid HMO DRG,16702,,DRG base rate x DRG weight + capital per discharge,16702,Other,100% of NY Medicaid HMO DRG,16702,,DRG base rate x DRG weight + capital per discharge,16702,Other,100% of NY Medicaid HMO DRG,16702,,DRG base rate x DRG weight + capital per discharge,16702,Other,100% of NY Medicaid HMO DRG,37580,,225% x Medicaid HMO amount,37580,Other,225% of NY Medicaid HMO DRG,25554,,153% x Medicaid HMO amount,25554,Other,153% of NY Medicaid HMO DRG,37580,,225% x Medicaid HMO amount,37580,Other,225% of NY Medicaid HMO DRG,23383,,140% x Medicaid HMO amount,23383,Other,140% of NY Medicaid HMO DRG,37580,,DRG base rate x DRG weight + capital per discharge,37580,Other,225% of NY Medicaid HMO DRG,45931,,275% x Medicaid HMO amount,45931,Other,275% of NY Medicaid HMO DRG,54115,,324% x Medicaid HMO amount,54115,Other,324% of NY Medicaid HMO DRG,35910,,215% x Medicaid HMO amount,35910,Other,215% of NY Medicaid HMO DRG,35910,,215% x Medicaid HMO amount,35910,Other,215% of NY Medicaid HMO DRG,20878,,125% x Medicaid HMO amount,20878,Other,125% of NY Medicaid HMO DRG,0.01,70624,
Major gastrointestinal & peritoneal infections,248-1,APR-DRG,,,,,,,,inpatient,,,69893.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7909,,186% x Medicaid HMO amount,7909,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16445,,"27,634 x DRG Weight",16445,Other,DRG Base Rate x DRG Weight,13978,,"23,488 x DRG Weight",13978,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4252.21,,DRG base rate x DRG weight + capital per discharge,4252.21,Other,100% of NY Medicaid HMO DRG,4252,,DRG base rate x DRG weight + capital per discharge,4252,Other,100% of NY Medicaid HMO DRG,4252,,DRG base rate x DRG weight + capital per discharge,4252,Other,100% of NY Medicaid HMO DRG,4252,,DRG base rate x DRG weight + capital per discharge,4252,Other,100% of NY Medicaid HMO DRG,9567,,225% x Medicaid HMO amount,9567,Other,225% of NY Medicaid HMO DRG,6506,,153% x Medicaid HMO amount,6506,Other,153% of NY Medicaid HMO DRG,9567,,225% x Medicaid HMO amount,9567,Other,225% of NY Medicaid HMO DRG,5953,,140% x Medicaid HMO amount,5953,Other,140% of NY Medicaid HMO DRG,9567,,DRG base rate x DRG weight + capital per discharge,9567,Other,225% of NY Medicaid HMO DRG,11694,,275% x Medicaid HMO amount,11694,Other,275% of NY Medicaid HMO DRG,13777,,324% x Medicaid HMO amount,13777,Other,324% of NY Medicaid HMO DRG,9142,,215% x Medicaid HMO amount,9142,Other,215% of NY Medicaid HMO DRG,9142,,215% x Medicaid HMO amount,9142,Other,215% of NY Medicaid HMO DRG,5315,,125% x Medicaid HMO amount,5315,Other,125% of NY Medicaid HMO DRG,0.01,16445,
Major gastrointestinal & peritoneal infections,248-2,APR-DRG,,,,,,,,inpatient,,,125491.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10877,,186% x Medicaid HMO amount,10877,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23389,,"27,634 x DRG Weight",23389,Other,DRG Base Rate x DRG Weight,19880,,"23,488 x DRG Weight",19880,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5848.21,,DRG base rate x DRG weight + capital per discharge,5848.21,Other,100% of NY Medicaid HMO DRG,5848,,DRG base rate x DRG weight + capital per discharge,5848,Other,100% of NY Medicaid HMO DRG,5848,,DRG base rate x DRG weight + capital per discharge,5848,Other,100% of NY Medicaid HMO DRG,5848,,DRG base rate x DRG weight + capital per discharge,5848,Other,100% of NY Medicaid HMO DRG,13158,,225% x Medicaid HMO amount,13158,Other,225% of NY Medicaid HMO DRG,8948,,153% x Medicaid HMO amount,8948,Other,153% of NY Medicaid HMO DRG,13158,,225% x Medicaid HMO amount,13158,Other,225% of NY Medicaid HMO DRG,8187,,140% x Medicaid HMO amount,8187,Other,140% of NY Medicaid HMO DRG,13158,,DRG base rate x DRG weight + capital per discharge,13158,Other,225% of NY Medicaid HMO DRG,16083,,275% x Medicaid HMO amount,16083,Other,275% of NY Medicaid HMO DRG,18948,,324% x Medicaid HMO amount,18948,Other,324% of NY Medicaid HMO DRG,12574,,215% x Medicaid HMO amount,12574,Other,215% of NY Medicaid HMO DRG,12574,,215% x Medicaid HMO amount,12574,Other,215% of NY Medicaid HMO DRG,7310,,125% x Medicaid HMO amount,7310,Other,125% of NY Medicaid HMO DRG,0.01,23389,
Major gastrointestinal & peritoneal infections,248-3,APR-DRG,,,,,,,,inpatient,,,160443.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16457,,186% x Medicaid HMO amount,16457,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36446,,"27,634 x DRG Weight",36446,Other,DRG Base Rate x DRG Weight,30978,,"23,488 x DRG Weight",30978,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8848.21,,DRG base rate x DRG weight + capital per discharge,8848.21,Other,100% of NY Medicaid HMO DRG,8848,,DRG base rate x DRG weight + capital per discharge,8848,Other,100% of NY Medicaid HMO DRG,8848,,DRG base rate x DRG weight + capital per discharge,8848,Other,100% of NY Medicaid HMO DRG,8848,,DRG base rate x DRG weight + capital per discharge,8848,Other,100% of NY Medicaid HMO DRG,19908,,225% x Medicaid HMO amount,19908,Other,225% of NY Medicaid HMO DRG,13538,,153% x Medicaid HMO amount,13538,Other,153% of NY Medicaid HMO DRG,19908,,225% x Medicaid HMO amount,19908,Other,225% of NY Medicaid HMO DRG,12387,,140% x Medicaid HMO amount,12387,Other,140% of NY Medicaid HMO DRG,19908,,DRG base rate x DRG weight + capital per discharge,19908,Other,225% of NY Medicaid HMO DRG,24333,,275% x Medicaid HMO amount,24333,Other,275% of NY Medicaid HMO DRG,28668,,324% x Medicaid HMO amount,28668,Other,324% of NY Medicaid HMO DRG,19024,,215% x Medicaid HMO amount,19024,Other,215% of NY Medicaid HMO DRG,19024,,215% x Medicaid HMO amount,19024,Other,215% of NY Medicaid HMO DRG,11060,,125% x Medicaid HMO amount,11060,Other,125% of NY Medicaid HMO DRG,0.01,36446,
Major gastrointestinal & peritoneal infections,248-4,APR-DRG,,,,,,,,inpatient,,,526142.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39107,,186% x Medicaid HMO amount,39107,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,89437,,"27,634 x DRG Weight",89437,Other,DRG Base Rate x DRG Weight,76019,,"23,488 x DRG Weight",76019,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21025.21,,DRG base rate x DRG weight + capital per discharge,21025.21,Other,100% of NY Medicaid HMO DRG,21025,,DRG base rate x DRG weight + capital per discharge,21025,Other,100% of NY Medicaid HMO DRG,21025,,DRG base rate x DRG weight + capital per discharge,21025,Other,100% of NY Medicaid HMO DRG,21025,,DRG base rate x DRG weight + capital per discharge,21025,Other,100% of NY Medicaid HMO DRG,47307,,225% x Medicaid HMO amount,47307,Other,225% of NY Medicaid HMO DRG,32169,,153% x Medicaid HMO amount,32169,Other,153% of NY Medicaid HMO DRG,47307,,225% x Medicaid HMO amount,47307,Other,225% of NY Medicaid HMO DRG,29435,,140% x Medicaid HMO amount,29435,Other,140% of NY Medicaid HMO DRG,47307,,DRG base rate x DRG weight + capital per discharge,47307,Other,225% of NY Medicaid HMO DRG,57819,,275% x Medicaid HMO amount,57819,Other,275% of NY Medicaid HMO DRG,68122,,324% x Medicaid HMO amount,68122,Other,324% of NY Medicaid HMO DRG,45204,,215% x Medicaid HMO amount,45204,Other,215% of NY Medicaid HMO DRG,45204,,215% x Medicaid HMO amount,45204,Other,215% of NY Medicaid HMO DRG,26282,,125% x Medicaid HMO amount,26282,Other,125% of NY Medicaid HMO DRG,0.01,89437,
"Other gastroenteritis, nausa & vomiting",249-1,APR-DRG,,,,,,,,inpatient,,,69371.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5900,,186% x Medicaid HMO amount,5900,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11747,,"27,634 x DRG Weight",11747,Other,DRG Base Rate x DRG Weight,9985,,"23,488 x DRG Weight",9985,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3172.21,,DRG base rate x DRG weight + capital per discharge,3172.21,Other,100% of NY Medicaid HMO DRG,3172,,DRG base rate x DRG weight + capital per discharge,3172,Other,100% of NY Medicaid HMO DRG,3172,,DRG base rate x DRG weight + capital per discharge,3172,Other,100% of NY Medicaid HMO DRG,3172,,DRG base rate x DRG weight + capital per discharge,3172,Other,100% of NY Medicaid HMO DRG,7137,,225% x Medicaid HMO amount,7137,Other,225% of NY Medicaid HMO DRG,4853,,153% x Medicaid HMO amount,4853,Other,153% of NY Medicaid HMO DRG,7137,,225% x Medicaid HMO amount,7137,Other,225% of NY Medicaid HMO DRG,4441,,140% x Medicaid HMO amount,4441,Other,140% of NY Medicaid HMO DRG,7137,,DRG base rate x DRG weight + capital per discharge,7137,Other,225% of NY Medicaid HMO DRG,8724,,275% x Medicaid HMO amount,8724,Other,275% of NY Medicaid HMO DRG,10278,,324% x Medicaid HMO amount,10278,Other,324% of NY Medicaid HMO DRG,6820,,215% x Medicaid HMO amount,6820,Other,215% of NY Medicaid HMO DRG,6820,,215% x Medicaid HMO amount,6820,Other,215% of NY Medicaid HMO DRG,3965,,125% x Medicaid HMO amount,3965,Other,125% of NY Medicaid HMO DRG,0.01,11747,
"Other gastroenteritis, nausa & vomiting",249-2,APR-DRG,,,,,,,,inpatient,,,87768.62,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7191,,186% x Medicaid HMO amount,7191,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14765,,"27,634 x DRG Weight",14765,Other,DRG Base Rate x DRG Weight,12550,,"23,488 x DRG Weight",12550,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3866.21,,DRG base rate x DRG weight + capital per discharge,3866.21,Other,100% of NY Medicaid HMO DRG,3866,,DRG base rate x DRG weight + capital per discharge,3866,Other,100% of NY Medicaid HMO DRG,3866,,DRG base rate x DRG weight + capital per discharge,3866,Other,100% of NY Medicaid HMO DRG,3866,,DRG base rate x DRG weight + capital per discharge,3866,Other,100% of NY Medicaid HMO DRG,8699,,225% x Medicaid HMO amount,8699,Other,225% of NY Medicaid HMO DRG,5915,,153% x Medicaid HMO amount,5915,Other,153% of NY Medicaid HMO DRG,8699,,225% x Medicaid HMO amount,8699,Other,225% of NY Medicaid HMO DRG,5413,,140% x Medicaid HMO amount,5413,Other,140% of NY Medicaid HMO DRG,8699,,DRG base rate x DRG weight + capital per discharge,8699,Other,225% of NY Medicaid HMO DRG,10632,,275% x Medicaid HMO amount,10632,Other,275% of NY Medicaid HMO DRG,12527,,324% x Medicaid HMO amount,12527,Other,324% of NY Medicaid HMO DRG,8312,,215% x Medicaid HMO amount,8312,Other,215% of NY Medicaid HMO DRG,8312,,215% x Medicaid HMO amount,8312,Other,215% of NY Medicaid HMO DRG,4833,,125% x Medicaid HMO amount,4833,Other,125% of NY Medicaid HMO DRG,0.01,14765,
"Other gastroenteritis, nausa & vomiting",249-3,APR-DRG,,,,,,,,inpatient,,,99367.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10747,,186% x Medicaid HMO amount,10747,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23085,,"27,634 x DRG Weight",23085,Other,DRG Base Rate x DRG Weight,19622,,"23,488 x DRG Weight",19622,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5778.21,,DRG base rate x DRG weight + capital per discharge,5778.21,Other,100% of NY Medicaid HMO DRG,5778,,DRG base rate x DRG weight + capital per discharge,5778,Other,100% of NY Medicaid HMO DRG,5778,,DRG base rate x DRG weight + capital per discharge,5778,Other,100% of NY Medicaid HMO DRG,5778,,DRG base rate x DRG weight + capital per discharge,5778,Other,100% of NY Medicaid HMO DRG,13001,,225% x Medicaid HMO amount,13001,Other,225% of NY Medicaid HMO DRG,8841,,153% x Medicaid HMO amount,8841,Other,153% of NY Medicaid HMO DRG,13001,,225% x Medicaid HMO amount,13001,Other,225% of NY Medicaid HMO DRG,8089,,140% x Medicaid HMO amount,8089,Other,140% of NY Medicaid HMO DRG,13001,,DRG base rate x DRG weight + capital per discharge,13001,Other,225% of NY Medicaid HMO DRG,15890,,275% x Medicaid HMO amount,15890,Other,275% of NY Medicaid HMO DRG,18721,,324% x Medicaid HMO amount,18721,Other,324% of NY Medicaid HMO DRG,12423,,215% x Medicaid HMO amount,12423,Other,215% of NY Medicaid HMO DRG,12423,,215% x Medicaid HMO amount,12423,Other,215% of NY Medicaid HMO DRG,7223,,125% x Medicaid HMO amount,7223,Other,125% of NY Medicaid HMO DRG,0.01,23085,
"Other gastroenteritis, nausa & vomiting",249-4,APR-DRG,,,,,,,,inpatient,,,338050.61,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24770,,186% x Medicaid HMO amount,24770,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,55895,,"27,634 x DRG Weight",55895,Other,DRG Base Rate x DRG Weight,47509,,"23,488 x DRG Weight",47509,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13317.21,,DRG base rate x DRG weight + capital per discharge,13317.21,Other,100% of NY Medicaid HMO DRG,13317,,DRG base rate x DRG weight + capital per discharge,13317,Other,100% of NY Medicaid HMO DRG,13317,,DRG base rate x DRG weight + capital per discharge,13317,Other,100% of NY Medicaid HMO DRG,13317,,DRG base rate x DRG weight + capital per discharge,13317,Other,100% of NY Medicaid HMO DRG,29964,,225% x Medicaid HMO amount,29964,Other,225% of NY Medicaid HMO DRG,20375,,153% x Medicaid HMO amount,20375,Other,153% of NY Medicaid HMO DRG,29964,,225% x Medicaid HMO amount,29964,Other,225% of NY Medicaid HMO DRG,18644,,140% x Medicaid HMO amount,18644,Other,140% of NY Medicaid HMO DRG,29964,,DRG base rate x DRG weight + capital per discharge,29964,Other,225% of NY Medicaid HMO DRG,36622,,275% x Medicaid HMO amount,36622,Other,275% of NY Medicaid HMO DRG,43148,,324% x Medicaid HMO amount,43148,Other,324% of NY Medicaid HMO DRG,28632,,215% x Medicaid HMO amount,28632,Other,215% of NY Medicaid HMO DRG,28632,,215% x Medicaid HMO amount,28632,Other,215% of NY Medicaid HMO DRG,16647,,125% x Medicaid HMO amount,16647,Other,125% of NY Medicaid HMO DRG,0.01,55895,
Abdominal pain,251-1,APR-DRG,,,,,,,,inpatient,,,109406.27,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5939,,186% x Medicaid HMO amount,5939,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11836,,"27,634 x DRG Weight",11836,Other,DRG Base Rate x DRG Weight,10060,,"23,488 x DRG Weight",10060,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3193.21,,DRG base rate x DRG weight + capital per discharge,3193.21,Other,100% of NY Medicaid HMO DRG,3193,,DRG base rate x DRG weight + capital per discharge,3193,Other,100% of NY Medicaid HMO DRG,3193,,DRG base rate x DRG weight + capital per discharge,3193,Other,100% of NY Medicaid HMO DRG,3193,,DRG base rate x DRG weight + capital per discharge,3193,Other,100% of NY Medicaid HMO DRG,7185,,225% x Medicaid HMO amount,7185,Other,225% of NY Medicaid HMO DRG,4886,,153% x Medicaid HMO amount,4886,Other,153% of NY Medicaid HMO DRG,7185,,225% x Medicaid HMO amount,7185,Other,225% of NY Medicaid HMO DRG,4470,,140% x Medicaid HMO amount,4470,Other,140% of NY Medicaid HMO DRG,7185,,DRG base rate x DRG weight + capital per discharge,7185,Other,225% of NY Medicaid HMO DRG,8781,,275% x Medicaid HMO amount,8781,Other,275% of NY Medicaid HMO DRG,10346,,324% x Medicaid HMO amount,10346,Other,324% of NY Medicaid HMO DRG,6865,,215% x Medicaid HMO amount,6865,Other,215% of NY Medicaid HMO DRG,6865,,215% x Medicaid HMO amount,6865,Other,215% of NY Medicaid HMO DRG,3992,,125% x Medicaid HMO amount,3992,Other,125% of NY Medicaid HMO DRG,0.01,11836,
Abdominal pain,251-2,APR-DRG,,,,,,,,inpatient,,,114457.78,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7576,,186% x Medicaid HMO amount,7576,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15666,,"27,634 x DRG Weight",15666,Other,DRG Base Rate x DRG Weight,13315,,"23,488 x DRG Weight",13315,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4073.21,,DRG base rate x DRG weight + capital per discharge,4073.21,Other,100% of NY Medicaid HMO DRG,4073,,DRG base rate x DRG weight + capital per discharge,4073,Other,100% of NY Medicaid HMO DRG,4073,,DRG base rate x DRG weight + capital per discharge,4073,Other,100% of NY Medicaid HMO DRG,4073,,DRG base rate x DRG weight + capital per discharge,4073,Other,100% of NY Medicaid HMO DRG,9165,,225% x Medicaid HMO amount,9165,Other,225% of NY Medicaid HMO DRG,6232,,153% x Medicaid HMO amount,6232,Other,153% of NY Medicaid HMO DRG,9165,,225% x Medicaid HMO amount,9165,Other,225% of NY Medicaid HMO DRG,5702,,140% x Medicaid HMO amount,5702,Other,140% of NY Medicaid HMO DRG,9165,,DRG base rate x DRG weight + capital per discharge,9165,Other,225% of NY Medicaid HMO DRG,11201,,275% x Medicaid HMO amount,11201,Other,275% of NY Medicaid HMO DRG,13197,,324% x Medicaid HMO amount,13197,Other,324% of NY Medicaid HMO DRG,8757,,215% x Medicaid HMO amount,8757,Other,215% of NY Medicaid HMO DRG,8757,,215% x Medicaid HMO amount,8757,Other,215% of NY Medicaid HMO DRG,5092,,125% x Medicaid HMO amount,5092,Other,125% of NY Medicaid HMO DRG,0.01,15666,
Abdominal pain,251-3,APR-DRG,,,,,,,,inpatient,,,199796.19,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10888,,186% x Medicaid HMO amount,10888,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23417,,"27,634 x DRG Weight",23417,Other,DRG Base Rate x DRG Weight,19904,,"23,488 x DRG Weight",19904,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5854.21,,DRG base rate x DRG weight + capital per discharge,5854.21,Other,100% of NY Medicaid HMO DRG,5854,,DRG base rate x DRG weight + capital per discharge,5854,Other,100% of NY Medicaid HMO DRG,5854,,DRG base rate x DRG weight + capital per discharge,5854,Other,100% of NY Medicaid HMO DRG,5854,,DRG base rate x DRG weight + capital per discharge,5854,Other,100% of NY Medicaid HMO DRG,13172,,225% x Medicaid HMO amount,13172,Other,225% of NY Medicaid HMO DRG,8957,,153% x Medicaid HMO amount,8957,Other,153% of NY Medicaid HMO DRG,13172,,225% x Medicaid HMO amount,13172,Other,225% of NY Medicaid HMO DRG,8196,,140% x Medicaid HMO amount,8196,Other,140% of NY Medicaid HMO DRG,13172,,DRG base rate x DRG weight + capital per discharge,13172,Other,225% of NY Medicaid HMO DRG,16099,,275% x Medicaid HMO amount,16099,Other,275% of NY Medicaid HMO DRG,18968,,324% x Medicaid HMO amount,18968,Other,324% of NY Medicaid HMO DRG,12587,,215% x Medicaid HMO amount,12587,Other,215% of NY Medicaid HMO DRG,12587,,215% x Medicaid HMO amount,12587,Other,215% of NY Medicaid HMO DRG,7318,,125% x Medicaid HMO amount,7318,Other,125% of NY Medicaid HMO DRG,0.01,23417,
Abdominal pain,251-4,APR-DRG,,,,,,,,inpatient,,,234267.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23748,,186% x Medicaid HMO amount,23748,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53508,,"27,634 x DRG Weight",53508,Other,DRG Base Rate x DRG Weight,45480,,"23,488 x DRG Weight",45480,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12768.21,,DRG base rate x DRG weight + capital per discharge,12768.21,Other,100% of NY Medicaid HMO DRG,12768,,DRG base rate x DRG weight + capital per discharge,12768,Other,100% of NY Medicaid HMO DRG,12768,,DRG base rate x DRG weight + capital per discharge,12768,Other,100% of NY Medicaid HMO DRG,12768,,DRG base rate x DRG weight + capital per discharge,12768,Other,100% of NY Medicaid HMO DRG,28728,,225% x Medicaid HMO amount,28728,Other,225% of NY Medicaid HMO DRG,19535,,153% x Medicaid HMO amount,19535,Other,153% of NY Medicaid HMO DRG,28728,,225% x Medicaid HMO amount,28728,Other,225% of NY Medicaid HMO DRG,17875,,140% x Medicaid HMO amount,17875,Other,140% of NY Medicaid HMO DRG,28728,,DRG base rate x DRG weight + capital per discharge,28728,Other,225% of NY Medicaid HMO DRG,35113,,275% x Medicaid HMO amount,35113,Other,275% of NY Medicaid HMO DRG,41369,,324% x Medicaid HMO amount,41369,Other,324% of NY Medicaid HMO DRG,27452,,215% x Medicaid HMO amount,27452,Other,215% of NY Medicaid HMO DRG,27452,,215% x Medicaid HMO amount,27452,Other,215% of NY Medicaid HMO DRG,15960,,125% x Medicaid HMO amount,15960,Other,125% of NY Medicaid HMO DRG,0.01,53508,
"Malfunction, reaction & complication of GI device or procedure",252-1,APR-DRG,,,,,,,,inpatient,,,54933.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8076,,186% x Medicaid HMO amount,8076,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16837,,"27,634 x DRG Weight",16837,Other,DRG Base Rate x DRG Weight,14311,,"23,488 x DRG Weight",14311,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4342.21,,DRG base rate x DRG weight + capital per discharge,4342.21,Other,100% of NY Medicaid HMO DRG,4342,,DRG base rate x DRG weight + capital per discharge,4342,Other,100% of NY Medicaid HMO DRG,4342,,DRG base rate x DRG weight + capital per discharge,4342,Other,100% of NY Medicaid HMO DRG,4342,,DRG base rate x DRG weight + capital per discharge,4342,Other,100% of NY Medicaid HMO DRG,9770,,225% x Medicaid HMO amount,9770,Other,225% of NY Medicaid HMO DRG,6644,,153% x Medicaid HMO amount,6644,Other,153% of NY Medicaid HMO DRG,9770,,225% x Medicaid HMO amount,9770,Other,225% of NY Medicaid HMO DRG,6079,,140% x Medicaid HMO amount,6079,Other,140% of NY Medicaid HMO DRG,9770,,DRG base rate x DRG weight + capital per discharge,9770,Other,225% of NY Medicaid HMO DRG,11941,,275% x Medicaid HMO amount,11941,Other,275% of NY Medicaid HMO DRG,14069,,324% x Medicaid HMO amount,14069,Other,324% of NY Medicaid HMO DRG,9336,,215% x Medicaid HMO amount,9336,Other,215% of NY Medicaid HMO DRG,9336,,215% x Medicaid HMO amount,9336,Other,215% of NY Medicaid HMO DRG,5428,,125% x Medicaid HMO amount,5428,Other,125% of NY Medicaid HMO DRG,0.01,16837,
"Malfunction, reaction & complication of GI device or procedure",252-2,APR-DRG,,,,,,,,inpatient,,,111395.84,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10102,,186% x Medicaid HMO amount,10102,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21577,,"27,634 x DRG Weight",21577,Other,DRG Base Rate x DRG Weight,18339,,"23,488 x DRG Weight",18339,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5431.21,,DRG base rate x DRG weight + capital per discharge,5431.21,Other,100% of NY Medicaid HMO DRG,5431,,DRG base rate x DRG weight + capital per discharge,5431,Other,100% of NY Medicaid HMO DRG,5431,,DRG base rate x DRG weight + capital per discharge,5431,Other,100% of NY Medicaid HMO DRG,5431,,DRG base rate x DRG weight + capital per discharge,5431,Other,100% of NY Medicaid HMO DRG,12220,,225% x Medicaid HMO amount,12220,Other,225% of NY Medicaid HMO DRG,8310,,153% x Medicaid HMO amount,8310,Other,153% of NY Medicaid HMO DRG,12220,,225% x Medicaid HMO amount,12220,Other,225% of NY Medicaid HMO DRG,7604,,140% x Medicaid HMO amount,7604,Other,140% of NY Medicaid HMO DRG,12220,,DRG base rate x DRG weight + capital per discharge,12220,Other,225% of NY Medicaid HMO DRG,14936,,275% x Medicaid HMO amount,14936,Other,275% of NY Medicaid HMO DRG,17597,,324% x Medicaid HMO amount,17597,Other,324% of NY Medicaid HMO DRG,11677,,215% x Medicaid HMO amount,11677,Other,215% of NY Medicaid HMO DRG,11677,,215% x Medicaid HMO amount,11677,Other,215% of NY Medicaid HMO DRG,6789,,125% x Medicaid HMO amount,6789,Other,125% of NY Medicaid HMO DRG,0.01,21577,
"Malfunction, reaction & complication of GI device or procedure",252-3,APR-DRG,,,,,,,,inpatient,,,156639.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15550,,186% x Medicaid HMO amount,15550,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34321,,"27,634 x DRG Weight",34321,Other,DRG Base Rate x DRG Weight,29172,,"23,488 x DRG Weight",29172,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8360.21,,DRG base rate x DRG weight + capital per discharge,8360.21,Other,100% of NY Medicaid HMO DRG,8360,,DRG base rate x DRG weight + capital per discharge,8360,Other,100% of NY Medicaid HMO DRG,8360,,DRG base rate x DRG weight + capital per discharge,8360,Other,100% of NY Medicaid HMO DRG,8360,,DRG base rate x DRG weight + capital per discharge,8360,Other,100% of NY Medicaid HMO DRG,18810,,225% x Medicaid HMO amount,18810,Other,225% of NY Medicaid HMO DRG,12791,,153% x Medicaid HMO amount,12791,Other,153% of NY Medicaid HMO DRG,18810,,225% x Medicaid HMO amount,18810,Other,225% of NY Medicaid HMO DRG,11704,,140% x Medicaid HMO amount,11704,Other,140% of NY Medicaid HMO DRG,18810,,DRG base rate x DRG weight + capital per discharge,18810,Other,225% of NY Medicaid HMO DRG,22991,,275% x Medicaid HMO amount,22991,Other,275% of NY Medicaid HMO DRG,27087,,324% x Medicaid HMO amount,27087,Other,324% of NY Medicaid HMO DRG,17974,,215% x Medicaid HMO amount,17974,Other,215% of NY Medicaid HMO DRG,17974,,215% x Medicaid HMO amount,17974,Other,215% of NY Medicaid HMO DRG,10450,,125% x Medicaid HMO amount,10450,Other,125% of NY Medicaid HMO DRG,0.01,34321,
"Malfunction, reaction & complication of GI device or procedure",252-4,APR-DRG,,,,,,,,inpatient,,,817997.36,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34354,,186% x Medicaid HMO amount,34354,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78320,,"27,634 x DRG Weight",78320,Other,DRG Base Rate x DRG Weight,66570,,"23,488 x DRG Weight",66570,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18470.21,,DRG base rate x DRG weight + capital per discharge,18470.21,Other,100% of NY Medicaid HMO DRG,18470,,DRG base rate x DRG weight + capital per discharge,18470,Other,100% of NY Medicaid HMO DRG,18470,,DRG base rate x DRG weight + capital per discharge,18470,Other,100% of NY Medicaid HMO DRG,18470,,DRG base rate x DRG weight + capital per discharge,18470,Other,100% of NY Medicaid HMO DRG,41558,,225% x Medicaid HMO amount,41558,Other,225% of NY Medicaid HMO DRG,28259,,153% x Medicaid HMO amount,28259,Other,153% of NY Medicaid HMO DRG,41558,,225% x Medicaid HMO amount,41558,Other,225% of NY Medicaid HMO DRG,25858,,140% x Medicaid HMO amount,25858,Other,140% of NY Medicaid HMO DRG,41558,,DRG base rate x DRG weight + capital per discharge,41558,Other,225% of NY Medicaid HMO DRG,50793,,275% x Medicaid HMO amount,50793,Other,275% of NY Medicaid HMO DRG,59843,,324% x Medicaid HMO amount,59843,Other,324% of NY Medicaid HMO DRG,39711,,215% x Medicaid HMO amount,39711,Other,215% of NY Medicaid HMO DRG,39711,,215% x Medicaid HMO amount,39711,Other,215% of NY Medicaid HMO DRG,23088,,125% x Medicaid HMO amount,23088,Other,125% of NY Medicaid HMO DRG,0.01,78320,
Other & unspecified gastrointestinal hemorrhage,253-1,APR-DRG,,,,,,,,inpatient,,,93809.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8089,,186% x Medicaid HMO amount,8089,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16868,,"27,634 x DRG Weight",16868,Other,DRG Base Rate x DRG Weight,14337,,"23,488 x DRG Weight",14337,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4349.21,,DRG base rate x DRG weight + capital per discharge,4349.21,Other,100% of NY Medicaid HMO DRG,4349,,DRG base rate x DRG weight + capital per discharge,4349,Other,100% of NY Medicaid HMO DRG,4349,,DRG base rate x DRG weight + capital per discharge,4349,Other,100% of NY Medicaid HMO DRG,4349,,DRG base rate x DRG weight + capital per discharge,4349,Other,100% of NY Medicaid HMO DRG,9786,,225% x Medicaid HMO amount,9786,Other,225% of NY Medicaid HMO DRG,6654,,153% x Medicaid HMO amount,6654,Other,153% of NY Medicaid HMO DRG,9786,,225% x Medicaid HMO amount,9786,Other,225% of NY Medicaid HMO DRG,6089,,140% x Medicaid HMO amount,6089,Other,140% of NY Medicaid HMO DRG,9786,,DRG base rate x DRG weight + capital per discharge,9786,Other,225% of NY Medicaid HMO DRG,11960,,275% x Medicaid HMO amount,11960,Other,275% of NY Medicaid HMO DRG,14091,,324% x Medicaid HMO amount,14091,Other,324% of NY Medicaid HMO DRG,9351,,215% x Medicaid HMO amount,9351,Other,215% of NY Medicaid HMO DRG,9351,,215% x Medicaid HMO amount,9351,Other,215% of NY Medicaid HMO DRG,5437,,125% x Medicaid HMO amount,5437,Other,125% of NY Medicaid HMO DRG,0.01,16868,
Other & unspecified gastrointestinal hemorrhage,253-2,APR-DRG,,,,,,,,inpatient,,,101111.68,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10509,,186% x Medicaid HMO amount,10509,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22530,,"27,634 x DRG Weight",22530,Other,DRG Base Rate x DRG Weight,19150,,"23,488 x DRG Weight",19150,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5650.21,,DRG base rate x DRG weight + capital per discharge,5650.21,Other,100% of NY Medicaid HMO DRG,5650,,DRG base rate x DRG weight + capital per discharge,5650,Other,100% of NY Medicaid HMO DRG,5650,,DRG base rate x DRG weight + capital per discharge,5650,Other,100% of NY Medicaid HMO DRG,5650,,DRG base rate x DRG weight + capital per discharge,5650,Other,100% of NY Medicaid HMO DRG,12713,,225% x Medicaid HMO amount,12713,Other,225% of NY Medicaid HMO DRG,8645,,153% x Medicaid HMO amount,8645,Other,153% of NY Medicaid HMO DRG,12713,,225% x Medicaid HMO amount,12713,Other,225% of NY Medicaid HMO DRG,7910,,140% x Medicaid HMO amount,7910,Other,140% of NY Medicaid HMO DRG,12713,,DRG base rate x DRG weight + capital per discharge,12713,Other,225% of NY Medicaid HMO DRG,15538,,275% x Medicaid HMO amount,15538,Other,275% of NY Medicaid HMO DRG,18307,,324% x Medicaid HMO amount,18307,Other,324% of NY Medicaid HMO DRG,12148,,215% x Medicaid HMO amount,12148,Other,215% of NY Medicaid HMO DRG,12148,,215% x Medicaid HMO amount,12148,Other,215% of NY Medicaid HMO DRG,7063,,125% x Medicaid HMO amount,7063,Other,125% of NY Medicaid HMO DRG,0.01,22530,
Other & unspecified gastrointestinal hemorrhage,253-3,APR-DRG,,,,,,,,inpatient,,,231917.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16667,,186% x Medicaid HMO amount,16667,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36938,,"27,634 x DRG Weight",36938,Other,DRG Base Rate x DRG Weight,31396,,"23,488 x DRG Weight",31396,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8961.21,,DRG base rate x DRG weight + capital per discharge,8961.21,Other,100% of NY Medicaid HMO DRG,8961,,DRG base rate x DRG weight + capital per discharge,8961,Other,100% of NY Medicaid HMO DRG,8961,,DRG base rate x DRG weight + capital per discharge,8961,Other,100% of NY Medicaid HMO DRG,8961,,DRG base rate x DRG weight + capital per discharge,8961,Other,100% of NY Medicaid HMO DRG,20163,,225% x Medicaid HMO amount,20163,Other,225% of NY Medicaid HMO DRG,13711,,153% x Medicaid HMO amount,13711,Other,153% of NY Medicaid HMO DRG,20163,,225% x Medicaid HMO amount,20163,Other,225% of NY Medicaid HMO DRG,12546,,140% x Medicaid HMO amount,12546,Other,140% of NY Medicaid HMO DRG,20163,,DRG base rate x DRG weight + capital per discharge,20163,Other,225% of NY Medicaid HMO DRG,24643,,275% x Medicaid HMO amount,24643,Other,275% of NY Medicaid HMO DRG,29034,,324% x Medicaid HMO amount,29034,Other,324% of NY Medicaid HMO DRG,19267,,215% x Medicaid HMO amount,19267,Other,215% of NY Medicaid HMO DRG,19267,,215% x Medicaid HMO amount,19267,Other,215% of NY Medicaid HMO DRG,11202,,125% x Medicaid HMO amount,11202,Other,125% of NY Medicaid HMO DRG,0.01,36938,
Other & unspecified gastrointestinal hemorrhage,253-4,APR-DRG,,,,,,,,inpatient,,,242914.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28823,,186% x Medicaid HMO amount,28823,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65379,,"27,634 x DRG Weight",65379,Other,DRG Base Rate x DRG Weight,55570,,"23,488 x DRG Weight",55570,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15496.21,,DRG base rate x DRG weight + capital per discharge,15496.21,Other,100% of NY Medicaid HMO DRG,15496,,DRG base rate x DRG weight + capital per discharge,15496,Other,100% of NY Medicaid HMO DRG,15496,,DRG base rate x DRG weight + capital per discharge,15496,Other,100% of NY Medicaid HMO DRG,15496,,DRG base rate x DRG weight + capital per discharge,15496,Other,100% of NY Medicaid HMO DRG,34866,,225% x Medicaid HMO amount,34866,Other,225% of NY Medicaid HMO DRG,23709,,153% x Medicaid HMO amount,23709,Other,153% of NY Medicaid HMO DRG,34866,,225% x Medicaid HMO amount,34866,Other,225% of NY Medicaid HMO DRG,21695,,140% x Medicaid HMO amount,21695,Other,140% of NY Medicaid HMO DRG,34866,,DRG base rate x DRG weight + capital per discharge,34866,Other,225% of NY Medicaid HMO DRG,42615,,275% x Medicaid HMO amount,42615,Other,275% of NY Medicaid HMO DRG,50208,,324% x Medicaid HMO amount,50208,Other,324% of NY Medicaid HMO DRG,33317,,215% x Medicaid HMO amount,33317,Other,215% of NY Medicaid HMO DRG,33317,,215% x Medicaid HMO amount,33317,Other,215% of NY Medicaid HMO DRG,19370,,125% x Medicaid HMO amount,19370,Other,125% of NY Medicaid HMO DRG,0.01,65379,
Other digestive system diagnoses,254-1,APR-DRG,,,,,,,,inpatient,,,93265.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6778,,186% x Medicaid HMO amount,6778,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13800,,"27,634 x DRG Weight",13800,Other,DRG Base Rate x DRG Weight,11730,,"23,488 x DRG Weight",11730,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3644.21,,DRG base rate x DRG weight + capital per discharge,3644.21,Other,100% of NY Medicaid HMO DRG,3644,,DRG base rate x DRG weight + capital per discharge,3644,Other,100% of NY Medicaid HMO DRG,3644,,DRG base rate x DRG weight + capital per discharge,3644,Other,100% of NY Medicaid HMO DRG,3644,,DRG base rate x DRG weight + capital per discharge,3644,Other,100% of NY Medicaid HMO DRG,8199,,225% x Medicaid HMO amount,8199,Other,225% of NY Medicaid HMO DRG,5576,,153% x Medicaid HMO amount,5576,Other,153% of NY Medicaid HMO DRG,8199,,225% x Medicaid HMO amount,8199,Other,225% of NY Medicaid HMO DRG,5102,,140% x Medicaid HMO amount,5102,Other,140% of NY Medicaid HMO DRG,8199,,DRG base rate x DRG weight + capital per discharge,8199,Other,225% of NY Medicaid HMO DRG,10022,,275% x Medicaid HMO amount,10022,Other,275% of NY Medicaid HMO DRG,11807,,324% x Medicaid HMO amount,11807,Other,324% of NY Medicaid HMO DRG,7835,,215% x Medicaid HMO amount,7835,Other,215% of NY Medicaid HMO DRG,7835,,215% x Medicaid HMO amount,7835,Other,215% of NY Medicaid HMO DRG,4555,,125% x Medicaid HMO amount,4555,Other,125% of NY Medicaid HMO DRG,0.01,13800,
Other digestive system diagnoses,254-2,APR-DRG,,,,,,,,inpatient,,,139161.81,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9404,,186% x Medicaid HMO amount,9404,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19943,,"27,634 x DRG Weight",19943,Other,DRG Base Rate x DRG Weight,16951,,"23,488 x DRG Weight",16951,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5056.21,,DRG base rate x DRG weight + capital per discharge,5056.21,Other,100% of NY Medicaid HMO DRG,5056,,DRG base rate x DRG weight + capital per discharge,5056,Other,100% of NY Medicaid HMO DRG,5056,,DRG base rate x DRG weight + capital per discharge,5056,Other,100% of NY Medicaid HMO DRG,5056,,DRG base rate x DRG weight + capital per discharge,5056,Other,100% of NY Medicaid HMO DRG,11376,,225% x Medicaid HMO amount,11376,Other,225% of NY Medicaid HMO DRG,7736,,153% x Medicaid HMO amount,7736,Other,153% of NY Medicaid HMO DRG,11376,,225% x Medicaid HMO amount,11376,Other,225% of NY Medicaid HMO DRG,7079,,140% x Medicaid HMO amount,7079,Other,140% of NY Medicaid HMO DRG,11376,,DRG base rate x DRG weight + capital per discharge,11376,Other,225% of NY Medicaid HMO DRG,13905,,275% x Medicaid HMO amount,13905,Other,275% of NY Medicaid HMO DRG,16382,,324% x Medicaid HMO amount,16382,Other,324% of NY Medicaid HMO DRG,10871,,215% x Medicaid HMO amount,10871,Other,215% of NY Medicaid HMO DRG,10871,,215% x Medicaid HMO amount,10871,Other,215% of NY Medicaid HMO DRG,6320,,125% x Medicaid HMO amount,6320,Other,125% of NY Medicaid HMO DRG,0.01,19943,
Other digestive system diagnoses,254-3,APR-DRG,,,,,,,,inpatient,,,175379.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15202,,186% x Medicaid HMO amount,15202,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33509,,"27,634 x DRG Weight",33509,Other,DRG Base Rate x DRG Weight,28482,,"23,488 x DRG Weight",28482,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8173.21,,DRG base rate x DRG weight + capital per discharge,8173.21,Other,100% of NY Medicaid HMO DRG,8173,,DRG base rate x DRG weight + capital per discharge,8173,Other,100% of NY Medicaid HMO DRG,8173,,DRG base rate x DRG weight + capital per discharge,8173,Other,100% of NY Medicaid HMO DRG,8173,,DRG base rate x DRG weight + capital per discharge,8173,Other,100% of NY Medicaid HMO DRG,18390,,225% x Medicaid HMO amount,18390,Other,225% of NY Medicaid HMO DRG,12505,,153% x Medicaid HMO amount,12505,Other,153% of NY Medicaid HMO DRG,18390,,225% x Medicaid HMO amount,18390,Other,225% of NY Medicaid HMO DRG,11442,,140% x Medicaid HMO amount,11442,Other,140% of NY Medicaid HMO DRG,18390,,DRG base rate x DRG weight + capital per discharge,18390,Other,225% of NY Medicaid HMO DRG,22476,,275% x Medicaid HMO amount,22476,Other,275% of NY Medicaid HMO DRG,26481,,324% x Medicaid HMO amount,26481,Other,324% of NY Medicaid HMO DRG,17572,,215% x Medicaid HMO amount,17572,Other,215% of NY Medicaid HMO DRG,17572,,215% x Medicaid HMO amount,17572,Other,215% of NY Medicaid HMO DRG,10217,,125% x Medicaid HMO amount,10217,Other,125% of NY Medicaid HMO DRG,0.01,33509,
Other digestive system diagnoses,254-4,APR-DRG,,,,,,,,inpatient,,,168762.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31683,,186% x Medicaid HMO amount,31683,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72072,,"27,634 x DRG Weight",72072,Other,DRG Base Rate x DRG Weight,61259,,"23,488 x DRG Weight",61259,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17034.21,,DRG base rate x DRG weight + capital per discharge,17034.21,Other,100% of NY Medicaid HMO DRG,17034,,DRG base rate x DRG weight + capital per discharge,17034,Other,100% of NY Medicaid HMO DRG,17034,,DRG base rate x DRG weight + capital per discharge,17034,Other,100% of NY Medicaid HMO DRG,17034,,DRG base rate x DRG weight + capital per discharge,17034,Other,100% of NY Medicaid HMO DRG,38327,,225% x Medicaid HMO amount,38327,Other,225% of NY Medicaid HMO DRG,26062,,153% x Medicaid HMO amount,26062,Other,153% of NY Medicaid HMO DRG,38327,,225% x Medicaid HMO amount,38327,Other,225% of NY Medicaid HMO DRG,23848,,140% x Medicaid HMO amount,23848,Other,140% of NY Medicaid HMO DRG,38327,,DRG base rate x DRG weight + capital per discharge,38327,Other,225% of NY Medicaid HMO DRG,46844,,275% x Medicaid HMO amount,46844,Other,275% of NY Medicaid HMO DRG,55191,,324% x Medicaid HMO amount,55191,Other,324% of NY Medicaid HMO DRG,36624,,215% x Medicaid HMO amount,36624,Other,215% of NY Medicaid HMO DRG,36624,,215% x Medicaid HMO amount,36624,Other,215% of NY Medicaid HMO DRG,21293,,125% x Medicaid HMO amount,21293,Other,125% of NY Medicaid HMO DRG,0.01,72072,
"Major pancreas, liver & shunt procedures",260-1,APR-DRG,,,,,,,,inpatient,,,269874.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18122,,186% x Medicaid HMO amount,18122,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40340,,"27,634 x DRG Weight",40340,Other,DRG Base Rate x DRG Weight,34288,,"23,488 x DRG Weight",34288,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9743.21,,DRG base rate x DRG weight + capital per discharge,9743.21,Other,100% of NY Medicaid HMO DRG,9743,,DRG base rate x DRG weight + capital per discharge,9743,Other,100% of NY Medicaid HMO DRG,9743,,DRG base rate x DRG weight + capital per discharge,9743,Other,100% of NY Medicaid HMO DRG,9743,,DRG base rate x DRG weight + capital per discharge,9743,Other,100% of NY Medicaid HMO DRG,21922,,225% x Medicaid HMO amount,21922,Other,225% of NY Medicaid HMO DRG,14907,,153% x Medicaid HMO amount,14907,Other,153% of NY Medicaid HMO DRG,21922,,225% x Medicaid HMO amount,21922,Other,225% of NY Medicaid HMO DRG,13640,,140% x Medicaid HMO amount,13640,Other,140% of NY Medicaid HMO DRG,21922,,DRG base rate x DRG weight + capital per discharge,21922,Other,225% of NY Medicaid HMO DRG,26794,,275% x Medicaid HMO amount,26794,Other,275% of NY Medicaid HMO DRG,31568,,324% x Medicaid HMO amount,31568,Other,324% of NY Medicaid HMO DRG,20948,,215% x Medicaid HMO amount,20948,Other,215% of NY Medicaid HMO DRG,20948,,215% x Medicaid HMO amount,20948,Other,215% of NY Medicaid HMO DRG,12179,,125% x Medicaid HMO amount,12179,Other,125% of NY Medicaid HMO DRG,0.01,40340,
"Major pancreas, liver & shunt procedures",260-2,APR-DRG,,,,,,,,inpatient,,,234321.88,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24411,,186% x Medicaid HMO amount,24411,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,55055,,"27,634 x DRG Weight",55055,Other,DRG Base Rate x DRG Weight,46795,,"23,488 x DRG Weight",46795,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13124.21,,DRG base rate x DRG weight + capital per discharge,13124.21,Other,100% of NY Medicaid HMO DRG,13124,,DRG base rate x DRG weight + capital per discharge,13124,Other,100% of NY Medicaid HMO DRG,13124,,DRG base rate x DRG weight + capital per discharge,13124,Other,100% of NY Medicaid HMO DRG,13124,,DRG base rate x DRG weight + capital per discharge,13124,Other,100% of NY Medicaid HMO DRG,29529,,225% x Medicaid HMO amount,29529,Other,225% of NY Medicaid HMO DRG,20080,,153% x Medicaid HMO amount,20080,Other,153% of NY Medicaid HMO DRG,29529,,225% x Medicaid HMO amount,29529,Other,225% of NY Medicaid HMO DRG,18374,,140% x Medicaid HMO amount,18374,Other,140% of NY Medicaid HMO DRG,29529,,DRG base rate x DRG weight + capital per discharge,29529,Other,225% of NY Medicaid HMO DRG,36092,,275% x Medicaid HMO amount,36092,Other,275% of NY Medicaid HMO DRG,42522,,324% x Medicaid HMO amount,42522,Other,324% of NY Medicaid HMO DRG,28217,,215% x Medicaid HMO amount,28217,Other,215% of NY Medicaid HMO DRG,28217,,215% x Medicaid HMO amount,28217,Other,215% of NY Medicaid HMO DRG,16405,,125% x Medicaid HMO amount,16405,Other,125% of NY Medicaid HMO DRG,0.01,55055,
"Major pancreas, liver & shunt procedures",260-3,APR-DRG,,,,,,,,inpatient,,,272459.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38028,,186% x Medicaid HMO amount,38028,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86914,,"27,634 x DRG Weight",86914,Other,DRG Base Rate x DRG Weight,73874,,"23,488 x DRG Weight",73874,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20445.21,,DRG base rate x DRG weight + capital per discharge,20445.21,Other,100% of NY Medicaid HMO DRG,20445,,DRG base rate x DRG weight + capital per discharge,20445,Other,100% of NY Medicaid HMO DRG,20445,,DRG base rate x DRG weight + capital per discharge,20445,Other,100% of NY Medicaid HMO DRG,20445,,DRG base rate x DRG weight + capital per discharge,20445,Other,100% of NY Medicaid HMO DRG,46002,,225% x Medicaid HMO amount,46002,Other,225% of NY Medicaid HMO DRG,31281,,153% x Medicaid HMO amount,31281,Other,153% of NY Medicaid HMO DRG,46002,,225% x Medicaid HMO amount,46002,Other,225% of NY Medicaid HMO DRG,28623,,140% x Medicaid HMO amount,28623,Other,140% of NY Medicaid HMO DRG,46002,,DRG base rate x DRG weight + capital per discharge,46002,Other,225% of NY Medicaid HMO DRG,56224,,275% x Medicaid HMO amount,56224,Other,275% of NY Medicaid HMO DRG,66242,,324% x Medicaid HMO amount,66242,Other,324% of NY Medicaid HMO DRG,43957,,215% x Medicaid HMO amount,43957,Other,215% of NY Medicaid HMO DRG,43957,,215% x Medicaid HMO amount,43957,Other,215% of NY Medicaid HMO DRG,25557,,125% x Medicaid HMO amount,25557,Other,125% of NY Medicaid HMO DRG,0.01,86914,
"Major pancreas, liver & shunt procedures",260-4,APR-DRG,,,,,,,,inpatient,,,791173,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,88594,,186% x Medicaid HMO amount,88594,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,205224,,"27,634 x DRG Weight",205224,Other,DRG Base Rate x DRG Weight,174434,,"23,488 x DRG Weight",174434,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47631.21,,DRG base rate x DRG weight + capital per discharge,47631.21,Other,100% of NY Medicaid HMO DRG,47631,,DRG base rate x DRG weight + capital per discharge,47631,Other,100% of NY Medicaid HMO DRG,47631,,DRG base rate x DRG weight + capital per discharge,47631,Other,100% of NY Medicaid HMO DRG,47631,,DRG base rate x DRG weight + capital per discharge,47631,Other,100% of NY Medicaid HMO DRG,107170,,225% x Medicaid HMO amount,107170,Other,225% of NY Medicaid HMO DRG,72876,,153% x Medicaid HMO amount,72876,Other,153% of NY Medicaid HMO DRG,107170,,225% x Medicaid HMO amount,107170,Other,225% of NY Medicaid HMO DRG,66684,,140% x Medicaid HMO amount,66684,Other,140% of NY Medicaid HMO DRG,107170,,DRG base rate x DRG weight + capital per discharge,107170,Other,225% of NY Medicaid HMO DRG,130986,,275% x Medicaid HMO amount,130986,Other,275% of NY Medicaid HMO DRG,154325,,324% x Medicaid HMO amount,154325,Other,324% of NY Medicaid HMO DRG,102407,,215% x Medicaid HMO amount,102407,Other,215% of NY Medicaid HMO DRG,102407,,215% x Medicaid HMO amount,102407,Other,215% of NY Medicaid HMO DRG,59539,,125% x Medicaid HMO amount,59539,Other,125% of NY Medicaid HMO DRG,0.01,205224,
Major biliary tract procedures,261-1,APR-DRG,,,,,,,,inpatient,,,102145.51,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17395,,186% x Medicaid HMO amount,17395,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38641,,"27,634 x DRG Weight",38641,Other,DRG Base Rate x DRG Weight,32843,,"23,488 x DRG Weight",32843,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9352.21,,DRG base rate x DRG weight + capital per discharge,9352.21,Other,100% of NY Medicaid HMO DRG,9352,,DRG base rate x DRG weight + capital per discharge,9352,Other,100% of NY Medicaid HMO DRG,9352,,DRG base rate x DRG weight + capital per discharge,9352,Other,100% of NY Medicaid HMO DRG,9352,,DRG base rate x DRG weight + capital per discharge,9352,Other,100% of NY Medicaid HMO DRG,21042,,225% x Medicaid HMO amount,21042,Other,225% of NY Medicaid HMO DRG,14309,,153% x Medicaid HMO amount,14309,Other,153% of NY Medicaid HMO DRG,21042,,225% x Medicaid HMO amount,21042,Other,225% of NY Medicaid HMO DRG,13093,,140% x Medicaid HMO amount,13093,Other,140% of NY Medicaid HMO DRG,21042,,DRG base rate x DRG weight + capital per discharge,21042,Other,225% of NY Medicaid HMO DRG,25719,,275% x Medicaid HMO amount,25719,Other,275% of NY Medicaid HMO DRG,30301,,324% x Medicaid HMO amount,30301,Other,324% of NY Medicaid HMO DRG,20107,,215% x Medicaid HMO amount,20107,Other,215% of NY Medicaid HMO DRG,20107,,215% x Medicaid HMO amount,20107,Other,215% of NY Medicaid HMO DRG,11690,,125% x Medicaid HMO amount,11690,Other,125% of NY Medicaid HMO DRG,0.01,38641,
Major biliary tract procedures,261-2,APR-DRG,,,,,,,,inpatient,,,184103.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24526,,186% x Medicaid HMO amount,24526,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,55323,,"27,634 x DRG Weight",55323,Other,DRG Base Rate x DRG Weight,47023,,"23,488 x DRG Weight",47023,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13186.21,,DRG base rate x DRG weight + capital per discharge,13186.21,Other,100% of NY Medicaid HMO DRG,13186,,DRG base rate x DRG weight + capital per discharge,13186,Other,100% of NY Medicaid HMO DRG,13186,,DRG base rate x DRG weight + capital per discharge,13186,Other,100% of NY Medicaid HMO DRG,13186,,DRG base rate x DRG weight + capital per discharge,13186,Other,100% of NY Medicaid HMO DRG,29669,,225% x Medicaid HMO amount,29669,Other,225% of NY Medicaid HMO DRG,20175,,153% x Medicaid HMO amount,20175,Other,153% of NY Medicaid HMO DRG,29669,,225% x Medicaid HMO amount,29669,Other,225% of NY Medicaid HMO DRG,18461,,140% x Medicaid HMO amount,18461,Other,140% of NY Medicaid HMO DRG,29669,,DRG base rate x DRG weight + capital per discharge,29669,Other,225% of NY Medicaid HMO DRG,36262,,275% x Medicaid HMO amount,36262,Other,275% of NY Medicaid HMO DRG,42723,,324% x Medicaid HMO amount,42723,Other,324% of NY Medicaid HMO DRG,28350,,215% x Medicaid HMO amount,28350,Other,215% of NY Medicaid HMO DRG,28350,,215% x Medicaid HMO amount,28350,Other,215% of NY Medicaid HMO DRG,16483,,125% x Medicaid HMO amount,16483,Other,125% of NY Medicaid HMO DRG,0.01,55323,
Major biliary tract procedures,261-3,APR-DRG,,,,,,,,inpatient,,,300116.27,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37356,,186% x Medicaid HMO amount,37356,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,85342,,"27,634 x DRG Weight",85342,Other,DRG Base Rate x DRG Weight,72538,,"23,488 x DRG Weight",72538,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20084.21,,DRG base rate x DRG weight + capital per discharge,20084.21,Other,100% of NY Medicaid HMO DRG,20084,,DRG base rate x DRG weight + capital per discharge,20084,Other,100% of NY Medicaid HMO DRG,20084,,DRG base rate x DRG weight + capital per discharge,20084,Other,100% of NY Medicaid HMO DRG,20084,,DRG base rate x DRG weight + capital per discharge,20084,Other,100% of NY Medicaid HMO DRG,45189,,225% x Medicaid HMO amount,45189,Other,225% of NY Medicaid HMO DRG,30729,,153% x Medicaid HMO amount,30729,Other,153% of NY Medicaid HMO DRG,45189,,225% x Medicaid HMO amount,45189,Other,225% of NY Medicaid HMO DRG,28118,,140% x Medicaid HMO amount,28118,Other,140% of NY Medicaid HMO DRG,45189,,DRG base rate x DRG weight + capital per discharge,45189,Other,225% of NY Medicaid HMO DRG,55232,,275% x Medicaid HMO amount,55232,Other,275% of NY Medicaid HMO DRG,65073,,324% x Medicaid HMO amount,65073,Other,324% of NY Medicaid HMO DRG,43181,,215% x Medicaid HMO amount,43181,Other,215% of NY Medicaid HMO DRG,43181,,215% x Medicaid HMO amount,43181,Other,215% of NY Medicaid HMO DRG,25105,,125% x Medicaid HMO amount,25105,Other,125% of NY Medicaid HMO DRG,0.01,85342,
Major biliary tract procedures,261-4,APR-DRG,,,,,,,,inpatient,,,832933.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73407,,186% x Medicaid HMO amount,73407,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,169689,,"27,634 x DRG Weight",169689,Other,DRG Base Rate x DRG Weight,144230,,"23,488 x DRG Weight",144230,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39466.21,,DRG base rate x DRG weight + capital per discharge,39466.21,Other,100% of NY Medicaid HMO DRG,39466,,DRG base rate x DRG weight + capital per discharge,39466,Other,100% of NY Medicaid HMO DRG,39466,,DRG base rate x DRG weight + capital per discharge,39466,Other,100% of NY Medicaid HMO DRG,39466,,DRG base rate x DRG weight + capital per discharge,39466,Other,100% of NY Medicaid HMO DRG,88799,,225% x Medicaid HMO amount,88799,Other,225% of NY Medicaid HMO DRG,60383,,153% x Medicaid HMO amount,60383,Other,153% of NY Medicaid HMO DRG,88799,,225% x Medicaid HMO amount,88799,Other,225% of NY Medicaid HMO DRG,55253,,140% x Medicaid HMO amount,55253,Other,140% of NY Medicaid HMO DRG,88799,,DRG base rate x DRG weight + capital per discharge,88799,Other,225% of NY Medicaid HMO DRG,108532,,275% x Medicaid HMO amount,108532,Other,275% of NY Medicaid HMO DRG,127871,,324% x Medicaid HMO amount,127871,Other,324% of NY Medicaid HMO DRG,84852,,215% x Medicaid HMO amount,84852,Other,215% of NY Medicaid HMO DRG,84852,,215% x Medicaid HMO amount,84852,Other,215% of NY Medicaid HMO DRG,49333,,125% x Medicaid HMO amount,49333,Other,125% of NY Medicaid HMO DRG,0.01,169689,
Cholecystectomy except laparoscopic,262-1,APR-DRG,,,,,,,,inpatient,,,133070.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16396,,186% x Medicaid HMO amount,16396,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36303,,"27,634 x DRG Weight",36303,Other,DRG Base Rate x DRG Weight,30856,,"23,488 x DRG Weight",30856,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8815.21,,DRG base rate x DRG weight + capital per discharge,8815.21,Other,100% of NY Medicaid HMO DRG,8815,,DRG base rate x DRG weight + capital per discharge,8815,Other,100% of NY Medicaid HMO DRG,8815,,DRG base rate x DRG weight + capital per discharge,8815,Other,100% of NY Medicaid HMO DRG,8815,,DRG base rate x DRG weight + capital per discharge,8815,Other,100% of NY Medicaid HMO DRG,19834,,225% x Medicaid HMO amount,19834,Other,225% of NY Medicaid HMO DRG,13487,,153% x Medicaid HMO amount,13487,Other,153% of NY Medicaid HMO DRG,19834,,225% x Medicaid HMO amount,19834,Other,225% of NY Medicaid HMO DRG,12341,,140% x Medicaid HMO amount,12341,Other,140% of NY Medicaid HMO DRG,19834,,DRG base rate x DRG weight + capital per discharge,19834,Other,225% of NY Medicaid HMO DRG,24242,,275% x Medicaid HMO amount,24242,Other,275% of NY Medicaid HMO DRG,28561,,324% x Medicaid HMO amount,28561,Other,324% of NY Medicaid HMO DRG,18953,,215% x Medicaid HMO amount,18953,Other,215% of NY Medicaid HMO DRG,18953,,215% x Medicaid HMO amount,18953,Other,215% of NY Medicaid HMO DRG,11019,,125% x Medicaid HMO amount,11019,Other,125% of NY Medicaid HMO DRG,0.01,36303,
Cholecystectomy except laparoscopic,262-2,APR-DRG,,,,,,,,inpatient,,,177590.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19842,,186% x Medicaid HMO amount,19842,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44366,,"27,634 x DRG Weight",44366,Other,DRG Base Rate x DRG Weight,37710,,"23,488 x DRG Weight",37710,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10668.21,,DRG base rate x DRG weight + capital per discharge,10668.21,Other,100% of NY Medicaid HMO DRG,10668,,DRG base rate x DRG weight + capital per discharge,10668,Other,100% of NY Medicaid HMO DRG,10668,,DRG base rate x DRG weight + capital per discharge,10668,Other,100% of NY Medicaid HMO DRG,10668,,DRG base rate x DRG weight + capital per discharge,10668,Other,100% of NY Medicaid HMO DRG,24003,,225% x Medicaid HMO amount,24003,Other,225% of NY Medicaid HMO DRG,16322,,153% x Medicaid HMO amount,16322,Other,153% of NY Medicaid HMO DRG,24003,,225% x Medicaid HMO amount,24003,Other,225% of NY Medicaid HMO DRG,14935,,140% x Medicaid HMO amount,14935,Other,140% of NY Medicaid HMO DRG,24003,,DRG base rate x DRG weight + capital per discharge,24003,Other,225% of NY Medicaid HMO DRG,29338,,275% x Medicaid HMO amount,29338,Other,275% of NY Medicaid HMO DRG,34565,,324% x Medicaid HMO amount,34565,Other,324% of NY Medicaid HMO DRG,22937,,215% x Medicaid HMO amount,22937,Other,215% of NY Medicaid HMO DRG,22937,,215% x Medicaid HMO amount,22937,Other,215% of NY Medicaid HMO DRG,13335,,125% x Medicaid HMO amount,13335,Other,125% of NY Medicaid HMO DRG,0.01,44366,
Cholecystectomy except laparoscopic,262-3,APR-DRG,,,,,,,,inpatient,,,334695.61,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33207,,186% x Medicaid HMO amount,33207,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75634,,"27,634 x DRG Weight",75634,Other,DRG Base Rate x DRG Weight,64287,,"23,488 x DRG Weight",64287,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17853.21,,DRG base rate x DRG weight + capital per discharge,17853.21,Other,100% of NY Medicaid HMO DRG,17853,,DRG base rate x DRG weight + capital per discharge,17853,Other,100% of NY Medicaid HMO DRG,17853,,DRG base rate x DRG weight + capital per discharge,17853,Other,100% of NY Medicaid HMO DRG,17853,,DRG base rate x DRG weight + capital per discharge,17853,Other,100% of NY Medicaid HMO DRG,40170,,225% x Medicaid HMO amount,40170,Other,225% of NY Medicaid HMO DRG,27315,,153% x Medicaid HMO amount,27315,Other,153% of NY Medicaid HMO DRG,40170,,225% x Medicaid HMO amount,40170,Other,225% of NY Medicaid HMO DRG,24994,,140% x Medicaid HMO amount,24994,Other,140% of NY Medicaid HMO DRG,40170,,DRG base rate x DRG weight + capital per discharge,40170,Other,225% of NY Medicaid HMO DRG,49096,,275% x Medicaid HMO amount,49096,Other,275% of NY Medicaid HMO DRG,57844,,324% x Medicaid HMO amount,57844,Other,324% of NY Medicaid HMO DRG,38384,,215% x Medicaid HMO amount,38384,Other,215% of NY Medicaid HMO DRG,38384,,215% x Medicaid HMO amount,38384,Other,215% of NY Medicaid HMO DRG,22317,,125% x Medicaid HMO amount,22317,Other,125% of NY Medicaid HMO DRG,0.01,75634,
Cholecystectomy except laparoscopic,262-4,APR-DRG,,,,,,,,inpatient,,,334695.61,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72378,,186% x Medicaid HMO amount,72378,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,167285,,"27,634 x DRG Weight",167285,Other,DRG Base Rate x DRG Weight,142187,,"23,488 x DRG Weight",142187,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38913.21,,DRG base rate x DRG weight + capital per discharge,38913.21,Other,100% of NY Medicaid HMO DRG,38913,,DRG base rate x DRG weight + capital per discharge,38913,Other,100% of NY Medicaid HMO DRG,38913,,DRG base rate x DRG weight + capital per discharge,38913,Other,100% of NY Medicaid HMO DRG,38913,,DRG base rate x DRG weight + capital per discharge,38913,Other,100% of NY Medicaid HMO DRG,87555,,225% x Medicaid HMO amount,87555,Other,225% of NY Medicaid HMO DRG,59537,,153% x Medicaid HMO amount,59537,Other,153% of NY Medicaid HMO DRG,87555,,225% x Medicaid HMO amount,87555,Other,225% of NY Medicaid HMO DRG,54478,,140% x Medicaid HMO amount,54478,Other,140% of NY Medicaid HMO DRG,87555,,DRG base rate x DRG weight + capital per discharge,87555,Other,225% of NY Medicaid HMO DRG,107011,,275% x Medicaid HMO amount,107011,Other,275% of NY Medicaid HMO DRG,126079,,324% x Medicaid HMO amount,126079,Other,324% of NY Medicaid HMO DRG,83663,,215% x Medicaid HMO amount,83663,Other,215% of NY Medicaid HMO DRG,83663,,215% x Medicaid HMO amount,83663,Other,215% of NY Medicaid HMO DRG,48642,,125% x Medicaid HMO amount,48642,Other,125% of NY Medicaid HMO DRG,0.01,167285,
Laparoscopic cholecystectomy,263-1,APR-DRG,,,,,,,,inpatient,,,125328.27,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11327,,186% x Medicaid HMO amount,11327,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24445,,"27,634 x DRG Weight",24445,Other,DRG Base Rate x DRG Weight,20777,,"23,488 x DRG Weight",20777,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6090.21,,DRG base rate x DRG weight + capital per discharge,6090.21,Other,100% of NY Medicaid HMO DRG,6090,,DRG base rate x DRG weight + capital per discharge,6090,Other,100% of NY Medicaid HMO DRG,6090,,DRG base rate x DRG weight + capital per discharge,6090,Other,100% of NY Medicaid HMO DRG,6090,,DRG base rate x DRG weight + capital per discharge,6090,Other,100% of NY Medicaid HMO DRG,13703,,225% x Medicaid HMO amount,13703,Other,225% of NY Medicaid HMO DRG,9318,,153% x Medicaid HMO amount,9318,Other,153% of NY Medicaid HMO DRG,13703,,225% x Medicaid HMO amount,13703,Other,225% of NY Medicaid HMO DRG,8526,,140% x Medicaid HMO amount,8526,Other,140% of NY Medicaid HMO DRG,13703,,DRG base rate x DRG weight + capital per discharge,13703,Other,225% of NY Medicaid HMO DRG,16748,,275% x Medicaid HMO amount,16748,Other,275% of NY Medicaid HMO DRG,19732,,324% x Medicaid HMO amount,19732,Other,324% of NY Medicaid HMO DRG,13094,,215% x Medicaid HMO amount,13094,Other,215% of NY Medicaid HMO DRG,13094,,215% x Medicaid HMO amount,13094,Other,215% of NY Medicaid HMO DRG,7613,,125% x Medicaid HMO amount,7613,Other,125% of NY Medicaid HMO DRG,0.01,24445,
Laparoscopic cholecystectomy,263-2,APR-DRG,,,,,,,,inpatient,,,151224.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14718,,186% x Medicaid HMO amount,14718,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32379,,"27,634 x DRG Weight",32379,Other,DRG Base Rate x DRG Weight,27521,,"23,488 x DRG Weight",27521,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7913.21,,DRG base rate x DRG weight + capital per discharge,7913.21,Other,100% of NY Medicaid HMO DRG,7913,,DRG base rate x DRG weight + capital per discharge,7913,Other,100% of NY Medicaid HMO DRG,7913,,DRG base rate x DRG weight + capital per discharge,7913,Other,100% of NY Medicaid HMO DRG,7913,,DRG base rate x DRG weight + capital per discharge,7913,Other,100% of NY Medicaid HMO DRG,17805,,225% x Medicaid HMO amount,17805,Other,225% of NY Medicaid HMO DRG,12107,,153% x Medicaid HMO amount,12107,Other,153% of NY Medicaid HMO DRG,17805,,225% x Medicaid HMO amount,17805,Other,225% of NY Medicaid HMO DRG,11078,,140% x Medicaid HMO amount,11078,Other,140% of NY Medicaid HMO DRG,17805,,DRG base rate x DRG weight + capital per discharge,17805,Other,225% of NY Medicaid HMO DRG,21761,,275% x Medicaid HMO amount,21761,Other,275% of NY Medicaid HMO DRG,25639,,324% x Medicaid HMO amount,25639,Other,324% of NY Medicaid HMO DRG,17013,,215% x Medicaid HMO amount,17013,Other,215% of NY Medicaid HMO DRG,17013,,215% x Medicaid HMO amount,17013,Other,215% of NY Medicaid HMO DRG,9892,,125% x Medicaid HMO amount,9892,Other,125% of NY Medicaid HMO DRG,0.01,32379,
Laparoscopic cholecystectomy,263-3,APR-DRG,,,,,,,,inpatient,,,183923.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19960,,186% x Medicaid HMO amount,19960,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44640,,"27,634 x DRG Weight",44640,Other,DRG Base Rate x DRG Weight,37943,,"23,488 x DRG Weight",37943,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10731.21,,DRG base rate x DRG weight + capital per discharge,10731.21,Other,100% of NY Medicaid HMO DRG,10731,,DRG base rate x DRG weight + capital per discharge,10731,Other,100% of NY Medicaid HMO DRG,10731,,DRG base rate x DRG weight + capital per discharge,10731,Other,100% of NY Medicaid HMO DRG,10731,,DRG base rate x DRG weight + capital per discharge,10731,Other,100% of NY Medicaid HMO DRG,24145,,225% x Medicaid HMO amount,24145,Other,225% of NY Medicaid HMO DRG,16419,,153% x Medicaid HMO amount,16419,Other,153% of NY Medicaid HMO DRG,24145,,225% x Medicaid HMO amount,24145,Other,225% of NY Medicaid HMO DRG,15024,,140% x Medicaid HMO amount,15024,Other,140% of NY Medicaid HMO DRG,24145,,DRG base rate x DRG weight + capital per discharge,24145,Other,225% of NY Medicaid HMO DRG,29511,,275% x Medicaid HMO amount,29511,Other,275% of NY Medicaid HMO DRG,34769,,324% x Medicaid HMO amount,34769,Other,324% of NY Medicaid HMO DRG,23072,,215% x Medicaid HMO amount,23072,Other,215% of NY Medicaid HMO DRG,23072,,215% x Medicaid HMO amount,23072,Other,215% of NY Medicaid HMO DRG,13414,,125% x Medicaid HMO amount,13414,Other,125% of NY Medicaid HMO DRG,0.01,44640,
Laparoscopic cholecystectomy,263-4,APR-DRG,,,,,,,,inpatient,,,386814.04,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44222,,186% x Medicaid HMO amount,44222,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,101408,,"27,634 x DRG Weight",101408,Other,DRG Base Rate x DRG Weight,86194,,"23,488 x DRG Weight",86194,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23775.21,,DRG base rate x DRG weight + capital per discharge,23775.21,Other,100% of NY Medicaid HMO DRG,23775,,DRG base rate x DRG weight + capital per discharge,23775,Other,100% of NY Medicaid HMO DRG,23775,,DRG base rate x DRG weight + capital per discharge,23775,Other,100% of NY Medicaid HMO DRG,23775,,DRG base rate x DRG weight + capital per discharge,23775,Other,100% of NY Medicaid HMO DRG,53494,,225% x Medicaid HMO amount,53494,Other,225% of NY Medicaid HMO DRG,36376,,153% x Medicaid HMO amount,36376,Other,153% of NY Medicaid HMO DRG,53494,,225% x Medicaid HMO amount,53494,Other,225% of NY Medicaid HMO DRG,33285,,140% x Medicaid HMO amount,33285,Other,140% of NY Medicaid HMO DRG,53494,,DRG base rate x DRG weight + capital per discharge,53494,Other,225% of NY Medicaid HMO DRG,65382,,275% x Medicaid HMO amount,65382,Other,275% of NY Medicaid HMO DRG,77032,,324% x Medicaid HMO amount,77032,Other,324% of NY Medicaid HMO DRG,51117,,215% x Medicaid HMO amount,51117,Other,215% of NY Medicaid HMO DRG,51117,,215% x Medicaid HMO amount,51117,Other,215% of NY Medicaid HMO DRG,29719,,125% x Medicaid HMO amount,29719,Other,125% of NY Medicaid HMO DRG,0.01,101408,
"Other hepatobiliary, pancreas & abdominal procedures",264-1,APR-DRG,,,,,,,,inpatient,,,116577.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16634,,186% x Medicaid HMO amount,16634,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36861,,"27,634 x DRG Weight",36861,Other,DRG Base Rate x DRG Weight,31331,,"23,488 x DRG Weight",31331,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8943.21,,DRG base rate x DRG weight + capital per discharge,8943.21,Other,100% of NY Medicaid HMO DRG,8943,,DRG base rate x DRG weight + capital per discharge,8943,Other,100% of NY Medicaid HMO DRG,8943,,DRG base rate x DRG weight + capital per discharge,8943,Other,100% of NY Medicaid HMO DRG,8943,,DRG base rate x DRG weight + capital per discharge,8943,Other,100% of NY Medicaid HMO DRG,20122,,225% x Medicaid HMO amount,20122,Other,225% of NY Medicaid HMO DRG,13683,,153% x Medicaid HMO amount,13683,Other,153% of NY Medicaid HMO DRG,20122,,225% x Medicaid HMO amount,20122,Other,225% of NY Medicaid HMO DRG,12520,,140% x Medicaid HMO amount,12520,Other,140% of NY Medicaid HMO DRG,20122,,DRG base rate x DRG weight + capital per discharge,20122,Other,225% of NY Medicaid HMO DRG,24594,,275% x Medicaid HMO amount,24594,Other,275% of NY Medicaid HMO DRG,28976,,324% x Medicaid HMO amount,28976,Other,324% of NY Medicaid HMO DRG,19228,,215% x Medicaid HMO amount,19228,Other,215% of NY Medicaid HMO DRG,19228,,215% x Medicaid HMO amount,19228,Other,215% of NY Medicaid HMO DRG,11179,,125% x Medicaid HMO amount,11179,Other,125% of NY Medicaid HMO DRG,0.01,36861,
"Other hepatobiliary, pancreas & abdominal procedures",264-2,APR-DRG,,,,,,,,inpatient,,,248042.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18740,,186% x Medicaid HMO amount,18740,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41785,,"27,634 x DRG Weight",41785,Other,DRG Base Rate x DRG Weight,35516,,"23,488 x DRG Weight",35516,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10075.21,,DRG base rate x DRG weight + capital per discharge,10075.21,Other,100% of NY Medicaid HMO DRG,10075,,DRG base rate x DRG weight + capital per discharge,10075,Other,100% of NY Medicaid HMO DRG,10075,,DRG base rate x DRG weight + capital per discharge,10075,Other,100% of NY Medicaid HMO DRG,10075,,DRG base rate x DRG weight + capital per discharge,10075,Other,100% of NY Medicaid HMO DRG,22669,,225% x Medicaid HMO amount,22669,Other,225% of NY Medicaid HMO DRG,15415,,153% x Medicaid HMO amount,15415,Other,153% of NY Medicaid HMO DRG,22669,,225% x Medicaid HMO amount,22669,Other,225% of NY Medicaid HMO DRG,14105,,140% x Medicaid HMO amount,14105,Other,140% of NY Medicaid HMO DRG,22669,,DRG base rate x DRG weight + capital per discharge,22669,Other,225% of NY Medicaid HMO DRG,27707,,275% x Medicaid HMO amount,27707,Other,275% of NY Medicaid HMO DRG,32644,,324% x Medicaid HMO amount,32644,Other,324% of NY Medicaid HMO DRG,21662,,215% x Medicaid HMO amount,21662,Other,215% of NY Medicaid HMO DRG,21662,,215% x Medicaid HMO amount,21662,Other,215% of NY Medicaid HMO DRG,12594,,125% x Medicaid HMO amount,12594,Other,125% of NY Medicaid HMO DRG,0.01,41785,
"Other hepatobiliary, pancreas & abdominal procedures",264-3,APR-DRG,,,,,,,,inpatient,,,193423.85,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34618,,186% x Medicaid HMO amount,34618,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78937,,"27,634 x DRG Weight",78937,Other,DRG Base Rate x DRG Weight,67093,,"23,488 x DRG Weight",67093,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18612.21,,DRG base rate x DRG weight + capital per discharge,18612.21,Other,100% of NY Medicaid HMO DRG,18612,,DRG base rate x DRG weight + capital per discharge,18612,Other,100% of NY Medicaid HMO DRG,18612,,DRG base rate x DRG weight + capital per discharge,18612,Other,100% of NY Medicaid HMO DRG,18612,,DRG base rate x DRG weight + capital per discharge,18612,Other,100% of NY Medicaid HMO DRG,41877,,225% x Medicaid HMO amount,41877,Other,225% of NY Medicaid HMO DRG,28477,,153% x Medicaid HMO amount,28477,Other,153% of NY Medicaid HMO DRG,41877,,225% x Medicaid HMO amount,41877,Other,225% of NY Medicaid HMO DRG,26057,,140% x Medicaid HMO amount,26057,Other,140% of NY Medicaid HMO DRG,41877,,DRG base rate x DRG weight + capital per discharge,41877,Other,225% of NY Medicaid HMO DRG,51184,,275% x Medicaid HMO amount,51184,Other,275% of NY Medicaid HMO DRG,60304,,324% x Medicaid HMO amount,60304,Other,324% of NY Medicaid HMO DRG,40016,,215% x Medicaid HMO amount,40016,Other,215% of NY Medicaid HMO DRG,40016,,215% x Medicaid HMO amount,40016,Other,215% of NY Medicaid HMO DRG,23265,,125% x Medicaid HMO amount,23265,Other,125% of NY Medicaid HMO DRG,0.01,78937,
"Other hepatobiliary, pancreas & abdominal procedures",264-4,APR-DRG,,,,,,,,inpatient,,,753257.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73572,,186% x Medicaid HMO amount,73572,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,170076,,"27,634 x DRG Weight",170076,Other,DRG Base Rate x DRG Weight,144559,,"23,488 x DRG Weight",144559,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39555.21,,DRG base rate x DRG weight + capital per discharge,39555.21,Other,100% of NY Medicaid HMO DRG,39555,,DRG base rate x DRG weight + capital per discharge,39555,Other,100% of NY Medicaid HMO DRG,39555,,DRG base rate x DRG weight + capital per discharge,39555,Other,100% of NY Medicaid HMO DRG,39555,,DRG base rate x DRG weight + capital per discharge,39555,Other,100% of NY Medicaid HMO DRG,88999,,225% x Medicaid HMO amount,88999,Other,225% of NY Medicaid HMO DRG,60519,,153% x Medicaid HMO amount,60519,Other,153% of NY Medicaid HMO DRG,88999,,225% x Medicaid HMO amount,88999,Other,225% of NY Medicaid HMO DRG,55377,,140% x Medicaid HMO amount,55377,Other,140% of NY Medicaid HMO DRG,88999,,DRG base rate x DRG weight + capital per discharge,88999,Other,225% of NY Medicaid HMO DRG,108777,,275% x Medicaid HMO amount,108777,Other,275% of NY Medicaid HMO DRG,128159,,324% x Medicaid HMO amount,128159,Other,324% of NY Medicaid HMO DRG,85044,,215% x Medicaid HMO amount,85044,Other,215% of NY Medicaid HMO DRG,85044,,215% x Medicaid HMO amount,85044,Other,215% of NY Medicaid HMO DRG,49444,,125% x Medicaid HMO amount,49444,Other,125% of NY Medicaid HMO DRG,0.01,170076,
Hepatic coma & other major acute liver disorders,279-1,APR-DRG,,,,,,,,inpatient,,,104262,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7371,,186% x Medicaid HMO amount,7371,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15188,,"27,634 x DRG Weight",15188,Other,DRG Base Rate x DRG Weight,12909,,"23,488 x DRG Weight",12909,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3963.21,,DRG base rate x DRG weight + capital per discharge,3963.21,Other,100% of NY Medicaid HMO DRG,3963,,DRG base rate x DRG weight + capital per discharge,3963,Other,100% of NY Medicaid HMO DRG,3963,,DRG base rate x DRG weight + capital per discharge,3963,Other,100% of NY Medicaid HMO DRG,3963,,DRG base rate x DRG weight + capital per discharge,3963,Other,100% of NY Medicaid HMO DRG,8917,,225% x Medicaid HMO amount,8917,Other,225% of NY Medicaid HMO DRG,6064,,153% x Medicaid HMO amount,6064,Other,153% of NY Medicaid HMO DRG,8917,,225% x Medicaid HMO amount,8917,Other,225% of NY Medicaid HMO DRG,5548,,140% x Medicaid HMO amount,5548,Other,140% of NY Medicaid HMO DRG,8917,,DRG base rate x DRG weight + capital per discharge,8917,Other,225% of NY Medicaid HMO DRG,10899,,275% x Medicaid HMO amount,10899,Other,275% of NY Medicaid HMO DRG,12841,,324% x Medicaid HMO amount,12841,Other,324% of NY Medicaid HMO DRG,8521,,215% x Medicaid HMO amount,8521,Other,215% of NY Medicaid HMO DRG,8521,,215% x Medicaid HMO amount,8521,Other,215% of NY Medicaid HMO DRG,4954,,125% x Medicaid HMO amount,4954,Other,125% of NY Medicaid HMO DRG,0.01,15188,
Hepatic coma & other major acute liver disorders,279-2,APR-DRG,,,,,,,,inpatient,,,136931.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10120,,186% x Medicaid HMO amount,10120,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21618,,"27,634 x DRG Weight",21618,Other,DRG Base Rate x DRG Weight,18375,,"23,488 x DRG Weight",18375,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5441.21,,DRG base rate x DRG weight + capital per discharge,5441.21,Other,100% of NY Medicaid HMO DRG,5441,,DRG base rate x DRG weight + capital per discharge,5441,Other,100% of NY Medicaid HMO DRG,5441,,DRG base rate x DRG weight + capital per discharge,5441,Other,100% of NY Medicaid HMO DRG,5441,,DRG base rate x DRG weight + capital per discharge,5441,Other,100% of NY Medicaid HMO DRG,12243,,225% x Medicaid HMO amount,12243,Other,225% of NY Medicaid HMO DRG,8325,,153% x Medicaid HMO amount,8325,Other,153% of NY Medicaid HMO DRG,12243,,225% x Medicaid HMO amount,12243,Other,225% of NY Medicaid HMO DRG,7618,,140% x Medicaid HMO amount,7618,Other,140% of NY Medicaid HMO DRG,12243,,DRG base rate x DRG weight + capital per discharge,12243,Other,225% of NY Medicaid HMO DRG,14963,,275% x Medicaid HMO amount,14963,Other,275% of NY Medicaid HMO DRG,17630,,324% x Medicaid HMO amount,17630,Other,324% of NY Medicaid HMO DRG,11699,,215% x Medicaid HMO amount,11699,Other,215% of NY Medicaid HMO DRG,11699,,215% x Medicaid HMO amount,11699,Other,215% of NY Medicaid HMO DRG,6802,,125% x Medicaid HMO amount,6802,Other,125% of NY Medicaid HMO DRG,0.01,21618,
Hepatic coma & other major acute liver disorders,279-3,APR-DRG,,,,,,,,inpatient,,,281532.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16915,,186% x Medicaid HMO amount,16915,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37519,,"27,634 x DRG Weight",37519,Other,DRG Base Rate x DRG Weight,31890,,"23,488 x DRG Weight",31890,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9094.21,,DRG base rate x DRG weight + capital per discharge,9094.21,Other,100% of NY Medicaid HMO DRG,9094,,DRG base rate x DRG weight + capital per discharge,9094,Other,100% of NY Medicaid HMO DRG,9094,,DRG base rate x DRG weight + capital per discharge,9094,Other,100% of NY Medicaid HMO DRG,9094,,DRG base rate x DRG weight + capital per discharge,9094,Other,100% of NY Medicaid HMO DRG,20462,,225% x Medicaid HMO amount,20462,Other,225% of NY Medicaid HMO DRG,13914,,153% x Medicaid HMO amount,13914,Other,153% of NY Medicaid HMO DRG,20462,,225% x Medicaid HMO amount,20462,Other,225% of NY Medicaid HMO DRG,12732,,140% x Medicaid HMO amount,12732,Other,140% of NY Medicaid HMO DRG,20462,,DRG base rate x DRG weight + capital per discharge,20462,Other,225% of NY Medicaid HMO DRG,25009,,275% x Medicaid HMO amount,25009,Other,275% of NY Medicaid HMO DRG,29465,,324% x Medicaid HMO amount,29465,Other,324% of NY Medicaid HMO DRG,19553,,215% x Medicaid HMO amount,19553,Other,215% of NY Medicaid HMO DRG,19553,,215% x Medicaid HMO amount,19553,Other,215% of NY Medicaid HMO DRG,11368,,125% x Medicaid HMO amount,11368,Other,125% of NY Medicaid HMO DRG,0.01,37519,
Hepatic coma & other major acute liver disorders,279-4,APR-DRG,,,,,,,,inpatient,,,269612.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44640,,186% x Medicaid HMO amount,44640,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,102384,,"27,634 x DRG Weight",102384,Other,DRG Base Rate x DRG Weight,87023,,"23,488 x DRG Weight",87023,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24000.21,,DRG base rate x DRG weight + capital per discharge,24000.21,Other,100% of NY Medicaid HMO DRG,24000,,DRG base rate x DRG weight + capital per discharge,24000,Other,100% of NY Medicaid HMO DRG,24000,,DRG base rate x DRG weight + capital per discharge,24000,Other,100% of NY Medicaid HMO DRG,24000,,DRG base rate x DRG weight + capital per discharge,24000,Other,100% of NY Medicaid HMO DRG,54000,,225% x Medicaid HMO amount,54000,Other,225% of NY Medicaid HMO DRG,36720,,153% x Medicaid HMO amount,36720,Other,153% of NY Medicaid HMO DRG,54000,,225% x Medicaid HMO amount,54000,Other,225% of NY Medicaid HMO DRG,33600,,140% x Medicaid HMO amount,33600,Other,140% of NY Medicaid HMO DRG,54000,,DRG base rate x DRG weight + capital per discharge,54000,Other,225% of NY Medicaid HMO DRG,66001,,275% x Medicaid HMO amount,66001,Other,275% of NY Medicaid HMO DRG,77761,,324% x Medicaid HMO amount,77761,Other,324% of NY Medicaid HMO DRG,51600,,215% x Medicaid HMO amount,51600,Other,215% of NY Medicaid HMO DRG,51600,,215% x Medicaid HMO amount,51600,Other,215% of NY Medicaid HMO DRG,30000,,125% x Medicaid HMO amount,30000,Other,125% of NY Medicaid HMO DRG,0.01,102384,
Alcoholic liver disease,280-1,APR-DRG,,,,,,,,inpatient,,,112061.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7209,,186% x Medicaid HMO amount,7209,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14809,,"27,634 x DRG Weight",14809,Other,DRG Base Rate x DRG Weight,12587,,"23,488 x DRG Weight",12587,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3876.21,,DRG base rate x DRG weight + capital per discharge,3876.21,Other,100% of NY Medicaid HMO DRG,3876,,DRG base rate x DRG weight + capital per discharge,3876,Other,100% of NY Medicaid HMO DRG,3876,,DRG base rate x DRG weight + capital per discharge,3876,Other,100% of NY Medicaid HMO DRG,3876,,DRG base rate x DRG weight + capital per discharge,3876,Other,100% of NY Medicaid HMO DRG,8721,,225% x Medicaid HMO amount,8721,Other,225% of NY Medicaid HMO DRG,5931,,153% x Medicaid HMO amount,5931,Other,153% of NY Medicaid HMO DRG,8721,,225% x Medicaid HMO amount,8721,Other,225% of NY Medicaid HMO DRG,5427,,140% x Medicaid HMO amount,5427,Other,140% of NY Medicaid HMO DRG,8721,,DRG base rate x DRG weight + capital per discharge,8721,Other,225% of NY Medicaid HMO DRG,10660,,275% x Medicaid HMO amount,10660,Other,275% of NY Medicaid HMO DRG,12559,,324% x Medicaid HMO amount,12559,Other,324% of NY Medicaid HMO DRG,8334,,215% x Medicaid HMO amount,8334,Other,215% of NY Medicaid HMO DRG,8334,,215% x Medicaid HMO amount,8334,Other,215% of NY Medicaid HMO DRG,4845,,125% x Medicaid HMO amount,4845,Other,125% of NY Medicaid HMO DRG,0.01,14809,
Alcoholic liver disease,280-2,APR-DRG,,,,,,,,inpatient,,,131466.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9772,,186% x Medicaid HMO amount,9772,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20808,,"27,634 x DRG Weight",20808,Other,DRG Base Rate x DRG Weight,17686,,"23,488 x DRG Weight",17686,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5254.21,,DRG base rate x DRG weight + capital per discharge,5254.21,Other,100% of NY Medicaid HMO DRG,5254,,DRG base rate x DRG weight + capital per discharge,5254,Other,100% of NY Medicaid HMO DRG,5254,,DRG base rate x DRG weight + capital per discharge,5254,Other,100% of NY Medicaid HMO DRG,5254,,DRG base rate x DRG weight + capital per discharge,5254,Other,100% of NY Medicaid HMO DRG,11822,,225% x Medicaid HMO amount,11822,Other,225% of NY Medicaid HMO DRG,8039,,153% x Medicaid HMO amount,8039,Other,153% of NY Medicaid HMO DRG,11822,,225% x Medicaid HMO amount,11822,Other,225% of NY Medicaid HMO DRG,7356,,140% x Medicaid HMO amount,7356,Other,140% of NY Medicaid HMO DRG,11822,,DRG base rate x DRG weight + capital per discharge,11822,Other,225% of NY Medicaid HMO DRG,14449,,275% x Medicaid HMO amount,14449,Other,275% of NY Medicaid HMO DRG,17024,,324% x Medicaid HMO amount,17024,Other,324% of NY Medicaid HMO DRG,11297,,215% x Medicaid HMO amount,11297,Other,215% of NY Medicaid HMO DRG,11297,,215% x Medicaid HMO amount,11297,Other,215% of NY Medicaid HMO DRG,6568,,125% x Medicaid HMO amount,6568,Other,125% of NY Medicaid HMO DRG,0.01,20808,
Alcoholic liver disease,280-3,APR-DRG,,,,,,,,inpatient,,,176449.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15847,,186% x Medicaid HMO amount,15847,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35018,,"27,634 x DRG Weight",35018,Other,DRG Base Rate x DRG Weight,29764,,"23,488 x DRG Weight",29764,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8520.21,,DRG base rate x DRG weight + capital per discharge,8520.21,Other,100% of NY Medicaid HMO DRG,8520,,DRG base rate x DRG weight + capital per discharge,8520,Other,100% of NY Medicaid HMO DRG,8520,,DRG base rate x DRG weight + capital per discharge,8520,Other,100% of NY Medicaid HMO DRG,8520,,DRG base rate x DRG weight + capital per discharge,8520,Other,100% of NY Medicaid HMO DRG,19170,,225% x Medicaid HMO amount,19170,Other,225% of NY Medicaid HMO DRG,13036,,153% x Medicaid HMO amount,13036,Other,153% of NY Medicaid HMO DRG,19170,,225% x Medicaid HMO amount,19170,Other,225% of NY Medicaid HMO DRG,11928,,140% x Medicaid HMO amount,11928,Other,140% of NY Medicaid HMO DRG,19170,,DRG base rate x DRG weight + capital per discharge,19170,Other,225% of NY Medicaid HMO DRG,23431,,275% x Medicaid HMO amount,23431,Other,275% of NY Medicaid HMO DRG,27605,,324% x Medicaid HMO amount,27605,Other,324% of NY Medicaid HMO DRG,18318,,215% x Medicaid HMO amount,18318,Other,215% of NY Medicaid HMO DRG,18318,,215% x Medicaid HMO amount,18318,Other,215% of NY Medicaid HMO DRG,10650,,125% x Medicaid HMO amount,10650,Other,125% of NY Medicaid HMO DRG,0.01,35018,
Alcoholic liver disease,280-4,APR-DRG,,,,,,,,inpatient,,,394717.61,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41182,,186% x Medicaid HMO amount,41182,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,94295,,"27,634 x DRG Weight",94295,Other,DRG Base Rate x DRG Weight,80148,,"23,488 x DRG Weight",80148,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22141.21,,DRG base rate x DRG weight + capital per discharge,22141.21,Other,100% of NY Medicaid HMO DRG,22141,,DRG base rate x DRG weight + capital per discharge,22141,Other,100% of NY Medicaid HMO DRG,22141,,DRG base rate x DRG weight + capital per discharge,22141,Other,100% of NY Medicaid HMO DRG,22141,,DRG base rate x DRG weight + capital per discharge,22141,Other,100% of NY Medicaid HMO DRG,49818,,225% x Medicaid HMO amount,49818,Other,225% of NY Medicaid HMO DRG,33876,,153% x Medicaid HMO amount,33876,Other,153% of NY Medicaid HMO DRG,49818,,225% x Medicaid HMO amount,49818,Other,225% of NY Medicaid HMO DRG,30998,,140% x Medicaid HMO amount,30998,Other,140% of NY Medicaid HMO DRG,49818,,DRG base rate x DRG weight + capital per discharge,49818,Other,225% of NY Medicaid HMO DRG,60888,,275% x Medicaid HMO amount,60888,Other,275% of NY Medicaid HMO DRG,71738,,324% x Medicaid HMO amount,71738,Other,324% of NY Medicaid HMO DRG,47604,,215% x Medicaid HMO amount,47604,Other,215% of NY Medicaid HMO DRG,47604,,215% x Medicaid HMO amount,47604,Other,215% of NY Medicaid HMO DRG,27677,,125% x Medicaid HMO amount,27677,Other,125% of NY Medicaid HMO DRG,0.01,94295,
Malignancy of hepatobiliary system & pancreas,281-1,APR-DRG,,,,,,,,inpatient,,,140808.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8759,,186% x Medicaid HMO amount,8759,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18435,,"27,634 x DRG Weight",18435,Other,DRG Base Rate x DRG Weight,15669,,"23,488 x DRG Weight",15669,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4709.21,,DRG base rate x DRG weight + capital per discharge,4709.21,Other,100% of NY Medicaid HMO DRG,4709,,DRG base rate x DRG weight + capital per discharge,4709,Other,100% of NY Medicaid HMO DRG,4709,,DRG base rate x DRG weight + capital per discharge,4709,Other,100% of NY Medicaid HMO DRG,4709,,DRG base rate x DRG weight + capital per discharge,4709,Other,100% of NY Medicaid HMO DRG,10596,,225% x Medicaid HMO amount,10596,Other,225% of NY Medicaid HMO DRG,7205,,153% x Medicaid HMO amount,7205,Other,153% of NY Medicaid HMO DRG,10596,,225% x Medicaid HMO amount,10596,Other,225% of NY Medicaid HMO DRG,6593,,140% x Medicaid HMO amount,6593,Other,140% of NY Medicaid HMO DRG,10596,,DRG base rate x DRG weight + capital per discharge,10596,Other,225% of NY Medicaid HMO DRG,12950,,275% x Medicaid HMO amount,12950,Other,275% of NY Medicaid HMO DRG,15258,,324% x Medicaid HMO amount,15258,Other,324% of NY Medicaid HMO DRG,10125,,215% x Medicaid HMO amount,10125,Other,215% of NY Medicaid HMO DRG,10125,,215% x Medicaid HMO amount,10125,Other,215% of NY Medicaid HMO DRG,5887,,125% x Medicaid HMO amount,5887,Other,125% of NY Medicaid HMO DRG,0.01,18435,
Malignancy of hepatobiliary system & pancreas,281-2,APR-DRG,,,,,,,,inpatient,,,140808.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11984,,186% x Medicaid HMO amount,11984,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25981,,"27,634 x DRG Weight",25981,Other,DRG Base Rate x DRG Weight,22083,,"23,488 x DRG Weight",22083,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6443.21,,DRG base rate x DRG weight + capital per discharge,6443.21,Other,100% of NY Medicaid HMO DRG,6443,,DRG base rate x DRG weight + capital per discharge,6443,Other,100% of NY Medicaid HMO DRG,6443,,DRG base rate x DRG weight + capital per discharge,6443,Other,100% of NY Medicaid HMO DRG,6443,,DRG base rate x DRG weight + capital per discharge,6443,Other,100% of NY Medicaid HMO DRG,14497,,225% x Medicaid HMO amount,14497,Other,225% of NY Medicaid HMO DRG,9858,,153% x Medicaid HMO amount,9858,Other,153% of NY Medicaid HMO DRG,14497,,225% x Medicaid HMO amount,14497,Other,225% of NY Medicaid HMO DRG,9020,,140% x Medicaid HMO amount,9020,Other,140% of NY Medicaid HMO DRG,14497,,DRG base rate x DRG weight + capital per discharge,14497,Other,225% of NY Medicaid HMO DRG,17719,,275% x Medicaid HMO amount,17719,Other,275% of NY Medicaid HMO DRG,20876,,324% x Medicaid HMO amount,20876,Other,324% of NY Medicaid HMO DRG,13853,,215% x Medicaid HMO amount,13853,Other,215% of NY Medicaid HMO DRG,13853,,215% x Medicaid HMO amount,13853,Other,215% of NY Medicaid HMO DRG,8054,,125% x Medicaid HMO amount,8054,Other,125% of NY Medicaid HMO DRG,0.01,25981,
Malignancy of hepatobiliary system & pancreas,281-3,APR-DRG,,,,,,,,inpatient,,,144959.85,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17157,,186% x Medicaid HMO amount,17157,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38082,,"27,634 x DRG Weight",38082,Other,DRG Base Rate x DRG Weight,32369,,"23,488 x DRG Weight",32369,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9224.21,,DRG base rate x DRG weight + capital per discharge,9224.21,Other,100% of NY Medicaid HMO DRG,9224,,DRG base rate x DRG weight + capital per discharge,9224,Other,100% of NY Medicaid HMO DRG,9224,,DRG base rate x DRG weight + capital per discharge,9224,Other,100% of NY Medicaid HMO DRG,9224,,DRG base rate x DRG weight + capital per discharge,9224,Other,100% of NY Medicaid HMO DRG,20754,,225% x Medicaid HMO amount,20754,Other,225% of NY Medicaid HMO DRG,14113,,153% x Medicaid HMO amount,14113,Other,153% of NY Medicaid HMO DRG,20754,,225% x Medicaid HMO amount,20754,Other,225% of NY Medicaid HMO DRG,12914,,140% x Medicaid HMO amount,12914,Other,140% of NY Medicaid HMO DRG,20754,,DRG base rate x DRG weight + capital per discharge,20754,Other,225% of NY Medicaid HMO DRG,25367,,275% x Medicaid HMO amount,25367,Other,275% of NY Medicaid HMO DRG,29886,,324% x Medicaid HMO amount,29886,Other,324% of NY Medicaid HMO DRG,19832,,215% x Medicaid HMO amount,19832,Other,215% of NY Medicaid HMO DRG,19832,,215% x Medicaid HMO amount,19832,Other,215% of NY Medicaid HMO DRG,11530,,125% x Medicaid HMO amount,11530,Other,125% of NY Medicaid HMO DRG,0.01,38082,
Malignancy of hepatobiliary system & pancreas,281-4,APR-DRG,,,,,,,,inpatient,,,394655.48,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29444,,186% x Medicaid HMO amount,29444,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,66833,,"27,634 x DRG Weight",66833,Other,DRG Base Rate x DRG Weight,56806,,"23,488 x DRG Weight",56806,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15830.21,,DRG base rate x DRG weight + capital per discharge,15830.21,Other,100% of NY Medicaid HMO DRG,15830,,DRG base rate x DRG weight + capital per discharge,15830,Other,100% of NY Medicaid HMO DRG,15830,,DRG base rate x DRG weight + capital per discharge,15830,Other,100% of NY Medicaid HMO DRG,15830,,DRG base rate x DRG weight + capital per discharge,15830,Other,100% of NY Medicaid HMO DRG,35618,,225% x Medicaid HMO amount,35618,Other,225% of NY Medicaid HMO DRG,24220,,153% x Medicaid HMO amount,24220,Other,153% of NY Medicaid HMO DRG,35618,,225% x Medicaid HMO amount,35618,Other,225% of NY Medicaid HMO DRG,22162,,140% x Medicaid HMO amount,22162,Other,140% of NY Medicaid HMO DRG,35618,,DRG base rate x DRG weight + capital per discharge,35618,Other,225% of NY Medicaid HMO DRG,43533,,275% x Medicaid HMO amount,43533,Other,275% of NY Medicaid HMO DRG,51290,,324% x Medicaid HMO amount,51290,Other,324% of NY Medicaid HMO DRG,34035,,215% x Medicaid HMO amount,34035,Other,215% of NY Medicaid HMO DRG,34035,,215% x Medicaid HMO amount,34035,Other,215% of NY Medicaid HMO DRG,19788,,125% x Medicaid HMO amount,19788,Other,125% of NY Medicaid HMO DRG,0.01,66833,
Disorders of pancreas except malignancy,282-1,APR-DRG,,,,,,,,inpatient,,,72804.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7399,,186% x Medicaid HMO amount,7399,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15254,,"27,634 x DRG Weight",15254,Other,DRG Base Rate x DRG Weight,12965,,"23,488 x DRG Weight",12965,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3978.21,,DRG base rate x DRG weight + capital per discharge,3978.21,Other,100% of NY Medicaid HMO DRG,3978,,DRG base rate x DRG weight + capital per discharge,3978,Other,100% of NY Medicaid HMO DRG,3978,,DRG base rate x DRG weight + capital per discharge,3978,Other,100% of NY Medicaid HMO DRG,3978,,DRG base rate x DRG weight + capital per discharge,3978,Other,100% of NY Medicaid HMO DRG,8951,,225% x Medicaid HMO amount,8951,Other,225% of NY Medicaid HMO DRG,6087,,153% x Medicaid HMO amount,6087,Other,153% of NY Medicaid HMO DRG,8951,,225% x Medicaid HMO amount,8951,Other,225% of NY Medicaid HMO DRG,5569,,140% x Medicaid HMO amount,5569,Other,140% of NY Medicaid HMO DRG,8951,,DRG base rate x DRG weight + capital per discharge,8951,Other,225% of NY Medicaid HMO DRG,10940,,275% x Medicaid HMO amount,10940,Other,275% of NY Medicaid HMO DRG,12889,,324% x Medicaid HMO amount,12889,Other,324% of NY Medicaid HMO DRG,8553,,215% x Medicaid HMO amount,8553,Other,215% of NY Medicaid HMO DRG,8553,,215% x Medicaid HMO amount,8553,Other,215% of NY Medicaid HMO DRG,4973,,125% x Medicaid HMO amount,4973,Other,125% of NY Medicaid HMO DRG,0.01,15254,
Disorders of pancreas except malignancy,282-2,APR-DRG,,,,,,,,inpatient,,,106860.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9702,,186% x Medicaid HMO amount,9702,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20640,,"27,634 x DRG Weight",20640,Other,DRG Base Rate x DRG Weight,17543,,"23,488 x DRG Weight",17543,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5216.21,,DRG base rate x DRG weight + capital per discharge,5216.21,Other,100% of NY Medicaid HMO DRG,5216,,DRG base rate x DRG weight + capital per discharge,5216,Other,100% of NY Medicaid HMO DRG,5216,,DRG base rate x DRG weight + capital per discharge,5216,Other,100% of NY Medicaid HMO DRG,5216,,DRG base rate x DRG weight + capital per discharge,5216,Other,100% of NY Medicaid HMO DRG,11736,,225% x Medicaid HMO amount,11736,Other,225% of NY Medicaid HMO DRG,7981,,153% x Medicaid HMO amount,7981,Other,153% of NY Medicaid HMO DRG,11736,,225% x Medicaid HMO amount,11736,Other,225% of NY Medicaid HMO DRG,7303,,140% x Medicaid HMO amount,7303,Other,140% of NY Medicaid HMO DRG,11736,,DRG base rate x DRG weight + capital per discharge,11736,Other,225% of NY Medicaid HMO DRG,14345,,275% x Medicaid HMO amount,14345,Other,275% of NY Medicaid HMO DRG,16901,,324% x Medicaid HMO amount,16901,Other,324% of NY Medicaid HMO DRG,11215,,215% x Medicaid HMO amount,11215,Other,215% of NY Medicaid HMO DRG,11215,,215% x Medicaid HMO amount,11215,Other,215% of NY Medicaid HMO DRG,6520,,125% x Medicaid HMO amount,6520,Other,125% of NY Medicaid HMO DRG,0.01,20640,
Disorders of pancreas except malignancy,282-3,APR-DRG,,,,,,,,inpatient,,,161341.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16965,,186% x Medicaid HMO amount,16965,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37635,,"27,634 x DRG Weight",37635,Other,DRG Base Rate x DRG Weight,31988,,"23,488 x DRG Weight",31988,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9121.21,,DRG base rate x DRG weight + capital per discharge,9121.21,Other,100% of NY Medicaid HMO DRG,9121,,DRG base rate x DRG weight + capital per discharge,9121,Other,100% of NY Medicaid HMO DRG,9121,,DRG base rate x DRG weight + capital per discharge,9121,Other,100% of NY Medicaid HMO DRG,9121,,DRG base rate x DRG weight + capital per discharge,9121,Other,100% of NY Medicaid HMO DRG,20523,,225% x Medicaid HMO amount,20523,Other,225% of NY Medicaid HMO DRG,13955,,153% x Medicaid HMO amount,13955,Other,153% of NY Medicaid HMO DRG,20523,,225% x Medicaid HMO amount,20523,Other,225% of NY Medicaid HMO DRG,12770,,140% x Medicaid HMO amount,12770,Other,140% of NY Medicaid HMO DRG,20523,,DRG base rate x DRG weight + capital per discharge,20523,Other,225% of NY Medicaid HMO DRG,25083,,275% x Medicaid HMO amount,25083,Other,275% of NY Medicaid HMO DRG,29553,,324% x Medicaid HMO amount,29553,Other,324% of NY Medicaid HMO DRG,19611,,215% x Medicaid HMO amount,19611,Other,215% of NY Medicaid HMO DRG,19611,,215% x Medicaid HMO amount,19611,Other,215% of NY Medicaid HMO DRG,11402,,125% x Medicaid HMO amount,11402,Other,125% of NY Medicaid HMO DRG,0.01,37635,
Disorders of pancreas except malignancy,282-4,APR-DRG,,,,,,,,inpatient,,,386058.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41709,,186% x Medicaid HMO amount,41709,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,95525,,"27,634 x DRG Weight",95525,Other,DRG Base Rate x DRG Weight,81193,,"23,488 x DRG Weight",81193,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22424.21,,DRG base rate x DRG weight + capital per discharge,22424.21,Other,100% of NY Medicaid HMO DRG,22424,,DRG base rate x DRG weight + capital per discharge,22424,Other,100% of NY Medicaid HMO DRG,22424,,DRG base rate x DRG weight + capital per discharge,22424,Other,100% of NY Medicaid HMO DRG,22424,,DRG base rate x DRG weight + capital per discharge,22424,Other,100% of NY Medicaid HMO DRG,50454,,225% x Medicaid HMO amount,50454,Other,225% of NY Medicaid HMO DRG,34309,,153% x Medicaid HMO amount,34309,Other,153% of NY Medicaid HMO DRG,50454,,225% x Medicaid HMO amount,50454,Other,225% of NY Medicaid HMO DRG,31394,,140% x Medicaid HMO amount,31394,Other,140% of NY Medicaid HMO DRG,50454,,DRG base rate x DRG weight + capital per discharge,50454,Other,225% of NY Medicaid HMO DRG,61667,,275% x Medicaid HMO amount,61667,Other,275% of NY Medicaid HMO DRG,72654,,324% x Medicaid HMO amount,72654,Other,324% of NY Medicaid HMO DRG,48212,,215% x Medicaid HMO amount,48212,Other,215% of NY Medicaid HMO DRG,48212,,215% x Medicaid HMO amount,48212,Other,215% of NY Medicaid HMO DRG,28030,,125% x Medicaid HMO amount,28030,Other,125% of NY Medicaid HMO DRG,0.01,95525,
Other disorders of the liver,283-1,APR-DRG,,,,,,,,inpatient,,,52012.6,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7537,,186% x Medicaid HMO amount,7537,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15575,,"27,634 x DRG Weight",15575,Other,DRG Base Rate x DRG Weight,13238,,"23,488 x DRG Weight",13238,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4052.21,,DRG base rate x DRG weight + capital per discharge,4052.21,Other,100% of NY Medicaid HMO DRG,4052,,DRG base rate x DRG weight + capital per discharge,4052,Other,100% of NY Medicaid HMO DRG,4052,,DRG base rate x DRG weight + capital per discharge,4052,Other,100% of NY Medicaid HMO DRG,4052,,DRG base rate x DRG weight + capital per discharge,4052,Other,100% of NY Medicaid HMO DRG,9117,,225% x Medicaid HMO amount,9117,Other,225% of NY Medicaid HMO DRG,6200,,153% x Medicaid HMO amount,6200,Other,153% of NY Medicaid HMO DRG,9117,,225% x Medicaid HMO amount,9117,Other,225% of NY Medicaid HMO DRG,5673,,140% x Medicaid HMO amount,5673,Other,140% of NY Medicaid HMO DRG,9117,,DRG base rate x DRG weight + capital per discharge,9117,Other,225% of NY Medicaid HMO DRG,11144,,275% x Medicaid HMO amount,11144,Other,275% of NY Medicaid HMO DRG,13129,,324% x Medicaid HMO amount,13129,Other,324% of NY Medicaid HMO DRG,8712,,215% x Medicaid HMO amount,8712,Other,215% of NY Medicaid HMO DRG,8712,,215% x Medicaid HMO amount,8712,Other,215% of NY Medicaid HMO DRG,5065,,125% x Medicaid HMO amount,5065,Other,125% of NY Medicaid HMO DRG,0.01,15575,
Other disorders of the liver,283-2,APR-DRG,,,,,,,,inpatient,,,147359.35,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9705,,186% x Medicaid HMO amount,9705,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20651,,"27,634 x DRG Weight",20651,Other,DRG Base Rate x DRG Weight,17553,,"23,488 x DRG Weight",17553,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5218.21,,DRG base rate x DRG weight + capital per discharge,5218.21,Other,100% of NY Medicaid HMO DRG,5218,,DRG base rate x DRG weight + capital per discharge,5218,Other,100% of NY Medicaid HMO DRG,5218,,DRG base rate x DRG weight + capital per discharge,5218,Other,100% of NY Medicaid HMO DRG,5218,,DRG base rate x DRG weight + capital per discharge,5218,Other,100% of NY Medicaid HMO DRG,11741,,225% x Medicaid HMO amount,11741,Other,225% of NY Medicaid HMO DRG,7984,,153% x Medicaid HMO amount,7984,Other,153% of NY Medicaid HMO DRG,11741,,225% x Medicaid HMO amount,11741,Other,225% of NY Medicaid HMO DRG,7305,,140% x Medicaid HMO amount,7305,Other,140% of NY Medicaid HMO DRG,11741,,DRG base rate x DRG weight + capital per discharge,11741,Other,225% of NY Medicaid HMO DRG,14350,,275% x Medicaid HMO amount,14350,Other,275% of NY Medicaid HMO DRG,16907,,324% x Medicaid HMO amount,16907,Other,324% of NY Medicaid HMO DRG,11219,,215% x Medicaid HMO amount,11219,Other,215% of NY Medicaid HMO DRG,11219,,215% x Medicaid HMO amount,11219,Other,215% of NY Medicaid HMO DRG,6523,,125% x Medicaid HMO amount,6523,Other,125% of NY Medicaid HMO DRG,0.01,20651,
Other disorders of the liver,283-3,APR-DRG,,,,,,,,inpatient,,,170913.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15105,,186% x Medicaid HMO amount,15105,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33285,,"27,634 x DRG Weight",33285,Other,DRG Base Rate x DRG Weight,28291,,"23,488 x DRG Weight",28291,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8121.21,,DRG base rate x DRG weight + capital per discharge,8121.21,Other,100% of NY Medicaid HMO DRG,8121,,DRG base rate x DRG weight + capital per discharge,8121,Other,100% of NY Medicaid HMO DRG,8121,,DRG base rate x DRG weight + capital per discharge,8121,Other,100% of NY Medicaid HMO DRG,8121,,DRG base rate x DRG weight + capital per discharge,8121,Other,100% of NY Medicaid HMO DRG,18273,,225% x Medicaid HMO amount,18273,Other,225% of NY Medicaid HMO DRG,12425,,153% x Medicaid HMO amount,12425,Other,153% of NY Medicaid HMO DRG,18273,,225% x Medicaid HMO amount,18273,Other,225% of NY Medicaid HMO DRG,11370,,140% x Medicaid HMO amount,11370,Other,140% of NY Medicaid HMO DRG,18273,,DRG base rate x DRG weight + capital per discharge,18273,Other,225% of NY Medicaid HMO DRG,22333,,275% x Medicaid HMO amount,22333,Other,275% of NY Medicaid HMO DRG,26313,,324% x Medicaid HMO amount,26313,Other,324% of NY Medicaid HMO DRG,17461,,215% x Medicaid HMO amount,17461,Other,215% of NY Medicaid HMO DRG,17461,,215% x Medicaid HMO amount,17461,Other,215% of NY Medicaid HMO DRG,10152,,125% x Medicaid HMO amount,10152,Other,125% of NY Medicaid HMO DRG,0.01,33285,
Other disorders of the liver,283-4,APR-DRG,,,,,,,,inpatient,,,287184.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31466,,186% x Medicaid HMO amount,31466,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,71564,,"27,634 x DRG Weight",71564,Other,DRG Base Rate x DRG Weight,60827,,"23,488 x DRG Weight",60827,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16917.21,,DRG base rate x DRG weight + capital per discharge,16917.21,Other,100% of NY Medicaid HMO DRG,16917,,DRG base rate x DRG weight + capital per discharge,16917,Other,100% of NY Medicaid HMO DRG,16917,,DRG base rate x DRG weight + capital per discharge,16917,Other,100% of NY Medicaid HMO DRG,16917,,DRG base rate x DRG weight + capital per discharge,16917,Other,100% of NY Medicaid HMO DRG,38064,,225% x Medicaid HMO amount,38064,Other,225% of NY Medicaid HMO DRG,25883,,153% x Medicaid HMO amount,25883,Other,153% of NY Medicaid HMO DRG,38064,,225% x Medicaid HMO amount,38064,Other,225% of NY Medicaid HMO DRG,23684,,140% x Medicaid HMO amount,23684,Other,140% of NY Medicaid HMO DRG,38064,,DRG base rate x DRG weight + capital per discharge,38064,Other,225% of NY Medicaid HMO DRG,46522,,275% x Medicaid HMO amount,46522,Other,275% of NY Medicaid HMO DRG,54812,,324% x Medicaid HMO amount,54812,Other,324% of NY Medicaid HMO DRG,36372,,215% x Medicaid HMO amount,36372,Other,215% of NY Medicaid HMO DRG,36372,,215% x Medicaid HMO amount,36372,Other,215% of NY Medicaid HMO DRG,21147,,125% x Medicaid HMO amount,21147,Other,125% of NY Medicaid HMO DRG,0.01,71564,
Disorders of gallbladder & biliary tract,284-1,APR-DRG,,,,,,,,inpatient,,,104250.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7702,,186% x Medicaid HMO amount,7702,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15961,,"27,634 x DRG Weight",15961,Other,DRG Base Rate x DRG Weight,13567,,"23,488 x DRG Weight",13567,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4141.21,,DRG base rate x DRG weight + capital per discharge,4141.21,Other,100% of NY Medicaid HMO DRG,4141,,DRG base rate x DRG weight + capital per discharge,4141,Other,100% of NY Medicaid HMO DRG,4141,,DRG base rate x DRG weight + capital per discharge,4141,Other,100% of NY Medicaid HMO DRG,4141,,DRG base rate x DRG weight + capital per discharge,4141,Other,100% of NY Medicaid HMO DRG,9318,,225% x Medicaid HMO amount,9318,Other,225% of NY Medicaid HMO DRG,6336,,153% x Medicaid HMO amount,6336,Other,153% of NY Medicaid HMO DRG,9318,,225% x Medicaid HMO amount,9318,Other,225% of NY Medicaid HMO DRG,5798,,140% x Medicaid HMO amount,5798,Other,140% of NY Medicaid HMO DRG,9318,,DRG base rate x DRG weight + capital per discharge,9318,Other,225% of NY Medicaid HMO DRG,11388,,275% x Medicaid HMO amount,11388,Other,275% of NY Medicaid HMO DRG,13418,,324% x Medicaid HMO amount,13418,Other,324% of NY Medicaid HMO DRG,8904,,215% x Medicaid HMO amount,8904,Other,215% of NY Medicaid HMO DRG,8904,,215% x Medicaid HMO amount,8904,Other,215% of NY Medicaid HMO DRG,5177,,125% x Medicaid HMO amount,5177,Other,125% of NY Medicaid HMO DRG,0.01,15961,
Disorders of gallbladder & biliary tract,284-2,APR-DRG,,,,,,,,inpatient,,,119435.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10654,,186% x Medicaid HMO amount,10654,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22870,,"27,634 x DRG Weight",22870,Other,DRG Base Rate x DRG Weight,19439,,"23,488 x DRG Weight",19439,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5728.21,,DRG base rate x DRG weight + capital per discharge,5728.21,Other,100% of NY Medicaid HMO DRG,5728,,DRG base rate x DRG weight + capital per discharge,5728,Other,100% of NY Medicaid HMO DRG,5728,,DRG base rate x DRG weight + capital per discharge,5728,Other,100% of NY Medicaid HMO DRG,5728,,DRG base rate x DRG weight + capital per discharge,5728,Other,100% of NY Medicaid HMO DRG,12888,,225% x Medicaid HMO amount,12888,Other,225% of NY Medicaid HMO DRG,8764,,153% x Medicaid HMO amount,8764,Other,153% of NY Medicaid HMO DRG,12888,,225% x Medicaid HMO amount,12888,Other,225% of NY Medicaid HMO DRG,8019,,140% x Medicaid HMO amount,8019,Other,140% of NY Medicaid HMO DRG,12888,,DRG base rate x DRG weight + capital per discharge,12888,Other,225% of NY Medicaid HMO DRG,15753,,275% x Medicaid HMO amount,15753,Other,275% of NY Medicaid HMO DRG,18559,,324% x Medicaid HMO amount,18559,Other,324% of NY Medicaid HMO DRG,12316,,215% x Medicaid HMO amount,12316,Other,215% of NY Medicaid HMO DRG,12316,,215% x Medicaid HMO amount,12316,Other,215% of NY Medicaid HMO DRG,7160,,125% x Medicaid HMO amount,7160,Other,125% of NY Medicaid HMO DRG,0.01,22870,
Disorders of gallbladder & biliary tract,284-3,APR-DRG,,,,,,,,inpatient,,,161164.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16446,,186% x Medicaid HMO amount,16446,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36419,,"27,634 x DRG Weight",36419,Other,DRG Base Rate x DRG Weight,30955,,"23,488 x DRG Weight",30955,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8842.21,,DRG base rate x DRG weight + capital per discharge,8842.21,Other,100% of NY Medicaid HMO DRG,8842,,DRG base rate x DRG weight + capital per discharge,8842,Other,100% of NY Medicaid HMO DRG,8842,,DRG base rate x DRG weight + capital per discharge,8842,Other,100% of NY Medicaid HMO DRG,8842,,DRG base rate x DRG weight + capital per discharge,8842,Other,100% of NY Medicaid HMO DRG,19895,,225% x Medicaid HMO amount,19895,Other,225% of NY Medicaid HMO DRG,13529,,153% x Medicaid HMO amount,13529,Other,153% of NY Medicaid HMO DRG,19895,,225% x Medicaid HMO amount,19895,Other,225% of NY Medicaid HMO DRG,12379,,140% x Medicaid HMO amount,12379,Other,140% of NY Medicaid HMO DRG,19895,,DRG base rate x DRG weight + capital per discharge,19895,Other,225% of NY Medicaid HMO DRG,24316,,275% x Medicaid HMO amount,24316,Other,275% of NY Medicaid HMO DRG,28649,,324% x Medicaid HMO amount,28649,Other,324% of NY Medicaid HMO DRG,19011,,215% x Medicaid HMO amount,19011,Other,215% of NY Medicaid HMO DRG,19011,,215% x Medicaid HMO amount,19011,Other,215% of NY Medicaid HMO DRG,11053,,125% x Medicaid HMO amount,11053,Other,125% of NY Medicaid HMO DRG,0.01,36419,
Disorders of gallbladder & biliary tract,284-4,APR-DRG,,,,,,,,inpatient,,,138819.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35891,,186% x Medicaid HMO amount,35891,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,81913,,"27,634 x DRG Weight",81913,Other,DRG Base Rate x DRG Weight,69623,,"23,488 x DRG Weight",69623,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19296.21,,DRG base rate x DRG weight + capital per discharge,19296.21,Other,100% of NY Medicaid HMO DRG,19296,,DRG base rate x DRG weight + capital per discharge,19296,Other,100% of NY Medicaid HMO DRG,19296,,DRG base rate x DRG weight + capital per discharge,19296,Other,100% of NY Medicaid HMO DRG,19296,,DRG base rate x DRG weight + capital per discharge,19296,Other,100% of NY Medicaid HMO DRG,43416,,225% x Medicaid HMO amount,43416,Other,225% of NY Medicaid HMO DRG,29523,,153% x Medicaid HMO amount,29523,Other,153% of NY Medicaid HMO DRG,43416,,225% x Medicaid HMO amount,43416,Other,225% of NY Medicaid HMO DRG,27015,,140% x Medicaid HMO amount,27015,Other,140% of NY Medicaid HMO DRG,43416,,DRG base rate x DRG weight + capital per discharge,43416,Other,225% of NY Medicaid HMO DRG,53065,,275% x Medicaid HMO amount,53065,Other,275% of NY Medicaid HMO DRG,62520,,324% x Medicaid HMO amount,62520,Other,324% of NY Medicaid HMO DRG,41487,,215% x Medicaid HMO amount,41487,Other,215% of NY Medicaid HMO DRG,41487,,215% x Medicaid HMO amount,41487,Other,215% of NY Medicaid HMO DRG,24120,,125% x Medicaid HMO amount,24120,Other,125% of NY Medicaid HMO DRG,0.01,81913,
Hip joint replacement,301-1,APR-DRG,,,,,,,,inpatient,,,205313.51,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22675,,186% x Medicaid HMO amount,22675,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,50996,,"27,634 x DRG Weight",50996,Other,DRG Base Rate x DRG Weight,43345,,"23,488 x DRG Weight",43345,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12191.21,,DRG base rate x DRG weight + capital per discharge,12191.21,Other,100% of NY Medicaid HMO DRG,12191,,DRG base rate x DRG weight + capital per discharge,12191,Other,100% of NY Medicaid HMO DRG,12191,,DRG base rate x DRG weight + capital per discharge,12191,Other,100% of NY Medicaid HMO DRG,12191,,DRG base rate x DRG weight + capital per discharge,12191,Other,100% of NY Medicaid HMO DRG,27430,,225% x Medicaid HMO amount,27430,Other,225% of NY Medicaid HMO DRG,18653,,153% x Medicaid HMO amount,18653,Other,153% of NY Medicaid HMO DRG,27430,,225% x Medicaid HMO amount,27430,Other,225% of NY Medicaid HMO DRG,17068,,140% x Medicaid HMO amount,17068,Other,140% of NY Medicaid HMO DRG,27430,,DRG base rate x DRG weight + capital per discharge,27430,Other,225% of NY Medicaid HMO DRG,33526,,275% x Medicaid HMO amount,33526,Other,275% of NY Medicaid HMO DRG,39500,,324% x Medicaid HMO amount,39500,Other,324% of NY Medicaid HMO DRG,26211,,215% x Medicaid HMO amount,26211,Other,215% of NY Medicaid HMO DRG,26211,,215% x Medicaid HMO amount,26211,Other,215% of NY Medicaid HMO DRG,15239,,125% x Medicaid HMO amount,15239,Other,125% of NY Medicaid HMO DRG,0.01,50996,
Hip joint replacement,301-2,APR-DRG,,,,,,,,inpatient,,,206062.91,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23533,,186% x Medicaid HMO amount,23533,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,52999,,"27,634 x DRG Weight",52999,Other,DRG Base Rate x DRG Weight,45048,,"23,488 x DRG Weight",45048,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12652.21,,DRG base rate x DRG weight + capital per discharge,12652.21,Other,100% of NY Medicaid HMO DRG,12652,,DRG base rate x DRG weight + capital per discharge,12652,Other,100% of NY Medicaid HMO DRG,12652,,DRG base rate x DRG weight + capital per discharge,12652,Other,100% of NY Medicaid HMO DRG,12652,,DRG base rate x DRG weight + capital per discharge,12652,Other,100% of NY Medicaid HMO DRG,28467,,225% x Medicaid HMO amount,28467,Other,225% of NY Medicaid HMO DRG,19358,,153% x Medicaid HMO amount,19358,Other,153% of NY Medicaid HMO DRG,28467,,225% x Medicaid HMO amount,28467,Other,225% of NY Medicaid HMO DRG,17713,,140% x Medicaid HMO amount,17713,Other,140% of NY Medicaid HMO DRG,28467,,DRG base rate x DRG weight + capital per discharge,28467,Other,225% of NY Medicaid HMO DRG,34794,,275% x Medicaid HMO amount,34794,Other,275% of NY Medicaid HMO DRG,40993,,324% x Medicaid HMO amount,40993,Other,324% of NY Medicaid HMO DRG,27202,,215% x Medicaid HMO amount,27202,Other,215% of NY Medicaid HMO DRG,27202,,215% x Medicaid HMO amount,27202,Other,215% of NY Medicaid HMO DRG,15815,,125% x Medicaid HMO amount,15815,Other,125% of NY Medicaid HMO DRG,0.01,52999,
Hip joint replacement,301-3,APR-DRG,,,,,,,,inpatient,,,534583.85,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30841,,186% x Medicaid HMO amount,30841,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70099,,"27,634 x DRG Weight",70099,Other,DRG Base Rate x DRG Weight,59582,,"23,488 x DRG Weight",59582,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16581.21,,DRG base rate x DRG weight + capital per discharge,16581.21,Other,100% of NY Medicaid HMO DRG,16581,,DRG base rate x DRG weight + capital per discharge,16581,Other,100% of NY Medicaid HMO DRG,16581,,DRG base rate x DRG weight + capital per discharge,16581,Other,100% of NY Medicaid HMO DRG,16581,,DRG base rate x DRG weight + capital per discharge,16581,Other,100% of NY Medicaid HMO DRG,37308,,225% x Medicaid HMO amount,37308,Other,225% of NY Medicaid HMO DRG,25369,,153% x Medicaid HMO amount,25369,Other,153% of NY Medicaid HMO DRG,37308,,225% x Medicaid HMO amount,37308,Other,225% of NY Medicaid HMO DRG,23214,,140% x Medicaid HMO amount,23214,Other,140% of NY Medicaid HMO DRG,37308,,DRG base rate x DRG weight + capital per discharge,37308,Other,225% of NY Medicaid HMO DRG,45598,,275% x Medicaid HMO amount,45598,Other,275% of NY Medicaid HMO DRG,53723,,324% x Medicaid HMO amount,53723,Other,324% of NY Medicaid HMO DRG,35650,,215% x Medicaid HMO amount,35650,Other,215% of NY Medicaid HMO DRG,35650,,215% x Medicaid HMO amount,35650,Other,215% of NY Medicaid HMO DRG,20727,,125% x Medicaid HMO amount,20727,Other,125% of NY Medicaid HMO DRG,0.01,70099,
Hip joint replacement,301-4,APR-DRG,,,,,,,,inpatient,,,1017525.91,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72380,,186% x Medicaid HMO amount,72380,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,167288,,"27,634 x DRG Weight",167288,Other,DRG Base Rate x DRG Weight,142189,,"23,488 x DRG Weight",142189,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38914.21,,DRG base rate x DRG weight + capital per discharge,38914.21,Other,100% of NY Medicaid HMO DRG,38914,,DRG base rate x DRG weight + capital per discharge,38914,Other,100% of NY Medicaid HMO DRG,38914,,DRG base rate x DRG weight + capital per discharge,38914,Other,100% of NY Medicaid HMO DRG,38914,,DRG base rate x DRG weight + capital per discharge,38914,Other,100% of NY Medicaid HMO DRG,87557,,225% x Medicaid HMO amount,87557,Other,225% of NY Medicaid HMO DRG,59539,,153% x Medicaid HMO amount,59539,Other,153% of NY Medicaid HMO DRG,87557,,225% x Medicaid HMO amount,87557,Other,225% of NY Medicaid HMO DRG,54480,,140% x Medicaid HMO amount,54480,Other,140% of NY Medicaid HMO DRG,87557,,DRG base rate x DRG weight + capital per discharge,87557,Other,225% of NY Medicaid HMO DRG,107014,,275% x Medicaid HMO amount,107014,Other,275% of NY Medicaid HMO DRG,126082,,324% x Medicaid HMO amount,126082,Other,324% of NY Medicaid HMO DRG,83666,,215% x Medicaid HMO amount,83666,Other,215% of NY Medicaid HMO DRG,83666,,215% x Medicaid HMO amount,83666,Other,215% of NY Medicaid HMO DRG,48643,,125% x Medicaid HMO amount,48643,Other,125% of NY Medicaid HMO DRG,0.01,167288,
Knee joint replacement,302-1,APR-DRG,,,,,,,,inpatient,,,156533.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21822,,186% x Medicaid HMO amount,21822,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48998,,"27,634 x DRG Weight",48998,Other,DRG Base Rate x DRG Weight,41647,,"23,488 x DRG Weight",41647,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11732.21,,DRG base rate x DRG weight + capital per discharge,11732.21,Other,100% of NY Medicaid HMO DRG,11732,,DRG base rate x DRG weight + capital per discharge,11732,Other,100% of NY Medicaid HMO DRG,11732,,DRG base rate x DRG weight + capital per discharge,11732,Other,100% of NY Medicaid HMO DRG,11732,,DRG base rate x DRG weight + capital per discharge,11732,Other,100% of NY Medicaid HMO DRG,26397,,225% x Medicaid HMO amount,26397,Other,225% of NY Medicaid HMO DRG,17950,,153% x Medicaid HMO amount,17950,Other,153% of NY Medicaid HMO DRG,26397,,225% x Medicaid HMO amount,26397,Other,225% of NY Medicaid HMO DRG,16425,,140% x Medicaid HMO amount,16425,Other,140% of NY Medicaid HMO DRG,26397,,DRG base rate x DRG weight + capital per discharge,26397,Other,225% of NY Medicaid HMO DRG,32264,,275% x Medicaid HMO amount,32264,Other,275% of NY Medicaid HMO DRG,38012,,324% x Medicaid HMO amount,38012,Other,324% of NY Medicaid HMO DRG,25224,,215% x Medicaid HMO amount,25224,Other,215% of NY Medicaid HMO DRG,25224,,215% x Medicaid HMO amount,25224,Other,215% of NY Medicaid HMO DRG,14665,,125% x Medicaid HMO amount,14665,Other,125% of NY Medicaid HMO DRG,0.01,48998,
Knee joint replacement,302-2,APR-DRG,,,,,,,,inpatient,,,205346.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24509,,186% x Medicaid HMO amount,24509,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,55285,,"27,634 x DRG Weight",55285,Other,DRG Base Rate x DRG Weight,46990,,"23,488 x DRG Weight",46990,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13177.21,,DRG base rate x DRG weight + capital per discharge,13177.21,Other,100% of NY Medicaid HMO DRG,13177,,DRG base rate x DRG weight + capital per discharge,13177,Other,100% of NY Medicaid HMO DRG,13177,,DRG base rate x DRG weight + capital per discharge,13177,Other,100% of NY Medicaid HMO DRG,13177,,DRG base rate x DRG weight + capital per discharge,13177,Other,100% of NY Medicaid HMO DRG,29649,,225% x Medicaid HMO amount,29649,Other,225% of NY Medicaid HMO DRG,20161,,153% x Medicaid HMO amount,20161,Other,153% of NY Medicaid HMO DRG,29649,,225% x Medicaid HMO amount,29649,Other,225% of NY Medicaid HMO DRG,18448,,140% x Medicaid HMO amount,18448,Other,140% of NY Medicaid HMO DRG,29649,,DRG base rate x DRG weight + capital per discharge,29649,Other,225% of NY Medicaid HMO DRG,36237,,275% x Medicaid HMO amount,36237,Other,275% of NY Medicaid HMO DRG,42694,,324% x Medicaid HMO amount,42694,Other,324% of NY Medicaid HMO DRG,28331,,215% x Medicaid HMO amount,28331,Other,215% of NY Medicaid HMO DRG,28331,,215% x Medicaid HMO amount,28331,Other,215% of NY Medicaid HMO DRG,16472,,125% x Medicaid HMO amount,16472,Other,125% of NY Medicaid HMO DRG,0.01,55285,
Knee joint replacement,302-3,APR-DRG,,,,,,,,inpatient,,,326053.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32693,,186% x Medicaid HMO amount,32693,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74435,,"27,634 x DRG Weight",74435,Other,DRG Base Rate x DRG Weight,63267,,"23,488 x DRG Weight",63267,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17577.21,,DRG base rate x DRG weight + capital per discharge,17577.21,Other,100% of NY Medicaid HMO DRG,17577,,DRG base rate x DRG weight + capital per discharge,17577,Other,100% of NY Medicaid HMO DRG,17577,,DRG base rate x DRG weight + capital per discharge,17577,Other,100% of NY Medicaid HMO DRG,17577,,DRG base rate x DRG weight + capital per discharge,17577,Other,100% of NY Medicaid HMO DRG,39549,,225% x Medicaid HMO amount,39549,Other,225% of NY Medicaid HMO DRG,26893,,153% x Medicaid HMO amount,26893,Other,153% of NY Medicaid HMO DRG,39549,,225% x Medicaid HMO amount,39549,Other,225% of NY Medicaid HMO DRG,24608,,140% x Medicaid HMO amount,24608,Other,140% of NY Medicaid HMO DRG,39549,,DRG base rate x DRG weight + capital per discharge,39549,Other,225% of NY Medicaid HMO DRG,48337,,275% x Medicaid HMO amount,48337,Other,275% of NY Medicaid HMO DRG,56950,,324% x Medicaid HMO amount,56950,Other,324% of NY Medicaid HMO DRG,37791,,215% x Medicaid HMO amount,37791,Other,215% of NY Medicaid HMO DRG,37791,,215% x Medicaid HMO amount,37791,Other,215% of NY Medicaid HMO DRG,21972,,125% x Medicaid HMO amount,21972,Other,125% of NY Medicaid HMO DRG,0.01,74435,
Knee joint replacement,302-4,APR-DRG,,,,,,,,inpatient,,,326053.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65165,,186% x Medicaid HMO amount,65165,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,150406,,"27,634 x DRG Weight",150406,Other,DRG Base Rate x DRG Weight,127840,,"23,488 x DRG Weight",127840,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35035.21,,DRG base rate x DRG weight + capital per discharge,35035.21,Other,100% of NY Medicaid HMO DRG,35035,,DRG base rate x DRG weight + capital per discharge,35035,Other,100% of NY Medicaid HMO DRG,35035,,DRG base rate x DRG weight + capital per discharge,35035,Other,100% of NY Medicaid HMO DRG,35035,,DRG base rate x DRG weight + capital per discharge,35035,Other,100% of NY Medicaid HMO DRG,78829,,225% x Medicaid HMO amount,78829,Other,225% of NY Medicaid HMO DRG,53604,,153% x Medicaid HMO amount,53604,Other,153% of NY Medicaid HMO DRG,78829,,225% x Medicaid HMO amount,78829,Other,225% of NY Medicaid HMO DRG,49049,,140% x Medicaid HMO amount,49049,Other,140% of NY Medicaid HMO DRG,78829,,DRG base rate x DRG weight + capital per discharge,78829,Other,225% of NY Medicaid HMO DRG,96347,,275% x Medicaid HMO amount,96347,Other,275% of NY Medicaid HMO DRG,113514,,324% x Medicaid HMO amount,113514,Other,324% of NY Medicaid HMO DRG,75326,,215% x Medicaid HMO amount,75326,Other,215% of NY Medicaid HMO DRG,75326,,215% x Medicaid HMO amount,75326,Other,215% of NY Medicaid HMO DRG,43794,,125% x Medicaid HMO amount,43794,Other,125% of NY Medicaid HMO DRG,0.01,150406,
Dorsal & lumbar fusion proc for curvature of back,303-1,APR-DRG,,,,,,,,inpatient,,,381245.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53083,,186% x Medicaid HMO amount,53083,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,122137,,"27,634 x DRG Weight",122137,Other,DRG Base Rate x DRG Weight,103812,,"23,488 x DRG Weight",103812,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28539.21,,DRG base rate x DRG weight + capital per discharge,28539.21,Other,100% of NY Medicaid HMO DRG,28539,,DRG base rate x DRG weight + capital per discharge,28539,Other,100% of NY Medicaid HMO DRG,28539,,DRG base rate x DRG weight + capital per discharge,28539,Other,100% of NY Medicaid HMO DRG,28539,,DRG base rate x DRG weight + capital per discharge,28539,Other,100% of NY Medicaid HMO DRG,64213,,225% x Medicaid HMO amount,64213,Other,225% of NY Medicaid HMO DRG,43665,,153% x Medicaid HMO amount,43665,Other,153% of NY Medicaid HMO DRG,64213,,225% x Medicaid HMO amount,64213,Other,225% of NY Medicaid HMO DRG,39955,,140% x Medicaid HMO amount,39955,Other,140% of NY Medicaid HMO DRG,64213,,DRG base rate x DRG weight + capital per discharge,64213,Other,225% of NY Medicaid HMO DRG,78483,,275% x Medicaid HMO amount,78483,Other,275% of NY Medicaid HMO DRG,92467,,324% x Medicaid HMO amount,92467,Other,324% of NY Medicaid HMO DRG,61359,,215% x Medicaid HMO amount,61359,Other,215% of NY Medicaid HMO DRG,61359,,215% x Medicaid HMO amount,61359,Other,215% of NY Medicaid HMO DRG,35674,,125% x Medicaid HMO amount,35674,Other,125% of NY Medicaid HMO DRG,0.01,122137,
Dorsal & lumbar fusion proc for curvature of back,303-2,APR-DRG,,,,,,,,inpatient,,,475680.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63340,,186% x Medicaid HMO amount,63340,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,146140,,"27,634 x DRG Weight",146140,Other,DRG Base Rate x DRG Weight,124214,,"23,488 x DRG Weight",124214,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34054.21,,DRG base rate x DRG weight + capital per discharge,34054.21,Other,100% of NY Medicaid HMO DRG,34054,,DRG base rate x DRG weight + capital per discharge,34054,Other,100% of NY Medicaid HMO DRG,34054,,DRG base rate x DRG weight + capital per discharge,34054,Other,100% of NY Medicaid HMO DRG,34054,,DRG base rate x DRG weight + capital per discharge,34054,Other,100% of NY Medicaid HMO DRG,76622,,225% x Medicaid HMO amount,76622,Other,225% of NY Medicaid HMO DRG,52103,,153% x Medicaid HMO amount,52103,Other,153% of NY Medicaid HMO DRG,76622,,225% x Medicaid HMO amount,76622,Other,225% of NY Medicaid HMO DRG,47676,,140% x Medicaid HMO amount,47676,Other,140% of NY Medicaid HMO DRG,76622,,DRG base rate x DRG weight + capital per discharge,76622,Other,225% of NY Medicaid HMO DRG,93649,,275% x Medicaid HMO amount,93649,Other,275% of NY Medicaid HMO DRG,110336,,324% x Medicaid HMO amount,110336,Other,324% of NY Medicaid HMO DRG,73217,,215% x Medicaid HMO amount,73217,Other,215% of NY Medicaid HMO DRG,73217,,215% x Medicaid HMO amount,73217,Other,215% of NY Medicaid HMO DRG,42568,,125% x Medicaid HMO amount,42568,Other,125% of NY Medicaid HMO DRG,0.01,146140,
Dorsal & lumbar fusion proc for curvature of back,303-3,APR-DRG,,,,,,,,inpatient,,,920228.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,83415,,186% x Medicaid HMO amount,83415,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,193106,,"27,634 x DRG Weight",193106,Other,DRG Base Rate x DRG Weight,164134,,"23,488 x DRG Weight",164134,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44847.21,,DRG base rate x DRG weight + capital per discharge,44847.21,Other,100% of NY Medicaid HMO DRG,44847,,DRG base rate x DRG weight + capital per discharge,44847,Other,100% of NY Medicaid HMO DRG,44847,,DRG base rate x DRG weight + capital per discharge,44847,Other,100% of NY Medicaid HMO DRG,44847,,DRG base rate x DRG weight + capital per discharge,44847,Other,100% of NY Medicaid HMO DRG,100906,,225% x Medicaid HMO amount,100906,Other,225% of NY Medicaid HMO DRG,68616,,153% x Medicaid HMO amount,68616,Other,153% of NY Medicaid HMO DRG,100906,,225% x Medicaid HMO amount,100906,Other,225% of NY Medicaid HMO DRG,62786,,140% x Medicaid HMO amount,62786,Other,140% of NY Medicaid HMO DRG,100906,,DRG base rate x DRG weight + capital per discharge,100906,Other,225% of NY Medicaid HMO DRG,123330,,275% x Medicaid HMO amount,123330,Other,275% of NY Medicaid HMO DRG,145305,,324% x Medicaid HMO amount,145305,Other,324% of NY Medicaid HMO DRG,96422,,215% x Medicaid HMO amount,96422,Other,215% of NY Medicaid HMO DRG,96422,,215% x Medicaid HMO amount,96422,Other,215% of NY Medicaid HMO DRG,56059,,125% x Medicaid HMO amount,56059,Other,125% of NY Medicaid HMO DRG,0.01,193106,
Dorsal & lumbar fusion proc for curvature of back,303-4,APR-DRG,,,,,,,,inpatient,,,720917.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,129555,,186% x Medicaid HMO amount,129555,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,301059,,"27,634 x DRG Weight",301059,Other,DRG Base Rate x DRG Weight,255890,,"23,488 x DRG Weight",255890,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69653.21,,DRG base rate x DRG weight + capital per discharge,69653.21,Other,100% of NY Medicaid HMO DRG,69653,,DRG base rate x DRG weight + capital per discharge,69653,Other,100% of NY Medicaid HMO DRG,69653,,DRG base rate x DRG weight + capital per discharge,69653,Other,100% of NY Medicaid HMO DRG,69653,,DRG base rate x DRG weight + capital per discharge,69653,Other,100% of NY Medicaid HMO DRG,156720,,225% x Medicaid HMO amount,156720,Other,225% of NY Medicaid HMO DRG,106569,,153% x Medicaid HMO amount,106569,Other,153% of NY Medicaid HMO DRG,156720,,225% x Medicaid HMO amount,156720,Other,225% of NY Medicaid HMO DRG,97514,,140% x Medicaid HMO amount,97514,Other,140% of NY Medicaid HMO DRG,156720,,DRG base rate x DRG weight + capital per discharge,156720,Other,225% of NY Medicaid HMO DRG,191546,,275% x Medicaid HMO amount,191546,Other,275% of NY Medicaid HMO DRG,225676,,324% x Medicaid HMO amount,225676,Other,324% of NY Medicaid HMO DRG,149754,,215% x Medicaid HMO amount,149754,Other,215% of NY Medicaid HMO DRG,149754,,215% x Medicaid HMO amount,149754,Other,215% of NY Medicaid HMO DRG,87067,,125% x Medicaid HMO amount,87067,Other,125% of NY Medicaid HMO DRG,0.01,301059,
Dorsal & lumbar fusion proc except for curvature of back,304-1,APR-DRG,,,,,,,,inpatient,,,370295.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37094,,186% x Medicaid HMO amount,37094,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,84729,,"27,634 x DRG Weight",84729,Other,DRG Base Rate x DRG Weight,72017,,"23,488 x DRG Weight",72017,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19943.21,,DRG base rate x DRG weight + capital per discharge,19943.21,Other,100% of NY Medicaid HMO DRG,19943,,DRG base rate x DRG weight + capital per discharge,19943,Other,100% of NY Medicaid HMO DRG,19943,,DRG base rate x DRG weight + capital per discharge,19943,Other,100% of NY Medicaid HMO DRG,19943,,DRG base rate x DRG weight + capital per discharge,19943,Other,100% of NY Medicaid HMO DRG,44872,,225% x Medicaid HMO amount,44872,Other,225% of NY Medicaid HMO DRG,30513,,153% x Medicaid HMO amount,30513,Other,153% of NY Medicaid HMO DRG,44872,,225% x Medicaid HMO amount,44872,Other,225% of NY Medicaid HMO DRG,27920,,140% x Medicaid HMO amount,27920,Other,140% of NY Medicaid HMO DRG,44872,,DRG base rate x DRG weight + capital per discharge,44872,Other,225% of NY Medicaid HMO DRG,54844,,275% x Medicaid HMO amount,54844,Other,275% of NY Medicaid HMO DRG,64616,,324% x Medicaid HMO amount,64616,Other,324% of NY Medicaid HMO DRG,42878,,215% x Medicaid HMO amount,42878,Other,215% of NY Medicaid HMO DRG,42878,,215% x Medicaid HMO amount,42878,Other,215% of NY Medicaid HMO DRG,24929,,125% x Medicaid HMO amount,24929,Other,125% of NY Medicaid HMO DRG,0.01,84729,
Dorsal & lumbar fusion proc except for curvature of back,304-2,APR-DRG,,,,,,,,inpatient,,,431640.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44992,,186% x Medicaid HMO amount,44992,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,103207,,"27,634 x DRG Weight",103207,Other,DRG Base Rate x DRG Weight,87723,,"23,488 x DRG Weight",87723,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24189.21,,DRG base rate x DRG weight + capital per discharge,24189.21,Other,100% of NY Medicaid HMO DRG,24189,,DRG base rate x DRG weight + capital per discharge,24189,Other,100% of NY Medicaid HMO DRG,24189,,DRG base rate x DRG weight + capital per discharge,24189,Other,100% of NY Medicaid HMO DRG,24189,,DRG base rate x DRG weight + capital per discharge,24189,Other,100% of NY Medicaid HMO DRG,54426,,225% x Medicaid HMO amount,54426,Other,225% of NY Medicaid HMO DRG,37009,,153% x Medicaid HMO amount,37009,Other,153% of NY Medicaid HMO DRG,54426,,225% x Medicaid HMO amount,54426,Other,225% of NY Medicaid HMO DRG,33865,,140% x Medicaid HMO amount,33865,Other,140% of NY Medicaid HMO DRG,54426,,DRG base rate x DRG weight + capital per discharge,54426,Other,225% of NY Medicaid HMO DRG,66520,,275% x Medicaid HMO amount,66520,Other,275% of NY Medicaid HMO DRG,78373,,324% x Medicaid HMO amount,78373,Other,324% of NY Medicaid HMO DRG,52007,,215% x Medicaid HMO amount,52007,Other,215% of NY Medicaid HMO DRG,52007,,215% x Medicaid HMO amount,52007,Other,215% of NY Medicaid HMO DRG,30237,,125% x Medicaid HMO amount,30237,Other,125% of NY Medicaid HMO DRG,0.01,103207,
Dorsal & lumbar fusion proc except for curvature of back,304-3,APR-DRG,,,,,,,,inpatient,,,556856,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63804,,186% x Medicaid HMO amount,63804,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,147223,,"27,634 x DRG Weight",147223,Other,DRG Base Rate x DRG Weight,125135,,"23,488 x DRG Weight",125135,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34303.21,,DRG base rate x DRG weight + capital per discharge,34303.21,Other,100% of NY Medicaid HMO DRG,34303,,DRG base rate x DRG weight + capital per discharge,34303,Other,100% of NY Medicaid HMO DRG,34303,,DRG base rate x DRG weight + capital per discharge,34303,Other,100% of NY Medicaid HMO DRG,34303,,DRG base rate x DRG weight + capital per discharge,34303,Other,100% of NY Medicaid HMO DRG,77182,,225% x Medicaid HMO amount,77182,Other,225% of NY Medicaid HMO DRG,52484,,153% x Medicaid HMO amount,52484,Other,153% of NY Medicaid HMO DRG,77182,,225% x Medicaid HMO amount,77182,Other,225% of NY Medicaid HMO DRG,48024,,140% x Medicaid HMO amount,48024,Other,140% of NY Medicaid HMO DRG,77182,,DRG base rate x DRG weight + capital per discharge,77182,Other,225% of NY Medicaid HMO DRG,94334,,275% x Medicaid HMO amount,94334,Other,275% of NY Medicaid HMO DRG,111142,,324% x Medicaid HMO amount,111142,Other,324% of NY Medicaid HMO DRG,73752,,215% x Medicaid HMO amount,73752,Other,215% of NY Medicaid HMO DRG,73752,,215% x Medicaid HMO amount,73752,Other,215% of NY Medicaid HMO DRG,42879,,125% x Medicaid HMO amount,42879,Other,125% of NY Medicaid HMO DRG,0.01,147223,
Dorsal & lumbar fusion proc except for curvature of back,304-4,APR-DRG,,,,,,,,inpatient,,,853371.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,109331,,186% x Medicaid HMO amount,109331,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,253741,,"27,634 x DRG Weight",253741,Other,DRG Base Rate x DRG Weight,215672,,"23,488 x DRG Weight",215672,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58780.21,,DRG base rate x DRG weight + capital per discharge,58780.21,Other,100% of NY Medicaid HMO DRG,58780,,DRG base rate x DRG weight + capital per discharge,58780,Other,100% of NY Medicaid HMO DRG,58780,,DRG base rate x DRG weight + capital per discharge,58780,Other,100% of NY Medicaid HMO DRG,58780,,DRG base rate x DRG weight + capital per discharge,58780,Other,100% of NY Medicaid HMO DRG,132255,,225% x Medicaid HMO amount,132255,Other,225% of NY Medicaid HMO DRG,89934,,153% x Medicaid HMO amount,89934,Other,153% of NY Medicaid HMO DRG,132255,,225% x Medicaid HMO amount,132255,Other,225% of NY Medicaid HMO DRG,82292,,140% x Medicaid HMO amount,82292,Other,140% of NY Medicaid HMO DRG,132255,,DRG base rate x DRG weight + capital per discharge,132255,Other,225% of NY Medicaid HMO DRG,161646,,275% x Medicaid HMO amount,161646,Other,275% of NY Medicaid HMO DRG,190448,,324% x Medicaid HMO amount,190448,Other,324% of NY Medicaid HMO DRG,126377,,215% x Medicaid HMO amount,126377,Other,215% of NY Medicaid HMO DRG,126377,,215% x Medicaid HMO amount,126377,Other,215% of NY Medicaid HMO DRG,73475,,125% x Medicaid HMO amount,73475,Other,125% of NY Medicaid HMO DRG,0.01,253741,
Amputation of lower limb except toes,305-1,APR-DRG,,,,,,,,inpatient,,,201582.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16958,,186% x Medicaid HMO amount,16958,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37615,,"27,634 x DRG Weight",37615,Other,DRG Base Rate x DRG Weight,31972,,"23,488 x DRG Weight",31972,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9117.21,,DRG base rate x DRG weight + capital per discharge,9117.21,Other,100% of NY Medicaid HMO DRG,9117,,DRG base rate x DRG weight + capital per discharge,9117,Other,100% of NY Medicaid HMO DRG,9117,,DRG base rate x DRG weight + capital per discharge,9117,Other,100% of NY Medicaid HMO DRG,9117,,DRG base rate x DRG weight + capital per discharge,9117,Other,100% of NY Medicaid HMO DRG,20514,,225% x Medicaid HMO amount,20514,Other,225% of NY Medicaid HMO DRG,13949,,153% x Medicaid HMO amount,13949,Other,153% of NY Medicaid HMO DRG,20514,,225% x Medicaid HMO amount,20514,Other,225% of NY Medicaid HMO DRG,12764,,140% x Medicaid HMO amount,12764,Other,140% of NY Medicaid HMO DRG,20514,,DRG base rate x DRG weight + capital per discharge,20514,Other,225% of NY Medicaid HMO DRG,25072,,275% x Medicaid HMO amount,25072,Other,275% of NY Medicaid HMO DRG,29540,,324% x Medicaid HMO amount,29540,Other,324% of NY Medicaid HMO DRG,19602,,215% x Medicaid HMO amount,19602,Other,215% of NY Medicaid HMO DRG,19602,,215% x Medicaid HMO amount,19602,Other,215% of NY Medicaid HMO DRG,11397,,125% x Medicaid HMO amount,11397,Other,125% of NY Medicaid HMO DRG,0.01,37615,
Amputation of lower limb except toes,305-2,APR-DRG,,,,,,,,inpatient,,,503908.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23522,,186% x Medicaid HMO amount,23522,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,52977,,"27,634 x DRG Weight",52977,Other,DRG Base Rate x DRG Weight,45029,,"23,488 x DRG Weight",45029,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12646.21,,DRG base rate x DRG weight + capital per discharge,12646.21,Other,100% of NY Medicaid HMO DRG,12646,,DRG base rate x DRG weight + capital per discharge,12646,Other,100% of NY Medicaid HMO DRG,12646,,DRG base rate x DRG weight + capital per discharge,12646,Other,100% of NY Medicaid HMO DRG,12646,,DRG base rate x DRG weight + capital per discharge,12646,Other,100% of NY Medicaid HMO DRG,28454,,225% x Medicaid HMO amount,28454,Other,225% of NY Medicaid HMO DRG,19349,,153% x Medicaid HMO amount,19349,Other,153% of NY Medicaid HMO DRG,28454,,225% x Medicaid HMO amount,28454,Other,225% of NY Medicaid HMO DRG,17705,,140% x Medicaid HMO amount,17705,Other,140% of NY Medicaid HMO DRG,28454,,DRG base rate x DRG weight + capital per discharge,28454,Other,225% of NY Medicaid HMO DRG,34777,,275% x Medicaid HMO amount,34777,Other,275% of NY Medicaid HMO DRG,40974,,324% x Medicaid HMO amount,40974,Other,324% of NY Medicaid HMO DRG,27189,,215% x Medicaid HMO amount,27189,Other,215% of NY Medicaid HMO DRG,27189,,215% x Medicaid HMO amount,27189,Other,215% of NY Medicaid HMO DRG,15808,,125% x Medicaid HMO amount,15808,Other,125% of NY Medicaid HMO DRG,0.01,52977,
Amputation of lower limb except toes,305-3,APR-DRG,,,,,,,,inpatient,,,482034.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40823,,186% x Medicaid HMO amount,40823,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,93455,,"27,634 x DRG Weight",93455,Other,DRG Base Rate x DRG Weight,79434,,"23,488 x DRG Weight",79434,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21948.21,,DRG base rate x DRG weight + capital per discharge,21948.21,Other,100% of NY Medicaid HMO DRG,21948,,DRG base rate x DRG weight + capital per discharge,21948,Other,100% of NY Medicaid HMO DRG,21948,,DRG base rate x DRG weight + capital per discharge,21948,Other,100% of NY Medicaid HMO DRG,21948,,DRG base rate x DRG weight + capital per discharge,21948,Other,100% of NY Medicaid HMO DRG,49383,,225% x Medicaid HMO amount,49383,Other,225% of NY Medicaid HMO DRG,33581,,153% x Medicaid HMO amount,33581,Other,153% of NY Medicaid HMO DRG,49383,,225% x Medicaid HMO amount,49383,Other,225% of NY Medicaid HMO DRG,30727,,140% x Medicaid HMO amount,30727,Other,140% of NY Medicaid HMO DRG,49383,,DRG base rate x DRG weight + capital per discharge,49383,Other,225% of NY Medicaid HMO DRG,60358,,275% x Medicaid HMO amount,60358,Other,275% of NY Medicaid HMO DRG,71112,,324% x Medicaid HMO amount,71112,Other,324% of NY Medicaid HMO DRG,47189,,215% x Medicaid HMO amount,47189,Other,215% of NY Medicaid HMO DRG,47189,,215% x Medicaid HMO amount,47189,Other,215% of NY Medicaid HMO DRG,27435,,125% x Medicaid HMO amount,27435,Other,125% of NY Medicaid HMO DRG,0.01,93455,
Amputation of lower limb except toes,305-4,APR-DRG,,,,,,,,inpatient,,,684953.3,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75310,,186% x Medicaid HMO amount,75310,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,174144,,"27,634 x DRG Weight",174144,Other,DRG Base Rate x DRG Weight,148017,,"23,488 x DRG Weight",148017,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40489.21,,DRG base rate x DRG weight + capital per discharge,40489.21,Other,100% of NY Medicaid HMO DRG,40489,,DRG base rate x DRG weight + capital per discharge,40489,Other,100% of NY Medicaid HMO DRG,40489,,DRG base rate x DRG weight + capital per discharge,40489,Other,100% of NY Medicaid HMO DRG,40489,,DRG base rate x DRG weight + capital per discharge,40489,Other,100% of NY Medicaid HMO DRG,91101,,225% x Medicaid HMO amount,91101,Other,225% of NY Medicaid HMO DRG,61948,,153% x Medicaid HMO amount,61948,Other,153% of NY Medicaid HMO DRG,91101,,225% x Medicaid HMO amount,91101,Other,225% of NY Medicaid HMO DRG,56685,,140% x Medicaid HMO amount,56685,Other,140% of NY Medicaid HMO DRG,91101,,DRG base rate x DRG weight + capital per discharge,91101,Other,225% of NY Medicaid HMO DRG,111345,,275% x Medicaid HMO amount,111345,Other,275% of NY Medicaid HMO DRG,131185,,324% x Medicaid HMO amount,131185,Other,324% of NY Medicaid HMO DRG,87052,,215% x Medicaid HMO amount,87052,Other,215% of NY Medicaid HMO DRG,87052,,215% x Medicaid HMO amount,87052,Other,215% of NY Medicaid HMO DRG,50612,,125% x Medicaid HMO amount,50612,Other,125% of NY Medicaid HMO DRG,0.01,174144,
Hip and femur fracture repair,308-1,APR-DRG,,,,,,,,inpatient,,,178777.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16654,,186% x Medicaid HMO amount,16654,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36908,,"27,634 x DRG Weight",36908,Other,DRG Base Rate x DRG Weight,31371,,"23,488 x DRG Weight",31371,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8954.21,,DRG base rate x DRG weight + capital per discharge,8954.21,Other,100% of NY Medicaid HMO DRG,8954,,DRG base rate x DRG weight + capital per discharge,8954,Other,100% of NY Medicaid HMO DRG,8954,,DRG base rate x DRG weight + capital per discharge,8954,Other,100% of NY Medicaid HMO DRG,8954,,DRG base rate x DRG weight + capital per discharge,8954,Other,100% of NY Medicaid HMO DRG,20147,,225% x Medicaid HMO amount,20147,Other,225% of NY Medicaid HMO DRG,13700,,153% x Medicaid HMO amount,13700,Other,153% of NY Medicaid HMO DRG,20147,,225% x Medicaid HMO amount,20147,Other,225% of NY Medicaid HMO DRG,12536,,140% x Medicaid HMO amount,12536,Other,140% of NY Medicaid HMO DRG,20147,,DRG base rate x DRG weight + capital per discharge,20147,Other,225% of NY Medicaid HMO DRG,24624,,275% x Medicaid HMO amount,24624,Other,275% of NY Medicaid HMO DRG,29012,,324% x Medicaid HMO amount,29012,Other,324% of NY Medicaid HMO DRG,19252,,215% x Medicaid HMO amount,19252,Other,215% of NY Medicaid HMO DRG,19252,,215% x Medicaid HMO amount,19252,Other,215% of NY Medicaid HMO DRG,11193,,125% x Medicaid HMO amount,11193,Other,125% of NY Medicaid HMO DRG,0.01,36908,
Hip and femur fracture repair,308-2,APR-DRG,,,,,,,,inpatient,,,202004.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22597,,186% x Medicaid HMO amount,22597,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,50813,,"27,634 x DRG Weight",50813,Other,DRG Base Rate x DRG Weight,43190,,"23,488 x DRG Weight",43190,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12149.21,,DRG base rate x DRG weight + capital per discharge,12149.21,Other,100% of NY Medicaid HMO DRG,12149,,DRG base rate x DRG weight + capital per discharge,12149,Other,100% of NY Medicaid HMO DRG,12149,,DRG base rate x DRG weight + capital per discharge,12149,Other,100% of NY Medicaid HMO DRG,12149,,DRG base rate x DRG weight + capital per discharge,12149,Other,100% of NY Medicaid HMO DRG,27336,,225% x Medicaid HMO amount,27336,Other,225% of NY Medicaid HMO DRG,18588,,153% x Medicaid HMO amount,18588,Other,153% of NY Medicaid HMO DRG,27336,,225% x Medicaid HMO amount,27336,Other,225% of NY Medicaid HMO DRG,17009,,140% x Medicaid HMO amount,17009,Other,140% of NY Medicaid HMO DRG,27336,,DRG base rate x DRG weight + capital per discharge,27336,Other,225% of NY Medicaid HMO DRG,33410,,275% x Medicaid HMO amount,33410,Other,275% of NY Medicaid HMO DRG,39363,,324% x Medicaid HMO amount,39363,Other,324% of NY Medicaid HMO DRG,26121,,215% x Medicaid HMO amount,26121,Other,215% of NY Medicaid HMO DRG,26121,,215% x Medicaid HMO amount,26121,Other,215% of NY Medicaid HMO DRG,15187,,125% x Medicaid HMO amount,15187,Other,125% of NY Medicaid HMO DRG,0.01,50813,
Hip and femur fracture repair,308-3,APR-DRG,,,,,,,,inpatient,,,349123.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33309,,186% x Medicaid HMO amount,33309,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75875,,"27,634 x DRG Weight",75875,Other,DRG Base Rate x DRG Weight,64491,,"23,488 x DRG Weight",64491,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17908.21,,DRG base rate x DRG weight + capital per discharge,17908.21,Other,100% of NY Medicaid HMO DRG,17908,,DRG base rate x DRG weight + capital per discharge,17908,Other,100% of NY Medicaid HMO DRG,17908,,DRG base rate x DRG weight + capital per discharge,17908,Other,100% of NY Medicaid HMO DRG,17908,,DRG base rate x DRG weight + capital per discharge,17908,Other,100% of NY Medicaid HMO DRG,40293,,225% x Medicaid HMO amount,40293,Other,225% of NY Medicaid HMO DRG,27400,,153% x Medicaid HMO amount,27400,Other,153% of NY Medicaid HMO DRG,40293,,225% x Medicaid HMO amount,40293,Other,225% of NY Medicaid HMO DRG,25071,,140% x Medicaid HMO amount,25071,Other,140% of NY Medicaid HMO DRG,40293,,DRG base rate x DRG weight + capital per discharge,40293,Other,225% of NY Medicaid HMO DRG,49248,,275% x Medicaid HMO amount,49248,Other,275% of NY Medicaid HMO DRG,58023,,324% x Medicaid HMO amount,58023,Other,324% of NY Medicaid HMO DRG,38503,,215% x Medicaid HMO amount,38503,Other,215% of NY Medicaid HMO DRG,38503,,215% x Medicaid HMO amount,38503,Other,215% of NY Medicaid HMO DRG,22385,,125% x Medicaid HMO amount,22385,Other,125% of NY Medicaid HMO DRG,0.01,75875,
Hip and femur fracture repair,308-4,APR-DRG,,,,,,,,inpatient,,,493957.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69015,,186% x Medicaid HMO amount,69015,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,159415,,"27,634 x DRG Weight",159415,Other,DRG Base Rate x DRG Weight,135498,,"23,488 x DRG Weight",135498,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37105.21,,DRG base rate x DRG weight + capital per discharge,37105.21,Other,100% of NY Medicaid HMO DRG,37105,,DRG base rate x DRG weight + capital per discharge,37105,Other,100% of NY Medicaid HMO DRG,37105,,DRG base rate x DRG weight + capital per discharge,37105,Other,100% of NY Medicaid HMO DRG,37105,,DRG base rate x DRG weight + capital per discharge,37105,Other,100% of NY Medicaid HMO DRG,83487,,225% x Medicaid HMO amount,83487,Other,225% of NY Medicaid HMO DRG,56771,,153% x Medicaid HMO amount,56771,Other,153% of NY Medicaid HMO DRG,83487,,225% x Medicaid HMO amount,83487,Other,225% of NY Medicaid HMO DRG,51947,,140% x Medicaid HMO amount,51947,Other,140% of NY Medicaid HMO DRG,83487,,DRG base rate x DRG weight + capital per discharge,83487,Other,225% of NY Medicaid HMO DRG,102039,,275% x Medicaid HMO amount,102039,Other,275% of NY Medicaid HMO DRG,120221,,324% x Medicaid HMO amount,120221,Other,324% of NY Medicaid HMO DRG,79776,,215% x Medicaid HMO amount,79776,Other,215% of NY Medicaid HMO DRG,79776,,215% x Medicaid HMO amount,79776,Other,215% of NY Medicaid HMO DRG,46382,,125% x Medicaid HMO amount,46382,Other,125% of NY Medicaid HMO DRG,0.01,159415,
Other significant hip and femur surgery,309-1,APR-DRG,,,,,,,,inpatient,,,188202.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15589,,186% x Medicaid HMO amount,15589,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34415,,"27,634 x DRG Weight",34415,Other,DRG Base Rate x DRG Weight,29252,,"23,488 x DRG Weight",29252,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8381.21,,DRG base rate x DRG weight + capital per discharge,8381.21,Other,100% of NY Medicaid HMO DRG,8381,,DRG base rate x DRG weight + capital per discharge,8381,Other,100% of NY Medicaid HMO DRG,8381,,DRG base rate x DRG weight + capital per discharge,8381,Other,100% of NY Medicaid HMO DRG,8381,,DRG base rate x DRG weight + capital per discharge,8381,Other,100% of NY Medicaid HMO DRG,18858,,225% x Medicaid HMO amount,18858,Other,225% of NY Medicaid HMO DRG,12823,,153% x Medicaid HMO amount,12823,Other,153% of NY Medicaid HMO DRG,18858,,225% x Medicaid HMO amount,18858,Other,225% of NY Medicaid HMO DRG,11734,,140% x Medicaid HMO amount,11734,Other,140% of NY Medicaid HMO DRG,18858,,DRG base rate x DRG weight + capital per discharge,18858,Other,225% of NY Medicaid HMO DRG,23048,,275% x Medicaid HMO amount,23048,Other,275% of NY Medicaid HMO DRG,27155,,324% x Medicaid HMO amount,27155,Other,324% of NY Medicaid HMO DRG,18020,,215% x Medicaid HMO amount,18020,Other,215% of NY Medicaid HMO DRG,18020,,215% x Medicaid HMO amount,18020,Other,215% of NY Medicaid HMO DRG,10477,,125% x Medicaid HMO amount,10477,Other,125% of NY Medicaid HMO DRG,0.01,34415,
Other significant hip and femur surgery,309-2,APR-DRG,,,,,,,,inpatient,,,202463.54,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23023,,186% x Medicaid HMO amount,23023,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51808,,"27,634 x DRG Weight",51808,Other,DRG Base Rate x DRG Weight,44035,,"23,488 x DRG Weight",44035,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12378.21,,DRG base rate x DRG weight + capital per discharge,12378.21,Other,100% of NY Medicaid HMO DRG,12378,,DRG base rate x DRG weight + capital per discharge,12378,Other,100% of NY Medicaid HMO DRG,12378,,DRG base rate x DRG weight + capital per discharge,12378,Other,100% of NY Medicaid HMO DRG,12378,,DRG base rate x DRG weight + capital per discharge,12378,Other,100% of NY Medicaid HMO DRG,27851,,225% x Medicaid HMO amount,27851,Other,225% of NY Medicaid HMO DRG,18939,,153% x Medicaid HMO amount,18939,Other,153% of NY Medicaid HMO DRG,27851,,225% x Medicaid HMO amount,27851,Other,225% of NY Medicaid HMO DRG,17329,,140% x Medicaid HMO amount,17329,Other,140% of NY Medicaid HMO DRG,27851,,DRG base rate x DRG weight + capital per discharge,27851,Other,225% of NY Medicaid HMO DRG,34040,,275% x Medicaid HMO amount,34040,Other,275% of NY Medicaid HMO DRG,40105,,324% x Medicaid HMO amount,40105,Other,324% of NY Medicaid HMO DRG,26613,,215% x Medicaid HMO amount,26613,Other,215% of NY Medicaid HMO DRG,26613,,215% x Medicaid HMO amount,26613,Other,215% of NY Medicaid HMO DRG,15473,,125% x Medicaid HMO amount,15473,Other,125% of NY Medicaid HMO DRG,0.01,51808,
Other significant hip and femur surgery,309-3,APR-DRG,,,,,,,,inpatient,,,714745.36,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36571,,186% x Medicaid HMO amount,36571,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,83507,,"27,634 x DRG Weight",83507,Other,DRG Base Rate x DRG Weight,70978,,"23,488 x DRG Weight",70978,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19662.21,,DRG base rate x DRG weight + capital per discharge,19662.21,Other,100% of NY Medicaid HMO DRG,19662,,DRG base rate x DRG weight + capital per discharge,19662,Other,100% of NY Medicaid HMO DRG,19662,,DRG base rate x DRG weight + capital per discharge,19662,Other,100% of NY Medicaid HMO DRG,19662,,DRG base rate x DRG weight + capital per discharge,19662,Other,100% of NY Medicaid HMO DRG,44240,,225% x Medicaid HMO amount,44240,Other,225% of NY Medicaid HMO DRG,30083,,153% x Medicaid HMO amount,30083,Other,153% of NY Medicaid HMO DRG,44240,,225% x Medicaid HMO amount,44240,Other,225% of NY Medicaid HMO DRG,27527,,140% x Medicaid HMO amount,27527,Other,140% of NY Medicaid HMO DRG,44240,,DRG base rate x DRG weight + capital per discharge,44240,Other,225% of NY Medicaid HMO DRG,54071,,275% x Medicaid HMO amount,54071,Other,275% of NY Medicaid HMO DRG,63706,,324% x Medicaid HMO amount,63706,Other,324% of NY Medicaid HMO DRG,42274,,215% x Medicaid HMO amount,42274,Other,215% of NY Medicaid HMO DRG,42274,,215% x Medicaid HMO amount,42274,Other,215% of NY Medicaid HMO DRG,24578,,125% x Medicaid HMO amount,24578,Other,125% of NY Medicaid HMO DRG,0.01,83507,
Other significant hip and femur surgery,309-4,APR-DRG,,,,,,,,inpatient,,,1173105.65,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,68734,,186% x Medicaid HMO amount,68734,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,158760,,"27,634 x DRG Weight",158760,Other,DRG Base Rate x DRG Weight,134941,,"23,488 x DRG Weight",134941,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36954.21,,DRG base rate x DRG weight + capital per discharge,36954.21,Other,100% of NY Medicaid HMO DRG,36954,,DRG base rate x DRG weight + capital per discharge,36954,Other,100% of NY Medicaid HMO DRG,36954,,DRG base rate x DRG weight + capital per discharge,36954,Other,100% of NY Medicaid HMO DRG,36954,,DRG base rate x DRG weight + capital per discharge,36954,Other,100% of NY Medicaid HMO DRG,83147,,225% x Medicaid HMO amount,83147,Other,225% of NY Medicaid HMO DRG,56540,,153% x Medicaid HMO amount,56540,Other,153% of NY Medicaid HMO DRG,83147,,225% x Medicaid HMO amount,83147,Other,225% of NY Medicaid HMO DRG,51736,,140% x Medicaid HMO amount,51736,Other,140% of NY Medicaid HMO DRG,83147,,DRG base rate x DRG weight + capital per discharge,83147,Other,225% of NY Medicaid HMO DRG,101624,,275% x Medicaid HMO amount,101624,Other,275% of NY Medicaid HMO DRG,119732,,324% x Medicaid HMO amount,119732,Other,324% of NY Medicaid HMO DRG,79452,,215% x Medicaid HMO amount,79452,Other,215% of NY Medicaid HMO DRG,79452,,215% x Medicaid HMO amount,79452,Other,215% of NY Medicaid HMO DRG,46193,,125% x Medicaid HMO amount,46193,Other,125% of NY Medicaid HMO DRG,0.01,158760,
Intervertebral disc excision & decompression,310-1,APR-DRG,,,,,,,,inpatient,,,186742.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11060,,186% x Medicaid HMO amount,11060,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23818,,"27,634 x DRG Weight",23818,Other,DRG Base Rate x DRG Weight,20244,,"23,488 x DRG Weight",20244,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5946.21,,DRG base rate x DRG weight + capital per discharge,5946.21,Other,100% of NY Medicaid HMO DRG,5946,,DRG base rate x DRG weight + capital per discharge,5946,Other,100% of NY Medicaid HMO DRG,5946,,DRG base rate x DRG weight + capital per discharge,5946,Other,100% of NY Medicaid HMO DRG,5946,,DRG base rate x DRG weight + capital per discharge,5946,Other,100% of NY Medicaid HMO DRG,13379,,225% x Medicaid HMO amount,13379,Other,225% of NY Medicaid HMO DRG,9098,,153% x Medicaid HMO amount,9098,Other,153% of NY Medicaid HMO DRG,13379,,225% x Medicaid HMO amount,13379,Other,225% of NY Medicaid HMO DRG,8325,,140% x Medicaid HMO amount,8325,Other,140% of NY Medicaid HMO DRG,13379,,DRG base rate x DRG weight + capital per discharge,13379,Other,225% of NY Medicaid HMO DRG,16352,,275% x Medicaid HMO amount,16352,Other,275% of NY Medicaid HMO DRG,19266,,324% x Medicaid HMO amount,19266,Other,324% of NY Medicaid HMO DRG,12784,,215% x Medicaid HMO amount,12784,Other,215% of NY Medicaid HMO DRG,12784,,215% x Medicaid HMO amount,12784,Other,215% of NY Medicaid HMO DRG,7433,,125% x Medicaid HMO amount,7433,Other,125% of NY Medicaid HMO DRG,0.01,23818,
Intervertebral disc excision & decompression,310-2,APR-DRG,,,,,,,,inpatient,,,268237.65,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15313,,186% x Medicaid HMO amount,15313,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33769,,"27,634 x DRG Weight",33769,Other,DRG Base Rate x DRG Weight,28702,,"23,488 x DRG Weight",28702,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8233.21,,DRG base rate x DRG weight + capital per discharge,8233.21,Other,100% of NY Medicaid HMO DRG,8233,,DRG base rate x DRG weight + capital per discharge,8233,Other,100% of NY Medicaid HMO DRG,8233,,DRG base rate x DRG weight + capital per discharge,8233,Other,100% of NY Medicaid HMO DRG,8233,,DRG base rate x DRG weight + capital per discharge,8233,Other,100% of NY Medicaid HMO DRG,18525,,225% x Medicaid HMO amount,18525,Other,225% of NY Medicaid HMO DRG,12597,,153% x Medicaid HMO amount,12597,Other,153% of NY Medicaid HMO DRG,18525,,225% x Medicaid HMO amount,18525,Other,225% of NY Medicaid HMO DRG,11526,,140% x Medicaid HMO amount,11526,Other,140% of NY Medicaid HMO DRG,18525,,DRG base rate x DRG weight + capital per discharge,18525,Other,225% of NY Medicaid HMO DRG,22641,,275% x Medicaid HMO amount,22641,Other,275% of NY Medicaid HMO DRG,26676,,324% x Medicaid HMO amount,26676,Other,324% of NY Medicaid HMO DRG,17701,,215% x Medicaid HMO amount,17701,Other,215% of NY Medicaid HMO DRG,17701,,215% x Medicaid HMO amount,17701,Other,215% of NY Medicaid HMO DRG,10292,,125% x Medicaid HMO amount,10292,Other,125% of NY Medicaid HMO DRG,0.01,33769,
Intervertebral disc excision & decompression,310-3,APR-DRG,,,,,,,,inpatient,,,396901.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30939,,186% x Medicaid HMO amount,30939,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70329,,"27,634 x DRG Weight",70329,Other,DRG Base Rate x DRG Weight,59777,,"23,488 x DRG Weight",59777,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16634.21,,DRG base rate x DRG weight + capital per discharge,16634.21,Other,100% of NY Medicaid HMO DRG,16634,,DRG base rate x DRG weight + capital per discharge,16634,Other,100% of NY Medicaid HMO DRG,16634,,DRG base rate x DRG weight + capital per discharge,16634,Other,100% of NY Medicaid HMO DRG,16634,,DRG base rate x DRG weight + capital per discharge,16634,Other,100% of NY Medicaid HMO DRG,37427,,225% x Medicaid HMO amount,37427,Other,225% of NY Medicaid HMO DRG,25450,,153% x Medicaid HMO amount,25450,Other,153% of NY Medicaid HMO DRG,37427,,225% x Medicaid HMO amount,37427,Other,225% of NY Medicaid HMO DRG,23288,,140% x Medicaid HMO amount,23288,Other,140% of NY Medicaid HMO DRG,37427,,DRG base rate x DRG weight + capital per discharge,37427,Other,225% of NY Medicaid HMO DRG,45744,,275% x Medicaid HMO amount,45744,Other,275% of NY Medicaid HMO DRG,53895,,324% x Medicaid HMO amount,53895,Other,324% of NY Medicaid HMO DRG,35764,,215% x Medicaid HMO amount,35764,Other,215% of NY Medicaid HMO DRG,35764,,215% x Medicaid HMO amount,35764,Other,215% of NY Medicaid HMO DRG,20793,,125% x Medicaid HMO amount,20793,Other,125% of NY Medicaid HMO DRG,0.01,70329,
Intervertebral disc excision & decompression,310-4,APR-DRG,,,,,,,,inpatient,,,594634.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,81693,,186% x Medicaid HMO amount,81693,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,189077,,"27,634 x DRG Weight",189077,Other,DRG Base Rate x DRG Weight,160710,,"23,488 x DRG Weight",160710,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43921.21,,DRG base rate x DRG weight + capital per discharge,43921.21,Other,100% of NY Medicaid HMO DRG,43921,,DRG base rate x DRG weight + capital per discharge,43921,Other,100% of NY Medicaid HMO DRG,43921,,DRG base rate x DRG weight + capital per discharge,43921,Other,100% of NY Medicaid HMO DRG,43921,,DRG base rate x DRG weight + capital per discharge,43921,Other,100% of NY Medicaid HMO DRG,98823,,225% x Medicaid HMO amount,98823,Other,225% of NY Medicaid HMO DRG,67199,,153% x Medicaid HMO amount,67199,Other,153% of NY Medicaid HMO DRG,98823,,225% x Medicaid HMO amount,98823,Other,225% of NY Medicaid HMO DRG,61490,,140% x Medicaid HMO amount,61490,Other,140% of NY Medicaid HMO DRG,98823,,DRG base rate x DRG weight + capital per discharge,98823,Other,225% of NY Medicaid HMO DRG,120783,,275% x Medicaid HMO amount,120783,Other,275% of NY Medicaid HMO DRG,142305,,324% x Medicaid HMO amount,142305,Other,324% of NY Medicaid HMO DRG,94431,,215% x Medicaid HMO amount,94431,Other,215% of NY Medicaid HMO DRG,94431,,215% x Medicaid HMO amount,94431,Other,215% of NY Medicaid HMO DRG,54902,,125% x Medicaid HMO amount,54902,Other,125% of NY Medicaid HMO DRG,0.01,189077,
"Skin graft, except hand, for musculoskeletal & connective tissue diagnoses",312-1,APR-DRG,,,,,,,,inpatient,,,195262.7,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15276,,186% x Medicaid HMO amount,15276,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33683,,"27,634 x DRG Weight",33683,Other,DRG Base Rate x DRG Weight,28630,,"23,488 x DRG Weight",28630,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8213.21,,DRG base rate x DRG weight + capital per discharge,8213.21,Other,100% of NY Medicaid HMO DRG,8213,,DRG base rate x DRG weight + capital per discharge,8213,Other,100% of NY Medicaid HMO DRG,8213,,DRG base rate x DRG weight + capital per discharge,8213,Other,100% of NY Medicaid HMO DRG,8213,,DRG base rate x DRG weight + capital per discharge,8213,Other,100% of NY Medicaid HMO DRG,18480,,225% x Medicaid HMO amount,18480,Other,225% of NY Medicaid HMO DRG,12566,,153% x Medicaid HMO amount,12566,Other,153% of NY Medicaid HMO DRG,18480,,225% x Medicaid HMO amount,18480,Other,225% of NY Medicaid HMO DRG,11498,,140% x Medicaid HMO amount,11498,Other,140% of NY Medicaid HMO DRG,18480,,DRG base rate x DRG weight + capital per discharge,18480,Other,225% of NY Medicaid HMO DRG,22586,,275% x Medicaid HMO amount,22586,Other,275% of NY Medicaid HMO DRG,26611,,324% x Medicaid HMO amount,26611,Other,324% of NY Medicaid HMO DRG,17658,,215% x Medicaid HMO amount,17658,Other,215% of NY Medicaid HMO DRG,17658,,215% x Medicaid HMO amount,17658,Other,215% of NY Medicaid HMO DRG,10267,,125% x Medicaid HMO amount,10267,Other,125% of NY Medicaid HMO DRG,0.01,33683,
"Skin graft, except hand, for musculoskeletal & connective tissue diagnoses",312-2,APR-DRG,,,,,,,,inpatient,,,523226.19,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27493,,186% x Medicaid HMO amount,27493,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62268,,"27,634 x DRG Weight",62268,Other,DRG Base Rate x DRG Weight,52926,,"23,488 x DRG Weight",52926,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14781.21,,DRG base rate x DRG weight + capital per discharge,14781.21,Other,100% of NY Medicaid HMO DRG,14781,,DRG base rate x DRG weight + capital per discharge,14781,Other,100% of NY Medicaid HMO DRG,14781,,DRG base rate x DRG weight + capital per discharge,14781,Other,100% of NY Medicaid HMO DRG,14781,,DRG base rate x DRG weight + capital per discharge,14781,Other,100% of NY Medicaid HMO DRG,33258,,225% x Medicaid HMO amount,33258,Other,225% of NY Medicaid HMO DRG,22615,,153% x Medicaid HMO amount,22615,Other,153% of NY Medicaid HMO DRG,33258,,225% x Medicaid HMO amount,33258,Other,225% of NY Medicaid HMO DRG,20694,,140% x Medicaid HMO amount,20694,Other,140% of NY Medicaid HMO DRG,33258,,DRG base rate x DRG weight + capital per discharge,33258,Other,225% of NY Medicaid HMO DRG,40648,,275% x Medicaid HMO amount,40648,Other,275% of NY Medicaid HMO DRG,47891,,324% x Medicaid HMO amount,47891,Other,324% of NY Medicaid HMO DRG,31780,,215% x Medicaid HMO amount,31780,Other,215% of NY Medicaid HMO DRG,31780,,215% x Medicaid HMO amount,31780,Other,215% of NY Medicaid HMO DRG,18477,,125% x Medicaid HMO amount,18477,Other,125% of NY Medicaid HMO DRG,0.01,62268,
"Skin graft, except hand, for musculoskeletal & connective tissue diagnoses",312-3,APR-DRG,,,,,,,,inpatient,,,239553.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54357,,186% x Medicaid HMO amount,54357,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,125118,,"27,634 x DRG Weight",125118,Other,DRG Base Rate x DRG Weight,106347,,"23,488 x DRG Weight",106347,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29224.21,,DRG base rate x DRG weight + capital per discharge,29224.21,Other,100% of NY Medicaid HMO DRG,29224,,DRG base rate x DRG weight + capital per discharge,29224,Other,100% of NY Medicaid HMO DRG,29224,,DRG base rate x DRG weight + capital per discharge,29224,Other,100% of NY Medicaid HMO DRG,29224,,DRG base rate x DRG weight + capital per discharge,29224,Other,100% of NY Medicaid HMO DRG,65754,,225% x Medicaid HMO amount,65754,Other,225% of NY Medicaid HMO DRG,44713,,153% x Medicaid HMO amount,44713,Other,153% of NY Medicaid HMO DRG,65754,,225% x Medicaid HMO amount,65754,Other,225% of NY Medicaid HMO DRG,40914,,140% x Medicaid HMO amount,40914,Other,140% of NY Medicaid HMO DRG,65754,,DRG base rate x DRG weight + capital per discharge,65754,Other,225% of NY Medicaid HMO DRG,80367,,275% x Medicaid HMO amount,80367,Other,275% of NY Medicaid HMO DRG,94686,,324% x Medicaid HMO amount,94686,Other,324% of NY Medicaid HMO DRG,62832,,215% x Medicaid HMO amount,62832,Other,215% of NY Medicaid HMO DRG,62832,,215% x Medicaid HMO amount,62832,Other,215% of NY Medicaid HMO DRG,36530,,125% x Medicaid HMO amount,36530,Other,125% of NY Medicaid HMO DRG,0.01,125118,
"Skin graft, except hand, for musculoskeletal & connective tissue diagnoses",312-4,APR-DRG,,,,,,,,inpatient,,,1431548.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,107207,,186% x Medicaid HMO amount,107207,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,248770,,"27,634 x DRG Weight",248770,Other,DRG Base Rate x DRG Weight,211446,,"23,488 x DRG Weight",211446,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57638.21,,DRG base rate x DRG weight + capital per discharge,57638.21,Other,100% of NY Medicaid HMO DRG,57638,,DRG base rate x DRG weight + capital per discharge,57638,Other,100% of NY Medicaid HMO DRG,57638,,DRG base rate x DRG weight + capital per discharge,57638,Other,100% of NY Medicaid HMO DRG,57638,,DRG base rate x DRG weight + capital per discharge,57638,Other,100% of NY Medicaid HMO DRG,129686,,225% x Medicaid HMO amount,129686,Other,225% of NY Medicaid HMO DRG,88186,,153% x Medicaid HMO amount,88186,Other,153% of NY Medicaid HMO DRG,129686,,225% x Medicaid HMO amount,129686,Other,225% of NY Medicaid HMO DRG,80693,,140% x Medicaid HMO amount,80693,Other,140% of NY Medicaid HMO DRG,129686,,DRG base rate x DRG weight + capital per discharge,129686,Other,225% of NY Medicaid HMO DRG,158505,,275% x Medicaid HMO amount,158505,Other,275% of NY Medicaid HMO DRG,186748,,324% x Medicaid HMO amount,186748,Other,324% of NY Medicaid HMO DRG,123922,,215% x Medicaid HMO amount,123922,Other,215% of NY Medicaid HMO DRG,123922,,215% x Medicaid HMO amount,123922,Other,215% of NY Medicaid HMO DRG,72048,,125% x Medicaid HMO amount,72048,Other,125% of NY Medicaid HMO DRG,0.01,248770,
Knee & lower leg procedures except foot,313-1,APR-DRG,,,,,,,,inpatient,,,218809.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15008,,186% x Medicaid HMO amount,15008,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33059,,"27,634 x DRG Weight",33059,Other,DRG Base Rate x DRG Weight,28099,,"23,488 x DRG Weight",28099,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8069.21,,DRG base rate x DRG weight + capital per discharge,8069.21,Other,100% of NY Medicaid HMO DRG,8069,,DRG base rate x DRG weight + capital per discharge,8069,Other,100% of NY Medicaid HMO DRG,8069,,DRG base rate x DRG weight + capital per discharge,8069,Other,100% of NY Medicaid HMO DRG,8069,,DRG base rate x DRG weight + capital per discharge,8069,Other,100% of NY Medicaid HMO DRG,18156,,225% x Medicaid HMO amount,18156,Other,225% of NY Medicaid HMO DRG,12346,,153% x Medicaid HMO amount,12346,Other,153% of NY Medicaid HMO DRG,18156,,225% x Medicaid HMO amount,18156,Other,225% of NY Medicaid HMO DRG,11297,,140% x Medicaid HMO amount,11297,Other,140% of NY Medicaid HMO DRG,18156,,DRG base rate x DRG weight + capital per discharge,18156,Other,225% of NY Medicaid HMO DRG,22190,,275% x Medicaid HMO amount,22190,Other,275% of NY Medicaid HMO DRG,26144,,324% x Medicaid HMO amount,26144,Other,324% of NY Medicaid HMO DRG,17349,,215% x Medicaid HMO amount,17349,Other,215% of NY Medicaid HMO DRG,17349,,215% x Medicaid HMO amount,17349,Other,215% of NY Medicaid HMO DRG,10087,,125% x Medicaid HMO amount,10087,Other,125% of NY Medicaid HMO DRG,0.01,33059,
Knee & lower leg procedures except foot,313-2,APR-DRG,,,,,,,,inpatient,,,264676.63,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21615,,186% x Medicaid HMO amount,21615,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48514,,"27,634 x DRG Weight",48514,Other,DRG Base Rate x DRG Weight,41236,,"23,488 x DRG Weight",41236,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11621.21,,DRG base rate x DRG weight + capital per discharge,11621.21,Other,100% of NY Medicaid HMO DRG,11621,,DRG base rate x DRG weight + capital per discharge,11621,Other,100% of NY Medicaid HMO DRG,11621,,DRG base rate x DRG weight + capital per discharge,11621,Other,100% of NY Medicaid HMO DRG,11621,,DRG base rate x DRG weight + capital per discharge,11621,Other,100% of NY Medicaid HMO DRG,26148,,225% x Medicaid HMO amount,26148,Other,225% of NY Medicaid HMO DRG,17780,,153% x Medicaid HMO amount,17780,Other,153% of NY Medicaid HMO DRG,26148,,225% x Medicaid HMO amount,26148,Other,225% of NY Medicaid HMO DRG,16270,,140% x Medicaid HMO amount,16270,Other,140% of NY Medicaid HMO DRG,26148,,DRG base rate x DRG weight + capital per discharge,26148,Other,225% of NY Medicaid HMO DRG,31958,,275% x Medicaid HMO amount,31958,Other,275% of NY Medicaid HMO DRG,37653,,324% x Medicaid HMO amount,37653,Other,324% of NY Medicaid HMO DRG,24986,,215% x Medicaid HMO amount,24986,Other,215% of NY Medicaid HMO DRG,24986,,215% x Medicaid HMO amount,24986,Other,215% of NY Medicaid HMO DRG,14527,,125% x Medicaid HMO amount,14527,Other,125% of NY Medicaid HMO DRG,0.01,48514,
Knee & lower leg procedures except foot,313-3,APR-DRG,,,,,,,,inpatient,,,667069.93,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34836,,186% x Medicaid HMO amount,34836,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,79448,,"27,634 x DRG Weight",79448,Other,DRG Base Rate x DRG Weight,67528,,"23,488 x DRG Weight",67528,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18729.21,,DRG base rate x DRG weight + capital per discharge,18729.21,Other,100% of NY Medicaid HMO DRG,18729,,DRG base rate x DRG weight + capital per discharge,18729,Other,100% of NY Medicaid HMO DRG,18729,,DRG base rate x DRG weight + capital per discharge,18729,Other,100% of NY Medicaid HMO DRG,18729,,DRG base rate x DRG weight + capital per discharge,18729,Other,100% of NY Medicaid HMO DRG,42141,,225% x Medicaid HMO amount,42141,Other,225% of NY Medicaid HMO DRG,28656,,153% x Medicaid HMO amount,28656,Other,153% of NY Medicaid HMO DRG,42141,,225% x Medicaid HMO amount,42141,Other,225% of NY Medicaid HMO DRG,26221,,140% x Medicaid HMO amount,26221,Other,140% of NY Medicaid HMO DRG,42141,,DRG base rate x DRG weight + capital per discharge,42141,Other,225% of NY Medicaid HMO DRG,51505,,275% x Medicaid HMO amount,51505,Other,275% of NY Medicaid HMO DRG,60683,,324% x Medicaid HMO amount,60683,Other,324% of NY Medicaid HMO DRG,40268,,215% x Medicaid HMO amount,40268,Other,215% of NY Medicaid HMO DRG,40268,,215% x Medicaid HMO amount,40268,Other,215% of NY Medicaid HMO DRG,23412,,125% x Medicaid HMO amount,23412,Other,125% of NY Medicaid HMO DRG,0.01,79448,
Knee & lower leg procedures except foot,313-4,APR-DRG,,,,,,,,inpatient,,,637267.49,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,77313,,186% x Medicaid HMO amount,77313,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,178828,,"27,634 x DRG Weight",178828,Other,DRG Base Rate x DRG Weight,151998,,"23,488 x DRG Weight",151998,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41566.21,,DRG base rate x DRG weight + capital per discharge,41566.21,Other,100% of NY Medicaid HMO DRG,41566,,DRG base rate x DRG weight + capital per discharge,41566,Other,100% of NY Medicaid HMO DRG,41566,,DRG base rate x DRG weight + capital per discharge,41566,Other,100% of NY Medicaid HMO DRG,41566,,DRG base rate x DRG weight + capital per discharge,41566,Other,100% of NY Medicaid HMO DRG,93524,,225% x Medicaid HMO amount,93524,Other,225% of NY Medicaid HMO DRG,63596,,153% x Medicaid HMO amount,63596,Other,153% of NY Medicaid HMO DRG,93524,,225% x Medicaid HMO amount,93524,Other,225% of NY Medicaid HMO DRG,58193,,140% x Medicaid HMO amount,58193,Other,140% of NY Medicaid HMO DRG,93524,,DRG base rate x DRG weight + capital per discharge,93524,Other,225% of NY Medicaid HMO DRG,114307,,275% x Medicaid HMO amount,114307,Other,275% of NY Medicaid HMO DRG,134675,,324% x Medicaid HMO amount,134675,Other,324% of NY Medicaid HMO DRG,89367,,215% x Medicaid HMO amount,89367,Other,215% of NY Medicaid HMO DRG,89367,,215% x Medicaid HMO amount,89367,Other,215% of NY Medicaid HMO DRG,51958,,125% x Medicaid HMO amount,51958,Other,125% of NY Medicaid HMO DRG,0.01,178828,
Foot & toe procedures,314-1,APR-DRG,,,,,,,,inpatient,,,151017.04,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13381,,186% x Medicaid HMO amount,13381,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29248,,"27,634 x DRG Weight",29248,Other,DRG Base Rate x DRG Weight,24860,,"23,488 x DRG Weight",24860,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7194.21,,DRG base rate x DRG weight + capital per discharge,7194.21,Other,100% of NY Medicaid HMO DRG,7194,,DRG base rate x DRG weight + capital per discharge,7194,Other,100% of NY Medicaid HMO DRG,7194,,DRG base rate x DRG weight + capital per discharge,7194,Other,100% of NY Medicaid HMO DRG,7194,,DRG base rate x DRG weight + capital per discharge,7194,Other,100% of NY Medicaid HMO DRG,16187,,225% x Medicaid HMO amount,16187,Other,225% of NY Medicaid HMO DRG,11007,,153% x Medicaid HMO amount,11007,Other,153% of NY Medicaid HMO DRG,16187,,225% x Medicaid HMO amount,16187,Other,225% of NY Medicaid HMO DRG,10072,,140% x Medicaid HMO amount,10072,Other,140% of NY Medicaid HMO DRG,16187,,DRG base rate x DRG weight + capital per discharge,16187,Other,225% of NY Medicaid HMO DRG,19784,,275% x Medicaid HMO amount,19784,Other,275% of NY Medicaid HMO DRG,23309,,324% x Medicaid HMO amount,23309,Other,324% of NY Medicaid HMO DRG,15468,,215% x Medicaid HMO amount,15468,Other,215% of NY Medicaid HMO DRG,15468,,215% x Medicaid HMO amount,15468,Other,215% of NY Medicaid HMO DRG,8993,,125% x Medicaid HMO amount,8993,Other,125% of NY Medicaid HMO DRG,0.01,29248,
Foot & toe procedures,314-2,APR-DRG,,,,,,,,inpatient,,,229184.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16876,,186% x Medicaid HMO amount,16876,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37425,,"27,634 x DRG Weight",37425,Other,DRG Base Rate x DRG Weight,31810,,"23,488 x DRG Weight",31810,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9073.21,,DRG base rate x DRG weight + capital per discharge,9073.21,Other,100% of NY Medicaid HMO DRG,9073,,DRG base rate x DRG weight + capital per discharge,9073,Other,100% of NY Medicaid HMO DRG,9073,,DRG base rate x DRG weight + capital per discharge,9073,Other,100% of NY Medicaid HMO DRG,9073,,DRG base rate x DRG weight + capital per discharge,9073,Other,100% of NY Medicaid HMO DRG,20415,,225% x Medicaid HMO amount,20415,Other,225% of NY Medicaid HMO DRG,13882,,153% x Medicaid HMO amount,13882,Other,153% of NY Medicaid HMO DRG,20415,,225% x Medicaid HMO amount,20415,Other,225% of NY Medicaid HMO DRG,12702,,140% x Medicaid HMO amount,12702,Other,140% of NY Medicaid HMO DRG,20415,,DRG base rate x DRG weight + capital per discharge,20415,Other,225% of NY Medicaid HMO DRG,24951,,275% x Medicaid HMO amount,24951,Other,275% of NY Medicaid HMO DRG,29397,,324% x Medicaid HMO amount,29397,Other,324% of NY Medicaid HMO DRG,19507,,215% x Medicaid HMO amount,19507,Other,215% of NY Medicaid HMO DRG,19507,,215% x Medicaid HMO amount,19507,Other,215% of NY Medicaid HMO DRG,11342,,125% x Medicaid HMO amount,11342,Other,125% of NY Medicaid HMO DRG,0.01,37425,
Foot & toe procedures,314-3,APR-DRG,,,,,,,,inpatient,,,353637.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24887,,186% x Medicaid HMO amount,24887,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,56169,,"27,634 x DRG Weight",56169,Other,DRG Base Rate x DRG Weight,47742,,"23,488 x DRG Weight",47742,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13380.21,,DRG base rate x DRG weight + capital per discharge,13380.21,Other,100% of NY Medicaid HMO DRG,13380,,DRG base rate x DRG weight + capital per discharge,13380,Other,100% of NY Medicaid HMO DRG,13380,,DRG base rate x DRG weight + capital per discharge,13380,Other,100% of NY Medicaid HMO DRG,13380,,DRG base rate x DRG weight + capital per discharge,13380,Other,100% of NY Medicaid HMO DRG,30105,,225% x Medicaid HMO amount,30105,Other,225% of NY Medicaid HMO DRG,20472,,153% x Medicaid HMO amount,20472,Other,153% of NY Medicaid HMO DRG,30105,,225% x Medicaid HMO amount,30105,Other,225% of NY Medicaid HMO DRG,18732,,140% x Medicaid HMO amount,18732,Other,140% of NY Medicaid HMO DRG,30105,,DRG base rate x DRG weight + capital per discharge,30105,Other,225% of NY Medicaid HMO DRG,36796,,275% x Medicaid HMO amount,36796,Other,275% of NY Medicaid HMO DRG,43352,,324% x Medicaid HMO amount,43352,Other,324% of NY Medicaid HMO DRG,28767,,215% x Medicaid HMO amount,28767,Other,215% of NY Medicaid HMO DRG,28767,,215% x Medicaid HMO amount,28767,Other,215% of NY Medicaid HMO DRG,16725,,125% x Medicaid HMO amount,16725,Other,125% of NY Medicaid HMO DRG,0.01,56169,
Foot & toe procedures,314-4,APR-DRG,,,,,,,,inpatient,,,380835.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46294,,186% x Medicaid HMO amount,46294,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,106253,,"27,634 x DRG Weight",106253,Other,DRG Base Rate x DRG Weight,90311,,"23,488 x DRG Weight",90311,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24889.21,,DRG base rate x DRG weight + capital per discharge,24889.21,Other,100% of NY Medicaid HMO DRG,24889,,DRG base rate x DRG weight + capital per discharge,24889,Other,100% of NY Medicaid HMO DRG,24889,,DRG base rate x DRG weight + capital per discharge,24889,Other,100% of NY Medicaid HMO DRG,24889,,DRG base rate x DRG weight + capital per discharge,24889,Other,100% of NY Medicaid HMO DRG,56001,,225% x Medicaid HMO amount,56001,Other,225% of NY Medicaid HMO DRG,38080,,153% x Medicaid HMO amount,38080,Other,153% of NY Medicaid HMO DRG,56001,,225% x Medicaid HMO amount,56001,Other,225% of NY Medicaid HMO DRG,34845,,140% x Medicaid HMO amount,34845,Other,140% of NY Medicaid HMO DRG,56001,,DRG base rate x DRG weight + capital per discharge,56001,Other,225% of NY Medicaid HMO DRG,68445,,275% x Medicaid HMO amount,68445,Other,275% of NY Medicaid HMO DRG,80641,,324% x Medicaid HMO amount,80641,Other,324% of NY Medicaid HMO DRG,53512,,215% x Medicaid HMO amount,53512,Other,215% of NY Medicaid HMO DRG,53512,,215% x Medicaid HMO amount,53512,Other,215% of NY Medicaid HMO DRG,31112,,125% x Medicaid HMO amount,31112,Other,125% of NY Medicaid HMO DRG,0.01,106253,
"Shoulder, upper arm & forearm procedures except joint replacement",315-1,APR-DRG,,,,,,,,inpatient,,,127992.88,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10431,,186% x Medicaid HMO amount,10431,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22348,,"27,634 x DRG Weight",22348,Other,DRG Base Rate x DRG Weight,18995,,"23,488 x DRG Weight",18995,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5608.21,,DRG base rate x DRG weight + capital per discharge,5608.21,Other,100% of NY Medicaid HMO DRG,5608,,DRG base rate x DRG weight + capital per discharge,5608,Other,100% of NY Medicaid HMO DRG,5608,,DRG base rate x DRG weight + capital per discharge,5608,Other,100% of NY Medicaid HMO DRG,5608,,DRG base rate x DRG weight + capital per discharge,5608,Other,100% of NY Medicaid HMO DRG,12618,,225% x Medicaid HMO amount,12618,Other,225% of NY Medicaid HMO DRG,8581,,153% x Medicaid HMO amount,8581,Other,153% of NY Medicaid HMO DRG,12618,,225% x Medicaid HMO amount,12618,Other,225% of NY Medicaid HMO DRG,7851,,140% x Medicaid HMO amount,7851,Other,140% of NY Medicaid HMO DRG,12618,,DRG base rate x DRG weight + capital per discharge,12618,Other,225% of NY Medicaid HMO DRG,15423,,275% x Medicaid HMO amount,15423,Other,275% of NY Medicaid HMO DRG,18171,,324% x Medicaid HMO amount,18171,Other,324% of NY Medicaid HMO DRG,12058,,215% x Medicaid HMO amount,12058,Other,215% of NY Medicaid HMO DRG,12058,,215% x Medicaid HMO amount,12058,Other,215% of NY Medicaid HMO DRG,7010,,125% x Medicaid HMO amount,7010,Other,125% of NY Medicaid HMO DRG,0.01,22348,
"Shoulder, upper arm & forearm procedures except joint replacement",315-2,APR-DRG,,,,,,,,inpatient,,,232920.76,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17214,,186% x Medicaid HMO amount,17214,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38218,,"27,634 x DRG Weight",38218,Other,DRG Base Rate x DRG Weight,32484,,"23,488 x DRG Weight",32484,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9255.21,,DRG base rate x DRG weight + capital per discharge,9255.21,Other,100% of NY Medicaid HMO DRG,9255,,DRG base rate x DRG weight + capital per discharge,9255,Other,100% of NY Medicaid HMO DRG,9255,,DRG base rate x DRG weight + capital per discharge,9255,Other,100% of NY Medicaid HMO DRG,9255,,DRG base rate x DRG weight + capital per discharge,9255,Other,100% of NY Medicaid HMO DRG,20824,,225% x Medicaid HMO amount,20824,Other,225% of NY Medicaid HMO DRG,14160,,153% x Medicaid HMO amount,14160,Other,153% of NY Medicaid HMO DRG,20824,,225% x Medicaid HMO amount,20824,Other,225% of NY Medicaid HMO DRG,12957,,140% x Medicaid HMO amount,12957,Other,140% of NY Medicaid HMO DRG,20824,,DRG base rate x DRG weight + capital per discharge,20824,Other,225% of NY Medicaid HMO DRG,25452,,275% x Medicaid HMO amount,25452,Other,275% of NY Medicaid HMO DRG,29987,,324% x Medicaid HMO amount,29987,Other,324% of NY Medicaid HMO DRG,19899,,215% x Medicaid HMO amount,19899,Other,215% of NY Medicaid HMO DRG,19899,,215% x Medicaid HMO amount,19899,Other,215% of NY Medicaid HMO DRG,11569,,125% x Medicaid HMO amount,11569,Other,125% of NY Medicaid HMO DRG,0.01,38218,
"Shoulder, upper arm & forearm procedures except joint replacement",315-3,APR-DRG,,,,,,,,inpatient,,,367391.1,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32394,,186% x Medicaid HMO amount,32394,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73733,,"27,634 x DRG Weight",73733,Other,DRG Base Rate x DRG Weight,62671,,"23,488 x DRG Weight",62671,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17416.21,,DRG base rate x DRG weight + capital per discharge,17416.21,Other,100% of NY Medicaid HMO DRG,17416,,DRG base rate x DRG weight + capital per discharge,17416,Other,100% of NY Medicaid HMO DRG,17416,,DRG base rate x DRG weight + capital per discharge,17416,Other,100% of NY Medicaid HMO DRG,17416,,DRG base rate x DRG weight + capital per discharge,17416,Other,100% of NY Medicaid HMO DRG,39186,,225% x Medicaid HMO amount,39186,Other,225% of NY Medicaid HMO DRG,26647,,153% x Medicaid HMO amount,26647,Other,153% of NY Medicaid HMO DRG,39186,,225% x Medicaid HMO amount,39186,Other,225% of NY Medicaid HMO DRG,24383,,140% x Medicaid HMO amount,24383,Other,140% of NY Medicaid HMO DRG,39186,,DRG base rate x DRG weight + capital per discharge,39186,Other,225% of NY Medicaid HMO DRG,47895,,275% x Medicaid HMO amount,47895,Other,275% of NY Medicaid HMO DRG,56429,,324% x Medicaid HMO amount,56429,Other,324% of NY Medicaid HMO DRG,37445,,215% x Medicaid HMO amount,37445,Other,215% of NY Medicaid HMO DRG,37445,,215% x Medicaid HMO amount,37445,Other,215% of NY Medicaid HMO DRG,21770,,125% x Medicaid HMO amount,21770,Other,125% of NY Medicaid HMO DRG,0.01,73733,
"Shoulder, upper arm & forearm procedures except joint replacement",315-4,APR-DRG,,,,,,,,inpatient,,,549334.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,61510,,186% x Medicaid HMO amount,61510,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,141856,,"27,634 x DRG Weight",141856,Other,DRG Base Rate x DRG Weight,120573,,"23,488 x DRG Weight",120573,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33070.21,,DRG base rate x DRG weight + capital per discharge,33070.21,Other,100% of NY Medicaid HMO DRG,33070,,DRG base rate x DRG weight + capital per discharge,33070,Other,100% of NY Medicaid HMO DRG,33070,,DRG base rate x DRG weight + capital per discharge,33070,Other,100% of NY Medicaid HMO DRG,33070,,DRG base rate x DRG weight + capital per discharge,33070,Other,100% of NY Medicaid HMO DRG,74408,,225% x Medicaid HMO amount,74408,Other,225% of NY Medicaid HMO DRG,50597,,153% x Medicaid HMO amount,50597,Other,153% of NY Medicaid HMO DRG,74408,,225% x Medicaid HMO amount,74408,Other,225% of NY Medicaid HMO DRG,46298,,140% x Medicaid HMO amount,46298,Other,140% of NY Medicaid HMO DRG,74408,,DRG base rate x DRG weight + capital per discharge,74408,Other,225% of NY Medicaid HMO DRG,90943,,275% x Medicaid HMO amount,90943,Other,275% of NY Medicaid HMO DRG,107147,,324% x Medicaid HMO amount,107147,Other,324% of NY Medicaid HMO DRG,71101,,215% x Medicaid HMO amount,71101,Other,215% of NY Medicaid HMO DRG,71101,,215% x Medicaid HMO amount,71101,Other,215% of NY Medicaid HMO DRG,41338,,125% x Medicaid HMO amount,41338,Other,125% of NY Medicaid HMO DRG,0.01,141856,
Hand & wrist procedures,316-1,APR-DRG,,,,,,,,inpatient,,,128483.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9343,,186% x Medicaid HMO amount,9343,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19800,,"27,634 x DRG Weight",19800,Other,DRG Base Rate x DRG Weight,16829,,"23,488 x DRG Weight",16829,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5023.21,,DRG base rate x DRG weight + capital per discharge,5023.21,Other,100% of NY Medicaid HMO DRG,5023,,DRG base rate x DRG weight + capital per discharge,5023,Other,100% of NY Medicaid HMO DRG,5023,,DRG base rate x DRG weight + capital per discharge,5023,Other,100% of NY Medicaid HMO DRG,5023,,DRG base rate x DRG weight + capital per discharge,5023,Other,100% of NY Medicaid HMO DRG,11302,,225% x Medicaid HMO amount,11302,Other,225% of NY Medicaid HMO DRG,7686,,153% x Medicaid HMO amount,7686,Other,153% of NY Medicaid HMO DRG,11302,,225% x Medicaid HMO amount,11302,Other,225% of NY Medicaid HMO DRG,7032,,140% x Medicaid HMO amount,7032,Other,140% of NY Medicaid HMO DRG,11302,,DRG base rate x DRG weight + capital per discharge,11302,Other,225% of NY Medicaid HMO DRG,13814,,275% x Medicaid HMO amount,13814,Other,275% of NY Medicaid HMO DRG,16275,,324% x Medicaid HMO amount,16275,Other,324% of NY Medicaid HMO DRG,10800,,215% x Medicaid HMO amount,10800,Other,215% of NY Medicaid HMO DRG,10800,,215% x Medicaid HMO amount,10800,Other,215% of NY Medicaid HMO DRG,6279,,125% x Medicaid HMO amount,6279,Other,125% of NY Medicaid HMO DRG,0.01,19800,
Hand & wrist procedures,316-2,APR-DRG,,,,,,,,inpatient,,,216293.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14824,,186% x Medicaid HMO amount,14824,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32625,,"27,634 x DRG Weight",32625,Other,DRG Base Rate x DRG Weight,27730,,"23,488 x DRG Weight",27730,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7970.21,,DRG base rate x DRG weight + capital per discharge,7970.21,Other,100% of NY Medicaid HMO DRG,7970,,DRG base rate x DRG weight + capital per discharge,7970,Other,100% of NY Medicaid HMO DRG,7970,,DRG base rate x DRG weight + capital per discharge,7970,Other,100% of NY Medicaid HMO DRG,7970,,DRG base rate x DRG weight + capital per discharge,7970,Other,100% of NY Medicaid HMO DRG,17933,,225% x Medicaid HMO amount,17933,Other,225% of NY Medicaid HMO DRG,12194,,153% x Medicaid HMO amount,12194,Other,153% of NY Medicaid HMO DRG,17933,,225% x Medicaid HMO amount,17933,Other,225% of NY Medicaid HMO DRG,11158,,140% x Medicaid HMO amount,11158,Other,140% of NY Medicaid HMO DRG,17933,,DRG base rate x DRG weight + capital per discharge,17933,Other,225% of NY Medicaid HMO DRG,21918,,275% x Medicaid HMO amount,21918,Other,275% of NY Medicaid HMO DRG,25823,,324% x Medicaid HMO amount,25823,Other,324% of NY Medicaid HMO DRG,17136,,215% x Medicaid HMO amount,17136,Other,215% of NY Medicaid HMO DRG,17136,,215% x Medicaid HMO amount,17136,Other,215% of NY Medicaid HMO DRG,9963,,125% x Medicaid HMO amount,9963,Other,125% of NY Medicaid HMO DRG,0.01,32625,
Hand & wrist procedures,316-3,APR-DRG,,,,,,,,inpatient,,,132593.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26073,,186% x Medicaid HMO amount,26073,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58946,,"27,634 x DRG Weight",58946,Other,DRG Base Rate x DRG Weight,50102,,"23,488 x DRG Weight",50102,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14018.21,,DRG base rate x DRG weight + capital per discharge,14018.21,Other,100% of NY Medicaid HMO DRG,14018,,DRG base rate x DRG weight + capital per discharge,14018,Other,100% of NY Medicaid HMO DRG,14018,,DRG base rate x DRG weight + capital per discharge,14018,Other,100% of NY Medicaid HMO DRG,14018,,DRG base rate x DRG weight + capital per discharge,14018,Other,100% of NY Medicaid HMO DRG,31541,,225% x Medicaid HMO amount,31541,Other,225% of NY Medicaid HMO DRG,21448,,153% x Medicaid HMO amount,21448,Other,153% of NY Medicaid HMO DRG,31541,,225% x Medicaid HMO amount,31541,Other,225% of NY Medicaid HMO DRG,19625,,140% x Medicaid HMO amount,19625,Other,140% of NY Medicaid HMO DRG,31541,,DRG base rate x DRG weight + capital per discharge,31541,Other,225% of NY Medicaid HMO DRG,38550,,275% x Medicaid HMO amount,38550,Other,275% of NY Medicaid HMO DRG,45419,,324% x Medicaid HMO amount,45419,Other,324% of NY Medicaid HMO DRG,30139,,215% x Medicaid HMO amount,30139,Other,215% of NY Medicaid HMO DRG,30139,,215% x Medicaid HMO amount,30139,Other,215% of NY Medicaid HMO DRG,17523,,125% x Medicaid HMO amount,17523,Other,125% of NY Medicaid HMO DRG,0.01,58946,
Hand & wrist procedures,316-4,APR-DRG,,,,,,,,inpatient,,,132593.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29077,,186% x Medicaid HMO amount,29077,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65973,,"27,634 x DRG Weight",65973,Other,DRG Base Rate x DRG Weight,56075,,"23,488 x DRG Weight",56075,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15633.21,,DRG base rate x DRG weight + capital per discharge,15633.21,Other,100% of NY Medicaid HMO DRG,15633,,DRG base rate x DRG weight + capital per discharge,15633,Other,100% of NY Medicaid HMO DRG,15633,,DRG base rate x DRG weight + capital per discharge,15633,Other,100% of NY Medicaid HMO DRG,15633,,DRG base rate x DRG weight + capital per discharge,15633,Other,100% of NY Medicaid HMO DRG,35175,,225% x Medicaid HMO amount,35175,Other,225% of NY Medicaid HMO DRG,23919,,153% x Medicaid HMO amount,23919,Other,153% of NY Medicaid HMO DRG,35175,,225% x Medicaid HMO amount,35175,Other,225% of NY Medicaid HMO DRG,21886,,140% x Medicaid HMO amount,21886,Other,140% of NY Medicaid HMO DRG,35175,,DRG base rate x DRG weight + capital per discharge,35175,Other,225% of NY Medicaid HMO DRG,42991,,275% x Medicaid HMO amount,42991,Other,275% of NY Medicaid HMO DRG,50652,,324% x Medicaid HMO amount,50652,Other,324% of NY Medicaid HMO DRG,33611,,215% x Medicaid HMO amount,33611,Other,215% of NY Medicaid HMO DRG,33611,,215% x Medicaid HMO amount,33611,Other,215% of NY Medicaid HMO DRG,19542,,125% x Medicaid HMO amount,19542,Other,125% of NY Medicaid HMO DRG,0.01,65973,
"Tendon, muscle & other soft tissue procedures",317-1,APR-DRG,,,,,,,,inpatient,,,170931.89,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11508,,186% x Medicaid HMO amount,11508,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24865,,"27,634 x DRG Weight",24865,Other,DRG Base Rate x DRG Weight,21135,,"23,488 x DRG Weight",21135,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6187.21,,DRG base rate x DRG weight + capital per discharge,6187.21,Other,100% of NY Medicaid HMO DRG,6187,,DRG base rate x DRG weight + capital per discharge,6187,Other,100% of NY Medicaid HMO DRG,6187,,DRG base rate x DRG weight + capital per discharge,6187,Other,100% of NY Medicaid HMO DRG,6187,,DRG base rate x DRG weight + capital per discharge,6187,Other,100% of NY Medicaid HMO DRG,13921,,225% x Medicaid HMO amount,13921,Other,225% of NY Medicaid HMO DRG,9466,,153% x Medicaid HMO amount,9466,Other,153% of NY Medicaid HMO DRG,13921,,225% x Medicaid HMO amount,13921,Other,225% of NY Medicaid HMO DRG,8662,,140% x Medicaid HMO amount,8662,Other,140% of NY Medicaid HMO DRG,13921,,DRG base rate x DRG weight + capital per discharge,13921,Other,225% of NY Medicaid HMO DRG,17015,,275% x Medicaid HMO amount,17015,Other,275% of NY Medicaid HMO DRG,20047,,324% x Medicaid HMO amount,20047,Other,324% of NY Medicaid HMO DRG,13303,,215% x Medicaid HMO amount,13303,Other,215% of NY Medicaid HMO DRG,13303,,215% x Medicaid HMO amount,13303,Other,215% of NY Medicaid HMO DRG,7734,,125% x Medicaid HMO amount,7734,Other,125% of NY Medicaid HMO DRG,0.01,24865,
"Tendon, muscle & other soft tissue procedures",317-2,APR-DRG,,,,,,,,inpatient,,,122473.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17828,,186% x Medicaid HMO amount,17828,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39652,,"27,634 x DRG Weight",39652,Other,DRG Base Rate x DRG Weight,33703,,"23,488 x DRG Weight",33703,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9585.21,,DRG base rate x DRG weight + capital per discharge,9585.21,Other,100% of NY Medicaid HMO DRG,9585,,DRG base rate x DRG weight + capital per discharge,9585,Other,100% of NY Medicaid HMO DRG,9585,,DRG base rate x DRG weight + capital per discharge,9585,Other,100% of NY Medicaid HMO DRG,9585,,DRG base rate x DRG weight + capital per discharge,9585,Other,100% of NY Medicaid HMO DRG,21567,,225% x Medicaid HMO amount,21567,Other,225% of NY Medicaid HMO DRG,14665,,153% x Medicaid HMO amount,14665,Other,153% of NY Medicaid HMO DRG,21567,,225% x Medicaid HMO amount,21567,Other,225% of NY Medicaid HMO DRG,13419,,140% x Medicaid HMO amount,13419,Other,140% of NY Medicaid HMO DRG,21567,,DRG base rate x DRG weight + capital per discharge,21567,Other,225% of NY Medicaid HMO DRG,26359,,275% x Medicaid HMO amount,26359,Other,275% of NY Medicaid HMO DRG,31056,,324% x Medicaid HMO amount,31056,Other,324% of NY Medicaid HMO DRG,20608,,215% x Medicaid HMO amount,20608,Other,215% of NY Medicaid HMO DRG,20608,,215% x Medicaid HMO amount,20608,Other,215% of NY Medicaid HMO DRG,11982,,125% x Medicaid HMO amount,11982,Other,125% of NY Medicaid HMO DRG,0.01,39652,
"Tendon, muscle & other soft tissue procedures",317-3,APR-DRG,,,,,,,,inpatient,,,350866.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31680,,186% x Medicaid HMO amount,31680,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72064,,"27,634 x DRG Weight",72064,Other,DRG Base Rate x DRG Weight,61252,,"23,488 x DRG Weight",61252,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17032.21,,DRG base rate x DRG weight + capital per discharge,17032.21,Other,100% of NY Medicaid HMO DRG,17032,,DRG base rate x DRG weight + capital per discharge,17032,Other,100% of NY Medicaid HMO DRG,17032,,DRG base rate x DRG weight + capital per discharge,17032,Other,100% of NY Medicaid HMO DRG,17032,,DRG base rate x DRG weight + capital per discharge,17032,Other,100% of NY Medicaid HMO DRG,38322,,225% x Medicaid HMO amount,38322,Other,225% of NY Medicaid HMO DRG,26059,,153% x Medicaid HMO amount,26059,Other,153% of NY Medicaid HMO DRG,38322,,225% x Medicaid HMO amount,38322,Other,225% of NY Medicaid HMO DRG,23845,,140% x Medicaid HMO amount,23845,Other,140% of NY Medicaid HMO DRG,38322,,DRG base rate x DRG weight + capital per discharge,38322,Other,225% of NY Medicaid HMO DRG,46839,,275% x Medicaid HMO amount,46839,Other,275% of NY Medicaid HMO DRG,55184,,324% x Medicaid HMO amount,55184,Other,324% of NY Medicaid HMO DRG,36619,,215% x Medicaid HMO amount,36619,Other,215% of NY Medicaid HMO DRG,36619,,215% x Medicaid HMO amount,36619,Other,215% of NY Medicaid HMO DRG,21290,,125% x Medicaid HMO amount,21290,Other,125% of NY Medicaid HMO DRG,0.01,72064,
"Tendon, muscle & other soft tissue procedures",317-4,APR-DRG,,,,,,,,inpatient,,,438312.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75501,,186% x Medicaid HMO amount,75501,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,174592,,"27,634 x DRG Weight",174592,Other,DRG Base Rate x DRG Weight,148397,,"23,488 x DRG Weight",148397,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40592.21,,DRG base rate x DRG weight + capital per discharge,40592.21,Other,100% of NY Medicaid HMO DRG,40592,,DRG base rate x DRG weight + capital per discharge,40592,Other,100% of NY Medicaid HMO DRG,40592,,DRG base rate x DRG weight + capital per discharge,40592,Other,100% of NY Medicaid HMO DRG,40592,,DRG base rate x DRG weight + capital per discharge,40592,Other,100% of NY Medicaid HMO DRG,91332,,225% x Medicaid HMO amount,91332,Other,225% of NY Medicaid HMO DRG,62106,,153% x Medicaid HMO amount,62106,Other,153% of NY Medicaid HMO DRG,91332,,225% x Medicaid HMO amount,91332,Other,225% of NY Medicaid HMO DRG,56829,,140% x Medicaid HMO amount,56829,Other,140% of NY Medicaid HMO DRG,91332,,DRG base rate x DRG weight + capital per discharge,91332,Other,225% of NY Medicaid HMO DRG,111629,,275% x Medicaid HMO amount,111629,Other,275% of NY Medicaid HMO DRG,131519,,324% x Medicaid HMO amount,131519,Other,324% of NY Medicaid HMO DRG,87273,,215% x Medicaid HMO amount,87273,Other,215% of NY Medicaid HMO DRG,87273,,215% x Medicaid HMO amount,87273,Other,215% of NY Medicaid HMO DRG,50740,,125% x Medicaid HMO amount,50740,Other,125% of NY Medicaid HMO DRG,0.01,174592,
Other musculoskeletal system & connective tissue procedures,320-1,APR-DRG,,,,,,,,inpatient,,,155382.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12990,,186% x Medicaid HMO amount,12990,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28336,,"27,634 x DRG Weight",28336,Other,DRG Base Rate x DRG Weight,24085,,"23,488 x DRG Weight",24085,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6984.21,,DRG base rate x DRG weight + capital per discharge,6984.21,Other,100% of NY Medicaid HMO DRG,6984,,DRG base rate x DRG weight + capital per discharge,6984,Other,100% of NY Medicaid HMO DRG,6984,,DRG base rate x DRG weight + capital per discharge,6984,Other,100% of NY Medicaid HMO DRG,6984,,DRG base rate x DRG weight + capital per discharge,6984,Other,100% of NY Medicaid HMO DRG,15714,,225% x Medicaid HMO amount,15714,Other,225% of NY Medicaid HMO DRG,10686,,153% x Medicaid HMO amount,10686,Other,153% of NY Medicaid HMO DRG,15714,,225% x Medicaid HMO amount,15714,Other,225% of NY Medicaid HMO DRG,9778,,140% x Medicaid HMO amount,9778,Other,140% of NY Medicaid HMO DRG,15714,,DRG base rate x DRG weight + capital per discharge,15714,Other,225% of NY Medicaid HMO DRG,19207,,275% x Medicaid HMO amount,19207,Other,275% of NY Medicaid HMO DRG,22629,,324% x Medicaid HMO amount,22629,Other,324% of NY Medicaid HMO DRG,15016,,215% x Medicaid HMO amount,15016,Other,215% of NY Medicaid HMO DRG,15016,,215% x Medicaid HMO amount,15016,Other,215% of NY Medicaid HMO DRG,8730,,125% x Medicaid HMO amount,8730,Other,125% of NY Medicaid HMO DRG,0.01,28336,
Other musculoskeletal system & connective tissue procedures,320-2,APR-DRG,,,,,,,,inpatient,,,384955.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20105,,186% x Medicaid HMO amount,20105,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44983,,"27,634 x DRG Weight",44983,Other,DRG Base Rate x DRG Weight,38234,,"23,488 x DRG Weight",38234,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10809.21,,DRG base rate x DRG weight + capital per discharge,10809.21,Other,100% of NY Medicaid HMO DRG,10809,,DRG base rate x DRG weight + capital per discharge,10809,Other,100% of NY Medicaid HMO DRG,10809,,DRG base rate x DRG weight + capital per discharge,10809,Other,100% of NY Medicaid HMO DRG,10809,,DRG base rate x DRG weight + capital per discharge,10809,Other,100% of NY Medicaid HMO DRG,24321,,225% x Medicaid HMO amount,24321,Other,225% of NY Medicaid HMO DRG,16538,,153% x Medicaid HMO amount,16538,Other,153% of NY Medicaid HMO DRG,24321,,225% x Medicaid HMO amount,24321,Other,225% of NY Medicaid HMO DRG,15133,,140% x Medicaid HMO amount,15133,Other,140% of NY Medicaid HMO DRG,24321,,DRG base rate x DRG weight + capital per discharge,24321,Other,225% of NY Medicaid HMO DRG,29725,,275% x Medicaid HMO amount,29725,Other,275% of NY Medicaid HMO DRG,35022,,324% x Medicaid HMO amount,35022,Other,324% of NY Medicaid HMO DRG,23240,,215% x Medicaid HMO amount,23240,Other,215% of NY Medicaid HMO DRG,23240,,215% x Medicaid HMO amount,23240,Other,215% of NY Medicaid HMO DRG,13512,,125% x Medicaid HMO amount,13512,Other,125% of NY Medicaid HMO DRG,0.01,44983,
Other musculoskeletal system & connective tissue procedures,320-3,APR-DRG,,,,,,,,inpatient,,,270615.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30584,,186% x Medicaid HMO amount,30584,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69497,,"27,634 x DRG Weight",69497,Other,DRG Base Rate x DRG Weight,59070,,"23,488 x DRG Weight",59070,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16443.21,,DRG base rate x DRG weight + capital per discharge,16443.21,Other,100% of NY Medicaid HMO DRG,16443,,DRG base rate x DRG weight + capital per discharge,16443,Other,100% of NY Medicaid HMO DRG,16443,,DRG base rate x DRG weight + capital per discharge,16443,Other,100% of NY Medicaid HMO DRG,16443,,DRG base rate x DRG weight + capital per discharge,16443,Other,100% of NY Medicaid HMO DRG,36997,,225% x Medicaid HMO amount,36997,Other,225% of NY Medicaid HMO DRG,25158,,153% x Medicaid HMO amount,25158,Other,153% of NY Medicaid HMO DRG,36997,,225% x Medicaid HMO amount,36997,Other,225% of NY Medicaid HMO DRG,23020,,140% x Medicaid HMO amount,23020,Other,140% of NY Medicaid HMO DRG,36997,,DRG base rate x DRG weight + capital per discharge,36997,Other,225% of NY Medicaid HMO DRG,45219,,275% x Medicaid HMO amount,45219,Other,275% of NY Medicaid HMO DRG,53276,,324% x Medicaid HMO amount,53276,Other,324% of NY Medicaid HMO DRG,35353,,215% x Medicaid HMO amount,35353,Other,215% of NY Medicaid HMO DRG,35353,,215% x Medicaid HMO amount,35353,Other,215% of NY Medicaid HMO DRG,20554,,125% x Medicaid HMO amount,20554,Other,125% of NY Medicaid HMO DRG,0.01,69497,
Other musculoskeletal system & connective tissue procedures,320-4,APR-DRG,,,,,,,,inpatient,,,809801.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59978,,186% x Medicaid HMO amount,59978,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,138269,,"27,634 x DRG Weight",138269,Other,DRG Base Rate x DRG Weight,117525,,"23,488 x DRG Weight",117525,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32246.21,,DRG base rate x DRG weight + capital per discharge,32246.21,Other,100% of NY Medicaid HMO DRG,32246,,DRG base rate x DRG weight + capital per discharge,32246,Other,100% of NY Medicaid HMO DRG,32246,,DRG base rate x DRG weight + capital per discharge,32246,Other,100% of NY Medicaid HMO DRG,32246,,DRG base rate x DRG weight + capital per discharge,32246,Other,100% of NY Medicaid HMO DRG,72554,,225% x Medicaid HMO amount,72554,Other,225% of NY Medicaid HMO DRG,49337,,153% x Medicaid HMO amount,49337,Other,153% of NY Medicaid HMO DRG,72554,,225% x Medicaid HMO amount,72554,Other,225% of NY Medicaid HMO DRG,45145,,140% x Medicaid HMO amount,45145,Other,140% of NY Medicaid HMO DRG,72554,,DRG base rate x DRG weight + capital per discharge,72554,Other,225% of NY Medicaid HMO DRG,88677,,275% x Medicaid HMO amount,88677,Other,275% of NY Medicaid HMO DRG,104478,,324% x Medicaid HMO amount,104478,Other,324% of NY Medicaid HMO DRG,69329,,215% x Medicaid HMO amount,69329,Other,215% of NY Medicaid HMO DRG,69329,,215% x Medicaid HMO amount,69329,Other,215% of NY Medicaid HMO DRG,40308,,125% x Medicaid HMO amount,40308,Other,125% of NY Medicaid HMO DRG,0.01,138269,
Cervical spinal fusion & other back/neck proc exc disc excis/decomp,321-1,APR-DRG,,,,,,,,inpatient,,,242825.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20151,,186% x Medicaid HMO amount,20151,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45090,,"27,634 x DRG Weight",45090,Other,DRG Base Rate x DRG Weight,38325,,"23,488 x DRG Weight",38325,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10834.21,,DRG base rate x DRG weight + capital per discharge,10834.21,Other,100% of NY Medicaid HMO DRG,10834,,DRG base rate x DRG weight + capital per discharge,10834,Other,100% of NY Medicaid HMO DRG,10834,,DRG base rate x DRG weight + capital per discharge,10834,Other,100% of NY Medicaid HMO DRG,10834,,DRG base rate x DRG weight + capital per discharge,10834,Other,100% of NY Medicaid HMO DRG,24377,,225% x Medicaid HMO amount,24377,Other,225% of NY Medicaid HMO DRG,16576,,153% x Medicaid HMO amount,16576,Other,153% of NY Medicaid HMO DRG,24377,,225% x Medicaid HMO amount,24377,Other,225% of NY Medicaid HMO DRG,15168,,140% x Medicaid HMO amount,15168,Other,140% of NY Medicaid HMO DRG,24377,,DRG base rate x DRG weight + capital per discharge,24377,Other,225% of NY Medicaid HMO DRG,29794,,275% x Medicaid HMO amount,29794,Other,275% of NY Medicaid HMO DRG,35103,,324% x Medicaid HMO amount,35103,Other,324% of NY Medicaid HMO DRG,23294,,215% x Medicaid HMO amount,23294,Other,215% of NY Medicaid HMO DRG,23294,,215% x Medicaid HMO amount,23294,Other,215% of NY Medicaid HMO DRG,13543,,125% x Medicaid HMO amount,13543,Other,125% of NY Medicaid HMO DRG,0.01,45090,
Cervical spinal fusion & other back/neck proc exc disc excis/decomp,321-2,APR-DRG,,,,,,,,inpatient,,,290126.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26239,,186% x Medicaid HMO amount,26239,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59333,,"27,634 x DRG Weight",59333,Other,DRG Base Rate x DRG Weight,50431,,"23,488 x DRG Weight",50431,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14107.21,,DRG base rate x DRG weight + capital per discharge,14107.21,Other,100% of NY Medicaid HMO DRG,14107,,DRG base rate x DRG weight + capital per discharge,14107,Other,100% of NY Medicaid HMO DRG,14107,,DRG base rate x DRG weight + capital per discharge,14107,Other,100% of NY Medicaid HMO DRG,14107,,DRG base rate x DRG weight + capital per discharge,14107,Other,100% of NY Medicaid HMO DRG,31741,,225% x Medicaid HMO amount,31741,Other,225% of NY Medicaid HMO DRG,21584,,153% x Medicaid HMO amount,21584,Other,153% of NY Medicaid HMO DRG,31741,,225% x Medicaid HMO amount,31741,Other,225% of NY Medicaid HMO DRG,19750,,140% x Medicaid HMO amount,19750,Other,140% of NY Medicaid HMO DRG,31741,,DRG base rate x DRG weight + capital per discharge,31741,Other,225% of NY Medicaid HMO DRG,38795,,275% x Medicaid HMO amount,38795,Other,275% of NY Medicaid HMO DRG,45707,,324% x Medicaid HMO amount,45707,Other,324% of NY Medicaid HMO DRG,30331,,215% x Medicaid HMO amount,30331,Other,215% of NY Medicaid HMO DRG,30331,,215% x Medicaid HMO amount,30331,Other,215% of NY Medicaid HMO DRG,17634,,125% x Medicaid HMO amount,17634,Other,125% of NY Medicaid HMO DRG,0.01,59333,
Cervical spinal fusion & other back/neck proc exc disc excis/decomp,321-3,APR-DRG,,,,,,,,inpatient,,,628457.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44610,,186% x Medicaid HMO amount,44610,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,102318,,"27,634 x DRG Weight",102318,Other,DRG Base Rate x DRG Weight,86967,,"23,488 x DRG Weight",86967,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23984.21,,DRG base rate x DRG weight + capital per discharge,23984.21,Other,100% of NY Medicaid HMO DRG,23984,,DRG base rate x DRG weight + capital per discharge,23984,Other,100% of NY Medicaid HMO DRG,23984,,DRG base rate x DRG weight + capital per discharge,23984,Other,100% of NY Medicaid HMO DRG,23984,,DRG base rate x DRG weight + capital per discharge,23984,Other,100% of NY Medicaid HMO DRG,53964,,225% x Medicaid HMO amount,53964,Other,225% of NY Medicaid HMO DRG,36696,,153% x Medicaid HMO amount,36696,Other,153% of NY Medicaid HMO DRG,53964,,225% x Medicaid HMO amount,53964,Other,225% of NY Medicaid HMO DRG,33578,,140% x Medicaid HMO amount,33578,Other,140% of NY Medicaid HMO DRG,53964,,DRG base rate x DRG weight + capital per discharge,53964,Other,225% of NY Medicaid HMO DRG,65957,,275% x Medicaid HMO amount,65957,Other,275% of NY Medicaid HMO DRG,77709,,324% x Medicaid HMO amount,77709,Other,324% of NY Medicaid HMO DRG,51566,,215% x Medicaid HMO amount,51566,Other,215% of NY Medicaid HMO DRG,51566,,215% x Medicaid HMO amount,51566,Other,215% of NY Medicaid HMO DRG,29980,,125% x Medicaid HMO amount,29980,Other,125% of NY Medicaid HMO DRG,0.01,102318,
Cervical spinal fusion & other back/neck proc exc disc excis/decomp,321-4,APR-DRG,,,,,,,,inpatient,,,526735.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,84316,,186% x Medicaid HMO amount,84316,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,195212,,"27,634 x DRG Weight",195212,Other,DRG Base Rate x DRG Weight,165924,,"23,488 x DRG Weight",165924,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45331.21,,DRG base rate x DRG weight + capital per discharge,45331.21,Other,100% of NY Medicaid HMO DRG,45331,,DRG base rate x DRG weight + capital per discharge,45331,Other,100% of NY Medicaid HMO DRG,45331,,DRG base rate x DRG weight + capital per discharge,45331,Other,100% of NY Medicaid HMO DRG,45331,,DRG base rate x DRG weight + capital per discharge,45331,Other,100% of NY Medicaid HMO DRG,101995,,225% x Medicaid HMO amount,101995,Other,225% of NY Medicaid HMO DRG,69357,,153% x Medicaid HMO amount,69357,Other,153% of NY Medicaid HMO DRG,101995,,225% x Medicaid HMO amount,101995,Other,225% of NY Medicaid HMO DRG,63464,,140% x Medicaid HMO amount,63464,Other,140% of NY Medicaid HMO DRG,101995,,DRG base rate x DRG weight + capital per discharge,101995,Other,225% of NY Medicaid HMO DRG,124661,,275% x Medicaid HMO amount,124661,Other,275% of NY Medicaid HMO DRG,146873,,324% x Medicaid HMO amount,146873,Other,324% of NY Medicaid HMO DRG,97462,,215% x Medicaid HMO amount,97462,Other,215% of NY Medicaid HMO DRG,97462,,215% x Medicaid HMO amount,97462,Other,215% of NY Medicaid HMO DRG,56664,,125% x Medicaid HMO amount,56664,Other,125% of NY Medicaid HMO DRG,0.01,195212,
Shoulder & elbow joint replacement #,322-1,APR-DRG,,,,,,,,inpatient,,,309470.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19545,,186% x Medicaid HMO amount,19545,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43670,,"27,634 x DRG Weight",43670,Other,DRG Base Rate x DRG Weight,37118,,"23,488 x DRG Weight",37118,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10508.21,,DRG base rate x DRG weight + capital per discharge,10508.21,Other,100% of NY Medicaid HMO DRG,10508,,DRG base rate x DRG weight + capital per discharge,10508,Other,100% of NY Medicaid HMO DRG,10508,,DRG base rate x DRG weight + capital per discharge,10508,Other,100% of NY Medicaid HMO DRG,10508,,DRG base rate x DRG weight + capital per discharge,10508,Other,100% of NY Medicaid HMO DRG,23643,,225% x Medicaid HMO amount,23643,Other,225% of NY Medicaid HMO DRG,16078,,153% x Medicaid HMO amount,16078,Other,153% of NY Medicaid HMO DRG,23643,,225% x Medicaid HMO amount,23643,Other,225% of NY Medicaid HMO DRG,14711,,140% x Medicaid HMO amount,14711,Other,140% of NY Medicaid HMO DRG,23643,,DRG base rate x DRG weight + capital per discharge,23643,Other,225% of NY Medicaid HMO DRG,28898,,275% x Medicaid HMO amount,28898,Other,275% of NY Medicaid HMO DRG,34047,,324% x Medicaid HMO amount,34047,Other,324% of NY Medicaid HMO DRG,22593,,215% x Medicaid HMO amount,22593,Other,215% of NY Medicaid HMO DRG,22593,,215% x Medicaid HMO amount,22593,Other,215% of NY Medicaid HMO DRG,13135,,125% x Medicaid HMO amount,13135,Other,125% of NY Medicaid HMO DRG,0.01,43670,
Shoulder & elbow joint replacement #,322-2,APR-DRG,,,,,,,,inpatient,,,267760.84,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21496,,186% x Medicaid HMO amount,21496,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48238,,"27,634 x DRG Weight",48238,Other,DRG Base Rate x DRG Weight,41001,,"23,488 x DRG Weight",41001,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11557.21,,DRG base rate x DRG weight + capital per discharge,11557.21,Other,100% of NY Medicaid HMO DRG,11557,,DRG base rate x DRG weight + capital per discharge,11557,Other,100% of NY Medicaid HMO DRG,11557,,DRG base rate x DRG weight + capital per discharge,11557,Other,100% of NY Medicaid HMO DRG,11557,,DRG base rate x DRG weight + capital per discharge,11557,Other,100% of NY Medicaid HMO DRG,26004,,225% x Medicaid HMO amount,26004,Other,225% of NY Medicaid HMO DRG,17683,,153% x Medicaid HMO amount,17683,Other,153% of NY Medicaid HMO DRG,26004,,225% x Medicaid HMO amount,26004,Other,225% of NY Medicaid HMO DRG,16180,,140% x Medicaid HMO amount,16180,Other,140% of NY Medicaid HMO DRG,26004,,DRG base rate x DRG weight + capital per discharge,26004,Other,225% of NY Medicaid HMO DRG,31782,,275% x Medicaid HMO amount,31782,Other,275% of NY Medicaid HMO DRG,37445,,324% x Medicaid HMO amount,37445,Other,324% of NY Medicaid HMO DRG,24848,,215% x Medicaid HMO amount,24848,Other,215% of NY Medicaid HMO DRG,24848,,215% x Medicaid HMO amount,24848,Other,215% of NY Medicaid HMO DRG,14447,,125% x Medicaid HMO amount,14447,Other,125% of NY Medicaid HMO DRG,0.01,48238,
Shoulder & elbow joint replacement #,322-3,APR-DRG,,,,,,,,inpatient,,,309470.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35411,,186% x Medicaid HMO amount,35411,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,80791,,"27,634 x DRG Weight",80791,Other,DRG Base Rate x DRG Weight,68670,,"23,488 x DRG Weight",68670,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19038.21,,DRG base rate x DRG weight + capital per discharge,19038.21,Other,100% of NY Medicaid HMO DRG,19038,,DRG base rate x DRG weight + capital per discharge,19038,Other,100% of NY Medicaid HMO DRG,19038,,DRG base rate x DRG weight + capital per discharge,19038,Other,100% of NY Medicaid HMO DRG,19038,,DRG base rate x DRG weight + capital per discharge,19038,Other,100% of NY Medicaid HMO DRG,42836,,225% x Medicaid HMO amount,42836,Other,225% of NY Medicaid HMO DRG,29128,,153% x Medicaid HMO amount,29128,Other,153% of NY Medicaid HMO DRG,42836,,225% x Medicaid HMO amount,42836,Other,225% of NY Medicaid HMO DRG,26653,,140% x Medicaid HMO amount,26653,Other,140% of NY Medicaid HMO DRG,42836,,DRG base rate x DRG weight + capital per discharge,42836,Other,225% of NY Medicaid HMO DRG,52355,,275% x Medicaid HMO amount,52355,Other,275% of NY Medicaid HMO DRG,61684,,324% x Medicaid HMO amount,61684,Other,324% of NY Medicaid HMO DRG,40932,,215% x Medicaid HMO amount,40932,Other,215% of NY Medicaid HMO DRG,40932,,215% x Medicaid HMO amount,40932,Other,215% of NY Medicaid HMO DRG,23798,,125% x Medicaid HMO amount,23798,Other,125% of NY Medicaid HMO DRG,0.01,80791,
Shoulder & elbow joint replacement #,322-4,APR-DRG,,,,,,,,inpatient,,,309470.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41255,,186% x Medicaid HMO amount,41255,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,94464,,"27,634 x DRG Weight",94464,Other,DRG Base Rate x DRG Weight,80291,,"23,488 x DRG Weight",80291,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22180.21,,DRG base rate x DRG weight + capital per discharge,22180.21,Other,100% of NY Medicaid HMO DRG,22180,,DRG base rate x DRG weight + capital per discharge,22180,Other,100% of NY Medicaid HMO DRG,22180,,DRG base rate x DRG weight + capital per discharge,22180,Other,100% of NY Medicaid HMO DRG,22180,,DRG base rate x DRG weight + capital per discharge,22180,Other,100% of NY Medicaid HMO DRG,49905,,225% x Medicaid HMO amount,49905,Other,225% of NY Medicaid HMO DRG,33936,,153% x Medicaid HMO amount,33936,Other,153% of NY Medicaid HMO DRG,49905,,225% x Medicaid HMO amount,49905,Other,225% of NY Medicaid HMO DRG,31052,,140% x Medicaid HMO amount,31052,Other,140% of NY Medicaid HMO DRG,49905,,DRG base rate x DRG weight + capital per discharge,49905,Other,225% of NY Medicaid HMO DRG,60996,,275% x Medicaid HMO amount,60996,Other,275% of NY Medicaid HMO DRG,71864,,324% x Medicaid HMO amount,71864,Other,324% of NY Medicaid HMO DRG,47687,,215% x Medicaid HMO amount,47687,Other,215% of NY Medicaid HMO DRG,47687,,215% x Medicaid HMO amount,47687,Other,215% of NY Medicaid HMO DRG,27725,,125% x Medicaid HMO amount,27725,Other,125% of NY Medicaid HMO DRG,0.01,94464,
Fracture of femur,340-1,APR-DRG,,,,,,,,inpatient,,,87567.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7124,,186% x Medicaid HMO amount,7124,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14610,,"27,634 x DRG Weight",14610,Other,DRG Base Rate x DRG Weight,12418,,"23,488 x DRG Weight",12418,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3830.21,,DRG base rate x DRG weight + capital per discharge,3830.21,Other,100% of NY Medicaid HMO DRG,3830,,DRG base rate x DRG weight + capital per discharge,3830,Other,100% of NY Medicaid HMO DRG,3830,,DRG base rate x DRG weight + capital per discharge,3830,Other,100% of NY Medicaid HMO DRG,3830,,DRG base rate x DRG weight + capital per discharge,3830,Other,100% of NY Medicaid HMO DRG,8618,,225% x Medicaid HMO amount,8618,Other,225% of NY Medicaid HMO DRG,5860,,153% x Medicaid HMO amount,5860,Other,153% of NY Medicaid HMO DRG,8618,,225% x Medicaid HMO amount,8618,Other,225% of NY Medicaid HMO DRG,5362,,140% x Medicaid HMO amount,5362,Other,140% of NY Medicaid HMO DRG,8618,,DRG base rate x DRG weight + capital per discharge,8618,Other,225% of NY Medicaid HMO DRG,10533,,275% x Medicaid HMO amount,10533,Other,275% of NY Medicaid HMO DRG,12410,,324% x Medicaid HMO amount,12410,Other,324% of NY Medicaid HMO DRG,8235,,215% x Medicaid HMO amount,8235,Other,215% of NY Medicaid HMO DRG,8235,,215% x Medicaid HMO amount,8235,Other,215% of NY Medicaid HMO DRG,4788,,125% x Medicaid HMO amount,4788,Other,125% of NY Medicaid HMO DRG,0.01,14610,
Fracture of femur,340-2,APR-DRG,,,,,,,,inpatient,,,29468,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9242,,186% x Medicaid HMO amount,9242,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19568,,"27,634 x DRG Weight",19568,Other,DRG Base Rate x DRG Weight,16632,,"23,488 x DRG Weight",16632,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4969.21,,DRG base rate x DRG weight + capital per discharge,4969.21,Other,100% of NY Medicaid HMO DRG,4969,,DRG base rate x DRG weight + capital per discharge,4969,Other,100% of NY Medicaid HMO DRG,4969,,DRG base rate x DRG weight + capital per discharge,4969,Other,100% of NY Medicaid HMO DRG,4969,,DRG base rate x DRG weight + capital per discharge,4969,Other,100% of NY Medicaid HMO DRG,11181,,225% x Medicaid HMO amount,11181,Other,225% of NY Medicaid HMO DRG,7603,,153% x Medicaid HMO amount,7603,Other,153% of NY Medicaid HMO DRG,11181,,225% x Medicaid HMO amount,11181,Other,225% of NY Medicaid HMO DRG,6957,,140% x Medicaid HMO amount,6957,Other,140% of NY Medicaid HMO DRG,11181,,DRG base rate x DRG weight + capital per discharge,11181,Other,225% of NY Medicaid HMO DRG,13665,,275% x Medicaid HMO amount,13665,Other,275% of NY Medicaid HMO DRG,16100,,324% x Medicaid HMO amount,16100,Other,324% of NY Medicaid HMO DRG,10684,,215% x Medicaid HMO amount,10684,Other,215% of NY Medicaid HMO DRG,10684,,215% x Medicaid HMO amount,10684,Other,215% of NY Medicaid HMO DRG,6212,,125% x Medicaid HMO amount,6212,Other,125% of NY Medicaid HMO DRG,0.01,19568,
Fracture of femur,340-3,APR-DRG,,,,,,,,inpatient,,,169647.97,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20999,,186% x Medicaid HMO amount,20999,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47075,,"27,634 x DRG Weight",47075,Other,DRG Base Rate x DRG Weight,40012,,"23,488 x DRG Weight",40012,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11290.21,,DRG base rate x DRG weight + capital per discharge,11290.21,Other,100% of NY Medicaid HMO DRG,11290,,DRG base rate x DRG weight + capital per discharge,11290,Other,100% of NY Medicaid HMO DRG,11290,,DRG base rate x DRG weight + capital per discharge,11290,Other,100% of NY Medicaid HMO DRG,11290,,DRG base rate x DRG weight + capital per discharge,11290,Other,100% of NY Medicaid HMO DRG,25403,,225% x Medicaid HMO amount,25403,Other,225% of NY Medicaid HMO DRG,17274,,153% x Medicaid HMO amount,17274,Other,153% of NY Medicaid HMO DRG,25403,,225% x Medicaid HMO amount,25403,Other,225% of NY Medicaid HMO DRG,15806,,140% x Medicaid HMO amount,15806,Other,140% of NY Medicaid HMO DRG,25403,,DRG base rate x DRG weight + capital per discharge,25403,Other,225% of NY Medicaid HMO DRG,31048,,275% x Medicaid HMO amount,31048,Other,275% of NY Medicaid HMO DRG,36580,,324% x Medicaid HMO amount,36580,Other,324% of NY Medicaid HMO DRG,24274,,215% x Medicaid HMO amount,24274,Other,215% of NY Medicaid HMO DRG,24274,,215% x Medicaid HMO amount,24274,Other,215% of NY Medicaid HMO DRG,14113,,125% x Medicaid HMO amount,14113,Other,125% of NY Medicaid HMO DRG,0.01,47075,
Fracture of femur,340-4,APR-DRG,,,,,,,,inpatient,,,65287.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28259,,186% x Medicaid HMO amount,28259,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64058,,"27,634 x DRG Weight",64058,Other,DRG Base Rate x DRG Weight,54448,,"23,488 x DRG Weight",54448,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15193.21,,DRG base rate x DRG weight + capital per discharge,15193.21,Other,100% of NY Medicaid HMO DRG,15193,,DRG base rate x DRG weight + capital per discharge,15193,Other,100% of NY Medicaid HMO DRG,15193,,DRG base rate x DRG weight + capital per discharge,15193,Other,100% of NY Medicaid HMO DRG,15193,,DRG base rate x DRG weight + capital per discharge,15193,Other,100% of NY Medicaid HMO DRG,34185,,225% x Medicaid HMO amount,34185,Other,225% of NY Medicaid HMO DRG,23246,,153% x Medicaid HMO amount,23246,Other,153% of NY Medicaid HMO DRG,34185,,225% x Medicaid HMO amount,34185,Other,225% of NY Medicaid HMO DRG,21270,,140% x Medicaid HMO amount,21270,Other,140% of NY Medicaid HMO DRG,34185,,DRG base rate x DRG weight + capital per discharge,34185,Other,225% of NY Medicaid HMO DRG,41781,,275% x Medicaid HMO amount,41781,Other,275% of NY Medicaid HMO DRG,49226,,324% x Medicaid HMO amount,49226,Other,324% of NY Medicaid HMO DRG,32665,,215% x Medicaid HMO amount,32665,Other,215% of NY Medicaid HMO DRG,32665,,215% x Medicaid HMO amount,32665,Other,215% of NY Medicaid HMO DRG,18992,,125% x Medicaid HMO amount,18992,Other,125% of NY Medicaid HMO DRG,0.01,64058,
Fracture of pelvis or dislocation of hip,341-1,APR-DRG,,,,,,,,inpatient,,,78139.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7641,,186% x Medicaid HMO amount,7641,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15820,,"27,634 x DRG Weight",15820,Other,DRG Base Rate x DRG Weight,13447,,"23,488 x DRG Weight",13447,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4108.21,,DRG base rate x DRG weight + capital per discharge,4108.21,Other,100% of NY Medicaid HMO DRG,4108,,DRG base rate x DRG weight + capital per discharge,4108,Other,100% of NY Medicaid HMO DRG,4108,,DRG base rate x DRG weight + capital per discharge,4108,Other,100% of NY Medicaid HMO DRG,4108,,DRG base rate x DRG weight + capital per discharge,4108,Other,100% of NY Medicaid HMO DRG,9243,,225% x Medicaid HMO amount,9243,Other,225% of NY Medicaid HMO DRG,6286,,153% x Medicaid HMO amount,6286,Other,153% of NY Medicaid HMO DRG,9243,,225% x Medicaid HMO amount,9243,Other,225% of NY Medicaid HMO DRG,5751,,140% x Medicaid HMO amount,5751,Other,140% of NY Medicaid HMO DRG,9243,,DRG base rate x DRG weight + capital per discharge,9243,Other,225% of NY Medicaid HMO DRG,11298,,275% x Medicaid HMO amount,11298,Other,275% of NY Medicaid HMO DRG,13311,,324% x Medicaid HMO amount,13311,Other,324% of NY Medicaid HMO DRG,8833,,215% x Medicaid HMO amount,8833,Other,215% of NY Medicaid HMO DRG,8833,,215% x Medicaid HMO amount,8833,Other,215% of NY Medicaid HMO DRG,5135,,125% x Medicaid HMO amount,5135,Other,125% of NY Medicaid HMO DRG,0.01,15820,
Fracture of pelvis or dislocation of hip,341-2,APR-DRG,,,,,,,,inpatient,,,114028.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9311,,186% x Medicaid HMO amount,9311,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19725,,"27,634 x DRG Weight",19725,Other,DRG Base Rate x DRG Weight,16766,,"23,488 x DRG Weight",16766,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5006.21,,DRG base rate x DRG weight + capital per discharge,5006.21,Other,100% of NY Medicaid HMO DRG,5006,,DRG base rate x DRG weight + capital per discharge,5006,Other,100% of NY Medicaid HMO DRG,5006,,DRG base rate x DRG weight + capital per discharge,5006,Other,100% of NY Medicaid HMO DRG,5006,,DRG base rate x DRG weight + capital per discharge,5006,Other,100% of NY Medicaid HMO DRG,11264,,225% x Medicaid HMO amount,11264,Other,225% of NY Medicaid HMO DRG,7660,,153% x Medicaid HMO amount,7660,Other,153% of NY Medicaid HMO DRG,11264,,225% x Medicaid HMO amount,11264,Other,225% of NY Medicaid HMO DRG,7009,,140% x Medicaid HMO amount,7009,Other,140% of NY Medicaid HMO DRG,11264,,DRG base rate x DRG weight + capital per discharge,11264,Other,225% of NY Medicaid HMO DRG,13767,,275% x Medicaid HMO amount,13767,Other,275% of NY Medicaid HMO DRG,16220,,324% x Medicaid HMO amount,16220,Other,324% of NY Medicaid HMO DRG,10763,,215% x Medicaid HMO amount,10763,Other,215% of NY Medicaid HMO DRG,10763,,215% x Medicaid HMO amount,10763,Other,215% of NY Medicaid HMO DRG,6258,,125% x Medicaid HMO amount,6258,Other,125% of NY Medicaid HMO DRG,0.01,19725,
Fracture of pelvis or dislocation of hip,341-3,APR-DRG,,,,,,,,inpatient,,,188391.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12243,,186% x Medicaid HMO amount,12243,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26587,,"27,634 x DRG Weight",26587,Other,DRG Base Rate x DRG Weight,22598,,"23,488 x DRG Weight",22598,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6582.21,,DRG base rate x DRG weight + capital per discharge,6582.21,Other,100% of NY Medicaid HMO DRG,6582,,DRG base rate x DRG weight + capital per discharge,6582,Other,100% of NY Medicaid HMO DRG,6582,,DRG base rate x DRG weight + capital per discharge,6582,Other,100% of NY Medicaid HMO DRG,6582,,DRG base rate x DRG weight + capital per discharge,6582,Other,100% of NY Medicaid HMO DRG,14810,,225% x Medicaid HMO amount,14810,Other,225% of NY Medicaid HMO DRG,10071,,153% x Medicaid HMO amount,10071,Other,153% of NY Medicaid HMO DRG,14810,,225% x Medicaid HMO amount,14810,Other,225% of NY Medicaid HMO DRG,9215,,140% x Medicaid HMO amount,9215,Other,140% of NY Medicaid HMO DRG,14810,,DRG base rate x DRG weight + capital per discharge,14810,Other,225% of NY Medicaid HMO DRG,18101,,275% x Medicaid HMO amount,18101,Other,275% of NY Medicaid HMO DRG,21326,,324% x Medicaid HMO amount,21326,Other,324% of NY Medicaid HMO DRG,14152,,215% x Medicaid HMO amount,14152,Other,215% of NY Medicaid HMO DRG,14152,,215% x Medicaid HMO amount,14152,Other,215% of NY Medicaid HMO DRG,8228,,125% x Medicaid HMO amount,8228,Other,125% of NY Medicaid HMO DRG,0.01,26587,
Fracture of pelvis or dislocation of hip,341-4,APR-DRG,,,,,,,,inpatient,,,413970,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12972,,186% x Medicaid HMO amount,12972,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28292,,"27,634 x DRG Weight",28292,Other,DRG Base Rate x DRG Weight,24047,,"23,488 x DRG Weight",24047,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6974.21,,DRG base rate x DRG weight + capital per discharge,6974.21,Other,100% of NY Medicaid HMO DRG,6974,,DRG base rate x DRG weight + capital per discharge,6974,Other,100% of NY Medicaid HMO DRG,6974,,DRG base rate x DRG weight + capital per discharge,6974,Other,100% of NY Medicaid HMO DRG,6974,,DRG base rate x DRG weight + capital per discharge,6974,Other,100% of NY Medicaid HMO DRG,15692,,225% x Medicaid HMO amount,15692,Other,225% of NY Medicaid HMO DRG,10671,,153% x Medicaid HMO amount,10671,Other,153% of NY Medicaid HMO DRG,15692,,225% x Medicaid HMO amount,15692,Other,225% of NY Medicaid HMO DRG,9764,,140% x Medicaid HMO amount,9764,Other,140% of NY Medicaid HMO DRG,15692,,DRG base rate x DRG weight + capital per discharge,15692,Other,225% of NY Medicaid HMO DRG,19179,,275% x Medicaid HMO amount,19179,Other,275% of NY Medicaid HMO DRG,22596,,324% x Medicaid HMO amount,22596,Other,324% of NY Medicaid HMO DRG,14995,,215% x Medicaid HMO amount,14995,Other,215% of NY Medicaid HMO DRG,14995,,215% x Medicaid HMO amount,14995,Other,215% of NY Medicaid HMO DRG,8718,,125% x Medicaid HMO amount,8718,Other,125% of NY Medicaid HMO DRG,0.01,28292,
"Fractures & dislocations except femur, pelvis & back",342-1,APR-DRG,,,,,,,,inpatient,,,92965.78,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6131,,186% x Medicaid HMO amount,6131,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12286,,"27,634 x DRG Weight",12286,Other,DRG Base Rate x DRG Weight,10443,,"23,488 x DRG Weight",10443,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3296.21,,DRG base rate x DRG weight + capital per discharge,3296.21,Other,100% of NY Medicaid HMO DRG,3296,,DRG base rate x DRG weight + capital per discharge,3296,Other,100% of NY Medicaid HMO DRG,3296,,DRG base rate x DRG weight + capital per discharge,3296,Other,100% of NY Medicaid HMO DRG,3296,,DRG base rate x DRG weight + capital per discharge,3296,Other,100% of NY Medicaid HMO DRG,7416,,225% x Medicaid HMO amount,7416,Other,225% of NY Medicaid HMO DRG,5043,,153% x Medicaid HMO amount,5043,Other,153% of NY Medicaid HMO DRG,7416,,225% x Medicaid HMO amount,7416,Other,225% of NY Medicaid HMO DRG,4615,,140% x Medicaid HMO amount,4615,Other,140% of NY Medicaid HMO DRG,7416,,DRG base rate x DRG weight + capital per discharge,7416,Other,225% of NY Medicaid HMO DRG,9065,,275% x Medicaid HMO amount,9065,Other,275% of NY Medicaid HMO DRG,10680,,324% x Medicaid HMO amount,10680,Other,324% of NY Medicaid HMO DRG,7087,,215% x Medicaid HMO amount,7087,Other,215% of NY Medicaid HMO DRG,7087,,215% x Medicaid HMO amount,7087,Other,215% of NY Medicaid HMO DRG,4120,,125% x Medicaid HMO amount,4120,Other,125% of NY Medicaid HMO DRG,0.01,12286,
"Fractures & dislocations except femur, pelvis & back",342-2,APR-DRG,,,,,,,,inpatient,,,120322.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8666,,186% x Medicaid HMO amount,8666,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18219,,"27,634 x DRG Weight",18219,Other,DRG Base Rate x DRG Weight,15486,,"23,488 x DRG Weight",15486,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4659.21,,DRG base rate x DRG weight + capital per discharge,4659.21,Other,100% of NY Medicaid HMO DRG,4659,,DRG base rate x DRG weight + capital per discharge,4659,Other,100% of NY Medicaid HMO DRG,4659,,DRG base rate x DRG weight + capital per discharge,4659,Other,100% of NY Medicaid HMO DRG,4659,,DRG base rate x DRG weight + capital per discharge,4659,Other,100% of NY Medicaid HMO DRG,10483,,225% x Medicaid HMO amount,10483,Other,225% of NY Medicaid HMO DRG,7129,,153% x Medicaid HMO amount,7129,Other,153% of NY Medicaid HMO DRG,10483,,225% x Medicaid HMO amount,10483,Other,225% of NY Medicaid HMO DRG,6523,,140% x Medicaid HMO amount,6523,Other,140% of NY Medicaid HMO DRG,10483,,DRG base rate x DRG weight + capital per discharge,10483,Other,225% of NY Medicaid HMO DRG,12813,,275% x Medicaid HMO amount,12813,Other,275% of NY Medicaid HMO DRG,15096,,324% x Medicaid HMO amount,15096,Other,324% of NY Medicaid HMO DRG,10017,,215% x Medicaid HMO amount,10017,Other,215% of NY Medicaid HMO DRG,10017,,215% x Medicaid HMO amount,10017,Other,215% of NY Medicaid HMO DRG,5824,,125% x Medicaid HMO amount,5824,Other,125% of NY Medicaid HMO DRG,0.01,18219,
"Fractures & dislocations except femur, pelvis & back",342-3,APR-DRG,,,,,,,,inpatient,,,192130.05,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13675,,186% x Medicaid HMO amount,13675,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29939,,"27,634 x DRG Weight",29939,Other,DRG Base Rate x DRG Weight,25447,,"23,488 x DRG Weight",25447,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7352.21,,DRG base rate x DRG weight + capital per discharge,7352.21,Other,100% of NY Medicaid HMO DRG,7352,,DRG base rate x DRG weight + capital per discharge,7352,Other,100% of NY Medicaid HMO DRG,7352,,DRG base rate x DRG weight + capital per discharge,7352,Other,100% of NY Medicaid HMO DRG,7352,,DRG base rate x DRG weight + capital per discharge,7352,Other,100% of NY Medicaid HMO DRG,16542,,225% x Medicaid HMO amount,16542,Other,225% of NY Medicaid HMO DRG,11249,,153% x Medicaid HMO amount,11249,Other,153% of NY Medicaid HMO DRG,16542,,225% x Medicaid HMO amount,16542,Other,225% of NY Medicaid HMO DRG,10293,,140% x Medicaid HMO amount,10293,Other,140% of NY Medicaid HMO DRG,16542,,DRG base rate x DRG weight + capital per discharge,16542,Other,225% of NY Medicaid HMO DRG,20219,,275% x Medicaid HMO amount,20219,Other,275% of NY Medicaid HMO DRG,23821,,324% x Medicaid HMO amount,23821,Other,324% of NY Medicaid HMO DRG,15807,,215% x Medicaid HMO amount,15807,Other,215% of NY Medicaid HMO DRG,15807,,215% x Medicaid HMO amount,15807,Other,215% of NY Medicaid HMO DRG,9190,,125% x Medicaid HMO amount,9190,Other,125% of NY Medicaid HMO DRG,0.01,29939,
"Fractures & dislocations except femur, pelvis & back",342-4,APR-DRG,,,,,,,,inpatient,,,240902.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32139,,186% x Medicaid HMO amount,32139,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73136,,"27,634 x DRG Weight",73136,Other,DRG Base Rate x DRG Weight,62163,,"23,488 x DRG Weight",62163,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17279.21,,DRG base rate x DRG weight + capital per discharge,17279.21,Other,100% of NY Medicaid HMO DRG,17279,,DRG base rate x DRG weight + capital per discharge,17279,Other,100% of NY Medicaid HMO DRG,17279,,DRG base rate x DRG weight + capital per discharge,17279,Other,100% of NY Medicaid HMO DRG,17279,,DRG base rate x DRG weight + capital per discharge,17279,Other,100% of NY Medicaid HMO DRG,38878,,225% x Medicaid HMO amount,38878,Other,225% of NY Medicaid HMO DRG,26437,,153% x Medicaid HMO amount,26437,Other,153% of NY Medicaid HMO DRG,38878,,225% x Medicaid HMO amount,38878,Other,225% of NY Medicaid HMO DRG,24191,,140% x Medicaid HMO amount,24191,Other,140% of NY Medicaid HMO DRG,38878,,DRG base rate x DRG weight + capital per discharge,38878,Other,225% of NY Medicaid HMO DRG,47518,,275% x Medicaid HMO amount,47518,Other,275% of NY Medicaid HMO DRG,55985,,324% x Medicaid HMO amount,55985,Other,324% of NY Medicaid HMO DRG,37150,,215% x Medicaid HMO amount,37150,Other,215% of NY Medicaid HMO DRG,37150,,215% x Medicaid HMO amount,37150,Other,215% of NY Medicaid HMO DRG,21599,,125% x Medicaid HMO amount,21599,Other,125% of NY Medicaid HMO DRG,0.01,73136,
Musculoskeletal malignancy & pathol fracture d/t muscskel malig,343-1,APR-DRG,,,,,,,,inpatient,,,305795.62,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10678,,186% x Medicaid HMO amount,10678,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22928,,"27,634 x DRG Weight",22928,Other,DRG Base Rate x DRG Weight,19488,,"23,488 x DRG Weight",19488,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5741.21,,DRG base rate x DRG weight + capital per discharge,5741.21,Other,100% of NY Medicaid HMO DRG,5741,,DRG base rate x DRG weight + capital per discharge,5741,Other,100% of NY Medicaid HMO DRG,5741,,DRG base rate x DRG weight + capital per discharge,5741,Other,100% of NY Medicaid HMO DRG,5741,,DRG base rate x DRG weight + capital per discharge,5741,Other,100% of NY Medicaid HMO DRG,12918,,225% x Medicaid HMO amount,12918,Other,225% of NY Medicaid HMO DRG,8784,,153% x Medicaid HMO amount,8784,Other,153% of NY Medicaid HMO DRG,12918,,225% x Medicaid HMO amount,12918,Other,225% of NY Medicaid HMO DRG,8038,,140% x Medicaid HMO amount,8038,Other,140% of NY Medicaid HMO DRG,12918,,DRG base rate x DRG weight + capital per discharge,12918,Other,225% of NY Medicaid HMO DRG,15788,,275% x Medicaid HMO amount,15788,Other,275% of NY Medicaid HMO DRG,18602,,324% x Medicaid HMO amount,18602,Other,324% of NY Medicaid HMO DRG,12344,,215% x Medicaid HMO amount,12344,Other,215% of NY Medicaid HMO DRG,12344,,215% x Medicaid HMO amount,12344,Other,215% of NY Medicaid HMO DRG,7177,,125% x Medicaid HMO amount,7177,Other,125% of NY Medicaid HMO DRG,0.01,22928,
Musculoskeletal malignancy & pathol fracture d/t muscskel malig,343-2,APR-DRG,,,,,,,,inpatient,,,423823.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12663,,186% x Medicaid HMO amount,12663,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27568,,"27,634 x DRG Weight",27568,Other,DRG Base Rate x DRG Weight,23432,,"23,488 x DRG Weight",23432,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6808.21,,DRG base rate x DRG weight + capital per discharge,6808.21,Other,100% of NY Medicaid HMO DRG,6808,,DRG base rate x DRG weight + capital per discharge,6808,Other,100% of NY Medicaid HMO DRG,6808,,DRG base rate x DRG weight + capital per discharge,6808,Other,100% of NY Medicaid HMO DRG,6808,,DRG base rate x DRG weight + capital per discharge,6808,Other,100% of NY Medicaid HMO DRG,15318,,225% x Medicaid HMO amount,15318,Other,225% of NY Medicaid HMO DRG,10417,,153% x Medicaid HMO amount,10417,Other,153% of NY Medicaid HMO DRG,15318,,225% x Medicaid HMO amount,15318,Other,225% of NY Medicaid HMO DRG,9531,,140% x Medicaid HMO amount,9531,Other,140% of NY Medicaid HMO DRG,15318,,DRG base rate x DRG weight + capital per discharge,15318,Other,225% of NY Medicaid HMO DRG,18723,,275% x Medicaid HMO amount,18723,Other,275% of NY Medicaid HMO DRG,22059,,324% x Medicaid HMO amount,22059,Other,324% of NY Medicaid HMO DRG,14638,,215% x Medicaid HMO amount,14638,Other,215% of NY Medicaid HMO DRG,14638,,215% x Medicaid HMO amount,14638,Other,215% of NY Medicaid HMO DRG,8510,,125% x Medicaid HMO amount,8510,Other,125% of NY Medicaid HMO DRG,0.01,27568,
Musculoskeletal malignancy & pathol fracture d/t muscskel malig,343-3,APR-DRG,,,,,,,,inpatient,,,479363.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26233,,186% x Medicaid HMO amount,26233,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59319,,"27,634 x DRG Weight",59319,Other,DRG Base Rate x DRG Weight,50419,,"23,488 x DRG Weight",50419,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14104.21,,DRG base rate x DRG weight + capital per discharge,14104.21,Other,100% of NY Medicaid HMO DRG,14104,,DRG base rate x DRG weight + capital per discharge,14104,Other,100% of NY Medicaid HMO DRG,14104,,DRG base rate x DRG weight + capital per discharge,14104,Other,100% of NY Medicaid HMO DRG,14104,,DRG base rate x DRG weight + capital per discharge,14104,Other,100% of NY Medicaid HMO DRG,31734,,225% x Medicaid HMO amount,31734,Other,225% of NY Medicaid HMO DRG,21579,,153% x Medicaid HMO amount,21579,Other,153% of NY Medicaid HMO DRG,31734,,225% x Medicaid HMO amount,31734,Other,225% of NY Medicaid HMO DRG,19746,,140% x Medicaid HMO amount,19746,Other,140% of NY Medicaid HMO DRG,31734,,DRG base rate x DRG weight + capital per discharge,31734,Other,225% of NY Medicaid HMO DRG,38787,,275% x Medicaid HMO amount,38787,Other,275% of NY Medicaid HMO DRG,45698,,324% x Medicaid HMO amount,45698,Other,324% of NY Medicaid HMO DRG,30324,,215% x Medicaid HMO amount,30324,Other,215% of NY Medicaid HMO DRG,30324,,215% x Medicaid HMO amount,30324,Other,215% of NY Medicaid HMO DRG,17630,,125% x Medicaid HMO amount,17630,Other,125% of NY Medicaid HMO DRG,0.01,59319,
Musculoskeletal malignancy & pathol fracture d/t muscskel malig,343-4,APR-DRG,,,,,,,,inpatient,,,325773,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46374,,186% x Medicaid HMO amount,46374,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,106441,,"27,634 x DRG Weight",106441,Other,DRG Base Rate x DRG Weight,90471,,"23,488 x DRG Weight",90471,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24932.21,,DRG base rate x DRG weight + capital per discharge,24932.21,Other,100% of NY Medicaid HMO DRG,24932,,DRG base rate x DRG weight + capital per discharge,24932,Other,100% of NY Medicaid HMO DRG,24932,,DRG base rate x DRG weight + capital per discharge,24932,Other,100% of NY Medicaid HMO DRG,24932,,DRG base rate x DRG weight + capital per discharge,24932,Other,100% of NY Medicaid HMO DRG,56097,,225% x Medicaid HMO amount,56097,Other,225% of NY Medicaid HMO DRG,38146,,153% x Medicaid HMO amount,38146,Other,153% of NY Medicaid HMO DRG,56097,,225% x Medicaid HMO amount,56097,Other,225% of NY Medicaid HMO DRG,34905,,140% x Medicaid HMO amount,34905,Other,140% of NY Medicaid HMO DRG,56097,,DRG base rate x DRG weight + capital per discharge,56097,Other,225% of NY Medicaid HMO DRG,68564,,275% x Medicaid HMO amount,68564,Other,275% of NY Medicaid HMO DRG,80780,,324% x Medicaid HMO amount,80780,Other,324% of NY Medicaid HMO DRG,53604,,215% x Medicaid HMO amount,53604,Other,215% of NY Medicaid HMO DRG,53604,,215% x Medicaid HMO amount,53604,Other,215% of NY Medicaid HMO DRG,31165,,125% x Medicaid HMO amount,31165,Other,125% of NY Medicaid HMO DRG,0.01,106441,
"Osteomyelitis, septic arthritis & other musculoskeletal infections",344-1,APR-DRG,,,,,,,,inpatient,,,57913.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10377,,186% x Medicaid HMO amount,10377,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22220,,"27,634 x DRG Weight",22220,Other,DRG Base Rate x DRG Weight,18887,,"23,488 x DRG Weight",18887,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5579.21,,DRG base rate x DRG weight + capital per discharge,5579.21,Other,100% of NY Medicaid HMO DRG,5579,,DRG base rate x DRG weight + capital per discharge,5579,Other,100% of NY Medicaid HMO DRG,5579,,DRG base rate x DRG weight + capital per discharge,5579,Other,100% of NY Medicaid HMO DRG,5579,,DRG base rate x DRG weight + capital per discharge,5579,Other,100% of NY Medicaid HMO DRG,12553,,225% x Medicaid HMO amount,12553,Other,225% of NY Medicaid HMO DRG,8536,,153% x Medicaid HMO amount,8536,Other,153% of NY Medicaid HMO DRG,12553,,225% x Medicaid HMO amount,12553,Other,225% of NY Medicaid HMO DRG,7811,,140% x Medicaid HMO amount,7811,Other,140% of NY Medicaid HMO DRG,12553,,DRG base rate x DRG weight + capital per discharge,12553,Other,225% of NY Medicaid HMO DRG,15343,,275% x Medicaid HMO amount,15343,Other,275% of NY Medicaid HMO DRG,18077,,324% x Medicaid HMO amount,18077,Other,324% of NY Medicaid HMO DRG,11995,,215% x Medicaid HMO amount,11995,Other,215% of NY Medicaid HMO DRG,11995,,215% x Medicaid HMO amount,11995,Other,215% of NY Medicaid HMO DRG,6974,,125% x Medicaid HMO amount,6974,Other,125% of NY Medicaid HMO DRG,0.01,22220,
"Osteomyelitis, septic arthritis & other musculoskeletal infections",344-2,APR-DRG,,,,,,,,inpatient,,,142328.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14460,,186% x Medicaid HMO amount,14460,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31774,,"27,634 x DRG Weight",31774,Other,DRG Base Rate x DRG Weight,27007,,"23,488 x DRG Weight",27007,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7774.21,,DRG base rate x DRG weight + capital per discharge,7774.21,Other,100% of NY Medicaid HMO DRG,7774,,DRG base rate x DRG weight + capital per discharge,7774,Other,100% of NY Medicaid HMO DRG,7774,,DRG base rate x DRG weight + capital per discharge,7774,Other,100% of NY Medicaid HMO DRG,7774,,DRG base rate x DRG weight + capital per discharge,7774,Other,100% of NY Medicaid HMO DRG,17492,,225% x Medicaid HMO amount,17492,Other,225% of NY Medicaid HMO DRG,11895,,153% x Medicaid HMO amount,11895,Other,153% of NY Medicaid HMO DRG,17492,,225% x Medicaid HMO amount,17492,Other,225% of NY Medicaid HMO DRG,10884,,140% x Medicaid HMO amount,10884,Other,140% of NY Medicaid HMO DRG,17492,,DRG base rate x DRG weight + capital per discharge,17492,Other,225% of NY Medicaid HMO DRG,21379,,275% x Medicaid HMO amount,21379,Other,275% of NY Medicaid HMO DRG,25188,,324% x Medicaid HMO amount,25188,Other,324% of NY Medicaid HMO DRG,16715,,215% x Medicaid HMO amount,16715,Other,215% of NY Medicaid HMO DRG,16715,,215% x Medicaid HMO amount,16715,Other,215% of NY Medicaid HMO DRG,9718,,125% x Medicaid HMO amount,9718,Other,125% of NY Medicaid HMO DRG,0.01,31774,
"Osteomyelitis, septic arthritis & other musculoskeletal infections",344-3,APR-DRG,,,,,,,,inpatient,,,235243.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21942,,186% x Medicaid HMO amount,21942,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49282,,"27,634 x DRG Weight",49282,Other,DRG Base Rate x DRG Weight,41888,,"23,488 x DRG Weight",41888,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11797.21,,DRG base rate x DRG weight + capital per discharge,11797.21,Other,100% of NY Medicaid HMO DRG,11797,,DRG base rate x DRG weight + capital per discharge,11797,Other,100% of NY Medicaid HMO DRG,11797,,DRG base rate x DRG weight + capital per discharge,11797,Other,100% of NY Medicaid HMO DRG,11797,,DRG base rate x DRG weight + capital per discharge,11797,Other,100% of NY Medicaid HMO DRG,26544,,225% x Medicaid HMO amount,26544,Other,225% of NY Medicaid HMO DRG,18050,,153% x Medicaid HMO amount,18050,Other,153% of NY Medicaid HMO DRG,26544,,225% x Medicaid HMO amount,26544,Other,225% of NY Medicaid HMO DRG,16516,,140% x Medicaid HMO amount,16516,Other,140% of NY Medicaid HMO DRG,26544,,DRG base rate x DRG weight + capital per discharge,26544,Other,225% of NY Medicaid HMO DRG,32442,,275% x Medicaid HMO amount,32442,Other,275% of NY Medicaid HMO DRG,38223,,324% x Medicaid HMO amount,38223,Other,324% of NY Medicaid HMO DRG,25364,,215% x Medicaid HMO amount,25364,Other,215% of NY Medicaid HMO DRG,25364,,215% x Medicaid HMO amount,25364,Other,215% of NY Medicaid HMO DRG,14747,,125% x Medicaid HMO amount,14747,Other,125% of NY Medicaid HMO DRG,0.01,49282,
"Osteomyelitis, septic arthritis & other musculoskeletal infections",344-4,APR-DRG,,,,,,,,inpatient,,,347789.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41424,,186% x Medicaid HMO amount,41424,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,94862,,"27,634 x DRG Weight",94862,Other,DRG Base Rate x DRG Weight,80630,,"23,488 x DRG Weight",80630,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22271.21,,DRG base rate x DRG weight + capital per discharge,22271.21,Other,100% of NY Medicaid HMO DRG,22271,,DRG base rate x DRG weight + capital per discharge,22271,Other,100% of NY Medicaid HMO DRG,22271,,DRG base rate x DRG weight + capital per discharge,22271,Other,100% of NY Medicaid HMO DRG,22271,,DRG base rate x DRG weight + capital per discharge,22271,Other,100% of NY Medicaid HMO DRG,50110,,225% x Medicaid HMO amount,50110,Other,225% of NY Medicaid HMO DRG,34075,,153% x Medicaid HMO amount,34075,Other,153% of NY Medicaid HMO DRG,50110,,225% x Medicaid HMO amount,50110,Other,225% of NY Medicaid HMO DRG,31180,,140% x Medicaid HMO amount,31180,Other,140% of NY Medicaid HMO DRG,50110,,DRG base rate x DRG weight + capital per discharge,50110,Other,225% of NY Medicaid HMO DRG,61246,,275% x Medicaid HMO amount,61246,Other,275% of NY Medicaid HMO DRG,72159,,324% x Medicaid HMO amount,72159,Other,324% of NY Medicaid HMO DRG,47883,,215% x Medicaid HMO amount,47883,Other,215% of NY Medicaid HMO DRG,47883,,215% x Medicaid HMO amount,47883,Other,215% of NY Medicaid HMO DRG,27839,,125% x Medicaid HMO amount,27839,Other,125% of NY Medicaid HMO DRG,0.01,94862,
Connective tissue disorders,346-1,APR-DRG,,,,,,,,inpatient,,,98482.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9519,,186% x Medicaid HMO amount,9519,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20214,,"27,634 x DRG Weight",20214,Other,DRG Base Rate x DRG Weight,17181,,"23,488 x DRG Weight",17181,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5118.21,,DRG base rate x DRG weight + capital per discharge,5118.21,Other,100% of NY Medicaid HMO DRG,5118,,DRG base rate x DRG weight + capital per discharge,5118,Other,100% of NY Medicaid HMO DRG,5118,,DRG base rate x DRG weight + capital per discharge,5118,Other,100% of NY Medicaid HMO DRG,5118,,DRG base rate x DRG weight + capital per discharge,5118,Other,100% of NY Medicaid HMO DRG,11516,,225% x Medicaid HMO amount,11516,Other,225% of NY Medicaid HMO DRG,7831,,153% x Medicaid HMO amount,7831,Other,153% of NY Medicaid HMO DRG,11516,,225% x Medicaid HMO amount,11516,Other,225% of NY Medicaid HMO DRG,7165,,140% x Medicaid HMO amount,7165,Other,140% of NY Medicaid HMO DRG,11516,,DRG base rate x DRG weight + capital per discharge,11516,Other,225% of NY Medicaid HMO DRG,14075,,275% x Medicaid HMO amount,14075,Other,275% of NY Medicaid HMO DRG,16583,,324% x Medicaid HMO amount,16583,Other,324% of NY Medicaid HMO DRG,11004,,215% x Medicaid HMO amount,11004,Other,215% of NY Medicaid HMO DRG,11004,,215% x Medicaid HMO amount,11004,Other,215% of NY Medicaid HMO DRG,6398,,125% x Medicaid HMO amount,6398,Other,125% of NY Medicaid HMO DRG,0.01,20214,
Connective tissue disorders,346-2,APR-DRG,,,,,,,,inpatient,,,147716.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12244,,186% x Medicaid HMO amount,12244,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26589,,"27,634 x DRG Weight",26589,Other,DRG Base Rate x DRG Weight,22600,,"23,488 x DRG Weight",22600,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6583.21,,DRG base rate x DRG weight + capital per discharge,6583.21,Other,100% of NY Medicaid HMO DRG,6583,,DRG base rate x DRG weight + capital per discharge,6583,Other,100% of NY Medicaid HMO DRG,6583,,DRG base rate x DRG weight + capital per discharge,6583,Other,100% of NY Medicaid HMO DRG,6583,,DRG base rate x DRG weight + capital per discharge,6583,Other,100% of NY Medicaid HMO DRG,14812,,225% x Medicaid HMO amount,14812,Other,225% of NY Medicaid HMO DRG,10072,,153% x Medicaid HMO amount,10072,Other,153% of NY Medicaid HMO DRG,14812,,225% x Medicaid HMO amount,14812,Other,225% of NY Medicaid HMO DRG,9216,,140% x Medicaid HMO amount,9216,Other,140% of NY Medicaid HMO DRG,14812,,DRG base rate x DRG weight + capital per discharge,14812,Other,225% of NY Medicaid HMO DRG,18104,,275% x Medicaid HMO amount,18104,Other,275% of NY Medicaid HMO DRG,21330,,324% x Medicaid HMO amount,21330,Other,324% of NY Medicaid HMO DRG,14154,,215% x Medicaid HMO amount,14154,Other,215% of NY Medicaid HMO DRG,14154,,215% x Medicaid HMO amount,14154,Other,215% of NY Medicaid HMO DRG,8229,,125% x Medicaid HMO amount,8229,Other,125% of NY Medicaid HMO DRG,0.01,26589,
Connective tissue disorders,346-3,APR-DRG,,,,,,,,inpatient,,,174289.57,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20520,,186% x Medicaid HMO amount,20520,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45953,,"27,634 x DRG Weight",45953,Other,DRG Base Rate x DRG Weight,39058,,"23,488 x DRG Weight",39058,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11032.21,,DRG base rate x DRG weight + capital per discharge,11032.21,Other,100% of NY Medicaid HMO DRG,11032,,DRG base rate x DRG weight + capital per discharge,11032,Other,100% of NY Medicaid HMO DRG,11032,,DRG base rate x DRG weight + capital per discharge,11032,Other,100% of NY Medicaid HMO DRG,11032,,DRG base rate x DRG weight + capital per discharge,11032,Other,100% of NY Medicaid HMO DRG,24822,,225% x Medicaid HMO amount,24822,Other,225% of NY Medicaid HMO DRG,16879,,153% x Medicaid HMO amount,16879,Other,153% of NY Medicaid HMO DRG,24822,,225% x Medicaid HMO amount,24822,Other,225% of NY Medicaid HMO DRG,15445,,140% x Medicaid HMO amount,15445,Other,140% of NY Medicaid HMO DRG,24822,,DRG base rate x DRG weight + capital per discharge,24822,Other,225% of NY Medicaid HMO DRG,30339,,275% x Medicaid HMO amount,30339,Other,275% of NY Medicaid HMO DRG,35744,,324% x Medicaid HMO amount,35744,Other,324% of NY Medicaid HMO DRG,23719,,215% x Medicaid HMO amount,23719,Other,215% of NY Medicaid HMO DRG,23719,,215% x Medicaid HMO amount,23719,Other,215% of NY Medicaid HMO DRG,13790,,125% x Medicaid HMO amount,13790,Other,125% of NY Medicaid HMO DRG,0.01,45953,
Connective tissue disorders,346-4,APR-DRG,,,,,,,,inpatient,,,414074.24,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58452,,186% x Medicaid HMO amount,58452,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,134702,,"27,634 x DRG Weight",134702,Other,DRG Base Rate x DRG Weight,114492,,"23,488 x DRG Weight",114492,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31426.21,,DRG base rate x DRG weight + capital per discharge,31426.21,Other,100% of NY Medicaid HMO DRG,31426,,DRG base rate x DRG weight + capital per discharge,31426,Other,100% of NY Medicaid HMO DRG,31426,,DRG base rate x DRG weight + capital per discharge,31426,Other,100% of NY Medicaid HMO DRG,31426,,DRG base rate x DRG weight + capital per discharge,31426,Other,100% of NY Medicaid HMO DRG,70709,,225% x Medicaid HMO amount,70709,Other,225% of NY Medicaid HMO DRG,48082,,153% x Medicaid HMO amount,48082,Other,153% of NY Medicaid HMO DRG,70709,,225% x Medicaid HMO amount,70709,Other,225% of NY Medicaid HMO DRG,43997,,140% x Medicaid HMO amount,43997,Other,140% of NY Medicaid HMO DRG,70709,,DRG base rate x DRG weight + capital per discharge,70709,Other,225% of NY Medicaid HMO DRG,86422,,275% x Medicaid HMO amount,86422,Other,275% of NY Medicaid HMO DRG,101821,,324% x Medicaid HMO amount,101821,Other,324% of NY Medicaid HMO DRG,67566,,215% x Medicaid HMO amount,67566,Other,215% of NY Medicaid HMO DRG,67566,,215% x Medicaid HMO amount,67566,Other,215% of NY Medicaid HMO DRG,39283,,125% x Medicaid HMO amount,39283,Other,125% of NY Medicaid HMO DRG,0.01,134702,
"Other back & neck disorders, fractures & injuries",347-1,APR-DRG,,,,,,,,inpatient,,,112218.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7366,,186% x Medicaid HMO amount,7366,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15174,,"27,634 x DRG Weight",15174,Other,DRG Base Rate x DRG Weight,12897,,"23,488 x DRG Weight",12897,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3960.21,,DRG base rate x DRG weight + capital per discharge,3960.21,Other,100% of NY Medicaid HMO DRG,3960,,DRG base rate x DRG weight + capital per discharge,3960,Other,100% of NY Medicaid HMO DRG,3960,,DRG base rate x DRG weight + capital per discharge,3960,Other,100% of NY Medicaid HMO DRG,3960,,DRG base rate x DRG weight + capital per discharge,3960,Other,100% of NY Medicaid HMO DRG,8910,,225% x Medicaid HMO amount,8910,Other,225% of NY Medicaid HMO DRG,6059,,153% x Medicaid HMO amount,6059,Other,153% of NY Medicaid HMO DRG,8910,,225% x Medicaid HMO amount,8910,Other,225% of NY Medicaid HMO DRG,5544,,140% x Medicaid HMO amount,5544,Other,140% of NY Medicaid HMO DRG,8910,,DRG base rate x DRG weight + capital per discharge,8910,Other,225% of NY Medicaid HMO DRG,10891,,275% x Medicaid HMO amount,10891,Other,275% of NY Medicaid HMO DRG,12831,,324% x Medicaid HMO amount,12831,Other,324% of NY Medicaid HMO DRG,8514,,215% x Medicaid HMO amount,8514,Other,215% of NY Medicaid HMO DRG,8514,,215% x Medicaid HMO amount,8514,Other,215% of NY Medicaid HMO DRG,4950,,125% x Medicaid HMO amount,4950,Other,125% of NY Medicaid HMO DRG,0.01,15174,
"Other back & neck disorders, fractures & injuries",347-2,APR-DRG,,,,,,,,inpatient,,,155698.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9676,,186% x Medicaid HMO amount,9676,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20579,,"27,634 x DRG Weight",20579,Other,DRG Base Rate x DRG Weight,17492,,"23,488 x DRG Weight",17492,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5202.21,,DRG base rate x DRG weight + capital per discharge,5202.21,Other,100% of NY Medicaid HMO DRG,5202,,DRG base rate x DRG weight + capital per discharge,5202,Other,100% of NY Medicaid HMO DRG,5202,,DRG base rate x DRG weight + capital per discharge,5202,Other,100% of NY Medicaid HMO DRG,5202,,DRG base rate x DRG weight + capital per discharge,5202,Other,100% of NY Medicaid HMO DRG,11705,,225% x Medicaid HMO amount,11705,Other,225% of NY Medicaid HMO DRG,7959,,153% x Medicaid HMO amount,7959,Other,153% of NY Medicaid HMO DRG,11705,,225% x Medicaid HMO amount,11705,Other,225% of NY Medicaid HMO DRG,7283,,140% x Medicaid HMO amount,7283,Other,140% of NY Medicaid HMO DRG,11705,,DRG base rate x DRG weight + capital per discharge,11705,Other,225% of NY Medicaid HMO DRG,14306,,275% x Medicaid HMO amount,14306,Other,275% of NY Medicaid HMO DRG,16855,,324% x Medicaid HMO amount,16855,Other,324% of NY Medicaid HMO DRG,11185,,215% x Medicaid HMO amount,11185,Other,215% of NY Medicaid HMO DRG,11185,,215% x Medicaid HMO amount,11185,Other,215% of NY Medicaid HMO DRG,6503,,125% x Medicaid HMO amount,6503,Other,125% of NY Medicaid HMO DRG,0.01,20579,
"Other back & neck disorders, fractures & injuries",347-3,APR-DRG,,,,,,,,inpatient,,,157162.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14151,,186% x Medicaid HMO amount,14151,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31052,,"27,634 x DRG Weight",31052,Other,DRG Base Rate x DRG Weight,26393,,"23,488 x DRG Weight",26393,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7608.21,,DRG base rate x DRG weight + capital per discharge,7608.21,Other,100% of NY Medicaid HMO DRG,7608,,DRG base rate x DRG weight + capital per discharge,7608,Other,100% of NY Medicaid HMO DRG,7608,,DRG base rate x DRG weight + capital per discharge,7608,Other,100% of NY Medicaid HMO DRG,7608,,DRG base rate x DRG weight + capital per discharge,7608,Other,100% of NY Medicaid HMO DRG,17118,,225% x Medicaid HMO amount,17118,Other,225% of NY Medicaid HMO DRG,11641,,153% x Medicaid HMO amount,11641,Other,153% of NY Medicaid HMO DRG,17118,,225% x Medicaid HMO amount,17118,Other,225% of NY Medicaid HMO DRG,10651,,140% x Medicaid HMO amount,10651,Other,140% of NY Medicaid HMO DRG,17118,,DRG base rate x DRG weight + capital per discharge,17118,Other,225% of NY Medicaid HMO DRG,20923,,275% x Medicaid HMO amount,20923,Other,275% of NY Medicaid HMO DRG,24651,,324% x Medicaid HMO amount,24651,Other,324% of NY Medicaid HMO DRG,16358,,215% x Medicaid HMO amount,16358,Other,215% of NY Medicaid HMO DRG,16358,,215% x Medicaid HMO amount,16358,Other,215% of NY Medicaid HMO DRG,9510,,125% x Medicaid HMO amount,9510,Other,125% of NY Medicaid HMO DRG,0.01,31052,
"Other back & neck disorders, fractures & injuries",347-4,APR-DRG,,,,,,,,inpatient,,,298192,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38147,,186% x Medicaid HMO amount,38147,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,87194,,"27,634 x DRG Weight",87194,Other,DRG Base Rate x DRG Weight,74112,,"23,488 x DRG Weight",74112,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20509.21,,DRG base rate x DRG weight + capital per discharge,20509.21,Other,100% of NY Medicaid HMO DRG,20509,,DRG base rate x DRG weight + capital per discharge,20509,Other,100% of NY Medicaid HMO DRG,20509,,DRG base rate x DRG weight + capital per discharge,20509,Other,100% of NY Medicaid HMO DRG,20509,,DRG base rate x DRG weight + capital per discharge,20509,Other,100% of NY Medicaid HMO DRG,46146,,225% x Medicaid HMO amount,46146,Other,225% of NY Medicaid HMO DRG,31379,,153% x Medicaid HMO amount,31379,Other,153% of NY Medicaid HMO DRG,46146,,225% x Medicaid HMO amount,46146,Other,225% of NY Medicaid HMO DRG,28713,,140% x Medicaid HMO amount,28713,Other,140% of NY Medicaid HMO DRG,46146,,DRG base rate x DRG weight + capital per discharge,46146,Other,225% of NY Medicaid HMO DRG,56400,,275% x Medicaid HMO amount,56400,Other,275% of NY Medicaid HMO DRG,66450,,324% x Medicaid HMO amount,66450,Other,324% of NY Medicaid HMO DRG,44095,,215% x Medicaid HMO amount,44095,Other,215% of NY Medicaid HMO DRG,44095,,215% x Medicaid HMO amount,44095,Other,215% of NY Medicaid HMO DRG,25637,,125% x Medicaid HMO amount,25637,Other,125% of NY Medicaid HMO DRG,0.01,87194,
"Malfunction, reaction, complic of orthopedic device or procedure",349-1,APR-DRG,,,,,,,,inpatient,,,36523.08,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7304,,186% x Medicaid HMO amount,7304,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15030,,"27,634 x DRG Weight",15030,Other,DRG Base Rate x DRG Weight,12775,,"23,488 x DRG Weight",12775,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3927.21,,DRG base rate x DRG weight + capital per discharge,3927.21,Other,100% of NY Medicaid HMO DRG,3927,,DRG base rate x DRG weight + capital per discharge,3927,Other,100% of NY Medicaid HMO DRG,3927,,DRG base rate x DRG weight + capital per discharge,3927,Other,100% of NY Medicaid HMO DRG,3927,,DRG base rate x DRG weight + capital per discharge,3927,Other,100% of NY Medicaid HMO DRG,8836,,225% x Medicaid HMO amount,8836,Other,225% of NY Medicaid HMO DRG,6009,,153% x Medicaid HMO amount,6009,Other,153% of NY Medicaid HMO DRG,8836,,225% x Medicaid HMO amount,8836,Other,225% of NY Medicaid HMO DRG,5498,,140% x Medicaid HMO amount,5498,Other,140% of NY Medicaid HMO DRG,8836,,DRG base rate x DRG weight + capital per discharge,8836,Other,225% of NY Medicaid HMO DRG,10800,,275% x Medicaid HMO amount,10800,Other,275% of NY Medicaid HMO DRG,12724,,324% x Medicaid HMO amount,12724,Other,324% of NY Medicaid HMO DRG,8444,,215% x Medicaid HMO amount,8444,Other,215% of NY Medicaid HMO DRG,8444,,215% x Medicaid HMO amount,8444,Other,215% of NY Medicaid HMO DRG,4909,,125% x Medicaid HMO amount,4909,Other,125% of NY Medicaid HMO DRG,0.01,15030,
"Malfunction, reaction, complic of orthopedic device or procedure",349-2,APR-DRG,,,,,,,,inpatient,,,71132.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11264,,186% x Medicaid HMO amount,11264,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24296,,"27,634 x DRG Weight",24296,Other,DRG Base Rate x DRG Weight,20651,,"23,488 x DRG Weight",20651,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6056.21,,DRG base rate x DRG weight + capital per discharge,6056.21,Other,100% of NY Medicaid HMO DRG,6056,,DRG base rate x DRG weight + capital per discharge,6056,Other,100% of NY Medicaid HMO DRG,6056,,DRG base rate x DRG weight + capital per discharge,6056,Other,100% of NY Medicaid HMO DRG,6056,,DRG base rate x DRG weight + capital per discharge,6056,Other,100% of NY Medicaid HMO DRG,13626,,225% x Medicaid HMO amount,13626,Other,225% of NY Medicaid HMO DRG,9266,,153% x Medicaid HMO amount,9266,Other,153% of NY Medicaid HMO DRG,13626,,225% x Medicaid HMO amount,13626,Other,225% of NY Medicaid HMO DRG,8479,,140% x Medicaid HMO amount,8479,Other,140% of NY Medicaid HMO DRG,13626,,DRG base rate x DRG weight + capital per discharge,13626,Other,225% of NY Medicaid HMO DRG,16655,,275% x Medicaid HMO amount,16655,Other,275% of NY Medicaid HMO DRG,19622,,324% x Medicaid HMO amount,19622,Other,324% of NY Medicaid HMO DRG,13021,,215% x Medicaid HMO amount,13021,Other,215% of NY Medicaid HMO DRG,13021,,215% x Medicaid HMO amount,13021,Other,215% of NY Medicaid HMO DRG,7570,,125% x Medicaid HMO amount,7570,Other,125% of NY Medicaid HMO DRG,0.01,24296,
"Malfunction, reaction, complic of orthopedic device or procedure",349-3,APR-DRG,,,,,,,,inpatient,,,278226.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19281,,186% x Medicaid HMO amount,19281,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43054,,"27,634 x DRG Weight",43054,Other,DRG Base Rate x DRG Weight,36594,,"23,488 x DRG Weight",36594,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10366.21,,DRG base rate x DRG weight + capital per discharge,10366.21,Other,100% of NY Medicaid HMO DRG,10366,,DRG base rate x DRG weight + capital per discharge,10366,Other,100% of NY Medicaid HMO DRG,10366,,DRG base rate x DRG weight + capital per discharge,10366,Other,100% of NY Medicaid HMO DRG,10366,,DRG base rate x DRG weight + capital per discharge,10366,Other,100% of NY Medicaid HMO DRG,23324,,225% x Medicaid HMO amount,23324,Other,225% of NY Medicaid HMO DRG,15860,,153% x Medicaid HMO amount,15860,Other,153% of NY Medicaid HMO DRG,23324,,225% x Medicaid HMO amount,23324,Other,225% of NY Medicaid HMO DRG,14513,,140% x Medicaid HMO amount,14513,Other,140% of NY Medicaid HMO DRG,23324,,DRG base rate x DRG weight + capital per discharge,23324,Other,225% of NY Medicaid HMO DRG,28507,,275% x Medicaid HMO amount,28507,Other,275% of NY Medicaid HMO DRG,33587,,324% x Medicaid HMO amount,33587,Other,324% of NY Medicaid HMO DRG,22287,,215% x Medicaid HMO amount,22287,Other,215% of NY Medicaid HMO DRG,22287,,215% x Medicaid HMO amount,22287,Other,215% of NY Medicaid HMO DRG,12958,,125% x Medicaid HMO amount,12958,Other,125% of NY Medicaid HMO DRG,0.01,43054,
"Malfunction, reaction, complic of orthopedic device or procedure",349-4,APR-DRG,,,,,,,,inpatient,,,278226.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43061,,186% x Medicaid HMO amount,43061,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,98692,,"27,634 x DRG Weight",98692,Other,DRG Base Rate x DRG Weight,83885,,"23,488 x DRG Weight",83885,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23151.21,,DRG base rate x DRG weight + capital per discharge,23151.21,Other,100% of NY Medicaid HMO DRG,23151,,DRG base rate x DRG weight + capital per discharge,23151,Other,100% of NY Medicaid HMO DRG,23151,,DRG base rate x DRG weight + capital per discharge,23151,Other,100% of NY Medicaid HMO DRG,23151,,DRG base rate x DRG weight + capital per discharge,23151,Other,100% of NY Medicaid HMO DRG,52090,,225% x Medicaid HMO amount,52090,Other,225% of NY Medicaid HMO DRG,35421,,153% x Medicaid HMO amount,35421,Other,153% of NY Medicaid HMO DRG,52090,,225% x Medicaid HMO amount,52090,Other,225% of NY Medicaid HMO DRG,32412,,140% x Medicaid HMO amount,32412,Other,140% of NY Medicaid HMO DRG,52090,,DRG base rate x DRG weight + capital per discharge,52090,Other,225% of NY Medicaid HMO DRG,63666,,275% x Medicaid HMO amount,63666,Other,275% of NY Medicaid HMO DRG,75010,,324% x Medicaid HMO amount,75010,Other,324% of NY Medicaid HMO DRG,49775,,215% x Medicaid HMO amount,49775,Other,215% of NY Medicaid HMO DRG,49775,,215% x Medicaid HMO amount,49775,Other,215% of NY Medicaid HMO DRG,28939,,125% x Medicaid HMO amount,28939,Other,125% of NY Medicaid HMO DRG,0.01,98692,
Other musculoskeletal system & connective tissue diagnoses,351-1,APR-DRG,,,,,,,,inpatient,,,91941.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6677,,186% x Medicaid HMO amount,6677,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13566,,"27,634 x DRG Weight",13566,Other,DRG Base Rate x DRG Weight,11530,,"23,488 x DRG Weight",11530,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3590.21,,DRG base rate x DRG weight + capital per discharge,3590.21,Other,100% of NY Medicaid HMO DRG,3590,,DRG base rate x DRG weight + capital per discharge,3590,Other,100% of NY Medicaid HMO DRG,3590,,DRG base rate x DRG weight + capital per discharge,3590,Other,100% of NY Medicaid HMO DRG,3590,,DRG base rate x DRG weight + capital per discharge,3590,Other,100% of NY Medicaid HMO DRG,8078,,225% x Medicaid HMO amount,8078,Other,225% of NY Medicaid HMO DRG,5493,,153% x Medicaid HMO amount,5493,Other,153% of NY Medicaid HMO DRG,8078,,225% x Medicaid HMO amount,8078,Other,225% of NY Medicaid HMO DRG,5026,,140% x Medicaid HMO amount,5026,Other,140% of NY Medicaid HMO DRG,8078,,DRG base rate x DRG weight + capital per discharge,8078,Other,225% of NY Medicaid HMO DRG,9873,,275% x Medicaid HMO amount,9873,Other,275% of NY Medicaid HMO DRG,11632,,324% x Medicaid HMO amount,11632,Other,324% of NY Medicaid HMO DRG,7719,,215% x Medicaid HMO amount,7719,Other,215% of NY Medicaid HMO DRG,7719,,215% x Medicaid HMO amount,7719,Other,215% of NY Medicaid HMO DRG,4488,,125% x Medicaid HMO amount,4488,Other,125% of NY Medicaid HMO DRG,0.01,13566,
Other musculoskeletal system & connective tissue diagnoses,351-2,APR-DRG,,,,,,,,inpatient,,,119058.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8424,,186% x Medicaid HMO amount,8424,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17653,,"27,634 x DRG Weight",17653,Other,DRG Base Rate x DRG Weight,15004,,"23,488 x DRG Weight",15004,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4529.21,,DRG base rate x DRG weight + capital per discharge,4529.21,Other,100% of NY Medicaid HMO DRG,4529,,DRG base rate x DRG weight + capital per discharge,4529,Other,100% of NY Medicaid HMO DRG,4529,,DRG base rate x DRG weight + capital per discharge,4529,Other,100% of NY Medicaid HMO DRG,4529,,DRG base rate x DRG weight + capital per discharge,4529,Other,100% of NY Medicaid HMO DRG,10191,,225% x Medicaid HMO amount,10191,Other,225% of NY Medicaid HMO DRG,6930,,153% x Medicaid HMO amount,6930,Other,153% of NY Medicaid HMO DRG,10191,,225% x Medicaid HMO amount,10191,Other,225% of NY Medicaid HMO DRG,6341,,140% x Medicaid HMO amount,6341,Other,140% of NY Medicaid HMO DRG,10191,,DRG base rate x DRG weight + capital per discharge,10191,Other,225% of NY Medicaid HMO DRG,12455,,275% x Medicaid HMO amount,12455,Other,275% of NY Medicaid HMO DRG,14675,,324% x Medicaid HMO amount,14675,Other,324% of NY Medicaid HMO DRG,9738,,215% x Medicaid HMO amount,9738,Other,215% of NY Medicaid HMO DRG,9738,,215% x Medicaid HMO amount,9738,Other,215% of NY Medicaid HMO DRG,5662,,125% x Medicaid HMO amount,5662,Other,125% of NY Medicaid HMO DRG,0.01,17653,
Other musculoskeletal system & connective tissue diagnoses,351-3,APR-DRG,,,,,,,,inpatient,,,143633.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14517,,186% x Medicaid HMO amount,14517,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31909,,"27,634 x DRG Weight",31909,Other,DRG Base Rate x DRG Weight,27122,,"23,488 x DRG Weight",27122,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7805.21,,DRG base rate x DRG weight + capital per discharge,7805.21,Other,100% of NY Medicaid HMO DRG,7805,,DRG base rate x DRG weight + capital per discharge,7805,Other,100% of NY Medicaid HMO DRG,7805,,DRG base rate x DRG weight + capital per discharge,7805,Other,100% of NY Medicaid HMO DRG,7805,,DRG base rate x DRG weight + capital per discharge,7805,Other,100% of NY Medicaid HMO DRG,17562,,225% x Medicaid HMO amount,17562,Other,225% of NY Medicaid HMO DRG,11942,,153% x Medicaid HMO amount,11942,Other,153% of NY Medicaid HMO DRG,17562,,225% x Medicaid HMO amount,17562,Other,225% of NY Medicaid HMO DRG,10927,,140% x Medicaid HMO amount,10927,Other,140% of NY Medicaid HMO DRG,17562,,DRG base rate x DRG weight + capital per discharge,17562,Other,225% of NY Medicaid HMO DRG,21464,,275% x Medicaid HMO amount,21464,Other,275% of NY Medicaid HMO DRG,25289,,324% x Medicaid HMO amount,25289,Other,324% of NY Medicaid HMO DRG,16781,,215% x Medicaid HMO amount,16781,Other,215% of NY Medicaid HMO DRG,16781,,215% x Medicaid HMO amount,16781,Other,215% of NY Medicaid HMO DRG,9757,,125% x Medicaid HMO amount,9757,Other,125% of NY Medicaid HMO DRG,0.01,31909,
Other musculoskeletal system & connective tissue diagnoses,351-4,APR-DRG,,,,,,,,inpatient,,,129634.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37263,,186% x Medicaid HMO amount,37263,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,85127,,"27,634 x DRG Weight",85127,Other,DRG Base Rate x DRG Weight,72355,,"23,488 x DRG Weight",72355,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20034.21,,DRG base rate x DRG weight + capital per discharge,20034.21,Other,100% of NY Medicaid HMO DRG,20034,,DRG base rate x DRG weight + capital per discharge,20034,Other,100% of NY Medicaid HMO DRG,20034,,DRG base rate x DRG weight + capital per discharge,20034,Other,100% of NY Medicaid HMO DRG,20034,,DRG base rate x DRG weight + capital per discharge,20034,Other,100% of NY Medicaid HMO DRG,45077,,225% x Medicaid HMO amount,45077,Other,225% of NY Medicaid HMO DRG,30652,,153% x Medicaid HMO amount,30652,Other,153% of NY Medicaid HMO DRG,45077,,225% x Medicaid HMO amount,45077,Other,225% of NY Medicaid HMO DRG,28048,,140% x Medicaid HMO amount,28048,Other,140% of NY Medicaid HMO DRG,45077,,DRG base rate x DRG weight + capital per discharge,45077,Other,225% of NY Medicaid HMO DRG,55094,,275% x Medicaid HMO amount,55094,Other,275% of NY Medicaid HMO DRG,64911,,324% x Medicaid HMO amount,64911,Other,324% of NY Medicaid HMO DRG,43074,,215% x Medicaid HMO amount,43074,Other,215% of NY Medicaid HMO DRG,43074,,215% x Medicaid HMO amount,43074,Other,215% of NY Medicaid HMO DRG,25043,,125% x Medicaid HMO amount,25043,Other,125% of NY Medicaid HMO DRG,0.01,85127,
Skin graft for skin & subcutaneous tissue diagnoses,361-1,APR-DRG,,,,,,,,inpatient,,,73123.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16545,,186% x Medicaid HMO amount,16545,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36651,,"27,634 x DRG Weight",36651,Other,DRG Base Rate x DRG Weight,31152,,"23,488 x DRG Weight",31152,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8895.21,,DRG base rate x DRG weight + capital per discharge,8895.21,Other,100% of NY Medicaid HMO DRG,8895,,DRG base rate x DRG weight + capital per discharge,8895,Other,100% of NY Medicaid HMO DRG,8895,,DRG base rate x DRG weight + capital per discharge,8895,Other,100% of NY Medicaid HMO DRG,8895,,DRG base rate x DRG weight + capital per discharge,8895,Other,100% of NY Medicaid HMO DRG,20014,,225% x Medicaid HMO amount,20014,Other,225% of NY Medicaid HMO DRG,13610,,153% x Medicaid HMO amount,13610,Other,153% of NY Medicaid HMO DRG,20014,,225% x Medicaid HMO amount,20014,Other,225% of NY Medicaid HMO DRG,12453,,140% x Medicaid HMO amount,12453,Other,140% of NY Medicaid HMO DRG,20014,,DRG base rate x DRG weight + capital per discharge,20014,Other,225% of NY Medicaid HMO DRG,24462,,275% x Medicaid HMO amount,24462,Other,275% of NY Medicaid HMO DRG,28820,,324% x Medicaid HMO amount,28820,Other,324% of NY Medicaid HMO DRG,19125,,215% x Medicaid HMO amount,19125,Other,215% of NY Medicaid HMO DRG,19125,,215% x Medicaid HMO amount,19125,Other,215% of NY Medicaid HMO DRG,11119,,125% x Medicaid HMO amount,11119,Other,125% of NY Medicaid HMO DRG,0.01,36651,
Skin graft for skin & subcutaneous tissue diagnoses,361-2,APR-DRG,,,,,,,,inpatient,,,339404.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23060,,186% x Medicaid HMO amount,23060,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51894,,"27,634 x DRG Weight",51894,Other,DRG Base Rate x DRG Weight,44108,,"23,488 x DRG Weight",44108,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12398.21,,DRG base rate x DRG weight + capital per discharge,12398.21,Other,100% of NY Medicaid HMO DRG,12398,,DRG base rate x DRG weight + capital per discharge,12398,Other,100% of NY Medicaid HMO DRG,12398,,DRG base rate x DRG weight + capital per discharge,12398,Other,100% of NY Medicaid HMO DRG,12398,,DRG base rate x DRG weight + capital per discharge,12398,Other,100% of NY Medicaid HMO DRG,27896,,225% x Medicaid HMO amount,27896,Other,225% of NY Medicaid HMO DRG,18969,,153% x Medicaid HMO amount,18969,Other,153% of NY Medicaid HMO DRG,27896,,225% x Medicaid HMO amount,27896,Other,225% of NY Medicaid HMO DRG,17357,,140% x Medicaid HMO amount,17357,Other,140% of NY Medicaid HMO DRG,27896,,DRG base rate x DRG weight + capital per discharge,27896,Other,225% of NY Medicaid HMO DRG,34095,,275% x Medicaid HMO amount,34095,Other,275% of NY Medicaid HMO DRG,40170,,324% x Medicaid HMO amount,40170,Other,324% of NY Medicaid HMO DRG,26656,,215% x Medicaid HMO amount,26656,Other,215% of NY Medicaid HMO DRG,26656,,215% x Medicaid HMO amount,26656,Other,215% of NY Medicaid HMO DRG,15498,,125% x Medicaid HMO amount,15498,Other,125% of NY Medicaid HMO DRG,0.01,51894,
Skin graft for skin & subcutaneous tissue diagnoses,361-3,APR-DRG,,,,,,,,inpatient,,,532079.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40327,,186% x Medicaid HMO amount,40327,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,92292,,"27,634 x DRG Weight",92292,Other,DRG Base Rate x DRG Weight,78445,,"23,488 x DRG Weight",78445,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21681.21,,DRG base rate x DRG weight + capital per discharge,21681.21,Other,100% of NY Medicaid HMO DRG,21681,,DRG base rate x DRG weight + capital per discharge,21681,Other,100% of NY Medicaid HMO DRG,21681,,DRG base rate x DRG weight + capital per discharge,21681,Other,100% of NY Medicaid HMO DRG,21681,,DRG base rate x DRG weight + capital per discharge,21681,Other,100% of NY Medicaid HMO DRG,48783,,225% x Medicaid HMO amount,48783,Other,225% of NY Medicaid HMO DRG,33172,,153% x Medicaid HMO amount,33172,Other,153% of NY Medicaid HMO DRG,48783,,225% x Medicaid HMO amount,48783,Other,225% of NY Medicaid HMO DRG,30354,,140% x Medicaid HMO amount,30354,Other,140% of NY Medicaid HMO DRG,48783,,DRG base rate x DRG weight + capital per discharge,48783,Other,225% of NY Medicaid HMO DRG,59623,,275% x Medicaid HMO amount,59623,Other,275% of NY Medicaid HMO DRG,70247,,324% x Medicaid HMO amount,70247,Other,324% of NY Medicaid HMO DRG,46615,,215% x Medicaid HMO amount,46615,Other,215% of NY Medicaid HMO DRG,46615,,215% x Medicaid HMO amount,46615,Other,215% of NY Medicaid HMO DRG,27102,,125% x Medicaid HMO amount,27102,Other,125% of NY Medicaid HMO DRG,0.01,92292,
Skin graft for skin & subcutaneous tissue diagnoses,361-4,APR-DRG,,,,,,,,inpatient,,,2455045.84,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,114271,,186% x Medicaid HMO amount,114271,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,265300,,"27,634 x DRG Weight",265300,Other,DRG Base Rate x DRG Weight,225497,,"23,488 x DRG Weight",225497,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,61436.21,,DRG base rate x DRG weight + capital per discharge,61436.21,Other,100% of NY Medicaid HMO DRG,61436,,DRG base rate x DRG weight + capital per discharge,61436,Other,100% of NY Medicaid HMO DRG,61436,,DRG base rate x DRG weight + capital per discharge,61436,Other,100% of NY Medicaid HMO DRG,61436,,DRG base rate x DRG weight + capital per discharge,61436,Other,100% of NY Medicaid HMO DRG,138231,,225% x Medicaid HMO amount,138231,Other,225% of NY Medicaid HMO DRG,93997,,153% x Medicaid HMO amount,93997,Other,153% of NY Medicaid HMO DRG,138231,,225% x Medicaid HMO amount,138231,Other,225% of NY Medicaid HMO DRG,86011,,140% x Medicaid HMO amount,86011,Other,140% of NY Medicaid HMO DRG,138231,,DRG base rate x DRG weight + capital per discharge,138231,Other,225% of NY Medicaid HMO DRG,168950,,275% x Medicaid HMO amount,168950,Other,275% of NY Medicaid HMO DRG,199053,,324% x Medicaid HMO amount,199053,Other,324% of NY Medicaid HMO DRG,132088,,215% x Medicaid HMO amount,132088,Other,215% of NY Medicaid HMO DRG,132088,,215% x Medicaid HMO amount,132088,Other,215% of NY Medicaid HMO DRG,76795,,125% x Medicaid HMO amount,76795,Other,125% of NY Medicaid HMO DRG,0.01,265300,
Mastectomy procedures,362-1,APR-DRG,,,,,,,,inpatient,,,148774.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16986,,186% x Medicaid HMO amount,16986,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37684,,"27,634 x DRG Weight",37684,Other,DRG Base Rate x DRG Weight,32031,,"23,488 x DRG Weight",32031,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9132.21,,DRG base rate x DRG weight + capital per discharge,9132.21,Other,100% of NY Medicaid HMO DRG,9132,,DRG base rate x DRG weight + capital per discharge,9132,Other,100% of NY Medicaid HMO DRG,9132,,DRG base rate x DRG weight + capital per discharge,9132,Other,100% of NY Medicaid HMO DRG,9132,,DRG base rate x DRG weight + capital per discharge,9132,Other,100% of NY Medicaid HMO DRG,20547,,225% x Medicaid HMO amount,20547,Other,225% of NY Medicaid HMO DRG,13972,,153% x Medicaid HMO amount,13972,Other,153% of NY Medicaid HMO DRG,20547,,225% x Medicaid HMO amount,20547,Other,225% of NY Medicaid HMO DRG,12785,,140% x Medicaid HMO amount,12785,Other,140% of NY Medicaid HMO DRG,20547,,DRG base rate x DRG weight + capital per discharge,20547,Other,225% of NY Medicaid HMO DRG,25114,,275% x Medicaid HMO amount,25114,Other,275% of NY Medicaid HMO DRG,29588,,324% x Medicaid HMO amount,29588,Other,324% of NY Medicaid HMO DRG,19634,,215% x Medicaid HMO amount,19634,Other,215% of NY Medicaid HMO DRG,19634,,215% x Medicaid HMO amount,19634,Other,215% of NY Medicaid HMO DRG,11415,,125% x Medicaid HMO amount,11415,Other,125% of NY Medicaid HMO DRG,0.01,37684,
Mastectomy procedures,362-2,APR-DRG,,,,,,,,inpatient,,,276151.19,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22203,,186% x Medicaid HMO amount,22203,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49888,,"27,634 x DRG Weight",49888,Other,DRG Base Rate x DRG Weight,42403,,"23,488 x DRG Weight",42403,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11937.21,,DRG base rate x DRG weight + capital per discharge,11937.21,Other,100% of NY Medicaid HMO DRG,11937,,DRG base rate x DRG weight + capital per discharge,11937,Other,100% of NY Medicaid HMO DRG,11937,,DRG base rate x DRG weight + capital per discharge,11937,Other,100% of NY Medicaid HMO DRG,11937,,DRG base rate x DRG weight + capital per discharge,11937,Other,100% of NY Medicaid HMO DRG,26859,,225% x Medicaid HMO amount,26859,Other,225% of NY Medicaid HMO DRG,18264,,153% x Medicaid HMO amount,18264,Other,153% of NY Medicaid HMO DRG,26859,,225% x Medicaid HMO amount,26859,Other,225% of NY Medicaid HMO DRG,16712,,140% x Medicaid HMO amount,16712,Other,140% of NY Medicaid HMO DRG,26859,,DRG base rate x DRG weight + capital per discharge,26859,Other,225% of NY Medicaid HMO DRG,32827,,275% x Medicaid HMO amount,32827,Other,275% of NY Medicaid HMO DRG,38677,,324% x Medicaid HMO amount,38677,Other,324% of NY Medicaid HMO DRG,25665,,215% x Medicaid HMO amount,25665,Other,215% of NY Medicaid HMO DRG,25665,,215% x Medicaid HMO amount,25665,Other,215% of NY Medicaid HMO DRG,14922,,125% x Medicaid HMO amount,14922,Other,125% of NY Medicaid HMO DRG,0.01,49888,
Mastectomy procedures,362-3,APR-DRG,,,,,,,,inpatient,,,148774.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33694,,186% x Medicaid HMO amount,33694,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,76776,,"27,634 x DRG Weight",76776,Other,DRG Base Rate x DRG Weight,65257,,"23,488 x DRG Weight",65257,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18115.21,,DRG base rate x DRG weight + capital per discharge,18115.21,Other,100% of NY Medicaid HMO DRG,18115,,DRG base rate x DRG weight + capital per discharge,18115,Other,100% of NY Medicaid HMO DRG,18115,,DRG base rate x DRG weight + capital per discharge,18115,Other,100% of NY Medicaid HMO DRG,18115,,DRG base rate x DRG weight + capital per discharge,18115,Other,100% of NY Medicaid HMO DRG,40759,,225% x Medicaid HMO amount,40759,Other,225% of NY Medicaid HMO DRG,27716,,153% x Medicaid HMO amount,27716,Other,153% of NY Medicaid HMO DRG,40759,,225% x Medicaid HMO amount,40759,Other,225% of NY Medicaid HMO DRG,25361,,140% x Medicaid HMO amount,25361,Other,140% of NY Medicaid HMO DRG,40759,,DRG base rate x DRG weight + capital per discharge,40759,Other,225% of NY Medicaid HMO DRG,49817,,275% x Medicaid HMO amount,49817,Other,275% of NY Medicaid HMO DRG,58693,,324% x Medicaid HMO amount,58693,Other,324% of NY Medicaid HMO DRG,38948,,215% x Medicaid HMO amount,38948,Other,215% of NY Medicaid HMO DRG,38948,,215% x Medicaid HMO amount,38948,Other,215% of NY Medicaid HMO DRG,22644,,125% x Medicaid HMO amount,22644,Other,125% of NY Medicaid HMO DRG,0.01,76776,
Mastectomy procedures,362-4,APR-DRG,,,,,,,,inpatient,,,148774.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35174,,186% x Medicaid HMO amount,35174,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,80241,,"27,634 x DRG Weight",80241,Other,DRG Base Rate x DRG Weight,68202,,"23,488 x DRG Weight",68202,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18911.21,,DRG base rate x DRG weight + capital per discharge,18911.21,Other,100% of NY Medicaid HMO DRG,18911,,DRG base rate x DRG weight + capital per discharge,18911,Other,100% of NY Medicaid HMO DRG,18911,,DRG base rate x DRG weight + capital per discharge,18911,Other,100% of NY Medicaid HMO DRG,18911,,DRG base rate x DRG weight + capital per discharge,18911,Other,100% of NY Medicaid HMO DRG,42550,,225% x Medicaid HMO amount,42550,Other,225% of NY Medicaid HMO DRG,28934,,153% x Medicaid HMO amount,28934,Other,153% of NY Medicaid HMO DRG,42550,,225% x Medicaid HMO amount,42550,Other,225% of NY Medicaid HMO DRG,26476,,140% x Medicaid HMO amount,26476,Other,140% of NY Medicaid HMO DRG,42550,,DRG base rate x DRG weight + capital per discharge,42550,Other,225% of NY Medicaid HMO DRG,52006,,275% x Medicaid HMO amount,52006,Other,275% of NY Medicaid HMO DRG,61272,,324% x Medicaid HMO amount,61272,Other,324% of NY Medicaid HMO DRG,40659,,215% x Medicaid HMO amount,40659,Other,215% of NY Medicaid HMO DRG,40659,,215% x Medicaid HMO amount,40659,Other,215% of NY Medicaid HMO DRG,23639,,125% x Medicaid HMO amount,23639,Other,125% of NY Medicaid HMO DRG,0.01,80241,
Breast procedures except mastectomy,363-1,APR-DRG,,,,,,,,inpatient,,,92974.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11573,,186% x Medicaid HMO amount,11573,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25017,,"27,634 x DRG Weight",25017,Other,DRG Base Rate x DRG Weight,21264,,"23,488 x DRG Weight",21264,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6222.21,,DRG base rate x DRG weight + capital per discharge,6222.21,Other,100% of NY Medicaid HMO DRG,6222,,DRG base rate x DRG weight + capital per discharge,6222,Other,100% of NY Medicaid HMO DRG,6222,,DRG base rate x DRG weight + capital per discharge,6222,Other,100% of NY Medicaid HMO DRG,6222,,DRG base rate x DRG weight + capital per discharge,6222,Other,100% of NY Medicaid HMO DRG,14000,,225% x Medicaid HMO amount,14000,Other,225% of NY Medicaid HMO DRG,9520,,153% x Medicaid HMO amount,9520,Other,153% of NY Medicaid HMO DRG,14000,,225% x Medicaid HMO amount,14000,Other,225% of NY Medicaid HMO DRG,8711,,140% x Medicaid HMO amount,8711,Other,140% of NY Medicaid HMO DRG,14000,,DRG base rate x DRG weight + capital per discharge,14000,Other,225% of NY Medicaid HMO DRG,17111,,275% x Medicaid HMO amount,17111,Other,275% of NY Medicaid HMO DRG,20160,,324% x Medicaid HMO amount,20160,Other,324% of NY Medicaid HMO DRG,13378,,215% x Medicaid HMO amount,13378,Other,215% of NY Medicaid HMO DRG,13378,,215% x Medicaid HMO amount,13378,Other,215% of NY Medicaid HMO DRG,7778,,125% x Medicaid HMO amount,7778,Other,125% of NY Medicaid HMO DRG,0.01,25017,
Breast procedures except mastectomy,363-2,APR-DRG,,,,,,,,inpatient,,,185533.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18814,,186% x Medicaid HMO amount,18814,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41959,,"27,634 x DRG Weight",41959,Other,DRG Base Rate x DRG Weight,35664,,"23,488 x DRG Weight",35664,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10115.21,,DRG base rate x DRG weight + capital per discharge,10115.21,Other,100% of NY Medicaid HMO DRG,10115,,DRG base rate x DRG weight + capital per discharge,10115,Other,100% of NY Medicaid HMO DRG,10115,,DRG base rate x DRG weight + capital per discharge,10115,Other,100% of NY Medicaid HMO DRG,10115,,DRG base rate x DRG weight + capital per discharge,10115,Other,100% of NY Medicaid HMO DRG,22759,,225% x Medicaid HMO amount,22759,Other,225% of NY Medicaid HMO DRG,15476,,153% x Medicaid HMO amount,15476,Other,153% of NY Medicaid HMO DRG,22759,,225% x Medicaid HMO amount,22759,Other,225% of NY Medicaid HMO DRG,14161,,140% x Medicaid HMO amount,14161,Other,140% of NY Medicaid HMO DRG,22759,,DRG base rate x DRG weight + capital per discharge,22759,Other,225% of NY Medicaid HMO DRG,27817,,275% x Medicaid HMO amount,27817,Other,275% of NY Medicaid HMO DRG,32773,,324% x Medicaid HMO amount,32773,Other,324% of NY Medicaid HMO DRG,21748,,215% x Medicaid HMO amount,21748,Other,215% of NY Medicaid HMO DRG,21748,,215% x Medicaid HMO amount,21748,Other,215% of NY Medicaid HMO DRG,12644,,125% x Medicaid HMO amount,12644,Other,125% of NY Medicaid HMO DRG,0.01,41959,
Breast procedures except mastectomy,363-3,APR-DRG,,,,,,,,inpatient,,,185533.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27989,,186% x Medicaid HMO amount,27989,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63428,,"27,634 x DRG Weight",63428,Other,DRG Base Rate x DRG Weight,53912,,"23,488 x DRG Weight",53912,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15048.21,,DRG base rate x DRG weight + capital per discharge,15048.21,Other,100% of NY Medicaid HMO DRG,15048,,DRG base rate x DRG weight + capital per discharge,15048,Other,100% of NY Medicaid HMO DRG,15048,,DRG base rate x DRG weight + capital per discharge,15048,Other,100% of NY Medicaid HMO DRG,15048,,DRG base rate x DRG weight + capital per discharge,15048,Other,100% of NY Medicaid HMO DRG,33858,,225% x Medicaid HMO amount,33858,Other,225% of NY Medicaid HMO DRG,23024,,153% x Medicaid HMO amount,23024,Other,153% of NY Medicaid HMO DRG,33858,,225% x Medicaid HMO amount,33858,Other,225% of NY Medicaid HMO DRG,21067,,140% x Medicaid HMO amount,21067,Other,140% of NY Medicaid HMO DRG,33858,,DRG base rate x DRG weight + capital per discharge,33858,Other,225% of NY Medicaid HMO DRG,41383,,275% x Medicaid HMO amount,41383,Other,275% of NY Medicaid HMO DRG,48756,,324% x Medicaid HMO amount,48756,Other,324% of NY Medicaid HMO DRG,32354,,215% x Medicaid HMO amount,32354,Other,215% of NY Medicaid HMO DRG,32354,,215% x Medicaid HMO amount,32354,Other,215% of NY Medicaid HMO DRG,18810,,125% x Medicaid HMO amount,18810,Other,125% of NY Medicaid HMO DRG,0.01,63428,
Breast procedures except mastectomy,363-4,APR-DRG,,,,,,,,inpatient,,,185533.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28757,,186% x Medicaid HMO amount,28757,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65225,,"27,634 x DRG Weight",65225,Other,DRG Base Rate x DRG Weight,55439,,"23,488 x DRG Weight",55439,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15461.21,,DRG base rate x DRG weight + capital per discharge,15461.21,Other,100% of NY Medicaid HMO DRG,15461,,DRG base rate x DRG weight + capital per discharge,15461,Other,100% of NY Medicaid HMO DRG,15461,,DRG base rate x DRG weight + capital per discharge,15461,Other,100% of NY Medicaid HMO DRG,15461,,DRG base rate x DRG weight + capital per discharge,15461,Other,100% of NY Medicaid HMO DRG,34788,,225% x Medicaid HMO amount,34788,Other,225% of NY Medicaid HMO DRG,23656,,153% x Medicaid HMO amount,23656,Other,153% of NY Medicaid HMO DRG,34788,,225% x Medicaid HMO amount,34788,Other,225% of NY Medicaid HMO DRG,21646,,140% x Medicaid HMO amount,21646,Other,140% of NY Medicaid HMO DRG,34788,,DRG base rate x DRG weight + capital per discharge,34788,Other,225% of NY Medicaid HMO DRG,42518,,275% x Medicaid HMO amount,42518,Other,275% of NY Medicaid HMO DRG,50094,,324% x Medicaid HMO amount,50094,Other,324% of NY Medicaid HMO DRG,33242,,215% x Medicaid HMO amount,33242,Other,215% of NY Medicaid HMO DRG,33242,,215% x Medicaid HMO amount,33242,Other,215% of NY Medicaid HMO DRG,19327,,125% x Medicaid HMO amount,19327,Other,125% of NY Medicaid HMO DRG,0.01,65225,
"Other skin, subcutaneous tissue & related procedures",364-1,APR-DRG,,,,,,,,inpatient,,,100955.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9968,,186% x Medicaid HMO amount,9968,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21264,,"27,634 x DRG Weight",21264,Other,DRG Base Rate x DRG Weight,18074,,"23,488 x DRG Weight",18074,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5359.21,,DRG base rate x DRG weight + capital per discharge,5359.21,Other,100% of NY Medicaid HMO DRG,5359,,DRG base rate x DRG weight + capital per discharge,5359,Other,100% of NY Medicaid HMO DRG,5359,,DRG base rate x DRG weight + capital per discharge,5359,Other,100% of NY Medicaid HMO DRG,5359,,DRG base rate x DRG weight + capital per discharge,5359,Other,100% of NY Medicaid HMO DRG,12058,,225% x Medicaid HMO amount,12058,Other,225% of NY Medicaid HMO DRG,8200,,153% x Medicaid HMO amount,8200,Other,153% of NY Medicaid HMO DRG,12058,,225% x Medicaid HMO amount,12058,Other,225% of NY Medicaid HMO DRG,7503,,140% x Medicaid HMO amount,7503,Other,140% of NY Medicaid HMO DRG,12058,,DRG base rate x DRG weight + capital per discharge,12058,Other,225% of NY Medicaid HMO DRG,14738,,275% x Medicaid HMO amount,14738,Other,275% of NY Medicaid HMO DRG,17364,,324% x Medicaid HMO amount,17364,Other,324% of NY Medicaid HMO DRG,11522,,215% x Medicaid HMO amount,11522,Other,215% of NY Medicaid HMO DRG,11522,,215% x Medicaid HMO amount,11522,Other,215% of NY Medicaid HMO DRG,6699,,125% x Medicaid HMO amount,6699,Other,125% of NY Medicaid HMO DRG,0.01,21264,
"Other skin, subcutaneous tissue & related procedures",364-2,APR-DRG,,,,,,,,inpatient,,,164365.11,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13987,,186% x Medicaid HMO amount,13987,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30668,,"27,634 x DRG Weight",30668,Other,DRG Base Rate x DRG Weight,26067,,"23,488 x DRG Weight",26067,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7520.21,,DRG base rate x DRG weight + capital per discharge,7520.21,Other,100% of NY Medicaid HMO DRG,7520,,DRG base rate x DRG weight + capital per discharge,7520,Other,100% of NY Medicaid HMO DRG,7520,,DRG base rate x DRG weight + capital per discharge,7520,Other,100% of NY Medicaid HMO DRG,7520,,DRG base rate x DRG weight + capital per discharge,7520,Other,100% of NY Medicaid HMO DRG,16920,,225% x Medicaid HMO amount,16920,Other,225% of NY Medicaid HMO DRG,11506,,153% x Medicaid HMO amount,11506,Other,153% of NY Medicaid HMO DRG,16920,,225% x Medicaid HMO amount,16920,Other,225% of NY Medicaid HMO DRG,10528,,140% x Medicaid HMO amount,10528,Other,140% of NY Medicaid HMO DRG,16920,,DRG base rate x DRG weight + capital per discharge,16920,Other,225% of NY Medicaid HMO DRG,20681,,275% x Medicaid HMO amount,20681,Other,275% of NY Medicaid HMO DRG,24365,,324% x Medicaid HMO amount,24365,Other,324% of NY Medicaid HMO DRG,16168,,215% x Medicaid HMO amount,16168,Other,215% of NY Medicaid HMO DRG,16168,,215% x Medicaid HMO amount,16168,Other,215% of NY Medicaid HMO DRG,9400,,125% x Medicaid HMO amount,9400,Other,125% of NY Medicaid HMO DRG,0.01,30668,
"Other skin, subcutaneous tissue & related procedures",364-3,APR-DRG,,,,,,,,inpatient,,,354842.22,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24775,,186% x Medicaid HMO amount,24775,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,55906,,"27,634 x DRG Weight",55906,Other,DRG Base Rate x DRG Weight,47519,,"23,488 x DRG Weight",47519,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13320.21,,DRG base rate x DRG weight + capital per discharge,13320.21,Other,100% of NY Medicaid HMO DRG,13320,,DRG base rate x DRG weight + capital per discharge,13320,Other,100% of NY Medicaid HMO DRG,13320,,DRG base rate x DRG weight + capital per discharge,13320,Other,100% of NY Medicaid HMO DRG,13320,,DRG base rate x DRG weight + capital per discharge,13320,Other,100% of NY Medicaid HMO DRG,29970,,225% x Medicaid HMO amount,29970,Other,225% of NY Medicaid HMO DRG,20380,,153% x Medicaid HMO amount,20380,Other,153% of NY Medicaid HMO DRG,29970,,225% x Medicaid HMO amount,29970,Other,225% of NY Medicaid HMO DRG,18648,,140% x Medicaid HMO amount,18648,Other,140% of NY Medicaid HMO DRG,29970,,DRG base rate x DRG weight + capital per discharge,29970,Other,225% of NY Medicaid HMO DRG,36631,,275% x Medicaid HMO amount,36631,Other,275% of NY Medicaid HMO DRG,43157,,324% x Medicaid HMO amount,43157,Other,324% of NY Medicaid HMO DRG,28638,,215% x Medicaid HMO amount,28638,Other,215% of NY Medicaid HMO DRG,28638,,215% x Medicaid HMO amount,28638,Other,215% of NY Medicaid HMO DRG,16650,,125% x Medicaid HMO amount,16650,Other,125% of NY Medicaid HMO DRG,0.01,55906,
"Other skin, subcutaneous tissue & related procedures",364-4,APR-DRG,,,,,,,,inpatient,,,328437.61,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63588,,186% x Medicaid HMO amount,63588,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,146717,,"27,634 x DRG Weight",146717,Other,DRG Base Rate x DRG Weight,124705,,"23,488 x DRG Weight",124705,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34187.21,,DRG base rate x DRG weight + capital per discharge,34187.21,Other,100% of NY Medicaid HMO DRG,34187,,DRG base rate x DRG weight + capital per discharge,34187,Other,100% of NY Medicaid HMO DRG,34187,,DRG base rate x DRG weight + capital per discharge,34187,Other,100% of NY Medicaid HMO DRG,34187,,DRG base rate x DRG weight + capital per discharge,34187,Other,100% of NY Medicaid HMO DRG,76921,,225% x Medicaid HMO amount,76921,Other,225% of NY Medicaid HMO DRG,52306,,153% x Medicaid HMO amount,52306,Other,153% of NY Medicaid HMO DRG,76921,,225% x Medicaid HMO amount,76921,Other,225% of NY Medicaid HMO DRG,47862,,140% x Medicaid HMO amount,47862,Other,140% of NY Medicaid HMO DRG,76921,,DRG base rate x DRG weight + capital per discharge,76921,Other,225% of NY Medicaid HMO DRG,94015,,275% x Medicaid HMO amount,94015,Other,275% of NY Medicaid HMO DRG,110767,,324% x Medicaid HMO amount,110767,Other,324% of NY Medicaid HMO DRG,73503,,215% x Medicaid HMO amount,73503,Other,215% of NY Medicaid HMO DRG,73503,,215% x Medicaid HMO amount,73503,Other,215% of NY Medicaid HMO DRG,42734,,125% x Medicaid HMO amount,42734,Other,125% of NY Medicaid HMO DRG,0.01,146717,
Skin ulcers,380-1,APR-DRG,,,,,,,,inpatient,,,60201.94,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8988,,186% x Medicaid HMO amount,8988,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18971,,"27,634 x DRG Weight",18971,Other,DRG Base Rate x DRG Weight,16125,,"23,488 x DRG Weight",16125,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4832.21,,DRG base rate x DRG weight + capital per discharge,4832.21,Other,100% of NY Medicaid HMO DRG,4832,,DRG base rate x DRG weight + capital per discharge,4832,Other,100% of NY Medicaid HMO DRG,4832,,DRG base rate x DRG weight + capital per discharge,4832,Other,100% of NY Medicaid HMO DRG,4832,,DRG base rate x DRG weight + capital per discharge,4832,Other,100% of NY Medicaid HMO DRG,10872,,225% x Medicaid HMO amount,10872,Other,225% of NY Medicaid HMO DRG,7393,,153% x Medicaid HMO amount,7393,Other,153% of NY Medicaid HMO DRG,10872,,225% x Medicaid HMO amount,10872,Other,225% of NY Medicaid HMO DRG,6765,,140% x Medicaid HMO amount,6765,Other,140% of NY Medicaid HMO DRG,10872,,DRG base rate x DRG weight + capital per discharge,10872,Other,225% of NY Medicaid HMO DRG,13289,,275% x Medicaid HMO amount,13289,Other,275% of NY Medicaid HMO DRG,15656,,324% x Medicaid HMO amount,15656,Other,324% of NY Medicaid HMO DRG,10389,,215% x Medicaid HMO amount,10389,Other,215% of NY Medicaid HMO DRG,10389,,215% x Medicaid HMO amount,10389,Other,215% of NY Medicaid HMO DRG,6040,,125% x Medicaid HMO amount,6040,Other,125% of NY Medicaid HMO DRG,0.01,18971,
Skin ulcers,380-2,APR-DRG,,,,,,,,inpatient,,,102054.89,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10734,,186% x Medicaid HMO amount,10734,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23055,,"27,634 x DRG Weight",23055,Other,DRG Base Rate x DRG Weight,19596,,"23,488 x DRG Weight",19596,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5771.21,,DRG base rate x DRG weight + capital per discharge,5771.21,Other,100% of NY Medicaid HMO DRG,5771,,DRG base rate x DRG weight + capital per discharge,5771,Other,100% of NY Medicaid HMO DRG,5771,,DRG base rate x DRG weight + capital per discharge,5771,Other,100% of NY Medicaid HMO DRG,5771,,DRG base rate x DRG weight + capital per discharge,5771,Other,100% of NY Medicaid HMO DRG,12985,,225% x Medicaid HMO amount,12985,Other,225% of NY Medicaid HMO DRG,8830,,153% x Medicaid HMO amount,8830,Other,153% of NY Medicaid HMO DRG,12985,,225% x Medicaid HMO amount,12985,Other,225% of NY Medicaid HMO DRG,8080,,140% x Medicaid HMO amount,8080,Other,140% of NY Medicaid HMO DRG,12985,,DRG base rate x DRG weight + capital per discharge,12985,Other,225% of NY Medicaid HMO DRG,15871,,275% x Medicaid HMO amount,15871,Other,275% of NY Medicaid HMO DRG,18699,,324% x Medicaid HMO amount,18699,Other,324% of NY Medicaid HMO DRG,12408,,215% x Medicaid HMO amount,12408,Other,215% of NY Medicaid HMO DRG,12408,,215% x Medicaid HMO amount,12408,Other,215% of NY Medicaid HMO DRG,7214,,125% x Medicaid HMO amount,7214,Other,125% of NY Medicaid HMO DRG,0.01,23055,
Skin ulcers,380-3,APR-DRG,,,,,,,,inpatient,,,232571.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16208,,186% x Medicaid HMO amount,16208,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35863,,"27,634 x DRG Weight",35863,Other,DRG Base Rate x DRG Weight,30483,,"23,488 x DRG Weight",30483,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8714.21,,DRG base rate x DRG weight + capital per discharge,8714.21,Other,100% of NY Medicaid HMO DRG,8714,,DRG base rate x DRG weight + capital per discharge,8714,Other,100% of NY Medicaid HMO DRG,8714,,DRG base rate x DRG weight + capital per discharge,8714,Other,100% of NY Medicaid HMO DRG,8714,,DRG base rate x DRG weight + capital per discharge,8714,Other,100% of NY Medicaid HMO DRG,19607,,225% x Medicaid HMO amount,19607,Other,225% of NY Medicaid HMO DRG,13333,,153% x Medicaid HMO amount,13333,Other,153% of NY Medicaid HMO DRG,19607,,225% x Medicaid HMO amount,19607,Other,225% of NY Medicaid HMO DRG,12200,,140% x Medicaid HMO amount,12200,Other,140% of NY Medicaid HMO DRG,19607,,DRG base rate x DRG weight + capital per discharge,19607,Other,225% of NY Medicaid HMO DRG,23964,,275% x Medicaid HMO amount,23964,Other,275% of NY Medicaid HMO DRG,28234,,324% x Medicaid HMO amount,28234,Other,324% of NY Medicaid HMO DRG,18736,,215% x Medicaid HMO amount,18736,Other,215% of NY Medicaid HMO DRG,18736,,215% x Medicaid HMO amount,18736,Other,215% of NY Medicaid HMO DRG,10893,,125% x Medicaid HMO amount,10893,Other,125% of NY Medicaid HMO DRG,0.01,35863,
Skin ulcers,380-4,APR-DRG,,,,,,,,inpatient,,,232571.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30316,,186% x Medicaid HMO amount,30316,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,68872,,"27,634 x DRG Weight",68872,Other,DRG Base Rate x DRG Weight,58539,,"23,488 x DRG Weight",58539,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16299.21,,DRG base rate x DRG weight + capital per discharge,16299.21,Other,100% of NY Medicaid HMO DRG,16299,,DRG base rate x DRG weight + capital per discharge,16299,Other,100% of NY Medicaid HMO DRG,16299,,DRG base rate x DRG weight + capital per discharge,16299,Other,100% of NY Medicaid HMO DRG,16299,,DRG base rate x DRG weight + capital per discharge,16299,Other,100% of NY Medicaid HMO DRG,36673,,225% x Medicaid HMO amount,36673,Other,225% of NY Medicaid HMO DRG,24938,,153% x Medicaid HMO amount,24938,Other,153% of NY Medicaid HMO DRG,36673,,225% x Medicaid HMO amount,36673,Other,225% of NY Medicaid HMO DRG,22819,,140% x Medicaid HMO amount,22819,Other,140% of NY Medicaid HMO DRG,36673,,DRG base rate x DRG weight + capital per discharge,36673,Other,225% of NY Medicaid HMO DRG,44823,,275% x Medicaid HMO amount,44823,Other,275% of NY Medicaid HMO DRG,52809,,324% x Medicaid HMO amount,52809,Other,324% of NY Medicaid HMO DRG,35043,,215% x Medicaid HMO amount,35043,Other,215% of NY Medicaid HMO DRG,35043,,215% x Medicaid HMO amount,35043,Other,215% of NY Medicaid HMO DRG,20374,,125% x Medicaid HMO amount,20374,Other,125% of NY Medicaid HMO DRG,0.01,68872,
Major skin disorders,381-1,APR-DRG,,,,,,,,inpatient,,,108112.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7901,,186% x Medicaid HMO amount,7901,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16428,,"27,634 x DRG Weight",16428,Other,DRG Base Rate x DRG Weight,13964,,"23,488 x DRG Weight",13964,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4248.21,,DRG base rate x DRG weight + capital per discharge,4248.21,Other,100% of NY Medicaid HMO DRG,4248,,DRG base rate x DRG weight + capital per discharge,4248,Other,100% of NY Medicaid HMO DRG,4248,,DRG base rate x DRG weight + capital per discharge,4248,Other,100% of NY Medicaid HMO DRG,4248,,DRG base rate x DRG weight + capital per discharge,4248,Other,100% of NY Medicaid HMO DRG,9558,,225% x Medicaid HMO amount,9558,Other,225% of NY Medicaid HMO DRG,6500,,153% x Medicaid HMO amount,6500,Other,153% of NY Medicaid HMO DRG,9558,,225% x Medicaid HMO amount,9558,Other,225% of NY Medicaid HMO DRG,5947,,140% x Medicaid HMO amount,5947,Other,140% of NY Medicaid HMO DRG,9558,,DRG base rate x DRG weight + capital per discharge,9558,Other,225% of NY Medicaid HMO DRG,11683,,275% x Medicaid HMO amount,11683,Other,275% of NY Medicaid HMO DRG,13764,,324% x Medicaid HMO amount,13764,Other,324% of NY Medicaid HMO DRG,9134,,215% x Medicaid HMO amount,9134,Other,215% of NY Medicaid HMO DRG,9134,,215% x Medicaid HMO amount,9134,Other,215% of NY Medicaid HMO DRG,5310,,125% x Medicaid HMO amount,5310,Other,125% of NY Medicaid HMO DRG,0.01,16428,
Major skin disorders,381-2,APR-DRG,,,,,,,,inpatient,,,98673.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11281,,186% x Medicaid HMO amount,11281,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24335,,"27,634 x DRG Weight",24335,Other,DRG Base Rate x DRG Weight,20684,,"23,488 x DRG Weight",20684,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6065.21,,DRG base rate x DRG weight + capital per discharge,6065.21,Other,100% of NY Medicaid HMO DRG,6065,,DRG base rate x DRG weight + capital per discharge,6065,Other,100% of NY Medicaid HMO DRG,6065,,DRG base rate x DRG weight + capital per discharge,6065,Other,100% of NY Medicaid HMO DRG,6065,,DRG base rate x DRG weight + capital per discharge,6065,Other,100% of NY Medicaid HMO DRG,13647,,225% x Medicaid HMO amount,13647,Other,225% of NY Medicaid HMO DRG,9280,,153% x Medicaid HMO amount,9280,Other,153% of NY Medicaid HMO DRG,13647,,225% x Medicaid HMO amount,13647,Other,225% of NY Medicaid HMO DRG,8491,,140% x Medicaid HMO amount,8491,Other,140% of NY Medicaid HMO DRG,13647,,DRG base rate x DRG weight + capital per discharge,13647,Other,225% of NY Medicaid HMO DRG,16679,,275% x Medicaid HMO amount,16679,Other,275% of NY Medicaid HMO DRG,19651,,324% x Medicaid HMO amount,19651,Other,324% of NY Medicaid HMO DRG,13040,,215% x Medicaid HMO amount,13040,Other,215% of NY Medicaid HMO DRG,13040,,215% x Medicaid HMO amount,13040,Other,215% of NY Medicaid HMO DRG,7582,,125% x Medicaid HMO amount,7582,Other,125% of NY Medicaid HMO DRG,0.01,24335,
Major skin disorders,381-3,APR-DRG,,,,,,,,inpatient,,,394675.08,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23641,,186% x Medicaid HMO amount,23641,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53253,,"27,634 x DRG Weight",53253,Other,DRG Base Rate x DRG Weight,45264,,"23,488 x DRG Weight",45264,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12710.21,,DRG base rate x DRG weight + capital per discharge,12710.21,Other,100% of NY Medicaid HMO DRG,12710,,DRG base rate x DRG weight + capital per discharge,12710,Other,100% of NY Medicaid HMO DRG,12710,,DRG base rate x DRG weight + capital per discharge,12710,Other,100% of NY Medicaid HMO DRG,12710,,DRG base rate x DRG weight + capital per discharge,12710,Other,100% of NY Medicaid HMO DRG,28598,,225% x Medicaid HMO amount,28598,Other,225% of NY Medicaid HMO DRG,19447,,153% x Medicaid HMO amount,19447,Other,153% of NY Medicaid HMO DRG,28598,,225% x Medicaid HMO amount,28598,Other,225% of NY Medicaid HMO DRG,17794,,140% x Medicaid HMO amount,17794,Other,140% of NY Medicaid HMO DRG,28598,,DRG base rate x DRG weight + capital per discharge,28598,Other,225% of NY Medicaid HMO DRG,34953,,275% x Medicaid HMO amount,34953,Other,275% of NY Medicaid HMO DRG,41181,,324% x Medicaid HMO amount,41181,Other,324% of NY Medicaid HMO DRG,27327,,215% x Medicaid HMO amount,27327,Other,215% of NY Medicaid HMO DRG,27327,,215% x Medicaid HMO amount,27327,Other,215% of NY Medicaid HMO DRG,15888,,125% x Medicaid HMO amount,15888,Other,125% of NY Medicaid HMO DRG,0.01,53253,
Major skin disorders,381-4,APR-DRG,,,,,,,,inpatient,,,1427628.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70598,,186% x Medicaid HMO amount,70598,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,163118,,"27,634 x DRG Weight",163118,Other,DRG Base Rate x DRG Weight,138645,,"23,488 x DRG Weight",138645,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37956.21,,DRG base rate x DRG weight + capital per discharge,37956.21,Other,100% of NY Medicaid HMO DRG,37956,,DRG base rate x DRG weight + capital per discharge,37956,Other,100% of NY Medicaid HMO DRG,37956,,DRG base rate x DRG weight + capital per discharge,37956,Other,100% of NY Medicaid HMO DRG,37956,,DRG base rate x DRG weight + capital per discharge,37956,Other,100% of NY Medicaid HMO DRG,85401,,225% x Medicaid HMO amount,85401,Other,225% of NY Medicaid HMO DRG,58073,,153% x Medicaid HMO amount,58073,Other,153% of NY Medicaid HMO DRG,85401,,225% x Medicaid HMO amount,85401,Other,225% of NY Medicaid HMO DRG,53139,,140% x Medicaid HMO amount,53139,Other,140% of NY Medicaid HMO DRG,85401,,DRG base rate x DRG weight + capital per discharge,85401,Other,225% of NY Medicaid HMO DRG,104380,,275% x Medicaid HMO amount,104380,Other,275% of NY Medicaid HMO DRG,122978,,324% x Medicaid HMO amount,122978,Other,324% of NY Medicaid HMO DRG,81606,,215% x Medicaid HMO amount,81606,Other,215% of NY Medicaid HMO DRG,81606,,215% x Medicaid HMO amount,81606,Other,215% of NY Medicaid HMO DRG,47445,,125% x Medicaid HMO amount,47445,Other,125% of NY Medicaid HMO DRG,0.01,163118,
Malignant breast disorders,382-1,APR-DRG,,,,,,,,inpatient,,,56201,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8232,,186% x Medicaid HMO amount,8232,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17202,,"27,634 x DRG Weight",17202,Other,DRG Base Rate x DRG Weight,14621,,"23,488 x DRG Weight",14621,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4426.21,,DRG base rate x DRG weight + capital per discharge,4426.21,Other,100% of NY Medicaid HMO DRG,4426,,DRG base rate x DRG weight + capital per discharge,4426,Other,100% of NY Medicaid HMO DRG,4426,,DRG base rate x DRG weight + capital per discharge,4426,Other,100% of NY Medicaid HMO DRG,4426,,DRG base rate x DRG weight + capital per discharge,4426,Other,100% of NY Medicaid HMO DRG,9959,,225% x Medicaid HMO amount,9959,Other,225% of NY Medicaid HMO DRG,6772,,153% x Medicaid HMO amount,6772,Other,153% of NY Medicaid HMO DRG,9959,,225% x Medicaid HMO amount,9959,Other,225% of NY Medicaid HMO DRG,6197,,140% x Medicaid HMO amount,6197,Other,140% of NY Medicaid HMO DRG,9959,,DRG base rate x DRG weight + capital per discharge,9959,Other,225% of NY Medicaid HMO DRG,12172,,275% x Medicaid HMO amount,12172,Other,275% of NY Medicaid HMO DRG,14341,,324% x Medicaid HMO amount,14341,Other,324% of NY Medicaid HMO DRG,9516,,215% x Medicaid HMO amount,9516,Other,215% of NY Medicaid HMO DRG,9516,,215% x Medicaid HMO amount,9516,Other,215% of NY Medicaid HMO DRG,5533,,125% x Medicaid HMO amount,5533,Other,125% of NY Medicaid HMO DRG,0.01,17202,
Malignant breast disorders,382-2,APR-DRG,,,,,,,,inpatient,,,56201,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10723,,186% x Medicaid HMO amount,10723,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23030,,"27,634 x DRG Weight",23030,Other,DRG Base Rate x DRG Weight,19575,,"23,488 x DRG Weight",19575,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5765.21,,DRG base rate x DRG weight + capital per discharge,5765.21,Other,100% of NY Medicaid HMO DRG,5765,,DRG base rate x DRG weight + capital per discharge,5765,Other,100% of NY Medicaid HMO DRG,5765,,DRG base rate x DRG weight + capital per discharge,5765,Other,100% of NY Medicaid HMO DRG,5765,,DRG base rate x DRG weight + capital per discharge,5765,Other,100% of NY Medicaid HMO DRG,12972,,225% x Medicaid HMO amount,12972,Other,225% of NY Medicaid HMO DRG,8821,,153% x Medicaid HMO amount,8821,Other,153% of NY Medicaid HMO DRG,12972,,225% x Medicaid HMO amount,12972,Other,225% of NY Medicaid HMO DRG,8071,,140% x Medicaid HMO amount,8071,Other,140% of NY Medicaid HMO DRG,12972,,DRG base rate x DRG weight + capital per discharge,12972,Other,225% of NY Medicaid HMO DRG,15854,,275% x Medicaid HMO amount,15854,Other,275% of NY Medicaid HMO DRG,18679,,324% x Medicaid HMO amount,18679,Other,324% of NY Medicaid HMO DRG,12395,,215% x Medicaid HMO amount,12395,Other,215% of NY Medicaid HMO DRG,12395,,215% x Medicaid HMO amount,12395,Other,215% of NY Medicaid HMO DRG,7207,,125% x Medicaid HMO amount,7207,Other,125% of NY Medicaid HMO DRG,0.01,23030,
Malignant breast disorders,382-3,APR-DRG,,,,,,,,inpatient,,,175779,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18669,,186% x Medicaid HMO amount,18669,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41620,,"27,634 x DRG Weight",41620,Other,DRG Base Rate x DRG Weight,35375,,"23,488 x DRG Weight",35375,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10037.21,,DRG base rate x DRG weight + capital per discharge,10037.21,Other,100% of NY Medicaid HMO DRG,10037,,DRG base rate x DRG weight + capital per discharge,10037,Other,100% of NY Medicaid HMO DRG,10037,,DRG base rate x DRG weight + capital per discharge,10037,Other,100% of NY Medicaid HMO DRG,10037,,DRG base rate x DRG weight + capital per discharge,10037,Other,100% of NY Medicaid HMO DRG,22584,,225% x Medicaid HMO amount,22584,Other,225% of NY Medicaid HMO DRG,15357,,153% x Medicaid HMO amount,15357,Other,153% of NY Medicaid HMO DRG,22584,,225% x Medicaid HMO amount,22584,Other,225% of NY Medicaid HMO DRG,14052,,140% x Medicaid HMO amount,14052,Other,140% of NY Medicaid HMO DRG,22584,,DRG base rate x DRG weight + capital per discharge,22584,Other,225% of NY Medicaid HMO DRG,27602,,275% x Medicaid HMO amount,27602,Other,275% of NY Medicaid HMO DRG,32521,,324% x Medicaid HMO amount,32521,Other,324% of NY Medicaid HMO DRG,21580,,215% x Medicaid HMO amount,21580,Other,215% of NY Medicaid HMO DRG,21580,,215% x Medicaid HMO amount,21580,Other,215% of NY Medicaid HMO DRG,12547,,125% x Medicaid HMO amount,12547,Other,125% of NY Medicaid HMO DRG,0.01,41620,
Malignant breast disorders,382-4,APR-DRG,,,,,,,,inpatient,,,189087.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35057,,186% x Medicaid HMO amount,35057,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,79965,,"27,634 x DRG Weight",79965,Other,DRG Base Rate x DRG Weight,67967,,"23,488 x DRG Weight",67967,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18848.21,,DRG base rate x DRG weight + capital per discharge,18848.21,Other,100% of NY Medicaid HMO DRG,18848,,DRG base rate x DRG weight + capital per discharge,18848,Other,100% of NY Medicaid HMO DRG,18848,,DRG base rate x DRG weight + capital per discharge,18848,Other,100% of NY Medicaid HMO DRG,18848,,DRG base rate x DRG weight + capital per discharge,18848,Other,100% of NY Medicaid HMO DRG,42408,,225% x Medicaid HMO amount,42408,Other,225% of NY Medicaid HMO DRG,28838,,153% x Medicaid HMO amount,28838,Other,153% of NY Medicaid HMO DRG,42408,,225% x Medicaid HMO amount,42408,Other,225% of NY Medicaid HMO DRG,26387,,140% x Medicaid HMO amount,26387,Other,140% of NY Medicaid HMO DRG,42408,,DRG base rate x DRG weight + capital per discharge,42408,Other,225% of NY Medicaid HMO DRG,51833,,275% x Medicaid HMO amount,51833,Other,275% of NY Medicaid HMO DRG,61068,,324% x Medicaid HMO amount,61068,Other,324% of NY Medicaid HMO DRG,40524,,215% x Medicaid HMO amount,40524,Other,215% of NY Medicaid HMO DRG,40524,,215% x Medicaid HMO amount,40524,Other,215% of NY Medicaid HMO DRG,23560,,125% x Medicaid HMO amount,23560,Other,125% of NY Medicaid HMO DRG,0.01,79965,
Cellulitis & other skin infections,383-1,APR-DRG,,,,,,,,inpatient,,,70147.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6845,,186% x Medicaid HMO amount,6845,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13958,,"27,634 x DRG Weight",13958,Other,DRG Base Rate x DRG Weight,11864,,"23,488 x DRG Weight",11864,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3680.21,,DRG base rate x DRG weight + capital per discharge,3680.21,Other,100% of NY Medicaid HMO DRG,3680,,DRG base rate x DRG weight + capital per discharge,3680,Other,100% of NY Medicaid HMO DRG,3680,,DRG base rate x DRG weight + capital per discharge,3680,Other,100% of NY Medicaid HMO DRG,3680,,DRG base rate x DRG weight + capital per discharge,3680,Other,100% of NY Medicaid HMO DRG,8280,,225% x Medicaid HMO amount,8280,Other,225% of NY Medicaid HMO DRG,5631,,153% x Medicaid HMO amount,5631,Other,153% of NY Medicaid HMO DRG,8280,,225% x Medicaid HMO amount,8280,Other,225% of NY Medicaid HMO DRG,5152,,140% x Medicaid HMO amount,5152,Other,140% of NY Medicaid HMO DRG,8280,,DRG base rate x DRG weight + capital per discharge,8280,Other,225% of NY Medicaid HMO DRG,10121,,275% x Medicaid HMO amount,10121,Other,275% of NY Medicaid HMO DRG,11924,,324% x Medicaid HMO amount,11924,Other,324% of NY Medicaid HMO DRG,7912,,215% x Medicaid HMO amount,7912,Other,215% of NY Medicaid HMO DRG,7912,,215% x Medicaid HMO amount,7912,Other,215% of NY Medicaid HMO DRG,4600,,125% x Medicaid HMO amount,4600,Other,125% of NY Medicaid HMO DRG,0.01,13958,
Cellulitis & other skin infections,383-2,APR-DRG,,,,,,,,inpatient,,,88425.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8961,,186% x Medicaid HMO amount,8961,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18907,,"27,634 x DRG Weight",18907,Other,DRG Base Rate x DRG Weight,16070,,"23,488 x DRG Weight",16070,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4818.21,,DRG base rate x DRG weight + capital per discharge,4818.21,Other,100% of NY Medicaid HMO DRG,4818,,DRG base rate x DRG weight + capital per discharge,4818,Other,100% of NY Medicaid HMO DRG,4818,,DRG base rate x DRG weight + capital per discharge,4818,Other,100% of NY Medicaid HMO DRG,4818,,DRG base rate x DRG weight + capital per discharge,4818,Other,100% of NY Medicaid HMO DRG,10841,,225% x Medicaid HMO amount,10841,Other,225% of NY Medicaid HMO DRG,7372,,153% x Medicaid HMO amount,7372,Other,153% of NY Medicaid HMO DRG,10841,,225% x Medicaid HMO amount,10841,Other,225% of NY Medicaid HMO DRG,6745,,140% x Medicaid HMO amount,6745,Other,140% of NY Medicaid HMO DRG,10841,,DRG base rate x DRG weight + capital per discharge,10841,Other,225% of NY Medicaid HMO DRG,13250,,275% x Medicaid HMO amount,13250,Other,275% of NY Medicaid HMO DRG,15611,,324% x Medicaid HMO amount,15611,Other,324% of NY Medicaid HMO DRG,10359,,215% x Medicaid HMO amount,10359,Other,215% of NY Medicaid HMO DRG,10359,,215% x Medicaid HMO amount,10359,Other,215% of NY Medicaid HMO DRG,6023,,125% x Medicaid HMO amount,6023,Other,125% of NY Medicaid HMO DRG,0.01,18907,
Cellulitis & other skin infections,383-3,APR-DRG,,,,,,,,inpatient,,,150076.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14839,,186% x Medicaid HMO amount,14839,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32661,,"27,634 x DRG Weight",32661,Other,DRG Base Rate x DRG Weight,27760,,"23,488 x DRG Weight",27760,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7978.21,,DRG base rate x DRG weight + capital per discharge,7978.21,Other,100% of NY Medicaid HMO DRG,7978,,DRG base rate x DRG weight + capital per discharge,7978,Other,100% of NY Medicaid HMO DRG,7978,,DRG base rate x DRG weight + capital per discharge,7978,Other,100% of NY Medicaid HMO DRG,7978,,DRG base rate x DRG weight + capital per discharge,7978,Other,100% of NY Medicaid HMO DRG,17951,,225% x Medicaid HMO amount,17951,Other,225% of NY Medicaid HMO DRG,12207,,153% x Medicaid HMO amount,12207,Other,153% of NY Medicaid HMO DRG,17951,,225% x Medicaid HMO amount,17951,Other,225% of NY Medicaid HMO DRG,11169,,140% x Medicaid HMO amount,11169,Other,140% of NY Medicaid HMO DRG,17951,,DRG base rate x DRG weight + capital per discharge,17951,Other,225% of NY Medicaid HMO DRG,21940,,275% x Medicaid HMO amount,21940,Other,275% of NY Medicaid HMO DRG,25849,,324% x Medicaid HMO amount,25849,Other,324% of NY Medicaid HMO DRG,17153,,215% x Medicaid HMO amount,17153,Other,215% of NY Medicaid HMO DRG,17153,,215% x Medicaid HMO amount,17153,Other,215% of NY Medicaid HMO DRG,9973,,125% x Medicaid HMO amount,9973,Other,125% of NY Medicaid HMO DRG,0.01,32661,
Cellulitis & other skin infections,383-4,APR-DRG,,,,,,,,inpatient,,,334963.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33874,,186% x Medicaid HMO amount,33874,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,77198,,"27,634 x DRG Weight",77198,Other,DRG Base Rate x DRG Weight,65616,,"23,488 x DRG Weight",65616,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18212.21,,DRG base rate x DRG weight + capital per discharge,18212.21,Other,100% of NY Medicaid HMO DRG,18212,,DRG base rate x DRG weight + capital per discharge,18212,Other,100% of NY Medicaid HMO DRG,18212,,DRG base rate x DRG weight + capital per discharge,18212,Other,100% of NY Medicaid HMO DRG,18212,,DRG base rate x DRG weight + capital per discharge,18212,Other,100% of NY Medicaid HMO DRG,40977,,225% x Medicaid HMO amount,40977,Other,225% of NY Medicaid HMO DRG,27865,,153% x Medicaid HMO amount,27865,Other,153% of NY Medicaid HMO DRG,40977,,225% x Medicaid HMO amount,40977,Other,225% of NY Medicaid HMO DRG,25497,,140% x Medicaid HMO amount,25497,Other,140% of NY Medicaid HMO DRG,40977,,DRG base rate x DRG weight + capital per discharge,40977,Other,225% of NY Medicaid HMO DRG,50084,,275% x Medicaid HMO amount,50084,Other,275% of NY Medicaid HMO DRG,59008,,324% x Medicaid HMO amount,59008,Other,324% of NY Medicaid HMO DRG,39156,,215% x Medicaid HMO amount,39156,Other,215% of NY Medicaid HMO DRG,39156,,215% x Medicaid HMO amount,39156,Other,215% of NY Medicaid HMO DRG,22765,,125% x Medicaid HMO amount,22765,Other,125% of NY Medicaid HMO DRG,0.01,77198,
"Contusion, open wound & other trauma to skin & subcutaneous tissue",384-1,APR-DRG,,,,,,,,inpatient,,,71053.7,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5755,,186% x Medicaid HMO amount,5755,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11407,,"27,634 x DRG Weight",11407,Other,DRG Base Rate x DRG Weight,9696,,"23,488 x DRG Weight",9696,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3094.21,,DRG base rate x DRG weight + capital per discharge,3094.21,Other,100% of NY Medicaid HMO DRG,3094,,DRG base rate x DRG weight + capital per discharge,3094,Other,100% of NY Medicaid HMO DRG,3094,,DRG base rate x DRG weight + capital per discharge,3094,Other,100% of NY Medicaid HMO DRG,3094,,DRG base rate x DRG weight + capital per discharge,3094,Other,100% of NY Medicaid HMO DRG,6962,,225% x Medicaid HMO amount,6962,Other,225% of NY Medicaid HMO DRG,4734,,153% x Medicaid HMO amount,4734,Other,153% of NY Medicaid HMO DRG,6962,,225% x Medicaid HMO amount,6962,Other,225% of NY Medicaid HMO DRG,4332,,140% x Medicaid HMO amount,4332,Other,140% of NY Medicaid HMO DRG,6962,,DRG base rate x DRG weight + capital per discharge,6962,Other,225% of NY Medicaid HMO DRG,8509,,275% x Medicaid HMO amount,8509,Other,275% of NY Medicaid HMO DRG,10025,,324% x Medicaid HMO amount,10025,Other,324% of NY Medicaid HMO DRG,6653,,215% x Medicaid HMO amount,6653,Other,215% of NY Medicaid HMO DRG,6653,,215% x Medicaid HMO amount,6653,Other,215% of NY Medicaid HMO DRG,3868,,125% x Medicaid HMO amount,3868,Other,125% of NY Medicaid HMO DRG,0.01,11407,
"Contusion, open wound & other trauma to skin & subcutaneous tissue",384-2,APR-DRG,,,,,,,,inpatient,,,104747.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7721,,186% x Medicaid HMO amount,7721,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16006,,"27,634 x DRG Weight",16006,Other,DRG Base Rate x DRG Weight,13604,,"23,488 x DRG Weight",13604,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4151.21,,DRG base rate x DRG weight + capital per discharge,4151.21,Other,100% of NY Medicaid HMO DRG,4151,,DRG base rate x DRG weight + capital per discharge,4151,Other,100% of NY Medicaid HMO DRG,4151,,DRG base rate x DRG weight + capital per discharge,4151,Other,100% of NY Medicaid HMO DRG,4151,,DRG base rate x DRG weight + capital per discharge,4151,Other,100% of NY Medicaid HMO DRG,9340,,225% x Medicaid HMO amount,9340,Other,225% of NY Medicaid HMO DRG,6351,,153% x Medicaid HMO amount,6351,Other,153% of NY Medicaid HMO DRG,9340,,225% x Medicaid HMO amount,9340,Other,225% of NY Medicaid HMO DRG,5812,,140% x Medicaid HMO amount,5812,Other,140% of NY Medicaid HMO DRG,9340,,DRG base rate x DRG weight + capital per discharge,9340,Other,225% of NY Medicaid HMO DRG,11416,,275% x Medicaid HMO amount,11416,Other,275% of NY Medicaid HMO DRG,13450,,324% x Medicaid HMO amount,13450,Other,324% of NY Medicaid HMO DRG,8925,,215% x Medicaid HMO amount,8925,Other,215% of NY Medicaid HMO DRG,8925,,215% x Medicaid HMO amount,8925,Other,215% of NY Medicaid HMO DRG,5189,,125% x Medicaid HMO amount,5189,Other,125% of NY Medicaid HMO DRG,0.01,16006,
"Contusion, open wound & other trauma to skin & subcutaneous tissue",384-3,APR-DRG,,,,,,,,inpatient,,,71480.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12847,,186% x Medicaid HMO amount,12847,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27999,,"27,634 x DRG Weight",27999,Other,DRG Base Rate x DRG Weight,23798,,"23,488 x DRG Weight",23798,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6907.21,,DRG base rate x DRG weight + capital per discharge,6907.21,Other,100% of NY Medicaid HMO DRG,6907,,DRG base rate x DRG weight + capital per discharge,6907,Other,100% of NY Medicaid HMO DRG,6907,,DRG base rate x DRG weight + capital per discharge,6907,Other,100% of NY Medicaid HMO DRG,6907,,DRG base rate x DRG weight + capital per discharge,6907,Other,100% of NY Medicaid HMO DRG,15541,,225% x Medicaid HMO amount,15541,Other,225% of NY Medicaid HMO DRG,10568,,153% x Medicaid HMO amount,10568,Other,153% of NY Medicaid HMO DRG,15541,,225% x Medicaid HMO amount,15541,Other,225% of NY Medicaid HMO DRG,9670,,140% x Medicaid HMO amount,9670,Other,140% of NY Medicaid HMO DRG,15541,,DRG base rate x DRG weight + capital per discharge,15541,Other,225% of NY Medicaid HMO DRG,18995,,275% x Medicaid HMO amount,18995,Other,275% of NY Medicaid HMO DRG,22379,,324% x Medicaid HMO amount,22379,Other,324% of NY Medicaid HMO DRG,14851,,215% x Medicaid HMO amount,14851,Other,215% of NY Medicaid HMO DRG,14851,,215% x Medicaid HMO amount,14851,Other,215% of NY Medicaid HMO DRG,8634,,125% x Medicaid HMO amount,8634,Other,125% of NY Medicaid HMO DRG,0.01,27999,
"Contusion, open wound & other trauma to skin & subcutaneous tissue",384-4,APR-DRG,,,,,,,,inpatient,,,152701,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22608,,186% x Medicaid HMO amount,22608,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,50838,,"27,634 x DRG Weight",50838,Other,DRG Base Rate x DRG Weight,43211,,"23,488 x DRG Weight",43211,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12155.21,,DRG base rate x DRG weight + capital per discharge,12155.21,Other,100% of NY Medicaid HMO DRG,12155,,DRG base rate x DRG weight + capital per discharge,12155,Other,100% of NY Medicaid HMO DRG,12155,,DRG base rate x DRG weight + capital per discharge,12155,Other,100% of NY Medicaid HMO DRG,12155,,DRG base rate x DRG weight + capital per discharge,12155,Other,100% of NY Medicaid HMO DRG,27349,,225% x Medicaid HMO amount,27349,Other,225% of NY Medicaid HMO DRG,18597,,153% x Medicaid HMO amount,18597,Other,153% of NY Medicaid HMO DRG,27349,,225% x Medicaid HMO amount,27349,Other,225% of NY Medicaid HMO DRG,17017,,140% x Medicaid HMO amount,17017,Other,140% of NY Medicaid HMO DRG,27349,,DRG base rate x DRG weight + capital per discharge,27349,Other,225% of NY Medicaid HMO DRG,33427,,275% x Medicaid HMO amount,33427,Other,275% of NY Medicaid HMO DRG,39383,,324% x Medicaid HMO amount,39383,Other,324% of NY Medicaid HMO DRG,26134,,215% x Medicaid HMO amount,26134,Other,215% of NY Medicaid HMO DRG,26134,,215% x Medicaid HMO amount,26134,Other,215% of NY Medicaid HMO DRG,15194,,125% x Medicaid HMO amount,15194,Other,125% of NY Medicaid HMO DRG,0.01,50838,
"Other skin, subcutaneous tissue & breast disorders",385-1,APR-DRG,,,,,,,,inpatient,,,83964.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6540,,186% x Medicaid HMO amount,6540,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13245,,"27,634 x DRG Weight",13245,Other,DRG Base Rate x DRG Weight,11258,,"23,488 x DRG Weight",11258,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3516.21,,DRG base rate x DRG weight + capital per discharge,3516.21,Other,100% of NY Medicaid HMO DRG,3516,,DRG base rate x DRG weight + capital per discharge,3516,Other,100% of NY Medicaid HMO DRG,3516,,DRG base rate x DRG weight + capital per discharge,3516,Other,100% of NY Medicaid HMO DRG,3516,,DRG base rate x DRG weight + capital per discharge,3516,Other,100% of NY Medicaid HMO DRG,7911,,225% x Medicaid HMO amount,7911,Other,225% of NY Medicaid HMO DRG,5380,,153% x Medicaid HMO amount,5380,Other,153% of NY Medicaid HMO DRG,7911,,225% x Medicaid HMO amount,7911,Other,225% of NY Medicaid HMO DRG,4923,,140% x Medicaid HMO amount,4923,Other,140% of NY Medicaid HMO DRG,7911,,DRG base rate x DRG weight + capital per discharge,7911,Other,225% of NY Medicaid HMO DRG,9670,,275% x Medicaid HMO amount,9670,Other,275% of NY Medicaid HMO DRG,11393,,324% x Medicaid HMO amount,11393,Other,324% of NY Medicaid HMO DRG,7560,,215% x Medicaid HMO amount,7560,Other,215% of NY Medicaid HMO DRG,7560,,215% x Medicaid HMO amount,7560,Other,215% of NY Medicaid HMO DRG,4395,,125% x Medicaid HMO amount,4395,Other,125% of NY Medicaid HMO DRG,0.01,13245,
"Other skin, subcutaneous tissue & breast disorders",385-2,APR-DRG,,,,,,,,inpatient,,,90574.6,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8625,,186% x Medicaid HMO amount,8625,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18122,,"27,634 x DRG Weight",18122,Other,DRG Base Rate x DRG Weight,15403,,"23,488 x DRG Weight",15403,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4637.21,,DRG base rate x DRG weight + capital per discharge,4637.21,Other,100% of NY Medicaid HMO DRG,4637,,DRG base rate x DRG weight + capital per discharge,4637,Other,100% of NY Medicaid HMO DRG,4637,,DRG base rate x DRG weight + capital per discharge,4637,Other,100% of NY Medicaid HMO DRG,4637,,DRG base rate x DRG weight + capital per discharge,4637,Other,100% of NY Medicaid HMO DRG,10434,,225% x Medicaid HMO amount,10434,Other,225% of NY Medicaid HMO DRG,7095,,153% x Medicaid HMO amount,7095,Other,153% of NY Medicaid HMO DRG,10434,,225% x Medicaid HMO amount,10434,Other,225% of NY Medicaid HMO DRG,6492,,140% x Medicaid HMO amount,6492,Other,140% of NY Medicaid HMO DRG,10434,,DRG base rate x DRG weight + capital per discharge,10434,Other,225% of NY Medicaid HMO DRG,12752,,275% x Medicaid HMO amount,12752,Other,275% of NY Medicaid HMO DRG,15025,,324% x Medicaid HMO amount,15025,Other,324% of NY Medicaid HMO DRG,9970,,215% x Medicaid HMO amount,9970,Other,215% of NY Medicaid HMO DRG,9970,,215% x Medicaid HMO amount,9970,Other,215% of NY Medicaid HMO DRG,5797,,125% x Medicaid HMO amount,5797,Other,125% of NY Medicaid HMO DRG,0.01,18122,
"Other skin, subcutaneous tissue & breast disorders",385-3,APR-DRG,,,,,,,,inpatient,,,171031.94,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13671,,186% x Medicaid HMO amount,13671,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29928,,"27,634 x DRG Weight",29928,Other,DRG Base Rate x DRG Weight,25438,,"23,488 x DRG Weight",25438,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7350.21,,DRG base rate x DRG weight + capital per discharge,7350.21,Other,100% of NY Medicaid HMO DRG,7350,,DRG base rate x DRG weight + capital per discharge,7350,Other,100% of NY Medicaid HMO DRG,7350,,DRG base rate x DRG weight + capital per discharge,7350,Other,100% of NY Medicaid HMO DRG,7350,,DRG base rate x DRG weight + capital per discharge,7350,Other,100% of NY Medicaid HMO DRG,16538,,225% x Medicaid HMO amount,16538,Other,225% of NY Medicaid HMO DRG,11246,,153% x Medicaid HMO amount,11246,Other,153% of NY Medicaid HMO DRG,16538,,225% x Medicaid HMO amount,16538,Other,225% of NY Medicaid HMO DRG,10290,,140% x Medicaid HMO amount,10290,Other,140% of NY Medicaid HMO DRG,16538,,DRG base rate x DRG weight + capital per discharge,16538,Other,225% of NY Medicaid HMO DRG,20213,,275% x Medicaid HMO amount,20213,Other,275% of NY Medicaid HMO DRG,23815,,324% x Medicaid HMO amount,23815,Other,324% of NY Medicaid HMO DRG,15803,,215% x Medicaid HMO amount,15803,Other,215% of NY Medicaid HMO DRG,15803,,215% x Medicaid HMO amount,15803,Other,215% of NY Medicaid HMO DRG,9188,,125% x Medicaid HMO amount,9188,Other,125% of NY Medicaid HMO DRG,0.01,29928,
"Other skin, subcutaneous tissue & breast disorders",385-4,APR-DRG,,,,,,,,inpatient,,,462863.09,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35068,,186% x Medicaid HMO amount,35068,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,79992,,"27,634 x DRG Weight",79992,Other,DRG Base Rate x DRG Weight,67991,,"23,488 x DRG Weight",67991,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18854.21,,DRG base rate x DRG weight + capital per discharge,18854.21,Other,100% of NY Medicaid HMO DRG,18854,,DRG base rate x DRG weight + capital per discharge,18854,Other,100% of NY Medicaid HMO DRG,18854,,DRG base rate x DRG weight + capital per discharge,18854,Other,100% of NY Medicaid HMO DRG,18854,,DRG base rate x DRG weight + capital per discharge,18854,Other,100% of NY Medicaid HMO DRG,42422,,225% x Medicaid HMO amount,42422,Other,225% of NY Medicaid HMO DRG,28847,,153% x Medicaid HMO amount,28847,Other,153% of NY Medicaid HMO DRG,42422,,225% x Medicaid HMO amount,42422,Other,225% of NY Medicaid HMO DRG,26396,,140% x Medicaid HMO amount,26396,Other,140% of NY Medicaid HMO DRG,42422,,DRG base rate x DRG weight + capital per discharge,42422,Other,225% of NY Medicaid HMO DRG,51849,,275% x Medicaid HMO amount,51849,Other,275% of NY Medicaid HMO DRG,61088,,324% x Medicaid HMO amount,61088,Other,324% of NY Medicaid HMO DRG,40537,,215% x Medicaid HMO amount,40537,Other,215% of NY Medicaid HMO DRG,40537,,215% x Medicaid HMO amount,40537,Other,215% of NY Medicaid HMO DRG,23568,,125% x Medicaid HMO amount,23568,Other,125% of NY Medicaid HMO DRG,0.01,79992,
Pituitary & adrenal procedures,401-1,APR-DRG,,,,,,,,inpatient,,,274171.94,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15490,,186% x Medicaid HMO amount,15490,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34186,,"27,634 x DRG Weight",34186,Other,DRG Base Rate x DRG Weight,29057,,"23,488 x DRG Weight",29057,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8328.21,,DRG base rate x DRG weight + capital per discharge,8328.21,Other,100% of NY Medicaid HMO DRG,8328,,DRG base rate x DRG weight + capital per discharge,8328,Other,100% of NY Medicaid HMO DRG,8328,,DRG base rate x DRG weight + capital per discharge,8328,Other,100% of NY Medicaid HMO DRG,8328,,DRG base rate x DRG weight + capital per discharge,8328,Other,100% of NY Medicaid HMO DRG,18738,,225% x Medicaid HMO amount,18738,Other,225% of NY Medicaid HMO DRG,12742,,153% x Medicaid HMO amount,12742,Other,153% of NY Medicaid HMO DRG,18738,,225% x Medicaid HMO amount,18738,Other,225% of NY Medicaid HMO DRG,11659,,140% x Medicaid HMO amount,11659,Other,140% of NY Medicaid HMO DRG,18738,,DRG base rate x DRG weight + capital per discharge,18738,Other,225% of NY Medicaid HMO DRG,22903,,275% x Medicaid HMO amount,22903,Other,275% of NY Medicaid HMO DRG,26983,,324% x Medicaid HMO amount,26983,Other,324% of NY Medicaid HMO DRG,17906,,215% x Medicaid HMO amount,17906,Other,215% of NY Medicaid HMO DRG,17906,,215% x Medicaid HMO amount,17906,Other,215% of NY Medicaid HMO DRG,10410,,125% x Medicaid HMO amount,10410,Other,125% of NY Medicaid HMO DRG,0.01,34186,
Pituitary & adrenal procedures,401-2,APR-DRG,,,,,,,,inpatient,,,266531.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20873,,186% x Medicaid HMO amount,20873,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46779,,"27,634 x DRG Weight",46779,Other,DRG Base Rate x DRG Weight,39760,,"23,488 x DRG Weight",39760,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11222.21,,DRG base rate x DRG weight + capital per discharge,11222.21,Other,100% of NY Medicaid HMO DRG,11222,,DRG base rate x DRG weight + capital per discharge,11222,Other,100% of NY Medicaid HMO DRG,11222,,DRG base rate x DRG weight + capital per discharge,11222,Other,100% of NY Medicaid HMO DRG,11222,,DRG base rate x DRG weight + capital per discharge,11222,Other,100% of NY Medicaid HMO DRG,25250,,225% x Medicaid HMO amount,25250,Other,225% of NY Medicaid HMO DRG,17170,,153% x Medicaid HMO amount,17170,Other,153% of NY Medicaid HMO DRG,25250,,225% x Medicaid HMO amount,25250,Other,225% of NY Medicaid HMO DRG,15711,,140% x Medicaid HMO amount,15711,Other,140% of NY Medicaid HMO DRG,25250,,DRG base rate x DRG weight + capital per discharge,25250,Other,225% of NY Medicaid HMO DRG,30861,,275% x Medicaid HMO amount,30861,Other,275% of NY Medicaid HMO DRG,36360,,324% x Medicaid HMO amount,36360,Other,324% of NY Medicaid HMO DRG,24128,,215% x Medicaid HMO amount,24128,Other,215% of NY Medicaid HMO DRG,24128,,215% x Medicaid HMO amount,24128,Other,215% of NY Medicaid HMO DRG,14028,,125% x Medicaid HMO amount,14028,Other,125% of NY Medicaid HMO DRG,0.01,46779,
Pituitary & adrenal procedures,401-3,APR-DRG,,,,,,,,inpatient,,,244178.54,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37481,,186% x Medicaid HMO amount,37481,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,85635,,"27,634 x DRG Weight",85635,Other,DRG Base Rate x DRG Weight,72787,,"23,488 x DRG Weight",72787,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20151.21,,DRG base rate x DRG weight + capital per discharge,20151.21,Other,100% of NY Medicaid HMO DRG,20151,,DRG base rate x DRG weight + capital per discharge,20151,Other,100% of NY Medicaid HMO DRG,20151,,DRG base rate x DRG weight + capital per discharge,20151,Other,100% of NY Medicaid HMO DRG,20151,,DRG base rate x DRG weight + capital per discharge,20151,Other,100% of NY Medicaid HMO DRG,45340,,225% x Medicaid HMO amount,45340,Other,225% of NY Medicaid HMO DRG,30831,,153% x Medicaid HMO amount,30831,Other,153% of NY Medicaid HMO DRG,45340,,225% x Medicaid HMO amount,45340,Other,225% of NY Medicaid HMO DRG,28212,,140% x Medicaid HMO amount,28212,Other,140% of NY Medicaid HMO DRG,45340,,DRG base rate x DRG weight + capital per discharge,45340,Other,225% of NY Medicaid HMO DRG,55416,,275% x Medicaid HMO amount,55416,Other,275% of NY Medicaid HMO DRG,65290,,324% x Medicaid HMO amount,65290,Other,324% of NY Medicaid HMO DRG,43325,,215% x Medicaid HMO amount,43325,Other,215% of NY Medicaid HMO DRG,43325,,215% x Medicaid HMO amount,43325,Other,215% of NY Medicaid HMO DRG,25189,,125% x Medicaid HMO amount,25189,Other,125% of NY Medicaid HMO DRG,0.01,85635,
Pituitary & adrenal procedures,401-4,APR-DRG,,,,,,,,inpatient,,,1215138.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,83412,,186% x Medicaid HMO amount,83412,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,193098,,"27,634 x DRG Weight",193098,Other,DRG Base Rate x DRG Weight,164127,,"23,488 x DRG Weight",164127,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44845.21,,DRG base rate x DRG weight + capital per discharge,44845.21,Other,100% of NY Medicaid HMO DRG,44845,,DRG base rate x DRG weight + capital per discharge,44845,Other,100% of NY Medicaid HMO DRG,44845,,DRG base rate x DRG weight + capital per discharge,44845,Other,100% of NY Medicaid HMO DRG,44845,,DRG base rate x DRG weight + capital per discharge,44845,Other,100% of NY Medicaid HMO DRG,100902,,225% x Medicaid HMO amount,100902,Other,225% of NY Medicaid HMO DRG,68613,,153% x Medicaid HMO amount,68613,Other,153% of NY Medicaid HMO DRG,100902,,225% x Medicaid HMO amount,100902,Other,225% of NY Medicaid HMO DRG,62783,,140% x Medicaid HMO amount,62783,Other,140% of NY Medicaid HMO DRG,100902,,DRG base rate x DRG weight + capital per discharge,100902,Other,225% of NY Medicaid HMO DRG,123324,,275% x Medicaid HMO amount,123324,Other,275% of NY Medicaid HMO DRG,145298,,324% x Medicaid HMO amount,145298,Other,324% of NY Medicaid HMO DRG,96417,,215% x Medicaid HMO amount,96417,Other,215% of NY Medicaid HMO DRG,96417,,215% x Medicaid HMO amount,96417,Other,215% of NY Medicaid HMO DRG,56057,,125% x Medicaid HMO amount,56057,Other,125% of NY Medicaid HMO DRG,0.01,193098,
Procedures for obesity,403-1,APR-DRG,,,,,,,,inpatient,,,71703.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14344,,186% x Medicaid HMO amount,14344,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31503,,"27,634 x DRG Weight",31503,Other,DRG Base Rate x DRG Weight,26776,,"23,488 x DRG Weight",26776,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7712.21,,DRG base rate x DRG weight + capital per discharge,7712.21,Other,100% of NY Medicaid HMO DRG,7712,,DRG base rate x DRG weight + capital per discharge,7712,Other,100% of NY Medicaid HMO DRG,7712,,DRG base rate x DRG weight + capital per discharge,7712,Other,100% of NY Medicaid HMO DRG,7712,,DRG base rate x DRG weight + capital per discharge,7712,Other,100% of NY Medicaid HMO DRG,17352,,225% x Medicaid HMO amount,17352,Other,225% of NY Medicaid HMO DRG,11800,,153% x Medicaid HMO amount,11800,Other,153% of NY Medicaid HMO DRG,17352,,225% x Medicaid HMO amount,17352,Other,225% of NY Medicaid HMO DRG,10797,,140% x Medicaid HMO amount,10797,Other,140% of NY Medicaid HMO DRG,17352,,DRG base rate x DRG weight + capital per discharge,17352,Other,225% of NY Medicaid HMO DRG,21209,,275% x Medicaid HMO amount,21209,Other,275% of NY Medicaid HMO DRG,24988,,324% x Medicaid HMO amount,24988,Other,324% of NY Medicaid HMO DRG,16581,,215% x Medicaid HMO amount,16581,Other,215% of NY Medicaid HMO DRG,16581,,215% x Medicaid HMO amount,16581,Other,215% of NY Medicaid HMO DRG,9640,,125% x Medicaid HMO amount,9640,Other,125% of NY Medicaid HMO DRG,0.01,31503,
Procedures for obesity,403-2,APR-DRG,,,,,,,,inpatient,,,69036.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16016,,186% x Medicaid HMO amount,16016,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35416,,"27,634 x DRG Weight",35416,Other,DRG Base Rate x DRG Weight,30102,,"23,488 x DRG Weight",30102,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8611.21,,DRG base rate x DRG weight + capital per discharge,8611.21,Other,100% of NY Medicaid HMO DRG,8611,,DRG base rate x DRG weight + capital per discharge,8611,Other,100% of NY Medicaid HMO DRG,8611,,DRG base rate x DRG weight + capital per discharge,8611,Other,100% of NY Medicaid HMO DRG,8611,,DRG base rate x DRG weight + capital per discharge,8611,Other,100% of NY Medicaid HMO DRG,19375,,225% x Medicaid HMO amount,19375,Other,225% of NY Medicaid HMO DRG,13175,,153% x Medicaid HMO amount,13175,Other,153% of NY Medicaid HMO DRG,19375,,225% x Medicaid HMO amount,19375,Other,225% of NY Medicaid HMO DRG,12056,,140% x Medicaid HMO amount,12056,Other,140% of NY Medicaid HMO DRG,19375,,DRG base rate x DRG weight + capital per discharge,19375,Other,225% of NY Medicaid HMO DRG,23681,,275% x Medicaid HMO amount,23681,Other,275% of NY Medicaid HMO DRG,27900,,324% x Medicaid HMO amount,27900,Other,324% of NY Medicaid HMO DRG,18514,,215% x Medicaid HMO amount,18514,Other,215% of NY Medicaid HMO DRG,18514,,215% x Medicaid HMO amount,18514,Other,215% of NY Medicaid HMO DRG,10764,,125% x Medicaid HMO amount,10764,Other,125% of NY Medicaid HMO DRG,0.01,35416,
Procedures for obesity,403-3,APR-DRG,,,,,,,,inpatient,,,91864.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25690,,186% x Medicaid HMO amount,25690,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58048,,"27,634 x DRG Weight",58048,Other,DRG Base Rate x DRG Weight,49339,,"23,488 x DRG Weight",49339,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13812.21,,DRG base rate x DRG weight + capital per discharge,13812.21,Other,100% of NY Medicaid HMO DRG,13812,,DRG base rate x DRG weight + capital per discharge,13812,Other,100% of NY Medicaid HMO DRG,13812,,DRG base rate x DRG weight + capital per discharge,13812,Other,100% of NY Medicaid HMO DRG,13812,,DRG base rate x DRG weight + capital per discharge,13812,Other,100% of NY Medicaid HMO DRG,31077,,225% x Medicaid HMO amount,31077,Other,225% of NY Medicaid HMO DRG,21133,,153% x Medicaid HMO amount,21133,Other,153% of NY Medicaid HMO DRG,31077,,225% x Medicaid HMO amount,31077,Other,225% of NY Medicaid HMO DRG,19337,,140% x Medicaid HMO amount,19337,Other,140% of NY Medicaid HMO DRG,31077,,DRG base rate x DRG weight + capital per discharge,31077,Other,225% of NY Medicaid HMO DRG,37984,,275% x Medicaid HMO amount,37984,Other,275% of NY Medicaid HMO DRG,44752,,324% x Medicaid HMO amount,44752,Other,324% of NY Medicaid HMO DRG,29696,,215% x Medicaid HMO amount,29696,Other,215% of NY Medicaid HMO DRG,29696,,215% x Medicaid HMO amount,29696,Other,215% of NY Medicaid HMO DRG,17265,,125% x Medicaid HMO amount,17265,Other,125% of NY Medicaid HMO DRG,0.01,58048,
Procedures for obesity,403-4,APR-DRG,,,,,,,,inpatient,,,71703.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78557,,186% x Medicaid HMO amount,78557,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,181741,,"27,634 x DRG Weight",181741,Other,DRG Base Rate x DRG Weight,154474,,"23,488 x DRG Weight",154474,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42235.21,,DRG base rate x DRG weight + capital per discharge,42235.21,Other,100% of NY Medicaid HMO DRG,42235,,DRG base rate x DRG weight + capital per discharge,42235,Other,100% of NY Medicaid HMO DRG,42235,,DRG base rate x DRG weight + capital per discharge,42235,Other,100% of NY Medicaid HMO DRG,42235,,DRG base rate x DRG weight + capital per discharge,42235,Other,100% of NY Medicaid HMO DRG,95029,,225% x Medicaid HMO amount,95029,Other,225% of NY Medicaid HMO DRG,64620,,153% x Medicaid HMO amount,64620,Other,153% of NY Medicaid HMO DRG,95029,,225% x Medicaid HMO amount,95029,Other,225% of NY Medicaid HMO DRG,59129,,140% x Medicaid HMO amount,59129,Other,140% of NY Medicaid HMO DRG,95029,,DRG base rate x DRG weight + capital per discharge,95029,Other,225% of NY Medicaid HMO DRG,116147,,275% x Medicaid HMO amount,116147,Other,275% of NY Medicaid HMO DRG,136842,,324% x Medicaid HMO amount,136842,Other,324% of NY Medicaid HMO DRG,90806,,215% x Medicaid HMO amount,90806,Other,215% of NY Medicaid HMO DRG,90806,,215% x Medicaid HMO amount,90806,Other,215% of NY Medicaid HMO DRG,52794,,125% x Medicaid HMO amount,52794,Other,125% of NY Medicaid HMO DRG,0.01,181741,
"Thyroid, parathyroid & thyroglossal procedures",404-1,APR-DRG,,,,,,,,inpatient,,,129539.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8774,,186% x Medicaid HMO amount,8774,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18471,,"27,634 x DRG Weight",18471,Other,DRG Base Rate x DRG Weight,15699,,"23,488 x DRG Weight",15699,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4717.21,,DRG base rate x DRG weight + capital per discharge,4717.21,Other,100% of NY Medicaid HMO DRG,4717,,DRG base rate x DRG weight + capital per discharge,4717,Other,100% of NY Medicaid HMO DRG,4717,,DRG base rate x DRG weight + capital per discharge,4717,Other,100% of NY Medicaid HMO DRG,4717,,DRG base rate x DRG weight + capital per discharge,4717,Other,100% of NY Medicaid HMO DRG,10614,,225% x Medicaid HMO amount,10614,Other,225% of NY Medicaid HMO DRG,7217,,153% x Medicaid HMO amount,7217,Other,153% of NY Medicaid HMO DRG,10614,,225% x Medicaid HMO amount,10614,Other,225% of NY Medicaid HMO DRG,6604,,140% x Medicaid HMO amount,6604,Other,140% of NY Medicaid HMO DRG,10614,,DRG base rate x DRG weight + capital per discharge,10614,Other,225% of NY Medicaid HMO DRG,12972,,275% x Medicaid HMO amount,12972,Other,275% of NY Medicaid HMO DRG,15284,,324% x Medicaid HMO amount,15284,Other,324% of NY Medicaid HMO DRG,10142,,215% x Medicaid HMO amount,10142,Other,215% of NY Medicaid HMO DRG,10142,,215% x Medicaid HMO amount,10142,Other,215% of NY Medicaid HMO DRG,5897,,125% x Medicaid HMO amount,5897,Other,125% of NY Medicaid HMO DRG,0.01,18471,
"Thyroid, parathyroid & thyroglossal procedures",404-2,APR-DRG,,,,,,,,inpatient,,,163820.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11134,,186% x Medicaid HMO amount,11134,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23992,,"27,634 x DRG Weight",23992,Other,DRG Base Rate x DRG Weight,20392,,"23,488 x DRG Weight",20392,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5986.21,,DRG base rate x DRG weight + capital per discharge,5986.21,Other,100% of NY Medicaid HMO DRG,5986,,DRG base rate x DRG weight + capital per discharge,5986,Other,100% of NY Medicaid HMO DRG,5986,,DRG base rate x DRG weight + capital per discharge,5986,Other,100% of NY Medicaid HMO DRG,5986,,DRG base rate x DRG weight + capital per discharge,5986,Other,100% of NY Medicaid HMO DRG,13469,,225% x Medicaid HMO amount,13469,Other,225% of NY Medicaid HMO DRG,9159,,153% x Medicaid HMO amount,9159,Other,153% of NY Medicaid HMO DRG,13469,,225% x Medicaid HMO amount,13469,Other,225% of NY Medicaid HMO DRG,8381,,140% x Medicaid HMO amount,8381,Other,140% of NY Medicaid HMO DRG,13469,,DRG base rate x DRG weight + capital per discharge,13469,Other,225% of NY Medicaid HMO DRG,16462,,275% x Medicaid HMO amount,16462,Other,275% of NY Medicaid HMO DRG,19395,,324% x Medicaid HMO amount,19395,Other,324% of NY Medicaid HMO DRG,12870,,215% x Medicaid HMO amount,12870,Other,215% of NY Medicaid HMO DRG,12870,,215% x Medicaid HMO amount,12870,Other,215% of NY Medicaid HMO DRG,7483,,125% x Medicaid HMO amount,7483,Other,125% of NY Medicaid HMO DRG,0.01,23992,
"Thyroid, parathyroid & thyroglossal procedures",404-3,APR-DRG,,,,,,,,inpatient,,,282536.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27212,,186% x Medicaid HMO amount,27212,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,61610,,"27,634 x DRG Weight",61610,Other,DRG Base Rate x DRG Weight,52366,,"23,488 x DRG Weight",52366,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14630.21,,DRG base rate x DRG weight + capital per discharge,14630.21,Other,100% of NY Medicaid HMO DRG,14630,,DRG base rate x DRG weight + capital per discharge,14630,Other,100% of NY Medicaid HMO DRG,14630,,DRG base rate x DRG weight + capital per discharge,14630,Other,100% of NY Medicaid HMO DRG,14630,,DRG base rate x DRG weight + capital per discharge,14630,Other,100% of NY Medicaid HMO DRG,32918,,225% x Medicaid HMO amount,32918,Other,225% of NY Medicaid HMO DRG,22384,,153% x Medicaid HMO amount,22384,Other,153% of NY Medicaid HMO DRG,32918,,225% x Medicaid HMO amount,32918,Other,225% of NY Medicaid HMO DRG,20482,,140% x Medicaid HMO amount,20482,Other,140% of NY Medicaid HMO DRG,32918,,DRG base rate x DRG weight + capital per discharge,32918,Other,225% of NY Medicaid HMO DRG,40233,,275% x Medicaid HMO amount,40233,Other,275% of NY Medicaid HMO DRG,47402,,324% x Medicaid HMO amount,47402,Other,324% of NY Medicaid HMO DRG,31455,,215% x Medicaid HMO amount,31455,Other,215% of NY Medicaid HMO DRG,31455,,215% x Medicaid HMO amount,31455,Other,215% of NY Medicaid HMO DRG,18288,,125% x Medicaid HMO amount,18288,Other,125% of NY Medicaid HMO DRG,0.01,61610,
"Thyroid, parathyroid & thyroglossal procedures",404-4,APR-DRG,,,,,,,,inpatient,,,755383.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32375,,186% x Medicaid HMO amount,32375,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73692,,"27,634 x DRG Weight",73692,Other,DRG Base Rate x DRG Weight,62635,,"23,488 x DRG Weight",62635,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17406.21,,DRG base rate x DRG weight + capital per discharge,17406.21,Other,100% of NY Medicaid HMO DRG,17406,,DRG base rate x DRG weight + capital per discharge,17406,Other,100% of NY Medicaid HMO DRG,17406,,DRG base rate x DRG weight + capital per discharge,17406,Other,100% of NY Medicaid HMO DRG,17406,,DRG base rate x DRG weight + capital per discharge,17406,Other,100% of NY Medicaid HMO DRG,39164,,225% x Medicaid HMO amount,39164,Other,225% of NY Medicaid HMO DRG,26632,,153% x Medicaid HMO amount,26632,Other,153% of NY Medicaid HMO DRG,39164,,225% x Medicaid HMO amount,39164,Other,225% of NY Medicaid HMO DRG,24369,,140% x Medicaid HMO amount,24369,Other,140% of NY Medicaid HMO DRG,39164,,DRG base rate x DRG weight + capital per discharge,39164,Other,225% of NY Medicaid HMO DRG,47867,,275% x Medicaid HMO amount,47867,Other,275% of NY Medicaid HMO DRG,56396,,324% x Medicaid HMO amount,56396,Other,324% of NY Medicaid HMO DRG,37423,,215% x Medicaid HMO amount,37423,Other,215% of NY Medicaid HMO DRG,37423,,215% x Medicaid HMO amount,37423,Other,215% of NY Medicaid HMO DRG,21758,,125% x Medicaid HMO amount,21758,Other,125% of NY Medicaid HMO DRG,0.01,73692,
"Other procedures for endocrine, nutritional & metabolic disorders",405-1,APR-DRG,,,,,,,,inpatient,,,296577.89,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14649,,186% x Medicaid HMO amount,14649,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32216,,"27,634 x DRG Weight",32216,Other,DRG Base Rate x DRG Weight,27382,,"23,488 x DRG Weight",27382,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7876.21,,DRG base rate x DRG weight + capital per discharge,7876.21,Other,100% of NY Medicaid HMO DRG,7876,,DRG base rate x DRG weight + capital per discharge,7876,Other,100% of NY Medicaid HMO DRG,7876,,DRG base rate x DRG weight + capital per discharge,7876,Other,100% of NY Medicaid HMO DRG,7876,,DRG base rate x DRG weight + capital per discharge,7876,Other,100% of NY Medicaid HMO DRG,17721,,225% x Medicaid HMO amount,17721,Other,225% of NY Medicaid HMO DRG,12051,,153% x Medicaid HMO amount,12051,Other,153% of NY Medicaid HMO DRG,17721,,225% x Medicaid HMO amount,17721,Other,225% of NY Medicaid HMO DRG,11027,,140% x Medicaid HMO amount,11027,Other,140% of NY Medicaid HMO DRG,17721,,DRG base rate x DRG weight + capital per discharge,17721,Other,225% of NY Medicaid HMO DRG,21660,,275% x Medicaid HMO amount,21660,Other,275% of NY Medicaid HMO DRG,25519,,324% x Medicaid HMO amount,25519,Other,324% of NY Medicaid HMO DRG,16934,,215% x Medicaid HMO amount,16934,Other,215% of NY Medicaid HMO DRG,16934,,215% x Medicaid HMO amount,16934,Other,215% of NY Medicaid HMO DRG,9845,,125% x Medicaid HMO amount,9845,Other,125% of NY Medicaid HMO DRG,0.01,32216,
"Other procedures for endocrine, nutritional & metabolic disorders",405-2,APR-DRG,,,,,,,,inpatient,,,206668.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20882,,186% x Medicaid HMO amount,20882,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46801,,"27,634 x DRG Weight",46801,Other,DRG Base Rate x DRG Weight,39779,,"23,488 x DRG Weight",39779,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11227.21,,DRG base rate x DRG weight + capital per discharge,11227.21,Other,100% of NY Medicaid HMO DRG,11227,,DRG base rate x DRG weight + capital per discharge,11227,Other,100% of NY Medicaid HMO DRG,11227,,DRG base rate x DRG weight + capital per discharge,11227,Other,100% of NY Medicaid HMO DRG,11227,,DRG base rate x DRG weight + capital per discharge,11227,Other,100% of NY Medicaid HMO DRG,25261,,225% x Medicaid HMO amount,25261,Other,225% of NY Medicaid HMO DRG,17178,,153% x Medicaid HMO amount,17178,Other,153% of NY Medicaid HMO DRG,25261,,225% x Medicaid HMO amount,25261,Other,225% of NY Medicaid HMO DRG,15718,,140% x Medicaid HMO amount,15718,Other,140% of NY Medicaid HMO DRG,25261,,DRG base rate x DRG weight + capital per discharge,25261,Other,225% of NY Medicaid HMO DRG,30875,,275% x Medicaid HMO amount,30875,Other,275% of NY Medicaid HMO DRG,36376,,324% x Medicaid HMO amount,36376,Other,324% of NY Medicaid HMO DRG,24139,,215% x Medicaid HMO amount,24139,Other,215% of NY Medicaid HMO DRG,24139,,215% x Medicaid HMO amount,24139,Other,215% of NY Medicaid HMO DRG,14034,,125% x Medicaid HMO amount,14034,Other,125% of NY Medicaid HMO DRG,0.01,46801,
"Other procedures for endocrine, nutritional & metabolic disorders",405-3,APR-DRG,,,,,,,,inpatient,,,615415.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35664,,186% x Medicaid HMO amount,35664,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,81385,,"27,634 x DRG Weight",81385,Other,DRG Base Rate x DRG Weight,69175,,"23,488 x DRG Weight",69175,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19174.21,,DRG base rate x DRG weight + capital per discharge,19174.21,Other,100% of NY Medicaid HMO DRG,19174,,DRG base rate x DRG weight + capital per discharge,19174,Other,100% of NY Medicaid HMO DRG,19174,,DRG base rate x DRG weight + capital per discharge,19174,Other,100% of NY Medicaid HMO DRG,19174,,DRG base rate x DRG weight + capital per discharge,19174,Other,100% of NY Medicaid HMO DRG,43142,,225% x Medicaid HMO amount,43142,Other,225% of NY Medicaid HMO DRG,29337,,153% x Medicaid HMO amount,29337,Other,153% of NY Medicaid HMO DRG,43142,,225% x Medicaid HMO amount,43142,Other,225% of NY Medicaid HMO DRG,26844,,140% x Medicaid HMO amount,26844,Other,140% of NY Medicaid HMO DRG,43142,,DRG base rate x DRG weight + capital per discharge,43142,Other,225% of NY Medicaid HMO DRG,52729,,275% x Medicaid HMO amount,52729,Other,275% of NY Medicaid HMO DRG,62124,,324% x Medicaid HMO amount,62124,Other,324% of NY Medicaid HMO DRG,41225,,215% x Medicaid HMO amount,41225,Other,215% of NY Medicaid HMO DRG,41225,,215% x Medicaid HMO amount,41225,Other,215% of NY Medicaid HMO DRG,23968,,125% x Medicaid HMO amount,23968,Other,125% of NY Medicaid HMO DRG,0.01,81385,
"Other procedures for endocrine, nutritional & metabolic disorders",405-4,APR-DRG,,,,,,,,inpatient,,,213344.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,99951,,186% x Medicaid HMO amount,99951,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,231797,,"27,634 x DRG Weight",231797,Other,DRG Base Rate x DRG Weight,197020,,"23,488 x DRG Weight",197020,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53737.21,,DRG base rate x DRG weight + capital per discharge,53737.21,Other,100% of NY Medicaid HMO DRG,53737,,DRG base rate x DRG weight + capital per discharge,53737,Other,100% of NY Medicaid HMO DRG,53737,,DRG base rate x DRG weight + capital per discharge,53737,Other,100% of NY Medicaid HMO DRG,53737,,DRG base rate x DRG weight + capital per discharge,53737,Other,100% of NY Medicaid HMO DRG,120909,,225% x Medicaid HMO amount,120909,Other,225% of NY Medicaid HMO DRG,82218,,153% x Medicaid HMO amount,82218,Other,153% of NY Medicaid HMO DRG,120909,,225% x Medicaid HMO amount,120909,Other,225% of NY Medicaid HMO DRG,75232,,140% x Medicaid HMO amount,75232,Other,140% of NY Medicaid HMO DRG,120909,,DRG base rate x DRG weight + capital per discharge,120909,Other,225% of NY Medicaid HMO DRG,147777,,275% x Medicaid HMO amount,147777,Other,275% of NY Medicaid HMO DRG,174109,,324% x Medicaid HMO amount,174109,Other,324% of NY Medicaid HMO DRG,115535,,215% x Medicaid HMO amount,115535,Other,215% of NY Medicaid HMO DRG,115535,,215% x Medicaid HMO amount,115535,Other,215% of NY Medicaid HMO DRG,67172,,125% x Medicaid HMO amount,67172,Other,125% of NY Medicaid HMO DRG,0.01,231797,
Diabetes,420-1,APR-DRG,,,,,,,,inpatient,,,62847.81,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6261,,186% x Medicaid HMO amount,6261,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12590,,"27,634 x DRG Weight",12590,Other,DRG Base Rate x DRG Weight,10701,,"23,488 x DRG Weight",10701,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3366.21,,DRG base rate x DRG weight + capital per discharge,3366.21,Other,100% of NY Medicaid HMO DRG,3366,,DRG base rate x DRG weight + capital per discharge,3366,Other,100% of NY Medicaid HMO DRG,3366,,DRG base rate x DRG weight + capital per discharge,3366,Other,100% of NY Medicaid HMO DRG,3366,,DRG base rate x DRG weight + capital per discharge,3366,Other,100% of NY Medicaid HMO DRG,7574,,225% x Medicaid HMO amount,7574,Other,225% of NY Medicaid HMO DRG,5150,,153% x Medicaid HMO amount,5150,Other,153% of NY Medicaid HMO DRG,7574,,225% x Medicaid HMO amount,7574,Other,225% of NY Medicaid HMO DRG,4713,,140% x Medicaid HMO amount,4713,Other,140% of NY Medicaid HMO DRG,7574,,DRG base rate x DRG weight + capital per discharge,7574,Other,225% of NY Medicaid HMO DRG,9257,,275% x Medicaid HMO amount,9257,Other,275% of NY Medicaid HMO DRG,10907,,324% x Medicaid HMO amount,10907,Other,324% of NY Medicaid HMO DRG,7237,,215% x Medicaid HMO amount,7237,Other,215% of NY Medicaid HMO DRG,7237,,215% x Medicaid HMO amount,7237,Other,215% of NY Medicaid HMO DRG,4208,,125% x Medicaid HMO amount,4208,Other,125% of NY Medicaid HMO DRG,0.01,12590,
Diabetes,420-2,APR-DRG,,,,,,,,inpatient,,,75207.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8333,,186% x Medicaid HMO amount,8333,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17440,,"27,634 x DRG Weight",17440,Other,DRG Base Rate x DRG Weight,14823,,"23,488 x DRG Weight",14823,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4480.21,,DRG base rate x DRG weight + capital per discharge,4480.21,Other,100% of NY Medicaid HMO DRG,4480,,DRG base rate x DRG weight + capital per discharge,4480,Other,100% of NY Medicaid HMO DRG,4480,,DRG base rate x DRG weight + capital per discharge,4480,Other,100% of NY Medicaid HMO DRG,4480,,DRG base rate x DRG weight + capital per discharge,4480,Other,100% of NY Medicaid HMO DRG,10080,,225% x Medicaid HMO amount,10080,Other,225% of NY Medicaid HMO DRG,6855,,153% x Medicaid HMO amount,6855,Other,153% of NY Medicaid HMO DRG,10080,,225% x Medicaid HMO amount,10080,Other,225% of NY Medicaid HMO DRG,6272,,140% x Medicaid HMO amount,6272,Other,140% of NY Medicaid HMO DRG,10080,,DRG base rate x DRG weight + capital per discharge,10080,Other,225% of NY Medicaid HMO DRG,12321,,275% x Medicaid HMO amount,12321,Other,275% of NY Medicaid HMO DRG,14516,,324% x Medicaid HMO amount,14516,Other,324% of NY Medicaid HMO DRG,9632,,215% x Medicaid HMO amount,9632,Other,215% of NY Medicaid HMO DRG,9632,,215% x Medicaid HMO amount,9632,Other,215% of NY Medicaid HMO DRG,5600,,125% x Medicaid HMO amount,5600,Other,125% of NY Medicaid HMO DRG,0.01,17440,
Diabetes,420-3,APR-DRG,,,,,,,,inpatient,,,133976.81,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12423,,186% x Medicaid HMO amount,12423,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27007,,"27,634 x DRG Weight",27007,Other,DRG Base Rate x DRG Weight,22955,,"23,488 x DRG Weight",22955,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6679.21,,DRG base rate x DRG weight + capital per discharge,6679.21,Other,100% of NY Medicaid HMO DRG,6679,,DRG base rate x DRG weight + capital per discharge,6679,Other,100% of NY Medicaid HMO DRG,6679,,DRG base rate x DRG weight + capital per discharge,6679,Other,100% of NY Medicaid HMO DRG,6679,,DRG base rate x DRG weight + capital per discharge,6679,Other,100% of NY Medicaid HMO DRG,15028,,225% x Medicaid HMO amount,15028,Other,225% of NY Medicaid HMO DRG,10219,,153% x Medicaid HMO amount,10219,Other,153% of NY Medicaid HMO DRG,15028,,225% x Medicaid HMO amount,15028,Other,225% of NY Medicaid HMO DRG,9351,,140% x Medicaid HMO amount,9351,Other,140% of NY Medicaid HMO DRG,15028,,DRG base rate x DRG weight + capital per discharge,15028,Other,225% of NY Medicaid HMO DRG,18368,,275% x Medicaid HMO amount,18368,Other,275% of NY Medicaid HMO DRG,21641,,324% x Medicaid HMO amount,21641,Other,324% of NY Medicaid HMO DRG,14360,,215% x Medicaid HMO amount,14360,Other,215% of NY Medicaid HMO DRG,14360,,215% x Medicaid HMO amount,14360,Other,215% of NY Medicaid HMO DRG,8349,,125% x Medicaid HMO amount,8349,Other,125% of NY Medicaid HMO DRG,0.01,27007,
Diabetes,420-4,APR-DRG,,,,,,,,inpatient,,,223694.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30880,,186% x Medicaid HMO amount,30880,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70190,,"27,634 x DRG Weight",70190,Other,DRG Base Rate x DRG Weight,59660,,"23,488 x DRG Weight",59660,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16602.21,,DRG base rate x DRG weight + capital per discharge,16602.21,Other,100% of NY Medicaid HMO DRG,16602,,DRG base rate x DRG weight + capital per discharge,16602,Other,100% of NY Medicaid HMO DRG,16602,,DRG base rate x DRG weight + capital per discharge,16602,Other,100% of NY Medicaid HMO DRG,16602,,DRG base rate x DRG weight + capital per discharge,16602,Other,100% of NY Medicaid HMO DRG,37355,,225% x Medicaid HMO amount,37355,Other,225% of NY Medicaid HMO DRG,25401,,153% x Medicaid HMO amount,25401,Other,153% of NY Medicaid HMO DRG,37355,,225% x Medicaid HMO amount,37355,Other,225% of NY Medicaid HMO DRG,23243,,140% x Medicaid HMO amount,23243,Other,140% of NY Medicaid HMO DRG,37355,,DRG base rate x DRG weight + capital per discharge,37355,Other,225% of NY Medicaid HMO DRG,45656,,275% x Medicaid HMO amount,45656,Other,275% of NY Medicaid HMO DRG,53791,,324% x Medicaid HMO amount,53791,Other,324% of NY Medicaid HMO DRG,35695,,215% x Medicaid HMO amount,35695,Other,215% of NY Medicaid HMO DRG,35695,,215% x Medicaid HMO amount,35695,Other,215% of NY Medicaid HMO DRG,20753,,125% x Medicaid HMO amount,20753,Other,125% of NY Medicaid HMO DRG,0.01,70190,
"Malnutrition, failure to thrive & other nutritional disorders",421-1,APR-DRG,,,,,,,,inpatient,,,127625.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8262,,186% x Medicaid HMO amount,8262,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17271,,"27,634 x DRG Weight",17271,Other,DRG Base Rate x DRG Weight,14680,,"23,488 x DRG Weight",14680,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4442.21,,DRG base rate x DRG weight + capital per discharge,4442.21,Other,100% of NY Medicaid HMO DRG,4442,,DRG base rate x DRG weight + capital per discharge,4442,Other,100% of NY Medicaid HMO DRG,4442,,DRG base rate x DRG weight + capital per discharge,4442,Other,100% of NY Medicaid HMO DRG,4442,,DRG base rate x DRG weight + capital per discharge,4442,Other,100% of NY Medicaid HMO DRG,9995,,225% x Medicaid HMO amount,9995,Other,225% of NY Medicaid HMO DRG,6797,,153% x Medicaid HMO amount,6797,Other,153% of NY Medicaid HMO DRG,9995,,225% x Medicaid HMO amount,9995,Other,225% of NY Medicaid HMO DRG,6219,,140% x Medicaid HMO amount,6219,Other,140% of NY Medicaid HMO DRG,9995,,DRG base rate x DRG weight + capital per discharge,9995,Other,225% of NY Medicaid HMO DRG,12216,,275% x Medicaid HMO amount,12216,Other,275% of NY Medicaid HMO DRG,14393,,324% x Medicaid HMO amount,14393,Other,324% of NY Medicaid HMO DRG,9551,,215% x Medicaid HMO amount,9551,Other,215% of NY Medicaid HMO DRG,9551,,215% x Medicaid HMO amount,9551,Other,215% of NY Medicaid HMO DRG,5553,,125% x Medicaid HMO amount,5553,Other,125% of NY Medicaid HMO DRG,0.01,17271,
"Malnutrition, failure to thrive & other nutritional disorders",421-2,APR-DRG,,,,,,,,inpatient,,,121725.63,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11666,,186% x Medicaid HMO amount,11666,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25238,,"27,634 x DRG Weight",25238,Other,DRG Base Rate x DRG Weight,21452,,"23,488 x DRG Weight",21452,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6272.21,,DRG base rate x DRG weight + capital per discharge,6272.21,Other,100% of NY Medicaid HMO DRG,6272,,DRG base rate x DRG weight + capital per discharge,6272,Other,100% of NY Medicaid HMO DRG,6272,,DRG base rate x DRG weight + capital per discharge,6272,Other,100% of NY Medicaid HMO DRG,6272,,DRG base rate x DRG weight + capital per discharge,6272,Other,100% of NY Medicaid HMO DRG,14112,,225% x Medicaid HMO amount,14112,Other,225% of NY Medicaid HMO DRG,9596,,153% x Medicaid HMO amount,9596,Other,153% of NY Medicaid HMO DRG,14112,,225% x Medicaid HMO amount,14112,Other,225% of NY Medicaid HMO DRG,8781,,140% x Medicaid HMO amount,8781,Other,140% of NY Medicaid HMO DRG,14112,,DRG base rate x DRG weight + capital per discharge,14112,Other,225% of NY Medicaid HMO DRG,17249,,275% x Medicaid HMO amount,17249,Other,275% of NY Medicaid HMO DRG,20322,,324% x Medicaid HMO amount,20322,Other,324% of NY Medicaid HMO DRG,13485,,215% x Medicaid HMO amount,13485,Other,215% of NY Medicaid HMO DRG,13485,,215% x Medicaid HMO amount,13485,Other,215% of NY Medicaid HMO DRG,7840,,125% x Medicaid HMO amount,7840,Other,125% of NY Medicaid HMO DRG,0.01,25238,
"Malnutrition, failure to thrive & other nutritional disorders",421-3,APR-DRG,,,,,,,,inpatient,,,355059.19,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17268,,186% x Medicaid HMO amount,17268,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38345,,"27,634 x DRG Weight",38345,Other,DRG Base Rate x DRG Weight,32592,,"23,488 x DRG Weight",32592,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9284.21,,DRG base rate x DRG weight + capital per discharge,9284.21,Other,100% of NY Medicaid HMO DRG,9284,,DRG base rate x DRG weight + capital per discharge,9284,Other,100% of NY Medicaid HMO DRG,9284,,DRG base rate x DRG weight + capital per discharge,9284,Other,100% of NY Medicaid HMO DRG,9284,,DRG base rate x DRG weight + capital per discharge,9284,Other,100% of NY Medicaid HMO DRG,20889,,225% x Medicaid HMO amount,20889,Other,225% of NY Medicaid HMO DRG,14205,,153% x Medicaid HMO amount,14205,Other,153% of NY Medicaid HMO DRG,20889,,225% x Medicaid HMO amount,20889,Other,225% of NY Medicaid HMO DRG,12998,,140% x Medicaid HMO amount,12998,Other,140% of NY Medicaid HMO DRG,20889,,DRG base rate x DRG weight + capital per discharge,20889,Other,225% of NY Medicaid HMO DRG,25532,,275% x Medicaid HMO amount,25532,Other,275% of NY Medicaid HMO DRG,30081,,324% x Medicaid HMO amount,30081,Other,324% of NY Medicaid HMO DRG,19961,,215% x Medicaid HMO amount,19961,Other,215% of NY Medicaid HMO DRG,19961,,215% x Medicaid HMO amount,19961,Other,215% of NY Medicaid HMO DRG,11605,,125% x Medicaid HMO amount,11605,Other,125% of NY Medicaid HMO DRG,0.01,38345,
"Malnutrition, failure to thrive & other nutritional disorders",421-4,APR-DRG,,,,,,,,inpatient,,,205682.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38690,,186% x Medicaid HMO amount,38690,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,88465,,"27,634 x DRG Weight",88465,Other,DRG Base Rate x DRG Weight,75192,,"23,488 x DRG Weight",75192,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20801.21,,DRG base rate x DRG weight + capital per discharge,20801.21,Other,100% of NY Medicaid HMO DRG,20801,,DRG base rate x DRG weight + capital per discharge,20801,Other,100% of NY Medicaid HMO DRG,20801,,DRG base rate x DRG weight + capital per discharge,20801,Other,100% of NY Medicaid HMO DRG,20801,,DRG base rate x DRG weight + capital per discharge,20801,Other,100% of NY Medicaid HMO DRG,46803,,225% x Medicaid HMO amount,46803,Other,225% of NY Medicaid HMO DRG,31826,,153% x Medicaid HMO amount,31826,Other,153% of NY Medicaid HMO DRG,46803,,225% x Medicaid HMO amount,46803,Other,225% of NY Medicaid HMO DRG,29122,,140% x Medicaid HMO amount,29122,Other,140% of NY Medicaid HMO DRG,46803,,DRG base rate x DRG weight + capital per discharge,46803,Other,225% of NY Medicaid HMO DRG,57203,,275% x Medicaid HMO amount,57203,Other,275% of NY Medicaid HMO DRG,67396,,324% x Medicaid HMO amount,67396,Other,324% of NY Medicaid HMO DRG,44723,,215% x Medicaid HMO amount,44723,Other,215% of NY Medicaid HMO DRG,44723,,215% x Medicaid HMO amount,44723,Other,215% of NY Medicaid HMO DRG,26002,,125% x Medicaid HMO amount,26002,Other,125% of NY Medicaid HMO DRG,0.01,88465,
Hypovolemia & related electrolyte disorders,422-1,APR-DRG,,,,,,,,inpatient,,,85262.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5346,,186% x Medicaid HMO amount,5346,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10448,,"27,634 x DRG Weight",10448,Other,DRG Base Rate x DRG Weight,8881,,"23,488 x DRG Weight",8881,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2874.21,,DRG base rate x DRG weight + capital per discharge,2874.21,Other,100% of NY Medicaid HMO DRG,2874,,DRG base rate x DRG weight + capital per discharge,2874,Other,100% of NY Medicaid HMO DRG,2874,,DRG base rate x DRG weight + capital per discharge,2874,Other,100% of NY Medicaid HMO DRG,2874,,DRG base rate x DRG weight + capital per discharge,2874,Other,100% of NY Medicaid HMO DRG,6467,,225% x Medicaid HMO amount,6467,Other,225% of NY Medicaid HMO DRG,4398,,153% x Medicaid HMO amount,4398,Other,153% of NY Medicaid HMO DRG,6467,,225% x Medicaid HMO amount,6467,Other,225% of NY Medicaid HMO DRG,4024,,140% x Medicaid HMO amount,4024,Other,140% of NY Medicaid HMO DRG,6467,,DRG base rate x DRG weight + capital per discharge,6467,Other,225% of NY Medicaid HMO DRG,7904,,275% x Medicaid HMO amount,7904,Other,275% of NY Medicaid HMO DRG,9312,,324% x Medicaid HMO amount,9312,Other,324% of NY Medicaid HMO DRG,6180,,215% x Medicaid HMO amount,6180,Other,215% of NY Medicaid HMO DRG,6180,,215% x Medicaid HMO amount,6180,Other,215% of NY Medicaid HMO DRG,3593,,125% x Medicaid HMO amount,3593,Other,125% of NY Medicaid HMO DRG,0.01,10448,
Hypovolemia & related electrolyte disorders,422-2,APR-DRG,,,,,,,,inpatient,,,81502.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7092,,186% x Medicaid HMO amount,7092,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14535,,"27,634 x DRG Weight",14535,Other,DRG Base Rate x DRG Weight,12355,,"23,488 x DRG Weight",12355,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3813.21,,DRG base rate x DRG weight + capital per discharge,3813.21,Other,100% of NY Medicaid HMO DRG,3813,,DRG base rate x DRG weight + capital per discharge,3813,Other,100% of NY Medicaid HMO DRG,3813,,DRG base rate x DRG weight + capital per discharge,3813,Other,100% of NY Medicaid HMO DRG,3813,,DRG base rate x DRG weight + capital per discharge,3813,Other,100% of NY Medicaid HMO DRG,8580,,225% x Medicaid HMO amount,8580,Other,225% of NY Medicaid HMO DRG,5834,,153% x Medicaid HMO amount,5834,Other,153% of NY Medicaid HMO DRG,8580,,225% x Medicaid HMO amount,8580,Other,225% of NY Medicaid HMO DRG,5338,,140% x Medicaid HMO amount,5338,Other,140% of NY Medicaid HMO DRG,8580,,DRG base rate x DRG weight + capital per discharge,8580,Other,225% of NY Medicaid HMO DRG,10486,,275% x Medicaid HMO amount,10486,Other,275% of NY Medicaid HMO DRG,12355,,324% x Medicaid HMO amount,12355,Other,324% of NY Medicaid HMO DRG,8198,,215% x Medicaid HMO amount,8198,Other,215% of NY Medicaid HMO DRG,8198,,215% x Medicaid HMO amount,8198,Other,215% of NY Medicaid HMO DRG,4767,,125% x Medicaid HMO amount,4767,Other,125% of NY Medicaid HMO DRG,0.01,14535,
Hypovolemia & related electrolyte disorders,422-3,APR-DRG,,,,,,,,inpatient,,,115102.3,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11534,,186% x Medicaid HMO amount,11534,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24926,,"27,634 x DRG Weight",24926,Other,DRG Base Rate x DRG Weight,21186,,"23,488 x DRG Weight",21186,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6201.21,,DRG base rate x DRG weight + capital per discharge,6201.21,Other,100% of NY Medicaid HMO DRG,6201,,DRG base rate x DRG weight + capital per discharge,6201,Other,100% of NY Medicaid HMO DRG,6201,,DRG base rate x DRG weight + capital per discharge,6201,Other,100% of NY Medicaid HMO DRG,6201,,DRG base rate x DRG weight + capital per discharge,6201,Other,100% of NY Medicaid HMO DRG,13953,,225% x Medicaid HMO amount,13953,Other,225% of NY Medicaid HMO DRG,9488,,153% x Medicaid HMO amount,9488,Other,153% of NY Medicaid HMO DRG,13953,,225% x Medicaid HMO amount,13953,Other,225% of NY Medicaid HMO DRG,8682,,140% x Medicaid HMO amount,8682,Other,140% of NY Medicaid HMO DRG,13953,,DRG base rate x DRG weight + capital per discharge,13953,Other,225% of NY Medicaid HMO DRG,17053,,275% x Medicaid HMO amount,17053,Other,275% of NY Medicaid HMO DRG,20092,,324% x Medicaid HMO amount,20092,Other,324% of NY Medicaid HMO DRG,13333,,215% x Medicaid HMO amount,13333,Other,215% of NY Medicaid HMO DRG,13333,,215% x Medicaid HMO amount,13333,Other,215% of NY Medicaid HMO DRG,7752,,125% x Medicaid HMO amount,7752,Other,125% of NY Medicaid HMO DRG,0.01,24926,
Hypovolemia & related electrolyte disorders,422-4,APR-DRG,,,,,,,,inpatient,,,105920.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27694,,186% x Medicaid HMO amount,27694,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62737,,"27,634 x DRG Weight",62737,Other,DRG Base Rate x DRG Weight,53325,,"23,488 x DRG Weight",53325,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14889.21,,DRG base rate x DRG weight + capital per discharge,14889.21,Other,100% of NY Medicaid HMO DRG,14889,,DRG base rate x DRG weight + capital per discharge,14889,Other,100% of NY Medicaid HMO DRG,14889,,DRG base rate x DRG weight + capital per discharge,14889,Other,100% of NY Medicaid HMO DRG,14889,,DRG base rate x DRG weight + capital per discharge,14889,Other,100% of NY Medicaid HMO DRG,33501,,225% x Medicaid HMO amount,33501,Other,225% of NY Medicaid HMO DRG,22780,,153% x Medicaid HMO amount,22780,Other,153% of NY Medicaid HMO DRG,33501,,225% x Medicaid HMO amount,33501,Other,225% of NY Medicaid HMO DRG,20845,,140% x Medicaid HMO amount,20845,Other,140% of NY Medicaid HMO DRG,33501,,DRG base rate x DRG weight + capital per discharge,33501,Other,225% of NY Medicaid HMO DRG,40945,,275% x Medicaid HMO amount,40945,Other,275% of NY Medicaid HMO DRG,48241,,324% x Medicaid HMO amount,48241,Other,324% of NY Medicaid HMO DRG,32012,,215% x Medicaid HMO amount,32012,Other,215% of NY Medicaid HMO DRG,32012,,215% x Medicaid HMO amount,32012,Other,215% of NY Medicaid HMO DRG,18612,,125% x Medicaid HMO amount,18612,Other,125% of NY Medicaid HMO DRG,0.01,62737,
Inborn errors of metabolism,423-1,APR-DRG,,,,,,,,inpatient,,,50691.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8136,,186% x Medicaid HMO amount,8136,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16978,,"27,634 x DRG Weight",16978,Other,DRG Base Rate x DRG Weight,14431,,"23,488 x DRG Weight",14431,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4374.21,,DRG base rate x DRG weight + capital per discharge,4374.21,Other,100% of NY Medicaid HMO DRG,4374,,DRG base rate x DRG weight + capital per discharge,4374,Other,100% of NY Medicaid HMO DRG,4374,,DRG base rate x DRG weight + capital per discharge,4374,Other,100% of NY Medicaid HMO DRG,4374,,DRG base rate x DRG weight + capital per discharge,4374,Other,100% of NY Medicaid HMO DRG,9842,,225% x Medicaid HMO amount,9842,Other,225% of NY Medicaid HMO DRG,6693,,153% x Medicaid HMO amount,6693,Other,153% of NY Medicaid HMO DRG,9842,,225% x Medicaid HMO amount,9842,Other,225% of NY Medicaid HMO DRG,6124,,140% x Medicaid HMO amount,6124,Other,140% of NY Medicaid HMO DRG,9842,,DRG base rate x DRG weight + capital per discharge,9842,Other,225% of NY Medicaid HMO DRG,12029,,275% x Medicaid HMO amount,12029,Other,275% of NY Medicaid HMO DRG,14172,,324% x Medicaid HMO amount,14172,Other,324% of NY Medicaid HMO DRG,9405,,215% x Medicaid HMO amount,9405,Other,215% of NY Medicaid HMO DRG,9405,,215% x Medicaid HMO amount,9405,Other,215% of NY Medicaid HMO DRG,5468,,125% x Medicaid HMO amount,5468,Other,125% of NY Medicaid HMO DRG,0.01,16978,
Inborn errors of metabolism,423-2,APR-DRG,,,,,,,,inpatient,,,93533.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12825,,186% x Medicaid HMO amount,12825,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27946,,"27,634 x DRG Weight",27946,Other,DRG Base Rate x DRG Weight,23753,,"23,488 x DRG Weight",23753,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6895.21,,DRG base rate x DRG weight + capital per discharge,6895.21,Other,100% of NY Medicaid HMO DRG,6895,,DRG base rate x DRG weight + capital per discharge,6895,Other,100% of NY Medicaid HMO DRG,6895,,DRG base rate x DRG weight + capital per discharge,6895,Other,100% of NY Medicaid HMO DRG,6895,,DRG base rate x DRG weight + capital per discharge,6895,Other,100% of NY Medicaid HMO DRG,15514,,225% x Medicaid HMO amount,15514,Other,225% of NY Medicaid HMO DRG,10550,,153% x Medicaid HMO amount,10550,Other,153% of NY Medicaid HMO DRG,15514,,225% x Medicaid HMO amount,15514,Other,225% of NY Medicaid HMO DRG,9653,,140% x Medicaid HMO amount,9653,Other,140% of NY Medicaid HMO DRG,15514,,DRG base rate x DRG weight + capital per discharge,15514,Other,225% of NY Medicaid HMO DRG,18962,,275% x Medicaid HMO amount,18962,Other,275% of NY Medicaid HMO DRG,22340,,324% x Medicaid HMO amount,22340,Other,324% of NY Medicaid HMO DRG,14825,,215% x Medicaid HMO amount,14825,Other,215% of NY Medicaid HMO DRG,14825,,215% x Medicaid HMO amount,14825,Other,215% of NY Medicaid HMO DRG,8619,,125% x Medicaid HMO amount,8619,Other,125% of NY Medicaid HMO DRG,0.01,27946,
Inborn errors of metabolism,423-3,APR-DRG,,,,,,,,inpatient,,,74556.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19776,,186% x Medicaid HMO amount,19776,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44209,,"27,634 x DRG Weight",44209,Other,DRG Base Rate x DRG Weight,37576,,"23,488 x DRG Weight",37576,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10632.21,,DRG base rate x DRG weight + capital per discharge,10632.21,Other,100% of NY Medicaid HMO DRG,10632,,DRG base rate x DRG weight + capital per discharge,10632,Other,100% of NY Medicaid HMO DRG,10632,,DRG base rate x DRG weight + capital per discharge,10632,Other,100% of NY Medicaid HMO DRG,10632,,DRG base rate x DRG weight + capital per discharge,10632,Other,100% of NY Medicaid HMO DRG,23922,,225% x Medicaid HMO amount,23922,Other,225% of NY Medicaid HMO DRG,16267,,153% x Medicaid HMO amount,16267,Other,153% of NY Medicaid HMO DRG,23922,,225% x Medicaid HMO amount,23922,Other,225% of NY Medicaid HMO DRG,14885,,140% x Medicaid HMO amount,14885,Other,140% of NY Medicaid HMO DRG,23922,,DRG base rate x DRG weight + capital per discharge,23922,Other,225% of NY Medicaid HMO DRG,29239,,275% x Medicaid HMO amount,29239,Other,275% of NY Medicaid HMO DRG,34448,,324% x Medicaid HMO amount,34448,Other,324% of NY Medicaid HMO DRG,22859,,215% x Medicaid HMO amount,22859,Other,215% of NY Medicaid HMO DRG,22859,,215% x Medicaid HMO amount,22859,Other,215% of NY Medicaid HMO DRG,13290,,125% x Medicaid HMO amount,13290,Other,125% of NY Medicaid HMO DRG,0.01,44209,
Inborn errors of metabolism,423-4,APR-DRG,,,,,,,,inpatient,,,93533.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65111,,186% x Medicaid HMO amount,65111,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,150282,,"27,634 x DRG Weight",150282,Other,DRG Base Rate x DRG Weight,127735,,"23,488 x DRG Weight",127735,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35006.21,,DRG base rate x DRG weight + capital per discharge,35006.21,Other,100% of NY Medicaid HMO DRG,35006,,DRG base rate x DRG weight + capital per discharge,35006,Other,100% of NY Medicaid HMO DRG,35006,,DRG base rate x DRG weight + capital per discharge,35006,Other,100% of NY Medicaid HMO DRG,35006,,DRG base rate x DRG weight + capital per discharge,35006,Other,100% of NY Medicaid HMO DRG,78764,,225% x Medicaid HMO amount,78764,Other,225% of NY Medicaid HMO DRG,53560,,153% x Medicaid HMO amount,53560,Other,153% of NY Medicaid HMO DRG,78764,,225% x Medicaid HMO amount,78764,Other,225% of NY Medicaid HMO DRG,49009,,140% x Medicaid HMO amount,49009,Other,140% of NY Medicaid HMO DRG,78764,,DRG base rate x DRG weight + capital per discharge,78764,Other,225% of NY Medicaid HMO DRG,96267,,275% x Medicaid HMO amount,96267,Other,275% of NY Medicaid HMO DRG,113420,,324% x Medicaid HMO amount,113420,Other,324% of NY Medicaid HMO DRG,75263,,215% x Medicaid HMO amount,75263,Other,215% of NY Medicaid HMO DRG,75263,,215% x Medicaid HMO amount,75263,Other,215% of NY Medicaid HMO DRG,43758,,125% x Medicaid HMO amount,43758,Other,125% of NY Medicaid HMO DRG,0.01,150282,
Other endocrine disorders,424-1,APR-DRG,,,,,,,,inpatient,,,68263.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6772,,186% x Medicaid HMO amount,6772,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13787,,"27,634 x DRG Weight",13787,Other,DRG Base Rate x DRG Weight,11718,,"23,488 x DRG Weight",11718,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3641.21,,DRG base rate x DRG weight + capital per discharge,3641.21,Other,100% of NY Medicaid HMO DRG,3641,,DRG base rate x DRG weight + capital per discharge,3641,Other,100% of NY Medicaid HMO DRG,3641,,DRG base rate x DRG weight + capital per discharge,3641,Other,100% of NY Medicaid HMO DRG,3641,,DRG base rate x DRG weight + capital per discharge,3641,Other,100% of NY Medicaid HMO DRG,8193,,225% x Medicaid HMO amount,8193,Other,225% of NY Medicaid HMO DRG,5571,,153% x Medicaid HMO amount,5571,Other,153% of NY Medicaid HMO DRG,8193,,225% x Medicaid HMO amount,8193,Other,225% of NY Medicaid HMO DRG,5098,,140% x Medicaid HMO amount,5098,Other,140% of NY Medicaid HMO DRG,8193,,DRG base rate x DRG weight + capital per discharge,8193,Other,225% of NY Medicaid HMO DRG,10013,,275% x Medicaid HMO amount,10013,Other,275% of NY Medicaid HMO DRG,11798,,324% x Medicaid HMO amount,11798,Other,324% of NY Medicaid HMO DRG,7829,,215% x Medicaid HMO amount,7829,Other,215% of NY Medicaid HMO DRG,7829,,215% x Medicaid HMO amount,7829,Other,215% of NY Medicaid HMO DRG,4552,,125% x Medicaid HMO amount,4552,Other,125% of NY Medicaid HMO DRG,0.01,13787,
Other endocrine disorders,424-2,APR-DRG,,,,,,,,inpatient,,,95654.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9849,,186% x Medicaid HMO amount,9849,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20985,,"27,634 x DRG Weight",20985,Other,DRG Base Rate x DRG Weight,17837,,"23,488 x DRG Weight",17837,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5295.21,,DRG base rate x DRG weight + capital per discharge,5295.21,Other,100% of NY Medicaid HMO DRG,5295,,DRG base rate x DRG weight + capital per discharge,5295,Other,100% of NY Medicaid HMO DRG,5295,,DRG base rate x DRG weight + capital per discharge,5295,Other,100% of NY Medicaid HMO DRG,5295,,DRG base rate x DRG weight + capital per discharge,5295,Other,100% of NY Medicaid HMO DRG,11914,,225% x Medicaid HMO amount,11914,Other,225% of NY Medicaid HMO DRG,8102,,153% x Medicaid HMO amount,8102,Other,153% of NY Medicaid HMO DRG,11914,,225% x Medicaid HMO amount,11914,Other,225% of NY Medicaid HMO DRG,7413,,140% x Medicaid HMO amount,7413,Other,140% of NY Medicaid HMO DRG,11914,,DRG base rate x DRG weight + capital per discharge,11914,Other,225% of NY Medicaid HMO DRG,14562,,275% x Medicaid HMO amount,14562,Other,275% of NY Medicaid HMO DRG,17156,,324% x Medicaid HMO amount,17156,Other,324% of NY Medicaid HMO DRG,11385,,215% x Medicaid HMO amount,11385,Other,215% of NY Medicaid HMO DRG,11385,,215% x Medicaid HMO amount,11385,Other,215% of NY Medicaid HMO DRG,6619,,125% x Medicaid HMO amount,6619,Other,125% of NY Medicaid HMO DRG,0.01,20985,
Other endocrine disorders,424-3,APR-DRG,,,,,,,,inpatient,,,207825.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14880,,186% x Medicaid HMO amount,14880,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32755,,"27,634 x DRG Weight",32755,Other,DRG Base Rate x DRG Weight,27840,,"23,488 x DRG Weight",27840,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8000.21,,DRG base rate x DRG weight + capital per discharge,8000.21,Other,100% of NY Medicaid HMO DRG,8000,,DRG base rate x DRG weight + capital per discharge,8000,Other,100% of NY Medicaid HMO DRG,8000,,DRG base rate x DRG weight + capital per discharge,8000,Other,100% of NY Medicaid HMO DRG,8000,,DRG base rate x DRG weight + capital per discharge,8000,Other,100% of NY Medicaid HMO DRG,18000,,225% x Medicaid HMO amount,18000,Other,225% of NY Medicaid HMO DRG,12240,,153% x Medicaid HMO amount,12240,Other,153% of NY Medicaid HMO DRG,18000,,225% x Medicaid HMO amount,18000,Other,225% of NY Medicaid HMO DRG,11200,,140% x Medicaid HMO amount,11200,Other,140% of NY Medicaid HMO DRG,18000,,DRG base rate x DRG weight + capital per discharge,18000,Other,225% of NY Medicaid HMO DRG,22001,,275% x Medicaid HMO amount,22001,Other,275% of NY Medicaid HMO DRG,25921,,324% x Medicaid HMO amount,25921,Other,324% of NY Medicaid HMO DRG,17200,,215% x Medicaid HMO amount,17200,Other,215% of NY Medicaid HMO DRG,17200,,215% x Medicaid HMO amount,17200,Other,215% of NY Medicaid HMO DRG,10000,,125% x Medicaid HMO amount,10000,Other,125% of NY Medicaid HMO DRG,0.01,32755,
Other endocrine disorders,424-4,APR-DRG,,,,,,,,inpatient,,,388170.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33752,,186% x Medicaid HMO amount,33752,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,76908,,"27,634 x DRG Weight",76908,Other,DRG Base Rate x DRG Weight,65369,,"23,488 x DRG Weight",65369,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18146.21,,DRG base rate x DRG weight + capital per discharge,18146.21,Other,100% of NY Medicaid HMO DRG,18146,,DRG base rate x DRG weight + capital per discharge,18146,Other,100% of NY Medicaid HMO DRG,18146,,DRG base rate x DRG weight + capital per discharge,18146,Other,100% of NY Medicaid HMO DRG,18146,,DRG base rate x DRG weight + capital per discharge,18146,Other,100% of NY Medicaid HMO DRG,40829,,225% x Medicaid HMO amount,40829,Other,225% of NY Medicaid HMO DRG,27764,,153% x Medicaid HMO amount,27764,Other,153% of NY Medicaid HMO DRG,40829,,225% x Medicaid HMO amount,40829,Other,225% of NY Medicaid HMO DRG,25405,,140% x Medicaid HMO amount,25405,Other,140% of NY Medicaid HMO DRG,40829,,DRG base rate x DRG weight + capital per discharge,40829,Other,225% of NY Medicaid HMO DRG,49902,,275% x Medicaid HMO amount,49902,Other,275% of NY Medicaid HMO DRG,58794,,324% x Medicaid HMO amount,58794,Other,324% of NY Medicaid HMO DRG,39014,,215% x Medicaid HMO amount,39014,Other,215% of NY Medicaid HMO DRG,39014,,215% x Medicaid HMO amount,39014,Other,215% of NY Medicaid HMO DRG,22683,,125% x Medicaid HMO amount,22683,Other,125% of NY Medicaid HMO DRG,0.01,76908,
Electrolyte disorders except hypovolemia related,425-1,APR-DRG,,,,,,,,inpatient,,,105839.05,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5967,,186% x Medicaid HMO amount,5967,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11905,,"27,634 x DRG Weight",11905,Other,DRG Base Rate x DRG Weight,10119,,"23,488 x DRG Weight",10119,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3208.21,,DRG base rate x DRG weight + capital per discharge,3208.21,Other,100% of NY Medicaid HMO DRG,3208,,DRG base rate x DRG weight + capital per discharge,3208,Other,100% of NY Medicaid HMO DRG,3208,,DRG base rate x DRG weight + capital per discharge,3208,Other,100% of NY Medicaid HMO DRG,3208,,DRG base rate x DRG weight + capital per discharge,3208,Other,100% of NY Medicaid HMO DRG,7218,,225% x Medicaid HMO amount,7218,Other,225% of NY Medicaid HMO DRG,4909,,153% x Medicaid HMO amount,4909,Other,153% of NY Medicaid HMO DRG,7218,,225% x Medicaid HMO amount,7218,Other,225% of NY Medicaid HMO DRG,4491,,140% x Medicaid HMO amount,4491,Other,140% of NY Medicaid HMO DRG,7218,,DRG base rate x DRG weight + capital per discharge,7218,Other,225% of NY Medicaid HMO DRG,8823,,275% x Medicaid HMO amount,8823,Other,275% of NY Medicaid HMO DRG,10395,,324% x Medicaid HMO amount,10395,Other,324% of NY Medicaid HMO DRG,6898,,215% x Medicaid HMO amount,6898,Other,215% of NY Medicaid HMO DRG,6898,,215% x Medicaid HMO amount,6898,Other,215% of NY Medicaid HMO DRG,4010,,125% x Medicaid HMO amount,4010,Other,125% of NY Medicaid HMO DRG,0.01,11905,
Electrolyte disorders except hypovolemia related,425-2,APR-DRG,,,,,,,,inpatient,,,120854.7,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7976,,186% x Medicaid HMO amount,7976,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16603,,"27,634 x DRG Weight",16603,Other,DRG Base Rate x DRG Weight,14112,,"23,488 x DRG Weight",14112,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4288.21,,DRG base rate x DRG weight + capital per discharge,4288.21,Other,100% of NY Medicaid HMO DRG,4288,,DRG base rate x DRG weight + capital per discharge,4288,Other,100% of NY Medicaid HMO DRG,4288,,DRG base rate x DRG weight + capital per discharge,4288,Other,100% of NY Medicaid HMO DRG,4288,,DRG base rate x DRG weight + capital per discharge,4288,Other,100% of NY Medicaid HMO DRG,9648,,225% x Medicaid HMO amount,9648,Other,225% of NY Medicaid HMO DRG,6561,,153% x Medicaid HMO amount,6561,Other,153% of NY Medicaid HMO DRG,9648,,225% x Medicaid HMO amount,9648,Other,225% of NY Medicaid HMO DRG,6003,,140% x Medicaid HMO amount,6003,Other,140% of NY Medicaid HMO DRG,9648,,DRG base rate x DRG weight + capital per discharge,9648,Other,225% of NY Medicaid HMO DRG,11793,,275% x Medicaid HMO amount,11793,Other,275% of NY Medicaid HMO DRG,13894,,324% x Medicaid HMO amount,13894,Other,324% of NY Medicaid HMO DRG,9220,,215% x Medicaid HMO amount,9220,Other,215% of NY Medicaid HMO DRG,9220,,215% x Medicaid HMO amount,9220,Other,215% of NY Medicaid HMO DRG,5360,,125% x Medicaid HMO amount,5360,Other,125% of NY Medicaid HMO DRG,0.01,16603,
Electrolyte disorders except hypovolemia related,425-3,APR-DRG,,,,,,,,inpatient,,,159337.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12672,,186% x Medicaid HMO amount,12672,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27590,,"27,634 x DRG Weight",27590,Other,DRG Base Rate x DRG Weight,23450,,"23,488 x DRG Weight",23450,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6813.21,,DRG base rate x DRG weight + capital per discharge,6813.21,Other,100% of NY Medicaid HMO DRG,6813,,DRG base rate x DRG weight + capital per discharge,6813,Other,100% of NY Medicaid HMO DRG,6813,,DRG base rate x DRG weight + capital per discharge,6813,Other,100% of NY Medicaid HMO DRG,6813,,DRG base rate x DRG weight + capital per discharge,6813,Other,100% of NY Medicaid HMO DRG,15330,,225% x Medicaid HMO amount,15330,Other,225% of NY Medicaid HMO DRG,10424,,153% x Medicaid HMO amount,10424,Other,153% of NY Medicaid HMO DRG,15330,,225% x Medicaid HMO amount,15330,Other,225% of NY Medicaid HMO DRG,9538,,140% x Medicaid HMO amount,9538,Other,140% of NY Medicaid HMO DRG,15330,,DRG base rate x DRG weight + capital per discharge,15330,Other,225% of NY Medicaid HMO DRG,18736,,275% x Medicaid HMO amount,18736,Other,275% of NY Medicaid HMO DRG,22075,,324% x Medicaid HMO amount,22075,Other,324% of NY Medicaid HMO DRG,14648,,215% x Medicaid HMO amount,14648,Other,215% of NY Medicaid HMO DRG,14648,,215% x Medicaid HMO amount,14648,Other,215% of NY Medicaid HMO DRG,8517,,125% x Medicaid HMO amount,8517,Other,125% of NY Medicaid HMO DRG,0.01,27590,
Electrolyte disorders except hypovolemia related,425-4,APR-DRG,,,,,,,,inpatient,,,303475.19,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30301,,186% x Medicaid HMO amount,30301,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,68836,,"27,634 x DRG Weight",68836,Other,DRG Base Rate x DRG Weight,58509,,"23,488 x DRG Weight",58509,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16291.21,,DRG base rate x DRG weight + capital per discharge,16291.21,Other,100% of NY Medicaid HMO DRG,16291,,DRG base rate x DRG weight + capital per discharge,16291,Other,100% of NY Medicaid HMO DRG,16291,,DRG base rate x DRG weight + capital per discharge,16291,Other,100% of NY Medicaid HMO DRG,16291,,DRG base rate x DRG weight + capital per discharge,16291,Other,100% of NY Medicaid HMO DRG,36655,,225% x Medicaid HMO amount,36655,Other,225% of NY Medicaid HMO DRG,24926,,153% x Medicaid HMO amount,24926,Other,153% of NY Medicaid HMO DRG,36655,,225% x Medicaid HMO amount,36655,Other,225% of NY Medicaid HMO DRG,22808,,140% x Medicaid HMO amount,22808,Other,140% of NY Medicaid HMO DRG,36655,,DRG base rate x DRG weight + capital per discharge,36655,Other,225% of NY Medicaid HMO DRG,44801,,275% x Medicaid HMO amount,44801,Other,275% of NY Medicaid HMO DRG,52784,,324% x Medicaid HMO amount,52784,Other,324% of NY Medicaid HMO DRG,35026,,215% x Medicaid HMO amount,35026,Other,215% of NY Medicaid HMO DRG,35026,,215% x Medicaid HMO amount,35026,Other,215% of NY Medicaid HMO DRG,20364,,125% x Medicaid HMO amount,20364,Other,125% of NY Medicaid HMO DRG,0.01,68836,
Major bladder procedures,441-1,APR-DRG,,,,,,,,inpatient,,,180473.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16002,,186% x Medicaid HMO amount,16002,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35383,,"27,634 x DRG Weight",35383,Other,DRG Base Rate x DRG Weight,30074,,"23,488 x DRG Weight",30074,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8603.21,,DRG base rate x DRG weight + capital per discharge,8603.21,Other,100% of NY Medicaid HMO DRG,8603,,DRG base rate x DRG weight + capital per discharge,8603,Other,100% of NY Medicaid HMO DRG,8603,,DRG base rate x DRG weight + capital per discharge,8603,Other,100% of NY Medicaid HMO DRG,8603,,DRG base rate x DRG weight + capital per discharge,8603,Other,100% of NY Medicaid HMO DRG,19357,,225% x Medicaid HMO amount,19357,Other,225% of NY Medicaid HMO DRG,13163,,153% x Medicaid HMO amount,13163,Other,153% of NY Medicaid HMO DRG,19357,,225% x Medicaid HMO amount,19357,Other,225% of NY Medicaid HMO DRG,12044,,140% x Medicaid HMO amount,12044,Other,140% of NY Medicaid HMO DRG,19357,,DRG base rate x DRG weight + capital per discharge,19357,Other,225% of NY Medicaid HMO DRG,23659,,275% x Medicaid HMO amount,23659,Other,275% of NY Medicaid HMO DRG,27874,,324% x Medicaid HMO amount,27874,Other,324% of NY Medicaid HMO DRG,18497,,215% x Medicaid HMO amount,18497,Other,215% of NY Medicaid HMO DRG,18497,,215% x Medicaid HMO amount,18497,Other,215% of NY Medicaid HMO DRG,10754,,125% x Medicaid HMO amount,10754,Other,125% of NY Medicaid HMO DRG,0.01,35383,
Major bladder procedures,441-2,APR-DRG,,,,,,,,inpatient,,,340110.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27175,,186% x Medicaid HMO amount,27175,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,61522,,"27,634 x DRG Weight",61522,Other,DRG Base Rate x DRG Weight,52291,,"23,488 x DRG Weight",52291,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14610.21,,DRG base rate x DRG weight + capital per discharge,14610.21,Other,100% of NY Medicaid HMO DRG,14610,,DRG base rate x DRG weight + capital per discharge,14610,Other,100% of NY Medicaid HMO DRG,14610,,DRG base rate x DRG weight + capital per discharge,14610,Other,100% of NY Medicaid HMO DRG,14610,,DRG base rate x DRG weight + capital per discharge,14610,Other,100% of NY Medicaid HMO DRG,32873,,225% x Medicaid HMO amount,32873,Other,225% of NY Medicaid HMO DRG,22354,,153% x Medicaid HMO amount,22354,Other,153% of NY Medicaid HMO DRG,32873,,225% x Medicaid HMO amount,32873,Other,225% of NY Medicaid HMO DRG,20454,,140% x Medicaid HMO amount,20454,Other,140% of NY Medicaid HMO DRG,32873,,DRG base rate x DRG weight + capital per discharge,32873,Other,225% of NY Medicaid HMO DRG,40178,,275% x Medicaid HMO amount,40178,Other,275% of NY Medicaid HMO DRG,47337,,324% x Medicaid HMO amount,47337,Other,324% of NY Medicaid HMO DRG,31412,,215% x Medicaid HMO amount,31412,Other,215% of NY Medicaid HMO DRG,31412,,215% x Medicaid HMO amount,31412,Other,215% of NY Medicaid HMO DRG,18263,,125% x Medicaid HMO amount,18263,Other,125% of NY Medicaid HMO DRG,0.01,61522,
Major bladder procedures,441-3,APR-DRG,,,,,,,,inpatient,,,322830.08,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38057,,186% x Medicaid HMO amount,38057,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86984,,"27,634 x DRG Weight",86984,Other,DRG Base Rate x DRG Weight,73933,,"23,488 x DRG Weight",73933,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20461.21,,DRG base rate x DRG weight + capital per discharge,20461.21,Other,100% of NY Medicaid HMO DRG,20461,,DRG base rate x DRG weight + capital per discharge,20461,Other,100% of NY Medicaid HMO DRG,20461,,DRG base rate x DRG weight + capital per discharge,20461,Other,100% of NY Medicaid HMO DRG,20461,,DRG base rate x DRG weight + capital per discharge,20461,Other,100% of NY Medicaid HMO DRG,46038,,225% x Medicaid HMO amount,46038,Other,225% of NY Medicaid HMO DRG,31306,,153% x Medicaid HMO amount,31306,Other,153% of NY Medicaid HMO DRG,46038,,225% x Medicaid HMO amount,46038,Other,225% of NY Medicaid HMO DRG,28646,,140% x Medicaid HMO amount,28646,Other,140% of NY Medicaid HMO DRG,46038,,DRG base rate x DRG weight + capital per discharge,46038,Other,225% of NY Medicaid HMO DRG,56268,,275% x Medicaid HMO amount,56268,Other,275% of NY Medicaid HMO DRG,66294,,324% x Medicaid HMO amount,66294,Other,324% of NY Medicaid HMO DRG,43992,,215% x Medicaid HMO amount,43992,Other,215% of NY Medicaid HMO DRG,43992,,215% x Medicaid HMO amount,43992,Other,215% of NY Medicaid HMO DRG,25577,,125% x Medicaid HMO amount,25577,Other,125% of NY Medicaid HMO DRG,0.01,86984,
Major bladder procedures,441-4,APR-DRG,,,,,,,,inpatient,,,1688756.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,80761,,186% x Medicaid HMO amount,80761,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,186897,,"27,634 x DRG Weight",186897,Other,DRG Base Rate x DRG Weight,158856,,"23,488 x DRG Weight",158856,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43420.21,,DRG base rate x DRG weight + capital per discharge,43420.21,Other,100% of NY Medicaid HMO DRG,43420,,DRG base rate x DRG weight + capital per discharge,43420,Other,100% of NY Medicaid HMO DRG,43420,,DRG base rate x DRG weight + capital per discharge,43420,Other,100% of NY Medicaid HMO DRG,43420,,DRG base rate x DRG weight + capital per discharge,43420,Other,100% of NY Medicaid HMO DRG,97695,,225% x Medicaid HMO amount,97695,Other,225% of NY Medicaid HMO DRG,66433,,153% x Medicaid HMO amount,66433,Other,153% of NY Medicaid HMO DRG,97695,,225% x Medicaid HMO amount,97695,Other,225% of NY Medicaid HMO DRG,60788,,140% x Medicaid HMO amount,60788,Other,140% of NY Medicaid HMO DRG,97695,,DRG base rate x DRG weight + capital per discharge,97695,Other,225% of NY Medicaid HMO DRG,119406,,275% x Medicaid HMO amount,119406,Other,275% of NY Medicaid HMO DRG,140681,,324% x Medicaid HMO amount,140681,Other,324% of NY Medicaid HMO DRG,93353,,215% x Medicaid HMO amount,93353,Other,215% of NY Medicaid HMO DRG,93353,,215% x Medicaid HMO amount,93353,Other,215% of NY Medicaid HMO DRG,54275,,125% x Medicaid HMO amount,54275,Other,125% of NY Medicaid HMO DRG,0.01,186897,
Kidney & urinary tract procedures for malignancy,442-1,APR-DRG,,,,,,,,inpatient,,,102373.65,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16163,,186% x Medicaid HMO amount,16163,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35758,,"27,634 x DRG Weight",35758,Other,DRG Base Rate x DRG Weight,30393,,"23,488 x DRG Weight",30393,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8690.21,,DRG base rate x DRG weight + capital per discharge,8690.21,Other,100% of NY Medicaid HMO DRG,8690,,DRG base rate x DRG weight + capital per discharge,8690,Other,100% of NY Medicaid HMO DRG,8690,,DRG base rate x DRG weight + capital per discharge,8690,Other,100% of NY Medicaid HMO DRG,8690,,DRG base rate x DRG weight + capital per discharge,8690,Other,100% of NY Medicaid HMO DRG,19553,,225% x Medicaid HMO amount,19553,Other,225% of NY Medicaid HMO DRG,13296,,153% x Medicaid HMO amount,13296,Other,153% of NY Medicaid HMO DRG,19553,,225% x Medicaid HMO amount,19553,Other,225% of NY Medicaid HMO DRG,12166,,140% x Medicaid HMO amount,12166,Other,140% of NY Medicaid HMO DRG,19553,,DRG base rate x DRG weight + capital per discharge,19553,Other,225% of NY Medicaid HMO DRG,23898,,275% x Medicaid HMO amount,23898,Other,275% of NY Medicaid HMO DRG,28156,,324% x Medicaid HMO amount,28156,Other,324% of NY Medicaid HMO DRG,18684,,215% x Medicaid HMO amount,18684,Other,215% of NY Medicaid HMO DRG,18684,,215% x Medicaid HMO amount,18684,Other,215% of NY Medicaid HMO DRG,10863,,125% x Medicaid HMO amount,10863,Other,125% of NY Medicaid HMO DRG,0.01,35758,
Kidney & urinary tract procedures for malignancy,442-2,APR-DRG,,,,,,,,inpatient,,,590501.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19037,,186% x Medicaid HMO amount,19037,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42482,,"27,634 x DRG Weight",42482,Other,DRG Base Rate x DRG Weight,36108,,"23,488 x DRG Weight",36108,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10235.21,,DRG base rate x DRG weight + capital per discharge,10235.21,Other,100% of NY Medicaid HMO DRG,10235,,DRG base rate x DRG weight + capital per discharge,10235,Other,100% of NY Medicaid HMO DRG,10235,,DRG base rate x DRG weight + capital per discharge,10235,Other,100% of NY Medicaid HMO DRG,10235,,DRG base rate x DRG weight + capital per discharge,10235,Other,100% of NY Medicaid HMO DRG,23029,,225% x Medicaid HMO amount,23029,Other,225% of NY Medicaid HMO DRG,15660,,153% x Medicaid HMO amount,15660,Other,153% of NY Medicaid HMO DRG,23029,,225% x Medicaid HMO amount,23029,Other,225% of NY Medicaid HMO DRG,14329,,140% x Medicaid HMO amount,14329,Other,140% of NY Medicaid HMO DRG,23029,,DRG base rate x DRG weight + capital per discharge,23029,Other,225% of NY Medicaid HMO DRG,28147,,275% x Medicaid HMO amount,28147,Other,275% of NY Medicaid HMO DRG,33162,,324% x Medicaid HMO amount,33162,Other,324% of NY Medicaid HMO DRG,22006,,215% x Medicaid HMO amount,22006,Other,215% of NY Medicaid HMO DRG,22006,,215% x Medicaid HMO amount,22006,Other,215% of NY Medicaid HMO DRG,12794,,125% x Medicaid HMO amount,12794,Other,125% of NY Medicaid HMO DRG,0.01,42482,
Kidney & urinary tract procedures for malignancy,442-3,APR-DRG,,,,,,,,inpatient,,,76036.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34137,,186% x Medicaid HMO amount,34137,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,77809,,"27,634 x DRG Weight",77809,Other,DRG Base Rate x DRG Weight,66135,,"23,488 x DRG Weight",66135,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18353.21,,DRG base rate x DRG weight + capital per discharge,18353.21,Other,100% of NY Medicaid HMO DRG,18353,,DRG base rate x DRG weight + capital per discharge,18353,Other,100% of NY Medicaid HMO DRG,18353,,DRG base rate x DRG weight + capital per discharge,18353,Other,100% of NY Medicaid HMO DRG,18353,,DRG base rate x DRG weight + capital per discharge,18353,Other,100% of NY Medicaid HMO DRG,41295,,225% x Medicaid HMO amount,41295,Other,225% of NY Medicaid HMO DRG,28080,,153% x Medicaid HMO amount,28080,Other,153% of NY Medicaid HMO DRG,41295,,225% x Medicaid HMO amount,41295,Other,225% of NY Medicaid HMO DRG,25694,,140% x Medicaid HMO amount,25694,Other,140% of NY Medicaid HMO DRG,41295,,DRG base rate x DRG weight + capital per discharge,41295,Other,225% of NY Medicaid HMO DRG,50471,,275% x Medicaid HMO amount,50471,Other,275% of NY Medicaid HMO DRG,59464,,324% x Medicaid HMO amount,59464,Other,324% of NY Medicaid HMO DRG,39459,,215% x Medicaid HMO amount,39459,Other,215% of NY Medicaid HMO DRG,39459,,215% x Medicaid HMO amount,39459,Other,215% of NY Medicaid HMO DRG,22942,,125% x Medicaid HMO amount,22942,Other,125% of NY Medicaid HMO DRG,0.01,77809,
Kidney & urinary tract procedures for malignancy,442-4,APR-DRG,,,,,,,,inpatient,,,988215.49,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,76186,,186% x Medicaid HMO amount,76186,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,176192,,"27,634 x DRG Weight",176192,Other,DRG Base Rate x DRG Weight,149757,,"23,488 x DRG Weight",149757,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40960.21,,DRG base rate x DRG weight + capital per discharge,40960.21,Other,100% of NY Medicaid HMO DRG,40960,,DRG base rate x DRG weight + capital per discharge,40960,Other,100% of NY Medicaid HMO DRG,40960,,DRG base rate x DRG weight + capital per discharge,40960,Other,100% of NY Medicaid HMO DRG,40960,,DRG base rate x DRG weight + capital per discharge,40960,Other,100% of NY Medicaid HMO DRG,92160,,225% x Medicaid HMO amount,92160,Other,225% of NY Medicaid HMO DRG,62669,,153% x Medicaid HMO amount,62669,Other,153% of NY Medicaid HMO DRG,92160,,225% x Medicaid HMO amount,92160,Other,225% of NY Medicaid HMO DRG,57344,,140% x Medicaid HMO amount,57344,Other,140% of NY Medicaid HMO DRG,92160,,DRG base rate x DRG weight + capital per discharge,92160,Other,225% of NY Medicaid HMO DRG,112641,,275% x Medicaid HMO amount,112641,Other,275% of NY Medicaid HMO DRG,132711,,324% x Medicaid HMO amount,132711,Other,324% of NY Medicaid HMO DRG,88064,,215% x Medicaid HMO amount,88064,Other,215% of NY Medicaid HMO DRG,88064,,215% x Medicaid HMO amount,88064,Other,215% of NY Medicaid HMO DRG,51200,,125% x Medicaid HMO amount,51200,Other,125% of NY Medicaid HMO DRG,0.01,176192,
Kidney & urinary tract procedures for nonmalignancy,443-1,APR-DRG,,,,,,,,inpatient,,,104003.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13546,,186% x Medicaid HMO amount,13546,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29637,,"27,634 x DRG Weight",29637,Other,DRG Base Rate x DRG Weight,25191,,"23,488 x DRG Weight",25191,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7283.21,,DRG base rate x DRG weight + capital per discharge,7283.21,Other,100% of NY Medicaid HMO DRG,7283,,DRG base rate x DRG weight + capital per discharge,7283,Other,100% of NY Medicaid HMO DRG,7283,,DRG base rate x DRG weight + capital per discharge,7283,Other,100% of NY Medicaid HMO DRG,7283,,DRG base rate x DRG weight + capital per discharge,7283,Other,100% of NY Medicaid HMO DRG,16387,,225% x Medicaid HMO amount,16387,Other,225% of NY Medicaid HMO DRG,11143,,153% x Medicaid HMO amount,11143,Other,153% of NY Medicaid HMO DRG,16387,,225% x Medicaid HMO amount,16387,Other,225% of NY Medicaid HMO DRG,10196,,140% x Medicaid HMO amount,10196,Other,140% of NY Medicaid HMO DRG,16387,,DRG base rate x DRG weight + capital per discharge,16387,Other,225% of NY Medicaid HMO DRG,20029,,275% x Medicaid HMO amount,20029,Other,275% of NY Medicaid HMO DRG,23598,,324% x Medicaid HMO amount,23598,Other,324% of NY Medicaid HMO DRG,15659,,215% x Medicaid HMO amount,15659,Other,215% of NY Medicaid HMO DRG,15659,,215% x Medicaid HMO amount,15659,Other,215% of NY Medicaid HMO DRG,9104,,125% x Medicaid HMO amount,9104,Other,125% of NY Medicaid HMO DRG,0.01,29637,
Kidney & urinary tract procedures for nonmalignancy,443-2,APR-DRG,,,,,,,,inpatient,,,167322.68,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14956,,186% x Medicaid HMO amount,14956,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32937,,"27,634 x DRG Weight",32937,Other,DRG Base Rate x DRG Weight,27995,,"23,488 x DRG Weight",27995,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8041.21,,DRG base rate x DRG weight + capital per discharge,8041.21,Other,100% of NY Medicaid HMO DRG,8041,,DRG base rate x DRG weight + capital per discharge,8041,Other,100% of NY Medicaid HMO DRG,8041,,DRG base rate x DRG weight + capital per discharge,8041,Other,100% of NY Medicaid HMO DRG,8041,,DRG base rate x DRG weight + capital per discharge,8041,Other,100% of NY Medicaid HMO DRG,18093,,225% x Medicaid HMO amount,18093,Other,225% of NY Medicaid HMO DRG,12303,,153% x Medicaid HMO amount,12303,Other,153% of NY Medicaid HMO DRG,18093,,225% x Medicaid HMO amount,18093,Other,225% of NY Medicaid HMO DRG,11258,,140% x Medicaid HMO amount,11258,Other,140% of NY Medicaid HMO DRG,18093,,DRG base rate x DRG weight + capital per discharge,18093,Other,225% of NY Medicaid HMO DRG,22113,,275% x Medicaid HMO amount,22113,Other,275% of NY Medicaid HMO DRG,26054,,324% x Medicaid HMO amount,26054,Other,324% of NY Medicaid HMO DRG,17289,,215% x Medicaid HMO amount,17289,Other,215% of NY Medicaid HMO DRG,17289,,215% x Medicaid HMO amount,17289,Other,215% of NY Medicaid HMO DRG,10052,,125% x Medicaid HMO amount,10052,Other,125% of NY Medicaid HMO DRG,0.01,32937,
Kidney & urinary tract procedures for nonmalignancy,443-3,APR-DRG,,,,,,,,inpatient,,,388033.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27712,,186% x Medicaid HMO amount,27712,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62779,,"27,634 x DRG Weight",62779,Other,DRG Base Rate x DRG Weight,53360,,"23,488 x DRG Weight",53360,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14899.21,,DRG base rate x DRG weight + capital per discharge,14899.21,Other,100% of NY Medicaid HMO DRG,14899,,DRG base rate x DRG weight + capital per discharge,14899,Other,100% of NY Medicaid HMO DRG,14899,,DRG base rate x DRG weight + capital per discharge,14899,Other,100% of NY Medicaid HMO DRG,14899,,DRG base rate x DRG weight + capital per discharge,14899,Other,100% of NY Medicaid HMO DRG,33523,,225% x Medicaid HMO amount,33523,Other,225% of NY Medicaid HMO DRG,22796,,153% x Medicaid HMO amount,22796,Other,153% of NY Medicaid HMO DRG,33523,,225% x Medicaid HMO amount,33523,Other,225% of NY Medicaid HMO DRG,20859,,140% x Medicaid HMO amount,20859,Other,140% of NY Medicaid HMO DRG,33523,,DRG base rate x DRG weight + capital per discharge,33523,Other,225% of NY Medicaid HMO DRG,40973,,275% x Medicaid HMO amount,40973,Other,275% of NY Medicaid HMO DRG,48273,,324% x Medicaid HMO amount,48273,Other,324% of NY Medicaid HMO DRG,32033,,215% x Medicaid HMO amount,32033,Other,215% of NY Medicaid HMO DRG,32033,,215% x Medicaid HMO amount,32033,Other,215% of NY Medicaid HMO DRG,18624,,125% x Medicaid HMO amount,18624,Other,125% of NY Medicaid HMO DRG,0.01,62779,
Kidney & urinary tract procedures for nonmalignancy,443-4,APR-DRG,,,,,,,,inpatient,,,689506.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60735,,186% x Medicaid HMO amount,60735,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,140044,,"27,634 x DRG Weight",140044,Other,DRG Base Rate x DRG Weight,119032,,"23,488 x DRG Weight",119032,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32653.21,,DRG base rate x DRG weight + capital per discharge,32653.21,Other,100% of NY Medicaid HMO DRG,32653,,DRG base rate x DRG weight + capital per discharge,32653,Other,100% of NY Medicaid HMO DRG,32653,,DRG base rate x DRG weight + capital per discharge,32653,Other,100% of NY Medicaid HMO DRG,32653,,DRG base rate x DRG weight + capital per discharge,32653,Other,100% of NY Medicaid HMO DRG,73470,,225% x Medicaid HMO amount,73470,Other,225% of NY Medicaid HMO DRG,49959,,153% x Medicaid HMO amount,49959,Other,153% of NY Medicaid HMO DRG,73470,,225% x Medicaid HMO amount,73470,Other,225% of NY Medicaid HMO DRG,45714,,140% x Medicaid HMO amount,45714,Other,140% of NY Medicaid HMO DRG,73470,,DRG base rate x DRG weight + capital per discharge,73470,Other,225% of NY Medicaid HMO DRG,89796,,275% x Medicaid HMO amount,89796,Other,275% of NY Medicaid HMO DRG,105796,,324% x Medicaid HMO amount,105796,Other,324% of NY Medicaid HMO DRG,70204,,215% x Medicaid HMO amount,70204,Other,215% of NY Medicaid HMO DRG,70204,,215% x Medicaid HMO amount,70204,Other,215% of NY Medicaid HMO DRG,40817,,125% x Medicaid HMO amount,40817,Other,125% of NY Medicaid HMO DRG,0.01,140044,
Renal dialysis access device procedure only,444-1,APR-DRG,,,,,,,,inpatient,,,321039.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12482,,186% x Medicaid HMO amount,12482,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27148,,"27,634 x DRG Weight",27148,Other,DRG Base Rate x DRG Weight,23075,,"23,488 x DRG Weight",23075,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6711.21,,DRG base rate x DRG weight + capital per discharge,6711.21,Other,100% of NY Medicaid HMO DRG,6711,,DRG base rate x DRG weight + capital per discharge,6711,Other,100% of NY Medicaid HMO DRG,6711,,DRG base rate x DRG weight + capital per discharge,6711,Other,100% of NY Medicaid HMO DRG,6711,,DRG base rate x DRG weight + capital per discharge,6711,Other,100% of NY Medicaid HMO DRG,15100,,225% x Medicaid HMO amount,15100,Other,225% of NY Medicaid HMO DRG,10268,,153% x Medicaid HMO amount,10268,Other,153% of NY Medicaid HMO DRG,15100,,225% x Medicaid HMO amount,15100,Other,225% of NY Medicaid HMO DRG,9396,,140% x Medicaid HMO amount,9396,Other,140% of NY Medicaid HMO DRG,15100,,DRG base rate x DRG weight + capital per discharge,15100,Other,225% of NY Medicaid HMO DRG,18456,,275% x Medicaid HMO amount,18456,Other,275% of NY Medicaid HMO DRG,21744,,324% x Medicaid HMO amount,21744,Other,324% of NY Medicaid HMO DRG,14429,,215% x Medicaid HMO amount,14429,Other,215% of NY Medicaid HMO DRG,14429,,215% x Medicaid HMO amount,14429,Other,215% of NY Medicaid HMO DRG,8389,,125% x Medicaid HMO amount,8389,Other,125% of NY Medicaid HMO DRG,0.01,27148,
Renal dialysis access device procedure only,444-2,APR-DRG,,,,,,,,inpatient,,,321039.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21513,,186% x Medicaid HMO amount,21513,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48274,,"27,634 x DRG Weight",48274,Other,DRG Base Rate x DRG Weight,41031,,"23,488 x DRG Weight",41031,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11566.21,,DRG base rate x DRG weight + capital per discharge,11566.21,Other,100% of NY Medicaid HMO DRG,11566,,DRG base rate x DRG weight + capital per discharge,11566,Other,100% of NY Medicaid HMO DRG,11566,,DRG base rate x DRG weight + capital per discharge,11566,Other,100% of NY Medicaid HMO DRG,11566,,DRG base rate x DRG weight + capital per discharge,11566,Other,100% of NY Medicaid HMO DRG,26024,,225% x Medicaid HMO amount,26024,Other,225% of NY Medicaid HMO DRG,17696,,153% x Medicaid HMO amount,17696,Other,153% of NY Medicaid HMO DRG,26024,,225% x Medicaid HMO amount,26024,Other,225% of NY Medicaid HMO DRG,16193,,140% x Medicaid HMO amount,16193,Other,140% of NY Medicaid HMO DRG,26024,,DRG base rate x DRG weight + capital per discharge,26024,Other,225% of NY Medicaid HMO DRG,31807,,275% x Medicaid HMO amount,31807,Other,275% of NY Medicaid HMO DRG,37475,,324% x Medicaid HMO amount,37475,Other,324% of NY Medicaid HMO DRG,24867,,215% x Medicaid HMO amount,24867,Other,215% of NY Medicaid HMO DRG,24867,,215% x Medicaid HMO amount,24867,Other,215% of NY Medicaid HMO DRG,14458,,125% x Medicaid HMO amount,14458,Other,125% of NY Medicaid HMO DRG,0.01,48274,
Renal dialysis access device procedure only,444-3,APR-DRG,,,,,,,,inpatient,,,556534.6,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39060,,186% x Medicaid HMO amount,39060,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,89330,,"27,634 x DRG Weight",89330,Other,DRG Base Rate x DRG Weight,75927,,"23,488 x DRG Weight",75927,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21000.21,,DRG base rate x DRG weight + capital per discharge,21000.21,Other,100% of NY Medicaid HMO DRG,21000,,DRG base rate x DRG weight + capital per discharge,21000,Other,100% of NY Medicaid HMO DRG,21000,,DRG base rate x DRG weight + capital per discharge,21000,Other,100% of NY Medicaid HMO DRG,21000,,DRG base rate x DRG weight + capital per discharge,21000,Other,100% of NY Medicaid HMO DRG,47250,,225% x Medicaid HMO amount,47250,Other,225% of NY Medicaid HMO DRG,32130,,153% x Medicaid HMO amount,32130,Other,153% of NY Medicaid HMO DRG,47250,,225% x Medicaid HMO amount,47250,Other,225% of NY Medicaid HMO DRG,29400,,140% x Medicaid HMO amount,29400,Other,140% of NY Medicaid HMO DRG,47250,,DRG base rate x DRG weight + capital per discharge,47250,Other,225% of NY Medicaid HMO DRG,57751,,275% x Medicaid HMO amount,57751,Other,275% of NY Medicaid HMO DRG,68041,,324% x Medicaid HMO amount,68041,Other,324% of NY Medicaid HMO DRG,45150,,215% x Medicaid HMO amount,45150,Other,215% of NY Medicaid HMO DRG,45150,,215% x Medicaid HMO amount,45150,Other,215% of NY Medicaid HMO DRG,26250,,125% x Medicaid HMO amount,26250,Other,125% of NY Medicaid HMO DRG,0.01,89330,
Renal dialysis access device procedure only,444-4,APR-DRG,,,,,,,,inpatient,,,1163823.62,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73941,,186% x Medicaid HMO amount,73941,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,170941,,"27,634 x DRG Weight",170941,Other,DRG Base Rate x DRG Weight,145294,,"23,488 x DRG Weight",145294,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39753.21,,DRG base rate x DRG weight + capital per discharge,39753.21,Other,100% of NY Medicaid HMO DRG,39753,,DRG base rate x DRG weight + capital per discharge,39753,Other,100% of NY Medicaid HMO DRG,39753,,DRG base rate x DRG weight + capital per discharge,39753,Other,100% of NY Medicaid HMO DRG,39753,,DRG base rate x DRG weight + capital per discharge,39753,Other,100% of NY Medicaid HMO DRG,89445,,225% x Medicaid HMO amount,89445,Other,225% of NY Medicaid HMO DRG,60822,,153% x Medicaid HMO amount,60822,Other,153% of NY Medicaid HMO DRG,89445,,225% x Medicaid HMO amount,89445,Other,225% of NY Medicaid HMO DRG,55654,,140% x Medicaid HMO amount,55654,Other,140% of NY Medicaid HMO DRG,89445,,DRG base rate x DRG weight + capital per discharge,89445,Other,225% of NY Medicaid HMO DRG,109321,,275% x Medicaid HMO amount,109321,Other,275% of NY Medicaid HMO DRG,128800,,324% x Medicaid HMO amount,128800,Other,324% of NY Medicaid HMO DRG,85469,,215% x Medicaid HMO amount,85469,Other,215% of NY Medicaid HMO DRG,85469,,215% x Medicaid HMO amount,85469,Other,215% of NY Medicaid HMO DRG,49692,,125% x Medicaid HMO amount,49692,Other,125% of NY Medicaid HMO DRG,0.01,170941,
Other bladder procedures,445-1,APR-DRG,,,,,,,,inpatient,,,101955.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10582,,186% x Medicaid HMO amount,10582,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22699,,"27,634 x DRG Weight",22699,Other,DRG Base Rate x DRG Weight,19293,,"23,488 x DRG Weight",19293,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5689.21,,DRG base rate x DRG weight + capital per discharge,5689.21,Other,100% of NY Medicaid HMO DRG,5689,,DRG base rate x DRG weight + capital per discharge,5689,Other,100% of NY Medicaid HMO DRG,5689,,DRG base rate x DRG weight + capital per discharge,5689,Other,100% of NY Medicaid HMO DRG,5689,,DRG base rate x DRG weight + capital per discharge,5689,Other,100% of NY Medicaid HMO DRG,12801,,225% x Medicaid HMO amount,12801,Other,225% of NY Medicaid HMO DRG,8704,,153% x Medicaid HMO amount,8704,Other,153% of NY Medicaid HMO DRG,12801,,225% x Medicaid HMO amount,12801,Other,225% of NY Medicaid HMO DRG,7965,,140% x Medicaid HMO amount,7965,Other,140% of NY Medicaid HMO DRG,12801,,DRG base rate x DRG weight + capital per discharge,12801,Other,225% of NY Medicaid HMO DRG,15645,,275% x Medicaid HMO amount,15645,Other,275% of NY Medicaid HMO DRG,18433,,324% x Medicaid HMO amount,18433,Other,324% of NY Medicaid HMO DRG,12232,,215% x Medicaid HMO amount,12232,Other,215% of NY Medicaid HMO DRG,12232,,215% x Medicaid HMO amount,12232,Other,215% of NY Medicaid HMO DRG,7112,,125% x Medicaid HMO amount,7112,Other,125% of NY Medicaid HMO DRG,0.01,22699,
Other bladder procedures,445-2,APR-DRG,,,,,,,,inpatient,,,205189.97,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15870,,186% x Medicaid HMO amount,15870,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35070,,"27,634 x DRG Weight",35070,Other,DRG Base Rate x DRG Weight,29809,,"23,488 x DRG Weight",29809,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8532.21,,DRG base rate x DRG weight + capital per discharge,8532.21,Other,100% of NY Medicaid HMO DRG,8532,,DRG base rate x DRG weight + capital per discharge,8532,Other,100% of NY Medicaid HMO DRG,8532,,DRG base rate x DRG weight + capital per discharge,8532,Other,100% of NY Medicaid HMO DRG,8532,,DRG base rate x DRG weight + capital per discharge,8532,Other,100% of NY Medicaid HMO DRG,19197,,225% x Medicaid HMO amount,19197,Other,225% of NY Medicaid HMO DRG,13054,,153% x Medicaid HMO amount,13054,Other,153% of NY Medicaid HMO DRG,19197,,225% x Medicaid HMO amount,19197,Other,225% of NY Medicaid HMO DRG,11945,,140% x Medicaid HMO amount,11945,Other,140% of NY Medicaid HMO DRG,19197,,DRG base rate x DRG weight + capital per discharge,19197,Other,225% of NY Medicaid HMO DRG,23464,,275% x Medicaid HMO amount,23464,Other,275% of NY Medicaid HMO DRG,27644,,324% x Medicaid HMO amount,27644,Other,324% of NY Medicaid HMO DRG,18344,,215% x Medicaid HMO amount,18344,Other,215% of NY Medicaid HMO DRG,18344,,215% x Medicaid HMO amount,18344,Other,215% of NY Medicaid HMO DRG,10665,,125% x Medicaid HMO amount,10665,Other,125% of NY Medicaid HMO DRG,0.01,35070,
Other bladder procedures,445-3,APR-DRG,,,,,,,,inpatient,,,132329.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22999,,186% x Medicaid HMO amount,22999,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51753,,"27,634 x DRG Weight",51753,Other,DRG Base Rate x DRG Weight,43988,,"23,488 x DRG Weight",43988,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12365.21,,DRG base rate x DRG weight + capital per discharge,12365.21,Other,100% of NY Medicaid HMO DRG,12365,,DRG base rate x DRG weight + capital per discharge,12365,Other,100% of NY Medicaid HMO DRG,12365,,DRG base rate x DRG weight + capital per discharge,12365,Other,100% of NY Medicaid HMO DRG,12365,,DRG base rate x DRG weight + capital per discharge,12365,Other,100% of NY Medicaid HMO DRG,27822,,225% x Medicaid HMO amount,27822,Other,225% of NY Medicaid HMO DRG,18919,,153% x Medicaid HMO amount,18919,Other,153% of NY Medicaid HMO DRG,27822,,225% x Medicaid HMO amount,27822,Other,225% of NY Medicaid HMO DRG,17311,,140% x Medicaid HMO amount,17311,Other,140% of NY Medicaid HMO DRG,27822,,DRG base rate x DRG weight + capital per discharge,27822,Other,225% of NY Medicaid HMO DRG,34004,,275% x Medicaid HMO amount,34004,Other,275% of NY Medicaid HMO DRG,40063,,324% x Medicaid HMO amount,40063,Other,324% of NY Medicaid HMO DRG,26585,,215% x Medicaid HMO amount,26585,Other,215% of NY Medicaid HMO DRG,26585,,215% x Medicaid HMO amount,26585,Other,215% of NY Medicaid HMO DRG,15457,,125% x Medicaid HMO amount,15457,Other,125% of NY Medicaid HMO DRG,0.01,51753,
Other bladder procedures,445-4,APR-DRG,,,,,,,,inpatient,,,196057.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29812,,186% x Medicaid HMO amount,29812,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,67692,,"27,634 x DRG Weight",67692,Other,DRG Base Rate x DRG Weight,57536,,"23,488 x DRG Weight",57536,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16028.21,,DRG base rate x DRG weight + capital per discharge,16028.21,Other,100% of NY Medicaid HMO DRG,16028,,DRG base rate x DRG weight + capital per discharge,16028,Other,100% of NY Medicaid HMO DRG,16028,,DRG base rate x DRG weight + capital per discharge,16028,Other,100% of NY Medicaid HMO DRG,16028,,DRG base rate x DRG weight + capital per discharge,16028,Other,100% of NY Medicaid HMO DRG,36063,,225% x Medicaid HMO amount,36063,Other,225% of NY Medicaid HMO DRG,24523,,153% x Medicaid HMO amount,24523,Other,153% of NY Medicaid HMO DRG,36063,,225% x Medicaid HMO amount,36063,Other,225% of NY Medicaid HMO DRG,22439,,140% x Medicaid HMO amount,22439,Other,140% of NY Medicaid HMO DRG,36063,,DRG base rate x DRG weight + capital per discharge,36063,Other,225% of NY Medicaid HMO DRG,44078,,275% x Medicaid HMO amount,44078,Other,275% of NY Medicaid HMO DRG,51931,,324% x Medicaid HMO amount,51931,Other,324% of NY Medicaid HMO DRG,34461,,215% x Medicaid HMO amount,34461,Other,215% of NY Medicaid HMO DRG,34461,,215% x Medicaid HMO amount,34461,Other,215% of NY Medicaid HMO DRG,20035,,125% x Medicaid HMO amount,20035,Other,125% of NY Medicaid HMO DRG,0.01,67692,
Urethral & transurethral procedures,446-1,APR-DRG,,,,,,,,inpatient,,,66444.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8963,,186% x Medicaid HMO amount,8963,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18915,,"27,634 x DRG Weight",18915,Other,DRG Base Rate x DRG Weight,16078,,"23,488 x DRG Weight",16078,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4819.21,,DRG base rate x DRG weight + capital per discharge,4819.21,Other,100% of NY Medicaid HMO DRG,4819,,DRG base rate x DRG weight + capital per discharge,4819,Other,100% of NY Medicaid HMO DRG,4819,,DRG base rate x DRG weight + capital per discharge,4819,Other,100% of NY Medicaid HMO DRG,4819,,DRG base rate x DRG weight + capital per discharge,4819,Other,100% of NY Medicaid HMO DRG,10843,,225% x Medicaid HMO amount,10843,Other,225% of NY Medicaid HMO DRG,7373,,153% x Medicaid HMO amount,7373,Other,153% of NY Medicaid HMO DRG,10843,,225% x Medicaid HMO amount,10843,Other,225% of NY Medicaid HMO DRG,6747,,140% x Medicaid HMO amount,6747,Other,140% of NY Medicaid HMO DRG,10843,,DRG base rate x DRG weight + capital per discharge,10843,Other,225% of NY Medicaid HMO DRG,13253,,275% x Medicaid HMO amount,13253,Other,275% of NY Medicaid HMO DRG,15614,,324% x Medicaid HMO amount,15614,Other,324% of NY Medicaid HMO DRG,10361,,215% x Medicaid HMO amount,10361,Other,215% of NY Medicaid HMO DRG,10361,,215% x Medicaid HMO amount,10361,Other,215% of NY Medicaid HMO DRG,6024,,125% x Medicaid HMO amount,6024,Other,125% of NY Medicaid HMO DRG,0.01,18915,
Urethral & transurethral procedures,446-2,APR-DRG,,,,,,,,inpatient,,,205189.97,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10213,,186% x Medicaid HMO amount,10213,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21836,,"27,634 x DRG Weight",21836,Other,DRG Base Rate x DRG Weight,18560,,"23,488 x DRG Weight",18560,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5491.21,,DRG base rate x DRG weight + capital per discharge,5491.21,Other,100% of NY Medicaid HMO DRG,5491,,DRG base rate x DRG weight + capital per discharge,5491,Other,100% of NY Medicaid HMO DRG,5491,,DRG base rate x DRG weight + capital per discharge,5491,Other,100% of NY Medicaid HMO DRG,5491,,DRG base rate x DRG weight + capital per discharge,5491,Other,100% of NY Medicaid HMO DRG,12355,,225% x Medicaid HMO amount,12355,Other,225% of NY Medicaid HMO DRG,8402,,153% x Medicaid HMO amount,8402,Other,153% of NY Medicaid HMO DRG,12355,,225% x Medicaid HMO amount,12355,Other,225% of NY Medicaid HMO DRG,7688,,140% x Medicaid HMO amount,7688,Other,140% of NY Medicaid HMO DRG,12355,,DRG base rate x DRG weight + capital per discharge,12355,Other,225% of NY Medicaid HMO DRG,15101,,275% x Medicaid HMO amount,15101,Other,275% of NY Medicaid HMO DRG,17792,,324% x Medicaid HMO amount,17792,Other,324% of NY Medicaid HMO DRG,11806,,215% x Medicaid HMO amount,11806,Other,215% of NY Medicaid HMO DRG,11806,,215% x Medicaid HMO amount,11806,Other,215% of NY Medicaid HMO DRG,6864,,125% x Medicaid HMO amount,6864,Other,125% of NY Medicaid HMO DRG,0.01,21836,
Urethral & transurethral procedures,446-3,APR-DRG,,,,,,,,inpatient,,,196057.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18687,,186% x Medicaid HMO amount,18687,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41667,,"27,634 x DRG Weight",41667,Other,DRG Base Rate x DRG Weight,35415,,"23,488 x DRG Weight",35415,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10047.21,,DRG base rate x DRG weight + capital per discharge,10047.21,Other,100% of NY Medicaid HMO DRG,10047,,DRG base rate x DRG weight + capital per discharge,10047,Other,100% of NY Medicaid HMO DRG,10047,,DRG base rate x DRG weight + capital per discharge,10047,Other,100% of NY Medicaid HMO DRG,10047,,DRG base rate x DRG weight + capital per discharge,10047,Other,100% of NY Medicaid HMO DRG,22606,,225% x Medicaid HMO amount,22606,Other,225% of NY Medicaid HMO DRG,15372,,153% x Medicaid HMO amount,15372,Other,153% of NY Medicaid HMO DRG,22606,,225% x Medicaid HMO amount,22606,Other,225% of NY Medicaid HMO DRG,14066,,140% x Medicaid HMO amount,14066,Other,140% of NY Medicaid HMO DRG,22606,,DRG base rate x DRG weight + capital per discharge,22606,Other,225% of NY Medicaid HMO DRG,27630,,275% x Medicaid HMO amount,27630,Other,275% of NY Medicaid HMO DRG,32553,,324% x Medicaid HMO amount,32553,Other,324% of NY Medicaid HMO DRG,21602,,215% x Medicaid HMO amount,21602,Other,215% of NY Medicaid HMO DRG,21602,,215% x Medicaid HMO amount,21602,Other,215% of NY Medicaid HMO DRG,12559,,125% x Medicaid HMO amount,12559,Other,125% of NY Medicaid HMO DRG,0.01,41667,
Urethral & transurethral procedures,446-4,APR-DRG,,,,,,,,inpatient,,,196057.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39724,,186% x Medicaid HMO amount,39724,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,90885,,"27,634 x DRG Weight",90885,Other,DRG Base Rate x DRG Weight,77250,,"23,488 x DRG Weight",77250,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21357.21,,DRG base rate x DRG weight + capital per discharge,21357.21,Other,100% of NY Medicaid HMO DRG,21357,,DRG base rate x DRG weight + capital per discharge,21357,Other,100% of NY Medicaid HMO DRG,21357,,DRG base rate x DRG weight + capital per discharge,21357,Other,100% of NY Medicaid HMO DRG,21357,,DRG base rate x DRG weight + capital per discharge,21357,Other,100% of NY Medicaid HMO DRG,48054,,225% x Medicaid HMO amount,48054,Other,225% of NY Medicaid HMO DRG,32677,,153% x Medicaid HMO amount,32677,Other,153% of NY Medicaid HMO DRG,48054,,225% x Medicaid HMO amount,48054,Other,225% of NY Medicaid HMO DRG,29900,,140% x Medicaid HMO amount,29900,Other,140% of NY Medicaid HMO DRG,48054,,DRG base rate x DRG weight + capital per discharge,48054,Other,225% of NY Medicaid HMO DRG,58732,,275% x Medicaid HMO amount,58732,Other,275% of NY Medicaid HMO DRG,69197,,324% x Medicaid HMO amount,69197,Other,324% of NY Medicaid HMO DRG,45918,,215% x Medicaid HMO amount,45918,Other,215% of NY Medicaid HMO DRG,45918,,215% x Medicaid HMO amount,45918,Other,215% of NY Medicaid HMO DRG,26697,,125% x Medicaid HMO amount,26697,Other,125% of NY Medicaid HMO DRG,0.01,90885,
"Other kidney, urinary tract & related procedures",447-1,APR-DRG,,,,,,,,inpatient,,,107041,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15014,,186% x Medicaid HMO amount,15014,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33070,,"27,634 x DRG Weight",33070,Other,DRG Base Rate x DRG Weight,28108,,"23,488 x DRG Weight",28108,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8072.21,,DRG base rate x DRG weight + capital per discharge,8072.21,Other,100% of NY Medicaid HMO DRG,8072,,DRG base rate x DRG weight + capital per discharge,8072,Other,100% of NY Medicaid HMO DRG,8072,,DRG base rate x DRG weight + capital per discharge,8072,Other,100% of NY Medicaid HMO DRG,8072,,DRG base rate x DRG weight + capital per discharge,8072,Other,100% of NY Medicaid HMO DRG,18162,,225% x Medicaid HMO amount,18162,Other,225% of NY Medicaid HMO DRG,12350,,153% x Medicaid HMO amount,12350,Other,153% of NY Medicaid HMO DRG,18162,,225% x Medicaid HMO amount,18162,Other,225% of NY Medicaid HMO DRG,11301,,140% x Medicaid HMO amount,11301,Other,140% of NY Medicaid HMO DRG,18162,,DRG base rate x DRG weight + capital per discharge,18162,Other,225% of NY Medicaid HMO DRG,22199,,275% x Medicaid HMO amount,22199,Other,275% of NY Medicaid HMO DRG,26154,,324% x Medicaid HMO amount,26154,Other,324% of NY Medicaid HMO DRG,17355,,215% x Medicaid HMO amount,17355,Other,215% of NY Medicaid HMO DRG,17355,,215% x Medicaid HMO amount,17355,Other,215% of NY Medicaid HMO DRG,10090,,125% x Medicaid HMO amount,10090,Other,125% of NY Medicaid HMO DRG,0.01,33070,
"Other kidney, urinary tract & related procedures",447-2,APR-DRG,,,,,,,,inpatient,,,162930.24,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16262,,186% x Medicaid HMO amount,16262,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35991,,"27,634 x DRG Weight",35991,Other,DRG Base Rate x DRG Weight,30591,,"23,488 x DRG Weight",30591,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8743.21,,DRG base rate x DRG weight + capital per discharge,8743.21,Other,100% of NY Medicaid HMO DRG,8743,,DRG base rate x DRG weight + capital per discharge,8743,Other,100% of NY Medicaid HMO DRG,8743,,DRG base rate x DRG weight + capital per discharge,8743,Other,100% of NY Medicaid HMO DRG,8743,,DRG base rate x DRG weight + capital per discharge,8743,Other,100% of NY Medicaid HMO DRG,19672,,225% x Medicaid HMO amount,19672,Other,225% of NY Medicaid HMO DRG,13377,,153% x Medicaid HMO amount,13377,Other,153% of NY Medicaid HMO DRG,19672,,225% x Medicaid HMO amount,19672,Other,225% of NY Medicaid HMO DRG,12240,,140% x Medicaid HMO amount,12240,Other,140% of NY Medicaid HMO DRG,19672,,DRG base rate x DRG weight + capital per discharge,19672,Other,225% of NY Medicaid HMO DRG,24044,,275% x Medicaid HMO amount,24044,Other,275% of NY Medicaid HMO DRG,28328,,324% x Medicaid HMO amount,28328,Other,324% of NY Medicaid HMO DRG,18798,,215% x Medicaid HMO amount,18798,Other,215% of NY Medicaid HMO DRG,18798,,215% x Medicaid HMO amount,18798,Other,215% of NY Medicaid HMO DRG,10929,,125% x Medicaid HMO amount,10929,Other,125% of NY Medicaid HMO DRG,0.01,35991,
"Other kidney, urinary tract & related procedures",447-3,APR-DRG,,,,,,,,inpatient,,,442194.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35500,,186% x Medicaid HMO amount,35500,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,81001,,"27,634 x DRG Weight",81001,Other,DRG Base Rate x DRG Weight,68848,,"23,488 x DRG Weight",68848,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19086.21,,DRG base rate x DRG weight + capital per discharge,19086.21,Other,100% of NY Medicaid HMO DRG,19086,,DRG base rate x DRG weight + capital per discharge,19086,Other,100% of NY Medicaid HMO DRG,19086,,DRG base rate x DRG weight + capital per discharge,19086,Other,100% of NY Medicaid HMO DRG,19086,,DRG base rate x DRG weight + capital per discharge,19086,Other,100% of NY Medicaid HMO DRG,42944,,225% x Medicaid HMO amount,42944,Other,225% of NY Medicaid HMO DRG,29202,,153% x Medicaid HMO amount,29202,Other,153% of NY Medicaid HMO DRG,42944,,225% x Medicaid HMO amount,42944,Other,225% of NY Medicaid HMO DRG,26721,,140% x Medicaid HMO amount,26721,Other,140% of NY Medicaid HMO DRG,42944,,DRG base rate x DRG weight + capital per discharge,42944,Other,225% of NY Medicaid HMO DRG,52487,,275% x Medicaid HMO amount,52487,Other,275% of NY Medicaid HMO DRG,61839,,324% x Medicaid HMO amount,61839,Other,324% of NY Medicaid HMO DRG,41035,,215% x Medicaid HMO amount,41035,Other,215% of NY Medicaid HMO DRG,41035,,215% x Medicaid HMO amount,41035,Other,215% of NY Medicaid HMO DRG,23858,,125% x Medicaid HMO amount,23858,Other,125% of NY Medicaid HMO DRG,0.01,81001,
"Other kidney, urinary tract & related procedures",447-4,APR-DRG,,,,,,,,inpatient,,,851118.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,91004,,186% x Medicaid HMO amount,91004,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,210864,,"27,634 x DRG Weight",210864,Other,DRG Base Rate x DRG Weight,179228,,"23,488 x DRG Weight",179228,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48927.21,,DRG base rate x DRG weight + capital per discharge,48927.21,Other,100% of NY Medicaid HMO DRG,48927,,DRG base rate x DRG weight + capital per discharge,48927,Other,100% of NY Medicaid HMO DRG,48927,,DRG base rate x DRG weight + capital per discharge,48927,Other,100% of NY Medicaid HMO DRG,48927,,DRG base rate x DRG weight + capital per discharge,48927,Other,100% of NY Medicaid HMO DRG,110086,,225% x Medicaid HMO amount,110086,Other,225% of NY Medicaid HMO DRG,74859,,153% x Medicaid HMO amount,74859,Other,153% of NY Medicaid HMO DRG,110086,,225% x Medicaid HMO amount,110086,Other,225% of NY Medicaid HMO DRG,68498,,140% x Medicaid HMO amount,68498,Other,140% of NY Medicaid HMO DRG,110086,,DRG base rate x DRG weight + capital per discharge,110086,Other,225% of NY Medicaid HMO DRG,134550,,275% x Medicaid HMO amount,134550,Other,275% of NY Medicaid HMO DRG,158524,,324% x Medicaid HMO amount,158524,Other,324% of NY Medicaid HMO DRG,105194,,215% x Medicaid HMO amount,105194,Other,215% of NY Medicaid HMO DRG,105194,,215% x Medicaid HMO amount,105194,Other,215% of NY Medicaid HMO DRG,61159,,125% x Medicaid HMO amount,61159,Other,125% of NY Medicaid HMO DRG,0.01,210864,
Kidney & urinary tract malignancy,461-1,APR-DRG,,,,,,,,inpatient,,,107211.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6250,,186% x Medicaid HMO amount,6250,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12562,,"27,634 x DRG Weight",12562,Other,DRG Base Rate x DRG Weight,10678,,"23,488 x DRG Weight",10678,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3360.21,,DRG base rate x DRG weight + capital per discharge,3360.21,Other,100% of NY Medicaid HMO DRG,3360,,DRG base rate x DRG weight + capital per discharge,3360,Other,100% of NY Medicaid HMO DRG,3360,,DRG base rate x DRG weight + capital per discharge,3360,Other,100% of NY Medicaid HMO DRG,3360,,DRG base rate x DRG weight + capital per discharge,3360,Other,100% of NY Medicaid HMO DRG,7560,,225% x Medicaid HMO amount,7560,Other,225% of NY Medicaid HMO DRG,5141,,153% x Medicaid HMO amount,5141,Other,153% of NY Medicaid HMO DRG,7560,,225% x Medicaid HMO amount,7560,Other,225% of NY Medicaid HMO DRG,4704,,140% x Medicaid HMO amount,4704,Other,140% of NY Medicaid HMO DRG,7560,,DRG base rate x DRG weight + capital per discharge,7560,Other,225% of NY Medicaid HMO DRG,9241,,275% x Medicaid HMO amount,9241,Other,275% of NY Medicaid HMO DRG,10887,,324% x Medicaid HMO amount,10887,Other,324% of NY Medicaid HMO DRG,7224,,215% x Medicaid HMO amount,7224,Other,215% of NY Medicaid HMO DRG,7224,,215% x Medicaid HMO amount,7224,Other,215% of NY Medicaid HMO DRG,4200,,125% x Medicaid HMO amount,4200,Other,125% of NY Medicaid HMO DRG,0.01,12562,
Kidney & urinary tract malignancy,461-2,APR-DRG,,,,,,,,inpatient,,,270287.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10390,,186% x Medicaid HMO amount,10390,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22251,,"27,634 x DRG Weight",22251,Other,DRG Base Rate x DRG Weight,18913,,"23,488 x DRG Weight",18913,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5586.21,,DRG base rate x DRG weight + capital per discharge,5586.21,Other,100% of NY Medicaid HMO DRG,5586,,DRG base rate x DRG weight + capital per discharge,5586,Other,100% of NY Medicaid HMO DRG,5586,,DRG base rate x DRG weight + capital per discharge,5586,Other,100% of NY Medicaid HMO DRG,5586,,DRG base rate x DRG weight + capital per discharge,5586,Other,100% of NY Medicaid HMO DRG,12569,,225% x Medicaid HMO amount,12569,Other,225% of NY Medicaid HMO DRG,8547,,153% x Medicaid HMO amount,8547,Other,153% of NY Medicaid HMO DRG,12569,,225% x Medicaid HMO amount,12569,Other,225% of NY Medicaid HMO DRG,7821,,140% x Medicaid HMO amount,7821,Other,140% of NY Medicaid HMO DRG,12569,,DRG base rate x DRG weight + capital per discharge,12569,Other,225% of NY Medicaid HMO DRG,15362,,275% x Medicaid HMO amount,15362,Other,275% of NY Medicaid HMO DRG,18099,,324% x Medicaid HMO amount,18099,Other,324% of NY Medicaid HMO DRG,12010,,215% x Medicaid HMO amount,12010,Other,215% of NY Medicaid HMO DRG,12010,,215% x Medicaid HMO amount,12010,Other,215% of NY Medicaid HMO DRG,6983,,125% x Medicaid HMO amount,6983,Other,125% of NY Medicaid HMO DRG,0.01,22251,
Kidney & urinary tract malignancy,461-3,APR-DRG,,,,,,,,inpatient,,,107211.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18630,,186% x Medicaid HMO amount,18630,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41531,,"27,634 x DRG Weight",41531,Other,DRG Base Rate x DRG Weight,35300,,"23,488 x DRG Weight",35300,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10016.21,,DRG base rate x DRG weight + capital per discharge,10016.21,Other,100% of NY Medicaid HMO DRG,10016,,DRG base rate x DRG weight + capital per discharge,10016,Other,100% of NY Medicaid HMO DRG,10016,,DRG base rate x DRG weight + capital per discharge,10016,Other,100% of NY Medicaid HMO DRG,10016,,DRG base rate x DRG weight + capital per discharge,10016,Other,100% of NY Medicaid HMO DRG,22536,,225% x Medicaid HMO amount,22536,Other,225% of NY Medicaid HMO DRG,15325,,153% x Medicaid HMO amount,15325,Other,153% of NY Medicaid HMO DRG,22536,,225% x Medicaid HMO amount,22536,Other,225% of NY Medicaid HMO DRG,14023,,140% x Medicaid HMO amount,14023,Other,140% of NY Medicaid HMO DRG,22536,,DRG base rate x DRG weight + capital per discharge,22536,Other,225% of NY Medicaid HMO DRG,27545,,275% x Medicaid HMO amount,27545,Other,275% of NY Medicaid HMO DRG,32453,,324% x Medicaid HMO amount,32453,Other,324% of NY Medicaid HMO DRG,21535,,215% x Medicaid HMO amount,21535,Other,215% of NY Medicaid HMO DRG,21535,,215% x Medicaid HMO amount,21535,Other,215% of NY Medicaid HMO DRG,12520,,125% x Medicaid HMO amount,12520,Other,125% of NY Medicaid HMO DRG,0.01,41531,
Kidney & urinary tract malignancy,461-4,APR-DRG,,,,,,,,inpatient,,,165176,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28376,,186% x Medicaid HMO amount,28376,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64335,,"27,634 x DRG Weight",64335,Other,DRG Base Rate x DRG Weight,54682,,"23,488 x DRG Weight",54682,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15256.21,,DRG base rate x DRG weight + capital per discharge,15256.21,Other,100% of NY Medicaid HMO DRG,15256,,DRG base rate x DRG weight + capital per discharge,15256,Other,100% of NY Medicaid HMO DRG,15256,,DRG base rate x DRG weight + capital per discharge,15256,Other,100% of NY Medicaid HMO DRG,15256,,DRG base rate x DRG weight + capital per discharge,15256,Other,100% of NY Medicaid HMO DRG,34326,,225% x Medicaid HMO amount,34326,Other,225% of NY Medicaid HMO DRG,23342,,153% x Medicaid HMO amount,23342,Other,153% of NY Medicaid HMO DRG,34326,,225% x Medicaid HMO amount,34326,Other,225% of NY Medicaid HMO DRG,21359,,140% x Medicaid HMO amount,21359,Other,140% of NY Medicaid HMO DRG,34326,,DRG base rate x DRG weight + capital per discharge,34326,Other,225% of NY Medicaid HMO DRG,41955,,275% x Medicaid HMO amount,41955,Other,275% of NY Medicaid HMO DRG,49430,,324% x Medicaid HMO amount,49430,Other,324% of NY Medicaid HMO DRG,32801,,215% x Medicaid HMO amount,32801,Other,215% of NY Medicaid HMO DRG,32801,,215% x Medicaid HMO amount,32801,Other,215% of NY Medicaid HMO DRG,19070,,125% x Medicaid HMO amount,19070,Other,125% of NY Medicaid HMO DRG,0.01,64335,
Nephritis & nephrosis,462-1,APR-DRG,,,,,,,,inpatient,,,101527,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7851,,186% x Medicaid HMO amount,7851,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16310,,"27,634 x DRG Weight",16310,Other,DRG Base Rate x DRG Weight,13863,,"23,488 x DRG Weight",13863,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4221.21,,DRG base rate x DRG weight + capital per discharge,4221.21,Other,100% of NY Medicaid HMO DRG,4221,,DRG base rate x DRG weight + capital per discharge,4221,Other,100% of NY Medicaid HMO DRG,4221,,DRG base rate x DRG weight + capital per discharge,4221,Other,100% of NY Medicaid HMO DRG,4221,,DRG base rate x DRG weight + capital per discharge,4221,Other,100% of NY Medicaid HMO DRG,9498,,225% x Medicaid HMO amount,9498,Other,225% of NY Medicaid HMO DRG,6458,,153% x Medicaid HMO amount,6458,Other,153% of NY Medicaid HMO DRG,9498,,225% x Medicaid HMO amount,9498,Other,225% of NY Medicaid HMO DRG,5910,,140% x Medicaid HMO amount,5910,Other,140% of NY Medicaid HMO DRG,9498,,DRG base rate x DRG weight + capital per discharge,9498,Other,225% of NY Medicaid HMO DRG,11608,,275% x Medicaid HMO amount,11608,Other,275% of NY Medicaid HMO DRG,13677,,324% x Medicaid HMO amount,13677,Other,324% of NY Medicaid HMO DRG,9076,,215% x Medicaid HMO amount,9076,Other,215% of NY Medicaid HMO DRG,9076,,215% x Medicaid HMO amount,9076,Other,215% of NY Medicaid HMO DRG,5277,,125% x Medicaid HMO amount,5277,Other,125% of NY Medicaid HMO DRG,0.01,16310,
Nephritis & nephrosis,462-2,APR-DRG,,,,,,,,inpatient,,,118283.36,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9347,,186% x Medicaid HMO amount,9347,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19811,,"27,634 x DRG Weight",19811,Other,DRG Base Rate x DRG Weight,16839,,"23,488 x DRG Weight",16839,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5025.21,,DRG base rate x DRG weight + capital per discharge,5025.21,Other,100% of NY Medicaid HMO DRG,5025,,DRG base rate x DRG weight + capital per discharge,5025,Other,100% of NY Medicaid HMO DRG,5025,,DRG base rate x DRG weight + capital per discharge,5025,Other,100% of NY Medicaid HMO DRG,5025,,DRG base rate x DRG weight + capital per discharge,5025,Other,100% of NY Medicaid HMO DRG,11307,,225% x Medicaid HMO amount,11307,Other,225% of NY Medicaid HMO DRG,7689,,153% x Medicaid HMO amount,7689,Other,153% of NY Medicaid HMO DRG,11307,,225% x Medicaid HMO amount,11307,Other,225% of NY Medicaid HMO DRG,7035,,140% x Medicaid HMO amount,7035,Other,140% of NY Medicaid HMO DRG,11307,,DRG base rate x DRG weight + capital per discharge,11307,Other,225% of NY Medicaid HMO DRG,13819,,275% x Medicaid HMO amount,13819,Other,275% of NY Medicaid HMO DRG,16282,,324% x Medicaid HMO amount,16282,Other,324% of NY Medicaid HMO DRG,10804,,215% x Medicaid HMO amount,10804,Other,215% of NY Medicaid HMO DRG,10804,,215% x Medicaid HMO amount,10804,Other,215% of NY Medicaid HMO DRG,6282,,125% x Medicaid HMO amount,6282,Other,125% of NY Medicaid HMO DRG,0.01,19811,
Nephritis & nephrosis,462-3,APR-DRG,,,,,,,,inpatient,,,159974.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15817,,186% x Medicaid HMO amount,15817,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34951,,"27,634 x DRG Weight",34951,Other,DRG Base Rate x DRG Weight,29708,,"23,488 x DRG Weight",29708,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8504.21,,DRG base rate x DRG weight + capital per discharge,8504.21,Other,100% of NY Medicaid HMO DRG,8504,,DRG base rate x DRG weight + capital per discharge,8504,Other,100% of NY Medicaid HMO DRG,8504,,DRG base rate x DRG weight + capital per discharge,8504,Other,100% of NY Medicaid HMO DRG,8504,,DRG base rate x DRG weight + capital per discharge,8504,Other,100% of NY Medicaid HMO DRG,19134,,225% x Medicaid HMO amount,19134,Other,225% of NY Medicaid HMO DRG,13011,,153% x Medicaid HMO amount,13011,Other,153% of NY Medicaid HMO DRG,19134,,225% x Medicaid HMO amount,19134,Other,225% of NY Medicaid HMO DRG,11906,,140% x Medicaid HMO amount,11906,Other,140% of NY Medicaid HMO DRG,19134,,DRG base rate x DRG weight + capital per discharge,19134,Other,225% of NY Medicaid HMO DRG,23387,,275% x Medicaid HMO amount,23387,Other,275% of NY Medicaid HMO DRG,27554,,324% x Medicaid HMO amount,27554,Other,324% of NY Medicaid HMO DRG,18284,,215% x Medicaid HMO amount,18284,Other,215% of NY Medicaid HMO DRG,18284,,215% x Medicaid HMO amount,18284,Other,215% of NY Medicaid HMO DRG,10630,,125% x Medicaid HMO amount,10630,Other,125% of NY Medicaid HMO DRG,0.01,34951,
Nephritis & nephrosis,462-4,APR-DRG,,,,,,,,inpatient,,,528355,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48338,,186% x Medicaid HMO amount,48338,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,111036,,"27,634 x DRG Weight",111036,Other,DRG Base Rate x DRG Weight,94377,,"23,488 x DRG Weight",94377,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25988.21,,DRG base rate x DRG weight + capital per discharge,25988.21,Other,100% of NY Medicaid HMO DRG,25988,,DRG base rate x DRG weight + capital per discharge,25988,Other,100% of NY Medicaid HMO DRG,25988,,DRG base rate x DRG weight + capital per discharge,25988,Other,100% of NY Medicaid HMO DRG,25988,,DRG base rate x DRG weight + capital per discharge,25988,Other,100% of NY Medicaid HMO DRG,58473,,225% x Medicaid HMO amount,58473,Other,225% of NY Medicaid HMO DRG,39762,,153% x Medicaid HMO amount,39762,Other,153% of NY Medicaid HMO DRG,58473,,225% x Medicaid HMO amount,58473,Other,225% of NY Medicaid HMO DRG,36383,,140% x Medicaid HMO amount,36383,Other,140% of NY Medicaid HMO DRG,58473,,DRG base rate x DRG weight + capital per discharge,58473,Other,225% of NY Medicaid HMO DRG,71468,,275% x Medicaid HMO amount,71468,Other,275% of NY Medicaid HMO DRG,84202,,324% x Medicaid HMO amount,84202,Other,324% of NY Medicaid HMO DRG,55875,,215% x Medicaid HMO amount,55875,Other,215% of NY Medicaid HMO DRG,55875,,215% x Medicaid HMO amount,55875,Other,215% of NY Medicaid HMO DRG,32485,,125% x Medicaid HMO amount,32485,Other,125% of NY Medicaid HMO DRG,0.01,111036,
Kidney & urinary tract infections,463-1,APR-DRG,,,,,,,,inpatient,,,88371.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6748,,186% x Medicaid HMO amount,6748,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13731,,"27,634 x DRG Weight",13731,Other,DRG Base Rate x DRG Weight,11671,,"23,488 x DRG Weight",11671,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3628.21,,DRG base rate x DRG weight + capital per discharge,3628.21,Other,100% of NY Medicaid HMO DRG,3628,,DRG base rate x DRG weight + capital per discharge,3628,Other,100% of NY Medicaid HMO DRG,3628,,DRG base rate x DRG weight + capital per discharge,3628,Other,100% of NY Medicaid HMO DRG,3628,,DRG base rate x DRG weight + capital per discharge,3628,Other,100% of NY Medicaid HMO DRG,8163,,225% x Medicaid HMO amount,8163,Other,225% of NY Medicaid HMO DRG,5551,,153% x Medicaid HMO amount,5551,Other,153% of NY Medicaid HMO DRG,8163,,225% x Medicaid HMO amount,8163,Other,225% of NY Medicaid HMO DRG,5079,,140% x Medicaid HMO amount,5079,Other,140% of NY Medicaid HMO DRG,8163,,DRG base rate x DRG weight + capital per discharge,8163,Other,225% of NY Medicaid HMO DRG,9978,,275% x Medicaid HMO amount,9978,Other,275% of NY Medicaid HMO DRG,11755,,324% x Medicaid HMO amount,11755,Other,324% of NY Medicaid HMO DRG,7801,,215% x Medicaid HMO amount,7801,Other,215% of NY Medicaid HMO DRG,7801,,215% x Medicaid HMO amount,7801,Other,215% of NY Medicaid HMO DRG,4535,,125% x Medicaid HMO amount,4535,Other,125% of NY Medicaid HMO DRG,0.01,13731,
Kidney & urinary tract infections,463-2,APR-DRG,,,,,,,,inpatient,,,98305.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8324,,186% x Medicaid HMO amount,8324,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17415,,"27,634 x DRG Weight",17415,Other,DRG Base Rate x DRG Weight,14802,,"23,488 x DRG Weight",14802,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4475.21,,DRG base rate x DRG weight + capital per discharge,4475.21,Other,100% of NY Medicaid HMO DRG,4475,,DRG base rate x DRG weight + capital per discharge,4475,Other,100% of NY Medicaid HMO DRG,4475,,DRG base rate x DRG weight + capital per discharge,4475,Other,100% of NY Medicaid HMO DRG,4475,,DRG base rate x DRG weight + capital per discharge,4475,Other,100% of NY Medicaid HMO DRG,10069,,225% x Medicaid HMO amount,10069,Other,225% of NY Medicaid HMO DRG,6847,,153% x Medicaid HMO amount,6847,Other,153% of NY Medicaid HMO DRG,10069,,225% x Medicaid HMO amount,10069,Other,225% of NY Medicaid HMO DRG,6265,,140% x Medicaid HMO amount,6265,Other,140% of NY Medicaid HMO DRG,10069,,DRG base rate x DRG weight + capital per discharge,10069,Other,225% of NY Medicaid HMO DRG,12307,,275% x Medicaid HMO amount,12307,Other,275% of NY Medicaid HMO DRG,14500,,324% x Medicaid HMO amount,14500,Other,324% of NY Medicaid HMO DRG,9622,,215% x Medicaid HMO amount,9622,Other,215% of NY Medicaid HMO DRG,9622,,215% x Medicaid HMO amount,9622,Other,215% of NY Medicaid HMO DRG,5594,,125% x Medicaid HMO amount,5594,Other,125% of NY Medicaid HMO DRG,0.01,17415,
Kidney & urinary tract infections,463-3,APR-DRG,,,,,,,,inpatient,,,133813.3,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12538,,186% x Medicaid HMO amount,12538,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27278,,"27,634 x DRG Weight",27278,Other,DRG Base Rate x DRG Weight,23185,,"23,488 x DRG Weight",23185,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6741.21,,DRG base rate x DRG weight + capital per discharge,6741.21,Other,100% of NY Medicaid HMO DRG,6741,,DRG base rate x DRG weight + capital per discharge,6741,Other,100% of NY Medicaid HMO DRG,6741,,DRG base rate x DRG weight + capital per discharge,6741,Other,100% of NY Medicaid HMO DRG,6741,,DRG base rate x DRG weight + capital per discharge,6741,Other,100% of NY Medicaid HMO DRG,15168,,225% x Medicaid HMO amount,15168,Other,225% of NY Medicaid HMO DRG,10314,,153% x Medicaid HMO amount,10314,Other,153% of NY Medicaid HMO DRG,15168,,225% x Medicaid HMO amount,15168,Other,225% of NY Medicaid HMO DRG,9438,,140% x Medicaid HMO amount,9438,Other,140% of NY Medicaid HMO DRG,15168,,DRG base rate x DRG weight + capital per discharge,15168,Other,225% of NY Medicaid HMO DRG,18538,,275% x Medicaid HMO amount,18538,Other,275% of NY Medicaid HMO DRG,21842,,324% x Medicaid HMO amount,21842,Other,324% of NY Medicaid HMO DRG,14494,,215% x Medicaid HMO amount,14494,Other,215% of NY Medicaid HMO DRG,14494,,215% x Medicaid HMO amount,14494,Other,215% of NY Medicaid HMO DRG,8427,,125% x Medicaid HMO amount,8427,Other,125% of NY Medicaid HMO DRG,0.01,27278,
Kidney & urinary tract infections,463-4,APR-DRG,,,,,,,,inpatient,,,201354.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26639,,186% x Medicaid HMO amount,26639,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60270,,"27,634 x DRG Weight",60270,Other,DRG Base Rate x DRG Weight,51227,,"23,488 x DRG Weight",51227,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14322.21,,DRG base rate x DRG weight + capital per discharge,14322.21,Other,100% of NY Medicaid HMO DRG,14322,,DRG base rate x DRG weight + capital per discharge,14322,Other,100% of NY Medicaid HMO DRG,14322,,DRG base rate x DRG weight + capital per discharge,14322,Other,100% of NY Medicaid HMO DRG,14322,,DRG base rate x DRG weight + capital per discharge,14322,Other,100% of NY Medicaid HMO DRG,32225,,225% x Medicaid HMO amount,32225,Other,225% of NY Medicaid HMO DRG,21913,,153% x Medicaid HMO amount,21913,Other,153% of NY Medicaid HMO DRG,32225,,225% x Medicaid HMO amount,32225,Other,225% of NY Medicaid HMO DRG,20051,,140% x Medicaid HMO amount,20051,Other,140% of NY Medicaid HMO DRG,32225,,DRG base rate x DRG weight + capital per discharge,32225,Other,225% of NY Medicaid HMO DRG,39386,,275% x Medicaid HMO amount,39386,Other,275% of NY Medicaid HMO DRG,46404,,324% x Medicaid HMO amount,46404,Other,324% of NY Medicaid HMO DRG,30793,,215% x Medicaid HMO amount,30793,Other,215% of NY Medicaid HMO DRG,30793,,215% x Medicaid HMO amount,30793,Other,215% of NY Medicaid HMO DRG,17903,,125% x Medicaid HMO amount,17903,Other,125% of NY Medicaid HMO DRG,0.01,60270,
Urinary stones & acquired upper urinary tract obstruction,465-1,APR-DRG,,,,,,,,inpatient,,,77236.57,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6173,,186% x Medicaid HMO amount,6173,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12386,,"27,634 x DRG Weight",12386,Other,DRG Base Rate x DRG Weight,10527,,"23,488 x DRG Weight",10527,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3319.21,,DRG base rate x DRG weight + capital per discharge,3319.21,Other,100% of NY Medicaid HMO DRG,3319,,DRG base rate x DRG weight + capital per discharge,3319,Other,100% of NY Medicaid HMO DRG,3319,,DRG base rate x DRG weight + capital per discharge,3319,Other,100% of NY Medicaid HMO DRG,3319,,DRG base rate x DRG weight + capital per discharge,3319,Other,100% of NY Medicaid HMO DRG,7468,,225% x Medicaid HMO amount,7468,Other,225% of NY Medicaid HMO DRG,5078,,153% x Medicaid HMO amount,5078,Other,153% of NY Medicaid HMO DRG,7468,,225% x Medicaid HMO amount,7468,Other,225% of NY Medicaid HMO DRG,4647,,140% x Medicaid HMO amount,4647,Other,140% of NY Medicaid HMO DRG,7468,,DRG base rate x DRG weight + capital per discharge,7468,Other,225% of NY Medicaid HMO DRG,9128,,275% x Medicaid HMO amount,9128,Other,275% of NY Medicaid HMO DRG,10754,,324% x Medicaid HMO amount,10754,Other,324% of NY Medicaid HMO DRG,7136,,215% x Medicaid HMO amount,7136,Other,215% of NY Medicaid HMO DRG,7136,,215% x Medicaid HMO amount,7136,Other,215% of NY Medicaid HMO DRG,4149,,125% x Medicaid HMO amount,4149,Other,125% of NY Medicaid HMO DRG,0.01,12386,
Urinary stones & acquired upper urinary tract obstruction,465-2,APR-DRG,,,,,,,,inpatient,,,66276.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7049,,186% x Medicaid HMO amount,7049,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14433,,"27,634 x DRG Weight",14433,Other,DRG Base Rate x DRG Weight,12268,,"23,488 x DRG Weight",12268,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3790.21,,DRG base rate x DRG weight + capital per discharge,3790.21,Other,100% of NY Medicaid HMO DRG,3790,,DRG base rate x DRG weight + capital per discharge,3790,Other,100% of NY Medicaid HMO DRG,3790,,DRG base rate x DRG weight + capital per discharge,3790,Other,100% of NY Medicaid HMO DRG,3790,,DRG base rate x DRG weight + capital per discharge,3790,Other,100% of NY Medicaid HMO DRG,8528,,225% x Medicaid HMO amount,8528,Other,225% of NY Medicaid HMO DRG,5799,,153% x Medicaid HMO amount,5799,Other,153% of NY Medicaid HMO DRG,8528,,225% x Medicaid HMO amount,8528,Other,225% of NY Medicaid HMO DRG,5306,,140% x Medicaid HMO amount,5306,Other,140% of NY Medicaid HMO DRG,8528,,DRG base rate x DRG weight + capital per discharge,8528,Other,225% of NY Medicaid HMO DRG,10423,,275% x Medicaid HMO amount,10423,Other,275% of NY Medicaid HMO DRG,12280,,324% x Medicaid HMO amount,12280,Other,324% of NY Medicaid HMO DRG,8149,,215% x Medicaid HMO amount,8149,Other,215% of NY Medicaid HMO DRG,8149,,215% x Medicaid HMO amount,8149,Other,215% of NY Medicaid HMO DRG,4738,,125% x Medicaid HMO amount,4738,Other,125% of NY Medicaid HMO DRG,0.01,14433,
Urinary stones & acquired upper urinary tract obstruction,465-3,APR-DRG,,,,,,,,inpatient,,,55073.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11162,,186% x Medicaid HMO amount,11162,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24058,,"27,634 x DRG Weight",24058,Other,DRG Base Rate x DRG Weight,20449,,"23,488 x DRG Weight",20449,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6001.21,,DRG base rate x DRG weight + capital per discharge,6001.21,Other,100% of NY Medicaid HMO DRG,6001,,DRG base rate x DRG weight + capital per discharge,6001,Other,100% of NY Medicaid HMO DRG,6001,,DRG base rate x DRG weight + capital per discharge,6001,Other,100% of NY Medicaid HMO DRG,6001,,DRG base rate x DRG weight + capital per discharge,6001,Other,100% of NY Medicaid HMO DRG,13503,,225% x Medicaid HMO amount,13503,Other,225% of NY Medicaid HMO DRG,9182,,153% x Medicaid HMO amount,9182,Other,153% of NY Medicaid HMO DRG,13503,,225% x Medicaid HMO amount,13503,Other,225% of NY Medicaid HMO DRG,8402,,140% x Medicaid HMO amount,8402,Other,140% of NY Medicaid HMO DRG,13503,,DRG base rate x DRG weight + capital per discharge,13503,Other,225% of NY Medicaid HMO DRG,16503,,275% x Medicaid HMO amount,16503,Other,275% of NY Medicaid HMO DRG,19444,,324% x Medicaid HMO amount,19444,Other,324% of NY Medicaid HMO DRG,12903,,215% x Medicaid HMO amount,12903,Other,215% of NY Medicaid HMO DRG,12903,,215% x Medicaid HMO amount,12903,Other,215% of NY Medicaid HMO DRG,7502,,125% x Medicaid HMO amount,7502,Other,125% of NY Medicaid HMO DRG,0.01,24058,
Urinary stones & acquired upper urinary tract obstruction,465-4,APR-DRG,,,,,,,,inpatient,,,66276.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26498,,186% x Medicaid HMO amount,26498,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59938,,"27,634 x DRG Weight",59938,Other,DRG Base Rate x DRG Weight,50945,,"23,488 x DRG Weight",50945,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14246.21,,DRG base rate x DRG weight + capital per discharge,14246.21,Other,100% of NY Medicaid HMO DRG,14246,,DRG base rate x DRG weight + capital per discharge,14246,Other,100% of NY Medicaid HMO DRG,14246,,DRG base rate x DRG weight + capital per discharge,14246,Other,100% of NY Medicaid HMO DRG,14246,,DRG base rate x DRG weight + capital per discharge,14246,Other,100% of NY Medicaid HMO DRG,32054,,225% x Medicaid HMO amount,32054,Other,225% of NY Medicaid HMO DRG,21797,,153% x Medicaid HMO amount,21797,Other,153% of NY Medicaid HMO DRG,32054,,225% x Medicaid HMO amount,32054,Other,225% of NY Medicaid HMO DRG,19945,,140% x Medicaid HMO amount,19945,Other,140% of NY Medicaid HMO DRG,32054,,DRG base rate x DRG weight + capital per discharge,32054,Other,225% of NY Medicaid HMO DRG,39177,,275% x Medicaid HMO amount,39177,Other,275% of NY Medicaid HMO DRG,46158,,324% x Medicaid HMO amount,46158,Other,324% of NY Medicaid HMO DRG,30629,,215% x Medicaid HMO amount,30629,Other,215% of NY Medicaid HMO DRG,30629,,215% x Medicaid HMO amount,30629,Other,215% of NY Medicaid HMO DRG,17808,,125% x Medicaid HMO amount,17808,Other,125% of NY Medicaid HMO DRG,0.01,59938,
"Malfunction, reaction, complic of genitourinary device or proc",466-1,APR-DRG,,,,,,,,inpatient,,,74000.35,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6813,,186% x Medicaid HMO amount,6813,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13881,,"27,634 x DRG Weight",13881,Other,DRG Base Rate x DRG Weight,11798,,"23,488 x DRG Weight",11798,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3663.21,,DRG base rate x DRG weight + capital per discharge,3663.21,Other,100% of NY Medicaid HMO DRG,3663,,DRG base rate x DRG weight + capital per discharge,3663,Other,100% of NY Medicaid HMO DRG,3663,,DRG base rate x DRG weight + capital per discharge,3663,Other,100% of NY Medicaid HMO DRG,3663,,DRG base rate x DRG weight + capital per discharge,3663,Other,100% of NY Medicaid HMO DRG,8242,,225% x Medicaid HMO amount,8242,Other,225% of NY Medicaid HMO DRG,5605,,153% x Medicaid HMO amount,5605,Other,153% of NY Medicaid HMO DRG,8242,,225% x Medicaid HMO amount,8242,Other,225% of NY Medicaid HMO DRG,5128,,140% x Medicaid HMO amount,5128,Other,140% of NY Medicaid HMO DRG,8242,,DRG base rate x DRG weight + capital per discharge,8242,Other,225% of NY Medicaid HMO DRG,10074,,275% x Medicaid HMO amount,10074,Other,275% of NY Medicaid HMO DRG,11869,,324% x Medicaid HMO amount,11869,Other,324% of NY Medicaid HMO DRG,7876,,215% x Medicaid HMO amount,7876,Other,215% of NY Medicaid HMO DRG,7876,,215% x Medicaid HMO amount,7876,Other,215% of NY Medicaid HMO DRG,4579,,125% x Medicaid HMO amount,4579,Other,125% of NY Medicaid HMO DRG,0.01,13881,
"Malfunction, reaction, complic of genitourinary device or proc",466-2,APR-DRG,,,,,,,,inpatient,,,142265.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9123,,186% x Medicaid HMO amount,9123,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19286,,"27,634 x DRG Weight",19286,Other,DRG Base Rate x DRG Weight,16392,,"23,488 x DRG Weight",16392,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4905.21,,DRG base rate x DRG weight + capital per discharge,4905.21,Other,100% of NY Medicaid HMO DRG,4905,,DRG base rate x DRG weight + capital per discharge,4905,Other,100% of NY Medicaid HMO DRG,4905,,DRG base rate x DRG weight + capital per discharge,4905,Other,100% of NY Medicaid HMO DRG,4905,,DRG base rate x DRG weight + capital per discharge,4905,Other,100% of NY Medicaid HMO DRG,11037,,225% x Medicaid HMO amount,11037,Other,225% of NY Medicaid HMO DRG,7505,,153% x Medicaid HMO amount,7505,Other,153% of NY Medicaid HMO DRG,11037,,225% x Medicaid HMO amount,11037,Other,225% of NY Medicaid HMO DRG,6867,,140% x Medicaid HMO amount,6867,Other,140% of NY Medicaid HMO DRG,11037,,DRG base rate x DRG weight + capital per discharge,11037,Other,225% of NY Medicaid HMO DRG,13489,,275% x Medicaid HMO amount,13489,Other,275% of NY Medicaid HMO DRG,15893,,324% x Medicaid HMO amount,15893,Other,324% of NY Medicaid HMO DRG,10546,,215% x Medicaid HMO amount,10546,Other,215% of NY Medicaid HMO DRG,10546,,215% x Medicaid HMO amount,10546,Other,215% of NY Medicaid HMO DRG,6132,,125% x Medicaid HMO amount,6132,Other,125% of NY Medicaid HMO DRG,0.01,19286,
"Malfunction, reaction, complic of genitourinary device or proc",466-3,APR-DRG,,,,,,,,inpatient,,,126134.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14621,,186% x Medicaid HMO amount,14621,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32152,,"27,634 x DRG Weight",32152,Other,DRG Base Rate x DRG Weight,27328,,"23,488 x DRG Weight",27328,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7861.21,,DRG base rate x DRG weight + capital per discharge,7861.21,Other,100% of NY Medicaid HMO DRG,7861,,DRG base rate x DRG weight + capital per discharge,7861,Other,100% of NY Medicaid HMO DRG,7861,,DRG base rate x DRG weight + capital per discharge,7861,Other,100% of NY Medicaid HMO DRG,7861,,DRG base rate x DRG weight + capital per discharge,7861,Other,100% of NY Medicaid HMO DRG,17688,,225% x Medicaid HMO amount,17688,Other,225% of NY Medicaid HMO DRG,12028,,153% x Medicaid HMO amount,12028,Other,153% of NY Medicaid HMO DRG,17688,,225% x Medicaid HMO amount,17688,Other,225% of NY Medicaid HMO DRG,11006,,140% x Medicaid HMO amount,11006,Other,140% of NY Medicaid HMO DRG,17688,,DRG base rate x DRG weight + capital per discharge,17688,Other,225% of NY Medicaid HMO DRG,21618,,275% x Medicaid HMO amount,21618,Other,275% of NY Medicaid HMO DRG,25470,,324% x Medicaid HMO amount,25470,Other,324% of NY Medicaid HMO DRG,16902,,215% x Medicaid HMO amount,16902,Other,215% of NY Medicaid HMO DRG,16902,,215% x Medicaid HMO amount,16902,Other,215% of NY Medicaid HMO DRG,9827,,125% x Medicaid HMO amount,9827,Other,125% of NY Medicaid HMO DRG,0.01,32152,
"Malfunction, reaction, complic of genitourinary device or proc",466-4,APR-DRG,,,,,,,,inpatient,,,252134.1,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28372,,186% x Medicaid HMO amount,28372,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64324,,"27,634 x DRG Weight",64324,Other,DRG Base Rate x DRG Weight,54673,,"23,488 x DRG Weight",54673,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15254.21,,DRG base rate x DRG weight + capital per discharge,15254.21,Other,100% of NY Medicaid HMO DRG,15254,,DRG base rate x DRG weight + capital per discharge,15254,Other,100% of NY Medicaid HMO DRG,15254,,DRG base rate x DRG weight + capital per discharge,15254,Other,100% of NY Medicaid HMO DRG,15254,,DRG base rate x DRG weight + capital per discharge,15254,Other,100% of NY Medicaid HMO DRG,34322,,225% x Medicaid HMO amount,34322,Other,225% of NY Medicaid HMO DRG,23339,,153% x Medicaid HMO amount,23339,Other,153% of NY Medicaid HMO DRG,34322,,225% x Medicaid HMO amount,34322,Other,225% of NY Medicaid HMO DRG,21356,,140% x Medicaid HMO amount,21356,Other,140% of NY Medicaid HMO DRG,34322,,DRG base rate x DRG weight + capital per discharge,34322,Other,225% of NY Medicaid HMO DRG,41949,,275% x Medicaid HMO amount,41949,Other,275% of NY Medicaid HMO DRG,49424,,324% x Medicaid HMO amount,49424,Other,324% of NY Medicaid HMO DRG,32797,,215% x Medicaid HMO amount,32797,Other,215% of NY Medicaid HMO DRG,32797,,215% x Medicaid HMO amount,32797,Other,215% of NY Medicaid HMO DRG,19068,,125% x Medicaid HMO amount,19068,Other,125% of NY Medicaid HMO DRG,0.01,64324,
"Other kidney & urinary tract diagnoses, signs & symptoms",468-1,APR-DRG,,,,,,,,inpatient,,,104668.6,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6828,,186% x Medicaid HMO amount,6828,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13916,,"27,634 x DRG Weight",13916,Other,DRG Base Rate x DRG Weight,11829,,"23,488 x DRG Weight",11829,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3671.21,,DRG base rate x DRG weight + capital per discharge,3671.21,Other,100% of NY Medicaid HMO DRG,3671,,DRG base rate x DRG weight + capital per discharge,3671,Other,100% of NY Medicaid HMO DRG,3671,,DRG base rate x DRG weight + capital per discharge,3671,Other,100% of NY Medicaid HMO DRG,3671,,DRG base rate x DRG weight + capital per discharge,3671,Other,100% of NY Medicaid HMO DRG,8260,,225% x Medicaid HMO amount,8260,Other,225% of NY Medicaid HMO DRG,5617,,153% x Medicaid HMO amount,5617,Other,153% of NY Medicaid HMO DRG,8260,,225% x Medicaid HMO amount,8260,Other,225% of NY Medicaid HMO DRG,5140,,140% x Medicaid HMO amount,5140,Other,140% of NY Medicaid HMO DRG,8260,,DRG base rate x DRG weight + capital per discharge,8260,Other,225% of NY Medicaid HMO DRG,10096,,275% x Medicaid HMO amount,10096,Other,275% of NY Medicaid HMO DRG,11895,,324% x Medicaid HMO amount,11895,Other,324% of NY Medicaid HMO DRG,7893,,215% x Medicaid HMO amount,7893,Other,215% of NY Medicaid HMO DRG,7893,,215% x Medicaid HMO amount,7893,Other,215% of NY Medicaid HMO DRG,4589,,125% x Medicaid HMO amount,4589,Other,125% of NY Medicaid HMO DRG,0.01,13916,
"Other kidney & urinary tract diagnoses, signs & symptoms",468-2,APR-DRG,,,,,,,,inpatient,,,163686.63,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9466,,186% x Medicaid HMO amount,9466,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20087,,"27,634 x DRG Weight",20087,Other,DRG Base Rate x DRG Weight,17073,,"23,488 x DRG Weight",17073,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5089.21,,DRG base rate x DRG weight + capital per discharge,5089.21,Other,100% of NY Medicaid HMO DRG,5089,,DRG base rate x DRG weight + capital per discharge,5089,Other,100% of NY Medicaid HMO DRG,5089,,DRG base rate x DRG weight + capital per discharge,5089,Other,100% of NY Medicaid HMO DRG,5089,,DRG base rate x DRG weight + capital per discharge,5089,Other,100% of NY Medicaid HMO DRG,11451,,225% x Medicaid HMO amount,11451,Other,225% of NY Medicaid HMO DRG,7786,,153% x Medicaid HMO amount,7786,Other,153% of NY Medicaid HMO DRG,11451,,225% x Medicaid HMO amount,11451,Other,225% of NY Medicaid HMO DRG,7125,,140% x Medicaid HMO amount,7125,Other,140% of NY Medicaid HMO DRG,11451,,DRG base rate x DRG weight + capital per discharge,11451,Other,225% of NY Medicaid HMO DRG,13995,,275% x Medicaid HMO amount,13995,Other,275% of NY Medicaid HMO DRG,16489,,324% x Medicaid HMO amount,16489,Other,324% of NY Medicaid HMO DRG,10942,,215% x Medicaid HMO amount,10942,Other,215% of NY Medicaid HMO DRG,10942,,215% x Medicaid HMO amount,10942,Other,215% of NY Medicaid HMO DRG,6362,,125% x Medicaid HMO amount,6362,Other,125% of NY Medicaid HMO DRG,0.01,20087,
"Other kidney & urinary tract diagnoses, signs & symptoms",468-3,APR-DRG,,,,,,,,inpatient,,,137408,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14928,,186% x Medicaid HMO amount,14928,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32868,,"27,634 x DRG Weight",32868,Other,DRG Base Rate x DRG Weight,27937,,"23,488 x DRG Weight",27937,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8026.21,,DRG base rate x DRG weight + capital per discharge,8026.21,Other,100% of NY Medicaid HMO DRG,8026,,DRG base rate x DRG weight + capital per discharge,8026,Other,100% of NY Medicaid HMO DRG,8026,,DRG base rate x DRG weight + capital per discharge,8026,Other,100% of NY Medicaid HMO DRG,8026,,DRG base rate x DRG weight + capital per discharge,8026,Other,100% of NY Medicaid HMO DRG,18059,,225% x Medicaid HMO amount,18059,Other,225% of NY Medicaid HMO DRG,12280,,153% x Medicaid HMO amount,12280,Other,153% of NY Medicaid HMO DRG,18059,,225% x Medicaid HMO amount,18059,Other,225% of NY Medicaid HMO DRG,11237,,140% x Medicaid HMO amount,11237,Other,140% of NY Medicaid HMO DRG,18059,,DRG base rate x DRG weight + capital per discharge,18059,Other,225% of NY Medicaid HMO DRG,22072,,275% x Medicaid HMO amount,22072,Other,275% of NY Medicaid HMO DRG,26005,,324% x Medicaid HMO amount,26005,Other,324% of NY Medicaid HMO DRG,17256,,215% x Medicaid HMO amount,17256,Other,215% of NY Medicaid HMO DRG,17256,,215% x Medicaid HMO amount,17256,Other,215% of NY Medicaid HMO DRG,10033,,125% x Medicaid HMO amount,10033,Other,125% of NY Medicaid HMO DRG,0.01,32868,
"Other kidney & urinary tract diagnoses, signs & symptoms",468-4,APR-DRG,,,,,,,,inpatient,,,274508.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34053,,186% x Medicaid HMO amount,34053,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,77616,,"27,634 x DRG Weight",77616,Other,DRG Base Rate x DRG Weight,65971,,"23,488 x DRG Weight",65971,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18308.21,,DRG base rate x DRG weight + capital per discharge,18308.21,Other,100% of NY Medicaid HMO DRG,18308,,DRG base rate x DRG weight + capital per discharge,18308,Other,100% of NY Medicaid HMO DRG,18308,,DRG base rate x DRG weight + capital per discharge,18308,Other,100% of NY Medicaid HMO DRG,18308,,DRG base rate x DRG weight + capital per discharge,18308,Other,100% of NY Medicaid HMO DRG,41193,,225% x Medicaid HMO amount,41193,Other,225% of NY Medicaid HMO DRG,28012,,153% x Medicaid HMO amount,28012,Other,153% of NY Medicaid HMO DRG,41193,,225% x Medicaid HMO amount,41193,Other,225% of NY Medicaid HMO DRG,25631,,140% x Medicaid HMO amount,25631,Other,140% of NY Medicaid HMO DRG,41193,,DRG base rate x DRG weight + capital per discharge,41193,Other,225% of NY Medicaid HMO DRG,50348,,275% x Medicaid HMO amount,50348,Other,275% of NY Medicaid HMO DRG,59319,,324% x Medicaid HMO amount,59319,Other,324% of NY Medicaid HMO DRG,39363,,215% x Medicaid HMO amount,39363,Other,215% of NY Medicaid HMO DRG,39363,,215% x Medicaid HMO amount,39363,Other,215% of NY Medicaid HMO DRG,22885,,125% x Medicaid HMO amount,22885,Other,125% of NY Medicaid HMO DRG,0.01,77616,
Acute Kidney Injury #,469-1,APR-DRG,,,,,,,,inpatient,,,29936.1,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7098,,186% x Medicaid HMO amount,7098,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14549,,"27,634 x DRG Weight",14549,Other,DRG Base Rate x DRG Weight,12366,,"23,488 x DRG Weight",12366,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3816.21,,DRG base rate x DRG weight + capital per discharge,3816.21,Other,100% of NY Medicaid HMO DRG,3816,,DRG base rate x DRG weight + capital per discharge,3816,Other,100% of NY Medicaid HMO DRG,3816,,DRG base rate x DRG weight + capital per discharge,3816,Other,100% of NY Medicaid HMO DRG,3816,,DRG base rate x DRG weight + capital per discharge,3816,Other,100% of NY Medicaid HMO DRG,8586,,225% x Medicaid HMO amount,8586,Other,225% of NY Medicaid HMO DRG,5839,,153% x Medicaid HMO amount,5839,Other,153% of NY Medicaid HMO DRG,8586,,225% x Medicaid HMO amount,8586,Other,225% of NY Medicaid HMO DRG,5343,,140% x Medicaid HMO amount,5343,Other,140% of NY Medicaid HMO DRG,8586,,DRG base rate x DRG weight + capital per discharge,8586,Other,225% of NY Medicaid HMO DRG,10495,,275% x Medicaid HMO amount,10495,Other,275% of NY Medicaid HMO DRG,12365,,324% x Medicaid HMO amount,12365,Other,324% of NY Medicaid HMO DRG,8205,,215% x Medicaid HMO amount,8205,Other,215% of NY Medicaid HMO DRG,8205,,215% x Medicaid HMO amount,8205,Other,215% of NY Medicaid HMO DRG,4770,,125% x Medicaid HMO amount,4770,Other,125% of NY Medicaid HMO DRG,0.01,14549,
Acute Kidney Injury #,469-2,APR-DRG,,,,,,,,inpatient,,,120863.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9672,,186% x Medicaid HMO amount,9672,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20574,,"27,634 x DRG Weight",20574,Other,DRG Base Rate x DRG Weight,17487,,"23,488 x DRG Weight",17487,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5200.21,,DRG base rate x DRG weight + capital per discharge,5200.21,Other,100% of NY Medicaid HMO DRG,5200,,DRG base rate x DRG weight + capital per discharge,5200,Other,100% of NY Medicaid HMO DRG,5200,,DRG base rate x DRG weight + capital per discharge,5200,Other,100% of NY Medicaid HMO DRG,5200,,DRG base rate x DRG weight + capital per discharge,5200,Other,100% of NY Medicaid HMO DRG,11700,,225% x Medicaid HMO amount,11700,Other,225% of NY Medicaid HMO DRG,7956,,153% x Medicaid HMO amount,7956,Other,153% of NY Medicaid HMO DRG,11700,,225% x Medicaid HMO amount,11700,Other,225% of NY Medicaid HMO DRG,7280,,140% x Medicaid HMO amount,7280,Other,140% of NY Medicaid HMO DRG,11700,,DRG base rate x DRG weight + capital per discharge,11700,Other,225% of NY Medicaid HMO DRG,14301,,275% x Medicaid HMO amount,14301,Other,275% of NY Medicaid HMO DRG,16849,,324% x Medicaid HMO amount,16849,Other,324% of NY Medicaid HMO DRG,11180,,215% x Medicaid HMO amount,11180,Other,215% of NY Medicaid HMO DRG,11180,,215% x Medicaid HMO amount,11180,Other,215% of NY Medicaid HMO DRG,6500,,125% x Medicaid HMO amount,6500,Other,125% of NY Medicaid HMO DRG,0.01,20574,
Acute Kidney Injury #,469-3,APR-DRG,,,,,,,,inpatient,,,161358.66,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16920,,186% x Medicaid HMO amount,16920,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37532,,"27,634 x DRG Weight",37532,Other,DRG Base Rate x DRG Weight,31901,,"23,488 x DRG Weight",31901,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9097.21,,DRG base rate x DRG weight + capital per discharge,9097.21,Other,100% of NY Medicaid HMO DRG,9097,,DRG base rate x DRG weight + capital per discharge,9097,Other,100% of NY Medicaid HMO DRG,9097,,DRG base rate x DRG weight + capital per discharge,9097,Other,100% of NY Medicaid HMO DRG,9097,,DRG base rate x DRG weight + capital per discharge,9097,Other,100% of NY Medicaid HMO DRG,20469,,225% x Medicaid HMO amount,20469,Other,225% of NY Medicaid HMO DRG,13919,,153% x Medicaid HMO amount,13919,Other,153% of NY Medicaid HMO DRG,20469,,225% x Medicaid HMO amount,20469,Other,225% of NY Medicaid HMO DRG,12736,,140% x Medicaid HMO amount,12736,Other,140% of NY Medicaid HMO DRG,20469,,DRG base rate x DRG weight + capital per discharge,20469,Other,225% of NY Medicaid HMO DRG,25017,,275% x Medicaid HMO amount,25017,Other,275% of NY Medicaid HMO DRG,29475,,324% x Medicaid HMO amount,29475,Other,324% of NY Medicaid HMO DRG,19559,,215% x Medicaid HMO amount,19559,Other,215% of NY Medicaid HMO DRG,19559,,215% x Medicaid HMO amount,19559,Other,215% of NY Medicaid HMO DRG,11372,,125% x Medicaid HMO amount,11372,Other,125% of NY Medicaid HMO DRG,0.01,37532,
Acute Kidney Injury #,469-4,APR-DRG,,,,,,,,inpatient,,,543360.57,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39871,,186% x Medicaid HMO amount,39871,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,91228,,"27,634 x DRG Weight",91228,Other,DRG Base Rate x DRG Weight,77541,,"23,488 x DRG Weight",77541,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21436.21,,DRG base rate x DRG weight + capital per discharge,21436.21,Other,100% of NY Medicaid HMO DRG,21436,,DRG base rate x DRG weight + capital per discharge,21436,Other,100% of NY Medicaid HMO DRG,21436,,DRG base rate x DRG weight + capital per discharge,21436,Other,100% of NY Medicaid HMO DRG,21436,,DRG base rate x DRG weight + capital per discharge,21436,Other,100% of NY Medicaid HMO DRG,48231,,225% x Medicaid HMO amount,48231,Other,225% of NY Medicaid HMO DRG,32797,,153% x Medicaid HMO amount,32797,Other,153% of NY Medicaid HMO DRG,48231,,225% x Medicaid HMO amount,48231,Other,225% of NY Medicaid HMO DRG,30011,,140% x Medicaid HMO amount,30011,Other,140% of NY Medicaid HMO DRG,48231,,DRG base rate x DRG weight + capital per discharge,48231,Other,225% of NY Medicaid HMO DRG,58950,,275% x Medicaid HMO amount,58950,Other,275% of NY Medicaid HMO DRG,69453,,324% x Medicaid HMO amount,69453,Other,324% of NY Medicaid HMO DRG,46088,,215% x Medicaid HMO amount,46088,Other,215% of NY Medicaid HMO DRG,46088,,215% x Medicaid HMO amount,46088,Other,215% of NY Medicaid HMO DRG,26795,,125% x Medicaid HMO amount,26795,Other,125% of NY Medicaid HMO DRG,0.01,91228,
Chronic Kidney Disease #,470-1,APR-DRG,,,,,,,,inpatient,,,174642.65,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6534,,186% x Medicaid HMO amount,6534,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13228,,"27,634 x DRG Weight",13228,Other,DRG Base Rate x DRG Weight,11244,,"23,488 x DRG Weight",11244,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3513.21,,DRG base rate x DRG weight + capital per discharge,3513.21,Other,100% of NY Medicaid HMO DRG,3513,,DRG base rate x DRG weight + capital per discharge,3513,Other,100% of NY Medicaid HMO DRG,3513,,DRG base rate x DRG weight + capital per discharge,3513,Other,100% of NY Medicaid HMO DRG,3513,,DRG base rate x DRG weight + capital per discharge,3513,Other,100% of NY Medicaid HMO DRG,7905,,225% x Medicaid HMO amount,7905,Other,225% of NY Medicaid HMO DRG,5375,,153% x Medicaid HMO amount,5375,Other,153% of NY Medicaid HMO DRG,7905,,225% x Medicaid HMO amount,7905,Other,225% of NY Medicaid HMO DRG,4918,,140% x Medicaid HMO amount,4918,Other,140% of NY Medicaid HMO DRG,7905,,DRG base rate x DRG weight + capital per discharge,7905,Other,225% of NY Medicaid HMO DRG,9661,,275% x Medicaid HMO amount,9661,Other,275% of NY Medicaid HMO DRG,11383,,324% x Medicaid HMO amount,11383,Other,324% of NY Medicaid HMO DRG,7553,,215% x Medicaid HMO amount,7553,Other,215% of NY Medicaid HMO DRG,7553,,215% x Medicaid HMO amount,7553,Other,215% of NY Medicaid HMO DRG,4392,,125% x Medicaid HMO amount,4392,Other,125% of NY Medicaid HMO DRG,0.01,13228,
Chronic Kidney Disease #,470-2,APR-DRG,,,,,,,,inpatient,,,262208.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8950,,186% x Medicaid HMO amount,8950,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18882,,"27,634 x DRG Weight",18882,Other,DRG Base Rate x DRG Weight,16049,,"23,488 x DRG Weight",16049,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4812.21,,DRG base rate x DRG weight + capital per discharge,4812.21,Other,100% of NY Medicaid HMO DRG,4812,,DRG base rate x DRG weight + capital per discharge,4812,Other,100% of NY Medicaid HMO DRG,4812,,DRG base rate x DRG weight + capital per discharge,4812,Other,100% of NY Medicaid HMO DRG,4812,,DRG base rate x DRG weight + capital per discharge,4812,Other,100% of NY Medicaid HMO DRG,10827,,225% x Medicaid HMO amount,10827,Other,225% of NY Medicaid HMO DRG,7363,,153% x Medicaid HMO amount,7363,Other,153% of NY Medicaid HMO DRG,10827,,225% x Medicaid HMO amount,10827,Other,225% of NY Medicaid HMO DRG,6737,,140% x Medicaid HMO amount,6737,Other,140% of NY Medicaid HMO DRG,10827,,DRG base rate x DRG weight + capital per discharge,10827,Other,225% of NY Medicaid HMO DRG,13234,,275% x Medicaid HMO amount,13234,Other,275% of NY Medicaid HMO DRG,15592,,324% x Medicaid HMO amount,15592,Other,324% of NY Medicaid HMO DRG,10346,,215% x Medicaid HMO amount,10346,Other,215% of NY Medicaid HMO DRG,10346,,215% x Medicaid HMO amount,10346,Other,215% of NY Medicaid HMO DRG,6015,,125% x Medicaid HMO amount,6015,Other,125% of NY Medicaid HMO DRG,0.01,18882,
Chronic Kidney Disease #,470-3,APR-DRG,,,,,,,,inpatient,,,174642.65,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14960,,186% x Medicaid HMO amount,14960,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32942,,"27,634 x DRG Weight",32942,Other,DRG Base Rate x DRG Weight,28000,,"23,488 x DRG Weight",28000,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8043.21,,DRG base rate x DRG weight + capital per discharge,8043.21,Other,100% of NY Medicaid HMO DRG,8043,,DRG base rate x DRG weight + capital per discharge,8043,Other,100% of NY Medicaid HMO DRG,8043,,DRG base rate x DRG weight + capital per discharge,8043,Other,100% of NY Medicaid HMO DRG,8043,,DRG base rate x DRG weight + capital per discharge,8043,Other,100% of NY Medicaid HMO DRG,18097,,225% x Medicaid HMO amount,18097,Other,225% of NY Medicaid HMO DRG,12306,,153% x Medicaid HMO amount,12306,Other,153% of NY Medicaid HMO DRG,18097,,225% x Medicaid HMO amount,18097,Other,225% of NY Medicaid HMO DRG,11260,,140% x Medicaid HMO amount,11260,Other,140% of NY Medicaid HMO DRG,18097,,DRG base rate x DRG weight + capital per discharge,18097,Other,225% of NY Medicaid HMO DRG,22119,,275% x Medicaid HMO amount,22119,Other,275% of NY Medicaid HMO DRG,26060,,324% x Medicaid HMO amount,26060,Other,324% of NY Medicaid HMO DRG,17293,,215% x Medicaid HMO amount,17293,Other,215% of NY Medicaid HMO DRG,17293,,215% x Medicaid HMO amount,17293,Other,215% of NY Medicaid HMO DRG,10054,,125% x Medicaid HMO amount,10054,Other,125% of NY Medicaid HMO DRG,0.01,32942,
Chronic Kidney Disease #,470-4,APR-DRG,,,,,,,,inpatient,,,617227.05,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32252,,186% x Medicaid HMO amount,32252,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73401,,"27,634 x DRG Weight",73401,Other,DRG Base Rate x DRG Weight,62389,,"23,488 x DRG Weight",62389,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17340.21,,DRG base rate x DRG weight + capital per discharge,17340.21,Other,100% of NY Medicaid HMO DRG,17340,,DRG base rate x DRG weight + capital per discharge,17340,Other,100% of NY Medicaid HMO DRG,17340,,DRG base rate x DRG weight + capital per discharge,17340,Other,100% of NY Medicaid HMO DRG,17340,,DRG base rate x DRG weight + capital per discharge,17340,Other,100% of NY Medicaid HMO DRG,39015,,225% x Medicaid HMO amount,39015,Other,225% of NY Medicaid HMO DRG,26531,,153% x Medicaid HMO amount,26531,Other,153% of NY Medicaid HMO DRG,39015,,225% x Medicaid HMO amount,39015,Other,225% of NY Medicaid HMO DRG,24276,,140% x Medicaid HMO amount,24276,Other,140% of NY Medicaid HMO DRG,39015,,DRG base rate x DRG weight + capital per discharge,39015,Other,225% of NY Medicaid HMO DRG,47686,,275% x Medicaid HMO amount,47686,Other,275% of NY Medicaid HMO DRG,56182,,324% x Medicaid HMO amount,56182,Other,324% of NY Medicaid HMO DRG,37281,,215% x Medicaid HMO amount,37281,Other,215% of NY Medicaid HMO DRG,37281,,215% x Medicaid HMO amount,37281,Other,215% of NY Medicaid HMO DRG,21675,,125% x Medicaid HMO amount,21675,Other,125% of NY Medicaid HMO DRG,0.01,73401,
Major male pelvic procedures,480-1,APR-DRG,,,,,,,,inpatient,,,155333.36,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13855,,186% x Medicaid HMO amount,13855,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30359,,"27,634 x DRG Weight",30359,Other,DRG Base Rate x DRG Weight,25804,,"23,488 x DRG Weight",25804,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7449.21,,DRG base rate x DRG weight + capital per discharge,7449.21,Other,100% of NY Medicaid HMO DRG,7449,,DRG base rate x DRG weight + capital per discharge,7449,Other,100% of NY Medicaid HMO DRG,7449,,DRG base rate x DRG weight + capital per discharge,7449,Other,100% of NY Medicaid HMO DRG,7449,,DRG base rate x DRG weight + capital per discharge,7449,Other,100% of NY Medicaid HMO DRG,16761,,225% x Medicaid HMO amount,16761,Other,225% of NY Medicaid HMO DRG,11397,,153% x Medicaid HMO amount,11397,Other,153% of NY Medicaid HMO DRG,16761,,225% x Medicaid HMO amount,16761,Other,225% of NY Medicaid HMO DRG,10429,,140% x Medicaid HMO amount,10429,Other,140% of NY Medicaid HMO DRG,16761,,DRG base rate x DRG weight + capital per discharge,16761,Other,225% of NY Medicaid HMO DRG,20485,,275% x Medicaid HMO amount,20485,Other,275% of NY Medicaid HMO DRG,24135,,324% x Medicaid HMO amount,24135,Other,324% of NY Medicaid HMO DRG,16016,,215% x Medicaid HMO amount,16016,Other,215% of NY Medicaid HMO DRG,16016,,215% x Medicaid HMO amount,16016,Other,215% of NY Medicaid HMO DRG,9312,,125% x Medicaid HMO amount,9312,Other,125% of NY Medicaid HMO DRG,0.01,30359,
Major male pelvic procedures,480-2,APR-DRG,,,,,,,,inpatient,,,155333.36,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15695,,186% x Medicaid HMO amount,15695,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34661,,"27,634 x DRG Weight",34661,Other,DRG Base Rate x DRG Weight,29461,,"23,488 x DRG Weight",29461,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8438.21,,DRG base rate x DRG weight + capital per discharge,8438.21,Other,100% of NY Medicaid HMO DRG,8438,,DRG base rate x DRG weight + capital per discharge,8438,Other,100% of NY Medicaid HMO DRG,8438,,DRG base rate x DRG weight + capital per discharge,8438,Other,100% of NY Medicaid HMO DRG,8438,,DRG base rate x DRG weight + capital per discharge,8438,Other,100% of NY Medicaid HMO DRG,18986,,225% x Medicaid HMO amount,18986,Other,225% of NY Medicaid HMO DRG,12910,,153% x Medicaid HMO amount,12910,Other,153% of NY Medicaid HMO DRG,18986,,225% x Medicaid HMO amount,18986,Other,225% of NY Medicaid HMO DRG,11813,,140% x Medicaid HMO amount,11813,Other,140% of NY Medicaid HMO DRG,18986,,DRG base rate x DRG weight + capital per discharge,18986,Other,225% of NY Medicaid HMO DRG,23205,,275% x Medicaid HMO amount,23205,Other,275% of NY Medicaid HMO DRG,27340,,324% x Medicaid HMO amount,27340,Other,324% of NY Medicaid HMO DRG,18142,,215% x Medicaid HMO amount,18142,Other,215% of NY Medicaid HMO DRG,18142,,215% x Medicaid HMO amount,18142,Other,215% of NY Medicaid HMO DRG,10548,,125% x Medicaid HMO amount,10548,Other,125% of NY Medicaid HMO DRG,0.01,34661,
Major male pelvic procedures,480-3,APR-DRG,,,,,,,,inpatient,,,155333.36,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26360,,186% x Medicaid HMO amount,26360,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59615,,"27,634 x DRG Weight",59615,Other,DRG Base Rate x DRG Weight,50671,,"23,488 x DRG Weight",50671,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14172.21,,DRG base rate x DRG weight + capital per discharge,14172.21,Other,100% of NY Medicaid HMO DRG,14172,,DRG base rate x DRG weight + capital per discharge,14172,Other,100% of NY Medicaid HMO DRG,14172,,DRG base rate x DRG weight + capital per discharge,14172,Other,100% of NY Medicaid HMO DRG,14172,,DRG base rate x DRG weight + capital per discharge,14172,Other,100% of NY Medicaid HMO DRG,31887,,225% x Medicaid HMO amount,31887,Other,225% of NY Medicaid HMO DRG,21683,,153% x Medicaid HMO amount,21683,Other,153% of NY Medicaid HMO DRG,31887,,225% x Medicaid HMO amount,31887,Other,225% of NY Medicaid HMO DRG,19841,,140% x Medicaid HMO amount,19841,Other,140% of NY Medicaid HMO DRG,31887,,DRG base rate x DRG weight + capital per discharge,31887,Other,225% of NY Medicaid HMO DRG,38974,,275% x Medicaid HMO amount,38974,Other,275% of NY Medicaid HMO DRG,45918,,324% x Medicaid HMO amount,45918,Other,324% of NY Medicaid HMO DRG,30470,,215% x Medicaid HMO amount,30470,Other,215% of NY Medicaid HMO DRG,30470,,215% x Medicaid HMO amount,30470,Other,215% of NY Medicaid HMO DRG,17715,,125% x Medicaid HMO amount,17715,Other,125% of NY Medicaid HMO DRG,0.01,59615,
Major male pelvic procedures,480-4,APR-DRG,,,,,,,,inpatient,,,155333.36,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31559,,186% x Medicaid HMO amount,31559,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,71779,,"27,634 x DRG Weight",71779,Other,DRG Base Rate x DRG Weight,61010,,"23,488 x DRG Weight",61010,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16967.21,,DRG base rate x DRG weight + capital per discharge,16967.21,Other,100% of NY Medicaid HMO DRG,16967,,DRG base rate x DRG weight + capital per discharge,16967,Other,100% of NY Medicaid HMO DRG,16967,,DRG base rate x DRG weight + capital per discharge,16967,Other,100% of NY Medicaid HMO DRG,16967,,DRG base rate x DRG weight + capital per discharge,16967,Other,100% of NY Medicaid HMO DRG,38176,,225% x Medicaid HMO amount,38176,Other,225% of NY Medicaid HMO DRG,25960,,153% x Medicaid HMO amount,25960,Other,153% of NY Medicaid HMO DRG,38176,,225% x Medicaid HMO amount,38176,Other,225% of NY Medicaid HMO DRG,23754,,140% x Medicaid HMO amount,23754,Other,140% of NY Medicaid HMO DRG,38176,,DRG base rate x DRG weight + capital per discharge,38176,Other,225% of NY Medicaid HMO DRG,46660,,275% x Medicaid HMO amount,46660,Other,275% of NY Medicaid HMO DRG,54974,,324% x Medicaid HMO amount,54974,Other,324% of NY Medicaid HMO DRG,36480,,215% x Medicaid HMO amount,36480,Other,215% of NY Medicaid HMO DRG,36480,,215% x Medicaid HMO amount,36480,Other,215% of NY Medicaid HMO DRG,21209,,125% x Medicaid HMO amount,21209,Other,125% of NY Medicaid HMO DRG,0.01,71779,
Penis procedures,481-1,APR-DRG,,,,,,,,inpatient,,,76497.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9644,,186% x Medicaid HMO amount,9644,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20507,,"27,634 x DRG Weight",20507,Other,DRG Base Rate x DRG Weight,17430,,"23,488 x DRG Weight",17430,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5185.21,,DRG base rate x DRG weight + capital per discharge,5185.21,Other,100% of NY Medicaid HMO DRG,5185,,DRG base rate x DRG weight + capital per discharge,5185,Other,100% of NY Medicaid HMO DRG,5185,,DRG base rate x DRG weight + capital per discharge,5185,Other,100% of NY Medicaid HMO DRG,5185,,DRG base rate x DRG weight + capital per discharge,5185,Other,100% of NY Medicaid HMO DRG,11667,,225% x Medicaid HMO amount,11667,Other,225% of NY Medicaid HMO DRG,7933,,153% x Medicaid HMO amount,7933,Other,153% of NY Medicaid HMO DRG,11667,,225% x Medicaid HMO amount,11667,Other,225% of NY Medicaid HMO DRG,7259,,140% x Medicaid HMO amount,7259,Other,140% of NY Medicaid HMO DRG,11667,,DRG base rate x DRG weight + capital per discharge,11667,Other,225% of NY Medicaid HMO DRG,14259,,275% x Medicaid HMO amount,14259,Other,275% of NY Medicaid HMO DRG,16800,,324% x Medicaid HMO amount,16800,Other,324% of NY Medicaid HMO DRG,11148,,215% x Medicaid HMO amount,11148,Other,215% of NY Medicaid HMO DRG,11148,,215% x Medicaid HMO amount,11148,Other,215% of NY Medicaid HMO DRG,6482,,125% x Medicaid HMO amount,6482,Other,125% of NY Medicaid HMO DRG,0.01,20507,
Penis procedures,481-2,APR-DRG,,,,,,,,inpatient,,,103094.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15284,,186% x Medicaid HMO amount,15284,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33700,,"27,634 x DRG Weight",33700,Other,DRG Base Rate x DRG Weight,28644,,"23,488 x DRG Weight",28644,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8217.21,,DRG base rate x DRG weight + capital per discharge,8217.21,Other,100% of NY Medicaid HMO DRG,8217,,DRG base rate x DRG weight + capital per discharge,8217,Other,100% of NY Medicaid HMO DRG,8217,,DRG base rate x DRG weight + capital per discharge,8217,Other,100% of NY Medicaid HMO DRG,8217,,DRG base rate x DRG weight + capital per discharge,8217,Other,100% of NY Medicaid HMO DRG,18489,,225% x Medicaid HMO amount,18489,Other,225% of NY Medicaid HMO DRG,12572,,153% x Medicaid HMO amount,12572,Other,153% of NY Medicaid HMO DRG,18489,,225% x Medicaid HMO amount,18489,Other,225% of NY Medicaid HMO DRG,11504,,140% x Medicaid HMO amount,11504,Other,140% of NY Medicaid HMO DRG,18489,,DRG base rate x DRG weight + capital per discharge,18489,Other,225% of NY Medicaid HMO DRG,22597,,275% x Medicaid HMO amount,22597,Other,275% of NY Medicaid HMO DRG,26624,,324% x Medicaid HMO amount,26624,Other,324% of NY Medicaid HMO DRG,17667,,215% x Medicaid HMO amount,17667,Other,215% of NY Medicaid HMO DRG,17667,,215% x Medicaid HMO amount,17667,Other,215% of NY Medicaid HMO DRG,10272,,125% x Medicaid HMO amount,10272,Other,125% of NY Medicaid HMO DRG,0.01,33700,
Penis procedures,481-3,APR-DRG,,,,,,,,inpatient,,,103094.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23966,,186% x Medicaid HMO amount,23966,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54013,,"27,634 x DRG Weight",54013,Other,DRG Base Rate x DRG Weight,45910,,"23,488 x DRG Weight",45910,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12885.21,,DRG base rate x DRG weight + capital per discharge,12885.21,Other,100% of NY Medicaid HMO DRG,12885,,DRG base rate x DRG weight + capital per discharge,12885,Other,100% of NY Medicaid HMO DRG,12885,,DRG base rate x DRG weight + capital per discharge,12885,Other,100% of NY Medicaid HMO DRG,12885,,DRG base rate x DRG weight + capital per discharge,12885,Other,100% of NY Medicaid HMO DRG,28992,,225% x Medicaid HMO amount,28992,Other,225% of NY Medicaid HMO DRG,19714,,153% x Medicaid HMO amount,19714,Other,153% of NY Medicaid HMO DRG,28992,,225% x Medicaid HMO amount,28992,Other,225% of NY Medicaid HMO DRG,18039,,140% x Medicaid HMO amount,18039,Other,140% of NY Medicaid HMO DRG,28992,,DRG base rate x DRG weight + capital per discharge,28992,Other,225% of NY Medicaid HMO DRG,35434,,275% x Medicaid HMO amount,35434,Other,275% of NY Medicaid HMO DRG,41748,,324% x Medicaid HMO amount,41748,Other,324% of NY Medicaid HMO DRG,27703,,215% x Medicaid HMO amount,27703,Other,215% of NY Medicaid HMO DRG,27703,,215% x Medicaid HMO amount,27703,Other,215% of NY Medicaid HMO DRG,16107,,125% x Medicaid HMO amount,16107,Other,125% of NY Medicaid HMO DRG,0.01,54013,
Penis procedures,481-4,APR-DRG,,,,,,,,inpatient,,,103094.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25287,,186% x Medicaid HMO amount,25287,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57103,,"27,634 x DRG Weight",57103,Other,DRG Base Rate x DRG Weight,48536,,"23,488 x DRG Weight",48536,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13595.21,,DRG base rate x DRG weight + capital per discharge,13595.21,Other,100% of NY Medicaid HMO DRG,13595,,DRG base rate x DRG weight + capital per discharge,13595,Other,100% of NY Medicaid HMO DRG,13595,,DRG base rate x DRG weight + capital per discharge,13595,Other,100% of NY Medicaid HMO DRG,13595,,DRG base rate x DRG weight + capital per discharge,13595,Other,100% of NY Medicaid HMO DRG,30589,,225% x Medicaid HMO amount,30589,Other,225% of NY Medicaid HMO DRG,20801,,153% x Medicaid HMO amount,20801,Other,153% of NY Medicaid HMO DRG,30589,,225% x Medicaid HMO amount,30589,Other,225% of NY Medicaid HMO DRG,19033,,140% x Medicaid HMO amount,19033,Other,140% of NY Medicaid HMO DRG,30589,,DRG base rate x DRG weight + capital per discharge,30589,Other,225% of NY Medicaid HMO DRG,37387,,275% x Medicaid HMO amount,37387,Other,275% of NY Medicaid HMO DRG,44048,,324% x Medicaid HMO amount,44048,Other,324% of NY Medicaid HMO DRG,29230,,215% x Medicaid HMO amount,29230,Other,215% of NY Medicaid HMO DRG,29230,,215% x Medicaid HMO amount,29230,Other,215% of NY Medicaid HMO DRG,16994,,125% x Medicaid HMO amount,16994,Other,125% of NY Medicaid HMO DRG,0.01,57103,
Transurethral prostatectomy,482-1,APR-DRG,,,,,,,,inpatient,,,65399.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8026,,186% x Medicaid HMO amount,8026,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16719,,"27,634 x DRG Weight",16719,Other,DRG Base Rate x DRG Weight,14210,,"23,488 x DRG Weight",14210,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4315.21,,DRG base rate x DRG weight + capital per discharge,4315.21,Other,100% of NY Medicaid HMO DRG,4315,,DRG base rate x DRG weight + capital per discharge,4315,Other,100% of NY Medicaid HMO DRG,4315,,DRG base rate x DRG weight + capital per discharge,4315,Other,100% of NY Medicaid HMO DRG,4315,,DRG base rate x DRG weight + capital per discharge,4315,Other,100% of NY Medicaid HMO DRG,9709,,225% x Medicaid HMO amount,9709,Other,225% of NY Medicaid HMO DRG,6602,,153% x Medicaid HMO amount,6602,Other,153% of NY Medicaid HMO DRG,9709,,225% x Medicaid HMO amount,9709,Other,225% of NY Medicaid HMO DRG,6041,,140% x Medicaid HMO amount,6041,Other,140% of NY Medicaid HMO DRG,9709,,DRG base rate x DRG weight + capital per discharge,9709,Other,225% of NY Medicaid HMO DRG,11867,,275% x Medicaid HMO amount,11867,Other,275% of NY Medicaid HMO DRG,13981,,324% x Medicaid HMO amount,13981,Other,324% of NY Medicaid HMO DRG,9278,,215% x Medicaid HMO amount,9278,Other,215% of NY Medicaid HMO DRG,9278,,215% x Medicaid HMO amount,9278,Other,215% of NY Medicaid HMO DRG,5394,,125% x Medicaid HMO amount,5394,Other,125% of NY Medicaid HMO DRG,0.01,16719,
Transurethral prostatectomy,482-2,APR-DRG,,,,,,,,inpatient,,,60783.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10892,,186% x Medicaid HMO amount,10892,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23428,,"27,634 x DRG Weight",23428,Other,DRG Base Rate x DRG Weight,19913,,"23,488 x DRG Weight",19913,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5856.21,,DRG base rate x DRG weight + capital per discharge,5856.21,Other,100% of NY Medicaid HMO DRG,5856,,DRG base rate x DRG weight + capital per discharge,5856,Other,100% of NY Medicaid HMO DRG,5856,,DRG base rate x DRG weight + capital per discharge,5856,Other,100% of NY Medicaid HMO DRG,5856,,DRG base rate x DRG weight + capital per discharge,5856,Other,100% of NY Medicaid HMO DRG,13176,,225% x Medicaid HMO amount,13176,Other,225% of NY Medicaid HMO DRG,8960,,153% x Medicaid HMO amount,8960,Other,153% of NY Medicaid HMO DRG,13176,,225% x Medicaid HMO amount,13176,Other,225% of NY Medicaid HMO DRG,8199,,140% x Medicaid HMO amount,8199,Other,140% of NY Medicaid HMO DRG,13176,,DRG base rate x DRG weight + capital per discharge,13176,Other,225% of NY Medicaid HMO DRG,16105,,275% x Medicaid HMO amount,16105,Other,275% of NY Medicaid HMO DRG,18974,,324% x Medicaid HMO amount,18974,Other,324% of NY Medicaid HMO DRG,12591,,215% x Medicaid HMO amount,12591,Other,215% of NY Medicaid HMO DRG,12591,,215% x Medicaid HMO amount,12591,Other,215% of NY Medicaid HMO DRG,7320,,125% x Medicaid HMO amount,7320,Other,125% of NY Medicaid HMO DRG,0.01,23428,
Transurethral prostatectomy,482-3,APR-DRG,,,,,,,,inpatient,,,220449.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28681,,186% x Medicaid HMO amount,28681,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65048,,"27,634 x DRG Weight",65048,Other,DRG Base Rate x DRG Weight,55288,,"23,488 x DRG Weight",55288,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15420.21,,DRG base rate x DRG weight + capital per discharge,15420.21,Other,100% of NY Medicaid HMO DRG,15420,,DRG base rate x DRG weight + capital per discharge,15420,Other,100% of NY Medicaid HMO DRG,15420,,DRG base rate x DRG weight + capital per discharge,15420,Other,100% of NY Medicaid HMO DRG,15420,,DRG base rate x DRG weight + capital per discharge,15420,Other,100% of NY Medicaid HMO DRG,34695,,225% x Medicaid HMO amount,34695,Other,225% of NY Medicaid HMO DRG,23593,,153% x Medicaid HMO amount,23593,Other,153% of NY Medicaid HMO DRG,34695,,225% x Medicaid HMO amount,34695,Other,225% of NY Medicaid HMO DRG,21588,,140% x Medicaid HMO amount,21588,Other,140% of NY Medicaid HMO DRG,34695,,DRG base rate x DRG weight + capital per discharge,34695,Other,225% of NY Medicaid HMO DRG,42406,,275% x Medicaid HMO amount,42406,Other,275% of NY Medicaid HMO DRG,49961,,324% x Medicaid HMO amount,49961,Other,324% of NY Medicaid HMO DRG,33153,,215% x Medicaid HMO amount,33153,Other,215% of NY Medicaid HMO DRG,33153,,215% x Medicaid HMO amount,33153,Other,215% of NY Medicaid HMO DRG,19275,,125% x Medicaid HMO amount,19275,Other,125% of NY Medicaid HMO DRG,0.01,65048,
Transurethral prostatectomy,482-4,APR-DRG,,,,,,,,inpatient,,,220449.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32836,,186% x Medicaid HMO amount,32836,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74769,,"27,634 x DRG Weight",74769,Other,DRG Base Rate x DRG Weight,63551,,"23,488 x DRG Weight",63551,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17654.21,,DRG base rate x DRG weight + capital per discharge,17654.21,Other,100% of NY Medicaid HMO DRG,17654,,DRG base rate x DRG weight + capital per discharge,17654,Other,100% of NY Medicaid HMO DRG,17654,,DRG base rate x DRG weight + capital per discharge,17654,Other,100% of NY Medicaid HMO DRG,17654,,DRG base rate x DRG weight + capital per discharge,17654,Other,100% of NY Medicaid HMO DRG,39722,,225% x Medicaid HMO amount,39722,Other,225% of NY Medicaid HMO DRG,27011,,153% x Medicaid HMO amount,27011,Other,153% of NY Medicaid HMO DRG,39722,,225% x Medicaid HMO amount,39722,Other,225% of NY Medicaid HMO DRG,24716,,140% x Medicaid HMO amount,24716,Other,140% of NY Medicaid HMO DRG,39722,,DRG base rate x DRG weight + capital per discharge,39722,Other,225% of NY Medicaid HMO DRG,48549,,275% x Medicaid HMO amount,48549,Other,275% of NY Medicaid HMO DRG,57200,,324% x Medicaid HMO amount,57200,Other,324% of NY Medicaid HMO DRG,37957,,215% x Medicaid HMO amount,37957,Other,215% of NY Medicaid HMO DRG,37957,,215% x Medicaid HMO amount,37957,Other,215% of NY Medicaid HMO DRG,22068,,125% x Medicaid HMO amount,22068,Other,125% of NY Medicaid HMO DRG,0.01,74769,
Testes & scrotal procedures,483-1,APR-DRG,,,,,,,,inpatient,,,64859.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8340,,186% x Medicaid HMO amount,8340,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17456,,"27,634 x DRG Weight",17456,Other,DRG Base Rate x DRG Weight,14837,,"23,488 x DRG Weight",14837,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4484.21,,DRG base rate x DRG weight + capital per discharge,4484.21,Other,100% of NY Medicaid HMO DRG,4484,,DRG base rate x DRG weight + capital per discharge,4484,Other,100% of NY Medicaid HMO DRG,4484,,DRG base rate x DRG weight + capital per discharge,4484,Other,100% of NY Medicaid HMO DRG,4484,,DRG base rate x DRG weight + capital per discharge,4484,Other,100% of NY Medicaid HMO DRG,10089,,225% x Medicaid HMO amount,10089,Other,225% of NY Medicaid HMO DRG,6861,,153% x Medicaid HMO amount,6861,Other,153% of NY Medicaid HMO DRG,10089,,225% x Medicaid HMO amount,10089,Other,225% of NY Medicaid HMO DRG,6278,,140% x Medicaid HMO amount,6278,Other,140% of NY Medicaid HMO DRG,10089,,DRG base rate x DRG weight + capital per discharge,10089,Other,225% of NY Medicaid HMO DRG,12332,,275% x Medicaid HMO amount,12332,Other,275% of NY Medicaid HMO DRG,14529,,324% x Medicaid HMO amount,14529,Other,324% of NY Medicaid HMO DRG,9641,,215% x Medicaid HMO amount,9641,Other,215% of NY Medicaid HMO DRG,9641,,215% x Medicaid HMO amount,9641,Other,215% of NY Medicaid HMO DRG,5605,,125% x Medicaid HMO amount,5605,Other,125% of NY Medicaid HMO DRG,0.01,17456,
Testes & scrotal procedures,483-2,APR-DRG,,,,,,,,inpatient,,,454050.94,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16009,,186% x Medicaid HMO amount,16009,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35399,,"27,634 x DRG Weight",35399,Other,DRG Base Rate x DRG Weight,30088,,"23,488 x DRG Weight",30088,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8607.21,,DRG base rate x DRG weight + capital per discharge,8607.21,Other,100% of NY Medicaid HMO DRG,8607,,DRG base rate x DRG weight + capital per discharge,8607,Other,100% of NY Medicaid HMO DRG,8607,,DRG base rate x DRG weight + capital per discharge,8607,Other,100% of NY Medicaid HMO DRG,8607,,DRG base rate x DRG weight + capital per discharge,8607,Other,100% of NY Medicaid HMO DRG,19366,,225% x Medicaid HMO amount,19366,Other,225% of NY Medicaid HMO DRG,13169,,153% x Medicaid HMO amount,13169,Other,153% of NY Medicaid HMO DRG,19366,,225% x Medicaid HMO amount,19366,Other,225% of NY Medicaid HMO DRG,12050,,140% x Medicaid HMO amount,12050,Other,140% of NY Medicaid HMO DRG,19366,,DRG base rate x DRG weight + capital per discharge,19366,Other,225% of NY Medicaid HMO DRG,23670,,275% x Medicaid HMO amount,23670,Other,275% of NY Medicaid HMO DRG,27887,,324% x Medicaid HMO amount,27887,Other,324% of NY Medicaid HMO DRG,18506,,215% x Medicaid HMO amount,18506,Other,215% of NY Medicaid HMO DRG,18506,,215% x Medicaid HMO amount,18506,Other,215% of NY Medicaid HMO DRG,10759,,125% x Medicaid HMO amount,10759,Other,125% of NY Medicaid HMO DRG,0.01,35399,
Testes & scrotal procedures,483-3,APR-DRG,,,,,,,,inpatient,,,75664.11,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38456,,186% x Medicaid HMO amount,38456,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,87918,,"27,634 x DRG Weight",87918,Other,DRG Base Rate x DRG Weight,74727,,"23,488 x DRG Weight",74727,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20675.21,,DRG base rate x DRG weight + capital per discharge,20675.21,Other,100% of NY Medicaid HMO DRG,20675,,DRG base rate x DRG weight + capital per discharge,20675,Other,100% of NY Medicaid HMO DRG,20675,,DRG base rate x DRG weight + capital per discharge,20675,Other,100% of NY Medicaid HMO DRG,20675,,DRG base rate x DRG weight + capital per discharge,20675,Other,100% of NY Medicaid HMO DRG,46519,,225% x Medicaid HMO amount,46519,Other,225% of NY Medicaid HMO DRG,31633,,153% x Medicaid HMO amount,31633,Other,153% of NY Medicaid HMO DRG,46519,,225% x Medicaid HMO amount,46519,Other,225% of NY Medicaid HMO DRG,28945,,140% x Medicaid HMO amount,28945,Other,140% of NY Medicaid HMO DRG,46519,,DRG base rate x DRG weight + capital per discharge,46519,Other,225% of NY Medicaid HMO DRG,56857,,275% x Medicaid HMO amount,56857,Other,275% of NY Medicaid HMO DRG,66988,,324% x Medicaid HMO amount,66988,Other,324% of NY Medicaid HMO DRG,44452,,215% x Medicaid HMO amount,44452,Other,215% of NY Medicaid HMO DRG,44452,,215% x Medicaid HMO amount,44452,Other,215% of NY Medicaid HMO DRG,25844,,125% x Medicaid HMO amount,25844,Other,125% of NY Medicaid HMO DRG,0.01,87918,
Testes & scrotal procedures,483-4,APR-DRG,,,,,,,,inpatient,,,75664.11,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51407,,186% x Medicaid HMO amount,51407,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,118218,,"27,634 x DRG Weight",118218,Other,DRG Base Rate x DRG Weight,100482,,"23,488 x DRG Weight",100482,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27638.21,,DRG base rate x DRG weight + capital per discharge,27638.21,Other,100% of NY Medicaid HMO DRG,27638,,DRG base rate x DRG weight + capital per discharge,27638,Other,100% of NY Medicaid HMO DRG,27638,,DRG base rate x DRG weight + capital per discharge,27638,Other,100% of NY Medicaid HMO DRG,27638,,DRG base rate x DRG weight + capital per discharge,27638,Other,100% of NY Medicaid HMO DRG,62186,,225% x Medicaid HMO amount,62186,Other,225% of NY Medicaid HMO DRG,42286,,153% x Medicaid HMO amount,42286,Other,153% of NY Medicaid HMO DRG,62186,,225% x Medicaid HMO amount,62186,Other,225% of NY Medicaid HMO DRG,38693,,140% x Medicaid HMO amount,38693,Other,140% of NY Medicaid HMO DRG,62186,,DRG base rate x DRG weight + capital per discharge,62186,Other,225% of NY Medicaid HMO DRG,76005,,275% x Medicaid HMO amount,76005,Other,275% of NY Medicaid HMO DRG,89548,,324% x Medicaid HMO amount,89548,Other,324% of NY Medicaid HMO DRG,59422,,215% x Medicaid HMO amount,59422,Other,215% of NY Medicaid HMO DRG,59422,,215% x Medicaid HMO amount,59422,Other,215% of NY Medicaid HMO DRG,34548,,125% x Medicaid HMO amount,34548,Other,125% of NY Medicaid HMO DRG,0.01,118218,
Other male reproductive system & related procedures,484-1,APR-DRG,,,,,,,,inpatient,,,87760.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11255,,186% x Medicaid HMO amount,11255,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24274,,"27,634 x DRG Weight",24274,Other,DRG Base Rate x DRG Weight,20632,,"23,488 x DRG Weight",20632,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6051.21,,DRG base rate x DRG weight + capital per discharge,6051.21,Other,100% of NY Medicaid HMO DRG,6051,,DRG base rate x DRG weight + capital per discharge,6051,Other,100% of NY Medicaid HMO DRG,6051,,DRG base rate x DRG weight + capital per discharge,6051,Other,100% of NY Medicaid HMO DRG,6051,,DRG base rate x DRG weight + capital per discharge,6051,Other,100% of NY Medicaid HMO DRG,13615,,225% x Medicaid HMO amount,13615,Other,225% of NY Medicaid HMO DRG,9258,,153% x Medicaid HMO amount,9258,Other,153% of NY Medicaid HMO DRG,13615,,225% x Medicaid HMO amount,13615,Other,225% of NY Medicaid HMO DRG,8472,,140% x Medicaid HMO amount,8472,Other,140% of NY Medicaid HMO DRG,13615,,DRG base rate x DRG weight + capital per discharge,13615,Other,225% of NY Medicaid HMO DRG,16641,,275% x Medicaid HMO amount,16641,Other,275% of NY Medicaid HMO DRG,19606,,324% x Medicaid HMO amount,19606,Other,324% of NY Medicaid HMO DRG,13010,,215% x Medicaid HMO amount,13010,Other,215% of NY Medicaid HMO DRG,13010,,215% x Medicaid HMO amount,13010,Other,215% of NY Medicaid HMO DRG,7564,,125% x Medicaid HMO amount,7564,Other,125% of NY Medicaid HMO DRG,0.01,24274,
Other male reproductive system & related procedures,484-2,APR-DRG,,,,,,,,inpatient,,,87760.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14776,,186% x Medicaid HMO amount,14776,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32514,,"27,634 x DRG Weight",32514,Other,DRG Base Rate x DRG Weight,27636,,"23,488 x DRG Weight",27636,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7944.21,,DRG base rate x DRG weight + capital per discharge,7944.21,Other,100% of NY Medicaid HMO DRG,7944,,DRG base rate x DRG weight + capital per discharge,7944,Other,100% of NY Medicaid HMO DRG,7944,,DRG base rate x DRG weight + capital per discharge,7944,Other,100% of NY Medicaid HMO DRG,7944,,DRG base rate x DRG weight + capital per discharge,7944,Other,100% of NY Medicaid HMO DRG,17874,,225% x Medicaid HMO amount,17874,Other,225% of NY Medicaid HMO DRG,12155,,153% x Medicaid HMO amount,12155,Other,153% of NY Medicaid HMO DRG,17874,,225% x Medicaid HMO amount,17874,Other,225% of NY Medicaid HMO DRG,11122,,140% x Medicaid HMO amount,11122,Other,140% of NY Medicaid HMO DRG,17874,,DRG base rate x DRG weight + capital per discharge,17874,Other,225% of NY Medicaid HMO DRG,21847,,275% x Medicaid HMO amount,21847,Other,275% of NY Medicaid HMO DRG,25739,,324% x Medicaid HMO amount,25739,Other,324% of NY Medicaid HMO DRG,17080,,215% x Medicaid HMO amount,17080,Other,215% of NY Medicaid HMO DRG,17080,,215% x Medicaid HMO amount,17080,Other,215% of NY Medicaid HMO DRG,9930,,125% x Medicaid HMO amount,9930,Other,125% of NY Medicaid HMO DRG,0.01,32514,
Other male reproductive system & related procedures,484-3,APR-DRG,,,,,,,,inpatient,,,110586.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24171,,186% x Medicaid HMO amount,24171,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54494,,"27,634 x DRG Weight",54494,Other,DRG Base Rate x DRG Weight,46318,,"23,488 x DRG Weight",46318,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12995.21,,DRG base rate x DRG weight + capital per discharge,12995.21,Other,100% of NY Medicaid HMO DRG,12995,,DRG base rate x DRG weight + capital per discharge,12995,Other,100% of NY Medicaid HMO DRG,12995,,DRG base rate x DRG weight + capital per discharge,12995,Other,100% of NY Medicaid HMO DRG,12995,,DRG base rate x DRG weight + capital per discharge,12995,Other,100% of NY Medicaid HMO DRG,29239,,225% x Medicaid HMO amount,29239,Other,225% of NY Medicaid HMO DRG,19883,,153% x Medicaid HMO amount,19883,Other,153% of NY Medicaid HMO DRG,29239,,225% x Medicaid HMO amount,29239,Other,225% of NY Medicaid HMO DRG,18193,,140% x Medicaid HMO amount,18193,Other,140% of NY Medicaid HMO DRG,29239,,DRG base rate x DRG weight + capital per discharge,29239,Other,225% of NY Medicaid HMO DRG,35737,,275% x Medicaid HMO amount,35737,Other,275% of NY Medicaid HMO DRG,42104,,324% x Medicaid HMO amount,42104,Other,324% of NY Medicaid HMO DRG,27940,,215% x Medicaid HMO amount,27940,Other,215% of NY Medicaid HMO DRG,27940,,215% x Medicaid HMO amount,27940,Other,215% of NY Medicaid HMO DRG,16244,,125% x Medicaid HMO amount,16244,Other,125% of NY Medicaid HMO DRG,0.01,54494,
Other male reproductive system & related procedures,484-4,APR-DRG,,,,,,,,inpatient,,,1687755.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26248,,186% x Medicaid HMO amount,26248,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59355,,"27,634 x DRG Weight",59355,Other,DRG Base Rate x DRG Weight,50450,,"23,488 x DRG Weight",50450,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14112.21,,DRG base rate x DRG weight + capital per discharge,14112.21,Other,100% of NY Medicaid HMO DRG,14112,,DRG base rate x DRG weight + capital per discharge,14112,Other,100% of NY Medicaid HMO DRG,14112,,DRG base rate x DRG weight + capital per discharge,14112,Other,100% of NY Medicaid HMO DRG,14112,,DRG base rate x DRG weight + capital per discharge,14112,Other,100% of NY Medicaid HMO DRG,31752,,225% x Medicaid HMO amount,31752,Other,225% of NY Medicaid HMO DRG,21592,,153% x Medicaid HMO amount,21592,Other,153% of NY Medicaid HMO DRG,31752,,225% x Medicaid HMO amount,31752,Other,225% of NY Medicaid HMO DRG,19757,,140% x Medicaid HMO amount,19757,Other,140% of NY Medicaid HMO DRG,31752,,DRG base rate x DRG weight + capital per discharge,31752,Other,225% of NY Medicaid HMO DRG,38809,,275% x Medicaid HMO amount,38809,Other,275% of NY Medicaid HMO DRG,45724,,324% x Medicaid HMO amount,45724,Other,324% of NY Medicaid HMO DRG,30341,,215% x Medicaid HMO amount,30341,Other,215% of NY Medicaid HMO DRG,30341,,215% x Medicaid HMO amount,30341,Other,215% of NY Medicaid HMO DRG,17640,,125% x Medicaid HMO amount,17640,Other,125% of NY Medicaid HMO DRG,0.01,59355,
"Malignancy, male reproductive system",500-1,APR-DRG,,,,,,,,inpatient,,,19635,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5863,,186% x Medicaid HMO amount,5863,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11659,,"27,634 x DRG Weight",11659,Other,DRG Base Rate x DRG Weight,9910,,"23,488 x DRG Weight",9910,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3152.21,,DRG base rate x DRG weight + capital per discharge,3152.21,Other,100% of NY Medicaid HMO DRG,3152,,DRG base rate x DRG weight + capital per discharge,3152,Other,100% of NY Medicaid HMO DRG,3152,,DRG base rate x DRG weight + capital per discharge,3152,Other,100% of NY Medicaid HMO DRG,3152,,DRG base rate x DRG weight + capital per discharge,3152,Other,100% of NY Medicaid HMO DRG,7092,,225% x Medicaid HMO amount,7092,Other,225% of NY Medicaid HMO DRG,4823,,153% x Medicaid HMO amount,4823,Other,153% of NY Medicaid HMO DRG,7092,,225% x Medicaid HMO amount,7092,Other,225% of NY Medicaid HMO DRG,4413,,140% x Medicaid HMO amount,4413,Other,140% of NY Medicaid HMO DRG,7092,,DRG base rate x DRG weight + capital per discharge,7092,Other,225% of NY Medicaid HMO DRG,8669,,275% x Medicaid HMO amount,8669,Other,275% of NY Medicaid HMO DRG,10213,,324% x Medicaid HMO amount,10213,Other,324% of NY Medicaid HMO DRG,6777,,215% x Medicaid HMO amount,6777,Other,215% of NY Medicaid HMO DRG,6777,,215% x Medicaid HMO amount,6777,Other,215% of NY Medicaid HMO DRG,3940,,125% x Medicaid HMO amount,3940,Other,125% of NY Medicaid HMO DRG,0.01,11659,
"Malignancy, male reproductive system",500-2,APR-DRG,,,,,,,,inpatient,,,236688.78,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12014,,186% x Medicaid HMO amount,12014,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26051,,"27,634 x DRG Weight",26051,Other,DRG Base Rate x DRG Weight,22142,,"23,488 x DRG Weight",22142,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6459.21,,DRG base rate x DRG weight + capital per discharge,6459.21,Other,100% of NY Medicaid HMO DRG,6459,,DRG base rate x DRG weight + capital per discharge,6459,Other,100% of NY Medicaid HMO DRG,6459,,DRG base rate x DRG weight + capital per discharge,6459,Other,100% of NY Medicaid HMO DRG,6459,,DRG base rate x DRG weight + capital per discharge,6459,Other,100% of NY Medicaid HMO DRG,14533,,225% x Medicaid HMO amount,14533,Other,225% of NY Medicaid HMO DRG,9883,,153% x Medicaid HMO amount,9883,Other,153% of NY Medicaid HMO DRG,14533,,225% x Medicaid HMO amount,14533,Other,225% of NY Medicaid HMO DRG,9043,,140% x Medicaid HMO amount,9043,Other,140% of NY Medicaid HMO DRG,14533,,DRG base rate x DRG weight + capital per discharge,14533,Other,225% of NY Medicaid HMO DRG,17763,,275% x Medicaid HMO amount,17763,Other,275% of NY Medicaid HMO DRG,20928,,324% x Medicaid HMO amount,20928,Other,324% of NY Medicaid HMO DRG,13887,,215% x Medicaid HMO amount,13887,Other,215% of NY Medicaid HMO DRG,13887,,215% x Medicaid HMO amount,13887,Other,215% of NY Medicaid HMO DRG,8074,,125% x Medicaid HMO amount,8074,Other,125% of NY Medicaid HMO DRG,0.01,26051,
"Malignancy, male reproductive system",500-3,APR-DRG,,,,,,,,inpatient,,,265957.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19537,,186% x Medicaid HMO amount,19537,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43653,,"27,634 x DRG Weight",43653,Other,DRG Base Rate x DRG Weight,37104,,"23,488 x DRG Weight",37104,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10504.21,,DRG base rate x DRG weight + capital per discharge,10504.21,Other,100% of NY Medicaid HMO DRG,10504,,DRG base rate x DRG weight + capital per discharge,10504,Other,100% of NY Medicaid HMO DRG,10504,,DRG base rate x DRG weight + capital per discharge,10504,Other,100% of NY Medicaid HMO DRG,10504,,DRG base rate x DRG weight + capital per discharge,10504,Other,100% of NY Medicaid HMO DRG,23634,,225% x Medicaid HMO amount,23634,Other,225% of NY Medicaid HMO DRG,16071,,153% x Medicaid HMO amount,16071,Other,153% of NY Medicaid HMO DRG,23634,,225% x Medicaid HMO amount,23634,Other,225% of NY Medicaid HMO DRG,14706,,140% x Medicaid HMO amount,14706,Other,140% of NY Medicaid HMO DRG,23634,,DRG base rate x DRG weight + capital per discharge,23634,Other,225% of NY Medicaid HMO DRG,28887,,275% x Medicaid HMO amount,28887,Other,275% of NY Medicaid HMO DRG,34034,,324% x Medicaid HMO amount,34034,Other,324% of NY Medicaid HMO DRG,22584,,215% x Medicaid HMO amount,22584,Other,215% of NY Medicaid HMO DRG,22584,,215% x Medicaid HMO amount,22584,Other,215% of NY Medicaid HMO DRG,13130,,125% x Medicaid HMO amount,13130,Other,125% of NY Medicaid HMO DRG,0.01,43653,
"Malignancy, male reproductive system",500-4,APR-DRG,,,,,,,,inpatient,,,265957.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22632,,186% x Medicaid HMO amount,22632,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,50896,,"27,634 x DRG Weight",50896,Other,DRG Base Rate x DRG Weight,43260,,"23,488 x DRG Weight",43260,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12168.21,,DRG base rate x DRG weight + capital per discharge,12168.21,Other,100% of NY Medicaid HMO DRG,12168,,DRG base rate x DRG weight + capital per discharge,12168,Other,100% of NY Medicaid HMO DRG,12168,,DRG base rate x DRG weight + capital per discharge,12168,Other,100% of NY Medicaid HMO DRG,12168,,DRG base rate x DRG weight + capital per discharge,12168,Other,100% of NY Medicaid HMO DRG,27378,,225% x Medicaid HMO amount,27378,Other,225% of NY Medicaid HMO DRG,18617,,153% x Medicaid HMO amount,18617,Other,153% of NY Medicaid HMO DRG,27378,,225% x Medicaid HMO amount,27378,Other,225% of NY Medicaid HMO DRG,17035,,140% x Medicaid HMO amount,17035,Other,140% of NY Medicaid HMO DRG,27378,,DRG base rate x DRG weight + capital per discharge,27378,Other,225% of NY Medicaid HMO DRG,33463,,275% x Medicaid HMO amount,33463,Other,275% of NY Medicaid HMO DRG,39425,,324% x Medicaid HMO amount,39425,Other,324% of NY Medicaid HMO DRG,26162,,215% x Medicaid HMO amount,26162,Other,215% of NY Medicaid HMO DRG,26162,,215% x Medicaid HMO amount,26162,Other,215% of NY Medicaid HMO DRG,15210,,125% x Medicaid HMO amount,15210,Other,125% of NY Medicaid HMO DRG,0.01,50896,
Male reproductive system diagnoses except malignancy,501-1,APR-DRG,,,,,,,,inpatient,,,77365.68,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6588,,186% x Medicaid HMO amount,6588,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13358,,"27,634 x DRG Weight",13358,Other,DRG Base Rate x DRG Weight,11354,,"23,488 x DRG Weight",11354,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3542.21,,DRG base rate x DRG weight + capital per discharge,3542.21,Other,100% of NY Medicaid HMO DRG,3542,,DRG base rate x DRG weight + capital per discharge,3542,Other,100% of NY Medicaid HMO DRG,3542,,DRG base rate x DRG weight + capital per discharge,3542,Other,100% of NY Medicaid HMO DRG,3542,,DRG base rate x DRG weight + capital per discharge,3542,Other,100% of NY Medicaid HMO DRG,7970,,225% x Medicaid HMO amount,7970,Other,225% of NY Medicaid HMO DRG,5420,,153% x Medicaid HMO amount,5420,Other,153% of NY Medicaid HMO DRG,7970,,225% x Medicaid HMO amount,7970,Other,225% of NY Medicaid HMO DRG,4959,,140% x Medicaid HMO amount,4959,Other,140% of NY Medicaid HMO DRG,7970,,DRG base rate x DRG weight + capital per discharge,7970,Other,225% of NY Medicaid HMO DRG,9741,,275% x Medicaid HMO amount,9741,Other,275% of NY Medicaid HMO DRG,11477,,324% x Medicaid HMO amount,11477,Other,324% of NY Medicaid HMO DRG,7616,,215% x Medicaid HMO amount,7616,Other,215% of NY Medicaid HMO DRG,7616,,215% x Medicaid HMO amount,7616,Other,215% of NY Medicaid HMO DRG,4428,,125% x Medicaid HMO amount,4428,Other,125% of NY Medicaid HMO DRG,0.01,13358,
Male reproductive system diagnoses except malignancy,501-2,APR-DRG,,,,,,,,inpatient,,,127380.27,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8980,,186% x Medicaid HMO amount,8980,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18954,,"27,634 x DRG Weight",18954,Other,DRG Base Rate x DRG Weight,16110,,"23,488 x DRG Weight",16110,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4828.21,,DRG base rate x DRG weight + capital per discharge,4828.21,Other,100% of NY Medicaid HMO DRG,4828,,DRG base rate x DRG weight + capital per discharge,4828,Other,100% of NY Medicaid HMO DRG,4828,,DRG base rate x DRG weight + capital per discharge,4828,Other,100% of NY Medicaid HMO DRG,4828,,DRG base rate x DRG weight + capital per discharge,4828,Other,100% of NY Medicaid HMO DRG,10863,,225% x Medicaid HMO amount,10863,Other,225% of NY Medicaid HMO DRG,7387,,153% x Medicaid HMO amount,7387,Other,153% of NY Medicaid HMO DRG,10863,,225% x Medicaid HMO amount,10863,Other,225% of NY Medicaid HMO DRG,6759,,140% x Medicaid HMO amount,6759,Other,140% of NY Medicaid HMO DRG,10863,,DRG base rate x DRG weight + capital per discharge,10863,Other,225% of NY Medicaid HMO DRG,13278,,275% x Medicaid HMO amount,13278,Other,275% of NY Medicaid HMO DRG,15643,,324% x Medicaid HMO amount,15643,Other,324% of NY Medicaid HMO DRG,10381,,215% x Medicaid HMO amount,10381,Other,215% of NY Medicaid HMO DRG,10381,,215% x Medicaid HMO amount,10381,Other,215% of NY Medicaid HMO DRG,6035,,125% x Medicaid HMO amount,6035,Other,125% of NY Medicaid HMO DRG,0.01,18954,
Male reproductive system diagnoses except malignancy,501-3,APR-DRG,,,,,,,,inpatient,,,179314.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14140,,186% x Medicaid HMO amount,14140,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31025,,"27,634 x DRG Weight",31025,Other,DRG Base Rate x DRG Weight,26370,,"23,488 x DRG Weight",26370,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7602.21,,DRG base rate x DRG weight + capital per discharge,7602.21,Other,100% of NY Medicaid HMO DRG,7602,,DRG base rate x DRG weight + capital per discharge,7602,Other,100% of NY Medicaid HMO DRG,7602,,DRG base rate x DRG weight + capital per discharge,7602,Other,100% of NY Medicaid HMO DRG,7602,,DRG base rate x DRG weight + capital per discharge,7602,Other,100% of NY Medicaid HMO DRG,17105,,225% x Medicaid HMO amount,17105,Other,225% of NY Medicaid HMO DRG,11631,,153% x Medicaid HMO amount,11631,Other,153% of NY Medicaid HMO DRG,17105,,225% x Medicaid HMO amount,17105,Other,225% of NY Medicaid HMO DRG,10643,,140% x Medicaid HMO amount,10643,Other,140% of NY Medicaid HMO DRG,17105,,DRG base rate x DRG weight + capital per discharge,17105,Other,225% of NY Medicaid HMO DRG,20906,,275% x Medicaid HMO amount,20906,Other,275% of NY Medicaid HMO DRG,24631,,324% x Medicaid HMO amount,24631,Other,324% of NY Medicaid HMO DRG,16345,,215% x Medicaid HMO amount,16345,Other,215% of NY Medicaid HMO DRG,16345,,215% x Medicaid HMO amount,16345,Other,215% of NY Medicaid HMO DRG,9503,,125% x Medicaid HMO amount,9503,Other,125% of NY Medicaid HMO DRG,0.01,31025,
Male reproductive system diagnoses except malignancy,501-4,APR-DRG,,,,,,,,inpatient,,,121672.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26068,,186% x Medicaid HMO amount,26068,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58932,,"27,634 x DRG Weight",58932,Other,DRG Base Rate x DRG Weight,50091,,"23,488 x DRG Weight",50091,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14015.21,,DRG base rate x DRG weight + capital per discharge,14015.21,Other,100% of NY Medicaid HMO DRG,14015,,DRG base rate x DRG weight + capital per discharge,14015,Other,100% of NY Medicaid HMO DRG,14015,,DRG base rate x DRG weight + capital per discharge,14015,Other,100% of NY Medicaid HMO DRG,14015,,DRG base rate x DRG weight + capital per discharge,14015,Other,100% of NY Medicaid HMO DRG,31534,,225% x Medicaid HMO amount,31534,Other,225% of NY Medicaid HMO DRG,21443,,153% x Medicaid HMO amount,21443,Other,153% of NY Medicaid HMO DRG,31534,,225% x Medicaid HMO amount,31534,Other,225% of NY Medicaid HMO DRG,19621,,140% x Medicaid HMO amount,19621,Other,140% of NY Medicaid HMO DRG,31534,,DRG base rate x DRG weight + capital per discharge,31534,Other,225% of NY Medicaid HMO DRG,38542,,275% x Medicaid HMO amount,38542,Other,275% of NY Medicaid HMO DRG,45409,,324% x Medicaid HMO amount,45409,Other,324% of NY Medicaid HMO DRG,30133,,215% x Medicaid HMO amount,30133,Other,215% of NY Medicaid HMO DRG,30133,,215% x Medicaid HMO amount,30133,Other,215% of NY Medicaid HMO DRG,17519,,125% x Medicaid HMO amount,17519,Other,125% of NY Medicaid HMO DRG,0.01,58932,
"Pelvic evisceration, radical hysterectomy & other radical GYN procs",510-1,APR-DRG,,,,,,,,inpatient,,,136847.81,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14160,,186% x Medicaid HMO amount,14160,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31072,,"27,634 x DRG Weight",31072,Other,DRG Base Rate x DRG Weight,26410,,"23,488 x DRG Weight",26410,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7613.21,,DRG base rate x DRG weight + capital per discharge,7613.21,Other,100% of NY Medicaid HMO DRG,7613,,DRG base rate x DRG weight + capital per discharge,7613,Other,100% of NY Medicaid HMO DRG,7613,,DRG base rate x DRG weight + capital per discharge,7613,Other,100% of NY Medicaid HMO DRG,7613,,DRG base rate x DRG weight + capital per discharge,7613,Other,100% of NY Medicaid HMO DRG,17130,,225% x Medicaid HMO amount,17130,Other,225% of NY Medicaid HMO DRG,11648,,153% x Medicaid HMO amount,11648,Other,153% of NY Medicaid HMO DRG,17130,,225% x Medicaid HMO amount,17130,Other,225% of NY Medicaid HMO DRG,10658,,140% x Medicaid HMO amount,10658,Other,140% of NY Medicaid HMO DRG,17130,,DRG base rate x DRG weight + capital per discharge,17130,Other,225% of NY Medicaid HMO DRG,20936,,275% x Medicaid HMO amount,20936,Other,275% of NY Medicaid HMO DRG,24667,,324% x Medicaid HMO amount,24667,Other,324% of NY Medicaid HMO DRG,16368,,215% x Medicaid HMO amount,16368,Other,215% of NY Medicaid HMO DRG,16368,,215% x Medicaid HMO amount,16368,Other,215% of NY Medicaid HMO DRG,9517,,125% x Medicaid HMO amount,9517,Other,125% of NY Medicaid HMO DRG,0.01,31072,
"Pelvic evisceration, radical hysterectomy & other radical GYN procs",510-2,APR-DRG,,,,,,,,inpatient,,,362405.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17815,,186% x Medicaid HMO amount,17815,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39622,,"27,634 x DRG Weight",39622,Other,DRG Base Rate x DRG Weight,33677,,"23,488 x DRG Weight",33677,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9578.21,,DRG base rate x DRG weight + capital per discharge,9578.21,Other,100% of NY Medicaid HMO DRG,9578,,DRG base rate x DRG weight + capital per discharge,9578,Other,100% of NY Medicaid HMO DRG,9578,,DRG base rate x DRG weight + capital per discharge,9578,Other,100% of NY Medicaid HMO DRG,9578,,DRG base rate x DRG weight + capital per discharge,9578,Other,100% of NY Medicaid HMO DRG,21551,,225% x Medicaid HMO amount,21551,Other,225% of NY Medicaid HMO DRG,14655,,153% x Medicaid HMO amount,14655,Other,153% of NY Medicaid HMO DRG,21551,,225% x Medicaid HMO amount,21551,Other,225% of NY Medicaid HMO DRG,13409,,140% x Medicaid HMO amount,13409,Other,140% of NY Medicaid HMO DRG,21551,,DRG base rate x DRG weight + capital per discharge,21551,Other,225% of NY Medicaid HMO DRG,26340,,275% x Medicaid HMO amount,26340,Other,275% of NY Medicaid HMO DRG,31033,,324% x Medicaid HMO amount,31033,Other,324% of NY Medicaid HMO DRG,20593,,215% x Medicaid HMO amount,20593,Other,215% of NY Medicaid HMO DRG,20593,,215% x Medicaid HMO amount,20593,Other,215% of NY Medicaid HMO DRG,11973,,125% x Medicaid HMO amount,11973,Other,125% of NY Medicaid HMO DRG,0.01,39622,
"Pelvic evisceration, radical hysterectomy & other radical GYN procs",510-3,APR-DRG,,,,,,,,inpatient,,,257184.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31959,,186% x Medicaid HMO amount,31959,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72713,,"27,634 x DRG Weight",72713,Other,DRG Base Rate x DRG Weight,61804,,"23,488 x DRG Weight",61804,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17182.21,,DRG base rate x DRG weight + capital per discharge,17182.21,Other,100% of NY Medicaid HMO DRG,17182,,DRG base rate x DRG weight + capital per discharge,17182,Other,100% of NY Medicaid HMO DRG,17182,,DRG base rate x DRG weight + capital per discharge,17182,Other,100% of NY Medicaid HMO DRG,17182,,DRG base rate x DRG weight + capital per discharge,17182,Other,100% of NY Medicaid HMO DRG,38660,,225% x Medicaid HMO amount,38660,Other,225% of NY Medicaid HMO DRG,26289,,153% x Medicaid HMO amount,26289,Other,153% of NY Medicaid HMO DRG,38660,,225% x Medicaid HMO amount,38660,Other,225% of NY Medicaid HMO DRG,24055,,140% x Medicaid HMO amount,24055,Other,140% of NY Medicaid HMO DRG,38660,,DRG base rate x DRG weight + capital per discharge,38660,Other,225% of NY Medicaid HMO DRG,47251,,275% x Medicaid HMO amount,47251,Other,275% of NY Medicaid HMO DRG,55670,,324% x Medicaid HMO amount,55670,Other,324% of NY Medicaid HMO DRG,36942,,215% x Medicaid HMO amount,36942,Other,215% of NY Medicaid HMO DRG,36942,,215% x Medicaid HMO amount,36942,Other,215% of NY Medicaid HMO DRG,21478,,125% x Medicaid HMO amount,21478,Other,125% of NY Medicaid HMO DRG,0.01,72713,
"Pelvic evisceration, radical hysterectomy & other radical GYN procs",510-4,APR-DRG,,,,,,,,inpatient,,,1688756.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,76580,,186% x Medicaid HMO amount,76580,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,177115,,"27,634 x DRG Weight",177115,Other,DRG Base Rate x DRG Weight,150542,,"23,488 x DRG Weight",150542,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41172.21,,DRG base rate x DRG weight + capital per discharge,41172.21,Other,100% of NY Medicaid HMO DRG,41172,,DRG base rate x DRG weight + capital per discharge,41172,Other,100% of NY Medicaid HMO DRG,41172,,DRG base rate x DRG weight + capital per discharge,41172,Other,100% of NY Medicaid HMO DRG,41172,,DRG base rate x DRG weight + capital per discharge,41172,Other,100% of NY Medicaid HMO DRG,92637,,225% x Medicaid HMO amount,92637,Other,225% of NY Medicaid HMO DRG,62993,,153% x Medicaid HMO amount,62993,Other,153% of NY Medicaid HMO DRG,92637,,225% x Medicaid HMO amount,92637,Other,225% of NY Medicaid HMO DRG,57641,,140% x Medicaid HMO amount,57641,Other,140% of NY Medicaid HMO DRG,92637,,DRG base rate x DRG weight + capital per discharge,92637,Other,225% of NY Medicaid HMO DRG,113224,,275% x Medicaid HMO amount,113224,Other,275% of NY Medicaid HMO DRG,133398,,324% x Medicaid HMO amount,133398,Other,324% of NY Medicaid HMO DRG,88520,,215% x Medicaid HMO amount,88520,Other,215% of NY Medicaid HMO DRG,88520,,215% x Medicaid HMO amount,88520,Other,215% of NY Medicaid HMO DRG,51465,,125% x Medicaid HMO amount,51465,Other,125% of NY Medicaid HMO DRG,0.01,177115,
Uterine & adnexa procedures for ovarian & adnexal malignancy,511-1,APR-DRG,,,,,,,,inpatient,,,126877.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16009,,186% x Medicaid HMO amount,16009,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35396,,"27,634 x DRG Weight",35396,Other,DRG Base Rate x DRG Weight,30086,,"23,488 x DRG Weight",30086,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8607.21,,DRG base rate x DRG weight + capital per discharge,8607.21,Other,100% of NY Medicaid HMO DRG,8607,,DRG base rate x DRG weight + capital per discharge,8607,Other,100% of NY Medicaid HMO DRG,8607,,DRG base rate x DRG weight + capital per discharge,8607,Other,100% of NY Medicaid HMO DRG,8607,,DRG base rate x DRG weight + capital per discharge,8607,Other,100% of NY Medicaid HMO DRG,19366,,225% x Medicaid HMO amount,19366,Other,225% of NY Medicaid HMO DRG,13169,,153% x Medicaid HMO amount,13169,Other,153% of NY Medicaid HMO DRG,19366,,225% x Medicaid HMO amount,19366,Other,225% of NY Medicaid HMO DRG,12050,,140% x Medicaid HMO amount,12050,Other,140% of NY Medicaid HMO DRG,19366,,DRG base rate x DRG weight + capital per discharge,19366,Other,225% of NY Medicaid HMO DRG,23670,,275% x Medicaid HMO amount,23670,Other,275% of NY Medicaid HMO DRG,27887,,324% x Medicaid HMO amount,27887,Other,324% of NY Medicaid HMO DRG,18506,,215% x Medicaid HMO amount,18506,Other,215% of NY Medicaid HMO DRG,18506,,215% x Medicaid HMO amount,18506,Other,215% of NY Medicaid HMO DRG,10759,,125% x Medicaid HMO amount,10759,Other,125% of NY Medicaid HMO DRG,0.01,35396,
Uterine & adnexa procedures for ovarian & adnexal malignancy,511-2,APR-DRG,,,,,,,,inpatient,,,191633.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19067,,186% x Medicaid HMO amount,19067,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42551,,"27,634 x DRG Weight",42551,Other,DRG Base Rate x DRG Weight,36167,,"23,488 x DRG Weight",36167,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10251.21,,DRG base rate x DRG weight + capital per discharge,10251.21,Other,100% of NY Medicaid HMO DRG,10251,,DRG base rate x DRG weight + capital per discharge,10251,Other,100% of NY Medicaid HMO DRG,10251,,DRG base rate x DRG weight + capital per discharge,10251,Other,100% of NY Medicaid HMO DRG,10251,,DRG base rate x DRG weight + capital per discharge,10251,Other,100% of NY Medicaid HMO DRG,23065,,225% x Medicaid HMO amount,23065,Other,225% of NY Medicaid HMO DRG,15684,,153% x Medicaid HMO amount,15684,Other,153% of NY Medicaid HMO DRG,23065,,225% x Medicaid HMO amount,23065,Other,225% of NY Medicaid HMO DRG,14352,,140% x Medicaid HMO amount,14352,Other,140% of NY Medicaid HMO DRG,23065,,DRG base rate x DRG weight + capital per discharge,23065,Other,225% of NY Medicaid HMO DRG,28191,,275% x Medicaid HMO amount,28191,Other,275% of NY Medicaid HMO DRG,33214,,324% x Medicaid HMO amount,33214,Other,324% of NY Medicaid HMO DRG,22040,,215% x Medicaid HMO amount,22040,Other,215% of NY Medicaid HMO DRG,22040,,215% x Medicaid HMO amount,22040,Other,215% of NY Medicaid HMO DRG,12814,,125% x Medicaid HMO amount,12814,Other,125% of NY Medicaid HMO DRG,0.01,42551,
Uterine & adnexa procedures for ovarian & adnexal malignancy,511-3,APR-DRG,,,,,,,,inpatient,,,440293.76,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31045,,186% x Medicaid HMO amount,31045,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70577,,"27,634 x DRG Weight",70577,Other,DRG Base Rate x DRG Weight,59988,,"23,488 x DRG Weight",59988,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16691.21,,DRG base rate x DRG weight + capital per discharge,16691.21,Other,100% of NY Medicaid HMO DRG,16691,,DRG base rate x DRG weight + capital per discharge,16691,Other,100% of NY Medicaid HMO DRG,16691,,DRG base rate x DRG weight + capital per discharge,16691,Other,100% of NY Medicaid HMO DRG,16691,,DRG base rate x DRG weight + capital per discharge,16691,Other,100% of NY Medicaid HMO DRG,37555,,225% x Medicaid HMO amount,37555,Other,225% of NY Medicaid HMO DRG,25538,,153% x Medicaid HMO amount,25538,Other,153% of NY Medicaid HMO DRG,37555,,225% x Medicaid HMO amount,37555,Other,225% of NY Medicaid HMO DRG,23368,,140% x Medicaid HMO amount,23368,Other,140% of NY Medicaid HMO DRG,37555,,DRG base rate x DRG weight + capital per discharge,37555,Other,225% of NY Medicaid HMO DRG,45901,,275% x Medicaid HMO amount,45901,Other,275% of NY Medicaid HMO DRG,54080,,324% x Medicaid HMO amount,54080,Other,324% of NY Medicaid HMO DRG,35886,,215% x Medicaid HMO amount,35886,Other,215% of NY Medicaid HMO DRG,35886,,215% x Medicaid HMO amount,35886,Other,215% of NY Medicaid HMO DRG,20864,,125% x Medicaid HMO amount,20864,Other,125% of NY Medicaid HMO DRG,0.01,70577,
Uterine & adnexa procedures for ovarian & adnexal malignancy,511-4,APR-DRG,,,,,,,,inpatient,,,504078.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74420,,186% x Medicaid HMO amount,74420,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,172060,,"27,634 x DRG Weight",172060,Other,DRG Base Rate x DRG Weight,146246,,"23,488 x DRG Weight",146246,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40011.21,,DRG base rate x DRG weight + capital per discharge,40011.21,Other,100% of NY Medicaid HMO DRG,40011,,DRG base rate x DRG weight + capital per discharge,40011,Other,100% of NY Medicaid HMO DRG,40011,,DRG base rate x DRG weight + capital per discharge,40011,Other,100% of NY Medicaid HMO DRG,40011,,DRG base rate x DRG weight + capital per discharge,40011,Other,100% of NY Medicaid HMO DRG,90025,,225% x Medicaid HMO amount,90025,Other,225% of NY Medicaid HMO DRG,61217,,153% x Medicaid HMO amount,61217,Other,153% of NY Medicaid HMO DRG,90025,,225% x Medicaid HMO amount,90025,Other,225% of NY Medicaid HMO DRG,56016,,140% x Medicaid HMO amount,56016,Other,140% of NY Medicaid HMO DRG,90025,,DRG base rate x DRG weight + capital per discharge,90025,Other,225% of NY Medicaid HMO DRG,110031,,275% x Medicaid HMO amount,110031,Other,275% of NY Medicaid HMO DRG,129636,,324% x Medicaid HMO amount,129636,Other,324% of NY Medicaid HMO DRG,86024,,215% x Medicaid HMO amount,86024,Other,215% of NY Medicaid HMO DRG,86024,,215% x Medicaid HMO amount,86024,Other,215% of NY Medicaid HMO DRG,50014,,125% x Medicaid HMO amount,50014,Other,125% of NY Medicaid HMO DRG,0.01,172060,
Uterine & adnexa procedures for non-ovarian & non-adnexal malig,512-1,APR-DRG,,,,,,,,inpatient,,,239707.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13814,,186% x Medicaid HMO amount,13814,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30262,,"27,634 x DRG Weight",30262,Other,DRG Base Rate x DRG Weight,25722,,"23,488 x DRG Weight",25722,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7427.21,,DRG base rate x DRG weight + capital per discharge,7427.21,Other,100% of NY Medicaid HMO DRG,7427,,DRG base rate x DRG weight + capital per discharge,7427,Other,100% of NY Medicaid HMO DRG,7427,,DRG base rate x DRG weight + capital per discharge,7427,Other,100% of NY Medicaid HMO DRG,7427,,DRG base rate x DRG weight + capital per discharge,7427,Other,100% of NY Medicaid HMO DRG,16711,,225% x Medicaid HMO amount,16711,Other,225% of NY Medicaid HMO DRG,11364,,153% x Medicaid HMO amount,11364,Other,153% of NY Medicaid HMO DRG,16711,,225% x Medicaid HMO amount,16711,Other,225% of NY Medicaid HMO DRG,10398,,140% x Medicaid HMO amount,10398,Other,140% of NY Medicaid HMO DRG,16711,,DRG base rate x DRG weight + capital per discharge,16711,Other,225% of NY Medicaid HMO DRG,20425,,275% x Medicaid HMO amount,20425,Other,275% of NY Medicaid HMO DRG,24064,,324% x Medicaid HMO amount,24064,Other,324% of NY Medicaid HMO DRG,15969,,215% x Medicaid HMO amount,15969,Other,215% of NY Medicaid HMO DRG,15969,,215% x Medicaid HMO amount,15969,Other,215% of NY Medicaid HMO DRG,9284,,125% x Medicaid HMO amount,9284,Other,125% of NY Medicaid HMO DRG,0.01,30262,
Uterine & adnexa procedures for non-ovarian & non-adnexal malig,512-2,APR-DRG,,,,,,,,inpatient,,,210970.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16902,,186% x Medicaid HMO amount,16902,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37488,,"27,634 x DRG Weight",37488,Other,DRG Base Rate x DRG Weight,31864,,"23,488 x DRG Weight",31864,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9087.21,,DRG base rate x DRG weight + capital per discharge,9087.21,Other,100% of NY Medicaid HMO DRG,9087,,DRG base rate x DRG weight + capital per discharge,9087,Other,100% of NY Medicaid HMO DRG,9087,,DRG base rate x DRG weight + capital per discharge,9087,Other,100% of NY Medicaid HMO DRG,9087,,DRG base rate x DRG weight + capital per discharge,9087,Other,100% of NY Medicaid HMO DRG,20446,,225% x Medicaid HMO amount,20446,Other,225% of NY Medicaid HMO DRG,13903,,153% x Medicaid HMO amount,13903,Other,153% of NY Medicaid HMO DRG,20446,,225% x Medicaid HMO amount,20446,Other,225% of NY Medicaid HMO DRG,12722,,140% x Medicaid HMO amount,12722,Other,140% of NY Medicaid HMO DRG,20446,,DRG base rate x DRG weight + capital per discharge,20446,Other,225% of NY Medicaid HMO DRG,24990,,275% x Medicaid HMO amount,24990,Other,275% of NY Medicaid HMO DRG,29443,,324% x Medicaid HMO amount,29443,Other,324% of NY Medicaid HMO DRG,19538,,215% x Medicaid HMO amount,19538,Other,215% of NY Medicaid HMO DRG,19538,,215% x Medicaid HMO amount,19538,Other,215% of NY Medicaid HMO DRG,11359,,125% x Medicaid HMO amount,11359,Other,125% of NY Medicaid HMO DRG,0.01,37488,
Uterine & adnexa procedures for non-ovarian & non-adnexal malig,512-3,APR-DRG,,,,,,,,inpatient,,,315251.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28099,,186% x Medicaid HMO amount,28099,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63685,,"27,634 x DRG Weight",63685,Other,DRG Base Rate x DRG Weight,54130,,"23,488 x DRG Weight",54130,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15107.21,,DRG base rate x DRG weight + capital per discharge,15107.21,Other,100% of NY Medicaid HMO DRG,15107,,DRG base rate x DRG weight + capital per discharge,15107,Other,100% of NY Medicaid HMO DRG,15107,,DRG base rate x DRG weight + capital per discharge,15107,Other,100% of NY Medicaid HMO DRG,15107,,DRG base rate x DRG weight + capital per discharge,15107,Other,100% of NY Medicaid HMO DRG,33991,,225% x Medicaid HMO amount,33991,Other,225% of NY Medicaid HMO DRG,23114,,153% x Medicaid HMO amount,23114,Other,153% of NY Medicaid HMO DRG,33991,,225% x Medicaid HMO amount,33991,Other,225% of NY Medicaid HMO DRG,21150,,140% x Medicaid HMO amount,21150,Other,140% of NY Medicaid HMO DRG,33991,,DRG base rate x DRG weight + capital per discharge,33991,Other,225% of NY Medicaid HMO DRG,41545,,275% x Medicaid HMO amount,41545,Other,275% of NY Medicaid HMO DRG,48947,,324% x Medicaid HMO amount,48947,Other,324% of NY Medicaid HMO DRG,32481,,215% x Medicaid HMO amount,32481,Other,215% of NY Medicaid HMO DRG,32481,,215% x Medicaid HMO amount,32481,Other,215% of NY Medicaid HMO DRG,18884,,125% x Medicaid HMO amount,18884,Other,125% of NY Medicaid HMO DRG,0.01,63685,
Uterine & adnexa procedures for non-ovarian & non-adnexal malig,512-4,APR-DRG,,,,,,,,inpatient,,,315251.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,89501,,186% x Medicaid HMO amount,89501,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,207349,,"27,634 x DRG Weight",207349,Other,DRG Base Rate x DRG Weight,176240,,"23,488 x DRG Weight",176240,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48119.21,,DRG base rate x DRG weight + capital per discharge,48119.21,Other,100% of NY Medicaid HMO DRG,48119,,DRG base rate x DRG weight + capital per discharge,48119,Other,100% of NY Medicaid HMO DRG,48119,,DRG base rate x DRG weight + capital per discharge,48119,Other,100% of NY Medicaid HMO DRG,48119,,DRG base rate x DRG weight + capital per discharge,48119,Other,100% of NY Medicaid HMO DRG,108268,,225% x Medicaid HMO amount,108268,Other,225% of NY Medicaid HMO DRG,73622,,153% x Medicaid HMO amount,73622,Other,153% of NY Medicaid HMO DRG,108268,,225% x Medicaid HMO amount,108268,Other,225% of NY Medicaid HMO DRG,67367,,140% x Medicaid HMO amount,67367,Other,140% of NY Medicaid HMO DRG,108268,,DRG base rate x DRG weight + capital per discharge,108268,Other,225% of NY Medicaid HMO DRG,132328,,275% x Medicaid HMO amount,132328,Other,275% of NY Medicaid HMO DRG,155906,,324% x Medicaid HMO amount,155906,Other,324% of NY Medicaid HMO DRG,103456,,215% x Medicaid HMO amount,103456,Other,215% of NY Medicaid HMO DRG,103456,,215% x Medicaid HMO amount,103456,Other,215% of NY Medicaid HMO DRG,60149,,125% x Medicaid HMO amount,60149,Other,125% of NY Medicaid HMO DRG,0.01,207349,
Uterine & adnexa procedures for non-malignancy except leiomyoma,513-1,APR-DRG,,,,,,,,inpatient,,,108883.19,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11188,,186% x Medicaid HMO amount,11188,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24116,,"27,634 x DRG Weight",24116,Other,DRG Base Rate x DRG Weight,20498,,"23,488 x DRG Weight",20498,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6015.21,,DRG base rate x DRG weight + capital per discharge,6015.21,Other,100% of NY Medicaid HMO DRG,6015,,DRG base rate x DRG weight + capital per discharge,6015,Other,100% of NY Medicaid HMO DRG,6015,,DRG base rate x DRG weight + capital per discharge,6015,Other,100% of NY Medicaid HMO DRG,6015,,DRG base rate x DRG weight + capital per discharge,6015,Other,100% of NY Medicaid HMO DRG,13534,,225% x Medicaid HMO amount,13534,Other,225% of NY Medicaid HMO DRG,9203,,153% x Medicaid HMO amount,9203,Other,153% of NY Medicaid HMO DRG,13534,,225% x Medicaid HMO amount,13534,Other,225% of NY Medicaid HMO DRG,8421,,140% x Medicaid HMO amount,8421,Other,140% of NY Medicaid HMO DRG,13534,,DRG base rate x DRG weight + capital per discharge,13534,Other,225% of NY Medicaid HMO DRG,16542,,275% x Medicaid HMO amount,16542,Other,275% of NY Medicaid HMO DRG,19489,,324% x Medicaid HMO amount,19489,Other,324% of NY Medicaid HMO DRG,12933,,215% x Medicaid HMO amount,12933,Other,215% of NY Medicaid HMO DRG,12933,,215% x Medicaid HMO amount,12933,Other,215% of NY Medicaid HMO DRG,7519,,125% x Medicaid HMO amount,7519,Other,125% of NY Medicaid HMO DRG,0.01,24116,
Uterine & adnexa procedures for non-malignancy except leiomyoma,513-2,APR-DRG,,,,,,,,inpatient,,,127769.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13141,,186% x Medicaid HMO amount,13141,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28690,,"27,634 x DRG Weight",28690,Other,DRG Base Rate x DRG Weight,24385,,"23,488 x DRG Weight",24385,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7065.21,,DRG base rate x DRG weight + capital per discharge,7065.21,Other,100% of NY Medicaid HMO DRG,7065,,DRG base rate x DRG weight + capital per discharge,7065,Other,100% of NY Medicaid HMO DRG,7065,,DRG base rate x DRG weight + capital per discharge,7065,Other,100% of NY Medicaid HMO DRG,7065,,DRG base rate x DRG weight + capital per discharge,7065,Other,100% of NY Medicaid HMO DRG,15897,,225% x Medicaid HMO amount,15897,Other,225% of NY Medicaid HMO DRG,10810,,153% x Medicaid HMO amount,10810,Other,153% of NY Medicaid HMO DRG,15897,,225% x Medicaid HMO amount,15897,Other,225% of NY Medicaid HMO DRG,9891,,140% x Medicaid HMO amount,9891,Other,140% of NY Medicaid HMO DRG,15897,,DRG base rate x DRG weight + capital per discharge,15897,Other,225% of NY Medicaid HMO DRG,19429,,275% x Medicaid HMO amount,19429,Other,275% of NY Medicaid HMO DRG,22891,,324% x Medicaid HMO amount,22891,Other,324% of NY Medicaid HMO DRG,15190,,215% x Medicaid HMO amount,15190,Other,215% of NY Medicaid HMO DRG,15190,,215% x Medicaid HMO amount,15190,Other,215% of NY Medicaid HMO DRG,8832,,125% x Medicaid HMO amount,8832,Other,125% of NY Medicaid HMO DRG,0.01,28690,
Uterine & adnexa procedures for non-malignancy except leiomyoma,513-3,APR-DRG,,,,,,,,inpatient,,,156746.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22733,,186% x Medicaid HMO amount,22733,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51128,,"27,634 x DRG Weight",51128,Other,DRG Base Rate x DRG Weight,43457,,"23,488 x DRG Weight",43457,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12222.21,,DRG base rate x DRG weight + capital per discharge,12222.21,Other,100% of NY Medicaid HMO DRG,12222,,DRG base rate x DRG weight + capital per discharge,12222,Other,100% of NY Medicaid HMO DRG,12222,,DRG base rate x DRG weight + capital per discharge,12222,Other,100% of NY Medicaid HMO DRG,12222,,DRG base rate x DRG weight + capital per discharge,12222,Other,100% of NY Medicaid HMO DRG,27500,,225% x Medicaid HMO amount,27500,Other,225% of NY Medicaid HMO DRG,18700,,153% x Medicaid HMO amount,18700,Other,153% of NY Medicaid HMO DRG,27500,,225% x Medicaid HMO amount,27500,Other,225% of NY Medicaid HMO DRG,17111,,140% x Medicaid HMO amount,17111,Other,140% of NY Medicaid HMO DRG,27500,,DRG base rate x DRG weight + capital per discharge,27500,Other,225% of NY Medicaid HMO DRG,33611,,275% x Medicaid HMO amount,33611,Other,275% of NY Medicaid HMO DRG,39600,,324% x Medicaid HMO amount,39600,Other,324% of NY Medicaid HMO DRG,26278,,215% x Medicaid HMO amount,26278,Other,215% of NY Medicaid HMO DRG,26278,,215% x Medicaid HMO amount,26278,Other,215% of NY Medicaid HMO DRG,15278,,125% x Medicaid HMO amount,15278,Other,125% of NY Medicaid HMO DRG,0.01,51128,
Uterine & adnexa procedures for non-malignancy except leiomyoma,513-4,APR-DRG,,,,,,,,inpatient,,,156746.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57591,,186% x Medicaid HMO amount,57591,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,132687,,"27,634 x DRG Weight",132687,Other,DRG Base Rate x DRG Weight,112780,,"23,488 x DRG Weight",112780,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30963.21,,DRG base rate x DRG weight + capital per discharge,30963.21,Other,100% of NY Medicaid HMO DRG,30963,,DRG base rate x DRG weight + capital per discharge,30963,Other,100% of NY Medicaid HMO DRG,30963,,DRG base rate x DRG weight + capital per discharge,30963,Other,100% of NY Medicaid HMO DRG,30963,,DRG base rate x DRG weight + capital per discharge,30963,Other,100% of NY Medicaid HMO DRG,69667,,225% x Medicaid HMO amount,69667,Other,225% of NY Medicaid HMO DRG,47374,,153% x Medicaid HMO amount,47374,Other,153% of NY Medicaid HMO DRG,69667,,225% x Medicaid HMO amount,69667,Other,225% of NY Medicaid HMO DRG,43348,,140% x Medicaid HMO amount,43348,Other,140% of NY Medicaid HMO DRG,69667,,DRG base rate x DRG weight + capital per discharge,69667,Other,225% of NY Medicaid HMO DRG,85149,,275% x Medicaid HMO amount,85149,Other,275% of NY Medicaid HMO DRG,100321,,324% x Medicaid HMO amount,100321,Other,324% of NY Medicaid HMO DRG,66571,,215% x Medicaid HMO amount,66571,Other,215% of NY Medicaid HMO DRG,66571,,215% x Medicaid HMO amount,66571,Other,215% of NY Medicaid HMO DRG,38704,,125% x Medicaid HMO amount,38704,Other,125% of NY Medicaid HMO DRG,0.01,132687,
Female reproductive system reconstructive procedures,514-1,APR-DRG,,,,,,,,inpatient,,,136418.46,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12622,,186% x Medicaid HMO amount,12622,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27474,,"27,634 x DRG Weight",27474,Other,DRG Base Rate x DRG Weight,23352,,"23,488 x DRG Weight",23352,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6786.21,,DRG base rate x DRG weight + capital per discharge,6786.21,Other,100% of NY Medicaid HMO DRG,6786,,DRG base rate x DRG weight + capital per discharge,6786,Other,100% of NY Medicaid HMO DRG,6786,,DRG base rate x DRG weight + capital per discharge,6786,Other,100% of NY Medicaid HMO DRG,6786,,DRG base rate x DRG weight + capital per discharge,6786,Other,100% of NY Medicaid HMO DRG,15269,,225% x Medicaid HMO amount,15269,Other,225% of NY Medicaid HMO DRG,10383,,153% x Medicaid HMO amount,10383,Other,153% of NY Medicaid HMO DRG,15269,,225% x Medicaid HMO amount,15269,Other,225% of NY Medicaid HMO DRG,9501,,140% x Medicaid HMO amount,9501,Other,140% of NY Medicaid HMO DRG,15269,,DRG base rate x DRG weight + capital per discharge,15269,Other,225% of NY Medicaid HMO DRG,18662,,275% x Medicaid HMO amount,18662,Other,275% of NY Medicaid HMO DRG,21987,,324% x Medicaid HMO amount,21987,Other,324% of NY Medicaid HMO DRG,14590,,215% x Medicaid HMO amount,14590,Other,215% of NY Medicaid HMO DRG,14590,,215% x Medicaid HMO amount,14590,Other,215% of NY Medicaid HMO DRG,8483,,125% x Medicaid HMO amount,8483,Other,125% of NY Medicaid HMO DRG,0.01,27474,
Female reproductive system reconstructive procedures,514-2,APR-DRG,,,,,,,,inpatient,,,394980.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12622,,186% x Medicaid HMO amount,12622,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27474,,"27,634 x DRG Weight",27474,Other,DRG Base Rate x DRG Weight,23352,,"23,488 x DRG Weight",23352,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6786.21,,DRG base rate x DRG weight + capital per discharge,6786.21,Other,100% of NY Medicaid HMO DRG,6786,,DRG base rate x DRG weight + capital per discharge,6786,Other,100% of NY Medicaid HMO DRG,6786,,DRG base rate x DRG weight + capital per discharge,6786,Other,100% of NY Medicaid HMO DRG,6786,,DRG base rate x DRG weight + capital per discharge,6786,Other,100% of NY Medicaid HMO DRG,15269,,225% x Medicaid HMO amount,15269,Other,225% of NY Medicaid HMO DRG,10383,,153% x Medicaid HMO amount,10383,Other,153% of NY Medicaid HMO DRG,15269,,225% x Medicaid HMO amount,15269,Other,225% of NY Medicaid HMO DRG,9501,,140% x Medicaid HMO amount,9501,Other,140% of NY Medicaid HMO DRG,15269,,DRG base rate x DRG weight + capital per discharge,15269,Other,225% of NY Medicaid HMO DRG,18662,,275% x Medicaid HMO amount,18662,Other,275% of NY Medicaid HMO DRG,21987,,324% x Medicaid HMO amount,21987,Other,324% of NY Medicaid HMO DRG,14590,,215% x Medicaid HMO amount,14590,Other,215% of NY Medicaid HMO DRG,14590,,215% x Medicaid HMO amount,14590,Other,215% of NY Medicaid HMO DRG,8483,,125% x Medicaid HMO amount,8483,Other,125% of NY Medicaid HMO DRG,0.01,27474,
Female reproductive system reconstructive procedures,514-3,APR-DRG,,,,,,,,inpatient,,,394980.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12622,,186% x Medicaid HMO amount,12622,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27474,,"27,634 x DRG Weight",27474,Other,DRG Base Rate x DRG Weight,23352,,"23,488 x DRG Weight",23352,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6786.21,,DRG base rate x DRG weight + capital per discharge,6786.21,Other,100% of NY Medicaid HMO DRG,6786,,DRG base rate x DRG weight + capital per discharge,6786,Other,100% of NY Medicaid HMO DRG,6786,,DRG base rate x DRG weight + capital per discharge,6786,Other,100% of NY Medicaid HMO DRG,6786,,DRG base rate x DRG weight + capital per discharge,6786,Other,100% of NY Medicaid HMO DRG,15269,,225% x Medicaid HMO amount,15269,Other,225% of NY Medicaid HMO DRG,10383,,153% x Medicaid HMO amount,10383,Other,153% of NY Medicaid HMO DRG,15269,,225% x Medicaid HMO amount,15269,Other,225% of NY Medicaid HMO DRG,9501,,140% x Medicaid HMO amount,9501,Other,140% of NY Medicaid HMO DRG,15269,,DRG base rate x DRG weight + capital per discharge,15269,Other,225% of NY Medicaid HMO DRG,18662,,275% x Medicaid HMO amount,18662,Other,275% of NY Medicaid HMO DRG,21987,,324% x Medicaid HMO amount,21987,Other,324% of NY Medicaid HMO DRG,14590,,215% x Medicaid HMO amount,14590,Other,215% of NY Medicaid HMO DRG,14590,,215% x Medicaid HMO amount,14590,Other,215% of NY Medicaid HMO DRG,8483,,125% x Medicaid HMO amount,8483,Other,125% of NY Medicaid HMO DRG,0.01,27474,
Female reproductive system reconstructive procedures,514-4,APR-DRG,,,,,,,,inpatient,,,394980.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37790,,186% x Medicaid HMO amount,37790,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86359,,"27,634 x DRG Weight",86359,Other,DRG Base Rate x DRG Weight,73402,,"23,488 x DRG Weight",73402,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20317.21,,DRG base rate x DRG weight + capital per discharge,20317.21,Other,100% of NY Medicaid HMO DRG,20317,,DRG base rate x DRG weight + capital per discharge,20317,Other,100% of NY Medicaid HMO DRG,20317,,DRG base rate x DRG weight + capital per discharge,20317,Other,100% of NY Medicaid HMO DRG,20317,,DRG base rate x DRG weight + capital per discharge,20317,Other,100% of NY Medicaid HMO DRG,45714,,225% x Medicaid HMO amount,45714,Other,225% of NY Medicaid HMO DRG,31085,,153% x Medicaid HMO amount,31085,Other,153% of NY Medicaid HMO DRG,45714,,225% x Medicaid HMO amount,45714,Other,225% of NY Medicaid HMO DRG,28444,,140% x Medicaid HMO amount,28444,Other,140% of NY Medicaid HMO DRG,45714,,DRG base rate x DRG weight + capital per discharge,45714,Other,225% of NY Medicaid HMO DRG,55872,,275% x Medicaid HMO amount,55872,Other,275% of NY Medicaid HMO DRG,65828,,324% x Medicaid HMO amount,65828,Other,324% of NY Medicaid HMO DRG,43682,,215% x Medicaid HMO amount,43682,Other,215% of NY Medicaid HMO DRG,43682,,215% x Medicaid HMO amount,43682,Other,215% of NY Medicaid HMO DRG,25397,,125% x Medicaid HMO amount,25397,Other,125% of NY Medicaid HMO DRG,0.01,86359,
Dilation & curettage for non-obstetric diagnoses,517-1,APR-DRG,,,,,,,,inpatient,,,163703.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8766,,186% x Medicaid HMO amount,8766,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18451,,"27,634 x DRG Weight",18451,Other,DRG Base Rate x DRG Weight,15683,,"23,488 x DRG Weight",15683,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4713.21,,DRG base rate x DRG weight + capital per discharge,4713.21,Other,100% of NY Medicaid HMO DRG,4713,,DRG base rate x DRG weight + capital per discharge,4713,Other,100% of NY Medicaid HMO DRG,4713,,DRG base rate x DRG weight + capital per discharge,4713,Other,100% of NY Medicaid HMO DRG,4713,,DRG base rate x DRG weight + capital per discharge,4713,Other,100% of NY Medicaid HMO DRG,10605,,225% x Medicaid HMO amount,10605,Other,225% of NY Medicaid HMO DRG,7211,,153% x Medicaid HMO amount,7211,Other,153% of NY Medicaid HMO DRG,10605,,225% x Medicaid HMO amount,10605,Other,225% of NY Medicaid HMO DRG,6598,,140% x Medicaid HMO amount,6598,Other,140% of NY Medicaid HMO DRG,10605,,DRG base rate x DRG weight + capital per discharge,10605,Other,225% of NY Medicaid HMO DRG,12961,,275% x Medicaid HMO amount,12961,Other,275% of NY Medicaid HMO DRG,15271,,324% x Medicaid HMO amount,15271,Other,324% of NY Medicaid HMO DRG,10133,,215% x Medicaid HMO amount,10133,Other,215% of NY Medicaid HMO DRG,10133,,215% x Medicaid HMO amount,10133,Other,215% of NY Medicaid HMO DRG,5892,,125% x Medicaid HMO amount,5892,Other,125% of NY Medicaid HMO DRG,0.01,18451,
Dilation & curettage for non-obstetric diagnoses,517-2,APR-DRG,,,,,,,,inpatient,,,163703.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11917,,186% x Medicaid HMO amount,11917,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25824,,"27,634 x DRG Weight",25824,Other,DRG Base Rate x DRG Weight,21950,,"23,488 x DRG Weight",21950,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6407.21,,DRG base rate x DRG weight + capital per discharge,6407.21,Other,100% of NY Medicaid HMO DRG,6407,,DRG base rate x DRG weight + capital per discharge,6407,Other,100% of NY Medicaid HMO DRG,6407,,DRG base rate x DRG weight + capital per discharge,6407,Other,100% of NY Medicaid HMO DRG,6407,,DRG base rate x DRG weight + capital per discharge,6407,Other,100% of NY Medicaid HMO DRG,14416,,225% x Medicaid HMO amount,14416,Other,225% of NY Medicaid HMO DRG,9803,,153% x Medicaid HMO amount,9803,Other,153% of NY Medicaid HMO DRG,14416,,225% x Medicaid HMO amount,14416,Other,225% of NY Medicaid HMO DRG,8970,,140% x Medicaid HMO amount,8970,Other,140% of NY Medicaid HMO DRG,14416,,DRG base rate x DRG weight + capital per discharge,14416,Other,225% of NY Medicaid HMO DRG,17620,,275% x Medicaid HMO amount,17620,Other,275% of NY Medicaid HMO DRG,20759,,324% x Medicaid HMO amount,20759,Other,324% of NY Medicaid HMO DRG,13776,,215% x Medicaid HMO amount,13776,Other,215% of NY Medicaid HMO DRG,13776,,215% x Medicaid HMO amount,13776,Other,215% of NY Medicaid HMO DRG,8009,,125% x Medicaid HMO amount,8009,Other,125% of NY Medicaid HMO DRG,0.01,25824,
Dilation & curettage for non-obstetric diagnoses,517-3,APR-DRG,,,,,,,,inpatient,,,488129.7,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24926,,186% x Medicaid HMO amount,24926,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,56260,,"27,634 x DRG Weight",56260,Other,DRG Base Rate x DRG Weight,47819,,"23,488 x DRG Weight",47819,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13401.21,,DRG base rate x DRG weight + capital per discharge,13401.21,Other,100% of NY Medicaid HMO DRG,13401,,DRG base rate x DRG weight + capital per discharge,13401,Other,100% of NY Medicaid HMO DRG,13401,,DRG base rate x DRG weight + capital per discharge,13401,Other,100% of NY Medicaid HMO DRG,13401,,DRG base rate x DRG weight + capital per discharge,13401,Other,100% of NY Medicaid HMO DRG,30153,,225% x Medicaid HMO amount,30153,Other,225% of NY Medicaid HMO DRG,20504,,153% x Medicaid HMO amount,20504,Other,153% of NY Medicaid HMO DRG,30153,,225% x Medicaid HMO amount,30153,Other,225% of NY Medicaid HMO DRG,18762,,140% x Medicaid HMO amount,18762,Other,140% of NY Medicaid HMO DRG,30153,,DRG base rate x DRG weight + capital per discharge,30153,Other,225% of NY Medicaid HMO DRG,36853,,275% x Medicaid HMO amount,36853,Other,275% of NY Medicaid HMO DRG,43420,,324% x Medicaid HMO amount,43420,Other,324% of NY Medicaid HMO DRG,28813,,215% x Medicaid HMO amount,28813,Other,215% of NY Medicaid HMO DRG,28813,,215% x Medicaid HMO amount,28813,Other,215% of NY Medicaid HMO DRG,16752,,125% x Medicaid HMO amount,16752,Other,125% of NY Medicaid HMO DRG,0.01,56260,
Dilation & curettage for non-obstetric diagnoses,517-4,APR-DRG,,,,,,,,inpatient,,,194724,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26273,,186% x Medicaid HMO amount,26273,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59410,,"27,634 x DRG Weight",59410,Other,DRG Base Rate x DRG Weight,50497,,"23,488 x DRG Weight",50497,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14125.21,,DRG base rate x DRG weight + capital per discharge,14125.21,Other,100% of NY Medicaid HMO DRG,14125,,DRG base rate x DRG weight + capital per discharge,14125,Other,100% of NY Medicaid HMO DRG,14125,,DRG base rate x DRG weight + capital per discharge,14125,Other,100% of NY Medicaid HMO DRG,14125,,DRG base rate x DRG weight + capital per discharge,14125,Other,100% of NY Medicaid HMO DRG,31782,,225% x Medicaid HMO amount,31782,Other,225% of NY Medicaid HMO DRG,21612,,153% x Medicaid HMO amount,21612,Other,153% of NY Medicaid HMO DRG,31782,,225% x Medicaid HMO amount,31782,Other,225% of NY Medicaid HMO DRG,19775,,140% x Medicaid HMO amount,19775,Other,140% of NY Medicaid HMO DRG,31782,,DRG base rate x DRG weight + capital per discharge,31782,Other,225% of NY Medicaid HMO DRG,38844,,275% x Medicaid HMO amount,38844,Other,275% of NY Medicaid HMO DRG,45766,,324% x Medicaid HMO amount,45766,Other,324% of NY Medicaid HMO DRG,30369,,215% x Medicaid HMO amount,30369,Other,215% of NY Medicaid HMO DRG,30369,,215% x Medicaid HMO amount,30369,Other,215% of NY Medicaid HMO DRG,17657,,125% x Medicaid HMO amount,17657,Other,125% of NY Medicaid HMO DRG,0.01,59410,
Other female reproductive system & related procedures,518-1,APR-DRG,,,,,,,,inpatient,,,95382.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9808,,186% x Medicaid HMO amount,9808,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20889,,"27,634 x DRG Weight",20889,Other,DRG Base Rate x DRG Weight,17755,,"23,488 x DRG Weight",17755,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5273.21,,DRG base rate x DRG weight + capital per discharge,5273.21,Other,100% of NY Medicaid HMO DRG,5273,,DRG base rate x DRG weight + capital per discharge,5273,Other,100% of NY Medicaid HMO DRG,5273,,DRG base rate x DRG weight + capital per discharge,5273,Other,100% of NY Medicaid HMO DRG,5273,,DRG base rate x DRG weight + capital per discharge,5273,Other,100% of NY Medicaid HMO DRG,11865,,225% x Medicaid HMO amount,11865,Other,225% of NY Medicaid HMO DRG,8068,,153% x Medicaid HMO amount,8068,Other,153% of NY Medicaid HMO DRG,11865,,225% x Medicaid HMO amount,11865,Other,225% of NY Medicaid HMO DRG,7382,,140% x Medicaid HMO amount,7382,Other,140% of NY Medicaid HMO DRG,11865,,DRG base rate x DRG weight + capital per discharge,11865,Other,225% of NY Medicaid HMO DRG,14501,,275% x Medicaid HMO amount,14501,Other,275% of NY Medicaid HMO DRG,17085,,324% x Medicaid HMO amount,17085,Other,324% of NY Medicaid HMO DRG,11337,,215% x Medicaid HMO amount,11337,Other,215% of NY Medicaid HMO DRG,11337,,215% x Medicaid HMO amount,11337,Other,215% of NY Medicaid HMO DRG,6592,,125% x Medicaid HMO amount,6592,Other,125% of NY Medicaid HMO DRG,0.01,20889,
Other female reproductive system & related procedures,518-2,APR-DRG,,,,,,,,inpatient,,,91113.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13665,,186% x Medicaid HMO amount,13665,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29914,,"27,634 x DRG Weight",29914,Other,DRG Base Rate x DRG Weight,25426,,"23,488 x DRG Weight",25426,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7347.21,,DRG base rate x DRG weight + capital per discharge,7347.21,Other,100% of NY Medicaid HMO DRG,7347,,DRG base rate x DRG weight + capital per discharge,7347,Other,100% of NY Medicaid HMO DRG,7347,,DRG base rate x DRG weight + capital per discharge,7347,Other,100% of NY Medicaid HMO DRG,7347,,DRG base rate x DRG weight + capital per discharge,7347,Other,100% of NY Medicaid HMO DRG,16531,,225% x Medicaid HMO amount,16531,Other,225% of NY Medicaid HMO DRG,11241,,153% x Medicaid HMO amount,11241,Other,153% of NY Medicaid HMO DRG,16531,,225% x Medicaid HMO amount,16531,Other,225% of NY Medicaid HMO DRG,10286,,140% x Medicaid HMO amount,10286,Other,140% of NY Medicaid HMO DRG,16531,,DRG base rate x DRG weight + capital per discharge,16531,Other,225% of NY Medicaid HMO DRG,20205,,275% x Medicaid HMO amount,20205,Other,275% of NY Medicaid HMO DRG,23805,,324% x Medicaid HMO amount,23805,Other,324% of NY Medicaid HMO DRG,15797,,215% x Medicaid HMO amount,15797,Other,215% of NY Medicaid HMO DRG,15797,,215% x Medicaid HMO amount,15797,Other,215% of NY Medicaid HMO DRG,9184,,125% x Medicaid HMO amount,9184,Other,125% of NY Medicaid HMO DRG,0.01,29914,
Other female reproductive system & related procedures,518-3,APR-DRG,,,,,,,,inpatient,,,599314.63,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25904,,186% x Medicaid HMO amount,25904,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58551,,"27,634 x DRG Weight",58551,Other,DRG Base Rate x DRG Weight,49766,,"23,488 x DRG Weight",49766,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13927.21,,DRG base rate x DRG weight + capital per discharge,13927.21,Other,100% of NY Medicaid HMO DRG,13927,,DRG base rate x DRG weight + capital per discharge,13927,Other,100% of NY Medicaid HMO DRG,13927,,DRG base rate x DRG weight + capital per discharge,13927,Other,100% of NY Medicaid HMO DRG,13927,,DRG base rate x DRG weight + capital per discharge,13927,Other,100% of NY Medicaid HMO DRG,31336,,225% x Medicaid HMO amount,31336,Other,225% of NY Medicaid HMO DRG,21309,,153% x Medicaid HMO amount,21309,Other,153% of NY Medicaid HMO DRG,31336,,225% x Medicaid HMO amount,31336,Other,225% of NY Medicaid HMO DRG,19498,,140% x Medicaid HMO amount,19498,Other,140% of NY Medicaid HMO DRG,31336,,DRG base rate x DRG weight + capital per discharge,31336,Other,225% of NY Medicaid HMO DRG,38300,,275% x Medicaid HMO amount,38300,Other,275% of NY Medicaid HMO DRG,45124,,324% x Medicaid HMO amount,45124,Other,324% of NY Medicaid HMO DRG,29944,,215% x Medicaid HMO amount,29944,Other,215% of NY Medicaid HMO DRG,29944,,215% x Medicaid HMO amount,29944,Other,215% of NY Medicaid HMO DRG,17409,,125% x Medicaid HMO amount,17409,Other,125% of NY Medicaid HMO DRG,0.01,58551,
Other female reproductive system & related procedures,518-4,APR-DRG,,,,,,,,inpatient,,,599314.63,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,71485,,186% x Medicaid HMO amount,71485,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,165193,,"27,634 x DRG Weight",165193,Other,DRG Base Rate x DRG Weight,140409,,"23,488 x DRG Weight",140409,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38433.21,,DRG base rate x DRG weight + capital per discharge,38433.21,Other,100% of NY Medicaid HMO DRG,38433,,DRG base rate x DRG weight + capital per discharge,38433,Other,100% of NY Medicaid HMO DRG,38433,,DRG base rate x DRG weight + capital per discharge,38433,Other,100% of NY Medicaid HMO DRG,38433,,DRG base rate x DRG weight + capital per discharge,38433,Other,100% of NY Medicaid HMO DRG,86475,,225% x Medicaid HMO amount,86475,Other,225% of NY Medicaid HMO DRG,58803,,153% x Medicaid HMO amount,58803,Other,153% of NY Medicaid HMO DRG,86475,,225% x Medicaid HMO amount,86475,Other,225% of NY Medicaid HMO DRG,53806,,140% x Medicaid HMO amount,53806,Other,140% of NY Medicaid HMO DRG,86475,,DRG base rate x DRG weight + capital per discharge,86475,Other,225% of NY Medicaid HMO DRG,105691,,275% x Medicaid HMO amount,105691,Other,275% of NY Medicaid HMO DRG,124524,,324% x Medicaid HMO amount,124524,Other,324% of NY Medicaid HMO DRG,82631,,215% x Medicaid HMO amount,82631,Other,215% of NY Medicaid HMO DRG,82631,,215% x Medicaid HMO amount,82631,Other,215% of NY Medicaid HMO DRG,48042,,125% x Medicaid HMO amount,48042,Other,125% of NY Medicaid HMO DRG,0.01,165193,
Uterine & adnexa procedures for leiomyoma,519-1,APR-DRG,,,,,,,,inpatient,,,144735.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11022,,186% x Medicaid HMO amount,11022,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23732,,"27,634 x DRG Weight",23732,Other,DRG Base Rate x DRG Weight,20171,,"23,488 x DRG Weight",20171,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5926.21,,DRG base rate x DRG weight + capital per discharge,5926.21,Other,100% of NY Medicaid HMO DRG,5926,,DRG base rate x DRG weight + capital per discharge,5926,Other,100% of NY Medicaid HMO DRG,5926,,DRG base rate x DRG weight + capital per discharge,5926,Other,100% of NY Medicaid HMO DRG,5926,,DRG base rate x DRG weight + capital per discharge,5926,Other,100% of NY Medicaid HMO DRG,13334,,225% x Medicaid HMO amount,13334,Other,225% of NY Medicaid HMO DRG,9067,,153% x Medicaid HMO amount,9067,Other,153% of NY Medicaid HMO DRG,13334,,225% x Medicaid HMO amount,13334,Other,225% of NY Medicaid HMO DRG,8297,,140% x Medicaid HMO amount,8297,Other,140% of NY Medicaid HMO DRG,13334,,DRG base rate x DRG weight + capital per discharge,13334,Other,225% of NY Medicaid HMO DRG,16297,,275% x Medicaid HMO amount,16297,Other,275% of NY Medicaid HMO DRG,19201,,324% x Medicaid HMO amount,19201,Other,324% of NY Medicaid HMO DRG,12741,,215% x Medicaid HMO amount,12741,Other,215% of NY Medicaid HMO DRG,12741,,215% x Medicaid HMO amount,12741,Other,215% of NY Medicaid HMO DRG,7408,,125% x Medicaid HMO amount,7408,Other,125% of NY Medicaid HMO DRG,0.01,23732,
Uterine & adnexa procedures for leiomyoma,519-2,APR-DRG,,,,,,,,inpatient,,,77003.59,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13578,,186% x Medicaid HMO amount,13578,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29709,,"27,634 x DRG Weight",29709,Other,DRG Base Rate x DRG Weight,25252,,"23,488 x DRG Weight",25252,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7300.21,,DRG base rate x DRG weight + capital per discharge,7300.21,Other,100% of NY Medicaid HMO DRG,7300,,DRG base rate x DRG weight + capital per discharge,7300,Other,100% of NY Medicaid HMO DRG,7300,,DRG base rate x DRG weight + capital per discharge,7300,Other,100% of NY Medicaid HMO DRG,7300,,DRG base rate x DRG weight + capital per discharge,7300,Other,100% of NY Medicaid HMO DRG,16425,,225% x Medicaid HMO amount,16425,Other,225% of NY Medicaid HMO DRG,11169,,153% x Medicaid HMO amount,11169,Other,153% of NY Medicaid HMO DRG,16425,,225% x Medicaid HMO amount,16425,Other,225% of NY Medicaid HMO DRG,10220,,140% x Medicaid HMO amount,10220,Other,140% of NY Medicaid HMO DRG,16425,,DRG base rate x DRG weight + capital per discharge,16425,Other,225% of NY Medicaid HMO DRG,20076,,275% x Medicaid HMO amount,20076,Other,275% of NY Medicaid HMO DRG,23653,,324% x Medicaid HMO amount,23653,Other,324% of NY Medicaid HMO DRG,15695,,215% x Medicaid HMO amount,15695,Other,215% of NY Medicaid HMO DRG,15695,,215% x Medicaid HMO amount,15695,Other,215% of NY Medicaid HMO DRG,9125,,125% x Medicaid HMO amount,9125,Other,125% of NY Medicaid HMO DRG,0.01,29709,
Uterine & adnexa procedures for leiomyoma,519-3,APR-DRG,,,,,,,,inpatient,,,289488.83,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24256,,186% x Medicaid HMO amount,24256,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54696,,"27,634 x DRG Weight",54696,Other,DRG Base Rate x DRG Weight,46490,,"23,488 x DRG Weight",46490,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13041.21,,DRG base rate x DRG weight + capital per discharge,13041.21,Other,100% of NY Medicaid HMO DRG,13041,,DRG base rate x DRG weight + capital per discharge,13041,Other,100% of NY Medicaid HMO DRG,13041,,DRG base rate x DRG weight + capital per discharge,13041,Other,100% of NY Medicaid HMO DRG,13041,,DRG base rate x DRG weight + capital per discharge,13041,Other,100% of NY Medicaid HMO DRG,29343,,225% x Medicaid HMO amount,29343,Other,225% of NY Medicaid HMO DRG,19953,,153% x Medicaid HMO amount,19953,Other,153% of NY Medicaid HMO DRG,29343,,225% x Medicaid HMO amount,29343,Other,225% of NY Medicaid HMO DRG,18258,,140% x Medicaid HMO amount,18258,Other,140% of NY Medicaid HMO DRG,29343,,DRG base rate x DRG weight + capital per discharge,29343,Other,225% of NY Medicaid HMO DRG,35863,,275% x Medicaid HMO amount,35863,Other,275% of NY Medicaid HMO DRG,42254,,324% x Medicaid HMO amount,42254,Other,324% of NY Medicaid HMO DRG,28039,,215% x Medicaid HMO amount,28039,Other,215% of NY Medicaid HMO DRG,28039,,215% x Medicaid HMO amount,28039,Other,215% of NY Medicaid HMO DRG,16302,,125% x Medicaid HMO amount,16302,Other,125% of NY Medicaid HMO DRG,0.01,54696,
Uterine & adnexa procedures for leiomyoma,519-4,APR-DRG,,,,,,,,inpatient,,,144735.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72322,,186% x Medicaid HMO amount,72322,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,167153,,"27,634 x DRG Weight",167153,Other,DRG Base Rate x DRG Weight,142074,,"23,488 x DRG Weight",142074,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38883.21,,DRG base rate x DRG weight + capital per discharge,38883.21,Other,100% of NY Medicaid HMO DRG,38883,,DRG base rate x DRG weight + capital per discharge,38883,Other,100% of NY Medicaid HMO DRG,38883,,DRG base rate x DRG weight + capital per discharge,38883,Other,100% of NY Medicaid HMO DRG,38883,,DRG base rate x DRG weight + capital per discharge,38883,Other,100% of NY Medicaid HMO DRG,87487,,225% x Medicaid HMO amount,87487,Other,225% of NY Medicaid HMO DRG,59491,,153% x Medicaid HMO amount,59491,Other,153% of NY Medicaid HMO DRG,87487,,225% x Medicaid HMO amount,87487,Other,225% of NY Medicaid HMO DRG,54436,,140% x Medicaid HMO amount,54436,Other,140% of NY Medicaid HMO DRG,87487,,DRG base rate x DRG weight + capital per discharge,87487,Other,225% of NY Medicaid HMO DRG,106929,,275% x Medicaid HMO amount,106929,Other,275% of NY Medicaid HMO DRG,125982,,324% x Medicaid HMO amount,125982,Other,324% of NY Medicaid HMO DRG,83599,,215% x Medicaid HMO amount,83599,Other,215% of NY Medicaid HMO DRG,83599,,215% x Medicaid HMO amount,83599,Other,215% of NY Medicaid HMO DRG,48604,,125% x Medicaid HMO amount,48604,Other,125% of NY Medicaid HMO DRG,0.01,167153,
Female reproductive system malignancy,530-1,APR-DRG,,,,,,,,inpatient,,,210556.88,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8087,,186% x Medicaid HMO amount,8087,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16862,,"27,634 x DRG Weight",16862,Other,DRG Base Rate x DRG Weight,14332,,"23,488 x DRG Weight",14332,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4348.21,,DRG base rate x DRG weight + capital per discharge,4348.21,Other,100% of NY Medicaid HMO DRG,4348,,DRG base rate x DRG weight + capital per discharge,4348,Other,100% of NY Medicaid HMO DRG,4348,,DRG base rate x DRG weight + capital per discharge,4348,Other,100% of NY Medicaid HMO DRG,4348,,DRG base rate x DRG weight + capital per discharge,4348,Other,100% of NY Medicaid HMO DRG,9783,,225% x Medicaid HMO amount,9783,Other,225% of NY Medicaid HMO DRG,6653,,153% x Medicaid HMO amount,6653,Other,153% of NY Medicaid HMO DRG,9783,,225% x Medicaid HMO amount,9783,Other,225% of NY Medicaid HMO DRG,6087,,140% x Medicaid HMO amount,6087,Other,140% of NY Medicaid HMO DRG,9783,,DRG base rate x DRG weight + capital per discharge,9783,Other,225% of NY Medicaid HMO DRG,11958,,275% x Medicaid HMO amount,11958,Other,275% of NY Medicaid HMO DRG,14088,,324% x Medicaid HMO amount,14088,Other,324% of NY Medicaid HMO DRG,9349,,215% x Medicaid HMO amount,9349,Other,215% of NY Medicaid HMO DRG,9349,,215% x Medicaid HMO amount,9349,Other,215% of NY Medicaid HMO DRG,5435,,125% x Medicaid HMO amount,5435,Other,125% of NY Medicaid HMO DRG,0.01,16862,
Female reproductive system malignancy,530-2,APR-DRG,,,,,,,,inpatient,,,155050.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10120,,186% x Medicaid HMO amount,10120,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21618,,"27,634 x DRG Weight",21618,Other,DRG Base Rate x DRG Weight,18375,,"23,488 x DRG Weight",18375,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5441.21,,DRG base rate x DRG weight + capital per discharge,5441.21,Other,100% of NY Medicaid HMO DRG,5441,,DRG base rate x DRG weight + capital per discharge,5441,Other,100% of NY Medicaid HMO DRG,5441,,DRG base rate x DRG weight + capital per discharge,5441,Other,100% of NY Medicaid HMO DRG,5441,,DRG base rate x DRG weight + capital per discharge,5441,Other,100% of NY Medicaid HMO DRG,12243,,225% x Medicaid HMO amount,12243,Other,225% of NY Medicaid HMO DRG,8325,,153% x Medicaid HMO amount,8325,Other,153% of NY Medicaid HMO DRG,12243,,225% x Medicaid HMO amount,12243,Other,225% of NY Medicaid HMO DRG,7618,,140% x Medicaid HMO amount,7618,Other,140% of NY Medicaid HMO DRG,12243,,DRG base rate x DRG weight + capital per discharge,12243,Other,225% of NY Medicaid HMO DRG,14963,,275% x Medicaid HMO amount,14963,Other,275% of NY Medicaid HMO DRG,17630,,324% x Medicaid HMO amount,17630,Other,324% of NY Medicaid HMO DRG,11699,,215% x Medicaid HMO amount,11699,Other,215% of NY Medicaid HMO DRG,11699,,215% x Medicaid HMO amount,11699,Other,215% of NY Medicaid HMO DRG,6802,,125% x Medicaid HMO amount,6802,Other,125% of NY Medicaid HMO DRG,0.01,21618,
Female reproductive system malignancy,530-3,APR-DRG,,,,,,,,inpatient,,,223676.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18027,,186% x Medicaid HMO amount,18027,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40122,,"27,634 x DRG Weight",40122,Other,DRG Base Rate x DRG Weight,34102,,"23,488 x DRG Weight",34102,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9692.21,,DRG base rate x DRG weight + capital per discharge,9692.21,Other,100% of NY Medicaid HMO DRG,9692,,DRG base rate x DRG weight + capital per discharge,9692,Other,100% of NY Medicaid HMO DRG,9692,,DRG base rate x DRG weight + capital per discharge,9692,Other,100% of NY Medicaid HMO DRG,9692,,DRG base rate x DRG weight + capital per discharge,9692,Other,100% of NY Medicaid HMO DRG,21807,,225% x Medicaid HMO amount,21807,Other,225% of NY Medicaid HMO DRG,14829,,153% x Medicaid HMO amount,14829,Other,153% of NY Medicaid HMO DRG,21807,,225% x Medicaid HMO amount,21807,Other,225% of NY Medicaid HMO DRG,13569,,140% x Medicaid HMO amount,13569,Other,140% of NY Medicaid HMO DRG,21807,,DRG base rate x DRG weight + capital per discharge,21807,Other,225% of NY Medicaid HMO DRG,26654,,275% x Medicaid HMO amount,26654,Other,275% of NY Medicaid HMO DRG,31403,,324% x Medicaid HMO amount,31403,Other,324% of NY Medicaid HMO DRG,20838,,215% x Medicaid HMO amount,20838,Other,215% of NY Medicaid HMO DRG,20838,,215% x Medicaid HMO amount,20838,Other,215% of NY Medicaid HMO DRG,12115,,125% x Medicaid HMO amount,12115,Other,125% of NY Medicaid HMO DRG,0.01,40122,
Female reproductive system malignancy,530-4,APR-DRG,,,,,,,,inpatient,,,166942.36,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30491,,186% x Medicaid HMO amount,30491,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69281,,"27,634 x DRG Weight",69281,Other,DRG Base Rate x DRG Weight,58887,,"23,488 x DRG Weight",58887,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16393.21,,DRG base rate x DRG weight + capital per discharge,16393.21,Other,100% of NY Medicaid HMO DRG,16393,,DRG base rate x DRG weight + capital per discharge,16393,Other,100% of NY Medicaid HMO DRG,16393,,DRG base rate x DRG weight + capital per discharge,16393,Other,100% of NY Medicaid HMO DRG,16393,,DRG base rate x DRG weight + capital per discharge,16393,Other,100% of NY Medicaid HMO DRG,36885,,225% x Medicaid HMO amount,36885,Other,225% of NY Medicaid HMO DRG,25082,,153% x Medicaid HMO amount,25082,Other,153% of NY Medicaid HMO DRG,36885,,225% x Medicaid HMO amount,36885,Other,225% of NY Medicaid HMO DRG,22950,,140% x Medicaid HMO amount,22950,Other,140% of NY Medicaid HMO DRG,36885,,DRG base rate x DRG weight + capital per discharge,36885,Other,225% of NY Medicaid HMO DRG,45081,,275% x Medicaid HMO amount,45081,Other,275% of NY Medicaid HMO DRG,53114,,324% x Medicaid HMO amount,53114,Other,324% of NY Medicaid HMO DRG,35245,,215% x Medicaid HMO amount,35245,Other,215% of NY Medicaid HMO DRG,35245,,215% x Medicaid HMO amount,35245,Other,215% of NY Medicaid HMO DRG,20492,,125% x Medicaid HMO amount,20492,Other,125% of NY Medicaid HMO DRG,0.01,69281,
Female reproductive system infections,531-1,APR-DRG,,,,,,,,inpatient,,,81959.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7258,,186% x Medicaid HMO amount,7258,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14922,,"27,634 x DRG Weight",14922,Other,DRG Base Rate x DRG Weight,12684,,"23,488 x DRG Weight",12684,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3902.21,,DRG base rate x DRG weight + capital per discharge,3902.21,Other,100% of NY Medicaid HMO DRG,3902,,DRG base rate x DRG weight + capital per discharge,3902,Other,100% of NY Medicaid HMO DRG,3902,,DRG base rate x DRG weight + capital per discharge,3902,Other,100% of NY Medicaid HMO DRG,3902,,DRG base rate x DRG weight + capital per discharge,3902,Other,100% of NY Medicaid HMO DRG,8780,,225% x Medicaid HMO amount,8780,Other,225% of NY Medicaid HMO DRG,5970,,153% x Medicaid HMO amount,5970,Other,153% of NY Medicaid HMO DRG,8780,,225% x Medicaid HMO amount,8780,Other,225% of NY Medicaid HMO DRG,5463,,140% x Medicaid HMO amount,5463,Other,140% of NY Medicaid HMO DRG,8780,,DRG base rate x DRG weight + capital per discharge,8780,Other,225% of NY Medicaid HMO DRG,10731,,275% x Medicaid HMO amount,10731,Other,275% of NY Medicaid HMO DRG,12643,,324% x Medicaid HMO amount,12643,Other,324% of NY Medicaid HMO DRG,8390,,215% x Medicaid HMO amount,8390,Other,215% of NY Medicaid HMO DRG,8390,,215% x Medicaid HMO amount,8390,Other,215% of NY Medicaid HMO DRG,4878,,125% x Medicaid HMO amount,4878,Other,125% of NY Medicaid HMO DRG,0.01,14922,
Female reproductive system infections,531-2,APR-DRG,,,,,,,,inpatient,,,139796.04,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9505,,186% x Medicaid HMO amount,9505,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20181,,"27,634 x DRG Weight",20181,Other,DRG Base Rate x DRG Weight,17153,,"23,488 x DRG Weight",17153,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5110.21,,DRG base rate x DRG weight + capital per discharge,5110.21,Other,100% of NY Medicaid HMO DRG,5110,,DRG base rate x DRG weight + capital per discharge,5110,Other,100% of NY Medicaid HMO DRG,5110,,DRG base rate x DRG weight + capital per discharge,5110,Other,100% of NY Medicaid HMO DRG,5110,,DRG base rate x DRG weight + capital per discharge,5110,Other,100% of NY Medicaid HMO DRG,11498,,225% x Medicaid HMO amount,11498,Other,225% of NY Medicaid HMO DRG,7819,,153% x Medicaid HMO amount,7819,Other,153% of NY Medicaid HMO DRG,11498,,225% x Medicaid HMO amount,11498,Other,225% of NY Medicaid HMO DRG,7154,,140% x Medicaid HMO amount,7154,Other,140% of NY Medicaid HMO DRG,11498,,DRG base rate x DRG weight + capital per discharge,11498,Other,225% of NY Medicaid HMO DRG,14053,,275% x Medicaid HMO amount,14053,Other,275% of NY Medicaid HMO DRG,16557,,324% x Medicaid HMO amount,16557,Other,324% of NY Medicaid HMO DRG,10987,,215% x Medicaid HMO amount,10987,Other,215% of NY Medicaid HMO DRG,10987,,215% x Medicaid HMO amount,10987,Other,215% of NY Medicaid HMO DRG,6388,,125% x Medicaid HMO amount,6388,Other,125% of NY Medicaid HMO DRG,0.01,20181,
Female reproductive system infections,531-3,APR-DRG,,,,,,,,inpatient,,,109572.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14569,,186% x Medicaid HMO amount,14569,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32028,,"27,634 x DRG Weight",32028,Other,DRG Base Rate x DRG Weight,27223,,"23,488 x DRG Weight",27223,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7833.21,,DRG base rate x DRG weight + capital per discharge,7833.21,Other,100% of NY Medicaid HMO DRG,7833,,DRG base rate x DRG weight + capital per discharge,7833,Other,100% of NY Medicaid HMO DRG,7833,,DRG base rate x DRG weight + capital per discharge,7833,Other,100% of NY Medicaid HMO DRG,7833,,DRG base rate x DRG weight + capital per discharge,7833,Other,100% of NY Medicaid HMO DRG,17625,,225% x Medicaid HMO amount,17625,Other,225% of NY Medicaid HMO DRG,11985,,153% x Medicaid HMO amount,11985,Other,153% of NY Medicaid HMO DRG,17625,,225% x Medicaid HMO amount,17625,Other,225% of NY Medicaid HMO DRG,10966,,140% x Medicaid HMO amount,10966,Other,140% of NY Medicaid HMO DRG,17625,,DRG base rate x DRG weight + capital per discharge,17625,Other,225% of NY Medicaid HMO DRG,21541,,275% x Medicaid HMO amount,21541,Other,275% of NY Medicaid HMO DRG,25380,,324% x Medicaid HMO amount,25380,Other,324% of NY Medicaid HMO DRG,16841,,215% x Medicaid HMO amount,16841,Other,215% of NY Medicaid HMO DRG,16841,,215% x Medicaid HMO amount,16841,Other,215% of NY Medicaid HMO DRG,9792,,125% x Medicaid HMO amount,9792,Other,125% of NY Medicaid HMO DRG,0.01,32028,
Female reproductive system infections,531-4,APR-DRG,,,,,,,,inpatient,,,139796.04,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16256,,186% x Medicaid HMO amount,16256,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35977,,"27,634 x DRG Weight",35977,Other,DRG Base Rate x DRG Weight,30579,,"23,488 x DRG Weight",30579,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8740.21,,DRG base rate x DRG weight + capital per discharge,8740.21,Other,100% of NY Medicaid HMO DRG,8740,,DRG base rate x DRG weight + capital per discharge,8740,Other,100% of NY Medicaid HMO DRG,8740,,DRG base rate x DRG weight + capital per discharge,8740,Other,100% of NY Medicaid HMO DRG,8740,,DRG base rate x DRG weight + capital per discharge,8740,Other,100% of NY Medicaid HMO DRG,19665,,225% x Medicaid HMO amount,19665,Other,225% of NY Medicaid HMO DRG,13373,,153% x Medicaid HMO amount,13373,Other,153% of NY Medicaid HMO DRG,19665,,225% x Medicaid HMO amount,19665,Other,225% of NY Medicaid HMO DRG,12236,,140% x Medicaid HMO amount,12236,Other,140% of NY Medicaid HMO DRG,19665,,DRG base rate x DRG weight + capital per discharge,19665,Other,225% of NY Medicaid HMO DRG,24036,,275% x Medicaid HMO amount,24036,Other,275% of NY Medicaid HMO DRG,28318,,324% x Medicaid HMO amount,28318,Other,324% of NY Medicaid HMO DRG,18791,,215% x Medicaid HMO amount,18791,Other,215% of NY Medicaid HMO DRG,18791,,215% x Medicaid HMO amount,18791,Other,215% of NY Medicaid HMO DRG,10925,,125% x Medicaid HMO amount,10925,Other,125% of NY Medicaid HMO DRG,0.01,35977,
Menstrual & other female reproductive system disorders,532-1,APR-DRG,,,,,,,,inpatient,,,46782.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5647,,186% x Medicaid HMO amount,5647,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11156,,"27,634 x DRG Weight",11156,Other,DRG Base Rate x DRG Weight,9482,,"23,488 x DRG Weight",9482,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3036.21,,DRG base rate x DRG weight + capital per discharge,3036.21,Other,100% of NY Medicaid HMO DRG,3036,,DRG base rate x DRG weight + capital per discharge,3036,Other,100% of NY Medicaid HMO DRG,3036,,DRG base rate x DRG weight + capital per discharge,3036,Other,100% of NY Medicaid HMO DRG,3036,,DRG base rate x DRG weight + capital per discharge,3036,Other,100% of NY Medicaid HMO DRG,6831,,225% x Medicaid HMO amount,6831,Other,225% of NY Medicaid HMO DRG,4645,,153% x Medicaid HMO amount,4645,Other,153% of NY Medicaid HMO DRG,6831,,225% x Medicaid HMO amount,6831,Other,225% of NY Medicaid HMO DRG,4251,,140% x Medicaid HMO amount,4251,Other,140% of NY Medicaid HMO DRG,6831,,DRG base rate x DRG weight + capital per discharge,6831,Other,225% of NY Medicaid HMO DRG,8350,,275% x Medicaid HMO amount,8350,Other,275% of NY Medicaid HMO DRG,9837,,324% x Medicaid HMO amount,9837,Other,324% of NY Medicaid HMO DRG,6528,,215% x Medicaid HMO amount,6528,Other,215% of NY Medicaid HMO DRG,6528,,215% x Medicaid HMO amount,6528,Other,215% of NY Medicaid HMO DRG,3795,,125% x Medicaid HMO amount,3795,Other,125% of NY Medicaid HMO DRG,0.01,11156,
Menstrual & other female reproductive system disorders,532-2,APR-DRG,,,,,,,,inpatient,,,67751.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7479,,186% x Medicaid HMO amount,7479,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15439,,"27,634 x DRG Weight",15439,Other,DRG Base Rate x DRG Weight,13123,,"23,488 x DRG Weight",13123,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4021.21,,DRG base rate x DRG weight + capital per discharge,4021.21,Other,100% of NY Medicaid HMO DRG,4021,,DRG base rate x DRG weight + capital per discharge,4021,Other,100% of NY Medicaid HMO DRG,4021,,DRG base rate x DRG weight + capital per discharge,4021,Other,100% of NY Medicaid HMO DRG,4021,,DRG base rate x DRG weight + capital per discharge,4021,Other,100% of NY Medicaid HMO DRG,9048,,225% x Medicaid HMO amount,9048,Other,225% of NY Medicaid HMO DRG,6152,,153% x Medicaid HMO amount,6152,Other,153% of NY Medicaid HMO DRG,9048,,225% x Medicaid HMO amount,9048,Other,225% of NY Medicaid HMO DRG,5630,,140% x Medicaid HMO amount,5630,Other,140% of NY Medicaid HMO DRG,9048,,DRG base rate x DRG weight + capital per discharge,9048,Other,225% of NY Medicaid HMO DRG,11058,,275% x Medicaid HMO amount,11058,Other,275% of NY Medicaid HMO DRG,13029,,324% x Medicaid HMO amount,13029,Other,324% of NY Medicaid HMO DRG,8646,,215% x Medicaid HMO amount,8646,Other,215% of NY Medicaid HMO DRG,8646,,215% x Medicaid HMO amount,8646,Other,215% of NY Medicaid HMO DRG,5027,,125% x Medicaid HMO amount,5027,Other,125% of NY Medicaid HMO DRG,0.01,15439,
Menstrual & other female reproductive system disorders,532-3,APR-DRG,,,,,,,,inpatient,,,128400.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12345,,186% x Medicaid HMO amount,12345,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26824,,"27,634 x DRG Weight",26824,Other,DRG Base Rate x DRG Weight,22800,,"23,488 x DRG Weight",22800,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6637.21,,DRG base rate x DRG weight + capital per discharge,6637.21,Other,100% of NY Medicaid HMO DRG,6637,,DRG base rate x DRG weight + capital per discharge,6637,Other,100% of NY Medicaid HMO DRG,6637,,DRG base rate x DRG weight + capital per discharge,6637,Other,100% of NY Medicaid HMO DRG,6637,,DRG base rate x DRG weight + capital per discharge,6637,Other,100% of NY Medicaid HMO DRG,14934,,225% x Medicaid HMO amount,14934,Other,225% of NY Medicaid HMO DRG,10155,,153% x Medicaid HMO amount,10155,Other,153% of NY Medicaid HMO DRG,14934,,225% x Medicaid HMO amount,14934,Other,225% of NY Medicaid HMO DRG,9292,,140% x Medicaid HMO amount,9292,Other,140% of NY Medicaid HMO DRG,14934,,DRG base rate x DRG weight + capital per discharge,14934,Other,225% of NY Medicaid HMO DRG,18252,,275% x Medicaid HMO amount,18252,Other,275% of NY Medicaid HMO DRG,21505,,324% x Medicaid HMO amount,21505,Other,324% of NY Medicaid HMO DRG,14270,,215% x Medicaid HMO amount,14270,Other,215% of NY Medicaid HMO DRG,14270,,215% x Medicaid HMO amount,14270,Other,215% of NY Medicaid HMO DRG,8297,,125% x Medicaid HMO amount,8297,Other,125% of NY Medicaid HMO DRG,0.01,26824,
Menstrual & other female reproductive system disorders,532-4,APR-DRG,,,,,,,,inpatient,,,321608.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13031,,186% x Medicaid HMO amount,13031,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28430,,"27,634 x DRG Weight",28430,Other,DRG Base Rate x DRG Weight,24164,,"23,488 x DRG Weight",24164,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7006.21,,DRG base rate x DRG weight + capital per discharge,7006.21,Other,100% of NY Medicaid HMO DRG,7006,,DRG base rate x DRG weight + capital per discharge,7006,Other,100% of NY Medicaid HMO DRG,7006,,DRG base rate x DRG weight + capital per discharge,7006,Other,100% of NY Medicaid HMO DRG,7006,,DRG base rate x DRG weight + capital per discharge,7006,Other,100% of NY Medicaid HMO DRG,15764,,225% x Medicaid HMO amount,15764,Other,225% of NY Medicaid HMO DRG,10720,,153% x Medicaid HMO amount,10720,Other,153% of NY Medicaid HMO DRG,15764,,225% x Medicaid HMO amount,15764,Other,225% of NY Medicaid HMO DRG,9809,,140% x Medicaid HMO amount,9809,Other,140% of NY Medicaid HMO DRG,15764,,DRG base rate x DRG weight + capital per discharge,15764,Other,225% of NY Medicaid HMO DRG,19267,,275% x Medicaid HMO amount,19267,Other,275% of NY Medicaid HMO DRG,22700,,324% x Medicaid HMO amount,22700,Other,324% of NY Medicaid HMO DRG,15063,,215% x Medicaid HMO amount,15063,Other,215% of NY Medicaid HMO DRG,15063,,215% x Medicaid HMO amount,15063,Other,215% of NY Medicaid HMO DRG,8758,,125% x Medicaid HMO amount,8758,Other,125% of NY Medicaid HMO DRG,0.01,28430,
Cesarean delivery,540-1,APR-DRG,,,,,,,,inpatient,,,105530.65,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10342,,186% x Medicaid HMO amount,10342,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22138,,"27,634 x DRG Weight",22138,Other,DRG Base Rate x DRG Weight,18816,,"23,488 x DRG Weight",18816,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5560.21,,DRG base rate x DRG weight + capital per discharge,5560.21,Other,100% of NY Medicaid HMO DRG,5560,,DRG base rate x DRG weight + capital per discharge,5560,Other,100% of NY Medicaid HMO DRG,5560,,DRG base rate x DRG weight + capital per discharge,5560,Other,100% of NY Medicaid HMO DRG,5560,,DRG base rate x DRG weight + capital per discharge,5560,Other,100% of NY Medicaid HMO DRG,12510,,225% x Medicaid HMO amount,12510,Other,225% of NY Medicaid HMO DRG,8507,,153% x Medicaid HMO amount,8507,Other,153% of NY Medicaid HMO DRG,12510,,225% x Medicaid HMO amount,12510,Other,225% of NY Medicaid HMO DRG,7784,,140% x Medicaid HMO amount,7784,Other,140% of NY Medicaid HMO DRG,12510,,DRG base rate x DRG weight + capital per discharge,12510,Other,225% of NY Medicaid HMO DRG,15291,,275% x Medicaid HMO amount,15291,Other,275% of NY Medicaid HMO DRG,18015,,324% x Medicaid HMO amount,18015,Other,324% of NY Medicaid HMO DRG,11954,,215% x Medicaid HMO amount,11954,Other,215% of NY Medicaid HMO DRG,11954,,215% x Medicaid HMO amount,11954,Other,215% of NY Medicaid HMO DRG,6950,,125% x Medicaid HMO amount,6950,Other,125% of NY Medicaid HMO DRG,0.01,22138,
Cesarean delivery,540-2,APR-DRG,,,,,,,,inpatient,,,140809.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11731,,186% x Medicaid HMO amount,11731,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25387,,"27,634 x DRG Weight",25387,Other,DRG Base Rate x DRG Weight,21578,,"23,488 x DRG Weight",21578,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6307.21,,DRG base rate x DRG weight + capital per discharge,6307.21,Other,100% of NY Medicaid HMO DRG,6307,,DRG base rate x DRG weight + capital per discharge,6307,Other,100% of NY Medicaid HMO DRG,6307,,DRG base rate x DRG weight + capital per discharge,6307,Other,100% of NY Medicaid HMO DRG,6307,,DRG base rate x DRG weight + capital per discharge,6307,Other,100% of NY Medicaid HMO DRG,14191,,225% x Medicaid HMO amount,14191,Other,225% of NY Medicaid HMO DRG,9650,,153% x Medicaid HMO amount,9650,Other,153% of NY Medicaid HMO DRG,14191,,225% x Medicaid HMO amount,14191,Other,225% of NY Medicaid HMO DRG,8830,,140% x Medicaid HMO amount,8830,Other,140% of NY Medicaid HMO DRG,14191,,DRG base rate x DRG weight + capital per discharge,14191,Other,225% of NY Medicaid HMO DRG,17345,,275% x Medicaid HMO amount,17345,Other,275% of NY Medicaid HMO DRG,20435,,324% x Medicaid HMO amount,20435,Other,324% of NY Medicaid HMO DRG,13561,,215% x Medicaid HMO amount,13561,Other,215% of NY Medicaid HMO DRG,13561,,215% x Medicaid HMO amount,13561,Other,215% of NY Medicaid HMO DRG,7884,,125% x Medicaid HMO amount,7884,Other,125% of NY Medicaid HMO DRG,0.01,25387,
Cesarean delivery,540-3,APR-DRG,,,,,,,,inpatient,,,185138.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14774,,186% x Medicaid HMO amount,14774,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32509,,"27,634 x DRG Weight",32509,Other,DRG Base Rate x DRG Weight,27631,,"23,488 x DRG Weight",27631,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7943.21,,DRG base rate x DRG weight + capital per discharge,7943.21,Other,100% of NY Medicaid HMO DRG,7943,,DRG base rate x DRG weight + capital per discharge,7943,Other,100% of NY Medicaid HMO DRG,7943,,DRG base rate x DRG weight + capital per discharge,7943,Other,100% of NY Medicaid HMO DRG,7943,,DRG base rate x DRG weight + capital per discharge,7943,Other,100% of NY Medicaid HMO DRG,17872,,225% x Medicaid HMO amount,17872,Other,225% of NY Medicaid HMO DRG,12153,,153% x Medicaid HMO amount,12153,Other,153% of NY Medicaid HMO DRG,17872,,225% x Medicaid HMO amount,17872,Other,225% of NY Medicaid HMO DRG,11120,,140% x Medicaid HMO amount,11120,Other,140% of NY Medicaid HMO DRG,17872,,DRG base rate x DRG weight + capital per discharge,17872,Other,225% of NY Medicaid HMO DRG,21844,,275% x Medicaid HMO amount,21844,Other,275% of NY Medicaid HMO DRG,25736,,324% x Medicaid HMO amount,25736,Other,324% of NY Medicaid HMO DRG,17078,,215% x Medicaid HMO amount,17078,Other,215% of NY Medicaid HMO DRG,17078,,215% x Medicaid HMO amount,17078,Other,215% of NY Medicaid HMO DRG,9929,,125% x Medicaid HMO amount,9929,Other,125% of NY Medicaid HMO DRG,0.01,32509,
Cesarean delivery,540-4,APR-DRG,,,,,,,,inpatient,,,334973.51,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32835,,186% x Medicaid HMO amount,32835,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74767,,"27,634 x DRG Weight",74767,Other,DRG Base Rate x DRG Weight,63549,,"23,488 x DRG Weight",63549,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17653.21,,DRG base rate x DRG weight + capital per discharge,17653.21,Other,100% of NY Medicaid HMO DRG,17653,,DRG base rate x DRG weight + capital per discharge,17653,Other,100% of NY Medicaid HMO DRG,17653,,DRG base rate x DRG weight + capital per discharge,17653,Other,100% of NY Medicaid HMO DRG,17653,,DRG base rate x DRG weight + capital per discharge,17653,Other,100% of NY Medicaid HMO DRG,39720,,225% x Medicaid HMO amount,39720,Other,225% of NY Medicaid HMO DRG,27009,,153% x Medicaid HMO amount,27009,Other,153% of NY Medicaid HMO DRG,39720,,225% x Medicaid HMO amount,39720,Other,225% of NY Medicaid HMO DRG,24714,,140% x Medicaid HMO amount,24714,Other,140% of NY Medicaid HMO DRG,39720,,DRG base rate x DRG weight + capital per discharge,39720,Other,225% of NY Medicaid HMO DRG,48546,,275% x Medicaid HMO amount,48546,Other,275% of NY Medicaid HMO DRG,57196,,324% x Medicaid HMO amount,57196,Other,324% of NY Medicaid HMO DRG,37954,,215% x Medicaid HMO amount,37954,Other,215% of NY Medicaid HMO DRG,37954,,215% x Medicaid HMO amount,37954,Other,215% of NY Medicaid HMO DRG,22067,,125% x Medicaid HMO amount,22067,Other,125% of NY Medicaid HMO DRG,0.01,74767,
Vaginal delivery w sterilization &/or D&C,541-1,APR-DRG,,,,,,,,inpatient,,,108561.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9185,,186% x Medicaid HMO amount,9185,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19429,,"27,634 x DRG Weight",19429,Other,DRG Base Rate x DRG Weight,16514,,"23,488 x DRG Weight",16514,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4938.21,,DRG base rate x DRG weight + capital per discharge,4938.21,Other,100% of NY Medicaid HMO DRG,4938,,DRG base rate x DRG weight + capital per discharge,4938,Other,100% of NY Medicaid HMO DRG,4938,,DRG base rate x DRG weight + capital per discharge,4938,Other,100% of NY Medicaid HMO DRG,4938,,DRG base rate x DRG weight + capital per discharge,4938,Other,100% of NY Medicaid HMO DRG,11111,,225% x Medicaid HMO amount,11111,Other,225% of NY Medicaid HMO DRG,7555,,153% x Medicaid HMO amount,7555,Other,153% of NY Medicaid HMO DRG,11111,,225% x Medicaid HMO amount,11111,Other,225% of NY Medicaid HMO DRG,6913,,140% x Medicaid HMO amount,6913,Other,140% of NY Medicaid HMO DRG,11111,,DRG base rate x DRG weight + capital per discharge,11111,Other,225% of NY Medicaid HMO DRG,13580,,275% x Medicaid HMO amount,13580,Other,275% of NY Medicaid HMO DRG,16000,,324% x Medicaid HMO amount,16000,Other,324% of NY Medicaid HMO DRG,10617,,215% x Medicaid HMO amount,10617,Other,215% of NY Medicaid HMO DRG,10617,,215% x Medicaid HMO amount,10617,Other,215% of NY Medicaid HMO DRG,6173,,125% x Medicaid HMO amount,6173,Other,125% of NY Medicaid HMO DRG,0.01,19429,
Vaginal delivery w sterilization &/or D&C,541-2,APR-DRG,,,,,,,,inpatient,,,107615.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9858,,186% x Medicaid HMO amount,9858,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21005,,"27,634 x DRG Weight",21005,Other,DRG Base Rate x DRG Weight,17853,,"23,488 x DRG Weight",17853,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5300.21,,DRG base rate x DRG weight + capital per discharge,5300.21,Other,100% of NY Medicaid HMO DRG,5300,,DRG base rate x DRG weight + capital per discharge,5300,Other,100% of NY Medicaid HMO DRG,5300,,DRG base rate x DRG weight + capital per discharge,5300,Other,100% of NY Medicaid HMO DRG,5300,,DRG base rate x DRG weight + capital per discharge,5300,Other,100% of NY Medicaid HMO DRG,11925,,225% x Medicaid HMO amount,11925,Other,225% of NY Medicaid HMO DRG,8109,,153% x Medicaid HMO amount,8109,Other,153% of NY Medicaid HMO DRG,11925,,225% x Medicaid HMO amount,11925,Other,225% of NY Medicaid HMO DRG,7420,,140% x Medicaid HMO amount,7420,Other,140% of NY Medicaid HMO DRG,11925,,DRG base rate x DRG weight + capital per discharge,11925,Other,225% of NY Medicaid HMO DRG,14576,,275% x Medicaid HMO amount,14576,Other,275% of NY Medicaid HMO DRG,17173,,324% x Medicaid HMO amount,17173,Other,324% of NY Medicaid HMO DRG,11395,,215% x Medicaid HMO amount,11395,Other,215% of NY Medicaid HMO DRG,11395,,215% x Medicaid HMO amount,11395,Other,215% of NY Medicaid HMO DRG,6625,,125% x Medicaid HMO amount,6625,Other,125% of NY Medicaid HMO DRG,0.01,21005,
Vaginal delivery w sterilization &/or D&C,541-3,APR-DRG,,,,,,,,inpatient,,,258103.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12641,,186% x Medicaid HMO amount,12641,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27518,,"27,634 x DRG Weight",27518,Other,DRG Base Rate x DRG Weight,23389,,"23,488 x DRG Weight",23389,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6796.21,,DRG base rate x DRG weight + capital per discharge,6796.21,Other,100% of NY Medicaid HMO DRG,6796,,DRG base rate x DRG weight + capital per discharge,6796,Other,100% of NY Medicaid HMO DRG,6796,,DRG base rate x DRG weight + capital per discharge,6796,Other,100% of NY Medicaid HMO DRG,6796,,DRG base rate x DRG weight + capital per discharge,6796,Other,100% of NY Medicaid HMO DRG,15291,,225% x Medicaid HMO amount,15291,Other,225% of NY Medicaid HMO DRG,10398,,153% x Medicaid HMO amount,10398,Other,153% of NY Medicaid HMO DRG,15291,,225% x Medicaid HMO amount,15291,Other,225% of NY Medicaid HMO DRG,9515,,140% x Medicaid HMO amount,9515,Other,140% of NY Medicaid HMO DRG,15291,,DRG base rate x DRG weight + capital per discharge,15291,Other,225% of NY Medicaid HMO DRG,18690,,275% x Medicaid HMO amount,18690,Other,275% of NY Medicaid HMO DRG,22020,,324% x Medicaid HMO amount,22020,Other,324% of NY Medicaid HMO DRG,14612,,215% x Medicaid HMO amount,14612,Other,215% of NY Medicaid HMO DRG,14612,,215% x Medicaid HMO amount,14612,Other,215% of NY Medicaid HMO DRG,8495,,125% x Medicaid HMO amount,8495,Other,125% of NY Medicaid HMO DRG,0.01,27518,
Vaginal delivery w sterilization &/or D&C,541-4,APR-DRG,,,,,,,,inpatient,,,258103.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13764,,186% x Medicaid HMO amount,13764,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30146,,"27,634 x DRG Weight",30146,Other,DRG Base Rate x DRG Weight,25623,,"23,488 x DRG Weight",25623,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7400.21,,DRG base rate x DRG weight + capital per discharge,7400.21,Other,100% of NY Medicaid HMO DRG,7400,,DRG base rate x DRG weight + capital per discharge,7400,Other,100% of NY Medicaid HMO DRG,7400,,DRG base rate x DRG weight + capital per discharge,7400,Other,100% of NY Medicaid HMO DRG,7400,,DRG base rate x DRG weight + capital per discharge,7400,Other,100% of NY Medicaid HMO DRG,16650,,225% x Medicaid HMO amount,16650,Other,225% of NY Medicaid HMO DRG,11322,,153% x Medicaid HMO amount,11322,Other,153% of NY Medicaid HMO DRG,16650,,225% x Medicaid HMO amount,16650,Other,225% of NY Medicaid HMO DRG,10360,,140% x Medicaid HMO amount,10360,Other,140% of NY Medicaid HMO DRG,16650,,DRG base rate x DRG weight + capital per discharge,16650,Other,225% of NY Medicaid HMO DRG,20351,,275% x Medicaid HMO amount,20351,Other,275% of NY Medicaid HMO DRG,23977,,324% x Medicaid HMO amount,23977,Other,324% of NY Medicaid HMO DRG,15910,,215% x Medicaid HMO amount,15910,Other,215% of NY Medicaid HMO DRG,15910,,215% x Medicaid HMO amount,15910,Other,215% of NY Medicaid HMO DRG,9250,,125% x Medicaid HMO amount,9250,Other,125% of NY Medicaid HMO DRG,0.01,30146,
Vaginal delivery w complicating procedures exc sterilization &/or D&C,542-1,APR-DRG,,,,,,,,inpatient,,,87122,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7909,,186% x Medicaid HMO amount,7909,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16445,,"27,634 x DRG Weight",16445,Other,DRG Base Rate x DRG Weight,13978,,"23,488 x DRG Weight",13978,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4252.21,,DRG base rate x DRG weight + capital per discharge,4252.21,Other,100% of NY Medicaid HMO DRG,4252,,DRG base rate x DRG weight + capital per discharge,4252,Other,100% of NY Medicaid HMO DRG,4252,,DRG base rate x DRG weight + capital per discharge,4252,Other,100% of NY Medicaid HMO DRG,4252,,DRG base rate x DRG weight + capital per discharge,4252,Other,100% of NY Medicaid HMO DRG,9567,,225% x Medicaid HMO amount,9567,Other,225% of NY Medicaid HMO DRG,6506,,153% x Medicaid HMO amount,6506,Other,153% of NY Medicaid HMO DRG,9567,,225% x Medicaid HMO amount,9567,Other,225% of NY Medicaid HMO DRG,5953,,140% x Medicaid HMO amount,5953,Other,140% of NY Medicaid HMO DRG,9567,,DRG base rate x DRG weight + capital per discharge,9567,Other,225% of NY Medicaid HMO DRG,11694,,275% x Medicaid HMO amount,11694,Other,275% of NY Medicaid HMO DRG,13777,,324% x Medicaid HMO amount,13777,Other,324% of NY Medicaid HMO DRG,9142,,215% x Medicaid HMO amount,9142,Other,215% of NY Medicaid HMO DRG,9142,,215% x Medicaid HMO amount,9142,Other,215% of NY Medicaid HMO DRG,5315,,125% x Medicaid HMO amount,5315,Other,125% of NY Medicaid HMO DRG,0.01,16445,
Vaginal delivery w complicating procedures exc sterilization &/or D&C,542-2,APR-DRG,,,,,,,,inpatient,,,79363.09,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8889,,186% x Medicaid HMO amount,8889,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18741,,"27,634 x DRG Weight",18741,Other,DRG Base Rate x DRG Weight,15930,,"23,488 x DRG Weight",15930,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4779.21,,DRG base rate x DRG weight + capital per discharge,4779.21,Other,100% of NY Medicaid HMO DRG,4779,,DRG base rate x DRG weight + capital per discharge,4779,Other,100% of NY Medicaid HMO DRG,4779,,DRG base rate x DRG weight + capital per discharge,4779,Other,100% of NY Medicaid HMO DRG,4779,,DRG base rate x DRG weight + capital per discharge,4779,Other,100% of NY Medicaid HMO DRG,10753,,225% x Medicaid HMO amount,10753,Other,225% of NY Medicaid HMO DRG,7312,,153% x Medicaid HMO amount,7312,Other,153% of NY Medicaid HMO DRG,10753,,225% x Medicaid HMO amount,10753,Other,225% of NY Medicaid HMO DRG,6691,,140% x Medicaid HMO amount,6691,Other,140% of NY Medicaid HMO DRG,10753,,DRG base rate x DRG weight + capital per discharge,10753,Other,225% of NY Medicaid HMO DRG,13143,,275% x Medicaid HMO amount,13143,Other,275% of NY Medicaid HMO DRG,15485,,324% x Medicaid HMO amount,15485,Other,324% of NY Medicaid HMO DRG,10275,,215% x Medicaid HMO amount,10275,Other,215% of NY Medicaid HMO DRG,10275,,215% x Medicaid HMO amount,10275,Other,215% of NY Medicaid HMO DRG,5974,,125% x Medicaid HMO amount,5974,Other,125% of NY Medicaid HMO DRG,0.01,18741,
Vaginal delivery w complicating procedures exc sterilization &/or D&C,542-3,APR-DRG,,,,,,,,inpatient,,,100826.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15308,,186% x Medicaid HMO amount,15308,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33758,,"27,634 x DRG Weight",33758,Other,DRG Base Rate x DRG Weight,28693,,"23,488 x DRG Weight",28693,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8230.21,,DRG base rate x DRG weight + capital per discharge,8230.21,Other,100% of NY Medicaid HMO DRG,8230,,DRG base rate x DRG weight + capital per discharge,8230,Other,100% of NY Medicaid HMO DRG,8230,,DRG base rate x DRG weight + capital per discharge,8230,Other,100% of NY Medicaid HMO DRG,8230,,DRG base rate x DRG weight + capital per discharge,8230,Other,100% of NY Medicaid HMO DRG,18518,,225% x Medicaid HMO amount,18518,Other,225% of NY Medicaid HMO DRG,12592,,153% x Medicaid HMO amount,12592,Other,153% of NY Medicaid HMO DRG,18518,,225% x Medicaid HMO amount,18518,Other,225% of NY Medicaid HMO DRG,11522,,140% x Medicaid HMO amount,11522,Other,140% of NY Medicaid HMO DRG,18518,,DRG base rate x DRG weight + capital per discharge,18518,Other,225% of NY Medicaid HMO DRG,22633,,275% x Medicaid HMO amount,22633,Other,275% of NY Medicaid HMO DRG,26666,,324% x Medicaid HMO amount,26666,Other,324% of NY Medicaid HMO DRG,17695,,215% x Medicaid HMO amount,17695,Other,215% of NY Medicaid HMO DRG,17695,,215% x Medicaid HMO amount,17695,Other,215% of NY Medicaid HMO DRG,10288,,125% x Medicaid HMO amount,10288,Other,125% of NY Medicaid HMO DRG,0.01,33758,
Vaginal delivery w complicating procedures exc sterilization &/or D&C,542-4,APR-DRG,,,,,,,,inpatient,,,100826.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19080,,186% x Medicaid HMO amount,19080,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42581,,"27,634 x DRG Weight",42581,Other,DRG Base Rate x DRG Weight,36193,,"23,488 x DRG Weight",36193,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10258.21,,DRG base rate x DRG weight + capital per discharge,10258.21,Other,100% of NY Medicaid HMO DRG,10258,,DRG base rate x DRG weight + capital per discharge,10258,Other,100% of NY Medicaid HMO DRG,10258,,DRG base rate x DRG weight + capital per discharge,10258,Other,100% of NY Medicaid HMO DRG,10258,,DRG base rate x DRG weight + capital per discharge,10258,Other,100% of NY Medicaid HMO DRG,23081,,225% x Medicaid HMO amount,23081,Other,225% of NY Medicaid HMO DRG,15695,,153% x Medicaid HMO amount,15695,Other,153% of NY Medicaid HMO DRG,23081,,225% x Medicaid HMO amount,23081,Other,225% of NY Medicaid HMO DRG,14361,,140% x Medicaid HMO amount,14361,Other,140% of NY Medicaid HMO DRG,23081,,DRG base rate x DRG weight + capital per discharge,23081,Other,225% of NY Medicaid HMO DRG,28210,,275% x Medicaid HMO amount,28210,Other,275% of NY Medicaid HMO DRG,33237,,324% x Medicaid HMO amount,33237,Other,324% of NY Medicaid HMO DRG,22055,,215% x Medicaid HMO amount,22055,Other,215% of NY Medicaid HMO DRG,22055,,215% x Medicaid HMO amount,22055,Other,215% of NY Medicaid HMO DRG,12823,,125% x Medicaid HMO amount,12823,Other,125% of NY Medicaid HMO DRG,0.01,42581,
"D&C, aspiration curettage or hysterotomy for obstetric diagnoses",544-1,APR-DRG,,,,,,,,inpatient,,,84340.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6547,,186% x Medicaid HMO amount,6547,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13262,,"27,634 x DRG Weight",13262,Other,DRG Base Rate x DRG Weight,11272,,"23,488 x DRG Weight",11272,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3520.21,,DRG base rate x DRG weight + capital per discharge,3520.21,Other,100% of NY Medicaid HMO DRG,3520,,DRG base rate x DRG weight + capital per discharge,3520,Other,100% of NY Medicaid HMO DRG,3520,,DRG base rate x DRG weight + capital per discharge,3520,Other,100% of NY Medicaid HMO DRG,3520,,DRG base rate x DRG weight + capital per discharge,3520,Other,100% of NY Medicaid HMO DRG,7920,,225% x Medicaid HMO amount,7920,Other,225% of NY Medicaid HMO DRG,5386,,153% x Medicaid HMO amount,5386,Other,153% of NY Medicaid HMO DRG,7920,,225% x Medicaid HMO amount,7920,Other,225% of NY Medicaid HMO DRG,4928,,140% x Medicaid HMO amount,4928,Other,140% of NY Medicaid HMO DRG,7920,,DRG base rate x DRG weight + capital per discharge,7920,Other,225% of NY Medicaid HMO DRG,9681,,275% x Medicaid HMO amount,9681,Other,275% of NY Medicaid HMO DRG,11405,,324% x Medicaid HMO amount,11405,Other,324% of NY Medicaid HMO DRG,7568,,215% x Medicaid HMO amount,7568,Other,215% of NY Medicaid HMO DRG,7568,,215% x Medicaid HMO amount,7568,Other,215% of NY Medicaid HMO DRG,4400,,125% x Medicaid HMO amount,4400,Other,125% of NY Medicaid HMO DRG,0.01,13262,
"D&C, aspiration curettage or hysterotomy for obstetric diagnoses",544-2,APR-DRG,,,,,,,,inpatient,,,121236.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8190,,186% x Medicaid HMO amount,8190,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17103,,"27,634 x DRG Weight",17103,Other,DRG Base Rate x DRG Weight,14537,,"23,488 x DRG Weight",14537,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4403.21,,DRG base rate x DRG weight + capital per discharge,4403.21,Other,100% of NY Medicaid HMO DRG,4403,,DRG base rate x DRG weight + capital per discharge,4403,Other,100% of NY Medicaid HMO DRG,4403,,DRG base rate x DRG weight + capital per discharge,4403,Other,100% of NY Medicaid HMO DRG,4403,,DRG base rate x DRG weight + capital per discharge,4403,Other,100% of NY Medicaid HMO DRG,9907,,225% x Medicaid HMO amount,9907,Other,225% of NY Medicaid HMO DRG,6737,,153% x Medicaid HMO amount,6737,Other,153% of NY Medicaid HMO DRG,9907,,225% x Medicaid HMO amount,9907,Other,225% of NY Medicaid HMO DRG,6164,,140% x Medicaid HMO amount,6164,Other,140% of NY Medicaid HMO DRG,9907,,DRG base rate x DRG weight + capital per discharge,9907,Other,225% of NY Medicaid HMO DRG,12109,,275% x Medicaid HMO amount,12109,Other,275% of NY Medicaid HMO DRG,14266,,324% x Medicaid HMO amount,14266,Other,324% of NY Medicaid HMO DRG,9467,,215% x Medicaid HMO amount,9467,Other,215% of NY Medicaid HMO DRG,9467,,215% x Medicaid HMO amount,9467,Other,215% of NY Medicaid HMO DRG,5504,,125% x Medicaid HMO amount,5504,Other,125% of NY Medicaid HMO DRG,0.01,17103,
"D&C, aspiration curettage or hysterotomy for obstetric diagnoses",544-3,APR-DRG,,,,,,,,inpatient,,,160697,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13864,,186% x Medicaid HMO amount,13864,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30381,,"27,634 x DRG Weight",30381,Other,DRG Base Rate x DRG Weight,25823,,"23,488 x DRG Weight",25823,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7454.21,,DRG base rate x DRG weight + capital per discharge,7454.21,Other,100% of NY Medicaid HMO DRG,7454,,DRG base rate x DRG weight + capital per discharge,7454,Other,100% of NY Medicaid HMO DRG,7454,,DRG base rate x DRG weight + capital per discharge,7454,Other,100% of NY Medicaid HMO DRG,7454,,DRG base rate x DRG weight + capital per discharge,7454,Other,100% of NY Medicaid HMO DRG,16772,,225% x Medicaid HMO amount,16772,Other,225% of NY Medicaid HMO DRG,11405,,153% x Medicaid HMO amount,11405,Other,153% of NY Medicaid HMO DRG,16772,,225% x Medicaid HMO amount,16772,Other,225% of NY Medicaid HMO DRG,10436,,140% x Medicaid HMO amount,10436,Other,140% of NY Medicaid HMO DRG,16772,,DRG base rate x DRG weight + capital per discharge,16772,Other,225% of NY Medicaid HMO DRG,20499,,275% x Medicaid HMO amount,20499,Other,275% of NY Medicaid HMO DRG,24152,,324% x Medicaid HMO amount,24152,Other,324% of NY Medicaid HMO DRG,16027,,215% x Medicaid HMO amount,16027,Other,215% of NY Medicaid HMO DRG,16027,,215% x Medicaid HMO amount,16027,Other,215% of NY Medicaid HMO DRG,9318,,125% x Medicaid HMO amount,9318,Other,125% of NY Medicaid HMO DRG,0.01,30381,
"D&C, aspiration curettage or hysterotomy for obstetric diagnoses",544-4,APR-DRG,,,,,,,,inpatient,,,160697,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34784,,186% x Medicaid HMO amount,34784,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,79326,,"27,634 x DRG Weight",79326,Other,DRG Base Rate x DRG Weight,67425,,"23,488 x DRG Weight",67425,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18701.21,,DRG base rate x DRG weight + capital per discharge,18701.21,Other,100% of NY Medicaid HMO DRG,18701,,DRG base rate x DRG weight + capital per discharge,18701,Other,100% of NY Medicaid HMO DRG,18701,,DRG base rate x DRG weight + capital per discharge,18701,Other,100% of NY Medicaid HMO DRG,18701,,DRG base rate x DRG weight + capital per discharge,18701,Other,100% of NY Medicaid HMO DRG,42078,,225% x Medicaid HMO amount,42078,Other,225% of NY Medicaid HMO DRG,28613,,153% x Medicaid HMO amount,28613,Other,153% of NY Medicaid HMO DRG,42078,,225% x Medicaid HMO amount,42078,Other,225% of NY Medicaid HMO DRG,26182,,140% x Medicaid HMO amount,26182,Other,140% of NY Medicaid HMO DRG,42078,,DRG base rate x DRG weight + capital per discharge,42078,Other,225% of NY Medicaid HMO DRG,51428,,275% x Medicaid HMO amount,51428,Other,275% of NY Medicaid HMO DRG,60592,,324% x Medicaid HMO amount,60592,Other,324% of NY Medicaid HMO DRG,40208,,215% x Medicaid HMO amount,40208,Other,215% of NY Medicaid HMO DRG,40208,,215% x Medicaid HMO amount,40208,Other,215% of NY Medicaid HMO DRG,23377,,125% x Medicaid HMO amount,23377,Other,125% of NY Medicaid HMO DRG,0.01,79326,
Ectopic pregnancy procedure,545-1,APR-DRG,,,,,,,,inpatient,,,169587.19,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9090,,186% x Medicaid HMO amount,9090,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19208,,"27,634 x DRG Weight",19208,Other,DRG Base Rate x DRG Weight,16327,,"23,488 x DRG Weight",16327,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4887.21,,DRG base rate x DRG weight + capital per discharge,4887.21,Other,100% of NY Medicaid HMO DRG,4887,,DRG base rate x DRG weight + capital per discharge,4887,Other,100% of NY Medicaid HMO DRG,4887,,DRG base rate x DRG weight + capital per discharge,4887,Other,100% of NY Medicaid HMO DRG,4887,,DRG base rate x DRG weight + capital per discharge,4887,Other,100% of NY Medicaid HMO DRG,10996,,225% x Medicaid HMO amount,10996,Other,225% of NY Medicaid HMO DRG,7477,,153% x Medicaid HMO amount,7477,Other,153% of NY Medicaid HMO DRG,10996,,225% x Medicaid HMO amount,10996,Other,225% of NY Medicaid HMO DRG,6842,,140% x Medicaid HMO amount,6842,Other,140% of NY Medicaid HMO DRG,10996,,DRG base rate x DRG weight + capital per discharge,10996,Other,225% of NY Medicaid HMO DRG,13440,,275% x Medicaid HMO amount,13440,Other,275% of NY Medicaid HMO DRG,15835,,324% x Medicaid HMO amount,15835,Other,324% of NY Medicaid HMO DRG,10508,,215% x Medicaid HMO amount,10508,Other,215% of NY Medicaid HMO DRG,10508,,215% x Medicaid HMO amount,10508,Other,215% of NY Medicaid HMO DRG,6109,,125% x Medicaid HMO amount,6109,Other,125% of NY Medicaid HMO DRG,0.01,19208,
Ectopic pregnancy procedure,545-2,APR-DRG,,,,,,,,inpatient,,,85244.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10152,,186% x Medicaid HMO amount,10152,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21693,,"27,634 x DRG Weight",21693,Other,DRG Base Rate x DRG Weight,18438,,"23,488 x DRG Weight",18438,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5458.21,,DRG base rate x DRG weight + capital per discharge,5458.21,Other,100% of NY Medicaid HMO DRG,5458,,DRG base rate x DRG weight + capital per discharge,5458,Other,100% of NY Medicaid HMO DRG,5458,,DRG base rate x DRG weight + capital per discharge,5458,Other,100% of NY Medicaid HMO DRG,5458,,DRG base rate x DRG weight + capital per discharge,5458,Other,100% of NY Medicaid HMO DRG,12281,,225% x Medicaid HMO amount,12281,Other,225% of NY Medicaid HMO DRG,8351,,153% x Medicaid HMO amount,8351,Other,153% of NY Medicaid HMO DRG,12281,,225% x Medicaid HMO amount,12281,Other,225% of NY Medicaid HMO DRG,7641,,140% x Medicaid HMO amount,7641,Other,140% of NY Medicaid HMO DRG,12281,,DRG base rate x DRG weight + capital per discharge,12281,Other,225% of NY Medicaid HMO DRG,15010,,275% x Medicaid HMO amount,15010,Other,275% of NY Medicaid HMO DRG,17685,,324% x Medicaid HMO amount,17685,Other,324% of NY Medicaid HMO DRG,11735,,215% x Medicaid HMO amount,11735,Other,215% of NY Medicaid HMO DRG,11735,,215% x Medicaid HMO amount,11735,Other,215% of NY Medicaid HMO DRG,6823,,125% x Medicaid HMO amount,6823,Other,125% of NY Medicaid HMO DRG,0.01,21693,
Ectopic pregnancy procedure,545-3,APR-DRG,,,,,,,,inpatient,,,128311.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13887,,186% x Medicaid HMO amount,13887,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30433,,"27,634 x DRG Weight",30433,Other,DRG Base Rate x DRG Weight,25867,,"23,488 x DRG Weight",25867,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7466.21,,DRG base rate x DRG weight + capital per discharge,7466.21,Other,100% of NY Medicaid HMO DRG,7466,,DRG base rate x DRG weight + capital per discharge,7466,Other,100% of NY Medicaid HMO DRG,7466,,DRG base rate x DRG weight + capital per discharge,7466,Other,100% of NY Medicaid HMO DRG,7466,,DRG base rate x DRG weight + capital per discharge,7466,Other,100% of NY Medicaid HMO DRG,16799,,225% x Medicaid HMO amount,16799,Other,225% of NY Medicaid HMO DRG,11423,,153% x Medicaid HMO amount,11423,Other,153% of NY Medicaid HMO DRG,16799,,225% x Medicaid HMO amount,16799,Other,225% of NY Medicaid HMO DRG,10453,,140% x Medicaid HMO amount,10453,Other,140% of NY Medicaid HMO DRG,16799,,DRG base rate x DRG weight + capital per discharge,16799,Other,225% of NY Medicaid HMO DRG,20532,,275% x Medicaid HMO amount,20532,Other,275% of NY Medicaid HMO DRG,24191,,324% x Medicaid HMO amount,24191,Other,324% of NY Medicaid HMO DRG,16052,,215% x Medicaid HMO amount,16052,Other,215% of NY Medicaid HMO DRG,16052,,215% x Medicaid HMO amount,16052,Other,215% of NY Medicaid HMO DRG,9333,,125% x Medicaid HMO amount,9333,Other,125% of NY Medicaid HMO DRG,0.01,30433,
Ectopic pregnancy procedure,545-4,APR-DRG,,,,,,,,inpatient,,,128311.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14759,,186% x Medicaid HMO amount,14759,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32473,,"27,634 x DRG Weight",32473,Other,DRG Base Rate x DRG Weight,27601,,"23,488 x DRG Weight",27601,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7935.21,,DRG base rate x DRG weight + capital per discharge,7935.21,Other,100% of NY Medicaid HMO DRG,7935,,DRG base rate x DRG weight + capital per discharge,7935,Other,100% of NY Medicaid HMO DRG,7935,,DRG base rate x DRG weight + capital per discharge,7935,Other,100% of NY Medicaid HMO DRG,7935,,DRG base rate x DRG weight + capital per discharge,7935,Other,100% of NY Medicaid HMO DRG,17854,,225% x Medicaid HMO amount,17854,Other,225% of NY Medicaid HMO DRG,12141,,153% x Medicaid HMO amount,12141,Other,153% of NY Medicaid HMO DRG,17854,,225% x Medicaid HMO amount,17854,Other,225% of NY Medicaid HMO DRG,11109,,140% x Medicaid HMO amount,11109,Other,140% of NY Medicaid HMO DRG,17854,,DRG base rate x DRG weight + capital per discharge,17854,Other,225% of NY Medicaid HMO DRG,21822,,275% x Medicaid HMO amount,21822,Other,275% of NY Medicaid HMO DRG,25710,,324% x Medicaid HMO amount,25710,Other,324% of NY Medicaid HMO DRG,17061,,215% x Medicaid HMO amount,17061,Other,215% of NY Medicaid HMO DRG,17061,,215% x Medicaid HMO amount,17061,Other,215% of NY Medicaid HMO DRG,9919,,125% x Medicaid HMO amount,9919,Other,125% of NY Medicaid HMO DRG,0.01,32473,
Other O.R. proc for obstetric diagnoses except delivery diagnoses,546-1,APR-DRG,,,,,,,,inpatient,,,68684.62,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7676,,186% x Medicaid HMO amount,7676,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15901,,"27,634 x DRG Weight",15901,Other,DRG Base Rate x DRG Weight,13515,,"23,488 x DRG Weight",13515,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4127.21,,DRG base rate x DRG weight + capital per discharge,4127.21,Other,100% of NY Medicaid HMO DRG,4127,,DRG base rate x DRG weight + capital per discharge,4127,Other,100% of NY Medicaid HMO DRG,4127,,DRG base rate x DRG weight + capital per discharge,4127,Other,100% of NY Medicaid HMO DRG,4127,,DRG base rate x DRG weight + capital per discharge,4127,Other,100% of NY Medicaid HMO DRG,9286,,225% x Medicaid HMO amount,9286,Other,225% of NY Medicaid HMO DRG,6315,,153% x Medicaid HMO amount,6315,Other,153% of NY Medicaid HMO DRG,9286,,225% x Medicaid HMO amount,9286,Other,225% of NY Medicaid HMO DRG,5778,,140% x Medicaid HMO amount,5778,Other,140% of NY Medicaid HMO DRG,9286,,DRG base rate x DRG weight + capital per discharge,9286,Other,225% of NY Medicaid HMO DRG,11350,,275% x Medicaid HMO amount,11350,Other,275% of NY Medicaid HMO DRG,13372,,324% x Medicaid HMO amount,13372,Other,324% of NY Medicaid HMO DRG,8874,,215% x Medicaid HMO amount,8874,Other,215% of NY Medicaid HMO DRG,8874,,215% x Medicaid HMO amount,8874,Other,215% of NY Medicaid HMO DRG,5159,,125% x Medicaid HMO amount,5159,Other,125% of NY Medicaid HMO DRG,0.01,15901,
Other O.R. proc for obstetric diagnoses except delivery diagnoses,546-2,APR-DRG,,,,,,,,inpatient,,,85260.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10087,,186% x Medicaid HMO amount,10087,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21541,,"27,634 x DRG Weight",21541,Other,DRG Base Rate x DRG Weight,18309,,"23,488 x DRG Weight",18309,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5423.21,,DRG base rate x DRG weight + capital per discharge,5423.21,Other,100% of NY Medicaid HMO DRG,5423,,DRG base rate x DRG weight + capital per discharge,5423,Other,100% of NY Medicaid HMO DRG,5423,,DRG base rate x DRG weight + capital per discharge,5423,Other,100% of NY Medicaid HMO DRG,5423,,DRG base rate x DRG weight + capital per discharge,5423,Other,100% of NY Medicaid HMO DRG,12202,,225% x Medicaid HMO amount,12202,Other,225% of NY Medicaid HMO DRG,8298,,153% x Medicaid HMO amount,8298,Other,153% of NY Medicaid HMO DRG,12202,,225% x Medicaid HMO amount,12202,Other,225% of NY Medicaid HMO DRG,7592,,140% x Medicaid HMO amount,7592,Other,140% of NY Medicaid HMO DRG,12202,,DRG base rate x DRG weight + capital per discharge,12202,Other,225% of NY Medicaid HMO DRG,14914,,275% x Medicaid HMO amount,14914,Other,275% of NY Medicaid HMO DRG,17571,,324% x Medicaid HMO amount,17571,Other,324% of NY Medicaid HMO DRG,11660,,215% x Medicaid HMO amount,11660,Other,215% of NY Medicaid HMO DRG,11660,,215% x Medicaid HMO amount,11660,Other,215% of NY Medicaid HMO DRG,6779,,125% x Medicaid HMO amount,6779,Other,125% of NY Medicaid HMO DRG,0.01,21541,
Other O.R. proc for obstetric diagnoses except delivery diagnoses,546-3,APR-DRG,,,,,,,,inpatient,,,144112.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20650,,186% x Medicaid HMO amount,20650,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46257,,"27,634 x DRG Weight",46257,Other,DRG Base Rate x DRG Weight,39317,,"23,488 x DRG Weight",39317,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11102.21,,DRG base rate x DRG weight + capital per discharge,11102.21,Other,100% of NY Medicaid HMO DRG,11102,,DRG base rate x DRG weight + capital per discharge,11102,Other,100% of NY Medicaid HMO DRG,11102,,DRG base rate x DRG weight + capital per discharge,11102,Other,100% of NY Medicaid HMO DRG,11102,,DRG base rate x DRG weight + capital per discharge,11102,Other,100% of NY Medicaid HMO DRG,24980,,225% x Medicaid HMO amount,24980,Other,225% of NY Medicaid HMO DRG,16986,,153% x Medicaid HMO amount,16986,Other,153% of NY Medicaid HMO DRG,24980,,225% x Medicaid HMO amount,24980,Other,225% of NY Medicaid HMO DRG,15543,,140% x Medicaid HMO amount,15543,Other,140% of NY Medicaid HMO DRG,24980,,DRG base rate x DRG weight + capital per discharge,24980,Other,225% of NY Medicaid HMO DRG,30531,,275% x Medicaid HMO amount,30531,Other,275% of NY Medicaid HMO DRG,35971,,324% x Medicaid HMO amount,35971,Other,324% of NY Medicaid HMO DRG,23870,,215% x Medicaid HMO amount,23870,Other,215% of NY Medicaid HMO DRG,23870,,215% x Medicaid HMO amount,23870,Other,215% of NY Medicaid HMO DRG,13878,,125% x Medicaid HMO amount,13878,Other,125% of NY Medicaid HMO DRG,0.01,46257,
Other O.R. proc for obstetric diagnoses except delivery diagnoses,546-4,APR-DRG,,,,,,,,inpatient,,,144112.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51758,,186% x Medicaid HMO amount,51758,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,119039,,"27,634 x DRG Weight",119039,Other,DRG Base Rate x DRG Weight,101179,,"23,488 x DRG Weight",101179,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27827.21,,DRG base rate x DRG weight + capital per discharge,27827.21,Other,100% of NY Medicaid HMO DRG,27827,,DRG base rate x DRG weight + capital per discharge,27827,Other,100% of NY Medicaid HMO DRG,27827,,DRG base rate x DRG weight + capital per discharge,27827,Other,100% of NY Medicaid HMO DRG,27827,,DRG base rate x DRG weight + capital per discharge,27827,Other,100% of NY Medicaid HMO DRG,62611,,225% x Medicaid HMO amount,62611,Other,225% of NY Medicaid HMO DRG,42576,,153% x Medicaid HMO amount,42576,Other,153% of NY Medicaid HMO DRG,62611,,225% x Medicaid HMO amount,62611,Other,225% of NY Medicaid HMO DRG,38958,,140% x Medicaid HMO amount,38958,Other,140% of NY Medicaid HMO DRG,62611,,DRG base rate x DRG weight + capital per discharge,62611,Other,225% of NY Medicaid HMO DRG,76525,,275% x Medicaid HMO amount,76525,Other,275% of NY Medicaid HMO DRG,90160,,324% x Medicaid HMO amount,90160,Other,324% of NY Medicaid HMO DRG,59829,,215% x Medicaid HMO amount,59829,Other,215% of NY Medicaid HMO DRG,59829,,215% x Medicaid HMO amount,59829,Other,215% of NY Medicaid HMO DRG,34784,,125% x Medicaid HMO amount,34784,Other,125% of NY Medicaid HMO DRG,0.01,119039,
Vaginal delivery,560-1,APR-DRG,,,,,,,,inpatient,,,66519.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7133,,186% x Medicaid HMO amount,7133,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14632,,"27,634 x DRG Weight",14632,Other,DRG Base Rate x DRG Weight,12437,,"23,488 x DRG Weight",12437,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3835.21,,DRG base rate x DRG weight + capital per discharge,3835.21,Other,100% of NY Medicaid HMO DRG,3835,,DRG base rate x DRG weight + capital per discharge,3835,Other,100% of NY Medicaid HMO DRG,3835,,DRG base rate x DRG weight + capital per discharge,3835,Other,100% of NY Medicaid HMO DRG,3835,,DRG base rate x DRG weight + capital per discharge,3835,Other,100% of NY Medicaid HMO DRG,8629,,225% x Medicaid HMO amount,8629,Other,225% of NY Medicaid HMO DRG,5868,,153% x Medicaid HMO amount,5868,Other,153% of NY Medicaid HMO DRG,8629,,225% x Medicaid HMO amount,8629,Other,225% of NY Medicaid HMO DRG,5369,,140% x Medicaid HMO amount,5369,Other,140% of NY Medicaid HMO DRG,8629,,DRG base rate x DRG weight + capital per discharge,8629,Other,225% of NY Medicaid HMO DRG,10547,,275% x Medicaid HMO amount,10547,Other,275% of NY Medicaid HMO DRG,12426,,324% x Medicaid HMO amount,12426,Other,324% of NY Medicaid HMO DRG,8246,,215% x Medicaid HMO amount,8246,Other,215% of NY Medicaid HMO DRG,8246,,215% x Medicaid HMO amount,8246,Other,215% of NY Medicaid HMO DRG,4794,,125% x Medicaid HMO amount,4794,Other,125% of NY Medicaid HMO DRG,0.01,14632,
Vaginal delivery,560-2,APR-DRG,,,,,,,,inpatient,,,75829.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7792,,186% x Medicaid HMO amount,7792,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16171,,"27,634 x DRG Weight",16171,Other,DRG Base Rate x DRG Weight,13745,,"23,488 x DRG Weight",13745,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4189.21,,DRG base rate x DRG weight + capital per discharge,4189.21,Other,100% of NY Medicaid HMO DRG,4189,,DRG base rate x DRG weight + capital per discharge,4189,Other,100% of NY Medicaid HMO DRG,4189,,DRG base rate x DRG weight + capital per discharge,4189,Other,100% of NY Medicaid HMO DRG,4189,,DRG base rate x DRG weight + capital per discharge,4189,Other,100% of NY Medicaid HMO DRG,9426,,225% x Medicaid HMO amount,9426,Other,225% of NY Medicaid HMO DRG,6409,,153% x Medicaid HMO amount,6409,Other,153% of NY Medicaid HMO DRG,9426,,225% x Medicaid HMO amount,9426,Other,225% of NY Medicaid HMO DRG,5865,,140% x Medicaid HMO amount,5865,Other,140% of NY Medicaid HMO DRG,9426,,DRG base rate x DRG weight + capital per discharge,9426,Other,225% of NY Medicaid HMO DRG,11520,,275% x Medicaid HMO amount,11520,Other,275% of NY Medicaid HMO DRG,13573,,324% x Medicaid HMO amount,13573,Other,324% of NY Medicaid HMO DRG,9007,,215% x Medicaid HMO amount,9007,Other,215% of NY Medicaid HMO DRG,9007,,215% x Medicaid HMO amount,9007,Other,215% of NY Medicaid HMO DRG,5237,,125% x Medicaid HMO amount,5237,Other,125% of NY Medicaid HMO DRG,0.01,16171,
Vaginal delivery,560-3,APR-DRG,,,,,,,,inpatient,,,118877.66,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9460,,186% x Medicaid HMO amount,9460,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20073,,"27,634 x DRG Weight",20073,Other,DRG Base Rate x DRG Weight,17062,,"23,488 x DRG Weight",17062,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5086.21,,DRG base rate x DRG weight + capital per discharge,5086.21,Other,100% of NY Medicaid HMO DRG,5086,,DRG base rate x DRG weight + capital per discharge,5086,Other,100% of NY Medicaid HMO DRG,5086,,DRG base rate x DRG weight + capital per discharge,5086,Other,100% of NY Medicaid HMO DRG,5086,,DRG base rate x DRG weight + capital per discharge,5086,Other,100% of NY Medicaid HMO DRG,11444,,225% x Medicaid HMO amount,11444,Other,225% of NY Medicaid HMO DRG,7782,,153% x Medicaid HMO amount,7782,Other,153% of NY Medicaid HMO DRG,11444,,225% x Medicaid HMO amount,11444,Other,225% of NY Medicaid HMO DRG,7121,,140% x Medicaid HMO amount,7121,Other,140% of NY Medicaid HMO DRG,11444,,DRG base rate x DRG weight + capital per discharge,11444,Other,225% of NY Medicaid HMO DRG,13987,,275% x Medicaid HMO amount,13987,Other,275% of NY Medicaid HMO DRG,16479,,324% x Medicaid HMO amount,16479,Other,324% of NY Medicaid HMO DRG,10935,,215% x Medicaid HMO amount,10935,Other,215% of NY Medicaid HMO DRG,10935,,215% x Medicaid HMO amount,10935,Other,215% of NY Medicaid HMO DRG,6358,,125% x Medicaid HMO amount,6358,Other,125% of NY Medicaid HMO DRG,0.01,20073,
Vaginal delivery,560-4,APR-DRG,,,,,,,,inpatient,,,366963.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20918,,186% x Medicaid HMO amount,20918,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46884,,"27,634 x DRG Weight",46884,Other,DRG Base Rate x DRG Weight,39850,,"23,488 x DRG Weight",39850,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11246.21,,DRG base rate x DRG weight + capital per discharge,11246.21,Other,100% of NY Medicaid HMO DRG,11246,,DRG base rate x DRG weight + capital per discharge,11246,Other,100% of NY Medicaid HMO DRG,11246,,DRG base rate x DRG weight + capital per discharge,11246,Other,100% of NY Medicaid HMO DRG,11246,,DRG base rate x DRG weight + capital per discharge,11246,Other,100% of NY Medicaid HMO DRG,25304,,225% x Medicaid HMO amount,25304,Other,225% of NY Medicaid HMO DRG,17207,,153% x Medicaid HMO amount,17207,Other,153% of NY Medicaid HMO DRG,25304,,225% x Medicaid HMO amount,25304,Other,225% of NY Medicaid HMO DRG,15745,,140% x Medicaid HMO amount,15745,Other,140% of NY Medicaid HMO DRG,25304,,DRG base rate x DRG weight + capital per discharge,25304,Other,225% of NY Medicaid HMO DRG,30927,,275% x Medicaid HMO amount,30927,Other,275% of NY Medicaid HMO DRG,36438,,324% x Medicaid HMO amount,36438,Other,324% of NY Medicaid HMO DRG,24179,,215% x Medicaid HMO amount,24179,Other,215% of NY Medicaid HMO DRG,24179,,215% x Medicaid HMO amount,24179,Other,215% of NY Medicaid HMO DRG,14058,,125% x Medicaid HMO amount,14058,Other,125% of NY Medicaid HMO DRG,0.01,46884,
Postpartum & post abortion diagnoses w/o procedure,561-1,APR-DRG,,,,,,,,inpatient,,,55444.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5357,,186% x Medicaid HMO amount,5357,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10473,,"27,634 x DRG Weight",10473,Other,DRG Base Rate x DRG Weight,8902,,"23,488 x DRG Weight",8902,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2880.21,,DRG base rate x DRG weight + capital per discharge,2880.21,Other,100% of NY Medicaid HMO DRG,2880,,DRG base rate x DRG weight + capital per discharge,2880,Other,100% of NY Medicaid HMO DRG,2880,,DRG base rate x DRG weight + capital per discharge,2880,Other,100% of NY Medicaid HMO DRG,2880,,DRG base rate x DRG weight + capital per discharge,2880,Other,100% of NY Medicaid HMO DRG,6480,,225% x Medicaid HMO amount,6480,Other,225% of NY Medicaid HMO DRG,4407,,153% x Medicaid HMO amount,4407,Other,153% of NY Medicaid HMO DRG,6480,,225% x Medicaid HMO amount,6480,Other,225% of NY Medicaid HMO DRG,4032,,140% x Medicaid HMO amount,4032,Other,140% of NY Medicaid HMO DRG,6480,,DRG base rate x DRG weight + capital per discharge,6480,Other,225% of NY Medicaid HMO DRG,7921,,275% x Medicaid HMO amount,7921,Other,275% of NY Medicaid HMO DRG,9332,,324% x Medicaid HMO amount,9332,Other,324% of NY Medicaid HMO DRG,6192,,215% x Medicaid HMO amount,6192,Other,215% of NY Medicaid HMO DRG,6192,,215% x Medicaid HMO amount,6192,Other,215% of NY Medicaid HMO DRG,3600,,125% x Medicaid HMO amount,3600,Other,125% of NY Medicaid HMO DRG,0.01,10473,
Postpartum & post abortion diagnoses w/o procedure,561-2,APR-DRG,,,,,,,,inpatient,,,74019.48,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6179,,186% x Medicaid HMO amount,6179,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12397,,"27,634 x DRG Weight",12397,Other,DRG Base Rate x DRG Weight,10537,,"23,488 x DRG Weight",10537,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3322.21,,DRG base rate x DRG weight + capital per discharge,3322.21,Other,100% of NY Medicaid HMO DRG,3322,,DRG base rate x DRG weight + capital per discharge,3322,Other,100% of NY Medicaid HMO DRG,3322,,DRG base rate x DRG weight + capital per discharge,3322,Other,100% of NY Medicaid HMO DRG,3322,,DRG base rate x DRG weight + capital per discharge,3322,Other,100% of NY Medicaid HMO DRG,7475,,225% x Medicaid HMO amount,7475,Other,225% of NY Medicaid HMO DRG,5083,,153% x Medicaid HMO amount,5083,Other,153% of NY Medicaid HMO DRG,7475,,225% x Medicaid HMO amount,7475,Other,225% of NY Medicaid HMO DRG,4651,,140% x Medicaid HMO amount,4651,Other,140% of NY Medicaid HMO DRG,7475,,DRG base rate x DRG weight + capital per discharge,7475,Other,225% of NY Medicaid HMO DRG,9136,,275% x Medicaid HMO amount,9136,Other,275% of NY Medicaid HMO DRG,10764,,324% x Medicaid HMO amount,10764,Other,324% of NY Medicaid HMO DRG,7143,,215% x Medicaid HMO amount,7143,Other,215% of NY Medicaid HMO DRG,7143,,215% x Medicaid HMO amount,7143,Other,215% of NY Medicaid HMO DRG,4153,,125% x Medicaid HMO amount,4153,Other,125% of NY Medicaid HMO DRG,0.01,12397,
Postpartum & post abortion diagnoses w/o procedure,561-3,APR-DRG,,,,,,,,inpatient,,,86038.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8837,,186% x Medicaid HMO amount,8837,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18617,,"27,634 x DRG Weight",18617,Other,DRG Base Rate x DRG Weight,15824,,"23,488 x DRG Weight",15824,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4751.21,,DRG base rate x DRG weight + capital per discharge,4751.21,Other,100% of NY Medicaid HMO DRG,4751,,DRG base rate x DRG weight + capital per discharge,4751,Other,100% of NY Medicaid HMO DRG,4751,,DRG base rate x DRG weight + capital per discharge,4751,Other,100% of NY Medicaid HMO DRG,4751,,DRG base rate x DRG weight + capital per discharge,4751,Other,100% of NY Medicaid HMO DRG,10690,,225% x Medicaid HMO amount,10690,Other,225% of NY Medicaid HMO DRG,7269,,153% x Medicaid HMO amount,7269,Other,153% of NY Medicaid HMO DRG,10690,,225% x Medicaid HMO amount,10690,Other,225% of NY Medicaid HMO DRG,6652,,140% x Medicaid HMO amount,6652,Other,140% of NY Medicaid HMO DRG,10690,,DRG base rate x DRG weight + capital per discharge,10690,Other,225% of NY Medicaid HMO DRG,13066,,275% x Medicaid HMO amount,13066,Other,275% of NY Medicaid HMO DRG,15394,,324% x Medicaid HMO amount,15394,Other,324% of NY Medicaid HMO DRG,10215,,215% x Medicaid HMO amount,10215,Other,215% of NY Medicaid HMO DRG,10215,,215% x Medicaid HMO amount,10215,Other,215% of NY Medicaid HMO DRG,5939,,125% x Medicaid HMO amount,5939,Other,125% of NY Medicaid HMO DRG,0.01,18617,
Postpartum & post abortion diagnoses w/o procedure,561-4,APR-DRG,,,,,,,,inpatient,,,86038.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18098,,186% x Medicaid HMO amount,18098,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40285,,"27,634 x DRG Weight",40285,Other,DRG Base Rate x DRG Weight,34241,,"23,488 x DRG Weight",34241,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9730.21,,DRG base rate x DRG weight + capital per discharge,9730.21,Other,100% of NY Medicaid HMO DRG,9730,,DRG base rate x DRG weight + capital per discharge,9730,Other,100% of NY Medicaid HMO DRG,9730,,DRG base rate x DRG weight + capital per discharge,9730,Other,100% of NY Medicaid HMO DRG,9730,,DRG base rate x DRG weight + capital per discharge,9730,Other,100% of NY Medicaid HMO DRG,21893,,225% x Medicaid HMO amount,21893,Other,225% of NY Medicaid HMO DRG,14887,,153% x Medicaid HMO amount,14887,Other,153% of NY Medicaid HMO DRG,21893,,225% x Medicaid HMO amount,21893,Other,225% of NY Medicaid HMO DRG,13622,,140% x Medicaid HMO amount,13622,Other,140% of NY Medicaid HMO DRG,21893,,DRG base rate x DRG weight + capital per discharge,21893,Other,225% of NY Medicaid HMO DRG,26758,,275% x Medicaid HMO amount,26758,Other,275% of NY Medicaid HMO DRG,31526,,324% x Medicaid HMO amount,31526,Other,324% of NY Medicaid HMO DRG,20920,,215% x Medicaid HMO amount,20920,Other,215% of NY Medicaid HMO DRG,20920,,215% x Medicaid HMO amount,20920,Other,215% of NY Medicaid HMO DRG,12163,,125% x Medicaid HMO amount,12163,Other,125% of NY Medicaid HMO DRG,0.01,40285,
Preterm labor,563-1,APR-DRG,,,,,,,,inpatient,,,59757.84,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4990,,186% x Medicaid HMO amount,4990,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9617,,"27,634 x DRG Weight",9617,Other,DRG Base Rate x DRG Weight,8174,,"23,488 x DRG Weight",8174,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2683.21,,DRG base rate x DRG weight + capital per discharge,2683.21,Other,100% of NY Medicaid HMO DRG,2683,,DRG base rate x DRG weight + capital per discharge,2683,Other,100% of NY Medicaid HMO DRG,2683,,DRG base rate x DRG weight + capital per discharge,2683,Other,100% of NY Medicaid HMO DRG,2683,,DRG base rate x DRG weight + capital per discharge,2683,Other,100% of NY Medicaid HMO DRG,6037,,225% x Medicaid HMO amount,6037,Other,225% of NY Medicaid HMO DRG,4105,,153% x Medicaid HMO amount,4105,Other,153% of NY Medicaid HMO DRG,6037,,225% x Medicaid HMO amount,6037,Other,225% of NY Medicaid HMO DRG,3756,,140% x Medicaid HMO amount,3756,Other,140% of NY Medicaid HMO DRG,6037,,DRG base rate x DRG weight + capital per discharge,6037,Other,225% of NY Medicaid HMO DRG,7379,,275% x Medicaid HMO amount,7379,Other,275% of NY Medicaid HMO DRG,8694,,324% x Medicaid HMO amount,8694,Other,324% of NY Medicaid HMO DRG,5769,,215% x Medicaid HMO amount,5769,Other,215% of NY Medicaid HMO DRG,5769,,215% x Medicaid HMO amount,5769,Other,215% of NY Medicaid HMO DRG,3354,,125% x Medicaid HMO amount,3354,Other,125% of NY Medicaid HMO DRG,0.01,9617,
Preterm labor,563-2,APR-DRG,,,,,,,,inpatient,,,62096.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5826,,186% x Medicaid HMO amount,5826,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11573,,"27,634 x DRG Weight",11573,Other,DRG Base Rate x DRG Weight,9837,,"23,488 x DRG Weight",9837,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3132.21,,DRG base rate x DRG weight + capital per discharge,3132.21,Other,100% of NY Medicaid HMO DRG,3132,,DRG base rate x DRG weight + capital per discharge,3132,Other,100% of NY Medicaid HMO DRG,3132,,DRG base rate x DRG weight + capital per discharge,3132,Other,100% of NY Medicaid HMO DRG,3132,,DRG base rate x DRG weight + capital per discharge,3132,Other,100% of NY Medicaid HMO DRG,7047,,225% x Medicaid HMO amount,7047,Other,225% of NY Medicaid HMO DRG,4792,,153% x Medicaid HMO amount,4792,Other,153% of NY Medicaid HMO DRG,7047,,225% x Medicaid HMO amount,7047,Other,225% of NY Medicaid HMO DRG,4385,,140% x Medicaid HMO amount,4385,Other,140% of NY Medicaid HMO DRG,7047,,DRG base rate x DRG weight + capital per discharge,7047,Other,225% of NY Medicaid HMO DRG,8614,,275% x Medicaid HMO amount,8614,Other,275% of NY Medicaid HMO DRG,10148,,324% x Medicaid HMO amount,10148,Other,324% of NY Medicaid HMO DRG,6734,,215% x Medicaid HMO amount,6734,Other,215% of NY Medicaid HMO DRG,6734,,215% x Medicaid HMO amount,6734,Other,215% of NY Medicaid HMO DRG,3915,,125% x Medicaid HMO amount,3915,Other,125% of NY Medicaid HMO DRG,0.01,11573,
Preterm labor,563-3,APR-DRG,,,,,,,,inpatient,,,46332.08,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7903,,186% x Medicaid HMO amount,7903,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16431,,"27,634 x DRG Weight",16431,Other,DRG Base Rate x DRG Weight,13966,,"23,488 x DRG Weight",13966,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4249.21,,DRG base rate x DRG weight + capital per discharge,4249.21,Other,100% of NY Medicaid HMO DRG,4249,,DRG base rate x DRG weight + capital per discharge,4249,Other,100% of NY Medicaid HMO DRG,4249,,DRG base rate x DRG weight + capital per discharge,4249,Other,100% of NY Medicaid HMO DRG,4249,,DRG base rate x DRG weight + capital per discharge,4249,Other,100% of NY Medicaid HMO DRG,9561,,225% x Medicaid HMO amount,9561,Other,225% of NY Medicaid HMO DRG,6501,,153% x Medicaid HMO amount,6501,Other,153% of NY Medicaid HMO DRG,9561,,225% x Medicaid HMO amount,9561,Other,225% of NY Medicaid HMO DRG,5949,,140% x Medicaid HMO amount,5949,Other,140% of NY Medicaid HMO DRG,9561,,DRG base rate x DRG weight + capital per discharge,9561,Other,225% of NY Medicaid HMO DRG,11685,,275% x Medicaid HMO amount,11685,Other,275% of NY Medicaid HMO DRG,13767,,324% x Medicaid HMO amount,13767,Other,324% of NY Medicaid HMO DRG,9136,,215% x Medicaid HMO amount,9136,Other,215% of NY Medicaid HMO DRG,9136,,215% x Medicaid HMO amount,9136,Other,215% of NY Medicaid HMO DRG,5312,,125% x Medicaid HMO amount,5312,Other,125% of NY Medicaid HMO DRG,0.01,16431,
Preterm labor,563-4,APR-DRG,,,,,,,,inpatient,,,62096.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7903,,186% x Medicaid HMO amount,7903,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16431,,"27,634 x DRG Weight",16431,Other,DRG Base Rate x DRG Weight,13966,,"23,488 x DRG Weight",13966,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4249.21,,DRG base rate x DRG weight + capital per discharge,4249.21,Other,100% of NY Medicaid HMO DRG,4249,,DRG base rate x DRG weight + capital per discharge,4249,Other,100% of NY Medicaid HMO DRG,4249,,DRG base rate x DRG weight + capital per discharge,4249,Other,100% of NY Medicaid HMO DRG,4249,,DRG base rate x DRG weight + capital per discharge,4249,Other,100% of NY Medicaid HMO DRG,9561,,225% x Medicaid HMO amount,9561,Other,225% of NY Medicaid HMO DRG,6501,,153% x Medicaid HMO amount,6501,Other,153% of NY Medicaid HMO DRG,9561,,225% x Medicaid HMO amount,9561,Other,225% of NY Medicaid HMO DRG,5949,,140% x Medicaid HMO amount,5949,Other,140% of NY Medicaid HMO DRG,9561,,DRG base rate x DRG weight + capital per discharge,9561,Other,225% of NY Medicaid HMO DRG,11685,,275% x Medicaid HMO amount,11685,Other,275% of NY Medicaid HMO DRG,13767,,324% x Medicaid HMO amount,13767,Other,324% of NY Medicaid HMO DRG,9136,,215% x Medicaid HMO amount,9136,Other,215% of NY Medicaid HMO DRG,9136,,215% x Medicaid HMO amount,9136,Other,215% of NY Medicaid HMO DRG,5312,,125% x Medicaid HMO amount,5312,Other,125% of NY Medicaid HMO DRG,0.01,16431,
"Abortion w/o D&C, aspiration curettage or hysterotomy",564-1,APR-DRG,,,,,,,,inpatient,,,39420,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5189,,186% x Medicaid HMO amount,5189,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10084,,"27,634 x DRG Weight",10084,Other,DRG Base Rate x DRG Weight,8571,,"23,488 x DRG Weight",8571,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2790.21,,DRG base rate x DRG weight + capital per discharge,2790.21,Other,100% of NY Medicaid HMO DRG,2790,,DRG base rate x DRG weight + capital per discharge,2790,Other,100% of NY Medicaid HMO DRG,2790,,DRG base rate x DRG weight + capital per discharge,2790,Other,100% of NY Medicaid HMO DRG,2790,,DRG base rate x DRG weight + capital per discharge,2790,Other,100% of NY Medicaid HMO DRG,6278,,225% x Medicaid HMO amount,6278,Other,225% of NY Medicaid HMO DRG,4269,,153% x Medicaid HMO amount,4269,Other,153% of NY Medicaid HMO DRG,6278,,225% x Medicaid HMO amount,6278,Other,225% of NY Medicaid HMO DRG,3906,,140% x Medicaid HMO amount,3906,Other,140% of NY Medicaid HMO DRG,6278,,DRG base rate x DRG weight + capital per discharge,6278,Other,225% of NY Medicaid HMO DRG,7673,,275% x Medicaid HMO amount,7673,Other,275% of NY Medicaid HMO DRG,9040,,324% x Medicaid HMO amount,9040,Other,324% of NY Medicaid HMO DRG,5999,,215% x Medicaid HMO amount,5999,Other,215% of NY Medicaid HMO DRG,5999,,215% x Medicaid HMO amount,5999,Other,215% of NY Medicaid HMO DRG,3488,,125% x Medicaid HMO amount,3488,Other,125% of NY Medicaid HMO DRG,0.01,10084,
"Abortion w/o D&C, aspiration curettage or hysterotomy",564-2,APR-DRG,,,,,,,,inpatient,,,49448.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5868,,186% x Medicaid HMO amount,5868,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11670,,"27,634 x DRG Weight",11670,Other,DRG Base Rate x DRG Weight,9919,,"23,488 x DRG Weight",9919,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3155.21,,DRG base rate x DRG weight + capital per discharge,3155.21,Other,100% of NY Medicaid HMO DRG,3155,,DRG base rate x DRG weight + capital per discharge,3155,Other,100% of NY Medicaid HMO DRG,3155,,DRG base rate x DRG weight + capital per discharge,3155,Other,100% of NY Medicaid HMO DRG,3155,,DRG base rate x DRG weight + capital per discharge,3155,Other,100% of NY Medicaid HMO DRG,7099,,225% x Medicaid HMO amount,7099,Other,225% of NY Medicaid HMO DRG,4827,,153% x Medicaid HMO amount,4827,Other,153% of NY Medicaid HMO DRG,7099,,225% x Medicaid HMO amount,7099,Other,225% of NY Medicaid HMO DRG,4417,,140% x Medicaid HMO amount,4417,Other,140% of NY Medicaid HMO DRG,7099,,DRG base rate x DRG weight + capital per discharge,7099,Other,225% of NY Medicaid HMO DRG,8677,,275% x Medicaid HMO amount,8677,Other,275% of NY Medicaid HMO DRG,10223,,324% x Medicaid HMO amount,10223,Other,324% of NY Medicaid HMO DRG,6784,,215% x Medicaid HMO amount,6784,Other,215% of NY Medicaid HMO DRG,6784,,215% x Medicaid HMO amount,6784,Other,215% of NY Medicaid HMO DRG,3944,,125% x Medicaid HMO amount,3944,Other,125% of NY Medicaid HMO DRG,0.01,11670,
"Abortion w/o D&C, aspiration curettage or hysterotomy",564-3,APR-DRG,,,,,,,,inpatient,,,90792.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8005,,186% x Medicaid HMO amount,8005,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16674,,"27,634 x DRG Weight",16674,Other,DRG Base Rate x DRG Weight,14173,,"23,488 x DRG Weight",14173,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4304.21,,DRG base rate x DRG weight + capital per discharge,4304.21,Other,100% of NY Medicaid HMO DRG,4304,,DRG base rate x DRG weight + capital per discharge,4304,Other,100% of NY Medicaid HMO DRG,4304,,DRG base rate x DRG weight + capital per discharge,4304,Other,100% of NY Medicaid HMO DRG,4304,,DRG base rate x DRG weight + capital per discharge,4304,Other,100% of NY Medicaid HMO DRG,9684,,225% x Medicaid HMO amount,9684,Other,225% of NY Medicaid HMO DRG,6585,,153% x Medicaid HMO amount,6585,Other,153% of NY Medicaid HMO DRG,9684,,225% x Medicaid HMO amount,9684,Other,225% of NY Medicaid HMO DRG,6026,,140% x Medicaid HMO amount,6026,Other,140% of NY Medicaid HMO DRG,9684,,DRG base rate x DRG weight + capital per discharge,9684,Other,225% of NY Medicaid HMO DRG,11837,,275% x Medicaid HMO amount,11837,Other,275% of NY Medicaid HMO DRG,13946,,324% x Medicaid HMO amount,13946,Other,324% of NY Medicaid HMO DRG,9254,,215% x Medicaid HMO amount,9254,Other,215% of NY Medicaid HMO DRG,9254,,215% x Medicaid HMO amount,9254,Other,215% of NY Medicaid HMO DRG,5380,,125% x Medicaid HMO amount,5380,Other,125% of NY Medicaid HMO DRG,0.01,16674,
"Abortion w/o D&C, aspiration curettage or hysterotomy",564-4,APR-DRG,,,,,,,,inpatient,,,90792.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9447,,186% x Medicaid HMO amount,9447,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20043,,"27,634 x DRG Weight",20043,Other,DRG Base Rate x DRG Weight,17036,,"23,488 x DRG Weight",17036,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5079.21,,DRG base rate x DRG weight + capital per discharge,5079.21,Other,100% of NY Medicaid HMO DRG,5079,,DRG base rate x DRG weight + capital per discharge,5079,Other,100% of NY Medicaid HMO DRG,5079,,DRG base rate x DRG weight + capital per discharge,5079,Other,100% of NY Medicaid HMO DRG,5079,,DRG base rate x DRG weight + capital per discharge,5079,Other,100% of NY Medicaid HMO DRG,11428,,225% x Medicaid HMO amount,11428,Other,225% of NY Medicaid HMO DRG,7771,,153% x Medicaid HMO amount,7771,Other,153% of NY Medicaid HMO DRG,11428,,225% x Medicaid HMO amount,11428,Other,225% of NY Medicaid HMO DRG,7111,,140% x Medicaid HMO amount,7111,Other,140% of NY Medicaid HMO DRG,11428,,DRG base rate x DRG weight + capital per discharge,11428,Other,225% of NY Medicaid HMO DRG,13968,,275% x Medicaid HMO amount,13968,Other,275% of NY Medicaid HMO DRG,16457,,324% x Medicaid HMO amount,16457,Other,324% of NY Medicaid HMO DRG,10920,,215% x Medicaid HMO amount,10920,Other,215% of NY Medicaid HMO DRG,10920,,215% x Medicaid HMO amount,10920,Other,215% of NY Medicaid HMO DRG,6349,,125% x Medicaid HMO amount,6349,Other,125% of NY Medicaid HMO DRG,0.01,20043,
False labor,565-1,APR-DRG,,,,,,,,inpatient,,,25446,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3567,,186% x Medicaid HMO amount,3567,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6289,,"27,634 x DRG Weight",6289,Other,DRG Base Rate x DRG Weight,5346,,"23,488 x DRG Weight",5346,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,1918.21,,DRG base rate x DRG weight + capital per discharge,1918.21,Other,100% of NY Medicaid HMO DRG,1918,,DRG base rate x DRG weight + capital per discharge,1918,Other,100% of NY Medicaid HMO DRG,1918,,DRG base rate x DRG weight + capital per discharge,1918,Other,100% of NY Medicaid HMO DRG,1918,,DRG base rate x DRG weight + capital per discharge,1918,Other,100% of NY Medicaid HMO DRG,4316,,225% x Medicaid HMO amount,4316,Other,225% of NY Medicaid HMO DRG,2935,,153% x Medicaid HMO amount,2935,Other,153% of NY Medicaid HMO DRG,4316,,225% x Medicaid HMO amount,4316,Other,225% of NY Medicaid HMO DRG,2685,,140% x Medicaid HMO amount,2685,Other,140% of NY Medicaid HMO DRG,4316,,DRG base rate x DRG weight + capital per discharge,4316,Other,225% of NY Medicaid HMO DRG,5275,,275% x Medicaid HMO amount,5275,Other,275% of NY Medicaid HMO DRG,6215,,324% x Medicaid HMO amount,6215,Other,324% of NY Medicaid HMO DRG,4124,,215% x Medicaid HMO amount,4124,Other,215% of NY Medicaid HMO DRG,4124,,215% x Medicaid HMO amount,4124,Other,215% of NY Medicaid HMO DRG,2398,,125% x Medicaid HMO amount,2398,Other,125% of NY Medicaid HMO DRG,0.01,6289,
False labor,565-2,APR-DRG,,,,,,,,inpatient,,,27853.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4215,,186% x Medicaid HMO amount,4215,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7804,,"27,634 x DRG Weight",7804,Other,DRG Base Rate x DRG Weight,6633,,"23,488 x DRG Weight",6633,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2266.21,,DRG base rate x DRG weight + capital per discharge,2266.21,Other,100% of NY Medicaid HMO DRG,2266,,DRG base rate x DRG weight + capital per discharge,2266,Other,100% of NY Medicaid HMO DRG,2266,,DRG base rate x DRG weight + capital per discharge,2266,Other,100% of NY Medicaid HMO DRG,2266,,DRG base rate x DRG weight + capital per discharge,2266,Other,100% of NY Medicaid HMO DRG,5099,,225% x Medicaid HMO amount,5099,Other,225% of NY Medicaid HMO DRG,3467,,153% x Medicaid HMO amount,3467,Other,153% of NY Medicaid HMO DRG,5099,,225% x Medicaid HMO amount,5099,Other,225% of NY Medicaid HMO DRG,3173,,140% x Medicaid HMO amount,3173,Other,140% of NY Medicaid HMO DRG,5099,,DRG base rate x DRG weight + capital per discharge,5099,Other,225% of NY Medicaid HMO DRG,6232,,275% x Medicaid HMO amount,6232,Other,275% of NY Medicaid HMO DRG,7343,,324% x Medicaid HMO amount,7343,Other,324% of NY Medicaid HMO DRG,4872,,215% x Medicaid HMO amount,4872,Other,215% of NY Medicaid HMO DRG,4872,,215% x Medicaid HMO amount,4872,Other,215% of NY Medicaid HMO DRG,2833,,125% x Medicaid HMO amount,2833,Other,125% of NY Medicaid HMO DRG,0.01,7804,
False labor,565-3,APR-DRG,,,,,,,,inpatient,,,126573.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4274,,186% x Medicaid HMO amount,4274,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7942,,"27,634 x DRG Weight",7942,Other,DRG Base Rate x DRG Weight,6750,,"23,488 x DRG Weight",6750,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2298.21,,DRG base rate x DRG weight + capital per discharge,2298.21,Other,100% of NY Medicaid HMO DRG,2298,,DRG base rate x DRG weight + capital per discharge,2298,Other,100% of NY Medicaid HMO DRG,2298,,DRG base rate x DRG weight + capital per discharge,2298,Other,100% of NY Medicaid HMO DRG,2298,,DRG base rate x DRG weight + capital per discharge,2298,Other,100% of NY Medicaid HMO DRG,5171,,225% x Medicaid HMO amount,5171,Other,225% of NY Medicaid HMO DRG,3516,,153% x Medicaid HMO amount,3516,Other,153% of NY Medicaid HMO DRG,5171,,225% x Medicaid HMO amount,5171,Other,225% of NY Medicaid HMO DRG,3217,,140% x Medicaid HMO amount,3217,Other,140% of NY Medicaid HMO DRG,5171,,DRG base rate x DRG weight + capital per discharge,5171,Other,225% of NY Medicaid HMO DRG,6320,,275% x Medicaid HMO amount,6320,Other,275% of NY Medicaid HMO DRG,7446,,324% x Medicaid HMO amount,7446,Other,324% of NY Medicaid HMO DRG,4941,,215% x Medicaid HMO amount,4941,Other,215% of NY Medicaid HMO DRG,4941,,215% x Medicaid HMO amount,4941,Other,215% of NY Medicaid HMO DRG,2873,,125% x Medicaid HMO amount,2873,Other,125% of NY Medicaid HMO DRG,0.01,7942,
False labor,565-4,APR-DRG,,,,,,,,inpatient,,,126573.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4274,,186% x Medicaid HMO amount,4274,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7942,,"27,634 x DRG Weight",7942,Other,DRG Base Rate x DRG Weight,6750,,"23,488 x DRG Weight",6750,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2298.21,,DRG base rate x DRG weight + capital per discharge,2298.21,Other,100% of NY Medicaid HMO DRG,2298,,DRG base rate x DRG weight + capital per discharge,2298,Other,100% of NY Medicaid HMO DRG,2298,,DRG base rate x DRG weight + capital per discharge,2298,Other,100% of NY Medicaid HMO DRG,2298,,DRG base rate x DRG weight + capital per discharge,2298,Other,100% of NY Medicaid HMO DRG,5171,,225% x Medicaid HMO amount,5171,Other,225% of NY Medicaid HMO DRG,3516,,153% x Medicaid HMO amount,3516,Other,153% of NY Medicaid HMO DRG,5171,,225% x Medicaid HMO amount,5171,Other,225% of NY Medicaid HMO DRG,3217,,140% x Medicaid HMO amount,3217,Other,140% of NY Medicaid HMO DRG,5171,,DRG base rate x DRG weight + capital per discharge,5171,Other,225% of NY Medicaid HMO DRG,6320,,275% x Medicaid HMO amount,6320,Other,275% of NY Medicaid HMO DRG,7446,,324% x Medicaid HMO amount,7446,Other,324% of NY Medicaid HMO DRG,4941,,215% x Medicaid HMO amount,4941,Other,215% of NY Medicaid HMO DRG,4941,,215% x Medicaid HMO amount,4941,Other,215% of NY Medicaid HMO DRG,2873,,125% x Medicaid HMO amount,2873,Other,125% of NY Medicaid HMO DRG,0.01,7942,
Other antepartum diagnoses,566-1,APR-DRG,,,,,,,,inpatient,,,53309.78,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4903,,186% x Medicaid HMO amount,4903,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9415,,"27,634 x DRG Weight",9415,Other,DRG Base Rate x DRG Weight,8002,,"23,488 x DRG Weight",8002,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2636.21,,DRG base rate x DRG weight + capital per discharge,2636.21,Other,100% of NY Medicaid HMO DRG,2636,,DRG base rate x DRG weight + capital per discharge,2636,Other,100% of NY Medicaid HMO DRG,2636,,DRG base rate x DRG weight + capital per discharge,2636,Other,100% of NY Medicaid HMO DRG,2636,,DRG base rate x DRG weight + capital per discharge,2636,Other,100% of NY Medicaid HMO DRG,5931,,225% x Medicaid HMO amount,5931,Other,225% of NY Medicaid HMO DRG,4033,,153% x Medicaid HMO amount,4033,Other,153% of NY Medicaid HMO DRG,5931,,225% x Medicaid HMO amount,5931,Other,225% of NY Medicaid HMO DRG,3691,,140% x Medicaid HMO amount,3691,Other,140% of NY Medicaid HMO DRG,5931,,DRG base rate x DRG weight + capital per discharge,5931,Other,225% of NY Medicaid HMO DRG,7250,,275% x Medicaid HMO amount,7250,Other,275% of NY Medicaid HMO DRG,8541,,324% x Medicaid HMO amount,8541,Other,324% of NY Medicaid HMO DRG,5668,,215% x Medicaid HMO amount,5668,Other,215% of NY Medicaid HMO DRG,5668,,215% x Medicaid HMO amount,5668,Other,215% of NY Medicaid HMO DRG,3295,,125% x Medicaid HMO amount,3295,Other,125% of NY Medicaid HMO DRG,0.01,9415,
Other antepartum diagnoses,566-2,APR-DRG,,,,,,,,inpatient,,,93972.09,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6145,,186% x Medicaid HMO amount,6145,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12322,,"27,634 x DRG Weight",12322,Other,DRG Base Rate x DRG Weight,10473,,"23,488 x DRG Weight",10473,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3304.21,,DRG base rate x DRG weight + capital per discharge,3304.21,Other,100% of NY Medicaid HMO DRG,3304,,DRG base rate x DRG weight + capital per discharge,3304,Other,100% of NY Medicaid HMO DRG,3304,,DRG base rate x DRG weight + capital per discharge,3304,Other,100% of NY Medicaid HMO DRG,3304,,DRG base rate x DRG weight + capital per discharge,3304,Other,100% of NY Medicaid HMO DRG,7434,,225% x Medicaid HMO amount,7434,Other,225% of NY Medicaid HMO DRG,5055,,153% x Medicaid HMO amount,5055,Other,153% of NY Medicaid HMO DRG,7434,,225% x Medicaid HMO amount,7434,Other,225% of NY Medicaid HMO DRG,4626,,140% x Medicaid HMO amount,4626,Other,140% of NY Medicaid HMO DRG,7434,,DRG base rate x DRG weight + capital per discharge,7434,Other,225% of NY Medicaid HMO DRG,9087,,275% x Medicaid HMO amount,9087,Other,275% of NY Medicaid HMO DRG,10706,,324% x Medicaid HMO amount,10706,Other,324% of NY Medicaid HMO DRG,7104,,215% x Medicaid HMO amount,7104,Other,215% of NY Medicaid HMO DRG,7104,,215% x Medicaid HMO amount,7104,Other,215% of NY Medicaid HMO DRG,4130,,125% x Medicaid HMO amount,4130,Other,125% of NY Medicaid HMO DRG,0.01,12322,
Other antepartum diagnoses,566-3,APR-DRG,,,,,,,,inpatient,,,124232.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8629,,186% x Medicaid HMO amount,8629,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18131,,"27,634 x DRG Weight",18131,Other,DRG Base Rate x DRG Weight,15410,,"23,488 x DRG Weight",15410,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4639.21,,DRG base rate x DRG weight + capital per discharge,4639.21,Other,100% of NY Medicaid HMO DRG,4639,,DRG base rate x DRG weight + capital per discharge,4639,Other,100% of NY Medicaid HMO DRG,4639,,DRG base rate x DRG weight + capital per discharge,4639,Other,100% of NY Medicaid HMO DRG,4639,,DRG base rate x DRG weight + capital per discharge,4639,Other,100% of NY Medicaid HMO DRG,10438,,225% x Medicaid HMO amount,10438,Other,225% of NY Medicaid HMO DRG,7098,,153% x Medicaid HMO amount,7098,Other,153% of NY Medicaid HMO DRG,10438,,225% x Medicaid HMO amount,10438,Other,225% of NY Medicaid HMO DRG,6495,,140% x Medicaid HMO amount,6495,Other,140% of NY Medicaid HMO DRG,10438,,DRG base rate x DRG weight + capital per discharge,10438,Other,225% of NY Medicaid HMO DRG,12758,,275% x Medicaid HMO amount,12758,Other,275% of NY Medicaid HMO DRG,15031,,324% x Medicaid HMO amount,15031,Other,324% of NY Medicaid HMO DRG,9974,,215% x Medicaid HMO amount,9974,Other,215% of NY Medicaid HMO DRG,9974,,215% x Medicaid HMO amount,9974,Other,215% of NY Medicaid HMO DRG,5799,,125% x Medicaid HMO amount,5799,Other,125% of NY Medicaid HMO DRG,0.01,18131,
Other antepartum diagnoses,566-4,APR-DRG,,,,,,,,inpatient,,,114510.91,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16963,,186% x Medicaid HMO amount,16963,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37632,,"27,634 x DRG Weight",37632,Other,DRG Base Rate x DRG Weight,31986,,"23,488 x DRG Weight",31986,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9120.21,,DRG base rate x DRG weight + capital per discharge,9120.21,Other,100% of NY Medicaid HMO DRG,9120,,DRG base rate x DRG weight + capital per discharge,9120,Other,100% of NY Medicaid HMO DRG,9120,,DRG base rate x DRG weight + capital per discharge,9120,Other,100% of NY Medicaid HMO DRG,9120,,DRG base rate x DRG weight + capital per discharge,9120,Other,100% of NY Medicaid HMO DRG,20520,,225% x Medicaid HMO amount,20520,Other,225% of NY Medicaid HMO DRG,13954,,153% x Medicaid HMO amount,13954,Other,153% of NY Medicaid HMO DRG,20520,,225% x Medicaid HMO amount,20520,Other,225% of NY Medicaid HMO DRG,12768,,140% x Medicaid HMO amount,12768,Other,140% of NY Medicaid HMO DRG,20520,,DRG base rate x DRG weight + capital per discharge,20520,Other,225% of NY Medicaid HMO DRG,25081,,275% x Medicaid HMO amount,25081,Other,275% of NY Medicaid HMO DRG,29549,,324% x Medicaid HMO amount,29549,Other,324% of NY Medicaid HMO DRG,19608,,215% x Medicaid HMO amount,19608,Other,215% of NY Medicaid HMO DRG,19608,,215% x Medicaid HMO amount,19608,Other,215% of NY Medicaid HMO DRG,11400,,125% x Medicaid HMO amount,11400,Other,125% of NY Medicaid HMO DRG,0.01,37632,
"Neonate, transferred <5 days old, not born here",580-1,APR-DRG,,,,,,,,inpatient,,,16942.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4481,,186% x Medicaid HMO amount,4481,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8426,,"27,634 x DRG Weight",8426,Other,DRG Base Rate x DRG Weight,7161,,"23,488 x DRG Weight",7161,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2409.21,,DRG base rate x DRG weight + capital per discharge,2409.21,Other,100% of NY Medicaid HMO DRG,2409,,DRG base rate x DRG weight + capital per discharge,2409,Other,100% of NY Medicaid HMO DRG,2409,,DRG base rate x DRG weight + capital per discharge,2409,Other,100% of NY Medicaid HMO DRG,2409,,DRG base rate x DRG weight + capital per discharge,2409,Other,100% of NY Medicaid HMO DRG,5421,,225% x Medicaid HMO amount,5421,Other,225% of NY Medicaid HMO DRG,3686,,153% x Medicaid HMO amount,3686,Other,153% of NY Medicaid HMO DRG,5421,,225% x Medicaid HMO amount,5421,Other,225% of NY Medicaid HMO DRG,3373,,140% x Medicaid HMO amount,3373,Other,140% of NY Medicaid HMO DRG,5421,,DRG base rate x DRG weight + capital per discharge,5421,Other,225% of NY Medicaid HMO DRG,6625,,275% x Medicaid HMO amount,6625,Other,275% of NY Medicaid HMO DRG,7806,,324% x Medicaid HMO amount,7806,Other,324% of NY Medicaid HMO DRG,5180,,215% x Medicaid HMO amount,5180,Other,215% of NY Medicaid HMO DRG,5180,,215% x Medicaid HMO amount,5180,Other,215% of NY Medicaid HMO DRG,3012,,125% x Medicaid HMO amount,3012,Other,125% of NY Medicaid HMO DRG,0.01,8426,
"Neonate, transferred <5 days old, not born here",580-2,APR-DRG,,,,,,,,inpatient,,,70194.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5439,,186% x Medicaid HMO amount,5439,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10667,,"27,634 x DRG Weight",10667,Other,DRG Base Rate x DRG Weight,9066,,"23,488 x DRG Weight",9066,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2924.21,,DRG base rate x DRG weight + capital per discharge,2924.21,Other,100% of NY Medicaid HMO DRG,2924,,DRG base rate x DRG weight + capital per discharge,2924,Other,100% of NY Medicaid HMO DRG,2924,,DRG base rate x DRG weight + capital per discharge,2924,Other,100% of NY Medicaid HMO DRG,2924,,DRG base rate x DRG weight + capital per discharge,2924,Other,100% of NY Medicaid HMO DRG,6579,,225% x Medicaid HMO amount,6579,Other,225% of NY Medicaid HMO DRG,4474,,153% x Medicaid HMO amount,4474,Other,153% of NY Medicaid HMO DRG,6579,,225% x Medicaid HMO amount,6579,Other,225% of NY Medicaid HMO DRG,4094,,140% x Medicaid HMO amount,4094,Other,140% of NY Medicaid HMO DRG,6579,,DRG base rate x DRG weight + capital per discharge,6579,Other,225% of NY Medicaid HMO DRG,8042,,275% x Medicaid HMO amount,8042,Other,275% of NY Medicaid HMO DRG,9474,,324% x Medicaid HMO amount,9474,Other,324% of NY Medicaid HMO DRG,6287,,215% x Medicaid HMO amount,6287,Other,215% of NY Medicaid HMO DRG,6287,,215% x Medicaid HMO amount,6287,Other,215% of NY Medicaid HMO DRG,3655,,125% x Medicaid HMO amount,3655,Other,125% of NY Medicaid HMO DRG,0.01,10667,
"Neonate, transferred <5 days old, not born here",580-3,APR-DRG,,,,,,,,inpatient,,,161498.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7278,,186% x Medicaid HMO amount,7278,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14972,,"27,634 x DRG Weight",14972,Other,DRG Base Rate x DRG Weight,12726,,"23,488 x DRG Weight",12726,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3913.21,,DRG base rate x DRG weight + capital per discharge,3913.21,Other,100% of NY Medicaid HMO DRG,3913,,DRG base rate x DRG weight + capital per discharge,3913,Other,100% of NY Medicaid HMO DRG,3913,,DRG base rate x DRG weight + capital per discharge,3913,Other,100% of NY Medicaid HMO DRG,3913,,DRG base rate x DRG weight + capital per discharge,3913,Other,100% of NY Medicaid HMO DRG,8805,,225% x Medicaid HMO amount,8805,Other,225% of NY Medicaid HMO DRG,5987,,153% x Medicaid HMO amount,5987,Other,153% of NY Medicaid HMO DRG,8805,,225% x Medicaid HMO amount,8805,Other,225% of NY Medicaid HMO DRG,5478,,140% x Medicaid HMO amount,5478,Other,140% of NY Medicaid HMO DRG,8805,,DRG base rate x DRG weight + capital per discharge,8805,Other,225% of NY Medicaid HMO DRG,10761,,275% x Medicaid HMO amount,10761,Other,275% of NY Medicaid HMO DRG,12679,,324% x Medicaid HMO amount,12679,Other,324% of NY Medicaid HMO DRG,8413,,215% x Medicaid HMO amount,8413,Other,215% of NY Medicaid HMO DRG,8413,,215% x Medicaid HMO amount,8413,Other,215% of NY Medicaid HMO DRG,4892,,125% x Medicaid HMO amount,4892,Other,125% of NY Medicaid HMO DRG,0.01,14972,
"Neonate, transferred <5 days old, not born here",580-4,APR-DRG,,,,,,,,inpatient,,,161498.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14028,,186% x Medicaid HMO amount,14028,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30762,,"27,634 x DRG Weight",30762,Other,DRG Base Rate x DRG Weight,26147,,"23,488 x DRG Weight",26147,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7542.21,,DRG base rate x DRG weight + capital per discharge,7542.21,Other,100% of NY Medicaid HMO DRG,7542,,DRG base rate x DRG weight + capital per discharge,7542,Other,100% of NY Medicaid HMO DRG,7542,,DRG base rate x DRG weight + capital per discharge,7542,Other,100% of NY Medicaid HMO DRG,7542,,DRG base rate x DRG weight + capital per discharge,7542,Other,100% of NY Medicaid HMO DRG,16970,,225% x Medicaid HMO amount,16970,Other,225% of NY Medicaid HMO DRG,11540,,153% x Medicaid HMO amount,11540,Other,153% of NY Medicaid HMO DRG,16970,,225% x Medicaid HMO amount,16970,Other,225% of NY Medicaid HMO DRG,10559,,140% x Medicaid HMO amount,10559,Other,140% of NY Medicaid HMO DRG,16970,,DRG base rate x DRG weight + capital per discharge,16970,Other,225% of NY Medicaid HMO DRG,20741,,275% x Medicaid HMO amount,20741,Other,275% of NY Medicaid HMO DRG,24437,,324% x Medicaid HMO amount,24437,Other,324% of NY Medicaid HMO DRG,16216,,215% x Medicaid HMO amount,16216,Other,215% of NY Medicaid HMO DRG,16216,,215% x Medicaid HMO amount,16216,Other,215% of NY Medicaid HMO DRG,9428,,125% x Medicaid HMO amount,9428,Other,125% of NY Medicaid HMO DRG,0.01,30762,
"Neonate, transferred < 5 days old, born here",581-1,APR-DRG,,,,,,,,inpatient,,,22137.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2492,,186% x Medicaid HMO amount,2492,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3772,,"27,634 x DRG Weight",3772,Other,DRG Base Rate x DRG Weight,3206,,"23,488 x DRG Weight",3206,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,1340.21,,DRG base rate x DRG weight + capital per discharge,1340.21,Other,100% of NY Medicaid HMO DRG,1340,,DRG base rate x DRG weight + capital per discharge,1340,Other,100% of NY Medicaid HMO DRG,1340,,DRG base rate x DRG weight + capital per discharge,1340,Other,100% of NY Medicaid HMO DRG,1340,,DRG base rate x DRG weight + capital per discharge,1340,Other,100% of NY Medicaid HMO DRG,3015,,225% x Medicaid HMO amount,3015,Other,225% of NY Medicaid HMO DRG,2051,,153% x Medicaid HMO amount,2051,Other,153% of NY Medicaid HMO DRG,3015,,225% x Medicaid HMO amount,3015,Other,225% of NY Medicaid HMO DRG,1876,,140% x Medicaid HMO amount,1876,Other,140% of NY Medicaid HMO DRG,3015,,DRG base rate x DRG weight + capital per discharge,3015,Other,225% of NY Medicaid HMO DRG,3686,,275% x Medicaid HMO amount,3686,Other,275% of NY Medicaid HMO DRG,4342,,324% x Medicaid HMO amount,4342,Other,324% of NY Medicaid HMO DRG,2881,,215% x Medicaid HMO amount,2881,Other,215% of NY Medicaid HMO DRG,2881,,215% x Medicaid HMO amount,2881,Other,215% of NY Medicaid HMO DRG,1675,,125% x Medicaid HMO amount,1675,Other,125% of NY Medicaid HMO DRG,0.01,4342,
"Neonate, transferred < 5 days old, born here",581-2,APR-DRG,,,,,,,,inpatient,,,37661,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3075,,186% x Medicaid HMO amount,3075,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5134,,"27,634 x DRG Weight",5134,Other,DRG Base Rate x DRG Weight,4364,,"23,488 x DRG Weight",4364,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,1653.21,,DRG base rate x DRG weight + capital per discharge,1653.21,Other,100% of NY Medicaid HMO DRG,1653,,DRG base rate x DRG weight + capital per discharge,1653,Other,100% of NY Medicaid HMO DRG,1653,,DRG base rate x DRG weight + capital per discharge,1653,Other,100% of NY Medicaid HMO DRG,1653,,DRG base rate x DRG weight + capital per discharge,1653,Other,100% of NY Medicaid HMO DRG,3720,,225% x Medicaid HMO amount,3720,Other,225% of NY Medicaid HMO DRG,2529,,153% x Medicaid HMO amount,2529,Other,153% of NY Medicaid HMO DRG,3720,,225% x Medicaid HMO amount,3720,Other,225% of NY Medicaid HMO DRG,2314,,140% x Medicaid HMO amount,2314,Other,140% of NY Medicaid HMO DRG,3720,,DRG base rate x DRG weight + capital per discharge,3720,Other,225% of NY Medicaid HMO DRG,4546,,275% x Medicaid HMO amount,4546,Other,275% of NY Medicaid HMO DRG,5356,,324% x Medicaid HMO amount,5356,Other,324% of NY Medicaid HMO DRG,3554,,215% x Medicaid HMO amount,3554,Other,215% of NY Medicaid HMO DRG,3554,,215% x Medicaid HMO amount,3554,Other,215% of NY Medicaid HMO DRG,2067,,125% x Medicaid HMO amount,2067,Other,125% of NY Medicaid HMO DRG,0.01,5356,
"Neonate, transferred < 5 days old, born here",581-3,APR-DRG,,,,,,,,inpatient,,,130270.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4116,,186% x Medicaid HMO amount,4116,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7572,,"27,634 x DRG Weight",7572,Other,DRG Base Rate x DRG Weight,6436,,"23,488 x DRG Weight",6436,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2213.21,,DRG base rate x DRG weight + capital per discharge,2213.21,Other,100% of NY Medicaid HMO DRG,2213,,DRG base rate x DRG weight + capital per discharge,2213,Other,100% of NY Medicaid HMO DRG,2213,,DRG base rate x DRG weight + capital per discharge,2213,Other,100% of NY Medicaid HMO DRG,2213,,DRG base rate x DRG weight + capital per discharge,2213,Other,100% of NY Medicaid HMO DRG,4980,,225% x Medicaid HMO amount,4980,Other,225% of NY Medicaid HMO DRG,3386,,153% x Medicaid HMO amount,3386,Other,153% of NY Medicaid HMO DRG,4980,,225% x Medicaid HMO amount,4980,Other,225% of NY Medicaid HMO DRG,3098,,140% x Medicaid HMO amount,3098,Other,140% of NY Medicaid HMO DRG,4980,,DRG base rate x DRG weight + capital per discharge,4980,Other,225% of NY Medicaid HMO DRG,6086,,275% x Medicaid HMO amount,6086,Other,275% of NY Medicaid HMO DRG,7171,,324% x Medicaid HMO amount,7171,Other,324% of NY Medicaid HMO DRG,4758,,215% x Medicaid HMO amount,4758,Other,215% of NY Medicaid HMO DRG,4758,,215% x Medicaid HMO amount,4758,Other,215% of NY Medicaid HMO DRG,2767,,125% x Medicaid HMO amount,2767,Other,125% of NY Medicaid HMO DRG,0.01,7572,
"Neonate, transferred < 5 days old, born here",581-4,APR-DRG,,,,,,,,inpatient,,,130270.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6722,,186% x Medicaid HMO amount,6722,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13668,,"27,634 x DRG Weight",13668,Other,DRG Base Rate x DRG Weight,11617,,"23,488 x DRG Weight",11617,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3614.21,,DRG base rate x DRG weight + capital per discharge,3614.21,Other,100% of NY Medicaid HMO DRG,3614,,DRG base rate x DRG weight + capital per discharge,3614,Other,100% of NY Medicaid HMO DRG,3614,,DRG base rate x DRG weight + capital per discharge,3614,Other,100% of NY Medicaid HMO DRG,3614,,DRG base rate x DRG weight + capital per discharge,3614,Other,100% of NY Medicaid HMO DRG,8132,,225% x Medicaid HMO amount,8132,Other,225% of NY Medicaid HMO DRG,5530,,153% x Medicaid HMO amount,5530,Other,153% of NY Medicaid HMO DRG,8132,,225% x Medicaid HMO amount,8132,Other,225% of NY Medicaid HMO DRG,5060,,140% x Medicaid HMO amount,5060,Other,140% of NY Medicaid HMO DRG,8132,,DRG base rate x DRG weight + capital per discharge,8132,Other,225% of NY Medicaid HMO DRG,9939,,275% x Medicaid HMO amount,9939,Other,275% of NY Medicaid HMO DRG,11710,,324% x Medicaid HMO amount,11710,Other,324% of NY Medicaid HMO DRG,7771,,215% x Medicaid HMO amount,7771,Other,215% of NY Medicaid HMO DRG,7771,,215% x Medicaid HMO amount,7771,Other,215% of NY Medicaid HMO DRG,4518,,125% x Medicaid HMO amount,4518,Other,125% of NY Medicaid HMO DRG,0.01,13668,
Neonate w ECMO,583-1,APR-DRG,,,,,,,,inpatient,,,819584.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,170008,,186% x Medicaid HMO amount,170008,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,395705,,"27,634 x DRG Weight",395705,Other,DRG Base Rate x DRG Weight,336336,,"23,488 x DRG Weight",336336,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,91402.21,,DRG base rate x DRG weight + capital per discharge,91402.21,Other,100% of NY Medicaid HMO DRG,91402,,DRG base rate x DRG weight + capital per discharge,91402,Other,100% of NY Medicaid HMO DRG,91402,,DRG base rate x DRG weight + capital per discharge,91402,Other,100% of NY Medicaid HMO DRG,91402,,DRG base rate x DRG weight + capital per discharge,91402,Other,100% of NY Medicaid HMO DRG,205655,,225% x Medicaid HMO amount,205655,Other,225% of NY Medicaid HMO DRG,139845,,153% x Medicaid HMO amount,139845,Other,153% of NY Medicaid HMO DRG,205655,,225% x Medicaid HMO amount,205655,Other,225% of NY Medicaid HMO DRG,127963,,140% x Medicaid HMO amount,127963,Other,140% of NY Medicaid HMO DRG,205655,,DRG base rate x DRG weight + capital per discharge,205655,Other,225% of NY Medicaid HMO DRG,251356,,275% x Medicaid HMO amount,251356,Other,275% of NY Medicaid HMO DRG,296143,,324% x Medicaid HMO amount,296143,Other,324% of NY Medicaid HMO DRG,196515,,215% x Medicaid HMO amount,196515,Other,215% of NY Medicaid HMO DRG,196515,,215% x Medicaid HMO amount,196515,Other,215% of NY Medicaid HMO DRG,114253,,125% x Medicaid HMO amount,114253,Other,125% of NY Medicaid HMO DRG,0.01,395705,
Neonate w ECMO,583-2,APR-DRG,,,,,,,,inpatient,,,819584.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,170008,,186% x Medicaid HMO amount,170008,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,395705,,"27,634 x DRG Weight",395705,Other,DRG Base Rate x DRG Weight,336336,,"23,488 x DRG Weight",336336,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,91402.21,,DRG base rate x DRG weight + capital per discharge,91402.21,Other,100% of NY Medicaid HMO DRG,91402,,DRG base rate x DRG weight + capital per discharge,91402,Other,100% of NY Medicaid HMO DRG,91402,,DRG base rate x DRG weight + capital per discharge,91402,Other,100% of NY Medicaid HMO DRG,91402,,DRG base rate x DRG weight + capital per discharge,91402,Other,100% of NY Medicaid HMO DRG,205655,,225% x Medicaid HMO amount,205655,Other,225% of NY Medicaid HMO DRG,139845,,153% x Medicaid HMO amount,139845,Other,153% of NY Medicaid HMO DRG,205655,,225% x Medicaid HMO amount,205655,Other,225% of NY Medicaid HMO DRG,127963,,140% x Medicaid HMO amount,127963,Other,140% of NY Medicaid HMO DRG,205655,,DRG base rate x DRG weight + capital per discharge,205655,Other,225% of NY Medicaid HMO DRG,251356,,275% x Medicaid HMO amount,251356,Other,275% of NY Medicaid HMO DRG,296143,,324% x Medicaid HMO amount,296143,Other,324% of NY Medicaid HMO DRG,196515,,215% x Medicaid HMO amount,196515,Other,215% of NY Medicaid HMO DRG,196515,,215% x Medicaid HMO amount,196515,Other,215% of NY Medicaid HMO DRG,114253,,125% x Medicaid HMO amount,114253,Other,125% of NY Medicaid HMO DRG,0.01,395705,
Neonate w ECMO,583-3,APR-DRG,,,,,,,,inpatient,,,819584.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,173231,,186% x Medicaid HMO amount,173231,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,403246,,"27,634 x DRG Weight",403246,Other,DRG Base Rate x DRG Weight,342746,,"23,488 x DRG Weight",342746,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,93135.21,,DRG base rate x DRG weight + capital per discharge,93135.21,Other,100% of NY Medicaid HMO DRG,93135,,DRG base rate x DRG weight + capital per discharge,93135,Other,100% of NY Medicaid HMO DRG,93135,,DRG base rate x DRG weight + capital per discharge,93135,Other,100% of NY Medicaid HMO DRG,93135,,DRG base rate x DRG weight + capital per discharge,93135,Other,100% of NY Medicaid HMO DRG,209554,,225% x Medicaid HMO amount,209554,Other,225% of NY Medicaid HMO DRG,142497,,153% x Medicaid HMO amount,142497,Other,153% of NY Medicaid HMO DRG,209554,,225% x Medicaid HMO amount,209554,Other,225% of NY Medicaid HMO DRG,130389,,140% x Medicaid HMO amount,130389,Other,140% of NY Medicaid HMO DRG,209554,,DRG base rate x DRG weight + capital per discharge,209554,Other,225% of NY Medicaid HMO DRG,256122,,275% x Medicaid HMO amount,256122,Other,275% of NY Medicaid HMO DRG,301758,,324% x Medicaid HMO amount,301758,Other,324% of NY Medicaid HMO DRG,200241,,215% x Medicaid HMO amount,200241,Other,215% of NY Medicaid HMO DRG,200241,,215% x Medicaid HMO amount,200241,Other,215% of NY Medicaid HMO DRG,116419,,125% x Medicaid HMO amount,116419,Other,125% of NY Medicaid HMO DRG,0.01,403246,
Neonate w ECMO,583-4,APR-DRG,,,,,,,,inpatient,,,2948357.83,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,304253,,186% x Medicaid HMO amount,304253,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,709799,,"27,634 x DRG Weight",709799,Other,DRG Base Rate x DRG Weight,603306,,"23,488 x DRG Weight",603306,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,163577.21,,DRG base rate x DRG weight + capital per discharge,163577.21,Other,100% of NY Medicaid HMO DRG,163577,,DRG base rate x DRG weight + capital per discharge,163577,Other,100% of NY Medicaid HMO DRG,163577,,DRG base rate x DRG weight + capital per discharge,163577,Other,100% of NY Medicaid HMO DRG,163577,,DRG base rate x DRG weight + capital per discharge,163577,Other,100% of NY Medicaid HMO DRG,368049,,225% x Medicaid HMO amount,368049,Other,225% of NY Medicaid HMO DRG,250273,,153% x Medicaid HMO amount,250273,Other,153% of NY Medicaid HMO DRG,368049,,225% x Medicaid HMO amount,368049,Other,225% of NY Medicaid HMO DRG,229008,,140% x Medicaid HMO amount,229008,Other,140% of NY Medicaid HMO DRG,368049,,DRG base rate x DRG weight + capital per discharge,368049,Other,225% of NY Medicaid HMO DRG,449837,,275% x Medicaid HMO amount,449837,Other,275% of NY Medicaid HMO DRG,529990,,324% x Medicaid HMO amount,529990,Other,324% of NY Medicaid HMO DRG,351691,,215% x Medicaid HMO amount,351691,Other,215% of NY Medicaid HMO DRG,351691,,215% x Medicaid HMO amount,351691,Other,215% of NY Medicaid HMO DRG,204472,,125% x Medicaid HMO amount,204472,Other,125% of NY Medicaid HMO DRG,0.01,709799,
Neonate bwt <1500g w major procedure,588-1,APR-DRG,,,,,,,,inpatient,,,1630601.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,228884,,186% x Medicaid HMO amount,228884,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,533461,,"27,634 x DRG Weight",533461,Other,DRG Base Rate x DRG Weight,453424,,"23,488 x DRG Weight",453424,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,123056.21,,DRG base rate x DRG weight + capital per discharge,123056.21,Other,100% of NY Medicaid HMO DRG,123056,,DRG base rate x DRG weight + capital per discharge,123056,Other,100% of NY Medicaid HMO DRG,123056,,DRG base rate x DRG weight + capital per discharge,123056,Other,100% of NY Medicaid HMO DRG,123056,,DRG base rate x DRG weight + capital per discharge,123056,Other,100% of NY Medicaid HMO DRG,276876,,225% x Medicaid HMO amount,276876,Other,225% of NY Medicaid HMO DRG,188276,,153% x Medicaid HMO amount,188276,Other,153% of NY Medicaid HMO DRG,276876,,225% x Medicaid HMO amount,276876,Other,225% of NY Medicaid HMO DRG,172279,,140% x Medicaid HMO amount,172279,Other,140% of NY Medicaid HMO DRG,276876,,DRG base rate x DRG weight + capital per discharge,276876,Other,225% of NY Medicaid HMO DRG,338405,,275% x Medicaid HMO amount,338405,Other,275% of NY Medicaid HMO DRG,398702,,324% x Medicaid HMO amount,398702,Other,324% of NY Medicaid HMO DRG,264571,,215% x Medicaid HMO amount,264571,Other,215% of NY Medicaid HMO DRG,264571,,215% x Medicaid HMO amount,264571,Other,215% of NY Medicaid HMO DRG,153820,,125% x Medicaid HMO amount,153820,Other,125% of NY Medicaid HMO DRG,0.01,533461,
Neonate bwt <1500g w major procedure,588-2,APR-DRG,,,,,,,,inpatient,,,1630601.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,228884,,186% x Medicaid HMO amount,228884,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,533461,,"27,634 x DRG Weight",533461,Other,DRG Base Rate x DRG Weight,453424,,"23,488 x DRG Weight",453424,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,123056.21,,DRG base rate x DRG weight + capital per discharge,123056.21,Other,100% of NY Medicaid HMO DRG,123056,,DRG base rate x DRG weight + capital per discharge,123056,Other,100% of NY Medicaid HMO DRG,123056,,DRG base rate x DRG weight + capital per discharge,123056,Other,100% of NY Medicaid HMO DRG,123056,,DRG base rate x DRG weight + capital per discharge,123056,Other,100% of NY Medicaid HMO DRG,276876,,225% x Medicaid HMO amount,276876,Other,225% of NY Medicaid HMO DRG,188276,,153% x Medicaid HMO amount,188276,Other,153% of NY Medicaid HMO DRG,276876,,225% x Medicaid HMO amount,276876,Other,225% of NY Medicaid HMO DRG,172279,,140% x Medicaid HMO amount,172279,Other,140% of NY Medicaid HMO DRG,276876,,DRG base rate x DRG weight + capital per discharge,276876,Other,225% of NY Medicaid HMO DRG,338405,,275% x Medicaid HMO amount,338405,Other,275% of NY Medicaid HMO DRG,398702,,324% x Medicaid HMO amount,398702,Other,324% of NY Medicaid HMO DRG,264571,,215% x Medicaid HMO amount,264571,Other,215% of NY Medicaid HMO DRG,264571,,215% x Medicaid HMO amount,264571,Other,215% of NY Medicaid HMO DRG,153820,,125% x Medicaid HMO amount,153820,Other,125% of NY Medicaid HMO DRG,0.01,533461,
Neonate bwt <1500g w major procedure,588-3,APR-DRG,,,,,,,,inpatient,,,3057311.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,298921,,186% x Medicaid HMO amount,298921,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,697322,,"27,634 x DRG Weight",697322,Other,DRG Base Rate x DRG Weight,592701,,"23,488 x DRG Weight",592701,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,160710.21,,DRG base rate x DRG weight + capital per discharge,160710.21,Other,100% of NY Medicaid HMO DRG,160710,,DRG base rate x DRG weight + capital per discharge,160710,Other,100% of NY Medicaid HMO DRG,160710,,DRG base rate x DRG weight + capital per discharge,160710,Other,100% of NY Medicaid HMO DRG,160710,,DRG base rate x DRG weight + capital per discharge,160710,Other,100% of NY Medicaid HMO DRG,361598,,225% x Medicaid HMO amount,361598,Other,225% of NY Medicaid HMO DRG,245887,,153% x Medicaid HMO amount,245887,Other,153% of NY Medicaid HMO DRG,361598,,225% x Medicaid HMO amount,361598,Other,225% of NY Medicaid HMO DRG,224994,,140% x Medicaid HMO amount,224994,Other,140% of NY Medicaid HMO DRG,361598,,DRG base rate x DRG weight + capital per discharge,361598,Other,225% of NY Medicaid HMO DRG,441953,,275% x Medicaid HMO amount,441953,Other,275% of NY Medicaid HMO DRG,520701,,324% x Medicaid HMO amount,520701,Other,324% of NY Medicaid HMO DRG,345527,,215% x Medicaid HMO amount,345527,Other,215% of NY Medicaid HMO DRG,345527,,215% x Medicaid HMO amount,345527,Other,215% of NY Medicaid HMO DRG,200888,,125% x Medicaid HMO amount,200888,Other,125% of NY Medicaid HMO DRG,0.01,697322,
Neonate bwt <1500g w major procedure,588-4,APR-DRG,,,,,,,,inpatient,,,4190879.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,298921,,186% x Medicaid HMO amount,298921,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,697322,,"27,634 x DRG Weight",697322,Other,DRG Base Rate x DRG Weight,592701,,"23,488 x DRG Weight",592701,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,160710.21,,DRG base rate x DRG weight + capital per discharge,160710.21,Other,100% of NY Medicaid HMO DRG,160710,,DRG base rate x DRG weight + capital per discharge,160710,Other,100% of NY Medicaid HMO DRG,160710,,DRG base rate x DRG weight + capital per discharge,160710,Other,100% of NY Medicaid HMO DRG,160710,,DRG base rate x DRG weight + capital per discharge,160710,Other,100% of NY Medicaid HMO DRG,361598,,225% x Medicaid HMO amount,361598,Other,225% of NY Medicaid HMO DRG,245887,,153% x Medicaid HMO amount,245887,Other,153% of NY Medicaid HMO DRG,361598,,225% x Medicaid HMO amount,361598,Other,225% of NY Medicaid HMO DRG,224994,,140% x Medicaid HMO amount,224994,Other,140% of NY Medicaid HMO DRG,361598,,DRG base rate x DRG weight + capital per discharge,361598,Other,225% of NY Medicaid HMO DRG,441953,,275% x Medicaid HMO amount,441953,Other,275% of NY Medicaid HMO DRG,520701,,324% x Medicaid HMO amount,520701,Other,324% of NY Medicaid HMO DRG,345527,,215% x Medicaid HMO amount,345527,Other,215% of NY Medicaid HMO DRG,345527,,215% x Medicaid HMO amount,345527,Other,215% of NY Medicaid HMO DRG,200888,,125% x Medicaid HMO amount,200888,Other,125% of NY Medicaid HMO DRG,0.01,697322,
Neonate bwt <500g or GA <24 weeks,589-1,APR-DRG,,,,,,,,inpatient,,,3723435,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,144252,,186% x Medicaid HMO amount,144252,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,335446,,"27,634 x DRG Weight",335446,Other,DRG Base Rate x DRG Weight,285118,,"23,488 x DRG Weight",285118,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,77555.21,,DRG base rate x DRG weight + capital per discharge,77555.21,Other,100% of NY Medicaid HMO DRG,77555,,DRG base rate x DRG weight + capital per discharge,77555,Other,100% of NY Medicaid HMO DRG,77555,,DRG base rate x DRG weight + capital per discharge,77555,Other,100% of NY Medicaid HMO DRG,77555,,DRG base rate x DRG weight + capital per discharge,77555,Other,100% of NY Medicaid HMO DRG,174499,,225% x Medicaid HMO amount,174499,Other,225% of NY Medicaid HMO DRG,118659,,153% x Medicaid HMO amount,118659,Other,153% of NY Medicaid HMO DRG,174499,,225% x Medicaid HMO amount,174499,Other,225% of NY Medicaid HMO DRG,108577,,140% x Medicaid HMO amount,108577,Other,140% of NY Medicaid HMO DRG,174499,,DRG base rate x DRG weight + capital per discharge,174499,Other,225% of NY Medicaid HMO DRG,213277,,275% x Medicaid HMO amount,213277,Other,275% of NY Medicaid HMO DRG,251279,,324% x Medicaid HMO amount,251279,Other,324% of NY Medicaid HMO DRG,166744,,215% x Medicaid HMO amount,166744,Other,215% of NY Medicaid HMO DRG,166744,,215% x Medicaid HMO amount,166744,Other,215% of NY Medicaid HMO DRG,96944,,125% x Medicaid HMO amount,96944,Other,125% of NY Medicaid HMO DRG,0.01,335446,
Neonate bwt <500g or GA <24 weeks,589-2,APR-DRG,,,,,,,,inpatient,,,3632622.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,144252,,186% x Medicaid HMO amount,144252,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,335446,,"27,634 x DRG Weight",335446,Other,DRG Base Rate x DRG Weight,285118,,"23,488 x DRG Weight",285118,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,77555.21,,DRG base rate x DRG weight + capital per discharge,77555.21,Other,100% of NY Medicaid HMO DRG,77555,,DRG base rate x DRG weight + capital per discharge,77555,Other,100% of NY Medicaid HMO DRG,77555,,DRG base rate x DRG weight + capital per discharge,77555,Other,100% of NY Medicaid HMO DRG,77555,,DRG base rate x DRG weight + capital per discharge,77555,Other,100% of NY Medicaid HMO DRG,174499,,225% x Medicaid HMO amount,174499,Other,225% of NY Medicaid HMO DRG,118659,,153% x Medicaid HMO amount,118659,Other,153% of NY Medicaid HMO DRG,174499,,225% x Medicaid HMO amount,174499,Other,225% of NY Medicaid HMO DRG,108577,,140% x Medicaid HMO amount,108577,Other,140% of NY Medicaid HMO DRG,174499,,DRG base rate x DRG weight + capital per discharge,174499,Other,225% of NY Medicaid HMO DRG,213277,,275% x Medicaid HMO amount,213277,Other,275% of NY Medicaid HMO DRG,251279,,324% x Medicaid HMO amount,251279,Other,324% of NY Medicaid HMO DRG,166744,,215% x Medicaid HMO amount,166744,Other,215% of NY Medicaid HMO DRG,166744,,215% x Medicaid HMO amount,166744,Other,215% of NY Medicaid HMO DRG,96944,,125% x Medicaid HMO amount,96944,Other,125% of NY Medicaid HMO DRG,0.01,335446,
Neonate bwt <500g or GA <24 weeks,589-3,APR-DRG,,,,,,,,inpatient,,,4659798.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,52846,,186% x Medicaid HMO amount,52846,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,121587,,"27,634 x DRG Weight",121587,Other,DRG Base Rate x DRG Weight,103345,,"23,488 x DRG Weight",103345,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28412.21,,DRG base rate x DRG weight + capital per discharge,28412.21,Other,100% of NY Medicaid HMO DRG,28412,,DRG base rate x DRG weight + capital per discharge,28412,Other,100% of NY Medicaid HMO DRG,28412,,DRG base rate x DRG weight + capital per discharge,28412,Other,100% of NY Medicaid HMO DRG,28412,,DRG base rate x DRG weight + capital per discharge,28412,Other,100% of NY Medicaid HMO DRG,63927,,225% x Medicaid HMO amount,63927,Other,225% of NY Medicaid HMO DRG,43471,,153% x Medicaid HMO amount,43471,Other,153% of NY Medicaid HMO DRG,63927,,225% x Medicaid HMO amount,63927,Other,225% of NY Medicaid HMO DRG,39777,,140% x Medicaid HMO amount,39777,Other,140% of NY Medicaid HMO DRG,63927,,DRG base rate x DRG weight + capital per discharge,63927,Other,225% of NY Medicaid HMO DRG,78134,,275% x Medicaid HMO amount,78134,Other,275% of NY Medicaid HMO DRG,92056,,324% x Medicaid HMO amount,92056,Other,324% of NY Medicaid HMO DRG,61086,,215% x Medicaid HMO amount,61086,Other,215% of NY Medicaid HMO DRG,61086,,215% x Medicaid HMO amount,61086,Other,215% of NY Medicaid HMO DRG,35515,,125% x Medicaid HMO amount,35515,Other,125% of NY Medicaid HMO DRG,0.01,121587,
Neonate bwt <500g or GA <24 weeks,589-4,APR-DRG,,,,,,,,inpatient,,,6068,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2221,,186% x Medicaid HMO amount,2221,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3136,,"27,634 x DRG Weight",3136,Other,DRG Base Rate x DRG Weight,2666,,"23,488 x DRG Weight",2666,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,1194.21,,DRG base rate x DRG weight + capital per discharge,1194.21,Other,100% of NY Medicaid HMO DRG,1194,,DRG base rate x DRG weight + capital per discharge,1194,Other,100% of NY Medicaid HMO DRG,1194,,DRG base rate x DRG weight + capital per discharge,1194,Other,100% of NY Medicaid HMO DRG,1194,,DRG base rate x DRG weight + capital per discharge,1194,Other,100% of NY Medicaid HMO DRG,2687,,225% x Medicaid HMO amount,2687,Other,225% of NY Medicaid HMO DRG,1827,,153% x Medicaid HMO amount,1827,Other,153% of NY Medicaid HMO DRG,2687,,225% x Medicaid HMO amount,2687,Other,225% of NY Medicaid HMO DRG,1672,,140% x Medicaid HMO amount,1672,Other,140% of NY Medicaid HMO DRG,2687,,DRG base rate x DRG weight + capital per discharge,2687,Other,225% of NY Medicaid HMO DRG,3284,,275% x Medicaid HMO amount,3284,Other,275% of NY Medicaid HMO DRG,3869,,324% x Medicaid HMO amount,3869,Other,324% of NY Medicaid HMO DRG,2568,,215% x Medicaid HMO amount,2568,Other,215% of NY Medicaid HMO DRG,2568,,215% x Medicaid HMO amount,2568,Other,215% of NY Medicaid HMO DRG,1493,,125% x Medicaid HMO amount,1493,Other,125% of NY Medicaid HMO DRG,0.01,3869,
Neonate birthwt 500-749g w/o major procedure,591-1,APR-DRG,,,,,,,,inpatient,,,29712,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,105873,,186% x Medicaid HMO amount,105873,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,245650,,"27,634 x DRG Weight",245650,Other,DRG Base Rate x DRG Weight,208794,,"23,488 x DRG Weight",208794,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,56921.21,,DRG base rate x DRG weight + capital per discharge,56921.21,Other,100% of NY Medicaid HMO DRG,56921,,DRG base rate x DRG weight + capital per discharge,56921,Other,100% of NY Medicaid HMO DRG,56921,,DRG base rate x DRG weight + capital per discharge,56921,Other,100% of NY Medicaid HMO DRG,56921,,DRG base rate x DRG weight + capital per discharge,56921,Other,100% of NY Medicaid HMO DRG,128073,,225% x Medicaid HMO amount,128073,Other,225% of NY Medicaid HMO DRG,87089,,153% x Medicaid HMO amount,87089,Other,153% of NY Medicaid HMO DRG,128073,,225% x Medicaid HMO amount,128073,Other,225% of NY Medicaid HMO DRG,79690,,140% x Medicaid HMO amount,79690,Other,140% of NY Medicaid HMO DRG,128073,,DRG base rate x DRG weight + capital per discharge,128073,Other,225% of NY Medicaid HMO DRG,156533,,275% x Medicaid HMO amount,156533,Other,275% of NY Medicaid HMO DRG,184425,,324% x Medicaid HMO amount,184425,Other,324% of NY Medicaid HMO DRG,122381,,215% x Medicaid HMO amount,122381,Other,215% of NY Medicaid HMO DRG,122381,,215% x Medicaid HMO amount,122381,Other,215% of NY Medicaid HMO DRG,71152,,125% x Medicaid HMO amount,71152,Other,125% of NY Medicaid HMO DRG,0.01,245650,
Neonate birthwt 500-749g w/o major procedure,591-2,APR-DRG,,,,,,,,inpatient,,,2735357.94,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,131059,,186% x Medicaid HMO amount,131059,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,304579,,"27,634 x DRG Weight",304579,Other,DRG Base Rate x DRG Weight,258882,,"23,488 x DRG Weight",258882,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70462.21,,DRG base rate x DRG weight + capital per discharge,70462.21,Other,100% of NY Medicaid HMO DRG,70462,,DRG base rate x DRG weight + capital per discharge,70462,Other,100% of NY Medicaid HMO DRG,70462,,DRG base rate x DRG weight + capital per discharge,70462,Other,100% of NY Medicaid HMO DRG,70462,,DRG base rate x DRG weight + capital per discharge,70462,Other,100% of NY Medicaid HMO DRG,158540,,225% x Medicaid HMO amount,158540,Other,225% of NY Medicaid HMO DRG,107807,,153% x Medicaid HMO amount,107807,Other,153% of NY Medicaid HMO DRG,158540,,225% x Medicaid HMO amount,158540,Other,225% of NY Medicaid HMO DRG,98647,,140% x Medicaid HMO amount,98647,Other,140% of NY Medicaid HMO DRG,158540,,DRG base rate x DRG weight + capital per discharge,158540,Other,225% of NY Medicaid HMO DRG,193771,,275% x Medicaid HMO amount,193771,Other,275% of NY Medicaid HMO DRG,228298,,324% x Medicaid HMO amount,228298,Other,324% of NY Medicaid HMO DRG,151494,,215% x Medicaid HMO amount,151494,Other,215% of NY Medicaid HMO DRG,151494,,215% x Medicaid HMO amount,151494,Other,215% of NY Medicaid HMO DRG,88078,,125% x Medicaid HMO amount,88078,Other,125% of NY Medicaid HMO DRG,0.01,304579,
Neonate birthwt 500-749g w/o major procedure,591-3,APR-DRG,,,,,,,,inpatient,,,232053,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,140424,,186% x Medicaid HMO amount,140424,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,326490,,"27,634 x DRG Weight",326490,Other,DRG Base Rate x DRG Weight,277506,,"23,488 x DRG Weight",277506,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75497.21,,DRG base rate x DRG weight + capital per discharge,75497.21,Other,100% of NY Medicaid HMO DRG,75497,,DRG base rate x DRG weight + capital per discharge,75497,Other,100% of NY Medicaid HMO DRG,75497,,DRG base rate x DRG weight + capital per discharge,75497,Other,100% of NY Medicaid HMO DRG,75497,,DRG base rate x DRG weight + capital per discharge,75497,Other,100% of NY Medicaid HMO DRG,169869,,225% x Medicaid HMO amount,169869,Other,225% of NY Medicaid HMO DRG,115511,,153% x Medicaid HMO amount,115511,Other,153% of NY Medicaid HMO DRG,169869,,225% x Medicaid HMO amount,169869,Other,225% of NY Medicaid HMO DRG,105696,,140% x Medicaid HMO amount,105696,Other,140% of NY Medicaid HMO DRG,169869,,DRG base rate x DRG weight + capital per discharge,169869,Other,225% of NY Medicaid HMO DRG,207617,,275% x Medicaid HMO amount,207617,Other,275% of NY Medicaid HMO DRG,244611,,324% x Medicaid HMO amount,244611,Other,324% of NY Medicaid HMO DRG,162319,,215% x Medicaid HMO amount,162319,Other,215% of NY Medicaid HMO DRG,162319,,215% x Medicaid HMO amount,162319,Other,215% of NY Medicaid HMO DRG,94372,,125% x Medicaid HMO amount,94372,Other,125% of NY Medicaid HMO DRG,0.01,326490,
Neonate birthwt 500-749g w/o major procedure,591-4,APR-DRG,,,,,,,,inpatient,,,4269592.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,229712,,186% x Medicaid HMO amount,229712,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,535395,,"27,634 x DRG Weight",535395,Other,DRG Base Rate x DRG Weight,455068,,"23,488 x DRG Weight",455068,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,123501.21,,DRG base rate x DRG weight + capital per discharge,123501.21,Other,100% of NY Medicaid HMO DRG,123501,,DRG base rate x DRG weight + capital per discharge,123501,Other,100% of NY Medicaid HMO DRG,123501,,DRG base rate x DRG weight + capital per discharge,123501,Other,100% of NY Medicaid HMO DRG,123501,,DRG base rate x DRG weight + capital per discharge,123501,Other,100% of NY Medicaid HMO DRG,277878,,225% x Medicaid HMO amount,277878,Other,225% of NY Medicaid HMO DRG,188957,,153% x Medicaid HMO amount,188957,Other,153% of NY Medicaid HMO DRG,277878,,225% x Medicaid HMO amount,277878,Other,225% of NY Medicaid HMO DRG,172902,,140% x Medicaid HMO amount,172902,Other,140% of NY Medicaid HMO DRG,277878,,DRG base rate x DRG weight + capital per discharge,277878,Other,225% of NY Medicaid HMO DRG,339628,,275% x Medicaid HMO amount,339628,Other,275% of NY Medicaid HMO DRG,400144,,324% x Medicaid HMO amount,400144,Other,324% of NY Medicaid HMO DRG,265528,,215% x Medicaid HMO amount,265528,Other,215% of NY Medicaid HMO DRG,265528,,215% x Medicaid HMO amount,265528,Other,215% of NY Medicaid HMO DRG,154377,,125% x Medicaid HMO amount,154377,Other,125% of NY Medicaid HMO DRG,0.01,535395,
Neonate birthwt 750-999g w/o major procedure,593-1,APR-DRG,,,,,,,,inpatient,,,1816271.51,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,128472,,186% x Medicaid HMO amount,128472,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,298525,,"27,634 x DRG Weight",298525,Other,DRG Base Rate x DRG Weight,253736,,"23,488 x DRG Weight",253736,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69071.21,,DRG base rate x DRG weight + capital per discharge,69071.21,Other,100% of NY Medicaid HMO DRG,69071,,DRG base rate x DRG weight + capital per discharge,69071,Other,100% of NY Medicaid HMO DRG,69071,,DRG base rate x DRG weight + capital per discharge,69071,Other,100% of NY Medicaid HMO DRG,69071,,DRG base rate x DRG weight + capital per discharge,69071,Other,100% of NY Medicaid HMO DRG,155410,,225% x Medicaid HMO amount,155410,Other,225% of NY Medicaid HMO DRG,105679,,153% x Medicaid HMO amount,105679,Other,153% of NY Medicaid HMO DRG,155410,,225% x Medicaid HMO amount,155410,Other,225% of NY Medicaid HMO DRG,96700,,140% x Medicaid HMO amount,96700,Other,140% of NY Medicaid HMO DRG,155410,,DRG base rate x DRG weight + capital per discharge,155410,Other,225% of NY Medicaid HMO DRG,189946,,275% x Medicaid HMO amount,189946,Other,275% of NY Medicaid HMO DRG,223791,,324% x Medicaid HMO amount,223791,Other,324% of NY Medicaid HMO DRG,148503,,215% x Medicaid HMO amount,148503,Other,215% of NY Medicaid HMO DRG,148503,,215% x Medicaid HMO amount,148503,Other,215% of NY Medicaid HMO DRG,86339,,125% x Medicaid HMO amount,86339,Other,125% of NY Medicaid HMO DRG,0.01,298525,
Neonate birthwt 750-999g w/o major procedure,593-2,APR-DRG,,,,,,,,inpatient,,,1816271.51,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,132479,,186% x Medicaid HMO amount,132479,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,307901,,"27,634 x DRG Weight",307901,Other,DRG Base Rate x DRG Weight,261706,,"23,488 x DRG Weight",261706,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,71225.21,,DRG base rate x DRG weight + capital per discharge,71225.21,Other,100% of NY Medicaid HMO DRG,71225,,DRG base rate x DRG weight + capital per discharge,71225,Other,100% of NY Medicaid HMO DRG,71225,,DRG base rate x DRG weight + capital per discharge,71225,Other,100% of NY Medicaid HMO DRG,71225,,DRG base rate x DRG weight + capital per discharge,71225,Other,100% of NY Medicaid HMO DRG,160257,,225% x Medicaid HMO amount,160257,Other,225% of NY Medicaid HMO DRG,108975,,153% x Medicaid HMO amount,108975,Other,153% of NY Medicaid HMO DRG,160257,,225% x Medicaid HMO amount,160257,Other,225% of NY Medicaid HMO DRG,99715,,140% x Medicaid HMO amount,99715,Other,140% of NY Medicaid HMO DRG,160257,,DRG base rate x DRG weight + capital per discharge,160257,Other,225% of NY Medicaid HMO DRG,195869,,275% x Medicaid HMO amount,195869,Other,275% of NY Medicaid HMO DRG,230770,,324% x Medicaid HMO amount,230770,Other,324% of NY Medicaid HMO DRG,153134,,215% x Medicaid HMO amount,153134,Other,215% of NY Medicaid HMO DRG,153134,,215% x Medicaid HMO amount,153134,Other,215% of NY Medicaid HMO DRG,89032,,125% x Medicaid HMO amount,89032,Other,125% of NY Medicaid HMO DRG,0.01,307901,
Neonate birthwt 750-999g w/o major procedure,593-3,APR-DRG,,,,,,,,inpatient,,,2109601,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,161721,,186% x Medicaid HMO amount,161721,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,376320,,"27,634 x DRG Weight",376320,Other,DRG Base Rate x DRG Weight,319860,,"23,488 x DRG Weight",319860,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86947.21,,DRG base rate x DRG weight + capital per discharge,86947.21,Other,100% of NY Medicaid HMO DRG,86947,,DRG base rate x DRG weight + capital per discharge,86947,Other,100% of NY Medicaid HMO DRG,86947,,DRG base rate x DRG weight + capital per discharge,86947,Other,100% of NY Medicaid HMO DRG,86947,,DRG base rate x DRG weight + capital per discharge,86947,Other,100% of NY Medicaid HMO DRG,195631,,225% x Medicaid HMO amount,195631,Other,225% of NY Medicaid HMO DRG,133029,,153% x Medicaid HMO amount,133029,Other,153% of NY Medicaid HMO DRG,195631,,225% x Medicaid HMO amount,195631,Other,225% of NY Medicaid HMO DRG,121726,,140% x Medicaid HMO amount,121726,Other,140% of NY Medicaid HMO DRG,195631,,DRG base rate x DRG weight + capital per discharge,195631,Other,225% of NY Medicaid HMO DRG,239105,,275% x Medicaid HMO amount,239105,Other,275% of NY Medicaid HMO DRG,281709,,324% x Medicaid HMO amount,281709,Other,324% of NY Medicaid HMO DRG,186937,,215% x Medicaid HMO amount,186937,Other,215% of NY Medicaid HMO DRG,186937,,215% x Medicaid HMO amount,186937,Other,215% of NY Medicaid HMO DRG,108684,,125% x Medicaid HMO amount,108684,Other,125% of NY Medicaid HMO DRG,0.01,376320,
Neonate birthwt 750-999g w/o major procedure,593-4,APR-DRG,,,,,,,,inpatient,,,2882995.51,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,206815,,186% x Medicaid HMO amount,206815,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,481824,,"27,634 x DRG Weight",481824,Other,DRG Base Rate x DRG Weight,409534,,"23,488 x DRG Weight",409534,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,111191.21,,DRG base rate x DRG weight + capital per discharge,111191.21,Other,100% of NY Medicaid HMO DRG,111191,,DRG base rate x DRG weight + capital per discharge,111191,Other,100% of NY Medicaid HMO DRG,111191,,DRG base rate x DRG weight + capital per discharge,111191,Other,100% of NY Medicaid HMO DRG,111191,,DRG base rate x DRG weight + capital per discharge,111191,Other,100% of NY Medicaid HMO DRG,250180,,225% x Medicaid HMO amount,250180,Other,225% of NY Medicaid HMO DRG,170123,,153% x Medicaid HMO amount,170123,Other,153% of NY Medicaid HMO DRG,250180,,225% x Medicaid HMO amount,250180,Other,225% of NY Medicaid HMO DRG,155668,,140% x Medicaid HMO amount,155668,Other,140% of NY Medicaid HMO DRG,250180,,DRG base rate x DRG weight + capital per discharge,250180,Other,225% of NY Medicaid HMO DRG,305776,,275% x Medicaid HMO amount,305776,Other,275% of NY Medicaid HMO DRG,360260,,324% x Medicaid HMO amount,360260,Other,324% of NY Medicaid HMO DRG,239061,,215% x Medicaid HMO amount,239061,Other,215% of NY Medicaid HMO DRG,239061,,215% x Medicaid HMO amount,239061,Other,215% of NY Medicaid HMO DRG,138989,,125% x Medicaid HMO amount,138989,Other,125% of NY Medicaid HMO DRG,0.01,481824,
Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom,602-1,APR-DRG,,,,,,,,inpatient,,,1630353.76,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,77566,,186% x Medicaid HMO amount,77566,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,179419,,"27,634 x DRG Weight",179419,Other,DRG Base Rate x DRG Weight,152501,,"23,488 x DRG Weight",152501,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41702.21,,DRG base rate x DRG weight + capital per discharge,41702.21,Other,100% of NY Medicaid HMO DRG,41702,,DRG base rate x DRG weight + capital per discharge,41702,Other,100% of NY Medicaid HMO DRG,41702,,DRG base rate x DRG weight + capital per discharge,41702,Other,100% of NY Medicaid HMO DRG,41702,,DRG base rate x DRG weight + capital per discharge,41702,Other,100% of NY Medicaid HMO DRG,93830,,225% x Medicaid HMO amount,93830,Other,225% of NY Medicaid HMO DRG,63804,,153% x Medicaid HMO amount,63804,Other,153% of NY Medicaid HMO DRG,93830,,225% x Medicaid HMO amount,93830,Other,225% of NY Medicaid HMO DRG,58383,,140% x Medicaid HMO amount,58383,Other,140% of NY Medicaid HMO DRG,93830,,DRG base rate x DRG weight + capital per discharge,93830,Other,225% of NY Medicaid HMO DRG,114681,,275% x Medicaid HMO amount,114681,Other,275% of NY Medicaid HMO DRG,135115,,324% x Medicaid HMO amount,135115,Other,324% of NY Medicaid HMO DRG,89660,,215% x Medicaid HMO amount,89660,Other,215% of NY Medicaid HMO DRG,89660,,215% x Medicaid HMO amount,89660,Other,215% of NY Medicaid HMO DRG,52128,,125% x Medicaid HMO amount,52128,Other,125% of NY Medicaid HMO DRG,0.01,179419,
Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom,602-2,APR-DRG,,,,,,,,inpatient,,,1630353.76,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,112895,,186% x Medicaid HMO amount,112895,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,262081,,"27,634 x DRG Weight",262081,Other,DRG Base Rate x DRG Weight,222760,,"23,488 x DRG Weight",222760,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60696.21,,DRG base rate x DRG weight + capital per discharge,60696.21,Other,100% of NY Medicaid HMO DRG,60696,,DRG base rate x DRG weight + capital per discharge,60696,Other,100% of NY Medicaid HMO DRG,60696,,DRG base rate x DRG weight + capital per discharge,60696,Other,100% of NY Medicaid HMO DRG,60696,,DRG base rate x DRG weight + capital per discharge,60696,Other,100% of NY Medicaid HMO DRG,136566,,225% x Medicaid HMO amount,136566,Other,225% of NY Medicaid HMO DRG,92865,,153% x Medicaid HMO amount,92865,Other,153% of NY Medicaid HMO DRG,136566,,225% x Medicaid HMO amount,136566,Other,225% of NY Medicaid HMO DRG,84975,,140% x Medicaid HMO amount,84975,Other,140% of NY Medicaid HMO DRG,136566,,DRG base rate x DRG weight + capital per discharge,136566,Other,225% of NY Medicaid HMO DRG,166915,,275% x Medicaid HMO amount,166915,Other,275% of NY Medicaid HMO DRG,196656,,324% x Medicaid HMO amount,196656,Other,324% of NY Medicaid HMO DRG,130497,,215% x Medicaid HMO amount,130497,Other,215% of NY Medicaid HMO DRG,130497,,215% x Medicaid HMO amount,130497,Other,215% of NY Medicaid HMO DRG,75870,,125% x Medicaid HMO amount,75870,Other,125% of NY Medicaid HMO DRG,0.01,262081,
Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom,602-3,APR-DRG,,,,,,,,inpatient,,,1653465.22,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,132715,,186% x Medicaid HMO amount,132715,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,308453,,"27,634 x DRG Weight",308453,Other,DRG Base Rate x DRG Weight,262175,,"23,488 x DRG Weight",262175,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,71352.21,,DRG base rate x DRG weight + capital per discharge,71352.21,Other,100% of NY Medicaid HMO DRG,71352,,DRG base rate x DRG weight + capital per discharge,71352,Other,100% of NY Medicaid HMO DRG,71352,,DRG base rate x DRG weight + capital per discharge,71352,Other,100% of NY Medicaid HMO DRG,71352,,DRG base rate x DRG weight + capital per discharge,71352,Other,100% of NY Medicaid HMO DRG,160542,,225% x Medicaid HMO amount,160542,Other,225% of NY Medicaid HMO DRG,109169,,153% x Medicaid HMO amount,109169,Other,153% of NY Medicaid HMO DRG,160542,,225% x Medicaid HMO amount,160542,Other,225% of NY Medicaid HMO DRG,99893,,140% x Medicaid HMO amount,99893,Other,140% of NY Medicaid HMO DRG,160542,,DRG base rate x DRG weight + capital per discharge,160542,Other,225% of NY Medicaid HMO DRG,196219,,275% x Medicaid HMO amount,196219,Other,275% of NY Medicaid HMO DRG,231181,,324% x Medicaid HMO amount,231181,Other,324% of NY Medicaid HMO DRG,153407,,215% x Medicaid HMO amount,153407,Other,215% of NY Medicaid HMO DRG,153407,,215% x Medicaid HMO amount,153407,Other,215% of NY Medicaid HMO DRG,89190,,125% x Medicaid HMO amount,89190,Other,125% of NY Medicaid HMO DRG,0.01,308453,
Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom,602-4,APR-DRG,,,,,,,,inpatient,,,3217411.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,179481,,186% x Medicaid HMO amount,179481,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,417870,,"27,634 x DRG Weight",417870,Other,DRG Base Rate x DRG Weight,355176,,"23,488 x DRG Weight",355176,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,96495.21,,DRG base rate x DRG weight + capital per discharge,96495.21,Other,100% of NY Medicaid HMO DRG,96495,,DRG base rate x DRG weight + capital per discharge,96495,Other,100% of NY Medicaid HMO DRG,96495,,DRG base rate x DRG weight + capital per discharge,96495,Other,100% of NY Medicaid HMO DRG,96495,,DRG base rate x DRG weight + capital per discharge,96495,Other,100% of NY Medicaid HMO DRG,217114,,225% x Medicaid HMO amount,217114,Other,225% of NY Medicaid HMO DRG,147638,,153% x Medicaid HMO amount,147638,Other,153% of NY Medicaid HMO DRG,217114,,225% x Medicaid HMO amount,217114,Other,225% of NY Medicaid HMO DRG,135093,,140% x Medicaid HMO amount,135093,Other,140% of NY Medicaid HMO DRG,217114,,DRG base rate x DRG weight + capital per discharge,217114,Other,225% of NY Medicaid HMO DRG,265362,,275% x Medicaid HMO amount,265362,Other,275% of NY Medicaid HMO DRG,312644,,324% x Medicaid HMO amount,312644,Other,324% of NY Medicaid HMO DRG,207465,,215% x Medicaid HMO amount,207465,Other,215% of NY Medicaid HMO DRG,207465,,215% x Medicaid HMO amount,207465,Other,215% of NY Medicaid HMO DRG,120619,,125% x Medicaid HMO amount,120619,Other,125% of NY Medicaid HMO DRG,0.01,417870,
Neonate birthwt 1000-1249g w or w/o other significant condition,603-1,APR-DRG,,,,,,,,inpatient,,,1630353.76,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,61992,,186% x Medicaid HMO amount,61992,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,142984,,"27,634 x DRG Weight",142984,Other,DRG Base Rate x DRG Weight,121532,,"23,488 x DRG Weight",121532,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33329.21,,DRG base rate x DRG weight + capital per discharge,33329.21,Other,100% of NY Medicaid HMO DRG,33329,,DRG base rate x DRG weight + capital per discharge,33329,Other,100% of NY Medicaid HMO DRG,33329,,DRG base rate x DRG weight + capital per discharge,33329,Other,100% of NY Medicaid HMO DRG,33329,,DRG base rate x DRG weight + capital per discharge,33329,Other,100% of NY Medicaid HMO DRG,74991,,225% x Medicaid HMO amount,74991,Other,225% of NY Medicaid HMO DRG,50994,,153% x Medicaid HMO amount,50994,Other,153% of NY Medicaid HMO DRG,74991,,225% x Medicaid HMO amount,74991,Other,225% of NY Medicaid HMO DRG,46661,,140% x Medicaid HMO amount,46661,Other,140% of NY Medicaid HMO DRG,74991,,DRG base rate x DRG weight + capital per discharge,74991,Other,225% of NY Medicaid HMO DRG,91655,,275% x Medicaid HMO amount,91655,Other,275% of NY Medicaid HMO DRG,107987,,324% x Medicaid HMO amount,107987,Other,324% of NY Medicaid HMO DRG,71658,,215% x Medicaid HMO amount,71658,Other,215% of NY Medicaid HMO DRG,71658,,215% x Medicaid HMO amount,71658,Other,215% of NY Medicaid HMO DRG,41662,,125% x Medicaid HMO amount,41662,Other,125% of NY Medicaid HMO DRG,0.01,142984,
Neonate birthwt 1000-1249g w or w/o other significant condition,603-2,APR-DRG,,,,,,,,inpatient,,,1050935.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,82357,,186% x Medicaid HMO amount,82357,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,190633,,"27,634 x DRG Weight",190633,Other,DRG Base Rate x DRG Weight,162032,,"23,488 x DRG Weight",162032,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44278.21,,DRG base rate x DRG weight + capital per discharge,44278.21,Other,100% of NY Medicaid HMO DRG,44278,,DRG base rate x DRG weight + capital per discharge,44278,Other,100% of NY Medicaid HMO DRG,44278,,DRG base rate x DRG weight + capital per discharge,44278,Other,100% of NY Medicaid HMO DRG,44278,,DRG base rate x DRG weight + capital per discharge,44278,Other,100% of NY Medicaid HMO DRG,99626,,225% x Medicaid HMO amount,99626,Other,225% of NY Medicaid HMO DRG,67746,,153% x Medicaid HMO amount,67746,Other,153% of NY Medicaid HMO DRG,99626,,225% x Medicaid HMO amount,99626,Other,225% of NY Medicaid HMO DRG,61989,,140% x Medicaid HMO amount,61989,Other,140% of NY Medicaid HMO DRG,99626,,DRG base rate x DRG weight + capital per discharge,99626,Other,225% of NY Medicaid HMO DRG,121765,,275% x Medicaid HMO amount,121765,Other,275% of NY Medicaid HMO DRG,143461,,324% x Medicaid HMO amount,143461,Other,324% of NY Medicaid HMO DRG,95198,,215% x Medicaid HMO amount,95198,Other,215% of NY Medicaid HMO DRG,95198,,215% x Medicaid HMO amount,95198,Other,215% of NY Medicaid HMO DRG,55348,,125% x Medicaid HMO amount,55348,Other,125% of NY Medicaid HMO DRG,0.01,190633,
Neonate birthwt 1000-1249g w or w/o other significant condition,603-3,APR-DRG,,,,,,,,inpatient,,,1987695,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,106924,,186% x Medicaid HMO amount,106924,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,248112,,"27,634 x DRG Weight",248112,Other,DRG Base Rate x DRG Weight,210887,,"23,488 x DRG Weight",210887,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57486.21,,DRG base rate x DRG weight + capital per discharge,57486.21,Other,100% of NY Medicaid HMO DRG,57486,,DRG base rate x DRG weight + capital per discharge,57486,Other,100% of NY Medicaid HMO DRG,57486,,DRG base rate x DRG weight + capital per discharge,57486,Other,100% of NY Medicaid HMO DRG,57486,,DRG base rate x DRG weight + capital per discharge,57486,Other,100% of NY Medicaid HMO DRG,129344,,225% x Medicaid HMO amount,129344,Other,225% of NY Medicaid HMO DRG,87954,,153% x Medicaid HMO amount,87954,Other,153% of NY Medicaid HMO DRG,129344,,225% x Medicaid HMO amount,129344,Other,225% of NY Medicaid HMO DRG,80481,,140% x Medicaid HMO amount,80481,Other,140% of NY Medicaid HMO DRG,129344,,DRG base rate x DRG weight + capital per discharge,129344,Other,225% of NY Medicaid HMO DRG,158087,,275% x Medicaid HMO amount,158087,Other,275% of NY Medicaid HMO DRG,186255,,324% x Medicaid HMO amount,186255,Other,324% of NY Medicaid HMO DRG,123595,,215% x Medicaid HMO amount,123595,Other,215% of NY Medicaid HMO DRG,123595,,215% x Medicaid HMO amount,123595,Other,215% of NY Medicaid HMO DRG,71858,,125% x Medicaid HMO amount,71858,Other,125% of NY Medicaid HMO DRG,0.01,248112,
Neonate birthwt 1000-1249g w or w/o other significant condition,603-4,APR-DRG,,,,,,,,inpatient,,,3217411.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,165404,,186% x Medicaid HMO amount,165404,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,384936,,"27,634 x DRG Weight",384936,Other,DRG Base Rate x DRG Weight,327183,,"23,488 x DRG Weight",327183,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,88927.21,,DRG base rate x DRG weight + capital per discharge,88927.21,Other,100% of NY Medicaid HMO DRG,88927,,DRG base rate x DRG weight + capital per discharge,88927,Other,100% of NY Medicaid HMO DRG,88927,,DRG base rate x DRG weight + capital per discharge,88927,Other,100% of NY Medicaid HMO DRG,88927,,DRG base rate x DRG weight + capital per discharge,88927,Other,100% of NY Medicaid HMO DRG,200086,,225% x Medicaid HMO amount,200086,Other,225% of NY Medicaid HMO DRG,136059,,153% x Medicaid HMO amount,136059,Other,153% of NY Medicaid HMO DRG,200086,,225% x Medicaid HMO amount,200086,Other,225% of NY Medicaid HMO DRG,124498,,140% x Medicaid HMO amount,124498,Other,140% of NY Medicaid HMO DRG,200086,,DRG base rate x DRG weight + capital per discharge,200086,Other,225% of NY Medicaid HMO DRG,244550,,275% x Medicaid HMO amount,244550,Other,275% of NY Medicaid HMO DRG,288124,,324% x Medicaid HMO amount,288124,Other,324% of NY Medicaid HMO DRG,191194,,215% x Medicaid HMO amount,191194,Other,215% of NY Medicaid HMO DRG,191194,,215% x Medicaid HMO amount,191194,Other,215% of NY Medicaid HMO DRG,111159,,125% x Medicaid HMO amount,111159,Other,125% of NY Medicaid HMO DRG,0.01,384936,
Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom,607-1,APR-DRG,,,,,,,,inpatient,,,977492.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72233,,186% x Medicaid HMO amount,72233,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,166943,,"27,634 x DRG Weight",166943,Other,DRG Base Rate x DRG Weight,141896,,"23,488 x DRG Weight",141896,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38835.21,,DRG base rate x DRG weight + capital per discharge,38835.21,Other,100% of NY Medicaid HMO DRG,38835,,DRG base rate x DRG weight + capital per discharge,38835,Other,100% of NY Medicaid HMO DRG,38835,,DRG base rate x DRG weight + capital per discharge,38835,Other,100% of NY Medicaid HMO DRG,38835,,DRG base rate x DRG weight + capital per discharge,38835,Other,100% of NY Medicaid HMO DRG,87379,,225% x Medicaid HMO amount,87379,Other,225% of NY Medicaid HMO DRG,59418,,153% x Medicaid HMO amount,59418,Other,153% of NY Medicaid HMO DRG,87379,,225% x Medicaid HMO amount,87379,Other,225% of NY Medicaid HMO DRG,54369,,140% x Medicaid HMO amount,54369,Other,140% of NY Medicaid HMO DRG,87379,,DRG base rate x DRG weight + capital per discharge,87379,Other,225% of NY Medicaid HMO DRG,106797,,275% x Medicaid HMO amount,106797,Other,275% of NY Medicaid HMO DRG,125826,,324% x Medicaid HMO amount,125826,Other,324% of NY Medicaid HMO DRG,83496,,215% x Medicaid HMO amount,83496,Other,215% of NY Medicaid HMO DRG,83496,,215% x Medicaid HMO amount,83496,Other,215% of NY Medicaid HMO DRG,48544,,125% x Medicaid HMO amount,48544,Other,125% of NY Medicaid HMO DRG,0.01,166943,
Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom,607-2,APR-DRG,,,,,,,,inpatient,,,1190888.43,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,89207,,186% x Medicaid HMO amount,89207,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,206658,,"27,634 x DRG Weight",206658,Other,DRG Base Rate x DRG Weight,175653,,"23,488 x DRG Weight",175653,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47961.21,,DRG base rate x DRG weight + capital per discharge,47961.21,Other,100% of NY Medicaid HMO DRG,47961,,DRG base rate x DRG weight + capital per discharge,47961,Other,100% of NY Medicaid HMO DRG,47961,,DRG base rate x DRG weight + capital per discharge,47961,Other,100% of NY Medicaid HMO DRG,47961,,DRG base rate x DRG weight + capital per discharge,47961,Other,100% of NY Medicaid HMO DRG,107913,,225% x Medicaid HMO amount,107913,Other,225% of NY Medicaid HMO DRG,73381,,153% x Medicaid HMO amount,73381,Other,153% of NY Medicaid HMO DRG,107913,,225% x Medicaid HMO amount,107913,Other,225% of NY Medicaid HMO DRG,67146,,140% x Medicaid HMO amount,67146,Other,140% of NY Medicaid HMO DRG,107913,,DRG base rate x DRG weight + capital per discharge,107913,Other,225% of NY Medicaid HMO DRG,131893,,275% x Medicaid HMO amount,131893,Other,275% of NY Medicaid HMO DRG,155394,,324% x Medicaid HMO amount,155394,Other,324% of NY Medicaid HMO DRG,103117,,215% x Medicaid HMO amount,103117,Other,215% of NY Medicaid HMO DRG,103117,,215% x Medicaid HMO amount,103117,Other,215% of NY Medicaid HMO DRG,59952,,125% x Medicaid HMO amount,59952,Other,125% of NY Medicaid HMO DRG,0.01,206658,
Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom,607-3,APR-DRG,,,,,,,,inpatient,,,977492.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,108940,,186% x Medicaid HMO amount,108940,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,252826,,"27,634 x DRG Weight",252826,Other,DRG Base Rate x DRG Weight,214894,,"23,488 x DRG Weight",214894,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58570.21,,DRG base rate x DRG weight + capital per discharge,58570.21,Other,100% of NY Medicaid HMO DRG,58570,,DRG base rate x DRG weight + capital per discharge,58570,Other,100% of NY Medicaid HMO DRG,58570,,DRG base rate x DRG weight + capital per discharge,58570,Other,100% of NY Medicaid HMO DRG,58570,,DRG base rate x DRG weight + capital per discharge,58570,Other,100% of NY Medicaid HMO DRG,131783,,225% x Medicaid HMO amount,131783,Other,225% of NY Medicaid HMO DRG,89612,,153% x Medicaid HMO amount,89612,Other,153% of NY Medicaid HMO DRG,131783,,225% x Medicaid HMO amount,131783,Other,225% of NY Medicaid HMO DRG,81998,,140% x Medicaid HMO amount,81998,Other,140% of NY Medicaid HMO DRG,131783,,DRG base rate x DRG weight + capital per discharge,131783,Other,225% of NY Medicaid HMO DRG,161068,,275% x Medicaid HMO amount,161068,Other,275% of NY Medicaid HMO DRG,189767,,324% x Medicaid HMO amount,189767,Other,324% of NY Medicaid HMO DRG,125926,,215% x Medicaid HMO amount,125926,Other,215% of NY Medicaid HMO DRG,125926,,215% x Medicaid HMO amount,125926,Other,215% of NY Medicaid HMO DRG,73213,,125% x Medicaid HMO amount,73213,Other,125% of NY Medicaid HMO DRG,0.01,252826,
Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom,607-4,APR-DRG,,,,,,,,inpatient,,,2843505.91,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,146693,,186% x Medicaid HMO amount,146693,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,341158,,"27,634 x DRG Weight",341158,Other,DRG Base Rate x DRG Weight,289973,,"23,488 x DRG Weight",289973,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78867.21,,DRG base rate x DRG weight + capital per discharge,78867.21,Other,100% of NY Medicaid HMO DRG,78867,,DRG base rate x DRG weight + capital per discharge,78867,Other,100% of NY Medicaid HMO DRG,78867,,DRG base rate x DRG weight + capital per discharge,78867,Other,100% of NY Medicaid HMO DRG,78867,,DRG base rate x DRG weight + capital per discharge,78867,Other,100% of NY Medicaid HMO DRG,177451,,225% x Medicaid HMO amount,177451,Other,225% of NY Medicaid HMO DRG,120667,,153% x Medicaid HMO amount,120667,Other,153% of NY Medicaid HMO DRG,177451,,225% x Medicaid HMO amount,177451,Other,225% of NY Medicaid HMO DRG,110414,,140% x Medicaid HMO amount,110414,Other,140% of NY Medicaid HMO DRG,177451,,DRG base rate x DRG weight + capital per discharge,177451,Other,225% of NY Medicaid HMO DRG,216885,,275% x Medicaid HMO amount,216885,Other,275% of NY Medicaid HMO DRG,255530,,324% x Medicaid HMO amount,255530,Other,324% of NY Medicaid HMO DRG,169565,,215% x Medicaid HMO amount,169565,Other,215% of NY Medicaid HMO DRG,169565,,215% x Medicaid HMO amount,169565,Other,215% of NY Medicaid HMO DRG,98584,,125% x Medicaid HMO amount,98584,Other,125% of NY Medicaid HMO DRG,0.01,341158,
Neonate bwt 1250-1499g w or w/o other significant condition,608-1,APR-DRG,,,,,,,,inpatient,,,840356,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51011,,186% x Medicaid HMO amount,51011,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,117290,,"27,634 x DRG Weight",117290,Other,DRG Base Rate x DRG Weight,99692,,"23,488 x DRG Weight",99692,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27425.21,,DRG base rate x DRG weight + capital per discharge,27425.21,Other,100% of NY Medicaid HMO DRG,27425,,DRG base rate x DRG weight + capital per discharge,27425,Other,100% of NY Medicaid HMO DRG,27425,,DRG base rate x DRG weight + capital per discharge,27425,Other,100% of NY Medicaid HMO DRG,27425,,DRG base rate x DRG weight + capital per discharge,27425,Other,100% of NY Medicaid HMO DRG,61707,,225% x Medicaid HMO amount,61707,Other,225% of NY Medicaid HMO DRG,41961,,153% x Medicaid HMO amount,41961,Other,153% of NY Medicaid HMO DRG,61707,,225% x Medicaid HMO amount,61707,Other,225% of NY Medicaid HMO DRG,38395,,140% x Medicaid HMO amount,38395,Other,140% of NY Medicaid HMO DRG,61707,,DRG base rate x DRG weight + capital per discharge,61707,Other,225% of NY Medicaid HMO DRG,75419,,275% x Medicaid HMO amount,75419,Other,275% of NY Medicaid HMO DRG,88858,,324% x Medicaid HMO amount,88858,Other,324% of NY Medicaid HMO DRG,58964,,215% x Medicaid HMO amount,58964,Other,215% of NY Medicaid HMO DRG,58964,,215% x Medicaid HMO amount,58964,Other,215% of NY Medicaid HMO DRG,34282,,125% x Medicaid HMO amount,34282,Other,125% of NY Medicaid HMO DRG,0.01,117290,
Neonate bwt 1250-1499g w or w/o other significant condition,608-2,APR-DRG,,,,,,,,inpatient,,,840356,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,68037,,186% x Medicaid HMO amount,68037,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,157127,,"27,634 x DRG Weight",157127,Other,DRG Base Rate x DRG Weight,133553,,"23,488 x DRG Weight",133553,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36579.21,,DRG base rate x DRG weight + capital per discharge,36579.21,Other,100% of NY Medicaid HMO DRG,36579,,DRG base rate x DRG weight + capital per discharge,36579,Other,100% of NY Medicaid HMO DRG,36579,,DRG base rate x DRG weight + capital per discharge,36579,Other,100% of NY Medicaid HMO DRG,36579,,DRG base rate x DRG weight + capital per discharge,36579,Other,100% of NY Medicaid HMO DRG,82303,,225% x Medicaid HMO amount,82303,Other,225% of NY Medicaid HMO DRG,55966,,153% x Medicaid HMO amount,55966,Other,153% of NY Medicaid HMO DRG,82303,,225% x Medicaid HMO amount,82303,Other,225% of NY Medicaid HMO DRG,51211,,140% x Medicaid HMO amount,51211,Other,140% of NY Medicaid HMO DRG,82303,,DRG base rate x DRG weight + capital per discharge,82303,Other,225% of NY Medicaid HMO DRG,100593,,275% x Medicaid HMO amount,100593,Other,275% of NY Medicaid HMO DRG,118517,,324% x Medicaid HMO amount,118517,Other,324% of NY Medicaid HMO DRG,78645,,215% x Medicaid HMO amount,78645,Other,215% of NY Medicaid HMO DRG,78645,,215% x Medicaid HMO amount,78645,Other,215% of NY Medicaid HMO DRG,45724,,125% x Medicaid HMO amount,45724,Other,125% of NY Medicaid HMO DRG,0.01,157127,
Neonate bwt 1250-1499g w or w/o other significant condition,608-3,APR-DRG,,,,,,,,inpatient,,,977492.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,81474,,186% x Medicaid HMO amount,81474,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,188563,,"27,634 x DRG Weight",188563,Other,DRG Base Rate x DRG Weight,160273,,"23,488 x DRG Weight",160273,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43803.21,,DRG base rate x DRG weight + capital per discharge,43803.21,Other,100% of NY Medicaid HMO DRG,43803,,DRG base rate x DRG weight + capital per discharge,43803,Other,100% of NY Medicaid HMO DRG,43803,,DRG base rate x DRG weight + capital per discharge,43803,Other,100% of NY Medicaid HMO DRG,43803,,DRG base rate x DRG weight + capital per discharge,43803,Other,100% of NY Medicaid HMO DRG,98557,,225% x Medicaid HMO amount,98557,Other,225% of NY Medicaid HMO DRG,67019,,153% x Medicaid HMO amount,67019,Other,153% of NY Medicaid HMO DRG,98557,,225% x Medicaid HMO amount,98557,Other,225% of NY Medicaid HMO DRG,61324,,140% x Medicaid HMO amount,61324,Other,140% of NY Medicaid HMO DRG,98557,,DRG base rate x DRG weight + capital per discharge,98557,Other,225% of NY Medicaid HMO DRG,120459,,275% x Medicaid HMO amount,120459,Other,275% of NY Medicaid HMO DRG,141922,,324% x Medicaid HMO amount,141922,Other,324% of NY Medicaid HMO DRG,94177,,215% x Medicaid HMO amount,94177,Other,215% of NY Medicaid HMO DRG,94177,,215% x Medicaid HMO amount,94177,Other,215% of NY Medicaid HMO DRG,54754,,125% x Medicaid HMO amount,54754,Other,125% of NY Medicaid HMO DRG,0.01,188563,
Neonate bwt 1250-1499g w or w/o other significant condition,608-4,APR-DRG,,,,,,,,inpatient,,,1190888.43,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,85711,,186% x Medicaid HMO amount,85711,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,198478,,"27,634 x DRG Weight",198478,Other,DRG Base Rate x DRG Weight,168700,,"23,488 x DRG Weight",168700,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46081.21,,DRG base rate x DRG weight + capital per discharge,46081.21,Other,100% of NY Medicaid HMO DRG,46081,,DRG base rate x DRG weight + capital per discharge,46081,Other,100% of NY Medicaid HMO DRG,46081,,DRG base rate x DRG weight + capital per discharge,46081,Other,100% of NY Medicaid HMO DRG,46081,,DRG base rate x DRG weight + capital per discharge,46081,Other,100% of NY Medicaid HMO DRG,103683,,225% x Medicaid HMO amount,103683,Other,225% of NY Medicaid HMO DRG,70504,,153% x Medicaid HMO amount,70504,Other,153% of NY Medicaid HMO DRG,103683,,225% x Medicaid HMO amount,103683,Other,225% of NY Medicaid HMO DRG,64514,,140% x Medicaid HMO amount,64514,Other,140% of NY Medicaid HMO DRG,103683,,DRG base rate x DRG weight + capital per discharge,103683,Other,225% of NY Medicaid HMO DRG,126723,,275% x Medicaid HMO amount,126723,Other,275% of NY Medicaid HMO DRG,149303,,324% x Medicaid HMO amount,149303,Other,324% of NY Medicaid HMO DRG,99075,,215% x Medicaid HMO amount,99075,Other,215% of NY Medicaid HMO DRG,99075,,215% x Medicaid HMO amount,99075,Other,215% of NY Medicaid HMO DRG,57602,,125% x Medicaid HMO amount,57602,Other,125% of NY Medicaid HMO DRG,0.01,198478,
Neonate bwt 1500-2499g w major procedure,609-1,APR-DRG,,,,,,,,inpatient,,,430675,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43018,,186% x Medicaid HMO amount,43018,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,98590,,"27,634 x DRG Weight",98590,Other,DRG Base Rate x DRG Weight,83798,,"23,488 x DRG Weight",83798,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23128.21,,DRG base rate x DRG weight + capital per discharge,23128.21,Other,100% of NY Medicaid HMO DRG,23128,,DRG base rate x DRG weight + capital per discharge,23128,Other,100% of NY Medicaid HMO DRG,23128,,DRG base rate x DRG weight + capital per discharge,23128,Other,100% of NY Medicaid HMO DRG,23128,,DRG base rate x DRG weight + capital per discharge,23128,Other,100% of NY Medicaid HMO DRG,52038,,225% x Medicaid HMO amount,52038,Other,225% of NY Medicaid HMO DRG,35386,,153% x Medicaid HMO amount,35386,Other,153% of NY Medicaid HMO DRG,52038,,225% x Medicaid HMO amount,52038,Other,225% of NY Medicaid HMO DRG,32379,,140% x Medicaid HMO amount,32379,Other,140% of NY Medicaid HMO DRG,52038,,DRG base rate x DRG weight + capital per discharge,52038,Other,225% of NY Medicaid HMO DRG,63603,,275% x Medicaid HMO amount,63603,Other,275% of NY Medicaid HMO DRG,74935,,324% x Medicaid HMO amount,74935,Other,324% of NY Medicaid HMO DRG,49726,,215% x Medicaid HMO amount,49726,Other,215% of NY Medicaid HMO DRG,49726,,215% x Medicaid HMO amount,49726,Other,215% of NY Medicaid HMO DRG,28910,,125% x Medicaid HMO amount,28910,Other,125% of NY Medicaid HMO DRG,0.01,98590,
Neonate bwt 1500-2499g w major procedure,609-2,APR-DRG,,,,,,,,inpatient,,,430675,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43342,,186% x Medicaid HMO amount,43342,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,99347,,"27,634 x DRG Weight",99347,Other,DRG Base Rate x DRG Weight,84442,,"23,488 x DRG Weight",84442,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23302.21,,DRG base rate x DRG weight + capital per discharge,23302.21,Other,100% of NY Medicaid HMO DRG,23302,,DRG base rate x DRG weight + capital per discharge,23302,Other,100% of NY Medicaid HMO DRG,23302,,DRG base rate x DRG weight + capital per discharge,23302,Other,100% of NY Medicaid HMO DRG,23302,,DRG base rate x DRG weight + capital per discharge,23302,Other,100% of NY Medicaid HMO DRG,52430,,225% x Medicaid HMO amount,52430,Other,225% of NY Medicaid HMO DRG,35652,,153% x Medicaid HMO amount,35652,Other,153% of NY Medicaid HMO DRG,52430,,225% x Medicaid HMO amount,52430,Other,225% of NY Medicaid HMO DRG,32623,,140% x Medicaid HMO amount,32623,Other,140% of NY Medicaid HMO DRG,52430,,DRG base rate x DRG weight + capital per discharge,52430,Other,225% of NY Medicaid HMO DRG,64081,,275% x Medicaid HMO amount,64081,Other,275% of NY Medicaid HMO DRG,75499,,324% x Medicaid HMO amount,75499,Other,324% of NY Medicaid HMO DRG,50100,,215% x Medicaid HMO amount,50100,Other,215% of NY Medicaid HMO DRG,50100,,215% x Medicaid HMO amount,50100,Other,215% of NY Medicaid HMO DRG,29128,,125% x Medicaid HMO amount,29128,Other,125% of NY Medicaid HMO DRG,0.01,99347,
Neonate bwt 1500-2499g w major procedure,609-3,APR-DRG,,,,,,,,inpatient,,,1250219.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86901,,186% x Medicaid HMO amount,86901,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,201261,,"27,634 x DRG Weight",201261,Other,DRG Base Rate x DRG Weight,171065,,"23,488 x DRG Weight",171065,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46721.21,,DRG base rate x DRG weight + capital per discharge,46721.21,Other,100% of NY Medicaid HMO DRG,46721,,DRG base rate x DRG weight + capital per discharge,46721,Other,100% of NY Medicaid HMO DRG,46721,,DRG base rate x DRG weight + capital per discharge,46721,Other,100% of NY Medicaid HMO DRG,46721,,DRG base rate x DRG weight + capital per discharge,46721,Other,100% of NY Medicaid HMO DRG,105123,,225% x Medicaid HMO amount,105123,Other,225% of NY Medicaid HMO DRG,71483,,153% x Medicaid HMO amount,71483,Other,153% of NY Medicaid HMO DRG,105123,,225% x Medicaid HMO amount,105123,Other,225% of NY Medicaid HMO DRG,65410,,140% x Medicaid HMO amount,65410,Other,140% of NY Medicaid HMO DRG,105123,,DRG base rate x DRG weight + capital per discharge,105123,Other,225% of NY Medicaid HMO DRG,128483,,275% x Medicaid HMO amount,128483,Other,275% of NY Medicaid HMO DRG,151377,,324% x Medicaid HMO amount,151377,Other,324% of NY Medicaid HMO DRG,100451,,215% x Medicaid HMO amount,100451,Other,215% of NY Medicaid HMO DRG,100451,,215% x Medicaid HMO amount,100451,Other,215% of NY Medicaid HMO DRG,58402,,125% x Medicaid HMO amount,58402,Other,125% of NY Medicaid HMO DRG,0.01,201261,
Neonate bwt 1500-2499g w major procedure,609-4,APR-DRG,,,,,,,,inpatient,,,3369237.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,189434,,186% x Medicaid HMO amount,189434,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,441155,,"27,634 x DRG Weight",441155,Other,DRG Base Rate x DRG Weight,374967,,"23,488 x DRG Weight",374967,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,101846.21,,DRG base rate x DRG weight + capital per discharge,101846.21,Other,100% of NY Medicaid HMO DRG,101846,,DRG base rate x DRG weight + capital per discharge,101846,Other,100% of NY Medicaid HMO DRG,101846,,DRG base rate x DRG weight + capital per discharge,101846,Other,100% of NY Medicaid HMO DRG,101846,,DRG base rate x DRG weight + capital per discharge,101846,Other,100% of NY Medicaid HMO DRG,229154,,225% x Medicaid HMO amount,229154,Other,225% of NY Medicaid HMO DRG,155825,,153% x Medicaid HMO amount,155825,Other,153% of NY Medicaid HMO DRG,229154,,225% x Medicaid HMO amount,229154,Other,225% of NY Medicaid HMO DRG,142585,,140% x Medicaid HMO amount,142585,Other,140% of NY Medicaid HMO DRG,229154,,DRG base rate x DRG weight + capital per discharge,229154,Other,225% of NY Medicaid HMO DRG,280077,,275% x Medicaid HMO amount,280077,Other,275% of NY Medicaid HMO DRG,329982,,324% x Medicaid HMO amount,329982,Other,324% of NY Medicaid HMO DRG,218969,,215% x Medicaid HMO amount,218969,Other,215% of NY Medicaid HMO DRG,218969,,215% x Medicaid HMO amount,218969,Other,215% of NY Medicaid HMO DRG,127308,,125% x Medicaid HMO amount,127308,Other,125% of NY Medicaid HMO DRG,0.01,441155,
Neonate birthwt 1500-1999g w major anomaly,611-1,APR-DRG,,,,,,,,inpatient,,,279695.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30467,,186% x Medicaid HMO amount,30467,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69223,,"27,634 x DRG Weight",69223,Other,DRG Base Rate x DRG Weight,58837,,"23,488 x DRG Weight",58837,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16380.21,,DRG base rate x DRG weight + capital per discharge,16380.21,Other,100% of NY Medicaid HMO DRG,16380,,DRG base rate x DRG weight + capital per discharge,16380,Other,100% of NY Medicaid HMO DRG,16380,,DRG base rate x DRG weight + capital per discharge,16380,Other,100% of NY Medicaid HMO DRG,16380,,DRG base rate x DRG weight + capital per discharge,16380,Other,100% of NY Medicaid HMO DRG,36855,,225% x Medicaid HMO amount,36855,Other,225% of NY Medicaid HMO DRG,25062,,153% x Medicaid HMO amount,25062,Other,153% of NY Medicaid HMO DRG,36855,,225% x Medicaid HMO amount,36855,Other,225% of NY Medicaid HMO DRG,22932,,140% x Medicaid HMO amount,22932,Other,140% of NY Medicaid HMO DRG,36855,,DRG base rate x DRG weight + capital per discharge,36855,Other,225% of NY Medicaid HMO DRG,45046,,275% x Medicaid HMO amount,45046,Other,275% of NY Medicaid HMO DRG,53072,,324% x Medicaid HMO amount,53072,Other,324% of NY Medicaid HMO DRG,35217,,215% x Medicaid HMO amount,35217,Other,215% of NY Medicaid HMO DRG,35217,,215% x Medicaid HMO amount,35217,Other,215% of NY Medicaid HMO DRG,20475,,125% x Medicaid HMO amount,20475,Other,125% of NY Medicaid HMO DRG,0.01,69223,
Neonate birthwt 1500-1999g w major anomaly,611-2,APR-DRG,,,,,,,,inpatient,,,172652.22,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48537,,186% x Medicaid HMO amount,48537,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,111500,,"27,634 x DRG Weight",111500,Other,DRG Base Rate x DRG Weight,94772,,"23,488 x DRG Weight",94772,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26095.21,,DRG base rate x DRG weight + capital per discharge,26095.21,Other,100% of NY Medicaid HMO DRG,26095,,DRG base rate x DRG weight + capital per discharge,26095,Other,100% of NY Medicaid HMO DRG,26095,,DRG base rate x DRG weight + capital per discharge,26095,Other,100% of NY Medicaid HMO DRG,26095,,DRG base rate x DRG weight + capital per discharge,26095,Other,100% of NY Medicaid HMO DRG,58714,,225% x Medicaid HMO amount,58714,Other,225% of NY Medicaid HMO DRG,39926,,153% x Medicaid HMO amount,39926,Other,153% of NY Medicaid HMO DRG,58714,,225% x Medicaid HMO amount,58714,Other,225% of NY Medicaid HMO DRG,36533,,140% x Medicaid HMO amount,36533,Other,140% of NY Medicaid HMO DRG,58714,,DRG base rate x DRG weight + capital per discharge,58714,Other,225% of NY Medicaid HMO DRG,71762,,275% x Medicaid HMO amount,71762,Other,275% of NY Medicaid HMO DRG,84548,,324% x Medicaid HMO amount,84548,Other,324% of NY Medicaid HMO DRG,56105,,215% x Medicaid HMO amount,56105,Other,215% of NY Medicaid HMO DRG,56105,,215% x Medicaid HMO amount,56105,Other,215% of NY Medicaid HMO DRG,32619,,125% x Medicaid HMO amount,32619,Other,125% of NY Medicaid HMO DRG,0.01,111500,
Neonate birthwt 1500-1999g w major anomaly,611-3,APR-DRG,,,,,,,,inpatient,,,1210512.11,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74885,,186% x Medicaid HMO amount,74885,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,173149,,"27,634 x DRG Weight",173149,Other,DRG Base Rate x DRG Weight,147171,,"23,488 x DRG Weight",147171,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40261.21,,DRG base rate x DRG weight + capital per discharge,40261.21,Other,100% of NY Medicaid HMO DRG,40261,,DRG base rate x DRG weight + capital per discharge,40261,Other,100% of NY Medicaid HMO DRG,40261,,DRG base rate x DRG weight + capital per discharge,40261,Other,100% of NY Medicaid HMO DRG,40261,,DRG base rate x DRG weight + capital per discharge,40261,Other,100% of NY Medicaid HMO DRG,90588,,225% x Medicaid HMO amount,90588,Other,225% of NY Medicaid HMO DRG,61600,,153% x Medicaid HMO amount,61600,Other,153% of NY Medicaid HMO DRG,90588,,225% x Medicaid HMO amount,90588,Other,225% of NY Medicaid HMO DRG,56366,,140% x Medicaid HMO amount,56366,Other,140% of NY Medicaid HMO DRG,90588,,DRG base rate x DRG weight + capital per discharge,90588,Other,225% of NY Medicaid HMO DRG,110718,,275% x Medicaid HMO amount,110718,Other,275% of NY Medicaid HMO DRG,130446,,324% x Medicaid HMO amount,130446,Other,324% of NY Medicaid HMO DRG,86562,,215% x Medicaid HMO amount,86562,Other,215% of NY Medicaid HMO DRG,86562,,215% x Medicaid HMO amount,86562,Other,215% of NY Medicaid HMO DRG,50327,,125% x Medicaid HMO amount,50327,Other,125% of NY Medicaid HMO DRG,0.01,173149,
Neonate birthwt 1500-1999g w major anomaly,611-4,APR-DRG,,,,,,,,inpatient,,,337029.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,97892,,186% x Medicaid HMO amount,97892,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,226977,,"27,634 x DRG Weight",226977,Other,DRG Base Rate x DRG Weight,192923,,"23,488 x DRG Weight",192923,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,52630.21,,DRG base rate x DRG weight + capital per discharge,52630.21,Other,100% of NY Medicaid HMO DRG,52630,,DRG base rate x DRG weight + capital per discharge,52630,Other,100% of NY Medicaid HMO DRG,52630,,DRG base rate x DRG weight + capital per discharge,52630,Other,100% of NY Medicaid HMO DRG,52630,,DRG base rate x DRG weight + capital per discharge,52630,Other,100% of NY Medicaid HMO DRG,118418,,225% x Medicaid HMO amount,118418,Other,225% of NY Medicaid HMO DRG,80524,,153% x Medicaid HMO amount,80524,Other,153% of NY Medicaid HMO DRG,118418,,225% x Medicaid HMO amount,118418,Other,225% of NY Medicaid HMO DRG,73682,,140% x Medicaid HMO amount,73682,Other,140% of NY Medicaid HMO DRG,118418,,DRG base rate x DRG weight + capital per discharge,118418,Other,225% of NY Medicaid HMO DRG,144733,,275% x Medicaid HMO amount,144733,Other,275% of NY Medicaid HMO DRG,170522,,324% x Medicaid HMO amount,170522,Other,324% of NY Medicaid HMO DRG,113155,,215% x Medicaid HMO amount,113155,Other,215% of NY Medicaid HMO DRG,113155,,215% x Medicaid HMO amount,113155,Other,215% of NY Medicaid HMO DRG,65788,,125% x Medicaid HMO amount,65788,Other,125% of NY Medicaid HMO DRG,0.01,226977,
Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond,612-1,APR-DRG,,,,,,,,inpatient,,,529544,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42432,,186% x Medicaid HMO amount,42432,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,97222,,"27,634 x DRG Weight",97222,Other,DRG Base Rate x DRG Weight,82635,,"23,488 x DRG Weight",82635,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22813.21,,DRG base rate x DRG weight + capital per discharge,22813.21,Other,100% of NY Medicaid HMO DRG,22813,,DRG base rate x DRG weight + capital per discharge,22813,Other,100% of NY Medicaid HMO DRG,22813,,DRG base rate x DRG weight + capital per discharge,22813,Other,100% of NY Medicaid HMO DRG,22813,,DRG base rate x DRG weight + capital per discharge,22813,Other,100% of NY Medicaid HMO DRG,51330,,225% x Medicaid HMO amount,51330,Other,225% of NY Medicaid HMO DRG,34904,,153% x Medicaid HMO amount,34904,Other,153% of NY Medicaid HMO DRG,51330,,225% x Medicaid HMO amount,51330,Other,225% of NY Medicaid HMO DRG,31938,,140% x Medicaid HMO amount,31938,Other,140% of NY Medicaid HMO DRG,51330,,DRG base rate x DRG weight + capital per discharge,51330,Other,225% of NY Medicaid HMO DRG,62736,,275% x Medicaid HMO amount,62736,Other,275% of NY Medicaid HMO DRG,73915,,324% x Medicaid HMO amount,73915,Other,324% of NY Medicaid HMO DRG,49048,,215% x Medicaid HMO amount,49048,Other,215% of NY Medicaid HMO DRG,49048,,215% x Medicaid HMO amount,49048,Other,215% of NY Medicaid HMO DRG,28517,,125% x Medicaid HMO amount,28517,Other,125% of NY Medicaid HMO DRG,0.01,97222,
Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond,612-2,APR-DRG,,,,,,,,inpatient,,,1012716.45,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54621,,186% x Medicaid HMO amount,54621,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,125737,,"27,634 x DRG Weight",125737,Other,DRG Base Rate x DRG Weight,106873,,"23,488 x DRG Weight",106873,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29366.21,,DRG base rate x DRG weight + capital per discharge,29366.21,Other,100% of NY Medicaid HMO DRG,29366,,DRG base rate x DRG weight + capital per discharge,29366,Other,100% of NY Medicaid HMO DRG,29366,,DRG base rate x DRG weight + capital per discharge,29366,Other,100% of NY Medicaid HMO DRG,29366,,DRG base rate x DRG weight + capital per discharge,29366,Other,100% of NY Medicaid HMO DRG,66074,,225% x Medicaid HMO amount,66074,Other,225% of NY Medicaid HMO DRG,44930,,153% x Medicaid HMO amount,44930,Other,153% of NY Medicaid HMO DRG,66074,,225% x Medicaid HMO amount,66074,Other,225% of NY Medicaid HMO DRG,41113,,140% x Medicaid HMO amount,41113,Other,140% of NY Medicaid HMO DRG,66074,,DRG base rate x DRG weight + capital per discharge,66074,Other,225% of NY Medicaid HMO DRG,80757,,275% x Medicaid HMO amount,80757,Other,275% of NY Medicaid HMO DRG,95147,,324% x Medicaid HMO amount,95147,Other,324% of NY Medicaid HMO DRG,63137,,215% x Medicaid HMO amount,63137,Other,215% of NY Medicaid HMO DRG,63137,,215% x Medicaid HMO amount,63137,Other,215% of NY Medicaid HMO DRG,36708,,125% x Medicaid HMO amount,36708,Other,125% of NY Medicaid HMO DRG,0.01,125737,
Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond,612-3,APR-DRG,,,,,,,,inpatient,,,1436069.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75797,,186% x Medicaid HMO amount,75797,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,175282,,"27,634 x DRG Weight",175282,Other,DRG Base Rate x DRG Weight,148984,,"23,488 x DRG Weight",148984,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40751.21,,DRG base rate x DRG weight + capital per discharge,40751.21,Other,100% of NY Medicaid HMO DRG,40751,,DRG base rate x DRG weight + capital per discharge,40751,Other,100% of NY Medicaid HMO DRG,40751,,DRG base rate x DRG weight + capital per discharge,40751,Other,100% of NY Medicaid HMO DRG,40751,,DRG base rate x DRG weight + capital per discharge,40751,Other,100% of NY Medicaid HMO DRG,91690,,225% x Medicaid HMO amount,91690,Other,225% of NY Medicaid HMO DRG,62349,,153% x Medicaid HMO amount,62349,Other,153% of NY Medicaid HMO DRG,91690,,225% x Medicaid HMO amount,91690,Other,225% of NY Medicaid HMO DRG,57052,,140% x Medicaid HMO amount,57052,Other,140% of NY Medicaid HMO DRG,91690,,DRG base rate x DRG weight + capital per discharge,91690,Other,225% of NY Medicaid HMO DRG,112066,,275% x Medicaid HMO amount,112066,Other,275% of NY Medicaid HMO DRG,132034,,324% x Medicaid HMO amount,132034,Other,324% of NY Medicaid HMO DRG,87615,,215% x Medicaid HMO amount,87615,Other,215% of NY Medicaid HMO DRG,87615,,215% x Medicaid HMO amount,87615,Other,215% of NY Medicaid HMO DRG,50939,,125% x Medicaid HMO amount,50939,Other,125% of NY Medicaid HMO DRG,0.01,175282,
Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond,612-4,APR-DRG,,,,,,,,inpatient,,,1436069.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,100961,,186% x Medicaid HMO amount,100961,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,234159,,"27,634 x DRG Weight",234159,Other,DRG Base Rate x DRG Weight,199028,,"23,488 x DRG Weight",199028,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54280.21,,DRG base rate x DRG weight + capital per discharge,54280.21,Other,100% of NY Medicaid HMO DRG,54280,,DRG base rate x DRG weight + capital per discharge,54280,Other,100% of NY Medicaid HMO DRG,54280,,DRG base rate x DRG weight + capital per discharge,54280,Other,100% of NY Medicaid HMO DRG,54280,,DRG base rate x DRG weight + capital per discharge,54280,Other,100% of NY Medicaid HMO DRG,122130,,225% x Medicaid HMO amount,122130,Other,225% of NY Medicaid HMO DRG,83049,,153% x Medicaid HMO amount,83049,Other,153% of NY Medicaid HMO DRG,122130,,225% x Medicaid HMO amount,122130,Other,225% of NY Medicaid HMO DRG,75992,,140% x Medicaid HMO amount,75992,Other,140% of NY Medicaid HMO DRG,122130,,DRG base rate x DRG weight + capital per discharge,122130,Other,225% of NY Medicaid HMO DRG,149271,,275% x Medicaid HMO amount,149271,Other,275% of NY Medicaid HMO DRG,175868,,324% x Medicaid HMO amount,175868,Other,324% of NY Medicaid HMO DRG,116702,,215% x Medicaid HMO amount,116702,Other,215% of NY Medicaid HMO DRG,116702,,215% x Medicaid HMO amount,116702,Other,215% of NY Medicaid HMO DRG,67850,,125% x Medicaid HMO amount,67850,Other,125% of NY Medicaid HMO DRG,0.01,234159,
Neonate birthwt 1500-1999g w congenital/perinatal infection,613-1,APR-DRG,,,,,,,,inpatient,,,362914,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32345,,186% x Medicaid HMO amount,32345,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73620,,"27,634 x DRG Weight",73620,Other,DRG Base Rate x DRG Weight,62574,,"23,488 x DRG Weight",62574,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17390.21,,DRG base rate x DRG weight + capital per discharge,17390.21,Other,100% of NY Medicaid HMO DRG,17390,,DRG base rate x DRG weight + capital per discharge,17390,Other,100% of NY Medicaid HMO DRG,17390,,DRG base rate x DRG weight + capital per discharge,17390,Other,100% of NY Medicaid HMO DRG,17390,,DRG base rate x DRG weight + capital per discharge,17390,Other,100% of NY Medicaid HMO DRG,39128,,225% x Medicaid HMO amount,39128,Other,225% of NY Medicaid HMO DRG,26607,,153% x Medicaid HMO amount,26607,Other,153% of NY Medicaid HMO DRG,39128,,225% x Medicaid HMO amount,39128,Other,225% of NY Medicaid HMO DRG,24346,,140% x Medicaid HMO amount,24346,Other,140% of NY Medicaid HMO DRG,39128,,DRG base rate x DRG weight + capital per discharge,39128,Other,225% of NY Medicaid HMO DRG,47823,,275% x Medicaid HMO amount,47823,Other,275% of NY Medicaid HMO DRG,56344,,324% x Medicaid HMO amount,56344,Other,324% of NY Medicaid HMO DRG,37389,,215% x Medicaid HMO amount,37389,Other,215% of NY Medicaid HMO DRG,37389,,215% x Medicaid HMO amount,37389,Other,215% of NY Medicaid HMO DRG,21738,,125% x Medicaid HMO amount,21738,Other,125% of NY Medicaid HMO DRG,0.01,73620,
Neonate birthwt 1500-1999g w congenital/perinatal infection,613-2,APR-DRG,,,,,,,,inpatient,,,1361680,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48449,,186% x Medicaid HMO amount,48449,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,111299,,"27,634 x DRG Weight",111299,Other,DRG Base Rate x DRG Weight,94600,,"23,488 x DRG Weight",94600,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26048.21,,DRG base rate x DRG weight + capital per discharge,26048.21,Other,100% of NY Medicaid HMO DRG,26048,,DRG base rate x DRG weight + capital per discharge,26048,Other,100% of NY Medicaid HMO DRG,26048,,DRG base rate x DRG weight + capital per discharge,26048,Other,100% of NY Medicaid HMO DRG,26048,,DRG base rate x DRG weight + capital per discharge,26048,Other,100% of NY Medicaid HMO DRG,58608,,225% x Medicaid HMO amount,58608,Other,225% of NY Medicaid HMO DRG,39854,,153% x Medicaid HMO amount,39854,Other,153% of NY Medicaid HMO DRG,58608,,225% x Medicaid HMO amount,58608,Other,225% of NY Medicaid HMO DRG,36467,,140% x Medicaid HMO amount,36467,Other,140% of NY Medicaid HMO DRG,58608,,DRG base rate x DRG weight + capital per discharge,58608,Other,225% of NY Medicaid HMO DRG,71633,,275% x Medicaid HMO amount,71633,Other,275% of NY Medicaid HMO DRG,84396,,324% x Medicaid HMO amount,84396,Other,324% of NY Medicaid HMO DRG,56004,,215% x Medicaid HMO amount,56004,Other,215% of NY Medicaid HMO DRG,56004,,215% x Medicaid HMO amount,56004,Other,215% of NY Medicaid HMO DRG,32560,,125% x Medicaid HMO amount,32560,Other,125% of NY Medicaid HMO DRG,0.01,111299,
Neonate birthwt 1500-1999g w congenital/perinatal infection,613-3,APR-DRG,,,,,,,,inpatient,,,814185.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60498,,186% x Medicaid HMO amount,60498,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,139488,,"27,634 x DRG Weight",139488,Other,DRG Base Rate x DRG Weight,118560,,"23,488 x DRG Weight",118560,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32526.21,,DRG base rate x DRG weight + capital per discharge,32526.21,Other,100% of NY Medicaid HMO DRG,32526,,DRG base rate x DRG weight + capital per discharge,32526,Other,100% of NY Medicaid HMO DRG,32526,,DRG base rate x DRG weight + capital per discharge,32526,Other,100% of NY Medicaid HMO DRG,32526,,DRG base rate x DRG weight + capital per discharge,32526,Other,100% of NY Medicaid HMO DRG,73184,,225% x Medicaid HMO amount,73184,Other,225% of NY Medicaid HMO DRG,49765,,153% x Medicaid HMO amount,49765,Other,153% of NY Medicaid HMO DRG,73184,,225% x Medicaid HMO amount,73184,Other,225% of NY Medicaid HMO DRG,45537,,140% x Medicaid HMO amount,45537,Other,140% of NY Medicaid HMO DRG,73184,,DRG base rate x DRG weight + capital per discharge,73184,Other,225% of NY Medicaid HMO DRG,89447,,275% x Medicaid HMO amount,89447,Other,275% of NY Medicaid HMO DRG,105385,,324% x Medicaid HMO amount,105385,Other,324% of NY Medicaid HMO DRG,69931,,215% x Medicaid HMO amount,69931,Other,215% of NY Medicaid HMO DRG,69931,,215% x Medicaid HMO amount,69931,Other,215% of NY Medicaid HMO DRG,40658,,125% x Medicaid HMO amount,40658,Other,125% of NY Medicaid HMO DRG,0.01,139488,
Neonate birthwt 1500-1999g w congenital/perinatal infection,613-4,APR-DRG,,,,,,,,inpatient,,,752150,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62038,,186% x Medicaid HMO amount,62038,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,143092,,"27,634 x DRG Weight",143092,Other,DRG Base Rate x DRG Weight,121623,,"23,488 x DRG Weight",121623,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33354.21,,DRG base rate x DRG weight + capital per discharge,33354.21,Other,100% of NY Medicaid HMO DRG,33354,,DRG base rate x DRG weight + capital per discharge,33354,Other,100% of NY Medicaid HMO DRG,33354,,DRG base rate x DRG weight + capital per discharge,33354,Other,100% of NY Medicaid HMO DRG,33354,,DRG base rate x DRG weight + capital per discharge,33354,Other,100% of NY Medicaid HMO DRG,75047,,225% x Medicaid HMO amount,75047,Other,225% of NY Medicaid HMO DRG,51032,,153% x Medicaid HMO amount,51032,Other,153% of NY Medicaid HMO DRG,75047,,225% x Medicaid HMO amount,75047,Other,225% of NY Medicaid HMO DRG,46696,,140% x Medicaid HMO amount,46696,Other,140% of NY Medicaid HMO DRG,75047,,DRG base rate x DRG weight + capital per discharge,75047,Other,225% of NY Medicaid HMO DRG,91724,,275% x Medicaid HMO amount,91724,Other,275% of NY Medicaid HMO DRG,108068,,324% x Medicaid HMO amount,108068,Other,324% of NY Medicaid HMO DRG,71712,,215% x Medicaid HMO amount,71712,Other,215% of NY Medicaid HMO DRG,71712,,215% x Medicaid HMO amount,71712,Other,215% of NY Medicaid HMO DRG,41693,,125% x Medicaid HMO amount,41693,Other,125% of NY Medicaid HMO DRG,0.01,143092,
Neonate bwt 1500-1999g w or w/o other significant condition,614-1,APR-DRG,,,,,,,,inpatient,,,236221,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24439,,186% x Medicaid HMO amount,24439,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,55119,,"27,634 x DRG Weight",55119,Other,DRG Base Rate x DRG Weight,46849,,"23,488 x DRG Weight",46849,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13139.21,,DRG base rate x DRG weight + capital per discharge,13139.21,Other,100% of NY Medicaid HMO DRG,13139,,DRG base rate x DRG weight + capital per discharge,13139,Other,100% of NY Medicaid HMO DRG,13139,,DRG base rate x DRG weight + capital per discharge,13139,Other,100% of NY Medicaid HMO DRG,13139,,DRG base rate x DRG weight + capital per discharge,13139,Other,100% of NY Medicaid HMO DRG,29563,,225% x Medicaid HMO amount,29563,Other,225% of NY Medicaid HMO DRG,20103,,153% x Medicaid HMO amount,20103,Other,153% of NY Medicaid HMO DRG,29563,,225% x Medicaid HMO amount,29563,Other,225% of NY Medicaid HMO DRG,18395,,140% x Medicaid HMO amount,18395,Other,140% of NY Medicaid HMO DRG,29563,,DRG base rate x DRG weight + capital per discharge,29563,Other,225% of NY Medicaid HMO DRG,36133,,275% x Medicaid HMO amount,36133,Other,275% of NY Medicaid HMO DRG,42571,,324% x Medicaid HMO amount,42571,Other,324% of NY Medicaid HMO DRG,28249,,215% x Medicaid HMO amount,28249,Other,215% of NY Medicaid HMO DRG,28249,,215% x Medicaid HMO amount,28249,Other,215% of NY Medicaid HMO DRG,16424,,125% x Medicaid HMO amount,16424,Other,125% of NY Medicaid HMO DRG,0.01,55119,
Neonate bwt 1500-1999g w or w/o other significant condition,614-2,APR-DRG,,,,,,,,inpatient,,,643544.69,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39836,,186% x Medicaid HMO amount,39836,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,91145,,"27,634 x DRG Weight",91145,Other,DRG Base Rate x DRG Weight,77470,,"23,488 x DRG Weight",77470,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21417.21,,DRG base rate x DRG weight + capital per discharge,21417.21,Other,100% of NY Medicaid HMO DRG,21417,,DRG base rate x DRG weight + capital per discharge,21417,Other,100% of NY Medicaid HMO DRG,21417,,DRG base rate x DRG weight + capital per discharge,21417,Other,100% of NY Medicaid HMO DRG,21417,,DRG base rate x DRG weight + capital per discharge,21417,Other,100% of NY Medicaid HMO DRG,48189,,225% x Medicaid HMO amount,48189,Other,225% of NY Medicaid HMO DRG,32768,,153% x Medicaid HMO amount,32768,Other,153% of NY Medicaid HMO DRG,48189,,225% x Medicaid HMO amount,48189,Other,225% of NY Medicaid HMO DRG,29984,,140% x Medicaid HMO amount,29984,Other,140% of NY Medicaid HMO DRG,48189,,DRG base rate x DRG weight + capital per discharge,48189,Other,225% of NY Medicaid HMO DRG,58897,,275% x Medicaid HMO amount,58897,Other,275% of NY Medicaid HMO DRG,69392,,324% x Medicaid HMO amount,69392,Other,324% of NY Medicaid HMO DRG,46047,,215% x Medicaid HMO amount,46047,Other,215% of NY Medicaid HMO DRG,46047,,215% x Medicaid HMO amount,46047,Other,215% of NY Medicaid HMO DRG,26772,,125% x Medicaid HMO amount,26772,Other,125% of NY Medicaid HMO DRG,0.01,91145,
Neonate bwt 1500-1999g w or w/o other significant condition,614-3,APR-DRG,,,,,,,,inpatient,,,1187147,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60361,,186% x Medicaid HMO amount,60361,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,139168,,"27,634 x DRG Weight",139168,Other,DRG Base Rate x DRG Weight,118288,,"23,488 x DRG Weight",118288,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32452.21,,DRG base rate x DRG weight + capital per discharge,32452.21,Other,100% of NY Medicaid HMO DRG,32452,,DRG base rate x DRG weight + capital per discharge,32452,Other,100% of NY Medicaid HMO DRG,32452,,DRG base rate x DRG weight + capital per discharge,32452,Other,100% of NY Medicaid HMO DRG,32452,,DRG base rate x DRG weight + capital per discharge,32452,Other,100% of NY Medicaid HMO DRG,73017,,225% x Medicaid HMO amount,73017,Other,225% of NY Medicaid HMO DRG,49652,,153% x Medicaid HMO amount,49652,Other,153% of NY Medicaid HMO DRG,73017,,225% x Medicaid HMO amount,73017,Other,225% of NY Medicaid HMO DRG,45433,,140% x Medicaid HMO amount,45433,Other,140% of NY Medicaid HMO DRG,73017,,DRG base rate x DRG weight + capital per discharge,73017,Other,225% of NY Medicaid HMO DRG,89244,,275% x Medicaid HMO amount,89244,Other,275% of NY Medicaid HMO DRG,105145,,324% x Medicaid HMO amount,105145,Other,324% of NY Medicaid HMO DRG,69772,,215% x Medicaid HMO amount,69772,Other,215% of NY Medicaid HMO DRG,69772,,215% x Medicaid HMO amount,69772,Other,215% of NY Medicaid HMO DRG,40565,,125% x Medicaid HMO amount,40565,Other,125% of NY Medicaid HMO DRG,0.01,139168,
Neonate bwt 1500-1999g w or w/o other significant condition,614-4,APR-DRG,,,,,,,,inpatient,,,31433,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60361,,186% x Medicaid HMO amount,60361,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,139168,,"27,634 x DRG Weight",139168,Other,DRG Base Rate x DRG Weight,118288,,"23,488 x DRG Weight",118288,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32452.21,,DRG base rate x DRG weight + capital per discharge,32452.21,Other,100% of NY Medicaid HMO DRG,32452,,DRG base rate x DRG weight + capital per discharge,32452,Other,100% of NY Medicaid HMO DRG,32452,,DRG base rate x DRG weight + capital per discharge,32452,Other,100% of NY Medicaid HMO DRG,32452,,DRG base rate x DRG weight + capital per discharge,32452,Other,100% of NY Medicaid HMO DRG,73017,,225% x Medicaid HMO amount,73017,Other,225% of NY Medicaid HMO DRG,49652,,153% x Medicaid HMO amount,49652,Other,153% of NY Medicaid HMO DRG,73017,,225% x Medicaid HMO amount,73017,Other,225% of NY Medicaid HMO DRG,45433,,140% x Medicaid HMO amount,45433,Other,140% of NY Medicaid HMO DRG,73017,,DRG base rate x DRG weight + capital per discharge,73017,Other,225% of NY Medicaid HMO DRG,89244,,275% x Medicaid HMO amount,89244,Other,275% of NY Medicaid HMO DRG,105145,,324% x Medicaid HMO amount,105145,Other,324% of NY Medicaid HMO DRG,69772,,215% x Medicaid HMO amount,69772,Other,215% of NY Medicaid HMO DRG,69772,,215% x Medicaid HMO amount,69772,Other,215% of NY Medicaid HMO DRG,40565,,125% x Medicaid HMO amount,40565,Other,125% of NY Medicaid HMO DRG,0.01,139168,
Neonate bwt 2000-2499g w major anomaly,621-1,APR-DRG,,,,,,,,inpatient,,,109375.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11601,,186% x Medicaid HMO amount,11601,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25083,,"27,634 x DRG Weight",25083,Other,DRG Base Rate x DRG Weight,21320,,"23,488 x DRG Weight",21320,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6237.21,,DRG base rate x DRG weight + capital per discharge,6237.21,Other,100% of NY Medicaid HMO DRG,6237,,DRG base rate x DRG weight + capital per discharge,6237,Other,100% of NY Medicaid HMO DRG,6237,,DRG base rate x DRG weight + capital per discharge,6237,Other,100% of NY Medicaid HMO DRG,6237,,DRG base rate x DRG weight + capital per discharge,6237,Other,100% of NY Medicaid HMO DRG,14034,,225% x Medicaid HMO amount,14034,Other,225% of NY Medicaid HMO DRG,9543,,153% x Medicaid HMO amount,9543,Other,153% of NY Medicaid HMO DRG,14034,,225% x Medicaid HMO amount,14034,Other,225% of NY Medicaid HMO DRG,8732,,140% x Medicaid HMO amount,8732,Other,140% of NY Medicaid HMO DRG,14034,,DRG base rate x DRG weight + capital per discharge,14034,Other,225% of NY Medicaid HMO DRG,17152,,275% x Medicaid HMO amount,17152,Other,275% of NY Medicaid HMO DRG,20209,,324% x Medicaid HMO amount,20209,Other,324% of NY Medicaid HMO DRG,13410,,215% x Medicaid HMO amount,13410,Other,215% of NY Medicaid HMO DRG,13410,,215% x Medicaid HMO amount,13410,Other,215% of NY Medicaid HMO DRG,7797,,125% x Medicaid HMO amount,7797,Other,125% of NY Medicaid HMO DRG,0.01,25083,
Neonate bwt 2000-2499g w major anomaly,621-2,APR-DRG,,,,,,,,inpatient,,,575261.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25612,,186% x Medicaid HMO amount,25612,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57866,,"27,634 x DRG Weight",57866,Other,DRG Base Rate x DRG Weight,49184,,"23,488 x DRG Weight",49184,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13770.21,,DRG base rate x DRG weight + capital per discharge,13770.21,Other,100% of NY Medicaid HMO DRG,13770,,DRG base rate x DRG weight + capital per discharge,13770,Other,100% of NY Medicaid HMO DRG,13770,,DRG base rate x DRG weight + capital per discharge,13770,Other,100% of NY Medicaid HMO DRG,13770,,DRG base rate x DRG weight + capital per discharge,13770,Other,100% of NY Medicaid HMO DRG,30983,,225% x Medicaid HMO amount,30983,Other,225% of NY Medicaid HMO DRG,21068,,153% x Medicaid HMO amount,21068,Other,153% of NY Medicaid HMO DRG,30983,,225% x Medicaid HMO amount,30983,Other,225% of NY Medicaid HMO DRG,19278,,140% x Medicaid HMO amount,19278,Other,140% of NY Medicaid HMO DRG,30983,,DRG base rate x DRG weight + capital per discharge,30983,Other,225% of NY Medicaid HMO DRG,37868,,275% x Medicaid HMO amount,37868,Other,275% of NY Medicaid HMO DRG,44615,,324% x Medicaid HMO amount,44615,Other,324% of NY Medicaid HMO DRG,29606,,215% x Medicaid HMO amount,29606,Other,215% of NY Medicaid HMO DRG,29606,,215% x Medicaid HMO amount,29606,Other,215% of NY Medicaid HMO DRG,17213,,125% x Medicaid HMO amount,17213,Other,125% of NY Medicaid HMO DRG,0.01,57866,
Neonate bwt 2000-2499g w major anomaly,621-3,APR-DRG,,,,,,,,inpatient,,,814185.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47867,,186% x Medicaid HMO amount,47867,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,109936,,"27,634 x DRG Weight",109936,Other,DRG Base Rate x DRG Weight,93442,,"23,488 x DRG Weight",93442,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25735.21,,DRG base rate x DRG weight + capital per discharge,25735.21,Other,100% of NY Medicaid HMO DRG,25735,,DRG base rate x DRG weight + capital per discharge,25735,Other,100% of NY Medicaid HMO DRG,25735,,DRG base rate x DRG weight + capital per discharge,25735,Other,100% of NY Medicaid HMO DRG,25735,,DRG base rate x DRG weight + capital per discharge,25735,Other,100% of NY Medicaid HMO DRG,57904,,225% x Medicaid HMO amount,57904,Other,225% of NY Medicaid HMO DRG,39375,,153% x Medicaid HMO amount,39375,Other,153% of NY Medicaid HMO DRG,57904,,225% x Medicaid HMO amount,57904,Other,225% of NY Medicaid HMO DRG,36029,,140% x Medicaid HMO amount,36029,Other,140% of NY Medicaid HMO DRG,57904,,DRG base rate x DRG weight + capital per discharge,57904,Other,225% of NY Medicaid HMO DRG,70772,,275% x Medicaid HMO amount,70772,Other,275% of NY Medicaid HMO DRG,83382,,324% x Medicaid HMO amount,83382,Other,324% of NY Medicaid HMO DRG,55331,,215% x Medicaid HMO amount,55331,Other,215% of NY Medicaid HMO DRG,55331,,215% x Medicaid HMO amount,55331,Other,215% of NY Medicaid HMO DRG,32169,,125% x Medicaid HMO amount,32169,Other,125% of NY Medicaid HMO DRG,0.01,109936,
Neonate bwt 2000-2499g w major anomaly,621-4,APR-DRG,,,,,,,,inpatient,,,752150,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,81102,,186% x Medicaid HMO amount,81102,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,187693,,"27,634 x DRG Weight",187693,Other,DRG Base Rate x DRG Weight,159533,,"23,488 x DRG Weight",159533,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43603.21,,DRG base rate x DRG weight + capital per discharge,43603.21,Other,100% of NY Medicaid HMO DRG,43603,,DRG base rate x DRG weight + capital per discharge,43603,Other,100% of NY Medicaid HMO DRG,43603,,DRG base rate x DRG weight + capital per discharge,43603,Other,100% of NY Medicaid HMO DRG,43603,,DRG base rate x DRG weight + capital per discharge,43603,Other,100% of NY Medicaid HMO DRG,98107,,225% x Medicaid HMO amount,98107,Other,225% of NY Medicaid HMO DRG,66713,,153% x Medicaid HMO amount,66713,Other,153% of NY Medicaid HMO DRG,98107,,225% x Medicaid HMO amount,98107,Other,225% of NY Medicaid HMO DRG,61044,,140% x Medicaid HMO amount,61044,Other,140% of NY Medicaid HMO DRG,98107,,DRG base rate x DRG weight + capital per discharge,98107,Other,225% of NY Medicaid HMO DRG,119909,,275% x Medicaid HMO amount,119909,Other,275% of NY Medicaid HMO DRG,141274,,324% x Medicaid HMO amount,141274,Other,324% of NY Medicaid HMO DRG,93747,,215% x Medicaid HMO amount,93747,Other,215% of NY Medicaid HMO DRG,93747,,215% x Medicaid HMO amount,93747,Other,215% of NY Medicaid HMO DRG,54504,,125% x Medicaid HMO amount,54504,Other,125% of NY Medicaid HMO DRG,0.01,187693,
Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond,622-1,APR-DRG,,,,,,,,inpatient,,,307909.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23762,,186% x Medicaid HMO amount,23762,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53535,,"27,634 x DRG Weight",53535,Other,DRG Base Rate x DRG Weight,45503,,"23,488 x DRG Weight",45503,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12775.21,,DRG base rate x DRG weight + capital per discharge,12775.21,Other,100% of NY Medicaid HMO DRG,12775,,DRG base rate x DRG weight + capital per discharge,12775,Other,100% of NY Medicaid HMO DRG,12775,,DRG base rate x DRG weight + capital per discharge,12775,Other,100% of NY Medicaid HMO DRG,12775,,DRG base rate x DRG weight + capital per discharge,12775,Other,100% of NY Medicaid HMO DRG,28744,,225% x Medicaid HMO amount,28744,Other,225% of NY Medicaid HMO DRG,19546,,153% x Medicaid HMO amount,19546,Other,153% of NY Medicaid HMO DRG,28744,,225% x Medicaid HMO amount,28744,Other,225% of NY Medicaid HMO DRG,17885,,140% x Medicaid HMO amount,17885,Other,140% of NY Medicaid HMO DRG,28744,,DRG base rate x DRG weight + capital per discharge,28744,Other,225% of NY Medicaid HMO DRG,35132,,275% x Medicaid HMO amount,35132,Other,275% of NY Medicaid HMO DRG,41392,,324% x Medicaid HMO amount,41392,Other,324% of NY Medicaid HMO DRG,27467,,215% x Medicaid HMO amount,27467,Other,215% of NY Medicaid HMO DRG,27467,,215% x Medicaid HMO amount,27467,Other,215% of NY Medicaid HMO DRG,15969,,125% x Medicaid HMO amount,15969,Other,125% of NY Medicaid HMO DRG,0.01,53535,
Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond,622-2,APR-DRG,,,,,,,,inpatient,,,519174,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31947,,186% x Medicaid HMO amount,31947,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72688,,"27,634 x DRG Weight",72688,Other,DRG Base Rate x DRG Weight,61783,,"23,488 x DRG Weight",61783,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17176.21,,DRG base rate x DRG weight + capital per discharge,17176.21,Other,100% of NY Medicaid HMO DRG,17176,,DRG base rate x DRG weight + capital per discharge,17176,Other,100% of NY Medicaid HMO DRG,17176,,DRG base rate x DRG weight + capital per discharge,17176,Other,100% of NY Medicaid HMO DRG,17176,,DRG base rate x DRG weight + capital per discharge,17176,Other,100% of NY Medicaid HMO DRG,38646,,225% x Medicaid HMO amount,38646,Other,225% of NY Medicaid HMO DRG,26280,,153% x Medicaid HMO amount,26280,Other,153% of NY Medicaid HMO DRG,38646,,225% x Medicaid HMO amount,38646,Other,225% of NY Medicaid HMO DRG,24047,,140% x Medicaid HMO amount,24047,Other,140% of NY Medicaid HMO DRG,38646,,DRG base rate x DRG weight + capital per discharge,38646,Other,225% of NY Medicaid HMO DRG,47235,,275% x Medicaid HMO amount,47235,Other,275% of NY Medicaid HMO DRG,55651,,324% x Medicaid HMO amount,55651,Other,324% of NY Medicaid HMO DRG,36929,,215% x Medicaid HMO amount,36929,Other,215% of NY Medicaid HMO DRG,36929,,215% x Medicaid HMO amount,36929,Other,215% of NY Medicaid HMO DRG,21470,,125% x Medicaid HMO amount,21470,Other,125% of NY Medicaid HMO DRG,0.01,72688,
Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond,622-3,APR-DRG,,,,,,,,inpatient,,,810939.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43468,,186% x Medicaid HMO amount,43468,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,99643,,"27,634 x DRG Weight",99643,Other,DRG Base Rate x DRG Weight,84693,,"23,488 x DRG Weight",84693,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23370.21,,DRG base rate x DRG weight + capital per discharge,23370.21,Other,100% of NY Medicaid HMO DRG,23370,,DRG base rate x DRG weight + capital per discharge,23370,Other,100% of NY Medicaid HMO DRG,23370,,DRG base rate x DRG weight + capital per discharge,23370,Other,100% of NY Medicaid HMO DRG,23370,,DRG base rate x DRG weight + capital per discharge,23370,Other,100% of NY Medicaid HMO DRG,52583,,225% x Medicaid HMO amount,52583,Other,225% of NY Medicaid HMO DRG,35756,,153% x Medicaid HMO amount,35756,Other,153% of NY Medicaid HMO DRG,52583,,225% x Medicaid HMO amount,52583,Other,225% of NY Medicaid HMO DRG,32718,,140% x Medicaid HMO amount,32718,Other,140% of NY Medicaid HMO DRG,52583,,DRG base rate x DRG weight + capital per discharge,52583,Other,225% of NY Medicaid HMO DRG,64268,,275% x Medicaid HMO amount,64268,Other,275% of NY Medicaid HMO DRG,75719,,324% x Medicaid HMO amount,75719,Other,324% of NY Medicaid HMO DRG,50246,,215% x Medicaid HMO amount,50246,Other,215% of NY Medicaid HMO DRG,50246,,215% x Medicaid HMO amount,50246,Other,215% of NY Medicaid HMO DRG,29213,,125% x Medicaid HMO amount,29213,Other,125% of NY Medicaid HMO DRG,0.01,99643,
Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond,622-4,APR-DRG,,,,,,,,inpatient,,,579822.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,61931,,186% x Medicaid HMO amount,61931,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,142840,,"27,634 x DRG Weight",142840,Other,DRG Base Rate x DRG Weight,121409,,"23,488 x DRG Weight",121409,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33296.21,,DRG base rate x DRG weight + capital per discharge,33296.21,Other,100% of NY Medicaid HMO DRG,33296,,DRG base rate x DRG weight + capital per discharge,33296,Other,100% of NY Medicaid HMO DRG,33296,,DRG base rate x DRG weight + capital per discharge,33296,Other,100% of NY Medicaid HMO DRG,33296,,DRG base rate x DRG weight + capital per discharge,33296,Other,100% of NY Medicaid HMO DRG,74916,,225% x Medicaid HMO amount,74916,Other,225% of NY Medicaid HMO DRG,50943,,153% x Medicaid HMO amount,50943,Other,153% of NY Medicaid HMO DRG,74916,,225% x Medicaid HMO amount,74916,Other,225% of NY Medicaid HMO DRG,46615,,140% x Medicaid HMO amount,46615,Other,140% of NY Medicaid HMO DRG,74916,,DRG base rate x DRG weight + capital per discharge,74916,Other,225% of NY Medicaid HMO DRG,91565,,275% x Medicaid HMO amount,91565,Other,275% of NY Medicaid HMO DRG,107880,,324% x Medicaid HMO amount,107880,Other,324% of NY Medicaid HMO DRG,71587,,215% x Medicaid HMO amount,71587,Other,215% of NY Medicaid HMO DRG,71587,,215% x Medicaid HMO amount,71587,Other,215% of NY Medicaid HMO DRG,41620,,125% x Medicaid HMO amount,41620,Other,125% of NY Medicaid HMO DRG,0.01,142840,
Neonate bwt 2000-2499g w congenital/perinatal infection,623-1,APR-DRG,,,,,,,,inpatient,,,316312.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18064,,186% x Medicaid HMO amount,18064,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40205,,"27,634 x DRG Weight",40205,Other,DRG Base Rate x DRG Weight,34173,,"23,488 x DRG Weight",34173,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9712.21,,DRG base rate x DRG weight + capital per discharge,9712.21,Other,100% of NY Medicaid HMO DRG,9712,,DRG base rate x DRG weight + capital per discharge,9712,Other,100% of NY Medicaid HMO DRG,9712,,DRG base rate x DRG weight + capital per discharge,9712,Other,100% of NY Medicaid HMO DRG,9712,,DRG base rate x DRG weight + capital per discharge,9712,Other,100% of NY Medicaid HMO DRG,21852,,225% x Medicaid HMO amount,21852,Other,225% of NY Medicaid HMO DRG,14860,,153% x Medicaid HMO amount,14860,Other,153% of NY Medicaid HMO DRG,21852,,225% x Medicaid HMO amount,21852,Other,225% of NY Medicaid HMO DRG,13597,,140% x Medicaid HMO amount,13597,Other,140% of NY Medicaid HMO DRG,21852,,DRG base rate x DRG weight + capital per discharge,21852,Other,225% of NY Medicaid HMO DRG,26709,,275% x Medicaid HMO amount,26709,Other,275% of NY Medicaid HMO DRG,31468,,324% x Medicaid HMO amount,31468,Other,324% of NY Medicaid HMO DRG,20881,,215% x Medicaid HMO amount,20881,Other,215% of NY Medicaid HMO DRG,20881,,215% x Medicaid HMO amount,20881,Other,215% of NY Medicaid HMO DRG,12140,,125% x Medicaid HMO amount,12140,Other,125% of NY Medicaid HMO DRG,0.01,40205,
Neonate bwt 2000-2499g w congenital/perinatal infection,623-2,APR-DRG,,,,,,,,inpatient,,,472011.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26369,,186% x Medicaid HMO amount,26369,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59640,,"27,634 x DRG Weight",59640,Other,DRG Base Rate x DRG Weight,50692,,"23,488 x DRG Weight",50692,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14177.21,,DRG base rate x DRG weight + capital per discharge,14177.21,Other,100% of NY Medicaid HMO DRG,14177,,DRG base rate x DRG weight + capital per discharge,14177,Other,100% of NY Medicaid HMO DRG,14177,,DRG base rate x DRG weight + capital per discharge,14177,Other,100% of NY Medicaid HMO DRG,14177,,DRG base rate x DRG weight + capital per discharge,14177,Other,100% of NY Medicaid HMO DRG,31899,,225% x Medicaid HMO amount,31899,Other,225% of NY Medicaid HMO DRG,21691,,153% x Medicaid HMO amount,21691,Other,153% of NY Medicaid HMO DRG,31899,,225% x Medicaid HMO amount,31899,Other,225% of NY Medicaid HMO DRG,19848,,140% x Medicaid HMO amount,19848,Other,140% of NY Medicaid HMO DRG,31899,,DRG base rate x DRG weight + capital per discharge,31899,Other,225% of NY Medicaid HMO DRG,38987,,275% x Medicaid HMO amount,38987,Other,275% of NY Medicaid HMO DRG,45934,,324% x Medicaid HMO amount,45934,Other,324% of NY Medicaid HMO DRG,30481,,215% x Medicaid HMO amount,30481,Other,215% of NY Medicaid HMO DRG,30481,,215% x Medicaid HMO amount,30481,Other,215% of NY Medicaid HMO DRG,17722,,125% x Medicaid HMO amount,17722,Other,125% of NY Medicaid HMO DRG,0.01,59640,
Neonate bwt 2000-2499g w congenital/perinatal infection,623-3,APR-DRG,,,,,,,,inpatient,,,549076,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37790,,186% x Medicaid HMO amount,37790,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86359,,"27,634 x DRG Weight",86359,Other,DRG Base Rate x DRG Weight,73402,,"23,488 x DRG Weight",73402,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20317.21,,DRG base rate x DRG weight + capital per discharge,20317.21,Other,100% of NY Medicaid HMO DRG,20317,,DRG base rate x DRG weight + capital per discharge,20317,Other,100% of NY Medicaid HMO DRG,20317,,DRG base rate x DRG weight + capital per discharge,20317,Other,100% of NY Medicaid HMO DRG,20317,,DRG base rate x DRG weight + capital per discharge,20317,Other,100% of NY Medicaid HMO DRG,45714,,225% x Medicaid HMO amount,45714,Other,225% of NY Medicaid HMO DRG,31085,,153% x Medicaid HMO amount,31085,Other,153% of NY Medicaid HMO DRG,45714,,225% x Medicaid HMO amount,45714,Other,225% of NY Medicaid HMO DRG,28444,,140% x Medicaid HMO amount,28444,Other,140% of NY Medicaid HMO DRG,45714,,DRG base rate x DRG weight + capital per discharge,45714,Other,225% of NY Medicaid HMO DRG,55872,,275% x Medicaid HMO amount,55872,Other,275% of NY Medicaid HMO DRG,65828,,324% x Medicaid HMO amount,65828,Other,324% of NY Medicaid HMO DRG,43682,,215% x Medicaid HMO amount,43682,Other,215% of NY Medicaid HMO DRG,43682,,215% x Medicaid HMO amount,43682,Other,215% of NY Medicaid HMO DRG,25397,,125% x Medicaid HMO amount,25397,Other,125% of NY Medicaid HMO DRG,0.01,86359,
Neonate bwt 2000-2499g w congenital/perinatal infection,623-4,APR-DRG,,,,,,,,inpatient,,,549076,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37790,,186% x Medicaid HMO amount,37790,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86359,,"27,634 x DRG Weight",86359,Other,DRG Base Rate x DRG Weight,73402,,"23,488 x DRG Weight",73402,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20317.21,,DRG base rate x DRG weight + capital per discharge,20317.21,Other,100% of NY Medicaid HMO DRG,20317,,DRG base rate x DRG weight + capital per discharge,20317,Other,100% of NY Medicaid HMO DRG,20317,,DRG base rate x DRG weight + capital per discharge,20317,Other,100% of NY Medicaid HMO DRG,20317,,DRG base rate x DRG weight + capital per discharge,20317,Other,100% of NY Medicaid HMO DRG,45714,,225% x Medicaid HMO amount,45714,Other,225% of NY Medicaid HMO DRG,31085,,153% x Medicaid HMO amount,31085,Other,153% of NY Medicaid HMO DRG,45714,,225% x Medicaid HMO amount,45714,Other,225% of NY Medicaid HMO DRG,28444,,140% x Medicaid HMO amount,28444,Other,140% of NY Medicaid HMO DRG,45714,,DRG base rate x DRG weight + capital per discharge,45714,Other,225% of NY Medicaid HMO DRG,55872,,275% x Medicaid HMO amount,55872,Other,275% of NY Medicaid HMO DRG,65828,,324% x Medicaid HMO amount,65828,Other,324% of NY Medicaid HMO DRG,43682,,215% x Medicaid HMO amount,43682,Other,215% of NY Medicaid HMO DRG,43682,,215% x Medicaid HMO amount,43682,Other,215% of NY Medicaid HMO DRG,25397,,125% x Medicaid HMO amount,25397,Other,125% of NY Medicaid HMO DRG,0.01,86359,
Neonate bwt 2000-2499g w other significant condition,625-1,APR-DRG,,,,,,,,inpatient,,,316312.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19776,,186% x Medicaid HMO amount,19776,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44209,,"27,634 x DRG Weight",44209,Other,DRG Base Rate x DRG Weight,37576,,"23,488 x DRG Weight",37576,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10632.21,,DRG base rate x DRG weight + capital per discharge,10632.21,Other,100% of NY Medicaid HMO DRG,10632,,DRG base rate x DRG weight + capital per discharge,10632,Other,100% of NY Medicaid HMO DRG,10632,,DRG base rate x DRG weight + capital per discharge,10632,Other,100% of NY Medicaid HMO DRG,10632,,DRG base rate x DRG weight + capital per discharge,10632,Other,100% of NY Medicaid HMO DRG,23922,,225% x Medicaid HMO amount,23922,Other,225% of NY Medicaid HMO DRG,16267,,153% x Medicaid HMO amount,16267,Other,153% of NY Medicaid HMO DRG,23922,,225% x Medicaid HMO amount,23922,Other,225% of NY Medicaid HMO DRG,14885,,140% x Medicaid HMO amount,14885,Other,140% of NY Medicaid HMO DRG,23922,,DRG base rate x DRG weight + capital per discharge,23922,Other,225% of NY Medicaid HMO DRG,29239,,275% x Medicaid HMO amount,29239,Other,275% of NY Medicaid HMO DRG,34448,,324% x Medicaid HMO amount,34448,Other,324% of NY Medicaid HMO DRG,22859,,215% x Medicaid HMO amount,22859,Other,215% of NY Medicaid HMO DRG,22859,,215% x Medicaid HMO amount,22859,Other,215% of NY Medicaid HMO DRG,13290,,125% x Medicaid HMO amount,13290,Other,125% of NY Medicaid HMO DRG,0.01,44209,
Neonate bwt 2000-2499g w other significant condition,625-2,APR-DRG,,,,,,,,inpatient,,,472011.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31438,,186% x Medicaid HMO amount,31438,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,71497,,"27,634 x DRG Weight",71497,Other,DRG Base Rate x DRG Weight,60771,,"23,488 x DRG Weight",60771,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16902.21,,DRG base rate x DRG weight + capital per discharge,16902.21,Other,100% of NY Medicaid HMO DRG,16902,,DRG base rate x DRG weight + capital per discharge,16902,Other,100% of NY Medicaid HMO DRG,16902,,DRG base rate x DRG weight + capital per discharge,16902,Other,100% of NY Medicaid HMO DRG,16902,,DRG base rate x DRG weight + capital per discharge,16902,Other,100% of NY Medicaid HMO DRG,38030,,225% x Medicaid HMO amount,38030,Other,225% of NY Medicaid HMO DRG,25860,,153% x Medicaid HMO amount,25860,Other,153% of NY Medicaid HMO DRG,38030,,225% x Medicaid HMO amount,38030,Other,225% of NY Medicaid HMO DRG,23663,,140% x Medicaid HMO amount,23663,Other,140% of NY Medicaid HMO DRG,38030,,DRG base rate x DRG weight + capital per discharge,38030,Other,225% of NY Medicaid HMO DRG,46481,,275% x Medicaid HMO amount,46481,Other,275% of NY Medicaid HMO DRG,54763,,324% x Medicaid HMO amount,54763,Other,324% of NY Medicaid HMO DRG,36340,,215% x Medicaid HMO amount,36340,Other,215% of NY Medicaid HMO DRG,36340,,215% x Medicaid HMO amount,36340,Other,215% of NY Medicaid HMO DRG,21128,,125% x Medicaid HMO amount,21128,Other,125% of NY Medicaid HMO DRG,0.01,71497,
Neonate bwt 2000-2499g w other significant condition,625-3,APR-DRG,,,,,,,,inpatient,,,549076,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39789,,186% x Medicaid HMO amount,39789,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,91035,,"27,634 x DRG Weight",91035,Other,DRG Base Rate x DRG Weight,77377,,"23,488 x DRG Weight",77377,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21392.21,,DRG base rate x DRG weight + capital per discharge,21392.21,Other,100% of NY Medicaid HMO DRG,21392,,DRG base rate x DRG weight + capital per discharge,21392,Other,100% of NY Medicaid HMO DRG,21392,,DRG base rate x DRG weight + capital per discharge,21392,Other,100% of NY Medicaid HMO DRG,21392,,DRG base rate x DRG weight + capital per discharge,21392,Other,100% of NY Medicaid HMO DRG,48132,,225% x Medicaid HMO amount,48132,Other,225% of NY Medicaid HMO DRG,32730,,153% x Medicaid HMO amount,32730,Other,153% of NY Medicaid HMO DRG,48132,,225% x Medicaid HMO amount,48132,Other,225% of NY Medicaid HMO DRG,29949,,140% x Medicaid HMO amount,29949,Other,140% of NY Medicaid HMO DRG,48132,,DRG base rate x DRG weight + capital per discharge,48132,Other,225% of NY Medicaid HMO DRG,58829,,275% x Medicaid HMO amount,58829,Other,275% of NY Medicaid HMO DRG,69311,,324% x Medicaid HMO amount,69311,Other,324% of NY Medicaid HMO DRG,45993,,215% x Medicaid HMO amount,45993,Other,215% of NY Medicaid HMO DRG,45993,,215% x Medicaid HMO amount,45993,Other,215% of NY Medicaid HMO DRG,26740,,125% x Medicaid HMO amount,26740,Other,125% of NY Medicaid HMO DRG,0.01,91035,
Neonate bwt 2000-2499g w other significant condition,625-4,APR-DRG,,,,,,,,inpatient,,,549076,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39789,,186% x Medicaid HMO amount,39789,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,91035,,"27,634 x DRG Weight",91035,Other,DRG Base Rate x DRG Weight,77377,,"23,488 x DRG Weight",77377,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21392.21,,DRG base rate x DRG weight + capital per discharge,21392.21,Other,100% of NY Medicaid HMO DRG,21392,,DRG base rate x DRG weight + capital per discharge,21392,Other,100% of NY Medicaid HMO DRG,21392,,DRG base rate x DRG weight + capital per discharge,21392,Other,100% of NY Medicaid HMO DRG,21392,,DRG base rate x DRG weight + capital per discharge,21392,Other,100% of NY Medicaid HMO DRG,48132,,225% x Medicaid HMO amount,48132,Other,225% of NY Medicaid HMO DRG,32730,,153% x Medicaid HMO amount,32730,Other,153% of NY Medicaid HMO DRG,48132,,225% x Medicaid HMO amount,48132,Other,225% of NY Medicaid HMO DRG,29949,,140% x Medicaid HMO amount,29949,Other,140% of NY Medicaid HMO DRG,48132,,DRG base rate x DRG weight + capital per discharge,48132,Other,225% of NY Medicaid HMO DRG,58829,,275% x Medicaid HMO amount,58829,Other,275% of NY Medicaid HMO DRG,69311,,324% x Medicaid HMO amount,69311,Other,324% of NY Medicaid HMO DRG,45993,,215% x Medicaid HMO amount,45993,Other,215% of NY Medicaid HMO DRG,45993,,215% x Medicaid HMO amount,45993,Other,215% of NY Medicaid HMO DRG,26740,,125% x Medicaid HMO amount,26740,Other,125% of NY Medicaid HMO DRG,0.01,91035,
"Neonate bwt 2000-2499g, normal newborn or neonate w other problem",626-1,APR-DRG,,,,,,,,inpatient,,,16942.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3341,,186% x Medicaid HMO amount,3341,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5756,,"27,634 x DRG Weight",5756,Other,DRG Base Rate x DRG Weight,4893,,"23,488 x DRG Weight",4893,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,1796.21,,DRG base rate x DRG weight + capital per discharge,1796.21,Other,100% of NY Medicaid HMO DRG,1796,,DRG base rate x DRG weight + capital per discharge,1796,Other,100% of NY Medicaid HMO DRG,1796,,DRG base rate x DRG weight + capital per discharge,1796,Other,100% of NY Medicaid HMO DRG,1796,,DRG base rate x DRG weight + capital per discharge,1796,Other,100% of NY Medicaid HMO DRG,4041,,225% x Medicaid HMO amount,4041,Other,225% of NY Medicaid HMO DRG,2748,,153% x Medicaid HMO amount,2748,Other,153% of NY Medicaid HMO DRG,4041,,225% x Medicaid HMO amount,4041,Other,225% of NY Medicaid HMO DRG,2515,,140% x Medicaid HMO amount,2515,Other,140% of NY Medicaid HMO DRG,4041,,DRG base rate x DRG weight + capital per discharge,4041,Other,225% of NY Medicaid HMO DRG,4940,,275% x Medicaid HMO amount,4940,Other,275% of NY Medicaid HMO DRG,5820,,324% x Medicaid HMO amount,5820,Other,324% of NY Medicaid HMO DRG,3862,,215% x Medicaid HMO amount,3862,Other,215% of NY Medicaid HMO DRG,3862,,215% x Medicaid HMO amount,3862,Other,215% of NY Medicaid HMO DRG,2245,,125% x Medicaid HMO amount,2245,Other,125% of NY Medicaid HMO DRG,0.01,5820,
"Neonate bwt 2000-2499g, normal newborn or neonate w other problem",626-2,APR-DRG,,,,,,,,inpatient,,,70194.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5799,,186% x Medicaid HMO amount,5799,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11512,,"27,634 x DRG Weight",11512,Other,DRG Base Rate x DRG Weight,9785,,"23,488 x DRG Weight",9785,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3118.21,,DRG base rate x DRG weight + capital per discharge,3118.21,Other,100% of NY Medicaid HMO DRG,3118,,DRG base rate x DRG weight + capital per discharge,3118,Other,100% of NY Medicaid HMO DRG,3118,,DRG base rate x DRG weight + capital per discharge,3118,Other,100% of NY Medicaid HMO DRG,3118,,DRG base rate x DRG weight + capital per discharge,3118,Other,100% of NY Medicaid HMO DRG,7016,,225% x Medicaid HMO amount,7016,Other,225% of NY Medicaid HMO DRG,4771,,153% x Medicaid HMO amount,4771,Other,153% of NY Medicaid HMO DRG,7016,,225% x Medicaid HMO amount,7016,Other,225% of NY Medicaid HMO DRG,4365,,140% x Medicaid HMO amount,4365,Other,140% of NY Medicaid HMO DRG,7016,,DRG base rate x DRG weight + capital per discharge,7016,Other,225% of NY Medicaid HMO DRG,8575,,275% x Medicaid HMO amount,8575,Other,275% of NY Medicaid HMO DRG,10103,,324% x Medicaid HMO amount,10103,Other,324% of NY Medicaid HMO DRG,6704,,215% x Medicaid HMO amount,6704,Other,215% of NY Medicaid HMO DRG,6704,,215% x Medicaid HMO amount,6704,Other,215% of NY Medicaid HMO DRG,3898,,125% x Medicaid HMO amount,3898,Other,125% of NY Medicaid HMO DRG,0.01,11512,
"Neonate bwt 2000-2499g, normal newborn or neonate w other problem",626-3,APR-DRG,,,,,,,,inpatient,,,161498.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16682,,186% x Medicaid HMO amount,16682,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36972,,"27,634 x DRG Weight",36972,Other,DRG Base Rate x DRG Weight,31425,,"23,488 x DRG Weight",31425,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8969.21,,DRG base rate x DRG weight + capital per discharge,8969.21,Other,100% of NY Medicaid HMO DRG,8969,,DRG base rate x DRG weight + capital per discharge,8969,Other,100% of NY Medicaid HMO DRG,8969,,DRG base rate x DRG weight + capital per discharge,8969,Other,100% of NY Medicaid HMO DRG,8969,,DRG base rate x DRG weight + capital per discharge,8969,Other,100% of NY Medicaid HMO DRG,20181,,225% x Medicaid HMO amount,20181,Other,225% of NY Medicaid HMO DRG,13723,,153% x Medicaid HMO amount,13723,Other,153% of NY Medicaid HMO DRG,20181,,225% x Medicaid HMO amount,20181,Other,225% of NY Medicaid HMO DRG,12557,,140% x Medicaid HMO amount,12557,Other,140% of NY Medicaid HMO DRG,20181,,DRG base rate x DRG weight + capital per discharge,20181,Other,225% of NY Medicaid HMO DRG,24665,,275% x Medicaid HMO amount,24665,Other,275% of NY Medicaid HMO DRG,29060,,324% x Medicaid HMO amount,29060,Other,324% of NY Medicaid HMO DRG,19284,,215% x Medicaid HMO amount,19284,Other,215% of NY Medicaid HMO DRG,19284,,215% x Medicaid HMO amount,19284,Other,215% of NY Medicaid HMO DRG,11212,,125% x Medicaid HMO amount,11212,Other,125% of NY Medicaid HMO DRG,0.01,36972,
"Neonate bwt 2000-2499g, normal newborn or neonate w other problem",626-4,APR-DRG,,,,,,,,inpatient,,,161498.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16699,,186% x Medicaid HMO amount,16699,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37013,,"27,634 x DRG Weight",37013,Other,DRG Base Rate x DRG Weight,31460,,"23,488 x DRG Weight",31460,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8978.21,,DRG base rate x DRG weight + capital per discharge,8978.21,Other,100% of NY Medicaid HMO DRG,8978,,DRG base rate x DRG weight + capital per discharge,8978,Other,100% of NY Medicaid HMO DRG,8978,,DRG base rate x DRG weight + capital per discharge,8978,Other,100% of NY Medicaid HMO DRG,8978,,DRG base rate x DRG weight + capital per discharge,8978,Other,100% of NY Medicaid HMO DRG,20201,,225% x Medicaid HMO amount,20201,Other,225% of NY Medicaid HMO DRG,13737,,153% x Medicaid HMO amount,13737,Other,153% of NY Medicaid HMO DRG,20201,,225% x Medicaid HMO amount,20201,Other,225% of NY Medicaid HMO DRG,12569,,140% x Medicaid HMO amount,12569,Other,140% of NY Medicaid HMO DRG,20201,,DRG base rate x DRG weight + capital per discharge,20201,Other,225% of NY Medicaid HMO DRG,24690,,275% x Medicaid HMO amount,24690,Other,275% of NY Medicaid HMO DRG,29089,,324% x Medicaid HMO amount,29089,Other,324% of NY Medicaid HMO DRG,19303,,215% x Medicaid HMO amount,19303,Other,215% of NY Medicaid HMO DRG,19303,,215% x Medicaid HMO amount,19303,Other,215% of NY Medicaid HMO DRG,11223,,125% x Medicaid HMO amount,11223,Other,125% of NY Medicaid HMO DRG,0.01,37013,
Neonate birthwt >2499g w major cardiovascular procedure,630-1,APR-DRG,,,,,,,,inpatient,,,318250,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41614,,186% x Medicaid HMO amount,41614,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,95304,,"27,634 x DRG Weight",95304,Other,DRG Base Rate x DRG Weight,81005,,"23,488 x DRG Weight",81005,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22373.21,,DRG base rate x DRG weight + capital per discharge,22373.21,Other,100% of NY Medicaid HMO DRG,22373,,DRG base rate x DRG weight + capital per discharge,22373,Other,100% of NY Medicaid HMO DRG,22373,,DRG base rate x DRG weight + capital per discharge,22373,Other,100% of NY Medicaid HMO DRG,22373,,DRG base rate x DRG weight + capital per discharge,22373,Other,100% of NY Medicaid HMO DRG,50340,,225% x Medicaid HMO amount,50340,Other,225% of NY Medicaid HMO DRG,34231,,153% x Medicaid HMO amount,34231,Other,153% of NY Medicaid HMO DRG,50340,,225% x Medicaid HMO amount,50340,Other,225% of NY Medicaid HMO DRG,31322,,140% x Medicaid HMO amount,31322,Other,140% of NY Medicaid HMO DRG,50340,,DRG base rate x DRG weight + capital per discharge,50340,Other,225% of NY Medicaid HMO DRG,61526,,275% x Medicaid HMO amount,61526,Other,275% of NY Medicaid HMO DRG,72489,,324% x Medicaid HMO amount,72489,Other,324% of NY Medicaid HMO DRG,48102,,215% x Medicaid HMO amount,48102,Other,215% of NY Medicaid HMO DRG,48102,,215% x Medicaid HMO amount,48102,Other,215% of NY Medicaid HMO DRG,27967,,125% x Medicaid HMO amount,27967,Other,125% of NY Medicaid HMO DRG,0.01,95304,
Neonate birthwt >2499g w major cardiovascular procedure,630-2,APR-DRG,,,,,,,,inpatient,,,519875,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43241,,186% x Medicaid HMO amount,43241,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,99115,,"27,634 x DRG Weight",99115,Other,DRG Base Rate x DRG Weight,84244,,"23,488 x DRG Weight",84244,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23248.21,,DRG base rate x DRG weight + capital per discharge,23248.21,Other,100% of NY Medicaid HMO DRG,23248,,DRG base rate x DRG weight + capital per discharge,23248,Other,100% of NY Medicaid HMO DRG,23248,,DRG base rate x DRG weight + capital per discharge,23248,Other,100% of NY Medicaid HMO DRG,23248,,DRG base rate x DRG weight + capital per discharge,23248,Other,100% of NY Medicaid HMO DRG,52308,,225% x Medicaid HMO amount,52308,Other,225% of NY Medicaid HMO DRG,35570,,153% x Medicaid HMO amount,35570,Other,153% of NY Medicaid HMO DRG,52308,,225% x Medicaid HMO amount,52308,Other,225% of NY Medicaid HMO DRG,32547,,140% x Medicaid HMO amount,32547,Other,140% of NY Medicaid HMO DRG,52308,,DRG base rate x DRG weight + capital per discharge,52308,Other,225% of NY Medicaid HMO DRG,63933,,275% x Medicaid HMO amount,63933,Other,275% of NY Medicaid HMO DRG,75324,,324% x Medicaid HMO amount,75324,Other,324% of NY Medicaid HMO DRG,49984,,215% x Medicaid HMO amount,49984,Other,215% of NY Medicaid HMO DRG,49984,,215% x Medicaid HMO amount,49984,Other,215% of NY Medicaid HMO DRG,29060,,125% x Medicaid HMO amount,29060,Other,125% of NY Medicaid HMO DRG,0.01,99115,
Neonate birthwt >2499g w major cardiovascular procedure,630-3,APR-DRG,,,,,,,,inpatient,,,868033.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70866,,186% x Medicaid HMO amount,70866,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,163745,,"27,634 x DRG Weight",163745,Other,DRG Base Rate x DRG Weight,139178,,"23,488 x DRG Weight",139178,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38100.21,,DRG base rate x DRG weight + capital per discharge,38100.21,Other,100% of NY Medicaid HMO DRG,38100,,DRG base rate x DRG weight + capital per discharge,38100,Other,100% of NY Medicaid HMO DRG,38100,,DRG base rate x DRG weight + capital per discharge,38100,Other,100% of NY Medicaid HMO DRG,38100,,DRG base rate x DRG weight + capital per discharge,38100,Other,100% of NY Medicaid HMO DRG,85725,,225% x Medicaid HMO amount,85725,Other,225% of NY Medicaid HMO DRG,58293,,153% x Medicaid HMO amount,58293,Other,153% of NY Medicaid HMO DRG,85725,,225% x Medicaid HMO amount,85725,Other,225% of NY Medicaid HMO DRG,53340,,140% x Medicaid HMO amount,53340,Other,140% of NY Medicaid HMO DRG,85725,,DRG base rate x DRG weight + capital per discharge,85725,Other,225% of NY Medicaid HMO DRG,104776,,275% x Medicaid HMO amount,104776,Other,275% of NY Medicaid HMO DRG,123445,,324% x Medicaid HMO amount,123445,Other,324% of NY Medicaid HMO DRG,81915,,215% x Medicaid HMO amount,81915,Other,215% of NY Medicaid HMO DRG,81915,,215% x Medicaid HMO amount,81915,Other,215% of NY Medicaid HMO DRG,47625,,125% x Medicaid HMO amount,47625,Other,125% of NY Medicaid HMO DRG,0.01,163745,
Neonate birthwt >2499g w major cardiovascular procedure,630-4,APR-DRG,,,,,,,,inpatient,,,809175.1,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,145322,,186% x Medicaid HMO amount,145322,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,337950,,"27,634 x DRG Weight",337950,Other,DRG Base Rate x DRG Weight,287246,,"23,488 x DRG Weight",287246,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78130.21,,DRG base rate x DRG weight + capital per discharge,78130.21,Other,100% of NY Medicaid HMO DRG,78130,,DRG base rate x DRG weight + capital per discharge,78130,Other,100% of NY Medicaid HMO DRG,78130,,DRG base rate x DRG weight + capital per discharge,78130,Other,100% of NY Medicaid HMO DRG,78130,,DRG base rate x DRG weight + capital per discharge,78130,Other,100% of NY Medicaid HMO DRG,175793,,225% x Medicaid HMO amount,175793,Other,225% of NY Medicaid HMO DRG,119539,,153% x Medicaid HMO amount,119539,Other,153% of NY Medicaid HMO DRG,175793,,225% x Medicaid HMO amount,175793,Other,225% of NY Medicaid HMO DRG,109382,,140% x Medicaid HMO amount,109382,Other,140% of NY Medicaid HMO DRG,175793,,DRG base rate x DRG weight + capital per discharge,175793,Other,225% of NY Medicaid HMO DRG,214858,,275% x Medicaid HMO amount,214858,Other,275% of NY Medicaid HMO DRG,253142,,324% x Medicaid HMO amount,253142,Other,324% of NY Medicaid HMO DRG,167980,,215% x Medicaid HMO amount,167980,Other,215% of NY Medicaid HMO DRG,167980,,215% x Medicaid HMO amount,167980,Other,215% of NY Medicaid HMO DRG,97663,,125% x Medicaid HMO amount,97663,Other,125% of NY Medicaid HMO DRG,0.01,337950,
Neonate birthwt >2499g w other major procedure,631-1,APR-DRG,,,,,,,,inpatient,,,137924.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20108,,186% x Medicaid HMO amount,20108,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44991,,"27,634 x DRG Weight",44991,Other,DRG Base Rate x DRG Weight,38241,,"23,488 x DRG Weight",38241,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10811.21,,DRG base rate x DRG weight + capital per discharge,10811.21,Other,100% of NY Medicaid HMO DRG,10811,,DRG base rate x DRG weight + capital per discharge,10811,Other,100% of NY Medicaid HMO DRG,10811,,DRG base rate x DRG weight + capital per discharge,10811,Other,100% of NY Medicaid HMO DRG,10811,,DRG base rate x DRG weight + capital per discharge,10811,Other,100% of NY Medicaid HMO DRG,24325,,225% x Medicaid HMO amount,24325,Other,225% of NY Medicaid HMO DRG,16541,,153% x Medicaid HMO amount,16541,Other,153% of NY Medicaid HMO DRG,24325,,225% x Medicaid HMO amount,24325,Other,225% of NY Medicaid HMO DRG,15136,,140% x Medicaid HMO amount,15136,Other,140% of NY Medicaid HMO DRG,24325,,DRG base rate x DRG weight + capital per discharge,24325,Other,225% of NY Medicaid HMO DRG,29731,,275% x Medicaid HMO amount,29731,Other,275% of NY Medicaid HMO DRG,35028,,324% x Medicaid HMO amount,35028,Other,324% of NY Medicaid HMO DRG,23244,,215% x Medicaid HMO amount,23244,Other,215% of NY Medicaid HMO DRG,23244,,215% x Medicaid HMO amount,23244,Other,215% of NY Medicaid HMO DRG,13514,,125% x Medicaid HMO amount,13514,Other,125% of NY Medicaid HMO DRG,0.01,44991,
Neonate birthwt >2499g w other major procedure,631-2,APR-DRG,,,,,,,,inpatient,,,513418.93,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35533,,186% x Medicaid HMO amount,35533,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,81078,,"27,634 x DRG Weight",81078,Other,DRG Base Rate x DRG Weight,68914,,"23,488 x DRG Weight",68914,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19104.21,,DRG base rate x DRG weight + capital per discharge,19104.21,Other,100% of NY Medicaid HMO DRG,19104,,DRG base rate x DRG weight + capital per discharge,19104,Other,100% of NY Medicaid HMO DRG,19104,,DRG base rate x DRG weight + capital per discharge,19104,Other,100% of NY Medicaid HMO DRG,19104,,DRG base rate x DRG weight + capital per discharge,19104,Other,100% of NY Medicaid HMO DRG,42984,,225% x Medicaid HMO amount,42984,Other,225% of NY Medicaid HMO DRG,29229,,153% x Medicaid HMO amount,29229,Other,153% of NY Medicaid HMO DRG,42984,,225% x Medicaid HMO amount,42984,Other,225% of NY Medicaid HMO DRG,26746,,140% x Medicaid HMO amount,26746,Other,140% of NY Medicaid HMO DRG,42984,,DRG base rate x DRG weight + capital per discharge,42984,Other,225% of NY Medicaid HMO DRG,52537,,275% x Medicaid HMO amount,52537,Other,275% of NY Medicaid HMO DRG,61898,,324% x Medicaid HMO amount,61898,Other,324% of NY Medicaid HMO DRG,41074,,215% x Medicaid HMO amount,41074,Other,215% of NY Medicaid HMO DRG,41074,,215% x Medicaid HMO amount,41074,Other,215% of NY Medicaid HMO DRG,23880,,125% x Medicaid HMO amount,23880,Other,125% of NY Medicaid HMO DRG,0.01,81078,
Neonate birthwt >2499g w other major procedure,631-3,APR-DRG,,,,,,,,inpatient,,,468154.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,58471,,186% x Medicaid HMO amount,58471,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,134743,,"27,634 x DRG Weight",134743,Other,DRG Base Rate x DRG Weight,114527,,"23,488 x DRG Weight",114527,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31436.21,,DRG base rate x DRG weight + capital per discharge,31436.21,Other,100% of NY Medicaid HMO DRG,31436,,DRG base rate x DRG weight + capital per discharge,31436,Other,100% of NY Medicaid HMO DRG,31436,,DRG base rate x DRG weight + capital per discharge,31436,Other,100% of NY Medicaid HMO DRG,31436,,DRG base rate x DRG weight + capital per discharge,31436,Other,100% of NY Medicaid HMO DRG,70731,,225% x Medicaid HMO amount,70731,Other,225% of NY Medicaid HMO DRG,48097,,153% x Medicaid HMO amount,48097,Other,153% of NY Medicaid HMO DRG,70731,,225% x Medicaid HMO amount,70731,Other,225% of NY Medicaid HMO DRG,44011,,140% x Medicaid HMO amount,44011,Other,140% of NY Medicaid HMO DRG,70731,,DRG base rate x DRG weight + capital per discharge,70731,Other,225% of NY Medicaid HMO DRG,86450,,275% x Medicaid HMO amount,86450,Other,275% of NY Medicaid HMO DRG,101853,,324% x Medicaid HMO amount,101853,Other,324% of NY Medicaid HMO DRG,67588,,215% x Medicaid HMO amount,67588,Other,215% of NY Medicaid HMO DRG,67588,,215% x Medicaid HMO amount,67588,Other,215% of NY Medicaid HMO DRG,39295,,125% x Medicaid HMO amount,39295,Other,125% of NY Medicaid HMO DRG,0.01,134743,
Neonate birthwt >2499g w other major procedure,631-4,APR-DRG,,,,,,,,inpatient,,,4292618.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,125053,,186% x Medicaid HMO amount,125053,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,290527,,"27,634 x DRG Weight",290527,Other,DRG Base Rate x DRG Weight,246939,,"23,488 x DRG Weight",246939,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,67233.21,,DRG base rate x DRG weight + capital per discharge,67233.21,Other,100% of NY Medicaid HMO DRG,67233,,DRG base rate x DRG weight + capital per discharge,67233,Other,100% of NY Medicaid HMO DRG,67233,,DRG base rate x DRG weight + capital per discharge,67233,Other,100% of NY Medicaid HMO DRG,67233,,DRG base rate x DRG weight + capital per discharge,67233,Other,100% of NY Medicaid HMO DRG,151275,,225% x Medicaid HMO amount,151275,Other,225% of NY Medicaid HMO DRG,102867,,153% x Medicaid HMO amount,102867,Other,153% of NY Medicaid HMO DRG,151275,,225% x Medicaid HMO amount,151275,Other,225% of NY Medicaid HMO DRG,94126,,140% x Medicaid HMO amount,94126,Other,140% of NY Medicaid HMO DRG,151275,,DRG base rate x DRG weight + capital per discharge,151275,Other,225% of NY Medicaid HMO DRG,184891,,275% x Medicaid HMO amount,184891,Other,275% of NY Medicaid HMO DRG,217836,,324% x Medicaid HMO amount,217836,Other,324% of NY Medicaid HMO DRG,144551,,215% x Medicaid HMO amount,144551,Other,215% of NY Medicaid HMO DRG,144551,,215% x Medicaid HMO amount,144551,Other,215% of NY Medicaid HMO DRG,84042,,125% x Medicaid HMO amount,84042,Other,125% of NY Medicaid HMO DRG,0.01,290527,
Neonate birthwt >2499g w major anomaly,633-1,APR-DRG,,,,,,,,inpatient,,,80935.35,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4207,,186% x Medicaid HMO amount,4207,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7787,,"27,634 x DRG Weight",7787,Other,DRG Base Rate x DRG Weight,6619,,"23,488 x DRG Weight",6619,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2262.21,,DRG base rate x DRG weight + capital per discharge,2262.21,Other,100% of NY Medicaid HMO DRG,2262,,DRG base rate x DRG weight + capital per discharge,2262,Other,100% of NY Medicaid HMO DRG,2262,,DRG base rate x DRG weight + capital per discharge,2262,Other,100% of NY Medicaid HMO DRG,2262,,DRG base rate x DRG weight + capital per discharge,2262,Other,100% of NY Medicaid HMO DRG,5090,,225% x Medicaid HMO amount,5090,Other,225% of NY Medicaid HMO DRG,3461,,153% x Medicaid HMO amount,3461,Other,153% of NY Medicaid HMO DRG,5090,,225% x Medicaid HMO amount,5090,Other,225% of NY Medicaid HMO DRG,3167,,140% x Medicaid HMO amount,3167,Other,140% of NY Medicaid HMO DRG,5090,,DRG base rate x DRG weight + capital per discharge,5090,Other,225% of NY Medicaid HMO DRG,6221,,275% x Medicaid HMO amount,6221,Other,275% of NY Medicaid HMO DRG,7330,,324% x Medicaid HMO amount,7330,Other,324% of NY Medicaid HMO DRG,4864,,215% x Medicaid HMO amount,4864,Other,215% of NY Medicaid HMO DRG,4864,,215% x Medicaid HMO amount,4864,Other,215% of NY Medicaid HMO DRG,2828,,125% x Medicaid HMO amount,2828,Other,125% of NY Medicaid HMO DRG,0.01,7787,
Neonate birthwt >2499g w major anomaly,633-2,APR-DRG,,,,,,,,inpatient,,,187603.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11634,,186% x Medicaid HMO amount,11634,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25161,,"27,634 x DRG Weight",25161,Other,DRG Base Rate x DRG Weight,21386,,"23,488 x DRG Weight",21386,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6255.21,,DRG base rate x DRG weight + capital per discharge,6255.21,Other,100% of NY Medicaid HMO DRG,6255,,DRG base rate x DRG weight + capital per discharge,6255,Other,100% of NY Medicaid HMO DRG,6255,,DRG base rate x DRG weight + capital per discharge,6255,Other,100% of NY Medicaid HMO DRG,6255,,DRG base rate x DRG weight + capital per discharge,6255,Other,100% of NY Medicaid HMO DRG,14074,,225% x Medicaid HMO amount,14074,Other,225% of NY Medicaid HMO DRG,9570,,153% x Medicaid HMO amount,9570,Other,153% of NY Medicaid HMO DRG,14074,,225% x Medicaid HMO amount,14074,Other,225% of NY Medicaid HMO DRG,8757,,140% x Medicaid HMO amount,8757,Other,140% of NY Medicaid HMO DRG,14074,,DRG base rate x DRG weight + capital per discharge,14074,Other,225% of NY Medicaid HMO DRG,17202,,275% x Medicaid HMO amount,17202,Other,275% of NY Medicaid HMO DRG,20267,,324% x Medicaid HMO amount,20267,Other,324% of NY Medicaid HMO DRG,13449,,215% x Medicaid HMO amount,13449,Other,215% of NY Medicaid HMO DRG,13449,,215% x Medicaid HMO amount,13449,Other,215% of NY Medicaid HMO DRG,7819,,125% x Medicaid HMO amount,7819,Other,125% of NY Medicaid HMO DRG,0.01,25161,
Neonate birthwt >2499g w major anomaly,633-3,APR-DRG,,,,,,,,inpatient,,,888642.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29183,,186% x Medicaid HMO amount,29183,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,66222,,"27,634 x DRG Weight",66222,Other,DRG Base Rate x DRG Weight,56287,,"23,488 x DRG Weight",56287,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15690.21,,DRG base rate x DRG weight + capital per discharge,15690.21,Other,100% of NY Medicaid HMO DRG,15690,,DRG base rate x DRG weight + capital per discharge,15690,Other,100% of NY Medicaid HMO DRG,15690,,DRG base rate x DRG weight + capital per discharge,15690,Other,100% of NY Medicaid HMO DRG,15690,,DRG base rate x DRG weight + capital per discharge,15690,Other,100% of NY Medicaid HMO DRG,35303,,225% x Medicaid HMO amount,35303,Other,225% of NY Medicaid HMO DRG,24006,,153% x Medicaid HMO amount,24006,Other,153% of NY Medicaid HMO DRG,35303,,225% x Medicaid HMO amount,35303,Other,225% of NY Medicaid HMO DRG,21966,,140% x Medicaid HMO amount,21966,Other,140% of NY Medicaid HMO DRG,35303,,DRG base rate x DRG weight + capital per discharge,35303,Other,225% of NY Medicaid HMO DRG,43148,,275% x Medicaid HMO amount,43148,Other,275% of NY Medicaid HMO DRG,50836,,324% x Medicaid HMO amount,50836,Other,324% of NY Medicaid HMO DRG,33734,,215% x Medicaid HMO amount,33734,Other,215% of NY Medicaid HMO DRG,33734,,215% x Medicaid HMO amount,33734,Other,215% of NY Medicaid HMO DRG,19613,,125% x Medicaid HMO amount,19613,Other,125% of NY Medicaid HMO DRG,0.01,66222,
Neonate birthwt >2499g w major anomaly,633-4,APR-DRG,,,,,,,,inpatient,,,1280483.78,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64114,,186% x Medicaid HMO amount,64114,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,147950,,"27,634 x DRG Weight",147950,Other,DRG Base Rate x DRG Weight,125752,,"23,488 x DRG Weight",125752,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34470.21,,DRG base rate x DRG weight + capital per discharge,34470.21,Other,100% of NY Medicaid HMO DRG,34470,,DRG base rate x DRG weight + capital per discharge,34470,Other,100% of NY Medicaid HMO DRG,34470,,DRG base rate x DRG weight + capital per discharge,34470,Other,100% of NY Medicaid HMO DRG,34470,,DRG base rate x DRG weight + capital per discharge,34470,Other,100% of NY Medicaid HMO DRG,77558,,225% x Medicaid HMO amount,77558,Other,225% of NY Medicaid HMO DRG,52739,,153% x Medicaid HMO amount,52739,Other,153% of NY Medicaid HMO DRG,77558,,225% x Medicaid HMO amount,77558,Other,225% of NY Medicaid HMO DRG,48258,,140% x Medicaid HMO amount,48258,Other,140% of NY Medicaid HMO DRG,77558,,DRG base rate x DRG weight + capital per discharge,77558,Other,225% of NY Medicaid HMO DRG,94793,,275% x Medicaid HMO amount,94793,Other,275% of NY Medicaid HMO DRG,111683,,324% x Medicaid HMO amount,111683,Other,324% of NY Medicaid HMO DRG,74111,,215% x Medicaid HMO amount,74111,Other,215% of NY Medicaid HMO DRG,74111,,215% x Medicaid HMO amount,74111,Other,215% of NY Medicaid HMO DRG,43088,,125% x Medicaid HMO amount,43088,Other,125% of NY Medicaid HMO DRG,0.01,147950,
"Neonate, birthwt >2499g w resp dist synd/oth maj resp cond",634-1,APR-DRG,,,,,,,,inpatient,,,150597,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10377,,186% x Medicaid HMO amount,10377,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22220,,"27,634 x DRG Weight",22220,Other,DRG Base Rate x DRG Weight,18887,,"23,488 x DRG Weight",18887,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5579.21,,DRG base rate x DRG weight + capital per discharge,5579.21,Other,100% of NY Medicaid HMO DRG,5579,,DRG base rate x DRG weight + capital per discharge,5579,Other,100% of NY Medicaid HMO DRG,5579,,DRG base rate x DRG weight + capital per discharge,5579,Other,100% of NY Medicaid HMO DRG,5579,,DRG base rate x DRG weight + capital per discharge,5579,Other,100% of NY Medicaid HMO DRG,12553,,225% x Medicaid HMO amount,12553,Other,225% of NY Medicaid HMO DRG,8536,,153% x Medicaid HMO amount,8536,Other,153% of NY Medicaid HMO DRG,12553,,225% x Medicaid HMO amount,12553,Other,225% of NY Medicaid HMO DRG,7811,,140% x Medicaid HMO amount,7811,Other,140% of NY Medicaid HMO DRG,12553,,DRG base rate x DRG weight + capital per discharge,12553,Other,225% of NY Medicaid HMO DRG,15343,,275% x Medicaid HMO amount,15343,Other,275% of NY Medicaid HMO DRG,18077,,324% x Medicaid HMO amount,18077,Other,324% of NY Medicaid HMO DRG,11995,,215% x Medicaid HMO amount,11995,Other,215% of NY Medicaid HMO DRG,11995,,215% x Medicaid HMO amount,11995,Other,215% of NY Medicaid HMO DRG,6974,,125% x Medicaid HMO amount,6974,Other,125% of NY Medicaid HMO DRG,0.01,22220,
"Neonate, birthwt >2499g w resp dist synd/oth maj resp cond",634-2,APR-DRG,,,,,,,,inpatient,,,224452.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16625,,186% x Medicaid HMO amount,16625,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36839,,"27,634 x DRG Weight",36839,Other,DRG Base Rate x DRG Weight,31312,,"23,488 x DRG Weight",31312,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8938.21,,DRG base rate x DRG weight + capital per discharge,8938.21,Other,100% of NY Medicaid HMO DRG,8938,,DRG base rate x DRG weight + capital per discharge,8938,Other,100% of NY Medicaid HMO DRG,8938,,DRG base rate x DRG weight + capital per discharge,8938,Other,100% of NY Medicaid HMO DRG,8938,,DRG base rate x DRG weight + capital per discharge,8938,Other,100% of NY Medicaid HMO DRG,20111,,225% x Medicaid HMO amount,20111,Other,225% of NY Medicaid HMO DRG,13675,,153% x Medicaid HMO amount,13675,Other,153% of NY Medicaid HMO DRG,20111,,225% x Medicaid HMO amount,20111,Other,225% of NY Medicaid HMO DRG,12513,,140% x Medicaid HMO amount,12513,Other,140% of NY Medicaid HMO DRG,20111,,DRG base rate x DRG weight + capital per discharge,20111,Other,225% of NY Medicaid HMO DRG,24580,,275% x Medicaid HMO amount,24580,Other,275% of NY Medicaid HMO DRG,28960,,324% x Medicaid HMO amount,28960,Other,324% of NY Medicaid HMO DRG,19217,,215% x Medicaid HMO amount,19217,Other,215% of NY Medicaid HMO DRG,19217,,215% x Medicaid HMO amount,19217,Other,215% of NY Medicaid HMO DRG,11173,,125% x Medicaid HMO amount,11173,Other,125% of NY Medicaid HMO DRG,0.01,36839,
"Neonate, birthwt >2499g w resp dist synd/oth maj resp cond",634-3,APR-DRG,,,,,,,,inpatient,,,563011.08,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27480,,186% x Medicaid HMO amount,27480,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,62237,,"27,634 x DRG Weight",62237,Other,DRG Base Rate x DRG Weight,52900,,"23,488 x DRG Weight",52900,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14774.21,,DRG base rate x DRG weight + capital per discharge,14774.21,Other,100% of NY Medicaid HMO DRG,14774,,DRG base rate x DRG weight + capital per discharge,14774,Other,100% of NY Medicaid HMO DRG,14774,,DRG base rate x DRG weight + capital per discharge,14774,Other,100% of NY Medicaid HMO DRG,14774,,DRG base rate x DRG weight + capital per discharge,14774,Other,100% of NY Medicaid HMO DRG,33242,,225% x Medicaid HMO amount,33242,Other,225% of NY Medicaid HMO DRG,22605,,153% x Medicaid HMO amount,22605,Other,153% of NY Medicaid HMO DRG,33242,,225% x Medicaid HMO amount,33242,Other,225% of NY Medicaid HMO DRG,20684,,140% x Medicaid HMO amount,20684,Other,140% of NY Medicaid HMO DRG,33242,,DRG base rate x DRG weight + capital per discharge,33242,Other,225% of NY Medicaid HMO DRG,40629,,275% x Medicaid HMO amount,40629,Other,275% of NY Medicaid HMO DRG,47868,,324% x Medicaid HMO amount,47868,Other,324% of NY Medicaid HMO DRG,31765,,215% x Medicaid HMO amount,31765,Other,215% of NY Medicaid HMO DRG,31765,,215% x Medicaid HMO amount,31765,Other,215% of NY Medicaid HMO DRG,18468,,125% x Medicaid HMO amount,18468,Other,125% of NY Medicaid HMO DRG,0.01,62237,
"Neonate, birthwt >2499g w resp dist synd/oth maj resp cond",634-4,APR-DRG,,,,,,,,inpatient,,,1081304.96,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48520,,186% x Medicaid HMO amount,48520,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,111462,,"27,634 x DRG Weight",111462,Other,DRG Base Rate x DRG Weight,94739,,"23,488 x DRG Weight",94739,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26086.21,,DRG base rate x DRG weight + capital per discharge,26086.21,Other,100% of NY Medicaid HMO DRG,26086,,DRG base rate x DRG weight + capital per discharge,26086,Other,100% of NY Medicaid HMO DRG,26086,,DRG base rate x DRG weight + capital per discharge,26086,Other,100% of NY Medicaid HMO DRG,26086,,DRG base rate x DRG weight + capital per discharge,26086,Other,100% of NY Medicaid HMO DRG,58694,,225% x Medicaid HMO amount,58694,Other,225% of NY Medicaid HMO DRG,39912,,153% x Medicaid HMO amount,39912,Other,153% of NY Medicaid HMO DRG,58694,,225% x Medicaid HMO amount,58694,Other,225% of NY Medicaid HMO DRG,36521,,140% x Medicaid HMO amount,36521,Other,140% of NY Medicaid HMO DRG,58694,,DRG base rate x DRG weight + capital per discharge,58694,Other,225% of NY Medicaid HMO DRG,71737,,275% x Medicaid HMO amount,71737,Other,275% of NY Medicaid HMO DRG,84519,,324% x Medicaid HMO amount,84519,Other,324% of NY Medicaid HMO DRG,56085,,215% x Medicaid HMO amount,56085,Other,215% of NY Medicaid HMO DRG,56085,,215% x Medicaid HMO amount,56085,Other,215% of NY Medicaid HMO DRG,32608,,125% x Medicaid HMO amount,32608,Other,125% of NY Medicaid HMO DRG,0.01,111462,
Neonate birthwt >2499g w congenital/perinatal infection,636-1,APR-DRG,,,,,,,,inpatient,,,104221.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12542,,186% x Medicaid HMO amount,12542,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27286,,"27,634 x DRG Weight",27286,Other,DRG Base Rate x DRG Weight,23192,,"23,488 x DRG Weight",23192,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6743.21,,DRG base rate x DRG weight + capital per discharge,6743.21,Other,100% of NY Medicaid HMO DRG,6743,,DRG base rate x DRG weight + capital per discharge,6743,Other,100% of NY Medicaid HMO DRG,6743,,DRG base rate x DRG weight + capital per discharge,6743,Other,100% of NY Medicaid HMO DRG,6743,,DRG base rate x DRG weight + capital per discharge,6743,Other,100% of NY Medicaid HMO DRG,15172,,225% x Medicaid HMO amount,15172,Other,225% of NY Medicaid HMO DRG,10317,,153% x Medicaid HMO amount,10317,Other,153% of NY Medicaid HMO DRG,15172,,225% x Medicaid HMO amount,15172,Other,225% of NY Medicaid HMO DRG,9440,,140% x Medicaid HMO amount,9440,Other,140% of NY Medicaid HMO DRG,15172,,DRG base rate x DRG weight + capital per discharge,15172,Other,225% of NY Medicaid HMO DRG,18544,,275% x Medicaid HMO amount,18544,Other,275% of NY Medicaid HMO DRG,21848,,324% x Medicaid HMO amount,21848,Other,324% of NY Medicaid HMO DRG,14498,,215% x Medicaid HMO amount,14498,Other,215% of NY Medicaid HMO DRG,14498,,215% x Medicaid HMO amount,14498,Other,215% of NY Medicaid HMO DRG,8429,,125% x Medicaid HMO amount,8429,Other,125% of NY Medicaid HMO DRG,0.01,27286,
Neonate birthwt >2499g w congenital/perinatal infection,636-2,APR-DRG,,,,,,,,inpatient,,,109625,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16707,,186% x Medicaid HMO amount,16707,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37030,,"27,634 x DRG Weight",37030,Other,DRG Base Rate x DRG Weight,31474,,"23,488 x DRG Weight",31474,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8982.21,,DRG base rate x DRG weight + capital per discharge,8982.21,Other,100% of NY Medicaid HMO DRG,8982,,DRG base rate x DRG weight + capital per discharge,8982,Other,100% of NY Medicaid HMO DRG,8982,,DRG base rate x DRG weight + capital per discharge,8982,Other,100% of NY Medicaid HMO DRG,8982,,DRG base rate x DRG weight + capital per discharge,8982,Other,100% of NY Medicaid HMO DRG,20210,,225% x Medicaid HMO amount,20210,Other,225% of NY Medicaid HMO DRG,13743,,153% x Medicaid HMO amount,13743,Other,153% of NY Medicaid HMO DRG,20210,,225% x Medicaid HMO amount,20210,Other,225% of NY Medicaid HMO DRG,12575,,140% x Medicaid HMO amount,12575,Other,140% of NY Medicaid HMO DRG,20210,,DRG base rate x DRG weight + capital per discharge,20210,Other,225% of NY Medicaid HMO DRG,24701,,275% x Medicaid HMO amount,24701,Other,275% of NY Medicaid HMO DRG,29102,,324% x Medicaid HMO amount,29102,Other,324% of NY Medicaid HMO DRG,19312,,215% x Medicaid HMO amount,19312,Other,215% of NY Medicaid HMO DRG,19312,,215% x Medicaid HMO amount,19312,Other,215% of NY Medicaid HMO DRG,11228,,125% x Medicaid HMO amount,11228,Other,125% of NY Medicaid HMO DRG,0.01,37030,
Neonate birthwt >2499g w congenital/perinatal infection,636-3,APR-DRG,,,,,,,,inpatient,,,558449.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25175,,186% x Medicaid HMO amount,25175,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,56846,,"27,634 x DRG Weight",56846,Other,DRG Base Rate x DRG Weight,48317,,"23,488 x DRG Weight",48317,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13535.21,,DRG base rate x DRG weight + capital per discharge,13535.21,Other,100% of NY Medicaid HMO DRG,13535,,DRG base rate x DRG weight + capital per discharge,13535,Other,100% of NY Medicaid HMO DRG,13535,,DRG base rate x DRG weight + capital per discharge,13535,Other,100% of NY Medicaid HMO DRG,13535,,DRG base rate x DRG weight + capital per discharge,13535,Other,100% of NY Medicaid HMO DRG,30454,,225% x Medicaid HMO amount,30454,Other,225% of NY Medicaid HMO DRG,20709,,153% x Medicaid HMO amount,20709,Other,153% of NY Medicaid HMO DRG,30454,,225% x Medicaid HMO amount,30454,Other,225% of NY Medicaid HMO DRG,18949,,140% x Medicaid HMO amount,18949,Other,140% of NY Medicaid HMO DRG,30454,,DRG base rate x DRG weight + capital per discharge,30454,Other,225% of NY Medicaid HMO DRG,37222,,275% x Medicaid HMO amount,37222,Other,275% of NY Medicaid HMO DRG,43854,,324% x Medicaid HMO amount,43854,Other,324% of NY Medicaid HMO DRG,29101,,215% x Medicaid HMO amount,29101,Other,215% of NY Medicaid HMO DRG,29101,,215% x Medicaid HMO amount,29101,Other,215% of NY Medicaid HMO DRG,16919,,125% x Medicaid HMO amount,16919,Other,125% of NY Medicaid HMO DRG,0.01,56846,
Neonate birthwt >2499g w congenital/perinatal infection,636-4,APR-DRG,,,,,,,,inpatient,,,558449.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32554,,186% x Medicaid HMO amount,32554,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74106,,"27,634 x DRG Weight",74106,Other,DRG Base Rate x DRG Weight,62988,,"23,488 x DRG Weight",62988,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17502.21,,DRG base rate x DRG weight + capital per discharge,17502.21,Other,100% of NY Medicaid HMO DRG,17502,,DRG base rate x DRG weight + capital per discharge,17502,Other,100% of NY Medicaid HMO DRG,17502,,DRG base rate x DRG weight + capital per discharge,17502,Other,100% of NY Medicaid HMO DRG,17502,,DRG base rate x DRG weight + capital per discharge,17502,Other,100% of NY Medicaid HMO DRG,39380,,225% x Medicaid HMO amount,39380,Other,225% of NY Medicaid HMO DRG,26778,,153% x Medicaid HMO amount,26778,Other,153% of NY Medicaid HMO DRG,39380,,225% x Medicaid HMO amount,39380,Other,225% of NY Medicaid HMO DRG,24503,,140% x Medicaid HMO amount,24503,Other,140% of NY Medicaid HMO DRG,39380,,DRG base rate x DRG weight + capital per discharge,39380,Other,225% of NY Medicaid HMO DRG,48131,,275% x Medicaid HMO amount,48131,Other,275% of NY Medicaid HMO DRG,56707,,324% x Medicaid HMO amount,56707,Other,324% of NY Medicaid HMO DRG,37630,,215% x Medicaid HMO amount,37630,Other,215% of NY Medicaid HMO DRG,37630,,215% x Medicaid HMO amount,37630,Other,215% of NY Medicaid HMO DRG,21878,,125% x Medicaid HMO amount,21878,Other,125% of NY Medicaid HMO DRG,0.01,74106,
Neonate birthwt >2499g w other significant condition,639-1,APR-DRG,,,,,,,,inpatient,,,151058.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6971,,186% x Medicaid HMO amount,6971,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14251,,"27,634 x DRG Weight",14251,Other,DRG Base Rate x DRG Weight,12113,,"23,488 x DRG Weight",12113,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3748.21,,DRG base rate x DRG weight + capital per discharge,3748.21,Other,100% of NY Medicaid HMO DRG,3748,,DRG base rate x DRG weight + capital per discharge,3748,Other,100% of NY Medicaid HMO DRG,3748,,DRG base rate x DRG weight + capital per discharge,3748,Other,100% of NY Medicaid HMO DRG,3748,,DRG base rate x DRG weight + capital per discharge,3748,Other,100% of NY Medicaid HMO DRG,8433,,225% x Medicaid HMO amount,8433,Other,225% of NY Medicaid HMO DRG,5735,,153% x Medicaid HMO amount,5735,Other,153% of NY Medicaid HMO DRG,8433,,225% x Medicaid HMO amount,8433,Other,225% of NY Medicaid HMO DRG,5247,,140% x Medicaid HMO amount,5247,Other,140% of NY Medicaid HMO DRG,8433,,DRG base rate x DRG weight + capital per discharge,8433,Other,225% of NY Medicaid HMO DRG,10308,,275% x Medicaid HMO amount,10308,Other,275% of NY Medicaid HMO DRG,12144,,324% x Medicaid HMO amount,12144,Other,324% of NY Medicaid HMO DRG,8059,,215% x Medicaid HMO amount,8059,Other,215% of NY Medicaid HMO DRG,8059,,215% x Medicaid HMO amount,8059,Other,215% of NY Medicaid HMO DRG,4685,,125% x Medicaid HMO amount,4685,Other,125% of NY Medicaid HMO DRG,0.01,14251,
Neonate birthwt >2499g w other significant condition,639-2,APR-DRG,,,,,,,,inpatient,,,441914.76,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16193,,186% x Medicaid HMO amount,16193,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35830,,"27,634 x DRG Weight",35830,Other,DRG Base Rate x DRG Weight,30455,,"23,488 x DRG Weight",30455,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8706.21,,DRG base rate x DRG weight + capital per discharge,8706.21,Other,100% of NY Medicaid HMO DRG,8706,,DRG base rate x DRG weight + capital per discharge,8706,Other,100% of NY Medicaid HMO DRG,8706,,DRG base rate x DRG weight + capital per discharge,8706,Other,100% of NY Medicaid HMO DRG,8706,,DRG base rate x DRG weight + capital per discharge,8706,Other,100% of NY Medicaid HMO DRG,19589,,225% x Medicaid HMO amount,19589,Other,225% of NY Medicaid HMO DRG,13321,,153% x Medicaid HMO amount,13321,Other,153% of NY Medicaid HMO DRG,19589,,225% x Medicaid HMO amount,19589,Other,225% of NY Medicaid HMO DRG,12189,,140% x Medicaid HMO amount,12189,Other,140% of NY Medicaid HMO DRG,19589,,DRG base rate x DRG weight + capital per discharge,19589,Other,225% of NY Medicaid HMO DRG,23942,,275% x Medicaid HMO amount,23942,Other,275% of NY Medicaid HMO DRG,28208,,324% x Medicaid HMO amount,28208,Other,324% of NY Medicaid HMO DRG,18718,,215% x Medicaid HMO amount,18718,Other,215% of NY Medicaid HMO DRG,18718,,215% x Medicaid HMO amount,18718,Other,215% of NY Medicaid HMO DRG,10883,,125% x Medicaid HMO amount,10883,Other,125% of NY Medicaid HMO DRG,0.01,35830,
Neonate birthwt >2499g w other significant condition,639-3,APR-DRG,,,,,,,,inpatient,,,433889.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22891,,186% x Medicaid HMO amount,22891,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51501,,"27,634 x DRG Weight",51501,Other,DRG Base Rate x DRG Weight,43775,,"23,488 x DRG Weight",43775,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12307.21,,DRG base rate x DRG weight + capital per discharge,12307.21,Other,100% of NY Medicaid HMO DRG,12307,,DRG base rate x DRG weight + capital per discharge,12307,Other,100% of NY Medicaid HMO DRG,12307,,DRG base rate x DRG weight + capital per discharge,12307,Other,100% of NY Medicaid HMO DRG,12307,,DRG base rate x DRG weight + capital per discharge,12307,Other,100% of NY Medicaid HMO DRG,27691,,225% x Medicaid HMO amount,27691,Other,225% of NY Medicaid HMO DRG,18830,,153% x Medicaid HMO amount,18830,Other,153% of NY Medicaid HMO DRG,27691,,225% x Medicaid HMO amount,27691,Other,225% of NY Medicaid HMO DRG,17230,,140% x Medicaid HMO amount,17230,Other,140% of NY Medicaid HMO DRG,27691,,DRG base rate x DRG weight + capital per discharge,27691,Other,225% of NY Medicaid HMO DRG,33845,,275% x Medicaid HMO amount,33845,Other,275% of NY Medicaid HMO DRG,39875,,324% x Medicaid HMO amount,39875,Other,324% of NY Medicaid HMO DRG,26461,,215% x Medicaid HMO amount,26461,Other,215% of NY Medicaid HMO DRG,26461,,215% x Medicaid HMO amount,26461,Other,215% of NY Medicaid HMO DRG,15384,,125% x Medicaid HMO amount,15384,Other,125% of NY Medicaid HMO DRG,0.01,51501,
Neonate birthwt >2499g w other significant condition,639-4,APR-DRG,,,,,,,,inpatient,,,3810096.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46167,,186% x Medicaid HMO amount,46167,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,105957,,"27,634 x DRG Weight",105957,Other,DRG Base Rate x DRG Weight,90060,,"23,488 x DRG Weight",90060,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24821.21,,DRG base rate x DRG weight + capital per discharge,24821.21,Other,100% of NY Medicaid HMO DRG,24821,,DRG base rate x DRG weight + capital per discharge,24821,Other,100% of NY Medicaid HMO DRG,24821,,DRG base rate x DRG weight + capital per discharge,24821,Other,100% of NY Medicaid HMO DRG,24821,,DRG base rate x DRG weight + capital per discharge,24821,Other,100% of NY Medicaid HMO DRG,55848,,225% x Medicaid HMO amount,55848,Other,225% of NY Medicaid HMO DRG,37976,,153% x Medicaid HMO amount,37976,Other,153% of NY Medicaid HMO DRG,55848,,225% x Medicaid HMO amount,55848,Other,225% of NY Medicaid HMO DRG,34750,,140% x Medicaid HMO amount,34750,Other,140% of NY Medicaid HMO DRG,55848,,DRG base rate x DRG weight + capital per discharge,55848,Other,225% of NY Medicaid HMO DRG,68258,,275% x Medicaid HMO amount,68258,Other,275% of NY Medicaid HMO DRG,80421,,324% x Medicaid HMO amount,80421,Other,324% of NY Medicaid HMO DRG,53366,,215% x Medicaid HMO amount,53366,Other,215% of NY Medicaid HMO DRG,53366,,215% x Medicaid HMO amount,53366,Other,215% of NY Medicaid HMO DRG,31027,,125% x Medicaid HMO amount,31027,Other,125% of NY Medicaid HMO DRG,0.01,105957,
"Neonate birthwt >2499g, normal newborn or neonate w other problem",640-1,APR-DRG,,,,,,,,inpatient,,,22137.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2946,,186% x Medicaid HMO amount,2946,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4833,,"27,634 x DRG Weight",4833,Other,DRG Base Rate x DRG Weight,4108,,"23,488 x DRG Weight",4108,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,1584.21,,DRG base rate x DRG weight + capital per discharge,1584.21,Other,100% of NY Medicaid HMO DRG,1584,,DRG base rate x DRG weight + capital per discharge,1584,Other,100% of NY Medicaid HMO DRG,1584,,DRG base rate x DRG weight + capital per discharge,1584,Other,100% of NY Medicaid HMO DRG,1584,,DRG base rate x DRG weight + capital per discharge,1584,Other,100% of NY Medicaid HMO DRG,3564,,225% x Medicaid HMO amount,3564,Other,225% of NY Medicaid HMO DRG,2424,,153% x Medicaid HMO amount,2424,Other,153% of NY Medicaid HMO DRG,3564,,225% x Medicaid HMO amount,3564,Other,225% of NY Medicaid HMO DRG,2218,,140% x Medicaid HMO amount,2218,Other,140% of NY Medicaid HMO DRG,3564,,DRG base rate x DRG weight + capital per discharge,3564,Other,225% of NY Medicaid HMO DRG,4357,,275% x Medicaid HMO amount,4357,Other,275% of NY Medicaid HMO DRG,5133,,324% x Medicaid HMO amount,5133,Other,324% of NY Medicaid HMO DRG,3406,,215% x Medicaid HMO amount,3406,Other,215% of NY Medicaid HMO DRG,3406,,215% x Medicaid HMO amount,3406,Other,215% of NY Medicaid HMO DRG,1980,,125% x Medicaid HMO amount,1980,Other,125% of NY Medicaid HMO DRG,0.01,5133,
"Neonate birthwt >2499g, normal newborn or neonate w other problem",640-2,APR-DRG,,,,,,,,inpatient,,,37661,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3750,,186% x Medicaid HMO amount,3750,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6715,,"27,634 x DRG Weight",6715,Other,DRG Base Rate x DRG Weight,5708,,"23,488 x DRG Weight",5708,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2016.21,,DRG base rate x DRG weight + capital per discharge,2016.21,Other,100% of NY Medicaid HMO DRG,2016,,DRG base rate x DRG weight + capital per discharge,2016,Other,100% of NY Medicaid HMO DRG,2016,,DRG base rate x DRG weight + capital per discharge,2016,Other,100% of NY Medicaid HMO DRG,2016,,DRG base rate x DRG weight + capital per discharge,2016,Other,100% of NY Medicaid HMO DRG,4536,,225% x Medicaid HMO amount,4536,Other,225% of NY Medicaid HMO DRG,3085,,153% x Medicaid HMO amount,3085,Other,153% of NY Medicaid HMO DRG,4536,,225% x Medicaid HMO amount,4536,Other,225% of NY Medicaid HMO DRG,2823,,140% x Medicaid HMO amount,2823,Other,140% of NY Medicaid HMO DRG,4536,,DRG base rate x DRG weight + capital per discharge,4536,Other,225% of NY Medicaid HMO DRG,5545,,275% x Medicaid HMO amount,5545,Other,275% of NY Medicaid HMO DRG,6533,,324% x Medicaid HMO amount,6533,Other,324% of NY Medicaid HMO DRG,4335,,215% x Medicaid HMO amount,4335,Other,215% of NY Medicaid HMO DRG,4335,,215% x Medicaid HMO amount,4335,Other,215% of NY Medicaid HMO DRG,2520,,125% x Medicaid HMO amount,2520,Other,125% of NY Medicaid HMO DRG,0.01,6715,
"Neonate birthwt >2499g, normal newborn or neonate w other problem",640-3,APR-DRG,,,,,,,,inpatient,,,130270.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7260,,186% x Medicaid HMO amount,7260,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14925,,"27,634 x DRG Weight",14925,Other,DRG Base Rate x DRG Weight,12686,,"23,488 x DRG Weight",12686,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3903.21,,DRG base rate x DRG weight + capital per discharge,3903.21,Other,100% of NY Medicaid HMO DRG,3903,,DRG base rate x DRG weight + capital per discharge,3903,Other,100% of NY Medicaid HMO DRG,3903,,DRG base rate x DRG weight + capital per discharge,3903,Other,100% of NY Medicaid HMO DRG,3903,,DRG base rate x DRG weight + capital per discharge,3903,Other,100% of NY Medicaid HMO DRG,8782,,225% x Medicaid HMO amount,8782,Other,225% of NY Medicaid HMO DRG,5972,,153% x Medicaid HMO amount,5972,Other,153% of NY Medicaid HMO DRG,8782,,225% x Medicaid HMO amount,8782,Other,225% of NY Medicaid HMO DRG,5464,,140% x Medicaid HMO amount,5464,Other,140% of NY Medicaid HMO DRG,8782,,DRG base rate x DRG weight + capital per discharge,8782,Other,225% of NY Medicaid HMO DRG,10734,,275% x Medicaid HMO amount,10734,Other,275% of NY Medicaid HMO DRG,12646,,324% x Medicaid HMO amount,12646,Other,324% of NY Medicaid HMO DRG,8392,,215% x Medicaid HMO amount,8392,Other,215% of NY Medicaid HMO DRG,8392,,215% x Medicaid HMO amount,8392,Other,215% of NY Medicaid HMO DRG,4879,,125% x Medicaid HMO amount,4879,Other,125% of NY Medicaid HMO DRG,0.01,14925,
"Neonate birthwt >2499g, normal newborn or neonate w other problem",640-4,APR-DRG,,,,,,,,inpatient,,,130270.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7265,,186% x Medicaid HMO amount,7265,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14942,,"27,634 x DRG Weight",14942,Other,DRG Base Rate x DRG Weight,12700,,"23,488 x DRG Weight",12700,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3906.21,,DRG base rate x DRG weight + capital per discharge,3906.21,Other,100% of NY Medicaid HMO DRG,3906,,DRG base rate x DRG weight + capital per discharge,3906,Other,100% of NY Medicaid HMO DRG,3906,,DRG base rate x DRG weight + capital per discharge,3906,Other,100% of NY Medicaid HMO DRG,3906,,DRG base rate x DRG weight + capital per discharge,3906,Other,100% of NY Medicaid HMO DRG,8789,,225% x Medicaid HMO amount,8789,Other,225% of NY Medicaid HMO DRG,5977,,153% x Medicaid HMO amount,5977,Other,153% of NY Medicaid HMO DRG,8789,,225% x Medicaid HMO amount,8789,Other,225% of NY Medicaid HMO DRG,5469,,140% x Medicaid HMO amount,5469,Other,140% of NY Medicaid HMO DRG,8789,,DRG base rate x DRG weight + capital per discharge,8789,Other,225% of NY Medicaid HMO DRG,10742,,275% x Medicaid HMO amount,10742,Other,275% of NY Medicaid HMO DRG,12656,,324% x Medicaid HMO amount,12656,Other,324% of NY Medicaid HMO DRG,8398,,215% x Medicaid HMO amount,8398,Other,215% of NY Medicaid HMO DRG,8398,,215% x Medicaid HMO amount,8398,Other,215% of NY Medicaid HMO DRG,4883,,125% x Medicaid HMO amount,4883,Other,125% of NY Medicaid HMO DRG,0.01,14942,
Splenectomy,650-1,APR-DRG,,,,,,,,inpatient,,,81755.94,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16225,,186% x Medicaid HMO amount,16225,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35905,,"27,634 x DRG Weight",35905,Other,DRG Base Rate x DRG Weight,30518,,"23,488 x DRG Weight",30518,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8723.21,,DRG base rate x DRG weight + capital per discharge,8723.21,Other,100% of NY Medicaid HMO DRG,8723,,DRG base rate x DRG weight + capital per discharge,8723,Other,100% of NY Medicaid HMO DRG,8723,,DRG base rate x DRG weight + capital per discharge,8723,Other,100% of NY Medicaid HMO DRG,8723,,DRG base rate x DRG weight + capital per discharge,8723,Other,100% of NY Medicaid HMO DRG,19627,,225% x Medicaid HMO amount,19627,Other,225% of NY Medicaid HMO DRG,13347,,153% x Medicaid HMO amount,13347,Other,153% of NY Medicaid HMO DRG,19627,,225% x Medicaid HMO amount,19627,Other,225% of NY Medicaid HMO DRG,12212,,140% x Medicaid HMO amount,12212,Other,140% of NY Medicaid HMO DRG,19627,,DRG base rate x DRG weight + capital per discharge,19627,Other,225% of NY Medicaid HMO DRG,23989,,275% x Medicaid HMO amount,23989,Other,275% of NY Medicaid HMO DRG,28263,,324% x Medicaid HMO amount,28263,Other,324% of NY Medicaid HMO DRG,18755,,215% x Medicaid HMO amount,18755,Other,215% of NY Medicaid HMO DRG,18755,,215% x Medicaid HMO amount,18755,Other,215% of NY Medicaid HMO DRG,10904,,125% x Medicaid HMO amount,10904,Other,125% of NY Medicaid HMO DRG,0.01,35905,
Splenectomy,650-2,APR-DRG,,,,,,,,inpatient,,,134326.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24318,,186% x Medicaid HMO amount,24318,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54837,,"27,634 x DRG Weight",54837,Other,DRG Base Rate x DRG Weight,46610,,"23,488 x DRG Weight",46610,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13074.21,,DRG base rate x DRG weight + capital per discharge,13074.21,Other,100% of NY Medicaid HMO DRG,13074,,DRG base rate x DRG weight + capital per discharge,13074,Other,100% of NY Medicaid HMO DRG,13074,,DRG base rate x DRG weight + capital per discharge,13074,Other,100% of NY Medicaid HMO DRG,13074,,DRG base rate x DRG weight + capital per discharge,13074,Other,100% of NY Medicaid HMO DRG,29417,,225% x Medicaid HMO amount,29417,Other,225% of NY Medicaid HMO DRG,20004,,153% x Medicaid HMO amount,20004,Other,153% of NY Medicaid HMO DRG,29417,,225% x Medicaid HMO amount,29417,Other,225% of NY Medicaid HMO DRG,18304,,140% x Medicaid HMO amount,18304,Other,140% of NY Medicaid HMO DRG,29417,,DRG base rate x DRG weight + capital per discharge,29417,Other,225% of NY Medicaid HMO DRG,35954,,275% x Medicaid HMO amount,35954,Other,275% of NY Medicaid HMO DRG,42360,,324% x Medicaid HMO amount,42360,Other,324% of NY Medicaid HMO DRG,28110,,215% x Medicaid HMO amount,28110,Other,215% of NY Medicaid HMO DRG,28110,,215% x Medicaid HMO amount,28110,Other,215% of NY Medicaid HMO DRG,16343,,125% x Medicaid HMO amount,16343,Other,125% of NY Medicaid HMO DRG,0.01,54837,
Splenectomy,650-3,APR-DRG,,,,,,,,inpatient,,,245187.35,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29124,,186% x Medicaid HMO amount,29124,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,66081,,"27,634 x DRG Weight",66081,Other,DRG Base Rate x DRG Weight,56167,,"23,488 x DRG Weight",56167,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15658.21,,DRG base rate x DRG weight + capital per discharge,15658.21,Other,100% of NY Medicaid HMO DRG,15658,,DRG base rate x DRG weight + capital per discharge,15658,Other,100% of NY Medicaid HMO DRG,15658,,DRG base rate x DRG weight + capital per discharge,15658,Other,100% of NY Medicaid HMO DRG,15658,,DRG base rate x DRG weight + capital per discharge,15658,Other,100% of NY Medicaid HMO DRG,35231,,225% x Medicaid HMO amount,35231,Other,225% of NY Medicaid HMO DRG,23957,,153% x Medicaid HMO amount,23957,Other,153% of NY Medicaid HMO DRG,35231,,225% x Medicaid HMO amount,35231,Other,225% of NY Medicaid HMO DRG,21921,,140% x Medicaid HMO amount,21921,Other,140% of NY Medicaid HMO DRG,35231,,DRG base rate x DRG weight + capital per discharge,35231,Other,225% of NY Medicaid HMO DRG,43060,,275% x Medicaid HMO amount,43060,Other,275% of NY Medicaid HMO DRG,50733,,324% x Medicaid HMO amount,50733,Other,324% of NY Medicaid HMO DRG,33665,,215% x Medicaid HMO amount,33665,Other,215% of NY Medicaid HMO DRG,33665,,215% x Medicaid HMO amount,33665,Other,215% of NY Medicaid HMO DRG,19573,,125% x Medicaid HMO amount,19573,Other,125% of NY Medicaid HMO DRG,0.01,66081,
Splenectomy,650-4,APR-DRG,,,,,,,,inpatient,,,526890.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,68238,,186% x Medicaid HMO amount,68238,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,157597,,"27,634 x DRG Weight",157597,Other,DRG Base Rate x DRG Weight,133952,,"23,488 x DRG Weight",133952,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36687.21,,DRG base rate x DRG weight + capital per discharge,36687.21,Other,100% of NY Medicaid HMO DRG,36687,,DRG base rate x DRG weight + capital per discharge,36687,Other,100% of NY Medicaid HMO DRG,36687,,DRG base rate x DRG weight + capital per discharge,36687,Other,100% of NY Medicaid HMO DRG,36687,,DRG base rate x DRG weight + capital per discharge,36687,Other,100% of NY Medicaid HMO DRG,82546,,225% x Medicaid HMO amount,82546,Other,225% of NY Medicaid HMO DRG,56131,,153% x Medicaid HMO amount,56131,Other,153% of NY Medicaid HMO DRG,82546,,225% x Medicaid HMO amount,82546,Other,225% of NY Medicaid HMO DRG,51362,,140% x Medicaid HMO amount,51362,Other,140% of NY Medicaid HMO DRG,82546,,DRG base rate x DRG weight + capital per discharge,82546,Other,225% of NY Medicaid HMO DRG,100890,,275% x Medicaid HMO amount,100890,Other,275% of NY Medicaid HMO DRG,118867,,324% x Medicaid HMO amount,118867,Other,324% of NY Medicaid HMO DRG,78878,,215% x Medicaid HMO amount,78878,Other,215% of NY Medicaid HMO DRG,78878,,215% x Medicaid HMO amount,78878,Other,215% of NY Medicaid HMO DRG,45859,,125% x Medicaid HMO amount,45859,Other,125% of NY Medicaid HMO DRG,0.01,157597,
Other procedures of blood & blood-forming organs,651-1,APR-DRG,,,,,,,,inpatient,,,149993.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13178,,186% x Medicaid HMO amount,13178,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28775,,"27,634 x DRG Weight",28775,Other,DRG Base Rate x DRG Weight,24458,,"23,488 x DRG Weight",24458,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7085.21,,DRG base rate x DRG weight + capital per discharge,7085.21,Other,100% of NY Medicaid HMO DRG,7085,,DRG base rate x DRG weight + capital per discharge,7085,Other,100% of NY Medicaid HMO DRG,7085,,DRG base rate x DRG weight + capital per discharge,7085,Other,100% of NY Medicaid HMO DRG,7085,,DRG base rate x DRG weight + capital per discharge,7085,Other,100% of NY Medicaid HMO DRG,15942,,225% x Medicaid HMO amount,15942,Other,225% of NY Medicaid HMO DRG,10840,,153% x Medicaid HMO amount,10840,Other,153% of NY Medicaid HMO DRG,15942,,225% x Medicaid HMO amount,15942,Other,225% of NY Medicaid HMO DRG,9919,,140% x Medicaid HMO amount,9919,Other,140% of NY Medicaid HMO DRG,15942,,DRG base rate x DRG weight + capital per discharge,15942,Other,225% of NY Medicaid HMO DRG,19484,,275% x Medicaid HMO amount,19484,Other,275% of NY Medicaid HMO DRG,22956,,324% x Medicaid HMO amount,22956,Other,324% of NY Medicaid HMO DRG,15233,,215% x Medicaid HMO amount,15233,Other,215% of NY Medicaid HMO DRG,15233,,215% x Medicaid HMO amount,15233,Other,215% of NY Medicaid HMO DRG,8857,,125% x Medicaid HMO amount,8857,Other,125% of NY Medicaid HMO DRG,0.01,28775,
Other procedures of blood & blood-forming organs,651-2,APR-DRG,,,,,,,,inpatient,,,138054.72,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17190,,186% x Medicaid HMO amount,17190,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38160,,"27,634 x DRG Weight",38160,Other,DRG Base Rate x DRG Weight,32435,,"23,488 x DRG Weight",32435,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9242.21,,DRG base rate x DRG weight + capital per discharge,9242.21,Other,100% of NY Medicaid HMO DRG,9242,,DRG base rate x DRG weight + capital per discharge,9242,Other,100% of NY Medicaid HMO DRG,9242,,DRG base rate x DRG weight + capital per discharge,9242,Other,100% of NY Medicaid HMO DRG,9242,,DRG base rate x DRG weight + capital per discharge,9242,Other,100% of NY Medicaid HMO DRG,20795,,225% x Medicaid HMO amount,20795,Other,225% of NY Medicaid HMO DRG,14141,,153% x Medicaid HMO amount,14141,Other,153% of NY Medicaid HMO DRG,20795,,225% x Medicaid HMO amount,20795,Other,225% of NY Medicaid HMO DRG,12939,,140% x Medicaid HMO amount,12939,Other,140% of NY Medicaid HMO DRG,20795,,DRG base rate x DRG weight + capital per discharge,20795,Other,225% of NY Medicaid HMO DRG,25416,,275% x Medicaid HMO amount,25416,Other,275% of NY Medicaid HMO DRG,29945,,324% x Medicaid HMO amount,29945,Other,324% of NY Medicaid HMO DRG,19871,,215% x Medicaid HMO amount,19871,Other,215% of NY Medicaid HMO DRG,19871,,215% x Medicaid HMO amount,19871,Other,215% of NY Medicaid HMO DRG,11553,,125% x Medicaid HMO amount,11553,Other,125% of NY Medicaid HMO DRG,0.01,38160,
Other procedures of blood & blood-forming organs,651-3,APR-DRG,,,,,,,,inpatient,,,470320.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31672,,186% x Medicaid HMO amount,31672,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72045,,"27,634 x DRG Weight",72045,Other,DRG Base Rate x DRG Weight,61236,,"23,488 x DRG Weight",61236,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17028.21,,DRG base rate x DRG weight + capital per discharge,17028.21,Other,100% of NY Medicaid HMO DRG,17028,,DRG base rate x DRG weight + capital per discharge,17028,Other,100% of NY Medicaid HMO DRG,17028,,DRG base rate x DRG weight + capital per discharge,17028,Other,100% of NY Medicaid HMO DRG,17028,,DRG base rate x DRG weight + capital per discharge,17028,Other,100% of NY Medicaid HMO DRG,38313,,225% x Medicaid HMO amount,38313,Other,225% of NY Medicaid HMO DRG,26053,,153% x Medicaid HMO amount,26053,Other,153% of NY Medicaid HMO DRG,38313,,225% x Medicaid HMO amount,38313,Other,225% of NY Medicaid HMO DRG,23839,,140% x Medicaid HMO amount,23839,Other,140% of NY Medicaid HMO DRG,38313,,DRG base rate x DRG weight + capital per discharge,38313,Other,225% of NY Medicaid HMO DRG,46828,,275% x Medicaid HMO amount,46828,Other,275% of NY Medicaid HMO DRG,55171,,324% x Medicaid HMO amount,55171,Other,324% of NY Medicaid HMO DRG,36611,,215% x Medicaid HMO amount,36611,Other,215% of NY Medicaid HMO DRG,36611,,215% x Medicaid HMO amount,36611,Other,215% of NY Medicaid HMO DRG,21285,,125% x Medicaid HMO amount,21285,Other,125% of NY Medicaid HMO DRG,0.01,72045,
Other procedures of blood & blood-forming organs,651-4,APR-DRG,,,,,,,,inpatient,,,5226480.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45429,,186% x Medicaid HMO amount,45429,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,104233,,"27,634 x DRG Weight",104233,Other,DRG Base Rate x DRG Weight,88594,,"23,488 x DRG Weight",88594,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24424.21,,DRG base rate x DRG weight + capital per discharge,24424.21,Other,100% of NY Medicaid HMO DRG,24424,,DRG base rate x DRG weight + capital per discharge,24424,Other,100% of NY Medicaid HMO DRG,24424,,DRG base rate x DRG weight + capital per discharge,24424,Other,100% of NY Medicaid HMO DRG,24424,,DRG base rate x DRG weight + capital per discharge,24424,Other,100% of NY Medicaid HMO DRG,54954,,225% x Medicaid HMO amount,54954,Other,225% of NY Medicaid HMO DRG,37369,,153% x Medicaid HMO amount,37369,Other,153% of NY Medicaid HMO DRG,54954,,225% x Medicaid HMO amount,54954,Other,225% of NY Medicaid HMO DRG,34194,,140% x Medicaid HMO amount,34194,Other,140% of NY Medicaid HMO DRG,54954,,DRG base rate x DRG weight + capital per discharge,54954,Other,225% of NY Medicaid HMO DRG,67167,,275% x Medicaid HMO amount,67167,Other,275% of NY Medicaid HMO DRG,79134,,324% x Medicaid HMO amount,79134,Other,324% of NY Medicaid HMO DRG,52512,,215% x Medicaid HMO amount,52512,Other,215% of NY Medicaid HMO DRG,52512,,215% x Medicaid HMO amount,52512,Other,215% of NY Medicaid HMO DRG,30530,,125% x Medicaid HMO amount,30530,Other,125% of NY Medicaid HMO DRG,0.01,104233,
Major hematologic/immunologic diag exc sickle cell crisis & coagul,660-1,APR-DRG,,,,,,,,inpatient,,,252504.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9116,,186% x Medicaid HMO amount,9116,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19269,,"27,634 x DRG Weight",19269,Other,DRG Base Rate x DRG Weight,16378,,"23,488 x DRG Weight",16378,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4901.21,,DRG base rate x DRG weight + capital per discharge,4901.21,Other,100% of NY Medicaid HMO DRG,4901,,DRG base rate x DRG weight + capital per discharge,4901,Other,100% of NY Medicaid HMO DRG,4901,,DRG base rate x DRG weight + capital per discharge,4901,Other,100% of NY Medicaid HMO DRG,4901,,DRG base rate x DRG weight + capital per discharge,4901,Other,100% of NY Medicaid HMO DRG,11028,,225% x Medicaid HMO amount,11028,Other,225% of NY Medicaid HMO DRG,7499,,153% x Medicaid HMO amount,7499,Other,153% of NY Medicaid HMO DRG,11028,,225% x Medicaid HMO amount,11028,Other,225% of NY Medicaid HMO DRG,6862,,140% x Medicaid HMO amount,6862,Other,140% of NY Medicaid HMO DRG,11028,,DRG base rate x DRG weight + capital per discharge,11028,Other,225% of NY Medicaid HMO DRG,13478,,275% x Medicaid HMO amount,13478,Other,275% of NY Medicaid HMO DRG,15880,,324% x Medicaid HMO amount,15880,Other,324% of NY Medicaid HMO DRG,10538,,215% x Medicaid HMO amount,10538,Other,215% of NY Medicaid HMO DRG,10538,,215% x Medicaid HMO amount,10538,Other,215% of NY Medicaid HMO DRG,6127,,125% x Medicaid HMO amount,6127,Other,125% of NY Medicaid HMO DRG,0.01,19269,
Major hematologic/immunologic diag exc sickle cell crisis & coagul,660-2,APR-DRG,,,,,,,,inpatient,,,171773.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11508,,186% x Medicaid HMO amount,11508,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24868,,"27,634 x DRG Weight",24868,Other,DRG Base Rate x DRG Weight,21137,,"23,488 x DRG Weight",21137,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6187.21,,DRG base rate x DRG weight + capital per discharge,6187.21,Other,100% of NY Medicaid HMO DRG,6187,,DRG base rate x DRG weight + capital per discharge,6187,Other,100% of NY Medicaid HMO DRG,6187,,DRG base rate x DRG weight + capital per discharge,6187,Other,100% of NY Medicaid HMO DRG,6187,,DRG base rate x DRG weight + capital per discharge,6187,Other,100% of NY Medicaid HMO DRG,13921,,225% x Medicaid HMO amount,13921,Other,225% of NY Medicaid HMO DRG,9466,,153% x Medicaid HMO amount,9466,Other,153% of NY Medicaid HMO DRG,13921,,225% x Medicaid HMO amount,13921,Other,225% of NY Medicaid HMO DRG,8662,,140% x Medicaid HMO amount,8662,Other,140% of NY Medicaid HMO DRG,13921,,DRG base rate x DRG weight + capital per discharge,13921,Other,225% of NY Medicaid HMO DRG,17015,,275% x Medicaid HMO amount,17015,Other,275% of NY Medicaid HMO DRG,20047,,324% x Medicaid HMO amount,20047,Other,324% of NY Medicaid HMO DRG,13303,,215% x Medicaid HMO amount,13303,Other,215% of NY Medicaid HMO DRG,13303,,215% x Medicaid HMO amount,13303,Other,215% of NY Medicaid HMO DRG,7734,,125% x Medicaid HMO amount,7734,Other,125% of NY Medicaid HMO DRG,0.01,24868,
Major hematologic/immunologic diag exc sickle cell crisis & coagul,660-3,APR-DRG,,,,,,,,inpatient,,,208287.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18853,,186% x Medicaid HMO amount,18853,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42051,,"27,634 x DRG Weight",42051,Other,DRG Base Rate x DRG Weight,35742,,"23,488 x DRG Weight",35742,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10136.21,,DRG base rate x DRG weight + capital per discharge,10136.21,Other,100% of NY Medicaid HMO DRG,10136,,DRG base rate x DRG weight + capital per discharge,10136,Other,100% of NY Medicaid HMO DRG,10136,,DRG base rate x DRG weight + capital per discharge,10136,Other,100% of NY Medicaid HMO DRG,10136,,DRG base rate x DRG weight + capital per discharge,10136,Other,100% of NY Medicaid HMO DRG,22806,,225% x Medicaid HMO amount,22806,Other,225% of NY Medicaid HMO DRG,15508,,153% x Medicaid HMO amount,15508,Other,153% of NY Medicaid HMO DRG,22806,,225% x Medicaid HMO amount,22806,Other,225% of NY Medicaid HMO DRG,14191,,140% x Medicaid HMO amount,14191,Other,140% of NY Medicaid HMO DRG,22806,,DRG base rate x DRG weight + capital per discharge,22806,Other,225% of NY Medicaid HMO DRG,27875,,275% x Medicaid HMO amount,27875,Other,275% of NY Medicaid HMO DRG,32841,,324% x Medicaid HMO amount,32841,Other,324% of NY Medicaid HMO DRG,21793,,215% x Medicaid HMO amount,21793,Other,215% of NY Medicaid HMO DRG,21793,,215% x Medicaid HMO amount,21793,Other,215% of NY Medicaid HMO DRG,12670,,125% x Medicaid HMO amount,12670,Other,125% of NY Medicaid HMO DRG,0.01,42051,
Major hematologic/immunologic diag exc sickle cell crisis & coagul,660-4,APR-DRG,,,,,,,,inpatient,,,344483.25,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59674,,186% x Medicaid HMO amount,59674,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,137562,,"27,634 x DRG Weight",137562,Other,DRG Base Rate x DRG Weight,116923,,"23,488 x DRG Weight",116923,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32083.21,,DRG base rate x DRG weight + capital per discharge,32083.21,Other,100% of NY Medicaid HMO DRG,32083,,DRG base rate x DRG weight + capital per discharge,32083,Other,100% of NY Medicaid HMO DRG,32083,,DRG base rate x DRG weight + capital per discharge,32083,Other,100% of NY Medicaid HMO DRG,32083,,DRG base rate x DRG weight + capital per discharge,32083,Other,100% of NY Medicaid HMO DRG,72187,,225% x Medicaid HMO amount,72187,Other,225% of NY Medicaid HMO DRG,49087,,153% x Medicaid HMO amount,49087,Other,153% of NY Medicaid HMO DRG,72187,,225% x Medicaid HMO amount,72187,Other,225% of NY Medicaid HMO DRG,44916,,140% x Medicaid HMO amount,44916,Other,140% of NY Medicaid HMO DRG,72187,,DRG base rate x DRG weight + capital per discharge,72187,Other,225% of NY Medicaid HMO DRG,88229,,275% x Medicaid HMO amount,88229,Other,275% of NY Medicaid HMO DRG,103950,,324% x Medicaid HMO amount,103950,Other,324% of NY Medicaid HMO DRG,68979,,215% x Medicaid HMO amount,68979,Other,215% of NY Medicaid HMO DRG,68979,,215% x Medicaid HMO amount,68979,Other,215% of NY Medicaid HMO DRG,40104,,125% x Medicaid HMO amount,40104,Other,125% of NY Medicaid HMO DRG,0.01,137562,
Coagulation & platelet disorders,661-1,APR-DRG,,,,,,,,inpatient,,,63070.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12804,,186% x Medicaid HMO amount,12804,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27899,,"27,634 x DRG Weight",27899,Other,DRG Base Rate x DRG Weight,23713,,"23,488 x DRG Weight",23713,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6884.21,,DRG base rate x DRG weight + capital per discharge,6884.21,Other,100% of NY Medicaid HMO DRG,6884,,DRG base rate x DRG weight + capital per discharge,6884,Other,100% of NY Medicaid HMO DRG,6884,,DRG base rate x DRG weight + capital per discharge,6884,Other,100% of NY Medicaid HMO DRG,6884,,DRG base rate x DRG weight + capital per discharge,6884,Other,100% of NY Medicaid HMO DRG,15489,,225% x Medicaid HMO amount,15489,Other,225% of NY Medicaid HMO DRG,10533,,153% x Medicaid HMO amount,10533,Other,153% of NY Medicaid HMO DRG,15489,,225% x Medicaid HMO amount,15489,Other,225% of NY Medicaid HMO DRG,9638,,140% x Medicaid HMO amount,9638,Other,140% of NY Medicaid HMO DRG,15489,,DRG base rate x DRG weight + capital per discharge,15489,Other,225% of NY Medicaid HMO DRG,18932,,275% x Medicaid HMO amount,18932,Other,275% of NY Medicaid HMO DRG,22305,,324% x Medicaid HMO amount,22305,Other,324% of NY Medicaid HMO DRG,14801,,215% x Medicaid HMO amount,14801,Other,215% of NY Medicaid HMO DRG,14801,,215% x Medicaid HMO amount,14801,Other,215% of NY Medicaid HMO DRG,8605,,125% x Medicaid HMO amount,8605,Other,125% of NY Medicaid HMO DRG,0.01,27899,
Coagulation & platelet disorders,661-2,APR-DRG,,,,,,,,inpatient,,,105753.81,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14886,,186% x Medicaid HMO amount,14886,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32768,,"27,634 x DRG Weight",32768,Other,DRG Base Rate x DRG Weight,27852,,"23,488 x DRG Weight",27852,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8003.21,,DRG base rate x DRG weight + capital per discharge,8003.21,Other,100% of NY Medicaid HMO DRG,8003,,DRG base rate x DRG weight + capital per discharge,8003,Other,100% of NY Medicaid HMO DRG,8003,,DRG base rate x DRG weight + capital per discharge,8003,Other,100% of NY Medicaid HMO DRG,8003,,DRG base rate x DRG weight + capital per discharge,8003,Other,100% of NY Medicaid HMO DRG,18007,,225% x Medicaid HMO amount,18007,Other,225% of NY Medicaid HMO DRG,12245,,153% x Medicaid HMO amount,12245,Other,153% of NY Medicaid HMO DRG,18007,,225% x Medicaid HMO amount,18007,Other,225% of NY Medicaid HMO DRG,11204,,140% x Medicaid HMO amount,11204,Other,140% of NY Medicaid HMO DRG,18007,,DRG base rate x DRG weight + capital per discharge,18007,Other,225% of NY Medicaid HMO DRG,22009,,275% x Medicaid HMO amount,22009,Other,275% of NY Medicaid HMO DRG,25930,,324% x Medicaid HMO amount,25930,Other,324% of NY Medicaid HMO DRG,17207,,215% x Medicaid HMO amount,17207,Other,215% of NY Medicaid HMO DRG,17207,,215% x Medicaid HMO amount,17207,Other,215% of NY Medicaid HMO DRG,10004,,125% x Medicaid HMO amount,10004,Other,125% of NY Medicaid HMO DRG,0.01,32768,
Coagulation & platelet disorders,661-3,APR-DRG,,,,,,,,inpatient,,,154412.12,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23979,,186% x Medicaid HMO amount,23979,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54047,,"27,634 x DRG Weight",54047,Other,DRG Base Rate x DRG Weight,45938,,"23,488 x DRG Weight",45938,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12892.21,,DRG base rate x DRG weight + capital per discharge,12892.21,Other,100% of NY Medicaid HMO DRG,12892,,DRG base rate x DRG weight + capital per discharge,12892,Other,100% of NY Medicaid HMO DRG,12892,,DRG base rate x DRG weight + capital per discharge,12892,Other,100% of NY Medicaid HMO DRG,12892,,DRG base rate x DRG weight + capital per discharge,12892,Other,100% of NY Medicaid HMO DRG,29007,,225% x Medicaid HMO amount,29007,Other,225% of NY Medicaid HMO DRG,19725,,153% x Medicaid HMO amount,19725,Other,153% of NY Medicaid HMO DRG,29007,,225% x Medicaid HMO amount,29007,Other,225% of NY Medicaid HMO DRG,18049,,140% x Medicaid HMO amount,18049,Other,140% of NY Medicaid HMO DRG,29007,,DRG base rate x DRG weight + capital per discharge,29007,Other,225% of NY Medicaid HMO DRG,35454,,275% x Medicaid HMO amount,35454,Other,275% of NY Medicaid HMO DRG,41771,,324% x Medicaid HMO amount,41771,Other,324% of NY Medicaid HMO DRG,27718,,215% x Medicaid HMO amount,27718,Other,215% of NY Medicaid HMO DRG,27718,,215% x Medicaid HMO amount,27718,Other,215% of NY Medicaid HMO DRG,16115,,125% x Medicaid HMO amount,16115,Other,125% of NY Medicaid HMO DRG,0.01,54047,
Coagulation & platelet disorders,661-4,APR-DRG,,,,,,,,inpatient,,,801302.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54810,,186% x Medicaid HMO amount,54810,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,126180,,"27,634 x DRG Weight",126180,Other,DRG Base Rate x DRG Weight,107249,,"23,488 x DRG Weight",107249,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29468.21,,DRG base rate x DRG weight + capital per discharge,29468.21,Other,100% of NY Medicaid HMO DRG,29468,,DRG base rate x DRG weight + capital per discharge,29468,Other,100% of NY Medicaid HMO DRG,29468,,DRG base rate x DRG weight + capital per discharge,29468,Other,100% of NY Medicaid HMO DRG,29468,,DRG base rate x DRG weight + capital per discharge,29468,Other,100% of NY Medicaid HMO DRG,66303,,225% x Medicaid HMO amount,66303,Other,225% of NY Medicaid HMO DRG,45086,,153% x Medicaid HMO amount,45086,Other,153% of NY Medicaid HMO DRG,66303,,225% x Medicaid HMO amount,66303,Other,225% of NY Medicaid HMO DRG,41255,,140% x Medicaid HMO amount,41255,Other,140% of NY Medicaid HMO DRG,66303,,DRG base rate x DRG weight + capital per discharge,66303,Other,225% of NY Medicaid HMO DRG,81038,,275% x Medicaid HMO amount,81038,Other,275% of NY Medicaid HMO DRG,95477,,324% x Medicaid HMO amount,95477,Other,324% of NY Medicaid HMO DRG,63357,,215% x Medicaid HMO amount,63357,Other,215% of NY Medicaid HMO DRG,63357,,215% x Medicaid HMO amount,63357,Other,215% of NY Medicaid HMO DRG,36835,,125% x Medicaid HMO amount,36835,Other,125% of NY Medicaid HMO DRG,0.01,126180,
Sickle cell anemia crisis,662-1,APR-DRG,,,,,,,,inpatient,,,104438.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8779,,186% x Medicaid HMO amount,8779,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18482,,"27,634 x DRG Weight",18482,Other,DRG Base Rate x DRG Weight,15709,,"23,488 x DRG Weight",15709,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4720.21,,DRG base rate x DRG weight + capital per discharge,4720.21,Other,100% of NY Medicaid HMO DRG,4720,,DRG base rate x DRG weight + capital per discharge,4720,Other,100% of NY Medicaid HMO DRG,4720,,DRG base rate x DRG weight + capital per discharge,4720,Other,100% of NY Medicaid HMO DRG,4720,,DRG base rate x DRG weight + capital per discharge,4720,Other,100% of NY Medicaid HMO DRG,10620,,225% x Medicaid HMO amount,10620,Other,225% of NY Medicaid HMO DRG,7222,,153% x Medicaid HMO amount,7222,Other,153% of NY Medicaid HMO DRG,10620,,225% x Medicaid HMO amount,10620,Other,225% of NY Medicaid HMO DRG,6608,,140% x Medicaid HMO amount,6608,Other,140% of NY Medicaid HMO DRG,10620,,DRG base rate x DRG weight + capital per discharge,10620,Other,225% of NY Medicaid HMO DRG,12981,,275% x Medicaid HMO amount,12981,Other,275% of NY Medicaid HMO DRG,15293,,324% x Medicaid HMO amount,15293,Other,324% of NY Medicaid HMO DRG,10148,,215% x Medicaid HMO amount,10148,Other,215% of NY Medicaid HMO DRG,10148,,215% x Medicaid HMO amount,10148,Other,215% of NY Medicaid HMO DRG,5900,,125% x Medicaid HMO amount,5900,Other,125% of NY Medicaid HMO DRG,0.01,18482,
Sickle cell anemia crisis,662-2,APR-DRG,,,,,,,,inpatient,,,170158.57,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12280,,186% x Medicaid HMO amount,12280,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26672,,"27,634 x DRG Weight",26672,Other,DRG Base Rate x DRG Weight,22671,,"23,488 x DRG Weight",22671,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6602.21,,DRG base rate x DRG weight + capital per discharge,6602.21,Other,100% of NY Medicaid HMO DRG,6602,,DRG base rate x DRG weight + capital per discharge,6602,Other,100% of NY Medicaid HMO DRG,6602,,DRG base rate x DRG weight + capital per discharge,6602,Other,100% of NY Medicaid HMO DRG,6602,,DRG base rate x DRG weight + capital per discharge,6602,Other,100% of NY Medicaid HMO DRG,14855,,225% x Medicaid HMO amount,14855,Other,225% of NY Medicaid HMO DRG,10101,,153% x Medicaid HMO amount,10101,Other,153% of NY Medicaid HMO DRG,14855,,225% x Medicaid HMO amount,14855,Other,225% of NY Medicaid HMO DRG,9243,,140% x Medicaid HMO amount,9243,Other,140% of NY Medicaid HMO DRG,14855,,DRG base rate x DRG weight + capital per discharge,14855,Other,225% of NY Medicaid HMO DRG,18156,,275% x Medicaid HMO amount,18156,Other,275% of NY Medicaid HMO DRG,21391,,324% x Medicaid HMO amount,21391,Other,324% of NY Medicaid HMO DRG,14195,,215% x Medicaid HMO amount,14195,Other,215% of NY Medicaid HMO DRG,14195,,215% x Medicaid HMO amount,14195,Other,215% of NY Medicaid HMO DRG,8253,,125% x Medicaid HMO amount,8253,Other,125% of NY Medicaid HMO DRG,0.01,26672,
Sickle cell anemia crisis,662-3,APR-DRG,,,,,,,,inpatient,,,231736.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19076,,186% x Medicaid HMO amount,19076,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42576,,"27,634 x DRG Weight",42576,Other,DRG Base Rate x DRG Weight,36188,,"23,488 x DRG Weight",36188,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10256.21,,DRG base rate x DRG weight + capital per discharge,10256.21,Other,100% of NY Medicaid HMO DRG,10256,,DRG base rate x DRG weight + capital per discharge,10256,Other,100% of NY Medicaid HMO DRG,10256,,DRG base rate x DRG weight + capital per discharge,10256,Other,100% of NY Medicaid HMO DRG,10256,,DRG base rate x DRG weight + capital per discharge,10256,Other,100% of NY Medicaid HMO DRG,23076,,225% x Medicaid HMO amount,23076,Other,225% of NY Medicaid HMO DRG,15692,,153% x Medicaid HMO amount,15692,Other,153% of NY Medicaid HMO DRG,23076,,225% x Medicaid HMO amount,23076,Other,225% of NY Medicaid HMO DRG,14359,,140% x Medicaid HMO amount,14359,Other,140% of NY Medicaid HMO DRG,23076,,DRG base rate x DRG weight + capital per discharge,23076,Other,225% of NY Medicaid HMO DRG,28205,,275% x Medicaid HMO amount,28205,Other,275% of NY Medicaid HMO DRG,33230,,324% x Medicaid HMO amount,33230,Other,324% of NY Medicaid HMO DRG,22051,,215% x Medicaid HMO amount,22051,Other,215% of NY Medicaid HMO DRG,22051,,215% x Medicaid HMO amount,22051,Other,215% of NY Medicaid HMO DRG,12820,,125% x Medicaid HMO amount,12820,Other,125% of NY Medicaid HMO DRG,0.01,42576,
Sickle cell anemia crisis,662-4,APR-DRG,,,,,,,,inpatient,,,510760.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40001,,186% x Medicaid HMO amount,40001,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,91532,,"27,634 x DRG Weight",91532,Other,DRG Base Rate x DRG Weight,77799,,"23,488 x DRG Weight",77799,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21506.21,,DRG base rate x DRG weight + capital per discharge,21506.21,Other,100% of NY Medicaid HMO DRG,21506,,DRG base rate x DRG weight + capital per discharge,21506,Other,100% of NY Medicaid HMO DRG,21506,,DRG base rate x DRG weight + capital per discharge,21506,Other,100% of NY Medicaid HMO DRG,21506,,DRG base rate x DRG weight + capital per discharge,21506,Other,100% of NY Medicaid HMO DRG,48389,,225% x Medicaid HMO amount,48389,Other,225% of NY Medicaid HMO DRG,32905,,153% x Medicaid HMO amount,32905,Other,153% of NY Medicaid HMO DRG,48389,,225% x Medicaid HMO amount,48389,Other,225% of NY Medicaid HMO DRG,30109,,140% x Medicaid HMO amount,30109,Other,140% of NY Medicaid HMO DRG,48389,,DRG base rate x DRG weight + capital per discharge,48389,Other,225% of NY Medicaid HMO DRG,59142,,275% x Medicaid HMO amount,59142,Other,275% of NY Medicaid HMO DRG,69680,,324% x Medicaid HMO amount,69680,Other,324% of NY Medicaid HMO DRG,46238,,215% x Medicaid HMO amount,46238,Other,215% of NY Medicaid HMO DRG,46238,,215% x Medicaid HMO amount,46238,Other,215% of NY Medicaid HMO DRG,26883,,125% x Medicaid HMO amount,26883,Other,125% of NY Medicaid HMO DRG,0.01,91532,
Other anemia & disorders of blood & blood-forming organs,663-1,APR-DRG,,,,,,,,inpatient,,,71386.2,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6942,,186% x Medicaid HMO amount,6942,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14185,,"27,634 x DRG Weight",14185,Other,DRG Base Rate x DRG Weight,12056,,"23,488 x DRG Weight",12056,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3732.21,,DRG base rate x DRG weight + capital per discharge,3732.21,Other,100% of NY Medicaid HMO DRG,3732,,DRG base rate x DRG weight + capital per discharge,3732,Other,100% of NY Medicaid HMO DRG,3732,,DRG base rate x DRG weight + capital per discharge,3732,Other,100% of NY Medicaid HMO DRG,3732,,DRG base rate x DRG weight + capital per discharge,3732,Other,100% of NY Medicaid HMO DRG,8397,,225% x Medicaid HMO amount,8397,Other,225% of NY Medicaid HMO DRG,5710,,153% x Medicaid HMO amount,5710,Other,153% of NY Medicaid HMO DRG,8397,,225% x Medicaid HMO amount,8397,Other,225% of NY Medicaid HMO DRG,5225,,140% x Medicaid HMO amount,5225,Other,140% of NY Medicaid HMO DRG,8397,,DRG base rate x DRG weight + capital per discharge,8397,Other,225% of NY Medicaid HMO DRG,10264,,275% x Medicaid HMO amount,10264,Other,275% of NY Medicaid HMO DRG,12092,,324% x Medicaid HMO amount,12092,Other,324% of NY Medicaid HMO DRG,8024,,215% x Medicaid HMO amount,8024,Other,215% of NY Medicaid HMO DRG,8024,,215% x Medicaid HMO amount,8024,Other,215% of NY Medicaid HMO DRG,4665,,125% x Medicaid HMO amount,4665,Other,125% of NY Medicaid HMO DRG,0.01,14185,
Other anemia & disorders of blood & blood-forming organs,663-2,APR-DRG,,,,,,,,inpatient,,,99629.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9201,,186% x Medicaid HMO amount,9201,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19471,,"27,634 x DRG Weight",19471,Other,DRG Base Rate x DRG Weight,16550,,"23,488 x DRG Weight",16550,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4947.21,,DRG base rate x DRG weight + capital per discharge,4947.21,Other,100% of NY Medicaid HMO DRG,4947,,DRG base rate x DRG weight + capital per discharge,4947,Other,100% of NY Medicaid HMO DRG,4947,,DRG base rate x DRG weight + capital per discharge,4947,Other,100% of NY Medicaid HMO DRG,4947,,DRG base rate x DRG weight + capital per discharge,4947,Other,100% of NY Medicaid HMO DRG,11131,,225% x Medicaid HMO amount,11131,Other,225% of NY Medicaid HMO DRG,7569,,153% x Medicaid HMO amount,7569,Other,153% of NY Medicaid HMO DRG,11131,,225% x Medicaid HMO amount,11131,Other,225% of NY Medicaid HMO DRG,6926,,140% x Medicaid HMO amount,6926,Other,140% of NY Medicaid HMO DRG,11131,,DRG base rate x DRG weight + capital per discharge,11131,Other,225% of NY Medicaid HMO DRG,13605,,275% x Medicaid HMO amount,13605,Other,275% of NY Medicaid HMO DRG,16029,,324% x Medicaid HMO amount,16029,Other,324% of NY Medicaid HMO DRG,10637,,215% x Medicaid HMO amount,10637,Other,215% of NY Medicaid HMO DRG,10637,,215% x Medicaid HMO amount,10637,Other,215% of NY Medicaid HMO DRG,6184,,125% x Medicaid HMO amount,6184,Other,125% of NY Medicaid HMO DRG,0.01,19471,
Other anemia & disorders of blood & blood-forming organs,663-3,APR-DRG,,,,,,,,inpatient,,,162030.83,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13995,,186% x Medicaid HMO amount,13995,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30685,,"27,634 x DRG Weight",30685,Other,DRG Base Rate x DRG Weight,26081,,"23,488 x DRG Weight",26081,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7524.21,,DRG base rate x DRG weight + capital per discharge,7524.21,Other,100% of NY Medicaid HMO DRG,7524,,DRG base rate x DRG weight + capital per discharge,7524,Other,100% of NY Medicaid HMO DRG,7524,,DRG base rate x DRG weight + capital per discharge,7524,Other,100% of NY Medicaid HMO DRG,7524,,DRG base rate x DRG weight + capital per discharge,7524,Other,100% of NY Medicaid HMO DRG,16929,,225% x Medicaid HMO amount,16929,Other,225% of NY Medicaid HMO DRG,11512,,153% x Medicaid HMO amount,11512,Other,153% of NY Medicaid HMO DRG,16929,,225% x Medicaid HMO amount,16929,Other,225% of NY Medicaid HMO DRG,10534,,140% x Medicaid HMO amount,10534,Other,140% of NY Medicaid HMO DRG,16929,,DRG base rate x DRG weight + capital per discharge,16929,Other,225% of NY Medicaid HMO DRG,20692,,275% x Medicaid HMO amount,20692,Other,275% of NY Medicaid HMO DRG,24378,,324% x Medicaid HMO amount,24378,Other,324% of NY Medicaid HMO DRG,16177,,215% x Medicaid HMO amount,16177,Other,215% of NY Medicaid HMO DRG,16177,,215% x Medicaid HMO amount,16177,Other,215% of NY Medicaid HMO DRG,9405,,125% x Medicaid HMO amount,9405,Other,125% of NY Medicaid HMO DRG,0.01,30685,
Other anemia & disorders of blood & blood-forming organs,663-4,APR-DRG,,,,,,,,inpatient,,,575292.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28700,,186% x Medicaid HMO amount,28700,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65089,,"27,634 x DRG Weight",65089,Other,DRG Base Rate x DRG Weight,55324,,"23,488 x DRG Weight",55324,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15430.21,,DRG base rate x DRG weight + capital per discharge,15430.21,Other,100% of NY Medicaid HMO DRG,15430,,DRG base rate x DRG weight + capital per discharge,15430,Other,100% of NY Medicaid HMO DRG,15430,,DRG base rate x DRG weight + capital per discharge,15430,Other,100% of NY Medicaid HMO DRG,15430,,DRG base rate x DRG weight + capital per discharge,15430,Other,100% of NY Medicaid HMO DRG,34718,,225% x Medicaid HMO amount,34718,Other,225% of NY Medicaid HMO DRG,23608,,153% x Medicaid HMO amount,23608,Other,153% of NY Medicaid HMO DRG,34718,,225% x Medicaid HMO amount,34718,Other,225% of NY Medicaid HMO DRG,21602,,140% x Medicaid HMO amount,21602,Other,140% of NY Medicaid HMO DRG,34718,,DRG base rate x DRG weight + capital per discharge,34718,Other,225% of NY Medicaid HMO DRG,42433,,275% x Medicaid HMO amount,42433,Other,275% of NY Medicaid HMO DRG,49994,,324% x Medicaid HMO amount,49994,Other,324% of NY Medicaid HMO DRG,33175,,215% x Medicaid HMO amount,33175,Other,215% of NY Medicaid HMO DRG,33175,,215% x Medicaid HMO amount,33175,Other,215% of NY Medicaid HMO DRG,19288,,125% x Medicaid HMO amount,19288,Other,125% of NY Medicaid HMO DRG,0.01,65089,
Major O.R. procedures for lymphatic/hematopoietic/other neoplasms,680-1,APR-DRG,,,,,,,,inpatient,,,81015.57,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17225,,186% x Medicaid HMO amount,17225,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38245,,"27,634 x DRG Weight",38245,Other,DRG Base Rate x DRG Weight,32507,,"23,488 x DRG Weight",32507,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9261.21,,DRG base rate x DRG weight + capital per discharge,9261.21,Other,100% of NY Medicaid HMO DRG,9261,,DRG base rate x DRG weight + capital per discharge,9261,Other,100% of NY Medicaid HMO DRG,9261,,DRG base rate x DRG weight + capital per discharge,9261,Other,100% of NY Medicaid HMO DRG,9261,,DRG base rate x DRG weight + capital per discharge,9261,Other,100% of NY Medicaid HMO DRG,20838,,225% x Medicaid HMO amount,20838,Other,225% of NY Medicaid HMO DRG,14170,,153% x Medicaid HMO amount,14170,Other,153% of NY Medicaid HMO DRG,20838,,225% x Medicaid HMO amount,20838,Other,225% of NY Medicaid HMO DRG,12966,,140% x Medicaid HMO amount,12966,Other,140% of NY Medicaid HMO DRG,20838,,DRG base rate x DRG weight + capital per discharge,20838,Other,225% of NY Medicaid HMO DRG,25468,,275% x Medicaid HMO amount,25468,Other,275% of NY Medicaid HMO DRG,30006,,324% x Medicaid HMO amount,30006,Other,324% of NY Medicaid HMO DRG,19912,,215% x Medicaid HMO amount,19912,Other,215% of NY Medicaid HMO DRG,19912,,215% x Medicaid HMO amount,19912,Other,215% of NY Medicaid HMO DRG,11577,,125% x Medicaid HMO amount,11577,Other,125% of NY Medicaid HMO DRG,0.01,38245,
Major O.R. procedures for lymphatic/hematopoietic/other neoplasms,680-2,APR-DRG,,,,,,,,inpatient,,,570412.22,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26648,,186% x Medicaid HMO amount,26648,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60289,,"27,634 x DRG Weight",60289,Other,DRG Base Rate x DRG Weight,51244,,"23,488 x DRG Weight",51244,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14327.21,,DRG base rate x DRG weight + capital per discharge,14327.21,Other,100% of NY Medicaid HMO DRG,14327,,DRG base rate x DRG weight + capital per discharge,14327,Other,100% of NY Medicaid HMO DRG,14327,,DRG base rate x DRG weight + capital per discharge,14327,Other,100% of NY Medicaid HMO DRG,14327,,DRG base rate x DRG weight + capital per discharge,14327,Other,100% of NY Medicaid HMO DRG,32236,,225% x Medicaid HMO amount,32236,Other,225% of NY Medicaid HMO DRG,21921,,153% x Medicaid HMO amount,21921,Other,153% of NY Medicaid HMO DRG,32236,,225% x Medicaid HMO amount,32236,Other,225% of NY Medicaid HMO DRG,20058,,140% x Medicaid HMO amount,20058,Other,140% of NY Medicaid HMO DRG,32236,,DRG base rate x DRG weight + capital per discharge,32236,Other,225% of NY Medicaid HMO DRG,39400,,275% x Medicaid HMO amount,39400,Other,275% of NY Medicaid HMO DRG,46420,,324% x Medicaid HMO amount,46420,Other,324% of NY Medicaid HMO DRG,30804,,215% x Medicaid HMO amount,30804,Other,215% of NY Medicaid HMO DRG,30804,,215% x Medicaid HMO amount,30804,Other,215% of NY Medicaid HMO DRG,17909,,125% x Medicaid HMO amount,17909,Other,125% of NY Medicaid HMO DRG,0.01,60289,
Major O.R. procedures for lymphatic/hematopoietic/other neoplasms,680-3,APR-DRG,,,,,,,,inpatient,,,456927.81,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46573,,186% x Medicaid HMO amount,46573,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,106908,,"27,634 x DRG Weight",106908,Other,DRG Base Rate x DRG Weight,90868,,"23,488 x DRG Weight",90868,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25039.21,,DRG base rate x DRG weight + capital per discharge,25039.21,Other,100% of NY Medicaid HMO DRG,25039,,DRG base rate x DRG weight + capital per discharge,25039,Other,100% of NY Medicaid HMO DRG,25039,,DRG base rate x DRG weight + capital per discharge,25039,Other,100% of NY Medicaid HMO DRG,25039,,DRG base rate x DRG weight + capital per discharge,25039,Other,100% of NY Medicaid HMO DRG,56338,,225% x Medicaid HMO amount,56338,Other,225% of NY Medicaid HMO DRG,38310,,153% x Medicaid HMO amount,38310,Other,153% of NY Medicaid HMO DRG,56338,,225% x Medicaid HMO amount,56338,Other,225% of NY Medicaid HMO DRG,35055,,140% x Medicaid HMO amount,35055,Other,140% of NY Medicaid HMO DRG,56338,,DRG base rate x DRG weight + capital per discharge,56338,Other,225% of NY Medicaid HMO DRG,68858,,275% x Medicaid HMO amount,68858,Other,275% of NY Medicaid HMO DRG,81127,,324% x Medicaid HMO amount,81127,Other,324% of NY Medicaid HMO DRG,53834,,215% x Medicaid HMO amount,53834,Other,215% of NY Medicaid HMO DRG,53834,,215% x Medicaid HMO amount,53834,Other,215% of NY Medicaid HMO DRG,31299,,125% x Medicaid HMO amount,31299,Other,125% of NY Medicaid HMO DRG,0.01,106908,
Major O.R. procedures for lymphatic/hematopoietic/other neoplasms,680-4,APR-DRG,,,,,,,,inpatient,,,1626126.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,106545,,186% x Medicaid HMO amount,106545,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,247222,,"27,634 x DRG Weight",247222,Other,DRG Base Rate x DRG Weight,210131,,"23,488 x DRG Weight",210131,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57282.21,,DRG base rate x DRG weight + capital per discharge,57282.21,Other,100% of NY Medicaid HMO DRG,57282,,DRG base rate x DRG weight + capital per discharge,57282,Other,100% of NY Medicaid HMO DRG,57282,,DRG base rate x DRG weight + capital per discharge,57282,Other,100% of NY Medicaid HMO DRG,57282,,DRG base rate x DRG weight + capital per discharge,57282,Other,100% of NY Medicaid HMO DRG,128885,,225% x Medicaid HMO amount,128885,Other,225% of NY Medicaid HMO DRG,87642,,153% x Medicaid HMO amount,87642,Other,153% of NY Medicaid HMO DRG,128885,,225% x Medicaid HMO amount,128885,Other,225% of NY Medicaid HMO DRG,80195,,140% x Medicaid HMO amount,80195,Other,140% of NY Medicaid HMO DRG,128885,,DRG base rate x DRG weight + capital per discharge,128885,Other,225% of NY Medicaid HMO DRG,157526,,275% x Medicaid HMO amount,157526,Other,275% of NY Medicaid HMO DRG,185594,,324% x Medicaid HMO amount,185594,Other,324% of NY Medicaid HMO DRG,123157,,215% x Medicaid HMO amount,123157,Other,215% of NY Medicaid HMO DRG,123157,,215% x Medicaid HMO amount,123157,Other,215% of NY Medicaid HMO DRG,71603,,125% x Medicaid HMO amount,71603,Other,125% of NY Medicaid HMO DRG,0.01,247222,
Other O.R. procedures for lymphatic/hematopoietic/other neoplasms,681-1,APR-DRG,,,,,,,,inpatient,,,306613.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12079,,186% x Medicaid HMO amount,12079,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26203,,"27,634 x DRG Weight",26203,Other,DRG Base Rate x DRG Weight,22271,,"23,488 x DRG Weight",22271,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6494.21,,DRG base rate x DRG weight + capital per discharge,6494.21,Other,100% of NY Medicaid HMO DRG,6494,,DRG base rate x DRG weight + capital per discharge,6494,Other,100% of NY Medicaid HMO DRG,6494,,DRG base rate x DRG weight + capital per discharge,6494,Other,100% of NY Medicaid HMO DRG,6494,,DRG base rate x DRG weight + capital per discharge,6494,Other,100% of NY Medicaid HMO DRG,14612,,225% x Medicaid HMO amount,14612,Other,225% of NY Medicaid HMO DRG,9936,,153% x Medicaid HMO amount,9936,Other,153% of NY Medicaid HMO DRG,14612,,225% x Medicaid HMO amount,14612,Other,225% of NY Medicaid HMO DRG,9092,,140% x Medicaid HMO amount,9092,Other,140% of NY Medicaid HMO DRG,14612,,DRG base rate x DRG weight + capital per discharge,14612,Other,225% of NY Medicaid HMO DRG,17859,,275% x Medicaid HMO amount,17859,Other,275% of NY Medicaid HMO DRG,21041,,324% x Medicaid HMO amount,21041,Other,324% of NY Medicaid HMO DRG,13963,,215% x Medicaid HMO amount,13963,Other,215% of NY Medicaid HMO DRG,13963,,215% x Medicaid HMO amount,13963,Other,215% of NY Medicaid HMO DRG,8118,,125% x Medicaid HMO amount,8118,Other,125% of NY Medicaid HMO DRG,0.01,26203,
Other O.R. procedures for lymphatic/hematopoietic/other neoplasms,681-2,APR-DRG,,,,,,,,inpatient,,,535313.46,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19606,,186% x Medicaid HMO amount,19606,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43814,,"27,634 x DRG Weight",43814,Other,DRG Base Rate x DRG Weight,37240,,"23,488 x DRG Weight",37240,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10541.21,,DRG base rate x DRG weight + capital per discharge,10541.21,Other,100% of NY Medicaid HMO DRG,10541,,DRG base rate x DRG weight + capital per discharge,10541,Other,100% of NY Medicaid HMO DRG,10541,,DRG base rate x DRG weight + capital per discharge,10541,Other,100% of NY Medicaid HMO DRG,10541,,DRG base rate x DRG weight + capital per discharge,10541,Other,100% of NY Medicaid HMO DRG,23718,,225% x Medicaid HMO amount,23718,Other,225% of NY Medicaid HMO DRG,16128,,153% x Medicaid HMO amount,16128,Other,153% of NY Medicaid HMO DRG,23718,,225% x Medicaid HMO amount,23718,Other,225% of NY Medicaid HMO DRG,14758,,140% x Medicaid HMO amount,14758,Other,140% of NY Medicaid HMO DRG,23718,,DRG base rate x DRG weight + capital per discharge,23718,Other,225% of NY Medicaid HMO DRG,28988,,275% x Medicaid HMO amount,28988,Other,275% of NY Medicaid HMO DRG,34154,,324% x Medicaid HMO amount,34154,Other,324% of NY Medicaid HMO DRG,22664,,215% x Medicaid HMO amount,22664,Other,215% of NY Medicaid HMO DRG,22664,,215% x Medicaid HMO amount,22664,Other,215% of NY Medicaid HMO DRG,13177,,125% x Medicaid HMO amount,13177,Other,125% of NY Medicaid HMO DRG,0.01,43814,
Other O.R. procedures for lymphatic/hematopoietic/other neoplasms,681-3,APR-DRG,,,,,,,,inpatient,,,1036518.43,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45989,,186% x Medicaid HMO amount,45989,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,105543,,"27,634 x DRG Weight",105543,Other,DRG Base Rate x DRG Weight,89708,,"23,488 x DRG Weight",89708,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24725.21,,DRG base rate x DRG weight + capital per discharge,24725.21,Other,100% of NY Medicaid HMO DRG,24725,,DRG base rate x DRG weight + capital per discharge,24725,Other,100% of NY Medicaid HMO DRG,24725,,DRG base rate x DRG weight + capital per discharge,24725,Other,100% of NY Medicaid HMO DRG,24725,,DRG base rate x DRG weight + capital per discharge,24725,Other,100% of NY Medicaid HMO DRG,55632,,225% x Medicaid HMO amount,55632,Other,225% of NY Medicaid HMO DRG,37830,,153% x Medicaid HMO amount,37830,Other,153% of NY Medicaid HMO DRG,55632,,225% x Medicaid HMO amount,55632,Other,225% of NY Medicaid HMO DRG,34615,,140% x Medicaid HMO amount,34615,Other,140% of NY Medicaid HMO DRG,55632,,DRG base rate x DRG weight + capital per discharge,55632,Other,225% of NY Medicaid HMO DRG,67994,,275% x Medicaid HMO amount,67994,Other,275% of NY Medicaid HMO DRG,80110,,324% x Medicaid HMO amount,80110,Other,324% of NY Medicaid HMO DRG,53159,,215% x Medicaid HMO amount,53159,Other,215% of NY Medicaid HMO DRG,53159,,215% x Medicaid HMO amount,53159,Other,215% of NY Medicaid HMO DRG,30907,,125% x Medicaid HMO amount,30907,Other,125% of NY Medicaid HMO DRG,0.01,105543,
Other O.R. procedures for lymphatic/hematopoietic/other neoplasms,681-4,APR-DRG,,,,,,,,inpatient,,,1888179.27,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,106838,,186% x Medicaid HMO amount,106838,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,247910,,"27,634 x DRG Weight",247910,Other,DRG Base Rate x DRG Weight,210716,,"23,488 x DRG Weight",210716,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57440.21,,DRG base rate x DRG weight + capital per discharge,57440.21,Other,100% of NY Medicaid HMO DRG,57440,,DRG base rate x DRG weight + capital per discharge,57440,Other,100% of NY Medicaid HMO DRG,57440,,DRG base rate x DRG weight + capital per discharge,57440,Other,100% of NY Medicaid HMO DRG,57440,,DRG base rate x DRG weight + capital per discharge,57440,Other,100% of NY Medicaid HMO DRG,129240,,225% x Medicaid HMO amount,129240,Other,225% of NY Medicaid HMO DRG,87884,,153% x Medicaid HMO amount,87884,Other,153% of NY Medicaid HMO DRG,129240,,225% x Medicaid HMO amount,129240,Other,225% of NY Medicaid HMO DRG,80416,,140% x Medicaid HMO amount,80416,Other,140% of NY Medicaid HMO DRG,129240,,DRG base rate x DRG weight + capital per discharge,129240,Other,225% of NY Medicaid HMO DRG,157961,,275% x Medicaid HMO amount,157961,Other,275% of NY Medicaid HMO DRG,186106,,324% x Medicaid HMO amount,186106,Other,324% of NY Medicaid HMO DRG,123496,,215% x Medicaid HMO amount,123496,Other,215% of NY Medicaid HMO DRG,123496,,215% x Medicaid HMO amount,123496,Other,215% of NY Medicaid HMO DRG,71800,,125% x Medicaid HMO amount,71800,Other,125% of NY Medicaid HMO DRG,0.01,247910,
Acute leukemia,690-1,APR-DRG,,,,,,,,inpatient,,,52522,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16667,,186% x Medicaid HMO amount,16667,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36938,,"27,634 x DRG Weight",36938,Other,DRG Base Rate x DRG Weight,31396,,"23,488 x DRG Weight",31396,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8961.21,,DRG base rate x DRG weight + capital per discharge,8961.21,Other,100% of NY Medicaid HMO DRG,8961,,DRG base rate x DRG weight + capital per discharge,8961,Other,100% of NY Medicaid HMO DRG,8961,,DRG base rate x DRG weight + capital per discharge,8961,Other,100% of NY Medicaid HMO DRG,8961,,DRG base rate x DRG weight + capital per discharge,8961,Other,100% of NY Medicaid HMO DRG,20163,,225% x Medicaid HMO amount,20163,Other,225% of NY Medicaid HMO DRG,13711,,153% x Medicaid HMO amount,13711,Other,153% of NY Medicaid HMO DRG,20163,,225% x Medicaid HMO amount,20163,Other,225% of NY Medicaid HMO DRG,12546,,140% x Medicaid HMO amount,12546,Other,140% of NY Medicaid HMO DRG,20163,,DRG base rate x DRG weight + capital per discharge,20163,Other,225% of NY Medicaid HMO DRG,24643,,275% x Medicaid HMO amount,24643,Other,275% of NY Medicaid HMO DRG,29034,,324% x Medicaid HMO amount,29034,Other,324% of NY Medicaid HMO DRG,19267,,215% x Medicaid HMO amount,19267,Other,215% of NY Medicaid HMO DRG,19267,,215% x Medicaid HMO amount,19267,Other,215% of NY Medicaid HMO DRG,11202,,125% x Medicaid HMO amount,11202,Other,125% of NY Medicaid HMO DRG,0.01,36938,
Acute leukemia,690-2,APR-DRG,,,,,,,,inpatient,,,634081.05,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32991,,186% x Medicaid HMO amount,32991,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75129,,"27,634 x DRG Weight",75129,Other,DRG Base Rate x DRG Weight,63857,,"23,488 x DRG Weight",63857,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17737.21,,DRG base rate x DRG weight + capital per discharge,17737.21,Other,100% of NY Medicaid HMO DRG,17737,,DRG base rate x DRG weight + capital per discharge,17737,Other,100% of NY Medicaid HMO DRG,17737,,DRG base rate x DRG weight + capital per discharge,17737,Other,100% of NY Medicaid HMO DRG,17737,,DRG base rate x DRG weight + capital per discharge,17737,Other,100% of NY Medicaid HMO DRG,39909,,225% x Medicaid HMO amount,39909,Other,225% of NY Medicaid HMO DRG,27138,,153% x Medicaid HMO amount,27138,Other,153% of NY Medicaid HMO DRG,39909,,225% x Medicaid HMO amount,39909,Other,225% of NY Medicaid HMO DRG,24832,,140% x Medicaid HMO amount,24832,Other,140% of NY Medicaid HMO DRG,39909,,DRG base rate x DRG weight + capital per discharge,39909,Other,225% of NY Medicaid HMO DRG,48777,,275% x Medicaid HMO amount,48777,Other,275% of NY Medicaid HMO DRG,57469,,324% x Medicaid HMO amount,57469,Other,324% of NY Medicaid HMO DRG,38135,,215% x Medicaid HMO amount,38135,Other,215% of NY Medicaid HMO DRG,38135,,215% x Medicaid HMO amount,38135,Other,215% of NY Medicaid HMO DRG,22172,,125% x Medicaid HMO amount,22172,Other,125% of NY Medicaid HMO DRG,0.01,75129,
Acute leukemia,690-3,APR-DRG,,,,,,,,inpatient,,,702609.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72488,,186% x Medicaid HMO amount,72488,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,167542,,"27,634 x DRG Weight",167542,Other,DRG Base Rate x DRG Weight,142405,,"23,488 x DRG Weight",142405,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38972.21,,DRG base rate x DRG weight + capital per discharge,38972.21,Other,100% of NY Medicaid HMO DRG,38972,,DRG base rate x DRG weight + capital per discharge,38972,Other,100% of NY Medicaid HMO DRG,38972,,DRG base rate x DRG weight + capital per discharge,38972,Other,100% of NY Medicaid HMO DRG,38972,,DRG base rate x DRG weight + capital per discharge,38972,Other,100% of NY Medicaid HMO DRG,87687,,225% x Medicaid HMO amount,87687,Other,225% of NY Medicaid HMO DRG,59627,,153% x Medicaid HMO amount,59627,Other,153% of NY Medicaid HMO DRG,87687,,225% x Medicaid HMO amount,87687,Other,225% of NY Medicaid HMO DRG,54561,,140% x Medicaid HMO amount,54561,Other,140% of NY Medicaid HMO DRG,87687,,DRG base rate x DRG weight + capital per discharge,87687,Other,225% of NY Medicaid HMO DRG,107174,,275% x Medicaid HMO amount,107174,Other,275% of NY Medicaid HMO DRG,126270,,324% x Medicaid HMO amount,126270,Other,324% of NY Medicaid HMO DRG,83790,,215% x Medicaid HMO amount,83790,Other,215% of NY Medicaid HMO DRG,83790,,215% x Medicaid HMO amount,83790,Other,215% of NY Medicaid HMO DRG,48715,,125% x Medicaid HMO amount,48715,Other,125% of NY Medicaid HMO DRG,0.01,167542,
Acute leukemia,690-4,APR-DRG,,,,,,,,inpatient,,,1803817.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,104262,,186% x Medicaid HMO amount,104262,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,241883,,"27,634 x DRG Weight",241883,Other,DRG Base Rate x DRG Weight,205593,,"23,488 x DRG Weight",205593,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,56055.21,,DRG base rate x DRG weight + capital per discharge,56055.21,Other,100% of NY Medicaid HMO DRG,56055,,DRG base rate x DRG weight + capital per discharge,56055,Other,100% of NY Medicaid HMO DRG,56055,,DRG base rate x DRG weight + capital per discharge,56055,Other,100% of NY Medicaid HMO DRG,56055,,DRG base rate x DRG weight + capital per discharge,56055,Other,100% of NY Medicaid HMO DRG,126124,,225% x Medicaid HMO amount,126124,Other,225% of NY Medicaid HMO DRG,85764,,153% x Medicaid HMO amount,85764,Other,153% of NY Medicaid HMO DRG,126124,,225% x Medicaid HMO amount,126124,Other,225% of NY Medicaid HMO DRG,78477,,140% x Medicaid HMO amount,78477,Other,140% of NY Medicaid HMO DRG,126124,,DRG base rate x DRG weight + capital per discharge,126124,Other,225% of NY Medicaid HMO DRG,154152,,275% x Medicaid HMO amount,154152,Other,275% of NY Medicaid HMO DRG,181619,,324% x Medicaid HMO amount,181619,Other,324% of NY Medicaid HMO DRG,120519,,215% x Medicaid HMO amount,120519,Other,215% of NY Medicaid HMO DRG,120519,,215% x Medicaid HMO amount,120519,Other,215% of NY Medicaid HMO DRG,70069,,125% x Medicaid HMO amount,70069,Other,125% of NY Medicaid HMO DRG,0.01,241883,
"Lymphoma, myeloma & non-acute leukemia",691-1,APR-DRG,,,,,,,,inpatient,,,65923,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12959,,186% x Medicaid HMO amount,12959,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28261,,"27,634 x DRG Weight",28261,Other,DRG Base Rate x DRG Weight,24021,,"23,488 x DRG Weight",24021,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6967.21,,DRG base rate x DRG weight + capital per discharge,6967.21,Other,100% of NY Medicaid HMO DRG,6967,,DRG base rate x DRG weight + capital per discharge,6967,Other,100% of NY Medicaid HMO DRG,6967,,DRG base rate x DRG weight + capital per discharge,6967,Other,100% of NY Medicaid HMO DRG,6967,,DRG base rate x DRG weight + capital per discharge,6967,Other,100% of NY Medicaid HMO DRG,15676,,225% x Medicaid HMO amount,15676,Other,225% of NY Medicaid HMO DRG,10660,,153% x Medicaid HMO amount,10660,Other,153% of NY Medicaid HMO DRG,15676,,225% x Medicaid HMO amount,15676,Other,225% of NY Medicaid HMO DRG,9754,,140% x Medicaid HMO amount,9754,Other,140% of NY Medicaid HMO DRG,15676,,DRG base rate x DRG weight + capital per discharge,15676,Other,225% of NY Medicaid HMO DRG,19160,,275% x Medicaid HMO amount,19160,Other,275% of NY Medicaid HMO DRG,22574,,324% x Medicaid HMO amount,22574,Other,324% of NY Medicaid HMO DRG,14980,,215% x Medicaid HMO amount,14980,Other,215% of NY Medicaid HMO DRG,14980,,215% x Medicaid HMO amount,14980,Other,215% of NY Medicaid HMO DRG,8709,,125% x Medicaid HMO amount,8709,Other,125% of NY Medicaid HMO DRG,0.01,28261,
"Lymphoma, myeloma & non-acute leukemia",691-2,APR-DRG,,,,,,,,inpatient,,,179939.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18407,,186% x Medicaid HMO amount,18407,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41009,,"27,634 x DRG Weight",41009,Other,DRG Base Rate x DRG Weight,34856,,"23,488 x DRG Weight",34856,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9896.21,,DRG base rate x DRG weight + capital per discharge,9896.21,Other,100% of NY Medicaid HMO DRG,9896,,DRG base rate x DRG weight + capital per discharge,9896,Other,100% of NY Medicaid HMO DRG,9896,,DRG base rate x DRG weight + capital per discharge,9896,Other,100% of NY Medicaid HMO DRG,9896,,DRG base rate x DRG weight + capital per discharge,9896,Other,100% of NY Medicaid HMO DRG,22266,,225% x Medicaid HMO amount,22266,Other,225% of NY Medicaid HMO DRG,15141,,153% x Medicaid HMO amount,15141,Other,153% of NY Medicaid HMO DRG,22266,,225% x Medicaid HMO amount,22266,Other,225% of NY Medicaid HMO DRG,13855,,140% x Medicaid HMO amount,13855,Other,140% of NY Medicaid HMO DRG,22266,,DRG base rate x DRG weight + capital per discharge,22266,Other,225% of NY Medicaid HMO DRG,27215,,275% x Medicaid HMO amount,27215,Other,275% of NY Medicaid HMO DRG,32064,,324% x Medicaid HMO amount,32064,Other,324% of NY Medicaid HMO DRG,21277,,215% x Medicaid HMO amount,21277,Other,215% of NY Medicaid HMO DRG,21277,,215% x Medicaid HMO amount,21277,Other,215% of NY Medicaid HMO DRG,12370,,125% x Medicaid HMO amount,12370,Other,125% of NY Medicaid HMO DRG,0.01,41009,
"Lymphoma, myeloma & non-acute leukemia",691-3,APR-DRG,,,,,,,,inpatient,,,301956.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30558,,186% x Medicaid HMO amount,30558,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,69436,,"27,634 x DRG Weight",69436,Other,DRG Base Rate x DRG Weight,59018,,"23,488 x DRG Weight",59018,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16429.21,,DRG base rate x DRG weight + capital per discharge,16429.21,Other,100% of NY Medicaid HMO DRG,16429,,DRG base rate x DRG weight + capital per discharge,16429,Other,100% of NY Medicaid HMO DRG,16429,,DRG base rate x DRG weight + capital per discharge,16429,Other,100% of NY Medicaid HMO DRG,16429,,DRG base rate x DRG weight + capital per discharge,16429,Other,100% of NY Medicaid HMO DRG,36966,,225% x Medicaid HMO amount,36966,Other,225% of NY Medicaid HMO DRG,25137,,153% x Medicaid HMO amount,25137,Other,153% of NY Medicaid HMO DRG,36966,,225% x Medicaid HMO amount,36966,Other,225% of NY Medicaid HMO DRG,23001,,140% x Medicaid HMO amount,23001,Other,140% of NY Medicaid HMO DRG,36966,,DRG base rate x DRG weight + capital per discharge,36966,Other,225% of NY Medicaid HMO DRG,45180,,275% x Medicaid HMO amount,45180,Other,275% of NY Medicaid HMO DRG,53231,,324% x Medicaid HMO amount,53231,Other,324% of NY Medicaid HMO DRG,35323,,215% x Medicaid HMO amount,35323,Other,215% of NY Medicaid HMO DRG,35323,,215% x Medicaid HMO amount,35323,Other,215% of NY Medicaid HMO DRG,20537,,125% x Medicaid HMO amount,20537,Other,125% of NY Medicaid HMO DRG,0.01,69436,
"Lymphoma, myeloma & non-acute leukemia",691-4,APR-DRG,,,,,,,,inpatient,,,807135.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75676,,186% x Medicaid HMO amount,75676,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,175001,,"27,634 x DRG Weight",175001,Other,DRG Base Rate x DRG Weight,148745,,"23,488 x DRG Weight",148745,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40686.21,,DRG base rate x DRG weight + capital per discharge,40686.21,Other,100% of NY Medicaid HMO DRG,40686,,DRG base rate x DRG weight + capital per discharge,40686,Other,100% of NY Medicaid HMO DRG,40686,,DRG base rate x DRG weight + capital per discharge,40686,Other,100% of NY Medicaid HMO DRG,40686,,DRG base rate x DRG weight + capital per discharge,40686,Other,100% of NY Medicaid HMO DRG,91544,,225% x Medicaid HMO amount,91544,Other,225% of NY Medicaid HMO DRG,62250,,153% x Medicaid HMO amount,62250,Other,153% of NY Medicaid HMO DRG,91544,,225% x Medicaid HMO amount,91544,Other,225% of NY Medicaid HMO DRG,56961,,140% x Medicaid HMO amount,56961,Other,140% of NY Medicaid HMO DRG,91544,,DRG base rate x DRG weight + capital per discharge,91544,Other,225% of NY Medicaid HMO DRG,111887,,275% x Medicaid HMO amount,111887,Other,275% of NY Medicaid HMO DRG,131823,,324% x Medicaid HMO amount,131823,Other,324% of NY Medicaid HMO DRG,87475,,215% x Medicaid HMO amount,87475,Other,215% of NY Medicaid HMO DRG,87475,,215% x Medicaid HMO amount,87475,Other,215% of NY Medicaid HMO DRG,50858,,125% x Medicaid HMO amount,50858,Other,125% of NY Medicaid HMO DRG,0.01,175001,
Radiotherapy,692-1,APR-DRG,,,,,,,,inpatient,,,121868.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7918,,186% x Medicaid HMO amount,7918,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16467,,"27,634 x DRG Weight",16467,Other,DRG Base Rate x DRG Weight,13996,,"23,488 x DRG Weight",13996,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4257.21,,DRG base rate x DRG weight + capital per discharge,4257.21,Other,100% of NY Medicaid HMO DRG,4257,,DRG base rate x DRG weight + capital per discharge,4257,Other,100% of NY Medicaid HMO DRG,4257,,DRG base rate x DRG weight + capital per discharge,4257,Other,100% of NY Medicaid HMO DRG,4257,,DRG base rate x DRG weight + capital per discharge,4257,Other,100% of NY Medicaid HMO DRG,9579,,225% x Medicaid HMO amount,9579,Other,225% of NY Medicaid HMO DRG,6514,,153% x Medicaid HMO amount,6514,Other,153% of NY Medicaid HMO DRG,9579,,225% x Medicaid HMO amount,9579,Other,225% of NY Medicaid HMO DRG,5960,,140% x Medicaid HMO amount,5960,Other,140% of NY Medicaid HMO DRG,9579,,DRG base rate x DRG weight + capital per discharge,9579,Other,225% of NY Medicaid HMO DRG,11707,,275% x Medicaid HMO amount,11707,Other,275% of NY Medicaid HMO DRG,13793,,324% x Medicaid HMO amount,13793,Other,324% of NY Medicaid HMO DRG,9153,,215% x Medicaid HMO amount,9153,Other,215% of NY Medicaid HMO DRG,9153,,215% x Medicaid HMO amount,9153,Other,215% of NY Medicaid HMO DRG,5322,,125% x Medicaid HMO amount,5322,Other,125% of NY Medicaid HMO DRG,0.01,16467,
Radiotherapy,692-2,APR-DRG,,,,,,,,inpatient,,,95287,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16245,,186% x Medicaid HMO amount,16245,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,35949,,"27,634 x DRG Weight",35949,Other,DRG Base Rate x DRG Weight,30556,,"23,488 x DRG Weight",30556,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8734.21,,DRG base rate x DRG weight + capital per discharge,8734.21,Other,100% of NY Medicaid HMO DRG,8734,,DRG base rate x DRG weight + capital per discharge,8734,Other,100% of NY Medicaid HMO DRG,8734,,DRG base rate x DRG weight + capital per discharge,8734,Other,100% of NY Medicaid HMO DRG,8734,,DRG base rate x DRG weight + capital per discharge,8734,Other,100% of NY Medicaid HMO DRG,19652,,225% x Medicaid HMO amount,19652,Other,225% of NY Medicaid HMO DRG,13363,,153% x Medicaid HMO amount,13363,Other,153% of NY Medicaid HMO DRG,19652,,225% x Medicaid HMO amount,19652,Other,225% of NY Medicaid HMO DRG,12228,,140% x Medicaid HMO amount,12228,Other,140% of NY Medicaid HMO DRG,19652,,DRG base rate x DRG weight + capital per discharge,19652,Other,225% of NY Medicaid HMO DRG,24019,,275% x Medicaid HMO amount,24019,Other,275% of NY Medicaid HMO DRG,28299,,324% x Medicaid HMO amount,28299,Other,324% of NY Medicaid HMO DRG,18779,,215% x Medicaid HMO amount,18779,Other,215% of NY Medicaid HMO DRG,18779,,215% x Medicaid HMO amount,18779,Other,215% of NY Medicaid HMO DRG,10918,,125% x Medicaid HMO amount,10918,Other,125% of NY Medicaid HMO DRG,0.01,35949,
Radiotherapy,692-3,APR-DRG,,,,,,,,inpatient,,,653583.84,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33759,,186% x Medicaid HMO amount,33759,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,76928,,"27,634 x DRG Weight",76928,Other,DRG Base Rate x DRG Weight,65386,,"23,488 x DRG Weight",65386,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18150.21,,DRG base rate x DRG weight + capital per discharge,18150.21,Other,100% of NY Medicaid HMO DRG,18150,,DRG base rate x DRG weight + capital per discharge,18150,Other,100% of NY Medicaid HMO DRG,18150,,DRG base rate x DRG weight + capital per discharge,18150,Other,100% of NY Medicaid HMO DRG,18150,,DRG base rate x DRG weight + capital per discharge,18150,Other,100% of NY Medicaid HMO DRG,40838,,225% x Medicaid HMO amount,40838,Other,225% of NY Medicaid HMO DRG,27770,,153% x Medicaid HMO amount,27770,Other,153% of NY Medicaid HMO DRG,40838,,225% x Medicaid HMO amount,40838,Other,225% of NY Medicaid HMO DRG,25410,,140% x Medicaid HMO amount,25410,Other,140% of NY Medicaid HMO DRG,40838,,DRG base rate x DRG weight + capital per discharge,40838,Other,225% of NY Medicaid HMO DRG,49913,,275% x Medicaid HMO amount,49913,Other,275% of NY Medicaid HMO DRG,58807,,324% x Medicaid HMO amount,58807,Other,324% of NY Medicaid HMO DRG,39023,,215% x Medicaid HMO amount,39023,Other,215% of NY Medicaid HMO DRG,39023,,215% x Medicaid HMO amount,39023,Other,215% of NY Medicaid HMO DRG,22688,,125% x Medicaid HMO amount,22688,Other,125% of NY Medicaid HMO DRG,0.01,76928,
Radiotherapy,692-4,APR-DRG,,,,,,,,inpatient,,,653583.84,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37773,,186% x Medicaid HMO amount,37773,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,86320,,"27,634 x DRG Weight",86320,Other,DRG Base Rate x DRG Weight,73369,,"23,488 x DRG Weight",73369,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20308.21,,DRG base rate x DRG weight + capital per discharge,20308.21,Other,100% of NY Medicaid HMO DRG,20308,,DRG base rate x DRG weight + capital per discharge,20308,Other,100% of NY Medicaid HMO DRG,20308,,DRG base rate x DRG weight + capital per discharge,20308,Other,100% of NY Medicaid HMO DRG,20308,,DRG base rate x DRG weight + capital per discharge,20308,Other,100% of NY Medicaid HMO DRG,45693,,225% x Medicaid HMO amount,45693,Other,225% of NY Medicaid HMO DRG,31072,,153% x Medicaid HMO amount,31072,Other,153% of NY Medicaid HMO DRG,45693,,225% x Medicaid HMO amount,45693,Other,225% of NY Medicaid HMO DRG,28431,,140% x Medicaid HMO amount,28431,Other,140% of NY Medicaid HMO DRG,45693,,DRG base rate x DRG weight + capital per discharge,45693,Other,225% of NY Medicaid HMO DRG,55848,,275% x Medicaid HMO amount,55848,Other,275% of NY Medicaid HMO DRG,65799,,324% x Medicaid HMO amount,65799,Other,324% of NY Medicaid HMO DRG,43663,,215% x Medicaid HMO amount,43663,Other,215% of NY Medicaid HMO DRG,43663,,215% x Medicaid HMO amount,43663,Other,215% of NY Medicaid HMO DRG,25385,,125% x Medicaid HMO amount,25385,Other,125% of NY Medicaid HMO DRG,0.01,86320,
Lymphatic & other malignancies & neoplasms of uncertain behavior,694-1,APR-DRG,,,,,,,,inpatient,,,54228,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8234,,186% x Medicaid HMO amount,8234,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17208,,"27,634 x DRG Weight",17208,Other,DRG Base Rate x DRG Weight,14626,,"23,488 x DRG Weight",14626,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4427.21,,DRG base rate x DRG weight + capital per discharge,4427.21,Other,100% of NY Medicaid HMO DRG,4427,,DRG base rate x DRG weight + capital per discharge,4427,Other,100% of NY Medicaid HMO DRG,4427,,DRG base rate x DRG weight + capital per discharge,4427,Other,100% of NY Medicaid HMO DRG,4427,,DRG base rate x DRG weight + capital per discharge,4427,Other,100% of NY Medicaid HMO DRG,9961,,225% x Medicaid HMO amount,9961,Other,225% of NY Medicaid HMO DRG,6774,,153% x Medicaid HMO amount,6774,Other,153% of NY Medicaid HMO DRG,9961,,225% x Medicaid HMO amount,9961,Other,225% of NY Medicaid HMO DRG,6198,,140% x Medicaid HMO amount,6198,Other,140% of NY Medicaid HMO DRG,9961,,DRG base rate x DRG weight + capital per discharge,9961,Other,225% of NY Medicaid HMO DRG,12175,,275% x Medicaid HMO amount,12175,Other,275% of NY Medicaid HMO DRG,14344,,324% x Medicaid HMO amount,14344,Other,324% of NY Medicaid HMO DRG,9519,,215% x Medicaid HMO amount,9519,Other,215% of NY Medicaid HMO DRG,9519,,215% x Medicaid HMO amount,9519,Other,215% of NY Medicaid HMO DRG,5534,,125% x Medicaid HMO amount,5534,Other,125% of NY Medicaid HMO DRG,0.01,17208,
Lymphatic & other malignancies & neoplasms of uncertain behavior,694-2,APR-DRG,,,,,,,,inpatient,,,133835.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12471,,186% x Medicaid HMO amount,12471,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27123,,"27,634 x DRG Weight",27123,Other,DRG Base Rate x DRG Weight,23053,,"23,488 x DRG Weight",23053,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6705.21,,DRG base rate x DRG weight + capital per discharge,6705.21,Other,100% of NY Medicaid HMO DRG,6705,,DRG base rate x DRG weight + capital per discharge,6705,Other,100% of NY Medicaid HMO DRG,6705,,DRG base rate x DRG weight + capital per discharge,6705,Other,100% of NY Medicaid HMO DRG,6705,,DRG base rate x DRG weight + capital per discharge,6705,Other,100% of NY Medicaid HMO DRG,15087,,225% x Medicaid HMO amount,15087,Other,225% of NY Medicaid HMO DRG,10259,,153% x Medicaid HMO amount,10259,Other,153% of NY Medicaid HMO DRG,15087,,225% x Medicaid HMO amount,15087,Other,225% of NY Medicaid HMO DRG,9387,,140% x Medicaid HMO amount,9387,Other,140% of NY Medicaid HMO DRG,15087,,DRG base rate x DRG weight + capital per discharge,15087,Other,225% of NY Medicaid HMO DRG,18439,,275% x Medicaid HMO amount,18439,Other,275% of NY Medicaid HMO DRG,21725,,324% x Medicaid HMO amount,21725,Other,324% of NY Medicaid HMO DRG,14416,,215% x Medicaid HMO amount,14416,Other,215% of NY Medicaid HMO DRG,14416,,215% x Medicaid HMO amount,14416,Other,215% of NY Medicaid HMO DRG,8382,,125% x Medicaid HMO amount,8382,Other,125% of NY Medicaid HMO DRG,0.01,27123,
Lymphatic & other malignancies & neoplasms of uncertain behavior,694-3,APR-DRG,,,,,,,,inpatient,,,362205.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20025,,186% x Medicaid HMO amount,20025,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44792,,"27,634 x DRG Weight",44792,Other,DRG Base Rate x DRG Weight,38072,,"23,488 x DRG Weight",38072,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10766.21,,DRG base rate x DRG weight + capital per discharge,10766.21,Other,100% of NY Medicaid HMO DRG,10766,,DRG base rate x DRG weight + capital per discharge,10766,Other,100% of NY Medicaid HMO DRG,10766,,DRG base rate x DRG weight + capital per discharge,10766,Other,100% of NY Medicaid HMO DRG,10766,,DRG base rate x DRG weight + capital per discharge,10766,Other,100% of NY Medicaid HMO DRG,24224,,225% x Medicaid HMO amount,24224,Other,225% of NY Medicaid HMO DRG,16472,,153% x Medicaid HMO amount,16472,Other,153% of NY Medicaid HMO DRG,24224,,225% x Medicaid HMO amount,24224,Other,225% of NY Medicaid HMO DRG,15073,,140% x Medicaid HMO amount,15073,Other,140% of NY Medicaid HMO DRG,24224,,DRG base rate x DRG weight + capital per discharge,24224,Other,225% of NY Medicaid HMO DRG,29607,,275% x Medicaid HMO amount,29607,Other,275% of NY Medicaid HMO DRG,34883,,324% x Medicaid HMO amount,34883,Other,324% of NY Medicaid HMO DRG,23147,,215% x Medicaid HMO amount,23147,Other,215% of NY Medicaid HMO DRG,23147,,215% x Medicaid HMO amount,23147,Other,215% of NY Medicaid HMO DRG,13458,,125% x Medicaid HMO amount,13458,Other,125% of NY Medicaid HMO DRG,0.01,44792,
Lymphatic & other malignancies & neoplasms of uncertain behavior,694-4,APR-DRG,,,,,,,,inpatient,,,569300.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40818,,186% x Medicaid HMO amount,40818,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,93442,,"27,634 x DRG Weight",93442,Other,DRG Base Rate x DRG Weight,79422,,"23,488 x DRG Weight",79422,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21945.21,,DRG base rate x DRG weight + capital per discharge,21945.21,Other,100% of NY Medicaid HMO DRG,21945,,DRG base rate x DRG weight + capital per discharge,21945,Other,100% of NY Medicaid HMO DRG,21945,,DRG base rate x DRG weight + capital per discharge,21945,Other,100% of NY Medicaid HMO DRG,21945,,DRG base rate x DRG weight + capital per discharge,21945,Other,100% of NY Medicaid HMO DRG,49377,,225% x Medicaid HMO amount,49377,Other,225% of NY Medicaid HMO DRG,33576,,153% x Medicaid HMO amount,33576,Other,153% of NY Medicaid HMO DRG,49377,,225% x Medicaid HMO amount,49377,Other,225% of NY Medicaid HMO DRG,30723,,140% x Medicaid HMO amount,30723,Other,140% of NY Medicaid HMO DRG,49377,,DRG base rate x DRG weight + capital per discharge,49377,Other,225% of NY Medicaid HMO DRG,60349,,275% x Medicaid HMO amount,60349,Other,275% of NY Medicaid HMO DRG,71102,,324% x Medicaid HMO amount,71102,Other,324% of NY Medicaid HMO DRG,47182,,215% x Medicaid HMO amount,47182,Other,215% of NY Medicaid HMO DRG,47182,,215% x Medicaid HMO amount,47182,Other,215% of NY Medicaid HMO DRG,27432,,125% x Medicaid HMO amount,27432,Other,125% of NY Medicaid HMO DRG,0.01,93442,
Chemotherapy for acute leukemia #,695-1,APR-DRG,,,,,,,,inpatient,,,125942.66,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11567,,186% x Medicaid HMO amount,11567,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25006,,"27,634 x DRG Weight",25006,Other,DRG Base Rate x DRG Weight,21254,,"23,488 x DRG Weight",21254,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6219.21,,DRG base rate x DRG weight + capital per discharge,6219.21,Other,100% of NY Medicaid HMO DRG,6219,,DRG base rate x DRG weight + capital per discharge,6219,Other,100% of NY Medicaid HMO DRG,6219,,DRG base rate x DRG weight + capital per discharge,6219,Other,100% of NY Medicaid HMO DRG,6219,,DRG base rate x DRG weight + capital per discharge,6219,Other,100% of NY Medicaid HMO DRG,13993,,225% x Medicaid HMO amount,13993,Other,225% of NY Medicaid HMO DRG,9515,,153% x Medicaid HMO amount,9515,Other,153% of NY Medicaid HMO DRG,13993,,225% x Medicaid HMO amount,13993,Other,225% of NY Medicaid HMO DRG,8707,,140% x Medicaid HMO amount,8707,Other,140% of NY Medicaid HMO DRG,13993,,DRG base rate x DRG weight + capital per discharge,13993,Other,225% of NY Medicaid HMO DRG,17103,,275% x Medicaid HMO amount,17103,Other,275% of NY Medicaid HMO DRG,20150,,324% x Medicaid HMO amount,20150,Other,324% of NY Medicaid HMO DRG,13371,,215% x Medicaid HMO amount,13371,Other,215% of NY Medicaid HMO DRG,13371,,215% x Medicaid HMO amount,13371,Other,215% of NY Medicaid HMO DRG,7774,,125% x Medicaid HMO amount,7774,Other,125% of NY Medicaid HMO DRG,0.01,25006,
Chemotherapy for acute leukemia #,695-2,APR-DRG,,,,,,,,inpatient,,,125942.66,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11582,,186% x Medicaid HMO amount,11582,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25042,,"27,634 x DRG Weight",25042,Other,DRG Base Rate x DRG Weight,21285,,"23,488 x DRG Weight",21285,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6227.21,,DRG base rate x DRG weight + capital per discharge,6227.21,Other,100% of NY Medicaid HMO DRG,6227,,DRG base rate x DRG weight + capital per discharge,6227,Other,100% of NY Medicaid HMO DRG,6227,,DRG base rate x DRG weight + capital per discharge,6227,Other,100% of NY Medicaid HMO DRG,6227,,DRG base rate x DRG weight + capital per discharge,6227,Other,100% of NY Medicaid HMO DRG,14011,,225% x Medicaid HMO amount,14011,Other,225% of NY Medicaid HMO DRG,9528,,153% x Medicaid HMO amount,9528,Other,153% of NY Medicaid HMO DRG,14011,,225% x Medicaid HMO amount,14011,Other,225% of NY Medicaid HMO DRG,8718,,140% x Medicaid HMO amount,8718,Other,140% of NY Medicaid HMO DRG,14011,,DRG base rate x DRG weight + capital per discharge,14011,Other,225% of NY Medicaid HMO DRG,17125,,275% x Medicaid HMO amount,17125,Other,275% of NY Medicaid HMO DRG,20176,,324% x Medicaid HMO amount,20176,Other,324% of NY Medicaid HMO DRG,13389,,215% x Medicaid HMO amount,13389,Other,215% of NY Medicaid HMO DRG,13389,,215% x Medicaid HMO amount,13389,Other,215% of NY Medicaid HMO DRG,7784,,125% x Medicaid HMO amount,7784,Other,125% of NY Medicaid HMO DRG,0.01,25042,
Chemotherapy for acute leukemia #,695-3,APR-DRG,,,,,,,,inpatient,,,354439.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29674,,186% x Medicaid HMO amount,29674,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,67372,,"27,634 x DRG Weight",67372,Other,DRG Base Rate x DRG Weight,57264,,"23,488 x DRG Weight",57264,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15954.21,,DRG base rate x DRG weight + capital per discharge,15954.21,Other,100% of NY Medicaid HMO DRG,15954,,DRG base rate x DRG weight + capital per discharge,15954,Other,100% of NY Medicaid HMO DRG,15954,,DRG base rate x DRG weight + capital per discharge,15954,Other,100% of NY Medicaid HMO DRG,15954,,DRG base rate x DRG weight + capital per discharge,15954,Other,100% of NY Medicaid HMO DRG,35897,,225% x Medicaid HMO amount,35897,Other,225% of NY Medicaid HMO DRG,24410,,153% x Medicaid HMO amount,24410,Other,153% of NY Medicaid HMO DRG,35897,,225% x Medicaid HMO amount,35897,Other,225% of NY Medicaid HMO DRG,22336,,140% x Medicaid HMO amount,22336,Other,140% of NY Medicaid HMO DRG,35897,,DRG base rate x DRG weight + capital per discharge,35897,Other,225% of NY Medicaid HMO DRG,43874,,275% x Medicaid HMO amount,43874,Other,275% of NY Medicaid HMO DRG,51692,,324% x Medicaid HMO amount,51692,Other,324% of NY Medicaid HMO DRG,34302,,215% x Medicaid HMO amount,34302,Other,215% of NY Medicaid HMO DRG,34302,,215% x Medicaid HMO amount,34302,Other,215% of NY Medicaid HMO DRG,19943,,125% x Medicaid HMO amount,19943,Other,125% of NY Medicaid HMO DRG,0.01,67372,
Chemotherapy for acute leukemia #,695-4,APR-DRG,,,,,,,,inpatient,,,391086.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,88125,,186% x Medicaid HMO amount,88125,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,204127,,"27,634 x DRG Weight",204127,Other,DRG Base Rate x DRG Weight,173501,,"23,488 x DRG Weight",173501,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47379.21,,DRG base rate x DRG weight + capital per discharge,47379.21,Other,100% of NY Medicaid HMO DRG,47379,,DRG base rate x DRG weight + capital per discharge,47379,Other,100% of NY Medicaid HMO DRG,47379,,DRG base rate x DRG weight + capital per discharge,47379,Other,100% of NY Medicaid HMO DRG,47379,,DRG base rate x DRG weight + capital per discharge,47379,Other,100% of NY Medicaid HMO DRG,106603,,225% x Medicaid HMO amount,106603,Other,225% of NY Medicaid HMO DRG,72490,,153% x Medicaid HMO amount,72490,Other,153% of NY Medicaid HMO DRG,106603,,225% x Medicaid HMO amount,106603,Other,225% of NY Medicaid HMO DRG,66331,,140% x Medicaid HMO amount,66331,Other,140% of NY Medicaid HMO DRG,106603,,DRG base rate x DRG weight + capital per discharge,106603,Other,225% of NY Medicaid HMO DRG,130293,,275% x Medicaid HMO amount,130293,Other,275% of NY Medicaid HMO DRG,153509,,324% x Medicaid HMO amount,153509,Other,324% of NY Medicaid HMO DRG,101865,,215% x Medicaid HMO amount,101865,Other,215% of NY Medicaid HMO DRG,101865,,215% x Medicaid HMO amount,101865,Other,215% of NY Medicaid HMO DRG,59224,,125% x Medicaid HMO amount,59224,Other,125% of NY Medicaid HMO DRG,0.01,204127,
Other Chemotherapy #,696-1,APR-DRG,,,,,,,,inpatient,,,79950.62,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9702,,186% x Medicaid HMO amount,9702,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20640,,"27,634 x DRG Weight",20640,Other,DRG Base Rate x DRG Weight,17543,,"23,488 x DRG Weight",17543,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5216.21,,DRG base rate x DRG weight + capital per discharge,5216.21,Other,100% of NY Medicaid HMO DRG,5216,,DRG base rate x DRG weight + capital per discharge,5216,Other,100% of NY Medicaid HMO DRG,5216,,DRG base rate x DRG weight + capital per discharge,5216,Other,100% of NY Medicaid HMO DRG,5216,,DRG base rate x DRG weight + capital per discharge,5216,Other,100% of NY Medicaid HMO DRG,11736,,225% x Medicaid HMO amount,11736,Other,225% of NY Medicaid HMO DRG,7981,,153% x Medicaid HMO amount,7981,Other,153% of NY Medicaid HMO DRG,11736,,225% x Medicaid HMO amount,11736,Other,225% of NY Medicaid HMO DRG,7303,,140% x Medicaid HMO amount,7303,Other,140% of NY Medicaid HMO DRG,11736,,DRG base rate x DRG weight + capital per discharge,11736,Other,225% of NY Medicaid HMO DRG,14345,,275% x Medicaid HMO amount,14345,Other,275% of NY Medicaid HMO DRG,16901,,324% x Medicaid HMO amount,16901,Other,324% of NY Medicaid HMO DRG,11215,,215% x Medicaid HMO amount,11215,Other,215% of NY Medicaid HMO DRG,11215,,215% x Medicaid HMO amount,11215,Other,215% of NY Medicaid HMO DRG,6520,,125% x Medicaid HMO amount,6520,Other,125% of NY Medicaid HMO DRG,0.01,20640,
Other Chemotherapy #,696-2,APR-DRG,,,,,,,,inpatient,,,105337.83,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12743,,186% x Medicaid HMO amount,12743,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,27756,,"27,634 x DRG Weight",27756,Other,DRG Base Rate x DRG Weight,23591,,"23,488 x DRG Weight",23591,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6851.21,,DRG base rate x DRG weight + capital per discharge,6851.21,Other,100% of NY Medicaid HMO DRG,6851,,DRG base rate x DRG weight + capital per discharge,6851,Other,100% of NY Medicaid HMO DRG,6851,,DRG base rate x DRG weight + capital per discharge,6851,Other,100% of NY Medicaid HMO DRG,6851,,DRG base rate x DRG weight + capital per discharge,6851,Other,100% of NY Medicaid HMO DRG,15415,,225% x Medicaid HMO amount,15415,Other,225% of NY Medicaid HMO DRG,10482,,153% x Medicaid HMO amount,10482,Other,153% of NY Medicaid HMO DRG,15415,,225% x Medicaid HMO amount,15415,Other,225% of NY Medicaid HMO DRG,9592,,140% x Medicaid HMO amount,9592,Other,140% of NY Medicaid HMO DRG,15415,,DRG base rate x DRG weight + capital per discharge,15415,Other,225% of NY Medicaid HMO DRG,18841,,275% x Medicaid HMO amount,18841,Other,275% of NY Medicaid HMO DRG,22198,,324% x Medicaid HMO amount,22198,Other,324% of NY Medicaid HMO DRG,14730,,215% x Medicaid HMO amount,14730,Other,215% of NY Medicaid HMO DRG,14730,,215% x Medicaid HMO amount,14730,Other,215% of NY Medicaid HMO DRG,8564,,125% x Medicaid HMO amount,8564,Other,125% of NY Medicaid HMO DRG,0.01,27756,
Other Chemotherapy #,696-3,APR-DRG,,,,,,,,inpatient,,,269183.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18773,,186% x Medicaid HMO amount,18773,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41866,,"27,634 x DRG Weight",41866,Other,DRG Base Rate x DRG Weight,35584,,"23,488 x DRG Weight",35584,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10093.21,,DRG base rate x DRG weight + capital per discharge,10093.21,Other,100% of NY Medicaid HMO DRG,10093,,DRG base rate x DRG weight + capital per discharge,10093,Other,100% of NY Medicaid HMO DRG,10093,,DRG base rate x DRG weight + capital per discharge,10093,Other,100% of NY Medicaid HMO DRG,10093,,DRG base rate x DRG weight + capital per discharge,10093,Other,100% of NY Medicaid HMO DRG,22710,,225% x Medicaid HMO amount,22710,Other,225% of NY Medicaid HMO DRG,15443,,153% x Medicaid HMO amount,15443,Other,153% of NY Medicaid HMO DRG,22710,,225% x Medicaid HMO amount,22710,Other,225% of NY Medicaid HMO DRG,14130,,140% x Medicaid HMO amount,14130,Other,140% of NY Medicaid HMO DRG,22710,,DRG base rate x DRG weight + capital per discharge,22710,Other,225% of NY Medicaid HMO DRG,27756,,275% x Medicaid HMO amount,27756,Other,275% of NY Medicaid HMO DRG,32702,,324% x Medicaid HMO amount,32702,Other,324% of NY Medicaid HMO DRG,21700,,215% x Medicaid HMO amount,21700,Other,215% of NY Medicaid HMO DRG,21700,,215% x Medicaid HMO amount,21700,Other,215% of NY Medicaid HMO DRG,12617,,125% x Medicaid HMO amount,12617,Other,125% of NY Medicaid HMO DRG,0.01,41866,
Other Chemotherapy #,696-4,APR-DRG,,,,,,,,inpatient,,,637148.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,52781,,186% x Medicaid HMO amount,52781,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,121435,,"27,634 x DRG Weight",121435,Other,DRG Base Rate x DRG Weight,103216,,"23,488 x DRG Weight",103216,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28377.21,,DRG base rate x DRG weight + capital per discharge,28377.21,Other,100% of NY Medicaid HMO DRG,28377,,DRG base rate x DRG weight + capital per discharge,28377,Other,100% of NY Medicaid HMO DRG,28377,,DRG base rate x DRG weight + capital per discharge,28377,Other,100% of NY Medicaid HMO DRG,28377,,DRG base rate x DRG weight + capital per discharge,28377,Other,100% of NY Medicaid HMO DRG,63849,,225% x Medicaid HMO amount,63849,Other,225% of NY Medicaid HMO DRG,43417,,153% x Medicaid HMO amount,43417,Other,153% of NY Medicaid HMO DRG,63849,,225% x Medicaid HMO amount,63849,Other,225% of NY Medicaid HMO DRG,39728,,140% x Medicaid HMO amount,39728,Other,140% of NY Medicaid HMO DRG,63849,,DRG base rate x DRG weight + capital per discharge,63849,Other,225% of NY Medicaid HMO DRG,78037,,275% x Medicaid HMO amount,78037,Other,275% of NY Medicaid HMO DRG,91942,,324% x Medicaid HMO amount,91942,Other,324% of NY Medicaid HMO DRG,61011,,215% x Medicaid HMO amount,61011,Other,215% of NY Medicaid HMO DRG,61011,,215% x Medicaid HMO amount,61011,Other,215% of NY Medicaid HMO DRG,35472,,125% x Medicaid HMO amount,35472,Other,125% of NY Medicaid HMO DRG,0.01,121435,
Infectious & parasitic diseases including HIV w O.R. procedure,710-1,APR-DRG,,,,,,,,inpatient,,,147260.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13682,,186% x Medicaid HMO amount,13682,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29952,,"27,634 x DRG Weight",29952,Other,DRG Base Rate x DRG Weight,25459,,"23,488 x DRG Weight",25459,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7356.21,,DRG base rate x DRG weight + capital per discharge,7356.21,Other,100% of NY Medicaid HMO DRG,7356,,DRG base rate x DRG weight + capital per discharge,7356,Other,100% of NY Medicaid HMO DRG,7356,,DRG base rate x DRG weight + capital per discharge,7356,Other,100% of NY Medicaid HMO DRG,7356,,DRG base rate x DRG weight + capital per discharge,7356,Other,100% of NY Medicaid HMO DRG,16551,,225% x Medicaid HMO amount,16551,Other,225% of NY Medicaid HMO DRG,11255,,153% x Medicaid HMO amount,11255,Other,153% of NY Medicaid HMO DRG,16551,,225% x Medicaid HMO amount,16551,Other,225% of NY Medicaid HMO DRG,10299,,140% x Medicaid HMO amount,10299,Other,140% of NY Medicaid HMO DRG,16551,,DRG base rate x DRG weight + capital per discharge,16551,Other,225% of NY Medicaid HMO DRG,20230,,275% x Medicaid HMO amount,20230,Other,275% of NY Medicaid HMO DRG,23834,,324% x Medicaid HMO amount,23834,Other,324% of NY Medicaid HMO DRG,15816,,215% x Medicaid HMO amount,15816,Other,215% of NY Medicaid HMO DRG,15816,,215% x Medicaid HMO amount,15816,Other,215% of NY Medicaid HMO DRG,9195,,125% x Medicaid HMO amount,9195,Other,125% of NY Medicaid HMO DRG,0.01,29952,
Infectious & parasitic diseases including HIV w O.R. procedure,710-2,APR-DRG,,,,,,,,inpatient,,,148121.49,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20559,,186% x Medicaid HMO amount,20559,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46041,,"27,634 x DRG Weight",46041,Other,DRG Base Rate x DRG Weight,39133,,"23,488 x DRG Weight",39133,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11053.21,,DRG base rate x DRG weight + capital per discharge,11053.21,Other,100% of NY Medicaid HMO DRG,11053,,DRG base rate x DRG weight + capital per discharge,11053,Other,100% of NY Medicaid HMO DRG,11053,,DRG base rate x DRG weight + capital per discharge,11053,Other,100% of NY Medicaid HMO DRG,11053,,DRG base rate x DRG weight + capital per discharge,11053,Other,100% of NY Medicaid HMO DRG,24870,,225% x Medicaid HMO amount,24870,Other,225% of NY Medicaid HMO DRG,16911,,153% x Medicaid HMO amount,16911,Other,153% of NY Medicaid HMO DRG,24870,,225% x Medicaid HMO amount,24870,Other,225% of NY Medicaid HMO DRG,15474,,140% x Medicaid HMO amount,15474,Other,140% of NY Medicaid HMO DRG,24870,,DRG base rate x DRG weight + capital per discharge,24870,Other,225% of NY Medicaid HMO DRG,30396,,275% x Medicaid HMO amount,30396,Other,275% of NY Medicaid HMO DRG,35812,,324% x Medicaid HMO amount,35812,Other,324% of NY Medicaid HMO DRG,23764,,215% x Medicaid HMO amount,23764,Other,215% of NY Medicaid HMO DRG,23764,,215% x Medicaid HMO amount,23764,Other,215% of NY Medicaid HMO DRG,13817,,125% x Medicaid HMO amount,13817,Other,125% of NY Medicaid HMO DRG,0.01,46041,
Infectious & parasitic diseases including HIV w O.R. procedure,710-3,APR-DRG,,,,,,,,inpatient,,,317633.24,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36024,,186% x Medicaid HMO amount,36024,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,82228,,"27,634 x DRG Weight",82228,Other,DRG Base Rate x DRG Weight,69891,,"23,488 x DRG Weight",69891,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19368.21,,DRG base rate x DRG weight + capital per discharge,19368.21,Other,100% of NY Medicaid HMO DRG,19368,,DRG base rate x DRG weight + capital per discharge,19368,Other,100% of NY Medicaid HMO DRG,19368,,DRG base rate x DRG weight + capital per discharge,19368,Other,100% of NY Medicaid HMO DRG,19368,,DRG base rate x DRG weight + capital per discharge,19368,Other,100% of NY Medicaid HMO DRG,43578,,225% x Medicaid HMO amount,43578,Other,225% of NY Medicaid HMO DRG,29633,,153% x Medicaid HMO amount,29633,Other,153% of NY Medicaid HMO DRG,43578,,225% x Medicaid HMO amount,43578,Other,225% of NY Medicaid HMO DRG,27115,,140% x Medicaid HMO amount,27115,Other,140% of NY Medicaid HMO DRG,43578,,DRG base rate x DRG weight + capital per discharge,43578,Other,225% of NY Medicaid HMO DRG,53263,,275% x Medicaid HMO amount,53263,Other,275% of NY Medicaid HMO DRG,62753,,324% x Medicaid HMO amount,62753,Other,324% of NY Medicaid HMO DRG,41642,,215% x Medicaid HMO amount,41642,Other,215% of NY Medicaid HMO DRG,41642,,215% x Medicaid HMO amount,41642,Other,215% of NY Medicaid HMO DRG,24210,,125% x Medicaid HMO amount,24210,Other,125% of NY Medicaid HMO DRG,0.01,82228,
Infectious & parasitic diseases including HIV w O.R. procedure,710-4,APR-DRG,,,,,,,,inpatient,,,891593.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,75529,,186% x Medicaid HMO amount,75529,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,174658,,"27,634 x DRG Weight",174658,Other,DRG Base Rate x DRG Weight,148454,,"23,488 x DRG Weight",148454,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40607.21,,DRG base rate x DRG weight + capital per discharge,40607.21,Other,100% of NY Medicaid HMO DRG,40607,,DRG base rate x DRG weight + capital per discharge,40607,Other,100% of NY Medicaid HMO DRG,40607,,DRG base rate x DRG weight + capital per discharge,40607,Other,100% of NY Medicaid HMO DRG,40607,,DRG base rate x DRG weight + capital per discharge,40607,Other,100% of NY Medicaid HMO DRG,91366,,225% x Medicaid HMO amount,91366,Other,225% of NY Medicaid HMO DRG,62129,,153% x Medicaid HMO amount,62129,Other,153% of NY Medicaid HMO DRG,91366,,225% x Medicaid HMO amount,91366,Other,225% of NY Medicaid HMO DRG,56850,,140% x Medicaid HMO amount,56850,Other,140% of NY Medicaid HMO DRG,91366,,DRG base rate x DRG weight + capital per discharge,91366,Other,225% of NY Medicaid HMO DRG,111670,,275% x Medicaid HMO amount,111670,Other,275% of NY Medicaid HMO DRG,131567,,324% x Medicaid HMO amount,131567,Other,324% of NY Medicaid HMO DRG,87306,,215% x Medicaid HMO amount,87306,Other,215% of NY Medicaid HMO DRG,87306,,215% x Medicaid HMO amount,87306,Other,215% of NY Medicaid HMO DRG,50759,,125% x Medicaid HMO amount,50759,Other,125% of NY Medicaid HMO DRG,0.01,174658,
"Post-op, post-trauma, other device infections w O.R. procedure",711-1,APR-DRG,,,,,,,,inpatient,,,41655.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14560,,186% x Medicaid HMO amount,14560,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32008,,"27,634 x DRG Weight",32008,Other,DRG Base Rate x DRG Weight,27206,,"23,488 x DRG Weight",27206,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7828.21,,DRG base rate x DRG weight + capital per discharge,7828.21,Other,100% of NY Medicaid HMO DRG,7828,,DRG base rate x DRG weight + capital per discharge,7828,Other,100% of NY Medicaid HMO DRG,7828,,DRG base rate x DRG weight + capital per discharge,7828,Other,100% of NY Medicaid HMO DRG,7828,,DRG base rate x DRG weight + capital per discharge,7828,Other,100% of NY Medicaid HMO DRG,17613,,225% x Medicaid HMO amount,17613,Other,225% of NY Medicaid HMO DRG,11977,,153% x Medicaid HMO amount,11977,Other,153% of NY Medicaid HMO DRG,17613,,225% x Medicaid HMO amount,17613,Other,225% of NY Medicaid HMO DRG,10959,,140% x Medicaid HMO amount,10959,Other,140% of NY Medicaid HMO DRG,17613,,DRG base rate x DRG weight + capital per discharge,17613,Other,225% of NY Medicaid HMO DRG,21528,,275% x Medicaid HMO amount,21528,Other,275% of NY Medicaid HMO DRG,25363,,324% x Medicaid HMO amount,25363,Other,324% of NY Medicaid HMO DRG,16831,,215% x Medicaid HMO amount,16831,Other,215% of NY Medicaid HMO DRG,16831,,215% x Medicaid HMO amount,16831,Other,215% of NY Medicaid HMO DRG,9785,,125% x Medicaid HMO amount,9785,Other,125% of NY Medicaid HMO DRG,0.01,32008,
"Post-op, post-trauma, other device infections w O.R. procedure",711-2,APR-DRG,,,,,,,,inpatient,,,311510.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19593,,186% x Medicaid HMO amount,19593,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43786,,"27,634 x DRG Weight",43786,Other,DRG Base Rate x DRG Weight,37217,,"23,488 x DRG Weight",37217,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10534.21,,DRG base rate x DRG weight + capital per discharge,10534.21,Other,100% of NY Medicaid HMO DRG,10534,,DRG base rate x DRG weight + capital per discharge,10534,Other,100% of NY Medicaid HMO DRG,10534,,DRG base rate x DRG weight + capital per discharge,10534,Other,100% of NY Medicaid HMO DRG,10534,,DRG base rate x DRG weight + capital per discharge,10534,Other,100% of NY Medicaid HMO DRG,23702,,225% x Medicaid HMO amount,23702,Other,225% of NY Medicaid HMO DRG,16117,,153% x Medicaid HMO amount,16117,Other,153% of NY Medicaid HMO DRG,23702,,225% x Medicaid HMO amount,23702,Other,225% of NY Medicaid HMO DRG,14748,,140% x Medicaid HMO amount,14748,Other,140% of NY Medicaid HMO DRG,23702,,DRG base rate x DRG weight + capital per discharge,23702,Other,225% of NY Medicaid HMO DRG,28969,,275% x Medicaid HMO amount,28969,Other,275% of NY Medicaid HMO DRG,34131,,324% x Medicaid HMO amount,34131,Other,324% of NY Medicaid HMO DRG,22649,,215% x Medicaid HMO amount,22649,Other,215% of NY Medicaid HMO DRG,22649,,215% x Medicaid HMO amount,22649,Other,215% of NY Medicaid HMO DRG,13168,,125% x Medicaid HMO amount,13168,Other,125% of NY Medicaid HMO DRG,0.01,43786,
"Post-op, post-trauma, other device infections w O.R. procedure",711-3,APR-DRG,,,,,,,,inpatient,,,328470.08,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34836,,186% x Medicaid HMO amount,34836,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,79445,,"27,634 x DRG Weight",79445,Other,DRG Base Rate x DRG Weight,67526,,"23,488 x DRG Weight",67526,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18729.21,,DRG base rate x DRG weight + capital per discharge,18729.21,Other,100% of NY Medicaid HMO DRG,18729,,DRG base rate x DRG weight + capital per discharge,18729,Other,100% of NY Medicaid HMO DRG,18729,,DRG base rate x DRG weight + capital per discharge,18729,Other,100% of NY Medicaid HMO DRG,18729,,DRG base rate x DRG weight + capital per discharge,18729,Other,100% of NY Medicaid HMO DRG,42141,,225% x Medicaid HMO amount,42141,Other,225% of NY Medicaid HMO DRG,28656,,153% x Medicaid HMO amount,28656,Other,153% of NY Medicaid HMO DRG,42141,,225% x Medicaid HMO amount,42141,Other,225% of NY Medicaid HMO DRG,26221,,140% x Medicaid HMO amount,26221,Other,140% of NY Medicaid HMO DRG,42141,,DRG base rate x DRG weight + capital per discharge,42141,Other,225% of NY Medicaid HMO DRG,51505,,275% x Medicaid HMO amount,51505,Other,275% of NY Medicaid HMO DRG,60683,,324% x Medicaid HMO amount,60683,Other,324% of NY Medicaid HMO DRG,40268,,215% x Medicaid HMO amount,40268,Other,215% of NY Medicaid HMO DRG,40268,,215% x Medicaid HMO amount,40268,Other,215% of NY Medicaid HMO DRG,23412,,125% x Medicaid HMO amount,23412,Other,125% of NY Medicaid HMO DRG,0.01,79445,
"Post-op, post-trauma, other device infections w O.R. procedure",711-4,APR-DRG,,,,,,,,inpatient,,,754875.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72170,,186% x Medicaid HMO amount,72170,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,166796,,"27,634 x DRG Weight",166796,Other,DRG Base Rate x DRG Weight,141771,,"23,488 x DRG Weight",141771,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38801.21,,DRG base rate x DRG weight + capital per discharge,38801.21,Other,100% of NY Medicaid HMO DRG,38801,,DRG base rate x DRG weight + capital per discharge,38801,Other,100% of NY Medicaid HMO DRG,38801,,DRG base rate x DRG weight + capital per discharge,38801,Other,100% of NY Medicaid HMO DRG,38801,,DRG base rate x DRG weight + capital per discharge,38801,Other,100% of NY Medicaid HMO DRG,87303,,225% x Medicaid HMO amount,87303,Other,225% of NY Medicaid HMO DRG,59366,,153% x Medicaid HMO amount,59366,Other,153% of NY Medicaid HMO DRG,87303,,225% x Medicaid HMO amount,87303,Other,225% of NY Medicaid HMO DRG,54322,,140% x Medicaid HMO amount,54322,Other,140% of NY Medicaid HMO DRG,87303,,DRG base rate x DRG weight + capital per discharge,87303,Other,225% of NY Medicaid HMO DRG,106703,,275% x Medicaid HMO amount,106703,Other,275% of NY Medicaid HMO DRG,125716,,324% x Medicaid HMO amount,125716,Other,324% of NY Medicaid HMO DRG,83423,,215% x Medicaid HMO amount,83423,Other,215% of NY Medicaid HMO DRG,83423,,215% x Medicaid HMO amount,83423,Other,215% of NY Medicaid HMO DRG,48502,,125% x Medicaid HMO amount,48502,Other,125% of NY Medicaid HMO DRG,0.01,166796,
Septicemia & disseminated infections,720-1,APR-DRG,,,,,,,,inpatient,,,93993.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8018,,186% x Medicaid HMO amount,8018,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16702,,"27,634 x DRG Weight",16702,Other,DRG Base Rate x DRG Weight,14196,,"23,488 x DRG Weight",14196,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4311.21,,DRG base rate x DRG weight + capital per discharge,4311.21,Other,100% of NY Medicaid HMO DRG,4311,,DRG base rate x DRG weight + capital per discharge,4311,Other,100% of NY Medicaid HMO DRG,4311,,DRG base rate x DRG weight + capital per discharge,4311,Other,100% of NY Medicaid HMO DRG,4311,,DRG base rate x DRG weight + capital per discharge,4311,Other,100% of NY Medicaid HMO DRG,9700,,225% x Medicaid HMO amount,9700,Other,225% of NY Medicaid HMO DRG,6596,,153% x Medicaid HMO amount,6596,Other,153% of NY Medicaid HMO DRG,9700,,225% x Medicaid HMO amount,9700,Other,225% of NY Medicaid HMO DRG,6036,,140% x Medicaid HMO amount,6036,Other,140% of NY Medicaid HMO DRG,9700,,DRG base rate x DRG weight + capital per discharge,9700,Other,225% of NY Medicaid HMO DRG,11856,,275% x Medicaid HMO amount,11856,Other,275% of NY Medicaid HMO DRG,13968,,324% x Medicaid HMO amount,13968,Other,324% of NY Medicaid HMO DRG,9269,,215% x Medicaid HMO amount,9269,Other,215% of NY Medicaid HMO DRG,9269,,215% x Medicaid HMO amount,9269,Other,215% of NY Medicaid HMO DRG,5389,,125% x Medicaid HMO amount,5389,Other,125% of NY Medicaid HMO DRG,0.01,16702,
Septicemia & disseminated infections,720-2,APR-DRG,,,,,,,,inpatient,,,116439.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10727,,186% x Medicaid HMO amount,10727,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23038,,"27,634 x DRG Weight",23038,Other,DRG Base Rate x DRG Weight,19582,,"23,488 x DRG Weight",19582,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5767.21,,DRG base rate x DRG weight + capital per discharge,5767.21,Other,100% of NY Medicaid HMO DRG,5767,,DRG base rate x DRG weight + capital per discharge,5767,Other,100% of NY Medicaid HMO DRG,5767,,DRG base rate x DRG weight + capital per discharge,5767,Other,100% of NY Medicaid HMO DRG,5767,,DRG base rate x DRG weight + capital per discharge,5767,Other,100% of NY Medicaid HMO DRG,12976,,225% x Medicaid HMO amount,12976,Other,225% of NY Medicaid HMO DRG,8824,,153% x Medicaid HMO amount,8824,Other,153% of NY Medicaid HMO DRG,12976,,225% x Medicaid HMO amount,12976,Other,225% of NY Medicaid HMO DRG,8074,,140% x Medicaid HMO amount,8074,Other,140% of NY Medicaid HMO DRG,12976,,DRG base rate x DRG weight + capital per discharge,12976,Other,225% of NY Medicaid HMO DRG,15860,,275% x Medicaid HMO amount,15860,Other,275% of NY Medicaid HMO DRG,18686,,324% x Medicaid HMO amount,18686,Other,324% of NY Medicaid HMO DRG,12400,,215% x Medicaid HMO amount,12400,Other,215% of NY Medicaid HMO DRG,12400,,215% x Medicaid HMO amount,12400,Other,215% of NY Medicaid HMO DRG,7209,,125% x Medicaid HMO amount,7209,Other,125% of NY Medicaid HMO DRG,0.01,23038,
Septicemia & disseminated infections,720-3,APR-DRG,,,,,,,,inpatient,,,187547.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18455,,186% x Medicaid HMO amount,18455,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41119,,"27,634 x DRG Weight",41119,Other,DRG Base Rate x DRG Weight,34950,,"23,488 x DRG Weight",34950,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9922.21,,DRG base rate x DRG weight + capital per discharge,9922.21,Other,100% of NY Medicaid HMO DRG,9922,,DRG base rate x DRG weight + capital per discharge,9922,Other,100% of NY Medicaid HMO DRG,9922,,DRG base rate x DRG weight + capital per discharge,9922,Other,100% of NY Medicaid HMO DRG,9922,,DRG base rate x DRG weight + capital per discharge,9922,Other,100% of NY Medicaid HMO DRG,22325,,225% x Medicaid HMO amount,22325,Other,225% of NY Medicaid HMO DRG,15181,,153% x Medicaid HMO amount,15181,Other,153% of NY Medicaid HMO DRG,22325,,225% x Medicaid HMO amount,22325,Other,225% of NY Medicaid HMO DRG,13891,,140% x Medicaid HMO amount,13891,Other,140% of NY Medicaid HMO DRG,22325,,DRG base rate x DRG weight + capital per discharge,22325,Other,225% of NY Medicaid HMO DRG,27286,,275% x Medicaid HMO amount,27286,Other,275% of NY Medicaid HMO DRG,32148,,324% x Medicaid HMO amount,32148,Other,324% of NY Medicaid HMO DRG,21333,,215% x Medicaid HMO amount,21333,Other,215% of NY Medicaid HMO DRG,21333,,215% x Medicaid HMO amount,21333,Other,215% of NY Medicaid HMO DRG,12403,,125% x Medicaid HMO amount,12403,Other,125% of NY Medicaid HMO DRG,0.01,41119,
Septicemia & disseminated infections,720-4,APR-DRG,,,,,,,,inpatient,,,358701.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38679,,186% x Medicaid HMO amount,38679,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,88437,,"27,634 x DRG Weight",88437,Other,DRG Base Rate x DRG Weight,75169,,"23,488 x DRG Weight",75169,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,20795.21,,DRG base rate x DRG weight + capital per discharge,20795.21,Other,100% of NY Medicaid HMO DRG,20795,,DRG base rate x DRG weight + capital per discharge,20795,Other,100% of NY Medicaid HMO DRG,20795,,DRG base rate x DRG weight + capital per discharge,20795,Other,100% of NY Medicaid HMO DRG,20795,,DRG base rate x DRG weight + capital per discharge,20795,Other,100% of NY Medicaid HMO DRG,46789,,225% x Medicaid HMO amount,46789,Other,225% of NY Medicaid HMO DRG,31817,,153% x Medicaid HMO amount,31817,Other,153% of NY Medicaid HMO DRG,46789,,225% x Medicaid HMO amount,46789,Other,225% of NY Medicaid HMO DRG,29113,,140% x Medicaid HMO amount,29113,Other,140% of NY Medicaid HMO DRG,46789,,DRG base rate x DRG weight + capital per discharge,46789,Other,225% of NY Medicaid HMO DRG,57187,,275% x Medicaid HMO amount,57187,Other,275% of NY Medicaid HMO DRG,67376,,324% x Medicaid HMO amount,67376,Other,324% of NY Medicaid HMO DRG,44710,,215% x Medicaid HMO amount,44710,Other,215% of NY Medicaid HMO DRG,44710,,215% x Medicaid HMO amount,44710,Other,215% of NY Medicaid HMO DRG,25994,,125% x Medicaid HMO amount,25994,Other,125% of NY Medicaid HMO DRG,0.01,88437,
"Post-operative, post-traumatic, other device infections",721-1,APR-DRG,,,,,,,,inpatient,,,163560.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8483,,186% x Medicaid HMO amount,8483,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17791,,"27,634 x DRG Weight",17791,Other,DRG Base Rate x DRG Weight,15122,,"23,488 x DRG Weight",15122,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4561.21,,DRG base rate x DRG weight + capital per discharge,4561.21,Other,100% of NY Medicaid HMO DRG,4561,,DRG base rate x DRG weight + capital per discharge,4561,Other,100% of NY Medicaid HMO DRG,4561,,DRG base rate x DRG weight + capital per discharge,4561,Other,100% of NY Medicaid HMO DRG,4561,,DRG base rate x DRG weight + capital per discharge,4561,Other,100% of NY Medicaid HMO DRG,10263,,225% x Medicaid HMO amount,10263,Other,225% of NY Medicaid HMO DRG,6979,,153% x Medicaid HMO amount,6979,Other,153% of NY Medicaid HMO DRG,10263,,225% x Medicaid HMO amount,10263,Other,225% of NY Medicaid HMO DRG,6386,,140% x Medicaid HMO amount,6386,Other,140% of NY Medicaid HMO DRG,10263,,DRG base rate x DRG weight + capital per discharge,10263,Other,225% of NY Medicaid HMO DRG,12543,,275% x Medicaid HMO amount,12543,Other,275% of NY Medicaid HMO DRG,14778,,324% x Medicaid HMO amount,14778,Other,324% of NY Medicaid HMO DRG,9807,,215% x Medicaid HMO amount,9807,Other,215% of NY Medicaid HMO DRG,9807,,215% x Medicaid HMO amount,9807,Other,215% of NY Medicaid HMO DRG,5702,,125% x Medicaid HMO amount,5702,Other,125% of NY Medicaid HMO DRG,0.01,17791,
"Post-operative, post-traumatic, other device infections",721-2,APR-DRG,,,,,,,,inpatient,,,139034.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10877,,186% x Medicaid HMO amount,10877,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23392,,"27,634 x DRG Weight",23392,Other,DRG Base Rate x DRG Weight,19883,,"23,488 x DRG Weight",19883,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5848.21,,DRG base rate x DRG weight + capital per discharge,5848.21,Other,100% of NY Medicaid HMO DRG,5848,,DRG base rate x DRG weight + capital per discharge,5848,Other,100% of NY Medicaid HMO DRG,5848,,DRG base rate x DRG weight + capital per discharge,5848,Other,100% of NY Medicaid HMO DRG,5848,,DRG base rate x DRG weight + capital per discharge,5848,Other,100% of NY Medicaid HMO DRG,13158,,225% x Medicaid HMO amount,13158,Other,225% of NY Medicaid HMO DRG,8948,,153% x Medicaid HMO amount,8948,Other,153% of NY Medicaid HMO DRG,13158,,225% x Medicaid HMO amount,13158,Other,225% of NY Medicaid HMO DRG,8187,,140% x Medicaid HMO amount,8187,Other,140% of NY Medicaid HMO DRG,13158,,DRG base rate x DRG weight + capital per discharge,13158,Other,225% of NY Medicaid HMO DRG,16083,,275% x Medicaid HMO amount,16083,Other,275% of NY Medicaid HMO DRG,18948,,324% x Medicaid HMO amount,18948,Other,324% of NY Medicaid HMO DRG,12574,,215% x Medicaid HMO amount,12574,Other,215% of NY Medicaid HMO DRG,12574,,215% x Medicaid HMO amount,12574,Other,215% of NY Medicaid HMO DRG,7310,,125% x Medicaid HMO amount,7310,Other,125% of NY Medicaid HMO DRG,0.01,23392,
"Post-operative, post-traumatic, other device infections",721-3,APR-DRG,,,,,,,,inpatient,,,153353.48,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17789,,186% x Medicaid HMO amount,17789,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39561,,"27,634 x DRG Weight",39561,Other,DRG Base Rate x DRG Weight,33625,,"23,488 x DRG Weight",33625,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9564.21,,DRG base rate x DRG weight + capital per discharge,9564.21,Other,100% of NY Medicaid HMO DRG,9564,,DRG base rate x DRG weight + capital per discharge,9564,Other,100% of NY Medicaid HMO DRG,9564,,DRG base rate x DRG weight + capital per discharge,9564,Other,100% of NY Medicaid HMO DRG,9564,,DRG base rate x DRG weight + capital per discharge,9564,Other,100% of NY Medicaid HMO DRG,21519,,225% x Medicaid HMO amount,21519,Other,225% of NY Medicaid HMO DRG,14633,,153% x Medicaid HMO amount,14633,Other,153% of NY Medicaid HMO DRG,21519,,225% x Medicaid HMO amount,21519,Other,225% of NY Medicaid HMO DRG,13390,,140% x Medicaid HMO amount,13390,Other,140% of NY Medicaid HMO DRG,21519,,DRG base rate x DRG weight + capital per discharge,21519,Other,225% of NY Medicaid HMO DRG,26302,,275% x Medicaid HMO amount,26302,Other,275% of NY Medicaid HMO DRG,30988,,324% x Medicaid HMO amount,30988,Other,324% of NY Medicaid HMO DRG,20563,,215% x Medicaid HMO amount,20563,Other,215% of NY Medicaid HMO DRG,20563,,215% x Medicaid HMO amount,20563,Other,215% of NY Medicaid HMO DRG,11955,,125% x Medicaid HMO amount,11955,Other,125% of NY Medicaid HMO DRG,0.01,39561,
"Post-operative, post-traumatic, other device infections",721-4,APR-DRG,,,,,,,,inpatient,,,427372.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34317,,186% x Medicaid HMO amount,34317,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78232,,"27,634 x DRG Weight",78232,Other,DRG Base Rate x DRG Weight,66495,,"23,488 x DRG Weight",66495,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18450.21,,DRG base rate x DRG weight + capital per discharge,18450.21,Other,100% of NY Medicaid HMO DRG,18450,,DRG base rate x DRG weight + capital per discharge,18450,Other,100% of NY Medicaid HMO DRG,18450,,DRG base rate x DRG weight + capital per discharge,18450,Other,100% of NY Medicaid HMO DRG,18450,,DRG base rate x DRG weight + capital per discharge,18450,Other,100% of NY Medicaid HMO DRG,41513,,225% x Medicaid HMO amount,41513,Other,225% of NY Medicaid HMO DRG,28229,,153% x Medicaid HMO amount,28229,Other,153% of NY Medicaid HMO DRG,41513,,225% x Medicaid HMO amount,41513,Other,225% of NY Medicaid HMO DRG,25830,,140% x Medicaid HMO amount,25830,Other,140% of NY Medicaid HMO DRG,41513,,DRG base rate x DRG weight + capital per discharge,41513,Other,225% of NY Medicaid HMO DRG,50738,,275% x Medicaid HMO amount,50738,Other,275% of NY Medicaid HMO DRG,59779,,324% x Medicaid HMO amount,59779,Other,324% of NY Medicaid HMO DRG,39668,,215% x Medicaid HMO amount,39668,Other,215% of NY Medicaid HMO DRG,39668,,215% x Medicaid HMO amount,39668,Other,215% of NY Medicaid HMO DRG,23063,,125% x Medicaid HMO amount,23063,Other,125% of NY Medicaid HMO DRG,0.01,78232,
Fever,722-1,APR-DRG,,,,,,,,inpatient,,,59760.53,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6943,,186% x Medicaid HMO amount,6943,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14187,,"27,634 x DRG Weight",14187,Other,DRG Base Rate x DRG Weight,12059,,"23,488 x DRG Weight",12059,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3733.21,,DRG base rate x DRG weight + capital per discharge,3733.21,Other,100% of NY Medicaid HMO DRG,3733,,DRG base rate x DRG weight + capital per discharge,3733,Other,100% of NY Medicaid HMO DRG,3733,,DRG base rate x DRG weight + capital per discharge,3733,Other,100% of NY Medicaid HMO DRG,3733,,DRG base rate x DRG weight + capital per discharge,3733,Other,100% of NY Medicaid HMO DRG,8400,,225% x Medicaid HMO amount,8400,Other,225% of NY Medicaid HMO DRG,5712,,153% x Medicaid HMO amount,5712,Other,153% of NY Medicaid HMO DRG,8400,,225% x Medicaid HMO amount,8400,Other,225% of NY Medicaid HMO DRG,5226,,140% x Medicaid HMO amount,5226,Other,140% of NY Medicaid HMO DRG,8400,,DRG base rate x DRG weight + capital per discharge,8400,Other,225% of NY Medicaid HMO DRG,10266,,275% x Medicaid HMO amount,10266,Other,275% of NY Medicaid HMO DRG,12096,,324% x Medicaid HMO amount,12096,Other,324% of NY Medicaid HMO DRG,8026,,215% x Medicaid HMO amount,8026,Other,215% of NY Medicaid HMO DRG,8026,,215% x Medicaid HMO amount,8026,Other,215% of NY Medicaid HMO DRG,4667,,125% x Medicaid HMO amount,4667,Other,125% of NY Medicaid HMO DRG,0.01,14187,
Fever,722-2,APR-DRG,,,,,,,,inpatient,,,55665.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7788,,186% x Medicaid HMO amount,7788,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16163,,"27,634 x DRG Weight",16163,Other,DRG Base Rate x DRG Weight,13738,,"23,488 x DRG Weight",13738,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4187.21,,DRG base rate x DRG weight + capital per discharge,4187.21,Other,100% of NY Medicaid HMO DRG,4187,,DRG base rate x DRG weight + capital per discharge,4187,Other,100% of NY Medicaid HMO DRG,4187,,DRG base rate x DRG weight + capital per discharge,4187,Other,100% of NY Medicaid HMO DRG,4187,,DRG base rate x DRG weight + capital per discharge,4187,Other,100% of NY Medicaid HMO DRG,9421,,225% x Medicaid HMO amount,9421,Other,225% of NY Medicaid HMO DRG,6406,,153% x Medicaid HMO amount,6406,Other,153% of NY Medicaid HMO DRG,9421,,225% x Medicaid HMO amount,9421,Other,225% of NY Medicaid HMO DRG,5862,,140% x Medicaid HMO amount,5862,Other,140% of NY Medicaid HMO DRG,9421,,DRG base rate x DRG weight + capital per discharge,9421,Other,225% of NY Medicaid HMO DRG,11515,,275% x Medicaid HMO amount,11515,Other,275% of NY Medicaid HMO DRG,13567,,324% x Medicaid HMO amount,13567,Other,324% of NY Medicaid HMO DRG,9003,,215% x Medicaid HMO amount,9003,Other,215% of NY Medicaid HMO DRG,9003,,215% x Medicaid HMO amount,9003,Other,215% of NY Medicaid HMO DRG,5234,,125% x Medicaid HMO amount,5234,Other,125% of NY Medicaid HMO DRG,0.01,16163,
Fever,722-3,APR-DRG,,,,,,,,inpatient,,,96880,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10907,,186% x Medicaid HMO amount,10907,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23461,,"27,634 x DRG Weight",23461,Other,DRG Base Rate x DRG Weight,19941,,"23,488 x DRG Weight",19941,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5864.21,,DRG base rate x DRG weight + capital per discharge,5864.21,Other,100% of NY Medicaid HMO DRG,5864,,DRG base rate x DRG weight + capital per discharge,5864,Other,100% of NY Medicaid HMO DRG,5864,,DRG base rate x DRG weight + capital per discharge,5864,Other,100% of NY Medicaid HMO DRG,5864,,DRG base rate x DRG weight + capital per discharge,5864,Other,100% of NY Medicaid HMO DRG,13194,,225% x Medicaid HMO amount,13194,Other,225% of NY Medicaid HMO DRG,8972,,153% x Medicaid HMO amount,8972,Other,153% of NY Medicaid HMO DRG,13194,,225% x Medicaid HMO amount,13194,Other,225% of NY Medicaid HMO DRG,8210,,140% x Medicaid HMO amount,8210,Other,140% of NY Medicaid HMO DRG,13194,,DRG base rate x DRG weight + capital per discharge,13194,Other,225% of NY Medicaid HMO DRG,16127,,275% x Medicaid HMO amount,16127,Other,275% of NY Medicaid HMO DRG,19000,,324% x Medicaid HMO amount,19000,Other,324% of NY Medicaid HMO DRG,12608,,215% x Medicaid HMO amount,12608,Other,215% of NY Medicaid HMO DRG,12608,,215% x Medicaid HMO amount,12608,Other,215% of NY Medicaid HMO DRG,7330,,125% x Medicaid HMO amount,7330,Other,125% of NY Medicaid HMO DRG,0.01,23461,
Fever,722-4,APR-DRG,,,,,,,,inpatient,,,57528.7,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22045,,186% x Medicaid HMO amount,22045,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49520,,"27,634 x DRG Weight",49520,Other,DRG Base Rate x DRG Weight,42090,,"23,488 x DRG Weight",42090,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11852.21,,DRG base rate x DRG weight + capital per discharge,11852.21,Other,100% of NY Medicaid HMO DRG,11852,,DRG base rate x DRG weight + capital per discharge,11852,Other,100% of NY Medicaid HMO DRG,11852,,DRG base rate x DRG weight + capital per discharge,11852,Other,100% of NY Medicaid HMO DRG,11852,,DRG base rate x DRG weight + capital per discharge,11852,Other,100% of NY Medicaid HMO DRG,26667,,225% x Medicaid HMO amount,26667,Other,225% of NY Medicaid HMO DRG,18134,,153% x Medicaid HMO amount,18134,Other,153% of NY Medicaid HMO DRG,26667,,225% x Medicaid HMO amount,26667,Other,225% of NY Medicaid HMO DRG,16593,,140% x Medicaid HMO amount,16593,Other,140% of NY Medicaid HMO DRG,26667,,DRG base rate x DRG weight + capital per discharge,26667,Other,225% of NY Medicaid HMO DRG,32594,,275% x Medicaid HMO amount,32594,Other,275% of NY Medicaid HMO DRG,38401,,324% x Medicaid HMO amount,38401,Other,324% of NY Medicaid HMO DRG,25482,,215% x Medicaid HMO amount,25482,Other,215% of NY Medicaid HMO DRG,25482,,215% x Medicaid HMO amount,25482,Other,215% of NY Medicaid HMO DRG,14815,,125% x Medicaid HMO amount,14815,Other,125% of NY Medicaid HMO DRG,0.01,49520,
Viral illness,723-1,APR-DRG,,,,,,,,inpatient,,,69955.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6311,,186% x Medicaid HMO amount,6311,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12706,,"27,634 x DRG Weight",12706,Other,DRG Base Rate x DRG Weight,10800,,"23,488 x DRG Weight",10800,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3393.21,,DRG base rate x DRG weight + capital per discharge,3393.21,Other,100% of NY Medicaid HMO DRG,3393,,DRG base rate x DRG weight + capital per discharge,3393,Other,100% of NY Medicaid HMO DRG,3393,,DRG base rate x DRG weight + capital per discharge,3393,Other,100% of NY Medicaid HMO DRG,3393,,DRG base rate x DRG weight + capital per discharge,3393,Other,100% of NY Medicaid HMO DRG,7635,,225% x Medicaid HMO amount,7635,Other,225% of NY Medicaid HMO DRG,5192,,153% x Medicaid HMO amount,5192,Other,153% of NY Medicaid HMO DRG,7635,,225% x Medicaid HMO amount,7635,Other,225% of NY Medicaid HMO DRG,4750,,140% x Medicaid HMO amount,4750,Other,140% of NY Medicaid HMO DRG,7635,,DRG base rate x DRG weight + capital per discharge,7635,Other,225% of NY Medicaid HMO DRG,9331,,275% x Medicaid HMO amount,9331,Other,275% of NY Medicaid HMO DRG,10994,,324% x Medicaid HMO amount,10994,Other,324% of NY Medicaid HMO DRG,7295,,215% x Medicaid HMO amount,7295,Other,215% of NY Medicaid HMO DRG,7295,,215% x Medicaid HMO amount,7295,Other,215% of NY Medicaid HMO DRG,4242,,125% x Medicaid HMO amount,4242,Other,125% of NY Medicaid HMO DRG,0.01,12706,
Viral illness,723-2,APR-DRG,,,,,,,,inpatient,,,61965.4,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7440,,186% x Medicaid HMO amount,7440,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15348,,"27,634 x DRG Weight",15348,Other,DRG Base Rate x DRG Weight,13045,,"23,488 x DRG Weight",13045,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4000.21,,DRG base rate x DRG weight + capital per discharge,4000.21,Other,100% of NY Medicaid HMO DRG,4000,,DRG base rate x DRG weight + capital per discharge,4000,Other,100% of NY Medicaid HMO DRG,4000,,DRG base rate x DRG weight + capital per discharge,4000,Other,100% of NY Medicaid HMO DRG,4000,,DRG base rate x DRG weight + capital per discharge,4000,Other,100% of NY Medicaid HMO DRG,9000,,225% x Medicaid HMO amount,9000,Other,225% of NY Medicaid HMO DRG,6120,,153% x Medicaid HMO amount,6120,Other,153% of NY Medicaid HMO DRG,9000,,225% x Medicaid HMO amount,9000,Other,225% of NY Medicaid HMO DRG,5600,,140% x Medicaid HMO amount,5600,Other,140% of NY Medicaid HMO DRG,9000,,DRG base rate x DRG weight + capital per discharge,9000,Other,225% of NY Medicaid HMO DRG,11001,,275% x Medicaid HMO amount,11001,Other,275% of NY Medicaid HMO DRG,12961,,324% x Medicaid HMO amount,12961,Other,324% of NY Medicaid HMO DRG,8600,,215% x Medicaid HMO amount,8600,Other,215% of NY Medicaid HMO DRG,8600,,215% x Medicaid HMO amount,8600,Other,215% of NY Medicaid HMO DRG,5000,,125% x Medicaid HMO amount,5000,Other,125% of NY Medicaid HMO DRG,0.01,15348,
Viral illness,723-3,APR-DRG,,,,,,,,inpatient,,,112808.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10970,,186% x Medicaid HMO amount,10970,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23610,,"27,634 x DRG Weight",23610,Other,DRG Base Rate x DRG Weight,20068,,"23,488 x DRG Weight",20068,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5898.21,,DRG base rate x DRG weight + capital per discharge,5898.21,Other,100% of NY Medicaid HMO DRG,5898,,DRG base rate x DRG weight + capital per discharge,5898,Other,100% of NY Medicaid HMO DRG,5898,,DRG base rate x DRG weight + capital per discharge,5898,Other,100% of NY Medicaid HMO DRG,5898,,DRG base rate x DRG weight + capital per discharge,5898,Other,100% of NY Medicaid HMO DRG,13271,,225% x Medicaid HMO amount,13271,Other,225% of NY Medicaid HMO DRG,9024,,153% x Medicaid HMO amount,9024,Other,153% of NY Medicaid HMO DRG,13271,,225% x Medicaid HMO amount,13271,Other,225% of NY Medicaid HMO DRG,8257,,140% x Medicaid HMO amount,8257,Other,140% of NY Medicaid HMO DRG,13271,,DRG base rate x DRG weight + capital per discharge,13271,Other,225% of NY Medicaid HMO DRG,16220,,275% x Medicaid HMO amount,16220,Other,275% of NY Medicaid HMO DRG,19110,,324% x Medicaid HMO amount,19110,Other,324% of NY Medicaid HMO DRG,12681,,215% x Medicaid HMO amount,12681,Other,215% of NY Medicaid HMO DRG,12681,,215% x Medicaid HMO amount,12681,Other,215% of NY Medicaid HMO DRG,7373,,125% x Medicaid HMO amount,7373,Other,125% of NY Medicaid HMO DRG,0.01,23610,
Viral illness,723-4,APR-DRG,,,,,,,,inpatient,,,204410.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32624,,186% x Medicaid HMO amount,32624,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74272,,"27,634 x DRG Weight",74272,Other,DRG Base Rate x DRG Weight,63129,,"23,488 x DRG Weight",63129,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17540.21,,DRG base rate x DRG weight + capital per discharge,17540.21,Other,100% of NY Medicaid HMO DRG,17540,,DRG base rate x DRG weight + capital per discharge,17540,Other,100% of NY Medicaid HMO DRG,17540,,DRG base rate x DRG weight + capital per discharge,17540,Other,100% of NY Medicaid HMO DRG,17540,,DRG base rate x DRG weight + capital per discharge,17540,Other,100% of NY Medicaid HMO DRG,39465,,225% x Medicaid HMO amount,39465,Other,225% of NY Medicaid HMO DRG,26837,,153% x Medicaid HMO amount,26837,Other,153% of NY Medicaid HMO DRG,39465,,225% x Medicaid HMO amount,39465,Other,225% of NY Medicaid HMO DRG,24556,,140% x Medicaid HMO amount,24556,Other,140% of NY Medicaid HMO DRG,39465,,DRG base rate x DRG weight + capital per discharge,39465,Other,225% of NY Medicaid HMO DRG,48236,,275% x Medicaid HMO amount,48236,Other,275% of NY Medicaid HMO DRG,56830,,324% x Medicaid HMO amount,56830,Other,324% of NY Medicaid HMO DRG,37711,,215% x Medicaid HMO amount,37711,Other,215% of NY Medicaid HMO DRG,37711,,215% x Medicaid HMO amount,37711,Other,215% of NY Medicaid HMO DRG,21925,,125% x Medicaid HMO amount,21925,Other,125% of NY Medicaid HMO DRG,0.01,74272,
Other infectious & parasitic diseases,724-1,APR-DRG,,,,,,,,inpatient,,,62714.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8511,,186% x Medicaid HMO amount,8511,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17854,,"27,634 x DRG Weight",17854,Other,DRG Base Rate x DRG Weight,15176,,"23,488 x DRG Weight",15176,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4576.21,,DRG base rate x DRG weight + capital per discharge,4576.21,Other,100% of NY Medicaid HMO DRG,4576,,DRG base rate x DRG weight + capital per discharge,4576,Other,100% of NY Medicaid HMO DRG,4576,,DRG base rate x DRG weight + capital per discharge,4576,Other,100% of NY Medicaid HMO DRG,4576,,DRG base rate x DRG weight + capital per discharge,4576,Other,100% of NY Medicaid HMO DRG,10296,,225% x Medicaid HMO amount,10296,Other,225% of NY Medicaid HMO DRG,7002,,153% x Medicaid HMO amount,7002,Other,153% of NY Medicaid HMO DRG,10296,,225% x Medicaid HMO amount,10296,Other,225% of NY Medicaid HMO DRG,6407,,140% x Medicaid HMO amount,6407,Other,140% of NY Medicaid HMO DRG,10296,,DRG base rate x DRG weight + capital per discharge,10296,Other,225% of NY Medicaid HMO DRG,12585,,275% x Medicaid HMO amount,12585,Other,275% of NY Medicaid HMO DRG,14827,,324% x Medicaid HMO amount,14827,Other,324% of NY Medicaid HMO DRG,9839,,215% x Medicaid HMO amount,9839,Other,215% of NY Medicaid HMO DRG,9839,,215% x Medicaid HMO amount,9839,Other,215% of NY Medicaid HMO DRG,5720,,125% x Medicaid HMO amount,5720,Other,125% of NY Medicaid HMO DRG,0.01,17854,
Other infectious & parasitic diseases,724-2,APR-DRG,,,,,,,,inpatient,,,82056.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9942,,186% x Medicaid HMO amount,9942,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21201,,"27,634 x DRG Weight",21201,Other,DRG Base Rate x DRG Weight,18020,,"23,488 x DRG Weight",18020,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5345.21,,DRG base rate x DRG weight + capital per discharge,5345.21,Other,100% of NY Medicaid HMO DRG,5345,,DRG base rate x DRG weight + capital per discharge,5345,Other,100% of NY Medicaid HMO DRG,5345,,DRG base rate x DRG weight + capital per discharge,5345,Other,100% of NY Medicaid HMO DRG,5345,,DRG base rate x DRG weight + capital per discharge,5345,Other,100% of NY Medicaid HMO DRG,12027,,225% x Medicaid HMO amount,12027,Other,225% of NY Medicaid HMO DRG,8178,,153% x Medicaid HMO amount,8178,Other,153% of NY Medicaid HMO DRG,12027,,225% x Medicaid HMO amount,12027,Other,225% of NY Medicaid HMO DRG,7483,,140% x Medicaid HMO amount,7483,Other,140% of NY Medicaid HMO DRG,12027,,DRG base rate x DRG weight + capital per discharge,12027,Other,225% of NY Medicaid HMO DRG,14699,,275% x Medicaid HMO amount,14699,Other,275% of NY Medicaid HMO DRG,17318,,324% x Medicaid HMO amount,17318,Other,324% of NY Medicaid HMO DRG,11492,,215% x Medicaid HMO amount,11492,Other,215% of NY Medicaid HMO DRG,11492,,215% x Medicaid HMO amount,11492,Other,215% of NY Medicaid HMO DRG,6682,,125% x Medicaid HMO amount,6682,Other,125% of NY Medicaid HMO DRG,0.01,21201,
Other infectious & parasitic diseases,724-3,APR-DRG,,,,,,,,inpatient,,,126325.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16976,,186% x Medicaid HMO amount,16976,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37662,,"27,634 x DRG Weight",37662,Other,DRG Base Rate x DRG Weight,32012,,"23,488 x DRG Weight",32012,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9127.21,,DRG base rate x DRG weight + capital per discharge,9127.21,Other,100% of NY Medicaid HMO DRG,9127,,DRG base rate x DRG weight + capital per discharge,9127,Other,100% of NY Medicaid HMO DRG,9127,,DRG base rate x DRG weight + capital per discharge,9127,Other,100% of NY Medicaid HMO DRG,9127,,DRG base rate x DRG weight + capital per discharge,9127,Other,100% of NY Medicaid HMO DRG,20536,,225% x Medicaid HMO amount,20536,Other,225% of NY Medicaid HMO DRG,13965,,153% x Medicaid HMO amount,13965,Other,153% of NY Medicaid HMO DRG,20536,,225% x Medicaid HMO amount,20536,Other,225% of NY Medicaid HMO DRG,12778,,140% x Medicaid HMO amount,12778,Other,140% of NY Medicaid HMO DRG,20536,,DRG base rate x DRG weight + capital per discharge,20536,Other,225% of NY Medicaid HMO DRG,25100,,275% x Medicaid HMO amount,25100,Other,275% of NY Medicaid HMO DRG,29572,,324% x Medicaid HMO amount,29572,Other,324% of NY Medicaid HMO DRG,19624,,215% x Medicaid HMO amount,19624,Other,215% of NY Medicaid HMO DRG,19624,,215% x Medicaid HMO amount,19624,Other,215% of NY Medicaid HMO DRG,11409,,125% x Medicaid HMO amount,11409,Other,125% of NY Medicaid HMO DRG,0.01,37662,
Other infectious & parasitic diseases,724-4,APR-DRG,,,,,,,,inpatient,,,93840.23,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43643,,186% x Medicaid HMO amount,43643,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,100052,,"27,634 x DRG Weight",100052,Other,DRG Base Rate x DRG Weight,85041,,"23,488 x DRG Weight",85041,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23464.21,,DRG base rate x DRG weight + capital per discharge,23464.21,Other,100% of NY Medicaid HMO DRG,23464,,DRG base rate x DRG weight + capital per discharge,23464,Other,100% of NY Medicaid HMO DRG,23464,,DRG base rate x DRG weight + capital per discharge,23464,Other,100% of NY Medicaid HMO DRG,23464,,DRG base rate x DRG weight + capital per discharge,23464,Other,100% of NY Medicaid HMO DRG,52794,,225% x Medicaid HMO amount,52794,Other,225% of NY Medicaid HMO DRG,35900,,153% x Medicaid HMO amount,35900,Other,153% of NY Medicaid HMO DRG,52794,,225% x Medicaid HMO amount,52794,Other,225% of NY Medicaid HMO DRG,32850,,140% x Medicaid HMO amount,32850,Other,140% of NY Medicaid HMO DRG,52794,,DRG base rate x DRG weight + capital per discharge,52794,Other,225% of NY Medicaid HMO DRG,64527,,275% x Medicaid HMO amount,64527,Other,275% of NY Medicaid HMO DRG,76024,,324% x Medicaid HMO amount,76024,Other,324% of NY Medicaid HMO DRG,50448,,215% x Medicaid HMO amount,50448,Other,215% of NY Medicaid HMO DRG,50448,,215% x Medicaid HMO amount,50448,Other,215% of NY Medicaid HMO DRG,29330,,125% x Medicaid HMO amount,29330,Other,125% of NY Medicaid HMO DRG,0.01,100052,
Mental illness diagnosis w O.R. procedure,740-1,APR-DRG,,,,,,,,inpatient,,,81616.58,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39309,,186% x Medicaid HMO amount,39309,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15540,,"1,110 x patient days",15540,Per diem,,13216,,944 x patient days,13216,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21133.87,,DRG base rate x DRG weight + capital per discharge,21133.87,Other,100% of NY Medicaid HMO DRG,21134,,DRG base rate x DRG weight + capital per discharge,21134,Other,100% of NY Medicaid HMO DRG,21134,,DRG base rate x DRG weight + capital per discharge,21134,Other,100% of NY Medicaid HMO DRG,12180,,870 x patient days,12180,Per diem,,47551,,225% x Medicaid HMO amount,47551,Other,225% of NY Medicaid HMO DRG,32335,,153% x Medicaid HMO amount,32335,Other,153% of NY Medicaid HMO DRG,47551,,225% x Medicaid HMO amount,47551,Other,225% of NY Medicaid HMO DRG,29587,,140% x Medicaid HMO amount,29587,Other,140% of NY Medicaid HMO DRG,47551,,DRG base rate x DRG weight + capital per discharge,47551,Other,225% of NY Medicaid HMO DRG,19600,,"1,400 x patient days",19600,Per diem,,21196,,"1,514 x patient days",21196,Per diem,,37406.74,,"2,671.91 x patient days",37406.74,Per diem,,37406.74,,"2,671.91 x patient days",37406.74,Per diem,,12180,,870 x patient days,12180,Per diem,,0.01,47551,
Mental illness diagnosis w O.R. procedure,740-2,APR-DRG,,,,,,,,inpatient,,,186006.24,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39309,,186% x Medicaid HMO amount,39309,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15540,,"1,110 x patient days",15540,Per diem,,13216,,944 x patient days,13216,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21133.87,,DRG base rate x DRG weight + capital per discharge,21133.87,Other,100% of NY Medicaid HMO DRG,21134,,DRG base rate x DRG weight + capital per discharge,21134,Other,100% of NY Medicaid HMO DRG,21134,,DRG base rate x DRG weight + capital per discharge,21134,Other,100% of NY Medicaid HMO DRG,12180,,870 x patient days,12180,Per diem,,47551,,225% x Medicaid HMO amount,47551,Other,225% of NY Medicaid HMO DRG,32335,,153% x Medicaid HMO amount,32335,Other,153% of NY Medicaid HMO DRG,47551,,225% x Medicaid HMO amount,47551,Other,225% of NY Medicaid HMO DRG,29587,,140% x Medicaid HMO amount,29587,Other,140% of NY Medicaid HMO DRG,47551,,DRG base rate x DRG weight + capital per discharge,47551,Other,225% of NY Medicaid HMO DRG,19600,,"1,400 x patient days",19600,Per diem,,21196,,"1,514 x patient days",21196,Per diem,,37406.74,,"2,671.91 x patient days",37406.74,Per diem,,37406.74,,"2,671.91 x patient days",37406.74,Per diem,,12180,,870 x patient days,12180,Per diem,,0.01,47551,
Mental illness diagnosis w O.R. procedure,740-3,APR-DRG,,,,,,,,inpatient,,,83138,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39309,,186% x Medicaid HMO amount,39309,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15540,,"1,110 x patient days",15540,Per diem,,13216,,944 x patient days,13216,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21133.87,,DRG base rate x DRG weight + capital per discharge,21133.87,Other,100% of NY Medicaid HMO DRG,21134,,DRG base rate x DRG weight + capital per discharge,21134,Other,100% of NY Medicaid HMO DRG,21134,,DRG base rate x DRG weight + capital per discharge,21134,Other,100% of NY Medicaid HMO DRG,12180,,870 x patient days,12180,Per diem,,47551,,225% x Medicaid HMO amount,47551,Other,225% of NY Medicaid HMO DRG,32335,,153% x Medicaid HMO amount,32335,Other,153% of NY Medicaid HMO DRG,47551,,225% x Medicaid HMO amount,47551,Other,225% of NY Medicaid HMO DRG,29587,,140% x Medicaid HMO amount,29587,Other,140% of NY Medicaid HMO DRG,47551,,DRG base rate x DRG weight + capital per discharge,47551,Other,225% of NY Medicaid HMO DRG,19600,,"1,400 x patient days",19600,Per diem,,21196,,"1,514 x patient days",21196,Per diem,,37406.74,,"2,671.91 x patient days",37406.74,Per diem,,37406.74,,"2,671.91 x patient days",37406.74,Per diem,,12180,,870 x patient days,12180,Per diem,,0.01,47551,
Mental illness diagnosis w O.R. procedure,740-4,APR-DRG,,,,,,,,inpatient,,,1111940.5,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39309,,186% x Medicaid HMO amount,39309,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15540,,"1,110 x patient days",15540,Per diem,,13216,,944 x patient days,13216,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21133.87,,DRG base rate x DRG weight + capital per discharge,21133.87,Other,100% of NY Medicaid HMO DRG,21134,,DRG base rate x DRG weight + capital per discharge,21134,Other,100% of NY Medicaid HMO DRG,21134,,DRG base rate x DRG weight + capital per discharge,21134,Other,100% of NY Medicaid HMO DRG,12180,,870 x patient days,12180,Per diem,,47551,,225% x Medicaid HMO amount,47551,Other,225% of NY Medicaid HMO DRG,32335,,153% x Medicaid HMO amount,32335,Other,153% of NY Medicaid HMO DRG,47551,,225% x Medicaid HMO amount,47551,Other,225% of NY Medicaid HMO DRG,29587,,140% x Medicaid HMO amount,29587,Other,140% of NY Medicaid HMO DRG,47551,,DRG base rate x DRG weight + capital per discharge,47551,Other,225% of NY Medicaid HMO DRG,19600,,"1,400 x patient days",19600,Per diem,,21196,,"1,514 x patient days",21196,Per diem,,37406.74,,"2,671.91 x patient days",37406.74,Per diem,,37406.74,,"2,671.91 x patient days",37406.74,Per diem,,12180,,870 x patient days,12180,Per diem,,0.01,47551,
Schizophrenia,750-1,APR-DRG,,,,,,,,inpatient,,,109668.43,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28218,,186% x Medicaid HMO amount,28218,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13320,,"1,110 x patient days",13320,Per diem,,11328,,944 x patient days,11328,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15170.92,,DRG base rate x DRG weight + capital per discharge,15170.92,Other,100% of NY Medicaid HMO DRG,15171,,DRG base rate x DRG weight + capital per discharge,15171,Other,100% of NY Medicaid HMO DRG,15171,,DRG base rate x DRG weight + capital per discharge,15171,Other,100% of NY Medicaid HMO DRG,10440,,870 x patient days,10440,Per diem,,34135,,225% x Medicaid HMO amount,34135,Other,225% of NY Medicaid HMO DRG,23212,,153% x Medicaid HMO amount,23212,Other,153% of NY Medicaid HMO DRG,34135,,225% x Medicaid HMO amount,34135,Other,225% of NY Medicaid HMO DRG,21239,,140% x Medicaid HMO amount,21239,Other,140% of NY Medicaid HMO DRG,34135,,DRG base rate x DRG weight + capital per discharge,34135,Other,225% of NY Medicaid HMO DRG,16800,,"1,400 x patient days",16800,Per diem,,18168,,"1,514 x patient days",18168,Per diem,,32062.92,,"2,671.91 x patient days",32062.92,Per diem,,32062.92,,"2,671.91 x patient days",32062.92,Per diem,,10440,,870 x patient days,10440,Per diem,,0.01,34135,
Schizophrenia,750-2,APR-DRG,,,,,,,,inpatient,,,125116.16,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29589,,186% x Medicaid HMO amount,29589,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13320,,"1,110 x patient days",13320,Per diem,,11328,,944 x patient days,11328,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15907.62,,DRG base rate x DRG weight + capital per discharge,15907.62,Other,100% of NY Medicaid HMO DRG,15908,,DRG base rate x DRG weight + capital per discharge,15908,Other,100% of NY Medicaid HMO DRG,15908,,DRG base rate x DRG weight + capital per discharge,15908,Other,100% of NY Medicaid HMO DRG,10440,,870 x patient days,10440,Per diem,,35792,,225% x Medicaid HMO amount,35792,Other,225% of NY Medicaid HMO DRG,24339,,153% x Medicaid HMO amount,24339,Other,153% of NY Medicaid HMO DRG,35792,,225% x Medicaid HMO amount,35792,Other,225% of NY Medicaid HMO DRG,22271,,140% x Medicaid HMO amount,22271,Other,140% of NY Medicaid HMO DRG,35792,,DRG base rate x DRG weight + capital per discharge,35792,Other,225% of NY Medicaid HMO DRG,16800,,"1,400 x patient days",16800,Per diem,,18168,,"1,514 x patient days",18168,Per diem,,32062.92,,"2,671.91 x patient days",32062.92,Per diem,,32062.92,,"2,671.91 x patient days",32062.92,Per diem,,10440,,870 x patient days,10440,Per diem,,0.01,35792,
Schizophrenia,750-3,APR-DRG,,,,,,,,inpatient,,,272826.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31222,,186% x Medicaid HMO amount,31222,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13320,,"1,110 x patient days",13320,Per diem,,11328,,944 x patient days,11328,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16786,,DRG base rate x DRG weight + capital per discharge,16786,Other,100% of NY Medicaid HMO DRG,16786,,DRG base rate x DRG weight + capital per discharge,16786,Other,100% of NY Medicaid HMO DRG,16786,,DRG base rate x DRG weight + capital per discharge,16786,Other,100% of NY Medicaid HMO DRG,10440,,870 x patient days,10440,Per diem,,37768,,225% x Medicaid HMO amount,37768,Other,225% of NY Medicaid HMO DRG,25683,,153% x Medicaid HMO amount,25683,Other,153% of NY Medicaid HMO DRG,37768,,225% x Medicaid HMO amount,37768,Other,225% of NY Medicaid HMO DRG,23500,,140% x Medicaid HMO amount,23500,Other,140% of NY Medicaid HMO DRG,37768,,DRG base rate x DRG weight + capital per discharge,37768,Other,225% of NY Medicaid HMO DRG,16800,,"1,400 x patient days",16800,Per diem,,18168,,"1,514 x patient days",18168,Per diem,,32062.92,,"2,671.91 x patient days",32062.92,Per diem,,32062.92,,"2,671.91 x patient days",32062.92,Per diem,,10440,,870 x patient days,10440,Per diem,,0.01,37768,
Schizophrenia,750-4,APR-DRG,,,,,,,,inpatient,,,455739.67,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31709,,186% x Medicaid HMO amount,31709,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13320,,"1,110 x patient days",13320,Per diem,,11328,,944 x patient days,11328,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17048.46,,DRG base rate x DRG weight + capital per discharge,17048.46,Other,100% of NY Medicaid HMO DRG,17048,,DRG base rate x DRG weight + capital per discharge,17048,Other,100% of NY Medicaid HMO DRG,17048,,DRG base rate x DRG weight + capital per discharge,17048,Other,100% of NY Medicaid HMO DRG,10440,,870 x patient days,10440,Per diem,,38359,,225% x Medicaid HMO amount,38359,Other,225% of NY Medicaid HMO DRG,26084,,153% x Medicaid HMO amount,26084,Other,153% of NY Medicaid HMO DRG,38359,,225% x Medicaid HMO amount,38359,Other,225% of NY Medicaid HMO DRG,23868,,140% x Medicaid HMO amount,23868,Other,140% of NY Medicaid HMO DRG,38359,,DRG base rate x DRG weight + capital per discharge,38359,Other,225% of NY Medicaid HMO DRG,16800,,"1,400 x patient days",16800,Per diem,,18168,,"1,514 x patient days",18168,Per diem,,32062.92,,"2,671.91 x patient days",32062.92,Per diem,,32062.92,,"2,671.91 x patient days",32062.92,Per diem,,10440,,870 x patient days,10440,Per diem,,0.01,38359,
Major depressive disorders & other/unspecified psychoses,751-1,APR-DRG,,,,,,,,inpatient,,,80748.71,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17177,,186% x Medicaid HMO amount,17177,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7770,,"1,110 x patient days",7770,Per diem,,6608,,944 x patient days,6608,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9235.08,,DRG base rate x DRG weight + capital per discharge,9235.08,Other,100% of NY Medicaid HMO DRG,9235,,DRG base rate x DRG weight + capital per discharge,9235,Other,100% of NY Medicaid HMO DRG,9235,,DRG base rate x DRG weight + capital per discharge,9235,Other,100% of NY Medicaid HMO DRG,6090,,870 x patient days,6090,Per diem,,20779,,225% x Medicaid HMO amount,20779,Other,225% of NY Medicaid HMO DRG,14130,,153% x Medicaid HMO amount,14130,Other,153% of NY Medicaid HMO DRG,20779,,225% x Medicaid HMO amount,20779,Other,225% of NY Medicaid HMO DRG,12929,,140% x Medicaid HMO amount,12929,Other,140% of NY Medicaid HMO DRG,20779,,DRG base rate x DRG weight + capital per discharge,20779,Other,225% of NY Medicaid HMO DRG,9800,,"1,400 x patient days",9800,Per diem,,10598,,"1,514 x patient days",10598,Per diem,,18703.37,,"2,671.91 x patient days",18703.37,Per diem,,18703.37,,"2,671.91 x patient days",18703.37,Per diem,,6090,,870 x patient days,6090,Per diem,,0.01,20779,
Major depressive disorders & other/unspecified psychoses,751-2,APR-DRG,,,,,,,,inpatient,,,101733.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18155,,186% x Medicaid HMO amount,18155,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7770,,"1,110 x patient days",7770,Per diem,,6608,,944 x patient days,6608,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9761.38,,DRG base rate x DRG weight + capital per discharge,9761.38,Other,100% of NY Medicaid HMO DRG,9761,,DRG base rate x DRG weight + capital per discharge,9761,Other,100% of NY Medicaid HMO DRG,9761,,DRG base rate x DRG weight + capital per discharge,9761,Other,100% of NY Medicaid HMO DRG,6090,,870 x patient days,6090,Per diem,,21963,,225% x Medicaid HMO amount,21963,Other,225% of NY Medicaid HMO DRG,14935,,153% x Medicaid HMO amount,14935,Other,153% of NY Medicaid HMO DRG,21963,,225% x Medicaid HMO amount,21963,Other,225% of NY Medicaid HMO DRG,13666,,140% x Medicaid HMO amount,13666,Other,140% of NY Medicaid HMO DRG,21963,,DRG base rate x DRG weight + capital per discharge,21963,Other,225% of NY Medicaid HMO DRG,9800,,"1,400 x patient days",9800,Per diem,,10598,,"1,514 x patient days",10598,Per diem,,18703.37,,"2,671.91 x patient days",18703.37,Per diem,,18703.37,,"2,671.91 x patient days",18703.37,Per diem,,6090,,870 x patient days,6090,Per diem,,0.01,21963,
Major depressive disorders & other/unspecified psychoses,751-3,APR-DRG,,,,,,,,inpatient,,,129729.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18438,,186% x Medicaid HMO amount,18438,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7770,,"1,110 x patient days",7770,Per diem,,6608,,944 x patient days,6608,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9912.75,,DRG base rate x DRG weight + capital per discharge,9912.75,Other,100% of NY Medicaid HMO DRG,9913,,DRG base rate x DRG weight + capital per discharge,9913,Other,100% of NY Medicaid HMO DRG,9913,,DRG base rate x DRG weight + capital per discharge,9913,Other,100% of NY Medicaid HMO DRG,6090,,870 x patient days,6090,Per diem,,22304,,225% x Medicaid HMO amount,22304,Other,225% of NY Medicaid HMO DRG,15167,,153% x Medicaid HMO amount,15167,Other,153% of NY Medicaid HMO DRG,22304,,225% x Medicaid HMO amount,22304,Other,225% of NY Medicaid HMO DRG,13878,,140% x Medicaid HMO amount,13878,Other,140% of NY Medicaid HMO DRG,22304,,DRG base rate x DRG weight + capital per discharge,22304,Other,225% of NY Medicaid HMO DRG,9800,,"1,400 x patient days",9800,Per diem,,10598,,"1,514 x patient days",10598,Per diem,,18703.37,,"2,671.91 x patient days",18703.37,Per diem,,18703.37,,"2,671.91 x patient days",18703.37,Per diem,,6090,,870 x patient days,6090,Per diem,,0.01,22304,
Major depressive disorders & other/unspecified psychoses,751-4,APR-DRG,,,,,,,,inpatient,,,286562.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19314,,186% x Medicaid HMO amount,19314,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7770,,"1,110 x patient days",7770,Per diem,,6608,,944 x patient days,6608,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10384.25,,DRG base rate x DRG weight + capital per discharge,10384.25,Other,100% of NY Medicaid HMO DRG,10384,,DRG base rate x DRG weight + capital per discharge,10384,Other,100% of NY Medicaid HMO DRG,10384,,DRG base rate x DRG weight + capital per discharge,10384,Other,100% of NY Medicaid HMO DRG,6090,,870 x patient days,6090,Per diem,,23365,,225% x Medicaid HMO amount,23365,Other,225% of NY Medicaid HMO DRG,15888,,153% x Medicaid HMO amount,15888,Other,153% of NY Medicaid HMO DRG,23365,,225% x Medicaid HMO amount,23365,Other,225% of NY Medicaid HMO DRG,14538,,140% x Medicaid HMO amount,14538,Other,140% of NY Medicaid HMO DRG,23365,,DRG base rate x DRG weight + capital per discharge,23365,Other,225% of NY Medicaid HMO DRG,9800,,"1,400 x patient days",9800,Per diem,,10598,,"1,514 x patient days",10598,Per diem,,18703.37,,"2,671.91 x patient days",18703.37,Per diem,,18703.37,,"2,671.91 x patient days",18703.37,Per diem,,6090,,870 x patient days,6090,Per diem,,0.01,23365,
Disorders of personality & impulse control,752-1,APR-DRG,,,,,,,,inpatient,,,85386,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12224,,186% x Medicaid HMO amount,12224,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6571.63,,DRG base rate x DRG weight + capital per discharge,6571.63,Other,100% of NY Medicaid HMO DRG,6572,,DRG base rate x DRG weight + capital per discharge,6572,Other,100% of NY Medicaid HMO DRG,6572,,DRG base rate x DRG weight + capital per discharge,6572,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,14786,,225% x Medicaid HMO amount,14786,Other,225% of NY Medicaid HMO DRG,10055,,153% x Medicaid HMO amount,10055,Other,153% of NY Medicaid HMO DRG,14786,,225% x Medicaid HMO amount,14786,Other,225% of NY Medicaid HMO DRG,9200,,140% x Medicaid HMO amount,9200,Other,140% of NY Medicaid HMO DRG,14786,,DRG base rate x DRG weight + capital per discharge,14786,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,14786,
Disorders of personality & impulse control,752-2,APR-DRG,,,,,,,,inpatient,,,63083.9,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12657,,186% x Medicaid HMO amount,12657,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6805.27,,DRG base rate x DRG weight + capital per discharge,6805.27,Other,100% of NY Medicaid HMO DRG,6805,,DRG base rate x DRG weight + capital per discharge,6805,Other,100% of NY Medicaid HMO DRG,6805,,DRG base rate x DRG weight + capital per discharge,6805,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,15312,,225% x Medicaid HMO amount,15312,Other,225% of NY Medicaid HMO DRG,10412,,153% x Medicaid HMO amount,10412,Other,153% of NY Medicaid HMO DRG,15312,,225% x Medicaid HMO amount,15312,Other,225% of NY Medicaid HMO DRG,9527,,140% x Medicaid HMO amount,9527,Other,140% of NY Medicaid HMO DRG,15312,,DRG base rate x DRG weight + capital per discharge,15312,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,15312,
Disorders of personality & impulse control,752-3,APR-DRG,,,,,,,,inpatient,,,1871278,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12657,,186% x Medicaid HMO amount,12657,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6805.27,,DRG base rate x DRG weight + capital per discharge,6805.27,Other,100% of NY Medicaid HMO DRG,6805,,DRG base rate x DRG weight + capital per discharge,6805,Other,100% of NY Medicaid HMO DRG,6805,,DRG base rate x DRG weight + capital per discharge,6805,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,15312,,225% x Medicaid HMO amount,15312,Other,225% of NY Medicaid HMO DRG,10412,,153% x Medicaid HMO amount,10412,Other,153% of NY Medicaid HMO DRG,15312,,225% x Medicaid HMO amount,15312,Other,225% of NY Medicaid HMO DRG,9527,,140% x Medicaid HMO amount,9527,Other,140% of NY Medicaid HMO DRG,15312,,DRG base rate x DRG weight + capital per discharge,15312,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,15312,
Disorders of personality & impulse control,752-4,APR-DRG,,,,,,,,inpatient,,,1871278,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12657,,186% x Medicaid HMO amount,12657,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6805.27,,DRG base rate x DRG weight + capital per discharge,6805.27,Other,100% of NY Medicaid HMO DRG,6805,,DRG base rate x DRG weight + capital per discharge,6805,Other,100% of NY Medicaid HMO DRG,6805,,DRG base rate x DRG weight + capital per discharge,6805,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,15312,,225% x Medicaid HMO amount,15312,Other,225% of NY Medicaid HMO DRG,10412,,153% x Medicaid HMO amount,10412,Other,153% of NY Medicaid HMO DRG,15312,,225% x Medicaid HMO amount,15312,Other,225% of NY Medicaid HMO DRG,9527,,140% x Medicaid HMO amount,9527,Other,140% of NY Medicaid HMO DRG,15312,,DRG base rate x DRG weight + capital per discharge,15312,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,15312,
Bipolar disorders,753-1,APR-DRG,,,,,,,,inpatient,,,81490.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14484,,186% x Medicaid HMO amount,14484,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6660,,"1,110 x patient days",6660,Per diem,,5664,,944 x patient days,5664,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7786.78,,DRG base rate x DRG weight + capital per discharge,7786.78,Other,100% of NY Medicaid HMO DRG,7787,,DRG base rate x DRG weight + capital per discharge,7787,Other,100% of NY Medicaid HMO DRG,7787,,DRG base rate x DRG weight + capital per discharge,7787,Other,100% of NY Medicaid HMO DRG,5220,,870 x patient days,5220,Per diem,,17520,,225% x Medicaid HMO amount,17520,Other,225% of NY Medicaid HMO DRG,11914,,153% x Medicaid HMO amount,11914,Other,153% of NY Medicaid HMO DRG,17520,,225% x Medicaid HMO amount,17520,Other,225% of NY Medicaid HMO DRG,10901,,140% x Medicaid HMO amount,10901,Other,140% of NY Medicaid HMO DRG,17520,,DRG base rate x DRG weight + capital per discharge,17520,Other,225% of NY Medicaid HMO DRG,8400,,"1,400 x patient days",8400,Per diem,,9084,,"1,514 x patient days",9084,Per diem,,16031.46,,"2,671.91 x patient days",16031.46,Per diem,,16031.46,,"2,671.91 x patient days",16031.46,Per diem,,5220,,870 x patient days,5220,Per diem,,0.01,17520,
Bipolar disorders,753-2,APR-DRG,,,,,,,,inpatient,,,109010.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15031,,186% x Medicaid HMO amount,15031,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6660,,"1,110 x patient days",6660,Per diem,,5664,,944 x patient days,5664,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8081.32,,DRG base rate x DRG weight + capital per discharge,8081.32,Other,100% of NY Medicaid HMO DRG,8081,,DRG base rate x DRG weight + capital per discharge,8081,Other,100% of NY Medicaid HMO DRG,8081,,DRG base rate x DRG weight + capital per discharge,8081,Other,100% of NY Medicaid HMO DRG,5220,,870 x patient days,5220,Per diem,,18183,,225% x Medicaid HMO amount,18183,Other,225% of NY Medicaid HMO DRG,12364,,153% x Medicaid HMO amount,12364,Other,153% of NY Medicaid HMO DRG,18183,,225% x Medicaid HMO amount,18183,Other,225% of NY Medicaid HMO DRG,11314,,140% x Medicaid HMO amount,11314,Other,140% of NY Medicaid HMO DRG,18183,,DRG base rate x DRG weight + capital per discharge,18183,Other,225% of NY Medicaid HMO DRG,8400,,"1,400 x patient days",8400,Per diem,,9084,,"1,514 x patient days",9084,Per diem,,16031.46,,"2,671.91 x patient days",16031.46,Per diem,,16031.46,,"2,671.91 x patient days",16031.46,Per diem,,5220,,870 x patient days,5220,Per diem,,0.01,18183,
Bipolar disorders,753-3,APR-DRG,,,,,,,,inpatient,,,121014.97,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15680,,186% x Medicaid HMO amount,15680,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6660,,"1,110 x patient days",6660,Per diem,,5664,,944 x patient days,5664,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8429.53,,DRG base rate x DRG weight + capital per discharge,8429.53,Other,100% of NY Medicaid HMO DRG,8430,,DRG base rate x DRG weight + capital per discharge,8430,Other,100% of NY Medicaid HMO DRG,8430,,DRG base rate x DRG weight + capital per discharge,8430,Other,100% of NY Medicaid HMO DRG,5220,,870 x patient days,5220,Per diem,,18966,,225% x Medicaid HMO amount,18966,Other,225% of NY Medicaid HMO DRG,12897,,153% x Medicaid HMO amount,12897,Other,153% of NY Medicaid HMO DRG,18966,,225% x Medicaid HMO amount,18966,Other,225% of NY Medicaid HMO DRG,11801,,140% x Medicaid HMO amount,11801,Other,140% of NY Medicaid HMO DRG,18966,,DRG base rate x DRG weight + capital per discharge,18966,Other,225% of NY Medicaid HMO DRG,8400,,"1,400 x patient days",8400,Per diem,,9084,,"1,514 x patient days",9084,Per diem,,16031.46,,"2,671.91 x patient days",16031.46,Per diem,,16031.46,,"2,671.91 x patient days",16031.46,Per diem,,5220,,870 x patient days,5220,Per diem,,0.01,18966,
Bipolar disorders,753-4,APR-DRG,,,,,,,,inpatient,,,1531612.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16954,,186% x Medicaid HMO amount,16954,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6660,,"1,110 x patient days",6660,Per diem,,5664,,944 x patient days,5664,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9114.79,,DRG base rate x DRG weight + capital per discharge,9114.79,Other,100% of NY Medicaid HMO DRG,9115,,DRG base rate x DRG weight + capital per discharge,9115,Other,100% of NY Medicaid HMO DRG,9115,,DRG base rate x DRG weight + capital per discharge,9115,Other,100% of NY Medicaid HMO DRG,5220,,870 x patient days,5220,Per diem,,20508,,225% x Medicaid HMO amount,20508,Other,225% of NY Medicaid HMO DRG,13946,,153% x Medicaid HMO amount,13946,Other,153% of NY Medicaid HMO DRG,20508,,225% x Medicaid HMO amount,20508,Other,225% of NY Medicaid HMO DRG,12761,,140% x Medicaid HMO amount,12761,Other,140% of NY Medicaid HMO DRG,20508,,DRG base rate x DRG weight + capital per discharge,20508,Other,225% of NY Medicaid HMO DRG,8400,,"1,400 x patient days",8400,Per diem,,9084,,"1,514 x patient days",9084,Per diem,,16031.46,,"2,671.91 x patient days",16031.46,Per diem,,16031.46,,"2,671.91 x patient days",16031.46,Per diem,,5220,,870 x patient days,5220,Per diem,,0.01,20508,
Depression except major depressive disorder,754-1,APR-DRG,,,,,,,,inpatient,,,64811.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10128,,186% x Medicaid HMO amount,10128,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4440,,"1,110 x patient days",4440,Per diem,,3776,,944 x patient days,3776,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5445.21,,DRG base rate x DRG weight + capital per discharge,5445.21,Other,100% of NY Medicaid HMO DRG,5445,,DRG base rate x DRG weight + capital per discharge,5445,Other,100% of NY Medicaid HMO DRG,5445,,DRG base rate x DRG weight + capital per discharge,5445,Other,100% of NY Medicaid HMO DRG,3480,,870 x patient days,3480,Per diem,,12252,,225% x Medicaid HMO amount,12252,Other,225% of NY Medicaid HMO DRG,8331,,153% x Medicaid HMO amount,8331,Other,153% of NY Medicaid HMO DRG,12252,,225% x Medicaid HMO amount,12252,Other,225% of NY Medicaid HMO DRG,7623,,140% x Medicaid HMO amount,7623,Other,140% of NY Medicaid HMO DRG,12252,,DRG base rate x DRG weight + capital per discharge,12252,Other,225% of NY Medicaid HMO DRG,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,3480,,870 x patient days,3480,Per diem,,0.01,12252,
Depression except major depressive disorder,754-2,APR-DRG,,,,,,,,inpatient,,,81229.56,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10485,,186% x Medicaid HMO amount,10485,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4440,,"1,110 x patient days",4440,Per diem,,3776,,944 x patient days,3776,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5637.09,,DRG base rate x DRG weight + capital per discharge,5637.09,Other,100% of NY Medicaid HMO DRG,5637,,DRG base rate x DRG weight + capital per discharge,5637,Other,100% of NY Medicaid HMO DRG,5637,,DRG base rate x DRG weight + capital per discharge,5637,Other,100% of NY Medicaid HMO DRG,3480,,870 x patient days,3480,Per diem,,12683,,225% x Medicaid HMO amount,12683,Other,225% of NY Medicaid HMO DRG,8625,,153% x Medicaid HMO amount,8625,Other,153% of NY Medicaid HMO DRG,12683,,225% x Medicaid HMO amount,12683,Other,225% of NY Medicaid HMO DRG,7892,,140% x Medicaid HMO amount,7892,Other,140% of NY Medicaid HMO DRG,12683,,DRG base rate x DRG weight + capital per discharge,12683,Other,225% of NY Medicaid HMO DRG,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,3480,,870 x patient days,3480,Per diem,,0.01,12683,
Depression except major depressive disorder,754-3,APR-DRG,,,,,,,,inpatient,,,166397.3,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10719,,186% x Medicaid HMO amount,10719,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4440,,"1,110 x patient days",4440,Per diem,,3776,,944 x patient days,3776,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5762.85,,DRG base rate x DRG weight + capital per discharge,5762.85,Other,100% of NY Medicaid HMO DRG,5763,,DRG base rate x DRG weight + capital per discharge,5763,Other,100% of NY Medicaid HMO DRG,5763,,DRG base rate x DRG weight + capital per discharge,5763,Other,100% of NY Medicaid HMO DRG,3480,,870 x patient days,3480,Per diem,,12966,,225% x Medicaid HMO amount,12966,Other,225% of NY Medicaid HMO DRG,8817,,153% x Medicaid HMO amount,8817,Other,153% of NY Medicaid HMO DRG,12966,,225% x Medicaid HMO amount,12966,Other,225% of NY Medicaid HMO DRG,8068,,140% x Medicaid HMO amount,8068,Other,140% of NY Medicaid HMO DRG,12966,,DRG base rate x DRG weight + capital per discharge,12966,Other,225% of NY Medicaid HMO DRG,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,3480,,870 x patient days,3480,Per diem,,0.01,12966,
Depression except major depressive disorder,754-4,APR-DRG,,,,,,,,inpatient,,,99048,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10719,,186% x Medicaid HMO amount,10719,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4440,,"1,110 x patient days",4440,Per diem,,3776,,944 x patient days,3776,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5762.85,,DRG base rate x DRG weight + capital per discharge,5762.85,Other,100% of NY Medicaid HMO DRG,5763,,DRG base rate x DRG weight + capital per discharge,5763,Other,100% of NY Medicaid HMO DRG,5763,,DRG base rate x DRG weight + capital per discharge,5763,Other,100% of NY Medicaid HMO DRG,3480,,870 x patient days,3480,Per diem,,12966,,225% x Medicaid HMO amount,12966,Other,225% of NY Medicaid HMO DRG,8817,,153% x Medicaid HMO amount,8817,Other,153% of NY Medicaid HMO DRG,12966,,225% x Medicaid HMO amount,12966,Other,225% of NY Medicaid HMO DRG,8068,,140% x Medicaid HMO amount,8068,Other,140% of NY Medicaid HMO DRG,12966,,DRG base rate x DRG weight + capital per discharge,12966,Other,225% of NY Medicaid HMO DRG,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,3480,,870 x patient days,3480,Per diem,,0.01,12966,
Adjustment disorders & neuroses except depressive diagnoses,755-1,APR-DRG,,,,,,,,inpatient,,,40924.11,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7762,,186% x Medicaid HMO amount,7762,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3330,,"1,110 x patient days",3330,Per diem,,2832,,944 x patient days,2832,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4173.01,,DRG base rate x DRG weight + capital per discharge,4173.01,Other,100% of NY Medicaid HMO DRG,4173,,DRG base rate x DRG weight + capital per discharge,4173,Other,100% of NY Medicaid HMO DRG,4173,,DRG base rate x DRG weight + capital per discharge,4173,Other,100% of NY Medicaid HMO DRG,2610,,870 x patient days,2610,Per diem,,9389,,225% x Medicaid HMO amount,9389,Other,225% of NY Medicaid HMO DRG,6385,,153% x Medicaid HMO amount,6385,Other,153% of NY Medicaid HMO DRG,9389,,225% x Medicaid HMO amount,9389,Other,225% of NY Medicaid HMO DRG,5842,,140% x Medicaid HMO amount,5842,Other,140% of NY Medicaid HMO DRG,9389,,DRG base rate x DRG weight + capital per discharge,9389,Other,225% of NY Medicaid HMO DRG,4200,,"1,400 x patient days",4200,Per diem,,4542,,"1,514 x patient days",4542,Per diem,,8015.73,,"2,671.91 x patient days",8015.73,Per diem,,8015.73,,"2,671.91 x patient days",8015.73,Per diem,,2610,,870 x patient days,2610,Per diem,,0.01,9389,
Adjustment disorders & neuroses except depressive diagnoses,755-2,APR-DRG,,,,,,,,inpatient,,,38617.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7762,,186% x Medicaid HMO amount,7762,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3330,,"1,110 x patient days",3330,Per diem,,2832,,944 x patient days,2832,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4173.01,,DRG base rate x DRG weight + capital per discharge,4173.01,Other,100% of NY Medicaid HMO DRG,4173,,DRG base rate x DRG weight + capital per discharge,4173,Other,100% of NY Medicaid HMO DRG,4173,,DRG base rate x DRG weight + capital per discharge,4173,Other,100% of NY Medicaid HMO DRG,2610,,870 x patient days,2610,Per diem,,9389,,225% x Medicaid HMO amount,9389,Other,225% of NY Medicaid HMO DRG,6385,,153% x Medicaid HMO amount,6385,Other,153% of NY Medicaid HMO DRG,9389,,225% x Medicaid HMO amount,9389,Other,225% of NY Medicaid HMO DRG,5842,,140% x Medicaid HMO amount,5842,Other,140% of NY Medicaid HMO DRG,9389,,DRG base rate x DRG weight + capital per discharge,9389,Other,225% of NY Medicaid HMO DRG,4200,,"1,400 x patient days",4200,Per diem,,4542,,"1,514 x patient days",4542,Per diem,,8015.73,,"2,671.91 x patient days",8015.73,Per diem,,8015.73,,"2,671.91 x patient days",8015.73,Per diem,,2610,,870 x patient days,2610,Per diem,,0.01,9389,
Adjustment disorders & neuroses except depressive diagnoses,755-3,APR-DRG,,,,,,,,inpatient,,,91172.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7762,,186% x Medicaid HMO amount,7762,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3330,,"1,110 x patient days",3330,Per diem,,2832,,944 x patient days,2832,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4173.01,,DRG base rate x DRG weight + capital per discharge,4173.01,Other,100% of NY Medicaid HMO DRG,4173,,DRG base rate x DRG weight + capital per discharge,4173,Other,100% of NY Medicaid HMO DRG,4173,,DRG base rate x DRG weight + capital per discharge,4173,Other,100% of NY Medicaid HMO DRG,2610,,870 x patient days,2610,Per diem,,9389,,225% x Medicaid HMO amount,9389,Other,225% of NY Medicaid HMO DRG,6385,,153% x Medicaid HMO amount,6385,Other,153% of NY Medicaid HMO DRG,9389,,225% x Medicaid HMO amount,9389,Other,225% of NY Medicaid HMO DRG,5842,,140% x Medicaid HMO amount,5842,Other,140% of NY Medicaid HMO DRG,9389,,DRG base rate x DRG weight + capital per discharge,9389,Other,225% of NY Medicaid HMO DRG,4200,,"1,400 x patient days",4200,Per diem,,4542,,"1,514 x patient days",4542,Per diem,,8015.73,,"2,671.91 x patient days",8015.73,Per diem,,8015.73,,"2,671.91 x patient days",8015.73,Per diem,,2610,,870 x patient days,2610,Per diem,,0.01,9389,
Adjustment disorders & neuroses except depressive diagnoses,755-4,APR-DRG,,,,,,,,inpatient,,,91172.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7762,,186% x Medicaid HMO amount,7762,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3330,,"1,110 x patient days",3330,Per diem,,2832,,944 x patient days,2832,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4173.01,,DRG base rate x DRG weight + capital per discharge,4173.01,Other,100% of NY Medicaid HMO DRG,4173,,DRG base rate x DRG weight + capital per discharge,4173,Other,100% of NY Medicaid HMO DRG,4173,,DRG base rate x DRG weight + capital per discharge,4173,Other,100% of NY Medicaid HMO DRG,2610,,870 x patient days,2610,Per diem,,9389,,225% x Medicaid HMO amount,9389,Other,225% of NY Medicaid HMO DRG,6385,,153% x Medicaid HMO amount,6385,Other,153% of NY Medicaid HMO DRG,9389,,225% x Medicaid HMO amount,9389,Other,225% of NY Medicaid HMO DRG,5842,,140% x Medicaid HMO amount,5842,Other,140% of NY Medicaid HMO DRG,9389,,DRG base rate x DRG weight + capital per discharge,9389,Other,225% of NY Medicaid HMO DRG,4200,,"1,400 x patient days",4200,Per diem,,4542,,"1,514 x patient days",4542,Per diem,,8015.73,,"2,671.91 x patient days",8015.73,Per diem,,8015.73,,"2,671.91 x patient days",8015.73,Per diem,,2610,,870 x patient days,2610,Per diem,,0.01,9389,
Acute anxiety & delirium states,756-1,APR-DRG,,,,,,,,inpatient,,,61648.57,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5489,,186% x Medicaid HMO amount,5489,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2220,,"1,110 x patient days",2220,Per diem,,1888,,944 x patient days,1888,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2951.02,,DRG base rate x DRG weight + capital per discharge,2951.02,Other,100% of NY Medicaid HMO DRG,2951,,DRG base rate x DRG weight + capital per discharge,2951,Other,100% of NY Medicaid HMO DRG,2951,,DRG base rate x DRG weight + capital per discharge,2951,Other,100% of NY Medicaid HMO DRG,1740,,870 x patient days,1740,Per diem,,6640,,225% x Medicaid HMO amount,6640,Other,225% of NY Medicaid HMO DRG,4515,,153% x Medicaid HMO amount,4515,Other,153% of NY Medicaid HMO DRG,6640,,225% x Medicaid HMO amount,6640,Other,225% of NY Medicaid HMO DRG,4131,,140% x Medicaid HMO amount,4131,Other,140% of NY Medicaid HMO DRG,6640,,DRG base rate x DRG weight + capital per discharge,6640,Other,225% of NY Medicaid HMO DRG,2800,,"1,400 x patient days",2800,Per diem,,3028,,"1,514 x patient days",3028,Per diem,,5343.82,,"2,671.91 x patient days",5343.82,Per diem,,5343.82,,"2,671.91 x patient days",5343.82,Per diem,,1740,,870 x patient days,1740,Per diem,,0.01,6640,
Acute anxiety & delirium states,756-2,APR-DRG,,,,,,,,inpatient,,,123851,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5680,,186% x Medicaid HMO amount,5680,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2220,,"1,110 x patient days",2220,Per diem,,1888,,944 x patient days,1888,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3053.92,,DRG base rate x DRG weight + capital per discharge,3053.92,Other,100% of NY Medicaid HMO DRG,3054,,DRG base rate x DRG weight + capital per discharge,3054,Other,100% of NY Medicaid HMO DRG,3054,,DRG base rate x DRG weight + capital per discharge,3054,Other,100% of NY Medicaid HMO DRG,1740,,870 x patient days,1740,Per diem,,6871,,225% x Medicaid HMO amount,6871,Other,225% of NY Medicaid HMO DRG,4672,,153% x Medicaid HMO amount,4672,Other,153% of NY Medicaid HMO DRG,6871,,225% x Medicaid HMO amount,6871,Other,225% of NY Medicaid HMO DRG,4275,,140% x Medicaid HMO amount,4275,Other,140% of NY Medicaid HMO DRG,6871,,DRG base rate x DRG weight + capital per discharge,6871,Other,225% of NY Medicaid HMO DRG,2800,,"1,400 x patient days",2800,Per diem,,3028,,"1,514 x patient days",3028,Per diem,,5343.82,,"2,671.91 x patient days",5343.82,Per diem,,5343.82,,"2,671.91 x patient days",5343.82,Per diem,,1740,,870 x patient days,1740,Per diem,,0.01,6871,
Acute anxiety & delirium states,756-3,APR-DRG,,,,,,,,inpatient,,,150160.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5680,,186% x Medicaid HMO amount,5680,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2220,,"1,110 x patient days",2220,Per diem,,1888,,944 x patient days,1888,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3053.92,,DRG base rate x DRG weight + capital per discharge,3053.92,Other,100% of NY Medicaid HMO DRG,3054,,DRG base rate x DRG weight + capital per discharge,3054,Other,100% of NY Medicaid HMO DRG,3054,,DRG base rate x DRG weight + capital per discharge,3054,Other,100% of NY Medicaid HMO DRG,1740,,870 x patient days,1740,Per diem,,6871,,225% x Medicaid HMO amount,6871,Other,225% of NY Medicaid HMO DRG,4672,,153% x Medicaid HMO amount,4672,Other,153% of NY Medicaid HMO DRG,6871,,225% x Medicaid HMO amount,6871,Other,225% of NY Medicaid HMO DRG,4275,,140% x Medicaid HMO amount,4275,Other,140% of NY Medicaid HMO DRG,6871,,DRG base rate x DRG weight + capital per discharge,6871,Other,225% of NY Medicaid HMO DRG,2800,,"1,400 x patient days",2800,Per diem,,3028,,"1,514 x patient days",3028,Per diem,,5343.82,,"2,671.91 x patient days",5343.82,Per diem,,5343.82,,"2,671.91 x patient days",5343.82,Per diem,,1740,,870 x patient days,1740,Per diem,,0.01,6871,
Acute anxiety & delirium states,756-4,APR-DRG,,,,,,,,inpatient,,,150160.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5680,,186% x Medicaid HMO amount,5680,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2220,,"1,110 x patient days",2220,Per diem,,1888,,944 x patient days,1888,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3053.92,,DRG base rate x DRG weight + capital per discharge,3053.92,Other,100% of NY Medicaid HMO DRG,3054,,DRG base rate x DRG weight + capital per discharge,3054,Other,100% of NY Medicaid HMO DRG,3054,,DRG base rate x DRG weight + capital per discharge,3054,Other,100% of NY Medicaid HMO DRG,1740,,870 x patient days,1740,Per diem,,6871,,225% x Medicaid HMO amount,6871,Other,225% of NY Medicaid HMO DRG,4672,,153% x Medicaid HMO amount,4672,Other,153% of NY Medicaid HMO DRG,6871,,225% x Medicaid HMO amount,6871,Other,225% of NY Medicaid HMO DRG,4275,,140% x Medicaid HMO amount,4275,Other,140% of NY Medicaid HMO DRG,6871,,DRG base rate x DRG weight + capital per discharge,6871,Other,225% of NY Medicaid HMO DRG,2800,,"1,400 x patient days",2800,Per diem,,3028,,"1,514 x patient days",3028,Per diem,,5343.82,,"2,671.91 x patient days",5343.82,Per diem,,5343.82,,"2,671.91 x patient days",5343.82,Per diem,,1740,,870 x patient days,1740,Per diem,,0.01,6871,
Organic mental health disturbances,757-1,APR-DRG,,,,,,,,inpatient,,,109618.46,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12564,,186% x Medicaid HMO amount,12564,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6754.94,,DRG base rate x DRG weight + capital per discharge,6754.94,Other,100% of NY Medicaid HMO DRG,6755,,DRG base rate x DRG weight + capital per discharge,6755,Other,100% of NY Medicaid HMO DRG,6755,,DRG base rate x DRG weight + capital per discharge,6755,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,15199,,225% x Medicaid HMO amount,15199,Other,225% of NY Medicaid HMO DRG,10335,,153% x Medicaid HMO amount,10335,Other,153% of NY Medicaid HMO DRG,15199,,225% x Medicaid HMO amount,15199,Other,225% of NY Medicaid HMO DRG,9457,,140% x Medicaid HMO amount,9457,Other,140% of NY Medicaid HMO DRG,15199,,DRG base rate x DRG weight + capital per discharge,15199,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,15199,
Organic mental health disturbances,757-2,APR-DRG,,,,,,,,inpatient,,,87934.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12564,,186% x Medicaid HMO amount,12564,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6754.94,,DRG base rate x DRG weight + capital per discharge,6754.94,Other,100% of NY Medicaid HMO DRG,6755,,DRG base rate x DRG weight + capital per discharge,6755,Other,100% of NY Medicaid HMO DRG,6755,,DRG base rate x DRG weight + capital per discharge,6755,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,15199,,225% x Medicaid HMO amount,15199,Other,225% of NY Medicaid HMO DRG,10335,,153% x Medicaid HMO amount,10335,Other,153% of NY Medicaid HMO DRG,15199,,225% x Medicaid HMO amount,15199,Other,225% of NY Medicaid HMO DRG,9457,,140% x Medicaid HMO amount,9457,Other,140% of NY Medicaid HMO DRG,15199,,DRG base rate x DRG weight + capital per discharge,15199,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,15199,
Organic mental health disturbances,757-3,APR-DRG,,,,,,,,inpatient,,,189355.26,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12921,,186% x Medicaid HMO amount,12921,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6946.94,,DRG base rate x DRG weight + capital per discharge,6946.94,Other,100% of NY Medicaid HMO DRG,6947,,DRG base rate x DRG weight + capital per discharge,6947,Other,100% of NY Medicaid HMO DRG,6947,,DRG base rate x DRG weight + capital per discharge,6947,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,15631,,225% x Medicaid HMO amount,15631,Other,225% of NY Medicaid HMO DRG,10629,,153% x Medicaid HMO amount,10629,Other,153% of NY Medicaid HMO DRG,15631,,225% x Medicaid HMO amount,15631,Other,225% of NY Medicaid HMO DRG,9726,,140% x Medicaid HMO amount,9726,Other,140% of NY Medicaid HMO DRG,15631,,DRG base rate x DRG weight + capital per discharge,15631,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,15631,
Organic mental health disturbances,757-4,APR-DRG,,,,,,,,inpatient,,,327169.09,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12921,,186% x Medicaid HMO amount,12921,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6946.94,,DRG base rate x DRG weight + capital per discharge,6946.94,Other,100% of NY Medicaid HMO DRG,6947,,DRG base rate x DRG weight + capital per discharge,6947,Other,100% of NY Medicaid HMO DRG,6947,,DRG base rate x DRG weight + capital per discharge,6947,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,15631,,225% x Medicaid HMO amount,15631,Other,225% of NY Medicaid HMO DRG,10629,,153% x Medicaid HMO amount,10629,Other,153% of NY Medicaid HMO DRG,15631,,225% x Medicaid HMO amount,15631,Other,225% of NY Medicaid HMO DRG,9726,,140% x Medicaid HMO amount,9726,Other,140% of NY Medicaid HMO DRG,15631,,DRG base rate x DRG weight + capital per discharge,15631,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,15631,
Behavioral disorders,758-1,APR-DRG,,,,,,,,inpatient,,,95710.57,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11978,,186% x Medicaid HMO amount,11978,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6439.9,,DRG base rate x DRG weight + capital per discharge,6439.9,Other,100% of NY Medicaid HMO DRG,6440,,DRG base rate x DRG weight + capital per discharge,6440,Other,100% of NY Medicaid HMO DRG,6440,,DRG base rate x DRG weight + capital per discharge,6440,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,14490,,225% x Medicaid HMO amount,14490,Other,225% of NY Medicaid HMO DRG,9853,,153% x Medicaid HMO amount,9853,Other,153% of NY Medicaid HMO DRG,14490,,225% x Medicaid HMO amount,14490,Other,225% of NY Medicaid HMO DRG,9016,,140% x Medicaid HMO amount,9016,Other,140% of NY Medicaid HMO DRG,14490,,DRG base rate x DRG weight + capital per discharge,14490,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,14490,
Behavioral disorders,758-2,APR-DRG,,,,,,,,inpatient,,,119513.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12823,,186% x Medicaid HMO amount,12823,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6893.5,,DRG base rate x DRG weight + capital per discharge,6893.5,Other,100% of NY Medicaid HMO DRG,6894,,DRG base rate x DRG weight + capital per discharge,6894,Other,100% of NY Medicaid HMO DRG,6894,,DRG base rate x DRG weight + capital per discharge,6894,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,15510,,225% x Medicaid HMO amount,15510,Other,225% of NY Medicaid HMO DRG,10547,,153% x Medicaid HMO amount,10547,Other,153% of NY Medicaid HMO DRG,15510,,225% x Medicaid HMO amount,15510,Other,225% of NY Medicaid HMO DRG,9651,,140% x Medicaid HMO amount,9651,Other,140% of NY Medicaid HMO DRG,15510,,DRG base rate x DRG weight + capital per discharge,15510,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,15510,
Behavioral disorders,758-3,APR-DRG,,,,,,,,inpatient,,,128765.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12823,,186% x Medicaid HMO amount,12823,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6893.5,,DRG base rate x DRG weight + capital per discharge,6893.5,Other,100% of NY Medicaid HMO DRG,6894,,DRG base rate x DRG weight + capital per discharge,6894,Other,100% of NY Medicaid HMO DRG,6894,,DRG base rate x DRG weight + capital per discharge,6894,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,15510,,225% x Medicaid HMO amount,15510,Other,225% of NY Medicaid HMO DRG,10547,,153% x Medicaid HMO amount,10547,Other,153% of NY Medicaid HMO DRG,15510,,225% x Medicaid HMO amount,15510,Other,225% of NY Medicaid HMO DRG,9651,,140% x Medicaid HMO amount,9651,Other,140% of NY Medicaid HMO DRG,15510,,DRG base rate x DRG weight + capital per discharge,15510,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,15510,
Behavioral disorders,758-4,APR-DRG,,,,,,,,inpatient,,,98349.48,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12823,,186% x Medicaid HMO amount,12823,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5550,,"1,110 x patient days",5550,Per diem,,4720,,944 x patient days,4720,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6893.5,,DRG base rate x DRG weight + capital per discharge,6893.5,Other,100% of NY Medicaid HMO DRG,6894,,DRG base rate x DRG weight + capital per discharge,6894,Other,100% of NY Medicaid HMO DRG,6894,,DRG base rate x DRG weight + capital per discharge,6894,Other,100% of NY Medicaid HMO DRG,4350,,870 x patient days,4350,Per diem,,15510,,225% x Medicaid HMO amount,15510,Other,225% of NY Medicaid HMO DRG,10547,,153% x Medicaid HMO amount,10547,Other,153% of NY Medicaid HMO DRG,15510,,225% x Medicaid HMO amount,15510,Other,225% of NY Medicaid HMO DRG,9651,,140% x Medicaid HMO amount,9651,Other,140% of NY Medicaid HMO DRG,15510,,DRG base rate x DRG weight + capital per discharge,15510,Other,225% of NY Medicaid HMO DRG,7000,,"1,400 x patient days",7000,Per diem,,7570,,"1,514 x patient days",7570,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,13359.55,,"2,671.91 x patient days",13359.55,Per diem,,4350,,870 x patient days,4350,Per diem,,0.01,15510,
Eating disorders,759-1,APR-DRG,,,,,,,,inpatient,,,37567,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21624,,186% x Medicaid HMO amount,21624,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11100,,"1,110 x patient days",11100,Per diem,,9440,,944 x patient days,9440,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11625.86,,DRG base rate x DRG weight + capital per discharge,11625.86,Other,100% of NY Medicaid HMO DRG,11626,,DRG base rate x DRG weight + capital per discharge,11626,Other,100% of NY Medicaid HMO DRG,11626,,DRG base rate x DRG weight + capital per discharge,11626,Other,100% of NY Medicaid HMO DRG,8700,,870 x patient days,8700,Per diem,,26158,,225% x Medicaid HMO amount,26158,Other,225% of NY Medicaid HMO DRG,17788,,153% x Medicaid HMO amount,17788,Other,153% of NY Medicaid HMO DRG,26158,,225% x Medicaid HMO amount,26158,Other,225% of NY Medicaid HMO DRG,16276,,140% x Medicaid HMO amount,16276,Other,140% of NY Medicaid HMO DRG,26158,,DRG base rate x DRG weight + capital per discharge,26158,Other,225% of NY Medicaid HMO DRG,14000,,"1,400 x patient days",14000,Per diem,,15140,,"1,514 x patient days",15140,Per diem,,26719.1,,"2,671.91 x patient days",26719.1,Per diem,,26719.1,,"2,671.91 x patient days",26719.1,Per diem,,8700,,870 x patient days,8700,Per diem,,0.01,26719.1,
Eating disorders,759-2,APR-DRG,,,,,,,,inpatient,,,102875.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23081,,186% x Medicaid HMO amount,23081,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11100,,"1,110 x patient days",11100,Per diem,,9440,,944 x patient days,9440,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12408.79,,DRG base rate x DRG weight + capital per discharge,12408.79,Other,100% of NY Medicaid HMO DRG,12409,,DRG base rate x DRG weight + capital per discharge,12409,Other,100% of NY Medicaid HMO DRG,12409,,DRG base rate x DRG weight + capital per discharge,12409,Other,100% of NY Medicaid HMO DRG,8700,,870 x patient days,8700,Per diem,,27920,,225% x Medicaid HMO amount,27920,Other,225% of NY Medicaid HMO DRG,18985,,153% x Medicaid HMO amount,18985,Other,153% of NY Medicaid HMO DRG,27920,,225% x Medicaid HMO amount,27920,Other,225% of NY Medicaid HMO DRG,17372,,140% x Medicaid HMO amount,17372,Other,140% of NY Medicaid HMO DRG,27920,,DRG base rate x DRG weight + capital per discharge,27920,Other,225% of NY Medicaid HMO DRG,14000,,"1,400 x patient days",14000,Per diem,,15140,,"1,514 x patient days",15140,Per diem,,26719.1,,"2,671.91 x patient days",26719.1,Per diem,,26719.1,,"2,671.91 x patient days",26719.1,Per diem,,8700,,870 x patient days,8700,Per diem,,0.01,27920,
Eating disorders,759-3,APR-DRG,,,,,,,,inpatient,,,242395.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23081,,186% x Medicaid HMO amount,23081,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11100,,"1,110 x patient days",11100,Per diem,,9440,,944 x patient days,9440,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12408.79,,DRG base rate x DRG weight + capital per discharge,12408.79,Other,100% of NY Medicaid HMO DRG,12409,,DRG base rate x DRG weight + capital per discharge,12409,Other,100% of NY Medicaid HMO DRG,12409,,DRG base rate x DRG weight + capital per discharge,12409,Other,100% of NY Medicaid HMO DRG,8700,,870 x patient days,8700,Per diem,,27920,,225% x Medicaid HMO amount,27920,Other,225% of NY Medicaid HMO DRG,18985,,153% x Medicaid HMO amount,18985,Other,153% of NY Medicaid HMO DRG,27920,,225% x Medicaid HMO amount,27920,Other,225% of NY Medicaid HMO DRG,17372,,140% x Medicaid HMO amount,17372,Other,140% of NY Medicaid HMO DRG,27920,,DRG base rate x DRG weight + capital per discharge,27920,Other,225% of NY Medicaid HMO DRG,14000,,"1,400 x patient days",14000,Per diem,,15140,,"1,514 x patient days",15140,Per diem,,26719.1,,"2,671.91 x patient days",26719.1,Per diem,,26719.1,,"2,671.91 x patient days",26719.1,Per diem,,8700,,870 x patient days,8700,Per diem,,0.01,27920,
Eating disorders,759-4,APR-DRG,,,,,,,,inpatient,,,292333,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23081,,186% x Medicaid HMO amount,23081,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11100,,"1,110 x patient days",11100,Per diem,,9440,,944 x patient days,9440,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12408.79,,DRG base rate x DRG weight + capital per discharge,12408.79,Other,100% of NY Medicaid HMO DRG,12409,,DRG base rate x DRG weight + capital per discharge,12409,Other,100% of NY Medicaid HMO DRG,12409,,DRG base rate x DRG weight + capital per discharge,12409,Other,100% of NY Medicaid HMO DRG,8700,,870 x patient days,8700,Per diem,,27920,,225% x Medicaid HMO amount,27920,Other,225% of NY Medicaid HMO DRG,18985,,153% x Medicaid HMO amount,18985,Other,153% of NY Medicaid HMO DRG,27920,,225% x Medicaid HMO amount,27920,Other,225% of NY Medicaid HMO DRG,17372,,140% x Medicaid HMO amount,17372,Other,140% of NY Medicaid HMO DRG,27920,,DRG base rate x DRG weight + capital per discharge,27920,Other,225% of NY Medicaid HMO DRG,14000,,"1,400 x patient days",14000,Per diem,,15140,,"1,514 x patient days",15140,Per diem,,26719.1,,"2,671.91 x patient days",26719.1,Per diem,,26719.1,,"2,671.91 x patient days",26719.1,Per diem,,8700,,870 x patient days,8700,Per diem,,0.01,27920,
Other mental health disorders,760-1,APR-DRG,,,,,,,,inpatient,,,9186,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9845,,186% x Medicaid HMO amount,9845,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4440,,"1,110 x patient days",4440,Per diem,,3776,,944 x patient days,3776,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5292.6,,DRG base rate x DRG weight + capital per discharge,5292.6,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,3480,,870 x patient days,3480,Per diem,,11908,,225% x Medicaid HMO amount,11908,Other,225% of NY Medicaid HMO DRG,8098,,153% x Medicaid HMO amount,8098,Other,153% of NY Medicaid HMO DRG,11908,,225% x Medicaid HMO amount,11908,Other,225% of NY Medicaid HMO DRG,7410,,140% x Medicaid HMO amount,7410,Other,140% of NY Medicaid HMO DRG,11908,,DRG base rate x DRG weight + capital per discharge,11908,Other,225% of NY Medicaid HMO DRG,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,3480,,870 x patient days,3480,Per diem,,0.01,11908,
Other mental health disorders,760-2,APR-DRG,,,,,,,,inpatient,,,184981.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9845,,186% x Medicaid HMO amount,9845,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4440,,"1,110 x patient days",4440,Per diem,,3776,,944 x patient days,3776,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5292.6,,DRG base rate x DRG weight + capital per discharge,5292.6,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,3480,,870 x patient days,3480,Per diem,,11908,,225% x Medicaid HMO amount,11908,Other,225% of NY Medicaid HMO DRG,8098,,153% x Medicaid HMO amount,8098,Other,153% of NY Medicaid HMO DRG,11908,,225% x Medicaid HMO amount,11908,Other,225% of NY Medicaid HMO DRG,7410,,140% x Medicaid HMO amount,7410,Other,140% of NY Medicaid HMO DRG,11908,,DRG base rate x DRG weight + capital per discharge,11908,Other,225% of NY Medicaid HMO DRG,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,3480,,870 x patient days,3480,Per diem,,0.01,11908,
Other mental health disorders,760-3,APR-DRG,,,,,,,,inpatient,,,72720,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9845,,186% x Medicaid HMO amount,9845,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4440,,"1,110 x patient days",4440,Per diem,,3776,,944 x patient days,3776,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5292.6,,DRG base rate x DRG weight + capital per discharge,5292.6,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,3480,,870 x patient days,3480,Per diem,,11908,,225% x Medicaid HMO amount,11908,Other,225% of NY Medicaid HMO DRG,8098,,153% x Medicaid HMO amount,8098,Other,153% of NY Medicaid HMO DRG,11908,,225% x Medicaid HMO amount,11908,Other,225% of NY Medicaid HMO DRG,7410,,140% x Medicaid HMO amount,7410,Other,140% of NY Medicaid HMO DRG,11908,,DRG base rate x DRG weight + capital per discharge,11908,Other,225% of NY Medicaid HMO DRG,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,3480,,870 x patient days,3480,Per diem,,0.01,11908,
Other mental health disorders,760-4,APR-DRG,,,,,,,,inpatient,,,184981.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9845,,186% x Medicaid HMO amount,9845,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4440,,"1,110 x patient days",4440,Per diem,,3776,,944 x patient days,3776,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5292.6,,DRG base rate x DRG weight + capital per discharge,5292.6,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,5293,,DRG base rate x DRG weight + capital per discharge,5293,Other,100% of NY Medicaid HMO DRG,3480,,870 x patient days,3480,Per diem,,11908,,225% x Medicaid HMO amount,11908,Other,225% of NY Medicaid HMO DRG,8098,,153% x Medicaid HMO amount,8098,Other,153% of NY Medicaid HMO DRG,11908,,225% x Medicaid HMO amount,11908,Other,225% of NY Medicaid HMO DRG,7410,,140% x Medicaid HMO amount,7410,Other,140% of NY Medicaid HMO DRG,11908,,DRG base rate x DRG weight + capital per discharge,11908,Other,225% of NY Medicaid HMO DRG,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,10687.64,,"2,671.91 x patient days",10687.64,Per diem,,3480,,870 x patient days,3480,Per diem,,0.01,11908,
"Drug & alcohol abuse or dependence, left against medical advice",770-1,APR-DRG,,,,,,,,inpatient,,,26733.75,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3042.63,,"1,521.31 x patient days",3042.63,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2136,,"1,068 x patient days",2136,Per diem,,1816,,908 x patient days,1816,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,1635.82,,817.91 x patient days,1635.82,Per diem,,1635.82,,817.91 x patient days,1635.82,Per diem,,1635.82,,817.91 x patient days,1635.82,Per diem,,1508,,754 x patient days,1508,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2502.8,,"1,251.40 x patient days",2502.8,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2290.15,,"1,145.08 x patient days",2290.15,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2800,,"1,400 x patient days",2800,Per diem,,3028,,"1,514 x patient days",3028,Per diem,,3518,,"1,759 x patient days",3518,Per diem,,3518,,"1,759 x patient days",3518,Per diem,,1508,,754 x patient days,1508,Per diem,,0.01,3680.6,
"Drug & alcohol abuse or dependence, left against medical advice",770-2,APR-DRG,,,,,,,,inpatient,,,31650.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3042.63,,"1,521.31 x patient days",3042.63,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2136,,"1,068 x patient days",2136,Per diem,,1816,,908 x patient days,1816,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,1635.82,,817.91 x patient days,1635.82,Per diem,,1635.82,,817.91 x patient days,1635.82,Per diem,,1635.82,,817.91 x patient days,1635.82,Per diem,,1508,,754 x patient days,1508,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2502.8,,"1,251.40 x patient days",2502.8,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2290.15,,"1,145.08 x patient days",2290.15,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2800,,"1,400 x patient days",2800,Per diem,,3028,,"1,514 x patient days",3028,Per diem,,3518,,"1,759 x patient days",3518,Per diem,,3518,,"1,759 x patient days",3518,Per diem,,1508,,754 x patient days,1508,Per diem,,0.01,3680.6,
"Drug & alcohol abuse or dependence, left against medical advice",770-3,APR-DRG,,,,,,,,inpatient,,,101364.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3042.63,,"1,521.31 x patient days",3042.63,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2136,,"1,068 x patient days",2136,Per diem,,1816,,908 x patient days,1816,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,1635.82,,817.91 x patient days,1635.82,Per diem,,1635.82,,817.91 x patient days,1635.82,Per diem,,1635.82,,817.91 x patient days,1635.82,Per diem,,1508,,754 x patient days,1508,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2502.8,,"1,251.40 x patient days",2502.8,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2290.15,,"1,145.08 x patient days",2290.15,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2800,,"1,400 x patient days",2800,Per diem,,3028,,"1,514 x patient days",3028,Per diem,,3518,,"1,759 x patient days",3518,Per diem,,3518,,"1,759 x patient days",3518,Per diem,,1508,,754 x patient days,1508,Per diem,,0.01,3680.6,
"Drug & alcohol abuse or dependence, left against medical advice",770-4,APR-DRG,,,,,,,,inpatient,,,511160.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3042.63,,"1,521.31 x patient days",3042.63,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2136,,"1,068 x patient days",2136,Per diem,,1816,,908 x patient days,1816,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,1635.82,,817.91 x patient days,1635.82,Per diem,,1635.82,,817.91 x patient days,1635.82,Per diem,,1635.82,,817.91 x patient days,1635.82,Per diem,,1508,,754 x patient days,1508,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2502.8,,"1,251.40 x patient days",2502.8,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2290.15,,"1,145.08 x patient days",2290.15,Per diem,,3680.6,,"1,840.30 x patient days",3680.6,Per diem,,2800,,"1,400 x patient days",2800,Per diem,,3028,,"1,514 x patient days",3028,Per diem,,3518,,"1,759 x patient days",3518,Per diem,,3518,,"1,759 x patient days",3518,Per diem,,1508,,754 x patient days,1508,Per diem,,0.01,3680.6,
Alcohol & drug dependence w rehab or rehab/detox therapy,772-1,APR-DRG,,,,,,,,inpatient,,,84637.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26230.95,,"1,192.32 x patient days",26230.95,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24420,,"1,110 x patient days",24420,Per diem,,20768,,944 x patient days,20768,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14102.66,,641.03 x patient days,14102.66,Per diem,,14102.66,,641.03 x patient days,14102.66,Per diem,,14102.66,,641.03 x patient days,14102.66,Per diem,,7260,,330 x patient days,7260,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,21577.07,,980.78 x patient days,21577.07,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,19743.72,,897.44 x patient days,19743.72,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,30800,,"1,400 x patient days",30800,Per diem,,33308,,"1,514 x patient days",33308,Per diem,,16034.26,,728.83 x patient days,16034.26,Per diem,,16034.26,,728.83 x patient days,16034.26,Per diem,,7260,,330 x patient days,7260,Per diem,,0.01,33308,
Alcohol & drug dependence w rehab or rehab/detox therapy,772-2,APR-DRG,,,,,,,,inpatient,,,90396.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26230.95,,"1,192.32 x patient days",26230.95,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24420,,"1,110 x patient days",24420,Per diem,,20768,,944 x patient days,20768,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14102.66,,641.03 x patient days,14102.66,Per diem,,14102.66,,641.03 x patient days,14102.66,Per diem,,14102.66,,641.03 x patient days,14102.66,Per diem,,7260,,330 x patient days,7260,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,21577.07,,980.78 x patient days,21577.07,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,19743.72,,897.44 x patient days,19743.72,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,30800,,"1,400 x patient days",30800,Per diem,,33308,,"1,514 x patient days",33308,Per diem,,16034.26,,728.83 x patient days,16034.26,Per diem,,16034.26,,728.83 x patient days,16034.26,Per diem,,7260,,330 x patient days,7260,Per diem,,0.01,33308,
Alcohol & drug dependence w rehab or rehab/detox therapy,772-3,APR-DRG,,,,,,,,inpatient,,,93554.36,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26230.95,,"1,192.32 x patient days",26230.95,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24420,,"1,110 x patient days",24420,Per diem,,20768,,944 x patient days,20768,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14102.66,,641.03 x patient days,14102.66,Per diem,,14102.66,,641.03 x patient days,14102.66,Per diem,,14102.66,,641.03 x patient days,14102.66,Per diem,,7260,,330 x patient days,7260,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,21577.07,,980.78 x patient days,21577.07,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,19743.72,,897.44 x patient days,19743.72,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,30800,,"1,400 x patient days",30800,Per diem,,33308,,"1,514 x patient days",33308,Per diem,,16034.26,,728.83 x patient days,16034.26,Per diem,,16034.26,,728.83 x patient days,16034.26,Per diem,,7260,,330 x patient days,7260,Per diem,,0.01,33308,
Alcohol & drug dependence w rehab or rehab/detox therapy,772-4,APR-DRG,,,,,,,,inpatient,,,191985,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26230.95,,"1,192.32 x patient days",26230.95,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24420,,"1,110 x patient days",24420,Per diem,,20768,,944 x patient days,20768,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14102.66,,641.03 x patient days,14102.66,Per diem,,14102.66,,641.03 x patient days,14102.66,Per diem,,14102.66,,641.03 x patient days,14102.66,Per diem,,7260,,330 x patient days,7260,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,21577.07,,980.78 x patient days,21577.07,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,19743.72,,897.44 x patient days,19743.72,Per diem,,31730.99,,"1,442.32 x patient days",31730.99,Per diem,,30800,,"1,400 x patient days",30800,Per diem,,33308,,"1,514 x patient days",33308,Per diem,,16034.26,,728.83 x patient days,16034.26,Per diem,,16034.26,,728.83 x patient days,16034.26,Per diem,,7260,,330 x patient days,7260,Per diem,,0.01,33308,
Opioid abuse & dependence,773-1,APR-DRG,,,,,,,,inpatient,,,41672.35,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Opioid abuse & dependence,773-2,APR-DRG,,,,,,,,inpatient,,,44466.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Opioid abuse & dependence,773-3,APR-DRG,,,,,,,,inpatient,,,55949.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Opioid abuse & dependence,773-4,APR-DRG,,,,,,,,inpatient,,,169388.82,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Cocaine abuse & dependence,774-1,APR-DRG,,,,,,,,inpatient,,,53217.35,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Cocaine abuse & dependence,774-2,APR-DRG,,,,,,,,inpatient,,,50531.66,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Cocaine abuse & dependence,774-3,APR-DRG,,,,,,,,inpatient,,,103713.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Cocaine abuse & dependence,774-4,APR-DRG,,,,,,,,inpatient,,,116645.6,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Alcohol abuse & dependence,775-1,APR-DRG,,,,,,,,inpatient,,,47007.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Alcohol abuse & dependence,775-2,APR-DRG,,,,,,,,inpatient,,,59759.43,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Alcohol abuse & dependence,775-3,APR-DRG,,,,,,,,inpatient,,,139133.89,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Alcohol abuse & dependence,775-4,APR-DRG,,,,,,,,inpatient,,,404300.87,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Other drug abuse & dependence,776-1,APR-DRG,,,,,,,,inpatient,,,52921.83,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Other drug abuse & dependence,776-2,APR-DRG,,,,,,,,inpatient,,,53333.61,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Other drug abuse & dependence,776-3,APR-DRG,,,,,,,,inpatient,,,105636.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
Other drug abuse & dependence,776-4,APR-DRG,,,,,,,,inpatient,,,105636.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6085.25,,"1,521.31 x patient days",6085.25,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4272,,"1,068 x patient days",4272,Per diem,,3632,,908 x patient days,3632,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3271.64,,817.91 x patient days,3271.64,Per diem,,3016,,754 x patient days,3016,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5005.61,,"1,251.40 x patient days",5005.61,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,4580.3,,"1,145.08 x patient days",4580.3,Per diem,,7361.19,,"1,840.30 x patient days",7361.19,Per diem,,5600,,"1,400 x patient days",5600,Per diem,,6056,,"1,514 x patient days",6056,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,7036,,"1,759 x patient days",7036,Per diem,,3016,,754 x patient days,3016,Per diem,,0.01,7361.19,
O.R. procedure for other complications of treatment,791-1,APR-DRG,,,,,,,,inpatient,,,172544.08,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10896,,186% x Medicaid HMO amount,10896,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23434,,"27,634 x DRG Weight",23434,Other,DRG Base Rate x DRG Weight,19918,,"23,488 x DRG Weight",19918,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5858.21,,DRG base rate x DRG weight + capital per discharge,5858.21,Other,100% of NY Medicaid HMO DRG,5858,,DRG base rate x DRG weight + capital per discharge,5858,Other,100% of NY Medicaid HMO DRG,5858,,DRG base rate x DRG weight + capital per discharge,5858,Other,100% of NY Medicaid HMO DRG,5858,,DRG base rate x DRG weight + capital per discharge,5858,Other,100% of NY Medicaid HMO DRG,13181,,225% x Medicaid HMO amount,13181,Other,225% of NY Medicaid HMO DRG,8963,,153% x Medicaid HMO amount,8963,Other,153% of NY Medicaid HMO DRG,13181,,225% x Medicaid HMO amount,13181,Other,225% of NY Medicaid HMO DRG,8201,,140% x Medicaid HMO amount,8201,Other,140% of NY Medicaid HMO DRG,13181,,225% x Medicaid HMO amount,13181,Other,225% of NY Medicaid HMO DRG,16110,,275% x Medicaid HMO amount,16110,Other,275% of NY Medicaid HMO DRG,18981,,324% x Medicaid HMO amount,18981,Other,324% of NY Medicaid HMO DRG,12595,,215% x Medicaid HMO amount,12595,Other,215% of NY Medicaid HMO DRG,12595,,215% x Medicaid HMO amount,12595,Other,215% of NY Medicaid HMO DRG,7323,,125% x Medicaid HMO amount,7323,Other,125% of NY Medicaid HMO DRG,0.01,23434,
O.R. procedure for other complications of treatment,791-2,APR-DRG,,,,,,,,inpatient,,,193040.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17690,,186% x Medicaid HMO amount,17690,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,39331,,"27,634 x DRG Weight",39331,Other,DRG Base Rate x DRG Weight,33430,,"23,488 x DRG Weight",33430,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9511.21,,DRG base rate x DRG weight + capital per discharge,9511.21,Other,100% of NY Medicaid HMO DRG,9511,,DRG base rate x DRG weight + capital per discharge,9511,Other,100% of NY Medicaid HMO DRG,9511,,DRG base rate x DRG weight + capital per discharge,9511,Other,100% of NY Medicaid HMO DRG,9511,,DRG base rate x DRG weight + capital per discharge,9511,Other,100% of NY Medicaid HMO DRG,21400,,225% x Medicaid HMO amount,21400,Other,225% of NY Medicaid HMO DRG,14552,,153% x Medicaid HMO amount,14552,Other,153% of NY Medicaid HMO DRG,21400,,225% x Medicaid HMO amount,21400,Other,225% of NY Medicaid HMO DRG,13316,,140% x Medicaid HMO amount,13316,Other,140% of NY Medicaid HMO DRG,21400,,225% x Medicaid HMO amount,21400,Other,225% of NY Medicaid HMO DRG,26156,,275% x Medicaid HMO amount,26156,Other,275% of NY Medicaid HMO DRG,30816,,324% x Medicaid HMO amount,30816,Other,324% of NY Medicaid HMO DRG,20449,,215% x Medicaid HMO amount,20449,Other,215% of NY Medicaid HMO DRG,20449,,215% x Medicaid HMO amount,20449,Other,215% of NY Medicaid HMO DRG,11889,,125% x Medicaid HMO amount,11889,Other,125% of NY Medicaid HMO DRG,0.01,39331,
O.R. procedure for other complications of treatment,791-3,APR-DRG,,,,,,,,inpatient,,,318880.06,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32463,,186% x Medicaid HMO amount,32463,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,73896,,"27,634 x DRG Weight",73896,Other,DRG Base Rate x DRG Weight,62809,,"23,488 x DRG Weight",62809,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17453.21,,DRG base rate x DRG weight + capital per discharge,17453.21,Other,100% of NY Medicaid HMO DRG,17453,,DRG base rate x DRG weight + capital per discharge,17453,Other,100% of NY Medicaid HMO DRG,17453,,DRG base rate x DRG weight + capital per discharge,17453,Other,100% of NY Medicaid HMO DRG,17453,,DRG base rate x DRG weight + capital per discharge,17453,Other,100% of NY Medicaid HMO DRG,39270,,225% x Medicaid HMO amount,39270,Other,225% of NY Medicaid HMO DRG,26703,,153% x Medicaid HMO amount,26703,Other,153% of NY Medicaid HMO DRG,39270,,225% x Medicaid HMO amount,39270,Other,225% of NY Medicaid HMO DRG,24434,,140% x Medicaid HMO amount,24434,Other,140% of NY Medicaid HMO DRG,39270,,225% x Medicaid HMO amount,39270,Other,225% of NY Medicaid HMO DRG,47996,,275% x Medicaid HMO amount,47996,Other,275% of NY Medicaid HMO DRG,56548,,324% x Medicaid HMO amount,56548,Other,324% of NY Medicaid HMO DRG,37524,,215% x Medicaid HMO amount,37524,Other,215% of NY Medicaid HMO DRG,37524,,215% x Medicaid HMO amount,37524,Other,215% of NY Medicaid HMO DRG,21817,,125% x Medicaid HMO amount,21817,Other,125% of NY Medicaid HMO DRG,0.01,73896,
O.R. procedure for other complications of treatment,791-4,APR-DRG,,,,,,,,inpatient,,,277307.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78959,,186% x Medicaid HMO amount,78959,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,182680,,"27,634 x DRG Weight",182680,Other,DRG Base Rate x DRG Weight,155272,,"23,488 x DRG Weight",155272,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42451.21,,DRG base rate x DRG weight + capital per discharge,42451.21,Other,100% of NY Medicaid HMO DRG,42451,,DRG base rate x DRG weight + capital per discharge,42451,Other,100% of NY Medicaid HMO DRG,42451,,DRG base rate x DRG weight + capital per discharge,42451,Other,100% of NY Medicaid HMO DRG,42451,,DRG base rate x DRG weight + capital per discharge,42451,Other,100% of NY Medicaid HMO DRG,95515,,225% x Medicaid HMO amount,95515,Other,225% of NY Medicaid HMO DRG,64950,,153% x Medicaid HMO amount,64950,Other,153% of NY Medicaid HMO DRG,95515,,225% x Medicaid HMO amount,95515,Other,225% of NY Medicaid HMO DRG,59432,,140% x Medicaid HMO amount,59432,Other,140% of NY Medicaid HMO DRG,95515,,225% x Medicaid HMO amount,95515,Other,225% of NY Medicaid HMO DRG,116741,,275% x Medicaid HMO amount,116741,Other,275% of NY Medicaid HMO DRG,137542,,324% x Medicaid HMO amount,137542,Other,324% of NY Medicaid HMO DRG,91270,,215% x Medicaid HMO amount,91270,Other,215% of NY Medicaid HMO DRG,91270,,215% x Medicaid HMO amount,91270,Other,215% of NY Medicaid HMO DRG,53064,,125% x Medicaid HMO amount,53064,Other,125% of NY Medicaid HMO DRG,0.01,182680,
Allergic reactions,811-1,APR-DRG,,,,,,,,inpatient,,,39948.24,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4884,,186% x Medicaid HMO amount,4884,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9368,,"27,634 x DRG Weight",9368,Other,DRG Base Rate x DRG Weight,7962,,"23,488 x DRG Weight",7962,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2626.21,,DRG base rate x DRG weight + capital per discharge,2626.21,Other,100% of NY Medicaid HMO DRG,2626,,DRG base rate x DRG weight + capital per discharge,2626,Other,100% of NY Medicaid HMO DRG,2626,,DRG base rate x DRG weight + capital per discharge,2626,Other,100% of NY Medicaid HMO DRG,2626,,DRG base rate x DRG weight + capital per discharge,2626,Other,100% of NY Medicaid HMO DRG,5909,,225% x Medicaid HMO amount,5909,Other,225% of NY Medicaid HMO DRG,4018,,153% x Medicaid HMO amount,4018,Other,153% of NY Medicaid HMO DRG,5909,,225% x Medicaid HMO amount,5909,Other,225% of NY Medicaid HMO DRG,3677,,140% x Medicaid HMO amount,3677,Other,140% of NY Medicaid HMO DRG,5909,,225% x Medicaid HMO amount,5909,Other,225% of NY Medicaid HMO DRG,7222,,275% x Medicaid HMO amount,7222,Other,275% of NY Medicaid HMO DRG,8509,,324% x Medicaid HMO amount,8509,Other,324% of NY Medicaid HMO DRG,5646,,215% x Medicaid HMO amount,5646,Other,215% of NY Medicaid HMO DRG,5646,,215% x Medicaid HMO amount,5646,Other,215% of NY Medicaid HMO DRG,3283,,125% x Medicaid HMO amount,3283,Other,125% of NY Medicaid HMO DRG,0.01,9368,
Allergic reactions,811-2,APR-DRG,,,,,,,,inpatient,,,86685.39,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6454,,186% x Medicaid HMO amount,6454,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13043,,"27,634 x DRG Weight",13043,Other,DRG Base Rate x DRG Weight,11086,,"23,488 x DRG Weight",11086,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3470.21,,DRG base rate x DRG weight + capital per discharge,3470.21,Other,100% of NY Medicaid HMO DRG,3470,,DRG base rate x DRG weight + capital per discharge,3470,Other,100% of NY Medicaid HMO DRG,3470,,DRG base rate x DRG weight + capital per discharge,3470,Other,100% of NY Medicaid HMO DRG,3470,,DRG base rate x DRG weight + capital per discharge,3470,Other,100% of NY Medicaid HMO DRG,7808,,225% x Medicaid HMO amount,7808,Other,225% of NY Medicaid HMO DRG,5309,,153% x Medicaid HMO amount,5309,Other,153% of NY Medicaid HMO DRG,7808,,225% x Medicaid HMO amount,7808,Other,225% of NY Medicaid HMO DRG,4858,,140% x Medicaid HMO amount,4858,Other,140% of NY Medicaid HMO DRG,7808,,225% x Medicaid HMO amount,7808,Other,225% of NY Medicaid HMO DRG,9543,,275% x Medicaid HMO amount,9543,Other,275% of NY Medicaid HMO DRG,11243,,324% x Medicaid HMO amount,11243,Other,324% of NY Medicaid HMO DRG,7461,,215% x Medicaid HMO amount,7461,Other,215% of NY Medicaid HMO DRG,7461,,215% x Medicaid HMO amount,7461,Other,215% of NY Medicaid HMO DRG,4338,,125% x Medicaid HMO amount,4338,Other,125% of NY Medicaid HMO DRG,0.01,13043,
Allergic reactions,811-3,APR-DRG,,,,,,,,inpatient,,,195596.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13251,,186% x Medicaid HMO amount,13251,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28944,,"27,634 x DRG Weight",28944,Other,DRG Base Rate x DRG Weight,24601,,"23,488 x DRG Weight",24601,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7124.21,,DRG base rate x DRG weight + capital per discharge,7124.21,Other,100% of NY Medicaid HMO DRG,7124,,DRG base rate x DRG weight + capital per discharge,7124,Other,100% of NY Medicaid HMO DRG,7124,,DRG base rate x DRG weight + capital per discharge,7124,Other,100% of NY Medicaid HMO DRG,7124,,DRG base rate x DRG weight + capital per discharge,7124,Other,100% of NY Medicaid HMO DRG,16029,,225% x Medicaid HMO amount,16029,Other,225% of NY Medicaid HMO DRG,10900,,153% x Medicaid HMO amount,10900,Other,153% of NY Medicaid HMO DRG,16029,,225% x Medicaid HMO amount,16029,Other,225% of NY Medicaid HMO DRG,9974,,140% x Medicaid HMO amount,9974,Other,140% of NY Medicaid HMO DRG,16029,,225% x Medicaid HMO amount,16029,Other,225% of NY Medicaid HMO DRG,19592,,275% x Medicaid HMO amount,19592,Other,275% of NY Medicaid HMO DRG,23082,,324% x Medicaid HMO amount,23082,Other,324% of NY Medicaid HMO DRG,15317,,215% x Medicaid HMO amount,15317,Other,215% of NY Medicaid HMO DRG,15317,,215% x Medicaid HMO amount,15317,Other,215% of NY Medicaid HMO DRG,8905,,125% x Medicaid HMO amount,8905,Other,125% of NY Medicaid HMO DRG,0.01,28944,
Allergic reactions,811-4,APR-DRG,,,,,,,,inpatient,,,195596.31,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28769,,186% x Medicaid HMO amount,28769,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65249,,"27,634 x DRG Weight",65249,Other,DRG Base Rate x DRG Weight,55460,,"23,488 x DRG Weight",55460,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15467.21,,DRG base rate x DRG weight + capital per discharge,15467.21,Other,100% of NY Medicaid HMO DRG,15467,,DRG base rate x DRG weight + capital per discharge,15467,Other,100% of NY Medicaid HMO DRG,15467,,DRG base rate x DRG weight + capital per discharge,15467,Other,100% of NY Medicaid HMO DRG,15467,,DRG base rate x DRG weight + capital per discharge,15467,Other,100% of NY Medicaid HMO DRG,34801,,225% x Medicaid HMO amount,34801,Other,225% of NY Medicaid HMO DRG,23665,,153% x Medicaid HMO amount,23665,Other,153% of NY Medicaid HMO DRG,34801,,225% x Medicaid HMO amount,34801,Other,225% of NY Medicaid HMO DRG,21654,,140% x Medicaid HMO amount,21654,Other,140% of NY Medicaid HMO DRG,34801,,225% x Medicaid HMO amount,34801,Other,225% of NY Medicaid HMO DRG,42535,,275% x Medicaid HMO amount,42535,Other,275% of NY Medicaid HMO DRG,50114,,324% x Medicaid HMO amount,50114,Other,324% of NY Medicaid HMO DRG,33255,,215% x Medicaid HMO amount,33255,Other,215% of NY Medicaid HMO DRG,33255,,215% x Medicaid HMO amount,33255,Other,215% of NY Medicaid HMO DRG,19334,,125% x Medicaid HMO amount,19334,Other,125% of NY Medicaid HMO DRG,0.01,65249,
Poisoning of medicinal agents,812-1,APR-DRG,,,,,,,,inpatient,,,46315.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5716,,186% x Medicaid HMO amount,5716,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11316,,"27,634 x DRG Weight",11316,Other,DRG Base Rate x DRG Weight,9618,,"23,488 x DRG Weight",9618,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3073.21,,DRG base rate x DRG weight + capital per discharge,3073.21,Other,100% of NY Medicaid HMO DRG,3073,,DRG base rate x DRG weight + capital per discharge,3073,Other,100% of NY Medicaid HMO DRG,3073,,DRG base rate x DRG weight + capital per discharge,3073,Other,100% of NY Medicaid HMO DRG,3073,,DRG base rate x DRG weight + capital per discharge,3073,Other,100% of NY Medicaid HMO DRG,6915,,225% x Medicaid HMO amount,6915,Other,225% of NY Medicaid HMO DRG,4702,,153% x Medicaid HMO amount,4702,Other,153% of NY Medicaid HMO DRG,6915,,225% x Medicaid HMO amount,6915,Other,225% of NY Medicaid HMO DRG,4302,,140% x Medicaid HMO amount,4302,Other,140% of NY Medicaid HMO DRG,6915,,225% x Medicaid HMO amount,6915,Other,225% of NY Medicaid HMO DRG,8451,,275% x Medicaid HMO amount,8451,Other,275% of NY Medicaid HMO DRG,9957,,324% x Medicaid HMO amount,9957,Other,324% of NY Medicaid HMO DRG,6607,,215% x Medicaid HMO amount,6607,Other,215% of NY Medicaid HMO DRG,6607,,215% x Medicaid HMO amount,6607,Other,215% of NY Medicaid HMO DRG,3842,,125% x Medicaid HMO amount,3842,Other,125% of NY Medicaid HMO DRG,0.01,11316,
Poisoning of medicinal agents,812-2,APR-DRG,,,,,,,,inpatient,,,77729.8,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7286,,186% x Medicaid HMO amount,7286,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14986,,"27,634 x DRG Weight",14986,Other,DRG Base Rate x DRG Weight,12738,,"23,488 x DRG Weight",12738,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3917.21,,DRG base rate x DRG weight + capital per discharge,3917.21,Other,100% of NY Medicaid HMO DRG,3917,,DRG base rate x DRG weight + capital per discharge,3917,Other,100% of NY Medicaid HMO DRG,3917,,DRG base rate x DRG weight + capital per discharge,3917,Other,100% of NY Medicaid HMO DRG,3917,,DRG base rate x DRG weight + capital per discharge,3917,Other,100% of NY Medicaid HMO DRG,8814,,225% x Medicaid HMO amount,8814,Other,225% of NY Medicaid HMO DRG,5993,,153% x Medicaid HMO amount,5993,Other,153% of NY Medicaid HMO DRG,8814,,225% x Medicaid HMO amount,8814,Other,225% of NY Medicaid HMO DRG,5484,,140% x Medicaid HMO amount,5484,Other,140% of NY Medicaid HMO DRG,8814,,225% x Medicaid HMO amount,8814,Other,225% of NY Medicaid HMO DRG,10772,,275% x Medicaid HMO amount,10772,Other,275% of NY Medicaid HMO DRG,12692,,324% x Medicaid HMO amount,12692,Other,324% of NY Medicaid HMO DRG,8422,,215% x Medicaid HMO amount,8422,Other,215% of NY Medicaid HMO DRG,8422,,215% x Medicaid HMO amount,8422,Other,215% of NY Medicaid HMO DRG,4897,,125% x Medicaid HMO amount,4897,Other,125% of NY Medicaid HMO DRG,0.01,14986,
Poisoning of medicinal agents,812-3,APR-DRG,,,,,,,,inpatient,,,110612.46,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11746,,186% x Medicaid HMO amount,11746,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25423,,"27,634 x DRG Weight",25423,Other,DRG Base Rate x DRG Weight,21609,,"23,488 x DRG Weight",21609,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6315.21,,DRG base rate x DRG weight + capital per discharge,6315.21,Other,100% of NY Medicaid HMO DRG,6315,,DRG base rate x DRG weight + capital per discharge,6315,Other,100% of NY Medicaid HMO DRG,6315,,DRG base rate x DRG weight + capital per discharge,6315,Other,100% of NY Medicaid HMO DRG,6315,,DRG base rate x DRG weight + capital per discharge,6315,Other,100% of NY Medicaid HMO DRG,14209,,225% x Medicaid HMO amount,14209,Other,225% of NY Medicaid HMO DRG,9662,,153% x Medicaid HMO amount,9662,Other,153% of NY Medicaid HMO DRG,14209,,225% x Medicaid HMO amount,14209,Other,225% of NY Medicaid HMO DRG,8841,,140% x Medicaid HMO amount,8841,Other,140% of NY Medicaid HMO DRG,14209,,225% x Medicaid HMO amount,14209,Other,225% of NY Medicaid HMO DRG,17367,,275% x Medicaid HMO amount,17367,Other,275% of NY Medicaid HMO DRG,20461,,324% x Medicaid HMO amount,20461,Other,324% of NY Medicaid HMO DRG,13578,,215% x Medicaid HMO amount,13578,Other,215% of NY Medicaid HMO DRG,13578,,215% x Medicaid HMO amount,13578,Other,215% of NY Medicaid HMO DRG,7894,,125% x Medicaid HMO amount,7894,Other,125% of NY Medicaid HMO DRG,0.01,25423,
Poisoning of medicinal agents,812-4,APR-DRG,,,,,,,,inpatient,,,169448.14,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26704,,186% x Medicaid HMO amount,26704,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60419,,"27,634 x DRG Weight",60419,Other,DRG Base Rate x DRG Weight,51354,,"23,488 x DRG Weight",51354,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14357.21,,DRG base rate x DRG weight + capital per discharge,14357.21,Other,100% of NY Medicaid HMO DRG,14357,,DRG base rate x DRG weight + capital per discharge,14357,Other,100% of NY Medicaid HMO DRG,14357,,DRG base rate x DRG weight + capital per discharge,14357,Other,100% of NY Medicaid HMO DRG,14357,,DRG base rate x DRG weight + capital per discharge,14357,Other,100% of NY Medicaid HMO DRG,32304,,225% x Medicaid HMO amount,32304,Other,225% of NY Medicaid HMO DRG,21967,,153% x Medicaid HMO amount,21967,Other,153% of NY Medicaid HMO DRG,32304,,225% x Medicaid HMO amount,32304,Other,225% of NY Medicaid HMO DRG,20100,,140% x Medicaid HMO amount,20100,Other,140% of NY Medicaid HMO DRG,32304,,225% x Medicaid HMO amount,32304,Other,225% of NY Medicaid HMO DRG,39482,,275% x Medicaid HMO amount,39482,Other,275% of NY Medicaid HMO DRG,46517,,324% x Medicaid HMO amount,46517,Other,324% of NY Medicaid HMO DRG,30868,,215% x Medicaid HMO amount,30868,Other,215% of NY Medicaid HMO DRG,30868,,215% x Medicaid HMO amount,30868,Other,215% of NY Medicaid HMO DRG,17947,,125% x Medicaid HMO amount,17947,Other,125% of NY Medicaid HMO DRG,0.01,60419,
Other complications of treatment,813-1,APR-DRG,,,,,,,,inpatient,,,64115.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6756,,186% x Medicaid HMO amount,6756,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13748,,"27,634 x DRG Weight",13748,Other,DRG Base Rate x DRG Weight,11685,,"23,488 x DRG Weight",11685,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3632.21,,DRG base rate x DRG weight + capital per discharge,3632.21,Other,100% of NY Medicaid HMO DRG,3632,,DRG base rate x DRG weight + capital per discharge,3632,Other,100% of NY Medicaid HMO DRG,3632,,DRG base rate x DRG weight + capital per discharge,3632,Other,100% of NY Medicaid HMO DRG,3632,,DRG base rate x DRG weight + capital per discharge,3632,Other,100% of NY Medicaid HMO DRG,8172,,225% x Medicaid HMO amount,8172,Other,225% of NY Medicaid HMO DRG,5557,,153% x Medicaid HMO amount,5557,Other,153% of NY Medicaid HMO DRG,8172,,225% x Medicaid HMO amount,8172,Other,225% of NY Medicaid HMO DRG,5085,,140% x Medicaid HMO amount,5085,Other,140% of NY Medicaid HMO DRG,8172,,225% x Medicaid HMO amount,8172,Other,225% of NY Medicaid HMO DRG,9989,,275% x Medicaid HMO amount,9989,Other,275% of NY Medicaid HMO DRG,11768,,324% x Medicaid HMO amount,11768,Other,324% of NY Medicaid HMO DRG,7809,,215% x Medicaid HMO amount,7809,Other,215% of NY Medicaid HMO DRG,7809,,215% x Medicaid HMO amount,7809,Other,215% of NY Medicaid HMO DRG,4540,,125% x Medicaid HMO amount,4540,Other,125% of NY Medicaid HMO DRG,0.01,13748,
Other complications of treatment,813-2,APR-DRG,,,,,,,,inpatient,,,139069.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8995,,186% x Medicaid HMO amount,8995,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18987,,"27,634 x DRG Weight",18987,Other,DRG Base Rate x DRG Weight,16139,,"23,488 x DRG Weight",16139,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4836.21,,DRG base rate x DRG weight + capital per discharge,4836.21,Other,100% of NY Medicaid HMO DRG,4836,,DRG base rate x DRG weight + capital per discharge,4836,Other,100% of NY Medicaid HMO DRG,4836,,DRG base rate x DRG weight + capital per discharge,4836,Other,100% of NY Medicaid HMO DRG,4836,,DRG base rate x DRG weight + capital per discharge,4836,Other,100% of NY Medicaid HMO DRG,10881,,225% x Medicaid HMO amount,10881,Other,225% of NY Medicaid HMO DRG,7399,,153% x Medicaid HMO amount,7399,Other,153% of NY Medicaid HMO DRG,10881,,225% x Medicaid HMO amount,10881,Other,225% of NY Medicaid HMO DRG,6771,,140% x Medicaid HMO amount,6771,Other,140% of NY Medicaid HMO DRG,10881,,225% x Medicaid HMO amount,10881,Other,225% of NY Medicaid HMO DRG,13300,,275% x Medicaid HMO amount,13300,Other,275% of NY Medicaid HMO DRG,15669,,324% x Medicaid HMO amount,15669,Other,324% of NY Medicaid HMO DRG,10398,,215% x Medicaid HMO amount,10398,Other,215% of NY Medicaid HMO DRG,10398,,215% x Medicaid HMO amount,10398,Other,215% of NY Medicaid HMO DRG,6045,,125% x Medicaid HMO amount,6045,Other,125% of NY Medicaid HMO DRG,0.01,18987,
Other complications of treatment,813-3,APR-DRG,,,,,,,,inpatient,,,157589.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14322,,186% x Medicaid HMO amount,14322,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31450,,"27,634 x DRG Weight",31450,Other,DRG Base Rate x DRG Weight,26732,,"23,488 x DRG Weight",26732,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7700.21,,DRG base rate x DRG weight + capital per discharge,7700.21,Other,100% of NY Medicaid HMO DRG,7700,,DRG base rate x DRG weight + capital per discharge,7700,Other,100% of NY Medicaid HMO DRG,7700,,DRG base rate x DRG weight + capital per discharge,7700,Other,100% of NY Medicaid HMO DRG,7700,,DRG base rate x DRG weight + capital per discharge,7700,Other,100% of NY Medicaid HMO DRG,17325,,225% x Medicaid HMO amount,17325,Other,225% of NY Medicaid HMO DRG,11781,,153% x Medicaid HMO amount,11781,Other,153% of NY Medicaid HMO DRG,17325,,225% x Medicaid HMO amount,17325,Other,225% of NY Medicaid HMO DRG,10780,,140% x Medicaid HMO amount,10780,Other,140% of NY Medicaid HMO DRG,17325,,225% x Medicaid HMO amount,17325,Other,225% of NY Medicaid HMO DRG,21176,,275% x Medicaid HMO amount,21176,Other,275% of NY Medicaid HMO DRG,24949,,324% x Medicaid HMO amount,24949,Other,324% of NY Medicaid HMO DRG,16555,,215% x Medicaid HMO amount,16555,Other,215% of NY Medicaid HMO DRG,16555,,215% x Medicaid HMO amount,16555,Other,215% of NY Medicaid HMO DRG,9625,,125% x Medicaid HMO amount,9625,Other,125% of NY Medicaid HMO DRG,0.01,31450,
Other complications of treatment,813-4,APR-DRG,,,,,,,,inpatient,,,249158.17,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31748,,186% x Medicaid HMO amount,31748,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,72224,,"27,634 x DRG Weight",72224,Other,DRG Base Rate x DRG Weight,61388,,"23,488 x DRG Weight",61388,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17069.21,,DRG base rate x DRG weight + capital per discharge,17069.21,Other,100% of NY Medicaid HMO DRG,17069,,DRG base rate x DRG weight + capital per discharge,17069,Other,100% of NY Medicaid HMO DRG,17069,,DRG base rate x DRG weight + capital per discharge,17069,Other,100% of NY Medicaid HMO DRG,17069,,DRG base rate x DRG weight + capital per discharge,17069,Other,100% of NY Medicaid HMO DRG,38406,,225% x Medicaid HMO amount,38406,Other,225% of NY Medicaid HMO DRG,26116,,153% x Medicaid HMO amount,26116,Other,153% of NY Medicaid HMO DRG,38406,,225% x Medicaid HMO amount,38406,Other,225% of NY Medicaid HMO DRG,23897,,140% x Medicaid HMO amount,23897,Other,140% of NY Medicaid HMO DRG,38406,,225% x Medicaid HMO amount,38406,Other,225% of NY Medicaid HMO DRG,46940,,275% x Medicaid HMO amount,46940,Other,275% of NY Medicaid HMO DRG,55304,,324% x Medicaid HMO amount,55304,Other,324% of NY Medicaid HMO DRG,36699,,215% x Medicaid HMO amount,36699,Other,215% of NY Medicaid HMO DRG,36699,,215% x Medicaid HMO amount,36699,Other,215% of NY Medicaid HMO DRG,21337,,125% x Medicaid HMO amount,21337,Other,125% of NY Medicaid HMO DRG,0.01,72224,
"Other injury, poisoning & toxic effect diagnoses",815-1,APR-DRG,,,,,,,,inpatient,,,84439.99,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5147,,186% x Medicaid HMO amount,5147,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9984,,"27,634 x DRG Weight",9984,Other,DRG Base Rate x DRG Weight,8486,,"23,488 x DRG Weight",8486,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,2767.21,,DRG base rate x DRG weight + capital per discharge,2767.21,Other,100% of NY Medicaid HMO DRG,2767,,DRG base rate x DRG weight + capital per discharge,2767,Other,100% of NY Medicaid HMO DRG,2767,,DRG base rate x DRG weight + capital per discharge,2767,Other,100% of NY Medicaid HMO DRG,2767,,DRG base rate x DRG weight + capital per discharge,2767,Other,100% of NY Medicaid HMO DRG,6226,,225% x Medicaid HMO amount,6226,Other,225% of NY Medicaid HMO DRG,4234,,153% x Medicaid HMO amount,4234,Other,153% of NY Medicaid HMO DRG,6226,,225% x Medicaid HMO amount,6226,Other,225% of NY Medicaid HMO DRG,3874,,140% x Medicaid HMO amount,3874,Other,140% of NY Medicaid HMO DRG,6226,,225% x Medicaid HMO amount,6226,Other,225% of NY Medicaid HMO DRG,7610,,275% x Medicaid HMO amount,7610,Other,275% of NY Medicaid HMO DRG,8966,,324% x Medicaid HMO amount,8966,Other,324% of NY Medicaid HMO DRG,5950,,215% x Medicaid HMO amount,5950,Other,215% of NY Medicaid HMO DRG,5950,,215% x Medicaid HMO amount,5950,Other,215% of NY Medicaid HMO DRG,3459,,125% x Medicaid HMO amount,3459,Other,125% of NY Medicaid HMO DRG,0.01,9984,
"Other injury, poisoning & toxic effect diagnoses",815-2,APR-DRG,,,,,,,,inpatient,,,143510.07,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8178,,186% x Medicaid HMO amount,8178,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17078,,"27,634 x DRG Weight",17078,Other,DRG Base Rate x DRG Weight,14516,,"23,488 x DRG Weight",14516,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4397.21,,DRG base rate x DRG weight + capital per discharge,4397.21,Other,100% of NY Medicaid HMO DRG,4397,,DRG base rate x DRG weight + capital per discharge,4397,Other,100% of NY Medicaid HMO DRG,4397,,DRG base rate x DRG weight + capital per discharge,4397,Other,100% of NY Medicaid HMO DRG,4397,,DRG base rate x DRG weight + capital per discharge,4397,Other,100% of NY Medicaid HMO DRG,9894,,225% x Medicaid HMO amount,9894,Other,225% of NY Medicaid HMO DRG,6728,,153% x Medicaid HMO amount,6728,Other,153% of NY Medicaid HMO DRG,9894,,225% x Medicaid HMO amount,9894,Other,225% of NY Medicaid HMO DRG,6156,,140% x Medicaid HMO amount,6156,Other,140% of NY Medicaid HMO DRG,9894,,225% x Medicaid HMO amount,9894,Other,225% of NY Medicaid HMO DRG,12092,,275% x Medicaid HMO amount,12092,Other,275% of NY Medicaid HMO DRG,14247,,324% x Medicaid HMO amount,14247,Other,324% of NY Medicaid HMO DRG,9454,,215% x Medicaid HMO amount,9454,Other,215% of NY Medicaid HMO DRG,9454,,215% x Medicaid HMO amount,9454,Other,215% of NY Medicaid HMO DRG,5497,,125% x Medicaid HMO amount,5497,Other,125% of NY Medicaid HMO DRG,0.01,17078,
"Other injury, poisoning & toxic effect diagnoses",815-3,APR-DRG,,,,,,,,inpatient,,,328313.63,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13336,,186% x Medicaid HMO amount,13336,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29143,,"27,634 x DRG Weight",29143,Other,DRG Base Rate x DRG Weight,24770,,"23,488 x DRG Weight",24770,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7170.21,,DRG base rate x DRG weight + capital per discharge,7170.21,Other,100% of NY Medicaid HMO DRG,7170,,DRG base rate x DRG weight + capital per discharge,7170,Other,100% of NY Medicaid HMO DRG,7170,,DRG base rate x DRG weight + capital per discharge,7170,Other,100% of NY Medicaid HMO DRG,7170,,DRG base rate x DRG weight + capital per discharge,7170,Other,100% of NY Medicaid HMO DRG,16133,,225% x Medicaid HMO amount,16133,Other,225% of NY Medicaid HMO DRG,10970,,153% x Medicaid HMO amount,10970,Other,153% of NY Medicaid HMO DRG,16133,,225% x Medicaid HMO amount,16133,Other,225% of NY Medicaid HMO DRG,10038,,140% x Medicaid HMO amount,10038,Other,140% of NY Medicaid HMO DRG,16133,,225% x Medicaid HMO amount,16133,Other,225% of NY Medicaid HMO DRG,19718,,275% x Medicaid HMO amount,19718,Other,275% of NY Medicaid HMO DRG,23231,,324% x Medicaid HMO amount,23231,Other,324% of NY Medicaid HMO DRG,15416,,215% x Medicaid HMO amount,15416,Other,215% of NY Medicaid HMO DRG,15416,,215% x Medicaid HMO amount,15416,Other,215% of NY Medicaid HMO DRG,8963,,125% x Medicaid HMO amount,8963,Other,125% of NY Medicaid HMO DRG,0.01,29143,
"Other injury, poisoning & toxic effect diagnoses",815-4,APR-DRG,,,,,,,,inpatient,,,295702.79,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32822,,186% x Medicaid HMO amount,32822,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74736,,"27,634 x DRG Weight",74736,Other,DRG Base Rate x DRG Weight,63523,,"23,488 x DRG Weight",63523,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17646.21,,DRG base rate x DRG weight + capital per discharge,17646.21,Other,100% of NY Medicaid HMO DRG,17646,,DRG base rate x DRG weight + capital per discharge,17646,Other,100% of NY Medicaid HMO DRG,17646,,DRG base rate x DRG weight + capital per discharge,17646,Other,100% of NY Medicaid HMO DRG,17646,,DRG base rate x DRG weight + capital per discharge,17646,Other,100% of NY Medicaid HMO DRG,39704,,225% x Medicaid HMO amount,39704,Other,225% of NY Medicaid HMO DRG,26999,,153% x Medicaid HMO amount,26999,Other,153% of NY Medicaid HMO DRG,39704,,225% x Medicaid HMO amount,39704,Other,225% of NY Medicaid HMO DRG,24705,,140% x Medicaid HMO amount,24705,Other,140% of NY Medicaid HMO DRG,39704,,225% x Medicaid HMO amount,39704,Other,225% of NY Medicaid HMO DRG,48527,,275% x Medicaid HMO amount,48527,Other,275% of NY Medicaid HMO DRG,57174,,324% x Medicaid HMO amount,57174,Other,324% of NY Medicaid HMO DRG,37939,,215% x Medicaid HMO amount,37939,Other,215% of NY Medicaid HMO DRG,37939,,215% x Medicaid HMO amount,37939,Other,215% of NY Medicaid HMO DRG,22058,,125% x Medicaid HMO amount,22058,Other,125% of NY Medicaid HMO DRG,0.01,74736,
Toxic effects of non-medicinal substances,816-1,APR-DRG,,,,,,,,inpatient,,,106006.35,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6171,,186% x Medicaid HMO amount,6171,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12380,,"27,634 x DRG Weight",12380,Other,DRG Base Rate x DRG Weight,10523,,"23,488 x DRG Weight",10523,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3318.21,,DRG base rate x DRG weight + capital per discharge,3318.21,Other,100% of NY Medicaid HMO DRG,3318,,DRG base rate x DRG weight + capital per discharge,3318,Other,100% of NY Medicaid HMO DRG,3318,,DRG base rate x DRG weight + capital per discharge,3318,Other,100% of NY Medicaid HMO DRG,3318,,DRG base rate x DRG weight + capital per discharge,3318,Other,100% of NY Medicaid HMO DRG,7466,,225% x Medicaid HMO amount,7466,Other,225% of NY Medicaid HMO DRG,5077,,153% x Medicaid HMO amount,5077,Other,153% of NY Medicaid HMO DRG,7466,,225% x Medicaid HMO amount,7466,Other,225% of NY Medicaid HMO DRG,4645,,140% x Medicaid HMO amount,4645,Other,140% of NY Medicaid HMO DRG,7466,,225% x Medicaid HMO amount,7466,Other,225% of NY Medicaid HMO DRG,9125,,275% x Medicaid HMO amount,9125,Other,275% of NY Medicaid HMO DRG,10751,,324% x Medicaid HMO amount,10751,Other,324% of NY Medicaid HMO DRG,7134,,215% x Medicaid HMO amount,7134,Other,215% of NY Medicaid HMO DRG,7134,,215% x Medicaid HMO amount,7134,Other,215% of NY Medicaid HMO DRG,4148,,125% x Medicaid HMO amount,4148,Other,125% of NY Medicaid HMO DRG,0.01,12380,
Toxic effects of non-medicinal substances,816-2,APR-DRG,,,,,,,,inpatient,,,83123.52,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7570,,186% x Medicaid HMO amount,7570,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15652,,"27,634 x DRG Weight",15652,Other,DRG Base Rate x DRG Weight,13304,,"23,488 x DRG Weight",13304,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4070.21,,DRG base rate x DRG weight + capital per discharge,4070.21,Other,100% of NY Medicaid HMO DRG,4070,,DRG base rate x DRG weight + capital per discharge,4070,Other,100% of NY Medicaid HMO DRG,4070,,DRG base rate x DRG weight + capital per discharge,4070,Other,100% of NY Medicaid HMO DRG,4070,,DRG base rate x DRG weight + capital per discharge,4070,Other,100% of NY Medicaid HMO DRG,9158,,225% x Medicaid HMO amount,9158,Other,225% of NY Medicaid HMO DRG,6227,,153% x Medicaid HMO amount,6227,Other,153% of NY Medicaid HMO DRG,9158,,225% x Medicaid HMO amount,9158,Other,225% of NY Medicaid HMO DRG,5698,,140% x Medicaid HMO amount,5698,Other,140% of NY Medicaid HMO DRG,9158,,225% x Medicaid HMO amount,9158,Other,225% of NY Medicaid HMO DRG,11193,,275% x Medicaid HMO amount,11193,Other,275% of NY Medicaid HMO DRG,13187,,324% x Medicaid HMO amount,13187,Other,324% of NY Medicaid HMO DRG,8751,,215% x Medicaid HMO amount,8751,Other,215% of NY Medicaid HMO DRG,8751,,215% x Medicaid HMO amount,8751,Other,215% of NY Medicaid HMO DRG,5088,,125% x Medicaid HMO amount,5088,Other,125% of NY Medicaid HMO DRG,0.01,15652,
Toxic effects of non-medicinal substances,816-3,APR-DRG,,,,,,,,inpatient,,,137476.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11286,,186% x Medicaid HMO amount,11286,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24348,,"27,634 x DRG Weight",24348,Other,DRG Base Rate x DRG Weight,20695,,"23,488 x DRG Weight",20695,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6068.21,,DRG base rate x DRG weight + capital per discharge,6068.21,Other,100% of NY Medicaid HMO DRG,6068,,DRG base rate x DRG weight + capital per discharge,6068,Other,100% of NY Medicaid HMO DRG,6068,,DRG base rate x DRG weight + capital per discharge,6068,Other,100% of NY Medicaid HMO DRG,6068,,DRG base rate x DRG weight + capital per discharge,6068,Other,100% of NY Medicaid HMO DRG,13653,,225% x Medicaid HMO amount,13653,Other,225% of NY Medicaid HMO DRG,9284,,153% x Medicaid HMO amount,9284,Other,153% of NY Medicaid HMO DRG,13653,,225% x Medicaid HMO amount,13653,Other,225% of NY Medicaid HMO DRG,8495,,140% x Medicaid HMO amount,8495,Other,140% of NY Medicaid HMO DRG,13653,,225% x Medicaid HMO amount,13653,Other,225% of NY Medicaid HMO DRG,16688,,275% x Medicaid HMO amount,16688,Other,275% of NY Medicaid HMO DRG,19661,,324% x Medicaid HMO amount,19661,Other,324% of NY Medicaid HMO DRG,13047,,215% x Medicaid HMO amount,13047,Other,215% of NY Medicaid HMO DRG,13047,,215% x Medicaid HMO amount,13047,Other,215% of NY Medicaid HMO DRG,7585,,125% x Medicaid HMO amount,7585,Other,125% of NY Medicaid HMO DRG,0.01,24348,
Toxic effects of non-medicinal substances,816-4,APR-DRG,,,,,,,,inpatient,,,157136.38,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25612,,186% x Medicaid HMO amount,25612,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57866,,"27,634 x DRG Weight",57866,Other,DRG Base Rate x DRG Weight,49184,,"23,488 x DRG Weight",49184,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13770.21,,DRG base rate x DRG weight + capital per discharge,13770.21,Other,100% of NY Medicaid HMO DRG,13770,,DRG base rate x DRG weight + capital per discharge,13770,Other,100% of NY Medicaid HMO DRG,13770,,DRG base rate x DRG weight + capital per discharge,13770,Other,100% of NY Medicaid HMO DRG,13770,,DRG base rate x DRG weight + capital per discharge,13770,Other,100% of NY Medicaid HMO DRG,30983,,225% x Medicaid HMO amount,30983,Other,225% of NY Medicaid HMO DRG,21068,,153% x Medicaid HMO amount,21068,Other,153% of NY Medicaid HMO DRG,30983,,225% x Medicaid HMO amount,30983,Other,225% of NY Medicaid HMO DRG,19278,,140% x Medicaid HMO amount,19278,Other,140% of NY Medicaid HMO DRG,30983,,225% x Medicaid HMO amount,30983,Other,225% of NY Medicaid HMO DRG,37868,,275% x Medicaid HMO amount,37868,Other,275% of NY Medicaid HMO DRG,44615,,324% x Medicaid HMO amount,44615,Other,324% of NY Medicaid HMO DRG,29606,,215% x Medicaid HMO amount,29606,Other,215% of NY Medicaid HMO DRG,29606,,215% x Medicaid HMO amount,29606,Other,215% of NY Medicaid HMO DRG,17213,,125% x Medicaid HMO amount,17213,Other,125% of NY Medicaid HMO DRG,0.01,57866,
Extensive 3rd degree burns w skin graft,841-1,APR-DRG,,,,,,,,inpatient,,,1260874.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64267,,186% x Medicaid HMO amount,64267,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,148306,,"27,634 x DRG Weight",148306,Other,DRG Base Rate x DRG Weight,126055,,"23,488 x DRG Weight",126055,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34552.21,,DRG base rate x DRG weight + capital per discharge,34552.21,Other,100% of NY Medicaid HMO DRG,34552,,DRG base rate x DRG weight + capital per discharge,34552,Other,100% of NY Medicaid HMO DRG,34552,,DRG base rate x DRG weight + capital per discharge,34552,Other,100% of NY Medicaid HMO DRG,34552,,DRG base rate x DRG weight + capital per discharge,34552,Other,100% of NY Medicaid HMO DRG,77742,,225% x Medicaid HMO amount,77742,Other,225% of NY Medicaid HMO DRG,52865,,153% x Medicaid HMO amount,52865,Other,153% of NY Medicaid HMO DRG,77742,,225% x Medicaid HMO amount,77742,Other,225% of NY Medicaid HMO DRG,48373,,140% x Medicaid HMO amount,48373,Other,140% of NY Medicaid HMO DRG,77742,,225% x Medicaid HMO amount,77742,Other,225% of NY Medicaid HMO DRG,95019,,275% x Medicaid HMO amount,95019,Other,275% of NY Medicaid HMO DRG,111949,,324% x Medicaid HMO amount,111949,Other,324% of NY Medicaid HMO DRG,74287,,215% x Medicaid HMO amount,74287,Other,215% of NY Medicaid HMO DRG,74287,,215% x Medicaid HMO amount,74287,Other,215% of NY Medicaid HMO DRG,43190,,125% x Medicaid HMO amount,43190,Other,125% of NY Medicaid HMO DRG,0.01,148306,
Extensive 3rd degree burns w skin graft,841-2,APR-DRG,,,,,,,,inpatient,,,1260874.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,84524,,186% x Medicaid HMO amount,84524,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,195701,,"27,634 x DRG Weight",195701,Other,DRG Base Rate x DRG Weight,166340,,"23,488 x DRG Weight",166340,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45443.21,,DRG base rate x DRG weight + capital per discharge,45443.21,Other,100% of NY Medicaid HMO DRG,45443,,DRG base rate x DRG weight + capital per discharge,45443,Other,100% of NY Medicaid HMO DRG,45443,,DRG base rate x DRG weight + capital per discharge,45443,Other,100% of NY Medicaid HMO DRG,45443,,DRG base rate x DRG weight + capital per discharge,45443,Other,100% of NY Medicaid HMO DRG,102247,,225% x Medicaid HMO amount,102247,Other,225% of NY Medicaid HMO DRG,69528,,153% x Medicaid HMO amount,69528,Other,153% of NY Medicaid HMO DRG,102247,,225% x Medicaid HMO amount,102247,Other,225% of NY Medicaid HMO DRG,63620,,140% x Medicaid HMO amount,63620,Other,140% of NY Medicaid HMO DRG,102247,,225% x Medicaid HMO amount,102247,Other,225% of NY Medicaid HMO DRG,124969,,275% x Medicaid HMO amount,124969,Other,275% of NY Medicaid HMO DRG,147236,,324% x Medicaid HMO amount,147236,Other,324% of NY Medicaid HMO DRG,97703,,215% x Medicaid HMO amount,97703,Other,215% of NY Medicaid HMO DRG,97703,,215% x Medicaid HMO amount,97703,Other,215% of NY Medicaid HMO DRG,56804,,125% x Medicaid HMO amount,56804,Other,125% of NY Medicaid HMO DRG,0.01,195701,
Extensive 3rd degree burns w skin graft,841-3,APR-DRG,,,,,,,,inpatient,,,1422878.29,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,173826,,186% x Medicaid HMO amount,173826,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,404642,,"27,634 x DRG Weight",404642,Other,DRG Base Rate x DRG Weight,343932,,"23,488 x DRG Weight",343932,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,93455.21,,DRG base rate x DRG weight + capital per discharge,93455.21,Other,100% of NY Medicaid HMO DRG,93455,,DRG base rate x DRG weight + capital per discharge,93455,Other,100% of NY Medicaid HMO DRG,93455,,DRG base rate x DRG weight + capital per discharge,93455,Other,100% of NY Medicaid HMO DRG,93455,,DRG base rate x DRG weight + capital per discharge,93455,Other,100% of NY Medicaid HMO DRG,210274,,225% x Medicaid HMO amount,210274,Other,225% of NY Medicaid HMO DRG,142986,,153% x Medicaid HMO amount,142986,Other,153% of NY Medicaid HMO DRG,210274,,225% x Medicaid HMO amount,210274,Other,225% of NY Medicaid HMO DRG,130837,,140% x Medicaid HMO amount,130837,Other,140% of NY Medicaid HMO DRG,210274,,225% x Medicaid HMO amount,210274,Other,225% of NY Medicaid HMO DRG,257002,,275% x Medicaid HMO amount,257002,Other,275% of NY Medicaid HMO DRG,302795,,324% x Medicaid HMO amount,302795,Other,324% of NY Medicaid HMO DRG,200929,,215% x Medicaid HMO amount,200929,Other,215% of NY Medicaid HMO DRG,200929,,215% x Medicaid HMO amount,200929,Other,215% of NY Medicaid HMO DRG,116819,,125% x Medicaid HMO amount,116819,Other,125% of NY Medicaid HMO DRG,0.01,404642,
Extensive 3rd degree burns w skin graft,841-4,APR-DRG,,,,,,,,inpatient,,,2504936.85,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,222199,,186% x Medicaid HMO amount,222199,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,517817,,"27,634 x DRG Weight",517817,Other,DRG Base Rate x DRG Weight,440128,,"23,488 x DRG Weight",440128,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,119462.21,,DRG base rate x DRG weight + capital per discharge,119462.21,Other,100% of NY Medicaid HMO DRG,119462,,DRG base rate x DRG weight + capital per discharge,119462,Other,100% of NY Medicaid HMO DRG,119462,,DRG base rate x DRG weight + capital per discharge,119462,Other,100% of NY Medicaid HMO DRG,119462,,DRG base rate x DRG weight + capital per discharge,119462,Other,100% of NY Medicaid HMO DRG,268790,,225% x Medicaid HMO amount,268790,Other,225% of NY Medicaid HMO DRG,182777,,153% x Medicaid HMO amount,182777,Other,153% of NY Medicaid HMO DRG,268790,,225% x Medicaid HMO amount,268790,Other,225% of NY Medicaid HMO DRG,167247,,140% x Medicaid HMO amount,167247,Other,140% of NY Medicaid HMO DRG,268790,,225% x Medicaid HMO amount,268790,Other,225% of NY Medicaid HMO DRG,328521,,275% x Medicaid HMO amount,328521,Other,275% of NY Medicaid HMO DRG,387058,,324% x Medicaid HMO amount,387058,Other,324% of NY Medicaid HMO DRG,256844,,215% x Medicaid HMO amount,256844,Other,215% of NY Medicaid HMO DRG,256844,,215% x Medicaid HMO amount,256844,Other,215% of NY Medicaid HMO DRG,149328,,125% x Medicaid HMO amount,149328,Other,125% of NY Medicaid HMO DRG,0.01,517817,
Burns with skin graft except extensive 3rd degree burns,842-1,APR-DRG,,,,,,,,inpatient,,,417507.42,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26334,,186% x Medicaid HMO amount,26334,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59557,,"27,634 x DRG Weight",59557,Other,DRG Base Rate x DRG Weight,50621,,"23,488 x DRG Weight",50621,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14158.21,,DRG base rate x DRG weight + capital per discharge,14158.21,Other,100% of NY Medicaid HMO DRG,14158,,DRG base rate x DRG weight + capital per discharge,14158,Other,100% of NY Medicaid HMO DRG,14158,,DRG base rate x DRG weight + capital per discharge,14158,Other,100% of NY Medicaid HMO DRG,14158,,DRG base rate x DRG weight + capital per discharge,14158,Other,100% of NY Medicaid HMO DRG,31856,,225% x Medicaid HMO amount,31856,Other,225% of NY Medicaid HMO DRG,21662,,153% x Medicaid HMO amount,21662,Other,153% of NY Medicaid HMO DRG,31856,,225% x Medicaid HMO amount,31856,Other,225% of NY Medicaid HMO DRG,19821,,140% x Medicaid HMO amount,19821,Other,140% of NY Medicaid HMO DRG,31856,,225% x Medicaid HMO amount,31856,Other,225% of NY Medicaid HMO DRG,38935,,275% x Medicaid HMO amount,38935,Other,275% of NY Medicaid HMO DRG,45873,,324% x Medicaid HMO amount,45873,Other,324% of NY Medicaid HMO DRG,30440,,215% x Medicaid HMO amount,30440,Other,215% of NY Medicaid HMO DRG,30440,,215% x Medicaid HMO amount,30440,Other,215% of NY Medicaid HMO DRG,17698,,125% x Medicaid HMO amount,17698,Other,125% of NY Medicaid HMO DRG,0.01,59557,
Burns with skin graft except extensive 3rd degree burns,842-2,APR-DRG,,,,,,,,inpatient,,,597490.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34356,,186% x Medicaid HMO amount,34356,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,78326,,"27,634 x DRG Weight",78326,Other,DRG Base Rate x DRG Weight,66574,,"23,488 x DRG Weight",66574,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18471.21,,DRG base rate x DRG weight + capital per discharge,18471.21,Other,100% of NY Medicaid HMO DRG,18471,,DRG base rate x DRG weight + capital per discharge,18471,Other,100% of NY Medicaid HMO DRG,18471,,DRG base rate x DRG weight + capital per discharge,18471,Other,100% of NY Medicaid HMO DRG,18471,,DRG base rate x DRG weight + capital per discharge,18471,Other,100% of NY Medicaid HMO DRG,41560,,225% x Medicaid HMO amount,41560,Other,225% of NY Medicaid HMO DRG,28261,,153% x Medicaid HMO amount,28261,Other,153% of NY Medicaid HMO DRG,41560,,225% x Medicaid HMO amount,41560,Other,225% of NY Medicaid HMO DRG,25860,,140% x Medicaid HMO amount,25860,Other,140% of NY Medicaid HMO DRG,41560,,225% x Medicaid HMO amount,41560,Other,225% of NY Medicaid HMO DRG,50796,,275% x Medicaid HMO amount,50796,Other,275% of NY Medicaid HMO DRG,59847,,324% x Medicaid HMO amount,59847,Other,324% of NY Medicaid HMO DRG,39713,,215% x Medicaid HMO amount,39713,Other,215% of NY Medicaid HMO DRG,39713,,215% x Medicaid HMO amount,39713,Other,215% of NY Medicaid HMO DRG,23089,,125% x Medicaid HMO amount,23089,Other,125% of NY Medicaid HMO DRG,0.01,78326,
Burns with skin graft except extensive 3rd degree burns,842-3,APR-DRG,,,,,,,,inpatient,,,644723.08,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,52417,,186% x Medicaid HMO amount,52417,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,120581,,"27,634 x DRG Weight",120581,Other,DRG Base Rate x DRG Weight,102490,,"23,488 x DRG Weight",102490,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28181.21,,DRG base rate x DRG weight + capital per discharge,28181.21,Other,100% of NY Medicaid HMO DRG,28181,,DRG base rate x DRG weight + capital per discharge,28181,Other,100% of NY Medicaid HMO DRG,28181,,DRG base rate x DRG weight + capital per discharge,28181,Other,100% of NY Medicaid HMO DRG,28181,,DRG base rate x DRG weight + capital per discharge,28181,Other,100% of NY Medicaid HMO DRG,63408,,225% x Medicaid HMO amount,63408,Other,225% of NY Medicaid HMO DRG,43117,,153% x Medicaid HMO amount,43117,Other,153% of NY Medicaid HMO DRG,63408,,225% x Medicaid HMO amount,63408,Other,225% of NY Medicaid HMO DRG,39454,,140% x Medicaid HMO amount,39454,Other,140% of NY Medicaid HMO DRG,63408,,225% x Medicaid HMO amount,63408,Other,225% of NY Medicaid HMO DRG,77498,,275% x Medicaid HMO amount,77498,Other,275% of NY Medicaid HMO DRG,91307,,324% x Medicaid HMO amount,91307,Other,324% of NY Medicaid HMO DRG,60590,,215% x Medicaid HMO amount,60590,Other,215% of NY Medicaid HMO DRG,60590,,215% x Medicaid HMO amount,60590,Other,215% of NY Medicaid HMO DRG,35227,,125% x Medicaid HMO amount,35227,Other,125% of NY Medicaid HMO DRG,0.01,120581,
Burns with skin graft except extensive 3rd degree burns,842-4,APR-DRG,,,,,,,,inpatient,,,1260874.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,102899,,186% x Medicaid HMO amount,102899,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,238694,,"27,634 x DRG Weight",238694,Other,DRG Base Rate x DRG Weight,202882,,"23,488 x DRG Weight",202882,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,55322.21,,DRG base rate x DRG weight + capital per discharge,55322.21,Other,100% of NY Medicaid HMO DRG,55322,,DRG base rate x DRG weight + capital per discharge,55322,Other,100% of NY Medicaid HMO DRG,55322,,DRG base rate x DRG weight + capital per discharge,55322,Other,100% of NY Medicaid HMO DRG,55322,,DRG base rate x DRG weight + capital per discharge,55322,Other,100% of NY Medicaid HMO DRG,124475,,225% x Medicaid HMO amount,124475,Other,225% of NY Medicaid HMO DRG,84643,,153% x Medicaid HMO amount,84643,Other,153% of NY Medicaid HMO DRG,124475,,225% x Medicaid HMO amount,124475,Other,225% of NY Medicaid HMO DRG,77451,,140% x Medicaid HMO amount,77451,Other,140% of NY Medicaid HMO DRG,124475,,225% x Medicaid HMO amount,124475,Other,225% of NY Medicaid HMO DRG,152136,,275% x Medicaid HMO amount,152136,Other,275% of NY Medicaid HMO DRG,179244,,324% x Medicaid HMO amount,179244,Other,324% of NY Medicaid HMO DRG,118943,,215% x Medicaid HMO amount,118943,Other,215% of NY Medicaid HMO DRG,118943,,215% x Medicaid HMO amount,118943,Other,215% of NY Medicaid HMO DRG,69153,,125% x Medicaid HMO amount,69153,Other,125% of NY Medicaid HMO DRG,0.01,238694,
Extensive 3rd degree or full thickness burns w/o skin graft,843-1,APR-DRG,,,,,,,,inpatient,,,232006.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24163,,186% x Medicaid HMO amount,24163,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54478,,"27,634 x DRG Weight",54478,Other,DRG Base Rate x DRG Weight,46304,,"23,488 x DRG Weight",46304,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12991.21,,DRG base rate x DRG weight + capital per discharge,12991.21,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,19877,,153% x Medicaid HMO amount,19877,Other,153% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,18188,,140% x Medicaid HMO amount,18188,Other,140% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,35726,,275% x Medicaid HMO amount,35726,Other,275% of NY Medicaid HMO DRG,42092,,324% x Medicaid HMO amount,42092,Other,324% of NY Medicaid HMO DRG,27931,,215% x Medicaid HMO amount,27931,Other,215% of NY Medicaid HMO DRG,27931,,215% x Medicaid HMO amount,27931,Other,215% of NY Medicaid HMO DRG,16239,,125% x Medicaid HMO amount,16239,Other,125% of NY Medicaid HMO DRG,0.01,54478,
Extensive 3rd degree or full thickness burns w/o skin graft,843-2,APR-DRG,,,,,,,,inpatient,,,232006.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24163,,186% x Medicaid HMO amount,24163,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54478,,"27,634 x DRG Weight",54478,Other,DRG Base Rate x DRG Weight,46304,,"23,488 x DRG Weight",46304,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12991.21,,DRG base rate x DRG weight + capital per discharge,12991.21,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,19877,,153% x Medicaid HMO amount,19877,Other,153% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,18188,,140% x Medicaid HMO amount,18188,Other,140% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,35726,,275% x Medicaid HMO amount,35726,Other,275% of NY Medicaid HMO DRG,42092,,324% x Medicaid HMO amount,42092,Other,324% of NY Medicaid HMO DRG,27931,,215% x Medicaid HMO amount,27931,Other,215% of NY Medicaid HMO DRG,27931,,215% x Medicaid HMO amount,27931,Other,215% of NY Medicaid HMO DRG,16239,,125% x Medicaid HMO amount,16239,Other,125% of NY Medicaid HMO DRG,0.01,54478,
Extensive 3rd degree or full thickness burns w/o skin graft,843-3,APR-DRG,,,,,,,,inpatient,,,232006.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24163,,186% x Medicaid HMO amount,24163,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54478,,"27,634 x DRG Weight",54478,Other,DRG Base Rate x DRG Weight,46304,,"23,488 x DRG Weight",46304,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12991.21,,DRG base rate x DRG weight + capital per discharge,12991.21,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,19877,,153% x Medicaid HMO amount,19877,Other,153% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,18188,,140% x Medicaid HMO amount,18188,Other,140% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,35726,,275% x Medicaid HMO amount,35726,Other,275% of NY Medicaid HMO DRG,42092,,324% x Medicaid HMO amount,42092,Other,324% of NY Medicaid HMO DRG,27931,,215% x Medicaid HMO amount,27931,Other,215% of NY Medicaid HMO DRG,27931,,215% x Medicaid HMO amount,27931,Other,215% of NY Medicaid HMO DRG,16239,,125% x Medicaid HMO amount,16239,Other,125% of NY Medicaid HMO DRG,0.01,54478,
Extensive 3rd degree or full thickness burns w/o skin graft,843-4,APR-DRG,,,,,,,,inpatient,,,232006.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24163,,186% x Medicaid HMO amount,24163,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,54478,,"27,634 x DRG Weight",54478,Other,DRG Base Rate x DRG Weight,46304,,"23,488 x DRG Weight",46304,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12991.21,,DRG base rate x DRG weight + capital per discharge,12991.21,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,12991,,DRG base rate x DRG weight + capital per discharge,12991,Other,100% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,19877,,153% x Medicaid HMO amount,19877,Other,153% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,18188,,140% x Medicaid HMO amount,18188,Other,140% of NY Medicaid HMO DRG,29230,,225% x Medicaid HMO amount,29230,Other,225% of NY Medicaid HMO DRG,35726,,275% x Medicaid HMO amount,35726,Other,275% of NY Medicaid HMO DRG,42092,,324% x Medicaid HMO amount,42092,Other,324% of NY Medicaid HMO DRG,27931,,215% x Medicaid HMO amount,27931,Other,215% of NY Medicaid HMO DRG,27931,,215% x Medicaid HMO amount,27931,Other,215% of NY Medicaid HMO DRG,16239,,125% x Medicaid HMO amount,16239,Other,125% of NY Medicaid HMO DRG,0.01,54478,
Partial thickness burns without skin graft,844-1,APR-DRG,,,,,,,,inpatient,,,112166.66,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8549,,186% x Medicaid HMO amount,8549,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17943,,"27,634 x DRG Weight",17943,Other,DRG Base Rate x DRG Weight,15251,,"23,488 x DRG Weight",15251,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4596.21,,DRG base rate x DRG weight + capital per discharge,4596.21,Other,100% of NY Medicaid HMO DRG,4596,,DRG base rate x DRG weight + capital per discharge,4596,Other,100% of NY Medicaid HMO DRG,4596,,DRG base rate x DRG weight + capital per discharge,4596,Other,100% of NY Medicaid HMO DRG,4596,,DRG base rate x DRG weight + capital per discharge,4596,Other,100% of NY Medicaid HMO DRG,10341,,225% x Medicaid HMO amount,10341,Other,225% of NY Medicaid HMO DRG,7032,,153% x Medicaid HMO amount,7032,Other,153% of NY Medicaid HMO DRG,10341,,225% x Medicaid HMO amount,10341,Other,225% of NY Medicaid HMO DRG,6435,,140% x Medicaid HMO amount,6435,Other,140% of NY Medicaid HMO DRG,10341,,225% x Medicaid HMO amount,10341,Other,225% of NY Medicaid HMO DRG,12640,,275% x Medicaid HMO amount,12640,Other,275% of NY Medicaid HMO DRG,14892,,324% x Medicaid HMO amount,14892,Other,324% of NY Medicaid HMO DRG,9882,,215% x Medicaid HMO amount,9882,Other,215% of NY Medicaid HMO DRG,9882,,215% x Medicaid HMO amount,9882,Other,215% of NY Medicaid HMO DRG,5745,,125% x Medicaid HMO amount,5745,Other,125% of NY Medicaid HMO DRG,0.01,17943,
Partial thickness burns without skin graft,844-2,APR-DRG,,,,,,,,inpatient,,,185513.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13442,,186% x Medicaid HMO amount,13442,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29392,,"27,634 x DRG Weight",29392,Other,DRG Base Rate x DRG Weight,24982,,"23,488 x DRG Weight",24982,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7227.21,,DRG base rate x DRG weight + capital per discharge,7227.21,Other,100% of NY Medicaid HMO DRG,7227,,DRG base rate x DRG weight + capital per discharge,7227,Other,100% of NY Medicaid HMO DRG,7227,,DRG base rate x DRG weight + capital per discharge,7227,Other,100% of NY Medicaid HMO DRG,7227,,DRG base rate x DRG weight + capital per discharge,7227,Other,100% of NY Medicaid HMO DRG,16261,,225% x Medicaid HMO amount,16261,Other,225% of NY Medicaid HMO DRG,11058,,153% x Medicaid HMO amount,11058,Other,153% of NY Medicaid HMO DRG,16261,,225% x Medicaid HMO amount,16261,Other,225% of NY Medicaid HMO DRG,10118,,140% x Medicaid HMO amount,10118,Other,140% of NY Medicaid HMO DRG,16261,,225% x Medicaid HMO amount,16261,Other,225% of NY Medicaid HMO DRG,19875,,275% x Medicaid HMO amount,19875,Other,275% of NY Medicaid HMO DRG,23416,,324% x Medicaid HMO amount,23416,Other,324% of NY Medicaid HMO DRG,15539,,215% x Medicaid HMO amount,15539,Other,215% of NY Medicaid HMO DRG,15539,,215% x Medicaid HMO amount,15539,Other,215% of NY Medicaid HMO DRG,9034,,125% x Medicaid HMO amount,9034,Other,125% of NY Medicaid HMO DRG,0.01,29392,
Partial thickness burns without skin graft,844-3,APR-DRG,,,,,,,,inpatient,,,395848.34,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23109,,186% x Medicaid HMO amount,23109,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,52010,,"27,634 x DRG Weight",52010,Other,DRG Base Rate x DRG Weight,44207,,"23,488 x DRG Weight",44207,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12424.21,,DRG base rate x DRG weight + capital per discharge,12424.21,Other,100% of NY Medicaid HMO DRG,12424,,DRG base rate x DRG weight + capital per discharge,12424,Other,100% of NY Medicaid HMO DRG,12424,,DRG base rate x DRG weight + capital per discharge,12424,Other,100% of NY Medicaid HMO DRG,12424,,DRG base rate x DRG weight + capital per discharge,12424,Other,100% of NY Medicaid HMO DRG,27954,,225% x Medicaid HMO amount,27954,Other,225% of NY Medicaid HMO DRG,19009,,153% x Medicaid HMO amount,19009,Other,153% of NY Medicaid HMO DRG,27954,,225% x Medicaid HMO amount,27954,Other,225% of NY Medicaid HMO DRG,17394,,140% x Medicaid HMO amount,17394,Other,140% of NY Medicaid HMO DRG,27954,,225% x Medicaid HMO amount,27954,Other,225% of NY Medicaid HMO DRG,34167,,275% x Medicaid HMO amount,34167,Other,275% of NY Medicaid HMO DRG,40254,,324% x Medicaid HMO amount,40254,Other,324% of NY Medicaid HMO DRG,26712,,215% x Medicaid HMO amount,26712,Other,215% of NY Medicaid HMO DRG,26712,,215% x Medicaid HMO amount,26712,Other,215% of NY Medicaid HMO DRG,15530,,125% x Medicaid HMO amount,15530,Other,125% of NY Medicaid HMO DRG,0.01,52010,
Partial thickness burns without skin graft,844-4,APR-DRG,,,,,,,,inpatient,,,955048.21,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60876,,186% x Medicaid HMO amount,60876,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,140372,,"27,634 x DRG Weight",140372,Other,DRG Base Rate x DRG Weight,119312,,"23,488 x DRG Weight",119312,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32729.21,,DRG base rate x DRG weight + capital per discharge,32729.21,Other,100% of NY Medicaid HMO DRG,32729,,DRG base rate x DRG weight + capital per discharge,32729,Other,100% of NY Medicaid HMO DRG,32729,,DRG base rate x DRG weight + capital per discharge,32729,Other,100% of NY Medicaid HMO DRG,32729,,DRG base rate x DRG weight + capital per discharge,32729,Other,100% of NY Medicaid HMO DRG,73641,,225% x Medicaid HMO amount,73641,Other,225% of NY Medicaid HMO DRG,50076,,153% x Medicaid HMO amount,50076,Other,153% of NY Medicaid HMO DRG,73641,,225% x Medicaid HMO amount,73641,Other,225% of NY Medicaid HMO DRG,45821,,140% x Medicaid HMO amount,45821,Other,140% of NY Medicaid HMO DRG,73641,,225% x Medicaid HMO amount,73641,Other,225% of NY Medicaid HMO DRG,90005,,275% x Medicaid HMO amount,90005,Other,275% of NY Medicaid HMO DRG,106043,,324% x Medicaid HMO amount,106043,Other,324% of NY Medicaid HMO DRG,70368,,215% x Medicaid HMO amount,70368,Other,215% of NY Medicaid HMO DRG,70368,,215% x Medicaid HMO amount,70368,Other,215% of NY Medicaid HMO DRG,40912,,125% x Medicaid HMO amount,40912,Other,125% of NY Medicaid HMO DRG,0.01,140372,
"Procedure w diag of rehab, aftercare or oth contact w health service",850-1,APR-DRG,,,,,,,,inpatient,,,137324.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9560,,"1,912.23 x patient days",9560,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13415,,"2,683 x patient days",13415,Per diem,,11405,,"2,281 x patient days",11405,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,7864,,"1,572.96 x patient days",7864,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,7196,,"1,439.31 x patient days",7196,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,14135,,"2,827.22 x patient days",14135,Per diem,,16654,,"3,330.98 x patient days",16654,Per diem,,11051,,"2,210.37 x patient days",11051,Per diem,,11051,,"2,210.37 x patient days",11051,Per diem,,6425,,"1,285.10 x patient days",6425,Per diem,,0.01,16654,
"Procedure w diag of rehab, aftercare or oth contact w health service",850-2,APR-DRG,,,,,,,,inpatient,,,301169.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9560,,"1,912.23 x patient days",9560,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13415,,"2,683 x patient days",13415,Per diem,,11405,,"2,281 x patient days",11405,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,7864,,"1,572.96 x patient days",7864,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,7196,,"1,439.31 x patient days",7196,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,14135,,"2,827.22 x patient days",14135,Per diem,,16654,,"3,330.98 x patient days",16654,Per diem,,11051,,"2,210.37 x patient days",11051,Per diem,,11051,,"2,210.37 x patient days",11051,Per diem,,6425,,"1,285.10 x patient days",6425,Per diem,,0.01,16654,
"Procedure w diag of rehab, aftercare or oth contact w health service",850-3,APR-DRG,,,,,,,,inpatient,,,530193.7,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9560,,"1,912.23 x patient days",9560,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13415,,"2,683 x patient days",13415,Per diem,,11405,,"2,281 x patient days",11405,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,7864,,"1,572.96 x patient days",7864,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,7196,,"1,439.31 x patient days",7196,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,14135,,"2,827.22 x patient days",14135,Per diem,,16654,,"3,330.98 x patient days",16654,Per diem,,11051,,"2,210.37 x patient days",11051,Per diem,,11051,,"2,210.37 x patient days",11051,Per diem,,6425,,"1,285.10 x patient days",6425,Per diem,,0.01,16654,
"Procedure w diag of rehab, aftercare or oth contact w health service",850-4,APR-DRG,,,,,,,,inpatient,,,83883.28,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9560,,"1,912.23 x patient days",9560,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13415,,"2,683 x patient days",13415,Per diem,,11405,,"2,281 x patient days",11405,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,5140,,"1,028.08 x patient days",5140,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,7864,,"1,572.96 x patient days",7864,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,7196,,"1,439.31 x patient days",7196,Per diem,,11565,,"2,313.18 x patient days",11565,Per diem,,14135,,"2,827.22 x patient days",14135,Per diem,,16654,,"3,330.98 x patient days",16654,Per diem,,11051,,"2,210.37 x patient days",11051,Per diem,,11051,,"2,210.37 x patient days",11051,Per diem,,6425,,"1,285.10 x patient days",6425,Per diem,,0.01,16654,
Rehabilitation,860-1,APR-DRG,,,,,,,,inpatient,,,123632.66,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30595,,"1,912.23 x patient days",30595,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42928,,"2,683 x patient days",42928,Per diem,,36496,,"2,281 x patient days",36496,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,25167,,"1,572.96 x patient days",25167,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,23029,,"1,439.31 x patient days",23029,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,45235,,"2,827.22 x patient days",45235,Per diem,,53295,,"3,330.98 x patient days",53295,Per diem,,35365,,"2,210.37 x patient days",35365,Per diem,,35365,,"2,210.37 x patient days",35365,Per diem,,20561,,"1,285.10 x patient days",20561,Per diem,,0.01,53295,
Rehabilitation,860-2,APR-DRG,,,,,,,,inpatient,,,147364.47,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30595,,"1,912.23 x patient days",30595,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42928,,"2,683 x patient days",42928,Per diem,,36496,,"2,281 x patient days",36496,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,25167,,"1,572.96 x patient days",25167,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,23029,,"1,439.31 x patient days",23029,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,45235,,"2,827.22 x patient days",45235,Per diem,,53295,,"3,330.98 x patient days",53295,Per diem,,35365,,"2,210.37 x patient days",35365,Per diem,,35365,,"2,210.37 x patient days",35365,Per diem,,20561,,"1,285.10 x patient days",20561,Per diem,,0.01,53295,
Rehabilitation,860-3,APR-DRG,,,,,,,,inpatient,,,194966.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30595,,"1,912.23 x patient days",30595,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42928,,"2,683 x patient days",42928,Per diem,,36496,,"2,281 x patient days",36496,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,25167,,"1,572.96 x patient days",25167,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,23029,,"1,439.31 x patient days",23029,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,45235,,"2,827.22 x patient days",45235,Per diem,,53295,,"3,330.98 x patient days",53295,Per diem,,35365,,"2,210.37 x patient days",35365,Per diem,,35365,,"2,210.37 x patient days",35365,Per diem,,20561,,"1,285.10 x patient days",20561,Per diem,,0.01,53295,
Rehabilitation,860-4,APR-DRG,,,,,,,,inpatient,,,318384,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30595,,"1,912.23 x patient days",30595,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,42928,,"2,683 x patient days",42928,Per diem,,36496,,"2,281 x patient days",36496,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,16449,,"1,028.08 x patient days",16449,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,25167,,"1,572.96 x patient days",25167,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,23029,,"1,439.31 x patient days",23029,Per diem,,37010,,"2,313.18 x patient days",37010,Per diem,,45235,,"2,827.22 x patient days",45235,Per diem,,53295,,"3,330.98 x patient days",53295,Per diem,,35365,,"2,210.37 x patient days",35365,Per diem,,35365,,"2,210.37 x patient days",35365,Per diem,,20561,,"1,285.10 x patient days",20561,Per diem,,0.01,53295,
"Signs, symptoms & other factors influencing health status",861-1,APR-DRG,,,,,,,,inpatient,,,66129.84,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6198,,186% x Medicaid HMO amount,6198,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12441,,"27,634 x DRG Weight",12441,Other,DRG Base Rate x DRG Weight,10574,,"23,488 x DRG Weight",10574,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3332.21,,DRG base rate x DRG weight + capital per discharge,3332.21,Other,100% of NY Medicaid HMO DRG,3332,,DRG base rate x DRG weight + capital per discharge,3332,Other,100% of NY Medicaid HMO DRG,3332,,DRG base rate x DRG weight + capital per discharge,3332,Other,100% of NY Medicaid HMO DRG,3332,,DRG base rate x DRG weight + capital per discharge,3332,Other,100% of NY Medicaid HMO DRG,7497,,225% x Medicaid HMO amount,7497,Other,225% of NY Medicaid HMO DRG,5098,,153% x Medicaid HMO amount,5098,Other,153% of NY Medicaid HMO DRG,7497,,225% x Medicaid HMO amount,7497,Other,225% of NY Medicaid HMO DRG,4665,,140% x Medicaid HMO amount,4665,Other,140% of NY Medicaid HMO DRG,7497,,225% x Medicaid HMO amount,7497,Other,225% of NY Medicaid HMO DRG,9164,,275% x Medicaid HMO amount,9164,Other,275% of NY Medicaid HMO DRG,10796,,324% x Medicaid HMO amount,10796,Other,324% of NY Medicaid HMO DRG,7164,,215% x Medicaid HMO amount,7164,Other,215% of NY Medicaid HMO DRG,7164,,215% x Medicaid HMO amount,7164,Other,215% of NY Medicaid HMO DRG,4165,,125% x Medicaid HMO amount,4165,Other,125% of NY Medicaid HMO DRG,0.01,12441,
"Signs, symptoms & other factors influencing health status",861-2,APR-DRG,,,,,,,,inpatient,,,119714.86,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8324,,186% x Medicaid HMO amount,8324,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17418,,"27,634 x DRG Weight",17418,Other,DRG Base Rate x DRG Weight,14804,,"23,488 x DRG Weight",14804,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4475.21,,DRG base rate x DRG weight + capital per discharge,4475.21,Other,100% of NY Medicaid HMO DRG,4475,,DRG base rate x DRG weight + capital per discharge,4475,Other,100% of NY Medicaid HMO DRG,4475,,DRG base rate x DRG weight + capital per discharge,4475,Other,100% of NY Medicaid HMO DRG,4475,,DRG base rate x DRG weight + capital per discharge,4475,Other,100% of NY Medicaid HMO DRG,10069,,225% x Medicaid HMO amount,10069,Other,225% of NY Medicaid HMO DRG,6847,,153% x Medicaid HMO amount,6847,Other,153% of NY Medicaid HMO DRG,10069,,225% x Medicaid HMO amount,10069,Other,225% of NY Medicaid HMO DRG,6265,,140% x Medicaid HMO amount,6265,Other,140% of NY Medicaid HMO DRG,10069,,225% x Medicaid HMO amount,10069,Other,225% of NY Medicaid HMO DRG,12307,,275% x Medicaid HMO amount,12307,Other,275% of NY Medicaid HMO DRG,14500,,324% x Medicaid HMO amount,14500,Other,324% of NY Medicaid HMO DRG,9622,,215% x Medicaid HMO amount,9622,Other,215% of NY Medicaid HMO DRG,9622,,215% x Medicaid HMO amount,9622,Other,215% of NY Medicaid HMO DRG,5594,,125% x Medicaid HMO amount,5594,Other,125% of NY Medicaid HMO DRG,0.01,17418,
"Signs, symptoms & other factors influencing health status",861-3,APR-DRG,,,,,,,,inpatient,,,152104.95,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13373,,186% x Medicaid HMO amount,13373,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29231,,"27,634 x DRG Weight",29231,Other,DRG Base Rate x DRG Weight,24846,,"23,488 x DRG Weight",24846,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7190.21,,DRG base rate x DRG weight + capital per discharge,7190.21,Other,100% of NY Medicaid HMO DRG,7190,,DRG base rate x DRG weight + capital per discharge,7190,Other,100% of NY Medicaid HMO DRG,7190,,DRG base rate x DRG weight + capital per discharge,7190,Other,100% of NY Medicaid HMO DRG,7190,,DRG base rate x DRG weight + capital per discharge,7190,Other,100% of NY Medicaid HMO DRG,16178,,225% x Medicaid HMO amount,16178,Other,225% of NY Medicaid HMO DRG,11001,,153% x Medicaid HMO amount,11001,Other,153% of NY Medicaid HMO DRG,16178,,225% x Medicaid HMO amount,16178,Other,225% of NY Medicaid HMO DRG,10066,,140% x Medicaid HMO amount,10066,Other,140% of NY Medicaid HMO DRG,16178,,225% x Medicaid HMO amount,16178,Other,225% of NY Medicaid HMO DRG,19773,,275% x Medicaid HMO amount,19773,Other,275% of NY Medicaid HMO DRG,23296,,324% x Medicaid HMO amount,23296,Other,324% of NY Medicaid HMO DRG,15459,,215% x Medicaid HMO amount,15459,Other,215% of NY Medicaid HMO DRG,15459,,215% x Medicaid HMO amount,15459,Other,215% of NY Medicaid HMO DRG,8988,,125% x Medicaid HMO amount,8988,Other,125% of NY Medicaid HMO DRG,0.01,29231,
"Signs, symptoms & other factors influencing health status",861-4,APR-DRG,,,,,,,,inpatient,,,398249,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25568,,186% x Medicaid HMO amount,25568,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,57761,,"27,634 x DRG Weight",57761,Other,DRG Base Rate x DRG Weight,49095,,"23,488 x DRG Weight",49095,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,13746.21,,DRG base rate x DRG weight + capital per discharge,13746.21,Other,100% of NY Medicaid HMO DRG,13746,,DRG base rate x DRG weight + capital per discharge,13746,Other,100% of NY Medicaid HMO DRG,13746,,DRG base rate x DRG weight + capital per discharge,13746,Other,100% of NY Medicaid HMO DRG,13746,,DRG base rate x DRG weight + capital per discharge,13746,Other,100% of NY Medicaid HMO DRG,30929,,225% x Medicaid HMO amount,30929,Other,225% of NY Medicaid HMO DRG,21032,,153% x Medicaid HMO amount,21032,Other,153% of NY Medicaid HMO DRG,30929,,225% x Medicaid HMO amount,30929,Other,225% of NY Medicaid HMO DRG,19245,,140% x Medicaid HMO amount,19245,Other,140% of NY Medicaid HMO DRG,30929,,225% x Medicaid HMO amount,30929,Other,225% of NY Medicaid HMO DRG,37802,,275% x Medicaid HMO amount,37802,Other,275% of NY Medicaid HMO DRG,44538,,324% x Medicaid HMO amount,44538,Other,324% of NY Medicaid HMO DRG,29554,,215% x Medicaid HMO amount,29554,Other,215% of NY Medicaid HMO DRG,29554,,215% x Medicaid HMO amount,29554,Other,215% of NY Medicaid HMO DRG,17183,,125% x Medicaid HMO amount,17183,Other,125% of NY Medicaid HMO DRG,0.01,57761,
Other aftercare & convalescence,862-1,APR-DRG,,,,,,,,inpatient,,,69762.46,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5736,,"1,912.23 x patient days",5736,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8049,,"2,683 x patient days",8049,Per diem,,6843,,"2,281 x patient days",6843,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,4719,,"1,572.96 x patient days",4719,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,4318,,"1,439.31 x patient days",4318,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,8481,,"2,827.22 x patient days",8481,Per diem,,9992,,"3,330.98 x patient days",9992,Per diem,,6631,,"2,210.37 x patient days",6631,Per diem,,6631,,"2,210.37 x patient days",6631,Per diem,,3855,,"1,285.10 x patient days",3855,Per diem,,0.01,9992,
Other aftercare & convalescence,862-2,APR-DRG,,,,,,,,inpatient,,,101967.93,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5736,,"1,912.23 x patient days",5736,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8049,,"2,683 x patient days",8049,Per diem,,6843,,"2,281 x patient days",6843,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,4719,,"1,572.96 x patient days",4719,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,4318,,"1,439.31 x patient days",4318,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,8481,,"2,827.22 x patient days",8481,Per diem,,9992,,"3,330.98 x patient days",9992,Per diem,,6631,,"2,210.37 x patient days",6631,Per diem,,6631,,"2,210.37 x patient days",6631,Per diem,,3855,,"1,285.10 x patient days",3855,Per diem,,0.01,9992,
Other aftercare & convalescence,862-3,APR-DRG,,,,,,,,inpatient,,,100262,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5736,,"1,912.23 x patient days",5736,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8049,,"2,683 x patient days",8049,Per diem,,6843,,"2,281 x patient days",6843,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,4719,,"1,572.96 x patient days",4719,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,4318,,"1,439.31 x patient days",4318,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,8481,,"2,827.22 x patient days",8481,Per diem,,9992,,"3,330.98 x patient days",9992,Per diem,,6631,,"2,210.37 x patient days",6631,Per diem,,6631,,"2,210.37 x patient days",6631,Per diem,,3855,,"1,285.10 x patient days",3855,Per diem,,0.01,9992,
Other aftercare & convalescence,862-4,APR-DRG,,,,,,,,inpatient,,,336749,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5736,,"1,912.23 x patient days",5736,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8049,,"2,683 x patient days",8049,Per diem,,6843,,"2,281 x patient days",6843,Per diem,,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,3084,,"1,028.08 x patient days",3084,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,4719,,"1,572.96 x patient days",4719,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,4318,,"1,439.31 x patient days",4318,Per diem,,6939,,"2,313.18 x patient days",6939,Per diem,,8481,,"2,827.22 x patient days",8481,Per diem,,9992,,"3,330.98 x patient days",9992,Per diem,,6631,,"2,210.37 x patient days",6631,Per diem,,6631,,"2,210.37 x patient days",6631,Per diem,,3855,,"1,285.10 x patient days",3855,Per diem,,0.01,9992,
Neonatal aftercare,863-1,APR-DRG,,,,,,,,inpatient,,,54897,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11634,,186% x Medicaid HMO amount,11634,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25161,,"27,634 x DRG Weight",25161,Other,DRG Base Rate x DRG Weight,21386,,"23,488 x DRG Weight",21386,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6255.21,,DRG base rate x DRG weight + capital per discharge,6255.21,Other,100% of NY Medicaid HMO DRG,6255,,DRG base rate x DRG weight + capital per discharge,6255,Other,100% of NY Medicaid HMO DRG,6255,,DRG base rate x DRG weight + capital per discharge,6255,Other,100% of NY Medicaid HMO DRG,6255,,DRG base rate x DRG weight + capital per discharge,6255,Other,100% of NY Medicaid HMO DRG,14074,,225% x Medicaid HMO amount,14074,Other,225% of NY Medicaid HMO DRG,9570,,153% x Medicaid HMO amount,9570,Other,153% of NY Medicaid HMO DRG,14074,,225% x Medicaid HMO amount,14074,Other,225% of NY Medicaid HMO DRG,8757,,140% x Medicaid HMO amount,8757,Other,140% of NY Medicaid HMO DRG,14074,,225% x Medicaid HMO amount,14074,Other,225% of NY Medicaid HMO DRG,17202,,275% x Medicaid HMO amount,17202,Other,275% of NY Medicaid HMO DRG,20267,,324% x Medicaid HMO amount,20267,Other,324% of NY Medicaid HMO DRG,13449,,215% x Medicaid HMO amount,13449,Other,215% of NY Medicaid HMO DRG,13449,,215% x Medicaid HMO amount,13449,Other,215% of NY Medicaid HMO DRG,7819,,125% x Medicaid HMO amount,7819,Other,125% of NY Medicaid HMO DRG,0.01,25161,
Neonatal aftercare,863-2,APR-DRG,,,,,,,,inpatient,,,54897,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26736,,186% x Medicaid HMO amount,26736,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,60496,,"27,634 x DRG Weight",60496,Other,DRG Base Rate x DRG Weight,51420,,"23,488 x DRG Weight",51420,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14374.21,,DRG base rate x DRG weight + capital per discharge,14374.21,Other,100% of NY Medicaid HMO DRG,14374,,DRG base rate x DRG weight + capital per discharge,14374,Other,100% of NY Medicaid HMO DRG,14374,,DRG base rate x DRG weight + capital per discharge,14374,Other,100% of NY Medicaid HMO DRG,14374,,DRG base rate x DRG weight + capital per discharge,14374,Other,100% of NY Medicaid HMO DRG,32342,,225% x Medicaid HMO amount,32342,Other,225% of NY Medicaid HMO DRG,21993,,153% x Medicaid HMO amount,21993,Other,153% of NY Medicaid HMO DRG,32342,,225% x Medicaid HMO amount,32342,Other,225% of NY Medicaid HMO DRG,20124,,140% x Medicaid HMO amount,20124,Other,140% of NY Medicaid HMO DRG,32342,,225% x Medicaid HMO amount,32342,Other,225% of NY Medicaid HMO DRG,39529,,275% x Medicaid HMO amount,39529,Other,275% of NY Medicaid HMO DRG,46572,,324% x Medicaid HMO amount,46572,Other,324% of NY Medicaid HMO DRG,30905,,215% x Medicaid HMO amount,30905,Other,215% of NY Medicaid HMO DRG,30905,,215% x Medicaid HMO amount,30905,Other,215% of NY Medicaid HMO DRG,17968,,125% x Medicaid HMO amount,17968,Other,125% of NY Medicaid HMO DRG,0.01,60496,
Neonatal aftercare,863-3,APR-DRG,,,,,,,,inpatient,,,1325617.15,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,49913,,186% x Medicaid HMO amount,49913,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,114723,,"27,634 x DRG Weight",114723,Other,DRG Base Rate x DRG Weight,97510,,"23,488 x DRG Weight",97510,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26835.21,,DRG base rate x DRG weight + capital per discharge,26835.21,Other,100% of NY Medicaid HMO DRG,26835,,DRG base rate x DRG weight + capital per discharge,26835,Other,100% of NY Medicaid HMO DRG,26835,,DRG base rate x DRG weight + capital per discharge,26835,Other,100% of NY Medicaid HMO DRG,26835,,DRG base rate x DRG weight + capital per discharge,26835,Other,100% of NY Medicaid HMO DRG,60379,,225% x Medicaid HMO amount,60379,Other,225% of NY Medicaid HMO DRG,41058,,153% x Medicaid HMO amount,41058,Other,153% of NY Medicaid HMO DRG,60379,,225% x Medicaid HMO amount,60379,Other,225% of NY Medicaid HMO DRG,37569,,140% x Medicaid HMO amount,37569,Other,140% of NY Medicaid HMO DRG,60379,,225% x Medicaid HMO amount,60379,Other,225% of NY Medicaid HMO DRG,73797,,275% x Medicaid HMO amount,73797,Other,275% of NY Medicaid HMO DRG,86946,,324% x Medicaid HMO amount,86946,Other,324% of NY Medicaid HMO DRG,57696,,215% x Medicaid HMO amount,57696,Other,215% of NY Medicaid HMO DRG,57696,,215% x Medicaid HMO amount,57696,Other,215% of NY Medicaid HMO DRG,33544,,125% x Medicaid HMO amount,33544,Other,125% of NY Medicaid HMO DRG,0.01,114723,
Neonatal aftercare,863-4,APR-DRG,,,,,,,,inpatient,,,160075,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,63467,,186% x Medicaid HMO amount,63467,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,146433,,"27,634 x DRG Weight",146433,Other,DRG Base Rate x DRG Weight,124463,,"23,488 x DRG Weight",124463,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,34122.21,,DRG base rate x DRG weight + capital per discharge,34122.21,Other,100% of NY Medicaid HMO DRG,34122,,DRG base rate x DRG weight + capital per discharge,34122,Other,100% of NY Medicaid HMO DRG,34122,,DRG base rate x DRG weight + capital per discharge,34122,Other,100% of NY Medicaid HMO DRG,34122,,DRG base rate x DRG weight + capital per discharge,34122,Other,100% of NY Medicaid HMO DRG,76775,,225% x Medicaid HMO amount,76775,Other,225% of NY Medicaid HMO DRG,52207,,153% x Medicaid HMO amount,52207,Other,153% of NY Medicaid HMO DRG,76775,,225% x Medicaid HMO amount,76775,Other,225% of NY Medicaid HMO DRG,47771,,140% x Medicaid HMO amount,47771,Other,140% of NY Medicaid HMO DRG,76775,,225% x Medicaid HMO amount,76775,Other,225% of NY Medicaid HMO DRG,93836,,275% x Medicaid HMO amount,93836,Other,275% of NY Medicaid HMO DRG,110556,,324% x Medicaid HMO amount,110556,Other,324% of NY Medicaid HMO DRG,73363,,215% x Medicaid HMO amount,73363,Other,215% of NY Medicaid HMO DRG,73363,,215% x Medicaid HMO amount,73363,Other,215% of NY Medicaid HMO DRG,42653,,125% x Medicaid HMO amount,42653,Other,125% of NY Medicaid HMO DRG,0.01,146433,
HIV w multiple major HIV related conditions,890-1,APR-DRG,,,,,,,,inpatient,,,160075,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14032,,186% x Medicaid HMO amount,14032,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30770,,"27,634 x DRG Weight",30770,Other,DRG Base Rate x DRG Weight,26154,,"23,488 x DRG Weight",26154,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7544.21,,DRG base rate x DRG weight + capital per discharge,7544.21,Other,100% of NY Medicaid HMO DRG,7544,,DRG base rate x DRG weight + capital per discharge,7544,Other,100% of NY Medicaid HMO DRG,7544,,DRG base rate x DRG weight + capital per discharge,7544,Other,100% of NY Medicaid HMO DRG,7544,,DRG base rate x DRG weight + capital per discharge,7544,Other,100% of NY Medicaid HMO DRG,16974,,225% x Medicaid HMO amount,16974,Other,225% of NY Medicaid HMO DRG,11543,,153% x Medicaid HMO amount,11543,Other,153% of NY Medicaid HMO DRG,16974,,225% x Medicaid HMO amount,16974,Other,225% of NY Medicaid HMO DRG,10562,,140% x Medicaid HMO amount,10562,Other,140% of NY Medicaid HMO DRG,16974,,225% x Medicaid HMO amount,16974,Other,225% of NY Medicaid HMO DRG,20747,,275% x Medicaid HMO amount,20747,Other,275% of NY Medicaid HMO DRG,24443,,324% x Medicaid HMO amount,24443,Other,324% of NY Medicaid HMO DRG,16220,,215% x Medicaid HMO amount,16220,Other,215% of NY Medicaid HMO DRG,16220,,215% x Medicaid HMO amount,16220,Other,215% of NY Medicaid HMO DRG,9430,,125% x Medicaid HMO amount,9430,Other,125% of NY Medicaid HMO DRG,0.01,30770,
HIV w multiple major HIV related conditions,890-2,APR-DRG,,,,,,,,inpatient,,,160075,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14050,,186% x Medicaid HMO amount,14050,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,30815,,"27,634 x DRG Weight",30815,Other,DRG Base Rate x DRG Weight,26191,,"23,488 x DRG Weight",26191,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7554.21,,DRG base rate x DRG weight + capital per discharge,7554.21,Other,100% of NY Medicaid HMO DRG,7554,,DRG base rate x DRG weight + capital per discharge,7554,Other,100% of NY Medicaid HMO DRG,7554,,DRG base rate x DRG weight + capital per discharge,7554,Other,100% of NY Medicaid HMO DRG,7554,,DRG base rate x DRG weight + capital per discharge,7554,Other,100% of NY Medicaid HMO DRG,16997,,225% x Medicaid HMO amount,16997,Other,225% of NY Medicaid HMO DRG,11558,,153% x Medicaid HMO amount,11558,Other,153% of NY Medicaid HMO DRG,16997,,225% x Medicaid HMO amount,16997,Other,225% of NY Medicaid HMO DRG,10576,,140% x Medicaid HMO amount,10576,Other,140% of NY Medicaid HMO DRG,16997,,225% x Medicaid HMO amount,16997,Other,225% of NY Medicaid HMO DRG,20774,,275% x Medicaid HMO amount,20774,Other,275% of NY Medicaid HMO DRG,24476,,324% x Medicaid HMO amount,24476,Other,324% of NY Medicaid HMO DRG,16242,,215% x Medicaid HMO amount,16242,Other,215% of NY Medicaid HMO DRG,16242,,215% x Medicaid HMO amount,16242,Other,215% of NY Medicaid HMO DRG,9443,,125% x Medicaid HMO amount,9443,Other,125% of NY Medicaid HMO DRG,0.01,30815,
HIV w multiple major HIV related conditions,890-3,APR-DRG,,,,,,,,inpatient,,,192976.57,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23628,,186% x Medicaid HMO amount,23628,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,53223,,"27,634 x DRG Weight",53223,Other,DRG Base Rate x DRG Weight,45238,,"23,488 x DRG Weight",45238,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12703.21,,DRG base rate x DRG weight + capital per discharge,12703.21,Other,100% of NY Medicaid HMO DRG,12703,,DRG base rate x DRG weight + capital per discharge,12703,Other,100% of NY Medicaid HMO DRG,12703,,DRG base rate x DRG weight + capital per discharge,12703,Other,100% of NY Medicaid HMO DRG,12703,,DRG base rate x DRG weight + capital per discharge,12703,Other,100% of NY Medicaid HMO DRG,28582,,225% x Medicaid HMO amount,28582,Other,225% of NY Medicaid HMO DRG,19436,,153% x Medicaid HMO amount,19436,Other,153% of NY Medicaid HMO DRG,28582,,225% x Medicaid HMO amount,28582,Other,225% of NY Medicaid HMO DRG,17784,,140% x Medicaid HMO amount,17784,Other,140% of NY Medicaid HMO DRG,28582,,225% x Medicaid HMO amount,28582,Other,225% of NY Medicaid HMO DRG,34934,,275% x Medicaid HMO amount,34934,Other,275% of NY Medicaid HMO DRG,41158,,324% x Medicaid HMO amount,41158,Other,324% of NY Medicaid HMO DRG,27312,,215% x Medicaid HMO amount,27312,Other,215% of NY Medicaid HMO DRG,27312,,215% x Medicaid HMO amount,27312,Other,215% of NY Medicaid HMO DRG,15879,,125% x Medicaid HMO amount,15879,Other,125% of NY Medicaid HMO DRG,0.01,53223,
HIV w multiple major HIV related conditions,890-4,APR-DRG,,,,,,,,inpatient,,,1536016.66,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45602,,186% x Medicaid HMO amount,45602,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,104636,,"27,634 x DRG Weight",104636,Other,DRG Base Rate x DRG Weight,88937,,"23,488 x DRG Weight",88937,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24517.21,,DRG base rate x DRG weight + capital per discharge,24517.21,Other,100% of NY Medicaid HMO DRG,24517,,DRG base rate x DRG weight + capital per discharge,24517,Other,100% of NY Medicaid HMO DRG,24517,,DRG base rate x DRG weight + capital per discharge,24517,Other,100% of NY Medicaid HMO DRG,24517,,DRG base rate x DRG weight + capital per discharge,24517,Other,100% of NY Medicaid HMO DRG,55164,,225% x Medicaid HMO amount,55164,Other,225% of NY Medicaid HMO DRG,37511,,153% x Medicaid HMO amount,37511,Other,153% of NY Medicaid HMO DRG,55164,,225% x Medicaid HMO amount,55164,Other,225% of NY Medicaid HMO DRG,34324,,140% x Medicaid HMO amount,34324,Other,140% of NY Medicaid HMO DRG,55164,,225% x Medicaid HMO amount,55164,Other,225% of NY Medicaid HMO DRG,67422,,275% x Medicaid HMO amount,67422,Other,275% of NY Medicaid HMO DRG,79436,,324% x Medicaid HMO amount,79436,Other,324% of NY Medicaid HMO DRG,52712,,215% x Medicaid HMO amount,52712,Other,215% of NY Medicaid HMO DRG,52712,,215% x Medicaid HMO amount,52712,Other,215% of NY Medicaid HMO DRG,30647,,125% x Medicaid HMO amount,30647,Other,125% of NY Medicaid HMO DRG,0.01,104636,
HIV w major HIV related condition,892-1,APR-DRG,,,,,,,,inpatient,,,136575.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9386,,186% x Medicaid HMO amount,9386,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19899,,"27,634 x DRG Weight",19899,Other,DRG Base Rate x DRG Weight,16914,,"23,488 x DRG Weight",16914,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5046.21,,DRG base rate x DRG weight + capital per discharge,5046.21,Other,100% of NY Medicaid HMO DRG,5046,,DRG base rate x DRG weight + capital per discharge,5046,Other,100% of NY Medicaid HMO DRG,5046,,DRG base rate x DRG weight + capital per discharge,5046,Other,100% of NY Medicaid HMO DRG,5046,,DRG base rate x DRG weight + capital per discharge,5046,Other,100% of NY Medicaid HMO DRG,11354,,225% x Medicaid HMO amount,11354,Other,225% of NY Medicaid HMO DRG,7721,,153% x Medicaid HMO amount,7721,Other,153% of NY Medicaid HMO DRG,11354,,225% x Medicaid HMO amount,11354,Other,225% of NY Medicaid HMO DRG,7065,,140% x Medicaid HMO amount,7065,Other,140% of NY Medicaid HMO DRG,11354,,225% x Medicaid HMO amount,11354,Other,225% of NY Medicaid HMO DRG,13877,,275% x Medicaid HMO amount,13877,Other,275% of NY Medicaid HMO DRG,16350,,324% x Medicaid HMO amount,16350,Other,324% of NY Medicaid HMO DRG,10849,,215% x Medicaid HMO amount,10849,Other,215% of NY Medicaid HMO DRG,10849,,215% x Medicaid HMO amount,10849,Other,215% of NY Medicaid HMO DRG,6308,,125% x Medicaid HMO amount,6308,Other,125% of NY Medicaid HMO DRG,0.01,19899,
HIV w major HIV related condition,892-2,APR-DRG,,,,,,,,inpatient,,,136575.41,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11900,,186% x Medicaid HMO amount,11900,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25785,,"27,634 x DRG Weight",25785,Other,DRG Base Rate x DRG Weight,21917,,"23,488 x DRG Weight",21917,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6398.21,,DRG base rate x DRG weight + capital per discharge,6398.21,Other,100% of NY Medicaid HMO DRG,6398,,DRG base rate x DRG weight + capital per discharge,6398,Other,100% of NY Medicaid HMO DRG,6398,,DRG base rate x DRG weight + capital per discharge,6398,Other,100% of NY Medicaid HMO DRG,6398,,DRG base rate x DRG weight + capital per discharge,6398,Other,100% of NY Medicaid HMO DRG,14396,,225% x Medicaid HMO amount,14396,Other,225% of NY Medicaid HMO DRG,9789,,153% x Medicaid HMO amount,9789,Other,153% of NY Medicaid HMO DRG,14396,,225% x Medicaid HMO amount,14396,Other,225% of NY Medicaid HMO DRG,8957,,140% x Medicaid HMO amount,8957,Other,140% of NY Medicaid HMO DRG,14396,,225% x Medicaid HMO amount,14396,Other,225% of NY Medicaid HMO DRG,17595,,275% x Medicaid HMO amount,17595,Other,275% of NY Medicaid HMO DRG,20730,,324% x Medicaid HMO amount,20730,Other,324% of NY Medicaid HMO DRG,13756,,215% x Medicaid HMO amount,13756,Other,215% of NY Medicaid HMO DRG,13756,,215% x Medicaid HMO amount,13756,Other,215% of NY Medicaid HMO DRG,7998,,125% x Medicaid HMO amount,7998,Other,125% of NY Medicaid HMO DRG,0.01,25785,
HIV w major HIV related condition,892-3,APR-DRG,,,,,,,,inpatient,,,238101.74,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16346,,186% x Medicaid HMO amount,16346,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,36187,,"27,634 x DRG Weight",36187,Other,DRG Base Rate x DRG Weight,30758,,"23,488 x DRG Weight",30758,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8788.21,,DRG base rate x DRG weight + capital per discharge,8788.21,Other,100% of NY Medicaid HMO DRG,8788,,DRG base rate x DRG weight + capital per discharge,8788,Other,100% of NY Medicaid HMO DRG,8788,,DRG base rate x DRG weight + capital per discharge,8788,Other,100% of NY Medicaid HMO DRG,8788,,DRG base rate x DRG weight + capital per discharge,8788,Other,100% of NY Medicaid HMO DRG,19773,,225% x Medicaid HMO amount,19773,Other,225% of NY Medicaid HMO DRG,13446,,153% x Medicaid HMO amount,13446,Other,153% of NY Medicaid HMO DRG,19773,,225% x Medicaid HMO amount,19773,Other,225% of NY Medicaid HMO DRG,12303,,140% x Medicaid HMO amount,12303,Other,140% of NY Medicaid HMO DRG,19773,,225% x Medicaid HMO amount,19773,Other,225% of NY Medicaid HMO DRG,24168,,275% x Medicaid HMO amount,24168,Other,275% of NY Medicaid HMO DRG,28474,,324% x Medicaid HMO amount,28474,Other,324% of NY Medicaid HMO DRG,18895,,215% x Medicaid HMO amount,18895,Other,215% of NY Medicaid HMO DRG,18895,,215% x Medicaid HMO amount,18895,Other,215% of NY Medicaid HMO DRG,10985,,125% x Medicaid HMO amount,10985,Other,125% of NY Medicaid HMO DRG,0.01,36187,
HIV w major HIV related condition,892-4,APR-DRG,,,,,,,,inpatient,,,157591.6,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28452,,186% x Medicaid HMO amount,28452,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,64512,,"27,634 x DRG Weight",64512,Other,DRG Base Rate x DRG Weight,54833,,"23,488 x DRG Weight",54833,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15297.21,,DRG base rate x DRG weight + capital per discharge,15297.21,Other,100% of NY Medicaid HMO DRG,15297,,DRG base rate x DRG weight + capital per discharge,15297,Other,100% of NY Medicaid HMO DRG,15297,,DRG base rate x DRG weight + capital per discharge,15297,Other,100% of NY Medicaid HMO DRG,15297,,DRG base rate x DRG weight + capital per discharge,15297,Other,100% of NY Medicaid HMO DRG,34419,,225% x Medicaid HMO amount,34419,Other,225% of NY Medicaid HMO DRG,23405,,153% x Medicaid HMO amount,23405,Other,153% of NY Medicaid HMO DRG,34419,,225% x Medicaid HMO amount,34419,Other,225% of NY Medicaid HMO DRG,21416,,140% x Medicaid HMO amount,21416,Other,140% of NY Medicaid HMO DRG,34419,,225% x Medicaid HMO amount,34419,Other,225% of NY Medicaid HMO DRG,42067,,275% x Medicaid HMO amount,42067,Other,275% of NY Medicaid HMO DRG,49563,,324% x Medicaid HMO amount,49563,Other,324% of NY Medicaid HMO DRG,32889,,215% x Medicaid HMO amount,32889,Other,215% of NY Medicaid HMO DRG,32889,,215% x Medicaid HMO amount,32889,Other,215% of NY Medicaid HMO DRG,19122,,125% x Medicaid HMO amount,19122,Other,125% of NY Medicaid HMO DRG,0.01,64512,
HIV w multiple significant HIV related conditions,893-1,APR-DRG,,,,,,,,inpatient,,,610134.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10120,,186% x Medicaid HMO amount,10120,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21618,,"27,634 x DRG Weight",21618,Other,DRG Base Rate x DRG Weight,18375,,"23,488 x DRG Weight",18375,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5441.21,,DRG base rate x DRG weight + capital per discharge,5441.21,Other,100% of NY Medicaid HMO DRG,5441,,DRG base rate x DRG weight + capital per discharge,5441,Other,100% of NY Medicaid HMO DRG,5441,,DRG base rate x DRG weight + capital per discharge,5441,Other,100% of NY Medicaid HMO DRG,5441,,DRG base rate x DRG weight + capital per discharge,5441,Other,100% of NY Medicaid HMO DRG,12243,,225% x Medicaid HMO amount,12243,Other,225% of NY Medicaid HMO DRG,8325,,153% x Medicaid HMO amount,8325,Other,153% of NY Medicaid HMO DRG,12243,,225% x Medicaid HMO amount,12243,Other,225% of NY Medicaid HMO DRG,7618,,140% x Medicaid HMO amount,7618,Other,140% of NY Medicaid HMO DRG,12243,,225% x Medicaid HMO amount,12243,Other,225% of NY Medicaid HMO DRG,14963,,275% x Medicaid HMO amount,14963,Other,275% of NY Medicaid HMO DRG,17630,,324% x Medicaid HMO amount,17630,Other,324% of NY Medicaid HMO DRG,11699,,215% x Medicaid HMO amount,11699,Other,215% of NY Medicaid HMO DRG,11699,,215% x Medicaid HMO amount,11699,Other,215% of NY Medicaid HMO DRG,6802,,125% x Medicaid HMO amount,6802,Other,125% of NY Medicaid HMO DRG,0.01,21618,
HIV w multiple significant HIV related conditions,893-2,APR-DRG,,,,,,,,inpatient,,,610134.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11798,,186% x Medicaid HMO amount,11798,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25548,,"27,634 x DRG Weight",25548,Other,DRG Base Rate x DRG Weight,21715,,"23,488 x DRG Weight",21715,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6343.21,,DRG base rate x DRG weight + capital per discharge,6343.21,Other,100% of NY Medicaid HMO DRG,6343,,DRG base rate x DRG weight + capital per discharge,6343,Other,100% of NY Medicaid HMO DRG,6343,,DRG base rate x DRG weight + capital per discharge,6343,Other,100% of NY Medicaid HMO DRG,6343,,DRG base rate x DRG weight + capital per discharge,6343,Other,100% of NY Medicaid HMO DRG,14272,,225% x Medicaid HMO amount,14272,Other,225% of NY Medicaid HMO DRG,9705,,153% x Medicaid HMO amount,9705,Other,153% of NY Medicaid HMO DRG,14272,,225% x Medicaid HMO amount,14272,Other,225% of NY Medicaid HMO DRG,8880,,140% x Medicaid HMO amount,8880,Other,140% of NY Medicaid HMO DRG,14272,,225% x Medicaid HMO amount,14272,Other,225% of NY Medicaid HMO DRG,17444,,275% x Medicaid HMO amount,17444,Other,275% of NY Medicaid HMO DRG,20552,,324% x Medicaid HMO amount,20552,Other,324% of NY Medicaid HMO DRG,13638,,215% x Medicaid HMO amount,13638,Other,215% of NY Medicaid HMO DRG,13638,,215% x Medicaid HMO amount,13638,Other,215% of NY Medicaid HMO DRG,7929,,125% x Medicaid HMO amount,7929,Other,125% of NY Medicaid HMO DRG,0.01,25548,
HIV w multiple significant HIV related conditions,893-3,APR-DRG,,,,,,,,inpatient,,,610134.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18035,,186% x Medicaid HMO amount,18035,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40136,,"27,634 x DRG Weight",40136,Other,DRG Base Rate x DRG Weight,34114,,"23,488 x DRG Weight",34114,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9696.21,,DRG base rate x DRG weight + capital per discharge,9696.21,Other,100% of NY Medicaid HMO DRG,9696,,DRG base rate x DRG weight + capital per discharge,9696,Other,100% of NY Medicaid HMO DRG,9696,,DRG base rate x DRG weight + capital per discharge,9696,Other,100% of NY Medicaid HMO DRG,9696,,DRG base rate x DRG weight + capital per discharge,9696,Other,100% of NY Medicaid HMO DRG,21816,,225% x Medicaid HMO amount,21816,Other,225% of NY Medicaid HMO DRG,14835,,153% x Medicaid HMO amount,14835,Other,153% of NY Medicaid HMO DRG,21816,,225% x Medicaid HMO amount,21816,Other,225% of NY Medicaid HMO DRG,13575,,140% x Medicaid HMO amount,13575,Other,140% of NY Medicaid HMO DRG,21816,,225% x Medicaid HMO amount,21816,Other,225% of NY Medicaid HMO DRG,26665,,275% x Medicaid HMO amount,26665,Other,275% of NY Medicaid HMO DRG,31416,,324% x Medicaid HMO amount,31416,Other,324% of NY Medicaid HMO DRG,20847,,215% x Medicaid HMO amount,20847,Other,215% of NY Medicaid HMO DRG,20847,,215% x Medicaid HMO amount,20847,Other,215% of NY Medicaid HMO DRG,12120,,125% x Medicaid HMO amount,12120,Other,125% of NY Medicaid HMO DRG,0.01,40136,
HIV w multiple significant HIV related conditions,893-4,APR-DRG,,,,,,,,inpatient,,,610134.92,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,18377,,186% x Medicaid HMO amount,18377,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40937,,"27,634 x DRG Weight",40937,Other,DRG Base Rate x DRG Weight,34795,,"23,488 x DRG Weight",34795,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9880.21,,DRG base rate x DRG weight + capital per discharge,9880.21,Other,100% of NY Medicaid HMO DRG,9880,,DRG base rate x DRG weight + capital per discharge,9880,Other,100% of NY Medicaid HMO DRG,9880,,DRG base rate x DRG weight + capital per discharge,9880,Other,100% of NY Medicaid HMO DRG,9880,,DRG base rate x DRG weight + capital per discharge,9880,Other,100% of NY Medicaid HMO DRG,22230,,225% x Medicaid HMO amount,22230,Other,225% of NY Medicaid HMO DRG,15117,,153% x Medicaid HMO amount,15117,Other,153% of NY Medicaid HMO DRG,22230,,225% x Medicaid HMO amount,22230,Other,225% of NY Medicaid HMO DRG,13832,,140% x Medicaid HMO amount,13832,Other,140% of NY Medicaid HMO DRG,22230,,225% x Medicaid HMO amount,22230,Other,225% of NY Medicaid HMO DRG,27171,,275% x Medicaid HMO amount,27171,Other,275% of NY Medicaid HMO DRG,32012,,324% x Medicaid HMO amount,32012,Other,324% of NY Medicaid HMO DRG,21242,,215% x Medicaid HMO amount,21242,Other,215% of NY Medicaid HMO DRG,21242,,215% x Medicaid HMO amount,21242,Other,215% of NY Medicaid HMO DRG,12350,,125% x Medicaid HMO amount,12350,Other,125% of NY Medicaid HMO DRG,0.01,40937,
HIV w one signif HIV cond or w/o signif related cond,894-1,APR-DRG,,,,,,,,inpatient,,,79599,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8130,,186% x Medicaid HMO amount,8130,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16962,,"27,634 x DRG Weight",16962,Other,DRG Base Rate x DRG Weight,14417,,"23,488 x DRG Weight",14417,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,4371.21,,DRG base rate x DRG weight + capital per discharge,4371.21,Other,100% of NY Medicaid HMO DRG,4371,,DRG base rate x DRG weight + capital per discharge,4371,Other,100% of NY Medicaid HMO DRG,4371,,DRG base rate x DRG weight + capital per discharge,4371,Other,100% of NY Medicaid HMO DRG,4371,,DRG base rate x DRG weight + capital per discharge,4371,Other,100% of NY Medicaid HMO DRG,9835,,225% x Medicaid HMO amount,9835,Other,225% of NY Medicaid HMO DRG,6688,,153% x Medicaid HMO amount,6688,Other,153% of NY Medicaid HMO DRG,9835,,225% x Medicaid HMO amount,9835,Other,225% of NY Medicaid HMO DRG,6120,,140% x Medicaid HMO amount,6120,Other,140% of NY Medicaid HMO DRG,9835,,225% x Medicaid HMO amount,9835,Other,225% of NY Medicaid HMO DRG,12021,,275% x Medicaid HMO amount,12021,Other,275% of NY Medicaid HMO DRG,14163,,324% x Medicaid HMO amount,14163,Other,324% of NY Medicaid HMO DRG,9398,,215% x Medicaid HMO amount,9398,Other,215% of NY Medicaid HMO DRG,9398,,215% x Medicaid HMO amount,9398,Other,215% of NY Medicaid HMO DRG,5464,,125% x Medicaid HMO amount,5464,Other,125% of NY Medicaid HMO DRG,0.01,16962,
HIV w one signif HIV cond or w/o signif related cond,894-2,APR-DRG,,,,,,,,inpatient,,,108793.55,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9880,,186% x Medicaid HMO amount,9880,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21057,,"27,634 x DRG Weight",21057,Other,DRG Base Rate x DRG Weight,17898,,"23,488 x DRG Weight",17898,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5312.21,,DRG base rate x DRG weight + capital per discharge,5312.21,Other,100% of NY Medicaid HMO DRG,5312,,DRG base rate x DRG weight + capital per discharge,5312,Other,100% of NY Medicaid HMO DRG,5312,,DRG base rate x DRG weight + capital per discharge,5312,Other,100% of NY Medicaid HMO DRG,5312,,DRG base rate x DRG weight + capital per discharge,5312,Other,100% of NY Medicaid HMO DRG,11952,,225% x Medicaid HMO amount,11952,Other,225% of NY Medicaid HMO DRG,8128,,153% x Medicaid HMO amount,8128,Other,153% of NY Medicaid HMO DRG,11952,,225% x Medicaid HMO amount,11952,Other,225% of NY Medicaid HMO DRG,7437,,140% x Medicaid HMO amount,7437,Other,140% of NY Medicaid HMO DRG,11952,,225% x Medicaid HMO amount,11952,Other,225% of NY Medicaid HMO DRG,14609,,275% x Medicaid HMO amount,14609,Other,275% of NY Medicaid HMO DRG,17212,,324% x Medicaid HMO amount,17212,Other,324% of NY Medicaid HMO DRG,11421,,215% x Medicaid HMO amount,11421,Other,215% of NY Medicaid HMO DRG,11421,,215% x Medicaid HMO amount,11421,Other,215% of NY Medicaid HMO DRG,6640,,125% x Medicaid HMO amount,6640,Other,125% of NY Medicaid HMO DRG,0.01,21057,
HIV w one signif HIV cond or w/o signif related cond,894-3,APR-DRG,,,,,,,,inpatient,,,338221.04,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14571,,186% x Medicaid HMO amount,14571,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32033,,"27,634 x DRG Weight",32033,Other,DRG Base Rate x DRG Weight,27227,,"23,488 x DRG Weight",27227,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7834.21,,DRG base rate x DRG weight + capital per discharge,7834.21,Other,100% of NY Medicaid HMO DRG,7834,,DRG base rate x DRG weight + capital per discharge,7834,Other,100% of NY Medicaid HMO DRG,7834,,DRG base rate x DRG weight + capital per discharge,7834,Other,100% of NY Medicaid HMO DRG,7834,,DRG base rate x DRG weight + capital per discharge,7834,Other,100% of NY Medicaid HMO DRG,17627,,225% x Medicaid HMO amount,17627,Other,225% of NY Medicaid HMO DRG,11986,,153% x Medicaid HMO amount,11986,Other,153% of NY Medicaid HMO DRG,17627,,225% x Medicaid HMO amount,17627,Other,225% of NY Medicaid HMO DRG,10968,,140% x Medicaid HMO amount,10968,Other,140% of NY Medicaid HMO DRG,17627,,225% x Medicaid HMO amount,17627,Other,225% of NY Medicaid HMO DRG,21544,,275% x Medicaid HMO amount,21544,Other,275% of NY Medicaid HMO DRG,25383,,324% x Medicaid HMO amount,25383,Other,324% of NY Medicaid HMO DRG,16844,,215% x Medicaid HMO amount,16844,Other,215% of NY Medicaid HMO DRG,16844,,215% x Medicaid HMO amount,16844,Other,215% of NY Medicaid HMO DRG,9793,,125% x Medicaid HMO amount,9793,Other,125% of NY Medicaid HMO DRG,0.01,32033,
HIV w one signif HIV cond or w/o signif related cond,894-4,APR-DRG,,,,,,,,inpatient,,,338221.04,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14571,,186% x Medicaid HMO amount,14571,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32033,,"27,634 x DRG Weight",32033,Other,DRG Base Rate x DRG Weight,27227,,"23,488 x DRG Weight",27227,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,7834.21,,DRG base rate x DRG weight + capital per discharge,7834.21,Other,100% of NY Medicaid HMO DRG,7834,,DRG base rate x DRG weight + capital per discharge,7834,Other,100% of NY Medicaid HMO DRG,7834,,DRG base rate x DRG weight + capital per discharge,7834,Other,100% of NY Medicaid HMO DRG,7834,,DRG base rate x DRG weight + capital per discharge,7834,Other,100% of NY Medicaid HMO DRG,17627,,225% x Medicaid HMO amount,17627,Other,225% of NY Medicaid HMO DRG,11986,,153% x Medicaid HMO amount,11986,Other,153% of NY Medicaid HMO DRG,17627,,225% x Medicaid HMO amount,17627,Other,225% of NY Medicaid HMO DRG,10968,,140% x Medicaid HMO amount,10968,Other,140% of NY Medicaid HMO DRG,17627,,225% x Medicaid HMO amount,17627,Other,225% of NY Medicaid HMO DRG,21544,,275% x Medicaid HMO amount,21544,Other,275% of NY Medicaid HMO DRG,25383,,324% x Medicaid HMO amount,25383,Other,324% of NY Medicaid HMO DRG,16844,,215% x Medicaid HMO amount,16844,Other,215% of NY Medicaid HMO DRG,16844,,215% x Medicaid HMO amount,16844,Other,215% of NY Medicaid HMO DRG,9793,,125% x Medicaid HMO amount,9793,Other,125% of NY Medicaid HMO DRG,0.01,32033,
Craniotomy for multiple significant trauma,910-1,APR-DRG,,,,,,,,inpatient,,,471439.81,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45282,,186% x Medicaid HMO amount,45282,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,103887,,"27,634 x DRG Weight",103887,Other,DRG Base Rate x DRG Weight,88301,,"23,488 x DRG Weight",88301,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24345.21,,DRG base rate x DRG weight + capital per discharge,24345.21,Other,100% of NY Medicaid HMO DRG,24345,,DRG base rate x DRG weight + capital per discharge,24345,Other,100% of NY Medicaid HMO DRG,24345,,DRG base rate x DRG weight + capital per discharge,24345,Other,100% of NY Medicaid HMO DRG,24345,,DRG base rate x DRG weight + capital per discharge,24345,Other,100% of NY Medicaid HMO DRG,54777,,225% x Medicaid HMO amount,54777,Other,225% of NY Medicaid HMO DRG,37248,,153% x Medicaid HMO amount,37248,Other,153% of NY Medicaid HMO DRG,54777,,225% x Medicaid HMO amount,54777,Other,225% of NY Medicaid HMO DRG,34083,,140% x Medicaid HMO amount,34083,Other,140% of NY Medicaid HMO DRG,54777,,225% x Medicaid HMO amount,54777,Other,225% of NY Medicaid HMO DRG,66949,,275% x Medicaid HMO amount,66949,Other,275% of NY Medicaid HMO DRG,78878,,324% x Medicaid HMO amount,78878,Other,324% of NY Medicaid HMO DRG,52342,,215% x Medicaid HMO amount,52342,Other,215% of NY Medicaid HMO DRG,52342,,215% x Medicaid HMO amount,52342,Other,215% of NY Medicaid HMO DRG,30432,,125% x Medicaid HMO amount,30432,Other,125% of NY Medicaid HMO DRG,0.01,103887,
Craniotomy for multiple significant trauma,910-2,APR-DRG,,,,,,,,inpatient,,,268119.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,45282,,186% x Medicaid HMO amount,45282,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,103887,,"27,634 x DRG Weight",103887,Other,DRG Base Rate x DRG Weight,88301,,"23,488 x DRG Weight",88301,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24345.21,,DRG base rate x DRG weight + capital per discharge,24345.21,Other,100% of NY Medicaid HMO DRG,24345,,DRG base rate x DRG weight + capital per discharge,24345,Other,100% of NY Medicaid HMO DRG,24345,,DRG base rate x DRG weight + capital per discharge,24345,Other,100% of NY Medicaid HMO DRG,24345,,DRG base rate x DRG weight + capital per discharge,24345,Other,100% of NY Medicaid HMO DRG,54777,,225% x Medicaid HMO amount,54777,Other,225% of NY Medicaid HMO DRG,37248,,153% x Medicaid HMO amount,37248,Other,153% of NY Medicaid HMO DRG,54777,,225% x Medicaid HMO amount,54777,Other,225% of NY Medicaid HMO DRG,34083,,140% x Medicaid HMO amount,34083,Other,140% of NY Medicaid HMO DRG,54777,,225% x Medicaid HMO amount,54777,Other,225% of NY Medicaid HMO DRG,66949,,275% x Medicaid HMO amount,66949,Other,275% of NY Medicaid HMO DRG,78878,,324% x Medicaid HMO amount,78878,Other,324% of NY Medicaid HMO DRG,52342,,215% x Medicaid HMO amount,52342,Other,215% of NY Medicaid HMO DRG,52342,,215% x Medicaid HMO amount,52342,Other,215% of NY Medicaid HMO DRG,30432,,125% x Medicaid HMO amount,30432,Other,125% of NY Medicaid HMO DRG,0.01,103887,
Craniotomy for multiple significant trauma,910-3,APR-DRG,,,,,,,,inpatient,,,538732.64,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46671,,186% x Medicaid HMO amount,46671,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,107140,,"27,634 x DRG Weight",107140,Other,DRG Base Rate x DRG Weight,91065,,"23,488 x DRG Weight",91065,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25092.21,,DRG base rate x DRG weight + capital per discharge,25092.21,Other,100% of NY Medicaid HMO DRG,25092,,DRG base rate x DRG weight + capital per discharge,25092,Other,100% of NY Medicaid HMO DRG,25092,,DRG base rate x DRG weight + capital per discharge,25092,Other,100% of NY Medicaid HMO DRG,25092,,DRG base rate x DRG weight + capital per discharge,25092,Other,100% of NY Medicaid HMO DRG,56457,,225% x Medicaid HMO amount,56457,Other,225% of NY Medicaid HMO DRG,38391,,153% x Medicaid HMO amount,38391,Other,153% of NY Medicaid HMO DRG,56457,,225% x Medicaid HMO amount,56457,Other,225% of NY Medicaid HMO DRG,35129,,140% x Medicaid HMO amount,35129,Other,140% of NY Medicaid HMO DRG,56457,,225% x Medicaid HMO amount,56457,Other,225% of NY Medicaid HMO DRG,69004,,275% x Medicaid HMO amount,69004,Other,275% of NY Medicaid HMO DRG,81299,,324% x Medicaid HMO amount,81299,Other,324% of NY Medicaid HMO DRG,53948,,215% x Medicaid HMO amount,53948,Other,215% of NY Medicaid HMO DRG,53948,,215% x Medicaid HMO amount,53948,Other,215% of NY Medicaid HMO DRG,31365,,125% x Medicaid HMO amount,31365,Other,125% of NY Medicaid HMO DRG,0.01,107140,
Craniotomy for multiple significant trauma,910-4,APR-DRG,,,,,,,,inpatient,,,814911.51,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,85713,,186% x Medicaid HMO amount,85713,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,198481,,"27,634 x DRG Weight",198481,Other,DRG Base Rate x DRG Weight,168703,,"23,488 x DRG Weight",168703,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,46082.21,,DRG base rate x DRG weight + capital per discharge,46082.21,Other,100% of NY Medicaid HMO DRG,46082,,DRG base rate x DRG weight + capital per discharge,46082,Other,100% of NY Medicaid HMO DRG,46082,,DRG base rate x DRG weight + capital per discharge,46082,Other,100% of NY Medicaid HMO DRG,46082,,DRG base rate x DRG weight + capital per discharge,46082,Other,100% of NY Medicaid HMO DRG,103685,,225% x Medicaid HMO amount,103685,Other,225% of NY Medicaid HMO DRG,70506,,153% x Medicaid HMO amount,70506,Other,153% of NY Medicaid HMO DRG,103685,,225% x Medicaid HMO amount,103685,Other,225% of NY Medicaid HMO DRG,64515,,140% x Medicaid HMO amount,64515,Other,140% of NY Medicaid HMO DRG,103685,,225% x Medicaid HMO amount,103685,Other,225% of NY Medicaid HMO DRG,126726,,275% x Medicaid HMO amount,126726,Other,275% of NY Medicaid HMO DRG,149306,,324% x Medicaid HMO amount,149306,Other,324% of NY Medicaid HMO DRG,99077,,215% x Medicaid HMO amount,99077,Other,215% of NY Medicaid HMO DRG,99077,,215% x Medicaid HMO amount,99077,Other,215% of NY Medicaid HMO DRG,57603,,125% x Medicaid HMO amount,57603,Other,125% of NY Medicaid HMO DRG,0.01,198481,
Extensive abdominal/thoracic procedures for mult significant trauma,911-1,APR-DRG,,,,,,,,inpatient,,,165345.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22982,,186% x Medicaid HMO amount,22982,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51714,,"27,634 x DRG Weight",51714,Other,DRG Base Rate x DRG Weight,43955,,"23,488 x DRG Weight",43955,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12356.21,,DRG base rate x DRG weight + capital per discharge,12356.21,Other,100% of NY Medicaid HMO DRG,12356,,DRG base rate x DRG weight + capital per discharge,12356,Other,100% of NY Medicaid HMO DRG,12356,,DRG base rate x DRG weight + capital per discharge,12356,Other,100% of NY Medicaid HMO DRG,12356,,DRG base rate x DRG weight + capital per discharge,12356,Other,100% of NY Medicaid HMO DRG,27801,,225% x Medicaid HMO amount,27801,Other,225% of NY Medicaid HMO DRG,18905,,153% x Medicaid HMO amount,18905,Other,153% of NY Medicaid HMO DRG,27801,,225% x Medicaid HMO amount,27801,Other,225% of NY Medicaid HMO DRG,17299,,140% x Medicaid HMO amount,17299,Other,140% of NY Medicaid HMO DRG,27801,,225% x Medicaid HMO amount,27801,Other,225% of NY Medicaid HMO DRG,33980,,275% x Medicaid HMO amount,33980,Other,275% of NY Medicaid HMO DRG,40034,,324% x Medicaid HMO amount,40034,Other,324% of NY Medicaid HMO DRG,26566,,215% x Medicaid HMO amount,26566,Other,215% of NY Medicaid HMO DRG,26566,,215% x Medicaid HMO amount,26566,Other,215% of NY Medicaid HMO DRG,15445,,125% x Medicaid HMO amount,15445,Other,125% of NY Medicaid HMO DRG,0.01,51714,
Extensive abdominal/thoracic procedures for mult significant trauma,911-2,APR-DRG,,,,,,,,inpatient,,,165345.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,22982,,186% x Medicaid HMO amount,22982,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51714,,"27,634 x DRG Weight",51714,Other,DRG Base Rate x DRG Weight,43955,,"23,488 x DRG Weight",43955,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,12356.21,,DRG base rate x DRG weight + capital per discharge,12356.21,Other,100% of NY Medicaid HMO DRG,12356,,DRG base rate x DRG weight + capital per discharge,12356,Other,100% of NY Medicaid HMO DRG,12356,,DRG base rate x DRG weight + capital per discharge,12356,Other,100% of NY Medicaid HMO DRG,12356,,DRG base rate x DRG weight + capital per discharge,12356,Other,100% of NY Medicaid HMO DRG,27801,,225% x Medicaid HMO amount,27801,Other,225% of NY Medicaid HMO DRG,18905,,153% x Medicaid HMO amount,18905,Other,153% of NY Medicaid HMO DRG,27801,,225% x Medicaid HMO amount,27801,Other,225% of NY Medicaid HMO DRG,17299,,140% x Medicaid HMO amount,17299,Other,140% of NY Medicaid HMO DRG,27801,,225% x Medicaid HMO amount,27801,Other,225% of NY Medicaid HMO DRG,33980,,275% x Medicaid HMO amount,33980,Other,275% of NY Medicaid HMO DRG,40034,,324% x Medicaid HMO amount,40034,Other,324% of NY Medicaid HMO DRG,26566,,215% x Medicaid HMO amount,26566,Other,215% of NY Medicaid HMO DRG,26566,,215% x Medicaid HMO amount,26566,Other,215% of NY Medicaid HMO DRG,15445,,125% x Medicaid HMO amount,15445,Other,125% of NY Medicaid HMO DRG,0.01,51714,
Extensive abdominal/thoracic procedures for mult significant trauma,911-3,APR-DRG,,,,,,,,inpatient,,,373998.98,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,31153,,186% x Medicaid HMO amount,31153,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70829,,"27,634 x DRG Weight",70829,Other,DRG Base Rate x DRG Weight,60202,,"23,488 x DRG Weight",60202,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16749.21,,DRG base rate x DRG weight + capital per discharge,16749.21,Other,100% of NY Medicaid HMO DRG,16749,,DRG base rate x DRG weight + capital per discharge,16749,Other,100% of NY Medicaid HMO DRG,16749,,DRG base rate x DRG weight + capital per discharge,16749,Other,100% of NY Medicaid HMO DRG,16749,,DRG base rate x DRG weight + capital per discharge,16749,Other,100% of NY Medicaid HMO DRG,37686,,225% x Medicaid HMO amount,37686,Other,225% of NY Medicaid HMO DRG,25626,,153% x Medicaid HMO amount,25626,Other,153% of NY Medicaid HMO DRG,37686,,225% x Medicaid HMO amount,37686,Other,225% of NY Medicaid HMO DRG,23449,,140% x Medicaid HMO amount,23449,Other,140% of NY Medicaid HMO DRG,37686,,225% x Medicaid HMO amount,37686,Other,225% of NY Medicaid HMO DRG,46060,,275% x Medicaid HMO amount,46060,Other,275% of NY Medicaid HMO DRG,54267,,324% x Medicaid HMO amount,54267,Other,324% of NY Medicaid HMO DRG,36011,,215% x Medicaid HMO amount,36011,Other,215% of NY Medicaid HMO DRG,36011,,215% x Medicaid HMO amount,36011,Other,215% of NY Medicaid HMO DRG,20937,,125% x Medicaid HMO amount,20937,Other,125% of NY Medicaid HMO DRG,0.01,70829,
Extensive abdominal/thoracic procedures for mult significant trauma,911-4,APR-DRG,,,,,,,,inpatient,,,704549.44,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,77536,,186% x Medicaid HMO amount,77536,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,179353,,"27,634 x DRG Weight",179353,Other,DRG Base Rate x DRG Weight,152444,,"23,488 x DRG Weight",152444,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,41686.21,,DRG base rate x DRG weight + capital per discharge,41686.21,Other,100% of NY Medicaid HMO DRG,41686,,DRG base rate x DRG weight + capital per discharge,41686,Other,100% of NY Medicaid HMO DRG,41686,,DRG base rate x DRG weight + capital per discharge,41686,Other,100% of NY Medicaid HMO DRG,41686,,DRG base rate x DRG weight + capital per discharge,41686,Other,100% of NY Medicaid HMO DRG,93794,,225% x Medicaid HMO amount,93794,Other,225% of NY Medicaid HMO DRG,63780,,153% x Medicaid HMO amount,63780,Other,153% of NY Medicaid HMO DRG,93794,,225% x Medicaid HMO amount,93794,Other,225% of NY Medicaid HMO DRG,58361,,140% x Medicaid HMO amount,58361,Other,140% of NY Medicaid HMO DRG,93794,,225% x Medicaid HMO amount,93794,Other,225% of NY Medicaid HMO DRG,114637,,275% x Medicaid HMO amount,114637,Other,275% of NY Medicaid HMO DRG,135063,,324% x Medicaid HMO amount,135063,Other,324% of NY Medicaid HMO DRG,89625,,215% x Medicaid HMO amount,89625,Other,215% of NY Medicaid HMO DRG,89625,,215% x Medicaid HMO amount,89625,Other,215% of NY Medicaid HMO DRG,52108,,125% x Medicaid HMO amount,52108,Other,125% of NY Medicaid HMO DRG,0.01,179353,
Musculoskeletal & other procedures for multiple significant trauma,912-1,APR-DRG,,,,,,,,inpatient,,,358233.46,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28800,,186% x Medicaid HMO amount,28800,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65327,,"27,634 x DRG Weight",65327,Other,DRG Base Rate x DRG Weight,55526,,"23,488 x DRG Weight",55526,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15484.21,,DRG base rate x DRG weight + capital per discharge,15484.21,Other,100% of NY Medicaid HMO DRG,15484,,DRG base rate x DRG weight + capital per discharge,15484,Other,100% of NY Medicaid HMO DRG,15484,,DRG base rate x DRG weight + capital per discharge,15484,Other,100% of NY Medicaid HMO DRG,15484,,DRG base rate x DRG weight + capital per discharge,15484,Other,100% of NY Medicaid HMO DRG,34839,,225% x Medicaid HMO amount,34839,Other,225% of NY Medicaid HMO DRG,23691,,153% x Medicaid HMO amount,23691,Other,153% of NY Medicaid HMO DRG,34839,,225% x Medicaid HMO amount,34839,Other,225% of NY Medicaid HMO DRG,21678,,140% x Medicaid HMO amount,21678,Other,140% of NY Medicaid HMO DRG,34839,,225% x Medicaid HMO amount,34839,Other,225% of NY Medicaid HMO DRG,42582,,275% x Medicaid HMO amount,42582,Other,275% of NY Medicaid HMO DRG,50169,,324% x Medicaid HMO amount,50169,Other,324% of NY Medicaid HMO DRG,33291,,215% x Medicaid HMO amount,33291,Other,215% of NY Medicaid HMO DRG,33291,,215% x Medicaid HMO amount,33291,Other,215% of NY Medicaid HMO DRG,19355,,125% x Medicaid HMO amount,19355,Other,125% of NY Medicaid HMO DRG,0.01,65327,
Musculoskeletal & other procedures for multiple significant trauma,912-2,APR-DRG,,,,,,,,inpatient,,,330220.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,28823,,186% x Medicaid HMO amount,28823,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,65377,,"27,634 x DRG Weight",65377,Other,DRG Base Rate x DRG Weight,55568,,"23,488 x DRG Weight",55568,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15496.21,,DRG base rate x DRG weight + capital per discharge,15496.21,Other,100% of NY Medicaid HMO DRG,15496,,DRG base rate x DRG weight + capital per discharge,15496,Other,100% of NY Medicaid HMO DRG,15496,,DRG base rate x DRG weight + capital per discharge,15496,Other,100% of NY Medicaid HMO DRG,15496,,DRG base rate x DRG weight + capital per discharge,15496,Other,100% of NY Medicaid HMO DRG,34866,,225% x Medicaid HMO amount,34866,Other,225% of NY Medicaid HMO DRG,23709,,153% x Medicaid HMO amount,23709,Other,153% of NY Medicaid HMO DRG,34866,,225% x Medicaid HMO amount,34866,Other,225% of NY Medicaid HMO DRG,21695,,140% x Medicaid HMO amount,21695,Other,140% of NY Medicaid HMO DRG,34866,,225% x Medicaid HMO amount,34866,Other,225% of NY Medicaid HMO DRG,42615,,275% x Medicaid HMO amount,42615,Other,275% of NY Medicaid HMO DRG,50208,,324% x Medicaid HMO amount,50208,Other,324% of NY Medicaid HMO DRG,33317,,215% x Medicaid HMO amount,33317,Other,215% of NY Medicaid HMO DRG,33317,,215% x Medicaid HMO amount,33317,Other,215% of NY Medicaid HMO DRG,19370,,125% x Medicaid HMO amount,19370,Other,125% of NY Medicaid HMO DRG,0.01,65377,
Musculoskeletal & other procedures for multiple significant trauma,912-3,APR-DRG,,,,,,,,inpatient,,,535118.73,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,47361,,186% x Medicaid HMO amount,47361,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,108754,,"27,634 x DRG Weight",108754,Other,DRG Base Rate x DRG Weight,92437,,"23,488 x DRG Weight",92437,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25463.21,,DRG base rate x DRG weight + capital per discharge,25463.21,Other,100% of NY Medicaid HMO DRG,25463,,DRG base rate x DRG weight + capital per discharge,25463,Other,100% of NY Medicaid HMO DRG,25463,,DRG base rate x DRG weight + capital per discharge,25463,Other,100% of NY Medicaid HMO DRG,25463,,DRG base rate x DRG weight + capital per discharge,25463,Other,100% of NY Medicaid HMO DRG,57292,,225% x Medicaid HMO amount,57292,Other,225% of NY Medicaid HMO DRG,38959,,153% x Medicaid HMO amount,38959,Other,153% of NY Medicaid HMO DRG,57292,,225% x Medicaid HMO amount,57292,Other,225% of NY Medicaid HMO DRG,35648,,140% x Medicaid HMO amount,35648,Other,140% of NY Medicaid HMO DRG,57292,,225% x Medicaid HMO amount,57292,Other,225% of NY Medicaid HMO DRG,70024,,275% x Medicaid HMO amount,70024,Other,275% of NY Medicaid HMO DRG,82501,,324% x Medicaid HMO amount,82501,Other,324% of NY Medicaid HMO DRG,54746,,215% x Medicaid HMO amount,54746,Other,215% of NY Medicaid HMO DRG,54746,,215% x Medicaid HMO amount,54746,Other,215% of NY Medicaid HMO DRG,31829,,125% x Medicaid HMO amount,31829,Other,125% of NY Medicaid HMO DRG,0.01,108754,
Musculoskeletal & other procedures for multiple significant trauma,912-4,APR-DRG,,,,,,,,inpatient,,,895444.01,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,90366,,186% x Medicaid HMO amount,90366,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,209372,,"27,634 x DRG Weight",209372,Other,DRG Base Rate x DRG Weight,177959,,"23,488 x DRG Weight",177959,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48584.21,,DRG base rate x DRG weight + capital per discharge,48584.21,Other,100% of NY Medicaid HMO DRG,48584,,DRG base rate x DRG weight + capital per discharge,48584,Other,100% of NY Medicaid HMO DRG,48584,,DRG base rate x DRG weight + capital per discharge,48584,Other,100% of NY Medicaid HMO DRG,48584,,DRG base rate x DRG weight + capital per discharge,48584,Other,100% of NY Medicaid HMO DRG,109314,,225% x Medicaid HMO amount,109314,Other,225% of NY Medicaid HMO DRG,74334,,153% x Medicaid HMO amount,74334,Other,153% of NY Medicaid HMO DRG,109314,,225% x Medicaid HMO amount,109314,Other,225% of NY Medicaid HMO DRG,68018,,140% x Medicaid HMO amount,68018,Other,140% of NY Medicaid HMO DRG,109314,,225% x Medicaid HMO amount,109314,Other,225% of NY Medicaid HMO DRG,133607,,275% x Medicaid HMO amount,133607,Other,275% of NY Medicaid HMO DRG,157413,,324% x Medicaid HMO amount,157413,Other,324% of NY Medicaid HMO DRG,104456,,215% x Medicaid HMO amount,104456,Other,215% of NY Medicaid HMO DRG,104456,,215% x Medicaid HMO amount,104456,Other,215% of NY Medicaid HMO DRG,60730,,125% x Medicaid HMO amount,60730,Other,125% of NY Medicaid HMO DRG,0.01,209372,
Multiple significant trauma w/o O.R. procedure,930-1,APR-DRG,,,,,,,,inpatient,,,157058,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11296,,186% x Medicaid HMO amount,11296,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24370,,"27,634 x DRG Weight",24370,Other,DRG Base Rate x DRG Weight,20714,,"23,488 x DRG Weight",20714,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6073.21,,DRG base rate x DRG weight + capital per discharge,6073.21,Other,100% of NY Medicaid HMO DRG,6073,,DRG base rate x DRG weight + capital per discharge,6073,Other,100% of NY Medicaid HMO DRG,6073,,DRG base rate x DRG weight + capital per discharge,6073,Other,100% of NY Medicaid HMO DRG,6073,,DRG base rate x DRG weight + capital per discharge,6073,Other,100% of NY Medicaid HMO DRG,13665,,225% x Medicaid HMO amount,13665,Other,225% of NY Medicaid HMO DRG,9292,,153% x Medicaid HMO amount,9292,Other,153% of NY Medicaid HMO DRG,13665,,225% x Medicaid HMO amount,13665,Other,225% of NY Medicaid HMO DRG,8502,,140% x Medicaid HMO amount,8502,Other,140% of NY Medicaid HMO DRG,13665,,225% x Medicaid HMO amount,13665,Other,225% of NY Medicaid HMO DRG,16701,,275% x Medicaid HMO amount,16701,Other,275% of NY Medicaid HMO DRG,19677,,324% x Medicaid HMO amount,19677,Other,324% of NY Medicaid HMO DRG,13057,,215% x Medicaid HMO amount,13057,Other,215% of NY Medicaid HMO DRG,13057,,215% x Medicaid HMO amount,13057,Other,215% of NY Medicaid HMO DRG,7592,,125% x Medicaid HMO amount,7592,Other,125% of NY Medicaid HMO DRG,0.01,24370,
Multiple significant trauma w/o O.R. procedure,930-2,APR-DRG,,,,,,,,inpatient,,,161187.65,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11350,,186% x Medicaid HMO amount,11350,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,24498,,"27,634 x DRG Weight",24498,Other,DRG Base Rate x DRG Weight,20822,,"23,488 x DRG Weight",20822,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6102.21,,DRG base rate x DRG weight + capital per discharge,6102.21,Other,100% of NY Medicaid HMO DRG,6102,,DRG base rate x DRG weight + capital per discharge,6102,Other,100% of NY Medicaid HMO DRG,6102,,DRG base rate x DRG weight + capital per discharge,6102,Other,100% of NY Medicaid HMO DRG,6102,,DRG base rate x DRG weight + capital per discharge,6102,Other,100% of NY Medicaid HMO DRG,13730,,225% x Medicaid HMO amount,13730,Other,225% of NY Medicaid HMO DRG,9336,,153% x Medicaid HMO amount,9336,Other,153% of NY Medicaid HMO DRG,13730,,225% x Medicaid HMO amount,13730,Other,225% of NY Medicaid HMO DRG,8543,,140% x Medicaid HMO amount,8543,Other,140% of NY Medicaid HMO DRG,13730,,225% x Medicaid HMO amount,13730,Other,225% of NY Medicaid HMO DRG,16781,,275% x Medicaid HMO amount,16781,Other,275% of NY Medicaid HMO DRG,19771,,324% x Medicaid HMO amount,19771,Other,324% of NY Medicaid HMO DRG,13120,,215% x Medicaid HMO amount,13120,Other,215% of NY Medicaid HMO DRG,13120,,215% x Medicaid HMO amount,13120,Other,215% of NY Medicaid HMO DRG,7628,,125% x Medicaid HMO amount,7628,Other,125% of NY Medicaid HMO DRG,0.01,24498,
Multiple significant trauma w/o O.R. procedure,930-3,APR-DRG,,,,,,,,inpatient,,,194551.13,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,19573,,186% x Medicaid HMO amount,19573,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,43736,,"27,634 x DRG Weight",43736,Other,DRG Base Rate x DRG Weight,37174,,"23,488 x DRG Weight",37174,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10523.21,,DRG base rate x DRG weight + capital per discharge,10523.21,Other,100% of NY Medicaid HMO DRG,10523,,DRG base rate x DRG weight + capital per discharge,10523,Other,100% of NY Medicaid HMO DRG,10523,,DRG base rate x DRG weight + capital per discharge,10523,Other,100% of NY Medicaid HMO DRG,10523,,DRG base rate x DRG weight + capital per discharge,10523,Other,100% of NY Medicaid HMO DRG,23677,,225% x Medicaid HMO amount,23677,Other,225% of NY Medicaid HMO DRG,16101,,153% x Medicaid HMO amount,16101,Other,153% of NY Medicaid HMO DRG,23677,,225% x Medicaid HMO amount,23677,Other,225% of NY Medicaid HMO DRG,14732,,140% x Medicaid HMO amount,14732,Other,140% of NY Medicaid HMO DRG,23677,,225% x Medicaid HMO amount,23677,Other,225% of NY Medicaid HMO DRG,28939,,275% x Medicaid HMO amount,28939,Other,275% of NY Medicaid HMO DRG,34095,,324% x Medicaid HMO amount,34095,Other,324% of NY Medicaid HMO DRG,22625,,215% x Medicaid HMO amount,22625,Other,215% of NY Medicaid HMO DRG,22625,,215% x Medicaid HMO amount,22625,Other,215% of NY Medicaid HMO DRG,13154,,125% x Medicaid HMO amount,13154,Other,125% of NY Medicaid HMO DRG,0.01,43736,
Multiple significant trauma w/o O.R. procedure,930-4,APR-DRG,,,,,,,,inpatient,,,364385.02,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,44037,,186% x Medicaid HMO amount,44037,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,100975,,"27,634 x DRG Weight",100975,Other,DRG Base Rate x DRG Weight,85825,,"23,488 x DRG Weight",85825,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,23676.21,,DRG base rate x DRG weight + capital per discharge,23676.21,Other,100% of NY Medicaid HMO DRG,23676,,DRG base rate x DRG weight + capital per discharge,23676,Other,100% of NY Medicaid HMO DRG,23676,,DRG base rate x DRG weight + capital per discharge,23676,Other,100% of NY Medicaid HMO DRG,23676,,DRG base rate x DRG weight + capital per discharge,23676,Other,100% of NY Medicaid HMO DRG,53271,,225% x Medicaid HMO amount,53271,Other,225% of NY Medicaid HMO DRG,36225,,153% x Medicaid HMO amount,36225,Other,153% of NY Medicaid HMO DRG,53271,,225% x Medicaid HMO amount,53271,Other,225% of NY Medicaid HMO DRG,33147,,140% x Medicaid HMO amount,33147,Other,140% of NY Medicaid HMO DRG,53271,,225% x Medicaid HMO amount,53271,Other,225% of NY Medicaid HMO DRG,65110,,275% x Medicaid HMO amount,65110,Other,275% of NY Medicaid HMO DRG,76711,,324% x Medicaid HMO amount,76711,Other,324% of NY Medicaid HMO DRG,50904,,215% x Medicaid HMO amount,50904,Other,215% of NY Medicaid HMO DRG,50904,,215% x Medicaid HMO amount,50904,Other,215% of NY Medicaid HMO DRG,29595,,125% x Medicaid HMO amount,29595,Other,125% of NY Medicaid HMO DRG,0.01,100975,
Extensive procedure unrelated to principal diagnosis,950-1,APR-DRG,,,,,,,,inpatient,,,101207.35,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,16971,,186% x Medicaid HMO amount,16971,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,37649,,"27,634 x DRG Weight",37649,Other,DRG Base Rate x DRG Weight,32000,,"23,488 x DRG Weight",32000,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9124.21,,DRG base rate x DRG weight + capital per discharge,9124.21,Other,100% of NY Medicaid HMO DRG,9124,,DRG base rate x DRG weight + capital per discharge,9124,Other,100% of NY Medicaid HMO DRG,9124,,DRG base rate x DRG weight + capital per discharge,9124,Other,100% of NY Medicaid HMO DRG,9124,,DRG base rate x DRG weight + capital per discharge,9124,Other,100% of NY Medicaid HMO DRG,20529,,225% x Medicaid HMO amount,20529,Other,225% of NY Medicaid HMO DRG,13960,,153% x Medicaid HMO amount,13960,Other,153% of NY Medicaid HMO DRG,20529,,225% x Medicaid HMO amount,20529,Other,225% of NY Medicaid HMO DRG,12774,,140% x Medicaid HMO amount,12774,Other,140% of NY Medicaid HMO DRG,20529,,225% x Medicaid HMO amount,20529,Other,225% of NY Medicaid HMO DRG,25092,,275% x Medicaid HMO amount,25092,Other,275% of NY Medicaid HMO DRG,29562,,324% x Medicaid HMO amount,29562,Other,324% of NY Medicaid HMO DRG,19617,,215% x Medicaid HMO amount,19617,Other,215% of NY Medicaid HMO DRG,19617,,215% x Medicaid HMO amount,19617,Other,215% of NY Medicaid HMO DRG,11405,,125% x Medicaid HMO amount,11405,Other,125% of NY Medicaid HMO DRG,0.01,37649,
Extensive procedure unrelated to principal diagnosis,950-2,APR-DRG,,,,,,,,inpatient,,,199694.51,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,26380,,186% x Medicaid HMO amount,26380,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,59662,,"27,634 x DRG Weight",59662,Other,DRG Base Rate x DRG Weight,50711,,"23,488 x DRG Weight",50711,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,14183.21,,DRG base rate x DRG weight + capital per discharge,14183.21,Other,100% of NY Medicaid HMO DRG,14183,,DRG base rate x DRG weight + capital per discharge,14183,Other,100% of NY Medicaid HMO DRG,14183,,DRG base rate x DRG weight + capital per discharge,14183,Other,100% of NY Medicaid HMO DRG,14183,,DRG base rate x DRG weight + capital per discharge,14183,Other,100% of NY Medicaid HMO DRG,31912,,225% x Medicaid HMO amount,31912,Other,225% of NY Medicaid HMO DRG,21700,,153% x Medicaid HMO amount,21700,Other,153% of NY Medicaid HMO DRG,31912,,225% x Medicaid HMO amount,31912,Other,225% of NY Medicaid HMO DRG,19856,,140% x Medicaid HMO amount,19856,Other,140% of NY Medicaid HMO DRG,31912,,225% x Medicaid HMO amount,31912,Other,225% of NY Medicaid HMO DRG,39004,,275% x Medicaid HMO amount,39004,Other,275% of NY Medicaid HMO DRG,45954,,324% x Medicaid HMO amount,45954,Other,324% of NY Medicaid HMO DRG,30494,,215% x Medicaid HMO amount,30494,Other,215% of NY Medicaid HMO DRG,30494,,215% x Medicaid HMO amount,30494,Other,215% of NY Medicaid HMO DRG,17729,,125% x Medicaid HMO amount,17729,Other,125% of NY Medicaid HMO DRG,0.01,59662,
Extensive procedure unrelated to principal diagnosis,950-3,APR-DRG,,,,,,,,inpatient,,,333490.77,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,48057,,186% x Medicaid HMO amount,48057,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,110381,,"27,634 x DRG Weight",110381,Other,DRG Base Rate x DRG Weight,93820,,"23,488 x DRG Weight",93820,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25837.21,,DRG base rate x DRG weight + capital per discharge,25837.21,Other,100% of NY Medicaid HMO DRG,25837,,DRG base rate x DRG weight + capital per discharge,25837,Other,100% of NY Medicaid HMO DRG,25837,,DRG base rate x DRG weight + capital per discharge,25837,Other,100% of NY Medicaid HMO DRG,25837,,DRG base rate x DRG weight + capital per discharge,25837,Other,100% of NY Medicaid HMO DRG,58134,,225% x Medicaid HMO amount,58134,Other,225% of NY Medicaid HMO DRG,39531,,153% x Medicaid HMO amount,39531,Other,153% of NY Medicaid HMO DRG,58134,,225% x Medicaid HMO amount,58134,Other,225% of NY Medicaid HMO DRG,36172,,140% x Medicaid HMO amount,36172,Other,140% of NY Medicaid HMO DRG,58134,,225% x Medicaid HMO amount,58134,Other,225% of NY Medicaid HMO DRG,71052,,275% x Medicaid HMO amount,71052,Other,275% of NY Medicaid HMO DRG,83713,,324% x Medicaid HMO amount,83713,Other,324% of NY Medicaid HMO DRG,55550,,215% x Medicaid HMO amount,55550,Other,215% of NY Medicaid HMO DRG,55550,,215% x Medicaid HMO amount,55550,Other,215% of NY Medicaid HMO DRG,32297,,125% x Medicaid HMO amount,32297,Other,125% of NY Medicaid HMO DRG,0.01,110381,
Extensive procedure unrelated to principal diagnosis,950-4,APR-DRG,,,,,,,,inpatient,,,2096908.33,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,96718,,186% x Medicaid HMO amount,96718,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,224231,,"27,634 x DRG Weight",224231,Other,DRG Base Rate x DRG Weight,190589,,"23,488 x DRG Weight",190589,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,51999.21,,DRG base rate x DRG weight + capital per discharge,51999.21,Other,100% of NY Medicaid HMO DRG,51999,,DRG base rate x DRG weight + capital per discharge,51999,Other,100% of NY Medicaid HMO DRG,51999,,DRG base rate x DRG weight + capital per discharge,51999,Other,100% of NY Medicaid HMO DRG,51999,,DRG base rate x DRG weight + capital per discharge,51999,Other,100% of NY Medicaid HMO DRG,116998,,225% x Medicaid HMO amount,116998,Other,225% of NY Medicaid HMO DRG,79559,,153% x Medicaid HMO amount,79559,Other,153% of NY Medicaid HMO DRG,116998,,225% x Medicaid HMO amount,116998,Other,225% of NY Medicaid HMO DRG,72799,,140% x Medicaid HMO amount,72799,Other,140% of NY Medicaid HMO DRG,116998,,225% x Medicaid HMO amount,116998,Other,225% of NY Medicaid HMO DRG,142998,,275% x Medicaid HMO amount,142998,Other,275% of NY Medicaid HMO DRG,168477,,324% x Medicaid HMO amount,168477,Other,324% of NY Medicaid HMO DRG,111798,,215% x Medicaid HMO amount,111798,Other,215% of NY Medicaid HMO DRG,111798,,215% x Medicaid HMO amount,111798,Other,215% of NY Medicaid HMO DRG,64999,,125% x Medicaid HMO amount,64999,Other,125% of NY Medicaid HMO DRG,0.01,224231,
Moderately extensive procedure unrelated to principal diagnosis,951-1,APR-DRG,,,,,,,,inpatient,,,102862.03,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,11759,,186% x Medicaid HMO amount,11759,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,25454,,"27,634 x DRG Weight",25454,Other,DRG Base Rate x DRG Weight,21635,,"23,488 x DRG Weight",21635,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,6322.21,,DRG base rate x DRG weight + capital per discharge,6322.21,Other,100% of NY Medicaid HMO DRG,6322,,DRG base rate x DRG weight + capital per discharge,6322,Other,100% of NY Medicaid HMO DRG,6322,,DRG base rate x DRG weight + capital per discharge,6322,Other,100% of NY Medicaid HMO DRG,6322,,DRG base rate x DRG weight + capital per discharge,6322,Other,100% of NY Medicaid HMO DRG,14225,,225% x Medicaid HMO amount,14225,Other,225% of NY Medicaid HMO DRG,9673,,153% x Medicaid HMO amount,9673,Other,153% of NY Medicaid HMO DRG,14225,,225% x Medicaid HMO amount,14225,Other,225% of NY Medicaid HMO DRG,8851,,140% x Medicaid HMO amount,8851,Other,140% of NY Medicaid HMO DRG,14225,,225% x Medicaid HMO amount,14225,Other,225% of NY Medicaid HMO DRG,17386,,275% x Medicaid HMO amount,17386,Other,275% of NY Medicaid HMO DRG,20484,,324% x Medicaid HMO amount,20484,Other,324% of NY Medicaid HMO DRG,13593,,215% x Medicaid HMO amount,13593,Other,215% of NY Medicaid HMO DRG,13593,,215% x Medicaid HMO amount,13593,Other,215% of NY Medicaid HMO DRG,7903,,125% x Medicaid HMO amount,7903,Other,125% of NY Medicaid HMO DRG,0.01,25454,
Moderately extensive procedure unrelated to principal diagnosis,951-2,APR-DRG,,,,,,,,inpatient,,,210190.27,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17304,,186% x Medicaid HMO amount,17304,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38428,,"27,634 x DRG Weight",38428,Other,DRG Base Rate x DRG Weight,32662,,"23,488 x DRG Weight",32662,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,9303.21,,DRG base rate x DRG weight + capital per discharge,9303.21,Other,100% of NY Medicaid HMO DRG,9303,,DRG base rate x DRG weight + capital per discharge,9303,Other,100% of NY Medicaid HMO DRG,9303,,DRG base rate x DRG weight + capital per discharge,9303,Other,100% of NY Medicaid HMO DRG,9303,,DRG base rate x DRG weight + capital per discharge,9303,Other,100% of NY Medicaid HMO DRG,20932,,225% x Medicaid HMO amount,20932,Other,225% of NY Medicaid HMO DRG,14234,,153% x Medicaid HMO amount,14234,Other,153% of NY Medicaid HMO DRG,20932,,225% x Medicaid HMO amount,20932,Other,225% of NY Medicaid HMO DRG,13024,,140% x Medicaid HMO amount,13024,Other,140% of NY Medicaid HMO DRG,20932,,225% x Medicaid HMO amount,20932,Other,225% of NY Medicaid HMO DRG,25584,,275% x Medicaid HMO amount,25584,Other,275% of NY Medicaid HMO DRG,30142,,324% x Medicaid HMO amount,30142,Other,324% of NY Medicaid HMO DRG,20002,,215% x Medicaid HMO amount,20002,Other,215% of NY Medicaid HMO DRG,20002,,215% x Medicaid HMO amount,20002,Other,215% of NY Medicaid HMO DRG,11629,,125% x Medicaid HMO amount,11629,Other,125% of NY Medicaid HMO DRG,0.01,38428,
Moderately extensive procedure unrelated to principal diagnosis,951-3,APR-DRG,,,,,,,,inpatient,,,357428,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,32909,,186% x Medicaid HMO amount,32909,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74938,,"27,634 x DRG Weight",74938,Other,DRG Base Rate x DRG Weight,63695,,"23,488 x DRG Weight",63695,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,17693.21,,DRG base rate x DRG weight + capital per discharge,17693.21,Other,100% of NY Medicaid HMO DRG,17693,,DRG base rate x DRG weight + capital per discharge,17693,Other,100% of NY Medicaid HMO DRG,17693,,DRG base rate x DRG weight + capital per discharge,17693,Other,100% of NY Medicaid HMO DRG,17693,,DRG base rate x DRG weight + capital per discharge,17693,Other,100% of NY Medicaid HMO DRG,39810,,225% x Medicaid HMO amount,39810,Other,225% of NY Medicaid HMO DRG,27071,,153% x Medicaid HMO amount,27071,Other,153% of NY Medicaid HMO DRG,39810,,225% x Medicaid HMO amount,39810,Other,225% of NY Medicaid HMO DRG,24770,,140% x Medicaid HMO amount,24770,Other,140% of NY Medicaid HMO DRG,39810,,225% x Medicaid HMO amount,39810,Other,225% of NY Medicaid HMO DRG,48656,,275% x Medicaid HMO amount,48656,Other,275% of NY Medicaid HMO DRG,57326,,324% x Medicaid HMO amount,57326,Other,324% of NY Medicaid HMO DRG,38040,,215% x Medicaid HMO amount,38040,Other,215% of NY Medicaid HMO DRG,38040,,215% x Medicaid HMO amount,38040,Other,215% of NY Medicaid HMO DRG,22117,,125% x Medicaid HMO amount,22117,Other,125% of NY Medicaid HMO DRG,0.01,74938,
Moderately extensive procedure unrelated to principal diagnosis,951-4,APR-DRG,,,,,,,,inpatient,,,535294.18,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,74995,,186% x Medicaid HMO amount,74995,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,173406,,"27,634 x DRG Weight",173406,Other,DRG Base Rate x DRG Weight,147390,,"23,488 x DRG Weight",147390,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,40320.21,,DRG base rate x DRG weight + capital per discharge,40320.21,Other,100% of NY Medicaid HMO DRG,40320,,DRG base rate x DRG weight + capital per discharge,40320,Other,100% of NY Medicaid HMO DRG,40320,,DRG base rate x DRG weight + capital per discharge,40320,Other,100% of NY Medicaid HMO DRG,40320,,DRG base rate x DRG weight + capital per discharge,40320,Other,100% of NY Medicaid HMO DRG,90720,,225% x Medicaid HMO amount,90720,Other,225% of NY Medicaid HMO DRG,61690,,153% x Medicaid HMO amount,61690,Other,153% of NY Medicaid HMO DRG,90720,,225% x Medicaid HMO amount,90720,Other,225% of NY Medicaid HMO DRG,56448,,140% x Medicaid HMO amount,56448,Other,140% of NY Medicaid HMO DRG,90720,,225% x Medicaid HMO amount,90720,Other,225% of NY Medicaid HMO DRG,110881,,275% x Medicaid HMO amount,110881,Other,275% of NY Medicaid HMO DRG,130637,,324% x Medicaid HMO amount,130637,Other,324% of NY Medicaid HMO DRG,86688,,215% x Medicaid HMO amount,86688,Other,215% of NY Medicaid HMO DRG,86688,,215% x Medicaid HMO amount,86688,Other,215% of NY Medicaid HMO DRG,50400,,125% x Medicaid HMO amount,50400,Other,125% of NY Medicaid HMO DRG,0.01,173406,
Nonextensive procedure unrelated to principal diagnosis,952-1,APR-DRG,,,,,,,,inpatient,,,86105.83,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,10150,,186% x Medicaid HMO amount,10150,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,21690,,"27,634 x DRG Weight",21690,Other,DRG Base Rate x DRG Weight,18436,,"23,488 x DRG Weight",18436,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,5457.21,,DRG base rate x DRG weight + capital per discharge,5457.21,Other,100% of NY Medicaid HMO DRG,5457,,DRG base rate x DRG weight + capital per discharge,5457,Other,100% of NY Medicaid HMO DRG,5457,,DRG base rate x DRG weight + capital per discharge,5457,Other,100% of NY Medicaid HMO DRG,5457,,DRG base rate x DRG weight + capital per discharge,5457,Other,100% of NY Medicaid HMO DRG,12279,,225% x Medicaid HMO amount,12279,Other,225% of NY Medicaid HMO DRG,8350,,153% x Medicaid HMO amount,8350,Other,153% of NY Medicaid HMO DRG,12279,,225% x Medicaid HMO amount,12279,Other,225% of NY Medicaid HMO DRG,7640,,140% x Medicaid HMO amount,7640,Other,140% of NY Medicaid HMO DRG,12279,,225% x Medicaid HMO amount,12279,Other,225% of NY Medicaid HMO DRG,15007,,275% x Medicaid HMO amount,15007,Other,275% of NY Medicaid HMO DRG,17681,,324% x Medicaid HMO amount,17681,Other,324% of NY Medicaid HMO DRG,11733,,215% x Medicaid HMO amount,11733,Other,215% of NY Medicaid HMO DRG,11733,,215% x Medicaid HMO amount,11733,Other,215% of NY Medicaid HMO DRG,6822,,125% x Medicaid HMO amount,6822,Other,125% of NY Medicaid HMO DRG,0.01,21690,
Nonextensive procedure unrelated to principal diagnosis,952-2,APR-DRG,,,,,,,,inpatient,,,194934,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15008,,186% x Medicaid HMO amount,15008,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,33056,,"27,634 x DRG Weight",33056,Other,DRG Base Rate x DRG Weight,28096,,"23,488 x DRG Weight",28096,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,8069.21,,DRG base rate x DRG weight + capital per discharge,8069.21,Other,100% of NY Medicaid HMO DRG,8069,,DRG base rate x DRG weight + capital per discharge,8069,Other,100% of NY Medicaid HMO DRG,8069,,DRG base rate x DRG weight + capital per discharge,8069,Other,100% of NY Medicaid HMO DRG,8069,,DRG base rate x DRG weight + capital per discharge,8069,Other,100% of NY Medicaid HMO DRG,18156,,225% x Medicaid HMO amount,18156,Other,225% of NY Medicaid HMO DRG,12346,,153% x Medicaid HMO amount,12346,Other,153% of NY Medicaid HMO DRG,18156,,225% x Medicaid HMO amount,18156,Other,225% of NY Medicaid HMO DRG,11297,,140% x Medicaid HMO amount,11297,Other,140% of NY Medicaid HMO DRG,18156,,225% x Medicaid HMO amount,18156,Other,225% of NY Medicaid HMO DRG,22190,,275% x Medicaid HMO amount,22190,Other,275% of NY Medicaid HMO DRG,26144,,324% x Medicaid HMO amount,26144,Other,324% of NY Medicaid HMO DRG,17349,,215% x Medicaid HMO amount,17349,Other,215% of NY Medicaid HMO DRG,17349,,215% x Medicaid HMO amount,17349,Other,215% of NY Medicaid HMO DRG,10087,,125% x Medicaid HMO amount,10087,Other,125% of NY Medicaid HMO DRG,0.01,33056,
Nonextensive procedure unrelated to principal diagnosis,952-3,APR-DRG,,,,,,,,inpatient,,,322751.37,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,29745,,186% x Medicaid HMO amount,29745,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,67535,,"27,634 x DRG Weight",67535,Other,DRG Base Rate x DRG Weight,57402,,"23,488 x DRG Weight",57402,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,15992.21,,DRG base rate x DRG weight + capital per discharge,15992.21,Other,100% of NY Medicaid HMO DRG,15992,,DRG base rate x DRG weight + capital per discharge,15992,Other,100% of NY Medicaid HMO DRG,15992,,DRG base rate x DRG weight + capital per discharge,15992,Other,100% of NY Medicaid HMO DRG,15992,,DRG base rate x DRG weight + capital per discharge,15992,Other,100% of NY Medicaid HMO DRG,35982,,225% x Medicaid HMO amount,35982,Other,225% of NY Medicaid HMO DRG,24468,,153% x Medicaid HMO amount,24468,Other,153% of NY Medicaid HMO DRG,35982,,225% x Medicaid HMO amount,35982,Other,225% of NY Medicaid HMO DRG,22389,,140% x Medicaid HMO amount,22389,Other,140% of NY Medicaid HMO DRG,35982,,225% x Medicaid HMO amount,35982,Other,225% of NY Medicaid HMO DRG,43979,,275% x Medicaid HMO amount,43979,Other,275% of NY Medicaid HMO DRG,51815,,324% x Medicaid HMO amount,51815,Other,324% of NY Medicaid HMO DRG,34383,,215% x Medicaid HMO amount,34383,Other,215% of NY Medicaid HMO DRG,34383,,215% x Medicaid HMO amount,34383,Other,215% of NY Medicaid HMO DRG,19990,,125% x Medicaid HMO amount,19990,Other,125% of NY Medicaid HMO DRG,0.01,67535,
Nonextensive procedure unrelated to principal diagnosis,952-4,APR-DRG,,,,,,,,inpatient,,,411452.32,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,70939,,186% x Medicaid HMO amount,70939,Other,186% of NY Medicaid HMO DRG,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,163914,,"27,634 x DRG Weight",163914,Other,DRG Base Rate x DRG Weight,139321,,"23,488 x DRG Weight",139321,Other,DRG Base Rate x DRG Weight,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,0.01,,,0.01,Other,See MS-DRG information,38139.21,,DRG base rate x DRG weight + capital per discharge,38139.21,Other,100% of NY Medicaid HMO DRG,38139,,DRG base rate x DRG weight + capital per discharge,38139,Other,100% of NY Medicaid HMO DRG,38139,,DRG base rate x DRG weight + capital per discharge,38139,Other,100% of NY Medicaid HMO DRG,38139,,DRG base rate x DRG weight + capital per discharge,38139,Other,100% of NY Medicaid HMO DRG,85813,,225% x Medicaid HMO amount,85813,Other,225% of NY Medicaid HMO DRG,58353,,153% x Medicaid HMO amount,58353,Other,153% of NY Medicaid HMO DRG,85813,,225% x Medicaid HMO amount,85813,Other,225% of NY Medicaid HMO DRG,53395,,140% x Medicaid HMO amount,53395,Other,140% of NY Medicaid HMO DRG,85813,,225% x Medicaid HMO amount,85813,Other,225% of NY Medicaid HMO DRG,104883,,275% x Medicaid HMO amount,104883,Other,275% of NY Medicaid HMO DRG,123571,,324% x Medicaid HMO amount,123571,Other,324% of NY Medicaid HMO DRG,81999,,215% x Medicaid HMO amount,81999,Other,215% of NY Medicaid HMO DRG,81999,,215% x Medicaid HMO amount,81999,Other,215% of NY Medicaid HMO DRG,47674,,125% x Medicaid HMO amount,47674,Other,125% of NY Medicaid HMO DRG,0.01,163914,
Fna bx w/o img gdn ea addl,10004,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,206.64,,,206.64,Fee Schedule,,175.14,,,175.14,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,0.01,25945.68,
Fna bx w/us gdn 1st les,10005,CPT,,,,,,,,both,,,21618.49,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,15132.94,70,,15132.94,percent of total billed charges,,14700.57,68,,14700.57,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,17294.79,80,,17294.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17294.79,80,,17294.79,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,15132.94,70,,15132.94,percent of total billed charges,,357.52,,,357.52,Fee Schedule,,303.02,,,303.02,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,303.02,17294.79,
Fna bx w/us gdn ea addl,10006,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,242.72,,,242.72,Fee Schedule,,205.72,,,205.72,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,0.01,25945.68,
Fna bx w/fluor gdn 1st les,10007,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,558.15,11839.04,
Fna bx w/fluor gdn ea addl,10008,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,254.2,,,254.2,Fee Schedule,,215.45,,,215.45,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,0.01,25945.68,
Fna bx w/ct gdn 1st les,10009,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,558.15,11839.04,
Fna bx w/ct gdn ea addl,10010,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,347.68,,,347.68,Fee Schedule,,294.68,,,294.68,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,0.01,25945.68,
Fna bx w/mr gdn 1st les,10011,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,9619.22,65,,9619.22,percent of total billed charges,,9619.22,65,,9619.22,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,558.15,11839.04,
Fna bx w/mr gdn ea addl,10012,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,21080.87,65,,21080.87,percent of total billed charges,,21080.87,65,,21080.87,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,0.01,25945.68,
Fna bx w/o img gdn 1st les,10021,CPT,,,,,,,,both,,,34782.5,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24347.75,70,,24347.75,percent of total billed charges,,23652.1,68,,23652.1,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,27826,80,,27826,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27826,80,,27826,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24347.75,70,,24347.75,percent of total billed charges,,267.32,,,267.32,Fee Schedule,,226.57,,,226.57,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,226.57,27826,
Guide cathet fluid drainage,10030,CPT,,,,,,,,both,,,17675.66,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,12372.96,70,,12372.96,percent of total billed charges,,12019.45,68,,12019.45,percent of total billed charges,,1207.71,,,1207.71,Other,186% of Medicaid,14140.53,80,,14140.53,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,14140.53,80,,14140.53,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,12372.96,70,,12372.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,649.31,14140.53,
Perq dev soft tiss 1st imag,10035,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1207.71,,,1207.71,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,410,,,410,Fee Schedule,,347.5,,,347.5,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,347.5,11839.04,
Perq dev soft tiss add imag,10036,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1207.71,,,1207.71,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,206.64,,,206.64,Fee Schedule,,175.14,,,175.14,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,0.01,25945.68,
Acne surgery,10040,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,252.56,,,252.56,Fee Schedule,,214.06,,,214.06,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,214.06,9473,
Drainage of skin abscess,10060,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,514.96,,,514.96,Fee Schedule,,436.46,,,436.46,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Drainage of skin abscess,10061,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Drainage of pilonidal cyst,10080,CPT,,,,,,,,both,,,35124.08,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24586.86,70,,24586.86,percent of total billed charges,,23884.37,68,,23884.37,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,28099.26,80,,28099.26,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28099.26,80,,28099.26,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,24586.86,70,,24586.86,percent of total billed charges,,511.68,,,511.68,Fee Schedule,,433.68,,,433.68,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,28099.26,
Drainage of pilonidal cyst,10081,CPT,,,,,,,,both,,,36188.86,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,25332.2,70,,25332.2,percent of total billed charges,,24608.42,68,,24608.42,percent of total billed charges,,1207.71,,,1207.71,Other,186% of Medicaid,28951.09,80,,28951.09,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28951.09,80,,28951.09,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,25332.2,70,,25332.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,649.31,28951.09,
Remove foreign body,10120,CPT,,,,,,,,both,,,35136.3,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24595.41,70,,24595.41,percent of total billed charges,,23892.68,68,,23892.68,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,28109.04,80,,28109.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28109.04,80,,28109.04,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24595.41,70,,24595.41,percent of total billed charges,,514.96,,,514.96,Fee Schedule,,436.46,,,436.46,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,28109.04,
Remove foreign body,10121,CPT,,,,,,,,both,,,34301.82,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23325.24,68,,23325.24,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,27441.46,80,,27441.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27441.46,80,,27441.46,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24011.27,70,,24011.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,27441.46,
Drainage of hematoma/fluid,10140,CPT,,,,,,,,both,,,36245.27,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,25371.69,70,,25371.69,percent of total billed charges,,24646.78,68,,24646.78,percent of total billed charges,,1207.71,,,1207.71,Other,186% of Medicaid,28996.22,80,,28996.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28996.22,80,,28996.22,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25371.69,70,,25371.69,percent of total billed charges,,575.64,,,575.64,Fee Schedule,,487.89,,,487.89,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,487.89,28996.22,
Puncture drainage of lesion,10160,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,472.32,,,472.32,Fee Schedule,,400.32,,,400.32,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Complex drainage wound,10180,CPT,,,,,,,,both,,,39608.75,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26933.95,68,,26933.95,percent of total billed charges,,2493.46,,,2493.46,Other,186% of Medicaid,31687,80,,31687,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31687,80,,31687,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27726.13,70,,27726.13,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,31687,
Debride infected skin,11000,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,131.2,,,131.2,Fee Schedule,,111.2,,,111.2,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,111.2,10568.18,
Debride infected skin add-on,11001,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,72.16,,,72.16,Fee Schedule,,61.16,,,61.16,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,0.01,25945.68,
Debride skin at fx site,11010,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,10063.18,68,,10063.18,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,727.5,11839.04,
Debride skin musc at fx site,11011,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,10063.18,68,,10063.18,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,727.5,11839.04,
Deb skin bone at fx site,11012,CPT,,,,,,,,both,,,60004.81,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40803.27,68,,40803.27,percent of total billed charges,,2493.46,,,2493.46,Other,186% of Medicaid,48003.85,80,,48003.85,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,48003.85,80,,48003.85,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,42003.37,70,,42003.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,48003.85,
Deb subq tissue 20 sq cm/<,11042,CPT,,,,,,,,both,,,37094.72,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25224.41,68,,25224.41,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,29675.78,80,,29675.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29675.78,80,,29675.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25966.3,70,,25966.3,percent of total billed charges,,290.28,,,290.28,Fee Schedule,,246.03,,,246.03,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,246.03,29675.78,
Deb musc/fascia 20 sq cm/<,11043,CPT,,,,,,,,both,,,39574.92,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26910.95,68,,26910.95,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,31659.94,80,,31659.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31659.94,80,,31659.94,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,27702.44,70,,27702.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,690.13,31659.94,
Deb bone 20 sq cm/<,11044,CPT,,,,,,,,both,,,38476.71,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26164.16,68,,26164.16,percent of total billed charges,,2493.46,,,2493.46,Other,186% of Medicaid,30781.37,80,,30781.37,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30781.37,80,,30781.37,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,26933.7,70,,26933.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,30781.37,
Deb subq tissue add-on,11045,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,2493.46,,,2493.46,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,123,,,123,Fee Schedule,,104.25,,,104.25,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,0.01,41257.63,
Deb musc/fascia add-on,11046,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,2493.46,,,2493.46,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,265.68,,,265.68,Fee Schedule,,225.18,,,225.18,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,0.01,41257.63,
Deb bone add-on,11047,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,43846.05,68,,43846.05,percent of total billed charges,,2493.46,,,2493.46,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,470.68,,,470.68,Fee Schedule,,398.93,,,398.93,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,0.01,51583.58,
Trim skin lesion,11055,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,77.08,,,77.08,Fee Schedule,,65.33,,,65.33,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,65.33,7216,
Trim skin lesions 2 to 4,11056,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,106.6,,,106.6,Fee Schedule,,90.35,,,90.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,90.35,7216,
Trim skin lesions over 4,11057,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,116.76,7216,
Tangntl bx skin single les,11102,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,183.68,,,183.68,Fee Schedule,,155.68,,,155.68,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,155.68,7216,
Tangntl bx skin ea sep/addl,11103,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,0.01,25945.68,
Punch bx skin single lesion,11104,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,193.21,7216,
Punch bx skin ea sep/addl,11105,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,124.64,,,124.64,Fee Schedule,,105.64,,,105.64,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,0.01,25945.68,
Incal bx skn single les,11106,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,273.88,,,273.88,Fee Schedule,,232.13,,,232.13,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,232.13,10568.18,
Incal bx skn ea sep/addl,11107,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,149.24,,,149.24,Fee Schedule,,126.49,,,126.49,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,0.01,25945.68,
Removal of skin tags <w/15,11200,CPT,,,,,,,,both,,,36910.34,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,25837.24,70,,25837.24,percent of total billed charges,,25099.03,68,,25099.03,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,29528.27,80,,29528.27,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29528.27,80,,29528.27,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25837.24,70,,25837.24,percent of total billed charges,,373.92,,,373.92,Fee Schedule,,316.92,,,316.92,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,29528.27,
Remove skin tags add-on,11201,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,0.01,22702.47,
Shave skin lesion 0.5 cm/<,11300,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,165.64,,,165.64,Fee Schedule,,140.39,,,140.39,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,140.39,9473,
Shave skin lesion 0.6-1.0 cm,11301,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,249.28,,,249.28,Fee Schedule,,211.28,,,211.28,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,211.28,9473,
Shave skin lesion 1.1-2.0 cm,11302,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,290.28,,,290.28,Fee Schedule,,246.03,,,246.03,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,9473,
Shave skin lesion >2.0 cm,11303,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,344.4,,,344.4,Fee Schedule,,291.9,,,291.9,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,291.9,9473,
Shave skin lesion 0.5 cm/<,11305,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,182.04,,,182.04,Fee Schedule,,154.29,,,154.29,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,154.29,9473,
Shave skin lesion 0.6-1.0 cm,11306,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,239.44,,,239.44,Fee Schedule,,202.94,,,202.94,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,202.94,9473,
Shave skin lesion 1.1-2.0 cm,11307,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,305.04,,,305.04,Fee Schedule,,258.54,,,258.54,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,9473,
Shave skin lesion >2.0 cm,11308,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,339.48,,,339.48,Fee Schedule,,287.73,,,287.73,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,287.73,9473,
Shave skin lesion 0.5 cm/<,11310,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,223.04,,,223.04,Fee Schedule,,189.04,,,189.04,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,189.04,9473,
Shave skin lesion 0.6-1.0 cm,11311,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,305.04,,,305.04,Fee Schedule,,258.54,,,258.54,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,9473,
Shave skin lesion 1.1-2.0 cm,11312,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,365.72,,,365.72,Fee Schedule,,309.97,,,309.97,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,309.97,9473,
Shave skin lesion >2.0 cm,11313,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,464.12,,,464.12,Fee Schedule,,393.37,,,393.37,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,393.37,9473,
Exc tr-ext b9+marg 0.5 cm<,11400,CPT,,,,,,,,both,,,35012.69,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24508.88,70,,24508.88,percent of total billed charges,,23808.63,68,,23808.63,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,28010.15,80,,28010.15,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28010.15,80,,28010.15,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,24508.88,70,,24508.88,percent of total billed charges,,411.64,,,411.64,Fee Schedule,,348.89,,,348.89,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,348.89,28010.15,
Exc tr-ext b9+marg 0.6-1 cm,11401,CPT,,,,,,,,both,,,34943.81,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24460.67,70,,24460.67,percent of total billed charges,,23761.79,68,,23761.79,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,27955.05,80,,27955.05,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27955.05,80,,27955.05,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24460.67,70,,24460.67,percent of total billed charges,,519.88,,,519.88,Fee Schedule,,440.63,,,440.63,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,438.16,27955.05,
Exc tr-ext b9+marg 1.1-2 cm,11402,CPT,,,,,,,,both,,,35381.88,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24767.32,70,,24767.32,percent of total billed charges,,24059.68,68,,24059.68,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,28305.5,80,,28305.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28305.5,80,,28305.5,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,24767.32,70,,24767.32,percent of total billed charges,,565.8,,,565.8,Fee Schedule,,479.55,,,479.55,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,479.55,28305.5,
Exc tr-ext b9+marg 2.1-3cm,11403,CPT,,,,,,,,both,,,35017.63,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24512.34,70,,24512.34,percent of total billed charges,,23811.99,68,,23811.99,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,28014.1,80,,28014.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28014.1,80,,28014.1,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,24512.34,70,,24512.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,28014.1,
Exc tr-ext b9+marg 3.1-4 cm,11404,CPT,,,,,,,,both,,,35816.42,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24355.17,68,,24355.17,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,28653.14,80,,28653.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28653.14,80,,28653.14,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25071.49,70,,25071.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,28653.14,
Exc tr-ext b9+marg >4.0 cm,11406,CPT,,,,,,,,both,,,37909.24,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25778.28,68,,25778.28,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,30327.39,80,,30327.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30327.39,80,,30327.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26536.47,70,,26536.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1781.56,30327.39,
Exc h-f-nk-sp b9+marg 0.5/<,11420,CPT,,,,,,,,both,,,37620.34,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26334.24,70,,26334.24,percent of total billed charges,,25581.83,68,,25581.83,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,30096.27,80,,30096.27,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30096.27,80,,30096.27,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,26334.24,70,,26334.24,percent of total billed charges,,401.8,,,401.8,Fee Schedule,,340.55,,,340.55,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,340.55,30096.27,
Exc h-f-nk-sp b9+marg 0.6-1,11421,CPT,,,,,,,,both,,,38590.22,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,27013.15,70,,27013.15,percent of total billed charges,,26241.35,68,,26241.35,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,30872.18,80,,30872.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30872.18,80,,30872.18,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,27013.15,70,,27013.15,percent of total billed charges,,536.28,,,536.28,Fee Schedule,,454.53,,,454.53,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,454.53,30872.18,
Exc h-f-nk-sp b9+marg 1.1-2,11422,CPT,,,,,,,,both,,,37502.29,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26251.6,70,,26251.6,percent of total billed charges,,25501.56,68,,25501.56,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,30001.83,80,,30001.83,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30001.83,80,,30001.83,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,26251.6,70,,26251.6,percent of total billed charges,,664.2,,,664.2,Fee Schedule,,562.95,,,562.95,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,562.95,30001.83,
Exc h-f-nk-sp b9+marg 2.1-3,11423,CPT,,,,,,,,both,,,36267.22,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,25387.05,70,,25387.05,percent of total billed charges,,24661.71,68,,24661.71,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,29013.78,80,,29013.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29013.78,80,,29013.78,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25387.05,70,,25387.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,29013.78,
Exc h-f-nk-sp b9+marg 3.1-4,11424,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,27281.4,
Exc h-f-nk-sp b9+marg >4 cm,11426,CPT,,,,,,,,both,,,36406.91,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24756.7,68,,24756.7,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,29125.53,80,,29125.53,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29125.53,80,,29125.53,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25484.84,70,,25484.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,29125.53,
Exc face-mm b9+marg 0.5 cm/<,11440,CPT,,,,,,,,both,,,36219.26,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,25353.48,70,,25353.48,percent of total billed charges,,24629.1,68,,24629.1,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,28975.41,80,,28975.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28975.41,80,,28975.41,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,25353.48,70,,25353.48,percent of total billed charges,,519.88,,,519.88,Fee Schedule,,440.63,,,440.63,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,440.63,28975.41,
Exc face-mm b9+marg 0.6-1 cm,11441,CPT,,,,,,,,both,,,34637.18,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24246.03,70,,24246.03,percent of total billed charges,,23553.28,68,,23553.28,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,27709.74,80,,27709.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27709.74,80,,27709.74,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,24246.03,70,,24246.03,percent of total billed charges,,651.08,,,651.08,Fee Schedule,,551.83,,,551.83,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,551.83,27709.74,
Exc face-mm b9+marg 1.1-2 cm,11442,CPT,,,,,,,,both,,,35219.66,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24653.76,70,,24653.76,percent of total billed charges,,23949.37,68,,23949.37,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,28175.73,80,,28175.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28175.73,80,,28175.73,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,24653.76,70,,24653.76,percent of total billed charges,,718.32,,,718.32,Fee Schedule,,608.82,,,608.82,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,608.82,28175.73,
Exc face-mm b9+marg 2.1-3 cm,11443,CPT,,,,,,,,both,,,37395.32,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26176.72,70,,26176.72,percent of total billed charges,,25428.82,68,,25428.82,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,29916.26,80,,29916.26,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29916.26,80,,29916.26,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,26176.72,70,,26176.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,29916.26,
Exc face-mm b9+marg 3.1-4 cm,11444,CPT,,,,,,,,both,,,44236.91,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,30081.1,68,,30081.1,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,35389.53,80,,35389.53,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35389.53,80,,35389.53,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,30965.84,70,,30965.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,35389.53,
Exc face-mm b9+marg >4 cm,11446,CPT,,,,,,,,both,,,43807.73,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29789.26,68,,29789.26,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,35046.18,80,,35046.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35046.18,80,,35046.18,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,30665.41,70,,30665.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,35046.18,
Removal sweat gland lesion,11450,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,47813.76,
Removal sweat gland lesion,11451,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,47813.76,
Removal sweat gland lesion,11462,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,47813.76,
Removal sweat gland lesion,11463,CPT,,,,,,,,both,,,79425.93,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,54009.63,68,,54009.63,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,63540.74,80,,63540.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,63540.74,80,,63540.74,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,55598.15,70,,55598.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,63540.74,
Removal sweat gland lesion,11470,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,47813.76,
Removal sweat gland lesion,11471,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,47813.76,
Exc tr-ext mal+marg 0.5 cm/<,11600,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,596.96,,,596.96,Fee Schedule,,505.96,,,505.96,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,505.96,11839.04,
Exc tr-ext mal+marg 0.6-1 cm,11601,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,11839.04,
Exc tr-ext mal+marg 1.1-2 cm,11602,CPT,,,,,,,,both,,,36725.63,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,25707.94,70,,25707.94,percent of total billed charges,,24973.43,68,,24973.43,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,29380.5,80,,29380.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29380.5,80,,29380.5,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25707.94,70,,25707.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,438.16,29380.5,
Exc tr-ext mal+marg 2.1-3 cm,11603,CPT,,,,,,,,both,,,39565.02,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,27695.51,70,,27695.51,percent of total billed charges,,26904.21,68,,26904.21,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,31652.02,80,,31652.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31652.02,80,,31652.02,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,27695.51,70,,27695.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,31652.02,
Exc tr-ext mal+marg 3.1-4 cm,11604,CPT,,,,,,,,both,,,55886.11,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,38002.55,68,,38002.55,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,44708.89,80,,44708.89,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,44708.89,80,,44708.89,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,39120.28,70,,39120.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,773.13,44708.89,
Exc tr-ext mal+marg >4 cm,11606,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1781.56,27281.4,
Exc h-f-nk-sp mal+marg 0.5/<,11620,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,600.24,,,600.24,Fee Schedule,,508.74,,,508.74,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,508.74,27281.4,
Exc s/n/h/f/g mal+mrg 0.6-1,11621,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,11839.04,
Exc s/n/h/f/g mal+mrg 1.1-2,11622,CPT,,,,,,,,both,,,37185.15,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,26029.61,70,,26029.61,percent of total billed charges,,25285.9,68,,25285.9,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,29748.12,80,,29748.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29748.12,80,,29748.12,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,26029.61,70,,26029.61,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,29748.12,
Exc s/n/h/f/g mal+mrg 2.1-3,11623,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,27281.4,
Exc s/n/h/f/g mal+mrg 3.1-4,11624,CPT,,,,,,,,both,,,38581.78,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26235.61,68,,26235.61,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,30865.42,80,,30865.42,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30865.42,80,,30865.42,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27007.25,70,,27007.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,30865.42,
Exc s/n/h/f/g mal+mrg >4 cm,11626,CPT,,,,,,,,both,,,39290.13,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26717.29,68,,26717.29,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,31432.1,80,,31432.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31432.1,80,,31432.1,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27503.09,70,,27503.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,31432.1,
Exc f/e/e/n/l mal+mrg 0.5cm<,11640,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,616.64,,,616.64,Fee Schedule,,522.64,,,522.64,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,522.64,11839.04,
Exc f/e/e/n/l mal+mrg 0.6-1,11641,CPT,,,,,,,,both,,,37472.95,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,26231.07,70,,26231.07,percent of total billed charges,,25481.61,68,,25481.61,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,29978.36,80,,29978.36,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29978.36,80,,29978.36,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,26231.07,70,,26231.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,29978.36,
Exc f/e/e/n/l mal+mrg 1.1-2,11642,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,11839.04,
Exc f/e/e/n/l mal+mrg 2.1-3,11643,CPT,,,,,,,,both,,,51235.38,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,35864.77,70,,35864.77,percent of total billed charges,,34840.06,68,,34840.06,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,40988.3,80,,40988.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,40988.3,80,,40988.3,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,35864.77,70,,35864.77,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,40988.3,
Exc f/e/e/n/l mal+mrg 3.1-4,11644,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,27281.4,
Exc f/e/e/n/l mal+mrg >4 cm,11646,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,47813.76,
Trim nail(s) any number,11719,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,900.61,70,,900.61,percent of total billed charges,,6152,,,6152,Case Rate,,354.16,,,354.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,36.08,,,36.08,Fee Schedule,,30.58,,,30.58,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,190.41,,,190.41,Other,New York Medicaid APG methodology,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,291.33,,,291.33,Other,153% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,266.58,,,266.58,Other,140% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,495.07,,,495.07,Other,260% New York Medicaid APG,616.93,,,616.93,Other,324% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,238.01,,,238.01,Other,125% New York Medicaid APG,30.58,9473,
Debride nail 1-5,11720,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,900.61,70,,900.61,percent of total billed charges,,874.87,68,,874.87,percent of total billed charges,,354.16,,,354.16,Other,186% of Medicaid,1029.26,80,,1029.26,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,1029.26,80,,1029.26,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,70.52,,,70.52,Fee Schedule,,59.77,,,59.77,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,190.41,,,190.41,Other,New York Medicaid APG methodology,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,291.33,,,291.33,Other,153% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,266.58,,,266.58,Other,140% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,495.07,,,495.07,Other,260% New York Medicaid APG,616.93,,,616.93,Other,324% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,238.01,,,238.01,Other,125% New York Medicaid APG,59.77,7216,
Debride nail 6 or more,11721,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,900.61,70,,900.61,percent of total billed charges,,874.87,68,,874.87,percent of total billed charges,,354.16,,,354.16,Other,186% of Medicaid,1029.26,80,,1029.26,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,1029.26,80,,1029.26,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,114.8,,,114.8,Fee Schedule,,97.3,,,97.3,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,190.41,,,190.41,Other,New York Medicaid APG methodology,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,291.33,,,291.33,Other,153% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,266.58,,,266.58,Other,140% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,495.07,,,495.07,Other,260% New York Medicaid APG,616.93,,,616.93,Other,324% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,238.01,,,238.01,Other,125% New York Medicaid APG,67.21,7216,
Removal of nail plate,11730,CPT,,,,,,,,both,,,35082.18,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24557.53,70,,24557.53,percent of total billed charges,,23855.88,68,,23855.88,percent of total billed charges,,354.16,,,354.16,Other,186% of Medicaid,28065.74,80,,28065.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28065.74,80,,28065.74,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24557.53,70,,24557.53,percent of total billed charges,,260.76,,,260.76,Fee Schedule,,221.01,,,221.01,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,190.41,,,190.41,Other,New York Medicaid APG methodology,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,291.33,,,291.33,Other,153% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,266.58,,,266.58,Other,140% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,495.07,,,495.07,Other,260% New York Medicaid APG,616.93,,,616.93,Other,324% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,238.01,,,238.01,Other,125% New York Medicaid APG,190.41,28065.74,
Remove nail plate add-on,11732,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,354.16,,,354.16,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,83.64,,,83.64,Fee Schedule,,70.89,,,70.89,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,190.41,,,190.41,Other,New York Medicaid APG methodology,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,291.33,,,291.33,Other,153% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,266.58,,,266.58,Other,140% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,495.07,,,495.07,Other,260% New York Medicaid APG,616.93,,,616.93,Other,324% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,238.01,,,238.01,Other,125% New York Medicaid APG,0.01,25945.68,
Drain blood from under nail,11740,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,1827.06,68,,1827.06,percent of total billed charges,,354.16,,,354.16,Other,186% of Medicaid,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,155.8,,,155.8,Fee Schedule,,132.05,,,132.05,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,190.41,,,190.41,Other,New York Medicaid APG methodology,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,291.33,,,291.33,Other,153% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,266.58,,,266.58,Other,140% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,495.07,,,495.07,Other,260% New York Medicaid APG,616.93,,,616.93,Other,324% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,238.01,,,238.01,Other,125% New York Medicaid APG,132.05,7216,
Removal of nail bed,11750,CPT,,,,,,,,both,,,34489.9,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24142.93,70,,24142.93,percent of total billed charges,,23453.13,68,,23453.13,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,27591.92,80,,27591.92,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27591.92,80,,27591.92,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24142.93,70,,24142.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,438.16,27591.92,
Biopsy nail unit,11755,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,293.56,,,293.56,Fee Schedule,,248.81,,,248.81,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,248.81,11839.04,
Repair of nail bed,11760,CPT,,,,,,,,both,,,35603.23,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24922.26,70,,24922.26,percent of total billed charges,,24210.2,68,,24210.2,percent of total billed charges,,354.16,,,354.16,Other,186% of Medicaid,28482.58,80,,28482.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28482.58,80,,28482.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24922.26,70,,24922.26,percent of total billed charges,,539.56,,,539.56,Fee Schedule,,457.31,,,457.31,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,190.41,,,190.41,Other,New York Medicaid APG methodology,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,291.33,,,291.33,Other,153% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,266.58,,,266.58,Other,140% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,495.07,,,495.07,Other,260% New York Medicaid APG,616.93,,,616.93,Other,324% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,238.01,,,238.01,Other,125% New York Medicaid APG,190.41,28482.58,
Reconstruction of nail bed,11762,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,26083.13,68,,26083.13,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,30686.04,
Excision of nail fold toe,11765,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,354.16,,,354.16,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,449.36,,,449.36,Fee Schedule,,380.86,,,380.86,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,190.41,,,190.41,Other,New York Medicaid APG methodology,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,190.41,,,190.41,Other,100% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,291.33,,,291.33,Other,153% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,266.58,,,266.58,Other,140% New York Medicaid APG,428.42,,,428.42,Other,225% New York Medicaid APG,495.07,,,495.07,Other,260% New York Medicaid APG,616.93,,,616.93,Other,324% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,409.38,,,409.38,Other,215% New York Medicaid APG,238.01,,,238.01,Other,125% New York Medicaid APG,190.41,7216,
Remove pilonidal cyst simple,11770,CPT,,,,,,,,both,,,35492.13,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2242.46,,,2242.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24844.49,70,,24844.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,1205.63,24844.49,
Remove pilonidal cyst exten,11771,CPT,,,,,,,,both,,,36470.63,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25529.44,70,,25529.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,25529.44,
Remove pilonidal cyst compl,11772,CPT,,,,,,,,both,,,37285.68,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26099.98,70,,26099.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,26099.98,
Inject skin lesions </w 7,11900,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,123.71,7216,
Inject skin lesions >7,11901,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,221.4,,,221.4,Fee Schedule,,187.65,,,187.65,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,187.65,7216,
Correct skin color 6.0 cm/<,11920,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,531.36,,,531.36,Fee Schedule,,450.36,,,450.36,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,450.36,10568.18,
Correct skn color 6.1-20.0cm,11921,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,10568.18,
Correct skin color ea 20.0cm,11922,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,142.68,,,142.68,Fee Schedule,,120.93,,,120.93,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,0.01,25945.68,
Tx contour defects 1 cc/<,11950,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,1241.44,,,1241.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,255.84,,,255.84,Fee Schedule,,216.84,,,216.84,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,216.84,9473,
Tx contour defects 1.1-5.0cc,11951,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,6152,,,6152,Case Rate,,1241.44,,,1241.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,355.88,,,355.88,Fee Schedule,,301.63,,,301.63,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,301.63,9473,
Tx contour defects 5.1-10cc,11952,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,6152,,,6152,Case Rate,,1241.44,,,1241.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,498.56,,,498.56,Fee Schedule,,422.56,,,422.56,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,422.56,9473,
Tx contour defects >10.0 cc,11954,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,6152,,,6152,Case Rate,,2242.46,,,2242.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,690.13,9473,
Insert tissue expander(s),11960,CPT,,,,,,,,both,,,41203.11,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,28018.11,68,,28018.11,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,32962.49,80,,32962.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32962.49,80,,32962.49,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28842.18,70,,28842.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,32962.49,
Rplcmt tiss xpndr perm implt,11970,CPT,,,,,,,,both,,,42031.03,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,29421.72,70,,29421.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,29421.72,
Rmvl tis xpndr wo insj implt,11971,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,47813.76,
Remove contraceptive capsule,11976,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,11839.04,
Implant hormone pellet(s),11980,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,5698.86,68,,5698.86,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,272.24,,,272.24,Fee Schedule,,230.74,,,230.74,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,230.74,7216,
Insert drug implant device,11981,CPT,,,,,,,,both,,,34479.41,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24135.59,70,,24135.59,percent of total billed charges,,23446,68,,23446,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,27583.53,80,,27583.53,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27583.53,80,,27583.53,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24135.59,70,,24135.59,percent of total billed charges,,305.04,,,305.04,Fee Schedule,,258.54,,,258.54,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,140.37,27583.53,
Remove drug implant device,11982,CPT,,,,,,,,both,,,34480.35,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24136.25,70,,24136.25,percent of total billed charges,,23446.64,68,,23446.64,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,27584.28,80,,27584.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27584.28,80,,27584.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24136.25,70,,24136.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,27584.28,
Remove/insert drug implant,11983,CPT,,,,,,,,both,,,34458.47,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24120.93,70,,24120.93,percent of total billed charges,,23431.76,68,,23431.76,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,27566.78,80,,27566.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27566.78,80,,27566.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24120.93,70,,24120.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,27566.78,
Rpr s/n/ax/gen/trnk 2.5cm/<,12001,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,219.76,,,219.76,Fee Schedule,,186.26,,,186.26,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,186.26,7216,
Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,958.33,,,958.33,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,287,,,287,Fee Schedule,,243.25,,,243.25,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,219.99,9473,
Rpr s/n/ax/gen/trk7.6-12.5cm,12004,CPT,,,,,,,,both,,,35302.99,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24712.09,70,,24712.09,percent of total billed charges,,24006.03,68,,24006.03,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,28242.39,80,,28242.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28242.39,80,,28242.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24712.09,70,,24712.09,percent of total billed charges,,355.88,,,355.88,Fee Schedule,,301.63,,,301.63,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,219.99,28242.39,
Rpr s/n/a/gen/trk12.6-20.0cm,12005,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,438.16,7216,
Rpr s/n/a/gen/trk20.1-30.0cm,12006,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,438.16,7216,
Rpr s/n/ax/gen/trnk >30.0 cm,12007,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,2863.47,68,,2863.47,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,219.99,7216,
Rpr f/e/e/n/l/m 2.5 cm/<,12011,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,958.33,,,958.33,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,268.96,,,268.96,Fee Schedule,,227.96,,,227.96,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,219.99,9473,
Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,958.33,,,958.33,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,285.36,,,285.36,Fee Schedule,,241.86,,,241.86,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,219.99,9473,
Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,364.08,,,364.08,Fee Schedule,,308.58,,,308.58,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,219.99,7216,
Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,219.99,7216,
Rpr fe/e/en/l/m 12.6-20.0 cm,12016,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,438.16,7216,
Rpr fe/e/en/l/m 20.1-30.0 cm,12017,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,438.16,7216,
Rpr f/e/e/n/l/m >30.0 cm,12018,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,2863.47,68,,2863.47,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,219.99,7216,
Closure of split wound,12020,CPT,,,,,,,,both,,,35741.92,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24304.51,68,,24304.51,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,28593.54,80,,28593.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28593.54,80,,28593.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25019.34,70,,25019.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,690.13,28593.54,
Closure of split wound,12021,CPT,,,,,,,,both,,,33626.79,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22866.22,68,,22866.22,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,26901.43,80,,26901.43,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26901.43,80,,26901.43,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23538.75,70,,23538.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,26901.43,
Intmd rpr s/a/t/ext 2.5 cm/<,12031,CPT,,,,,,,,both,,,37087.59,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,25961.31,70,,25961.31,percent of total billed charges,,25219.56,68,,25219.56,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,29670.07,80,,29670.07,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29670.07,80,,29670.07,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25961.31,70,,25961.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,29670.07,
Intmd rpr s/a/t/ext 2.6-7.5,12032,CPT,,,,,,,,both,,,34955.57,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24468.9,70,,24468.9,percent of total billed charges,,23769.79,68,,23769.79,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,27964.46,80,,27964.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27964.46,80,,27964.46,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24468.9,70,,24468.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,27964.46,
Intmd rpr s/tr/ext 7.6-12.5,12034,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Intmd rpr s/a/t/ext 12.6-20,12035,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Intmd rpr s/a/t/ext 20.1-30,12036,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8982.95,68,,8982.95,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,690.13,10568.18,
Intmd rpr s/tr/ext >30.0 cm,12037,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,727.5,30686.04,
Intmd rpr n-hf/genit 2.5cm/<,12041,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Intmd rpr n-hf/genit2.6-7.5,12042,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Intmd rpr n-hf/genit7.6-12.5,12044,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8982.95,68,,8982.95,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,690.13,10568.18,
Intmd rpr n-hf/genit12.6-20,12045,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8982.95,68,,8982.95,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,690.13,10568.18,
Intmd rpr n-hf/genit20.1-30,12046,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8982.95,68,,8982.95,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,690.13,10568.18,
Intmd rpr n-hf/genit >30.0cm,12047,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,727.5,30686.04,
Intmd rpr face/mm 2.5 cm/<,12051,CPT,,,,,,,,both,,,35324.33,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24727.03,70,,24727.03,percent of total billed charges,,24020.54,68,,24020.54,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,28259.46,80,,28259.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28259.46,80,,28259.46,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24727.03,70,,24727.03,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,28259.46,
Intmd rpr face/mm 2.6-5.0 cm,12052,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Intmd rpr face/mm 5.1-7.5 cm,12053,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Intmd rpr face/mm 7.6-12.5cm,12054,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Intmd rpr face/mm 12.6-20 cm,12055,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Intmd rpr face/mm 20.1-30.0,12056,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Intmd rpr face/mm >30.0 cm,12057,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Cmplx rpr trunk 1.1-2.5 cm,13100,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8982.95,68,,8982.95,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,10568.18,
Cmplx rpr trunk 2.6-7.5 cm,13101,CPT,,,,,,,,both,,,34403.66,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1241.44,,,1241.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24082.56,70,,24082.56,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,24082.56,
Cmplx rpr trunk addl 5cm/<,13102,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,347.68,,,347.68,Fee Schedule,,294.68,,,294.68,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,0.01,41257.63,
Cmplx rpr s/a/l 1.1-2.5 cm,13120,CPT,,,,,,,,both,,,38708.34,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26321.67,68,,26321.67,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,30966.67,80,,30966.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30966.67,80,,30966.67,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,27095.84,70,,27095.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,30966.67,
Cmplx rpr s/a/l 2.6-7.5 cm,13121,CPT,,,,,,,,both,,,34012,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1241.44,,,1241.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23808.4,70,,23808.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,23808.4,
Cmplx rpr s/a/l addl 5 cm/>,13122,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,401.8,,,401.8,Fee Schedule,,340.55,,,340.55,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,0.01,41257.63,
Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,CPT,,,,,,,,both,,,34288.5,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23316.18,68,,23316.18,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,27430.8,80,,27430.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27430.8,80,,27430.8,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24001.95,70,,24001.95,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,438.16,27430.8,
Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,CPT,,,,,,,,both,,,36334.59,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1241.44,,,1241.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25434.21,70,,25434.21,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,25434.21,
Cmplx rpr f/c/c/m/n/ax/g/h/f,13133,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,0.01,41257.63,
Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1241.44,,,1241.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,9473,
Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1241.44,,,1241.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,9473,
Cmplx rpr e/n/e/l addl 5cm/<,13153,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2242.46,,,2242.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,0.01,36100.43,
Late closure of wound,13160,CPT,,,,,,,,both,,,42510.74,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,28907.3,68,,28907.3,percent of total billed charges,,2493.46,,,2493.46,Other,186% of Medicaid,34008.59,80,,34008.59,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34008.59,80,,34008.59,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29757.52,70,,29757.52,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,34008.59,
Tis trnfr trunk 10 sq cm/<,14000,CPT,,,,,,,,both,,,37536.83,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25525.04,68,,25525.04,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,30029.46,80,,30029.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30029.46,80,,30029.46,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26275.78,70,,26275.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,30029.46,
Tis trnfr trunk 10.1-30sqcm,14001,CPT,,,,,,,,both,,,45392.1,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,31774.47,70,,31774.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,31774.47,
Tis trnfr s/a/l 10 sq cm/<,14020,CPT,,,,,,,,both,,,39919.58,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27943.71,70,,27943.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,27943.71,
Tis trnfr s/a/l 10.1-30 sqcm,14021,CPT,,,,,,,,both,,,39136.09,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27395.26,70,,27395.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,27395.26,
Tis trnfr f/c/c/m/n/a/g/h/f,14040,CPT,,,,,,,,both,,,35494.9,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24136.53,68,,24136.53,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,28395.92,80,,28395.92,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28395.92,80,,28395.92,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24846.43,70,,24846.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,28395.92,
Tis trnfr f/c/c/m/n/a/g/h/f,14041,CPT,,,,,,,,both,,,36489.01,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25542.31,70,,25542.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,25542.31,
Tis trnfr e/n/e/l 10 sq cm/<,14060,CPT,,,,,,,,both,,,37887.21,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26521.05,70,,26521.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26521.05,
Tis trnfr e/n/e/l10.1-30sqcm,14061,CPT,,,,,,,,both,,,41980.43,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29386.3,70,,29386.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,29386.3,
Tis trnfr any 30.1-60 sq cm,14301,CPT,,,,,,,,both,,,38120.07,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26684.05,70,,26684.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26684.05,
Tis trnfr addl 30 sq cm,14302,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,66803.2,
Filleted finger/toe flap,14350,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Wound prep trk/arm/leg,15002,CPT,,,,,,,,both,,,52099.26,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35427.5,68,,35427.5,percent of total billed charges,,2493.46,,,2493.46,Other,186% of Medicaid,41679.41,80,,41679.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41679.41,80,,41679.41,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,36469.48,70,,36469.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,41679.41,
Wound prep addl 100 cm,15003,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,219.76,,,219.76,Fee Schedule,,186.26,,,186.26,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,0.01,25945.68,
Wound prep f/n/hf/g,15004,CPT,,,,,,,,both,,,53677.47,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,36500.68,68,,36500.68,percent of total billed charges,,2493.46,,,2493.46,Other,186% of Medicaid,42941.98,80,,42941.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,42941.98,80,,42941.98,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,37574.23,70,,37574.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,690.13,42941.98,
Wnd prep f/n/hf/g addl cm,15005,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,434.6,,,434.6,Fee Schedule,,368.35,,,368.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,0.01,25945.68,
Harvest cultured skin graft,15040,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,30686.04,
Skin pinch graft,15050,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8982.95,68,,8982.95,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,10568.18,
Skin splt grft trnk/arm/leg,15100,CPT,,,,,,,,both,,,44592.35,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,30322.8,68,,30322.8,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,35673.88,80,,35673.88,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35673.88,80,,35673.88,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,31214.65,70,,31214.65,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,35673.88,
Skin splt grft t/a/l add-on,15101,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,539.56,,,539.56,Fee Schedule,,457.31,,,457.31,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,45135.64,
Epidrm autogrft trnk/arm/leg,15110,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,30686.04,
Epidrm autogrft t/a/l add-on,15111,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,41257.63,
Epidrm a-grft face/nck/hf/g,15115,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,30686.04,
Epidrm a-grft f/n/hf/g addl,15116,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Skn splt a-grft fac/nck/hf/g,15120,CPT,,,,,,,,both,,,43467.36,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29557.8,68,,29557.8,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,34773.89,80,,34773.89,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34773.89,80,,34773.89,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,30427.15,70,,30427.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,34773.89,
Skn splt a-grft f/n/hf/g add,15121,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,45135.64,
Derm autograft trnk/arm/leg,15130,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,30686.04,
Derm autograft t/a/l add-on,15131,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,436.24,,,436.24,Fee Schedule,,369.74,,,369.74,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Derm autograft face/nck/hf/g,15135,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,51313.6,68,,51313.6,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,60368.94,
Derm autograft f/n/hf/g add,15136,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,436.24,,,436.24,Fee Schedule,,369.74,,,369.74,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Cult skin grft t/arm/leg,15150,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,30686.04,
Cult skin grft t/a/l addl,15151,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Cult skin graft t/a/l +%,15152,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Cult skin graft f/n/hf/g,15155,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,51313.6,68,,51313.6,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,60368.94,
Cult skin grft f/n/hfg add,15156,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Cult epiderm grft f/n/hfg +%,15157,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Skin full graft trunk,15200,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Skin full graft trunk add-on,15201,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,372.28,,,372.28,Fee Schedule,,315.53,,,315.53,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,41257.63,
Skin full graft sclp/arm/leg,15220,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,30686.04,
Skin full graft add-on,15221,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,334.56,,,334.56,Fee Schedule,,283.56,,,283.56,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,41257.63,
Skin full grft face/genit/hf,15240,CPT,,,,,,,,both,,,35564.94,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24895.46,70,,24895.46,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,24895.46,
Skin full graft add-on,15241,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,45135.64,
Skin full graft een & lips,15260,CPT,,,,,,,,both,,,36243.1,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24645.31,68,,24645.31,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,28994.48,80,,28994.48,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28994.48,80,,28994.48,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25370.17,70,,25370.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,28994.48,
Skin full graft add-on,15261,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,41257.63,
Skin sub graft trnk/arm/leg,15271,CPT,,,,,,,,both,,,48047.99,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,32672.63,68,,32672.63,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,38438.39,80,,38438.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,38438.39,80,,38438.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,33633.59,70,,33633.59,percent of total billed charges,,405.08,,,405.08,Fee Schedule,,343.33,,,343.33,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,343.33,38438.39,
Skin sub graft t/a/l add-on,15272,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Skin sub grft t/arm/lg child,15273,CPT,,,,,,,,both,,,76185.34,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,51806.03,68,,51806.03,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,60948.27,80,,60948.27,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,60948.27,80,,60948.27,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,53329.74,70,,53329.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,60948.27,
Skn sub grft t/a/l child add,15274,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Skin sub graft face/nk/hf/g,15275,CPT,,,,,,,,both,,,45432.24,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,30893.92,68,,30893.92,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,36345.79,80,,36345.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,36345.79,80,,36345.79,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,31802.57,70,,31802.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,36345.79,
Skin sub graft f/n/hf/g addl,15276,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Skn sub grft f/n/hf/g child,15277,CPT,,,,,,,,both,,,68206.6,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46380.49,68,,46380.49,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,54565.28,80,,54565.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54565.28,80,,54565.28,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47744.62,70,,47744.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,54565.28,
Skn sub grft f/n/hf/g ch add,15278,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,270.6,,,270.6,Fee Schedule,,229.35,,,229.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,25945.68,
Skin pedicle flap trunk,15570,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Skin pedicle flap arms/legs,15572,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,52822.83,
Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Pedicle e/n/e/l/ntroral,15576,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Delay flap trunk,15600,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,52822.83,
Delay flap arms/legs,15610,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Delay flap f/c/c/n/ax/g/h/f,15620,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Delay flap eye/nos/ear/lip,15630,CPT,,,,,,,,both,,,35844.47,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25091.13,70,,25091.13,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,25091.13,
Transfer skin pedicle flap,15650,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Mdfc flap w/prsrv vasc pedcl,15730,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,52822.83,
Forehead flap w/vasc pedicle,15731,CPT,,,,,,,,both,,,37166,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26016.2,70,,26016.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26016.2,
Musc myoq/fscq flp h&n pedcl,15733,CPT,,,,,,,,both,,,114832.81,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,80382.97,70,,80382.97,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,80382.97,
Muscle-skin graft trunk,15734,CPT,,,,,,,,both,,,41979.88,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,29385.92,70,,29385.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,29385.92,
Muscle-skin graft arm,15736,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Muscle-skin graft leg,15738,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,52822.83,
Island pedicle flap graft,15740,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,30686.04,
Neurovascular pedicle flap,15750,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,51313.6,68,,51313.6,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,60368.94,
Composite skin graft,15760,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,30686.04,
Grfg autol soft tiss dir exc,15769,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,52822.83,
Derma-fat-fascia graft,15770,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,52822.83,
Grfg autol fat lipo 50 cc/<,15771,CPT,,,,,,,,both,,,37767.03,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26436.92,70,,26436.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26436.92,
Grfg autol fat lipo 25 cc/<,15773,CPT,,,,,,,,both,,,36802.85,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25025.94,68,,25025.94,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,29442.28,80,,29442.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29442.28,80,,29442.28,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25762,70,,25762,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,29442.28,
Hair trnspl 1-15 punch grfts,15775,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1241.44,,,1241.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,438.16,9473,
Hair trnspl >15 punch grafts,15776,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1241.44,,,1241.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,438.16,9473,
Acellular derm matrix implt,15777,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,41257.63,
Dermabrasion total face,15780,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,6152,,,6152,Case Rate,,1207.71,,,1207.71,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,649.31,41837.04,
Dermabrasion segmental face,15781,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,6152,,,6152,Case Rate,,1207.71,,,1207.71,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,649.31,10359.16,
Dermabrasion other than face,15782,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,6152,,,6152,Case Rate,,1207.71,,,1207.71,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,649.31,41837.04,
Dermabrasion suprfl any site,15783,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,6152,,,6152,Case Rate,,1207.71,,,1207.71,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,438.16,9473,
Abrasion lesion single,15786,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,9473,
Abrasion lesions add-on,15787,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,80.36,,,80.36,Fee Schedule,,68.11,,,68.11,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,0.01,45135.64,
Chemical peel face epiderm,15788,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,9473,
Chemical peel face dermal,15789,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,9473,
Chemical peel nonfacial,15792,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,9473,
Chemical peel nonfacial,15793,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,9473,
Plastic surgery neck,15819,CPT,,,,,,,,both,,,42554.16,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29787.91,70,,29787.91,percent of total billed charges,,28936.83,68,,28936.83,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,34043.33,80,,34043.33,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34043.33,80,,34043.33,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29787.91,70,,29787.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,34043.33,
Revision of lower eyelid,15820,CPT,,,,,,,,both,,,52507.66,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,36755.36,70,,36755.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,36755.36,
Revision of lower eyelid,15821,CPT,,,,,,,,both,,,38470.57,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26929.4,70,,26929.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,26929.4,
Revision of upper eyelid,15822,CPT,,,,,,,,both,,,33859.66,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23701.76,70,,23701.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,23701.76,
Revision of upper eyelid,15823,CPT,,,,,,,,both,,,35176.52,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24623.56,70,,24623.56,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,24623.56,
Removal of forehead wrinkles,15824,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,24932.41,65,,24932.41,percent of total billed charges,,24932.41,65,,24932.41,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,26850.29,
Removal of neck wrinkles,15825,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,49049.77,65,,49049.77,percent of total billed charges,,49049.77,65,,49049.77,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,52822.83,
Removal of brow wrinkles,15826,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,49049.77,65,,49049.77,percent of total billed charges,,49049.77,65,,49049.77,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,52822.83,
Removal of face wrinkles,15828,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,49049.77,65,,49049.77,percent of total billed charges,,49049.77,65,,49049.77,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,52822.83,
Removal of skin wrinkles,15829,CPT,,,,,,,,both,,,70986.49,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,49690.54,70,,49690.54,percent of total billed charges,,46141.22,65,,46141.22,percent of total billed charges,,46141.22,65,,46141.22,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,49690.54,
Exc skin abd,15830,CPT,,,,,,,,both,,,54151.53,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,37906.07,70,,37906.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,37906.07,
Excise excessive skin thigh,15832,CPT,,,,,,,,both,,,34291.71,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24004.2,70,,24004.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,24004.2,
Excise excessive skin leg,15833,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,41837.04,
Excise excessive skin hip,15834,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,41837.04,
Excise excessive skin buttck,15835,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,41837.04,
Excise excessive skin arm,15836,CPT,,,,,,,,both,,,67795.49,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47456.84,70,,47456.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,47456.84,
Excise excess skin arm/hand,15837,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,40641.7,68,,40641.7,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,47813.76,
Excise excess skin fat pad,15838,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,40641.7,68,,40641.7,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,47813.76,
Excise excess skin & tissue,15839,CPT,,,,,,,,both,,,42064.03,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29444.82,70,,29444.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,29444.82,
Nerve palsy fascial graft,15840,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,52822.83,
Nerve palsy muscle graft,15841,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,52822.83,
Nerve palsy microsurg graft,15842,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Skin and muscle repair face,15845,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,52822.83,
Exc skin abd add-on,15847,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,41911.66,65,,41911.66,percent of total billed charges,,41911.66,65,,41911.66,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,0.01,45135.64,
Remove sutures diff surgeon,15851,CPT,,,,,,,,both,,,34850.17,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,24395.12,70,,24395.12,percent of total billed charges,,23698.12,68,,23698.12,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,27880.14,80,,27880.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27880.14,80,,27880.14,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24395.12,70,,24395.12,percent of total billed charges,,316.52,,,316.52,Fee Schedule,,268.27,,,268.27,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,268.27,27880.14,
Dressing change not for burn,15852,CPT,,,,,,,,both,,,35304.33,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24713.03,70,,24713.03,percent of total billed charges,,24006.94,68,,24006.94,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,28243.46,80,,28243.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28243.46,80,,28243.46,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24713.03,70,,24713.03,percent of total billed charges,,224.68,,,224.68,Fee Schedule,,190.43,,,190.43,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,190.43,28243.46,
Test for blood flow in graft,15860,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,5698.86,68,,5698.86,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,437.83,7216,
Suction lipectomy head&neck,15876,CPT,,,,,,,,both,,,51329.22,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,35930.45,70,,35930.45,percent of total billed charges,,33363.99,65,,33363.99,percent of total billed charges,,33363.99,65,,33363.99,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,35930.45,
Suction lipectomy trunk,15877,CPT,,,,,,,,both,,,31862.45,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,22303.72,70,,22303.72,percent of total billed charges,,20710.59,65,,20710.59,percent of total billed charges,,20710.59,65,,20710.59,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,22303.72,
Suction lipectomy upr extrem,15878,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,24932.41,65,,24932.41,percent of total billed charges,,24932.41,65,,24932.41,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,26850.29,
Suction lipectomy lwr extrem,15879,CPT,,,,,,,,both,,,38854.71,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27198.3,70,,27198.3,percent of total billed charges,,25255.56,65,,25255.56,percent of total billed charges,,25255.56,65,,25255.56,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,27198.3,
Removal of tail bone ulcer,15920,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,41837.04,
Removal of tail bone ulcer,15922,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,52822.83,
Remove sacrum pressure sore,15931,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,41837.04,
Remove sacrum pressure sore,15933,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,41837.04,
Remove sacrum pressure sore,15934,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,52822.83,
Remove sacrum pressure sore,15935,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,52822.83,
Remove sacrum pressure sore,15936,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,26850.29,
Remove sacrum pressure sore,15937,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,26850.29,
Remove hip pressure sore,15940,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,41837.04,
Remove hip pressure sore,15941,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,41837.04,
Remove hip pressure sore,15944,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,52822.83,
Remove hip pressure sore,15945,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,26850.29,
Remove hip pressure sore,15946,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,26850.29,
Remove thigh pressure sore,15950,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,23871.23,
Remove thigh pressure sore,15951,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,41837.04,
Remove thigh pressure sore,15952,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,26850.29,
Remove thigh pressure sore,15953,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,52822.83,
Remove thigh pressure sore,15956,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,26850.29,
Remove thigh pressure sore,15958,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,52822.83,
Initial treatment of burn(s),16000,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,958.33,,,958.33,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,223.04,,,223.04,Fee Schedule,,189.04,,,189.04,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,189.04,9473,
Dress/debrid p-thick burn s,16020,CPT,,,,,,,,both,,,33793.97,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23655.78,70,,23655.78,percent of total billed charges,,22979.9,68,,22979.9,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,27035.18,80,,27035.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27035.18,80,,27035.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23655.78,70,,23655.78,percent of total billed charges,,270.6,,,270.6,Fee Schedule,,229.35,,,229.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,219.99,27035.18,
Dress/debrid p-thick burn m,16025,CPT,,,,,,,,both,,,38051.11,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25874.75,68,,25874.75,percent of total billed charges,,958.33,,,958.33,Other,186% of Medicaid,30440.89,80,,30440.89,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30440.89,80,,30440.89,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,26635.78,70,,26635.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,515.23,,,515.23,Other,New York Medicaid APG methodology,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,515.23,,,515.23,Other,100% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,788.3,,,788.3,Other,153% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,721.32,,,721.32,Other,140% New York Medicaid APG,1159.26,,,1159.26,Other,225% New York Medicaid APG,1339.59,,,1339.59,Other,260% New York Medicaid APG,1669.34,,,1669.34,Other,324% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,1107.74,,,1107.74,Other,215% New York Medicaid APG,644.04,,,644.04,Other,125% New York Medicaid APG,219.99,30440.89,
Dress/debrid p-thick burn l,16030,CPT,,,,,,,,both,,,34605.58,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23531.79,68,,23531.79,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,27684.46,80,,27684.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27684.46,80,,27684.46,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24223.91,70,,24223.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,27684.46,
Incision of burn scab initi,16035,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,438.16,7216,
Destruct premalg lesion,17000,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,267.32,,,267.32,Fee Schedule,,226.57,,,226.57,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Destruct premalg les 2-14,17003,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,9.84,,,9.84,Fee Schedule,,8.34,,,8.34,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,0.01,25945.68,
Destroy premal lesions 15/>,17004,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,483.8,,,483.8,Fee Schedule,,410.05,,,410.05,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Destruction of skin lesions,17106,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,1207.71,,,1207.71,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,438.16,7216,
Destruction of skin lesions,17107,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,1207.71,,,1207.71,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,649.31,10568.18,
Destruction of skin lesions,17108,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,26083.13,68,,26083.13,percent of total billed charges,,1207.71,,,1207.71,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,649.31,30686.04,
Destruct b9 lesion 1-14,17110,CPT,,,,,,,,both,,,36111.92,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,25278.34,70,,25278.34,percent of total billed charges,,24556.11,68,,24556.11,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,28889.54,80,,28889.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28889.54,80,,28889.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25278.34,70,,25278.34,percent of total billed charges,,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,28889.54,
Destruct lesion 15 or more,17111,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,401.8,,,401.8,Fee Schedule,,340.55,,,340.55,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Chem caut of granltj tissue,17250,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,182.04,,,182.04,Fee Schedule,,154.29,,,154.29,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,154.29,7216,
Destruction of skin lesions,17260,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,344.4,,,344.4,Fee Schedule,,291.9,,,291.9,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Destruction of skin lesions,17261,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,421.48,,,421.48,Fee Schedule,,357.23,,,357.23,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Destruction of skin lesions,17262,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,537.92,,,537.92,Fee Schedule,,455.92,,,455.92,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Destruction of skin lesions,17263,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Destruction of skin lesions,17264,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Destruction of skin lesions,17266,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Destruction of skin lesions,17270,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,465.76,,,465.76,Fee Schedule,,394.76,,,394.76,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Destruction of skin lesions,17271,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,513.32,,,513.32,Fee Schedule,,435.07,,,435.07,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Destruction of skin lesions,17272,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Destruction of skin lesions,17273,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Destruction of skin lesions,17274,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Destruction of skin lesions,17276,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Destruction of skin lesions,17280,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,419.84,,,419.84,Fee Schedule,,355.84,,,355.84,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Destruction of skin lesions,17281,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,575.64,,,575.64,Fee Schedule,,487.89,,,487.89,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Destruction of skin lesions,17282,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Destruction of skin lesions,17283,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,7216,
Destruction of skin lesions,17284,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,10568.18,
Destruction of skin lesions,17286,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,10568.18,
Mohs 1 stage h/n/hf/g,17311,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,2242.47,,,2242.47,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,3134.64,,,3134.64,Other,260% New York Medicaid APG,3906.24,,,3906.24,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.04,,,1507.04,Other,125% New York Medicaid APG,690.13,10568.18,
Mohs addl stage,17312,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,2242.47,,,2242.47,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,3134.64,,,3134.64,Other,260% New York Medicaid APG,3906.24,,,3906.24,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.04,,,1507.04,Other,125% New York Medicaid APG,0.01,41257.63,
Mohs 1 stage t/a/l,17313,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,2242.47,,,2242.47,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,3134.64,,,3134.64,Other,260% New York Medicaid APG,3906.24,,,3906.24,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.04,,,1507.04,Other,125% New York Medicaid APG,690.13,10568.18,
Mohs addl stage t/a/l,17314,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,2242.47,,,2242.47,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,3134.64,,,3134.64,Other,260% New York Medicaid APG,3906.24,,,3906.24,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.04,,,1507.04,Other,125% New York Medicaid APG,0.01,41257.63,
Mohs surg addl block,17315,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,2242.47,,,2242.47,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,244.36,,,244.36,Fee Schedule,,207.11,,,207.11,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.67,,,2712.67,Other,225% New York Medicaid APG,3134.64,,,3134.64,Other,260% New York Medicaid APG,3906.24,,,3906.24,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.04,,,1507.04,Other,125% New York Medicaid APG,0.01,41257.63,
Cryotherapy of skin,17340,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,900.61,70,,900.61,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,67.21,9473,
Skin peel therapy,17360,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,454.28,,,454.28,Fee Schedule,,385.03,,,385.03,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,9473,
Hair removal by electrolysis,17380,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8586.64,65,,8586.64,percent of total billed charges,,8586.64,65,,8586.64,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,9473,
Drainage of breast lesion,19000,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,206.64,,,206.64,Fee Schedule,,175.14,,,175.14,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,175.14,11839.04,
Drain breast lesion add-on,19001,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,100.04,,,100.04,Fee Schedule,,84.79,,,84.79,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,0.01,25945.68,
Incision of breast lesion,19020,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,27281.4,
Injection for breast x-ray,19030,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,370.64,,,370.64,Fee Schedule,,314.14,,,314.14,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Bx breast 1st lesion strtctc,19081,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,27281.4,
Bx breast add lesion strtctc,19082,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,398.52,,,398.52,Fee Schedule,,337.77,,,337.77,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,0.01,41257.63,
Bx breast 1st lesion us imag,19083,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,27281.4,
Bx breast add lesion us imag,19084,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,375.56,,,375.56,Fee Schedule,,318.31,,,318.31,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,0.01,41257.63,
Bx breast 1st lesion mr imag,19085,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2794,,,2794,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,23871.23,
Bx breast add lesion mr imag,19086,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,0.01,41257.63,
Bx breast percut w/o image,19100,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,336.2,,,336.2,Fee Schedule,,284.95,,,284.95,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,284.95,27281.4,
Biopsy of breast open,19101,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,54519.03,68,,54519.03,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,64140.04,
Cryosurg ablate fa each,19105,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,6152,,,6152,Case Rate,,2794,,,2794,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,56122.54,
Nipple exploration,19110,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,54519.03,68,,54519.03,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,64140.04,
Excise breast duct fistula,19112,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2794,,,2794,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,56122.54,
Removal of breast lesion,19120,CPT,,,,,,,,both,,,38519.06,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2794,,,2794,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26963.34,70,,26963.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,26963.34,
Excision breast lesion,19125,CPT,,,,,,,,both,,,68236.71,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2794,,,2794,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47765.7,70,,47765.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,47765.7,
Excision addl breast lesion,19126,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2794,,,2794,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,0.01,45135.64,
Perq device breast 1st imag,19281,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,27281.4,
Perq device breast ea imag,19282,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,0.01,25945.68,
Perq dev breast 1st strtctc,19283,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,773.13,11839.04,
Perq dev breast add strtctc,19284,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,0.01,25945.68,
Perq dev breast 1st us imag,19285,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,410,,,410,Fee Schedule,,347.5,,,347.5,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,347.5,11839.04,
Perq dev breast add us imag,19286,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,206.64,,,206.64,Fee Schedule,,175.14,,,175.14,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,0.01,25945.68,
Perq dev breast 1st mr guide,19287,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,6152,,,6152,Case Rate,,2794,,,2794,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,773.13,10359.16,
Perq dev breast add mr guide,19288,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,2794,,,2794,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,305.04,,,305.04,Fee Schedule,,258.54,,,258.54,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,0.01,25945.68,
Prep tum cav iort prtl mast,19294,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,5443.32,,,5443.32,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2926.52,,,2926.52,Other,New York Medicaid APG methodology,2926.52,,,2926.52,Other,100% New York Medicaid APG,2926.52,,,2926.52,Other,100% New York Medicaid APG,2926.52,,,2926.52,Other,100% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,4477.57,,,4477.57,Other,153% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,4097.13,,,4097.13,Other,140% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,7608.95,,,7608.95,Other,260% New York Medicaid APG,9481.92,,,9481.92,Other,324% New York Medicaid APG,6292.01,,,6292.01,Other,215% New York Medicaid APG,6292.01,,,6292.01,Other,215% New York Medicaid APG,3658.15,,,3658.15,Other,125% New York Medicaid APG,0.01,25945.68,
Place po breast cath for rad,19296,CPT,,,,,,,,both,,,198277.38,17034.04,,,17034.04,Other,150% of Medicare + 9.63% HCRA Surcharge,10358.5,,,10358.5,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,138794.17,70,,138794.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,138794.17,
Place breast cath for rad,19297,CPT,,,,,,,,both,,,98219.64,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5443.32,,,5443.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,68753.75,70,,68753.75,percent of total billed charges,,459.2,,,459.2,Fee Schedule,,389.2,,,389.2,Fee Schedule,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2926.52,,,2926.52,Other,New York Medicaid APG methodology,2926.52,,,2926.52,Other,100% New York Medicaid APG,2926.52,,,2926.52,Other,100% New York Medicaid APG,2926.52,,,2926.52,Other,100% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,4477.57,,,4477.57,Other,153% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,4097.13,,,4097.13,Other,140% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,7608.95,,,7608.95,Other,260% New York Medicaid APG,9481.92,,,9481.92,Other,324% New York Medicaid APG,6292.01,,,6292.01,Other,215% New York Medicaid APG,6292.01,,,6292.01,Other,215% New York Medicaid APG,3658.15,,,3658.15,Other,125% New York Medicaid APG,0.01,68753.75,
Place breast rad tube/caths,19298,CPT,,,,,,,,both,,,137162.89,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,96014.02,
Removal of breast tissue,19300,CPT,,,,,,,,both,,,45740.64,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2794,,,2794,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,32018.45,70,,32018.45,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,32018.45,
Partial mastectomy,19301,CPT,,,,,,,,both,,,76143.29,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,53300.3,70,,53300.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,53300.3,
P-mastectomy w/ln removal,19302,CPT,,,,,,,,both,,,137162.89,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,96014.02,
Mast simple complete,19303,CPT,,,,,,,,both,,,62715.23,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,43900.66,70,,43900.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,43900.66,
Mast mod rad,19307,CPT,,,,,,,,both,,,137162.89,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,6152,,,6152,Case Rate,,5443.32,,,5443.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2926.52,,,2926.52,Other,New York Medicaid APG methodology,2926.52,,,2926.52,Other,100% New York Medicaid APG,2926.52,,,2926.52,Other,100% New York Medicaid APG,2926.52,,,2926.52,Other,100% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,4477.57,,,4477.57,Other,153% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,4097.13,,,4097.13,Other,140% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,7608.95,,,7608.95,Other,260% New York Medicaid APG,9481.92,,,9481.92,Other,324% New York Medicaid APG,6292.01,,,6292.01,Other,215% New York Medicaid APG,6292.01,,,6292.01,Other,215% New York Medicaid APG,3658.15,,,3658.15,Other,125% New York Medicaid APG,2926.52,96014.02,
Suspension of breast,19316,CPT,,,,,,,,both,,,46805.83,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,32764.08,70,,32764.08,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,32764.08,
Breast reduction,19318,CPT,,,,,,,,both,,,61371.41,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5443.32,,,5443.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,42959.99,70,,42959.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2926.52,,,2926.52,Other,New York Medicaid APG methodology,2926.52,,,2926.52,Other,100% New York Medicaid APG,2926.52,,,2926.52,Other,100% New York Medicaid APG,2926.52,,,2926.52,Other,100% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,4477.57,,,4477.57,Other,153% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,4097.13,,,4097.13,Other,140% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,7608.95,,,7608.95,Other,260% New York Medicaid APG,9481.92,,,9481.92,Other,324% New York Medicaid APG,6292.01,,,6292.01,Other,215% New York Medicaid APG,6292.01,,,6292.01,Other,215% New York Medicaid APG,3658.15,,,3658.15,Other,125% New York Medicaid APG,2926.52,42959.99,
Breast augmentation w/implt,19325,CPT,,,,,,,,both,,,47509.98,17034.04,,,17034.04,Other,150% of Medicare + 9.63% HCRA Surcharge,10358.5,,,10358.5,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,33256.99,70,,33256.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,33256.99,
Rmvl intact breast implant,19328,CPT,,,,,,,,both,,,39084.49,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,26577.45,68,,26577.45,percent of total billed charges,,3861.82,,,3861.82,Other,186% of Medicaid,31267.59,80,,31267.59,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31267.59,80,,31267.59,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27359.14,70,,27359.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2053,31267.59,
Rmvl ruptured breast implant,19330,CPT,,,,,,,,both,,,40997.58,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27878.35,68,,27878.35,percent of total billed charges,,3861.82,,,3861.82,Other,186% of Medicaid,32798.06,80,,32798.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32798.06,80,,32798.06,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28698.31,70,,28698.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2053,32798.06,
Insj breast implt sm d mast,19340,CPT,,,,,,,,both,,,137162.89,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,93270.77,68,,93270.77,percent of total billed charges,,3861.82,,,3861.82,Other,186% of Medicaid,109730.31,80,,109730.31,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,109730.31,80,,109730.31,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,109730.31,
Insj/rplcmt brst implt sep d,19342,CPT,,,,,,,,both,,,50740.85,17034.04,,,17034.04,Other,150% of Medicare + 9.63% HCRA Surcharge,10358.5,,,10358.5,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,35518.6,70,,35518.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,35518.6,
Breast reconstruction,19350,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,56122.54,
Correct inverted nipple(s),19355,CPT,,,,,,,,both,,,35214.64,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24650.25,70,,24650.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,24650.25,
Tiss xpndr plmt brst rcnstj,19357,CPT,,,,,,,,both,,,42861.71,31843,,,31843,Other,150% of Medicare + 9.63% HCRA Surcharge,19363.92,,,19363.92,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5443.32,,,5443.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,30003.2,70,,30003.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2926.52,,,2926.52,Other,New York Medicaid APG methodology,2926.52,,,2926.52,Other,100% New York Medicaid APG,2926.52,,,2926.52,Other,100% New York Medicaid APG,2926.52,,,2926.52,Other,100% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,4477.57,,,4477.57,Other,153% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,4097.13,,,4097.13,Other,140% New York Medicaid APG,6584.67,,,6584.67,Other,225% New York Medicaid APG,7608.95,,,7608.95,Other,260% New York Medicaid APG,9481.92,,,9481.92,Other,324% New York Medicaid APG,6292.01,,,6292.01,Other,215% New York Medicaid APG,6292.01,,,6292.01,Other,215% New York Medicaid APG,3658.15,,,3658.15,Other,125% New York Medicaid APG,2926.52,31843,
Revj peri-implt capsule brst,19370,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,56122.54,
Peri-implt capslc brst compl,19371,CPT,,,,,,,,both,,,51010.09,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,35707.06,70,,35707.06,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,35707.06,
Revj reconstructed breast,19380,CPT,,,,,,,,both,,,42520.22,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3861.82,,,3861.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,29764.15,70,,29764.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2076.25,,,2076.25,Other,New York Medicaid APG methodology,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,2076.25,,,2076.25,Other,100% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,3176.66,,,3176.66,Other,153% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,2906.75,,,2906.75,Other,140% New York Medicaid APG,4671.56,,,4671.56,Other,225% New York Medicaid APG,5398.25,,,5398.25,Other,260% New York Medicaid APG,6727.04,,,6727.04,Other,324% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,4463.93,,,4463.93,Other,215% New York Medicaid APG,2595.31,,,2595.31,Other,125% New York Medicaid APG,2076.25,29764.15,
Design custom breast implant,19396,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,6152,,,6152,Case Rate,,2794,,,2794,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1502.15,,,1502.15,Other,New York Medicaid APG methodology,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,1502.15,,,1502.15,Other,100% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2298.29,,,2298.29,Other,153% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,2103.01,,,2103.01,Other,140% New York Medicaid APG,3379.84,,,3379.84,Other,225% New York Medicaid APG,3905.59,,,3905.59,Other,260% New York Medicaid APG,4866.97,,,4866.97,Other,324% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,3229.62,,,3229.62,Other,215% New York Medicaid APG,1877.69,,,1877.69,Other,125% New York Medicaid APG,1502.15,56122.54,
Explore wound neck,20100,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8101,70,,8101,percent of total billed charges,,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,604.59,9473,
Explore wound chest,20101,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,26850.29,
Explore wound abdomen,20102,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,6152,,,6152,Case Rate,,2493.46,,,2493.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1340.57,,,1340.57,Other,New York Medicaid APG methodology,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,1340.57,,,1340.57,Other,100% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,2051.07,,,2051.07,Other,153% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,1876.8,,,1876.8,Other,140% New York Medicaid APG,3016.28,,,3016.28,Other,225% New York Medicaid APG,3485.48,,,3485.48,Other,260% New York Medicaid APG,4343.45,,,4343.45,Other,324% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,2882.23,,,2882.23,Other,215% New York Medicaid APG,1675.71,,,1675.71,Other,125% New York Medicaid APG,1340.57,26850.29,
Explore wound extremity,20103,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,1353.14,,,1353.14,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,727.5,27281.4,
Excise epiphyseal bar,20150,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47657.93,
Muscle biopsy,20200,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,464.12,,,464.12,Fee Schedule,,393.37,,,393.37,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,393.37,27281.4,
Deep muscle biopsy,20205,CPT,,,,,,,,both,,,42752,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29926.4,70,,29926.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,29926.4,
Needle biopsy muscle,20206,CPT,,,,,,,,both,,,67811.2,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46111.62,68,,46111.62,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,54248.96,80,,54248.96,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54248.96,80,,54248.96,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47467.84,70,,47467.84,percent of total billed charges,,277.16,,,277.16,Fee Schedule,,234.91,,,234.91,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,234.91,54248.96,
Bone biopsy trocar/needle,20220,CPT,,,,,,,,both,,,41632.49,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,28310.09,68,,28310.09,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,33305.99,80,,33305.99,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33305.99,80,,33305.99,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,29142.74,70,,29142.74,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,360.01,33305.99,
Bone biopsy trocar/needle,20225,CPT,,,,,,,,both,,,40382.03,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27459.78,68,,27459.78,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,32305.62,80,,32305.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32305.62,80,,32305.62,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28267.42,70,,28267.42,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,32305.62,
Bone biopsy open superficial,20240,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Bone biopsy open deep,20245,CPT,,,,,,,,both,,,47982.32,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,33587.62,70,,33587.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,33587.62,
Open bone biopsy,20250,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,47657.93,
Open bone biopsy,20251,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Injection of sinus tract,20500,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,436.24,,,436.24,Fee Schedule,,369.74,,,369.74,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,369.74,25661.91,
Inject sinus tract for x-ray,20501,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,177.12,,,177.12,Fee Schedule,,150.12,,,150.12,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Removal of foreign body,20520,CPT,,,,,,,,both,,,34057.08,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23839.96,70,,23839.96,percent of total billed charges,,23158.81,68,,23158.81,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27245.66,80,,27245.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27245.66,80,,27245.66,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23839.96,70,,23839.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27245.66,
Removal of foreign body,20525,CPT,,,,,,,,both,,,33471.9,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23430.33,70,,23430.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,23430.33,
Ther injection carp tunnel,20526,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,278.8,,,278.8,Fee Schedule,,236.3,,,236.3,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,236.3,7216,
Inj dupuytren cord w/enzyme,20527,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,321.44,,,321.44,Fee Schedule,,272.44,,,272.44,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,272.44,7216,
Inj tendon sheath/ligament,20550,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,190.24,,,190.24,Fee Schedule,,161.24,,,161.24,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,161.24,7216,
Inj tendon origin/insertion,20551,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,190.24,,,190.24,Fee Schedule,,161.24,,,161.24,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,161.24,7216,
Inj trigger point 1/2 muscl,20552,CPT,,,,,,,,both,,,10572.63,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,7400.84,70,,7400.84,percent of total billed charges,,7189.39,68,,7189.39,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,8458.1,80,,8458.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,8458.1,80,,8458.1,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,7400.84,70,,7400.84,percent of total billed charges,,180.4,,,180.4,Fee Schedule,,152.9,,,152.9,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,152.9,8458.1,
Inject trigger points 3/>,20553,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,206.64,,,206.64,Fee Schedule,,175.14,,,175.14,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,175.14,7216,
Place ndl musc/tis for rt,20555,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,54466.2,
Drain/inj joint/bursa w/o us,20600,CPT,,,,,,,,both,,,34087.51,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23861.26,70,,23861.26,percent of total billed charges,,23179.51,68,,23179.51,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,27270.01,80,,27270.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27270.01,80,,27270.01,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23861.26,70,,23861.26,percent of total billed charges,,172.2,,,172.2,Fee Schedule,,145.95,,,145.95,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,145.95,27270.01,
Drain/inj joint/bursa w/us,20604,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,1080.24,,,1080.24,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,223.04,,,223.04,Fee Schedule,,189.04,,,189.04,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,580.77,,,580.77,Other,New York Medicaid APG methodology,580.77,,,580.77,Other,100% New York Medicaid APG,580.77,,,580.77,Other,100% New York Medicaid APG,580.77,,,580.77,Other,100% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,888.58,,,888.58,Other,153% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,813.08,,,813.08,Other,140% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,1510.01,,,1510.01,Other,260% New York Medicaid APG,1881.7,,,1881.7,Other,324% New York Medicaid APG,1248.66,,,1248.66,Other,215% New York Medicaid APG,1248.66,,,1248.66,Other,215% New York Medicaid APG,725.97,,,725.97,Other,125% New York Medicaid APG,189.04,7216,
Drain/inj joint/bursa w/o us,20605,CPT,,,,,,,,both,,,3766.45,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2636.52,70,,2636.52,percent of total billed charges,,2561.19,68,,2561.19,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,3013.16,80,,3013.16,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3013.16,80,,3013.16,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2636.52,70,,2636.52,percent of total billed charges,,180.4,,,180.4,Fee Schedule,,152.9,,,152.9,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,152.9,7216,
Drain/inj joint/bursa w/us,20606,CPT,,,,,,,,both,,,3266.33,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2286.43,70,,2286.43,percent of total billed charges,,2221.1,68,,2221.1,percent of total billed charges,,1080.24,,,1080.24,Other,186% of Medicaid,2613.06,80,,2613.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2613.06,80,,2613.06,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2286.43,70,,2286.43,percent of total billed charges,,252.56,,,252.56,Fee Schedule,,214.06,,,214.06,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,580.77,,,580.77,Other,New York Medicaid APG methodology,580.77,,,580.77,Other,100% New York Medicaid APG,580.77,,,580.77,Other,100% New York Medicaid APG,580.77,,,580.77,Other,100% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,888.58,,,888.58,Other,153% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,813.08,,,813.08,Other,140% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,1510.01,,,1510.01,Other,260% New York Medicaid APG,1881.7,,,1881.7,Other,324% New York Medicaid APG,1248.66,,,1248.66,Other,215% New York Medicaid APG,1248.66,,,1248.66,Other,215% New York Medicaid APG,725.97,,,725.97,Other,125% New York Medicaid APG,214.06,7216,
Drain/inj joint/bursa w/o us,20610,CPT,,,,,,,,both,,,9021.14,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6314.8,70,,6314.8,percent of total billed charges,,6134.38,68,,6134.38,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,7216.91,80,,7216.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,7216.91,80,,7216.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6314.8,70,,6314.8,percent of total billed charges,,219.76,,,219.76,Fee Schedule,,186.26,,,186.26,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,186.26,7216.91,
Drain/inj joint/bursa w/us,20611,CPT,,,,,,,,both,,,19379.67,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13565.77,70,,13565.77,percent of total billed charges,,13178.18,68,,13178.18,percent of total billed charges,,1080.24,,,1080.24,Other,186% of Medicaid,15503.74,80,,15503.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15503.74,80,,15503.74,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,13565.77,70,,13565.77,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,580.77,,,580.77,Other,New York Medicaid APG methodology,580.77,,,580.77,Other,100% New York Medicaid APG,580.77,,,580.77,Other,100% New York Medicaid APG,580.77,,,580.77,Other,100% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,888.58,,,888.58,Other,153% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,813.08,,,813.08,Other,140% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,1510.01,,,1510.01,Other,260% New York Medicaid APG,1881.7,,,1881.7,Other,324% New York Medicaid APG,1248.66,,,1248.66,Other,215% New York Medicaid APG,1248.66,,,1248.66,Other,215% New York Medicaid APG,725.97,,,725.97,Other,125% New York Medicaid APG,247.42,15503.74,
Aspirate/inj ganglion cyst,20612,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,200.08,,,200.08,Fee Schedule,,169.58,,,169.58,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,169.58,7216,
Treatment of bone cyst,20615,CPT,,,,,,,,both,,,56392.4,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,39474.68,70,,39474.68,percent of total billed charges,,38346.83,68,,38346.83,percent of total billed charges,,1080.24,,,1080.24,Other,186% of Medicaid,45113.92,80,,45113.92,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,45113.92,80,,45113.92,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,39474.68,70,,39474.68,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,580.77,,,580.77,Other,New York Medicaid APG methodology,580.77,,,580.77,Other,100% New York Medicaid APG,580.77,,,580.77,Other,100% New York Medicaid APG,580.77,,,580.77,Other,100% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,888.58,,,888.58,Other,153% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,813.08,,,813.08,Other,140% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,1510.01,,,1510.01,Other,260% New York Medicaid APG,1881.7,,,1881.7,Other,324% New York Medicaid APG,1248.66,,,1248.66,Other,215% New York Medicaid APG,1248.66,,,1248.66,Other,215% New York Medicaid APG,725.97,,,725.97,Other,125% New York Medicaid APG,580.77,45113.92,
Insert and remove bone pin,20650,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3028.75,,,3028.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,47657.93,
Apply rem fixation device,20660,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,22987.73,68,,22987.73,percent of total billed charges,,3028.75,,,3028.75,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,27044.39,
Application of pelvis brace,20662,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,6152,,,6152,Case Rate,,3028.75,,,3028.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,23663.84,
Application of thigh brace,20663,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3028.75,,,3028.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,47657.93,
Removal of fixation device,20665,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,5698.86,68,,5698.86,percent of total billed charges,,982.66,,,982.66,Other,186% of Medicaid,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,477.24,,,477.24,Fee Schedule,,404.49,,,404.49,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,528.31,,,528.31,Other,New York Medicaid APG methodology,528.31,,,528.31,Other,100% New York Medicaid APG,528.31,,,528.31,Other,100% New York Medicaid APG,528.31,,,528.31,Other,100% New York Medicaid APG,1188.7,,,1188.7,Other,225% New York Medicaid APG,808.32,,,808.32,Other,153% New York Medicaid APG,1188.7,,,1188.7,Other,225% New York Medicaid APG,739.64,,,739.64,Other,140% New York Medicaid APG,1188.7,,,1188.7,Other,225% New York Medicaid APG,1373.61,,,1373.61,Other,260% New York Medicaid APG,1711.73,,,1711.73,Other,324% New York Medicaid APG,1135.87,,,1135.87,Other,215% New York Medicaid APG,1135.87,,,1135.87,Other,215% New York Medicaid APG,660.39,,,660.39,Other,125% New York Medicaid APG,404.49,7216,
Removal of support implant,20670,CPT,,,,,,,,both,,,37746.38,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25667.54,68,,25667.54,percent of total billed charges,,3028.75,,,3028.75,Other,186% of Medicaid,30197.1,80,,30197.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30197.1,80,,30197.1,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26422.47,70,,26422.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,30197.1,
Removal of support implant,20680,CPT,,,,,,,,both,,,50892.55,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3028.75,,,3028.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,35624.79,70,,35624.79,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,35624.79,
Apply bone fixation device,20690,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3028.75,,,3028.75,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,120381.32,
Apply bone fixation device,20692,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3028.75,,,3028.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,193779.51,
Adjust bone fixation device,20693,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3028.75,,,3028.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,105333.66,
Remove bone fixation device,20694,CPT,,,,,,,,both,,,37783.1,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25692.51,68,,25692.51,percent of total billed charges,,3028.75,,,3028.75,Other,186% of Medicaid,30226.48,80,,30226.48,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30226.48,80,,30226.48,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26448.17,70,,26448.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,30226.48,
Comp multiplane ext fixation,20696,CPT,,,,,,,,both,,,391985.94,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3028.75,,,3028.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,5746.56,,,5746.56,Fee Schedule,,4870.56,,,4870.56,Fee Schedule,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,274390.16,
Comp ext fixate strut change,20697,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7448,,"100% primary, 50% secondary, 25% tertiary procedure",7448,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3028.75,,,3028.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,9005.24,,,9005.24,Fee Schedule,,7632.49,,,7632.49,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,23663.84,
Replantation digit complete,20822,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1766.08,23663.84,
Removal of bone for graft,20900,CPT,,,,,,,,both,,,105951.37,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,74165.96,70,,74165.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,74165.96,
Removal of bone for graft,20902,CPT,,,,,,,,both,,,144359.91,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,101051.94,70,,101051.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,101051.94,
Remove cartilage for graft,20910,CPT,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,690.13,9473,
Remove cartilage for graft,20912,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,52822.83,
Removal of fascia for graft,20920,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Removal of fascia for graft,20922,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,26850.29,
Removal of tendon for graft,20924,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2594.15,,,2594.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,105333.66,
Sp bone algrft morsel add-on,20930,CPT,,,,,,,,both,,,36356.27,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,21813.76,60,,21813.76,percent of total billed charges,,20359.51,56,,20359.51,percent of total billed charges,,19632.39,54,,19632.39,percent of total billed charges,,25449.39,70,,25449.39,percent of total billed charges,,24722.26,68,,24722.26,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,29085.02,80,,29085.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29085.02,80,,29085.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25449.39,70,,25449.39,percent of total billed charges,,23631.58,65,,23631.58,percent of total billed charges,,23631.58,65,,23631.58,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,29085.02,
Sp bone algrft struct add-on,20931,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,41257.63,
Osteoart algrft w/surf & b1,20932,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,51583.58,
Hemicrt intrclry algrft prtl,20933,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,51583.58,
Intercalary algrft compl,20934,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,0.01,51583.58,
Sp bone agrft local add-on,20936,CPT,,,,,,,,both,,,36356.27,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,21813.76,60,,21813.76,percent of total billed charges,,20359.51,56,,20359.51,percent of total billed charges,,19632.39,54,,19632.39,percent of total billed charges,,25449.39,70,,25449.39,percent of total billed charges,,24722.26,68,,24722.26,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,29085.02,80,,29085.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29085.02,80,,29085.02,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25449.39,70,,25449.39,percent of total billed charges,,23631.58,65,,23631.58,percent of total billed charges,,23631.58,65,,23631.58,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,29085.02,
Sp bone agrft morsel add-on,20937,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,41257.63,
Sp bone agrft struct add-on,20938,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,41257.63,
Bone marrow aspir bone grfg,20939,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,342.76,,,342.76,Fee Schedule,,290.51,,,290.51,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,66803.2,
Fluid pressure muscle,20950,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,982.66,,,982.66,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,428.04,,,428.04,Fee Schedule,,362.79,,,362.79,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,528.31,,,528.31,Other,New York Medicaid APG methodology,528.31,,,528.31,Other,100% New York Medicaid APG,528.31,,,528.31,Other,100% New York Medicaid APG,528.31,,,528.31,Other,100% New York Medicaid APG,1188.7,,,1188.7,Other,225% New York Medicaid APG,808.32,,,808.32,Other,153% New York Medicaid APG,1188.7,,,1188.7,Other,225% New York Medicaid APG,739.64,,,739.64,Other,140% New York Medicaid APG,1188.7,,,1188.7,Other,225% New York Medicaid APG,1373.61,,,1373.61,Other,260% New York Medicaid APG,1711.73,,,1711.73,Other,324% New York Medicaid APG,1135.87,,,1135.87,Other,215% New York Medicaid APG,1135.87,,,1135.87,Other,215% New York Medicaid APG,660.39,,,660.39,Other,125% New York Medicaid APG,362.79,11839.04,
Bone/skin graft metatarsal,20972,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Bone/skin graft great toe,20973,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Electrical bone stimulation,20975,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,0.01,41257.63,
Us bone stimulation,20979,CPT,,,,,,,,both,,,626.29,53.8,,,53.8,Other,150% of Medicare + 9.63% HCRA Surcharge,32.72,,,32.72,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,438.4,70,,438.4,percent of total billed charges,,6152,,,6152,Case Rate,,982.66,,,982.66,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,438.4,70,,438.4,percent of total billed charges,,157.44,,,157.44,Fee Schedule,,133.44,,,133.44,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,528.31,,,528.31,Other,New York Medicaid APG methodology,528.31,,,528.31,Other,100% New York Medicaid APG,528.31,,,528.31,Other,100% New York Medicaid APG,528.31,,,528.31,Other,100% New York Medicaid APG,1188.7,,,1188.7,Other,225% New York Medicaid APG,808.32,,,808.32,Other,153% New York Medicaid APG,1188.7,,,1188.7,Other,225% New York Medicaid APG,739.64,,,739.64,Other,140% New York Medicaid APG,1188.7,,,1188.7,Other,225% New York Medicaid APG,1373.61,,,1373.61,Other,260% New York Medicaid APG,1711.73,,,1711.73,Other,324% New York Medicaid APG,1135.87,,,1135.87,Other,215% New York Medicaid APG,1135.87,,,1135.87,Other,215% New York Medicaid APG,660.39,,,660.39,Other,125% New York Medicaid APG,32.72,9473,
Ablate bone tumor(s) perq,20982,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,188242.95,68,,188242.95,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,221462.3,80,,221462.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,221462.3,80,,221462.3,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,221462.3,
Ablate bone tumor(s) perq,20983,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,120381.32,
Cptr-asst dir ms px,20985,CPT,,,,,,,,both,,,36356.27,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,21813.76,60,,21813.76,percent of total billed charges,,20359.51,56,,20359.51,percent of total billed charges,,19632.39,54,,19632.39,percent of total billed charges,,25449.39,70,,25449.39,percent of total billed charges,,24722.26,68,,24722.26,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,29085.02,80,,29085.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29085.02,80,,29085.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25449.39,70,,25449.39,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,29085.02,
Incision of jaw joint,21010,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2232,54176.39,
Exc face les sc <2 cm,21011,CPT,,,,,,,,both,,,37587.99,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26311.59,70,,26311.59,percent of total billed charges,,25559.83,68,,25559.83,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,30070.39,80,,30070.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30070.39,80,,30070.39,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,26311.59,70,,26311.59,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,30070.39,
Exc face les sbq 2 cm/>,21012,CPT,,,,,,,,both,,,35914.52,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,25140.16,70,,25140.16,percent of total billed charges,,24421.87,68,,24421.87,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,28731.62,80,,28731.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28731.62,80,,28731.62,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,25140.16,70,,25140.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,28731.62,
Exc face tum deep < 2 cm,21013,CPT,,,,,,,,both,,,42004.82,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29403.37,70,,29403.37,percent of total billed charges,,28563.28,68,,28563.28,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,33603.86,80,,33603.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33603.86,80,,33603.86,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,29403.37,70,,29403.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,33603.86,
Exc face tum deep 2 cm/>,21014,CPT,,,,,,,,both,,,42535.57,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,29774.9,70,,29774.9,percent of total billed charges,,28924.19,68,,28924.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,34028.46,80,,34028.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34028.46,80,,34028.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,29774.9,70,,29774.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,34028.46,
Resect face/scalp tum < 2 cm,21015,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Resect face/scalp tum 2 cm/>,21016,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Excision of bone lower jaw,21025,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2232,98541.71,
Excision of facial bone(s),21026,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2232,98541.71,
Contour of face bone lesion,21029,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2232,54176.39,
Excise max/zygoma b9 tumor,21030,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,83760.46,68,,83760.46,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2232,98541.71,
Remove exostosis mandible,21031,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2053,54176.39,
Remove exostosis maxilla,21032,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2053,54176.39,
Excise max/zygoma mal tumor,21034,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Excise mandible lesion,21040,CPT,,,,,,,,both,,,92070.37,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,62607.85,68,,62607.85,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,73656.3,80,,73656.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,73656.3,80,,73656.3,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,64449.26,70,,64449.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2232,73656.3,
Removal of jaw bone lesion,21044,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Remove mandible cyst complex,21046,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,5483.35,,,5483.35,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2232,98541.71,
Excise lwr jaw cyst w/repair,21047,CPT,,,,,,,,both,,,56587.86,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,38479.74,68,,38479.74,percent of total billed charges,,5483.35,,,5483.35,Other,186% of Medicaid,45270.29,80,,45270.29,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,45270.29,80,,45270.29,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,39611.5,70,,39611.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2232,45270.29,
Remove maxilla cyst complex,21048,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,83760.46,68,,83760.46,percent of total billed charges,,5483.35,,,5483.35,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2232,98541.71,
Excis uppr jaw cyst w/repair,21049,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,83760.46,68,,83760.46,percent of total billed charges,,5483.35,,,5483.35,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2232,98541.71,
Removal of jaw joint,21050,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Remove jaw joint cartilage,21060,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,5483.35,,,5483.35,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2232,98541.71,
Remove coronoid process,21070,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Mnpj of tmj w/anesth,21073,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,25661.91,
Prepare face/oral prosthesis,21076,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,6152,,,6152,Case Rate,,280.2,,,280.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,150.64,,,150.64,Other,New York Medicaid APG methodology,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,230.48,,,230.48,Other,153% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,210.9,,,210.9,Other,140% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,391.67,,,391.67,Other,260% New York Medicaid APG,488.08,,,488.08,Other,324% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,188.3,,,188.3,Other,125% New York Medicaid APG,150.64,22454.17,
Prepare face/oral prosthesis,21077,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,607.2,,,607.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,326.45,,,326.45,Other,New York Medicaid APG methodology,326.45,,,326.45,Other,100% New York Medicaid APG,326.45,,,326.45,Other,100% New York Medicaid APG,326.45,,,326.45,Other,100% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,499.47,,,499.47,Other,153% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,457.03,,,457.03,Other,140% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,848.77,,,848.77,Other,260% New York Medicaid APG,1057.7,,,1057.7,Other,324% New York Medicaid APG,701.87,,,701.87,Other,215% New York Medicaid APG,701.87,,,701.87,Other,215% New York Medicaid APG,408.06,,,408.06,Other,125% New York Medicaid APG,326.45,86224,
Prepare face/oral prosthesis,21079,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,280.2,,,280.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,150.64,,,150.64,Other,New York Medicaid APG methodology,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,230.48,,,230.48,Other,153% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,210.9,,,210.9,Other,140% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,391.67,,,391.67,Other,260% New York Medicaid APG,488.08,,,488.08,Other,324% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,188.3,,,188.3,Other,125% New York Medicaid APG,150.64,47404.34,
Prepare face/oral prosthesis,21080,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,280.2,,,280.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,150.64,,,150.64,Other,New York Medicaid APG methodology,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,230.48,,,230.48,Other,153% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,210.9,,,210.9,Other,140% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,391.67,,,391.67,Other,260% New York Medicaid APG,488.08,,,488.08,Other,324% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,188.3,,,188.3,Other,125% New York Medicaid APG,150.64,47404.34,
Prepare face/oral prosthesis,21081,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,607.2,,,607.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,326.45,,,326.45,Other,New York Medicaid APG methodology,326.45,,,326.45,Other,100% New York Medicaid APG,326.45,,,326.45,Other,100% New York Medicaid APG,326.45,,,326.45,Other,100% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,499.47,,,499.47,Other,153% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,457.03,,,457.03,Other,140% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,848.77,,,848.77,Other,260% New York Medicaid APG,1057.7,,,1057.7,Other,324% New York Medicaid APG,701.87,,,701.87,Other,215% New York Medicaid APG,701.87,,,701.87,Other,215% New York Medicaid APG,408.06,,,408.06,Other,125% New York Medicaid APG,326.45,86224,
Prepare face/oral prosthesis,21082,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,607.2,,,607.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,326.45,,,326.45,Other,New York Medicaid APG methodology,326.45,,,326.45,Other,100% New York Medicaid APG,326.45,,,326.45,Other,100% New York Medicaid APG,326.45,,,326.45,Other,100% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,499.47,,,499.47,Other,153% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,457.03,,,457.03,Other,140% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,848.77,,,848.77,Other,260% New York Medicaid APG,1057.7,,,1057.7,Other,324% New York Medicaid APG,701.87,,,701.87,Other,215% New York Medicaid APG,701.87,,,701.87,Other,215% New York Medicaid APG,408.06,,,408.06,Other,125% New York Medicaid APG,326.45,47404.34,
Prepare face/oral prosthesis,21083,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,280.2,,,280.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,150.64,,,150.64,Other,New York Medicaid APG methodology,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,230.48,,,230.48,Other,153% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,210.9,,,210.9,Other,140% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,391.67,,,391.67,Other,260% New York Medicaid APG,488.08,,,488.08,Other,324% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,188.3,,,188.3,Other,125% New York Medicaid APG,150.64,47404.34,
Prepare face/oral prosthesis,21084,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,280.2,,,280.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,150.64,,,150.64,Other,New York Medicaid APG methodology,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,230.48,,,230.48,Other,153% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,210.9,,,210.9,Other,140% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,391.67,,,391.67,Other,260% New York Medicaid APG,488.08,,,488.08,Other,324% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,188.3,,,188.3,Other,125% New York Medicaid APG,150.64,47404.34,
Prepare face/oral prosthesis,21085,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,6152,,,6152,Case Rate,,280.2,,,280.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,150.64,,,150.64,Other,New York Medicaid APG methodology,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,230.48,,,230.48,Other,153% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,210.9,,,210.9,Other,140% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,391.67,,,391.67,Other,260% New York Medicaid APG,488.08,,,488.08,Other,324% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,188.3,,,188.3,Other,125% New York Medicaid APG,150.64,9473,
Prepare face/oral prosthesis,21086,CPT,,,,,,,,both,,,117516.12,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,82261.28,70,,82261.28,percent of total billed charges,,6152,,,6152,Case Rate,,607.2,,,607.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,82261.28,70,,82261.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,326.45,,,326.45,Other,New York Medicaid APG methodology,326.45,,,326.45,Other,100% New York Medicaid APG,326.45,,,326.45,Other,100% New York Medicaid APG,326.45,,,326.45,Other,100% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,499.47,,,499.47,Other,153% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,457.03,,,457.03,Other,140% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,848.77,,,848.77,Other,260% New York Medicaid APG,1057.7,,,1057.7,Other,324% New York Medicaid APG,701.87,,,701.87,Other,215% New York Medicaid APG,701.87,,,701.87,Other,215% New York Medicaid APG,408.06,,,408.06,Other,125% New York Medicaid APG,326.45,82261.28,
Prepare face/oral prosthesis,21087,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,607.2,,,607.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,326.45,,,326.45,Other,New York Medicaid APG methodology,326.45,,,326.45,Other,100% New York Medicaid APG,326.45,,,326.45,Other,100% New York Medicaid APG,326.45,,,326.45,Other,100% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,499.47,,,499.47,Other,153% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,457.03,,,457.03,Other,140% New York Medicaid APG,734.51,,,734.51,Other,225% New York Medicaid APG,848.77,,,848.77,Other,260% New York Medicaid APG,1057.7,,,1057.7,Other,324% New York Medicaid APG,701.87,,,701.87,Other,215% New York Medicaid APG,701.87,,,701.87,Other,215% New York Medicaid APG,408.06,,,408.06,Other,125% New York Medicaid APG,326.45,86224,
Prepare face/oral prosthesis,21088,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,280.2,,,280.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,44018.32,65,,44018.32,percent of total billed charges,,44018.32,65,,44018.32,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,150.64,,,150.64,Other,New York Medicaid APG methodology,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,230.48,,,230.48,Other,153% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,210.9,,,210.9,Other,140% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,391.67,,,391.67,Other,260% New York Medicaid APG,488.08,,,488.08,Other,324% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,188.3,,,188.3,Other,125% New York Medicaid APG,150.64,47404.34,
Maxillofacial fixation,21100,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,3028.75,,,3028.75,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1628.36,,,1628.36,Other,New York Medicaid APG methodology,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,1628.36,,,1628.36,Other,100% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2491.39,,,2491.39,Other,153% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,2279.71,,,2279.71,Other,140% New York Medicaid APG,3663.81,,,3663.81,Other,225% New York Medicaid APG,4233.74,,,4233.74,Other,260% New York Medicaid APG,5275.89,,,5275.89,Other,324% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,3500.98,,,3500.98,Other,215% New York Medicaid APG,2035.45,,,2035.45,Other,125% New York Medicaid APG,1628.36,98541.71,
Interdental fixation,21110,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,25661.91,
Injection jaw joint x-ray,21116,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Reconstruction of chin,21120,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruction of chin,21121,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,47404.34,
Reconstruction of chin,21122,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruction of chin,21123,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,47404.34,
Augmentation lower jaw bone,21125,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Augmentation lower jaw bone,21127,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reduction of forehead,21137,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,47404.34,
Reduction of forehead,21138,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reduction of forehead,21139,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Lefort ii anterior intrusion,21150,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruct orbit/forehead,21172,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruct orbit/forehead,21175,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Contour cranial bone lesion,21181,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,86224,
Reconst lwr jaw w/o graft,21193,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,86224,
Reconst lwr jaw w/o fixation,21195,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstr lwr jaw segment,21198,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstr lwr jaw w/advance,21199,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,86224,
Reconstruct upper jaw bone,21206,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Augmentation of facial bones,21208,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reduction of facial bones,21209,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Face bone graft,21210,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Lower jaw bone graft,21215,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Rib cartilage graft,21230,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Ear cartilage graft,21235,CPT,,,,,,,,both,,,43855.99,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,30699.19,70,,30699.19,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,30699.19,
Reconstruction of jaw joint,21240,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruction of jaw joint,21242,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruction of jaw joint,21243,CPT,,,,,,,,both,,,391985.94,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,274390.16,
Reconstruction of lower jaw,21244,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruction of jaw,21245,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruction of jaw,21246,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruction of jaw,21248,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruction of jaw,21249,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Reconstruction of orbit,21256,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Revise eye sockets,21260,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Revise eye sockets,21261,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Revise eye sockets,21263,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Revise eye sockets,21267,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,86224,
Augmentation cheek bone,21270,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Revision orbitofacial bones,21275,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,86224,
Revision of eyelid,21280,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,47404.34,
Revision of eyelid,21282,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,47404.34,
Revision of jaw muscle/bone,21295,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,970.88,,,970.88,Fee Schedule,,822.88,,,822.88,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,822.88,25661.91,
Revision of jaw muscle/bone,21296,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2053,54176.39,
Closed tx nose fx w/o stablj,21315,CPT,,,,,,,,both,,,33597.35,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22846.2,68,,22846.2,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,26877.88,80,,26877.88,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26877.88,80,,26877.88,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23518.15,70,,23518.15,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,250.2,26877.88,
Closed tx nose fx w/ stablj,21320,CPT,,,,,,,,both,,,35105.05,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23871.43,68,,23871.43,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,28084.04,80,,28084.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28084.04,80,,28084.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24573.54,70,,24573.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,28084.04,
Open tx nose fx uncomplicatd,21325,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,47404.34,
Open tx nose fx w/skele fixj,21330,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,86224,
Open tx nose & septal fx,21335,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,47404.34,
Open tx septal fx w/wo stabj,21336,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,47657.93,
Closed tx septal&nose fx,21337,CPT,,,,,,,,both,,,35285.27,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23993.98,68,,23993.98,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,28228.22,80,,28228.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28228.22,80,,28228.22,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24699.69,70,,24699.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,28228.22,
Open nasoethmoid fx w/o fixj,21338,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Open nasoethmoid fx w/ fixj,21339,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Perq tx nasoethmoid fx,21340,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,47404.34,
Closed tx nose/jaw fx,21345,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,22454.17,
Opn tx nasomax fx w/fixj,21346,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Perq tx malar fracture,21355,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,47404.34,
Opn tx dprsd zygomatic arch,21356,CPT,,,,,,,,both,,,35212.73,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24648.91,70,,24648.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,24648.91,
Opn tx dprsd malar fracture,21360,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,86224,
Opn tx complx malar fx,21365,CPT,,,,,,,,both,,,61736.97,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,43215.88,70,,43215.88,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,43215.88,70,,43215.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,43215.88,
Opn tx orbit fx transantral,21385,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Opn tx orbit fx periorbital,21386,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Opn tx orbit fx combined,21387,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Opn tx orbit periorbtl implt,21390,CPT,,,,,,,,both,,,53237.37,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,37266.16,70,,37266.16,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,37266.16,70,,37266.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,37266.16,
Opn tx orbit periorbt w/grft,21395,CPT,,,,,,,,both,,,36969.66,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,25878.76,70,,25878.76,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25878.76,70,,25878.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,25878.76,
Closed tx orbit w/o manipulj,21400,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,828.2,,,828.2,Fee Schedule,,701.95,,,701.95,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,9258.28,
Closed tx orbit w/manipulj,21401,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,22454.17,
Opn tx orbit fx w/o implant,21406,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Opn tx orbit fx w/implant,21407,CPT,,,,,,,,both,,,89055.11,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,62338.58,70,,62338.58,percent of total billed charges,,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,62338.58,70,,62338.58,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,62338.58,
Opn tx orbit fx w/bone grft,21408,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,86224,
Treat mouth roof fracture,21421,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,47404.34,
Treat dental ridge fracture,21440,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,47404.34,
Treat dental ridge fracture,21445,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Treat lower jaw fracture,21450,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,9473,
Treat lower jaw fracture,21451,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,22454.17,
Treat lower jaw fracture,21452,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,5483.35,,,5483.35,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2232,98541.71,
Treat lower jaw fracture,21453,CPT,,,,,,,,both,,,62366.91,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,43656.84,70,,43656.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,43656.84,
Treat lower jaw fracture,21454,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Treat lower jaw fracture,21461,CPT,,,,,,,,both,,,78075.46,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,54652.82,70,,54652.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,54652.82,
Treat lower jaw fracture,21462,CPT,,,,,,,,both,,,88543.08,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,61980.16,70,,61980.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,61980.16,
Treat lower jaw fracture,21465,CPT,,,,,,,,both,,,131486.31,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,92040.42,70,,92040.42,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,92040.42,
Treat lower jaw fracture,21470,CPT,,,,,,,,both,,,131285.49,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,91899.84,70,,91899.84,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,91899.84,70,,91899.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,91899.84,
Reset dislocated jaw,21480,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,152.52,,,152.52,Fee Schedule,,129.27,,,129.27,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,129.27,7216,
Reset dislocated jaw,21485,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,25661.91,
Repair dislocated jaw,21490,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,47404.34,
Interdental wiring,21497,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,25661.91,
Drain neck/chest lesion,21501,CPT,,,,,,,,both,,,35589.06,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24200.56,68,,24200.56,percent of total billed charges,,3165.14,,,3165.14,Other,186% of Medicaid,28471.25,80,,28471.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28471.25,80,,28471.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24912.34,70,,24912.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,28471.25,
Drain chest lesion,21502,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3165.14,,,3165.14,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,54466.2,
Biopsy of neck/chest,21550,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,3165.14,,,3165.14,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,27281.4,
Exc neck les sc 3 cm/>,21552,CPT,,,,,,,,both,,,36268.05,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3165.14,,,3165.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25387.64,70,,25387.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,25387.64,
Exc neck tum deep 5 cm/>,21554,CPT,,,,,,,,both,,,38757.88,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3165.14,,,3165.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27130.52,70,,27130.52,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,27130.52,
Exc neck les sc < 3 cm,21555,CPT,,,,,,,,both,,,39200.03,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26656.02,68,,26656.02,percent of total billed charges,,3165.14,,,3165.14,Other,186% of Medicaid,31360.02,80,,31360.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31360.02,80,,31360.02,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27440.02,70,,27440.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,31360.02,
Exc neck tum deep < 5 cm,21556,CPT,,,,,,,,both,,,47349.43,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,32197.61,68,,32197.61,percent of total billed charges,,3165.14,,,3165.14,Other,186% of Medicaid,37879.54,80,,37879.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,37879.54,80,,37879.54,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,33144.6,70,,33144.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,37879.54,
Resect neck thorax tumor<5cm,21557,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,40641.7,68,,40641.7,percent of total billed charges,,3165.14,,,3165.14,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,47813.76,
Resect neck tumor 5 cm/>,21558,CPT,,,,,,,,both,,,38983.69,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4047.34,,,4047.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27288.58,70,,27288.58,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2175.99,,,2175.99,Other,New York Medicaid APG methodology,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3329.26,,,3329.26,Other,153% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3046.38,,,3046.38,Other,140% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,5657.57,,,5657.57,Other,260% New York Medicaid APG,7050.2,,,7050.2,Other,324% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,2719.99,,,2719.99,Other,125% New York Medicaid APG,2175.99,27288.58,
Partial removal of rib,21600,CPT,,,,,,,,both,,,38379.86,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26098.3,68,,26098.3,percent of total billed charges,,3165.14,,,3165.14,Other,186% of Medicaid,30703.89,80,,30703.89,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30703.89,80,,30703.89,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26865.9,70,,26865.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,30703.89,
Exc chest wall tumor w/ribs,21601,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,6152,,,6152,Case Rate,,3165.14,,,3165.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,47813.76,
Partial removal of rib,21610,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2232,54466.2,
Hyoid myotomy & suspension,21685,CPT,,,,,,,,both,,,53041.12,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,37128.78,70,,37128.78,percent of total billed charges,,36067.96,68,,36067.96,percent of total billed charges,,5483.35,,,5483.35,Other,186% of Medicaid,42432.9,80,,42432.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,42432.9,80,,42432.9,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,37128.78,70,,37128.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2232,42432.9,
Revision of neck muscle,21700,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2232,120381.32,
Revision of neck muscle,21720,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3165.14,,,3165.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,47657.93,
Revision of neck muscle,21725,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,773.13,10359.16,
Repair stern/nuss w/o scope,21742,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3165.14,,,3165.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,44253.79,65,,44253.79,percent of total billed charges,,44253.79,65,,44253.79,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,47657.93,
Repair sternum/nuss w/scope,21743,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3165.14,,,3165.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,44253.79,65,,44253.79,percent of total billed charges,,44253.79,65,,44253.79,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,47657.93,
Treat sternum fracture,21820,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,741.28,,,741.28,Fee Schedule,,628.28,,,628.28,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Biopsy soft tissue of back,21920,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27281.4,
Biopsy soft tissue of back,21925,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27281.4,
Exc back les sc < 3 cm,21930,CPT,,,,,,,,both,,,34713.64,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23605.28,68,,23605.28,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27770.91,80,,27770.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27770.91,80,,27770.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24299.55,70,,24299.55,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27770.91,
Exc back les sc 3 cm/>,21931,CPT,,,,,,,,both,,,35507.52,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24855.26,70,,24855.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,24855.26,
Exc back tum deep < 5 cm,21932,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Exc back tum deep 5 cm/>,21933,CPT,,,,,,,,both,,,35676.57,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24973.6,70,,24973.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,24973.6,
Resect back tum < 5 cm,21935,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Resect back tum 5 cm/>,21936,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Remove part of neck vertebra,22100,CPT,,,,,,,,both,,,46679.93,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,32675.95,70,,32675.95,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,32675.95,70,,32675.95,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,32675.95,
Remove part thorax vertebra,22101,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Remove part lumbar vertebra,22102,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Remove extra spine segment,22103,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,0.01,45135.64,
Closed tx vert fx w/o manj,22310,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Closed tx vert fx w/manj,22315,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,54466.2,
Manipulation of spine,22505,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Perq cervicothoracic inject,22510,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,47657.93,
Perq lumbosacral injection,22511,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,47657.93,
Vertebroplasty addl inject,22512,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,0.01,51583.58,
Perq vertebral augmentation,22513,CPT,,,,,,,,both,,,75398.29,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,52778.8,70,,52778.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,52778.8,
Perq vertebral augmentation,22514,CPT,,,,,,,,both,,,62785.99,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,43950.19,70,,43950.19,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,43950.19,
Perq vertebral augmentation,22515,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,0.01,66803.2,
Neck spine fuse&remov bel c2,22551,CPT,,,,,,,,both,,,127397.61,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6658.98,,,6658.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,89178.33,70,,89178.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,3343,89178.33,
Addl neck spine fusion,22552,CPT,,,,,,,,both,,,90852.2,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,61779.5,68,,61779.5,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,72681.76,
Neck spine fusion,22554,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6658.98,,,6658.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,3343,193779.51,
Additional spinal fusion,22585,CPT,,,,,,,,both,,,90852.2,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,6152,,,6152,Case Rate,,6658.98,,,6658.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,63596.54,
Lumbar spine fusion,22612,CPT,,,,,,,,both,,,165681.16,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,115976.81,70,,115976.81,percent of total billed charges,,6152,,,6152,Case Rate,,6658.98,,,6658.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,115976.81,70,,115976.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,3343,115976.81,
Spine fusion extra segment,22614,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,58882.15,68,,58882.15,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,69273.12,
Insert spine fixation device,22840,CPT,,,,,,,,both,,,90852.2,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,61779.5,68,,61779.5,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,72681.76,
Insert spine fixation device,22842,CPT,,,,,,,,both,,,90852.2,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,61779.5,68,,61779.5,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,72681.76,
Insert spine fixation device,22845,CPT,,,,,,,,both,,,90852.2,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,61779.5,68,,61779.5,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,72681.76,
Insj biomechanical device,22853,CPT,,,,,,,,both,,,90852.2,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,61779.5,68,,61779.5,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,72681.76,
Insj biomechanical device,22854,CPT,,,,,,,,both,,,90852.2,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,61779.5,68,,61779.5,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,72681.76,
Cerv artific diskectomy,22856,CPT,,,,,,,,both,,,138249.61,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6658.98,,,6658.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,96774.73,70,,96774.73,percent of total billed charges,,7999.92,,,7999.92,Fee Schedule,,6780.42,,,6780.42,Fee Schedule,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,3580.1,96774.73,
Second level cer diskectomy,22858,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,66803.2,
Insj biomechanical device,22859,CPT,,,,,,,,both,,,90852.2,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,61779.5,68,,61779.5,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,72681.76,80,,72681.76,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,63596.54,70,,63596.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,72681.76,
Insj stablj dev w/dcmprn,22867,CPT,,,,,,,,both,,,391985.94,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6658.98,,,6658.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,3343,274390.16,
Insj stablj dev w/dcmprn,22868,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,41257.63,
Insj stablj dev w/o dcmprn,22869,CPT,,,,,,,,both,,,60822,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,41358.96,68,,41358.96,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,48657.6,80,,48657.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,48657.6,80,,48657.6,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,42575.4,70,,42575.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,2232,48657.6,
Insj stablj dev w/o dcmprn,22870,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,41257.63,
Exc abdl tum deep < 5 cm,22900,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Exc abdl tum deep 5 cm/>,22901,CPT,,,,,,,,both,,,37474.21,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26231.95,70,,26231.95,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,26231.95,
Exc abd les sc < 3 cm,22902,CPT,,,,,,,,both,,,38632.15,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,27042.51,70,,27042.51,percent of total billed charges,,26269.86,68,,26269.86,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,30905.72,80,,30905.72,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30905.72,80,,30905.72,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27042.51,70,,27042.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,30905.72,
Exc abd les sc 3 cm/>,22903,CPT,,,,,,,,both,,,36069.68,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25248.78,70,,25248.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,25248.78,
Radical resect abd tumor<5cm,22904,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Rad resect abd tumor 5 cm/>,22905,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Removal of calcium deposits,23000,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Release shoulder joint,23020,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3961.19,,,3961.19,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,54466.2,
Drain shoulder lesion,23030,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Drain shoulder bursa,23031,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Drain shoulder bone lesion,23035,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,1766.08,23663.84,
Exploratory shoulder surgery,23040,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Exploratory shoulder surgery,23044,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Biopsy shoulder tissues,23065,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27281.4,
Biopsy shoulder tissues,23066,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Exc shoulder les sc 3 cm/>,23071,CPT,,,,,,,,both,,,36184.86,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25329.4,70,,25329.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,25329.4,
Exc shoulder tum deep 5 cm/>,23073,CPT,,,,,,,,both,,,34368.36,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24057.85,70,,24057.85,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,24057.85,
Exc shoulder les sc < 3 cm,23075,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27281.4,
Exc shoulder tum deep < 5 cm,23076,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Resect shoulder tumor < 5 cm,23077,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,41837.04,
Resect shoulder tumor 5 cm/>,23078,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,41837.04,
Biopsy of shoulder joint,23100,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3961.19,,,3961.19,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,54466.2,
Shoulder joint surgery,23101,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Remove shoulder joint lining,23105,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Incision of collarbone joint,23106,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Explore treat shoulder joint,23107,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Partial removal collar bone,23120,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Removal of collar bone,23125,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Remove shoulder bone part,23130,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Removal of bone lesion,23140,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Removal of bone lesion,23145,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Removal of bone lesion,23146,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Removal of humerus lesion,23150,CPT,,,,,,,,both,,,72471.02,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50729.71,70,,50729.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,50729.71,
Removal of humerus lesion,23155,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Removal of humerus lesion,23156,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Remove collar bone lesion,23170,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3961.19,,,3961.19,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,54466.2,
Remove shoulder blade lesion,23172,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3961.19,,,3961.19,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,54466.2,
Remove humerus lesion,23174,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3961.19,,,3961.19,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,120381.32,
Remove collar bone lesion,23180,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Remove shoulder blade lesion,23182,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Remove humerus lesion,23184,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Partial removal of scapula,23190,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Removal of head of humerus,23195,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Remove shoulder foreign body,23330,CPT,,,,,,,,both,,,36843.73,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25053.74,68,,25053.74,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,29474.98,80,,29474.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29474.98,80,,29474.98,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,25790.61,70,,25790.61,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,29474.98,
Remove shoulder fb deep,23333,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Shoulder prosthesis removal,23334,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,41837.04,
Injection for shoulder x-ray,23350,CPT,,,,,,,,both,,,17336.09,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,12135.26,70,,12135.26,percent of total billed charges,,11788.54,68,,11788.54,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,13868.87,80,,13868.87,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13868.87,80,,13868.87,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,12135.26,70,,12135.26,percent of total billed charges,,242.72,,,242.72,Fee Schedule,,205.72,,,205.72,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,13868.87,
Muscle transfer shoulder/arm,23395,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Muscle transfers,23397,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Fixation of shoulder blade,23400,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Incision of tendon & muscle,23405,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3961.19,,,3961.19,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,120381.32,
Incise tendon(s) & muscle(s),23406,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3961.19,,,3961.19,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,120381.32,
Repair rotator cuff acute,23410,CPT,,,,,,,,both,,,64366.42,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,45056.49,70,,45056.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,45056.49,
Repair rotator cuff chronic,23412,CPT,,,,,,,,both,,,77787.8,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,54451.46,70,,54451.46,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,54451.46,
Release of shoulder ligament,23415,CPT,,,,,,,,both,,,33231.42,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,23261.99,70,,23261.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,23261.99,
Repair of shoulder,23420,CPT,,,,,,,,both,,,82673.24,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,57871.27,70,,57871.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,57871.27,
Repair biceps tendon,23430,CPT,,,,,,,,both,,,75416.77,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,52791.74,70,,52791.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,52791.74,
Remove/transplant tendon,23440,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Repair shoulder capsule,23450,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Repair shoulder capsule,23455,CPT,,,,,,,,both,,,98387.69,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,68871.38,70,,68871.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,68871.38,
Repair shoulder capsule,23460,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Repair shoulder capsule,23462,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Repair shoulder capsule,23465,CPT,,,,,,,,both,,,77128.57,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,53990,70,,53990,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,53990,
Repair shoulder capsule,23466,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Reconstruct shoulder joint,23470,CPT,,,,,,,,both,,,135326.42,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,94728.49,70,,94728.49,percent of total billed charges,,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,94728.49,70,,94728.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,94728.49,
Revis reconst shoulder joint,23473,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,193779.51,
Revision of collar bone,23480,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Revision of collar bone,23485,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,193779.51,
Reinforce clavicle,23490,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Reinforce shoulder bones,23491,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,193779.51,
Treat clavicle fracture,23500,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat clavicle fracture,23505,CPT,,,,,,,,both,,,34955.66,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23769.85,68,,23769.85,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27964.53,80,,27964.53,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27964.53,80,,27964.53,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,24468.96,70,,24468.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27964.53,
Treat clavicle fracture,23515,CPT,,,,,,,,both,,,90442.05,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,63309.44,70,,63309.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,63309.44,
Treat clavicle dislocation,23520,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat clavicle dislocation,23525,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat clavicle dislocation,23530,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat clavicle dislocation,23532,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat clavicle dislocation,23540,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat clavicle dislocation,23545,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat clavicle dislocation,23550,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat clavicle dislocation,23552,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat shoulder blade fx,23570,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat shoulder blade fx,23575,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat scapula fracture,23585,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat humerus fracture,23600,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat humerus fracture,23605,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat humerus fracture,23615,CPT,,,,,,,,both,,,58174.44,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,40722.11,70,,40722.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,40722.11,
Treat humerus fracture,23616,CPT,,,,,,,,both,,,391985.94,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,274390.16,
Treat humerus fracture,23620,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat humerus fracture,23625,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat humerus fracture,23630,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat shoulder dislocation,23650,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat shoulder dislocation,23655,CPT,,,,,,,,both,,,32785,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22293.8,68,,22293.8,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,26228,80,,26228,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26228,80,,26228,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22949.5,70,,22949.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,26228,
Treat shoulder dislocation,23660,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat dislocation/fracture,23665,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat dislocation/fracture,23670,CPT,,,,,,,,both,,,113841.17,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,79688.82,70,,79688.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,79688.82,
Treat dislocation/fracture,23675,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat dislocation/fracture,23680,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,193779.51,
Fixation of shoulder,23700,CPT,,,,,,,,both,,,34321,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23338.28,68,,23338.28,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27456.8,80,,27456.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27456.8,80,,27456.8,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24024.7,70,,24024.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27456.8,
Fusion of shoulder joint,23800,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Fusion of shoulder joint,23802,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,193779.51,
Amputation follow-up surgery,23921,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,26850.29,
Drainage of arm lesion,23930,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Drainage of arm bursa,23931,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27281.4,
Drain arm/elbow bone lesion,23935,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3937.82,,,3937.82,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,54466.2,
Exploratory elbow surgery,24000,CPT,,,,,,,,both,,,32829.65,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,22980.76,70,,22980.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,22980.76,
Release elbow joint,24006,CPT,,,,,,,,both,,,99422.14,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,69595.5,70,,69595.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,69595.5,
Biopsy arm/elbow soft tissue,24065,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27281.4,
Biopsy arm/elbow soft tissue,24066,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Exc arm/elbow les sc 3 cm/>,24071,CPT,,,,,,,,both,,,38614.54,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27030.18,70,,27030.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27030.18,
Ex arm/elbow tum deep 5 cm/>,24073,CPT,,,,,,,,both,,,36465.26,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25525.68,70,,25525.68,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,25525.68,
Exc arm/elbow les sc < 3 cm,24075,CPT,,,,,,,,both,,,34597,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23525.96,68,,23525.96,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27677.6,80,,27677.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27677.6,80,,27677.6,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24217.9,70,,24217.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27677.6,
Ex arm/elbow tum deep < 5 cm,24076,CPT,,,,,,,,both,,,59475.75,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40443.51,68,,40443.51,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47580.6,80,,47580.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47580.6,80,,47580.6,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41633.03,70,,41633.03,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47580.6,
Resect arm/elbow tum < 5 cm,24077,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,41837.04,
Resect arm/elbow tum 5 cm/>,24079,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,41837.04,
Biopsy elbow joint lining,24100,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,54466.2,
Explore/treat elbow joint,24101,CPT,,,,,,,,both,,,57993.89,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,40595.72,70,,40595.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,40595.72,
Remove elbow joint lining,24102,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Removal of elbow bursa,24105,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Remove humerus lesion,24110,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3961.19,,,3961.19,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,54466.2,
Remove/graft bone lesion,24115,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Remove/graft bone lesion,24116,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Remove elbow lesion,24120,CPT,,,,,,,,both,,,44500.73,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31150.51,70,,31150.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,31150.51,
Remove/graft bone lesion,24125,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Remove/graft bone lesion,24126,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Removal of head of radius,24130,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,47657.93,
Removal of arm bone lesion,24134,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3961.19,,,3961.19,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,120381.32,
Remove radius bone lesion,24136,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,54466.2,
Remove elbow bone lesion,24138,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3937.82,,,3937.82,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,120381.32,
Partial removal of arm bone,24140,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Partial removal of radius,24145,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Partial removal of elbow,24147,CPT,,,,,,,,both,,,53513.08,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,36388.89,68,,36388.89,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,42810.46,80,,42810.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,42810.46,80,,42810.46,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,37459.16,70,,37459.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,42810.46,
Radical resection of elbow,24149,CPT,,,,,,,,both,,,63247.95,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,44273.57,70,,44273.57,percent of total billed charges,,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,44273.57,70,,44273.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,44273.57,
Resect distal humerus tumor,24150,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Resect radius tumor,24152,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Removal of elbow joint,24155,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Remove elbow joint implant,24160,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,54466.2,
Remove radius head implant,24164,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Removal of arm foreign body,24200,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,23871.23,
Removal of arm foreign body,24201,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Injection for elbow x-ray,24220,CPT,,,,,,,,both,,,34215,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23950.5,70,,23950.5,percent of total billed charges,,23266.2,68,,23266.2,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,27372,80,,27372,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27372,80,,27372,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23950.5,70,,23950.5,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,27372,
Manipulate elbow w/anesth,24300,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Muscle/tendon transfer,24301,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Arm tendon lengthening,24305,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Revision of arm tendon,24310,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Repair of arm tendon,24320,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Revision of arm muscles,24330,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Revision of arm muscles,24331,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,105333.66,
Tenolysis triceps,24332,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,46296.27,68,,46296.27,percent of total billed charges,,3961.19,,,3961.19,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,54466.2,
Repair of biceps tendon,24340,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Repair arm tendon/muscle,24341,CPT,,,,,,,,both,,,34715.08,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,24300.56,70,,24300.56,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,24300.56,
Repair of ruptured tendon,24342,CPT,,,,,,,,both,,,45187.14,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,31631,70,,31631,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,31631,
Repr elbow lat ligmnt w/tiss,24343,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Reconstruct elbow lat ligmnt,24344,CPT,,,,,,,,both,,,93480.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,65436.46,70,,65436.46,percent of total billed charges,,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,65436.46,70,,65436.46,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,65436.46,
Repr elbw med ligmnt w/tissu,24345,CPT,,,,,,,,both,,,36880.56,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25078.78,68,,25078.78,percent of total billed charges,,3937.82,,,3937.82,Other,186% of Medicaid,29504.45,80,,29504.45,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29504.45,80,,29504.45,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25816.39,70,,25816.39,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,29504.45,
Reconstruct elbow med ligmnt,24346,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,193779.51,
Repair elbow perc,24357,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Repair elbow w/deb open,24358,CPT,,,,,,,,both,,,37172.82,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26020.97,70,,26020.97,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,26020.97,
Repair elbow deb/attch open,24359,CPT,,,,,,,,both,,,36006.59,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25204.61,70,,25204.61,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,25204.61,
Reconstruct elbow joint,24360,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,105333.66,
Reconstruct elbow joint,24361,CPT,,,,,,,,both,,,391985.94,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,274390.16,
Reconstruct elbow joint,24362,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,193779.51,
Replace elbow joint,24363,CPT,,,,,,,,both,,,391985.94,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,274390.16,
Reconstruct head of radius,24365,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,193779.51,
Reconstruct head of radius,24366,CPT,,,,,,,,both,,,140987.9,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,98691.53,70,,98691.53,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,98691.53,
Revise reconst elbow joint,24370,CPT,,,,,,,,both,,,108194.17,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,75735.92,70,,75735.92,percent of total billed charges,,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,75735.92,70,,75735.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,75735.92,
Revise reconst elbow joint,24371,CPT,,,,,,,,both,,,391985.94,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,274390.16,
Revision of humerus,24400,CPT,,,,,,,,both,,,66665.03,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,46665.52,70,,46665.52,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,46665.52,
Revision of humerus,24410,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,193779.51,
Revision of humerus,24420,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Repair of humerus,24430,CPT,,,,,,,,both,,,49923.06,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,34946.14,70,,34946.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,34946.14,
Repair humerus with graft,24435,CPT,,,,,,,,both,,,217636.6,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,152345.62,70,,152345.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,152345.62,
Revision of elbow joint,24470,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Decompression of forearm,24495,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3937.82,,,3937.82,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,120381.32,
Reinforce humerus,24498,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,193779.51,
Treat humerus fracture,24500,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat humerus fracture,24505,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat humerus fracture,24515,CPT,,,,,,,,both,,,94061.82,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,65843.27,70,,65843.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,65843.27,
Treat humerus fracture,24516,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,193779.51,
Treat humerus fracture,24530,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat humerus fracture,24535,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat humerus fracture,24538,CPT,,,,,,,,both,,,36409.89,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24758.73,68,,24758.73,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,29127.91,80,,29127.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29127.91,80,,29127.91,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25486.92,70,,25486.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,29127.91,
Treat humerus fracture,24545,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,193779.51,
Treat humerus fracture,24546,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,193779.51,
Treat humerus fracture,24560,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat humerus fracture,24565,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat humerus fracture,24566,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,1766.08,27044.39,
Treat humerus fracture,24575,CPT,,,,,,,,both,,,69504.72,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,48653.3,70,,48653.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,48653.3,
Treat humerus fracture,24576,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat humerus fracture,24577,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat humerus fracture,24579,CPT,,,,,,,,both,,,54780.48,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,38346.34,70,,38346.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,38346.34,
Treat humerus fracture,24582,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,120381.32,
Treat elbow fracture,24586,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,193779.51,
Treat elbow fracture,24587,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,193779.51,
Treat elbow dislocation,24600,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat elbow dislocation,24605,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Treat elbow dislocation,24615,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat elbow fracture,24620,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat elbow fracture,24635,CPT,,,,,,,,both,,,105508.14,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,73855.7,70,,73855.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,73855.7,
Treat elbow dislocation,24640,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,391.96,,,391.96,Fee Schedule,,332.21,,,332.21,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Treat radius fracture,24650,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat radius fracture,24655,CPT,,,,,,,,both,,,35625.51,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24225.35,68,,24225.35,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,28500.41,80,,28500.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28500.41,80,,28500.41,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24937.86,70,,24937.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,28500.41,
Treat radius fracture,24665,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat radius fracture,24666,CPT,,,,,,,,both,,,147376.01,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,103163.21,70,,103163.21,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,103163.21,
Treat ulnar fracture,24670,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat ulnar fracture,24675,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat ulnar fracture,24685,CPT,,,,,,,,both,,,81461.92,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,57023.34,70,,57023.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,57023.34,
Fusion of elbow joint,24800,CPT,,,,,,,,both,,,121655.19,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,85158.63,70,,85158.63,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,85158.63,
Fusion/graft of elbow joint,24802,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,193779.51,
Amputation follow-up surgery,24925,CPT,,,,,,,,both,,,33870,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23709,70,,23709,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,23709,
Revision of amputation,24935,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,105333.66,
Incision of tendon sheath,25000,CPT,,,,,,,,both,,,33625.42,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23537.79,70,,23537.79,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,23537.79,
Incise flexor carpi radialis,25001,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Decompress forearm 1 space,25020,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,23663.84,
Decompress forearm 1 space,25023,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Decompress forearm 2 spaces,25024,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Decompress forearm 2 spaces,25025,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,23663.84,
Drainage of forearm lesion,25028,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,54466.2,
Drainage of forearm bursa,25031,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,27044.39,
Treat forearm bone lesion,25035,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3937.82,,,3937.82,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,120381.32,
Explore/treat wrist joint,25040,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Biopsy forearm soft tissues,25065,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1781.56,27281.4,
Biopsy forearm soft tissues,25066,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47813.76,
Exc forearm les sc 3 cm/>,25071,CPT,,,,,,,,both,,,34918.19,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24442.73,70,,24442.73,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1781.56,24442.73,
Exc forearm tum deep 3 cm/>,25073,CPT,,,,,,,,both,,,38778.36,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27144.85,70,,27144.85,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,27144.85,
Exc forearm les sc < 3 cm,25075,CPT,,,,,,,,both,,,36818.43,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25036.53,68,,25036.53,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,29454.74,80,,29454.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29454.74,80,,29454.74,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25772.9,70,,25772.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1781.56,29454.74,
Exc forearm tum deep < 3 cm,25076,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1781.56,23871.23,
Resect forearm/wrist tum<3cm,25077,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,41837.04,
Resect forarm/wrist tum 3cm>,25078,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,41837.04,
Incision of wrist capsule,25085,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Biopsy of wrist joint,25100,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,54466.2,
Explore/treat wrist joint,25101,CPT,,,,,,,,both,,,39926.3,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27948.41,70,,27948.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,27948.41,
Remove wrist joint lining,25105,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Remove wrist joint cartilage,25107,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Excise tendon forearm/wrist,25109,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Remove wrist tendon lesion,25110,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,23663.84,
Remove wrist tendon lesion,25111,CPT,,,,,,,,both,,,34202.63,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23941.84,70,,23941.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23941.84,
Reremove wrist tendon lesion,25112,CPT,,,,,,,,both,,,32239.98,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22567.99,70,,22567.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,22567.99,
Remove wrist/forearm lesion,25115,CPT,,,,,,,,both,,,34227.66,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23959.36,70,,23959.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,23959.36,
Remove wrist/forearm lesion,25116,CPT,,,,,,,,both,,,32789.65,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22952.76,70,,22952.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,22952.76,
Excise wrist tendon sheath,25118,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,27044.39,
Partial removal of ulna,25119,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Removal of forearm lesion,25120,CPT,,,,,,,,both,,,71784.48,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50249.14,70,,50249.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,50249.14,
Remove/graft forearm lesion,25125,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,23663.84,
Remove/graft forearm lesion,25126,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Removal of wrist lesion,25130,CPT,,,,,,,,both,,,35523.66,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24866.56,70,,24866.56,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,24866.56,
Remove & graft wrist lesion,25135,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,105333.66,
Remove & graft wrist lesion,25136,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Remove forearm bone lesion,25145,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3937.82,,,3937.82,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,54466.2,
Partial removal of ulna,25150,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,54466.2,
Partial removal of radius,25151,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,54466.2,
Resect radius/ulnar tumor,25170,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Removal of wrist bone,25210,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Removal of wrist bones,25215,CPT,,,,,,,,both,,,37702.27,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26391.59,70,,26391.59,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,26391.59,
Partial removal of radius,25230,CPT,,,,,,,,both,,,44454.65,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,31118.26,70,,31118.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,31118.26,
Partial removal of ulna,25240,CPT,,,,,,,,both,,,44514.25,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,31159.98,70,,31159.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,31159.98,
Injection for wrist x-ray,25246,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,352.6,,,352.6,Fee Schedule,,298.85,,,298.85,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Remove forearm foreign body,25248,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,27044.39,
Removal of wrist prosthesis,25250,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,27044.39,
Removal of wrist prosthesis,25251,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,54466.2,
Manipulate wrist w/anesthes,25259,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Repair forearm tendon/muscle,25260,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Repair forearm tendon/muscle,25263,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3480.22,,,3480.22,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,120381.32,
Repair forearm tendon/muscle,25265,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Repair forearm tendon/muscle,25270,CPT,,,,,,,,both,,,36049.16,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25234.41,70,,25234.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,25234.41,
Repair forearm tendon/muscle,25272,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Repair forearm tendon/muscle,25274,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Repair forearm tendon sheath,25275,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Revise wrist/forearm tendon,25280,CPT,,,,,,,,both,,,33503.24,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23452.27,70,,23452.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,23452.27,
Incise wrist/forearm tendon,25290,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Release wrist/forearm tendon,25295,CPT,,,,,,,,both,,,37971.28,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26579.9,70,,26579.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,26579.9,
Fusion of tendons at wrist,25300,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,47657.93,
Fusion of tendons at wrist,25301,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Transplant forearm tendon,25310,CPT,,,,,,,,both,,,33536.25,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23475.38,70,,23475.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,23475.38,
Transplant forearm tendon,25312,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Revise palsy hand tendon(s),25315,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Revise palsy hand tendon(s),25316,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Repair/revise wrist joint,25320,CPT,,,,,,,,both,,,60861.39,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,42602.97,70,,42602.97,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,42602.97,
Revise wrist joint,25332,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,47657.93,
Realignment of hand,25335,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Reconstruct ulna/radioulnar,25337,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Revision of radius,25350,CPT,,,,,,,,both,,,67938.48,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47556.94,70,,47556.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,47556.94,
Revision of radius,25355,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Revision of ulna,25360,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Revise radius & ulna,25365,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,193779.51,
Revise radius or ulna,25370,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Revise radius & ulna,25375,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Shorten radius or ulna,25390,CPT,,,,,,,,both,,,79263.94,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,55484.76,70,,55484.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,55484.76,
Lengthen radius or ulna,25391,CPT,,,,,,,,both,,,56622.67,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,39635.87,70,,39635.87,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,39635.87,
Shorten radius & ulna,25392,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Lengthen radius & ulna,25393,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Repair carpal bone shorten,25394,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Repair radius or ulna,25400,CPT,,,,,,,,both,,,68184.32,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47729.02,70,,47729.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,47729.02,
Repair/graft radius or ulna,25405,CPT,,,,,,,,both,,,71753.49,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,50227.44,70,,50227.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,50227.44,
Repair radius & ulna,25415,CPT,,,,,,,,both,,,120422.45,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84295.72,70,,84295.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,84295.72,
Repair/graft radius & ulna,25420,CPT,,,,,,,,both,,,89164.01,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,62414.81,70,,62414.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,62414.81,
Repair/graft radius or ulna,25425,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Repair/graft radius & ulna,25426,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,47657.93,
Vasc graft into carpal bone,25430,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Repair nonunion carpal bone,25431,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Repair/graft wrist bone,25440,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Reconstruct wrist joint,25441,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,193779.51,
Reconstruct wrist joint,25442,CPT,,,,,,,,both,,,391985.94,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,274390.16,
Reconstruct wrist joint,25443,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,105333.66,
Reconstruct wrist joint,25444,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,193779.51,
Reconstruct wrist joint,25445,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,105333.66,
Wrist replacement,25446,CPT,,,,,,,,both,,,391985.94,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,274390.16,
Repair wrist joints,25447,CPT,,,,,,,,both,,,53642.7,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,37549.89,70,,37549.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,37549.89,
Remove wrist joint implant,25449,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,105333.66,
Revision of wrist joint,25450,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Revision of wrist joint,25455,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Reinforce radius,25490,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Reinforce ulna,25491,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,193779.51,
Reinforce radius and ulna,25492,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Treat fracture of radius,25500,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat fracture of radius,25505,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat fracture of radius,25515,CPT,,,,,,,,both,,,85719.93,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,60003.95,70,,60003.95,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,60003.95,
Treat fracture of radius,25520,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat fracture of radius,25525,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat fracture of radius,25526,CPT,,,,,,,,both,,,86255.66,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,60378.96,70,,60378.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,60378.96,
Treat fracture of ulna,25530,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat fracture of ulna,25535,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat fracture of ulna,25545,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat fracture radius & ulna,25560,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat fracture radius & ulna,25565,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat fracture radius & ulna,25574,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat fracture radius/ulna,25575,CPT,,,,,,,,both,,,78802.27,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,55161.59,70,,55161.59,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,55161.59,
Treat fracture radius/ulna,25600,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat fracture radius/ulna,25605,CPT,,,,,,,,both,,,34409.3,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,24086.51,70,,24086.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,24086.51,
Treat fx distal radial,25606,CPT,,,,,,,,both,,,36026.77,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25218.74,70,,25218.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,25218.74,
Treat fx rad extra-articul,25607,CPT,,,,,,,,both,,,99538.86,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,69677.2,70,,69677.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,69677.2,
Treat fx rad intra-articul,25608,CPT,,,,,,,,both,,,62978.56,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,44084.99,70,,44084.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,44084.99,
Treat fx radial 3+ frag,25609,CPT,,,,,,,,both,,,74400.22,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,52080.15,70,,52080.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,52080.15,
Treat wrist bone fracture,25622,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Treat wrist bone fracture,25624,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat wrist bone fracture,25628,CPT,,,,,,,,both,,,66045.92,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,46232.14,70,,46232.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,46232.14,
Treat wrist bone fracture,25630,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat wrist bone fracture,25635,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat wrist bone fracture,25645,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,47657.93,
Treat wrist bone fracture,25650,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Pin ulnar styloid fracture,25651,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,46296.27,68,,46296.27,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2053,54466.2,
Treat fracture ulnar styloid,25652,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat wrist dislocation,25660,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat wrist dislocation,25670,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Pin radioulnar dislocation,25671,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2053,54466.2,
Treat wrist dislocation,25675,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat wrist dislocation,25676,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,120381.32,
Treat wrist fracture,25680,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat wrist fracture,25685,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat wrist dislocation,25690,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat wrist dislocation,25695,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,120381.32,
Fusion of wrist joint,25800,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Fusion/graft of wrist joint,25805,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Fusion/graft of wrist joint,25810,CPT,,,,,,,,both,,,56204.17,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,39342.92,70,,39342.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,39342.92,
Fusion of hand bones,25820,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Fuse hand bones with graft,25825,CPT,,,,,,,,both,,,71599.92,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,50119.94,70,,50119.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,50119.94,
Fusion radioulnar jnt/ulna,25830,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Amputation follow-up surgery,25907,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Amputation follow-up surgery,25909,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3937.82,,,3937.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2117.11,,,2117.11,Other,New York Medicaid APG methodology,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,2117.11,,,2117.11,Other,100% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,3239.17,,,3239.17,Other,153% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,2963.95,,,2963.95,Other,140% New York Medicaid APG,4763.49,,,4763.49,Other,225% New York Medicaid APG,5504.48,,,5504.48,Other,260% New York Medicaid APG,6859.43,,,6859.43,Other,324% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,4551.78,,,4551.78,Other,215% New York Medicaid APG,2646.38,,,2646.38,Other,125% New York Medicaid APG,2117.11,105333.66,
Amputate hand at wrist,25922,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1766.08,23663.84,
Amputation follow-up surgery,25929,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,26850.29,
Amputation follow-up surgery,25931,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3480.22,,,3480.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1871.08,,,1871.08,Other,New York Medicaid APG methodology,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,1871.08,,,1871.08,Other,100% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2862.76,,,2862.76,Other,153% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,2619.52,,,2619.52,Other,140% New York Medicaid APG,4209.94,,,4209.94,Other,225% New York Medicaid APG,4864.82,,,4864.82,Other,260% New York Medicaid APG,6062.31,,,6062.31,Other,324% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,4022.83,,,4022.83,Other,215% New York Medicaid APG,2338.86,,,2338.86,Other,125% New York Medicaid APG,1871.08,47657.93,
Drainage of finger abscess,26010,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,733.72,,,733.72,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,697,,,697,Fee Schedule,,590.75,,,590.75,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,9473,
Drainage of finger abscess,26011,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,1207.71,,,1207.71,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,649.31,,,649.31,Other,New York Medicaid APG methodology,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,649.31,,,649.31,Other,100% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,993.44,,,993.44,Other,153% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,909.03,,,909.03,Other,140% New York Medicaid APG,1460.94,,,1460.94,Other,225% New York Medicaid APG,1688.2,,,1688.2,Other,260% New York Medicaid APG,2103.76,,,2103.76,Other,324% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,1396.01,,,1396.01,Other,215% New York Medicaid APG,811.64,,,811.64,Other,125% New York Medicaid APG,649.31,27281.4,
Drain hand tendon sheath,26020,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Drainage of palm bursa,26025,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Drainage of palm bursas,26030,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Treat hand bone lesion,26034,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27044.39,
Decompress fingers/hand,26035,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Decompress fingers/hand,26037,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Release palm contracture,26040,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23663.84,
Release palm contracture,26045,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Incise finger tendon sheath,26055,CPT,,,,,,,,both,,,33711.03,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22923.5,68,,22923.5,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,26968.82,80,,26968.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26968.82,80,,26968.82,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23597.72,70,,23597.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,26968.82,
Incision of finger tendon,26060,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27044.39,
Explore/treat hand joint,26070,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27044.39,
Explore/treat finger joint,26075,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Explore/treat finger joint,26080,CPT,,,,,,,,both,,,33671.19,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23569.83,70,,23569.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23569.83,
Biopsy hand joint lining,26100,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Biopsy finger joint lining,26105,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Biopsy finger joint lining,26110,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27044.39,
Exc hand les sc 1.5 cm/>,26111,CPT,,,,,,,,both,,,35595.01,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,24916.51,70,,24916.51,percent of total billed charges,,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24916.51,70,,24916.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,24916.51,
Exc hand tum deep 1.5 cm/>,26113,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23871.23,
Exc hand les sc < 1.5 cm,26115,CPT,,,,,,,,both,,,33585.72,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22838.29,68,,22838.29,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,26868.58,80,,26868.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26868.58,80,,26868.58,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23510,70,,23510,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,26868.58,
Exc hand tum deep < 1.5 cm,26116,CPT,,,,,,,,both,,,34505.64,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23463.84,68,,23463.84,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,27604.51,80,,27604.51,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27604.51,80,,27604.51,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24153.95,70,,24153.95,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27604.51,
Rad resect hand tumor < 3 cm,26117,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,41837.04,
Rad resect hand tumor 3 cm/>,26118,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,41837.04,
Release palm contracture,26121,CPT,,,,,,,,both,,,35559.44,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24891.61,70,,24891.61,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,24891.61,
Release palm contracture,26123,CPT,,,,,,,,both,,,35036.5,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24525.55,70,,24525.55,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,24525.55,
Release palm contracture,26125,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,0.01,58452.8,
Remove wrist joint lining,26130,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Revise finger joint each,26135,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Revise finger joint each,26140,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27044.39,
Tendon excision palm/finger,26145,CPT,,,,,,,,both,,,33317,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23321.9,70,,23321.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1766.08,23321.9,
Remove tendon sheath lesion,26160,CPT,,,,,,,,both,,,33778.34,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23644.84,70,,23644.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23644.84,
Removal of palm tendon each,26170,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23663.84,
Removal of finger tendon,26180,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23663.84,
Remove finger bone,26185,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23663.84,
Remove hand bone lesion,26200,CPT,,,,,,,,both,,,41803.66,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,28426.49,68,,28426.49,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,33442.93,80,,33442.93,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33442.93,80,,33442.93,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29262.56,70,,29262.56,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,33442.93,
Remove/graft bone lesion,26205,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Removal of finger lesion,26210,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27044.39,
Remove/graft finger lesion,26215,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Partial removal of hand bone,26230,CPT,,,,,,,,both,,,39242.3,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27469.61,70,,27469.61,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,27469.61,
Partial removal finger bone,26235,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1766.08,23663.84,
Partial removal finger bone,26236,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23663.84,
Extensive hand surgery,26250,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Resect prox finger tumor,26260,CPT,,,,,,,,both,,,41609.73,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29126.81,70,,29126.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,29126.81,
Resect distal finger tumor,26262,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27044.39,
Removal of implant from hand,26320,CPT,,,,,,,,both,,,35678.49,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24261.37,68,,24261.37,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,28542.79,80,,28542.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28542.79,80,,28542.79,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24974.94,70,,24974.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,28542.79,
Manipulate finger w/anesth,26340,CPT,,,,,,,,both,,,33748.75,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23624.13,70,,23624.13,percent of total billed charges,,22949.15,68,,22949.15,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,26999,80,,26999,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26999,80,,26999,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23624.13,70,,23624.13,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,26999,
Manipulat palm cord post inj,26341,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,387.04,,,387.04,Fee Schedule,,328.04,,,328.04,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Repair finger/hand tendon,26350,CPT,,,,,,,,both,,,33832.37,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23006.01,68,,23006.01,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,27065.9,80,,27065.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27065.9,80,,27065.9,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23682.66,70,,23682.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27065.9,
Repair/graft hand tendon,26352,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Repair finger/hand tendon,26356,CPT,,,,,,,,both,,,40034.5,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28024.15,70,,28024.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,28024.15,
Repair finger/hand tendon,26357,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Repair/graft hand tendon,26358,CPT,,,,,,,,both,,,54507.34,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,38155.14,70,,38155.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,38155.14,
Repair finger/hand tendon,26370,CPT,,,,,,,,both,,,37850.35,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26495.25,70,,26495.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,26495.25,
Repair/graft hand tendon,26372,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Repair finger/hand tendon,26373,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Revise hand/finger tendon,26390,CPT,,,,,,,,both,,,37645.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26351.96,70,,26351.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,26351.96,
Repair/graft hand tendon,26392,CPT,,,,,,,,both,,,56888.22,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,39821.75,70,,39821.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,39821.75,
Repair hand tendon,26410,CPT,,,,,,,,both,,,32157.65,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22510.36,70,,22510.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,22510.36,
Repair/graft hand tendon,26412,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Excision hand/finger tendon,26415,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Graft hand or finger tendon,26416,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Repair finger tendon,26418,CPT,,,,,,,,both,,,34562.54,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24193.78,70,,24193.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,24193.78,
Repair/graft finger tendon,26420,CPT,,,,,,,,both,,,61393.55,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,42975.49,70,,42975.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,42975.49,
Repair finger/hand tendon,26426,CPT,,,,,,,,both,,,35216.28,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24651.4,70,,24651.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,24651.4,
Repair/graft finger tendon,26428,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Repair finger tendon,26432,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23663.84,
Repair finger tendon,26433,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Repair/graft finger tendon,26434,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Realignment of tendons,26437,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Release palm/finger tendon,26440,CPT,,,,,,,,both,,,38676.66,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27073.66,70,,27073.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27073.66,
Release palm & finger tendon,26442,CPT,,,,,,,,both,,,42387.74,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,29671.42,70,,29671.42,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,29671.42,
Release hand/finger tendon,26445,CPT,,,,,,,,both,,,34927.48,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24449.24,70,,24449.24,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,24449.24,
Release forearm/hand tendon,26449,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Incision of palm tendon,26450,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Incision of finger tendon,26455,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,23663.84,
Incise hand/finger tendon,26460,CPT,,,,,,,,both,,,51889.91,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,36322.94,70,,36322.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,36322.94,
Fusion of finger tendons,26471,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Fusion of finger tendons,26474,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,27044.39,
Tendon lengthening,26476,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Tendon shortening,26477,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Lengthening of hand tendon,26478,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Shortening of hand tendon,26479,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Transplant hand tendon,26480,CPT,,,,,,,,both,,,41084.27,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28758.99,70,,28758.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,28758.99,
Transplant/graft hand tendon,26483,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Transplant palm tendon,26485,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3655.51,,,3655.51,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,54466.2,
Transplant/graft palm tendon,26489,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Revise thumb tendon,26490,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Tendon transfer with graft,26492,CPT,,,,,,,,both,,,32843,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,22990.1,70,,22990.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,22990.1,
Hand tendon/muscle transfer,26494,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Revise thumb tendon,26496,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Finger tendon transfer,26497,CPT,,,,,,,,both,,,56674.81,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,39672.37,70,,39672.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,39672.37,
Finger tendon transfer,26498,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Revision of finger,26499,CPT,,,,,,,,both,,,34322.65,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24025.86,70,,24025.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,24025.86,
Hand tendon reconstruction,26500,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Hand tendon reconstruction,26502,CPT,,,,,,,,both,,,39162.16,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27413.51,70,,27413.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,27413.51,
Release thumb contracture,26508,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Thumb tendon transfer,26510,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Fusion of knuckle joint,26516,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,54466.2,
Fusion of knuckle joints,26517,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Fusion of knuckle joints,26518,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Release knuckle contracture,26520,CPT,,,,,,,,both,,,36530.43,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25571.3,70,,25571.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,25571.3,
Release finger contracture,26525,CPT,,,,,,,,both,,,36510.01,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25557.01,70,,25557.01,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,25557.01,
Revise knuckle joint,26530,CPT,,,,,,,,both,,,37234.15,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,26063.91,70,,26063.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,26063.91,
Revise knuckle with implant,26531,CPT,,,,,,,,both,,,50570.66,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,35399.46,70,,35399.46,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,35399.46,
Revise finger joint,26535,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,47657.93,
Revise/implant finger joint,26536,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,105333.66,
Repair hand joint,26540,CPT,,,,,,,,both,,,47774.16,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,33441.91,70,,33441.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,33441.91,
Repair hand joint with graft,26541,CPT,,,,,,,,both,,,51006.86,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,35704.8,70,,35704.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,35704.8,
Repair hand joint with graft,26542,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Reconstruct finger joint,26545,CPT,,,,,,,,both,,,42409.65,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,29686.76,70,,29686.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,29686.76,
Repair nonunion hand,26546,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Reconstruct finger joint,26548,CPT,,,,,,,,both,,,39006.65,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27304.66,70,,27304.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,27304.66,
Construct thumb replacement,26550,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3655.51,,,3655.51,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,54466.2,
Positional change of finger,26555,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Repair of web finger,26560,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,3655.51,,,3655.51,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1766.08,27044.39,
Repair of web finger,26561,CPT,,,,,,,,both,,,41047.15,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28733.01,70,,28733.01,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,28733.01,
Repair of web finger,26562,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Correct metacarpal flaw,26565,CPT,,,,,,,,both,,,55334.13,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,38733.89,70,,38733.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,38733.89,
Correct finger deformity,26567,CPT,,,,,,,,both,,,49243.45,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,34470.42,70,,34470.42,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,34470.42,
Lengthen metacarpal/finger,26568,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Repair hand deformity,26580,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Reconstruct extra finger,26587,CPT,,,,,,,,both,,,34877.63,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24414.34,70,,24414.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,24414.34,
Repair finger deformity,26590,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1766.08,23663.84,
Repair muscles of hand,26591,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Release muscles of hand,26593,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,47657.93,
Excision constricting tissue,26596,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3655.51,,,3655.51,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,54466.2,
Treat metacarpal fracture,26600,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Treat metacarpal fracture,26605,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat metacarpal fracture,26607,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,54466.2,
Treat metacarpal fracture,26608,CPT,,,,,,,,both,,,33165.32,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23215.72,70,,23215.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,23215.72,
Treat metacarpal fracture,26615,CPT,,,,,,,,both,,,54008.81,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,37806.17,70,,37806.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,37806.17,
Treat thumb dislocation,26641,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Treat thumb fracture,26645,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat thumb fracture,26650,CPT,,,,,,,,both,,,73072.3,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49689.16,68,,49689.16,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,58457.84,80,,58457.84,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58457.84,80,,58457.84,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51150.61,70,,51150.61,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,58457.84,
Treat thumb fracture,26665,CPT,,,,,,,,both,,,38014.32,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,26610.02,70,,26610.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,26610.02,
Treat hand dislocation,26670,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Treat hand dislocation,26675,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Pin hand dislocation,26676,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,54466.2,
Treat hand dislocation,26685,CPT,,,,,,,,both,,,45313.25,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31719.28,70,,31719.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,31719.28,
Treat hand dislocation,26686,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,47657.93,
Treat knuckle dislocation,26700,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Treat knuckle dislocation,26705,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Pin knuckle dislocation,26706,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,54466.2,
Treat knuckle dislocation,26715,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,47657.93,
Treat finger fracture each,26720,CPT,,,,,,,,both,,,33713.65,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23599.56,70,,23599.56,percent of total billed charges,,22925.28,68,,22925.28,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,26970.92,80,,26970.92,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26970.92,80,,26970.92,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23599.56,70,,23599.56,percent of total billed charges,,956.12,,,956.12,Fee Schedule,,810.37,,,810.37,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,26970.92,
Treat finger fracture each,26725,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat finger fracture each,26727,CPT,,,,,,,,both,,,36735.79,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25715.05,70,,25715.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,25715.05,
Treat finger fracture each,26735,CPT,,,,,,,,both,,,53414.96,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,37390.47,70,,37390.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,37390.47,
Treat finger fracture each,26740,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat finger fracture each,26742,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat finger fracture each,26746,CPT,,,,,,,,both,,,44085.92,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,30860.14,70,,30860.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,30860.14,
Treat finger fracture each,26750,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,961.04,,,961.04,Fee Schedule,,814.54,,,814.54,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Treat finger fracture each,26755,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Pin finger fracture each,26756,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,54466.2,
Treat finger fracture each,26765,CPT,,,,,,,,both,,,42356.52,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29649.56,70,,29649.56,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,29649.56,
Treat finger dislocation,26770,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Treat finger dislocation,26775,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,1731,,,1731,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,295.11,9473,
Pin finger dislocation,26776,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,54466.2,
Treat finger dislocation,26785,CPT,,,,,,,,both,,,37112.76,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25236.68,68,,25236.68,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,29690.21,80,,29690.21,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29690.21,80,,29690.21,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25978.93,70,,25978.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,29690.21,
Thumb fusion with graft,26820,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Fusion of thumb,26841,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Thumb fusion with graft,26842,CPT,,,,,,,,both,,,81392.29,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56974.6,70,,56974.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,56974.6,
Fusion of hand joint,26843,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,105333.66,
Fusion/graft of hand joint,26844,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Fusion of knuckle,26850,CPT,,,,,,,,both,,,59284.06,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41498.84,70,,41498.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,41498.84,
Fusion of knuckle with graft,26852,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,105333.66,
Fusion of finger joint,26860,CPT,,,,,,,,both,,,41021.1,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28714.77,70,,28714.77,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,28714.77,
Fusion of finger jnt add-on,26861,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,0.01,41257.63,
Fusion/graft of finger joint,26862,CPT,,,,,,,,both,,,32178.46,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,22524.92,70,,22524.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,22524.92,
Fuse/graft added joint,26863,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2290.26,,,2290.26,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,0.01,45135.64,
Amputate metacarpal bone,26910,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,47657.93,
Amputation of finger/thumb,26951,CPT,,,,,,,,both,,,37728.36,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25655.28,68,,25655.28,percent of total billed charges,,2290.26,,,2290.26,Other,186% of Medicaid,30182.69,80,,30182.69,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30182.69,80,,30182.69,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26409.85,70,,26409.85,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1231.33,,,1231.33,Other,New York Medicaid APG methodology,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,1231.33,,,1231.33,Other,100% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1883.93,,,1883.93,Other,153% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,1723.86,,,1723.86,Other,140% New York Medicaid APG,2770.48,,,2770.48,Other,225% New York Medicaid APG,3201.45,,,3201.45,Other,260% New York Medicaid APG,3989.49,,,3989.49,Other,324% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,2647.35,,,2647.35,Other,215% New York Medicaid APG,1539.16,,,1539.16,Other,125% New York Medicaid APG,1231.33,30182.69,
Amputation of finger/thumb,26952,CPT,,,,,,,,both,,,34439.27,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3655.51,,,3655.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24107.49,70,,24107.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1965.33,,,1965.33,Other,New York Medicaid APG methodology,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,1965.33,,,1965.33,Other,100% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,3006.95,,,3006.95,Other,153% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,2751.46,,,2751.46,Other,140% New York Medicaid APG,4421.99,,,4421.99,Other,225% New York Medicaid APG,5109.86,,,5109.86,Other,260% New York Medicaid APG,6367.67,,,6367.67,Other,324% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,4225.46,,,4225.46,Other,215% New York Medicaid APG,2456.66,,,2456.66,Other,125% New York Medicaid APG,1965.33,24107.49,
Drainage of pelvis lesion,26990,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,54466.2,
Drainage of pelvis bursa,26991,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27044.39,
Incision of hip tendon,27000,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,1766.08,27044.39,
Incision of hip tendon,27001,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Incision of hip tendon,27003,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Incision of hip tendons,27006,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Buttock fasciotomy,27027,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,120381.32,
Exploration of hip joint,27033,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Denervation of hip joint,27035,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Biopsy of soft tissues,27040,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27281.4,
Biopsy of soft tissues,27041,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27281.4,
Exc hip pelvis les sc 3 cm/>,27043,CPT,,,,,,,,both,,,37916.56,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26541.59,70,,26541.59,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,26541.59,
Exc hip/pelv tum deep 5 cm/>,27045,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Exc hip/pelvis les sc < 3 cm,27047,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Exc hip/pelv tum deep < 5 cm,27048,CPT,,,,,,,,both,,,72101.84,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,50471.29,70,,50471.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,50471.29,
Resect hip/pelv tum < 5 cm,27049,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,41837.04,
Biopsy of sacroiliac joint,27050,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,1766.08,23663.84,
Biopsy of hip joint,27052,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,1766.08,23663.84,
Buttock fasciotomy w/dbrdmt,27057,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,1766.08,27044.39,
Resect hip/pelv tum 5 cm/>,27059,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,41837.04,
Removal of ischial bursa,27060,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Remove femur lesion/bursa,27062,CPT,,,,,,,,both,,,51263.95,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,35884.77,70,,35884.77,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,35884.77,
Remove hip bone les super,27065,CPT,,,,,,,,both,,,38551,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26985.7,70,,26985.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,26985.7,
Remove hip bone les deep,27066,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Remove/graft hip bone lesion,27067,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Removal of tail bone,27080,CPT,,,,,,,,both,,,53815.49,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,36594.53,68,,36594.53,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,43052.39,80,,43052.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,43052.39,80,,43052.39,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,37670.84,70,,37670.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,43052.39,
Remove hip foreign body,27086,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Remove hip foreign body,27087,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Injection for hip x-ray,27093,CPT,,,,,,,,both,,,13750.07,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9625.05,70,,9625.05,percent of total billed charges,,9350.05,68,,9350.05,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,11000.06,80,,11000.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11000.06,80,,11000.06,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9625.05,70,,9625.05,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,11000.06,
Injection for hip x-ray,27095,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,398.52,,,398.52,Fee Schedule,,337.77,,,337.77,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Revision of hip tendon,27097,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Transfer tendon to pelvis,27098,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Transfer of abdominal muscle,27100,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Transfer of spinal muscle,27105,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Transfer of iliopsoas muscle,27110,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Transfer of iliopsoas muscle,27111,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Total hip arthroplasty,27130,CPT,,,,,,,,both,,,95245.67,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,66671.97,70,,66671.97,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,66671.97,
Revise head/neck of femur,27179,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Clsd tx pelvic ring fx,27197,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,659.28,,,659.28,Fee Schedule,,558.78,,,558.78,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Clsd tx pelvic ring fx,27198,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat tail bone fracture,27200,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat tail bone fracture,27202,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,54466.2,
Treat hip socket fracture,27220,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Treat thigh fracture,27230,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat thigh fracture,27235,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat thigh fracture,27238,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat thigh fracture,27246,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat hip dislocation,27250,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat hip dislocation,27252,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Treat hip dislocation,27256,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat hip dislocation,27257,CPT,,,,,,,,both,,,48847.39,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1731,,,1731,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,34193.17,70,,34193.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,34193.17,
Treat hip dislocation,27265,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat hip dislocation,27266,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Cltx thigh fx,27267,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,2194.32,,,2194.32,Fee Schedule,,1859.82,,,1859.82,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,54466.2,
Manipulation of hip joint,27275,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Arthrodesis sacroiliac joint,27279,CPT,,,,,,,,both,,,117408.93,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,82186.25,70,,82186.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,82186.25,
Drain thigh/knee lesion,27301,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Incise thigh tendon & fascia,27305,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,54466.2,
Incision of thigh tendon,27306,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Incision of thigh tendons,27307,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Exploration of knee joint,27310,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Biopsy thigh soft tissues,27323,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27281.4,
Biopsy thigh soft tissues,27324,CPT,,,,,,,,both,,,71152.91,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,48383.98,68,,48383.98,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,56922.33,80,,56922.33,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,56922.33,80,,56922.33,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,49807.04,70,,49807.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,56922.33,
Neurectomy hamstring,27325,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,32489.2,
Neurectomy popliteal,27326,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,32489.2,
Exc thigh/knee les sc < 3 cm,27327,CPT,,,,,,,,both,,,35232.08,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23957.81,68,,23957.81,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,28185.66,80,,28185.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28185.66,80,,28185.66,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24662.46,70,,24662.46,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,28185.66,
Exc thigh/knee tum deep <5cm,27328,CPT,,,,,,,,both,,,39215.98,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27451.19,70,,27451.19,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27451.19,
Resect thigh/knee tum < 5 cm,27329,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,41837.04,
Biopsy knee joint lining,27330,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Explore/treat knee joint,27331,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Removal of knee cartilage,27332,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Removal of knee cartilage,27333,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Remove knee joint lining,27334,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Remove knee joint lining,27335,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,105333.66,
Exc thigh/knee les sc 3 cm/>,27337,CPT,,,,,,,,both,,,35216.67,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24651.67,70,,24651.67,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,24651.67,
Exc thigh/knee tum dep 5cm/>,27339,CPT,,,,,,,,both,,,39221.15,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27454.81,70,,27454.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27454.81,
Removal of kneecap bursa,27340,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Removal of knee cyst,27345,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Remove knee cyst,27347,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Removal of kneecap,27350,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,105333.66,
Remove femur lesion,27355,CPT,,,,,,,,both,,,37524.27,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26266.99,70,,26266.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,26266.99,
Remove femur lesion/graft,27356,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,193779.51,
Remove femur lesion/graft,27357,CPT,,,,,,,,both,,,49274.1,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,34491.87,70,,34491.87,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,34491.87,
Remove femur lesion/fixation,27358,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,0.01,60613.98,
Partial removal leg bone(s),27360,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Resect thigh/knee tum 5 cm/>,27364,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,41837.04,
Njx cntrst kne arthg/ct/mri,27369,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,196.8,,,196.8,Fee Schedule,,166.8,,,166.8,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Removal of foreign body,27372,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Repair of kneecap tendon,27380,CPT,,,,,,,,both,,,38422.81,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,26127.51,68,,26127.51,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,30738.25,80,,30738.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30738.25,80,,30738.25,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26895.97,70,,26895.97,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,30738.25,
Repair/graft kneecap tendon,27381,CPT,,,,,,,,both,,,93520.15,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,65464.11,70,,65464.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,65464.11,
Repair of thigh muscle,27385,CPT,,,,,,,,both,,,44183.39,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,30928.37,70,,30928.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,30928.37,
Repair/graft of thigh muscle,27386,CPT,,,,,,,,both,,,66941.66,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46859.16,70,,46859.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,46859.16,
Incision of thigh tendon,27390,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,54466.2,
Incision of thigh tendons,27391,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,54466.2,
Incision of thigh tendons,27392,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Lengthening of thigh tendon,27393,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,120381.32,
Lengthening of thigh tendons,27394,CPT,,,,,,,,both,,,51096.05,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,35767.24,70,,35767.24,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,35767.24,
Lengthening of thigh tendons,27395,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Transplant of thigh tendon,27396,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Transplants of thigh tendons,27397,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Revise thigh muscles/tendons,27400,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Repair of knee cartilage,27403,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,105333.66,
Repair of knee ligament,27405,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,105333.66,
Repair of knee ligament,27407,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,105333.66,
Repair of knee ligaments,27409,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,105333.66,
Autochondrocyte implant knee,27412,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,105333.66,
Osteochondral knee allograft,27415,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,193779.51,
Osteochondral knee autograft,27416,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,4824.88,,,4824.88,Fee Schedule,,4089.38,,,4089.38,Fee Schedule,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,105333.66,
Repair degenerated kneecap,27418,CPT,,,,,,,,both,,,68506.97,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47954.88,70,,47954.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,47954.88,
Revision of unstable kneecap,27420,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,105333.66,
Revision of unstable kneecap,27422,CPT,,,,,,,,both,,,70807.26,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,49565.08,70,,49565.08,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,49565.08,
Revision/removal of kneecap,27424,CPT,,,,,,,,both,,,50657.5,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,35460.25,70,,35460.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,35460.25,
Lat retinacular release open,27425,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Reconstruction knee,27427,CPT,,,,,,,,both,,,100972.69,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,70680.88,70,,70680.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,70680.88,
Reconstruction knee,27428,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,193779.51,
Reconstruction knee,27429,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,193779.51,
Revision of thigh muscles,27430,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Incision of knee joint,27435,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Revise kneecap,27437,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,105333.66,
Revise kneecap with implant,27438,CPT,,,,,,,,both,,,46878.57,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,32815,70,,32815,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,32815,
Revision of knee joint,27440,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,193779.51,
Revision of knee joint,27441,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,193779.51,
Revision of knee joint,27442,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,193779.51,
Revision of knee joint,27443,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,193779.51,
Revision of knee joint,27446,CPT,,,,,,,,both,,,77786.36,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,54450.45,70,,54450.45,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,54450.45,
Total knee arthroplasty,27447,CPT,,,,,,,,both,,,86226.6,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5965.87,,,5965.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,60358.62,70,,60358.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3207.46,,,3207.46,Other,New York Medicaid APG methodology,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,3207.46,,,3207.46,Other,100% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4907.41,,,4907.41,Other,153% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,4490.44,,,4490.44,Other,140% New York Medicaid APG,7216.77,,,7216.77,Other,225% New York Medicaid APG,8339.38,,,8339.38,Other,260% New York Medicaid APG,10392.16,,,10392.16,Other,324% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,6896.03,,,6896.03,Other,215% New York Medicaid APG,4009.32,,,4009.32,Other,125% New York Medicaid APG,3207.46,60358.62,
Surgery to stop leg growth,27475,CPT,,,,,,,,both,,,38859.59,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,27201.71,70,,27201.71,percent of total billed charges,,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27201.71,70,,27201.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,27201.71,
Surgery to stop leg growth,27477,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,105333.66,
Surgery to stop leg growth,27479,CPT,,,,,,,,both,,,39487.52,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,27641.26,70,,27641.26,percent of total billed charges,,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27641.26,70,,27641.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,27641.26,
Surgery to stop leg growth,27485,CPT,,,,,,,,both,,,63947.43,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,44763.2,70,,44763.2,percent of total billed charges,,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,44763.2,70,,44763.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,44763.2,
Decompression of thigh/knee,27496,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Decompression of thigh/knee,27497,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Decompression of thigh/knee,27498,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,23663.84,
Decompression of thigh/knee,27499,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,105333.66,
Treatment of thigh fracture,27500,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of thigh fracture,27501,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of thigh fracture,27502,CPT,,,,,,,,both,,,35094.81,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23864.47,68,,23864.47,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,28075.85,80,,28075.85,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28075.85,80,,28075.85,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24566.37,70,,24566.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,28075.85,
Treatment of thigh fracture,27503,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,23663.84,
Treatment of thigh fracture,27508,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of thigh fracture,27509,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treatment of thigh fracture,27510,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat thigh fx growth plate,27516,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat thigh fx growth plate,27517,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat kneecap fracture,27520,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat kneecap fracture,27524,CPT,,,,,,,,both,,,78201.22,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,54740.85,70,,54740.85,percent of total billed charges,,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,54740.85,70,,54740.85,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,54740.85,
Treat knee fracture,27530,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat knee fracture,27532,CPT,,,,,,,,both,,,39345.83,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,26755.16,68,,26755.16,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,31476.66,80,,31476.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31476.66,80,,31476.66,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27542.08,70,,27542.08,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,31476.66,
Treat knee fracture(s),27538,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat knee dislocation,27550,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat knee dislocation,27552,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Treat kneecap dislocation,27560,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat kneecap dislocation,27562,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,259.13,7216,
Treat kneecap dislocation,27566,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,120381.32,
Fixation of knee joint,27570,CPT,,,,,,,,both,,,44434.54,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,30215.49,68,,30215.49,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,35547.63,80,,35547.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35547.63,80,,35547.63,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,31104.18,70,,31104.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,35547.63,
Amputation follow-up surgery,27594,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Decompression of lower leg,27600,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Decompression of lower leg,27601,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Decompression of lower leg,27602,CPT,,,,,,,,both,,,38724.79,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27107.35,70,,27107.35,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,27107.35,
Drain lower leg lesion,27603,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Drain lower leg bursa,27604,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Incision of achilles tendon,27605,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27044.39,
Incision of achilles tendon,27606,CPT,,,,,,,,both,,,33463.8,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22755.38,68,,22755.38,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,26771.04,80,,26771.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26771.04,80,,26771.04,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23424.66,70,,23424.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,26771.04,
Treat lower leg bone lesion,27607,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Explore/treat ankle joint,27610,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Exploration of ankle joint,27612,CPT,,,,,,,,both,,,69465.45,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,48625.82,70,,48625.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,48625.82,
Biopsy lower leg soft tissue,27613,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27281.4,
Biopsy lower leg soft tissue,27614,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47813.76,
Resect leg/ankle tum < 5 cm,27615,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Resect leg/ankle tum 5 cm/>,27616,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,41837.04,
Exc leg/ankle tum < 3 cm,27618,CPT,,,,,,,,both,,,34747.3,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23628.16,68,,23628.16,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,27797.84,80,,27797.84,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27797.84,80,,27797.84,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24323.11,70,,24323.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,27797.84,
Exc leg/ankle tum deep <5 cm,27619,CPT,,,,,,,,both,,,42722.51,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29905.76,70,,29905.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,29905.76,
Explore/treat ankle joint,27620,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Remove ankle joint lining,27625,CPT,,,,,,,,both,,,121665.15,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,85165.61,70,,85165.61,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,85165.61,
Remove ankle joint lining,27626,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Removal of tendon lesion,27630,CPT,,,,,,,,both,,,35493.32,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24845.32,70,,24845.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,24845.32,
Exc leg/ankle les sc 3 cm/>,27632,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,41837.04,
Exc leg/ankle tum dep 5 cm/>,27634,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,41837.04,
Remove lower leg bone lesion,27635,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Remove/graft leg bone lesion,27637,CPT,,,,,,,,both,,,161949.55,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,113364.69,70,,113364.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,113364.69,
Remove/graft leg bone lesion,27638,CPT,,,,,,,,both,,,39228.79,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27460.15,70,,27460.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,27460.15,
Partial removal of tibia,27640,CPT,,,,,,,,both,,,43528.56,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29599.42,68,,29599.42,percent of total billed charges,,3502.65,,,3502.65,Other,186% of Medicaid,34822.85,80,,34822.85,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34822.85,80,,34822.85,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,30469.99,70,,30469.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,34822.85,
Partial removal of fibula,27641,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Resect talus/calcaneus tum,27647,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,47657.93,
Injection for ankle x-ray,27648,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,247.64,,,247.64,Fee Schedule,,209.89,,,209.89,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Repair achilles tendon,27650,CPT,,,,,,,,both,,,65373.37,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,45761.36,70,,45761.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,45761.36,
Repair/graft achilles tendon,27652,CPT,,,,,,,,both,,,56945.95,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,39862.17,70,,39862.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,39862.17,
Repair of achilles tendon,27654,CPT,,,,,,,,both,,,84319.85,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,59023.9,70,,59023.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,59023.9,
Repair leg fascia defect,27656,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3818.45,,,3818.45,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,54466.2,
Repair of leg tendon each,27658,CPT,,,,,,,,both,,,87326.11,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,59381.75,68,,59381.75,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,69860.89,80,,69860.89,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69860.89,80,,69860.89,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,61128.28,70,,61128.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,69860.89,
Repair of leg tendon each,27659,CPT,,,,,,,,both,,,61576.68,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,41872.14,68,,41872.14,percent of total billed charges,,3502.65,,,3502.65,Other,186% of Medicaid,49261.34,80,,49261.34,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,49261.34,80,,49261.34,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,43103.68,70,,43103.68,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,49261.34,
Repair of leg tendon each,27664,CPT,,,,,,,,both,,,45470.79,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,30920.14,68,,30920.14,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,36376.63,80,,36376.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,36376.63,80,,36376.63,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,31829.55,70,,31829.55,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,36376.63,
Repair of leg tendon each,27665,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3502.65,,,3502.65,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,120381.32,
Repair lower leg tendons,27675,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Repair lower leg tendons,27676,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,105333.66,
Release of lower leg tendon,27680,CPT,,,,,,,,both,,,59649.87,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41754.91,70,,41754.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,41754.91,
Release of lower leg tendons,27681,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Revision of lower leg tendon,27685,CPT,,,,,,,,both,,,40974.55,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28682.19,70,,28682.19,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,28682.19,
Revise lower leg tendons,27686,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,47657.93,
Revision of calf tendon,27687,CPT,,,,,,,,both,,,46751.12,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,32725.78,70,,32725.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,32725.78,
Revise lower leg tendon,27690,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,105333.66,
Revise lower leg tendon,27691,CPT,,,,,,,,both,,,97738.58,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,68417.01,70,,68417.01,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,68417.01,
Revise additional leg tendon,27692,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,0.01,45135.64,
Repair of ankle ligament,27695,CPT,,,,,,,,both,,,100988.85,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,68672.42,68,,68672.42,percent of total billed charges,,3502.65,,,3502.65,Other,186% of Medicaid,80791.08,80,,80791.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,80791.08,80,,80791.08,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,70692.2,70,,70692.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,80791.08,
Repair of ankle ligaments,27696,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3502.65,,,3502.65,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,120381.32,
Repair of ankle ligament,27698,CPT,,,,,,,,both,,,79440.32,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,54019.42,68,,54019.42,percent of total billed charges,,3502.65,,,3502.65,Other,186% of Medicaid,63552.26,80,,63552.26,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,63552.26,80,,63552.26,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,55608.22,70,,55608.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,63552.26,
Revision of ankle joint,27700,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5219.19,,,5219.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2806.01,,,2806.01,Other,New York Medicaid APG methodology,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,2806.01,,,2806.01,Other,100% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,4293.2,,,4293.2,Other,153% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,3928.42,,,3928.42,Other,140% New York Medicaid APG,6313.53,,,6313.53,Other,225% New York Medicaid APG,7295.64,,,7295.64,Other,260% New York Medicaid APG,9091.49,,,9091.49,Other,324% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,6032.93,,,6032.93,Other,215% New York Medicaid APG,3507.52,,,3507.52,Other,125% New York Medicaid APG,2806.01,105333.66,
Removal of ankle implant,27704,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Incision of tibia,27705,CPT,,,,,,,,both,,,48338.46,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,32870.15,68,,32870.15,percent of total billed charges,,3502.65,,,3502.65,Other,186% of Medicaid,38670.77,80,,38670.77,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,38670.77,80,,38670.77,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,33836.92,70,,33836.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,38670.77,
Incision of fibula,27707,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3502.65,,,3502.65,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,54466.2,
Incision of tibia & fibula,27709,CPT,,,,,,,,both,,,110739.67,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,75302.98,68,,75302.98,percent of total billed charges,,3502.65,,,3502.65,Other,186% of Medicaid,88591.74,80,,88591.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,88591.74,80,,88591.74,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,77517.77,70,,77517.77,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,88591.74,
Repair of tibia,27720,CPT,,,,,,,,both,,,75013.17,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,52509.22,70,,52509.22,percent of total billed charges,,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,52509.22,70,,52509.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,52509.22,
Repair/graft of tibia,27722,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Repair fibula nonunion,27726,CPT,,,,,,,,both,,,102271.53,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,71590.07,70,,71590.07,percent of total billed charges,,4710.08,,,4710.08,Fee Schedule,,3992.08,,,3992.08,Fee Schedule,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,71590.07,
Repair of tibia epiphysis,27730,CPT,,,,,,,,both,,,34131.15,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23209.18,68,,23209.18,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,27304.92,80,,27304.92,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27304.92,80,,27304.92,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23891.81,70,,23891.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,27304.92,
Repair of fibula epiphysis,27732,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Repair lower leg epiphyses,27734,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Repair of leg epiphyses,27740,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Repair of leg epiphyses,27742,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3097.88,,,3097.88,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,54466.2,
Reinforce tibia,27745,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,105333.66,
Treatment of tibia fracture,27750,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of tibia fracture,27752,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treatment of tibia fracture,27756,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treatment of tibia fracture,27758,CPT,,,,,,,,both,,,170284.2,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,119198.94,70,,119198.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,119198.94,
Treatment of tibia fracture,27759,CPT,,,,,,,,both,,,80308.42,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,56215.89,70,,56215.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,56215.89,
Cltx medial ankle fx,27760,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Cltx med ankle fx w/mnpj,27762,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Optx medial ankle fx,27766,CPT,,,,,,,,both,,,50346.88,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,35242.82,70,,35242.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,35242.82,
Cltx post ankle fx,27767,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,1464.52,,,1464.52,Fee Schedule,,1241.27,,,1241.27,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Cltx post ankle fx w/mnpj,27768,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,2240.24,,,2240.24,Fee Schedule,,1898.74,,,1898.74,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Optx post ankle fx,27769,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3588.32,,,3588.32,Fee Schedule,,3041.32,,,3041.32,Fee Schedule,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treatment of fibula fracture,27780,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of fibula fracture,27781,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treatment of fibula fracture,27784,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treatment of ankle fracture,27786,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of ankle fracture,27788,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of ankle fracture,27792,CPT,,,,,,,,both,,,82253.84,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,57577.69,70,,57577.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,57577.69,
Treatment of ankle fracture,27808,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of ankle fracture,27810,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treatment of ankle fracture,27814,CPT,,,,,,,,both,,,101018.81,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,70713.17,70,,70713.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,70713.17,
Treatment of ankle fracture,27816,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of ankle fracture,27818,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treatment of ankle fracture,27822,CPT,,,,,,,,both,,,110876.23,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,77613.36,70,,77613.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,77613.36,
Treatment of ankle fracture,27823,CPT,,,,,,,,both,,,118330,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,82831,70,,82831,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,82831,
Treat lower leg fracture,27824,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat lower leg fracture,27825,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat lower leg fracture,27826,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat lower leg fracture,27827,CPT,,,,,,,,both,,,66604.04,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,46622.83,70,,46622.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,46622.83,
Treat lower leg fracture,27828,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,193779.51,
Treat lower leg joint,27829,CPT,,,,,,,,both,,,52382.9,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35620.37,68,,35620.37,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,41906.32,80,,41906.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41906.32,80,,41906.32,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,36668.03,70,,36668.03,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,41906.32,
Treat lower leg dislocation,27830,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat lower leg dislocation,27831,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,54466.2,
Treat lower leg dislocation,27832,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,120381.32,
Treat ankle dislocation,27840,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat ankle dislocation,27842,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Treat ankle dislocation,27846,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat ankle dislocation,27848,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Fixation of ankle joint,27860,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,54466.2,
Fusion of ankle joint open,27870,CPT,,,,,,,,both,,,124203.23,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,86942.26,70,,86942.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,86942.26,
Fusion of tibiofibular joint,27871,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,193779.51,
Amputation follow-up surgery,27884,CPT,,,,,,,,both,,,38158.9,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26711.23,70,,26711.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,26711.23,
Amputation of foot at ankle,27889,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3502.65,,,3502.65,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1883.14,,,1883.14,Other,New York Medicaid APG methodology,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,1883.14,,,1883.14,Other,100% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2881.21,,,2881.21,Other,153% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,2636.4,,,2636.4,Other,140% New York Medicaid APG,4237.07,,,4237.07,Other,225% New York Medicaid APG,4896.17,,,4896.17,Other,260% New York Medicaid APG,6101.38,,,6101.38,Other,324% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,4048.76,,,4048.76,Other,215% New York Medicaid APG,2353.93,,,2353.93,Other,125% New York Medicaid APG,1883.14,105333.66,
Decompression of leg,27892,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Decompression of leg,27893,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,105333.66,
Decompression of leg,27894,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3818.45,,,3818.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2052.93,,,2052.93,Other,New York Medicaid APG methodology,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,2052.93,,,2052.93,Other,100% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,3140.98,,,3140.98,Other,153% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,2874.1,,,2874.1,Other,140% New York Medicaid APG,4619.09,,,4619.09,Other,225% New York Medicaid APG,5337.61,,,5337.61,Other,260% New York Medicaid APG,6651.49,,,6651.49,Other,324% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,4413.8,,,4413.8,Other,215% New York Medicaid APG,2566.16,,,2566.16,Other,125% New York Medicaid APG,2052.93,47657.93,
Drainage of bursa of foot,28001,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27281.4,
Treatment of foot infection,28002,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23663.84,
Treatment of foot infection,28003,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1973.68,,,1973.68,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,47657.93,
Treat foot bone lesion,28005,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,47657.93,
Incision of foot fascia,28008,CPT,,,,,,,,both,,,39365.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27556.03,70,,27556.03,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27556.03,
Incision of toe tendon,28010,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,22987.73,68,,22987.73,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27044.39,
Incision of toe tendons,28011,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23663.84,
Exploration of foot joint,28020,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Exploration of foot joint,28022,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Exploration of toe joint,28024,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27044.39,
Decompression of tibia nerve,28035,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3097.88,,,3097.88,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1665.53,,,1665.53,Other,New York Medicaid APG methodology,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,1665.53,,,1665.53,Other,100% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2548.26,,,2548.26,Other,153% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,2331.74,,,2331.74,Other,140% New York Medicaid APG,3747.44,,,3747.44,Other,225% New York Medicaid APG,4330.38,,,4330.38,Other,260% New York Medicaid APG,5396.31,,,5396.31,Other,324% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,3580.89,,,3580.89,Other,215% New York Medicaid APG,2081.91,,,2081.91,Other,125% New York Medicaid APG,1665.53,28428.05,
Exc foot/toe tum sc 1.5 cm/>,28039,CPT,,,,,,,,both,,,41783.13,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,29248.19,70,,29248.19,percent of total billed charges,,28412.53,68,,28412.53,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,33426.5,80,,33426.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33426.5,80,,33426.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29248.19,70,,29248.19,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,33426.5,
Exc foot/toe tum dep 1.5cm/>,28041,CPT,,,,,,,,both,,,58093.92,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,40665.74,70,,40665.74,percent of total billed charges,,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,40665.74,70,,40665.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,40665.74,
Exc foot/toe tum sc < 1.5 cm,28043,CPT,,,,,,,,both,,,36382.58,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24740.15,68,,24740.15,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,29106.06,80,,29106.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29106.06,80,,29106.06,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25467.81,70,,25467.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,29106.06,
Exc foot/toe tum deep <1.5cm,28045,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,41837.04,
Resect foot/toe tumor < 3 cm,28046,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,41837.04,
Resect foot/toe tumor 3 cm/>,28047,CPT,,,,,,,,both,,,35622.92,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24936.04,70,,24936.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,24936.04,
Biopsy of foot joint lining,28050,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Biopsy of foot joint lining,28052,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Biopsy of toe joint lining,28054,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Neurectomy foot,28055,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,28428.05,
Partial removal foot fascia,28060,CPT,,,,,,,,both,,,35068.64,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23846.68,68,,23846.68,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,28054.91,80,,28054.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28054.91,80,,28054.91,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24548.05,70,,24548.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,28054.91,
Removal of foot fascia,28062,CPT,,,,,,,,both,,,51449.55,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,36014.69,70,,36014.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,36014.69,
Removal of foot joint lining,28070,CPT,,,,,,,,both,,,37759.44,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26431.61,70,,26431.61,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,26431.61,
Removal of foot joint lining,28072,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Removal of foot lesion,28080,CPT,,,,,,,,both,,,34738.77,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24317.14,70,,24317.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,24317.14,
Excise foot tendon sheath,28086,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Excise foot tendon sheath,28088,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Removal of foot lesion,28090,CPT,,,,,,,,both,,,33789.97,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23652.98,70,,23652.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23652.98,
Removal of toe lesions,28092,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23663.84,
Removal of ankle/heel lesion,28100,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3643.47,,,3643.47,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,54466.2,
Remove/graft foot lesion,28102,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Remove/graft foot lesion,28103,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Removal of foot lesion,28104,CPT,,,,,,,,both,,,35913.38,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24421.1,68,,24421.1,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,28730.7,80,,28730.7,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28730.7,80,,28730.7,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25139.37,70,,25139.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,28730.7,
Remove/graft foot lesion,28106,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Remove/graft foot lesion,28107,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Removal of toe lesions,28108,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27044.39,
Part removal of metatarsal,28110,CPT,,,,,,,,both,,,44380.59,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31066.41,70,,31066.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,31066.41,
Part removal of metatarsal,28111,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Part removal of metatarsal,28112,CPT,,,,,,,,both,,,34923.41,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24446.39,70,,24446.39,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,24446.39,
Part removal of metatarsal,28113,CPT,,,,,,,,both,,,34840.86,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24388.6,70,,24388.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,24388.6,
Removal of metatarsal heads,28114,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,47657.93,
Revision of foot,28116,CPT,,,,,,,,both,,,67355.24,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47148.67,70,,47148.67,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47148.67,
Removal of heel bone,28118,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Removal of heel spur,28119,CPT,,,,,,,,both,,,42571.64,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29800.15,70,,29800.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,29800.15,
Part removal of ankle/heel,28120,CPT,,,,,,,,both,,,36961.26,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25872.88,70,,25872.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,25872.88,
Partial removal of foot bone,28122,CPT,,,,,,,,both,,,39159.77,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27411.84,70,,27411.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,27411.84,
Partial removal of toe,28124,CPT,,,,,,,,both,,,33224.17,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,22592.44,68,,22592.44,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,26579.34,80,,26579.34,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26579.34,80,,26579.34,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23256.92,70,,23256.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,26579.34,
Partial removal of toe,28126,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Removal of ankle bone,28130,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Removal of metatarsal,28140,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Removal of toe,28150,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Partial removal of toe,28153,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Partial removal of toe,28160,CPT,,,,,,,,both,,,45697.03,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31987.92,70,,31987.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,31987.92,
Resect tarsal tumor,28171,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,47657.93,
Resect metatarsal tumor,28173,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,47657.93,
Resect phalanx of toe tumor,28175,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23663.84,
Removal of foot foreign body,28190,CPT,,,,,,,,both,,,34116.99,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23881.89,70,,23881.89,percent of total billed charges,,23199.55,68,,23199.55,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,27293.59,80,,27293.59,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27293.59,80,,27293.59,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23881.89,70,,23881.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,667.44,27293.59,
Removal of foot foreign body,28192,CPT,,,,,,,,both,,,35216.74,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23947.38,68,,23947.38,percent of total billed charges,,1973.68,,,1973.68,Other,186% of Medicaid,28173.39,80,,28173.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28173.39,80,,28173.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24651.72,70,,24651.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1061.12,,,1061.12,Other,New York Medicaid APG methodology,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,1061.12,,,1061.12,Other,100% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1623.51,,,1623.51,Other,153% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,1485.56,,,1485.56,Other,140% New York Medicaid APG,2387.51,,,2387.51,Other,225% New York Medicaid APG,2758.9,,,2758.9,Other,260% New York Medicaid APG,3438.02,,,3438.02,Other,324% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,2281.4,,,2281.4,Other,215% New York Medicaid APG,1326.4,,,1326.4,Other,125% New York Medicaid APG,1061.12,28173.39,
Removal of foot foreign body,28193,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23871.23,
Repair of foot tendon,28200,CPT,,,,,,,,both,,,66385.42,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46469.79,70,,46469.79,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,46469.79,
Repair/graft of foot tendon,28202,CPT,,,,,,,,both,,,58632.75,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41042.93,70,,41042.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,41042.93,
Repair of foot tendon,28208,CPT,,,,,,,,both,,,33901.61,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23731.13,70,,23731.13,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23731.13,
Repair/graft of foot tendon,28210,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Release of foot tendon,28220,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,22987.73,68,,22987.73,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27044.39,
Release of foot tendons,28222,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Release of foot tendon,28225,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Release of foot tendons,28226,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Incision of foot tendon(s),28230,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,22987.73,68,,22987.73,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27044.39,
Incision of toe tendon,28232,CPT,,,,,,,,both,,,36409.48,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,25486.64,70,,25486.64,percent of total billed charges,,24758.45,68,,24758.45,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,29127.58,80,,29127.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29127.58,80,,29127.58,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25486.64,70,,25486.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,29127.58,
Incision of foot tendon,28234,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27044.39,
Revision of foot tendon,28238,CPT,,,,,,,,both,,,74342.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,52039.86,70,,52039.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,52039.86,
Release of big toe,28240,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Revision of foot fascia,28250,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Release of midfoot joint,28260,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,47657.93,
Revision of foot tendon,28261,CPT,,,,,,,,both,,,57176.73,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,40023.71,70,,40023.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1766.08,40023.71,
Revision of foot and ankle,28262,CPT,,,,,,,,both,,,93565.48,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,65495.84,70,,65495.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,65495.84,
Release of midfoot joint,28264,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,3643.47,,,3643.47,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1766.08,27044.39,
Release of foot contracture,28270,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Release of toe joint each,28272,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,22987.73,68,,22987.73,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27044.39,
Fusion of toes,28280,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Repair of hammertoe,28285,CPT,,,,,,,,both,,,39003.16,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27302.21,70,,27302.21,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,27302.21,
Repair of hammertoe,28286,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Partial removal of foot bone,28288,CPT,,,,,,,,both,,,34275.11,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23992.58,70,,23992.58,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23992.58,
Corrj halux rigdus w/o implt,28289,CPT,,,,,,,,both,,,34937.05,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24455.94,70,,24455.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,24455.94,
Corrj halux rigdus w/implt,28291,CPT,,,,,,,,both,,,74358.15,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,52050.71,70,,52050.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,52050.71,
Correction hallux valgus,28292,CPT,,,,,,,,both,,,40898.42,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27810.93,68,,27810.93,percent of total billed charges,,3643.47,,,3643.47,Other,186% of Medicaid,32718.74,80,,32718.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32718.74,80,,32718.74,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28628.89,70,,28628.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,32718.74,
Correction hallux valgus,28295,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,3643.47,,,3643.47,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,54466.2,
Correction hallux valgus,28296,CPT,,,,,,,,both,,,37862.65,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26503.86,70,,26503.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,26503.86,
Correction hallux valgus,28297,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Correction hallux valgus,28298,CPT,,,,,,,,both,,,38569.2,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26998.44,70,,26998.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,26998.44,
Correction hallux valgus,28299,CPT,,,,,,,,both,,,53511.09,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,37457.76,70,,37457.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,37457.76,
Incision of heel bone,28300,CPT,,,,,,,,both,,,116501.74,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,79221.18,68,,79221.18,percent of total billed charges,,3643.47,,,3643.47,Other,186% of Medicaid,93201.39,80,,93201.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,93201.39,80,,93201.39,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,81551.22,70,,81551.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,93201.39,
Incision of ankle bone,28302,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3643.47,,,3643.47,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,120381.32,
Incision of midfoot bones,28304,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,3643.47,,,3643.47,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,120381.32,
Incise/graft midfoot bones,28305,CPT,,,,,,,,both,,,99047.96,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,69333.57,70,,69333.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,69333.57,
Incision of metatarsal,28306,CPT,,,,,,,,both,,,33438.04,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23406.63,70,,23406.63,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23406.63,
Incision of metatarsal,28307,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Incision of metatarsal,28308,CPT,,,,,,,,both,,,50631.12,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,34429.16,68,,34429.16,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,40504.9,80,,40504.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,40504.9,80,,40504.9,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,35441.78,70,,35441.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,40504.9,
Incision of metatarsals,28309,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Revision of big toe,28310,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,105333.66,
Revision of toe,28312,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Repair deformity of toe,28313,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,54466.2,
Removal of sesamoid bone,28315,CPT,,,,,,,,both,,,33217,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23251.9,70,,23251.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23251.9,
Repair of foot bones,28320,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,193779.51,
Repair of metatarsals,28322,CPT,,,,,,,,both,,,78188.55,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,54731.99,70,,54731.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,54731.99,
Resect enlarged toe tissue,28340,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Resect enlarged toe,28341,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,47657.93,
Repair extra toe(s),28344,CPT,,,,,,,,both,,,38069.18,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26648.43,70,,26648.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,26648.43,
Repair webbed toe(s),28345,CPT,,,,,,,,both,,,51736.25,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,36215.38,70,,36215.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,36215.38,
Reconstruct cleft foot,28360,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Treatment of heel fracture,28400,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of heel fracture,28405,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of heel fracture,28406,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,120381.32,
Treat heel fracture,28415,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat/graft heel fracture,28420,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,193779.51,
Treatment of ankle fracture,28430,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of ankle fracture,28435,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treatment of ankle fracture,28436,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,120381.32,
Treat ankle fracture,28445,CPT,,,,,,,,both,,,137108.27,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,95975.79,70,,95975.79,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,95975.79,
Osteochondral talus autogrft,28446,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6018.8,,,6018.8,Fee Schedule,,5101.3,,,5101.3,Fee Schedule,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Treat midfoot fracture each,28450,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat midfoot fracture each,28455,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,22987.73,68,,22987.73,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,554.86,27044.39,
Treat midfoot fracture,28456,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,120381.32,
Treat midfoot fracture each,28465,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat metatarsal fracture,28470,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat metatarsal fracture,28475,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat metatarsal fracture,28476,CPT,,,,,,,,both,,,36963.26,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25135.02,68,,25135.02,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,29570.61,80,,29570.61,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29570.61,80,,29570.61,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25874.28,70,,25874.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,29570.61,
Treat metatarsal fracture,28485,CPT,,,,,,,,both,,,77830.44,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,54481.31,70,,54481.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,54481.31,
Treat big toe fracture,28490,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,623.2,,,623.2,Fee Schedule,,528.2,,,528.2,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat big toe fracture,28495,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,738,,,738,Fee Schedule,,625.5,,,625.5,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat big toe fracture,28496,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,54466.2,
Treat big toe fracture,28505,CPT,,,,,,,,both,,,64933,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,45453.1,70,,45453.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,45453.1,
Treatment of toe fracture,28510,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,598.6,,,598.6,Fee Schedule,,507.35,,,507.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treatment of toe fracture,28515,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,711.76,,,711.76,Fee Schedule,,603.26,,,603.26,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat toe fracture,28525,CPT,,,,,,,,both,,,52709.62,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,36896.73,70,,36896.73,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,36896.73,
Treat sesamoid bone fracture,28530,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,498.56,,,498.56,Fee Schedule,,422.56,,,422.56,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat sesamoid bone fracture,28531,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat foot dislocation,28540,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat foot dislocation,28545,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,54466.2,
Treat foot dislocation,28546,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,1766.08,27044.39,
Repair foot dislocation,28555,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,102324.12,68,,102324.12,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,120381.32,
Treat foot dislocation,28570,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,987.28,,,987.28,Fee Schedule,,836.78,,,836.78,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat foot dislocation,28575,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,54466.2,
Treat foot dislocation,28576,CPT,,,,,,,,both,,,36779.05,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25745.34,70,,25745.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,25745.34,
Repair foot dislocation,28585,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat foot dislocation,28600,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat foot dislocation,28605,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3372.96,68,,3372.96,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,259.13,7216,
Treat foot dislocation,28606,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46296.27,68,,46296.27,percent of total billed charges,,5093.12,,,5093.12,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2232,54466.2,
Repair foot dislocation,28615,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,105333.66,
Treat toe dislocation,28630,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,544.48,,,544.48,Fee Schedule,,461.48,,,461.48,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat toe dislocation,28635,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22987.73,68,,22987.73,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27044.39,80,,27044.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,930.64,27044.39,
Treat toe dislocation,28636,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,47657.93,
Repair toe dislocation,28645,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,47657.93,
Treat toe dislocation,28660,CPT,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3372.96,68,,3372.96,percent of total billed charges,,1032.04,,,1032.04,Other,186% of Medicaid,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3968.18,80,,3968.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,459.2,,,459.2,Fee Schedule,,389.2,,,389.2,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,7216,
Treat toe dislocation,28665,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3841.17,68,,3841.17,percent of total billed charges,,1731,,,1731,Other,186% of Medicaid,4519.02,80,,4519.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4519.02,80,,4519.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.64,,,930.64,Other,New York Medicaid APG methodology,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,930.64,,,930.64,Other,100% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1423.89,,,1423.89,Other,153% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,1302.9,,,1302.9,Other,140% New York Medicaid APG,2093.95,,,2093.95,Other,225% New York Medicaid APG,2419.68,,,2419.68,Other,260% New York Medicaid APG,3015.29,,,3015.29,Other,324% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,2000.89,,,2000.89,Other,215% New York Medicaid APG,1163.31,,,1163.31,Other,125% New York Medicaid APG,295.11,7216,
Treat toe dislocation,28666,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,47657.93,
Repair of toe dislocation,28675,CPT,,,,,,,,both,,,41462.4,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5093.12,,,5093.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29023.68,70,,29023.68,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2738.24,,,2738.24,Other,New York Medicaid APG methodology,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,2738.24,,,2738.24,Other,100% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,4189.5,,,4189.5,Other,153% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,3833.53,,,3833.53,Other,140% New York Medicaid APG,6161.03,,,6161.03,Other,225% New York Medicaid APG,7119.41,,,7119.41,Other,260% New York Medicaid APG,8871.88,,,8871.88,Other,324% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,5887.21,,,5887.21,Other,215% New York Medicaid APG,3422.79,,,3422.79,Other,125% New York Medicaid APG,2738.24,29023.68,
Fusion of foot bones,28705,CPT,,,,,,,,both,,,391985.94,33675.57,,,33675.57,Other,150% of Medicare + 9.63% HCRA Surcharge,20478.32,,,20478.32,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,274390.16,70,,274390.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,274390.16,
Fusion of foot bones,28715,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,193779.51,
Fusion of foot bones,28725,CPT,,,,,,,,both,,,111393.97,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,77975.78,70,,77975.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,77975.78,
Fusion of foot bones,28730,CPT,,,,,,,,both,,,121482.05,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,85037.44,70,,85037.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,85037.44,
Fusion of foot bones,28735,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,193779.51,
Revision of foot bones,28737,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,193779.51,
Fusion of foot bones,28740,CPT,,,,,,,,both,,,128635.84,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,90045.09,70,,90045.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,90045.09,
Fusion of big toe joint,28750,CPT,,,,,,,,both,,,83667.26,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,58567.08,70,,58567.08,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,58567.08,
Fusion of big toe joint,28755,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,105333.66,
Fusion of big toe joint,28760,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Amputation thru metatarsal,28805,CPT,,,,,,,,both,,,38333.33,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,26833.33,70,,26833.33,percent of total billed charges,,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26833.33,70,,26833.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,26833.33,
Amputation toe & metatarsal,28810,CPT,,,,,,,,both,,,48080.72,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,32694.89,68,,32694.89,percent of total billed charges,,3643.47,,,3643.47,Other,186% of Medicaid,38464.58,80,,38464.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,38464.58,80,,38464.58,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,33656.5,70,,33656.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,38464.58,
Amputation of toe,28820,CPT,,,,,,,,both,,,35523.77,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24156.16,68,,24156.16,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,28419.02,80,,28419.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28419.02,80,,28419.02,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24866.64,70,,24866.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,28419.02,
Partial amputation of toe,28825,CPT,,,,,,,,both,,,36834.32,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25047.34,68,,25047.34,percent of total billed charges,,2891.77,,,2891.77,Other,186% of Medicaid,29467.46,80,,29467.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29467.46,80,,29467.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25784.02,70,,25784.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,29467.46,
Hi enrgy eswt plantar fascia,28890,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,23663.84,
Application of body cast,29000,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Application of body cast,29010,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Application of body cast,29015,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Application of body cast,29035,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Application of body cast,29040,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Application of body cast,29044,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,173.14,9473,
Application of body cast,29046,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Application of figure eight,29049,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,339.48,,,339.48,Fee Schedule,,287.73,,,287.73,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,287.73,9473,
Application of shoulder cast,29055,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Application of shoulder cast,29058,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,457.56,,,457.56,Fee Schedule,,387.81,,,387.81,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Application of long arm cast,29065,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,334.56,,,334.56,Fee Schedule,,283.56,,,283.56,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,283.56,9473,
Application of forearm cast,29075,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,308.32,,,308.32,Fee Schedule,,261.32,,,261.32,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,261.32,9473,
Apply hand/wrist cast,29085,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,329.64,,,329.64,Fee Schedule,,279.39,,,279.39,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,173.14,9473,
Apply finger cast,29086,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,173.14,9473,
Apply long arm splint,29105,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,206.64,,,206.64,Fee Schedule,,175.14,,,175.14,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,173.14,9473,
Apply forearm splint,29125,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,198.44,,,198.44,Fee Schedule,,168.19,,,168.19,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,140.37,9473,
Apply forearm splint,29126,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,140.37,9473,
Application of finger splint,29130,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,122.32,9473,
Application of finger splint,29131,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,900.61,70,,900.61,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,170.56,,,170.56,Fee Schedule,,144.56,,,144.56,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,67.21,9473,
Strapping of chest,29200,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,90.2,,,90.2,Fee Schedule,,76.45,,,76.45,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,76.45,9473,
Strapping of shoulder,29240,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,88.56,,,88.56,Fee Schedule,,75.06,,,75.06,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,75.06,9473,
Strapping of elbow or wrist,29260,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,900.61,70,,900.61,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,93.48,,,93.48,Fee Schedule,,79.23,,,79.23,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,67.21,9473,
Strapping of hand or finger,29280,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,900.61,70,,900.61,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,96.76,,,96.76,Fee Schedule,,82.01,,,82.01,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,67.21,9473,
Application of hip cast,29305,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3841.17,68,,3841.17,percent of total billed charges,,680.83,,,680.83,Other,186% of Medicaid,4519.02,80,,4519.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4519.02,80,,4519.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,7216,
Application of hip casts,29325,CPT,,,,,,,,both,,,50856.25,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,35599.38,70,,35599.38,percent of total billed charges,,34582.25,68,,34582.25,percent of total billed charges,,680.83,,,680.83,Other,186% of Medicaid,40685,80,,40685,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,40685,80,,40685,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,35599.38,70,,35599.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,40685,
Application of long leg cast,29345,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3841.17,68,,3841.17,percent of total billed charges,,680.83,,,680.83,Other,186% of Medicaid,4519.02,80,,4519.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4519.02,80,,4519.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,487.08,,,487.08,Fee Schedule,,412.83,,,412.83,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,7216,
Application of long leg cast,29355,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,519.88,,,519.88,Fee Schedule,,440.63,,,440.63,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Apply long leg cast brace,29358,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,503.48,,,503.48,Fee Schedule,,426.73,,,426.73,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Application of long leg cast,29365,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,426.4,,,426.4,Fee Schedule,,361.4,,,361.4,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Apply short leg cast,29405,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,285.36,,,285.36,Fee Schedule,,241.86,,,241.86,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,241.86,9473,
Apply short leg cast,29425,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,264.04,,,264.04,Fee Schedule,,223.79,,,223.79,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,223.79,9473,
Apply short leg cast,29435,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,395.24,,,395.24,Fee Schedule,,334.99,,,334.99,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Addition of walker to cast,29440,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,134.48,,,134.48,Fee Schedule,,113.98,,,113.98,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,113.98,9473,
Apply rigid leg cast,29445,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Application of leg cast,29450,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,173.14,9473,
Application long leg splint,29505,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,254.2,,,254.2,Fee Schedule,,215.45,,,215.45,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,173.14,9473,
Application lower leg splint,29515,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,173.14,9473,
Strapping of hip,29520,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,88.56,,,88.56,Fee Schedule,,75.06,,,75.06,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,75.06,9473,
Strapping of knee,29530,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,88.56,,,88.56,Fee Schedule,,75.06,,,75.06,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,75.06,9473,
Strapping of ankle and/or ft,29540,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,85.28,,,85.28,Fee Schedule,,72.28,,,72.28,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,72.28,9473,
Strapping of toes,29550,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,900.61,70,,900.61,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,54.12,,,54.12,Fee Schedule,,45.87,,,45.87,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,45.87,9473,
Application of paste boot,29580,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,127.92,,,127.92,Fee Schedule,,108.42,,,108.42,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,108.42,9473,
Apply multlay comprs lwr leg,29581,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,129.56,,,129.56,Fee Schedule,,109.81,,,109.81,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,109.81,9473,
Appl multlay comprs arm/hand,29584,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,552.56,,,552.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,77.08,,,77.08,Fee Schedule,,65.33,,,65.33,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,297.07,,,297.07,Other,New York Medicaid APG methodology,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,297.07,,,297.07,Other,100% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,454.52,,,454.52,Other,153% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,415.9,,,415.9,Other,140% New York Medicaid APG,668.42,,,668.42,Other,225% New York Medicaid APG,772.39,,,772.39,Other,260% New York Medicaid APG,962.52,,,962.52,Other,324% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,638.71,,,638.71,Other,215% New York Medicaid APG,371.34,,,371.34,Other,125% New York Medicaid APG,65.33,9473,
Removal/revision of cast,29700,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,160.72,,,160.72,Fee Schedule,,136.22,,,136.22,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,136.22,9473,
Removal/revision of cast,29705,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,184.87,9473,
Removal/revision of cast,29710,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,401.8,,,401.8,Fee Schedule,,340.55,,,340.55,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Repair of body cast,29720,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,213.2,,,213.2,Fee Schedule,,180.7,,,180.7,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,173.14,9473,
Windowing of cast,29730,CPT,,,,,,,,both,,,3314.26,284.73,,,284.73,Other,150% of Medicare + 9.63% HCRA Surcharge,173.14,,,173.14,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2319.98,70,,2319.98,percent of total billed charges,,216.48,,,216.48,Fee Schedule,,183.48,,,183.48,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,173.14,9473,
Wedging of cast,29740,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,336.2,,,336.2,Fee Schedule,,284.95,,,284.95,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,284.95,9473,
Wedging of clubfoot cast,29750,CPT,,,,,,,,both,,,5648.78,485.29,,,485.29,Other,150% of Medicare + 9.63% HCRA Surcharge,295.11,,,295.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,6152,,,6152,Case Rate,,680.83,,,680.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3954.15,70,,3954.15,percent of total billed charges,,375.56,,,375.56,Fee Schedule,,318.31,,,318.31,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,366.04,,,366.04,Other,New York Medicaid APG methodology,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,366.04,,,366.04,Other,100% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,560.04,,,560.04,Other,153% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,512.45,,,512.45,Other,140% New York Medicaid APG,823.58,,,823.58,Other,225% New York Medicaid APG,951.69,,,951.69,Other,260% New York Medicaid APG,1185.96,,,1185.96,Other,324% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,786.98,,,786.98,Other,215% New York Medicaid APG,457.54,,,457.54,Other,125% New York Medicaid APG,295.11,9473,
Jaw arthroscopy/surgery,29800,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Jaw arthroscopy/surgery,29804,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Sho arthrs dx +- synovial bx,29805,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Sho arthrs srg capsulorpaphy,29806,CPT,,,,,,,,both,,,74747.75,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,52323.43,70,,52323.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,52323.43,
Sho arthrs srg rpr slap les,29807,CPT,,,,,,,,both,,,62418.33,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,43692.83,70,,43692.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,43692.83,
Sho arthrs srg rmvl loose/fb,29819,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Sho arthrs srg prtl synvct,29820,CPT,,,,,,,,both,,,64371.33,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,45059.93,70,,45059.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,45059.93,
Sho arthrs srg compl synvct,29821,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,47657.93,
Sho arthrs srg lmtd dbrdmt,29822,CPT,,,,,,,,both,,,55898.02,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,39128.61,70,,39128.61,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,39128.61,
Sho arthrs srg xtnsv dbrdmt,29823,CPT,,,,,,,,both,,,43934.41,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,30754.09,70,,30754.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,30754.09,
Sho arthrs srg dstl claviclc,29824,CPT,,,,,,,,both,,,52694.18,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,36885.93,70,,36885.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,36885.93,
Sho arthrs srg lss&rescj ads,29825,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Sho arthrs srg decompression,29826,CPT,,,,,,,,both,,,64222.15,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,44955.51,70,,44955.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,0.01,44955.51,
Sho arthrs srg rt8tr cuf rpr,29827,CPT,,,,,,,,both,,,88593.2,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,62015.24,70,,62015.24,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3182.36,62015.24,
Sho arthrs srg bicp tenodsis,29828,CPT,,,,,,,,both,,,65898.99,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,46129.29,70,,46129.29,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,2879,46129.29,
Elbow arthroscopy,29830,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Elbow arthroscopy/surgery,29834,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Elbow arthroscopy/surgery,29835,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Elbow arthroscopy/surgery,29836,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,105333.66,
Elbow arthroscopy/surgery,29837,CPT,,,,,,,,both,,,42892.81,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,30024.97,70,,30024.97,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,30024.97,
Elbow arthroscopy/surgery,29838,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Wrist arthroscopy,29840,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Wrist arthroscopy/surgery,29843,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Wrist arthroscopy/surgery,29844,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Wrist arthroscopy/surgery,29845,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Wrist arthroscopy/surgery,29846,CPT,,,,,,,,both,,,48604.71,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,34023.3,70,,34023.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,34023.3,
Wrist arthroscopy/surgery,29847,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,105333.66,
Wrist endoscopy/surgery,29848,CPT,,,,,,,,both,,,32256.3,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,22579.41,70,,22579.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,22579.41,
Knee arthroscopy/surgery,29850,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,23663.84,
Knee arthroscopy/surgery,29851,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,23663.84,
Tibial arthroscopy/surgery,29855,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3182.36,105333.66,
Tibial arthroscopy/surgery,29856,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3182.36,193779.51,
Hip arthroscopy dx,29860,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3182.36,105333.66,
Hip arthro w/fb removal,29861,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,105333.66,
Hip arthr0 w/debridement,29862,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3182.36,105333.66,
Hip arthr0 w/synovectomy,29863,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Autgrft implnt knee w/scope,29866,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,105333.66,
Allgrft implnt knee w/scope,29867,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,193779.51,
Meniscal trnspl knee w/scpe,29868,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,105333.66,
Knee arthroscopy dx,29870,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Knee arthroscopy/drainage,29871,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Knee arthroscopy/surgery,29873,CPT,,,,,,,,both,,,35991.34,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25193.94,70,,25193.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,25193.94,
Knee arthroscopy/surgery,29874,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Knee arthroscopy/surgery,29875,CPT,,,,,,,,both,,,39883.71,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27918.6,70,,27918.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,27918.6,
Knee arthroscopy/surgery,29876,CPT,,,,,,,,both,,,38574.18,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27001.93,70,,27001.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,27001.93,
Knee arthroscopy/surgery,29877,CPT,,,,,,,,both,,,40524.95,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28367.47,70,,28367.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,28367.47,
Knee arthroscopy/surgery,29879,CPT,,,,,,,,both,,,39316.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27521.73,70,,27521.73,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,27521.73,
Knee arthroscopy/surgery,29880,CPT,,,,,,,,both,,,40879.28,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28615.5,70,,28615.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,28615.5,
Knee arthroscopy/surgery,29881,CPT,,,,,,,,both,,,38920.36,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27244.25,70,,27244.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,27244.25,
Knee arthroscopy/surgery,29882,CPT,,,,,,,,both,,,58881.06,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41216.74,70,,41216.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,41216.74,
Knee arthroscopy/surgery,29883,CPT,,,,,,,,both,,,59564.36,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41695.05,70,,41695.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,41695.05,
Knee arthroscopy/surgery,29884,CPT,,,,,,,,both,,,40094.07,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28065.85,70,,28065.85,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,28065.85,
Knee arthroscopy/surgery,29885,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,105333.66,
Knee arthroscopy/surgery,29886,CPT,,,,,,,,both,,,48477.88,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,33934.52,70,,33934.52,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,33934.52,
Knee arthroscopy/surgery,29887,CPT,,,,,,,,both,,,49933.99,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,34953.79,70,,34953.79,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,34953.79,
Knee arthroscopy/surgery,29888,CPT,,,,,,,,both,,,91694.76,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,64186.33,70,,64186.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,64186.33,
Knee arthroscopy/surgery,29889,CPT,,,,,,,,both,,,134126.7,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,93888.69,70,,93888.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,93888.69,
Ankle arthroscopy/surgery,29891,CPT,,,,,,,,both,,,33768.9,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,23638.23,70,,23638.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,23638.23,
Ankle arthroscopy/surgery,29892,CPT,,,,,,,,both,,,104708.88,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,73296.22,70,,73296.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,73296.22,
Scope plantar fasciotomy,29893,CPT,,,,,,,,both,,,41676.94,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29173.86,70,,29173.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,29173.86,
Ankle arthroscopy/surgery,29894,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Ankle arthroscopy/surgery,29895,CPT,,,,,,,,both,,,58681.23,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41076.86,70,,41076.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,41076.86,
Ankle arthroscopy/surgery,29897,CPT,,,,,,,,both,,,39196.19,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27437.33,70,,27437.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,27437.33,
Ankle arthroscopy/surgery,29898,CPT,,,,,,,,both,,,101597.45,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,71118.22,70,,71118.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,71118.22,
Ankle arthroscopy/surgery,29899,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3126,105333.66,
Mcp joint arthroscopy dx,29900,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Mcp joint arthroscopy surg,29901,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Mcp joint arthroscopy surg,29902,CPT,,,,,,,,both,,,33805.49,2904.24,,,2904.24,Other,150% of Medicare + 9.63% HCRA Surcharge,1766.08,,,1766.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23663.84,70,,23663.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,23663.84,
Subtalar arthro w/fb rmvl,29904,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Subtalar arthro w/exc,29905,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,105333.66,
Subtalar arthro w/deb,29906,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3210.78,,,3210.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1726.23,,,1726.23,Other,New York Medicaid APG methodology,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,1726.23,,,1726.23,Other,100% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2641.13,,,2641.13,Other,153% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,2416.72,,,2416.72,Other,140% New York Medicaid APG,3884.01,,,3884.01,Other,225% New York Medicaid APG,4488.19,,,4488.19,Other,260% New York Medicaid APG,5592.98,,,5592.98,Other,324% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,3711.39,,,3711.39,Other,215% New York Medicaid APG,2157.78,,,2157.78,Other,125% New York Medicaid APG,1726.23,47657.93,
Subtalar arthro w/fusion,29907,CPT,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,2879,193779.51,
Hip arthro w/femoroplasty,29914,CPT,,,,,,,,both,,,93714.83,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,65600.38,70,,65600.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3182.36,65600.38,
Hip arthro acetabuloplasty,29915,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3182.36,105333.66,
Hip arthro w/labral repair,29916,CPT,,,,,,,,both,,,104264.25,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5919.19,,,5919.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,72984.98,70,,72984.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3182.36,,,3182.36,Other,New York Medicaid APG methodology,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,3182.36,,,3182.36,Other,100% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4869.01,,,4869.01,Other,153% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,4455.31,,,4455.31,Other,140% New York Medicaid APG,7160.31,,,7160.31,Other,225% New York Medicaid APG,8274.14,,,8274.14,Other,260% New York Medicaid APG,10310.85,,,10310.85,Other,324% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,6842.08,,,6842.08,Other,215% New York Medicaid APG,3977.95,,,3977.95,Other,125% New York Medicaid APG,3182.36,72984.98,
Drainage of nose lesion,30000,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3493.66,68,,3493.66,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,598.6,,,598.6,Fee Schedule,,507.35,,,507.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,7216,
Drainage of nose lesion,30020,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8101,70,,8101,percent of total billed charges,,7869.54,68,,7869.54,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,603.52,,,603.52,Fee Schedule,,511.52,,,511.52,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,511.52,9258.28,
Intranasal biopsy,30100,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,331.28,,,331.28,Fee Schedule,,280.78,,,280.78,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,280.78,25661.91,
Removal of nose polyp(s),30110,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,652.72,,,652.72,Fee Schedule,,553.22,,,553.22,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,553.22,25661.91,
Removal of nose polyp(s),30115,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,54176.39,
Removal of intranasal lesion,30117,CPT,,,,,,,,both,,,35951.86,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25166.3,70,,25166.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,25166.3,
Removal of intranasal lesion,30118,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,47404.34,
Revision of nose,30120,CPT,,,,,,,,both,,,35129.63,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23888.15,68,,23888.15,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,28103.7,80,,28103.7,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28103.7,80,,28103.7,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24590.74,70,,24590.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,28103.7,
Removal of nose lesion,30124,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,25661.91,
Removal of nose lesion,30125,CPT,,,,,,,,both,,,51239.1,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,34842.59,68,,34842.59,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,40991.28,80,,40991.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,40991.28,80,,40991.28,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,35867.37,70,,35867.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,40991.28,
Excise inferior turbinate,30130,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,47404.34,
Resect inferior turbinate,30140,CPT,,,,,,,,both,,,35888.55,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24404.21,68,,24404.21,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,28710.84,80,,28710.84,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28710.84,80,,28710.84,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25121.99,70,,25121.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2232,28710.84,
Partial removal of nose,30150,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Removal of nose,30160,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Injection treatment of nose,30200,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8101,70,,8101,percent of total billed charges,,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,9473,
Nasal sinus therapy,30210,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,508.4,,,508.4,Fee Schedule,,430.9,,,430.9,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,22454.17,
Insert nasal septal button,30220,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,629.76,,,629.76,Fee Schedule,,533.76,,,533.76,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,533.76,22454.17,
Remove nasal foreign body,30300,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,615,,,615,Fee Schedule,,521.25,,,521.25,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,140.37,9473,
Remove nasal foreign body,30310,CPT,,,,,,,,both,,,35579.78,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24194.25,68,,24194.25,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,28463.82,80,,28463.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28463.82,80,,28463.82,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24905.85,70,,24905.85,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,28463.82,
Remove nasal foreign body,30320,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,25661.91,
Reconstruction of nose,30400,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,86224,
Reconstruction of nose,30410,CPT,,,,,,,,both,,,56761.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,39732.8,70,,39732.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,39732.8,
Reconstruction of nose,30420,CPT,,,,,,,,both,,,55638.22,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,38946.75,70,,38946.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,38946.75,
Revision of nose,30430,CPT,,,,,,,,both,,,44143.84,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,30900.69,70,,30900.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,30900.69,
Revision of nose,30435,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Revision of nose,30450,CPT,,,,,,,,both,,,82062.41,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,57443.69,70,,57443.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,57443.69,
Revision of nose,30460,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Revision of nose,30462,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Repair nasal stenosis,30465,CPT,,,,,,,,both,,,46270.96,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,32389.67,70,,32389.67,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,32389.67,
Rpr nsl vlv collapse w/implt,30468,CPT,,,,,,,,both,,,36572.73,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,29258.18,80,,29258.18,percent of total billed charges,,25600.91,70,,25600.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,29258.18,
Repair of nasal septum,30520,CPT,,,,,,,,both,,,39526.16,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27668.31,70,,27668.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,27668.31,
Repair nasal defect,30540,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Repair nasal defect,30545,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,86224,
Release of nasal adhesions,30560,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,746.2,,,746.2,Fee Schedule,,632.45,,,632.45,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,604.59,9258.28,
Repair upper jaw fistula,30580,CPT,,,,,,,,both,,,44575.28,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,31202.7,70,,31202.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,31202.7,
Repair mouth/nose fistula,30600,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Intranasal reconstruction,30620,CPT,,,,,,,,both,,,78477.05,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,54933.94,70,,54933.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,54933.94,
Repair nasal septum defect,30630,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,47404.34,
Ablate inf turbinate superf,30801,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,757.68,,,757.68,Fee Schedule,,642.18,,,642.18,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,642.18,25661.91,
Ablate inf turbinate submuc,30802,CPT,,,,,,,,both,,,35088.16,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23859.95,68,,23859.95,percent of total billed charges,,4398.84,,,4398.84,Other,186% of Medicaid,28070.53,80,,28070.53,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28070.53,80,,28070.53,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24561.71,70,,24561.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,1675.8,28070.53,
Control of nosebleed,30901,CPT,,,,,,,,both,,,11865.24,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8305.67,70,,8305.67,percent of total billed charges,,8068.36,68,,8068.36,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,9492.19,80,,9492.19,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9492.19,80,,9492.19,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8305.67,70,,8305.67,percent of total billed charges,,277.16,,,277.16,Fee Schedule,,234.91,,,234.91,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,140.37,9492.19,
Control of nosebleed,30903,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,1827.06,68,,1827.06,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,378.84,,,378.84,Fee Schedule,,321.09,,,321.09,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,140.37,7216,
Control of nosebleed,30905,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,1827.06,68,,1827.06,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,140.37,7216,
Repeat control of nosebleed,30906,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3493.66,68,,3493.66,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,7216,
Ligation nasal sinus artery,30915,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,45590.42,68,,45590.42,percent of total billed charges,,4418.97,,,4418.97,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2232,53635.79,
Ligation upper jaw artery,30920,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Ther fx nasal inf turbinate,30930,CPT,,,,,,,,both,,,36197.05,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25337.94,70,,25337.94,percent of total billed charges,,582.2,,,582.2,Fee Schedule,,493.45,,,493.45,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,493.45,25337.94,
Irrigation maxillary sinus,31000,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3493.66,68,,3493.66,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,544.48,,,544.48,Fee Schedule,,461.48,,,461.48,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,268.41,7216,
Irrigation sphenoid sinus,31002,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,25661.91,
Exploration maxillary sinus,31020,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,54176.39,
Exploration maxillary sinus,31030,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Explore sinus remove polyps,31032,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Exploration behind upper jaw,31040,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Exploration sphenoid sinus,31050,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,98541.71,
Sphenoid sinus surgery,31051,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Exploration of frontal sinus,31070,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,98541.71,
Exploration of frontal sinus,31075,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Removal of frontal sinus,31080,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Removal of frontal sinus,31081,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Removal of frontal sinus,31084,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Removal of frontal sinus,31085,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Removal of frontal sinus,31086,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Removal of frontal sinus,31087,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Exploration of sinuses,31090,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Removal of ethmoid sinus,31200,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,98541.71,
Removal of ethmoid sinus,31201,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,22454.17,
Removal of ethmoid sinus,31205,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,47404.34,
Nasal endoscopy dx,31231,CPT,,,,,,,,both,,,35228.49,357.93,,,357.93,Other,150% of Medicare + 9.63% HCRA Surcharge,217.66,,,217.66,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24659.94,70,,24659.94,percent of total billed charges,,23955.37,68,,23955.37,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,28182.79,80,,28182.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28182.79,80,,28182.79,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24659.94,70,,24659.94,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,217.66,28182.79,
Nsl/sins ndsc dx max sinusc,31233,CPT,,,,,,,,both,,,8588.63,737.85,,,737.85,Other,150% of Medicare + 9.63% HCRA Surcharge,448.69,,,448.69,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5840.27,68,,5840.27,percent of total billed charges,,832.2,,,832.2,Other,186% of Medicaid,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6012.04,70,,6012.04,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,7216,
Nsl/sins ndsc dx sphn sinusc,31235,CPT,,,,,,,,both,,,35699.83,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24275.88,68,,24275.88,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24989.88,70,,24989.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,28559.86,
Nasal/sinus endoscopy surg,31237,CPT,,,,,,,,both,,,38391.34,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26106.11,68,,26106.11,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,30713.07,80,,30713.07,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30713.07,80,,30713.07,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26873.94,70,,26873.94,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,30713.07,
Nasal/sinus endoscopy surg,31238,CPT,,,,,,,,both,,,37288.61,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25356.25,68,,25356.25,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,29830.89,80,,29830.89,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29830.89,80,,29830.89,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26102.03,70,,26102.03,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,29830.89,
Nasal/sinus endoscopy surg,31239,CPT,,,,,,,,both,,,78767.93,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,55137.55,70,,55137.55,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,55137.55,
Nasal/sinus endoscopy surg,31240,CPT,,,,,,,,both,,,35699.83,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24275.88,68,,24275.88,percent of total billed charges,,832.2,,,832.2,Other,186% of Medicaid,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24989.88,70,,24989.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,28559.86,
Nsl/sins ndsc w/artery lig,31241,CPT,,,,,,,,both,,,35699.83,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,24989.88,70,,24989.88,percent of total billed charges,,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,28559.86,80,,28559.86,percent of total billed charges,,24989.88,70,,24989.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,28559.86,
Nsl/sins ndsc total,31253,CPT,,,,,,,,both,,,39119.74,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27383.82,70,,27383.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,27383.82,
Nsl/sins ndsc w/prtl ethmdct,31254,CPT,,,,,,,,both,,,38226.57,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26758.6,70,,26758.6,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,26758.6,
Nsl/sins ndsc w/tot ethmdct,31255,CPT,,,,,,,,both,,,46439.9,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,32507.93,70,,32507.93,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,2879,32507.93,
Exploration maxillary sinus,31256,CPT,,,,,,,,both,,,41549.37,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29084.56,70,,29084.56,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,29084.56,
Nsl/sins ndsc tot w/sphendt,31257,CPT,,,,,,,,both,,,40828.4,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28579.88,70,,28579.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,28579.88,
Nsl/sins ndsc sphn tiss rmvl,31259,CPT,,,,,,,,both,,,64583.51,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,45208.46,70,,45208.46,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,45208.46,
Endoscopy maxillary sinus,31267,CPT,,,,,,,,both,,,41890.73,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,832.2,,,832.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29323.51,70,,29323.51,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,29323.51,
Nsl/sins ndsc frnt tiss rmvl,31276,CPT,,,,,,,,both,,,51273.89,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,832.2,,,832.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,35891.72,70,,35891.72,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,35891.72,
Nasal/sinus endoscopy surg,31287,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,832.2,,,832.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,100772.82,
Nasal/sinus endoscopy surg,31288,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,832.2,,,832.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,100772.82,
Nsl/sins ndsc med/inf dcmprn,31292,CPT,,,,,,,,both,,,64741.66,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,45319.16,70,,45319.16,percent of total billed charges,,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,45319.16,70,,45319.16,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,45319.16,
Nsl/sins ndsc med&inf dcmprn,31293,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,100772.82,
Nsl/sins ndsc surg on dcmprn,31294,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,100772.82,
Nsl/sins ndsc surg max sins,31295,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,100772.82,
Nsl/sins ndsc surg frnt sins,31296,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,832.2,,,832.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,100772.82,
Nsl/sins ndsc surg sphn sins,31297,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,832.2,,,832.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,100772.82,
Nsl/sins ndsc surg frnt&sphn,31298,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,832.2,,,832.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,100772.82,
Removal of larynx lesion,31300,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,47404.34,
Revision of larynx,31400,CPT,,,,,,,,both,,,42086.37,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,28618.73,68,,28618.73,percent of total billed charges,,5842.35,,,5842.35,Other,186% of Medicaid,33669.1,80,,33669.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33669.1,80,,33669.1,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,29460.46,70,,29460.46,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,2232,33669.1,
Removal of epiglottis,31420,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,5842.35,,,5842.35,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,2232,98541.71,
Insert emergency airway,31500,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3493.66,68,,3493.66,percent of total billed charges,,1148.48,,,1148.48,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,617.46,,,617.46,Other,New York Medicaid APG methodology,617.46,,,617.46,Other,100% New York Medicaid APG,617.46,,,617.46,Other,100% New York Medicaid APG,617.46,,,617.46,Other,100% New York Medicaid APG,1389.29,,,1389.29,Other,225% New York Medicaid APG,944.71,,,944.71,Other,153% New York Medicaid APG,1389.29,,,1389.29,Other,225% New York Medicaid APG,864.44,,,864.44,Other,140% New York Medicaid APG,1389.29,,,1389.29,Other,225% New York Medicaid APG,1605.4,,,1605.4,Other,260% New York Medicaid APG,2000.57,,,2000.57,Other,324% New York Medicaid APG,1327.54,,,1327.54,Other,215% New York Medicaid APG,1327.54,,,1327.54,Other,215% New York Medicaid APG,771.83,,,771.83,Other,125% New York Medicaid APG,268.41,7216,
Change of windpipe airway,31502,CPT,,,,,,,,both,,,28281.42,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,19796.99,70,,19796.99,percent of total billed charges,,19231.37,68,,19231.37,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,22625.14,80,,22625.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,22625.14,80,,22625.14,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,19796.99,70,,19796.99,percent of total billed charges,,170.56,,,170.56,Fee Schedule,,144.56,,,144.56,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,144.56,22625.14,
Diagnostic laryngoscopy,31505,CPT,,,,,,,,both,,,4166.39,357.93,,,357.93,Other,150% of Medicare + 9.63% HCRA Surcharge,217.66,,,217.66,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2916.47,70,,2916.47,percent of total billed charges,,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2916.47,70,,2916.47,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,217.66,9473,
Laryngoscopy with biopsy,31510,CPT,,,,,,,,both,,,78767.93,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,53562.19,68,,53562.19,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,63014.34,80,,63014.34,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,63014.34,80,,63014.34,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,55137.55,70,,55137.55,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,63014.34,
Remove foreign body larynx,31511,CPT,,,,,,,,both,,,4166.39,357.93,,,357.93,Other,150% of Medicare + 9.63% HCRA Surcharge,217.66,,,217.66,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,2833.15,68,,2833.15,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,3333.11,80,,3333.11,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3333.11,80,,3333.11,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2916.47,70,,2916.47,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,217.66,7216,
Removal of larynx lesion,31512,CPT,,,,,,,,both,,,78767.93,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,53562.19,68,,53562.19,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,63014.34,80,,63014.34,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,63014.34,80,,63014.34,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,55137.55,70,,55137.55,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,63014.34,
Injection into vocal cord,31513,CPT,,,,,,,,both,,,8588.63,737.85,,,737.85,Other,150% of Medicare + 9.63% HCRA Surcharge,448.69,,,448.69,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5840.27,68,,5840.27,percent of total billed charges,,832.2,,,832.2,Other,186% of Medicaid,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6012.04,70,,6012.04,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,7216,
Laryngoscopy for aspiration,31515,CPT,,,,,,,,both,,,8588.63,737.85,,,737.85,Other,150% of Medicare + 9.63% HCRA Surcharge,448.69,,,448.69,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,5840.27,68,,5840.27,percent of total billed charges,,832.2,,,832.2,Other,186% of Medicaid,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6012.04,70,,6012.04,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,7216,
Dx laryngoscopy newborn,31520,CPT,,,,,,,,both,,,8588.63,737.85,,,737.85,Other,150% of Medicare + 9.63% HCRA Surcharge,448.69,,,448.69,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6012.04,70,,6012.04,percent of total billed charges,,5840.27,68,,5840.27,percent of total billed charges,,832.2,,,832.2,Other,186% of Medicaid,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6012.04,70,,6012.04,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,7216,
Dx laryngoscopy excl nb,31525,CPT,,,,,,,,both,,,34333.7,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23346.92,68,,23346.92,percent of total billed charges,,832.2,,,832.2,Other,186% of Medicaid,27466.96,80,,27466.96,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27466.96,80,,27466.96,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24033.59,70,,24033.59,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,27466.96,
Dx laryngoscopy w/oper scope,31526,CPT,,,,,,,,both,,,38383.39,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26100.71,68,,26100.71,percent of total billed charges,,832.2,,,832.2,Other,186% of Medicaid,30706.71,80,,30706.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30706.71,80,,30706.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26868.37,70,,26868.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,30706.71,
Laryngoscopy for treatment,31527,CPT,,,,,,,,both,,,78767.93,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,53562.19,68,,53562.19,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,63014.34,80,,63014.34,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,63014.34,80,,63014.34,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,55137.55,70,,55137.55,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,63014.34,
Laryngoscopy and dilation,31528,CPT,,,,,,,,both,,,39598.13,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26926.73,68,,26926.73,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,31678.5,80,,31678.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31678.5,80,,31678.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27718.69,70,,27718.69,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,31678.5,
Laryngoscopy and dilation,31529,CPT,,,,,,,,both,,,38922.21,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26467.1,68,,26467.1,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,31137.77,80,,31137.77,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31137.77,80,,31137.77,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27245.55,70,,27245.55,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,31137.77,
Laryngoscopy w/fb removal,31530,CPT,,,,,,,,both,,,35699.83,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24275.88,68,,24275.88,percent of total billed charges,,832.2,,,832.2,Other,186% of Medicaid,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24989.88,70,,24989.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,28559.86,
Laryngoscopy w/fb & op scope,31531,CPT,,,,,,,,both,,,35300,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24710,70,,24710,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,24710,
Laryngoscopy w/biopsy,31535,CPT,,,,,,,,both,,,40730.91,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27697.02,68,,27697.02,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,32584.73,80,,32584.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32584.73,80,,32584.73,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28511.64,70,,28511.64,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,32584.73,
Laryngoscopy w/bx & op scope,31536,CPT,,,,,,,,both,,,38456,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26919.2,70,,26919.2,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,26919.2,
Laryngoscopy w/exc of tumor,31540,CPT,,,,,,,,both,,,78767.93,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,55137.55,70,,55137.55,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,55137.55,
Larynscop w/tumr exc + scope,31541,CPT,,,,,,,,both,,,39879.43,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27915.6,70,,27915.6,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,27915.6,
Remove vc lesion w/scope,31545,CPT,,,,,,,,both,,,36077,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25253.9,70,,25253.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,25253.9,
Remove vc lesion scope/graft,31546,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,100772.82,
Laryngoplasty laryngeal sten,31551,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Laryngoplasty laryngeal sten,31552,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Laryngoplasty laryngeal sten,31553,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Laryngoplasty laryngeal sten,31554,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Laryngoscop w/arytenoidectom,31560,CPT,,,,,,,,both,,,36585.05,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25609.54,70,,25609.54,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,25609.54,
Larynscop remve cart + scop,31561,CPT,,,,,,,,both,,,38171.03,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2982.93,,,2982.93,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26719.72,70,,26719.72,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,26719.72,
Laryngoscope w/vc inj,31570,CPT,,,,,,,,both,,,37684.84,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25625.69,68,,25625.69,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,30147.87,80,,30147.87,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30147.87,80,,30147.87,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26379.39,70,,26379.39,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,30147.87,
Laryngoscop w/vc inj + scope,31571,CPT,,,,,,,,both,,,38146.33,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25939.5,68,,25939.5,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,30517.06,80,,30517.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30517.06,80,,30517.06,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26702.43,70,,26702.43,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,30517.06,
Largsc w/laser dstrj les,31572,CPT,,,,,,,,both,,,35485.78,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24130.33,68,,24130.33,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,28388.62,80,,28388.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28388.62,80,,28388.62,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24840.05,70,,24840.05,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,28388.62,
Largsc w/ther injection,31573,CPT,,,,,,,,both,,,35699.83,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24275.88,68,,24275.88,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24989.88,70,,24989.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,28559.86,
Largsc w/njx augmentation,31574,CPT,,,,,,,,both,,,35276,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23987.68,68,,23987.68,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,28220.8,80,,28220.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28220.8,80,,28220.8,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24693.2,70,,24693.2,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,28220.8,
Diagnostic laryngoscopy,31575,CPT,,,,,,,,both,,,4166.39,357.93,,,357.93,Other,150% of Medicare + 9.63% HCRA Surcharge,217.66,,,217.66,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2916.47,70,,2916.47,percent of total billed charges,,2833.15,68,,2833.15,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,3333.11,80,,3333.11,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3333.11,80,,3333.11,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2916.47,70,,2916.47,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,217.66,7216,
Laryngoscopy with biopsy,31576,CPT,,,,,,,,both,,,35699.83,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24275.88,68,,24275.88,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24989.88,70,,24989.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,28559.86,
Largsc w/rmvl foreign bdy(s),31577,CPT,,,,,,,,both,,,8588.63,737.85,,,737.85,Other,150% of Medicare + 9.63% HCRA Surcharge,448.69,,,448.69,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5840.27,68,,5840.27,percent of total billed charges,,832.2,,,832.2,Other,186% of Medicaid,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6012.04,70,,6012.04,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,7216,
Largsc w/removal lesion,31578,CPT,,,,,,,,both,,,175702.48,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,119477.69,68,,119477.69,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,140561.98,80,,140561.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,140561.98,80,,140561.98,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,122991.74,70,,122991.74,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,140561.98,
Laryngoscopy telescopic,31579,CPT,,,,,,,,both,,,8588.63,737.85,,,737.85,Other,150% of Medicare + 9.63% HCRA Surcharge,448.69,,,448.69,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6012.04,70,,6012.04,percent of total billed charges,,5840.27,68,,5840.27,percent of total billed charges,,832.2,,,832.2,Other,186% of Medicaid,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6012.04,70,,6012.04,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,447.42,,,447.42,Other,New York Medicaid APG methodology,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,447.42,,,447.42,Other,100% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,684.55,,,684.55,Other,153% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,626.39,,,626.39,Other,140% New York Medicaid APG,1006.69,,,1006.69,Other,225% New York Medicaid APG,1163.29,,,1163.29,Other,260% New York Medicaid APG,1449.64,,,1449.64,Other,324% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,961.95,,,961.95,Other,215% New York Medicaid APG,559.27,,,559.27,Other,125% New York Medicaid APG,447.42,7216,
Laryngoplasty laryngeal web,31580,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Laryngoplasty fx rdctj fixj,31584,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Laryngoplasty cricoid split,31587,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Reinnervate larynx,31590,CPT,,,,,,,,both,,,55388,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,38771.6,70,,38771.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,38771.6,
Laryngoplasty medialization,31591,CPT,,,,,,,,both,,,34997.18,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,24498.03,70,,24498.03,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,24498.03,
Cricotracheal resection,31592,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,4047.34,,,4047.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2175.99,,,2175.99,Other,New York Medicaid APG methodology,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3329.26,,,3329.26,Other,153% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3046.38,,,3046.38,Other,140% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,5657.57,,,5657.57,Other,260% New York Medicaid APG,7050.2,,,7050.2,Other,324% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,2719.99,,,2719.99,Other,125% New York Medicaid APG,2175.99,86224,
Incision of windpipe,31600,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,3494.33,,,3494.33,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,54176.39,
Incision of windpipe,31601,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,3494.33,,,3494.33,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,86224,
Incision of windpipe,31603,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,3494.33,,,3494.33,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1675.8,25661.91,
Incision of windpipe,31605,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3493.66,68,,3493.66,percent of total billed charges,,3494.33,,,3494.33,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,268.41,7216,
Incision of windpipe,31610,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,3494.33,,,3494.33,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,86224,
Surgery/speech prosthesis,31611,CPT,,,,,,,,both,,,39071.66,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3494.33,,,3494.33,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27350.16,70,,27350.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,27350.16,
Puncture/clear windpipe,31612,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,237.8,,,237.8,Fee Schedule,,201.55,,,201.55,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,201.55,54176.39,
Repair windpipe opening,31613,CPT,,,,,,,,both,,,36827.53,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25042.72,68,,25042.72,percent of total billed charges,,3494.33,,,3494.33,Other,186% of Medicaid,29462.02,80,,29462.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29462.02,80,,29462.02,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25779.27,70,,25779.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,29462.02,
Repair windpipe opening,31614,CPT,,,,,,,,both,,,46626.08,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,31705.73,68,,31705.73,percent of total billed charges,,3494.33,,,3494.33,Other,186% of Medicaid,37300.86,80,,37300.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,37300.86,80,,37300.86,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,32638.26,70,,32638.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,37300.86,
Visualization of windpipe,31615,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,604.59,9258.28,
Dx bronchoscope/wash,31622,CPT,,,,,,,,both,,,37079.01,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25213.73,68,,25213.73,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,29663.21,80,,29663.21,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29663.21,80,,29663.21,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25955.31,70,,25955.31,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,1148.26,29663.21,
Dx bronchoscope/brush,31623,CPT,,,,,,,,both,,,43100.6,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29308.41,68,,29308.41,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,34480.48,80,,34480.48,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34480.48,80,,34480.48,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,30170.42,70,,30170.42,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,1148.26,34480.48,
Dx bronchoscope/lavage,31624,CPT,,,,,,,,both,,,39238.97,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26682.5,68,,26682.5,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,31391.18,80,,31391.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31391.18,80,,31391.18,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27467.28,70,,27467.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,1148.26,31391.18,
Bronchoscopy w/biopsy(s),31625,CPT,,,,,,,,both,,,45889.33,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,31204.74,68,,31204.74,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,36711.46,80,,36711.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,36711.46,80,,36711.46,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,32122.53,70,,32122.53,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,1148.26,36711.46,
Bronchoscopy w/markers,31626,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2135.76,,,2135.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,1148.26,100772.82,
Navigational bronchoscopy,31627,CPT,,,,,,,,both,,,59722.25,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,35833.35,60,,35833.35,percent of total billed charges,,33444.46,56,,33444.46,percent of total billed charges,,32250.02,54,,32250.02,percent of total billed charges,,41805.58,70,,41805.58,percent of total billed charges,,40611.13,68,,40611.13,percent of total billed charges,,3003.12,,,3003.12,Other,186% of Medicaid,47777.8,80,,47777.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47777.8,80,,47777.8,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,41805.58,70,,41805.58,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1614.58,,,1614.58,Other,New York Medicaid APG methodology,1614.58,,,1614.58,Other,100% New York Medicaid APG,1614.58,,,1614.58,Other,100% New York Medicaid APG,1614.58,,,1614.58,Other,100% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,2470.31,,,2470.31,Other,153% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,2260.41,,,2260.41,Other,140% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,4197.91,,,4197.91,Other,260% New York Medicaid APG,5231.24,,,5231.24,Other,324% New York Medicaid APG,3471.34,,,3471.34,Other,215% New York Medicaid APG,3471.34,,,3471.34,Other,215% New York Medicaid APG,2018.22,,,2018.22,Other,125% New York Medicaid APG,0.01,47777.8,
Bronchoscopy/lung bx each,31628,CPT,,,,,,,,both,,,56748.72,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,38589.13,68,,38589.13,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,45398.98,80,,45398.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,45398.98,80,,45398.98,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,39724.1,70,,39724.1,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,1148.26,45398.98,
Bronchoscopy/needle bx each,31629,CPT,,,,,,,,both,,,68153.41,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46344.32,68,,46344.32,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,54522.73,80,,54522.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54522.73,80,,54522.73,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47707.39,70,,47707.39,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,1148.26,54522.73,
Bronchoscopy dilate/fx repr,31630,CPT,,,,,,,,both,,,37547.22,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25532.11,68,,25532.11,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,30037.78,80,,30037.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30037.78,80,,30037.78,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26283.05,70,,26283.05,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,1252.19,30037.78,
Bronchoscopy dilate w/stent,31631,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,97893.6,68,,97893.6,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,115168.94,80,,115168.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,115168.94,80,,115168.94,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,1252.19,115168.94,
Bronchoscopy/lung bx addl,31632,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,0.01,41257.63,
Bronchoscopy/needle bx addl,31633,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,0.01,41257.63,
Bronch w/balloon occlusion,31634,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2329.06,,,2329.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,1252.19,100772.82,
Bronchoscopy w/fb removal,31635,CPT,,,,,,,,both,,,35553.87,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24176.63,68,,24176.63,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,28443.1,80,,28443.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28443.1,80,,28443.1,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24887.71,70,,24887.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,1148.26,28443.1,
Bronchoscopy bronch stents,31636,CPT,,,,,,,,both,,,44965.28,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,30576.39,68,,30576.39,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,35972.22,80,,35972.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35972.22,80,,35972.22,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,31475.7,70,,31475.7,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,1252.19,35972.22,
Bronchoscopy stent add-on,31637,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,0.01,25945.68,
Bronchoscopy revise stent,31638,CPT,,,,,,,,both,,,38273,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26025.64,68,,26025.64,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,30618.4,80,,30618.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30618.4,80,,30618.4,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26791.1,70,,26791.1,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,1252.19,30618.4,
Bronchoscopy w/tumor excise,31640,CPT,,,,,,,,both,,,46256.93,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,31454.71,68,,31454.71,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,37005.54,80,,37005.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,37005.54,80,,37005.54,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,32379.85,70,,32379.85,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,1252.19,37005.54,
Bronchoscopy treat blockage,31641,CPT,,,,,,,,both,,,37178.25,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25281.21,68,,25281.21,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,29742.6,80,,29742.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29742.6,80,,29742.6,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26024.78,70,,26024.78,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,1252.19,29742.6,
Diag bronchoscope/catheter,31643,CPT,,,,,,,,both,,,35699.83,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24275.88,68,,24275.88,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24989.88,70,,24989.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,1148.26,28559.86,
Brnchsc w/ther aspir 1st,31645,CPT,,,,,,,,both,,,36693.03,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24951.26,68,,24951.26,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,29354.42,80,,29354.42,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29354.42,80,,29354.42,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25685.12,70,,25685.12,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,1148.26,29354.42,
Brnchsc w/ther aspir sbsq,31646,CPT,,,,,,,,both,,,8588.63,737.85,,,737.85,Other,150% of Medicare + 9.63% HCRA Surcharge,448.69,,,448.69,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,5840.27,68,,5840.27,percent of total billed charges,,2135.76,,,2135.76,Other,186% of Medicaid,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6012.04,70,,6012.04,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1148.26,,,1148.26,Other,New York Medicaid APG methodology,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,1148.26,,,1148.26,Other,100% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1756.84,,,1756.84,Other,153% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,1607.56,,,1607.56,Other,140% New York Medicaid APG,2583.58,,,2583.58,Other,225% New York Medicaid APG,2985.48,,,2985.48,Other,260% New York Medicaid APG,3720.36,,,3720.36,Other,324% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,2468.76,,,2468.76,Other,215% New York Medicaid APG,1435.32,,,1435.32,Other,125% New York Medicaid APG,448.69,7216,
Bronchial valve init insert,31647,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,97893.6,68,,97893.6,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,115168.94,80,,115168.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,115168.94,80,,115168.94,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,980.72,,,980.72,Fee Schedule,,831.22,,,831.22,Fee Schedule,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,831.22,115168.94,
Bronchial valve remov init,31648,CPT,,,,,,,,both,,,38917.96,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,27242.57,70,,27242.57,percent of total billed charges,,26464.21,68,,26464.21,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,31134.37,80,,31134.37,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31134.37,80,,31134.37,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27242.57,70,,27242.57,percent of total billed charges,,939.72,,,939.72,Fee Schedule,,796.47,,,796.47,Fee Schedule,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,796.47,31134.37,
Bronchial valve remov addl,31649,CPT,,,,,,,,both,,,35699.83,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,24989.88,70,,24989.88,percent of total billed charges,,24275.88,68,,24275.88,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24989.88,70,,24989.88,percent of total billed charges,,319.8,,,319.8,Fee Schedule,,271.05,,,271.05,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,271.05,28559.86,
Bronchial valve addl insert,31651,CPT,,,,,,,,both,,,36356.27,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,21813.76,60,,21813.76,percent of total billed charges,,20359.51,56,,20359.51,percent of total billed charges,,19632.39,54,,19632.39,percent of total billed charges,,25449.39,70,,25449.39,percent of total billed charges,,24722.26,68,,24722.26,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,29085.02,80,,29085.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29085.02,80,,29085.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25449.39,70,,25449.39,percent of total billed charges,,367.36,,,367.36,Fee Schedule,,311.36,,,311.36,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,0.01,29085.02,
Bronch ebus samplng 1/2 node,31652,CPT,,,,,,,,both,,,57482.41,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,40237.69,70,,40237.69,percent of total billed charges,,39088.04,68,,39088.04,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,45985.93,80,,45985.93,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,45985.93,80,,45985.93,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,40237.69,70,,40237.69,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,1252.19,45985.93,
Bronch ebus samplng 3/> node,31653,CPT,,,,,,,,both,,,61306.09,6766.96,,,6766.96,Other,150% of Medicare + 9.63% HCRA Surcharge,4115.03,,,4115.03,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,42914.26,70,,42914.26,percent of total billed charges,,41688.14,68,,41688.14,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,49044.87,80,,49044.87,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,49044.87,80,,49044.87,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,42914.26,70,,42914.26,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,1252.19,49044.87,
Bronch ebus ivntj perph les,31654,CPT,,,,,,,,both,,,71595.02,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,50116.51,70,,50116.51,percent of total billed charges,,48684.61,68,,48684.61,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,57276.02,80,,57276.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,57276.02,80,,57276.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,50116.51,70,,50116.51,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,0.01,57276.02,
Bronch thermoplsty 1 lobe,31660,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,6152,,,6152,Case Rate,,2329.06,,,2329.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,946.28,,,946.28,Fee Schedule,,802.03,,,802.03,Fee Schedule,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,802.03,100772.82,
Bronch thermoplsty 2/> lobes,31661,CPT,,,,,,,,both,,,143961.17,12367.72,,,12367.72,Other,150% of Medicare + 9.63% HCRA Surcharge,7520.89,,,7520.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,6152,,,6152,Case Rate,,2329.06,,,2329.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,100772.82,70,,100772.82,percent of total billed charges,,957.76,,,957.76,Fee Schedule,,811.76,,,811.76,Fee Schedule,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,811.76,100772.82,
Bronchial brush biopsy,31717,CPT,,,,,,,,both,,,8588.63,737.85,,,737.85,Other,150% of Medicare + 9.63% HCRA Surcharge,448.69,,,448.69,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,5840.27,68,,5840.27,percent of total billed charges,,2329.06,,,2329.06,Other,186% of Medicaid,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6870.9,80,,6870.9,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6012.04,70,,6012.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,448.69,7216,
Clearance of airways,31720,CPT,,,,,,,,both,,,4486.27,385.42,,,385.42,Other,150% of Medicare + 9.63% HCRA Surcharge,234.37,,,234.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3050.66,68,,3050.66,percent of total billed charges,,324.74,,,324.74,Other,186% of Medicaid,3589.02,80,,3589.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3589.02,80,,3589.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3140.39,70,,3140.39,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,174.59,,,174.59,Other,New York Medicaid APG methodology,174.59,,,174.59,Other,100% New York Medicaid APG,174.59,,,174.59,Other,100% New York Medicaid APG,174.59,,,174.59,Other,100% New York Medicaid APG,392.83,,,392.83,Other,225% New York Medicaid APG,267.12,,,267.12,Other,153% New York Medicaid APG,392.83,,,392.83,Other,225% New York Medicaid APG,244.43,,,244.43,Other,140% New York Medicaid APG,392.83,,,392.83,Other,225% New York Medicaid APG,453.93,,,453.93,Other,260% New York Medicaid APG,565.67,,,565.67,Other,324% New York Medicaid APG,375.37,,,375.37,Other,215% New York Medicaid APG,375.37,,,375.37,Other,215% New York Medicaid APG,218.24,,,218.24,Other,125% New York Medicaid APG,174.59,7216,
Intro windpipe wire/tube,31730,CPT,,,,,,,,both,,,35699.83,3066.98,,,3066.98,Other,150% of Medicare + 9.63% HCRA Surcharge,1865.05,,,1865.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24275.88,68,,24275.88,percent of total billed charges,,3494.33,,,3494.33,Other,186% of Medicaid,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28559.86,80,,28559.86,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24989.88,70,,24989.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1865.05,28559.86,
Repair of windpipe,31750,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3494.33,,,3494.33,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,86224,
Repair of windpipe,31755,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,3494.33,,,3494.33,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,98541.71,
Remove windpipe lesion,31785,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,3494.33,,,3494.33,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,86224,
Closure of windpipe lesion,31820,CPT,,,,,,,,both,,,36971.74,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25140.78,68,,25140.78,percent of total billed charges,,3494.33,,,3494.33,Other,186% of Medicaid,29577.39,80,,29577.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29577.39,80,,29577.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25880.22,70,,25880.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,29577.39,
Repair of windpipe defect,31825,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,3494.33,,,3494.33,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,54176.39,
Revise windpipe scar,31830,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,3494.33,,,3494.33,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1878.67,,,1878.67,Other,New York Medicaid APG methodology,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,1878.67,,,1878.67,Other,100% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2874.37,,,2874.37,Other,153% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,2630.14,,,2630.14,Other,140% New York Medicaid APG,4227.02,,,4227.02,Other,225% New York Medicaid APG,4884.55,,,4884.55,Other,260% New York Medicaid APG,6086.9,,,6086.9,Other,324% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,4039.15,,,4039.15,Other,215% New York Medicaid APG,2348.34,,,2348.34,Other,125% New York Medicaid APG,1878.67,54176.39,
Needle biopsy chest lining,32400,CPT,,,,,,,,both,,,50166.38,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,34113.14,68,,34113.14,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,40133.1,80,,40133.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,40133.1,80,,40133.1,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,35116.47,70,,35116.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,40133.1,
Core ndl bx lng/med perq,32408,CPT,,,,,,,,both,,,48462.88,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,32954.76,68,,32954.76,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,38770.3,80,,38770.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,38770.3,80,,38770.3,percent of total billed charges,,7216,,,7216,Case Rate,,38770.3,80,,38770.3,percent of total billed charges,,33924.02,70,,33924.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,38770.3,
Insert pleural cath,32550,CPT,,,,,,,,both,,,34976,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23783.68,68,,23783.68,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,27980.8,80,,27980.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27980.8,80,,27980.8,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24483.2,70,,24483.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,27980.8,
Insertion of chest tube,32551,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,22906.67,68,,22906.67,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,26949.02,
Remove lung catheter,32552,CPT,,,,,,,,both,,,33893,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23047.24,68,,23047.24,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,27114.4,80,,27114.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27114.4,80,,27114.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23725.1,70,,23725.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,27114.4,
Ins mark thor for rt perq,32553,CPT,,,,,,,,both,,,29144.83,2503.84,,,2503.84,Other,150% of Medicare + 9.63% HCRA Surcharge,1522.6,,,1522.6,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,19818.48,68,,19818.48,percent of total billed charges,,480.27,,,480.27,Other,186% of Medicaid,23315.86,80,,23315.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,23315.86,80,,23315.86,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,20401.38,70,,20401.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,258.21,,,258.21,Other,New York Medicaid APG methodology,258.21,,,258.21,Other,100% New York Medicaid APG,258.21,,,258.21,Other,100% New York Medicaid APG,258.21,,,258.21,Other,100% New York Medicaid APG,580.98,,,580.98,Other,225% New York Medicaid APG,395.06,,,395.06,Other,153% New York Medicaid APG,580.98,,,580.98,Other,225% New York Medicaid APG,361.5,,,361.5,Other,140% New York Medicaid APG,580.98,,,580.98,Other,225% New York Medicaid APG,671.35,,,671.35,Other,260% New York Medicaid APG,836.6,,,836.6,Other,324% New York Medicaid APG,555.15,,,555.15,Other,215% New York Medicaid APG,555.15,,,555.15,Other,215% New York Medicaid APG,322.76,,,322.76,Other,125% New York Medicaid APG,258.21,23315.86,
Aspirate pleura w/o imaging,32554,CPT,,,,,,,,both,,,13213.53,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,8985.2,68,,8985.2,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,10570.82,
Aspirate pleura w/ imaging,32555,CPT,,,,,,,,both,,,24290.55,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,17003.39,70,,17003.39,percent of total billed charges,,16517.57,68,,16517.57,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,19432.44,80,,19432.44,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19432.44,80,,19432.44,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,17003.39,70,,17003.39,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,19432.44,
Insert cath pleura w/o image,32556,CPT,,,,,,,,both,,,38003,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26602.1,70,,26602.1,percent of total billed charges,,25842.04,68,,25842.04,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,30402.4,80,,30402.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30402.4,80,,30402.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26602.1,70,,26602.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,30402.4,
Insert cath pleura w/ image,32557,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,22906.67,68,,22906.67,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,26949.02,
Treat pleurodesis w/agent,32560,CPT,,,,,,,,both,,,13213.53,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,8985.2,68,,8985.2,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,365.72,,,365.72,Fee Schedule,,309.97,,,309.97,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,309.97,10570.82,
Lyse chest fibrin init day,32561,CPT,,,,,,,,both,,,13213.53,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,8985.2,68,,8985.2,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,326.36,,,326.36,Fee Schedule,,276.61,,,276.61,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,276.61,10570.82,
Lyse chest fibrin subq day,32562,CPT,,,,,,,,both,,,13213.53,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,8985.2,68,,8985.2,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,290.28,,,290.28,Fee Schedule,,246.03,,,246.03,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,246.03,10570.82,
Thoracoscopy diagnostic,32601,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,4047.34,,,4047.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2175.99,,,2175.99,Other,New York Medicaid APG methodology,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3329.26,,,3329.26,Other,153% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3046.38,,,3046.38,Other,140% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,5657.57,,,5657.57,Other,260% New York Medicaid APG,7050.2,,,7050.2,Other,324% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,2719.99,,,2719.99,Other,125% New York Medicaid APG,2175.99,84954.99,
Thoracoscopy wbx sac,32604,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,3165.14,,,3165.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,151560.62,
Thoracoscopy w/bx med space,32606,CPT,,,,,,,,both,,,115664.62,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,80965.23,70,,80965.23,percent of total billed charges,,6152,,,6152,Case Rate,,4047.34,,,4047.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,80965.23,70,,80965.23,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2175.99,,,2175.99,Other,New York Medicaid APG methodology,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3329.26,,,3329.26,Other,153% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3046.38,,,3046.38,Other,140% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,5657.57,,,5657.57,Other,260% New York Medicaid APG,7050.2,,,7050.2,Other,324% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,2719.99,,,2719.99,Other,125% New York Medicaid APG,2175.99,80965.23,
Thoracoscopy w/bx infiltrate,32607,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,4047.34,,,4047.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2175.99,,,2175.99,Other,New York Medicaid APG methodology,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3329.26,,,3329.26,Other,153% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3046.38,,,3046.38,Other,140% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,5657.57,,,5657.57,Other,260% New York Medicaid APG,7050.2,,,7050.2,Other,324% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,2719.99,,,2719.99,Other,125% New York Medicaid APG,2175.99,151560.62,
Thoracoscopy w/bx nodule,32608,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,4047.34,,,4047.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2175.99,,,2175.99,Other,New York Medicaid APG methodology,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3329.26,,,3329.26,Other,153% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3046.38,,,3046.38,Other,140% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,5657.57,,,5657.57,Other,260% New York Medicaid APG,7050.2,,,7050.2,Other,324% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,2719.99,,,2719.99,Other,125% New York Medicaid APG,2175.99,151560.62,
Thoracoscopy w/bx pleura,32609,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,3165.14,,,3165.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,84954.99,
Therapeutic pneumothorax,32960,CPT,,,,,,,,both,,,13213.53,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,6152,,,6152,Case Rate,,1197.25,,,1197.25,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,9473,
Ablate pulm tumor perq crybl,32994,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4047.34,,,4047.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2175.99,,,2175.99,Other,New York Medicaid APG methodology,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3329.26,,,3329.26,Other,153% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3046.38,,,3046.38,Other,140% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,5657.57,,,5657.57,Other,260% New York Medicaid APG,7050.2,,,7050.2,Other,324% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,2719.99,,,2719.99,Other,125% New York Medicaid APG,2175.99,151560.62,
Ablate pulm tumor perq rf,32998,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,4047.34,,,4047.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2175.99,,,2175.99,Other,New York Medicaid APG methodology,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3329.26,,,3329.26,Other,153% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3046.38,,,3046.38,Other,140% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,5657.57,,,5657.57,Other,260% New York Medicaid APG,7050.2,,,7050.2,Other,324% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,2719.99,,,2719.99,Other,125% New York Medicaid APG,2175.99,84954.99,
Pericardiocentesis w/imaging,33016,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22906.67,68,,22906.67,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,26949.02,
Insert heart pm atrial,33206,CPT,,,,,,,,both,,,155525,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,108867.5,70,,108867.5,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,108867.5,70,,108867.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3343,108867.5,
Insert heart pm ventricular,33207,CPT,,,,,,,,both,,,224603.78,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3343,157222.65,
Insrt heart pm atrial & vent,33208,CPT,,,,,,,,both,,,119138.84,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,83397.19,70,,83397.19,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,83397.19,70,,83397.19,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6628,,"100% primary, 50% secondary, 25% tertiary procedure",6628,Other,United Healthcare ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6260,,"100% primary, 50% secondary, 25% tertiary procedure",6260,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3343,83397.19,
Insert electrd/pm cath sngl,33210,CPT,,,,,,,,both,,,52092,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,36464.4,70,,36464.4,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,36464.4,70,,36464.4,percent of total billed charges,,777.36,,,777.36,Fee Schedule,,658.86,,,658.86,Fee Schedule,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,658.86,36464.4,
Insert card electrodes dual,33211,CPT,,,,,,,,both,,,178695.84,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,125087.09,
Insert pulse gen sngl lead,33212,CPT,,,,,,,,both,,,178695.84,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3126,125087.09,
Insert pulse gen dual leads,33213,CPT,,,,,,,,both,,,224603.78,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3126,157222.65,
Upgrade of pacemaker system,33214,CPT,,,,,,,,both,,,224603.78,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6628,,"100% primary, 50% secondary, 25% tertiary procedure",6628,Other,United Healthcare ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6260,,"100% primary, 50% secondary, 25% tertiary procedure",6260,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3343,157222.65,
Reposition pacing-defib lead,33215,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,46931.32,
Insert 1 electrode pm-defib,33216,CPT,,,,,,,,both,,,122462.33,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,85723.63,70,,85723.63,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,85723.63,70,,85723.63,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,85723.63,
Insert 2 electrode pm-defib,33217,CPT,,,,,,,,both,,,178695.84,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,125087.09,
Repair lead pace-defib one,33218,CPT,,,,,,,,both,,,115106,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,80574.2,70,,80574.2,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,80574.2,70,,80574.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,80574.2,
Repair lead pace-defib dual,33220,CPT,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,57819.76,
Insert pulse gen mult leads,33221,CPT,,,,,,,,both,,,409846.89,35210.01,,,35210.01,Other,150% of Medicare + 9.63% HCRA Surcharge,21411.42,,,21411.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,286892.82,70,,286892.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3126,286892.82,
Relocation pocket pacemaker,33222,CPT,,,,,,,,both,,,72120,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49041.6,68,,49041.6,percent of total billed charges,,4537.53,,,4537.53,Other,186% of Medicaid,57696,80,,57696,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,57696,80,,57696,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,50484,70,,50484,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2003.89,57696,
Relocate pocket for defib,33223,CPT,,,,,,,,both,,,107123.53,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,72844,68,,72844,percent of total billed charges,,4537.53,,,4537.53,Other,186% of Medicaid,85698.82,80,,85698.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,85698.82,80,,85698.82,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,74986.47,70,,74986.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2003.89,85698.82,
Insert pacing lead & connect,33224,CPT,,,,,,,,both,,,127078,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,88954.6,70,,88954.6,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,88954.6,70,,88954.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6628,,"100% primary, 50% secondary, 25% tertiary procedure",6628,Other,United Healthcare ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6260,,"100% primary, 50% secondary, 25% tertiary procedure",6260,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3126,88954.6,
L ventric pacing lead add-on,33225,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6628,,"100% primary, 50% secondary, 25% tertiary procedure",6628,Other,United Healthcare ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6260,,"100% primary, 50% secondary, 25% tertiary procedure",6260,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,0.01,36100.43,
Reposition l ventric lead,33226,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,3947.45,,,3947.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2122.28,,,2122.28,Other,New York Medicaid APG methodology,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,3247.09,,,3247.09,Other,153% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,2971.2,,,2971.2,Other,140% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,5517.94,,,5517.94,Other,260% New York Medicaid APG,6876.2,,,6876.2,Other,324% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,2652.86,,,2652.86,Other,125% New York Medicaid APG,2122.28,46931.32,
Remove&replace pm gen singl,33227,CPT,,,,,,,,both,,,80557,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,56389.9,70,,56389.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3126,56389.9,
Remv&replc pm gen dual lead,33228,CPT,,,,,,,,both,,,90306.48,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,63214.54,70,,63214.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3126,63214.54,
Remv&replc pm gen mult leads,33229,CPT,,,,,,,,both,,,162903.47,35210.01,,,35210.01,Other,150% of Medicare + 9.63% HCRA Surcharge,21411.42,,,21411.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,114032.43,70,,114032.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3126,114032.43,
Insrt pulse gen w/dual leads,33230,CPT,,,,,,,,both,,,495795.01,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,347056.51,70,,347056.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,3126,347056.51,
Insrt pulse gen w/mult leads,33231,CPT,,,,,,,,both,,,691990.86,59449.04,,,59449.04,Other,150% of Medicare + 9.63% HCRA Surcharge,36151.32,,,36151.32,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,484393.6,70,,484393.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,3126,484393.6,
Removal of pm generator,33233,CPT,,,,,,,,both,,,178695.84,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,121513.17,68,,121513.17,percent of total billed charges,,3947.45,,,3947.45,Other,186% of Medicaid,142956.67,80,,142956.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,142956.67,80,,142956.67,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2122.28,,,2122.28,Other,New York Medicaid APG methodology,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,3247.09,,,3247.09,Other,153% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,2971.2,,,2971.2,Other,140% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,5517.94,,,5517.94,Other,260% New York Medicaid APG,6876.2,,,6876.2,Other,324% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,2652.86,,,2652.86,Other,125% New York Medicaid APG,2122.28,142956.67,
Removal of pacemaker system,33234,CPT,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,57819.76,
Removal pacemaker electrode,33235,CPT,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,57819.76,
Insrt pulse gen w/singl lead,33240,CPT,,,,,,,,both,,,495795.01,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,347056.51,70,,347056.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,3343,347056.51,
Remove pulse generator,33241,CPT,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3947.45,,,3947.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2122.28,,,2122.28,Other,New York Medicaid APG methodology,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,3247.09,,,3247.09,Other,153% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,2971.2,,,2971.2,Other,140% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,5517.94,,,5517.94,Other,260% New York Medicaid APG,6876.2,,,6876.2,Other,324% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,2652.86,,,2652.86,Other,125% New York Medicaid APG,2122.28,57819.76,
Remove elctrd transvenously,33244,CPT,,,,,,,,both,,,273034.86,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,191124.4,70,,191124.4,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,191124.4,70,,191124.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,191124.4,
Insj/rplcmt defib w/lead(s),33249,CPT,,,,,,,,both,,,169009.67,59449.04,,,59449.04,Other,150% of Medicare + 9.63% HCRA Surcharge,36151.32,,,36151.32,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,118306.77,70,,118306.77,percent of total billed charges,,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,118306.77,70,,118306.77,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,3343,118306.77,
Rmvl& replc pulse gen 1 lead,33262,CPT,,,,,,,,both,,,128383.53,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,89868.47,70,,89868.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,3126,89868.47,
Rmvl & rplcmt dfb gen 2 lead,33263,CPT,,,,,,,,both,,,135571.71,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,94900.2,70,,94900.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,3126,94900.2,
Rmvl & rplcmt dfb gen mlt ld,33264,CPT,,,,,,,,both,,,153330.86,59449.04,,,59449.04,Other,150% of Medicare + 9.63% HCRA Surcharge,36151.32,,,36151.32,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,107331.6,70,,107331.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,3126,107331.6,
Ins/rep subq defibrillator,33270,CPT,,,,,,,,both,,,209767.75,59449.04,,,59449.04,Other,150% of Medicare + 9.63% HCRA Surcharge,36151.32,,,36151.32,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,146837.43,70,,146837.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,3126,146837.43,
Insj subq impltbl dfb elctrd,33271,CPT,,,,,,,,both,,,178695.84,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,125087.09,
Rmvl of subq defibrillator,33272,CPT,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,57819.76,
Repos prev impltbl subq dfb,33273,CPT,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,57819.76,
Tcat insj/rpl perm ldls pm,33274,CPT,,,,,,,,both,,,111843.5,35210.01,,,35210.01,Other,150% of Medicare + 9.63% HCRA Surcharge,21411.42,,,21411.42,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,78290.45,70,,78290.45,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,78290.45,70,,78290.45,percent of total billed charges,,2325.52,,,2325.52,Fee Schedule,,1971.02,,,1971.02,Fee Schedule,,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,1971.02,78290.45,
Tcat rmvl perm ldls pm w/img,33275,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,3947.45,,,3947.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,2425.56,,,2425.56,Fee Schedule,,2055.81,,,2055.81,Fee Schedule,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2122.28,,,2122.28,Other,New York Medicaid APG methodology,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,3247.09,,,3247.09,Other,153% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,2971.2,,,2971.2,Other,140% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,5517.94,,,5517.94,Other,260% New York Medicaid APG,6876.2,,,6876.2,Other,324% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,2652.86,,,2652.86,Other,125% New York Medicaid APG,2055.81,46931.32,
Insj subq car rhythm mntr,33285,CPT,,,,,,,,both,,,63517.36,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,43191.8,68,,43191.8,percent of total billed charges,,10684.37,,,10684.37,Other,186% of Medicaid,50813.89,80,,50813.89,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,50813.89,80,,50813.89,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,44462.15,70,,44462.15,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,360.01,50813.89,
Rmvl subq car rhythm mntr,33286,CPT,,,,,,,,both,,,49862.63,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33906.59,68,,33906.59,percent of total billed charges,,4537.53,,,4537.53,Other,186% of Medicaid,39890.1,80,,39890.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39890.1,80,,39890.1,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,34903.84,70,,34903.84,percent of total billed charges,,418.2,,,418.2,Fee Schedule,,354.45,,,354.45,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,354.45,39890.1,
Repair tcat mitral valve,33419,CPT,,,,,,,,both,,,87274.28,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,52364.57,60,,52364.57,percent of total billed charges,,48873.6,56,,48873.6,percent of total billed charges,,47128.11,54,,47128.11,percent of total billed charges,,61092,70,,61092,percent of total billed charges,,6152,,,6152,Case Rate,,4728.14,,,4728.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,61092,70,,61092,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2542.01,,,2542.01,Other,New York Medicaid APG methodology,2542.01,,,2542.01,Other,100% New York Medicaid APG,2542.01,,,2542.01,Other,100% New York Medicaid APG,2542.01,,,2542.01,Other,100% New York Medicaid APG,5719.53,,,5719.53,Other,225% New York Medicaid APG,3889.28,,,3889.28,Other,153% New York Medicaid APG,5719.53,,,5719.53,Other,225% New York Medicaid APG,3558.82,,,3558.82,Other,140% New York Medicaid APG,5719.53,,,5719.53,Other,225% New York Medicaid APG,6609.23,,,6609.23,Other,260% New York Medicaid APG,8236.12,,,8236.12,Other,324% New York Medicaid APG,5465.33,,,5465.33,Other,215% New York Medicaid APG,5465.33,,,5465.33,Other,215% New York Medicaid APG,3177.52,,,3177.52,Other,125% New York Medicaid APG,0.01,61092,
Endoscopic vein harvest,33508,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,22702.47,
Aortic hemiarch graft,33866,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,0.01,60613.98,
Removal of artery clot,34101,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Removal of arm artery clot,34111,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Removal of artery clot,34201,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Removal of leg artery clot,34203,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Removal of vein clot,34421,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Removal of vein clot,34471,CPT,,,,,,,,both,,,13213.53,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,690.31,9473,
Removal of vein clot,34490,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Repair valve femoral vein,34501,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Transposition of vein valve,34510,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Cross-over vein graft,34520,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Leg vein fusion,34530,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Perq access & clsr fem art,34713,CPT,,,,,,,,both,,,98219.64,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,68753.75,70,,68753.75,percent of total billed charges,,66789.36,68,,66789.36,percent of total billed charges,,2758.57,,,2758.57,Other,186% of Medicaid,78575.71,80,,78575.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,78575.71,80,,78575.71,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,68753.75,70,,68753.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1483.1,,,1483.1,Other,New York Medicaid APG methodology,1483.1,,,1483.1,Other,100% New York Medicaid APG,1483.1,,,1483.1,Other,100% New York Medicaid APG,1483.1,,,1483.1,Other,100% New York Medicaid APG,3336.98,,,3336.98,Other,225% New York Medicaid APG,2269.14,,,2269.14,Other,153% New York Medicaid APG,3336.98,,,3336.98,Other,225% New York Medicaid APG,2076.34,,,2076.34,Other,140% New York Medicaid APG,3336.98,,,3336.98,Other,225% New York Medicaid APG,3856.06,,,3856.06,Other,260% New York Medicaid APG,4805.25,,,4805.25,Other,324% New York Medicaid APG,3188.67,,,3188.67,Other,215% New York Medicaid APG,3188.67,,,3188.67,Other,215% New York Medicaid APG,1853.88,,,1853.88,Other,125% New York Medicaid APG,0.01,78575.71,
Opn fem art expos cndt crtj,34714,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,3003.12,,,3003.12,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1614.58,,,1614.58,Other,New York Medicaid APG methodology,1614.58,,,1614.58,Other,100% New York Medicaid APG,1614.58,,,1614.58,Other,100% New York Medicaid APG,1614.58,,,1614.58,Other,100% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,2470.31,,,2470.31,Other,153% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,2260.41,,,2260.41,Other,140% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,4197.91,,,4197.91,Other,260% New York Medicaid APG,5231.24,,,5231.24,Other,324% New York Medicaid APG,3471.34,,,3471.34,Other,215% New York Medicaid APG,3471.34,,,3471.34,Other,215% New York Medicaid APG,2018.22,,,2018.22,Other,125% New York Medicaid APG,0.01,66803.2,
Opn ax/subcla art expos,34715,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,4418.97,,,4418.97,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,0.01,66803.2,
Opn ax/subcla art expos cndt,34716,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,3003.12,,,3003.12,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1614.58,,,1614.58,Other,New York Medicaid APG methodology,1614.58,,,1614.58,Other,100% New York Medicaid APG,1614.58,,,1614.58,Other,100% New York Medicaid APG,1614.58,,,1614.58,Other,100% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,2470.31,,,2470.31,Other,153% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,2260.41,,,2260.41,Other,140% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,4197.91,,,4197.91,Other,260% New York Medicaid APG,5231.24,,,5231.24,Other,324% New York Medicaid APG,3471.34,,,3471.34,Other,215% New York Medicaid APG,3471.34,,,3471.34,Other,215% New York Medicaid APG,2018.22,,,2018.22,Other,125% New York Medicaid APG,0.01,66803.2,
Repair defect of artery,35011,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Repair defect of arm artery,35045,CPT,,,,,,,,both,,,32847.72,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,22993.4,70,,22993.4,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,22993.4,70,,22993.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,22993.4,
Repair blood vessel lesion,35180,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,1759.86,23580.4,
Repair blood vessel lesion,35184,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Repair blood vessel lesion,35188,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Repair blood vessel lesion,35190,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Repair blood vessel lesion,35201,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Repair blood vessel lesion,35206,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Repair blood vessel lesion,35207,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Repair blood vessel lesion,35226,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,773.13,10359.16,
Repair blood vessel lesion,35231,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Repair blood vessel lesion,35236,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Repair blood vessel lesion,35256,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Repair blood vessel lesion,35261,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Repair blood vessel lesion,35266,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Repair blood vessel lesion,35286,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4077.11,,,4077.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2192,,,2192,Other,New York Medicaid APG methodology,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3353.75,,,3353.75,Other,153% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3068.79,,,3068.79,Other,140% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,5699.19,,,5699.19,Other,260% New York Medicaid APG,7102.07,,,7102.07,Other,324% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,2740,,,2740,Other,125% New York Medicaid APG,2192,80911.37,
Rechanneling of artery,35321,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Harvest femoropopliteal vein,35572,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,6152,,,6152,Case Rate,,4077.11,,,4077.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2192,,,2192,Other,New York Medicaid APG methodology,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3353.75,,,3353.75,Other,153% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3068.79,,,3068.79,Other,140% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,5699.19,,,5699.19,Other,260% New York Medicaid APG,7102.07,,,7102.07,Other,324% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,2740,,,2740,Other,125% New York Medicaid APG,0.01,36100.43,
Explore limb vessels,35860,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Removal of clot in graft,35875,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Removal of clot in graft,35876,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Revise graft w/vein,35879,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4077.11,,,4077.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2192,,,2192,Other,New York Medicaid APG methodology,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3353.75,,,3353.75,Other,153% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3068.79,,,3068.79,Other,140% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,5699.19,,,5699.19,Other,260% New York Medicaid APG,7102.07,,,7102.07,Other,324% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,2740,,,2740,Other,125% New York Medicaid APG,2192,80911.37,
Revise graft w/vein,35881,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4077.11,,,4077.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2192,,,2192,Other,New York Medicaid APG methodology,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3353.75,,,3353.75,Other,153% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3068.79,,,3068.79,Other,140% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,5699.19,,,5699.19,Other,260% New York Medicaid APG,7102.07,,,7102.07,Other,324% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,2740,,,2740,Other,125% New York Medicaid APG,2192,80911.37,
Revise graft w/nonauto graft,35883,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4077.11,,,4077.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2192,,,2192,Other,New York Medicaid APG methodology,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3353.75,,,3353.75,Other,153% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3068.79,,,3068.79,Other,140% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,5699.19,,,5699.19,Other,260% New York Medicaid APG,7102.07,,,7102.07,Other,324% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,2740,,,2740,Other,125% New York Medicaid APG,2192,80911.37,
Revise graft w/vein,35884,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4077.11,,,4077.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2192,,,2192,Other,New York Medicaid APG methodology,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,2192,,,2192,Other,100% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3353.75,,,3353.75,Other,153% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,3068.79,,,3068.79,Other,140% New York Medicaid APG,4931.99,,,4931.99,Other,225% New York Medicaid APG,5699.19,,,5699.19,Other,260% New York Medicaid APG,7102.07,,,7102.07,Other,324% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,4712.79,,,4712.79,Other,215% New York Medicaid APG,2740,,,2740,Other,125% New York Medicaid APG,2192,80911.37,
Excision graft extremity,35903,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Place needle in vein,36000,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,255.48,,,255.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,44.28,,,44.28,Fee Schedule,,37.53,,,37.53,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,137.35,,,137.35,Other,New York Medicaid APG methodology,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,210.15,,,210.15,Other,153% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,192.29,,,192.29,Other,140% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,357.12,,,357.12,Other,260% New York Medicaid APG,445.03,,,445.03,Other,324% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,171.69,,,171.69,Other,125% New York Medicaid APG,0.01,22702.47,
Pseudoaneurysm injection trt,36002,CPT,,,,,,,,both,,,13213.53,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,8985.2,68,,8985.2,percent of total billed charges,,729.08,,,729.08,Other,186% of Medicaid,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,391.98,,,391.98,Other,New York Medicaid APG methodology,391.98,,,391.98,Other,100% New York Medicaid APG,391.98,,,391.98,Other,100% New York Medicaid APG,391.98,,,391.98,Other,100% New York Medicaid APG,881.96,,,881.96,Other,225% New York Medicaid APG,599.73,,,599.73,Other,153% New York Medicaid APG,881.96,,,881.96,Other,225% New York Medicaid APG,548.77,,,548.77,Other,140% New York Medicaid APG,881.96,,,881.96,Other,225% New York Medicaid APG,1019.15,,,1019.15,Other,260% New York Medicaid APG,1270.02,,,1270.02,Other,324% New York Medicaid APG,842.76,,,842.76,Other,215% New York Medicaid APG,842.76,,,842.76,Other,215% New York Medicaid APG,489.98,,,489.98,Other,125% New York Medicaid APG,391.98,10570.82,
Injection ext venography,36005,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,231.24,,,231.24,Fee Schedule,,195.99,,,195.99,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,25945.68,
Place catheter in vein,36010,CPT,,,,,,,,both,,,70032,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,49022.4,70,,49022.4,percent of total billed charges,,47621.76,68,,47621.76,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,56025.6,80,,56025.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,56025.6,80,,56025.6,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,49022.4,70,,49022.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,56025.6,
Place catheter in vein,36011,CPT,,,,,,,,both,,,71652,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,50156.4,70,,50156.4,percent of total billed charges,,48723.36,68,,48723.36,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,57321.6,80,,57321.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,57321.6,80,,57321.6,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,50156.4,70,,50156.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,57321.6,
Place catheter in vein,36012,CPT,,,,,,,,both,,,35764.36,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,25035.05,70,,25035.05,percent of total billed charges,,24319.76,68,,24319.76,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,28611.49,80,,28611.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28611.49,80,,28611.49,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25035.05,70,,25035.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,28611.49,
Place catheter in artery,36013,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,66803.2,
Place catheter in artery,36014,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,66803.2,
Place catheter in artery,36015,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,66803.2,
Establish access to artery,36100,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,25945.68,
Intro ndl icath upr/lxtr art,36140,CPT,,,,,,,,both,,,82502.75,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,57751.93,70,,57751.93,percent of total billed charges,,56101.87,68,,56101.87,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,66002.2,80,,66002.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66002.2,80,,66002.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,57751.93,70,,57751.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,66002.2,
Establish access to aorta,36160,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,41257.63,
Place catheter in aorta,36200,CPT,,,,,,,,both,,,32242.94,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22570.06,70,,22570.06,percent of total billed charges,,21925.2,68,,21925.2,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,25794.35,80,,25794.35,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25794.35,80,,25794.35,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22570.06,70,,22570.06,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,25794.35,
Place catheter in artery,36215,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,51583.58,
Place catheter in artery,36216,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,51583.58,
Place catheter in artery,36217,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,51583.58,
Place catheter in artery,36218,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,249.28,,,249.28,Fee Schedule,,211.28,,,211.28,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,51583.58,
Place cath thoracic aorta,36221,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,45590.42,68,,45590.42,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,53635.79,
Place cath carotid/inom art,36222,CPT,,,,,,,,both,,,23345,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,16341.5,70,,16341.5,percent of total billed charges,,15874.6,68,,15874.6,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,18676,80,,18676,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,18676,80,,18676,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,16341.5,70,,16341.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,18676,
Place cath carotid/inom art,36223,CPT,,,,,,,,both,,,25923.2,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,18146.24,70,,18146.24,percent of total billed charges,,17627.78,68,,17627.78,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,20738.56,80,,20738.56,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,20738.56,80,,20738.56,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,18146.24,70,,18146.24,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,20738.56,
Place cath carotd art,36224,CPT,,,,,,,,both,,,28636.41,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,20045.49,70,,20045.49,percent of total billed charges,,6152,,,6152,Case Rate,,1730.08,,,1730.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,20045.49,70,,20045.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,20045.49,
Place cath subclavian art,36225,CPT,,,,,,,,both,,,29080.31,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,20356.22,70,,20356.22,percent of total billed charges,,19774.61,68,,19774.61,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,23264.25,80,,23264.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,23264.25,80,,23264.25,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,20356.22,70,,20356.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,23264.25,
Place cath vertebral art,36226,CPT,,,,,,,,both,,,29146.36,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,20402.45,70,,20402.45,percent of total billed charges,,6152,,,6152,Case Rate,,1730.08,,,1730.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,20402.45,70,,20402.45,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,20402.45,
Place cath xtrnl carotid,36227,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,0.01,51583.58,
Place cath intracranial art,36228,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,0.01,51583.58,
Ins cath abd/l-ext art 1st,36245,CPT,,,,,,,,both,,,50737.16,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,35516.01,70,,35516.01,percent of total billed charges,,34501.27,68,,34501.27,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,40589.73,80,,40589.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,40589.73,80,,40589.73,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,35516.01,70,,35516.01,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,40589.73,
Ins cath abd/l-ext art 2nd,36246,CPT,,,,,,,,both,,,68028.63,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,47620.04,70,,47620.04,percent of total billed charges,,46259.47,68,,46259.47,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,54422.9,80,,54422.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54422.9,80,,54422.9,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,47620.04,70,,47620.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,54422.9,
Ins cath abd/l-ext art 3rd,36247,CPT,,,,,,,,both,,,81571.9,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,57100.33,70,,57100.33,percent of total billed charges,,55468.89,68,,55468.89,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,65257.52,80,,65257.52,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,65257.52,80,,65257.52,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,57100.33,70,,57100.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,65257.52,
Ins cath abd/l-ext art addl,36248,CPT,,,,,,,,both,,,50142.2,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,35099.54,70,,35099.54,percent of total billed charges,,34096.7,68,,34096.7,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,40113.76,80,,40113.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,40113.76,80,,40113.76,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,35099.54,70,,35099.54,percent of total billed charges,,231.24,,,231.24,Fee Schedule,,195.99,,,195.99,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,40113.76,
Ins cath ren art 1st unilat,36251,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,45590.42,68,,45590.42,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,53635.79,
Ins cath ren art 1st bilat,36252,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,45590.42,68,,45590.42,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,53635.79,
Ins cath ren art 2nd+ unilat,36253,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,78599.62,68,,78599.62,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,92470.14,80,,92470.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,92470.14,80,,92470.14,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,92470.14,
Ins cath ren art 2nd+ bilat,36254,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,45590.42,68,,45590.42,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,53635.79,
Insertion of infusion pump,36260,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3126,80911.37,
Revision of infusion pump,36261,CPT,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,56167.76,68,,56167.76,percent of total billed charges,,4537.53,,,4537.53,Other,186% of Medicaid,66079.72,80,,66079.72,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66079.72,80,,66079.72,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2232,66079.72,
Removal of infusion pump,36262,CPT,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,56167.76,68,,56167.76,percent of total billed charges,,4537.53,,,4537.53,Other,186% of Medicaid,66079.72,80,,66079.72,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66079.72,80,,66079.72,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2053,66079.72,
Bl draw < 3 yrs fem/jugular,36400,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,268.42,,,268.42,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,22702.47,70,,22702.47,percent of total billed charges,,91.84,,,91.84,Fee Schedule,,77.84,,,77.84,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,144.31,,,144.31,Other,New York Medicaid APG methodology,144.31,,,144.31,Other,100% New York Medicaid APG,144.31,,,144.31,Other,100% New York Medicaid APG,144.31,,,144.31,Other,100% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,220.79,,,220.79,Other,153% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,202.03,,,202.03,Other,140% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,375.2,,,375.2,Other,260% New York Medicaid APG,467.56,,,467.56,Other,324% New York Medicaid APG,310.27,,,310.27,Other,215% New York Medicaid APG,310.27,,,310.27,Other,215% New York Medicaid APG,180.39,,,180.39,Other,125% New York Medicaid APG,0.01,25945.68,
Bl draw <3 yrs scalp vein,36405,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,268.42,,,268.42,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,22702.47,70,,22702.47,percent of total billed charges,,72.16,,,72.16,Fee Schedule,,61.16,,,61.16,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,144.31,,,144.31,Other,New York Medicaid APG methodology,144.31,,,144.31,Other,100% New York Medicaid APG,144.31,,,144.31,Other,100% New York Medicaid APG,144.31,,,144.31,Other,100% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,220.79,,,220.79,Other,153% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,202.03,,,202.03,Other,140% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,375.2,,,375.2,Other,260% New York Medicaid APG,467.56,,,467.56,Other,324% New York Medicaid APG,310.27,,,310.27,Other,215% New York Medicaid APG,310.27,,,310.27,Other,215% New York Medicaid APG,180.39,,,180.39,Other,125% New York Medicaid APG,0.01,25945.68,
Bl draw <3 yrs other vein,36406,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,268.42,,,268.42,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,22702.47,70,,22702.47,percent of total billed charges,,42.64,,,42.64,Fee Schedule,,36.14,,,36.14,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,144.31,,,144.31,Other,New York Medicaid APG methodology,144.31,,,144.31,Other,100% New York Medicaid APG,144.31,,,144.31,Other,100% New York Medicaid APG,144.31,,,144.31,Other,100% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,220.79,,,220.79,Other,153% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,202.03,,,202.03,Other,140% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,375.2,,,375.2,Other,260% New York Medicaid APG,467.56,,,467.56,Other,324% New York Medicaid APG,310.27,,,310.27,Other,215% New York Medicaid APG,310.27,,,310.27,Other,215% New York Medicaid APG,180.39,,,180.39,Other,125% New York Medicaid APG,0.01,25945.68,
Non-routine bl draw 3/> yrs,36410,CPT,,,,,,,,both,,,35243,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,115.19,,,115.19,Fee Schedule,,103.7,,,103.7,Fee Schedule,,97.95,,,97.95,Fee Schedule,,24670.1,70,,24670.1,percent of total billed charges,,6152,,,6152,Case Rate,,255.48,,,255.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,28194.4,80,,28194.4,percent of total billed charges,,24670.1,70,,24670.1,percent of total billed charges,,44.28,,,44.28,Fee Schedule,,37.53,,,37.53,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,137.35,,,137.35,Other,New York Medicaid APG methodology,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,210.15,,,210.15,Other,153% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,192.29,,,192.29,Other,140% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,357.12,,,357.12,Other,260% New York Medicaid APG,445.03,,,445.03,Other,324% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,171.69,,,171.69,Other,125% New York Medicaid APG,0.01,28194.4,
Capillary blood draw,36416,CPT,,,,,,,,both,,,11.73,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,1.22,,,1.22,Fee Schedule,,1.22,,,1.22,Fee Schedule,,1.22,,,1.22,Fee Schedule,,8.21,70,,8.21,percent of total billed charges,,6152,,,6152,Case Rate,,268.42,,,268.42,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9.38,80,,9.38,percent of total billed charges,,8.21,70,,8.21,percent of total billed charges,,7.62,65,,7.62,percent of total billed charges,,7.62,65,,7.62,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,144.31,,,144.31,Other,New York Medicaid APG methodology,144.31,,,144.31,Other,100% New York Medicaid APG,144.31,,,144.31,Other,100% New York Medicaid APG,144.31,,,144.31,Other,100% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,220.79,,,220.79,Other,153% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,202.03,,,202.03,Other,140% New York Medicaid APG,324.7,,,324.7,Other,225% New York Medicaid APG,375.2,,,375.2,Other,260% New York Medicaid APG,467.56,,,467.56,Other,324% New York Medicaid APG,310.27,,,310.27,Other,215% New York Medicaid APG,310.27,,,310.27,Other,215% New York Medicaid APG,180.39,,,180.39,Other,125% New York Medicaid APG,0.01,9473,
Vein access cutdown < 1 yr,36420,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,1827.06,68,,1827.06,percent of total billed charges,,255.48,,,255.48,Other,186% of Medicaid,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,231.24,,,231.24,Fee Schedule,,195.99,,,195.99,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,137.35,,,137.35,Other,New York Medicaid APG methodology,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,210.15,,,210.15,Other,153% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,192.29,,,192.29,Other,140% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,357.12,,,357.12,Other,260% New York Medicaid APG,445.03,,,445.03,Other,324% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,171.69,,,171.69,Other,125% New York Medicaid APG,137.35,7216,
Vein access cutdown > 1 yr,36425,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,5698.86,68,,5698.86,percent of total billed charges,,255.48,,,255.48,Other,186% of Medicaid,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,191.88,,,191.88,Fee Schedule,,162.63,,,162.63,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,137.35,,,137.35,Other,New York Medicaid APG methodology,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,210.15,,,210.15,Other,153% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,192.29,,,192.29,Other,140% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,357.12,,,357.12,Other,260% New York Medicaid APG,445.03,,,445.03,Other,324% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,171.69,,,171.69,Other,125% New York Medicaid APG,137.35,7216,
Blood transfusion service,36430,CPT,,,,,,,,both,,,11735,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8214.5,70,,8214.5,percent of total billed charges,,7979.8,68,,7979.8,percent of total billed charges,,1097.46,,,1097.46,Other,186% of Medicaid,9388,80,,9388,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9388,80,,9388,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8214.5,70,,8214.5,percent of total billed charges,,191.88,,,191.88,Fee Schedule,,162.63,,,162.63,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,590.03,,,590.03,Other,New York Medicaid APG methodology,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,902.75,,,902.75,Other,153% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,826.04,,,826.04,Other,140% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,1534.08,,,1534.08,Other,260% New York Medicaid APG,1911.7,,,1911.7,Other,324% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,737.54,,,737.54,Other,125% New York Medicaid APG,162.63,9388,
Bl push transfuse 2 yr/<,36440,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6208.95,68,,6208.95,percent of total billed charges,,1097.46,,,1097.46,Other,186% of Medicaid,7304.65,80,,7304.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,7304.65,80,,7304.65,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,242.72,,,242.72,Fee Schedule,,205.72,,,205.72,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,590.03,,,590.03,Other,New York Medicaid APG methodology,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,902.75,,,902.75,Other,153% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,826.04,,,826.04,Other,140% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,1534.08,,,1534.08,Other,260% New York Medicaid APG,1911.7,,,1911.7,Other,324% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,737.54,,,737.54,Other,125% New York Medicaid APG,205.72,7304.65,
Bl exchange/transfuse nb,36450,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6208.95,68,,6208.95,percent of total billed charges,,1097.46,,,1097.46,Other,186% of Medicaid,7304.65,80,,7304.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,7304.65,80,,7304.65,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,590.03,,,590.03,Other,New York Medicaid APG methodology,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,902.75,,,902.75,Other,153% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,826.04,,,826.04,Other,140% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,1534.08,,,1534.08,Other,260% New York Medicaid APG,1911.7,,,1911.7,Other,324% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,737.54,,,737.54,Other,125% New York Medicaid APG,477.02,7304.65,
Bl exchange/transfuse non-nb,36455,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6208.95,68,,6208.95,percent of total billed charges,,1097.46,,,1097.46,Other,186% of Medicaid,7304.65,80,,7304.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,7304.65,80,,7304.65,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,590.03,,,590.03,Other,New York Medicaid APG methodology,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,902.75,,,902.75,Other,153% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,826.04,,,826.04,Other,140% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,1534.08,,,1534.08,Other,260% New York Medicaid APG,1911.7,,,1911.7,Other,324% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,737.54,,,737.54,Other,125% New York Medicaid APG,477.02,7304.65,
Transfusion service fetal,36460,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6208.95,68,,6208.95,percent of total billed charges,,1097.46,,,1097.46,Other,186% of Medicaid,7304.65,80,,7304.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,7304.65,80,,7304.65,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,590.03,,,590.03,Other,New York Medicaid APG methodology,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,902.75,,,902.75,Other,153% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,826.04,,,826.04,Other,140% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,1534.08,,,1534.08,Other,260% New York Medicaid APG,1911.7,,,1911.7,Other,324% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,737.54,,,737.54,Other,125% New York Medicaid APG,477.02,7304.65,
Njx noncmpnd sclrsnt 1 vein,36465,CPT,,,,,,,,both,,,32059.3,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22441.51,70,,22441.51,percent of total billed charges,,21800.32,68,,21800.32,percent of total billed charges,,1930.84,,,1930.84,Other,186% of Medicaid,25647.44,80,,25647.44,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25647.44,80,,25647.44,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22441.51,70,,22441.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1038.09,,,1038.09,Other,New York Medicaid APG methodology,1038.09,,,1038.09,Other,100% New York Medicaid APG,1038.09,,,1038.09,Other,100% New York Medicaid APG,1038.09,,,1038.09,Other,100% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,1588.27,,,1588.27,Other,153% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,1453.32,,,1453.32,Other,140% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,2699.02,,,2699.02,Other,260% New York Medicaid APG,3363.4,,,3363.4,Other,324% New York Medicaid APG,2231.89,,,2231.89,Other,215% New York Medicaid APG,2231.89,,,2231.89,Other,215% New York Medicaid APG,1297.61,,,1297.61,Other,125% New York Medicaid APG,1038.09,25647.44,
Njx noncmpnd sclrsnt mlt vn,36466,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,26083.13,68,,26083.13,percent of total billed charges,,1930.84,,,1930.84,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1038.09,,,1038.09,Other,New York Medicaid APG methodology,1038.09,,,1038.09,Other,100% New York Medicaid APG,1038.09,,,1038.09,Other,100% New York Medicaid APG,1038.09,,,1038.09,Other,100% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,1588.27,,,1588.27,Other,153% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,1453.32,,,1453.32,Other,140% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,2699.02,,,2699.02,Other,260% New York Medicaid APG,3363.4,,,3363.4,Other,324% New York Medicaid APG,2231.89,,,2231.89,Other,215% New York Medicaid APG,2231.89,,,2231.89,Other,215% New York Medicaid APG,1297.61,,,1297.61,Other,125% New York Medicaid APG,1038.09,30686.04,
Njx sclrsnt spider veins,36468,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,1930.84,,,1930.84,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5451.6,65,,5451.6,percent of total billed charges,,5451.6,65,,5451.6,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1038.09,,,1038.09,Other,New York Medicaid APG methodology,1038.09,,,1038.09,Other,100% New York Medicaid APG,1038.09,,,1038.09,Other,100% New York Medicaid APG,1038.09,,,1038.09,Other,100% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,1588.27,,,1588.27,Other,153% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,1453.32,,,1453.32,Other,140% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,2699.02,,,2699.02,Other,260% New York Medicaid APG,3363.4,,,3363.4,Other,324% New York Medicaid APG,2231.89,,,2231.89,Other,215% New York Medicaid APG,2231.89,,,2231.89,Other,215% New York Medicaid APG,1297.61,,,1297.61,Other,125% New York Medicaid APG,438.16,7216,
Njx sclrsnt 1 incmptnt vein,36470,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,1930.84,,,1930.84,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,186.96,,,186.96,Fee Schedule,,158.46,,,158.46,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1038.09,,,1038.09,Other,New York Medicaid APG methodology,1038.09,,,1038.09,Other,100% New York Medicaid APG,1038.09,,,1038.09,Other,100% New York Medicaid APG,1038.09,,,1038.09,Other,100% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,1588.27,,,1588.27,Other,153% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,1453.32,,,1453.32,Other,140% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,2699.02,,,2699.02,Other,260% New York Medicaid APG,3363.4,,,3363.4,Other,324% New York Medicaid APG,2231.89,,,2231.89,Other,215% New York Medicaid APG,2231.89,,,2231.89,Other,215% New York Medicaid APG,1297.61,,,1297.61,Other,125% New York Medicaid APG,158.46,7216,
Njx sclrsnt mlt incmptnt vn,36471,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,1930.84,,,1930.84,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,365.72,,,365.72,Fee Schedule,,309.97,,,309.97,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1038.09,,,1038.09,Other,New York Medicaid APG methodology,1038.09,,,1038.09,Other,100% New York Medicaid APG,1038.09,,,1038.09,Other,100% New York Medicaid APG,1038.09,,,1038.09,Other,100% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,1588.27,,,1588.27,Other,153% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,1453.32,,,1453.32,Other,140% New York Medicaid APG,2335.69,,,2335.69,Other,225% New York Medicaid APG,2699.02,,,2699.02,Other,260% New York Medicaid APG,3363.4,,,3363.4,Other,324% New York Medicaid APG,2231.89,,,2231.89,Other,215% New York Medicaid APG,2231.89,,,2231.89,Other,215% New York Medicaid APG,1297.61,,,1297.61,Other,125% New York Medicaid APG,309.97,7216,
Endovenous mchnchem 1st vein,36473,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,46931.32,
Endovenous mchnchem add-on,36474,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,43846.05,68,,43846.05,percent of total billed charges,,4157.07,,,4157.07,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,0.01,51583.58,
Endovenous rf 1st vein,36475,CPT,,,,,,,,both,,,35971.87,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25180.31,70,,25180.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,25180.31,
Endovenous rf vein add-on,36476,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,43846.05,68,,43846.05,percent of total billed charges,,4157.07,,,4157.07,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,0.01,51583.58,
Endovenous laser 1st vein,36478,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,46931.32,
Endovenous laser vein addon,36479,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,43846.05,68,,43846.05,percent of total billed charges,,4157.07,,,4157.07,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,0.01,51583.58,
Insertion of catheter vein,36481,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,25945.68,
Endoven ther chem adhes 1st,36482,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,80911.37,
Endoven ther chem adhes sbsq,36483,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,4157.07,,,4157.07,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,0.01,51583.58,
Insertion of catheter vein,36500,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,25945.68,
Insertion of catheter vein,36510,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,255.48,,,255.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,257.48,,,257.48,Fee Schedule,,218.23,,,218.23,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,137.35,,,137.35,Other,New York Medicaid APG methodology,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,210.15,,,210.15,Other,153% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,192.29,,,192.29,Other,140% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,357.12,,,357.12,Other,260% New York Medicaid APG,445.03,,,445.03,Other,324% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,171.69,,,171.69,Other,125% New York Medicaid APG,0.01,22702.47,
Apheresis wbc,36511,CPT,,,,,,,,both,,,32272.54,2772.54,,,2772.54,Other,150% of Medicare + 9.63% HCRA Surcharge,1686,,,1686,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,21945.33,68,,21945.33,percent of total billed charges,,3574.48,,,3574.48,Other,186% of Medicaid,25818.03,80,,25818.03,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25818.03,80,,25818.03,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,528.08,,,528.08,Fee Schedule,,447.58,,,447.58,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,447.58,25818.03,
Apheresis rbc,36512,CPT,,,,,,,,both,,,32272.54,2772.54,,,2772.54,Other,150% of Medicare + 9.63% HCRA Surcharge,1686,,,1686,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,21945.33,68,,21945.33,percent of total billed charges,,3574.48,,,3574.48,Other,186% of Medicaid,25818.03,80,,25818.03,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25818.03,80,,25818.03,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,513.32,,,513.32,Fee Schedule,,435.07,,,435.07,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,435.07,25818.03,
Apheresis platelets,36513,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6208.95,68,,6208.95,percent of total billed charges,,3574.48,,,3574.48,Other,186% of Medicaid,7304.65,80,,7304.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,7304.65,80,,7304.65,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,511.68,,,511.68,Fee Schedule,,433.68,,,433.68,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,433.68,7304.65,
Apheresis plasma,36514,CPT,,,,,,,,both,,,32272.54,2772.54,,,2772.54,Other,150% of Medicare + 9.63% HCRA Surcharge,1686,,,1686,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,21945.33,68,,21945.33,percent of total billed charges,,3574.48,,,3574.48,Other,186% of Medicaid,25818.03,80,,25818.03,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25818.03,80,,25818.03,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,449.36,,,449.36,Fee Schedule,,380.86,,,380.86,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,380.86,25818.03,
Apheresis immunoads slctv,36516,CPT,,,,,,,,both,,,97340.17,8362.51,,,8362.51,Other,150% of Medicare + 9.63% HCRA Surcharge,5085.29,,,5085.29,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,6152,,,6152,Case Rate,,3574.47,,,3574.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,411.64,,,411.64,Fee Schedule,,348.89,,,348.89,Fee Schedule,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.96,,,4323.96,Other,225% New York Medicaid APG,2940.29,,,2940.29,Other,153% New York Medicaid APG,4323.96,,,4323.96,Other,225% New York Medicaid APG,2690.46,,,2690.46,Other,140% New York Medicaid APG,4323.96,,,4323.96,Other,225% New York Medicaid APG,4996.57,,,4996.57,Other,260% New York Medicaid APG,6226.5,,,6226.5,Other,324% New York Medicaid APG,4131.78,,,4131.78,Other,215% New York Medicaid APG,4131.78,,,4131.78,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,348.89,68138.12,
Photopheresis,36522,CPT,,,,,,,,both,,,97340.17,8362.51,,,8362.51,Other,150% of Medicare + 9.63% HCRA Surcharge,5085.29,,,5085.29,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,66191.32,68,,66191.32,percent of total billed charges,,3574.47,,,3574.47,Other,186% of Medicaid,77872.14,80,,77872.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,77872.14,80,,77872.14,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,464.12,,,464.12,Fee Schedule,,393.37,,,393.37,Fee Schedule,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.96,,,4323.96,Other,225% New York Medicaid APG,2940.29,,,2940.29,Other,153% New York Medicaid APG,4323.96,,,4323.96,Other,225% New York Medicaid APG,2690.46,,,2690.46,Other,140% New York Medicaid APG,4323.96,,,4323.96,Other,225% New York Medicaid APG,4996.57,,,4996.57,Other,260% New York Medicaid APG,6226.5,,,6226.5,Other,324% New York Medicaid APG,4131.78,,,4131.78,Other,215% New York Medicaid APG,4131.78,,,4131.78,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,393.37,77872.14,
Insert non-tunnel cv cath,36555,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,45590.42,68,,45590.42,percent of total billed charges,,587.3,,,587.3,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,315.75,53635.79,
Insert non-tunnel cv cath,36556,CPT,,,,,,,,both,,,24711.85,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16804.06,68,,16804.06,percent of total billed charges,,587.3,,,587.3,Other,186% of Medicaid,19769.48,80,,19769.48,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19769.48,80,,19769.48,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,17298.3,70,,17298.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,315.75,19769.48,
Insert tunneled cv cath,36557,CPT,,,,,,,,both,,,48529.02,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,32999.73,68,,32999.73,percent of total billed charges,,2490.76,,,2490.76,Other,186% of Medicaid,38823.22,80,,38823.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,38823.22,80,,38823.22,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,33970.31,70,,33970.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,38823.22,
Insert tunneled cv cath,36558,CPT,,,,,,,,both,,,24444.27,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,16622.1,68,,16622.1,percent of total billed charges,,2490.76,,,2490.76,Other,186% of Medicaid,19555.42,80,,19555.42,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19555.42,80,,19555.42,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,17110.99,70,,17110.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,19555.42,
Insert tunneled cv cath,36560,CPT,,,,,,,,both,,,37353.29,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2490.76,,,2490.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26147.3,70,,26147.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,26147.3,
Insert tunneled cv cath,36561,CPT,,,,,,,,both,,,26377.3,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2490.76,,,2490.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,18464.11,70,,18464.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,18464.11,
Insert tunneled cv cath,36563,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2490.76,,,2490.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,80911.37,
Insert tunneled cv cath,36565,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2490.76,,,2490.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,46931.32,
Insert tunneled cv cath,36566,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2490.76,,,2490.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,80911.37,
Insj picc <5 yr w/o imaging,36568,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22906.67,68,,22906.67,percent of total billed charges,,587.3,,,587.3,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,444.44,,,444.44,Fee Schedule,,376.69,,,376.69,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,315.75,26949.02,
Insj picc 5 yr+ w/o imaging,36569,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22906.67,68,,22906.67,percent of total billed charges,,587.3,,,587.3,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,451,,,451,Fee Schedule,,382.25,,,382.25,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,315.75,26949.02,
Insert picvad cath,36570,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,587.3,,,587.3,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,315.75,46931.32,
Insert picvad cath,36571,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,587.3,,,587.3,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,315.75,46931.32,
Insj picc rs&i <5 yr,36572,CPT,,,,,,,,both,,,13213.53,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,8985.2,68,,8985.2,percent of total billed charges,,587.3,,,587.3,Other,186% of Medicaid,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,315.75,10570.82,
Insj picc rs&i 5 yr+,36573,CPT,,,,,,,,both,,,15068.01,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,10246.25,68,,10246.25,percent of total billed charges,,587.3,,,587.3,Other,186% of Medicaid,12054.41,80,,12054.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,12054.41,80,,12054.41,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,10547.61,70,,10547.61,percent of total billed charges,,405.08,,,405.08,Fee Schedule,,343.33,,,343.33,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,315.75,12054.41,
Repair tunneled cv cath,36575,CPT,,,,,,,,both,,,13213.53,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8985.2,68,,8985.2,percent of total billed charges,,1557.34,,,1557.34,Other,186% of Medicaid,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,160.72,,,160.72,Fee Schedule,,136.22,,,136.22,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,837.28,,,837.28,Other,New York Medicaid APG methodology,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1281.04,,,1281.04,Other,153% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1172.19,,,1172.19,Other,140% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,2176.92,,,2176.92,Other,260% New York Medicaid APG,2712.78,,,2712.78,Other,324% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1046.6,,,1046.6,Other,125% New York Medicaid APG,136.22,10570.82,
Repair tunneled cv cath,36576,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22906.67,68,,22906.67,percent of total billed charges,,1557.34,,,1557.34,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,837.28,,,837.28,Other,New York Medicaid APG methodology,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1281.04,,,1281.04,Other,153% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1172.19,,,1172.19,Other,140% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,2176.92,,,2176.92,Other,260% New York Medicaid APG,2712.78,,,2712.78,Other,324% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1046.6,,,1046.6,Other,125% New York Medicaid APG,837.28,26949.02,
Replace tunneled cv cath,36578,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,45590.42,68,,45590.42,percent of total billed charges,,1557.34,,,1557.34,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,837.28,,,837.28,Other,New York Medicaid APG methodology,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1281.04,,,1281.04,Other,153% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1172.19,,,1172.19,Other,140% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,2176.92,,,2176.92,Other,260% New York Medicaid APG,2712.78,,,2712.78,Other,324% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1046.6,,,1046.6,Other,125% New York Medicaid APG,837.28,53635.79,
Replace cvad cath,36580,CPT,,,,,,,,both,,,14619,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,9940.92,68,,9940.92,percent of total billed charges,,587.3,,,587.3,Other,186% of Medicaid,11695.2,80,,11695.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11695.2,80,,11695.2,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10233.3,70,,10233.3,percent of total billed charges,,316.52,,,316.52,Fee Schedule,,268.27,,,268.27,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,268.27,11695.2,
Replace tunneled cv cath,36581,CPT,,,,,,,,both,,,21192.57,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,14410.95,68,,14410.95,percent of total billed charges,,2490.76,,,2490.76,Other,186% of Medicaid,16954.06,80,,16954.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,16954.06,80,,16954.06,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,14834.8,70,,14834.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,16954.06,
Replace tunneled cv cath,36582,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2490.76,,,2490.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,46931.32,
Replace tunneled cv cath,36583,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2490.76,,,2490.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,80911.37,
Compl rplcmt picc rs&i,36584,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22906.67,68,,22906.67,percent of total billed charges,,587.3,,,587.3,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,282.08,,,282.08,Fee Schedule,,239.08,,,239.08,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,239.08,26949.02,
Replace picvad cath,36585,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,587.3,,,587.3,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,315.75,46931.32,
Removal tunneled cv cath,36589,CPT,,,,,,,,both,,,35837.87,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24369.75,68,,24369.75,percent of total billed charges,,1557.34,,,1557.34,Other,186% of Medicaid,28670.3,80,,28670.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28670.3,80,,28670.3,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,25086.51,70,,25086.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,837.28,,,837.28,Other,New York Medicaid APG methodology,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1281.04,,,1281.04,Other,153% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1172.19,,,1172.19,Other,140% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,2176.92,,,2176.92,Other,260% New York Medicaid APG,2712.78,,,2712.78,Other,324% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1046.6,,,1046.6,Other,125% New York Medicaid APG,690.31,28670.3,
Removal tunneled cv cath,36590,CPT,,,,,,,,both,,,26044.81,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,17710.47,68,,17710.47,percent of total billed charges,,1557.34,,,1557.34,Other,186% of Medicaid,20835.85,80,,20835.85,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,20835.85,80,,20835.85,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,18231.37,70,,18231.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,837.28,,,837.28,Other,New York Medicaid APG methodology,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1281.04,,,1281.04,Other,153% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1172.19,,,1172.19,Other,140% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,2176.92,,,2176.92,Other,260% New York Medicaid APG,2712.78,,,2712.78,Other,324% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1046.6,,,1046.6,Other,125% New York Medicaid APG,837.28,20835.85,
Draw blood off venous device,36591,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,153.96,,,153.96,Fee Schedule,,138.59,,,138.59,Fee Schedule,,130.91,,,130.91,Fee Schedule,,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,255.48,,,255.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,131.2,,,131.2,Fee Schedule,,111.2,,,111.2,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,137.35,,,137.35,Other,New York Medicaid APG methodology,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,210.15,,,210.15,Other,153% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,192.29,,,192.29,Other,140% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,357.12,,,357.12,Other,260% New York Medicaid APG,445.03,,,445.03,Other,324% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,171.69,,,171.69,Other,125% New York Medicaid APG,111.2,9473,
Collect blood from picc,36592,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,172.03,,,172.03,Fee Schedule,,154.86,,,154.86,Fee Schedule,,146.28,,,146.28,Fee Schedule,,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,255.48,,,255.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,142.68,,,142.68,Fee Schedule,,120.93,,,120.93,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,137.35,,,137.35,Other,New York Medicaid APG methodology,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,210.15,,,210.15,Other,153% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,192.29,,,192.29,Other,140% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,357.12,,,357.12,Other,260% New York Medicaid APG,445.03,,,445.03,Other,324% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,171.69,,,171.69,Other,125% New York Medicaid APG,120.93,9473,
Declot vascular device,36593,CPT,,,,,,,,both,,,41600.5,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,29120.35,70,,29120.35,percent of total billed charges,,28288.34,68,,28288.34,percent of total billed charges,,644.83,,,644.83,Other,186% of Medicaid,33280.4,80,,33280.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33280.4,80,,33280.4,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,29120.35,70,,29120.35,percent of total billed charges,,162.36,,,162.36,Fee Schedule,,137.61,,,137.61,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,346.68,,,346.68,Other,New York Medicaid APG methodology,346.68,,,346.68,Other,100% New York Medicaid APG,346.68,,,346.68,Other,100% New York Medicaid APG,346.68,,,346.68,Other,100% New York Medicaid APG,780.04,,,780.04,Other,225% New York Medicaid APG,530.43,,,530.43,Other,153% New York Medicaid APG,780.04,,,780.04,Other,225% New York Medicaid APG,485.36,,,485.36,Other,140% New York Medicaid APG,780.04,,,780.04,Other,225% New York Medicaid APG,901.38,,,901.38,Other,260% New York Medicaid APG,1123.26,,,1123.26,Other,324% New York Medicaid APG,745.37,,,745.37,Other,215% New York Medicaid APG,745.37,,,745.37,Other,215% New York Medicaid APG,433.36,,,433.36,Other,125% New York Medicaid APG,137.61,33280.4,
Mech remov tunneled cv cath,36595,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,1557.34,,,1557.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,837.28,,,837.28,Other,New York Medicaid APG methodology,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1281.04,,,1281.04,Other,153% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1172.19,,,1172.19,Other,140% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,2176.92,,,2176.92,Other,260% New York Medicaid APG,2712.78,,,2712.78,Other,324% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1046.6,,,1046.6,Other,125% New York Medicaid APG,837.28,46931.32,
Mech remov tunneled cv cath,36596,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,22906.67,68,,22906.67,percent of total billed charges,,1557.34,,,1557.34,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,213.2,,,213.2,Fee Schedule,,180.7,,,180.7,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,837.28,,,837.28,Other,New York Medicaid APG methodology,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1281.04,,,1281.04,Other,153% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1172.19,,,1172.19,Other,140% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,2176.92,,,2176.92,Other,260% New York Medicaid APG,2712.78,,,2712.78,Other,324% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1046.6,,,1046.6,Other,125% New York Medicaid APG,180.7,26949.02,
Reposition venous catheter,36597,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,22906.67,68,,22906.67,percent of total billed charges,,1557.34,,,1557.34,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,293.56,,,293.56,Fee Schedule,,248.81,,,248.81,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,837.28,,,837.28,Other,New York Medicaid APG methodology,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,837.28,,,837.28,Other,100% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1281.04,,,1281.04,Other,153% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,1172.19,,,1172.19,Other,140% New York Medicaid APG,1883.88,,,1883.88,Other,225% New York Medicaid APG,2176.92,,,2176.92,Other,260% New York Medicaid APG,2712.78,,,2712.78,Other,324% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1800.15,,,1800.15,Other,215% New York Medicaid APG,1046.6,,,1046.6,Other,125% New York Medicaid APG,248.81,26949.02,
Inj w/fluor eval cv device,36598,CPT,,,,,,,,both,,,13047.71,387.31,,,387.31,Other,150% of Medicare + 9.63% HCRA Surcharge,235.53,,,235.53,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9133.4,70,,9133.4,percent of total billed charges,,8872.44,68,,8872.44,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,10438.17,80,,10438.17,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10438.17,80,,10438.17,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9133.4,70,,9133.4,percent of total billed charges,,172.2,,,172.2,Fee Schedule,,145.95,,,145.95,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,145.95,10438.17,
Withdrawal of arterial blood,36600,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,0.01,,"100% primary, 50% supplemental procedure",0.01,Other,Aetna ASC Grouper,0.01,,"100% primary, 50% supplemental procedure",0.01,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,255.48,,,255.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,72.16,,,72.16,Fee Schedule,,61.16,,,61.16,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,137.35,,,137.35,Other,New York Medicaid APG methodology,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,137.35,,,137.35,Other,100% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,210.15,,,210.15,Other,153% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,192.29,,,192.29,Other,140% New York Medicaid APG,309.05,,,309.05,Other,225% New York Medicaid APG,357.12,,,357.12,Other,260% New York Medicaid APG,445.03,,,445.03,Other,324% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,295.31,,,295.31,Other,215% New York Medicaid APG,171.69,,,171.69,Other,125% New York Medicaid APG,0.01,9473,
Insertion catheter artery,36620,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,516.63,,,516.63,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,214.84,,,214.84,Fee Schedule,,182.09,,,182.09,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,25945.68,
Insertion catheter artery,36625,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,516.63,,,516.63,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,22702.47,
Insertion catheter artery,36640,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,45590.42,68,,45590.42,percent of total billed charges,,1730.08,,,1730.08,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,930.15,,,930.15,Other,New York Medicaid APG methodology,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,930.15,,,930.15,Other,100% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1423.13,,,1423.13,Other,153% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,1302.21,,,1302.21,Other,140% New York Medicaid APG,2092.83,,,2092.83,Other,225% New York Medicaid APG,2418.39,,,2418.39,Other,260% New York Medicaid APG,3013.68,,,3013.68,Other,324% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1999.82,,,1999.82,Other,215% New York Medicaid APG,1162.69,,,1162.69,Other,125% New York Medicaid APG,930.15,53635.79,
Insert needle bone cavity,36680,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,5698.86,68,,5698.86,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,288.64,,,288.64,Fee Schedule,,244.64,,,244.64,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,244.64,7216,
Insertion of cannula,36800,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2490.76,,,2490.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,80911.37,
Insertion of cannula,36810,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2490.76,,,2490.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,46931.32,
Insertion of cannula,36815,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2490.76,,,2490.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1339.12,,,1339.12,Other,New York Medicaid APG methodology,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,1339.12,,,1339.12,Other,100% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,2048.85,,,2048.85,Other,153% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,1874.77,,,1874.77,Other,140% New York Medicaid APG,3013.02,,,3013.02,Other,225% New York Medicaid APG,3481.71,,,3481.71,Other,260% New York Medicaid APG,4338.75,,,4338.75,Other,324% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,2879.11,,,2879.11,Other,215% New York Medicaid APG,1673.9,,,1673.9,Other,125% New York Medicaid APG,1339.12,80911.37,
Av fuse uppr arm cephalic,36818,CPT,,,,,,,,both,,,46108.27,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,32275.79,70,,32275.79,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,32275.79,
Av fuse uppr arm basilic,36819,CPT,,,,,,,,both,,,39936.33,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,27955.43,70,,27955.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,27955.43,
Av fusion/forearm vein,36820,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,80911.37,
Av fusion direct any site,36821,CPT,,,,,,,,both,,,40013.59,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28009.51,70,,28009.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,28009.51,
Artery-vein autograft,36825,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,80911.37,
Artery-vein nonautograft,36830,CPT,,,,,,,,both,,,47662.49,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,33363.74,70,,33363.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,33363.74,
Open thrombect av fistula,36831,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,80911.37,
Av fistula revision open,36832,CPT,,,,,,,,both,,,46489.03,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,32542.32,70,,32542.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,32542.32,
Av fistula revision,36833,CPT,,,,,,,,both,,,48927.34,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,34249.14,70,,34249.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,34249.14,
Artery to vein shunt,36835,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,46931.32,
Dist revas ligation hemo,36838,CPT,,,,,,,,both,,,71342.33,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,49939.63,70,,49939.63,percent of total billed charges,,6152,,,6152,Case Rate,,4390.13,,,4390.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,49939.63,70,,49939.63,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2360.29,,,2360.29,Other,New York Medicaid APG methodology,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,2360.29,,,2360.29,Other,100% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3611.24,,,3611.24,Other,153% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,3304.4,,,3304.4,Other,140% New York Medicaid APG,5310.64,,,5310.64,Other,225% New York Medicaid APG,6136.74,,,6136.74,Other,260% New York Medicaid APG,7647.33,,,7647.33,Other,324% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,5074.61,,,5074.61,Other,215% New York Medicaid APG,2950.36,,,2950.36,Other,125% New York Medicaid APG,2360.29,49939.63,
External cannula declotting,36860,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22906.67,68,,22906.67,percent of total billed charges,,644.83,,,644.83,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23580.4,70,,23580.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,346.68,,,346.68,Other,New York Medicaid APG methodology,346.68,,,346.68,Other,100% New York Medicaid APG,346.68,,,346.68,Other,100% New York Medicaid APG,346.68,,,346.68,Other,100% New York Medicaid APG,780.04,,,780.04,Other,225% New York Medicaid APG,530.43,,,530.43,Other,153% New York Medicaid APG,780.04,,,780.04,Other,225% New York Medicaid APG,485.36,,,485.36,Other,140% New York Medicaid APG,780.04,,,780.04,Other,225% New York Medicaid APG,901.38,,,901.38,Other,260% New York Medicaid APG,1123.26,,,1123.26,Other,324% New York Medicaid APG,745.37,,,745.37,Other,215% New York Medicaid APG,745.37,,,745.37,Other,215% New York Medicaid APG,433.36,,,433.36,Other,125% New York Medicaid APG,346.68,26949.02,
Cannula declotting,36861,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,80911.37,
Intro cath dialysis circuit,36901,CPT,,,,,,,,both,,,45783.33,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,31132.66,68,,31132.66,percent of total billed charges,,787.56,,,787.56,Other,186% of Medicaid,36626.66,80,,36626.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,36626.66,80,,36626.66,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,32048.33,70,,32048.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,423.42,,,423.42,Other,New York Medicaid APG methodology,423.42,,,423.42,Other,100% New York Medicaid APG,423.42,,,423.42,Other,100% New York Medicaid APG,423.42,,,423.42,Other,100% New York Medicaid APG,952.7,,,952.7,Other,225% New York Medicaid APG,647.83,,,647.83,Other,153% New York Medicaid APG,952.7,,,952.7,Other,225% New York Medicaid APG,592.79,,,592.79,Other,140% New York Medicaid APG,952.7,,,952.7,Other,225% New York Medicaid APG,1100.9,,,1100.9,Other,260% New York Medicaid APG,1371.88,,,1371.88,Other,324% New York Medicaid APG,910.36,,,910.36,Other,215% New York Medicaid APG,910.36,,,910.36,Other,215% New York Medicaid APG,529.28,,,529.28,Other,125% New York Medicaid APG,423.42,36626.66,
Intro cath dialysis circuit,36902,CPT,,,,,,,,both,,,59916.11,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,41941.28,70,,41941.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,41941.28,
Intro cath dialysis circuit,36903,CPT,,,,,,,,both,,,84539,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,59177.3,70,,59177.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,59177.3,
Thrmbc/nfs dialysis circuit,36904,CPT,,,,,,,,both,,,120221.84,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84155.29,70,,84155.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,84155.29,
Thrmbc/nfs dialysis circuit,36905,CPT,,,,,,,,both,,,33272.33,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.15,,,4606.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,23290.63,70,,23290.63,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,2476.42,23290.63,
Thrmbc/nfs dialysis circuit,36906,CPT,,,,,,,,both,,,37210,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,26047,70,,26047,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,31686.15,
Balo angiop ctr dialysis seg,36907,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,58882.15,68,,58882.15,percent of total billed charges,,4606.15,,,4606.15,Other,186% of Medicaid,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,0.01,69273.12,
Stent plmt ctr dialysis seg,36908,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,56782.72,68,,56782.72,percent of total billed charges,,4606.15,,,4606.15,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,0.01,66803.2,
Dialysis circuit embolj,36909,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,43846.05,68,,43846.05,percent of total billed charges,,4606.16,,,4606.16,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,0.01,51583.58,
Remove hepatic shunt (tips),37183,CPT,,,,,,,,both,,,53851.78,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,37696.25,70,,37696.25,percent of total billed charges,,6152,,,6152,Case Rate,,4606.15,,,4606.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,37696.25,70,,37696.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,2476.42,37696.25,
Prim art m-thrmbc 1st vsl,37184,CPT,,,,,,,,both,,,150309.5,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,105216.65,70,,105216.65,percent of total billed charges,,6152,,,6152,Case Rate,,4606.15,,,4606.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105216.65,70,,105216.65,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,2476.42,105216.65,
Prim art m-thrmbc sbsq vsl,37185,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,4606.15,,,4606.15,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,0.01,51583.58,
Sec art thrombectomy add-on,37186,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,4606.16,,,4606.16,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,0.01,51583.58,
Venous mech thrombectomy,37187,CPT,,,,,,,,both,,,126314.5,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,88420.15,70,,88420.15,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,88420.15,70,,88420.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,88420.15,
Ven mechnl thrmbc repeat tx,37188,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,46931.32,
Ins endovas vena cava filtr,37191,CPT,,,,,,,,both,,,20501.41,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,14350.99,70,,14350.99,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,14350.99,70,,14350.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,14350.99,
Redo endovas vena cava filtr,37192,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,46931.32,
Rem endovas vena cava filter,37193,CPT,,,,,,,,both,,,41084.31,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,28759.02,70,,28759.02,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28759.02,70,,28759.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,28759.02,
Thrombolytic therapy stroke,37195,CPT,,,,,,,,both,,,7123.45,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4986.42,70,,4986.42,percent of total billed charges,,6152,,,6152,Case Rate,,644.83,,,644.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4986.42,70,,4986.42,percent of total billed charges,,4630.24,65,,4630.24,percent of total billed charges,,4630.24,65,,4630.24,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,346.68,,,346.68,Other,New York Medicaid APG methodology,346.68,,,346.68,Other,100% New York Medicaid APG,346.68,,,346.68,Other,100% New York Medicaid APG,346.68,,,346.68,Other,100% New York Medicaid APG,780.04,,,780.04,Other,225% New York Medicaid APG,530.43,,,530.43,Other,153% New York Medicaid APG,780.04,,,780.04,Other,225% New York Medicaid APG,485.36,,,485.36,Other,140% New York Medicaid APG,780.04,,,780.04,Other,225% New York Medicaid APG,901.38,,,901.38,Other,260% New York Medicaid APG,1123.26,,,1123.26,Other,324% New York Medicaid APG,745.37,,,745.37,Other,215% New York Medicaid APG,745.37,,,745.37,Other,215% New York Medicaid APG,433.36,,,433.36,Other,125% New York Medicaid APG,346.68,9473,
Remove intrvas foreign body,37197,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,46931.32,
Transcatheter biopsy,37200,CPT,,,,,,,,both,,,27909.7,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,19536.79,70,,19536.79,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,19536.79,70,,19536.79,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,19536.79,
Thrombolytic art therapy,37211,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,78599.62,68,,78599.62,percent of total billed charges,,3854.06,,,3854.06,Other,186% of Medicaid,92470.14,80,,92470.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,92470.14,80,,92470.14,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2053,92470.14,
Thrombolytic venous therapy,37212,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,45590.42,68,,45590.42,percent of total billed charges,,3854.06,,,3854.06,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2053,53635.79,
Thromblytic art/ven therapy,37213,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,46931.32,
Cessj therapy cath removal,37214,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,46931.32,
Iliac revasc,37220,CPT,,,,,,,,both,,,27747,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.15,,,4606.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,19422.9,70,,19422.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,2476.42,19422.9,
Iliac revasc w/stent,37221,CPT,,,,,,,,both,,,147449.05,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,103214.34,70,,103214.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,103214.34,
Iliac revasc add-on,37222,CPT,,,,,,,,both,,,98219.64,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,66789.36,68,,66789.36,percent of total billed charges,,4606.16,,,4606.16,Other,186% of Medicaid,78575.71,80,,78575.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,78575.71,80,,78575.71,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,68753.75,70,,68753.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,0.01,78575.71,
Iliac revasc w/stent add-on,37223,CPT,,,,,,,,both,,,98219.64,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,66789.36,68,,66789.36,percent of total billed charges,,4606.16,,,4606.16,Other,186% of Medicaid,78575.71,80,,78575.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,78575.71,80,,78575.71,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,68753.75,70,,68753.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,0.01,78575.71,
Fem/popl revas w/tla,37224,CPT,,,,,,,,both,,,93611,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.15,,,4606.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,65527.7,70,,65527.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,2476.42,65527.7,
Fem/popl revas w/ather,37225,CPT,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,258180.29,70,,258180.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,258180.29,
Fem/popl revasc w/stent,37226,CPT,,,,,,,,both,,,108112.64,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,75678.85,70,,75678.85,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,75678.85,
Fem/popl revasc stnt & ather,37227,CPT,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,258180.29,70,,258180.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,258180.29,
Tib/per revasc w/tla,37228,CPT,,,,,,,,both,,,148904.54,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.15,,,4606.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,104233.18,70,,104233.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,2476.42,104233.18,
Tib/per revasc w/ather,37229,CPT,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,258180.29,70,,258180.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,258180.29,
Tib/per revasc w/stent,37230,CPT,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,258180.29,70,,258180.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,258180.29,
Tib/per revasc stent & ather,37231,CPT,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,258180.29,70,,258180.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,258180.29,
Tib/per revasc add-on,37232,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,58882.15,68,,58882.15,percent of total billed charges,,4606.16,,,4606.16,Other,186% of Medicaid,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,0.01,69273.12,
Tibper revasc w/ather add-on,37233,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,58882.15,68,,58882.15,percent of total billed charges,,4606.16,,,4606.16,Other,186% of Medicaid,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,0.01,69273.12,
Revsc opn/prq tib/pero stent,37234,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,58882.15,68,,58882.15,percent of total billed charges,,4606.16,,,4606.16,Other,186% of Medicaid,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,0.01,69273.12,
Tib/per revasc stnt & ather,37235,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,58882.15,68,,58882.15,percent of total billed charges,,4606.16,,,4606.16,Other,186% of Medicaid,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,0.01,69273.12,
Open/perq place stent 1st,37236,CPT,,,,,,,,both,,,128514,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,89959.8,70,,89959.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,89959.8,
Open/perq place stent ea add,37237,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,4606.16,,,4606.16,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,0.01,41257.63,
Open/perq place stent same,37238,CPT,,,,,,,,both,,,99592.33,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,69714.63,70,,69714.63,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,69714.63,
Open/perq place stent ea add,37239,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,4606.16,,,4606.16,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,0.01,41257.63,
Vasc embolize/occlude venous,37241,CPT,,,,,,,,both,,,71391.01,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,49973.71,70,,49973.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,49973.71,
Vasc embolize/occlude artery,37242,CPT,,,,,,,,both,,,58008,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,40605.6,70,,40605.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,40605.6,
Vasc embolize/occlude organ,37243,CPT,,,,,,,,both,,,105190.95,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,73633.67,70,,73633.67,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,73633.67,
Vasc embolize/occlude bleed,37244,CPT,,,,,,,,both,,,59963.33,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,41974.33,70,,41974.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,41974.33,
Trluml balo angiop 1st art,37246,CPT,,,,,,,,both,,,120221.84,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,84155.29,70,,84155.29,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84155.29,70,,84155.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,84155.29,
Trluml balo angiop addl art,37247,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,4606.15,,,4606.15,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,0.01,66803.2,
Trluml balo angiop 1st vein,37248,CPT,,,,,,,,both,,,76655,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,53658.5,70,,53658.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,53658.5,
Trluml balo angiop addl vein,37249,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,56782.72,68,,56782.72,percent of total billed charges,,4606.15,,,4606.15,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,0.01,66803.2,
Intrvasc us noncoronary 1st,37252,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,3003.12,,,3003.12,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1614.58,,,1614.58,Other,New York Medicaid APG methodology,1614.58,,,1614.58,Other,100% New York Medicaid APG,1614.58,,,1614.58,Other,100% New York Medicaid APG,1614.58,,,1614.58,Other,100% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,2470.31,,,2470.31,Other,153% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,2260.41,,,2260.41,Other,140% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,4197.91,,,4197.91,Other,260% New York Medicaid APG,5231.24,,,5231.24,Other,324% New York Medicaid APG,3471.34,,,3471.34,Other,215% New York Medicaid APG,3471.34,,,3471.34,Other,215% New York Medicaid APG,2018.22,,,2018.22,Other,125% New York Medicaid APG,0.01,25945.68,
Intrvasc us noncoronary addl,37253,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,3003.12,,,3003.12,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,337.84,,,337.84,Fee Schedule,,286.34,,,286.34,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1614.58,,,1614.58,Other,New York Medicaid APG methodology,1614.58,,,1614.58,Other,100% New York Medicaid APG,1614.58,,,1614.58,Other,100% New York Medicaid APG,1614.58,,,1614.58,Other,100% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,2470.31,,,2470.31,Other,153% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,2260.41,,,2260.41,Other,140% New York Medicaid APG,3632.8,,,3632.8,Other,225% New York Medicaid APG,4197.91,,,4197.91,Other,260% New York Medicaid APG,5231.24,,,5231.24,Other,324% New York Medicaid APG,3471.34,,,3471.34,Other,215% New York Medicaid APG,3471.34,,,3471.34,Other,215% New York Medicaid APG,2018.22,,,2018.22,Other,125% New York Medicaid APG,0.01,25945.68,
Endoscopy ligate perf veins,37500,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Ligation of neck vein,37565,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Ligation of neck artery,37600,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4350.59,,,4350.59,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2339.03,,,2339.03,Other,New York Medicaid APG methodology,2339.03,,,2339.03,Other,100% New York Medicaid APG,2339.03,,,2339.03,Other,100% New York Medicaid APG,2339.03,,,2339.03,Other,100% New York Medicaid APG,5262.81,,,5262.81,Other,225% New York Medicaid APG,3578.71,,,3578.71,Other,153% New York Medicaid APG,5262.81,,,5262.81,Other,225% New York Medicaid APG,3274.64,,,3274.64,Other,140% New York Medicaid APG,5262.81,,,5262.81,Other,225% New York Medicaid APG,6081.47,,,6081.47,Other,260% New York Medicaid APG,7578.45,,,7578.45,Other,324% New York Medicaid APG,5028.91,,,5028.91,Other,215% New York Medicaid APG,5028.91,,,5028.91,Other,215% New York Medicaid APG,2923.79,,,2923.79,Other,125% New York Medicaid APG,2339.03,46931.32,
Ligation of neck artery,37605,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4350.59,,,4350.59,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2339.03,,,2339.03,Other,New York Medicaid APG methodology,2339.03,,,2339.03,Other,100% New York Medicaid APG,2339.03,,,2339.03,Other,100% New York Medicaid APG,2339.03,,,2339.03,Other,100% New York Medicaid APG,5262.81,,,5262.81,Other,225% New York Medicaid APG,3578.71,,,3578.71,Other,153% New York Medicaid APG,5262.81,,,5262.81,Other,225% New York Medicaid APG,3274.64,,,3274.64,Other,140% New York Medicaid APG,5262.81,,,5262.81,Other,225% New York Medicaid APG,6081.47,,,6081.47,Other,260% New York Medicaid APG,7578.45,,,7578.45,Other,324% New York Medicaid APG,5028.91,,,5028.91,Other,215% New York Medicaid APG,5028.91,,,5028.91,Other,215% New York Medicaid APG,2923.79,,,2923.79,Other,125% New York Medicaid APG,2339.03,46931.32,
Ligation of neck artery,37606,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4350.59,,,4350.59,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2339.03,,,2339.03,Other,New York Medicaid APG methodology,2339.03,,,2339.03,Other,100% New York Medicaid APG,2339.03,,,2339.03,Other,100% New York Medicaid APG,2339.03,,,2339.03,Other,100% New York Medicaid APG,5262.81,,,5262.81,Other,225% New York Medicaid APG,3578.71,,,3578.71,Other,153% New York Medicaid APG,5262.81,,,5262.81,Other,225% New York Medicaid APG,3274.64,,,3274.64,Other,140% New York Medicaid APG,5262.81,,,5262.81,Other,225% New York Medicaid APG,6081.47,,,6081.47,Other,260% New York Medicaid APG,7578.45,,,7578.45,Other,324% New York Medicaid APG,5028.91,,,5028.91,Other,215% New York Medicaid APG,5028.91,,,5028.91,Other,215% New York Medicaid APG,2923.79,,,2923.79,Other,125% New York Medicaid APG,2339.03,46931.32,
Ligation of a-v fistula,37607,CPT,,,,,,,,both,,,37131.52,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25992.06,70,,25992.06,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,25992.06,
Temporal artery procedure,37609,CPT,,,,,,,,both,,,34281.79,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23311.62,68,,23311.62,percent of total billed charges,,4418.97,,,4418.97,Other,186% of Medicaid,27425.43,80,,27425.43,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27425.43,80,,27425.43,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23997.25,70,,23997.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,1781.56,27425.43,
Ligation of neck artery,37615,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,46931.32,
Ligation of inf vena cava,37619,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,6152,,,6152,Case Rate,,4418.97,,,4418.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.06,,,6177.06,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2375.79,80911.37,
Revision of major vein,37650,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,45590.42,68,,45590.42,percent of total billed charges,,4418.97,,,4418.97,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2375.79,,,2375.79,Other,New York Medicaid APG methodology,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,2375.79,,,2375.79,Other,100% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3634.96,,,3634.96,Other,153% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,3326.11,,,3326.11,Other,140% New York Medicaid APG,5345.53,,,5345.53,Other,225% New York Medicaid APG,6177.05,,,6177.05,Other,260% New York Medicaid APG,7697.56,,,7697.56,Other,324% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,5107.95,,,5107.95,Other,215% New York Medicaid APG,2969.74,,,2969.74,Other,125% New York Medicaid APG,2232,53635.79,
Revise leg vein,37700,CPT,,,,,,,,both,,,41492.11,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,28214.63,68,,28214.63,percent of total billed charges,,4157.07,,,4157.07,Other,186% of Medicaid,33193.69,80,,33193.69,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33193.69,80,,33193.69,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,29044.48,70,,29044.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2232,33193.69,
Ligate/strip short leg vein,37718,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,46931.32,
Ligate/strip long leg vein,37722,CPT,,,,,,,,both,,,44299.77,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,31009.84,70,,31009.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,31009.84,
Removal of leg veins/lesion,37735,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,46931.32,
Ligate leg veins radical,37760,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,46931.32,
Ligate leg veins open,37761,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,46931.32,
Stab phleb veins xtr 10-20,37765,CPT,,,,,,,,both,,,38028.55,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,26619.99,70,,26619.99,percent of total billed charges,,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26619.99,70,,26619.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,26619.99,
Phleb veins - extrem 20+,37766,CPT,,,,,,,,both,,,52151.56,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,36506.09,70,,36506.09,percent of total billed charges,,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,36506.09,70,,36506.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,36506.09,
Revision of leg vein,37780,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,46931.32,
Ligate/divide/excise vein,37785,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,46931.32,
Penile venous occlusion,37790,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Laparoscopy splenectomy,38120,CPT,,,,,,,,both,,,44931.54,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,31452.08,70,,31452.08,percent of total billed charges,,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,31452.08,70,,31452.08,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,31452.08,
Injection for spleen x-ray,38200,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Bl donor search management,38204,CPT,,,,,,,,both,,,87274.28,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,52364.57,60,,52364.57,percent of total billed charges,,48873.6,56,,48873.6,percent of total billed charges,,47128.11,54,,47128.11,percent of total billed charges,,61092,70,,61092,percent of total billed charges,,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,69819.42,80,,69819.42,percent of total billed charges,,61092,70,,61092,percent of total billed charges,,487.08,,,487.08,Fee Schedule,,412.83,,,412.83,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,69819.42,
Harvest auto stem cells,38206,CPT,,,,,,,,both,,,32272.54,2772.54,,,2772.54,Other,150% of Medicare + 9.63% HCRA Surcharge,1686,,,1686,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,403.44,,,403.44,Fee Schedule,,341.94,,,341.94,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,341.94,22590.78,
Cryopreserve stem cells,38207,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,218.12,,,218.12,Fee Schedule,,184.87,,,184.87,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,184.87,9473,
Thaw preserved stem cells,38208,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,137.76,,,137.76,Fee Schedule,,116.76,,,116.76,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,116.76,9473,
Wash harvest stem cells,38209,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5478.49,60,,5478.49,percent of total billed charges,,5113.25,56,,5113.25,percent of total billed charges,,4930.64,54,,4930.64,percent of total billed charges,,6391.57,70,,6391.57,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,57.4,,,57.4,Fee Schedule,,48.65,,,48.65,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,48.65,9473,
T-cell depletion of harvest,38210,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5478.49,60,,5478.49,percent of total billed charges,,5113.25,56,,5113.25,percent of total billed charges,,4930.64,54,,4930.64,percent of total billed charges,,6391.57,70,,6391.57,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,385.4,,,385.4,Fee Schedule,,326.65,,,326.65,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,326.65,9473,
Tumor cell deplete of harvst,38211,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5478.49,60,,5478.49,percent of total billed charges,,5113.25,56,,5113.25,percent of total billed charges,,4930.64,54,,4930.64,percent of total billed charges,,6391.57,70,,6391.57,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,350.96,,,350.96,Fee Schedule,,297.46,,,297.46,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,297.46,9473,
Rbc depletion of harvest,38212,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6152,,,6152,Case Rate,,1097.46,,,1097.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,229.6,,,229.6,Fee Schedule,,194.6,,,194.6,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,590.03,,,590.03,Other,New York Medicaid APG methodology,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,590.03,,,590.03,Other,100% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,902.75,,,902.75,Other,153% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,826.04,,,826.04,Other,140% New York Medicaid APG,1327.57,,,1327.57,Other,225% New York Medicaid APG,1534.08,,,1534.08,Other,260% New York Medicaid APG,1911.7,,,1911.7,Other,324% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,1268.57,,,1268.57,Other,215% New York Medicaid APG,737.54,,,737.54,Other,125% New York Medicaid APG,194.6,9473,
Platelet deplete of harvest,38213,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,57.4,,,57.4,Fee Schedule,,48.65,,,48.65,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,48.65,9473,
Volume deplete of harvest,38214,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,196.8,,,196.8,Fee Schedule,,166.8,,,166.8,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,166.8,9473,
Harvest stem cell concentrte,38215,CPT,,,,,,,,both,,,9130.81,784.43,,,784.43,Other,150% of Medicare + 9.63% HCRA Surcharge,477.02,,,477.02,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6391.57,70,,6391.57,percent of total billed charges,,229.6,,,229.6,Fee Schedule,,194.6,,,194.6,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,194.6,9473,
Dx bone marrow aspirations,38220,CPT,,,,,,,,both,,,55779.91,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,39045.94,70,,39045.94,percent of total billed charges,,37930.34,68,,37930.34,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,44623.93,80,,44623.93,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,44623.93,80,,44623.93,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,39045.94,70,,39045.94,percent of total billed charges,,328,,,328,Fee Schedule,,278,,,278,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.19,,,1451.19,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.02,,,1200.02,Other,215% New York Medicaid APG,1200.02,,,1200.02,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,278,44623.93,
Dx bone marrow biopsies,38221,CPT,,,,,,,,both,,,71841.53,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,48852.24,68,,48852.24,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,57473.22,80,,57473.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,57473.22,80,,57473.22,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,50289.07,70,,50289.07,percent of total billed charges,,339.48,,,339.48,Fee Schedule,,287.73,,,287.73,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.19,,,1451.19,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.02,,,1200.02,Other,215% New York Medicaid APG,1200.02,,,1200.02,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,287.73,57473.22,
Dx bone marrow bx & aspir,38222,CPT,,,,,,,,both,,,65070.68,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,45549.48,70,,45549.48,percent of total billed charges,,44248.06,68,,44248.06,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,52056.54,80,,52056.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52056.54,80,,52056.54,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,45549.48,70,,45549.48,percent of total billed charges,,365.72,,,365.72,Fee Schedule,,309.97,,,309.97,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.19,,,1451.19,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.02,,,1200.02,Other,215% New York Medicaid APG,1200.02,,,1200.02,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,309.97,52056.54,
Bone marrow harvest allogen,38230,CPT,,,,,,,,both,,,45489.38,2772.54,,,2772.54,Other,150% of Medicare + 9.63% HCRA Surcharge,1686,,,1686,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,31842.57,70,,31842.57,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,31842.57,70,,31842.57,percent of total billed charges,,988.92,,,988.92,Fee Schedule,,838.17,,,838.17,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,838.17,31842.57,
Bone marrow harvest autolog,38232,CPT,,,,,,,,both,,,97340.17,8362.51,,,8362.51,Other,150% of Medicare + 9.63% HCRA Surcharge,5085.29,,,5085.29,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,1921.76,68138.12,
Transplt allo hct/donor,38240,CPT,,,,,,,,both,,,50891.17,98745.79,,,98745.79,Other,150% of Medicare + 9.63% HCRA Surcharge,60047.91,,,60047.91,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,35623.82,70,,35623.82,percent of total billed charges,,6152,,,6152,Case Rate,,3574.47,,,3574.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,35623.82,70,,35623.82,percent of total billed charges,,1159.48,,,1159.48,Fee Schedule,,982.73,,,982.73,Fee Schedule,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.96,,,4323.96,Other,225% New York Medicaid APG,2940.29,,,2940.29,Other,153% New York Medicaid APG,4323.96,,,4323.96,Other,225% New York Medicaid APG,2690.46,,,2690.46,Other,140% New York Medicaid APG,4323.96,,,4323.96,Other,225% New York Medicaid APG,4996.57,,,4996.57,Other,260% New York Medicaid APG,6226.5,,,6226.5,Other,324% New York Medicaid APG,4131.78,,,4131.78,Other,215% New York Medicaid APG,4131.78,,,4131.78,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,982.73,98745.79,
Transplt autol hct/donor,38241,CPT,,,,,,,,both,,,32272.54,2772.54,,,2772.54,Other,150% of Medicare + 9.63% HCRA Surcharge,1686,,,1686,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,856.08,,,856.08,Fee Schedule,,725.58,,,725.58,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,725.58,22590.78,
Transplt allo lymphocytes,38242,CPT,,,,,,,,both,,,32272.54,2772.54,,,2772.54,Other,150% of Medicare + 9.63% HCRA Surcharge,1686,,,1686,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,606.8,,,606.8,Fee Schedule,,514.3,,,514.3,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,514.3,22590.78,
Transplj hematopoietic boost,38243,CPT,,,,,,,,both,,,32272.54,2772.54,,,2772.54,Other,150% of Medicare + 9.63% HCRA Surcharge,1686,,,1686,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,21945.33,68,,21945.33,percent of total billed charges,,3574.48,,,3574.48,Other,186% of Medicaid,25818.03,80,,25818.03,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25818.03,80,,25818.03,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22590.78,70,,22590.78,percent of total billed charges,,593.68,,,593.68,Fee Schedule,,503.18,,,503.18,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,503.18,25818.03,
Drainage lymph node lesion,38300,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,47813.76,
Drainage lymph node lesion,38305,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,47813.76,
Incision of lymph channels,38308,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,54519.03,68,,54519.03,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,64140.04,
Biopsy/removal lymph nodes,38500,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,54519.03,68,,54519.03,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,64140.04,
Needle biopsy lymph nodes,38505,CPT,,,,,,,,both,,,47084.53,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,32017.48,68,,32017.48,percent of total billed charges,,2242.46,,,2242.46,Other,186% of Medicaid,37667.62,80,,37667.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,37667.62,80,,37667.62,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,32959.17,70,,32959.17,percent of total billed charges,,416.56,,,416.56,Fee Schedule,,353.06,,,353.06,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1205.63,,,1205.63,Other,New York Medicaid APG methodology,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,1205.63,,,1205.63,Other,100% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1844.61,,,1844.61,Other,153% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,1687.88,,,1687.88,Other,140% New York Medicaid APG,2712.66,,,2712.66,Other,225% New York Medicaid APG,3134.63,,,3134.63,Other,260% New York Medicaid APG,3906.23,,,3906.23,Other,324% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,2592.1,,,2592.1,Other,215% New York Medicaid APG,1507.03,,,1507.03,Other,125% New York Medicaid APG,353.06,37667.62,
Biopsy/removal lymph nodes,38510,CPT,,,,,,,,both,,,54121.87,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,36802.87,68,,36802.87,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,43297.5,80,,43297.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,43297.5,80,,43297.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,37885.31,70,,37885.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,43297.5,
Biopsy/removal lymph nodes,38520,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,54519.03,68,,54519.03,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,64140.04,
Biopsy/removal lymph nodes,38525,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,54519.03,68,,54519.03,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,64140.04,
Biopsy/removal lymph nodes,38530,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,54519.03,68,,54519.03,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,64140.04,80,,64140.04,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,64140.04,
Open bx/exc inguinofem nodes,38531,CPT,,,,,,,,both,,,49445.29,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33622.8,68,,33622.8,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,39556.23,80,,39556.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39556.23,80,,39556.23,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,34611.7,70,,34611.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,39556.23,
Explore deep node(s) neck,38542,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,82527.7,68,,82527.7,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,97091.42,80,,97091.42,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,97091.42,80,,97091.42,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,97091.42,
Removal neck/armpit lesion,38550,CPT,,,,,,,,both,,,80175.05,6887.85,,,6887.85,Other,150% of Medicare + 9.63% HCRA Surcharge,4188.54,,,4188.54,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2573.16,,,2573.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56122.54,70,,56122.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,56122.54,
Removal neck/armpit lesion,38555,CPT,,,,,,,,both,,,137162.89,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2573.16,,,2573.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,96014.02,
Laparoscopy lymph node biop,38570,CPT,,,,,,,,both,,,64506.8,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,45154.76,70,,45154.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,45154.76,
Laparoscopy lymphadenectomy,38571,CPT,,,,,,,,both,,,76185.64,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,53329.95,70,,53329.95,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,53329.95,
Laparoscopy lymphadenectomy,38572,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,151560.62,
Laps pelvic lymphadec,38573,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,151560.62,
Removal of lymph nodes neck,38700,CPT,,,,,,,,both,,,137162.89,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,93270.77,68,,93270.77,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,109730.31,80,,109730.31,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,109730.31,80,,109730.31,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,109730.31,
Removal of lymph nodes neck,38720,CPT,,,,,,,,both,,,137162.89,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,6152,,,6152,Case Rate,,2573.16,,,2573.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,96014.02,
Remove armpit lymph nodes,38740,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,82527.7,68,,82527.7,percent of total billed charges,,3622.38,,,3622.38,Other,186% of Medicaid,97091.42,80,,97091.42,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,97091.42,80,,97091.42,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,97091.42,
Remove armpit lymph nodes,38745,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3622.38,,,3622.38,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1947.52,,,1947.52,Other,New York Medicaid APG methodology,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,1947.52,,,1947.52,Other,100% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2979.7,,,2979.7,Other,153% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,2726.53,,,2726.53,Other,140% New York Medicaid APG,4381.92,,,4381.92,Other,225% New York Medicaid APG,5063.55,,,5063.55,Other,260% New York Medicaid APG,6309.96,,,6309.96,Other,324% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,4187.16,,,4187.16,Other,215% New York Medicaid APG,2434.4,,,2434.4,Other,125% New York Medicaid APG,1947.52,84954.99,
Remove groin lymph nodes,38760,CPT,,,,,,,,both,,,137162.89,11783.68,,,11783.68,Other,150% of Medicare + 9.63% HCRA Surcharge,7165.73,,,7165.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,93270.77,68,,93270.77,percent of total billed charges,,2573.16,,,2573.16,Other,186% of Medicaid,109730.31,80,,109730.31,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,109730.31,80,,109730.31,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,96014.02,70,,96014.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1383.42,,,1383.42,Other,New York Medicaid APG methodology,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,1383.42,,,1383.42,Other,100% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,2116.63,,,2116.63,Other,153% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,1936.79,,,1936.79,Other,140% New York Medicaid APG,3112.69,,,3112.69,Other,225% New York Medicaid APG,3596.89,,,3596.89,Other,260% New York Medicaid APG,4482.27,,,4482.27,Other,324% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,2974.35,,,2974.35,Other,215% New York Medicaid APG,1729.27,,,1729.27,Other,125% New York Medicaid APG,1383.42,109730.31,
Inject for lymphatic x-ray,38790,CPT,,,,,,,,both,,,31549.03,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22084.32,70,,22084.32,percent of total billed charges,,21453.34,68,,21453.34,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25239.22,80,,25239.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25239.22,80,,25239.22,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22084.32,70,,22084.32,percent of total billed charges,,398.52,,,398.52,Fee Schedule,,337.77,,,337.77,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25239.22,
Ra tracer id of sentinl node,38792,CPT,,,,,,,,both,,,8675.17,745.28,,,745.28,Other,150% of Medicare + 9.63% HCRA Surcharge,453.21,,,453.21,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6072.62,70,,6072.62,percent of total billed charges,,5899.12,68,,5899.12,percent of total billed charges,,766.46,,,766.46,Other,186% of Medicaid,6940.14,80,,6940.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6940.14,80,,6940.14,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6072.62,70,,6072.62,percent of total billed charges,,157.44,,,157.44,Fee Schedule,,133.44,,,133.44,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,412.07,,,412.07,Other,New York Medicaid APG methodology,412.07,,,412.07,Other,100% New York Medicaid APG,412.07,,,412.07,Other,100% New York Medicaid APG,412.07,,,412.07,Other,100% New York Medicaid APG,927.16,,,927.16,Other,225% New York Medicaid APG,630.47,,,630.47,Other,153% New York Medicaid APG,927.16,,,927.16,Other,225% New York Medicaid APG,576.9,,,576.9,Other,140% New York Medicaid APG,927.16,,,927.16,Other,225% New York Medicaid APG,1071.39,,,1071.39,Other,260% New York Medicaid APG,1335.12,,,1335.12,Other,324% New York Medicaid APG,885.96,,,885.96,Other,215% New York Medicaid APG,885.96,,,885.96,Other,215% New York Medicaid APG,515.09,,,515.09,Other,125% New York Medicaid APG,133.44,7216,
Access thoracic lymph duct,38794,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,6152,,,6152,Case Rate,,516.63,,,516.63,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,277.76,,,277.76,Other,New York Medicaid APG methodology,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,277.76,,,277.76,Other,100% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,424.97,,,424.97,Other,153% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,388.86,,,388.86,Other,140% New York Medicaid APG,624.96,,,624.96,Other,225% New York Medicaid APG,722.17,,,722.17,Other,260% New York Medicaid APG,899.94,,,899.94,Other,324% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,597.18,,,597.18,Other,215% New York Medicaid APG,347.2,,,347.2,Other,125% New York Medicaid APG,0.01,36100.43,
Io map of sent lymph node,38900,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Mediastinoscpy w/medstnl bx,39401,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3165.14,,,3165.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,84954.99,
Mediastinoscpy w/lmph nod bx,39402,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3165.14,,,3165.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1701.69,,,1701.69,Other,New York Medicaid APG methodology,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,1701.69,,,1701.69,Other,100% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2603.59,,,2603.59,Other,153% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,2382.37,,,2382.37,Other,140% New York Medicaid APG,3828.8,,,3828.8,Other,225% New York Medicaid APG,4424.39,,,4424.39,Other,260% New York Medicaid APG,5513.47,,,5513.47,Other,324% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,3658.63,,,3658.63,Other,215% New York Medicaid APG,2127.11,,,2127.11,Other,125% New York Medicaid APG,1701.69,84954.99,
Biopsy of lip,40490,CPT,,,,,,,,both,,,34446.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24112.71,70,,24112.71,percent of total billed charges,,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24112.71,70,,24112.71,percent of total billed charges,,336.2,,,336.2,Fee Schedule,,284.95,,,284.95,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,24112.71,
Partial excision of lip,40500,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,54176.39,
Partial excision of lip,40510,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,54176.39,
Partial excision of lip,40520,CPT,,,,,,,,both,,,35222.09,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23951.02,68,,23951.02,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,28177.67,80,,28177.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28177.67,80,,28177.67,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24655.46,70,,24655.46,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,28177.67,
Reconstruct lip with flap,40525,CPT,,,,,,,,both,,,60680.73,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,41262.9,68,,41262.9,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,48544.58,80,,48544.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,48544.58,80,,48544.58,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,42476.51,70,,42476.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,48544.58,
Reconstruct lip with flap,40527,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,98541.71,
Partial removal of lip,40530,CPT,,,,,,,,both,,,36028.54,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24499.41,68,,24499.41,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,28822.83,80,,28822.83,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28822.83,80,,28822.83,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25219.98,70,,25219.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,28822.83,
Repair lip,40650,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,9473,
Repair lip,40652,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,9473,
Repair lip,40654,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,22454.17,
Repair cleft lip/nasal,40700,CPT,,,,,,,,both,,,37061.46,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25943.02,70,,25943.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,25943.02,
Repair cleft lip/nasal,40701,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,86224,
Repair cleft lip/nasal,40702,CPT,,,,,,,,both,,,37204.04,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,26042.83,70,,26042.83,percent of total billed charges,,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,26042.83,70,,26042.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,26042.83,
Repair cleft lip/nasal,40720,CPT,,,,,,,,both,,,46637.53,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,32646.27,70,,32646.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,32646.27,
Repair cleft lip/nasal,40761,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,86224,
Drainage of mouth lesion,40800,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,6152,,,6152,Case Rate,,429.21,,,429.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,580.56,,,580.56,Fee Schedule,,492.06,,,492.06,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,10359.16,
Drainage of mouth lesion,40801,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,9258.28,
Removal foreign body mouth,40804,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,6152,,,6152,Case Rate,,429.21,,,429.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,554.32,,,554.32,Fee Schedule,,469.82,,,469.82,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,13346.72,
Removal foreign body mouth,40805,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8101,70,,8101,percent of total billed charges,,7869.54,68,,7869.54,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,9258.28,
Incision of lip fold,40806,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8101,70,,8101,percent of total billed charges,,7869.54,68,,7869.54,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,141.04,,,141.04,Fee Schedule,,119.54,,,119.54,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,119.54,9258.28,
Biopsy of mouth lesion,40808,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8101,70,,8101,percent of total billed charges,,7869.54,68,,7869.54,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,434.6,,,434.6,Fee Schedule,,368.35,,,368.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,9258.28,
Excision of mouth lesion,40810,CPT,,,,,,,,both,,,36908.56,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,25835.99,70,,25835.99,percent of total billed charges,,25097.82,68,,25097.82,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,29526.85,80,,29526.85,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29526.85,80,,29526.85,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25835.99,70,,25835.99,percent of total billed charges,,605.16,,,605.16,Fee Schedule,,512.91,,,512.91,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,29526.85,
Excise/repair mouth lesion,40812,CPT,,,,,,,,both,,,35262.79,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,24683.95,70,,24683.95,percent of total billed charges,,23978.7,68,,23978.7,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,28210.23,80,,28210.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28210.23,80,,28210.23,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24683.95,70,,24683.95,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,28210.23,
Excise/repair mouth lesion,40814,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,54176.39,
Excision of mouth lesion,40816,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,54176.39,
Excise oral mucosa for graft,40818,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,9258.28,
Excise lip or cheek fold,40819,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,25661.91,
Treatment of mouth lesion,40820,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,816.72,,,816.72,Fee Schedule,,692.22,,,692.22,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,54176.39,
Repair mouth laceration,40830,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,9473,
Repair mouth laceration,40831,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,9258.28,
Reconstruction of mouth,40840,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,98541.71,
Reconstruction of mouth,40842,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,86224,
Reconstruction of mouth,40843,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,86224,
Reconstruction of mouth,40844,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,86224,
Reconstruction of mouth,40845,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,86224,
Drainage of mouth lesion,41000,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8101,70,,8101,percent of total billed charges,,7869.54,68,,7869.54,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,518.24,,,518.24,Fee Schedule,,439.24,,,439.24,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,439.24,9258.28,
Drainage of mouth lesion,41005,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3493.66,68,,3493.66,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,588.76,,,588.76,Fee Schedule,,499.01,,,499.01,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,7216,
Drainage of mouth lesion,41006,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,25661.91,
Drainage of mouth lesion,41007,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,25661.91,
Drainage of mouth lesion,41008,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,54176.39,
Drainage of mouth lesion,41009,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,604.59,9258.28,
Incision of tongue fold,41010,CPT,,,,,,,,both,,,33613.92,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22857.47,68,,22857.47,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,26891.14,80,,26891.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26891.14,80,,26891.14,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23529.74,70,,23529.74,percent of total billed charges,,544.48,,,544.48,Fee Schedule,,461.48,,,461.48,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,461.48,26891.14,
Drainage of mouth lesion,41015,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,9258.28,
Drainage of mouth lesion,41016,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,98541.71,
Drainage of mouth lesion,41017,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,54176.39,
Drainage of mouth lesion,41018,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,25661.91,
Place needles h&n for rt,41019,CPT,,,,,,,,both,,,39024.79,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,26536.86,68,,26536.86,percent of total billed charges,,5842.35,,,5842.35,Other,186% of Medicaid,31219.83,80,,31219.83,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31219.83,80,,31219.83,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27317.35,70,,27317.35,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,2053,31219.83,
Biopsy of tongue,41100,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8101,70,,8101,percent of total billed charges,,7869.54,68,,7869.54,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,528.08,,,528.08,Fee Schedule,,447.58,,,447.58,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,9258.28,
Biopsy of tongue,41105,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,541.2,,,541.2,Fee Schedule,,458.7,,,458.7,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,458.7,54176.39,
Biopsy of floor of mouth,41108,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,451,,,451,Fee Schedule,,382.25,,,382.25,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,382.25,27281.4,
Excision of tongue lesion,41110,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,641.24,,,641.24,Fee Schedule,,543.49,,,543.49,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,543.49,54176.39,
Excision of tongue lesion,41112,CPT,,,,,,,,both,,,48875.01,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33235.01,68,,33235.01,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,39100.01,80,,39100.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39100.01,80,,39100.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,34212.51,70,,34212.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,39100.01,
Excision of tongue lesion,41113,CPT,,,,,,,,both,,,34482.73,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23448.26,68,,23448.26,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,27586.18,80,,27586.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27586.18,80,,27586.18,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24137.91,70,,24137.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,27586.18,
Excision of tongue lesion,41114,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,54176.39,
Excision of tongue fold,41115,CPT,,,,,,,,both,,,34373.25,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,24061.28,70,,24061.28,percent of total billed charges,,23373.81,68,,23373.81,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,27498.6,80,,27498.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27498.6,80,,27498.6,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24061.28,70,,24061.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,27498.6,
Excision of mouth lesion,41116,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,54176.39,
Partial removal of tongue,41120,CPT,,,,,,,,both,,,50582.73,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,35407.91,70,,35407.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,35407.91,
Repair tongue laceration,41250,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,5698.86,68,,5698.86,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,7216,
Repair tongue laceration,41251,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,3493.66,68,,3493.66,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,7216,
Repair tongue laceration,41252,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,3493.66,68,,3493.66,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,7216,
Tongue to lip surgery,41510,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,54176.39,
Tongue suspension,41512,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,5842.35,,,5842.35,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,2232,98541.71,
Reconstruction tongue fold,41520,CPT,,,,,,,,both,,,34094.95,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23184.57,68,,23184.57,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,27275.96,80,,27275.96,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27275.96,80,,27275.96,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,23866.47,70,,23866.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,27275.96,
Tongue base vol reduction,41530,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,1866.32,,,1866.32,Fee Schedule,,1581.82,,,1581.82,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1581.82,54176.39,
Drainage of gum lesion,41800,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,1827.06,68,,1827.06,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,757.68,,,757.68,Fee Schedule,,642.18,,,642.18,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,140.37,7216,
Removal foreign body gum,41805,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,972.52,,,972.52,Fee Schedule,,824.27,,,824.27,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,25661.91,
Removal foreign body jawbone,41806,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,25661.91,
Excision gum each quadrant,41820,CPT,,,,,,,,both,,,11190,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7833,70,,7833,percent of total billed charges,,7609.2,68,,7609.2,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,8952,80,,8952,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,8952,80,,8952,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,7833,70,,7833,percent of total billed charges,,7273.5,65,,7273.5,percent of total billed charges,,7273.5,65,,7273.5,percent of total billed charges,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,8952,
Excision of gum flap,41821,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,342.99,,,342.99,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,20850.3,65,,20850.3,percent of total billed charges,,20850.3,65,,20850.3,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,184.4,,,184.4,Other,New York Medicaid APG methodology,184.4,,,184.4,Other,100% New York Medicaid APG,184.4,,,184.4,Other,100% New York Medicaid APG,184.4,,,184.4,Other,100% New York Medicaid APG,414.91,,,414.91,Other,225% New York Medicaid APG,282.14,,,282.14,Other,153% New York Medicaid APG,414.91,,,414.91,Other,225% New York Medicaid APG,258.17,,,258.17,Other,140% New York Medicaid APG,414.91,,,414.91,Other,225% New York Medicaid APG,479.45,,,479.45,Other,260% New York Medicaid APG,597.47,,,597.47,Other,324% New York Medicaid APG,396.47,,,396.47,Other,215% New York Medicaid APG,396.47,,,396.47,Other,215% New York Medicaid APG,230.51,,,230.51,Other,125% New York Medicaid APG,184.4,25661.91,
Excision of gum lesion,41822,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,25661.91,
Excision of gum lesion,41823,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,83760.46,68,,83760.46,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,98541.71,
Excision of gum lesion,41825,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,595.32,,,595.32,Fee Schedule,,504.57,,,504.57,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,54176.39,
Excision of gum lesion,41826,CPT,,,,,,,,both,,,33723,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23606.1,70,,23606.1,percent of total billed charges,,22931.64,68,,22931.64,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,26978.4,80,,26978.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26978.4,80,,26978.4,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23606.1,70,,23606.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,26978.4,
Excision of gum lesion,41827,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,98541.71,
Excision of gum lesion,41828,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,25661.91,
Removal of gum tissue,41830,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,54176.39,
Treatment of gum lesion,41850,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,20850.3,65,,20850.3,percent of total billed charges,,20850.3,65,,20850.3,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,25661.91,
Gum graft,41870,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,20850.3,65,,20850.3,percent of total billed charges,,20850.3,65,,20850.3,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,25661.91,
Repair gum,41872,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,47404.34,
Repair tooth socket,41874,CPT,,,,,,,,both,,,12102.9,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,8472.03,70,,8472.03,percent of total billed charges,,8229.97,68,,8229.97,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,9682.32,80,,9682.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9682.32,80,,9682.32,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,8472.03,70,,8472.03,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,9682.32,
Drainage mouth roof lesion,42000,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,3493.66,68,,3493.66,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,536.28,,,536.28,Fee Schedule,,454.53,,,454.53,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,7216,
Biopsy roof of mouth,42100,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,541.2,,,541.2,Fee Schedule,,458.7,,,458.7,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,458.7,25661.91,
Excision lesion mouth roof,42104,CPT,,,,,,,,both,,,32876,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23013.2,70,,23013.2,percent of total billed charges,,22355.68,68,,22355.68,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,26300.8,80,,26300.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26300.8,80,,26300.8,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23013.2,70,,23013.2,percent of total billed charges,,662.56,,,662.56,Fee Schedule,,561.56,,,561.56,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,561.56,26300.8,
Excision lesion mouth roof,42106,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,54176.39,
Excision lesion mouth roof,42107,CPT,,,,,,,,both,,,45847.43,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,31176.25,68,,31176.25,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,36677.94,80,,36677.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,36677.94,80,,36677.94,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,32093.2,70,,32093.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,36677.94,
Remove palate/lesion,42120,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,86224,
Excision of uvula,42140,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,800.32,,,800.32,Fee Schedule,,678.32,,,678.32,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,678.32,54176.39,
Repair palate pharynx/uvula,42145,CPT,,,,,,,,both,,,40196.92,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28137.84,70,,28137.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,28137.84,
Treatment mouth roof lesion,42160,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,54176.39,
Repair palate,42180,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,9258.28,
Repair palate,42182,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,98541.71,
Reconstruct cleft palate,42200,CPT,,,,,,,,both,,,57820.07,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,40474.05,70,,40474.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,40474.05,
Reconstruct cleft palate,42205,CPT,,,,,,,,both,,,49217.65,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,34452.36,70,,34452.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,34452.36,
Reconstruct cleft palate,42210,CPT,,,,,,,,both,,,34416.87,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,24091.81,70,,24091.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,24091.81,
Reconstruct cleft palate,42215,CPT,,,,,,,,both,,,36696.4,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25687.48,70,,25687.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,25687.48,
Reconstruct cleft palate,42220,CPT,,,,,,,,both,,,37009.4,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25906.58,70,,25906.58,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,25906.58,
Reconstruct cleft palate,42225,CPT,,,,,,,,both,,,36570.71,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,25599.5,70,,25599.5,percent of total billed charges,,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25599.5,70,,25599.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,25599.5,
Lengthening of palate,42226,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,86224,
Lengthening of palate,42227,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,86224,
Repair palate,42235,CPT,,,,,,,,both,,,33741.06,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5267.55,,,5267.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,23618.74,70,,23618.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2832.02,,,2832.02,Other,New York Medicaid APG methodology,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,2832.02,,,2832.02,Other,100% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,4332.99,,,4332.99,Other,153% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,3964.82,,,3964.82,Other,140% New York Medicaid APG,6372.04,,,6372.04,Other,225% New York Medicaid APG,7363.24,,,7363.24,Other,260% New York Medicaid APG,9175.73,,,9175.73,Other,324% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,6088.84,,,6088.84,Other,215% New York Medicaid APG,3540.02,,,3540.02,Other,125% New York Medicaid APG,2832.02,23618.74,
Repair nose to lip fistula,42260,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Preparation palate mold,42280,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8101,70,,8101,percent of total billed charges,,7869.54,68,,7869.54,percent of total billed charges,,280.2,,,280.2,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,536.28,,,536.28,Fee Schedule,,454.53,,,454.53,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,150.64,,,150.64,Other,New York Medicaid APG methodology,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,150.64,,,150.64,Other,100% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,230.48,,,230.48,Other,153% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,210.9,,,210.9,Other,140% New York Medicaid APG,338.95,,,338.95,Other,225% New York Medicaid APG,391.67,,,391.67,Other,260% New York Medicaid APG,488.08,,,488.08,Other,324% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,323.88,,,323.88,Other,215% New York Medicaid APG,188.3,,,188.3,Other,125% New York Medicaid APG,150.64,9258.28,
Insertion palate prosthesis,42281,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,86224,
Drainage of salivary gland,42300,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,25661.91,
Drainage of salivary gland,42305,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,54176.39,
Drainage of salivary gland,42310,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,665.84,,,665.84,Fee Schedule,,564.34,,,564.34,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,9258.28,
Drainage of salivary gland,42320,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,9258.28,
Removal of salivary stone,42330,CPT,,,,,,,,both,,,19986.89,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,13990.82,70,,13990.82,percent of total billed charges,,13591.09,68,,13591.09,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,15989.51,80,,15989.51,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15989.51,80,,15989.51,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13990.82,70,,13990.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,15989.51,
Removal of salivary stone,42335,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,47404.34,
Removal of salivary stone,42340,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,54176.39,
Biopsy of salivary gland,42400,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,429.21,,,429.21,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,257.48,,,257.48,Fee Schedule,,218.23,,,218.23,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,218.23,11839.04,
Biopsy of salivary gland,42405,CPT,,,,,,,,both,,,40860,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27784.8,68,,27784.8,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,32688,80,,32688,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32688,80,,32688,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28602,70,,28602,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,32688,
Excision of salivary cyst,42408,CPT,,,,,,,,both,,,42114.67,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29480.27,70,,29480.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,29480.27,
Drainage of salivary cyst,42409,CPT,,,,,,,,both,,,36553.88,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25587.72,70,,25587.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,25587.72,
Excise parotid gland/lesion,42410,CPT,,,,,,,,both,,,52234.44,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,36564.11,70,,36564.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,36564.11,
Excise parotid gland/lesion,42415,CPT,,,,,,,,both,,,47640.68,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,33348.48,70,,33348.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,33348.48,
Excise parotid gland/lesion,42420,CPT,,,,,,,,both,,,105173.42,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,73621.39,70,,73621.39,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,73621.39,
Excise parotid gland/lesion,42425,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Excise submaxillary gland,42440,CPT,,,,,,,,both,,,46934.86,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,32854.4,70,,32854.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,32854.4,
Excise sublingual gland,42450,CPT,,,,,,,,both,,,41640.28,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,28315.39,68,,28315.39,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,33312.22,80,,33312.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33312.22,80,,33312.22,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29148.2,70,,29148.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,33312.22,
Repair salivary duct,42500,CPT,,,,,,,,both,,,35276.6,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24693.62,70,,24693.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,24693.62,
Repair salivary duct,42505,CPT,,,,,,,,both,,,34960,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,830.02,,,830.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,24472,70,,24472,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,446.25,24472,
Parotid duct diversion,42507,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Parotid duct diversion,42509,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Parotid duct diversion,42510,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,47404.34,
Injection for salivary x-ray,42550,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,298.48,,,298.48,Fee Schedule,,252.98,,,252.98,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Closure of salivary fistula,42600,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2053,54176.39,
Dilation of salivary duct,42650,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,288.64,,,288.64,Fee Schedule,,244.64,,,244.64,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,244.64,25661.91,
Dilation of salivary duct,42660,CPT,,,,,,,,both,,,33480.3,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23436.21,70,,23436.21,percent of total billed charges,,22766.6,68,,22766.6,percent of total billed charges,,830.02,,,830.02,Other,186% of Medicaid,26784.24,80,,26784.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26784.24,80,,26784.24,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23436.21,70,,23436.21,percent of total billed charges,,434.6,,,434.6,Fee Schedule,,368.35,,,368.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,446.25,,,446.25,Other,New York Medicaid APG methodology,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,446.25,,,446.25,Other,100% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,682.76,,,682.76,Other,153% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,624.75,,,624.75,Other,140% New York Medicaid APG,1004.06,,,1004.06,Other,225% New York Medicaid APG,1160.25,,,1160.25,Other,260% New York Medicaid APG,1445.84,,,1445.84,Other,324% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,959.43,,,959.43,Other,215% New York Medicaid APG,557.81,,,557.81,Other,125% New York Medicaid APG,368.35,26784.24,
Ligation of salivary duct,42665,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,429.21,,,429.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,230.76,,,230.76,Other,New York Medicaid APG methodology,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,230.76,,,230.76,Other,100% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,353.06,,,353.06,Other,153% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,323.06,,,323.06,Other,140% New York Medicaid APG,519.21,,,519.21,Other,225% New York Medicaid APG,599.97,,,599.97,Other,260% New York Medicaid APG,747.66,,,747.66,Other,324% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,496.13,,,496.13,Other,215% New York Medicaid APG,288.45,,,288.45,Other,125% New York Medicaid APG,230.76,47404.34,
Drainage of tonsil abscess,42700,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3493.66,68,,3493.66,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,670.76,,,670.76,Fee Schedule,,568.51,,,568.51,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,7216,
Drainage of throat abscess,42720,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,54176.39,
Drainage of throat abscess,42725,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,98541.71,
Biopsy of throat,42800,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,574,,,574,Fee Schedule,,486.5,,,486.5,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,486.5,25661.91,
Biopsy of upper nose/throat,42804,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,606.8,,,606.8,Fee Schedule,,514.3,,,514.3,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,514.3,54176.39,
Biopsy of upper nose/throat,42806,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,697,,,697,Fee Schedule,,590.75,,,590.75,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,590.75,54176.39,
Excise pharynx lesion,42808,CPT,,,,,,,,both,,,99331.66,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,67545.53,68,,67545.53,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,79465.33,80,,79465.33,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,79465.33,80,,79465.33,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,69532.16,70,,69532.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,79465.33,
Remove pharynx foreign body,42809,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,5698.86,68,,5698.86,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,7216,
Excision of neck cyst,42810,CPT,,,,,,,,both,,,36766.28,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25736.4,70,,25736.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,25736.4,
Excision of neck cyst,42815,CPT,,,,,,,,both,,,36519.76,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25563.83,70,,25563.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,25563.83,
Remove tonsils and adenoids,42820,CPT,,,,,,,,both,,,35805.32,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25063.72,70,,25063.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,25063.72,
Remove tonsils and adenoids,42821,CPT,,,,,,,,both,,,36490.36,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25543.25,70,,25543.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,25543.25,
Removal of tonsils,42825,CPT,,,,,,,,both,,,36380.39,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25466.27,70,,25466.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,25466.27,
Removal of tonsils,42826,CPT,,,,,,,,both,,,38466.62,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26926.63,70,,26926.63,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,26926.63,
Removal of adenoids,42830,CPT,,,,,,,,both,,,34982.02,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24487.41,70,,24487.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,24487.41,
Removal of adenoids,42831,CPT,,,,,,,,both,,,34792.95,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24355.07,70,,24355.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,24355.07,
Removal of adenoids,42835,CPT,,,,,,,,both,,,35678.62,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24975.03,70,,24975.03,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,24975.03,
Removal of adenoids,42836,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,47404.34,
Extensive surgery of throat,42842,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,86224,
Extensive surgery of throat,42844,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,86224,
Excision of tonsil tags,42860,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,47404.34,
Excision of lingual tonsil,42870,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2582.21,,,2582.21,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1388.29,,,1388.29,Other,New York Medicaid APG methodology,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,1388.29,,,1388.29,Other,100% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,2124.08,,,2124.08,Other,153% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,1943.6,,,1943.6,Other,140% New York Medicaid APG,3123.64,,,3123.64,Other,225% New York Medicaid APG,3609.55,,,3609.55,Other,260% New York Medicaid APG,4498.05,,,4498.05,Other,324% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,2984.82,,,2984.82,Other,215% New York Medicaid APG,1735.36,,,1735.36,Other,125% New York Medicaid APG,1388.29,86224,
Partial removal of pharynx,42890,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Revision of pharyngeal walls,42892,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Repair throat wound,42900,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,25661.91,
Reconstruction of throat,42950,CPT,,,,,,,,both,,,35704.71,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24279.2,68,,24279.2,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,28563.77,80,,28563.77,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28563.77,80,,28563.77,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24993.3,70,,24993.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,28563.77,
Surgical opening of throat,42955,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,25661.91,
Control throat bleeding,42960,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,7869.54,68,,7869.54,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,604.59,9258.28,
Control throat bleeding,42962,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,54176.39,
Control nose/throat bleeding,42970,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3493.66,68,,3493.66,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4110.18,80,,4110.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,7216,
Control nose/throat bleeding,42972,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,47404.34,
Incision of esophagus,43020,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,22454.17,
Throat muscle surgery,43030,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Removal of esophagus pouch,43130,CPT,,,,,,,,both,,,35116.91,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,24581.84,70,,24581.84,percent of total billed charges,,6152,,,6152,Case Rate,,4163.11,,,4163.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,24581.84,70,,24581.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2238.23,,,2238.23,Other,New York Medicaid APG methodology,2238.23,,,2238.23,Other,100% New York Medicaid APG,2238.23,,,2238.23,Other,100% New York Medicaid APG,2238.23,,,2238.23,Other,100% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,3424.5,,,3424.5,Other,153% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,3133.53,,,3133.53,Other,140% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,5819.41,,,5819.41,Other,260% New York Medicaid APG,7251.88,,,7251.88,Other,324% New York Medicaid APG,4812.2,,,4812.2,Other,215% New York Medicaid APG,4812.2,,,4812.2,Other,215% New York Medicaid APG,2797.79,,,2797.79,Other,125% New York Medicaid APG,2238.23,24581.84,
Esophagoscopy rigid trnso,43180,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,83760.46,68,,83760.46,percent of total billed charges,,1814.43,,,1814.43,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,975.5,,,975.5,Other,New York Medicaid APG methodology,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1492.52,,,1492.52,Other,153% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1365.7,,,1365.7,Other,140% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,2536.3,,,2536.3,Other,260% New York Medicaid APG,3160.63,,,3160.63,Other,324% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,1219.38,,,1219.38,Other,125% New York Medicaid APG,975.5,98541.71,
Esophagoscopy rigid trnso dx,43191,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,32018.71,
Esophagoscp rig trnso inject,43192,CPT,,,,,,,,both,,,34010.82,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23127.36,68,,23127.36,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,27208.66,80,,27208.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27208.66,80,,27208.66,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23807.57,70,,23807.57,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,27208.66,
Esophagoscp rig trnso biopsy,43193,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,32018.71,
Esophagoscp rig trnso rem fb,43194,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,32018.71,
Esophagoscopy rigid balloon,43195,CPT,,,,,,,,both,,,37422.98,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25447.63,68,,25447.63,percent of total billed charges,,1814.43,,,1814.43,Other,186% of Medicaid,29938.38,80,,29938.38,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29938.38,80,,29938.38,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26196.09,70,,26196.09,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,975.5,,,975.5,Other,New York Medicaid APG methodology,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1492.52,,,1492.52,Other,153% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1365.7,,,1365.7,Other,140% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,2536.3,,,2536.3,Other,260% New York Medicaid APG,3160.63,,,3160.63,Other,324% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,1219.38,,,1219.38,Other,125% New York Medicaid APG,975.5,29938.38,
Esophagoscp guide wire dilat,43196,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,32018.71,
Esophagoscopy flex dx brush,43197,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,398.52,,,398.52,Fee Schedule,,337.77,,,337.77,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,337.77,15253.39,
Esophagosc flex trnsn biopsy,43198,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,15253.39,
Esophagoscopy flexible brush,43200,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,15253.39,
Esoph scope w/submucous inj,43201,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Esophagoscopy flex biopsy,43202,CPT,,,,,,,,both,,,37898,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25770.64,68,,25770.64,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,30318.4,80,,30318.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30318.4,80,,30318.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26528.6,70,,26528.6,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,30318.4,
Esoph scope w/sclerosis inj,43204,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Esophagus endoscopy/ligation,43205,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Esoph optical endomicroscopy,43206,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,27215.91,68,,27215.91,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,639.6,,,639.6,Fee Schedule,,542.1,,,542.1,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,542.1,32018.71,
Egd esophagogastrc fndoplsty,43210,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1814.43,,,1814.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,975.5,,,975.5,Other,New York Medicaid APG methodology,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1492.52,,,1492.52,Other,153% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1365.7,,,1365.7,Other,140% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,2536.3,,,2536.3,Other,260% New York Medicaid APG,3160.63,,,3160.63,Other,324% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,1219.38,,,1219.38,Other,125% New York Medicaid APG,975.5,151560.62,
Esophagoscop mucosal resect,43211,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Esophagoscop stent placement,43212,CPT,,,,,,,,both,,,119876.35,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,81515.92,68,,81515.92,percent of total billed charges,,1814.43,,,1814.43,Other,186% of Medicaid,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,975.5,,,975.5,Other,New York Medicaid APG methodology,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1492.52,,,1492.52,Other,153% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1365.7,,,1365.7,Other,140% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,2536.3,,,2536.3,Other,260% New York Medicaid APG,3160.63,,,3160.63,Other,324% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,1219.38,,,1219.38,Other,125% New York Medicaid APG,975.5,95901.08,
Esophagoscopy retro balloon,43213,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Esophagosc dilate balloon 30,43214,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,32018.71,
Esophagoscopy flex remove fb,43215,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Esophagoscopy lesion removal,43216,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Esophagoscopy snare les remv,43217,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Esophagoscopy balloon <30mm,43220,CPT,,,,,,,,both,,,31351.03,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21318.7,68,,21318.7,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,25080.82,80,,25080.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25080.82,80,,25080.82,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,21945.72,70,,21945.72,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,25080.82,
Esoph endoscopy dilation,43226,CPT,,,,,,,,both,,,36025,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24497,68,,24497,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,28820,80,,28820,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28820,80,,28820,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25217.5,70,,25217.5,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,28820,
Esophagoscopy control bleed,43227,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Esophagoscopy lesion ablate,43229,CPT,,,,,,,,both,,,80554.09,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,54776.78,68,,54776.78,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,64443.27,80,,64443.27,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,64443.27,80,,64443.27,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56387.86,70,,56387.86,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,64443.27,
Esophagoscop ultrasound exam,43231,CPT,,,,,,,,both,,,12293.8,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8359.78,68,,8359.78,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,9835.04,80,,9835.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9835.04,80,,9835.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,8605.66,70,,8605.66,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,9835.04,
Esophagoscopy w/us needle bx,43232,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Egd balloon dil esoph30 mm/>,43233,CPT,,,,,,,,both,,,31175.65,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,21199.44,68,,21199.44,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,24940.52,80,,24940.52,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,24940.52,80,,24940.52,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,21822.96,70,,21822.96,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,24940.52,
Egd diagnostic brush wash,43235,CPT,,,,,,,,both,,,13363.62,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,9087.26,68,,9087.26,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,10690.9,80,,10690.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10690.9,80,,10690.9,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,9354.53,70,,9354.53,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,10690.9,
Uppr gi scope w/submuc inj,43236,CPT,,,,,,,,both,,,16160.18,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,10988.92,68,,10988.92,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,12928.14,80,,12928.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,12928.14,80,,12928.14,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,11312.13,70,,11312.13,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,12928.14,
Endoscopic us exam esoph,43237,CPT,,,,,,,,both,,,17728.21,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,12055.18,68,,12055.18,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,14182.57,80,,14182.57,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,14182.57,80,,14182.57,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,12409.75,70,,12409.75,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,14182.57,
Egd us fine needle bx/aspir,43238,CPT,,,,,,,,both,,,29340.91,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,19951.82,68,,19951.82,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,23472.73,80,,23472.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,23472.73,80,,23472.73,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,20538.64,70,,20538.64,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,23472.73,
Egd biopsy single/multiple,43239,CPT,,,,,,,,both,,,23634.5,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,16071.46,68,,16071.46,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,18907.6,80,,18907.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,18907.6,80,,18907.6,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,16544.15,70,,16544.15,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,18907.6,
Egd w/transmural drain cyst,43240,CPT,,,,,,,,both,,,119876.35,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,81515.92,68,,81515.92,percent of total billed charges,,1814.43,,,1814.43,Other,186% of Medicaid,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,975.5,,,975.5,Other,New York Medicaid APG methodology,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1492.52,,,1492.52,Other,153% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1365.7,,,1365.7,Other,140% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,2536.3,,,2536.3,Other,260% New York Medicaid APG,3160.63,,,3160.63,Other,324% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,1219.38,,,1219.38,Other,125% New York Medicaid APG,975.5,95901.08,
Egd tube/cath insertion,43241,CPT,,,,,,,,both,,,44542.16,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,30288.67,68,,30288.67,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,35633.73,80,,35633.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35633.73,80,,35633.73,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,31179.51,70,,31179.51,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,35633.73,
Egd us fine needle bx/aspir,43242,CPT,,,,,,,,both,,,29434.97,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,20015.78,68,,20015.78,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,23547.98,80,,23547.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,23547.98,80,,23547.98,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,20604.48,70,,20604.48,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,23547.98,
Egd injection varices,43243,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Egd varices ligation,43244,CPT,,,,,,,,both,,,15264.53,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,10379.88,68,,10379.88,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,12211.62,80,,12211.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,12211.62,80,,12211.62,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,10685.17,70,,10685.17,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,12211.62,
Egd dilate stricture,43245,CPT,,,,,,,,both,,,21612.12,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,14696.24,68,,14696.24,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,17289.7,80,,17289.7,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17289.7,80,,17289.7,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,15128.48,70,,15128.48,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,17289.7,
Egd place gastrostomy tube,43246,CPT,,,,,,,,both,,,25442.5,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,17300.9,68,,17300.9,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,20354,80,,20354,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,20354,80,,20354,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17809.75,70,,17809.75,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,20354,
Egd remove foreign body,43247,CPT,,,,,,,,both,,,22283.81,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,15152.99,68,,15152.99,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,17827.05,80,,17827.05,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17827.05,80,,17827.05,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,15598.67,70,,15598.67,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,17827.05,
Egd guide wire insertion,43248,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,15253.39,
Esoph egd dilation <30 mm,43249,CPT,,,,,,,,both,,,20422.88,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,13887.56,68,,13887.56,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,16338.3,80,,16338.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,16338.3,80,,16338.3,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14296.02,70,,14296.02,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,16338.3,
Egd cautery tumor polyp,43250,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Egd remove lesion snare,43251,CPT,,,,,,,,both,,,23659.1,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,16088.19,68,,16088.19,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,18927.28,80,,18927.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,18927.28,80,,18927.28,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,16561.37,70,,16561.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,18927.28,
Egd optical endomicroscopy,43252,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,27215.91,68,,27215.91,percent of total billed charges,,1814.43,,,1814.43,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,808.52,,,808.52,Fee Schedule,,685.27,,,685.27,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,975.5,,,975.5,Other,New York Medicaid APG methodology,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1492.52,,,1492.52,Other,153% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1365.7,,,1365.7,Other,140% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,2536.3,,,2536.3,Other,260% New York Medicaid APG,3160.63,,,3160.63,Other,324% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,1219.38,,,1219.38,Other,125% New York Medicaid APG,685.27,32018.71,
Egd us transmural injxn/mark,43253,CPT,,,,,,,,both,,,28190.73,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1531.48,,,1531.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,19733.51,70,,19733.51,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,19733.51,
Egd endo mucosal resection,43254,CPT,,,,,,,,both,,,28195.3,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1722.49,,,1722.49,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,19736.71,70,,19736.71,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,19736.71,
Egd control bleeding any,43255,CPT,,,,,,,,both,,,14839.33,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,10090.74,68,,10090.74,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,11871.46,80,,11871.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11871.46,80,,11871.46,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,10387.53,70,,10387.53,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,11871.46,
Egd w/thrml txmnt gerd,43257,CPT,,,,,,,,both,,,80554.09,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1722.49,,,1722.49,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,56387.86,70,,56387.86,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,56387.86,
Egd us exam duodenum/jejunum,43259,CPT,,,,,,,,both,,,16503.83,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1531.48,,,1531.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,11552.68,70,,11552.68,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,11552.68,
Ercp w/specimen collection,43260,CPT,,,,,,,,both,,,44600.39,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,30328.27,68,,30328.27,percent of total billed charges,,2349.8,,,2349.8,Other,186% of Medicaid,35680.31,80,,35680.31,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35680.31,80,,35680.31,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31220.27,70,,31220.27,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1263.33,,,1263.33,Other,New York Medicaid APG methodology,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1932.9,,,1932.9,Other,153% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1768.67,,,1768.67,Other,140% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,3284.66,,,3284.66,Other,260% New York Medicaid APG,4093.2,,,4093.2,Other,324% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,1579.17,,,1579.17,Other,125% New York Medicaid APG,1263.33,35680.31,
Endo cholangiopancreatograph,43261,CPT,,,,,,,,both,,,48894.68,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33248.38,68,,33248.38,percent of total billed charges,,2349.8,,,2349.8,Other,186% of Medicaid,39115.74,80,,39115.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39115.74,80,,39115.74,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34226.28,70,,34226.28,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1263.33,,,1263.33,Other,New York Medicaid APG methodology,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1932.9,,,1932.9,Other,153% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1768.67,,,1768.67,Other,140% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,3284.66,,,3284.66,Other,260% New York Medicaid APG,4093.2,,,4093.2,Other,324% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,1579.17,,,1579.17,Other,125% New York Medicaid APG,1263.33,39115.74,
Endo cholangiopancreatograph,43262,CPT,,,,,,,,both,,,35727.6,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24294.77,68,,24294.77,percent of total billed charges,,2349.8,,,2349.8,Other,186% of Medicaid,28582.08,80,,28582.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28582.08,80,,28582.08,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25009.32,70,,25009.32,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1263.33,,,1263.33,Other,New York Medicaid APG methodology,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1932.9,,,1932.9,Other,153% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1768.67,,,1768.67,Other,140% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,3284.66,,,3284.66,Other,260% New York Medicaid APG,4093.2,,,4093.2,Other,324% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,1579.17,,,1579.17,Other,125% New York Medicaid APG,1263.33,28582.08,
Ercp sphincter pressure meas,43263,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,2349.8,,,2349.8,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1263.33,,,1263.33,Other,New York Medicaid APG methodology,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1932.9,,,1932.9,Other,153% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1768.67,,,1768.67,Other,140% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,3284.66,,,3284.66,Other,260% New York Medicaid APG,4093.2,,,4093.2,Other,324% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,1579.17,,,1579.17,Other,125% New York Medicaid APG,1263.33,32018.71,
Ercp remove duct calculi,43264,CPT,,,,,,,,both,,,32360.33,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22005.02,68,,22005.02,percent of total billed charges,,2349.8,,,2349.8,Other,186% of Medicaid,25888.26,80,,25888.26,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25888.26,80,,25888.26,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22652.23,70,,22652.23,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1263.33,,,1263.33,Other,New York Medicaid APG methodology,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1932.9,,,1932.9,Other,153% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1768.67,,,1768.67,Other,140% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,3284.66,,,3284.66,Other,260% New York Medicaid APG,4093.2,,,4093.2,Other,324% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,1579.17,,,1579.17,Other,125% New York Medicaid APG,1263.33,25888.26,
Ercp lithotripsy calculi,43265,CPT,,,,,,,,both,,,119876.35,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,81515.92,68,,81515.92,percent of total billed charges,,2564.5,,,2564.5,Other,186% of Medicaid,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,1378.76,95901.08,
Egd endoscopic stent place,43266,CPT,,,,,,,,both,,,29477.85,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1814.43,,,1814.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,20634.5,70,,20634.5,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,975.5,,,975.5,Other,New York Medicaid APG methodology,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,975.5,,,975.5,Other,100% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1492.52,,,1492.52,Other,153% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,1365.7,,,1365.7,Other,140% New York Medicaid APG,2194.88,,,2194.88,Other,225% New York Medicaid APG,2536.3,,,2536.3,Other,260% New York Medicaid APG,3160.63,,,3160.63,Other,324% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,2097.33,,,2097.33,Other,215% New York Medicaid APG,1219.38,,,1219.38,Other,125% New York Medicaid APG,975.5,20634.5,
Egd lesion ablation,43270,CPT,,,,,,,,both,,,20371.8,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1722.49,,,1722.49,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14260.26,70,,14260.26,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,14260.26,
Endoscopic pancreatoscopy,43273,CPT,,,,,,,,both,,,25918.71,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,18143.1,70,,18143.1,percent of total billed charges,,17624.72,68,,17624.72,percent of total billed charges,,2564.5,,,2564.5,Other,186% of Medicaid,20734.97,80,,20734.97,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,20734.97,80,,20734.97,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,18143.1,70,,18143.1,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,0.01,20734.97,
Ercp duct stent placement,43274,CPT,,,,,,,,both,,,44985.34,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2564.5,,,2564.5,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31489.74,70,,31489.74,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,1378.76,31489.74,
Ercp remove forgn body duct,43275,CPT,,,,,,,,both,,,29252.14,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2349.8,,,2349.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,20476.5,70,,20476.5,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1263.33,,,1263.33,Other,New York Medicaid APG methodology,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,1263.33,,,1263.33,Other,100% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1932.9,,,1932.9,Other,153% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,1768.67,,,1768.67,Other,140% New York Medicaid APG,2842.5,,,2842.5,Other,225% New York Medicaid APG,3284.66,,,3284.66,Other,260% New York Medicaid APG,4093.2,,,4093.2,Other,324% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,2716.16,,,2716.16,Other,215% New York Medicaid APG,1579.17,,,1579.17,Other,125% New York Medicaid APG,1263.33,20476.5,
Ercp stent exchange w/dilate,43276,CPT,,,,,,,,both,,,37978.7,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2564.5,,,2564.5,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26585.09,70,,26585.09,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,1378.76,26585.09,
Ercp ea duct/ampulla dilate,43277,CPT,,,,,,,,both,,,22214.78,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2564.5,,,2564.5,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,15550.35,70,,15550.35,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,1378.76,15550.35,
Ercp lesion ablate w/dilate,43278,CPT,,,,,,,,both,,,33649.33,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2564.5,,,2564.5,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23554.53,70,,23554.53,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,1378.76,23554.53,
Laparoscopy fundoplasty,43280,CPT,,,,,,,,both,,,68977.61,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,48284.33,70,,48284.33,percent of total billed charges,,6152,,,6152,Case Rate,,4367.67,,,4367.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,48284.33,70,,48284.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2348.21,,,2348.21,Other,New York Medicaid APG methodology,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3592.76,,,3592.76,Other,153% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3287.49,,,3287.49,Other,140% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,6105.35,,,6105.35,Other,260% New York Medicaid APG,7608.2,,,7608.2,Other,324% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,2935.26,,,2935.26,Other,125% New York Medicaid APG,2348.21,48284.33,
Lap paraesophag hern repair,43281,CPT,,,,,,,,both,,,51978.93,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4034.67,,,4034.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,36385.25,70,,36385.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2169.18,,,2169.18,Other,New York Medicaid APG methodology,2169.18,,,2169.18,Other,100% New York Medicaid APG,2169.18,,,2169.18,Other,100% New York Medicaid APG,2169.18,,,2169.18,Other,100% New York Medicaid APG,4880.65,,,4880.65,Other,225% New York Medicaid APG,3318.84,,,3318.84,Other,153% New York Medicaid APG,4880.65,,,4880.65,Other,225% New York Medicaid APG,3036.85,,,3036.85,Other,140% New York Medicaid APG,4880.65,,,4880.65,Other,225% New York Medicaid APG,5639.86,,,5639.86,Other,260% New York Medicaid APG,7028.14,,,7028.14,Other,324% New York Medicaid APG,4663.73,,,4663.73,Other,215% New York Medicaid APG,4663.73,,,4663.73,Other,215% New York Medicaid APG,2711.47,,,2711.47,Other,125% New York Medicaid APG,2169.18,36385.25,
Lap paraesoph her rpr w/mesh,43282,CPT,,,,,,,,both,,,50030.79,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4034.67,,,4034.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,35021.55,70,,35021.55,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2169.18,,,2169.18,Other,New York Medicaid APG methodology,2169.18,,,2169.18,Other,100% New York Medicaid APG,2169.18,,,2169.18,Other,100% New York Medicaid APG,2169.18,,,2169.18,Other,100% New York Medicaid APG,4880.65,,,4880.65,Other,225% New York Medicaid APG,3318.84,,,3318.84,Other,153% New York Medicaid APG,4880.65,,,4880.65,Other,225% New York Medicaid APG,3036.85,,,3036.85,Other,140% New York Medicaid APG,4880.65,,,4880.65,Other,225% New York Medicaid APG,5639.86,,,5639.86,Other,260% New York Medicaid APG,7028.14,,,7028.14,Other,324% New York Medicaid APG,4663.73,,,4663.73,Other,215% New York Medicaid APG,4663.73,,,4663.73,Other,215% New York Medicaid APG,2711.47,,,2711.47,Other,125% New York Medicaid APG,2169.18,35021.55,
Laps esophgl sphnctr agmntj,43284,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,4367.67,,,4367.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2348.21,,,2348.21,Other,New York Medicaid APG methodology,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3592.76,,,3592.76,Other,153% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3287.49,,,3287.49,Other,140% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,6105.35,,,6105.35,Other,260% New York Medicaid APG,7608.2,,,7608.2,Other,324% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,2935.26,,,2935.26,Other,125% New York Medicaid APG,2348.21,151560.62,
Rmvl esophgl sphnctr dev,43285,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,4367.67,,,4367.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2348.21,,,2348.21,Other,New York Medicaid APG methodology,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3592.76,,,3592.76,Other,153% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3287.49,,,3287.49,Other,140% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,6105.35,,,6105.35,Other,260% New York Medicaid APG,7608.2,,,7608.2,Other,324% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,2935.26,,,2935.26,Other,125% New York Medicaid APG,2348.21,84954.99,
Repair esophagus opening,43420,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,46049.93,68,,46049.93,percent of total billed charges,,4163.11,,,4163.11,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2238.23,,,2238.23,Other,New York Medicaid APG methodology,2238.23,,,2238.23,Other,100% New York Medicaid APG,2238.23,,,2238.23,Other,100% New York Medicaid APG,2238.23,,,2238.23,Other,100% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,3424.5,,,3424.5,Other,153% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,3133.53,,,3133.53,Other,140% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,5819.41,,,5819.41,Other,260% New York Medicaid APG,7251.88,,,7251.88,Other,324% New York Medicaid APG,4812.2,,,4812.2,Other,215% New York Medicaid APG,4812.2,,,4812.2,Other,215% New York Medicaid APG,2797.79,,,2797.79,Other,125% New York Medicaid APG,2232,54176.39,
Dilate esophagus 1/mult pass,43450,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,387.04,,,387.04,Fee Schedule,,328.04,,,328.04,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,328.04,15253.39,
Dilate esophagus,43453,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,418.2,,,418.2,Fee Schedule,,354.45,,,354.45,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,354.45,32018.71,
Surgical opening of stomach,43510,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,6152,,,6152,Case Rate,,4163.11,,,4163.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2238.23,,,2238.23,Other,New York Medicaid APG methodology,2238.23,,,2238.23,Other,100% New York Medicaid APG,2238.23,,,2238.23,Other,100% New York Medicaid APG,2238.23,,,2238.23,Other,100% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,3424.5,,,3424.5,Other,153% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,3133.53,,,3133.53,Other,140% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,5819.41,,,5819.41,Other,260% New York Medicaid APG,7251.88,,,7251.88,Other,324% New York Medicaid APG,4812.2,,,4812.2,Other,215% New York Medicaid APG,4812.2,,,4812.2,Other,215% New York Medicaid APG,2797.79,,,2797.79,Other,125% New York Medicaid APG,996.09,13346.72,
Lap impl electrode antrum,43647,CPT,,,,,,,,both,,,71765.7,24615.15,,,24615.15,Other,150% of Medicare + 9.63% HCRA Surcharge,14968.62,,,14968.62,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,50235.99,70,,50235.99,percent of total billed charges,,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,50235.99,70,,50235.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,50235.99,
Lap revise/remv eltrd antrum,43648,CPT,,,,,,,,both,,,38857.5,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,27200.25,70,,27200.25,percent of total billed charges,,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,27200.25,70,,27200.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,27200.25,
Laparoscopy vagus nerve,43651,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,84954.99,
Laparoscopy vagus nerve,43652,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,84954.99,
Laparoscopy gastrostomy,43653,CPT,,,,,,,,both,,,40291.87,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4163.11,,,4163.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,28204.31,70,,28204.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2238.23,,,2238.23,Other,New York Medicaid APG methodology,2238.23,,,2238.23,Other,100% New York Medicaid APG,2238.23,,,2238.23,Other,100% New York Medicaid APG,2238.23,,,2238.23,Other,100% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,3424.5,,,3424.5,Other,153% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,3133.53,,,3133.53,Other,140% New York Medicaid APG,5036.02,,,5036.02,Other,225% New York Medicaid APG,5819.41,,,5819.41,Other,260% New York Medicaid APG,7251.88,,,7251.88,Other,324% New York Medicaid APG,4812.2,,,4812.2,Other,215% New York Medicaid APG,4812.2,,,4812.2,Other,215% New York Medicaid APG,2797.79,,,2797.79,Other,125% New York Medicaid APG,2238.23,28204.31,
Nasal/orogastric w/tube plmt,43752,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,5698.86,68,,5698.86,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6704.54,80,,6704.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,195.16,,,195.16,Fee Schedule,,165.41,,,165.41,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,165.41,7216,
Tx gastro intub w/asp,43753,CPT,,,,,,,,both,,,6602.02,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,4489.37,68,,4489.37,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,5281.62,80,,5281.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5281.62,80,,5281.62,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4621.41,70,,4621.41,percent of total billed charges,,104.96,,,104.96,Fee Schedule,,88.96,,,88.96,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,7216,
Dx gastr intub w/asp spec,43754,CPT,,,,,,,,both,,,6602.02,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,4489.37,68,,4489.37,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,5281.62,80,,5281.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5281.62,80,,5281.62,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4621.41,70,,4621.41,percent of total billed charges,,183.68,,,183.68,Fee Schedule,,155.68,,,155.68,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,7216,
Dx gastr intub w/asp specs,43755,CPT,,,,,,,,both,,,3285.56,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,2234.18,68,,2234.18,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,2628.45,80,,2628.45,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2628.45,80,,2628.45,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2299.89,70,,2299.89,percent of total billed charges,,288.64,,,288.64,Fee Schedule,,244.64,,,244.64,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,171.65,7216,
Dx duod intub w/asp spec,43756,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,247.64,,,247.64,Fee Schedule,,209.89,,,209.89,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,209.89,15253.39,
Dx duod intub w/asp specs,43757,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,373.92,,,373.92,Fee Schedule,,316.92,,,316.92,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,316.92,15253.39,
Reposition gastrostomy tube,43761,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3534.93,68,,3534.93,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,271.58,7216,
Rplc gtube no revj trc,43762,CPT,,,,,,,,both,,,34227.74,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23274.86,68,,23274.86,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,27382.19,80,,27382.19,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27382.19,80,,27382.19,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23959.42,70,,23959.42,percent of total billed charges,,178.76,,,178.76,Fee Schedule,,151.51,,,151.51,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,151.51,27382.19,
Rplc gtube revj gstrst trc,43763,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3534.93,68,,3534.93,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,271.58,7216,
Lap place gastr adj device,43770,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,4367.67,,,4367.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2348.21,,,2348.21,Other,New York Medicaid APG methodology,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3592.76,,,3592.76,Other,153% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3287.49,,,3287.49,Other,140% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,6105.35,,,6105.35,Other,260% New York Medicaid APG,7608.2,,,7608.2,Other,324% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,2935.26,,,2935.26,Other,125% New York Medicaid APG,2348.21,151560.62,
Lap rmvl gastr adj device,43772,CPT,,,,,,,,both,,,80554.09,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4367.67,,,4367.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56387.86,70,,56387.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2348.21,,,2348.21,Other,New York Medicaid APG methodology,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3592.76,,,3592.76,Other,153% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3287.49,,,3287.49,Other,140% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,6105.35,,,6105.35,Other,260% New York Medicaid APG,7608.2,,,7608.2,Other,324% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,2935.26,,,2935.26,Other,125% New York Medicaid APG,2348.21,56387.86,
Lap replace gastr adj device,43773,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4367.67,,,4367.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2348.21,,,2348.21,Other,New York Medicaid APG methodology,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3592.76,,,3592.76,Other,153% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3287.49,,,3287.49,Other,140% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,6105.35,,,6105.35,Other,260% New York Medicaid APG,7608.2,,,7608.2,Other,324% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,2935.26,,,2935.26,Other,125% New York Medicaid APG,2348.21,84954.99,
Lap rmvl gastr adj all parts,43774,CPT,,,,,,,,both,,,43538.66,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4367.67,,,4367.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,30477.06,70,,30477.06,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2348.21,,,2348.21,Other,New York Medicaid APG methodology,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3592.76,,,3592.76,Other,153% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3287.49,,,3287.49,Other,140% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,6105.35,,,6105.35,Other,260% New York Medicaid APG,7608.2,,,7608.2,Other,324% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,2935.26,,,2935.26,Other,125% New York Medicaid APG,2348.21,30477.06,
Place gastrostomy tube,43830,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,6152,,,6152,Case Rate,,3157.95,,,3157.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1697.82,,,1697.82,Other,New York Medicaid APG methodology,1697.82,,,1697.82,Other,100% New York Medicaid APG,1697.82,,,1697.82,Other,100% New York Medicaid APG,1697.82,,,1697.82,Other,100% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,2597.67,,,2597.67,Other,153% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,2376.95,,,2376.95,Other,140% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,4414.34,,,4414.34,Other,260% New York Medicaid APG,5500.94,,,5500.94,Other,324% New York Medicaid APG,3650.32,,,3650.32,Other,215% New York Medicaid APG,3650.32,,,3650.32,Other,215% New York Medicaid APG,2122.28,,,2122.28,Other,125% New York Medicaid APG,1697.82,28016.37,
Place gastrostomy tube,43831,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,6152,,,6152,Case Rate,,3157.95,,,3157.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1697.82,,,1697.82,Other,New York Medicaid APG methodology,1697.82,,,1697.82,Other,100% New York Medicaid APG,1697.82,,,1697.82,Other,100% New York Medicaid APG,1697.82,,,1697.82,Other,100% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,2597.67,,,2597.67,Other,153% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,2376.95,,,2376.95,Other,140% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,4414.34,,,4414.34,Other,260% New York Medicaid APG,5500.94,,,5500.94,Other,324% New York Medicaid APG,3650.32,,,3650.32,Other,215% New York Medicaid APG,3650.32,,,3650.32,Other,215% New York Medicaid APG,2122.28,,,2122.28,Other,125% New York Medicaid APG,996.09,13346.72,
Repair stomach opening,43870,CPT,,,,,,,,both,,,35558.33,6920.41,,,6920.41,Other,150% of Medicare + 9.63% HCRA Surcharge,4208.35,,,4208.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24179.66,68,,24179.66,percent of total billed charges,,3157.95,,,3157.95,Other,186% of Medicaid,28446.66,80,,28446.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28446.66,80,,28446.66,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24890.83,70,,24890.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1697.82,,,1697.82,Other,New York Medicaid APG methodology,1697.82,,,1697.82,Other,100% New York Medicaid APG,1697.82,,,1697.82,Other,100% New York Medicaid APG,1697.82,,,1697.82,Other,100% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,2597.67,,,2597.67,Other,153% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,2376.95,,,2376.95,Other,140% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,4414.34,,,4414.34,Other,260% New York Medicaid APG,5500.94,,,5500.94,Other,324% New York Medicaid APG,3650.32,,,3650.32,Other,215% New York Medicaid APG,3650.32,,,3650.32,Other,215% New York Medicaid APG,2122.28,,,2122.28,Other,125% New York Medicaid APG,1697.82,28446.66,
Revise gastric port open,43886,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,51313.6,68,,51313.6,percent of total billed charges,,3157.95,,,3157.95,Other,186% of Medicaid,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1697.82,,,1697.82,Other,New York Medicaid APG methodology,1697.82,,,1697.82,Other,100% New York Medicaid APG,1697.82,,,1697.82,Other,100% New York Medicaid APG,1697.82,,,1697.82,Other,100% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,2597.67,,,2597.67,Other,153% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,2376.95,,,2376.95,Other,140% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,4414.34,,,4414.34,Other,260% New York Medicaid APG,5500.94,,,5500.94,Other,324% New York Medicaid APG,3650.32,,,3650.32,Other,215% New York Medicaid APG,3650.32,,,3650.32,Other,215% New York Medicaid APG,2122.28,,,2122.28,Other,125% New York Medicaid APG,1697.82,60368.94,
Remove gastric port open,43887,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,26083.13,68,,26083.13,percent of total billed charges,,3157.95,,,3157.95,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1697.82,,,1697.82,Other,New York Medicaid APG methodology,1697.82,,,1697.82,Other,100% New York Medicaid APG,1697.82,,,1697.82,Other,100% New York Medicaid APG,1697.82,,,1697.82,Other,100% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,2597.67,,,2597.67,Other,153% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,2376.95,,,2376.95,Other,140% New York Medicaid APG,3820.1,,,3820.1,Other,225% New York Medicaid APG,4414.34,,,4414.34,Other,260% New York Medicaid APG,5500.94,,,5500.94,Other,324% New York Medicaid APG,3650.32,,,3650.32,Other,215% New York Medicaid APG,3650.32,,,3650.32,Other,215% New York Medicaid APG,2122.28,,,2122.28,Other,125% New York Medicaid APG,1697.82,30686.04,
Change gastric port open,43888,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,51313.6,68,,51313.6,percent of total billed charges,,4367.67,,,4367.67,Other,186% of Medicaid,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2348.21,,,2348.21,Other,New York Medicaid APG methodology,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,2348.21,,,2348.21,Other,100% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3592.76,,,3592.76,Other,153% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,3287.49,,,3287.49,Other,140% New York Medicaid APG,5283.47,,,5283.47,Other,225% New York Medicaid APG,6105.35,,,6105.35,Other,260% New York Medicaid APG,7608.2,,,7608.2,Other,324% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,5048.65,,,5048.65,Other,215% New York Medicaid APG,2935.26,,,2935.26,Other,125% New York Medicaid APG,2232,60368.94,
Biopsy of bowel,44100,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,15253.39,
Lap enterolysis,44180,CPT,,,,,,,,both,,,36727.13,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4363.47,,,4363.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,25708.99,70,,25708.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2345.95,,,2345.95,Other,New York Medicaid APG methodology,2345.95,,,2345.95,Other,100% New York Medicaid APG,2345.95,,,2345.95,Other,100% New York Medicaid APG,2345.95,,,2345.95,Other,100% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,3589.31,,,3589.31,Other,153% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,3284.33,,,3284.33,Other,140% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,6099.47,,,6099.47,Other,260% New York Medicaid APG,7600.88,,,7600.88,Other,324% New York Medicaid APG,5043.8,,,5043.8,Other,215% New York Medicaid APG,5043.8,,,5043.8,Other,215% New York Medicaid APG,2932.44,,,2932.44,Other,125% New York Medicaid APG,2345.95,25708.99,
Lap jejunostomy,44186,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,4363.47,,,4363.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2345.95,,,2345.95,Other,New York Medicaid APG methodology,2345.95,,,2345.95,Other,100% New York Medicaid APG,2345.95,,,2345.95,Other,100% New York Medicaid APG,2345.95,,,2345.95,Other,100% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,3589.31,,,3589.31,Other,153% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,3284.33,,,3284.33,Other,140% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,6099.47,,,6099.47,Other,260% New York Medicaid APG,7600.88,,,7600.88,Other,324% New York Medicaid APG,5043.8,,,5043.8,Other,215% New York Medicaid APG,5043.8,,,5043.8,Other,215% New York Medicaid APG,2932.44,,,2932.44,Other,125% New York Medicaid APG,2345.95,84954.99,
Revision of ileostomy,44312,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,51313.6,68,,51313.6,percent of total billed charges,,3995.74,,,3995.74,Other,186% of Medicaid,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,60368.94,80,,60368.94,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2148.25,,,2148.25,Other,New York Medicaid APG methodology,2148.25,,,2148.25,Other,100% New York Medicaid APG,2148.25,,,2148.25,Other,100% New York Medicaid APG,2148.25,,,2148.25,Other,100% New York Medicaid APG,4833.55,,,4833.55,Other,225% New York Medicaid APG,3286.82,,,3286.82,Other,153% New York Medicaid APG,4833.55,,,4833.55,Other,225% New York Medicaid APG,3007.54,,,3007.54,Other,140% New York Medicaid APG,4833.55,,,4833.55,Other,225% New York Medicaid APG,5585.44,,,5585.44,Other,260% New York Medicaid APG,6960.32,,,6960.32,Other,324% New York Medicaid APG,4618.73,,,4618.73,Other,215% New York Medicaid APG,4618.73,,,4618.73,Other,215% New York Medicaid APG,2685.31,,,2685.31,Other,125% New York Medicaid APG,2053,60368.94,
Revision of colostomy,44340,CPT,,,,,,,,both,,,75461.18,6482.88,,,6482.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3942.28,,,3942.28,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3995.74,,,3995.74,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52822.83,70,,52822.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2148.25,,,2148.25,Other,New York Medicaid APG methodology,2148.25,,,2148.25,Other,100% New York Medicaid APG,2148.25,,,2148.25,Other,100% New York Medicaid APG,2148.25,,,2148.25,Other,100% New York Medicaid APG,4833.55,,,4833.55,Other,225% New York Medicaid APG,3286.82,,,3286.82,Other,153% New York Medicaid APG,4833.55,,,4833.55,Other,225% New York Medicaid APG,3007.54,,,3007.54,Other,140% New York Medicaid APG,4833.55,,,4833.55,Other,225% New York Medicaid APG,5585.44,,,5585.44,Other,260% New York Medicaid APG,6960.32,,,6960.32,Other,324% New York Medicaid APG,4618.73,,,4618.73,Other,215% New York Medicaid APG,4618.73,,,4618.73,Other,215% New York Medicaid APG,2685.31,,,2685.31,Other,125% New York Medicaid APG,2148.25,52822.83,
Small bowel endoscopy,44360,CPT,,,,,,,,both,,,12741.73,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8664.38,68,,8664.38,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,10193.38,80,,10193.38,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10193.38,80,,10193.38,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,8919.21,70,,8919.21,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,10193.38,
Small bowel endoscopy/biopsy,44361,CPT,,,,,,,,both,,,18601.74,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,12649.18,68,,12649.18,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,14881.39,80,,14881.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,14881.39,80,,14881.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13021.22,70,,13021.22,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,14881.39,
Small bowel endoscopy,44363,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,32018.71,
Small bowel endoscopy,44364,CPT,,,,,,,,both,,,20520,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,13953.6,68,,13953.6,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,16416,80,,16416,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,16416,80,,16416,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14364,70,,14364,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,16416,
Small bowel endoscopy,44365,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,32018.71,
Small bowel endoscopy,44366,CPT,,,,,,,,both,,,13853.17,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,9420.16,68,,9420.16,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,11082.54,80,,11082.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11082.54,80,,11082.54,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,9697.22,70,,9697.22,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,11082.54,
Small bowel endoscopy,44369,CPT,,,,,,,,both,,,21770.89,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,14804.21,68,,14804.21,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,17416.71,80,,17416.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17416.71,80,,17416.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,15239.62,70,,15239.62,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,17416.71,
Small bowel endoscopy/stent,44370,CPT,,,,,,,,both,,,119876.35,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1722.49,,,1722.49,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,83913.45,
Small bowel endoscopy,44372,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Small bowel endoscopy,44373,CPT,,,,,,,,both,,,14298,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,9722.64,68,,9722.64,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,11438.4,80,,11438.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11438.4,80,,11438.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,10008.6,70,,10008.6,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,11438.4,
Small bowel endoscopy,44376,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Small bowel endoscopy/biopsy,44377,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1531.48,,,1531.48,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,823.37,,,823.37,Other,New York Medicaid APG methodology,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,823.37,,,823.37,Other,100% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1259.76,,,1259.76,Other,153% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,1152.72,,,1152.72,Other,140% New York Medicaid APG,1852.59,,,1852.59,Other,225% New York Medicaid APG,2140.77,,,2140.77,Other,260% New York Medicaid APG,2667.73,,,2667.73,Other,324% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1770.25,,,1770.25,Other,215% New York Medicaid APG,1029.22,,,1029.22,Other,125% New York Medicaid APG,823.37,32018.71,
Small bowel endoscopy,44378,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1722.49,,,1722.49,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,32018.71,
S bowel endoscope w/stent,44379,CPT,,,,,,,,both,,,119876.35,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1722.49,,,1722.49,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,926.07,,,926.07,Other,New York Medicaid APG methodology,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,926.07,,,926.07,Other,100% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1416.89,,,1416.89,Other,153% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,1296.5,,,1296.5,Other,140% New York Medicaid APG,2083.66,,,2083.66,Other,225% New York Medicaid APG,2407.78,,,2407.78,Other,260% New York Medicaid APG,3000.47,,,3000.47,Other,324% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1991.05,,,1991.05,Other,215% New York Medicaid APG,1157.59,,,1157.59,Other,125% New York Medicaid APG,926.07,83913.45,
Small bowel endoscopy br/wa,44380,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,15253.39,
Small bowel endoscopy br/wa,44381,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,27215.91,68,,27215.91,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,32018.71,
Small bowel endoscopy,44382,CPT,,,,,,,,both,,,14892,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,10126.56,68,,10126.56,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,11913.6,80,,11913.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11913.6,80,,11913.6,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,10424.4,70,,10424.4,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,11913.6,
Small bowel endoscopy,44384,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,27215.91,68,,27215.91,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,32018.71,
Endoscopy of bowel pouch,44385,CPT,,,,,,,,both,,,11038,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,7505.84,68,,7505.84,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,8830.4,80,,8830.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,8830.4,80,,8830.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,7726.6,70,,7726.6,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,8830.4,
Endoscopy bowel pouch/biop,44386,CPT,,,,,,,,both,,,15400,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,10472,68,,10472,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,12320,80,,12320,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,12320,80,,12320,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,10780,70,,10780,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,12320,
Colonoscopy thru stoma spx,44388,CPT,,,,,,,,both,,,17317.69,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,11776.03,68,,11776.03,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,13854.15,80,,13854.15,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13854.15,80,,13854.15,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,12122.38,70,,12122.38,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,13854.15,
Colonoscopy with biopsy,44389,CPT,,,,,,,,both,,,22258.28,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,15135.63,68,,15135.63,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,17806.62,80,,17806.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17806.62,80,,17806.62,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,15580.8,70,,15580.8,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,17806.62,
Colonoscopy for foreign body,44390,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13072.27,68,,13072.27,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,15379.14,
Colonoscopy for bleeding,44391,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Colonoscopy & polypectomy,44392,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Colonoscopy w/snare,44394,CPT,,,,,,,,both,,,23738.78,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16142.37,68,,16142.37,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,18991.02,80,,18991.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,18991.02,80,,18991.02,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,16617.15,70,,16617.15,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,18991.02,
Colonoscopy with ablation,44401,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Colonoscopy w/stent plcmt,44402,CPT,,,,,,,,both,,,119876.35,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,81515.92,68,,81515.92,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,95901.08,
Colonoscopy w/resection,44403,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Colonoscopy w/injection,44404,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Colonoscopy w/dilation,44405,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Colonoscopy w/ultrasound,44406,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Colonoscopy w/ndl aspir/bx,44407,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Colonoscopy w/decompression,44408,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,13072.27,68,,13072.27,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,15379.14,
Intro gastrointestinal tube,44500,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,6152,,,6152,Case Rate,,1030.98,,,1030.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,93.48,,,93.48,Fee Schedule,,79.23,,,79.23,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,79.23,13346.72,
Intraop colon lavage add-on,44701,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,4363.47,,,4363.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2345.95,,,2345.95,Other,New York Medicaid APG methodology,2345.95,,,2345.95,Other,100% New York Medicaid APG,2345.95,,,2345.95,Other,100% New York Medicaid APG,2345.95,,,2345.95,Other,100% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,3589.31,,,3589.31,Other,153% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,3284.33,,,3284.33,Other,140% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,6099.47,,,6099.47,Other,260% New York Medicaid APG,7600.88,,,7600.88,Other,324% New York Medicaid APG,5043.8,,,5043.8,Other,215% New York Medicaid APG,5043.8,,,5043.8,Other,215% New York Medicaid APG,2932.44,,,2932.44,Other,125% New York Medicaid APG,0.01,22702.47,
Appendectomy,44950,CPT,,,,,,,,both,,,40609.56,13671.07,,,13671.07,Other,150% of Medicare + 9.63% HCRA Surcharge,8313.46,,,8313.46,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,28426.69,70,,28426.69,percent of total billed charges,,6152,,,6152,Case Rate,,4363.47,,,4363.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28426.69,70,,28426.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2345.95,,,2345.95,Other,New York Medicaid APG methodology,2345.95,,,2345.95,Other,100% New York Medicaid APG,2345.95,,,2345.95,Other,100% New York Medicaid APG,2345.95,,,2345.95,Other,100% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,3589.31,,,3589.31,Other,153% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,3284.33,,,3284.33,Other,140% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,6099.47,,,6099.47,Other,260% New York Medicaid APG,7600.88,,,7600.88,Other,324% New York Medicaid APG,5043.8,,,5043.8,Other,215% New York Medicaid APG,5043.8,,,5043.8,Other,215% New York Medicaid APG,2932.44,,,2932.44,Other,125% New York Medicaid APG,2345.95,28426.69,
Appendectomy add-on,44955,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,406.72,,,406.72,Fee Schedule,,344.72,,,344.72,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,0.01,60613.98,
Laparoscopy appendectomy,44970,CPT,,,,,,,,both,,,44035.36,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4363.47,,,4363.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,30824.75,70,,30824.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2345.95,,,2345.95,Other,New York Medicaid APG methodology,2345.95,,,2345.95,Other,100% New York Medicaid APG,2345.95,,,2345.95,Other,100% New York Medicaid APG,2345.95,,,2345.95,Other,100% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,3589.31,,,3589.31,Other,153% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,3284.33,,,3284.33,Other,140% New York Medicaid APG,5278.39,,,5278.39,Other,225% New York Medicaid APG,6099.47,,,6099.47,Other,260% New York Medicaid APG,7600.88,,,7600.88,Other,324% New York Medicaid APG,5043.8,,,5043.8,Other,215% New York Medicaid APG,5043.8,,,5043.8,Other,215% New York Medicaid APG,2932.44,,,2932.44,Other,125% New York Medicaid APG,2345.95,30824.75,
Drainage of pelvic abscess,45000,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1296.72,19857.01,
Drainage of rectal abscess,45005,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,19857.01,
Drainage of rectal abscess,45020,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Biopsy of rectum,45100,CPT,,,,,,,,both,,,37185.79,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25286.34,68,,25286.34,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,29748.63,80,,29748.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29748.63,80,,29748.63,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26030.05,70,,26030.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,29748.63,
Removal of anorectal lesion,45108,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Excision of rectal stricture,45150,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1296.72,19857.01,
Excision of rectal lesion,45160,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Exc rect tum transanal part,45171,CPT,,,,,,,,both,,,35248.2,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,23968.78,68,,23968.78,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,28198.56,80,,28198.56,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28198.56,80,,28198.56,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24673.74,70,,24673.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,28198.56,
Exc rect tum transanal full,45172,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Destruction rectal tumor,45190,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Proctosigmoidoscopy dx,45300,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,13072.27,68,,13072.27,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,15379.14,
Proctosigmoidoscopy dilate,45303,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,16878.46,68,,16878.46,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,19857.01,
Proctosigmoidoscopy w/bx,45305,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Proctosigmoidoscopy fb,45307,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,47246.67,
Proctosigmoidoscopy removal,45308,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,47246.67,
Proctosigmoidoscopy removal,45309,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Proctosigmoidoscopy removal,45315,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Proctosigmoidoscopy bleed,45317,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,19857.01,
Proctosigmoidoscopy ablate,45320,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,47246.67,
Proctosigmoidoscopy volvul,45321,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,47246.67,
Proctosigmoidoscopy w/stent,45327,CPT,,,,,,,,both,,,119876.35,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,81515.92,68,,81515.92,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,95901.08,
Diagnostic sigmoidoscopy,45330,CPT,,,,,,,,both,,,12997.89,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9098.52,70,,9098.52,percent of total billed charges,,8838.57,68,,8838.57,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,10398.31,80,,10398.31,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10398.31,80,,10398.31,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9098.52,70,,9098.52,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,10398.31,
Sigmoidoscopy and biopsy,45331,CPT,,,,,,,,both,,,17108.6,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,11633.85,68,,11633.85,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,13686.88,80,,13686.88,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13686.88,80,,13686.88,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,11976.02,70,,11976.02,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,13686.88,
Sigmoidoscopy w/fb removal,45332,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Sigmoidoscopy & polypectomy,45333,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13072.27,68,,13072.27,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,15379.14,
Sigmoidoscopy for bleeding,45334,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Sigmoidoscopy w/submuc inj,45335,CPT,,,,,,,,both,,,13730.67,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,9336.86,68,,9336.86,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,10984.54,80,,10984.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10984.54,80,,10984.54,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9611.47,70,,9611.47,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,10984.54,
Sigmoidoscopy & decompress,45337,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13072.27,68,,13072.27,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,15379.14,
Sigmoidoscopy w/tumr remove,45338,CPT,,,,,,,,both,,,20445.33,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13902.82,68,,13902.82,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,16356.26,80,,16356.26,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,16356.26,80,,16356.26,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14311.73,70,,14311.73,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,16356.26,
Sig w/tndsc balloon dilation,45340,CPT,,,,,,,,both,,,20062.56,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13642.54,68,,13642.54,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,16050.05,80,,16050.05,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,16050.05,80,,16050.05,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14043.79,70,,14043.79,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,16050.05,
Sigmoidoscopy w/ultrasound,45341,CPT,,,,,,,,both,,,12269.31,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,8343.13,68,,8343.13,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,9815.45,80,,9815.45,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9815.45,80,,9815.45,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,8588.52,70,,8588.52,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,9815.45,
Sigmoidoscopy w/us guide bx,45342,CPT,,,,,,,,both,,,29003,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,19722.04,68,,19722.04,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,23202.4,80,,23202.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,23202.4,80,,23202.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,20302.1,70,,20302.1,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,23202.4,
Sigmoidoscopy w/ablation,45346,CPT,,,,,,,,both,,,11592,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,8114.4,70,,8114.4,percent of total billed charges,,7882.56,68,,7882.56,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,9273.6,80,,9273.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9273.6,80,,9273.6,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,8114.4,70,,8114.4,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,9273.6,
Sigmoidoscopy w/plcmt stent,45347,CPT,,,,,,,,both,,,36950.9,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,25865.63,70,,25865.63,percent of total billed charges,,25126.61,68,,25126.61,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,29560.72,80,,29560.72,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29560.72,80,,29560.72,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25865.63,70,,25865.63,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,29560.72,
Sigmoidoscopy w/resection,45349,CPT,,,,,,,,both,,,26478,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,18534.6,70,,18534.6,percent of total billed charges,,18005.04,68,,18005.04,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,21182.4,80,,21182.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,21182.4,80,,21182.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,18534.6,70,,18534.6,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,21182.4,
Sgmdsc w/band ligation,45350,CPT,,,,,,,,both,,,21132,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,14792.4,70,,14792.4,percent of total billed charges,,14369.76,68,,14369.76,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,16905.6,80,,16905.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,16905.6,80,,16905.6,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14792.4,70,,14792.4,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,16905.6,
Diagnostic colonoscopy,45378,CPT,,,,,,,,both,,,18300.47,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,12444.32,68,,12444.32,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,14640.38,80,,14640.38,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,14640.38,80,,14640.38,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,12810.33,70,,12810.33,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,14640.38,
Colonoscopy w/fb removal,45379,CPT,,,,,,,,both,,,15782.42,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,10732.05,68,,10732.05,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,12625.94,80,,12625.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,12625.94,80,,12625.94,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,11047.69,70,,11047.69,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,12625.94,
Colonoscopy and biopsy,45380,CPT,,,,,,,,both,,,25392.05,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,17266.59,68,,17266.59,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,20313.64,80,,20313.64,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,20313.64,80,,20313.64,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17774.44,70,,17774.44,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,20313.64,
Colonoscopy submucous njx,45381,CPT,,,,,,,,both,,,30844.27,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,20974.1,68,,20974.1,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,24675.42,80,,24675.42,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,24675.42,80,,24675.42,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,21590.99,70,,21590.99,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,24675.42,
Colonoscopy w/control bleed,45382,CPT,,,,,,,,both,,,12868.66,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8750.69,68,,8750.69,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,10294.93,80,,10294.93,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10294.93,80,,10294.93,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,9008.06,70,,9008.06,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,10294.93,
Colonoscopy w/lesion removal,45384,CPT,,,,,,,,both,,,17656,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,12006.08,68,,12006.08,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,14124.8,80,,14124.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,14124.8,80,,14124.8,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,12359.2,70,,12359.2,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,14124.8,
Colonoscopy w/lesion removal,45385,CPT,,,,,,,,both,,,23753.5,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,16152.38,68,,16152.38,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19002.8,80,,19002.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19002.8,80,,19002.8,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,16627.45,70,,16627.45,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19002.8,
Colonoscopy w/balloon dilat,45386,CPT,,,,,,,,both,,,32175.67,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,21879.46,68,,21879.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,25740.54,80,,25740.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25740.54,80,,25740.54,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22522.97,70,,22522.97,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,25740.54,
Colonoscopy w/ablation,45388,CPT,,,,,,,,both,,,24635.95,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17245.17,70,,17245.17,percent of total billed charges,,16752.45,68,,16752.45,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19708.76,80,,19708.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19708.76,80,,19708.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17245.17,70,,17245.17,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19708.76,
Colonoscopy w/stent plcmt,45389,CPT,,,,,,,,both,,,119876.35,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,81515.92,68,,81515.92,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,95901.08,80,,95901.08,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,95901.08,
Colonoscopy w/resection,45390,CPT,,,,,,,,both,,,32260.86,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22582.6,70,,22582.6,percent of total billed charges,,21937.38,68,,21937.38,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,25808.69,80,,25808.69,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25808.69,80,,25808.69,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22582.6,70,,22582.6,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,25808.69,
Colonoscopy w/endoscope us,45391,CPT,,,,,,,,both,,,14789.75,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,10057.03,68,,10057.03,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,11831.8,80,,11831.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11831.8,80,,11831.8,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,10352.83,70,,10352.83,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,11831.8,
Colonoscopy w/endoscopic fnb,45392,CPT,,,,,,,,both,,,25125,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,17085,68,,17085,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,20100,80,,20100,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,20100,80,,20100,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17587.5,70,,17587.5,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,20100,
Colonoscopy w/decompression,45393,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Colonoscopy w/band ligation,45398,CPT,,,,,,,,both,,,20872.6,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,14610.82,70,,14610.82,percent of total billed charges,,14193.37,68,,14193.37,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,16698.08,80,,16698.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,16698.08,80,,16698.08,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14610.82,70,,14610.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,16698.08,
Repair of rectum,45500,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Repair of rectum,45505,CPT,,,,,,,,both,,,34496.71,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23457.76,68,,23457.76,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,27597.37,80,,27597.37,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27597.37,80,,27597.37,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24147.7,70,,24147.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,27597.37,
Treatment of rectal prolapse,45520,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,13072.27,68,,13072.27,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,196.8,,,196.8,Fee Schedule,,166.8,,,166.8,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,166.8,15379.14,
Correct rectal prolapse,45541,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Repair of rectocele,45560,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Reduction of rectal prolapse,45900,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13072.27,68,,13072.27,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1004.31,15379.14,
Dilation of anal sphincter,45905,CPT,,,,,,,,both,,,34516.73,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23471.38,68,,23471.38,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,27613.38,80,,27613.38,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27613.38,80,,27613.38,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24161.71,70,,24161.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,27613.38,
Dilation of rectal narrowing,45910,CPT,,,,,,,,both,,,19172.43,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13037.25,68,,13037.25,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,15337.94,80,,15337.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.94,80,,15337.94,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13420.7,70,,13420.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,15337.94,
Remove rectal obstruction,45915,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,19857.01,
Surg dx exam anorectal,45990,CPT,,,,,,,,both,,,34896.01,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23729.29,68,,23729.29,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,27916.81,80,,27916.81,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27916.81,80,,27916.81,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24427.21,70,,24427.21,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,27916.81,
Placement of seton,46020,CPT,,,,,,,,both,,,36040.94,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2000.77,,,2000.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25228.66,70,,25228.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,25228.66,
Removal of rectal marker,46030,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,360.01,19857.01,
Incision of rectal abscess,46040,CPT,,,,,,,,both,,,33065.33,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2000.77,,,2000.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23145.73,70,,23145.73,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,23145.73,
Incision of rectal abscess,46045,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Incision of anal abscess,46050,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13072.27,68,,13072.27,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,498.56,,,498.56,Fee Schedule,,422.56,,,422.56,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,422.56,15379.14,
Incision of rectal abscess,46060,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Incision of anal septum,46070,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,40159.67,68,,40159.67,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,47246.67,
Incision of anal sphincter,46080,CPT,,,,,,,,both,,,34783.06,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2000.77,,,2000.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24348.14,70,,24348.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,24348.14,
Incise external hemorrhoid,46083,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3534.93,68,,3534.93,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,539.56,,,539.56,Fee Schedule,,457.31,,,457.31,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,271.58,7216,
Removal of anal fissure,46200,CPT,,,,,,,,both,,,36254.69,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24653.19,68,,24653.19,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,29003.75,80,,29003.75,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29003.75,80,,29003.75,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25378.28,70,,25378.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,29003.75,
Excise anal ext tag/papilla,46220,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,596.96,,,596.96,Fee Schedule,,505.96,,,505.96,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,505.96,19857.01,
Ligation of hemorrhoid(s),46221,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,13072.27,68,,13072.27,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1004.31,15379.14,
Removal of anal tags,46230,CPT,,,,,,,,both,,,34206.69,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23260.55,68,,23260.55,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,27365.35,80,,27365.35,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27365.35,80,,27365.35,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23944.68,70,,23944.68,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,27365.35,
Remove ext hem groups 2+,46250,CPT,,,,,,,,both,,,36111.37,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25277.96,70,,25277.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,25277.96,
Remove int/ext hem 1 group,46255,CPT,,,,,,,,both,,,30279.6,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,21195.72,70,,21195.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,21195.72,
Remove in/ex hem grp & fiss,46257,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,41340.84,
Remove in/ex hem grp w/fistu,46258,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,41340.84,
Remove in/ex hem groups 2+,46260,CPT,,,,,,,,both,,,37527.47,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26269.23,70,,26269.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,26269.23,
Remove in/ex hem grps & fiss,46261,CPT,,,,,,,,both,,,38923.23,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27246.26,70,,27246.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,27246.26,
Remove in/ex hem grps w/fist,46262,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,41340.84,
Remove anal fist subq,46270,CPT,,,,,,,,both,,,34672.13,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24270.49,70,,24270.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,24270.49,
Remove anal fist inter,46275,CPT,,,,,,,,both,,,35748.17,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25023.72,70,,25023.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,25023.72,
Remove anal fist complex,46280,CPT,,,,,,,,both,,,36371.95,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25460.37,70,,25460.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,25460.37,
Remove anal fist 2 stage,46285,CPT,,,,,,,,both,,,32112.66,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21836.61,68,,21836.61,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,25690.13,80,,25690.13,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25690.13,80,,25690.13,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22478.86,70,,22478.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,25690.13,
Repair anal fistula,46288,CPT,,,,,,,,both,,,35532.32,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24872.62,70,,24872.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,24872.62,
Removal of hemorrhoid clot,46320,CPT,,,,,,,,both,,,34261.11,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23982.78,70,,23982.78,percent of total billed charges,,23297.55,68,,23297.55,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,27408.89,80,,27408.89,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27408.89,80,,27408.89,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23982.78,70,,23982.78,percent of total billed charges,,554.32,,,554.32,Fee Schedule,,469.82,,,469.82,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,469.82,27408.89,
Injection into hemorrhoid(s),46500,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,6152,,,6152,Case Rate,,2000.77,,,2000.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,910.2,,,910.2,Fee Schedule,,771.45,,,771.45,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,771.45,13456.74,
Chemodenervation anal musc,46505,CPT,,,,,,,,both,,,25418.06,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17792.64,70,,17792.64,percent of total billed charges,,17284.28,68,,17284.28,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,20334.45,80,,20334.45,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,20334.45,80,,20334.45,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17792.64,70,,17792.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,20334.45,
Diagnostic anoscopy spx,46600,CPT,,,,,,,,both,,,38102.91,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,26672.04,70,,26672.04,percent of total billed charges,,25909.98,68,,25909.98,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,30482.33,80,,30482.33,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30482.33,80,,30482.33,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,26672.04,70,,26672.04,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,140.37,30482.33,
Diagnostic anoscopy,46601,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,1827.06,68,,1827.06,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,140.37,7216,
Anoscopy and dilation,46604,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Anoscopy and biopsy,46606,CPT,,,,,,,,both,,,42463.29,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29724.3,70,,29724.3,percent of total billed charges,,28875.04,68,,28875.04,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,33970.63,80,,33970.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33970.63,80,,33970.63,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29724.3,70,,29724.3,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,33970.63,
Diagnostic anoscopy & biopsy,46607,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,16878.46,68,,16878.46,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,19857.01,
Anoscopy remove for body,46608,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13072.27,68,,13072.27,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,15379.14,
Anoscopy remove lesion,46610,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,47246.67,
Anoscopy,46611,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13072.27,68,,13072.27,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,15379.14,
Anoscopy remove lesions,46612,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,47246.67,
Anoscopy control bleeding,46614,CPT,,,,,,,,both,,,25806,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,18064.2,70,,18064.2,percent of total billed charges,,17548.08,68,,17548.08,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,20644.8,80,,20644.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,20644.8,80,,20644.8,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,18064.2,70,,18064.2,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,795.24,20644.8,
Anoscopy,46615,CPT,,,,,,,,both,,,33680.29,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22902.6,68,,22902.6,percent of total billed charges,,1648.86,,,1648.86,Other,186% of Medicaid,26944.23,80,,26944.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26944.23,80,,26944.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23576.2,70,,23576.2,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,886.48,,,886.48,Other,New York Medicaid APG methodology,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,886.48,,,886.48,Other,100% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1356.32,,,1356.32,Other,153% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,1241.07,,,1241.07,Other,140% New York Medicaid APG,1994.58,,,1994.58,Other,225% New York Medicaid APG,2304.85,,,2304.85,Other,260% New York Medicaid APG,2872.2,,,2872.2,Other,324% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1905.94,,,1905.94,Other,215% New York Medicaid APG,1108.1,,,1108.1,Other,125% New York Medicaid APG,886.48,26944.23,
Repair of anal stricture,46700,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,41340.84,
Repr of anal fistula w/glue,46706,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,47246.67,
Repair anorectal fist w/plug,46707,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2000.77,,,2000.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,41340.84,
Repair of anal sphincter,46750,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,41340.84,
Reconstruction of anus,46753,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,41340.84,
Removal of suture from anus,46754,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,47246.67,
Repair of anal sphincter,46760,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,40159.67,68,,40159.67,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,47246.67,
Repair of anal sphincter,46761,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,41340.84,
Destruction anal lesion(s),46900,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,5703.21,68,,5703.21,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6709.66,80,,6709.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,438.16,7216,
Destruction anal lesion(s),46910,CPT,,,,,,,,both,,,38456.29,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,26150.28,68,,26150.28,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,30765.03,80,,30765.03,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30765.03,80,,30765.03,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26919.4,70,,26919.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,30765.03,
Cryosurgery anal lesion(s),46916,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,219.99,7216,
Laser surgery anal lesions,46917,CPT,,,,,,,,both,,,44593.69,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,30323.71,68,,30323.71,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,35674.95,80,,35674.95,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35674.95,80,,35674.95,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31215.58,70,,31215.58,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,35674.95,
Excision of anal lesion(s),46922,CPT,,,,,,,,both,,,35119.53,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23881.28,68,,23881.28,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,28095.62,80,,28095.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28095.62,80,,28095.62,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24583.67,70,,24583.67,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,28095.62,
Destruction anal lesion(s),46924,CPT,,,,,,,,both,,,40608.23,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27613.6,68,,27613.6,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,32486.58,80,,32486.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32486.58,80,,32486.58,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28425.76,70,,28425.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,32486.58,
Destroy internal hemorrhoids,46930,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,744.56,,,744.56,Fee Schedule,,631.06,,,631.06,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,631.06,19857.01,
Treatment of anal fissure,46940,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,40159.67,68,,40159.67,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47246.67,80,,47246.67,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,47246.67,
Treatment of anal fissure,46942,CPT,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,13072.27,68,,13072.27,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1004.31,15379.14,
Int hrhc lig 1 hroid w/o img,46945,CPT,,,,,,,,both,,,31715.04,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,21566.23,68,,21566.23,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,25372.03,80,,25372.03,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25372.03,80,,25372.03,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22200.53,70,,22200.53,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,25372.03,
Int hrhc lig 2+hroid w/o img,46946,CPT,,,,,,,,both,,,34725.26,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23613.18,68,,23613.18,percent of total billed charges,,2000.77,,,2000.77,Other,186% of Medicaid,27780.21,80,,27780.21,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27780.21,80,,27780.21,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24307.68,70,,24307.68,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,27780.21,
Hemorrhoidopexy by stapling,46947,CPT,,,,,,,,both,,,59058.34,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41340.84,70,,41340.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,41340.84,
Int hrhc tranal dartlzj 2+,46948,CPT,,,,,,,,both,,,39511.68,5073.71,,,5073.71,Other,150% of Medicare + 9.63% HCRA Surcharge,3085.35,,,3085.35,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26867.94,68,,26867.94,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,31609.34,80,,31609.34,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31609.34,80,,31609.34,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27658.18,70,,27658.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,31609.34,
Needle biopsy of liver,47000,CPT,,,,,,,,both,,,29488.87,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,20052.43,68,,20052.43,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,23591.1,80,,23591.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,23591.1,80,,23591.1,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,20642.21,70,,20642.21,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,23591.1,
Needle biopsy liver add-on,47001,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,0.01,25945.68,
Laparo ablate liver tumor rf,47370,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,3989.99,,,3989.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2145.16,,,2145.16,Other,New York Medicaid APG methodology,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3282.09,,,3282.09,Other,153% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3003.22,,,3003.22,Other,140% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,5577.41,,,5577.41,Other,260% New York Medicaid APG,6950.31,,,6950.31,Other,324% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,2681.45,,,2681.45,Other,125% New York Medicaid APG,2145.16,151560.62,
Laparo ablate liver cryosurg,47371,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,3989.99,,,3989.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2145.16,,,2145.16,Other,New York Medicaid APG methodology,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3282.09,,,3282.09,Other,153% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3003.22,,,3003.22,Other,140% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,5577.41,,,5577.41,Other,260% New York Medicaid APG,6950.31,,,6950.31,Other,324% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,2681.45,,,2681.45,Other,125% New York Medicaid APG,2145.16,151560.62,
Percut ablate liver rf,47382,CPT,,,,,,,,both,,,49249.91,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,34474.94,70,,34474.94,percent of total billed charges,,6152,,,6152,Case Rate,,3989.99,,,3989.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,34474.94,70,,34474.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2145.16,,,2145.16,Other,New York Medicaid APG methodology,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3282.09,,,3282.09,Other,153% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3003.22,,,3003.22,Other,140% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,5577.41,,,5577.41,Other,260% New York Medicaid APG,6950.31,,,6950.31,Other,324% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,2681.45,,,2681.45,Other,125% New York Medicaid APG,2145.16,34474.94,
Perq abltj lvr cryoablation,47383,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3989.99,,,3989.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2145.16,,,2145.16,Other,New York Medicaid APG methodology,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3282.09,,,3282.09,Other,153% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3003.22,,,3003.22,Other,140% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,5577.41,,,5577.41,Other,260% New York Medicaid APG,6950.31,,,6950.31,Other,324% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,2681.45,,,2681.45,Other,125% New York Medicaid APG,2145.16,151560.62,
Incision of gallbladder,47490,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,6152,,,6152,Case Rate,,2589.53,,,2589.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1392.22,,,1392.22,Other,New York Medicaid APG methodology,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,2130.1,,,2130.1,Other,153% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,1949.11,,,1949.11,Other,140% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,3619.77,,,3619.77,Other,260% New York Medicaid APG,4510.79,,,4510.79,Other,324% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,1740.27,,,1740.27,Other,125% New York Medicaid APG,1392.22,50938.78,
Injection for cholangiogram,47531,CPT,,,,,,,,both,,,17151.17,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,11662.8,68,,11662.8,percent of total billed charges,,787.56,,,787.56,Other,186% of Medicaid,13720.94,80,,13720.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13720.94,80,,13720.94,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,12005.82,70,,12005.82,percent of total billed charges,,336.2,,,336.2,Fee Schedule,,284.95,,,284.95,Fee Schedule,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,423.42,,,423.42,Other,New York Medicaid APG methodology,423.42,,,423.42,Other,100% New York Medicaid APG,423.42,,,423.42,Other,100% New York Medicaid APG,423.42,,,423.42,Other,100% New York Medicaid APG,952.7,,,952.7,Other,225% New York Medicaid APG,647.83,,,647.83,Other,153% New York Medicaid APG,952.7,,,952.7,Other,225% New York Medicaid APG,592.79,,,592.79,Other,140% New York Medicaid APG,952.7,,,952.7,Other,225% New York Medicaid APG,1100.9,,,1100.9,Other,260% New York Medicaid APG,1371.88,,,1371.88,Other,324% New York Medicaid APG,910.36,,,910.36,Other,215% New York Medicaid APG,910.36,,,910.36,Other,215% New York Medicaid APG,529.28,,,529.28,Other,125% New York Medicaid APG,284.95,13720.94,
Injection for cholangiogram,47532,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49483.39,68,,49483.39,percent of total billed charges,,787.56,,,787.56,Other,186% of Medicaid,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,423.42,,,423.42,Other,New York Medicaid APG methodology,423.42,,,423.42,Other,100% New York Medicaid APG,423.42,,,423.42,Other,100% New York Medicaid APG,423.42,,,423.42,Other,100% New York Medicaid APG,952.7,,,952.7,Other,225% New York Medicaid APG,647.83,,,647.83,Other,153% New York Medicaid APG,952.7,,,952.7,Other,225% New York Medicaid APG,592.79,,,592.79,Other,140% New York Medicaid APG,952.7,,,952.7,Other,225% New York Medicaid APG,1100.9,,,1100.9,Other,260% New York Medicaid APG,1371.88,,,1371.88,Other,324% New York Medicaid APG,910.36,,,910.36,Other,215% New York Medicaid APG,910.36,,,910.36,Other,215% New York Medicaid APG,529.28,,,529.28,Other,125% New York Medicaid APG,423.42,58215.75,
Plmt biliary drainage cath,47533,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49483.39,68,,49483.39,percent of total billed charges,,2589.53,,,2589.53,Other,186% of Medicaid,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1392.22,,,1392.22,Other,New York Medicaid APG methodology,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,2130.1,,,2130.1,Other,153% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,1949.11,,,1949.11,Other,140% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,3619.77,,,3619.77,Other,260% New York Medicaid APG,4510.79,,,4510.79,Other,324% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,1740.27,,,1740.27,Other,125% New York Medicaid APG,1392.22,58215.75,
Plmt biliary drainage cath,47534,CPT,,,,,,,,both,,,45203,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,30738.04,68,,30738.04,percent of total billed charges,,2589.53,,,2589.53,Other,186% of Medicaid,36162.4,80,,36162.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,36162.4,80,,36162.4,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,31642.1,70,,31642.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1392.22,,,1392.22,Other,New York Medicaid APG methodology,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,2130.1,,,2130.1,Other,153% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,1949.11,,,1949.11,Other,140% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,3619.77,,,3619.77,Other,260% New York Medicaid APG,4510.79,,,4510.79,Other,324% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,1740.27,,,1740.27,Other,125% New York Medicaid APG,1392.22,36162.4,
Conversion ext bil drg cath,47535,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49483.39,68,,49483.39,percent of total billed charges,,2589.53,,,2589.53,Other,186% of Medicaid,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1392.22,,,1392.22,Other,New York Medicaid APG methodology,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,2130.1,,,2130.1,Other,153% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,1949.11,,,1949.11,Other,140% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,3619.77,,,3619.77,Other,260% New York Medicaid APG,4510.79,,,4510.79,Other,324% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,1740.27,,,1740.27,Other,125% New York Medicaid APG,1392.22,58215.75,
Exchange biliary drg cath,47536,CPT,,,,,,,,both,,,22519.57,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,15313.31,68,,15313.31,percent of total billed charges,,2589.53,,,2589.53,Other,186% of Medicaid,18015.66,80,,18015.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,18015.66,80,,18015.66,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,15763.7,70,,15763.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1392.22,,,1392.22,Other,New York Medicaid APG methodology,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,2130.1,,,2130.1,Other,153% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,1949.11,,,1949.11,Other,140% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,3619.77,,,3619.77,Other,260% New York Medicaid APG,4510.79,,,4510.79,Other,324% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,1740.27,,,1740.27,Other,125% New York Medicaid APG,1392.22,18015.66,
Removal biliary drg cath,47537,CPT,,,,,,,,both,,,16182.01,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,11003.77,68,,11003.77,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,12945.61,80,,12945.61,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,12945.61,80,,12945.61,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,11327.41,70,,11327.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,554.29,12945.61,
Perq plmt bile duct stent,47538,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2589.53,,,2589.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1392.22,,,1392.22,Other,New York Medicaid APG methodology,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,2130.1,,,2130.1,Other,153% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,1949.11,,,1949.11,Other,140% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,3619.77,,,3619.77,Other,260% New York Medicaid APG,4510.79,,,4510.79,Other,324% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,1740.27,,,1740.27,Other,125% New York Medicaid APG,1392.22,84954.99,
Perq plmt bile duct stent,47539,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2589.53,,,2589.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1392.22,,,1392.22,Other,New York Medicaid APG methodology,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,2130.1,,,2130.1,Other,153% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,1949.11,,,1949.11,Other,140% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,3619.77,,,3619.77,Other,260% New York Medicaid APG,4510.79,,,4510.79,Other,324% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,1740.27,,,1740.27,Other,125% New York Medicaid APG,1392.22,84954.99,
Perq plmt bile duct stent,47540,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3989.99,,,3989.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2145.16,,,2145.16,Other,New York Medicaid APG methodology,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3282.09,,,3282.09,Other,153% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3003.22,,,3003.22,Other,140% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,5577.41,,,5577.41,Other,260% New York Medicaid APG,6950.31,,,6950.31,Other,324% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,2681.45,,,2681.45,Other,125% New York Medicaid APG,2145.16,84954.99,
Plmt access bil tree sm bwl,47541,CPT,,,,,,,,both,,,159132.17,13671.07,,,13671.07,Other,150% of Medicare + 9.63% HCRA Surcharge,8313.46,,,8313.46,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,108209.88,68,,108209.88,percent of total billed charges,,3989.99,,,3989.99,Other,186% of Medicaid,127305.74,80,,127305.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,127305.74,80,,127305.74,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,111392.52,70,,111392.52,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2145.16,,,2145.16,Other,New York Medicaid APG methodology,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3282.09,,,3282.09,Other,153% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3003.22,,,3003.22,Other,140% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,5577.41,,,5577.41,Other,260% New York Medicaid APG,6950.31,,,6950.31,Other,324% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,2681.45,,,2681.45,Other,125% New York Medicaid APG,2145.16,127305.74,
Dilate biliary duct/ampulla,47542,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,3989.99,,,3989.99,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2145.16,,,2145.16,Other,New York Medicaid APG methodology,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3282.09,,,3282.09,Other,153% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3003.22,,,3003.22,Other,140% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,5577.41,,,5577.41,Other,260% New York Medicaid APG,6950.31,,,6950.31,Other,324% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,2681.45,,,2681.45,Other,125% New York Medicaid APG,0.01,41257.63,
Endoluminal bx biliary tree,47543,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,3989.99,,,3989.99,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2145.16,,,2145.16,Other,New York Medicaid APG methodology,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3282.09,,,3282.09,Other,153% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3003.22,,,3003.22,Other,140% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,5577.41,,,5577.41,Other,260% New York Medicaid APG,6950.31,,,6950.31,Other,324% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,2681.45,,,2681.45,Other,125% New York Medicaid APG,0.01,41257.63,
Removal duct glbldr calculi,47544,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,3989.99,,,3989.99,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2145.16,,,2145.16,Other,New York Medicaid APG methodology,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,2145.16,,,2145.16,Other,100% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3282.09,,,3282.09,Other,153% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,3003.22,,,3003.22,Other,140% New York Medicaid APG,4826.61,,,4826.61,Other,225% New York Medicaid APG,5577.41,,,5577.41,Other,260% New York Medicaid APG,6950.31,,,6950.31,Other,324% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,4612.09,,,4612.09,Other,215% New York Medicaid APG,2681.45,,,2681.45,Other,125% New York Medicaid APG,0.01,41257.63,
Biliary endo perq dx w/speci,47552,CPT,,,,,,,,both,,,159132.17,13671.07,,,13671.07,Other,150% of Medicare + 9.63% HCRA Surcharge,8313.46,,,8313.46,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,108209.88,68,,108209.88,percent of total billed charges,,2564.5,,,2564.5,Other,186% of Medicaid,127305.74,80,,127305.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,127305.74,80,,127305.74,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,111392.52,70,,111392.52,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,1378.76,127305.74,
Biliary endoscopy thru skin,47553,CPT,,,,,,,,both,,,159132.17,13671.07,,,13671.07,Other,150% of Medicare + 9.63% HCRA Surcharge,8313.46,,,8313.46,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2564.5,,,2564.5,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,111392.52,70,,111392.52,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,1378.76,111392.52,
Biliary endoscopy thru skin,47554,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2564.5,,,2564.5,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,1378.76,151560.62,
Biliary endoscopy thru skin,47555,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2564.5,,,2564.5,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,1378.76,50938.78,
Biliary endoscopy thru skin,47556,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2564.5,,,2564.5,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1378.76,,,1378.76,Other,New York Medicaid APG methodology,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,1378.76,,,1378.76,Other,100% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,2109.51,,,2109.51,Other,153% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,1930.27,,,1930.27,Other,140% New York Medicaid APG,3102.22,,,3102.22,Other,225% New York Medicaid APG,3584.78,,,3584.78,Other,260% New York Medicaid APG,4467.19,,,4467.19,Other,324% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,2964.34,,,2964.34,Other,215% New York Medicaid APG,1723.45,,,1723.45,Other,125% New York Medicaid APG,1378.76,151560.62,
Laparoscopic cholecystectomy,47562,CPT,,,,,,,,both,,,39561.06,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4649.43,,,4649.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,27692.74,70,,27692.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2499.7,,,2499.7,Other,New York Medicaid APG methodology,2499.7,,,2499.7,Other,100% New York Medicaid APG,2499.7,,,2499.7,Other,100% New York Medicaid APG,2499.7,,,2499.7,Other,100% New York Medicaid APG,5624.31,,,5624.31,Other,225% New York Medicaid APG,3824.53,,,3824.53,Other,153% New York Medicaid APG,5624.31,,,5624.31,Other,225% New York Medicaid APG,3499.57,,,3499.57,Other,140% New York Medicaid APG,5624.31,,,5624.31,Other,225% New York Medicaid APG,6499.21,,,6499.21,Other,260% New York Medicaid APG,8099.01,,,8099.01,Other,324% New York Medicaid APG,5374.35,,,5374.35,Other,215% New York Medicaid APG,5374.35,,,5374.35,Other,215% New York Medicaid APG,3124.62,,,3124.62,Other,125% New York Medicaid APG,2499.7,27692.74,
Laparo cholecystectomy/graph,47563,CPT,,,,,,,,both,,,39396.88,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4649.43,,,4649.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,27577.82,70,,27577.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2499.7,,,2499.7,Other,New York Medicaid APG methodology,2499.7,,,2499.7,Other,100% New York Medicaid APG,2499.7,,,2499.7,Other,100% New York Medicaid APG,2499.7,,,2499.7,Other,100% New York Medicaid APG,5624.31,,,5624.31,Other,225% New York Medicaid APG,3824.53,,,3824.53,Other,153% New York Medicaid APG,5624.31,,,5624.31,Other,225% New York Medicaid APG,3499.57,,,3499.57,Other,140% New York Medicaid APG,5624.31,,,5624.31,Other,225% New York Medicaid APG,6499.21,,,6499.21,Other,260% New York Medicaid APG,8099.01,,,8099.01,Other,324% New York Medicaid APG,5374.35,,,5374.35,Other,215% New York Medicaid APG,5374.35,,,5374.35,Other,215% New York Medicaid APG,3124.62,,,3124.62,Other,125% New York Medicaid APG,2499.7,27577.82,
Laparo cholecystectomy/explr,47564,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4649.43,,,4649.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2499.7,,,2499.7,Other,New York Medicaid APG methodology,2499.7,,,2499.7,Other,100% New York Medicaid APG,2499.7,,,2499.7,Other,100% New York Medicaid APG,2499.7,,,2499.7,Other,100% New York Medicaid APG,5624.31,,,5624.31,Other,225% New York Medicaid APG,3824.53,,,3824.53,Other,153% New York Medicaid APG,5624.31,,,5624.31,Other,225% New York Medicaid APG,3499.57,,,3499.57,Other,140% New York Medicaid APG,5624.31,,,5624.31,Other,225% New York Medicaid APG,6499.21,,,6499.21,Other,260% New York Medicaid APG,8099.01,,,8099.01,Other,324% New York Medicaid APG,5374.35,,,5374.35,Other,215% New York Medicaid APG,5374.35,,,5374.35,Other,215% New York Medicaid APG,3124.62,,,3124.62,Other,125% New York Medicaid APG,2499.7,151560.62,
Needle biopsy pancreas,48102,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,27281.4,
Abd paracentesis,49082,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,354.24,,,354.24,Fee Schedule,,300.24,,,300.24,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,300.24,15253.39,
Abd paracentesis w/imaging,49083,CPT,,,,,,,,both,,,22401.51,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,15233.03,68,,15233.03,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,17921.21,80,,17921.21,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17921.21,80,,17921.21,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,15681.06,70,,15681.06,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,17921.21,
Peritoneal lavage,49084,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,15253.39,
Biopsy abdominal mass,49180,CPT,,,,,,,,both,,,39815.4,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27074.47,68,,27074.47,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,31852.32,80,,31852.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31852.32,80,,31852.32,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27870.78,70,,27870.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,31852.32,
Sclerotx fluid collection,49185,CPT,,,,,,,,both,,,36148.51,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,25303.96,70,,25303.96,percent of total billed charges,,24580.99,68,,24580.99,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,28918.81,80,,28918.81,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28918.81,80,,28918.81,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,25303.96,70,,25303.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,28918.81,
Excision of umbilicus,49250,CPT,,,,,,,,both,,,35159.27,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24611.49,70,,24611.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,24611.49,
Diag laparo separate proc,49320,CPT,,,,,,,,both,,,41980.23,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,29386.16,70,,29386.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,29386.16,
Laparoscopy biopsy,49321,CPT,,,,,,,,both,,,47480.52,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,33236.36,70,,33236.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,33236.36,
Laparoscopy aspiration,49322,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,84954.99,
Laparo drain lymphocele,49323,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,84954.99,
Lap insert tunnel ip cath,49324,CPT,,,,,,,,both,,,40853.43,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,28597.4,70,,28597.4,percent of total billed charges,,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28597.4,70,,28597.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,28597.4,
Lap revision perm ip cath,49325,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,3633.23,,,3633.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,84954.99,
Lap w/omentopexy add-on,49326,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,56782.72,68,,56782.72,percent of total billed charges,,3633.23,,,3633.23,Other,186% of Medicaid,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,66803.2,80,,66803.2,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,0.01,66803.2,
Lap ins device for rt,49327,CPT,,,,,,,,both,,,98219.64,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,66789.36,68,,66789.36,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,78575.71,80,,78575.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,78575.71,80,,78575.71,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,68753.75,70,,68753.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,78575.71,
Air injection into abdomen,49400,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Remove foreign body adbomen,49402,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49483.39,68,,49483.39,percent of total billed charges,,3633.23,,,3633.23,Other,186% of Medicaid,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,58215.75,
Image cath fluid colxn visc,49405,CPT,,,,,,,,both,,,12479.89,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,8735.92,70,,8735.92,percent of total billed charges,,8486.33,68,,8486.33,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,9983.91,80,,9983.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9983.91,80,,9983.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,8735.92,70,,8735.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,9983.91,
Image cath fluid peri/retro,49406,CPT,,,,,,,,both,,,13910.07,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,9737.05,70,,9737.05,percent of total billed charges,,9458.85,68,,9458.85,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,11128.06,80,,11128.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11128.06,80,,11128.06,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,9737.05,70,,9737.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,11128.06,
Image cath fluid trns/vgnl,49407,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,6152,,,6152,Case Rate,,1197.25,,,1197.25,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,23871.23,
Ins mark abd/pel for rt perq,49411,CPT,,,,,,,,both,,,29144.83,2503.84,,,2503.84,Other,150% of Medicare + 9.63% HCRA Surcharge,1522.6,,,1522.6,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,20401.38,70,,20401.38,percent of total billed charges,,19818.48,68,,19818.48,percent of total billed charges,,480.27,,,480.27,Other,186% of Medicaid,23315.86,80,,23315.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,23315.86,80,,23315.86,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,20401.38,70,,20401.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,258.21,,,258.21,Other,New York Medicaid APG methodology,258.21,,,258.21,Other,100% New York Medicaid APG,258.21,,,258.21,Other,100% New York Medicaid APG,258.21,,,258.21,Other,100% New York Medicaid APG,580.98,,,580.98,Other,225% New York Medicaid APG,395.06,,,395.06,Other,153% New York Medicaid APG,580.98,,,580.98,Other,225% New York Medicaid APG,361.5,,,361.5,Other,140% New York Medicaid APG,580.98,,,580.98,Other,225% New York Medicaid APG,671.35,,,671.35,Other,260% New York Medicaid APG,836.6,,,836.6,Other,324% New York Medicaid APG,555.15,,,555.15,Other,215% New York Medicaid APG,555.15,,,555.15,Other,215% New York Medicaid APG,322.76,,,322.76,Other,125% New York Medicaid APG,258.21,23315.86,
Insert tun ip cath perc,49418,CPT,,,,,,,,both,,,26173,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,17797.64,68,,17797.64,percent of total billed charges,,3633.23,,,3633.23,Other,186% of Medicaid,20938.4,80,,20938.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,20938.4,80,,20938.4,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,18321.1,70,,18321.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,20938.4,
Insert tun ip cath w/port,49419,CPT,,,,,,,,both,,,115587.67,9930.15,,,9930.15,Other,150% of Medicare + 9.63% HCRA Surcharge,6038.59,,,6038.59,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,78599.62,68,,78599.62,percent of total billed charges,,3633.23,,,3633.23,Other,186% of Medicaid,92470.14,80,,92470.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,92470.14,80,,92470.14,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,80911.37,70,,80911.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,92470.14,
Ins tun ip cath for dial opn,49421,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49483.39,68,,49483.39,percent of total billed charges,,3633.23,,,3633.23,Other,186% of Medicaid,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,58215.75,
Remove tunneled ip cath,49422,CPT,,,,,,,,both,,,34083.58,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23176.83,68,,23176.83,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,27266.86,80,,27266.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27266.86,80,,27266.86,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23858.51,70,,23858.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,27266.86,
Exchange drainage catheter,49423,CPT,,,,,,,,both,,,20387,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,14270.9,70,,14270.9,percent of total billed charges,,13863.16,68,,13863.16,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,16309.6,80,,16309.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,16309.6,80,,16309.6,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14270.9,70,,14270.9,percent of total billed charges,,341.12,,,341.12,Fee Schedule,,289.12,,,289.12,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,289.12,16309.6,
Assess cyst contrast inject,49424,CPT,,,,,,,,both,,,12706.39,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8894.47,70,,8894.47,percent of total billed charges,,8640.35,68,,8640.35,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,10165.11,80,,10165.11,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10165.11,80,,10165.11,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8894.47,70,,8894.47,percent of total billed charges,,180.4,,,180.4,Fee Schedule,,152.9,,,152.9,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,10165.11,
Revise abdomen-venous shunt,49426,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49483.39,68,,49483.39,percent of total billed charges,,3633.23,,,3633.23,Other,186% of Medicaid,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58215.75,80,,58215.75,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,58215.75,
Injection abdominal shunt,49427,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,188.6,,,188.6,Fee Schedule,,159.85,,,159.85,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Removal of shunt,49429,CPT,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,45590.42,68,,45590.42,percent of total billed charges,,3633.23,,,3633.23,Other,186% of Medicaid,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53635.79,80,,53635.79,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1953.35,,,1953.35,Other,New York Medicaid APG methodology,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,1953.35,,,1953.35,Other,100% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2988.63,,,2988.63,Other,153% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,2734.69,,,2734.69,Other,140% New York Medicaid APG,4395.04,,,4395.04,Other,225% New York Medicaid APG,5078.72,,,5078.72,Other,260% New York Medicaid APG,6328.86,,,6328.86,Other,324% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,4199.71,,,4199.71,Other,215% New York Medicaid APG,2441.69,,,2441.69,Other,125% New York Medicaid APG,1953.35,53635.79,
Insert subq exten to ip cath,49435,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,58882.15,68,,58882.15,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,0.01,69273.12,
Embedded ip cath exit-site,49436,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,27215.91,68,,27215.91,percent of total billed charges,,1197.25,,,1197.25,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,643.68,,,643.68,Other,New York Medicaid APG methodology,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,643.68,,,643.68,Other,100% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,984.84,,,984.84,Other,153% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,901.16,,,901.16,Other,140% New York Medicaid APG,1448.29,,,1448.29,Other,225% New York Medicaid APG,1673.58,,,1673.58,Other,260% New York Medicaid APG,2085.54,,,2085.54,Other,324% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,1383.92,,,1383.92,Other,215% New York Medicaid APG,804.61,,,804.61,Other,125% New York Medicaid APG,643.68,32018.71,
Place gastrostomy tube perc,49440,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,554.29,32018.71,
Place duod/jej tube perc,49441,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,554.29,32018.71,
Place cecostomy tube perc,49442,CPT,,,,,,,,both,,,24821.26,2132.4,,,2132.4,Other,150% of Medicare + 9.63% HCRA Surcharge,1296.72,,,1296.72,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16878.46,68,,16878.46,percent of total billed charges,,2733.37,,,2733.37,Other,186% of Medicaid,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19857.01,80,,19857.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,17374.88,70,,17374.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1296.72,19857.01,
Change g-tube to g-j perc,49446,CPT,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27215.91,68,,27215.91,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,554.29,32018.71,
Replace g/c tube perc,49450,CPT,,,,,,,,both,,,32413.64,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22041.28,68,,22041.28,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,25930.91,80,,25930.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25930.91,80,,25930.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22689.55,70,,22689.55,percent of total billed charges,,319.8,,,319.8,Fee Schedule,,271.05,,,271.05,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,271.05,25930.91,
Replace duod/jej tube perc,49451,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,423.12,,,423.12,Fee Schedule,,358.62,,,358.62,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,358.62,15253.39,
Replace g-j tube perc,49452,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,554.29,15253.39,
Fix g/colon tube w/device,49460,CPT,,,,,,,,both,,,19066.74,1638.03,,,1638.03,Other,150% of Medicare + 9.63% HCRA Surcharge,996.09,,,996.09,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12965.38,68,,12965.38,percent of total billed charges,,1030.98,,,1030.98,Other,186% of Medicaid,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15253.39,80,,15253.39,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,13346.72,70,,13346.72,percent of total billed charges,,239.44,,,239.44,Fee Schedule,,202.94,,,202.94,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,554.29,,,554.29,Other,New York Medicaid APG methodology,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,554.29,,,554.29,Other,100% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,848.07,,,848.07,Other,153% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,776.01,,,776.01,Other,140% New York Medicaid APG,1247.16,,,1247.16,Other,225% New York Medicaid APG,1441.16,,,1441.16,Other,260% New York Medicaid APG,1795.9,,,1795.9,Other,324% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,1191.73,,,1191.73,Other,215% New York Medicaid APG,692.86,,,692.86,Other,125% New York Medicaid APG,202.94,15253.39,
Fluoro exam of g/colon tube,49465,CPT,,,,,,,,both,,,5154.06,442.79,,,442.79,Other,150% of Medicare + 9.63% HCRA Surcharge,269.26,,,269.26,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3607.84,70,,3607.84,percent of total billed charges,,3504.76,68,,3504.76,percent of total billed charges,,623.84,,,623.84,Other,186% of Medicaid,4123.25,80,,4123.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4123.25,80,,4123.25,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3607.84,70,,3607.84,percent of total billed charges,,147.6,,,147.6,Fee Schedule,,125.1,,,125.1,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,335.4,,,335.4,Other,New York Medicaid APG methodology,335.4,,,335.4,Other,100% New York Medicaid APG,335.4,,,335.4,Other,100% New York Medicaid APG,335.4,,,335.4,Other,100% New York Medicaid APG,754.65,,,754.65,Other,225% New York Medicaid APG,513.16,,,513.16,Other,153% New York Medicaid APG,754.65,,,754.65,Other,225% New York Medicaid APG,469.56,,,469.56,Other,140% New York Medicaid APG,754.65,,,754.65,Other,225% New York Medicaid APG,872.04,,,872.04,Other,260% New York Medicaid APG,1086.7,,,1086.7,Other,324% New York Medicaid APG,721.11,,,721.11,Other,215% New York Medicaid APG,721.11,,,721.11,Other,215% New York Medicaid APG,419.25,,,419.25,Other,125% New York Medicaid APG,125.1,7216,
Rpr hern preemie reduc,49491,CPT,,,,,,,,both,,,36476.2,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,25533.34,70,,25533.34,percent of total billed charges,,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25533.34,70,,25533.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,25533.34,
Rpr ing hern premie blocked,49492,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,50938.78,
Rpr ing hernia baby reduc,49495,CPT,,,,,,,,both,,,34971.91,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24480.34,70,,24480.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,24480.34,
Rpr ing hernia baby blocked,49496,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,50938.78,
Rpr ing hernia init reduce,49500,CPT,,,,,,,,both,,,35650.88,13671.07,,,13671.07,Other,150% of Medicare + 9.63% HCRA Surcharge,8313.46,,,8313.46,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24955.62,70,,24955.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,24955.62,
Rpr ing hernia init blocked,49501,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,50938.78,
Prp i/hern init reduc >5 yr,49505,CPT,,,,,,,,both,,,37203.27,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26042.29,70,,26042.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,26042.29,
Prp i/hern init block >5 yr,49507,CPT,,,,,,,,both,,,44660.6,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,31262.42,70,,31262.42,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,31262.42,
Rerepair ing hernia reduce,49520,CPT,,,,,,,,both,,,40414.17,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28289.92,70,,28289.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,28289.92,
Rerepair ing hernia blocked,49521,CPT,,,,,,,,both,,,37127.91,13671.07,,,13671.07,Other,150% of Medicare + 9.63% HCRA Surcharge,8313.46,,,8313.46,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25989.54,70,,25989.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,25989.54,
Repair ing hernia sliding,49525,CPT,,,,,,,,both,,,43308.47,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,30315.93,70,,30315.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,30315.93,
Repair lumbar hernia,49540,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,82527.7,68,,82527.7,percent of total billed charges,,3792.33,,,3792.33,Other,186% of Medicaid,97091.42,80,,97091.42,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,97091.42,80,,97091.42,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2038.89,,,2038.89,Other,New York Medicaid APG methodology,2038.89,,,2038.89,Other,100% New York Medicaid APG,2038.89,,,2038.89,Other,100% New York Medicaid APG,2038.89,,,2038.89,Other,100% New York Medicaid APG,4587.49,,,4587.49,Other,225% New York Medicaid APG,3119.5,,,3119.5,Other,153% New York Medicaid APG,4587.49,,,4587.49,Other,225% New York Medicaid APG,2854.44,,,2854.44,Other,140% New York Medicaid APG,4587.49,,,4587.49,Other,225% New York Medicaid APG,5301.1,,,5301.1,Other,260% New York Medicaid APG,6605.99,,,6605.99,Other,324% New York Medicaid APG,4383.61,,,4383.61,Other,215% New York Medicaid APG,4383.61,,,4383.61,Other,215% New York Medicaid APG,2548.61,,,2548.61,Other,125% New York Medicaid APG,2038.89,97091.42,
Rpr rem hernia init reduce,49550,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,50938.78,
Rpr fem hernia init blocked,49553,CPT,,,,,,,,both,,,61084.35,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,42759.05,70,,42759.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,42759.05,
Rerepair fem hernia reduce,49555,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,50938.78,
Rerepair fem hernia blocked,49557,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,50938.78,
Repair umbilical lesion,49600,CPT,,,,,,,,both,,,39921.1,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3792.33,,,3792.33,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27944.77,70,,27944.77,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2038.89,,,2038.89,Other,New York Medicaid APG methodology,2038.89,,,2038.89,Other,100% New York Medicaid APG,2038.89,,,2038.89,Other,100% New York Medicaid APG,2038.89,,,2038.89,Other,100% New York Medicaid APG,4587.49,,,4587.49,Other,225% New York Medicaid APG,3119.5,,,3119.5,Other,153% New York Medicaid APG,4587.49,,,4587.49,Other,225% New York Medicaid APG,2854.44,,,2854.44,Other,140% New York Medicaid APG,4587.49,,,4587.49,Other,225% New York Medicaid APG,5301.1,,,5301.1,Other,260% New York Medicaid APG,6605.99,,,6605.99,Other,324% New York Medicaid APG,4383.61,,,4383.61,Other,215% New York Medicaid APG,4383.61,,,4383.61,Other,215% New York Medicaid APG,2548.61,,,2548.61,Other,125% New York Medicaid APG,2038.89,27944.77,
Lap ing hernia repair init,49650,CPT,,,,,,,,both,,,42549.81,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,29784.87,70,,29784.87,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,29784.87,
Lap ing hernia repair recur,49651,CPT,,,,,,,,both,,,46480.03,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,32536.02,70,,32536.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,32536.02,
Renal abscess open drain,50020,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,29132.44,68,,29132.44,percent of total billed charges,,3436.32,,,3436.32,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,1847.49,34273.46,
Removal of kidney stone,50080,CPT,,,,,,,,both,,,43674.9,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,30572.43,70,,30572.43,percent of total billed charges,,6152,,,6152,Case Rate,,3436.32,,,3436.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,30572.43,70,,30572.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,1847.49,30572.43,
Removal of kidney stone,50081,CPT,,,,,,,,both,,,45007.64,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,31505.35,70,,31505.35,percent of total billed charges,,6152,,,6152,Case Rate,,3436.32,,,3436.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,31505.35,70,,31505.35,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,1847.49,31505.35,
Renal biopsy perq,50200,CPT,,,,,,,,both,,,31170.32,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21195.82,68,,21195.82,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,24936.26,80,,24936.26,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,24936.26,80,,24936.26,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,21819.22,70,,21819.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,24936.26,
Change ureter stent percut,50382,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,29132.44,68,,29132.44,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,34273.46,
Remove ureter stent percut,50384,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,29132.44,68,,29132.44,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,34273.46,
Change stent via transureth,50385,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,34273.46,
Remove stent via transureth,50386,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,34273.46,
Change nephroureteral cath,50387,CPT,,,,,,,,both,,,26629,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,18640.3,70,,18640.3,percent of total billed charges,,18107.72,68,,18107.72,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,21303.2,80,,21303.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,21303.2,80,,21303.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,18640.3,70,,18640.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,21303.2,
Remove renal tube w/fluoro,50389,CPT,,,,,,,,both,,,10806,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,7564.2,70,,7564.2,percent of total billed charges,,7348.08,68,,7348.08,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,8644.8,80,,8644.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,8644.8,80,,8644.8,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,7564.2,70,,7564.2,percent of total billed charges,,255.84,,,255.84,Fee Schedule,,216.84,,,216.84,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,216.84,8644.8,
Drainage of kidney lesion,50390,CPT,,,,,,,,both,,,28765,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,19560.2,68,,19560.2,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,23012,80,,23012,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,23012,80,,23012,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,20135.5,70,,20135.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,486.05,23012,
Instll rx agnt into rnal tub,50391,CPT,,,,,,,,both,,,35086.55,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24560.59,70,,24560.59,percent of total billed charges,,23858.85,68,,23858.85,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,28069.24,80,,28069.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28069.24,80,,28069.24,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24560.59,70,,24560.59,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,271.58,28069.24,
Measure kidney pressure,50396,CPT,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,9770.46,68,,9770.46,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,486.05,11494.66,
Njx px nfrosgrm &/urtrgrm,50430,CPT,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,9770.46,68,,9770.46,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,486.05,11494.66,
Njx px nfrosgrm &/urtrgrm,50431,CPT,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,9770.46,68,,9770.46,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,316.52,,,316.52,Fee Schedule,,268.27,,,268.27,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,268.27,11494.66,
Plmt nephrostomy catheter,50432,CPT,,,,,,,,both,,,18708.67,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,12721.9,68,,12721.9,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,14966.94,80,,14966.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,14966.94,80,,14966.94,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,13096.07,70,,13096.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,14966.94,
Plmt nephroureteral catheter,50433,CPT,,,,,,,,both,,,31502,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21421.36,68,,21421.36,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,25201.6,80,,25201.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25201.6,80,,25201.6,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22051.4,70,,22051.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,25201.6,
Convert nephrostomy catheter,50434,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,34273.46,
Exchange nephrostomy cath,50435,CPT,,,,,,,,both,,,21380.09,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,14538.46,68,,14538.46,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,17104.07,80,,17104.07,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17104.07,80,,17104.07,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,14966.06,70,,14966.06,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,17104.07,
Dilat xst trc ndurlgc px,50436,CPT,,,,,,,,both,,,48568.73,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33026.74,68,,33026.74,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,38854.98,80,,38854.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,38854.98,80,,38854.98,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,33998.11,70,,33998.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,38854.98,
Dilat xst trc new access rcs,50437,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,58661.5,
Laparo ablate renal cyst,50541,CPT,,,,,,,,both,,,43179.12,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,30225.38,70,,30225.38,percent of total billed charges,,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,30225.38,70,,30225.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,30225.38,
Laparo ablate renal mass,50542,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,3436.32,,,3436.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,1847.49,151560.62,
Laparo partial nephrectomy,50543,CPT,,,,,,,,both,,,53399.3,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,37379.51,70,,37379.51,percent of total billed charges,,6152,,,6152,Case Rate,,3436.32,,,3436.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,37379.51,70,,37379.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,1847.49,37379.51,
Laparoscopy pyeloplasty,50544,CPT,,,,,,,,both,,,44766.15,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,31336.31,70,,31336.31,percent of total billed charges,,6152,,,6152,Case Rate,,3436.32,,,3436.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,31336.31,70,,31336.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,1847.49,31336.31,
Kidney endoscopy,50551,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,87068.78,
Kidney endoscopy,50553,CPT,,,,,,,,both,,,36540,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24847.2,68,,24847.2,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,29232,80,,29232,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29232,80,,29232,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25578,70,,25578,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,29232,
Kidney endoscopy & biopsy,50555,CPT,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,131763.1,68,,131763.1,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,155015.41,
Kidney endoscopy & treatment,50557,CPT,,,,,,,,both,,,57942.78,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,39401.09,68,,39401.09,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,46354.22,80,,46354.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,46354.22,80,,46354.22,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,40559.95,70,,40559.95,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,46354.22,
Kidney endoscopy & treatment,50561,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,87068.78,
Renal scope w/tumor resect,50562,CPT,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,131763.1,68,,131763.1,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,155015.41,
Kidney endoscopy,50570,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,49862.28,68,,49862.28,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,58661.5,
Kidney endoscopy,50572,CPT,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,9770.46,68,,9770.46,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,750.64,11494.66,
Kidney endoscopy & biopsy,50574,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,49862.28,68,,49862.28,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,58661.5,
Kidney endoscopy,50575,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,76185.18,
Kidney endoscopy & treatment,50576,CPT,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,131763.1,68,,131763.1,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,155015.41,
Kidney endoscopy & treatment,50580,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,74008.46,68,,74008.46,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,87068.78,
Fragmenting of kidney stone,50590,CPT,,,,,,,,both,,,33416.74,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,23391.72,70,,23391.72,percent of total billed charges,,2769.96,,,2769.96,Fee Schedule,,2347.71,,,2347.71,Fee Schedule,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,23391.72,
Perc rf ablate renal tumor,50592,CPT,,,,,,,,both,,,39799.33,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,27859.53,70,,27859.53,percent of total billed charges,,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,27859.53,70,,27859.53,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,27859.53,
Perc cryo ablate renal tum,50593,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3436.32,,,3436.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,1847.49,151560.62,
Endoluminal bx urtr rnl plvs,50606,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,3436.32,,,3436.32,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,0.01,25945.68,
Injection for ureter x-ray,50684,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,246,,,246,Fee Schedule,,208.5,,,208.5,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Measure ureter pressure,50686,CPT,,,,,,,,both,,,3285.56,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2299.89,70,,2299.89,percent of total billed charges,,6152,,,6152,Case Rate,,848.41,,,848.41,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2299.89,70,,2299.89,percent of total billed charges,,424.76,,,424.76,Fee Schedule,,360.01,,,360.01,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,171.65,9473,
Change of ureter tube/stent,50688,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,373.92,,,373.92,Fee Schedule,,316.92,,,316.92,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,316.92,34273.46,
Injection for ureter x-ray,50690,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,337.84,,,337.84,Fee Schedule,,286.34,,,286.34,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Plmt ureteral stent prq,50693,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,51328.82,
Plmt ureteral stent prq,50694,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,51328.82,
Plmt ureteral stent prq,50695,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,51328.82,
Ureteral embolization/occl,50705,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,3436.32,,,3436.32,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,0.01,51583.58,
Balloon dilate urtrl strix,50706,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,3436.32,,,3436.32,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,0.01,51583.58,
Revise ureter,50727,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,51328.82,
Laparoscopy ureterolithotomy,50945,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,84954.99,
Laparo new ureter/bladder,50947,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3436.32,,,3436.32,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1847.49,,,1847.49,Other,New York Medicaid APG methodology,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,1847.49,,,1847.49,Other,100% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2826.65,,,2826.65,Other,153% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,2586.48,,,2586.48,Other,140% New York Medicaid APG,4156.84,,,4156.84,Other,225% New York Medicaid APG,4803.46,,,4803.46,Other,260% New York Medicaid APG,5985.86,,,5985.86,Other,324% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,3972.1,,,3972.1,Other,215% New York Medicaid APG,2309.36,,,2309.36,Other,125% New York Medicaid APG,1847.49,151560.62,
Laparo new ureter/bladder,50948,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,151560.62,
Endoscopy of ureter,50951,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,58661.5,
Endoscopy of ureter,50953,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,58661.5,
Ureter endoscopy & biopsy,50955,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,87068.78,
Ureter endoscopy & treatment,50957,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,87068.78,
Ureter endoscopy & treatment,50961,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,87068.78,
Ureter endoscopy,50970,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,58661.5,
Ureter endoscopy & catheter,50972,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,58661.5,
Ureter endoscopy & biopsy,50974,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,87068.78,
Ureter endoscopy & treatment,50976,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,87068.78,
Ureter endoscopy & treatment,50980,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,2586.87,,,2586.87,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,87068.78,
Incise & treat bladder,51020,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,51328.82,
Incise & treat bladder,51030,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,51328.82,
Incise & drain bladder,51040,CPT,,,,,,,,both,,,31647.7,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22153.39,70,,22153.39,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,22153.39,
Incise bladder/drain ureter,51045,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,29989.27,
Removal of bladder stone,51050,CPT,,,,,,,,both,,,35106.99,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3412.75,,,3412.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24574.89,70,,24574.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,24574.89,
Removal of ureter stone,51060,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,6152,,,6152,Case Rate,,2011.8,,,2011.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,29989.27,
Remove ureter calculus,51065,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,51328.82,
Drainage of bladder abscess,51080,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,47813.76,
Drain bladder by needle,51100,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3534.93,68,,3534.93,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,188.6,,,188.6,Fee Schedule,,159.85,,,159.85,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,159.85,7216,
Drain bladder by trocar/cath,51101,CPT,,,,,,,,both,,,21991.57,1889.3,,,1889.3,Other,150% of Medicare + 9.63% HCRA Surcharge,1148.89,,,1148.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,15394.1,70,,15394.1,percent of total billed charges,,14954.27,68,,14954.27,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,17593.26,80,,17593.26,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17593.26,80,,17593.26,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,15394.1,70,,15394.1,percent of total billed charges,,244.36,,,244.36,Fee Schedule,,207.11,,,207.11,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,207.11,17593.26,
Drain bl w/cath insertion,51102,CPT,,,,,,,,both,,,24721.94,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,16810.92,68,,16810.92,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,19777.55,80,,19777.55,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,19777.55,80,,19777.55,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,17305.36,70,,17305.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,19777.55,
Removal of bladder cyst,51500,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3639.95,,,3639.95,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1956.96,,,1956.96,Other,New York Medicaid APG methodology,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,1956.96,,,1956.96,Other,100% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2994.15,,,2994.15,Other,153% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,2739.74,,,2739.74,Other,140% New York Medicaid APG,4403.16,,,4403.16,Other,225% New York Medicaid APG,5088.1,,,5088.1,Other,260% New York Medicaid APG,6340.55,,,6340.55,Other,324% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,4207.46,,,4207.46,Other,215% New York Medicaid APG,2446.2,,,2446.2,Other,125% New York Medicaid APG,1956.96,84954.99,
Removal of bladder lesion,51520,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,51328.82,
Repair of ureter lesion,51535,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,51328.82,
Injection for bladder x-ray,51600,CPT,,,,,,,,both,,,11088.61,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,7762.03,70,,7762.03,percent of total billed charges,,6152,,,6152,Case Rate,,967.55,,,967.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,7762.03,70,,7762.03,percent of total billed charges,,211.56,,,211.56,Fee Schedule,,179.31,,,179.31,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,9473,
Preparation for bladder xray,51605,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,967.55,,,967.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,185.32,,,185.32,Fee Schedule,,157.07,,,157.07,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,22702.47,
Injection for bladder x-ray,51610,CPT,,,,,,,,both,,,13768.75,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9638.13,70,,9638.13,percent of total billed charges,,6152,,,6152,Case Rate,,967.55,,,967.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9638.13,70,,9638.13,percent of total billed charges,,309.96,,,309.96,Fee Schedule,,262.71,,,262.71,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,9638.13,
Irrigation of bladder,51700,CPT,,,,,,,,both,,,31905.96,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22334.17,70,,22334.17,percent of total billed charges,,21696.05,68,,21696.05,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,25524.77,80,,25524.77,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25524.77,80,,25524.77,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22334.17,70,,22334.17,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,123.71,25524.77,
Insert bladder catheter,51701,CPT,,,,,,,,both,,,35280.75,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24696.53,70,,24696.53,percent of total billed charges,,23990.91,68,,23990.91,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,28224.6,80,,28224.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28224.6,80,,28224.6,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24696.53,70,,24696.53,percent of total billed charges,,123,,,123,Fee Schedule,,104.25,,,104.25,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,104.25,28224.6,
Insert temp bladder cath,51702,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,1827.06,68,,1827.06,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,121.36,,,121.36,Fee Schedule,,102.86,,,102.86,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,102.86,7216,
Insert bladder cath complex,51703,CPT,,,,,,,,both,,,3285.56,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2299.89,70,,2299.89,percent of total billed charges,,2234.18,68,,2234.18,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,2628.45,80,,2628.45,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2628.45,80,,2628.45,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2299.89,70,,2299.89,percent of total billed charges,,369,,,369,Fee Schedule,,312.75,,,312.75,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,171.65,7216,
Change of bladder tube,51705,CPT,,,,,,,,both,,,17435.51,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,12204.86,70,,12204.86,percent of total billed charges,,11856.15,68,,11856.15,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,13948.41,80,,13948.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13948.41,80,,13948.41,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,12204.86,70,,12204.86,percent of total billed charges,,249.28,,,249.28,Fee Schedule,,211.28,,,211.28,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,211.28,13948.41,
Change of bladder tube,51710,CPT,,,,,,,,both,,,35147.83,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23900.52,68,,23900.52,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,28118.26,80,,28118.26,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28118.26,80,,28118.26,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,24603.48,70,,24603.48,percent of total billed charges,,387.04,,,387.04,Fee Schedule,,328.04,,,328.04,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,328.04,28118.26,
Endoscopic injection/implant,51715,CPT,,,,,,,,both,,,32444.16,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,22710.91,70,,22710.91,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,22710.91,
Treatment of bladder lesion,51720,CPT,,,,,,,,both,,,98730.7,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,69111.49,70,,69111.49,percent of total billed charges,,67136.88,68,,67136.88,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,78984.56,80,,78984.56,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,78984.56,80,,78984.56,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,69111.49,70,,69111.49,percent of total billed charges,,211.56,,,211.56,Fee Schedule,,179.31,,,179.31,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,179.31,78984.56,
Simple cystometrogram,51725,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,886.9,,,886.9,Fee Schedule,,798.38,,,798.38,Fee Schedule,,754.12,,,754.12,Fee Schedule,,3638.9,70,,3638.9,percent of total billed charges,,3534.93,68,,3534.93,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3378.98,65,,3378.98,percent of total billed charges,,3378.98,65,,3378.98,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,271.58,7216,
Complex cystometrogram,51726,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,1461.72,,,1461.72,Fee Schedule,,1315.83,,,1315.83,Fee Schedule,,1242.88,,,1242.88,Fee Schedule,,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3534.93,68,,3534.93,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3378.98,65,,3378.98,percent of total billed charges,,3378.98,65,,3378.98,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,271.58,7216,
Cystometrogram w/up,51727,CPT,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,1309.95,,,1309.95,Fee Schedule,,1179.21,,,1179.21,Fee Schedule,,1113.83,,,1113.83,Fee Schedule,,10057.82,70,,10057.82,percent of total billed charges,,9770.46,68,,9770.46,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,9339.41,65,,9339.41,percent of total billed charges,,9339.41,65,,9339.41,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,486.05,11494.66,
Cystometrogram w/vp,51728,CPT,,,,,,,,both,,,13756.02,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,1305.42,,,1305.42,Fee Schedule,,1175.13,,,1175.13,Fee Schedule,,1109.98,,,1109.98,Fee Schedule,,9629.21,70,,9629.21,percent of total billed charges,,9354.09,68,,9354.09,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,11004.82,80,,11004.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11004.82,80,,11004.82,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9629.21,70,,9629.21,percent of total billed charges,,8941.41,65,,8941.41,percent of total billed charges,,8941.41,65,,8941.41,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,486.05,11004.82,
Cystometrogram w/vp&up,51729,CPT,,,,,,,,both,,,16915.05,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,1350.69,,,1350.69,Fee Schedule,,1215.88,,,1215.88,Fee Schedule,,1148.48,,,1148.48,Fee Schedule,,11840.54,70,,11840.54,percent of total billed charges,,11502.23,68,,11502.23,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,13532.04,80,,13532.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13532.04,80,,13532.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,11840.54,70,,11840.54,percent of total billed charges,,10994.78,65,,10994.78,percent of total billed charges,,10994.78,65,,10994.78,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,486.05,13532.04,
Urine flow measurement,51736,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,153.96,,,153.96,Fee Schedule,,138.59,,,138.59,Fee Schedule,,130.91,,,130.91,Fee Schedule,,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,848.41,,,848.41,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,1746.46,65,,1746.46,percent of total billed charges,,1746.46,65,,1746.46,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,130.91,9473,
Electro-uroflowmetry first,51741,CPT,,,,,,,,both,,,3263,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,176.57,,,176.57,Fee Schedule,,158.94,,,158.94,Fee Schedule,,150.13,,,150.13,Fee Schedule,,2284.1,70,,2284.1,percent of total billed charges,,6152,,,6152,Case Rate,,904.04,,,904.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2284.1,70,,2284.1,percent of total billed charges,,2120.95,65,,2120.95,percent of total billed charges,,2120.95,65,,2120.95,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,150.13,9473,
Anal/urinary muscle study,51784,CPT,,,,,,,,both,,,3285.56,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,846.21,,,846.21,Fee Schedule,,761.75,,,761.75,Fee Schedule,,719.52,,,719.52,Fee Schedule,,2299.89,70,,2299.89,percent of total billed charges,,6152,,,6152,Case Rate,,428.78,,,428.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2299.89,70,,2299.89,percent of total billed charges,,2135.61,65,,2135.61,percent of total billed charges,,2135.61,65,,2135.61,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.53,,,230.53,Other,New York Medicaid APG methodology,230.53,,,230.53,Other,100% New York Medicaid APG,230.53,,,230.53,Other,100% New York Medicaid APG,230.53,,,230.53,Other,100% New York Medicaid APG,518.68,,,518.68,Other,225% New York Medicaid APG,352.7,,,352.7,Other,153% New York Medicaid APG,518.68,,,518.68,Other,225% New York Medicaid APG,322.74,,,322.74,Other,140% New York Medicaid APG,518.68,,,518.68,Other,225% New York Medicaid APG,599.37,,,599.37,Other,260% New York Medicaid APG,746.9,,,746.9,Other,324% New York Medicaid APG,495.63,,,495.63,Other,215% New York Medicaid APG,495.63,,,495.63,Other,215% New York Medicaid APG,288.16,,,288.16,Other,125% New York Medicaid APG,171.65,9473,
Anal/urinary muscle study,51785,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,979.69,,,979.69,Fee Schedule,,881.91,,,881.91,Fee Schedule,,833.02,,,833.02,Fee Schedule,,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3534.93,68,,3534.93,percent of total billed charges,,428.78,,,428.78,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3378.98,65,,3378.98,percent of total billed charges,,3378.98,65,,3378.98,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.53,,,230.53,Other,New York Medicaid APG methodology,230.53,,,230.53,Other,100% New York Medicaid APG,230.53,,,230.53,Other,100% New York Medicaid APG,230.53,,,230.53,Other,100% New York Medicaid APG,518.68,,,518.68,Other,225% New York Medicaid APG,352.7,,,352.7,Other,153% New York Medicaid APG,518.68,,,518.68,Other,225% New York Medicaid APG,322.74,,,322.74,Other,140% New York Medicaid APG,518.68,,,518.68,Other,225% New York Medicaid APG,599.37,,,599.37,Other,260% New York Medicaid APG,746.9,,,746.9,Other,324% New York Medicaid APG,495.63,,,495.63,Other,215% New York Medicaid APG,495.63,,,495.63,Other,215% New York Medicaid APG,288.16,,,288.16,Other,125% New York Medicaid APG,230.53,7216,
Urinary reflex study,51792,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,1169.7,,,1169.7,Fee Schedule,,1052.95,,,1052.95,Fee Schedule,,994.58,,,994.58,Fee Schedule,,900.61,70,,900.61,percent of total billed charges,,6152,,,6152,Case Rate,,428.78,,,428.78,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,836.28,65,,836.28,percent of total billed charges,,836.28,65,,836.28,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,230.53,,,230.53,Other,New York Medicaid APG methodology,230.53,,,230.53,Other,100% New York Medicaid APG,230.53,,,230.53,Other,100% New York Medicaid APG,230.53,,,230.53,Other,100% New York Medicaid APG,518.68,,,518.68,Other,225% New York Medicaid APG,352.7,,,352.7,Other,153% New York Medicaid APG,518.68,,,518.68,Other,225% New York Medicaid APG,322.74,,,322.74,Other,140% New York Medicaid APG,518.68,,,518.68,Other,225% New York Medicaid APG,599.37,,,599.37,Other,260% New York Medicaid APG,746.9,,,746.9,Other,324% New York Medicaid APG,495.63,,,495.63,Other,215% New York Medicaid APG,495.63,,,495.63,Other,215% New York Medicaid APG,288.16,,,288.16,Other,125% New York Medicaid APG,67.21,9473,
Intraabdominal pressure test,51797,CPT,,,,,,,,both,,,9018.37,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,619.99,,,619.99,Fee Schedule,,558.11,,,558.11,Fee Schedule,,527.17,,,527.17,Fee Schedule,,6312.86,70,,6312.86,percent of total billed charges,,6132.49,68,,6132.49,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,7214.7,80,,7214.7,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,7214.7,80,,7214.7,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,6312.86,70,,6312.86,percent of total billed charges,,5861.94,65,,5861.94,percent of total billed charges,,5861.94,65,,5861.94,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,0.01,7216,
Us urine capacity measure,51798,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,131.29,,,131.29,Fee Schedule,,118.19,,,118.19,Fee Schedule,,111.64,,,111.64,Fee Schedule,,900.61,70,,900.61,percent of total billed charges,,6152,,,6152,Case Rate,,848.41,,,848.41,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,52.48,,,52.48,Fee Schedule,,44.48,,,44.48,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,44.48,9473,
Repair bladder neck,51845,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3412.75,,,3412.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,73233.94,
Repair of bladder wound,51860,CPT,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,131763.1,68,,131763.1,percent of total billed charges,,3412.75,,,3412.75,Other,186% of Medicaid,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,155015.41,
Repair of bladder opening,51880,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,58661.5,
Laparo urethral suspension,51990,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,84954.99,
Laparo sling operation,51992,CPT,,,,,,,,both,,,38182.29,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,26727.6,70,,26727.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,26727.6,
Cystoscopy,52000,CPT,,,,,,,,both,,,16926.21,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,11509.82,68,,11509.82,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,13540.97,80,,13540.97,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13540.97,80,,13540.97,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,11848.35,70,,11848.35,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,750.64,13540.97,
Cystoscopy removal of clots,52001,CPT,,,,,,,,both,,,35649.23,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24241.48,68,,24241.48,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,28519.38,80,,28519.38,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28519.38,80,,28519.38,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24954.46,70,,24954.46,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,28519.38,
Cystoscopy & ureter catheter,52005,CPT,,,,,,,,both,,,47893.05,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,32567.27,68,,32567.27,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,38314.44,80,,38314.44,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,38314.44,80,,38314.44,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,33525.14,70,,33525.14,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,38314.44,
Cystoscopy and biopsy,52007,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2011.8,,,2011.8,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,58661.5,
Cystoscopy & duct catheter,52010,CPT,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,9770.46,68,,9770.46,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,750.64,11494.66,
Cystoscopy w/biopsy(s),52204,CPT,,,,,,,,both,,,41108.08,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27953.49,68,,27953.49,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,32886.46,80,,32886.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32886.46,80,,32886.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28775.66,70,,28775.66,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,32886.46,
Cystoscopy and treatment,52214,CPT,,,,,,,,both,,,38081.64,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25895.52,68,,25895.52,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,30465.31,80,,30465.31,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30465.31,80,,30465.31,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26657.15,70,,26657.15,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,30465.31,
Cystoscopy and treatment,52224,CPT,,,,,,,,both,,,39655,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26965.4,68,,26965.4,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,31724,80,,31724,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31724,80,,31724,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27758.5,70,,27758.5,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,31724,
Cystoscopy and treatment,52234,CPT,,,,,,,,both,,,42962.38,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29214.42,68,,29214.42,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,34369.9,80,,34369.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34369.9,80,,34369.9,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,30073.67,70,,30073.67,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,34369.9,
Cystoscopy and treatment,52235,CPT,,,,,,,,both,,,50035.16,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,35024.61,70,,35024.61,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,35024.61,
Cystoscopy and treatment,52240,CPT,,,,,,,,both,,,49683.71,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34778.6,70,,34778.6,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,34778.6,
Cystoscopy and radiotracer,52250,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,51328.82,
Cystoscopy and treatment,52260,CPT,,,,,,,,both,,,34343.96,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23353.89,68,,23353.89,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,27475.17,80,,27475.17,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27475.17,80,,27475.17,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24040.77,70,,24040.77,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,27475.17,
Cystoscopy and treatment,52265,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,29132.44,68,,29132.44,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,34273.46,
Cystoscopy & revise urethra,52270,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,34273.46,
Cystoscopy & revise urethra,52275,CPT,,,,,,,,both,,,34791.72,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23658.37,68,,23658.37,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,27833.38,80,,27833.38,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27833.38,80,,27833.38,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24354.2,70,,24354.2,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,27833.38,
Cystoscopy and treatment,52276,CPT,,,,,,,,both,,,35920.96,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25144.67,70,,25144.67,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,25144.67,
Cystoscopy and treatment,52277,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,58661.5,
Cystoscopy and treatment,52281,CPT,,,,,,,,both,,,35971.51,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24460.63,68,,24460.63,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,28777.21,80,,28777.21,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28777.21,80,,28777.21,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25180.06,70,,25180.06,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,28777.21,
Cystoscopy implant stent,52282,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,51328.82,
Cystoscopy and treatment,52283,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,34273.46,
Cystoscopy and treatment,52285,CPT,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,9770.46,68,,9770.46,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,750.64,11494.66,
Cystoscopy chemodenervation,52287,CPT,,,,,,,,both,,,31072.26,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,21750.58,70,,21750.58,percent of total billed charges,,21129.14,68,,21129.14,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,24857.81,80,,24857.81,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,24857.81,80,,24857.81,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,21750.58,70,,21750.58,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,24857.81,
Cystoscopy and treatment,52290,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,34273.46,
Cystoscopy and treatment,52300,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,3412.75,,,3412.75,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,58661.5,
Cystoscopy and treatment,52301,CPT,,,,,,,,both,,,35370.79,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24759.55,70,,24759.55,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,24759.55,
Cystoscopy and treatment,52305,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,3412.75,,,3412.75,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,87068.78,
Cystoscopy and treatment,52310,CPT,,,,,,,,both,,,29225.24,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,19873.16,68,,19873.16,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,23380.19,80,,23380.19,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,23380.19,80,,23380.19,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,20457.67,70,,20457.67,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,23380.19,
Cystoscopy and treatment,52315,CPT,,,,,,,,both,,,40381.04,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27459.11,68,,27459.11,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,32304.83,80,,32304.83,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32304.83,80,,32304.83,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28266.73,70,,28266.73,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,32304.83,
Remove bladder stone,52317,CPT,,,,,,,,both,,,38038.46,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25866.15,68,,25866.15,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,30430.77,80,,30430.77,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30430.77,80,,30430.77,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26626.92,70,,26626.92,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,30430.77,
Remove bladder stone,52318,CPT,,,,,,,,both,,,37429.91,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25452.34,68,,25452.34,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,29943.93,80,,29943.93,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29943.93,80,,29943.93,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26200.94,70,,26200.94,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,29943.93,
Cystoscopy and treatment,52320,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,51328.82,
Cystoscopy stone removal,52325,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3412.75,,,3412.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,76185.18,
Cystoscopy inject material,52327,CPT,,,,,,,,both,,,51504.42,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35023.01,68,,35023.01,percent of total billed charges,,3412.75,,,3412.75,Other,186% of Medicaid,41203.54,80,,41203.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41203.54,80,,41203.54,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,36053.09,70,,36053.09,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,41203.54,
Cystoscopy and treatment,52330,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,58661.5,
Cystoscopy and treatment,52332,CPT,,,,,,,,both,,,35791.89,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24338.49,68,,24338.49,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,28633.51,80,,28633.51,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28633.51,80,,28633.51,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25054.32,70,,25054.32,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,28633.51,
Create passage to kidney,52334,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2011.8,,,2011.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,51328.82,
Cysto w/ureter stricture tx,52341,CPT,,,,,,,,both,,,36893.08,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25825.16,70,,25825.16,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,25825.16,
Cysto w/up stricture tx,52342,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2011.8,,,2011.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,51328.82,
Cysto w/renal stricture tx,52343,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2011.8,,,2011.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1081.61,,,1081.61,Other,New York Medicaid APG methodology,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,1081.61,,,1081.61,Other,100% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1654.86,,,1654.86,Other,153% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,1514.26,,,1514.26,Other,140% New York Medicaid APG,2433.62,,,2433.62,Other,225% New York Medicaid APG,2812.19,,,2812.19,Other,260% New York Medicaid APG,3504.42,,,3504.42,Other,324% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,2325.46,,,2325.46,Other,215% New York Medicaid APG,1352.01,,,1352.01,Other,125% New York Medicaid APG,1081.61,51328.82,
Cysto/uretero stricture tx,52344,CPT,,,,,,,,both,,,45216.91,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31651.84,70,,31651.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,31651.84,
Cysto/uretero w/up stricture,52345,CPT,,,,,,,,both,,,43912.97,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3412.75,,,3412.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,30739.08,70,,30739.08,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,30739.08,
Cystouretero w/renal strict,52346,CPT,,,,,,,,both,,,37179.82,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26025.87,70,,26025.87,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,26025.87,
Cystouretero & or pyeloscope,52351,CPT,,,,,,,,both,,,37162.02,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26013.41,70,,26013.41,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,26013.41,
Cystouretero w/stone remove,52352,CPT,,,,,,,,both,,,36808.59,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25766.01,70,,25766.01,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,25766.01,
Cystouretero w/lithotripsy,52353,CPT,,,,,,,,both,,,38384.49,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,26869.14,70,,26869.14,percent of total billed charges,,1874.52,,,1874.52,Fee Schedule,,1588.77,,,1588.77,Fee Schedule,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,26869.14,
Cystouretero w/biopsy,52354,CPT,,,,,,,,both,,,43957.07,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,30769.95,70,,30769.95,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,30769.95,
Cystouretero w/excise tumor,52355,CPT,,,,,,,,both,,,42146.56,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29502.59,70,,29502.59,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,29502.59,
Cysto/uretero w/lithotripsy,52356,CPT,,,,,,,,both,,,39439.09,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3412.75,,,3412.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,27607.36,70,,27607.36,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,27607.36,
Cystouretero w/congen repr,52400,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,51328.82,
Cystourethro cut ejacul duct,52402,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,51328.82,
Incision of prostate,52450,CPT,,,,,,,,both,,,35499.75,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3487.59,,,3487.59,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24849.83,70,,24849.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1875.05,,,1875.05,Other,New York Medicaid APG methodology,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2868.83,,,2868.83,Other,153% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2625.07,,,2625.07,Other,140% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,4875.13,,,4875.13,Other,260% New York Medicaid APG,6075.16,,,6075.16,Other,324% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,2343.81,,,2343.81,Other,125% New York Medicaid APG,1875.05,24849.83,
Revision of bladder neck,52500,CPT,,,,,,,,both,,,47447.14,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2877.34,,,2877.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,33213,70,,33213,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,33213,
Prostatectomy (turp),52601,CPT,,,,,,,,both,,,40724.65,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28507.26,70,,28507.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,28507.26,
Remove prostate regrowth,52630,CPT,,,,,,,,both,,,41807.35,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,28429,68,,28429,percent of total billed charges,,4646.12,,,4646.12,Other,186% of Medicaid,33445.88,80,,33445.88,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33445.88,80,,33445.88,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,29265.15,70,,29265.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2232,33445.88,
Relieve bladder contracture,52640,CPT,,,,,,,,both,,,36213.63,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24625.27,68,,24625.27,percent of total billed charges,,2877.34,,,2877.34,Other,186% of Medicaid,28970.9,80,,28970.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28970.9,80,,28970.9,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25349.54,70,,25349.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1546.95,,,1546.95,Other,New York Medicaid APG methodology,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,1546.95,,,1546.95,Other,100% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2366.84,,,2366.84,Other,153% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,2165.74,,,2165.74,Other,140% New York Medicaid APG,3480.65,,,3480.65,Other,225% New York Medicaid APG,4022.08,,,4022.08,Other,260% New York Medicaid APG,5012.13,,,5012.13,Other,324% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,3325.95,,,3325.95,Other,215% New York Medicaid APG,1933.69,,,1933.69,Other,125% New York Medicaid APG,1546.95,28970.9,
Laser surgery of prostate,52647,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,76185.18,
Laser surgery of prostate,52648,CPT,,,,,,,,both,,,44600.84,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,31220.59,70,,31220.59,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,31220.59,
Prostate laser enucleation,52649,CPT,,,,,,,,both,,,42526.4,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,29768.48,70,,29768.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,29768.48,
Drainage of prostate abscess,52700,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,3487.59,,,3487.59,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1875.05,,,1875.05,Other,New York Medicaid APG methodology,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2868.83,,,2868.83,Other,153% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2625.07,,,2625.07,Other,140% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,4875.13,,,4875.13,Other,260% New York Medicaid APG,6075.16,,,6075.16,Other,324% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,2343.81,,,2343.81,Other,125% New York Medicaid APG,1875.05,58661.5,
Incision of urethra,53000,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,34273.46,
Incision of urethra,53010,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2053,87068.78,
Incision of urethra,53020,CPT,,,,,,,,both,,,36826.76,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25042.2,68,,25042.2,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,29461.41,80,,29461.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29461.41,80,,29461.41,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25778.73,70,,25778.73,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,29461.41,
Incision of urethra,53025,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,29132.44,68,,29132.44,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,331.28,,,331.28,Fee Schedule,,280.78,,,280.78,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,280.78,34273.46,
Drainage of urethra abscess,53040,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,58661.5,
Drainage of urethra abscess,53060,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,29132.44,68,,29132.44,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,34273.46,
Drainage of urinary leakage,53080,CPT,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,904.04,,,904.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,486.05,10057.82,
Drainage of urinary leakage,53085,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,29989.27,
Biopsy of urethra,53200,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,34273.46,
Removal of urethra,53210,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,51328.82,
Removal of urethra,53215,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4378.56,,,4378.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2354.06,76185.18,
Treatment of urethra lesion,53220,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,58661.5,
Removal of urethra lesion,53230,CPT,,,,,,,,both,,,40310.96,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27411.45,68,,27411.45,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,32248.77,80,,32248.77,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32248.77,80,,32248.77,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28217.67,70,,28217.67,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,32248.77,
Removal of urethra lesion,53235,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4378.56,,,4378.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2354.06,76185.18,
Surgery for urethra pouch,53240,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,58661.5,
Removal of urethra gland,53250,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,58661.5,
Treatment of urethra lesion,53260,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,58661.5,
Treatment of urethra lesion,53265,CPT,,,,,,,,both,,,40279.92,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27390.35,68,,27390.35,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,32223.94,80,,32223.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32223.94,80,,32223.94,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28195.94,70,,28195.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,32223.94,
Removal of urethra gland,53270,CPT,,,,,,,,both,,,40917.43,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27823.85,68,,27823.85,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,32733.94,80,,32733.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32733.94,80,,32733.94,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28642.2,70,,28642.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,32733.94,
Repair of urethra defect,53275,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,58661.5,
Revise urethra stage 1,53400,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4378.56,,,4378.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2354.06,76185.18,
Revise urethra stage 2,53405,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,87068.78,
Reconstruction of urethra,53410,CPT,,,,,,,,both,,,69570.13,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,47307.69,68,,47307.69,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,55656.1,80,,55656.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,55656.1,80,,55656.1,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,48699.09,70,,48699.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,55656.1,
Reconstruct urethra stage 1,53420,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4378.56,,,4378.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2354.06,76185.18,
Reconstruct urethra stage 2,53425,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,87068.78,
Reconstruction of urethra,53430,CPT,,,,,,,,both,,,44694.44,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,30392.22,68,,30392.22,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,35755.55,80,,35755.55,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35755.55,80,,35755.55,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,31286.11,70,,31286.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,35755.55,
Reconstruct urethra/bladder,53431,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,87068.78,
Male sling procedure,53440,CPT,,,,,,,,both,,,79572.43,23196.31,,,23196.31,Other,150% of Medicare + 9.63% HCRA Surcharge,14105.82,,,14105.82,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,54109.25,68,,54109.25,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,63657.94,80,,63657.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,63657.94,80,,63657.94,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,55700.7,70,,55700.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,63657.94,
Remove/revise male sling,53442,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2053,87068.78,
Insert tandem cuff,53444,CPT,,,,,,,,both,,,424287.84,36450.63,,,36450.63,Other,150% of Medicare + 9.63% HCRA Surcharge,22165.85,,,22165.85,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,288515.73,68,,288515.73,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,339430.27,80,,339430.27,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,339430.27,80,,339430.27,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,297001.49,70,,297001.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,339430.27,
Insert uro/ves nck sphincter,53445,CPT,,,,,,,,both,,,110991.64,36450.63,,,36450.63,Other,150% of Medicare + 9.63% HCRA Surcharge,22165.85,,,22165.85,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,75474.32,68,,75474.32,percent of total billed charges,,3412.75,,,3412.75,Other,186% of Medicaid,88793.31,80,,88793.31,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,88793.31,80,,88793.31,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,77694.15,70,,77694.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6628,,"100% primary, 50% secondary, 25% tertiary procedure",6628,Other,United Healthcare ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6260,,"100% primary, 50% secondary, 25% tertiary procedure",6260,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,88793.31,
Remove uro sphincter,53446,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2053,87068.78,
Remove/replace ur sphincter,53447,CPT,,,,,,,,both,,,424287.84,36450.63,,,36450.63,Other,150% of Medicare + 9.63% HCRA Surcharge,22165.85,,,22165.85,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,288515.73,68,,288515.73,percent of total billed charges,,3412.75,,,3412.75,Other,186% of Medicaid,339430.27,80,,339430.27,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,339430.27,80,,339430.27,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,297001.49,70,,297001.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6628,,"100% primary, 50% secondary, 25% tertiary procedure",6628,Other,United Healthcare ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6260,,"100% primary, 50% secondary, 25% tertiary procedure",6260,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,339430.27,
Repair uro sphincter,53449,CPT,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,131763.1,68,,131763.1,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2053,155015.41,
Revision of urethra,53450,CPT,,,,,,,,both,,,34741.59,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23624.28,68,,23624.28,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,27793.27,80,,27793.27,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27793.27,80,,27793.27,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24319.11,70,,24319.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,27793.27,
Revision of urethra,53460,CPT,,,,,,,,both,,,35421.42,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24086.57,68,,24086.57,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,28337.14,80,,28337.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28337.14,80,,28337.14,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24794.99,70,,24794.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,28337.14,
Urethrlys transvag w/ scope,53500,CPT,,,,,,,,both,,,38827.66,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,27179.36,70,,27179.36,percent of total billed charges,,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27179.36,70,,27179.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,27179.36,
Repair of urethra injury,53502,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,58661.5,
Repair of urethra injury,53505,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,87068.78,
Repair of urethra injury,53510,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,87068.78,
Repair of urethra injury,53515,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,87068.78,
Repair of urethra defect,53520,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,4378.56,,,4378.56,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,2232,87068.78,
Dilate urethra stricture,53600,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3534.93,68,,3534.93,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,309.96,,,309.96,Fee Schedule,,262.71,,,262.71,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,262.71,7216,
Dilate urethra stricture,53601,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,1827.06,68,,1827.06,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2149.49,80,,2149.49,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,257.48,,,257.48,Fee Schedule,,218.23,,,218.23,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,140.37,7216,
Dilate urethra stricture,53605,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,309.96,,,309.96,Fee Schedule,,262.71,,,262.71,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,262.71,58661.5,
Dilate urethra stricture,53620,CPT,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,9770.46,68,,9770.46,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,418.2,,,418.2,Fee Schedule,,354.45,,,354.45,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,354.45,11494.66,
Dilate urethra stricture,53621,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3534.93,68,,3534.93,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,347.68,,,347.68,Fee Schedule,,294.68,,,294.68,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,271.58,7216,
Dilation of urethra,53660,CPT,,,,,,,,both,,,3285.56,282.26,,,282.26,Other,150% of Medicare + 9.63% HCRA Surcharge,171.65,,,171.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2299.89,70,,2299.89,percent of total billed charges,,2234.18,68,,2234.18,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,2628.45,80,,2628.45,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2628.45,80,,2628.45,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2299.89,70,,2299.89,percent of total billed charges,,201.72,,,201.72,Fee Schedule,,170.97,,,170.97,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,170.97,7216,
Dilation of urethra,53661,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,848.41,,,848.41,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,196.8,,,196.8,Fee Schedule,,166.8,,,166.8,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,140.37,9473,
Dilation of urethra,53665,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,183.68,,,183.68,Fee Schedule,,155.68,,,155.68,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,155.68,34273.46,
Prostatic microwave thermotx,53850,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,6152,,,6152,Case Rate,,3487.59,,,3487.59,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1875.05,,,1875.05,Other,New York Medicaid APG methodology,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2868.83,,,2868.83,Other,153% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2625.07,,,2625.07,Other,140% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,4875.13,,,4875.13,Other,260% New York Medicaid APG,6075.16,,,6075.16,Other,324% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,2343.81,,,2343.81,Other,125% New York Medicaid APG,1875.05,51328.82,
Prostatic rf thermotx,53852,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,49862.28,68,,49862.28,percent of total billed charges,,3487.59,,,3487.59,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1875.05,,,1875.05,Other,New York Medicaid APG methodology,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2868.83,,,2868.83,Other,153% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2625.07,,,2625.07,Other,140% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,4875.13,,,4875.13,Other,260% New York Medicaid APG,6075.16,,,6075.16,Other,324% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,2343.81,,,2343.81,Other,125% New York Medicaid APG,1875.05,58661.5,
Trurl dstrj prst8 tiss rf wv,53854,CPT,,,,,,,,both,,,36141.18,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,25298.83,70,,25298.83,percent of total billed charges,,24576,68,,24576,percent of total billed charges,,3487.59,,,3487.59,Other,186% of Medicaid,28912.94,80,,28912.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28912.94,80,,28912.94,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25298.83,70,,25298.83,percent of total billed charges,,1849.92,,,1849.92,Fee Schedule,,1567.92,,,1567.92,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1875.05,,,1875.05,Other,New York Medicaid APG methodology,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2868.83,,,2868.83,Other,153% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2625.07,,,2625.07,Other,140% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,4875.13,,,4875.13,Other,260% New York Medicaid APG,6075.16,,,6075.16,Other,324% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,2343.81,,,2343.81,Other,125% New York Medicaid APG,1567.92,28912.94,
Insert prost urethral stent,53855,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,29132.44,68,,29132.44,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,393.6,,,393.6,Fee Schedule,,333.6,,,333.6,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,333.6,34273.46,
Transurethral rf treatment,53860,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,1858.11,,,1858.11,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,34273.46,
Slitting of prepuce,54000,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,537.92,,,537.92,Fee Schedule,,455.92,,,455.92,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,455.92,58661.5,
Slitting of prepuce,54001,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,34273.46,
Drain penis lesion,54015,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,23871.23,
Destruction penis lesion(s),54050,CPT,,,,,,,,both,,,8387.08,720.54,,,720.54,Other,150% of Medicare + 9.63% HCRA Surcharge,438.16,,,438.16,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,6152,,,6152,Case Rate,,904.04,,,904.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5870.96,70,,5870.96,percent of total billed charges,,523.16,,,523.16,Fee Schedule,,443.41,,,443.41,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,438.16,9473,
Destruction penis lesion(s),54055,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,469.04,,,469.04,Fee Schedule,,397.54,,,397.54,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,397.54,26850.29,
Cryosurgery penis lesion(s),54056,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,904.04,,,904.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,544.48,,,544.48,Fee Schedule,,461.48,,,461.48,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,219.99,9473,
Laser surg penis lesion(s),54057,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,478.88,,,478.88,Fee Schedule,,405.88,,,405.88,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,405.88,30686.04,
Excision of penis lesion(s),54060,CPT,,,,,,,,both,,,38953.63,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,26488.47,68,,26488.47,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,31162.9,80,,31162.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31162.9,80,,31162.9,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27267.54,70,,27267.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,31162.9,
Destruction penis lesion(s),54065,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,26083.13,68,,26083.13,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,30686.04,
Biopsy of penis,54100,CPT,,,,,,,,both,,,39273.29,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,26705.84,68,,26705.84,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,31418.63,80,,31418.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31418.63,80,,31418.63,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,27491.3,70,,27491.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,31418.63,
Biopsy of penis,54105,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,47813.76,
Treatment of penis lesion,54110,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,58661.5,
Treat penis lesion graft,54111,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,74008.46,68,,74008.46,percent of total billed charges,,1837.37,,,1837.37,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,87068.78,
Treat penis lesion graft,54112,CPT,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,131763.1,68,,131763.1,percent of total billed charges,,1837.37,,,1837.37,Other,186% of Medicaid,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,155015.41,
Treatment of penis lesion,54115,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,47813.76,
Partial removal of penis,54120,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1837.37,,,1837.37,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,58661.5,
Circumcision w/regionl block,54150,CPT,,,,,,,,both,,,35318.53,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24016.6,68,,24016.6,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,28254.82,80,,28254.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28254.82,80,,28254.82,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24722.97,70,,24722.97,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,28254.82,
Circumcision neonate,54160,CPT,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,9770.46,68,,9770.46,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,750.64,11494.66,
Circum 28 days or older,54161,CPT,,,,,,,,both,,,35519.59,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24153.32,68,,24153.32,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,28415.67,80,,28415.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28415.67,80,,28415.67,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24863.71,70,,24863.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,28415.67,
Lysis penil circumic lesion,54162,CPT,,,,,,,,both,,,35190.53,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23929.56,68,,23929.56,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,28152.42,80,,28152.42,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28152.42,80,,28152.42,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24633.37,70,,24633.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,28152.42,
Repair of circumcision,54163,CPT,,,,,,,,both,,,35023.11,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23815.71,68,,23815.71,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,28018.49,80,,28018.49,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28018.49,80,,28018.49,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24516.18,70,,24516.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,28018.49,
Frenulotomy of penis,54164,CPT,,,,,,,,both,,,35753.88,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24312.64,68,,24312.64,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,28603.1,80,,28603.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28603.1,80,,28603.1,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25027.72,70,,25027.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,28603.1,
Treatment of penis lesion,54200,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,6152,,,6152,Case Rate,,848.41,,,848.41,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,421.48,,,421.48,Fee Schedule,,357.23,,,357.23,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,271.58,9473,
Treatment of penis lesion,54205,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,76185.18,
Treatment of penis lesion,54220,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3534.93,68,,3534.93,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,271.58,7216,
Prepare penis study,54230,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,385.4,,,385.4,Fee Schedule,,326.65,,,326.65,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,0.01,25945.68,
Dynamic cavernosometry,54231,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,271.58,9473,
Penile injection,54235,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,6152,,,6152,Case Rate,,848.41,,,848.41,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,359.16,,,359.16,Fee Schedule,,304.41,,,304.41,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,271.58,9473,
Penis study,54240,CPT,,,,,,,,both,,,6602.02,567.18,,,567.18,Other,150% of Medicare + 9.63% HCRA Surcharge,344.91,,,344.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,235.39,,,235.39,Fee Schedule,,211.89,,,211.89,Fee Schedule,,200.15,,,200.15,Fee Schedule,,4621.41,70,,4621.41,percent of total billed charges,,4489.37,68,,4489.37,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,5281.62,80,,5281.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5281.62,80,,5281.62,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4621.41,70,,4621.41,percent of total billed charges,,4291.31,65,,4291.31,percent of total billed charges,,4291.31,65,,4291.31,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,200.15,7216,
Penis study,54250,CPT,,,,,,,,both,,,5198.43,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,79.3,,,79.3,Fee Schedule,,71.38,,,71.38,Fee Schedule,,67.42,,,67.42,Fee Schedule,,3638.9,70,,3638.9,percent of total billed charges,,3534.93,68,,3534.93,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4158.74,80,,4158.74,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3638.9,70,,3638.9,percent of total billed charges,,3378.98,65,,3378.98,percent of total billed charges,,3378.98,65,,3378.98,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,67.42,7216,
Revision of penis,54300,CPT,,,,,,,,both,,,34835.02,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,24384.51,70,,24384.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,24384.51,
Revision of penis,54304,CPT,,,,,,,,both,,,34641.1,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,24248.77,70,,24248.77,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,24248.77,
Reconstruction of urethra,54308,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,76185.18,
Reconstruction of urethra,54312,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,51328.82,
Reconstruction of urethra,54316,CPT,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,135638.48,
Reconstruction of urethra,54318,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,51328.82,
Reconstruction of urethra,54322,CPT,,,,,,,,both,,,35358.69,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24751.08,70,,24751.08,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,24751.08,
Reconstruction of urethra,54324,CPT,,,,,,,,both,,,35720.35,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25004.25,70,,25004.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,25004.25,
Reconstruction of urethra,54326,CPT,,,,,,,,both,,,37150.74,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26005.52,70,,26005.52,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,26005.52,
Revise penis/urethra,54328,CPT,,,,,,,,both,,,37096.03,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25967.22,70,,25967.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,25967.22,
Revise penis/urethra,54332,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,51328.82,
Revise penis/urethra,54336,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,51328.82,
Secondary urethral surgery,54340,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Secondary urethral surgery,54344,CPT,,,,,,,,both,,,35737.57,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25016.3,70,,25016.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,25016.3,
Secondary urethral surgery,54348,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,76185.18,
Reconstruct urethra/penis,54352,CPT,,,,,,,,both,,,43661.58,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1837.37,,,1837.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,30563.11,70,,30563.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,30563.11,
Penis plastic surgery,54360,CPT,,,,,,,,both,,,34270.38,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,23989.27,70,,23989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,23989.27,
Repair penis,54380,CPT,,,,,,,,both,,,49175.08,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,34422.56,70,,34422.56,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,34422.56,
Repair penis,54385,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,29989.27,
Insert semi-rigid prosthesis,54400,CPT,,,,,,,,both,,,270006.63,23196.31,,,23196.31,Other,150% of Medicare + 9.63% HCRA Surcharge,14105.82,,,14105.82,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,8925.83,,,8925.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,189004.64,70,,189004.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,4798.83,,,4798.83,Other,New York Medicaid APG methodology,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,7342.21,,,7342.21,Other,153% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,6718.36,,,6718.36,Other,140% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,12476.96,,,12476.96,Other,260% New York Medicaid APG,15548.21,,,15548.21,Other,324% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,5998.54,,,5998.54,Other,125% New York Medicaid APG,3126,189004.64,
Insert self-contd prosthesis,54401,CPT,,,,,,,,both,,,424287.84,36450.63,,,36450.63,Other,150% of Medicare + 9.63% HCRA Surcharge,22165.85,,,22165.85,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,8925.83,,,8925.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,297001.49,70,,297001.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6628,,"100% primary, 50% secondary, 25% tertiary procedure",6628,Other,United Healthcare ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6260,,"100% primary, 50% secondary, 25% tertiary procedure",6260,Other,United Healthcare ASC Grouper,4798.83,,,4798.83,Other,New York Medicaid APG methodology,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,7342.21,,,7342.21,Other,153% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,6718.36,,,6718.36,Other,140% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,12476.96,,,12476.96,Other,260% New York Medicaid APG,15548.21,,,15548.21,Other,324% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,5998.54,,,5998.54,Other,125% New York Medicaid APG,3126,297001.49,
Insert multi-comp penis pros,54405,CPT,,,,,,,,both,,,79905.35,36450.63,,,36450.63,Other,150% of Medicare + 9.63% HCRA Surcharge,22165.85,,,22165.85,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,8925.83,,,8925.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,55933.75,70,,55933.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6628,,"100% primary, 50% secondary, 25% tertiary procedure",6628,Other,United Healthcare ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6260,,"100% primary, 50% secondary, 25% tertiary procedure",6260,Other,United Healthcare ASC Grouper,4798.83,,,4798.83,Other,New York Medicaid APG methodology,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,7342.21,,,7342.21,Other,153% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,6718.36,,,6718.36,Other,140% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,12476.96,,,12476.96,Other,260% New York Medicaid APG,15548.21,,,15548.21,Other,324% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,5998.54,,,5998.54,Other,125% New York Medicaid APG,3126,55933.75,
Remove muti-comp penis pros,54406,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Repair multi-comp penis pros,54408,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,76185.18,
Remove/replace penis prosth,54410,CPT,,,,,,,,both,,,103369.65,36450.63,,,36450.63,Other,150% of Medicare + 9.63% HCRA Surcharge,22165.85,,,22165.85,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,8925.83,,,8925.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,72358.76,70,,72358.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6628,,"100% primary, 50% secondary, 25% tertiary procedure",6628,Other,United Healthcare ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6260,,"100% primary, 50% secondary, 25% tertiary procedure",6260,Other,United Healthcare ASC Grouper,4798.83,,,4798.83,Other,New York Medicaid APG methodology,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,7342.21,,,7342.21,Other,153% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,6718.36,,,6718.36,Other,140% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,12476.96,,,12476.96,Other,260% New York Medicaid APG,15548.21,,,15548.21,Other,324% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,5998.54,,,5998.54,Other,125% New York Medicaid APG,3126,72358.76,
Remov/replc penis pros comp,54411,CPT,,,,,,,,both,,,424287.84,36450.63,,,36450.63,Other,150% of Medicare + 9.63% HCRA Surcharge,22165.85,,,22165.85,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,297001.49,70,,297001.49,percent of total billed charges,,6152,,,6152,Case Rate,,8925.83,,,8925.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,297001.49,70,,297001.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,4798.83,,,4798.83,Other,New York Medicaid APG methodology,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,7342.21,,,7342.21,Other,153% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,6718.36,,,6718.36,Other,140% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,12476.96,,,12476.96,Other,260% New York Medicaid APG,15548.21,,,15548.21,Other,324% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,5998.54,,,5998.54,Other,125% New York Medicaid APG,2743,297001.49,
Remove self-contd penis pros,54415,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Remv/repl penis contain pros,54416,CPT,,,,,,,,both,,,47066.38,36450.63,,,36450.63,Other,150% of Medicare + 9.63% HCRA Surcharge,22165.85,,,22165.85,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,8925.83,,,8925.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,32946.47,70,,32946.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6628,,"100% primary, 50% secondary, 25% tertiary procedure",6628,Other,United Healthcare ASC Grouper,7364,,"100% primary, 50% secondary, 25% tertiary procedure",7364,Other,United Healthcare ASC Grouper,6260,,"100% primary, 50% secondary, 25% tertiary procedure",6260,Other,United Healthcare ASC Grouper,4798.83,,,4798.83,Other,New York Medicaid APG methodology,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,7342.21,,,7342.21,Other,153% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,6718.36,,,6718.36,Other,140% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,12476.96,,,12476.96,Other,260% New York Medicaid APG,15548.21,,,15548.21,Other,324% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,5998.54,,,5998.54,Other,125% New York Medicaid APG,3126,36450.63,
Remv/replc penis pros compl,54417,CPT,,,,,,,,both,,,270006.63,23196.31,,,23196.31,Other,150% of Medicare + 9.63% HCRA Surcharge,14105.82,,,14105.82,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,189004.64,70,,189004.64,percent of total billed charges,,6152,,,6152,Case Rate,,8925.83,,,8925.83,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,189004.64,70,,189004.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,4798.83,,,4798.83,Other,New York Medicaid APG methodology,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,4798.83,,,4798.83,Other,100% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,7342.21,,,7342.21,Other,153% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,6718.36,,,6718.36,Other,140% New York Medicaid APG,10797.37,,,10797.37,Other,225% New York Medicaid APG,12476.96,,,12476.96,Other,260% New York Medicaid APG,15548.21,,,15548.21,Other,324% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,10317.49,,,10317.49,Other,215% New York Medicaid APG,5998.54,,,5998.54,Other,125% New York Medicaid APG,2743,189004.64,
Revision of penis,54420,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Revision of penis,54435,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Repair corporeal tear,54437,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1837.37,,,1837.37,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,987.84,,,987.84,Other,New York Medicaid APG methodology,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,987.84,,,987.84,Other,100% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1511.39,,,1511.39,Other,153% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,1382.97,,,1382.97,Other,140% New York Medicaid APG,2222.63,,,2222.63,Other,225% New York Medicaid APG,2568.37,,,2568.37,Other,260% New York Medicaid APG,3200.59,,,3200.59,Other,324% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,2123.85,,,2123.85,Other,215% New York Medicaid APG,1234.79,,,1234.79,Other,125% New York Medicaid APG,987.84,58661.5,
Repair of penis,54440,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,47662.47,65,,47662.47,percent of total billed charges,,47662.47,65,,47662.47,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Preputial stretching,54450,CPT,,,,,,,,both,,,34263.79,446.6,,,446.6,Other,150% of Medicare + 9.63% HCRA Surcharge,271.58,,,271.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23299.38,68,,23299.38,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,27411.03,80,,27411.03,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27411.03,80,,27411.03,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23984.65,70,,23984.65,percent of total billed charges,,275.52,,,275.52,Fee Schedule,,233.52,,,233.52,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,233.52,27411.03,
Biopsy of testis,54500,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,360.8,,,360.8,Fee Schedule,,305.8,,,305.8,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,305.8,47813.76,
Biopsy of testis,54505,CPT,,,,,,,,both,,,43881.96,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,29839.73,68,,29839.73,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,35105.57,80,,35105.57,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35105.57,80,,35105.57,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,30717.37,70,,30717.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,35105.57,
Excise lesion testis,54512,CPT,,,,,,,,both,,,35393.63,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24067.67,68,,24067.67,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,28314.9,80,,28314.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28314.9,80,,28314.9,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24775.54,70,,24775.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,28314.9,
Removal of testis,54520,CPT,,,,,,,,both,,,35952.94,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25167.06,70,,25167.06,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,25167.06,
Orchiectomy partial,54522,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Removal of testis,54530,CPT,,,,,,,,both,,,46027.24,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,32219.07,70,,32219.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,32219.07,
Extensive testis surgery,54535,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Exploration for testis,54550,CPT,,,,,,,,both,,,36454.18,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25517.93,70,,25517.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,25517.93,
Exploration for testis,54560,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,29989.27,
Reduce testis torsion,54600,CPT,,,,,,,,both,,,33768.86,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23638.2,70,,23638.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,23638.2,
Suspension of testis,54620,CPT,,,,,,,,both,,,35695.25,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24986.68,70,,24986.68,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,24986.68,
Orchiopexy ingun/scrot appr,54640,CPT,,,,,,,,both,,,35467.74,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24827.42,70,,24827.42,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,24827.42,
Orchiopexy (fowler-stephens),54650,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,50938.78,
Revision of testis,54660,CPT,,,,,,,,both,,,41031.71,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27901.56,68,,27901.56,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,32825.37,80,,32825.37,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32825.37,80,,32825.37,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28722.2,70,,28722.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,32825.37,
Repair testis injury,54670,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,51328.82,
Relocation of testis(es),54680,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Laparoscopy orchiectomy,54690,CPT,,,,,,,,both,,,36925.31,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,25847.72,70,,25847.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,25847.72,
Laparoscopy orchiopexy,54692,CPT,,,,,,,,both,,,36506.42,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,25554.49,70,,25554.49,percent of total billed charges,,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,25554.49,70,,25554.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,25554.49,
Drainage of scrotum,54700,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,34273.46,
Biopsy of epididymis,54800,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,27281.4,
Remove epididymis lesion,54830,CPT,,,,,,,,both,,,46383.69,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,32468.58,70,,32468.58,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,32468.58,
Remove epididymis lesion,54840,CPT,,,,,,,,both,,,33168.4,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23217.88,70,,23217.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,23217.88,
Removal of epididymis,54860,CPT,,,,,,,,both,,,38579.03,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27005.32,70,,27005.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,27005.32,
Removal of epididymis,54861,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Explore epididymis,54865,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,58661.5,
Fusion of spermatic ducts,54900,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,29989.27,
Fusion of spermatic ducts,54901,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,51328.82,
Drainage of hydrocele,55000,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,6152,,,6152,Case Rate,,848.41,,,848.41,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,408.36,,,408.36,Fee Schedule,,346.11,,,346.11,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,346.11,10359.16,
Removal of hydrocele,55040,CPT,,,,,,,,both,,,35509.29,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,24856.5,70,,24856.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,24856.5,
Removal of hydroceles,55041,CPT,,,,,,,,both,,,37008.86,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25906.2,70,,25906.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,25906.2,
Repair of hydrocele,55060,CPT,,,,,,,,both,,,35016.25,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24511.38,70,,24511.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,24511.38,
Drainage of scrotum abscess,55100,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,27281.4,
Explore scrotum,55110,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,58661.5,
Removal of scrotum lesion,55120,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29132.44,68,,29132.44,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,34273.46,
Removal of scrotum,55150,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,58661.5,
Revision of scrotum,55175,CPT,,,,,,,,both,,,35943.65,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24441.68,68,,24441.68,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,28754.92,80,,28754.92,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28754.92,80,,28754.92,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25160.56,70,,25160.56,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,28754.92,
Revision of scrotum,55180,CPT,,,,,,,,both,,,35884.32,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24401.34,68,,24401.34,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,28707.46,80,,28707.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28707.46,80,,28707.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25119.02,70,,25119.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,28707.46,
Incision of sperm duct,55200,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,58661.5,
Removal of sperm duct(s),55250,CPT,,,,,,,,both,,,35521.46,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24154.59,68,,24154.59,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,28417.17,80,,28417.17,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28417.17,80,,28417.17,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24865.02,70,,24865.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,28417.17,
Prepare sperm duct x-ray,55300,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,848.41,,,848.41,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,456.14,,,456.14,Other,New York Medicaid APG methodology,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,456.14,,,456.14,Other,100% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,697.89,,,697.89,Other,153% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,638.59,,,638.59,Other,140% New York Medicaid APG,1026.31,,,1026.31,Other,225% New York Medicaid APG,1185.95,,,1185.95,Other,260% New York Medicaid APG,1477.88,,,1477.88,Other,324% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,980.69,,,980.69,Other,215% New York Medicaid APG,570.17,,,570.17,Other,125% New York Medicaid APG,0.01,25945.68,
Repair of sperm duct,55400,CPT,,,,,,,,both,,,70514.14,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,47949.62,68,,47949.62,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,56411.31,80,,56411.31,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,56411.31,80,,56411.31,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,49359.9,70,,49359.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,56411.31,
Removal of hydrocele,55500,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,51328.82,
Removal of sperm cord lesion,55520,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,51328.82,
Revise spermatic cord veins,55530,CPT,,,,,,,,both,,,36449.42,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25514.59,70,,25514.59,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,25514.59,
Revise spermatic cord veins,55535,CPT,,,,,,,,both,,,159132.17,13671.07,,,13671.07,Other,150% of Medicare + 9.63% HCRA Surcharge,8313.46,,,8313.46,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2347.75,,,2347.75,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,111392.52,70,,111392.52,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,111392.52,
Revise hernia & sperm veins,55540,CPT,,,,,,,,both,,,72769.69,6251.65,,,6251.65,Other,150% of Medicare + 9.63% HCRA Surcharge,3801.67,,,3801.67,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50938.78,70,,50938.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,50938.78,
Laparo ligate spermatic vein,55550,CPT,,,,,,,,both,,,36303.04,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1763.08,,,1763.08,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,25412.13,70,,25412.13,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,25412.13,
Incise sperm duct pouch,55600,CPT,,,,,,,,both,,,42841.82,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,29132.44,68,,29132.44,percent of total billed charges,,2347.75,,,2347.75,Other,186% of Medicaid,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34273.46,80,,34273.46,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29989.27,70,,29989.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1262.23,,,1262.23,Other,New York Medicaid APG methodology,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,1262.23,,,1262.23,Other,100% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1931.21,,,1931.21,Other,153% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,1767.12,,,1767.12,Other,140% New York Medicaid APG,2840.02,,,2840.02,Other,225% New York Medicaid APG,3281.8,,,3281.8,Other,260% New York Medicaid APG,4089.63,,,4089.63,Other,324% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,2713.8,,,2713.8,Other,215% New York Medicaid APG,1577.79,,,1577.79,Other,125% New York Medicaid APG,1262.23,34273.46,
Remove sperm pouch lesion,55680,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,1763.08,,,1763.08,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,947.89,,,947.89,Other,New York Medicaid APG methodology,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,947.89,,,947.89,Other,100% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1450.28,,,1450.28,Other,153% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,1327.05,,,1327.05,Other,140% New York Medicaid APG,2132.76,,,2132.76,Other,225% New York Medicaid APG,2464.53,,,2464.53,Other,260% New York Medicaid APG,3071.18,,,3071.18,Other,324% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,2037.97,,,2037.97,Other,215% New York Medicaid APG,1184.87,,,1184.87,Other,125% New York Medicaid APG,947.89,58661.5,
Biopsy of prostate,55700,CPT,,,,,,,,both,,,42130.06,3680.55,,,3680.55,Other,150% of Medicare + 9.63% HCRA Surcharge,2238.16,,,2238.16,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,28648.44,68,,28648.44,percent of total billed charges,,3487.59,,,3487.59,Other,186% of Medicaid,33704.05,80,,33704.05,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33704.05,80,,33704.05,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29491.04,70,,29491.04,percent of total billed charges,,624.84,,,624.84,Fee Schedule,,529.59,,,529.59,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1875.05,,,1875.05,Other,New York Medicaid APG methodology,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2868.83,,,2868.83,Other,153% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2625.07,,,2625.07,Other,140% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,4875.13,,,4875.13,Other,260% New York Medicaid APG,6075.16,,,6075.16,Other,324% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,2343.81,,,2343.81,Other,125% New York Medicaid APG,529.59,33704.05,
Biopsy of prostate,55705,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,3487.59,,,3487.59,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1875.05,,,1875.05,Other,New York Medicaid APG methodology,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2868.83,,,2868.83,Other,153% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2625.07,,,2625.07,Other,140% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,4875.13,,,4875.13,Other,260% New York Medicaid APG,6075.16,,,6075.16,Other,324% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,2343.81,,,2343.81,Other,125% New York Medicaid APG,1875.05,58661.5,
Prostate saturation sampling,55706,CPT,,,,,,,,both,,,46242.51,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,31444.91,68,,31444.91,percent of total billed charges,,3487.59,,,3487.59,Other,186% of Medicaid,36994.01,80,,36994.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,36994.01,80,,36994.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,32369.76,70,,32369.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1875.05,,,1875.05,Other,New York Medicaid APG methodology,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2868.83,,,2868.83,Other,153% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2625.07,,,2625.07,Other,140% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,4875.13,,,4875.13,Other,260% New York Medicaid APG,6075.16,,,6075.16,Other,324% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,2343.81,,,2343.81,Other,125% New York Medicaid APG,1875.05,36994.01,
Drainage of prostate abscess,55720,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,3487.59,,,3487.59,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1875.05,,,1875.05,Other,New York Medicaid APG methodology,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2868.83,,,2868.83,Other,153% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2625.07,,,2625.07,Other,140% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,4875.13,,,4875.13,Other,260% New York Medicaid APG,6075.16,,,6075.16,Other,324% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,2343.81,,,2343.81,Other,125% New York Medicaid APG,1875.05,58661.5,
Drainage of prostate abscess,55725,CPT,,,,,,,,both,,,73326.88,6299.52,,,6299.52,Other,150% of Medicare + 9.63% HCRA Surcharge,3830.78,,,3830.78,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,49862.28,68,,49862.28,percent of total billed charges,,3487.59,,,3487.59,Other,186% of Medicaid,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,58661.5,80,,58661.5,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,51328.82,70,,51328.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1875.05,,,1875.05,Other,New York Medicaid APG methodology,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,1875.05,,,1875.05,Other,100% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2868.83,,,2868.83,Other,153% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,2625.07,,,2625.07,Other,140% New York Medicaid APG,4218.86,,,4218.86,Other,225% New York Medicaid APG,4875.13,,,4875.13,Other,260% New York Medicaid APG,6075.16,,,6075.16,Other,324% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,4031.36,,,4031.36,Other,215% New York Medicaid APG,2343.81,,,2343.81,Other,125% New York Medicaid APG,1875.05,58661.5,
Surgical exposure prostate,55860,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,74008.46,68,,74008.46,percent of total billed charges,,4646.12,,,4646.12,Other,186% of Medicaid,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,87068.78,80,,87068.78,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2053,87068.78,
Laparo radical prostatectomy,55866,CPT,,,,,,,,both,,,74675.71,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,52273,70,,52273,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,52273,
Electroejaculation,55870,CPT,,,,,,,,both,,,16909.26,1452.68,,,1452.68,Other,150% of Medicare + 9.63% HCRA Surcharge,883.38,,,883.38,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,1106.55,,,1106.55,Fee Schedule,,996.11,,,996.11,Fee Schedule,,940.89,,,940.89,Fee Schedule,,11836.48,70,,11836.48,percent of total billed charges,,11498.3,68,,11498.3,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,486.05,13527.41,
Cryoablate prostate,55873,CPT,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,135638.48,
Tprnl plmt biodegrdabl matrl,55874,CPT,,,,,,,,both,,,47733.67,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,33413.57,70,,33413.57,percent of total billed charges,,32458.9,68,,32458.9,percent of total billed charges,,4646.12,,,4646.12,Other,186% of Medicaid,38186.94,80,,38186.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,38186.94,80,,38186.94,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,33413.57,70,,33413.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2053,38186.94,
Transperi needle place pros,55875,CPT,,,,,,,,both,,,108835.97,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,76185.18,70,,76185.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,76185.18,
Place rt device/marker pros,55876,CPT,,,,,,,,both,,,45265.72,2503.84,,,2503.84,Other,150% of Medicare + 9.63% HCRA Surcharge,1522.6,,,1522.6,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,31686,70,,31686,percent of total billed charges,,30780.69,68,,30780.69,percent of total billed charges,,480.27,,,480.27,Other,186% of Medicaid,36212.58,80,,36212.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,36212.58,80,,36212.58,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,31686,70,,31686,percent of total billed charges,,492,,,492,Fee Schedule,,417,,,417,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,258.21,,,258.21,Other,New York Medicaid APG methodology,258.21,,,258.21,Other,100% New York Medicaid APG,258.21,,,258.21,Other,100% New York Medicaid APG,258.21,,,258.21,Other,100% New York Medicaid APG,580.98,,,580.98,Other,225% New York Medicaid APG,395.06,,,395.06,Other,153% New York Medicaid APG,580.98,,,580.98,Other,225% New York Medicaid APG,361.5,,,361.5,Other,140% New York Medicaid APG,580.98,,,580.98,Other,225% New York Medicaid APG,671.35,,,671.35,Other,260% New York Medicaid APG,836.6,,,836.6,Other,324% New York Medicaid APG,555.15,,,555.15,Other,215% New York Medicaid APG,555.15,,,555.15,Other,215% New York Medicaid APG,322.76,,,322.76,Other,125% New York Medicaid APG,258.21,36212.58,
Abltj mal prst8 tiss hifu,55880,CPT,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,131763.1,68,,131763.1,percent of total billed charges,,4646.12,,,4646.12,Other,186% of Medicaid,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,135638.48,70,,135638.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2232,155015.41,
Place needles pelvic for rt,55920,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,71141.55,68,,71141.55,percent of total billed charges,,3412.75,,,3412.75,Other,186% of Medicaid,83695.94,80,,83695.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,83695.94,80,,83695.94,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1834.81,,,1834.81,Other,New York Medicaid APG methodology,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,1834.81,,,1834.81,Other,100% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2807.26,,,2807.26,Other,153% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,2568.73,,,2568.73,Other,140% New York Medicaid APG,4128.32,,,4128.32,Other,225% New York Medicaid APG,4770.51,,,4770.51,Other,260% New York Medicaid APG,5944.78,,,5944.78,Other,324% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,3944.84,,,3944.84,Other,215% New York Medicaid APG,2293.51,,,2293.51,Other,125% New York Medicaid APG,1834.81,83695.94,
I & d of vulva/perineum,56405,CPT,,,,,,,,both,,,33103.16,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23172.21,70,,23172.21,percent of total billed charges,,22510.15,68,,22510.15,percent of total billed charges,,445.82,,,445.82,Other,186% of Medicaid,26482.53,80,,26482.53,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26482.53,80,,26482.53,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23172.21,70,,23172.21,percent of total billed charges,,628.12,,,628.12,Fee Schedule,,532.37,,,532.37,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,239.69,,,239.69,Other,New York Medicaid APG methodology,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,366.72,,,366.72,Other,153% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,335.56,,,335.56,Other,140% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,623.19,,,623.19,Other,260% New York Medicaid APG,776.58,,,776.58,Other,324% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,299.61,,,299.61,Other,125% New York Medicaid APG,239.69,26482.53,
Drainage of gland abscess,56420,CPT,,,,,,,,both,,,4191.33,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,2850.1,68,,2850.1,percent of total billed charges,,445.82,,,445.82,Other,186% of Medicaid,3353.06,80,,3353.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3353.06,80,,3353.06,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,549.4,,,549.4,Fee Schedule,,465.65,,,465.65,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,239.69,,,239.69,Other,New York Medicaid APG methodology,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,366.72,,,366.72,Other,153% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,335.56,,,335.56,Other,140% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,623.19,,,623.19,Other,260% New York Medicaid APG,776.58,,,776.58,Other,324% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,299.61,,,299.61,Other,125% New York Medicaid APG,218.97,7216,
Surgery for vulva lesion,56440,CPT,,,,,,,,both,,,33439.03,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22738.54,68,,22738.54,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,26751.22,80,,26751.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26751.22,80,,26751.22,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23407.32,70,,23407.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,26751.22,
Lysis of labial lesion(s),56441,CPT,,,,,,,,both,,,44954.42,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,30569.01,68,,30569.01,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,35963.54,80,,35963.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35963.54,80,,35963.54,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31468.09,70,,31468.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,35963.54,
Hymenotomy,56442,CPT,,,,,,,,both,,,35682.23,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24263.92,68,,24263.92,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,28545.78,80,,28545.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28545.78,80,,28545.78,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24977.56,70,,24977.56,percent of total billed charges,,232.88,,,232.88,Fee Schedule,,197.38,,,197.38,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,197.38,28545.78,
Destroy vulva lesions sim,56501,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,26083.13,68,,26083.13,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,660.92,,,660.92,Fee Schedule,,560.17,,,560.17,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,560.17,30686.04,
Destroy vulva lesion/s compl,56515,CPT,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,26850.29,
Biopsy of vulva/perineum,56605,CPT,,,,,,,,both,,,43090.66,1452.68,,,1452.68,Other,150% of Medicare + 9.63% HCRA Surcharge,883.38,,,883.38,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,30163.46,70,,30163.46,percent of total billed charges,,29301.65,68,,29301.65,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,34472.53,80,,34472.53,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34472.53,80,,34472.53,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,30163.46,70,,30163.46,percent of total billed charges,,290.28,,,290.28,Fee Schedule,,246.03,,,246.03,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,246.03,34472.53,
Biopsy of vulva/perineum,56606,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,144.32,,,144.32,Fee Schedule,,122.32,,,122.32,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,0.01,25945.68,
Partial removal of vulva,56620,CPT,,,,,,,,both,,,43594.74,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,30516.32,70,,30516.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,30516.32,
Complete removal of vulva,56625,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,46031.33,
Partial removal of hymen,56700,CPT,,,,,,,,both,,,33094.53,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22504.28,68,,22504.28,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,26475.62,80,,26475.62,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26475.62,80,,26475.62,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23166.17,70,,23166.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,26475.62,
Remove vagina gland lesion,56740,CPT,,,,,,,,both,,,41024.22,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28716.95,70,,28716.95,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,28716.95,
Repair of vagina,56800,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,46031.33,
Repair clitoris,56805,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,46031.33,
Repair of perineum,56810,CPT,,,,,,,,both,,,39228.34,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27459.84,70,,27459.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,27459.84,
Exam of vulva w/scope,56820,CPT,,,,,,,,both,,,4191.33,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,2850.1,68,,2850.1,percent of total billed charges,,445.82,,,445.82,Other,186% of Medicaid,3353.06,80,,3353.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3353.06,80,,3353.06,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,413.28,,,413.28,Fee Schedule,,350.28,,,350.28,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,239.69,,,239.69,Other,New York Medicaid APG methodology,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,366.72,,,366.72,Other,153% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,335.56,,,335.56,Other,140% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,623.19,,,623.19,Other,260% New York Medicaid APG,776.58,,,776.58,Other,324% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,299.61,,,299.61,Other,125% New York Medicaid APG,218.97,7216,
Exam/biopsy of vulva w/scope,56821,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,4588.45,68,,4588.45,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,352.52,7216,
Exploration of vagina,57000,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,44716.15,68,,44716.15,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,52607.23,
Drainage of pelvic abscess,57010,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,44716.15,68,,44716.15,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,52607.23,
Drainage of pelvic fluid,57020,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,71141.55,68,,71141.55,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,83695.94,80,,83695.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,83695.94,80,,83695.94,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,388.68,,,388.68,Fee Schedule,,329.43,,,329.43,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,329.43,83695.94,
I & d vaginal hematoma pp,57022,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,40641.7,68,,40641.7,percent of total billed charges,,1902.94,,,1902.94,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1023.09,,,1023.09,Other,New York Medicaid APG methodology,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1565.32,,,1565.32,Other,153% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1432.32,,,1432.32,Other,140% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,2660.03,,,2660.03,Other,260% New York Medicaid APG,3314.8,,,3314.8,Other,324% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,1278.86,,,1278.86,Other,125% New York Medicaid APG,1023.09,47813.76,
I & d vag hematoma non-ob,57023,CPT,,,,,,,,both,,,59767.2,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,40641.7,68,,40641.7,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47813.76,80,,47813.76,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,41837.04,70,,41837.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,47813.76,
Destroy vag lesions simple,57061,CPT,,,,,,,,both,,,35477.16,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,24834.01,70,,24834.01,percent of total billed charges,,24124.47,68,,24124.47,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,28381.73,80,,28381.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28381.73,80,,28381.73,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24834.01,70,,24834.01,percent of total billed charges,,570.72,,,570.72,Fee Schedule,,483.72,,,483.72,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,483.72,28381.73,
Destroy vag lesions complex,57065,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,44716.15,68,,44716.15,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,52607.23,
Biopsy of vagina,57100,CPT,,,,,,,,both,,,42428.87,1452.68,,,1452.68,Other,150% of Medicare + 9.63% HCRA Surcharge,883.38,,,883.38,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,29700.21,70,,29700.21,percent of total billed charges,,28851.63,68,,28851.63,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,33943.1,80,,33943.1,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33943.1,80,,33943.1,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,29700.21,70,,29700.21,percent of total billed charges,,318.16,,,318.16,Fee Schedule,,269.66,,,269.66,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,269.66,33943.1,
Biopsy of vagina,57105,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,44716.15,68,,44716.15,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,723.24,,,723.24,Fee Schedule,,612.99,,,612.99,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,612.99,52607.23,
Remove vagina wall partial,57106,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,46031.33,
Remove vagina tissue part,57107,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,44716.15,68,,44716.15,percent of total billed charges,,2611.99,,,2611.99,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,52607.23,
Vaginectomy partial w/nodes,57109,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,44716.15,68,,44716.15,percent of total billed charges,,2611.99,,,2611.99,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,52607.23,
Closure of vagina,57120,CPT,,,,,,,,both,,,42611.09,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,29827.76,70,,29827.76,percent of total billed charges,,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,29827.76,70,,29827.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,29827.76,
Remove vagina lesion,57130,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,44716.15,68,,44716.15,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,52607.23,
Remove vagina lesion,57135,CPT,,,,,,,,both,,,36783.79,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25012.98,68,,25012.98,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,29427.03,80,,29427.03,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29427.03,80,,29427.03,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25748.65,70,,25748.65,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,29427.03,
Treat vagina infection,57150,CPT,,,,,,,,both,,,1286.58,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,900.61,70,,900.61,percent of total billed charges,,6152,,,6152,Case Rate,,445.82,,,445.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,900.61,70,,900.61,percent of total billed charges,,126.28,,,126.28,Fee Schedule,,107.03,,,107.03,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,239.69,,,239.69,Other,New York Medicaid APG methodology,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,366.72,,,366.72,Other,153% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,335.56,,,335.56,Other,140% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,623.19,,,623.19,Other,260% New York Medicaid APG,776.58,,,776.58,Other,324% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,299.61,,,299.61,Other,125% New York Medicaid APG,67.21,9473,
Insert uteri tandem/ovoids,57155,CPT,,,,,,,,both,,,61324.15,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,41700.42,68,,41700.42,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,49059.32,80,,49059.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,49059.32,80,,49059.32,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,42926.91,70,,42926.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,49059.32,
Ins vag brachytx device,57156,CPT,,,,,,,,both,,,31449.57,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21385.71,68,,21385.71,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,25159.66,80,,25159.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25159.66,80,,25159.66,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22014.7,70,,22014.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,352.52,25159.66,
Insert pessary/other device,57160,CPT,,,,,,,,both,,,4191.33,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,6152,,,6152,Case Rate,,445.82,,,445.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,224.68,,,224.68,Fee Schedule,,190.43,,,190.43,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,239.69,,,239.69,Other,New York Medicaid APG methodology,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,366.72,,,366.72,Other,153% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,335.56,,,335.56,Other,140% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,623.19,,,623.19,Other,260% New York Medicaid APG,776.58,,,776.58,Other,324% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,299.61,,,299.61,Other,125% New York Medicaid APG,190.43,9473,
Fitting of diaphragm/cap,57170,CPT,,,,,,,,both,,,4191.33,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,2514.8,60,,2514.8,percent of total billed charges,,2347.14,56,,2347.14,percent of total billed charges,,2263.32,54,,2263.32,percent of total billed charges,,2933.93,70,,2933.93,percent of total billed charges,,6152,,,6152,Case Rate,,445.82,,,445.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,239.69,,,239.69,Other,New York Medicaid APG methodology,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,366.72,,,366.72,Other,153% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,335.56,,,335.56,Other,140% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,623.19,,,623.19,Other,260% New York Medicaid APG,776.58,,,776.58,Other,324% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,299.61,,,299.61,Other,125% New York Medicaid APG,198.77,9473,
Treat vaginal bleeding,57180,CPT,,,,,,,,both,,,4191.33,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1132.81,,,1132.81,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,600.24,,,600.24,Fee Schedule,,508.74,,,508.74,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,218.97,9473,
Repair of vagina,57200,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,44716.15,68,,44716.15,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,52607.23,
Repair vagina/perineum,57210,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,44716.15,68,,44716.15,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,52607.23,
Revision of urethra,57220,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,73233.94,
Repair of urethral lesion,57230,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,46031.33,
Anterior colporrhaphy,57240,CPT,,,,,,,,both,,,39831.69,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27882.18,70,,27882.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,27882.18,
Repair rectum & vagina,57250,CPT,,,,,,,,both,,,42205.47,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2000.77,,,2000.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,29543.83,70,,29543.83,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,29543.83,
Cmbn ant pst colprhy,57260,CPT,,,,,,,,both,,,39020.79,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27314.55,70,,27314.55,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,27314.55,
Cmbn ap colprhy w/ntrcl rpr,57265,CPT,,,,,,,,both,,,45645.86,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2000.77,,,2000.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,31952.1,70,,31952.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,31952.1,
Insert mesh/pelvic flr addon,57267,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4378.56,,,4378.56,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2354.06,,,2354.06,Other,New York Medicaid APG methodology,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,2354.06,,,2354.06,Other,100% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3601.72,,,3601.72,Other,153% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,3295.69,,,3295.69,Other,140% New York Medicaid APG,5296.64,,,5296.64,Other,225% New York Medicaid APG,6120.56,,,6120.56,Other,260% New York Medicaid APG,7627.16,,,7627.16,Other,324% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,5061.24,,,5061.24,Other,215% New York Medicaid APG,2942.58,,,2942.58,Other,125% New York Medicaid APG,0.01,22702.47,
Repair of bowel bulge,57268,CPT,,,,,,,,both,,,39241.66,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2000.77,,,2000.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27469.16,70,,27469.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1075.68,27469.16,
Colpopexy extraperitoneal,57282,CPT,,,,,,,,both,,,43146.62,13654.74,,,13654.74,Other,150% of Medicare + 9.63% HCRA Surcharge,8303.53,,,8303.53,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,30202.63,70,,30202.63,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,30202.63,
Colpopexy intraperitoneal,57283,CPT,,,,,,,,both,,,56441.72,13654.74,,,13654.74,Other,150% of Medicare + 9.63% HCRA Surcharge,8303.53,,,8303.53,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,39509.2,70,,39509.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,39509.2,
Repair paravag defect open,57284,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,73233.94,
Repair paravag defect vag,57285,CPT,,,,,,,,both,,,158942.1,13654.74,,,13654.74,Other,150% of Medicare + 9.63% HCRA Surcharge,8303.53,,,8303.53,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,111259.47,
Revise/remove sling repair,57287,CPT,,,,,,,,both,,,33689.25,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23582.48,70,,23582.48,percent of total billed charges,,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23582.48,70,,23582.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,23582.48,
Repair bladder defect,57288,CPT,,,,,,,,both,,,40467.29,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28327.1,70,,28327.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,28327.1,
Repair bladder & vagina,57289,CPT,,,,,,,,both,,,158942.1,13654.74,,,13654.74,Other,150% of Medicare + 9.63% HCRA Surcharge,8303.53,,,8303.53,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1858.11,,,1858.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,998.99,,,998.99,Other,New York Medicaid APG methodology,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,998.99,,,998.99,Other,100% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1528.45,,,1528.45,Other,153% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,1398.58,,,1398.58,Other,140% New York Medicaid APG,2247.72,,,2247.72,Other,225% New York Medicaid APG,2597.36,,,2597.36,Other,260% New York Medicaid APG,3236.71,,,3236.71,Other,324% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,2147.82,,,2147.82,Other,215% New York Medicaid APG,1248.73,,,1248.73,Other,125% New York Medicaid APG,998.99,111259.47,
Construction of vagina,57291,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,73233.94,
Construct vagina with graft,57292,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,73233.94,
Revise vag graft via vagina,57295,CPT,,,,,,,,both,,,37502.18,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26251.53,70,,26251.53,percent of total billed charges,,6152,,,6152,Case Rate,,2339.54,,,2339.54,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26251.53,70,,26251.53,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,26251.53,
Repair rectum-vagina fistula,57300,CPT,,,,,,,,both,,,39120.59,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27384.41,70,,27384.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,27384.41,
Repair urethrovaginal lesion,57310,CPT,,,,,,,,both,,,158942.1,13654.74,,,13654.74,Other,150% of Medicare + 9.63% HCRA Surcharge,8303.53,,,8303.53,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,111259.47,
Repair bladder-vagina lesion,57320,CPT,,,,,,,,both,,,49528.37,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,34669.86,70,,34669.86,percent of total billed charges,,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,34669.86,70,,34669.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,34669.86,
Repair bladder-vagina lesion,57330,CPT,,,,,,,,both,,,158942.1,13654.74,,,13654.74,Other,150% of Medicare + 9.63% HCRA Surcharge,8303.53,,,8303.53,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,111259.47,
Repair vagina,57335,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,73233.94,
Dilation of vagina,57400,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,44716.15,68,,44716.15,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,52607.23,
Pelvic examination,57410,CPT,,,,,,,,both,,,31115.46,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,21158.51,68,,21158.51,percent of total billed charges,,445.82,,,445.82,Other,186% of Medicaid,24892.37,80,,24892.37,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,24892.37,80,,24892.37,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,21780.82,70,,21780.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,239.69,,,239.69,Other,New York Medicaid APG methodology,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,366.72,,,366.72,Other,153% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,335.56,,,335.56,Other,140% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,623.19,,,623.19,Other,260% New York Medicaid APG,776.58,,,776.58,Other,324% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,299.61,,,299.61,Other,125% New York Medicaid APG,239.69,24892.37,
Remove vaginal foreign body,57415,CPT,,,,,,,,both,,,33811.25,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22991.65,68,,22991.65,percent of total billed charges,,2339.54,,,2339.54,Other,186% of Medicaid,27049,80,,27049,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27049,80,,27049,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23667.88,70,,23667.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1257.82,,,1257.82,Other,New York Medicaid APG methodology,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,1257.82,,,1257.82,Other,100% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1924.46,,,1924.46,Other,153% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,1760.94,,,1760.94,Other,140% New York Medicaid APG,2830.08,,,2830.08,Other,225% New York Medicaid APG,3270.32,,,3270.32,Other,260% New York Medicaid APG,4075.32,,,4075.32,Other,324% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,2704.3,,,2704.3,Other,215% New York Medicaid APG,1572.27,,,1572.27,Other,125% New York Medicaid APG,1257.82,27049,
Exam of vagina w/scope,57420,CPT,,,,,,,,both,,,34222.09,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23955.46,70,,23955.46,percent of total billed charges,,23271.02,68,,23271.02,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,27377.67,80,,27377.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27377.67,80,,27377.67,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23955.46,70,,23955.46,percent of total billed charges,,436.24,,,436.24,Fee Schedule,,369.74,,,369.74,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,352.52,27377.67,
Exam/biopsy of vag w/scope,57421,CPT,,,,,,,,both,,,33260,1452.68,,,1452.68,Other,150% of Medicare + 9.63% HCRA Surcharge,883.38,,,883.38,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23282,70,,23282,percent of total billed charges,,22616.8,68,,22616.8,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,26608,80,,26608,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26608,80,,26608,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23282,70,,23282,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,609.04,26608,
Repair paravag defect lap,57423,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,151560.62,
Laparoscopy surg colpopexy,57425,CPT,,,,,,,,both,,,65062.69,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,45543.88,70,,45543.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,45543.88,
Revise prosth vag graft lap,57426,CPT,,,,,,,,both,,,158942.1,13654.74,,,13654.74,Other,150% of Medicare + 9.63% HCRA Surcharge,8303.53,,,8303.53,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2611.99,,,2611.99,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1404.29,,,1404.29,Other,New York Medicaid APG methodology,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,1404.29,,,1404.29,Other,100% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,2148.57,,,2148.57,Other,153% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,1966.01,,,1966.01,Other,140% New York Medicaid APG,3159.66,,,3159.66,Other,225% New York Medicaid APG,3651.17,,,3651.17,Other,260% New York Medicaid APG,4549.91,,,4549.91,Other,324% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,3019.23,,,3019.23,Other,215% New York Medicaid APG,1755.37,,,1755.37,Other,125% New York Medicaid APG,1404.29,111259.47,
Exam of cervix w/scope,57452,CPT,,,,,,,,both,,,4191.33,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,2850.1,68,,2850.1,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,3353.06,80,,3353.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3353.06,80,,3353.06,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,218.97,7216,
Bx/curett of cervix w/scope,57454,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,4588.45,68,,4588.45,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,352.52,7216,
Biopsy of cervix w/scope,57455,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,4588.45,68,,4588.45,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,352.52,7216,
Endocerv curettage w/scope,57456,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,4588.45,68,,4588.45,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,352.52,7216,
Bx of cervix w/scope leep,57460,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,44716.15,68,,44716.15,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,52607.23,
Conz of cervix w/scope leep,57461,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,46031.33,
Biopsy of cervix,57500,CPT,,,,,,,,both,,,16909.26,1452.68,,,1452.68,Other,150% of Medicare + 9.63% HCRA Surcharge,883.38,,,883.38,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,11498.3,68,,11498.3,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,365.72,,,365.72,Fee Schedule,,309.97,,,309.97,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,309.97,13527.41,
Endocervical curettage,57505,CPT,,,,,,,,both,,,16909.26,1452.68,,,1452.68,Other,150% of Medicare + 9.63% HCRA Surcharge,883.38,,,883.38,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,11498.3,68,,11498.3,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,539.56,,,539.56,Fee Schedule,,457.31,,,457.31,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,457.31,13527.41,
Cauterization of cervix,57510,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,44716.15,68,,44716.15,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,52607.23,
Cryocautery of cervix,57511,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,4588.45,68,,4588.45,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,352.52,7216,
Laser surgery of cervix,57513,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,44716.15,68,,44716.15,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,52607.23,
Conization of cervix,57520,CPT,,,,,,,,both,,,41976.39,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,28543.95,68,,28543.95,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,33581.11,80,,33581.11,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33581.11,80,,33581.11,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,29383.47,70,,29383.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,33581.11,
Conization of cervix,57522,CPT,,,,,,,,both,,,40520.37,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27553.85,68,,27553.85,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,32416.3,80,,32416.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32416.3,80,,32416.3,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28364.26,70,,28364.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,32416.3,
Removal of cervix,57530,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,73233.94,
Removal of residual cervix,57550,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,73233.94,
Remove cervix/repair vagina,57555,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,73233.94,
Remove cervix repair bowel,57556,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,73233.94,
D&c of cervical stump,57558,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,636.32,,,636.32,Fee Schedule,,539.32,,,539.32,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,539.32,46031.33,
Revision of cervix,57700,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,44716.15,68,,44716.15,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,52607.23,
Revision of cervix,57720,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,46031.33,
Dilation of cervical canal,57800,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,44716.15,68,,44716.15,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,232.88,,,232.88,Fee Schedule,,197.38,,,197.38,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,197.38,52607.23,
Biopsy of uterus lining,58100,CPT,,,,,,,,both,,,37490.66,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,26243.46,70,,26243.46,percent of total billed charges,,25493.65,68,,25493.65,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,29992.53,80,,29992.53,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29992.53,80,,29992.53,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,26243.46,70,,26243.46,percent of total billed charges,,308.32,,,308.32,Fee Schedule,,261.32,,,261.32,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,218.97,29992.53,
Bx done w/colposcopy add-on,58110,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1132.81,,,1132.81,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,195.16,,,195.16,Fee Schedule,,165.41,,,165.41,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,609.04,,,609.04,Other,New York Medicaid APG methodology,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,609.04,,,609.04,Other,100% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,931.82,,,931.82,Other,153% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,852.65,,,852.65,Other,140% New York Medicaid APG,1370.33,,,1370.33,Other,225% New York Medicaid APG,1583.49,,,1583.49,Other,260% New York Medicaid APG,1973.27,,,1973.27,Other,324% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,1309.43,,,1309.43,Other,215% New York Medicaid APG,761.29,,,761.29,Other,125% New York Medicaid APG,0.01,25945.68,
Dilation and curettage,58120,CPT,,,,,,,,both,,,37545.36,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25530.84,68,,25530.84,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,30036.29,80,,30036.29,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30036.29,80,,30036.29,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26281.75,70,,26281.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,30036.29,
Myomectomy vag method,58145,CPT,,,,,,,,both,,,38290.05,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2183.01,,,2183.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26803.04,70,,26803.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1173.66,,,1173.66,Other,New York Medicaid APG methodology,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1795.7,,,1795.7,Other,153% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1643.13,,,1643.13,Other,140% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,3051.52,,,3051.52,Other,260% New York Medicaid APG,3802.67,,,3802.67,Other,324% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,1467.08,,,1467.08,Other,125% New York Medicaid APG,1173.66,26803.04,
Vaginal hysterectomy,58260,CPT,,,,,,,,both,,,49369.2,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,34558.44,70,,34558.44,percent of total billed charges,,6152,,,6152,Case Rate,,2183.01,,,2183.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,34558.44,70,,34558.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1173.66,,,1173.66,Other,New York Medicaid APG methodology,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1795.7,,,1795.7,Other,153% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1643.13,,,1643.13,Other,140% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,3051.52,,,3051.52,Other,260% New York Medicaid APG,3802.67,,,3802.67,Other,324% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,1467.08,,,1467.08,Other,125% New York Medicaid APG,1173.66,34558.44,
Vag hyst including t/o,58262,CPT,,,,,,,,both,,,59177.42,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,41424.19,70,,41424.19,percent of total billed charges,,6152,,,6152,Case Rate,,2183.01,,,2183.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,41424.19,70,,41424.19,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1173.66,,,1173.66,Other,New York Medicaid APG methodology,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1795.7,,,1795.7,Other,153% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1643.13,,,1643.13,Other,140% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,3051.52,,,3051.52,Other,260% New York Medicaid APG,3802.67,,,3802.67,Other,324% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,1467.08,,,1467.08,Other,125% New York Medicaid APG,1173.66,41424.19,
Vag hyst w/t/o & vag repair,58263,CPT,,,,,,,,both,,,61845.31,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,43291.72,70,,43291.72,percent of total billed charges,,6152,,,6152,Case Rate,,2183.01,,,2183.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,43291.72,70,,43291.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1173.66,,,1173.66,Other,New York Medicaid APG methodology,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1795.7,,,1795.7,Other,153% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1643.13,,,1643.13,Other,140% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,3051.52,,,3051.52,Other,260% New York Medicaid APG,3802.67,,,3802.67,Other,324% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,1467.08,,,1467.08,Other,125% New York Medicaid APG,1173.66,43291.72,
Vag hyst w/enterocele repair,58270,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,6152,,,6152,Case Rate,,2183.01,,,2183.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1173.66,,,1173.66,Other,New York Medicaid APG methodology,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1795.7,,,1795.7,Other,153% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1643.13,,,1643.13,Other,140% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,3051.52,,,3051.52,Other,260% New York Medicaid APG,3802.67,,,3802.67,Other,324% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,1467.08,,,1467.08,Other,125% New York Medicaid APG,1173.66,73233.94,
Vag hyst complex,58290,CPT,,,,,,,,both,,,49648.56,13654.74,,,13654.74,Other,150% of Medicare + 9.63% HCRA Surcharge,8303.53,,,8303.53,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,34753.99,70,,34753.99,percent of total billed charges,,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,34753.99,70,,34753.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,34753.99,
Vag hyst incl t/o complex,58291,CPT,,,,,,,,both,,,48303.82,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,33812.67,70,,33812.67,percent of total billed charges,,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,33812.67,70,,33812.67,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,33812.67,
Vag hyst t/o & repair compl,58292,CPT,,,,,,,,both,,,158942.1,13654.74,,,13654.74,Other,150% of Medicare + 9.63% HCRA Surcharge,8303.53,,,8303.53,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,111259.47,
Vag hyst w/enterocele compl,58294,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,73233.94,
Remove intrauterine device,58301,CPT,,,,,,,,both,,,36346.93,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,25442.85,70,,25442.85,percent of total billed charges,,24715.91,68,,24715.91,percent of total billed charges,,445.82,,,445.82,Other,186% of Medicaid,29077.54,80,,29077.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29077.54,80,,29077.54,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25442.85,70,,25442.85,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,239.69,,,239.69,Other,New York Medicaid APG methodology,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,239.69,,,239.69,Other,100% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,366.72,,,366.72,Other,153% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,335.56,,,335.56,Other,140% New York Medicaid APG,539.29,,,539.29,Other,225% New York Medicaid APG,623.19,,,623.19,Other,260% New York Medicaid APG,776.58,,,776.58,Other,324% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,515.33,,,515.33,Other,215% New York Medicaid APG,299.61,,,299.61,Other,125% New York Medicaid APG,239.69,29077.54,
Artificial insemination,58321,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4048.63,60,,4048.63,percent of total billed charges,,3778.72,56,,3778.72,percent of total billed charges,,3643.77,54,,3643.77,percent of total billed charges,,4723.4,70,,4723.4,percent of total billed charges,,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,237.8,,,237.8,Fee Schedule,,201.55,,,201.55,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,9473,
Artificial insemination,58322,CPT,,,,,,,,both,,,4191.33,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,2514.8,60,,2514.8,percent of total billed charges,,2347.14,56,,2347.14,percent of total billed charges,,2263.32,54,,2263.32,percent of total billed charges,,2933.93,70,,2933.93,percent of total billed charges,,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,282.08,,,282.08,Fee Schedule,,239.08,,,239.08,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,9473,
Sperm washing,58323,CPT,,,,,,,,both,,,4191.33,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,2514.8,60,,2514.8,percent of total billed charges,,2347.14,56,,2347.14,percent of total billed charges,,2263.32,54,,2263.32,percent of total billed charges,,2933.93,70,,2933.93,percent of total billed charges,,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,59.04,,,59.04,Fee Schedule,,50.04,,,50.04,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,9473,
Catheter for hysterography,58340,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,280.44,,,280.44,Fee Schedule,,237.69,,,237.69,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Reopen fallopian tube,58345,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,44716.15,68,,44716.15,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,52607.23,
Insert heyman uteri capsule,58346,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,71141.55,68,,71141.55,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,83695.94,80,,83695.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,83695.94,80,,83695.94,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,83695.94,
Reopen fallopian tube,58350,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,472.32,,,472.32,Fee Schedule,,400.32,,,400.32,Fee Schedule,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,400.32,73233.94,
Endometr ablate thermal,58353,CPT,,,,,,,,both,,,36275.62,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25392.93,70,,25392.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,25392.93,
Endometrial cryoablation,58356,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,73233.94,
Lsh uterus 250 g or less,58541,CPT,,,,,,,,both,,,72794.83,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,50956.38,70,,50956.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,50956.38,
Lsh w/t/o ut 250 g or less,58542,CPT,,,,,,,,both,,,74539.51,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,52177.66,70,,52177.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,52177.66,
Lsh uterus above 250 g,58543,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,151560.62,
Lsh w/t/o uterus above 250 g,58544,CPT,,,,,,,,both,,,61808.81,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,43266.17,70,,43266.17,percent of total billed charges,,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,43266.17,70,,43266.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,43266.17,
Laparoscopic myomectomy,58545,CPT,,,,,,,,both,,,55214.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,38649.99,70,,38649.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,38649.99,
Laparo-myomectomy complex,58546,CPT,,,,,,,,both,,,63611.71,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,44528.2,70,,44528.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,44528.2,
Laparo-asst vag hysterectomy,58550,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,84954.99,
Laparo-vag hyst incl t/o,58552,CPT,,,,,,,,both,,,66652.29,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,46656.6,70,,46656.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,46656.6,
Laparo-vag hyst complex,58553,CPT,,,,,,,,both,,,71770.12,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,50239.08,70,,50239.08,percent of total billed charges,,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,50239.08,70,,50239.08,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,50239.08,
Laparo-vag hyst w/t/o compl,58554,CPT,,,,,,,,both,,,97317.14,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,68122,70,,68122,percent of total billed charges,,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,68122,70,,68122,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,68122,
Hysteroscopy dx sep proc,58555,CPT,,,,,,,,both,,,34430.83,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23412.96,68,,23412.96,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,27544.66,80,,27544.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27544.66,80,,27544.66,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24101.58,70,,24101.58,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,27544.66,
Hysteroscopy biopsy,58558,CPT,,,,,,,,both,,,39392.83,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27574.98,70,,27574.98,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,27574.98,
Hysteroscopy lysis,58559,CPT,,,,,,,,both,,,36552.16,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24855.47,68,,24855.47,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,29241.73,80,,29241.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29241.73,80,,29241.73,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25586.51,70,,25586.51,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,29241.73,
Hysteroscopy resect septum,58560,CPT,,,,,,,,both,,,37501.05,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26250.74,70,,26250.74,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,26250.74,
Hysteroscopy remove myoma,58561,CPT,,,,,,,,both,,,40296.84,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2183.01,,,2183.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,28207.79,70,,28207.79,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1173.66,,,1173.66,Other,New York Medicaid APG methodology,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,1173.66,,,1173.66,Other,100% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1795.7,,,1795.7,Other,153% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,1643.13,,,1643.13,Other,140% New York Medicaid APG,2640.74,,,2640.74,Other,225% New York Medicaid APG,3051.52,,,3051.52,Other,260% New York Medicaid APG,3802.67,,,3802.67,Other,324% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,2523.37,,,2523.37,Other,215% New York Medicaid APG,1467.08,,,1467.08,Other,125% New York Medicaid APG,1173.66,28207.79,
Hysteroscopy remove fb,58562,CPT,,,,,,,,both,,,37612.98,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26329.09,70,,26329.09,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,26329.09,
Hysteroscopy ablation,58563,CPT,,,,,,,,both,,,39521.04,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27664.73,70,,27664.73,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,27664.73,
Hysteroscopy sterilization,58565,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,73233.94,
Tlh uterus 250 g or less,58570,CPT,,,,,,,,both,,,56767.61,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,39737.33,70,,39737.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,39737.33,
Tlh w/t/o 250 g or less,58571,CPT,,,,,,,,both,,,69079.78,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,48355.85,70,,48355.85,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,48355.85,
Tlh uterus over 250 g,58572,CPT,,,,,,,,both,,,66943.71,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,46860.6,70,,46860.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,46860.6,
Tlh w/t/o uterus over 250 g,58573,CPT,,,,,,,,both,,,65388.32,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,45771.82,70,,45771.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,45771.82,
Division of fallopian tube,58600,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,44716.15,68,,44716.15,percent of total billed charges,,2506.67,,,2506.67,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,52607.23,
Occlude fallopian tube(s),58615,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,46031.33,
Laparoscopy lysis,58660,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,84954.99,
Laparoscopy remove adnexa,58661,CPT,,,,,,,,both,,,47043.3,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,32930.31,70,,32930.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,32930.31,
Laparoscopy excise lesions,58662,CPT,,,,,,,,both,,,51210.47,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,35847.33,70,,35847.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,35847.33,
Laparoscopy tubal cautery,58670,CPT,,,,,,,,both,,,40404.53,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,28283.17,70,,28283.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,28283.17,
Laparoscopy tubal block,58671,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,84954.99,
Laparoscopy fimbrioplasty,58672,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,84954.99,
Laparoscopy salpingostomy,58673,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,151560.62,
Laps abltj uterine fibroids,58674,CPT,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,3591.19,,,3591.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1930.75,,,1930.75,Other,New York Medicaid APG methodology,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,1930.75,,,1930.75,Other,100% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2954.04,,,2954.04,Other,153% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,2703.04,,,2703.04,Other,140% New York Medicaid APG,4344.18,,,4344.18,Other,225% New York Medicaid APG,5019.94,,,5019.94,Other,260% New York Medicaid APG,6255.62,,,6255.62,Other,324% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,4151.1,,,4151.1,Other,215% New York Medicaid APG,2413.43,,,2413.43,Other,125% New York Medicaid APG,1930.75,151560.62,
Create new tubal opening,58770,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,46031.33,
Drainage of ovarian cyst(s),58800,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,46031.33,
Drainage of ovarian cyst(s),58805,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,46031.33,
Drain ovary abscess open,58820,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,46031.33,
Biopsy of ovary(s),58900,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2506.67,,,2506.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1347.67,,,1347.67,Other,New York Medicaid APG methodology,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,1347.67,,,1347.67,Other,100% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,2061.94,,,2061.94,Other,153% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,1886.74,,,1886.74,Other,140% New York Medicaid APG,3032.26,,,3032.26,Other,225% New York Medicaid APG,3503.95,,,3503.95,Other,260% New York Medicaid APG,4366.46,,,4366.46,Other,324% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,2897.5,,,2897.5,Other,215% New York Medicaid APG,1684.59,,,1684.59,Other,125% New York Medicaid APG,1347.67,46031.33,
Partial removal of ovary(s),58920,CPT,,,,,,,,both,,,158942.1,13654.74,,,13654.74,Other,150% of Medicare + 9.63% HCRA Surcharge,8303.53,,,8303.53,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,111259.47,70,,111259.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,111259.47,
Removal of ovarian cyst(s),58925,CPT,,,,,,,,both,,,42664.12,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,29864.88,70,,29864.88,percent of total billed charges,,6152,,,6152,Case Rate,,3049.55,,,3049.55,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,29864.88,70,,29864.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1639.54,,,1639.54,Other,New York Medicaid APG methodology,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,1639.54,,,1639.54,Other,100% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2508.5,,,2508.5,Other,153% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,2295.36,,,2295.36,Other,140% New York Medicaid APG,3688.97,,,3688.97,Other,225% New York Medicaid APG,4262.81,,,4262.81,Other,260% New York Medicaid APG,5312.12,,,5312.12,Other,324% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,3525.02,,,3525.02,Other,215% New York Medicaid APG,2049.43,,,2049.43,Other,125% New York Medicaid APG,1639.54,29864.88,
Retrieval of oocyte,58970,CPT,,,,,,,,both,,,16909.26,1452.68,,,1452.68,Other,150% of Medicare + 9.63% HCRA Surcharge,883.38,,,883.38,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,11498.3,68,,11498.3,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,13527.41,
Transfer of embryo,58974,CPT,,,,,,,,both,,,16909.26,1452.68,,,1452.68,Other,150% of Medicare + 9.63% HCRA Surcharge,883.38,,,883.38,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,11498.3,68,,11498.3,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,10991.02,65,,10991.02,percent of total billed charges,,10991.02,65,,10991.02,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,13527.41,
Transfer of embryo,58976,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,4588.45,68,,4588.45,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,7216,
Amniocentesis diagnostic,59000,CPT,,,,,,,,both,,,16909.26,1452.68,,,1452.68,Other,150% of Medicare + 9.63% HCRA Surcharge,883.38,,,883.38,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,11498.3,68,,11498.3,percent of total billed charges,,1454.11,,,1454.11,Other,186% of Medicaid,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13527.41,80,,13527.41,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,393.6,,,393.6,Fee Schedule,,333.6,,,333.6,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,781.78,,,781.78,Other,New York Medicaid APG methodology,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1196.12,,,1196.12,Other,153% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1094.49,,,1094.49,Other,140% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,2032.62,,,2032.62,Other,260% New York Medicaid APG,2532.96,,,2532.96,Other,324% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,977.22,,,977.22,Other,125% New York Medicaid APG,333.6,13527.41,
Amniocentesis therapeutic,59001,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,4588.45,68,,4588.45,percent of total billed charges,,1454.11,,,1454.11,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,781.78,,,781.78,Other,New York Medicaid APG methodology,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1196.12,,,1196.12,Other,153% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1094.49,,,1094.49,Other,140% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,2032.62,,,2032.62,Other,260% New York Medicaid APG,2532.96,,,2532.96,Other,324% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,977.22,,,977.22,Other,125% New York Medicaid APG,352.52,7216,
Fetal cord puncture prenatal,59012,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,6152,,,6152,Case Rate,,1454.11,,,1454.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,781.78,,,781.78,Other,New York Medicaid APG methodology,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1196.12,,,1196.12,Other,153% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1094.49,,,1094.49,Other,140% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,2032.62,,,2032.62,Other,260% New York Medicaid APG,2532.96,,,2532.96,Other,324% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,977.22,,,977.22,Other,125% New York Medicaid APG,352.52,9473,
Chorion biopsy,59015,CPT,,,,,,,,both,,,16909.26,1452.68,,,1452.68,Other,150% of Medicare + 9.63% HCRA Surcharge,883.38,,,883.38,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,6152,,,6152,Case Rate,,1454.11,,,1454.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,11836.48,70,,11836.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,781.78,,,781.78,Other,New York Medicaid APG methodology,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1196.12,,,1196.12,Other,153% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1094.49,,,1094.49,Other,140% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,2032.62,,,2032.62,Other,260% New York Medicaid APG,2532.96,,,2532.96,Other,324% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,977.22,,,977.22,Other,125% New York Medicaid APG,781.78,11836.48,
Fetal contract stress test,59020,CPT,,,,,,,,both,,,4191.33,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,6152,,,6152,Case Rate,,594.79,,,594.79,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,2724.36,65,,2724.36,percent of total billed charges,,2724.36,65,,2724.36,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,319.78,,,319.78,Other,New York Medicaid APG methodology,319.78,,,319.78,Other,100% New York Medicaid APG,319.78,,,319.78,Other,100% New York Medicaid APG,319.78,,,319.78,Other,100% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,489.26,,,489.26,Other,153% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,447.69,,,447.69,Other,140% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,831.43,,,831.43,Other,260% New York Medicaid APG,1036.08,,,1036.08,Other,324% New York Medicaid APG,687.53,,,687.53,Other,215% New York Medicaid APG,687.53,,,687.53,Other,215% New York Medicaid APG,399.72,,,399.72,Other,125% New York Medicaid APG,218.97,9473,
Fetal non-stress test,59025,CPT,,,,,,,,both,,,4191.33,360.08,,,360.08,Other,150% of Medicare + 9.63% HCRA Surcharge,218.97,,,218.97,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,115.45,,,115.45,Fee Schedule,,103.93,,,103.93,Fee Schedule,,98.17,,,98.17,Fee Schedule,,2933.93,70,,2933.93,percent of total billed charges,,6152,,,6152,Case Rate,,594.79,,,594.79,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2933.93,70,,2933.93,percent of total billed charges,,2724.36,65,,2724.36,percent of total billed charges,,2724.36,65,,2724.36,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,319.78,,,319.78,Other,New York Medicaid APG methodology,319.78,,,319.78,Other,100% New York Medicaid APG,319.78,,,319.78,Other,100% New York Medicaid APG,319.78,,,319.78,Other,100% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,489.26,,,489.26,Other,153% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,447.69,,,447.69,Other,140% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,831.43,,,831.43,Other,260% New York Medicaid APG,1036.08,,,1036.08,Other,324% New York Medicaid APG,687.53,,,687.53,Other,215% New York Medicaid APG,687.53,,,687.53,Other,215% New York Medicaid APG,399.72,,,399.72,Other,125% New York Medicaid APG,98.17,9473,
Fetal scalp blood sample,59030,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,6152,,,6152,Case Rate,,594.79,,,594.79,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,319.78,,,319.78,Other,New York Medicaid APG methodology,319.78,,,319.78,Other,100% New York Medicaid APG,319.78,,,319.78,Other,100% New York Medicaid APG,319.78,,,319.78,Other,100% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,489.26,,,489.26,Other,153% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,447.69,,,447.69,Other,140% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,831.43,,,831.43,Other,260% New York Medicaid APG,1036.08,,,1036.08,Other,324% New York Medicaid APG,687.53,,,687.53,Other,215% New York Medicaid APG,687.53,,,687.53,Other,215% New York Medicaid APG,399.72,,,399.72,Other,125% New York Medicaid APG,319.78,9473,
Transabdom amnioinfus w/us,59070,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,4588.45,68,,4588.45,percent of total billed charges,,1454.11,,,1454.11,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,781.78,,,781.78,Other,New York Medicaid APG methodology,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1196.12,,,1196.12,Other,153% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1094.49,,,1094.49,Other,140% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,2032.62,,,2032.62,Other,260% New York Medicaid APG,2532.96,,,2532.96,Other,324% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,977.22,,,977.22,Other,125% New York Medicaid APG,352.52,7216,
Umbilical cord occlud w/us,59072,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,4588.45,68,,4588.45,percent of total billed charges,,1377.33,,,1377.33,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,740.5,,,740.5,Other,New York Medicaid APG methodology,740.5,,,740.5,Other,100% New York Medicaid APG,740.5,,,740.5,Other,100% New York Medicaid APG,740.5,,,740.5,Other,100% New York Medicaid APG,1666.13,,,1666.13,Other,225% New York Medicaid APG,1132.97,,,1132.97,Other,153% New York Medicaid APG,1666.13,,,1666.13,Other,225% New York Medicaid APG,1036.7,,,1036.7,Other,140% New York Medicaid APG,1666.13,,,1666.13,Other,225% New York Medicaid APG,1925.3,,,1925.3,Other,260% New York Medicaid APG,2399.23,,,2399.23,Other,324% New York Medicaid APG,1592.08,,,1592.08,Other,215% New York Medicaid APG,1592.08,,,1592.08,Other,215% New York Medicaid APG,925.63,,,925.63,Other,125% New York Medicaid APG,352.52,7216,
Fetal fluid drainage w/us,59074,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,4588.45,68,,4588.45,percent of total billed charges,,594.79,,,594.79,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,319.78,,,319.78,Other,New York Medicaid APG methodology,319.78,,,319.78,Other,100% New York Medicaid APG,319.78,,,319.78,Other,100% New York Medicaid APG,319.78,,,319.78,Other,100% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,489.26,,,489.26,Other,153% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,447.69,,,447.69,Other,140% New York Medicaid APG,719.5,,,719.5,Other,225% New York Medicaid APG,831.43,,,831.43,Other,260% New York Medicaid APG,1036.08,,,1036.08,Other,324% New York Medicaid APG,687.53,,,687.53,Other,215% New York Medicaid APG,687.53,,,687.53,Other,215% New York Medicaid APG,399.72,,,399.72,Other,125% New York Medicaid APG,319.78,7216,
Fetal shunt placement w/us,59076,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,4588.45,68,,4588.45,percent of total billed charges,,1377.33,,,1377.33,Other,186% of Medicaid,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5398.18,80,,5398.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,740.5,,,740.5,Other,New York Medicaid APG methodology,740.5,,,740.5,Other,100% New York Medicaid APG,740.5,,,740.5,Other,100% New York Medicaid APG,740.5,,,740.5,Other,100% New York Medicaid APG,1666.13,,,1666.13,Other,225% New York Medicaid APG,1132.97,,,1132.97,Other,153% New York Medicaid APG,1666.13,,,1666.13,Other,225% New York Medicaid APG,1036.7,,,1036.7,Other,140% New York Medicaid APG,1666.13,,,1666.13,Other,225% New York Medicaid APG,1925.3,,,1925.3,Other,260% New York Medicaid APG,2399.23,,,2399.23,Other,324% New York Medicaid APG,1592.08,,,1592.08,Other,215% New York Medicaid APG,1592.08,,,1592.08,Other,215% New York Medicaid APG,925.63,,,925.63,Other,125% New York Medicaid APG,352.52,7216,
Remove uterus lesion,59100,CPT,,,,,,,,both,,,104619.92,8987.91,,,8987.91,Other,150% of Medicare + 9.63% HCRA Surcharge,5465.6,,,5465.6,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,6152,,,6152,Case Rate,,2860.98,,,2860.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,73233.94,70,,73233.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1538.16,,,1538.16,Other,New York Medicaid APG methodology,1538.16,,,1538.16,Other,100% New York Medicaid APG,1538.16,,,1538.16,Other,100% New York Medicaid APG,1538.16,,,1538.16,Other,100% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,2353.39,,,2353.39,Other,153% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,2153.43,,,2153.43,Other,140% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,3999.22,,,3999.22,Other,260% New York Medicaid APG,4983.65,,,4983.65,Other,324% New York Medicaid APG,3307.05,,,3307.05,Other,215% New York Medicaid APG,3307.05,,,3307.05,Other,215% New York Medicaid APG,1922.7,,,1922.7,Other,125% New York Medicaid APG,1538.16,73233.94,
Treat ectopic pregnancy,59150,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,2860.98,,,2860.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1538.16,,,1538.16,Other,New York Medicaid APG methodology,1538.16,,,1538.16,Other,100% New York Medicaid APG,1538.16,,,1538.16,Other,100% New York Medicaid APG,1538.16,,,1538.16,Other,100% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,2353.39,,,2353.39,Other,153% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,2153.43,,,2153.43,Other,140% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,3999.22,,,3999.22,Other,260% New York Medicaid APG,4983.65,,,4983.65,Other,324% New York Medicaid APG,3307.05,,,3307.05,Other,215% New York Medicaid APG,3307.05,,,3307.05,Other,215% New York Medicaid APG,1922.7,,,1922.7,Other,125% New York Medicaid APG,1538.16,84954.99,
Treat ectopic pregnancy,59151,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,2860.98,,,2860.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1538.16,,,1538.16,Other,New York Medicaid APG methodology,1538.16,,,1538.16,Other,100% New York Medicaid APG,1538.16,,,1538.16,Other,100% New York Medicaid APG,1538.16,,,1538.16,Other,100% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,2353.39,,,2353.39,Other,153% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,2153.43,,,2153.43,Other,140% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,3999.22,,,3999.22,Other,260% New York Medicaid APG,4983.65,,,4983.65,Other,324% New York Medicaid APG,3307.05,,,3307.05,Other,215% New York Medicaid APG,3307.05,,,3307.05,Other,215% New York Medicaid APG,1922.7,,,1922.7,Other,125% New York Medicaid APG,1538.16,84954.99,
D & c after delivery,59160,CPT,,,,,,,,both,,,38362.92,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1902.94,,,1902.94,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26854.04,70,,26854.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1023.09,,,1023.09,Other,New York Medicaid APG methodology,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1565.32,,,1565.32,Other,153% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1432.32,,,1432.32,Other,140% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,2660.03,,,2660.03,Other,260% New York Medicaid APG,3314.8,,,3314.8,Other,324% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,1278.86,,,1278.86,Other,125% New York Medicaid APG,1023.09,26854.04,
Insert cervical dilator,59200,CPT,,,,,,,,both,,,38886.96,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,27220.87,70,,27220.87,percent of total billed charges,,26443.13,68,,26443.13,percent of total billed charges,,1454.11,,,1454.11,Other,186% of Medicaid,31109.57,80,,31109.57,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31109.57,80,,31109.57,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,27220.87,70,,27220.87,percent of total billed charges,,216.48,,,216.48,Fee Schedule,,183.48,,,183.48,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,781.78,,,781.78,Other,New York Medicaid APG methodology,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1196.12,,,1196.12,Other,153% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1094.49,,,1094.49,Other,140% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,2032.62,,,2032.62,Other,260% New York Medicaid APG,2532.96,,,2532.96,Other,324% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,977.22,,,977.22,Other,125% New York Medicaid APG,183.48,31109.57,
Episiotomy or vaginal repair,59300,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,44716.15,68,,44716.15,percent of total billed charges,,1902.94,,,1902.94,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1023.09,,,1023.09,Other,New York Medicaid APG methodology,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1565.32,,,1565.32,Other,153% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1432.32,,,1432.32,Other,140% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,2660.03,,,2660.03,Other,260% New York Medicaid APG,3314.8,,,3314.8,Other,324% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,1278.86,,,1278.86,Other,125% New York Medicaid APG,1023.09,52607.23,
Revision of cervix,59320,CPT,,,,,,,,both,,,36825.48,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25041.33,68,,25041.33,percent of total billed charges,,1902.94,,,1902.94,Other,186% of Medicaid,29460.38,80,,29460.38,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29460.38,80,,29460.38,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25777.84,70,,25777.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1023.09,,,1023.09,Other,New York Medicaid APG methodology,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1565.32,,,1565.32,Other,153% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1432.32,,,1432.32,Other,140% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,2660.03,,,2660.03,Other,260% New York Medicaid APG,3314.8,,,3314.8,Other,324% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,1278.86,,,1278.86,Other,125% New York Medicaid APG,1023.09,29460.38,
Obstetrical care,59409,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,39455.42,60,,39455.42,percent of total billed charges,,36825.06,56,,36825.06,percent of total billed charges,,35509.88,54,,35509.88,percent of total billed charges,,46031.33,70,,46031.33,percent of total billed charges,,44716.15,68,,44716.15,percent of total billed charges,,3500.44,,,3500.44,Other,186% of Medicaid,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52607.23,80,,52607.23,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1881.96,,,1881.96,Other,New York Medicaid APG methodology,1881.96,,,1881.96,Other,100% New York Medicaid APG,1881.96,,,1881.96,Other,100% New York Medicaid APG,1881.96,,,1881.96,Other,100% New York Medicaid APG,4234.4,,,4234.4,Other,225% New York Medicaid APG,2879.39,,,2879.39,Other,153% New York Medicaid APG,4234.4,,,4234.4,Other,225% New York Medicaid APG,2634.74,,,2634.74,Other,140% New York Medicaid APG,4234.4,,,4234.4,Other,225% New York Medicaid APG,4893.09,,,4893.09,Other,260% New York Medicaid APG,6097.54,,,6097.54,Other,324% New York Medicaid APG,4046.21,,,4046.21,Other,215% New York Medicaid APG,4046.21,,,4046.21,Other,215% New York Medicaid APG,2352.45,,,2352.45,Other,125% New York Medicaid APG,1881.96,52607.23,
Antepartum manipulation,59412,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,6152,,,6152,Case Rate,,1454.11,,,1454.11,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,503.48,,,503.48,Fee Schedule,,426.73,,,426.73,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,781.78,,,781.78,Other,New York Medicaid APG methodology,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,781.78,,,781.78,Other,100% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1196.12,,,1196.12,Other,153% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,1094.49,,,1094.49,Other,140% New York Medicaid APG,1759,,,1759,Other,225% New York Medicaid APG,2032.62,,,2032.62,Other,260% New York Medicaid APG,2532.96,,,2532.96,Other,324% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,1680.82,,,1680.82,Other,215% New York Medicaid APG,977.22,,,977.22,Other,125% New York Medicaid APG,426.73,46031.33,
Deliver placenta,59414,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,39455.42,60,,39455.42,percent of total billed charges,,36825.06,56,,36825.06,percent of total billed charges,,35509.88,54,,35509.88,percent of total billed charges,,46031.33,70,,46031.33,percent of total billed charges,,6152,,,6152,Case Rate,,1902.94,,,1902.94,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,444.44,,,444.44,Fee Schedule,,376.69,,,376.69,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1023.09,,,1023.09,Other,New York Medicaid APG methodology,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1565.32,,,1565.32,Other,153% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1432.32,,,1432.32,Other,140% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,2660.03,,,2660.03,Other,260% New York Medicaid APG,3314.8,,,3314.8,Other,324% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,1278.86,,,1278.86,Other,125% New York Medicaid APG,376.69,46031.33,
Vbac delivery only,59612,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,39455.42,60,,39455.42,percent of total billed charges,,36825.06,56,,36825.06,percent of total billed charges,,35509.88,54,,35509.88,percent of total billed charges,,46031.33,70,,46031.33,percent of total billed charges,,6152,,,6152,Case Rate,,3500.44,,,3500.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1881.96,,,1881.96,Other,New York Medicaid APG methodology,1881.96,,,1881.96,Other,100% New York Medicaid APG,1881.96,,,1881.96,Other,100% New York Medicaid APG,1881.96,,,1881.96,Other,100% New York Medicaid APG,4234.4,,,4234.4,Other,225% New York Medicaid APG,2879.39,,,2879.39,Other,153% New York Medicaid APG,4234.4,,,4234.4,Other,225% New York Medicaid APG,2634.74,,,2634.74,Other,140% New York Medicaid APG,4234.4,,,4234.4,Other,225% New York Medicaid APG,4893.09,,,4893.09,Other,260% New York Medicaid APG,6097.54,,,6097.54,Other,324% New York Medicaid APG,4046.21,,,4046.21,Other,215% New York Medicaid APG,4046.21,,,4046.21,Other,215% New York Medicaid APG,2352.45,,,2352.45,Other,125% New York Medicaid APG,1881.96,46031.33,
Treatment of miscarriage,59812,CPT,,,,,,,,both,,,40386.74,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1456.53,,,1456.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28270.72,70,,28270.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,783.08,,,783.08,Other,New York Medicaid APG methodology,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1198.12,,,1198.12,Other,153% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1096.32,,,1096.32,Other,140% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,2036.01,,,2036.01,Other,260% New York Medicaid APG,2537.19,,,2537.19,Other,324% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,978.85,,,978.85,Other,125% New York Medicaid APG,783.08,28270.72,
Care of miscarriage,59820,CPT,,,,,,,,both,,,39754.42,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1456.53,,,1456.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27828.09,70,,27828.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,783.08,,,783.08,Other,New York Medicaid APG methodology,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1198.12,,,1198.12,Other,153% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1096.32,,,1096.32,Other,140% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,2036.01,,,2036.01,Other,260% New York Medicaid APG,2537.19,,,2537.19,Other,324% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,978.85,,,978.85,Other,125% New York Medicaid APG,783.08,27828.09,
Treatment of miscarriage,59821,CPT,,,,,,,,both,,,40901.98,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1456.53,,,1456.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28631.39,70,,28631.39,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,783.08,,,783.08,Other,New York Medicaid APG methodology,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1198.12,,,1198.12,Other,153% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1096.32,,,1096.32,Other,140% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,2036.01,,,2036.01,Other,260% New York Medicaid APG,2537.19,,,2537.19,Other,324% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,978.85,,,978.85,Other,125% New York Medicaid APG,783.08,28631.39,
Abortion,59840,CPT,,,,,,,,both,,,37030.15,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1456.53,,,1456.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25921.11,70,,25921.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,783.08,,,783.08,Other,New York Medicaid APG methodology,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1198.12,,,1198.12,Other,153% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1096.32,,,1096.32,Other,140% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,2036.01,,,2036.01,Other,260% New York Medicaid APG,2537.19,,,2537.19,Other,324% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,978.85,,,978.85,Other,125% New York Medicaid APG,783.08,25921.11,
Abortion,59841,CPT,,,,,,,,both,,,38231,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1456.53,,,1456.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26761.7,70,,26761.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,783.08,,,783.08,Other,New York Medicaid APG methodology,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1198.12,,,1198.12,Other,153% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1096.32,,,1096.32,Other,140% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,2036.01,,,2036.01,Other,260% New York Medicaid APG,2537.19,,,2537.19,Other,324% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,978.85,,,978.85,Other,125% New York Medicaid APG,783.08,26761.7,
Abortion (mpr),59866,CPT,,,,,,,,both,,,6747.72,579.7,,,579.7,Other,150% of Medicare + 9.63% HCRA Surcharge,352.52,,,352.52,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,6152,,,6152,Case Rate,,1456.53,,,1456.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4723.4,70,,4723.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,783.08,,,783.08,Other,New York Medicaid APG methodology,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,783.08,,,783.08,Other,100% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1198.12,,,1198.12,Other,153% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,1096.32,,,1096.32,Other,140% New York Medicaid APG,1761.94,,,1761.94,Other,225% New York Medicaid APG,2036.01,,,2036.01,Other,260% New York Medicaid APG,2537.19,,,2537.19,Other,324% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,1683.63,,,1683.63,Other,215% New York Medicaid APG,978.85,,,978.85,Other,125% New York Medicaid APG,352.52,9473,
Evacuate mole of uterus,59870,CPT,,,,,,,,both,,,41359.84,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2860.98,,,2860.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28951.89,70,,28951.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1538.16,,,1538.16,Other,New York Medicaid APG methodology,1538.16,,,1538.16,Other,100% New York Medicaid APG,1538.16,,,1538.16,Other,100% New York Medicaid APG,1538.16,,,1538.16,Other,100% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,2353.39,,,2353.39,Other,153% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,2153.43,,,2153.43,Other,140% New York Medicaid APG,3460.86,,,3460.86,Other,225% New York Medicaid APG,3999.22,,,3999.22,Other,260% New York Medicaid APG,4983.65,,,4983.65,Other,324% New York Medicaid APG,3307.05,,,3307.05,Other,215% New York Medicaid APG,3307.05,,,3307.05,Other,215% New York Medicaid APG,1922.7,,,1922.7,Other,125% New York Medicaid APG,1538.16,28951.89,
Remove cerclage suture,59871,CPT,,,,,,,,both,,,65759.04,5649.37,,,5649.37,Other,150% of Medicare + 9.63% HCRA Surcharge,3435.42,,,3435.42,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1902.94,,,1902.94,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46031.33,70,,46031.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1023.09,,,1023.09,Other,New York Medicaid APG methodology,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,1023.09,,,1023.09,Other,100% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1565.32,,,1565.32,Other,153% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,1432.32,,,1432.32,Other,140% New York Medicaid APG,2301.95,,,2301.95,Other,225% New York Medicaid APG,2660.03,,,2660.03,Other,260% New York Medicaid APG,3314.8,,,3314.8,Other,324% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,2199.64,,,2199.64,Other,215% New York Medicaid APG,1278.86,,,1278.86,Other,125% New York Medicaid APG,1023.09,46031.33,
Drain thyroid/tongue cyst,60000,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,25661.91,
Biopsy of thyroid,60100,CPT,,,,,,,,both,,,17214.5,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,12050.15,70,,12050.15,percent of total billed charges,,11705.86,68,,11705.86,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,13771.6,80,,13771.6,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13771.6,80,,13771.6,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,12050.15,70,,12050.15,percent of total billed charges,,373.92,,,373.92,Fee Schedule,,316.92,,,316.92,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,316.92,13771.6,
Remove thyroid lesion,60200,CPT,,,,,,,,both,,,39149.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,26621.5,68,,26621.5,percent of total billed charges,,5021.76,,,5021.76,Other,186% of Medicaid,31319.42,80,,31319.42,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31319.42,80,,31319.42,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,27404.49,70,,27404.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2232,31319.42,
Partial thyroid excision,60210,CPT,,,,,,,,both,,,47061.73,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,32943.21,70,,32943.21,percent of total billed charges,,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,32943.21,70,,32943.21,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,32943.21,
Partial thyroid excision,60212,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,84954.99,
Partial removal of thyroid,60220,CPT,,,,,,,,both,,,46869.66,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,31871.37,68,,31871.37,percent of total billed charges,,5021.76,,,5021.76,Other,186% of Medicaid,37495.73,80,,37495.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,37495.73,80,,37495.73,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,32808.76,70,,32808.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2232,37495.73,
Partial removal of thyroid,60225,CPT,,,,,,,,both,,,121364.27,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84954.99,70,,84954.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,84954.99,
Removal of thyroid,60240,CPT,,,,,,,,both,,,52929.92,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,37050.94,70,,37050.94,percent of total billed charges,,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,37050.94,70,,37050.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,37050.94,
Removal of thyroid,60252,CPT,,,,,,,,both,,,71608.73,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,50126.11,70,,50126.11,percent of total billed charges,,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,50126.11,70,,50126.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,50126.11,
Repeat thyroid surgery,60260,CPT,,,,,,,,both,,,51516.16,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,36061.31,70,,36061.31,percent of total billed charges,,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,36061.31,70,,36061.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,36061.31,
Removal of thyroid,60271,CPT,,,,,,,,both,,,60382.91,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,42268.04,70,,42268.04,percent of total billed charges,,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,42268.04,70,,42268.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,42268.04,
Remove thyroid duct lesion,60280,CPT,,,,,,,,both,,,35344.62,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,24741.23,70,,24741.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,24741.23,
Remove thyroid duct lesion,60281,CPT,,,,,,,,both,,,68111.61,10426.42,,,10426.42,Other,150% of Medicare + 9.63% HCRA Surcharge,6340.37,,,6340.37,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,47678.13,70,,47678.13,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,47678.13,
Aspir/inj thyroid cyst,60300,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,10063.18,68,,10063.18,percent of total billed charges,,1038.16,,,1038.16,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,234.52,,,234.52,Fee Schedule,,198.77,,,198.77,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,558.15,,,558.15,Other,New York Medicaid APG methodology,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,558.15,,,558.15,Other,100% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,853.97,,,853.97,Other,153% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,781.41,,,781.41,Other,140% New York Medicaid APG,1255.84,,,1255.84,Other,225% New York Medicaid APG,1451.2,,,1451.2,Other,260% New York Medicaid APG,1808.41,,,1808.41,Other,324% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,1200.03,,,1200.03,Other,215% New York Medicaid APG,697.69,,,697.69,Other,125% New York Medicaid APG,198.77,11839.04,
Explore parathyroid glands,60500,CPT,,,,,,,,both,,,51334.91,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,35934.44,70,,35934.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,35934.44,
Re-explore parathyroids,60502,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,2699.87,86224,
Autotransplant parathyroid,60512,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,6152,,,6152,Case Rate,,5021.76,,,5021.76,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2699.87,,,2699.87,Other,New York Medicaid APG methodology,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,2699.87,,,2699.87,Other,100% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,4130.8,,,4130.8,Other,153% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,3779.82,,,3779.82,Other,140% New York Medicaid APG,6074.71,,,6074.71,Other,225% New York Medicaid APG,7019.67,,,7019.67,Other,260% New York Medicaid APG,8747.58,,,8747.58,Other,324% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,5804.72,,,5804.72,Other,215% New York Medicaid APG,3374.84,,,3374.84,Other,125% New York Medicaid APG,0.01,58452.8,
Removal of thymus gland,60520,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,4047.34,,,4047.34,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2175.99,,,2175.99,Other,New York Medicaid APG methodology,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,2175.99,,,2175.99,Other,100% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3329.26,,,3329.26,Other,153% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,3046.38,,,3046.38,Other,140% New York Medicaid APG,4895.97,,,4895.97,Other,225% New York Medicaid APG,5657.57,,,5657.57,Other,260% New York Medicaid APG,7050.2,,,7050.2,Other,324% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,4678.37,,,4678.37,Other,215% New York Medicaid APG,2719.99,,,2719.99,Other,125% New York Medicaid APG,2175.99,86224,
Remove cranial cavity fluid,61000,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,9891.15,68,,9891.15,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,559.24,,,559.24,Fee Schedule,,473.99,,,473.99,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,473.99,11636.65,
Remove cranial cavity fluid,61001,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,9891.15,68,,9891.15,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,528.08,,,528.08,Fee Schedule,,447.58,,,447.58,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,447.58,11636.65,
Remove brain cavity fluid,61020,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,521.52,,,521.52,Fee Schedule,,442.02,,,442.02,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,442.02,15337.46,
Injection into brain canal,61026,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,9891.15,68,,9891.15,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,523.16,,,523.16,Fee Schedule,,443.41,,,443.41,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,443.41,11636.65,
Remove brain canal fluid,61050,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,4236.28,68,,4236.28,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,388.68,,,388.68,Fee Schedule,,329.43,,,329.43,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,325.46,7216,
Injection into brain canal,61055,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,4236.28,68,,4236.28,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,325.46,7216,
Brain canal shunt procedure,61070,CPT,,,,,,,,both,,,31698,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21554.64,68,,21554.64,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,25358.4,80,,25358.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25358.4,80,,25358.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,22188.6,70,,22188.6,percent of total billed charges,,275.52,,,275.52,Fee Schedule,,233.52,,,233.52,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,233.52,25358.4,
Insert brain-fluid device,61215,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,98080.57,
Decompress eye socket,61330,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,47404.34,
Endovasc tempory vessel occl,61623,CPT,,,,,,,,both,,,231395.43,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,161976.8,70,,161976.8,percent of total billed charges,,6152,,,6152,Case Rate,,4556,,,4556,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,161976.8,70,,161976.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2449.46,,,2449.46,Other,New York Medicaid APG methodology,2449.46,,,2449.46,Other,100% New York Medicaid APG,2449.46,,,2449.46,Other,100% New York Medicaid APG,2449.46,,,2449.46,Other,100% New York Medicaid APG,5511.29,,,5511.29,Other,225% New York Medicaid APG,3747.67,,,3747.67,Other,153% New York Medicaid APG,5511.29,,,5511.29,Other,225% New York Medicaid APG,3429.24,,,3429.24,Other,140% New York Medicaid APG,5511.29,,,5511.29,Other,225% New York Medicaid APG,6368.6,,,6368.6,Other,260% New York Medicaid APG,7936.25,,,7936.25,Other,324% New York Medicaid APG,5266.34,,,5266.34,Other,215% New York Medicaid APG,5266.34,,,5266.34,Other,215% New York Medicaid APG,3061.83,,,3061.83,Other,125% New York Medicaid APG,2449.46,161976.8,
Transcath occlusion non-cns,61626,CPT,,,,,,,,both,,,231395.43,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,161976.8,70,,161976.8,percent of total billed charges,,6152,,,6152,Case Rate,,4556,,,4556,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,161976.8,70,,161976.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2449.46,,,2449.46,Other,New York Medicaid APG methodology,2449.46,,,2449.46,Other,100% New York Medicaid APG,2449.46,,,2449.46,Other,100% New York Medicaid APG,2449.46,,,2449.46,Other,100% New York Medicaid APG,5511.29,,,5511.29,Other,225% New York Medicaid APG,3747.67,,,3747.67,Other,153% New York Medicaid APG,5511.29,,,5511.29,Other,225% New York Medicaid APG,3429.24,,,3429.24,Other,140% New York Medicaid APG,5511.29,,,5511.29,Other,225% New York Medicaid APG,6368.6,,,6368.6,Other,260% New York Medicaid APG,7936.25,,,7936.25,Other,324% New York Medicaid APG,5266.34,,,5266.34,Other,215% New York Medicaid APG,5266.34,,,5266.34,Other,215% New York Medicaid APG,3061.83,,,3061.83,Other,125% New York Medicaid APG,2449.46,161976.8,
Incise skull/brain surgery,61720,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,6152,,,6152,Case Rate,,4659.8,,,4659.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2505.27,,,2505.27,Other,New York Medicaid APG methodology,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3833.06,,,3833.06,Other,153% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3507.38,,,3507.38,Other,140% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,6513.7,,,6513.7,Other,260% New York Medicaid APG,8117.07,,,8117.07,Other,324% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,3131.59,,,3131.59,Other,125% New York Medicaid APG,2505.27,98080.57,
Incise skull for treatment,61770,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,6152,,,6152,Case Rate,,4659.8,,,4659.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2505.27,,,2505.27,Other,New York Medicaid APG methodology,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3833.06,,,3833.06,Other,153% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3507.38,,,3507.38,Other,140% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,6513.7,,,6513.7,Other,260% New York Medicaid APG,8117.07,,,8117.07,Other,324% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,3131.59,,,3131.59,Other,125% New York Medicaid APG,2505.27,98080.57,
Scan proc cranial intra,61781,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,41257.63,
Scan proc cranial extra,61782,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,41257.63,
Scan proc spinal,61783,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,0.01,41257.63,
Treat trigeminal nerve,61790,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,28428.05,
Treat trigeminal tract,61791,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,28428.05,
Revise/remove neuroelectrode,61880,CPT,,,,,,,,both,,,71436.43,6148.41,,,6148.41,Other,150% of Medicare + 9.63% HCRA Surcharge,3738.88,,,3738.88,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,50005.5,70,,50005.5,percent of total billed charges,,6152,,,6152,Case Rate,,3389.29,,,3389.29,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50005.5,70,,50005.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1822.2,,,1822.2,Other,New York Medicaid APG methodology,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2787.96,,,2787.96,Other,153% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2551.08,,,2551.08,Other,140% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,4737.72,,,4737.72,Other,260% New York Medicaid APG,5903.92,,,5903.92,Other,324% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,2277.75,,,2277.75,Other,125% New York Medicaid APG,1822.2,50005.5,
Insrt/redo neurostim 1 array,61885,CPT,,,,,,,,both,,,136359.6,39529.37,,,39529.37,Other,150% of Medicare + 9.63% HCRA Surcharge,24038.05,,,24038.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,92724.53,68,,92724.53,percent of total billed charges,,31376.13,,,31376.13,Other,186% of Medicaid,109087.68,80,,109087.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,109087.68,80,,109087.68,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,95451.72,70,,95451.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,2232,109087.68,
Implant neurostim arrays,61886,CPT,,,,,,,,both,,,127026.69,56111.71,,,56111.71,Other,150% of Medicare + 9.63% HCRA Surcharge,34121.87,,,34121.87,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,31376.13,,,31376.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,88918.68,70,,88918.68,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,3126,88918.68,
Revise/remove neuroreceiver,61888,CPT,,,,,,,,both,,,215576.2,24615.15,,,24615.15,Other,150% of Medicare + 9.63% HCRA Surcharge,14968.62,,,14968.62,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,146591.82,68,,146591.82,percent of total billed charges,,3389.29,,,3389.29,Other,186% of Medicaid,172460.96,80,,172460.96,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,172460.96,80,,172460.96,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,150903.34,70,,150903.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1822.2,,,1822.2,Other,New York Medicaid APG methodology,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2787.96,,,2787.96,Other,153% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2551.08,,,2551.08,Other,140% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,4737.72,,,4737.72,Other,260% New York Medicaid APG,5903.92,,,5903.92,Other,324% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,2277.75,,,2277.75,Other,125% New York Medicaid APG,1822.2,172460.96,
Treat skull fracture,62000,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,6152,,,6152,Case Rate,,4659.8,,,4659.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2505.27,,,2505.27,Other,New York Medicaid APG methodology,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3833.06,,,3833.06,Other,153% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3507.38,,,3507.38,Other,140% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,6513.7,,,6513.7,Other,260% New York Medicaid APG,8117.07,,,8117.07,Other,324% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,3131.59,,,3131.59,Other,125% New York Medicaid APG,2505.27,47404.34,
Neuroendoscopy add-on,62160,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,4659.8,,,4659.8,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2505.27,,,2505.27,Other,New York Medicaid APG methodology,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3833.06,,,3833.06,Other,153% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3507.38,,,3507.38,Other,140% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,6513.7,,,6513.7,Other,260% New York Medicaid APG,8117.07,,,8117.07,Other,324% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,3131.59,,,3131.59,Other,125% New York Medicaid APG,0.01,41257.63,
Replace/irrigate catheter,62194,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,32489.2,
Replace/irrigate catheter,62225,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,3252.28,,,3252.28,Other,New York Medicaid APG methodology,3252.28,,,3252.28,Other,100% New York Medicaid APG,3252.28,,,3252.28,Other,100% New York Medicaid APG,3252.28,,,3252.28,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.19,,,4553.19,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.92,,,8455.92,Other,260% New York Medicaid APG,10537.38,,,10537.38,Other,324% New York Medicaid APG,6992.4,,,6992.4,Other,215% New York Medicaid APG,6992.4,,,6992.4,Other,215% New York Medicaid APG,4065.35,,,4065.35,Other,125% New York Medicaid APG,2053,112092.08,
Replace/revise brain shunt,62230,CPT,,,,,,,,both,,,96963.46,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,65935.15,68,,65935.15,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,77570.77,80,,77570.77,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,77570.77,80,,77570.77,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,67874.42,70,,67874.42,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.28,,,3252.28,Other,New York Medicaid APG methodology,3252.28,,,3252.28,Other,100% New York Medicaid APG,3252.28,,,3252.28,Other,100% New York Medicaid APG,3252.28,,,3252.28,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.19,,,4553.19,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.92,,,8455.92,Other,260% New York Medicaid APG,10537.38,,,10537.38,Other,324% New York Medicaid APG,6992.4,,,6992.4,Other,215% New York Medicaid APG,6992.4,,,6992.4,Other,215% New York Medicaid APG,4065.35,,,4065.35,Other,125% New York Medicaid APG,2232,77570.77,
Csf shunt reprogram,62252,CPT,,,,,,,,both,,,6282.58,539.74,,,539.74,Other,150% of Medicare + 9.63% HCRA Surcharge,328.22,,,328.22,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4397.81,70,,4397.81,percent of total billed charges,,6152,,,6152,Case Rate,,340.13,,,340.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4397.81,70,,4397.81,percent of total billed charges,,4083.68,65,,4083.68,percent of total billed charges,,4083.68,65,,4083.68,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,182.86,,,182.86,Other,New York Medicaid APG methodology,182.86,,,182.86,Other,100% New York Medicaid APG,182.86,,,182.86,Other,100% New York Medicaid APG,182.86,,,182.86,Other,100% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,279.78,,,279.78,Other,153% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,256.01,,,256.01,Other,140% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,475.45,,,475.45,Other,260% New York Medicaid APG,592.48,,,592.48,Other,324% New York Medicaid APG,393.16,,,393.16,Other,215% New York Medicaid APG,393.16,,,393.16,Other,215% New York Medicaid APG,228.58,,,228.58,Other,125% New York Medicaid APG,182.86,9473,
Epidural lysis mult sessions,62263,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Epidural lysis on single day,62264,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Interdiscal perq aspir dx,62267,CPT,,,,,,,,both,,,33788,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22975.84,68,,22975.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,27030.4,80,,27030.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27030.4,80,,27030.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,23651.6,70,,23651.6,percent of total billed charges,,746.2,,,746.2,Fee Schedule,,632.45,,,632.45,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,27030.4,
Drain spinal cord cyst,62268,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Needle biopsy spinal cord,62269,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23189.19,68,,23189.19,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,27281.4,
Dx lmbr spi pnxr,62270,CPT,,,,,,,,both,,,15589.61,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,10600.93,68,,10600.93,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,12471.69,80,,12471.69,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,12471.69,80,,12471.69,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10912.73,70,,10912.73,percent of total billed charges,,305.04,,,305.04,Fee Schedule,,258.54,,,258.54,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,258.54,12471.69,
Ther spi pnxr drg csf,62272,CPT,,,,,,,,both,,,402930,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,273992.4,68,,273992.4,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,322344,80,,322344,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,322344,80,,322344,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,282051,70,,282051,percent of total billed charges,,442.8,,,442.8,Fee Schedule,,375.3,,,375.3,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,375.3,322344,
Inject epidural patch,62273,CPT,,,,,,,,both,,,3306,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,2248.08,68,,2248.08,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,2644.8,80,,2644.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2644.8,80,,2644.8,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2314.2,70,,2314.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,7216,
Treat spinal cord lesion,62280,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Treat spinal cord lesion,62281,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Treat spinal canal lesion,62282,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Injection for myelogram,62284,CPT,,,,,,,,both,,,32979.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23085.58,70,,23085.58,percent of total billed charges,,22425.99,68,,22425.99,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,26383.52,80,,26383.52,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26383.52,80,,26383.52,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23085.58,70,,23085.58,percent of total billed charges,,408.36,,,408.36,Fee Schedule,,346.11,,,346.11,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,26383.52,
Percutaneous diskectomy,62287,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2121.65,28428.05,
Njx px discography lumbar,62290,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Njx px discography crv/thrc,62291,CPT,,,,,,,,both,,,36356.27,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,21813.76,60,,21813.76,percent of total billed charges,,20359.51,56,,20359.51,percent of total billed charges,,19632.39,54,,19632.39,percent of total billed charges,,25449.39,70,,25449.39,percent of total billed charges,,24722.26,68,,24722.26,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,29085.02,80,,29085.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29085.02,80,,29085.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25449.39,70,,25449.39,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,29085.02,
Njx chemonucleolysis lmbr,62292,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,27615.82,68,,27615.82,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,32489.2,
Injection into spinal artery,62294,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1116.97,,,1116.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,13420.27,
Myelography lumbar injection,62302,CPT,,,,,,,,both,,,16841.27,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,11788.89,70,,11788.89,percent of total billed charges,,11452.06,68,,11452.06,percent of total billed charges,,1185.95,,,1185.95,Other,186% of Medicaid,13473.02,80,,13473.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13473.02,80,,13473.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,11788.89,70,,11788.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,637.61,,,637.61,Other,New York Medicaid APG methodology,637.61,,,637.61,Other,100% New York Medicaid APG,637.61,,,637.61,Other,100% New York Medicaid APG,637.61,,,637.61,Other,100% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,975.54,,,975.54,Other,153% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,892.65,,,892.65,Other,140% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,1657.77,,,1657.77,Other,260% New York Medicaid APG,2065.84,,,2065.84,Other,324% New York Medicaid APG,1370.85,,,1370.85,Other,215% New York Medicaid APG,1370.85,,,1370.85,Other,215% New York Medicaid APG,797.01,,,797.01,Other,125% New York Medicaid APG,637.61,13473.02,
Myelography lumbar injection,62303,CPT,,,,,,,,both,,,16841.27,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,11788.89,70,,11788.89,percent of total billed charges,,11452.06,68,,11452.06,percent of total billed charges,,1185.95,,,1185.95,Other,186% of Medicaid,13473.02,80,,13473.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13473.02,80,,13473.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,11788.89,70,,11788.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,637.61,,,637.61,Other,New York Medicaid APG methodology,637.61,,,637.61,Other,100% New York Medicaid APG,637.61,,,637.61,Other,100% New York Medicaid APG,637.61,,,637.61,Other,100% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,975.54,,,975.54,Other,153% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,892.65,,,892.65,Other,140% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,1657.77,,,1657.77,Other,260% New York Medicaid APG,2065.84,,,2065.84,Other,324% New York Medicaid APG,1370.85,,,1370.85,Other,215% New York Medicaid APG,1370.85,,,1370.85,Other,215% New York Medicaid APG,797.01,,,797.01,Other,125% New York Medicaid APG,637.61,13473.02,
Myelography lumbar injection,62304,CPT,,,,,,,,both,,,4472.8,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3130.96,70,,3130.96,percent of total billed charges,,3041.5,68,,3041.5,percent of total billed charges,,1185.95,,,1185.95,Other,186% of Medicaid,3578.24,80,,3578.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3578.24,80,,3578.24,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3130.96,70,,3130.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,637.61,,,637.61,Other,New York Medicaid APG methodology,637.61,,,637.61,Other,100% New York Medicaid APG,637.61,,,637.61,Other,100% New York Medicaid APG,637.61,,,637.61,Other,100% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,975.54,,,975.54,Other,153% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,892.65,,,892.65,Other,140% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,1657.77,,,1657.77,Other,260% New York Medicaid APG,2065.84,,,2065.84,Other,324% New York Medicaid APG,1370.85,,,1370.85,Other,215% New York Medicaid APG,1370.85,,,1370.85,Other,215% New York Medicaid APG,797.01,,,797.01,Other,125% New York Medicaid APG,637.61,7216,
Myelography lumbar injection,62305,CPT,,,,,,,,both,,,16841.27,1446.84,,,1446.84,Other,150% of Medicare + 9.63% HCRA Surcharge,879.83,,,879.83,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,11788.89,70,,11788.89,percent of total billed charges,,11452.06,68,,11452.06,percent of total billed charges,,1185.95,,,1185.95,Other,186% of Medicaid,13473.02,80,,13473.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,13473.02,80,,13473.02,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,11788.89,70,,11788.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,637.61,,,637.61,Other,New York Medicaid APG methodology,637.61,,,637.61,Other,100% New York Medicaid APG,637.61,,,637.61,Other,100% New York Medicaid APG,637.61,,,637.61,Other,100% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,975.54,,,975.54,Other,153% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,892.65,,,892.65,Other,140% New York Medicaid APG,1434.61,,,1434.61,Other,225% New York Medicaid APG,1657.77,,,1657.77,Other,260% New York Medicaid APG,2065.84,,,2065.84,Other,324% New York Medicaid APG,1370.85,,,1370.85,Other,215% New York Medicaid APG,1370.85,,,1370.85,Other,215% New York Medicaid APG,797.01,,,797.01,Other,125% New York Medicaid APG,637.61,13473.02,
Njx interlaminar crv/thrc,62320,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,9891.15,68,,9891.15,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,11636.65,
Njx interlaminar crv/thrc,62321,CPT,,,,,,,,both,,,4598.34,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3126.87,68,,3126.87,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,3678.67,80,,3678.67,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3678.67,80,,3678.67,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,3218.84,70,,3218.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,7216,
Njx interlaminar lmbr/sac,62322,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,390.32,,,390.32,Fee Schedule,,330.82,,,330.82,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,330.82,15337.46,
Njx interlaminar lmbr/sac,62323,CPT,,,,,,,,both,,,4568.12,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3106.32,68,,3106.32,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,3654.5,80,,3654.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3654.5,80,,3654.5,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,3197.68,70,,3197.68,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,7216,
Njx interlaminar crv/thrc,62324,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Njx interlaminar crv/thrc,62325,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Njx interlaminar lmbr/sac,62326,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Njx interlaminar lmbr/sac,62327,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Dx lmbr spi pnxr w/fluor/ct,62328,CPT,,,,,,,,both,,,13095.35,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9166.75,70,,9166.75,percent of total billed charges,,8904.84,68,,8904.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,10476.28,80,,10476.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10476.28,80,,10476.28,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9166.75,70,,9166.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,10476.28,
Ther spi pnxr csf fluor/ct,62329,CPT,,,,,,,,both,,,402933,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,282053.1,70,,282053.1,percent of total billed charges,,273994.44,68,,273994.44,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,322346.4,80,,322346.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,322346.4,80,,322346.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,282053.1,70,,282053.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,322346.4,
Implant spinal canal cath,62350,CPT,,,,,,,,both,,,69692.06,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,47390.6,68,,47390.6,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,55753.65,80,,55753.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,55753.65,80,,55753.65,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,48784.44,70,,48784.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2232,55753.65,
Implant spinal canal cath,62351,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,102324.12,68,,102324.12,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,2232,120381.32,
Remove spinal canal catheter,62355,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,32489.2,
Insert spine infusion device,62360,CPT,,,,,,,,both,,,94708.62,32226.8,,,32226.8,Other,150% of Medicare + 9.63% HCRA Surcharge,19597.31,,,19597.31,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,64401.86,68,,64401.86,percent of total billed charges,,23605.53,,,23605.53,Other,186% of Medicaid,75766.9,80,,75766.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,75766.9,80,,75766.9,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,66296.03,70,,66296.03,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,12691.15,,,12691.15,Other,New York Medicaid APG methodology,12691.15,,,12691.15,Other,100% New York Medicaid APG,12691.15,,,12691.15,Other,100% New York Medicaid APG,12691.15,,,12691.15,Other,100% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,19417.45,,,19417.45,Other,153% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,17767.6,,,17767.6,Other,140% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,32996.98,,,32996.98,Other,260% New York Medicaid APG,41119.31,,,41119.31,Other,324% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,15863.93,,,15863.93,Other,125% New York Medicaid APG,2232,75766.9,
Implant spine infusion pump,62361,CPT,,,,,,,,both,,,63160.62,32226.8,,,32226.8,Other,150% of Medicare + 9.63% HCRA Surcharge,19597.31,,,19597.31,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,42949.22,68,,42949.22,percent of total billed charges,,23605.53,,,23605.53,Other,186% of Medicaid,50528.5,80,,50528.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,50528.5,80,,50528.5,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,44212.43,70,,44212.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,12691.15,,,12691.15,Other,New York Medicaid APG methodology,12691.15,,,12691.15,Other,100% New York Medicaid APG,12691.15,,,12691.15,Other,100% New York Medicaid APG,12691.15,,,12691.15,Other,100% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,19417.45,,,19417.45,Other,153% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,17767.6,,,17767.6,Other,140% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,32996.98,,,32996.98,Other,260% New York Medicaid APG,41119.31,,,41119.31,Other,324% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,15863.93,,,15863.93,Other,125% New York Medicaid APG,2232,50528.5,
Implant spine infusion pump,62362,CPT,,,,,,,,both,,,94208.46,32226.8,,,32226.8,Other,150% of Medicare + 9.63% HCRA Surcharge,19597.31,,,19597.31,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,64061.75,68,,64061.75,percent of total billed charges,,23605.53,,,23605.53,Other,186% of Medicaid,75366.77,80,,75366.77,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,75366.77,80,,75366.77,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,65945.92,70,,65945.92,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,12691.15,,,12691.15,Other,New York Medicaid APG methodology,12691.15,,,12691.15,Other,100% New York Medicaid APG,12691.15,,,12691.15,Other,100% New York Medicaid APG,12691.15,,,12691.15,Other,100% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,19417.45,,,19417.45,Other,153% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,17767.6,,,17767.6,Other,140% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,32996.98,,,32996.98,Other,260% New York Medicaid APG,41119.31,,,41119.31,Other,324% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,15863.93,,,15863.93,Other,125% New York Medicaid APG,2232,75366.77,
Remove spine infusion device,62365,CPT,,,,,,,,both,,,60516.25,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,41151.05,68,,41151.05,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,48413,80,,48413,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,48413,80,,48413,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,42361.38,70,,42361.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2232,48413,
Analyze spine infus pump,62367,CPT,,,,,,,,both,,,6282.58,539.74,,,539.74,Other,150% of Medicare + 9.63% HCRA Surcharge,328.22,,,328.22,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4397.81,70,,4397.81,percent of total billed charges,,4272.15,68,,4272.15,percent of total billed charges,,340.13,,,340.13,Other,186% of Medicaid,5026.06,80,,5026.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5026.06,80,,5026.06,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4397.81,70,,4397.81,percent of total billed charges,,119.72,,,119.72,Fee Schedule,,101.47,,,101.47,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,182.86,,,182.86,Other,New York Medicaid APG methodology,182.86,,,182.86,Other,100% New York Medicaid APG,182.86,,,182.86,Other,100% New York Medicaid APG,182.86,,,182.86,Other,100% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,279.78,,,279.78,Other,153% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,256.01,,,256.01,Other,140% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,475.45,,,475.45,Other,260% New York Medicaid APG,592.48,,,592.48,Other,324% New York Medicaid APG,393.16,,,393.16,Other,215% New York Medicaid APG,393.16,,,393.16,Other,215% New York Medicaid APG,228.58,,,228.58,Other,125% New York Medicaid APG,101.47,7216,
Analyze sp inf pump w/reprog,62368,CPT,,,,,,,,both,,,6282.58,539.74,,,539.74,Other,150% of Medicare + 9.63% HCRA Surcharge,328.22,,,328.22,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4397.81,70,,4397.81,percent of total billed charges,,4272.15,68,,4272.15,percent of total billed charges,,340.13,,,340.13,Other,186% of Medicaid,5026.06,80,,5026.06,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5026.06,80,,5026.06,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4397.81,70,,4397.81,percent of total billed charges,,167.28,,,167.28,Fee Schedule,,141.78,,,141.78,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,182.86,,,182.86,Other,New York Medicaid APG methodology,182.86,,,182.86,Other,100% New York Medicaid APG,182.86,,,182.86,Other,100% New York Medicaid APG,182.86,,,182.86,Other,100% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,279.78,,,279.78,Other,153% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,256.01,,,256.01,Other,140% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,475.45,,,475.45,Other,260% New York Medicaid APG,592.48,,,592.48,Other,324% New York Medicaid APG,393.16,,,393.16,Other,215% New York Medicaid APG,393.16,,,393.16,Other,215% New York Medicaid APG,228.58,,,228.58,Other,125% New York Medicaid APG,141.78,7216,
Anal sp inf pmp w/reprg&fill,62369,CPT,,,,,,,,both,,,6282.58,539.74,,,539.74,Other,150% of Medicare + 9.63% HCRA Surcharge,328.22,,,328.22,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,340.13,,,340.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4397.81,70,,4397.81,percent of total billed charges,,168.92,,,168.92,Fee Schedule,,143.17,,,143.17,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,182.86,,,182.86,Other,New York Medicaid APG methodology,182.86,,,182.86,Other,100% New York Medicaid APG,182.86,,,182.86,Other,100% New York Medicaid APG,182.86,,,182.86,Other,100% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,279.78,,,279.78,Other,153% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,256.01,,,256.01,Other,140% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,475.45,,,475.45,Other,260% New York Medicaid APG,592.48,,,592.48,Other,324% New York Medicaid APG,393.16,,,393.16,Other,215% New York Medicaid APG,393.16,,,393.16,Other,215% New York Medicaid APG,228.58,,,228.58,Other,125% New York Medicaid APG,143.17,9473,
Anl sp inf pmp w/mdreprg&fil,62370,CPT,,,,,,,,both,,,32757.93,539.74,,,539.74,Other,150% of Medicare + 9.63% HCRA Surcharge,328.22,,,328.22,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22275.39,68,,22275.39,percent of total billed charges,,340.13,,,340.13,Other,186% of Medicaid,26206.34,80,,26206.34,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26206.34,80,,26206.34,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22930.55,70,,22930.55,percent of total billed charges,,223.04,,,223.04,Fee Schedule,,189.04,,,189.04,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,182.86,,,182.86,Other,New York Medicaid APG methodology,182.86,,,182.86,Other,100% New York Medicaid APG,182.86,,,182.86,Other,100% New York Medicaid APG,182.86,,,182.86,Other,100% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,279.78,,,279.78,Other,153% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,256.01,,,256.01,Other,140% New York Medicaid APG,411.45,,,411.45,Other,225% New York Medicaid APG,475.45,,,475.45,Other,260% New York Medicaid APG,592.48,,,592.48,Other,324% New York Medicaid APG,393.16,,,393.16,Other,215% New York Medicaid APG,393.16,,,393.16,Other,215% New York Medicaid APG,228.58,,,228.58,Other,125% New York Medicaid APG,182.86,26206.34,
Ndsc dcmprn 1 ntrspc lumbar,62380,CPT,,,,,,,,both,,,65343.2,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,45740.24,70,,45740.24,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2879,45740.24,
Remove spine lamina 1/2 crvl,63001,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Remove spine lamina 1/2 thrc,63003,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Remove spine lamina 1/2 lmbr,63005,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Remove spine lamina 1/2 scrl,63011,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Remove lamina/facets lumbar,63012,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Remove spine lamina >2 crvcl,63015,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Remove spine lamina >2 thrc,63016,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Remove spine lamina >2 lmbr,63017,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Neck spine disk surgery,63020,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Low back disk surgery,63030,CPT,,,,,,,,both,,,83836.24,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,58685.37,70,,58685.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,58685.37,
Spinal disk surgery add-on,63035,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,0.01,60613.98,
Laminotomy single cervical,63040,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Laminotomy single lumbar,63042,CPT,,,,,,,,both,,,52792.86,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,36955,70,,36955,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,36955,
Laminotomy addl cervical,63043,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,58882.15,68,,58882.15,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,56284.41,65,,56284.41,percent of total billed charges,,56284.41,65,,56284.41,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,0.01,69273.12,
Laminotomy addl lumbar,63044,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,58882.15,68,,58882.15,percent of total billed charges,,6658.98,,,6658.98,Other,186% of Medicaid,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,56284.41,65,,56284.41,percent of total billed charges,,56284.41,65,,56284.41,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,69273.12,
Remove spine lamina 1 crvl,63045,CPT,,,,,,,,both,,,58179.26,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,40725.48,70,,40725.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,40725.48,
Remove spine lamina 1 thrc,63046,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Remove spine lamina 1 lmbr,63047,CPT,,,,,,,,both,,,87385.96,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,61170.17,70,,61170.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,61170.17,
Remove spinal lamina add-on,63048,CPT,,,,,,,,both,,,95161.09,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,66612.76,70,,66612.76,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,66612.76,70,,66612.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,0.01,66612.76,
Decompress spinal cord thrc,63055,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Decompress spinal cord lmbr,63056,CPT,,,,,,,,both,,,81823.59,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,57276.51,70,,57276.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,57276.51,
Decompress spine cord add-on,63057,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,58882.15,68,,58882.15,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,69273.12,80,,69273.12,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,0.01,69273.12,
Decompress spinal cord thrc,63064,CPT,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Decompress spine cord add-on,63066,CPT,,,,,,,,both,,,86591.4,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,60613.98,70,,60613.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,0.01,60613.98,
Neck spine disk surgery,63075,CPT,,,,,,,,both,,,248791,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,174153.7,70,,174153.7,percent of total billed charges,,6152,,,6152,Case Rate,,6658.98,,,6658.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,174153.7,70,,174153.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,3343,174153.7,
Neck spine disk surgery,63076,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,6152,,,6152,Case Rate,,6658.98,,,6658.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,0.01,58452.8,
Remove spinal cord lesion,63600,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2121.65,32489.2,
Stimulation of spinal cord,63610,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,5526.1,,,5526.1,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2053,32489.2,
Implant neuroelectrodes,63650,CPT,,,,,,,,both,,,100920.91,12358.41,,,12358.41,Other,150% of Medicare + 9.63% HCRA Surcharge,7515.23,,,7515.23,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,68626.22,68,,68626.22,percent of total billed charges,,23605.53,,,23605.53,Other,186% of Medicaid,80736.73,80,,80736.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,80736.73,80,,80736.73,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,70644.64,70,,70644.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,12691.14,,,12691.14,Other,New York Medicaid APG methodology,12691.14,,,12691.14,Other,100% New York Medicaid APG,12691.14,,,12691.14,Other,100% New York Medicaid APG,12691.14,,,12691.14,Other,100% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,19417.45,,,19417.45,Other,153% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,17767.6,,,17767.6,Other,140% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,32996.98,,,32996.98,Other,260% New York Medicaid APG,41119.31,,,41119.31,Other,324% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,15863.93,,,15863.93,Other,125% New York Medicaid APG,2232,80736.73,
Implant neuroelectrodes,63655,CPT,,,,,,,,both,,,128738.78,39529.37,,,39529.37,Other,150% of Medicare + 9.63% HCRA Surcharge,24038.05,,,24038.05,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,90117.15,70,,90117.15,percent of total billed charges,,6152,,,6152,Case Rate,,31376.13,,,31376.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,90117.15,70,,90117.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,3343,90117.15,
Remove spine eltrd perq aray,63661,CPT,,,,,,,,both,,,58200.2,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,39576.14,68,,39576.14,percent of total billed charges,,3389.29,,,3389.29,Other,186% of Medicaid,46560.16,80,,46560.16,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,46560.16,80,,46560.16,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,40740.14,70,,40740.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1822.2,,,1822.2,Other,New York Medicaid APG methodology,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2787.96,,,2787.96,Other,153% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2551.08,,,2551.08,Other,140% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,4737.72,,,4737.72,Other,260% New York Medicaid APG,5903.92,,,5903.92,Other,324% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,2277.75,,,2277.75,Other,125% New York Medicaid APG,1822.2,46560.16,
Remove spine eltrd plate,63662,CPT,,,,,,,,both,,,74313.89,6148.41,,,6148.41,Other,150% of Medicare + 9.63% HCRA Surcharge,3738.88,,,3738.88,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,50533.45,68,,50533.45,percent of total billed charges,,3389.29,,,3389.29,Other,186% of Medicaid,59451.11,80,,59451.11,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,59451.11,80,,59451.11,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,52019.72,70,,52019.72,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1822.2,,,1822.2,Other,New York Medicaid APG methodology,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2787.96,,,2787.96,Other,153% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2551.08,,,2551.08,Other,140% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,4737.72,,,4737.72,Other,260% New York Medicaid APG,5903.92,,,5903.92,Other,324% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,2277.75,,,2277.75,Other,125% New York Medicaid APG,1822.2,59451.11,
Revise spine eltrd perq aray,63663,CPT,,,,,,,,both,,,65841.59,12358.41,,,12358.41,Other,150% of Medicare + 9.63% HCRA Surcharge,7515.23,,,7515.23,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,46089.11,70,,46089.11,percent of total billed charges,,44772.28,68,,44772.28,percent of total billed charges,,23605.53,,,23605.53,Other,186% of Medicaid,52673.27,80,,52673.27,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52673.27,80,,52673.27,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,46089.11,70,,46089.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,12691.14,,,12691.14,Other,New York Medicaid APG methodology,12691.14,,,12691.14,Other,100% New York Medicaid APG,12691.14,,,12691.14,Other,100% New York Medicaid APG,12691.14,,,12691.14,Other,100% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,19417.45,,,19417.45,Other,153% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,17767.6,,,17767.6,Other,140% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,32996.98,,,32996.98,Other,260% New York Medicaid APG,41119.31,,,41119.31,Other,324% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,15863.93,,,15863.93,Other,125% New York Medicaid APG,2053,52673.27,
Revise spine eltrd plate,63664,CPT,,,,,,,,both,,,286522.06,24615.15,,,24615.15,Other,150% of Medicare + 9.63% HCRA Surcharge,14968.62,,,14968.62,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,200565.44,70,,200565.44,percent of total billed charges,,194835,68,,194835,percent of total billed charges,,31376.13,,,31376.13,Other,186% of Medicaid,229217.65,80,,229217.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,229217.65,80,,229217.65,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,200565.44,70,,200565.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,2053,229217.65,
Insrt/redo spine n generator,63685,CPT,,,,,,,,both,,,143297.21,56111.71,,,56111.71,Other,150% of Medicare + 9.63% HCRA Surcharge,34121.87,,,34121.87,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,97442.1,68,,97442.1,percent of total billed charges,,31376.13,,,31376.13,Other,186% of Medicaid,114637.77,80,,114637.77,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,114637.77,80,,114637.77,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,100308.05,70,,100308.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,2232,114637.77,
Revise/remove neuroreceiver,63688,CPT,,,,,,,,both,,,54133.48,6148.41,,,6148.41,Other,150% of Medicare + 9.63% HCRA Surcharge,3738.88,,,3738.88,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,36810.77,68,,36810.77,percent of total billed charges,,3389.29,,,3389.29,Other,186% of Medicaid,43306.78,80,,43306.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,43306.78,80,,43306.78,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,37893.44,70,,37893.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1822.2,,,1822.2,Other,New York Medicaid APG methodology,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2787.96,,,2787.96,Other,153% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2551.08,,,2551.08,Other,140% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,4737.72,,,4737.72,Other,260% New York Medicaid APG,5903.92,,,5903.92,Other,324% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,2277.75,,,2277.75,Other,125% New York Medicaid APG,1822.2,43306.78,
Install spinal shunt,63741,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.28,,,3252.28,Other,New York Medicaid APG methodology,3252.28,,,3252.28,Other,100% New York Medicaid APG,3252.28,,,3252.28,Other,100% New York Medicaid APG,3252.28,,,3252.28,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.19,,,4553.19,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.92,,,8455.92,Other,260% New York Medicaid APG,10537.38,,,10537.38,Other,324% New York Medicaid APG,6992.4,,,6992.4,Other,215% New York Medicaid APG,6992.4,,,6992.4,Other,215% New York Medicaid APG,4065.35,,,4065.35,Other,125% New York Medicaid APG,2232,112092.08,
Revision of spinal shunt,63744,CPT,,,,,,,,both,,,96667.79,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,67667.45,70,,67667.45,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.28,,,3252.28,Other,New York Medicaid APG methodology,3252.28,,,3252.28,Other,100% New York Medicaid APG,3252.28,,,3252.28,Other,100% New York Medicaid APG,3252.28,,,3252.28,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.19,,,4553.19,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.92,,,8455.92,Other,260% New York Medicaid APG,10537.38,,,10537.38,Other,324% New York Medicaid APG,6992.4,,,6992.4,Other,215% New York Medicaid APG,6992.4,,,6992.4,Other,215% New York Medicaid APG,4065.35,,,4065.35,Other,125% New York Medicaid APG,3126,67667.45,
Removal of spinal shunt,63746,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Njx aa&/strd trigeminal nrv,64400,CPT,,,,,,,,both,,,3311,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2317.7,70,,2317.7,percent of total billed charges,,2251.48,68,,2251.48,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,2648.8,80,,2648.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2648.8,80,,2648.8,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2317.7,70,,2317.7,percent of total billed charges,,246,,,246,Fee Schedule,,208.5,,,208.5,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,208.5,7216,
Njx aa&/strd gr ocpl nrv,64405,CPT,,,,,,,,both,,,12430.65,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8701.46,70,,8701.46,percent of total billed charges,,8452.84,68,,8452.84,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,9944.52,80,,9944.52,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9944.52,80,,9944.52,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8701.46,70,,8701.46,percent of total billed charges,,257.48,,,257.48,Fee Schedule,,218.23,,,218.23,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,218.23,9944.52,
Njx aa&/strd vagus nrv,64408,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,219.76,,,219.76,Fee Schedule,,186.26,,,186.26,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,186.26,7216,
Njx aa&/strd brach plexus,64415,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,336.2,,,336.2,Fee Schedule,,284.95,,,284.95,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,284.95,15337.46,
Njx aa&/strd brach plex nfs,64416,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,13036.84,68,,13036.84,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,378.84,,,378.84,Fee Schedule,,321.09,,,321.09,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,321.09,15337.46,
Njx aa&/strd axillary nrv,64417,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,306.68,,,306.68,Fee Schedule,,259.93,,,259.93,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,259.93,15337.46,
Njx aa&/strd sprscap nrv,64418,CPT,,,,,,,,both,,,3215,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2250.5,70,,2250.5,percent of total billed charges,,2186.2,68,,2186.2,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,2572,80,,2572,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2572,80,,2572,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2250.5,70,,2250.5,percent of total billed charges,,270.6,,,270.6,Fee Schedule,,229.35,,,229.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,229.35,7216,
Njx aa&/strd ntrcost nrv 1,64420,CPT,,,,,,,,both,,,3260.17,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,2216.92,68,,2216.92,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,2608.14,80,,2608.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2608.14,80,,2608.14,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2282.12,70,,2282.12,percent of total billed charges,,283.72,,,283.72,Fee Schedule,,240.47,,,240.47,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,240.47,7216,
Njx aa&/strd ntrcost nrv ea,64421,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,118.08,,,118.08,Fee Schedule,,100.08,,,100.08,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,100.08,15337.46,
Njx aa&/strd ii ih nerves,64425,CPT,,,,,,,,both,,,3245,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2271.5,70,,2271.5,percent of total billed charges,,2206.6,68,,2206.6,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,2596,80,,2596,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2596,80,,2596,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2271.5,70,,2271.5,percent of total billed charges,,265.68,,,265.68,Fee Schedule,,225.18,,,225.18,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,225.18,7216,
Njx aa&/strd pudendal nerve,64430,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,265.68,,,265.68,Fee Schedule,,225.18,,,225.18,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,225.18,15337.46,
Njx aa&/strd paracrv nrv,64435,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,9891.15,68,,9891.15,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,211.56,,,211.56,Fee Schedule,,179.31,,,179.31,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,179.31,11636.65,
Njx aa&/strd sciatic nerve,64445,CPT,,,,,,,,both,,,4328,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3029.6,70,,3029.6,percent of total billed charges,,2943.04,68,,2943.04,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,3462.4,80,,3462.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3462.4,80,,3462.4,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,3029.6,70,,3029.6,percent of total billed charges,,355.88,,,355.88,Fee Schedule,,301.63,,,301.63,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,301.63,7216,
Njx aa&/strd sciatic nrv nfs,64446,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,6152,,,6152,Case Rate,,1120.46,,,1120.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,370.64,,,370.64,Fee Schedule,,314.14,,,314.14,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,314.14,13420.27,
Njx aa&/strd femoral nerve,64447,CPT,,,,,,,,both,,,2169.93,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1518.95,70,,1518.95,percent of total billed charges,,6152,,,6152,Case Rate,,1120.46,,,1120.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,1518.95,70,,1518.95,percent of total billed charges,,305.04,,,305.04,Fee Schedule,,258.54,,,258.54,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,258.54,9473,
Njx aa&/strd fem nerve nfs,64448,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,6152,,,6152,Case Rate,,1120.46,,,1120.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,349.32,,,349.32,Fee Schedule,,296.07,,,296.07,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,296.07,13420.27,
Njx aa&/strd lmbr plex nfs,64449,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,13036.84,68,,13036.84,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,300.12,,,300.12,Fee Schedule,,254.37,,,254.37,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,254.37,15337.46,
Njx aa&/strd other pn/branch,64450,CPT,,,,,,,,both,,,3878.41,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2714.89,70,,2714.89,percent of total billed charges,,2637.32,68,,2637.32,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,3102.73,80,,3102.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3102.73,80,,3102.73,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2714.89,70,,2714.89,percent of total billed charges,,203.36,,,203.36,Fee Schedule,,172.36,,,172.36,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,172.36,7216,
Njx aa&/strd nrv nrvtg si jt,64451,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,9891.15,68,,9891.15,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,395.24,,,395.24,Fee Schedule,,334.99,,,334.99,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,334.99,11636.65,
Njx aa&/strd gnclr nrv brnch,64454,CPT,,,,,,,,both,,,3540.73,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2478.51,70,,2478.51,percent of total billed charges,,2407.7,68,,2407.7,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,2832.58,80,,2832.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2832.58,80,,2832.58,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2478.51,70,,2478.51,percent of total billed charges,,396.88,,,396.88,Fee Schedule,,336.38,,,336.38,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,336.38,7216,
Njx aa&/strd pltr com dg nrv,64455,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,4236.28,68,,4236.28,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,162.36,,,162.36,Fee Schedule,,137.61,,,137.61,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,137.61,7216,
Pvb thoracic single inj site,64461,CPT,,,,,,,,both,,,4296.71,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3007.7,70,,3007.7,percent of total billed charges,,2921.76,68,,2921.76,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,3437.37,80,,3437.37,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3437.37,80,,3437.37,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,3007.7,70,,3007.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,7216,
Pvb thoracic 2nd+ inj site,64462,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,236.16,,,236.16,Fee Schedule,,200.16,,,200.16,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,0.01,25945.68,
Pvb thoracic cont infusion,64463,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,9891.15,68,,9891.15,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,11636.65,
Njx aa&/strd tfrm epi c/t 1,64479,CPT,,,,,,,,both,,,3200.4,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,2176.27,68,,2176.27,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,2560.32,80,,2560.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2560.32,80,,2560.32,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2240.28,70,,2240.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,7216,
Njx aa&/strd tfrm epi c/t ea,64480,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,296.84,,,296.84,Fee Schedule,,251.59,,,251.59,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,0.01,25945.68,
Njx aa&/strd tfrm epi l/s 1,64483,CPT,,,,,,,,both,,,5501.56,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3741.06,68,,3741.06,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,4401.25,80,,4401.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4401.25,80,,4401.25,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,3851.09,70,,3851.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,7216,
Njx aa&/strd tfrm epi l/s ea,64484,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,249.28,,,249.28,Fee Schedule,,211.28,,,211.28,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,0.01,25945.68,
Tap block unil by injection,64486,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,267.32,,,267.32,Fee Schedule,,226.57,,,226.57,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,0.01,25945.68,
Tap block uni by infusion,64487,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,306.68,,,306.68,Fee Schedule,,259.93,,,259.93,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,0.01,25945.68,
Tap block bi injection,64488,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,331.28,,,331.28,Fee Schedule,,280.78,,,280.78,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,0.01,25945.68,
Tap block bi by infusion,64489,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,0.01,25945.68,
Inj paravert f jnt c/t 1 lev,64490,CPT,,,,,,,,both,,,3824.58,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,2600.71,68,,2600.71,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,3059.66,80,,3059.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3059.66,80,,3059.66,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2677.21,70,,2677.21,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,7216,
Inj paravert f jnt c/t 2 lev,64491,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,287,,,287,Fee Schedule,,243.25,,,243.25,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,0.01,25945.68,
Inj paravert f jnt c/t 3 lev,64492,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,291.92,,,291.92,Fee Schedule,,247.42,,,247.42,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,0.01,25945.68,
Inj paravert f jnt l/s 1 lev,64493,CPT,,,,,,,,both,,,4305.72,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,2927.89,68,,2927.89,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,3444.58,80,,3444.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3444.58,80,,3444.58,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,3014,70,,3014,percent of total billed charges,,437.88,,,437.88,Fee Schedule,,371.13,,,371.13,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,371.13,7216,
Inj paravert f jnt l/s 2 lev,64494,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,247.64,,,247.64,Fee Schedule,,209.89,,,209.89,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,0.01,25945.68,
Inj paravert f jnt l/s 3 lev,64495,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,250.92,,,250.92,Fee Schedule,,212.67,,,212.67,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,0.01,25945.68,
N block spenopalatine gangl,64505,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,510.04,,,510.04,Fee Schedule,,432.29,,,432.29,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,325.46,7216,
N block stellate ganglion,64510,CPT,,,,,,,,both,,,3927.29,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,2670.56,68,,2670.56,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,3141.83,80,,3141.83,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3141.83,80,,3141.83,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2749.1,70,,2749.1,percent of total billed charges,,372.28,,,372.28,Fee Schedule,,315.53,,,315.53,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,315.53,7216,
N block inj hypogas plxs,64517,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,15337.46,
N block lumbar/thoracic,64520,CPT,,,,,,,,both,,,4279.6,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,2910.13,68,,2910.13,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,3423.68,80,,3423.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3423.68,80,,3423.68,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2995.72,70,,2995.72,percent of total billed charges,,408.36,,,408.36,Fee Schedule,,346.11,,,346.11,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,346.11,7216,
N block inj celiac pelus,64530,CPT,,,,,,,,both,,,12137.22,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,8253.31,68,,8253.31,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,9709.78,80,,9709.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9709.78,80,,9709.78,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8496.05,70,,8496.05,percent of total billed charges,,459.2,,,459.2,Fee Schedule,,389.2,,,389.2,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,389.2,9709.78,
Implant neuroelectrodes,64553,CPT,,,,,,,,both,,,80880.22,24615.15,,,24615.15,Other,150% of Medicare + 9.63% HCRA Surcharge,14968.62,,,14968.62,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,54998.55,68,,54998.55,percent of total billed charges,,31376.13,,,31376.13,Other,186% of Medicaid,64704.18,80,,64704.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,64704.18,80,,64704.18,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,56616.15,70,,56616.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,2053,64704.18,
Implant neuroelectrodes,64555,CPT,,,,,,,,both,,,39267.55,12358.41,,,12358.41,Other,150% of Medicare + 9.63% HCRA Surcharge,7515.23,,,7515.23,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,27487.29,70,,27487.29,percent of total billed charges,,26701.93,68,,26701.93,percent of total billed charges,,23605.53,,,23605.53,Other,186% of Medicaid,31414.04,80,,31414.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31414.04,80,,31414.04,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,27487.29,70,,27487.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,12691.14,,,12691.14,Other,New York Medicaid APG methodology,12691.14,,,12691.14,Other,100% New York Medicaid APG,12691.14,,,12691.14,Other,100% New York Medicaid APG,12691.14,,,12691.14,Other,100% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,19417.45,,,19417.45,Other,153% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,17767.6,,,17767.6,Other,140% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,32996.98,,,32996.98,Other,260% New York Medicaid APG,41119.31,,,41119.31,Other,324% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,15863.93,,,15863.93,Other,125% New York Medicaid APG,2053,41119.31,
Implant neuroelectrodes,64561,CPT,,,,,,,,both,,,36824.15,12358.41,,,12358.41,Other,150% of Medicare + 9.63% HCRA Surcharge,7515.23,,,7515.23,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,23605.53,,,23605.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,25776.91,70,,25776.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,12691.14,,,12691.14,Other,New York Medicaid APG methodology,12691.14,,,12691.14,Other,100% New York Medicaid APG,12691.14,,,12691.14,Other,100% New York Medicaid APG,12691.14,,,12691.14,Other,100% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,19417.45,,,19417.45,Other,153% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,17767.6,,,17767.6,Other,140% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,32996.98,,,32996.98,Other,260% New York Medicaid APG,41119.31,,,41119.31,Other,324% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,15863.93,,,15863.93,Other,125% New York Medicaid APG,3126,41119.31,
Neuroeltrd stim post tibial,64566,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,4236.28,68,,4236.28,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,145.96,,,145.96,Fee Schedule,,123.71,,,123.71,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,123.71,7216,
Inc for vagus n elect impl,64568,CPT,,,,,,,,both,,,196832.52,56111.71,,,56111.71,Other,150% of Medicare + 9.63% HCRA Surcharge,34121.87,,,34121.87,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,133846.11,68,,133846.11,percent of total billed charges,,31376.13,,,31376.13,Other,186% of Medicaid,157466.02,80,,157466.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,157466.02,80,,157466.02,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,137782.76,70,,137782.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,2232,157466.02,
Revise/repl vagus n eltrd,64569,CPT,,,,,,,,both,,,214748.89,24615.15,,,24615.15,Other,150% of Medicare + 9.63% HCRA Surcharge,14968.62,,,14968.62,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,146029.25,68,,146029.25,percent of total billed charges,,31376.13,,,31376.13,Other,186% of Medicaid,171799.11,80,,171799.11,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,171799.11,80,,171799.11,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,150324.22,70,,150324.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,2232,171799.11,
Remove vagus n eltrd,64570,CPT,,,,,,,,both,,,57908.89,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,39378.05,68,,39378.05,percent of total billed charges,,3389.29,,,3389.29,Other,186% of Medicaid,46327.11,80,,46327.11,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,46327.11,80,,46327.11,percent of total billed charges,,7216,,,7216,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,40536.22,70,,40536.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1822.2,,,1822.2,Other,New York Medicaid APG methodology,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2787.96,,,2787.96,Other,153% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2551.08,,,2551.08,Other,140% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,4737.72,,,4737.72,Other,260% New York Medicaid APG,5903.92,,,5903.92,Other,324% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,2277.75,,,2277.75,Other,125% New York Medicaid APG,1822.2,46327.11,
Implant neuroelectrodes,64575,CPT,,,,,,,,both,,,286522.06,24615.15,,,24615.15,Other,150% of Medicare + 9.63% HCRA Surcharge,14968.62,,,14968.62,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,194835,68,,194835,percent of total billed charges,,31376.13,,,31376.13,Other,186% of Medicaid,229217.65,80,,229217.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,229217.65,80,,229217.65,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,200565.44,70,,200565.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,2053,229217.65,
Implant neuroelectrodes,64580,CPT,,,,,,,,both,,,460124.54,39529.37,,,39529.37,Other,150% of Medicare + 9.63% HCRA Surcharge,24038.05,,,24038.05,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,312884.69,68,,312884.69,percent of total billed charges,,31376.13,,,31376.13,Other,186% of Medicaid,368099.63,80,,368099.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,368099.63,80,,368099.63,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,322087.18,70,,322087.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,2053,368099.63,
Implant neuroelectrodes,64581,CPT,,,,,,,,both,,,54207.22,12358.41,,,12358.41,Other,150% of Medicare + 9.63% HCRA Surcharge,7515.23,,,7515.23,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,23605.53,,,23605.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,37945.05,70,,37945.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,12691.14,,,12691.14,Other,New York Medicaid APG methodology,12691.14,,,12691.14,Other,100% New York Medicaid APG,12691.14,,,12691.14,Other,100% New York Medicaid APG,12691.14,,,12691.14,Other,100% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,19417.45,,,19417.45,Other,153% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,17767.6,,,17767.6,Other,140% New York Medicaid APG,28555.08,,,28555.08,Other,225% New York Medicaid APG,32996.98,,,32996.98,Other,260% New York Medicaid APG,41119.31,,,41119.31,Other,324% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,27285.96,,,27285.96,Other,215% New York Medicaid APG,15863.93,,,15863.93,Other,125% New York Medicaid APG,3126,41119.31,
Revise/remove neuroelectrode,64585,CPT,,,,,,,,both,,,48312.19,6148.41,,,6148.41,Other,150% of Medicare + 9.63% HCRA Surcharge,3738.88,,,3738.88,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,32852.29,68,,32852.29,percent of total billed charges,,3389.29,,,3389.29,Other,186% of Medicaid,38649.75,80,,38649.75,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,38649.75,80,,38649.75,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,33818.53,70,,33818.53,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1822.2,,,1822.2,Other,New York Medicaid APG methodology,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2787.96,,,2787.96,Other,153% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2551.08,,,2551.08,Other,140% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,4737.72,,,4737.72,Other,260% New York Medicaid APG,5903.92,,,5903.92,Other,324% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,2277.75,,,2277.75,Other,125% New York Medicaid APG,1822.2,38649.75,
Insrt/redo pn/gastr stimul,64590,CPT,,,,,,,,both,,,79112.92,39529.37,,,39529.37,Other,150% of Medicare + 9.63% HCRA Surcharge,24038.05,,,24038.05,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,53796.79,68,,53796.79,percent of total billed charges,,31376.13,,,31376.13,Other,186% of Medicaid,63290.34,80,,63290.34,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,63290.34,80,,63290.34,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,55379.04,70,,55379.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,2232,63290.34,
Revise/rmv pn/gastr stimul,64595,CPT,,,,,,,,both,,,36457.37,6148.41,,,6148.41,Other,150% of Medicare + 9.63% HCRA Surcharge,3738.88,,,3738.88,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24791.01,68,,24791.01,percent of total billed charges,,3389.29,,,3389.29,Other,186% of Medicaid,29165.9,80,,29165.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29165.9,80,,29165.9,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25520.16,70,,25520.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1822.2,,,1822.2,Other,New York Medicaid APG methodology,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,1822.2,,,1822.2,Other,100% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2787.96,,,2787.96,Other,153% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,2551.08,,,2551.08,Other,140% New York Medicaid APG,4099.95,,,4099.95,Other,225% New York Medicaid APG,4737.72,,,4737.72,Other,260% New York Medicaid APG,5903.92,,,5903.92,Other,324% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,3917.73,,,3917.73,Other,215% New York Medicaid APG,2277.75,,,2277.75,Other,125% New York Medicaid APG,1822.2,29165.9,
Injection treatment of nerve,64600,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,15337.46,
Injection treatment of nerve,64605,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,32489.2,
Injection treatment of nerve,64610,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,32489.2,
Chemodenerv saliv glands,64611,CPT,,,,,,,,both,,,31532.05,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21441.79,68,,21441.79,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,25225.64,80,,25225.64,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25225.64,80,,25225.64,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22072.44,70,,22072.44,percent of total billed charges,,546.12,,,546.12,Fee Schedule,,462.87,,,462.87,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,325.46,25225.64,
Destroy nerve face muscle,64612,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,580.56,,,580.56,Fee Schedule,,492.06,,,492.06,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,325.46,7216,
Chemodenerv musc migraine,64615,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,325.46,7216,
Chemodenerv musc neck dyston,64616,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,533,,,533,Fee Schedule,,451.75,,,451.75,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,325.46,7216,
Chemodener muscle larynx emg,64617,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,9891.15,68,,9891.15,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,519.75,11636.65,
Injection treatment of nerve,64620,CPT,,,,,,,,both,,,3105,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,2111.4,68,,2111.4,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,2484,80,,2484,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,2484,80,,2484,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2173.5,70,,2173.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,7216,
Dstrj nulyt agt gnclr nrv,64624,CPT,,,,,,,,both,,,11278.42,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,7669.33,68,,7669.33,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,9022.74,80,,9022.74,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9022.74,80,,9022.74,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,7894.89,70,,7894.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,9022.74,
Rf abltj nrv nrvtg si jt,64625,CPT,,,,,,,,both,,,16895.98,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,11827.19,70,,11827.19,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,11827.19,
Injection treatment of nerve,64630,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,15337.46,
N block inj common digit,64632,CPT,,,,,,,,both,,,32316.64,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,21975.32,68,,21975.32,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,25853.31,80,,25853.31,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25853.31,80,,25853.31,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22621.65,70,,22621.65,percent of total billed charges,,324.72,,,324.72,Fee Schedule,,275.22,,,275.22,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,275.22,25853.31,
Destroy cerv/thor facet jnt,64633,CPT,,,,,,,,both,,,7145.41,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,4858.88,68,,4858.88,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,5716.33,80,,5716.33,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5716.33,80,,5716.33,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,5001.79,70,,5001.79,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,7216,
Destroy c/th facet jnt addl,64634,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,323.08,,,323.08,Fee Schedule,,273.83,,,273.83,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,0.01,25945.68,
Destroy lumb/sac facet jnt,64635,CPT,,,,,,,,both,,,7323.18,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,4979.76,68,,4979.76,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,5858.54,80,,5858.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5858.54,80,,5858.54,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,5126.23,70,,5126.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,7216,
Destroy l/s facet jnt addl,64636,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,285.36,,,285.36,Fee Schedule,,241.86,,,241.86,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,0.01,25945.68,
Injection treatment of nerve,64640,CPT,,,,,,,,both,,,8581.36,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,6006.95,70,,6006.95,percent of total billed charges,,5835.32,68,,5835.32,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,6865.09,80,,6865.09,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,6865.09,80,,6865.09,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,6006.95,70,,6006.95,percent of total billed charges,,574,,,574,Fee Schedule,,486.5,,,486.5,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,486.5,7216,
Chemodenerv 1 extremity 1-4,64642,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,9891.15,68,,9891.15,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,518.24,,,518.24,Fee Schedule,,439.24,,,439.24,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,439.24,11636.65,
Chemodenerv 1 extrem 1-4 ea,64643,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,342.76,,,342.76,Fee Schedule,,290.51,,,290.51,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,0.01,25945.68,
Chemodenerv 1 extrem 5/> mus,64644,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,9891.15,68,,9891.15,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,519.75,11636.65,
Chemodenerv 1 extrem 5/> ea,64645,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,398.52,,,398.52,Fee Schedule,,337.77,,,337.77,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,0.01,25945.68,
Chemodenerv trunk musc 1-5,64646,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,9891.15,68,,9891.15,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,519.75,11636.65,
Chemodenerv trunk musc 6/>,64647,CPT,,,,,,,,both,,,14545.81,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,9891.15,68,,9891.15,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11636.65,80,,11636.65,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10182.07,70,,10182.07,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,519.75,11636.65,
Chemodenerv eccrine glands,64650,CPT,,,,,,,,both,,,6229.82,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,4236.28,68,,4236.28,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4983.86,80,,4983.86,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4360.87,70,,4360.87,percent of total billed charges,,198.44,,,198.44,Fee Schedule,,168.19,,,168.19,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,168.19,7216,
Chemodenerv eccrine glands,64653,CPT,,,,,,,,both,,,37692.12,535.2,,,535.2,Other,150% of Medicare + 9.63% HCRA Surcharge,325.46,,,325.46,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,26384.48,70,,26384.48,percent of total billed charges,,25630.64,68,,25630.64,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,30153.7,80,,30153.7,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30153.7,80,,30153.7,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,26384.48,70,,26384.48,percent of total billed charges,,252.56,,,252.56,Fee Schedule,,214.06,,,214.06,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,214.06,30153.7,
Injection treatment of nerve,64680,CPT,,,,,,,,both,,,22394,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,15227.92,68,,15227.92,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,17915.2,80,,17915.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17915.2,80,,17915.2,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,15675.8,70,,15675.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,17915.2,
Injection treatment of nerve,64681,CPT,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,13036.84,68,,13036.84,percent of total billed charges,,1120.46,,,1120.46,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,602.4,,,602.4,Other,New York Medicaid APG methodology,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,602.4,,,602.4,Other,100% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,921.67,,,921.67,Other,153% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,843.35,,,843.35,Other,140% New York Medicaid APG,1355.39,,,1355.39,Other,225% New York Medicaid APG,1566.23,,,1566.23,Other,260% New York Medicaid APG,1951.76,,,1951.76,Other,324% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,1295.15,,,1295.15,Other,215% New York Medicaid APG,752.99,,,752.99,Other,125% New York Medicaid APG,602.4,15337.46,
Revise finger/toe nerve,64702,CPT,,,,,,,,both,,,39486.15,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,26850.58,68,,26850.58,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,31588.92,80,,31588.92,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31588.92,80,,31588.92,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27640.31,70,,27640.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,31588.92,
Revise hand/foot nerve,64704,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Revise arm/leg nerve,64708,CPT,,,,,,,,both,,,44531.93,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,30281.71,68,,30281.71,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,35625.54,80,,35625.54,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35625.54,80,,35625.54,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31172.35,70,,31172.35,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,35625.54,
Revision of sciatic nerve,64712,CPT,,,,,,,,both,,,66847.9,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,45456.57,68,,45456.57,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,53478.32,80,,53478.32,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,53478.32,80,,53478.32,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,46793.53,70,,46793.53,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,53478.32,
Revision of arm nerve(s),64713,CPT,,,,,,,,both,,,67907.61,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,46177.17,68,,46177.17,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,54326.09,80,,54326.09,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54326.09,80,,54326.09,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47535.33,70,,47535.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,54326.09,
Revise low back nerve(s),64714,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,32489.2,
Revision of cranial nerve,64716,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,28428.05,
Revise ulnar nerve at elbow,64718,CPT,,,,,,,,both,,,46351.11,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,31518.75,68,,31518.75,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,37080.89,80,,37080.89,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,37080.89,80,,37080.89,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,32445.78,70,,32445.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,37080.89,
Revise ulnar nerve at wrist,64719,CPT,,,,,,,,both,,,55878.32,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,37997.26,68,,37997.26,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,44702.66,80,,44702.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,44702.66,80,,44702.66,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,39114.82,70,,39114.82,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,44702.66,
Carpal tunnel surgery,64721,CPT,,,,,,,,both,,,35340.41,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24031.48,68,,24031.48,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,28272.33,80,,28272.33,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28272.33,80,,28272.33,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24738.29,70,,24738.29,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,28272.33,
Relieve pressure on nerve(s),64722,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Release foot/toe nerve,64726,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Internal nerve revision,64727,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,25945.68,
Incision of brow nerve,64732,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Incision of cheek nerve,64734,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Incision of chin nerve,64736,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Incision of jaw nerve,64738,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Incision of tongue nerve,64740,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Incision of facial nerve,64742,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Incise nerve back of head,64744,CPT,,,,,,,,both,,,65635.43,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,44632.09,68,,44632.09,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,52508.34,80,,52508.34,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,52508.34,80,,52508.34,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,45944.8,70,,45944.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,52508.34,
Incise diaphragm nerve,64746,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,32489.2,
Incise hip/thigh nerve,64763,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,28428.05,
Incise hip/thigh nerve,64766,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,28428.05,
Sever cranial nerve,64771,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,32489.2,
Incision of spinal nerve,64772,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Remove skin nerve lesion,64774,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Remove digit nerve lesion,64776,CPT,,,,,,,,both,,,32128.65,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22490.06,70,,22490.06,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,22490.06,
Digit nerve surgery add-on,64778,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,0.01,41257.63,
Remove limb nerve lesion,64782,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,28428.05,
Limb nerve surgery add-on,64783,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,0.01,41257.63,
Remove nerve lesion,64784,CPT,,,,,,,,both,,,71512.33,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,50058.63,70,,50058.63,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,50058.63,
Remove sciatic nerve lesion,64786,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3126,98080.57,
Implant nerve end,64787,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,41257.63,
Remove skin nerve lesion,64788,CPT,,,,,,,,both,,,40767.87,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28537.51,70,,28537.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,28537.51,
Removal of nerve lesion,64790,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,28428.05,
Removal of nerve lesion,64792,CPT,,,,,,,,both,,,74117.29,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,51882.1,70,,51882.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3126,51882.1,
Biopsy of nerve,64795,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Sympathectomy cervical,64802,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,32489.2,
Remove sympathetic nerves,64804,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,28428.05,
Sympathectomy digital artery,64820,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,28428.05,
Remove sympathetic nerves,64821,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,47657.93,
Remove sympathetic nerves,64822,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,46296.27,68,,46296.27,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,54466.2,
Sympathectomy supfc palmar,64823,CPT,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,46296.27,68,,46296.27,percent of total billed charges,,2391.82,,,2391.82,Other,186% of Medicaid,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54466.2,80,,54466.2,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,54466.2,
Repair of digit nerve,64831,CPT,,,,,,,,both,,,39185.65,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,27429.96,70,,27429.96,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,27429.96,
Repair nerve add-on,64832,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,25945.68,
Repair of hand or foot nerve,64834,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,112092.08,
Repair of hand or foot nerve,64835,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3126,98080.57,
Repair of hand or foot nerve,64836,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3126,98080.57,
Repair nerve add-on,64837,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,25945.68,
Repair of leg nerve,64840,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,112092.08,
Repair/transpose nerve,64856,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,112092.08,
Repair arm/leg nerve,64857,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,112092.08,
Repair sciatic nerve,64858,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,27615.82,68,,27615.82,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32489.2,80,,32489.2,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,32489.2,
Nerve surgery,64859,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,22053.83,68,,22053.83,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,25945.68,
Repair of arm nerves,64861,CPT,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2121.65,28428.05,
Repair of low back nerves,64862,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3126,98080.57,
Repair of facial nerve,64864,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3126,98080.57,
Repair of facial nerve,64865,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3252.27,98080.57,
Subsequent repair of nerve,64872,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,41257.63,
Repair & revise nerve add-on,64874,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,45135.64,
Repair nerve/shorten bone,64876,CPT,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,45135.64,
Nerve graft head/neck </4 cm,64885,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,112092.08,
Nerve graft head/neck >4 cm,64886,CPT,,,,,,,,both,,,86224.88,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,58632.92,68,,58632.92,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,68979.9,80,,68979.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,68979.9,80,,68979.9,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,60357.42,70,,60357.42,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,68979.9,
Nerve graft hand/foot </4 cm,64890,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,112092.08,
Nerve graft hand/foot >4 cm,64891,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,112092.08,
Nerve graft arm/leg <4 cm,64892,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,112092.08,
Nerve graft arm/leg >4 cm,64893,CPT,,,,,,,,both,,,60558.97,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,41180.1,68,,41180.1,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,48447.18,80,,48447.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,48447.18,80,,48447.18,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,42391.28,70,,42391.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,48447.18,
Nerve graft hand/foot </4 cm,64895,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3126,98080.57,
Nerve graft hand/foot >4 cm,64896,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3126,98080.57,
Nerve graft arm/leg </4 cm,64897,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3126,98080.57,
Nerve graft arm/leg >4 cm,64898,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3126,98080.57,
Nerve graft add-on,64901,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,41257.63,
Nerve graft add-on,64902,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,35068.99,68,,35068.99,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,41257.63,
Nerve pedicle transfer,64905,CPT,,,,,,,,both,,,143860.38,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,97825.06,68,,97825.06,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,115088.3,80,,115088.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,115088.3,80,,115088.3,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,100702.27,70,,100702.27,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,115088.3,
Nerve pedicle transfer,64907,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2053,112092.08,
Nerve repair w/allograft,64910,CPT,,,,,,,,both,,,59519.34,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,41663.54,70,,41663.54,percent of total billed charges,,40473.15,68,,40473.15,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,47615.47,80,,47615.47,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47615.47,80,,47615.47,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,41663.54,70,,41663.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,47615.47,
Neurorraphy w/vein autograft,64911,CPT,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,95278.27,68,,95278.27,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,112092.08,80,,112092.08,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,112092.08,
Nrv rpr w/nrv algrft 1st,64912,CPT,,,,,,,,both,,,124326.97,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,87028.88,70,,87028.88,percent of total billed charges,,84542.34,68,,84542.34,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,99461.58,80,,99461.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,99461.58,80,,99461.58,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,87028.88,70,,87028.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,2232,99461.58,
Nrv rpr w/nrv algrft ea addl,64913,CPT,,,,,,,,both,,,51572.04,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,35068.99,68,,35068.99,percent of total billed charges,,6049.23,,,6049.23,Other,186% of Medicaid,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41257.63,80,,41257.63,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,36100.43,70,,36100.43,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,0.01,41257.63,
Revise eye,65091,CPT,,,,,,,,both,,,39067.66,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,27347.36,70,,27347.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,27347.36,
Revise eye with implant,65093,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Removal of eye,65101,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Remove eye/insert implant,65103,CPT,,,,,,,,both,,,49058.26,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,34340.78,70,,34340.78,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,34340.78,
Remove eye/attach implant,65105,CPT,,,,,,,,both,,,55881.02,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,39116.71,70,,39116.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,39116.71,
Removal of eye,65110,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Remove eye/revise socket,65112,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Remove eye/revise socket,65114,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Revise ocular implant,65125,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,34406.09,
Insert ocular implant,65130,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Insert ocular implant,65135,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,55300.69,68,,55300.69,percent of total billed charges,,3349.87,,,3349.87,Other,186% of Medicaid,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,65059.63,
Attach ocular implant,65140,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Revise ocular implant,65150,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,55300.69,68,,55300.69,percent of total billed charges,,3349.87,,,3349.87,Other,186% of Medicaid,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,65059.63,
Reinsert ocular implant,65155,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Removal of ocular implant,65175,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,55300.69,68,,55300.69,percent of total billed charges,,3349.87,,,3349.87,Other,186% of Medicaid,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,65059.63,
Remove foreign body from eye,65205,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,352.46,,,352.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,141.04,,,141.04,Fee Schedule,,119.54,,,119.54,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,189.49,,,189.49,Other,New York Medicaid APG methodology,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,289.92,,,289.92,Other,153% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,265.29,,,265.29,Other,140% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,492.68,,,492.68,Other,260% New York Medicaid APG,613.96,,,613.96,Other,324% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,236.87,,,236.87,Other,125% New York Medicaid APG,119.54,9473,
Remove foreign body from eye,65210,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,6152,,,6152,Case Rate,,352.46,,,352.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,173.84,,,173.84,Fee Schedule,,147.34,,,147.34,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,189.49,,,189.49,Other,New York Medicaid APG methodology,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,289.92,,,289.92,Other,153% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,265.29,,,265.29,Other,140% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,492.68,,,492.68,Other,260% New York Medicaid APG,613.96,,,613.96,Other,324% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,236.87,,,236.87,Other,125% New York Medicaid APG,147.34,9473,
Remove foreign body from eye,65220,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,6152,,,6152,Case Rate,,352.46,,,352.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,201.72,,,201.72,Fee Schedule,,170.97,,,170.97,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,189.49,,,189.49,Other,New York Medicaid APG methodology,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,289.92,,,289.92,Other,153% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,265.29,,,265.29,Other,140% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,492.68,,,492.68,Other,260% New York Medicaid APG,613.96,,,613.96,Other,324% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,236.87,,,236.87,Other,125% New York Medicaid APG,170.97,9473,
Remove foreign body from eye,65222,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,352.46,,,352.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,241.08,,,241.08,Fee Schedule,,204.33,,,204.33,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,189.49,,,189.49,Other,New York Medicaid APG methodology,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,289.92,,,289.92,Other,153% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,265.29,,,265.29,Other,140% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,492.68,,,492.68,Other,260% New York Medicaid APG,613.96,,,613.96,Other,324% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,236.87,,,236.87,Other,125% New York Medicaid APG,140.37,9473,
Remove foreign body from eye,65235,CPT,,,,,,,,both,,,34057.95,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23159.41,68,,23159.41,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,27246.36,80,,27246.36,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27246.36,80,,27246.36,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23840.57,70,,23840.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,27246.36,
Remove foreign body from eye,65260,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1161.22,,,1161.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,34311.36,
Remove foreign body from eye,65265,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1161.22,,,1161.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,34311.36,
Repair of eye wound,65270,CPT,,,,,,,,both,,,33818.71,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22996.72,68,,22996.72,percent of total billed charges,,3169.8,,,3169.8,Other,186% of Medicaid,27054.97,80,,27054.97,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27054.97,80,,27054.97,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23673.1,70,,23673.1,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,27054.97,
Repair of eye wound,65272,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,39321.25,
Repair of eye wound,65275,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,56927.18,
Repair of eye wound,65280,CPT,,,,,,,,both,,,109933.59,9444.41,,,9444.41,Other,150% of Medicare + 9.63% HCRA Surcharge,5743.2,,,5743.2,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76953.51,70,,76953.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,76953.51,
Repair of eye wound,65285,CPT,,,,,,,,both,,,109933.59,9444.41,,,9444.41,Other,150% of Medicare + 9.63% HCRA Surcharge,5743.2,,,5743.2,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76953.51,70,,76953.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,76953.51,
Repair of eye wound,65286,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,33331.04,68,,33331.04,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,1537.71,39212.98,
Repair of eye socket wound,65290,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Removal of eye lesion,65400,CPT,,,,,,,,both,,,35141.42,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23896.17,68,,23896.17,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,28113.14,80,,28113.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28113.14,80,,28113.14,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24598.99,70,,24598.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,1112.52,28113.14,
Biopsy of cornea,65410,CPT,,,,,,,,both,,,35214.66,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23945.97,68,,23945.97,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,28171.73,80,,28171.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28171.73,80,,28171.73,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,24650.26,70,,24650.26,percent of total billed charges,,490.36,,,490.36,Fee Schedule,,415.61,,,415.61,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,415.61,28171.73,
Removal of eye lesion,65420,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,1537.71,39321.25,
Removal of eye lesion,65426,CPT,,,,,,,,both,,,37961.77,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26573.24,70,,26573.24,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2567.8,26573.24,
Corneal smear,65430,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,6152,,,6152,Case Rate,,526.37,,,526.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,487.08,,,487.08,Fee Schedule,,412.83,,,412.83,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,9473,
Curette/treat cornea,65435,CPT,,,,,,,,both,,,38018.76,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26613.13,70,,26613.13,percent of total billed charges,,25852.76,68,,25852.76,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,30415.01,80,,30415.01,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30415.01,80,,30415.01,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26613.13,70,,26613.13,percent of total billed charges,,332.92,,,332.92,Fee Schedule,,282.17,,,282.17,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,282.17,30415.01,
Curette/treat cornea,65436,CPT,,,,,,,,both,,,34632.26,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,24242.58,70,,24242.58,percent of total billed charges,,23549.94,68,,23549.94,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,27705.81,80,,27705.81,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27705.81,80,,27705.81,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24242.58,70,,24242.58,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,1537.71,27705.81,
Treatment of corneal lesion,65450,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,320.11,7216,
Revision of cornea,65600,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,33423.06,68,,33423.06,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,1537.71,39321.25,
Corneal transplant,65710,CPT,,,,,,,,both,,,53411.26,9444.41,,,9444.41,Other,150% of Medicare + 9.63% HCRA Surcharge,5743.2,,,5743.2,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,37387.88,70,,37387.88,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,37387.88,
Corneal transplant,65730,CPT,,,,,,,,both,,,50825.67,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,35577.97,70,,35577.97,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,35577.97,
Corneal transplant,65750,CPT,,,,,,,,both,,,63976.41,9444.41,,,9444.41,Other,150% of Medicare + 9.63% HCRA Surcharge,5743.2,,,5743.2,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,44783.49,70,,44783.49,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,44783.49,
Corneal transplant,65755,CPT,,,,,,,,both,,,56854.87,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,39798.41,70,,39798.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,39798.41,
Corneal trnspl endothelial,65756,CPT,,,,,,,,both,,,49335.48,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,34534.84,70,,34534.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,34534.84,
Prep corneal endo allograft,65757,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,21080.87,65,,21080.87,percent of total billed charges,,21080.87,65,,21080.87,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,0.01,22702.47,
Revise cornea with implant,65770,CPT,,,,,,,,both,,,260759.04,22401.85,,,22401.85,Other,150% of Medicare + 9.63% HCRA Surcharge,13622.7,,,13622.7,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,182531.33,70,,182531.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,182531.33,
Correction of astigmatism,65772,CPT,,,,,,,,both,,,21295.3,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2860.14,,,2860.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,1112.52,14906.71,
Correction of astigmatism,65775,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2860.14,,,2860.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,1537.71,34406.09,
Cover eye w/membrane,65778,CPT,,,,,,,,both,,,21295.3,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,14480.8,68,,14480.8,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,254.2,,,254.2,Fee Schedule,,215.45,,,215.45,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,215.45,17036.24,
Cover eye w/membrane suture,65779,CPT,,,,,,,,both,,,33053.92,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22476.67,68,,22476.67,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,26443.14,80,,26443.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26443.14,80,,26443.14,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,23137.74,70,,23137.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,1537.71,26443.14,
Ocular reconst transplant,65780,CPT,,,,,,,,both,,,38106.26,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,26674.38,70,,26674.38,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,26674.38,
Ocular reconst transplant,65781,CPT,,,,,,,,both,,,109933.59,9444.41,,,9444.41,Other,150% of Medicare + 9.63% HCRA Surcharge,5743.2,,,5743.2,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,76953.51,70,,76953.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,76953.51,
Ocular reconst transplant,65782,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,56927.18,
Impltj ntrstrml crnl rng seg,65785,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5059.67,,,5059.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2720.25,,,2720.25,Other,New York Medicaid APG methodology,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,2720.25,,,2720.25,Other,100% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,4161.98,,,4161.98,Other,153% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,3808.35,,,3808.35,Other,140% New York Medicaid APG,6120.57,,,6120.57,Other,225% New York Medicaid APG,7072.65,,,7072.65,Other,260% New York Medicaid APG,8813.61,,,8813.61,Other,324% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,5848.54,,,5848.54,Other,215% New York Medicaid APG,3400.31,,,3400.31,Other,125% New York Medicaid APG,2720.25,59863.9,
Drainage of eye,65800,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,428.04,,,428.04,Fee Schedule,,362.79,,,362.79,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,362.79,39212.98,
Drainage of eye,65810,CPT,,,,,,,,both,,,35561.95,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24893.37,70,,24893.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,24893.37,
Drainage of eye,65815,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,39212.98,
Relieve inner eye pressure,65820,CPT,,,,,,,,both,,,36931.35,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,25113.32,68,,25113.32,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,29545.08,80,,29545.08,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29545.08,80,,29545.08,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25851.95,70,,25851.95,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,29545.08,
Incision of eye,65850,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,34311.36,
Trabeculoplasty laser surg,65855,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,8313.88,68,,8313.88,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,638.73,9781.04,
Incise inner eye adhesions,65860,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,638.73,9473,
Incise inner eye adhesions,65865,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,39212.98,
Incise inner eye adhesions,65870,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,34311.36,
Incise inner eye adhesions,65875,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,34311.36,
Incise inner eye adhesions,65880,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,59863.9,
Remove eye lesion,65900,CPT,,,,,,,,both,,,35724.95,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25007.47,70,,25007.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,25007.47,
Remove implant of eye,65920,CPT,,,,,,,,both,,,35663.57,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24964.5,70,,24964.5,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,24964.5,
Remove blood clot from eye,65930,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,34311.36,
Injection treatment of eye,66020,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,633.04,,,633.04,Fee Schedule,,536.54,,,536.54,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,536.54,39212.98,
Injection treatment of eye,66030,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,537.92,,,537.92,Fee Schedule,,455.92,,,455.92,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,455.92,39212.98,
Remove eye lesion,66130,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,34406.09,
Glaucoma surgery,66150,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,59863.9,
Glaucoma surgery,66155,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,59863.9,
Glaucoma surgery,66160,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,3820.51,,,3820.51,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,39212.98,
Glaucoma surgery,66170,CPT,,,,,,,,both,,,33203.28,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23242.3,70,,23242.3,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,23242.3,
Incision of eye,66172,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,34311.36,
Translum dil eye canal,66174,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,59863.9,
Trnslum dil eye canal w/stnt,66175,CPT,,,,,,,,both,,,109933.59,9444.41,,,9444.41,Other,150% of Medicare + 9.63% HCRA Surcharge,5743.2,,,5743.2,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,76953.51,70,,76953.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,76953.51,
Aqueous shunt eye w/o graft,66179,CPT,,,,,,,,both,,,109933.59,9444.41,,,9444.41,Other,150% of Medicare + 9.63% HCRA Surcharge,5743.2,,,5743.2,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,76953.51,70,,76953.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,76953.51,
Aqueous shunt eye w/graft,66180,CPT,,,,,,,,both,,,37790.35,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,26453.25,70,,26453.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,26453.25,
Insert ant drainage device,66183,CPT,,,,,,,,both,,,40479.02,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28335.31,70,,28335.31,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,28335.31,
Revision of aqueous shunt,66184,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,34311.36,
Revise aqueous shunt eye,66185,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,39212.98,
Repair/graft eye lesion,66225,CPT,,,,,,,,both,,,109933.59,9444.41,,,9444.41,Other,150% of Medicare + 9.63% HCRA Surcharge,5743.2,,,5743.2,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,76953.51,70,,76953.51,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,76953.51,
Follow-up surgery of eye,66250,CPT,,,,,,,,both,,,35284.74,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23993.62,68,,23993.62,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,28227.79,80,,28227.79,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28227.79,80,,28227.79,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24699.32,70,,24699.32,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,28227.79,
Incision of iris,66500,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,39212.98,
Incision of iris,66505,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,39212.98,
Remove iris and lesion,66600,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,59863.9,
Removal of iris,66605,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,34311.36,
Removal of iris,66625,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,34311.36,
Removal of iris,66630,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,34311.36,
Removal of iris,66635,CPT,,,,,,,,both,,,34653.65,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24257.56,70,,24257.56,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,24257.56,
Repair iris & ciliary body,66680,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,34311.36,
Repair iris & ciliary body,66682,CPT,,,,,,,,both,,,34563.38,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23503.1,68,,23503.1,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,27650.7,80,,27650.7,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27650.7,80,,27650.7,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24194.37,70,,24194.37,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,27650.7,
Destruction ciliary body,66700,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,39212.98,
Ciliary transsleral therapy,66710,CPT,,,,,,,,both,,,35866.05,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24388.91,68,,24388.91,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,28692.84,80,,28692.84,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28692.84,80,,28692.84,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25106.24,70,,25106.24,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,28692.84,
Ecp ciliary body destruction,66711,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,39212.98,
Destruction ciliary body,66720,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,39321.25,
Destruction ciliary body,66740,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,39321.25,
Revision of iris,66761,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,8313.88,68,,8313.88,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,638.73,9781.04,
Revision of iris,66762,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,8313.88,68,,8313.88,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,638.73,9781.04,
Removal of inner eye lesion,66770,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,8313.88,68,,8313.88,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,638.73,9781.04,
Incision secondary cataract,66820,CPT,,,,,,,,both,,,36328.3,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,25429.81,70,,25429.81,percent of total billed charges,,24703.24,68,,24703.24,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,29062.64,80,,29062.64,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29062.64,80,,29062.64,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,25429.81,70,,25429.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,1537.71,29062.64,
After cataract laser surgery,66821,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8313.88,68,,8313.88,percent of total billed charges,,2860.14,,,2860.14,Other,186% of Medicaid,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,638.73,9781.04,
Reposition intraocular lens,66825,CPT,,,,,,,,both,,,34585.06,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24209.54,70,,24209.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,24209.54,
Removal of lens lesion,66830,CPT,,,,,,,,both,,,36830.68,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2860.14,,,2860.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25781.48,70,,25781.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1537.71,,,1537.71,Other,New York Medicaid APG methodology,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,1537.71,,,1537.71,Other,100% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2352.69,,,2352.69,Other,153% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,2152.79,,,2152.79,Other,140% New York Medicaid APG,3459.84,,,3459.84,Other,225% New York Medicaid APG,3998.04,,,3998.04,Other,260% New York Medicaid APG,4982.17,,,4982.17,Other,324% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,3306.07,,,3306.07,Other,215% New York Medicaid APG,1922.13,,,1922.13,Other,125% New York Medicaid APG,1537.71,25781.48,
Removal of lens material,66840,CPT,,,,,,,,both,,,34704.95,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24293.47,70,,24293.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,24293.47,
Removal of lens material,66850,CPT,,,,,,,,both,,,35390.55,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24773.39,70,,24773.39,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,24773.39,
Removal of lens material,66852,CPT,,,,,,,,both,,,36152.09,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25306.46,70,,25306.46,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,25306.46,
Extraction of lens,66920,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,34311.36,
Extraction of lens,66930,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,59863.9,
Extraction of lens,66940,CPT,,,,,,,,both,,,34887.95,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24421.57,70,,24421.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,24421.57,
Xcapsl ctrc rmvl cplx wo ecp,66982,CPT,,,,,,,,both,,,36521.55,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7448,,"100% primary, 50% secondary, 25% tertiary procedure",7448,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25565.09,70,,25565.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,25565.09,
Cataract surg w/iol 1 stage,66983,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7448,,"100% primary, 50% secondary, 25% tertiary procedure",7448,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,34311.36,
Xcapsl ctrc rmvl w/o ecp,66984,CPT,,,,,,,,both,,,35854.93,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7448,,"100% primary, 50% secondary, 25% tertiary procedure",7448,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25098.45,70,,25098.45,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,25098.45,
Insert lens prosthesis,66985,CPT,,,,,,,,both,,,36877,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25813.9,70,,25813.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,25813.9,
Exchange lens prosthesis,66986,CPT,,,,,,,,both,,,36572.97,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,6320,,"100% primary, 50% secondary, 25% tertiary procedure",6320,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25601.08,70,,25601.08,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,25601.08,
Xcapsl ctrc rmvl cplx w/ecp,66987,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,55587.9,65,,55587.9,percent of total billed charges,,55587.9,65,,55587.9,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,59863.9,
Xcapsl ctrc rmvl w/ecp,66988,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3564.7,,,3564.7,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,55587.9,65,,55587.9,percent of total billed charges,,55587.9,65,,55587.9,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1916.5,,,1916.5,Other,New York Medicaid APG methodology,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,1916.5,,,1916.5,Other,100% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2932.25,,,2932.25,Other,153% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,2683.11,,,2683.11,Other,140% New York Medicaid APG,4312.13,,,4312.13,Other,225% New York Medicaid APG,4982.91,,,4982.91,Other,260% New York Medicaid APG,6209.47,,,6209.47,Other,324% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,4120.48,,,4120.48,Other,215% New York Medicaid APG,2395.63,,,2395.63,Other,125% New York Medicaid APG,1916.5,59863.9,
Ophthalmic endoscope add-on,66990,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3387,,,3387,Case Rate,MVP ASC Grouper,2879,,,2879,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,25945.68,
Partial removal of eye fluid,67005,CPT,,,,,,,,both,,,38164.45,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1161.22,,,1161.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26715.12,70,,26715.12,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,26715.12,
Partial removal of eye fluid,67010,CPT,,,,,,,,both,,,37177.13,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1161.22,,,1161.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26023.99,70,,26023.99,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,26023.99,
Release of eye fluid,67015,CPT,,,,,,,,both,,,39587.11,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,26919.23,68,,26919.23,percent of total billed charges,,4784.01,,,4784.01,Other,186% of Medicaid,31669.69,80,,31669.69,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,31669.69,80,,31669.69,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27710.98,70,,27710.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2053,31669.69,
Replace eye fluid,67025,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,39212.98,
Implant eye drug system,67027,CPT,,,,,,,,both,,,331986.72,28521.03,,,28521.03,Other,150% of Medicare + 9.63% HCRA Surcharge,17343.81,,,17343.81,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,232390.7,70,,232390.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,232390.7,
Injection eye drug,67028,CPT,,,,,,,,both,,,7123.45,611.98,,,611.98,Other,150% of Medicare + 9.63% HCRA Surcharge,372.15,,,372.15,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4986.42,70,,4986.42,percent of total billed charges,,4843.95,68,,4843.95,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,5698.76,80,,5698.76,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,5698.76,80,,5698.76,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4986.42,70,,4986.42,percent of total billed charges,,441.16,,,441.16,Fee Schedule,,373.91,,,373.91,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,7216,
Incise inner eye strands,67030,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,39212.98,
Laser surgery eye strands,67031,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,8313.88,68,,8313.88,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,9781.04,
Removal of inner eye fluid,67036,CPT,,,,,,,,both,,,39683.14,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,27778.2,70,,27778.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,27778.2,
Laser treatment of retina,67039,CPT,,,,,,,,both,,,36633.79,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25643.65,70,,25643.65,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,25643.65,
Laser treatment of retina,67040,CPT,,,,,,,,both,,,36695.92,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25687.14,70,,25687.14,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,25687.14,
Vit for macular pucker,67041,CPT,,,,,,,,both,,,34629.14,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,24240.4,70,,24240.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,24240.4,
Vit for macular hole,67042,CPT,,,,,,,,both,,,36517.02,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25561.91,70,,25561.91,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,25561.91,
Vit for membrane dissect,67043,CPT,,,,,,,,both,,,34704.14,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,24292.9,70,,24292.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,24292.9,
Repair detached retina crtx,67101,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2560.73,34311.36,
Repair detached retina pc,67105,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,6152,,,6152,Case Rate,,1161.22,,,1161.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,9473,
Repair detached retina,67107,CPT,,,,,,,,both,,,37944.14,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,26560.9,70,,26560.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,26560.9,
Repair detached retina,67108,CPT,,,,,,,,both,,,37702.06,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,26391.44,70,,26391.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,26391.44,
Repair detached retina,67110,CPT,,,,,,,,both,,,34169.97,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23918.98,70,,23918.98,percent of total billed charges,,6152,,,6152,Case Rate,,1161.22,,,1161.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23918.98,70,,23918.98,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,23918.98,
Repair retinal detach cplx,67113,CPT,,,,,,,,both,,,38858.37,9444.41,,,9444.41,Other,150% of Medicare + 9.63% HCRA Surcharge,5743.2,,,5743.2,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,27200.86,70,,27200.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,27200.86,
Release encircling material,67115,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,58153.5,68,,58153.5,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,68415.88,80,,68415.88,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,68415.88,80,,68415.88,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,68415.88,
Remove eye implant material,67120,CPT,,,,,,,,both,,,34478.92,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23445.67,68,,23445.67,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,27583.14,80,,27583.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27583.14,80,,27583.14,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24135.24,70,,24135.24,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,27583.14,
Remove eye implant material,67121,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33331.04,68,,33331.04,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39212.98,80,,39212.98,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,39212.98,
Treatment of retina,67141,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,7216,
Treatment of retina,67145,CPT,,,,,,,,both,,,36129.72,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,25290.8,70,,25290.8,percent of total billed charges,,24568.21,68,,24568.21,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,28903.78,80,,28903.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28903.78,80,,28903.78,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,25290.8,70,,25290.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,28903.78,
Treatment of retinal lesion,67208,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,6152,,,6152,Case Rate,,526.37,,,526.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,9473,
Treatment of retinal lesion,67210,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,6152,,,6152,Case Rate,,1161.22,,,1161.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,9473,
Treatment of retinal lesion,67218,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2572.05,56927.18,
Treatment of choroid lesion,67220,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,8313.88,68,,8313.88,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,9781.04,
Ocular photodynamic ther,67221,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,8313.88,68,,8313.88,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,9781.04,
Eye photodynamic ther add-on,67225,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,132.84,,,132.84,Fee Schedule,,112.59,,,112.59,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,0.01,25945.68,
Dstrj extensive retinopathy,67227,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,55300.69,68,,55300.69,percent of total billed charges,,4784.01,,,4784.01,Other,186% of Medicaid,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,2053,65059.63,
Treatment x10sv retinopathy,67228,CPT,,,,,,,,both,,,32171.72,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22520.2,70,,22520.2,percent of total billed charges,,21876.77,68,,21876.77,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,25737.38,80,,25737.38,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25737.38,80,,25737.38,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,22520.2,70,,22520.2,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,25737.38,
Tr retinal les preterm inf,67229,CPT,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,8313.88,68,,8313.88,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,9781.04,
Reinforce eye wall,67250,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1161.22,,,1161.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,34406.09,
Reinforce/graft eye wall,67255,CPT,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,1161.22,,,1161.22,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,59863.9,
Revise eye muscle,67311,CPT,,,,,,,,both,,,35853.95,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25097.77,70,,25097.77,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,1650.7,25097.77,
Revise two eye muscles,67312,CPT,,,,,,,,both,,,36970.21,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25879.15,70,,25879.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,1650.7,25879.15,
Revise eye muscle,67314,CPT,,,,,,,,both,,,38694.02,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27085.81,70,,27085.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,1650.7,27085.81,
Revise two eye muscles,67316,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,1650.7,34406.09,
Revise eye muscle(s),67318,CPT,,,,,,,,both,,,38658.01,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,27060.61,70,,27060.61,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,1650.7,27060.61,
Revise eye muscle(s) add-on,67320,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,0.01,58452.8,
Eye surgery follow-up add-on,67331,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,0.01,58452.8,
Rerevise eye muscles add-on,67332,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,0.01,58452.8,
Revise eye muscle w/suture,67334,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,0.01,58452.8,
Eye suture during surgery,67335,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,0.01,58452.8,
Revise eye muscle add-on,67340,CPT,,,,,,,,both,,,83504,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,58452.8,70,,58452.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,0.01,58452.8,
Release eye tissue,67343,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3070.31,,,3070.31,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,1650.7,34406.09,
Destroy nerve of eye muscle,67345,CPT,,,,,,,,both,,,35389.26,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24772.48,70,,24772.48,percent of total billed charges,,24064.7,68,,24064.7,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,28311.41,80,,28311.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28311.41,80,,28311.41,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24772.48,70,,24772.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,28311.41,
Biopsy eye muscle,67346,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,55300.69,68,,55300.69,percent of total billed charges,,3070.31,,,3070.31,Other,186% of Medicaid,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1650.7,,,1650.7,Other,New York Medicaid APG methodology,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,1650.7,,,1650.7,Other,100% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2525.58,,,2525.58,Other,153% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,2310.98,,,2310.98,Other,140% New York Medicaid APG,3714.08,,,3714.08,Other,225% New York Medicaid APG,4291.83,,,4291.83,Other,260% New York Medicaid APG,5348.28,,,5348.28,Other,324% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,3549.01,,,3549.01,Other,215% New York Medicaid APG,2063.38,,,2063.38,Other,125% New York Medicaid APG,1650.7,65059.63,
Explore/biopsy eye socket,67400,CPT,,,,,,,,both,,,47822.67,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,33475.87,70,,33475.87,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,33475.87,
Explore/drain eye socket,67405,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,34406.09,
Explore/treat eye socket,67412,CPT,,,,,,,,both,,,45885.35,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,32119.75,70,,32119.75,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,32119.75,
Explore/treat eye socket,67413,CPT,,,,,,,,both,,,34994.66,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24496.26,70,,24496.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,24496.26,
Explr/decompress eye socket,67414,CPT,,,,,,,,both,,,71687.2,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,50181.04,70,,50181.04,percent of total billed charges,,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50181.04,70,,50181.04,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,50181.04,
Aspiration orbital contents,67415,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,39321.25,
Explore/treat eye socket,67420,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,56927.18,
Explore/treat eye socket,67430,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4398.84,,,4398.84,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2364.97,,,2364.97,Other,New York Medicaid APG methodology,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,2364.97,,,2364.97,Other,100% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3618.4,,,3618.4,Other,153% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,3310.95,,,3310.95,Other,140% New York Medicaid APG,5321.17,,,5321.17,Other,225% New York Medicaid APG,6148.91,,,6148.91,Other,260% New York Medicaid APG,7662.49,,,7662.49,Other,324% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,5084.68,,,5084.68,Other,215% New York Medicaid APG,2956.21,,,2956.21,Other,125% New York Medicaid APG,2364.97,56927.18,
Explore/drain eye socket,67440,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,56927.18,
Explr/decompress eye socket,67445,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,56927.18,
Explore/biopsy eye socket,67450,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,56927.18,
Inject/treat eye socket,67500,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,6152,,,6152,Case Rate,,526.37,,,526.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,308.32,,,308.32,Fee Schedule,,261.32,,,261.32,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,261.32,9473,
Inject/treat eye socket,67505,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,349.32,,,349.32,Fee Schedule,,296.07,,,296.07,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,7216,
Inject/treat eye socket,67515,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,193.21,7216,
Insert eye socket implant,67550,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Revise eye socket implant,67560,CPT,,,,,,,,both,,,43213.48,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29385.17,68,,29385.17,percent of total billed charges,,3349.87,,,3349.87,Other,186% of Medicaid,34570.78,80,,34570.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34570.78,80,,34570.78,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,30249.44,70,,30249.44,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,34570.78,
Decompress optic nerve,67570,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3349.87,,,3349.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1801.01,,,1801.01,Other,New York Medicaid APG methodology,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,1801.01,,,1801.01,Other,100% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2755.54,,,2755.54,Other,153% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,2521.41,,,2521.41,Other,140% New York Medicaid APG,4052.26,,,4052.26,Other,225% New York Medicaid APG,4682.61,,,4682.61,Other,260% New York Medicaid APG,5835.26,,,5835.26,Other,324% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,3872.16,,,3872.16,Other,215% New York Medicaid APG,2251.26,,,2251.26,Other,125% New York Medicaid APG,1801.01,56927.18,
Drainage of eyelid abscess,67700,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,562.52,,,562.52,Fee Schedule,,476.77,,,476.77,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,7216,
Incision of eyelid,67710,CPT,,,,,,,,both,,,21295.3,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,14480.8,68,,14480.8,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,475.6,,,475.6,Fee Schedule,,403.1,,,403.1,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,403.1,17036.24,
Incision of eyelid fold,67715,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,526.44,,,526.44,Fee Schedule,,446.19,,,446.19,Fee Schedule,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,446.19,39321.25,
Remove eyelid lesion,67800,CPT,,,,,,,,both,,,35091.21,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23862.02,68,,23862.02,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,28072.97,80,,28072.97,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28072.97,80,,28072.97,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24563.85,70,,24563.85,percent of total billed charges,,493.64,,,493.64,Fee Schedule,,418.39,,,418.39,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,28072.97,
Remove eyelid lesions,67801,CPT,,,,,,,,both,,,21295.3,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,14480.8,68,,14480.8,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1112.52,17036.24,
Remove eyelid lesions,67805,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,7216,
Remove eyelid lesion(s),67808,CPT,,,,,,,,both,,,34585.73,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23518.3,68,,23518.3,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,27668.58,80,,27668.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27668.58,80,,27668.58,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24210.01,70,,24210.01,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,27668.58,
Biopsy eyelid & lid margin,67810,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,329.64,,,329.64,Fee Schedule,,279.39,,,279.39,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,279.39,7216,
Revise eyelashes,67820,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,352.46,,,352.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,106.6,,,106.6,Fee Schedule,,90.35,,,90.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,189.49,,,189.49,Other,New York Medicaid APG methodology,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,289.92,,,289.92,Other,153% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,265.29,,,265.29,Other,140% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,492.68,,,492.68,Other,260% New York Medicaid APG,613.96,,,613.96,Other,324% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,236.87,,,236.87,Other,125% New York Medicaid APG,90.35,9473,
Revise eyelashes,67825,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,6152,,,6152,Case Rate,,526.37,,,526.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,588.76,,,588.76,Fee Schedule,,499.01,,,499.01,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,9473,
Revise eyelashes,67830,CPT,,,,,,,,both,,,33992.81,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23115.11,68,,23115.11,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,27194.25,80,,27194.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27194.25,80,,27194.25,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23794.97,70,,23794.97,percent of total billed charges,,664.2,,,664.2,Fee Schedule,,562.95,,,562.95,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,27194.25,
Revise eyelashes,67835,CPT,,,,,,,,both,,,33679.66,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22902.17,68,,22902.17,percent of total billed charges,,3169.8,,,3169.8,Other,186% of Medicaid,26943.73,80,,26943.73,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26943.73,80,,26943.73,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23575.76,70,,23575.76,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,26943.73,
Remove eyelid lesion,67840,CPT,,,,,,,,both,,,35626.99,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24226.35,68,,24226.35,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,28501.59,80,,28501.59,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28501.59,80,,28501.59,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24938.89,70,,24938.89,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1112.52,28501.59,
Treat eyelid lesion,67850,CPT,,,,,,,,both,,,21295.3,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,14480.8,68,,14480.8,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,637.96,,,637.96,Fee Schedule,,540.71,,,540.71,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,17036.24,
Closure of eyelid by suture,67875,CPT,,,,,,,,both,,,21295.3,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,14480.8,68,,14480.8,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,459.2,,,459.2,Fee Schedule,,389.2,,,389.2,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,389.2,17036.24,
Revision of eyelid,67880,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,34406.09,
Revision of eyelid,67882,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,34406.09,
Repair brow defect,67900,CPT,,,,,,,,both,,,32669.57,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22868.7,70,,22868.7,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,22868.7,
Repair eyelid defect,67901,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,34406.09,
Repair eyelid defect,67902,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,56927.18,
Repair eyelid defect,67903,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,34406.09,
Repair eyelid defect,67904,CPT,,,,,,,,both,,,33846.09,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23692.26,70,,23692.26,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,23692.26,
Repair eyelid defect,67906,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,56927.18,
Repair eyelid defect,67908,CPT,,,,,,,,both,,,43046.76,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,30132.73,70,,30132.73,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,30132.73,
Revise eyelid defect,67909,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,34406.09,
Revise eyelid defect,67911,CPT,,,,,,,,both,,,35896.32,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25127.42,70,,25127.42,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,25127.42,
Correction eyelid w/implant,67912,CPT,,,,,,,,both,,,36009.67,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25206.77,70,,25206.77,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,25206.77,
Repair eyelid defect,67914,CPT,,,,,,,,both,,,33626.66,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23538.66,70,,23538.66,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,23538.66,
Repair eyelid defect,67915,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,34406.09,
Repair eyelid defect,67916,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,34406.09,
Repair eyelid defect,67917,CPT,,,,,,,,both,,,34560.91,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24192.64,70,,24192.64,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,24192.64,
Repair eyelid defect,67921,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,34406.09,
Repair eyelid defect,67922,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,34406.09,
Repair eyelid defect,67923,CPT,,,,,,,,both,,,35662.66,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24963.86,70,,24963.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,24963.86,
Repair eyelid defect,67924,CPT,,,,,,,,both,,,34504.61,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24153.23,70,,24153.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,24153.23,
Repair eyelid wound,67930,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,33423.06,68,,33423.06,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,39321.25,
Repair eyelid wound,67935,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,39321.25,
Remove eyelid foreign body,67938,CPT,,,,,,,,both,,,35326.8,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24728.76,70,,24728.76,percent of total billed charges,,24022.22,68,,24022.22,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,28261.44,80,,28261.44,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28261.44,80,,28261.44,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24728.76,70,,24728.76,percent of total billed charges,,572.36,,,572.36,Fee Schedule,,485.11,,,485.11,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,28261.44,
Revision of eyelid,67950,CPT,,,,,,,,both,,,38209.71,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,25982.6,68,,25982.6,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,30567.77,80,,30567.77,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30567.77,80,,30567.77,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26746.8,70,,26746.8,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,30567.77,
Revision of eyelid,67961,CPT,,,,,,,,both,,,32676.36,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,22873.45,70,,22873.45,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,22873.45,
Revision of eyelid,67966,CPT,,,,,,,,both,,,45328.93,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31730.25,70,,31730.25,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,31730.25,
Reconstruction of eyelid,67971,CPT,,,,,,,,both,,,37061.66,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,25943.16,70,,25943.16,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,25943.16,
Reconstruction of eyelid,67973,CPT,,,,,,,,both,,,44410.93,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,31087.65,70,,31087.65,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,31087.65,
Reconstruction of eyelid,67974,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,56927.18,
Reconstruction of eyelid,67975,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,34406.09,
Incise/drain eyelid lining,68020,CPT,,,,,,,,both,,,21295.3,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,14480.8,68,,14480.8,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,533,,,533,Fee Schedule,,451.75,,,451.75,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,451.75,17036.24,
Treatment of eyelid lesions,68040,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,6152,,,6152,Case Rate,,526.37,,,526.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,193.21,9473,
Biopsy of eyelid lining,68100,CPT,,,,,,,,both,,,47374.26,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,33161.98,70,,33161.98,percent of total billed charges,,32214.5,68,,32214.5,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,37899.41,80,,37899.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,37899.41,80,,37899.41,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,33161.98,70,,33161.98,percent of total billed charges,,459.2,,,459.2,Fee Schedule,,389.2,,,389.2,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,389.2,37899.41,
Remove eyelid lining lesion,68110,CPT,,,,,,,,both,,,37675.27,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26372.69,70,,26372.69,percent of total billed charges,,25619.18,68,,25619.18,percent of total billed charges,,2902.47,,,2902.47,Other,186% of Medicaid,30140.22,80,,30140.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30140.22,80,,30140.22,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26372.69,70,,26372.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,30140.22,
Remove eyelid lining lesion,68115,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,3169.8,,,3169.8,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,39321.25,
Remove eyelid lining lesion,68130,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,3169.8,,,3169.8,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,39321.25,
Remove eyelid lining lesion,68135,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,33423.06,68,,33423.06,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,39321.25,
Treat eyelid by injection,68200,CPT,,,,,,,,both,,,8380.68,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,6152,,,6152,Case Rate,,352.46,,,352.46,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,5866.48,70,,5866.48,percent of total billed charges,,164,,,164,Fee Schedule,,139,,,139,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,189.49,,,189.49,Other,New York Medicaid APG methodology,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,189.49,,,189.49,Other,100% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,289.92,,,289.92,Other,153% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,265.29,,,265.29,Other,140% New York Medicaid APG,426.36,,,426.36,Other,225% New York Medicaid APG,492.68,,,492.68,Other,260% New York Medicaid APG,613.96,,,613.96,Other,324% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,407.41,,,407.41,Other,215% New York Medicaid APG,236.87,,,236.87,Other,125% New York Medicaid APG,139,9473,
Revise/graft eyelid lining,68320,CPT,,,,,,,,both,,,38099.24,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26669.47,70,,26669.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,26669.47,
Revise/graft eyelid lining,68325,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,56927.18,
Revise/graft eyelid lining,68326,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,56927.18,
Revise/graft eyelid lining,68328,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,34406.09,
Revise eyelid lining,68330,CPT,,,,,,,,both,,,49016.23,4210.99,,,4210.99,Other,150% of Medicare + 9.63% HCRA Surcharge,2560.73,,,2560.73,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34311.36,70,,34311.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,34311.36,
Revise/graft eyelid lining,68335,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,56927.18,
Separate eyelid adhesions,68340,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2168.2,,,2168.2,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,34406.09,
Revise eyelid lining,68360,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,55300.69,68,,55300.69,percent of total billed charges,,3169.8,,,3169.8,Other,186% of Medicaid,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,65059.63,80,,65059.63,percent of total billed charges,,7216,,,7216,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,65059.63,
Revise eyelid lining,68362,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,3169.8,,,3169.8,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,39321.25,
Harvest eye tissue alograft,68371,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,39321.25,
Incise/drain tear gland,68400,CPT,,,,,,,,both,,,21295.3,1829.48,,,1829.48,Other,150% of Medicare + 9.63% HCRA Surcharge,1112.52,,,1112.52,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,14480.8,68,,14480.8,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,17036.24,80,,17036.24,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,14906.71,70,,14906.71,percent of total billed charges,,633.04,,,633.04,Fee Schedule,,536.54,,,536.54,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,536.54,17036.24,
Incise/drain tear sac,68420,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,33423.06,68,,33423.06,percent of total billed charges,,3169.8,,,3169.8,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,39321.25,
Incise tear duct opening,68440,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,483.8,,,483.8,Fee Schedule,,410.05,,,410.05,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,7216,
Removal of tear gland,68500,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,56927.18,
Partial removal tear gland,68505,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,56927.18,
Biopsy of tear gland,68510,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,3169.8,,,3169.8,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,39321.25,
Removal of tear sac,68520,CPT,,,,,,,,both,,,35849.33,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25094.53,70,,25094.53,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,25094.53,
Biopsy of tear sac,68525,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,33423.06,68,,33423.06,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,39321.25,80,,39321.25,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,39321.25,
Clearance of tear duct,68530,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,7216,
Remove tear gland lesion,68540,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,34406.09,
Remove tear gland lesion,68550,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,56927.18,
Repair tear ducts,68700,CPT,,,,,,,,both,,,51267.66,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,34862.01,68,,34862.01,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,41014.13,80,,41014.13,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,41014.13,80,,41014.13,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,35887.36,70,,35887.36,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,41014.13,
Revise tear duct opening,68705,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,7216,
Create tear sac drain,68720,CPT,,,,,,,,both,,,42835.34,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,29984.74,70,,29984.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,29984.74,
Create tear duct drain,68745,CPT,,,,,,,,both,,,81324.54,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,56927.18,70,,56927.18,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,56927.18,
Create tear duct drain,68750,CPT,,,,,,,,both,,,36863.66,6986.6,,,6986.6,Other,150% of Medicare + 9.63% HCRA Surcharge,4248.6,,,4248.6,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,25804.56,70,,25804.56,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,25804.56,
Close tear duct opening,68760,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,7216,
Close tear duct opening,68761,CPT,,,,,,,,both,,,6127.39,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,4166.63,68,,4166.63,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,4901.91,80,,4901.91,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,4289.17,70,,4289.17,percent of total billed charges,,567.44,,,567.44,Fee Schedule,,480.94,,,480.94,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,7216,
Close tear system fistula,68770,CPT,,,,,,,,both,,,49151.56,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,3169.8,,,3169.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,34406.09,70,,34406.09,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1704.19,,,1704.19,Other,New York Medicaid APG methodology,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,1704.19,,,1704.19,Other,100% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2607.41,,,2607.41,Other,153% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,2385.87,,,2385.87,Other,140% New York Medicaid APG,3834.43,,,3834.43,Other,225% New York Medicaid APG,4430.9,,,4430.9,Other,260% New York Medicaid APG,5521.58,,,5521.58,Other,324% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,3664.01,,,3664.01,Other,215% New York Medicaid APG,2130.24,,,2130.24,Other,125% New York Medicaid APG,1704.19,34406.09,
Dilate tear duct opening,68801,CPT,,,,,,,,both,,,34022.66,719.99,,,719.99,Other,150% of Medicare + 9.63% HCRA Surcharge,437.83,,,437.83,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23815.86,70,,23815.86,percent of total billed charges,,6152,,,6152,Case Rate,,526.37,,,526.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23815.86,70,,23815.86,percent of total billed charges,,382.12,,,382.12,Fee Schedule,,323.87,,,323.87,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,23815.86,
Probe nasolacrimal duct,68810,CPT,,,,,,,,both,,,35689.63,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,24268.95,68,,24268.95,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,28551.7,80,,28551.7,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28551.7,80,,28551.7,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24982.74,70,,24982.74,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,28551.7,
Probe nasolacrimal duct,68811,CPT,,,,,,,,both,,,34474.4,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,23442.59,68,,23442.59,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,27579.52,80,,27579.52,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27579.52,80,,27579.52,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24132.08,70,,24132.08,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,27579.52,
Probe nasolacrimal duct,68815,CPT,,,,,,,,both,,,35564.69,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24183.99,68,,24183.99,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,28451.75,80,,28451.75,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28451.75,80,,28451.75,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24895.28,70,,24895.28,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,28451.75,
Probe nl duct w/balloon,68816,CPT,,,,,,,,both,,,37327.44,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,25382.66,68,,25382.66,percent of total billed charges,,2168.2,,,2168.2,Other,186% of Medicaid,29861.95,80,,29861.95,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,29861.95,80,,29861.95,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26129.21,70,,26129.21,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1165.7,,,1165.7,Other,New York Medicaid APG methodology,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,1165.7,,,1165.7,Other,100% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1783.52,,,1783.52,Other,153% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,1631.98,,,1631.98,Other,140% New York Medicaid APG,2622.82,,,2622.82,Other,225% New York Medicaid APG,3030.82,,,3030.82,Other,260% New York Medicaid APG,3776.86,,,3776.86,Other,324% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,2506.25,,,2506.25,Other,215% New York Medicaid APG,1457.12,,,1457.12,Other,125% New York Medicaid APG,1165.7,29861.95,
Explore/irrigate tear ducts,68840,CPT,,,,,,,,both,,,34394.38,526.4,,,526.4,Other,150% of Medicare + 9.63% HCRA Surcharge,320.11,,,320.11,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24076.07,70,,24076.07,percent of total billed charges,,23388.18,68,,23388.18,percent of total billed charges,,526.37,,,526.37,Other,186% of Medicaid,27515.5,80,,27515.5,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27515.5,80,,27515.5,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24076.07,70,,24076.07,percent of total billed charges,,567.44,,,567.44,Fee Schedule,,480.94,,,480.94,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,283,,,283,Other,New York Medicaid APG methodology,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,283,,,283,Other,100% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,432.99,,,432.99,Other,153% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,396.2,,,396.2,Other,140% New York Medicaid APG,636.74,,,636.74,Other,225% New York Medicaid APG,735.79,,,735.79,Other,260% New York Medicaid APG,916.91,,,916.91,Other,324% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,608.44,,,608.44,Other,215% New York Medicaid APG,353.75,,,353.75,Other,125% New York Medicaid APG,283,27515.5,
Injection for tear sac x-ray,68850,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,967.55,,,967.55,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,250.92,,,250.92,Fee Schedule,,212.67,,,212.67,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,520.19,,,520.19,Other,New York Medicaid APG methodology,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,520.19,,,520.19,Other,100% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,795.88,,,795.88,Other,153% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,728.26,,,728.26,Other,140% New York Medicaid APG,1170.42,,,1170.42,Other,225% New York Medicaid APG,1352.48,,,1352.48,Other,260% New York Medicaid APG,1685.4,,,1685.4,Other,324% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,1118.4,,,1118.4,Other,215% New York Medicaid APG,650.23,,,650.23,Other,125% New York Medicaid APG,0.01,25945.68,
Drain external ear lesion,69000,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,615,,,615,Fee Schedule,,521.25,,,521.25,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,11839.04,
Drain external ear lesion,69005,CPT,,,,,,,,both,,,34101.75,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,23189.19,68,,23189.19,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27281.4,80,,27281.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23871.23,70,,23871.23,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,27281.4,
Drain outer ear canal lesion,69020,CPT,,,,,,,,both,,,14798.8,1271.37,,,1271.37,Other,150% of Medicare + 9.63% HCRA Surcharge,773.13,,,773.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,10063.18,68,,10063.18,percent of total billed charges,,423.67,,,423.67,Other,186% of Medicaid,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11839.04,80,,11839.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,10359.16,70,,10359.16,percent of total billed charges,,713.4,,,713.4,Fee Schedule,,604.65,,,604.65,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,11839.04,
Biopsy of external ear,69100,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,227.96,,,227.96,Fee Schedule,,193.21,,,193.21,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,193.21,9473,
Biopsy of external ear canal,69105,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,311.6,,,311.6,Fee Schedule,,264.1,,,264.1,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,264.1,22454.17,
Remove external ear partial,69110,CPT,,,,,,,,both,,,44858,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,30503.44,68,,30503.44,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,35886.4,80,,35886.4,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,35886.4,80,,35886.4,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,31400.6,70,,31400.6,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,35886.4,
Removal of external ear,69120,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,83760.46,68,,83760.46,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,98541.71,80,,98541.71,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,98541.71,
Remove ear canal lesion(s),69140,CPT,,,,,,,,both,,,35546.28,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24171.47,68,,24171.47,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,28437.02,80,,28437.02,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28437.02,80,,28437.02,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,24882.4,70,,24882.4,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,28437.02,
Remove ear canal lesion(s),69145,CPT,,,,,,,,both,,,35810.3,5134.61,,,5134.61,Other,150% of Medicare + 9.63% HCRA Surcharge,3122.39,,,3122.39,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,24351,68,,24351,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,28648.24,80,,28648.24,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,28648.24,80,,28648.24,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,25067.21,70,,25067.21,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,28648.24,
Extensive ear canal surgery,69150,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Clear outer ear canal,69200,CPT,,,,,,,,both,,,2686.86,230.83,,,230.83,Other,150% of Medicare + 9.63% HCRA Surcharge,140.37,,,140.37,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,1880.8,70,,1880.8,percent of total billed charges,,231.24,,,231.24,Fee Schedule,,195.99,,,195.99,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,9473,
Clear outer ear canal,69205,CPT,,,,,,,,both,,,34377.37,2929.69,,,2929.69,Other,150% of Medicare + 9.63% HCRA Surcharge,1781.56,,,1781.56,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,23376.61,68,,23376.61,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,27501.9,80,,27501.9,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27501.9,80,,27501.9,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,24064.16,70,,24064.16,percent of total billed charges,,472.32,,,472.32,Fee Schedule,,400.32,,,400.32,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,400.32,27501.9,
Remove impacted ear wax uni,69209,CPT,,,,,,,,both,,,33401,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,23380.7,70,,23380.7,percent of total billed charges,,22712.68,68,,22712.68,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,26720.8,80,,26720.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26720.8,80,,26720.8,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,23380.7,70,,23380.7,percent of total billed charges,,75.44,,,75.44,Fee Schedule,,63.94,,,63.94,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,26720.8,
Remove impacted ear wax uni,69210,CPT,,,,,,,,both,,,34338.86,110.53,,,110.53,Other,150% of Medicare + 9.63% HCRA Surcharge,67.21,,,67.21,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,24037.2,70,,24037.2,percent of total billed charges,,23350.42,68,,23350.42,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,27471.09,80,,27471.09,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27471.09,80,,27471.09,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,24037.2,70,,24037.2,percent of total billed charges,,159.08,,,159.08,Fee Schedule,,134.83,,,134.83,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,27471.09,
Clean out mastoid cavity,69220,CPT,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,250.92,,,250.92,Fee Schedule,,212.67,,,212.67,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,212.67,9473,
Clean out mastoid cavity,69222,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,8101,70,,8101,percent of total billed charges,,7869.54,68,,7869.54,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9258.28,80,,9258.28,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,674.04,,,674.04,Fee Schedule,,571.29,,,571.29,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,571.29,9258.28,
Revise external ear,69300,CPT,,,,,,,,both,,,37965.27,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26575.69,70,,26575.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,26575.69,
Rebuild outer ear canal,69310,CPT,,,,,,,,both,,,35952.72,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25166.9,70,,25166.9,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3126,25166.9,
Rebuild outer ear canal,69320,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Incision of eardrum,69420,CPT,,,,,,,,both,,,5137.73,441.38,,,441.38,Other,150% of Medicare + 9.63% HCRA Surcharge,268.41,,,268.41,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,3596.41,70,,3596.41,percent of total billed charges,,593.68,,,593.68,Fee Schedule,,503.18,,,503.18,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,9473,
Incision of eardrum,69421,CPT,,,,,,,,both,,,37342.12,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26139.48,70,,26139.48,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,26139.48,
Remove ventilating tube,69424,CPT,,,,,,,,both,,,34127.61,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,23889.33,70,,23889.33,percent of total billed charges,,23206.77,68,,23206.77,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,27302.09,80,,27302.09,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,27302.09,80,,27302.09,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23889.33,70,,23889.33,percent of total billed charges,,295.2,,,295.2,Fee Schedule,,250.2,,,250.2,Fee Schedule,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,250.2,27302.09,
Create eardrum opening,69433,CPT,,,,,,,,both,,,11572.85,994.23,,,994.23,Other,150% of Medicare + 9.63% HCRA Surcharge,604.59,,,604.59,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,423.67,,,423.67,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,8101,70,,8101,percent of total billed charges,,652.72,,,652.72,Fee Schedule,,553.22,,,553.22,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,227.78,,,227.78,Other,New York Medicaid APG methodology,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,227.78,,,227.78,Other,100% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,348.5,,,348.5,Other,153% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,318.89,,,318.89,Other,140% New York Medicaid APG,512.5,,,512.5,Other,225% New York Medicaid APG,592.23,,,592.23,Other,260% New York Medicaid APG,738.01,,,738.01,Other,324% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,489.73,,,489.73,Other,215% New York Medicaid APG,284.72,,,284.72,Other,125% New York Medicaid APG,227.78,9473,
Create eardrum opening,69436,CPT,,,,,,,,both,,,34207.45,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,23945.22,70,,23945.22,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,23945.22,
Exploration of middle ear,69440,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,47404.34,
Eardrum revision,69450,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,54176.39,
Mastoidectomy,69501,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Mastoidectomy,69502,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Remove mastoid structures,69505,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Extensive mastoid surgery,69511,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Extensive mastoid surgery,69530,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Remove ear lesion,69540,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,21812.63,68,,21812.63,percent of total billed charges,,2257.18,,,2257.18,Other,186% of Medicaid,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,646.16,,,646.16,Fee Schedule,,547.66,,,547.66,Fee Schedule,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,547.66,25661.91,
Remove ear lesion,69550,CPT,,,,,,,,both,,,37626.87,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,26338.81,70,,26338.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,26338.81,
Remove ear lesion,69552,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Mastoid surgery revision,69601,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Mastoid surgery revision,69602,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Mastoid surgery revision,69603,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Mastoid surgery revision,69604,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Repair of eardrum,69610,CPT,,,,,,,,both,,,33921.46,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23745.02,70,,23745.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,23745.02,
Repair of eardrum,69620,CPT,,,,,,,,both,,,33597.07,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,22846.01,68,,22846.01,percent of total billed charges,,2966.44,,,2966.44,Other,186% of Medicaid,26877.66,80,,26877.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,26877.66,80,,26877.66,percent of total billed charges,,7216,,,7216,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,23517.95,70,,23517.95,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,26877.66,
Repair eardrum structures,69631,CPT,,,,,,,,both,,,36367.95,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,25457.57,70,,25457.57,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,25457.57,
Rebuild eardrum structures,69632,CPT,,,,,,,,both,,,37346.62,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,26142.63,70,,26142.63,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,26142.63,
Rebuild eardrum structures,69633,CPT,,,,,,,,both,,,39184.76,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,27429.33,70,,27429.33,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,27429.33,
Repair eardrum structures,69635,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Rebuild eardrum structures,69636,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Rebuild eardrum structures,69637,CPT,,,,,,,,both,,,52926.47,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,37048.53,70,,37048.53,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,37048.53,
Revise middle ear & mastoid,69641,CPT,,,,,,,,both,,,40642.42,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28449.69,70,,28449.69,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,28449.69,
Revise middle ear & mastoid,69642,CPT,,,,,,,,both,,,41363.34,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28954.34,70,,28954.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,28954.34,
Revise middle ear & mastoid,69643,CPT,,,,,,,,both,,,38155.74,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,26709.02,70,,26709.02,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,26709.02,
Revise middle ear & mastoid,69644,CPT,,,,,,,,both,,,43513.63,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,30459.54,70,,30459.54,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,30459.54,
Revise middle ear & mastoid,69645,CPT,,,,,,,,both,,,53911.16,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,37737.81,70,,37737.81,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,37737.81,
Revise middle ear & mastoid,69646,CPT,,,,,,,,both,,,51043.02,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,35730.11,70,,35730.11,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,35730.11,
Release middle ear bone,69650,CPT,,,,,,,,both,,,38340.88,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,26838.62,70,,26838.62,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,26838.62,
Revise middle ear bone,69660,CPT,,,,,,,,both,,,37994.47,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,26596.13,70,,26596.13,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,26596.13,
Revise middle ear bone,69661,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Revise middle ear bone,69662,CPT,,,,,,,,both,,,41026.91,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28718.84,70,,28718.84,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,28718.84,
Repair middle ear structures,69666,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,47404.34,
Repair middle ear structures,69667,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,47404.34,
Remove mastoid air cells,69670,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3126,86224,
Remove middle ear nerve,69676,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,47404.34,
Close mastoid fistula,69700,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2966.44,,,2966.44,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1594.86,,,1594.86,Other,New York Medicaid APG methodology,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,1594.86,,,1594.86,Other,100% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2440.14,,,2440.14,Other,153% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,2232.81,,,2232.81,Other,140% New York Medicaid APG,3588.44,,,3588.44,Other,225% New York Medicaid APG,4146.64,,,4146.64,Other,260% New York Medicaid APG,5167.36,,,5167.36,Other,324% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,3428.95,,,3428.95,Other,215% New York Medicaid APG,1993.58,,,1993.58,Other,125% New York Medicaid APG,1594.86,22454.17,
Nps surg dilat eust tube uni,69705,CPT,,,,,,,,both,,,42766.21,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,29081.02,68,,29081.02,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,34212.97,80,,34212.97,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,34212.97,80,,34212.97,percent of total billed charges,,7216,,,7216,Case Rate,,34212.97,80,,34212.97,percent of total billed charges,,29936.35,70,,29936.35,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,34212.97,
Nps surg dilat eust tube bi,69706,CPT,,,,,,,,both,,,41447.35,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,28184.2,68,,28184.2,percent of total billed charges,,2982.93,,,2982.93,Other,186% of Medicaid,33157.88,80,,33157.88,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33157.88,80,,33157.88,percent of total billed charges,,7216,,,7216,Case Rate,,33157.88,80,,33157.88,percent of total billed charges,,29013.15,70,,29013.15,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1603.72,,,1603.72,Other,New York Medicaid APG methodology,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,1603.72,,,1603.72,Other,100% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2453.7,,,2453.7,Other,153% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,2245.21,,,2245.21,Other,140% New York Medicaid APG,3608.38,,,3608.38,Other,225% New York Medicaid APG,4169.68,,,4169.68,Other,260% New York Medicaid APG,5196.07,,,5196.07,Other,324% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,3448.01,,,3448.01,Other,215% New York Medicaid APG,2004.65,,,2004.65,Other,125% New York Medicaid APG,1603.72,33157.88,
Remove/repair hearing aid,69711,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,46049.93,68,,46049.93,percent of total billed charges,,4119.89,,,4119.89,Other,186% of Medicaid,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,54176.39,80,,54176.39,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2053,54176.39,
Implant temple bone w/stimul,69714,CPT,,,,,,,,both,,,66923.42,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,46846.39,70,,46846.39,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,46846.39,
Temple bone implant revision,69717,CPT,,,,,,,,both,,,66227.05,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,7938,,"100% primary, 50% supplemental procedure",7938,Other,Aetna ASC Grouper,7144,,"100% primary, 50% supplemental procedure",7144,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,10243,,"100% primary, 50% secondary, 25% tertiary procedure",10243,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,46358.94,70,,46358.94,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,46358.94,
Release facial nerve,69720,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,86224,
Release facial nerve,69725,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,86224,
Repair facial nerve,69740,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,86224,
Repair facial nerve,69745,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,0.02,,,0.02,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,86224,
Incise inner ear,69801,CPT,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,5391,,"100% primary, 50% secondary, 25% tertiary procedure",5391,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,22454.17,
Explore inner ear,69805,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Explore inner ear,69806,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Remove inner ear,69905,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,86224,
Remove inner ear & mastoid,69910,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,5842.35,,,5842.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,3141.05,,,3141.05,Other,New York Medicaid APG methodology,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,3141.05,,,3141.05,Other,100% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4805.8,,,4805.8,Other,153% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,4397.47,,,4397.47,Other,140% New York Medicaid APG,7067.36,,,7067.36,Other,225% New York Medicaid APG,8166.73,,,8166.73,Other,260% New York Medicaid APG,10177,,,10177,Other,324% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,6753.25,,,6753.25,Other,215% New York Medicaid APG,3926.31,,,3926.31,Other,125% New York Medicaid APG,3141.05,86224,
Incise inner ear nerve,69915,CPT,,,,,,,,both,,,67720.49,5817.88,,,5817.88,Other,150% of Medicare + 9.63% HCRA Surcharge,3537.89,,,3537.89,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4119.89,,,4119.89,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,47404.34,70,,47404.34,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2215,,,2215,Other,New York Medicaid APG methodology,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,2215,,,2215,Other,100% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3388.94,,,3388.94,Other,153% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,3100.99,,,3100.99,Other,140% New York Medicaid APG,4983.74,,,4983.74,Other,225% New York Medicaid APG,5758.99,,,5758.99,Other,260% New York Medicaid APG,7176.59,,,7176.59,Other,324% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,4762.24,,,4762.24,Other,215% New York Medicaid APG,2768.74,,,2768.74,Other,125% New York Medicaid APG,2215,47404.34,
Implant cochlear device,69930,CPT,,,,,,,,both,,,144542.65,60597.24,,,60597.24,Other,150% of Medicare + 9.63% HCRA Surcharge,36849.55,,,36849.55,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,51118.92,,,51118.92,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,101179.86,70,,101179.86,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,27483.29,,,27483.29,Other,New York Medicaid APG methodology,27483.29,,,27483.29,Other,100% New York Medicaid APG,27483.29,,,27483.29,Other,100% New York Medicaid APG,27483.29,,,27483.29,Other,100% New York Medicaid APG,61837.4,,,61837.4,Other,225% New York Medicaid APG,42049.43,,,42049.43,Other,153% New York Medicaid APG,61837.4,,,61837.4,Other,225% New York Medicaid APG,38476.6,,,38476.6,Other,140% New York Medicaid APG,61837.4,,,61837.4,Other,225% New York Medicaid APG,71456.55,,,71456.55,Other,260% New York Medicaid APG,89045.85,,,89045.85,Other,324% New York Medicaid APG,59089.07,,,59089.07,Other,215% New York Medicaid APG,59089.07,,,59089.07,Other,215% New York Medicaid APG,34354.11,,,34354.11,Other,125% New York Medicaid APG,3343,101179.86,
Release facial nerve,69955,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,4659.8,,,4659.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2505.27,,,2505.27,Other,New York Medicaid APG methodology,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3833.06,,,3833.06,Other,153% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3507.38,,,3507.38,Other,140% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,6513.7,,,6513.7,Other,260% New York Medicaid APG,8117.07,,,8117.07,Other,324% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,3131.59,,,3131.59,Other,125% New York Medicaid APG,2505.27,86224,
Release inner ear canal,69960,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,4659.8,,,4659.8,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2505.27,,,2505.27,Other,New York Medicaid APG methodology,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,2505.27,,,2505.27,Other,100% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3833.06,,,3833.06,Other,153% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,3507.38,,,3507.38,Other,140% New York Medicaid APG,5636.86,,,5636.86,Other,225% New York Medicaid APG,6513.7,,,6513.7,Other,260% New York Medicaid APG,8117.07,,,8117.07,Other,324% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,5386.33,,,5386.33,Other,215% New York Medicaid APG,3131.59,,,3131.59,Other,125% New York Medicaid APG,2505.27,86224,
Remove inner ear lesion,69970,CPT,,,,,,,,both,,,123177.14,10582.17,,,10582.17,Other,150% of Medicare + 9.63% HCRA Surcharge,6435.08,,,6435.08,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,86224,70,,86224,percent of total billed charges,,6152,,,6152,Case Rate,,5483.35,,,5483.35,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,86224,70,,86224,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2948.04,,,2948.04,Other,New York Medicaid APG methodology,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,2948.04,,,2948.04,Other,100% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4510.5,,,4510.5,Other,153% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,4127.26,,,4127.26,Other,140% New York Medicaid APG,6633.09,,,6633.09,Other,225% New York Medicaid APG,7664.9,,,7664.9,Other,260% New York Medicaid APG,9551.65,,,9551.65,Other,324% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,6338.28,,,6338.28,Other,215% New York Medicaid APG,3685.05,,,3685.05,Other,125% New York Medicaid APG,2948.04,86224,
Microsurgery add-on,69990,CPT,,,,,,,,both,,,32432.1,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,22053.83,68,,22053.83,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,25945.68,80,,25945.68,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,22702.47,70,,22702.47,percent of total billed charges,,3933,,,3933,Case Rate,MVP ASC Grouper,3343,,,3343,Case Rate,MVP ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,25945.68,
Insert/place heart catheter,93503,CPT,,,,,,,,both,,,33686.28,2893.99,,,2893.99,Other,150% of Medicare + 9.63% HCRA Surcharge,1759.86,,,1759.86,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,22906.67,68,,22906.67,percent of total billed charges,,587.3,,,587.3,Other,186% of Medicaid,26949.02,80,,26949.02,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,26949.02,80,,26949.02,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,23580.4,70,,23580.4,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,315.75,,,315.75,Other,New York Medicaid APG methodology,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,315.75,,,315.75,Other,100% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,483.1,,,483.1,Other,153% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,442.05,,,442.05,Other,140% New York Medicaid APG,710.44,,,710.44,Other,225% New York Medicaid APG,820.95,,,820.95,Other,260% New York Medicaid APG,1023.04,,,1023.04,Other,324% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,678.87,,,678.87,Other,215% New York Medicaid APG,394.69,,,394.69,Other,125% New York Medicaid APG,315.75,26949.02,
Biopsy of heart lining,93505,CPT,,,,,,,,both,,,72939.09,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,49598.58,68,,49598.58,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,58351.27,80,,58351.27,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,58351.27,80,,58351.27,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,51057.36,70,,51057.36,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,58351.27,
Right heart cath,93451,CPT,,,,,,,,both,,,61830.11,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,42044.47,68,,42044.47,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,49464.09,80,,49464.09,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,49464.09,80,,49464.09,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,43281.08,70,,43281.08,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,49464.09,
Left hrt cath w/ventrclgrphy,93452,CPT,,,,,,,,both,,,68539.72,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,46607.01,68,,46607.01,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,54831.78,80,,54831.78,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,54831.78,80,,54831.78,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,47977.8,70,,47977.8,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,54831.78,
R&l hrt cath w/ventriclgrphy,93453,CPT,,,,,,,,both,,,75685.6,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,51466.21,68,,51466.21,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,60548.48,80,,60548.48,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,60548.48,80,,60548.48,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,52979.92,70,,52979.92,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,60548.48,
Coronary artery angio s&i,93454,CPT,,,,,,,,both,,,65729.71,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,44696.2,68,,44696.2,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,52583.77,80,,52583.77,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,52583.77,80,,52583.77,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,46010.8,70,,46010.8,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,52583.77,
Coronary art/grft angio s&i,93455,CPT,,,,,,,,both,,,74923,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,50947.64,68,,50947.64,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,59938.4,80,,59938.4,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,59938.4,80,,59938.4,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,52446.1,70,,52446.1,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,59938.4,
R hrt coronary artery angio,93456,CPT,,,,,,,,both,,,80496.47,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,54737.6,68,,54737.6,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,64397.18,80,,64397.18,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,64397.18,80,,64397.18,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,56347.53,70,,56347.53,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,64397.18,
R hrt art/grft angio,93457,CPT,,,,,,,,both,,,77610,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,52774.8,68,,52774.8,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,62088,80,,62088,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,62088,80,,62088,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,54327,70,,54327,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,62088,
L hrt artery/ventricle angio,93458,CPT,,,,,,,,both,,,72973.25,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,49621.81,68,,49621.81,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,58378.6,80,,58378.6,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,58378.6,80,,58378.6,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,51081.28,70,,51081.28,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,58378.6,
L hrt art/grft angio,93459,CPT,,,,,,,,both,,,79193.42,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,53851.53,68,,53851.53,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,63354.74,80,,63354.74,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,63354.74,80,,63354.74,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,55435.39,70,,55435.39,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,63354.74,
R&l hrt art/ventricle angio,93460,CPT,,,,,,,,both,,,78047.52,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,53072.31,68,,53072.31,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,62438.02,80,,62438.02,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,62438.02,80,,62438.02,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,54633.26,70,,54633.26,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,62438.02,
R&l hrt art/ventricle angio,93461,CPT,,,,,,,,both,,,92590.93,5888.26,,,5888.26,Other,150% of Medicare + 9.63% HCRA Surcharge,3580.69,,,3580.69,Other,Medicare OPPS methodology,14237,,"100% primary, 50% supplemental procedure",14237,Other,Aetna ASC Grouper,12813,,"100% primary, 50% supplemental procedure",12813,Other,Aetna ASC Grouper,12563,,"100% primary, 50% secondary, 25% supplemental procedure",12563,Other,Blue Cross ASC Grouper,11307,,"100% primary, 50% secondary, 25% supplemental procedure",11307,Other,Blue Cross ASC Grouper,10679,,"100% primary, 50% secondary, 25% supplemental procedure",10679,Other,Blue Cross ASC Grouper,14533,,,14533,Case Rate,Cardiac Cath Case Rate,62961.83,68,,62961.83,percent of total billed charges,,3171.34,,,3171.34,Other,186% of Medicaid,74072.74,80,,74072.74,percent of total billed charges,,11847,,,11847,Case Rate,,10971,,,10971,Case Rate,,74072.74,80,,74072.74,percent of total billed charges,,11847,,,11847,Case Rate,,15214,,,15214,Case Rate,Cardiac Cath Case Rate,64813.65,70,,64813.65,percent of total billed charges,,15035,,,15035,Case Rate,Cardiac Cath Case Rate,12780,,,12780,Case Rate,Cardiac Cath Case Rate,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1705.02,,,1705.02,Other,New York Medicaid APG methodology,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,1705.02,,,1705.02,Other,100% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2608.69,,,2608.69,Other,153% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,2387.03,,,2387.03,Other,140% New York Medicaid APG,3836.3,,,3836.3,Other,225% New York Medicaid APG,4433.06,,,4433.06,Other,260% New York Medicaid APG,5524.28,,,5524.28,Other,324% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,3665.8,,,3665.8,Other,215% New York Medicaid APG,2131.28,,,2131.28,Other,125% New York Medicaid APG,1705.02,74072.74,
"Microwave bronch, 3d, ebus",C9751,HCPCS,,,,,,,,both,,,82795.68,7112.99,,,7112.99,Other,150% of Medicare + 9.63% HCRA Surcharge,4325.45,,,4325.45,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,57956.98,70,,57956.98,percent of total billed charges,,6152,,,6152,Case Rate,,2329.06,,,2329.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,57956.98,70,,57956.98,percent of total billed charges,,53817.19,65,,53817.19,percent of total billed charges,,53817.19,65,,53817.19,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1252.19,,,1252.19,Other,New York Medicaid APG methodology,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,1252.19,,,1252.19,Other,100% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1915.84,,,1915.84,Other,153% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,1753.06,,,1753.06,Other,140% New York Medicaid APG,2817.42,,,2817.42,Other,225% New York Medicaid APG,3255.68,,,3255.68,Other,260% New York Medicaid APG,4057.08,,,4057.08,Other,324% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,2692.2,,,2692.2,Other,215% New York Medicaid APG,1565.23,,,1565.23,Other,125% New York Medicaid APG,1252.19,57956.98,
Blind interatrial shunt ide,C9758,HCPCS,,,,,,,,both,,,386339.36,33190.47,,,33190.47,Other,150% of Medicare + 9.63% HCRA Surcharge,20183.33,,,20183.33,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4728.14,,,4728.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,309071.49,80,,309071.49,percent of total billed charges,,270437.55,70,,270437.55,percent of total billed charges,,251120.58,65,,251120.58,percent of total billed charges,,251120.58,65,,251120.58,percent of total billed charges,,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,2542.01,,,2542.01,Other,New York Medicaid APG methodology,2542.01,,,2542.01,Other,100% New York Medicaid APG,2542.01,,,2542.01,Other,100% New York Medicaid APG,2542.01,,,2542.01,Other,100% New York Medicaid APG,5719.53,,,5719.53,Other,225% New York Medicaid APG,3889.28,,,3889.28,Other,153% New York Medicaid APG,5719.53,,,5719.53,Other,225% New York Medicaid APG,3558.82,,,3558.82,Other,140% New York Medicaid APG,5719.53,,,5719.53,Other,225% New York Medicaid APG,6609.23,,,6609.23,Other,260% New York Medicaid APG,8236.12,,,8236.12,Other,324% New York Medicaid APG,5465.33,,,5465.33,Other,215% New York Medicaid APG,5465.33,,,5465.33,Other,215% New York Medicaid APG,3177.52,,,3177.52,Other,125% New York Medicaid APG,2542.01,309071.49,
Prosth retina receive&gen,0100T,HCPCS,,,,,,,,both,,,98219.64,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,68753.75,70,,68753.75,percent of total billed charges,,6152,,,6152,Case Rate,,4784.01,,,4784.01,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,68753.75,70,,68753.75,percent of total billed charges,,63842.77,65,,63842.77,percent of total billed charges,,63842.77,65,,63842.77,percent of total billed charges,,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,2572.05,,,2572.05,Other,New York Medicaid APG methodology,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,2572.05,,,2572.05,Other,100% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3935.24,,,3935.24,Other,153% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,3600.87,,,3600.87,Other,140% New York Medicaid APG,5787.11,,,5787.11,Other,225% New York Medicaid APG,6687.33,,,6687.33,Other,260% New York Medicaid APG,8333.44,,,8333.44,Other,324% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,5529.91,,,5529.91,Other,215% New York Medicaid APG,3215.06,,,3215.06,Other,125% New York Medicaid APG,0.01,68753.75,
Rmvl impltbl glucose sensor,0447T,HCPCS,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2863.47,68,,2863.47,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3368.78,80,,3368.78,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,319.8,,,319.8,Fee Schedule,,271.05,,,271.05,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,219.99,7216,
Esw integ wnd hlg 1st wnd,0512T,HCPCS,,,,,,,,both,,,4210.98,361.77,,,361.77,Other,150% of Medicare + 9.63% HCRA Surcharge,219.99,,,219.99,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,6152,,,6152,Case Rate,,1353.14,,,1353.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,2947.69,70,,2947.69,percent of total billed charges,,2737.14,65,,2737.14,percent of total billed charges,,2737.14,65,,2737.14,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,219.99,9473,
Dstrj neurofibroma xtnsv,0419T,HCPCS,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8586.64,65,,8586.64,percent of total billed charges,,8586.64,65,,8586.64,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,10568.18,
Dstrj neurofibroma xtnsv,0420T,HCPCS,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,733.72,,,733.72,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8586.64,65,,8586.64,percent of total billed charges,,8586.64,65,,8586.64,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,394.47,,,394.47,Other,New York Medicaid APG methodology,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,394.47,,,394.47,Other,100% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,603.55,,,603.55,Other,153% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,552.26,,,552.26,Other,140% New York Medicaid APG,887.57,,,887.57,Other,225% New York Medicaid APG,1025.63,,,1025.63,Other,260% New York Medicaid APG,1278.1,,,1278.1,Other,324% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,848.12,,,848.12,Other,215% New York Medicaid APG,493.09,,,493.09,Other,125% New York Medicaid APG,394.47,10568.18,
Fxjl abl lsr 1st 100 sq cm,0479T,HCPCS,,,,,,,,both,,,38421.99,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,26895.39,70,,26895.39,percent of total billed charges,,6152,,,6152,Case Rate,,1353.14,,,1353.14,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,26895.39,70,,26895.39,percent of total billed charges,,24974.29,65,,24974.29,percent of total billed charges,,24974.29,65,,24974.29,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,727.5,,,727.5,Other,New York Medicaid APG methodology,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,727.5,,,727.5,Other,100% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1113.07,,,1113.07,Other,153% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1018.49,,,1018.49,Other,140% New York Medicaid APG,1636.87,,,1636.87,Other,225% New York Medicaid APG,1891.49,,,1891.49,Other,260% New York Medicaid APG,2357.09,,,2357.09,Other,324% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,1564.12,,,1564.12,Other,215% New York Medicaid APG,909.37,,,909.37,Other,125% New York Medicaid APG,690.13,26895.39,
Low cost skin substitute app,C5271,HCPCS,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8586.64,65,,8586.64,percent of total billed charges,,8586.64,65,,8586.64,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,690.13,10568.18,
Low cost skin substitute app,C5275,HCPCS,,,,,,,,both,,,42128.5,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,29489.95,70,,29489.95,percent of total billed charges,,28647.38,68,,28647.38,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,33702.8,80,,33702.8,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33702.8,80,,33702.8,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,29489.95,70,,29489.95,percent of total billed charges,,27383.53,65,,27383.53,percent of total billed charges,,27383.53,65,,27383.53,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,690.13,33702.8,
Low cost skin substitute app,C5277,HCPCS,,,,,,,,both,,,13210.22,1134.89,,,1134.89,Other,150% of Medicare + 9.63% HCRA Surcharge,690.13,,,690.13,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8982.95,68,,8982.95,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10568.18,80,,10568.18,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,9247.15,70,,9247.15,percent of total billed charges,,8586.64,65,,8586.64,percent of total billed charges,,8586.64,65,,8586.64,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,690.13,10568.18,
Reloc skin pocket pls gen,0416T,HCPCS,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,26083.13,68,,26083.13,percent of total billed charges,,4537.53,,,4537.53,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,24932.41,65,,24932.41,percent of total billed charges,,24932.41,65,,24932.41,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2003.89,30686.04,
Insj impltbl glucose sensor,0446T,HCPCS,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,26083.13,68,,26083.13,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,272.24,,,272.24,Fee Schedule,,230.74,,,230.74,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,230.74,30686.04,
Remvl insj impltbl gluc sens,0448T,HCPCS,,,,,,,,both,,,38357.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,26083.13,68,,26083.13,percent of total billed charges,,1241.44,,,1241.44,Other,186% of Medicaid,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,30686.04,80,,30686.04,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,26850.29,70,,26850.29,percent of total billed charges,,455.92,,,455.92,Fee Schedule,,386.42,,,386.42,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,667.44,,,667.44,Other,New York Medicaid APG methodology,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,667.44,,,667.44,Other,100% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1021.19,,,1021.19,Other,153% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,934.42,,,934.42,Other,140% New York Medicaid APG,1501.75,,,1501.75,Other,225% New York Medicaid APG,1735.35,,,1735.35,Other,260% New York Medicaid APG,2162.51,,,2162.51,Other,324% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,1435,,,1435,Other,215% New York Medicaid APG,834.3,,,834.3,Other,125% New York Medicaid APG,386.42,30686.04,
Low cost skin substitute app,C5273,HCPCS,,,,,,,,both,,,59774.55,3295.3,,,3295.3,Other,150% of Medicare + 9.63% HCRA Surcharge,2003.89,,,2003.89,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,41842.19,70,,41842.19,percent of total billed charges,,40646.69,68,,40646.69,percent of total billed charges,,2594.15,,,2594.15,Other,186% of Medicaid,47819.64,80,,47819.64,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,47819.64,80,,47819.64,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,41842.19,70,,41842.19,percent of total billed charges,,38853.46,65,,38853.46,percent of total billed charges,,38853.46,65,,38853.46,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1394.71,,,1394.71,Other,New York Medicaid APG methodology,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,1394.71,,,1394.71,Other,100% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,2133.9,,,2133.9,Other,153% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,1952.59,,,1952.59,Other,140% New York Medicaid APG,3138.09,,,3138.09,Other,225% New York Medicaid APG,3626.23,,,3626.23,Other,260% New York Medicaid APG,4518.85,,,4518.85,Other,324% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,2998.62,,,2998.62,Other,215% New York Medicaid APG,1743.38,,,1743.38,Other,125% New York Medicaid APG,1394.71,47819.64,
Extracorp shockwv tx hi enrg,0101T,HCPCS,,,,,,,,both,,,4960.23,426.13,,,426.13,Other,150% of Medicare + 9.63% HCRA Surcharge,259.13,,,259.13,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,6152,,,6152,Case Rate,,1032.04,,,1032.04,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,3472.16,70,,3472.16,percent of total billed charges,,3224.15,65,,3224.15,percent of total billed charges,,3224.15,65,,3224.15,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,554.86,,,554.86,Other,New York Medicaid APG methodology,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,554.86,,,554.86,Other,100% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,848.94,,,848.94,Other,153% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,776.81,,,776.81,Other,140% New York Medicaid APG,1248.44,,,1248.44,Other,225% New York Medicaid APG,1442.64,,,1442.64,Other,260% New York Medicaid APG,1797.75,,,1797.75,Other,324% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,1192.95,,,1192.95,Other,215% New York Medicaid APG,693.58,,,693.58,Other,125% New York Medicaid APG,259.13,9473,
Extracorp shockwv tx anesth,0102T,HCPCS,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,44253.79,65,,44253.79,percent of total billed charges,,44253.79,65,,44253.79,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,47657.93,
Rmvl sinus tarsi implant,0510T,HCPCS,,,,,,,,both,,,68082.75,5849,,,5849,Other,150% of Medicare + 9.63% HCRA Surcharge,3556.81,,,3556.81,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,47657.93,70,,47657.93,percent of total billed charges,,44253.79,65,,44253.79,percent of total billed charges,,44253.79,65,,44253.79,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,1554.71,47657.93,
Perq sacral augmt unilat inj,0200T,HCPCS,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Perq sacral augmt bilat inj,0201T,HCPCS,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Plmt post facet implt lumb,0221T,HCPCS,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Perq lamot/lam crv/thrc,0274T,HCPCS,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,105333.66,
Perq lamot/lam lumbar,0275T,HCPCS,,,,,,,,both,,,152786.49,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,106950.54,70,,106950.54,percent of total billed charges,,6152,,,6152,Case Rate,,5526.1,,,5526.1,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,106950.54,70,,106950.54,percent of total billed charges,,99311.22,65,,99311.22,percent of total billed charges,,99311.22,65,,99311.22,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2971.02,,,2971.02,Other,New York Medicaid APG methodology,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,2971.02,,,2971.02,Other,100% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4545.66,,,4545.66,Other,153% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,4159.43,,,4159.43,Other,140% New York Medicaid APG,6684.79,,,6684.79,Other,225% New York Medicaid APG,7724.65,,,7724.65,Other,260% New York Medicaid APG,9626.1,,,9626.1,Other,324% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,6387.69,,,6387.69,Other,215% New York Medicaid APG,3713.77,,,3713.77,Other,125% New York Medicaid APG,2971.02,106950.54,
Insj sinus tarsi implant,0335T,HCPCS,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,0.01,,"100% primary, 50% supplemental procedure",0.01,Other,Aetna ASC Grouper,0.01,,"100% primary, 50% supplemental procedure",0.01,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,2891.77,,,2891.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1554.71,,,1554.71,Other,New York Medicaid APG methodology,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,1554.71,,,1554.71,Other,100% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2378.71,,,2378.71,Other,153% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,2176.6,,,2176.6,Other,140% New York Medicaid APG,3498.11,,,3498.11,Other,225% New York Medicaid APG,4042.26,,,4042.26,Other,260% New York Medicaid APG,5037.27,,,5037.27,Other,324% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,3342.64,,,3342.64,Other,215% New York Medicaid APG,1943.39,,,1943.39,Other,125% New York Medicaid APG,0.01,105333.66,
Rmvl&rinsj sinus tarsi implt,0511T,HCPCS,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3643.47,,,3643.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1958.85,,,1958.85,Other,New York Medicaid APG methodology,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,1958.85,,,1958.85,Other,100% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2997.05,,,2997.05,Other,153% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,2742.4,,,2742.4,Other,140% New York Medicaid APG,4407.42,,,4407.42,Other,225% New York Medicaid APG,5093.02,,,5093.02,Other,260% New York Medicaid APG,6346.69,,,6346.69,Other,324% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,4211.54,,,4211.54,Other,215% New York Medicaid APG,2448.57,,,2448.57,Other,125% New York Medicaid APG,1958.85,105333.66,
Osteot hum xtrnl lngth dev,0594T,HCPCS,,,,,,,,both,,,150476.65,12927.47,,,12927.47,Other,150% of Medicare + 9.63% HCRA Surcharge,7861.27,,,7861.27,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,105333.66,70,,105333.66,percent of total billed charges,,6152,,,6152,Case Rate,,3961.19,,,3961.19,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,120381.32,80,,120381.32,percent of total billed charges,,105333.66,70,,105333.66,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,97809.82,65,,97809.82,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2129.67,,,2129.67,Other,New York Medicaid APG methodology,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,2129.67,,,2129.67,Other,100% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,3258.39,,,3258.39,Other,153% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,2981.54,,,2981.54,Other,140% New York Medicaid APG,4791.76,,,4791.76,Other,225% New York Medicaid APG,5537.14,,,5537.14,Other,260% New York Medicaid APG,6900.13,,,6900.13,Other,324% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,4578.79,,,4578.79,Other,215% New York Medicaid APG,2662.09,,,2662.09,Other,125% New York Medicaid APG,2129.67,120381.32,
Perq njx algc fluor lmbr 1st,0627T,HCPCS,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,188242.95,68,,188242.95,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,221462.3,80,,221462.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,221462.3,80,,221462.3,percent of total billed charges,,7216,,,7216,Case Rate,,221462.3,80,,221462.3,percent of total billed charges,,193779.51,70,,193779.51,percent of total billed charges,,179938.12,65,,179938.12,percent of total billed charges,,179938.12,65,,179938.12,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,221462.3,
Perq njx algc ct lmbr 1st,0629T,HCPCS,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,193779.51,70,,193779.51,percent of total billed charges,,188242.95,68,,188242.95,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,221462.3,80,,221462.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,221462.3,80,,221462.3,percent of total billed charges,,7216,,,7216,Case Rate,,221462.3,80,,221462.3,percent of total billed charges,,193779.51,70,,193779.51,percent of total billed charges,,179938.12,65,,179938.12,percent of total billed charges,,179938.12,65,,179938.12,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,221462.3,
Spine/lumbar disk surgery,C9757,HCPCS,,,,,,,,both,,,276827.87,23782.32,,,23782.32,Other,150% of Medicare + 9.63% HCRA Surcharge,14462.17,,,14462.17,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,7617,,"100% primary, 50% secondary, 25% tertiary procedure",7617,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,6658.98,,,6658.98,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,221462.3,80,,221462.3,percent of total billed charges,,193779.51,70,,193779.51,percent of total billed charges,,179938.12,65,,179938.12,percent of total billed charges,,179938.12,65,,179938.12,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,3580.1,,,3580.1,Other,New York Medicaid APG methodology,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,3580.1,,,3580.1,Other,100% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5477.55,,,5477.55,Other,153% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,5012.13,,,5012.13,Other,140% New York Medicaid APG,8055.22,,,8055.22,Other,225% New York Medicaid APG,9308.25,,,9308.25,Other,260% New York Medicaid APG,11599.51,,,11599.51,Other,324% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,7697.21,,,7697.21,Other,215% New York Medicaid APG,4475.12,,,4475.12,Other,125% New York Medicaid APG,3580.1,221462.3,
Tmpst auto tube dlvr sys,0583T,HCPCS,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,25661.91,80,,25661.91,percent of total billed charges,,22454.17,70,,22454.17,percent of total billed charges,,20850.3,65,,20850.3,percent of total billed charges,,20850.3,65,,20850.3,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,25661.91,
Insert palate implants,C9727,HCPCS,,,,,,,,both,,,32077.39,2755.77,,,2755.77,Other,150% of Medicare + 9.63% HCRA Surcharge,1675.8,,,1675.8,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,6152,,,6152,Case Rate,,2257.18,,,2257.18,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,22454.17,70,,22454.17,percent of total billed charges,,20850.3,65,,20850.3,percent of total billed charges,,20850.3,65,,20850.3,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,1213.54,,,1213.54,Other,New York Medicaid APG methodology,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,1213.54,,,1213.54,Other,100% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1856.71,,,1856.71,Other,153% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,1698.95,,,1698.95,Other,140% New York Medicaid APG,2730.46,,,2730.46,Other,225% New York Medicaid APG,3155.2,,,3155.2,Other,260% New York Medicaid APG,3931.86,,,3931.86,Other,324% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,2609.11,,,2609.11,Other,215% New York Medicaid APG,1516.92,,,1516.92,Other,125% New York Medicaid APG,1213.54,22454.17,
Repos car modulj tranvns elt,0415T,HCPCS,,,,,,,,both,,,13213.53,1135.18,,,1135.18,Other,150% of Medicare + 9.63% HCRA Surcharge,690.31,,,690.31,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,8985.2,68,,8985.2,percent of total billed charges,,4537.53,,,4537.53,Other,186% of Medicaid,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,10570.82,80,,10570.82,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,9249.47,70,,9249.47,percent of total billed charges,,8588.79,65,,8588.79,percent of total billed charges,,8588.79,65,,8588.79,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,690.31,10570.82,
Ev cath dir chem abltj w/img,0524T,HCPCS,,,,,,,,both,,,67044.74,5759.82,,,5759.82,Other,150% of Medicare + 9.63% HCRA Surcharge,3502.58,,,3502.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,6152,,,6152,Case Rate,,4157.07,,,4157.07,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,46931.32,70,,46931.32,percent of total billed charges,,43579.08,65,,43579.08,percent of total billed charges,,43579.08,65,,43579.08,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2234.98,,,2234.98,Other,New York Medicaid APG methodology,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,2234.98,,,2234.98,Other,100% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3419.52,,,3419.52,Other,153% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,3128.98,,,3128.98,Other,140% New York Medicaid APG,5028.71,,,5028.71,Other,225% New York Medicaid APG,5810.96,,,5810.96,Other,260% New York Medicaid APG,7241.34,,,7241.34,Other,324% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,4805.21,,,4805.21,Other,215% New York Medicaid APG,2793.73,,,2793.73,Other,125% New York Medicaid APG,2234.98,46931.32,
Trnscth renal symp denrv unl,0338T,HCPCS,,,,,,,,both,,,120221.84,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,84155.29,70,,84155.29,percent of total billed charges,,6152,,,6152,Case Rate,,2758.57,,,2758.57,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,84155.29,70,,84155.29,percent of total billed charges,,78144.2,65,,78144.2,percent of total billed charges,,78144.2,65,,78144.2,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1483.1,,,1483.1,Other,New York Medicaid APG methodology,1483.1,,,1483.1,Other,100% New York Medicaid APG,1483.1,,,1483.1,Other,100% New York Medicaid APG,1483.1,,,1483.1,Other,100% New York Medicaid APG,3336.98,,,3336.98,Other,225% New York Medicaid APG,2269.14,,,2269.14,Other,153% New York Medicaid APG,3336.98,,,3336.98,Other,225% New York Medicaid APG,2076.34,,,2076.34,Other,140% New York Medicaid APG,3336.98,,,3336.98,Other,225% New York Medicaid APG,3856.06,,,3856.06,Other,260% New York Medicaid APG,4805.25,,,4805.25,Other,324% New York Medicaid APG,3188.67,,,3188.67,Other,215% New York Medicaid APG,3188.67,,,3188.67,Other,215% New York Medicaid APG,1853.88,,,1853.88,Other,125% New York Medicaid APG,1483.1,84155.29,
Trnscth renal symp denrv bil,0339T,HCPCS,,,,,,,,both,,,120221.84,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,84155.29,70,,84155.29,percent of total billed charges,,6152,,,6152,Case Rate,,2758.57,,,2758.57,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,84155.29,70,,84155.29,percent of total billed charges,,78144.2,65,,78144.2,percent of total billed charges,,78144.2,65,,78144.2,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1483.1,,,1483.1,Other,New York Medicaid APG methodology,1483.1,,,1483.1,Other,100% New York Medicaid APG,1483.1,,,1483.1,Other,100% New York Medicaid APG,1483.1,,,1483.1,Other,100% New York Medicaid APG,3336.98,,,3336.98,Other,225% New York Medicaid APG,2269.14,,,2269.14,Other,153% New York Medicaid APG,3336.98,,,3336.98,Other,225% New York Medicaid APG,2076.34,,,2076.34,Other,140% New York Medicaid APG,3336.98,,,3336.98,Other,225% New York Medicaid APG,3856.06,,,3856.06,Other,260% New York Medicaid APG,4805.25,,,4805.25,Other,324% New York Medicaid APG,3188.67,,,3188.67,Other,215% New York Medicaid APG,3188.67,,,3188.67,Other,215% New York Medicaid APG,1853.88,,,1853.88,Other,125% New York Medicaid APG,1483.1,84155.29,
Prq cardiac angioplast 1 art,92920,CPT,,,,,,,,both,,,120221.84,10328.28,,,10328.28,Other,150% of Medicare + 9.63% HCRA Surcharge,6280.69,,,6280.69,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,84155.29,70,,84155.29,percent of total billed charges,,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,84155.29,70,,84155.29,percent of total billed charges,,2523.96,,,2523.96,Fee Schedule,,2139.21,,,2139.21,Fee Schedule,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2139.21,84155.29,
Revasc intravasc lithotripsy,C9764,HCPCS,,,,,,,,both,,,119648,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,7397,,"100% primary, 50% secondary, 25% supplemental procedure",7397,Other,Blue Cross ASC Grouper,6657,,"100% primary, 50% secondary, 25% supplemental procedure",6657,Other,Blue Cross ASC Grouper,6287,,"100% primary, 50% secondary, 25% supplemental procedure",6287,Other,Blue Cross ASC Grouper,83753.6,70,,83753.6,percent of total billed charges,,6152,,,6152,Case Rate,,3854.06,,,3854.06,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,95718.4,80,,95718.4,percent of total billed charges,,83753.6,70,,83753.6,percent of total billed charges,,77771.2,65,,77771.2,percent of total billed charges,,77771.2,65,,77771.2,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2072.07,,,2072.07,Other,New York Medicaid APG methodology,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,2072.07,,,2072.07,Other,100% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,3170.27,,,3170.27,Other,153% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,2900.9,,,2900.9,Other,140% New York Medicaid APG,4662.16,,,4662.16,Other,225% New York Medicaid APG,5387.39,,,5387.39,Other,260% New York Medicaid APG,6713.52,,,6713.52,Other,324% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,4454.96,,,4454.96,Other,215% New York Medicaid APG,2590.09,,,2590.09,Other,125% New York Medicaid APG,2072.07,95718.4,
Ev fempop artl revsc,0505T,HCPCS,,,,,,,,both,,,231395.43,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,161976.8,70,,161976.8,percent of total billed charges,,6152,,,6152,Case Rate,,4606.15,,,4606.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,161976.8,70,,161976.8,percent of total billed charges,,150407.03,65,,150407.03,percent of total billed charges,,150407.03,65,,150407.03,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,2476.42,161976.8,
Prq card stent w/angio 1 vsl,92928,CPT,,,,,,,,both,,,231395.43,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,161976.8,70,,161976.8,percent of total billed charges,,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,161976.8,70,,161976.8,percent of total billed charges,,2814.24,,,2814.24,Fee Schedule,,2385.24,,,2385.24,Fee Schedule,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2385.24,161976.8,
Perc drug-el cor stent sing,C9600,HCPCS,,,,,,,,both,,,100522.73,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,70365.91,70,,70365.91,percent of total billed charges,,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,70365.91,70,,70365.91,percent of total billed charges,,65339.77,65,,65339.77,percent of total billed charges,,65339.77,65,,65339.77,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,70365.91,
Perc d-e cor revasc t cabg s,C9604,HCPCS,,,,,,,,both,,,120990,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,84693,70,,84693,percent of total billed charges,,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,84693,70,,84693,percent of total billed charges,,78643.5,65,,78643.5,percent of total billed charges,,78643.5,65,,78643.5,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,84693,
Revasc intra lithotrip-stent,C9765,HCPCS,,,,,,,,both,,,183637,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,128545.9,70,,128545.9,percent of total billed charges,,6152,,,6152,Case Rate,,4606.15,,,4606.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,146909.6,80,,146909.6,percent of total billed charges,,128545.9,70,,128545.9,percent of total billed charges,,119364.05,65,,119364.05,percent of total billed charges,,119364.05,65,,119364.05,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,2476.42,146909.6,
Revasc intra lithotrip-ather,C9766,HCPCS,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,258180.29,70,,258180.29,percent of total billed charges,,6152,,,6152,Case Rate,,4606.15,,,4606.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,295063.18,80,,295063.18,percent of total billed charges,,258180.29,70,,258180.29,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,2476.42,295063.18,
Revasc lithotrip tibi/perone,C9772,HCPCS,,,,,,,,both,,,231395.43,19879.22,,,19879.22,Other,150% of Medicare + 9.63% HCRA Surcharge,12088.67,,,12088.67,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.15,,,4606.15,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,185116.34,80,,185116.34,percent of total billed charges,,161976.8,70,,161976.8,percent of total billed charges,,150407.03,65,,150407.03,percent of total billed charges,,150407.03,65,,150407.03,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.42,,,2476.42,Other,New York Medicaid APG methodology,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,2476.42,,,2476.42,Other,100% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,3466.99,,,3466.99,Other,140% New York Medicaid APG,5571.95,,,5571.95,Other,225% New York Medicaid APG,6438.7,,,6438.7,Other,260% New York Medicaid APG,8023.61,,,8023.61,Other,324% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,5324.31,,,5324.31,Other,215% New York Medicaid APG,3095.53,,,3095.53,Other,125% New York Medicaid APG,2476.42,185116.34,
Trluml perip athrc iliac art,0238T,HCPCS,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,258180.29,70,,258180.29,percent of total billed charges,,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,258180.29,70,,258180.29,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,258180.29,
Evasc ven artlz tibl/prnl vn,0620T,HCPCS,,,,,,,,both,,,607098.41,52155.91,,,52155.91,Other,150% of Medicare + 9.63% HCRA Surcharge,31716.33,,,31716.33,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,424968.89,70,,424968.89,percent of total billed charges,,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,485678.73,80,,485678.73,percent of total billed charges,,424968.89,70,,424968.89,percent of total billed charges,,394613.97,65,,394613.97,percent of total billed charges,,394613.97,65,,394613.97,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,485678.73,
Perq tcat us abltj nrv p-art,0632T,HCPCS,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,258180.29,70,,258180.29,percent of total billed charges,,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,295063.18,80,,295063.18,percent of total billed charges,,258180.29,70,,258180.29,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,295063.18,
Perc d-e cor stent ather s,C9602,HCPCS,,,,,,,,both,,,131418,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,91992.6,70,,91992.6,percent of total billed charges,,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,91992.6,70,,91992.6,percent of total billed charges,,85421.7,65,,85421.7,percent of total billed charges,,85421.7,65,,85421.7,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,91992.6,
Perc d-e cor revasc chro sin,C9607,HCPCS,,,,,,,,both,,,131274,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,91891.8,70,,91891.8,percent of total billed charges,,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,91891.8,70,,91891.8,percent of total billed charges,,85328.1,65,,85328.1,percent of total billed charges,,85328.1,65,,85328.1,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,91891.8,
Revasc lithotrip-stent-ather,C9767,HCPCS,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,258180.29,70,,258180.29,percent of total billed charges,,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,295063.18,80,,295063.18,percent of total billed charges,,258180.29,70,,258180.29,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,295063.18,
Revasc lithotr-stent tib/per,C9773,HCPCS,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,295063.18,80,,295063.18,percent of total billed charges,,258180.29,70,,258180.29,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,295063.18,
Revasc lithotr-ather tib/per,C9774,HCPCS,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,295063.18,80,,295063.18,percent of total billed charges,,258180.29,70,,258180.29,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,295063.18,
Revasc lith-sten-ath tib/per,C9775,HCPCS,,,,,,,,both,,,368828.98,31686.15,,,31686.15,Other,150% of Medicare + 9.63% HCRA Surcharge,19268.54,,,19268.54,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,4820,,"100% primary, 50% secondary, 25% tertiary procedure",4820,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4606.16,,,4606.16,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,295063.18,80,,295063.18,percent of total billed charges,,258180.29,70,,258180.29,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,239738.84,65,,239738.84,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2476.43,,,2476.43,Other,New York Medicaid APG methodology,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,2476.43,,,2476.43,Other,100% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3788.93,,,3788.93,Other,153% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,3467,,,3467,Other,140% New York Medicaid APG,5571.96,,,5571.96,Other,225% New York Medicaid APG,6438.71,,,6438.71,Other,260% New York Medicaid APG,8023.63,,,8023.63,Other,324% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,5324.32,,,5324.32,Other,215% New York Medicaid APG,3095.54,,,3095.54,Other,125% New York Medicaid APG,2476.43,295063.18,
Rmvl cardiac modulj pls gen,0412T,HCPCS,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,6152,,,6152,Case Rate,,3947.45,,,3947.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2122.28,,,2122.28,Other,New York Medicaid APG methodology,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,3247.09,,,3247.09,Other,153% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,2971.2,,,2971.2,Other,140% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,5517.94,,,5517.94,Other,260% New York Medicaid APG,6876.2,,,6876.2,Other,324% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,2652.86,,,2652.86,Other,125% New York Medicaid APG,2122.28,57819.76,
Rmvl car modulj tranvns elt,0413T,HCPCS,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,57819.76,
Rmvl pg compnt wcs,0518T,HCPCS,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,6152,,,6152,Case Rate,,3947.45,,,3947.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2122.28,,,2122.28,Other,New York Medicaid APG methodology,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,3247.09,,,3247.09,Other,153% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,2971.2,,,2971.2,Other,140% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,5517.94,,,5517.94,Other,260% New York Medicaid APG,6876.2,,,6876.2,Other,324% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,2652.86,,,2652.86,Other,125% New York Medicaid APG,2122.28,57819.76,
Rmvl & rplcmt pg compnt wcs,0519T,HCPCS,,,,,,,,both,,,224603.78,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,145992.46,65,,145992.46,percent of total billed charges,,145992.46,65,,145992.46,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,4109,157222.65,
Removal complete iims,0530T,HCPCS,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,6152,,,6152,Case Rate,,3947.45,,,3947.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2122.28,,,2122.28,Other,New York Medicaid APG methodology,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,3247.09,,,3247.09,Other,153% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,2971.2,,,2971.2,Other,140% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,5517.94,,,5517.94,Other,260% New York Medicaid APG,6876.2,,,6876.2,Other,324% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,2652.86,,,2652.86,Other,125% New York Medicaid APG,2122.28,57819.76,
Removal iims electrode only,0531T,HCPCS,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,57819.76,
Removal iims implt mntr only,0532T,HCPCS,,,,,,,,both,,,82599.65,7096.15,,,7096.15,Other,150% of Medicare + 9.63% HCRA Surcharge,4315.21,,,4315.21,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,6152,,,6152,Case Rate,,3947.45,,,3947.45,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,57819.76,70,,57819.76,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,53689.77,65,,53689.77,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,2122.28,,,2122.28,Other,New York Medicaid APG methodology,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,2122.28,,,2122.28,Other,100% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,3247.09,,,3247.09,Other,153% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,2971.2,,,2971.2,Other,140% New York Medicaid APG,4775.14,,,4775.14,Other,225% New York Medicaid APG,5517.94,,,5517.94,Other,260% New York Medicaid APG,6876.2,,,6876.2,Other,324% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,4562.91,,,4562.91,Other,215% New York Medicaid APG,2652.86,,,2652.86,Other,125% New York Medicaid APG,2122.28,57819.76,
Insj/rplc car modulj atr elt,0410T,HCPCS,,,,,,,,both,,,178695.84,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,116152.3,65,,116152.3,percent of total billed charges,,116152.3,65,,116152.3,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,125087.09,
Insj/rplc car modulj vnt elt,0411T,HCPCS,,,,,,,,both,,,178695.84,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,116152.3,65,,116152.3,percent of total billed charges,,116152.3,65,,116152.3,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,125087.09,
Insj wcs lv eltrd only,0516T,HCPCS,,,,,,,,both,,,224603.78,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,145992.46,65,,145992.46,percent of total billed charges,,145992.46,65,,145992.46,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,157222.65,
Insj wcs lv pg compnt,0517T,HCPCS,,,,,,,,both,,,224603.78,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,145992.46,65,,145992.46,percent of total billed charges,,145992.46,65,,145992.46,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,4109,157222.65,
Insj/rplcmt iims eltrd only,0526T,HCPCS,,,,,,,,both,,,178695.84,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,6152,,,6152,Case Rate,,4537.53,,,4537.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,116152.3,65,,116152.3,percent of total billed charges,,116152.3,65,,116152.3,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,2439.53,,,2439.53,Other,New York Medicaid APG methodology,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,2439.53,,,2439.53,Other,100% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3732.48,,,3732.48,Other,153% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,3415.34,,,3415.34,Other,140% New York Medicaid APG,5488.94,,,5488.94,Other,225% New York Medicaid APG,6342.78,,,6342.78,Other,260% New York Medicaid APG,7904.08,,,7904.08,Other,324% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,5244.99,,,5244.99,Other,215% New York Medicaid APG,3049.41,,,3049.41,Other,125% New York Medicaid APG,2439.53,125087.09,
Insj/rplcmt iims implt mntr,0527T,HCPCS,,,,,,,,both,,,178695.84,15351.79,,,15351.79,Other,150% of Medicare + 9.63% HCRA Surcharge,9335.51,,,9335.51,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,125087.09,70,,125087.09,percent of total billed charges,,116152.3,65,,116152.3,percent of total billed charges,,116152.3,65,,116152.3,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3148,125087.09,
Insj/rplcmt compl iims,0525T,HCPCS,,,,,,,,both,,,224603.78,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,145992.46,65,,145992.46,percent of total billed charges,,145992.46,65,,145992.46,percent of total billed charges,,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,6261,,"100% primary, 50% secondary, 25% tertiary procedure",6261,Other,United Healthcare ASC Grouper,6956,,"100% primary, 50% secondary, 25% tertiary procedure",6956,Other,United Healthcare ASC Grouper,5913,,"100% primary, 50% secondary, 25% tertiary procedure",5913,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,3148,157222.65,
Insj/rplc cardiac modulj sys,0408T,HCPCS,,,,,,,,both,,,691990.86,59449.04,,,59449.04,Other,150% of Medicare + 9.63% HCRA Surcharge,36151.32,,,36151.32,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,484393.6,70,,484393.6,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,484393.6,70,,484393.6,percent of total billed charges,,449794.06,65,,449794.06,percent of total billed charges,,449794.06,65,,449794.06,percent of total billed charges,,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,5359,484393.6,
Insj/rplc car modulj pls gn,0409T,HCPCS,,,,,,,,both,,,495795.01,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,347056.51,70,,347056.51,percent of total billed charges,,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,347056.51,70,,347056.51,percent of total billed charges,,322266.76,65,,322266.76,percent of total billed charges,,322266.76,65,,322266.76,percent of total billed charges,,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,5359,347056.51,
Rmvl & rpl car modulj pls gn,0414T,HCPCS,,,,,,,,both,,,495795.01,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS methodology,5954,,"100% primary, 50% supplemental procedure",5954,Other,Aetna ASC Grouper,5359,,"100% primary, 50% supplemental procedure",5359,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,347056.51,70,,347056.51,percent of total billed charges,,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,347056.51,70,,347056.51,percent of total billed charges,,322266.76,65,,322266.76,percent of total billed charges,,322266.76,65,,322266.76,percent of total billed charges,,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,5359,347056.51,
Insj wcs lv compl sys,0515T,HCPCS,,,,,,,,both,,,495795.01,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,347056.51,70,,347056.51,percent of total billed charges,,6152,,,6152,Case Rate,,10684.37,,,10684.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,347056.51,70,,347056.51,percent of total billed charges,,322266.76,65,,322266.76,percent of total billed charges,,322266.76,65,,322266.76,percent of total billed charges,,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,5744.28,,,5744.28,Other,New York Medicaid APG methodology,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,5744.28,,,5744.28,Other,100% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8788.75,,,8788.75,Other,153% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,8042,,,8042,Other,140% New York Medicaid APG,12924.64,,,12924.64,Other,225% New York Medicaid APG,14935.14,,,14935.14,Other,260% New York Medicaid APG,18611.48,,,18611.48,Other,324% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,12350.21,,,12350.21,Other,215% New York Medicaid APG,7180.36,,,7180.36,Other,125% New York Medicaid APG,4109,347056.51,
Rmvl&rplcmt pg wcs new eltrd,0520T,HCPCS,,,,,,,,both,,,224603.78,19295.74,,,19295.74,Other,150% of Medicare + 9.63% HCRA Surcharge,11733.86,,,11733.86,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,157222.65,70,,157222.65,percent of total billed charges,,145992.46,65,,145992.46,percent of total billed charges,,145992.46,65,,145992.46,percent of total billed charges,,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,4109,157222.65,
Rmvl&rplcmt ss impl dfb pg,0614T,HCPCS,,,,,,,,both,,,495795.01,42593.82,,,42593.82,Other,150% of Medicare + 9.63% HCRA Surcharge,25901.56,,,25901.56,Other,Medicare OPPS methodology,5459,,"100% primary, 50% supplemental procedure",5459,Other,Aetna ASC Grouper,4913,,"100% primary, 50% supplemental procedure",4913,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,347056.51,70,,347056.51,percent of total billed charges,,6152,,,6152,Case Rate,,25103.43,,,25103.43,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,396636.01,80,,396636.01,percent of total billed charges,,347056.51,70,,347056.51,percent of total billed charges,,322266.76,65,,322266.76,percent of total billed charges,,322266.76,65,,322266.76,percent of total billed charges,,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,13740,,"100% primary, 50% secondary, 25% tertiary procedure",13740,Other,United Healthcare ASC Grouper,15267,,"100% primary, 50% secondary, 25% tertiary procedure",15267,Other,United Healthcare ASC Grouper,12977,,"100% primary, 50% secondary, 25% tertiary procedure",12977,Other,United Healthcare ASC Grouper,13496.47,,,13496.47,Other,New York Medicaid APG methodology,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,13496.47,,,13496.47,Other,100% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,20649.6,,,20649.6,Other,153% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,18895.06,,,18895.06,Other,140% New York Medicaid APG,30367.06,,,30367.06,Other,225% New York Medicaid APG,35090.82,,,35090.82,Other,260% New York Medicaid APG,43728.56,,,43728.56,Other,324% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,29017.41,,,29017.41,Other,215% New York Medicaid APG,16870.59,,,16870.59,Other,125% New York Medicaid APG,4913,396636.01,
Im b1 mrw cel ther cmpl,0263T,HCPCS,,,,,,,,both,,,97340.17,8362.51,,,8362.51,Other,150% of Medicare + 9.63% HCRA Surcharge,5085.29,,,5085.29,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,63271.11,65,,63271.11,percent of total billed charges,,63271.11,65,,63271.11,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,1921.76,68138.12,
Im b1 mrw cel ther xcl hrvst,0264T,HCPCS,,,,,,,,both,,,97340.17,8362.51,,,8362.51,Other,150% of Medicare + 9.63% HCRA Surcharge,5085.29,,,5085.29,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,63271.11,65,,63271.11,percent of total billed charges,,63271.11,65,,63271.11,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,1921.76,68138.12,
Im b1 mrw cel ther hrvst onl,0265T,HCPCS,,,,,,,,both,,,97340.17,8362.51,,,8362.51,Other,150% of Medicare + 9.63% HCRA Surcharge,5085.29,,,5085.29,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,63271.11,65,,63271.11,percent of total billed charges,,63271.11,65,,63271.11,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,1921.76,68138.12,
Thxp apheresis w/hdl delip,0342T,HCPCS,,,,,,,,both,,,97340.17,8362.51,,,8362.51,Other,150% of Medicare + 9.63% HCRA Surcharge,5085.29,,,5085.29,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,6152,,,6152,Case Rate,,3574.48,,,3574.48,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,68138.12,70,,68138.12,percent of total billed charges,,63271.11,65,,63271.11,percent of total billed charges,,63271.11,65,,63271.11,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1921.76,,,1921.76,Other,New York Medicaid APG methodology,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,1921.76,,,1921.76,Other,100% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2940.3,,,2940.3,Other,153% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,2690.47,,,2690.47,Other,140% New York Medicaid APG,4323.97,,,4323.97,Other,225% New York Medicaid APG,4996.58,,,4996.58,Other,260% New York Medicaid APG,6226.51,,,6226.51,Other,324% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,4131.79,,,4131.79,Other,215% New York Medicaid APG,2402.2,,,2402.2,Other,125% New York Medicaid APG,1921.76,68138.12,
Egd flx transnasal dx br/wa,0652T,HCPCS,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,27215.91,68,,27215.91,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,28016.37,70,,28016.37,percent of total billed charges,,26015.2,65,,26015.2,percent of total billed charges,,26015.2,65,,26015.2,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,32018.71,
Egd flx transnasal bx 1/ml,0653T,HCPCS,,,,,,,,both,,,40023.39,3438.42,,,3438.42,Other,150% of Medicare + 9.63% HCRA Surcharge,2090.92,,,2090.92,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,28016.37,70,,28016.37,percent of total billed charges,,27215.91,68,,27215.91,percent of total billed charges,,0.02,,,0.02,Other,186% of Medicaid,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,7216,,,7216,Case Rate,,32018.71,80,,32018.71,percent of total billed charges,,28016.37,70,,28016.37,percent of total billed charges,,26015.2,65,,26015.2,percent of total billed charges,,26015.2,65,,26015.2,percent of total billed charges,,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3649,,"100% primary, 50% secondary, 25% tertiary procedure",3649,Other,United Healthcare ASC Grouper,4055,,"100% primary, 50% secondary, 25% tertiary procedure",4055,Other,United Healthcare ASC Grouper,3448,,"100% primary, 50% secondary, 25% tertiary procedure",3448,Other,United Healthcare ASC Grouper,0.01,,,0.01,Other,New York Medicaid APG methodology,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.01,,,0.01,Other,100% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.02,,,0.02,Other,153% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.01,,,0.01,Other,140% New York Medicaid APG,0.02,,,0.02,Other,225% New York Medicaid APG,0.03,,,0.03,Other,260% New York Medicaid APG,0.03,,,0.03,Other,324% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.02,,,0.02,Other,215% New York Medicaid APG,0.01,,,0.01,Other,125% New York Medicaid APG,0.01,32018.71,
Place endorectal app,C9725,HCPCS,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,6152,,,6152,Case Rate,,2000.77,,,2000.77,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,12495.55,65,,12495.55,percent of total billed charges,,12495.55,65,,12495.55,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,1075.68,,,1075.68,Other,New York Medicaid APG methodology,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,1075.68,,,1075.68,Other,100% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1645.8,,,1645.8,Other,153% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,1505.96,,,1505.96,Other,140% New York Medicaid APG,2420.29,,,2420.29,Other,225% New York Medicaid APG,2796.78,,,2796.78,Other,260% New York Medicaid APG,3485.22,,,3485.22,Other,324% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,2312.72,,,2312.72,Other,215% New York Medicaid APG,1344.61,,,1344.61,Other,125% New York Medicaid APG,1004.31,13456.74,
Ca screen;flexi sigmoidscope,G0104,HCPCS,,,,,,,,both,,,19223.92,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,13072.27,68,,13072.27,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15379.14,80,,15379.14,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13456.74,70,,13456.74,percent of total billed charges,,270.6,,,270.6,Fee Schedule,,229.35,,,229.35,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,229.35,15379.14,
Colorectal scrn; hi risk ind,G0105,HCPCS,,,,,,,,both,,,18767.42,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,12761.85,68,,12761.85,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,15013.94,80,,15013.94,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15013.94,80,,15013.94,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13137.19,70,,13137.19,percent of total billed charges,,888.88,,,888.88,Fee Schedule,,753.38,,,753.38,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,753.38,15013.94,
Colon ca scrn not hi rsk ind,G0121,HCPCS,,,,,,,,both,,,17927.96,1651.53,,,1651.53,Other,150% of Medicare + 9.63% HCRA Surcharge,1004.31,,,1004.31,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,3414,,"100% primary, 50% secondary, 25% tertiary procedure",3414,Other,CDPHP ASC Grouper,12191.01,68,,12191.01,percent of total billed charges,,1479.15,,,1479.15,Other,186% of Medicaid,14342.37,80,,14342.37,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,14342.37,80,,14342.37,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,12549.57,70,,12549.57,percent of total billed charges,,890.52,,,890.52,Fee Schedule,,754.77,,,754.77,Fee Schedule,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,795.24,,,795.24,Other,New York Medicaid APG methodology,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,795.24,,,795.24,Other,100% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1216.72,,,1216.72,Other,153% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,1113.34,,,1113.34,Other,140% New York Medicaid APG,1789.3,,,1789.3,Other,225% New York Medicaid APG,2067.63,,,2067.63,Other,260% New York Medicaid APG,2576.59,,,2576.59,Other,324% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,1709.77,,,1709.77,Other,215% New York Medicaid APG,994.05,,,994.05,Other,125% New York Medicaid APG,754.77,14342.37,
Exc rectal tumor endoscopic,0184T,HCPCS,,,,,,,,both,,,119876.35,10298.6,,,10298.6,Other,150% of Medicare + 9.63% HCRA Surcharge,6262.64,,,6262.64,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,6152,,,6152,Case Rate,,2733.37,,,2733.37,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,83913.45,70,,83913.45,percent of total billed charges,,77919.63,65,,77919.63,percent of total billed charges,,77919.63,65,,77919.63,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1469.56,,,1469.56,Other,New York Medicaid APG methodology,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,1469.56,,,1469.56,Other,100% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2248.42,,,2248.42,Other,153% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,2057.38,,,2057.38,Other,140% New York Medicaid APG,3306.5,,,3306.5,Other,225% New York Medicaid APG,3820.84,,,3820.84,Other,260% New York Medicaid APG,4761.36,,,4761.36,Other,324% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,3159.54,,,3159.54,Other,215% New York Medicaid APG,1836.94,,,1836.94,Other,125% New York Medicaid APG,1469.56,83913.45,
Ire abltj 1+tum organ perq,0600T,HCPCS,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,2589.53,,,2589.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,173212.14,80,,173212.14,percent of total billed charges,,151560.62,70,,151560.62,percent of total billed charges,,140734.86,65,,140734.86,percent of total billed charges,,140734.86,65,,140734.86,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1392.22,,,1392.22,Other,New York Medicaid APG methodology,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,2130.1,,,2130.1,Other,153% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,1949.11,,,1949.11,Other,140% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,3619.77,,,3619.77,Other,260% New York Medicaid APG,4510.79,,,4510.79,Other,324% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,1740.27,,,1740.27,Other,125% New York Medicaid APG,1392.22,173212.14,
Ire abltj 1+tumors open,0601T,HCPCS,,,,,,,,both,,,216515.17,18600.85,,,18600.85,Other,150% of Medicare + 9.63% HCRA Surcharge,11311.29,,,11311.29,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,6234,,"100% primary, 50% secondary, 25% supplemental procedure",6234,Other,Blue Cross ASC Grouper,5611,,"100% primary, 50% secondary, 25% supplemental procedure",5611,Other,Blue Cross ASC Grouper,5299,,"100% primary, 50% secondary, 25% supplemental procedure",5299,Other,Blue Cross ASC Grouper,151560.62,70,,151560.62,percent of total billed charges,,6152,,,6152,Case Rate,,2589.53,,,2589.53,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,173212.14,80,,173212.14,percent of total billed charges,,151560.62,70,,151560.62,percent of total billed charges,,140734.86,65,,140734.86,percent of total billed charges,,140734.86,65,,140734.86,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1392.22,,,1392.22,Other,New York Medicaid APG methodology,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,1392.22,,,1392.22,Other,100% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,2130.1,,,2130.1,Other,153% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,1949.11,,,1949.11,Other,140% New York Medicaid APG,3132.49,,,3132.49,Other,225% New York Medicaid APG,3619.77,,,3619.77,Other,260% New York Medicaid APG,4510.79,,,4510.79,Other,324% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,2993.27,,,2993.27,Other,215% New York Medicaid APG,1740.27,,,1740.27,Other,125% New York Medicaid APG,1392.22,173212.14,
Temp fml iu vlv-pmp 1st insj,0596T,HCPCS,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,9770.46,68,,9770.46,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,10057.82,70,,10057.82,percent of total billed charges,,9339.41,65,,9339.41,percent of total billed charges,,9339.41,65,,9339.41,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,486.05,11494.66,
Temp fml iu valve-pmp rplcmt,0597T,HCPCS,,,,,,,,both,,,14368.32,1234.38,,,1234.38,Other,150% of Medicare + 9.63% HCRA Surcharge,750.64,,,750.64,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,10057.82,70,,10057.82,percent of total billed charges,,9770.46,68,,9770.46,percent of total billed charges,,904.04,,,904.04,Other,186% of Medicaid,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,7216,,,7216,Case Rate,,11494.66,80,,11494.66,percent of total billed charges,,10057.82,70,,10057.82,percent of total billed charges,,9339.41,65,,9339.41,percent of total billed charges,,9339.41,65,,9339.41,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,486.05,,,486.05,Other,New York Medicaid APG methodology,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,486.05,,,486.05,Other,100% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,743.65,,,743.65,Other,153% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,680.46,,,680.46,Other,140% New York Medicaid APG,1093.6,,,1093.6,Other,225% New York Medicaid APG,1263.72,,,1263.72,Other,260% New York Medicaid APG,1574.79,,,1574.79,Other,324% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,1045,,,1045,Other,215% New York Medicaid APG,607.56,,,607.56,Other,125% New York Medicaid APG,486.05,11494.66,
Cysto w/prst8 commissurotomy,0619T,HCPCS,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,135638.48,70,,135638.48,percent of total billed charges,,125950.02,65,,125950.02,percent of total billed charges,,125950.02,65,,125950.02,percent of total billed charges,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,155015.41,
Cystoscopy prostatic imp 1-3,C9739,HCPCS,,,,,,,,both,,,52017.94,9350.11,,,9350.11,Other,150% of Medicare + 9.63% HCRA Surcharge,5685.86,,,5685.86,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,36412.56,70,,36412.56,percent of total billed charges,,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5266,,"100% primary, 0% secondary procedures",5266,Other,MagnaCare ASC Grouper,36412.56,70,,36412.56,percent of total billed charges,,33811.66,65,,33811.66,percent of total billed charges,,33811.66,65,,33811.66,percent of total billed charges,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,36412.56,
"Cysto, litho, vacuum kidney",C9761,HCPCS,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,3969,,"100% primary, 50% supplemental procedure",3969,Other,Aetna ASC Grouper,3572,,"100% primary, 50% supplemental procedure",3572,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,3907,,"100% primary, 50% secondary, 25% tertiary procedure",3907,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,2586.87,,,2586.87,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,135638.48,70,,135638.48,percent of total billed charges,,125950.02,65,,125950.02,percent of total billed charges,,125950.02,65,,125950.02,percent of total billed charges,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1390.79,,,1390.79,Other,New York Medicaid APG methodology,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,1390.79,,,1390.79,Other,100% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,2127.91,,,2127.91,Other,153% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,1947.1,,,1947.1,Other,140% New York Medicaid APG,3129.28,,,3129.28,Other,225% New York Medicaid APG,3616.05,,,3616.05,Other,260% New York Medicaid APG,4506.16,,,4506.16,Other,324% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,2990.2,,,2990.2,Other,215% New York Medicaid APG,1738.49,,,1738.49,Other,125% New York Medicaid APG,1390.79,155015.41,
Cysto w/temp pros implant,C9769,HCPCS,,,,,,,,both,,,46339.76,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,37071.81,80,,37071.81,percent of total billed charges,,32437.83,70,,32437.83,percent of total billed charges,,30120.84,65,,30120.84,percent of total billed charges,,30120.84,65,,30120.84,percent of total billed charges,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,37071.81,
Waterjet prostate abltj cmpl,0421T,HCPCS,,,,,,,,both,,,193769.26,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,131763.1,68,,131763.1,percent of total billed charges,,4646.12,,,4646.12,Other,186% of Medicaid,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,155015.41,80,,155015.41,percent of total billed charges,,7216,,,7216,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,135638.48,70,,135638.48,percent of total billed charges,,125950.02,65,,125950.02,percent of total billed charges,,125950.02,65,,125950.02,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2232,155015.41,
Cysto impl 4 or more,C9740,HCPCS,,,,,,,,both,,,50923.5,16646.75,,,16646.75,Other,150% of Medicare + 9.63% HCRA Surcharge,10122.99,,,10122.99,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,35646.45,70,,35646.45,percent of total billed charges,,6152,,,6152,Case Rate,,4646.12,,,4646.12,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,35646.45,70,,35646.45,percent of total billed charges,,33100.28,65,,33100.28,percent of total billed charges,,33100.28,65,,33100.28,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,2497.91,,,2497.91,Other,New York Medicaid APG methodology,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,2497.91,,,2497.91,Other,100% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3821.8,,,3821.8,Other,153% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,3497.08,,,3497.08,Other,140% New York Medicaid APG,5620.3,,,5620.3,Other,225% New York Medicaid APG,6494.57,,,6494.57,Other,260% New York Medicaid APG,8093.23,,,8093.23,Other,324% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,5370.51,,,5370.51,Other,215% New York Medicaid APG,3122.39,,,3122.39,Other,125% New York Medicaid APG,2497.91,35646.45,
Abltj perc uxtr/perph nrv,0440T,HCPCS,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,26397.48,65,,26397.48,percent of total billed charges,,26397.48,65,,26397.48,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,28428.05,
Abltj perc lxtr/perph nrv,0441T,HCPCS,,,,,,,,both,,,40611.5,3488.94,,,3488.94,Other,150% of Medicare + 9.63% HCRA Surcharge,2121.65,,,2121.65,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,28428.05,70,,28428.05,percent of total billed charges,,26397.48,65,,26397.48,percent of total billed charges,,26397.48,65,,26397.48,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,28428.05,
Rev/remvl crtd sns dev total,0269T,HCPCS,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,7900,,"100% primary, 0% secondary procedures",7900,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,91074.82,65,,91074.82,percent of total billed charges,,91074.82,65,,91074.82,percent of total billed charges,,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5698,,"100% primary, 50% secondary, 25% tertiary procedure",5698,Other,United Healthcare ASC Grouper,6331,,"100% primary, 50% secondary, 25% tertiary procedure",6331,Other,United Healthcare ASC Grouper,5381,,"100% primary, 50% secondary, 25% tertiary procedure",5381,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,98080.57,
Abltj perc plex/trncl nrv,0442T,HCPCS,,,,,,,,both,,,140115.1,12037.31,,,12037.31,Other,150% of Medicare + 9.63% HCRA Surcharge,7319.96,,,7319.96,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,98080.57,70,,98080.57,percent of total billed charges,,91074.82,65,,91074.82,percent of total billed charges,,91074.82,65,,91074.82,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,98080.57,
Autol cell implt adps njx,0566T,HCPCS,,,,,,,,both,,,64479.48,0.02,,,0.02,Other,150% of Medicare + 9.63% HCRA Surcharge,0.01,,,0.01,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,43846.05,68,,43846.05,percent of total billed charges,,686.28,,,686.28,Other,186% of Medicaid,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,51583.58,80,,51583.58,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,45135.64,70,,45135.64,percent of total billed charges,,41911.66,65,,41911.66,percent of total billed charges,,41911.66,65,,41911.66,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,368.97,,,368.97,Other,New York Medicaid APG methodology,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,368.97,,,368.97,Other,100% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,564.52,,,564.52,Other,153% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,516.56,,,516.56,Other,140% New York Medicaid APG,830.18,,,830.18,Other,225% New York Medicaid APG,959.32,,,959.32,Other,260% New York Medicaid APG,1195.46,,,1195.46,Other,324% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,793.29,,,793.29,Other,215% New York Medicaid APG,461.21,,,461.21,Other,125% New York Medicaid APG,0.01,51583.58,
Inj for sacroiliac jt anesth,G0260,HCPCS,,,,,,,,both,,,4530.6,1249.63,,,1249.63,Other,150% of Medicare + 9.63% HCRA Surcharge,759.91,,,759.91,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2546,,"100% primary, 50% secondary, 25% tertiary procedure",2546,Other,CDPHP ASC Grouper,3080.81,68,,3080.81,percent of total billed charges,,1080.24,,,1080.24,Other,186% of Medicaid,3624.48,80,,3624.48,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,3624.48,80,,3624.48,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,3171.42,70,,3171.42,percent of total billed charges,,2944.89,65,,2944.89,percent of total billed charges,,2944.89,65,,2944.89,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,580.77,,,580.77,Other,New York Medicaid APG methodology,580.77,,,580.77,Other,100% New York Medicaid APG,580.77,,,580.77,Other,100% New York Medicaid APG,580.77,,,580.77,Other,100% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,888.58,,,888.58,Other,153% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,813.08,,,813.08,Other,140% New York Medicaid APG,1306.74,,,1306.74,Other,225% New York Medicaid APG,1510.01,,,1510.01,Other,260% New York Medicaid APG,1881.7,,,1881.7,Other,324% New York Medicaid APG,1248.66,,,1248.66,Other,215% New York Medicaid APG,1248.66,,,1248.66,Other,215% New York Medicaid APG,725.97,,,725.97,Other,125% New York Medicaid APG,580.77,7216,
Njx paravert w/us cer/thor,0213T,HCPCS,,,,,,,,both,,,3238,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,2266.6,70,,2266.6,percent of total billed charges,,6152,,,6152,Case Rate,,1116.97,,,1116.97,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,2266.6,70,,2266.6,percent of total billed charges,,2104.7,65,,2104.7,percent of total billed charges,,2104.7,65,,2104.7,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,9473,
Njx paravert w/us lumb/sac,0216T,HCPCS,,,,,,,,both,,,19171.82,1647.05,,,1647.05,Other,150% of Medicare + 9.63% HCRA Surcharge,1001.58,,,1001.58,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3285,,"100% primary, 50% secondary, 25% supplemental procedure",3285,Other,Blue Cross ASC Grouper,2957,,"100% primary, 50% secondary, 25% supplemental procedure",2957,Other,Blue Cross ASC Grouper,2792,,"100% primary, 50% secondary, 25% supplemental procedure",2792,Other,Blue Cross ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,13036.84,68,,13036.84,percent of total billed charges,,1116.97,,,1116.97,Other,186% of Medicaid,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,15337.46,80,,15337.46,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,13420.27,70,,13420.27,percent of total billed charges,,12461.68,65,,12461.68,percent of total billed charges,,12461.68,65,,12461.68,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,600.52,,,600.52,Other,New York Medicaid APG methodology,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,600.52,,,600.52,Other,100% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,918.79,,,918.79,Other,153% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,840.73,,,840.73,Other,140% New York Medicaid APG,1351.17,,,1351.17,Other,225% New York Medicaid APG,1561.35,,,1561.35,Other,260% New York Medicaid APG,1945.68,,,1945.68,Other,324% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,1291.12,,,1291.12,Other,215% New York Medicaid APG,750.65,,,750.65,Other,125% New York Medicaid APG,600.52,15337.46,
Implt/rpl crtd sns dev lead,0267T,HCPCS,,,,,,,,both,,,71567.87,6148.41,,,6148.41,Other,150% of Medicare + 9.63% HCRA Surcharge,3738.88,,,3738.88,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,50097.51,70,,50097.51,percent of total billed charges,,6152,,,6152,Case Rate,,6049.23,,,6049.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50097.51,70,,50097.51,percent of total billed charges,,46519.12,65,,46519.12,percent of total billed charges,,46519.12,65,,46519.12,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,3252.27,,,3252.27,Other,New York Medicaid APG methodology,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,3252.27,,,3252.27,Other,100% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4975.98,,,4975.98,Other,153% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,4553.18,,,4553.18,Other,140% New York Medicaid APG,7317.62,,,7317.62,Other,225% New York Medicaid APG,8455.91,,,8455.91,Other,260% New York Medicaid APG,10537.37,,,10537.37,Other,324% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,6992.39,,,6992.39,Other,215% New York Medicaid APG,4065.34,,,4065.34,Other,125% New York Medicaid APG,3252.27,50097.51,
Rev/remvl crtd sns dev lead,0270T,HCPCS,,,,,,,,both,,,71567.87,6148.41,,,6148.41,Other,150% of Medicare + 9.63% HCRA Surcharge,3738.88,,,3738.88,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,50097.51,70,,50097.51,percent of total billed charges,,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50097.51,70,,50097.51,percent of total billed charges,,46519.12,65,,46519.12,percent of total billed charges,,46519.12,65,,46519.12,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,50097.51,
Rev/remvl crtd sns dev gen,0271T,HCPCS,,,,,,,,both,,,71567.87,6148.41,,,6148.41,Other,150% of Medicare + 9.63% HCRA Surcharge,3738.88,,,3738.88,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,4863,,"100% primary, 50% secondary, 25% supplemental procedure",4863,Other,Blue Cross ASC Grouper,4377,,"100% primary, 50% secondary, 25% supplemental procedure",4377,Other,Blue Cross ASC Grouper,4134,,"100% primary, 50% secondary, 25% supplemental procedure",4134,Other,Blue Cross ASC Grouper,50097.51,70,,50097.51,percent of total billed charges,,6152,,,6152,Case Rate,,2391.82,,,2391.82,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,5743,,"100% primary, 0% secondary procedures",5743,Other,MagnaCare ASC Grouper,50097.51,70,,50097.51,percent of total billed charges,,46519.12,65,,46519.12,percent of total billed charges,,46519.12,65,,46519.12,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,1285.92,,,1285.92,Other,New York Medicaid APG methodology,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,1285.92,,,1285.92,Other,100% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1967.46,,,1967.46,Other,153% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,1800.29,,,1800.29,Other,140% New York Medicaid APG,2893.33,,,2893.33,Other,225% New York Medicaid APG,3343.4,,,3343.4,Other,260% New York Medicaid APG,4166.39,,,4166.39,Other,324% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,2764.73,,,2764.73,Other,215% New York Medicaid APG,1607.4,,,1607.4,Other,125% New York Medicaid APG,1285.92,50097.51,
Revision/removal isdns ptn,0588T,HCPCS,,,,,,,,both,,,71567.87,6148.41,,,6148.41,Other,150% of Medicare + 9.63% HCRA Surcharge,3738.88,,,3738.88,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,50097.51,70,,50097.51,percent of total billed charges,,48666.15,68,,48666.15,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,57254.3,80,,57254.3,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,57254.3,80,,57254.3,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,50097.51,70,,50097.51,percent of total billed charges,,46519.12,65,,46519.12,percent of total billed charges,,46519.12,65,,46519.12,percent of total billed charges,,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4422,,"100% primary, 50% secondary, 25% tertiary procedure",4422,Other,United Healthcare ASC Grouper,4913,,"100% primary, 50% secondary, 25% tertiary procedure",4913,Other,United Healthcare ASC Grouper,4176,,"100% primary, 50% secondary, 25% tertiary procedure",4176,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,519.75,57254.3,
Perq impltj/rplcmt isdns ptn,0587T,HCPCS,,,,,,,,both,,,143852.77,12358.41,,,12358.41,Other,150% of Medicare + 9.63% HCRA Surcharge,7515.23,,,7515.23,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,100696.94,70,,100696.94,percent of total billed charges,,97819.88,68,,97819.88,percent of total billed charges,,966.73,,,966.73,Other,186% of Medicaid,115082.22,80,,115082.22,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,115082.22,80,,115082.22,percent of total billed charges,,7216,,,7216,Case Rate,,3148,,"100% primary, 0% secondary procedures",3148,Other,MagnaCare ASC Grouper,100696.94,70,,100696.94,percent of total billed charges,,93504.3,65,,93504.3,percent of total billed charges,,93504.3,65,,93504.3,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,519.75,,,519.75,Other,New York Medicaid APG methodology,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,519.75,,,519.75,Other,100% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,795.21,,,795.21,Other,153% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,727.64,,,727.64,Other,140% New York Medicaid APG,1169.43,,,1169.43,Other,225% New York Medicaid APG,1351.34,,,1351.34,Other,260% New York Medicaid APG,1683.98,,,1683.98,Other,324% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,1117.45,,,1117.45,Other,215% New York Medicaid APG,649.68,,,649.68,Other,125% New York Medicaid APG,519.75,115082.22,
Implt/rpl crtd sns dev total,0266T,HCPCS,,,,,,,,both,,,993426.73,85345.44,,,85345.44,Other,150% of Medicare + 9.63% HCRA Surcharge,51899.08,,,51899.08,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,695398.71,70,,695398.71,percent of total billed charges,,6152,,,6152,Case Rate,,31376.13,,,31376.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,794741.38,80,,794741.38,percent of total billed charges,,695398.71,70,,695398.71,percent of total billed charges,,645727.37,65,,645727.37,percent of total billed charges,,645727.37,65,,645727.37,percent of total billed charges,,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,4109,794741.38,
Implt/rpl crtd sns dev gen,0268T,HCPCS,,,,,,,,both,,,653144.11,56111.71,,,56111.71,Other,150% of Medicare + 9.63% HCRA Surcharge,34121.87,,,34121.87,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,457200.88,70,,457200.88,percent of total billed charges,,6152,,,6152,Case Rate,,31376.13,,,31376.13,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,457200.88,70,,457200.88,percent of total billed charges,,424543.67,65,,424543.67,percent of total billed charges,,424543.67,65,,424543.67,percent of total billed charges,,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,16868.89,,,16868.89,Other,New York Medicaid APG methodology,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,16868.89,,,16868.89,Other,100% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,25809.39,,,25809.39,Other,153% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,23616.44,,,23616.44,Other,140% New York Medicaid APG,37954.99,,,37954.99,Other,225% New York Medicaid APG,43859.1,,,43859.1,Other,260% New York Medicaid APG,54655.19,,,54655.19,Other,324% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,36268.1,,,36268.1,Other,215% New York Medicaid APG,21086.11,,,21086.11,Other,125% New York Medicaid APG,4109,457200.88,
"Dstry eye lesn,fdr vssl tech",G0186,HCPCS,,,,,,,,both,,,12226.3,1050.36,,,1050.36,Other,150% of Medicare + 9.63% HCRA Surcharge,638.73,,,638.73,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,8313.88,68,,8313.88,percent of total billed charges,,1161.22,,,1161.22,Other,186% of Medicaid,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,9781.04,80,,9781.04,percent of total billed charges,,7216,,,7216,Case Rate,,3578,,"100% primary, 0% secondary procedures",3578,Other,MagnaCare ASC Grouper,8558.41,70,,8558.41,percent of total billed charges,,7947.1,65,,7947.1,percent of total billed charges,,7947.1,65,,7947.1,percent of total billed charges,,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2904,,"100% primary, 50% secondary, 25% tertiary procedure",2904,Other,United Healthcare ASC Grouper,3227,,"100% primary, 50% secondary, 25% tertiary procedure",3227,Other,United Healthcare ASC Grouper,2743,,"100% primary, 50% secondary, 25% tertiary procedure",2743,Other,United Healthcare ASC Grouper,624.31,,,624.31,Other,New York Medicaid APG methodology,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,624.31,,,624.31,Other,100% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,955.2,,,955.2,Other,153% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,874.04,,,874.04,Other,140% New York Medicaid APG,1404.71,,,1404.71,Other,225% New York Medicaid APG,1623.22,,,1623.22,Other,260% New York Medicaid APG,2022.78,,,2022.78,Other,324% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,1342.27,,,1342.27,Other,215% New York Medicaid APG,780.39,,,780.39,Other,125% New York Medicaid APG,624.31,9781.04,
Insertion of iris prosthesis,0616T,HCPCS,,,,,,,,both,,,364923.31,31350.62,,,31350.62,Other,150% of Medicare + 9.63% HCRA Surcharge,19064.5,,,19064.5,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,255446.32,70,,255446.32,percent of total billed charges,,6152,,,6152,Case Rate,,2902.47,,,2902.47,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,291938.65,80,,291938.65,percent of total billed charges,,255446.32,70,,255446.32,percent of total billed charges,,237200.15,65,,237200.15,percent of total billed charges,,237200.15,65,,237200.15,percent of total billed charges,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,1560.47,,,1560.47,Other,New York Medicaid APG methodology,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,1560.47,,,1560.47,Other,100% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2387.52,,,2387.52,Other,153% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,2184.66,,,2184.66,Other,140% New York Medicaid APG,3511.06,,,3511.06,Other,225% New York Medicaid APG,4057.22,,,4057.22,Other,260% New York Medicaid APG,5055.92,,,5055.92,Other,324% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,3355.01,,,3355.01,Other,215% New York Medicaid APG,1950.59,,,1950.59,Other,125% New York Medicaid APG,1560.47,291938.65,
Insert aqueous drain device,0253T,HCPCS,,,,,,,,both,,,85519.85,7347.02,,,7347.02,Other,150% of Medicare + 9.63% HCRA Surcharge,4467.77,,,4467.77,Other,Medicare OPPS methodology,4565,,"100% primary, 50% supplemental procedure",4565,Other,Aetna ASC Grouper,4109,,"100% primary, 50% supplemental procedure",4109,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,6152,,,6152,Case Rate,,5416.23,,,5416.23,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,59863.9,70,,59863.9,percent of total billed charges,,55587.9,65,,55587.9,percent of total billed charges,,55587.9,65,,55587.9,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2911.95,,,2911.95,Other,New York Medicaid APG methodology,2911.95,,,2911.95,Other,100% New York Medicaid APG,2911.95,,,2911.95,Other,100% New York Medicaid APG,2911.95,,,2911.95,Other,100% New York Medicaid APG,6551.89,,,6551.89,Other,225% New York Medicaid APG,4455.29,,,4455.29,Other,153% New York Medicaid APG,6551.89,,,6551.89,Other,225% New York Medicaid APG,4076.73,,,4076.73,Other,140% New York Medicaid APG,6551.89,,,6551.89,Other,225% New York Medicaid APG,7571.08,,,7571.08,Other,260% New York Medicaid APG,9434.72,,,9434.72,Other,324% New York Medicaid APG,6260.7,,,6260.7,Other,215% New York Medicaid APG,6260.7,,,6260.7,Other,215% New York Medicaid APG,3639.94,,,3639.94,Other,125% New York Medicaid APG,2911.95,59863.9,
Insj aqueous drain dev 1st,0449T,HCPCS,,,,,,,,both,,,109933.59,9444.41,,,9444.41,Other,150% of Medicare + 9.63% HCRA Surcharge,5743.2,,,5743.2,Other,Medicare OPPS methodology,3473,,"100% primary, 50% supplemental procedure",3473,Other,Aetna ASC Grouper,3126,,"100% primary, 50% supplemental procedure",3126,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,76953.51,70,,76953.51,percent of total billed charges,,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,6751,,"100% primary, 0% secondary procedures",6751,Other,MagnaCare ASC Grouper,76953.51,70,,76953.51,percent of total billed charges,,71456.83,65,,71456.83,percent of total billed charges,,71456.83,65,,71456.83,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,76953.51,
Insj iris prosth w/rmvl&insj,0617T,HCPCS,,,,,,,,both,,,364923.31,31350.62,,,31350.62,Other,150% of Medicare + 9.63% HCRA Surcharge,19064.5,,,19064.5,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,255446.32,70,,255446.32,percent of total billed charges,,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,291938.65,80,,291938.65,percent of total billed charges,,255446.32,70,,255446.32,percent of total billed charges,,237200.15,65,,237200.15,percent of total billed charges,,237200.15,65,,237200.15,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,291938.65,
Insj iris prosth sec io lens,0618T,HCPCS,,,,,,,,both,,,41438.26,31350.62,,,31350.62,Other,150% of Medicare + 9.63% HCRA Surcharge,19064.5,,,19064.5,Other,Medicare OPPS methodology,4827,,"100% primary, 50% supplemental procedure",4827,Other,Aetna ASC Grouper,4344,,"100% primary, 50% supplemental procedure",4344,Other,Aetna ASC Grouper,5402,,"100% primary, 50% secondary, 25% supplemental procedure",5402,Other,Blue Cross ASC Grouper,4862,,"100% primary, 50% secondary, 25% supplemental procedure",4862,Other,Blue Cross ASC Grouper,4592,,"100% primary, 50% secondary, 25% supplemental procedure",4592,Other,Blue Cross ASC Grouper,29006.78,70,,29006.78,percent of total billed charges,,6152,,,6152,Case Rate,,3820.51,,,3820.51,Other,186% of Medicaid,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,9473,,,9473,Case Rate,,7237,,,7237,Case Rate,,9473,,,9473,Case Rate,,33150.61,80,,33150.61,percent of total billed charges,,29006.78,70,,29006.78,percent of total billed charges,,26934.87,65,,26934.87,percent of total billed charges,,26934.87,65,,26934.87,percent of total billed charges,,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,6232,,"100% primary, 50% secondary, 25% tertiary procedure",6232,Other,United Healthcare ASC Grouper,6924,,"100% primary, 50% secondary, 25% tertiary procedure",6924,Other,United Healthcare ASC Grouper,5885,,"100% primary, 50% secondary, 25% tertiary procedure",5885,Other,United Healthcare ASC Grouper,2054.04,,,2054.04,Other,New York Medicaid APG methodology,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,2054.04,,,2054.04,Other,100% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,3142.68,,,3142.68,Other,153% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,2875.65,,,2875.65,Other,140% New York Medicaid APG,4621.58,,,4621.58,Other,225% New York Medicaid APG,5340.5,,,5340.5,Other,260% New York Medicaid APG,6655.08,,,6655.08,Other,324% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,4416.18,,,4416.18,Other,215% New York Medicaid APG,2567.55,,,2567.55,Other,125% New York Medicaid APG,2054.04,33150.61,
Insj ocular telescope prosth,0308T,HCPCS,,,,,,,,both,,,364923.31,31350.62,,,31350.62,Other,150% of Medicare + 9.63% HCRA Surcharge,19064.5,,,19064.5,Other,Medicare OPPS methodology,2480,,"100% primary, 50% supplemental procedure",2480,Other,Aetna ASC Grouper,2232,,"100% primary, 50% supplemental procedure",2232,Other,Aetna ASC Grouper,8668,,"100% primary, 50% secondary, 25% supplemental procedure",8668,Other,Blue Cross ASC Grouper,7801,,"100% primary, 50% secondary, 25% supplemental procedure",7801,Other,Blue Cross ASC Grouper,7368,,"100% primary, 50% secondary, 25% supplemental procedure",7368,Other,Blue Cross ASC Grouper,255446.32,70,,255446.32,percent of total billed charges,,248147.85,68,,248147.85,percent of total billed charges,,5416.23,,,5416.23,Other,186% of Medicaid,291938.65,80,,291938.65,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,291938.65,80,,291938.65,percent of total billed charges,,7216,,,7216,Case Rate,,9196,,"100% primary, 0% secondary procedures",9196,Other,MagnaCare ASC Grouper,255446.32,70,,255446.32,percent of total billed charges,,237200.15,65,,237200.15,percent of total billed charges,,237200.15,65,,237200.15,percent of total billed charges,,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7730,,"100% primary, 50% secondary, 25% tertiary procedure",7730,Other,United Healthcare ASC Grouper,8589,,"100% primary, 50% secondary, 25% tertiary procedure",8589,Other,United Healthcare ASC Grouper,7301,,"100% primary, 50% secondary, 25% tertiary procedure",7301,Other,United Healthcare ASC Grouper,2911.95,,,2911.95,Other,New York Medicaid APG methodology,2911.95,,,2911.95,Other,100% New York Medicaid APG,2911.95,,,2911.95,Other,100% New York Medicaid APG,2911.95,,,2911.95,Other,100% New York Medicaid APG,6551.89,,,6551.89,Other,225% New York Medicaid APG,4455.29,,,4455.29,Other,153% New York Medicaid APG,6551.89,,,6551.89,Other,225% New York Medicaid APG,4076.73,,,4076.73,Other,140% New York Medicaid APG,6551.89,,,6551.89,Other,225% New York Medicaid APG,7571.08,,,7571.08,Other,260% New York Medicaid APG,9434.72,,,9434.72,Other,324% New York Medicaid APG,6260.7,,,6260.7,Other,215% New York Medicaid APG,6260.7,,,6260.7,Other,215% New York Medicaid APG,3639.94,,,3639.94,Other,125% New York Medicaid APG,2232,291938.65,
Colgn cross-link crn med sep,0402T,HCPCS,,,,,,,,both,,,42122.79,4222.62,,,4222.62,Other,150% of Medicare + 9.63% HCRA Surcharge,2567.8,,,2567.8,Other,Medicare OPPS methodology,2281,,"100% primary, 50% supplemental procedure",2281,Other,Aetna ASC Grouper,2053,,"100% primary, 50% supplemental procedure",2053,Other,Aetna ASC Grouper,3962,,"100% primary, 50% secondary, 25% supplemental procedure",3962,Other,Blue Cross ASC Grouper,3566,,"100% primary, 50% secondary, 25% supplemental procedure",3566,Other,Blue Cross ASC Grouper,3368,,"100% primary, 50% secondary, 25% supplemental procedure",3368,Other,Blue Cross ASC Grouper,29485.95,70,,29485.95,percent of total billed charges,,28643.5,68,,28643.5,percent of total billed charges,,1465.29,,,1465.29,Other,186% of Medicaid,33698.23,80,,33698.23,percent of total billed charges,,7216,,,7216,Case Rate,,7216,,,7216,Case Rate,,33698.23,80,,33698.23,percent of total billed charges,,7216,,,7216,Case Rate,,4252,,"100% primary, 0% secondary procedures",4252,Other,MagnaCare ASC Grouper,29485.95,70,,29485.95,percent of total billed charges,,27379.81,65,,27379.81,percent of total billed charges,,27379.81,65,,27379.81,percent of total billed charges,,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,4079,,"100% primary, 50% secondary, 25% tertiary procedure",4079,Other,United Healthcare ASC Grouper,4531,,"100% primary, 50% secondary, 25% tertiary procedure",4531,Other,United Healthcare ASC Grouper,3852,,"100% primary, 50% secondary, 25% tertiary procedure",3852,Other,United Healthcare ASC Grouper,787.79,,,787.79,Other,New York Medicaid APG methodology,787.79,,,787.79,Other,100% New York Medicaid APG,787.79,,,787.79,Other,100% New York Medicaid APG,787.79,,,787.79,Other,100% New York Medicaid APG,1772.53,,,1772.53,Other,225% New York Medicaid APG,1205.32,,,1205.32,Other,153% New York Medicaid APG,1772.53,,,1772.53,Other,225% New York Medicaid APG,1102.91,,,1102.91,Other,140% New York Medicaid APG,1772.53,,,1772.53,Other,225% New York Medicaid APG,2048.25,,,2048.25,Other,260% New York Medicaid APG,2552.44,,,2552.44,Other,324% New York Medicaid APG,1693.75,,,1693.75,Other,215% New York Medicaid APG,1693.75,,,1693.75,Other,215% New York Medicaid APG,984.74,,,984.74,Other,125% New York Medicaid APG,787.79,33698.23,